"WhidbeyHealth Medical Center
101 N Main St., Coupeville, WA 98239 
Prices Posted and Effective 02/28/2024
Good faith effort has been made to ensure standard charges are true, accurate, and complete as of the date indicated in this file.",Line Type,Charge/Package Code, Charge/Package  Description,Charge Type,IP/OP/Pro,CPT/HCPCS Code,Gross Charge,Minimum Negotiated Rate,Maximum Negotiated Rate,Discounted Cash Price,Aetna,AmeriGrp,Cigna,Coordinated,First Choice,First Health,GroupHealth,Premera,Regence,United
,CDM,3010000779.10.3010,OBSERVATION DIRECT ADMIT ICU,CDM Code,Outpatient,G0379,$324.,$80.1544,"$1,304.9358",$259.2,$294.84,$84.9635,$307.8,$80.1544,$307.8,$307.8,"$1,304.9358",$221.13,$285.12,$298.08
,CDM,3010000813.10.3010,IV HYDRATION INITIAL 1ST HR,CDM Code,Outpatient,96360,$408.,$66.,$479.9859,$326.4,$371.28,$106.9911,$387.6,$100.9351,$387.6,$387.6,$479.9859,$278.46,$66.,$375.36
,CDM,3010000814.10.3010,IV HYDRATION EA ADD'L HR,CDM Code,Outpatient,96361,$206.,$19.5,$195.7,$164.8,$187.46,$54.02,$195.7,$50.9623,$195.7,$195.7,$92.8626,$140.595,$19.5,$189.52
,CDM,3010000815.10.3010,THER/PROPH/DIAG IV INFUS 1ST H,CDM Code,Outpatient,96365,$527.,$103.,$500.65,$421.6,$479.57,$138.1968,$500.65,$130.3745,$500.65,$500.65,$479.9859,$359.6775,$103.,$484.84
,CDM,3010000816.10.3010,THER/PROPH/DX IV INFUS EA ADDL,CDM Code,Outpatient,96366,$339.,$31.,$322.05,$271.2,$308.49,$88.897,$322.05,$83.8652,$322.05,$322.05,$92.8626,$231.3675,$31.,$311.88
,CDM,3010000817.10.3010,THER/PROPH/DX IV INFUS ADDL SE,CDM Code,Outpatient,96367,$221.,$44.5,$209.95,$176.8,$201.11,$57.9535,$209.95,$54.6732,$209.95,$209.95,$141.9639,$150.8325,$44.5,$203.32
,CDM,3010000818.10.3010,THER/PROPH/DX IV INFUS CONCURR,CDM Code,Outpatient,96368,$207.,$29.5,$196.65,$165.6,$188.37,$54.2822,$196.65,$51.2097,$196.65,$196.65,$20.7,$141.2775,$29.5,$190.44
,CDM,3010000824.10.3010,THER/DIAG SC/IM INJECTION,CDM Code,Outpatient,96372,$130.,$29.,$141.9639,$104.,$118.3,$34.0903,$123.5,$32.1607,$123.5,$123.5,$141.9639,$88.725,$29.,$119.6
,CDM,3010000825.10.3010,"IVP,SINGLE,INITIAL DRUG",CDM Code,Outpatient,96374,$278.,$65.5,$479.9859,$222.4,$252.98,$72.9008,$264.1,$68.7744,$264.1,$264.1,$479.9859,$189.735,$65.5,$255.76
,CDM,3010000826.10.3010,IVP EA ADDL SEQ DRUG,CDM Code,Outpatient,96375,$145.,$25.5,$137.75,$116.,$131.95,$38.0238,$137.75,$35.8715,$137.75,$137.75,$92.8626,$98.9625,$25.5,$133.4
,CDM,3010000828.10.3010,"IV PUSH, SEQUENTIAL-SAME DRUG",CDM Code,Outpatient,96376,$183.,$17.,$173.85,$146.4,$166.53,$47.9886,$173.85,$45.2724,$173.85,$173.85,$18.3,$124.8975,$17.,$168.36
,CDM,3010001010.10.3010,INCISION OF WINDPIPE,CDM Code,Outpatient,31605,$510.,$126.1689,"$1,181.7954",$408.,$464.1,$133.7388,$484.5,$126.1689,$484.5,$484.5,"$1,181.7954",$348.075,$481.5,$469.2
,CDM,3010001975.10.3010,TEMP INDWELLING FOLEY SIMPLE,CDM Code,Outpatient,51702,$139.,$34.3872,$267.0534,$111.2,$126.49,$36.4504,$132.05,$34.3872,$132.05,$132.05,$267.0534,$94.8675,$122.32,$127.88
,CDM,3010001978.10.3010,PICC LINE PLACEMENT,CDM Code,Outpatient,36569,"$2,217.",$351.5,"$2,106.15","$1,773.6","$2,017.47",$581.3706,"$2,106.15",$548.4636,"$2,106.15","$2,106.15","$1,826.6271","$1,513.1025",$351.5,"$2,039.64"
,CDM,3010001980.10.3010,CHEST TUBE INSERTION NSG SUP,CDM Code,Outpatient,32551,$852.,$210.7763,"$1,826.6271",$681.6,$775.32,$223.4225,$809.4,$210.7763,$809.4,$809.4,"$1,826.6271",$581.49,$227.,$783.84
,CDM,3010001996.10.3010,STRAIGHT FOLEY CATH INSERTION,CDM Code,Outpatient,51701,$121.,$29.9342,$267.0534,$96.8,$110.11,$31.7302,$114.95,$29.9342,$114.95,$114.95,$267.0534,$82.5825,$106.48,$111.32
,CDM,3010001997.10.3010,MDFEE ICU ENDOTRACHEAL INTUBAT,CDM Code,Professional,31500,$494.,$83.88,$454.48,$395.2,$449.54,$88.9128,$179.65,$83.88,$166.6775,$165.88,$177.09,$337.155,$203.,$454.48
,CDM,3010007402.10.3010,BLOOD ADMINISTRATION-1 HR,CDM Code,Outpatient,36430,"$1,187.",$50.,"$1,127.65",$949.6,"$1,080.17",$311.2706,"$1,127.65",$293.6519,"$1,127.65","$1,127.65",$946.6218,$810.1275,$50.,"$1,092.04"
,CDM,3010007406.10.3010,BLOOD ADMINISTRATION-5 HRS,CDM Code,Outpatient,36430,"$1,247.",$50.,"$1,184.65",$997.6,"$1,134.77",$327.0046,"$1,184.65",$308.4953,"$1,184.65","$1,184.65",$946.6218,$851.0775,$50.,"$1,147.24"
,CDM,3010007408.10.3010,BLOOD ADMINISTRATION-7 HRS,CDM Code,Outpatient,36430,"$1,500.",$50.,"$1,425.","$1,200.","$1,365.",$393.3495,"$1,425.",$371.085,"$1,425.","$1,425.",$946.6218,"$1,023.75",$50.,"$1,380."
,CDM,3010007409.10.3010,BLOOD ADMINISTRATION-8 HRS,CDM Code,Outpatient,36430,"$1,585.",$50.,"$1,505.75","$1,268.","$1,442.35",$415.6393,"$1,505.75",$392.1132,"$1,505.75","$1,505.75",$946.6218,"$1,081.7625",$50.,"$1,458.2"
,CDM,3010007410.10.3010,BLOOD ADMINISTRATION-9 HRS,CDM Code,Outpatient,36430,"$1,623.",$50.,"$1,541.85","$1,298.4","$1,476.93",$425.6042,"$1,541.85",$401.514,"$1,541.85","$1,541.85",$946.6218,"$1,107.6975",$50.,"$1,493.16"
,CDM,3010007566.10.3010,IV HYDRATION EA ADD L HR,CDM Code,Outpatient,96361XU,$206.,$19.5,$195.7,$164.8,$187.46,$54.02,$195.7,$50.9623,$195.7,$195.7,$92.8626,$140.595,$19.5,$189.52
,CDM,3010007567.10.3010,THER/PROPH/DIAG IV INFUS 1ST,CDM Code,Outpatient,96365XU,$0.,$0.,$479.9859,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$479.9859,$0.,$103.,$0.
,CDM,3010007568.10.3010,THER/PROPH/DX IV INFUS EA ADD,CDM Code,Outpatient,96366XU,$339.,$31.,$322.05,$271.2,$308.49,$88.897,$322.05,$83.8652,$322.05,$322.05,$92.8626,$231.3675,$31.,$311.88
,CDM,3010007569.10.3010,THER/PROPH/DX IV INFUS ADDL S,CDM Code,Outpatient,96367XU,$221.,$44.5,$209.95,$176.8,$201.11,$57.9535,$209.95,$54.6732,$209.95,$209.95,$141.9639,$150.8325,$44.5,$203.32
,CDM,3010007570.10.3010,THER/PROPH/DX IV INFUS CONCUR,CDM Code,Outpatient,96368XU,$207.,$29.5,$196.65,$165.6,$188.37,$54.2822,$196.65,$51.2097,$196.65,$196.65,$20.7,$141.2775,$29.5,$190.44
,CDM,3010007571.10.3010,THER/DIAG SC/IM INJECTION,CDM Code,Outpatient,96372XU,$130.,$29.,$141.9639,$104.,$118.3,$34.0903,$123.5,$32.1607,$123.5,$123.5,$141.9639,$88.725,$29.,$119.6
,CDM,3010007573.10.3010,"IVP EA SEQ,NEW DRUG",CDM Code,Outpatient,96375XU,$145.,$25.5,$137.75,$116.,$131.95,$38.0238,$137.75,$35.8715,$137.75,$137.75,$92.8626,$98.9625,$25.5,$133.4
,CDM,3010007574.10.3010,"IV PUSH, SEQUENTIAL - SAME DR",CDM Code,Outpatient,96376XU,$183.,$17.,$173.85,$146.4,$166.53,$47.9886,$173.85,$45.2724,$173.85,$173.85,$18.3,$124.8975,$17.,$168.36
,CDM,3070000426.10.3070,M/S IP TELECONSULT 50 MIN,CDM Code,Professional,G0426GT,$408.,$40.8,$387.6,$326.4,$371.28,$84.1428,$387.6,$79.38,$387.6,$387.6,$40.8,$278.46,$191.,$375.36
,CDM,3070000776.10.3070,"IV PUSH, SEQUENTIAL - SAME DRU",CDM Code,Outpatient,96376,$183.,$17.,$173.85,$146.4,$166.53,$47.9886,$173.85,$45.2724,$173.85,$173.85,$18.3,$124.8975,$17.,$168.36
,CDM,3070000779.10.3070,OBSERVATION DIRECT ADMIT,CDM Code,Outpatient,G0379,$341.,$84.36,"$1,304.9358",$272.8,$310.31,$89.4215,$323.95,$84.36,$323.95,$323.95,"$1,304.9358",$232.7325,$300.08,$313.72
,CDM,3070000813.10.3070,IV HYDRATION INITIAL 1ST HR,CDM Code,Outpatient,96360,$408.,$66.,$479.9859,$326.4,$371.28,$106.9911,$387.6,$100.9351,$387.6,$387.6,$479.9859,$278.46,$66.,$375.36
,CDM,3070000814.10.3070,IV HYDRATIN EA ADD'L HR,CDM Code,Outpatient,96361,$206.,$19.5,$195.7,$164.8,$187.46,$54.02,$195.7,$50.9623,$195.7,$195.7,$92.8626,$140.595,$19.5,$189.52
,CDM,3070000815.10.3070,THER/PROPH/DIAG IV INFUS 1ST H,CDM Code,Outpatient,96365,$527.,$103.,$500.65,$421.6,$479.57,$138.1968,$500.65,$130.3745,$500.65,$500.65,$479.9859,$359.6775,$103.,$484.84
,CDM,3070000816.10.3070,THER/PROPH/DX IV INFUS EA ADDL,CDM Code,Outpatient,96366,$339.,$31.,$322.05,$271.2,$308.49,$88.897,$322.05,$83.8652,$322.05,$322.05,$92.8626,$231.3675,$31.,$311.88
,CDM,3070000817.10.3070,THER/PROPH/DX IV INFUS ADDL SE,CDM Code,Outpatient,96367,$221.,$44.5,$209.95,$176.8,$201.11,$57.9535,$209.95,$54.6732,$209.95,$209.95,$141.9639,$150.8325,$44.5,$203.32
,CDM,3070000818.10.3070,THER/PROPH/DX IV INFUS CONCURR,CDM Code,Outpatient,96368,$207.,$29.5,$196.65,$165.6,$188.37,$54.2822,$196.65,$51.2097,$196.65,$196.65,$20.7,$141.2775,$29.5,$190.44
,CDM,3070000824.10.3070,THER/DIAG SC/IM INJECTION,CDM Code,Outpatient,96372,$130.,$29.,$141.9639,$104.,$118.3,$34.0903,$123.5,$32.1607,$123.5,$123.5,$141.9639,$88.725,$29.,$119.6
,CDM,3070000825.10.3070,"IVP,SINGLE,INITIAL DRUG",CDM Code,Outpatient,96374,$278.,$65.5,$479.9859,$222.4,$252.98,$72.9008,$264.1,$68.7744,$264.1,$264.1,$479.9859,$189.735,$65.5,$255.76
,CDM,3070000826.10.3070,"IVP EA SEQ,NEW DRUG",CDM Code,Outpatient,96375,$145.,$25.5,$137.75,$116.,$131.95,$38.0238,$137.75,$35.8715,$137.75,$137.75,$92.8626,$98.9625,$25.5,$133.4
,CDM,3070000828.10.3070,BURN DRESS OR DEBRIDE-SMALL,CDM Code,Outpatient,16020,$371.,$91.7817,$408.8304,$296.8,$337.61,$97.2884,$352.45,$91.7817,$352.45,$352.45,$408.8304,$253.2075,$117.5,$341.32
,CDM,3070000834.10.3070,PICC LINE PLACEMENT,CDM Code,Outpatient,36569,"$2,217.",$351.5,"$2,106.15","$1,773.6","$2,017.47",$581.3706,"$2,106.15",$548.4636,"$2,106.15","$2,106.15","$1,826.6271","$1,513.1025",$351.5,"$2,039.64"
,CDM,3070000836.10.3070,ADMIN ONE VACCINE/TOXO1D,CDM Code,Outpatient,90471,$122.,$29.,$141.9639,$97.6,$111.02,$31.9924,$115.9,$30.1816,$115.9,$115.9,$141.9639,$83.265,$29.,$112.24
,CDM,3070000837.10.3070,ADMIN EA ADD'L VACCINE/TOXO1D,CDM Code,Outpatient,90472,$80.,$18.,$76.,$64.,$72.8,$20.9786,$76.,$19.7912,$76.,$76.,$8.,$54.6,$18.,$73.6
,CDM,3070000838.10.3070,COMPRESSION DRESSING VENOUS,CDM Code,Outpatient,29581,$522.,$121.,$495.9,$417.6,$475.02,$136.8856,$495.9,$129.1376,$495.9,$495.9,$334.1505,$356.265,$121.,$480.24
,CDM,3070000839.10.3070,MAC LEVEL 1 ON M/S FLOOR,CDM Code,Outpatient,99211,$151.,$30.5,$143.45,$120.8,$137.41,$39.5972,$143.45,$37.3559,$143.45,$143.45,$15.1,$103.0575,$30.5,$138.92
,CDM,3070000840.10.3070,MAC LEVEL 2 ON M/S FLOOR,CDM Code,Outpatient,99212,$164.,$40.572,$155.8,$131.2,$149.24,$43.0062,$155.8,$40.572,$155.8,$155.8,$16.4,$111.93,$62.,$150.88
,CDM,3070000841.10.3070,MAC LEVEL 3 ON M/S FLOOR,CDM Code,Outpatient,99213,$217.,$53.6836,$206.15,$173.6,$197.47,$56.9046,$206.15,$53.6836,$206.15,$206.15,$21.7,$148.1025,$103.,$199.64
,CDM,3070000842.10.3070,MAC LEVEL 4 ON M/S FLOOR,CDM Code,Outpatient,99214,$243.,$60.1158,$230.85,$194.4,$221.13,$63.7226,$230.85,$60.1158,$230.85,$230.85,$24.3,$165.8475,$152.,$223.56
,CDM,3070000847.10.3070,ACTIVE WOUND CARE,CDM Code,Outpatient,97597,$301.,$74.4644,$408.8304,$240.8,$273.91,$78.9321,$285.95,$74.4644,$285.95,$285.95,$408.8304,$205.4325,$118.5,$276.92
,CDM,3070000850.10.3070,N BLOCK INJ SUPRASCAPULAR,CDM Code,Outpatient,64418,"$1,198.",$296.3732,"$1,354.1973",$958.4,"$1,090.18",$314.1551,"$1,138.1",$296.3732,"$1,138.1","$1,138.1","$1,354.1973",$817.635,"$1,054.24","$1,102.16"
,CDM,3070000851.10.3070,IV PUSH SAME DRUG,CDM Code,Outpatient,96376,$183.,$17.,$173.85,$146.4,$166.53,$47.9886,$173.85,$45.2724,$173.85,$173.85,$18.3,$124.8975,$17.,$168.36
,CDM,3070001013.10.3070,CHEST TUBE INSERTION-NSG SUP,CDM Code,Outpatient,32551,$957.,$227.,"$1,826.6271",$765.6,$870.87,$250.957,$909.15,$236.7522,$909.15,$909.15,"$1,826.6271",$653.1525,$227.,$880.44
,CDM,3070001051.10.3070,RPR F/E/E/N/L/M 2.5 CM/<,CDM Code,Outpatient,12011,$474.,$117.2629,$450.3,$379.2,$431.34,$124.2984,$450.3,$117.2629,$450.3,$450.3,$408.8304,$323.505,$158.,$436.08
,CDM,3070001052.10.3070,DRAIN EXTERNAL EAR LESION,CDM Code,Outpatient,69000,$522.,$129.1376,"$1,439.4237",$417.6,$475.02,$136.8856,$495.9,$129.1376,$495.9,$495.9,"$1,439.4237",$356.265,$459.36,$480.24
,CDM,3070001053.10.3070,BLADDER IRRIGATION SIMPLE,CDM Code,Outpatient,51700,$506.,$125.1793,$576.8268,$404.8,$460.46,$132.6899,$480.7,$125.1793,$480.7,$480.7,$576.8268,$345.345,$445.28,$465.52
,CDM,3070001054.10.3070,LIGATION OF HEMORRHOID(S),CDM Code,Outpatient,46221,$985.,$243.6791,"$1,782.6789",$788.,$896.35,$258.2995,$935.75,$243.6791,$935.75,$935.75,"$1,782.6789",$672.2625,$866.8,$906.2
,CDM,3070001055.10.3070,THORACENTESIS W/O IMAG,CDM Code,Outpatient,32554,$834.,$206.3233,"$1,826.6271",$667.2,$758.94,$218.7023,$792.3,$206.3233,$792.3,$792.3,"$1,826.6271",$569.205,$289.,$767.28
,CDM,3070001056.10.3070,PARACENTESIS,CDM Code,Outpatient,49083,$794.,$196.4277,"$1,868.4393",$635.2,$722.54,$208.213,$754.3,$196.4277,$754.3,$754.3,"$1,868.4393",$541.905,$698.72,$730.48
,CDM,3070001058.10.3070,LUMBAR PUNCTURE,CDM Code,Outpatient,62270,$683.,$168.9674,"$1,354.1973",$546.4,$621.53,$179.1051,$648.85,$168.9674,$648.85,$648.85,"$1,354.1973",$466.1475,$601.04,$628.36
,CDM,3070001059.10.3070,DIAGNOSTIC ANOSCOPY SPX,CDM Code,Outpatient,46600,$210.,$51.9519,$267.0534,$168.,$191.1,$55.0689,$199.5,$51.9519,$199.5,$199.5,$267.0534,$143.325,$184.8,$193.2
,CDM,3070001073.10.3070,STRAIGHT CATH NON INDWELLNG,CDM Code,Outpatient,51701,$607.,$150.1657,$576.65,$485.6,$552.37,$159.1754,$576.65,$150.1657,$576.65,$576.65,$267.0534,$414.2775,$534.16,$558.44
,CDM,3070001074.10.3070,TEMPORARY INDWELLING FOLEY SIM,CDM Code,Outpatient,51702,$258.,$63.8266,$267.0534,$206.4,$234.78,$67.6561,$245.1,$63.8266,$245.1,$245.1,$267.0534,$176.085,$227.04,$237.36
,CDM,3070001075.10.3070,TEMP INDWELLING FOLEY COMPLCD,CDM Code,Outpatient,51703,$461.,$114.0468,$437.95,$368.8,$419.51,$120.8894,$437.95,$114.0468,$437.95,$437.95,$339.357,$314.6325,$405.68,$424.12
,CDM,3070001076.10.3070,ASPIRATION/INJECTION MED JOINT,CDM Code,Outpatient,20605,$333.,$72.,$616.77,$266.4,$303.03,$87.3236,$316.35,$82.3809,$316.35,$316.35,$616.77,$227.2725,$72.,$306.36
,CDM,3070001086.10.3070,ASPIRATION/INJECTION LG JOINT,CDM Code,Outpatient,20610,$472.,$86.,$616.77,$377.6,$429.52,$123.774,$448.4,$116.7681,$448.4,$448.4,$616.77,$322.14,$86.,$434.24
,CDM,3070001090.10.3070,MS INSERT INTRAUTERINE DEVICE,CDM Code,Outpatient,58300,"$1,170.",$289.4463,"$1,111.5",$936.,"$1,064.7",$306.8126,"$1,111.5",$289.4463,"$1,111.5","$1,111.5",$117.,$798.525,"$1,029.6","$1,076.4"
,CDM,3070002010.10.3070,M/S COMPLEX DRAINAGE WOUND,CDM Code,Outpatient,10180,"$4,638.",$353.,"$5,737.5897","$3,710.4","$4,220.58","$1,216.2367","$4,406.1","$1,147.3948","$4,406.1","$4,406.1","$5,737.5897","$3,165.435",$353.,"$4,266.96"
,CDM,3070003014.10.3070,M/S ORIGINATING SITE FEE,CDM Code,Outpatient,Q3014,$80.,$19.7912,$76.,$64.,$72.8,$20.9786,$76.,$19.7912,$76.,$76.,$8.,$54.6,$70.4,$73.6
,CDM,3070003642.10.3070,I & D ABSCESS SIMPLE,CDM Code,Outpatient,10060,$419.,$103.6564,$408.8304,$335.2,$381.29,$109.8756,$398.05,$103.6564,$398.05,$398.05,$408.8304,$285.9675,$169.,$385.48
,CDM,3070005179.10.3070,BLADDER ULTRASOUND POST VOIDIN,CDM Code,Outpatient,51798,$146.,$36.1189,$145.6485,$116.8,$132.86,$38.286,$138.7,$36.1189,$138.7,$138.7,$145.6485,$99.645,$128.48,$134.32
,CDM,3070007402.10.3070,BLOOD ADMINISTRATION-1 HR,CDM Code,Outpatient,36430,"$1,247.",$50.,"$1,184.65",$997.6,"$1,134.77",$327.0046,"$1,184.65",$308.4953,"$1,184.65","$1,184.65",$946.6218,$851.0775,$50.,"$1,147.24"
,CDM,3070007403.10.3070,BLOOD ADMINISTRATION-2 HRS,CDM Code,Outpatient,36430,"$1,247.",$50.,"$1,184.65",$997.6,"$1,134.77",$327.0046,"$1,184.65",$308.4953,"$1,184.65","$1,184.65",$946.6218,$851.0775,$50.,"$1,147.24"
,CDM,3070007404.10.3070,BLOOD ADMINISTRATION-3 HRS,CDM Code,Outpatient,36430,"$1,247.",$50.,"$1,184.65",$997.6,"$1,134.77",$327.0046,"$1,184.65",$308.4953,"$1,184.65","$1,184.65",$946.6218,$851.0775,$50.,"$1,147.24"
,CDM,3070007405.10.3070,BLOOD ADMINISTRATION-4 HRS,CDM Code,Outpatient,36430,"$1,247.",$50.,"$1,184.65",$997.6,"$1,134.77",$327.0046,"$1,184.65",$308.4953,"$1,184.65","$1,184.65",$946.6218,$851.0775,$50.,"$1,147.24"
,CDM,3070007406.10.3070,BLOOD ADMINISTRATION-5 HRS,CDM Code,Outpatient,36430,"$1,247.",$50.,"$1,184.65",$997.6,"$1,134.77",$327.0046,"$1,184.65",$308.4953,"$1,184.65","$1,184.65",$946.6218,$851.0775,$50.,"$1,147.24"
,CDM,3070007407.10.3070,BLOOD ADMINISTRATION-6 HRS,CDM Code,Outpatient,36430,"$1,247.",$50.,"$1,184.65",$997.6,"$1,134.77",$327.0046,"$1,184.65",$308.4953,"$1,184.65","$1,184.65",$946.6218,$851.0775,$50.,"$1,147.24"
,CDM,3070007408.10.3070,BLOOD ADMINISTRATION-7 HRS,CDM Code,Outpatient,36430,"$1,500.",$50.,"$1,425.","$1,200.","$1,365.",$393.3495,"$1,425.",$371.085,"$1,425.","$1,425.",$946.6218,"$1,023.75",$50.,"$1,380."
,CDM,3070007409.10.3070,BLOOD ADMINISTRATION-8 HRS,CDM Code,Outpatient,36430,"$1,585.",$50.,"$1,505.75","$1,268.","$1,442.35",$415.6393,"$1,505.75",$392.1132,"$1,505.75","$1,505.75",$946.6218,"$1,081.7625",$50.,"$1,458.2"
,CDM,3070007410.10.3070,BLOOD ADMINISTRATION-9 HRS,CDM Code,Outpatient,36430,"$1,705.",$50.,"$1,619.75","$1,364.","$1,551.55",$447.1073,"$1,619.75",$421.8,"$1,619.75","$1,619.75",$946.6218,"$1,163.6625",$50.,"$1,568.6"
,CDM,3070007411.10.3070,BLOOD ADMINISTRATION-10 HRS,CDM Code,Outpatient,36430,"$1,910.",$50.,"$1,814.5","$1,528.","$1,738.1",$500.865,"$1,814.5",$472.5149,"$1,814.5","$1,814.5",$946.6218,"$1,303.575",$50.,"$1,757.2"
,CDM,3070007562.10.3070,IV HYDRATION INITIAL 1ST HR,CDM Code,Outpatient,96360XU,$408.,$66.,$479.9859,$326.4,$371.28,$106.9911,$387.6,$100.9351,$387.6,$387.6,$479.9859,$278.46,$66.,$375.36
,CDM,3070007563.10.3070,IV HYDRATIN EA ADD L HR,CDM Code,Outpatient,96361XU,$206.,$19.5,$195.7,$164.8,$187.46,$54.02,$195.7,$50.9623,$195.7,$195.7,$92.8626,$140.595,$19.5,$189.52
,CDM,3070007564.10.3070,THER/PROPH/DIAG IV INFUS 1ST,CDM Code,Outpatient,96365XU,$527.,$103.,$500.65,$421.6,$479.57,$138.1968,$500.65,$130.3745,$500.65,$500.65,$479.9859,$359.6775,$103.,$484.84
,CDM,3070007565.10.3070,THER/PROPH/DX IV INFUS EA ADD,CDM Code,Outpatient,96366XU,$339.,$31.,$322.05,$271.2,$308.49,$88.897,$322.05,$83.8652,$322.05,$322.05,$92.8626,$231.3675,$31.,$311.88
,CDM,3070007566.10.3070,THER/PROPH/DX IV INFUS ADDL S,CDM Code,Outpatient,96367XU,$221.,$44.5,$209.95,$176.8,$201.11,$57.9535,$209.95,$54.6732,$209.95,$209.95,$141.9639,$150.8325,$44.5,$203.32
,CDM,3070007567.10.3070,THER/PROPH/DX IV INFUS CONCUR,CDM Code,Outpatient,96368XU,$207.,$29.5,$196.65,$165.6,$188.37,$54.2822,$196.65,$51.2097,$196.65,$196.65,$20.7,$141.2775,$29.5,$190.44
,CDM,3070007568.10.3070,THER/DIAG SC/IM INJECTION,CDM Code,Outpatient,96372XU,$130.,$29.,$141.9639,$104.,$118.3,$34.0903,$123.5,$32.1607,$123.5,$123.5,$141.9639,$88.725,$29.,$119.6
,CDM,3070007569.10.3070,"IVP,SINGLE,INITIAL DRUG",CDM Code,Outpatient,96374XU,$278.,$65.5,$479.9859,$222.4,$252.98,$72.9008,$264.1,$68.7744,$264.1,$264.1,$479.9859,$189.735,$65.5,$255.76
,CDM,3070007570.10.3070,"IVP EA SEQ,NEW DRUG",CDM Code,Outpatient,96375XU,$145.,$25.5,$137.75,$116.,$131.95,$38.0238,$137.75,$35.8715,$137.75,$137.75,$92.8626,$98.9625,$25.5,$133.4
,CDM,3070007571.10.3070,"IV PUSH, SEQUENTIAL - SAME DR",CDM Code,Outpatient,96376XU,$183.,$17.,$173.85,$146.4,$166.53,$47.9886,$173.85,$45.2724,$173.85,$173.85,$18.3,$124.8975,$17.,$168.36
,CDM,3070007585.10.3070,ADMIN INFLUENZA VIRUS VAC,CDM Code,Outpatient,G0008,$113.,$27.9551,$107.35,$90.4,$102.83,$29.6323,$107.35,$27.9551,$107.35,$107.35,$92.8626,$77.1225,$99.44,$103.96
,CDM,3070007590.10.3070,OBSERVATION DIRECT ADMIT W/PRO,CDM Code,Outpatient,G037925,$341.,$84.36,"$1,304.9358",$272.8,$310.31,$89.4215,$323.95,$84.36,$323.95,$323.95,"$1,304.9358",$232.7325,$300.08,$313.72
,CDM,3170002000.10.3170,MD FEE INIT NB EM PER DAY HOSP,CDM Code,Professional,99460,$194.,$76.38,$184.3,$155.2,$128.75,$80.9628,$120.52,$76.38,$184.3,$184.3,$106.61,$132.405,$135.5,$178.48
,CDM,3170002005.10.3170,MD FEE SBSQ NB EM PER DAY HOSP,CDM Code,Professional,99462,$86.,$8.6,$81.7,$68.8,$57.47,$35.6266,$52.49,$33.61,$81.7,$81.7,$8.6,$58.695,$59.,$79.12
,CDM,3170002010.10.3170,MD FEE HOSPITAL DISCHARGE DAY,CDM Code,Professional,99238,$149.,$14.9,$137.08,$119.2,$93.99,$45.5376,$92.18,$42.96,$108.68,$108.16,$14.9,$101.6925,$103.5,$137.08
,CDM,3170002015.10.3170,MD FEE ATTENDANCE AT DELIVERY,CDM Code,Professional,99464,$152.,$15.2,$144.4,$121.6,$99.11,$46.6187,$94.25,$43.9799,$144.4,$144.4,$15.2,$103.74,$106.,$139.84
,CDM,3170002020.10.3170,MD FEE HOSPITAL DSCHG DAY >30M,CDM Code,Professional,99239,$218.,$21.8,$207.1,$174.4,$139.35,$66.7906,$135.88,$63.01,$207.1,$207.1,$21.8,$148.785,$152.5,$200.56
,CDM,4010000772.10.4010,"INJECTION,SC1M",CDM Code,Outpatient,96372,$130.,$29.,$141.9639,$104.,$118.3,$34.0903,$123.5,$32.1607,$123.5,$123.5,$141.9639,$88.725,$29.,$119.6
,CDM,4010001002.10.4010,AMNIOCENTESIS,CDM Code,Outpatient,59000,$247.5,$61.229,"$1,777.8729",$198.,$225.225,$64.9027,$235.125,$61.229,$235.125,$235.125,"$1,777.8729",$168.9187,$217.8,$227.7
,CDM,4010001010.10.4010,BIOPSY OF VULVA/PERINEUM,CDM Code,Outpatient,56605,"$1,116.",$276.0872,"$1,060.2",$892.8,"$1,015.56",$292.652,"$1,060.2",$276.0872,"$1,060.2","$1,060.2",$736.2792,$761.67,$982.08,"$1,026.72"
,CDM,4010001018.10.4010,CONTRACTION STRESS TEST,CDM Code,Outpatient,59020,$681.,$168.4726,$646.95,$544.8,$619.71,$178.5807,$646.95,$168.4726,$646.95,$646.95,$406.4007,$464.7825,$599.28,$626.52
,CDM,4010001019.10.4010,EXT CEPHALIC VERSION W/WO TERB,CDM Code,Outpatient,59412,"$1,669.",$412.8939,"$5,568.2049","$1,335.2","$1,518.79",$437.6669,"$1,585.55",$412.8939,"$1,585.55","$1,585.55","$5,568.2049","$1,139.0925","$1,468.72","$1,535.48"
,CDM,4010001020.10.4010,FAILED EXT CEPH VERSION W/WO T,CDM Code,Outpatient,5941252,"$1,669.",$412.8939,"$5,568.2049","$1,335.2","$1,518.79",$437.6669,"$1,585.55",$412.8939,"$1,585.55","$1,585.55","$5,568.2049","$1,139.0925","$1,468.72","$1,535.48"
,CDM,4010001029.10.4010,"INJECT, EPIDURAL BLOOD PATCH",CDM Code,Outpatient,62273,"$1,298.",$321.1122,"$1,354.1973","$1,038.4","$1,181.18",$340.3784,"$1,233.1",$321.1122,"$1,233.1","$1,233.1","$1,354.1973",$885.885,"$1,142.24","$1,194.16"
,CDM,4010001035.10.4010,STRAIGHT CATH NON INDWELLING,CDM Code,Outpatient,51701,$607.,$150.1657,$576.65,$485.6,$552.37,$159.1754,$576.65,$150.1657,$576.65,$576.65,$267.0534,$414.2775,$534.16,$558.44
,CDM,4010001036.10.4010,TEMPORARY INDWELLING FOLEY SI,CDM Code,Outpatient,51702,$258.,$63.8266,$267.0534,$206.4,$234.78,$67.6561,$245.1,$63.8266,$245.1,$245.1,$267.0534,$176.085,$227.04,$237.36
,CDM,4010001044.10.4010,OBSERVATION OB DIRECT ADMIT,CDM Code,Outpatient,G0379,$341.,$84.36,"$1,304.9358",$272.8,$310.31,$89.4215,$323.95,$84.36,$323.95,$323.95,"$1,304.9358",$232.7325,$300.08,$313.72
,CDM,4010001047.10.4010,OB OP LEVEL 1,CDM Code,Outpatient,99211,$151.,$30.5,$143.45,$120.8,$137.41,$39.5972,$143.45,$37.3559,$143.45,$143.45,$15.1,$103.0575,$30.5,$138.92
,CDM,4010001049.10.4010,OB OP LEVEL II,CDM Code,Outpatient,99212,$181.,$44.7776,$171.95,$144.8,$164.71,$47.4642,$171.95,$44.7776,$171.95,$171.95,$18.1,$123.5325,$62.,$166.52
,CDM,4010001050.10.4010,OB OP LEVEL III,CDM Code,Outpatient,99213,$217.,$53.6836,$206.15,$173.6,$197.47,$56.9046,$206.15,$53.6836,$206.15,$206.15,$21.7,$148.1025,$103.,$199.64
,CDM,4010001051.10.4010,OB OP LEVEL IV,CDM Code,Outpatient,99214,$474.,$117.2629,$450.3,$379.2,$431.34,$124.2984,$450.3,$117.2629,$450.3,$450.3,$47.4,$323.505,$152.,$436.08
,CDM,4010001052.10.4010,OB OP LEVEL V,CDM Code,Outpatient,99215,$517.,$127.9006,$491.15,$413.6,$470.47,$135.5745,$491.15,$127.9006,$491.15,$491.15,$51.7,$352.8525,$205.,$475.64
,CDM,4010001061.10.4010,LACTATION CONSULT 15 MIN,CDM Code,Outpatient,99401,$151.,$37.3559,$143.45,$120.8,$137.41,$39.5972,$143.45,$37.3559,$143.45,$143.45,$15.1,$103.0575,$53.5,$138.92
,CDM,4010001062.10.4010,LACTATION CONSULT 30 MIN,CDM Code,Outpatient,99402,$181.,$44.7776,$171.95,$144.8,$164.71,$47.4642,$171.95,$44.7776,$171.95,$171.95,$18.1,$123.5325,$89.,$166.52
,CDM,4010001063.10.4010,LACTATION CONSULT 45 MIN,CDM Code,Outpatient,99403,$217.,$53.6836,$206.15,$173.6,$197.47,$56.9046,$206.15,$53.6836,$206.15,$206.15,$21.7,$148.1025,$124.,$199.64
,CDM,4010001064.10.4010,LACTATION CONSULT 60+ MIN,CDM Code,Outpatient,99404,$247.,$61.1053,$234.65,$197.6,$224.77,$64.7716,$234.65,$61.1053,$234.65,$234.65,$24.7,$168.5775,$159.5,$227.24
,CDM,4010002003.10.4010,FETAL NON-STRESS TEST,CDM Code,Outpatient,59025,$774.,$191.4799,$735.3,$619.2,$704.34,$202.9683,$735.3,$191.4799,$735.3,$735.3,$406.4007,$528.255,$681.12,$712.08
,CDM,4010002005.10.4010,"IV INFUSION HYDRAT, 1ST HR",CDM Code,Outpatient,96360,$408.,$66.,$479.9859,$326.4,$371.28,$106.9911,$387.6,$100.9351,$387.6,$387.6,$479.9859,$278.46,$66.,$375.36
,CDM,4010002006.10.4010,IV HYDRATION INFUSION ES ADDL,CDM Code,Outpatient,96361,$206.,$19.5,$195.7,$164.8,$187.46,$54.02,$195.7,$50.9623,$195.7,$195.7,$92.8626,$140.595,$19.5,$189.52
,CDM,4010002007.10.4010,THER/PROPH/DIAG INFUS 1ST HR,CDM Code,Outpatient,96365,$527.,$103.,$500.65,$421.6,$479.57,$138.1968,$500.65,$130.3745,$500.65,$500.65,$479.9859,$359.6775,$103.,$484.84
,CDM,4010002008.10.4010,THER/PROPH/DX INFUS EA ADD'L,CDM Code,Outpatient,96366,$339.,$31.,$322.05,$271.2,$308.49,$88.897,$322.05,$83.8652,$322.05,$322.05,$92.8626,$231.3675,$31.,$311.88
,CDM,4010002009.10.4010,TX/PROPH/DX SEQ INFUS,CDM Code,Outpatient,96367,$221.,$44.5,$209.95,$176.8,$201.11,$57.9535,$209.95,$54.6732,$209.95,$209.95,$141.9639,$150.8325,$44.5,$203.32
,CDM,4010002010.10.4010,THER/DIAG CONCURRENT INFUS,CDM Code,Outpatient,96368,$207.,$29.5,$196.65,$165.6,$188.37,$54.2822,$196.65,$51.2097,$196.65,$196.65,$20.7,$141.2775,$29.5,$190.44
,CDM,4010002011.10.4010,IV PUSH INITIAL,CDM Code,Outpatient,96374,$278.,$65.5,$479.9859,$222.4,$252.98,$72.9008,$264.1,$68.7744,$264.1,$264.1,$479.9859,$189.735,$65.5,$255.76
,CDM,4010002012.10.4010,IV PUSH SAME DRUG,CDM Code,Outpatient,96376,$183.,$17.,$173.85,$146.4,$166.53,$47.9886,$173.85,$45.2724,$173.85,$173.85,$18.3,$124.8975,$17.,$168.36
,CDM,4010002013.10.4010,ADMINISTRATION OF ONE VACCINE,CDM Code,Outpatient,90471,$122.,$29.,$141.9639,$97.6,$111.02,$31.9924,$115.9,$30.1816,$115.9,$115.9,$141.9639,$83.265,$29.,$112.24
,CDM,4010002014.10.4010,DELIVERY OF RETAINED PLACENTA,CDM Code,Outpatient,59414,"$3,028.",$749.0969,"$5,568.2049","$2,422.4","$2,755.48",$794.0415,"$2,876.6",$749.0969,"$2,876.6","$2,876.6","$5,568.2049","$2,066.61","$2,664.64","$2,785.76"
,CDM,4010003003.10.4010,INSERTION OF CERVICAL DILATOR,CDM Code,Outpatient,59200,$472.,$116.7681,$736.2792,$377.6,$429.52,$123.774,$448.4,$116.7681,$448.4,$448.4,$736.2792,$322.14,$415.36,$434.24
,CDM,4010003020.10.4010,INCISION OF TONGUE FOLD,CDM Code,Outpatient,41010,"$2,699.",$288.5,"$2,772.9285","$2,159.2","$2,456.09",$707.7669,"$2,564.05",$667.7056,"$2,564.05","$2,564.05","$2,772.9285","$1,842.0675",$288.5,"$2,483.08"
,CDM,4010005930.10.4010,VAG REPAIR NOT BY ATTENDING MD,CDM Code,Outpatient,59300,"$3,129.",$774.0833,"$5,568.2049","$2,503.2","$2,847.39",$820.5271,"$2,972.55",$774.0833,"$2,972.55","$2,972.55","$5,568.2049","$2,135.5425","$2,753.52","$2,878.68"
,CDM,4010007402.10.4010,BLOOD ADMINISTRATION-1 HR,CDM Code,Outpatient,36430,"$1,247.",$50.,"$1,184.65",$997.6,"$1,134.77",$327.0046,"$1,184.65",$308.4953,"$1,184.65","$1,184.65",$946.6218,$851.0775,$50.,"$1,147.24"
,CDM,4010007403.10.4010,BLOOD ADMINISTRATION-2 HRS,CDM Code,Outpatient,36430,$997.,$50.,$947.15,$797.6,$907.27,$261.4463,$947.15,$246.6478,$947.15,$947.15,$946.6218,$680.4525,$50.,$917.24
,CDM,4010007404.10.4010,BLOOD ADMINISTRATION-3 HRS,CDM Code,Outpatient,36430,$997.,$50.,$947.15,$797.6,$907.27,$261.4463,$947.15,$246.6478,$947.15,$947.15,$946.6218,$680.4525,$50.,$917.24
,CDM,4010007405.10.4010,BLOOD ADMINISTRATION-4 HRS,CDM Code,Outpatient,36430,"$1,247.",$50.,"$1,184.65",$997.6,"$1,134.77",$327.0046,"$1,184.65",$308.4953,"$1,184.65","$1,184.65",$946.6218,$851.0775,$50.,"$1,147.24"
,CDM,4010007502.10.4010,THER/PROPH/DIAG INFUS 1ST HR,CDM Code,Outpatient,96365XU,$527.,$103.,$500.65,$421.6,$479.57,$138.1968,$500.65,$130.3745,$500.65,$500.65,$479.9859,$359.6775,$103.,$484.84
,CDM,4010007503.10.4010,THER/PROPH/DX INFUS EA ADD L,CDM Code,Outpatient,96366XU,$339.,$31.,$322.05,$271.2,$308.49,$88.897,$322.05,$83.8652,$322.05,$322.05,$92.8626,$231.3675,$31.,$311.88
,CDM,4010007506.10.4010,"INJECTION,SC1M",CDM Code,Outpatient,96372XU,$130.,$29.,$141.9639,$104.,$118.3,$34.0903,$123.5,$32.1607,$123.5,$123.5,$141.9639,$88.725,$29.,$119.6
,CDM,4010007508.10.4010,IV PUSH EA ADD L DRUG,CDM Code,Outpatient,96375XU,$145.,$25.5,$137.75,$116.,$131.95,$38.0238,$137.75,$35.8715,$137.75,$137.75,$92.8626,$98.9625,$25.5,$133.4
,CDM,4010007510.10.4010,OB GENITAL SURGERY PROCEDURE,CDM Code,Outpatient,58999,"$4,996.","$1,235.9604","$4,746.2","$3,996.8","$4,546.36","$1,310.1161","$4,746.2","$1,235.9604","$4,746.2","$4,746.2",$406.4007,"$3,409.77","$4,396.48","$4,596.32"
,CDM,4010007520.10.4010,OBS OB DIRECT ADMIT W/PROC,CDM Code,Outpatient,G037925,$341.,$84.36,"$1,304.9358",$272.8,$310.31,$89.4215,$323.95,$84.36,$323.95,$323.95,"$1,304.9358",$232.7325,$300.08,$313.72
,CDM,4010008953.10.4010,IV PUSH EA ADD'L DRUG,CDM Code,Outpatient,96375,$145.,$25.5,$137.75,$116.,$131.95,$38.0238,$137.75,$35.8715,$137.75,$137.75,$92.8626,$98.9625,$25.5,$133.4
,CDM,4020005501.10.4020,MD EGD DIAGNOSTIC BRUSH WASH,CDM Code,Professional,43235,$572.,$160.2,$699.79,$457.6,$520.52,$170.6706,$160.2,$161.01,$480.1774,$477.88,$699.79,$390.39,$365.5,$526.24
,CDM,4020005502.10.4020,F/ MD EGD BIOPSY SINGLE/MULTIP,CDM Code,Professional,43239,$628.,$180.23,$699.79,$502.4,$571.48,$229.0024,$180.23,$216.04,$553.3275,$550.68,$699.79,$428.61,$489.,$577.76
,CDM,4020005503.10.4020,MD EGD W/DILATION STRICTURE,CDM Code,Professional,43245,$341.,$229.11,"$1,334.83",$272.8,$310.31,$365.4032,$229.11,$344.72,$323.95,$323.95,"$1,334.83",$232.7325,$789.,$313.72
,CDM,4020005504.10.4020,MD EGD GUIDE WIRE INSERTION,CDM Code,Professional,43248,$411.,$216.62,$699.79,$328.8,$374.01,$235.9348,$216.62,$222.58,$291.0325,$289.64,$699.79,$280.5075,$499.,$378.12
,CDM,4020005505.10.4020,MD SMALL BOWEL ENDOSCOPY,CDM Code,Professional,44376,$647.,$172.6699,"$1,334.83",$517.6,$588.77,$183.0301,$370.76,$172.6699,$614.65,$614.65,"$1,334.83",$441.5775,$418.,$595.24
,CDM,4020005506.10.4020,MD COLONOSCOPY,CDM Code,Professional,45378,$724.,$193.12,$667.67,$579.2,$658.84,$204.7072,$241.19,$193.12,$631.1799,$628.16,$667.67,$494.13,$451.,$666.08
,CDM,4020005507.10.4020,F/ MD COLONOSCOPY W/ BX,CDM Code,Professional,45380,$858.,$248.98,$877.6,$686.4,$780.78,$263.9188,$262.16,$248.98,$752.4,$748.8,$877.6,$585.585,$577.5,$789.36
,CDM,4020005508.10.4020,MD COLO W/MASS RMVL SNARE,CDM Code,Professional,45385,"$1,015.",$260.43,$933.8,$812.,$923.65,$276.0558,$331.75,$260.43,$845.9275,$841.88,$877.6,$692.7375,$606.5,$933.8
,CDM,4020005509.10.4020,MD COLONOSCOPY W/INJ,CDM Code,Professional,45381,$899.,$243.25,$877.6,$719.2,$818.09,$257.845,$262.16,$243.25,$854.05,$854.05,$877.6,$613.5675,$552.5,$827.08
,CDM,4020005510.10.4020,MD COLO W/MASS RMVL HOT FORCEP,CDM Code,Professional,45384,$852.,$277.,$877.6,$681.6,$775.32,$293.62,$297.27,$277.,$747.6975,$744.12,$877.6,$581.49,$641.5,$783.84
,CDM,4020005511.10.4020,MD COLONSCOPY HIGH RISK,CDM Code,Professional,G0105,"$1,048.",$192.9199,$995.6,$838.4,$953.68,$204.4951,$995.6,$192.9199,$631.1799,$628.16,$667.67,$715.26,$450.5,$964.16
,CDM,4020005512.10.4020,MD COLONOSCOPY LOW RISK,CDM Code,Professional,G0121,$993.,$193.12,$943.35,$794.4,$903.63,$204.7072,$943.35,$193.12,$631.1799,$628.16,$667.67,$677.7225,$451.,$913.56
,CDM,4020005513.10.4020,MD COLONOSCOPY W/ABLATION,CDM Code,Professional,45388,$734.,$352.83,"$4,588.",$587.2,$667.94,"$1,973.3914",$352.83,"$1,861.69",$697.3,$697.3,$877.6,$500.955,"$4,588.",$675.28
,CDM,4020005514.10.4020,MD EGD W/BALLOON ESOPH <30MM,CDM Code,Professional,43249,$332.,$199.72,"$1,334.83",$265.6,$302.12,$679.8416,$199.72,$641.36,$315.4,$315.4,"$1,334.83",$226.59,$292.16,$305.44
,CDM,4020005515.10.4020,MD SIGMOIDOSCOPY FLX W/BIOPSY,CDM Code,Professional,45331,$322.,$93.33,$667.67,$257.6,$293.02,$171.7518,$93.33,$162.03,$305.9,$305.9,$667.67,$219.765,$368.,$296.24
,CDM,4020005516.10.4020,F/ MD DIAGNOSTIC SIGMOIDOSCOPY,CDM Code,Professional,45330,$268.,$72.91,$667.67,$214.4,$243.88,$110.1658,$72.91,$103.93,$254.6,$254.6,$667.67,$182.91,$240.5,$246.56
,CDM,4020005525.10.4020,F/ PICC LINE PLACEMENT,CDM Code,Outpatient,36569,"$3,420.",$351.5,"$3,249.","$2,736.","$3,112.2",$896.8369,"$3,249.",$846.0738,"$3,249.","$3,249.","$1,826.6271","$2,334.15",$351.5,"$3,146.4"
,CDM,4020005540.10.4020,LASER ARC CORNEAL ASTG CORCTN,CDM Code,Outpatient,A9270GY,$63.,$15.5856,$59.85,$50.4,$57.33,$16.5207,$59.85,$15.5856,$59.85,$59.85,$6.3,$42.9975,$55.44,$57.96
,CDM,4020007002.10.4020,F/ US GUIDANCE OF IMPLANT,CDM Code,Outpatient,76965,$295.,$72.9801,$280.25,$236.,$268.45,$77.3587,$280.25,$72.9801,$280.25,$280.25,$29.5,$201.3375,$96.,$271.4
,CDM,4020007003.10.4020,F/ BRACHY TX INTERSTITIAL COMP,CDM Code,Outpatient,77778,"$5,300.",$647.,"$5,035.","$4,240.","$4,823.","$1,389.8349","$5,035.","$1,311.167","$5,035.","$5,035.","$1,972.1421","$3,617.25",$647.,"$4,876."
,CDM,4020007004.10.4020,F/ SIMULATION COMPLEX,CDM Code,Outpatient,77290,"$1,004.",$248.3796,$953.8,$803.2,$913.64,$263.2819,$953.8,$248.3796,$953.8,$953.8,$831.8919,$685.23,$632.,$923.68
,CDM,4020007005.10.4020,F/ DEVICE SIMPLE TEMPLATE,CDM Code,Outpatient,77332,"$1,033.",$50.,$981.35,$826.4,$940.03,$270.8867,$981.35,$255.5539,$981.35,$981.35,$313.9653,$705.0225,$50.,$950.36
,CDM,4020007008.10.4020,F/ DOSE VERIFICATION DOSIMETRY,CDM Code,Outpatient,77331,$297.,$64.5,$313.9653,$237.6,$270.27,$77.8832,$282.15,$73.4748,$282.15,$282.15,$313.9653,$202.7025,$64.5,$273.24
,CDM,4020007009.10.4020,"F/ SPECIAL TX, BRACHYTHERAPY",CDM Code,Outpatient,77470,"$2,988.",$150.,"$2,838.6","$2,390.4","$2,719.08",$783.5522,"$2,838.6",$739.2013,"$2,838.6","$2,838.6","$1,320.6621","$2,039.31",$150.,"$2,748.96"
,CDM,4020007010.10.4020,F/ URO VOLUME U/S VOL STUDY,CDM Code,Outpatient,76873,$911.,$135.5,$865.45,$728.8,$829.01,$238.8943,$865.45,$225.3723,$865.45,$865.45,$300.9891,$621.7575,$135.5,$838.12
,CDM,4020007011.10.4020,F/ GUIDANCE FOR RADIAJ TX DLVR,CDM Code,Outpatient,77387,$582.,$93.,$552.9,$465.6,$529.62,$152.6196,$552.9,$143.981,$552.9,$552.9,$58.2,$397.215,$93.,$535.44
,CDM,4020007015.10.4020,F/ SPCL MEDCL RADIATION PHYS C,CDM Code,Outpatient,77370,"$1,248.",$177.,"$1,185.6",$998.4,"$1,135.68",$327.2668,"$1,185.6",$308.7427,"$1,185.6","$1,185.6",$313.9653,$851.76,$177.,"$1,148.16"
,CDM,4020007019.10.4020,F/ 3-D SIMULATION FIELD SETTIN,CDM Code,Outpatient,77295,"$11,946.",$389.5,"$11,348.7","$9,556.8","$10,870.86","$3,132.6354","$11,348.7","$2,955.3209","$11,348.7","$11,348.7","$2,846.8608","$8,153.145",$389.5,"$10,990.32"
,CDM,4020007020.10.4020,F/ US GUIDANCE FUDUCIAL MARKER,CDM Code,Outpatient,76942,"$1,119.",$46.,"$1,063.05",$895.2,"$1,018.29",$293.4387,"$1,063.05",$276.8294,"$1,063.05","$1,063.05",$111.9,$763.7175,$46.,"$1,029.48"
,CDM,4020007021.10.4020,F/ BASIC DOSE CALCULATION,CDM Code,Outpatient,77300,$674.,$49.5,$640.3,$539.2,$613.34,$176.745,$640.3,$166.7409,$640.3,$640.3,$313.9653,$460.005,$49.5,$620.08
,CDM,4050000477.10.4020,F/ CATH URETERAL POLLACK FLEX,CDM Code,Outpatient,C1758,$98.,$24.2442,$93.1,$78.4,$89.18,$25.6988,$93.1,$24.2442,$93.1,$93.1,$9.8,$66.885,$0.,$90.16
,CDM,4050001773.10.4020,F/ BONE CHIPS RONG OR CANC CC0,CDM Code,Outpatient,C1713,"$1,481.",$366.3846,"$1,406.95","$1,184.8","$1,347.71",$388.3671,"$1,406.95",$366.3846,"$1,406.95","$1,406.95",$148.1,"$1,010.7825","$1,303.28","$1,362.52"
,CDM,4050001780.10.4020,F/ BONE CHIPS CANC 30CC CC0022,CDM Code,Outpatient,C1713,"$2,080.",$514.5712,"$1,976.","$1,664.","$1,892.8",$545.4446,"$1,976.",$514.5712,"$1,976.","$1,976.",$208.,"$1,419.6","$1,830.4","$1,913.6"
,CDM,4050001792.10.4020,F/ SCRW CORT LCK 02.200.012,CDM Code,Outpatient,C1713,$385.,$95.2451,$365.75,$308.,$350.35,$100.9597,$365.75,$95.2451,$365.75,$365.75,$38.5,$262.7625,$338.8,$354.2
,CDM,4050001793.10.4020,F/ SCRW CORT LCK 02.200.028,CDM Code,Outpatient,C1713,$385.,$95.2451,$365.75,$308.,$350.35,$100.9597,$365.75,$95.2451,$365.75,$365.75,$38.5,$262.7625,$338.8,$354.2
,CDM,4050001816.10.4020,F/ EX.FIX FRAME ANKLE LARGE,CDM Code,Outpatient,C1713,"$13,874.","$3,432.2889","$13,180.3","$11,099.2","$12,625.34","$3,638.2206","$13,180.3","$3,432.2889","$13,180.3","$13,180.3","$1,387.4","$9,469.005","$12,209.12","$12,764.08"
,CDM,4050001841.10.4020,F/ GLIDE WIRE ANGLE STIFF 630-,CDM Code,Outpatient,C1769,$742.,$183.5634,$704.9,$593.6,$675.22,$194.5769,$704.9,$183.5634,$704.9,$704.9,$74.2,$506.415,$0.,$682.64
,CDM,4050001842.10.4020,F/ GLIDE WIRE STIFF 630-108,CDM Code,Outpatient,C1769,$706.,$174.6573,$670.7,$564.8,$642.46,$185.1365,$670.7,$174.6573,$670.7,$670.7,$70.6,$481.845,$0.,$649.52
,CDM,4050001843.10.4020,F/ GLIDE WIRE STRAIGHT 630-109,CDM Code,Outpatient,C1769,$705.,$174.41,$669.75,$564.,$641.55,$184.8743,$669.75,$174.41,$669.75,$669.75,$70.5,$481.1625,$0.,$648.6
,CDM,4050001909.10.4020,F/ K WIRE .028 1642-00,CDM Code,Outpatient,C1713,$112.,$27.7077,$106.4,$89.6,$101.92,$29.3701,$106.4,$27.7077,$106.4,$106.4,$11.2,$76.44,$98.56,$103.04
,CDM,4050001910.10.4020,F/ K WIRE .035 1643-10,CDM Code,Outpatient,C1713,$152.,$37.6033,$144.4,$121.6,$138.32,$39.8594,$144.4,$37.6033,$144.4,$144.4,$15.2,$103.74,$133.76,$139.84
,CDM,4050001911.10.4020,F/ K WIRE .045 16441000,CDM Code,Outpatient,C1713,$160.,$39.5824,$152.,$128.,$145.6,$41.9573,$152.,$39.5824,$152.,$152.,$16.,$109.2,$140.8,$147.2
,CDM,4050001913.10.4020,F/ K WIRE .062 164206062,CDM Code,Outpatient,C1713,$241.,$59.621,$228.95,$192.8,$219.31,$63.1982,$228.95,$59.621,$228.95,$228.95,$24.1,$164.4825,$212.08,$221.72
,CDM,4050001914.10.4020,F/ K WIRE 1.25M 292.12,CDM Code,Outpatient,C1713,$103.,$25.4812,$97.85,$82.4,$93.73,$27.01,$97.85,$25.4812,$97.85,$97.85,$10.3,$70.2975,$90.64,$94.76
,CDM,4050001915.10.4020,F/ K WIRE 1.6 150MM 492.16,CDM Code,Outpatient,C1713,$119.,$29.4394,$113.05,$95.2,$108.29,$31.2057,$113.05,$29.4394,$113.05,$113.05,$11.9,$81.2175,$104.72,$109.48
,CDM,4050001918.10.4020,F/ K WIRE 164610,CDM Code,Outpatient,C1713,$136.,$33.645,$129.2,$108.8,$123.76,$35.6637,$129.2,$33.645,$129.2,$129.2,$13.6,$92.82,$119.68,$125.12
,CDM,4050001920.10.4020,F/ K WIRE 2.0 492.20,CDM Code,Outpatient,C1713,$119.,$29.4394,$113.05,$95.2,$108.29,$31.2057,$113.05,$29.4394,$113.05,$113.05,$11.9,$81.2175,$104.72,$109.48
,CDM,4050001921.10.4020,F/ K WIRE 292.16,CDM Code,Outpatient,C1713,$130.,$32.1607,$123.5,$104.,$118.3,$34.0903,$123.5,$32.1607,$123.5,$123.5,$13.,$88.725,$114.4,$119.6
,CDM,4050001924.10.4020,F/ K WIRE 9X0.045 SMO 16481000,CDM Code,Outpatient,C1713,$136.,$33.645,$129.2,$108.8,$123.76,$35.6637,$129.2,$33.645,$129.2,$129.2,$13.6,$92.82,$119.68,$125.12
,CDM,4050001925.10.4020,F/ K WIRE 9X0.062 SMO 16491000,CDM Code,Outpatient,C1713,$138.,$34.1398,$131.1,$110.4,$125.58,$36.1882,$131.1,$34.1398,$131.1,$131.1,$13.8,$94.185,$121.44,$126.96
,CDM,4050001926.10.4020,F/ K WIRES 292.71,CDM Code,Outpatient,C1769,$242.,$59.8684,$229.9,$193.6,$220.22,$63.4604,$229.9,$59.8684,$229.9,$229.9,$24.2,$165.165,$212.96,$222.64
,CDM,4050001964.10.4020,F/ MESH ELIPTICAL 0123460,CDM Code,Outpatient,C1781,"$2,984.",$738.2118,"$2,834.8","$2,387.2","$2,715.44",$782.5033,"$2,834.8",$738.2118,"$2,834.8","$2,834.8",$298.4,"$2,036.58","$2,625.92","$2,745.28"
,CDM,4050001965.10.4020,F/ MESH ELIPTICAL 0123680,CDM Code,Outpatient,C1781,"$3,714.",$918.8065,"$3,528.3","$2,971.2","$3,379.74",$973.9334,"$3,528.3",$918.8065,"$3,528.3","$3,528.3",$371.4,"$2,534.805","$3,268.32","$3,416.88"
,CDM,4050001967.10.4020,F/ MESH LG LFT 3D MAX 0115311,CDM Code,Outpatient,C1781,"$1,307.",$323.3387,"$1,241.65","$1,045.6","$1,189.37",$342.7385,"$1,241.65",$323.3387,"$1,241.65","$1,241.65",$130.7,$892.0275,"$1,150.16","$1,202.44"
,CDM,4050001968.10.4020,F/ MESH LG RT 3D MAX 0115321,CDM Code,Outpatient,C1781,"$1,307.",$323.3387,"$1,241.65","$1,045.6","$1,189.37",$342.7385,"$1,241.65",$323.3387,"$1,241.65","$1,241.65",$130.7,$892.0275,"$1,150.16","$1,202.44"
,CDM,4050001969.10.4020,F/ MESH MARLEX PLUG 011277,CDM Code,Outpatient,C1781,"$1,110.",$274.6029,"$1,054.5",$888.,"$1,010.1",$291.0786,"$1,054.5",$274.6029,"$1,054.5","$1,054.5",$111.,$757.575,$976.8,"$1,021.2"
,CDM,4050001974.10.4020,F/ MESH POLYPROPYLENE 0112660,CDM Code,Outpatient,C1781,"$1,785.",$441.5911,"$1,695.75","$1,428.","$1,624.35",$468.0859,"$1,695.75",$441.5911,"$1,695.75","$1,695.75",$178.5,"$1,218.2625","$1,570.8","$1,642.2"
,CDM,4050001975.10.4020,F/ MESH POLYPROPYLENE 0112720,CDM Code,Outpatient,C1781,$560.,$138.5384,$532.,$448.,$509.6,$146.8505,$532.,$138.5384,$532.,$532.,$56.,$382.2,$492.8,$515.2
,CDM,4050001979.10.4020,F/ MESH PROCEED VENTRAL PTCH P,CDM Code,Outpatient,C1781,"$3,195.",$790.4111,"$3,035.25","$2,556.","$2,907.45",$837.8344,"$3,035.25",$790.4111,"$3,035.25","$3,035.25",$319.5,"$2,180.5875","$2,811.6","$2,939.4"
,CDM,4050001981.10.4020,F/ MESH PROLENE 112680,CDM Code,Outpatient,C1781,$411.,$101.6773,$390.45,$328.8,$374.01,$107.7778,$390.45,$101.6773,$390.45,$390.45,$41.1,$280.5075,$361.68,$378.12
,CDM,4050001988.10.4020,F/ MESH VENTRALEX ST HERN 5950,CDM Code,Outpatient,C1781,"$2,504.",$619.4646,"$2,378.8","$2,003.2","$2,278.64",$656.6314,"$2,378.8",$619.4646,"$2,378.8","$2,378.8",$250.4,"$1,708.98","$2,203.52","$2,303.68"
,CDM,4050001989.10.4020,F/ MESH VENTRALEX ST HERN 5950,CDM Code,Outpatient,C1781,"$3,784.",$936.1238,"$3,594.8","$3,027.2","$3,443.44",$992.2897,"$3,594.8",$936.1238,"$3,594.8","$3,594.8",$378.4,"$2,582.58","$3,329.92","$3,481.28"
,CDM,4050001990.10.4020,F/ MESH VENTRALEX ST HERN 5950,CDM Code,Outpatient,C1781,"$3,899.",$964.5736,"$3,704.05","$3,119.2","$3,548.09","$1,022.4465","$3,704.05",$964.5736,"$3,704.05","$3,704.05",$389.9,"$2,661.0675","$3,431.12","$3,587.08"
,CDM,4050001997.10.4020,F/ MESH XL LEFT 3D 0115312,CDM Code,Outpatient,C1781,"$1,632.",$403.7405,"$1,550.4","$1,305.6","$1,485.12",$427.9643,"$1,550.4",$403.7405,"$1,550.4","$1,550.4",$163.2,"$1,113.84","$1,436.16","$1,501.44"
,CDM,4050001998.10.4020,F/ MESH XL RIGHT 3D 0115322,CDM Code,Outpatient,C1781,"$1,632.",$403.7405,"$1,550.4","$1,305.6","$1,485.12",$427.9643,"$1,550.4",$403.7405,"$1,550.4","$1,550.4",$163.2,"$1,113.84","$1,436.16","$1,501.44"
,CDM,4050001999.10.4020,F/ MINI ARC 720046-01,CDM Code,Outpatient,C1771,"$6,496.","$1,607.0454","$6,171.2","$5,196.8","$5,911.36","$1,703.4656","$6,171.2","$1,607.0454","$6,171.2","$6,171.2",$649.6,"$4,433.52","$5,716.48","$5,976.32"
,CDM,4050002000.10.4020,F/ MINIARC R PRECISE 720191-01,CDM Code,Outpatient,C1771,"$6,186.","$1,530.3545","$5,876.7","$4,948.8","$5,629.26","$1,622.1733","$5,876.7","$1,530.3545","$5,876.7","$5,876.7",$618.6,"$4,221.945","$5,443.68","$5,691.12"
,CDM,4050002074.10.4020,F/ PLT 1/3 TUBE LCP 5 HOL 241.,CDM Code,Outpatient,C1713,"$1,611.",$398.5453,"$1,530.45","$1,288.8","$1,466.01",$422.4574,"$1,530.45",$398.5453,"$1,530.45","$1,530.45",$161.1,"$1,099.5075","$1,417.68","$1,482.12"
,CDM,4050002076.10.4020,F/ PLT 1/3 TUBULAR 241.40,CDM Code,Outpatient,C1713,$794.,$196.4277,$754.3,$635.2,$722.54,$208.213,$754.3,$196.4277,$754.3,$754.3,$79.4,$541.905,$698.72,$730.48
,CDM,4050002077.10.4020,F/ PLT 1/3 TUBULAR 6 HOL 241.3,CDM Code,Outpatient,C1713,$833.,$206.0759,$791.35,$666.4,$758.03,$218.4401,$791.35,$206.0759,$791.35,$791.35,$83.3,$568.5225,$733.04,$766.36
,CDM,4050002078.10.4020,F/ PLT 1/3 TUBULAR 7 HOL 241.3,CDM Code,Outpatient,C1713,$860.,$212.7554,$817.,$688.,$782.6,$225.5204,$817.,$212.7554,$817.,$817.,$86.,$586.95,$756.8,$791.2
,CDM,4050002079.10.4020,F/ PLT 1/3 TUBULAR 8 HOL 241.3,CDM Code,Outpatient,C1713,$835.,$206.5706,$793.25,$668.,$759.85,$218.9646,$793.25,$206.5706,$793.25,$793.25,$83.5,$569.8875,$734.8,$768.2
,CDM,4050002095.10.4020,F/ PLT 4 HOL 02.112.138,CDM Code,Outpatient,C1713,"$3,525.",$872.0498,"$3,348.75","$2,820.","$3,207.75",$924.3713,"$3,348.75",$872.0498,"$3,348.75","$3,348.75",$352.5,"$2,405.8125","$3,102.","$3,243."
,CDM,4050002106.10.4020,F/ PLT 6 HOL TI DCP 449.936,CDM Code,Outpatient,C1713,"$2,803.",$693.4342,"$2,662.85","$2,242.4","$2,550.73",$735.0391,"$2,662.85",$693.4342,"$2,662.85","$2,662.85",$280.3,"$1,913.0475","$2,466.64","$2,578.76"
,CDM,4050002107.10.4020,F/ PLT 7 HOL 241.371,CDM Code,Outpatient,C1713,"$1,810.",$447.7759,"$1,719.5","$1,448.","$1,647.1",$474.6417,"$1,719.5",$447.7759,"$1,719.5","$1,719.5",$181.,"$1,235.325","$1,592.8","$1,665.2"
,CDM,4050002132.10.4020,F/ PLT FIB 4 HOL LFT 02.112.13,CDM Code,Outpatient,C1713,"$3,917.",$969.0266,"$3,721.15","$3,133.6","$3,564.47","$1,027.1667","$3,721.15",$969.0266,"$3,721.15","$3,721.15",$391.7,"$2,673.3525","$3,446.96","$3,603.64"
,CDM,4050002135.10.4020,F/ PLT FIB 7 HOL 02.112.144,CDM Code,Outpatient,C1713,"$4,844.","$1,198.3572","$4,601.8","$3,875.2","$4,408.04","$1,270.2567","$4,601.8","$1,198.3572","$4,601.8","$4,601.8",$484.4,"$3,306.03","$4,262.72","$4,456.48"
,CDM,4050002154.10.4020,F/ PLT LCP RECON 6 HOL 245.061,CDM Code,Outpatient,C1713,"$3,294.",$814.9027,"$3,129.3","$2,635.2","$2,997.54",$863.7955,"$3,129.3",$814.9027,"$3,129.3","$3,129.3",$329.4,"$2,248.155","$2,898.72","$3,030.48"
,CDM,4050002167.10.4020,F/ PLT TUBE LCP 12 HOL 241.421,CDM Code,Outpatient,C1713,"$1,714.",$424.0265,"$1,628.3","$1,371.2","$1,559.74",$449.4674,"$1,628.3",$424.0265,"$1,628.3","$1,628.3",$171.4,"$1,169.805","$1,508.32","$1,576.88"
,CDM,4050002168.10.4020,F/ PLT TUBE LCP 6 HOLE 241.361,CDM Code,Outpatient,C1713,"$1,779.",$440.1068,"$1,690.05","$1,423.2","$1,618.89",$466.5125,"$1,690.05",$440.1068,"$1,690.05","$1,690.05",$177.9,"$1,214.1675","$1,565.52","$1,636.68"
,CDM,4050002169.10.4020,F/ PLT TUBULAR 93MM 241.381,CDM Code,Outpatient,C1713,"$1,693.",$418.8313,"$1,608.35","$1,354.4","$1,540.63",$443.9605,"$1,608.35",$418.8313,"$1,608.35","$1,608.35",$169.3,"$1,155.4725","$1,489.84","$1,557.56"
,CDM,4050002174.10.4020,F/ MESH PROLENE HERN SYSTEM PH,CDM Code,Outpatient,C1713,"$2,781.",$687.9916,"$2,641.95","$2,224.8","$2,530.71",$729.27,"$2,641.95",$687.9916,"$2,641.95","$2,641.95",$278.1,"$1,898.0325","$2,447.28","$2,558.52"
,CDM,4050002175.10.4020,F/ MESH PROLENE HERN SYS LRG P,CDM Code,Outpatient,C1781,"$2,894.",$715.9467,"$2,749.3","$2,315.2","$2,633.54",$758.9023,"$2,749.3",$715.9467,"$2,749.3","$2,749.3",$289.4,"$1,975.155","$2,546.72","$2,662.48"
,CDM,4050002176.10.4020,F/ MESH PROLENE HERN SYS MED P,CDM Code,Outpatient,C1781,"$2,781.",$687.9916,"$2,641.95","$2,224.8","$2,530.71",$729.27,"$2,641.95",$687.9916,"$2,641.95","$2,641.95",$278.1,"$1,898.0325","$2,447.28","$2,558.52"
,CDM,4050002195.10.4020,F/ SCREW 202.828,CDM Code,Outpatient,C1713,$626.,$154.8661,$594.7,$500.8,$569.66,$164.1579,$594.7,$154.8661,$594.7,$594.7,$62.6,$427.245,$550.88,$575.92
,CDM,4050002200.10.4020,F/ SCRW CORT 02.200.010,CDM Code,Outpatient,C1713,$385.,$95.2451,$365.75,$308.,$350.35,$100.9597,$365.75,$95.2451,$365.75,$365.75,$38.5,$262.7625,$338.8,$354.2
,CDM,4050002201.10.4020,F/ SCRW CORT SELF TAP 204.845,CDM Code,Outpatient,C1713,$330.,$81.6387,$313.5,$264.,$300.3,$86.5369,$313.5,$81.6387,$313.5,$313.5,$33.,$225.225,$290.4,$303.6
,CDM,4050002204.10.4020,F/ SCRW LCK 212.101,CDM Code,Outpatient,C1713,"$1,195.",$295.6311,"$1,135.25",$956.,"$1,087.45",$313.3684,"$1,135.25",$295.6311,"$1,135.25","$1,135.25",$119.5,$815.5875,"$1,051.6","$1,099.4"
,CDM,4050002206.10.4020,F/ SCRW LCK 212.136,CDM Code,Outpatient,C1713,"$1,255.",$310.4744,"$1,192.25","$1,004.","$1,142.05",$329.1024,"$1,192.25",$310.4744,"$1,192.25","$1,192.25",$125.5,$856.5375,"$1,104.4","$1,154.6"
,CDM,4050002207.10.4020,F/ SCRW LCK 212.120,CDM Code,Outpatient,C1713,"$1,195.",$295.6311,"$1,135.25",$956.,"$1,087.45",$313.3684,"$1,135.25",$295.6311,"$1,135.25","$1,135.25",$119.5,$815.5875,"$1,051.6","$1,099.4"
,CDM,4050002211.10.4020,F/ SCREW 204.826,CDM Code,Outpatient,C1713,$303.,$74.9592,$287.85,$242.4,$275.73,$79.4566,$287.85,$74.9592,$287.85,$287.85,$30.3,$206.7975,$266.64,$278.76
,CDM,4050002224.10.4020,F/ SCREW CANC 206.012,CDM Code,Outpatient,C1713,$292.,$72.2379,$277.4,$233.6,$265.72,$76.572,$277.4,$72.2379,$277.4,$277.4,$29.2,$199.29,$256.96,$268.64
,CDM,4050002226.10.4020,F/ SCREW CANCELLOUS,CDM Code,Outpatient,C1713,$292.,$72.2379,$277.4,$233.6,$265.72,$76.572,$277.4,$72.2379,$277.4,$277.4,$29.2,$199.29,$256.96,$268.64
,CDM,4050002227.10.4020,F/ SCREW CANCELLOUS,CDM Code,Outpatient,C1713,$286.,$70.7535,$271.7,$228.8,$260.26,$74.9986,$271.7,$70.7535,$271.7,$271.7,$28.6,$195.195,$251.68,$263.12
,CDM,4050002229.10.4020,F/ SCREW CANC 206.018,CDM Code,Outpatient,C1713,$336.,$83.123,$319.2,$268.8,$305.76,$88.1103,$319.2,$83.123,$319.2,$319.2,$33.6,$229.32,$295.68,$309.12
,CDM,4050002245.10.4020,F/ SCREW CANC THREAD PART 207.,CDM Code,Outpatient,C1713,$292.,$72.2379,$277.4,$233.6,$265.72,$76.572,$277.4,$72.2379,$277.4,$277.4,$29.2,$199.29,$256.96,$268.64
,CDM,4050002265.10.4020,F/ SCREW CANN 207.640,CDM Code,Outpatient,C1713,"$1,669.",$412.8939,"$1,585.55","$1,335.2","$1,518.79",$437.6669,"$1,585.55",$412.8939,"$1,585.55","$1,585.55",$166.9,"$1,139.0925","$1,468.72","$1,535.48"
,CDM,4050002266.10.4020,F/ SCREW CANN 207.644,CDM Code,Outpatient,C1713,"$1,330.",$329.0287,"$1,263.5","$1,064.","$1,210.3",$348.7699,"$1,263.5",$329.0287,"$1,263.5","$1,263.5",$133.,$907.725,"$1,170.4","$1,223.6"
,CDM,4050002272.10.4020,F/ SCREW CANN 207.638,CDM Code,Outpatient,C1713,"$1,330.",$329.0287,"$1,263.5","$1,064.","$1,210.3",$348.7699,"$1,263.5",$329.0287,"$1,263.5","$1,263.5",$133.,$907.725,"$1,170.4","$1,223.6"
,CDM,4050002273.10.4020,F/ SCREW CANN 207.642,CDM Code,Outpatient,C1713,"$1,848.",$457.1767,"$1,755.6","$1,478.4","$1,681.68",$484.6066,"$1,755.6",$457.1767,"$1,755.6","$1,755.6",$184.8,"$1,261.26","$1,626.24","$1,700.16"
,CDM,4050002274.10.4020,F/ SCREW CANN 207.646,CDM Code,Outpatient,C1713,"$1,714.",$424.0265,"$1,628.3","$1,371.2","$1,559.74",$449.4674,"$1,628.3",$424.0265,"$1,628.3","$1,628.3",$171.4,"$1,169.805","$1,508.32","$1,576.88"
,CDM,4050002275.10.4020,F/ SCREW CANN 207.650,CDM Code,Outpatient,C1713,"$1,265.",$312.9484,"$1,201.75","$1,012.","$1,151.15",$331.7247,"$1,201.75",$312.9484,"$1,201.75","$1,201.75",$126.5,$863.3625,"$1,113.2","$1,163.8"
,CDM,4050002277.10.4020,F/ SCREW CANN 207.648,CDM Code,Outpatient,C1713,"$1,714.",$424.0265,"$1,628.3","$1,371.2","$1,559.74",$449.4674,"$1,628.3",$424.0265,"$1,628.3","$1,628.3",$171.4,"$1,169.805","$1,508.32","$1,576.88"
,CDM,4050002307.10.4020,F/ SCRW CORT 02.200.026,CDM Code,Outpatient,C1713,$442.,$109.3464,$419.9,$353.6,$402.22,$115.907,$419.9,$109.3464,$419.9,$419.9,$44.2,$301.665,$388.96,$406.64
,CDM,4050002314.10.4020,F/ SCRW CORT SLF TAP 200.808,CDM Code,Outpatient,C1713,$351.,$86.8339,$333.45,$280.8,$319.41,$92.0438,$333.45,$86.8339,$333.45,$333.45,$35.1,$239.5575,$308.88,$322.92
,CDM,4050002318.10.4020,F/ SCRW CORT 202.814,CDM Code,Outpatient,C1713,$415.,$102.6668,$394.25,$332.,$377.65,$108.8267,$394.25,$102.6668,$394.25,$394.25,$41.5,$283.2375,$365.2,$381.8
,CDM,4050002319.10.4020,F/ SCRW CORT 202.816,CDM Code,Outpatient,C1713,$415.,$102.6668,$394.25,$332.,$377.65,$108.8267,$394.25,$102.6668,$394.25,$394.25,$41.5,$283.2375,$365.2,$381.8
,CDM,4050002320.10.4020,F/ SCRW CORT 202.818,CDM Code,Outpatient,C1713,$390.,$96.4821,$370.5,$312.,$354.9,$102.2709,$370.5,$96.4821,$370.5,$370.5,$39.,$266.175,$343.2,$358.8
,CDM,4050002323.10.4020,F/ SCRW CORT 2.0MMX9MM 401.809,CDM Code,Outpatient,C1713,$523.,$129.385,$496.85,$418.4,$475.93,$137.1479,$496.85,$129.385,$496.85,$496.85,$52.3,$356.9475,$460.24,$481.16
,CDM,4050002324.10.4020,F/ SCRW CORT SLF TAP 201.816,CDM Code,Outpatient,C1713,$399.,$98.7086,$379.05,$319.2,$363.09,$104.631,$379.05,$98.7086,$379.05,$379.05,$39.9,$272.3175,$351.12,$367.08
,CDM,4050002335.10.4020,F/ SCRW CORT 202.830,CDM Code,Outpatient,C1713,$395.,$97.719,$375.25,$316.,$359.45,$103.582,$375.25,$97.719,$375.25,$375.25,$39.5,$269.5875,$347.6,$363.4
,CDM,4050002336.10.4020,F/ SCRW CORT SLF TAP 202.810,CDM Code,Outpatient,C1713,$449.,$111.0781,$426.55,$359.2,$408.59,$117.7426,$426.55,$111.0781,$426.55,$426.55,$44.9,$306.4425,$395.12,$413.08
,CDM,4050002337.10.4020,F/ SCRW CORT 202.822,CDM Code,Outpatient,C1713,$384.,$94.9978,$364.8,$307.2,$349.44,$100.6975,$364.8,$94.9978,$364.8,$364.8,$38.4,$262.08,$337.92,$353.28
,CDM,4050002340.10.4020,F/ SCREW CORT 202.826,CDM Code,Outpatient,C1713,$415.,$102.6668,$394.25,$332.,$377.65,$108.8267,$394.25,$102.6668,$394.25,$394.25,$41.5,$283.2375,$365.2,$381.8
,CDM,4050002341.10.4020,F/ SCRW CORT 202.820,CDM Code,Outpatient,C1713,$399.,$98.7086,$379.05,$319.2,$363.09,$104.631,$379.05,$98.7086,$379.05,$379.05,$39.9,$272.3175,$351.12,$367.08
,CDM,4050002342.10.4020,F/ SCRW CORT 202.824,CDM Code,Outpatient,C1713,$427.,$105.6355,$405.65,$341.6,$388.57,$111.9735,$405.65,$105.6355,$405.65,$405.65,$42.7,$291.4275,$375.76,$392.84
,CDM,4050002346.10.4020,F/ SCRW CORT 204.812,CDM Code,Outpatient,C1713,$347.,$85.8443,$329.65,$277.6,$315.77,$90.9949,$329.65,$85.8443,$329.65,$329.65,$34.7,$236.8275,$305.36,$319.24
,CDM,4050002347.10.4020,F/ SCRW CORT 204.816,CDM Code,Outpatient,C1713,$374.,$92.5239,$355.3,$299.2,$340.34,$98.0751,$355.3,$92.5239,$355.3,$355.3,$37.4,$255.255,$329.12,$344.08
,CDM,4050002348.10.4020,F/ SCRW CORT 204.822,CDM Code,Outpatient,C1713,$303.,$74.9592,$287.85,$242.4,$275.73,$79.4566,$287.85,$74.9592,$287.85,$287.85,$30.3,$206.7975,$266.64,$278.76
,CDM,4050002349.10.4020,F/ SCRW CORT 204.828,CDM Code,Outpatient,C1713,$315.,$77.9279,$299.25,$252.,$286.65,$82.6034,$299.25,$77.9279,$299.25,$299.25,$31.5,$214.9875,$277.2,$289.8
,CDM,4050002350.10.4020,F/ SCRW CORT SLF TAP 202.810,CDM Code,Outpatient,C1713,$507.,$125.4267,$481.65,$405.6,$461.37,$132.9521,$481.65,$125.4267,$481.65,$481.65,$50.7,$346.0275,$446.16,$466.44
,CDM,4050002351.10.4020,F/ SCRW CORT SLF TAP 201.812,CDM Code,Outpatient,C1713,$507.,$125.4267,$481.65,$405.6,$461.37,$132.9521,$481.65,$125.4267,$481.65,$481.65,$50.7,$346.0275,$446.16,$466.44
,CDM,4050002352.10.4020,F/ SCRW CORT SLF TAP 201.814,CDM Code,Outpatient,C1713,$458.,$113.3046,$435.1,$366.4,$416.78,$120.1027,$435.1,$113.3046,$435.1,$435.1,$45.8,$312.585,$403.04,$421.36
,CDM,4050002353.10.4020,F/ SCREW CORT SLF TAP 201.818,CDM Code,Outpatient,C1713,$458.,$113.3046,$435.1,$366.4,$416.78,$120.1027,$435.1,$113.3046,$435.1,$435.1,$45.8,$312.585,$403.04,$421.36
,CDM,4050002354.10.4020,F/ SCRW CORT SLF TAP 201.820,CDM Code,Outpatient,C1713,$458.,$113.3046,$435.1,$366.4,$416.78,$120.1027,$435.1,$113.3046,$435.1,$435.1,$45.8,$312.585,$403.04,$421.36
,CDM,4050002356.10.4020,F/ SCRW CORT SLF TAP 201.808,CDM Code,Outpatient,C1713,$507.,$125.4267,$481.65,$405.6,$461.37,$132.9521,$481.65,$125.4267,$481.65,$481.65,$50.7,$346.0275,$446.16,$466.44
,CDM,4050002357.10.4020,F/ SCRW CORT 204.818,CDM Code,Outpatient,C1713,$373.,$92.2765,$354.35,$298.4,$339.43,$97.8129,$354.35,$92.2765,$354.35,$354.35,$37.3,$254.5725,$328.24,$343.16
,CDM,4050002359.10.4020,F/ SCRW CORT 204.814,CDM Code,Outpatient,C1713,$374.,$92.5239,$355.3,$299.2,$340.34,$98.0751,$355.3,$92.5239,$355.3,$355.3,$37.4,$255.255,$329.12,$344.08
,CDM,4050002360.10.4020,F/ SCRW CORT 204.850,CDM Code,Outpatient,C1713,$347.,$85.8443,$329.65,$277.6,$315.77,$90.9949,$329.65,$85.8443,$329.65,$329.65,$34.7,$236.8275,$305.36,$319.24
,CDM,4050002361.10.4020,F/ SCRW CORT 204.855,CDM Code,Outpatient,C1713,$288.,$71.2483,$273.6,$230.4,$262.08,$75.5231,$273.6,$71.2483,$273.6,$273.6,$28.8,$196.56,$253.44,$264.96
,CDM,4050002362.10.4020,F/ SCRW CORT 204.820,CDM Code,Outpatient,C1713,$373.,$92.2765,$354.35,$298.4,$339.43,$97.8129,$354.35,$92.2765,$354.35,$354.35,$37.3,$254.5725,$328.24,$343.16
,CDM,4050002363.10.4020,F/ SCRW CORT 204.824,CDM Code,Outpatient,C1713,$324.,$80.1544,$307.8,$259.2,$294.84,$84.9635,$307.8,$80.1544,$307.8,$307.8,$32.4,$221.13,$285.12,$298.08
,CDM,4050002366.10.4020,F/ SCRW CORT 02.200.050,CDM Code,Outpatient,C1713,$413.,$102.1721,$392.35,$330.4,$375.83,$108.3022,$392.35,$102.1721,$392.35,$392.35,$41.3,$281.8725,$363.44,$379.96
,CDM,4050002367.10.4020,F/ SCRW CORT 02.200.016,CDM Code,Outpatient,C1713,$442.,$109.3464,$419.9,$353.6,$402.22,$115.907,$419.9,$109.3464,$419.9,$419.9,$44.2,$301.665,$388.96,$406.64
,CDM,4050002368.10.4020,F/ SCRW CORT TAP 02.200.020,CDM Code,Outpatient,C1713,$413.,$102.1721,$392.35,$330.4,$375.83,$108.3022,$392.35,$102.1721,$392.35,$392.35,$41.3,$281.8725,$363.44,$379.96
,CDM,4050002369.10.4020,F/ SCRW CORT 02.200.022,CDM Code,Outpatient,C1713,$359.,$88.813,$341.05,$287.2,$326.69,$94.1416,$341.05,$88.813,$341.05,$341.05,$35.9,$245.0175,$315.92,$330.28
,CDM,4050002370.10.4020,F/ SCRW CORT 02.200.024,CDM Code,Outpatient,C1713,$413.,$102.1721,$392.35,$330.4,$375.83,$108.3022,$392.35,$102.1721,$392.35,$392.35,$41.3,$281.8725,$363.44,$379.96
,CDM,4050002371.10.4020,F/ SCREW CORTEX SLF TAP 204.83,CDM Code,Outpatient,C1713,$303.,$74.9592,$287.85,$242.4,$275.73,$79.4566,$287.85,$74.9592,$287.85,$287.85,$30.3,$206.7975,$266.64,$278.76
,CDM,4050002372.10.4020,F/ SCRW CORT SLF TAP 204.840,CDM Code,Outpatient,C1713,$315.,$77.9279,$299.25,$252.,$286.65,$82.6034,$299.25,$77.9279,$299.25,$299.25,$31.5,$214.9875,$277.2,$289.8
,CDM,4050002373.10.4020,F/ SCRW CORT 02.200.012,CDM Code,Outpatient,C1713,$359.,$88.813,$341.05,$287.2,$326.69,$94.1416,$341.05,$88.813,$341.05,$341.05,$35.9,$245.0175,$315.92,$330.28
,CDM,4050002374.10.4020,F/ SCRW CORT 02.200.018,CDM Code,Outpatient,C1713,$413.,$102.1721,$392.35,$330.4,$375.83,$108.3022,$392.35,$102.1721,$392.35,$392.35,$41.3,$281.8725,$363.44,$379.96
,CDM,4050002375.10.4020,F/ SCRW CORT 02.200.20,CDM Code,Outpatient,C1713,$260.,$64.3214,$247.,$208.,$236.6,$68.1806,$247.,$64.3214,$247.,$247.,$26.,$177.45,$228.8,$239.2
,CDM,4050002376.10.4020,F/ SCRW CORT SLF TAP 02.200.01,CDM Code,Outpatient,C1713,$413.,$102.1721,$392.35,$330.4,$375.83,$108.3022,$392.35,$102.1721,$392.35,$392.35,$41.3,$281.8725,$363.44,$379.96
,CDM,4050002377.10.4020,F/ SCRW CORT 204.830,CDM Code,Outpatient,C1713,$303.,$74.9592,$287.85,$242.4,$275.73,$79.4566,$287.85,$74.9592,$287.85,$287.85,$30.3,$206.7975,$266.64,$278.76
,CDM,4050002378.10.4020,F/ SCRW CORT 02.200.038,CDM Code,Outpatient,C1713,$313.,$77.4331,$297.35,$250.4,$284.83,$82.0789,$297.35,$77.4331,$297.35,$297.35,$31.3,$213.6225,$275.44,$287.96
,CDM,4050002382.10.4020,F/ SCRW CORT SLF TAP 214.818,CDM Code,Outpatient,C1713,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.
,CDM,4050002384.10.4020,F/ SCRW CORT 214.824,CDM Code,Outpatient,C1713,$278.,$68.7744,$264.1,$222.4,$252.98,$72.9008,$264.1,$68.7744,$264.1,$264.1,$27.8,$189.735,$244.64,$255.76
,CDM,4050002386.10.4020,F/ SCRW CORT SLF TAP 214.826,CDM Code,Outpatient,C1713,$278.,$68.7744,$264.1,$222.4,$252.98,$72.9008,$264.1,$68.7744,$264.1,$264.1,$27.8,$189.735,$244.64,$255.76
,CDM,4050002387.10.4020,F/ SCRW CORT SLF TAP 214.828,CDM Code,Outpatient,C1713,$278.,$68.7744,$264.1,$222.4,$252.98,$72.9008,$264.1,$68.7744,$264.1,$264.1,$27.8,$189.735,$244.64,$255.76
,CDM,4050002390.10.4020,F/ SCRW CORT 02.200.042,CDM Code,Outpatient,C1713,"$1,605.",$397.0609,"$1,524.75","$1,284.","$1,460.55",$420.884,"$1,524.75",$397.0609,"$1,524.75","$1,524.75",$160.5,"$1,095.4125","$1,412.4","$1,476.6"
,CDM,4050002392.10.4020,F/ SCRW CORT 02.200.46,CDM Code,Outpatient,C1713,$413.,$102.1721,$392.35,$330.4,$375.83,$108.3022,$392.35,$102.1721,$392.35,$392.35,$41.3,$281.8725,$363.44,$379.96
,CDM,4050002394.10.4020,F/ SCRW CORT 02.200.055,CDM Code,Outpatient,C1713,$310.,$76.6909,$294.5,$248.,$282.1,$81.2922,$294.5,$76.6909,$294.5,$294.5,$31.,$211.575,$272.8,$285.2
,CDM,4050002396.10.4020,F/ SCRW CORT SLF TAP 204.832,CDM Code,Outpatient,C1713,$288.,$71.2483,$273.6,$230.4,$262.08,$75.5231,$273.6,$71.2483,$273.6,$273.6,$28.8,$196.56,$253.44,$264.96
,CDM,4050002403.10.4020,F/ SCRW CORT SLF TAP 214.854,CDM Code,Outpatient,C1713,$263.,$65.0636,$249.85,$210.4,$239.33,$68.9673,$249.85,$65.0636,$249.85,$249.85,$26.3,$179.4975,$231.44,$241.96
,CDM,4050002410.10.4020,F/ SCRW CORT SLF TAP 202.838,CDM Code,Outpatient,C1713,$440.,$108.8516,$418.,$352.,$400.4,$115.3825,$418.,$108.8516,$418.,$418.,$44.,$300.3,$387.2,$404.8
,CDM,4050002414.10.4020,F/ SCRW CORT 202.836,CDM Code,Outpatient,C1713,$440.,$108.8516,$418.,$352.,$400.4,$115.3825,$418.,$108.8516,$418.,$418.,$44.,$300.3,$387.2,$404.8
,CDM,4050002437.10.4020,F/ SCRW CORT 204.836,CDM Code,Outpatient,C1713,$303.,$74.9592,$287.85,$242.4,$275.73,$79.4566,$287.85,$74.9592,$287.85,$287.85,$30.3,$206.7975,$266.64,$278.76
,CDM,4050002462.10.4020,F/ SCRW LCK ST 212.103,CDM Code,Outpatient,C1713,"$1,467.",$362.9211,"$1,393.65","$1,173.6","$1,334.97",$384.6958,"$1,393.65",$362.9211,"$1,393.65","$1,393.65",$146.7,"$1,001.2275","$1,290.96","$1,349.64"
,CDM,4050002466.10.4020,F/ SCRW LCK 202.214,CDM Code,Outpatient,C1713,"$1,306.",$323.0913,"$1,240.7","$1,044.8","$1,188.46",$342.4763,"$1,240.7",$323.0913,"$1,240.7","$1,240.7",$130.6,$891.345,"$1,149.28","$1,201.52"
,CDM,4050002468.10.4020,F/ SCRW LCK 212.105,CDM Code,Outpatient,C1713,"$1,605.",$397.0609,"$1,524.75","$1,284.","$1,460.55",$420.884,"$1,524.75",$397.0609,"$1,524.75","$1,524.75",$160.5,"$1,095.4125","$1,412.4","$1,476.6"
,CDM,4050002471.10.4020,F/ SCRW LCK 202.208,CDM Code,Outpatient,C1713,"$1,210.",$299.3419,"$1,149.5",$968.,"$1,101.1",$317.3019,"$1,149.5",$299.3419,"$1,149.5","$1,149.5",$121.,$825.825,"$1,064.8","$1,113.2"
,CDM,4050002472.10.4020,F/ SCRW LCK 202.210,CDM Code,Outpatient,C1713,"$1,124.",$278.0664,"$1,067.8",$899.2,"$1,022.84",$294.7499,"$1,067.8",$278.0664,"$1,067.8","$1,067.8",$112.4,$767.13,$989.12,"$1,034.08"
,CDM,4050002473.10.4020,F/ SCRW LCK 202.212,CDM Code,Outpatient,C1713,"$1,124.",$278.0664,"$1,067.8",$899.2,"$1,022.84",$294.7499,"$1,067.8",$278.0664,"$1,067.8","$1,067.8",$112.4,$767.13,$989.12,"$1,034.08"
,CDM,4050002477.10.4020,F/ SCRW LCK 212.106,CDM Code,Outpatient,C1713,"$1,388.",$343.3773,"$1,318.6","$1,110.4","$1,263.08",$363.9794,"$1,318.6",$343.3773,"$1,318.6","$1,318.6",$138.8,$947.31,"$1,221.44","$1,276.96"
,CDM,4050002479.10.4020,F/ SCRW LCK 202.224,CDM Code,Outpatient,C1713,"$1,243.",$307.5058,"$1,180.85",$994.4,"$1,131.13",$325.9556,"$1,180.85",$307.5058,"$1,180.85","$1,180.85",$124.3,$848.3475,"$1,093.84","$1,143.56"
,CDM,4050002481.10.4020,F/ SCRW LCK 212.109,CDM Code,Outpatient,C1713,"$1,460.",$361.1894,"$1,387.","$1,168.","$1,328.6",$382.8602,"$1,387.",$361.1894,"$1,387.","$1,387.",$146.,$996.45,"$1,284.8","$1,343.2"
,CDM,4050002482.10.4020,F/ SCRW LCK 212.110,CDM Code,Outpatient,C1713,"$1,605.",$397.0609,"$1,524.75","$1,284.","$1,460.55",$420.884,"$1,524.75",$397.0609,"$1,524.75","$1,524.75",$160.5,"$1,095.4125","$1,412.4","$1,476.6"
,CDM,4050002483.10.4020,F/ SCRW LCK 212.107,CDM Code,Outpatient,C1713,"$1,388.",$343.3773,"$1,318.6","$1,110.4","$1,263.08",$363.9794,"$1,318.6",$343.3773,"$1,318.6","$1,318.6",$138.8,$947.31,"$1,221.44","$1,276.96"
,CDM,4050002490.10.4020,F/ SCRW LCK STAR DRIVE 212.102,CDM Code,Outpatient,C1713,"$1,491.",$368.8585,"$1,416.45","$1,192.8","$1,356.81",$390.9894,"$1,416.45",$368.8585,"$1,416.45","$1,416.45",$149.1,"$1,017.6075","$1,312.08","$1,371.72"
,CDM,4050002491.10.4020,F/ SCRW LCK 212.104,CDM Code,Outpatient,C1713,"$1,388.",$343.3773,"$1,318.6","$1,110.4","$1,263.08",$363.9794,"$1,318.6",$343.3773,"$1,318.6","$1,318.6",$138.8,$947.31,"$1,221.44","$1,276.96"
,CDM,4050002492.10.4020,F/ SCRW LCK 212.117,CDM Code,Outpatient,C1713,"$1,460.",$361.1894,"$1,387.","$1,168.","$1,328.6",$382.8602,"$1,387.",$361.1894,"$1,387.","$1,387.",$146.,$996.45,"$1,284.8","$1,343.2"
,CDM,4050002494.10.4020,F/ SCRW LOCK 212.121,CDM Code,Outpatient,C1713,"$1,460.",$361.1894,"$1,387.","$1,168.","$1,328.6",$382.8602,"$1,387.",$361.1894,"$1,387.","$1,387.",$146.,$996.45,"$1,284.8","$1,343.2"
,CDM,4050002497.10.4020,F/ SCRW LCK 212.113,CDM Code,Outpatient,C1713,"$1,460.",$361.1894,"$1,387.","$1,168.","$1,328.6",$382.8602,"$1,387.",$361.1894,"$1,387.","$1,387.",$146.,$996.45,"$1,284.8","$1,343.2"
,CDM,4050002503.10.4020,F/ SCRW LCK 212.134,CDM Code,Outpatient,C1713,"$1,201.",$297.1154,"$1,140.95",$960.8,"$1,092.91",$314.9418,"$1,140.95",$297.1154,"$1,140.95","$1,140.95",$120.1,$819.6825,"$1,056.88","$1,104.92"
,CDM,4050002521.10.4020,F/ SCRW SLF TAP 202.834,CDM Code,Outpatient,C1713,$596.,$147.4444,$566.2,$476.8,$542.36,$156.2909,$566.2,$147.4444,$566.2,$566.2,$59.6,$406.77,$524.48,$548.32
,CDM,4050002522.10.4020,F/ SCRW SLF TAP 214.830,CDM Code,Outpatient,C1713,$263.,$65.0636,$249.85,$210.4,$239.33,$68.9673,$249.85,$65.0636,$249.85,$249.85,$26.3,$179.4975,$231.44,$241.96
,CDM,4050002523.10.4020,F/ SCRW SLF TAP 214.832,CDM Code,Outpatient,C1713,$263.,$65.0636,$249.85,$210.4,$239.33,$68.9673,$249.85,$65.0636,$249.85,$249.85,$26.3,$179.4975,$231.44,$241.96
,CDM,4050002686.10.4020,F/ VERSALOK ANCHOR W/ORTHO 210,CDM Code,Outpatient,C1713,"$2,832.",$700.6085,"$2,690.4","$2,265.6","$2,577.12",$742.6439,"$2,690.4",$700.6085,"$2,690.4","$2,690.4",$283.2,"$1,932.84","$2,492.16","$2,605.44"
,CDM,4050002687.10.4020,F/ WASHER 13.0MM 219.99,CDM Code,Outpatient,C1713,$461.,$114.0468,$437.95,$368.8,$419.51,$120.8894,$437.95,$114.0468,$437.95,$437.95,$46.1,$314.6325,$405.68,$424.12
,CDM,4050003116.10.4020,F/ ESSURE PERMANENT BIRTH,CDM Code,Outpatient,A4264,"$7,056.","$1,745.5838","$6,703.2","$5,644.8","$6,420.96","$1,850.316","$6,703.2","$1,745.5838","$6,703.2","$6,703.2",$705.6,"$4,815.72",$0.,"$6,491.52"
,CDM,4050003120.10.4020,F/ GROSHONG POWER PORT ISP,CDM Code,Outpatient,C1751,"$2,844.",$703.5772,"$2,701.8","$2,275.2","$2,588.04",$745.7907,"$2,701.8",$703.5772,"$2,701.8","$2,701.8",$284.4,"$1,941.03","$2,502.72","$2,616.48"
,CDM,4050006261.10.4020,F/ SLING ARIS SYSTEM,CDM Code,Outpatient,C1771,"$4,043.","$1,000.1978","$3,840.85","$3,234.4","$3,679.13","$1,060.208","$3,840.85","$1,000.1978","$3,840.85","$3,840.85",$404.3,"$2,759.3475","$3,557.84","$3,719.56"
,CDM,4050006411.10.4020,F/ MATRIX DEMINERALIZED BONE,CDM Code,Outpatient,C1713,"$1,927.",$476.7205,"$1,830.65","$1,541.6","$1,753.57",$505.323,"$1,830.65",$476.7205,"$1,830.65","$1,830.65",$192.7,"$1,315.1775","$1,695.76","$1,772.84"
,CDM,4050007368.10.4020,F/ CHEST TUBE 32FR FAR RT ANGL,CDM Code,Outpatient,C1729,$65.,$16.0803,$61.75,$52.,$59.15,$17.0451,$61.75,$16.0803,$61.75,$61.75,$6.5,$44.3625,$0.,$59.8
,CDM,4050007920.10.4020,F/ STENT 6X22 BARD#788622 OR,CDM Code,Outpatient,C2617,"$1,267.",$313.4431,"$1,203.65","$1,013.6","$1,152.97",$332.2492,"$1,203.65",$313.4431,"$1,203.65","$1,203.65",$126.7,$864.7275,"$1,114.96","$1,165.64"
,CDM,4050007921.10.4020,F/ STENT 6X24 BARD#788624,CDM Code,Outpatient,C2617,"$1,267.",$313.4431,"$1,203.65","$1,013.6","$1,152.97",$332.2492,"$1,203.65",$313.4431,"$1,203.65","$1,203.65",$126.7,$864.7275,"$1,114.96","$1,165.64"
,CDM,4050007923.10.4020,F/ STENT 6X26 BARD#788626,CDM Code,Outpatient,C2617,"$1,273.",$314.9275,"$1,209.35","$1,018.4","$1,158.43",$333.8226,"$1,209.35",$314.9275,"$1,209.35","$1,209.35",$127.3,$868.8225,"$1,120.24","$1,171.16"
,CDM,4050007924.10.4020,F/ STENT 6X28 BARD#788628,CDM Code,Outpatient,C2617,"$1,328.",$328.5339,"$1,261.6","$1,062.4","$1,208.48",$348.2454,"$1,261.6",$328.5339,"$1,261.6","$1,261.6",$132.8,$906.36,"$1,168.64","$1,221.76"
,CDM,4050007927.10.4020,F/ STENT 7X24 BARD#788724,CDM Code,Outpatient,C2617,"$1,273.",$314.9275,"$1,209.35","$1,018.4","$1,158.43",$333.8226,"$1,209.35",$314.9275,"$1,209.35","$1,209.35",$127.3,$868.8225,"$1,120.24","$1,171.16"
,CDM,4050007929.10.4020,F/ STENT 7X26 BARD#788726,CDM Code,Outpatient,C2617,"$1,267.",$313.4431,"$1,203.65","$1,013.6","$1,152.97",$332.2492,"$1,203.65",$313.4431,"$1,203.65","$1,203.65",$126.7,$864.7275,"$1,114.96","$1,165.64"
,CDM,4050007932.10.4020,F/ STENT 8X22 BARD#788822,CDM Code,Outpatient,C2617,"$1,267.",$313.4431,"$1,203.65","$1,013.6","$1,152.97",$332.2492,"$1,203.65",$313.4431,"$1,203.65","$1,203.65",$126.7,$864.7275,"$1,114.96","$1,165.64"
,CDM,4050007933.10.4020,F/ STENT URETERAL 8FR 24CM,CDM Code,Outpatient,C2617,"$1,184.",$292.9098,"$1,124.8",$947.2,"$1,077.44",$310.4839,"$1,124.8",$292.9098,"$1,124.8","$1,124.8",$118.4,$808.08,"$1,041.92","$1,089.28"
,CDM,4050007946.10.4020,F/ URETERAL STENT,CDM Code,Outpatient,C2617,"$1,267.",$313.4431,"$1,203.65","$1,013.6","$1,152.97",$332.2492,"$1,203.65",$313.4431,"$1,203.65","$1,203.65",$126.7,$864.7275,"$1,114.96","$1,165.64"
,CDM,4050007947.10.4020,"F/ URETERAL STENT 10F, 22CM",CDM Code,Outpatient,C2617,$632.,$156.3505,$600.4,$505.6,$575.12,$165.7313,$600.4,$156.3505,$600.4,$600.4,$63.2,$431.34,$556.16,$581.44
,CDM,4050007951.10.4020,"F/ URETERAL STENT, 75FR X 28CM",CDM Code,Outpatient,C2617,"$1,267.",$313.4431,"$1,203.65","$1,013.6","$1,152.97",$332.2492,"$1,203.65",$313.4431,"$1,203.65","$1,203.65",$126.7,$864.7275,"$1,114.96","$1,165.64"
,CDM,4050008006.10.4020,F/ KIT PICC PWR SHRLCK 4FR 1 L,CDM Code,Outpatient,C1751,"$1,583.",$391.6184,"$1,503.85","$1,266.4","$1,440.53",$415.1148,"$1,503.85",$391.6184,"$1,503.85","$1,503.85",$158.3,"$1,080.3975",$0.,"$1,456.36"
,CDM,4050008007.10.4040,KIT PICC PWR SHRLCK 5FR 2LUM,CDM Code,Outpatient,C1751,"$3,269.",$808.7179,"$3,105.55","$2,615.2","$2,974.79",$857.2397,"$3,105.55",$808.7179,"$3,105.55","$3,105.55",$326.9,"$2,231.0925",$0.,"$3,007.48"
,CDM,4050008157.10.4020,F/ MESH SEPRA 12X14 5959124,CDM Code,Outpatient,C1781,"$7,407.","$1,832.4177","$7,036.65","$5,925.6","$6,740.37","$1,942.3598","$7,036.65","$1,832.4177","$7,036.65","$7,036.65",$740.7,"$5,055.2775","$6,518.16","$6,814.44"
,CDM,4050008298.10.4020,F/ GROSHONG PWR PORT CATH 1808,CDM Code,Outpatient,C1788,"$2,720.",$672.9008,"$2,584.","$2,176.","$2,475.2",$713.2738,"$2,584.",$672.9008,"$2,584.","$2,584.",$272.,"$1,856.4","$2,393.6","$2,502.4"
,CDM,4050008300.10.4020,F/ KIT PICC LINE 5FR,CDM Code,Outpatient,C1751,"$1,453.",$359.4577,"$1,380.35","$1,162.4","$1,322.23",$381.0245,"$1,380.35",$359.4577,"$1,380.35","$1,380.35",$145.3,$991.6725,$0.,"$1,336.76"
,CDM,4050008370.10.4020,F/ PLT DCP 223.560,CDM Code,Outpatient,C1713,"$3,057.",$756.2712,"$2,904.15","$2,445.6","$2,781.87",$801.6463,"$2,904.15",$756.2712,"$2,904.15","$2,904.15",$305.7,"$2,086.4025","$2,690.16","$2,812.44"
,CDM,4050008378.10.4020,F/ K WIRE 2.0X150MM,CDM Code,Outpatient,C1713,$139.,$34.3872,$132.05,$111.2,$126.49,$36.4504,$132.05,$34.3872,$132.05,$132.05,$13.9,$94.8675,$122.32,$127.88
,CDM,4050008379.10.4020,F/ PLATE T 2.0MM 2H 243.41,CDM Code,Outpatient,C1713,$377.,$93.266,$358.15,$301.6,$343.07,$98.8618,$358.15,$93.266,$358.15,$358.15,$37.7,$257.3025,$331.76,$346.84
,CDM,4050008386.10.4020,F/ PLT TUBE 1/3 5H,CDM Code,Outpatient,C1713,$777.,$192.222,$738.15,$621.6,$707.07,$203.755,$738.15,$192.222,$738.15,$738.15,$77.7,$530.3025,$683.76,$714.84
,CDM,4050008390.10.4020,F/ PLT STRT 2.0MM 5H,CDM Code,Outpatient,C1713,$239.,$59.1262,$227.05,$191.2,$217.49,$62.6737,$227.05,$59.1262,$227.05,$227.05,$23.9,$163.1175,$210.32,$219.88
,CDM,4050008393.10.4020,F/ SCREW CANC,CDM Code,Outpatient,C1713,$313.,$77.4331,$297.35,$250.4,$284.83,$82.0789,$297.35,$77.4331,$297.35,$297.35,$31.3,$213.6225,$275.44,$287.96
,CDM,4050008394.10.4020,F/ SCREW CANC,CDM Code,Outpatient,C1713,$255.,$63.0844,$242.25,$204.,$232.05,$66.8694,$242.25,$63.0844,$242.25,$242.25,$25.5,$174.0375,$224.4,$234.6
,CDM,4050008395.10.4020,F/ SCREW CANC PT,CDM Code,Outpatient,C1713,$255.,$63.0844,$242.25,$204.,$232.05,$66.8694,$242.25,$63.0844,$242.25,$242.25,$25.5,$174.0375,$224.4,$234.6
,CDM,4050008406.10.4020,F/ SCREW CANC 4.0 PT,CDM Code,Outpatient,C1713,$255.,$63.0844,$242.25,$204.,$232.05,$66.8694,$242.25,$63.0844,$242.25,$242.25,$25.5,$174.0375,$224.4,$234.6
,CDM,4050008407.10.4020,F/ SCREW CANC 4.0 PT,CDM Code,Outpatient,C1713,$255.,$63.0844,$242.25,$204.,$232.05,$66.8694,$242.25,$63.0844,$242.25,$242.25,$25.5,$174.0375,$224.4,$234.6
,CDM,4050008410.10.4020,F/ SCREW CANC 4.0 PT,CDM Code,Outpatient,C1713,$255.,$63.0844,$242.25,$204.,$232.05,$66.8694,$242.25,$63.0844,$242.25,$242.25,$25.5,$174.0375,$224.4,$234.6
,CDM,4050008412.10.4020,F/ SCREW CANC 4.0 PT,CDM Code,Outpatient,C1713,$255.,$63.0844,$242.25,$204.,$232.05,$66.8694,$242.25,$63.0844,$242.25,$242.25,$25.5,$174.0375,$224.4,$234.6
,CDM,4050008413.10.4020,F/ SCREW CANC 4.0 PT,CDM Code,Outpatient,C1713,$255.,$63.0844,$242.25,$204.,$232.05,$66.8694,$242.25,$63.0844,$242.25,$242.25,$25.5,$174.0375,$224.4,$234.6
,CDM,4050008414.10.4020,F/ SCREW CANC 4.0 PT,CDM Code,Outpatient,C1713,$255.,$63.0844,$242.25,$204.,$232.05,$66.8694,$242.25,$63.0844,$242.25,$242.25,$25.5,$174.0375,$224.4,$234.6
,CDM,4050008459.10.4020,F/ SCRW CANC 6.5 218.040,CDM Code,Outpatient,C1713,$453.,$112.0677,$430.35,$362.4,$412.23,$118.7915,$430.35,$112.0677,$430.35,$430.35,$45.3,$309.1725,$398.64,$416.76
,CDM,4050008462.10.4020,F/ WASHER 7.0MM,CDM Code,Outpatient,C1713,$385.,$95.2451,$365.75,$308.,$350.35,$100.9597,$365.75,$95.2451,$365.75,$365.75,$38.5,$262.7625,$338.8,$354.2
,CDM,4050008527.10.4020,F/ KWIRE 9X.054 1601-32,CDM Code,Outpatient,C1713,$65.,$16.0803,$61.75,$52.,$59.15,$17.0451,$61.75,$16.0803,$61.75,$61.75,$6.5,$44.3625,$57.2,$59.8
,CDM,4050008532.10.4020,F/ SCREW CANC,CDM Code,Outpatient,C1713,$255.,$63.0844,$242.25,$204.,$232.05,$66.8694,$242.25,$63.0844,$242.25,$242.25,$25.5,$174.0375,$224.4,$234.6
,CDM,4050008542.10.4020,F/ K WIRE 3/16,CDM Code,Outpatient,C1713,$112.,$27.7077,$106.4,$89.6,$101.92,$29.3701,$106.4,$27.7077,$106.4,$106.4,$11.2,$76.44,$98.56,$103.04
,CDM,4050008543.10.4020,F/ K WIRE 5/32 1629-38 9,CDM Code,Outpatient,C1713,$150.,$37.1085,$142.5,$120.,$136.5,$39.3349,$142.5,$37.1085,$142.5,$142.5,$15.,$102.375,$132.,$138.
,CDM,4050008546.10.4020,F/ SCREW CANC 4.0MM,CDM Code,Outpatient,C1713,$255.,$63.0844,$242.25,$204.,$232.05,$66.8694,$242.25,$63.0844,$242.25,$242.25,$25.5,$174.0375,$224.4,$234.6
,CDM,4050008550.10.4020,F/ SCREW CANC 4.0MM,CDM Code,Outpatient,C1713,$226.,$55.9101,$214.7,$180.8,$205.66,$59.2647,$214.7,$55.9101,$214.7,$214.7,$22.6,$154.245,$198.88,$207.92
,CDM,4050008563.10.4020,F/ K WIRE 292.06,CDM Code,Outpatient,C1713,$24.,$5.9374,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$2.4,$16.38,$21.12,$22.08
,CDM,4050008564.10.4020,F/ K WIRE 292.08,CDM Code,Outpatient,C1713,$24.,$5.9374,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$2.4,$16.38,$21.12,$22.08
,CDM,4050008573.10.4020,F/ 5 HOLE 1/4 TUBULAR PLATE,CDM Code,Outpatient,C1713,$847.,$209.5393,$804.65,$677.6,$770.77,$222.1114,$804.65,$209.5393,$804.65,$804.65,$84.7,$578.0775,$745.36,$779.24
,CDM,4050008574.10.4020,F/ SCREW CORT 3.5MM,CDM Code,Outpatient,C1713,$341.,$84.36,$323.95,$272.8,$310.31,$89.4215,$323.95,$84.36,$323.95,$323.95,$34.1,$232.7325,$300.08,$313.72
,CDM,4050008576.10.4020,F/ SCREW CORT 3.5X36MM STR DR,CDM Code,Outpatient,C1713,$341.,$84.36,$323.95,$272.8,$310.31,$89.4215,$323.95,$84.36,$323.95,$323.95,$34.1,$232.7325,$300.08,$313.72
,CDM,4050008577.10.4020,F/ PLT NRW LCP 4.5MM 224.581,CDM Code,Outpatient,C1713,"$3,271.",$809.2127,"$3,107.45","$2,616.8","$2,976.61",$857.7641,"$3,107.45",$809.2127,"$3,107.45","$3,107.45",$327.1,"$2,232.4575","$2,878.48","$3,009.32"
,CDM,4050008600.10.4020,"F/ PLATE LCP 3.5MM 8 HOLE 223,",CDM Code,Outpatient,C1713,"$2,820.",$697.6398,"$2,679.","$2,256.","$2,566.2",$739.4971,"$2,679.",$697.6398,"$2,679.","$2,679.",$282.,"$1,924.65","$2,481.6","$2,594.4"
,CDM,4050008647.10.4020,F/ KIT CATH GROSHONG 8FR,CDM Code,Outpatient,C1788,"$3,085.",$763.1981,"$2,930.75","$2,468.","$2,807.35",$808.9888,"$2,930.75",$763.1981,"$2,930.75","$2,930.75",$308.5,"$2,105.5125","$2,714.8","$2,838.2"
,CDM,4050008703.10.4020,F/ PLT LCP 7 HOLE,CDM Code,Outpatient,C1713,"$2,509.",$620.7015,"$2,383.55","$2,007.2","$2,283.19",$657.9426,"$2,383.55",$620.7015,"$2,383.55","$2,383.55",$250.9,"$1,712.3925","$2,207.92","$2,308.28"
,CDM,4050008764.10.4020,F/ MESH ULTRAPRO UML1 30X30CM,CDM Code,Outpatient,C1781,"$3,246.",$803.0279,"$3,083.7","$2,596.8","$2,953.86",$851.2083,"$3,083.7",$803.0279,"$3,083.7","$3,083.7",$324.6,"$2,215.395","$2,856.48","$2,986.32"
,CDM,4050008800.10.4020,F/ 6.5 CANN SCREW 16MMX75MM,CDM Code,Outpatient,C1713,"$2,158.",$533.8676,"$2,050.1","$1,726.4","$1,963.78",$565.8988,"$2,050.1",$533.8676,"$2,050.1","$2,050.1",$215.8,"$1,472.835","$1,899.04","$1,985.36"
,CDM,4050008801.10.4020,F/ 6.5 SCREW CANN 16X80,CDM Code,Outpatient,C1713,"$2,654.",$656.5731,"$2,521.3","$2,123.2","$2,415.14",$695.9664,"$2,521.3",$656.5731,"$2,521.3","$2,521.3",$265.4,"$1,811.355","$2,335.52","$2,441.68"
,CDM,4050008802.10.4020,F/ 6.5 CANN SCREW 16MMX85MM,CDM Code,Outpatient,C1713,"$2,654.",$656.5731,"$2,521.3","$2,123.2","$2,415.14",$695.9664,"$2,521.3",$656.5731,"$2,521.3","$2,521.3",$265.4,"$1,811.355","$2,335.52","$2,441.68"
,CDM,4050008811.10.4020,F/ 6.5 CANN SCREW 32MMX75MM,CDM Code,Outpatient,C1713,"$2,158.",$533.8676,"$2,050.1","$1,726.4","$1,963.78",$565.8988,"$2,050.1",$533.8676,"$2,050.1","$2,050.1",$215.8,"$1,472.835","$1,899.04","$1,985.36"
,CDM,4050008812.10.4020,F/ 6.5 CANN SCREW 32MMX80MM,CDM Code,Outpatient,C1713,"$2,055.",$508.3865,"$1,952.25","$1,644.","$1,870.05",$538.8888,"$1,952.25",$508.3865,"$1,952.25","$1,952.25",$205.5,"$1,402.5375","$1,808.4","$1,890.6"
,CDM,4050008813.10.4020,F/ 6.5 CANN SCREW 32MMX85MM,CDM Code,Outpatient,C1713,"$2,360.",$583.8404,"$2,242.","$1,888.","$2,147.6",$618.8699,"$2,242.",$583.8404,"$2,242.","$2,242.",$236.,"$1,610.7","$2,076.8","$2,171.2"
,CDM,4050008865.10.4020,F/ MESH PARIETEX RT,CDM Code,Outpatient,C1781,"$2,286.",$565.5335,"$2,171.7","$1,828.8","$2,080.26",$599.4646,"$2,171.7",$565.5335,"$2,171.7","$2,171.7",$228.6,"$1,560.195","$2,011.68","$2,103.12"
,CDM,4050008866.10.4020,F/ MESH PARIETEX LT,CDM Code,Outpatient,C1781,"$2,177.",$538.568,"$2,068.15","$1,741.6","$1,981.07",$570.8812,"$2,068.15",$538.568,"$2,068.15","$2,068.15",$217.7,"$1,485.8025","$1,915.76","$2,002.84"
,CDM,4050008935.10.4020,F/ SCRW CANN 4.0 207.660,CDM Code,Outpatient,C1713,"$1,569.",$388.1549,"$1,490.55","$1,255.2","$1,427.79",$411.4436,"$1,490.55",$388.1549,"$1,490.55","$1,490.55",$156.9,"$1,070.8425","$1,380.72","$1,443.48"
,CDM,4050009034.10.4020,F/ MESH FREEDOM FIHR 25MMK,CDM Code,Outpatient,C1781,"$2,173.",$537.5785,"$2,064.35","$1,738.4","$1,977.43",$569.8323,"$2,064.35",$537.5785,"$2,064.35","$2,064.35",$217.3,"$1,483.0725","$1,912.24","$1,999.16"
,CDM,4050009035.10.4020,F/ MESH FREEDOM 40MM FIHR40MMK,CDM Code,Outpatient,C1781,"$2,173.",$537.5785,"$2,064.35","$1,738.4","$1,977.43",$569.8323,"$2,064.35",$537.5785,"$2,064.35","$2,064.35",$217.3,"$1,483.0725","$1,912.24","$1,999.16"
,CDM,4050009077.10.4020,F/ MESH 3D MAX LT/MED,CDM Code,Outpatient,C1781,"$1,953.",$483.1527,"$1,855.35","$1,562.4","$1,777.23",$512.141,"$1,855.35",$483.1527,"$1,855.35","$1,855.35",$195.3,"$1,332.9225","$1,718.64","$1,796.76"
,CDM,4050009079.10.4020,F/ MESH 3D MAX LT/LG,CDM Code,Outpatient,C1781,"$1,403.",$347.0882,"$1,332.85","$1,122.4","$1,276.73",$367.9129,"$1,332.85",$347.0882,"$1,332.85","$1,332.85",$140.3,$957.5475,"$1,234.64","$1,290.76"
,CDM,4050009081.10.4020,F/ MESH 3D MAX RT/MED,CDM Code,Outpatient,C1781,"$1,529.",$378.2593,"$1,452.55","$1,223.2","$1,391.39",$400.9543,"$1,452.55",$378.2593,"$1,452.55","$1,452.55",$152.9,"$1,043.5425","$1,345.52","$1,406.68"
,CDM,4050009082.10.4020,F/ MESH 3D MAX RT/LG,CDM Code,Outpatient,C1781,"$2,070.",$512.0973,"$1,966.5","$1,656.","$1,883.7",$542.8223,"$1,966.5",$512.0973,"$1,966.5","$1,966.5",$207.,"$1,412.775","$1,821.6","$1,904.4"
,CDM,4050010305.10.4020,F/ PARIETEX COMPOSITE ROUND 12,CDM Code,Outpatient,C1781,"$2,996.",$741.1804,"$2,846.2","$2,396.8","$2,726.36",$785.6501,"$2,846.2",$741.1804,"$2,846.2","$2,846.2",$299.6,"$2,044.77","$2,636.48","$2,756.32"
,CDM,4050010563.10.4020,F/ SCREW CORT 204.860 3.5X60,CDM Code,Outpatient,C1713,$233.,$57.6419,$221.35,$186.4,$212.03,$61.1003,$221.35,$57.6419,$221.35,$221.35,$23.3,$159.0225,$205.04,$214.36
,CDM,4050010803.10.4020,F/ LCP T-PLATE RT ANGLE 3 HOLE,CDM Code,Outpatient,C1713,"$2,479.",$613.2798,"$2,355.05","$1,983.2","$2,255.89",$650.0756,"$2,355.05",$613.2798,"$2,355.05","$2,355.05",$247.9,"$1,691.9175","$2,181.52","$2,280.68"
,CDM,4050010852.10.4020,F/ ANCHOR GII 222983,CDM Code,Outpatient,C1713,"$2,726.",$674.3851,"$2,589.7","$2,180.8","$2,480.66",$714.8472,"$2,589.7",$674.3851,"$2,589.7","$2,589.7",$272.6,"$1,860.495","$2,398.88","$2,507.92"
,CDM,4050010909.10.4020,F/ FAST FIX 360 CRVD NDL,CDM Code,Outpatient,C1713,"$2,943.",$728.0688,"$2,795.85","$2,354.4","$2,678.13",$771.7517,"$2,795.85",$728.0688,"$2,795.85","$2,795.85",$294.3,"$2,008.5975","$2,589.84","$2,707.56"
,CDM,4050011067.10.4020,"F/ STAPLER, EEA HEMROID 33X4.8",CDM Code,Outpatient,A4649,"$2,731.",$675.6221,"$2,594.45","$2,184.8","$2,485.21",$716.1583,"$2,594.45",$675.6221,"$2,594.45","$2,594.45",$273.1,"$1,863.9075",$0.,"$2,512.52"
,CDM,4050011234.10.4020,F/ PORT SMART CT H787CT96SDSDV,CDM Code,Outpatient,C1788,"$1,425.",$352.5308,"$1,353.75","$1,140.","$1,296.75",$373.682,"$1,353.75",$352.5308,"$1,353.75","$1,353.75",$142.5,$972.5625,"$1,254.","$1,311."
,CDM,4050011421.10.4020,F/ ANCHOR SUTURE BIO-CORKSCREW,CDM Code,Outpatient,C1713,"$2,015.",$498.4909,"$1,914.25","$1,612.","$1,833.65",$528.3995,"$1,914.25",$498.4909,"$1,914.25","$1,914.25",$201.5,"$1,375.2375","$1,773.2","$1,853.8"
,CDM,4050011422.10.4020,F/ ANCHOR SUT BIOCOMP 4.75X19.,CDM Code,Outpatient,C1713,"$2,823.",$698.382,"$2,681.85","$2,258.4","$2,568.93",$740.2838,"$2,681.85",$698.382,"$2,681.85","$2,681.85",$282.3,"$1,926.6975","$2,484.24","$2,597.16"
,CDM,4050011489.10.4020,F/ STAPLE LARGE WITHOUT SPIKES,CDM Code,Outpatient,C1713,"$1,584.",$391.8658,"$1,504.8","$1,267.2","$1,441.44",$415.3771,"$1,504.8",$391.8658,"$1,504.8","$1,504.8",$158.4,"$1,081.08","$1,393.92","$1,457.28"
,CDM,4050011928.10.4020,F/ LCP PL 4 HOLE DIS FIB PLT L,CDM Code,Outpatient,C1713,"$3,890.",$962.3471,"$3,695.5","$3,112.","$3,539.9","$1,020.0864","$3,695.5",$962.3471,"$3,695.5","$3,695.5",$389.,"$2,654.925","$3,423.2","$3,578.8"
,CDM,4050012216.10.4020,F/ PALACOS R BONE CEMENT,CDM Code,Outpatient,C1713,"$1,035.",$256.0487,$983.25,$828.,$941.85,$271.4112,$983.25,$256.0487,$983.25,$983.25,$103.5,$706.3875,$910.8,$952.2
,CDM,4050012263.10.4020,F/ PALACOS CEMENT 40G R+G,CDM Code,Outpatient,C1713,"$2,530.",$625.8967,"$2,403.5","$2,024.","$2,302.3",$663.4495,"$2,403.5",$625.8967,"$2,403.5","$2,403.5",$253.,"$1,726.725","$2,226.4","$2,327.6"
,CDM,4050012298.10.4020,F/ SCREW 3.5 CORT ST 46MM,CDM Code,Outpatient,C1713,$324.,$80.1544,$307.8,$259.2,$294.84,$84.9635,$307.8,$80.1544,$307.8,$307.8,$32.4,$221.13,$285.12,$298.08
,CDM,4050012299.10.4020,F/ SCREW CORT 3.5MM ST 48MM,CDM Code,Outpatient,C1713,$324.,$80.1544,$307.8,$259.2,$294.84,$84.9635,$307.8,$80.1544,$307.8,$307.8,$32.4,$221.13,$285.12,$298.08
,CDM,4050012588.10.4020,F/ MESH 3DMAX MEDIUM LEFT,CDM Code,Outpatient,C1781,"$1,110.",$274.6029,"$1,054.5",$888.,"$1,010.1",$291.0786,"$1,054.5",$274.6029,"$1,054.5","$1,054.5",$111.,$757.575,$976.8,"$1,021.2"
,CDM,4050012602.10.4020,F/ PEG TUBE KIT 003027,CDM Code,Outpatient,B4087,"$1,764.",$436.396,"$1,675.8","$1,411.2","$1,605.24",$462.579,"$1,675.8",$436.396,"$1,675.8","$1,675.8",$78.4713,"$1,203.93","$1,552.32","$1,622.88"
,CDM,4050013267.10.4020,F/ MESH MARLEX PLUG XL 1.6X2.0,CDM Code,Outpatient,C1781,"$2,040.",$504.6756,"$1,938.","$1,632.","$1,856.4",$534.9553,"$1,938.",$504.6756,"$1,938.","$1,938.",$204.,"$1,392.3","$1,795.2","$1,876.8"
,CDM,4050013584.10.4020,F/ MESH BARD 3DMAX RT/MED 0115,CDM Code,Outpatient,C1781,"$1,763.",$436.1486,"$1,674.85","$1,410.4","$1,604.33",$462.3168,"$1,674.85",$436.1486,"$1,674.85","$1,674.85",$176.3,"$1,203.2475","$1,551.44","$1,621.96"
,CDM,4050014920.10.4020,F/ SCREW CORT SELF TAP 204.844,CDM Code,Outpatient,C1713,$324.,$80.1544,$307.8,$259.2,$294.84,$84.9635,$307.8,$80.1544,$307.8,$307.8,$32.4,$221.13,$285.12,$298.08
,CDM,4050015524.10.4020,F/ MESH LAP HERNIA LPG1510AL,CDM Code,Outpatient,C1781,"$2,923.",$723.121,"$2,776.85","$2,338.4","$2,659.93",$766.5071,"$2,776.85",$723.121,"$2,776.85","$2,776.85",$292.3,"$1,994.9475","$2,572.24","$2,689.16"
,CDM,4050015624.10.4020,F/ MESH LAB HERNIA LPG1510AR,CDM Code,Outpatient,C1781,"$2,923.",$723.121,"$2,776.85","$2,338.4","$2,659.93",$766.5071,"$2,776.85",$723.121,"$2,776.85","$2,776.85",$292.3,"$1,994.9475","$2,572.24","$2,689.16"
,CDM,4050015719.10.4020,F/ SCREW CANN 6.5X32MM,CDM Code,Outpatient,C1713,"$2,852.",$705.5563,"$2,709.4","$2,281.6","$2,595.32",$747.8885,"$2,709.4",$705.5563,"$2,709.4","$2,709.4",$285.2,"$1,946.49","$2,509.76","$2,623.84"
,CDM,4050015726.10.4020,F/ MESH PLUG MED SMPM02,CDM Code,Outpatient,C1781,"$1,221.",$302.0632,"$1,159.95",$976.8,"$1,111.11",$320.1865,"$1,159.95",$302.0632,"$1,159.95","$1,159.95",$122.1,$833.3325,"$1,074.48","$1,123.32"
,CDM,4050015785.10.4020,F/ PLT LC-DCP 6 HOLE 223.56,CDM Code,Outpatient,C1713,"$2,778.",$687.2494,"$2,639.1","$2,222.4","$2,527.98",$728.4833,"$2,639.1",$687.2494,"$2,639.1","$2,639.1",$277.8,"$1,895.985","$2,444.64","$2,555.76"
,CDM,4050015923.10.4020,F/ SCREW CANNULATED 4.0 X 52MM,CDM Code,Outpatient,C1713,"$1,891.",$467.8145,"$1,796.45","$1,512.8","$1,720.81",$495.8826,"$1,796.45",$467.8145,"$1,796.45","$1,796.45",$189.1,"$1,290.6075","$1,664.08","$1,739.72"
,CDM,4050015925.10.4020,F/ SCREW CANNULATED 4.0 X 54MM,CDM Code,Outpatient,C1713,"$1,891.",$467.8145,"$1,796.45","$1,512.8","$1,720.81",$495.8826,"$1,796.45",$467.8145,"$1,796.45","$1,796.45",$189.1,"$1,290.6075","$1,664.08","$1,739.72"
,CDM,4050015982.10.4020,F/ CANN REV DOWEL-ZORC PCD12,CDM Code,Outpatient,C1713,"$4,715.","$1,166.4438","$4,479.25","$3,772.","$4,290.65","$1,236.4286","$4,479.25","$1,166.4438","$4,479.25","$4,479.25",$471.5,"$3,217.9875","$4,149.2","$4,337.8"
,CDM,4050015988.10.4020,F/ CANN REV DOWEL-ZORC PCDXL12,CDM Code,Outpatient,C1713,"$4,715.","$1,166.4438","$4,479.25","$3,772.","$4,290.65","$1,236.4286","$4,479.25","$1,166.4438","$4,479.25","$4,479.25",$471.5,"$3,217.9875","$4,149.2","$4,337.8"
,CDM,4050016217.10.4020,F/ SUTURE CORKSCREW 5.5X14.7MM,CDM Code,Outpatient,C1713,"$2,108.",$521.4981,"$2,002.6","$1,686.4","$1,918.28",$552.7872,"$2,002.6",$521.4981,"$2,002.6","$2,002.6",$210.8,"$1,438.71","$1,855.04","$1,939.36"
,CDM,4050016225.10.4020,F/ SWVLK TENO BIO-COMP 7X19.1M,CDM Code,Outpatient,C1713,"$2,697.",$667.2108,"$2,562.15","$2,157.6","$2,454.27",$707.2424,"$2,562.15",$667.2108,"$2,562.15","$2,562.15",$269.7,"$1,840.7025","$2,373.36","$2,481.24"
,CDM,4050016226.10.4020,F/ SUTRE ANCHOR 8 X 19.1MM,CDM Code,Outpatient,C1713,"$2,697.",$667.2108,"$2,562.15","$2,157.6","$2,454.27",$707.2424,"$2,562.15",$667.2108,"$2,562.15","$2,562.15",$269.7,"$1,840.7025","$2,373.36","$2,481.24"
,CDM,4050016376.10.4020,"F/ ANCHOR SUTURE,PEEK SWIVELOC",CDM Code,Outpatient,C1713,"$2,325.",$575.1817,"$2,208.75","$1,860.","$2,115.75",$609.6917,"$2,208.75",$575.1817,"$2,208.75","$2,208.75",$232.5,"$1,586.8125","$2,046.","$2,139."
,CDM,4050016446.10.4020,F/ SUT SET MENISCUS PROT AR-40,CDM Code,Outpatient,A4649,"$1,020.",$252.3378,$969.,$816.,$928.2,$267.4777,$969.,$252.3378,$969.,$969.,$102.,$696.15,$897.6,$938.4
,CDM,4050016447.10.4020,F/ SUT TAPE MENISCUS REP AR-75,CDM Code,Outpatient,A4649,$863.,$213.4976,$819.85,$690.4,$785.33,$226.3071,$819.85,$213.4976,$819.85,$819.85,$86.3,$588.9975,$0.,$793.96
,CDM,4050016454.10.4020,F/ FAST FIX 360 REVSD CRVD NDL,CDM Code,Outpatient,C1713,"$2,943.",$728.0688,"$2,795.85","$2,354.4","$2,678.13",$771.7517,"$2,795.85",$728.0688,"$2,795.85","$2,795.85",$294.3,"$2,008.5975","$2,589.84","$2,707.56"
,CDM,4050017360.10.4020,F/ SCREW 2.0X20MM CORTEX,CDM Code,Outpatient,C1713,$509.,$125.9215,$483.55,$407.2,$463.19,$133.4766,$483.55,$125.9215,$483.55,$483.55,$50.9,$347.3925,$447.92,$468.28
,CDM,4050900330.10.4020,F/ TORIC LENS SN6AT3,CDM Code,Outpatient,V2787GY,$468.,$115.7785,$444.6,$374.4,$425.88,$122.725,$444.6,$115.7785,$444.6,$444.6,$46.8,$319.41,$411.84,$430.56
,CDM,4050900473.10.4020,F/ CANN. SCREW 7.3X16MMX70MM,CDM Code,Outpatient,C1713,"$2,342.",$579.3874,"$2,224.9","$1,873.6","$2,131.22",$614.1497,"$2,224.9",$579.3874,"$2,224.9","$2,224.9",$234.2,"$1,598.415","$2,060.96","$2,154.64"
,CDM,4050900475.10.4020,F/ CANN. SCREW 7.3X16MMX80MM,CDM Code,Outpatient,C1713,"$2,508.",$620.4541,"$2,382.6","$2,006.4","$2,282.28",$657.6804,"$2,382.6",$620.4541,"$2,382.6","$2,382.6",$250.8,"$1,711.71","$2,207.04","$2,307.36"
,CDM,4050900476.10.4020,F/ CANN. SCREW 7.3X16MMX85MM,CDM Code,Outpatient,C1713,"$2,634.",$651.6253,"$2,502.3","$2,107.2","$2,396.94",$690.7217,"$2,502.3",$651.6253,"$2,502.3","$2,502.3",$263.4,"$1,797.705","$2,317.92","$2,423.28"
,CDM,4050900477.10.4020,F/ CANN. SCREW 7.3X16MMX90MM,CDM Code,Outpatient,C1713,"$2,635.",$651.8727,"$2,503.25","$2,108.","$2,397.85",$690.984,"$2,503.25",$651.8727,"$2,503.25","$2,503.25",$263.5,"$1,798.3875","$2,318.8","$2,424.2"
,CDM,4050900478.10.4020,F/ CANN. SCREW 7.3X16MMX95MM,CDM Code,Outpatient,C1713,"$2,635.",$651.8727,"$2,503.25","$2,108.","$2,397.85",$690.984,"$2,503.25",$651.8727,"$2,503.25","$2,503.25",$263.5,"$1,798.3875","$2,318.8","$2,424.2"
,CDM,4050900479.10.4020,F/ CANN. SCREW 7.3X16MMX100MM,CDM Code,Outpatient,C1713,"$2,294.",$567.5127,"$2,179.3","$1,835.2","$2,087.54",$601.5625,"$2,179.3",$567.5127,"$2,179.3","$2,179.3",$229.4,"$1,565.655","$2,018.72","$2,110.48"
,CDM,4050900480.10.4020,F/ CANN. SCREW 7.3X16MMX105MM,CDM Code,Outpatient,C1713,"$2,635.",$651.8727,"$2,503.25","$2,108.","$2,397.85",$690.984,"$2,503.25",$651.8727,"$2,503.25","$2,503.25",$263.5,"$1,798.3875","$2,318.8","$2,424.2"
,CDM,4050900481.10.4020,F/ CANN. SCREW 7.3X16MMX110MM,CDM Code,Outpatient,C1713,"$2,227.",$550.9375,"$2,115.65","$1,781.6","$2,026.57",$583.9929,"$2,115.65",$550.9375,"$2,115.65","$2,115.65",$222.7,"$1,519.9275","$1,959.76","$2,048.84"
,CDM,4050900482.10.4020,F/ CANN. SCREW 7.3X16MMX115MM,CDM Code,Outpatient,C1713,"$2,041.",$504.923,"$1,938.95","$1,632.8","$1,857.31",$535.2176,"$1,938.95",$504.923,"$1,938.95","$1,938.95",$204.1,"$1,392.9825","$1,796.08","$1,877.72"
,CDM,4050900497.10.4020,F/ CANN. SCREW 7.3X32MMX80MM,CDM Code,Outpatient,C1713,"$2,041.",$504.923,"$1,938.95","$1,632.8","$1,857.31",$535.2176,"$1,938.95",$504.923,"$1,938.95","$1,938.95",$204.1,"$1,392.9825","$1,796.08","$1,877.72"
,CDM,4050900498.10.4020,F/ CANN. SCREW 7.3X32MMX85MM,CDM Code,Outpatient,C1713,"$2,508.",$620.4541,"$2,382.6","$2,006.4","$2,282.28",$657.6804,"$2,382.6",$620.4541,"$2,382.6","$2,382.6",$250.8,"$1,711.71","$2,207.04","$2,307.36"
,CDM,4050900499.10.4020,F/ CANN. SCREW 7.3X32MMX90MM,CDM Code,Outpatient,C1713,"$2,041.",$504.923,"$1,938.95","$1,632.8","$1,857.31",$535.2176,"$1,938.95",$504.923,"$1,938.95","$1,938.95",$204.1,"$1,392.9825","$1,796.08","$1,877.72"
,CDM,4050900500.10.4020,F/ CANN. SCREW 7.3X32MMX95MM,CDM Code,Outpatient,C1713,"$2,041.",$504.923,"$1,938.95","$1,632.8","$1,857.31",$535.2176,"$1,938.95",$504.923,"$1,938.95","$1,938.95",$204.1,"$1,392.9825","$1,796.08","$1,877.72"
,CDM,4050900502.10.4020,F/ CANN. SCREW 7.3X32MMX105MM,CDM Code,Outpatient,C1713,"$1,660.",$410.6674,"$1,577.","$1,328.","$1,510.6",$435.3068,"$1,577.",$410.6674,"$1,577.","$1,577.",$166.,"$1,132.95","$1,460.8","$1,527.2"
,CDM,4050900503.10.4020,F/ CANN. SCREW 7.3X32MMX110MM,CDM Code,Outpatient,C1713,"$1,660.",$410.6674,"$1,577.","$1,328.","$1,510.6",$435.3068,"$1,577.",$410.6674,"$1,577.","$1,577.",$166.,"$1,132.95","$1,460.8","$1,527.2"
,CDM,4050900541.10.4020,F/ LENS MN60AC 18.0,CDM Code,Outpatient,V2632,"$1,060.",$262.2334,"$1,007.",$848.,$964.6,$277.967,"$1,007.",$262.2334,"$1,007.","$1,007.",$106.,$723.45,$932.8,$975.2
,CDM,4050900545.10.4020,F/ LENS MN60AC +20.0,CDM Code,Outpatient,V2632,$990.,$244.9161,$940.5,$792.,$900.9,$259.6107,$940.5,$244.9161,$940.5,$940.5,$99.,$675.675,$871.2,$910.8
,CDM,4050900559.10.4020,F/ LENS SN60WF +9.5 DIOP,CDM Code,Outpatient,V2632,"$1,060.",$262.2334,"$1,007.",$848.,$964.6,$277.967,"$1,007.",$262.2334,"$1,007.","$1,007.",$106.,$723.45,$932.8,$975.2
,CDM,4050900560.10.4020,F/ LENS SN60WF +10.0 DIOP,CDM Code,Outpatient,V2632,"$1,060.",$262.2334,"$1,007.",$848.,$964.6,$277.967,"$1,007.",$262.2334,"$1,007.","$1,007.",$106.,$723.45,$932.8,$975.2
,CDM,4050900561.10.4020,F/ LENS SN60WF +10.5 DIOP,CDM Code,Outpatient,V2632,$990.,$244.9161,$940.5,$792.,$900.9,$259.6107,$940.5,$244.9161,$940.5,$940.5,$99.,$675.675,$871.2,$910.8
,CDM,4050900562.10.4020,F/ LENS SN60WF +13.0 DIOP,CDM Code,Outpatient,V2632,"$1,113.",$275.3451,"$1,057.35",$890.4,"$1,012.83",$291.8653,"$1,057.35",$275.3451,"$1,057.35","$1,057.35",$111.3,$759.6225,$979.44,"$1,023.96"
,CDM,4050900563.10.4020,F/ LENS SN60WF +15.0 DIOP,CDM Code,Outpatient,V2632,"$1,113.",$275.3451,"$1,057.35",$890.4,"$1,012.83",$291.8653,"$1,057.35",$275.3451,"$1,057.35","$1,057.35",$111.3,$759.6225,$979.44,"$1,023.96"
,CDM,4050900564.10.4020,F/ LENS SN60WF +16.0 DIOP,CDM Code,Outpatient,V2632,"$1,060.",$262.2334,"$1,007.",$848.,$964.6,$277.967,"$1,007.",$262.2334,"$1,007.","$1,007.",$106.,$723.45,$932.8,$975.2
,CDM,4050900565.10.4020,F/ LENS SN60WF +16.5 DIOP,CDM Code,Outpatient,V2632,"$1,060.",$262.2334,"$1,007.",$848.,$964.6,$277.967,"$1,007.",$262.2334,"$1,007.","$1,007.",$106.,$723.45,$932.8,$975.2
,CDM,4050900566.10.4020,F/ LENS SN60WF +17.0 DIOP,CDM Code,Outpatient,V2632,"$1,060.",$262.2334,"$1,007.",$848.,$964.6,$277.967,"$1,007.",$262.2334,"$1,007.","$1,007.",$106.,$723.45,$932.8,$975.2
,CDM,4050900567.10.4020,F/ LENS SN60WF +17.5 DIOP,CDM Code,Outpatient,V2632,"$1,060.",$262.2334,"$1,007.",$848.,$964.6,$277.967,"$1,007.",$262.2334,"$1,007.","$1,007.",$106.,$723.45,$932.8,$975.2
,CDM,4050900568.10.4020,F/ LENS SN60WF +18.0 DIOP,CDM Code,Outpatient,V2632,"$1,060.",$262.2334,"$1,007.",$848.,$964.6,$277.967,"$1,007.",$262.2334,"$1,007.","$1,007.",$106.,$723.45,$932.8,$975.2
,CDM,4050900569.10.4020,F/ LENS SN60WF +18.5 DIOP,CDM Code,Outpatient,V2632,"$1,113.",$275.3451,"$1,057.35",$890.4,"$1,012.83",$291.8653,"$1,057.35",$275.3451,"$1,057.35","$1,057.35",$111.3,$759.6225,$979.44,"$1,023.96"
,CDM,4050900570.10.4020,F/ LENS SN60WF +19.0 DIOP.,CDM Code,Outpatient,V2632,"$1,060.",$262.2334,"$1,007.",$848.,$964.6,$277.967,"$1,007.",$262.2334,"$1,007.","$1,007.",$106.,$723.45,$932.8,$975.2
,CDM,4050900571.10.4020,F/ LENS SN60WF +19.5 DIOP,CDM Code,Outpatient,V2632,"$1,060.",$262.2334,"$1,007.",$848.,$964.6,$277.967,"$1,007.",$262.2334,"$1,007.","$1,007.",$106.,$723.45,$932.8,$975.2
,CDM,4050900572.10.4020,F/ LENS SN60WF +20.0 DIOP.,CDM Code,Outpatient,V2632,"$1,060.",$262.2334,"$1,007.",$848.,$964.6,$277.967,"$1,007.",$262.2334,"$1,007.","$1,007.",$106.,$723.45,$932.8,$975.2
,CDM,4050900573.10.4020,F/ LENS SN60WF +20.5 DIOP,CDM Code,Outpatient,V2632,"$1,060.",$262.2334,"$1,007.",$848.,$964.6,$277.967,"$1,007.",$262.2334,"$1,007.","$1,007.",$106.,$723.45,$932.8,$975.2
,CDM,4050900574.10.4020,F/ LENS SN60WF +21.0 DIOP,CDM Code,Outpatient,V2632,"$1,060.",$262.2334,"$1,007.",$848.,$964.6,$277.967,"$1,007.",$262.2334,"$1,007.","$1,007.",$106.,$723.45,$932.8,$975.2
,CDM,4050900575.10.4020,F/ LENS SN60WF +21.5 DIOP.,CDM Code,Outpatient,V2632,"$1,060.",$262.2334,"$1,007.",$848.,$964.6,$277.967,"$1,007.",$262.2334,"$1,007.","$1,007.",$106.,$723.45,$932.8,$975.2
,CDM,4050900576.10.4020,F/ LENS SN60WF +22.0 DIOP.,CDM Code,Outpatient,V2632,"$1,060.",$262.2334,"$1,007.",$848.,$964.6,$277.967,"$1,007.",$262.2334,"$1,007.","$1,007.",$106.,$723.45,$932.8,$975.2
,CDM,4050900577.10.4020,F/ LENS SN60WF +22.5 DIOP.,CDM Code,Outpatient,V2632,"$1,060.",$262.2334,"$1,007.",$848.,$964.6,$277.967,"$1,007.",$262.2334,"$1,007.","$1,007.",$106.,$723.45,$932.8,$975.2
,CDM,4050900578.10.4020,F/ LENS SN60WF +23.0 DIOP.,CDM Code,Outpatient,V2632,"$1,060.",$262.2334,"$1,007.",$848.,$964.6,$277.967,"$1,007.",$262.2334,"$1,007.","$1,007.",$106.,$723.45,$932.8,$975.2
,CDM,4050900579.10.4020,F/ LENS SN60WF +23.5 DIOP.,CDM Code,Outpatient,V2632,"$1,060.",$262.2334,"$1,007.",$848.,$964.6,$277.967,"$1,007.",$262.2334,"$1,007.","$1,007.",$106.,$723.45,$932.8,$975.2
,CDM,4050900580.10.4020,F/ LENS SN60WF +24.0 DIOP.,CDM Code,Outpatient,V2632,"$1,060.",$262.2334,"$1,007.",$848.,$964.6,$277.967,"$1,007.",$262.2334,"$1,007.","$1,007.",$106.,$723.45,$932.8,$975.2
,CDM,4050900581.10.4020,F/ LENS SN60WF +24.5 DIOP.,CDM Code,Outpatient,V2632,"$1,060.",$262.2334,"$1,007.",$848.,$964.6,$277.967,"$1,007.",$262.2334,"$1,007.","$1,007.",$106.,$723.45,$932.8,$975.2
,CDM,4050900582.10.4020,F/ LENS SN60WF +25.0 DIOP.,CDM Code,Outpatient,V2632,"$1,060.",$262.2334,"$1,007.",$848.,$964.6,$277.967,"$1,007.",$262.2334,"$1,007.","$1,007.",$106.,$723.45,$932.8,$975.2
,CDM,4050900583.10.4020,F/ LENS SN60WF +25.5 DIOP.,CDM Code,Outpatient,V2632,"$1,060.",$262.2334,"$1,007.",$848.,$964.6,$277.967,"$1,007.",$262.2334,"$1,007.","$1,007.",$106.,$723.45,$932.8,$975.2
,CDM,4050900584.10.4020,F/ LENS SN60WF +26.0 DIOP.,CDM Code,Outpatient,V2632,"$1,060.",$262.2334,"$1,007.",$848.,$964.6,$277.967,"$1,007.",$262.2334,"$1,007.","$1,007.",$106.,$723.45,$932.8,$975.2
,CDM,4050900586.10.4020,F/ LENS SN60WF +27.0 DIOP.,CDM Code,Outpatient,V2632,"$1,113.",$275.3451,"$1,057.35",$890.4,"$1,012.83",$291.8653,"$1,057.35",$275.3451,"$1,057.35","$1,057.35",$111.3,$759.6225,$979.44,"$1,023.96"
,CDM,4050900688.10.4020,F/ LENS SN60WF +12.5 DIOP.,CDM Code,Outpatient,V2632,"$1,060.",$262.2334,"$1,007.",$848.,$964.6,$277.967,"$1,007.",$262.2334,"$1,007.","$1,007.",$106.,$723.45,$932.8,$975.2
,CDM,4050900857.10.4020,F/ 2.4MM DSTL RAD PLATE 6HX3H,CDM Code,Outpatient,C1713,"$5,733.","$1,418.2869","$5,446.35","$4,586.4","$5,217.03","$1,503.3818","$5,446.35","$1,418.2869","$5,446.35","$5,446.35",$573.3,"$3,912.7725","$5,045.04","$5,274.36"
,CDM,4050900862.10.4020,F/ DIST RAD PLATE 7H HDX3H SH,CDM Code,Outpatient,C1713,"$4,805.","$1,188.709","$4,564.75","$3,844.","$4,372.55","$1,260.0296","$4,564.75","$1,188.709","$4,564.75","$4,564.75",$480.5,"$3,279.4125","$4,228.4","$4,420.6"
,CDM,4050900863.10.4020,F/ DIST RAD PLATE 7H HDX3H SH,CDM Code,Outpatient,C1713,"$3,858.",$954.4306,"$3,665.1","$3,086.4","$3,510.78","$1,011.6949","$3,665.1",$954.4306,"$3,665.1","$3,665.1",$385.8,"$2,633.085","$3,395.04","$3,549.36"
,CDM,4050900867.10.4020,F/ DIST RAD PLATE 7H HDX5H SH,CDM Code,Outpatient,C1713,"$5,101.","$1,261.9364","$4,845.95","$4,080.8","$4,641.91","$1,337.6505","$4,845.95","$1,261.9364","$4,845.95","$4,845.95",$510.1,"$3,481.4325","$4,488.88","$4,692.92"
,CDM,4050900881.10.4020,F/ 2.4MMX14MM SLF-TAP LCK SCRE,CDM Code,Outpatient,C1713,"$1,427.",$353.0255,"$1,355.65","$1,141.6","$1,298.57",$374.2065,"$1,355.65",$353.0255,"$1,355.65","$1,355.65",$142.7,$973.9275,"$1,255.76","$1,312.84"
,CDM,4050900882.10.4020,F/ 2.4MMX16MM SLF-TAP LCK SCRE,CDM Code,Outpatient,C1713,$971.,$240.2157,$922.45,$776.8,$883.61,$254.6282,$922.45,$240.2157,$922.45,$922.45,$97.1,$662.7075,$854.48,$893.32
,CDM,4050900883.10.4020,F/ 2.4MMX18MM SLF-TAP LCK SCRE,CDM Code,Outpatient,C1713,$971.,$240.2157,$922.45,$776.8,$883.61,$254.6282,$922.45,$240.2157,$922.45,$922.45,$97.1,$662.7075,$854.48,$893.32
,CDM,4050900884.10.4020,F/ 2.4MMX20MM SLF-TAP LCK SCRE,CDM Code,Outpatient,C1713,$971.,$240.2157,$922.45,$776.8,$883.61,$254.6282,$922.45,$240.2157,$922.45,$922.45,$97.1,$662.7075,$854.48,$893.32
,CDM,4050900886.10.4020,F/ 2.4MMX24MM SLF-TAP LCK SCRE,CDM Code,Outpatient,C1713,$971.,$240.2157,$922.45,$776.8,$883.61,$254.6282,$922.45,$240.2157,$922.45,$922.45,$97.1,$662.7075,$854.48,$893.32
,CDM,4050900888.10.4020,F/ 2.4MMX28MM SLF-TAP LCK SCRE,CDM Code,Outpatient,C1713,$971.,$240.2157,$922.45,$776.8,$883.61,$254.6282,$922.45,$240.2157,$922.45,$922.45,$97.1,$662.7075,$854.48,$893.32
,CDM,4050900891.10.4020,F/ 2.4MMX10MM SLF-TAP CORT SCR,CDM Code,Outpatient,C1713,$755.,$186.7794,$717.25,$604.,$687.05,$197.9859,$717.25,$186.7794,$717.25,$717.25,$75.5,$515.2875,$664.4,$694.6
,CDM,4050900892.10.4020,F/ 2.4MMX12MM SLF-TAP CORT SCR,CDM Code,Outpatient,C1713,$755.,$186.7794,$717.25,$604.,$687.05,$197.9859,$717.25,$186.7794,$717.25,$717.25,$75.5,$515.2875,$664.4,$694.6
,CDM,4050900893.10.4020,F/ 2.4MMX14MM SLF-TAP CORT SCR,CDM Code,Outpatient,C1713,$659.,$163.03,$626.05,$527.2,$599.69,$172.8115,$626.05,$163.03,$626.05,$626.05,$65.9,$449.7675,$579.92,$606.28
,CDM,4050900894.10.4020,F/ 2.4MMX16MM SLF-TAP CORT SCR,CDM Code,Outpatient,C1713,$659.,$163.03,$626.05,$527.2,$599.69,$172.8115,$626.05,$163.03,$626.05,$626.05,$65.9,$449.7675,$579.92,$606.28
,CDM,4050900895.10.4020,F/ 2.4MMX18MM SLF-TAP CORT SCR,CDM Code,Outpatient,C1713,$659.,$163.03,$626.05,$527.2,$599.69,$172.8115,$626.05,$163.03,$626.05,$626.05,$65.9,$449.7675,$579.92,$606.28
,CDM,4050900896.10.4020,F/ 2.4MMX20MM SLF-TAP CORT SCR,CDM Code,Outpatient,C1713,$659.,$163.03,$626.05,$527.2,$599.69,$172.8115,$626.05,$163.03,$626.05,$626.05,$65.9,$449.7675,$579.92,$606.28
,CDM,4050900897.10.4020,F/ 2.4MMX22MM SLF-TAP CORT SCR,CDM Code,Outpatient,C1713,$755.,$186.7794,$717.25,$604.,$687.05,$197.9859,$717.25,$186.7794,$717.25,$717.25,$75.5,$515.2875,$664.4,$694.6
,CDM,4050900899.10.4020,F/ 2.4MMX26MM SLF-TAP CORT SCR,CDM Code,Outpatient,C1713,$546.,$135.0749,$518.7,$436.8,$496.86,$143.1792,$518.7,$135.0749,$518.7,$518.7,$54.6,$372.645,$480.48,$502.32
,CDM,4050900900.10.4020,F/ 2.4MMX28MM SLF-TAP CORT SCR,CDM Code,Outpatient,C1713,$659.,$163.03,$626.05,$527.2,$599.69,$172.8115,$626.05,$163.03,$626.05,$626.05,$65.9,$449.7675,$579.92,$606.28
,CDM,4050900901.10.4020,F/ 2.7MMX10MM SLF-TAP CORT SCR,CDM Code,Outpatient,C1713,$411.,$101.6773,$390.45,$328.8,$374.01,$107.7778,$390.45,$101.6773,$390.45,$390.45,$41.1,$280.5075,$361.68,$378.12
,CDM,4050900902.10.4020,F/ 2.7MMX12MM SLF-TAP CORT SCR,CDM Code,Outpatient,C1713,$411.,$101.6773,$390.45,$328.8,$374.01,$107.7778,$390.45,$101.6773,$390.45,$390.45,$41.1,$280.5075,$361.68,$378.12
,CDM,4050900903.10.4020,F/ 2.7MMX14MM SLF-TAP CORT SCR,CDM Code,Outpatient,C1713,$453.,$112.0677,$430.35,$362.4,$412.23,$118.7915,$430.35,$112.0677,$430.35,$430.35,$45.3,$309.1725,$398.64,$416.76
,CDM,4050900905.10.4020,F/ 2.7MMX18MM SLF-TAP CORT SCR,CDM Code,Outpatient,C1713,$487.,$120.4789,$462.65,$389.6,$443.17,$127.7075,$462.65,$120.4789,$462.65,$462.65,$48.7,$332.3775,$428.56,$448.04
,CDM,4050900906.10.4020,F/ 2.7MMX20MM SLF-TAP CORT SCR,CDM Code,Outpatient,C1713,$453.,$112.0677,$430.35,$362.4,$412.23,$118.7915,$430.35,$112.0677,$430.35,$430.35,$45.3,$309.1725,$398.64,$416.76
,CDM,4050900908.10.4020,F/ 2.7MMX24MM SLF-TAP CORT SCR,CDM Code,Outpatient,C1713,$372.,$92.0291,$353.4,$297.6,$338.52,$97.5507,$353.4,$92.0291,$353.4,$353.4,$37.2,$253.89,$327.36,$342.24
,CDM,4050900914.10.4020,F/ SEED I-125 IODINE,CDM Code,Outpatient,C2638,$164.,$40.572,$155.8,$131.2,$149.24,$43.0062,$155.8,$40.572,$155.8,$155.8,$101.3799,$111.93,$144.32,$150.88
,CDM,4050900939.10.4020,F/ VANGUARD M UNI BRNG D5 RM/L,CDM Code,Outpatient,L8699,"$5,731.","$1,417.7921","$5,444.45","$4,584.8","$5,215.21","$1,502.8573","$5,444.45","$1,417.7921","$5,444.45","$5,444.45",$573.1,"$3,911.4075","$5,043.28","$5,272.52"
,CDM,4050900966.10.4020,F/ DVR ANATOMIC STANDARD LEFT,CDM Code,Outpatient,C1713,"$3,507.",$867.5967,"$3,331.65","$2,805.6","$3,191.37",$919.6511,"$3,331.65",$867.5967,"$3,331.65","$3,331.65",$350.7,"$2,393.5275","$3,086.16","$3,226.44"
,CDM,4050900967.10.4020,F/ DVR ANATOMIC NARROW LEFT,CDM Code,Outpatient,C1713,"$5,617.","$1,389.5896","$5,336.15","$4,493.6","$5,111.47","$1,472.9628","$5,336.15","$1,389.5896","$5,336.15","$5,336.15",$561.7,"$3,833.6025","$4,942.96","$5,167.64"
,CDM,4050900973.10.4020,F/ DVR ANATOMIC SHORT RIGHT,CDM Code,Outpatient,C1713,"$3,858.",$954.4306,"$3,665.1","$3,086.4","$3,510.78","$1,011.6949","$3,665.1",$954.4306,"$3,665.1","$3,665.1",$385.8,"$2,633.085","$3,395.04","$3,549.36"
,CDM,4050900987.10.4020,F/ DVR SCREW CORTICAL 3.5x10MM,CDM Code,Outpatient,C1713,$702.,$173.6678,$666.9,$561.6,$638.82,$184.0876,$666.9,$173.6678,$666.9,$666.9,$70.2,$479.115,$617.76,$645.84
,CDM,4050900988.10.4020,F/ DVR SCREW CORTICAL 3.5x12MM,CDM Code,Outpatient,C1713,$773.,$191.2325,$734.35,$618.4,$703.43,$202.7061,$734.35,$191.2325,$734.35,$734.35,$77.3,$527.5725,$680.24,$711.16
,CDM,4050900990.10.4020,F/ DVR SCREW CORTICAL 3.5x14MM,CDM Code,Outpatient,C1713,$702.,$173.6678,$666.9,$561.6,$638.82,$184.0876,$666.9,$173.6678,$666.9,$666.9,$70.2,$479.115,$617.76,$645.84
,CDM,4050900992.10.4020,F/ DVR SCREW CORTICAL 3.5x16MM,CDM Code,Outpatient,C1713,$773.,$191.2325,$734.35,$618.4,$703.43,$202.7061,$734.35,$191.2325,$734.35,$734.35,$77.3,$527.5725,$680.24,$711.16
,CDM,4050900997.10.4020,F/ DVR PEG FULL THREAD 2.5x14M,CDM Code,Outpatient,C1713,$773.,$191.2325,$734.35,$618.4,$703.43,$202.7061,$734.35,$191.2325,$734.35,$734.35,$77.3,$527.5725,$680.24,$711.16
,CDM,4050900998.10.4020,F/ DVR PEG FULL THREAD 2.5x16M,CDM Code,Outpatient,C1713,$773.,$191.2325,$734.35,$618.4,$703.43,$202.7061,$734.35,$191.2325,$734.35,$734.35,$77.3,$527.5725,$680.24,$711.16
,CDM,4050900999.10.4020,F/ DVR PEG FULL THREAD 2.5x18M,CDM Code,Outpatient,C1713,$773.,$191.2325,$734.35,$618.4,$703.43,$202.7061,$734.35,$191.2325,$734.35,$734.35,$77.3,$527.5725,$680.24,$711.16
,CDM,4050901001.10.4020,F/ DVR PEG FULL THREAD 2.5x22M,CDM Code,Outpatient,C1713,$702.,$173.6678,$666.9,$561.6,$638.82,$184.0876,$666.9,$173.6678,$666.9,$666.9,$70.2,$479.115,$617.76,$645.84
,CDM,4050901002.10.4020,F/ DVR PEG FULL THREAD 2.5x24M,CDM Code,Outpatient,C1713,$702.,$173.6678,$666.9,$561.6,$638.82,$184.0876,$666.9,$173.6678,$666.9,$666.9,$70.2,$479.115,$617.76,$645.84
,CDM,4050901010.10.4020,F/ DVR PEG SMOOTH 2.0x18MM,CDM Code,Outpatient,C1713,$702.,$173.6678,$666.9,$561.6,$638.82,$184.0876,$666.9,$173.6678,$666.9,$666.9,$70.2,$479.115,$617.76,$645.84
,CDM,4050901011.10.4020,F/ DVR PEG SMOOTH 2.0x20MM,CDM Code,Outpatient,C1713,$702.,$173.6678,$666.9,$561.6,$638.82,$184.0876,$666.9,$173.6678,$666.9,$666.9,$70.2,$479.115,$617.76,$645.84
,CDM,4050901012.10.4020,F/ DVR PEG SMOOTH 2.0x22MM,CDM Code,Outpatient,C1713,$702.,$173.6678,$666.9,$561.6,$638.82,$184.0876,$666.9,$173.6678,$666.9,$666.9,$70.2,$479.115,$617.76,$645.84
,CDM,4050901022.10.4020,F/ DVR PEG SCREW 2.5x20MM,CDM Code,Outpatient,C1713,$702.,$173.6678,$666.9,$561.6,$638.82,$184.0876,$666.9,$173.6678,$666.9,$666.9,$70.2,$479.115,$617.76,$645.84
,CDM,4050901023.10.4020,F/ DVR PEG SCREW 2.5x22MM,CDM Code,Outpatient,C1713,$684.,$169.2148,$649.8,$547.2,$622.44,$179.3674,$649.8,$169.2148,$649.8,$649.8,$68.4,$466.83,$601.92,$629.28
,CDM,4050901042.10.4020,F/ DVR K-WIRE 1.6MM SS,CDM Code,Outpatient,C1713,$384.,$94.9978,$364.8,$307.2,$349.44,$100.6975,$364.8,$94.9978,$364.8,$364.8,$38.4,$262.08,$337.92,$353.28
,CDM,4050901043.10.4020,F/ PARIETEX PROGRIP MESH 15X9C,CDM Code,Outpatient,C1781,"$1,740.",$430.4586,"$1,653.","$1,392.","$1,583.4",$456.2854,"$1,653.",$430.4586,"$1,653.","$1,653.",$174.,"$1,187.55","$1,531.2","$1,600.8"
,CDM,4050901044.10.4020,F/ PARIETEX PROGRIP MESH 15X15,CDM Code,Outpatient,C1781,"$2,219.",$548.9584,"$2,108.05","$1,775.2","$2,019.29",$581.895,"$2,108.05",$548.9584,"$2,108.05","$2,108.05",$221.9,"$1,514.4675","$1,952.72","$2,041.48"
,CDM,4050901045.10.4020,F/ PARIETEX PROGRIP MESH 30X15,CDM Code,Outpatient,C1781,"$2,995.",$740.933,"$2,845.25","$2,396.","$2,725.45",$785.3878,"$2,845.25",$740.933,"$2,845.25","$2,845.25",$299.5,"$2,044.0875","$2,635.6","$2,755.4"
,CDM,4050901048.10.4020,F/ SURGIPRO MONOFILAMENT 14X9,CDM Code,Outpatient,C1781,$951.,$235.2679,$903.45,$760.8,$865.41,$249.3836,$903.45,$235.2679,$903.45,$903.45,$95.1,$649.0575,$836.88,$874.92
,CDM,4050901049.10.4020,F/ SURGIPRO MONOFILAMENT 6X6,CDM Code,Outpatient,C1781,$744.,$184.0582,$706.8,$595.2,$677.04,$195.1014,$706.8,$184.0582,$706.8,$706.8,$74.4,$507.78,$654.72,$684.48
,CDM,4050901050.10.4020,F/ SURGIPRO MONOFILAMENT 4X6,CDM Code,Outpatient,C1781,$377.,$93.266,$358.15,$301.6,$343.07,$98.8618,$358.15,$93.266,$358.15,$358.15,$37.7,$257.3025,$331.76,$346.84
,CDM,4050901051.10.4020,F/ PARIETEX PLUG & PATCH 6CM P,CDM Code,Outpatient,C1781,"$2,175.",$538.0733,"$2,066.25","$1,740.","$1,979.25",$570.3568,"$2,066.25",$538.0733,"$2,066.25","$2,066.25",$217.5,"$1,484.4375","$1,914.","$2,001."
,CDM,4050901052.10.4020,F/ PARIETEX VENTRAL PATCH 4.6C,CDM Code,Outpatient,C1781,"$2,663.",$658.7996,"$2,529.85","$2,130.4","$2,423.33",$698.3265,"$2,529.85",$658.7996,"$2,529.85","$2,529.85",$266.3,"$1,817.4975","$2,343.44","$2,449.96"
,CDM,4050901053.10.4020,F/ PARIETEX VENTRAL PATCH 6.6C,CDM Code,Outpatient,C1781,"$2,554.",$631.8341,"$2,426.3","$2,043.2","$2,324.14",$669.7431,"$2,426.3",$631.8341,"$2,426.3","$2,426.3",$255.4,"$1,743.105","$2,247.52","$2,349.68"
,CDM,4050901054.10.4020,F/ PARIETEX VENTRAL PATCH 8.6C,CDM Code,Outpatient,C1781,"$3,565.",$881.9453,"$3,386.75","$2,852.","$3,244.15",$934.8606,"$3,386.75",$881.9453,"$3,386.75","$3,386.75",$356.5,"$2,433.1125","$3,137.2","$3,279.8"
,CDM,4050901056.10.4020,F/ PARIETEX COMPOSITE 25X20CM,CDM Code,Outpatient,C1781,"$6,021.","$1,489.5352","$5,719.95","$4,816.8","$5,479.11","$1,578.9049","$5,719.95","$1,489.5352","$5,719.95","$5,719.95",$602.1,"$4,109.3325","$5,298.48","$5,539.32"
,CDM,4050901057.10.4020,F/ PARIETEX COMPOSITE ROUND 12,CDM Code,Outpatient,C1781,"$2,539.",$628.1232,"$2,412.05","$2,031.2","$2,310.49",$665.8096,"$2,412.05",$628.1232,"$2,412.05","$2,412.05",$253.9,"$1,732.8675","$2,234.32","$2,335.88"
,CDM,4050901063.10.4020,F/ LENS SN60WF +6.0 DIOP,CDM Code,Outpatient,V2632,"$1,113.",$275.3451,"$1,057.35",$890.4,"$1,012.83",$291.8653,"$1,057.35",$275.3451,"$1,057.35","$1,057.35",$111.3,$759.6225,$979.44,"$1,023.96"
,CDM,4050901076.10.4020,F/ TORIC LENS SN6AT3 +12.0,CDM Code,Outpatient,V2787GY,$654.,$161.7931,$621.3,$523.2,$595.14,$171.5004,$621.3,$161.7931,$621.3,$621.3,$65.4,$446.355,$575.52,$601.68
,CDM,4050901077.10.4020,F/ TORIC LENS SN6AT3 +12.5,CDM Code,Outpatient,V2787GY,$654.,$161.7931,$621.3,$523.2,$595.14,$171.5004,$621.3,$161.7931,$621.3,$621.3,$65.4,$446.355,$575.52,$601.68
,CDM,4050901078.10.4020,F/ TORIC LENS SN6AT3 +13.0,CDM Code,Outpatient,V2787GY,$445.,$110.0886,$422.75,$356.,$404.95,$116.6937,$422.75,$110.0886,$422.75,$422.75,$44.5,$303.7125,$391.6,$409.4
,CDM,4050901079.10.4020,F/ TORIC LENS SN6AT3 +13.5,CDM Code,Outpatient,V2787GY,$468.,$115.7785,$444.6,$374.4,$425.88,$122.725,$444.6,$115.7785,$444.6,$444.6,$46.8,$319.41,$411.84,$430.56
,CDM,4050901081.10.4020,F/ TORIC LENS SN6AT3 +14.5,CDM Code,Outpatient,V2787GY,$594.,$146.9497,$564.3,$475.2,$540.54,$155.7664,$564.3,$146.9497,$564.3,$564.3,$59.4,$405.405,$522.72,$546.48
,CDM,4050901082.10.4020,F/ TORIC LENS SN6AT3 +15.0,CDM Code,Outpatient,V2787GY,$654.,$161.7931,$621.3,$523.2,$595.14,$171.5004,$621.3,$161.7931,$621.3,$621.3,$65.4,$446.355,$575.52,$601.68
,CDM,4050901083.10.4020,F/ TORIC LENS SN6AT3 +15.5,CDM Code,Outpatient,V2787GY,$654.,$161.7931,$621.3,$523.2,$595.14,$171.5004,$621.3,$161.7931,$621.3,$621.3,$65.4,$446.355,$575.52,$601.68
,CDM,4050901084.10.4020,F/ TORIC LENS SN6AT3 +16.0,CDM Code,Outpatient,V2787GY,$445.,$110.0886,$422.75,$356.,$404.95,$116.6937,$422.75,$110.0886,$422.75,$422.75,$44.5,$303.7125,$391.6,$409.4
,CDM,4050901085.10.4020,F/ TORIC LENS SN6AT3 +16.5,CDM Code,Outpatient,V2787GY,$654.,$161.7931,$621.3,$523.2,$595.14,$171.5004,$621.3,$161.7931,$621.3,$621.3,$65.4,$446.355,$575.52,$601.68
,CDM,4050901086.10.4020,F/ TORIC LENS SN6AT3 +17.0,CDM Code,Outpatient,V2787GY,$468.,$115.7785,$444.6,$374.4,$425.88,$122.725,$444.6,$115.7785,$444.6,$444.6,$46.8,$319.41,$411.84,$430.56
,CDM,4050901087.10.4020,F/ TORIC LENS SN6AT3 +17.5,CDM Code,Outpatient,V2787GY,$468.,$115.7785,$444.6,$374.4,$425.88,$122.725,$444.6,$115.7785,$444.6,$444.6,$46.8,$319.41,$411.84,$430.56
,CDM,4050901088.10.4020,F/ TORIC LENS SN6AT3 +18.0,CDM Code,Outpatient,V2787GY,$654.,$161.7931,$621.3,$523.2,$595.14,$171.5004,$621.3,$161.7931,$621.3,$621.3,$65.4,$446.355,$575.52,$601.68
,CDM,4050901090.10.4020,F/ TORIC LENS SN6AT3 +19.0,CDM Code,Outpatient,V2787GY,$468.,$115.7785,$444.6,$374.4,$425.88,$122.725,$444.6,$115.7785,$444.6,$444.6,$46.8,$319.41,$411.84,$430.56
,CDM,4050901091.10.4020,F/ TORIC LENS SN6AT3 +19.5,CDM Code,Outpatient,V2787GY,$468.,$115.7785,$444.6,$374.4,$425.88,$122.725,$444.6,$115.7785,$444.6,$444.6,$46.8,$319.41,$411.84,$430.56
,CDM,4050901092.10.4020,F/ TORIC LENS SN6AT3 +20.0,CDM Code,Outpatient,V2787GY,$468.,$115.7785,$444.6,$374.4,$425.88,$122.725,$444.6,$115.7785,$444.6,$444.6,$46.8,$319.41,$411.84,$430.56
,CDM,4050901093.10.4020,F/ TORIC LENS +20.5,CDM Code,Outpatient,V2787GY,$468.,$115.7785,$444.6,$374.4,$425.88,$122.725,$444.6,$115.7785,$444.6,$444.6,$46.8,$319.41,$411.84,$430.56
,CDM,4050901094.10.4020,F/ TORIC LENS SN6AT3 +21.0,CDM Code,Outpatient,V2787GY,$468.,$115.7785,$444.6,$374.4,$425.88,$122.725,$444.6,$115.7785,$444.6,$444.6,$46.8,$319.41,$411.84,$430.56
,CDM,4050901095.10.4020,F/ TORIC LENS SN6AT3 +21.5,CDM Code,Outpatient,V2787GY,$445.,$110.0886,$422.75,$356.,$404.95,$116.6937,$422.75,$110.0886,$422.75,$422.75,$44.5,$303.7125,$391.6,$409.4
,CDM,4050901096.10.4020,F/ TORIC LENS SN6AT3 +22.0,CDM Code,Outpatient,V2787GY,$468.,$115.7785,$444.6,$374.4,$425.88,$122.725,$444.6,$115.7785,$444.6,$444.6,$46.8,$319.41,$411.84,$430.56
,CDM,4050901098.10.4020,F/ TORIC LENS SN6AT3 +23.0,CDM Code,Outpatient,V2787GY,$468.,$115.7785,$444.6,$374.4,$425.88,$122.725,$444.6,$115.7785,$444.6,$444.6,$46.8,$319.41,$411.84,$430.56
,CDM,4050901099.10.4020,F/ TORIC LENS SN6AT3 +23.5,CDM Code,Outpatient,V2787GY,$468.,$115.7785,$444.6,$374.4,$425.88,$122.725,$444.6,$115.7785,$444.6,$444.6,$46.8,$319.41,$411.84,$430.56
,CDM,4050901100.10.4020,F/ TORIC LENS SN6AT3+24.0,CDM Code,Outpatient,V2787GY,$445.,$110.0886,$422.75,$356.,$404.95,$116.6937,$422.75,$110.0886,$422.75,$422.75,$44.5,$303.7125,$391.6,$409.4
,CDM,4050901101.10.4020,F/ TORIC LENS SN6AT3 +24.5,CDM Code,Outpatient,V2787GY,$594.,$146.9497,$564.3,$475.2,$540.54,$155.7664,$564.3,$146.9497,$564.3,$564.3,$59.4,$405.405,$522.72,$546.48
,CDM,4050901104.10.4020,F/ TORIC LENS SN6AT3 +26.0,CDM Code,Outpatient,V2787GY,$445.,$110.0886,$422.75,$356.,$404.95,$116.6937,$422.75,$110.0886,$422.75,$422.75,$44.5,$303.7125,$391.6,$409.4
,CDM,4050901119.10.4020,F/ TORIC LENS SN6AT4 +7.0,CDM Code,Outpatient,V2787GY,$445.,$110.0886,$422.75,$356.,$404.95,$116.6937,$422.75,$110.0886,$422.75,$422.75,$44.5,$303.7125,$391.6,$409.4
,CDM,4050901122.10.4020,F/ TORIC LENS SN6AT4 +8.5,CDM Code,Outpatient,V2787GY,$445.,$110.0886,$422.75,$356.,$404.95,$116.6937,$422.75,$110.0886,$422.75,$422.75,$44.5,$303.7125,$391.6,$409.4
,CDM,4050901123.10.4020,F/ TORIC LENS SN6AT4 +9.0,CDM Code,Outpatient,V2787GY,$445.,$110.0886,$422.75,$356.,$404.95,$116.6937,$422.75,$110.0886,$422.75,$422.75,$44.5,$303.7125,$391.6,$409.4
,CDM,4050901125.10.4020,F/ TORIC LENS SN6AT4 +10.0,CDM Code,Outpatient,V2787GY,$594.,$146.9497,$564.3,$475.2,$540.54,$155.7664,$564.3,$146.9497,$564.3,$564.3,$59.4,$405.405,$522.72,$546.48
,CDM,4050901129.10.4020,F/ TORIC LENS SN6AT4 +12.0,CDM Code,Outpatient,V2787GY,$654.,$161.7931,$621.3,$523.2,$595.14,$171.5004,$621.3,$161.7931,$621.3,$621.3,$65.4,$446.355,$575.52,$601.68
,CDM,4050901131.10.4020,F/ TORIC LENS SN6AT4 +13.0,CDM Code,Outpatient,V2787GY,$654.,$161.7931,$621.3,$523.2,$595.14,$171.5004,$621.3,$161.7931,$621.3,$621.3,$65.4,$446.355,$575.52,$601.68
,CDM,4050901132.10.4020,F/ TORIC LENS SN6AT4 +13.5,CDM Code,Outpatient,V2787GY,$594.,$146.9497,$564.3,$475.2,$540.54,$155.7664,$564.3,$146.9497,$564.3,$564.3,$59.4,$405.405,$522.72,$546.48
,CDM,4050901133.10.4020,F/ TORIC LENS SN6AT4 +14.0,CDM Code,Outpatient,V2787GY,$468.,$115.7785,$444.6,$374.4,$425.88,$122.725,$444.6,$115.7785,$444.6,$444.6,$46.8,$319.41,$411.84,$430.56
,CDM,4050901134.10.4020,F/ TORIC LENS SN6AT4 +14.5,CDM Code,Outpatient,V2787GY,$654.,$161.7931,$621.3,$523.2,$595.14,$171.5004,$621.3,$161.7931,$621.3,$621.3,$65.4,$446.355,$575.52,$601.68
,CDM,4050901135.10.4020,F/ TORIC LENS SN6AT4 +15.0,CDM Code,Outpatient,V2787GY,$468.,$115.7785,$444.6,$374.4,$425.88,$122.725,$444.6,$115.7785,$444.6,$444.6,$46.8,$319.41,$411.84,$430.56
,CDM,4050901137.10.4020,F/ TORIC LENS SN6AT4 +16.0,CDM Code,Outpatient,V2787GY,$594.,$146.9497,$564.3,$475.2,$540.54,$155.7664,$564.3,$146.9497,$564.3,$564.3,$59.4,$405.405,$522.72,$546.48
,CDM,4050901138.10.4020,F/ TORIC LENS SN6AT4 +16.5,CDM Code,Outpatient,V2787GY,$654.,$161.7931,$621.3,$523.2,$595.14,$171.5004,$621.3,$161.7931,$621.3,$621.3,$65.4,$446.355,$575.52,$601.68
,CDM,4050901139.10.4020,F/ TORIC LENS SN6AT4 +17.0,CDM Code,Outpatient,V2787GY,$654.,$161.7931,$621.3,$523.2,$595.14,$171.5004,$621.3,$161.7931,$621.3,$621.3,$65.4,$446.355,$575.52,$601.68
,CDM,4050901140.10.4020,F/ TORIC LENS SN6AT4 +17.5,CDM Code,Outpatient,V2787GY,$468.,$115.7785,$444.6,$374.4,$425.88,$122.725,$444.6,$115.7785,$444.6,$444.6,$46.8,$319.41,$411.84,$430.56
,CDM,4050901143.10.4020,F/ TORIC LENS SN6AT4 +19.0,CDM Code,Outpatient,V2787GY,$445.,$110.0886,$422.75,$356.,$404.95,$116.6937,$422.75,$110.0886,$422.75,$422.75,$44.5,$303.7125,$391.6,$409.4
,CDM,4050901144.10.4020,F/ TORIC LENS SN6AT4 +19.5,CDM Code,Outpatient,V2787GY,$445.,$110.0886,$422.75,$356.,$404.95,$116.6937,$422.75,$110.0886,$422.75,$422.75,$44.5,$303.7125,$391.6,$409.4
,CDM,4050901145.10.4020,F/ TORIC LENS SN6AT4 +20.0,CDM Code,Outpatient,V2787GY,$468.,$115.7785,$444.6,$374.4,$425.88,$122.725,$444.6,$115.7785,$444.6,$444.6,$46.8,$319.41,$411.84,$430.56
,CDM,4050901146.10.4020,F/ TORIC LENS SN6AT4 +20.5,CDM Code,Outpatient,V2787GY,$468.,$115.7785,$444.6,$374.4,$425.88,$122.725,$444.6,$115.7785,$444.6,$444.6,$46.8,$319.41,$411.84,$430.56
,CDM,4050901147.10.4020,F/ TORIC LENS SN6AT4 +21.0,CDM Code,Outpatient,V2787GY,$445.,$110.0886,$422.75,$356.,$404.95,$116.6937,$422.75,$110.0886,$422.75,$422.75,$44.5,$303.7125,$391.6,$409.4
,CDM,4050901149.10.4020,F/ TORIC LENS SN6AT4 +22.0,CDM Code,Outpatient,V2787GY,$445.,$110.0886,$422.75,$356.,$404.95,$116.6937,$422.75,$110.0886,$422.75,$422.75,$44.5,$303.7125,$391.6,$409.4
,CDM,4050901150.10.4020,F/ TORIC LENS SN6AT4 +22.5,CDM Code,Outpatient,V2787GY,$654.,$161.7931,$621.3,$523.2,$595.14,$171.5004,$621.3,$161.7931,$621.3,$621.3,$65.4,$446.355,$575.52,$601.68
,CDM,4050901152.10.4020,F/ TORIC LENS SN6AT4 +23.5,CDM Code,Outpatient,V2787GY,$445.,$110.0886,$422.75,$356.,$404.95,$116.6937,$422.75,$110.0886,$422.75,$422.75,$44.5,$303.7125,$391.6,$409.4
,CDM,4050901179.10.4020,F/ TORIC LENS +10.5,CDM Code,Outpatient,V2787GY,$445.,$110.0886,$422.75,$356.,$404.95,$116.6937,$422.75,$110.0886,$422.75,$422.75,$44.5,$303.7125,$391.6,$409.4
,CDM,4050901182.10.4020,F/ TORIC LENS SN6AT5 +12.0,CDM Code,Outpatient,V2787GY,$445.,$110.0886,$422.75,$356.,$404.95,$116.6937,$422.75,$110.0886,$422.75,$422.75,$44.5,$303.7125,$391.6,$409.4
,CDM,4050901185.10.4020,F/ TORIC LENS SN6AT5 +13.5,CDM Code,Outpatient,V2787GY,$468.,$115.7785,$444.6,$374.4,$425.88,$122.725,$444.6,$115.7785,$444.6,$444.6,$46.8,$319.41,$411.84,$430.56
,CDM,4050901187.10.4020,F/ TORIC LENS SN6AT5 +14.5,CDM Code,Outpatient,V2787GY,$654.,$161.7931,$621.3,$523.2,$595.14,$171.5004,$621.3,$161.7931,$621.3,$621.3,$65.4,$446.355,$575.52,$601.68
,CDM,4050901190.10.4020,F/ TORIC LENS SN6AT5 +16.0,CDM Code,Outpatient,V2787GY,$445.,$110.0886,$422.75,$356.,$404.95,$116.6937,$422.75,$110.0886,$422.75,$422.75,$44.5,$303.7125,$391.6,$409.4
,CDM,4050901191.10.4020,F/ TORIC LENS SN6AT5 +16.5,CDM Code,Outpatient,V2787GY,$468.,$115.7785,$444.6,$374.4,$425.88,$122.725,$444.6,$115.7785,$444.6,$444.6,$46.8,$319.41,$411.84,$430.56
,CDM,4050901193.10.4020,F/ TORIC LENS SN6AT5 +17.5,CDM Code,Outpatient,V2787GY,$594.,$146.9497,$564.3,$475.2,$540.54,$155.7664,$564.3,$146.9497,$564.3,$564.3,$59.4,$405.405,$522.72,$546.48
,CDM,4050901194.10.4020,F/ TORIC LENS SN6AT5 +18.0,CDM Code,Outpatient,V2787GY,$654.,$161.7931,$621.3,$523.2,$595.14,$171.5004,$621.3,$161.7931,$621.3,$621.3,$65.4,$446.355,$575.52,$601.68
,CDM,4050901198.10.4020,F/ TORIC LENS SN6AT5 +20.0,CDM Code,Outpatient,V2787GY,$654.,$161.7931,$621.3,$523.2,$595.14,$171.5004,$621.3,$161.7931,$621.3,$621.3,$65.4,$446.355,$575.52,$601.68
,CDM,4050901204.10.4020,F/ TORIC LENS SN6AT5 +23.0,CDM Code,Outpatient,V2787GY,$654.,$161.7931,$621.3,$523.2,$595.14,$171.5004,$621.3,$161.7931,$621.3,$621.3,$65.4,$446.355,$575.52,$601.68
,CDM,4050901208.10.4020,F/ TORIC LENS SN6AT5 +25.0,CDM Code,Outpatient,V2787GY,$445.,$110.0886,$422.75,$356.,$404.95,$116.6937,$422.75,$110.0886,$422.75,$422.75,$44.5,$303.7125,$391.6,$409.4
,CDM,4050901213.10.4020,F/ TORIC LENS SN6AT5 +27.5,CDM Code,Outpatient,V2787GY,$594.,$146.9497,$564.3,$475.2,$540.54,$155.7664,$564.3,$146.9497,$564.3,$564.3,$59.4,$405.405,$522.72,$546.48
,CDM,4050901239.10.4020,F/ TORIC LENS SN6AT6 +14.0,CDM Code,Outpatient,V2787GY,$468.,$115.7785,$444.6,$374.4,$425.88,$122.725,$444.6,$115.7785,$444.6,$444.6,$46.8,$319.41,$411.84,$430.56
,CDM,4050901243.10.4020,F/ TORIC LENS SN6AT6 +16.0,CDM Code,Outpatient,V2787GY,$445.,$110.0886,$422.75,$356.,$404.95,$116.6937,$422.75,$110.0886,$422.75,$422.75,$44.5,$303.7125,$391.6,$409.4
,CDM,4050901249.10.4020,F/ TORIC LENS SN6AT6 +19.0,CDM Code,Outpatient,V2787GY,$445.,$110.0886,$422.75,$356.,$404.95,$116.6937,$422.75,$110.0886,$422.75,$422.75,$44.5,$303.7125,$391.6,$409.4
,CDM,4050901253.10.4020,F/ TORIC LENS SN6AT6 +21.0,CDM Code,Outpatient,V2787GY,$445.,$110.0886,$422.75,$356.,$404.95,$116.6937,$422.75,$110.0886,$422.75,$422.75,$44.5,$303.7125,$391.6,$409.4
,CDM,4050901254.10.4020,F/ TORIC LENS SN6AT6 +21.5,CDM Code,Outpatient,V2787GY,$654.,$161.7931,$621.3,$523.2,$595.14,$171.5004,$621.3,$161.7931,$621.3,$621.3,$65.4,$446.355,$575.52,$601.68
,CDM,4050901259.10.4020,F/ TORIC LENS SN6AT6 +24.0,CDM Code,Outpatient,V2787GY,$445.,$110.0886,$422.75,$356.,$404.95,$116.6937,$422.75,$110.0886,$422.75,$422.75,$44.5,$303.7125,$391.6,$409.4
,CDM,4050901262.10.4020,F/ TORIC LENS SN6AT6 +25.5,CDM Code,Outpatient,V2787GY,$445.,$110.0886,$422.75,$356.,$404.95,$116.6937,$422.75,$110.0886,$422.75,$422.75,$44.5,$303.7125,$391.6,$409.4
,CDM,4050901265.10.4020,F/ TORIC LENS SN6AT6 +27.0,CDM Code,Outpatient,V2787GY,$654.,$161.7931,$621.3,$523.2,$595.14,$171.5004,$621.3,$161.7931,$621.3,$621.3,$65.4,$446.355,$575.52,$601.68
,CDM,4050901296.10.4020,F/ TORIC LENS SN6AT7 +16.0,CDM Code,Outpatient,V2787GY,$445.,$110.0886,$422.75,$356.,$404.95,$116.6937,$422.75,$110.0886,$422.75,$422.75,$44.5,$303.7125,$391.6,$409.4
,CDM,4050901304.10.4020,F/ TORIC LENS SN6AT7 +20.0,CDM Code,Outpatient,V2787GY,$468.,$115.7785,$444.6,$374.4,$425.88,$122.725,$444.6,$115.7785,$444.6,$444.6,$46.8,$319.41,$411.84,$430.56
,CDM,4050901310.10.4020,F/ TORIC LENS SN6AT7 +23.0,CDM Code,Outpatient,V2787GY,$594.,$146.9497,$564.3,$475.2,$540.54,$155.7664,$564.3,$146.9497,$564.3,$564.3,$59.4,$405.405,$522.72,$546.48
,CDM,4050901313.10.4020,F/ TORIC LENS SN6AT7 +24.5,CDM Code,Outpatient,V2787GY,$654.,$161.7931,$621.3,$523.2,$595.14,$171.5004,$621.3,$161.7931,$621.3,$621.3,$65.4,$446.355,$575.52,$601.68
,CDM,4050901314.10.4020,F/ TORIC LENS SN6AT7 +25.0,CDM Code,Outpatient,V2787GY,$445.,$110.0886,$422.75,$356.,$404.95,$116.6937,$422.75,$110.0886,$422.75,$422.75,$44.5,$303.7125,$391.6,$409.4
,CDM,4050901320.10.4020,F/ TORIC LENS SN6AT7 +28.0,CDM Code,Outpatient,V2787GY,$654.,$161.7931,$621.3,$523.2,$595.14,$171.5004,$621.3,$161.7931,$621.3,$621.3,$65.4,$446.355,$575.52,$601.68
,CDM,4050901342.10.4020,F/ TORIC LENS SN6AT8 +12.5,CDM Code,Outpatient,V2787GY,$445.,$110.0886,$422.75,$356.,$404.95,$116.6937,$422.75,$110.0886,$422.75,$422.75,$44.5,$303.7125,$391.6,$409.4
,CDM,4050901404.10.4020,F/ TORIC LENS SN6AT9 +17.0,CDM Code,Outpatient,V2787GY,$445.,$110.0886,$422.75,$356.,$404.95,$116.6937,$422.75,$110.0886,$422.75,$422.75,$44.5,$303.7125,$391.6,$409.4
,CDM,4050901435.10.4020,F/ VANGUARD M UNI FEMORAL LARG,CDM Code,Outpatient,L8699,"$9,497.","$2,349.4628","$9,022.15","$7,597.6","$8,642.27","$2,490.4268","$9,022.15","$2,349.4628","$9,022.15","$9,022.15",$949.7,"$6,481.7025","$8,357.36","$8,737.24"
,CDM,4050901440.10.4020,F/ LENS SN60WF +13.5 DIOP.,CDM Code,Outpatient,V2632,"$1,060.",$262.2334,"$1,007.",$848.,$964.6,$277.967,"$1,007.",$262.2334,"$1,007.","$1,007.",$106.,$723.45,$932.8,$975.2
,CDM,4050901906.10.4020,F/ LOCK SCREW SQUARE 2.7MM X 1,CDM Code,Outpatient,C1713,"$1,350.",$333.9765,"$1,282.5","$1,080.","$1,228.5",$354.0145,"$1,282.5",$333.9765,"$1,282.5","$1,282.5",$135.,$921.375,"$1,188.","$1,242."
,CDM,4050901909.10.4020,F/ KWIRE 0.28MM,CDM Code,Outpatient,C1713,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.
,CDM,4050901910.10.4020,F/ KWIRE 0.35,CDM Code,Outpatient,C1713,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.
,CDM,4050901917.10.4020,F/ K-WIRE SS 1.6X127MM NS,CDM Code,Outpatient,C1713,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.
,CDM,4050901972.10.4020,F/ PROGRIP MESH 15X9,CDM Code,Outpatient,C1781,"$2,157.",$533.6202,"$2,049.15","$1,725.6","$1,962.87",$565.6366,"$2,049.15",$533.6202,"$2,049.15","$2,049.15",$215.7,"$1,472.1525","$1,898.16","$1,984.44"
,CDM,4050902111.10.4020,F/ PLT 7H/LT CLAV 3.5MM LCP SU,CDM Code,Outpatient,C1713,"$5,327.","$1,317.8465","$5,060.65","$4,261.6","$4,847.57","$1,396.9152","$5,060.65","$1,317.8465","$5,060.65","$5,060.65",$532.7,"$3,635.6775","$4,687.76","$4,900.84"
,CDM,4050902162.10.4020,F/ 1.25MM PLATE RED WIRE 150MM,CDM Code,Outpatient,C1713,"$1,680.",$415.6152,"$1,596.","$1,344.","$1,528.8",$440.5514,"$1,596.",$415.6152,"$1,596.","$1,596.",$168.,"$1,146.6","$1,478.4","$1,545.6"
,CDM,4050902186.10.4020,F/ SCREW 2.4 X 14MM VA LCK,CDM Code,Outpatient,C1713,"$1,427.",$353.0255,"$1,355.65","$1,141.6","$1,298.57",$374.2065,"$1,355.65",$353.0255,"$1,355.65","$1,355.65",$142.7,$973.9275,"$1,255.76","$1,312.84"
,CDM,4050902187.10.4020,F/ SCREW VA LCK STRDR 2.4X18MM,CDM Code,Outpatient,C1713,"$1,427.",$353.0255,"$1,355.65","$1,141.6","$1,298.57",$374.2065,"$1,355.65",$353.0255,"$1,355.65","$1,355.65",$142.7,$973.9275,"$1,255.76","$1,312.84"
,CDM,4050902189.10.4020,F/ SCREW 2.4X20MM VA LCK,CDM Code,Outpatient,C1713,"$1,427.",$353.0255,"$1,355.65","$1,141.6","$1,298.57",$374.2065,"$1,355.65",$353.0255,"$1,355.65","$1,355.65",$142.7,$973.9275,"$1,255.76","$1,312.84"
,CDM,4050902190.10.4020,F/ SCREW 2.4MM VARIABLE ANGLE,CDM Code,Outpatient,C1713,"$1,427.",$353.0255,"$1,355.65","$1,141.6","$1,298.57",$374.2065,"$1,355.65",$353.0255,"$1,355.65","$1,355.65",$142.7,$973.9275,"$1,255.76","$1,312.84"
,CDM,4050902199.10.4020,F/ SCREW LCK 2.4X22MM,CDM Code,Outpatient,C1713,"$1,620.",$400.7718,"$1,539.","$1,296.","$1,474.2",$424.8175,"$1,539.",$400.7718,"$1,539.","$1,539.",$162.,"$1,105.65","$1,425.6","$1,490.4"
,CDM,4050902239.10.4020,F/ 6.5X25MM CANC BONE SCREW,CDM Code,Outpatient,C1713,"$1,447.",$357.9733,"$1,374.65","$1,157.6","$1,316.77",$379.4512,"$1,374.65",$357.9733,"$1,374.65","$1,374.65",$144.7,$987.5775,"$1,273.36","$1,331.24"
,CDM,4050902240.10.4020,F/ 6.5X30MM CANC BONE SCREW,CDM Code,Outpatient,C1713,"$1,315.",$325.3179,"$1,249.25","$1,052.","$1,196.65",$344.8364,"$1,249.25",$325.3179,"$1,249.25","$1,249.25",$131.5,$897.4875,"$1,157.2","$1,209.8"
,CDM,4050902241.10.4020,F/ 6.5X35MM CANC BONE SCREW,CDM Code,Outpatient,C1713,"$1,315.",$325.3179,"$1,249.25","$1,052.","$1,196.65",$344.8364,"$1,249.25",$325.3179,"$1,249.25","$1,249.25",$131.5,$897.4875,"$1,157.2","$1,209.8"
,CDM,4050902242.10.4020,F/ 6.5X40MM CANC BONE SCREW,CDM Code,Outpatient,C1713,"$1,447.",$357.9733,"$1,374.65","$1,157.6","$1,316.77",$379.4512,"$1,374.65",$357.9733,"$1,374.65","$1,374.65",$144.7,$987.5775,"$1,273.36","$1,331.24"
,CDM,4050902246.10.4020,F/ 6.5X15MM CANC BONE SCREW,CDM Code,Outpatient,C1713,"$1,447.",$357.9733,"$1,374.65","$1,157.6","$1,316.77",$379.4512,"$1,374.65",$357.9733,"$1,374.65","$1,374.65",$144.7,$987.5775,"$1,273.36","$1,331.24"
,CDM,4050902247.10.4020,F/ 6.5X20MM CANC. BONE SCREW,CDM Code,Outpatient,C1713,"$1,447.",$357.9733,"$1,374.65","$1,157.6","$1,316.77",$379.4512,"$1,374.65",$357.9733,"$1,374.65","$1,374.65",$144.7,$987.5775,"$1,273.36","$1,331.24"
,CDM,4050902311.10.4020,F/ SCREW CORTEX 1.5MM 16MM,CDM Code,Outpatient,C1713,$527.,$130.3745,$500.65,$421.6,$479.57,$138.1968,$500.65,$130.3745,$500.65,$500.65,$52.7,$359.6775,$463.76,$484.84
,CDM,4050902321.10.4020,F/ SCREW TI CORT ST 2.0X10MM,CDM Code,Outpatient,C1713,$488.,$120.7263,$463.6,$390.4,$444.08,$127.9697,$463.6,$120.7263,$463.6,$463.6,$48.8,$333.06,$429.44,$448.96
,CDM,4050902322.10.4020,F/ SCREW TI CORT ST 2.0X8MM,CDM Code,Outpatient,C1713,$523.,$129.385,$496.85,$418.4,$475.93,$137.1479,$496.85,$129.385,$496.85,$496.85,$52.3,$356.9475,$460.24,$481.16
,CDM,4050902327.10.4020,F/ SCREW 2.4X14MM CORTEX STAR,CDM Code,Outpatient,C1713,$854.,$211.2711,$811.3,$683.2,$777.14,$223.947,$811.3,$211.2711,$811.3,$811.3,$85.4,$582.855,$751.52,$785.68
,CDM,4050902328.10.4020,F/ SCREW 2.4X16MM CORTEX STAR,CDM Code,Outpatient,C1713,$854.,$211.2711,$811.3,$683.2,$777.14,$223.947,$811.3,$211.2711,$811.3,$811.3,$85.4,$582.855,$751.52,$785.68
,CDM,4050902330.10.4020,F/ 2.4MM CORTEX SCREW 22MM,CDM Code,Outpatient,C1713,$854.,$211.2711,$811.3,$683.2,$777.14,$223.947,$811.3,$211.2711,$811.3,$811.3,$85.4,$582.855,$751.52,$785.68
,CDM,4050902333.10.4020,F/ SCREW 2.7X12MM CORTEX STAR,CDM Code,Outpatient,C1713,$519.,$128.3954,$493.05,$415.2,$472.29,$136.0989,$493.05,$128.3954,$493.05,$493.05,$51.9,$354.2175,$456.72,$477.48
,CDM,4050902343.10.4020,F/ SCREW TI CORT ST 2.0X12MM,CDM Code,Outpatient,C1713,$523.,$129.385,$496.85,$418.4,$475.93,$137.1479,$496.85,$129.385,$496.85,$496.85,$52.3,$356.9475,$460.24,$481.16
,CDM,4050902349.10.4020,F/ 3.5MM CORTEX SELF-TAP 28MM,CDM Code,Outpatient,C1713,$315.,$77.9279,$299.25,$252.,$286.65,$82.6034,$299.25,$77.9279,$299.25,$299.25,$31.5,$214.9875,$277.2,$289.8
,CDM,4050902363.10.4020,F/ SCREW 3.5X24MM ST,CDM Code,Outpatient,C1713,$307.,$75.9487,$291.65,$245.6,$279.37,$80.5055,$291.65,$75.9487,$291.65,$291.65,$30.7,$209.5275,$270.16,$282.44
,CDM,4050902409.10.4020,F/ 2.4MM CORT SCREW 30MM,CDM Code,Outpatient,C1713,$854.,$211.2711,$811.3,$683.2,$777.14,$223.947,$811.3,$211.2711,$811.3,$811.3,$85.4,$582.855,$751.52,$785.68
,CDM,4050902419.10.4020,F/ SCREW 2.7X14MM CORTEX STAR,CDM Code,Outpatient,C1713,$519.,$128.3954,$493.05,$415.2,$472.29,$136.0989,$493.05,$128.3954,$493.05,$493.05,$51.9,$354.2175,$456.72,$477.48
,CDM,4050902420.10.4020,F/ SCREW CORT 2.7X16MM SLF TAP,CDM Code,Outpatient,C1713,$519.,$128.3954,$493.05,$415.2,$472.29,$136.0989,$493.05,$128.3954,$493.05,$493.05,$51.9,$354.2175,$456.72,$477.48
,CDM,4050902446.10.4020,F/ STRYK GAM LAG SCREW 10.5X10,CDM Code,Outpatient,C1713,"$3,119.",$771.6094,"$2,963.05","$2,495.2","$2,838.29",$817.9047,"$2,963.05",$771.6094,"$2,963.05","$2,963.05",$311.9,"$2,128.7175","$2,744.72","$2,869.48"
,CDM,4050902484.10.4020,F/ 3.5MM LOCK SCREW 30MM,CDM Code,Outpatient,C1713,"$1,460.",$361.1894,"$1,387.","$1,168.","$1,328.6",$382.8602,"$1,387.",$361.1894,"$1,387.","$1,387.",$146.,$996.45,"$1,284.8","$1,343.2"
,CDM,4050902492.10.4020,F/ 3.5MM LOCKING SCREW 40MM,CDM Code,Outpatient,C1713,"$1,316.",$325.5652,"$1,250.2","$1,052.8","$1,197.56",$345.0986,"$1,250.2",$325.5652,"$1,250.2","$1,250.2",$131.6,$898.17,"$1,158.08","$1,210.72"
,CDM,4050902493.10.4020,F/ 3.5MM LOCKING SCREW 45MM,CDM Code,Outpatient,C1713,"$1,316.",$325.5652,"$1,250.2","$1,052.8","$1,197.56",$345.0986,"$1,250.2",$325.5652,"$1,250.2","$1,250.2",$131.6,$898.17,"$1,158.08","$1,210.72"
,CDM,4050902496.10.4020,F/ 3.5MM LOCKING SCREW 32MM,CDM Code,Outpatient,C1713,"$1,460.",$361.1894,"$1,387.","$1,168.","$1,328.6",$382.8602,"$1,387.",$361.1894,"$1,387.","$1,387.",$146.,$996.45,"$1,284.8","$1,343.2"
,CDM,4050904060.10.4020,F/ LENS SN60WF +14.0 DIOP,CDM Code,Outpatient,V2632,"$1,060.",$262.2334,"$1,007.",$848.,$964.6,$277.967,"$1,007.",$262.2334,"$1,007.","$1,007.",$106.,$723.45,$932.8,$975.2
,CDM,4050904092.10.4020,F/ LENS SN60WF 30.0 DIOP,CDM Code,Outpatient,V2632,$990.,$244.9161,$940.5,$792.,$900.9,$259.6107,$940.5,$244.9161,$940.5,$940.5,$99.,$675.675,$871.2,$910.8
,CDM,4050905704.10.4020,F/ SEED WAXED GOLD 18X20,CDM Code,Outpatient,C1716,"$1,737.",$429.7164,"$1,650.15","$1,389.6","$1,580.67",$455.4987,"$1,650.15",$429.7164,"$1,650.15","$1,650.15",$361.251,"$1,185.5025","$1,528.56","$1,598.04"
,CDM,4050907987.10.4020,F/ SCREW 2.4X20MM CORTEX STAR,CDM Code,Outpatient,C1713,$755.,$186.7794,$717.25,$604.,$687.05,$197.9859,$717.25,$186.7794,$717.25,$717.25,$75.5,$515.2875,$664.4,$694.6
,CDM,4050908337.10.4020,F/ SCRW VAR ANGLE LCK 02.211.0,CDM Code,Outpatient,C1713,"$1,482.",$366.632,"$1,407.9","$1,185.6","$1,348.62",$388.6293,"$1,407.9",$366.632,"$1,407.9","$1,407.9",$148.2,"$1,011.465","$1,304.16","$1,363.44"
,CDM,4050908338.10.4020,F/ SCRW VA LCK STAR DR 2.7X30M,CDM Code,Outpatient,C1713,"$1,482.",$366.632,"$1,407.9","$1,185.6","$1,348.62",$388.6293,"$1,407.9",$366.632,"$1,407.9","$1,407.9",$148.2,"$1,011.465","$1,304.16","$1,363.44"
,CDM,4050910173.10.4020,F/ 2.4MM CORT SCREW 28MM,CDM Code,Outpatient,C1713,$854.,$211.2711,$811.3,$683.2,$777.14,$223.947,$811.3,$211.2711,$811.3,$811.3,$85.4,$582.855,$751.52,$785.68
,CDM,4050910175.10.4020,F/ 2.7MMX20MM SLF-TAP CORT SCR,CDM Code,Outpatient,C1713,$624.,$154.3714,$592.8,$499.2,$567.84,$163.6334,$592.8,$154.3714,$592.8,$592.8,$62.4,$425.88,$549.12,$574.08
,CDM,4050910177.10.4020,F/ 2.7MMX24MM SLF-TAP SCREW,CDM Code,Outpatient,C1713,$624.,$154.3714,$592.8,$499.2,$567.84,$163.6334,$592.8,$154.3714,$592.8,$592.8,$62.4,$425.88,$549.12,$574.08
,CDM,4050910564.10.4020,F/ GRAFT ANTERIOR TIBIALIS,CDM Code,Outpatient,C1762,"$7,220.","$1,786.1558","$6,859.","$5,776.","$6,570.2","$1,893.3223","$6,859.","$1,786.1558","$6,859.","$6,859.",$722.,"$4,927.65","$6,353.6","$6,642.4"
,CDM,4050910733.10.4020,F/ SCREW CORTEX 2.0MM SLF-TP 1,CDM Code,Outpatient,C1713,$578.,$142.9914,$549.1,$462.4,$525.98,$151.5707,$549.1,$142.9914,$549.1,$549.1,$57.8,$394.485,$508.64,$531.76
,CDM,4050910747.10.4020,F/ BIOCAMP PUSH ANCHOR 2.9,CDM Code,Outpatient,C1713,"$2,803.",$693.4342,"$2,662.85","$2,242.4","$2,550.73",$735.0391,"$2,662.85",$693.4342,"$2,662.85","$2,662.85",$280.3,"$1,913.0475","$2,466.64","$2,578.76"
,CDM,4050910748.10.4020,F/ SCREW 2.4 VARIABLE ANGLE 12,CDM Code,Outpatient,C1713,"$1,427.",$353.0255,"$1,355.65","$1,141.6","$1,298.57",$374.2065,"$1,355.65",$353.0255,"$1,355.65","$1,355.65",$142.7,$973.9275,"$1,255.76","$1,312.84"
,CDM,4050910749.10.4020,F/ SPIKED WASHER 18MM,CDM Code,Outpatient,C1713,"$1,073.",$265.4495,"$1,019.35",$858.4,$976.43,$281.376,"$1,019.35",$265.4495,"$1,019.35","$1,019.35",$107.3,$732.3225,$944.24,$987.16
,CDM,4050910750.10.4020,F/ SCREW CANC 6.5X30MM,CDM Code,Outpatient,C1713,$960.,$237.4944,$912.,$768.,$873.6,$251.7437,$912.,$237.4944,$912.,$912.,$96.,$655.2,$844.8,$883.2
,CDM,4050910752.10.4020,F/ ACL TIGHTROPE RT,CDM Code,Outpatient,C1713,"$2,450.",$606.1055,"$2,327.5","$1,960.","$2,229.5",$642.4709,"$2,327.5",$606.1055,"$2,327.5","$2,327.5",$245.,"$1,672.125","$2,156.","$2,254."
,CDM,4050910779.10.4020,F/ LENS SN60WF +15.5 DIOP,CDM Code,Outpatient,V2632,"$1,060.",$262.2334,"$1,007.",$848.,$964.6,$277.967,"$1,007.",$262.2334,"$1,007.","$1,007.",$106.,$723.45,$932.8,$975.2
,CDM,4050910783.10.4020,F/ SCREW LOCKING LOWPRO 2.7X14,CDM Code,Outpatient,C1713,"$1,238.",$306.2688,"$1,176.1",$990.4,"$1,126.58",$324.6445,"$1,176.1",$306.2688,"$1,176.1","$1,176.1",$123.8,$844.935,"$1,089.44","$1,138.96"
,CDM,4050910785.10.4020,F/ SCREW CORTICAL LOWPRO 3.5X1,CDM Code,Outpatient,C1713,$480.,$118.7472,$456.,$384.,$436.8,$125.8718,$456.,$118.7472,$456.,$456.,$48.,$327.6,$422.4,$441.6
,CDM,4050910786.10.4020,F/ SCREW CORTICAL LOWPRO 3.5X1,CDM Code,Outpatient,C1713,$480.,$118.7472,$456.,$384.,$436.8,$125.8718,$456.,$118.7472,$456.,$456.,$48.,$327.6,$422.4,$441.6
,CDM,4050910826.10.4020,F/ LENS SN60WF +26.5,CDM Code,Outpatient,V2632,"$1,060.",$262.2334,"$1,007.",$848.,$964.6,$277.967,"$1,007.",$262.2334,"$1,007.","$1,007.",$106.,$723.45,$932.8,$975.2
,CDM,4050910854.10.4020,F/ SCREW CANC 6.5X35MM,CDM Code,Outpatient,C1713,$909.,$224.8775,$863.55,$727.2,$827.19,$238.3698,$863.55,$224.8775,$863.55,$863.55,$90.9,$620.3925,$799.92,$836.28
,CDM,4050910855.10.4020,F/ SCREW BIOCOMP INTERFERENCE,CDM Code,Outpatient,C1713,"$2,083.",$515.3134,"$1,978.85","$1,666.4","$1,895.53",$546.2313,"$1,978.85",$515.3134,"$1,978.85","$1,978.85",$208.3,"$1,421.6475","$1,833.04","$1,916.36"
,CDM,4050910870.10.4020,F/ ANCHOR MINI BIOCOMP 2.4X8.5,CDM Code,Outpatient,C1713,"$2,883.",$713.2254,"$2,738.85","$2,306.4","$2,623.53",$756.0177,"$2,738.85",$713.2254,"$2,738.85","$2,738.85",$288.3,"$1,967.6475","$2,537.04","$2,652.36"
,CDM,4050910908.10.4020,F/ FAST FIX 360 STR NDL 722024,CDM Code,Outpatient,C1713,"$2,943.",$728.0688,"$2,795.85","$2,354.4","$2,678.13",$771.7517,"$2,795.85",$728.0688,"$2,795.85","$2,795.85",$294.3,"$2,008.5975","$2,589.84","$2,707.56"
,CDM,4050910909.10.4020,F/ FAST FIX 360 CRVD NDL 72202,CDM Code,Outpatient,C1713,"$2,943.",$728.0688,"$2,795.85","$2,354.4","$2,678.13",$771.7517,"$2,795.85",$728.0688,"$2,795.85","$2,795.85",$294.3,"$2,008.5975","$2,589.84","$2,707.56"
,CDM,4050910974.10.4020,F/ LENS SN60WF +29.0 DIOP,CDM Code,Outpatient,V2787,$900.,$222.651,$855.,$720.,$819.,$236.0097,$855.,$222.651,$855.,$855.,$90.,$614.25,$792.,$828.
,CDM,4050910989.10.4020,F/ SCRW CANC LOW PROFILE AR-13,CDM Code,Outpatient,C1713,$960.,$237.4944,$912.,$768.,$873.6,$251.7437,$912.,$237.4944,$912.,$912.,$96.,$655.2,$844.8,$883.2
,CDM,4050910992.10.4020,F/ GRAFT ALLOGRAFT 9X75 GRAFTL,CDM Code,Outpatient,L8699,"$6,715.","$1,661.2239","$6,379.25","$5,372.","$6,110.65","$1,760.8946","$6,379.25","$1,661.2239","$6,379.25","$6,379.25",$671.5,"$4,582.9875","$5,909.2","$6,177.8"
,CDM,4050911001.10.4020,F/ TIGHTROPE BTB 1588BTB,CDM Code,Outpatient,C1713,"$2,979.",$736.9748,"$2,830.05","$2,383.2","$2,710.89",$781.1921,"$2,830.05",$736.9748,"$2,830.05","$2,830.05",$297.9,"$2,033.1675","$2,621.52","$2,740.68"
,CDM,4050911002.10.4020,F/ TIGHTROPE ABS 8X12 BUTT 158,CDM Code,Outpatient,C1713,"$1,230.",$304.2897,"$1,168.5",$984.,"$1,119.3",$322.5466,"$1,168.5",$304.2897,"$1,168.5","$1,168.5",$123.,$839.475,"$1,082.4","$1,131.6"
,CDM,4050911003.10.4020,F/ TIGHTROPE ABS OPEN 1588TN-1,CDM Code,Outpatient,C1713,"$1,390.",$343.8721,"$1,320.5","$1,112.","$1,264.9",$364.5039,"$1,320.5",$343.8721,"$1,320.5","$1,320.5",$139.,$948.675,"$1,223.2","$1,278.8"
,CDM,4050911014.10.4020,F/ LENS SN60WF +11.0 DIOP,CDM Code,Outpatient,V2632,"$1,060.",$262.2334,"$1,007.",$848.,$964.6,$277.967,"$1,007.",$262.2334,"$1,007.","$1,007.",$106.,$723.45,$932.8,$975.2
,CDM,4050911019.10.4020,F/ LENS SN60WF +11.5 DIOP,CDM Code,Outpatient,V2632,"$1,060.",$262.2334,"$1,007.",$848.,$964.6,$277.967,"$1,007.",$262.2334,"$1,007.","$1,007.",$106.,$723.45,$932.8,$975.2
,CDM,4050911020.10.4020,F/ LENS SN60WF +12.0 DIOP,CDM Code,Outpatient,V2632,"$1,060.",$262.2334,"$1,007.",$848.,$964.6,$277.967,"$1,007.",$262.2334,"$1,007.","$1,007.",$106.,$723.45,$932.8,$975.2
,CDM,4050911021.10.4020,F/ LENS SN60WF +14.5 DIOP,CDM Code,Outpatient,V2632,"$1,060.",$262.2334,"$1,007.",$848.,$964.6,$277.967,"$1,007.",$262.2334,"$1,007.","$1,007.",$106.,$723.45,$932.8,$975.2
,CDM,4050911055.10.4020,F/ SCREW BIO-COMP CANN 11X35MM,CDM Code,Outpatient,C1713,"$2,082.",$515.066,"$1,977.9","$1,665.6","$1,894.62",$545.9691,"$1,977.9",$515.066,"$1,977.9","$1,977.9",$208.2,"$1,420.965","$1,832.16","$1,915.44"
,CDM,4050911083.10.4020,F/ PLATE ANT.CLAV. 2.7/3.5 9 H,CDM Code,Outpatient,C1713,"$5,547.","$1,372.2723","$5,269.65","$4,437.6","$5,047.77","$1,454.6065","$5,269.65","$1,372.2723","$5,269.65","$5,269.65",$554.7,"$3,785.8275","$4,881.36","$5,103.24"
,CDM,4050911084.10.4020,F/ SCREW 2.7X26MM SLF TAP LCK,CDM Code,Outpatient,C1713,"$1,598.",$395.3292,"$1,518.1","$1,278.4","$1,454.18",$419.0483,"$1,518.1",$395.3292,"$1,518.1","$1,518.1",$159.8,"$1,090.635","$1,406.24","$1,470.16"
,CDM,4050911101.10.4020,F/ LENS SA60AT +15.0 DIOP,CDM Code,Outpatient,V2632,$960.,$237.4944,$912.,$768.,$873.6,$251.7437,$912.,$237.4944,$912.,$912.,$96.,$655.2,$844.8,$883.2
,CDM,4050911120.10.4020,F/ LENS SN60WF +27.5 DIOP,CDM Code,Outpatient,V2632,"$1,060.",$262.2334,"$1,007.",$848.,$964.6,$277.967,"$1,007.",$262.2334,"$1,007.","$1,007.",$106.,$723.45,$932.8,$975.2
,CDM,4050911122.10.4020,F/ IOL,CDM Code,Outpatient,V2632,$1.,$0.2474,$0.95,$0.8,$0.91,$0.2622,$0.95,$0.2474,$0.95,$0.95,$0.1,$0.6825,$0.88,$0.92
,CDM,4050911145.10.4020,F/ ANCHOR 2.9 W/TAPER NDL,CDM Code,Outpatient,C1713,"$2,597.",$642.4718,"$2,467.15","$2,077.6","$2,363.27",$681.0191,"$2,467.15",$642.4718,"$2,467.15","$2,467.15",$259.7,"$1,772.4525","$2,285.36","$2,389.24"
,CDM,4050911169.10.4020,F/ SCREW BIOCOMP INTER 10X35MM,CDM Code,Outpatient,C1713,"$2,083.",$515.3134,"$1,978.85","$1,666.4","$1,895.53",$546.2313,"$1,978.85",$515.3134,"$1,978.85","$1,978.85",$208.3,"$1,421.6475","$1,833.04","$1,916.36"
,CDM,4050911176.10.4020,F/ LENS SN60WF +28.0 DIOP,CDM Code,Outpatient,V2632,"$1,060.",$262.2334,"$1,007.",$848.,$964.6,$277.967,"$1,007.",$262.2334,"$1,007.","$1,007.",$106.,$723.45,$932.8,$975.2
,CDM,4050911178.10.4020,F/ RESTOR LENS SN6AD1 +22.5 DI,CDM Code,Outpatient,V2788GY,$480.,$118.7472,$456.,$384.,$436.8,$125.8718,$456.,$118.7472,$456.,$456.,$48.,$327.6,$422.4,$441.6
,CDM,4050911248.10.4020,F/ SCRW METAPH STR.DR. 2.7X62M,CDM Code,Outpatient,C1713,$614.,$151.8975,$583.3,$491.2,$558.74,$161.0111,$583.3,$151.8975,$583.3,$583.3,$61.4,$419.055,$540.32,$564.88
,CDM,4050911253.10.4020,F/ SCRW VAR ANGLE LCK 2.7X36MM,CDM Code,Outpatient,C1713,"$1,688.",$417.5943,"$1,603.6","$1,350.4","$1,536.08",$442.6493,"$1,603.6",$417.5943,"$1,603.6","$1,603.6",$168.8,"$1,152.06","$1,485.44","$1,552.96"
,CDM,4050911254.10.4020,F/ HEAD RADIAL EXPLOR 10X22MM,CDM Code,Outpatient,C1776,"$8,774.","$2,170.5999","$8,335.3","$7,019.2","$7,984.34","$2,300.8323","$8,335.3","$2,170.5999","$8,335.3","$8,335.3",$877.4,"$5,988.255","$7,721.12","$8,072.08"
,CDM,4050911255.10.4020,F/ STEM RADIAL EXPLOR 6X24MM,CDM Code,Outpatient,C1776,"$5,749.","$1,422.2451","$5,461.55","$4,599.2","$5,231.59","$1,507.5775","$5,461.55","$1,422.2451","$5,461.55","$5,461.55",$574.9,"$3,923.6925","$5,059.12","$5,289.08"
,CDM,4050911287.10.4020,F/ SCREW CANN CONICAL 5.0X75MM,CDM Code,Outpatient,C1713,"$1,434.",$354.7573,"$1,362.3","$1,147.2","$1,304.94",$376.0421,"$1,362.3",$354.7573,"$1,362.3","$1,362.3",$143.4,$978.705,"$1,261.92","$1,319.28"
,CDM,4050911288.10.4020,F/ SCREW CANN CONICAL 7.3X80MM,CDM Code,Outpatient,C1713,"$1,790.",$442.8281,"$1,700.5","$1,432.","$1,628.9",$469.3971,"$1,700.5",$442.8281,"$1,700.5","$1,700.5",$179.,"$1,221.675","$1,575.2","$1,646.8"
,CDM,4050911294.10.4020,F/ SCRW CONIC SLF TAP P/T 3.5X,CDM Code,Outpatient,C1713,"$1,548.",$382.9597,"$1,470.6","$1,238.4","$1,408.68",$405.9367,"$1,470.6",$382.9597,"$1,470.6","$1,470.6",$154.8,"$1,056.51","$1,362.24","$1,424.16"
,CDM,4050911389.10.4020,F/ SCREW PEEK TENODESIS,CDM Code,Outpatient,C1713,"$2,523.",$624.165,"$2,396.85","$2,018.4","$2,295.93",$661.6139,"$2,396.85",$624.165,"$2,396.85","$2,396.85",$252.3,"$1,721.9475","$2,220.24","$2,321.16"
,CDM,4050911393.10.4020,F/ GRAFT SEMI-TENDINOSUS TENDO,CDM Code,Outpatient,C1762,"$4,084.","$1,010.3408","$3,879.8","$3,267.2","$3,716.44","$1,070.9596","$3,879.8","$1,010.3408","$3,879.8","$3,879.8",$408.4,"$2,787.33","$3,593.92","$3,757.28"
,CDM,4050911395.10.4020,F/ JUGGERKNOT SHORT RIGID SZ 1,CDM Code,Outpatient,C1713,"$2,543.",$629.1128,"$2,415.85","$2,034.4","$2,314.13",$666.8585,"$2,415.85",$629.1128,"$2,415.85","$2,415.85",$254.3,"$1,735.5975","$2,237.84","$2,339.56"
,CDM,4050911414.10.4020,F/ SCREW TENODESIS PEEK 6.25X1,CDM Code,Outpatient,C1713,"$2,790.",$690.2181,"$2,650.5","$2,232.","$2,538.9",$731.6301,"$2,650.5",$690.2181,"$2,650.5","$2,650.5",$279.,"$1,904.175","$2,455.2","$2,566.8"
,CDM,4050911421.10.4020,F/ ANCHOR SUTURE BIO-CORKSCREW,CDM Code,Outpatient,C1713,"$3,013.",$745.3861,"$2,862.35","$2,410.4","$2,741.83",$790.108,"$2,862.35",$745.3861,"$2,862.35","$2,862.35",$301.3,"$2,056.3725","$2,651.44","$2,771.96"
,CDM,4050911422.10.4020,F/ ANCHOR SUT BIOCOMP 4.75X19.,CDM Code,Outpatient,C1713,"$2,803.",$693.4342,"$2,662.85","$2,242.4","$2,550.73",$735.0391,"$2,662.85",$693.4342,"$2,662.85","$2,662.85",$280.3,"$1,913.0475","$2,466.64","$2,578.76"
,CDM,4050911423.10.4020,F/ ANCHOR SUT BIOCOMP 4.75X24.,CDM Code,Outpatient,C1713,"$2,967.",$734.0061,"$2,818.65","$2,373.6","$2,699.97",$778.0453,"$2,818.65",$734.0061,"$2,818.65","$2,818.65",$296.7,"$2,024.9775","$2,610.96","$2,729.64"
,CDM,4050911426.10.4020,F/ ANCHORSUT MICBIOCOMP 2.4X6.,CDM Code,Outpatient,C1713,"$2,875.",$711.2463,"$2,731.25","$2,300.","$2,616.25",$753.9199,"$2,731.25",$711.2463,"$2,731.25","$2,731.25",$287.5,"$1,962.1875","$2,530.","$2,645."
,CDM,4050911484.10.4020,F/ SCREW INTERFERENCE COMP 9X2,CDM Code,Outpatient,C1713,"$2,673.",$661.2735,"$2,539.35","$2,138.4","$2,432.43",$700.9488,"$2,539.35",$661.2735,"$2,539.35","$2,539.35",$267.3,"$1,824.3225","$2,352.24","$2,459.16"
,CDM,4050911485.10.4020,F/ FIXATION DEVICE TOGGLELOC 1,CDM Code,Outpatient,C1713,"$2,376.",$587.7986,"$2,257.2","$1,900.8","$2,162.16",$623.0656,"$2,257.2",$587.7986,"$2,257.2","$2,257.2",$237.6,"$1,621.62","$2,090.88","$2,185.92"
,CDM,4050911570.10.4020,F/ PLATE ANTCLAV 11 HOLE 2.7/3,CDM Code,Outpatient,C1713,"$4,712.","$1,165.7017","$4,476.4","$3,769.6","$4,287.92","$1,235.6419","$4,476.4","$1,165.7017","$4,476.4","$4,476.4",$471.2,"$3,215.94","$4,146.56","$4,335.04"
,CDM,4050911632.10.4020,F/ SCRW LAG HIP FX NAIL 10.5X9,CDM Code,Outpatient,C1713,"$4,346.","$1,075.1569","$4,128.7","$3,476.8","$3,954.86","$1,139.6646","$4,128.7","$1,075.1569","$4,128.7","$4,128.7",$434.6,"$2,966.145","$3,824.48","$3,998.32"
,CDM,4050911634.10.4020,F/ SCREW CORTICAL BONE 5.0X36M,CDM Code,Outpatient,C1713,"$1,922.",$475.4836,"$1,825.9","$1,537.6","$1,749.02",$504.0118,"$1,825.9",$475.4836,"$1,825.9","$1,825.9",$192.2,"$1,311.765","$1,691.36","$1,768.24"
,CDM,4050911675.10.4020,F/ SCRW BIOCOMP INTER. FT 10X2,CDM Code,Outpatient,C1713,"$1,978.",$489.3374,"$1,879.1","$1,582.4","$1,799.98",$518.6969,"$1,879.1",$489.3374,"$1,879.1","$1,879.1",$197.8,"$1,349.985","$1,740.64","$1,819.76"
,CDM,4050911775.10.4020,F/ CORTEX SCREW 30MM 7382-6030,CDM Code,Outpatient,C1713,$323.,$79.907,$306.85,$258.4,$293.93,$84.7013,$306.85,$79.907,$306.85,$306.85,$32.3,$220.4475,$284.24,$297.16
,CDM,4050911776.10.4020,F/ 4.5MM CORTEX SCREW 38MM,CDM Code,Outpatient,C1713,$323.,$79.907,$306.85,$258.4,$293.93,$84.7013,$306.85,$79.907,$306.85,$306.85,$32.3,$220.4475,$284.24,$297.16
,CDM,4050911777.10.4020,F/ CORTEX SCREW 50MM 7382-6050,CDM Code,Outpatient,C1713,$323.,$79.907,$306.85,$258.4,$293.93,$84.7013,$306.85,$79.907,$306.85,$306.85,$32.3,$220.4475,$284.24,$297.16
,CDM,4050911788.10.4020,F/ G7 ACET SCREW 6.5MMX20MM,CDM Code,Outpatient,C1713,"$1,500.",$371.085,"$1,425.","$1,200.","$1,365.",$393.3495,"$1,425.",$371.085,"$1,425.","$1,425.",$150.,"$1,023.75","$1,320.","$1,380."
,CDM,4050911818.10.4020,F/ TRIGEN LAG SCREW 105MM/100M,CDM Code,Outpatient,C1713,"$5,258.","$1,300.7766","$4,995.1","$4,206.4","$4,784.78","$1,378.8211","$4,995.1","$1,300.7766","$4,995.1","$4,995.1",$525.8,"$3,588.585","$4,627.04","$4,837.36"
,CDM,4050911819.10.4020,F/ TRIGEN L-P SCREW 5.0MMX32.5,CDM Code,Outpatient,C1713,"$2,492.",$616.4959,"$2,367.4","$1,993.6","$2,267.72",$653.4846,"$2,367.4",$616.4959,"$2,367.4","$2,367.4",$249.2,"$1,700.79","$2,192.96","$2,292.64"
,CDM,4050911849.10.4020,F/ SCREW CORTICAL 5.0X34.0MM,CDM Code,Outpatient,C1713,"$1,922.",$475.4836,"$1,825.9","$1,537.6","$1,749.02",$504.0118,"$1,825.9",$475.4836,"$1,825.9","$1,825.9",$192.2,"$1,311.765","$1,691.36","$1,768.24"
,CDM,4050911862.10.4020,F/ SCRW HIP FX NAIL LAG 10.5X8,CDM Code,Outpatient,C1713,"$4,091.","$1,012.0725","$3,886.45","$3,272.8","$3,722.81","$1,072.7952","$3,886.45","$1,012.0725","$3,886.45","$3,886.45",$409.1,"$2,792.1075","$3,600.08","$3,763.72"
,CDM,4050911871.10.4020,F/ G7 ACET SCREW 6.5X40MM,CDM Code,Outpatient,C1713,"$1,500.",$371.085,"$1,425.","$1,200.","$1,365.",$393.3495,"$1,425.",$371.085,"$1,425.","$1,425.",$150.,"$1,023.75","$1,320.","$1,380."
,CDM,4050911904.10.4020,F/ SMOOTH LOCK PEG 2.2X20MM,CDM Code,Outpatient,C1713,"$1,350.",$333.9765,"$1,282.5","$1,080.","$1,228.5",$354.0145,"$1,282.5",$333.9765,"$1,282.5","$1,282.5",$135.,$921.375,"$1,188.","$1,242."
,CDM,4050911905.10.4020,F/ LOCK SCREW SQUARE 2.7X10MM,CDM Code,Outpatient,C1713,"$1,058.",$261.7386,"$1,005.1",$846.4,$962.78,$277.4425,"$1,005.1",$261.7386,"$1,005.1","$1,005.1",$105.8,$722.085,$931.04,$973.36
,CDM,4050911906.10.4020,F/ LOCK SCREW SQUARE 2.7X14MM,CDM Code,Outpatient,C1713,$900.,$222.651,$855.,$720.,$819.,$236.0097,$855.,$222.651,$855.,$855.,$90.,$614.25,$792.,$828.
,CDM,4050911907.10.4020,F/ LOW PROFILE NL SCREW 2.7X14,CDM Code,Outpatient,C1713,$691.,$170.9465,$656.45,$552.8,$628.81,$181.203,$656.45,$170.9465,$656.45,$656.45,$69.1,$471.6075,$608.08,$635.72
,CDM,4050911908.10.4020,F/ LOCK SCREW SQUARE 2.7X20MM,CDM Code,Outpatient,C1713,$900.,$222.651,$855.,$720.,$819.,$236.0097,$855.,$222.651,$855.,$855.,$90.,$614.25,$792.,$828.
,CDM,4050911909.10.4020,F/ LOCK SCREW SQUARE 2.7X22MM,CDM Code,Outpatient,C1713,$900.,$222.651,$855.,$720.,$819.,$236.0097,$855.,$222.651,$855.,$855.,$90.,$614.25,$792.,$828.
,CDM,4050911910.10.4020,F/ LOCK SCREW SQUARE 2.7X28MM,CDM Code,Outpatient,C1713,$931.,$230.3201,$884.45,$744.8,$847.21,$244.1389,$884.45,$230.3201,$884.45,$884.45,$93.1,$635.4075,$819.28,$856.52
,CDM,4050911911.10.4020,F/ PLATE DVR CROSSLOCK STD LEF,CDM Code,Outpatient,C1713,"$6,109.","$1,511.3055","$5,803.55","$4,887.2","$5,559.19","$1,601.9814","$5,803.55","$1,511.3055","$5,803.55","$5,803.55",$610.9,"$4,169.3925","$5,375.92","$5,620.28"
,CDM,4050911925.10.4020,F/ TIBIAL PLATE FIXED CRUC 79M,CDM Code,Outpatient,C1713,"$8,420.","$2,083.0238","$7,999.","$6,736.","$7,662.2","$2,208.0019","$7,999.","$2,083.0238","$7,999.","$7,999.",$842.,"$5,746.65","$7,409.6","$7,746.4"
,CDM,4050911950.10.4020,F/ SCREW LOCKING LOWPRO 2.7X12,CDM Code,Outpatient,C1713,"$1,238.",$306.2688,"$1,176.1",$990.4,"$1,126.58",$324.6445,"$1,176.1",$306.2688,"$1,176.1","$1,176.1",$123.8,$844.935,"$1,089.44","$1,138.96"
,CDM,4050911951.10.4020,F/ SCREW LOCKING LOWPRO 2.7X18,CDM Code,Outpatient,C1713,"$1,238.",$306.2688,"$1,176.1",$990.4,"$1,126.58",$324.6445,"$1,176.1",$306.2688,"$1,176.1","$1,176.1",$123.8,$844.935,"$1,089.44","$1,138.96"
,CDM,4050911952.10.4020,F/ SCREW LOCKING LOWPRO 2.7X20,CDM Code,Outpatient,C1713,"$1,089.",$269.4077,"$1,034.55",$871.2,$990.99,$285.5717,"$1,034.55",$269.4077,"$1,034.55","$1,034.55",$108.9,$743.2425,$958.32,"$1,001.88"
,CDM,4050911953.10.4020,F/ SCREW LOWPRO NL 3.5X16MM,CDM Code,Outpatient,C1713,$480.,$118.7472,$456.,$384.,$436.8,$125.8718,$456.,$118.7472,$456.,$456.,$48.,$327.6,$422.4,$441.6
,CDM,4050911954.10.4020,F/ SCREW LP CANN 4.0X30MM,CDM Code,Outpatient,C1713,"$1,558.",$385.4336,"$1,480.1","$1,246.4","$1,417.78",$408.559,"$1,480.1",$385.4336,"$1,480.1","$1,480.1",$155.8,"$1,063.335","$1,371.04","$1,433.36"
,CDM,4050911955.10.4020,F/ SCREW LP CANN 4.0X40MM,CDM Code,Outpatient,C1713,"$1,558.",$385.4336,"$1,480.1","$1,246.4","$1,417.78",$408.559,"$1,480.1",$385.4336,"$1,480.1","$1,480.1",$155.8,"$1,063.335","$1,371.04","$1,433.36"
,CDM,4050911956.10.4020,F/ PLATE LCK DISTAL FIBULA 5 H,CDM Code,Outpatient,C1713,"$4,088.","$1,011.3303","$3,883.6","$3,270.4","$3,720.08","$1,072.0085","$3,883.6","$1,011.3303","$3,883.6","$3,883.6",$408.8,"$2,790.06","$3,597.44","$3,760.96"
,CDM,4050911968.10.4020,F/ PLATE DIS CLAV 8 HOLE RIGHT,CDM Code,Outpatient,C1713,"$3,458.",$855.4746,"$3,285.1","$2,766.4","$3,146.78",$906.8017,"$3,285.1",$855.4746,"$3,285.1","$3,285.1",$345.8,"$2,360.085","$3,043.04","$3,181.36"
,CDM,4050911969.10.4020,F/ SCREW CANC FT 3X14MM,CDM Code,Outpatient,C1713,$425.,$105.1408,$403.75,$340.,$386.75,$111.449,$403.75,$105.1408,$403.75,$403.75,$42.5,$290.0625,$374.,$391.
,CDM,4050911970.10.4020,F/ SCREW LOWPRO TM SS 3.5X14MM,CDM Code,Outpatient,C1713,"$1,172.",$289.9411,"$1,113.4",$937.6,"$1,066.52",$307.3371,"$1,113.4",$289.9411,"$1,113.4","$1,113.4",$117.2,$799.89,"$1,031.36","$1,078.24"
,CDM,4050911972.10.4020,F/ SCREW SOLID CORT FT 6.5X65M,CDM Code,Outpatient,C1713,"$1,551.",$383.7019,"$1,473.45","$1,240.8","$1,411.41",$406.7234,"$1,473.45",$383.7019,"$1,473.45","$1,473.45",$155.1,"$1,058.5575","$1,364.88","$1,426.92"
,CDM,4050911973.10.4020,F/ SCREW SOLID CORT FT LCK 6.5,CDM Code,Outpatient,C1713,"$1,922.",$475.4836,"$1,825.9","$1,537.6","$1,749.02",$504.0118,"$1,825.9",$475.4836,"$1,825.9","$1,825.9",$192.2,"$1,311.765","$1,691.36","$1,768.24"
,CDM,4050911981.10.4020,F/ ACET SCREW G7 6.5MMX30MM,CDM Code,Outpatient,C1713,"$1,500.",$371.085,"$1,425.","$1,200.","$1,365.",$393.3495,"$1,425.",$371.085,"$1,425.","$1,425.",$150.,"$1,023.75","$1,320.","$1,380."
,CDM,4050912033.10.4020,F/ ZIPTIGHT AC JOINT 2 ZIPLOOP,CDM Code,Outpatient,C1713,"$4,007.",$991.2917,"$3,806.65","$3,205.6","$3,646.37","$1,050.7676","$3,806.65",$991.2917,"$3,806.65","$3,806.65",$400.7,"$2,734.7775","$3,526.16","$3,686.44"
,CDM,4050912035.10.4020,F/ SCREW CONICAL 3.5X85MM ST F,CDM Code,Outpatient,C1713,"$1,247.",$308.4953,"$1,184.65",$997.6,"$1,134.77",$327.0046,"$1,184.65",$308.4953,"$1,184.65","$1,184.65",$124.7,$851.0775,"$1,097.36","$1,147.24"
,CDM,4050912036.10.4020,F/ PLATE 3.5X87MM 4HL VA-LCP R,CDM Code,Outpatient,C1713,"$7,578.","$1,874.7214","$7,199.1","$6,062.4","$6,895.98","$1,987.2017","$7,199.1","$1,874.7214","$7,199.1","$7,199.1",$757.8,"$5,171.985","$6,668.64","$6,971.76"
,CDM,4050912037.10.4020,F/ SCREW 3.5X36MM ST LCKG,CDM Code,Outpatient,C1713,"$1,373.",$339.6665,"$1,304.35","$1,098.4","$1,249.43",$360.0459,"$1,304.35",$339.6665,"$1,304.35","$1,304.35",$137.3,$937.0725,"$1,208.24","$1,263.16"
,CDM,4050912038.10.4020,F/ SCREW 3.5X40MM ST LCKG,CDM Code,Outpatient,C1713,"$1,373.",$339.6665,"$1,304.35","$1,098.4","$1,249.43",$360.0459,"$1,304.35",$339.6665,"$1,304.35","$1,304.35",$137.3,$937.0725,"$1,208.24","$1,263.16"
,CDM,4050912039.10.4020,F/ SCREW 3.5X60MM ST LCKG,CDM Code,Outpatient,C1713,"$1,697.",$419.8208,"$1,612.15","$1,357.6","$1,544.27",$445.0094,"$1,612.15",$419.8208,"$1,612.15","$1,612.15",$169.7,"$1,158.2025","$1,493.36","$1,561.24"
,CDM,4050912040.10.4020,F/ SCREW 3.5X80MM ST LCKG,CDM Code,Outpatient,C1713,"$1,544.",$381.9702,"$1,466.8","$1,235.2","$1,405.04",$404.8878,"$1,466.8",$381.9702,"$1,466.8","$1,466.8",$154.4,"$1,053.78","$1,358.72","$1,420.48"
,CDM,4050912045.10.4020,F/ SCREW LAG HIP NL 10.5X100MM,CDM Code,Outpatient,C1713,"$4,346.","$1,075.1569","$4,128.7","$3,476.8","$3,954.86","$1,139.6646","$4,128.7","$1,075.1569","$4,128.7","$4,128.7",$434.6,"$2,966.145","$3,824.48","$3,998.32"
,CDM,4050912049.10.4020,F/ SCREW HIP FX NL ANTI-ROT 85,CDM Code,Outpatient,C1713,"$2,484.",$614.5168,"$2,359.8","$1,987.2","$2,260.44",$651.3868,"$2,359.8",$614.5168,"$2,359.8","$2,359.8",$248.4,"$1,695.33","$2,185.92","$2,285.28"
,CDM,4050912050.10.4020,F/ SCREW CORTICAL 5.0X40MM AFF,CDM Code,Outpatient,C1713,"$1,922.",$475.4836,"$1,825.9","$1,537.6","$1,749.02",$504.0118,"$1,825.9",$475.4836,"$1,825.9","$1,825.9",$192.2,"$1,311.765","$1,691.36","$1,768.24"
,CDM,4050912076.10.4020,F/ 2.9MM JUGGERKNOT,CDM Code,Outpatient,C1713,"$2,548.",$630.3497,"$2,420.6","$2,038.4","$2,318.68",$668.1697,"$2,420.6",$630.3497,"$2,420.6","$2,420.6",$254.8,"$1,739.01","$2,242.24","$2,344.16"
,CDM,4050912088.10.4020,F/ PLATE 2.7/3.5MM VAR ANG 8HL,CDM Code,Outpatient,C1713,"$5,904.","$1,460.5906","$5,608.8","$4,723.2","$5,372.64","$1,548.2236","$5,608.8","$1,460.5906","$5,608.8","$5,608.8",$590.4,"$4,029.48","$5,195.52","$5,431.68"
,CDM,4050912090.10.4020,F/ SCREW 2.7MM METAPHYSEAL 22M,CDM Code,Outpatient,C1713,$536.,$132.601,$509.2,$428.8,$487.76,$140.5569,$509.2,$132.601,$509.2,$509.2,$53.6,$365.82,$471.68,$493.12
,CDM,4050912091.10.4020,F/ SCREW 2.7 METAPHYSEAL 26MM,CDM Code,Outpatient,C1713,$536.,$132.601,$509.2,$428.8,$487.76,$140.5569,$509.2,$132.601,$509.2,$509.2,$53.6,$365.82,$471.68,$493.12
,CDM,4050912092.10.4020,F/ SCREW 2.7 METAPHYSEAL 28MM,CDM Code,Outpatient,C1713,$536.,$132.601,$509.2,$428.8,$487.76,$140.5569,$509.2,$132.601,$509.2,$509.2,$53.6,$365.82,$471.68,$493.12
,CDM,4050912093.10.4020,F/ SCREW 2.7 VAR ANGLE LCK 20M,CDM Code,Outpatient,C1713,"$1,482.",$366.632,"$1,407.9","$1,185.6","$1,348.62",$388.6293,"$1,407.9",$366.632,"$1,407.9","$1,407.9",$148.2,"$1,011.465","$1,304.16","$1,363.44"
,CDM,4050912132.10.4020,F/ TIGHTROPE ACL RT W/ DEPL SU,CDM Code,Outpatient,C1713,"$2,491.",$616.2485,"$2,366.45","$1,992.8","$2,266.81",$653.2224,"$2,366.45",$616.2485,"$2,366.45","$2,366.45",$249.1,"$1,700.1075","$2,192.08","$2,291.72"
,CDM,4050912139.10.4020,F/ SCREW CORTICAL BONE 5.0X44M,CDM Code,Outpatient,C1713,"$1,776.",$439.3646,"$1,687.2","$1,420.8","$1,616.16",$465.7258,"$1,687.2",$439.3646,"$1,687.2","$1,687.2",$177.6,"$1,212.12","$1,562.88","$1,633.92"
,CDM,4050912141.10.4020,F/ PLATE 2.4/2.7 TI VA-LCP 2HL,CDM Code,Outpatient,C1713,"$4,234.","$1,047.4493","$4,022.3","$3,387.2","$3,852.94","$1,110.2945","$4,022.3","$1,047.4493","$4,022.3","$4,022.3",$423.4,"$2,889.705","$3,725.92","$3,895.28"
,CDM,4050912142.10.4020,F/ SCREW 2.7 VA LCK ST 14MM,CDM Code,Outpatient,C1713,"$1,228.",$303.7949,"$1,166.6",$982.4,"$1,117.48",$322.0221,"$1,166.6",$303.7949,"$1,166.6","$1,166.6",$122.8,$838.11,"$1,080.64","$1,129.76"
,CDM,4050912146.10.4020,F/ SCREW 2.7MM VA LCK ST 24MM,CDM Code,Outpatient,C1713,"$1,228.",$303.7949,"$1,166.6",$982.4,"$1,117.48",$322.0221,"$1,166.6",$303.7949,"$1,166.6","$1,166.6",$122.8,$838.11,"$1,080.64","$1,129.76"
,CDM,4050912148.10.4020,F/ SCREW 2.7MM VA LCK ST 26MM,CDM Code,Outpatient,C1713,"$1,228.",$303.7949,"$1,166.6",$982.4,"$1,117.48",$322.0221,"$1,166.6",$303.7949,"$1,166.6","$1,166.6",$122.8,$838.11,"$1,080.64","$1,129.76"
,CDM,4050912149.10.4020,F/ SCREW 2.7MM TI CORTEX ST 20,CDM Code,Outpatient,C1713,$446.,$110.3359,$423.7,$356.8,$405.86,$116.9559,$423.7,$110.3359,$423.7,$423.7,$44.6,$304.395,$392.48,$410.32
,CDM,4050912153.10.4020,F/ SCREW CORTICAL BONE 5.0 X 3,CDM Code,Outpatient,C1713,"$1,922.",$475.4836,"$1,825.9","$1,537.6","$1,749.02",$504.0118,"$1,825.9",$475.4836,"$1,825.9","$1,825.9",$192.2,"$1,311.765","$1,691.36","$1,768.24"
,CDM,4050912154.10.4020,F/ SCREW HIP FX NAIL LAG 10.5X,CDM Code,Outpatient,C1713,"$4,346.","$1,075.1569","$4,128.7","$3,476.8","$3,954.86","$1,139.6646","$4,128.7","$1,075.1569","$4,128.7","$4,128.7",$434.6,"$2,966.145","$3,824.48","$3,998.32"
,CDM,4050912155.10.4020,F/ SCREW ANTI-ROT 80MM,CDM Code,Outpatient,C1713,"$2,101.",$519.7664,"$1,995.95","$1,680.8","$1,911.91",$550.9515,"$1,995.95",$519.7664,"$1,995.95","$1,995.95",$210.1,"$1,433.9325","$1,848.88","$1,932.92"
,CDM,4050912158.10.4020,F/ SCREW CORTICAL BONE 5.0X42M,CDM Code,Outpatient,C1713,"$1,502.",$371.5798,"$1,426.9","$1,201.6","$1,366.82",$393.874,"$1,426.9",$371.5798,"$1,426.9","$1,426.9",$150.2,"$1,025.115","$1,321.76","$1,381.84"
,CDM,4050912159.10.4020,F/ SCREW HIP FX ANTI-ROT 75MM,CDM Code,Outpatient,C1713,"$2,484.",$614.5168,"$2,359.8","$1,987.2","$2,260.44",$651.3868,"$2,359.8",$614.5168,"$2,359.8","$2,359.8",$248.4,"$1,695.33","$2,185.92","$2,285.28"
,CDM,4050912170.10.4020,F/ PLATE 7HL 3.5 LCP CLAV 100M,CDM Code,Outpatient,C1713,"$4,594.","$1,136.5097","$4,364.3","$3,675.2","$4,180.54","$1,204.6984","$4,364.3","$1,136.5097","$4,364.3","$4,364.3",$459.4,"$3,135.405","$4,042.72","$4,226.48"
,CDM,4050912182.10.4020,F/ GRAFTBOLT TIBIAL 10MM,CDM Code,Outpatient,C1713,"$2,769.",$685.0229,"$2,630.55","$2,215.2","$2,519.79",$726.1232,"$2,630.55",$685.0229,"$2,630.55","$2,630.55",$276.9,"$1,889.8425","$2,436.72","$2,547.48"
,CDM,4050912183.10.4020,F/ SCREW LAG AFFIXUS 10.5X100M,CDM Code,Outpatient,C1713,"$4,510.","$1,115.7289","$4,284.5","$3,608.","$4,104.1","$1,182.6708","$4,284.5","$1,115.7289","$4,284.5","$4,284.5",$451.,"$3,078.075","$3,968.8","$4,149.2"
,CDM,4050912198.10.4020,F/ LENS SN60WF +8.0 D,CDM Code,Outpatient,V2632,$990.,$244.9161,$940.5,$792.,$900.9,$259.6107,$940.5,$244.9161,$940.5,$940.5,$99.,$675.675,$871.2,$910.8
,CDM,4050912207.10.4020,F/ SCREW BONE ACUTRAK 2 16.0MM,CDM Code,Outpatient,C1713,"$2,464.",$609.569,"$2,340.8","$1,971.2","$2,242.24",$646.1421,"$2,340.8",$609.569,"$2,340.8","$2,340.8",$246.4,"$1,681.68","$2,168.32","$2,266.88"
,CDM,4050912217.10.4020,F/ 3.5MM LCP PLATE 4 HOLE 76MM,CDM Code,Outpatient,C1713,"$7,027.","$1,738.4095","$6,675.65","$5,621.6","$6,394.57","$1,842.7113","$6,675.65","$1,738.4095","$6,675.65","$6,675.65",$702.7,"$4,795.9275","$6,183.76","$6,464.84"
,CDM,4050912218.10.4020,F/ SCREW 3.5 CONICAL ST FT 65M,CDM Code,Outpatient,C1713,"$1,247.",$308.4953,"$1,184.65",$997.6,"$1,134.77",$327.0046,"$1,184.65",$308.4953,"$1,184.65","$1,184.65",$124.7,$851.0775,"$1,097.36","$1,147.24"
,CDM,4050912240.10.4020,F/ 4050912240,CDM Code,Outpatient,C1713,$319.,$78.9174,$303.05,$255.2,$290.29,$83.6523,$303.05,$78.9174,$303.05,$303.05,$31.9,$217.7175,$280.72,$293.48
,CDM,4050912241.10.4020,F/ SCREW BONE MICRO 2.3X14MM,CDM Code,Outpatient,C1713,"$2,266.",$560.5857,"$2,152.7","$1,812.8","$2,062.06",$594.22,"$2,152.7",$560.5857,"$2,152.7","$2,152.7",$226.6,"$1,546.545","$1,994.08","$2,084.72"
,CDM,4050912248.10.4020,F/ BIOCOMP PUSH ANCHOR 3.5X19.,CDM Code,Outpatient,C1713,"$2,517.",$622.6806,"$2,391.15","$2,013.6","$2,290.47",$660.0405,"$2,391.15",$622.6806,"$2,391.15","$2,391.15",$251.7,"$1,717.8525","$2,214.96","$2,315.64"
,CDM,4050912309.10.4020,F/ PLATE DVR CROSSLINK NARROW,CDM Code,Outpatient,C1713,"$6,109.","$1,511.3055","$5,803.55","$4,887.2","$5,559.19","$1,601.9814","$5,803.55","$1,511.3055","$5,803.55","$5,803.55",$610.9,"$4,169.3925","$5,375.92","$5,620.28"
,CDM,4050912310.10.4020,F/ SCREW 2.7 LP NL 12MM,CDM Code,Outpatient,C1713,$900.,$222.651,$855.,$720.,$819.,$236.0097,$855.,$222.651,$855.,$855.,$90.,$614.25,$792.,$828.
,CDM,4050912314.10.4020,F/ SCREW LOCKING SQUARE 2.7MMX,CDM Code,Outpatient,C1713,$900.,$222.651,$855.,$720.,$819.,$236.0097,$855.,$222.651,$855.,$855.,$90.,$614.25,$792.,$828.
,CDM,4050912315.10.4020,F/ LOCKING SCREW SQUARE 2.7MMX,CDM Code,Outpatient,C1713,$900.,$222.651,$855.,$720.,$819.,$236.0097,$855.,$222.651,$855.,$855.,$90.,$614.25,$792.,$828.
,CDM,4050912354.10.4020,F/ ANCHOR SUTURE PEEK MINI 2.5,CDM Code,Outpatient,C1713,"$2,266.",$560.5857,"$2,152.7","$1,812.8","$2,062.06",$594.22,"$2,152.7",$560.5857,"$2,152.7","$2,152.7",$226.6,"$1,546.545","$1,994.08","$2,084.72"
,CDM,4050912356.10.4020,F/ SCREW CORTICAL BONE 5.0X32M,CDM Code,Outpatient,C1713,"$1,922.",$475.4836,"$1,825.9","$1,537.6","$1,749.02",$504.0118,"$1,825.9",$475.4836,"$1,825.9","$1,825.9",$192.2,"$1,311.765","$1,691.36","$1,768.24"
,CDM,4050912359.10.4020,F/ SCREW HIP ANTI-ROT AFFIX 95,CDM Code,Outpatient,C1713,"$2,101.",$519.7664,"$1,995.95","$1,680.8","$1,911.91",$550.9515,"$1,995.95",$519.7664,"$1,995.95","$1,995.95",$210.1,"$1,433.9325","$1,848.88","$1,932.92"
,CDM,4050912362.10.4020,F/ JUGGERKNOT SNGL SZ1 1.4MM,CDM Code,Outpatient,C1713,"$2,852.",$705.5563,"$2,709.4","$2,281.6","$2,595.32",$747.8885,"$2,709.4",$705.5563,"$2,709.4","$2,709.4",$285.2,"$1,946.49","$2,509.76","$2,623.84"
,CDM,4050912379.10.4020,F/ PLATE DVR CROSSLINK NRW MIN,CDM Code,Outpatient,C1713,"$6,109.","$1,511.3055","$5,803.55","$4,887.2","$5,559.19","$1,601.9814","$5,803.55","$1,511.3055","$5,803.55","$5,803.55",$610.9,"$4,169.3925","$5,375.92","$5,620.28"
,CDM,4050912381.10.4020,F/ PEG LOCKING SMOOTH 2.2 X 14,CDM Code,Outpatient,C1713,"$1,425.",$352.5308,"$1,353.75","$1,140.","$1,296.75",$373.682,"$1,353.75",$352.5308,"$1,353.75","$1,353.75",$142.5,$972.5625,"$1,254.","$1,311."
,CDM,4050912383.10.4020,F/ SCREW LOW PROFILE NL 2.7X16,CDM Code,Outpatient,C1713,$691.,$170.9465,$656.45,$552.8,$628.81,$181.203,$656.45,$170.9465,$656.45,$656.45,$69.1,$471.6075,$608.08,$635.72
,CDM,4050912386.10.4020,F/ SCREW LOCKING 2.7MM X 12MM,CDM Code,Outpatient,C1713,$900.,$222.651,$855.,$720.,$819.,$236.0097,$855.,$222.651,$855.,$855.,$90.,$614.25,$792.,$828.
,CDM,4050912441.10.4020,F/ RESTOR SN6AD1 +21.5 DIOP,CDM Code,Outpatient,V2788GY,$845.,$209.0445,$802.75,$676.,$768.95,$221.5869,$802.75,$209.0445,$802.75,$802.75,$84.5,$576.7125,$743.6,$777.4
,CDM,4050912464.10.4020,F/ SCREW CORT FT 4.5 X 36MM NS,CDM Code,Outpatient,C1713,$564.,$139.528,$535.8,$451.2,$513.24,$147.8994,$535.8,$139.528,$535.8,$535.8,$56.4,$384.93,$496.32,$518.88
,CDM,4050912466.10.4020,F/ SCREW CORT FT 4.5MM X 40MM,CDM Code,Outpatient,C1713,$672.,$166.2461,$638.4,$537.6,$611.52,$176.2206,$638.4,$166.2461,$638.4,$638.4,$67.2,$458.64,$591.36,$618.24
,CDM,4050912472.10.4020,F/ CORT SCREW FT 5.5MM X 40MM,CDM Code,Outpatient,C1713,"$1,674.",$414.1309,"$1,590.3","$1,339.2","$1,523.34",$438.978,"$1,590.3",$414.1309,"$1,590.3","$1,590.3",$167.4,"$1,142.505","$1,473.12","$1,540.08"
,CDM,4050912476.10.4020,F/ GRAFT GRACILIS TENDON FZ,CDM Code,Outpatient,C1762,"$4,077.","$1,008.609","$3,873.15","$3,261.6","$3,710.07","$1,069.1239","$3,873.15","$1,008.609","$3,873.15","$3,873.15",$407.7,"$2,782.5525","$3,587.76","$3,750.84"
,CDM,4050912477.10.4020,F/ MPFL BIOCOMPOSITE IMPLANT S,CDM Code,Outpatient,C1713,"$8,713.","$2,155.5091","$8,277.35","$6,970.4","$7,928.83","$2,284.8361","$8,277.35","$2,155.5091","$8,277.35","$8,277.35",$871.3,"$5,946.6225","$7,667.44","$8,015.96"
,CDM,4050912486.10.4020,F/ NAIL TIBIAL 10MMX34.5CM,CDM Code,Outpatient,C1713,"$8,198.","$2,028.1032","$7,788.1","$6,558.4","$7,460.18","$2,149.7861","$7,788.1","$2,028.1032","$7,788.1","$7,788.1",$819.8,"$5,595.135","$7,214.24","$7,542.16"
,CDM,4050912489.10.4020,F/ SCREW CORTICAL FT 5.5X65MM,CDM Code,Outpatient,C1713,"$1,516.",$375.0432,"$1,440.2","$1,212.8","$1,379.56",$397.5452,"$1,440.2",$375.0432,"$1,440.2","$1,440.2",$151.6,"$1,034.67","$1,334.08","$1,394.72"
,CDM,4050912490.10.4020,F/ SCREW CORTICAL FT 4.5X38MM,CDM Code,Outpatient,C1713,$864.,$213.745,$820.8,$691.2,$786.24,$226.5693,$820.8,$213.745,$820.8,$820.8,$86.4,$589.68,$760.32,$794.88
,CDM,4050912503.10.4020,F/ TENODESIS SCREW PEEK 3X8MM,CDM Code,Outpatient,C1713,"$2,453.",$606.8477,"$2,330.35","$1,962.4","$2,232.23",$643.2575,"$2,330.35",$606.8477,"$2,330.35","$2,330.35",$245.3,"$1,674.1725","$2,158.64","$2,256.76"
,CDM,4050912504.10.4020,F/ INTERNAL BRACE LIGAMENT AUG,CDM Code,Outpatient,C1713,"$4,778.","$1,182.0294","$4,539.1","$3,822.4","$4,347.98","$1,252.9493","$4,539.1","$1,182.0294","$4,539.1","$4,539.1",$477.8,"$3,260.985","$4,204.64","$4,395.76"
,CDM,4050912505.10.4020,F/ GRAFTBOLT TIBIAL 9MM,CDM Code,Outpatient,C1713,"$2,769.",$685.0229,"$2,630.55","$2,215.2","$2,519.79",$726.1232,"$2,630.55",$685.0229,"$2,630.55","$2,630.55",$276.9,"$1,889.8425","$2,436.72","$2,547.48"
,CDM,4050912506.10.4020,F/ PERONEUS LONGUS TENDON GRAF,CDM Code,Outpatient,C1762,"$6,323.","$1,564.247","$6,006.85","$5,058.4","$5,753.93","$1,658.0993","$6,006.85","$1,564.247","$6,006.85","$6,006.85",$632.3,"$4,315.4475","$5,564.24","$5,817.16"
,CDM,4050912508.10.4020,F/ SCREW TENODESIS PEEK 4.75X1,CDM Code,Outpatient,C1713,"$2,790.",$690.2181,"$2,650.5","$2,232.","$2,538.9",$731.6301,"$2,650.5",$690.2181,"$2,650.5","$2,650.5",$279.,"$1,904.175","$2,455.2","$2,566.8"
,CDM,4050912511.10.4020,F/ G7 ACET SCREW 6.5MM X 35MM,CDM Code,Outpatient,C1713,"$1,500.",$371.085,"$1,425.","$1,200.","$1,365.",$393.3495,"$1,425.",$371.085,"$1,425.","$1,425.",$150.,"$1,023.75","$1,320.","$1,380."
,CDM,4050912518.10.4020,F/ RESTOR CAT SV25T0 +21.0 DIO,CDM Code,Outpatient,V2788GY,$845.,$209.0445,$802.75,$676.,$768.95,$221.5869,$802.75,$209.0445,$802.75,$802.75,$84.5,$576.7125,$743.6,$777.4
,CDM,4050912525.10.4020,F/ PLATE STRAIGHT 2.0MMX6H,CDM Code,Outpatient,C1713,"$2,018.",$499.233,"$1,917.1","$1,614.4","$1,836.38",$529.1862,"$1,917.1",$499.233,"$1,917.1","$1,917.1",$201.8,"$1,377.285","$1,775.84","$1,856.56"
,CDM,4050912526.10.4020,F/ PLATE LC-DCP 2.0MMX6H 39MM,CDM Code,Outpatient,C1713,"$2,189.",$541.5367,"$2,079.55","$1,751.2","$1,991.99",$574.028,"$2,079.55",$541.5367,"$2,079.55","$2,079.55",$218.9,"$1,493.9925","$1,926.32","$2,013.88"
,CDM,4050912554.10.4020,F/ SCREW CORTEX 2.0X9MM ST,CDM Code,Outpatient,C1713,$482.,$119.242,$457.9,$385.6,$438.62,$126.3963,$457.9,$119.242,$457.9,$457.9,$48.2,$328.965,$424.16,$443.44
,CDM,4050912556.10.4020,F/ SCREW CORTEX 2.4X12MM ST,CDM Code,Outpatient,C1713,$655.,$162.0404,$622.25,$524.,$596.05,$171.7626,$622.25,$162.0404,$622.25,$622.25,$65.5,$447.0375,$576.4,$602.6
,CDM,4050912557.10.4020,F/ SCREW CORTEX 2.4X6MM ST,CDM Code,Outpatient,C1713,$678.,$167.7304,$644.1,$542.4,$616.98,$177.794,$644.1,$167.7304,$644.1,$644.1,$67.8,$462.735,$596.64,$623.76
,CDM,4050912572.10.4020,F/ SCREW CORTEX 4.5 X 46MM NS,CDM Code,Outpatient,C1713,$864.,$213.745,$820.8,$691.2,$786.24,$226.5693,$820.8,$213.745,$820.8,$820.8,$86.4,$589.68,$760.32,$794.88
,CDM,4050912573.10.4020,F/ SCREW CORTICAL FT 5.5X50MM,CDM Code,Outpatient,C1713,"$1,922.",$475.4836,"$1,825.9","$1,537.6","$1,749.02",$504.0118,"$1,825.9",$475.4836,"$1,825.9","$1,825.9",$192.2,"$1,311.765","$1,691.36","$1,768.24"
,CDM,4050912575.10.4020,F/ NAIL TIBIAL VERSANAIL 11MMX,CDM Code,Outpatient,C1713,"$8,897.","$2,201.0288","$8,452.15","$7,117.6","$8,096.27","$2,333.087","$8,452.15","$2,201.0288","$8,452.15","$8,452.15",$889.7,"$6,072.2025","$7,829.36","$8,185.24"
,CDM,4050912607.10.4020,F/ PLATE 2.4MM VA-LCP 7H HD/4H,CDM Code,Outpatient,C1713,"$5,948.","$1,471.4757","$5,650.6","$4,758.4","$5,412.68","$1,559.7619","$5,650.6","$1,471.4757","$5,650.6","$5,650.6",$594.8,"$4,059.51","$5,234.24","$5,472.16"
,CDM,4050912608.10.4020,F/ PL 2.4MM DOR. 5H SH/90DE 2H,CDM Code,Outpatient,C1713,"$3,981.",$984.8596,"$3,781.95","$3,184.8","$3,622.71","$1,043.9496","$3,781.95",$984.8596,"$3,781.95","$3,781.95",$398.1,"$2,717.0325","$3,503.28","$3,662.52"
,CDM,4050912610.10.4020,F/ PIN BUTTRESS 1.8 VA LCK 14M,CDM Code,Outpatient,C1713,"$1,427.",$353.0255,"$1,355.65","$1,141.6","$1,298.57",$374.2065,"$1,355.65",$353.0255,"$1,355.65","$1,355.65",$142.7,$973.9275,"$1,255.76","$1,312.84"
,CDM,4050912624.10.4020,F/ PLT 2.7/3.5MM VA-LCP TIB 4H,CDM Code,Outpatient,C1713,"$9,001.","$2,226.7574","$8,550.95","$7,200.8","$8,190.91","$2,360.3592","$8,550.95","$2,226.7574","$8,550.95","$8,550.95",$900.1,"$6,143.1825","$7,920.88","$8,280.92"
,CDM,4050912625.10.4020,F/ SCRW 2.7X38MM METAPHYSEAL S,CDM Code,Outpatient,C1713,$614.,$151.8975,$583.3,$491.2,$558.74,$161.0111,$583.3,$151.8975,$583.3,$583.3,$61.4,$419.055,$540.32,$564.88
,CDM,4050912626.10.4020,F/ SCRW 2.7X38MM VA LCK SLF TA,CDM Code,Outpatient,C1713,"$1,688.",$417.5943,"$1,603.6","$1,350.4","$1,536.08",$442.6493,"$1,603.6",$417.5943,"$1,603.6","$1,603.6",$168.8,"$1,152.06","$1,485.44","$1,552.96"
,CDM,4050912627.10.4020,F/ SCRW 2.7X40MM VA LCK STAR D,CDM Code,Outpatient,C1713,"$1,688.",$417.5943,"$1,603.6","$1,350.4","$1,536.08",$442.6493,"$1,603.6",$417.5943,"$1,603.6","$1,603.6",$168.8,"$1,152.06","$1,485.44","$1,552.96"
,CDM,4050912628.10.4020,F/ SCRW 2.7X42MM VA LCK STAR D,CDM Code,Outpatient,C1713,"$1,688.",$417.5943,"$1,603.6","$1,350.4","$1,536.08",$442.6493,"$1,603.6",$417.5943,"$1,603.6","$1,603.6",$168.8,"$1,152.06","$1,485.44","$1,552.96"
,CDM,4050912629.10.4020,F/ SCRW 3.5X30MM LOW PRO SLF T,CDM Code,Outpatient,C1713,$482.,$119.242,$457.9,$385.6,$438.62,$126.3963,$457.9,$119.242,$457.9,$457.9,$48.2,$328.965,$424.16,$443.44
,CDM,4050912630.10.4020,F/ SCRW 3.5X32MM LOW PRO SLF T,CDM Code,Outpatient,C1713,$482.,$119.242,$457.9,$385.6,$438.62,$126.3963,$457.9,$119.242,$457.9,$457.9,$48.2,$328.965,$424.16,$443.44
,CDM,4050912631.10.4020,F/ SCRW 3.5X34MM LOW PRO SLF T,CDM Code,Outpatient,C1713,$482.,$119.242,$457.9,$385.6,$438.62,$126.3963,$457.9,$119.242,$457.9,$457.9,$48.2,$328.965,$424.16,$443.44
,CDM,4050912632.10.4020,F/ NORIAN DRILLABEL INJECTION,CDM Code,Outpatient,C1713,"$5,345.","$1,322.2996","$5,077.75","$4,276.","$4,863.95","$1,401.6354","$5,077.75","$1,322.2996","$5,077.75","$5,077.75",$534.5,"$3,647.9625","$4,703.6","$4,917.4"
,CDM,4050912634.10.4020,F/ SCREW CANC LP 6.5 X 40MM,CDM Code,Outpatient,C1713,$909.,$224.8775,$863.55,$727.2,$827.19,$238.3698,$863.55,$224.8775,$863.55,$863.55,$90.9,$620.3925,$799.92,$836.28
,CDM,4050912635.10.4020,F/ SPEEDCINCH CRV NDL 2-0 FW,CDM Code,Outpatient,C1713,"$2,331.",$576.6661,"$2,214.45","$1,864.8","$2,121.21",$611.2651,"$2,214.45",$576.6661,"$2,214.45","$2,214.45",$233.1,"$1,590.9075","$2,051.28","$2,144.52"
,CDM,4050912641.10.4020,F/ SCREW CORTICAL 5.0X38MM,CDM Code,Outpatient,C1713,"$1,984.",$490.8218,"$1,884.8","$1,587.2","$1,805.44",$520.2703,"$1,884.8",$490.8218,"$1,884.8","$1,884.8",$198.4,"$1,354.08","$1,745.92","$1,825.28"
,CDM,4050912665.10.4020,F/ SCREW 2.7X46MM VA LCK STR D,CDM Code,Outpatient,C1713,"$1,598.",$395.3292,"$1,518.1","$1,278.4","$1,454.18",$419.0483,"$1,518.1",$395.3292,"$1,518.1","$1,518.1",$159.8,"$1,090.635","$1,406.24","$1,470.16"
,CDM,4050912677.10.4020,F/ PLATE 4.5MM VA-LCP 10HL 230,CDM Code,Outpatient,C1713,"$7,598.","$1,879.6692","$7,218.1","$6,078.4","$6,914.18","$1,992.4463","$7,218.1","$1,879.6692","$7,218.1","$7,218.1",$759.8,"$5,185.635","$6,686.24","$6,990.16"
,CDM,4050912678.10.4020,F/ SCREW 5.0MM VA LCK ST 26MM,CDM Code,Outpatient,C1713,"$1,587.",$392.6079,"$1,507.65","$1,269.6","$1,444.17",$416.1638,"$1,507.65",$392.6079,"$1,507.65","$1,507.65",$158.7,"$1,083.1275","$1,396.56","$1,460.04"
,CDM,4050912679.10.4020,F/ SCREW 5.0MM VA LCK ST 30MM,CDM Code,Outpatient,C1713,"$1,587.",$392.6079,"$1,507.65","$1,269.6","$1,444.17",$416.1638,"$1,507.65",$392.6079,"$1,507.65","$1,507.65",$158.7,"$1,083.1275","$1,396.56","$1,460.04"
,CDM,4050912680.10.4020,F/ SCREW 5.0MM VA LCK ST 36MM,CDM Code,Outpatient,C1713,"$1,786.",$441.8385,"$1,696.7","$1,428.8","$1,625.26",$468.3481,"$1,696.7",$441.8385,"$1,696.7","$1,696.7",$178.6,"$1,218.945","$1,571.68","$1,643.12"
,CDM,4050912681.10.4020,F/ SCREW 5.0MM VA LCK ST 38MM,CDM Code,Outpatient,C1713,"$1,786.",$441.8385,"$1,696.7","$1,428.8","$1,625.26",$468.3481,"$1,696.7",$441.8385,"$1,696.7","$1,696.7",$178.6,"$1,218.945","$1,571.68","$1,643.12"
,CDM,4050912682.10.4020,F/ SCREW 5.0MM VA LCK ST 40MM,CDM Code,Outpatient,C1713,"$1,587.",$392.6079,"$1,507.65","$1,269.6","$1,444.17",$416.1638,"$1,507.65",$392.6079,"$1,507.65","$1,507.65",$158.7,"$1,083.1275","$1,396.56","$1,460.04"
,CDM,4050912683.10.4020,F/ SCREW 5.0MM VA LCK ST 50MM,CDM Code,Outpatient,C1713,"$1,587.",$392.6079,"$1,507.65","$1,269.6","$1,444.17",$416.1638,"$1,507.65",$392.6079,"$1,507.65","$1,507.65",$158.7,"$1,083.1275","$1,396.56","$1,460.04"
,CDM,4050912684.10.4020,F/ SCREW 5.0MM VA LCK ST 65MM,CDM Code,Outpatient,C1713,"$1,587.",$392.6079,"$1,507.65","$1,269.6","$1,444.17",$416.1638,"$1,507.65",$392.6079,"$1,507.65","$1,507.65",$158.7,"$1,083.1275","$1,396.56","$1,460.04"
,CDM,4050912685.10.4020,F/ SCREW 5.0MM VA LCK ST 70MM,CDM Code,Outpatient,C1713,"$1,587.",$392.6079,"$1,507.65","$1,269.6","$1,444.17",$416.1638,"$1,507.65",$392.6079,"$1,507.65","$1,507.65",$158.7,"$1,083.1275","$1,396.56","$1,460.04"
,CDM,4050912686.10.4020,F/ SCREW 5.0MM VA LCK ST 80MM,CDM Code,Outpatient,C1713,"$1,786.",$441.8385,"$1,696.7","$1,428.8","$1,625.26",$468.3481,"$1,696.7",$441.8385,"$1,696.7","$1,696.7",$178.6,"$1,218.945","$1,571.68","$1,643.12"
,CDM,4050912727.10.4020,"F/ PLATE CLAVICLE CENT THIRD,",CDM Code,Outpatient,C1713,"$4,982.","$1,232.497","$4,732.9","$3,985.6","$4,533.62","$1,306.4448","$4,732.9","$1,232.497","$4,732.9","$4,732.9",$498.2,"$3,400.215","$4,384.16","$4,583.44"
,CDM,4050912746.10.4020,F/ PLATE 2.4MM VA-LCP DSTRAD 6,CDM Code,Outpatient,C1713,"$6,170.","$1,526.3963","$5,861.5","$4,936.","$5,614.7","$1,617.9776","$5,861.5","$1,526.3963","$5,861.5","$5,861.5",$617.,"$4,211.025","$5,429.6","$5,676.4"
,CDM,4050912765.10.4020,F/ K-WIRE 2.0X152MM,CDM Code,Outpatient,C1713,$480.,$118.7472,$456.,$384.,$436.8,$125.8718,$456.,$118.7472,$456.,$456.,$48.,$327.6,$422.4,$441.6
,CDM,4050912768.10.4020,F/ SCREW SET 90DEG LCK,CDM Code,Outpatient,C1713,$900.,$222.651,$855.,$720.,$819.,$236.0097,$855.,$222.651,$855.,$855.,$90.,$614.25,$792.,$828.
,CDM,4050912772.10.4020,F/ PEG STANDARD 4.0X40.0MM,CDM Code,Outpatient,C1713,"$1,125.",$278.3137,"$1,068.75",$900.,"$1,023.75",$295.0121,"$1,068.75",$278.3137,"$1,068.75","$1,068.75",$112.5,$767.8125,$990.,"$1,035."
,CDM,4050912790.10.4020,F/ SCREW TI CORT ST 2.0X14MM,CDM Code,Outpatient,C1713,$487.,$120.4789,$462.65,$389.6,$443.17,$127.7075,$462.65,$120.4789,$462.65,$462.65,$48.7,$332.3775,$428.56,$448.04
,CDM,4050912792.10.4020,F/ PLATE TI LC-DCP 2.0MM/8H/48,CDM Code,Outpatient,C1713,"$2,885.",$713.7201,"$2,740.75","$2,308.","$2,625.35",$756.5422,"$2,740.75",$713.7201,"$2,740.75","$2,740.75",$288.5,"$1,969.0125","$2,538.8","$2,654.2"
,CDM,4050912799.10.4020,F/ SCRW HEADLESS 2.4X14MM SH T,CDM Code,Outpatient,C1713,"$2,500.",$618.475,"$2,375.","$2,000.","$2,275.",$655.5825,"$2,375.",$618.475,"$2,375.","$2,375.",$250.,"$1,706.25","$2,200.","$2,300."
,CDM,4050912800.10.4020,F/ SCRW HEADLESS 2.4X18MM SHT,CDM Code,Outpatient,C1713,"$2,500.",$618.475,"$2,375.","$2,000.","$2,275.",$655.5825,"$2,375.",$618.475,"$2,375.","$2,375.",$250.,"$1,706.25","$2,200.","$2,300."
,CDM,4050912801.10.4020,F/ SCRW HEADLESS 2.4X32MM SHT,CDM Code,Outpatient,C1713,"$5,200.","$1,286.428","$4,940.","$4,160.","$4,732.","$1,363.6116","$4,940.","$1,286.428","$4,940.","$4,940.",$520.,"$3,549.","$4,576.","$4,784."
,CDM,4050912817.10.4020,F/ SCREW 90 DEG. LCK 3.8X30MM,CDM Code,Outpatient,C1713,"$1,350.",$333.9765,"$1,282.5","$1,080.","$1,228.5",$354.0145,"$1,282.5",$333.9765,"$1,282.5","$1,282.5",$135.,$921.375,"$1,188.","$1,242."
,CDM,4050912843.10.4020,F/ BONE SCREW CORTICAL 42MM,CDM Code,Outpatient,C1713,$864.,$213.745,$820.8,$691.2,$786.24,$226.5693,$820.8,$213.745,$820.8,$820.8,$86.4,$589.68,$760.32,$794.88
,CDM,4050912844.10.4020,F/ SCREW CORTICAL FT 4.5X48MM,CDM Code,Outpatient,C1713,$564.,$139.528,$535.8,$451.2,$513.24,$147.8994,$535.8,$139.528,$535.8,$535.8,$56.4,$384.93,$496.32,$518.88
,CDM,4050912846.10.4020,F/ TIBIAL NAIL 12MMX33.0CM STE,CDM Code,Outpatient,C1713,"$8,198.","$2,028.1032","$7,788.1","$6,558.4","$7,460.18","$2,149.7861","$7,788.1","$2,028.1032","$7,788.1","$7,788.1",$819.8,"$5,595.135","$7,214.24","$7,542.16"
,CDM,4050912872.10.4020,F/ PLATE LC-DCP 2.4MM 6H/51MM,CDM Code,Outpatient,C1713,"$2,921.",$722.6262,"$2,774.95","$2,336.8","$2,658.11",$765.9826,"$2,774.95",$722.6262,"$2,774.95","$2,774.95",$292.1,"$1,993.5825","$2,570.48","$2,687.32"
,CDM,4050912875.10.4020,F/ SCREW CORTEX ST 2.4X14MM,CDM Code,Outpatient,C1713,$655.,$162.0404,$622.25,$524.,$596.05,$171.7626,$622.25,$162.0404,$622.25,$622.25,$65.5,$447.0375,$576.4,$602.6
,CDM,4050912909.10.4020,F/ PUTTY STIMUBLAST CB 5CC,CDM Code,Outpatient,C1713,"$4,571.","$1,130.8197","$4,342.45","$3,656.8","$4,159.61","$1,198.667","$4,342.45","$1,130.8197","$4,342.45","$4,342.45",$457.1,"$3,119.7075","$4,022.48","$4,205.32"
,CDM,4050912914.10.4020,F/ SCREW LCK LOWPROFILE 2.7X16,CDM Code,Outpatient,C1713,"$1,172.",$289.9411,"$1,113.4",$937.6,"$1,066.52",$307.3371,"$1,113.4",$289.9411,"$1,113.4","$1,113.4",$117.2,$799.89,"$1,031.36","$1,078.24"
,CDM,4050912915.10.4020,F/ SCREW LCK LOWPROFILE 2.7X22,CDM Code,Outpatient,C1713,"$1,172.",$289.9411,"$1,113.4",$937.6,"$1,066.52",$307.3371,"$1,113.4",$289.9411,"$1,113.4","$1,113.4",$117.2,$799.89,"$1,031.36","$1,078.24"
,CDM,4050912916.10.4020,F/ SCREW LCK LOWPROFILE 3.5X14,CDM Code,Outpatient,C1713,"$1,231.",$304.5371,"$1,169.45",$984.8,"$1,120.21",$322.8088,"$1,169.45",$304.5371,"$1,169.45","$1,169.45",$123.1,$840.1575,"$1,083.28","$1,132.52"
,CDM,4050912917.10.4020,F/ SCRW LOWPRO 4.0X50MM CANN L,CDM Code,Outpatient,C1713,"$1,676.",$414.6256,"$1,592.2","$1,340.8","$1,525.16",$439.5025,"$1,592.2",$414.6256,"$1,592.2","$1,592.2",$167.6,"$1,143.87","$1,474.88","$1,541.92"
,CDM,4050912918.10.4020,F/ SCRW LOWPRO 4.0X55MM CANN L,CDM Code,Outpatient,C1713,"$1,676.",$414.6256,"$1,592.2","$1,340.8","$1,525.16",$439.5025,"$1,592.2",$414.6256,"$1,592.2","$1,592.2",$167.6,"$1,143.87","$1,474.88","$1,541.92"
,CDM,4050912919.10.4020,F/ PLATE LCK DIST FIB 6H/LT,CDM Code,Outpatient,C1713,"$4,040.",$999.4556,"$3,838.","$3,232.","$3,676.4","$1,059.4213","$3,838.",$999.4556,"$3,838.","$3,838.",$404.,"$2,757.3","$3,555.2","$3,716.8"
,CDM,4050912926.10.4020,F/ SCRW CORT LOW PROFILE 2.4X2,CDM Code,Outpatient,C1713,"$1,185.",$293.1572,"$1,125.75",$948.,"$1,078.35",$310.7461,"$1,125.75",$293.1572,"$1,125.75","$1,125.75",$118.5,$808.7625,"$1,042.8","$1,090.2"
,CDM,4050912927.10.4020,F/ SCRW CORT LOW PROFILE 2.4X3,CDM Code,Outpatient,C1713,"$1,122.",$277.5716,"$1,065.9",$897.6,"$1,021.02",$294.2254,"$1,065.9",$277.5716,"$1,065.9","$1,065.9",$112.2,$765.765,$987.36,"$1,032.24"
,CDM,4050912928.10.4020,F/ SCRW CORT LOW PROFILE 2.4X3,CDM Code,Outpatient,C1713,"$1,122.",$277.5716,"$1,065.9",$897.6,"$1,021.02",$294.2254,"$1,065.9",$277.5716,"$1,065.9","$1,065.9",$112.2,$765.765,$987.36,"$1,032.24"
,CDM,4050912929.10.4020,F/ SCREW VAL TI 2.4X20MM,CDM Code,Outpatient,C1713,"$1,500.",$371.085,"$1,425.","$1,200.","$1,365.",$393.3495,"$1,425.",$371.085,"$1,425.","$1,425.",$150.,"$1,023.75","$1,320.","$1,380."
,CDM,4050912930.10.4020,F/ SCREW VAL TI 2.4X24MM,CDM Code,Outpatient,C1713,"$1,420.",$351.2938,"$1,349.","$1,136.","$1,292.2",$372.3709,"$1,349.",$351.2938,"$1,349.","$1,349.",$142.,$969.15,"$1,249.6","$1,306.4"
,CDM,4050912931.10.4020,F/ SCREW VAL TI 2.4X34MM,CDM Code,Outpatient,C1713,"$1,420.",$351.2938,"$1,349.","$1,136.","$1,292.2",$372.3709,"$1,349.",$351.2938,"$1,349.","$1,349.",$142.,$969.15,"$1,249.6","$1,306.4"
,CDM,4050912932.10.4020,F/ PLATE DIST RAD STYLOID 5H,CDM Code,Outpatient,C1713,"$4,667.","$1,154.5691","$4,433.65","$3,733.6","$4,246.97","$1,223.8414","$4,433.65","$1,154.5691","$4,433.65","$4,433.65",$466.7,"$3,185.2275","$4,106.96","$4,293.64"
,CDM,4050912946.10.4020,F/ SCREW VAL TI 2.4X14MM,CDM Code,Outpatient,C1713,"$1,420.",$351.2938,"$1,349.","$1,136.","$1,292.2",$372.3709,"$1,349.",$351.2938,"$1,349.","$1,349.",$142.,$969.15,"$1,249.6","$1,306.4"
,CDM,4050912947.10.4020,F/ SCREW VAL TI 2.4X16MM,CDM Code,Outpatient,C1713,"$1,420.",$351.2938,"$1,349.","$1,136.","$1,292.2",$372.3709,"$1,349.",$351.2938,"$1,349.","$1,349.",$142.,$969.15,"$1,249.6","$1,306.4"
,CDM,4050912948.10.4020,F/ SCREW VAL TI 2.4X26MM,CDM Code,Outpatient,C1713,"$1,420.",$351.2938,"$1,349.","$1,136.","$1,292.2",$372.3709,"$1,349.",$351.2938,"$1,349.","$1,349.",$142.,$969.15,"$1,249.6","$1,306.4"
,CDM,4050912949.10.4020,F/ SCREW LO-PRO TI 3.5X14MM,CDM Code,Outpatient,C1713,$854.,$211.2711,$811.3,$683.2,$777.14,$223.947,$811.3,$211.2711,$811.3,$811.3,$85.4,$582.855,$751.52,$785.68
,CDM,4050912950.10.4020,F/ SCREW LO-PRO TI 3.5X16MM,CDM Code,Outpatient,C1713,$783.,$193.7064,$743.85,$626.4,$712.53,$205.3284,$743.85,$193.7064,$743.85,$743.85,$78.3,$534.3975,$689.04,$720.36
,CDM,4050912951.10.4020,F/ PLATE DORS DIST RAD TI RT 4,CDM Code,Outpatient,C1713,"$4,430.","$1,095.9377","$4,208.5","$3,544.","$4,031.3","$1,161.6922","$4,208.5","$1,095.9377","$4,208.5","$4,208.5",$443.,"$3,023.475","$3,898.4","$4,075.6"
,CDM,4050912998.10.4020,F/ SCRW LOW PRO CORT 3.5X22MM,CDM Code,Outpatient,C1713,$478.,$118.2524,$454.1,$382.4,$434.98,$125.3474,$454.1,$118.2524,$454.1,$454.1,$47.8,$326.235,$420.64,$439.76
,CDM,4050912999.10.4020,F/ SCRW LOW PRO CANC 4.0X14MM,CDM Code,Outpatient,C1713,$455.,$112.5624,$432.25,$364.,$414.05,$119.316,$432.25,$112.5624,$432.25,$432.25,$45.5,$310.5375,$400.4,$418.6
,CDM,4050913000.10.4020,F/ T-ROPE KNOTLES SYN-DESMOSIS,CDM Code,Outpatient,C1713,"$5,158.","$1,276.0376","$4,900.1","$4,126.4","$4,693.78","$1,352.5978","$4,900.1","$1,276.0376","$4,900.1","$4,900.1",$515.8,"$3,520.335","$4,539.04","$4,745.36"
,CDM,4050913001.10.4020,F/ PLATE 1/3 TUBULAR LCK 8/H S,CDM Code,Outpatient,C1713,"$2,236.",$553.164,"$2,124.2","$1,788.8","$2,034.76",$586.353,"$2,124.2",$553.164,"$2,124.2","$2,124.2",$223.6,"$1,526.07","$1,967.68","$2,057.12"
,CDM,4050913078.10.4020,F/ LENS AU00T0 +11.0 DIOP,CDM Code,Outpatient,V2632,"$1,129.",$279.3033,"$1,072.55",$903.2,"$1,027.39",$296.0611,"$1,072.55",$279.3033,"$1,072.55","$1,072.55",$112.9,$770.5425,$993.52,"$1,038.68"
,CDM,4050913079.10.4020,F/ LENS AU00T0 +17.5 DIOP,CDM Code,Outpatient,V2632,"$1,186.",$293.4045,"$1,126.7",$948.8,"$1,079.26",$311.0083,"$1,126.7",$293.4045,"$1,126.7","$1,126.7",$118.6,$809.445,"$1,043.68","$1,091.12"
,CDM,4050913080.10.4020,F/ LENS AU00T0 +22.0 DIOP,CDM Code,Outpatient,V2632,"$1,186.",$293.4045,"$1,126.7",$948.8,"$1,079.26",$311.0083,"$1,126.7",$293.4045,"$1,126.7","$1,126.7",$118.6,$809.445,"$1,043.68","$1,091.12"
,CDM,4050913081.10.4020,F/ LENS AU00T0 +18.5 DIOP,CDM Code,Outpatient,V2632,"$1,186.",$293.4045,"$1,126.7",$948.8,"$1,079.26",$311.0083,"$1,126.7",$293.4045,"$1,126.7","$1,126.7",$118.6,$809.445,"$1,043.68","$1,091.12"
,CDM,4050913082.10.4020,F/ LENS AU00T0 +20.0 DIOP,CDM Code,Outpatient,V2632,"$1,186.",$293.4045,"$1,126.7",$948.8,"$1,079.26",$311.0083,"$1,126.7",$293.4045,"$1,126.7","$1,126.7",$118.6,$809.445,"$1,043.68","$1,091.12"
,CDM,4050913085.10.4020,F/ LENS AU00T0 +20.5 DIOP,CDM Code,Outpatient,V2632,"$1,148.",$284.0037,"$1,090.6",$918.4,"$1,044.68",$301.0435,"$1,090.6",$284.0037,"$1,090.6","$1,090.6",$114.8,$783.51,"$1,010.24","$1,056.16"
,CDM,4050913088.10.4020,F/ LENS AU00T0 +23.0 DIOP,CDM Code,Outpatient,V2632,"$1,167.",$288.7041,"$1,108.65",$933.6,"$1,061.97",$306.0259,"$1,108.65",$288.7041,"$1,108.65","$1,108.65",$116.7,$796.4775,"$1,026.96","$1,073.64"
,CDM,4050913089.10.4020,F/ LENS AU00T0 +23.5 DIOP,CDM Code,Outpatient,V2632,"$1,186.",$293.4045,"$1,126.7",$948.8,"$1,079.26",$311.0083,"$1,126.7",$293.4045,"$1,126.7","$1,126.7",$118.6,$809.445,"$1,043.68","$1,091.12"
,CDM,4050913090.10.4020,F/ LENS AU00T0 +24.0 DIOP,CDM Code,Outpatient,V2632,"$1,186.",$293.4045,"$1,126.7",$948.8,"$1,079.26",$311.0083,"$1,126.7",$293.4045,"$1,126.7","$1,126.7",$118.6,$809.445,"$1,043.68","$1,091.12"
,CDM,4050913157.10.4020,F/ PLT CLAV CENT THIRD LT SS,CDM Code,Outpatient,C1713,"$3,694.",$913.8587,"$3,509.3","$2,955.2","$3,361.54",$968.6887,"$3,509.3",$913.8587,"$3,509.3","$3,509.3",$369.4,"$2,521.155","$3,250.72","$3,398.48"
,CDM,4050913158.10.4020,F/ SCRW LO-PRO TM SS 2.7X16MM,CDM Code,Outpatient,C1713,$619.,$153.1344,$588.05,$495.2,$563.29,$162.3222,$588.05,$153.1344,$588.05,$588.05,$61.9,$422.4675,$544.72,$569.48
,CDM,4050913159.10.4020,F/ SCRW LO-PRO TM SS 2.7X18MM,CDM Code,Outpatient,C1713,$619.,$153.1344,$588.05,$495.2,$563.29,$162.3222,$588.05,$153.1344,$588.05,$588.05,$61.9,$422.4675,$544.72,$569.48
,CDM,4050913160.10.4020,F/ SCRW LO-PRO TM SS 3.5X12MM,CDM Code,Outpatient,C1713,$480.,$118.7472,$456.,$384.,$436.8,$125.8718,$456.,$118.7472,$456.,$456.,$48.,$327.6,$422.4,$441.6
,CDM,4050913187.10.4020,F/ LENS AU00T0 +10.0 DIOP,CDM Code,Outpatient,V2632,"$1,186.",$293.4045,"$1,126.7",$948.8,"$1,079.26",$311.0083,"$1,126.7",$293.4045,"$1,126.7","$1,126.7",$118.6,$809.445,"$1,043.68","$1,091.12"
,CDM,4050913191.10.4020,F/ LENS AU00T0 +12.5 DIOP,CDM Code,Outpatient,V2632,"$1,129.",$279.3033,"$1,072.55",$903.2,"$1,027.39",$296.0611,"$1,072.55",$279.3033,"$1,072.55","$1,072.55",$112.9,$770.5425,$993.52,"$1,038.68"
,CDM,4050913193.10.4020,F/ LENS AU00T0 +13.0 DIOP,CDM Code,Outpatient,V2632,"$1,186.",$293.4045,"$1,126.7",$948.8,"$1,079.26",$311.0083,"$1,126.7",$293.4045,"$1,126.7","$1,126.7",$118.6,$809.445,"$1,043.68","$1,091.12"
,CDM,4050913194.10.4020,F/ LENS AU00T0 +13.5 DIOP,CDM Code,Outpatient,V2632,"$1,186.",$293.4045,"$1,126.7",$948.8,"$1,079.26",$311.0083,"$1,126.7",$293.4045,"$1,126.7","$1,126.7",$118.6,$809.445,"$1,043.68","$1,091.12"
,CDM,4050913195.10.4020,F/ LENS AU00T0 +14.0 DIOP,CDM Code,Outpatient,V2632,"$1,129.",$279.3033,"$1,072.55",$903.2,"$1,027.39",$296.0611,"$1,072.55",$279.3033,"$1,072.55","$1,072.55",$112.9,$770.5425,$993.52,"$1,038.68"
,CDM,4050913196.10.4020,F/ LENS AU00T0 +14.5 DIOP,CDM Code,Outpatient,V2632,"$1,186.",$293.4045,"$1,126.7",$948.8,"$1,079.26",$311.0083,"$1,126.7",$293.4045,"$1,126.7","$1,126.7",$118.6,$809.445,"$1,043.68","$1,091.12"
,CDM,4050913197.10.4020,F/ LENS AU00T0 +15.0 DIOP,CDM Code,Outpatient,V2632,"$1,186.",$293.4045,"$1,126.7",$948.8,"$1,079.26",$311.0083,"$1,126.7",$293.4045,"$1,126.7","$1,126.7",$118.6,$809.445,"$1,043.68","$1,091.12"
,CDM,4050913198.10.4020,F/ LENS AU00T0 +15.5 DIOP,CDM Code,Outpatient,V2632,"$1,186.",$293.4045,"$1,126.7",$948.8,"$1,079.26",$311.0083,"$1,126.7",$293.4045,"$1,126.7","$1,126.7",$118.6,$809.445,"$1,043.68","$1,091.12"
,CDM,4050913199.10.4020,F/ LENS AU00T0 +16.0 DIOP,CDM Code,Outpatient,V2632,"$1,186.",$293.4045,"$1,126.7",$948.8,"$1,079.26",$311.0083,"$1,126.7",$293.4045,"$1,126.7","$1,126.7",$118.6,$809.445,"$1,043.68","$1,091.12"
,CDM,4050913200.10.4020,F/ LENS AU00T0 +16.5 DIOP,CDM Code,Outpatient,V2632,"$1,186.",$293.4045,"$1,126.7",$948.8,"$1,079.26",$311.0083,"$1,126.7",$293.4045,"$1,126.7","$1,126.7",$118.6,$809.445,"$1,043.68","$1,091.12"
,CDM,4050913202.10.4020,F/ LENS AU00T0 +17.0 DIOP,CDM Code,Outpatient,V2632,"$1,186.",$293.4045,"$1,126.7",$948.8,"$1,079.26",$311.0083,"$1,126.7",$293.4045,"$1,126.7","$1,126.7",$118.6,$809.445,"$1,043.68","$1,091.12"
,CDM,4050913203.10.4020,F/ LENS AU00T0 +18.0 DIOP,CDM Code,Outpatient,V2632,"$1,186.",$293.4045,"$1,126.7",$948.8,"$1,079.26",$311.0083,"$1,126.7",$293.4045,"$1,126.7","$1,126.7",$118.6,$809.445,"$1,043.68","$1,091.12"
,CDM,4050913204.10.4020,F/ LENS AU00T0 +19.0 DIOP,CDM Code,Outpatient,V2632,"$1,186.",$293.4045,"$1,126.7",$948.8,"$1,079.26",$311.0083,"$1,126.7",$293.4045,"$1,126.7","$1,126.7",$118.6,$809.445,"$1,043.68","$1,091.12"
,CDM,4050913205.10.4020,F/ LENS AU00T0 +19.5 DIOP,CDM Code,Outpatient,V2632,"$1,186.",$293.4045,"$1,126.7",$948.8,"$1,079.26",$311.0083,"$1,126.7",$293.4045,"$1,126.7","$1,126.7",$118.6,$809.445,"$1,043.68","$1,091.12"
,CDM,4050913207.10.4020,F/ LENS AU00T0 +21.00 DIOP,CDM Code,Outpatient,V2632,"$1,186.",$293.4045,"$1,126.7",$948.8,"$1,079.26",$311.0083,"$1,126.7",$293.4045,"$1,126.7","$1,126.7",$118.6,$809.445,"$1,043.68","$1,091.12"
,CDM,4050913208.10.4020,F/ LENS AU00T0 +21.5 DIOP,CDM Code,Outpatient,V2632,"$1,186.",$293.4045,"$1,126.7",$948.8,"$1,079.26",$311.0083,"$1,126.7",$293.4045,"$1,126.7","$1,126.7",$118.6,$809.445,"$1,043.68","$1,091.12"
,CDM,4050913209.10.4020,F/ LENS AU00T0 +22.5 DIOP,CDM Code,Outpatient,V2632,"$1,186.",$293.4045,"$1,126.7",$948.8,"$1,079.26",$311.0083,"$1,126.7",$293.4045,"$1,126.7","$1,126.7",$118.6,$809.445,"$1,043.68","$1,091.12"
,CDM,4050913211.10.4020,F/ LENS AU00T0 +24.5 DIOP,CDM Code,Outpatient,V2632,"$1,186.",$293.4045,"$1,126.7",$948.8,"$1,079.26",$311.0083,"$1,126.7",$293.4045,"$1,126.7","$1,126.7",$118.6,$809.445,"$1,043.68","$1,091.12"
,CDM,4050913212.10.4020,F/ LENS AU00T0 +25.0 DIOP,CDM Code,Outpatient,V2632,"$1,186.",$293.4045,"$1,126.7",$948.8,"$1,079.26",$311.0083,"$1,126.7",$293.4045,"$1,126.7","$1,126.7",$118.6,$809.445,"$1,043.68","$1,091.12"
,CDM,4050913213.10.4020,F/ LENS AU00T0 +25.5 DIOP,CDM Code,Outpatient,V2632,"$1,186.",$293.4045,"$1,126.7",$948.8,"$1,079.26",$311.0083,"$1,126.7",$293.4045,"$1,126.7","$1,126.7",$118.6,$809.445,"$1,043.68","$1,091.12"
,CDM,4050913215.10.4020,F/ LENS AU00T0 +26.0 DIOP,CDM Code,Outpatient,V2632,"$1,129.",$279.3033,"$1,072.55",$903.2,"$1,027.39",$296.0611,"$1,072.55",$279.3033,"$1,072.55","$1,072.55",$112.9,$770.5425,$993.52,"$1,038.68"
,CDM,4050913216.10.4020,F/ LENS AU00T0 +26.5 DIOP,CDM Code,Outpatient,V2632,"$1,129.",$279.3033,"$1,072.55",$903.2,"$1,027.39",$296.0611,"$1,072.55",$279.3033,"$1,072.55","$1,072.55",$112.9,$770.5425,$993.52,"$1,038.68"
,CDM,4050913217.10.4020,F/ LENS AU00T0 +27.0 DIOP,CDM Code,Outpatient,V2632,"$1,129.",$279.3033,"$1,072.55",$903.2,"$1,027.39",$296.0611,"$1,072.55",$279.3033,"$1,072.55","$1,072.55",$112.9,$770.5425,$993.52,"$1,038.68"
,CDM,4050913222.10.4020,F/ NAIL TIBIAL 12MMX31.5CM,CDM Code,Outpatient,C1713,"$8,198.","$2,028.1032","$7,788.1","$6,558.4","$7,460.18","$2,149.7861","$7,788.1","$2,028.1032","$7,788.1","$7,788.1",$819.8,"$5,595.135","$7,214.24","$7,542.16"
,CDM,4050913223.10.4020,F/ CORT SCREW 5.5X45MM,CDM Code,Outpatient,C1713,"$1,982.",$490.327,"$1,882.9","$1,585.6","$1,803.62",$519.7458,"$1,882.9",$490.327,"$1,882.9","$1,882.9",$198.2,"$1,352.715","$1,744.16","$1,823.44"
,CDM,4050913227.10.4020,F/ SCRW BIOCOMP INTER FT 11X28,CDM Code,Outpatient,C1713,"$1,982.",$490.327,"$1,882.9","$1,585.6","$1,803.62",$519.7458,"$1,882.9",$490.327,"$1,882.9","$1,882.9",$198.2,"$1,352.715","$1,744.16","$1,823.44"
,CDM,4050913305.10.4020,F/ SCRW CORT SLF TAP 1.3X14MM,CDM Code,Outpatient,C1713,$893.,$220.9193,$848.35,$714.4,$812.63,$234.1741,$848.35,$220.9193,$848.35,$848.35,$89.3,$609.4725,$785.84,$821.56
,CDM,4050913363.10.4020,F/ PLATE DVR CROSSLOCK WIDE LE,CDM Code,Outpatient,C1713,"$4,926.","$1,218.6431","$4,679.7","$3,940.8","$4,482.66","$1,291.7598","$4,679.7","$1,218.6431","$4,679.7","$4,679.7",$492.6,"$3,361.995","$4,334.88","$4,531.92"
,CDM,4050913364.10.4020,F/ PEG LOCKING SMOOTH 2.2X16MM,CDM Code,Outpatient,C1713,"$1,425.",$352.5308,"$1,353.75","$1,140.","$1,296.75",$373.682,"$1,353.75",$352.5308,"$1,353.75","$1,353.75",$142.5,$972.5625,"$1,254.","$1,311."
,CDM,4050913365.10.4020,F/ PEG LOCKING SMOOTH 2.2X18MM,CDM Code,Outpatient,C1713,"$1,425.",$352.5308,"$1,353.75","$1,140.","$1,296.75",$373.682,"$1,353.75",$352.5308,"$1,353.75","$1,353.75",$142.5,$972.5625,"$1,254.","$1,311."
,CDM,4050913366.10.4020,F/ PEG LOCKING SMOOTH 2.2X22MM,CDM Code,Outpatient,C1713,"$1,425.",$352.5308,"$1,353.75","$1,140.","$1,296.75",$373.682,"$1,353.75",$352.5308,"$1,353.75","$1,353.75",$142.5,$972.5625,"$1,254.","$1,311."
,CDM,4050913367.10.4020,F/ PEG LOCKING SMOOTH 2.2X24MM,CDM Code,Outpatient,C1713,"$1,058.",$261.7386,"$1,005.1",$846.4,$962.78,$277.4425,"$1,005.1",$261.7386,"$1,005.1","$1,005.1",$105.8,$722.085,$931.04,$973.36
,CDM,4050913368.10.4020,F/ SCREW NL LOW PROFILE 2.7X14,CDM Code,Outpatient,C1713,$900.,$222.651,$855.,$720.,$819.,$236.0097,$855.,$222.651,$855.,$855.,$90.,$614.25,$792.,$828.
,CDM,4050913372.10.4020,F/ SCREW CORTEX 2.0MM SLF-TP 8,CDM Code,Outpatient,C1713,$578.,$142.9914,$549.1,$462.4,$525.98,$151.5707,$549.1,$142.9914,$549.1,$549.1,$57.8,$394.485,$508.64,$531.76
,CDM,4050913373.10.4020,F/ SCREW CORTEX 2MM SLF-TP 10M,CDM Code,Outpatient,C1713,$578.,$142.9914,$549.1,$462.4,$525.98,$151.5707,$549.1,$142.9914,$549.1,$549.1,$57.8,$394.485,$508.64,$531.76
,CDM,4050913374.10.4020,F/ SCREW CORTEX 2MM SLF-TP 11M,CDM Code,Outpatient,C1713,$578.,$142.9914,$549.1,$462.4,$525.98,$151.5707,$549.1,$142.9914,$549.1,$549.1,$57.8,$394.485,$508.64,$531.76
,CDM,4050913400.10.4020,F/ PLATE 2.4MM VA-LCP 7H HD/5H,CDM Code,Outpatient,C1713,"$5,503.","$1,361.3872","$5,227.85","$4,402.4","$5,007.73","$1,443.0682","$5,227.85","$1,361.3872","$5,227.85","$5,227.85",$550.3,"$3,755.7975","$4,842.64","$5,062.76"
,CDM,4050913404.10.4020,F/ PERI-LOC VLP 3.5X10MM LCK S,CDM Code,Outpatient,C1713,"$1,748.",$432.4377,"$1,660.6","$1,398.4","$1,590.68",$458.3833,"$1,660.6",$432.4377,"$1,660.6","$1,660.6",$174.8,"$1,193.01","$1,538.24","$1,608.16"
,CDM,4050913405.10.4020,F/ PERI-LOC VLP 3.5X16MM LCK S,CDM Code,Outpatient,C1713,"$1,748.",$432.4377,"$1,660.6","$1,398.4","$1,590.68",$458.3833,"$1,660.6",$432.4377,"$1,660.6","$1,660.6",$174.8,"$1,193.01","$1,538.24","$1,608.16"
,CDM,4050913406.10.4020,F/ PERI-LOC VLP 3.5X18MM LCK S,CDM Code,Outpatient,C1713,"$1,748.",$432.4377,"$1,660.6","$1,398.4","$1,590.68",$458.3833,"$1,660.6",$432.4377,"$1,660.6","$1,660.6",$174.8,"$1,193.01","$1,538.24","$1,608.16"
,CDM,4050913447.10.4020,F/ LCP WRIST FUSION S/BENDPLAT,CDM Code,Outpatient,C1713,"$9,625.","$2,381.1287","$9,143.75","$7,700.","$8,758.75","$2,523.9926","$9,143.75","$2,381.1287","$9,143.75","$9,143.75",$962.5,"$6,569.0625","$8,470.","$8,855."
,CDM,4050913449.10.4020,F/ SCRW LO-PRO TM SS 2.7X14MM,CDM Code,Outpatient,C1713,$587.,$145.2179,$557.65,$469.6,$534.17,$153.9308,$557.65,$145.2179,$557.65,$557.65,$58.7,$400.6275,$516.56,$540.04
,CDM,4050913450.10.4020,F/ SCREW LOWPRO NL TM 3.5X18MM,CDM Code,Outpatient,C1713,$480.,$118.7472,$456.,$384.,$436.8,$125.8718,$456.,$118.7472,$456.,$456.,$48.,$327.6,$422.4,$441.6
,CDM,4050913451.10.4020,F/ SCREW LOWPRO NL TM 3.5X20MM,CDM Code,Outpatient,C1713,$480.,$118.7472,$456.,$384.,$436.8,$125.8718,$456.,$118.7472,$456.,$456.,$48.,$327.6,$422.4,$441.6
,CDM,4050913452.10.4020,F/ SCREW LCK LOWPROFILE 3.5X22,CDM Code,Outpatient,C1713,"$1,172.",$289.9411,"$1,113.4",$937.6,"$1,066.52",$307.3371,"$1,113.4",$289.9411,"$1,113.4","$1,113.4",$117.2,$799.89,"$1,031.36","$1,078.24"
,CDM,4050913453.10.4020,F/ SCREW LCK LOWPROFILE 3.5X24,CDM Code,Outpatient,C1713,"$1,172.",$289.9411,"$1,113.4",$937.6,"$1,066.52",$307.3371,"$1,113.4",$289.9411,"$1,113.4","$1,113.4",$117.2,$799.89,"$1,031.36","$1,078.24"
,CDM,4050913456.10.4020,F/ SCREW MULTIDIRECT 2.7X20MM,CDM Code,Outpatient,C1713,"$1,305.",$322.844,"$1,239.75","$1,044.","$1,187.55",$342.2141,"$1,239.75",$322.844,"$1,239.75","$1,239.75",$130.5,$890.6625,"$1,148.4","$1,200.6"
,CDM,4050913465.10.4020,F/ PLATE DVR LOCK NARROW MINI,CDM Code,Outpatient,C1713,"$5,617.","$1,389.5896","$5,336.15","$4,493.6","$5,111.47","$1,472.9628","$5,336.15","$1,389.5896","$5,336.15","$5,336.15",$561.7,"$3,833.6025","$4,942.96","$5,167.64"
,CDM,4050913467.10.4020,F/ PEG LOCKING SMOOTH 2.2X28MM,CDM Code,Outpatient,C1713,"$1,058.",$261.7386,"$1,005.1",$846.4,$962.78,$277.4425,"$1,005.1",$261.7386,"$1,005.1","$1,005.1",$105.8,$722.085,$931.04,$973.36
,CDM,4050913468.10.4020,F/ PEG LOCKING SMOOTH 2.2X30MM,CDM Code,Outpatient,C1713,"$1,058.",$261.7386,"$1,005.1",$846.4,$962.78,$277.4425,"$1,005.1",$261.7386,"$1,005.1","$1,005.1",$105.8,$722.085,$931.04,$973.36
,CDM,4050913469.10.4020,F/ SCREW NL LOW PROFILE 2.7X18,CDM Code,Outpatient,C1713,$691.,$170.9465,$656.45,$552.8,$628.81,$181.203,$656.45,$170.9465,$656.45,$656.45,$69.1,$471.6075,$608.08,$635.72
,CDM,4050913470.10.4020,F/ SCREW NL LOW PROFILE 2.7X20,CDM Code,Outpatient,C1713,$691.,$170.9465,$656.45,$552.8,$628.81,$181.203,$656.45,$170.9465,$656.45,$656.45,$69.1,$471.6075,$608.08,$635.72
,CDM,4050913471.10.4020,F/ SCREW NL LOW PROFILE 2.7X24,CDM Code,Outpatient,C1713,$825.,$204.0967,$783.75,$660.,$750.75,$216.3422,$783.75,$204.0967,$783.75,$783.75,$82.5,$563.0625,$726.,$759.
,CDM,4050913475.10.4020,F/ GRAFTBOLT TIBIAL 8MM,CDM Code,Outpatient,C1713,"$2,769.",$685.0229,"$2,630.55","$2,215.2","$2,519.79",$726.1232,"$2,630.55",$685.0229,"$2,630.55","$2,630.55",$276.9,"$1,889.8425","$2,436.72","$2,547.48"
,CDM,4050913495.10.4020,F/ PLATE 3.5 VA LCP PT 4H/87MM,CDM Code,Outpatient,C1713,"$8,787.","$2,173.8159","$8,347.65","$7,029.6","$7,996.17","$2,304.2414","$8,347.65","$2,173.8159","$8,347.65","$8,347.65",$878.7,"$5,997.1275","$7,732.56","$8,084.04"
,CDM,4050913496.10.4020,F/ SCREW 3.5X70MM ST LCKG,CDM Code,Outpatient,C1713,"$1,697.",$419.8208,"$1,612.15","$1,357.6","$1,544.27",$445.0094,"$1,612.15",$419.8208,"$1,612.15","$1,612.15",$169.7,"$1,158.2025","$1,493.36","$1,561.24"
,CDM,4050913497.10.4020,F/ SCREW 3.5X75MM ST LCKG,CDM Code,Outpatient,C1713,"$1,663.",$411.4096,"$1,579.85","$1,330.4","$1,513.33",$436.0935,"$1,579.85",$411.4096,"$1,579.85","$1,579.85",$166.3,"$1,134.9975","$1,463.44","$1,529.96"
,CDM,4050913523.10.4020,F/ 2.4MM TI CORTEX STSCRW 12MM,CDM Code,Outpatient,C1713,$888.,$219.6823,$843.6,$710.4,$808.08,$232.8629,$843.6,$219.6823,$843.6,$843.6,$88.8,$606.06,$781.44,$816.96
,CDM,4050913525.10.4020,F/ 2.4MM TI LCDCP PLATE 6H/47M,CDM Code,Outpatient,C1713,"$2,688.",$664.9843,"$2,553.6","$2,150.4","$2,446.08",$704.8823,"$2,553.6",$664.9843,"$2,553.6","$2,553.6",$268.8,"$1,834.56","$2,365.44","$2,472.96"
,CDM,4050913527.10.4020,F/ 2.4MM TI CORTEX STSCRW 14MM,CDM Code,Outpatient,C1713,$888.,$219.6823,$843.6,$710.4,$808.08,$232.8629,$843.6,$219.6823,$843.6,$843.6,$88.8,$606.06,$781.44,$816.96
,CDM,4050913528.10.4020,F/ 2.4MM TI CORTEX STSCRW 10MM,CDM Code,Outpatient,C1713,$888.,$219.6823,$843.6,$710.4,$808.08,$232.8629,$843.6,$219.6823,$843.6,$843.6,$88.8,$606.06,$781.44,$816.96
,CDM,4050913569.10.4020,F/ 3.5MM VA-LCP PRX TIBPT8H/14,CDM Code,Outpatient,C1713,"$8,042.","$1,989.5104","$7,639.9","$6,433.6","$7,318.22","$2,108.8778","$7,639.9","$1,989.5104","$7,639.9","$7,639.9",$804.2,"$5,488.665","$7,076.96","$7,398.64"
,CDM,4050913571.10.4020,F/ SCREW 3.5X65MM ST LCKG,CDM Code,Outpatient,C1713,"$1,782.",$440.849,"$1,692.9","$1,425.6","$1,621.62",$467.2992,"$1,692.9",$440.849,"$1,692.9","$1,692.9",$178.2,"$1,216.215","$1,568.16","$1,639.44"
,CDM,4050913611.10.4020,F/ 2.7MMX24MM VA LOCKING SCREW,CDM Code,Outpatient,C1713,"$1,482.",$366.632,"$1,407.9","$1,185.6","$1,348.62",$388.6293,"$1,407.9",$366.632,"$1,407.9","$1,407.9",$148.2,"$1,011.465","$1,304.16","$1,363.44"
,CDM,4050913628.10.4020,F/ LENS ZXR00 +9.5 SYMFONY RES,CDM Code,Outpatient,V2788GY,$845.,$209.0445,$802.75,$676.,$768.95,$221.5869,$802.75,$209.0445,$802.75,$802.75,$84.5,$576.7125,$743.6,$777.4
,CDM,4050913643.10.4020,F/ TRIGEN 11.5MMX38CM 125 NAIL,CDM Code,Outpatient,C1713,"$12,245.","$3,029.2906","$11,632.75","$9,796.","$11,142.95","$3,211.0431","$11,632.75","$3,029.2906","$11,632.75","$11,632.75","$1,224.5","$8,357.2125","$10,775.6","$11,265.4"
,CDM,4050913649.10.4020,F/ INTERTAN ST LAG SCRW 11MMX9,CDM Code,Outpatient,C1713,"$4,226.","$1,045.4701","$4,014.7","$3,380.8","$3,845.66","$1,108.1967","$4,014.7","$1,045.4701","$4,014.7","$4,014.7",$422.6,"$2,884.245","$3,718.88","$3,887.92"
,CDM,4050913650.10.4020,F/ TRIGEN LP SCRW 5MMX30MM,CDM Code,Outpatient,C1713,"$2,509.",$620.7015,"$2,383.55","$2,007.2","$2,283.19",$657.9426,"$2,383.55",$620.7015,"$2,383.55","$2,383.55",$250.9,"$1,712.3925","$2,207.92","$2,308.28"
,CDM,4050913693.10.4020,F/ PLATE 5H/140MM PRX TIBLISS,CDM Code,Outpatient,C1713,"$7,743.","$1,915.5408","$7,355.85","$6,194.4","$7,046.13","$2,030.4701","$7,355.85","$1,915.5408","$7,355.85","$7,355.85",$774.3,"$5,284.5975","$6,813.84","$7,123.56"
,CDM,4050913695.10.4020,F/ SCREW LC ST 5.0MMX32MM 413.,CDM Code,Outpatient,C1713,"$2,000.",$494.78,"$1,900.","$1,600.","$1,820.",$524.466,"$1,900.",$494.78,"$1,900.","$1,900.",$200.,"$1,365.","$1,760.","$1,840."
,CDM,4050913697.10.4020,F/ SCREW LC ST 5.0MMX65MM 413.,CDM Code,Outpatient,C1713,"$2,000.",$494.78,"$1,900.","$1,600.","$1,820.",$524.466,"$1,900.",$494.78,"$1,900.","$1,900.",$200.,"$1,365.","$1,760.","$1,840."
,CDM,4050913698.10.4020,F/ SCREW LC ST 5.0MMX70MM 413.,CDM Code,Outpatient,C1713,"$2,000.",$494.78,"$1,900.","$1,600.","$1,820.",$524.466,"$1,900.",$494.78,"$1,900.","$1,900.",$200.,"$1,365.","$1,760.","$1,840."
,CDM,4050913702.10.4020,F/ SCREW BLUNT 5.0MMX200MM SCH,CDM Code,Outpatient,C1713,"$1,243.",$307.5058,"$1,180.85",$994.4,"$1,131.13",$325.9556,"$1,180.85",$307.5058,"$1,180.85","$1,180.85",$124.3,$848.3475,"$1,093.84","$1,143.56"
,CDM,4050913710.10.4020,F/ PL HUML STD PROX 3.5MM LCP,CDM Code,Outpatient,C1713,"$8,304.","$2,054.3266","$7,888.8","$6,643.2","$7,556.64","$2,177.5828","$7,888.8","$2,054.3266","$7,888.8","$7,888.8",$830.4,"$5,667.48","$7,307.52","$7,639.68"
,CDM,4050913716.10.4020,F/ SCRW CORT LOW PROFILE 2.4X8,CDM Code,Outpatient,C1713,"$1,122.",$277.5716,"$1,065.9",$897.6,"$1,021.02",$294.2254,"$1,065.9",$277.5716,"$1,065.9","$1,065.9",$112.2,$765.765,$987.36,"$1,032.24"
,CDM,4050913717.10.4020,F/ SCRW CORT LOW PROFILE 2.4X1,CDM Code,Outpatient,C1713,"$1,122.",$277.5716,"$1,065.9",$897.6,"$1,021.02",$294.2254,"$1,065.9",$277.5716,"$1,065.9","$1,065.9",$112.2,$765.765,$987.36,"$1,032.24"
,CDM,4050913718.10.4020,F/ SCRW CORT LOW PROFILE 2.4X1,CDM Code,Outpatient,C1713,"$1,122.",$277.5716,"$1,065.9",$897.6,"$1,021.02",$294.2254,"$1,065.9",$277.5716,"$1,065.9","$1,065.9",$112.2,$765.765,$987.36,"$1,032.24"
,CDM,4050913719.10.4020,F/ SCRW CORT LOW PROFILE 2.4X2,CDM Code,Outpatient,C1713,"$1,122.",$277.5716,"$1,065.9",$897.6,"$1,021.02",$294.2254,"$1,065.9",$277.5716,"$1,065.9","$1,065.9",$112.2,$765.765,$987.36,"$1,032.24"
,CDM,4050913722.10.4020,F/ PLATE HOOK UNIV 5TH METARSA,CDM Code,Outpatient,C1713,"$5,156.","$1,275.5428","$4,898.2","$4,124.8","$4,691.96","$1,352.0733","$4,898.2","$1,275.5428","$4,898.2","$4,898.2",$515.6,"$3,518.97","$4,537.28","$4,743.52"
,CDM,4050913723.10.4020,F/ SCREW 2.7X32MM SLF TAP LCK,CDM Code,Outpatient,C1713,"$1,482.",$366.632,"$1,407.9","$1,185.6","$1,348.62",$388.6293,"$1,407.9",$366.632,"$1,407.9","$1,407.9",$148.2,"$1,011.465","$1,304.16","$1,363.44"
,CDM,4050913724.10.4020,F/ SCREW 2.7X50MM SLF TAP LCK,CDM Code,Outpatient,C1713,"$1,598.",$395.3292,"$1,518.1","$1,278.4","$1,454.18",$419.0483,"$1,518.1",$395.3292,"$1,518.1","$1,518.1",$159.8,"$1,090.635","$1,406.24","$1,470.16"
,CDM,4050913725.10.4020,F/ PLATE OLCECRANON 2.7/3.5 2H,CDM Code,Outpatient,C1713,"$6,304.","$1,559.5466","$5,988.8","$5,043.2","$5,736.64","$1,653.1168","$5,988.8","$1,559.5466","$5,988.8","$5,988.8",$630.4,"$4,302.48","$5,547.52","$5,799.68"
,CDM,4050913755.10.4020,F/ CLAV FRAC PLT CENT THIRD RT,CDM Code,Outpatient,C1713,"$3,694.",$913.8587,"$3,509.3","$2,955.2","$3,361.54",$968.6887,"$3,509.3",$913.8587,"$3,509.3","$3,509.3",$369.4,"$2,521.155","$3,250.72","$3,398.48"
,CDM,4050913772.10.4020,F/ SCREW CORT ST NCB 5X34MM,CDM Code,Outpatient,C1713,"$1,307.",$323.3387,"$1,241.65","$1,045.6","$1,189.37",$342.7385,"$1,241.65",$323.3387,"$1,241.65","$1,241.65",$130.7,$892.0275,"$1,150.16","$1,202.44"
,CDM,4050913773.10.4020,F/ SCREW CORT ST NCB 5X36MM,CDM Code,Outpatient,C1713,"$1,307.",$323.3387,"$1,241.65","$1,045.6","$1,189.37",$342.7385,"$1,241.65",$323.3387,"$1,241.65","$1,241.65",$130.7,$892.0275,"$1,150.16","$1,202.44"
,CDM,4050913774.10.4020,F/ SCREW CORT ST NCB 5X30MM,CDM Code,Outpatient,C1713,"$1,237.",$306.0214,"$1,175.15",$989.6,"$1,125.67",$324.3822,"$1,175.15",$306.0214,"$1,175.15","$1,175.15",$123.7,$844.2525,"$1,088.56","$1,138.04"
,CDM,4050913775.10.4020,F/ SCREW CORT ST NCB 5X30MM,CDM Code,Outpatient,C1713,"$1,237.",$306.0214,"$1,175.15",$989.6,"$1,125.67",$324.3822,"$1,175.15",$306.0214,"$1,175.15","$1,175.15",$123.7,$844.2525,"$1,088.56","$1,138.04"
,CDM,4050913776.10.4020,F/ SCREW CORT ST NCB 5X75MM,CDM Code,Outpatient,C1713,"$1,237.",$306.0214,"$1,175.15",$989.6,"$1,125.67",$324.3822,"$1,175.15",$306.0214,"$1,175.15","$1,175.15",$123.7,$844.2525,"$1,088.56","$1,138.04"
,CDM,4050913777.10.4020,F/ SCREW CORT ST NCB 5X80MM,CDM Code,Outpatient,C1713,"$1,237.",$306.0214,"$1,175.15",$989.6,"$1,125.67",$324.3822,"$1,175.15",$306.0214,"$1,175.15","$1,175.15",$123.7,$844.2525,"$1,088.56","$1,138.04"
,CDM,4050913778.10.4020,F/ SCREW CAP LOCKING NCB,CDM Code,Outpatient,C1713,"$1,196.",$295.8784,"$1,136.2",$956.8,"$1,088.36",$313.6307,"$1,136.2",$295.8784,"$1,136.2","$1,136.2",$119.6,$816.27,"$1,052.48","$1,100.32"
,CDM,4050913779.10.4020,F/ PLATE DISTALFEMUR LFT 9H 24,CDM Code,Outpatient,C1713,"$5,784.","$1,430.9038","$5,494.8","$4,627.2","$5,263.44","$1,516.7557","$5,494.8","$1,430.9038","$5,494.8","$5,494.8",$578.4,"$3,947.58","$5,089.92","$5,321.28"
,CDM,4050913780.10.4020,F/ LENS SN60WF +28.5 DIOP,CDM Code,Outpatient,V2632,"$1,060.",$262.2334,"$1,007.",$848.,$964.6,$277.967,"$1,007.",$262.2334,"$1,007.","$1,007.",$106.,$723.45,$932.8,$975.2
,CDM,4050913786.10.4020,F/ CLAV FRAC PLT CENT THIRD RT,CDM Code,Outpatient,C1713,"$4,982.","$1,232.497","$4,732.9","$3,985.6","$4,533.62","$1,306.4448","$4,732.9","$1,232.497","$4,732.9","$4,732.9",$498.2,"$3,400.215","$4,384.16","$4,583.44"
,CDM,4050913787.10.4020,F/ SCRW LO-PRO TM SS 2.7X22MM,CDM Code,Outpatient,C1713,$587.,$145.2179,$557.65,$469.6,$534.17,$153.9308,$557.65,$145.2179,$557.65,$557.65,$58.7,$400.6275,$516.56,$540.04
,CDM,4050913788.10.4020,F/ SCREW LCK LOWPROFILE 3.5X16,CDM Code,Outpatient,C1713,"$1,172.",$289.9411,"$1,113.4",$937.6,"$1,066.52",$307.3371,"$1,113.4",$289.9411,"$1,113.4","$1,113.4",$117.2,$799.89,"$1,031.36","$1,078.24"
,CDM,4050913802.10.4020,F/ 1.5MM TI CORTEX SCREW ST 8M,CDM Code,Outpatient,C1713,$595.,$147.197,$565.25,$476.,$541.45,$156.0286,$565.25,$147.197,$565.25,$565.25,$59.5,$406.0875,$523.6,$547.4
,CDM,4050913810.10.4020,F/ LENS PCB00 +15.5 TECNIS ITE,CDM Code,Outpatient,V2632,$878.,$217.2084,$834.1,$702.4,$798.98,$230.2406,$834.1,$217.2084,$834.1,$834.1,$87.8,$599.235,$772.64,$807.76
,CDM,4050913811.10.4020,F/ LENS PCB00 +18.5 TECNIS ITE,CDM Code,Outpatient,V2632,$878.,$217.2084,$834.1,$702.4,$798.98,$230.2406,$834.1,$217.2084,$834.1,$834.1,$87.8,$599.235,$772.64,$807.76
,CDM,4050913812.10.4020,F/ LENS PCB00 +22.5 TECNIS ITE,CDM Code,Outpatient,V2632,$878.,$217.2084,$834.1,$702.4,$798.98,$230.2406,$834.1,$217.2084,$834.1,$834.1,$87.8,$599.235,$772.64,$807.76
,CDM,4050913813.10.4020,F/ LENS PCB00 +20.0 TECNIS ITE,CDM Code,Outpatient,V2632,$878.,$217.2084,$834.1,$702.4,$798.98,$230.2406,$834.1,$217.2084,$834.1,$834.1,$87.8,$599.235,$772.64,$807.76
,CDM,4050913814.10.4020,F/ LENS PCB00 +23.0 TECNIS ITE,CDM Code,Outpatient,V2632,$878.,$217.2084,$834.1,$702.4,$798.98,$230.2406,$834.1,$217.2084,$834.1,$834.1,$87.8,$599.235,$772.64,$807.76
,CDM,4050913815.10.4020,F/ LENS ZA9003 +15.0 TECNIS AC,CDM Code,Outpatient,V2632,"$1,043.",$258.0278,$990.85,$834.4,$949.13,$273.509,$990.85,$258.0278,$990.85,$990.85,$104.3,$711.8475,$917.84,$959.56
,CDM,4050913817.10.4020,F/ LENS ZA9003 +21.5 TECNIS AC,CDM Code,Outpatient,V2632,"$1,043.",$258.0278,$990.85,$834.4,$949.13,$273.509,$990.85,$258.0278,$990.85,$990.85,$104.3,$711.8475,$917.84,$959.56
,CDM,4050913818.10.4020,F/ LENS ZA9003 +19.0 TECNIS AC,CDM Code,Outpatient,V2632,"$1,043.",$258.0278,$990.85,$834.4,$949.13,$273.509,$990.85,$258.0278,$990.85,$990.85,$104.3,$711.8475,$917.84,$959.56
,CDM,4050913819.10.4020,F/ LENS ZA9003 +22.0 TECNIS AC,CDM Code,Outpatient,V2632,"$1,043.",$258.0278,$990.85,$834.4,$949.13,$273.509,$990.85,$258.0278,$990.85,$990.85,$104.3,$711.8475,$917.84,$959.56
,CDM,4050913849.10.4020,F/ PLATE SHOULDER S3 4H/RT SSP,CDM Code,Outpatient,C1713,"$8,569.","$2,119.8849","$8,140.55","$6,855.2","$7,797.79","$2,247.0746","$8,140.55","$2,119.8849","$8,140.55","$8,140.55",$856.9,"$5,848.3425","$7,540.72","$7,883.48"
,CDM,4050913850.10.4020,F/ SCREW MULTI DIREC 3.8X30MM,CDM Code,Outpatient,C1713,"$1,350.",$333.9765,"$1,282.5","$1,080.","$1,228.5",$354.0145,"$1,282.5",$333.9765,"$1,282.5","$1,282.5",$135.,$921.375,"$1,188.","$1,242."
,CDM,4050913854.10.4020,F/ CORT SCREW FA 5.0X35 Z NAIL,CDM Code,Outpatient,C1713,"$1,557.",$385.1862,"$1,479.15","$1,245.6","$1,416.87",$408.2968,"$1,479.15",$385.1862,"$1,479.15","$1,479.15",$155.7,"$1,062.6525","$1,370.16","$1,432.44"
,CDM,4050913856.10.4020,F/ PIN THREADED 3.0MMX305MM,CDM Code,Outpatient,C1713,$926.,$229.0831,$879.7,$740.8,$842.66,$242.8278,$879.7,$229.0831,$879.7,$879.7,$92.6,$631.995,$814.88,$851.92
,CDM,4050913860.10.4020,F/ LENS PCB00 +21.0 TECNIS ITE,CDM Code,Outpatient,V2632,$878.,$217.2084,$834.1,$702.4,$798.98,$230.2406,$834.1,$217.2084,$834.1,$834.1,$87.8,$599.235,$772.64,$807.76
,CDM,4050913861.10.4020,F/ LENS PCB00 +16.0 TECNIS ITE,CDM Code,Outpatient,V2632,$878.,$217.2084,$834.1,$702.4,$798.98,$230.2406,$834.1,$217.2084,$834.1,$834.1,$87.8,$599.235,$772.64,$807.76
,CDM,4050913862.10.4020,F/ LENS PCB00 +17.5 TECNIS ITE,CDM Code,Outpatient,V2632,$878.,$217.2084,$834.1,$702.4,$798.98,$230.2406,$834.1,$217.2084,$834.1,$834.1,$87.8,$599.235,$772.64,$807.76
,CDM,4050913863.10.4020,F/ LENS PCB00 +14.5 TECNIS ITE,CDM Code,Outpatient,V2632,$878.,$217.2084,$834.1,$702.4,$798.98,$230.2406,$834.1,$217.2084,$834.1,$834.1,$87.8,$599.235,$772.64,$807.76
,CDM,4050913865.10.4020,F/ LENS ZA9003 +15.5 TECNIS AC,CDM Code,Outpatient,V2632,"$1,043.",$258.0278,$990.85,$834.4,$949.13,$273.509,$990.85,$258.0278,$990.85,$990.85,$104.3,$711.8475,$917.84,$959.56
,CDM,4050913872.10.4020,F/ FEMORAL IMPL 10X29MM APERFI,CDM Code,Outpatient,C1776,"$5,699.","$1,409.8756","$5,414.05","$4,559.2","$5,186.09","$1,494.4659","$5,414.05","$1,409.8756","$5,414.05","$5,414.05",$569.9,"$3,889.5675","$5,015.12","$5,243.08"
,CDM,4050913873.10.4020,F/ TIBIAL CANN PEEK IMPL 10X30,CDM Code,Outpatient,C1776,"$3,381.",$836.4256,"$3,211.95","$2,704.8","$3,076.71",$886.6098,"$3,211.95",$836.4256,"$3,211.95","$3,211.95",$338.1,"$2,307.5325","$2,975.28","$3,110.52"
,CDM,4050913878.10.4020,F/ LENS PCBOO +21.5 TECNIS ITE,CDM Code,Outpatient,V2632,$878.,$217.2084,$834.1,$702.4,$798.98,$230.2406,$834.1,$217.2084,$834.1,$834.1,$87.8,$599.235,$772.64,$807.76
,CDM,4050913879.10.4020,F/ LENS ZA9003 20.5 TECNIS ACR,CDM Code,Outpatient,V2632,"$1,043.",$258.0278,$990.85,$834.4,$949.13,$273.509,$990.85,$258.0278,$990.85,$990.85,$104.3,$711.8475,$917.84,$959.56
,CDM,4050913880.10.4020,F/ GRAFT TIBIALIS ANTERIOR ASP,CDM Code,Outpatient,L8699,"$6,765.","$1,673.5934","$6,426.75","$5,412.","$6,156.15","$1,774.0062","$6,426.75","$1,673.5934","$6,426.75","$6,426.75",$676.5,"$4,617.1125","$5,953.2","$6,223.8"
,CDM,4050913881.10.4020,F/ LENS PCB00 +10.0 TECNIS ITE,CDM Code,Outpatient,V2632,$878.,$217.2084,$834.1,$702.4,$798.98,$230.2406,$834.1,$217.2084,$834.1,$834.1,$87.8,$599.235,$772.64,$807.76
,CDM,4050913882.10.4020,F/ LENS PCB00 +10.5 TECNIS ITE,CDM Code,Outpatient,V2632,$878.,$217.2084,$834.1,$702.4,$798.98,$230.2406,$834.1,$217.2084,$834.1,$834.1,$87.8,$599.235,$772.64,$807.76
,CDM,4050913883.10.4020,F/ LENS PCB00 +11.0 TECNIS ITE,CDM Code,Outpatient,V2632,$878.,$217.2084,$834.1,$702.4,$798.98,$230.2406,$834.1,$217.2084,$834.1,$834.1,$87.8,$599.235,$772.64,$807.76
,CDM,4050913884.10.4020,F/ LENS PCB00 +11.5 TECNIS ITE,CDM Code,Outpatient,V2632,$878.,$217.2084,$834.1,$702.4,$798.98,$230.2406,$834.1,$217.2084,$834.1,$834.1,$87.8,$599.235,$772.64,$807.76
,CDM,4050913885.10.4020,F/ LENS PCB00 +12.0 TECNIS ITE,CDM Code,Outpatient,V2632,$878.,$217.2084,$834.1,$702.4,$798.98,$230.2406,$834.1,$217.2084,$834.1,$834.1,$87.8,$599.235,$772.64,$807.76
,CDM,4050913886.10.4020,F/ LENS PCB00 +12.5 TECNIS ITE,CDM Code,Outpatient,V2632,$878.,$217.2084,$834.1,$702.4,$798.98,$230.2406,$834.1,$217.2084,$834.1,$834.1,$87.8,$599.235,$772.64,$807.76
,CDM,4050913887.10.4020,F/ LENS PCB00 +13.0 TECNIS ITE,CDM Code,Outpatient,V2632,$878.,$217.2084,$834.1,$702.4,$798.98,$230.2406,$834.1,$217.2084,$834.1,$834.1,$87.8,$599.235,$772.64,$807.76
,CDM,4050913888.10.4020,F/ LENS PCB00 +13.5 TECNIS ITE,CDM Code,Outpatient,V2632,$878.,$217.2084,$834.1,$702.4,$798.98,$230.2406,$834.1,$217.2084,$834.1,$834.1,$87.8,$599.235,$772.64,$807.76
,CDM,4050913889.10.4020,F/ LENS PCB00 +14.0 TECNIS ITE,CDM Code,Outpatient,V2632,$878.,$217.2084,$834.1,$702.4,$798.98,$230.2406,$834.1,$217.2084,$834.1,$834.1,$87.8,$599.235,$772.64,$807.76
,CDM,4050913890.10.4020,F/ LENS PCB00 +15.0 TECNIS ITE,CDM Code,Outpatient,V2632,$878.,$217.2084,$834.1,$702.4,$798.98,$230.2406,$834.1,$217.2084,$834.1,$834.1,$87.8,$599.235,$772.64,$807.76
,CDM,4050913891.10.4020,F/ LENS PCB00 +16.5 TECNIS ITE,CDM Code,Outpatient,V2632,$878.,$217.2084,$834.1,$702.4,$798.98,$230.2406,$834.1,$217.2084,$834.1,$834.1,$87.8,$599.235,$772.64,$807.76
,CDM,4050913892.10.4020,F/ LENS PCB00 +17.0 TECNIS ITE,CDM Code,Outpatient,V2632,$878.,$217.2084,$834.1,$702.4,$798.98,$230.2406,$834.1,$217.2084,$834.1,$834.1,$87.8,$599.235,$772.64,$807.76
,CDM,4050913893.10.4020,F/ LENS PCB00 +18.0 TECNIS ITE,CDM Code,Outpatient,V2632,$878.,$217.2084,$834.1,$702.4,$798.98,$230.2406,$834.1,$217.2084,$834.1,$834.1,$87.8,$599.235,$772.64,$807.76
,CDM,4050913894.10.4020,F/ LENS PCB00 +19.0 TECNIS ITE,CDM Code,Outpatient,V2632,$878.,$217.2084,$834.1,$702.4,$798.98,$230.2406,$834.1,$217.2084,$834.1,$834.1,$87.8,$599.235,$772.64,$807.76
,CDM,4050913895.10.4020,F/ LENS PCB00 +19.5 TECNIS ITE,CDM Code,Outpatient,V2632,$878.,$217.2084,$834.1,$702.4,$798.98,$230.2406,$834.1,$217.2084,$834.1,$834.1,$87.8,$599.235,$772.64,$807.76
,CDM,4050913896.10.4020,F/ LENS PCB00 +20.5 TECNIS ITE,CDM Code,Outpatient,V2632,$878.,$217.2084,$834.1,$702.4,$798.98,$230.2406,$834.1,$217.2084,$834.1,$834.1,$87.8,$599.235,$772.64,$807.76
,CDM,4050913897.10.4020,F/ LENS PCB00 +22.0 TECNIS ITE,CDM Code,Outpatient,V2632,$878.,$217.2084,$834.1,$702.4,$798.98,$230.2406,$834.1,$217.2084,$834.1,$834.1,$87.8,$599.235,$772.64,$807.76
,CDM,4050913898.10.4020,F/ LENS PCB00 +23.5 TECNIS ITE,CDM Code,Outpatient,V2632,$878.,$217.2084,$834.1,$702.4,$798.98,$230.2406,$834.1,$217.2084,$834.1,$834.1,$87.8,$599.235,$772.64,$807.76
,CDM,4050913899.10.4020,F/ LENS PCB00 +24.0 TECNIS ITE,CDM Code,Outpatient,V2632,$878.,$217.2084,$834.1,$702.4,$798.98,$230.2406,$834.1,$217.2084,$834.1,$834.1,$87.8,$599.235,$772.64,$807.76
,CDM,4050913900.10.4020,F/ LENS PCB00 +24.5 TECNIS ITE,CDM Code,Outpatient,V2632,$878.,$217.2084,$834.1,$702.4,$798.98,$230.2406,$834.1,$217.2084,$834.1,$834.1,$87.8,$599.235,$772.64,$807.76
,CDM,4050913901.10.4020,F/ LENS PCB00 +25.0 TECNIS ITE,CDM Code,Outpatient,V2632,$878.,$217.2084,$834.1,$702.4,$798.98,$230.2406,$834.1,$217.2084,$834.1,$834.1,$87.8,$599.235,$772.64,$807.76
,CDM,4050913902.10.4020,F/ LENS PCB00 +25.5 TECNIS ITE,CDM Code,Outpatient,V2632,$878.,$217.2084,$834.1,$702.4,$798.98,$230.2406,$834.1,$217.2084,$834.1,$834.1,$87.8,$599.235,$772.64,$807.76
,CDM,4050913903.10.4020,F/ LENS PCB00 +26.0 TECNIS ITE,CDM Code,Outpatient,V2632,$878.,$217.2084,$834.1,$702.4,$798.98,$230.2406,$834.1,$217.2084,$834.1,$834.1,$87.8,$599.235,$772.64,$807.76
,CDM,4050913904.10.4020,F/ LENS PCB00 +26.5 TECNIS ITE,CDM Code,Outpatient,V2632,$878.,$217.2084,$834.1,$702.4,$798.98,$230.2406,$834.1,$217.2084,$834.1,$834.1,$87.8,$599.235,$772.64,$807.76
,CDM,4050913906.10.4020,F/ LENS PCB00 +27.5 TECNIS ITE,CDM Code,Outpatient,V2632,$878.,$217.2084,$834.1,$702.4,$798.98,$230.2406,$834.1,$217.2084,$834.1,$834.1,$87.8,$599.235,$772.64,$807.76
,CDM,4050913910.10.4020,F/ LENS PCB00 +29.5 TECNIS ITE,CDM Code,Outpatient,V2632,$878.,$217.2084,$834.1,$702.4,$798.98,$230.2406,$834.1,$217.2084,$834.1,$834.1,$87.8,$599.235,$772.64,$807.76
,CDM,4050913911.10.4020,F/ LENS PCB00 +30.0 TECNIS ITE,CDM Code,Outpatient,V2632,$878.,$217.2084,$834.1,$702.4,$798.98,$230.2406,$834.1,$217.2084,$834.1,$834.1,$87.8,$599.235,$772.64,$807.76
,CDM,4050913918.10.4020,F/ LENS ZA9003 +13.0 TECNIS AC,CDM Code,Outpatient,V2632,"$1,043.",$258.0278,$990.85,$834.4,$949.13,$273.509,$990.85,$258.0278,$990.85,$990.85,$104.3,$711.8475,$917.84,$959.56
,CDM,4050913922.10.4020,F/ LENS ZA9003 +16.5 TECNIS AC,CDM Code,Outpatient,V2632,"$1,043.",$258.0278,$990.85,$834.4,$949.13,$273.509,$990.85,$258.0278,$990.85,$990.85,$104.3,$711.8475,$917.84,$959.56
,CDM,4050913925.10.4020,F/ LENS ZA9003 +19.5 TECNIS AC,CDM Code,Outpatient,V2632,"$1,043.",$258.0278,$990.85,$834.4,$949.13,$273.509,$990.85,$258.0278,$990.85,$990.85,$104.3,$711.8475,$917.84,$959.56
,CDM,4050913926.10.4020,F/ LENS ZA9003 +21.0 TECNIS AC,CDM Code,Outpatient,V2632,"$1,043.",$258.0278,$990.85,$834.4,$949.13,$273.509,$990.85,$258.0278,$990.85,$990.85,$104.3,$711.8475,$917.84,$959.56
,CDM,4050913928.10.4020,F/ LENS ZA9003 +23.0 TECNIS AC,CDM Code,Outpatient,V2632,"$1,043.",$258.0278,$990.85,$834.4,$949.13,$273.509,$990.85,$258.0278,$990.85,$990.85,$104.3,$711.8475,$917.84,$959.56
,CDM,4050913958.10.4020,F/ SCREW LP CORT 3.5MMX18MM,CDM Code,Outpatient,C1713,$825.,$204.0967,$783.75,$660.,$750.75,$216.3422,$783.75,$204.0967,$783.75,$783.75,$82.5,$563.0625,$726.,$759.
,CDM,4050913960.10.4020,F/ SCREW LP CORT 3.5MMX38MM,CDM Code,Outpatient,C1713,$750.,$185.5425,$712.5,$600.,$682.5,$196.6747,$712.5,$185.5425,$712.5,$712.5,$75.,$511.875,$660.,$690.
,CDM,4050913961.10.4020,F/ SCREW LCK CORT NS 3.5MMX16M,CDM Code,Outpatient,C1713,"$1,725.",$426.7478,"$1,638.75","$1,380.","$1,569.75",$452.3519,"$1,638.75",$426.7478,"$1,638.75","$1,638.75",$172.5,"$1,177.3125","$1,518.","$1,587."
,CDM,4050913962.10.4020,F/ SCREW LCK CORT NS 3.5MMX14M,CDM Code,Outpatient,C1713,"$1,800.",$445.302,"$1,710.","$1,440.","$1,638.",$472.0194,"$1,710.",$445.302,"$1,710.","$1,710.",$180.,"$1,228.5","$1,584.","$1,656."
,CDM,4050913963.10.4020,F/ SCREW LCK CORT NS 3.5MMX18M,CDM Code,Outpatient,C1713,"$1,725.",$426.7478,"$1,638.75","$1,380.","$1,569.75",$452.3519,"$1,638.75",$426.7478,"$1,638.75","$1,638.75",$172.5,"$1,177.3125","$1,518.","$1,587."
,CDM,4050913964.10.4020,F/ SCREW LCK CORT NS 3.5MMX20M,CDM Code,Outpatient,C1713,"$1,725.",$426.7478,"$1,638.75","$1,380.","$1,569.75",$452.3519,"$1,638.75",$426.7478,"$1,638.75","$1,638.75",$172.5,"$1,177.3125","$1,518.","$1,587."
,CDM,4050913965.10.4020,F/ SCREW LCK CORT NS 3.5MMX10M,CDM Code,Outpatient,C1713,"$1,800.",$445.302,"$1,710.","$1,440.","$1,638.",$472.0194,"$1,710.",$445.302,"$1,710.","$1,710.",$180.,"$1,228.5","$1,584.","$1,656."
,CDM,4050913966.10.4020,F/ WASHER LP CORT 3.5MM,CDM Code,Outpatient,C1713,$825.,$204.0967,$783.75,$660.,$750.75,$216.3422,$783.75,$204.0967,$783.75,$783.75,$82.5,$563.0625,$726.,$759.
,CDM,4050913967.10.4020,F/ PLATE ALPS 1ST MTP FUSION L,CDM Code,Outpatient,C1713,"$5,904.","$1,460.5906","$5,608.8","$4,723.2","$5,372.64","$1,548.2236","$5,608.8","$1,460.5906","$5,608.8","$5,608.8",$590.4,"$4,029.48","$5,195.52","$5,431.68"
,CDM,4050913973.10.4020,F/ LENS ZXR00 +20.0 SYMFONY RE,CDM Code,Outpatient,V2788GY,$888.,$219.6823,$843.6,$710.4,$808.08,$232.8629,$843.6,$219.6823,$843.6,$843.6,$88.8,$606.06,$781.44,$816.96
,CDM,4050913996.10.4020,F/ SCREW LP TM 3.5X26MM CORT,CDM Code,Outpatient,C1713,$480.,$118.7472,$456.,$384.,$436.8,$125.8718,$456.,$118.7472,$456.,$456.,$48.,$327.6,$422.4,$441.6
,CDM,4050913997.10.4020,F/ PLATE LOCK DIST FIB 5H RT,CDM Code,Outpatient,C1713,"$4,552.","$1,126.1193","$4,324.4","$3,641.6","$4,142.32","$1,193.6846","$4,324.4","$1,126.1193","$4,324.4","$4,324.4",$455.2,"$3,106.74","$4,005.76","$4,187.84"
,CDM,4050914034.10.4020,F/ LENS ZXR00 +26.0 SYMFONY RE,CDM Code,Outpatient,V2788GY,$888.,$219.6823,$843.6,$710.4,$808.08,$232.8629,$843.6,$219.6823,$843.6,$843.6,$88.8,$606.06,$781.44,$816.96
,CDM,4050914035.10.4020,F/ LENS ZXT300 +18.5 SYMFONY,CDM Code,Outpatient,V2788GY,$888.,$219.6823,$843.6,$710.4,$808.08,$232.8629,$843.6,$219.6823,$843.6,$843.6,$88.8,$606.06,$781.44,$816.96
,CDM,4050914062.10.4020,F/ GUIDE WIRE .062X6 WS-1607ST,CDM Code,Outpatient,C1713,$211.,$52.1993,$200.45,$168.8,$192.01,$55.3312,$200.45,$52.1993,$200.45,$200.45,$21.1,$144.0075,$0.,$194.12
,CDM,4050914063.10.4020,F/ PLATE PROX ACU-LOC VDR L,CDM Code,Outpatient,C1713,"$5,506.","$1,362.1293","$5,230.7","$4,404.8","$5,010.46","$1,443.8549","$5,230.7","$1,362.1293","$5,230.7","$5,230.7",$550.6,"$3,757.845","$4,845.28","$5,065.52"
,CDM,4050914064.10.4020,F/ PLATE LEFT STD ACU-LOC VDU,CDM Code,Outpatient,C1713,"$4,420.","$1,093.4638","$4,199.","$3,536.","$4,022.2","$1,159.0699","$4,199.","$1,093.4638","$4,199.","$4,199.",$442.,"$3,016.65","$3,889.6","$4,066.4"
,CDM,4050914065.10.4020,F/ PLATE OLECRANON EXT 5H LT,CDM Code,Outpatient,C1713,"$5,277.","$1,305.477","$5,013.15","$4,221.6","$4,802.07","$1,383.8035","$5,013.15","$1,305.477","$5,013.15","$5,013.15",$527.7,"$3,601.5525","$4,643.76","$4,854.84"
,CDM,4050914066.10.4020,F/ PLATE 6H L STANDARD POLARUS,CDM Code,Outpatient,C1713,"$6,818.","$1,686.705","$6,477.1","$5,454.4","$6,204.38","$1,787.9046","$6,477.1","$1,686.705","$6,477.1","$6,477.1",$681.8,"$4,653.285","$5,999.84","$6,272.56"
,CDM,4050914067.10.4020,F/ SCREW CORTICAL NT 2.3X18MM,CDM Code,Outpatient,C1713,$863.,$213.4976,$819.85,$690.4,$785.33,$226.3071,$819.85,$213.4976,$819.85,$819.85,$86.3,$588.9975,$759.44,$793.96
,CDM,4050914068.10.4020,F/ SCREW CORTICAL NT 2.3X20MM,CDM Code,Outpatient,C1713,$863.,$213.4976,$819.85,$690.4,$785.33,$226.3071,$819.85,$213.4976,$819.85,$819.85,$86.3,$588.9975,$759.44,$793.96
,CDM,4050914069.10.4020,F/ PEG CORTICAL LOCKING 2.3X16,CDM Code,Outpatient,C1713,$863.,$213.4976,$819.85,$690.4,$785.33,$226.3071,$819.85,$213.4976,$819.85,$819.85,$86.3,$588.9975,$759.44,$793.96
,CDM,4050914070.10.4020,F/ PEG CORTICAL LOCKING 2.3X18,CDM Code,Outpatient,C1713,$863.,$213.4976,$819.85,$690.4,$785.33,$226.3071,$819.85,$213.4976,$819.85,$819.85,$86.3,$588.9975,$759.44,$793.96
,CDM,4050914071.10.4020,F/ PEG CORTICAL LOCKING 2.3X22,CDM Code,Outpatient,C1713,$863.,$213.4976,$819.85,$690.4,$785.33,$226.3071,$819.85,$213.4976,$819.85,$819.85,$86.3,$588.9975,$759.44,$793.96
,CDM,4050914072.10.4020,F/ SCREW CORTICAL LCKING 2.3X1,CDM Code,Outpatient,C1713,$863.,$213.4976,$819.85,$690.4,$785.33,$226.3071,$819.85,$213.4976,$819.85,$819.85,$86.3,$588.9975,$759.44,$793.96
,CDM,4050914073.10.4020,F/ SCREW CORTICAL LCKING 2.3X2,CDM Code,Outpatient,C1713,$863.,$213.4976,$819.85,$690.4,$785.33,$226.3071,$819.85,$213.4976,$819.85,$819.85,$86.3,$588.9975,$759.44,$793.96
,CDM,4050914074.10.4020,F/ SCREW HEXALOBE LCKING 3.5X1,CDM Code,Outpatient,C1713,"$1,200.",$296.868,"$1,140.",$960.,"$1,092.",$314.6796,"$1,140.",$296.868,"$1,140.","$1,140.",$120.,$819.,"$1,056.","$1,104."
,CDM,4050914075.10.4020,F/ SCREW HEXALOBE LCKING 3.5X1,CDM Code,Outpatient,C1713,"$1,440.",$356.2416,"$1,368.","$1,152.","$1,310.4",$377.6155,"$1,368.",$356.2416,"$1,368.","$1,368.",$144.,$982.8,"$1,267.2","$1,324.8"
,CDM,4050914076.10.4020,F/ SCREW HEXALOBE NL 3.5X12MM,CDM Code,Outpatient,C1713,$912.,$225.6197,$866.4,$729.6,$829.92,$239.1565,$866.4,$225.6197,$866.4,$866.4,$91.2,$622.44,$802.56,$839.04
,CDM,4050914077.10.4020,F/ SCREW HEXALOBE NL 3.5X14MM,CDM Code,Outpatient,C1713,$765.,$189.2534,$726.75,$612.,$696.15,$200.6082,$726.75,$189.2534,$726.75,$726.75,$76.5,$522.1125,$673.2,$703.8
,CDM,4050914078.10.4020,F/ SCREW HEXALOBE NL 3.5X22MM,CDM Code,Outpatient,C1713,$912.,$225.6197,$866.4,$729.6,$829.92,$239.1565,$866.4,$225.6197,$866.4,$866.4,$91.2,$622.44,$802.56,$839.04
,CDM,4050914079.10.4020,F/ SCREW HEXALOBE NL 3.5X26MM,CDM Code,Outpatient,C1713,$912.,$225.6197,$866.4,$729.6,$829.92,$239.1565,$866.4,$225.6197,$866.4,$866.4,$91.2,$622.44,$802.56,$839.04
,CDM,4050914080.10.4020,F/ SCREW HEXALOBE NL 3.5X65MM,CDM Code,Outpatient,C1713,$938.,$232.0518,$891.1,$750.4,$853.58,$245.9746,$891.1,$232.0518,$891.1,$891.1,$93.8,$640.185,$825.44,$862.96
,CDM,4050914081.10.4020,F/ SCREW HEXALOBE LCKING 2.7X1,CDM Code,Outpatient,C1713,"$1,440.",$356.2416,"$1,368.","$1,152.","$1,310.4",$377.6155,"$1,368.",$356.2416,"$1,368.","$1,368.",$144.,$982.8,"$1,267.2","$1,324.8"
,CDM,4050914082.10.4020,F/ SCREW HEXALOBE LP 4.3X28MM,CDM Code,Outpatient,C1713,"$1,163.",$287.7146,"$1,104.85",$930.4,"$1,058.33",$304.977,"$1,104.85",$287.7146,"$1,104.85","$1,104.85",$116.3,$793.7475,"$1,023.44","$1,069.96"
,CDM,4050914083.10.4020,F/ SCREW HEXALOBE LP 4.3X34MM,CDM Code,Outpatient,C1713,"$1,163.",$287.7146,"$1,104.85",$930.4,"$1,058.33",$304.977,"$1,104.85",$287.7146,"$1,104.85","$1,104.85",$116.3,$793.7475,"$1,023.44","$1,069.96"
,CDM,4050914084.10.4020,F/ SCREW HEXALOBE LP 4.3X40MM,CDM Code,Outpatient,C1713,"$1,163.",$287.7146,"$1,104.85",$930.4,"$1,058.33",$304.977,"$1,104.85",$287.7146,"$1,104.85","$1,104.85",$116.3,$793.7475,"$1,023.44","$1,069.96"
,CDM,4050914085.10.4020,F/ SCREW HEXALOBE LP 4.3X42MM,CDM Code,Outpatient,C1713,"$1,163.",$287.7146,"$1,104.85",$930.4,"$1,058.33",$304.977,"$1,104.85",$287.7146,"$1,104.85","$1,104.85",$116.3,$793.7475,"$1,023.44","$1,069.96"
,CDM,4050914086.10.4020,F/ SCREW HEXALOBE LP 4.3X44MM,CDM Code,Outpatient,C1713,"$1,163.",$287.7146,"$1,104.85",$930.4,"$1,058.33",$304.977,"$1,104.85",$287.7146,"$1,104.85","$1,104.85",$116.3,$793.7475,"$1,023.44","$1,069.96"
,CDM,4050914087.10.4020,F/ SCREW HEXALOBE LP 4.3X48MM,CDM Code,Outpatient,C1713,"$1,163.",$287.7146,"$1,104.85",$930.4,"$1,058.33",$304.977,"$1,104.85",$287.7146,"$1,104.85","$1,104.85",$116.3,$793.7475,"$1,023.44","$1,069.96"
,CDM,4050914134.10.4020,F/ PLATE OLECRANON EXT 5H RT,CDM Code,Outpatient,C1713,"$5,277.","$1,305.477","$5,013.15","$4,221.6","$4,802.07","$1,383.8035","$5,013.15","$1,305.477","$5,013.15","$5,013.15",$527.7,"$3,601.5525","$4,643.76","$4,854.84"
,CDM,4050914135.10.4020,F/ SCREW HEXALOBE NL 3.5X18MM,CDM Code,Outpatient,C1713,$912.,$225.6197,$866.4,$729.6,$829.92,$239.1565,$866.4,$225.6197,$866.4,$866.4,$91.2,$622.44,$802.56,$839.04
,CDM,4050914136.10.4020,F/ SCREW HEXALOBE LCKING 3.5X1,CDM Code,Outpatient,C1713,"$1,440.",$356.2416,"$1,368.","$1,152.","$1,310.4",$377.6155,"$1,368.",$356.2416,"$1,368.","$1,368.",$144.,$982.8,"$1,267.2","$1,324.8"
,CDM,4050914137.10.4020,F/ SCREW HEXALOBE LCKING 3.5X6,CDM Code,Outpatient,C1713,"$1,448.",$358.2207,"$1,375.6","$1,158.4","$1,317.68",$379.7134,"$1,375.6",$358.2207,"$1,375.6","$1,375.6",$144.8,$988.26,"$1,274.24","$1,332.16"
,CDM,4050914138.10.4020,F/ SCREW HEXALOBE LCKING 2.7X2,CDM Code,Outpatient,C1713,"$1,440.",$356.2416,"$1,368.","$1,152.","$1,310.4",$377.6155,"$1,368.",$356.2416,"$1,368.","$1,368.",$144.,$982.8,"$1,267.2","$1,324.8"
,CDM,4050914139.10.4020,F/ SCREW HEXALOBE LCKING 2.7X2,CDM Code,Outpatient,C1713,"$1,200.",$296.868,"$1,140.",$960.,"$1,092.",$314.6796,"$1,140.",$296.868,"$1,140.","$1,140.",$120.,$819.,"$1,056.","$1,104."
,CDM,4050914150.10.4020,F/ SCREW LO-PRO CANC 4.0X16MM,CDM Code,Outpatient,C1713,$480.,$118.7472,$456.,$384.,$436.8,$125.8718,$456.,$118.7472,$456.,$456.,$48.,$327.6,$422.4,$441.6
,CDM,4050914151.10.4020,F/ SCREW LO-PRO CANC 4.0X18MM,CDM Code,Outpatient,C1713,$480.,$118.7472,$456.,$384.,$436.8,$125.8718,$456.,$118.7472,$456.,$456.,$48.,$327.6,$422.4,$441.6
,CDM,4050914152.10.4020,F/ SCREW LO-PRO CANC 4.0X20MM,CDM Code,Outpatient,C1713,$480.,$118.7472,$456.,$384.,$436.8,$125.8718,$456.,$118.7472,$456.,$456.,$48.,$327.6,$422.4,$441.6
,CDM,4050914154.10.4020,F/ PLATE LCK STRAIGHT 7H SS,CDM Code,Outpatient,C1713,"$3,675.",$909.1582,"$3,491.25","$2,940.","$3,344.25",$963.7063,"$3,491.25",$909.1582,"$3,491.25","$3,491.25",$367.5,"$2,508.1875","$3,234.","$3,381."
,CDM,4050914201.10.4020,F/ LENS ZXT375 +16.0 SYMFONY,CDM Code,Outpatient,V2788GY,$888.,$219.6823,$843.6,$710.4,$808.08,$232.8629,$843.6,$219.6823,$843.6,$843.6,$88.8,$606.06,$781.44,$816.96
,CDM,4050914204.10.4020,F/ LENS ZXT375 +26.5 SYMFONY,CDM Code,Outpatient,V2788GY,$468.,$115.7785,$444.6,$374.4,$425.88,$122.725,$444.6,$115.7785,$444.6,$444.6,$46.8,$319.41,$411.84,$430.56
,CDM,4050914227.10.4020,F/ LENS ZXT225 +26.5D SE 2.25D,CDM Code,Outpatient,V2788GY,$888.,$219.6823,$843.6,$710.4,$808.08,$232.8629,$843.6,$219.6823,$843.6,$843.6,$88.8,$606.06,$781.44,$816.96
,CDM,4050914253.10.4020,F/ LENS PCB00 +9.0 TECNIS ITEC,CDM Code,Outpatient,V2632,$878.,$217.2084,$834.1,$702.4,$798.98,$230.2406,$834.1,$217.2084,$834.1,$834.1,$87.8,$599.235,$772.64,$807.76
,CDM,4050914268.10.4020,F/ JUGGERKNOT SNGL SZ2 1.5MM,CDM Code,Outpatient,C1713,"$2,450.",$606.1055,"$2,327.5","$1,960.","$2,229.5",$642.4709,"$2,327.5",$606.1055,"$2,327.5","$2,327.5",$245.,"$1,672.125","$2,156.","$2,254."
,CDM,4050914274.10.4020,F/ PLATE LCP 3.5MM CLVC HK 4H1,CDM Code,Outpatient,C1713,"$4,565.","$1,129.3354","$4,336.75","$3,652.","$4,154.15","$1,197.0936","$4,336.75","$1,129.3354","$4,336.75","$4,336.75",$456.5,"$3,115.6125","$4,017.2","$4,199.8"
,CDM,4050914288.10.4020,F/ LENS ZXR00 +9.0 SYMFONY RES,CDM Code,Outpatient,V2788GY,$888.,$219.6823,$843.6,$710.4,$808.08,$232.8629,$843.6,$219.6823,$843.6,$843.6,$88.8,$606.06,$781.44,$816.96
,CDM,4050914289.10.4020,F/ LENS ZCT300 +14.0 TECNIS TO,CDM Code,Outpatient,V2787GY,$945.,$233.7835,$897.75,$756.,$859.95,$247.8102,$897.75,$233.7835,$897.75,$897.75,$94.5,$644.9625,$831.6,$869.4
,CDM,4050914294.10.4020,F/ LENS ZCB00 +18.5 TECNIS AC,CDM Code,Outpatient,V2632,$878.,$217.2084,$834.1,$702.4,$798.98,$230.2406,$834.1,$217.2084,$834.1,$834.1,$87.8,$599.235,$772.64,$807.76
,CDM,4050914298.10.4020,F/ DVR LOCK MINI R 131812040,CDM Code,Outpatient,C1713,"$4,381.","$1,083.8156","$4,161.95","$3,504.8","$3,986.71","$1,148.8428","$4,161.95","$1,083.8156","$4,161.95","$4,161.95",$438.1,"$2,990.0325","$3,855.28","$4,030.52"
,CDM,4050914347.10.4020,F/ 3-0 MAXBRAID W/NEEDLE & DRI,CDM Code,Outpatient,C1713,"$2,852.",$705.5563,"$2,709.4","$2,281.6","$2,595.32",$747.8885,"$2,709.4",$705.5563,"$2,709.4","$2,709.4",$285.2,"$1,946.49","$2,509.76","$2,623.84"
,CDM,4050914355.10.4020,F/ DVR CROSSLOCK STD PLT RT,CDM Code,Outpatient,C1713,"$4,381.","$1,083.8156","$4,161.95","$3,504.8","$3,986.71","$1,148.8428","$4,161.95","$1,083.8156","$4,161.95","$4,161.95",$438.1,"$2,990.0325","$3,855.28","$4,030.52"
,CDM,4050914356.10.4020,F/ SCREW NL LOW PROFILE 2.7X30,CDM Code,Outpatient,C1713,$750.,$185.5425,$712.5,$600.,$682.5,$196.6747,$712.5,$185.5425,$712.5,$712.5,$75.,$511.875,$660.,$690.
,CDM,4050914360.10.4020,F/ LENS ZXR00 +17.5 SYMFONY RE,CDM Code,Outpatient,V2788GY,$888.,$219.6823,$843.6,$710.4,$808.08,$232.8629,$843.6,$219.6823,$843.6,$843.6,$88.8,$606.06,$781.44,$816.96
,CDM,4050914361.10.4020,F/ LENS ZXR00 +22.SYMFONY REST,CDM Code,Outpatient,V2788GY,$888.,$219.6823,$843.6,$710.4,$808.08,$232.8629,$843.6,$219.6823,$843.6,$843.6,$88.8,$606.06,$781.44,$816.96
,CDM,4050914369.10.4020,F/ 3.5 X 14MM HEXALOBE SCREW,CDM Code,Outpatient,C1713,"$1,200.",$296.868,"$1,140.",$960.,"$1,092.",$314.6796,"$1,140.",$296.868,"$1,140.","$1,140.",$120.,$819.,"$1,056.","$1,104."
,CDM,4050914371.10.4020,F/ 3.5 X 16MM NON-LOCK HEX SCR,CDM Code,Outpatient,C1713,$765.,$189.2534,$726.75,$612.,$696.15,$200.6082,$726.75,$189.2534,$726.75,$726.75,$76.5,$522.1125,$673.2,$703.8
,CDM,4050914374.10.4020,F/ 3.5 X 40MM NON-LOCK HEX SCR,CDM Code,Outpatient,C1713,$765.,$189.2534,$726.75,$612.,$696.15,$200.6082,$726.75,$189.2534,$726.75,$726.75,$76.5,$522.1125,$673.2,$703.8
,CDM,4050914475.10.4020,F/ INTERNALBRACE LIGAMENT,CDM Code,Outpatient,C1713,"$6,298.","$1,558.0622","$5,983.1","$5,038.4","$5,731.18","$1,651.5434","$5,983.1","$1,558.0622","$5,983.1","$5,983.1",$629.8,"$4,298.385","$5,542.24","$5,794.16"
,CDM,4050914481.10.4020,F/ DVR CROSSLOCK PLATE WIDE L,CDM Code,Outpatient,C1713,"$6,109.","$1,511.3055","$5,803.55","$4,887.2","$5,559.19","$1,601.9814","$5,803.55","$1,511.3055","$5,803.55","$5,803.55",$610.9,"$4,169.3925","$5,375.92","$5,620.28"
,CDM,4050914482.10.4020,F/ SYS SMALL BONE FIXATION 1.6,CDM Code,Outpatient,C1713,"$2,597.",$642.4718,"$2,467.15","$2,077.6","$2,363.27",$681.0191,"$2,467.15",$642.4718,"$2,467.15","$2,467.15",$259.7,"$1,772.4525","$2,285.36","$2,389.24"
,CDM,4050914483.10.4020,F/ 1.5MM LOCK PLATE Y-SHAPE,CDM Code,Outpatient,C1713,"$3,332.",$824.3035,"$3,165.4","$2,665.6","$3,032.12",$873.7604,"$3,165.4",$824.3035,"$3,165.4","$3,165.4",$333.2,"$2,274.09","$2,932.16","$3,065.44"
,CDM,4050914484.10.4020,F/ NON LOCK SCREW 1.5 X 10MM,CDM Code,Outpatient,C1713,$975.,$241.2053,$926.25,$780.,$887.25,$255.6772,$926.25,$241.2053,$926.25,$926.25,$97.5,$665.4375,$858.,$897.
,CDM,4050914485.10.4020,F/ NON LOCK SCREW 1.5 X 12MM,CDM Code,Outpatient,C1713,$975.,$241.2053,$926.25,$780.,$887.25,$255.6772,$926.25,$241.2053,$926.25,$926.25,$97.5,$665.4375,$858.,$897.
,CDM,4050914486.10.4020,F/ NON LOCK SCREW 1.5 X 14MM,CDM Code,Outpatient,C1713,$975.,$241.2053,$926.25,$780.,$887.25,$255.6772,$926.25,$241.2053,$926.25,$926.25,$97.5,$665.4375,$858.,$897.
,CDM,4050914488.10.4020,F/ LOCK SCREW 1.5 X 16MM,CDM Code,Outpatient,C1713,$975.,$241.2053,$926.25,$780.,$887.25,$255.6772,$926.25,$241.2053,$926.25,$926.25,$97.5,$665.4375,$858.,$897.
,CDM,4050914489.10.4020,F/ LOCK SCREW 1.5 X 18MM,CDM Code,Outpatient,C1713,$975.,$241.2053,$926.25,$780.,$887.25,$255.6772,$926.25,$241.2053,$926.25,$926.25,$97.5,$665.4375,$858.,$897.
,CDM,4050914493.10.4020,F/ LOCK SCREW 1.5 X 12MM,CDM Code,Outpatient,C1713,$975.,$241.2053,$926.25,$780.,$887.25,$255.6772,$926.25,$241.2053,$926.25,$926.25,$97.5,$665.4375,$858.,$897.
,CDM,4050914530.10.4020,F/ LENS ZCT300 +15.0 TECNIS,CDM Code,Outpatient,V2787GY,$488.,$120.7263,$463.6,$390.4,$444.08,$127.9697,$463.6,$120.7263,$463.6,$463.6,$48.8,$333.06,$429.44,$448.96
,CDM,4050914531.10.4020,F/ LENS ZCT225 +22.5,CDM Code,Outpatient,V2787GY,$488.,$120.7263,$463.6,$390.4,$444.08,$127.9697,$463.6,$120.7263,$463.6,$463.6,$48.8,$333.06,$429.44,$448.96
,CDM,4050914545.10.4020,F/ LENS ZCT 300 +16.5 TECNIS,CDM Code,Outpatient,V2787GY,$488.,$120.7263,$463.6,$390.4,$444.08,$127.9697,$463.6,$120.7263,$463.6,$463.6,$48.8,$333.06,$429.44,$448.96
,CDM,4050914563.10.4020,F/ MD SCREW 2.7MM X 18MM,CDM Code,Outpatient,C1713,"$1,674.",$414.1309,"$1,590.3","$1,339.2","$1,523.34",$438.978,"$1,590.3",$414.1309,"$1,590.3","$1,590.3",$167.4,"$1,142.505","$1,473.12","$1,540.08"
,CDM,4050914581.10.4020,F/ Z NAIL 5.0X30 CORT SCREW FA,CDM Code,Outpatient,C1713,"$1,557.",$385.1862,"$1,479.15","$1,245.6","$1,416.87",$408.2968,"$1,479.15",$385.1862,"$1,479.15","$1,479.15",$155.7,"$1,062.6525","$1,370.16","$1,432.44"
,CDM,4050914587.10.4020,F/ P-L VLP 3.5MM FIB LK PL 11H,CDM Code,Outpatient,C1713,"$6,048.","$1,496.2147","$5,745.6","$4,838.4","$5,503.68","$1,585.9852","$5,745.6","$1,496.2147","$5,745.6","$5,745.6",$604.8,"$4,127.76","$5,322.24","$5,564.16"
,CDM,4050914588.10.4020,F/ PERI-LOC VLP 3.5MM X 12MM C,CDM Code,Outpatient,C1713,$398.,$98.4612,$378.1,$318.4,$362.18,$104.3687,$378.1,$98.4612,$378.1,$378.1,$39.8,$271.635,$350.24,$366.16
,CDM,4050914589.10.4020,F/ PERI-LOC VLP 3.5MM X 14MM C,CDM Code,Outpatient,C1713,$435.,$107.6146,$413.25,$348.,$395.85,$114.0714,$413.25,$107.6146,$413.25,$413.25,$43.5,$296.8875,$382.8,$400.2
,CDM,4050914590.10.4020,F/ PERI-LOC VLP 3.5MM X 16MM C,CDM Code,Outpatient,C1713,$435.,$107.6146,$413.25,$348.,$395.85,$114.0714,$413.25,$107.6146,$413.25,$413.25,$43.5,$296.8875,$382.8,$400.2
,CDM,4050914591.10.4020,F/ PERI-LOC VLP 3.5MM X 42MM C,CDM Code,Outpatient,C1713,$374.,$92.5239,$355.3,$299.2,$340.34,$98.0751,$355.3,$92.5239,$355.3,$355.3,$37.4,$255.255,$329.12,$344.08
,CDM,4050914592.10.4020,F/ PERI-LOC VLP 3.5MM X 44MM C,CDM Code,Outpatient,C1713,$374.,$92.5239,$355.3,$299.2,$340.34,$98.0751,$355.3,$92.5239,$355.3,$355.3,$37.4,$255.255,$329.12,$344.08
,CDM,4050914593.10.4020,F/ PERI-LOC VLP 3.5MM 80MM CRT,CDM Code,Outpatient,C1713,$374.,$92.5239,$355.3,$299.2,$340.34,$98.0751,$355.3,$92.5239,$355.3,$355.3,$37.4,$255.255,$329.12,$344.08
,CDM,4050914594.10.4020,F/ 7.0MM O.D. WASHER,CDM Code,Outpatient,C1713,$588.,$145.4653,$558.6,$470.4,$535.08,$154.193,$558.6,$145.4653,$558.6,$558.6,$58.8,$401.31,$517.44,$540.96
,CDM,4050914595.10.4020,F/ PERI-LOC VLP 3.5MM X 14MM L,CDM Code,Outpatient,C1713,"$1,579.",$390.6288,"$1,500.05","$1,263.2","$1,436.89",$414.0659,"$1,500.05",$390.6288,"$1,500.05","$1,500.05",$157.9,"$1,077.6675","$1,389.52","$1,452.68"
,CDM,4050914620.10.4020,F/ JUGGERKNOT 1.4MM SHRT W/NDL,CDM Code,Outpatient,C1713,"$2,450.",$606.1055,"$2,327.5","$1,960.","$2,229.5",$642.4709,"$2,327.5",$606.1055,"$2,327.5","$2,327.5",$245.,"$1,672.125","$2,156.","$2,254."
,CDM,4050914622.10.4020,F/ JUGGERKNOT SHRT IMPL SYS 1.,CDM Code,Outpatient,C1713,"$4,214.","$1,042.5015","$4,003.3","$3,371.2","$3,834.74","$1,105.0499","$4,003.3","$1,042.5015","$4,003.3","$4,003.3",$421.4,"$2,876.055","$3,708.32","$3,876.88"
,CDM,4050914625.10.4020,"F/ NRW PROF CLAVICLE PLATE,6-H",CDM Code,Outpatient,C1713,"$5,219.","$1,291.1284","$4,958.05","$4,175.2","$4,749.29","$1,368.594","$4,958.05","$1,291.1284","$4,958.05","$4,958.05",$521.9,"$3,561.9675","$4,592.72","$4,801.48"
,CDM,4050914626.10.4020,F/ ZCT300U0 +18.0 TECNIS TORIC,CDM Code,Outpatient,V2787GY,$488.,$120.7263,$463.6,$390.4,$444.08,$127.9697,$463.6,$120.7263,$463.6,$463.6,$48.8,$333.06,$429.44,$448.96
,CDM,4050914630.10.4020,F/ LENS ZCT300 +18.0 TECNIS,CDM Code,Outpatient,V2787GY,$468.,$0.,$444.6,$374.4,$425.88,$122.725,$444.6,$115.7785,$444.6,$444.6,$46.8,$319.41,$411.84,$430.56
,CDM,4050914718.10.4020,F/ ZXR00 +18.0 SYMFONY RESTO,CDM Code,Outpatient,V2788GY,$888.,$219.6823,$843.6,$710.4,$808.08,$232.8629,$843.6,$219.6823,$843.6,$843.6,$88.8,$606.06,$781.44,$816.96
,CDM,4050914726.10.4020,F/ LENS ZCT300 +23.0 TENIS,CDM Code,Outpatient,V2787GY,$488.,$120.7263,$463.6,$390.4,$444.08,$127.9697,$463.6,$120.7263,$463.6,$463.6,$48.8,$333.06,$429.44,$448.96
,CDM,4050914790.10.4020,F/ IMPL DEL SYS DISTAL BICEPS,CDM Code,Outpatient,C1713,"$4,982.","$1,232.497","$4,732.9","$3,985.6","$4,533.62","$1,306.4448","$4,732.9","$1,232.497","$4,732.9","$4,732.9",$498.2,"$3,400.215","$4,384.16","$4,583.44"
,CDM,4050914799.10.4020,F/ IMPLANT SYSTEM MEN ROOT REP,CDM Code,Outpatient,C1713,"$5,830.","$1,442.2837","$5,538.5","$4,664.","$5,305.3","$1,528.8184","$5,538.5","$1,442.2837","$5,538.5","$5,538.5",$583.,"$3,978.975","$5,130.4","$5,363.6"
,CDM,4050914813.10.4020,F/ 2.7MM VA-LKNG CALC PLT 64MM,CDM Code,Outpatient,C1713,"$6,822.","$1,687.6946","$6,480.9","$5,457.6","$6,208.02","$1,788.9535","$6,480.9","$1,687.6946","$6,480.9","$6,480.9",$682.2,"$4,656.015","$6,003.36","$6,276.24"
,CDM,4050914814.10.4020,F/ SCRW VAR ANGLE LCK 2.7X34MM,CDM Code,Outpatient,C1713,"$1,688.",$417.5943,"$1,603.6","$1,350.4","$1,536.08",$442.6493,"$1,603.6",$417.5943,"$1,603.6","$1,603.6",$168.8,"$1,152.06","$1,485.44","$1,552.96"
,CDM,4050914825.10.4020,"F/ IMPL SYS,BIO-COMP ACH MID-S",CDM Code,Outpatient,C1713,"$5,711.","$1,412.8443","$5,425.45","$4,568.8","$5,197.01","$1,497.6127","$5,425.45","$1,412.8443","$5,425.45","$5,425.45",$571.1,"$3,897.7575","$5,025.68","$5,254.12"
,CDM,4050914836.10.4020,F/ 3.5 X 18MM LOCK HEX SCREW,CDM Code,Outpatient,C1713,"$1,440.",$356.2416,"$1,368.","$1,152.","$1,310.4",$377.6155,"$1,368.",$356.2416,"$1,368.","$1,368.",$144.,$982.8,"$1,267.2","$1,324.8"
,CDM,4050914851.10.4020,F/ Z NAIL 5.0X30 CORT SCREW FA,CDM Code,Outpatient,C1713,"$1,557.",$385.1862,"$1,479.15","$1,245.6","$1,416.87",$408.2968,"$1,479.15",$385.1862,"$1,479.15","$1,479.15",$155.7,"$1,062.6525","$1,370.16","$1,432.44"
,CDM,4050914865.10.4020,F/ LENS ZCT300 +23.5 TECNIS TO,CDM Code,Outpatient,V2787GY,$488.,$120.7263,$463.6,$390.4,$444.08,$127.9697,$463.6,$120.7263,$463.6,$463.6,$48.8,$333.06,$429.44,$448.96
,CDM,4050914866.10.4020,F/ LENS ZXR00 +19.0 SYMFONY RE,CDM Code,Outpatient,V2788GY,$888.,$219.6823,$843.6,$710.4,$808.08,$232.8629,$843.6,$219.6823,$843.6,$843.6,$88.8,$606.06,$781.44,$816.96
,CDM,4050914880.10.4020,F/ 3.0 CANN SCREW LONG TH 36MM,CDM Code,Outpatient,C1713,"$2,083.",$515.3134,"$1,978.85","$1,666.4","$1,895.53",$546.2313,"$1,978.85",$515.3134,"$1,978.85","$1,978.85",$208.3,"$1,421.6475","$1,833.04","$1,916.36"
,CDM,4050914881.10.4020,F/ THREAD WASHER FOR 3.0 CANN,CDM Code,Outpatient,C1713,"$1,680.",$415.6152,"$1,596.","$1,344.","$1,528.8",$440.5514,"$1,596.",$415.6152,"$1,596.","$1,596.",$168.,"$1,146.6","$1,478.4","$1,545.6"
,CDM,4050914883.10.4020,F/ 2.3 X 12MM NON TOG CORT SCR,CDM Code,Outpatient,C1713,$863.,$213.4976,$819.85,$690.4,$785.33,$226.3071,$819.85,$213.4976,$819.85,$819.85,$86.3,$588.9975,$759.44,$793.96
,CDM,4050914884.10.4020,F/ 2.3 X 16MM NON TOG CORT SCR,CDM Code,Outpatient,C1713,$863.,$213.4976,$819.85,$690.4,$785.33,$226.3071,$819.85,$213.4976,$819.85,$819.85,$86.3,$588.9975,$759.44,$793.96
,CDM,4050914885.10.4020,F/ 2.4MM VA-LCP PLATE -90/2H,CDM Code,Outpatient,C1713,"$4,224.","$1,044.9754","$4,012.8","$3,379.2","$3,843.84","$1,107.6722","$4,012.8","$1,044.9754","$4,012.8","$4,012.8",$422.4,"$2,882.88","$3,717.12","$3,886.08"
,CDM,4050914888.10.4020,F/ 2.4MM VA-LCP PLATE 5H,CDM Code,Outpatient,C1713,"$4,145.","$1,025.4316","$3,937.75","$3,316.","$3,771.95","$1,086.9558","$3,937.75","$1,025.4316","$3,937.75","$3,937.75",$414.5,"$2,828.9625","$3,647.6","$3,813.4"
,CDM,4050914901.10.4020,F/ SUTR ANCH PEEK S-TAK 3X12.7,CDM Code,Outpatient,C1713,"$2,695.",$666.716,"$2,560.25","$2,156.","$2,452.45",$706.7179,"$2,560.25",$666.716,"$2,560.25","$2,560.25",$269.5,"$1,839.3375","$2,371.6","$2,479.4"
,CDM,4050914918.10.4020,F/ SCRW CANN INT. W/DISP SHTH,CDM Code,Outpatient,C1713,"$1,238.",$306.2688,"$1,176.1",$990.4,"$1,126.58",$324.6445,"$1,176.1",$306.2688,"$1,176.1","$1,176.1",$123.8,$844.935,"$1,089.44","$1,138.96"
,CDM,4050914919.10.4020,F/ TIGHTROPE BUTTON EXTENDER,CDM Code,Outpatient,C1713,"$1,996.",$493.7904,"$1,896.2","$1,596.8","$1,816.36",$523.4171,"$1,896.2",$493.7904,"$1,896.2","$1,896.2",$199.6,"$1,362.27","$1,756.48","$1,836.32"
,CDM,4050914930.10.4020,F/ PROX TENODESIS SYS REV:0,CDM Code,Outpatient,C1713,"$4,729.","$1,169.9073","$4,492.55","$3,783.2","$4,303.39","$1,240.0999","$4,492.55","$1,169.9073","$4,492.55","$4,492.55",$472.9,"$3,227.5425","$4,161.52","$4,350.68"
,CDM,4050914982.10.4020,F/ Z NAIL TIBIA 10MMX32CM UNIV,CDM Code,Outpatient,C1713,"$7,145.","$1,767.6016","$6,787.75","$5,716.","$6,501.95","$1,873.6548","$6,787.75","$1,767.6016","$6,787.75","$6,787.75",$714.5,"$4,876.4625","$6,287.6","$6,573.4"
,CDM,4050914998.10.4020,F/ LENS ZCT 150 +19.5 TECNIS,CDM Code,Outpatient,V2787GY,$488.,$120.7263,$463.6,$390.4,$444.08,$127.9697,$463.6,$120.7263,$463.6,$463.6,$48.8,$333.06,$429.44,$448.96
,CDM,4050914999.10.4020,F/ LENS ZCT 600 +6.0 TECNIS,CDM Code,Outpatient,V2787GY,$488.,$120.7263,$463.6,$390.4,$444.08,$127.9697,$463.6,$120.7263,$463.6,$463.6,$48.8,$333.06,$429.44,$448.96
,CDM,4050915000.10.4020,F/ LENS ZXT 375 +20.5 SYMFONY,CDM Code,Outpatient,V2788GY,$988.,$244.4213,$938.6,$790.4,$899.08,$259.0862,$938.6,$244.4213,$938.6,$938.6,$98.8,$674.31,$869.44,$908.96
,CDM,4050915001.10.4020,"F/ TENODESIS SCREW, PEEK, VENT",CDM Code,Outpatient,C1713,"$2,790.",$690.2181,"$2,650.5","$2,232.","$2,538.9",$731.6301,"$2,650.5",$690.2181,"$2,650.5","$2,650.5",$279.,"$1,904.175","$2,455.2","$2,566.8"
,CDM,4050915005.10.4020,F/ DVR LOCK NAROW PLATE LEFT,CDM Code,Outpatient,C1713,"$3,401.",$841.3734,"$3,230.95","$2,720.8","$3,094.91",$891.8544,"$3,230.95",$841.3734,"$3,230.95","$3,230.95",$340.1,"$2,321.1825","$2,992.88","$3,128.92"
,CDM,4050915024.10.4020,F/ 1.5MM TI CORTEX SCREW ST 7M,CDM Code,Outpatient,C1713,$595.,$147.197,$565.25,$476.,$541.45,$156.0286,$565.25,$147.197,$565.25,$565.25,$59.5,$406.0875,$523.6,$547.4
,CDM,4050915025.10.4020,F/ 1.5MM TI CORTEX ST 9MM,CDM Code,Outpatient,C1713,$595.,$147.197,$565.25,$476.,$541.45,$156.0286,$565.25,$147.197,$565.25,$565.25,$59.5,$406.0875,$523.6,$547.4
,CDM,4050915026.10.4020,F/ 1.5MM TI CORTEX SCREW ST 10,CDM Code,Outpatient,C1713,$595.,$147.197,$565.25,$476.,$541.45,$156.0286,$565.25,$147.197,$565.25,$565.25,$59.5,$406.0875,$523.6,$547.4
,CDM,4050915027.10.4020,F/ 1.5MM TI T-PLATE 4H HEAD 8H,CDM Code,Outpatient,C1713,"$4,043.","$1,000.1978","$3,840.85","$3,234.4","$3,679.13","$1,060.208","$3,840.85","$1,000.1978","$3,840.85","$3,840.85",$404.3,"$2,759.3475","$3,557.84","$3,719.56"
,CDM,4050915059.10.4020,F/ SCREW CANN INT 9X20MM,CDM Code,Outpatient,C1713,"$1,020.",$252.3378,$969.,$816.,$928.2,$267.4777,$969.,$252.3378,$969.,$969.,$102.,$696.15,$897.6,$938.4
,CDM,4050915062.10.4020,F/ SCREW CANN INT 9X25MM,CDM Code,Outpatient,C1713,"$1,020.",$252.3378,$969.,$816.,$928.2,$267.4777,$969.,$252.3378,$969.,$969.,$102.,$696.15,$897.6,$938.4
,CDM,4050915081.10.4020,F/ 1.5MM TI EXTENDED H-PLATE R,CDM Code,Outpatient,C1713,"$4,043.","$1,000.1978","$3,840.85","$3,234.4","$3,679.13","$1,060.208","$3,840.85","$1,000.1978","$3,840.85","$3,840.85",$404.3,"$2,759.3475","$3,557.84","$3,719.56"
,CDM,4050915082.10.4020,F/ 1.5MM TI CORTEX SCREW ST 14,CDM Code,Outpatient,C1713,$595.,$147.197,$565.25,$476.,$541.45,$156.0286,$565.25,$147.197,$565.25,$565.25,$59.5,$406.0875,$523.6,$547.4
,CDM,4050915083.10.4020,F/ 1.5MM TI CORTEX SCREW ST 16,CDM Code,Outpatient,C1713,$595.,$147.197,$565.25,$476.,$541.45,$156.0286,$565.25,$147.197,$565.25,$565.25,$59.5,$406.0875,$523.6,$547.4
,CDM,4050915084.10.4020,F/ 1.5MM TI CORTEX SCREW ST 18,CDM Code,Outpatient,C1713,$595.,$147.197,$565.25,$476.,$541.45,$156.0286,$565.25,$147.197,$565.25,$565.25,$59.5,$406.0875,$523.6,$547.4
,CDM,4050915100.10.4020,F/ LENS ZCT600 +7.5 TECNIS,CDM Code,Outpatient,V2787GY,$488.,$120.7263,$463.6,$390.4,$444.08,$127.9697,$463.6,$120.7263,$463.6,$463.6,$48.8,$333.06,$429.44,$448.96
,CDM,4050915149.10.4020,"F/ SUT ANCH,BIO-COM P-LCK2.9X1",CDM Code,Outpatient,C1713,"$2,803.",$693.4342,"$2,662.85","$2,242.4","$2,550.73",$735.0391,"$2,662.85",$693.4342,"$2,662.85","$2,662.85",$280.3,"$1,913.0475","$2,466.64","$2,578.76"
,CDM,4050915153.10.4020,"F/ SCREW,CANN INTERFERENCE",CDM Code,Outpatient,C1713,"$1,020.",$252.3378,$969.,$816.,$928.2,$267.4777,$969.,$252.3378,$969.,$969.,$102.,$696.15,$897.6,$938.4
,CDM,4050915154.10.4020,"F/ SECONDARY FIX KIT, ACL/PCL",CDM Code,Outpatient,C1713,"$4,204.","$1,040.0276","$3,993.8","$3,363.2","$3,825.64","$1,102.4275","$3,993.8","$1,040.0276","$3,993.8","$3,993.8",$420.4,"$2,869.23","$3,699.52","$3,867.68"
,CDM,4050915156.10.4020,F/ 20MM STANDARD BONE SCREW,CDM Code,Outpatient,C1713,"$2,744.",$678.8382,"$2,606.8","$2,195.2","$2,497.04",$719.5674,"$2,606.8",$678.8382,"$2,606.8","$2,606.8",$274.4,"$1,872.78","$2,414.72","$2,524.48"
,CDM,4050915226.10.4020,F/ OMNIMAX ARCH BAR,CDM Code,Outpatient,C1713,"$2,479.",$613.2798,"$2,355.05","$1,983.2","$2,255.89",$650.0756,"$2,355.05",$613.2798,"$2,355.05","$2,355.05",$247.9,"$1,691.9175","$2,181.52","$2,280.68"
,CDM,4050915227.10.4020,F/ OMNIMAX SD SCREW 2.0X7.0,CDM Code,Outpatient,C1713,"$1,245.",$308.0005,"$1,182.75",$996.,"$1,132.95",$326.4801,"$1,182.75",$308.0005,"$1,182.75","$1,182.75",$124.5,$849.7125,"$1,095.6","$1,145.4"
,CDM,4050915228.10.4020,F/ OMNIMAX SD SCREW 2.0X9.0,CDM Code,Outpatient,C1713,"$1,245.",$308.0005,"$1,182.75",$996.,"$1,132.95",$326.4801,"$1,182.75",$308.0005,"$1,182.75","$1,182.75",$124.5,$849.7125,"$1,095.6","$1,145.4"
,CDM,4050915229.10.4020,F/ OMNIMAX SD SCREW 2.0X11.0,CDM Code,Outpatient,C1713,"$1,245.",$308.0005,"$1,182.75",$996.,"$1,132.95",$326.4801,"$1,182.75",$308.0005,"$1,182.75","$1,182.75",$124.5,$849.7125,"$1,095.6","$1,145.4"
,CDM,4050915231.10.4020,F/ LENS ZCT 400 +26.5 TECNIS,CDM Code,Outpatient,V2787GY,$488.,$120.7263,$463.6,$390.4,$444.08,$127.9697,$463.6,$120.7263,$463.6,$463.6,$48.8,$333.06,$429.44,$448.96
,CDM,4050915233.10.4020,F/ WIRE LIGATURE 24 GA 10-PK,CDM Code,Outpatient,C1713,$77.,$19.049,$73.15,$61.6,$70.07,$20.1919,$73.15,$19.049,$73.15,$73.15,$7.7,$52.5525,$67.76,$70.84
,CDM,4050915234.10.4020,F/ IMF SCREW SELF DRILL 2.0X7.,CDM Code,Outpatient,C1713,"$1,110.",$274.6029,"$1,054.5",$888.,"$1,010.1",$291.0786,"$1,054.5",$274.6029,"$1,054.5","$1,054.5",$111.,$757.575,$976.8,"$1,021.2"
,CDM,4050915235.10.4020,F/ IMF SCREW SELF DRILL 2.0X9.,CDM Code,Outpatient,C1713,"$1,110.",$274.6029,"$1,054.5",$888.,"$1,010.1",$291.0786,"$1,054.5",$274.6029,"$1,054.5","$1,054.5",$111.,$757.575,$976.8,"$1,021.2"
,CDM,4050915236.10.4020,F/ IMF SCREW SELF DRILL 2.0X11,CDM Code,Outpatient,C1713,"$1,110.",$274.6029,"$1,054.5",$888.,"$1,010.1",$291.0786,"$1,054.5",$274.6029,"$1,054.5","$1,054.5",$111.,$757.575,$976.8,"$1,021.2"
,CDM,4050915296.10.4020,F/ LENS ZXR00 +20.5 SYMFONY RE,CDM Code,Outpatient,V2788GY,$888.,$219.6823,$843.6,$710.4,$808.08,$232.8629,$843.6,$219.6823,$843.6,$843.6,$88.8,$606.06,$781.44,$816.96
,CDM,4050915312.10.4020,F/ PEG LOCKING SMOOTH 2.2X20MM,CDM Code,Outpatient,C1713,"$1,425.",$352.5308,"$1,353.75","$1,140.","$1,296.75",$373.682,"$1,353.75",$352.5308,"$1,353.75","$1,353.75",$142.5,$972.5625,"$1,254.","$1,311."
,CDM,4050915368.10.4020,F/ CANC CRUSH 5CC FD ASP,CDM Code,Outpatient,C1713,$702.,$173.6678,$666.9,$561.6,$638.82,$184.0876,$666.9,$173.6678,$666.9,$666.9,$70.2,$479.115,$617.76,$645.84
,CDM,4050915369.10.4020,F/ PLATE 4 HOLE STR W/GAP 1.6M,CDM Code,Outpatient,C1713,"$3,214.",$795.1115,"$3,053.3","$2,571.2","$2,924.74",$842.8169,"$3,053.3",$795.1115,"$3,053.3","$3,053.3",$321.4,"$2,193.555","$2,828.32","$2,956.88"
,CDM,4050915370.10.4020,F/ PLATE SMALL ANGLE 1.6MM,CDM Code,Outpatient,C1713,"$4,358.","$1,078.1256","$4,140.1","$3,486.4","$3,965.78","$1,142.8114","$4,140.1","$1,078.1256","$4,140.1","$4,140.1",$435.8,"$2,974.335","$3,835.04","$4,009.36"
,CDM,4050915374.10.4020,F/ SCREW 2.0X6MM CROSS-DRIVE,CDM Code,Outpatient,C1713,$730.,$180.5947,$693.5,$584.,$664.3,$191.4301,$693.5,$180.5947,$693.5,$693.5,$73.,$498.225,$642.4,$671.6
,CDM,4050915375.10.4020,F/ SCREW 2.0X10MM CROSS-DRIVE,CDM Code,Outpatient,C1713,$730.,$180.5947,$693.5,$584.,$664.3,$191.4301,$693.5,$180.5947,$693.5,$693.5,$73.,$498.225,$642.4,$671.6
,CDM,4050915378.10.4020,F/ LENS PCB00 +30.5 TECNIS ITE,CDM Code,Outpatient,V2632,$878.,$217.2084,$834.1,$702.4,$798.98,$230.2406,$834.1,$217.2084,$834.1,$834.1,$87.8,$599.235,$772.64,$807.76
,CDM,4050915379.10.4020,F/ SCREW 2.7 LP NL 13MM,CDM Code,Outpatient,C1713,$691.,$170.9465,$656.45,$552.8,$628.81,$181.203,$656.45,$170.9465,$656.45,$656.45,$69.1,$471.6075,$608.08,$635.72
,CDM,4050915381.10.4020,F/ MD SCREW 2.7MM X 14MM,CDM Code,Outpatient,C1713,"$1,674.",$414.1309,"$1,590.3","$1,339.2","$1,523.34",$438.978,"$1,590.3",$414.1309,"$1,590.3","$1,590.3",$167.4,"$1,142.505","$1,473.12","$1,540.08"
,CDM,4050915415.10.4020,F/ TMJ FOSSA COMP SM LEFT,CDM Code,Outpatient,C1776,"$13,677.","$3,383.553","$12,993.15","$10,941.6","$12,446.07","$3,586.5607","$12,993.15","$3,383.553","$12,993.15","$12,993.15","$1,367.7","$9,334.5525","$12,035.76","$12,582.84"
,CDM,4050915416.10.4020,F/ MANDIBLE IMPLANT 50MM LEFT,CDM Code,Outpatient,C1776,"$12,103.","$2,994.1612","$11,497.85","$9,682.4","$11,013.73","$3,173.806","$11,497.85","$2,994.1612","$11,497.85","$11,497.85","$1,210.3","$8,260.2975","$10,650.64","$11,134.76"
,CDM,4050915417.10.4020,F/ TMJ SCREW X-DR FOSSA 2.0X7M,CDM Code,Outpatient,C1713,$941.,$232.794,$893.95,$752.8,$856.31,$246.7613,$893.95,$232.794,$893.95,$893.95,$94.1,$642.2325,$828.08,$865.72
,CDM,4050915418.10.4020,F/ TMJ SCREW X-DR FOSSA 2.0X9M,CDM Code,Outpatient,C1713,$941.,$232.794,$893.95,$752.8,$856.31,$246.7613,$893.95,$232.794,$893.95,$893.95,$94.1,$642.2325,$828.08,$865.72
,CDM,4050915419.10.4020,F/ TMJ SCREW X-DR FOSSA 2.0X11,CDM Code,Outpatient,C1713,$941.,$232.794,$893.95,$752.8,$856.31,$246.7613,$893.95,$232.794,$893.95,$893.95,$94.1,$642.2325,$828.08,$865.72
,CDM,4050915420.10.4020,F/ TMJ SCREW X-DR MAND 2.7X8MM,CDM Code,Outpatient,C1713,$893.,$220.9193,$848.35,$714.4,$812.63,$234.1741,$848.35,$220.9193,$848.35,$848.35,$89.3,$609.4725,$785.84,$821.56
,CDM,4050915421.10.4020,F/ TMJ SCREW X-DR MAND 2.7X10M,CDM Code,Outpatient,C1713,$893.,$220.9193,$848.35,$714.4,$812.63,$234.1741,$848.35,$220.9193,$848.35,$848.35,$89.3,$609.4725,$785.84,$821.56
,CDM,4050915468.10.4020,F/ LENS ZCT600 +16.5 TECNIS,CDM Code,Outpatient,V2787GY,$488.,$120.7263,$463.6,$390.4,$444.08,$127.9697,$463.6,$120.7263,$463.6,$463.6,$48.8,$333.06,$429.44,$448.96
,CDM,4050915469.10.4020,F/ LENS ZCT400 +8.0 TECNIS,CDM Code,Outpatient,V2787GY,$488.,$120.7263,$463.6,$390.4,$444.08,$127.9697,$463.6,$120.7263,$463.6,$463.6,$48.8,$333.06,$429.44,$448.96
,CDM,4050915476.10.4020,F/ GRACILIS TENDON FZ,CDM Code,Outpatient,C1771,"$4,795.","$1,186.235","$4,555.25","$3,836.","$4,363.45","$1,257.4072","$4,555.25","$1,186.235","$4,555.25","$4,555.25",$479.5,"$3,272.5875","$4,219.6","$4,411.4"
,CDM,4050915478.10.4020,F/ GRACILIS TENDON FZ,CDM Code,Outpatient,C1762,"$7,223.","$1,786.898","$6,861.85","$5,778.4","$6,572.93","$1,894.109","$6,861.85","$1,786.898","$6,861.85","$6,861.85",$722.3,"$4,929.6975","$6,356.24","$6,645.16"
,CDM,4050915517.10.4020,F/ MESH PROGRIP LT&RT LPG1510A,CDM Code,Outpatient,C1781,"$2,861.",$707.7828,"$2,717.95","$2,288.8","$2,603.51",$750.2486,"$2,717.95",$707.7828,"$2,717.95","$2,717.95",$286.1,"$1,952.6325","$2,517.68","$2,632.12"
,CDM,4050915533.10.4020,F/ LOCK SCREW SQUARE 2.7MMX24M,CDM Code,Outpatient,C1713,$900.,$222.651,$855.,$720.,$819.,$236.0097,$855.,$222.651,$855.,$855.,$90.,$614.25,$792.,$828.
,CDM,4050915544.10.4020,F/ LENS ZCT 150 +21.0 TECNIS,CDM Code,Outpatient,V2787GY,$488.,$120.7263,$463.6,$390.4,$444.08,$127.9697,$463.6,$120.7263,$463.6,$463.6,$48.8,$333.06,$429.44,$448.96
,CDM,4050915546.10.4020,F/ SCREW TI W/ANCHOR 3.0MM,CDM Code,Outpatient,C1713,"$2,793.",$690.9603,"$2,653.35","$2,234.4","$2,541.63",$732.4168,"$2,653.35",$690.9603,"$2,653.35","$2,653.35",$279.3,"$1,906.2225","$2,457.84","$2,569.56"
,CDM,4050915556.10.4020,F/ LENS ZCT300 +9.0 TECNIS TOR,CDM Code,Outpatient,V2787GY,$488.,$120.7263,$463.6,$390.4,$444.08,$127.9697,$463.6,$120.7263,$463.6,$463.6,$48.8,$333.06,$429.44,$448.96
,CDM,4050915630.10.4020,F/ SCREW NL LOW PROFILE 2.7X22,CDM Code,Outpatient,C1713,$691.,$170.9465,$656.45,$552.8,$628.81,$181.203,$656.45,$170.9465,$656.45,$656.45,$69.1,$471.6075,$608.08,$635.72
,CDM,4050915631.10.4020,F/ LOCK SCREW SQUARE 2.7MMX26M,CDM Code,Outpatient,C1713,"$1,425.",$352.5308,"$1,353.75","$1,140.","$1,296.75",$373.682,"$1,353.75",$352.5308,"$1,353.75","$1,353.75",$142.5,$972.5625,"$1,254.","$1,311."
,CDM,4050915636.10.4020,F/ PRX HUM HI PLT RT 3H 80MM,CDM Code,Outpatient,C1713,"$10,209.","$2,525.6045","$9,698.55","$8,167.2","$9,290.19","$2,677.1367","$9,698.55","$2,525.6045","$9,698.55","$9,698.55","$1,020.9","$6,967.6425","$8,983.92","$9,392.28"
,CDM,4050915637.10.4020,F/ 3.2MM PEGS 42MM,CDM Code,Outpatient,C1713,"$1,500.",$371.085,"$1,425.","$1,200.","$1,365.",$393.3495,"$1,425.",$371.085,"$1,425.","$1,425.",$150.,"$1,023.75","$1,320.","$1,380."
,CDM,4050915638.10.4020,F/ 3.5MM CORT LOCK SCR 24MM,CDM Code,Outpatient,C1713,"$1,725.",$426.7478,"$1,638.75","$1,380.","$1,569.75",$452.3519,"$1,638.75",$426.7478,"$1,638.75","$1,638.75",$172.5,"$1,177.3125","$1,518.","$1,587."
,CDM,4050915639.10.4020,F/ 3.5MM CORT LOCK SCR 26MM,CDM Code,Outpatient,C1713,"$1,725.",$426.7478,"$1,638.75","$1,380.","$1,569.75",$452.3519,"$1,638.75",$426.7478,"$1,638.75","$1,638.75",$172.5,"$1,177.3125","$1,518.","$1,587."
,CDM,4050915640.10.4020,F/ 3.5MM CORT LOCK SCR 36MM,CDM Code,Outpatient,C1713,"$1,725.",$426.7478,"$1,638.75","$1,380.","$1,569.75",$452.3519,"$1,638.75",$426.7478,"$1,638.75","$1,638.75",$172.5,"$1,177.3125","$1,518.","$1,587."
,CDM,4050915641.10.4020,F/ 3.5MM CORT LOCK SCR 40MM,CDM Code,Outpatient,C1713,"$1,495.",$369.848,"$1,420.25","$1,196.","$1,360.45",$392.0383,"$1,420.25",$369.848,"$1,420.25","$1,420.25",$149.5,"$1,020.3375","$1,315.6","$1,375.4"
,CDM,4050915642.10.4020,F/ 3.5MM CORT LOCK SCR 42MM,CDM Code,Outpatient,C1713,"$1,725.",$426.7478,"$1,638.75","$1,380.","$1,569.75",$452.3519,"$1,638.75",$426.7478,"$1,638.75","$1,638.75",$172.5,"$1,177.3125","$1,518.","$1,587."
,CDM,4050915643.10.4020,F/ 3.5MM CORT LOCK SCR 44MM,CDM Code,Outpatient,C1713,"$1,725.",$426.7478,"$1,638.75","$1,380.","$1,569.75",$452.3519,"$1,638.75",$426.7478,"$1,638.75","$1,638.75",$172.5,"$1,177.3125","$1,518.","$1,587."
,CDM,4050915644.10.4020,F/ 3.5MM CORT LOCK SCR 46MM,CDM Code,Outpatient,C1713,"$1,725.",$426.7478,"$1,638.75","$1,380.","$1,569.75",$452.3519,"$1,638.75",$426.7478,"$1,638.75","$1,638.75",$172.5,"$1,177.3125","$1,518.","$1,587."
,CDM,4050915645.10.4020,F/ 3.5MM CORT LOCK SCR 45MM,CDM Code,Outpatient,C1713,"$1,725.",$426.7478,"$1,638.75","$1,380.","$1,569.75",$452.3519,"$1,638.75",$426.7478,"$1,638.75","$1,638.75",$172.5,"$1,177.3125","$1,518.","$1,587."
,CDM,4050915646.10.4020,F/ 3.5MM CORT LOCK SCR 50MM,CDM Code,Outpatient,C1713,"$1,725.",$426.7478,"$1,638.75","$1,380.","$1,569.75",$452.3519,"$1,638.75",$426.7478,"$1,638.75","$1,638.75",$172.5,"$1,177.3125","$1,518.","$1,587."
,CDM,4050915647.10.4020,F/ 3.5MM CORT LOCK SCR 65MM,CDM Code,Outpatient,C1713,"$1,725.",$426.7478,"$1,638.75","$1,380.","$1,569.75",$452.3519,"$1,638.75",$426.7478,"$1,638.75","$1,638.75",$172.5,"$1,177.3125","$1,518.","$1,587."
,CDM,4050915649.10.4020,F/ SCREW T15 LP CORT 3.5X26MM,CDM Code,Outpatient,C1713,$750.,$185.5425,$712.5,$600.,$682.5,$196.6747,$712.5,$185.5425,$712.5,$712.5,$75.,$511.875,$660.,$690.
,CDM,4050915687.10.4020,F/ TMJ FOSSA COMP SM RIGHT,CDM Code,Outpatient,C1776,"$13,677.","$3,383.553","$12,993.15","$10,941.6","$12,446.07","$3,586.5607","$12,993.15","$3,383.553","$12,993.15","$12,993.15","$1,367.7","$9,334.5525","$12,035.76","$12,582.84"
,CDM,4050915688.10.4020,F/ MANDIBLE IMPLANT 50MM RIGHT,CDM Code,Outpatient,C1776,"$12,103.","$2,994.1612","$11,497.85","$9,682.4","$11,013.73","$3,173.806","$11,497.85","$2,994.1612","$11,497.85","$11,497.85","$1,210.3","$8,260.2975","$10,650.64","$11,134.76"
,CDM,4050915706.10.4020,"F/ SCREW, 4.5X54MM CANN PT",CDM Code,Outpatient,C1713,"$2,213.",$547.4741,"$2,102.35","$1,770.4","$2,013.83",$580.3216,"$2,102.35",$547.4741,"$2,102.35","$2,102.35",$221.3,"$1,510.3725","$1,947.44","$2,035.96"
,CDM,4050915707.10.4020,"F/ SCREW, 4.5X56MM CANN PT",CDM Code,Outpatient,C1713,"$2,213.",$547.4741,"$2,102.35","$1,770.4","$2,013.83",$580.3216,"$2,102.35",$547.4741,"$2,102.35","$2,102.35",$221.3,"$1,510.3725","$1,947.44","$2,035.96"
,CDM,4050915708.10.4020,"F/ SCREW, 4.5X56MM CANN FULL T",CDM Code,Outpatient,C1713,"$2,275.",$562.8122,"$2,161.25","$1,820.","$2,070.25",$596.5801,"$2,161.25",$562.8122,"$2,161.25","$2,161.25",$227.5,"$1,552.6875","$2,002.","$2,093."
,CDM,4050915710.10.4020,F/ PRO-DENSE INJ IMPL KIT,CDM Code,Outpatient,C1713,"$7,859.","$1,944.238","$7,466.05","$6,287.2","$7,151.69","$2,060.8891","$7,466.05","$1,944.238","$7,466.05","$7,466.05",$785.9,"$5,363.7675","$6,915.92","$7,230.28"
,CDM,4050915756.10.4020,F/ LENS ZXT 225 + 16.0D,CDM Code,Outpatient,V2788GY,$988.,$244.4213,$938.6,$790.4,$899.08,$259.0862,$938.6,$244.4213,$938.6,$938.6,$98.8,$674.31,$869.44,$908.96
,CDM,4050915757.10.4020,F/ LENS ZCT 400 +17.5,CDM Code,Outpatient,V2787GY,$488.,$120.7263,$463.6,$390.4,$444.08,$127.9697,$463.6,$120.7263,$463.6,$463.6,$48.8,$333.06,$429.44,$448.96
,CDM,4050915805.10.4020,F/ VPC SCREW 2.5X24MM,CDM Code,Outpatient,C1713,"$2,940.",$727.3266,"$2,793.","$2,352.","$2,675.4",$770.965,"$2,793.",$727.3266,"$2,793.","$2,793.",$294.,"$2,006.55","$2,587.2","$2,704.8"
,CDM,4050915808.10.4020,F/ VPC SCREW 3.4X20MM,CDM Code,Outpatient,C1713,"$2,940.",$727.3266,"$2,793.","$2,352.","$2,675.4",$770.965,"$2,793.",$727.3266,"$2,793.","$2,793.",$294.,"$2,006.55","$2,587.2","$2,704.8"
,CDM,4050915829.10.4020,F/ LENS ZXT225 +23.0D,CDM Code,Outpatient,V2788GY,$988.,$244.4213,$938.6,$790.4,$899.08,$259.0862,$938.6,$244.4213,$938.6,$938.6,$98.8,$674.31,$869.44,$908.96
,CDM,4050915842.10.4020,F/ DVR LOCK MEDIUM L,CDM Code,Outpatient,C1713,"$6,519.","$1,612.7354","$6,193.05","$5,215.2","$5,932.29","$1,709.4969","$6,193.05","$1,612.7354","$6,193.05","$6,193.05",$651.9,"$4,449.2175","$5,736.72","$5,997.48"
,CDM,4050915843.10.4020,F/ SCREW LOCKING SQUARE 2.7MMX,CDM Code,Outpatient,C1713,$900.,$222.651,$855.,$720.,$819.,$236.0097,$855.,$222.651,$855.,$855.,$90.,$614.25,$792.,$828.
,CDM,4050915891.10.4020,F/ LOCK SCREW SQUARE 2.7X15MM,CDM Code,Outpatient,C1713,"$1,500.",$371.085,"$1,425.","$1,200.","$1,365.",$393.3495,"$1,425.",$371.085,"$1,425.","$1,425.",$150.,"$1,023.75","$1,320.","$1,380."
,CDM,4050915911.10.4020,F/ LENS ZXT225 +20.5D,CDM Code,Outpatient,V2788GY,$988.,$244.4213,$938.6,$790.4,$899.08,$259.0862,$938.6,$244.4213,$938.6,$938.6,$98.8,$674.31,$869.44,$908.96
,CDM,4050915912.10.4020,F/ LENS ZXT150 +23.0,CDM Code,Outpatient,V2788GY,$988.,$244.4213,$938.6,$790.4,$899.08,$259.0862,$938.6,$244.4213,$938.6,$938.6,$98.8,$674.31,$869.44,$908.96
,CDM,4050915936.10.4020,F/ 2.7MM CORT SCRW ST SM HEX 1,CDM Code,Outpatient,C1713,$228.,$56.4049,$216.6,$182.4,$207.48,$59.7891,$216.6,$56.4049,$216.6,$216.6,$22.8,$155.61,$200.64,$209.76
,CDM,4050915937.10.4020,F/ 3.5MM PERI SCRW ST 14MM,CDM Code,Outpatient,C1713,$370.,$91.5343,$351.5,$296.,$336.7,$97.0262,$351.5,$91.5343,$351.5,$351.5,$37.,$252.525,$325.6,$340.4
,CDM,4050915938.10.4020,F/ 3.5MM PERI SCRW ST 16MM,CDM Code,Outpatient,C1713,$370.,$91.5343,$351.5,$296.,$336.7,$97.0262,$351.5,$91.5343,$351.5,$351.5,$37.,$252.525,$325.6,$340.4
,CDM,4050915939.10.4020,F/ 4.0MM CANN SCRW 10MM FT,CDM Code,Outpatient,C1713,$665.,$164.5144,$631.75,$532.,$605.15,$174.3849,$631.75,$164.5144,$631.75,$631.75,$66.5,$453.8625,$585.2,$611.8
,CDM,4050915940.10.4020,F/ 4.0MM FORT CANN SCRW 12MM F,CDM Code,Outpatient,C1713,$655.,$162.0404,$622.25,$524.,$596.05,$171.7626,$622.25,$162.0404,$622.25,$622.25,$65.5,$447.0375,$576.4,$602.6
,CDM,4050915941.10.4020,F/ 4.0MM FORT CANN SCRW 14MM F,CDM Code,Outpatient,C1713,$665.,$164.5144,$631.75,$532.,$605.15,$174.3849,$631.75,$164.5144,$631.75,$631.75,$66.5,$453.8625,$585.2,$611.8
,CDM,4050915942.10.4020,F/ DISTAL FIBULAR PLT 6H LT,CDM Code,Outpatient,C1713,"$2,453.",$606.8477,"$2,330.35","$1,962.4","$2,232.23",$643.2575,"$2,330.35",$606.8477,"$2,330.35","$2,330.35",$245.3,"$1,674.1725","$2,158.64","$2,256.76"
,CDM,4050915943.10.4020,F/ 3.5MM PERI SCRW 12MM ST,CDM Code,Outpatient,C1713,$370.,$91.5343,$351.5,$296.,$336.7,$97.0262,$351.5,$91.5343,$351.5,$351.5,$37.,$252.525,$325.6,$340.4
,CDM,4050916016.10.4020,F/ PERI-LOC VLP 3.5X12MM LCK S,CDM Code,Outpatient,C1713,"$1,748.",$432.4377,"$1,660.6","$1,398.4","$1,590.68",$458.3833,"$1,660.6",$432.4377,"$1,660.6","$1,660.6",$174.8,"$1,193.01","$1,538.24","$1,608.16"
,CDM,4050916017.10.4020,F/ PERI-LOC VLP 3.5X14MM LCK S,CDM Code,Outpatient,C1713,"$1,748.",$432.4377,"$1,660.6","$1,398.4","$1,590.68",$458.3833,"$1,660.6",$432.4377,"$1,660.6","$1,660.6",$174.8,"$1,193.01","$1,538.24","$1,608.16"
,CDM,4050916026.10.4020,F/ SCREW CORT ST 4.0X56MM,CDM Code,Outpatient,C1713,$499.,$123.4476,$474.05,$399.2,$454.09,$130.8543,$474.05,$123.4476,$474.05,$474.05,$49.9,$340.5675,$439.12,$459.08
,CDM,4050916029.10.4020,F/ FIBERTAK WITH SUTURETAPE,CDM Code,Outpatient,C1713,"$2,489.",$615.7537,"$2,364.55","$1,991.2","$2,264.99",$652.6979,"$2,364.55",$615.7537,"$2,364.55","$2,364.55",$248.9,"$1,698.7425","$2,190.32","$2,289.88"
,CDM,4050916072.10.4020,F/ SCREW MINI 20MM,CDM Code,Outpatient,C1713,"$2,999.",$741.9226,"$2,849.05","$2,399.2","$2,729.09",$786.4368,"$2,849.05",$741.9226,"$2,849.05","$2,849.05",$299.9,"$2,046.8175","$2,639.12","$2,759.08"
,CDM,4050916087.10.4020,F/ ANCHOR SUTURE BCC,CDM Code,Outpatient,C1713,"$2,803.",$693.4342,"$2,662.85","$2,242.4","$2,550.73",$735.0391,"$2,662.85",$693.4342,"$2,662.85","$2,662.85",$280.3,"$1,913.0475","$2,466.64","$2,578.76"
,CDM,4050916093.10.4020,F/ LENS ZCT 225 + 11.0 TECNIS,CDM Code,Outpatient,V2787GY,$488.,$120.7263,$463.6,$390.4,$444.08,$127.9697,$463.6,$120.7263,$463.6,$463.6,$48.8,$333.06,$429.44,$448.96
,CDM,4050916104.10.4020,F/ ANCHOR SUTURE BIO-CORKSCREW,CDM Code,Outpatient,C1713,"$2,489.",$615.7537,"$2,364.55","$1,991.2","$2,264.99",$652.6979,"$2,364.55",$615.7537,"$2,364.55","$2,364.55",$248.9,"$1,698.7425","$2,190.32","$2,289.88"
,CDM,4050916110.10.4020,"F/ SCREW LP, PT THD, TI, 5.5X4",CDM Code,Outpatient,C1713,"$4,658.","$1,152.3426","$4,425.1","$3,726.4","$4,238.78","$1,221.4813","$4,425.1","$1,152.3426","$4,425.1","$4,425.1",$465.8,"$3,179.085","$4,099.04","$4,285.36"
,CDM,4050916147.10.4020,F/ SCREW INTERFERENCE 10X30MM,CDM Code,Outpatient,C1713,"$2,616.",$647.1722,"$2,485.2","$2,092.8","$2,380.56",$686.0015,"$2,485.2",$647.1722,"$2,485.2","$2,485.2",$261.6,"$1,785.42","$2,302.08","$2,406.72"
,CDM,4050916154.10.4020,F/ BONUS DBM FIBER 2CC,CDM Code,Outpatient,C1713,"$5,148.","$1,273.5637","$4,890.6","$4,118.4","$4,684.68","$1,349.9755","$4,890.6","$1,273.5637","$4,890.6","$4,890.6",$514.8,"$3,513.51","$4,530.24","$4,736.16"
,CDM,4050916155.10.4020,F/ SCREW PEEK TENODESIS,CDM Code,Outpatient,C1713,"$2,530.",$625.8967,"$2,403.5","$2,024.","$2,302.3",$663.4495,"$2,403.5",$625.8967,"$2,403.5","$2,403.5",$253.,"$1,726.725","$2,226.4","$2,327.6"
,CDM,4050916156.10.4020,F/ SUTURETAPE FIBERLOOP W/ NDL,CDM Code,Outpatient,C1713,$750.,$185.5425,$712.5,$600.,$682.5,$196.6747,$712.5,$185.5425,$712.5,$712.5,$75.,$511.875,$660.,$690.
,CDM,4050916167.10.4020,F/ FORTE CANN SCRW 4X16MM FT,CDM Code,Outpatient,C1713,$655.,$162.0404,$622.25,$524.,$596.05,$171.7626,$622.25,$162.0404,$622.25,$622.25,$65.5,$447.0375,$576.4,$602.6
,CDM,4050916169.10.4020,F/ K-WIRE TRC PT 1.25X150MM 10,CDM Code,Outpatient,C1713,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.
,CDM,4050916208.10.4020,F/ CLAV FRAC PLT CENT THIRD RT,CDM Code,Outpatient,C1713,"$4,873.","$1,205.5315","$4,629.35","$3,898.4","$4,434.43","$1,277.8614","$4,629.35","$1,205.5315","$4,629.35","$4,629.35",$487.3,"$3,325.8225","$4,288.24","$4,483.16"
,CDM,4050916211.10.4020,F/ SCREW TENODESIS BIO 7X10MM,CDM Code,Outpatient,C1713,"$3,057.",$756.2712,"$2,904.15","$2,445.6","$2,781.87",$801.6463,"$2,904.15",$756.2712,"$2,904.15","$2,904.15",$305.7,"$2,086.4025","$2,690.16","$2,812.44"
,CDM,4050916217.10.4020,F/ SUTURE CORKSCREW 5.5X14.7MM,CDM Code,Outpatient,C1713,"$2,381.",$589.0356,"$2,261.95","$1,904.8","$2,166.71",$624.3768,"$2,261.95",$589.0356,"$2,261.95","$2,261.95",$238.1,"$1,625.0325","$2,095.28","$2,190.52"
,CDM,4050916222.10.4020,F/ SCREW TENODESIS BIO 7X23MM,CDM Code,Outpatient,C1713,"$3,057.",$756.2712,"$2,904.15","$2,445.6","$2,781.87",$801.6463,"$2,904.15",$756.2712,"$2,904.15","$2,904.15",$305.7,"$2,086.4025","$2,690.16","$2,812.44"
,CDM,4050916306.10.4020,F/ SCRW CORT LOW PROFILE 2.4X2,CDM Code,Outpatient,C1713,"$1,185.",$293.1572,"$1,125.75",$948.,"$1,078.35",$310.7461,"$1,125.75",$293.1572,"$1,125.75","$1,125.75",$118.5,$808.7625,"$1,042.8","$1,090.2"
,CDM,4050916307.10.4020,F/ SCREW VAL TI 2.4X18MM,CDM Code,Outpatient,C1713,"$1,500.",$371.085,"$1,425.","$1,200.","$1,365.",$393.3495,"$1,425.",$371.085,"$1,425.","$1,425.",$150.,"$1,023.75","$1,320.","$1,380."
,CDM,4050916309.10.4020,F/ PLATE DIST RAD TI STD LT 3H,CDM Code,Outpatient,C1713,"$4,658.","$1,152.3426","$4,425.1","$3,726.4","$4,238.78","$1,221.4813","$4,425.1","$1,152.3426","$4,425.1","$4,425.1",$465.8,"$3,179.085","$4,099.04","$4,285.36"
,CDM,4050916311.10.4020,F/ SCREW LO-PRO LOCK TI 3.5X12,CDM Code,Outpatient,C1713,"$1,613.",$399.0401,"$1,532.35","$1,290.4","$1,467.83",$422.9818,"$1,532.35",$399.0401,"$1,532.35","$1,532.35",$161.3,"$1,100.8725","$1,419.44","$1,483.96"
,CDM,4050916313.10.4020,F/ SCREW LO-PRO LOCK TI 3.5X14,CDM Code,Outpatient,C1713,"$1,613.",$399.0401,"$1,532.35","$1,290.4","$1,467.83",$422.9818,"$1,532.35",$399.0401,"$1,532.35","$1,532.35",$161.3,"$1,100.8725","$1,419.44","$1,483.96"
,CDM,4050916326.10.4020,F/ SCREW 2.0MM NL 12MM,CDM Code,Outpatient,C1713,$730.,$180.5947,$693.5,$584.,$664.3,$191.4301,$693.5,$180.5947,$693.5,$693.5,$73.,$498.225,$642.4,$671.6
,CDM,4050916398.10.4020,F/ SCREW 2.3MM NL 6MM,CDM Code,Outpatient,C1713,$730.,$180.5947,$693.5,$584.,$664.3,$191.4301,$693.5,$180.5947,$693.5,$693.5,$73.,$498.225,$642.4,$671.6
,CDM,4050916399.10.4020,F/ SCREW 2.0MM NL 5MM,CDM Code,Outpatient,C1713,$893.,$220.9193,$848.35,$714.4,$812.63,$234.1741,$848.35,$220.9193,$848.35,$848.35,$89.3,$609.4725,$785.84,$821.56
,CDM,4050916400.10.4020,F/ SCREW 2.0MM NL 8MM,CDM Code,Outpatient,C1713,$730.,$180.5947,$693.5,$584.,$664.3,$191.4301,$693.5,$180.5947,$693.5,$693.5,$73.,$498.225,$642.4,$671.6
,CDM,4050916401.10.4020,F/ SCREW 2.0MM NL 14MM,CDM Code,Outpatient,C1713,$730.,$180.5947,$693.5,$584.,$664.3,$191.4301,$693.5,$180.5947,$693.5,$693.5,$73.,$498.225,$642.4,$671.6
,CDM,4050916402.10.4020,F/ PLATE 1.0MM THICK 4HOLE,CDM Code,Outpatient,C1713,"$3,214.",$795.1115,"$3,053.3","$2,571.2","$2,924.74",$842.8169,"$3,053.3",$795.1115,"$3,053.3","$3,053.3",$321.4,"$2,193.555","$2,828.32","$2,956.88"
,CDM,4050916403.10.4020,F/ PLATE 1.0MM THICK 7HOLE,CDM Code,Outpatient,C1713,"$3,214.",$795.1115,"$3,053.3","$2,571.2","$2,924.74",$842.8169,"$3,053.3",$795.1115,"$3,053.3","$3,053.3",$321.4,"$2,193.555","$2,828.32","$2,956.88"
,CDM,4050916404.10.4020,F/ PLATE 1.6MM THICK 4HOLE,CDM Code,Outpatient,C1713,"$3,214.",$795.1115,"$3,053.3","$2,571.2","$2,924.74",$842.8169,"$3,053.3",$795.1115,"$3,053.3","$3,053.3",$321.4,"$2,193.555","$2,828.32","$2,956.88"
,CDM,4050916412.10.4020,F/ LENS ZCT 300 +19.5 TECNIS,CDM Code,Outpatient,V2787GY,$488.,$120.7263,$463.6,$390.4,$444.08,$127.9697,$463.6,$120.7263,$463.6,$463.6,$48.8,$333.06,$429.44,$448.96
,CDM,4050916450.10.4020,F/ SCREW 2.7 LP NL 11MM,CDM Code,Outpatient,C1713,$900.,$222.651,$855.,$720.,$819.,$236.0097,$855.,$222.651,$855.,$855.,$90.,$614.25,$792.,$828.
,CDM,4050916453.10.4020,"F/ PLATE CLAVICLE CENT THIRD,",CDM Code,Outpatient,C1713,"$3,851.",$952.6989,"$3,658.45","$3,080.8","$3,504.41","$1,009.8593","$3,658.45",$952.6989,"$3,658.45","$3,658.45",$385.1,"$2,628.3075","$3,388.88","$3,542.92"
,CDM,4050916454.10.4020,F/ FAST FIX 360 REVSD CRVD NDL,CDM Code,Outpatient,C1713,"$2,943.",$728.0688,"$2,795.85","$2,354.4","$2,678.13",$771.7517,"$2,795.85",$728.0688,"$2,795.85","$2,795.85",$294.3,"$2,008.5975","$2,589.84","$2,707.56"
,CDM,4050916535.10.4020,"F/ DISTAL LAT FIB PLT 8 HOLE,L",CDM Code,Outpatient,C1713,"$2,689.",$665.2317,"$2,554.55","$2,151.2","$2,446.99",$705.1445,"$2,554.55",$665.2317,"$2,554.55","$2,554.55",$268.9,"$1,835.2425","$2,366.32","$2,473.88"
,CDM,4050916536.10.4020,F/ 3.5MM PERI SCRW ST 18MM,CDM Code,Outpatient,C1713,$370.,$91.5343,$351.5,$296.,$336.7,$97.0262,$351.5,$91.5343,$351.5,$351.5,$37.,$252.525,$325.6,$340.4
,CDM,4050916537.10.4020,F/ 3.5MM PERI SCRW ST 20MM,CDM Code,Outpatient,C1713,$370.,$91.5343,$351.5,$296.,$336.7,$97.0262,$351.5,$91.5343,$351.5,$351.5,$37.,$252.525,$325.6,$340.4
,CDM,4050916538.10.4020,F/ FORTE CANN SCRW 4X18MM FT,CDM Code,Outpatient,C1713,$655.,$162.0404,$622.25,$524.,$596.05,$171.7626,$622.25,$162.0404,$622.25,$622.25,$65.5,$447.0375,$576.4,$602.6
,CDM,4050916539.10.4020,F/ FORTE CANN SCRW 4X20MM FT,CDM Code,Outpatient,C1713,$655.,$162.0404,$622.25,$524.,$596.05,$171.7626,$622.25,$162.0404,$622.25,$622.25,$65.5,$447.0375,$576.4,$602.6
,CDM,4050916638.10.4020,F/ SUT ANCHOR PEEK CORK 4.75X1,CDM Code,Outpatient,C1713,"$2,790.",$690.2181,"$2,650.5","$2,232.","$2,538.9",$731.6301,"$2,650.5",$690.2181,"$2,650.5","$2,650.5",$279.,"$1,904.175","$2,455.2","$2,566.8"
,CDM,4050916681.10.4020,F/ 2.3 X 14MM NON TOG CORT SCR,CDM Code,Outpatient,C1713,$863.,$213.4976,$819.85,$690.4,$785.33,$226.3071,$819.85,$213.4976,$819.85,$819.85,$86.3,$588.9975,$759.44,$793.96
,CDM,4050916682.10.4020,"F/ NRW PROF CLAVICLE PLATE, 8-",CDM Code,Outpatient,C1713,"$6,281.","$1,553.8566","$5,966.95","$5,024.8","$5,715.71","$1,647.0855","$5,966.95","$1,553.8566","$5,966.95","$5,966.95",$628.1,"$4,286.7825","$5,527.28","$5,778.52"
,CDM,4050916701.10.4020,F/ 5MMX1.5MM ST SCREW-GOLD,CDM Code,Outpatient,C1713,$778.,$192.4694,$739.1,$622.4,$707.98,$204.0173,$739.1,$192.4694,$739.1,$739.1,$77.8,$530.985,$684.64,$715.76
,CDM,4050916727.10.4020,F/ SUTURE CORKSCREW 5.5X14.7 F,CDM Code,Outpatient,C1713,"$2,489.",$615.7537,"$2,364.55","$1,991.2","$2,264.99",$652.6979,"$2,364.55",$615.7537,"$2,364.55","$2,364.55",$248.9,"$1,698.7425","$2,190.32","$2,289.88"
,CDM,4050916760.10.4020,F/ DVR LOCK LONG RT,CDM Code,Outpatient,C1713,"$7,339.","$1,815.5952","$6,972.05","$5,871.2","$6,678.49","$1,924.528","$6,972.05","$1,815.5952","$6,972.05","$6,972.05",$733.9,"$5,008.8675","$6,458.32","$6,751.88"
,CDM,4050916764.10.4020,F/ LENS ZCT 400 + 21.5 TECNIS,CDM Code,Outpatient,V2787GY,$488.,$120.7263,$463.6,$390.4,$444.08,$127.9697,$463.6,$120.7263,$463.6,$463.6,$48.8,$333.06,$429.44,$448.96
,CDM,4050916766.10.4020,F/ SCREW MINI 24MM,CDM Code,Outpatient,C1713,"$2,798.",$692.1972,"$2,658.1","$2,238.4","$2,546.18",$733.7279,"$2,658.1",$692.1972,"$2,658.1","$2,658.1",$279.8,"$1,909.635","$2,462.24","$2,574.16"
,CDM,4050916800.10.4020,F/ FIBERTAK BICEPS IMPLANT SET,CDM Code,Outpatient,C1713,"$4,376.","$1,082.5786","$4,157.2","$3,500.8","$3,982.16","$1,147.5316","$4,157.2","$1,082.5786","$4,157.2","$4,157.2",$437.6,"$2,986.62","$3,850.88","$4,025.92"
,CDM,4050916812.10.4020,F/ PLATE TI LC-DCP 2.0MM/4H,CDM Code,Outpatient,C1713,"$2,249.",$556.3801,"$2,136.55","$1,799.2","$2,046.59",$589.762,"$2,136.55",$556.3801,"$2,136.55","$2,136.55",$224.9,"$1,534.9425","$1,979.12","$2,069.08"
,CDM,4050916854.10.4020,F/ PLATE DVR CROSSLOCK MINI LE,CDM Code,Outpatient,C1713,"$4,381.","$1,083.8156","$4,161.95","$3,504.8","$3,986.71","$1,148.8428","$4,161.95","$1,083.8156","$4,161.95","$4,161.95",$438.1,"$2,990.0325","$3,855.28","$4,030.52"
,CDM,4050916858.10.4020,F/ SCREW 2.0X12MM LOCK,CDM Code,Outpatient,C1713,$998.,$246.8952,$948.1,$798.4,$908.18,$261.7085,$948.1,$246.8952,$948.1,$948.1,$99.8,$681.135,$878.24,$918.16
,CDM,4050916866.10.4020,F/ SCRW VAR ANGLE LCK 02.211.0,CDM Code,Outpatient,C1713,"$1,482.",$366.632,"$1,407.9","$1,185.6","$1,348.62",$388.6293,"$1,407.9",$366.632,"$1,407.9","$1,407.9",$148.2,"$1,011.465","$1,304.16","$1,363.44"
,CDM,4050916867.10.4020,F/ SCRW VAR ANGLE LCK 02.211.0,CDM Code,Outpatient,C1713,"$1,482.",$366.632,"$1,407.9","$1,185.6","$1,348.62",$388.6293,"$1,407.9",$366.632,"$1,407.9","$1,407.9",$148.2,"$1,011.465","$1,304.16","$1,363.44"
,CDM,4050916870.10.4020,F/ PATELLAR LIG BISECT 2.9X4.8,CDM Code,Outpatient,L8699,"$10,912.","$2,699.5197","$10,366.4","$8,729.6","$9,929.92","$2,861.4865","$10,366.4","$2,699.5197","$10,366.4","$10,366.4","$1,091.2","$7,447.44","$9,602.56","$10,039.04"
,CDM,4050916879.10.4020,F/ SCREW 3.5MMX16MM,CDM Code,Outpatient,C1713,$370.,$91.5343,$351.5,$296.,$336.7,$97.0262,$351.5,$91.5343,$351.5,$351.5,$37.,$252.525,$325.6,$340.4
,CDM,4050916882.10.4020,F/ PLATE 10 HOLE RIGHT,CDM Code,Outpatient,C1713,"$2,962.",$732.7692,"$2,813.9","$2,369.6","$2,695.42",$776.7341,"$2,813.9",$732.7692,"$2,813.9","$2,813.9",$296.2,"$2,021.565","$2,606.56","$2,725.04"
,CDM,4050916884.10.4020,F/ SCREW 3.5MMX14MM,CDM Code,Outpatient,C1713,$370.,$91.5343,$351.5,$296.,$336.7,$97.0262,$351.5,$91.5343,$351.5,$351.5,$37.,$252.525,$325.6,$340.4
,CDM,4050916885.10.4020,F/ SCREW 3.5MMX12MM,CDM Code,Outpatient,C1713,$370.,$91.5343,$351.5,$296.,$336.7,$97.0262,$351.5,$91.5343,$351.5,$351.5,$37.,$252.525,$325.6,$340.4
,CDM,4050916888.10.4020,F/ SCREW 4.0MMX40MM PT,CDM Code,Outpatient,C1713,$655.,$162.0404,$622.25,$524.,$596.05,$171.7626,$622.25,$162.0404,$622.25,$622.25,$65.5,$447.0375,$576.4,$602.6
,CDM,4050916889.10.4020,F/ SCREW 4.0MMX12MM FT,CDM Code,Outpatient,C1713,$655.,$162.0404,$622.25,$524.,$596.05,$171.7626,$622.25,$162.0404,$622.25,$622.25,$65.5,$447.0375,$576.4,$602.6
,CDM,4050916890.10.4020,F/ SCREW 4.0MMX14MM FT,CDM Code,Outpatient,C1713,$655.,$162.0404,$622.25,$524.,$596.05,$171.7626,$622.25,$162.0404,$622.25,$622.25,$65.5,$447.0375,$576.4,$602.6
,CDM,4050916892.10.4020,"F/ SUTURE ANCH, NANO CORKSCREW",CDM Code,Outpatient,C1713,"$2,979.",$736.9748,"$2,830.05","$2,383.2","$2,710.89",$781.1921,"$2,830.05",$736.9748,"$2,830.05","$2,830.05",$297.9,"$2,033.1675","$2,621.52","$2,740.68"
,CDM,4050916901.10.4020,F/ LENS ZCT 225 +210 TECNIS,CDM Code,Outpatient,V2787GY,$488.,$120.7263,$463.6,$390.4,$444.08,$127.9697,$463.6,$120.7263,$463.6,$463.6,$48.8,$333.06,$429.44,$448.96
,CDM,4050916933.10.4020,F/ SCREW INTERFERENCE 30X11MM,CDM Code,Outpatient,C1713,"$2,616.",$647.1722,"$2,485.2","$2,092.8","$2,380.56",$686.0015,"$2,485.2",$647.1722,"$2,485.2","$2,485.2",$261.6,"$1,785.42","$2,302.08","$2,406.72"
,CDM,4050916970.10.4020,"F/ SCREW PEEK TENODESIS,VENT",CDM Code,Outpatient,C1713,"$2,790.",$690.2181,"$2,650.5","$2,232.","$2,538.9",$731.6301,"$2,650.5",$690.2181,"$2,650.5","$2,650.5",$279.,"$1,904.175","$2,455.2","$2,566.8"
,CDM,4050916986.10.4020,F/ LENS ZCT 300 + 18.5 TECNIS,CDM Code,Outpatient,V2787GY,$488.,$120.7263,$463.6,$390.4,$444.08,$127.9697,$463.6,$120.7263,$463.6,$463.6,$48.8,$333.06,$429.44,$448.96
,CDM,4050917016.10.4020,F/ FIBER TAK KNOTLESS,CDM Code,Outpatient,C1713,"$2,940.",$727.3266,"$2,793.","$2,352.","$2,675.4",$770.965,"$2,793.",$727.3266,"$2,793.","$2,793.",$294.,"$2,006.55","$2,587.2","$2,704.8"
,CDM,4050917019.10.4020,F/ FOSSA IMPLANT MEDIUM RIGHT,CDM Code,Outpatient,C1716,"$13,677.","$3,383.553","$12,993.15","$10,941.6","$12,446.07","$3,586.5607","$12,993.15","$3,383.553","$12,993.15","$12,993.15",$361.251,"$9,334.5525","$12,035.76","$12,582.84"
,CDM,4050917022.10.4020,F/ BONUS DBM FIBER 10CC,CDM Code,Outpatient,C1713,"$8,928.","$2,208.6979","$8,481.6","$7,142.4","$8,124.48","$2,341.2162","$8,481.6","$2,208.6979","$8,481.6","$8,481.6",$892.8,"$6,093.36","$7,856.64","$8,213.76"
,CDM,4050917064.10.4020,F/ MENISCAL CINCH II,CDM Code,Outpatient,C1713,"$2,769.",$685.0229,"$2,630.55","$2,215.2","$2,519.79",$726.1232,"$2,630.55",$685.0229,"$2,630.55","$2,630.55",$276.9,"$1,889.8425","$2,436.72","$2,547.48"
,CDM,4050917078.10.4020,F/ FIBER TAK ANCHOR W/ FIBERWI,CDM Code,Outpatient,C1713,"$3,259.",$806.244,"$3,096.05","$2,607.2","$2,965.69",$854.6173,"$3,096.05",$806.244,"$3,096.05","$3,096.05",$325.9,"$2,224.2675","$2,867.92","$2,998.28"
,CDM,4050917088.10.4020,F/ FIBERLINK,CDM Code,Outpatient,C1713,$758.,$187.5216,$720.1,$606.4,$689.78,$198.7726,$720.1,$187.5216,$720.1,$720.1,$75.8,$517.335,$667.04,$697.36
,CDM,4050917124.10.4020,F/ TMJ FOSSA COMP MED LT,CDM Code,Outpatient,C1776,"$13,677.","$3,383.553","$12,993.15","$10,941.6","$12,446.07","$3,586.5607","$12,993.15","$3,383.553","$12,993.15","$12,993.15","$1,367.7","$9,334.5525","$12,035.76","$12,582.84"
,CDM,4050917146.10.4020,F/ SCREW INTERFERENCE 9X30MM,CDM Code,Outpatient,C1713,"$2,616.",$647.1722,"$2,485.2","$2,092.8","$2,380.56",$686.0015,"$2,485.2",$647.1722,"$2,485.2","$2,485.2",$261.6,"$1,785.42","$2,302.08","$2,406.72"
,CDM,4050917156.10.4020,F/ LENS ZCT 300 + 20.0 TECNIS,CDM Code,Outpatient,V2787GY,$488.,$120.7263,$463.6,$390.4,$444.08,$127.9697,$463.6,$120.7263,$463.6,$463.6,$48.8,$333.06,$429.44,$448.96
,CDM,4050917157.10.4020,F/ LENS ZXT150 + 25.5,CDM Code,Outpatient,V2788GY,$985.,$243.6791,$935.75,$788.,$896.35,$258.2995,$935.75,$243.6791,$935.75,$935.75,$98.5,$672.2625,$866.8,$906.2
,CDM,4050917193.10.4020,"F/ NRW PROF CLAVICLE PLATE, 8-",CDM Code,Outpatient,C1713,"$6,281.","$1,553.8566","$5,966.95","$5,024.8","$5,715.71","$1,647.0855","$5,966.95","$1,553.8566","$5,966.95","$5,966.95",$628.1,"$4,286.7825","$5,527.28","$5,778.52"
,CDM,4050917194.10.4020,F/ SCREW HEXALOBE LCKING 3.5X8,CDM Code,Outpatient,C1713,"$1,200.",$296.868,"$1,140.",$960.,"$1,092.",$314.6796,"$1,140.",$296.868,"$1,140.","$1,140.",$120.,$819.,"$1,056.","$1,104."
,CDM,4050917195.10.4020,F/ SCREW HEXALOBE NL 3.5X8MM,CDM Code,Outpatient,C1713,$912.,$225.6197,$866.4,$729.6,$829.92,$239.1565,$866.4,$225.6197,$866.4,$866.4,$91.2,$622.44,$802.56,$839.04
,CDM,4050917199.10.4020,F/ SCRW LO-PRO TM SS 2.7X20MM,CDM Code,Outpatient,C1713,$619.,$153.1344,$588.05,$495.2,$563.29,$162.3222,$588.05,$153.1344,$588.05,$588.05,$61.9,$422.4675,$544.72,$569.48
,CDM,4050917200.10.4020,F/ SCREW LO-PRO NL TM 3.5X24MM,CDM Code,Outpatient,C1713,$480.,$118.7472,$456.,$384.,$436.8,$125.8718,$456.,$118.7472,$456.,$456.,$48.,$327.6,$422.4,$441.6
,CDM,4050917201.10.4020,F/ PLATE-T 2MM 2HHEAD/8HOLE SH,CDM Code,Outpatient,C1713,"$2,305.",$570.234,"$2,189.75","$1,844.","$2,097.55",$604.4471,"$2,189.75",$570.234,"$2,189.75","$2,189.75",$230.5,"$1,573.1625","$2,028.4","$2,120.6"
,CDM,4050917202.10.4020,F/ PLATE LC-DCP 2MM 8H/51MM,CDM Code,Outpatient,C1713,"$2,544.",$629.3602,"$2,416.8","$2,035.2","$2,315.04",$667.1208,"$2,416.8",$629.3602,"$2,416.8","$2,416.8",$254.4,"$1,736.28","$2,238.72","$2,340.48"
,CDM,4050917203.10.4020,F/ SCREW CORTEX 1.3 ST 9MM,CDM Code,Outpatient,C1713,$806.,$199.3963,$765.7,$644.8,$733.46,$211.3598,$765.7,$199.3963,$765.7,$765.7,$80.6,$550.095,$709.28,$741.52
,CDM,4050917204.10.4020,F/ SCREW CORTEX 1.3 ST 11MM,CDM Code,Outpatient,C1713,$806.,$199.3963,$765.7,$644.8,$733.46,$211.3598,$765.7,$199.3963,$765.7,$765.7,$80.6,$550.095,$709.28,$741.52
,CDM,4050917205.10.4020,F/ SCREW CORTEX 2.0 ST 9MM,CDM Code,Outpatient,C1713,$527.,$130.3745,$500.65,$421.6,$479.57,$138.1968,$500.65,$130.3745,$500.65,$500.65,$52.7,$359.6775,$463.76,$484.84
,CDM,4050917206.10.4020,F/ SCREW CORTEX 2.0 ST 10MM,CDM Code,Outpatient,C1713,$527.,$130.3745,$500.65,$421.6,$479.57,$138.1968,$500.65,$130.3745,$500.65,$500.65,$52.7,$359.6775,$463.76,$484.84
,CDM,4050917207.10.4020,F/ SCREW CORTEX 2.0 ST 11MM,CDM Code,Outpatient,C1713,$527.,$130.3745,$500.65,$421.6,$479.57,$138.1968,$500.65,$130.3745,$500.65,$500.65,$52.7,$359.6775,$463.76,$484.84
,CDM,4050917208.10.4020,F/ SCREW CORTEX 2.0 ST 12MM,CDM Code,Outpatient,C1713,$527.,$130.3745,$500.65,$421.6,$479.57,$138.1968,$500.65,$130.3745,$500.65,$500.65,$52.7,$359.6775,$463.76,$484.84
,CDM,4050917209.10.4020,F/ SCREW CORTEX 2.0 ST 14MM,CDM Code,Outpatient,C1713,$527.,$130.3745,$500.65,$421.6,$479.57,$138.1968,$500.65,$130.3745,$500.65,$500.65,$52.7,$359.6775,$463.76,$484.84
,CDM,4050917210.10.4020,F/ SCREW CORTEX 2.0 ST 16MM,CDM Code,Outpatient,C1713,$527.,$130.3745,$500.65,$421.6,$479.57,$138.1968,$500.65,$130.3745,$500.65,$500.65,$52.7,$359.6775,$463.76,$484.84
,CDM,4050917232.10.4020,"F/ CHONDRAL DART, 18MM (5-BOX)",CDM Code,Outpatient,C1713,"$1,298.",$321.1122,"$1,233.1","$1,038.4","$1,181.18",$340.3784,"$1,233.1",$321.1122,"$1,233.1","$1,233.1",$129.8,$885.885,"$1,142.24","$1,194.16"
,CDM,4050917244.10.4020,F/ SCREW LOCKING 3.5MM 20MM,CDM Code,Outpatient,C1713,"$1,316.",$325.5652,"$1,250.2","$1,052.8","$1,197.56",$345.0986,"$1,250.2",$325.5652,"$1,250.2","$1,250.2",$131.6,$898.17,"$1,158.08","$1,210.72"
,CDM,4050917245.10.4020,F/ SCREW LOCKING 3.5MM 22MM,CDM Code,Outpatient,C1713,"$1,316.",$325.5652,"$1,250.2","$1,052.8","$1,197.56",$345.0986,"$1,250.2",$325.5652,"$1,250.2","$1,250.2",$131.6,$898.17,"$1,158.08","$1,210.72"
,CDM,4050917246.10.4020,F/ SCREW LOCKING 3.5MM 24MM,CDM Code,Outpatient,C1713,"$1,316.",$325.5652,"$1,250.2","$1,052.8","$1,197.56",$345.0986,"$1,250.2",$325.5652,"$1,250.2","$1,250.2",$131.6,$898.17,"$1,158.08","$1,210.72"
,CDM,4050917247.10.4020,F/ SCREW LOCKING 3.5MM 38MM,CDM Code,Outpatient,C1713,"$1,316.",$325.5652,"$1,250.2","$1,052.8","$1,197.56",$345.0986,"$1,250.2",$325.5652,"$1,250.2","$1,250.2",$131.6,$898.17,"$1,158.08","$1,210.72"
,CDM,4050917259.10.4020,F/ TMJ SCREW X-DR FOSSA 2.3X7M,CDM Code,Outpatient,C1713,$941.,$232.794,$893.95,$752.8,$856.31,$246.7613,$893.95,$232.794,$893.95,$893.95,$94.1,$642.2325,$828.08,$865.72
,CDM,4050917260.10.4020,"F/ PLATE,NAR 50MM/7HOLE CO-CR",CDM Code,Outpatient,C1713,"$12,103.","$2,994.1612","$11,497.85","$9,682.4","$11,013.73","$3,173.806","$11,497.85","$2,994.1612","$11,497.85","$11,497.85","$1,210.3","$8,260.2975","$10,650.64","$11,134.76"
,CDM,4050917275.10.4020,F/ PLATE CHIN 26MM 5X0.6MM,CDM Code,Outpatient,C1713,"$2,021.",$499.9752,"$1,919.95","$1,616.8","$1,839.11",$529.9729,"$1,919.95",$499.9752,"$1,919.95","$1,919.95",$202.1,"$1,379.3325","$1,778.48","$1,859.32"
,CDM,4050917276.10.4020,F/ SCREW 2.0 X 17MM HT X-DRIVE,CDM Code,Outpatient,C1713,$816.,$201.8702,$775.2,$652.8,$742.56,$213.9821,$775.2,$201.8702,$775.2,$775.2,$81.6,$556.92,$718.08,$750.72
,CDM,4050917277.10.4020,F/ SCREW 2.0 X 15MM HT X-DRIVE,CDM Code,Outpatient,C1713,$816.,$201.8702,$775.2,$652.8,$742.56,$213.9821,$775.2,$201.8702,$775.2,$775.2,$81.6,$556.92,$718.08,$750.72
,CDM,4050917278.10.4020,F/ SCREW 2.0 X 13MM HT X-DRIVE,CDM Code,Outpatient,C1713,$816.,$201.8702,$775.2,$652.8,$742.56,$213.9821,$775.2,$201.8702,$775.2,$775.2,$81.6,$556.92,$718.08,$750.72
,CDM,4050917279.10.4020,F/ SCREW 2.0 X 5MM HT X-DRIVE,CDM Code,Outpatient,C1713,$816.,$201.8702,$775.2,$652.8,$742.56,$213.9821,$775.2,$201.8702,$775.2,$775.2,$81.6,$556.92,$718.08,$750.72
,CDM,4050917280.10.4020,F/ SCREW 1.5MM X 5MM HT X-DR S,CDM Code,Outpatient,C1713,$797.,$197.1698,$757.15,$637.6,$725.27,$208.9997,$757.15,$197.1698,$757.15,$757.15,$79.7,$543.9525,$701.36,$733.24
,CDM,4050917281.10.4020,F/ SCREW 1.5MM X 4MM HT X-DR S,CDM Code,Outpatient,C1713,$797.,$197.1698,$757.15,$637.6,$725.27,$208.9997,$757.15,$197.1698,$757.15,$757.15,$79.7,$543.9525,$701.36,$733.24
,CDM,4050917282.10.4020,F/ PLATE 1.5MM X 3MM ADVANCE,CDM Code,Outpatient,C1713,"$3,636.",$899.51,"$3,454.2","$2,908.8","$3,308.76",$953.4792,"$3,454.2",$899.51,"$3,454.2","$3,454.2",$363.6,"$2,481.57","$3,199.68","$3,345.12"
,CDM,4050917283.10.4020,F/ PLATE-L MEDIUM RIGHT,CDM Code,Outpatient,C1713,"$1,624.",$401.7614,"$1,542.8","$1,299.2","$1,477.84",$425.8664,"$1,542.8",$401.7614,"$1,542.8","$1,542.8",$162.4,"$1,108.38","$1,429.12","$1,494.08"
,CDM,4050917284.10.4020,F/ PLATE-L MEDIUM LEFT,CDM Code,Outpatient,C1713,"$1,624.",$401.7614,"$1,542.8","$1,299.2","$1,477.84",$425.8664,"$1,542.8",$401.7614,"$1,542.8","$1,542.8",$162.4,"$1,108.38","$1,429.12","$1,494.08"
,CDM,4050917311.10.4020,F/ PEEK KNTLESS CORKSCREW 3.9M,CDM Code,Outpatient,C1713,"$2,695.",$666.716,"$2,560.25","$2,156.","$2,452.45",$706.7179,"$2,560.25",$666.716,"$2,560.25","$2,560.25",$269.5,"$1,839.3375","$2,371.6","$2,479.4"
,CDM,4050917334.10.4020,F/ SCREW 4.0X16MM FT,CDM Code,Outpatient,C1713,$655.,$162.0404,$622.25,$524.,$596.05,$171.7626,$622.25,$162.0404,$622.25,$622.25,$65.5,$447.0375,$576.4,$602.6
,CDM,4050917351.10.4020,"F/ SWIVELOCK SL, 3.5X8.5MM EYE",CDM Code,Outpatient,C1713,"$2,979.",$736.9748,"$2,830.05","$2,383.2","$2,710.89",$781.1921,"$2,830.05",$736.9748,"$2,830.05","$2,830.05",$297.9,"$2,033.1675","$2,621.52","$2,740.68"
,CDM,4050917368.10.4020,F/ SUT ANCH SUT TAK W/ FIBER W,CDM Code,Outpatient,C1713,"$2,703.",$668.6952,"$2,567.85","$2,162.4","$2,459.73",$708.8158,"$2,567.85",$668.6952,"$2,567.85","$2,567.85",$270.3,"$1,844.7975","$2,378.64","$2,486.76"
,CDM,4050917369.10.4020,"F/ SCREW, FASTTHREAD 7X20MM",CDM Code,Outpatient,C1713,"$2,616.",$647.1722,"$2,485.2","$2,092.8","$2,380.56",$686.0015,"$2,485.2",$647.1722,"$2,485.2","$2,485.2",$261.6,"$1,785.42","$2,302.08","$2,406.72"
,CDM,4050917371.10.4020,F/ SCREW 4.0 FT CANN 45MM,CDM Code,Outpatient,C1713,"$2,356.",$582.8508,"$2,238.2","$1,884.8","$2,143.96",$617.8209,"$2,238.2",$582.8508,"$2,238.2","$2,238.2",$235.6,"$1,607.97","$2,073.28","$2,167.52"
,CDM,4050917375.10.4020,F/ SCREW 4.0MMX22MM FT,CDM Code,Outpatient,C1713,$655.,$162.0404,$622.25,$524.,$596.05,$171.7626,$622.25,$162.0404,$622.25,$622.25,$65.5,$447.0375,$576.4,$602.6
,CDM,4050917376.10.4020,F/ SCREW 4.0X14MM CORT FT,CDM Code,Outpatient,C1713,$228.,$56.4049,$216.6,$182.4,$207.48,$59.7891,$216.6,$56.4049,$216.6,$216.6,$22.8,$155.61,$200.64,$209.76
,CDM,4050917377.10.4020,F/ SCREW 4.0X12MM CORT FT,CDM Code,Outpatient,C1713,$228.,$56.4049,$216.6,$182.4,$207.48,$59.7891,$216.6,$56.4049,$216.6,$216.6,$22.8,$155.61,$200.64,$209.76
,CDM,4050917378.10.4020,F/ SCREW 4.0X28MM CORT FT,CDM Code,Outpatient,C1713,$228.,$56.4049,$216.6,$182.4,$207.48,$59.7891,$216.6,$56.4049,$216.6,$216.6,$22.8,$155.61,$200.64,$209.76
,CDM,4050917381.10.4020,"F/ IMPL DEL SYS PEC REP, LG EY",CDM Code,Outpatient,C1713,"$9,668.","$2,391.7665","$9,184.6","$7,734.4","$8,797.88","$2,535.2686","$9,184.6","$2,391.7665","$9,184.6","$9,184.6",$966.8,"$6,598.41","$8,507.84","$8,894.56"
,CDM,4050917388.10.4020,F/ ANCHOR BIO SUT TAK SM JOINT,CDM Code,Outpatient,C1713,"$2,883.",$713.2254,"$2,738.85","$2,306.4","$2,623.53",$756.0177,"$2,738.85",$713.2254,"$2,738.85","$2,738.85",$288.3,"$1,967.6475","$2,537.04","$2,652.36"
,CDM,4050917396.10.4020,F/ SCREW 4.0MMX34MM PT,CDM Code,Outpatient,C1713,$655.,$162.0404,$622.25,$524.,$596.05,$171.7626,$622.25,$162.0404,$622.25,$622.25,$65.5,$447.0375,$576.4,$602.6
,CDM,4050917397.10.4020,F/ SCREW CANC 4.0X18MM PT,CDM Code,Outpatient,C1713,$214.,$52.9415,$203.3,$171.2,$194.74,$56.1179,$203.3,$52.9415,$203.3,$203.3,$21.4,$146.055,$188.32,$196.88
,CDM,4050917398.10.4020,F/ SCREW CANC 4.0X35MM PT,CDM Code,Outpatient,C1713,$214.,$52.9415,$203.3,$171.2,$194.74,$56.1179,$203.3,$52.9415,$203.3,$203.3,$21.4,$146.055,$188.32,$196.88
,CDM,4050917399.10.4020,F/ SCREW CORT 3.5X18MM SH,CDM Code,Outpatient,C1713,$228.,$56.4049,$216.6,$182.4,$207.48,$59.7891,$216.6,$56.4049,$216.6,$216.6,$22.8,$155.61,$200.64,$209.76
,CDM,4050917404.10.4020,"F/ FIBERSTITCH IMPLANT, CURVED",CDM Code,Outpatient,C1713,"$3,469.",$858.1959,"$3,295.55","$2,775.2","$3,156.79",$909.6863,"$3,295.55",$858.1959,"$3,295.55","$3,295.55",$346.9,"$2,367.5925","$3,052.72","$3,191.48"
,CDM,4050917407.10.4020,F/ SCREW HEXALOBE NL 2.7X14MM,CDM Code,Outpatient,C1713,$765.,$189.2534,$726.75,$612.,$696.15,$200.6082,$726.75,$189.2534,$726.75,$726.75,$76.5,$522.1125,$673.2,$703.8
,CDM,4050917408.10.4020,F/ SCREW HEXALOBE NL 2.7X16MM,CDM Code,Outpatient,C1713,$765.,$189.2534,$726.75,$612.,$696.15,$200.6082,$726.75,$189.2534,$726.75,$726.75,$76.5,$522.1125,$673.2,$703.8
,CDM,4050917409.10.4020,F/ SCREW HEXALOBE NL 2.7X18MM,CDM Code,Outpatient,C1713,$765.,$189.2534,$726.75,$612.,$696.15,$200.6082,$726.75,$189.2534,$726.75,$726.75,$76.5,$522.1125,$673.2,$703.8
,CDM,4050917410.10.4020,F/ SCREW HEXALOBE NL 2.7X20MM,CDM Code,Outpatient,C1713,$765.,$189.2534,$726.75,$612.,$696.15,$200.6082,$726.75,$189.2534,$726.75,$726.75,$76.5,$522.1125,$673.2,$703.8
,CDM,4050917411.10.4020,F/ SCREW HEXALOBE LOCK 2.7X16M,CDM Code,Outpatient,C1713,"$1,440.",$356.2416,"$1,368.","$1,152.","$1,310.4",$377.6155,"$1,368.",$356.2416,"$1,368.","$1,368.",$144.,$982.8,"$1,267.2","$1,324.8"
,CDM,4050917412.10.4020,F/ SCREW HEXALOBE LOCK 2.7X26M,CDM Code,Outpatient,C1713,$765.,$189.2534,$726.75,$612.,$696.15,$200.6082,$726.75,$189.2534,$726.75,$726.75,$76.5,$522.1125,$673.2,$703.8
,CDM,4050917413.10.4020,F/ LENS ZCT 300 +14.5 TECNIS,CDM Code,Outpatient,V2787GY,$488.,$120.7263,$463.6,$390.4,$444.08,$127.9697,$463.6,$120.7263,$463.6,$463.6,$48.8,$333.06,$429.44,$448.96
,CDM,4050917448.10.4020,"F/ PLATE 6 HOLE, RIGHT",CDM Code,Outpatient,C1713,"$2,453.",$606.8477,"$2,330.35","$1,962.4","$2,232.23",$643.2575,"$2,330.35",$606.8477,"$2,330.35","$2,330.35",$245.3,"$1,674.1725","$2,158.64","$2,256.76"
,CDM,4050917486.10.4020,F/ OLECRANON PLATE 7 HOLE LT,CDM Code,Outpatient,C1713,"$8,139.","$2,013.5072","$7,732.05","$6,511.2","$7,406.49","$2,134.3144","$7,732.05","$2,013.5072","$7,732.05","$7,732.05",$813.9,"$5,554.8675","$7,162.32","$7,487.88"
,CDM,4050917487.10.4020,F/ 3.0 X16MM LOCKING SCREW,CDM Code,Outpatient,C1713,"$1,440.",$356.2416,"$1,368.","$1,152.","$1,310.4",$377.6155,"$1,368.",$356.2416,"$1,368.","$1,368.",$144.,$982.8,"$1,267.2","$1,324.8"
,CDM,4050917488.10.4020,F/ 3.0 X18MM LOCKING SCREW,CDM Code,Outpatient,C1713,"$1,440.",$356.2416,"$1,368.","$1,152.","$1,310.4",$377.6155,"$1,368.",$356.2416,"$1,368.","$1,368.",$144.,$982.8,"$1,267.2","$1,324.8"
,CDM,4050917489.10.4020,F/ 3.0 X20MM LOCKING SCREW,CDM Code,Outpatient,C1713,"$1,440.",$356.2416,"$1,368.","$1,152.","$1,310.4",$377.6155,"$1,368.",$356.2416,"$1,368.","$1,368.",$144.,$982.8,"$1,267.2","$1,324.8"
,CDM,4050917490.10.4020,F/ 3.5 X 30MM NON-LOCK HEX SCR,CDM Code,Outpatient,C1713,$765.,$189.2534,$726.75,$612.,$696.15,$200.6082,$726.75,$189.2534,$726.75,$726.75,$76.5,$522.1125,$673.2,$703.8
,CDM,4050917491.10.4020,F/ 3.5 X55MM NON-LOCK HEX SCRE,CDM Code,Outpatient,C1713,"$1,005.",$248.6269,$954.75,$804.,$914.55,$263.5442,$954.75,$248.6269,$954.75,$954.75,$100.5,$685.9125,$884.4,$924.6
,CDM,4050917536.10.4020,F/ PLATE RGD 1.5/0.6 4X6 RT LN,CDM Code,Outpatient,C1713,"$2,139.",$529.1672,"$2,032.05","$1,711.2","$1,946.49",$560.9164,"$2,032.05",$529.1672,"$2,032.05","$2,032.05",$213.9,"$1,459.8675","$1,882.32","$1,967.88"
,CDM,4050917611.10.4020,F/ SCREW MINI 22MM,CDM Code,Outpatient,C1713,"$2,999.",$741.9226,"$2,849.05","$2,399.2","$2,729.09",$786.4368,"$2,849.05",$741.9226,"$2,849.05","$2,849.05",$299.9,"$2,046.8175","$2,639.12","$2,759.08"
,CDM,4070000631.10.4070,DETECT AGENT NOS DNA QUANT,CDM Code,Outpatient,87799,$315.,$47.124,$299.25,$252.,$286.65,$82.6034,$299.25,$77.9279,$299.25,$299.25,$42.84,$214.9875,$47.124,$289.8
,CDM,4070001000.10.4070,ACETAMINOPHEN,CDM Code,Outpatient,80307,$141.,$34.882,$133.95,$112.8,$128.31,$36.9749,$133.95,$34.882,$133.95,$133.95,$62.14,$96.2325,$68.354,$129.72
,CDM,4070001009.10.4070,VENIPUNCTURE,CDM Code,Outpatient,36415,$42.,$3.3,$39.9,$33.6,$38.22,$11.0138,$39.9,$10.3904,$39.9,$39.9,$3.,$28.665,$3.3,$38.64
,CDM,4070001010.10.4070,ARTERIAL PUNCTURE - CHRG ONLY,CDM Code,Outpatient,36600,$105.,$25.976,$145.6485,$84.,$95.55,$27.5345,$99.75,$25.976,$99.75,$99.75,$145.6485,$71.6625,$46.5,$96.6
,CDM,4070001014.10.4070,VITAMIN K LEVEL,CDM Code,Outpatient,84597,$167.,$15.092,$158.65,$133.6,$151.97,$43.7929,$158.65,$41.3141,$158.65,$158.65,$13.72,$113.9775,$15.092,$153.64
,CDM,4070001015.10.4070,KIT COLLECT VENI + HANDLG CHG,CDM Code,Outpatient,36415,$84.,$3.3,$79.8,$67.2,$76.44,$22.0276,$79.8,$20.7808,$79.8,$79.8,$3.,$57.33,$3.3,$77.28
,CDM,4070001016.10.4070,HIGH SENSITIVITY CRP,CDM Code,Outpatient,86141,$80.,$14.245,$76.,$64.,$72.8,$20.9786,$76.,$19.7912,$76.,$76.,$12.95,$54.6,$14.245,$73.6
,CDM,4070001017.10.4070,CA 125 ANTIGEN,CDM Code,Outpatient,86304,$129.,$22.891,$122.55,$103.2,$117.39,$33.8281,$122.55,$31.9133,$122.55,$122.55,$20.81,$88.0425,$22.891,$118.68
,CDM,4070001018.10.4070,CA 15-3 ANTIGEN,CDM Code,Outpatient,86300,$129.,$22.891,$122.55,$103.2,$117.39,$33.8281,$122.55,$31.9133,$122.55,$122.55,$20.81,$88.0425,$22.891,$118.68
,CDM,4070001020.10.4070,TROFILE DNA,CDM Code,Outpatient,87999,"$3,108.",$768.8881,"$2,952.6","$2,486.4","$2,828.28",$815.0202,"$2,952.6",$768.8881,"$2,952.6","$2,952.6",$310.8,"$2,121.21","$2,735.04","$2,859.36"
,CDM,4070001021.10.4070,ZINC ZN RBC,CDM Code,Outpatient,84630,$115.,$12.529,$109.25,$92.,$104.65,$30.1568,$109.25,$28.4499,$109.25,$109.25,$11.39,$78.4875,$12.529,$105.8
,CDM,4070001022.10.4070,TRIIODOTHYRONINE T3 REVERSE,CDM Code,Outpatient,84482,$97.,$17.336,$92.15,$77.6,$88.27,$25.4366,$92.15,$23.9968,$92.15,$92.15,$15.76,$66.2025,$17.336,$89.24
,CDM,4070001023.10.4070,VON WILLEBRAND FACTOR ANTIGEN,CDM Code,Outpatient,85244,$189.,$22.462,$179.55,$151.2,$171.99,$49.562,$179.55,$46.7567,$179.55,$179.55,$20.42,$128.9925,$22.462,$173.88
,CDM,4070001024.10.4070,CLOT FACTOR VIII VW RISTOCTIN,CDM Code,Outpatient,85245,$144.,$25.234,$136.8,$115.2,$131.04,$37.7616,$136.8,$35.6242,$136.8,$136.8,$22.94,$98.28,$25.234,$132.48
,CDM,4070001025.10.4070,VITAMIN B2 RIBOFLAVIN,CDM Code,Outpatient,84252,$219.,$22.264,$208.05,$175.2,$199.29,$57.429,$208.05,$54.1784,$208.05,$208.05,$20.24,$149.4675,$22.264,$201.48
,CDM,4070001026.10.4070,"CARISOPRODOL METABOLITE, URINE",CDM Code,Outpatient,80369,$50.,$12.3695,$47.5,$40.,$45.5,$13.1116,$47.5,$12.3695,$47.5,$47.5,$5.,$34.125,$33.5,$46.
,CDM,4070001027.10.4070,DRUG SCRN QUAN ZONISAMIDE,CDM Code,Outpatient,80203,$121.,$14.575,$114.95,$96.8,$110.11,$31.7302,$114.95,$29.9342,$114.95,$114.95,$13.25,$82.5825,$14.575,$111.32
,CDM,4070001028.10.4070,DRUG SCREENING TRAMADOL,CDM Code,Outpatient,80373,$111.,$27.4603,$105.45,$88.8,$101.01,$29.1079,$105.45,$27.4603,$105.45,$105.45,$11.1,$75.7575,$33.5,$102.12
,CDM,4070001029.10.4070,"DRUG OF ABUSE(DAS-11), URINE",CDM Code,Outpatient,80305,$97.,$13.86,$92.15,$77.6,$88.27,$25.4366,$92.15,$23.9968,$92.15,$92.15,$12.6,$66.2025,$13.86,$89.24
,CDM,4070001030.10.4070,IMMUNOASSAY QUANT NOS NONAB,CDM Code,Outpatient,83520,$312.,$18.997,$296.4,$249.6,$283.92,$81.8167,$296.4,$77.1857,$296.4,$296.4,$17.27,$212.94,$18.997,$287.04
,CDM,4070001031.10.4070,HEMOGLOBIN S SICKLE CELL EXAM,CDM Code,Outpatient,85660,$20.,$4.9478,$19.,$16.,$18.2,$5.2447,$19.,$4.9478,$19.,$19.,$5.51,$13.65,$6.061,$18.4
,CDM,4070001033.10.4070,SELENIUM (SE),CDM Code,Outpatient,84255,$46.,$11.3799,$43.7,$36.8,$41.86,$12.0627,$43.7,$11.3799,$43.7,$43.7,$25.53,$31.395,$28.083,$42.32
,CDM,4070001034.10.4070,"SQNTL INTGTD SCRN,FRST TRMSTR",CDM Code,Outpatient,81508,$227.,$56.1575,$215.65,$181.6,$206.57,$59.5269,$215.65,$56.1575,$215.65,$215.65,$54.3,$154.9275,$59.73,$208.84
,CDM,4070001035.10.4070,PSEUDOCHOLINESTERASE,CDM Code,Outpatient,82480,$40.,$8.657,$38.,$32.,$36.4,$10.4893,$38.,$9.8956,$38.,$38.,$7.87,$27.3,$8.657,$36.8
,CDM,4070001036.10.4070,ANTI-JO 1,CDM Code,Outpatient,86235,$109.,$19.723,$103.55,$87.2,$99.19,$28.5834,$103.55,$26.9655,$103.55,$103.55,$17.93,$74.3925,$19.723,$100.28
,CDM,4070001037.10.4070,ALPHA 1 ANTI PHNOTP W/ANTITRPS,CDM Code,Outpatient,82103,$96.,$14.784,$91.2,$76.8,$87.36,$25.1744,$91.2,$23.7494,$91.2,$91.2,$13.44,$65.52,$14.784,$88.32
,CDM,4070001038.10.4070,ANDROSTENEDIONE,CDM Code,Outpatient,82157,$104.,$25.7286,$98.8,$83.2,$94.64,$27.2722,$98.8,$25.7286,$98.8,$98.8,$29.28,$70.98,$32.208,$95.68
,CDM,4070001039.10.4070,ACETLCHLN RCPTR(ACHR) MOD ANTB,CDM Code,Outpatient,88182,$113.,$27.9551,$129.5,$90.4,$102.83,$29.6323,$107.35,$27.9551,$107.35,$107.35,$105.999,$77.1225,$129.5,$103.96
,CDM,4070001040.10.4070,CEA,CDM Code,Outpatient,82378,$117.,$20.856,$111.15,$93.6,$106.47,$30.6813,$111.15,$28.9446,$111.15,$111.15,$18.96,$79.8525,$20.856,$107.64
,CDM,4070001042.10.4070,INSULIN NEW,CDM Code,Outpatient,83525,$70.,$12.573,$66.5,$56.,$63.7,$18.3563,$66.5,$17.3173,$66.5,$66.5,$11.43,$47.775,$12.573,$64.4
,CDM,4070001043.10.4070,CORTISOL INHOUSE,CDM Code,Outpatient,82533,$101.,$17.93,$95.95,$80.8,$91.91,$26.4855,$95.95,$24.9864,$95.95,$95.95,$16.3,$68.9325,$17.93,$92.92
,CDM,4070001044.10.4070,TESTOSTERONE NEW,CDM Code,Outpatient,84403,$159.,$28.391,$151.05,$127.2,$144.69,$41.695,$151.05,$39.335,$151.05,$151.05,$25.81,$108.5175,$28.391,$146.28
,CDM,4070001045.10.4070,IONIZED CALCIUM,CDM Code,Outpatient,82330,$84.,$15.048,$79.8,$67.2,$76.44,$22.0276,$79.8,$20.7808,$79.8,$79.8,$13.68,$57.33,$15.048,$77.28
,CDM,4070001049.10.4070,CORTISOL PM (4-5),CDM Code,Outpatient,82533,$139.,$17.93,$132.05,$111.2,$126.49,$36.4504,$132.05,$34.3872,$132.05,$132.05,$16.3,$94.8675,$17.93,$127.88
,CDM,4070001050.10.4070,DIGOXIN,CDM Code,Outpatient,80162,$82.,$14.608,$77.9,$65.6,$74.62,$21.5031,$77.9,$20.286,$77.9,$77.9,$13.28,$55.965,$14.608,$75.44
,CDM,4070001052.10.4070,CORTISOL NITE (8-9PM),CDM Code,Outpatient,82533,$139.,$17.93,$132.05,$111.2,$126.49,$36.4504,$132.05,$34.3872,$132.05,$132.05,$16.3,$94.8675,$17.93,$127.88
,CDM,4070001053.10.4070,INSULIN FASTING,CDM Code,Outpatient,83525,$70.,$12.573,$66.5,$56.,$63.7,$18.3563,$66.5,$17.3173,$66.5,$66.5,$11.43,$47.775,$12.573,$64.4
,CDM,4070001055.10.4070,FERRITIN,CDM Code,Outpatient,82728,$84.,$14.993,$79.8,$67.2,$76.44,$22.0276,$79.8,$20.7808,$79.8,$79.8,$13.63,$57.33,$14.993,$77.28
,CDM,4070001056.10.4070,VITAMIN B 12,CDM Code,Outpatient,82607,$93.,$16.588,$88.35,$74.4,$84.63,$24.3877,$88.35,$23.0073,$88.35,$88.35,$15.08,$63.4725,$16.588,$85.56
,CDM,4070001057.10.4070,FOLATE(FOLIC ACID),CDM Code,Outpatient,82746,$91.,$16.17,$86.45,$72.8,$82.81,$23.8632,$86.45,$22.5125,$86.45,$86.45,$14.7,$62.1075,$16.17,$83.72
,CDM,4070001058.10.4070,SMEAR SPECIAL STAIN,CDM Code,Outpatient,87207,$51.,$12.6169,$48.45,$40.8,$46.41,$13.3739,$48.45,$12.6169,$48.45,$48.45,$5.99,$34.8075,$22.1,$46.92
,CDM,4070001060.10.4070,"GENTAMICIN, PEAK",CDM Code,Outpatient,80170,$118.,$18.018,$112.1,$94.4,$107.38,$30.9435,$112.1,$29.192,$112.1,$112.1,$16.38,$80.535,$18.018,$108.56
,CDM,4070001061.10.4070,DRUG SCREEN 7 URINE,CDM Code,Outpatient,80301,$71.,$17.5647,$67.45,$56.8,$64.61,$18.6185,$67.45,$17.5647,$67.45,$67.45,$7.1,$48.4575,$62.48,$65.32
,CDM,4070001062.10.4070,CORTISOL AM(8-9),CDM Code,Outpatient,82533,$101.,$17.93,$95.95,$80.8,$91.91,$26.4855,$95.95,$24.9864,$95.95,$95.95,$16.3,$68.9325,$17.93,$92.92
,CDM,4070001063.10.4070,FRAGILE X DNA ANALYSIS,CDM Code,Outpatient,81243,"$1,109.",$62.744,"$1,053.55",$887.2,"$1,009.19",$290.8164,"$1,053.55",$274.3555,"$1,053.55","$1,053.55",$57.04,$756.8925,$62.744,"$1,020.28"
,CDM,4070001064.10.4070,FACTOR X ACTIVITY,CDM Code,Outpatient,85260,$144.,$19.69,$136.8,$115.2,$131.04,$37.7616,$136.8,$35.6242,$136.8,$136.8,$17.9,$98.28,$19.69,$132.48
,CDM,4070001065.10.4070,"GENTAMICIAN, TROUGH",CDM Code,Outpatient,80170,$118.,$18.018,$112.1,$94.4,$107.38,$30.9435,$112.1,$29.192,$112.1,$112.1,$16.38,$80.535,$18.018,$108.56
,CDM,4070001066.10.4070,FRUCTOSAMINE,CDM Code,Outpatient,82985,$35.,$8.6586,$33.25,$28.,$31.85,$9.1782,$33.25,$8.6586,$33.25,$33.25,$16.76,$23.8875,$18.436,$32.2
,CDM,4070001068.10.4070,TRYPTASE,CDM Code,Outpatient,83520,$41.,$10.143,$38.95,$32.8,$37.31,$10.7516,$38.95,$10.143,$38.95,$38.95,$17.27,$27.9825,$18.997,$37.72
,CDM,4070001069.10.4070,TYRD STIMLTNG IMMUNOGLBLN(TSI),CDM Code,Outpatient,84445,$204.,$50.4676,$193.8,$163.2,$185.64,$53.4955,$193.8,$50.4676,$193.8,$193.8,$50.86,$139.23,$55.946,$187.68
,CDM,4070001070.10.4070,HCG QUANTITATIVE,CDM Code,Outpatient,84702,$93.,$16.555,$88.35,$74.4,$84.63,$24.3877,$88.35,$23.0073,$88.35,$88.35,$15.05,$63.4725,$16.555,$85.56
,CDM,4070001072.10.4070,NEURONAL AB LGG BY IMMUNOBLOT,CDM Code,Outpatient,83516,$355.,$12.683,$337.25,$284.,$323.05,$93.0927,$337.25,$87.8234,$337.25,$337.25,$11.53,$242.2875,$12.683,$326.6
,CDM,4070001074.10.4070,MANGANESE (MN),CDM Code,Outpatient,83785,$46.,$11.3799,$43.7,$36.8,$41.86,$12.0627,$43.7,$11.3799,$43.7,$43.7,$26.65,$31.395,$29.315,$42.32
,CDM,4070001075.10.4070,"MUMPS VIRUS AB, IGM",CDM Code,Outpatient,86735,$29.,$7.1743,$27.55,$23.2,$26.39,$7.6048,$27.55,$7.1743,$27.55,$27.55,$13.05,$19.7925,$14.355,$26.68
,CDM,4070001077.10.4070,"OSMOTIC FRAGILITY TEST,RBC",CDM Code,Outpatient,85557,$83.,$14.696,$78.85,$66.4,$75.53,$21.7653,$78.85,$20.5334,$78.85,$78.85,$13.36,$56.6475,$14.696,$76.36
,CDM,4070001078.10.4070,"UREA NITROGEN,BODY FLUID",CDM Code,Outpatient,84520,$47.,$4.345,$44.65,$37.6,$42.77,$12.325,$44.65,$11.6273,$44.65,$44.65,$3.95,$32.0775,$4.345,$43.24
,CDM,4070001079.10.4070,EPSTEIN BARR AB VCA IgG,CDM Code,Outpatient,86665,$78.,$19.2964,$74.1,$62.4,$70.98,$20.4542,$74.1,$19.2964,$74.1,$74.1,$18.14,$53.235,$19.954,$71.76
,CDM,4070001080.10.4070,COLLAGEN CROSSLINKS,CDM Code,Outpatient,82523,$87.,$20.548,$82.65,$69.6,$79.17,$22.8143,$82.65,$21.5229,$82.65,$82.65,$18.68,$59.3775,$20.548,$80.04
,CDM,4070001081.10.4070,DET AGNT NOS DNA QUANT PLASMA,CDM Code,Outpatient,87799,$389.,$47.124,$369.55,$311.2,$353.99,$102.0086,$369.55,$96.2347,$369.55,$369.55,$42.84,$265.4925,$47.124,$357.88
,CDM,4070001082.10.4070,COPPER (CU) RBC,CDM Code,Outpatient,82525,$40.,$9.8956,$38.,$32.,$36.4,$10.4893,$38.,$9.8956,$38.,$38.,$12.41,$27.3,$13.651,$36.8
,CDM,4070001083.10.4070,"ALCOHOL SCREEN, URINE",CDM Code,Outpatient,80320,$62.,$15.3382,$58.9,$49.6,$56.42,$16.2584,$58.9,$15.3382,$58.9,$58.9,$6.2,$42.315,$33.5,$57.04
,CDM,4070001084.10.4070,ANTI-SMITH,CDM Code,Outpatient,86235,$109.,$19.723,$103.55,$87.2,$99.19,$28.5834,$103.55,$26.9655,$103.55,$103.55,$17.93,$74.3925,$19.723,$100.28
,CDM,4070001085.10.4070,UREALYT/MYCOPL HOMINIS CULTURE,CDM Code,Outpatient,87109,$112.,$16.929,$106.4,$89.6,$101.92,$29.3701,$106.4,$27.7077,$106.4,$106.4,$15.39,$76.44,$16.929,$103.04
,CDM,4070001087.10.4070,ACHR BLOCKING ANTIBODY,CDM Code,Outpatient,83519,$109.,$20.24,$103.55,$87.2,$99.19,$28.5834,$103.55,$26.9655,$103.55,$103.55,$18.4,$74.3925,$20.24,$100.28
,CDM,4070001088.10.4070,ACHR BINDING ANTIBODY,CDM Code,Outpatient,83519,$109.,$20.24,$103.55,$87.2,$99.19,$28.5834,$103.55,$26.9655,$103.55,$103.55,$18.4,$74.3925,$20.24,$100.28
,CDM,4070001089.10.4070,AMIODARONE METABOLITE LEVELS,CDM Code,Outpatient,80375,$113.,$27.9551,$107.35,$90.4,$102.83,$29.6323,$107.35,$27.9551,$107.35,$107.35,$11.3,$77.1225,$33.5,$103.96
,CDM,4070001090.10.4070,ANTIDIURETIC ARGININE VASPRSN,CDM Code,Outpatient,84588,$73.,$18.0595,$69.35,$58.4,$66.43,$19.143,$69.35,$18.0595,$69.35,$69.35,$33.94,$49.8225,$37.334,$67.16
,CDM,4070001091.10.4070,ADRENAL TOTAL AUTOANTIBODIES,CDM Code,Outpatient,86255,$113.,$22.1,$107.35,$90.4,$102.83,$29.6323,$107.35,$27.9551,$107.35,$107.35,$12.05,$77.1225,$22.1,$103.96
,CDM,4070001092.10.4070,"ALA, 24 HOUR URINE",CDM Code,Outpatient,82135,$101.,$18.095,$95.95,$80.8,$91.91,$26.4855,$95.95,$24.9864,$95.95,$95.95,$16.45,$68.9325,$18.095,$92.92
,CDM,4070001093.10.4070,CYTOMEG DNA AMP PROBE,CDM Code,Outpatient,87496,$266.,$38.599,$252.7,$212.8,$242.06,$69.754,$252.7,$65.8057,$252.7,$252.7,$35.09,$181.545,$38.599,$244.72
,CDM,4070001095.10.4070,MTHFR MUTATIONS,CDM Code,Outpatient,81291,$207.,$51.2097,$196.65,$165.6,$188.37,$54.2822,$196.65,$51.2097,$196.65,$196.65,$159.8796,$141.2775,$71.874,$190.44
,CDM,4070001097.10.4070,"LEGIONELLA ANTIGEN, URINE",CDM Code,Outpatient,87449,$66.,$13.178,$62.7,$52.8,$60.06,$17.3074,$62.7,$16.3277,$62.7,$62.7,$11.98,$45.045,$13.178,$60.72
,CDM,4070001098.10.4070,IgG & IgM BY WESTERN BLOT,CDM Code,Outpatient,86617,$124.,$17.039,$117.8,$99.2,$112.84,$32.5169,$117.8,$30.6764,$117.8,$117.8,$15.49,$84.63,$17.039,$114.08
,CDM,4070001099.10.4070,LACOSAMIDE,CDM Code,Outpatient,83789,$323.,$26.521,$306.85,$258.4,$293.93,$84.7013,$306.85,$79.907,$306.85,$306.85,$24.11,$220.4475,$26.521,$297.16
,CDM,4070001100.10.4070,PHENOBARBITAL,CDM Code,Outpatient,80184,$82.,$16.83,$77.9,$65.6,$74.62,$21.5031,$77.9,$20.286,$77.9,$77.9,$15.3,$55.965,$16.83,$75.44
,CDM,4070001101.10.4070,"IODINE,TOTAL",CDM Code,Outpatient,83789,$413.,$26.521,$392.35,$330.4,$375.83,$108.3022,$392.35,$102.1721,$392.35,$392.35,$24.11,$281.8725,$26.521,$379.96
,CDM,4070001102.10.4070,IMMUNE CELL FUNCTION(CYLEX)-UW,CDM Code,Outpatient,86352,$555.,$137.3014,$527.25,$444.,$505.05,$145.5393,$527.25,$137.3014,$527.25,$527.25,$135.86,$378.7875,$149.446,$510.6
,CDM,4070001103.10.4070,HELICOBACTER PYLORI A,CDM Code,Outpatient,86677,$74.,$18.3069,$70.3,$59.2,$67.34,$19.4052,$70.3,$18.3069,$70.3,$70.3,$16.85,$50.505,$18.535,$68.08
,CDM,4070001104.10.4070,HUNTINGTON DISEASE,CDM Code,Outpatient,81401,$450.,$111.3255,$427.5,$360.,$409.5,$118.0048,$427.5,$111.3255,$427.5,$427.5,$137.,$307.125,$150.7,$414.
,CDM,4070001105.10.4070,VALPROIC ACID,CDM Code,Outpatient,80164,$84.,$14.894,$79.8,$67.2,$76.44,$22.0276,$79.8,$20.7808,$79.8,$79.8,$13.54,$57.33,$14.894,$77.28
,CDM,4070001105.20.4070,VALPROIC ACID,CDM Code,Outpatient,80164,$84.,$14.894,$79.8,$67.2,$76.44,$22.0276,$79.8,$20.7808,$79.8,$79.8,$13.54,$57.33,$14.894,$77.28
,CDM,4070001105.30.4070,VALPROIC ACID,CDM Code,Outpatient,80164,$84.,$14.894,$79.8,$67.2,$76.44,$22.0276,$79.8,$20.7808,$79.8,$79.8,$13.54,$57.33,$14.894,$77.28
,CDM,4070001105.82.4070,VALPROIC ACID,CDM Code,Outpatient,80164,$84.,$14.894,$79.8,$67.2,$76.44,$22.0276,$79.8,$20.7808,$79.8,$79.8,$13.54,$57.33,$14.894,$77.28
,CDM,4070001105.83.4070,VALPROIC ACID,CDM Code,Outpatient,80164,$84.,$14.894,$79.8,$67.2,$76.44,$22.0276,$79.8,$20.7808,$79.8,$79.8,$13.54,$57.33,$14.894,$77.28
,CDM,4070001106.10.4070,PLATELET ANTIBODIES,CDM Code,Outpatient,86022,$331.,$20.207,$314.45,$264.8,$301.21,$86.7991,$314.45,$81.8861,$314.45,$314.45,$18.37,$225.9075,$20.207,$304.52
,CDM,4070001108.10.4070,"CLONAZEPAM, SERUM",CDM Code,Outpatient,80346,$329.,$33.5,$312.55,$263.2,$299.39,$86.2747,$312.55,$81.3913,$312.55,$312.55,$32.9,$224.5425,$33.5,$302.68
,CDM,4070001109.10.4070,"CARNINTINE,FREE & TOTAL",CDM Code,Outpatient,82379,$88.,$18.557,$83.6,$70.4,$80.08,$23.0765,$83.6,$21.7703,$83.6,$83.6,$16.87,$60.06,$18.557,$80.96
,CDM,4070001110.10.4070,BETA-HYDROXYBUTYRATE,CDM Code,Outpatient,82010,$59.,$8.987,$56.05,$47.2,$53.69,$15.4717,$56.05,$14.596,$56.05,$56.05,$8.17,$40.2675,$8.987,$54.28
,CDM,4070001112.10.4070,DRUG SCREENING BUPRENORPHINE,CDM Code,Outpatient,80348,$138.,$34.1398,$131.1,$110.4,$125.58,$36.1882,$131.1,$34.1398,$131.1,$131.1,$13.8,$94.185,$121.44,$126.96
,CDM,4070001113.10.4070,"BILE ACIDS, TOTAL",CDM Code,Outpatient,82239,$37.,$9.1534,$35.15,$29.6,$33.67,$9.7026,$35.15,$9.1534,$35.15,$35.15,$17.12,$25.2525,$18.832,$34.04
,CDM,4070001114.10.4070,"ETHYL GLUC & ETHYL SULF,URINE",CDM Code,Outpatient,80321,$157.,$38.8402,$149.15,$125.6,$142.87,$41.1706,$149.15,$38.8402,$149.15,$149.15,$15.7,$107.1525,$138.16,$144.44
,CDM,4070001115.10.4070,"VANCOMYCIN PEAK (60""P DOSE)",CDM Code,Outpatient,80202,$150.,$14.894,$142.5,$120.,$136.5,$39.3349,$142.5,$37.1085,$142.5,$142.5,$13.54,$102.375,$14.894,$138.
,CDM,4070001118.10.4070,DRUG SCREEN 9 PANEL,CDM Code,Outpatient,80307,$174.,$43.0459,$165.3,$139.2,$158.34,$45.6285,$165.3,$43.0459,$165.3,$165.3,$62.14,$118.755,$68.354,$160.08
,CDM,4070001119.10.4070,11 DEOXYCORTISOL QUANTITATIVE,CDM Code,Outpatient,82634,$100.,$24.739,$95.,$80.,$91.,$26.2233,$95.,$24.739,$95.,$95.,$29.28,$68.25,$32.208,$92.
,CDM,4070001120.10.4070,"KAPPA-LAMDA QUANT FLC/ R,SERUM",CDM Code,Outpatient,83883,$84.,$14.96,$79.8,$67.2,$76.44,$22.0276,$79.8,$20.7808,$79.8,$79.8,$13.6,$57.33,$14.96,$77.28
,CDM,4070001121.10.4070,"PROTEIN ELECTROPHORESIS,URINE",CDM Code,Outpatient,84166,$62.,$15.3382,$58.9,$49.6,$56.42,$16.2584,$58.9,$15.3382,$58.9,$58.9,$17.83,$42.315,$22.1,$57.04
,CDM,4070001122.10.4070,DET AGNT NOS DNA QUANT UR,CDM Code,Outpatient,87799,$370.,$47.124,$351.5,$296.,$336.7,$97.0262,$351.5,$91.5343,$351.5,$351.5,$42.84,$252.525,$47.124,$340.4
,CDM,4070001123.10.4070,CYTOMEG DNA QUANT,CDM Code,Outpatient,87497,$249.,$47.124,$236.55,$199.2,$226.59,$65.296,$236.55,$61.6001,$236.55,$236.55,$42.84,$169.9425,$47.124,$229.08
,CDM,4070001124.10.4070,CHROMOTOGRAPHY QUANT MULT,CDM Code,Outpatient,82542,$335.,$26.499,$318.25,$268.,$304.85,$87.8481,$318.25,$82.8756,$318.25,$318.25,$24.09,$228.6375,$26.499,$308.2
,CDM,4070001125.10.4070,VANCOMYCIN TROUGH (30'PRIOR DO,CDM Code,Outpatient,80202,$84.,$14.894,$79.8,$67.2,$76.44,$22.0276,$79.8,$20.7808,$79.8,$79.8,$13.54,$57.33,$14.894,$77.28
,CDM,4070001126.10.4070,PAPPA SERUM,CDM Code,Outpatient,84163,$114.,$16.555,$108.3,$91.2,$103.74,$29.8946,$108.3,$28.2025,$108.3,$108.3,$15.05,$77.805,$16.555,$104.88
,CDM,4070001127.10.4070,FLUORESCENT ANTIBODY TITER,CDM Code,Outpatient,86256,$177.,$22.1,$168.15,$141.6,$161.07,$46.4152,$168.15,$43.788,$168.15,$168.15,$12.05,$120.8025,$22.1,$162.84
,CDM,4070001128.10.4070,FTL CGEN ABNOR FOUR ANAL,CDM Code,Outpatient,81511,$768.,$168.85,$729.6,$614.4,$698.88,$201.3949,$729.6,$189.9955,$729.6,$729.6,$153.5,$524.16,$168.85,$706.56
,CDM,4070001129.10.4070,DETECT AGENT NOS DNA AMP JVC,CDM Code,Outpatient,87798,$570.,$38.599,$541.5,$456.,$518.7,$149.4728,$541.5,$141.0123,$541.5,$541.5,$35.09,$389.025,$38.599,$524.4
,CDM,4070001131.10.4070,ENTEROVIRUS PROBE & REVRS TRNS,CDM Code,Outpatient,87498,$427.,$38.599,$405.65,$341.6,$388.57,$111.9735,$405.65,$105.6355,$405.65,$405.65,$35.09,$291.4275,$38.599,$392.84
,CDM,4070001132.10.4070,FLUORESCENT ANTIBODY SCREEN,CDM Code,Outpatient,86255,$168.,$22.1,$159.6,$134.4,$152.88,$44.0551,$159.6,$41.5615,$159.6,$159.6,$12.05,$114.66,$22.1,$154.56
,CDM,4070001133.10.4070,PROTEIN E-PHORESIS SERUM(IF),CDM Code,Outpatient,84165,$22.,$5.4426,$22.1,$17.6,$20.02,$5.7691,$20.9,$5.4426,$20.9,$20.9,$10.74,$15.015,$22.1,$20.24
,CDM,4070001134.10.4070,"PROTEIN, TOTAL (SEP-IF)",CDM Code,Outpatient,84155,$12.,$2.9687,$11.4,$9.6,$10.92,$3.1468,$11.4,$2.9687,$11.4,$11.4,$3.67,$8.19,$4.037,$11.04
,CDM,4070001135.10.4070,SALICYLATE,CDM Code,Outpatient,80329,$100.,$24.739,$95.,$80.,$91.,$26.2233,$95.,$24.739,$95.,$95.,$10.,$68.25,$33.5,$92.
,CDM,4070001136.10.4070,IMMUNOHISTO ANTIBOD ADD SLID,CDM Code,Outpatient,88344,$345.,$85.3495,$491.3067,$276.,$313.95,$90.4704,$327.75,$85.3495,$327.75,$327.75,$491.3067,$235.4625,$191.,$317.4
,CDM,4070001140.10.4070,T-3 UPTAKE,CDM Code,Outpatient,84479,$69.,$7.117,$65.55,$55.2,$62.79,$18.0941,$65.55,$17.0699,$65.55,$65.55,$6.47,$47.0925,$7.117,$63.48
,CDM,4070001141.10.4070,"PHOSPHOLIPID NEUTRALIZTN,PLT",CDM Code,Outpatient,85597,$97.,$19.778,$92.15,$77.6,$88.27,$25.4366,$92.15,$23.9968,$92.15,$92.15,$17.98,$66.2025,$19.778,$89.24
,CDM,4070001142.10.4070,CANDIDA ANTIBODY,CDM Code,Outpatient,86628,$39.,$9.6482,$37.05,$31.2,$35.49,$10.2271,$37.05,$9.6482,$37.05,$37.05,$12.01,$26.6175,$13.211,$35.88
,CDM,4070001143.10.4070,IMMUNODIFFUSION OUCHTERLONY,CDM Code,Outpatient,86331,$58.,$13.178,$55.1,$46.4,$52.78,$15.2095,$55.1,$14.3486,$55.1,$55.1,$11.98,$39.585,$13.178,$53.36
,CDM,4070001144.10.4070,FLECAINIDE (TAMBOCOR) LVL,CDM Code,Outpatient,80299,$60.,$14.8434,$57.,$48.,$54.6,$15.734,$57.,$14.8434,$57.,$57.,$18.64,$40.95,$20.504,$55.2
,CDM,4070001145.10.4070,"T-4, THYROXINE",CDM Code,Outpatient,84436,$72.,$7.557,$68.4,$57.6,$65.52,$18.8808,$68.4,$17.8121,$68.4,$68.4,$6.87,$49.14,$7.557,$66.24
,CDM,4070001146.10.4070,CARBAMAZEPINE,CDM Code,Outpatient,80156,$90.,$16.027,$85.5,$72.,$81.9,$23.601,$85.5,$22.2651,$85.5,$85.5,$14.57,$61.425,$16.027,$82.8
,CDM,4070001147.10.4070,GENET VIRUS ISOLATE HSV,CDM Code,Outpatient,87255,$0.,$0.,$37.246,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$33.86,$0.,$37.246,$0.
,CDM,4070001148.10.4070,ASSAY OF PLASMA HEMOGLOBIN,CDM Code,Outpatient,83051,$30.,$7.4217,$28.5,$24.,$27.3,$7.867,$28.5,$7.4217,$28.5,$28.5,$7.31,$20.475,$8.041,$27.6
,CDM,4070001150.10.4070,THEOPHYLLINE,CDM Code,Outpatient,80198,$113.,$15.554,$107.35,$90.4,$102.83,$29.6323,$107.35,$27.9551,$107.35,$107.35,$14.14,$77.1225,$15.554,$103.96
,CDM,4070001151.10.4070,HERPES SIMPLEX NES ANTIBODY,CDM Code,Outpatient,86694,$139.,$15.829,$132.05,$111.2,$126.49,$36.4504,$132.05,$34.3872,$132.05,$132.05,$14.39,$94.8675,$15.829,$127.88
,CDM,4070001152.10.4070,COMPLEMENT ANTIGEN,CDM Code,Outpatient,86160,$128.,$13.2,$121.6,$102.4,$116.48,$33.5658,$121.6,$31.6659,$121.6,$121.6,$12.,$87.36,$13.2,$117.76
,CDM,4070001153.10.4070,BORDETELLA ANTIBODY,CDM Code,Outpatient,86615,$159.,$14.509,$151.05,$127.2,$144.69,$41.695,$151.05,$39.335,$151.05,$151.05,$13.19,$108.5175,$14.509,$146.28
,CDM,4070001154.10.4070,ASSAY OF NICOTINE,CDM Code,Outpatient,80323,$192.,$33.5,$182.4,$153.6,$174.72,$50.3487,$182.4,$47.4989,$182.4,$182.4,$19.2,$131.04,$33.5,$176.64
,CDM,4070001155.10.4070,ASSAY OF LIPOPROTEIN (A),CDM Code,Outpatient,83695,$160.,$15.752,$152.,$128.,$145.6,$41.9573,$152.,$39.5824,$152.,$152.,$14.32,$109.2,$15.752,$147.2
,CDM,4070001157.10.4070,LIPOPROTEIN BLD HR FRACTION,CDM Code,Outpatient,83701,$84.,$20.7808,$79.8,$67.2,$76.44,$22.0276,$79.8,$20.7808,$79.8,$79.8,$33.86,$57.33,$37.246,$77.28
,CDM,4070001158.10.4070,CLOT INHIBIT PROT S FREE,CDM Code,Outpatient,85306,$121.,$16.852,$114.95,$96.8,$110.11,$31.7302,$114.95,$29.9342,$114.95,$114.95,$15.32,$82.5825,$16.852,$111.32
,CDM,4070001159.10.4070,OVA & PARASITES SMEARS,CDM Code,Outpatient,87177,$65.,$9.79,$61.75,$52.,$59.15,$17.0451,$61.75,$16.0803,$61.75,$61.75,$8.9,$44.3625,$9.79,$59.8
,CDM,4070001160.10.4070,THYROID STIMULATING HORMONE,CDM Code,Outpatient,84443,$104.,$18.48,$98.8,$83.2,$94.64,$27.2722,$98.8,$25.7286,$98.8,$98.8,$16.8,$70.98,$18.48,$95.68
,CDM,4070001160.20.4070,THYROID STIMULATING HORMONE,CDM Code,Outpatient,84443,$0.,$0.,$18.48,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$16.8,$0.,$18.48,$0.
,CDM,4070001160.30.4070,THYROID STIMULATING HORMONE,CDM Code,Outpatient,84443,$0.,$0.,$18.48,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$16.8,$0.,$18.48,$0.
,CDM,4070001160.82.4070,THYROID STIMULATING HORMONE,CDM Code,Outpatient,84443,$0.,$0.,$18.48,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$16.8,$0.,$18.48,$0.
,CDM,4070001160.83.4070,THYROID STIMULATING HORMONE,CDM Code,Outpatient,84443,$0.,$0.,$18.48,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$16.8,$0.,$18.48,$0.
,CDM,4070001162.10.4070,THROMBOLPLASTIN TIME PARTL(PH),CDM Code,Outpatient,85730,$98.,$6.611,$93.1,$78.4,$89.18,$25.6988,$93.1,$24.2442,$93.1,$93.1,$6.01,$66.885,$6.611,$90.16
,CDM,4070001163.10.4070,"T3,FREE",CDM Code,Outpatient,84481,$105.,$18.634,$99.75,$84.,$95.55,$27.5345,$99.75,$25.976,$99.75,$99.75,$16.94,$71.6625,$18.634,$96.6
,CDM,4070001164.10.4070,SMEAR COMPLEX STAIN,CDM Code,Outpatient,87209,$111.,$19.778,$105.45,$88.8,$101.01,$29.1079,$105.45,$27.4603,$105.45,$105.45,$17.98,$75.7575,$19.778,$102.12
,CDM,4070001165.10.4070,ASSAY ACTIVATED PROTEIN C,CDM Code,Outpatient,85307,$157.,$16.852,$149.15,$125.6,$142.87,$41.1706,$149.15,$38.8402,$149.15,$149.15,$15.32,$107.1525,$16.852,$144.44
,CDM,4070001166.10.4070,CYTO/MOLECULAR REPORT,CDM Code,Outpatient,88291,$48.,$11.8747,$47.,$38.4,$43.68,$12.5872,$45.6,$11.8747,$45.6,$45.6,$4.8,$32.76,$47.,$44.16
,CDM,4070001167.10.4070,TETANUS ANTIBODY,CDM Code,Outpatient,86774,$56.,$13.8538,$53.2,$44.8,$50.96,$14.685,$53.2,$13.8538,$53.2,$53.2,$14.8,$38.22,$16.28,$51.52
,CDM,4070001168.10.4070,DIPTHERIA ANTIBODY,CDM Code,Outpatient,86648,$57.,$14.1012,$54.15,$45.6,$51.87,$14.9473,$54.15,$14.1012,$54.15,$54.15,$15.21,$38.9025,$16.731,$52.44
,CDM,4070001169.10.4070,CHROMOSOME ANALYSIS 15-20,CDM Code,Outpatient,88262,$18.,$4.453,$138.039,$14.4,$16.38,$4.7202,$17.1,$4.453,$17.1,$17.1,$125.49,$12.285,$138.039,$16.56
,CDM,4070001170.10.4070,TISSUE CULTURE LYMPHOCYTE,CDM Code,Outpatient,88230,$520.,$128.139,$494.,$416.,$473.2,$136.3612,$494.,$128.6428,$494.,$494.,$116.49,$354.9,$128.139,$478.4
,CDM,4070001171.10.4070,ASSAY FOR CALPROTECTIN FECAL,CDM Code,Outpatient,83993,$121.,$21.593,$114.95,$96.8,$110.11,$31.7302,$114.95,$29.9342,$114.95,$114.95,$19.63,$82.5825,$21.593,$111.32
,CDM,4070001172.10.4070,LEMELLAR BDY FETAL LUNG,CDM Code,Outpatient,83664,$127.,$21.252,$120.65,$101.6,$115.57,$33.3036,$120.65,$31.4185,$120.65,$120.65,$19.32,$86.6775,$21.252,$116.84
,CDM,4070001173.10.4070,FUNGI IDENTIFICATION MOLD,CDM Code,Outpatient,87107,$92.,$11.352,$87.4,$73.6,$83.72,$24.1254,$87.4,$22.7599,$87.4,$87.4,$10.32,$62.79,$11.352,$84.64
,CDM,4070001174.10.4070,CHROMOSOME KARYOTYPE STUDY,CDM Code,Outpatient,88280,$184.,$36.817,$174.8,$147.2,$167.44,$48.2509,$174.8,$45.5198,$174.8,$174.8,$33.47,$125.58,$36.817,$169.28
,CDM,4070001175.10.4070,COCCIDIOIDES ANTIBODY,CDM Code,Outpatient,86635,$60.,$12.617,$57.,$48.,$54.6,$15.734,$57.,$14.8434,$57.,$57.,$11.47,$40.95,$12.617,$55.2
,CDM,4070001176.10.4070,TREPONEMA PALLIDUM,CDM Code,Outpatient,86780,$82.,$14.564,$77.9,$65.6,$74.62,$21.5031,$77.9,$20.286,$77.9,$77.9,$48.4872,$55.965,$14.564,$75.44
,CDM,4070001177.10.4070,ASPERAILLUS ANTIBODY,CDM Code,Outpatient,86606,$84.,$16.555,$79.8,$67.2,$76.44,$22.0276,$79.8,$20.7808,$79.8,$79.8,$15.05,$57.33,$16.555,$77.28
,CDM,4070001178.10.4070,CHLAMYDIA 1gM ANTIBODY,CDM Code,Outpatient,86632,$38.,$9.4008,$46.458,$30.4,$34.58,$9.9649,$36.1,$9.4008,$36.1,$36.1,$46.458,$25.935,$13.948,$34.96
,CDM,4070001179.10.4070,CHLAMYDIA ANTIBODY,CDM Code,Outpatient,86631,$58.,$13.002,$55.1,$46.4,$52.78,$15.2095,$55.1,$14.3486,$55.1,$55.1,$43.3074,$39.585,$13.002,$53.36
,CDM,4070001180.10.4070,EPSTEIN-BARR NUCLEAR ANTIGEN,CDM Code,Outpatient,86664,$115.,$16.819,$109.25,$92.,$104.65,$30.1568,$109.25,$28.4499,$109.25,$109.25,$15.29,$78.4875,$16.819,$105.8
,CDM,4070001182.10.4070,ASSAY OF CADMIUM,CDM Code,Outpatient,82300,$114.,$26.004,$108.3,$91.2,$103.74,$29.8946,$108.3,$28.2025,$108.3,$108.3,$23.64,$77.805,$26.004,$104.88
,CDM,4070001183.10.4070,T CELLS TOTAL COUNT,CDM Code,Outpatient,86359,$168.,$41.503,$159.6,$134.4,$152.88,$44.0551,$159.6,$41.5615,$159.6,$159.6,$37.73,$114.66,$41.503,$154.56
,CDM,4070001184.10.4070,NK CELLS TOTAL COUNT,CDM Code,Outpatient,86357,$172.,$41.503,$163.4,$137.6,$156.52,$45.1041,$163.4,$42.5511,$163.4,$163.4,$37.73,$117.39,$41.503,$158.24
,CDM,4070001185.10.4070,EPSTEIN-BARR ANTIBODY,CDM Code,Outpatient,86663,$125.,$14.432,$118.75,$100.,$113.75,$32.7791,$118.75,$30.9237,$118.75,$118.75,$13.12,$85.3125,$14.432,$115.
,CDM,4070001186.10.4070,MONONUCLEAR CELL ANTIGEN,CDM Code,Outpatient,86356,$121.,$29.458,$114.95,$96.8,$110.11,$31.7302,$114.95,$29.9342,$114.95,$114.95,$26.78,$82.5825,$29.458,$111.32
,CDM,4070001187.10.4070,F2 GENE,CDM Code,Outpatient,81240,$352.,$72.259,$334.4,$281.6,$320.32,$92.306,$334.4,$87.0813,$334.4,$334.4,$180.225,$240.24,$72.259,$323.84
,CDM,4070001188.10.4070,PROCALCITONIN (POT),CDM Code,Outpatient,84145,$208.,$29.942,$197.6,$166.4,$189.28,$54.5445,$197.6,$51.4571,$197.6,$197.6,$27.22,$141.96,$29.942,$191.36
,CDM,4070001189.10.4070,B-CELLS TOTAL COUNT,CDM Code,Outpatient,86355,$185.,$41.503,$175.75,$148.,$168.35,$48.5131,$175.75,$45.7672,$175.75,$175.75,$37.73,$126.2625,$41.503,$170.2
,CDM,4070001190.10.4070,FATS/LIPIDS FECES QUAL,CDM Code,Outpatient,82705,$39.,$5.61,$37.05,$31.2,$35.49,$10.2271,$37.05,$9.6482,$37.05,$37.05,$5.1,$26.6175,$5.61,$35.88
,CDM,4070001191.10.4070,COPPER 24HR URINE,CDM Code,Outpatient,82525,$58.,$13.651,$55.1,$46.4,$52.78,$15.2095,$55.1,$14.3486,$55.1,$55.1,$12.41,$39.585,$13.651,$53.36
,CDM,4070001192.10.4070,ASSAY OF URINE PORPHYRINS,CDM Code,Outpatient,84120,$83.,$16.181,$78.85,$66.4,$75.53,$21.7653,$78.85,$20.5334,$78.85,$78.85,$14.71,$56.6475,$16.181,$76.36
,CDM,4070001193.10.4070,ASSAY OF SWEAT SODIUM,CDM Code,Outpatient,84302,$41.,$5.346,$38.95,$32.8,$37.31,$10.7516,$38.95,$10.143,$38.95,$38.95,$4.86,$27.9825,$5.346,$37.72
,CDM,4070001194.10.4070,BLOOD VISCOSITY EXAMINATION,CDM Code,Outpatient,85810,$49.,$12.1221,$46.55,$39.2,$44.59,$12.8494,$46.55,$12.1221,$46.55,$46.55,$11.67,$33.4425,$12.837,$45.08
,CDM,4070001195.10.4070,PARVOVIRUS ANTIBODY,CDM Code,Outpatient,86747,$97.,$16.533,$92.15,$77.6,$88.27,$25.4366,$92.15,$23.9968,$92.15,$92.15,$15.03,$66.2025,$16.533,$89.24
,CDM,4070001196.10.4070,RUBELLA IgM,CDM Code,Outpatient,86762,$91.,$15.829,$86.45,$72.8,$82.81,$23.8632,$86.45,$22.5125,$86.45,$86.45,$14.39,$62.1075,$15.829,$83.72
,CDM,4070001197.10.4070,ASSAY TEST FOR BLOOD FECAL,CDM Code,Outpatient,82274,$98.,$17.512,$93.1,$78.4,$89.18,$25.6988,$93.1,$24.2442,$93.1,$93.1,$15.92,$66.885,$17.512,$90.16
,CDM,4070001198.10.4070,TRICHOMONAS VAGINALIS AMPLIF,CDM Code,Outpatient,87661,$122.,$30.1816,$115.9,$97.6,$111.02,$31.9924,$115.9,$30.1816,$115.9,$115.9,$35.09,$83.265,$38.599,$112.24
,CDM,4070001200.10.4070,"KETONE, SERUM",CDM Code,Outpatient,82009,$90.,$4.972,$85.5,$72.,$81.9,$23.601,$85.5,$22.2651,$85.5,$85.5,$4.52,$61.425,$4.972,$82.8
,CDM,4070001201.10.4070,FACTOR INHIBITOR TEST,CDM Code,Outpatient,85335,$285.,$14.157,$270.75,$228.,$259.35,$74.7364,$270.75,$70.5062,$270.75,$270.75,$12.87,$194.5125,$14.157,$262.2
,CDM,4070001202.10.4070,"ADAM T13 ANTIBODY, REFLXD",CDM Code,Outpatient,83520,$316.,$18.997,$300.2,$252.8,$287.56,$82.8656,$300.2,$78.1752,$300.2,$300.2,$17.27,$215.67,$18.997,$290.72
,CDM,4070001203.10.4070,ASSAY OF FOLIC ACID RBC,CDM Code,Outpatient,82747,$46.,$11.3799,$43.7,$36.8,$41.86,$12.0627,$43.7,$11.3799,$43.7,$43.7,$17.65,$31.395,$19.415,$42.32
,CDM,4070001204.10.4070,ALLERGEN SPECIFIC IGE,CDM Code,Outpatient,86003,$32.,$5.742,$30.4,$25.6,$29.12,$8.3915,$30.4,$7.9165,$30.4,$30.4,$5.22,$21.84,$5.742,$29.44
,CDM,4070001205.10.4070,VIRUS INOCULATION TISSUE,CDM Code,Outpatient,87252,$161.,$28.677,$152.95,$128.8,$146.51,$42.2195,$152.95,$39.8298,$152.95,$152.95,$26.07,$109.8825,$28.677,$148.12
,CDM,4070001206.10.4070,BARTONELLA henselae AB IgG,CDM Code,Outpatient,86611,$93.,$11.198,$88.35,$74.4,$84.63,$24.3877,$88.35,$23.0073,$88.35,$88.35,$10.18,$63.4725,$11.198,$85.56
,CDM,4070001207.10.4070,BACTERIUM ANTIBODY,CDM Code,Outpatient,86609,$158.,$14.168,$150.1,$126.4,$143.78,$41.4328,$150.1,$39.0876,$150.1,$150.1,$12.88,$107.835,$14.168,$145.36
,CDM,4070001208.10.4070,CHLAMYDIA CULTURE,CDM Code,Outpatient,87110,$212.,$21.56,$201.4,$169.6,$192.92,$55.5934,$201.4,$52.4467,$201.4,$201.4,$71.7696,$144.69,$21.56,$195.04
,CDM,4070001209.10.4070,FLOWCYTOMETRY/TC ADD-ON,CDM Code,Outpatient,88185,$155.,$38.3454,$147.25,$124.,$141.05,$40.6461,$147.25,$38.3454,$147.25,$147.25,$15.5,$105.7875,$42.5,$142.6
,CDM,4070001210.10.4070,"ALBUMIN, SERUM",CDM Code,Outpatient,82040,$31.,$5.445,$29.45,$24.8,$28.21,$8.1292,$29.45,$7.6691,$29.45,$29.45,$4.95,$21.1575,$5.445,$28.52
,CDM,4070001211.10.4070,"ALBUMIN, BODY FLUID",CDM Code,Outpatient,82042,$45.,$8.558,$42.75,$36.,$40.95,$11.8005,$42.75,$11.1326,$42.75,$42.75,$7.78,$30.7125,$8.558,$41.4
,CDM,4070001212.10.4070,BCR/ABL 1 GENE MAJOR BP,CDM Code,Outpatient,81206,$608.,$150.4131,$600.5097,$486.4,$553.28,$159.4377,$577.6,$150.4131,$577.6,$577.6,$600.5097,$414.96,$180.356,$559.36
,CDM,4070001213.10.4070,BCR/ABL 1 GENE MINOR BP,CDM Code,Outpatient,81207,$402.,$99.4508,$530.4756,$321.6,$365.82,$105.4177,$381.9,$99.4508,$381.9,$381.9,$530.4756,$274.365,$159.324,$369.84
,CDM,4070001215.10.4070,ALCOHOL (ETHANOL),CDM Code,Outpatient,80320,$201.,$33.5,$190.95,$160.8,$182.91,$52.7088,$190.95,$49.7254,$190.95,$190.95,$20.1,$137.1825,$33.5,$184.92
,CDM,4070001216.10.4070,"B PERT/ PARA PERT, PCR",CDM Code,Outpatient,87801,$433.,$77.22,$411.35,$346.4,$394.03,$113.5469,$411.35,$107.1199,$411.35,$411.35,$70.2,$295.5225,$77.22,$398.36
,CDM,4070001217.10.4070,NUCLEAR ANTIGEN ANTIBODY,CDM Code,Outpatient,86235,$109.,$19.723,$103.55,$87.2,$99.19,$28.5834,$103.55,$26.9655,$103.55,$103.55,$17.93,$74.3925,$19.723,$100.28
,CDM,4070001218.10.4070,DRUG CONFIRMATION,CDM Code,Outpatient,80349,$126.,$31.1711,$119.7,$100.8,$114.66,$33.0414,$119.7,$31.1711,$119.7,$119.7,$12.6,$85.995,$33.5,$115.92
,CDM,4070001219.10.4070,ANTI MULLERIAN HORMONE,CDM Code,Outpatient,83520,$216.,$18.997,$205.2,$172.8,$196.56,$56.6423,$205.2,$53.4362,$205.2,$205.2,$17.27,$147.42,$18.997,$198.72
,CDM,4070001220.10.4070,ALKALINE PHOSPHATASE,CDM Code,Outpatient,84075,$41.,$5.698,$38.95,$32.8,$37.31,$10.7516,$38.95,$10.143,$38.95,$38.95,$5.18,$27.9825,$5.698,$37.72
,CDM,4070001222.10.4070,LIPASE,CDM Code,Outpatient,83690,$43.,$7.579,$40.85,$34.4,$39.13,$11.276,$40.85,$10.6378,$40.85,$40.85,$6.89,$29.3475,$7.579,$39.56
,CDM,4070001223.10.4070,"AMMONIA, PLASMA",CDM Code,Outpatient,82140,$90.,$16.027,$85.5,$72.,$81.9,$23.601,$85.5,$22.2651,$85.5,$85.5,$14.57,$61.425,$16.027,$82.8
,CDM,4070001224.10.4070,ASSAY OF SIROLIMUS,CDM Code,Outpatient,80195,$98.,$15.103,$93.1,$78.4,$89.18,$25.6988,$93.1,$24.2442,$93.1,$93.1,$13.73,$66.885,$15.103,$90.16
,CDM,4070001227.10.4070,MICROBE SUSCEPTIBLE ENZYME,CDM Code,Outpatient,87185,$41.,$5.225,$38.95,$32.8,$37.31,$10.7516,$38.95,$10.143,$38.95,$38.95,$4.75,$27.9825,$5.225,$37.72
,CDM,4070001228.10.4070,CULTURE SCREEN ONLY,CDM Code,Outpatient,87081,$88.,$7.293,$83.6,$70.4,$80.08,$23.0765,$83.6,$21.7703,$83.6,$83.6,$6.63,$60.06,$7.293,$80.96
,CDM,4070001229.10.4070,5-a-DIHYDROTESTOSTERONE,CDM Code,Outpatient,82542,$117.,$26.499,$111.15,$93.6,$106.47,$30.6813,$111.15,$28.9446,$111.15,$111.15,$24.09,$79.8525,$26.499,$107.64
,CDM,4070001230.10.4070,"AMYLASE, SERUM",CDM Code,Outpatient,82150,$40.,$7.128,$38.,$32.,$36.4,$10.4893,$38.,$9.8956,$38.,$38.,$6.48,$27.3,$7.128,$36.8
,CDM,4070001231.10.4070,MICROBE SUSCEPTIBLE MIC,CDM Code,Outpatient,87186,$156.,$9.515,$148.2,$124.8,$141.96,$40.9083,$148.2,$38.5928,$148.2,$148.2,$8.65,$106.47,$9.515,$143.52
,CDM,4070001232.10.4070,MICROBE SUSCEPTIBLE DISK,CDM Code,Outpatient,87184,$27.,$6.6795,$25.65,$21.6,$24.57,$7.0803,$25.65,$6.6795,$25.65,$25.65,$7.48,$18.4275,$8.228,$24.84
,CDM,4070001233.10.4070,HEPATITIS B SURFACE AG EIA,CDM Code,Outpatient,87341,$183.,$11.363,$173.85,$146.4,$166.53,$47.9886,$173.85,$45.2724,$173.85,$173.85,$37.8339,$124.8975,$11.363,$168.36
,CDM,4070001234.10.4070,DRUG ANALYSIS TISSUE PREP,CDM Code,Outpatient,80307,$93.,$23.0073,$88.35,$74.4,$84.63,$24.3877,$88.35,$23.0073,$88.35,$88.35,$62.14,$63.4725,$68.354,$85.56
,CDM,4070001235.10.4070,"AMYLASE, BODY FLUID",CDM Code,Outpatient,82150,$96.,$7.128,$91.2,$76.8,$87.36,$25.1744,$91.2,$23.7494,$91.2,$91.2,$6.48,$65.52,$7.128,$88.32
,CDM,4070001236.10.4070,INTRINSIC FACTOR ANTIBODY,CDM Code,Outpatient,86340,$51.,$12.6169,$48.45,$40.8,$46.41,$13.3739,$48.45,$12.6169,$48.45,$48.45,$15.08,$34.8075,$16.588,$46.92
,CDM,4070001237.10.4070,HEMOGLOBIN ELECTROPHORESIS,CDM Code,Outpatient,83020,$92.,$22.1,$87.4,$73.6,$83.72,$24.1254,$87.4,$22.7599,$87.4,$87.4,$12.87,$62.79,$22.1,$84.64
,CDM,4070001238.10.4070,CORTISOL FREE,CDM Code,Outpatient,82530,$143.,$18.381,$135.85,$114.4,$130.13,$37.4993,$135.85,$35.3768,$135.85,$135.85,$16.71,$97.5975,$18.381,$131.56
,CDM,4070001240.10.4070,"CORTISOL, PRE-STIMULATION",CDM Code,Outpatient,82533,$134.,$17.93,$127.3,$107.2,$121.94,$35.1392,$127.3,$33.1503,$127.3,$127.3,$16.3,$91.455,$17.93,$123.28
,CDM,4070001241.10.4070,DETECT AGENT NOS DNA DIR,CDM Code,Outpatient,87797,$121.,$29.9342,$114.95,$96.8,$110.11,$31.7302,$114.95,$29.9342,$114.95,$114.95,$30.03,$82.5825,$33.033,$111.32
,CDM,4070001242.10.4070,FUNGUS NES ANTIBODY,CDM Code,Outpatient,86671,$162.,$13.475,$153.9,$129.6,$147.42,$42.4817,$153.9,$40.0772,$153.9,$153.9,$12.25,$110.565,$13.475,$149.04
,CDM,4070001243.10.4070,TISSUE HOMOGENIZATION CULTR,CDM Code,Outpatient,87176,$61.,$6.468,$57.95,$48.8,$55.51,$15.9962,$57.95,$15.0908,$57.95,$57.95,$5.88,$41.6325,$6.468,$56.12
,CDM,4070001244.10.4070,THROMBIN TIME PLASMA,CDM Code,Outpatient,85670,$98.,$6.347,$93.1,$78.4,$89.18,$25.6988,$93.1,$24.2442,$93.1,$93.1,$5.77,$66.885,$6.347,$90.16
,CDM,4070001245.10.4070,CHEMILUMINESCENT ASSAY,CDM Code,Outpatient,82397,$63.,$15.532,$59.85,$50.4,$57.33,$16.5207,$59.85,$15.5856,$59.85,$59.85,$14.12,$42.9975,$15.532,$57.96
,CDM,4070001246.10.4070,HCV GENOSURE R NS3 4A,CDM Code,Outpatient,87900,$809.,$143.385,$768.55,$647.2,$736.19,$212.1465,$768.55,$200.1385,$768.55,$768.55,$130.35,$552.1425,$143.385,$744.28
,CDM,4070001247.10.4070,THROMOPLASTIN TIME PARTIAL,CDM Code,Outpatient,85732,$111.,$7.117,$105.45,$88.8,$101.01,$29.1079,$105.45,$27.4603,$105.45,$105.45,$6.47,$75.7575,$7.117,$102.12
,CDM,4070001248.10.4070,HEXAGNAL PHOSPH FLTLT NEUTRL,CDM Code,Outpatient,85598,$149.,$19.778,$141.55,$119.2,$135.59,$39.0727,$141.55,$36.8611,$141.55,$141.55,$17.98,$101.6925,$19.778,$137.08
,CDM,4070001249.10.4070,CYSTATIN C,CDM Code,Outpatient,82610,$158.,$20.372,$150.1,$126.4,$143.78,$41.4328,$150.1,$39.0876,$150.1,$150.1,$18.52,$107.835,$20.372,$145.36
,CDM,4070001250.10.4070,"CORTISOL, 30 MIN POST STIMULAT",CDM Code,Outpatient,82533,$134.,$17.93,$127.3,$107.2,$121.94,$35.1392,$127.3,$33.1503,$127.3,$127.3,$16.3,$91.455,$17.93,$123.28
,CDM,4070001251.10.4070,WEST NILE VIRUS AB IGM,CDM Code,Outpatient,86788,$123.,$18.535,$116.85,$98.4,$111.93,$32.2547,$116.85,$30.429,$116.85,$116.85,$16.85,$83.9475,$18.535,$113.16
,CDM,4070001252.10.4070,QUANTITATIVE ASSAY DRUG,CDM Code,Outpatient,80299,$185.,$20.504,$175.75,$148.,$168.35,$48.5131,$175.75,$45.7672,$175.75,$175.75,$18.64,$126.2625,$20.504,$170.2
,CDM,4070001253.10.4070,T CELL ABSOLUTE COUNT,CDM Code,Outpatient,86361,$99.,$24.4916,$94.05,$79.2,$90.09,$25.9611,$94.05,$24.4916,$94.05,$94.05,$26.78,$67.5675,$29.458,$91.08
,CDM,4070001254.10.4070,ALPHA 1 ANTITRYPSIN PHENO,CDM Code,Outpatient,82104,$61.,$15.0908,$57.95,$48.8,$55.51,$15.9962,$57.95,$15.0908,$57.95,$57.95,$14.46,$41.6325,$15.906,$56.12
,CDM,4070001258.10.4070,DNA/RNA DIRECT PROBE,CDM Code,Outpatient,87149,$213.,$22.055,$202.35,$170.4,$193.83,$55.8556,$202.35,$52.6941,$202.35,$202.35,$20.05,$145.3725,$22.055,$195.96
,CDM,4070001259.10.4070,FUNGITELL,CDM Code,Outpatient,87449,$293.,$13.178,$278.35,$234.4,$266.63,$76.8343,$278.35,$72.4853,$278.35,$278.35,$11.98,$199.9725,$13.178,$269.56
,CDM,4070001260.10.4070,CARBOXYHEMOGLOBIN,CDM Code,Outpatient,82375,$95.,$13.552,$90.25,$76.,$86.45,$24.9121,$90.25,$23.5021,$90.25,$90.25,$12.32,$64.8375,$13.552,$87.4
,CDM,4070001262.10.4070,IMMUNOASSAY INFECTIOUS AGENT,CDM Code,Outpatient,86317,$93.,$16.489,$88.35,$74.4,$84.63,$24.3877,$88.35,$23.0073,$88.35,$88.35,$14.99,$63.4725,$16.489,$85.56
,CDM,4070001263.10.4070,VIRUS ANTIBODY NOS,CDM Code,Outpatient,86790,$124.,$14.168,$117.8,$99.2,$112.84,$32.5169,$117.8,$30.6764,$117.8,$117.8,$12.88,$84.63,$14.168,$114.08
,CDM,4070001265.10.4070,"BILIRUBIN, TOTAL",CDM Code,Outpatient,82247,$41.,$5.522,$38.95,$32.8,$37.31,$10.7516,$38.95,$10.143,$38.95,$38.95,$5.02,$27.9825,$5.522,$37.72
,CDM,4070001267.10.4070,DIRECT BILIRUBIN,CDM Code,Outpatient,82248,$31.,$5.522,$29.45,$24.8,$28.21,$8.1292,$29.45,$7.6691,$29.45,$29.45,$5.02,$21.1575,$5.522,$28.52
,CDM,4070001269.10.4070,IONIZED CALCIUM,CDM Code,Outpatient,82330,$96.,$15.048,$91.2,$76.8,$87.36,$25.1744,$91.2,$23.7494,$91.2,$91.2,$13.68,$65.52,$15.048,$88.32
,CDM,4070001271.10.4070,NEUTRALIZATION TEST VIRAL,CDM Code,Outpatient,86382,$240.,$18.601,$228.,$192.,$218.4,$62.9359,$228.,$59.3736,$228.,$228.,$16.91,$163.8,$18.601,$220.8
,CDM,4070001272.10.4070,CLOBAZAM QUANT,CDM Code,Outpatient,80299,$337.,$20.504,$320.15,$269.6,$306.67,$88.3725,$320.15,$83.3704,$320.15,$320.15,$18.64,$230.0025,$20.504,$310.04
,CDM,4070001274.10.4070,CLOT FACTOR II PROTHROM SPEC,CDM Code,Outpatient,85210,$222.,$14.278,$210.9,$177.6,$202.02,$58.2157,$210.9,$54.9206,$210.9,$210.9,$12.98,$151.515,$14.278,$204.24
,CDM,4070001275.10.4070,BLOOD GASSES ANY COMBINATION,CDM Code,Outpatient,82803,$130.,$28.677,$123.5,$104.,$118.3,$34.0903,$123.5,$32.1607,$123.5,$123.5,$26.07,$88.725,$28.677,$119.6
,CDM,4070001278.10.4070,ASSAY LIPOPROTEIN PLAZ,CDM Code,Outpatient,83698,$245.,$50.941,$232.75,$196.,$222.95,$64.2471,$232.75,$60.6105,$232.75,$232.75,$46.31,$167.2125,$50.941,$225.4
,CDM,4070001279.10.4070,"PHENOL EXP QUANT 2 OF 2, UR",CDM Code,Outpatient,84600,$110.,$18.821,$104.5,$88.,$100.1,$28.8456,$104.5,$27.2129,$104.5,$104.5,$17.11,$75.075,$18.821,$101.2
,CDM,4070001280.10.4070,BUN,CDM Code,Outpatient,84520,$38.,$4.345,$36.1,$30.4,$34.58,$9.9649,$36.1,$9.4008,$36.1,$36.1,$3.95,$25.935,$4.345,$34.96
,CDM,4070001281.10.4070,ASSAY OF GLUTATHIONE,CDM Code,Outpatient,82978,$192.,$16.995,$182.4,$153.6,$174.72,$50.3487,$182.4,$47.4989,$182.4,$182.4,$15.45,$131.04,$16.995,$176.64
,CDM,4070001282.10.4070,PAC21HYDROXYLASE AB,CDM Code,Outpatient,83519,$191.,$20.24,$181.45,$152.8,$173.81,$50.0865,$181.45,$47.2515,$181.45,$181.45,$18.4,$130.3575,$20.24,$175.72
,CDM,4070001283.10.4070,ASSAY OF NICKEL,CDM Code,Outpatient,83885,$109.,$26.961,$103.55,$87.2,$99.19,$28.5834,$103.55,$26.9655,$103.55,$103.55,$24.51,$74.3925,$26.961,$100.28
,CDM,4070001284.10.4070,DET AGNT NOS AMP NORD EA,CDM Code,Outpatient,87798,$238.,$38.599,$226.1,$190.4,$216.58,$62.4115,$226.1,$58.8788,$226.1,$226.1,$35.09,$162.435,$38.599,$218.96
,CDM,4070001285.10.4070,"CALCIUM, SERUM",CDM Code,Outpatient,82310,$32.,$5.676,$30.4,$25.6,$29.12,$8.3915,$30.4,$7.9165,$30.4,$30.4,$5.16,$21.84,$5.676,$29.44
,CDM,4070001286.10.4070,DET AGNT NOS DNA AMP NORO EA,CDM Code,Outpatient,87798,$250.,$38.599,$237.5,$200.,$227.5,$65.5583,$237.5,$61.8475,$237.5,$237.5,$35.09,$170.625,$38.599,$230.
,CDM,4070001287.10.4070,DET AGNT NOS DNA QUANT WB,CDM Code,Outpatient,87799,$389.,$47.124,$369.55,$311.2,$353.99,$102.0086,$369.55,$96.2347,$369.55,$369.55,$42.84,$265.4925,$47.124,$357.88
,CDM,4070001288.10.4070,DET AGNT NOS DNA QUANT CSF,CDM Code,Outpatient,87799,$318.,$47.124,$302.1,$254.4,$289.38,$83.3901,$302.1,$78.67,$302.1,$302.1,$42.84,$217.035,$47.124,$292.56
,CDM,4070001290.10.4070,HEROIN METABOLITE,CDM Code,Outpatient,80356,$126.,$31.1711,$119.7,$100.8,$114.66,$33.0414,$119.7,$31.1711,$119.7,$119.7,$12.6,$85.995,$33.5,$115.92
,CDM,4070001291.10.4070,ENTEROVIRUS ANTIBODY,CDM Code,Outpatient,86658,$81.,$14.333,$76.95,$64.8,$73.71,$21.2409,$76.95,$20.0386,$76.95,$76.95,$13.03,$55.2825,$14.333,$74.52
,CDM,4070001292.10.4070,RICKETTSIA ANTIBODY,CDM Code,Outpatient,86757,$114.,$21.285,$108.3,$91.2,$103.74,$29.8946,$108.3,$28.2025,$108.3,$108.3,$19.35,$77.805,$21.285,$104.88
,CDM,4070001293.10.4070,CFTR GENE COM VARIANTS,CDM Code,Outpatient,81220,$462.,$114.2942,$612.26,$369.6,$420.42,$121.1516,$438.9,$114.2942,$438.9,$438.9,$556.6,$315.315,$612.26,$425.04
,CDM,4070001294.10.4070,ASSAY NEPHELOMETRY NOT SPEC,CDM Code,Outpatient,83883,$150.,$14.96,$142.5,$120.,$136.5,$39.3349,$142.5,$37.1085,$142.5,$142.5,$13.6,$102.375,$14.96,$138.
,CDM,4070001295.10.4070,"CORTISOL, 60 MIN POST STIMULAT",CDM Code,Outpatient,82533,$132.,$17.93,$125.4,$105.6,$120.12,$34.6148,$125.4,$32.6555,$125.4,$125.4,$16.3,$90.09,$17.93,$121.44
,CDM,4070001296.10.4070,PLATELET ANTIBODIES CONFIRMTN,CDM Code,Outpatient,86022,$315.,$20.207,$299.25,$252.,$286.65,$82.6034,$299.25,$77.9279,$299.25,$299.25,$18.37,$214.9875,$20.207,$289.8
,CDM,4070001297.10.4070,MOPATH PROCEDURE LEVEL 4,CDM Code,Outpatient,81403,$232.,$57.3945,$220.4,$185.6,$211.12,$60.8381,$220.4,$57.3945,$220.4,$220.4,$185.2,$158.34,$203.72,$213.44
,CDM,4070001298.10.4070,ISLET CELL ANTIBODY,CDM Code,Outpatient,86341,$134.,$25.927,$127.3,$107.2,$121.94,$35.1392,$127.3,$33.1503,$127.3,$127.3,$23.57,$91.455,$25.927,$123.28
,CDM,4070001299.10.4070,QUANTITATIVE SCREEN METALS,CDM Code,Outpatient,83018,$128.,$24.156,$121.6,$102.4,$116.48,$33.5658,$121.6,$31.6659,$121.6,$121.6,$21.96,$87.36,$24.156,$117.76
,CDM,4070001300.10.4070,HUMAN EPIDIDYMIS PROTEIN 4,CDM Code,Outpatient,86305,$284.,$22.891,$269.8,$227.2,$258.44,$74.4742,$269.8,$70.2588,$269.8,$269.8,$20.81,$193.83,$22.891,$261.28
,CDM,4070001301.10.4070,ASSAY OF PROINSULIN,CDM Code,Outpatient,84206,$88.,$21.7703,$83.6,$70.4,$80.08,$23.0765,$83.6,$21.7703,$83.6,$83.6,$26.69,$60.06,$29.359,$80.96
,CDM,4070001302.10.4070,CRYPTOSPORIDIUM AG EIA,CDM Code,Outpatient,87328,$74.,$15.202,$70.3,$59.2,$67.34,$19.4052,$70.3,$18.3069,$70.3,$70.3,$13.82,$50.505,$15.202,$68.08
,CDM,4070001303.10.4070,EHRLICHIA ANTIBODY,CDM Code,Outpatient,86666,$47.,$11.198,$44.65,$37.6,$42.77,$12.325,$44.65,$11.6273,$44.65,$44.65,$10.18,$32.0775,$11.198,$43.24
,CDM,4070001305.10.4070,TOBRAMYCIN TROUGH,CDM Code,Outpatient,80200,$116.,$17.743,$110.2,$92.8,$105.56,$30.419,$110.2,$28.6972,$110.2,$110.2,$16.13,$79.17,$17.743,$106.72
,CDM,4070001306.10.4070,FISH AUTO - GLOBAL,CDM Code,Outpatient,88374,"$2,109.",$424.,"$2,003.55","$1,687.2","$1,919.19",$553.0494,"$2,003.55",$521.7455,"$2,003.55","$2,003.55",$277.3596,"$1,439.3925",$424.,"$1,940.28"
,CDM,4070001307.10.4070,INDIVIDUAL MARKER,CDM Code,Outpatient,88184,$137.,$33.8924,$491.3067,$109.6,$124.67,$35.9259,$130.15,$33.8924,$130.15,$130.15,$491.3067,$93.5025,$94.5,$126.04
,CDM,4070001309.10.4070,CREATININE BODY FLUID,CDM Code,Outpatient,82570,$60.,$5.698,$57.,$48.,$54.6,$15.734,$57.,$14.8434,$57.,$57.,$5.18,$40.95,$5.698,$55.2
,CDM,4070001310.10.4070,"EPSTEIN BARR AB, VCA IgM",CDM Code,Outpatient,86665,$78.,$19.2964,$74.1,$62.4,$70.98,$20.4542,$74.1,$19.2964,$74.1,$74.1,$18.14,$53.235,$19.954,$71.76
,CDM,4070001311.10.4070,"RUBEOLA ANTIBODY, IgM",CDM Code,Outpatient,86765,$74.,$14.168,$70.3,$59.2,$67.34,$19.4052,$70.3,$18.3069,$70.3,$70.3,$12.88,$50.505,$14.168,$68.08
,CDM,4070001312.10.4070,HISTAMINE,CDM Code,Outpatient,83088,$161.,$32.483,$152.95,$128.8,$146.51,$42.2195,$152.95,$39.8298,$152.95,$152.95,$29.53,$109.8825,$32.483,$148.12
,CDM,4070001313.10.4070,ANTI STREPTOCOCCAL ABS,CDM Code,Outpatient,86060,$70.,$8.03,$66.5,$56.,$63.7,$18.3563,$66.5,$17.3173,$66.5,$66.5,$7.3,$47.775,$8.03,$64.4
,CDM,4070001314.10.4070,HETEROPHILE AB SCREEN,CDM Code,Outpatient,86308,$51.,$5.698,$48.45,$40.8,$46.41,$13.3739,$48.45,$12.6169,$48.45,$48.45,$5.18,$34.8075,$5.698,$46.92
,CDM,4070001315.10.4070,FRAGILE X DNA,CDM Code,Outpatient,81244,$815.,$49.379,$774.25,$652.,$741.65,$213.7199,$774.25,$201.6228,$774.25,$774.25,$44.89,$556.2375,$49.379,$749.8
,CDM,4070001316.10.4070,FRAGILE X INTERPRETATION,CDM Code,Outpatient,G0452,$191.,$47.2515,$181.45,$152.8,$173.81,$50.0865,$181.45,$47.2515,$181.45,$181.45,$19.1,$130.3575,$168.08,$175.72
,CDM,4070001317.10.4070,HIV 1 ANTIBODY BY MULTISPOT,CDM Code,Outpatient,86701,$120.,$9.779,$114.,$96.,$109.2,$31.468,$114.,$29.6868,$114.,$114.,$8.89,$81.9,$9.779,$110.4
,CDM,4070001318.10.4070,HIV 2 ANITBODY BY MULTISPOT,CDM Code,Outpatient,86702,$180.,$14.872,$171.,$144.,$163.8,$47.2019,$171.,$44.5302,$171.,$171.,$13.52,$122.85,$14.872,$165.6
,CDM,4070001319.10.4070,BLASTOMYCES TOTAL AB,CDM Code,Outpatient,86612,$80.,$14.19,$76.,$64.,$72.8,$20.9786,$76.,$19.7912,$76.,$76.,$12.9,$54.6,$14.19,$73.6
,CDM,4070001320.10.4070,"PHOSPHOLIPIDS,SERUM or PLASMA",CDM Code,Outpatient,84311,$85.,$8.91,$80.75,$68.,$77.35,$22.2898,$80.75,$21.0282,$80.75,$80.75,$8.1,$58.0125,$8.91,$78.2
,CDM,4070001321.10.4070,IMMUNOGLOBULIN D (IgD),CDM Code,Outpatient,82784,$96.,$10.23,$91.2,$76.8,$87.36,$25.1744,$91.2,$23.7494,$91.2,$91.2,$9.3,$65.52,$10.23,$88.32
,CDM,4070001322.10.4070,ETHOSUXIMIDE,CDM Code,Outpatient,80168,$117.,$17.974,$111.15,$93.6,$106.47,$30.6813,$111.15,$28.9446,$111.15,$111.15,$16.34,$79.8525,$17.974,$107.64
,CDM,4070001323.10.4070,"OSMOLALITY, STOOL",CDM Code,Outpatient,84999,$58.,$14.3486,$55.1,$46.4,$52.78,$15.2095,$55.1,$14.3486,$55.1,$55.1,$5.8,$39.585,$51.04,$53.36
,CDM,4070001324.10.4070,CLOSTRIDIUM DIFF CULT,CDM Code,Outpatient,87075,$143.,$10.417,$135.85,$114.4,$130.13,$37.4993,$135.85,$35.3768,$135.85,$135.85,$9.47,$97.5975,$10.417,$131.56
,CDM,4070001325.10.4070,CYTOTOXIN CELL ASSAY,CDM Code,Outpatient,87230,$126.,$21.714,$119.7,$100.8,$114.66,$33.0414,$119.7,$31.1711,$119.7,$119.7,$19.74,$85.995,$21.714,$115.92
,CDM,4070001326.10.4070,TPMT METABOLITE,CDM Code,Outpatient,82542,$323.,$26.499,$306.85,$258.4,$293.93,$84.7013,$306.85,$79.907,$306.85,$306.85,$24.09,$220.4475,$26.499,$297.16
,CDM,4070001327.10.4070,ETEST MIC,CDM Code,Outpatient,87181,$75.,$5.225,$71.25,$60.,$68.25,$19.6675,$71.25,$18.5542,$71.25,$71.25,$4.75,$51.1875,$5.225,$69.
,CDM,4070001328.10.4070,LEPTIN,CDM Code,Outpatient,83520,$190.,$18.997,$180.5,$152.,$172.9,$49.8243,$180.5,$47.0041,$180.5,$180.5,$17.27,$129.675,$18.997,$174.8
,CDM,4070001329.10.4070,LYSOZYME,CDM Code,Outpatient,85549,$95.,$20.625,$90.25,$76.,$86.45,$24.9121,$90.25,$23.5021,$90.25,$90.25,$18.75,$64.8375,$20.625,$87.4
,CDM,4070001330.10.4070,"CHOLESTEROL,TOTAL",CDM Code,Outpatient,82465,$42.,$4.785,$39.9,$33.6,$38.22,$11.0138,$39.9,$10.3904,$39.9,$39.9,$15.9399,$28.665,$4.785,$38.64
,CDM,4070001331.10.4070,ASSAY OF CHROMIUM,CDM Code,Outpatient,82495,$103.,$22.308,$97.85,$82.4,$93.73,$27.01,$97.85,$25.4812,$97.85,$97.85,$20.28,$70.2975,$22.308,$94.76
,CDM,4070001334.10.4070,PACRNP AUTO ABS,CDM Code,Outpatient,86235,$109.,$19.723,$103.55,$87.2,$99.19,$28.5834,$103.55,$26.9655,$103.55,$103.55,$17.93,$74.3925,$19.723,$100.28
,CDM,4070001335.10.4070,GLUTAMIC ACID DECARBOXYLASE AB,CDM Code,Outpatient,83519,$137.,$20.24,$130.15,$109.6,$124.67,$35.9259,$130.15,$33.8924,$130.15,$130.15,$18.4,$93.5025,$20.24,$126.04
,CDM,4070001336.10.4070,HELICOBACTER PYLORI M,CDM Code,Outpatient,86677,$74.,$18.3069,$70.3,$59.2,$67.34,$19.4052,$70.3,$18.3069,$70.3,$70.3,$16.85,$50.505,$18.535,$68.08
,CDM,4070001337.10.4070,CYTO-BANDS,CDM Code,Outpatient,88283,$150.,$37.1085,$142.5,$120.,$136.5,$39.3349,$142.5,$37.1085,$142.5,$142.5,$68.6,$102.375,$75.46,$138.
,CDM,4070001338.10.4070,SOLUBLE TRANSFERRIN RECPT,CDM Code,Outpatient,84238,$158.,$39.0876,$150.1,$126.4,$143.78,$41.4328,$150.1,$39.0876,$150.1,$150.1,$36.57,$107.835,$40.227,$145.36
,CDM,4070001339.10.4070,C1Q BINDING ASSAY,CDM Code,Outpatient,86332,$110.,$26.807,$104.5,$88.,$100.1,$28.8456,$104.5,$27.2129,$104.5,$104.5,$24.37,$75.075,$26.807,$101.2
,CDM,4070001340.10.4070,CPK TOTAL,CDM Code,Outpatient,82550,$40.,$7.161,$38.,$32.,$36.4,$10.4893,$38.,$9.8956,$38.,$38.,$6.51,$27.3,$7.161,$36.8
,CDM,4070001342.10.4070,CKMB,CDM Code,Outpatient,82553,$71.,$12.705,$67.45,$56.8,$64.61,$18.6185,$67.45,$17.5647,$67.45,$67.45,$11.55,$48.4575,$12.705,$65.32
,CDM,4070001343.10.4070,METHYLPHENIDATE,CDM Code,Outpatient,80360,$181.,$33.5,$171.95,$144.8,$164.71,$47.4642,$171.95,$44.7776,$171.95,$171.95,$18.1,$123.5325,$33.5,$166.52
,CDM,4070001344.10.4070,MACROGLOBULIN A-2,CDM Code,Outpatient,83883,$155.,$14.96,$147.25,$124.,$141.05,$40.6461,$147.25,$38.3454,$147.25,$147.25,$13.6,$105.7875,$14.96,$142.6
,CDM,4070001346.10.4070,CHROMIUM AND COBALT,CDM Code,Outpatient,82495,$158.,$22.308,$150.1,$126.4,$143.78,$41.4328,$150.1,$39.0876,$150.1,$150.1,$20.28,$107.835,$22.308,$145.36
,CDM,4070001347.10.4070,PREGNENOLONE,CDM Code,Outpatient,84140,$171.,$22.737,$162.45,$136.8,$155.61,$44.8418,$162.45,$42.3037,$162.45,$162.45,$20.67,$116.7075,$22.737,$157.32
,CDM,4070001348.10.4070,"PREGABALIN,URINE",CDM Code,Outpatient,80366,$88.,$21.7703,$83.6,$70.4,$80.08,$23.0765,$83.6,$21.7703,$83.6,$83.6,$8.8,$60.06,$33.5,$80.96
,CDM,4070001349.10.4070,B TYPE NATRIURETIC PEPTIDE BNP,CDM Code,Outpatient,83880,$210.,$43.186,$199.5,$168.,$191.1,$55.0689,$199.5,$51.9519,$199.5,$199.5,$39.26,$143.325,$43.186,$193.2
,CDM,4070001350.10.4070,VASOACTIVE INSTESTINAL POL,CDM Code,Outpatient,84586,$167.,$38.863,$158.65,$133.6,$151.97,$43.7929,$158.65,$41.3141,$158.65,$158.65,$35.33,$113.9775,$38.863,$153.64
,CDM,4070001351.10.4070,"MUSK ANTIBODY, QUANT",CDM Code,Outpatient,83519,"$1,575.",$20.24,"$1,496.25","$1,260.","$1,433.25",$413.017,"$1,496.25",$389.6392,"$1,496.25","$1,496.25",$18.4,"$1,074.9375",$20.24,"$1,449."
,CDM,4070001352.10.4070,"PTH RELATED PEPTITDE,PLASMA",CDM Code,Outpatient,82397,$569.,$15.532,$540.55,$455.2,$517.79,$149.2106,$540.55,$140.7649,$540.55,$540.55,$14.12,$388.3425,$15.532,$523.48
,CDM,4070001353.10.4070,"GM1,MAG,SGPG,ANTIBODIES",CDM Code,Outpatient,83516,$95.,$12.683,$90.25,$76.,$86.45,$24.9121,$90.25,$23.5021,$90.25,$90.25,$11.53,$64.8375,$12.683,$87.4
,CDM,4070001354.10.4070,ANNA ANTIBODIES,CDM Code,Outpatient,86255,$116.,$22.1,$110.2,$92.8,$105.56,$30.419,$110.2,$28.6972,$110.2,$110.2,$12.05,$79.17,$22.1,$106.72
,CDM,4070001355.10.4070,"CREATININE CLEARANCE, 24 HR UR",CDM Code,Outpatient,82575,$95.,$10.406,$90.25,$76.,$86.45,$24.9121,$90.25,$23.5021,$90.25,$90.25,$9.46,$64.8375,$10.406,$87.4
,CDM,4070001358.10.4070,"NEISSERIA GONORRHOEAE AB, TOTA",CDM Code,Outpatient,86171,$136.,$11.011,$129.2,$108.8,$123.76,$35.6637,$129.2,$33.645,$129.2,$129.2,$10.01,$92.82,$11.011,$125.12
,CDM,4070001359.10.4070,"MAGNESIUM, URINE 24 HR",CDM Code,Outpatient,83735,$74.,$7.37,$70.3,$59.2,$67.34,$19.4052,$70.3,$18.3069,$70.3,$70.3,$6.7,$50.505,$7.37,$68.08
,CDM,4070001360.10.4070,COMPREHENSIVE METABOLIC PANEL,CDM Code,Outpatient,80053,$65.,$11.616,$61.75,$52.,$59.15,$17.0451,$61.75,$16.0803,$61.75,$61.75,$10.56,$44.3625,$11.616,$59.8
,CDM,4070001361.10.4070,"PORPHOBILINOGEN DEAMINASE, RBC",CDM Code,Outpatient,82657,$190.,$24.387,$180.5,$152.,$172.9,$49.8243,$180.5,$47.0041,$180.5,$180.5,$22.17,$129.675,$24.387,$174.8
,CDM,4070001362.10.4070,"PORPHOBILINOGEN (PBG), URINE",CDM Code,Outpatient,84110,$80.,$9.284,$76.,$64.,$72.8,$20.9786,$76.,$19.7912,$76.,$76.,$8.44,$54.6,$9.284,$73.6
,CDM,4070001363.10.4070,"DRUG SCRN, 9-SERUM/PLASMA",CDM Code,Outpatient,80307,$399.,$68.354,$379.05,$319.2,$363.09,$104.631,$379.05,$98.7086,$379.05,$379.05,$62.14,$272.3175,$68.354,$367.08
,CDM,4070001364.10.4070,CYCLOBENZAPRINE,CDM Code,Outpatient,80369,$187.,$33.5,$177.65,$149.6,$170.17,$49.0376,$177.65,$46.2619,$177.65,$177.65,$18.7,$127.6275,$33.5,$172.04
,CDM,4070001365.10.4070,"CREATININE, SERUM",CDM Code,Outpatient,82565,$51.,$5.632,$48.45,$40.8,$46.41,$13.3739,$48.45,$12.6169,$48.45,$48.45,$5.12,$34.8075,$5.632,$46.92
,CDM,4070001366.10.4070,SLIDE REVIEW,CDM Code,Outpatient,88381,$306.,$75.7013,$290.7,$244.8,$278.46,$80.2433,$290.7,$75.7013,$290.7,$290.7,$30.6,$208.845,$137.,$281.52
,CDM,4070001367.10.4070,EMPLOYEE HEALTH QUANTIFERON GO,CDM Code,Outpatient,86480,$68.,$16.8225,$68.178,$54.4,$61.88,$17.8318,$64.6,$16.8225,$64.6,$64.6,$61.98,$46.41,$68.178,$62.56
,CDM,4070001368.10.4070,FACTOR IX ACTIVITY,CDM Code,Outpatient,85250,$209.,$20.944,$198.55,$167.2,$190.19,$54.8067,$198.55,$51.7045,$198.55,$198.55,$19.04,$142.6425,$20.944,$192.28
,CDM,4070001369.10.4070,MLH1 GENE,CDM Code,Outpatient,81288,$642.,$158.8244,$609.9,$513.6,$584.22,$168.3536,$609.9,$158.8244,$609.9,$609.9,$429.2292,$438.165,$211.552,$590.64
,CDM,4070001370.10.4070,"HISTOPLASMA AG BY EIA, UR",CDM Code,Outpatient,87385,$281.,$14.575,$266.95,$224.8,$255.71,$73.6875,$266.95,$69.5166,$266.95,$266.95,$13.25,$191.7825,$14.575,$258.52
,CDM,4070001371.10.4070,"CRYPTOCOCCAL ANTIGEN, BL",CDM Code,Outpatient,87899,$110.,$17.677,$104.5,$88.,$100.1,$28.8456,$104.5,$27.2129,$104.5,$104.5,$16.07,$75.075,$17.677,$101.2
,CDM,4070001372.10.4070,CHROMOSOME ANALYSIS 5,CDM Code,Outpatient,88261,$759.,$187.769,$721.05,$607.2,$690.69,$199.0348,$721.05,$187.769,$721.05,$721.05,$264.34,$518.0175,$290.774,$698.28
,CDM,4070001373.10.4070,FISH FAIL,CDM Code,Outpatient,88271,$155.,$23.562,$147.25,$124.,$141.05,$40.6461,$147.25,$38.3454,$147.25,$147.25,$21.42,$105.7875,$23.562,$142.6
,CDM,4070001374.10.4070,CYTOGENETICS 25-99,CDM Code,Outpatient,88274,$250.,$46.618,$237.5,$200.,$227.5,$65.5583,$237.5,$61.8475,$237.5,$237.5,$42.38,$170.625,$46.618,$230.
,CDM,4070001375.10.4070,"CREATININE, URINE RANDOM",CDM Code,Outpatient,82570,$68.,$5.698,$64.6,$54.4,$61.88,$17.8318,$64.6,$16.8225,$64.6,$64.6,$5.18,$46.41,$5.698,$62.56
,CDM,4070001378.10.4070,PARASITIC WORM ID,CDM Code,Outpatient,87169,$217.,$4.741,$206.15,$173.6,$197.47,$56.9046,$206.15,$53.6836,$206.15,$206.15,$4.31,$148.1025,$4.741,$199.64
,CDM,4070001379.10.4070,HEAT SHOCK PROTEIN 70,CDM Code,Outpatient,84182,$474.,$22.1,$450.3,$379.2,$431.34,$124.2984,$450.3,$117.2629,$450.3,$450.3,$29.21,$323.505,$22.1,$436.08
,CDM,4070001380.10.4070,"CREATININE, URINE 24 HOUR",CDM Code,Outpatient,82570,$68.,$5.698,$64.6,$54.4,$61.88,$17.8318,$64.6,$16.8225,$64.6,$64.6,$5.18,$46.41,$5.698,$62.56
,CDM,4070001382.10.4070,CYTOGENETICS 100-300,CDM Code,Outpatient,88275,$247.,$56.309,$234.65,$197.6,$224.77,$64.7716,$234.65,$61.1053,$234.65,$234.65,$51.19,$168.5775,$56.309,$227.24
,CDM,4070001383.10.4070,SULFATIDE ANTIBODY,CDM Code,Outpatient,83520,$547.,$18.997,$519.65,$437.6,$497.77,$143.4415,$519.65,$135.3223,$519.65,$519.65,$17.27,$373.3275,$18.997,$503.24
,CDM,4070001384.10.4070,"MAG ANTIBODY IgM, EIA",CDM Code,Outpatient,83520,$77.,$18.997,$73.15,$61.6,$70.07,$20.1919,$73.15,$19.049,$73.15,$73.15,$17.27,$52.5525,$18.997,$70.84
,CDM,4070001385.10.4070,PHENYTOIN (DILANTIN),CDM Code,Outpatient,80185,$82.,$14.575,$77.9,$65.6,$74.62,$21.5031,$77.9,$20.286,$77.9,$77.9,$13.25,$55.965,$14.575,$75.44
,CDM,4070001387.10.4070,HER2 by FISH,CDM Code,Outpatient,88374,$646.,$159.8139,$613.7,$516.8,$587.86,$169.4025,$613.7,$159.8139,$613.7,$613.7,$277.3596,$440.895,$424.,$594.32
,CDM,4070001388.10.4070,"17-HYDROXPREGNENOLONE,QUANT",CDM Code,Outpatient,84143,$226.,$25.091,$214.7,$180.8,$205.66,$59.2647,$214.7,$55.9101,$214.7,$214.7,$22.81,$154.245,$25.091,$207.92
,CDM,4070001389.10.4070,PATH IMMUNOFLUOR ANTB ADDL STA,CDM Code,Outpatient,88350,$213.,$52.6941,$202.35,$170.4,$193.83,$55.8556,$202.35,$52.6941,$202.35,$202.35,$21.3,$145.3725,$60.5,$195.96
,CDM,4070001390.10.4070,"ELECTROLYTE PANEL, SERUM",CDM Code,Outpatient,80051,$43.,$7.711,$40.85,$34.4,$39.13,$11.276,$40.85,$10.6378,$40.85,$40.85,$7.01,$29.3475,$7.711,$39.56
,CDM,4070001395.10.4070,"FETAL FIBRONECTIN, RAPID",CDM Code,Outpatient,82731,$398.,$70.851,$378.1,$318.4,$362.18,$104.3687,$378.1,$98.4612,$378.1,$378.1,$64.41,$271.635,$70.851,$366.16
,CDM,4070001396.10.4070,FOLLICLE STIMULATING HORMONE(F,CDM Code,Outpatient,83001,$115.,$20.438,$109.25,$92.,$104.65,$30.1568,$109.25,$28.4499,$109.25,$109.25,$18.58,$78.4875,$20.438,$105.8
,CDM,4070001397.10.4070,IGF BINDING PROTEIN-1,CDM Code,Outpatient,83519,$143.,$20.24,$135.85,$114.4,$130.13,$37.4993,$135.85,$35.3768,$135.85,$135.85,$18.4,$97.5975,$20.24,$131.56
,CDM,4070001398.10.4070,CLOMIPRAMINE,CDM Code,Outpatient,80299,$56.,$13.8538,$53.2,$44.8,$50.96,$14.685,$53.2,$13.8538,$53.2,$53.2,$18.64,$38.22,$20.504,$51.52
,CDM,4070001399.10.4070,DESMETHYCHLOMIPRAMINE,CDM Code,Outpatient,80299,$56.,$13.8538,$53.2,$44.8,$50.96,$14.685,$53.2,$13.8538,$53.2,$53.2,$18.64,$38.22,$20.504,$51.52
,CDM,4070001400.10.4070,CARBON DIOXIDE,CDM Code,Outpatient,82374,$28.,$5.368,$26.6,$22.4,$25.48,$7.3425,$26.6,$6.9269,$26.6,$26.6,$4.88,$19.11,$5.368,$25.76
,CDM,4070001401.10.4070,VITAMIN B5 SERUM,CDM Code,Outpatient,84591,$204.,$18.766,$193.8,$163.2,$185.64,$53.4955,$193.8,$50.4676,$193.8,$193.8,$17.06,$139.23,$18.766,$187.68
,CDM,4070001402.10.4070,GTT 2HR (3SAMP INCLD GLU),CDM Code,Outpatient,82951,$79.,$14.157,$75.05,$63.2,$71.89,$20.7164,$75.05,$19.5438,$75.05,$75.05,$47.1522,$53.9175,$14.157,$72.68
,CDM,4070001403.10.4070,VITAMIN B12 BINDING CAPACITY,CDM Code,Outpatient,82608,$59.,$14.596,$56.05,$47.2,$53.69,$15.4717,$56.05,$14.596,$56.05,$56.05,$14.32,$40.2675,$15.752,$54.28
,CDM,4070001404.10.4070,RIA NONANTIBODY,CDM Code,Outpatient,83519,$182.,$20.24,$172.9,$145.6,$165.62,$47.7264,$172.9,$45.025,$172.9,$172.9,$18.4,$124.215,$20.24,$167.44
,CDM,4070001408.10.4070,"MULTI-DRUG SCREEN, URINE",CDM Code,Outpatient,80306,$90.,$18.854,$85.5,$72.,$81.9,$23.601,$85.5,$22.2651,$85.5,$85.5,$17.14,$61.425,$18.854,$82.8
,CDM,4070001411.10.4070,GTT 3 HR SAMPLE,CDM Code,Outpatient,82952,$38.,$4.312,$36.1,$30.4,$34.58,$9.9649,$36.1,$9.4008,$36.1,$36.1,$3.92,$25.935,$4.312,$34.96
,CDM,4070001424.10.4070,THIOPURINE METHYLTRANSFERASE,CDM Code,Outpatient,82657,$342.,$24.387,$324.9,$273.6,$311.22,$89.6837,$324.9,$84.6074,$324.9,$324.9,$22.17,$233.415,$24.387,$314.64
,CDM,4070001425.10.4070,"BARIUM,SERUM",CDM Code,Outpatient,83018,$211.,$24.156,$200.45,$168.8,$192.01,$55.3312,$200.45,$52.1993,$200.45,$200.45,$21.96,$144.0075,$24.156,$194.12
,CDM,4070001426.10.4070,DRUG - PAYLESS COLLECTION,CDM Code,Professional,,$90.,$9.,$85.5,$72.,$81.9,$23.601,$85.5,$22.2651,$85.5,$85.5,$9.,$61.425,$79.2,$82.8
,CDM,4070001427.10.4070,"HEP B VIRUS DRUG, GENOTYPING",CDM Code,Outpatient,87912,$575.,$142.2492,$546.25,$460.,$523.25,$150.784,$546.25,$142.2492,$546.25,$546.25,$257.45,$392.4375,$283.195,$529.
,CDM,4070001429.10.4070,H PYLORI BREATH,CDM Code,Outpatient,83013,$416.,$74.096,$395.2,$332.8,$378.56,$109.0889,$395.2,$102.9142,$395.2,$395.2,$67.36,$283.92,$74.096,$382.72
,CDM,4070001430.10.4070,STRATIFY JCV AB,CDM Code,Outpatient,86711,"$1,981.",$18.579,"$1,881.95","$1,584.8","$1,802.71",$519.4836,"$1,881.95",$490.0796,"$1,881.95","$1,881.95",$16.89,"$1,352.0325",$18.579,"$1,822.52"
,CDM,4070001431.10.4070,SOMATOSTATIN,CDM Code,Outpatient,84307,$400.,$20.108,$380.,$320.,$364.,$104.8932,$380.,$98.956,$380.,$380.,$18.28,$273.,$20.108,$368.
,CDM,4070001432.10.4070,CULTURE WOUND,CDM Code,Outpatient,87070,$133.,$9.482,$126.35,$106.4,$121.03,$34.877,$126.35,$32.9029,$126.35,$126.35,$8.62,$90.7725,$9.482,$122.36
,CDM,4070001435.10.4070,RESPIRATORY VIRUS PANEL,CDM Code,Outpatient,87633,"$1,789.",$442.5807,"$1,699.55","$1,431.2","$1,627.99",$469.1348,"$1,699.55",$442.5807,"$1,699.55","$1,699.55",$416.78,"$1,220.9925",$458.458,"$1,645.88"
,CDM,4070001436.10.4070,PEPSINOGEN 1,CDM Code,Outpatient,83519,$304.,$20.24,$288.8,$243.2,$276.64,$79.7188,$288.8,$75.2066,$288.8,$288.8,$18.4,$207.48,$20.24,$279.68
,CDM,4070001437.10.4070,PEPSINOGEN 2,CDM Code,Outpatient,83519,$304.,$20.24,$288.8,$243.2,$276.64,$79.7188,$288.8,$75.2066,$288.8,$288.8,$18.4,$207.48,$20.24,$279.68
,CDM,4070001441.10.4070,TOTAL T3,CDM Code,Outpatient,84480,$88.,$15.598,$83.6,$70.4,$80.08,$23.0765,$83.6,$21.7703,$83.6,$83.6,$14.18,$60.06,$15.598,$80.96
,CDM,4070001460.10.4070,"GLUCOSE, 2 HR PP",CDM Code,Outpatient,82950,$53.,$5.225,$50.35,$42.4,$48.23,$13.8983,$50.35,$13.1117,$50.35,$50.35,$17.3817,$36.1725,$5.225,$48.76
,CDM,4070001465.10.4070,"GLUCOSE, BODY FLUID",CDM Code,Outpatient,82945,$101.,$4.323,$95.95,$80.8,$91.91,$26.4855,$95.95,$24.9864,$95.95,$95.95,$3.93,$68.9325,$4.323,$92.92
,CDM,4070001467.10.4070,HLA CLASS I SEMIQUANT PANEL,CDM Code,Outpatient,86834,$525.,$129.8798,$498.75,$420.,$477.75,$137.6723,$498.75,$129.8798,$498.75,$498.75,$357.56,$358.3125,$393.316,$483.
,CDM,4070001468.10.4070,HLA CLASS II SEMIQUANT PANEL,CDM Code,Outpatient,86835,$525.,$129.8798,$498.75,$420.,$477.75,$137.6723,$498.75,$129.8798,$498.75,$498.75,$322.96,$358.3125,$355.256,$483.
,CDM,4070001470.10.4070,"GLUCOSE, CSF",CDM Code,Outpatient,82945,$24.,$4.323,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$3.93,$16.38,$4.323,$22.08
,CDM,4070001475.10.4070,"GLUCOSE, FASTING",CDM Code,Outpatient,82947,$54.,$4.323,$51.3,$43.2,$49.14,$14.1606,$51.3,$13.3591,$51.3,$51.3,$14.3913,$36.855,$4.323,$49.68
,CDM,4070001480.10.4070,ESSENTIAL FATTY ACIDS,CDM Code,Outpatient,82542,$552.,$26.499,$524.4,$441.6,$502.32,$144.7526,$524.4,$136.5593,$524.4,$524.4,$24.09,$376.74,$26.499,$507.84
,CDM,4070001482.10.4070,HEP DELTA VIRUS AB,CDM Code,Outpatient,86692,$83.,$18.876,$78.85,$66.4,$75.53,$21.7653,$78.85,$20.5334,$78.85,$78.85,$17.16,$56.6475,$18.876,$76.36
,CDM,4070001483.10.4070,FELBAMATE,CDM Code,Outpatient,80299,$137.,$20.504,$130.15,$109.6,$124.67,$35.9259,$130.15,$33.8924,$130.15,$130.15,$18.64,$93.5025,$20.504,$126.04
,CDM,4070001484.10.4070,"BK VIRUS DNA,QN,PCR",CDM Code,Outpatient,87799,$347.,$47.124,$329.65,$277.6,$315.77,$90.9949,$329.65,$85.8443,$329.65,$329.65,$42.84,$236.8275,$47.124,$319.24
,CDM,4070001485.10.4070,SPECIAL STAINS GROUP 1,CDM Code,Outpatient,88312,$163.,$40.3246,$154.85,$130.4,$148.33,$42.744,$154.85,$40.3246,$154.85,$154.85,$105.999,$111.2475,$99.,$149.96
,CDM,4070001490.10.4070,"GLUCOSE, 1 HR PP",CDM Code,Outpatient,82950,$54.,$5.225,$51.3,$43.2,$49.14,$14.1606,$51.3,$13.3591,$51.3,$51.3,$17.3817,$36.855,$5.225,$49.68
,CDM,4070001493.10.4070,TBII-THYRO.BIND.IG,CDM Code,Outpatient,83519,$235.,$20.24,$223.25,$188.,$213.85,$61.6248,$223.25,$58.1367,$223.25,$223.25,$18.4,$160.3875,$20.24,$216.2
,CDM,4070001494.10.4070,"PROT,TL,PLEURAL FL",CDM Code,Outpatient,84157,$72.,$4.4,$68.4,$57.6,$65.52,$18.8808,$68.4,$17.8121,$68.4,$68.4,$4.,$49.14,$4.4,$66.24
,CDM,4070001495.10.4070,IGRBP-3,CDM Code,Outpatient,82397,$182.,$15.532,$172.9,$145.6,$165.62,$47.7264,$172.9,$45.025,$172.9,$172.9,$14.12,$124.215,$15.532,$167.44
,CDM,4070001502.10.4070,BENZODIAZEPINES 1-12,CDM Code,Outpatient,80346,$119.,$29.4394,$113.05,$95.2,$108.29,$31.2057,$113.05,$29.4394,$113.05,$113.05,$11.9,$81.2175,$33.5,$109.48
,CDM,4070001504.10.4070,TRANSFERRIN(TRFN),CDM Code,Outpatient,84466,$79.,$14.036,$75.05,$63.2,$71.89,$20.7164,$75.05,$19.5438,$75.05,$75.05,$12.76,$53.9175,$14.036,$72.68
,CDM,4070001505.10.4070,FECAL PANCREATIC ELASTASE,CDM Code,Outpatient,82656,$134.,$12.683,$127.3,$107.2,$121.94,$35.1392,$127.3,$33.1503,$127.3,$127.3,$11.53,$91.455,$12.683,$123.28
,CDM,4070001507.10.4070,PML/RARA BY RT-PCR,CDM Code,Outpatient,81315,$675.,$166.9882,$759.2946,$540.,$614.25,$177.0073,$641.25,$166.9882,$641.25,$641.25,$759.2946,$460.6875,$228.041,$621.
,CDM,4070001510.10.4070,KIT COLLECTION VENI ONLY,CDM Code,Outpatient,36415,$42.,$3.3,$39.9,$33.6,$38.22,$11.0138,$39.9,$10.3904,$39.9,$39.9,$3.,$28.665,$3.3,$38.64
,CDM,4070001511.10.4070,KIT COLLECTION HANDLING ONLY,CDM Code,Outpatient,99001,$45.,$8.5,$42.75,$36.,$40.95,$11.8005,$42.75,$11.1326,$42.75,$42.75,$4.5,$30.7125,$8.5,$41.4
,CDM,4070001515.10.4070,LACTATE,CDM Code,Outpatient,83605,$66.,$12.727,$62.7,$52.8,$60.06,$17.3074,$62.7,$16.3277,$62.7,$62.7,$11.57,$45.045,$12.727,$60.72
,CDM,4070001516.10.4070,EGFR GENE COM VARIANTS,CDM Code,Outpatient,81235,"$1,995.",$357.038,"$1,895.25","$1,596.","$1,815.45",$523.1548,"$1,895.25",$493.543,"$1,895.25","$1,895.25",$885.9594,"$1,361.5875",$357.038,"$1,835.4"
,CDM,4070001525.10.4070,LDH TOTAL,CDM Code,Outpatient,83615,$37.,$6.644,$35.15,$29.6,$33.67,$9.7026,$35.15,$9.1534,$35.15,$35.15,$6.04,$25.2525,$6.644,$34.04
,CDM,4070001530.10.4070,"LDH, BODY FLUID",CDM Code,Outpatient,83615,$73.,$6.644,$69.35,$58.4,$66.43,$19.143,$69.35,$18.0595,$69.35,$69.35,$6.04,$49.8225,$6.644,$67.16
,CDM,4070001531.10.4070,LUTEINIZING HORMONE(LH),CDM Code,Outpatient,83002,$114.,$20.372,$108.3,$91.2,$103.74,$29.8946,$108.3,$28.2025,$108.3,$108.3,$18.52,$77.805,$20.372,$104.88
,CDM,4070001540.10.4070,LIPID SCREEN FASTING,CDM Code,Outpatient,80061,$83.,$14.729,$78.85,$66.4,$75.53,$21.7653,$78.85,$20.5334,$78.85,$78.85,$49.0479,$56.6475,$14.729,$76.36
,CDM,4070001541.10.4070,LIPID SCREEN FASTING UNKNOWN,CDM Code,Outpatient,80061,$135.,$14.729,$128.25,$108.,$122.85,$35.4015,$128.25,$33.3976,$128.25,$128.25,$49.0479,$92.1375,$14.729,$124.2
,CDM,4070001545.10.4070,LITHIUM,CDM Code,Outpatient,80178,$41.,$7.271,$38.95,$32.8,$37.31,$10.7516,$38.95,$10.143,$38.95,$38.95,$6.61,$27.9825,$7.271,$37.72
,CDM,4070001546.10.4070,HIGH DENSITY LIPOPROTEIN,CDM Code,Outpatient,83718,$49.,$9.009,$46.55,$39.2,$44.59,$12.8494,$46.55,$12.1221,$46.55,$46.55,$30.0108,$33.4425,$9.009,$45.08
,CDM,4070001547.10.4070,LDL CHOL,CDM Code,Outpatient,83721,$59.,$11.55,$56.05,$47.2,$53.69,$15.4717,$56.05,$14.596,$56.05,$56.05,$10.5,$40.2675,$11.55,$54.28
,CDM,4070001548.10.4070,"ASPERGILLUS AG, EIA, SERUM",CDM Code,Outpatient,87305,$146.,$13.178,$138.7,$116.8,$132.86,$38.286,$138.7,$36.1189,$138.7,$138.7,$11.98,$99.645,$13.178,$134.32
,CDM,4070001549.10.4070,HLA B27 DNA TYPING,CDM Code,Outpatient,86812,$194.,$28.391,$184.3,$155.2,$176.54,$50.8732,$184.3,$47.9937,$184.3,$184.3,$25.81,$132.405,$28.391,$178.48
,CDM,4070001551.10.4070,DETECT AGENT NOS DNA AMP 70172,CDM Code,Outpatient,87798,$303.,$38.599,$287.85,$242.4,$275.73,$79.4566,$287.85,$74.9592,$287.85,$287.85,$35.09,$206.7975,$38.599,$278.76
,CDM,4070001552.10.4070,IMUNOASAY QUANT NOS NONAB30321,CDM Code,Outpatient,83520,$176.,$18.997,$167.2,$140.8,$160.16,$46.153,$167.2,$43.5406,$167.2,$167.2,$17.27,$120.12,$18.997,$161.92
,CDM,4070001553.10.4070,ASSAY OF PYRUVATE 765,CDM Code,Outpatient,84210,$88.,$15.928,$83.6,$70.4,$80.08,$23.0765,$83.6,$21.7703,$83.6,$83.6,$14.48,$60.06,$15.928,$80.96
,CDM,4070001554.10.4070,ASSAY OF ETHYLENE GLYCOL 11331,CDM Code,Outpatient,82693,$132.,$16.39,$125.4,$105.6,$120.12,$34.6148,$125.4,$32.6555,$125.4,$125.4,$14.9,$90.09,$16.39,$121.44
,CDM,4070001555.10.4070,MAGNESIUM,CDM Code,Outpatient,83735,$41.,$7.37,$38.95,$32.8,$37.31,$10.7516,$38.95,$10.143,$38.95,$38.95,$6.7,$27.9825,$7.37,$37.72
,CDM,4070001557.10.4070,"TRYPSIN, SERUM",CDM Code,Outpatient,83519,$130.,$20.24,$123.5,$104.,$118.3,$34.0903,$123.5,$32.1607,$123.5,$123.5,$18.4,$88.725,$20.24,$119.6
,CDM,4070001560.10.4070,LIVER PROFILE,CDM Code,Outpatient,80076,$50.,$8.987,$47.5,$40.,$45.5,$13.1116,$47.5,$12.3695,$47.5,$47.5,$8.17,$34.125,$8.987,$46.
,CDM,4070001565.10.4070,ARTERIAL BLOOD GASES NEONATAL,CDM Code,Outpatient,82803,$130.,$28.677,$123.5,$104.,$118.3,$34.0903,$123.5,$32.1607,$123.5,$123.5,$26.07,$88.725,$28.677,$119.6
,CDM,4070001566.10.4070,ARA H1,CDM Code,Outpatient,86003,$76.,$5.742,$72.2,$60.8,$69.16,$19.9297,$72.2,$18.8016,$72.2,$72.2,$5.22,$51.87,$5.742,$69.92
,CDM,4070001567.10.4070,ARA H2,CDM Code,Outpatient,86003,$76.,$5.742,$72.2,$60.8,$69.16,$19.9297,$72.2,$18.8016,$72.2,$72.2,$5.22,$51.87,$5.742,$69.92
,CDM,4070001568.10.4070,ARA H3,CDM Code,Outpatient,86003,$76.,$5.742,$72.2,$60.8,$69.16,$19.9297,$72.2,$18.8016,$72.2,$72.2,$5.22,$51.87,$5.742,$69.92
,CDM,4070001569.10.4070,ARA H8,CDM Code,Outpatient,86003,$76.,$5.742,$72.2,$60.8,$69.16,$19.9297,$72.2,$18.8016,$72.2,$72.2,$5.22,$51.87,$5.742,$69.92
,CDM,4070001570.10.4070,ARH H9,CDM Code,Outpatient,86003,$76.,$5.742,$72.2,$60.8,$69.16,$19.9297,$72.2,$18.8016,$72.2,$72.2,$5.22,$51.87,$5.742,$69.92
,CDM,4070001571.10.4070,"CAMPY AG,EIA",CDM Code,Outpatient,87449,$113.,$13.178,$107.35,$90.4,$102.83,$29.6323,$107.35,$27.9551,$107.35,$107.35,$11.98,$77.1225,$13.178,$103.96
,CDM,4070001572.10.4070,ENDOMYSIAL IGA AB,CDM Code,Outpatient,86255,$102.,$22.1,$96.9,$81.6,$92.82,$26.7478,$96.9,$25.2338,$96.9,$96.9,$12.05,$69.615,$22.1,$93.84
,CDM,4070001573.10.4070,MITOCHONDRIAL W/ REFL,CDM Code,Outpatient,86255,$117.,$22.1,$111.15,$93.6,$106.47,$30.6813,$111.15,$28.9446,$111.15,$111.15,$12.05,$79.8525,$22.1,$107.64
,CDM,4070001574.10.4070,LYMPH SUBSET PNL 4,CDM Code,Outpatient,86360,$194.,$47.9937,$184.3,$155.2,$176.54,$50.8732,$184.3,$47.9937,$184.3,$184.3,$46.98,$132.405,$51.678,$178.48
,CDM,4070001575.10.4070,OPIATE SCREEN,CDM Code,Outpatient,80307,$0.,$0.,$68.354,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$62.14,$0.,$68.354,$0.
,CDM,4070001580.10.4070,ALLERGEN-ALTGERNARIA TENUIS,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070001581.10.4070,ALLERGEN-JAPANESE CEDAR,CDM Code,Outpatient,86003,$22.,$5.4426,$20.9,$17.6,$20.02,$5.7691,$20.9,$5.4426,$20.9,$20.9,$5.22,$15.015,$5.742,$20.24
,CDM,4070001582.10.4070,ALLERGEN-PENICILLIUM CHRYSOGEN,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070001583.10.4070,ALLERGEN-ROUGH MARSH ELDER,CDM Code,Outpatient,86003,$22.,$5.4426,$20.9,$17.6,$20.02,$5.7691,$20.9,$5.4426,$20.9,$20.9,$5.22,$15.015,$5.742,$20.24
,CDM,4070001584.10.4070,ALLERGEN-SWEET VERNAL GRASS,CDM Code,Outpatient,86003,$22.,$5.4426,$20.9,$17.6,$20.02,$5.7691,$20.9,$5.4426,$20.9,$20.9,$5.22,$15.015,$5.742,$20.24
,CDM,4070001585.10.4070,ALLERGEN-WHITE PINE,CDM Code,Outpatient,86003,$22.,$5.4426,$20.9,$17.6,$20.02,$5.7691,$20.9,$5.4426,$20.9,$20.9,$5.22,$15.015,$5.742,$20.24
,CDM,4070001586.10.4070,ALLERGEN - HAZELNUT TREE,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070001590.10.4070,"PH, BODY FLUID",CDM Code,Outpatient,83986,$81.,$3.938,$76.95,$64.8,$73.71,$21.2409,$76.95,$20.0386,$76.95,$76.95,$3.58,$55.2825,$3.938,$74.52
,CDM,4070001591.10.4070,BARTONELLA henselae AB IgM,CDM Code,Outpatient,86611,$93.,$11.198,$88.35,$74.4,$84.63,$24.3877,$88.35,$23.0073,$88.35,$88.35,$10.18,$63.4725,$11.198,$85.56
,CDM,4070001592.10.4070,BARTONELLA quintana AB IgG,CDM Code,Outpatient,86611,$93.,$11.198,$88.35,$74.4,$84.63,$24.3877,$88.35,$23.0073,$88.35,$88.35,$10.18,$63.4725,$11.198,$85.56
,CDM,4070001593.10.4070,BARTONELLA quintana AB IgM,CDM Code,Outpatient,86611,$93.,$11.198,$88.35,$74.4,$84.63,$24.3877,$88.35,$23.0073,$88.35,$88.35,$10.18,$63.4725,$11.198,$85.56
,CDM,4070001595.10.4070,"PHOSPHOROUS, SERUM",CDM Code,Outpatient,84100,$46.,$5.214,$43.7,$36.8,$41.86,$12.0627,$43.7,$11.3799,$43.7,$43.7,$4.74,$31.395,$5.214,$42.32
,CDM,4070001596.10.4070,DIHYDROTESTOSTERONE,CDM Code,Outpatient,80327,$128.,$31.6659,$121.6,$102.4,$116.48,$33.5658,$121.6,$31.6659,$121.6,$121.6,$12.8,$87.36,$33.5,$117.76
,CDM,4070001601.10.4070,CRYPTOCOCCAL AG TITER,CDM Code,Outpatient,87899,$116.,$17.677,$110.2,$92.8,$105.56,$30.419,$110.2,$28.6972,$110.2,$110.2,$16.07,$79.17,$17.677,$106.72
,CDM,4070001603.10.4070,FREE T4,CDM Code,Outpatient,84439,$56.,$9.922,$53.2,$44.8,$50.96,$14.685,$53.2,$13.8538,$53.2,$53.2,$9.02,$38.22,$9.922,$51.52
,CDM,4070001603.20.4070,FREE T4,CDM Code,Outpatient,84439,$0.,$0.,$9.922,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$9.02,$0.,$9.922,$0.
,CDM,4070001603.30.4070,FREE T4,CDM Code,Outpatient,84439,$0.,$0.,$9.922,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$9.02,$0.,$9.922,$0.
,CDM,4070001603.82.4070,FREE T4,CDM Code,Outpatient,84439,$56.,$9.922,$53.2,$44.8,$50.96,$14.685,$53.2,$13.8538,$53.2,$53.2,$9.02,$38.22,$9.922,$51.52
,CDM,4070001604.10.4070,INFLUENZA VIRUS ANTIBODY,CDM Code,Outpatient,86710,$98.,$14.905,$93.1,$78.4,$89.18,$25.6988,$93.1,$24.2442,$93.1,$93.1,$13.55,$66.885,$14.905,$90.16
,CDM,4070001605.10.4070,GENERAL HEALTH PANEL,CDM Code,Outpatient,80050,$361.,$66.,$342.95,$288.8,$328.51,$94.6661,$342.95,$89.3078,$342.95,$342.95,$36.1,$246.3825,$66.,$332.12
,CDM,4070001606.10.4070,OLIGOCLONAL BANDS,CDM Code,Outpatient,83916,$81.,$20.0386,$76.95,$64.8,$73.71,$21.2409,$76.95,$20.0386,$76.95,$76.95,$27.39,$55.2825,$30.129,$74.52
,CDM,4070001607.10.4070,ASSAY OF CPK IN BLOOD,CDM Code,Outpatient,82552,$91.,$14.729,$86.45,$72.8,$82.81,$23.8632,$86.45,$22.5125,$86.45,$86.45,$13.39,$62.1075,$14.729,$83.72
,CDM,4070001608.10.4070,DRUG SCRN QUANT OXCARBAZEPIN,CDM Code,Outpatient,80183,$139.,$14.575,$132.05,$111.2,$126.49,$36.4504,$132.05,$34.3872,$132.05,$132.05,$13.25,$94.8675,$14.575,$127.88
,CDM,4070001609.10.4070,MULT ENDOCRINE NEOPLA,CDM Code,Outpatient,81404,$750.,$185.5425,$712.5,$600.,$682.5,$196.6747,$712.5,$185.5425,$712.5,$712.5,$274.83,$511.875,$302.313,$690.
,CDM,4070001610.10.4070,MICROBE SUSCEPT MACROBROTH,CDM Code,Outpatient,87188,$72.,$7.304,$68.4,$57.6,$65.52,$18.8808,$68.4,$17.8121,$68.4,$68.4,$6.64,$49.14,$7.304,$66.24
,CDM,4070001611.10.4070,HCM FAMILIAL MUTATION,CDM Code,Outpatient,81403,$786.,$194.4485,$746.7,$628.8,$715.26,$206.1151,$746.7,$194.4485,$746.7,$746.7,$185.2,$536.445,$203.72,$723.12
,CDM,4070001612.10.4070,CHEMILUMINESCENT ASSAY,CDM Code,Outpatient,82397,$297.,$15.532,$282.15,$237.6,$270.27,$77.8832,$282.15,$73.4748,$282.15,$282.15,$14.12,$202.7025,$15.532,$273.24
,CDM,4070001613.10.4070,DRUG SCREEN CLASS LIST A,CDM Code,Outpatient,80301,$52.,$12.8643,$49.4,$41.6,$47.32,$13.6361,$49.4,$12.8643,$49.4,$49.4,$5.2,$35.49,$45.76,$47.84
,CDM,4070001615.10.4070,"POTASSIUM, SERUM",CDM Code,Outpatient,84132,$37.,$5.236,$35.15,$29.6,$33.67,$9.7026,$35.15,$9.1534,$35.15,$35.15,$4.76,$25.2525,$5.236,$34.04
,CDM,4070001615.30.4070,"POTASSIUM, SERUM",CDM Code,Outpatient,84132,$0.,$0.,$5.236,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$4.76,$0.,$5.236,$0.
,CDM,4070001615.82.4070,"POTASSIUM, SERUM",CDM Code,Outpatient,84132,$0.,$0.,$5.236,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$4.76,$0.,$5.236,$0.
,CDM,4070001616.10.4070,DRUG SCREEN AMPHETAMINES 1/2,CDM Code,Outpatient,80324,$134.,$33.1503,$127.3,$107.2,$121.94,$35.1392,$127.3,$33.1503,$127.3,$127.3,$13.4,$91.455,$33.5,$123.28
,CDM,4070001617.10.4070,CYTOGEN M ARRAY COPY NO&SNP,CDM Code,Outpatient,81229,"$3,700.",$915.343,"$3,515.","$2,960.","$3,367.",$970.2621,"$3,515.",$915.343,"$3,515.","$3,515.","$1,160.","$2,525.25","$1,276.","$3,404."
,CDM,4070001619.10.4070,RVVT MIXING STUDIES,CDM Code,Outpatient,8561391,$144.,$35.6242,$136.8,$115.2,$131.04,$37.7616,$136.8,$35.6242,$136.8,$136.8,$9.58,$98.28,$126.72,$132.48
,CDM,4070001620.10.4070,"POTASSIUM, URINE 24HR",CDM Code,Outpatient,84133,$37.,$5.203,$35.15,$29.6,$33.67,$9.7026,$35.15,$9.1534,$35.15,$35.15,$4.73,$25.2525,$5.203,$34.04
,CDM,4070001621.10.4070,RVVT PHOSPHOLIPID NEUTRAL,CDM Code,Outpatient,8561391,$137.,$33.8924,$130.15,$109.6,$124.67,$35.9259,$130.15,$33.8924,$130.15,$130.15,$9.58,$93.5025,$120.56,$126.04
,CDM,4070001622.10.4070,HISTOPLASMA ANTIBODY,CDM Code,Outpatient,86698,$68.,$15.169,$64.6,$54.4,$61.88,$17.8318,$64.6,$16.8225,$64.6,$64.6,$13.79,$46.41,$15.169,$62.56
,CDM,4070001623.10.4070,HISTOPLASMA MYCELIA,CDM Code,Outpatient,86698,$68.,$15.169,$64.6,$54.4,$61.88,$17.8318,$64.6,$16.8225,$64.6,$64.6,$13.79,$46.41,$15.169,$62.56
,CDM,4070001624.10.4070,HISTOPLASMA YEAST,CDM Code,Outpatient,86698,$68.,$15.169,$64.6,$54.4,$61.88,$17.8318,$64.6,$16.8225,$64.6,$64.6,$13.79,$46.41,$15.169,$62.56
,CDM,4070001625.10.4070,"POTASSIUM, URINE RANDOM",CDM Code,Outpatient,84133,$37.,$5.203,$35.15,$29.6,$33.67,$9.7026,$35.15,$9.1534,$35.15,$35.15,$4.73,$25.2525,$5.203,$34.04
,CDM,4070001626.10.4070,IMMUNOHOSTO ANTIBODY STAIN,CDM Code,Outpatient,88341,$147.,$36.3663,$139.65,$117.6,$133.77,$38.5483,$139.65,$36.3663,$139.65,$139.65,$14.7,$100.3275,$90.,$135.24
,CDM,4070001627.10.4070,IMMUNOHISTO ANTIBODY SLIDE,CDM Code,Outpatient,88344,$246.,$60.8579,$491.3067,$196.8,$223.86,$64.5093,$233.7,$60.8579,$233.7,$233.7,$491.3067,$167.895,$191.,$226.32
,CDM,4070001628.10.4070,"STREP PNEUMONIAE AG,UR",CDM Code,Outpatient,87899,$169.,$17.677,$160.55,$135.2,$153.79,$44.3174,$160.55,$41.8089,$160.55,$160.55,$16.07,$115.3425,$17.677,$155.48
,CDM,4070001629.10.4070,ASSAY OF HOMOVANILLIC ACID,CDM Code,Outpatient,83150,$92.,$22.7599,$87.4,$73.6,$83.72,$24.1254,$87.4,$22.7599,$87.4,$87.4,$22.41,$62.79,$24.651,$84.64
,CDM,4070001630.10.4070,PRE-ALBUMIN,CDM Code,Outpatient,84134,$90.,$16.049,$85.5,$72.,$81.9,$23.601,$85.5,$22.2651,$85.5,$85.5,$14.59,$61.425,$16.049,$82.8
,CDM,4070001631.10.4070,PROLACTIN(PRL),CDM Code,Outpatient,84146,$120.,$21.318,$114.,$96.,$109.2,$31.468,$114.,$29.6868,$114.,$114.,$19.38,$81.9,$21.318,$110.4
,CDM,4070001632.10.4070,INSULIN ANTIBODIES,CDM Code,Outpatient,86337,$133.,$23.551,$126.35,$106.4,$121.03,$34.877,$126.35,$32.9029,$126.35,$126.35,$21.41,$90.7725,$23.551,$122.36
,CDM,4070001633.10.4070,DRUG SCREENING COCAINE,CDM Code,Outpatient,80353,$132.,$32.6555,$125.4,$105.6,$120.12,$34.6148,$125.4,$32.6555,$125.4,$125.4,$13.2,$90.09,$33.5,$121.44
,CDM,4070001636.10.4070,RESP VIRUS 12-25 TARGETS,CDM Code,Outpatient,87633,$767.,$189.7481,$728.65,$613.6,$697.97,$201.1327,$728.65,$189.7481,$728.65,$728.65,$416.78,$523.4775,$458.458,$705.64
,CDM,4070001638.10.4070,OPIATES 1 OR MORE,CDM Code,Outpatient,80361,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$33.5,$0.
,CDM,4070001639.10.4070,DRUG SCREEN QUANTALCOHOLS,CDM Code,Outpatient,80320,$132.,$32.6555,$125.4,$105.6,$120.12,$34.6148,$125.4,$32.6555,$125.4,$125.4,$13.2,$90.09,$33.5,$121.44
,CDM,4070001640.10.4070,"PROTEIN, BODY FLUID",CDM Code,Outpatient,84157,$93.,$4.4,$88.35,$74.4,$84.63,$24.3877,$88.35,$23.0073,$88.35,$88.35,$4.,$63.4725,$4.4,$85.56
,CDM,4070001641.10.4070,CANNABINOIDS NATURAL,CDM Code,Outpatient,80349,$132.,$32.6555,$125.4,$105.6,$120.12,$34.6148,$125.4,$32.6555,$125.4,$125.4,$13.2,$90.09,$33.5,$121.44
,CDM,4070001642.10.4070,DRUG/SUBSTANCE NOS 103,CDM Code,Outpatient,80375,$125.,$30.9237,$118.75,$100.,$113.75,$32.7791,$118.75,$30.9237,$118.75,$118.75,$12.5,$85.3125,$33.5,$115.
,CDM,4070001643.10.4070,DRUG SCREENING METHADONE,CDM Code,Outpatient,80358,$132.,$32.6555,$125.4,$105.6,$120.12,$34.6148,$125.4,$32.6555,$125.4,$125.4,$13.2,$90.09,$33.5,$121.44
,CDM,4070001645.10.4070,"PROTEIN, CSF",CDM Code,Outpatient,84157,$0.,$0.,$4.4,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$4.,$0.,$4.4,$0.
,CDM,4070001646.10.4070,PSA FREE & TOTAL,CDM Code,Outpatient,84154,$113.,$20.229,$107.35,$90.4,$102.83,$29.6323,$107.35,$27.9551,$107.35,$107.35,$18.39,$77.1225,$20.229,$103.96
,CDM,4070001647.10.4070,"PSA, SCREENING",CDM Code,Outpatient,84153,$114.,$20.229,$108.3,$91.2,$103.74,$29.8946,$108.3,$28.2025,$108.3,$108.3,$18.39,$77.805,$20.229,$104.88
,CDM,4070001648.10.4070,GALACTOSEMIA MUTATION ANALYSIS,CDM Code,Outpatient,81401,$671.,$150.7,$637.45,$536.8,$610.61,$175.9583,$637.45,$165.9987,$637.45,$637.45,$137.,$457.9575,$150.7,$617.32
,CDM,4070001649.10.4070,"PSA, DIAGNOSTIC",CDM Code,Outpatient,84153,$114.,$20.229,$108.3,$91.2,$103.74,$29.8946,$108.3,$28.2025,$108.3,$108.3,$18.39,$77.805,$20.229,$104.88
,CDM,4070001650.10.4070,"PROTEIN, TOTAL",CDM Code,Outpatient,84155,$45.,$4.037,$42.75,$36.,$40.95,$11.8005,$42.75,$11.1326,$42.75,$42.75,$3.67,$30.7125,$4.037,$41.4
,CDM,4070001651.10.4070,AEROBIC ORGANISM ID,CDM Code,Outpatient,87077,$405.,$8.888,$384.75,$324.,$368.55,$106.2044,$384.75,$100.193,$384.75,$384.75,$8.08,$276.4125,$8.888,$372.6
,CDM,4070001652.10.4070,POLIO VIRUS ANTIBODIES,CDM Code,Outpatient,86658,$258.,$14.333,$245.1,$206.4,$234.78,$67.6561,$245.1,$63.8266,$245.1,$245.1,$13.03,$176.085,$14.333,$237.36
,CDM,4070001655.10.4070,"PROTEIN, URINE 24HR",CDM Code,Outpatient,84156,$23.,$4.037,$21.85,$18.4,$20.93,$6.0314,$21.85,$5.69,$21.85,$21.85,$3.67,$15.6975,$4.037,$21.16
,CDM,4070001657.10.4070,INTACT PTH,CDM Code,Outpatient,83970,$255.,$45.408,$242.25,$204.,$232.05,$66.8694,$242.25,$63.0844,$242.25,$242.25,$41.28,$174.0375,$45.408,$234.6
,CDM,4070001657.20.4070,INTACT PTH,CDM Code,Outpatient,83970,$0.,$0.,$45.408,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$41.28,$0.,$45.408,$0.
,CDM,4070001657.82.4070,INTACT PTH,CDM Code,Outpatient,83970,$0.,$0.,$45.408,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$41.28,$0.,$45.408,$0.
,CDM,4070001657.83.4070,INTACT PTH,CDM Code,Outpatient,83970,$0.,$0.,$45.408,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$41.28,$0.,$45.408,$0.
,CDM,4070001660.10.4070,AST (SGOT),CDM Code,Outpatient,84450,$57.,$5.698,$54.15,$45.6,$51.87,$14.9473,$54.15,$14.1012,$54.15,$54.15,$5.18,$38.9025,$5.698,$52.44
,CDM,4070001663.10.4070,ASSAY OF PSA FREE,CDM Code,Outpatient,84154,$113.,$20.229,$107.35,$90.4,$102.83,$29.6323,$107.35,$27.9551,$107.35,$107.35,$18.39,$77.1225,$20.229,$103.96
,CDM,4070001665.10.4070,ALT (SGPT),CDM Code,Outpatient,84460,$57.,$5.83,$54.15,$45.6,$51.87,$14.9473,$54.15,$14.1012,$54.15,$54.15,$5.3,$38.9025,$5.83,$52.44
,CDM,4070001666.10.4070,C.REACTIVE PROTEIN,CDM Code,Outpatient,86140,$88.,$5.698,$83.6,$70.4,$80.08,$23.0765,$83.6,$21.7703,$83.6,$83.6,$5.18,$60.06,$5.698,$80.96
,CDM,4070001667.10.4070,C REACTIVE PROTEIN,CDM Code,Outpatient,86140,$32.,$5.698,$30.4,$25.6,$29.12,$8.3915,$30.4,$7.9165,$30.4,$30.4,$5.18,$21.84,$5.698,$29.44
,CDM,4070001670.10.4070,M/PHMTRC ALYS ISHQUANT/SEMIQ,CDM Code,Outpatient,88377,$646.,$159.8139,$613.7,$516.8,$587.86,$169.4025,$613.7,$159.8139,$613.7,$613.7,$277.3596,$440.895,$487.,$594.32
,CDM,4070001671.10.4070,CHROMOSOME COUNT ADDITIONAL,CDM Code,Outpatient,88285,$105.,$25.976,$99.75,$84.,$95.55,$27.5345,$99.75,$25.976,$99.75,$99.75,$26.91,$71.6625,$29.601,$96.6
,CDM,4070001672.10.4070,INSITU HYBRIDIZATION AUTO,CDM Code,Outpatient,88367,$552.,$101.5,$524.4,$441.6,$502.32,$144.7526,$524.4,$136.5593,$524.4,$524.4,$491.3067,$376.74,$101.5,$507.84
,CDM,4070001673.10.4070,M/PHMTRC ALYS ISHQUANT/SEMIQ,CDM Code,Outpatient,88373,$117.,$28.9446,$111.15,$93.6,$106.47,$30.6813,$111.15,$28.9446,$111.15,$111.15,$11.7,$79.8525,$71.5,$107.64
,CDM,4070001674.10.4070,HEPATITIS C VIRAL RNA-QUAL-TMA,CDM Code,Outpatient,87521,$276.,$38.599,$262.2,$220.8,$251.16,$72.3763,$262.2,$68.2796,$262.2,$262.2,$35.09,$188.37,$38.599,$253.92
,CDM,4070001675.10.4070,"SODIUM, SERUM",CDM Code,Outpatient,84295,$30.,$5.291,$28.5,$24.,$27.3,$7.867,$28.5,$7.4217,$28.5,$28.5,$4.81,$20.475,$5.291,$27.6
,CDM,4070001680.10.4070,"SODIUM, URINE 24 HOUR",CDM Code,Outpatient,84300,$30.,$5.566,$28.5,$24.,$27.3,$7.867,$28.5,$7.4217,$28.5,$28.5,$5.06,$20.475,$5.566,$27.6
,CDM,4070001681.10.4070,FIBRINOGEN DEGRAD PRODUCT(FDP),CDM Code,Outpatient,85362,$115.,$7.579,$109.25,$92.,$104.65,$30.1568,$109.25,$28.4499,$109.25,$109.25,$6.89,$78.4875,$7.579,$105.8
,CDM,4070001682.10.4070,BRAF GENE,CDM Code,Outpatient,81210,$541.,$133.838,$513.95,$432.8,$492.31,$141.8681,$513.95,$133.838,$513.95,$513.95,$481.2141,$369.2325,$192.94,$497.72
,CDM,4070001683.10.4070,VZV- RAPID METHOD- CULTURE,CDM Code,Outpatient,87254,$128.,$21.516,$121.6,$102.4,$116.48,$33.5658,$121.6,$31.6659,$121.6,$121.6,$19.56,$87.36,$21.516,$117.76
,CDM,4070001684.10.4070,BETA-2 TRANSFERRIN,CDM Code,Outpatient,86335,$341.,$22.1,$323.95,$272.8,$310.31,$89.4215,$323.95,$84.36,$323.95,$323.95,$29.35,$232.7325,$22.1,$313.72
,CDM,4070001685.10.4070,"SODIUM, URINE RANDOM",CDM Code,Outpatient,84300,$52.,$5.566,$49.4,$41.6,$47.32,$13.6361,$49.4,$12.8643,$49.4,$49.4,$5.06,$35.49,$5.566,$47.84
,CDM,4070001686.10.4070,"CHLORIDE,URINE",CDM Code,Outpatient,82436,$31.,$6.325,$29.45,$24.8,$28.21,$8.1292,$29.45,$7.6691,$29.45,$29.45,$5.75,$21.1575,$6.325,$28.52
,CDM,4070001688.10.4070,"BKV PCR, QUANT",CDM Code,Outpatient,87799,$264.,$47.124,$250.8,$211.2,$240.24,$69.2295,$250.8,$65.311,$250.8,$250.8,$42.84,$180.18,$47.124,$242.88
,CDM,4070001690.10.4070,TRIGLYCERIDES,CDM Code,Outpatient,84478,$50.,$6.314,$47.5,$40.,$45.5,$13.1116,$47.5,$12.3695,$47.5,$47.5,$21.0396,$34.125,$6.314,$46.
,CDM,4070001690.20.4070,TRIGLYCERIDES,CDM Code,Outpatient,84478,$0.,$0.,$21.0396,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$21.0396,$0.,$6.314,$0.
,CDM,4070001691.10.4070,"TRIGLYCERIDE, BODY FLUID",CDM Code,Outpatient,84478,$59.,$6.314,$56.05,$47.2,$53.69,$15.4717,$56.05,$14.596,$56.05,$56.05,$21.0396,$40.2675,$6.314,$54.28
,CDM,4070001700.10.4070,"URIC ACID, SERUM",CDM Code,Outpatient,84550,$51.,$4.972,$48.45,$40.8,$46.41,$13.3739,$48.45,$12.6169,$48.45,$48.45,$4.52,$34.8075,$4.972,$46.92
,CDM,4070001701.10.4070,CLO TEST,CDM Code,Outpatient,87081,$41.,$7.293,$38.95,$32.8,$37.31,$10.7516,$38.95,$10.143,$38.95,$38.95,$6.63,$27.9825,$7.293,$37.72
,CDM,4070001708.10.4070,CD 20 MARKER,CDM Code,Outpatient,8818459,$130.,$32.1607,$491.3067,$104.,$118.3,$34.0903,$123.5,$32.1607,$123.5,$123.5,$491.3067,$88.725,$94.5,$119.6
,CDM,4070001711.10.4070,"RUBEOLA ANTIBODY, IgM",CDM Code,Outpatient,86765,$74.,$14.168,$70.3,$59.2,$67.34,$19.4052,$70.3,$18.3069,$70.3,$70.3,$12.88,$50.505,$14.168,$68.08
,CDM,4070001720.10.4070,"PHENOL EXP QUANT 1 OF 2, UR",CDM Code,Outpatient,82570,$110.,$5.698,$104.5,$88.,$100.1,$28.8456,$104.5,$27.2129,$104.5,$104.5,$5.18,$75.075,$5.698,$101.2
,CDM,4070001721.10.4070,CLOT INHIBIT PROT S TOTAL,CDM Code,Outpatient,85305,$220.,$12.771,$209.,$176.,$200.2,$57.6913,$209.,$54.4258,$209.,$209.,$11.61,$150.15,$12.771,$202.4
,CDM,4070001725.10.4070,MYCOPLASMA PNEUMONIAE BY PCR,CDM Code,Outpatient,87581,$238.,$38.599,$226.1,$190.4,$216.58,$62.4115,$226.1,$58.8788,$226.1,$226.1,$35.09,$162.435,$38.599,$218.96
,CDM,4070001726.10.4070,VARICELLA ZOSTER VIRUS (VZV)DF,CDM Code,Outpatient,87290,$84.,$14.762,$79.8,$67.2,$76.44,$22.0276,$79.8,$20.7808,$79.8,$79.8,$13.42,$57.33,$14.762,$77.28
,CDM,4070001727.10.4070,FACTOR V ACTIVITY,CDM Code,Outpatient,85220,$209.,$19.415,$198.55,$167.2,$190.19,$54.8067,$198.55,$51.7045,$198.55,$198.55,$17.65,$142.6425,$19.415,$192.28
,CDM,4070001728.10.4070,CANDIDA DIRECT PROBE,CDM Code,Outpatient,87480,$124.,$22.055,$117.8,$99.2,$112.84,$32.5169,$117.8,$30.6764,$117.8,$117.8,$20.05,$84.63,$22.055,$114.08
,CDM,4070001729.10.4070,GARDNERELLA DIRECT PROBE,CDM Code,Outpatient,87510,$124.,$22.055,$117.8,$99.2,$112.84,$32.5169,$117.8,$30.6764,$117.8,$117.8,$20.05,$84.63,$22.055,$114.08
,CDM,4070001730.10.4070,TRICHOMONAS DIRECT PROBE,CDM Code,Outpatient,87660,$124.,$22.055,$117.8,$99.2,$112.84,$32.5169,$117.8,$30.6764,$117.8,$117.8,$20.05,$84.63,$22.055,$114.08
,CDM,4070001731.10.4070,VASOACTIVE INTESTINAL POLYPEPT,CDM Code,Outpatient,84586,$144.,$35.6242,$136.8,$115.2,$131.04,$37.7616,$136.8,$35.6242,$136.8,$136.8,$35.33,$98.28,$38.863,$132.48
,CDM,4070001732.10.4070,MATRIX METALLOPROTEINASE-9 (MM,CDM Code,Outpatient,83520,$203.,$18.997,$192.85,$162.4,$184.73,$53.2333,$192.85,$50.2202,$192.85,$192.85,$17.27,$138.5475,$18.997,$186.76
,CDM,4070001733.10.4070,VASOPRESSIN,CDM Code,Outpatient,84588,$146.,$36.1189,$138.7,$116.8,$132.86,$38.286,$138.7,$36.1189,$138.7,$138.7,$33.94,$99.645,$37.334,$134.32
,CDM,4070001734.10.4070,TRANSFOMING GROWTH FACTOR BETA,CDM Code,Outpatient,83520,$216.,$18.997,$205.2,$172.8,$196.56,$56.6423,$205.2,$53.4362,$205.2,$205.2,$17.27,$147.42,$18.997,$198.72
,CDM,4070001735.10.4070,COMPLEMENT COMPONENT LEVEL 4a,CDM Code,Outpatient,86160,$144.,$13.2,$136.8,$115.2,$131.04,$37.7616,$136.8,$35.6242,$136.8,$136.8,$12.,$98.28,$13.2,$132.48
,CDM,4070001736.10.4070,VASCULAR ENDOTHELIAL GROWTH FA,CDM Code,Outpatient,82397,$273.,$15.532,$259.35,$218.4,$248.43,$71.5896,$259.35,$67.5375,$259.35,$259.35,$14.12,$186.3225,$15.532,$251.16
,CDM,4070001737.10.4070,HLA DR TYPING,CDM Code,Outpatient,81376,$525.,$129.8798,$498.75,$420.,$477.75,$137.6723,$498.75,$129.8798,$498.75,$498.75,$447.6522,$358.3125,$134.442,$483.
,CDM,4070001738.10.4070,MELANOCYTE-STIMULATING HORMONE,CDM Code,Outpatient,83519,$204.,$20.24,$193.8,$163.2,$185.64,$53.4955,$193.8,$50.4676,$193.8,$193.8,$18.4,$139.23,$20.24,$187.68
,CDM,4070001739.10.4070,TYROSINE,CDM Code,Outpatient,84510,$162.,$11.693,$153.9,$129.6,$147.42,$42.4817,$153.9,$40.0772,$153.9,$153.9,$10.63,$110.565,$11.693,$149.04
,CDM,4070001740.10.4070,"PROTEIN, URINE RANDOM",CDM Code,Outpatient,84156,$23.,$4.037,$21.85,$18.4,$20.93,$6.0314,$21.85,$5.69,$21.85,$21.85,$3.67,$15.6975,$4.037,$21.16
,CDM,4070001741.10.4070,MICROALBUMIN-RANDOM URINE,CDM Code,Outpatient,82043,$36.,$6.358,$34.2,$28.8,$32.76,$9.4404,$34.2,$8.906,$34.2,$34.2,$5.78,$24.57,$6.358,$33.12
,CDM,4070001745.10.4070,MICROALBUMIN 24 HOUR URINE,CDM Code,Outpatient,82043,$76.,$6.358,$72.2,$60.8,$69.16,$19.9297,$72.2,$18.8016,$72.2,$72.2,$5.78,$51.87,$6.358,$69.92
,CDM,4070001750.10.4070,"GLUCOSE, RANDOM",CDM Code,Outpatient,82947,$40.,$4.323,$38.,$32.,$36.4,$10.4893,$38.,$9.8956,$38.,$38.,$14.3913,$27.3,$4.323,$36.8
,CDM,4070001751.10.4070,RISPERDAL,CDM Code,Outpatient,80342,$108.,$26.7181,$102.6,$86.4,$98.28,$28.3212,$102.6,$26.7181,$102.6,$102.6,$10.8,$73.71,$33.5,$99.36
,CDM,4070001775.10.4070,GAMMA-GLUTAMYL TRANSFERASE,CDM Code,Outpatient,82977,$44.,$7.92,$41.8,$35.2,$40.04,$11.5383,$41.8,$10.8852,$41.8,$41.8,$7.2,$30.03,$7.92,$40.48
,CDM,4070001777.10.4070,IRON-FE,CDM Code,Outpatient,83540,$40.,$7.117,$38.,$32.,$36.4,$10.4893,$38.,$9.8956,$38.,$38.,$6.47,$27.3,$7.117,$36.8
,CDM,4070001778.10.4070,IRON BINDING,CDM Code,Outpatient,83550,$57.,$9.614,$54.15,$45.6,$51.87,$14.9473,$54.15,$14.1012,$54.15,$54.15,$8.74,$38.9025,$9.614,$52.44
,CDM,4070001780.10.4070,CHEM 8 (BMP),CDM Code,Outpatient,80048,$52.,$9.306,$49.4,$41.6,$47.32,$13.6361,$49.4,$12.8643,$49.4,$49.4,$8.46,$35.49,$9.306,$47.84
,CDM,4070001782.10.4070,RENAL PANEL,CDM Code,Outpatient,80069,$54.,$9.548,$51.3,$43.2,$49.14,$14.1606,$51.3,$13.3591,$51.3,$51.3,$8.68,$36.855,$9.548,$49.68
,CDM,4070001790.10.4070,ALLERGEN SPECIFIC IGG,CDM Code,Outpatient,86001,$24.,$5.9374,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$7.82,$16.38,$8.602,$22.08
,CDM,4070001795.10.4070,TROPONIN TNI,CDM Code,Outpatient,84484,$62.,$13.717,$58.9,$49.6,$56.42,$16.2584,$58.9,$15.3382,$58.9,$58.9,$12.47,$42.315,$13.717,$57.04
,CDM,4070001796.10.4070,ALLERGEN - MOUNTAIN CEDAR TREE,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070001800.10.4070,ALLERGEN-CHICKEN FEATHERS,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070001802.10.4070,ALLERGEN-GOOSE FEATHERS,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070001804.10.4070,ALLERGEN-CLADOSPORIUM HERBARUM,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070001809.10.4070,ALLERGEN-PERENNIAL RYE GRASS,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070001815.10.4070,ALLERGEN-SCALE (LENSCALE),CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070001818.10.4070,ALLERGEN-HAMSTER EPITHELIUM,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070001819.10.4070,ALLERGEN-MOUSE EPITHELIUM,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070001824.10.4070,ALLERGEN-ORCHARD GRASS,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070001855.10.4070,"A1C,HEMOGLOBIN",CDM Code,Outpatient,83036,$60.,$10.681,$57.,$48.,$54.6,$15.734,$57.,$14.8434,$57.,$57.,$9.71,$40.95,$10.681,$55.2
,CDM,4070001856.10.4070,"DAS 5, URINE",CDM Code,Outpatient,80307,$63.,$15.5856,$68.354,$50.4,$57.33,$16.5207,$59.85,$15.5856,$59.85,$59.85,$62.14,$42.9975,$68.354,$57.96
,CDM,4070001862.10.4070,RPR TITER,CDM Code,Outpatient,86593,$34.,$4.84,$32.3,$27.2,$30.94,$8.9159,$32.3,$8.4113,$32.3,$32.3,$16.1268,$23.205,$4.84,$31.28
,CDM,4070001863.10.4070,"HIV AB/AG 4TH GEN, RFL TO CONF",CDM Code,Outpatient,87389,$149.,$26.488,$141.55,$119.2,$135.59,$39.0727,$141.55,$36.8611,$141.55,$141.55,$24.08,$101.6925,$26.488,$137.08
,CDM,4070001864.10.4070,ALUMINUM,CDM Code,Outpatient,82108,$116.,$28.028,$110.2,$92.8,$105.56,$30.419,$110.2,$28.6972,$110.2,$110.2,$25.48,$79.17,$28.028,$106.72
,CDM,4070001865.10.4070,ANCA TITER RELEX TEST,CDM Code,Outpatient,86256,$105.,$22.1,$99.75,$84.,$95.55,$27.5345,$99.75,$25.976,$99.75,$99.75,$12.05,$71.6625,$22.1,$96.6
,CDM,4070001866.10.4070,PROTEINASE 3 AB,CDM Code,Outpatient,83516,$95.,$12.683,$90.25,$76.,$86.45,$24.9121,$90.25,$23.5021,$90.25,$90.25,$11.53,$64.8375,$12.683,$87.4
,CDM,4070001867.10.4070,MYELOPEROXIDASE AB,CDM Code,Outpatient,83516,$95.,$12.683,$90.25,$76.,$86.45,$24.9121,$90.25,$23.5021,$90.25,$90.25,$11.53,$64.8375,$12.683,$87.4
,CDM,4070001870.10.4070,"TOXICOLOGY SCREEN, URINE",CDM Code,Outpatient,80307,$124.,$30.6764,$117.8,$99.2,$112.84,$32.5169,$117.8,$30.6764,$117.8,$117.8,$62.14,$84.63,$68.354,$114.08
,CDM,4070001900.10.4070,CORD TOX SCRN,CDM Code,Outpatient,80307,$360.,$68.354,$342.,$288.,$327.6,$94.4039,$342.,$89.0604,$342.,$342.,$62.14,$245.7,$68.354,$331.2
,CDM,4070001917.10.4070,IMMUNOASSAY QUANT NOS NONAB,CDM Code,Outpatient,83520,$129.,$18.997,$122.55,$103.2,$117.39,$33.8281,$122.55,$31.9133,$122.55,$122.55,$17.27,$88.0425,$18.997,$118.68
,CDM,4070001918.10.4070,HEMOPHILUS INFLUENZA ANTIBDY,CDM Code,Outpatient,86684,$79.,$17.424,$75.05,$63.2,$71.89,$20.7164,$75.05,$19.5438,$75.05,$75.05,$15.84,$53.9175,$17.424,$72.68
,CDM,4070001919.10.4070,CHEMILCNT ASSAY-ANTI-MULLERI,CDM Code,Outpatient,82397,$128.,$15.532,$121.6,$102.4,$116.48,$33.5658,$121.6,$31.6659,$121.6,$121.6,$14.12,$87.36,$15.532,$117.76
,CDM,4070001920.10.4070,DRUG ASSAY LACOSAMIDE,CDM Code,Outpatient,80235,$136.,$29.821,$129.2,$108.8,$123.76,$35.6637,$129.2,$33.645,$129.2,$129.2,$27.11,$92.82,$29.821,$125.12
,CDM,4070001921.10.4070,DRUG/SUBSTANCE NOS 7/MORE - HY,CDM Code,Outpatient,80377,$572.,$33.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$57.2,$390.39,$33.5,$526.24
,CDM,4070001922.10.4070,AG DETECT NOS IA MULT-CLOSTRID,CDM Code,Outpatient,87449,$60.,$13.178,$57.,$48.,$54.6,$15.734,$57.,$14.8434,$57.,$57.,$11.98,$40.95,$13.178,$55.2
,CDM,4070001923.10.4070,CLOSTRIDIUM AG IA DIFFICILE,CDM Code,Outpatient,87324,$60.,$13.178,$57.,$48.,$54.6,$15.734,$57.,$14.8434,$57.,$57.,$11.98,$40.95,$13.178,$55.2
,CDM,4070001924.10.4070,CLOT FACTOR VII PROCONVERTIN,CDM Code,Outpatient,85230,$90.,$19.69,$85.5,$72.,$81.9,$23.601,$85.5,$22.2651,$85.5,$85.5,$17.9,$61.425,$19.69,$82.8
,CDM,4070002095.10.4070,CBC W/AUTO DIFF,CDM Code,Outpatient,85025,$48.,$8.547,$45.6,$38.4,$43.68,$12.5872,$45.6,$11.8747,$45.6,$45.6,$7.77,$32.76,$8.547,$44.16
,CDM,4070002099.10.4070,MACBC,CDM Code,Outpatient,85027,$40.,$7.117,$38.,$32.,$36.4,$10.4893,$38.,$9.8956,$38.,$38.,$6.47,$27.3,$7.117,$36.8
,CDM,4070002100.10.4070,"DIFFERENTIAL,MANUAL",CDM Code,Outpatient,85007,$27.,$4.18,$25.65,$21.6,$24.57,$7.0803,$25.65,$6.6795,$25.65,$25.65,$3.8,$18.4275,$4.18,$24.84
,CDM,4070002110.10.4070,"CELL COUNT, CSF",CDM Code,Outpatient,89051,$125.,$6.16,$118.75,$100.,$113.75,$32.7791,$118.75,$30.9237,$118.75,$118.75,$5.6,$85.3125,$6.16,$115.
,CDM,4070002135.10.4070,"CELL COUNT, BODY FLUID",CDM Code,Outpatient,89051,$125.,$6.16,$118.75,$100.,$113.75,$32.7791,$118.75,$30.9237,$118.75,$118.75,$5.6,$85.3125,$6.16,$115.
,CDM,4070002161.10.4070,CRYSTAL EXAM,CDM Code,Outpatient,89060,$69.,$17.0699,$65.55,$55.2,$62.79,$18.0941,$65.55,$17.0699,$65.55,$65.55,$7.33,$47.0925,$22.1,$63.48
,CDM,4070002190.10.4070,"EOSINOPHIL SMEAR, BODY FLUIDS",CDM Code,Outpatient,89190,$66.,$6.369,$62.7,$52.8,$60.06,$17.3074,$62.7,$16.3277,$62.7,$62.7,$5.79,$45.045,$6.369,$60.72
,CDM,4070002246.10.4070,D-DIMER(FDP),CDM Code,Outpatient,85379,$165.,$11.198,$156.75,$132.,$150.15,$43.2684,$156.75,$40.8194,$156.75,$156.75,$10.18,$112.6125,$11.198,$151.8
,CDM,4070002247.10.4070,D-DIMER QUALITATIVE,CDM Code,Outpatient,85378,$0.,$0.,$10.692,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$9.72,$0.,$10.692,$0.
,CDM,4070002250.10.4070,FIBRINOGEN,CDM Code,Outpatient,85384,$52.,$10.692,$49.4,$41.6,$47.32,$13.6361,$49.4,$12.8643,$49.4,$49.4,$9.72,$35.49,$10.692,$47.84
,CDM,4070002301.10.4070,ANTI-PHOSPHOLIPID ANTIBODY,CDM Code,Outpatient,86148,$151.,$17.677,$143.45,$120.8,$137.41,$39.5972,$143.45,$37.3559,$143.45,$143.45,$16.07,$103.0575,$17.677,$138.92
,CDM,4070002302.10.4070,COL CHROMOTOGRAPHY QUAL/QUAN,CDM Code,Outpatient,82542,$166.,$26.499,$157.7,$132.8,$151.06,$43.5307,$157.7,$41.0667,$157.7,$157.7,$24.09,$113.295,$26.499,$152.72
,CDM,4070002303.10.4070,DNA ANTIBODY SINGLE STRAND,CDM Code,Outpatient,86226,$186.,$13.321,$176.7,$148.8,$169.26,$48.7753,$176.7,$46.0145,$176.7,$176.7,$12.11,$126.945,$13.321,$171.12
,CDM,4070002304.10.4070,CFTR GENE COM VARIANTS,CDM Code,Outpatient,81220,$765.,$189.2534,$726.75,$612.,$696.15,$200.6082,$726.75,$189.2534,$726.75,$726.75,$556.6,$522.1125,$612.26,$703.8
,CDM,4070002310.10.4070,HEMOGRAM (CBC NO DIFF),CDM Code,Outpatient,85027,$40.,$7.117,$38.,$32.,$36.4,$10.4893,$38.,$9.8956,$38.,$38.,$6.47,$27.3,$7.117,$36.8
,CDM,4070002315.10.4070,KRAS GENE VARIANTS EXON 2,CDM Code,Outpatient,81275,$966.,$212.575,$917.7,$772.8,$879.06,$253.3171,$917.7,$238.9787,$917.7,$917.7,$530.1819,$659.295,$212.575,$888.72
,CDM,4070002390.10.4070,PLATELET COUNT,CDM Code,Outpatient,85049,$56.,$4.928,$53.2,$44.8,$50.96,$14.685,$53.2,$13.8538,$53.2,$53.2,$4.48,$38.22,$4.928,$51.52
,CDM,4070002403.10.4070,WHOLE BLOOD PROTIME,CDM Code,Outpatient,85610,$58.,$4.719,$55.1,$46.4,$52.78,$15.2095,$55.1,$14.3486,$55.1,$55.1,$4.29,$39.585,$4.719,$53.36
,CDM,4070002403.20.4070,WHOLE BLOOD PROTIME,CDM Code,Outpatient,85610,$58.,$4.719,$55.1,$46.4,$52.78,$15.2095,$55.1,$14.3486,$55.1,$55.1,$4.29,$39.585,$4.719,$53.36
,CDM,4070002403.30.4070,WHOLE BLOOD PROTIME,CDM Code,Outpatient,85610,$58.,$4.719,$55.1,$46.4,$52.78,$15.2095,$55.1,$14.3486,$55.1,$55.1,$4.29,$39.585,$4.719,$53.36
,CDM,4070002403.82.4070,WHOLE BLOOD PROTIME,CDM Code,Outpatient,85610,$58.,$4.719,$55.1,$46.4,$52.78,$15.2095,$55.1,$14.3486,$55.1,$55.1,$4.29,$39.585,$4.719,$53.36
,CDM,4070002403.83.4070,WHOLE BLOOD PROTIME,CDM Code,Outpatient,85610,$58.,$4.719,$55.1,$46.4,$52.78,$15.2095,$55.1,$14.3486,$55.1,$55.1,$4.29,$39.585,$4.719,$53.36
,CDM,4070002405.10.4070,HEMATOCRIT-AUTO,CDM Code,Outpatient,85014,$38.,$2.607,$36.1,$30.4,$34.58,$9.9649,$36.1,$9.4008,$36.1,$36.1,$2.37,$25.935,$2.607,$34.96
,CDM,4070002405.82.4070,HEMATOCRIT-AUTO,CDM Code,Outpatient,85014,$0.,$0.,$2.607,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$2.37,$0.,$2.607,$0.
,CDM,4070002406.10.4070,HEMOGLOBIN,CDM Code,Outpatient,85018,$33.,$2.607,$31.35,$26.4,$30.03,$8.6537,$31.35,$8.1639,$31.35,$31.35,$2.37,$22.5225,$2.607,$30.36
,CDM,4070002407.10.4070,PT MIXING STUDY,CDM Code,Outpatient,8561191,$0.,$0.,$3.94,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$3.94,$0.,$0.,$0.
,CDM,4070002408.10.4070,PROTIME,CDM Code,Outpatient,85610,$58.,$4.719,$55.1,$46.4,$52.78,$15.2095,$55.1,$14.3486,$55.1,$55.1,$4.29,$39.585,$4.719,$53.36
,CDM,4070002410.10.4070,PARTIAL THROMBOPLASTIN TIME,CDM Code,Outpatient,85730,$98.,$6.611,$93.1,$78.4,$89.18,$25.6988,$93.1,$24.2442,$93.1,$93.1,$6.01,$66.885,$6.611,$90.16
,CDM,4070002413.10.4070,PTT MIXING STUDY,CDM Code,Outpatient,8573291,$0.,$0.,$6.47,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$6.47,$0.,$0.,$0.
,CDM,4070002417.10.4070,HEMOGRAMCRIT,CDM Code,Outpatient,85014,$30.,$2.607,$28.5,$24.,$27.3,$7.867,$28.5,$7.4217,$28.5,$28.5,$2.37,$20.475,$2.607,$27.6
,CDM,4070002440.10.4070,RETICULOCYTE COUNT,CDM Code,Outpatient,85045,$56.,$4.389,$53.2,$44.8,$50.96,$14.685,$53.2,$13.8538,$53.2,$53.2,$3.99,$38.22,$4.389,$51.52
,CDM,4070002460.10.4070,"SPERM COUNT, POST VASECTOMY",CDM Code,Outpatient,89321,$0.,$0.,$13.255,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$12.05,$0.,$13.255,$0.
,CDM,4070002501.10.4070,DETECT AGENT NOS DNA AMP,CDM Code,Outpatient,87798,$210.,$38.599,$199.5,$168.,$191.1,$55.0689,$199.5,$51.9519,$199.5,$199.5,$35.09,$143.325,$38.599,$193.2
,CDM,4070002530.10.4070,SEDIMENTATION RATE,CDM Code,Outpatient,85651,$60.,$4.697,$57.,$48.,$54.6,$15.734,$57.,$14.8434,$57.,$57.,$4.27,$40.95,$4.697,$55.2
,CDM,4070003100.10.4070,CEBPA GENE FULL SEQUENCE,CDM Code,Outpatient,81218,$332.,$82.1335,$885.9594,$265.6,$302.12,$87.0614,$315.4,$82.1335,$315.4,$315.4,$885.9594,$226.59,$266.09,$305.44
,CDM,4070003101.10.4070,NPM1 GENE,CDM Code,Outpatient,81310,$476.,$117.7576,$663.495,$380.8,$433.16,$124.8229,$452.2,$117.7576,$452.2,$452.2,$663.495,$324.87,$271.172,$437.92
,CDM,4070003102.10.4070,FLT3 GENE,CDM Code,Outpatient,81245,$411.,$101.6773,$445.4628,$328.8,$374.01,$107.7778,$390.45,$101.6773,$390.45,$390.45,$445.4628,$280.5075,$182.061,$378.12
,CDM,4070003103.10.4070,FLT3 GENE ANALYSIS,CDM Code,Outpatient,81246,$272.,$67.2901,$258.4,$217.6,$247.52,$71.3274,$258.4,$67.2901,$258.4,$258.4,$223.2654,$185.64,$91.3,$250.24
,CDM,4070003104.10.4070,ACHR MODULATING AB,CDM Code,Outpatient,83519,$174.,$20.24,$165.3,$139.2,$158.34,$45.6285,$165.3,$43.0459,$165.3,$165.3,$18.4,$118.755,$20.24,$160.08
,CDM,4070003105.10.4070,AAT MUTATION ANALYSIS,CDM Code,Outpatient,81332,$370.,$48.015,$351.5,$296.,$336.7,$97.0262,$351.5,$91.5343,$351.5,$351.5,$159.8796,$252.525,$48.015,$340.4
,CDM,4070003106.10.4070,MSA AB PANEL,CDM Code,Outpatient,86235,$106.,$19.723,$100.7,$84.8,$96.46,$27.7967,$100.7,$26.2233,$100.7,$100.7,$17.93,$72.345,$19.723,$97.52
,CDM,4070003107.10.4070,MSA AB PANEL,CDM Code,Outpatient,84182,$260.,$22.1,$247.,$208.,$236.6,$68.1806,$247.,$64.3214,$247.,$247.,$29.21,$177.45,$22.1,$239.2
,CDM,4070003108.10.4070,VGCC AB ASSAY,CDM Code,Outpatient,83519,$278.,$20.24,$264.1,$222.4,$252.98,$72.9008,$264.1,$68.7744,$264.1,$264.1,$18.4,$189.735,$20.24,$255.76
,CDM,4070003109.10.4070,ALPHA 3 AB,CDM Code,Outpatient,83519,$425.,$20.24,$403.75,$340.,$386.75,$111.449,$403.75,$105.1408,$403.75,$403.75,$18.4,$290.0625,$20.24,$391.
,CDM,4070003110.10.4070,VGCC TYPE N AB,CDM Code,Outpatient,83519,$235.,$20.24,$223.25,$188.,$213.85,$61.6248,$223.25,$58.1367,$223.25,$223.25,$18.4,$160.3875,$20.24,$216.2
,CDM,4070003111.10.4070,"NEURO AB, CBA IFA",CDM Code,Outpatient,86255,$183.,$22.1,$173.85,$146.4,$166.53,$47.9886,$173.85,$45.2724,$173.85,$173.85,$12.05,$124.8975,$22.1,$168.36
,CDM,4070003112.10.4070,"NEURO AB, LINE BLOT",CDM Code,Outpatient,86341,$128.,$25.927,$121.6,$102.4,$116.48,$33.5658,$121.6,$31.6659,$121.6,$121.6,$23.57,$87.36,$25.927,$117.76
,CDM,4070003113.10.4070,"NEURO AB, LINE BLOT",CDM Code,Outpatient,84182,$160.,$22.1,$152.,$128.,$145.6,$41.9573,$152.,$39.5824,$152.,$152.,$29.21,$109.2,$22.1,$147.2
,CDM,4070003236.10.4070,TISSUE CULTURE SKIN/BIOPSY,CDM Code,Outpatient,88233,$782.,$154.803,$742.9,$625.6,$711.62,$205.0662,$742.9,$193.459,$742.9,$742.9,$140.73,$533.715,$154.803,$719.44
,CDM,4070004000.10.4070,ANTIEPILEPTICS NOS 1-3,CDM Code,Outpatient,80339,$294.,$33.5,$279.3,$235.2,$267.54,$77.0965,$279.3,$72.7327,$279.3,$279.3,$29.4,$200.655,$33.5,$270.48
,CDM,4070004001.10.4070,LEFLUNOMIDE,CDM Code,Outpatient,80299,$292.,$20.504,$277.4,$233.6,$265.72,$76.572,$277.4,$72.2379,$277.4,$277.4,$18.64,$199.29,$20.504,$268.64
,CDM,4070004002.10.4070,ACYLCARNITINE QUANT,CDM Code,Outpatient,82017,$357.,$18.557,$339.15,$285.6,$324.87,$93.6172,$339.15,$88.3182,$339.15,$339.15,$16.87,$243.6525,$18.557,$328.44
,CDM,4070004003.10.4070,MASS SPECTROMETRY QUANT,CDM Code,Outpatient,83789,$292.,$26.521,$277.4,$233.6,$265.72,$76.572,$277.4,$72.2379,$277.4,$277.4,$24.11,$199.29,$26.521,$268.64
,CDM,4070004004.10.4070,AMINO ACIDS QUAN 6 OR MORE,CDM Code,Outpatient,82139,$708.,$18.557,$672.6,$566.4,$644.28,$185.661,$672.6,$175.1521,$672.6,$672.6,$16.87,$483.21,$18.557,$651.36
,CDM,4070004005.10.4070,TISSUE TRANSGLUTAMINASE IgG,CDM Code,Outpatient,83516,$199.,$12.683,$189.05,$159.2,$181.09,$52.1844,$189.05,$49.2306,$189.05,$189.05,$11.53,$135.8175,$12.683,$183.08
,CDM,4070004006.10.4070,DRUG SCREENING FENTANYL,CDM Code,Outpatient,80354,$238.,$33.5,$226.1,$190.4,$216.58,$62.4115,$226.1,$58.8788,$226.1,$226.1,$23.8,$162.435,$33.5,$218.96
,CDM,4070004020.10.4070,OCCULT BLOOD OP - FECES,CDM Code,Outpatient,82270,$42.,$4.818,$39.9,$33.6,$38.22,$11.0138,$39.9,$10.3904,$39.9,$39.9,$11.9082,$28.665,$4.818,$38.64
,CDM,4070004021.10.4070,"OCCULT BLOOD IP,FECES",CDM Code,Outpatient,82272,$42.,$4.653,$39.9,$33.6,$38.22,$11.0138,$39.9,$10.3904,$39.9,$39.9,$4.23,$28.665,$4.653,$38.64
,CDM,4070004024.10.4070,GASTROCCULT,CDM Code,Outpatient,82271,$27.,$5.852,$25.65,$21.6,$24.57,$7.0803,$25.65,$6.6795,$25.65,$25.65,$5.32,$18.4275,$5.852,$24.84
,CDM,4070004035.10.4070,C. DIFFICLE PCR,CDM Code,Outpatient,87493,$217.,$40.997,$206.15,$173.6,$197.47,$56.9046,$206.15,$53.6836,$206.15,$206.15,$37.27,$148.1025,$40.997,$199.64
,CDM,4070004037.10.4070,INFLUENZA A ANTIGEN,CDM Code,Outpatient,87276,$80.,$17.677,$76.,$64.,$72.8,$20.9786,$76.,$19.7912,$76.,$76.,$16.07,$54.6,$17.677,$73.6
,CDM,4070004038.10.4070,INFLUENZA B ANTIGEN,CDM Code,Outpatient,87275,$74.,$13.475,$70.3,$59.2,$67.34,$19.4052,$70.3,$18.3069,$70.3,$70.3,$12.25,$50.505,$13.475,$68.08
,CDM,4070004039.10.4070,RSV DIRECT,CDM Code,Outpatient,87280,$74.,$14.762,$70.3,$59.2,$67.34,$19.4052,$70.3,$18.3069,$70.3,$70.3,$13.42,$50.505,$14.762,$68.08
,CDM,4070004045.10.4070,WET MOUNT,CDM Code,Outpatient,87210,$29.,$6.402,$27.55,$23.2,$26.39,$7.6048,$27.55,$7.1743,$27.55,$27.55,$5.82,$19.7925,$6.402,$26.68
,CDM,4070004050.10.4070,FECAL LEUKOCYTES,CDM Code,Outpatient,89055,$88.,$4.697,$83.6,$70.4,$80.08,$23.0765,$83.6,$21.7703,$83.6,$83.6,$4.27,$60.06,$4.697,$80.96
,CDM,4070004060.10.4070,KOH PREP,CDM Code,Outpatient,87220,$26.,$4.697,$24.7,$20.8,$23.66,$6.8181,$24.7,$6.4321,$24.7,$24.7,$4.27,$17.745,$4.697,$23.92
,CDM,4070004071.10.4070,STOOL CULTURE PART TWO,CDM Code,Outpatient,8704691,$0.,$0.,$9.44,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$9.44,$0.,$0.,$0.
,CDM,4070004072.10.4070,STOOL CULTURE,CDM Code,Outpatient,87045,$58.,$10.384,$55.1,$46.4,$52.78,$15.2095,$55.1,$14.3486,$55.1,$55.1,$9.44,$39.585,$10.384,$53.36
,CDM,4070004073.10.4070,STOOL ADDITIONAL CAMPY,CDM Code,Outpatient,87046,$58.,$10.384,$55.1,$46.4,$52.78,$15.2095,$55.1,$14.3486,$55.1,$55.1,$9.44,$39.585,$10.384,$53.36
,CDM,4070004100.10.4070,"RAPID STREP TEST, GROUP A",CDM Code,Outpatient,87430,$84.,$18.491,$79.8,$67.2,$76.44,$22.0276,$79.8,$20.7808,$79.8,$79.8,$16.81,$57.33,$18.491,$77.28
,CDM,4070004112.10.4070,RUPTURE OF MEMBRANES TEST(ROM),CDM Code,Outpatient,84112,$265.,$65.5584,$251.75,$212.,$241.15,$69.4917,$251.75,$65.5584,$251.75,$251.75,$98.11,$180.8625,$107.921,$243.8
,CDM,4070004200.10.4070,GRAM STAIN,CDM Code,Outpatient,87205,$26.,$4.697,$24.7,$20.8,$23.66,$6.8181,$24.7,$6.4321,$24.7,$24.7,$4.27,$17.745,$4.697,$23.92
,CDM,4070004201.10.4070,DETECT AGNT MULT DNA AMPLI,CDM Code,Outpatient,87801,$390.,$77.22,$370.5,$312.,$354.9,$102.2709,$370.5,$96.4821,$370.5,$370.5,$70.2,$266.175,$77.22,$358.8
,CDM,4070004202.10.4070,CANDIDA DNA AMP PROBE,CDM Code,Outpatient,8748159,$195.,$48.2411,$185.25,$156.,$177.45,$51.1354,$185.25,$48.2411,$185.25,$185.25,$35.09,$133.0875,$171.6,$179.4
,CDM,4070004203.10.4070,CANDIDA DNA AMP PROBE,CDM Code,Outpatient,8748159,$195.,$48.2411,$185.25,$156.,$177.45,$51.1354,$185.25,$48.2411,$185.25,$185.25,$35.09,$133.0875,$171.6,$179.4
,CDM,4070004205.10.4070,SMN1 GENE DOS/DELETION ALYS,CDM Code,Outpatient,81329,$685.,$150.7,$650.75,$548.,$623.35,$179.6296,$650.75,$169.4622,$650.75,$650.75,$365.79,$467.5125,$150.7,$630.2
,CDM,4070004206.10.4070,HLA II TYPING 1 LOCUS LR,CDM Code,Outpatient,81376,$263.,$65.0636,$447.6522,$210.4,$239.33,$68.9673,$249.85,$65.0636,$249.85,$249.85,$447.6522,$179.4975,$134.442,$241.96
,CDM,4070004207.10.4070,FLOWCYTOMETRY/ TC 1 MARKER,CDM Code,Outpatient,88184,$343.,$84.8548,$491.3067,$274.4,$312.13,$89.9459,$325.85,$84.8548,$325.85,$325.85,$491.3067,$234.0975,$94.5,$315.56
,CDM,4070004500.10.4070,CULT URINE,CDM Code,Outpatient,87086,$50.,$8.877,$47.5,$40.,$45.5,$13.1116,$47.5,$12.3695,$47.5,$47.5,$8.07,$34.125,$8.877,$46.
,CDM,4070004501.10.4070,CULT VRE SCREEN,CDM Code,Outpatient,87081,$145.,$7.293,$137.75,$116.,$131.95,$38.0238,$137.75,$35.8715,$137.75,$137.75,$6.63,$98.9625,$7.293,$133.4
,CDM,4070004505.10.4070,CULT BLOOD,CDM Code,Outpatient,87040,$64.,$11.352,$60.8,$51.2,$58.24,$16.7829,$60.8,$15.833,$60.8,$60.8,$10.32,$43.68,$11.352,$58.88
,CDM,4070004510.10.4070,CULT RESPIRATORY,CDM Code,Outpatient,87070,$53.,$9.482,$50.35,$42.4,$48.23,$13.8983,$50.35,$13.1117,$50.35,$50.35,$8.62,$36.1725,$9.482,$48.76
,CDM,4070004515.10.4070,CULT ROUTINE,CDM Code,Outpatient,87070,$126.,$9.482,$119.7,$100.8,$114.66,$33.0414,$119.7,$31.1711,$119.7,$119.7,$8.62,$85.995,$9.482,$115.92
,CDM,4070004525.10.4070,"CULT, FUNGUS",CDM Code,Outpatient,87102,$52.,$9.251,$49.4,$41.6,$47.32,$13.6361,$49.4,$12.8643,$49.4,$49.4,$8.41,$35.49,$9.251,$47.84
,CDM,4070004530.10.4070,"CULTURE,FUNGUS OR AFB(BLOOD)",CDM Code,Outpatient,87103,$174.,$22.506,$165.3,$139.2,$158.34,$45.6285,$165.3,$43.0459,$165.3,$165.3,$20.46,$118.755,$22.506,$160.08
,CDM,4070004535.10.4070,"CULTURE,FUNGUS SKIN",CDM Code,Outpatient,87101,$112.,$8.481,$106.4,$89.6,$101.92,$29.3701,$106.4,$27.7077,$106.4,$106.4,$7.71,$76.44,$8.481,$103.04
,CDM,4070004540.10.4070,CULT THROAT COMPLETE,CDM Code,Outpatient,87070,$53.,$9.482,$50.35,$42.4,$48.23,$13.8983,$50.35,$13.1117,$50.35,$50.35,$8.62,$36.1725,$9.482,$48.76
,CDM,4070004550.10.4070,CULT THROAT STREP SCREEN,CDM Code,Outpatient,87070,$53.,$9.482,$50.35,$42.4,$48.23,$13.8983,$50.35,$13.1117,$50.35,$50.35,$8.62,$36.1725,$9.482,$48.76
,CDM,4070004555.10.4070,"CULTURE,GROUP B STREP",CDM Code,Outpatient,87081,$41.,$7.293,$38.95,$32.8,$37.31,$10.7516,$38.95,$10.143,$38.95,$38.95,$6.63,$27.9825,$7.293,$37.72
,CDM,4070004557.10.4070,"CULT, MRSA SCREEN",CDM Code,Outpatient,87081,$41.,$7.293,$38.95,$32.8,$37.31,$10.7516,$38.95,$10.143,$38.95,$38.95,$6.63,$27.9825,$7.293,$37.72
,CDM,4070004560.10.4070,CULT GC SCREEN,CDM Code,Outpatient,87081,$0.,$0.,$7.293,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$6.63,$0.,$7.293,$0.
,CDM,4070004561.10.4070,CULT BODY FLUID ANAEROBIC,CDM Code,Outpatient,87075,$141.,$10.417,$133.95,$112.8,$128.31,$36.9749,$133.95,$34.882,$133.95,$133.95,$9.47,$96.2325,$10.417,$129.72
,CDM,4070004562.10.4070,CULT BODY FLUID AEROBIC,CDM Code,Outpatient,87070,$53.,$9.482,$50.35,$42.4,$48.23,$13.8983,$50.35,$13.1117,$50.35,$50.35,$8.62,$36.1725,$9.482,$48.76
,CDM,4070004565.10.4070,CULT E.COLI 0157-H7 SCREEN,CDM Code,Outpatient,87081,$89.,$7.293,$84.55,$71.2,$80.99,$23.3387,$84.55,$22.0177,$84.55,$84.55,$6.63,$60.7425,$7.293,$81.88
,CDM,4070004566.10.4070,CULT CSF AEROBIC,CDM Code,Outpatient,87070,$53.,$9.482,$50.35,$42.4,$48.23,$13.8983,$50.35,$13.1117,$50.35,$50.35,$8.62,$36.1725,$9.482,$48.76
,CDM,4070004600.10.4070,CULTURE ANAEROBIC,CDM Code,Outpatient,87075,$58.,$10.417,$55.1,$46.4,$52.78,$15.2095,$55.1,$14.3486,$55.1,$55.1,$9.47,$39.585,$10.417,$53.36
,CDM,4070004900.10.4070,ORGANISM ID - CHRG ONLY,CDM Code,Outpatient,87077,$50.,$8.888,$47.5,$40.,$45.5,$13.1116,$47.5,$12.3695,$47.5,$47.5,$8.08,$34.125,$8.888,$46.
,CDM,4070004905.10.4070,ANAEROBIC ID,CDM Code,Outpatient,87076,$81.,$8.888,$76.95,$64.8,$73.71,$21.2409,$76.95,$20.0386,$76.95,$76.95,$8.08,$55.2825,$8.888,$74.52
,CDM,4070004910.10.4070,SENSITIVITY,CDM Code,Outpatient,87181,$29.,$5.225,$27.55,$23.2,$26.39,$7.6048,$27.55,$7.1743,$27.55,$27.55,$4.75,$19.7925,$5.225,$26.68
,CDM,4070004911.10.4070,KOH/WET MOUNT - CHRG ONLY,CDM Code,Outpatient,87210,$61.,$6.402,$57.95,$48.8,$55.51,$15.9962,$57.95,$15.0908,$57.95,$57.95,$5.82,$41.6325,$6.402,$56.12
,CDM,4070004915.10.4070,FUNGUS ID,CDM Code,Outpatient,87106,$102.,$11.352,$96.9,$81.6,$92.82,$26.7478,$96.9,$25.2338,$96.9,$96.9,$10.32,$69.615,$11.352,$93.84
,CDM,4070004917.10.4070,"STREP TYPE,MICRO",CDM Code,Outpatient,87147,$57.,$5.698,$54.15,$45.6,$51.87,$14.9473,$54.15,$14.1012,$54.15,$54.15,$5.18,$38.9025,$5.698,$52.44
,CDM,4070004920.10.4070,"GRAM STAIN, DIRECT - CHRG ONLY",CDM Code,Outpatient,87205,$26.,$4.697,$24.7,$20.8,$23.66,$6.8181,$24.7,$6.4321,$24.7,$24.7,$4.27,$17.745,$4.697,$23.92
,CDM,4070004959.10.4070,CULT GENITAL,CDM Code,Outpatient,87070,$99.,$9.482,$94.05,$79.2,$90.09,$25.9611,$94.05,$24.4916,$94.05,$94.05,$8.62,$67.5675,$9.482,$91.08
,CDM,4070005001.10.4070,ACTH-PLASMA,CDM Code,Outpatient,82024,$0.,$0.,$42.482,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$38.62,$0.,$42.482,$0.
,CDM,4070005002.10.4070,ADENOVIRUS ANTIBODY,CDM Code,Outpatient,86603,$33.,$8.1639,$31.35,$26.4,$30.03,$8.6537,$31.35,$8.1639,$31.35,$31.35,$12.87,$22.5225,$14.157,$30.36
,CDM,4070005005.10.4070,ALDOLASE OML,CDM Code,Outpatient,82085,$77.,$10.681,$73.15,$61.6,$70.07,$20.1919,$73.15,$19.049,$73.15,$73.15,$9.71,$52.5525,$10.681,$70.84
,CDM,4070005010.10.4070,"ALDOSTERONE,SERUM",CDM Code,Outpatient,82088,$62.,$15.3382,$58.9,$49.6,$56.42,$16.2584,$58.9,$15.3382,$58.9,$58.9,$40.75,$42.315,$44.825,$57.04
,CDM,4070005011.10.4070,CARDIOLIPIN AB EA IG,CDM Code,Outpatient,86147,$66.,$16.3277,$62.7,$52.8,$60.06,$17.3074,$62.7,$16.3277,$62.7,$62.7,$25.45,$45.045,$27.995,$60.72
,CDM,4070005013.10.4070,CARDIOLIPIN AB IGA,CDM Code,Outpatient,86147,$131.,$27.995,$124.45,$104.8,$119.21,$34.3525,$124.45,$32.4081,$124.45,$124.45,$25.45,$89.4075,$27.995,$120.52
,CDM,4070005014.10.4070,CARDIOLIPIN IGG&IGM,CDM Code,Outpatient,8614791,$124.,$30.6764,$117.8,$99.2,$112.84,$32.5169,$117.8,$30.6764,$117.8,$117.8,$25.45,$84.63,$109.12,$114.08
,CDM,4070005015.10.4070,ALDOSTERONE URINE REF,CDM Code,Outpatient,82088,$62.,$15.3382,$58.9,$49.6,$56.42,$16.2584,$58.9,$15.3382,$58.9,$58.9,$40.75,$42.315,$44.825,$57.04
,CDM,4070005016.10.4070,ALDOSTERONE/RENIN ACTIVITY,CDM Code,Outpatient,84244,$86.,$21.2755,$81.7,$68.8,$78.26,$22.552,$81.7,$21.2755,$81.7,$81.7,$21.99,$58.695,$24.189,$79.12
,CDM,4070005019.10.4070,ALKALINE PHOS ISOENZYMES,CDM Code,Outpatient,84080,$151.,$16.258,$143.45,$120.8,$137.41,$39.5972,$143.45,$37.3559,$143.45,$143.45,$14.78,$103.0575,$16.258,$138.92
,CDM,4070005020.10.4070,ALPHA 1 ANTITRYPSIN REF,CDM Code,Outpatient,82103,$96.,$14.784,$91.2,$76.8,$87.36,$25.1744,$91.2,$23.7494,$91.2,$91.2,$13.44,$65.52,$14.784,$88.32
,CDM,4070005021.10.4070,"AMPHETAMINES,CONFIRMATION",CDM Code,Outpatient,80324,$126.,$31.1711,$119.7,$100.8,$114.66,$33.0414,$119.7,$31.1711,$119.7,$119.7,$12.6,$85.995,$33.5,$115.92
,CDM,4070005022.10.4070,FUNGUS CULTURE - OML,CDM Code,Outpatient,87102,$46.,$9.251,$43.7,$36.8,$41.86,$12.0627,$43.7,$11.3799,$43.7,$43.7,$8.41,$31.395,$9.251,$42.32
,CDM,4070005024.10.4070,AMITRIPTYLINE,CDM Code,Outpatient,80335,$62.,$15.3382,$58.9,$49.6,$56.42,$16.2584,$58.9,$15.3382,$58.9,$58.9,$6.2,$42.315,$33.5,$57.04
,CDM,4070005025.10.4070,ALPHAFETOPROTEIN SERUM COMPLET,CDM Code,Outpatient,82105,$126.,$18.447,$119.7,$100.8,$114.66,$33.0414,$119.7,$31.1711,$119.7,$119.7,$16.77,$85.995,$18.447,$115.92
,CDM,4070005027.10.4070,ALPHA FETOPROTEIN,CDM Code,Outpatient,82105,$104.,$18.447,$98.8,$83.2,$94.64,$27.2722,$98.8,$25.7286,$98.8,$98.8,$16.77,$70.98,$18.447,$95.68
,CDM,4070005028.10.4070,AMIKACIN PEAK,CDM Code,Outpatient,80150,$72.,$16.588,$68.4,$57.6,$65.52,$18.8808,$68.4,$17.8121,$68.4,$68.4,$15.08,$49.14,$16.588,$66.24
,CDM,4070005029.10.4070,AMIKACIN TROUGH REF,CDM Code,Outpatient,80150,$72.,$16.588,$68.4,$57.6,$65.52,$18.8808,$68.4,$17.8121,$68.4,$68.4,$15.08,$49.14,$16.588,$66.24
,CDM,4070005035.10.4070,ANGIOTESIN CONVERT ENZYME,CDM Code,Outpatient,82164,$77.,$16.06,$73.15,$61.6,$70.07,$20.1919,$73.15,$19.049,$73.15,$73.15,$14.6,$52.5525,$16.06,$70.84
,CDM,4070005037.10.4070,AFB STAIN,CDM Code,Outpatient,87206,$57.,$5.929,$54.15,$45.6,$51.87,$14.9473,$54.15,$14.1012,$54.15,$54.15,$5.39,$38.9025,$5.929,$52.44
,CDM,4070005042.10.4070,TITER OF STREPTOZYME,CDM Code,Outpatient,86060,$67.,$8.03,$63.65,$53.6,$60.97,$17.5696,$63.65,$16.5751,$63.65,$63.65,$7.3,$45.7275,$8.03,$61.64
,CDM,4070005046.10.4070,SEX HORMONE BINDING HORMONE,CDM Code,Outpatient,84270,$134.,$23.903,$127.3,$107.2,$121.94,$35.1392,$127.3,$33.1503,$127.3,$127.3,$21.73,$91.455,$23.903,$123.28
,CDM,4070005047.10.4070,"HEPATITIS B VIRAL DNA, PCR",CDM Code,Outpatient,87517,$235.,$47.124,$223.25,$188.,$213.85,$61.6248,$223.25,$58.1367,$223.25,$223.25,$42.84,$160.3875,$47.124,$216.2
,CDM,4070005049.10.4070,THC CONFIRMATION,CDM Code,Outpatient,80349,$126.,$31.1711,$119.7,$100.8,$114.66,$33.0414,$119.7,$31.1711,$119.7,$119.7,$12.6,$85.995,$33.5,$115.92
,CDM,4070005050.10.4070,GLOMERULAR BASEMENT MEMBRANE,CDM Code,Outpatient,83516,$68.,$12.683,$64.6,$54.4,$61.88,$17.8318,$64.6,$16.8225,$64.6,$64.6,$11.53,$46.41,$12.683,$62.56
,CDM,4070005052.10.4070,BENZODIAZEPINES CONFIRMATION,CDM Code,Outpatient,80348,$126.,$31.1711,$119.7,$100.8,$114.66,$33.0414,$119.7,$31.1711,$119.7,$119.7,$12.6,$85.995,$110.88,$115.92
,CDM,4070005053.10.4070,DRUG SCREENING BARBITURATES,CDM Code,Outpatient,80345,$126.,$31.1711,$119.7,$100.8,$114.66,$33.0414,$119.7,$31.1711,$119.7,$119.7,$12.6,$85.995,$33.5,$115.92
,CDM,4070005054.10.4070,ANA TITER(REFLEX ONLY),CDM Code,Outpatient,86039,$115.,$12.276,$109.25,$92.,$104.65,$30.1568,$109.25,$28.4499,$109.25,$109.25,$11.16,$78.4875,$12.276,$105.8
,CDM,4070005055.10.4070,IMMUNOASSAY NONANTIBODY,CDM Code,Outpatient,83516,$130.,$12.683,$123.5,$104.,$118.3,$34.0903,$123.5,$32.1607,$123.5,$123.5,$11.53,$88.725,$12.683,$119.6
,CDM,4070005056.10.4070,ANA SCREEN,CDM Code,Outpatient,86038,$75.,$13.299,$71.25,$60.,$68.25,$19.6675,$71.25,$18.5542,$71.25,$71.25,$12.09,$51.1875,$13.299,$69.
,CDM,4070005058.10.4070,LIVER/KIDNEY MICROSOME ANTIBOD,CDM Code,Outpatient,86376,$65.,$16.005,$61.75,$52.,$59.15,$17.0451,$61.75,$16.0803,$61.75,$61.75,$14.55,$44.3625,$16.005,$59.8
,CDM,4070005060.10.4070,SMOOTH MUSCLE AB,CDM Code,Outpatient,86255,$132.,$22.1,$125.4,$105.6,$120.12,$34.6148,$125.4,$32.6555,$125.4,$125.4,$12.05,$90.09,$22.1,$121.44
,CDM,4070005062.10.4070,F/ STRIATED MUSCLE ANTIBODY IG,CDM Code,Outpatient,86255,$107.,$22.1,$101.65,$85.6,$97.37,$28.0589,$101.65,$26.4707,$101.65,$101.65,$12.05,$73.0275,$22.1,$98.44
,CDM,4070005063.10.4070,OPIATES CONFIRMATION,CDM Code,Outpatient,80361,$126.,$31.1711,$119.7,$100.8,$114.66,$33.0414,$119.7,$31.1711,$119.7,$119.7,$12.6,$85.995,$33.5,$115.92
,CDM,4070005064.10.4070,OXYCODONE CONFIRMATION,CDM Code,Outpatient,80365,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$33.5,$0.
,CDM,4070005065.10.4070,BETA 2 GLYCOPROTEIN,CDM Code,Outpatient,86146,$81.,$20.0386,$76.95,$64.8,$73.71,$21.2409,$76.95,$20.0386,$76.95,$76.95,$25.45,$55.2825,$27.995,$74.52
,CDM,4070005067.10.4070,ADAMTS13 ACTIVITY,CDM Code,Outpatient,85397,$199.,$33.946,$189.05,$159.2,$181.09,$52.1844,$189.05,$49.2306,$189.05,$189.05,$30.86,$135.8175,$33.946,$183.08
,CDM,4070005068.10.4070,ANTITHROMBIN 3 ACTIVITY,CDM Code,Outpatient,85300,$116.,$13.035,$110.2,$92.8,$105.56,$30.419,$110.2,$28.6972,$110.2,$110.2,$11.85,$79.17,$13.035,$106.72
,CDM,4070005070.10.4070,THYROID PEROXIDASE AB,CDM Code,Outpatient,86376,$90.,$16.005,$85.5,$72.,$81.9,$23.601,$85.5,$22.2651,$85.5,$85.5,$14.55,$61.425,$16.005,$82.8
,CDM,4070005072.10.4070,THYROGLOBULIN,CDM Code,Outpatient,84432,$99.,$17.666,$94.05,$79.2,$90.09,$25.9611,$94.05,$24.4916,$94.05,$94.05,$16.06,$67.5675,$17.666,$91.08
,CDM,4070005073.10.4070,"ARSENIC,BLOOD REF",CDM Code,Outpatient,82175,$133.,$20.867,$126.35,$106.4,$121.03,$34.877,$126.35,$32.9029,$126.35,$126.35,$18.97,$90.7725,$20.867,$122.36
,CDM,4070005074.10.4070,"ARSENIC, 24 HOUR URINE",CDM Code,Outpatient,82175,$70.,$17.3173,$66.5,$56.,$63.7,$18.3563,$66.5,$17.3173,$66.5,$66.5,$18.97,$47.775,$20.867,$64.4
,CDM,4070005079.10.4070,VITAMIN A LEVEL,CDM Code,Outpatient,84590,$62.,$12.771,$58.9,$49.6,$56.42,$16.2584,$58.9,$15.3382,$58.9,$58.9,$11.61,$42.315,$12.771,$57.04
,CDM,4070005082.10.4070,FACTOR(8) VIII ACTIVITY,CDM Code,Outpatient,85240,$109.,$19.69,$103.55,$87.2,$99.19,$28.5834,$103.55,$26.9655,$103.55,$103.55,$17.9,$74.3925,$19.69,$100.28
,CDM,4070005083.10.4070,BETA 2 MICROGLOBULIN,CDM Code,Outpatient,82232,$104.,$17.798,$98.8,$83.2,$94.64,$27.2722,$98.8,$25.7286,$98.8,$98.8,$16.18,$70.98,$17.798,$95.68
,CDM,4070005084.10.4070,"COENZYME Q10, TOTAL",CDM Code,Outpatient,82542,$299.,$26.499,$284.05,$239.2,$272.09,$78.4077,$284.05,$73.9696,$284.05,$284.05,$24.09,$204.0675,$26.499,$275.08
,CDM,4070005085.10.4070,APOLIPOPROTEIN A-1,CDM Code,Outpatient,82172,$102.,$23.199,$96.9,$81.6,$92.82,$26.7478,$96.9,$25.2338,$96.9,$96.9,$21.09,$69.615,$23.199,$93.84
,CDM,4070005086.10.4070,VITAMIN B1-WHOLE BLOOD,CDM Code,Outpatient,84425,$63.,$15.5856,$59.85,$50.4,$57.33,$16.5207,$59.85,$15.5856,$59.85,$59.85,$21.23,$42.9975,$23.353,$57.96
,CDM,4070005090.10.4070,CALCITONIN (OML),CDM Code,Outpatient,82308,$82.,$20.286,$77.9,$65.6,$74.62,$21.5031,$77.9,$20.286,$77.9,$77.9,$26.79,$55.965,$29.469,$75.44
,CDM,4070005092.10.4070,CARBOHYDRATE ANTIGEN 19-9 REF,CDM Code,Outpatient,86301,$129.,$22.891,$122.55,$103.2,$117.39,$33.8281,$122.55,$31.9133,$122.55,$122.55,$20.81,$88.0425,$22.891,$118.68
,CDM,4070005103.10.4070,PROSTATIC ACID PHOSPHATASE(PAP,CDM Code,Outpatient,84066,$49.,$10.626,$46.55,$39.2,$44.59,$12.8494,$46.55,$12.1221,$46.55,$46.55,$9.66,$33.4425,$10.626,$45.08
,CDM,4070005104.10.4070,17 HYDROXYPROGESTERONE,CDM Code,Outpatient,83498,$121.,$29.887,$114.95,$96.8,$110.11,$31.7302,$114.95,$29.9342,$114.95,$114.95,$27.17,$82.5825,$29.887,$111.32
,CDM,4070005105.10.4070,"CATECHOLAMINES, FRACTIONATED",CDM Code,Outpatient,82384,$126.,$27.775,$119.7,$100.8,$114.66,$33.0414,$119.7,$31.1711,$119.7,$119.7,$25.25,$85.995,$27.775,$115.92
,CDM,4070005107.10.4070,DRUG SCRN QUAN MYCOPHENOLATE,CDM Code,Outpatient,80180,$136.,$19.855,$129.2,$108.8,$123.76,$35.6637,$129.2,$33.645,$129.2,$129.2,$18.05,$92.82,$19.855,$125.12
,CDM,4070005108.10.4070,THEOPHYLLINE(AMINOPHYLLINE),CDM Code,Outpatient,80198,$128.,$15.554,$121.6,$102.4,$116.48,$33.5658,$121.6,$31.6659,$121.6,$121.6,$14.14,$87.36,$15.554,$117.76
,CDM,4070005109.10.4070,HIGH SENSITIVITY CRP REF,CDM Code,Outpatient,86141,$0.,$0.,$14.245,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$12.95,$0.,$14.245,$0.
,CDM,4070005110.10.4070,NEISSERIA TMA AMP,CDM Code,Outpatient,87591,$217.,$38.599,$206.15,$173.6,$197.47,$56.9046,$206.15,$53.6836,$206.15,$206.15,$128.5338,$148.1025,$38.599,$199.64
,CDM,4070005113.10.4070,C1 ESTERASE INHIBITOR FUNCTION,CDM Code,Outpatient,86161,$58.,$13.2,$55.1,$46.4,$52.78,$15.2095,$55.1,$14.3486,$55.1,$55.1,$12.,$39.585,$13.2,$53.36
,CDM,4070005114.10.4070,C 1 ESTERASE INHIBITOR TOTAL,CDM Code,Outpatient,86160,$74.,$13.2,$70.3,$59.2,$67.34,$19.4052,$70.3,$18.3069,$70.3,$70.3,$12.,$50.505,$13.2,$68.08
,CDM,4070005115.10.4070,"C1 ESTERASE INHIBITOR, TOTAL",CDM Code,Outpatient,86160,$81.,$13.2,$76.95,$64.8,$73.71,$21.2409,$76.95,$20.0386,$76.95,$76.95,$12.,$55.2825,$13.2,$74.52
,CDM,4070005118.10.4070,CYTOMEGALOVIRUS IGG,CDM Code,Outpatient,86644,$81.,$15.829,$76.95,$64.8,$73.71,$21.2409,$76.95,$20.0386,$76.95,$76.95,$14.39,$55.2825,$15.829,$74.52
,CDM,4070005120.10.4070,CERULOPLASMIN REF,CDM Code,Outpatient,82390,$102.,$11.814,$96.9,$81.6,$92.82,$26.7478,$96.9,$25.2338,$96.9,$96.9,$10.74,$69.615,$11.814,$93.84
,CDM,4070005121.10.4070,"METANEPHRINES, TOTAL URINE",CDM Code,Outpatient,83835,$0.,$0.,$18.634,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$16.94,$0.,$18.634,$0.
,CDM,4070005122.10.4070,CHLAMYDIA ANTIBODY IGM,CDM Code,Outpatient,86632,$63.,$13.948,$59.85,$50.4,$57.33,$16.5207,$59.85,$15.5856,$59.85,$59.85,$46.458,$42.9975,$13.948,$57.96
,CDM,4070005124.10.4070,CYCLIC CITRULLINATED PEPTIDE I,CDM Code,Outpatient,86200,$80.,$14.245,$76.,$64.,$72.8,$20.9786,$76.,$19.7912,$76.,$76.,$12.95,$54.6,$14.245,$73.6
,CDM,4070005126.10.4070,CHLAMYDIA ANTIBODY IGG,CDM Code,Outpatient,86631,$58.,$13.002,$55.1,$46.4,$52.78,$15.2095,$55.1,$14.3486,$55.1,$55.1,$43.3074,$39.585,$13.002,$53.36
,CDM,4070005127.10.4070,CHLAMYDIA DNA PROBE,CDM Code,Outpatient,87491,$122.,$30.1816,$128.5338,$97.6,$111.02,$31.9924,$115.9,$30.1816,$115.9,$115.9,$128.5338,$83.265,$38.599,$112.24
,CDM,4070005132.10.4070,GC DNA PROBE,CDM Code,Outpatient,87591,$122.,$30.1816,$128.5338,$97.6,$111.02,$31.9924,$115.9,$30.1816,$115.9,$115.9,$128.5338,$83.265,$38.599,$112.24
,CDM,4070005134.10.4070,BRCA1 2 SEQ   FULL DUP/DEL,CDM Code,Outpatient,81162,"$2,817.",$696.8976,"$6,683.7042","$2,253.6","$2,563.47",$738.7104,"$2,676.15",$696.8976,"$2,676.15","$2,676.15","$6,683.7042","$1,922.6025","$2,007.368","$2,591.64"
,CDM,4070005135.10.4070,HLA II TYPING 1 LOC HR,CDM Code,Outpatient,81382,$458.,$113.3046,$452.9922,$366.4,$416.78,$120.1027,$435.1,$113.3046,$435.1,$435.1,$452.9922,$312.585,$136.048,$421.36
,CDM,4070005151.10.4070,C 3 COMPLEMENT REF,CDM Code,Outpatient,8616091,$77.,$19.049,$73.15,$61.6,$70.07,$20.1919,$73.15,$19.049,$73.15,$73.15,$12.,$52.5525,$67.76,$70.84
,CDM,4070005152.10.4070,C 4 COMPLEMENT REF,CDM Code,Outpatient,86160,$77.,$13.2,$73.15,$61.6,$70.07,$20.1919,$73.15,$19.049,$73.15,$73.15,$12.,$52.5525,$13.2,$70.84
,CDM,4070005153.10.4070,COMPLEMENT C1Q,CDM Code,Outpatient,86160,$81.,$13.2,$76.95,$64.8,$73.71,$21.2409,$76.95,$20.0386,$76.95,$76.95,$12.,$55.2825,$13.2,$74.52
,CDM,4070005154.10.4070,COLD AGGLUTININ,CDM Code,Outpatient,86157,$58.,$8.866,$55.1,$46.4,$52.78,$15.2095,$55.1,$14.3486,$55.1,$55.1,$8.06,$39.585,$8.866,$53.36
,CDM,4070005155.10.4070,CH 50 COMPLEMENT,CDM Code,Outpatient,86162,$156.,$22.352,$148.2,$124.8,$141.96,$40.9083,$148.2,$38.5928,$148.2,$148.2,$20.32,$106.47,$22.352,$143.52
,CDM,4070005156.10.4070,"CITRIC ACID ,URINE",CDM Code,Outpatient,82507,$41.,$10.143,$38.95,$32.8,$37.31,$10.7516,$38.95,$10.143,$38.95,$38.95,$27.8,$27.9825,$30.58,$37.72
,CDM,4070005161.10.4070,"COPPER, SERUM (OML)",CDM Code,Outpatient,82525,$45.,$11.1326,$42.75,$36.,$40.95,$11.8005,$42.75,$11.1326,$42.75,$42.75,$12.41,$30.7125,$13.651,$41.4
,CDM,4070005168.10.4070,"CORTISOL,URINARY FREE, 24 HR",CDM Code,Outpatient,82530,$143.,$18.381,$135.85,$114.4,$130.13,$37.4993,$135.85,$35.3768,$135.85,$135.85,$16.71,$97.5975,$18.381,$131.56
,CDM,4070005172.10.4070,CANCER ANTIGEN 27-29,CDM Code,Outpatient,86300,$129.,$22.891,$122.55,$103.2,$117.39,$33.8281,$122.55,$31.9133,$122.55,$122.55,$20.81,$88.0425,$22.891,$118.68
,CDM,4070005177.10.4070,FACTOR V LEIDEN REF,CDM Code,Outpatient,81241,$377.,$80.707,$358.15,$301.6,$343.07,$98.8618,$358.15,$93.266,$358.15,$358.15,$223.7991,$257.3025,$80.707,$346.84
,CDM,4070005179.10.4070,"CRYOGLOBULINS,QUALITATIVE",CDM Code,Outpatient,82595,$57.,$7.117,$54.15,$45.6,$51.87,$14.9473,$54.15,$14.1012,$54.15,$54.15,$6.47,$38.9025,$7.117,$52.44
,CDM,4070005181.10.4070,CRYPTOCOCCUS ANTIGEN CSF,CDM Code,Outpatient,86403,$81.,$12.694,$76.95,$64.8,$73.71,$21.2409,$76.95,$20.0386,$76.95,$76.95,$11.54,$55.2825,$12.694,$74.52
,CDM,4070005185.10.4070,CHLAMYDIA CULTURE,CDM Code,Outpatient,87140,$84.,$6.127,$79.8,$67.2,$76.44,$22.0276,$79.8,$20.7808,$79.8,$79.8,$5.57,$57.33,$6.127,$77.28
,CDM,4070005186.10.4070,CRYPTOSPORIDUIM SMEAR,CDM Code,Outpatient,87272,$77.,$13.178,$73.15,$61.6,$70.07,$20.1919,$73.15,$19.049,$73.15,$73.15,$11.98,$52.5525,$13.178,$70.84
,CDM,4070005187.10.4070,STOOL FOR HELICOBACTER PYLORI,CDM Code,Outpatient,87338,$89.,$15.818,$84.55,$71.2,$80.99,$23.3387,$84.55,$22.0177,$84.55,$84.55,$14.38,$60.7425,$15.818,$81.88
,CDM,4070005188.10.4070,CYCLOSPORINE-UW,CDM Code,Outpatient,80158,$146.,$19.855,$138.7,$116.8,$132.86,$38.286,$138.7,$36.1189,$138.7,$138.7,$18.05,$99.645,$19.855,$134.32
,CDM,4070005189.10.4070,CYCLOSPORINE (SANDIMMUNE),CDM Code,Outpatient,80158,$141.,$19.855,$133.95,$112.8,$128.31,$36.9749,$133.95,$34.882,$133.95,$133.95,$18.05,$96.2325,$19.855,$129.72
,CDM,4070005194.10.4070,CMV BY PCR (OML),CDM Code,Outpatient,87496,$361.,$38.599,$342.95,$288.8,$328.51,$94.6661,$342.95,$89.3078,$342.95,$342.95,$35.09,$246.3825,$38.599,$332.12
,CDM,4070005195.10.4070,CYTOMEGALOVIRUS IGM,CDM Code,Outpatient,86645,$81.,$18.535,$76.95,$64.8,$73.71,$21.2409,$76.95,$20.0386,$76.95,$76.95,$16.85,$55.2825,$18.535,$74.52
,CDM,4070005196.10.4070,CHROMOGRANIN A,CDM Code,Outpatient,86316,$92.,$22.7599,$87.4,$73.6,$83.72,$24.1254,$87.4,$22.7599,$87.4,$87.4,$20.81,$62.79,$22.891,$84.64
,CDM,4070005203.10.4070,DHEA SERUM,CDM Code,Outpatient,82626,$156.,$27.797,$148.2,$124.8,$141.96,$40.9083,$148.2,$38.5928,$148.2,$148.2,$25.27,$106.47,$27.797,$143.52
,CDM,4070005204.10.4070,RUSSELL VIPER VENOM,CDM Code,Outpatient,85613,$88.,$10.538,$83.6,$70.4,$80.08,$23.0765,$83.6,$21.7703,$83.6,$83.6,$9.58,$60.06,$10.538,$80.96
,CDM,4070005205.10.4070,DHEA SULFATE,CDM Code,Outpatient,82627,$137.,$24.453,$130.15,$109.6,$124.67,$35.9259,$130.15,$33.8924,$130.15,$130.15,$22.23,$93.5025,$24.453,$126.04
,CDM,4070005213.10.4070,MECONIUM DRUG SCREEN,CDM Code,Outpatient,80307,$130.,$32.1607,$123.5,$104.,$118.3,$34.0903,$123.5,$32.1607,$123.5,$123.5,$62.14,$88.725,$68.354,$119.6
,CDM,4070005218.10.4070,DOUBLE STRANDED DNA,CDM Code,Outpatient,86225,$99.,$15.114,$94.05,$79.2,$90.09,$25.9611,$94.05,$24.4916,$94.05,$94.05,$13.74,$67.5675,$15.114,$91.08
,CDM,4070005219.10.4070,"SODIUM, BODY FLUID",CDM Code,Outpatient,84300,$39.,$5.566,$37.05,$31.2,$35.49,$10.2271,$37.05,$9.6482,$37.05,$37.05,$5.06,$26.6175,$5.566,$35.88
,CDM,4070005220.10.4070,"POTASSIUM, BODY FLUID",CDM Code,Outpatient,84133,$39.,$5.203,$37.05,$31.2,$35.49,$10.2271,$37.05,$9.6482,$37.05,$37.05,$4.73,$26.6175,$5.203,$35.88
,CDM,4070005221.10.4070,"CHLORIDE, BODY FLUID",CDM Code,Outpatient,82438,$45.,$5.5,$42.75,$36.,$40.95,$11.8005,$42.75,$11.1326,$42.75,$42.75,$5.,$30.7125,$5.5,$41.4
,CDM,4070005222.10.4070,"OSMOLALITY, BODY FLUID",CDM Code,Outpatient,83930,$60.,$7.271,$57.,$48.,$54.6,$15.734,$57.,$14.8434,$57.,$57.,$6.61,$40.95,$7.271,$55.2
,CDM,4070005227.10.4070,ENDOMYSIAL ANTIBODY IGA,CDM Code,Outpatient,86256,$121.,$22.1,$114.95,$96.8,$110.11,$31.7302,$114.95,$29.9342,$114.95,$114.95,$12.05,$82.5825,$22.1,$111.32
,CDM,4070005231.10.4070,"HEPARIN,LMW",CDM Code,Outpatient,85520,$81.,$14.399,$76.95,$64.8,$73.71,$21.2409,$76.95,$20.0386,$76.95,$76.95,$13.09,$55.2825,$14.399,$74.52
,CDM,4070005232.10.4070,OPIOIDS SCREEN URINE QUANT,CDM Code,Outpatient,80356,$347.,$33.5,$329.65,$277.6,$315.77,$90.9949,$329.65,$85.8443,$329.65,$329.65,$34.7,$236.8275,$33.5,$319.24
,CDM,4070005233.10.4070,METHADONE CONFIRM,CDM Code,Outpatient,80358,$126.,$31.1711,$119.7,$100.8,$114.66,$33.0414,$119.7,$31.1711,$119.7,$119.7,$12.6,$85.995,$33.5,$115.92
,CDM,4070005234.10.4070,ERYTHROPOIETIN LEVEL,CDM Code,Outpatient,82668,$135.,$20.669,$128.25,$108.,$122.85,$35.4015,$128.25,$33.3976,$128.25,$128.25,$18.79,$92.1375,$20.669,$124.2
,CDM,4070005235.10.4070,ASSAY OF ESTRADIOL,CDM Code,Outpatient,82670,$172.,$30.734,$163.4,$137.6,$156.52,$45.1041,$163.4,$42.5511,$163.4,$163.4,$27.94,$117.39,$30.734,$158.24
,CDM,4070005240.10.4070,ESTRIOL REF,CDM Code,Outpatient,82677,$126.,$26.598,$119.7,$100.8,$114.66,$33.0414,$119.7,$31.1711,$119.7,$119.7,$24.18,$85.995,$26.598,$115.92
,CDM,4070005241.10.4070,TB TEST CELL IMMUN MEASURE,CDM Code,Outpatient,86480,$383.,$68.178,$363.85,$306.4,$348.53,$100.4352,$363.85,$94.7504,$363.85,$363.85,$61.98,$261.3975,$68.178,$352.36
,CDM,4070005265.10.4070,FLUORESCENT TREPONOMAL AB,CDM Code,Outpatient,86780,$82.,$14.564,$77.9,$65.6,$74.62,$21.5031,$77.9,$20.286,$77.9,$77.9,$48.4872,$55.965,$14.564,$75.44
,CDM,4070005268.10.4070,PHOSPHATIDYL GLYCEROL,CDM Code,Outpatient,84081,$74.5,$18.172,$70.775,$59.6,$67.795,$19.5364,$70.775,$18.4306,$70.775,$70.775,$16.52,$50.8462,$18.172,$68.54
,CDM,4070005270.10.4070,GASTRIN (OML),CDM Code,Outpatient,82941,$92.,$19.393,$87.4,$73.6,$83.72,$24.1254,$87.4,$22.7599,$87.4,$87.4,$17.63,$62.79,$19.393,$84.64
,CDM,4070005271.10.4070,ASSAY OF G6PD ENZYME,CDM Code,Outpatient,82955,$58.,$10.67,$55.1,$46.4,$52.78,$15.2095,$55.1,$14.3486,$55.1,$55.1,$9.7,$39.585,$10.67,$53.36
,CDM,4070005272.10.4070,GIARDIA LAMBLIA STOOL EIA,CDM Code,Outpatient,87329,$74.,$13.178,$70.3,$59.2,$67.34,$19.4052,$70.3,$18.3069,$70.3,$70.3,$11.98,$50.505,$13.178,$68.08
,CDM,4070005274.10.4070,GIARDIA SERUM ANTIBODIES,CDM Code,Outpatient,86674,$49.,$12.1221,$46.55,$39.2,$44.59,$12.8494,$46.55,$12.1221,$46.55,$46.55,$14.72,$33.4425,$16.192,$45.08
,CDM,4070005275.10.4070,GROWTH HORMONE OML,CDM Code,Outpatient,83003,$119.,$18.337,$113.05,$95.2,$108.29,$31.2057,$113.05,$29.4394,$113.05,$113.05,$16.67,$81.2175,$18.337,$109.48
,CDM,4070005277.10.4070,GLIADIN ABS (IGG&IGA),CDM Code,Outpatient,83516,$199.,$12.683,$189.05,$159.2,$181.09,$52.1844,$189.05,$49.2306,$189.05,$189.05,$11.53,$135.8175,$12.683,$183.08
,CDM,4070005278.10.4070,HELICOBACTER PYLORI G,CDM Code,Outpatient,86677,$78.,$18.535,$74.1,$62.4,$70.98,$20.4542,$74.1,$19.2964,$74.1,$74.1,$16.85,$53.235,$18.535,$71.76
,CDM,4070005279.10.4070,HAPTOGLOBIN REF,CDM Code,Outpatient,83010,$78.,$13.838,$74.1,$62.4,$70.98,$20.4542,$74.1,$19.2964,$74.1,$74.1,$12.58,$53.235,$13.838,$71.76
,CDM,4070005280.10.4070,HEAVY METAL SCREEN BLOOD,CDM Code,Outpatient,83015,$0.,$0.,$23.034,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$20.94,$0.,$23.034,$0.
,CDM,4070005283.10.4070,OPIOIDS & OPIATE ANALOGS 1/2,CDM Code,Outpatient,80362,$193.,$33.5,$183.35,$154.4,$175.63,$50.611,$183.35,$47.7463,$183.35,$183.35,$19.3,$131.7225,$33.5,$177.56
,CDM,4070005295.10.4070,TRILEPTAL,CDM Code,Outpatient,82542,$147.,$26.499,$139.65,$117.6,$133.77,$38.5483,$139.65,$36.3663,$139.65,$139.65,$24.09,$100.3275,$26.499,$135.24
,CDM,4070005296.10.4070,HEMOCHROMATOSIS MUTATION ANALY,CDM Code,Outpatient,81256,$365.,$71.896,$346.75,$292.,$332.15,$95.715,$346.75,$90.2973,$346.75,$346.75,$239.3922,$249.1125,$71.896,$335.8
,CDM,4070005297.10.4070,DRUG SCRN QUAN LEVETIRACETAM,CDM Code,Outpatient,80177,$82.,$14.575,$77.9,$65.6,$74.62,$21.5031,$77.9,$20.286,$77.9,$77.9,$13.25,$55.965,$14.575,$75.44
,CDM,4070005304.10.4070,HEPATITIS A AB TOTAL,CDM Code,Outpatient,86708,$76.,$13.629,$72.2,$60.8,$69.16,$19.9297,$72.2,$18.8016,$72.2,$72.2,$12.39,$51.87,$13.629,$69.92
,CDM,4070005305.10.4070,HEPATITIS B CORE AB TOTAL,CDM Code,Outpatient,86704,$74.,$13.255,$70.3,$59.2,$67.34,$19.4052,$70.3,$18.3069,$70.3,$70.3,$12.05,$50.505,$13.255,$68.08
,CDM,4070005306.10.4070,HEPATITIS BE ANTIBODY,CDM Code,Outpatient,86707,$75.,$12.727,$71.25,$60.,$68.25,$19.6675,$71.25,$18.5542,$71.25,$71.25,$11.57,$51.1875,$12.727,$69.
,CDM,4070005307.10.4070,HEPATITIS BE ANTIGEN,CDM Code,Outpatient,87350,$68.,$12.683,$64.6,$54.4,$61.88,$17.8318,$64.6,$16.8225,$64.6,$64.6,$11.53,$46.41,$12.683,$62.56
,CDM,4070005308.10.4070,HEPATITIS C ANTIBODY,CDM Code,Outpatient,86803,$88.,$15.697,$83.6,$70.4,$80.08,$23.0765,$83.6,$21.7703,$83.6,$83.6,$14.27,$60.06,$15.697,$80.96
,CDM,4070005309.10.4070,HEPATITIS C REVRS TRNSCRPJ,CDM Code,Outpatient,87522,$264.,$47.124,$250.8,$211.2,$240.24,$69.2295,$250.8,$65.311,$250.8,$250.8,$42.84,$180.18,$47.124,$242.88
,CDM,4070005310.10.4070,HBSAB,CDM Code,Outpatient,86706,$66.,$11.814,$62.7,$52.8,$60.06,$17.3074,$62.7,$16.3277,$62.7,$62.7,$10.74,$45.045,$11.814,$60.72
,CDM,4070005311.10.4070,VARICELLA ZOSTER PCR,CDM Code,Outpatient,87798,$305.,$38.599,$289.75,$244.,$277.55,$79.9811,$289.75,$75.454,$289.75,$289.75,$35.09,$208.1625,$38.599,$280.6
,CDM,4070005312.10.4070,HEP B S AG,CDM Code,Outpatient,87340,$64.,$11.363,$60.8,$51.2,$58.24,$16.7829,$60.8,$15.833,$60.8,$60.8,$10.33,$43.68,$11.363,$58.88
,CDM,4070005313.10.4070,HERPES SIMPLEX TYPE 2,CDM Code,Outpatient,86696,$120.,$21.285,$114.,$96.,$109.2,$31.468,$114.,$29.6868,$114.,$114.,$19.35,$81.9,$21.285,$110.4
,CDM,4070005315.10.4070,HERPES SIMPLEX 1/2 PCR,CDM Code,Outpatient,87529,$217.,$38.599,$206.15,$173.6,$197.47,$56.9046,$206.15,$53.6836,$206.15,$206.15,$35.09,$148.1025,$38.599,$199.64
,CDM,4070005317.10.4070,HEPATITIS A AB IGM,CDM Code,Outpatient,86709,$70.,$12.386,$66.5,$56.,$63.7,$18.3563,$66.5,$17.3173,$66.5,$66.5,$11.26,$47.775,$12.386,$64.4
,CDM,4070005319.10.4070,HERPES SIMPLEX TYPE 1,CDM Code,Outpatient,86695,$81.,$14.509,$76.95,$64.8,$73.71,$21.2409,$76.95,$20.0386,$76.95,$76.95,$13.19,$55.2825,$14.509,$74.52
,CDM,4070005320.10.4070,5-HIAA,CDM Code,Outpatient,83497,$89.,$14.19,$84.55,$71.2,$80.99,$23.3387,$84.55,$22.0177,$84.55,$84.55,$12.9,$60.7425,$14.19,$81.88
,CDM,4070005329.10.4070,WESTERN BLOT HIV,CDM Code,Outpatient,86689,$137.,$21.285,$130.15,$109.6,$124.67,$35.9259,$130.15,$33.8924,$130.15,$130.15,$19.35,$93.5025,$21.285,$126.04
,CDM,4070005330.10.4070,HIV 1/2 AG/AB RFLX TO MUTISPOT,CDM Code,Outpatient,86703,$92.,$15.081,$87.4,$73.6,$83.72,$24.1254,$87.4,$22.7599,$87.4,$87.4,$13.71,$62.79,$15.081,$84.64
,CDM,4070005332.10.4070,"HIV,RNA QUANT. BY PCR",CDM Code,Outpatient,87536,$548.,$93.61,$520.6,$438.4,$498.68,$143.7037,$520.6,$135.5697,$520.6,$520.6,$85.1,$374.01,$93.61,$504.16
,CDM,4070005335.10.4070,HLA B27,CDM Code,Outpatient,86812,$153.,$28.391,$145.35,$122.4,$139.23,$40.1216,$145.35,$37.8507,$145.35,$145.35,$25.81,$104.4225,$28.391,$140.76
,CDM,4070005336.10.4070,IMMUNOGLOBULIN A (IGA),CDM Code,Outpatient,82784,$57.,$10.23,$54.15,$45.6,$51.87,$14.9473,$54.15,$14.1012,$54.15,$54.15,$9.3,$38.9025,$10.23,$52.44
,CDM,4070005337.10.4070,IMMUNOGLOBULIN G,CDM Code,Outpatient,82784,$101.,$10.23,$95.95,$80.8,$91.91,$26.4855,$95.95,$24.9864,$95.95,$95.95,$9.3,$68.9325,$10.23,$92.92
,CDM,4070005338.10.4070,IMMUNOGLOBULIN M REF,CDM Code,Outpatient,82784,$87.,$10.23,$82.65,$69.6,$79.17,$22.8143,$82.65,$21.5229,$82.65,$82.65,$9.3,$59.3775,$10.23,$80.04
,CDM,4070005340.10.4070,SM ANTIBODIES,CDM Code,Outpatient,86235,$109.,$19.723,$103.55,$87.2,$99.19,$28.5834,$103.55,$26.9655,$103.55,$103.55,$17.93,$74.3925,$19.723,$100.28
,CDM,4070005341.10.4070,17-OH-PROGESTERONE URINE,CDM Code,Outpatient,83498,$91.,$22.5125,$86.45,$72.8,$82.81,$23.8632,$86.45,$22.5125,$86.45,$86.45,$27.17,$62.1075,$29.887,$83.72
,CDM,4070005344.10.4070,HOMOCYSTINE REF,CDM Code,Outpatient,83090,$104.,$19.712,$98.8,$83.2,$94.64,$27.2722,$98.8,$25.7286,$98.8,$98.8,$17.92,$70.98,$19.712,$95.68
,CDM,4070005347.10.4070,RIBOSOMAL P,CDM Code,Outpatient,86235,$109.,$19.723,$103.55,$87.2,$99.19,$28.5834,$103.55,$26.9655,$103.55,$103.55,$17.93,$74.3925,$19.723,$100.28
,CDM,4070005354.10.4070,IMMUNOELECTROPHORES & UPEP URI,CDM Code,Outpatient,86335,$125.,$22.1,$118.75,$100.,$113.75,$32.7791,$118.75,$30.9237,$118.75,$118.75,$29.35,$85.3125,$22.1,$115.
,CDM,4070005357.10.4070,IGE,CDM Code,Outpatient,82785,$39.,$9.6482,$37.05,$31.2,$35.49,$10.2271,$37.05,$9.6482,$37.05,$37.05,$16.46,$26.6175,$18.106,$35.88
,CDM,4070005360.10.4070,INSULIN REF,CDM Code,Outpatient,83525,$68.,$12.573,$64.6,$54.4,$61.88,$17.8318,$64.6,$16.8225,$64.6,$64.6,$11.43,$46.41,$12.573,$62.56
,CDM,4070005361.10.4070,IMMUNOFIXATION SERUM,CDM Code,Outpatient,86334,$138.,$22.1,$131.1,$110.4,$125.58,$36.1882,$131.1,$34.1398,$131.1,$131.1,$22.34,$94.185,$22.1,$126.96
,CDM,4070005362.10.4070,IGG SUBCLASSES OML,CDM Code,Outpatient,82787,$104.,$8.822,$98.8,$83.2,$94.64,$27.2722,$98.8,$25.7286,$98.8,$98.8,$8.02,$70.98,$8.822,$95.68
,CDM,4070005364.10.4070,INSULIN GROWTH FACTOR BP3,CDM Code,Outpatient,83519,$128.,$20.24,$121.6,$102.4,$116.48,$33.5658,$121.6,$31.6659,$121.6,$121.6,$18.4,$87.36,$20.24,$117.76
,CDM,4070005380.10.4070,LEAD QUANTITATIVE,CDM Code,Outpatient,83655,$63.,$13.321,$59.85,$50.4,$57.33,$16.5207,$59.85,$15.5856,$59.85,$59.85,$12.11,$42.9975,$13.321,$57.96
,CDM,4070005388.10.4070,GLUCAGON,CDM Code,Outpatient,82943,$83.,$15.719,$78.85,$66.4,$75.53,$21.7653,$78.85,$20.5334,$78.85,$78.85,$14.29,$56.6475,$15.719,$76.36
,CDM,4070005390.10.4070,"LEGIONELLA AB, IGM",CDM Code,Outpatient,86713,$49.,$12.1221,$46.55,$39.2,$44.59,$12.8494,$46.55,$12.1221,$46.55,$46.55,$15.3,$33.4425,$16.83,$45.08
,CDM,4070005393.10.4070,DRUG SCRN QUAN LAMOTRIGINE,CDM Code,Outpatient,80175,$82.,$14.575,$77.9,$65.6,$74.62,$21.5031,$77.9,$20.286,$77.9,$77.9,$13.25,$55.965,$14.575,$75.44
,CDM,4070005394.10.4070,HEPATITIS ACUTE ABC PANEL,CDM Code,Outpatient,80074,$294.,$52.393,$279.3,$235.2,$267.54,$77.0965,$279.3,$72.7327,$279.3,$279.3,$47.63,$200.655,$52.393,$270.48
,CDM,4070005395.10.4070,JAK2 MUTATION,CDM Code,Outpatient,81270,$566.,$100.826,$537.7,$452.8,$515.06,$148.4239,$537.7,$140.0227,$537.7,$537.7,$335.7258,$386.295,$100.826,$520.72
,CDM,4070005396.10.4070,"NMR LIPOPROFILE, PARTICLE COUN",CDM Code,Outpatient,83704,$195.,$37.609,$185.25,$156.,$177.45,$51.1354,$185.25,$48.2411,$185.25,$185.25,$34.19,$133.0875,$37.609,$179.4
,CDM,4070005397.10.4070,APOLIPOPROTEIN B 100,CDM Code,Outpatient,82172,$102.,$23.199,$96.9,$81.6,$92.82,$26.7478,$96.9,$25.2338,$96.9,$96.9,$21.09,$69.615,$23.199,$93.84
,CDM,4070005399.10.4070,HEPATITIS B CORE AB IGM,CDM Code,Outpatient,86705,$102.,$12.947,$96.9,$81.6,$92.82,$26.7478,$96.9,$25.2338,$96.9,$96.9,$11.77,$69.615,$12.947,$93.84
,CDM,4070005400.10.4070,NW MICRO ID/SENSITIVITY,CDM Code,Outpatient,87077,$75.,$8.888,$71.25,$60.,$68.25,$19.6675,$71.25,$18.5542,$71.25,$71.25,$8.08,$51.1875,$8.888,$69.
,CDM,4070005401.10.4070,KAPPA/LAMBDA LIGHT CHAINS,CDM Code,Outpatient,8388391,$114.,$28.2025,$108.3,$91.2,$103.74,$29.8946,$108.3,$28.2025,$108.3,$108.3,$13.6,$77.805,$100.32,$104.88
,CDM,4070005403.10.4070,LUPUS TYPE ANTICOAGULANT,CDM Code,Outpatient,85705,$86.,$10.593,$81.7,$68.8,$78.26,$22.552,$81.7,$21.2755,$81.7,$81.7,$9.63,$58.695,$10.593,$79.12
,CDM,4070005406.10.4070,LYME DISEASE ANTIBODY,CDM Code,Outpatient,86618,$65.,$16.0803,$61.75,$52.,$59.15,$17.0451,$61.75,$16.0803,$61.75,$61.75,$17.03,$44.3625,$18.733,$59.8
,CDM,4070005406.20.4070,LYME DISEASE ANTIBODY,CDM Code,Outpatient,86618,$61.,$15.0908,$57.95,$48.8,$55.51,$15.9962,$57.95,$15.0908,$57.95,$57.95,$17.03,$41.6325,$18.733,$56.12
,CDM,4070005406.30.4070,LYME DISEASE ANTIBODY,CDM Code,Outpatient,86618,$61.,$15.0908,$57.95,$48.8,$55.51,$15.9962,$57.95,$15.0908,$57.95,$57.95,$17.03,$41.6325,$18.733,$56.12
,CDM,4070005406.82.4070,LYME DISEASE ANTIBODY,CDM Code,Outpatient,86618,$61.,$15.0908,$57.95,$48.8,$55.51,$15.9962,$57.95,$15.0908,$57.95,$57.95,$17.03,$41.6325,$18.733,$56.12
,CDM,4070005406.83.4070,LYME DISEASE ANTIBODY,CDM Code,Outpatient,86618,$61.,$15.0908,$57.95,$48.8,$55.51,$15.9962,$57.95,$15.0908,$57.95,$57.95,$17.03,$41.6325,$18.733,$56.12
,CDM,4070005407.10.4070,MALARIA SMEAR NWRL,CDM Code,Outpatient,87207,$62.,$15.3382,$58.9,$49.6,$56.42,$16.2584,$58.9,$15.3382,$58.9,$58.9,$5.99,$42.315,$22.1,$57.04
,CDM,4070005410.10.4070,"CATECHOLAMINES,URINE FRACTON",CDM Code,Outpatient,82384,$126.,$27.775,$119.7,$100.8,$114.66,$33.0414,$119.7,$31.1711,$119.7,$119.7,$25.25,$85.995,$27.775,$115.92
,CDM,4070005412.10.4070,"N-TELOPEPTIDE,CROSS-LINK",CDM Code,Outpatient,82523,$162.,$20.548,$153.9,$129.6,$147.42,$42.4817,$153.9,$40.0772,$153.9,$153.9,$18.68,$110.565,$20.548,$149.04
,CDM,4070005414.10.4070,MERCURY BLOOD LEVEL,CDM Code,Outpatient,83825,$111.,$17.886,$105.45,$88.8,$101.01,$29.1079,$105.45,$27.4603,$105.45,$105.45,$16.26,$75.7575,$17.886,$102.12
,CDM,4070005416.10.4070,"METANEPHRINE,PLASMA",CDM Code,Outpatient,83835,$285.,$18.634,$270.75,$228.,$259.35,$74.7364,$270.75,$70.5062,$270.75,$270.75,$16.94,$194.5125,$18.634,$262.2
,CDM,4070005417.10.4070,MUMPS VIRUS ANTIBODY IGG,CDM Code,Outpatient,86735,$81.,$14.355,$76.95,$64.8,$73.71,$21.2409,$76.95,$20.0386,$76.95,$76.95,$13.05,$55.2825,$14.355,$74.52
,CDM,4070005420.10.4070,AMYLASE ISO-ENZYMES,CDM Code,Outpatient,82150,$0.,$0.,$7.128,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$6.48,$0.,$7.128,$0.
,CDM,4070005422.10.4070,"METHYLMALONIC ACID, SERUM",CDM Code,Outpatient,83921,$106.,$23.331,$100.7,$84.8,$96.46,$27.7967,$100.7,$26.2233,$100.7,$100.7,$21.21,$72.345,$23.331,$97.52
,CDM,4070005423.10.4070,DRUG SCRN QUAN GABAPENTIN,CDM Code,Outpatient,80171,$160.,$23.837,$152.,$128.,$145.6,$41.9573,$152.,$39.5824,$152.,$152.,$21.67,$109.2,$23.837,$147.2
,CDM,4070005435.10.4070,SERUM MYOGLOBIN,CDM Code,Outpatient,83874,$132.,$14.212,$125.4,$105.6,$120.12,$34.6148,$125.4,$32.6555,$125.4,$125.4,$12.92,$90.09,$14.212,$121.44
,CDM,4070005436.10.4070,MYOGLOBIN URINE,CDM Code,Outpatient,83874,$128.,$14.212,$121.6,$102.4,$116.48,$33.5658,$121.6,$31.6659,$121.6,$121.6,$12.92,$87.36,$14.212,$117.76
,CDM,4070005438.10.4070,NORTRIPTYLINE,CDM Code,Outpatient,80335,$63.,$15.5856,$59.85,$50.4,$57.33,$16.5207,$59.85,$15.5856,$59.85,$59.85,$6.3,$42.9975,$33.5,$57.96
,CDM,4070005439.10.4070,M. PNEUMONIAE IGG/IGM AB,CDM Code,Outpatient,86738,$79.,$14.564,$75.05,$63.2,$71.89,$20.7164,$75.05,$19.5438,$75.05,$75.05,$13.24,$53.9175,$14.564,$72.68
,CDM,4070005440.10.4070,5-NUCLEOTIDASE REF,CDM Code,Outpatient,83915,$71.,$12.265,$67.45,$56.8,$64.61,$18.6185,$67.45,$17.5647,$67.45,$67.45,$11.15,$48.4575,$12.265,$65.32
,CDM,4070005441.10.4070,"OSMOLALITY,SERUM",CDM Code,Outpatient,83930,$41.,$7.271,$38.95,$32.8,$37.31,$10.7516,$38.95,$10.143,$38.95,$38.95,$6.61,$27.9825,$7.271,$37.72
,CDM,4070005442.10.4070,"OSMOLALITY,URINE",CDM Code,Outpatient,83935,$42.,$7.502,$39.9,$33.6,$38.22,$11.0138,$39.9,$10.3904,$39.9,$39.9,$6.82,$28.665,$7.502,$38.64
,CDM,4070005445.10.4070,"OXALATE, 24HR URINE",CDM Code,Outpatient,83945,$102.,$15.895,$96.9,$81.6,$92.82,$26.7478,$96.9,$25.2338,$96.9,$96.9,$14.45,$69.615,$15.895,$93.84
,CDM,4070005446.10.4070,MYCOPLASMA PNEUM IGG/IGM,CDM Code,Outpatient,86738,$28.,$6.9269,$26.6,$22.4,$25.48,$7.3425,$26.6,$6.9269,$26.6,$26.6,$13.24,$19.11,$14.564,$25.76
,CDM,4070005447.10.4070,NOROVIRUS,CDM Code,Outpatient,87449,$185.,$13.178,$175.75,$148.,$168.35,$48.5131,$175.75,$45.7672,$175.75,$175.75,$11.98,$126.2625,$13.178,$170.2
,CDM,4070005449.10.4070,PHENYTOIN FREE AND TOTAL,CDM Code,Outpatient,80186,$33.,$8.1639,$31.35,$26.4,$30.03,$8.6537,$31.35,$8.1639,$31.35,$31.35,$13.76,$22.5225,$15.136,$30.36
,CDM,4070005457.10.4070,NEUTROPHIL CYTOPLASMIC ANTIBOD,CDM Code,Outpatient,86021,$93.,$16.555,$88.35,$74.4,$84.63,$24.3877,$88.35,$23.0073,$88.35,$88.35,$15.05,$63.4725,$16.555,$85.56
,CDM,4070005463.10.4070,INSULIN-LIKE GROWTH FACTOR I,CDM Code,Outpatient,84305,$182.,$23.386,$172.9,$145.6,$165.62,$47.7264,$172.9,$45.025,$172.9,$172.9,$21.26,$124.215,$23.386,$167.44
,CDM,4070005465.10.4070,PROGESTERONE SERUM,CDM Code,Outpatient,84144,$129.,$22.946,$122.55,$103.2,$117.39,$33.8281,$122.55,$31.9133,$122.55,$122.55,$20.86,$88.0425,$22.946,$118.68
,CDM,4070005471.10.4070,PROTEIN ELECTROPHORSIS BD FLD,CDM Code,Outpatient,84166,$132.,$22.1,$125.4,$105.6,$120.12,$34.6148,$125.4,$32.6555,$125.4,$125.4,$17.83,$90.09,$22.1,$121.44
,CDM,4070005472.10.4070,SERUM PROTEIN ELECTROPHORESIS,CDM Code,Outpatient,84165,$104.,$22.1,$98.8,$83.2,$94.64,$27.2722,$98.8,$25.7286,$98.8,$98.8,$10.74,$70.98,$22.1,$95.68
,CDM,4070005473.10.4070,URINE PROTEIN ELECTROPHORESIS,CDM Code,Outpatient,84166,$110.,$22.1,$104.5,$88.,$100.1,$28.8456,$104.5,$27.2129,$104.5,$104.5,$17.83,$75.075,$22.1,$101.2
,CDM,4070005481.10.4070,GLUCOSE - BODY FLUID,CDM Code,Outpatient,82945,$20.,$4.323,$19.,$16.,$18.2,$5.2447,$19.,$4.9478,$19.,$19.,$3.93,$13.65,$4.323,$18.4
,CDM,4070005482.10.4070,PROTEIN C ACTIVITY REF,CDM Code,Outpatient,85303,$121.,$15.224,$114.95,$96.8,$110.11,$31.7302,$114.95,$29.9342,$114.95,$114.95,$13.84,$82.5825,$15.224,$111.32
,CDM,4070005483.10.4070,PROTEIN S ACTIVITY REF,CDM Code,Outpatient,85303,$121.,$15.224,$114.95,$96.8,$110.11,$31.7302,$114.95,$29.9342,$114.95,$114.95,$13.84,$82.5825,$15.224,$111.32
,CDM,4070005485.10.4070,ANTI SMOOTH MUSCLE AB,CDM Code,Outpatient,83516,$100.,$12.683,$95.,$80.,$91.,$26.2233,$95.,$24.739,$95.,$95.,$11.53,$68.25,$12.683,$92.
,CDM,4070005486.10.4070,ANTI MITOCHONDRIAL AB,CDM Code,Outpatient,83516,$68.,$12.683,$64.6,$54.4,$61.88,$17.8318,$64.6,$16.8225,$64.6,$64.6,$11.53,$46.41,$12.683,$62.56
,CDM,4070005487.10.4070,BACTERIA SEQUENCING,CDM Code,Outpatient,87153,$487.,$120.4789,$462.65,$389.6,$443.17,$127.7075,$462.65,$120.4789,$462.65,$462.65,$115.36,$332.3775,$126.896,$448.04
,CDM,4070005488.10.4070,SSA ANTIBODIES,CDM Code,Outpatient,86235,$109.,$19.723,$103.55,$87.2,$99.19,$28.5834,$103.55,$26.9655,$103.55,$103.55,$17.93,$74.3925,$19.723,$100.28
,CDM,4070005489.10.4070,SSB ANTIBODIES,CDM Code,Outpatient,86235,$109.,$19.723,$103.55,$87.2,$99.19,$28.5834,$103.55,$26.9655,$103.55,$103.55,$17.93,$74.3925,$19.723,$100.28
,CDM,4070005491.10.4070,ALK PHOS - BODY FLUID,CDM Code,Outpatient,84075,$23.,$5.69,$21.85,$18.4,$20.93,$6.0314,$21.85,$5.69,$21.85,$21.85,$5.18,$15.6975,$5.698,$21.16
,CDM,4070005492.10.4070,CEA - BODY FLUID,CDM Code,Outpatient,82378,$34.,$8.4113,$32.3,$27.2,$30.94,$8.9159,$32.3,$8.4113,$32.3,$32.3,$18.96,$23.205,$20.856,$31.28
,CDM,4070005493.10.4070,TRIGLYCERIDES - BODY FLUID,CDM Code,Outpatient,84478,$21.,$5.1952,$21.0396,$16.8,$19.11,$5.5069,$19.95,$5.1952,$19.95,$19.95,$21.0396,$14.3325,$6.314,$19.32
,CDM,4070005494.10.4070,AMYLASE - BODY FLUID,CDM Code,Outpatient,82150,$31.,$7.128,$29.45,$24.8,$28.21,$8.1292,$29.45,$7.6691,$29.45,$29.45,$6.48,$21.1575,$7.128,$28.52
,CDM,4070005495.10.4070,LDH - BODY FLUID,CDM Code,Outpatient,83615,$22.,$5.4426,$20.9,$17.6,$20.02,$5.7691,$20.9,$5.4426,$20.9,$20.9,$6.04,$15.015,$6.644,$20.24
,CDM,4070005497.10.4070,ALBUMIN - BODY FLUID,CDM Code,Outpatient,82042,$21.,$5.1952,$19.95,$16.8,$19.11,$5.5069,$19.95,$5.1952,$19.95,$19.95,$7.78,$14.3325,$8.558,$19.32
,CDM,4070005499.10.4070,"PHOSPHORUS,24 HR URINE",CDM Code,Outpatient,84105,$55.,$6.358,$52.25,$44.,$50.05,$14.4228,$52.25,$13.6065,$52.25,$52.25,$5.78,$37.5375,$6.358,$50.6
,CDM,4070005500.10.4070,"SEROTONIN,SERUM",CDM Code,Outpatient,84260,$103.,$25.4812,$97.85,$82.4,$93.73,$27.01,$97.85,$25.4812,$97.85,$97.85,$30.98,$70.2975,$34.078,$94.76
,CDM,4070005501.10.4070,"CORTISOL,SALIVA",CDM Code,Outpatient,82533,$91.,$17.93,$86.45,$72.8,$82.81,$23.8632,$86.45,$22.5125,$86.45,$86.45,$16.3,$62.1075,$17.93,$83.72
,CDM,4070005504.10.4070,SM/RNP,CDM Code,Outpatient,86235,$109.,$19.723,$103.55,$87.2,$99.19,$28.5834,$103.55,$26.9655,$103.55,$103.55,$17.93,$74.3925,$19.723,$100.28
,CDM,4070005507.10.4070,DRUG ABUSE 9,CDM Code,Outpatient,80307,$359.,$68.354,$341.05,$287.2,$326.69,$94.1416,$341.05,$88.813,$341.05,$341.05,$62.14,$245.0175,$68.354,$330.28
,CDM,4070005508.10.4070,FK 506(OML)TACROLIMUS,CDM Code,Outpatient,80197,$85.,$15.103,$80.75,$68.,$77.35,$22.2898,$80.75,$21.0282,$80.75,$80.75,$13.73,$58.0125,$15.103,$78.2
,CDM,4070005519.10.4070,"VITAMIN D,1,25 DIHYDROXY",CDM Code,Outpatient,82652,$136.,$33.645,$129.2,$108.8,$123.76,$35.6637,$129.2,$33.645,$129.2,$129.2,$38.5,$92.82,$42.35,$125.12
,CDM,4070005520.10.4070,TESTOSTERONE TOTAL,CDM Code,Outpatient,84403,$159.,$28.391,$151.05,$127.2,$144.69,$41.695,$151.05,$39.335,$151.05,$151.05,$25.81,$108.5175,$28.391,$146.28
,CDM,4070005521.10.4070,"VITAMIN D,25-HYDROXY,SERUM",CDM Code,Outpatient,82306,$183.,$32.56,$173.85,$146.4,$166.53,$47.9886,$173.85,$45.2724,$173.85,$173.85,$29.6,$124.8975,$32.56,$168.36
,CDM,4070005523.10.4070,25-HYDROXYVITAMIN D2 & D3,CDM Code,Outpatient,82306,$182.,$32.56,$172.9,$145.6,$165.62,$47.7264,$172.9,$45.025,$172.9,$172.9,$29.6,$124.215,$32.56,$167.44
,CDM,4070005524.10.4070,VITAMIN B 1 PLASMA,CDM Code,Outpatient,84425,$63.,$15.5856,$59.85,$50.4,$57.33,$16.5207,$59.85,$15.5856,$59.85,$59.85,$21.23,$42.9975,$23.353,$57.96
,CDM,4070005525.10.4070,VITAMIN C (ASCORBIC ACID),CDM Code,Outpatient,82180,$55.,$10.879,$52.25,$44.,$50.05,$14.4228,$52.25,$13.6065,$52.25,$52.25,$9.89,$37.5375,$10.879,$50.6
,CDM,4070005528.10.4070,VITAMIN E LEVEL,CDM Code,Outpatient,84446,$109.,$15.598,$103.55,$87.2,$99.19,$28.5834,$103.55,$26.9655,$103.55,$103.55,$14.18,$74.3925,$15.598,$100.28
,CDM,4070005529.10.4070,VITAMIN B 6 (OML),CDM Code,Outpatient,84207,$77.,$19.049,$73.15,$61.6,$70.07,$20.1919,$73.15,$19.049,$73.15,$73.15,$28.1,$52.5525,$30.91,$70.84
,CDM,4070005530.10.4070,THYROGLOBULIN ANTIBODY,CDM Code,Outpatient,86800,$98.,$17.501,$93.1,$78.4,$89.18,$25.6988,$93.1,$24.2442,$93.1,$93.1,$15.91,$66.885,$17.501,$90.16
,CDM,4070005535.10.4070,THYROXINE-BINDING GLOBULIN,CDM Code,Outpatient,84442,$46.,$11.3799,$43.7,$36.8,$41.86,$12.0627,$43.7,$11.3799,$43.7,$43.7,$14.78,$31.395,$16.258,$42.32
,CDM,4070005540.10.4070,TOPRIAMATE,CDM Code,Outpatient,80201,$123.,$13.112,$116.85,$98.4,$111.93,$32.2547,$116.85,$30.429,$116.85,$116.85,$11.92,$83.9475,$13.112,$113.16
,CDM,4070005542.10.4070,TOXOPLASMA ANTIBODY IGM,CDM Code,Outpatient,86778,$70.,$15.851,$66.5,$56.,$63.7,$18.3563,$66.5,$17.3173,$66.5,$66.5,$14.41,$47.775,$15.851,$64.4
,CDM,4070005544.10.4070,FK 506 UW TACROLIMUS,CDM Code,Outpatient,80197,$167.,$15.103,$158.65,$133.6,$151.97,$43.7929,$158.65,$41.3141,$158.65,$158.65,$13.73,$113.9775,$15.103,$153.64
,CDM,4070005545.10.4070,TOXOPLASMOSIS SEROLOGY IGG,CDM Code,Outpatient,86777,$70.,$15.829,$66.5,$56.,$63.7,$18.3563,$66.5,$17.3173,$66.5,$66.5,$14.39,$47.775,$15.829,$64.4
,CDM,4070005548.10.4070,CULTURE VIRAL,CDM Code,Outpatient,87254,$120.,$21.516,$114.,$96.,$109.2,$31.468,$114.,$29.6868,$114.,$114.,$19.56,$81.9,$21.516,$110.4
,CDM,4070005553.10.4070,INHIBIN A,CDM Code,Outpatient,86336,$188.,$17.149,$178.6,$150.4,$171.08,$49.2998,$178.6,$46.5093,$178.6,$178.6,$15.59,$128.31,$17.149,$172.96
,CDM,4070005555.10.4070,"VMA,URINE",CDM Code,Outpatient,84585,$55.,$13.6065,$52.25,$44.,$50.05,$14.4228,$52.25,$13.6065,$52.25,$52.25,$15.5,$37.5375,$17.05,$50.6
,CDM,4070005556.10.4070,VDRL/CSF (OML),CDM Code,Outpatient,86592,$34.,$4.697,$32.3,$27.2,$30.94,$8.9159,$32.3,$8.4113,$32.3,$32.3,$15.6462,$23.205,$4.697,$31.28
,CDM,4070005560.10.4070,ZINC PROTOPORPHYRIN (ZPP),CDM Code,Outpatient,84202,$78.,$15.785,$74.1,$62.4,$70.98,$20.4542,$74.1,$19.2964,$74.1,$74.1,$14.35,$53.235,$15.785,$71.76
,CDM,4070005565.10.4070,"ZINC,SERUM",CDM Code,Outpatient,84630,$70.,$12.529,$66.5,$56.,$63.7,$18.3563,$66.5,$17.3173,$66.5,$66.5,$11.39,$47.775,$12.529,$64.4
,CDM,4070005568.10.4070,RHEUMATOID FACTOR,CDM Code,Outpatient,86431,$51.,$6.237,$48.45,$40.8,$46.41,$13.3739,$48.45,$12.6169,$48.45,$48.45,$5.67,$34.8075,$6.237,$46.92
,CDM,4070005570.10.4070,RUBELLA IGG QUANT,CDM Code,Outpatient,86762,$89.,$15.829,$84.55,$71.2,$80.99,$23.3387,$84.55,$22.0177,$84.55,$84.55,$14.39,$60.7425,$15.829,$81.88
,CDM,4070005571.10.4070,RUBEOLA ANTIBODY IGG,CDM Code,Outpatient,86765,$80.,$14.168,$76.,$64.,$72.8,$20.9786,$76.,$19.7912,$76.,$76.,$12.88,$54.6,$14.168,$73.6
,CDM,4070005573.10.4070,ROTAVIRUS ANTIGEN,CDM Code,Outpatient,87425,$86.,$13.178,$81.7,$68.8,$78.26,$22.552,$81.7,$21.2755,$81.7,$81.7,$11.98,$58.695,$13.178,$79.12
,CDM,4070005585.10.4070,UREA NITROGEN 24HR URINE,CDM Code,Outpatient,84540,$50.,$6.116,$47.5,$40.,$45.5,$13.1116,$47.5,$12.3695,$47.5,$47.5,$5.56,$34.125,$6.116,$46.
,CDM,4070005592.10.4070,TISSUE TRANSGLUTAMINASE IGA,CDM Code,Outpatient,83516,$71.,$12.683,$67.45,$56.8,$64.61,$18.6185,$67.45,$17.5647,$67.45,$67.45,$11.53,$48.4575,$12.683,$65.32
,CDM,4070005593.10.4070,ALPRAZOLAM (XANAX),CDM Code,Outpatient,80346,$83.,$20.5334,$78.85,$66.4,$75.53,$21.7653,$78.85,$20.5334,$78.85,$78.85,$8.3,$56.6475,$33.5,$76.36
,CDM,4070005595.10.4070,ASSAY OF URINE/URIC ACID,CDM Code,Outpatient,84560,$51.,$5.588,$48.45,$40.8,$46.41,$13.3739,$48.45,$12.6169,$48.45,$48.45,$5.08,$34.8075,$5.588,$46.92
,CDM,4070005596.10.4070,"VARICELLA ZOSTER AB, IGG",CDM Code,Outpatient,86787,$80.,$14.168,$76.,$64.,$72.8,$20.9786,$76.,$19.7912,$76.,$76.,$12.88,$54.6,$14.168,$73.6
,CDM,4070005597.10.4070,VARICELLA ZOSTER AB IGM,CDM Code,Outpatient,86787,$89.,$14.168,$84.55,$71.2,$80.99,$23.3387,$84.55,$22.0177,$84.55,$84.55,$12.88,$60.7425,$14.168,$81.88
,CDM,4070005598.10.4070,"CALCIUM, 24 HOUR URINE",CDM Code,Outpatient,82340,$47.,$6.633,$44.65,$37.6,$42.77,$12.325,$44.65,$11.6273,$44.65,$44.65,$6.03,$32.0775,$6.633,$43.24
,CDM,4070005600.10.4070,"CALCIUM,URINE",CDM Code,Outpatient,82340,$47.,$6.633,$44.65,$37.6,$42.77,$12.325,$44.65,$11.6273,$44.65,$44.65,$6.03,$32.0775,$6.633,$43.24
,CDM,4070005602.10.4070,HEPATITIS C VIRUS GENOTYPING,CDM Code,Outpatient,87902,"$1,589.",$283.195,"$1,509.55","$1,271.2","$1,445.99",$416.6882,"$1,509.55",$393.1027,"$1,509.55","$1,509.55",$257.45,"$1,084.4925",$283.195,"$1,461.88"
,CDM,4070005603.10.4070,TESTOSTERONE FREE,CDM Code,Outpatient,84402,$157.,$28.017,$149.15,$125.6,$142.87,$41.1706,$149.15,$38.8402,$149.15,$149.15,$25.47,$107.1525,$28.017,$144.44
,CDM,4070005604.10.4070,ESTROGEN FRACTION PANEL,CDM Code,Outpatient,82671,$128.,$31.6659,$121.6,$102.4,$116.48,$33.5658,$121.6,$31.6659,$121.6,$121.6,$32.3,$87.36,$35.53,$117.76
,CDM,4070005606.10.4070,RETICULIN ANTIBODIES,CDM Code,Outpatient,86255,$99.,$22.1,$94.05,$79.2,$90.09,$25.9611,$94.05,$24.4916,$94.05,$94.05,$12.05,$67.5675,$22.1,$91.08
,CDM,4070005607.10.4070,TOTAL ESTROGENS,CDM Code,Outpatient,82672,$114.,$23.87,$108.3,$91.2,$103.74,$29.8946,$108.3,$28.2025,$108.3,$108.3,$21.7,$77.805,$23.87,$104.88
,CDM,4070005609.10.4070,"C-PEPTIDE,SERUM",CDM Code,Outpatient,84681,$81.,$20.0386,$76.95,$64.8,$73.71,$21.2409,$76.95,$20.0386,$76.95,$76.95,$20.81,$55.2825,$22.891,$74.52
,CDM,4070005610.10.4070,PARASITE EXAM FORMALIN,CDM Code,Outpatient,87209,$130.,$19.778,$123.5,$104.,$118.3,$34.0903,$123.5,$32.1607,$123.5,$123.5,$17.98,$88.725,$19.778,$119.6
,CDM,4070005621.10.4070,VON WILLEBRANDS WORKUP UW,CDM Code,Outpatient,85247,$101.,$24.9864,$95.95,$80.8,$91.91,$26.4855,$95.95,$24.9864,$95.95,$95.95,$22.94,$68.9325,$25.234,$92.92
,CDM,4070005622.10.4070,ESTRONE REF,CDM Code,Outpatient,82679,$142.,$27.445,$134.9,$113.6,$129.22,$37.2371,$134.9,$35.1294,$134.9,$134.9,$24.95,$96.915,$27.445,$130.64
,CDM,4070005625.10.4070,RAPAMYCIN OML,CDM Code,Outpatient,83789,$292.,$26.521,$277.4,$233.6,$265.72,$76.572,$277.4,$72.2379,$277.4,$277.4,$24.11,$199.29,$26.521,$268.64
,CDM,4070005626.10.4070,WEST NILE VIRUS ABS,CDM Code,Outpatient,86789,$112.,$15.829,$106.4,$89.6,$101.92,$29.3701,$106.4,$27.7077,$106.4,$106.4,$14.39,$76.44,$15.829,$103.04
,CDM,4070005631.10.4070,DETECT AGENT NOS DNA AMP,CDM Code,Outpatient,87798,$0.,$0.,$38.599,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$35.09,$0.,$38.599,$0.
,CDM,4070005658.10.4070,B PERTUSSIS   PARAPERTUSSIS PC,CDM Code,Outpatient,86615,$213.,$14.509,$202.35,$170.4,$193.83,$55.8556,$202.35,$52.6941,$202.35,$202.35,$13.19,$145.3725,$14.509,$195.96
,CDM,4070005680.10.4070,HEMOGLOBINOPATHY EVALUATION RE,CDM Code,Outpatient,83021,$173.,$19.866,$164.35,$138.4,$157.43,$45.3663,$164.35,$42.7985,$164.35,$164.35,$18.06,$118.0725,$19.866,$159.16
,CDM,4070005681.10.4070,HEMOGLOBIN EVAL INTERPRETATION,CDM Code,Outpatient,80500,$19.,$4.7004,$105.999,$15.2,$17.29,$4.9824,$18.05,$4.7004,$18.05,$18.05,$105.999,$12.9675,$33.,$17.48
,CDM,4070005684.10.4070,PORPHYRINS TOTAL,CDM Code,Outpatient,84311,$90.,$8.91,$85.5,$72.,$81.9,$23.601,$85.5,$22.2651,$85.5,$85.5,$8.1,$61.425,$8.91,$82.8
,CDM,4070005690.10.4070,CULT CATHETER TIP,CDM Code,Outpatient,87071,$88.,$10.879,$83.6,$70.4,$80.08,$23.0765,$83.6,$21.7703,$83.6,$83.6,$9.89,$60.06,$10.879,$80.96
,CDM,4070005691.10.4070,ANTIGEN GEL DIFFUSION,CDM Code,Outpatient,86331,$42.,$10.3904,$39.9,$33.6,$38.22,$11.0138,$39.9,$10.3904,$39.9,$39.9,$11.98,$28.665,$13.178,$38.64
,CDM,4070005693.10.4070,CULT EAR,CDM Code,Outpatient,87070,$133.,$9.482,$126.35,$106.4,$121.03,$34.877,$126.35,$32.9029,$126.35,$126.35,$8.62,$90.7725,$9.482,$122.36
,CDM,4070005695.10.4070,CULT EYE,CDM Code,Outpatient,87070,$133.,$9.482,$126.35,$106.4,$121.03,$34.877,$126.35,$32.9029,$126.35,$126.35,$8.62,$90.7725,$9.482,$122.36
,CDM,4070005711.10.4070,ALLERGEN - ASPERGILLUS FUMIGAT,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005712.10.4070,ALLERGEN - CAT DANDER,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005713.10.4070,ALLERGEN - COTTONWOOD,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005714.10.4070,ALLERGEN - EGG WHITES,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005715.10.4070,ALLERGEN - ELM,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005716.10.4070,ALLERGEN - HORMODENDRUM,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005717.10.4070,ALLERGEN - HOUSE DUST HOLLISTE,CDM Code,Outpatient,86003,$22.,$5.4426,$20.9,$17.6,$20.02,$5.7691,$20.9,$5.4426,$20.9,$20.9,$5.22,$15.015,$5.742,$20.24
,CDM,4070005718.10.4070,ALLERGEN - MEADOW GRASS/KY BLU,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005719.10.4070,ALLERGEN - MILK,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005720.10.4070,ALLERGEN -COCKSFOOT,CDM Code,Outpatient,86003,$22.,$5.4426,$20.9,$17.6,$20.02,$5.7691,$20.9,$5.4426,$20.9,$20.9,$5.22,$15.015,$5.742,$20.24
,CDM,4070005721.10.4070,ALLERGEN - PEANUT,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005722.10.4070,ALLERGEN - RYE GRASS,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005723.10.4070,ALLERGEN - COMMON PIGWEED,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005724.10.4070,ALLERGEN - SALTWORT/RUSSIAN TH,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005725.10.4070,ALLERGEN - SAGEBRUSH/WORMWOOD,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005726.10.4070,ALLERGEN - WHEAT,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005727.10.4070,ALLERGEN - DOG DANDER,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005728.10.4070,ALLERGEN - BOX ELDER/MAPLE,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005729.10.4070,ALLERGEN - GREY ALDER,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005730.10.4070,ALLERGEN - COMMON SILVER BIRCH,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005731.10.4070,ALLERGEN - OAK,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005732.10.4070,ALLERGEN - TIMOTHY GRASS,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005733.10.4070,ALLERGEN - WESTERN JUNIPER,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005734.10.4070,ALLERGEN - D FARINAE (DUST MIT,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005735.10.4070,ALLERGEN - ALTERNARIA MOLD,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005736.10.4070,ALLERGEN - COCKROACH,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005737.10.4070,ALLERGEN - D PTERONYSSINUS,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005738.10.4070,ALLERGEN - WALNUT TREE,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005739.10.4070,ALLERGEN - PENICILLIUM NOTATUM,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005740.10.4070,ALLERGEN - SHEEP SORREL,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005741.10.4070,ALLERGEN - WHITE ASH,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005742.10.4070,ALLERGEN - COMMON RAGWEED,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005743.10.4070,ALLERGEN - NETTLES,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005744.10.4070,ALLERGEN - MUGWORT,CDM Code,Outpatient,86003,$22.,$5.4426,$20.9,$17.6,$20.02,$5.7691,$20.9,$5.4426,$20.9,$20.9,$5.22,$15.015,$5.742,$20.24
,CDM,4070005745.10.4070,ALLERGEN - ENGLISH PLANTAIN,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005746.10.4070,ALLERGEN - SCOTCH BROOM,CDM Code,Outpatient,86003,$22.,$5.4426,$20.9,$17.6,$20.02,$5.7691,$20.9,$5.4426,$20.9,$20.9,$5.22,$15.015,$5.742,$20.24
,CDM,4070005747.10.4070,ALLERGEN - SOYBEAN,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005748.10.4070,ALLERGEN - FISH/COD,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005749.10.4070,ALLERGEN - WALNUT,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005750.10.4070,ALLERGEN - SHRIMP,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005751.10.4070,ALLERGEN - CORN,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005752.10.4070,ALLERGEN - CLAM,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005753.10.4070,ALLERGEN - SCALLOPS,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005754.10.4070,ALLERGEN - SESAME,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005755.10.4070,ALLERGEN - OAT,CDM Code,Outpatient,86003,$22.,$5.4426,$20.9,$17.6,$20.02,$5.7691,$20.9,$5.4426,$20.9,$20.9,$5.22,$15.015,$5.742,$20.24
,CDM,4070005756.10.4070,ALLERGEN - BARLEY,CDM Code,Outpatient,86003,$22.,$5.4426,$20.9,$17.6,$20.02,$5.7691,$20.9,$5.4426,$20.9,$20.9,$5.22,$15.015,$5.742,$20.24
,CDM,4070005757.10.4070,ALLERGEN - EGG YOLK,CDM Code,Outpatient,86003,$22.,$5.4426,$20.9,$17.6,$20.02,$5.7691,$20.9,$5.4426,$20.9,$20.9,$5.22,$15.015,$5.742,$20.24
,CDM,4070005758.10.4070,ALLERGEN-MEADOW FESCUE,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005759.10.4070,ALLERGEN-JOHNSON GRASS,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005760.10.4070,ALLERGEN-WHITE/NAVY BEAN,CDM Code,Outpatient,86003,$22.,$5.4426,$20.9,$17.6,$20.02,$5.7691,$20.9,$5.4426,$20.9,$20.9,$5.22,$15.015,$5.742,$20.24
,CDM,4070005761.10.4070,ALLERGEN-HORSE DANDER,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005763.10.4070,ALLERGEN - COW DANDER,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005765.10.4070,ALLERGEN - BERMUDA GRASS,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005766.10.4070,ALLERGEN - ASPERGILLUS NIGER,CDM Code,Outpatient,86003,$22.,$5.4426,$20.9,$17.6,$20.02,$5.7691,$20.9,$5.4426,$20.9,$20.9,$5.22,$15.015,$5.742,$20.24
,CDM,4070005770.10.4070,ALLERGEN - BEEF,CDM Code,Outpatient,86003,$22.,$5.4426,$20.9,$17.6,$20.02,$5.7691,$20.9,$5.4426,$20.9,$20.9,$5.22,$15.015,$5.742,$20.24
,CDM,4070005771.10.4070,ALLERGEN - CHOCOLATE,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005772.10.4070,ALLERGEN - GARLIC,CDM Code,Outpatient,86003,$22.,$5.4426,$20.9,$17.6,$20.02,$5.7691,$20.9,$5.4426,$20.9,$20.9,$5.22,$15.015,$5.742,$20.24
,CDM,4070005773.10.4070,ALLERGEN - MUSTARD,CDM Code,Outpatient,86003,$22.,$5.4426,$20.9,$17.6,$20.02,$5.7691,$20.9,$5.4426,$20.9,$20.9,$5.22,$15.015,$5.742,$20.24
,CDM,4070005774.10.4070,ALLERGEN - ORANGE,CDM Code,Outpatient,86003,$22.,$5.4426,$20.9,$17.6,$20.02,$5.7691,$20.9,$5.4426,$20.9,$20.9,$5.22,$15.015,$5.742,$20.24
,CDM,4070005775.10.4070,ALLERGEN - PEA,CDM Code,Outpatient,86003,$22.,$5.4426,$20.9,$17.6,$20.02,$5.7691,$20.9,$5.4426,$20.9,$20.9,$5.22,$15.015,$5.742,$20.24
,CDM,4070005776.10.4070,ALLERGEN - PORK,CDM Code,Outpatient,86003,$22.,$5.4426,$20.9,$17.6,$20.02,$5.7691,$20.9,$5.4426,$20.9,$20.9,$5.22,$15.015,$5.742,$20.24
,CDM,4070005777.10.4070,ALLERGEN - POTATO (WHITE),CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005778.10.4070,ALLERGEN - RICE,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005779.10.4070,ALLERGEN - TOMATO,CDM Code,Outpatient,86003,$22.,$5.4426,$20.9,$17.6,$20.02,$5.7691,$20.9,$5.4426,$20.9,$20.9,$5.22,$15.015,$5.742,$20.24
,CDM,4070005780.10.4070,ALLERGEN - TUNA,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005781.10.4070,ALLERGEN - YEAST BREWER/BAKERS,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005782.10.4070,ALLERGEN - BANANA,CDM Code,Outpatient,86003,$22.,$5.4426,$20.9,$17.6,$20.02,$5.7691,$20.9,$5.4426,$20.9,$20.9,$5.22,$15.015,$5.742,$20.24
,CDM,4070005783.10.4070,ALLERGEN - RYE,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005784.10.4070,ALLERGEN - ALMOND,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005785.10.4070,ALLERGEN - CASHEW,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005786.10.4070,ALLERGEN - HAZEL NUT,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005787.10.4070,ALLERGEN - BRAZIL NUT,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005788.10.4070,ALLERGEN - PECAN,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005789.10.4070,ALLERGEN - PINE NUT,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005790.10.4070,ALLERGEN - PISTACHIO,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005796.10.4070,ALLERGEN - CRAB,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005797.10.4070,ALLERGEN - MUSSELL,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005798.10.4070,ALLERGEN - HALIBUT,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005799.10.4070,ALLERGEN - TROUT,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005800.10.4070,MISC SEND OUT (OML),CDM Code,Outpatient,81599,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.
,CDM,4070005812.10.4070,"FECAL FAT, QUANTITATIVE",CDM Code,Outpatient,82710,$109.,$18.48,$103.55,$87.2,$99.19,$28.5834,$103.55,$26.9655,$103.55,$103.55,$16.8,$74.3925,$18.48,$100.28
,CDM,4070005817.10.4070,CULT VAGINAL/CERVICAL,CDM Code,Outpatient,87070,$25.,$6.1848,$23.75,$20.,$22.75,$6.5558,$23.75,$6.1848,$23.75,$23.75,$8.62,$17.0625,$9.482,$23.
,CDM,4070005818.10.4070,CULT NASAL,CDM Code,Outpatient,87070,$26.,$6.4321,$24.7,$20.8,$23.66,$6.8181,$24.7,$6.4321,$24.7,$24.7,$8.62,$17.745,$9.482,$23.92
,CDM,4070005819.10.4070,CULT NASAL W/GRAM STAIN,CDM Code,Outpatient,87070,$29.,$7.1743,$27.55,$23.2,$26.39,$7.6048,$27.55,$7.1743,$27.55,$27.55,$8.62,$19.7925,$9.482,$26.68
,CDM,4070005835.10.4070,"ALLERGEN - EGG,WHOLE",CDM Code,Outpatient,86003,$22.,$5.4426,$20.9,$17.6,$20.02,$5.7691,$20.9,$5.4426,$20.9,$20.9,$5.22,$15.015,$5.742,$20.24
,CDM,4070005842.10.4070,ALLERGEN - OYSTER,CDM Code,Outpatient,86003,$26.,$5.742,$24.7,$20.8,$23.66,$6.8181,$24.7,$6.4321,$24.7,$24.7,$5.22,$17.745,$5.742,$23.92
,CDM,4070005853.10.4070,ALLERGEN - SETOMELANOMMA ROSTR,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005854.10.4070,ALLERGEN - LATEX,CDM Code,Outpatient,86003,$22.,$5.4426,$20.9,$17.6,$20.02,$5.7691,$20.9,$5.4426,$20.9,$20.9,$5.22,$15.015,$5.742,$20.24
,CDM,4070005856.10.4070,ALLERGEN - GOOSEFOOT/LAMB'S QT,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005857.10.4070,ALLERGEN - WESTERN RAGWEED,CDM Code,Outpatient,86003,$22.,$5.4426,$20.9,$17.6,$20.02,$5.7691,$20.9,$5.4426,$20.9,$20.9,$5.22,$15.015,$5.742,$20.24
,CDM,4070005858.10.4070,ALLERGEN - STRAWBERRY,CDM Code,Outpatient,86003,$22.,$5.4426,$20.9,$17.6,$20.02,$5.7691,$20.9,$5.4426,$20.9,$20.9,$5.22,$15.015,$5.742,$20.24
,CDM,4070005859.10.4070,ALLERGEN - LOBSTER,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005860.10.4070,ALLERGEN - SALMON,CDM Code,Outpatient,86003,$24.,$5.742,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$5.22,$16.38,$5.742,$22.08
,CDM,4070005872.10.4070,CULT WOUND AEROBIC W/GR STAIN,CDM Code,Outpatient,87070,$29.,$7.1743,$27.55,$23.2,$26.39,$7.6048,$27.55,$7.1743,$27.55,$27.55,$8.62,$19.7925,$9.482,$26.68
,CDM,4070005873.10.4070,CULT WOUND W/GM STAIN &ANA,CDM Code,Outpatient,87070,$72.,$9.482,$68.4,$57.6,$65.52,$18.8808,$68.4,$17.8121,$68.4,$68.4,$8.62,$49.14,$9.482,$66.24
,CDM,4070005874.10.4070,CULT ANAEROBIC,CDM Code,Outpatient,87075,$0.,$0.,$10.417,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$9.47,$0.,$10.417,$0.
,CDM,4070005875.10.4070,CULT WOUND AEROBIC,CDM Code,Outpatient,87070,$53.,$9.482,$50.35,$42.4,$48.23,$13.8983,$50.35,$13.1117,$50.35,$50.35,$8.62,$36.1725,$9.482,$48.76
,CDM,4070005876.10.4070,CULT WOUND ANAEROBIC,CDM Code,Outpatient,87075,$141.,$10.417,$133.95,$112.8,$128.31,$36.9749,$133.95,$34.882,$133.95,$133.95,$9.47,$96.2325,$10.417,$129.72
,CDM,4070005877.10.4070,FUNGUS SMEAR INDIA INK PREP,CDM Code,Outpatient,87210,$25.,$6.1848,$23.75,$20.,$22.75,$6.5558,$23.75,$6.1848,$23.75,$23.75,$5.82,$17.0625,$6.402,$23.
,CDM,4070005878.10.4070,CULT SKIN HAIR OR NAILS,CDM Code,Outpatient,87101,$31.,$7.6691,$29.45,$24.8,$28.21,$8.1292,$29.45,$7.6691,$29.45,$29.45,$7.71,$21.1575,$8.481,$28.52
,CDM,4070005882.10.4070,ACID FAST SMEAR DIRECT,CDM Code,Outpatient,87206,$37.,$5.929,$35.15,$29.6,$33.67,$9.7026,$35.15,$9.1534,$35.15,$35.15,$5.39,$25.2525,$5.929,$34.04
,CDM,4070005883.10.4070,CULT ACID FAST BLOOD,CDM Code,Outpatient,87116,$65.,$11.88,$61.75,$52.,$59.15,$17.0451,$61.75,$16.0803,$61.75,$61.75,$10.8,$44.3625,$11.88,$59.8
,CDM,4070005890.10.4070,CRYPTOSPORIDIUM SMEAR,CDM Code,Outpatient,87206,$33.,$5.929,$31.35,$26.4,$30.03,$8.6537,$31.35,$8.1639,$31.35,$31.35,$5.39,$22.5225,$5.929,$30.36
,CDM,4070005891.10.4070,GIARDIA LAMBLIA EIA,CDM Code,Outpatient,87329,$39.,$9.6482,$37.05,$31.2,$35.49,$10.2271,$37.05,$9.6482,$37.05,$37.05,$11.98,$26.6175,$13.178,$35.88
,CDM,4070005892.10.4070,PH STOOL,CDM Code,Outpatient,83986,$18.,$3.938,$17.1,$14.4,$16.38,$4.7202,$17.1,$4.453,$17.1,$17.1,$3.58,$12.285,$3.938,$16.56
,CDM,4070005895.10.4070,REDUCING SUBSTANCES STOOL,CDM Code,Outpatient,84376,$19.,$4.7004,$18.05,$15.2,$17.29,$4.9824,$18.05,$4.7004,$18.05,$18.05,$5.5,$12.9675,$6.05,$17.48
,CDM,4070005896.10.4070,"LACTOFERRIN, FECAL",CDM Code,Outpatient,83630,$121.,$21.67,$114.95,$96.8,$110.11,$31.7302,$114.95,$29.9342,$114.95,$114.95,$19.7,$82.5825,$21.67,$111.32
,CDM,4070005900.10.4070,KLEIHAUER-BETKE STAIN,CDM Code,Outpatient,85460,$168.,$8.503,$159.6,$134.4,$152.88,$44.0551,$159.6,$41.5615,$159.6,$159.6,$7.73,$114.66,$8.503,$154.56
,CDM,4070005959.10.4070,CULT TRANSFUSION BLOOD RX,CDM Code,Outpatient,87040,$133.,$11.352,$126.35,$106.4,$121.03,$34.877,$126.35,$32.9029,$126.35,$126.35,$10.32,$90.7725,$11.352,$122.36
,CDM,4070006002.10.4070,M.AVIUM-INTRA DNA AMP PROB,CDM Code,Outpatient,87561,$506.,$38.599,$480.7,$404.8,$460.46,$132.6899,$480.7,$125.1793,$480.7,$480.7,$35.09,$345.345,$38.599,$465.52
,CDM,4070006003.10.4070,ISLET CELL ANTIBODY,CDM Code,Outpatient,86341,$128.,$25.927,$121.6,$102.4,$116.48,$33.5658,$121.6,$31.6659,$121.6,$121.6,$23.57,$87.36,$25.927,$117.76
,CDM,4070006004.10.4070,ZIKA VIRUS DNA/RNA AMP PROBE,CDM Code,Outpatient,87662,$481.,$56.441,$456.95,$384.8,$437.71,$126.1341,$456.95,$118.9946,$456.95,$456.95,$51.31,$328.2825,$56.441,$442.52
,CDM,4070006005.10.4070,IGA SUBCLASS IGA1,CDM Code,Outpatient,82787,$63.,$8.822,$59.85,$50.4,$57.33,$16.5207,$59.85,$15.5856,$59.85,$59.85,$8.02,$42.9975,$8.822,$57.96
,CDM,4070006006.10.4070,IGA SUBCLASS IGA2,CDM Code,Outpatient,82787,$63.,$8.822,$59.85,$50.4,$57.33,$16.5207,$59.85,$15.5856,$59.85,$59.85,$8.02,$42.9975,$8.822,$57.96
,CDM,4070006007.10.4070,THIOPURINE S-METHTRANS (TPMT),CDM Code,Outpatient,81401,$525.,$129.8798,$498.75,$420.,$477.75,$137.6723,$498.75,$129.8798,$498.75,$498.75,$137.,$358.3125,$150.7,$483.
,CDM,4070006008.10.4070,"MPL W515 & MPL ANALYSIS, QUALI",CDM Code,Outpatient,81402,$579.,$143.2388,$550.05,$463.2,$526.89,$151.8329,$550.05,$143.2388,$550.05,$550.05,$150.33,$395.1675,$165.363,$532.68
,CDM,4070006009.10.4070,CALRETICULIN CALR MUTATION ANA,CDM Code,Outpatient,81219,$578.,$133.793,$549.1,$462.4,$525.98,$151.5707,$549.1,$142.9914,$549.1,$549.1,$445.4628,$394.485,$133.793,$531.76
,CDM,4070006010.10.4070,PROTEIN C ANTIGEN,CDM Code,Outpatient,85302,$191.,$13.211,$181.45,$152.8,$173.81,$50.0865,$181.45,$47.2515,$181.45,$181.45,$12.01,$130.3575,$13.211,$175.72
,CDM,4070006011.10.4070,CARDIOLIPIN IGM AB,CDM Code,Outpatient,86147,$134.,$27.995,$127.3,$107.2,$121.94,$35.1392,$127.3,$33.1503,$127.3,$127.3,$25.45,$91.455,$27.995,$123.28
,CDM,4070006012.10.4070,DRVVT W/RFL PHOS.NEU,CDM Code,Outpatient,85613,$82.,$10.538,$77.9,$65.6,$74.62,$21.5031,$77.9,$20.286,$77.9,$77.9,$9.58,$55.965,$10.538,$75.44
,CDM,4070006013.10.4070,IGVH MUTATION PLASMA,CDM Code,Outpatient,81263,"$1,091.",$269.9025,"$1,078.68",$872.8,$992.81,$286.0962,"$1,036.45",$269.9025,"$1,036.45","$1,036.45","$1,078.68",$744.6075,$323.972,"$1,003.72"
,CDM,4070006014.10.4070,PROTHROMBIN GENE,CDM Code,Outpatient,81240,$232.,$57.3945,$220.4,$185.6,$211.12,$60.8381,$220.4,$57.3945,$220.4,$220.4,$180.225,$158.34,$72.259,$213.44
,CDM,4070006015.10.4070,DRUG TEST PRSMV CHEM ANLYZR,CDM Code,Outpatient,80307,$192.,$47.4989,$182.4,$153.6,$174.72,$50.3487,$182.4,$47.4989,$182.4,$182.4,$62.14,$131.04,$68.354,$176.64
,CDM,4070006017.10.4070,"CONCENTRATION, INFECTIOUS AGNT",CDM Code,Outpatient,87015,$68.,$7.348,$64.6,$54.4,$61.88,$17.8318,$64.6,$16.8225,$64.6,$64.6,$6.68,$46.41,$7.348,$62.56
,CDM,4070006018.10.4070,CULTURE ACID FAST BACILLI,CDM Code,Outpatient,87116,$193.,$11.88,$183.35,$154.4,$175.63,$50.611,$183.35,$47.7463,$183.35,$183.35,$10.8,$131.7225,$11.88,$177.56
,CDM,4070006020.10.4070,RITUXAN CD20,CDM Code,Outpatient,86356,$188.,$29.458,$178.6,$150.4,$171.08,$49.2998,$178.6,$46.5093,$178.6,$178.6,$26.78,$128.31,$29.458,$172.96
,CDM,4070006021.10.4070,GLTAMIC ACID DECAROXYLASE-65 A,CDM Code,Outpatient,86341,$179.,$25.927,$170.05,$143.2,$162.89,$46.9397,$170.05,$44.2828,$170.05,$170.05,$23.57,$122.1675,$25.927,$164.68
,CDM,4070006024.10.4070,DRUG TEST PRSMV CHEM ANLYZR,CDM Code,Outpatient,80307,$299.,$68.354,$284.05,$239.2,$272.09,$78.4077,$284.05,$73.9696,$284.05,$284.05,$62.14,$204.0675,$68.354,$275.08
,CDM,4070006025.10.4070,QUANTITATIVE ASSAY DRUG 35299,CDM Code,Outpatient,80299,$164.,$20.504,$155.8,$131.2,$149.24,$43.0062,$155.8,$40.572,$155.8,$155.8,$18.64,$111.93,$20.504,$150.88
,CDM,4070006029.10.4070,COL CHROMOTOGRAPHY QUAL/QUAN,CDM Code,Outpatient,82542,$337.,$26.499,$320.15,$269.6,$306.67,$88.3725,$320.15,$83.3704,$320.15,$320.15,$24.09,$230.0025,$26.499,$310.04
,CDM,4070006030.10.4070,SMPD1 GENE COMMON VARIANTS,CDM Code,Outpatient,81330,$410.,$51.7,$389.5,$328.,$373.1,$107.5155,$389.5,$101.4299,$389.5,$389.5,$47.,$279.825,$51.7,$377.2
,CDM,4070006031.10.4070,MOPATH PROCEDURE LEVEL 1,CDM Code,Outpatient,81400,$672.,$70.356,$638.4,$537.6,$611.52,$176.2206,$638.4,$166.2461,$638.4,$638.4,$63.96,$458.64,$70.356,$618.24
,CDM,4070006032.10.4070,DRUG TEST PRSMV CHEM ANLYZR,CDM Code,Outpatient,80307,$215.,$53.1889,$204.25,$172.,$195.65,$56.3801,$204.25,$53.1889,$204.25,$204.25,$62.14,$146.7375,$68.354,$197.8
,CDM,4070006033.10.4070,DRUG TEST PRSMV CHEM ANLYZR,CDM Code,Outpatient,80307,$323.,$68.354,$306.85,$258.4,$293.93,$84.7013,$306.85,$79.907,$306.85,$306.85,$62.14,$220.4475,$68.354,$297.16
,CDM,4070006035.10.4070,MICROSLIDE CONSULTATION,CDM Code,Outpatient,88323,$517.,$127.,$491.15,$413.6,$470.47,$135.5745,$491.15,$127.9006,$491.15,$491.15,$277.3596,$352.8525,$127.,$475.64
,CDM,4070006036.10.4070,TPMT GENE COM VARIANTS,CDM Code,Outpatient,81335,$525.,$129.8798,$498.75,$420.,$477.75,$137.6723,$498.75,$129.8798,$498.75,$498.75,$466.7427,$358.3125,$192.291,$483.
,CDM,4070006037.10.4070,ACID FAST STAIN,CDM Code,Outpatient,87206,$65.,$5.929,$61.75,$52.,$59.15,$17.0451,$61.75,$16.0803,$61.75,$61.75,$5.39,$44.3625,$5.929,$59.8
,CDM,4070006038.10.4070,ASSAY FOR PHENCYCLIDINE,CDM Code,Outpatient,83992,$139.,$34.3872,$132.05,$111.2,$126.49,$36.4504,$132.05,$34.3872,$132.05,$132.05,$13.9,$94.8675,$60.,$127.88
,CDM,4070006039.10.4070,MYD88 PCR,CDM Code,Outpatient,81479,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.
,CDM,4070006040.10.4070,DETECT AGENT NOS DNA AMP 10992,CDM Code,Outpatient,87798,$406.,$38.599,$385.7,$324.8,$369.46,$106.4666,$385.7,$100.4403,$385.7,$385.7,$35.09,$277.095,$38.599,$373.52
,CDM,4070006041.10.4070,CHEMILUMINESCENT ASSAY 37226,CDM Code,Outpatient,82397,$230.,$15.532,$218.5,$184.,$209.3,$60.3136,$218.5,$56.8997,$218.5,$218.5,$14.12,$156.975,$15.532,$211.6
,CDM,4070006042.10.4070,QUANTITATIVE ASSAY DRUG 94096,CDM Code,Outpatient,80299,$222.,$20.504,$210.9,$177.6,$202.02,$58.2157,$210.9,$54.9206,$210.9,$210.9,$18.64,$151.515,$20.504,$204.24
,CDM,4070006044.10.4070,NRAS GENE VARIANTS EXON 2 3,CDM Code,Outpatient,81311,$370.,$91.5343,$795.2862,$296.,$336.7,$97.0262,$351.5,$91.5343,$351.5,$351.5,$795.2862,$252.525,$325.369,$340.4
,CDM,4070006046.10.4070,GENOTYPE DNA/RNA HIV 94809,CDM Code,Outpatient,87906,$693.,$141.603,$658.35,$554.4,$630.63,$181.7275,$658.35,$171.4413,$658.35,$658.35,$128.73,$472.9725,$141.603,$637.56
,CDM,4070006047.10.4070,STEREOISOMER ANALYSIS 90319,CDM Code,Outpatient,80374,$192.,$33.5,$182.4,$153.6,$174.72,$50.3487,$182.4,$47.4989,$182.4,$182.4,$19.2,$131.04,$33.5,$176.64
,CDM,4070006048.10.4070,AUTOMATED DIFF WBC COUNT 8561,CDM Code,Outpatient,85048,$10.,$2.4739,$9.5,$8.,$9.1,$2.6223,$9.5,$2.4739,$9.5,$9.5,$2.54,$6.825,$2.794,$9.2
,CDM,4070006049.10.4070,AUTOMATED LEUKOCYTE COUNT 8561,CDM Code,Outpatient,85004,$25.,$6.1848,$23.75,$20.,$22.75,$6.5558,$23.75,$6.1848,$23.75,$23.75,$6.47,$17.0625,$7.117,$23.
,CDM,4070006055.10.4070,KRAS GENE ADDL VARIANTS,CDM Code,Outpatient,81276,$966.,$212.575,$917.7,$772.8,$879.06,$253.3171,$917.7,$238.9787,$917.7,$917.7,$530.1819,$659.295,$212.575,$888.72
,CDM,4070006056.10.4070,TARGETED GENOMIC SEQ ANALYS,CDM Code,Outpatient,81450,"$1,225.",$303.0528,"$1,743.3498",$980.,"$1,114.75",$321.2354,"$1,163.75",$303.0528,"$1,163.75","$1,163.75","$1,743.3498",$836.0625,$835.483,"$1,127."
,CDM,4070006057.10.4070,NFCT DS CHRNC HCV 6 ASSAYS,CDM Code,Outpatient,81596,$361.,$79.409,$342.95,$288.8,$328.51,$94.6661,$342.95,$89.3078,$342.95,$342.95,$192.7473,$246.3825,$79.409,$332.12
,CDM,4070006059.10.4070,DRUG TEST PRSMV CHEM ANLYZR,CDM Code,Outpatient,80307,$323.,$68.354,$306.85,$258.4,$293.93,$84.7013,$306.85,$79.907,$306.85,$306.85,$62.14,$220.4475,$68.354,$297.16
,CDM,4070006061.10.4070,IMMUNOASSAY NONANTIBODY,CDM Code,Outpatient,83516,$146.,$12.683,$138.7,$116.8,$132.86,$38.286,$138.7,$36.1189,$138.7,$138.7,$11.53,$99.645,$12.683,$134.32
,CDM,4070006062.10.4070,HIV-1 PROBE REVERSE TRNSCRPJ,CDM Code,Outpatient,87535,$312.,$38.599,$296.4,$249.6,$283.92,$81.8167,$296.4,$77.1857,$296.4,$296.4,$35.09,$212.94,$38.599,$287.04
,CDM,4070006063.10.4070,ASSAY CARBAMAZEPINE FREE,CDM Code,Outpatient,80157,$45.,$11.1326,$42.75,$36.,$40.95,$11.8005,$42.75,$11.1326,$42.75,$42.75,$13.25,$30.7125,$14.575,$41.4
,CDM,4070006064.10.4070,FLUORESCENT ANTIBODY SCREEN,CDM Code,Outpatient,86255,$67.,$16.5751,$63.65,$53.6,$60.97,$17.5696,$63.65,$16.5751,$63.65,$63.65,$12.05,$45.7275,$22.1,$61.64
,CDM,4070006065.10.4070,PROTOZOA ANTIBODY NOS,CDM Code,Outpatient,86753,$69.,$13.629,$65.55,$55.2,$62.79,$18.0941,$65.55,$17.0699,$65.55,$65.55,$12.39,$47.0925,$13.629,$63.48
,CDM,4070006100.10.4070,MLH1 GENE FULL SEQ,CDM Code,Outpatient,81292,$844.,$208.7972,"$1,734.9126",$675.2,$768.04,$221.3247,$801.8,$208.7972,$801.8,$801.8,"$1,734.9126",$576.03,$742.94,$776.48
,CDM,4070006101.10.4070,MSH2 GENE FULL SEQ,CDM Code,Outpatient,81295,$477.,$118.005,$453.15,$381.6,$434.07,$125.0851,$453.15,$118.005,$453.15,$453.15,$407.2818,$325.5525,$419.87,$438.84
,CDM,4070006102.10.4070,MSH6 GENE FULL SEQ,CDM Code,Outpatient,81298,$802.,$198.4068,$772.7247,$641.6,$729.82,$210.3109,$761.9,$198.4068,$761.9,$761.9,$772.7247,$547.365,$706.035,$737.84
,CDM,4070006103.10.4070,PMS2 GENE FULL SEQ ANALYSIS,CDM Code,Outpatient,81317,$846.,$209.2919,"$2,097.4986",$676.8,$769.86,$221.8491,$803.7,$209.2919,$803.7,$803.7,"$2,097.4986",$577.395,$744.15,$778.32
,CDM,4070006104.10.4070,MLH1 GENE DUP/DELETE VARIANT,CDM Code,Outpatient,81294,$253.,$62.5897,$511.8924,$202.4,$230.23,$66.3449,$240.35,$62.5897,$240.35,$240.35,$511.8924,$172.6725,$222.64,$232.76
,CDM,4070006105.10.4070,MSH6 GENE DUP/DELETE VARIANT,CDM Code,Outpatient,81300,$298.,$73.7222,$434.0619,$238.4,$271.18,$78.1454,$283.1,$73.7222,$283.1,$283.1,$434.0619,$203.385,$261.8,$274.16
,CDM,4070006106.10.4070,PMS2 GENE DUP/DELET VARIANTS,CDM Code,Outpatient,81319,$254.,$62.8371,$595.0896,$203.2,$231.14,$66.6072,$241.3,$62.8371,$241.3,$241.3,$595.0896,$173.355,$223.85,$233.68
,CDM,4070006107.10.4070,MSH2 GENE DUP/DELETE VARIANT,CDM Code,Outpatient,81297,$267.,$66.0531,$407.2818,$213.6,$242.97,$70.0162,$253.65,$66.0531,$253.65,$253.65,$407.2818,$182.2275,$234.63,$245.64
,CDM,4070006108.10.4070,QUANTITATIVE ASSAY DRUG,CDM Code,Outpatient,80299,$265.,$20.504,$251.75,$212.,$241.15,$69.4917,$251.75,$65.5584,$251.75,$251.75,$18.64,$180.8625,$20.504,$243.8
,CDM,4070006109.10.4070,QUANTITATIVE ASSAY DRUG,CDM Code,Outpatient,80299,$93.,$20.504,$88.35,$74.4,$84.63,$24.3877,$88.35,$23.0073,$88.35,$88.35,$18.64,$63.4725,$20.504,$85.56
,CDM,4070006110.10.4070,CHEMILUMINESCENT ASSAY,CDM Code,Outpatient,82397,$110.,$15.532,$104.5,$88.,$100.1,$28.8456,$104.5,$27.2129,$104.5,$104.5,$14.12,$75.075,$15.532,$101.2
,CDM,4070006152.10.4070,C4 COMPLIMENT,CDM Code,Outpatient,86160,$99.,$13.2,$94.05,$79.2,$90.09,$25.9611,$94.05,$24.4916,$94.05,$94.05,$12.,$67.5675,$13.2,$91.08
,CDM,4070006199.10.4070,ALLERGEN SPECIFIC IGE,CDM Code,Outpatient,8600391,$39.,$9.6482,$37.05,$31.2,$35.49,$10.2271,$37.05,$9.6482,$37.05,$37.05,$5.22,$26.6175,$34.32,$35.88
,CDM,4070006201.10.4070,IADNA-DNA/RNA PROBE TQ 6-11 -,CDM Code,Outpatient,87506,"$1,315.",$289.289,"$1,249.25","$1,052.","$1,196.65",$344.8364,"$1,249.25",$325.3179,"$1,249.25","$1,249.25",$262.99,$897.4875,$289.289,"$1,209.8"
,CDM,4070006202.10.4070,ASSAY OF CRYOFIBRINOGEN,CDM Code,Outpatient,82585,$71.,$15.554,$67.45,$56.8,$64.61,$18.6185,$67.45,$17.5647,$67.45,$67.45,$14.14,$48.4575,$15.554,$65.32
,CDM,4070006218.10.4070,ANTI DNA DOUBLE STRANDED,CDM Code,Outpatient,86225,$99.,$15.114,$94.05,$79.2,$90.09,$25.9611,$94.05,$24.4916,$94.05,$94.05,$13.74,$67.5675,$15.114,$91.08
,CDM,4070006223.10.4070,FACTOR VIII PART 2,CDM Code,Outpatient,85240,$257.,$19.69,$244.15,$205.6,$233.87,$67.3939,$244.15,$63.5792,$244.15,$244.15,$17.9,$175.4025,$19.69,$236.44
,CDM,4070006228.10.4070,PORPHYRINS(PLASMA)FRACTIONATED,CDM Code,Outpatient,82542,$146.,$26.499,$138.7,$116.8,$132.86,$38.286,$138.7,$36.1189,$138.7,$138.7,$24.09,$99.645,$26.499,$134.32
,CDM,4070006230.10.4070,IMMUNOASSAY QUANT NOS NONAB,CDM Code,Outpatient,83520,$239.,$18.997,$227.05,$191.2,$217.49,$62.6737,$227.05,$59.1262,$227.05,$227.05,$17.27,$163.1175,$18.997,$219.88
,CDM,4070006232.10.4070,HPV HIGH-RISK TYPES,CDM Code,Outpatient,87624,$195.,$38.599,$185.25,$156.,$177.45,$51.1354,$185.25,$48.2411,$185.25,$185.25,$35.09,$133.0875,$38.599,$179.4
,CDM,4070006233.10.4070,AMPHETAMINES 3OR 4,CDM Code,Outpatient,80325,$115.,$28.4499,$109.25,$92.,$104.65,$30.1568,$109.25,$28.4499,$109.25,$109.25,$11.5,$78.4875,$101.2,$105.8
,CDM,4070006234.10.4070,METHYLENEDIOXYAMPHETAMINES,CDM Code,Outpatient,80359,$115.,$28.4499,$109.25,$92.,$104.65,$30.1568,$109.25,$28.4499,$109.25,$109.25,$11.5,$78.4875,$33.5,$105.8
,CDM,4070006235.10.4070,AUTOMATED RBC COUNT,CDM Code,Outpatient,85041,$17.,$3.322,$16.15,$13.6,$15.47,$4.458,$16.15,$4.2056,$16.15,$16.15,$3.02,$11.6025,$3.322,$15.64
,CDM,4070006236.10.4070,QUANTITATIVE ASSAY DRUG 16325,CDM Code,Outpatient,80299,$93.,$20.504,$88.35,$74.4,$84.63,$24.3877,$88.35,$23.0073,$88.35,$88.35,$18.64,$63.4725,$20.504,$85.56
,CDM,4070006237.10.4070,MOPATH PROCEDURE LEVEL 7,CDM Code,Outpatient,81406,"$2,175.",$311.168,"$2,066.25","$1,740.","$1,979.25",$570.3568,"$2,066.25",$538.0733,"$2,066.25","$2,066.25",$282.88,"$1,484.4375",$311.168,"$2,001."
,CDM,4070006238.10.4070,NFCT DS CHRNC HCV 6 ASSAYS,CDM Code,Outpatient,81596,$361.,$79.409,$342.95,$288.8,$328.51,$94.6661,$342.95,$89.3078,$342.95,$342.95,$192.7473,$246.3825,$79.409,$332.12
,CDM,4070006239.10.4070,NUCLEAR ANTIGEN ANTIBODY,CDM Code,Outpatient,86235,$150.,$19.723,$142.5,$120.,$136.5,$39.3349,$142.5,$37.1085,$142.5,$142.5,$17.93,$102.375,$19.723,$138.
,CDM,4070006240.10.4070,IMMUNOASSAY NONANTIBODY,CDM Code,Outpatient,83516,$100.,$12.683,$95.,$80.,$91.,$26.2233,$95.,$24.739,$95.,$95.,$11.53,$68.25,$12.683,$92.
,CDM,4070006241.10.4070,IMMUNOASSAY QUANT NOS NONAB,CDM Code,Outpatient,83520,$86.,$18.997,$81.7,$68.8,$78.26,$22.552,$81.7,$21.2755,$81.7,$81.7,$17.27,$58.695,$18.997,$79.12
,CDM,4070006242.10.4070,ASSAY OF URINE SULFATE,CDM Code,Outpatient,84392,$27.,$6.039,$25.65,$21.6,$24.57,$7.0803,$25.65,$6.6795,$25.65,$25.65,$5.49,$18.4275,$6.039,$24.84
,CDM,4070006246.10.4070,"ALCOHOL, LEGAL",CDM Code,Outpatient,80320,$96.,$23.7494,$91.2,$76.8,$87.36,$25.1744,$91.2,$23.7494,$91.2,$91.2,$9.6,$65.52,$33.5,$88.32
,CDM,4070006247.10.4070,IMMUNOASSAY NONANTIBODY,CDM Code,Outpatient,83516,$64.,$12.683,$60.8,$51.2,$58.24,$16.7829,$60.8,$15.833,$60.8,$60.8,$11.53,$43.68,$12.683,$58.88
,CDM,4070006248.10.4070,IADNA-DNA/RNA PROBE TQ 12-25,CDM Code,Outpatient,87507,$960.,$237.4944,$912.,$768.,$873.6,$251.7437,$912.,$237.4944,$912.,$912.,$416.78,$655.2,$458.458,$883.2
,CDM,4070006256.10.4070,"6720 GASTRIN, 8 SPEC",CDM Code,Outpatient,82938,$88.,$19.459,$83.6,$70.4,$80.08,$23.0765,$83.6,$21.7703,$83.6,$83.6,$17.69,$60.06,$19.459,$80.96
,CDM,4070006265.10.4070,L/S RATIO FLM,CDM Code,Outpatient,83661,$289.,$24.189,$274.55,$231.2,$262.99,$75.7853,$274.55,$71.4957,$274.55,$274.55,$21.99,$197.2425,$24.189,$265.88
,CDM,4070006266.10.4070,HLA I TYPING COMPLETE LR - HLA,CDM Code,Outpatient,81372,"$2,018.",$443.949,"$1,917.1","$1,614.4","$1,836.38",$529.1862,"$1,917.1",$499.233,"$1,917.1","$1,917.1",$809.0634,"$1,377.285",$443.949,"$1,856.56"
,CDM,4070006270.10.4070,COL CHROMOTOGRAPHY QUAL/QUAN -,CDM Code,Outpatient,82542,$120.,$26.499,$114.,$96.,$109.2,$31.468,$114.,$29.6868,$114.,$114.,$24.09,$81.9,$26.499,$110.4
,CDM,4070006284.10.4070,QUANTITATIVE ASSAY DRUG,CDM Code,Outpatient,80299,$93.,$20.504,$88.35,$74.4,$84.63,$24.3877,$88.35,$23.0073,$88.35,$88.35,$18.64,$63.4725,$20.504,$85.56
,CDM,4070006285.10.4070,ASSAY IGA/IGD/IGG/IGM EACH,CDM Code,Outpatient,82784,$93.,$10.23,$88.35,$74.4,$84.63,$24.3877,$88.35,$23.0073,$88.35,$88.35,$9.3,$63.4725,$10.23,$85.56
,CDM,4070006286.10.4070,SARS-COV-2 COVID-19 AMP PRB,CDM Code,Outpatient,87635CRC,$176.,$43.5406,$167.2,$140.8,$160.16,$46.153,$167.2,$43.5406,$167.2,$167.2,$17.6,$120.12,$154.88,$161.92
,CDM,4070006290.10.4070,UW SARS-COV-2COVID-19 AMP PRB,CDM Code,Outpatient,87635CRC,$250.,$61.8475,$237.5,$200.,$227.5,$65.5583,$237.5,$61.8475,$237.5,$237.5,$25.,$170.625,$220.,$230.
,CDM,4070006295.10.4070,NWL SARS-COV-2 COVID19 AMP PRB,CDM Code,Outpatient,87635CRC,$150.191,$37.1558,$142.6814,$120.1528,$136.6738,$39.385,$142.6814,$37.1558,$142.6814,$142.6814,$15.0191,$102.5054,$132.1681,$138.1757
,CDM,4070006296.10.4070,SARS-COV-2 COVID-19 ANTIBODY,CDM Code,Outpatient,86769,$155.,$38.3454,$147.25,$124.,$141.05,$40.6461,$147.25,$38.3454,$147.25,$147.25,$15.5,$105.7875,$136.4,$142.6
,CDM,4070006301.10.4070,QUANTITATIVE ASSAY DRUG - METH,CDM Code,Outpatient,80299,$810.,$20.504,$769.5,$648.,$737.1,$212.4087,$769.5,$200.3859,$769.5,$769.5,$18.64,$552.825,$20.504,$745.2
,CDM,4070006302.10.4070,CHEMILUMINESCENT ASSAY -LEPTIN,CDM Code,Outpatient,82397,$165.,$15.532,$156.75,$132.,$150.15,$43.2684,$156.75,$40.8194,$156.75,$156.75,$14.12,$112.6125,$15.532,$151.8
,CDM,4070006303.10.4070,IMUNOASAY NONANTIBODY-21-HYDRO,CDM Code,Outpatient,83516,$240.,$12.683,$228.,$192.,$218.4,$62.9359,$228.,$59.3736,$228.,$228.,$11.53,$163.8,$12.683,$220.8
,CDM,4070006304.10.4070,IMMUNO AS 14.3.3 ETA PROTEIN,CDM Code,Outpatient,83520,$243.,$18.997,$230.85,$194.4,$221.13,$63.7226,$230.85,$60.1158,$230.85,$230.85,$17.27,$165.8475,$18.997,$223.56
,CDM,4070006305.10.4070,CLOT FACTOR XIII FIBRIN STAB,CDM Code,Outpatient,85290,$183.,$17.974,$173.85,$146.4,$166.53,$47.9886,$173.85,$45.2724,$173.85,$173.85,$16.34,$124.8975,$17.974,$168.36
,CDM,4070006306.10.4070,GI PATHOGEN 22 TARGETS GASTRO,CDM Code,Outpatient,0097U,$960.,$237.4944,$912.,$768.,$873.6,$251.7437,$912.,$237.4944,$912.,$912.,$96.,$655.2,$844.8,$883.2
,CDM,4070006310.10.4070,ASSAY OF NOS VITAMIN B3,CDM Code,Outpatient,84591,$348.,$18.766,$330.6,$278.4,$316.68,$91.2571,$330.6,$86.0917,$330.6,$330.6,$17.06,$237.51,$18.766,$320.16
,CDM,4070006312.10.4070,HEPATITIS B SURFACE AG,CDM Code,Outpatient,87340,$115.,$11.363,$109.25,$92.,$104.65,$30.1568,$109.25,$28.4499,$109.25,$109.25,$10.33,$78.4875,$11.363,$105.8
,CDM,4070006337.10.4070,IMMUNOGLOBULIN G,CDM Code,Outpatient,82784,$57.,$10.23,$54.15,$45.6,$51.87,$14.9473,$54.15,$14.1012,$54.15,$54.15,$9.3,$38.9025,$10.23,$52.44
,CDM,4070006338.10.4070,IMMUNOGLOBULIN M,CDM Code,Outpatient,82784,$57.,$10.23,$54.15,$45.6,$51.87,$14.9473,$54.15,$14.1012,$54.15,$54.15,$9.3,$38.9025,$10.23,$52.44
,CDM,4070006340.10.4070,COL CHROMOTOGRAPHY QUAL/QUAN,CDM Code,Outpatient,82542,$120.,$26.499,$114.,$96.,$109.2,$31.468,$114.,$29.6868,$114.,$114.,$24.09,$81.9,$26.499,$110.4
,CDM,4070006341.10.4070,BENZODIAZEPINES1-12,CDM Code,Outpatient,80346,$194.,$33.5,$184.3,$155.2,$176.54,$50.8732,$184.3,$47.9937,$184.3,$184.3,$19.4,$132.405,$33.5,$178.48
,CDM,4070006343.10.4070,FLUORESCENT ANTIBODY SCREEN,CDM Code,Outpatient,86255,$295.,$22.1,$280.25,$236.,$268.45,$77.3587,$280.25,$72.9801,$280.25,$280.25,$12.05,$201.3375,$22.1,$271.4
,CDM,4070006360.10.4070,AG DETECT NOS IA MULT,CDM Code,Outpatient,87449,$219.,$13.178,$208.05,$175.2,$199.29,$57.429,$208.05,$54.1784,$208.05,$208.05,$11.98,$149.4675,$13.178,$201.48
,CDM,4070006361.10.4070,COL CHROMOTOGRAPHY QUAL/QUAN,CDM Code,Outpatient,82542,$120.,$26.499,$114.,$96.,$109.2,$31.468,$114.,$29.6868,$114.,$114.,$24.09,$81.9,$26.499,$110.4
,CDM,4070006385.10.4070,"LEAD, URINE",CDM Code,Outpatient,83655,$47.,$11.6273,$44.65,$37.6,$42.77,$12.325,$44.65,$11.6273,$44.65,$44.65,$12.11,$32.0775,$13.321,$43.24
,CDM,4070006400.10.4070,LEGAL DRAW VENIPUNCTURE,CDM Code,Outpatient,36415,$42.,$3.3,$39.9,$33.6,$38.22,$11.0138,$39.9,$10.3904,$39.9,$39.9,$3.,$28.665,$3.3,$38.64
,CDM,4070006410.10.4070,"MERCURY,URINE",CDM Code,Outpatient,83825,$61.,$15.0908,$57.95,$48.8,$55.51,$15.9962,$57.95,$15.0908,$57.95,$57.95,$16.26,$41.6325,$17.886,$56.12
,CDM,4070006414.10.4070,"MERCURY, BLOOD",CDM Code,Outpatient,83825,$141.,$17.886,$133.95,$112.8,$128.31,$36.9749,$133.95,$34.882,$133.95,$133.95,$16.26,$96.2325,$17.886,$129.72
,CDM,4070006432.10.4070,PINWORM,CDM Code,Outpatient,87172,$50.,$4.697,$47.5,$40.,$45.5,$13.1116,$47.5,$12.3695,$47.5,$47.5,$4.27,$34.125,$4.697,$46.
,CDM,4070006437.10.4070,MYSOLINE,CDM Code,Outpatient,80188,$119.,$18.249,$113.05,$95.2,$108.29,$31.2057,$113.05,$29.4394,$113.05,$113.05,$16.59,$81.2175,$18.249,$109.48
,CDM,4070006450.10.4070,"PKU, INPATIENT",CDM Code,Outpatient,84030,$150.,$6.05,$142.5,$120.,$136.5,$39.3349,$142.5,$37.1085,$142.5,$142.5,$5.5,$102.375,$6.05,$138.
,CDM,4070006451.10.4070,"PKU,FOLLOW-UP",CDM Code,Outpatient,84030,$34.,$6.05,$32.3,$27.2,$30.94,$8.9159,$32.3,$8.4113,$32.3,$32.3,$5.5,$23.205,$6.05,$31.28
,CDM,4070006460.10.4070,"PORPHYRINS, QUANT",CDM Code,Outpatient,84110,$71.,$9.284,$67.45,$56.8,$64.61,$18.6185,$67.45,$17.5647,$67.45,$67.45,$8.44,$48.4575,$9.284,$65.32
,CDM,4070006467.10.4070,PARVOVIRUS AB (IGG/M),CDM Code,Outpatient,86747,$92.,$16.533,$87.4,$73.6,$83.72,$24.1254,$87.4,$22.7599,$87.4,$87.4,$15.03,$62.79,$16.533,$84.64
,CDM,4070006472.10.4070,"PROTEIN ELECTROPHORESIS,SERUM",CDM Code,Outpatient,84165,$66.,$16.3277,$62.7,$52.8,$60.06,$17.3074,$62.7,$16.3277,$62.7,$62.7,$10.74,$45.045,$22.1,$60.72
,CDM,4070006487.10.4070,Deoxyribonuclease Antibody,CDM Code,Outpatient,86215,$70.,$14.575,$66.5,$56.,$63.7,$18.3563,$66.5,$17.3173,$66.5,$66.5,$13.25,$47.775,$14.575,$64.4
,CDM,4070006490.10.4070,RENIN ACTIVITY,CDM Code,Outpatient,84244,$41.,$10.143,$38.95,$32.8,$37.31,$10.7516,$38.95,$10.143,$38.95,$38.95,$21.99,$27.9825,$24.189,$37.72
,CDM,4070006491.10.4070,SUBSTITUTION OF PLASMA FRACTIO,CDM Code,Outpatient,85732,$127.,$7.117,$120.65,$101.6,$115.57,$33.3036,$120.65,$31.4185,$120.65,$120.65,$6.47,$86.6775,$7.117,$116.84
,CDM,4070006495.10.4070,SCL-70,CDM Code,Outpatient,86235,$109.,$19.723,$103.55,$87.2,$99.19,$28.5834,$103.55,$26.9655,$103.55,$103.55,$17.93,$74.3925,$19.723,$100.28
,CDM,4070006504.10.4070,ENA SM&RNP ANTIBODIES,CDM Code,Outpatient,86235,$109.,$19.723,$103.55,$87.2,$99.19,$28.5834,$103.55,$26.9655,$103.55,$103.55,$17.93,$74.3925,$19.723,$100.28
,CDM,4070006505.10.4070,STONE ANALYSIS,CDM Code,Outpatient,82365,$131.,$14.19,$124.45,$104.8,$119.21,$34.3525,$124.45,$32.4081,$124.45,$124.45,$12.9,$89.4075,$14.19,$120.52
,CDM,4070006597.10.4070,VARICELLA ZOSTER ANTIBODY,CDM Code,Outpatient,86787,$123.,$14.168,$116.85,$98.4,$111.93,$32.2547,$116.85,$30.429,$116.85,$116.85,$12.88,$83.9475,$14.168,$113.16
,CDM,4070006603.10.4070,"TESTOSTERONE, FREE",CDM Code,Outpatient,84402,$157.,$28.017,$149.15,$125.6,$142.87,$41.1706,$149.15,$38.8402,$149.15,$149.15,$25.47,$107.1525,$28.017,$144.44
,CDM,4070006612.10.4070,"PARASITE EXAM,TRICHROME",CDM Code,Outpatient,87177,$93.,$9.79,$88.35,$74.4,$84.63,$24.3877,$88.35,$23.0073,$88.35,$88.35,$8.9,$63.4725,$9.79,$85.56
,CDM,4070006621.10.4070,CLOT FACTOR VIII ANTIGEN,CDM Code,Outpatient,85246,$366.,$25.234,$347.7,$292.8,$333.06,$95.9773,$347.7,$90.5447,$347.7,$347.7,$22.94,$249.795,$25.234,$336.72
,CDM,4070006622.10.4070,ESTRONE,CDM Code,Outpatient,82679,$141.,$27.445,$133.95,$112.8,$128.31,$36.9749,$133.95,$34.882,$133.95,$133.95,$24.95,$96.2325,$27.445,$129.72
,CDM,4070006623.10.4070,"SCHISTOSOMIASIS AB,IGG",CDM Code,Outpatient,86682,$122.,$14.311,$115.9,$97.6,$111.02,$31.9924,$115.9,$30.1816,$115.9,$115.9,$13.01,$83.265,$14.311,$112.24
,CDM,4070006905.10.4070,T CELL ABSOLULTE COUNT/RATIO,CDM Code,Outpatient,86360,$121.,$29.9342,$114.95,$96.8,$110.11,$31.7302,$114.95,$29.9342,$114.95,$114.95,$46.98,$82.5825,$51.678,$111.32
,CDM,4070006915.10.4070,PATERNITY COLLECTION & DISPATC,CDM Code,Outpatient,99001,$71.,$8.5,$67.45,$56.8,$64.61,$18.6185,$67.45,$17.5647,$67.45,$67.45,$7.1,$48.4575,$8.5,$65.32
,CDM,4070006992.10.4070,SPECIAL TRANSPORT - CHRG ONLY,CDM Code,Outpatient,99001,$343.,$8.5,$325.85,$274.4,$312.13,$89.9459,$325.85,$84.8548,$325.85,$325.85,$34.3,$234.0975,$8.5,$315.56
,CDM,4070006999.10.4070,PATH CYTO CONC TECH,CDM Code,Outpatient,88108,$159.,$39.335,$151.05,$127.2,$144.69,$41.695,$151.05,$39.335,$151.05,$151.05,$75.7746,$108.5175,$53.5,$146.28
,CDM,4070007001.10.4070,"PREGNANCY TEST, SERUM",CDM Code,Outpatient,84703,$46.,$8.272,$43.7,$36.8,$41.86,$12.0627,$43.7,$11.3799,$43.7,$43.7,$7.52,$31.395,$8.272,$42.32
,CDM,4070007003.10.4070,MRSA NASAL SCREEN BY PCR,CDM Code,Outpatient,87640,$217.,$38.599,$206.15,$173.6,$197.47,$56.9046,$206.15,$53.6836,$206.15,$206.15,$35.09,$148.1025,$38.599,$199.64
,CDM,4070007004.10.4070,GROUP B STREP BY PCR,CDM Code,Outpatient,87797,$150.,$33.033,$142.5,$120.,$136.5,$39.3349,$142.5,$37.1085,$142.5,$142.5,$30.03,$102.375,$33.033,$138.
,CDM,4070007008.10.4070,CCU MRSA PCR ADMIT,CDM Code,Outpatient,87150,$0.,$0.,$38.599,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$35.09,$0.,$38.599,$0.
,CDM,4070007020.10.4070,POC URINALYSIS NAUTO W/O SCOPE,CDM Code,Outpatient,81002,$30.,$3.828,$28.5,$24.,$27.3,$7.867,$28.5,$7.4217,$28.5,$28.5,$3.48,$20.475,$3.828,$27.6
,CDM,4070007021.10.4070,POC STREP A ASSAY W/OPTIC,CDM Code,Outpatient,87880QW,$30.,$7.4217,$28.5,$24.,$27.3,$7.867,$28.5,$7.4217,$28.5,$28.5,$16.53,$20.475,$18.183,$27.6
,CDM,4070007022.10.4070,POC GLUCOSE BLOOD TEST,CDM Code,Outpatient,82962,$30.,$3.608,$28.5,$24.,$27.3,$7.867,$28.5,$7.4217,$28.5,$28.5,$3.28,$20.475,$3.608,$27.6
,CDM,4070007024.10.4070,POC PROTHROMBIN TIME,CDM Code,Outpatient,85610QW,$30.,$4.719,$28.5,$24.,$27.3,$7.867,$28.5,$7.4217,$28.5,$28.5,$4.29,$20.475,$4.719,$27.6
,CDM,4070007025.10.4070,POC URINE PREGNANCY TEST,CDM Code,Outpatient,81025,$25.,$6.1848,$23.75,$20.,$22.75,$6.5558,$23.75,$6.1848,$23.75,$23.75,$8.61,$17.0625,$9.471,$23.
,CDM,4070007040.10.4070,MONO TEST,CDM Code,Outpatient,86308,$32.,$5.698,$30.4,$25.6,$29.12,$8.3915,$30.4,$7.9165,$30.4,$30.4,$5.18,$21.84,$5.698,$29.44
,CDM,4070007041.10.4070,RUBELLA IGG,CDM Code,Outpatient,86762,$91.,$15.829,$86.45,$72.8,$82.81,$23.8632,$86.45,$22.5125,$86.45,$86.45,$14.39,$62.1075,$15.829,$83.72
,CDM,4070007044.10.4070,"PREGNANCY TEST, URINE",CDM Code,Outpatient,81025,$43.,$9.471,$40.85,$34.4,$39.13,$11.276,$40.85,$10.6378,$40.85,$40.85,$8.61,$29.3475,$9.471,$39.56
,CDM,4070007045.10.4070,RHEUMATOID FACTOR,CDM Code,Outpatient,86430,$63.,$6.754,$59.85,$50.4,$57.33,$16.5207,$59.85,$15.5856,$59.85,$59.85,$6.14,$42.9975,$6.754,$57.96
,CDM,4070007050.10.4070,RPR,CDM Code,Outpatient,86592,$26.,$4.697,$24.7,$20.8,$23.66,$6.8181,$24.7,$6.4321,$24.7,$24.7,$15.6462,$17.745,$4.697,$23.92
,CDM,4070007059.10.4070,H PYLORI AB IGG QUAL,CDM Code,Outpatient,87339,$63.,$15.5856,$59.85,$50.4,$57.33,$16.5207,$59.85,$15.5856,$59.85,$59.85,$16.,$42.9975,$17.6,$57.96
,CDM,4070007063.10.4070,HIV STAT (INHOUSE),CDM Code,Outpatient,86703,$81.,$15.081,$76.95,$64.8,$73.71,$21.2409,$76.95,$20.0386,$76.95,$76.95,$13.71,$55.2825,$15.081,$74.52
,CDM,4070007500.10.4070,"KETONE, URINE",CDM Code,Outpatient,81002,$41.,$3.828,$38.95,$32.8,$37.31,$10.7516,$38.95,$10.143,$38.95,$38.95,$3.48,$27.9825,$3.828,$37.72
,CDM,4070007600.10.4070,"REDUCING SUBSTANCES, URINE",CDM Code,Outpatient,81005,$47.,$2.387,$44.65,$37.6,$42.77,$12.325,$44.65,$11.6273,$44.65,$44.65,$2.17,$32.0775,$2.387,$43.24
,CDM,4070007639.10.4070,MICROSCOPIC ONLY,CDM Code,Outpatient,81015,$38.,$3.355,$36.1,$30.4,$34.58,$9.9649,$36.1,$9.4008,$36.1,$36.1,$3.05,$25.935,$3.355,$34.96
,CDM,4070007640.10.4070,UA + MICROSCOPIC,CDM Code,Outpatient,81001,$20.,$3.487,$19.,$16.,$18.2,$5.2447,$19.,$4.9478,$19.,$19.,$3.17,$13.65,$3.487,$18.4
,CDM,4070007641.10.4070,UA DIP ONLY,CDM Code,Outpatient,81003,$20.,$2.475,$19.,$16.,$18.2,$5.2447,$19.,$4.9478,$19.,$19.,$2.25,$13.65,$2.475,$18.4
,CDM,4070008900.10.4070,PATH TECH SURG PATH GROSS,CDM Code,Outpatient,88300,$93.,$17.,$88.35,$74.4,$84.63,$24.3877,$88.35,$23.0073,$88.35,$88.35,$75.7746,$63.4725,$17.,$85.56
,CDM,4070008901.10.4070,PATH TECH SURG G & M L4,CDM Code,Outpatient,88305,$224.,$55.4154,$212.8,$179.2,$203.84,$58.7402,$212.8,$55.4154,$212.8,$212.8,$105.999,$152.88,$55.5,$206.08
,CDM,4070008902.10.4070,SURG PATH MICRO & GROSS L2,CDM Code,Outpatient,88302,$159.,$33.5,$151.05,$127.2,$144.69,$41.695,$151.05,$39.335,$151.05,$151.05,$75.7746,$108.5175,$33.5,$146.28
,CDM,4070008903.10.4070,PATH TECH F/S 1ST SITE,CDM Code,Outpatient,88331,$258.,$63.8266,$277.3596,$206.4,$234.78,$67.6561,$245.1,$63.8266,$245.1,$245.1,$277.3596,$176.085,$92.5,$237.36
,CDM,4070008905.10.4070,PATH TECH SPECIAL STAIN GR 1,CDM Code,Outpatient,88106,$133.,$32.9029,$126.35,$106.4,$121.03,$34.877,$126.35,$32.9029,$126.35,$126.35,$75.7746,$90.7725,$63.,$122.36
,CDM,4070008906.10.4070,PATH TECH CYTO-CELL BLOCK,CDM Code,Outpatient,88160,$132.,$32.6555,$125.4,$105.6,$120.12,$34.6148,$125.4,$32.6555,$125.4,$125.4,$33.6951,$90.09,$65.,$121.44
,CDM,4070008909.10.4070,SPECIAL STAIN OTHER,CDM Code,Outpatient,88313,$240.,$59.3736,$228.,$192.,$218.4,$62.9359,$228.,$59.3736,$228.,$228.,$75.7746,$163.8,$82.5,$220.8
,CDM,4070008910.10.4070,PATH TECH DECALCIFICATION,CDM Code,Outpatient,88311,$79.,$18.5,$75.05,$63.2,$71.89,$20.7164,$75.05,$19.5438,$75.05,$75.05,$7.9,$53.9175,$18.5,$72.68
,CDM,4070008911.10.4070,PATH TECH IMMUNO,CDM Code,Outpatient,88342,$405.,$100.193,$491.3067,$324.,$368.55,$106.2044,$384.75,$100.193,$384.75,$384.75,$491.3067,$276.4125,$103.,$372.6
,CDM,4070008916.10.4070,SURG PATH GROSS & MICRO L3,CDM Code,Outpatient,88304,$224.,$41.,$212.8,$179.2,$203.84,$58.7402,$212.8,$55.4154,$212.8,$212.8,$105.999,$152.88,$41.,$206.08
,CDM,4070008917.10.4070,PATH TECH FNA-DIAG REPORT,CDM Code,Outpatient,88173,$224.,$55.4154,$212.8,$179.2,$203.84,$58.7402,$212.8,$55.4154,$212.8,$212.8,$105.999,$152.88,$115.5,$206.08
,CDM,4070008918.10.4070,PATH TECH SURG L5,CDM Code,Outpatient,88307,$507.,$125.4267,$491.3067,$405.6,$461.37,$132.9521,$481.65,$125.4267,$481.65,$481.65,$491.3067,$346.0275,$253.,$466.44
,CDM,4070008919.10.4070,PATH TECH SURG PATH COMPLEX,CDM Code,Outpatient,88309,$749.,$185.2951,"$1,212.6072",$599.2,$681.59,$196.4125,$711.55,$185.2951,$711.55,$711.55,"$1,212.6072",$511.1925,$353.,$689.08
,CDM,4070008928.10.4070,PATH IMMUNOFLOURES STUDY EA AN,CDM Code,Outpatient,88346,$291.,$71.9905,$491.3067,$232.8,$264.81,$76.3098,$276.45,$71.9905,$276.45,$276.45,$491.3067,$198.6075,$80.5,$267.72
,CDM,4070008929.10.4070,PATH CLINICAL CONSULT LIMITED,CDM Code,Outpatient,80500,$81.,$20.0386,$105.999,$64.8,$73.71,$21.2409,$76.95,$20.0386,$76.95,$76.95,$105.999,$55.2825,$33.,$74.52
,CDM,4070008931.10.4070,"FLOW CYTOMETRY,CYTO OR NUC",CDM Code,Outpatient,88184,$123.,$30.429,$491.3067,$98.4,$111.93,$32.2547,$116.85,$30.429,$116.85,$116.85,$491.3067,$83.9475,$94.5,$113.16
,CDM,4070008935.10.4070,"TISSUE CULTURE,NEO(BONE MARROW",CDM Code,Outpatient,88237,$780.,$158.125,$741.,$624.,$709.8,$204.5417,$741.,$192.9642,$741.,$741.,$143.75,$532.35,$158.125,$717.6
,CDM,4070008936.10.4070,ANALYZE 20-50 CELLS(CYTO),CDM Code,Outpatient,88264,$525.,$129.8798,$498.75,$420.,$477.75,$137.6723,$498.75,$129.8798,$498.75,$498.75,$144.61,$358.3125,$159.071,$483.
,CDM,4070008939.10.4070,PATH CONSULT IN SURGERY,CDM Code,Outpatient,88329,$258.,$63.8266,$245.1,$206.4,$234.78,$67.6561,$245.1,$63.8266,$245.1,$245.1,$75.7746,$176.085,$74.,$237.36
,CDM,4070008940.10.4070,PATH TECH NONGYN THIN PREP,CDM Code,Outpatient,88112,$194.,$47.9937,$184.3,$155.2,$176.54,$50.8732,$184.3,$47.9937,$184.3,$184.3,$105.999,$132.405,$56.5,$178.48
,CDM,4070008942.10.4070,FLOW INTERP 9-15 MARKERS,CDM Code,Outpatient,88188,$245.,$60.6105,$232.75,$196.,$222.95,$64.2471,$232.75,$60.6105,$232.75,$232.75,$24.5,$167.2125,$92.5,$225.4
,CDM,4070008943.10.4070,FLOW INTERP 16 + MARKERS,CDM Code,Outpatient,88189,$373.,$92.2765,$354.35,$298.4,$339.43,$97.8129,$354.35,$92.2765,$354.35,$354.35,$37.3,$254.5725,$123.5,$343.16
,CDM,4070008944.10.4070,PATH TECH CYTO EXAM INITIAL,CDM Code,Outpatient,88333,$112.,$27.7077,"$1,212.6072",$89.6,$101.92,$29.3701,$106.4,$27.7077,$106.4,$106.4,"$1,212.6072",$76.44,$92.5,$103.04
,CDM,4070008945.10.4070,"MORPHOMETRIC ANAL,HISTOCHEM,HE",CDM Code,Outpatient,88360,$367.,$90.7921,$491.3067,$293.6,$333.97,$96.2395,$348.65,$90.7921,$348.65,$348.65,$491.3067,$250.4775,$124.5,$337.64
,CDM,4070009116.10.4070,"VAGINAL PATHOGENS, DNA PRB",CDM Code,Outpatient,87800,$107.,$26.4707,$146.9301,$85.6,$97.37,$28.0589,$101.65,$26.4707,$101.65,$101.65,$146.9301,$73.0275,$48.037,$98.44
,CDM,4070009915.10.4070,HCG PANEL,CDM Code,Outpatient,84702,$51.,$12.6169,$48.45,$40.8,$46.41,$13.3739,$48.45,$12.6169,$48.45,$48.45,$15.05,$34.8075,$16.555,$46.92
,CDM,4078003002.10.4078,PLATELETS LEUKOREDUCED IRRAD,CDM Code,Outpatient,P9033,"$1,352.",$334.4713,"$1,284.4","$1,081.6","$1,230.32",$354.539,"$1,284.4",$334.4713,"$1,284.4","$1,284.4",$432.7803,$922.74,"$1,189.76","$1,243.84"
,CDM,4078003025.10.4078,FETAL/MATERNAL BLEED SCREEN,CDM Code,Outpatient,83033,$118.,$8.8,$112.1,$94.4,$107.38,$30.9435,$112.1,$29.192,$112.1,$112.1,$8.,$80.535,$8.8,$108.56
,CDM,4078003170.10.4078,RH TYPE,CDM Code,Outpatient,86901,$61.,$3.289,$75.7746,$48.8,$55.51,$15.9962,$57.95,$15.0908,$57.95,$57.95,$75.7746,$41.6325,$3.289,$56.12
,CDM,4078003502.10.4078,ABO GROUP,CDM Code,Outpatient,86900,$61.,$3.289,$145.6485,$48.8,$55.51,$15.9962,$57.95,$15.0908,$57.95,$57.95,$145.6485,$41.6325,$3.289,$56.12
,CDM,4078003505.10.4078,ANTIBODY IDENTIFICATION,CDM Code,Outpatient,86870,$241.,$59.621,$491.3067,$192.8,$219.31,$63.1982,$228.95,$59.621,$228.95,$228.95,$491.3067,$164.4825,$63.5,$221.72
,CDM,4078003510.10.4078,ANTIBODY SCREEN,CDM Code,Outpatient,86850,$122.,$10.747,$115.9,$97.6,$111.02,$31.9924,$115.9,$30.1816,$115.9,$115.9,$105.999,$83.265,$10.747,$112.24
,CDM,4078003520.10.4078,DIRECT COOMBS,CDM Code,Outpatient,86880,$96.,$5.929,$91.2,$76.8,$87.36,$25.1744,$91.2,$23.7494,$91.2,$91.2,$75.7746,$65.52,$5.929,$88.32
,CDM,4078003610.10.4078,TRANS.REACT.INVES.-DEFINITIVE,CDM Code,Outpatient,80500,$86.,$21.2755,$105.999,$68.8,$78.26,$22.552,$81.7,$21.2755,$81.7,$81.7,$105.999,$58.695,$33.,$79.12
,CDM,4078003901.10.4078,TYPE CHECK BLOOD UNIT - CHRG O,CDM Code,Outpatient,86900,$135.,$3.289,$145.6485,$108.,$122.85,$35.4015,$128.25,$33.3976,$128.25,$128.25,$145.6485,$92.1375,$3.289,$124.2
,CDM,4078003903.10.4078,IMMEDIATE SPIN CROSSMATCH - CH,CDM Code,Outpatient,86920,$201.,$49.7254,$277.3596,$160.8,$182.91,$52.7088,$190.95,$49.7254,$190.95,$190.95,$277.3596,$137.1825,$51.5,$184.92
,CDM,4078003905.10.4078,AHG CROSSMATCH - CHRG ONLY,CDM Code,Outpatient,86922,$341.,$55.,$323.95,$272.8,$310.31,$89.4215,$323.95,$84.36,$323.95,$323.95,$277.3596,$232.7325,$55.,$313.72
,CDM,4078003907.10.4078,PRETREATMENT RBCS/LISS-CHRG ON,CDM Code,Outpatient,86970,$37.,$9.1534,$75.7746,$29.6,$33.67,$9.7026,$35.15,$9.1534,$35.15,$35.15,$75.7746,$25.2525,$43.,$34.04
,CDM,4078003925.10.4078,RBC LEUKOPOOR/PALL FILTERED,CDM Code,Outpatient,P9016,$632.,$156.3505,$600.4,$505.6,$575.12,$165.7313,$600.4,$156.3505,$600.4,$600.4,$496.1394,$431.34,$556.16,$581.44
,CDM,4078003930.10.4078,ANTIGEN TYPING - CHRG ONLY,CDM Code,Outpatient,86905,$73.,$4.213,$491.3067,$58.4,$66.43,$19.143,$69.35,$18.0595,$69.35,$69.35,$491.3067,$49.8225,$4.213,$67.16
,CDM,4078003941.10.4078,CYROPRECIPITATE POOLED UNIT,CDM Code,Outpatient,P9012,$573.,$141.7545,$544.35,$458.4,$521.43,$150.2595,$544.35,$141.7545,$544.35,$544.35,$141.5901,$391.0725,$504.24,$527.16
,CDM,4078003945.10.4078,FRESH FROZEN PLASMA - CHRG ONL,CDM Code,Outpatient,P9017,$300.,$74.217,$285.,$240.,$273.,$78.6699,$285.,$74.217,$285.,$285.,$196.8591,$204.75,$264.,$276.
,CDM,4078003950.10.4078,PLATELETS LEUKOCYTES REDUCED,CDM Code,Outpatient,P9031,"$1,352.",$334.4713,"$1,284.4","$1,081.6","$1,230.32",$354.539,"$1,284.4",$334.4713,"$1,284.4","$1,284.4",$335.6991,$922.74,"$1,189.76","$1,243.84"
,CDM,4078003954.10.4078,PLATELETPHERESIS (LR) CHRG ONL,CDM Code,Outpatient,P9035,"$1,649.",$407.9461,"$1,566.55","$1,319.2","$1,500.59",$432.4222,"$1,566.55",$407.9461,"$1,566.55","$1,566.55","$1,334.8665","$1,125.4425","$1,451.12","$1,517.08"
,CDM,4078003956.10.4078,PLATELET PHERESIS BLOOD BANK,CDM Code,Outpatient,P9034,"$1,246.",$308.2479,"$1,183.7",$996.8,"$1,133.86",$326.7423,"$1,183.7",$308.2479,"$1,183.7","$1,183.7","$1,100.307",$850.395,"$1,096.48","$1,146.32"
,CDM,4078003957.10.4078,"PLATELET PHERESIS, IRRADIATED",CDM Code,Outpatient,P9036,"$1,296.",$320.6174,"$1,486.0686","$1,036.8","$1,179.36",$339.854,"$1,231.2",$320.6174,"$1,231.2","$1,231.2","$1,486.0686",$884.52,"$1,140.48","$1,192.32"
,CDM,4078003958.10.4078,"PLATELET PHERESIS, LR, IRRD",CDM Code,Outpatient,P9037,"$1,624.",$401.7614,"$1,728.558","$1,299.2","$1,477.84",$425.8664,"$1,542.8",$401.7614,"$1,542.8","$1,542.8","$1,728.558","$1,108.38","$1,429.12","$1,494.08"
,CDM,4078003959.10.4078,"RBC, LR, CMVN, IRRD",CDM Code,Outpatient,P9058,$792.,$195.9329,$752.4,$633.6,$720.72,$207.6885,$752.4,$195.9329,$752.4,$752.4,$667.767,$540.54,$696.96,$728.64
,CDM,4078003960.10.4078,BLOOD PROD POOLING - CHRG ONLY,CDM Code,Outpatient,86965,$122.,$30.1816,$277.3596,$97.6,$111.02,$31.9924,$115.9,$30.1816,$115.9,$115.9,$277.3596,$83.265,$48.,$112.24
,CDM,4078003970.10.4078,THAWING UNIT - CHRG ONLY,CDM Code,Outpatient,86927,$259.,$29.,$491.3067,$207.2,$235.69,$67.9183,$246.05,$64.074,$246.05,$246.05,$491.3067,$176.7675,$29.,$238.28
,CDM,4078003985.10.4078,DAT-ADULT - CHRG ONLY,CDM Code,Outpatient,86880,$125.,$5.929,$118.75,$100.,$113.75,$32.7791,$118.75,$30.9237,$118.75,$118.75,$75.7746,$85.3125,$5.929,$115.
,CDM,4078003986.10.4078,AB ID ADDITIONAL-CHRG ONLY,CDM Code,Outpatient,86870,$308.,$63.5,$491.3067,$246.4,$280.28,$80.7678,$292.6,$76.1961,$292.6,$292.6,$491.3067,$210.21,$63.5,$283.36
,CDM,4078003987.10.4078,HEMOGLOBIN S - CHRG ONLY,CDM Code,Outpatient,85660,$62.,$6.061,$58.9,$49.6,$56.42,$16.2584,$58.9,$15.3382,$58.9,$58.9,$5.51,$42.315,$6.061,$57.04
,CDM,4078003988.10.4078,LR RBC IRRADIATED - CHRG ONLY,CDM Code,Outpatient,P9040,$713.,$176.3891,$710.9673,$570.4,$648.83,$186.9721,$677.35,$176.3891,$677.35,$677.35,$710.9673,$486.6225,$627.44,$655.96
,CDM,4078003989.10.4078,LR RBC CMV NEG - CHRG ONLY,CDM Code,Outpatient,P9051,$527.,$130.3745,$551.3016,$421.6,$479.57,$138.1968,$500.65,$130.3745,$500.65,$500.65,$551.3016,$359.6775,$463.76,$484.84
,CDM,4078004005.10.4078,PLAT.PHERESIS LEUKO REDUC CMV,CDM Code,Outpatient,P9055,"$1,499.",$370.8376,"$1,424.05","$1,199.2","$1,364.09",$393.0873,"$1,424.05",$370.8376,"$1,424.05","$1,424.05","$1,126.74","$1,023.0675","$1,319.12","$1,379.08"
,CDM,4078004006.10.4078,PLAT.PHERESIS LR CMV IRRAD,CDM Code,Outpatient,P9053,"$1,694.",$419.0787,"$1,652.4363","$1,355.2","$1,541.54",$444.2227,"$1,609.3",$419.0787,"$1,609.3","$1,609.3","$1,652.4363","$1,156.155","$1,490.72","$1,558.48"
,CDM,4078004011.10.4078,FRESH FRZN PLASMA PER UNIT,CDM Code,Outpatient,P9017,$300.,$74.217,$285.,$240.,$273.,$78.6699,$285.,$74.217,$285.,$285.,$196.8591,$204.75,$264.,$276.
,CDM,4078004013.10.4078,KLEIHAUER BETKE STAIN(PH),CDM Code,Outpatient,85460,$581.,$8.503,$551.95,$464.8,$528.71,$152.3574,$551.95,$143.7336,$551.95,$551.95,$7.73,$396.5325,$8.503,$534.52
,CDM,4078004014.10.4078,RH PHENOTYPING COMPLETE(PSBC),CDM Code,Outpatient,86906,$203.,$8.525,$192.85,$162.4,$184.73,$53.2333,$192.85,$50.2202,$192.85,$192.85,$75.7746,$138.5475,$8.525,$186.76
,CDM,4078004015.10.4078,ANTIBODY TITRATION (PSBC),CDM Code,Outpatient,86886,$376.,$5.698,$357.2,$300.8,$342.16,$98.5996,$357.2,$93.0186,$357.2,$357.2,$277.3596,$256.62,$5.698,$345.92
,CDM,4078004016.10.4078,AUTOABSORPTION CHG (PSBC),CDM Code,Outpatient,86978,$409.,$51.5,$388.55,$327.2,$372.19,$107.2533,$388.55,$101.1825,$388.55,$388.55,$33.6951,$279.1425,$51.5,$376.28
,CDM,4078004017.10.4078,ALLOABSORPTION (PSBC),CDM Code,Outpatient,86978,$665.,$51.5,$631.75,$532.,$605.15,$174.3849,$631.75,$164.5144,$631.75,$631.75,$33.6951,$453.8625,$51.5,$611.8
,CDM,4078004018.10.4078,ELUTION (PSBC),CDM Code,Outpatient,86860,$278.,$46.5,$277.3596,$222.4,$252.98,$72.9008,$264.1,$68.7744,$264.1,$264.1,$277.3596,$189.735,$46.5,$255.76
,CDM,4078004019.10.4078,NEUTRALIZATION (PSBC),CDM Code,Outpatient,86977,$92.,$22.7599,$277.3596,$73.6,$83.72,$24.1254,$87.4,$22.7599,$87.4,$87.4,$277.3596,$62.79,$51.5,$84.64
,CDM,4078004021.10.4078,CHEM TREATMNT RED CELLS (PSBC),CDM Code,Outpatient,86970,$103.,$25.4812,$97.85,$82.4,$93.73,$27.01,$97.85,$25.4812,$97.85,$97.85,$75.7746,$70.2975,$43.,$94.76
,CDM,4078004022.10.4078,ENZYME TREATMNT REDCELLS(PSBC,CDM Code,Outpatient,86971,$103.,$25.4812,$491.3067,$82.4,$93.73,$27.01,$97.85,$25.4812,$97.85,$97.85,$491.3067,$70.2975,$34.5,$94.76
,CDM,4078004025.10.4078,REDCELL PHENOTYPE NEG ANTIG,CDM Code,Outpatient,86902,$194.,$6.985,$491.3067,$155.2,$176.54,$50.8732,$184.3,$47.9937,$184.3,$184.3,$491.3067,$132.405,$6.985,$178.48
,CDM,4078004026.10.4078,PLATELET ALLOANTIBODY (PSBC),CDM Code,Outpatient,86022,$542.,$20.207,$514.9,$433.6,$493.22,$142.1303,$514.9,$134.0854,$514.9,$514.9,$18.37,$369.915,$20.207,$498.64
,CDM,4078004027.10.4078,BLOOD PRODUCT IRRADIATION,CDM Code,Outpatient,86945,$86.,$21.2755,$81.7,$68.8,$78.26,$22.552,$81.7,$21.2755,$81.7,$81.7,$75.7746,$58.695,$43.,$79.12
,CDM,4078006430.10.4078,PLATELET ASSC. IMMUNOGLOBULIN,CDM Code,Outpatient,86023,$150.,$13.706,$142.5,$120.,$136.5,$39.3349,$142.5,$37.1085,$142.5,$142.5,$12.46,$102.375,$13.706,$138.
,CDM,4110000502.10.4110,EKG,CDM Code,Outpatient,93005,$206.,$50.9623,$195.7,$164.8,$187.46,$54.02,$195.7,$50.9623,$195.7,$195.7,$145.6485,$140.595,$181.28,$189.52
,CDM,4110000502.20.4180,EKG,CDM Code,Outpatient,93005,$206.,$50.9623,$195.7,$164.8,$187.46,$54.02,$195.7,$50.9623,$195.7,$195.7,$145.6485,$140.595,$181.28,$189.52
,CDM,4110000502.30.4180,EKG,CDM Code,Outpatient,93005,$206.,$50.9623,$195.7,$164.8,$187.46,$54.02,$195.7,$50.9623,$195.7,$195.7,$145.6485,$140.595,$181.28,$189.52
,CDM,4120000001.10.4120,MRI ABDOMEN W/CONT,CDM Code,Outpatient,74182,"$3,423.",$419.,"$3,251.85","$2,738.4","$3,114.93",$897.6236,"$3,251.85",$846.816,"$3,251.85","$3,251.85","$1,138.8084","$2,336.1975",$419.,"$3,149.16"
,CDM,4120000002.10.4120,MRI ABDOMEN W/O CONT,CDM Code,Outpatient,74181,"$1,742.",$296.,"$1,654.9","$1,393.6","$1,585.22",$456.8099,"$1,654.9",$430.9534,"$1,654.9","$1,654.9",$603.1797,"$1,188.915",$296.,"$1,602.64"
,CDM,4120000003.10.4120,MRI ABDOMEN W/O & W/CONT,CDM Code,Outpatient,74183,"$3,423.",$448.5,"$3,251.85","$2,738.4","$3,114.93",$897.6236,"$3,251.85",$846.816,"$3,251.85","$3,251.85","$1,138.8084","$2,336.1975",$448.5,"$3,149.16"
,CDM,4120000011.10.4120,MRI ANGIO HEAD W/O CONT,CDM Code,Outpatient,70544,"$1,742.",$378.5,"$1,654.9","$1,393.6","$1,585.22",$456.8099,"$1,654.9",$430.9534,"$1,654.9","$1,654.9",$603.1797,"$1,188.915",$378.5,"$1,602.64"
,CDM,4120000013.10.4120,MRI BRAIN W/O CONTRAST,CDM Code,Outpatient,70551,"$1,742.",$221.5,"$1,654.9","$1,393.6","$1,585.22",$456.8099,"$1,654.9",$430.9534,"$1,654.9","$1,654.9",$603.1797,"$1,188.915",$221.5,"$1,602.64"
,CDM,4120000014.10.4120,MRI BRAIN W/CONT,CDM Code,Outpatient,70552,"$1,896.",$327.,"$1,801.2","$1,516.8","$1,725.36",$497.1938,"$1,801.2",$469.0514,"$1,801.2","$1,801.2","$1,138.8084","$1,294.02",$327.,"$1,744.32"
,CDM,4120000015.10.4120,MRI BRAIN W/O THEN W/CONTR,CDM Code,Outpatient,70553,"$3,423.",$373.,"$3,251.85","$2,738.4","$3,114.93",$897.6236,"$3,251.85",$846.816,"$3,251.85","$3,251.85","$1,138.8084","$2,336.1975",$373.,"$3,149.16"
,CDM,4120000017.10.4120,MRI BX BREAST RT,CDM Code,Outpatient,19085RT,"$4,618.","$1,142.447","$4,387.1","$3,694.4","$4,202.38","$1,210.992","$4,387.1","$1,142.447","$4,387.1","$4,387.1","$3,301.7754","$3,151.785","$1,426.","$4,248.56"
,CDM,4120000018.10.4120,MRI BX BREAST LT,CDM Code,Outpatient,19085LT,"$5,369.","$1,328.2369","$5,100.55","$4,295.2","$4,885.79","$1,407.929","$5,100.55","$1,328.2369","$5,100.55","$5,100.55","$3,301.7754","$3,664.3425","$1,426.","$4,939.48"
,CDM,4120000019.10.4120,MRI BREAST BI W/O CONT,CDM Code,Outpatient,77059,"$3,063.",$757.7556,"$2,909.85","$2,450.4","$2,787.33",$803.2197,"$2,909.85",$757.7556,"$2,909.85","$2,909.85",$306.3,"$2,090.4975","$2,695.44","$2,817.96"
,CDM,4120000020.10.4120,MRI BREAST BI W & W/O CONT,CDM Code,Outpatient,77059,"$5,150.","$1,274.0585","$4,892.5","$4,120.","$4,686.5","$1,350.4999","$4,892.5","$1,274.0585","$4,892.5","$4,892.5",$515.,"$3,514.875","$4,532.","$4,738."
,CDM,4120000022.10.4120,MRI BREAST RT,CDM Code,Outpatient,77058,"$4,666.","$1,154.3217","$4,432.7","$3,732.8","$4,246.06","$1,223.5792","$4,432.7","$1,154.3217","$4,432.7","$4,432.7",$466.6,"$3,184.545","$4,106.08","$4,292.72"
,CDM,4120000023.10.4120,MRI CERVICAL SPINE W/CONTRAST,CDM Code,Outpatient,72142,"$4,656.",$462.5,"$4,423.2","$3,724.8","$4,236.96","$1,220.9568","$4,423.2","$1,151.8478","$4,423.2","$4,423.2","$1,138.8084","$3,177.72",$462.5,"$4,283.52"
,CDM,4120000024.10.4120,MRI CERVICAL SPINE W/O CONTRAS,CDM Code,Outpatient,72141,"$1,742.",$318.5,"$1,654.9","$1,393.6","$1,585.22",$456.8099,"$1,654.9",$430.9534,"$1,654.9","$1,654.9",$603.1797,"$1,188.915",$318.5,"$1,602.64"
,CDM,4120000025.10.4120,MRI CERVICAL W & W/O CONT,CDM Code,Outpatient,72156,"$3,423.",$538.5,"$3,251.85","$2,738.4","$3,114.93",$897.6236,"$3,251.85",$846.816,"$3,251.85","$3,251.85","$1,138.8084","$2,336.1975",$538.5,"$3,149.16"
,CDM,4120000030.10.4120,MRI CHEST W/O CONT,CDM Code,Outpatient,71550,"$1,742.",$430.9534,"$1,654.9","$1,393.6","$1,585.22",$456.8099,"$1,654.9",$430.9534,"$1,654.9","$1,654.9",$603.1797,"$1,188.915",$588.,"$1,602.64"
,CDM,4120000032.10.4120,MRI CHEST W/ & W/O,CDM Code,Outpatient,71552,"$3,423.",$820.5,"$3,251.85","$2,738.4","$3,114.93",$897.6236,"$3,251.85",$846.816,"$3,251.85","$3,251.85","$1,138.8084","$2,336.1975",$820.5,"$3,149.16"
,CDM,4120000034.10.4120,MRI FACIAL W/O,CDM Code,Outpatient,70540,$0.,$0.,$603.1797,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$603.1797,$0.,$288.,$0.
,CDM,4120000035.10.4120,MRI FACIAL W/WO,CDM Code,Outpatient,70543,"$4,541.",$420.,"$4,313.95","$3,632.8","$4,132.31","$1,190.8001","$4,313.95","$1,123.398","$4,313.95","$4,313.95","$1,138.8084","$3,099.2325",$420.,"$4,177.72"
,CDM,4120000041.10.4120,"MRI ORBIT,FACE,NECK W/O CONT",CDM Code,Outpatient,70540,"$3,268.",$288.,"$3,104.6","$2,614.4","$2,973.88",$856.9774,"$3,104.6",$808.4705,"$3,104.6","$3,104.6",$603.1797,"$2,230.41",$288.,"$3,006.56"
,CDM,4120000042.10.4120,"MRI ORBIT,FACE,NECK W/O & W/",CDM Code,Outpatient,70543,"$3,423.",$420.,"$3,251.85","$2,738.4","$3,114.93",$897.6236,"$3,251.85",$846.816,"$3,251.85","$3,251.85","$1,138.8084","$2,336.1975",$420.,"$3,149.16"
,CDM,4120000047.10.4120,MRI BILAT LOWER EXT W/O CONT,CDM Code,Outpatient,73718,"$2,720.",$338.5,"$2,584.","$2,176.","$2,475.2",$713.2738,"$2,584.",$672.9008,"$2,584.","$2,584.",$603.1797,"$1,856.4",$338.5,"$2,502.4"
,CDM,4120000052.10.4120,MRI LOWER EXT W/O CONT LT,CDM Code,Outpatient,73718LT,"$1,742.",$338.5,"$1,654.9","$1,393.6","$1,585.22",$456.8099,"$1,654.9",$430.9534,"$1,654.9","$1,654.9",$603.1797,"$1,188.915",$338.5,"$1,602.64"
,CDM,4120000053.10.4120,MRI LOWER EXT W/O & W/CONT LT,CDM Code,Outpatient,73720LT,"$3,423.",$450.,"$3,251.85","$2,738.4","$3,114.93",$897.6236,"$3,251.85",$846.816,"$3,251.85","$3,251.85","$1,138.8084","$2,336.1975",$450.,"$3,149.16"
,CDM,4120000057.10.4120,MRI LOWER EXT W/O CONT RT,CDM Code,Outpatient,73718RT,"$1,742.",$338.5,"$1,654.9","$1,393.6","$1,585.22",$456.8099,"$1,654.9",$430.9534,"$1,654.9","$1,654.9",$603.1797,"$1,188.915",$338.5,"$1,602.64"
,CDM,4120000058.10.4120,MRI LOWER EXT W/O & W/CONT RT,CDM Code,Outpatient,73720RT,"$3,423.",$450.,"$3,251.85","$2,738.4","$3,114.93",$897.6236,"$3,251.85",$846.816,"$3,251.85","$3,251.85","$1,138.8084","$2,336.1975",$450.,"$3,149.16"
,CDM,4120000061.10.4120,MRI BILAT LOWER JOINT W/O CONT,CDM Code,Outpatient,7372150,"$2,408.",$239.5,"$2,287.6","$1,926.4","$2,191.28",$631.4571,"$2,287.6",$595.7151,"$2,287.6","$2,287.6",$603.1797,"$1,643.46",$239.5,"$2,215.36"
,CDM,4120000064.10.4120,MRI LOWER JOINT W/O CONT LT,CDM Code,Outpatient,73721LT,"$1,742.",$239.5,"$1,654.9","$1,393.6","$1,585.22",$456.8099,"$1,654.9",$430.9534,"$1,654.9","$1,654.9",$603.1797,"$1,188.915",$239.5,"$1,602.64"
,CDM,4120000065.10.4120,MRI LOWER JOINT W/O &W/CONT LT,CDM Code,Outpatient,73723LT,"$3,423.",$513.,"$3,251.85","$2,738.4","$3,114.93",$897.6236,"$3,251.85",$846.816,"$3,251.85","$3,251.85","$1,138.8084","$2,336.1975",$513.,"$3,149.16"
,CDM,4120000071.10.4120,MRI LOWER JOINT W/O CONT RT,CDM Code,Outpatient,73721RT,"$1,742.",$239.5,"$1,654.9","$1,393.6","$1,585.22",$456.8099,"$1,654.9",$430.9534,"$1,654.9","$1,654.9",$603.1797,"$1,188.915",$239.5,"$1,602.64"
,CDM,4120000072.10.4120,MRI LOWER JOINT W/O &W/CONT RT,CDM Code,Outpatient,73723RT,"$3,423.",$513.,"$3,251.85","$2,738.4","$3,114.93",$897.6236,"$3,251.85",$846.816,"$3,251.85","$3,251.85","$1,138.8084","$2,336.1975",$513.,"$3,149.16"
,CDM,4120000073.10.4120,MRI LUMBAR SPINE W/CONT,CDM Code,Outpatient,72149,"$3,423.",$456.5,"$3,251.85","$2,738.4","$3,114.93",$897.6236,"$3,251.85",$846.816,"$3,251.85","$3,251.85","$1,138.8084","$2,336.1975",$456.5,"$3,149.16"
,CDM,4120000074.10.4120,MRI LUMBAR W/O CONT,CDM Code,Outpatient,72148,"$1,742.",$318.5,"$1,654.9","$1,393.6","$1,585.22",$456.8099,"$1,654.9",$430.9534,"$1,654.9","$1,654.9",$603.1797,"$1,188.915",$318.5,"$1,602.64"
,CDM,4120000075.10.4120,MRI LUMBAR W/ & W/O CONT,CDM Code,Outpatient,72158,"$3,423.",$537.5,"$3,251.85","$2,738.4","$3,114.93",$897.6236,"$3,251.85",$846.816,"$3,251.85","$3,251.85","$1,138.8084","$2,336.1975",$537.5,"$3,149.16"
,CDM,4120000081.10.4120,MRI ANGIO NECK W/O CONT,CDM Code,Outpatient,70547,"$1,742.",$380.5,"$1,654.9","$1,393.6","$1,585.22",$456.8099,"$1,654.9",$430.9534,"$1,654.9","$1,654.9",$603.1797,"$1,188.915",$380.5,"$1,602.64"
,CDM,4120000082.10.4120,MRI ANGIO NECK W/O & W/CONT,CDM Code,Outpatient,70549,"$3,423.",$584.,"$3,251.85","$2,738.4","$3,114.93",$897.6236,"$3,251.85",$846.816,"$3,251.85","$3,251.85","$1,138.8084","$2,336.1975",$584.,"$3,149.16"
,CDM,4120000084.10.4120,MRI NECK SOFT TISSUE W/O,CDM Code,Outpatient,70540,"$1,742.",$288.,"$1,654.9","$1,393.6","$1,585.22",$456.8099,"$1,654.9",$430.9534,"$1,654.9","$1,654.9",$603.1797,"$1,188.915",$288.,"$1,602.64"
,CDM,4120000085.10.4120,MRI NECK SOFT TISSUE W/WO,CDM Code,Outpatient,70543,"$3,423.",$420.,"$3,251.85","$2,738.4","$3,114.93",$897.6236,"$3,251.85",$846.816,"$3,251.85","$3,251.85","$1,138.8084","$2,336.1975",$420.,"$3,149.16"
,CDM,4120000091.10.4120,MRI ORBITS W/O,CDM Code,Outpatient,70540,"$3,268.",$288.,"$3,104.6","$2,614.4","$2,973.88",$856.9774,"$3,104.6",$808.4705,"$3,104.6","$3,104.6",$603.1797,"$2,230.41",$288.,"$3,006.56"
,CDM,4120000092.10.4120,MRI ORBITS W/WO,CDM Code,Outpatient,70543,"$3,423.",$420.,"$3,251.85","$2,738.4","$3,114.93",$897.6236,"$3,251.85",$846.816,"$3,251.85","$3,251.85","$1,138.8084","$2,336.1975",$420.,"$3,149.16"
,CDM,4120000094.10.4120,MRI PELVIS W/O CONT,CDM Code,Outpatient,72195,"$1,742.",$430.9534,"$1,654.9","$1,393.6","$1,585.22",$456.8099,"$1,654.9",$430.9534,"$1,654.9","$1,654.9",$603.1797,"$1,188.915",$448.5,"$1,602.64"
,CDM,4120000095.10.4120,MRI PELVIS W/O THEN W/CONT,CDM Code,Outpatient,72197,"$3,423.",$603.5,"$3,251.85","$2,738.4","$3,114.93",$897.6236,"$3,251.85",$846.816,"$3,251.85","$3,251.85","$1,138.8084","$2,336.1975",$603.5,"$3,149.16"
,CDM,4120000101.10.4120,MRI THORACIC SPINE W/O CONTRAS,CDM Code,Outpatient,72146,"$1,742.",$319.,"$1,654.9","$1,393.6","$1,585.22",$456.8099,"$1,654.9",$430.9534,"$1,654.9","$1,654.9",$603.1797,"$1,188.915",$319.,"$1,602.64"
,CDM,4120000102.10.4120,MRI THORACIC W/ & W/O CONT,CDM Code,Outpatient,72157,"$3,423.",$539.5,"$3,251.85","$2,738.4","$3,114.93",$897.6236,"$3,251.85",$846.816,"$3,251.85","$3,251.85","$1,138.8084","$2,336.1975",$539.5,"$3,149.16"
,CDM,4120000110.10.4120,MRI UPPER EXT W/CONT LT,CDM Code,Outpatient,73219LT,$0.,$0.,"$1,138.8084",$0.,$0.,$0.,$0.,$0.,$0.,$0.,"$1,138.8084",$0.,$455.5,$0.
,CDM,4120000111.10.4120,MRI UPPER EXT W/O CONT LT,CDM Code,Outpatient,73218LT,"$1,742.",$423.,"$1,654.9","$1,393.6","$1,585.22",$456.8099,"$1,654.9",$430.9534,"$1,654.9","$1,654.9",$603.1797,"$1,188.915",$423.,"$1,602.64"
,CDM,4120000112.10.4120,MRI UPPER EXT W/O & W/CONT LT,CDM Code,Outpatient,73220LT,"$3,423.",$555.,"$3,251.85","$2,738.4","$3,114.93",$897.6236,"$3,251.85",$846.816,"$3,251.85","$3,251.85","$1,138.8084","$2,336.1975",$555.,"$3,149.16"
,CDM,4120000114.10.4120,MRI UPPER EXT W/O CONT RT,CDM Code,Outpatient,73218RT,"$1,742.",$423.,"$1,654.9","$1,393.6","$1,585.22",$456.8099,"$1,654.9",$430.9534,"$1,654.9","$1,654.9",$603.1797,"$1,188.915",$423.,"$1,602.64"
,CDM,4120000115.10.4120,MRI UPPER EXT W/O & W/CONT RT,CDM Code,Outpatient,73220RT,"$3,423.",$555.,"$3,251.85","$2,738.4","$3,114.93",$897.6236,"$3,251.85",$846.816,"$3,251.85","$3,251.85","$1,138.8084","$2,336.1975",$555.,"$3,149.16"
,CDM,4120000121.10.4120,MRI BILAT UPPER JOINT W/O CONT,CDM Code,Outpatient,73221,"$2,399.",$239.5,"$2,279.05","$1,919.2","$2,183.09",$629.097,"$2,279.05",$593.4886,"$2,279.05","$2,279.05",$603.1797,"$1,637.3175",$239.5,"$2,207.08"
,CDM,4120000124.10.4120,MRI UPPER JOINT W/O CONT LT,CDM Code,Outpatient,73221LT,"$1,742.",$239.5,"$1,654.9","$1,393.6","$1,585.22",$456.8099,"$1,654.9",$430.9534,"$1,654.9","$1,654.9",$603.1797,"$1,188.915",$239.5,"$1,602.64"
,CDM,4120000125.10.4120,MRI UPPER JOINT W/O &W/CONT LT,CDM Code,Outpatient,73223LT,"$3,423.",$513.5,"$3,251.85","$2,738.4","$3,114.93",$897.6236,"$3,251.85",$846.816,"$3,251.85","$3,251.85","$1,138.8084","$2,336.1975",$513.5,"$3,149.16"
,CDM,4120000131.10.4120,MRI UPPER JOINT W/O CONT RT,CDM Code,Outpatient,73221RT,"$1,742.",$239.5,"$1,654.9","$1,393.6","$1,585.22",$456.8099,"$1,654.9",$430.9534,"$1,654.9","$1,654.9",$603.1797,"$1,188.915",$239.5,"$1,602.64"
,CDM,4120000132.10.4120,MRI UPPER JOINT W/O &W/CONT RT,CDM Code,Outpatient,73223RT,"$3,423.",$513.5,"$3,251.85","$2,738.4","$3,114.93",$897.6236,"$3,251.85",$846.816,"$3,251.85","$3,251.85","$1,138.8084","$2,336.1975",$513.5,"$3,149.16"
,CDM,4120000134.10.4120,MRI PITUITARY W/WO,CDM Code,Outpatient,70553,"$4,618.",$373.,"$4,387.1","$3,694.4","$4,202.38","$1,210.992","$4,387.1","$1,142.447","$4,387.1","$4,387.1","$1,138.8084","$3,151.785",$373.,"$4,248.56"
,CDM,4120000136.10.4120,MRI ANGIO ABDOMEN,CDM Code,Outpatient,74185,"$1,529.",$378.2593,"$1,452.55","$1,223.2","$1,391.39",$400.9543,"$1,452.55",$378.2593,"$1,452.55","$1,452.55",$152.9,"$1,043.5425",$444.,"$1,406.68"
,CDM,4120000139.10.4120,MRI ANGIO CHEST,CDM Code,Outpatient,71555,"$3,054.",$566.,"$2,901.3","$2,443.2","$2,779.14",$800.8596,"$2,901.3",$755.5291,"$2,901.3","$2,901.3",$305.4,"$2,084.355",$566.,"$2,809.68"
,CDM,4120000160.10.4120,MRI BILAT ANGIO LOWER EXT,CDM Code,Outpatient,73725,"$1,474.",$364.6529,"$1,400.3","$1,179.2","$1,341.34",$386.5314,"$1,400.3",$364.6529,"$1,400.3","$1,400.3",$147.4,"$1,006.005",$440.,"$1,356.08"
,CDM,4120000170.10.4120,MRI MRCP W/O,CDM Code,Outpatient,74181,"$1,742.",$296.,"$1,654.9","$1,393.6","$1,585.22",$456.8099,"$1,654.9",$430.9534,"$1,654.9","$1,654.9",$603.1797,"$1,188.915",$296.,"$1,602.64"
,CDM,4120000171.10.4120,MRI MRCP W/WO,CDM Code,Outpatient,74183,"$3,423.",$448.5,"$3,251.85","$2,738.4","$3,114.93",$897.6236,"$3,251.85",$846.816,"$3,251.85","$3,251.85","$1,138.8084","$2,336.1975",$448.5,"$3,149.16"
,CDM,4120000173.10.4120,MRI ARTHROGRAM SHOULDER LT,CDM Code,Outpatient,73222LT,"$5,103.",$421.5,"$4,847.85","$4,082.4","$4,643.73","$1,338.175","$4,847.85","$1,262.4312","$4,847.85","$4,847.85","$1,753.9497","$3,482.7975",$421.5,"$4,694.76"
,CDM,4120000174.10.4120,MRI ARTHROGRAM SHOULDER RT,CDM Code,Outpatient,73222RT,"$5,103.",$421.5,"$4,847.85","$4,082.4","$4,643.73","$1,338.175","$4,847.85","$1,262.4312","$4,847.85","$4,847.85","$1,753.9497","$3,482.7975",$421.5,"$4,694.76"
,CDM,4120000175.10.4120,MRI ARTHROGRAM WRIST LT,CDM Code,Outpatient,73222LT,"$5,103.",$421.5,"$4,847.85","$4,082.4","$4,643.73","$1,338.175","$4,847.85","$1,262.4312","$4,847.85","$4,847.85","$1,753.9497","$3,482.7975",$421.5,"$4,694.76"
,CDM,4120000176.10.4120,MRI ARTHROGRAM WRIST RT,CDM Code,Outpatient,73222RT,"$5,103.",$421.5,"$4,847.85","$4,082.4","$4,643.73","$1,338.175","$4,847.85","$1,262.4312","$4,847.85","$4,847.85","$1,753.9497","$3,482.7975",$421.5,"$4,694.76"
,CDM,4120000177.10.4120,MRI ARTHROGRAM ANKLE LT,CDM Code,Outpatient,73722,"$5,103.",$425.,"$4,847.85","$4,082.4","$4,643.73","$1,338.175","$4,847.85","$1,262.4312","$4,847.85","$4,847.85","$1,753.9497","$3,482.7975",$425.,"$4,694.76"
,CDM,4120000178.10.4120,MRI ARTHROGRAM ANKLE RT,CDM Code,Outpatient,73722,"$3,666.",$425.,"$3,482.7","$2,932.8","$3,336.06",$961.3462,"$3,482.7",$906.9317,"$3,482.7","$3,482.7","$1,753.9497","$2,502.045",$425.,"$3,372.72"
,CDM,4120000179.10.4120,MRI ARTHROGRAM ELBOW RT,CDM Code,Outpatient,73722,"$3,740.",$425.,"$3,553.","$2,992.","$3,403.4",$980.7514,"$3,553.",$925.2386,"$3,553.","$3,553.","$1,753.9497","$2,552.55",$425.,"$3,440.8"
,CDM,4120000181.10.4120,MRI ARTHROGRAM HIP LT,CDM Code,Outpatient,73722,"$5,103.",$425.,"$4,847.85","$4,082.4","$4,643.73","$1,338.175","$4,847.85","$1,262.4312","$4,847.85","$4,847.85","$1,753.9497","$3,482.7975",$425.,"$4,694.76"
,CDM,4120000182.10.4120,MRI ARTHROGRAM KNEE LT,CDM Code,Outpatient,73722,"$5,103.",$425.,"$4,847.85","$4,082.4","$4,643.73","$1,338.175","$4,847.85","$1,262.4312","$4,847.85","$4,847.85","$1,753.9497","$3,482.7975",$425.,"$4,694.76"
,CDM,4120000183.10.4120,MRI ARTHROGRAM HIP RT,CDM Code,Outpatient,73722,"$5,103.",$425.,"$4,847.85","$4,082.4","$4,643.73","$1,338.175","$4,847.85","$1,262.4312","$4,847.85","$4,847.85","$1,753.9497","$3,482.7975",$425.,"$4,694.76"
,CDM,4120000184.10.4120,MRI ARTHROGRAM KNEE RT,CDM Code,Outpatient,73722,"$5,103.",$425.,"$4,847.85","$4,082.4","$4,643.73","$1,338.175","$4,847.85","$1,262.4312","$4,847.85","$4,847.85","$1,753.9497","$3,482.7975",$425.,"$4,694.76"
,CDM,4120000202.10.4120,MRI 3D RENDERING,CDM Code,Outpatient,76376,$929.,$19.,$882.55,$743.2,$845.39,$243.6145,$882.55,$229.8253,$882.55,$882.55,$92.9,$634.0425,$19.,$854.68
,CDM,4120000207.10.4120,MRI BREAST W/O CON BILAT,CDM Code,Outpatient,77047,"$2,721.",$114.,"$2,584.95","$2,176.8","$2,476.11",$713.536,"$2,584.95",$673.1482,"$2,584.95","$2,584.95",$615.5952,"$1,857.0825",$114.,"$2,503.32"
,CDM,4120000210.10.4120,MRI BREAST W/WO CONT,CDM Code,Outpatient,77049,"$3,422.",$569.5,"$3,250.9","$2,737.6","$3,114.02",$897.3613,"$3,250.9",$846.5686,"$3,250.9","$3,250.9",$342.2,"$2,335.515",$569.5,"$3,148.24"
,CDM,4120000211.10.4120,MRI BONEMARROW BLD SUPPLY W/O,CDM Code,Outpatient,77084,"$1,730.",$427.9847,"$1,643.5","$1,384.","$1,574.3",$453.6631,"$1,643.5",$427.9847,"$1,643.5","$1,643.5","$1,200.6456","$1,180.725",$437.,"$1,591.6"
,CDM,4130000001.10.4130,CT HEAD W/O CONTRAST,CDM Code,Outpatient,70450,$858.,$103.5,$815.1,$686.4,$780.78,$224.9959,$815.1,$212.2606,$815.1,$815.1,$300.9891,$585.585,$103.5,$789.36
,CDM,4130000002.10.4130,CT HEAD W&W/O CONTRAST,CDM Code,Outpatient,70470,"$1,896.",$180.5,"$1,801.2","$1,516.8","$1,725.36",$497.1938,"$1,801.2",$469.0514,"$1,801.2","$1,801.2",$707.6034,"$1,294.02",$180.5,"$1,744.32"
,CDM,4130000003.10.4130,CT HEAD WITH CONTRAST,CDM Code,Outpatient,70460,"$1,896.",$150.,"$1,801.2","$1,516.8","$1,725.36",$497.1938,"$1,801.2",$469.0514,"$1,801.2","$1,801.2",$707.6034,"$1,294.02",$150.,"$1,744.32"
,CDM,4130000004.10.4130,"CT ORBITS,SELLA,IACS W/O CONT",CDM Code,Outpatient,70480,$858.,$212.2606,$815.1,$686.4,$780.78,$224.9959,$815.1,$212.2606,$815.1,$815.1,$300.9891,$585.585,$238.5,$789.36
,CDM,4130000005.10.4130,"CT ORBITS,SELLA,IAC W&W/O CONT",CDM Code,Outpatient,70482,"$2,693.",$322.,"$2,558.35","$2,154.4","$2,450.63",$706.1935,"$2,558.35",$666.2213,"$2,558.35","$2,558.35",$707.6034,"$1,837.9725",$322.,"$2,477.56"
,CDM,4130000006.10.4130,"CT ORBITS,SELLA,IAC W/CON",CDM Code,Outpatient,70481,"$1,194.",$291.5,"$1,134.3",$955.2,"$1,086.54",$313.1062,"$1,134.3",$295.3837,"$1,134.3","$1,134.3",$707.6034,$814.905,$291.5,"$1,098.48"
,CDM,4130000007.10.4130,CT HEAD W/O STROKE PROTOCOL,CDM Code,Outpatient,70450,$858.,$103.5,$815.1,$686.4,$780.78,$224.9959,$815.1,$212.2606,$815.1,$815.1,$300.9891,$585.585,$103.5,$789.36
,CDM,4130000010.10.4130,CT ORBITS W/O,CDM Code,Outpatient,70480,$858.,$212.2606,$815.1,$686.4,$780.78,$224.9959,$815.1,$212.2606,$815.1,$815.1,$300.9891,$585.585,$238.5,$789.36
,CDM,4130000011.10.4130,CT ORBITS W/WO,CDM Code,Outpatient,70482,"$2,693.",$322.,"$2,558.35","$2,154.4","$2,450.63",$706.1935,"$2,558.35",$666.2213,"$2,558.35","$2,558.35",$707.6034,"$1,837.9725",$322.,"$2,477.56"
,CDM,4130000012.10.4130,CT ORBITS W/,CDM Code,Outpatient,70481,"$1,896.",$291.5,"$1,801.2","$1,516.8","$1,725.36",$497.1938,"$1,801.2",$469.0514,"$1,801.2","$1,801.2",$707.6034,"$1,294.02",$291.5,"$1,744.32"
,CDM,4130000013.10.4130,CT SELLA TURCICA W/O,CDM Code,Outpatient,70480,"$1,979.",$238.5,"$1,880.05","$1,583.2","$1,800.89",$518.9591,"$1,880.05",$489.5848,"$1,880.05","$1,880.05",$300.9891,"$1,350.6675",$238.5,"$1,820.68"
,CDM,4130000020.10.4130,CT SOFT TISSUE NECK WO CON,CDM Code,Outpatient,70490,$858.,$146.5,$815.1,$686.4,$780.78,$224.9959,$815.1,$212.2606,$815.1,$815.1,$300.9891,$585.585,$146.5,$789.36
,CDM,4130000021.10.4130,CT SOFT TISSUE NECK W&W/O CONT,CDM Code,Outpatient,70492,"$1,896.",$231.,"$1,801.2","$1,516.8","$1,725.36",$497.1938,"$1,801.2",$469.0514,"$1,801.2","$1,801.2",$707.6034,"$1,294.02",$231.,"$1,744.32"
,CDM,4130000022.10.4130,CT SOFT TISSUE NECK W/CONTRAST,CDM Code,Outpatient,70491,"$1,896.",$189.,"$1,801.2","$1,516.8","$1,725.36",$497.1938,"$1,801.2",$469.0514,"$1,801.2","$1,801.2",$707.6034,"$1,294.02",$189.,"$1,744.32"
,CDM,4130000023.10.4130,CT THORAX WITH CONTRAST,CDM Code,Outpatient,71260,"$1,896.",$469.0514,"$1,801.2","$1,516.8","$1,725.36",$497.1938,"$1,801.2",$469.0514,"$1,801.2","$1,801.2",$707.6034,"$1,294.02","$1,668.48","$1,744.32"
,CDM,4130000024.10.4130,CT THORAX W/O CONTRAST,CDM Code,Outpatient,71250,$858.,$212.2606,$815.1,$686.4,$780.78,$224.9959,$815.1,$212.2606,$815.1,$815.1,$300.9891,$585.585,$755.04,$789.36
,CDM,4130000025.10.4130,CT THORAX W&W/O CONTRAST,CDM Code,Outpatient,71270,"$1,896.",$333.,"$1,801.2","$1,516.8","$1,725.36",$497.1938,"$1,801.2",$469.0514,"$1,801.2","$1,801.2",$707.6034,"$1,294.02",$333.,"$1,744.32"
,CDM,4130000026.10.4130,CT STERNO CLAV JOINT,CDM Code,Outpatient,7125052,"$2,048.",$506.6547,"$1,945.6","$1,638.4","$1,863.68",$537.0532,"$1,945.6",$506.6547,"$1,945.6","$1,945.6",$300.9891,"$1,397.76","$1,802.24","$1,884.16"
,CDM,4130000030.10.4130,CT ABDOMEN WITH CONTRAST,CDM Code,Outpatient,74160,"$1,896.",$236.,"$1,801.2","$1,516.8","$1,725.36",$497.1938,"$1,801.2",$469.0514,"$1,801.2","$1,801.2",$707.6034,"$1,294.02",$236.,"$1,744.32"
,CDM,4130000031.10.4130,CT ABDOMEN W/O CONTRAST,CDM Code,Outpatient,74150,$858.,$127.,$815.1,$686.4,$780.78,$224.9959,$815.1,$212.2606,$815.1,$815.1,$300.9891,$585.585,$127.,$789.36
,CDM,4130000032.10.4130,CT ABDOMEN W & W/O CONTRAST,CDM Code,Outpatient,74170,"$1,896.",$271.5,"$1,801.2","$1,516.8","$1,725.36",$497.1938,"$1,801.2",$469.0514,"$1,801.2","$1,801.2",$707.6034,"$1,294.02",$271.5,"$1,744.32"
,CDM,4130000033.10.4130,CT ABD AND PELVIS WITH CONTRAS,CDM Code,Outpatient,74177,"$1,896.",$311.,"$1,801.2","$1,516.8","$1,725.36",$497.1938,"$1,801.2",$469.0514,"$1,801.2","$1,801.2",$707.6034,"$1,294.02",$311.,"$1,744.32"
,CDM,4130000034.10.4130,CT ABD AND PELVIS W & WO CONTR,CDM Code,Outpatient,74178,"$1,896.",$357.,"$1,801.2","$1,516.8","$1,725.36",$497.1938,"$1,801.2",$469.0514,"$1,801.2","$1,801.2","$1,138.8084","$1,294.02",$357.,"$1,744.32"
,CDM,4130000035.10.4130,CT ABD AND PELVIS W/O CONTRAST,CDM Code,Outpatient,74176,"$1,742.",$160.,"$1,654.9","$1,393.6","$1,585.22",$456.8099,"$1,654.9",$430.9534,"$1,654.9","$1,654.9",$603.1797,"$1,188.915",$160.,"$1,602.64"
,CDM,4130000040.10.4130,CT PELVIS WITH CONTRAST,CDM Code,Outpatient,72193,"$1,896.",$319.5,"$1,801.2","$1,516.8","$1,725.36",$497.1938,"$1,801.2",$469.0514,"$1,801.2","$1,801.2",$707.6034,"$1,294.02",$319.5,"$1,744.32"
,CDM,4130000041.10.4130,CT PELVIS W/O CONTRAST,CDM Code,Outpatient,72192,$858.,$206.5,$815.1,$686.4,$780.78,$224.9959,$815.1,$212.2606,$815.1,$815.1,$300.9891,$585.585,$206.5,$789.36
,CDM,4130000042.10.4130,CT PELVIS W&W/O CONTRAST,CDM Code,Outpatient,72194,"$2,528.",$368.,"$2,401.6","$2,022.4","$2,300.48",$662.925,"$2,401.6",$625.4019,"$2,401.6","$2,401.6",$707.6034,"$1,725.36",$368.,"$2,325.76"
,CDM,4130000043.10.4130,CT CERVICAL SPINE W/O CONT,CDM Code,Outpatient,72125,$858.,$212.2606,$815.1,$686.4,$780.78,$224.9959,$815.1,$212.2606,$815.1,$815.1,$300.9891,$585.585,$261.,$789.36
,CDM,4130000044.10.4130,CT CERVICAL SPINE W/CONT,CDM Code,Outpatient,72126,"$3,423.",$322.5,"$3,251.85","$2,738.4","$3,114.93",$897.6236,"$3,251.85",$846.816,"$3,251.85","$3,251.85","$1,138.8084","$2,336.1975",$322.5,"$3,149.16"
,CDM,4130000050.10.4130,CT LUMBAR SPINE W/O CONT,CDM Code,Outpatient,72131,$858.,$212.2606,$815.1,$686.4,$780.78,$224.9959,$815.1,$212.2606,$815.1,$815.1,$300.9891,$585.585,$254.5,$789.36
,CDM,4130000051.10.4130,CT LUMBAR SPINE WITH CONT,CDM Code,Outpatient,72132,"$3,423.",$322.5,"$3,251.85","$2,738.4","$3,114.93",$897.6236,"$3,251.85",$846.816,"$3,251.85","$3,251.85","$1,138.8084","$2,336.1975",$322.5,"$3,149.16"
,CDM,4130000052.10.4130,CT LUMBAR SPINE WO/W CONT,CDM Code,Outpatient,72133,"$1,896.",$381.,"$1,801.2","$1,516.8","$1,725.36",$497.1938,"$1,801.2",$469.0514,"$1,801.2","$1,801.2",$707.6034,"$1,294.02",$381.,"$1,744.32"
,CDM,4130000053.10.4130,CT THORACIC SPINE W/O CONTRAST,CDM Code,Outpatient,72128,$858.,$212.2606,$815.1,$686.4,$780.78,$224.9959,$815.1,$212.2606,$815.1,$815.1,$300.9891,$585.585,$255.5,$789.36
,CDM,4130000054.10.4130,CT THORACIC SPINE W/CONT,CDM Code,Outpatient,72129,"$1,896.",$324.,"$1,801.2","$1,516.8","$1,725.36",$497.1938,"$1,801.2",$469.0514,"$1,801.2","$1,801.2",$707.6034,"$1,294.02",$324.,"$1,744.32"
,CDM,4130000055.10.4130,CT THORACIC SPINE W&W/O CONTRA,CDM Code,Outpatient,72130,"$3,205.",$384.5,"$3,044.75","$2,564.","$2,916.55",$840.4568,"$3,044.75",$792.885,"$3,044.75","$3,044.75",$707.6034,"$2,187.4125",$384.5,"$2,948.6"
,CDM,4130000060.10.4130,CT BILAT UPPER EXT W/O CONT,CDM Code,Outpatient,73200,"$1,461.",$182.5,"$1,387.95","$1,168.8","$1,329.51",$383.1224,"$1,387.95",$361.4368,"$1,387.95","$1,387.95",$300.9891,$997.1325,$182.5,"$1,344.12"
,CDM,4130000063.10.4130,CT UPPER EXTREMITY W/O CONT LT,CDM Code,Outpatient,73200LT,$858.,$182.5,$815.1,$686.4,$780.78,$224.9959,$815.1,$212.2606,$815.1,$815.1,$300.9891,$585.585,$182.5,$789.36
,CDM,4130000064.10.4130,CT UPPER EXTREMITY WO/W CON LT,CDM Code,Outpatient,73202LT,"$2,568.",$306.,"$2,439.6","$2,054.4","$2,336.88",$673.4143,"$2,439.6",$635.2975,"$2,439.6","$2,439.6",$707.6034,"$1,752.66",$306.,"$2,362.56"
,CDM,4130000065.10.4130,CT UPPER EXTREMITY WITH CON LT,CDM Code,Outpatient,73201LT,"$1,896.",$232.,"$1,801.2","$1,516.8","$1,725.36",$497.1938,"$1,801.2",$469.0514,"$1,801.2","$1,801.2",$707.6034,"$1,294.02",$232.,"$1,744.32"
,CDM,4130000070.10.4130,CT UPPER EXTREMITY W/O CONT RT,CDM Code,Outpatient,73200RT,$858.,$182.5,$815.1,$686.4,$780.78,$224.9959,$815.1,$212.2606,$815.1,$815.1,$300.9891,$585.585,$182.5,$789.36
,CDM,4130000072.10.4130,CT UPPER EXTREMITY WITH CON RT,CDM Code,Outpatient,73201RT,"$1,896.",$232.,"$1,801.2","$1,516.8","$1,725.36",$497.1938,"$1,801.2",$469.0514,"$1,801.2","$1,801.2",$707.6034,"$1,294.02",$232.,"$1,744.32"
,CDM,4130000073.10.4130,CT BILAT LOWER EXT W/O CONT,CDM Code,Outpatient,73700,"$1,369.",$254.5,"$1,300.55","$1,095.2","$1,245.79",$358.997,"$1,300.55",$338.6769,"$1,300.55","$1,300.55",$300.9891,$934.3425,$254.5,"$1,259.48"
,CDM,4130000075.10.4130,CT BILAT LOWER EXT W/CONT,CDM Code,Outpatient,73701,"$2,275.",$319.5,"$2,161.25","$1,820.","$2,070.25",$596.5801,"$2,161.25",$562.8122,"$2,161.25","$2,161.25",$707.6034,"$1,552.6875",$319.5,"$2,093."
,CDM,4130000080.10.4130,CT LOWER EXTREMITY W/O LT,CDM Code,Outpatient,73700LT,$858.,$212.2606,$815.1,$686.4,$780.78,$224.9959,$815.1,$212.2606,$815.1,$815.1,$300.9891,$585.585,$254.5,$789.36
,CDM,4130000081.10.4130,CT LOWER EXTEMITY WO/W CON LT,CDM Code,Outpatient,73702LT,"$2,693.",$388.,"$2,558.35","$2,154.4","$2,450.63",$706.1935,"$2,558.35",$666.2213,"$2,558.35","$2,558.35",$707.6034,"$1,837.9725",$388.,"$2,477.56"
,CDM,4130000082.10.4130,CT LOWER EXTREMITY W/CONT LT,CDM Code,Outpatient,73701LT,"$1,896.",$319.5,"$1,801.2","$1,516.8","$1,725.36",$497.1938,"$1,801.2",$469.0514,"$1,801.2","$1,801.2",$707.6034,"$1,294.02",$319.5,"$1,744.32"
,CDM,4130000083.10.4130,CT LOWER EXTREMITY W/O RT,CDM Code,Outpatient,73700RT,$858.,$212.2606,$815.1,$686.4,$780.78,$224.9959,$815.1,$212.2606,$815.1,$815.1,$300.9891,$585.585,$254.5,$789.36
,CDM,4130000084.10.4130,CT LOWER EXTEMITY WO/W CON RT,CDM Code,Outpatient,73702RT,"$1,896.",$388.,"$1,801.2","$1,516.8","$1,725.36",$497.1938,"$1,801.2",$469.0514,"$1,801.2","$1,801.2",$707.6034,"$1,294.02",$388.,"$1,744.32"
,CDM,4130000085.10.4130,CT LOWER EXTREMITY W/CONT RT,CDM Code,Outpatient,73701RT,"$1,896.",$319.5,"$1,801.2","$1,516.8","$1,725.36",$497.1938,"$1,801.2",$469.0514,"$1,801.2","$1,801.2",$707.6034,"$1,294.02",$319.5,"$1,744.32"
,CDM,4130000090.10.4130,CT MAXILLOFACIAL W/O CONTRAST,CDM Code,Outpatient,70486,$858.,$136.,$815.1,$686.4,$780.78,$224.9959,$815.1,$212.2606,$815.1,$815.1,$300.9891,$585.585,$136.,$789.36
,CDM,4130000091.10.4130,CT MAXILLOFACIAL WO/W CONT,CDM Code,Outpatient,70488,"$1,896.",$198.5,"$1,801.2","$1,516.8","$1,725.36",$497.1938,"$1,801.2",$469.0514,"$1,801.2","$1,801.2",$707.6034,"$1,294.02",$198.5,"$1,744.32"
,CDM,4130000092.10.4130,CT MAXILLOFACIAL AREA W/CON,CDM Code,Outpatient,70487,"$1,896.",$157.,"$1,801.2","$1,516.8","$1,725.36",$497.1938,"$1,801.2",$469.0514,"$1,801.2","$1,801.2",$707.6034,"$1,294.02",$157.,"$1,744.32"
,CDM,4130000093.10.4130,CT SINUS SCREENING,CDM Code,Outpatient,70486,$858.,$136.,$815.1,$686.4,$780.78,$224.9959,$815.1,$212.2606,$815.1,$815.1,$300.9891,$585.585,$136.,$789.36
,CDM,4130000100.10.4130,CT ANGIO ABD W/O & W/CONT,CDM Code,Outpatient,74175,"$1,896.",$306.,"$1,801.2","$1,516.8","$1,725.36",$497.1938,"$1,801.2",$469.0514,"$1,801.2","$1,801.2",$707.6034,"$1,294.02",$306.,"$1,744.32"
,CDM,4130000101.10.4130,CT ANGIO CHEST W/O & W/CONT,CDM Code,Outpatient,71275,"$1,896.",$424.5,"$1,801.2","$1,516.8","$1,725.36",$497.1938,"$1,801.2",$469.0514,"$1,801.2","$1,801.2",$707.6034,"$1,294.02",$424.5,"$1,744.32"
,CDM,4130000102.10.4130,CT ANGIO HEAD,CDM Code,Outpatient,70496,"$1,896.",$290.,"$1,801.2","$1,516.8","$1,725.36",$497.1938,"$1,801.2",$469.0514,"$1,801.2","$1,801.2",$707.6034,"$1,294.02",$290.,"$1,744.32"
,CDM,4130000103.10.4130,CT ANGIO NECK,CDM Code,Outpatient,70498,"$1,896.",$289.,"$1,801.2","$1,516.8","$1,725.36",$497.1938,"$1,801.2",$469.0514,"$1,801.2","$1,801.2",$707.6034,"$1,294.02",$289.,"$1,744.32"
,CDM,4130000104.10.4130,CT ANGIO PELVIS W&W/O,CDM Code,Outpatient,72191,"$1,896.",$432.5,"$1,801.2","$1,516.8","$1,725.36",$497.1938,"$1,801.2",$469.0514,"$1,801.2","$1,801.2",$707.6034,"$1,294.02",$432.5,"$1,744.32"
,CDM,4130000107.10.4130,CT LWR EXTRIEM ANGIO W/ LT,CDM Code,Outpatient,73706LT,"$1,896.",$469.0514,"$1,801.2","$1,516.8","$1,725.36",$497.1938,"$1,801.2",$469.0514,"$1,801.2","$1,801.2",$707.6034,"$1,294.02",$503.,"$1,744.32"
,CDM,4130000108.10.4130,CT LWR EXTRIEM ANGIO W/ RT,CDM Code,Outpatient,73706RT,"$1,896.",$469.0514,"$1,801.2","$1,516.8","$1,725.36",$497.1938,"$1,801.2",$469.0514,"$1,801.2","$1,801.2",$707.6034,"$1,294.02",$503.,"$1,744.32"
,CDM,4130000111.10.4130,CT UPR EXTREM ANGIO W/ LT,CDM Code,Outpatient,73206LT,"$1,896.",$336.5,"$1,801.2","$1,516.8","$1,725.36",$497.1938,"$1,801.2",$469.0514,"$1,801.2","$1,801.2",$707.6034,"$1,294.02",$336.5,"$1,744.32"
,CDM,4130000112.10.4130,CT UPR EXTREM ANGIO W/ RT,CDM Code,Outpatient,73206RT,"$1,896.",$336.5,"$1,801.2","$1,516.8","$1,725.36",$497.1938,"$1,801.2",$469.0514,"$1,801.2","$1,801.2",$707.6034,"$1,294.02",$336.5,"$1,744.32"
,CDM,4130000113.10.4130,CT BILAT ANGIO LOWER EXT,CDM Code,Outpatient,73706,"$1,896.",$469.0514,"$1,801.2","$1,516.8","$1,725.36",$497.1938,"$1,801.2",$469.0514,"$1,801.2","$1,801.2",$707.6034,"$1,294.02",$503.,"$1,744.32"
,CDM,4130000114.10.4130,CT ANGIO ABD/PEL W CONTRAST,CDM Code,Outpatient,74174,"$1,896.",$394.,"$1,801.2","$1,516.8","$1,725.36",$497.1938,"$1,801.2",$469.0514,"$1,801.2","$1,801.2",$707.6034,"$1,294.02",$394.,"$1,744.32"
,CDM,4130000116.10.4130,CT ANGIO AORTA W/RUNOFF,CDM Code,Outpatient,75635,"$1,896.",$455.5,"$1,801.2","$1,516.8","$1,725.36",$497.1938,"$1,801.2",$469.0514,"$1,801.2","$1,801.2",$707.6034,"$1,294.02",$455.5,"$1,744.32"
,CDM,4130000125.10.4130,CT KUB,CDM Code,Outpatient,74176,"$1,742.",$160.,"$1,654.9","$1,393.6","$1,585.22",$456.8099,"$1,654.9",$430.9534,"$1,654.9","$1,654.9",$603.1797,"$1,188.915",$160.,"$1,602.64"
,CDM,4130000126.10.4130,CT IVP,CDM Code,Outpatient,74178,"$1,896.",$357.,"$1,801.2","$1,516.8","$1,725.36",$497.1938,"$1,801.2",$469.0514,"$1,801.2","$1,801.2","$1,138.8084","$1,294.02",$357.,"$1,744.32"
,CDM,4130000128.10.4130,LDCT LUNG SCREEN,CDM Code,Outpatient,G0297,$466.,$115.2837,$442.7,$372.8,$424.06,$122.2006,$442.7,$115.2837,$442.7,$442.7,$159.8262,$318.045,$410.08,$428.72
,CDM,4130000129.10.4130,CT 3D RENDERING,CDM Code,Outpatient,76376,$826.54,$19.,$785.213,$661.232,$752.1514,$216.7461,$785.213,$204.4777,$785.213,$785.213,$82.654,$564.1135,$19.,$760.4168
,CDM,4130000130.10.4130,CT HRT W/3D IMAGE CCTA,CDM Code,Outpatient,75572,"$1,264.",$280.5,"$1,200.8","$1,011.2","$1,150.24",$331.4625,"$1,200.8",$312.701,"$1,200.8","$1,200.8",$707.6034,$862.68,$280.5,"$1,162.88"
,CDM,4130000131.10.4130,CT HRT W/O DYE W/CA TEST,CDM Code,Outpatient,75571,$311.,$76.9383,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$105.,$286.12
,CDM,4130000132.10.4130,CT BIOPSY BONE NEEDLE SUPERFIC,CDM Code,Outpatient,20220,"$6,741.",$238.5,"$6,403.95","$5,392.8","$6,134.31","$1,767.7127","$6,403.95","$1,667.656","$6,403.95","$6,403.95","$3,301.7754","$4,600.7325",$238.5,"$6,201.72"
,CDM,4130000139.10.4130,CT 3D REND INDEPENDENT WORKSTA,CDM Code,Outpatient,76377,"$1,109.",$56.5,"$1,053.55",$887.2,"$1,009.19",$290.8164,"$1,053.55",$274.3555,"$1,053.55","$1,053.55",$110.9,$756.8925,$56.5,"$1,020.28"
,CDM,4139000001.10.4139,MM DIAG DIGIT MAMMO BILAT,CDM Code,Outpatient,77066,$877.,$170.5,$833.15,$701.6,$798.07,$229.9783,$833.15,$216.961,$833.15,$833.15,$457.0773,$598.5525,$170.5,$806.84
,CDM,4139000002.10.4139,MM DIAG DIGIT MAMMO LT,CDM Code,Outpatient,77065LT,$694.,$133.5,$659.3,$555.2,$631.54,$181.9897,$659.3,$171.6887,$659.3,$659.3,$360.2898,$473.655,$133.5,$638.48
,CDM,4139000003.10.4139,MM DIAG DIGIT MAMMO RT,CDM Code,Outpatient,77065RT,$694.,$133.5,$659.3,$555.2,$631.54,$181.9897,$659.3,$171.6887,$659.3,$659.3,$360.2898,$473.655,$133.5,$638.48
,CDM,4139000004.10.4139,MM DIAG SP VIEW MAMMO BILAT,CDM Code,Outpatient,77066,$877.,$170.5,$833.15,$701.6,$798.07,$229.9783,$833.15,$216.961,$833.15,$833.15,$457.0773,$598.5525,$170.5,$806.84
,CDM,4139000005.10.4139,MM DIAG SP VIEW MAMMO LT,CDM Code,Outpatient,77065LT,$694.,$133.5,$659.3,$555.2,$631.54,$181.9897,$659.3,$171.6887,$659.3,$659.3,$360.2898,$473.655,$133.5,$638.48
,CDM,4139000006.10.4139,MM DIAG SP VIEW MAMMO RT,CDM Code,Outpatient,77065RT,$694.,$133.5,$659.3,$555.2,$631.54,$181.9897,$659.3,$171.6887,$659.3,$659.3,$360.2898,$473.655,$133.5,$638.48
,CDM,4139000010.10.4139,MM SCR DIGITAL MAMMO BILAT,CDM Code,Outpatient,77067,$405.92,$100.4205,$385.624,$324.736,$369.3872,$106.4456,$385.624,$100.4205,$385.624,$385.624,$368.9136,$277.0404,$141.,$373.4464
,CDM,4139000010.20.4139,MM SCR DIGITAL MAMMO BILAT,CDM Code,Outpatient,77057,$707.,$174.9047,$671.65,$565.6,$643.37,$185.3987,$671.65,$174.9047,$671.65,$671.65,$70.7,$482.5275,$622.16,$650.44
,CDM,4139000010.30.4139,MM SCR DIGITAL MAMMO BILAT,CDM Code,Outpatient,77057,$707.,$174.9047,$671.65,$565.6,$643.37,$185.3987,$671.65,$174.9047,$671.65,$671.65,$70.7,$482.5275,$622.16,$650.44
,CDM,4139000011.10.4139,MM SCR DIGITAL MAMMO LT,CDM Code,Outpatient,7706752,$629.,$141.,$597.55,$503.2,$572.39,$164.9446,$597.55,$155.6083,$597.55,$597.55,$368.9136,$429.2925,$141.,$578.68
,CDM,4139000011.20.4139,MM SCR DIGITAL MAMMO LT,CDM Code,Outpatient,77057,$629.,$155.6083,$597.55,$503.2,$572.39,$164.9446,$597.55,$155.6083,$597.55,$597.55,$62.9,$429.2925,$553.52,$578.68
,CDM,4139000011.30.4139,MM SCR DIGITAL MAMMO LT,CDM Code,Outpatient,77057,$707.,$174.9047,$671.65,$565.6,$643.37,$185.3987,$671.65,$174.9047,$671.65,$671.65,$70.7,$482.5275,$622.16,$650.44
,CDM,4139000012.10.4139,MM SCR DIGITAL MAMMO RT,CDM Code,Outpatient,7706752,$395.,$97.719,$375.25,$316.,$359.45,$103.582,$375.25,$97.719,$375.25,$375.25,$368.9136,$269.5875,$141.,$363.4
,CDM,4139000012.20.4139,MM SCR DIGITAL MAMMO RT,CDM Code,Outpatient,77057,$707.,$174.9047,$671.65,$565.6,$643.37,$185.3987,$671.65,$174.9047,$671.65,$671.65,$70.7,$482.5275,$622.16,$650.44
,CDM,4139000012.30.4139,MM SCR DIGITAL MAMMO RT,CDM Code,Outpatient,77057,$707.,$174.9047,$671.65,$565.6,$643.37,$185.3987,$671.65,$174.9047,$671.65,$671.65,$70.7,$482.5275,$622.16,$650.44
,CDM,4139000013.10.4139,MM SCR DIGITAL MAMMO IMPLANT,CDM Code,Outpatient,77067,$395.,$97.719,$375.25,$316.,$359.45,$103.582,$375.25,$97.719,$375.25,$375.25,$368.9136,$269.5875,$141.,$363.4
,CDM,4139000013.20.4139,MM SCR DIGITAL MAMMO IMPLANT,CDM Code,Outpatient,77057,$707.,$174.9047,$671.65,$565.6,$643.37,$185.3987,$671.65,$174.9047,$671.65,$671.65,$70.7,$482.5275,$622.16,$650.44
,CDM,4139000013.30.4139,MM SCR DIGITAL MAMMO IMPLANT,CDM Code,Outpatient,77057,$707.,$174.9047,$671.65,$565.6,$643.37,$185.3987,$671.65,$174.9047,$671.65,$671.65,$70.7,$482.5275,$622.16,$650.44
,CDM,4139000024.10.4139,MM RADIOLOGY BREAST SPECIMN,CDM Code,Outpatient,76098,$487.,$12.5,"$1,200.6456",$389.6,$443.17,$127.7075,$462.65,$120.4789,$462.65,$462.65,"$1,200.6456",$332.3775,$12.5,$448.04
,CDM,4139000029.10.4139,MM SCREENING CAD MAMMO,CDM Code,Outpatient,77052,$90.,$22.2651,$85.5,$72.,$81.9,$23.601,$85.5,$22.2651,$85.5,$85.5,$9.,$61.425,$79.2,$82.8
,CDM,4139000029.20.4139,MM SCREENING CAD MAMMO,CDM Code,Outpatient,77052,$90.,$22.2651,$85.5,$72.,$81.9,$23.601,$85.5,$22.2651,$85.5,$85.5,$9.,$61.425,$79.2,$82.8
,CDM,4139000029.30.4139,MM SCREENING CAD MAMMO,CDM Code,Outpatient,77052,$90.,$22.2651,$85.5,$72.,$81.9,$23.601,$85.5,$22.2651,$85.5,$85.5,$9.,$61.425,$79.2,$82.8
,CDM,4139000032.10.4139,MM COMP DX MAMMO,CDM Code,Outpatient,77051,$97.,$23.9968,$92.15,$77.6,$88.27,$25.4366,$92.15,$23.9968,$92.15,$92.15,$9.7,$66.2025,$85.36,$89.24
,CDM,4139000036.10.4139,MM STEREO WIRE LOC LT,CDM Code,Outpatient,19283LT,"$2,864.",$386.,"$2,720.8","$2,291.2","$2,606.24",$751.0353,"$2,720.8",$708.525,"$2,720.8","$2,720.8","$1,439.4237","$1,954.68",$386.,"$2,634.88"
,CDM,4139000038.10.4139,MM BX STEREO EA ADDL,CDM Code,Outpatient,19082,"$2,943.",$728.0688,"$2,795.85","$2,354.4","$2,678.13",$771.7517,"$2,795.85",$728.0688,"$2,795.85","$2,795.85",$294.3,"$2,008.5975",$810.5,"$2,707.56"
,CDM,4139000039.10.4139,MM BX STEREO LT,CDM Code,Outpatient,19081,"$3,539.",$875.5132,"$3,362.05","$2,831.2","$3,220.49",$928.0426,"$3,362.05",$875.5132,"$3,362.05","$3,362.05","$3,301.7754","$2,415.3675",$981.5,"$3,255.88"
,CDM,4139000040.10.4139,MM BX STEREO RT,CDM Code,Outpatient,19081,"$3,539.",$875.5132,"$3,362.05","$2,831.2","$3,220.49",$928.0426,"$3,362.05",$875.5132,"$3,362.05","$3,362.05","$3,301.7754","$2,415.3675",$981.5,"$3,255.88"
,CDM,4139000041.10.4139,MM WIRE LOC ADDL LESION,CDM Code,Outpatient,19282,$859.,$212.508,$816.05,$687.2,$781.69,$225.2581,$816.05,$212.508,$816.05,$816.05,$85.9,$586.2675,$237.,$790.28
,CDM,4139000042.10.4139,MM WIRE LOC RT,CDM Code,Outpatient,19281RT,"$2,864.",$341.5,"$2,720.8","$2,291.2","$2,606.24",$751.0353,"$2,720.8",$708.525,"$2,720.8","$2,720.8","$1,439.4237","$1,954.68",$341.5,"$2,634.88"
,CDM,4139000043.10.4139,MM WIRE LOC LT,CDM Code,Outpatient,19281LT,"$2,864.",$341.5,"$2,720.8","$2,291.2","$2,606.24",$751.0353,"$2,720.8",$708.525,"$2,720.8","$2,720.8","$1,439.4237","$1,954.68",$341.5,"$2,634.88"
,CDM,4139000045.10.4139,MM BREAST TOMOSYNTHESIS UNI LT,CDM Code,Outpatient,77061LT,$100.,$24.739,$95.,$80.,$91.,$26.2233,$95.,$24.739,$95.,$95.,$10.,$68.25,$58.,$92.
,CDM,4139000046.10.4139,MM BREAST TOMOSYNTHESIS UNI RT,CDM Code,Outpatient,77061RT,$100.,$24.739,$95.,$80.,$91.,$26.2233,$95.,$24.739,$95.,$95.,$10.,$68.25,$58.,$92.
,CDM,4139000047.10.4139,MM BREAST TOMOSYNTHESIS BILAT,CDM Code,Outpatient,77062,$100.,$24.739,$95.,$80.,$91.,$26.2233,$95.,$24.739,$95.,$95.,$10.,$68.25,$71.5,$92.
,CDM,4139000048.10.4139,MM SCREENING BREAST TOMO BILAT,CDM Code,Outpatient,77063,$100.,$24.739,$150.4545,$80.,$91.,$26.2233,$95.,$24.739,$95.,$95.,$150.4545,$68.25,$35.5,$92.
,CDM,4140000001.10.4140,XR ABDOMEN AP (KUB),CDM Code,Outpatient,74000,$253.,$62.5897,$240.35,$202.4,$230.23,$66.3449,$240.35,$62.5897,$240.35,$240.35,$159.8262,$172.6725,$222.64,$232.76
,CDM,4140000001.20.4140,XR ABDOMEN AP (KUB),CDM Code,Outpatient,74000,$253.,$62.5897,$240.35,$202.4,$230.23,$66.3449,$240.35,$62.5897,$240.35,$240.35,$159.8262,$172.6725,$222.64,$232.76
,CDM,4140000001.30.4140,XR ABDOMEN AP (KUB),CDM Code,Outpatient,74000,$253.,$62.5897,$240.35,$202.4,$230.23,$66.3449,$240.35,$62.5897,$240.35,$240.35,$159.8262,$172.6725,$222.64,$232.76
,CDM,4140000002.10.4140,XR ABDOMEN SUPINE & UPRIGHT,CDM Code,Outpatient,74020,$337.,$83.3704,$320.15,$269.6,$306.67,$88.3725,$320.15,$83.3704,$320.15,$320.15,$159.8262,$230.0025,$296.56,$310.04
,CDM,4140000002.20.4140,XR ABDOMEN SUPINE & UPRIGHT,CDM Code,Outpatient,74020,$337.,$83.3704,$320.15,$269.6,$306.67,$88.3725,$320.15,$83.3704,$320.15,$320.15,$159.8262,$230.0025,$296.56,$310.04
,CDM,4140000002.30.4140,XR ABDOMEN SUPINE & UPRIGHT,CDM Code,Outpatient,74020,$337.,$83.3704,$320.15,$269.6,$306.67,$88.3725,$320.15,$83.3704,$320.15,$320.15,$159.8262,$230.0025,$296.56,$310.04
,CDM,4140000003.10.4140,XR ACUTE ABDOMEN SERIES,CDM Code,Outpatient,74022,$572.,$40.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$40.,$526.24
,CDM,4140000003.20.4140,XR ACUTE ABDOMEN SERIES,CDM Code,Outpatient,74022,$601.,$40.,$570.95,$480.8,$546.91,$157.602,$570.95,$148.6814,$570.95,$570.95,$300.9891,$410.1825,$40.,$552.92
,CDM,4140000003.30.4140,XR ACUTE ABDOMEN SERIES,CDM Code,Outpatient,74022,$572.,$40.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$40.,$526.24
,CDM,4140000004.10.4140,XR ABDOMEN W/DECUB,CDM Code,Outpatient,74020,$361.,$89.3078,$342.95,$288.8,$328.51,$94.6661,$342.95,$89.3078,$342.95,$342.95,$159.8262,$246.3825,$317.68,$332.12
,CDM,4140000005.10.4140,XR AC JOINTS BILAT,CDM Code,Outpatient,73050,$311.,$35.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$35.5,$286.12
,CDM,4140000005.20.4140,XR AC JOINTS BILAT,CDM Code,Outpatient,73050,$519.,$35.5,$493.05,$415.2,$472.29,$136.0989,$493.05,$128.3954,$493.05,$493.05,$159.8262,$354.2175,$35.5,$477.48
,CDM,4140000005.30.4140,XR AC JOINTS BILAT,CDM Code,Outpatient,73050,$508.,$35.5,$482.6,$406.4,$462.28,$133.2144,$482.6,$125.6741,$482.6,$482.6,$159.8262,$346.71,$35.5,$467.36
,CDM,4140000010.10.4140,XR ANKLE 2 VIEWS LT,CDM Code,Outpatient,73600LT,$311.,$30.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$30.,$286.12
,CDM,4140000010.20.4140,XR ANKLE 2 VIEWS LT,CDM Code,Outpatient,73600,$344.,$30.,$326.8,$275.2,$313.04,$90.2082,$326.8,$85.1022,$326.8,$326.8,$159.8262,$234.78,$30.,$316.48
,CDM,4140000011.10.4140,XR ANKLE 2 VIEWS RT,CDM Code,Outpatient,73600RT,$311.,$30.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$30.,$286.12
,CDM,4140000011.20.4140,XR ANKLE 2 VIEWS RT,CDM Code,Outpatient,73600,$344.,$30.,$326.8,$275.2,$313.04,$90.2082,$326.8,$85.1022,$326.8,$326.8,$159.8262,$234.78,$30.,$316.48
,CDM,4140000011.30.4140,XR ANKLE 2 VIEWS RT,CDM Code,Outpatient,73600,$337.,$30.,$320.15,$269.6,$306.67,$88.3725,$320.15,$83.3704,$320.15,$320.15,$159.8262,$230.0025,$30.,$310.04
,CDM,4140000012.10.4140,XR BILAT ANKLES 2VW,CDM Code,Outpatient,7360050,$622.,$30.,$590.9,$497.6,$566.02,$163.1089,$590.9,$153.8766,$590.9,$590.9,$159.8262,$424.515,$30.,$572.24
,CDM,4140000013.10.4140,XR ANKLE COMPLETE MIN 3VW LT,CDM Code,Outpatient,73610LT,$311.,$32.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$32.,$286.12
,CDM,4140000013.20.4140,XR ANKLE COMPLETE MIN 3VW LT,CDM Code,Outpatient,73610,$311.,$32.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$32.,$286.12
,CDM,4140000013.30.4140,XR ANKLE COMPLETE MIN 3VW LT,CDM Code,Outpatient,73610,$311.,$32.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$32.,$286.12
,CDM,4140000014.10.4140,XR ANKLE COMPLETE MIN 3VW RT,CDM Code,Outpatient,73610RT,$311.,$32.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$32.,$286.12
,CDM,4140000014.20.4140,XR ANKLE COMPLETE MIN 3VW RT,CDM Code,Outpatient,73610,$311.,$32.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$32.,$286.12
,CDM,4140000014.30.4140,XR ANKLE COMPLETE MIN 3VW RT,CDM Code,Outpatient,73610,$311.,$32.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$32.,$286.12
,CDM,4140000015.10.4140,XR BILAT ANKLES 3VW,CDM Code,Outpatient,7361050,$622.,$32.,$590.9,$497.6,$566.02,$163.1089,$590.9,$153.8766,$590.9,$590.9,$159.8262,$424.515,$32.,$572.24
,CDM,4140000015.20.4140,XR BILAT ANKLES 3VW,CDM Code,Outpatient,73610,$622.,$32.,$590.9,$497.6,$566.02,$163.1089,$590.9,$153.8766,$590.9,$590.9,$159.8262,$424.515,$32.,$572.24
,CDM,4140000015.30.4140,XR BILAT ANKLES 3VW,CDM Code,Outpatient,73610,$622.,$32.,$590.9,$497.6,$566.02,$163.1089,$590.9,$153.8766,$590.9,$590.9,$159.8262,$424.515,$32.,$572.24
,CDM,4140000020.10.4140,XR CALCANEUS MIN 2 VIEWS LT,CDM Code,Outpatient,73650LT,$311.,$27.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$27.,$286.12
,CDM,4140000020.20.4140,XR CALCANEUS MIN 2 VIEWS LT,CDM Code,Outpatient,73650,$311.,$27.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$27.,$286.12
,CDM,4140000020.30.4140,XR CALCANEUS MIN 2 VIEWS LT,CDM Code,Outpatient,73650,$311.,$27.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$27.,$286.12
,CDM,4140000021.10.4140,XR CALCANEUS MIN 2 VIEWS RT,CDM Code,Outpatient,73650RT,$311.,$27.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$27.,$286.12
,CDM,4140000021.20.4140,XR CALCANEUS MIN 2 VIEWS RT,CDM Code,Outpatient,73650,$311.,$27.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$27.,$286.12
,CDM,4140000021.30.4140,XR CALCANEUS MIN 2 VIEWS RT,CDM Code,Outpatient,73650,$311.,$27.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$27.,$286.12
,CDM,4140000022.10.4140,XR BILAT CALCANEUS,CDM Code,Outpatient,7365050,$311.,$27.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$27.,$286.12
,CDM,4140000022.30.4140,XR BILAT CALCANEUS,CDM Code,Outpatient,73650,$329.,$27.,$312.55,$263.2,$299.39,$86.2747,$312.55,$81.3913,$312.55,$312.55,$159.8262,$224.5425,$27.,$302.68
,CDM,4140000023.10.4140,XR TOE OR TOES MIN 2 VIEWS RT,CDM Code,Outpatient,73660,$311.,$30.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$30.5,$286.12
,CDM,4140000023.20.4140,XR TOE OR TOES MIN 2 VIEWS RT,CDM Code,Outpatient,73660,$311.,$30.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$30.5,$286.12
,CDM,4140000023.30.4140,XR TOE OR TOES MIN 2 VIEWS RT,CDM Code,Outpatient,73660,$311.,$30.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$30.5,$286.12
,CDM,4140000024.10.4140,XR TOE OR TOES MIN 2 VIEWS LT,CDM Code,Outpatient,73660,$311.,$30.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$30.5,$286.12
,CDM,4140000024.20.4140,XR TOE OR TOES MIN 2 VIEWS LT,CDM Code,Outpatient,73660,$311.,$30.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$30.5,$286.12
,CDM,4140000024.30.4140,XR TOE OR TOES MIN 2 VIEWS LT,CDM Code,Outpatient,73660,$311.,$30.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$30.5,$286.12
,CDM,4140000025.10.4140,XR BILAT TOES,CDM Code,Outpatient,73660,$311.,$30.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$30.5,$286.12
,CDM,4140000030.10.4140,XR FOOT 2 VIEWS LT,CDM Code,Outpatient,73620LT,$311.,$26.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$26.,$286.12
,CDM,4140000030.20.4140,XR FOOT 2 VIEWS LT,CDM Code,Outpatient,73620,$311.,$26.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$26.,$286.12
,CDM,4140000030.30.4140,XR FOOT 2 VIEWS LT,CDM Code,Outpatient,73620,$311.,$26.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$26.,$286.12
,CDM,4140000031.10.4140,XR FOOT 2 VIEWS RT,CDM Code,Outpatient,73620RT,$311.,$26.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$26.,$286.12
,CDM,4140000031.20.4140,XR FOOT 2 VIEWS RT,CDM Code,Outpatient,73620,$311.,$26.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$26.,$286.12
,CDM,4140000031.30.4140,XR FOOT 2 VIEWS RT,CDM Code,Outpatient,73620,$311.,$26.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$26.,$286.12
,CDM,4140000032.10.4140,XR BILAT FOOT 2VW,CDM Code,Outpatient,7362050,$622.,$26.,$590.9,$497.6,$566.02,$163.1089,$590.9,$153.8766,$590.9,$590.9,$159.8262,$424.515,$26.,$572.24
,CDM,4140000032.20.4140,XR BILAT FOOT 2VW,CDM Code,Outpatient,73620,$328.,$26.,$311.6,$262.4,$298.48,$86.0124,$311.6,$81.1439,$311.6,$311.6,$159.8262,$223.86,$26.,$301.76
,CDM,4140000033.10.4140,XR FOOT COMPLETE MIN 3VW LT,CDM Code,Outpatient,73630LT,$311.,$29.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$29.5,$286.12
,CDM,4140000033.20.4140,XR FOOT COMPLETE MIN 3VW LT,CDM Code,Outpatient,73630,$311.,$29.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$29.5,$286.12
,CDM,4140000033.30.4140,XR FOOT COMPLETE MIN 3VW LT,CDM Code,Outpatient,73630,$311.,$29.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$29.5,$286.12
,CDM,4140000034.10.4140,XR FOOT COMPLETE MIN 3VW RT,CDM Code,Outpatient,73630RT,$311.,$29.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$29.5,$286.12
,CDM,4140000034.20.4140,XR FOOT COMPLETE MIN 3VW RT,CDM Code,Outpatient,73630,$311.,$29.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$29.5,$286.12
,CDM,4140000034.30.4140,XR FOOT COMPLETE MIN 3VW RT,CDM Code,Outpatient,73630,$311.,$29.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$29.5,$286.12
,CDM,4140000035.10.4140,XR BILAT FOOT 3VW,CDM Code,Outpatient,7363050,$622.,$29.5,$590.9,$497.6,$566.02,$163.1089,$590.9,$153.8766,$590.9,$590.9,$159.8262,$424.515,$29.5,$572.24
,CDM,4140000035.20.4140,XR BILAT FOOT 3VW,CDM Code,Outpatient,73630,$622.,$29.5,$590.9,$497.6,$566.02,$163.1089,$590.9,$153.8766,$590.9,$590.9,$159.8262,$424.515,$29.5,$572.24
,CDM,4140000035.30.4140,XR BILAT FOOT 3VW,CDM Code,Outpatient,73630,$622.,$29.5,$590.9,$497.6,$566.02,$163.1089,$590.9,$153.8766,$590.9,$590.9,$159.8262,$424.515,$29.5,$572.24
,CDM,4140000040.10.4140,XR TIBIA & FIBULA 2 VIEWS LT,CDM Code,Outpatient,73590LT,$311.,$28.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$28.5,$286.12
,CDM,4140000040.20.4140,XR TIBIA & FIBULA 2 VIEWS LT,CDM Code,Outpatient,73590,$311.,$28.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$28.5,$286.12
,CDM,4140000040.30.4140,XR TIBIA & FIBULA 2 VIEWS LT,CDM Code,Outpatient,73590,$311.,$28.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$28.5,$286.12
,CDM,4140000041.10.4140,XR TIBIA & FIBULA 2 VIEWS RT,CDM Code,Outpatient,73590RT,$311.,$28.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$28.5,$286.12
,CDM,4140000041.20.4140,XR TIBIA & FIBULA 2 VIEWS RT,CDM Code,Outpatient,73590,$311.,$28.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$28.5,$286.12
,CDM,4140000041.30.4140,XR TIBIA & FIBULA 2 VIEWS RT,CDM Code,Outpatient,73590,$311.,$28.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$28.5,$286.12
,CDM,4140000042.10.4140,XR BILAT TIBIA & FIBULA,CDM Code,Outpatient,7359050,$622.,$28.5,$590.9,$497.6,$566.02,$163.1089,$590.9,$153.8766,$590.9,$590.9,$159.8262,$424.515,$28.5,$572.24
,CDM,4140000045.10.4140,XR KNEE 1 OR 2VW LT,CDM Code,Outpatient,73560LT,$311.,$32.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$32.,$286.12
,CDM,4140000045.20.4140,XR KNEE 1 OR 2VW LT,CDM Code,Outpatient,73560,$311.,$32.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$32.,$286.12
,CDM,4140000045.30.4140,XR KNEE 1 OR 2VW LT,CDM Code,Outpatient,73560,$311.,$32.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$32.,$286.12
,CDM,4140000046.10.4140,XR KNEE 1 OR 2VW RT,CDM Code,Outpatient,73560RT,$311.,$32.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$32.,$286.12
,CDM,4140000046.20.4140,XR KNEE 1 OR 2VW RT,CDM Code,Outpatient,73560,$311.,$32.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$32.,$286.12
,CDM,4140000046.30.4140,XR KNEE 1 OR 2VW RT,CDM Code,Outpatient,73560,$311.,$32.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$32.,$286.12
,CDM,4140000047.10.4140,XR BILAT KNEES 2VW,CDM Code,Outpatient,73565,$311.,$38.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$38.,$286.12
,CDM,4140000047.20.4140,XR BILAT KNEES 2VW,CDM Code,Outpatient,73565,$434.,$38.,$412.3,$347.2,$394.94,$113.8091,$412.3,$107.3673,$412.3,$412.3,$159.8262,$296.205,$38.,$399.28
,CDM,4140000047.30.4140,XR BILAT KNEES 2VW,CDM Code,Outpatient,73565,$311.,$38.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$38.,$286.12
,CDM,4140000048.10.4140,XR KNEE 3V LT,CDM Code,Outpatient,73562LT,$311.,$37.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$37.,$286.12
,CDM,4140000048.20.4140,XR KNEE 3V LT,CDM Code,Outpatient,73562,$311.,$37.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$37.,$286.12
,CDM,4140000048.30.4140,XR KNEE 3V LT,CDM Code,Outpatient,73562,$311.,$37.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$37.,$286.12
,CDM,4140000049.10.4140,XR KNEE 3V RT,CDM Code,Outpatient,73562RT,$311.,$37.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$37.,$286.12
,CDM,4140000049.20.4140,XR KNEE 3V RT,CDM Code,Outpatient,73562,$311.,$37.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$37.,$286.12
,CDM,4140000049.30.4140,XR KNEE 3V RT,CDM Code,Outpatient,73562,$311.,$37.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$37.,$286.12
,CDM,4140000050.10.4140,XR BILAT KNEES 3VW,CDM Code,Outpatient,7356250,$622.,$37.,$590.9,$497.6,$566.02,$163.1089,$590.9,$153.8766,$590.9,$590.9,$159.8262,$424.515,$37.,$572.24
,CDM,4140000050.20.4140,XR BILAT KNEES 3VW,CDM Code,Outpatient,73562,$622.,$37.,$590.9,$497.6,$566.02,$163.1089,$590.9,$153.8766,$590.9,$590.9,$159.8262,$424.515,$37.,$572.24
,CDM,4140000050.30.4140,XR BILAT KNEES 3VW,CDM Code,Outpatient,73562,$622.,$37.,$590.9,$497.6,$566.02,$163.1089,$590.9,$153.8766,$590.9,$590.9,$159.8262,$424.515,$37.,$572.24
,CDM,4140000051.10.4140,XR KNEE 4 OR MOVE VIEWS LT,CDM Code,Outpatient,73564LT,$572.,$40.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$40.,$526.24
,CDM,4140000051.20.4140,XR KNEE 4 OR MOVE VIEWS LT,CDM Code,Outpatient,73564,$572.,$40.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$40.,$526.24
,CDM,4140000051.30.4140,XR KNEE 4 OR MOVE VIEWS LT,CDM Code,Outpatient,73564,$572.,$40.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$40.,$526.24
,CDM,4140000052.10.4140,XR KNEE 4 OR MOVE VIEWS RT,CDM Code,Outpatient,73564RT,$572.,$40.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$40.,$526.24
,CDM,4140000052.20.4140,XR KNEE 4 OR MOVE VIEWS RT,CDM Code,Outpatient,73564,$572.,$40.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$40.,$526.24
,CDM,4140000052.30.4140,XR KNEE 4 OR MOVE VIEWS RT,CDM Code,Outpatient,73564,$572.,$40.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$40.,$526.24
,CDM,4140000053.10.4140,XR BILAT KNEES 4VW,CDM Code,Outpatient,7356450,"$1,144.",$40.,"$1,086.8",$915.2,"$1,041.04",$299.9946,"$1,086.8",$283.0142,"$1,086.8","$1,086.8",$300.9891,$780.78,$40.,"$1,052.48"
,CDM,4140000053.20.4140,XR BILAT KNEES 4VW,CDM Code,Outpatient,73564,$485.,$40.,$460.75,$388.,$441.35,$127.183,$460.75,$119.9842,$460.75,$460.75,$300.9891,$331.0125,$40.,$446.2
,CDM,4140000054.10.4140,XR KNEES-STANDING BILAT,CDM Code,Outpatient,73565,$311.,$38.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$38.,$286.12
,CDM,4140000054.20.4140,XR KNEES-STANDING BILAT,CDM Code,Outpatient,73565,$311.,$38.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$38.,$286.12
,CDM,4140000054.30.4140,XR KNEES-STANDING BILAT,CDM Code,Outpatient,73565,$311.,$38.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$38.,$286.12
,CDM,4140000062.10.4140,XR BILAT FEMURS,CDM Code,Outpatient,73552,$311.,$33.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$33.,$286.12
,CDM,4140000062.20.4140,XR BILAT FEMURS,CDM Code,Outpatient,73552,$326.,$33.,$309.7,$260.8,$296.66,$85.488,$309.7,$80.6491,$309.7,$309.7,$159.8262,$222.495,$33.,$299.92
,CDM,4140000065.10.4140,XR HIP UNILAT 1 VIEW LT,CDM Code,Outpatient,73501LT,$311.,$29.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$29.,$286.12
,CDM,4140000065.20.4140,XR HIP UNILAT 1 VIEW LT,CDM Code,Outpatient,73501,$311.,$29.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$29.,$286.12
,CDM,4140000065.30.4140,XR HIP UNILAT 1 VIEW LT,CDM Code,Outpatient,73501,$304.,$29.,$288.8,$243.2,$276.64,$79.7188,$288.8,$75.2066,$288.8,$288.8,$159.8262,$207.48,$29.,$279.68
,CDM,4140000066.10.4140,XR HIP UNILAT 1 VIEW RT,CDM Code,Outpatient,73501RT,$311.,$29.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$29.,$286.12
,CDM,4140000066.20.4140,XR HIP UNILAT 1 VIEW RT,CDM Code,Outpatient,73501,$311.,$29.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$29.,$286.12
,CDM,4140000066.30.4140,XR HIP UNILAT 1 VIEW RT,CDM Code,Outpatient,73501,$304.,$29.,$288.8,$243.2,$276.64,$79.7188,$288.8,$75.2066,$288.8,$288.8,$159.8262,$207.48,$29.,$279.68
,CDM,4140000069.10.4140,XR HIPS BILATERAL,CDM Code,Outpatient,73521,$572.,$37.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$37.,$526.24
,CDM,4140000069.20.4140,XR HIPS BILATERAL,CDM Code,Outpatient,73521,$572.,$37.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$37.,$526.24
,CDM,4140000069.30.4140,XR HIPS BILATERAL,CDM Code,Outpatient,73521,$572.,$37.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$37.,$526.24
,CDM,4140000075.10.4140,XR PELVIS 1 OR 2 VIEWS,CDM Code,Outpatient,72170,$572.,$32.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$32.5,$526.24
,CDM,4140000075.20.4140,XR PELVIS 1 OR 2 VIEWS,CDM Code,Outpatient,72170,$572.,$32.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$32.5,$526.24
,CDM,4140000075.30.4140,XR PELVIS 1 OR 2 VIEWS,CDM Code,Outpatient,72170,$572.,$32.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$32.5,$526.24
,CDM,4140000076.10.4140,XR PELVIS COMPLETE 3V,CDM Code,Outpatient,72190,$572.,$38.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$38.,$526.24
,CDM,4140000076.30.4140,XR PELVIS COMPLETE 3V,CDM Code,Outpatient,72190,$572.,$38.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$38.,$526.24
,CDM,4140000079.10.4140,XR SACRUM AND COCCYX MIN 2 VIE,CDM Code,Outpatient,72220,$311.,$27.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$27.5,$286.12
,CDM,4140000079.20.4140,XR SACRUM AND COCCYX MIN 2 VIE,CDM Code,Outpatient,72220,$311.,$27.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$27.5,$286.12
,CDM,4140000079.30.4140,XR SACRUM AND COCCYX MIN 2 VIE,CDM Code,Outpatient,72220,$311.,$27.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$27.5,$286.12
,CDM,4140000080.10.4140,XR SACROILIAC JOINTS 3VW,CDM Code,Outpatient,72202,$572.,$33.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$33.,$526.24
,CDM,4140000080.20.4140,XR SACROILIAC JOINTS 3VW,CDM Code,Outpatient,72202,$572.,$33.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$33.,$526.24
,CDM,4140000080.30.4140,XR SACROILIAC JOINTS 3VW,CDM Code,Outpatient,72202,$572.,$33.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$33.,$526.24
,CDM,4140000085.10.4140,XR FINGER MIN 2 VIEWS LT,CDM Code,Outpatient,73140,$311.,$35.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$35.5,$286.12
,CDM,4140000085.20.4140,XR FINGER MIN 2 VIEWS LT,CDM Code,Outpatient,73140,$311.,$35.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$35.5,$286.12
,CDM,4140000085.30.4140,XR FINGER MIN 2 VIEWS LT,CDM Code,Outpatient,73140,$311.,$35.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$35.5,$286.12
,CDM,4140000086.10.4140,XR FINGER MIN 2 VIEWS RT,CDM Code,Outpatient,73140,$311.,$35.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$35.5,$286.12
,CDM,4140000086.20.4140,XR FINGER MIN 2 VIEWS RT,CDM Code,Outpatient,73140,$311.,$35.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$35.5,$286.12
,CDM,4140000086.30.4140,XR FINGER MIN 2 VIEWS RT,CDM Code,Outpatient,73140,$311.,$35.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$35.5,$286.12
,CDM,4140000087.10.4140,XR BILAT FINGERS,CDM Code,Outpatient,73140,$311.,$35.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$35.5,$286.12
,CDM,4140000087.20.4140,XR BILAT FINGERS,CDM Code,Outpatient,73140,$311.,$35.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$35.5,$286.12
,CDM,4140000087.30.4140,XR BILAT FINGERS,CDM Code,Outpatient,73140,$297.,$35.5,$282.15,$237.6,$270.27,$77.8832,$282.15,$73.4748,$282.15,$282.15,$159.8262,$202.7025,$35.5,$273.24
,CDM,4140000090.10.4140,XR HAND - TWO VIEWS  LT,CDM Code,Outpatient,73120LT,$572.,$28.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$28.,$526.24
,CDM,4140000090.20.4140,XR HAND - TWO VIEWS  LT,CDM Code,Outpatient,73120,$572.,$28.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$28.,$526.24
,CDM,4140000091.10.4140,XR HAND - TWO VIEWS  RT,CDM Code,Outpatient,73120RT,$572.,$28.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$28.,$526.24
,CDM,4140000091.20.4140,XR HAND - TWO VIEWS  RT,CDM Code,Outpatient,73120,$572.,$28.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$28.,$526.24
,CDM,4140000092.10.4140,XR BILAT HANDS 2VW,CDM Code,Outpatient,7312050,"$1,144.",$28.,"$1,086.8",$915.2,"$1,041.04",$299.9946,"$1,086.8",$283.0142,"$1,086.8","$1,086.8",$300.9891,$780.78,$28.,"$1,052.48"
,CDM,4140000092.20.4140,XR BILAT HANDS 2VW,CDM Code,Outpatient,73120,"$1,144.",$28.,"$1,086.8",$915.2,"$1,041.04",$299.9946,"$1,086.8",$283.0142,"$1,086.8","$1,086.8",$300.9891,$780.78,$28.,"$1,052.48"
,CDM,4140000092.30.4140,XR BILAT HANDS 2VW,CDM Code,Outpatient,73120,"$1,144.",$28.,"$1,086.8",$915.2,"$1,041.04",$299.9946,"$1,086.8",$283.0142,"$1,086.8","$1,086.8",$300.9891,$780.78,$28.,"$1,052.48"
,CDM,4140000093.10.4140,XR HAND MIN 3V LT,CDM Code,Outpatient,73130LT,$311.,$32.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$32.5,$286.12
,CDM,4140000093.20.4140,XR HAND MIN 3V LT,CDM Code,Outpatient,73130,$311.,$32.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$32.5,$286.12
,CDM,4140000093.30.4140,XR HAND MIN 3V LT,CDM Code,Outpatient,73130,$311.,$32.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$32.5,$286.12
,CDM,4140000094.10.4140,XR HAND MIN 3V RT,CDM Code,Outpatient,73130RT,$311.,$32.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$32.5,$286.12
,CDM,4140000094.20.4140,XR HAND MIN 3V RT,CDM Code,Outpatient,73130,$311.,$32.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$32.5,$286.12
,CDM,4140000094.30.4140,XR HAND MIN 3V RT,CDM Code,Outpatient,73130,$311.,$32.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$32.5,$286.12
,CDM,4140000095.10.4140,XR BILAT HANDS 3VW,CDM Code,Outpatient,7313050,$622.,$32.5,$590.9,$497.6,$566.02,$163.1089,$590.9,$153.8766,$590.9,$590.9,$159.8262,$424.515,$32.5,$572.24
,CDM,4140000095.20.4140,XR BILAT HANDS 3VW,CDM Code,Outpatient,73130,$622.,$32.5,$590.9,$497.6,$566.02,$163.1089,$590.9,$153.8766,$590.9,$590.9,$159.8262,$424.515,$32.5,$572.24
,CDM,4140000095.30.4140,XR BILAT HANDS 3VW,CDM Code,Outpatient,73130,$622.,$32.5,$590.9,$497.6,$566.02,$163.1089,$590.9,$153.8766,$590.9,$590.9,$159.8262,$424.515,$32.5,$572.24
,CDM,4140000100.10.4140,XR WRIST 2V  LT,CDM Code,Outpatient,73100LT,$311.,$32.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$32.,$286.12
,CDM,4140000100.20.4140,XR WRIST 2V  LT,CDM Code,Outpatient,73100,$311.,$32.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$32.,$286.12
,CDM,4140000101.10.4140,XR WRIST 2V  RT,CDM Code,Outpatient,73100RT,$311.,$32.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$32.,$286.12
,CDM,4140000101.20.4140,XR WRIST 2V  RT,CDM Code,Outpatient,73100,$311.,$32.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$32.,$286.12
,CDM,4140000101.30.4140,XR WRIST 2V  RT,CDM Code,Outpatient,73100,$311.,$32.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$32.,$286.12
,CDM,4140000102.10.4140,XR BILAT WRISTS 2VW,CDM Code,Outpatient,7310050,$622.,$32.,$590.9,$497.6,$566.02,$163.1089,$590.9,$153.8766,$590.9,$590.9,$159.8262,$424.515,$32.,$572.24
,CDM,4140000103.10.4140,XR WRIST COMPLETE 3 VIEWS LT,CDM Code,Outpatient,73110LT,$311.,$37.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$37.,$286.12
,CDM,4140000103.20.4140,XR WRIST COMPLETE 3 VIEWS LT,CDM Code,Outpatient,73110,$311.,$37.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$37.,$286.12
,CDM,4140000103.30.4140,XR WRIST COMPLETE 3 VIEWS LT,CDM Code,Outpatient,73110,$311.,$37.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$37.,$286.12
,CDM,4140000104.10.4140,XR WRIST COMPLETE 3 VIEWS RT,CDM Code,Outpatient,73110RT,$311.,$37.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$37.,$286.12
,CDM,4140000104.20.4140,XR WRIST COMPLETE 3 VIEWS RT,CDM Code,Outpatient,73110,$311.,$37.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$37.,$286.12
,CDM,4140000105.10.4140,XR BILAT WRISTS 3 VIEWS,CDM Code,Outpatient,7311050,$622.,$37.,$590.9,$497.6,$566.02,$163.1089,$590.9,$153.8766,$590.9,$590.9,$159.8262,$424.515,$37.,$572.24
,CDM,4140000105.20.4140,XR BILAT WRISTS 3 VIEWS,CDM Code,Outpatient,73110,$324.,$37.,$307.8,$259.2,$294.84,$84.9635,$307.8,$80.1544,$307.8,$307.8,$159.8262,$221.13,$37.,$298.08
,CDM,4140000106.10.4140,XR WRIST COMPLETE 4 VIEWS LT,CDM Code,Outpatient,73110LT,$311.,$37.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$37.,$286.12
,CDM,4140000106.20.4140,XR WRIST COMPLETE 4 VIEWS LT,CDM Code,Outpatient,73110,$311.,$37.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$37.,$286.12
,CDM,4140000106.30.4140,XR WRIST COMPLETE 4 VIEWS LT,CDM Code,Outpatient,73110,$311.,$37.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$37.,$286.12
,CDM,4140000107.10.4140,XR WRIST COMPLETE 4 VIEWS RT,CDM Code,Outpatient,73110RT,$311.,$37.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$37.,$286.12
,CDM,4140000107.20.4140,XR WRIST COMPLETE 4 VIEWS RT,CDM Code,Outpatient,73110,$311.,$37.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$37.,$286.12
,CDM,4140000107.30.4140,XR WRIST COMPLETE 4 VIEWS RT,CDM Code,Outpatient,73110,$311.,$37.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$37.,$286.12
,CDM,4140000108.10.4140,XR BILAT WRISTS 4VW,CDM Code,Outpatient,7311050,$622.,$37.,$590.9,$497.6,$566.02,$163.1089,$590.9,$153.8766,$590.9,$590.9,$159.8262,$424.515,$37.,$572.24
,CDM,4140000108.20.4140,XR BILAT WRISTS 4VW,CDM Code,Outpatient,73110,$324.,$37.,$307.8,$259.2,$294.84,$84.9635,$307.8,$80.1544,$307.8,$307.8,$159.8262,$221.13,$37.,$298.08
,CDM,4140000108.30.4140,XR BILAT WRISTS 4VW,CDM Code,Outpatient,73110,$622.,$37.,$590.9,$497.6,$566.02,$163.1089,$590.9,$153.8766,$590.9,$590.9,$159.8262,$424.515,$37.,$572.24
,CDM,4140000110.10.4140,XR FOREARM 2V  LT,CDM Code,Outpatient,73090LT,$311.,$24.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$24.5,$286.12
,CDM,4140000110.20.4140,XR FOREARM 2V  LT,CDM Code,Outpatient,73090,$311.,$24.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$24.5,$286.12
,CDM,4140000110.30.4140,XR FOREARM 2V  LT,CDM Code,Outpatient,73090,$311.,$24.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$24.5,$286.12
,CDM,4140000111.10.4140,XR FOREARM 2V  RT,CDM Code,Outpatient,73090RT,$311.,$24.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$24.5,$286.12
,CDM,4140000111.20.4140,XR FOREARM 2V  RT,CDM Code,Outpatient,73090,$311.,$24.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$24.5,$286.12
,CDM,4140000111.30.4140,XR FOREARM 2V  RT,CDM Code,Outpatient,73090,$311.,$24.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$24.5,$286.12
,CDM,4140000112.10.4140,XR BILAT FOREARMS,CDM Code,Outpatient,7309050,$622.,$24.5,$590.9,$497.6,$566.02,$163.1089,$590.9,$153.8766,$590.9,$590.9,$159.8262,$424.515,$24.5,$572.24
,CDM,4140000115.10.4140,XR ELBOW TWO VIEWS LT,CDM Code,Outpatient,73070LT,$311.,$27.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$27.,$286.12
,CDM,4140000115.20.4140,XR ELBOW TWO VIEWS LT,CDM Code,Outpatient,73070,$303.,$27.,$287.85,$242.4,$275.73,$79.4566,$287.85,$74.9592,$287.85,$287.85,$159.8262,$206.7975,$27.,$278.76
,CDM,4140000115.30.4140,XR ELBOW TWO VIEWS LT,CDM Code,Outpatient,73070,$303.,$27.,$287.85,$242.4,$275.73,$79.4566,$287.85,$74.9592,$287.85,$287.85,$159.8262,$206.7975,$27.,$278.76
,CDM,4140000116.10.4140,XR ELBOW TWO VIEWS RT,CDM Code,Outpatient,73070RT,$311.,$27.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$27.,$286.12
,CDM,4140000117.10.4140,XR BILAT ELBOWS 2VW,CDM Code,Outpatient,7307050,$447.,$27.,$424.65,$357.6,$406.77,$117.2182,$424.65,$110.5833,$424.65,$424.65,$159.8262,$305.0775,$27.,$411.24
,CDM,4140000118.10.4140,XR ELBOW COMPLETE LT,CDM Code,Outpatient,73080LT,$311.,$32.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$32.,$286.12
,CDM,4140000118.20.4140,XR ELBOW COMPLETE LT,CDM Code,Outpatient,73080,$311.,$32.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$32.,$286.12
,CDM,4140000118.30.4140,XR ELBOW COMPLETE LT,CDM Code,Outpatient,73080,$311.,$32.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$32.,$286.12
,CDM,4140000119.10.4140,XR ELBOW COMPLETE RT,CDM Code,Outpatient,73080RT,$311.,$32.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$32.,$286.12
,CDM,4140000119.20.4140,XR ELBOW COMPLETE RT,CDM Code,Outpatient,73080,$311.,$32.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$32.,$286.12
,CDM,4140000119.30.4140,XR ELBOW COMPLETE RT,CDM Code,Outpatient,73080,$311.,$32.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$32.,$286.12
,CDM,4140000120.10.4140,XR BILAT ELBOWS 3VW,CDM Code,Outpatient,7308050,$622.,$32.,$590.9,$497.6,$566.02,$163.1089,$590.9,$153.8766,$590.9,$590.9,$159.8262,$424.515,$32.,$572.24
,CDM,4140000125.10.4140,XR HUMERUS LT,CDM Code,Outpatient,73060LT,$311.,$29.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$29.,$286.12
,CDM,4140000125.20.4140,XR HUMERUS LT,CDM Code,Outpatient,73060,$311.,$29.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$29.,$286.12
,CDM,4140000125.30.4140,XR HUMERUS LT,CDM Code,Outpatient,73060,$311.,$29.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$29.,$286.12
,CDM,4140000126.10.4140,XR HUMERUS RT,CDM Code,Outpatient,73060RT,$311.,$29.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$29.,$286.12
,CDM,4140000126.20.4140,XR HUMERUS RT,CDM Code,Outpatient,73060,$311.,$29.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$29.,$286.12
,CDM,4140000126.30.4140,XR HUMERUS RT,CDM Code,Outpatient,73060,$311.,$29.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$29.,$286.12
,CDM,4140000127.10.4140,XR BILAT HUMERUS,CDM Code,Outpatient,7306050,$376.,$29.,$357.2,$300.8,$342.16,$98.5996,$357.2,$93.0186,$357.2,$357.2,$159.8262,$256.62,$29.,$345.92
,CDM,4140000130.10.4140,XR SHOULDER 1 VIEW LT,CDM Code,Outpatient,73020LT,$311.,$21.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$21.,$286.12
,CDM,4140000131.10.4140,XR SHOULDER 1 VIEW RT,CDM Code,Outpatient,73020RT,$311.,$21.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$21.,$286.12
,CDM,4140000131.30.4140,XR SHOULDER 1 VIEW RT,CDM Code,Outpatient,73020,$282.,$21.,$267.9,$225.6,$256.62,$73.9497,$267.9,$69.764,$267.9,$267.9,$159.8262,$192.465,$21.,$259.44
,CDM,4140000132.10.4140,XR BILAT SHOULDERS 1VW,CDM Code,Outpatient,7302050,$301.,$21.,$285.95,$240.8,$273.91,$78.9321,$285.95,$74.4644,$285.95,$285.95,$159.8262,$205.4325,$21.,$276.92
,CDM,4140000133.10.4140,XR SHOULDER COMPLETE 2V LT,CDM Code,Outpatient,73030LT,$311.,$28.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$28.,$286.12
,CDM,4140000133.20.4140,XR SHOULDER COMPLETE 2V LT,CDM Code,Outpatient,73030,$311.,$28.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$28.,$286.12
,CDM,4140000133.30.4140,XR SHOULDER COMPLETE 2V LT,CDM Code,Outpatient,73030,$311.,$28.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$28.,$286.12
,CDM,4140000134.10.4140,XR SHOULDER COMPLETE 2V RT,CDM Code,Outpatient,73030RT,$311.,$28.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$28.,$286.12
,CDM,4140000134.20.4140,XR SHOULDER COMPLETE 2V RT,CDM Code,Outpatient,73030,$311.,$28.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$28.,$286.12
,CDM,4140000134.30.4140,XR SHOULDER COMPLETE 2V RT,CDM Code,Outpatient,73030,$311.,$28.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$28.,$286.12
,CDM,4140000135.10.4140,XR BILAT SHOULDERS 2VWS,CDM Code,Outpatient,7303050,$622.,$28.,$590.9,$497.6,$566.02,$163.1089,$590.9,$153.8766,$590.9,$590.9,$159.8262,$424.515,$28.,$572.24
,CDM,4140000135.30.4140,XR BILAT SHOULDERS 2VWS,CDM Code,Outpatient,73030,$485.,$28.,$460.75,$388.,$441.35,$127.183,$460.75,$119.9842,$460.75,$460.75,$159.8262,$331.0125,$28.,$446.2
,CDM,4140000140.10.4140,XR SHOULDER COMPLETE 3V LT,CDM Code,Outpatient,73030LT,$311.,$28.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$28.,$286.12
,CDM,4140000140.20.4140,XR SHOULDER COMPLETE 3V LT,CDM Code,Outpatient,73030,$311.,$28.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$28.,$286.12
,CDM,4140000140.30.4140,XR SHOULDER COMPLETE 3V LT,CDM Code,Outpatient,73030,$311.,$28.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$28.,$286.12
,CDM,4140000141.10.4140,XR SHOULDER COMPLETE 3V RT,CDM Code,Outpatient,73030RT,$311.,$28.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$28.,$286.12
,CDM,4140000141.20.4140,XR SHOULDER COMPLETE 3V RT,CDM Code,Outpatient,73030,$311.,$28.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$28.,$286.12
,CDM,4140000141.30.4140,XR SHOULDER COMPLETE 3V RT,CDM Code,Outpatient,73030,$311.,$28.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$28.,$286.12
,CDM,4140000142.10.4140,XR BILAT SHOULDERS 3 VIEWS,CDM Code,Outpatient,7303050,$622.,$28.,$590.9,$497.6,$566.02,$163.1089,$590.9,$153.8766,$590.9,$590.9,$159.8262,$424.515,$28.,$572.24
,CDM,4140000142.20.4140,XR BILAT SHOULDERS 3 VIEWS,CDM Code,Outpatient,73030,$622.,$28.,$590.9,$497.6,$566.02,$163.1089,$590.9,$153.8766,$590.9,$590.9,$159.8262,$424.515,$28.,$572.24
,CDM,4140000142.30.4140,XR BILAT SHOULDERS 3 VIEWS,CDM Code,Outpatient,73030,$622.,$28.,$590.9,$497.6,$566.02,$163.1089,$590.9,$153.8766,$590.9,$590.9,$159.8262,$424.515,$28.,$572.24
,CDM,4140000143.10.4140,XR SCAPULA COMPLETE LT,CDM Code,Outpatient,73010LT,$572.,$30.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$159.8262,$390.39,$30.,$526.24
,CDM,4140000143.30.4140,XR SCAPULA COMPLETE LT,CDM Code,Outpatient,73010,$329.,$30.,$312.55,$263.2,$299.39,$86.2747,$312.55,$81.3913,$312.55,$312.55,$159.8262,$224.5425,$30.,$302.68
,CDM,4140000144.10.4140,XR SCAPULA COMPLETE RT,CDM Code,Outpatient,73010RT,$572.,$30.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$159.8262,$390.39,$30.,$526.24
,CDM,4140000150.10.4140,XR CLAVICLE LT,CDM Code,Outpatient,73000LT,$311.,$27.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$27.5,$286.12
,CDM,4140000150.20.4140,XR CLAVICLE LT,CDM Code,Outpatient,73000,$311.,$27.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$27.5,$286.12
,CDM,4140000150.30.4140,XR CLAVICLE LT,CDM Code,Outpatient,73000,$311.,$27.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$27.5,$286.12
,CDM,4140000151.10.4140,XR CLAVICLE RT,CDM Code,Outpatient,73000RT,$311.,$27.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$27.5,$286.12
,CDM,4140000151.20.4140,XR CLAVICLE RT,CDM Code,Outpatient,73000,$311.,$27.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$27.5,$286.12
,CDM,4140000151.30.4140,XR CLAVICLE RT,CDM Code,Outpatient,73000,$311.,$27.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$27.5,$286.12
,CDM,4140000152.10.4140,XR CLAVICLE BI,CDM Code,Outpatient,7300050,$622.,$27.5,$590.9,$497.6,$566.02,$163.1089,$590.9,$153.8766,$590.9,$590.9,$159.8262,$424.515,$27.5,$572.24
,CDM,4140000152.30.4140,XR CLAVICLE BI,CDM Code,Outpatient,73000,$304.,$27.5,$288.8,$243.2,$276.64,$79.7188,$288.8,$75.2066,$288.8,$288.8,$159.8262,$207.48,$27.5,$279.68
,CDM,4140000153.10.4140,XR STERNOCAVICULAR JOINTS MIN,CDM Code,Outpatient,71130,$311.,$35.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$35.,$286.12
,CDM,4140000153.30.4140,XR STERNOCAVICULAR JOINTS MIN,CDM Code,Outpatient,71130,$541.,$35.,$513.95,$432.8,$492.31,$141.8681,$513.95,$133.838,$513.95,$513.95,$159.8262,$369.2325,$35.,$497.72
,CDM,4140000155.10.4140,XR BONE AGE STUDY,CDM Code,Outpatient,77072,$572.,$19.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$19.,$526.24
,CDM,4140000155.20.4140,XR BONE AGE STUDY,CDM Code,Outpatient,77072,$572.,$19.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$19.,$526.24
,CDM,4140000155.30.4140,XR BONE AGE STUDY,CDM Code,Outpatient,77072,$572.,$19.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$19.,$526.24
,CDM,4140000156.10.4140,XR BONE LENGTH STUDY,CDM Code,Outpatient,77073,$572.,$30.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$159.8262,$390.39,$30.5,$526.24
,CDM,4140000157.10.4140,XR BONE SURVEY INFANT,CDM Code,Outpatient,77076,$833.,$85.5,$791.35,$666.4,$758.03,$218.4401,$791.35,$206.0759,$791.35,$791.35,$300.9891,$568.5225,$85.5,$766.36
,CDM,4140000158.10.4140,XR BONE SURVEY LMTD,CDM Code,Outpatient,77074,$646.,$58.5,$613.7,$516.8,$587.86,$169.4025,$613.7,$159.8139,$613.7,$613.7,$300.9891,$440.895,$58.5,$594.32
,CDM,4140000159.10.4140,XR BONE SURVEY COMPLETE,CDM Code,Outpatient,77075,$572.,$85.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$85.,$526.24
,CDM,4140000163.10.4140,XR MASTOIDS 3 VW,CDM Code,Outpatient,70130,$473.,$52.,$449.35,$378.4,$430.43,$124.0362,$449.35,$117.0155,$449.35,$449.35,$300.9891,$322.8225,$52.,$435.16
,CDM,4140000165.10.4140,XR CERVICAL SPINE 2 OR 3VW,CDM Code,Outpatient,72040,$311.,$31.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$31.,$286.12
,CDM,4140000165.20.4140,XR CERVICAL SPINE 2 OR 3VW,CDM Code,Outpatient,72040,$311.,$31.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$31.,$286.12
,CDM,4140000165.30.4140,XR CERVICAL SPINE 2 OR 3VW,CDM Code,Outpatient,72040,$311.,$31.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$31.,$286.12
,CDM,4140000166.10.4140,XR CERVICAL SPINE MIN 4VW,CDM Code,Outpatient,72050,$572.,$41.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$41.5,$526.24
,CDM,4140000166.20.4140,XR CERVICAL SPINE MIN 4VW,CDM Code,Outpatient,72050,$572.,$41.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$41.5,$526.24
,CDM,4140000166.30.4140,XR CERVICAL SPINE MIN 4VW,CDM Code,Outpatient,72050,$572.,$41.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$41.5,$526.24
,CDM,4140000167.10.4140,XR CERVICAL SPINE COMPLETE,CDM Code,Outpatient,72052,$572.,$53.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$53.,$526.24
,CDM,4140000167.20.4140,XR CERVICAL SPINE COMPLETE,CDM Code,Outpatient,72052,$572.,$53.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$53.,$526.24
,CDM,4140000167.30.4140,XR CERVICAL SPINE COMPLETE,CDM Code,Outpatient,72052,$572.,$53.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$53.,$526.24
,CDM,4140000168.10.4140,XR LUMBAR SPINE 2 OR 3VW,CDM Code,Outpatient,72100,$572.,$33.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$33.5,$526.24
,CDM,4140000168.20.4140,XR LUMBAR SPINE 2 OR 3VW,CDM Code,Outpatient,72100,$572.,$33.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$33.5,$526.24
,CDM,4140000168.30.4140,XR LUMBAR SPINE 2 OR 3VW,CDM Code,Outpatient,72100,$572.,$33.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$33.5,$526.24
,CDM,4140000169.10.4140,XR LUMBOSACRAL SPINE 4VW,CDM Code,Outpatient,72110,$572.,$46.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$46.5,$526.24
,CDM,4140000169.20.4140,XR LUMBOSACRAL SPINE 4VW,CDM Code,Outpatient,72110,$572.,$46.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$46.5,$526.24
,CDM,4140000169.30.4140,XR LUMBOSACRAL SPINE 4VW,CDM Code,Outpatient,72110,$572.,$46.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$46.5,$526.24
,CDM,4140000170.10.4140,XR LUMBAR SPINE W/BENDING 6 VW,CDM Code,Outpatient,72114,$572.,$63.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$63.5,$526.24
,CDM,4140000170.20.4140,XR LUMBAR SPINE W/BENDING 6 VW,CDM Code,Outpatient,72114,$572.,$63.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$63.5,$526.24
,CDM,4140000170.30.4140,XR LUMBAR SPINE W/BENDING 6 VW,CDM Code,Outpatient,72114,$572.,$63.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$63.5,$526.24
,CDM,4140000171.10.4140,XR LUMBR SPN BENDING ONLY 2-3,CDM Code,Outpatient,72120,$572.,$41.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$159.8262,$390.39,$41.5,$526.24
,CDM,4140000174.10.4140,XR THORACOLUMBAR 2 VIEW,CDM Code,Outpatient,72080,$311.,$31.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$31.5,$286.12
,CDM,4140000175.10.4140,XR THORACIC SPINE 2VW,CDM Code,Outpatient,72070,$572.,$32.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$32.,$526.24
,CDM,4140000175.20.4140,XR THORACIC SPINE 2VW,CDM Code,Outpatient,72070,$572.,$32.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$32.,$526.24
,CDM,4140000175.30.4140,XR THORACIC SPINE 2VW,CDM Code,Outpatient,72070,$572.,$32.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$32.,$526.24
,CDM,4140000176.10.4140,XR THORACIC SPINE 3VW,CDM Code,Outpatient,72072,$572.,$33.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$33.5,$526.24
,CDM,4140000176.20.4140,XR THORACIC SPINE 3VW,CDM Code,Outpatient,72072,$572.,$33.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$33.5,$526.24
,CDM,4140000176.30.4140,XR THORACIC SPINE 3VW,CDM Code,Outpatient,72072,$572.,$33.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$33.5,$526.24
,CDM,4140000177.10.4140,XR SPINE SINGLE VIEW,CDM Code,Outpatient,72020,$303.,$20.5,$287.85,$242.4,$275.73,$79.4566,$287.85,$74.9592,$287.85,$287.85,$159.8262,$206.7975,$20.5,$278.76
,CDM,4140000179.10.4140,XR SPINE ENTIRE AP   LAT,CDM Code,Outpatient,72082,$572.,$65.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$65.,$526.24
,CDM,4140000180.10.4140,XR LWR EXTREM INFNT MIN 2 V LT,CDM Code,Outpatient,73592LT,$311.,$27.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$27.,$286.12
,CDM,4140000181.10.4140,XR LWR EXTREM INFNT MIN 2 V RT,CDM Code,Outpatient,73592RT,$311.,$27.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$27.,$286.12
,CDM,4140000182.10.4140,XR BILAT INFANT LOWER EXT,CDM Code,Outpatient,7359250,$367.,$27.,$348.65,$293.6,$333.97,$96.2395,$348.65,$90.7921,$348.65,$348.65,$159.8262,$250.4775,$27.,$337.64
,CDM,4140000183.10.4140,XR UPR EXTREM INFANT MIN LT,CDM Code,Outpatient,73092LT,$572.,$27.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$27.,$526.24
,CDM,4140000184.10.4140,XR UPR EXTREM INFANT MIN RT,CDM Code,Outpatient,73092RT,$572.,$27.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$27.,$526.24
,CDM,4140000185.10.4140,XR BILAT INFANT UPPER EXT,CDM Code,Outpatient,73092,$475.,$27.,$451.25,$380.,$432.25,$124.5607,$451.25,$117.5102,$451.25,$451.25,$300.9891,$324.1875,$27.,$437.
,CDM,4140000190.10.4140,XR CHEST 1V FRONTAL,CDM Code,Outpatient,71010,$371.,$91.7817,$352.45,$296.8,$337.61,$97.2884,$352.45,$91.7817,$352.45,$352.45,$159.8262,$253.2075,$326.48,$341.32
,CDM,4140000190.20.4140,XR CHEST 1V FRONTAL,CDM Code,Outpatient,71010,$363.,$89.8026,$344.85,$290.4,$330.33,$95.1906,$344.85,$89.8026,$344.85,$344.85,$159.8262,$247.7475,$319.44,$333.96
,CDM,4140000190.30.4140,XR CHEST 1V FRONTAL,CDM Code,Outpatient,71010,$371.,$91.7817,$352.45,$296.8,$337.61,$97.2884,$352.45,$91.7817,$352.45,$352.45,$159.8262,$253.2075,$326.48,$341.32
,CDM,4140000191.10.4140,XR CHEST PA AND LATERAL,CDM Code,Outpatient,71020,$439.,$108.6042,$417.05,$351.2,$399.49,$115.1203,$417.05,$108.6042,$417.05,$417.05,$159.8262,$299.6175,$386.32,$403.88
,CDM,4140000191.20.4140,XR CHEST PA AND LATERAL,CDM Code,Outpatient,71020,$439.,$108.6042,$417.05,$351.2,$399.49,$115.1203,$417.05,$108.6042,$417.05,$417.05,$159.8262,$299.6175,$386.32,$403.88
,CDM,4140000191.30.4140,XR CHEST PA AND LATERAL,CDM Code,Outpatient,71020,$439.,$108.6042,$417.05,$351.2,$399.49,$115.1203,$417.05,$108.6042,$417.05,$417.05,$159.8262,$299.6175,$386.32,$403.88
,CDM,4140000192.10.4140,XR CHEST FOR LINE PLACEMENT,CDM Code,Professional,71045,$0.,$0.,$62.12,$0.,$12.85,$5.6392,$25.06,$5.32,$0.,$0.,$62.12,$0.,$18.,$0.
,CDM,4140000193.10.4140,XR CHEST SPECIAL VIEW,CDM Code,Outpatient,71035,$414.,$102.4195,$393.3,$331.2,$376.74,$108.5645,$393.3,$102.4195,$393.3,$393.3,$159.8262,$282.555,$364.32,$380.88
,CDM,4140000193.20.4140,XR CHEST SPECIAL VIEW,CDM Code,Outpatient,71035,$414.,$102.4195,$393.3,$331.2,$376.74,$108.5645,$393.3,$102.4195,$393.3,$393.3,$159.8262,$282.555,$364.32,$380.88
,CDM,4140000193.30.4140,XR CHEST SPECIAL VIEW,CDM Code,Outpatient,71035,$405.,$100.193,$384.75,$324.,$368.55,$106.2044,$384.75,$100.193,$384.75,$384.75,$159.8262,$276.4125,$356.4,$372.6
,CDM,4140000195.10.4140,XR CHEST APICAL LORDOTIC,CDM Code,Outpatient,71021,$622.,$153.8766,$590.9,$497.6,$566.02,$163.1089,$590.9,$153.8766,$590.9,$590.9,$159.8262,$424.515,$547.36,$572.24
,CDM,4140000196.10.4140,XR 2V CXR INSP/EXP POST THORAC,CDM Code,Professional,71046,$0.,$0.,$62.12,$0.,$23.63,$6.7204,$38.58,$6.34,$0.,$0.,$62.12,$0.,$27.5,$0.
,CDM,4140000200.10.4140,XR RIBS UNILAT 2V LT,CDM Code,Outpatient,71100LT,$311.,$31.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$31.,$286.12
,CDM,4140000200.20.4140,XR RIBS UNILAT 2V LT,CDM Code,Outpatient,71100,$311.,$31.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$31.,$286.12
,CDM,4140000200.30.4140,XR RIBS UNILAT 2V LT,CDM Code,Outpatient,71100,$311.,$31.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$31.,$286.12
,CDM,4140000201.10.4140,XR RIBS UNILAT 2V RT,CDM Code,Outpatient,71100RT,$311.,$31.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$31.,$286.12
,CDM,4140000201.20.4140,XR RIBS UNILAT 2V RT,CDM Code,Outpatient,71100,$311.,$31.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$31.,$286.12
,CDM,4140000201.30.4140,XR RIBS UNILAT 2V RT,CDM Code,Outpatient,71100,$311.,$31.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$31.,$286.12
,CDM,4140000205.10.4140,XR RIBS BILAT 3V 71110,CDM Code,Outpatient,71110,$572.,$35.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$35.5,$526.24
,CDM,4140000205.20.4140,XR RIBS BILAT 3V 71110,CDM Code,Outpatient,71110,$572.,$35.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$35.5,$526.24
,CDM,4140000205.30.4140,XR RIBS BILAT 3V 71110,CDM Code,Outpatient,71110,$572.,$35.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$35.5,$526.24
,CDM,4140000206.10.4140,XR RIBS UNI W/PA CHEST MIN LT,CDM Code,Outpatient,71101LT,$572.,$34.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$34.5,$526.24
,CDM,4140000206.20.4140,XR RIBS UNI W/PA CHEST MIN LT,CDM Code,Outpatient,71101,$572.,$34.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$34.5,$526.24
,CDM,4140000206.30.4140,XR RIBS UNI W/PA CHEST MIN LT,CDM Code,Outpatient,71101,$572.,$34.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$34.5,$526.24
,CDM,4140000207.10.4140,XR RIBS UNI W/PA CHEST MIN RT,CDM Code,Outpatient,71101RT,$572.,$34.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$34.5,$526.24
,CDM,4140000207.20.4140,XR RIBS UNI W/PA CHEST MIN RT,CDM Code,Outpatient,71101,$572.,$34.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$34.5,$526.24
,CDM,4140000207.30.4140,XR RIBS UNI W/PA CHEST MIN RT,CDM Code,Outpatient,71101,$572.,$34.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$34.5,$526.24
,CDM,4140000208.10.4140,XR RIBS BILAT W/PA CHEST MIN 4,CDM Code,Outpatient,71111,$572.,$43.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$43.,$526.24
,CDM,4140000208.30.4140,XR RIBS BILAT W/PA CHEST MIN 4,CDM Code,Outpatient,71111,$851.,$43.,$808.45,$680.8,$774.41,$223.1603,$808.45,$210.5289,$808.45,$808.45,$300.9891,$580.8075,$43.,$782.92
,CDM,4140000215.10.4140,XR STERNUM MIN 2 VIEWS,CDM Code,Outpatient,71120,$311.,$27.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$27.5,$286.12
,CDM,4140000215.20.4140,XR STERNUM MIN 2 VIEWS,CDM Code,Outpatient,71120,$597.,$27.5,$567.15,$477.6,$543.27,$156.5531,$567.15,$147.6918,$567.15,$567.15,$159.8262,$407.4525,$27.5,$549.24
,CDM,4140000216.10.4140,XR IVP ROUTINE,CDM Code,Outpatient,74400,"$1,355.",$120.,"$1,287.25","$1,084.","$1,233.05",$355.3257,"$1,287.25",$335.2135,"$1,287.25","$1,287.25",$603.1797,$924.7875,$120.,"$1,246.6"
,CDM,4140000222.10.4140,XR EYE FOREIGN BODY,CDM Code,Outpatient,70030,$311.,$27.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$27.5,$286.12
,CDM,4140000223.10.4140,XR FACIAL BONES <3 VIEWS,CDM Code,Outpatient,70140,$311.,$27.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$27.,$286.12
,CDM,4140000224.10.4140,XR FACIAL BONES COMPLETE,CDM Code,Outpatient,70150,$572.,$39.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$39.5,$526.24
,CDM,4140000224.20.4140,XR FACIAL BONES COMPLETE,CDM Code,Outpatient,70150,$572.,$39.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$39.5,$526.24
,CDM,4140000224.30.4140,XR FACIAL BONES COMPLETE,CDM Code,Outpatient,70150,$572.,$39.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$39.5,$526.24
,CDM,4140000225.10.4140,XR CYSTO RETROGRADE C-ARM,CDM Code,Outpatient,74450,$798.,$78.5,$758.1,$638.4,$726.18,$209.2619,$758.1,$197.4172,$758.1,$758.1,$603.1797,$544.635,$78.5,$734.16
,CDM,4140000229.10.4140,XR TMJ BILAT,CDM Code,Outpatient,70330,$311.,$49.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$49.,$286.12
,CDM,4140000230.10.4140,XR SKULL <4 VIEWS,CDM Code,Outpatient,70250,$572.,$33.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$33.5,$526.24
,CDM,4140000231.10.4140,XR SKULL COMPLETE,CDM Code,Outpatient,70260,$572.,$39.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$39.5,$526.24
,CDM,4140000231.20.4140,XR SKULL COMPLETE,CDM Code,Outpatient,70260,$572.,$39.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$39.5,$526.24
,CDM,4140000231.30.4140,XR SKULL COMPLETE,CDM Code,Outpatient,70260,$572.,$39.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$39.5,$526.24
,CDM,4140000232.10.4140,XR SINUS WATERS VIEW,CDM Code,Outpatient,70210,$311.,$29.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$29.5,$286.12
,CDM,4140000232.20.4140,XR SINUS WATERS VIEW,CDM Code,Outpatient,70210,$404.,$29.5,$383.8,$323.2,$367.64,$105.9421,$383.8,$99.9456,$383.8,$383.8,$159.8262,$275.73,$29.5,$371.68
,CDM,4140000232.30.4140,XR SINUS WATERS VIEW,CDM Code,Outpatient,70210,$413.,$29.5,$392.35,$330.4,$375.83,$108.3022,$392.35,$102.1721,$392.35,$392.35,$159.8262,$281.8725,$29.5,$379.96
,CDM,4140000233.10.4140,XR SINUSES COMPL MIN 3 VIEW,CDM Code,Outpatient,70220,$311.,$35.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$35.,$286.12
,CDM,4140000233.20.4140,XR SINUSES COMPL MIN 3 VIEW,CDM Code,Outpatient,70220,$311.,$35.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$35.,$286.12
,CDM,4140000233.30.4140,XR SINUSES COMPL MIN 3 VIEW,CDM Code,Outpatient,70220,$311.,$35.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$35.,$286.12
,CDM,4140000234.10.4140,XR MANDIBLE COMPLETE 4V,CDM Code,Outpatient,70110,$572.,$35.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$35.5,$526.24
,CDM,4140000234.20.4140,XR MANDIBLE COMPLETE 4V,CDM Code,Outpatient,70110,$572.,$35.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$35.5,$526.24
,CDM,4140000234.30.4140,XR MANDIBLE COMPLETE 4V,CDM Code,Outpatient,70110,$572.,$35.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$35.5,$526.24
,CDM,4140000235.10.4140,XR NASAL BONE COMPLETE 3V,CDM Code,Outpatient,70160,$311.,$34.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$34.,$286.12
,CDM,4140000235.20.4140,XR NASAL BONE COMPLETE 3V,CDM Code,Outpatient,70160,$515.,$34.,$489.25,$412.,$468.65,$135.05,$489.25,$127.4058,$489.25,$489.25,$159.8262,$351.4875,$34.,$473.8
,CDM,4140000240.10.4140,XR NECK SOFT TISSUE,CDM Code,Outpatient,70360,$311.,$28.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$28.,$286.12
,CDM,4140000240.20.4140,XR NECK SOFT TISSUE,CDM Code,Outpatient,70360,$311.,$28.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$28.,$286.12
,CDM,4140000240.30.4140,XR NECK SOFT TISSUE,CDM Code,Outpatient,70360,$311.,$28.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$28.,$286.12
,CDM,4140000241.10.4140,XR ORBITS COMPLETE 4V,CDM Code,Outpatient,70200,$572.,$39.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$39.5,$526.24
,CDM,4140000241.30.4140,XR ORBITS COMPLETE 4V,CDM Code,Outpatient,70200,$729.,$39.5,$692.55,$583.2,$663.39,$191.1679,$692.55,$180.3473,$692.55,$692.55,$300.9891,$497.5425,$39.5,$670.68
,CDM,4140000242.10.4140,XR SINGLE FILM FOR FB (INFANT),CDM Code,Outpatient,76010,$311.,$24.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$24.,$286.12
,CDM,4140000243.10.4140,XR SHUNTOGRAM,CDM Code,Outpatient,75809,$702.,$106.,$666.9,$561.6,$638.82,$184.0876,$666.9,$173.6678,$666.9,$666.9,$300.9891,$479.115,$106.,$645.84
,CDM,4140000245.10.4140,XR URETHROCYSTO VOIDING,CDM Code,Outpatient,74455,$922.,$93.,$875.9,$737.6,$839.02,$241.7788,$875.9,$228.0936,$875.9,$875.9,$603.1797,$629.265,$93.,$848.24
,CDM,4140000246.10.4140,XR ECHO STRESS TEST,CDM Code,Outpatient,93017,"$1,244.",$48.5,"$1,181.8",$995.2,"$1,132.04",$326.2179,"$1,181.8",$307.7532,"$1,181.8","$1,181.8",$620.2677,$849.03,$48.5,"$1,144.48"
,CDM,4140000247.10.4140,XR CHOLANGIOGRAPHY,CDM Code,Outpatient,74300,$627.,$48.5,$595.65,$501.6,$570.57,$164.4201,$595.65,$155.1135,$595.65,$595.65,$62.7,$427.9275,$48.5,$576.84
,CDM,4140000251.10.4140,XR TMJ UNILATERAL LT,CDM Code,Outpatient,70328LT,$430.,$30.,$408.5,$344.,$391.3,$112.7602,$408.5,$106.3777,$408.5,$408.5,$159.8262,$293.475,$30.,$395.6
,CDM,4140000275.10.4140,FL GUIDANCE NP HIP ARTH,CDM Code,Outpatient,73525,"$1,449.",$104.5,"$1,376.55","$1,159.2","$1,318.59",$379.9756,"$1,376.55",$358.4681,"$1,376.55","$1,376.55","$1,200.6456",$988.9425,$104.5,"$1,333.08"
,CDM,4140000301.10.4140,FL BARIUM ENEMA W/AIR,CDM Code,Outpatient,74280,"$1,264.",$230.5,"$1,200.8","$1,011.2","$1,150.24",$331.4625,"$1,200.8",$312.701,"$1,200.8","$1,200.8",$300.9891,$862.68,$230.5,"$1,162.88"
,CDM,4140000302.10.4140,FL BE SCREENING HI RISK W/AIR,CDM Code,Outpatient,G0120,"$1,779.",$440.1068,"$1,690.05","$1,423.2","$1,618.89",$466.5125,"$1,690.05",$440.1068,"$1,690.05","$1,690.05","$1,200.6456","$1,214.1675","$1,565.52","$1,636.68"
,CDM,4140000304.10.4140,FL BARIUM ENEMA SINGLE CONTRAS,CDM Code,Outpatient,74270,"$1,264.",$163.,"$1,200.8","$1,011.2","$1,150.24",$331.4625,"$1,200.8",$312.701,"$1,200.8","$1,200.8",$300.9891,$862.68,$163.,"$1,162.88"
,CDM,4140000305.10.4140,FL BE SCREENING W/AIR,CDM Code,Outpatient,G0106,"$1,264.",$312.701,"$1,200.8","$1,011.2","$1,150.24",$331.4625,"$1,200.8",$312.701,"$1,200.8","$1,200.8",$603.1797,$862.68,"$1,112.32","$1,162.88"
,CDM,4140000306.10.4140,FL BE SCREENING SINGLE CONTRAS,CDM Code,Outpatient,G0106,"$1,020.",$252.3378,$969.,$816.,$928.2,$267.4777,$969.,$252.3378,$969.,$969.,$603.1797,$696.15,$897.6,$938.4
,CDM,4140000314.10.4140,FL CYSTOGRAM CONTRAST COMPLETE,CDM Code,Outpatient,74430,"$1,264.",$31.,"$1,200.8","$1,011.2","$1,150.24",$331.4625,"$1,200.8",$312.701,"$1,200.8","$1,200.8",$603.1797,$862.68,$31.,"$1,162.88"
,CDM,4140000315.10.4140,FL FEEDING TUBE PLACEMENT,CDM Code,Outpatient,43752,$724.,$59.,$703.8387,$579.2,$658.84,$189.8567,$687.8,$179.1104,$687.8,$687.8,$703.8387,$494.13,$59.,$666.08
,CDM,4140000320.10.4140,FL FIST/SINUS TRACT STUDY,CDM Code,Outpatient,76080,$730.,$40.5,"$1,200.6456",$584.,$664.3,$191.4301,$693.5,$180.5947,$693.5,$693.5,"$1,200.6456",$498.225,$40.5,$671.6
,CDM,4140000321.10.4140,FL HYSTEROSALPINGOGRAM S&I,CDM Code,Outpatient,74740,"$1,162.",$78.5,"$1,103.9",$929.6,"$1,057.42",$304.7147,"$1,103.9",$287.4672,"$1,103.9","$1,103.9",$603.1797,$793.065,$78.5,"$1,069.04"
,CDM,4140000322.10.4140,FL FLUORO/INDEPENDENT PROCEDUR,CDM Code,Outpatient,76000,"$1,162.",$55.,"$1,103.9",$929.6,"$1,057.42",$304.7147,"$1,103.9",$287.4672,"$1,103.9","$1,103.9",$603.1797,$793.065,$55.,"$1,069.04"
,CDM,4140000323.10.4140,FL INJ/ASP MAJOR JOINT,CDM Code,Outpatient,20610,"$1,224.",$86.,"$1,162.8",$979.2,"$1,113.84",$320.9732,"$1,162.8",$302.8054,"$1,162.8","$1,162.8",$616.77,$835.38,$86.,"$1,126.08"
,CDM,4140000324.10.4140,FL INJ HIP ARTHOGRAM LT,CDM Code,Outpatient,27093LT,$508.,$125.6741,$482.6,$406.4,$462.28,$133.2144,$482.6,$125.6741,$482.6,$482.6,$50.8,$346.71,$266.5,$467.36
,CDM,4140000326.10.4140,FL INJEC ANKLE ARTHROGRAM LT,CDM Code,Outpatient,27648LT,$812.,$200.8807,$771.4,$649.6,$738.92,$212.9332,$771.4,$200.8807,$771.4,$771.4,$81.2,$554.19,$239.,$747.04
,CDM,4140000337.10.4140,FL INJ HIP ARTHOGRAM RT,CDM Code,Outpatient,27093RT,$508.,$125.6741,$482.6,$406.4,$462.28,$133.2144,$482.6,$125.6741,$482.6,$482.6,$50.8,$346.71,$266.5,$467.36
,CDM,4140000346.10.4140,FL INJECT SHOULDER ARTHROGR LT,CDM Code,Outpatient,23350LT,$678.,$167.7304,$644.1,$542.4,$616.98,$177.794,$644.1,$167.7304,$644.1,$644.1,$67.8,$462.735,$185.,$623.76
,CDM,4140000347.10.4140,FL INJECT SHOULDER ARTHROGR RT,CDM Code,Outpatient,23350RT,$678.,$167.7304,$644.1,$542.4,$616.98,$177.794,$644.1,$167.7304,$644.1,$644.1,$67.8,$462.735,$185.,$623.76
,CDM,4140000349.10.4140,FL INJECT WRIST ARTHOGRAM LT,CDM Code,Outpatient,25246LT,$869.,$214.9819,$825.55,$695.2,$790.79,$227.8805,$825.55,$214.9819,$825.55,$825.55,$86.9,$593.0925,$229.5,$799.48
,CDM,4140000350.10.4140,FL INJECT WRIST ARTHOGRAM RT,CDM Code,Outpatient,25246RT,$869.,$214.9819,$825.55,$695.2,$790.79,$227.8805,$825.55,$214.9819,$825.55,$825.55,$86.9,$593.0925,$229.5,$799.48
,CDM,4140000355.10.4140,FL GUIDANCE NEEDLE PLACEMENT,CDM Code,Outpatient,77002,$547.,$93.5,$519.65,$437.6,$497.77,$143.4415,$519.65,$135.3223,$519.65,$519.65,$54.7,$373.3275,$93.5,$503.24
,CDM,4140000366.10.4140,FL CINE ESOPHOGRAM,CDM Code,Outpatient,74230,$572.,$141.5071,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$144.5,$526.24
,CDM,4140000367.10.4140,FL ESOPHAGRAM,CDM Code,Outpatient,74220,"$1,264.",$92.,"$1,200.8","$1,011.2","$1,150.24",$331.4625,"$1,200.8",$312.701,"$1,200.8","$1,200.8",$300.9891,$862.68,$92.,"$1,162.88"
,CDM,4140000370.10.4140,FL UGI W/AIR AND KUB,CDM Code,Outpatient,74246,"$1,264.",$129.5,"$1,200.8","$1,011.2","$1,150.24",$331.4625,"$1,200.8",$312.701,"$1,200.8","$1,200.8",$300.9891,$862.68,$129.5,"$1,162.88"
,CDM,4140000371.10.4140,FL UGI W/KUB,CDM Code,Outpatient,74240,"$1,264.",$110.,"$1,200.8","$1,011.2","$1,150.24",$331.4625,"$1,200.8",$312.701,"$1,200.8","$1,200.8",$300.9891,$862.68,$110.,"$1,162.88"
,CDM,4140000372.10.4140,FL UPPER GI W/AIR & SBFT,CDM Code,Outpatient,74249,"$1,264.",$194.,"$1,200.8","$1,011.2","$1,150.24",$331.4625,"$1,200.8",$312.701,"$1,200.8","$1,200.8",$603.1797,$862.68,$194.,"$1,162.88"
,CDM,4140000373.10.4140,FL UPPER GI SERIES W/SMALL BOW,CDM Code,Outpatient,74245,"$1,162.",$176.5,"$1,103.9",$929.6,"$1,057.42",$304.7147,"$1,103.9",$287.4672,"$1,103.9","$1,103.9",$603.1797,$793.065,$176.5,"$1,069.04"
,CDM,4140000374.10.4140,FL UPPER GI SERIES W/AIR,CDM Code,Outpatient,74246,"$1,264.",$129.5,"$1,200.8","$1,011.2","$1,150.24",$331.4625,"$1,200.8",$312.701,"$1,200.8","$1,200.8",$300.9891,$862.68,$129.5,"$1,162.88"
,CDM,4140000375.10.4140,FL UPPER GI SERIES,CDM Code,Outpatient,74240,"$1,264.",$110.,"$1,200.8","$1,011.2","$1,150.24",$331.4625,"$1,200.8",$312.701,"$1,200.8","$1,200.8",$300.9891,$862.68,$110.,"$1,162.88"
,CDM,4140000380.10.4140,FL SMALL BOWEL SERIES,CDM Code,Outpatient,74250,$572.,$112.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$112.5,$526.24
,CDM,4140000381.10.4140,FL SPINAL PUNCTURE LUMBAR,CDM Code,Outpatient,62270,"$2,717.",$672.1586,"$2,581.15","$2,173.6","$2,472.47",$712.4871,"$2,581.15",$672.1586,"$2,581.15","$2,581.15","$1,354.1973","$1,854.3525","$2,390.96","$2,499.64"
,CDM,4140000383.10.4140,FL GUIDANCE VENOUS ACCESS,CDM Code,Outpatient,77001,$456.,$92.5,$433.2,$364.8,$414.96,$119.5782,$433.2,$112.8098,$433.2,$433.2,$45.6,$311.22,$92.5,$419.52
,CDM,4140000390.10.4140,FL INJECTION EXISTING J TUBE,CDM Code,Outpatient,49465,$418.,$103.409,$603.1797,$334.4,$380.38,$109.6134,$397.1,$103.409,$397.1,$397.1,$603.1797,$285.285,$367.84,$384.56
,CDM,4140000410.10.4140,XR SPINE SCOLIOSIS STUDY 1V,CDM Code,Outpatient,72081,$468.,$35.5,$444.6,$374.4,$425.88,$122.725,$444.6,$115.7785,$444.6,$444.6,$159.8262,$319.41,$35.5,$430.56
,CDM,4140000410.20.4140,XR SPINE SCOLIOSIS STUDY 1V,CDM Code,Outpatient,72081,$458.,$35.5,$435.1,$366.4,$416.78,$120.1027,$435.1,$113.3046,$435.1,$435.1,$159.8262,$312.585,$35.5,$421.36
,CDM,4140000411.10.4140,XR SPINE SCOLIOSIS STUDY 2-3 V,CDM Code,Outpatient,72082,$572.,$65.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$65.,$526.24
,CDM,4140000411.20.4140,XR SPINE SCOLIOSIS STUDY 2-3 V,CDM Code,Outpatient,72082,$572.,$65.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$65.,$526.24
,CDM,4140000411.30.4140,XR SPINE SCOLIOSIS STUDY 2-3 V,CDM Code,Outpatient,72082,$572.,$65.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$65.,$526.24
,CDM,4140000412.10.4140,XR SPINE SCOLIOSIS STUDY 4-5V,CDM Code,Outpatient,72083,$572.,$80.,$603.1797,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$603.1797,$390.39,$80.,$526.24
,CDM,4140000413.10.4140,XR SPINE SCOLIOSIS STUDY 6+ V,CDM Code,Outpatient,72084,$572.,$93.,$603.1797,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$603.1797,$390.39,$93.,$526.24
,CDM,4140000414.10.4140,XR HIP UNIL W/PEL 2 - 3 V LT,CDM Code,Outpatient,73502LT,$311.,$42.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$42.5,$286.12
,CDM,4140000414.20.4140,XR HIP UNIL W/PEL 2 - 3 V LT,CDM Code,Outpatient,73502,$311.,$42.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$42.5,$286.12
,CDM,4140000414.30.4140,XR HIP UNIL W/PEL 2 - 3 V LT,CDM Code,Outpatient,73502,$311.,$42.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$42.5,$286.12
,CDM,4140000415.10.4140,XR HIP UNIL W/PEL MIN 4 V LT,CDM Code,Outpatient,73503LT,$503.,$52.5,$477.85,$402.4,$457.73,$131.9032,$477.85,$124.4372,$477.85,$477.85,$300.9891,$343.2975,$52.5,$462.76
,CDM,4140000416.10.4140,XR HIP UNIL W/PEL 2 - 3 V RT,CDM Code,Outpatient,73502RT,$311.,$42.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$42.5,$286.12
,CDM,4140000416.20.4140,XR HIP UNIL W/PEL 2 - 3 V RT,CDM Code,Outpatient,73502,$311.,$42.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$42.5,$286.12
,CDM,4140000416.30.4140,XR HIP UNIL W/PEL 2 - 3 V RT,CDM Code,Outpatient,73502,$311.,$42.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$42.5,$286.12
,CDM,4140000417.10.4140,XR HIP UNIL W/PEL MIN 4 V RT,CDM Code,Outpatient,73503RT,$572.,$52.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$52.5,$526.24
,CDM,4140000418.10.4140,XR HIPS BILATERAL 3-4 V,CDM Code,Outpatient,73522,$572.,$47.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$47.5,$526.24
,CDM,4140000422.10.4140,XR FEMUR 1 V  LT,CDM Code,Outpatient,73551LT,$311.,$27.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$27.5,$286.12
,CDM,4140000423.10.4140,XR FEMUR MIN 2V  LT,CDM Code,Outpatient,73552LT,$311.,$33.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$33.,$286.12
,CDM,4140000423.20.4140,XR FEMUR MIN 2V  LT,CDM Code,Outpatient,73552,$333.,$33.,$316.35,$266.4,$303.03,$87.3236,$316.35,$82.3809,$316.35,$316.35,$159.8262,$227.2725,$33.,$306.36
,CDM,4140000423.30.4140,XR FEMUR MIN 2V  LT,CDM Code,Outpatient,73552,$311.,$33.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$33.,$286.12
,CDM,4140000424.10.4140,XR FEMUR 1 V  RT,CDM Code,Outpatient,73551RT,$311.,$27.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$27.5,$286.12
,CDM,4140000425.10.4140,XR FEMUR MIN 2V  RT,CDM Code,Outpatient,73552RT,$311.,$33.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$33.,$286.12
,CDM,4140000425.20.4140,XR FEMUR MIN 2V  RT,CDM Code,Outpatient,73552,$326.,$33.,$309.7,$260.8,$296.66,$85.488,$309.7,$80.6491,$309.7,$309.7,$159.8262,$222.495,$33.,$299.92
,CDM,4140000425.30.4140,XR FEMUR MIN 2V  RT,CDM Code,Outpatient,73552,$333.,$33.,$316.35,$266.4,$303.03,$87.3236,$316.35,$82.3809,$316.35,$316.35,$159.8262,$227.2725,$33.,$306.36
,CDM,4140000450.10.4140,X-RAY EXAM CHEST 1 VIEW,CDM Code,Outpatient,71045,$311.,$18.,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$165.8604,$212.2575,$18.,$286.12
,CDM,4140000451.10.4140,X-RAY EXAM CHEST 2 VIEWS,CDM Code,Outpatient,71046,$341.,$27.5,$323.95,$272.8,$310.31,$89.4215,$323.95,$84.36,$323.95,$323.95,$165.8604,$232.7325,$27.5,$313.72
,CDM,4140000452.10.4140,X-RAY EXAM CHEST 3 VIEWS,CDM Code,Outpatient,71047,$371.,$35.,$352.45,$296.8,$337.61,$97.2884,$352.45,$91.7817,$352.45,$352.45,$165.8604,$253.2075,$35.,$341.32
,CDM,4140000453.10.4140,X-RAY EXAM CHEST 4+ VIEWS,CDM Code,Outpatient,71048,$572.,$36.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$305.6082,$390.39,$36.,$526.24
,CDM,4140000454.10.4140,X-RAY EXAM ABDOMEN 1 VIEW,CDM Code,Outpatient,74018,$311.,$25.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$165.8604,$212.2575,$25.5,$286.12
,CDM,4140000455.10.4140,X-RAY EXAM ABDOMEN 2 VIEWS,CDM Code,Outpatient,74019,$572.,$30.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$305.6082,$390.39,$30.5,$526.24
,CDM,4140000456.10.4140,X-RAY EXAM ABDOMEN 3+ VIEWS,CDM Code,Outpatient,74021,$572.,$35.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$305.6082,$390.39,$35.5,$526.24
,CDM,4140000457.10.4140,FL CATHETER CHANGE W/ CONTRAST,CDM Code,Outpatient,75984,"$1,124.",$100.5,"$1,067.8",$899.2,"$1,022.84",$294.7499,"$1,067.8",$278.0664,"$1,067.8","$1,067.8",$112.4,$767.13,$100.5,"$1,034.08"
,CDM,4140000458.10.4140,FL INJECTION OF BLADDER,CDM Code,Outpatient,51600,$896.,$221.6614,$851.2,$716.8,$815.36,$234.9608,$851.2,$221.6614,$851.2,$851.2,$89.6,$611.52,$788.48,$824.32
,CDM,4140000459.10.4140,XR NO-CHARGE 1V ABDOMEN,CDM Code,Professional,74018,$0.,$0.,$62.12,$0.,$21.9,$5.6392,$34.54,$5.32,$0.,$0.,$62.12,$0.,$25.5,$0.
,CDM,4140000460.10.4140,FL INJECT KNEE ARTHROGRAPH LT,CDM Code,Outpatient,27369LT,$869.,$203.,$825.55,$695.2,$790.79,$227.8805,$825.55,$214.9819,$825.55,$825.55,$86.9,$593.0925,$203.,$799.48
,CDM,4140000461.10.4140,FL INJECT KNEE ARTHROGRAPH RT,CDM Code,Outpatient,27369RT,$869.,$203.,$825.55,$695.2,$790.79,$227.8805,$825.55,$214.9819,$825.55,$825.55,$86.9,$593.0925,$203.,$799.48
,CDM,4140001100.10.4140,POST THORACENTESIS 1V CXR,CDM Code,Professional,71045,$0.,$0.,$62.12,$0.,$12.85,$5.6392,$25.06,$5.32,$0.,$0.,$62.12,$0.,$18.,$0.
,CDM,4140001101.10.4140,POST THORACENTESIS 2V CXR,CDM Code,Professional,71046,$0.,$0.,$62.12,$0.,$23.63,$6.7204,$38.58,$6.34,$0.,$0.,$62.12,$0.,$27.5,$0.
,CDM,4140001102.10.4140,POST PORT PLACEMENT 1V CXR,CDM Code,Professional,71045,$0.,$0.,$62.12,$0.,$12.85,$5.6392,$25.06,$5.32,$0.,$0.,$62.12,$0.,$18.,$0.
,CDM,4140001103.10.4140,POST ET TUBE 1V CXR,CDM Code,Professional,71045,$0.,$0.,$62.12,$0.,$12.85,$5.6392,$25.06,$5.32,$0.,$0.,$62.12,$0.,$18.,$0.
,CDM,4140001106.10.4140,SMALL BOWEL SERIES ADDON,CDM Code,Outpatient,74248,$547.,$135.3223,$519.65,$437.6,$497.77,$143.4415,$519.65,$135.3223,$519.65,$519.65,$54.7,$373.3275,$481.36,$503.24
,CDM,4141000003.10.4141,PF MRI ABDOMEN W/O   W/CONT,CDM Code,Professional,7418326,$223.,$65.06,$605.,$178.4,$477.53,$68.9636,$543.97,$65.06,$211.85,$211.85,$426.52,$152.1975,$605.,$205.16
,CDM,4141000005.10.4141,PF MRI ANGIO HEAD W/O CONT,CDM Code,Professional,7054426,$122.,$35.6,$417.62,$97.6,$271.35,$37.736,$417.62,$35.6,$115.9,$115.9,$225.91,$83.265,$378.5,$112.24
,CDM,4141000007.10.4141,PF MRI BRAIN W/O CONTRAST,CDM Code,Professional,7055126,$152.,$43.78,$294.19,$121.6,$190.2,$46.4068,$294.19,$43.78,$144.4,$144.4,$225.91,$103.74,$221.5,$139.84
,CDM,4141000009.10.4141,PF MRI BRAIN W/O THEN W/CONTR,CDM Code,Professional,7055326,$223.,$67.51,$481.19,$178.4,$318.67,$71.5606,$481.19,$67.51,$211.85,$211.85,$426.52,$152.1975,$373.,$205.16
,CDM,4141000014.10.4141,PF MRI CERVICAL SPINE W/O CONT,CDM Code,Professional,7214126,$152.,$43.9799,$318.5,$121.6,$182.,$46.6187,$286.07,$43.9799,$144.4,$144.4,$225.91,$103.74,$318.5,$139.84
,CDM,4141000015.10.4141,PF MRI CERVICAL W   W/O CONT,CDM Code,Professional,7215626,$234.,$67.51,$538.5,$187.2,$321.7,$71.5606,$483.89,$67.51,$222.3,$222.3,$426.52,$159.705,$538.5,$215.28
,CDM,4141000024.10.4141,"PF MRI ORBIT,FACE,NECK W/O   W",CDM Code,Professional,7054326,$218.,$63.22,$514.27,$174.4,$375.22,$67.0132,$514.27,$63.22,$207.1,$207.1,$426.52,$148.785,$420.,$200.56
,CDM,4141000029.10.4141,PF  MRI LOWER EXT W/O CONT LT,CDM Code,Professional,73718LT2,$138.,$39.89,$435.,$110.4,$271.62,$42.2834,$391.35,$39.89,$131.1,$131.1,$225.91,$94.185,$435.,$126.96
,CDM,4141000030.10.4141,PF  MRI LOWER EXT W/O   W/CONT,CDM Code,Professional,73720LT2,$218.,$63.42,$602.5,$174.4,$479.25,$67.2252,$541.8,$63.42,$207.1,$207.1,$426.52,$148.785,$602.5,$200.56
,CDM,4141000037.10.4141,PF  MRI LOWER JOINT W/O CONT L,CDM Code,Professional,73721LT2,$138.,$40.3,$336.5,$110.4,$204.71,$42.718,$302.4,$40.3,$131.1,$131.1,$225.91,$94.185,$336.5,$126.96
,CDM,4141000040.10.4141,PF  MRI LOWER JOINT W/O CONT R,CDM Code,Professional,73721RT2,$138.,$40.3,$336.5,$110.4,$204.71,$42.718,$302.4,$40.3,$131.1,$131.1,$225.91,$94.185,$336.5,$126.96
,CDM,4141000043.10.4141,PF MRI LUMBAR W/O CONT,CDM Code,Professional,7214826,$152.,$43.9799,$318.5,$121.6,$180.7,$46.6187,$286.07,$43.9799,$144.4,$144.4,$225.91,$103.74,$318.5,$139.84
,CDM,4141000044.10.4141,PF MRI LUMBAR W/   W/O CONT,CDM Code,Professional,7215826,$234.,$67.51,$537.5,$187.2,$319.54,$71.5606,$482.99,$67.51,$222.3,$222.3,$426.52,$159.705,$537.5,$215.28
,CDM,4141000047.10.4141,PF MRI ANGIO NECK W/O   W/CONT,CDM Code,Professional,7054926,$184.,$53.19,$640.9,$147.2,$512.92,$56.3814,$640.9,$53.19,$174.8,$174.8,$426.52,$125.58,$584.,$169.28
,CDM,4141000053.10.4141,PF MRI ORBITS W/WO,CDM Code,Professional,7054326,$218.,$63.22,$514.27,$174.4,$375.22,$67.0132,$514.27,$63.22,$207.1,$207.1,$426.52,$148.785,$420.,$200.56
,CDM,4141000055.10.4141,PF MRI PELVIS W/O CONT,CDM Code,Professional,7219526,$150.,$43.17,$448.5,$120.,$271.35,$45.7602,$403.47,$43.17,$142.5,$142.5,$225.91,$102.375,$448.5,$138.
,CDM,4141000056.10.4141,PF MRI PELVIS W/O THEN W/CONT,CDM Code,Professional,7219726,$223.,$65.06,$603.5,$178.4,$476.23,$68.9636,$542.62,$65.06,$211.85,$211.85,$426.52,$152.1975,$603.5,$205.16
,CDM,4141000061.10.4141,PF MRI THORACIC SPINE W/O CONT,CDM Code,Professional,7214626,$152.,$43.9799,$319.,$121.6,$182.43,$46.6187,$286.52,$43.9799,$144.4,$144.4,$225.91,$103.74,$319.,$139.84
,CDM,4141000067.10.4141,PF  MRI UPPER EXT W/O CONT LT,CDM Code,Professional,73218LT2,$138.,$40.1,$467.58,$110.4,$271.62,$42.506,$467.58,$40.1,$131.1,$131.1,$225.91,$94.185,$423.,$126.96
,CDM,4141000068.10.4141,PF  MRI UPPER EXT W/O   W/CONT,CDM Code,Professional,73220LT2,$219.,$63.42,$637.02,$175.2,$476.23,$67.2252,$637.02,$63.42,$208.05,$208.05,$426.52,$149.4675,$555.,$201.48
,CDM,4141000076.10.4141,PF  MRI UPPER JOINT W/O CONT L,CDM Code,Professional,73221LT2,$140.,$40.3,$302.4,$112.,$204.71,$42.718,$302.4,$40.3,$133.,$133.,$225.91,$95.55,$239.5,$128.8
,CDM,4141000079.10.4141,PF  MRI UPPER JOINT W/O CONT R,CDM Code,Professional,73221RT2,$140.,$40.3,$302.4,$112.,$204.71,$42.718,$302.4,$40.3,$133.,$133.,$225.91,$95.55,$239.5,$128.8
,CDM,4141000113.10.4141,PF  MRI ARTHROGRAM SHOULDER LT,CDM Code,Professional,73222LT2,$167.,$48.28,$656.91,$133.6,$360.11,$51.1768,$483.61,$48.28,$158.65,$158.65,$656.91,$113.9775,$421.5,$153.64
,CDM,4141000114.10.4141,PF  MRI ARTHROGRAM SHOULDER RT,CDM Code,Professional,73222RT2,$167.,$48.28,$656.91,$133.6,$360.11,$51.1768,$483.61,$48.28,$158.65,$158.65,$656.91,$113.9775,$421.5,$153.64
,CDM,4141000124.10.4141,PF MRI ARTHROGRAM KNEE RT,CDM Code,Professional,7372226,$167.,$48.28,$656.91,$133.6,$364.,$51.1768,$486.76,$48.28,$158.65,$158.65,$656.91,$113.9775,$541.,$153.64
,CDM,4141000146.10.4141,PF MRI BREAST W/WO CONT,CDM Code,Professional,7704926,$235.,$23.5,$569.5,$188.,$350.72,$71.7832,$511.87,$67.72,$223.25,$223.25,$23.5,$160.3875,$569.5,$216.2
,CDM,4141000149.10.4141,PF CT HEAD W/O CONTRAST,CDM Code,Professional,7045026,$87.,$25.16,$147.21,$69.6,$88.76,$26.6696,$147.21,$25.16,$82.65,$82.65,$112.73,$59.3775,$103.5,$80.04
,CDM,4141000152.10.4141,"PF CT ORBITS,SELLA,IACS W/O CO",CDM Code,Professional,7048026,$130.,$37.85,$296.22,$104.,$135.38,$40.121,$296.22,$37.85,$123.5,$123.5,$112.73,$88.725,$238.5,$119.6
,CDM,4141000155.10.4141,PF CT HEAD W/O STROKE PROTOCOL,CDM Code,Professional,7045026,$87.,$25.16,$147.21,$69.6,$88.76,$26.6696,$147.21,$25.16,$82.65,$82.65,$112.73,$59.3775,$103.5,$80.04
,CDM,4141000156.10.4141,PF CT ORBITS W/O,CDM Code,Professional,7048026,$30.,$20.475,$296.22,$24.,$135.38,$40.121,$296.22,$37.85,$28.5,$28.5,$112.73,$20.475,$238.5,$27.6
,CDM,4141000158.10.4141,PF CT ORBITS W/,CDM Code,Professional,7048126,$115.,$40.92,$350.72,$92.,$250.63,$43.3752,$350.72,$40.92,$109.25,$109.25,$265.02,$78.4875,$291.5,$105.8
,CDM,4141000164.10.4141,PF CT SOFT TISSUE NECK W/CONTR,CDM Code,Professional,7049126,$141.,$40.92,$265.02,$112.8,$201.42,$43.3752,$258.2,$40.92,$133.95,$133.95,$265.02,$96.2325,$189.,$129.72
,CDM,4141000165.10.4141,PF CT THORAX WITH CONTRAST,CDM Code,Professional,7126026,$127.,$36.82,$265.02,$101.6,$202.72,$39.0292,$249.76,$36.82,$120.65,$120.65,$265.02,$86.6775,$111.76,$116.84
,CDM,4141000166.10.4141,PF CT THORAX W/O CONTRAST,CDM Code,Professional,7125026,$118.,$34.37,$206.94,$94.4,$135.38,$36.4322,$206.94,$34.37,$112.1,$112.1,$112.73,$80.535,$103.84,$108.56
,CDM,4141000169.10.4141,PF CT ABDOMEN WITH CONTRAST,CDM Code,Professional,7416026,$129.,$37.64,$326.5,$103.2,$202.72,$39.8984,$293.52,$37.64,$122.55,$122.55,$265.02,$88.0425,$326.5,$118.68
,CDM,4141000170.10.4141,PF CT ABDOMEN W/O CONTRAST,CDM Code,Professional,7415026,$122.,$35.39,$212.,$97.6,$109.05,$37.5134,$190.22,$35.39,$115.9,$115.9,$112.73,$83.265,$212.,$112.24
,CDM,4141000171.10.4141,PF CT ABDOMEN W   W/O CONTRAST,CDM Code,Professional,7417026,$143.,$41.33,$371.5,$114.4,$233.37,$43.8098,$334.01,$41.33,$135.85,$135.85,$265.02,$97.5975,$371.5,$131.56
,CDM,4141000172.10.4141,PF CT ABD AND PELVIS WITH CONT,CDM Code,Professional,7417726,$186.,$54.01,$441.,$148.8,$267.04,$57.2506,$396.38,$54.01,$176.7,$176.7,$265.02,$126.945,$441.,$171.12
,CDM,4141000173.10.4141,PF CT ABD AND PELVIS W   WO CO,CDM Code,Professional,7417826,$204.,$59.12,$499.5,$163.2,$306.59,$62.6672,$448.97,$59.12,$193.8,$193.8,$426.52,$139.23,$499.5,$187.68
,CDM,4141000174.10.4141,PF CT ABD AND PELVIS W/O CONTR,CDM Code,Professional,7417626,$178.,$51.55,$284.,$142.4,$137.54,$54.643,$254.72,$51.55,$169.1,$169.1,$225.91,$121.485,$284.,$163.76
,CDM,4141000175.10.4141,PF CT PELVIS WITH CONTRAST,CDM Code,Professional,7219326,$118.,$34.37,$319.5,$94.4,$203.58,$36.4322,$287.27,$34.37,$112.1,$112.1,$265.02,$80.535,$319.5,$108.56
,CDM,4141000176.10.4141,PF CT PELVIS W/O CONTRAST,CDM Code,Professional,7219226,$111.,$32.12,$206.5,$88.8,$110.77,$34.0472,$185.37,$32.12,$105.45,$105.45,$112.73,$75.7575,$206.5,$102.12
,CDM,4141000178.10.4141,PF CT CERVICAL SPINE W/O CONT,CDM Code,Professional,7212526,$102.,$31.51,$261.,$81.6,$135.38,$33.4006,$234.57,$31.51,$96.9,$96.9,$112.73,$69.615,$261.,$93.84
,CDM,4141000181.10.4141,PF CT LUMBAR SPINE W/O CONT,CDM Code,Professional,7213126,$102.,$29.66,$254.5,$81.6,$135.38,$31.4396,$228.75,$29.66,$96.9,$96.9,$112.73,$69.615,$254.5,$93.84
,CDM,4141000182.10.4141,PF CT LUMBAR SPINE WITH CONT,CDM Code,Professional,7213226,$125.,$36.21,$426.52,$100.,$202.72,$38.3826,$289.94,$36.21,$118.75,$118.75,$426.52,$85.3125,$322.5,$115.
,CDM,4141000184.10.4141,PF CT THORACIC SPINE W/O CONTR,CDM Code,Professional,7212826,$102.,$29.66,$255.5,$81.6,$135.38,$31.4396,$229.65,$29.66,$96.9,$96.9,$112.73,$69.615,$255.5,$93.84
,CDM,4141000193.10.4141,PF  CT UPPER EXTREMITY W/O CON,CDM Code,Professional,73200RT2,$102.,$29.66,$228.3,$81.6,$135.38,$31.4396,$228.3,$29.66,$96.9,$96.9,$112.73,$69.615,$182.5,$93.84
,CDM,4141000199.10.4141,PF  CT LOWER EXTREMITY W/O LT,CDM Code,Professional,73700LT2,$102.,$29.66,$254.5,$81.6,$135.38,$31.4396,$228.75,$29.66,$96.9,$96.9,$112.73,$69.615,$254.5,$93.84
,CDM,4141000201.10.4141,PF  CT LOWER EXTREMITY W/CONT,CDM Code,Professional,73701LT2,$118.,$34.37,$319.5,$94.4,$203.58,$36.4322,$287.27,$34.37,$112.1,$112.1,$265.02,$80.535,$319.5,$108.56
,CDM,4141000202.10.4141,PF  CT LOWER EXTREMITY W/O RT,CDM Code,Professional,73700RT2,$102.,$29.66,$254.5,$81.6,$135.38,$31.4396,$228.75,$29.66,$96.9,$96.9,$112.73,$69.615,$254.5,$93.84
,CDM,4141000205.10.4141,PF CT MAXILLOFACIAL W/O CONTRA,CDM Code,Professional,7048626,$88.,$25.37,$176.99,$70.4,$116.82,$26.8922,$176.99,$25.37,$83.6,$83.6,$112.73,$60.06,$136.,$80.96
,CDM,4141000208.10.4141,PF CT SINUS SCREENING,CDM Code,Professional,7048626,$88.,$25.37,$176.99,$70.4,$116.82,$26.8922,$176.99,$25.37,$83.6,$83.6,$112.73,$60.06,$136.,$80.96
,CDM,4141000212.10.4141,PF CT ANGIO ABD W/O   W/CONT,CDM Code,Professional,7417526,$185.,$53.4,$434.5,$148.,$262.56,$56.604,$390.46,$53.4,$175.75,$175.75,$265.02,$126.2625,$434.5,$170.2
,CDM,4141000213.10.4141,PF CT ANGIO CHEST W/O   W/CONT,CDM Code,Professional,7127526,$186.,$53.8,$424.5,$148.8,$253.49,$57.028,$381.44,$53.8,$176.7,$176.7,$265.02,$126.945,$424.5,$171.12
,CDM,4141000214.10.4141,PF CT ANGIO HEAD,CDM Code,Professional,7049626,$178.,$51.76,$372.45,$142.4,$249.18,$54.8656,$372.45,$51.76,$169.1,$169.1,$265.02,$121.485,$290.,$163.76
,CDM,4141000215.10.4141,PF CT ANGIO NECK,CDM Code,Professional,7049826,$178.,$51.76,$371.55,$142.4,$248.31,$54.8656,$371.55,$51.76,$169.1,$169.1,$265.02,$121.485,$289.,$163.76
,CDM,4141000226.10.4141,PF CT ANGIO ABD/PEL W CONTRAST,CDM Code,Professional,7417426,$223.,$64.44,$549.,$178.4,$318.67,$68.3064,$493.43,$64.44,$211.85,$211.85,$265.02,$152.1975,$549.,$205.16
,CDM,4141000230.10.4141,PF CT IVP,CDM Code,Professional,7417826,$204.,$59.12,$499.5,$163.2,$306.59,$62.6672,$448.97,$59.12,$193.8,$193.8,$426.52,$139.23,$499.5,$187.68
,CDM,4141000232.10.4141,PF LDCT LUNG SCREEN,CDM Code,Professional,G029726,$104.,$30.28,$336.5,$83.2,$94.64,$32.0968,$98.8,$30.28,$98.8,$98.8,$59.86,$70.98,$336.5,$95.68
,CDM,4141000243.10.4141,PF MM DIAG DIGIT MAMMO BILAT,CDM Code,Professional,7706626,$102.,$29.66,$217.47,$81.6,$146.17,$31.4396,$217.47,$29.66,$96.9,$96.9,$171.19,$69.615,$170.5,$93.84
,CDM,4141000244.10.4141,PF MM DIAG DIGIT MAMMO LT,CDM Code,Professional,77065LT2,$83.,$24.14,$172.05,$66.4,$114.23,$25.5884,$172.05,$24.14,$78.85,$78.85,$134.94,$56.6475,$133.5,$76.36
,CDM,4141000245.10.4141,PF MM DIAG DIGIT MAMMO RT,CDM Code,Professional,77065RT2,$83.,$24.14,$172.05,$66.4,$114.23,$25.5884,$172.05,$24.14,$78.85,$78.85,$134.94,$56.6475,$133.5,$76.36
,CDM,4141000247.10.4141,PF MM DIAG SP VIEW MAMMO LT,CDM Code,Professional,77065LT2,$83.,$24.14,$172.05,$66.4,$114.23,$25.5884,$172.05,$24.14,$78.85,$78.85,$134.94,$56.6475,$133.5,$76.36
,CDM,4141000248.10.4141,PF MM DIAG SP VIEW MAMMO RT,CDM Code,Professional,7706526,$83.,$24.14,$172.05,$66.4,$114.23,$25.5884,$172.05,$24.14,$78.85,$78.85,$134.94,$56.6475,$133.5,$76.36
,CDM,4141000249.10.4141,PF MM SCR DIGITAL MAMMO BILAT,CDM Code,Professional,7706726,$78.,$22.5,$175.29,$62.4,$120.7,$23.85,$175.29,$22.5,$74.1,$74.1,$138.1699,$53.235,$141.,$71.76
,CDM,4141000250.10.4141,PF MM SCR DIGITAL MAMMO LT,CDM Code,Professional,77067522,$78.,$22.5,$175.29,$62.4,$120.7,$23.85,$175.29,$22.5,$74.1,$74.1,$138.1699,$53.235,$141.,$71.76
,CDM,4141000251.10.4141,PF MM SCR DIGITAL MAMMO RT,CDM Code,Professional,77067522,$78.,$22.5,$175.29,$62.4,$120.7,$23.85,$175.29,$22.5,$74.1,$74.1,$138.1699,$53.235,$141.,$71.76
,CDM,4141000252.10.4141,PF MM SCR DIGITAL MAMMO IMPLAN,CDM Code,Professional,77067522,$78.,$22.5,$175.29,$62.4,$120.7,$23.85,$175.29,$22.5,$74.1,$74.1,$138.1699,$53.235,$141.,$71.76
,CDM,4141000254.10.4141,PF MM RADIOLOGY BREAST SPECIMN,CDM Code,Professional,7609826,$32.,$4.71,$449.68,$25.6,$10.2,$4.9926,$21.47,$4.71,$30.4,$30.4,$449.68,$21.84,$12.5,$29.44
,CDM,4141000256.10.4141,PF MM STEREO WIRE LOC LT,CDM Code,Professional,19283LT2,$210.,$129.96,$539.11,$168.,$191.1,$173.7022,$129.96,$163.87,$199.5,$199.5,$539.11,$143.325,$386.,$193.2
,CDM,4141000262.10.4140,PF MM WIRE LOC RT,CDM Code,Professional,19281RT2,$208.,$129.2,$539.11,$166.4,$189.28,$154.8342,$129.2,$146.07,$197.6,$197.6,$539.11,$141.96,$341.5,$191.36
,CDM,4141000263.10.4141,PF MM WIRE LOC LT,CDM Code,Professional,19281LT2,$208.,$129.2,$539.11,$166.4,$189.28,$154.8342,$129.2,$146.07,$197.6,$197.6,$539.11,$141.96,$341.5,$191.36
,CDM,4141000264.10.4141,PF MM BREAST TOMOSYNTHESIS UNI,CDM Code,Professional,77061LT2,$112.,$0.,$114.23,$89.6,$114.23,$29.3701,$0.,$27.7077,$106.4,$106.4,$11.2,$76.44,$58.,$103.04
,CDM,4141000265.10.4141,PF MM BREAST TOMOSYNTHESIS UNI,CDM Code,Professional,77061RT2,$112.,$0.,$114.23,$89.6,$114.23,$29.3701,$0.,$27.7077,$106.4,$106.4,$11.2,$76.44,$58.,$103.04
,CDM,4141000266.10.4141,PF MM BREAST TOMOSYNTHESIS BIL,CDM Code,Professional,7706226,$112.,$0.,$146.17,$89.6,$146.17,$29.3701,$0.,$27.7077,$106.4,$106.4,$11.2,$76.44,$71.5,$103.04
,CDM,4141000267.10.4141,PF MM SCREENING BREAST TOMO BI,CDM Code,Professional,7706326,$69.005,$17.0711,$69.88,$55.204,$30.65,$18.0954,$69.88,$17.0711,$65.5547,$65.5547,$56.35,$47.0959,$42.5,$63.4846
,CDM,4141000275.10.4141,PF XR ANKLE 2 VIEWS LT,CDM Code,Professional,73600LT2,$17.,$4.91,$59.86,$13.6,$25.74,$5.2046,$37.71,$4.91,$46.5025,$46.28,$59.86,$11.6025,$30.,$15.64
,CDM,4141000276.10.4141,PF XR ANKLE 2 VIEWS RT,CDM Code,Professional,73600RT2,$17.,$4.91,$59.86,$13.6,$25.74,$5.2046,$37.71,$4.91,$46.5025,$46.28,$59.86,$11.6025,$30.,$15.64
,CDM,4141000278.10.4141,PF XR ANKLE COMPLETE MIN 3VW L,CDM Code,Professional,73610LT2,$18.,$5.11,$59.86,$14.4,$27.46,$5.4166,$39.96,$5.11,$53.8175,$53.56,$59.86,$12.285,$32.,$16.56
,CDM,4141000279.10.4141,PF XR ANKLE COMPLETE MIN 3VW R,CDM Code,Professional,73610RT2,$18.,$5.11,$59.86,$14.4,$27.46,$5.4166,$39.96,$5.11,$53.8175,$53.56,$59.86,$12.285,$32.,$16.56
,CDM,4141000280.10.4141,PF XR BILAT ANKLES 3VW,CDM Code,Professional,73610502,$36.,$5.11,$59.86,$28.8,$27.46,$5.4166,$39.96,$5.11,$53.8175,$53.56,$59.86,$24.57,$32.,$33.12
,CDM,4141000282.10.4141,PF XR CALCANEUS MIN 2 VIEWS RT,CDM Code,Professional,73650RT2,$17.,$4.71,$59.86,$13.6,$22.71,$4.9926,$34.55,$4.71,$33.9625,$33.8,$59.86,$11.6025,$27.,$15.64
,CDM,4141000284.10.4141,PF XR TOE OR TOES MIN 2 VIEWS,CDM Code,Professional,7366026,$14.,$3.89,$59.86,$11.2,$25.74,$4.1234,$35.93,$3.89,$39.1875,$39.,$59.86,$9.555,$30.5,$12.88
,CDM,4141000285.10.4141,PF XR TOE OR TOES MIN 2 VIEWS,CDM Code,Professional,7366026,$14.,$3.89,$59.86,$11.2,$25.74,$4.1234,$35.93,$3.89,$39.1875,$39.,$59.86,$9.555,$30.5,$12.88
,CDM,4141000286.10.4141,PF XR BILAT TOES,CDM Code,Professional,7366026,$28.,$3.89,$59.86,$22.4,$25.74,$4.1234,$35.93,$3.89,$39.1875,$39.,$59.86,$19.11,$30.5,$25.76
,CDM,4141000287.10.4141,PF XR FOOT 2 VIEWS LT,CDM Code,Professional,73620LT2,$16.,$4.5,$59.86,$12.8,$21.85,$4.77,$33.2,$4.5,$32.9174,$32.76,$59.86,$10.92,$26.,$14.72
,CDM,4141000288.10.4141,PF XR FOOT 2 VIEWS RT,CDM Code,Professional,73620RT2,$16.,$4.5,$59.86,$12.8,$21.85,$4.77,$33.2,$4.5,$32.9174,$32.76,$59.86,$10.92,$26.,$14.72
,CDM,4141000289.10.4141,PF XR BILAT FOOT 2VW,CDM Code,Professional,73620502,$16.,$4.5,$59.86,$12.8,$21.85,$4.77,$33.2,$4.5,$32.9174,$32.76,$59.86,$10.92,$26.,$14.72
,CDM,4141000290.10.4141,PF XR FOOT COMPLETE MIN 3VW LT,CDM Code,Professional,73630LT2,$17.,$4.91,$59.86,$13.6,$24.87,$5.2046,$37.25,$4.91,$38.1425,$37.96,$59.86,$11.6025,$29.5,$15.64
,CDM,4141000291.10.4141,PF XR FOOT COMPLETE MIN 3VW RT,CDM Code,Professional,73630RT2,$17.,$4.91,$59.86,$13.6,$24.87,$5.2046,$37.25,$4.91,$38.1425,$37.96,$59.86,$11.6025,$29.5,$15.64
,CDM,4141000292.10.4141,PF XR BILAT FOOT 3VW,CDM Code,Professional,73630502,$17.,$4.91,$59.86,$13.6,$24.87,$5.2046,$37.25,$4.91,$38.1425,$37.96,$59.86,$11.6025,$29.5,$15.64
,CDM,4141000293.10.4141,PF XR TIBIA   FIBULA 2 VIEWS L,CDM Code,Professional,73590LT2,$17.,$4.71,$59.86,$13.6,$24.44,$4.9926,$36.36,$4.71,$31.35,$31.2,$59.86,$11.6025,$28.5,$15.64
,CDM,4141000294.10.4141,PF XR TIBIA   FIBULA 2 VIEWS R,CDM Code,Professional,73590RT2,$17.,$4.71,$59.86,$13.6,$24.44,$4.9926,$36.36,$4.71,$31.35,$31.2,$59.86,$11.6025,$28.5,$15.64
,CDM,4141000296.10.4141,PF XR KNEE 1 OR 2VW LT,CDM Code,Professional,73560LT2,$17.,$4.91,$59.86,$13.6,$27.03,$5.2046,$39.52,$4.91,$49.6374,$49.4,$59.86,$11.6025,$32.,$15.64
,CDM,4141000297.10.4141,PF XR KNEE 1 OR 2VW RT,CDM Code,Professional,73560RT2,$17.,$4.91,$59.86,$13.6,$27.03,$5.2046,$39.52,$4.91,$49.6374,$49.4,$59.86,$11.6025,$32.,$15.64
,CDM,4141000298.10.4141,PF XR BILAT KNEES 2VW,CDM Code,Professional,7356526,$18.,$5.11,$59.86,$14.4,$32.64,$5.4166,$45.38,$5.11,$17.1,$17.1,$59.86,$12.285,$38.,$16.56
,CDM,4141000299.10.4141,PF XR KNEE 3V LT,CDM Code,Professional,73562LT2,$19.,$5.5199,$60.6099,$15.2,$31.78,$5.8511,$45.37,$5.5199,$60.6099,$60.32,$59.86,$12.9675,$37.,$17.48
,CDM,4141000300.10.4141,PF XR KNEE 3V RT,CDM Code,Professional,73562RT2,$19.,$5.5199,$60.6099,$15.2,$31.78,$5.8511,$45.37,$5.5199,$60.6099,$60.32,$59.86,$12.9675,$37.,$17.48
,CDM,4141000301.10.4141,PF XR BILAT KNEES 3VW,CDM Code,Professional,73562502,$19.,$5.5199,$60.6099,$15.2,$31.78,$5.8511,$45.37,$5.5199,$60.6099,$60.32,$59.86,$12.9675,$37.,$17.48
,CDM,4141000302.10.4141,PF XR KNEE 4 OR MOVE VIEWS LT,CDM Code,Professional,73564LT2,$23.,$6.75,$112.73,$18.4,$34.37,$7.155,$50.31,$6.75,$70.5375,$70.2,$112.73,$15.6975,$40.,$21.16
,CDM,4141000303.10.4141,PF XR KNEE 4 OR MOVE VIEWS RT,CDM Code,Professional,73564RT2,$23.,$6.75,$112.73,$18.4,$34.37,$7.155,$50.31,$6.75,$70.5375,$70.2,$112.73,$15.6975,$40.,$21.16
,CDM,4141000304.10.4141,PF XR BILAT KNEES 4VW,CDM Code,Professional,73564502,$23.,$6.75,$112.73,$18.4,$34.37,$7.155,$50.31,$6.75,$70.5375,$70.2,$112.73,$15.6975,$40.,$21.16
,CDM,4141000305.10.4141,PF XR KNEES-STANDING BILAT,CDM Code,Professional,7356526,$18.,$5.11,$59.86,$14.4,$32.64,$5.4166,$45.38,$5.11,$17.1,$17.1,$59.86,$12.285,$38.,$16.56
,CDM,4141000307.10.4141,PF XR HIP UNILAT 1 VIEW LT,CDM Code,Professional,73501LT2,$19.,$5.5199,$59.86,$15.2,$24.44,$5.8511,$38.15,$5.5199,$18.05,$18.05,$59.86,$12.9675,$29.,$17.48
,CDM,4141000308.10.4141,PF XR HIP UNILAT 1 VIEW RT,CDM Code,Professional,73501RT2,$19.,$5.5199,$59.86,$15.2,$24.44,$5.8511,$38.15,$5.5199,$18.05,$18.05,$59.86,$12.9675,$29.,$17.48
,CDM,4141000309.10.4141,PF XR HIPS BILATERAL,CDM Code,Professional,7352126,$23.,$6.75,$112.73,$18.4,$33.94,$7.155,$47.6,$6.75,$58.52,$58.24,$112.73,$15.6975,$37.,$21.16
,CDM,4141000310.10.4141,PF XR PELVIS 1 OR 2 VIEWS,CDM Code,Professional,7217026,$18.,$5.11,$112.73,$14.4,$27.89,$5.4166,$40.41,$5.11,$45.9799,$45.76,$112.73,$12.285,$32.5,$16.56
,CDM,4141000311.10.4141,PF XR PELVIS COMPLETE 3V,CDM Code,Professional,7219026,$26.,$6.55,$112.73,$20.8,$32.64,$6.943,$48.06,$6.55,$24.7,$24.7,$112.73,$17.745,$38.,$23.92
,CDM,4141000312.10.4141,PF XR SACRUM AND COCCYX MIN 2,CDM Code,Professional,7222026,$18.,$5.11,$59.86,$14.4,$23.15,$5.4166,$35.9,$5.11,$17.1,$17.1,$59.86,$12.285,$27.5,$16.56
,CDM,4141000313.10.4141,PF XR SACROILIAC JOINTS 3VW,CDM Code,Professional,7220226,$24.,$5.5199,$112.73,$19.2,$28.33,$5.8511,$41.76,$5.5199,$22.8,$22.8,$112.73,$16.38,$33.,$22.08
,CDM,4141000314.10.4141,PF XR FINGER MIN 2 VIEWS LT,CDM Code,Professional,7314026,$14.,$4.09,$59.86,$11.2,$29.62,$4.3354,$40.89,$4.09,$54.34,$54.08,$59.86,$9.555,$35.5,$12.88
,CDM,4141000315.10.4141,PF XR FINGER MIN 2 VIEWS RT,CDM Code,Professional,7314026,$14.,$4.09,$59.86,$11.2,$29.62,$4.3354,$40.89,$4.09,$54.34,$54.08,$59.86,$9.555,$35.5,$12.88
,CDM,4141000317.10.4141,PF XR HAND - TWO VIEWS  LT,CDM Code,Professional,73120LT2,$17.,$4.91,$112.73,$13.6,$21.42,$5.2046,$35.91,$4.91,$44.4125,$44.2,$112.73,$11.6025,$28.,$15.64
,CDM,4141000318.10.4141,PF XR HAND - TWO VIEWS  RT,CDM Code,Professional,73120RT2,$17.,$4.91,$112.73,$13.6,$21.42,$5.2046,$35.91,$4.91,$44.4125,$44.2,$112.73,$11.6025,$28.,$15.64
,CDM,4141000319.10.4141,PF XR BILAT HANDS 2VW,CDM Code,Professional,73120502,$34.,$4.91,$112.73,$27.2,$21.42,$5.2046,$35.91,$4.91,$44.4125,$44.2,$112.73,$23.205,$28.,$31.28
,CDM,4141000320.10.4140,PF XR HAND MIN 3V LT,CDM Code,Professional,73130LT2,$71.,$5.11,$65.32,$56.8,$26.6,$5.4166,$40.41,$5.11,$52.25,$52.,$59.86,$48.4575,$32.5,$65.32
,CDM,4141000321.10.4141,PF XR HAND MIN 3V RT,CDM Code,Professional,73130RT2,$71.,$5.11,$65.32,$56.8,$26.6,$5.4166,$40.41,$5.11,$52.25,$52.,$59.86,$48.4575,$32.5,$65.32
,CDM,4141000322.10.4141,PF XR BILAT HANDS 3VW,CDM Code,Professional,73130502,$142.,$5.11,$130.64,$113.6,$26.6,$5.4166,$40.41,$5.11,$52.25,$52.,$59.86,$96.915,$32.5,$130.64
,CDM,4141000323.10.4141,PF XR WRIST 2V  LT,CDM Code,Professional,73100LT2,$17.,$4.91,$59.86,$13.6,$24.87,$5.2046,$39.97,$4.91,$37.62,$37.44,$59.86,$11.6025,$32.,$15.64
,CDM,4141000324.10.4141,PF XR WRIST 2V  RT,CDM Code,Professional,73100RT2,$17.,$4.91,$59.86,$13.6,$24.87,$5.2046,$39.97,$4.91,$37.62,$37.44,$59.86,$11.6025,$32.,$15.64
,CDM,4141000325.10.4141,PF XR BILAT WRISTS 2VW,CDM Code,Professional,73100502,$36.,$4.91,$59.86,$28.8,$24.87,$5.2046,$39.97,$4.91,$37.62,$37.44,$59.86,$24.57,$32.,$33.12
,CDM,4141000326.10.4141,PF XR WRIST COMPLETE 3 VIEWS L,CDM Code,Professional,73110LT2,$18.,$5.11,$60.6099,$14.4,$32.21,$5.4166,$44.48,$5.11,$60.6099,$60.32,$59.86,$12.285,$37.,$16.56
,CDM,4141000327.10.4141,PF XR WRIST COMPLETE 3 VIEWS R,CDM Code,Professional,73110RT2,$18.,$5.11,$60.6099,$14.4,$32.21,$5.4166,$44.48,$5.11,$60.6099,$60.32,$59.86,$12.285,$37.,$16.56
,CDM,4141000328.10.4141,PF XR BILAT WRISTS 3 VIEWS,CDM Code,Professional,73110502,$36.,$5.11,$60.6099,$28.8,$32.21,$5.4166,$44.48,$5.11,$60.6099,$60.32,$59.86,$24.57,$37.,$33.12
,CDM,4141000329.10.4141,PF XR WRIST COMPLETE 4 VIEWS L,CDM Code,Professional,73110LT2,$18.,$5.11,$60.6099,$14.4,$32.21,$5.4166,$44.48,$5.11,$60.6099,$60.32,$59.86,$12.285,$37.,$16.56
,CDM,4141000330.10.4141,PF XR WRIST COMPLETE 4 VIEWS R,CDM Code,Professional,73110RT2,$18.,$5.11,$60.6099,$14.4,$32.21,$5.4166,$44.48,$5.11,$60.6099,$60.32,$59.86,$12.285,$37.,$16.56
,CDM,4141000332.10.4141,PF XR FOREARM 2V  LT,CDM Code,Professional,73090LT2,$17.,$4.91,$59.86,$13.6,$20.99,$5.2046,$32.75,$4.91,$32.395,$32.24,$59.86,$11.6025,$24.5,$15.64
,CDM,4141000333.10.4141,PF XR FOREARM 2V  RT,CDM Code,Professional,73090RT2,$17.,$4.91,$59.86,$13.6,$20.99,$5.2046,$32.75,$4.91,$32.395,$32.24,$59.86,$11.6025,$24.5,$15.64
,CDM,4141000335.10.4141,PF XR ELBOW TWO VIEWS LT,CDM Code,Professional,73070LT2,$17.,$4.71,$59.86,$13.6,$23.15,$4.9926,$34.56,$4.71,$45.9799,$45.76,$59.86,$11.6025,$27.,$15.64
,CDM,4141000336.10.4141,PF XR ELBOW TWO VIEWS RT,CDM Code,Professional,73070RT2,$17.,$4.71,$59.86,$13.6,$23.15,$4.9926,$34.56,$4.71,$45.9799,$45.76,$59.86,$11.6025,$27.,$15.64
,CDM,4141000338.10.4141,PF XR ELBOW COMPLETE LT,CDM Code,Professional,73080LT2,$18.,$5.11,$59.86,$14.4,$27.03,$5.4166,$39.96,$5.11,$40.755,$40.56,$59.86,$12.285,$32.,$16.56
,CDM,4141000339.10.4141,PF XR ELBOW COMPLETE RT,CDM Code,Professional,73080RT2,$18.,$5.11,$59.86,$14.4,$27.03,$5.4166,$39.96,$5.11,$40.755,$40.56,$59.86,$12.285,$32.,$16.56
,CDM,4141000341.10.4141,PF XR HUMERUS LT,CDM Code,Professional,73060LT2,$17.,$4.91,$59.86,$13.6,$24.87,$5.2046,$36.81,$4.91,$46.5025,$46.28,$59.86,$11.6025,$29.,$15.64
,CDM,4141000342.10.4141,PF XR HUMERUS RT,CDM Code,Professional,73060RT2,$17.,$4.91,$59.86,$13.6,$24.87,$5.2046,$36.81,$4.91,$46.5025,$46.28,$59.86,$11.6025,$29.,$15.64
,CDM,4141000347.10.4141,PF XR SHOULDER COMPLETE 2V LT,CDM Code,Professional,73030LT2,$19.,$5.5199,$59.86,$15.2,$23.58,$5.8511,$37.25,$5.5199,$49.1149,$48.88,$59.86,$12.9675,$28.,$17.48
,CDM,4141000348.10.4141,PF XR SHOULDER COMPLETE 2V RT,CDM Code,Professional,73030RT2,$19.,$5.5199,$59.86,$15.2,$23.58,$5.8511,$37.25,$5.5199,$49.1149,$48.88,$59.86,$12.9675,$28.,$17.48
,CDM,4141000349.10.4141,PF XR BILAT SHOULDERS 2VWS,CDM Code,Professional,73030502,$38.,$5.5199,$59.86,$30.4,$23.58,$5.8511,$37.25,$5.5199,$49.1149,$48.88,$59.86,$25.935,$28.,$34.96
,CDM,4141000350.10.4141,PF XR SHOULDER COMPLETE 3V LT,CDM Code,Professional,73030LT2,$19.,$5.5199,$59.86,$15.2,$23.58,$5.8511,$37.25,$5.5199,$49.1149,$48.88,$59.86,$12.9675,$28.,$17.48
,CDM,4141000351.10.4141,PF XR SHOULDER COMPLETE 3V RT,CDM Code,Professional,73030RT2,$19.,$5.5199,$59.86,$15.2,$23.58,$5.8511,$37.25,$5.5199,$49.1149,$48.88,$59.86,$12.9675,$28.,$17.48
,CDM,4141000352.10.4141,PF XR BILAT SHOULDERS 3 VIEWS,CDM Code,Professional,73030502,$39.,$5.5199,$59.86,$31.2,$23.58,$5.8511,$37.25,$5.5199,$49.1149,$48.88,$59.86,$26.6175,$28.,$35.88
,CDM,4141000353.10.4141,PF XR SCAPULA COMPLETE LT,CDM Code,Professional,73010LT2,$19.,$5.32,$59.86,$15.2,$25.3,$5.6392,$38.61,$5.32,$18.05,$18.05,$59.86,$12.9675,$30.,$17.48
,CDM,4141000356.10.4141,PF XR CLAVICLE LT,CDM Code,Professional,73000LT2,$17.,$4.91,$59.86,$13.6,$23.15,$5.2046,$35.46,$4.91,$33.9625,$33.8,$59.86,$11.6025,$27.5,$15.64
,CDM,4141000357.10.4141,PF XR CLAVICLE RT,CDM Code,Professional,73000RT2,$17.,$4.91,$59.86,$13.6,$23.15,$5.2046,$35.46,$4.91,$33.9625,$33.8,$59.86,$11.6025,$27.5,$15.64
,CDM,4141000360.10.4141,PF XR BONE AGE STUDY,CDM Code,Professional,7707226,$19.,$5.5199,$112.73,$15.2,$16.24,$5.8511,$29.12,$5.5199,$18.05,$18.05,$112.73,$12.9675,$19.,$17.48
,CDM,4141000368.10.4141,PF XR CERVICAL SPINE 2 OR 3VW,CDM Code,Professional,7204026,$23.,$6.75,$59.86,$18.4,$26.17,$7.155,$42.19,$6.75,$56.43,$56.16,$59.86,$15.6975,$31.,$21.16
,CDM,4141000369.10.4141,PF XR CERVICAL SPINE MIN 4VW,CDM Code,Professional,7205026,$28.,$9.41,$112.73,$22.4,$35.66,$9.9746,$57.43,$9.41,$52.7725,$52.52,$112.73,$19.11,$41.5,$25.76
,CDM,4141000370.10.4141,PF XR CERVICAL SPINE COMPLETE,CDM Code,Professional,7205226,$31.,$10.84,$112.73,$24.8,$45.59,$11.4904,$70.94,$10.84,$29.45,$29.45,$112.73,$21.1575,$53.,$28.52
,CDM,4141000371.10.4141,PF XR LUMBAR SPINE 2 OR 3VW,CDM Code,Professional,7210026,$23.,$6.75,$112.73,$18.4,$28.76,$7.155,$44.44,$6.75,$56.9525,$56.68,$112.73,$15.6975,$33.5,$21.16
,CDM,4141000372.10.4141,PF XR LUMBOSACRAL SPINE 4VW,CDM Code,Professional,7211026,$27.,$9.41,$112.73,$21.6,$39.98,$9.9746,$61.94,$9.41,$53.8175,$53.56,$112.73,$18.4275,$46.5,$24.84
,CDM,4141000376.10.4141,PF XR THORACIC SPINE 2VW,CDM Code,Professional,7207026,$21.,$6.75,$112.73,$16.8,$27.46,$7.155,$43.09,$6.75,$37.0974,$36.92,$112.73,$14.3325,$32.,$19.32
,CDM,4141000377.10.4141,PF XR THORACIC SPINE 3VW,CDM Code,Professional,7207226,$24.,$6.34,$112.73,$19.2,$28.33,$6.7204,$43.99,$6.34,$22.8,$22.8,$112.73,$16.38,$33.5,$22.08
,CDM,4141000386.10.4141,PF XR CHEST FOR LINE PLACEMENT,CDM Code,Professional,7104526,$19.,$5.32,$62.12,$15.2,$12.85,$5.6392,$25.06,$5.32,$18.05,$18.05,$62.12,$12.9675,$18.,$17.48
,CDM,4141000388.10.4141,PF XR RIBS UNILAT 2V LT,CDM Code,Professional,71100LT2,$23.,$6.75,$59.86,$18.4,$26.17,$7.155,$42.19,$6.75,$21.85,$21.85,$59.86,$15.6975,$31.,$21.16
,CDM,4141000391.10.4141,PF XR RIBS UNI W/PA CHEST MIN,CDM Code,Professional,71101LT2,$27.,$8.18,$112.73,$21.6,$27.46,$8.6708,$48.43,$8.18,$62.7,$62.4,$112.73,$18.4275,$34.5,$24.84
,CDM,4141000392.10.4141,PF XR RIBS UNI W/PA CHEST MIN,CDM Code,Professional,71101RT2,$27.,$8.18,$112.73,$21.6,$27.46,$8.6708,$48.43,$8.18,$62.7,$62.4,$112.73,$18.4275,$34.5,$24.84
,CDM,4141000393.10.4141,PF XR RIBS BILAT W/PA CHEST MI,CDM Code,Professional,7111126,$33.,$9.82,$112.73,$26.4,$38.25,$10.4092,$59.68,$9.82,$60.6099,$60.32,$112.73,$22.5225,$43.,$30.36
,CDM,4141000406.10.4141,PF XR SKULL <4 VIEWS,CDM Code,Professional,7025026,$21.,$7.57,$112.73,$16.8,$28.33,$8.0242,$46.24,$7.57,$19.95,$19.95,$112.73,$14.3325,$33.5,$19.32
,CDM,4141000409.10.4140,PF XR SINUSES COMPL MIN 3 VIEW,CDM Code,Professional,7022026,$23.,$7.57,$59.86,$18.4,$30.05,$8.0242,$47.58,$7.57,$21.85,$21.85,$59.86,$15.6975,$35.,$21.16
,CDM,4141000411.10.4141,PF XR NASAL BONE COMPLETE 3V,CDM Code,Professional,7016026,$18.,$5.11,$59.86,$14.4,$28.76,$5.4166,$41.77,$5.11,$17.1,$17.1,$59.86,$12.285,$34.,$16.56
,CDM,4141000412.10.4141,PF XR PORT A CATH C-ARM,CDM Code,Professional,,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.
,CDM,4141000414.10.4141,PF XR C-ARM PROCEDURE,CDM Code,Professional,,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.
,CDM,4141000415.10.4141,PF XR NECK SOFT TISSUE,CDM Code,Professional,7036026,$19.,$4.91,$59.86,$15.2,$23.58,$5.2046,$35.9,$4.91,$18.05,$18.05,$59.86,$12.9675,$28.,$17.48
,CDM,4141000417.10.4141,PF XR SINGLE FILM FOR FB (INFA,CDM Code,Professional,7601026,$19.,$5.32,$59.86,$15.2,$20.56,$5.6392,$33.19,$5.32,$18.05,$18.05,$59.86,$12.9675,$24.,$17.48
,CDM,4141000456.10.4141,PF FL GUIDANCE NEEDLE PLACEMEN,CDM Code,Professional,7700226,$57.,$5.7,$119.92,$45.6,$78.83,$17.3522,$119.92,$16.37,$54.15,$54.15,$5.7,$38.9025,$93.5,$52.44
,CDM,4141000490.10.4141,PF XR SPINE SCOLIOSIS STUDY 2-,CDM Code,Professional,7208226,$33.,$9.6199,$112.73,$26.4,$55.95,$10.1971,$79.09,$9.6199,$31.35,$31.35,$112.73,$22.5225,$65.,$30.36
,CDM,4141000492.10.4141,PF XR SPINE SCOLIOSIS STUDY 6+,CDM Code,Professional,7208426,$42.,$12.48,$225.91,$33.6,$72.79,$13.2288,$111.02,$12.48,$39.9,$39.9,$225.91,$28.665,$93.,$38.64
,CDM,4141000493.10.4141,PF XR HIP UNIL W/PEL 2 - 3 V L,CDM Code,Professional,73502LT2,$23.,$6.75,$60.6099,$18.4,$36.53,$7.155,$52.57,$6.75,$60.6099,$60.32,$59.86,$15.6975,$42.5,$21.16
,CDM,4141000495.10.4141,PF XR HIP UNIL W/PEL 2 - 3 V R,CDM Code,Professional,73502RT2,$23.,$6.75,$60.6099,$18.4,$36.53,$7.155,$52.57,$6.75,$60.6099,$60.32,$59.86,$15.6975,$42.5,$21.16
,CDM,4141000497.10.4141,PF XR HIPS BILATERAL 3-4 V,CDM Code,Professional,7352226,$30.,$9.,$112.73,$24.,$40.84,$9.54,$61.95,$9.,$28.5,$28.5,$112.73,$20.475,$47.5,$27.6
,CDM,4141000502.10.4141,PF XR FEMUR MIN 2V  LT,CDM Code,Professional,73552LT2,$19.,$5.32,$59.86,$15.2,$27.89,$5.6392,$41.76,$5.32,$33.44,$33.28,$59.86,$12.9675,$33.,$17.48
,CDM,4141000504.10.4141,PF XR FEMUR MIN 2V  RT,CDM Code,Professional,73552RT2,$19.,$5.32,$59.86,$15.2,$27.89,$5.6392,$41.76,$5.32,$33.44,$33.28,$59.86,$12.9675,$33.,$17.48
,CDM,4141000505.10.4141,PF X-RAY EXAM CHEST 1 VIEW,CDM Code,Professional,7104526,$19.,$5.32,$62.12,$15.2,$12.85,$5.6392,$25.06,$5.32,$18.05,$18.05,$62.12,$12.9675,$18.,$17.48
,CDM,4141000506.10.4141,PF X-RAY EXAM CHEST 2 VIEWS,CDM Code,Professional,7104626,$22.,$6.34,$62.12,$17.6,$23.63,$6.7204,$38.58,$6.34,$20.9,$20.9,$62.12,$15.015,$27.5,$20.24
,CDM,4141000509.10.4141,PF X-RAY EXAM ABDOMEN 1 VIEW,CDM Code,Professional,7401826,$19.,$5.32,$62.12,$15.2,$21.9,$5.6392,$34.54,$5.32,$18.05,$18.05,$62.12,$12.9675,$25.5,$17.48
,CDM,4141000510.10.4141,PF X-RAY EXAM ABDOMEN 2 VIEWS,CDM Code,Professional,7401926,$24.,$6.96,$114.46,$19.2,$26.22,$7.3776,$42.18,$6.96,$22.8,$22.8,$114.46,$16.38,$30.5,$22.08
,CDM,4141000519.10.4141,PF POST THORACENTESIS 1V CXR,CDM Code,Professional,7104526,$19.,$5.32,$62.12,$15.2,$12.85,$5.6392,$25.06,$5.32,$18.05,$18.05,$62.12,$12.9675,$18.,$17.48
,CDM,4141000520.10.4141,PF POST THORACENTESIS 2V CXR,CDM Code,Professional,7104626,$22.,$6.34,$62.12,$17.6,$23.63,$6.7204,$38.58,$6.34,$20.9,$20.9,$62.12,$15.015,$27.5,$20.24
,CDM,4141000521.10.4141,PF POST PORT PLACEMENT 1V CXR,CDM Code,Professional,7104526,$19.,$5.32,$62.12,$15.2,$12.85,$5.6392,$25.06,$5.32,$18.05,$18.05,$62.12,$12.9675,$18.,$17.48
,CDM,4141000540.10.4141,PF US ABDOMEN LIMITED,CDM Code,Professional,7670526,$60.,$17.18,$117.23,$48.,$75.81,$18.2108,$117.23,$17.18,$57.,$57.,$112.73,$40.95,$88.5,$55.2
,CDM,4141000541.10.4141,PF US ABDOMINAL COMPLETE,CDM Code,Professional,7670026,$83.,$23.94,$156.76,$66.4,$100.41,$25.3764,$156.76,$23.94,$78.85,$78.85,$112.73,$56.6475,$117.,$76.36
,CDM,4141000542.10.4141,PF US ANKLE BRACHIAL INDEX,CDM Code,Professional,9392226,$26.,$7.36,$122.83,$20.8,$122.83,$7.8016,$112.93,$7.36,$24.7,$24.7,$100.02,$17.745,$107.5,$23.92
,CDM,4141000543.10.4141,PF US AORTA SCREENING,CDM Code,Professional,7670626,$56.,$16.16,$120.81,$44.8,$80.56,$17.1296,$120.81,$16.16,$53.2,$53.2,$112.73,$38.22,$39.5,$51.52
,CDM,4141000545.10.4141,PF US ARTERIAL VISCERAL COMPLE,CDM Code,Professional,9397526,$117.,$33.96,$386.68,$93.6,$386.68,$35.9976,$363.3,$33.96,$111.15,$111.15,$225.91,$79.8525,$321.5,$107.64
,CDM,4141000547.10.4141,PF US BLADDER,CDM Code,Professional,7685726,$50.,$14.73,$150.48,$40.,$28.33,$15.6138,$61.77,$14.73,$150.48,$149.76,$112.73,$34.125,$35.5,$46.
,CDM,4141000548.10.4141,PF US CAROTID DOPPLER COMPLETE,CDM Code,Professional,9388026,$81.,$23.53,$279.19,$64.8,$279.19,$24.9418,$261.27,$23.53,$76.95,$76.95,$225.91,$55.2825,$233.5,$74.52
,CDM,4141000551.10.4141,PF US DOPPLER COMPLETE,CDM Code,Professional,9397526,$117.,$33.96,$386.68,$93.6,$386.68,$35.9976,$363.3,$33.96,$111.15,$111.15,$225.91,$79.8525,$321.5,$107.64
,CDM,4141000554.10.4141,PF US DUPLEX EXT VEINS BILATER,CDM Code,Professional,9397026,$70.,$20.25,$272.45,$56.,$272.45,$21.465,$252.36,$20.25,$66.5,$66.5,$225.91,$47.775,$231.5,$64.4
,CDM,4141000555.10.4141,PF US DUPLEX EXT VEINS LIMITED,CDM Code,Professional,93971RT2,$45.,$13.3,$166.05,$36.,$166.05,$14.098,$154.72,$13.3,$42.75,$42.75,$112.73,$30.7125,$140.,$41.4
,CDM,4141000556.10.4141,PF US DUPLEX EXT VEINS LIMITED,CDM Code,Professional,93971LT2,$45.,$13.3,$166.05,$36.,$166.05,$14.098,$154.72,$13.3,$42.75,$42.75,$112.73,$30.7125,$140.,$41.4
,CDM,4141000559.10.4141,PF US DUPLEX LWR EXT ART BILAT,CDM Code,Professional,9392526,$80.,$23.12,$359.02,$64.,$359.02,$24.5072,$335.24,$23.12,$76.,$76.,$225.91,$54.6,$316.,$73.6
,CDM,4141000560.10.4141,PF US DUPLEX LOWER EXT ART LTD,CDM Code,Professional,93926RT2,$49.,$14.32,$196.12,$39.2,$186.61,$15.1792,$196.12,$14.32,$46.55,$46.55,$112.73,$33.4425,$183.5,$45.08
,CDM,4141000561.10.4141,PF US DUPLEX LOWER EXT ART LTD,CDM Code,Professional,93926LT2,$49.,$14.32,$196.12,$39.2,$186.61,$15.1792,$196.12,$14.32,$46.55,$46.55,$112.73,$33.4425,$183.5,$45.08
,CDM,4141000564.10.4141,PF US DUPLEX UPR EXT ART LTD L,CDM Code,Professional,93931LT2,$50.,$14.53,$177.35,$40.,$177.35,$15.4018,$166.83,$14.53,$47.5,$47.5,$112.73,$34.125,$150.5,$46.
,CDM,4141000565.10.4141,PF US DUPLEX VENOUS LMTD,CDM Code,Professional,9397126,$45.,$13.3,$166.05,$36.,$166.05,$14.098,$154.72,$13.3,$42.75,$42.75,$112.73,$30.7125,$140.,$41.4
,CDM,4141000566.10.4141,PF US EXTREMITY LMTD NON VASCU,CDM Code,Professional,7688226,$50.,$13.65,$73.51,$40.,$13.65,$15.4018,$73.51,$14.53,$47.5,$47.5,$59.86,$34.125,$47.,$46.
,CDM,4141000568.10.4141,PF US FETAL BIOPHYSICAL PROFIL,CDM Code,Professional,7681926,$79.,$23.32,$114.71,$63.2,$62.43,$24.7192,$114.71,$23.32,$75.05,$75.05,$112.73,$53.9175,$72.,$72.68
,CDM,4141000578.10.4141,PF US OB 14+ WEEKS,CDM Code,Professional,7680526,$101.,$29.66,$182.22,$80.8,$112.93,$31.4396,$182.22,$29.66,$95.95,$95.95,$112.73,$68.9325,$131.,$92.92
,CDM,4141000579.10.4141,PF US OB 14+ WEEKS ADDL FETUS,CDM Code,Professional,7681026,$101.,$10.1,$119.09,$80.8,$53.1,$31.4396,$119.09,$29.66,$95.95,$95.95,$10.1,$68.9325,$71.5,$92.92
,CDM,4141000580.10.4141,PF US OB DETAILED FETAL EVALUA,CDM Code,Professional,7681126,$193.,$57.49,$233.52,$154.4,$104.57,$60.9394,$233.52,$57.49,$183.35,$183.35,$112.73,$131.7225,$139.5,$177.56
,CDM,4141000582.10.4141,PF US OB FIRST TRIMESTER,CDM Code,Professional,7680126,$101.,$29.46,$157.9,$80.8,$90.05,$31.2276,$157.9,$29.46,$95.95,$95.95,$112.73,$68.9325,$105.,$92.92
,CDM,4141000584.10.4141,PF US OB FOLLOW-UP,CDM Code,Professional,7681626,$87.,$25.78,$148.01,$69.6,$88.33,$27.3268,$148.01,$25.78,$82.65,$82.65,$112.73,$59.3775,$102.5,$80.04
,CDM,4141000585.10.4141,PF US OB LIMITED,CDM Code,Professional,7681526,$66.,$19.23,$142.12,$52.8,$63.72,$20.3838,$108.12,$19.23,$142.12,$141.44,$112.73,$45.045,$74.,$60.72
,CDM,4141000586.10.4141,PF US OB TRANSVAGINAL,CDM Code,Professional,7681726,$76.,$22.5,$160.93,$60.8,$72.79,$23.85,$124.25,$22.5,$160.93,$160.16,$112.73,$51.87,$84.5,$69.92
,CDM,4141000587.10.4141,PF US PELVIS GENERAL,CDM Code,Professional,7685626,$70.,$20.25,$141.04,$56.,$92.64,$21.465,$141.04,$20.25,$66.5,$66.5,$112.73,$47.775,$108.,$64.4
,CDM,4141000588.10.4141,PF US PELVIS LIMITED,CDM Code,Professional,7685726,$50.,$14.73,$150.48,$40.,$28.33,$15.6138,$61.77,$14.73,$150.48,$149.76,$112.73,$34.125,$35.5,$46.
,CDM,4141000589.10.4141,PF US TRANSVAGINAL PROC,CDM Code,Professional,7683026,$71.,$20.66,$156.38,$56.8,$107.32,$21.8996,$156.38,$20.66,$117.5625,$117.,$112.73,$48.4575,$124.5,$65.32
,CDM,4141000591.10.4141,PF US BX BREAST CORE,CDM Code,Professional,1908326,$326.,$202.25,"$1,236.62",$260.8,$296.66,$407.252,$202.25,$384.2,$309.7,$309.7,"$1,236.62",$222.495,$954.5,$299.92
,CDM,4141000598.10.4141,PF US RENAL,CDM Code,Professional,7677026,$75.,$21.89,$145.07,$60.,$93.51,$23.2034,$145.07,$21.89,$71.25,$71.25,$112.73,$51.1875,$109.,$69.
,CDM,4141000599.10.4141,PF US RENAL LTD,CDM Code,Professional,7677526,$59.,$16.98,$112.73,$47.2,$36.1,$17.9988,$73.91,$16.98,$56.05,$56.05,$112.73,$40.2675,$41.5,$54.28
,CDM,4141000600.10.4141,PF US SCROTUM/TESTICLE,CDM Code,Professional,7687026,$65.,$18.82,$112.73,$52.,$43.87,$19.9492,$86.46,$18.82,$61.75,$61.75,$112.73,$44.3625,$51.,$59.8
,CDM,4141000601.10.4141,PF US THYROID/NECK,CDM Code,Professional,7653626,$58.,$16.57,$149.29,$46.4,$108.18,$17.5642,$149.29,$16.57,$55.1,$55.1,$112.73,$39.585,$126.,$53.36
,CDM,4141000603.10.4141,PF US THORACENTESIS PUNCTURE,CDM Code,Professional,3255526,$231.,$142.98,$684.13,$184.8,$210.21,$191.2664,$142.98,$180.44,$219.45,$219.45,$684.13,$157.6575,$413.,$212.52
,CDM,4141000607.10.4141,PF US ABD PARACENTESIS W/IMAG,CDM Code,Professional,4908326,$223.,$139.13,$699.79,$178.4,$202.93,$189.9626,$139.13,$179.21,$211.85,$211.85,$699.79,$152.1975,$420.,$205.16
,CDM,4141000610.10.4141,PF RF HSG CATHETER,CDM Code,Professional,5834026,$182.,$18.2,$172.9,$145.6,$165.62,$100.8378,$73.88,$95.13,$172.9,$172.9,$18.2,$124.215,$170.,$167.44
,CDM,4141000613.10.4141,PF INJ SINGLE TENDON SHEATH/LI,CDM Code,Professional,2055026,$81.,$31.51,$231.,$64.8,$73.71,$33.4006,$50.09,$31.51,$76.95,$76.95,$231.,$55.2825,$75.5,$74.52
,CDM,4141000628.10.4141,PF US BREAST UNILATERAL LIMITE,CDM Code,Professional,7664226,$69.,$20.05,$112.61,$55.2,$66.31,$21.253,$112.61,$20.05,$65.55,$65.55,$59.86,$47.0925,$77.,$63.48
,CDM,4141000631.10.4141,PF US FNA BX W/US GDN 1ST LES,CDM Code,Professional,1000526,$148.,$75.49,$579.34,$118.4,$134.68,$80.0194,$93.13,$75.49,$140.6,$140.6,$579.34,$101.01,$179.5,$136.16
,CDM,4141000637.10.4141,PF DEXA BONE DENSITY LIMITED,CDM Code,Professional,7708126,$21.,$5.93,$59.86,$16.8,$20.56,$6.2858,$35.87,$5.93,$19.95,$19.95,$59.86,$14.3325,$24.5,$19.32
,CDM,4141000638.10.4141,PF DEXA BONE DENSITY COMPLETE,CDM Code,Professional,7708026,$25.,$5.73,$112.73,$20.,$37.39,$6.0738,$53.48,$5.73,$23.75,$23.75,$112.73,$17.0625,$45.,$23.
,CDM,4141000643.10.4141,PF NM BONE SCAN TOTAL BODY,CDM Code,Professional,7830626,$87.,$24.96,$400.74,$69.6,$264.98,$26.4576,$400.74,$24.96,$82.65,$82.65,$333.08,$59.3775,$384.5,$80.04
,CDM,4141000647.10.4141,PF NM MPS STRESS/REST,CDM Code,Professional,7845226,$161.,$46.64,"$1,138.94",$128.8,$497.16,$49.4384,$625.67,$46.64,$152.95,$152.95,"$1,138.94",$109.8825,$582.5,$148.12
,CDM,4141000651.10.4141,PF NM GASTRIC EMPTY SMALL BOWE,CDM Code,Professional,7826526,$99.,$28.44,$526.48,$79.2,$400.2,$30.1464,$526.48,$28.44,$94.05,$94.05,$333.08,$67.5675,$516.,$91.08
,CDM,4141000664.10.4141,PF NM LYMPH GLAND IMAGING,CDM Code,Professional,7819526,$119.,$34.57,$469.88,$95.2,$376.62,$36.6442,$469.88,$34.57,$113.05,$113.05,$429.13,$81.2175,$438.5,$109.48
,CDM,4142000001.10.4142,ECHO TRANSTHORACIC LMTD,CDM Code,Outpatient,93308,"$1,162.",$113.5,"$1,103.9",$929.6,"$1,057.42",$304.7147,"$1,103.9",$287.4672,"$1,103.9","$1,103.9",$603.1797,$793.065,$113.5,"$1,069.04"
,CDM,4142000002.10.4142,ECHO TRANSTHORACIC COMPLETE,CDM Code,Outpatient,93306,"$2,433.",$601.8999,"$2,311.35","$1,946.4","$2,214.03",$638.0129,"$2,311.35",$601.8999,"$2,311.35","$2,311.35","$1,200.6456","$1,660.5225","$2,141.04","$2,238.36"
,CDM,4142000003.10.4142,ECHO TREADMILL STRESS/REST,CDM Code,Outpatient,93350,"$2,433.",$193.5,"$2,311.35","$1,946.4","$2,214.03",$638.0129,"$2,311.35",$601.8999,"$2,311.35","$2,311.35","$1,200.6456","$1,660.5225",$193.5,"$2,238.36"
,CDM,4142000005.10.4142,ECHO TRANSTHORACIC W/ CONTRAST,CDM Code,Outpatient,93306,"$2,433.",$601.8999,"$2,311.35","$1,946.4","$2,214.03",$638.0129,"$2,311.35",$601.8999,"$2,311.35","$2,311.35","$1,200.6456","$1,660.5225","$2,141.04","$2,238.36"
,CDM,4142000006.10.4160,ECHO CARDIOVASC TREADMILL TEST,CDM Code,Outpatient,93017,"$1,244.",$48.5,"$1,181.8",$995.2,"$1,132.04",$326.2179,"$1,181.8",$307.7532,"$1,181.8","$1,181.8",$620.2677,$849.03,$48.5,"$1,144.48"
,CDM,4142000008.10.4142,PROFEE ECHO TREAD STRESS REST,CDM Code,Professional,9335126,$491.,$50.33,$451.72,$392.8,$370.12,$53.3498,$298.14,$50.33,$128.0125,$127.4,$449.68,$335.1075,$211.,$451.72
,CDM,4142000009.10.4160,FACFEE ECHO TREAD STRESS REST,CDM Code,Outpatient,93351,"$2,433.",$211.,"$2,311.35","$1,946.4","$2,214.03",$638.0129,"$2,311.35",$601.8999,"$2,311.35","$2,311.35","$1,200.6456","$1,660.5225",$211.,"$2,238.36"
,CDM,4142000015.10.4142,MYOCARDIAL STRAIN IMAGING,CDM Code,Outpatient,93356,$335.,$82.8756,$318.25,$268.,$304.85,$87.8481,$318.25,$82.8756,$318.25,$318.25,$33.5,$228.6375,$294.8,$308.2
,CDM,4143000001.10.4143,US ABDOMEN LIMITED,CDM Code,Outpatient,76705,$572.,$88.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$88.5,$526.24
,CDM,4143000002.10.4143,US ABDOMINAL COMPLETE,CDM Code,Outpatient,76700,$572.,$117.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$117.,$526.24
,CDM,4143000003.10.4143,US ANKLE BRACHIAL INDEX,CDM Code,Outpatient,93922,$572.,$107.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$267.0534,$390.39,$107.5,$526.24
,CDM,4143000004.10.4143,US AORTA SCREENING,CDM Code,Outpatient,76706,$572.,$39.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$39.5,$526.24
,CDM,4143000005.10.4143,US ARTERIAL ABDOMINAL LIMITED,CDM Code,Outpatient,93976,$916.,$178.5,$870.2,$732.8,$833.56,$240.2054,$870.2,$226.6092,$870.2,$870.2,$300.9891,$625.17,$178.5,$842.72
,CDM,4143000006.10.4143,US ARTERIAL VISCERAL COMPLETE,CDM Code,Outpatient,93975,"$1,162.",$287.4672,"$1,103.9",$929.6,"$1,057.42",$304.7147,"$1,103.9",$287.4672,"$1,103.9","$1,103.9",$603.1797,$793.065,$321.5,"$1,069.04"
,CDM,4143000010.10.4143,US BLADDER,CDM Code,Outpatient,76857,$572.,$35.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$35.5,$526.24
,CDM,4143000014.10.4143,US CAROTID DOPPLER COMPLETE,CDM Code,Outpatient,93880,"$1,162.",$233.5,"$1,103.9",$929.6,"$1,057.42",$304.7147,"$1,103.9",$287.4672,"$1,103.9","$1,103.9",$603.1797,$793.065,$233.5,"$1,069.04"
,CDM,4143000015.10.4143,US CHEST,CDM Code,Outpatient,76604,$572.,$88.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$88.5,$526.24
,CDM,4143000016.10.4143,US AXILLA,CDM Code,Outpatient,76882,$572.,$47.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$159.8262,$390.39,$47.,$526.24
,CDM,4143000018.10.4143,US DOPPLER COMPLETE,CDM Code,Outpatient,93975,"$1,162.",$287.4672,"$1,103.9",$929.6,"$1,057.42",$304.7147,"$1,103.9",$287.4672,"$1,103.9","$1,103.9",$603.1797,$793.065,$321.5,"$1,069.04"
,CDM,4143000019.10.4143,US DOPPLER LIMITED,CDM Code,Outpatient,93976,$572.,$141.5071,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$178.5,$526.24
,CDM,4143000021.10.4143,US DUPLEX EXT VEINS BILATERAL,CDM Code,Outpatient,93970,"$1,162.",$231.5,"$1,103.9",$929.6,"$1,057.42",$304.7147,"$1,103.9",$287.4672,"$1,103.9","$1,103.9",$603.1797,$793.065,$231.5,"$1,069.04"
,CDM,4143000022.10.4143,US DUPLEX EXT VEINS LIMITED RT,CDM Code,Outpatient,93971RT,$572.,$140.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$140.,$526.24
,CDM,4143000023.10.4143,US DUPLEX EXT VEINS LIMITED LT,CDM Code,Outpatient,93971LT,$572.,$140.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$140.,$526.24
,CDM,4143000024.10.4143,US DUPLEX AORTA COMPLETE,CDM Code,Outpatient,93978,"$1,162.",$217.5,"$1,103.9",$929.6,"$1,057.42",$304.7147,"$1,103.9",$287.4672,"$1,103.9","$1,103.9",$603.1797,$793.065,$217.5,"$1,069.04"
,CDM,4143000025.10.4143,US DUPLEX SCAN AORTA LIMITED,CDM Code,Outpatient,93979,$572.,$137.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$137.5,$526.24
,CDM,4143000030.10.4143,US DUPLEX LWR EXT ART BILAT,CDM Code,Outpatient,93925,"$1,162.",$287.4672,"$1,103.9",$929.6,"$1,057.42",$304.7147,"$1,103.9",$287.4672,"$1,103.9","$1,103.9",$603.1797,$793.065,$316.,"$1,069.04"
,CDM,4143000031.10.4143,US DUPLEX LOWER EXT ART LTD RT,CDM Code,Outpatient,93926RT,$572.,$141.5071,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$183.5,$526.24
,CDM,4143000032.10.4143,US DUPLEX LOWER EXT ART LTD LT,CDM Code,Outpatient,93926LT,$572.,$141.5071,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$183.5,$526.24
,CDM,4143000033.10.4143,US DUPLEX UPR EXT ART BILAT,CDM Code,Outpatient,93930,"$1,162.",$241.5,"$1,103.9",$929.6,"$1,057.42",$304.7147,"$1,103.9",$287.4672,"$1,103.9","$1,103.9",$603.1797,$793.065,$241.5,"$1,069.04"
,CDM,4143000034.10.4143,US DUPLEX UPR EXT ART LTD RT,CDM Code,Outpatient,93931RT,$572.,$141.5071,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$150.5,$526.24
,CDM,4143000035.10.4143,US DUPLEX UPR EXT ART LTD LT,CDM Code,Outpatient,93931LT,$572.,$141.5071,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$150.5,$526.24
,CDM,4143000040.10.4143,US DUPLEX VENOUS LMTD,CDM Code,Outpatient,93971,$572.,$140.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$140.,$526.24
,CDM,4143000042.10.4143,US EXTREMITY LMTD NON VASCULA,CDM Code,Outpatient,76882,$572.,$47.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$159.8262,$390.39,$47.,$526.24
,CDM,4143000045.10.4143,US FETAL BIO W/NON STRESS,CDM Code,Outpatient,76818,$572.,$98.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$98.5,$526.24
,CDM,4143000046.10.4143,US FETAL BIOPHYSICAL PROFILE,CDM Code,Outpatient,76819,$572.,$72.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$72.,$526.24
,CDM,4143000056.10.4143,US INFANT HIPS WITH MANIPULATI,CDM Code,Outpatient,76885,$561.,$138.7858,$532.95,$448.8,$510.51,$147.1127,$532.95,$138.7858,$532.95,$532.95,$159.8262,$382.8825,$153.,$516.12
,CDM,4143000057.10.4143,US NDL BX LYMPH NODES,CDM Code,Outpatient,38505,"$1,377.",$179.,"$3,301.7754","$1,101.6","$1,253.07",$361.0948,"$1,308.15",$340.656,"$1,308.15","$1,308.15","$3,301.7754",$939.8025,$179.,"$1,266.84"
,CDM,4143000065.10.4143,US OB 14+ WEEKS,CDM Code,Outpatient,76805,$572.,$131.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$131.,$526.24
,CDM,4143000066.10.4143,US OB 14+ WEEKS ADDL FETUS,CDM Code,Outpatient,76810,$727.,$71.5,$690.65,$581.6,$661.57,$190.6434,$690.65,$179.8525,$690.65,$690.65,$72.7,$496.1775,$71.5,$668.84
,CDM,4143000067.10.4143,US OB DETAILED FETAL EVALUATIO,CDM Code,Outpatient,76811,$572.,$139.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$139.5,$526.24
,CDM,4143000068.10.4143,US OB DETAILED FETAL EVAL EA A,CDM Code,Outpatient,76812,"$1,041.",$160.5,$988.95,$832.8,$947.31,$272.9846,$988.95,$257.533,$988.95,$988.95,$104.1,$710.4825,$160.5,$957.72
,CDM,4143000069.10.4143,US OB FIRST TRIMESTER,CDM Code,Outpatient,76801,$572.,$105.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$105.,$526.24
,CDM,4143000070.10.4143,US OB FIRST TRIMESTER ADDL FET,CDM Code,Outpatient,76802,$324.,$60.5,$307.8,$259.2,$294.84,$84.9635,$307.8,$80.1544,$307.8,$307.8,$32.4,$221.13,$60.5,$298.08
,CDM,4143000075.10.4143,US OB FOLLOW-UP,CDM Code,Outpatient,76816,$572.,$102.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$102.5,$526.24
,CDM,4143000076.10.4143,US OB LIMITED,CDM Code,Outpatient,76815,$572.,$74.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$74.,$526.24
,CDM,4143000077.10.4143,US OB TRANSVAGINAL,CDM Code,Outpatient,76817,$572.,$84.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$84.5,$526.24
,CDM,4143000078.10.4143,US PELVIS GENERAL,CDM Code,Outpatient,76856,$572.,$108.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$108.,$526.24
,CDM,4143000079.10.4143,US PELVIS LIMITED,CDM Code,Outpatient,76857,$572.,$35.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$35.5,$526.24
,CDM,4143000080.10.4143,US TRANSVAGINAL PROC,CDM Code,Outpatient,76830,$572.,$124.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$124.5,$526.24
,CDM,4143000081.10.4143,US BX BREAST EA ADD CORE,CDM Code,Outpatient,19084,"$1,734.",$428.9743,"$1,647.3","$1,387.2","$1,577.94",$454.712,"$1,647.3",$428.9743,"$1,647.3","$1,647.3",$173.4,"$1,183.455",$778.,"$1,595.28"
,CDM,4143000082.10.4143,US BX BREAST CORE,CDM Code,Outpatient,19083,"$3,167.",$783.4841,"$3,301.7754","$2,533.6","$2,881.97",$830.4919,"$3,008.65",$783.4841,"$3,008.65","$3,008.65","$3,301.7754","$2,161.4775",$954.5,"$2,913.64"
,CDM,4143000083.10.4143,US WIRE EA ADD LESION,CDM Code,Outpatient,19286,"$1,734.",$428.9743,"$1,647.3","$1,387.2","$1,577.94",$454.712,"$1,647.3",$428.9743,"$1,647.3","$1,647.3",$173.4,"$1,183.455",$644.5,"$1,595.28"
,CDM,4143000084.10.4143,US WIRE LOC,CDM Code,Outpatient,19285,"$2,864.",$708.525,"$2,720.8","$2,291.2","$2,606.24",$751.0353,"$2,720.8",$708.525,"$2,720.8","$2,720.8","$1,439.4237","$1,954.68",$736.5,"$2,634.88"
,CDM,4143000089.10.4143,US PUNCT ASPIRATION BREAST CYS,CDM Code,Outpatient,19000,$732.,$160.,"$1,439.4237",$585.6,$666.12,$191.9546,$695.4,$181.0895,$695.4,$695.4,"$1,439.4237",$499.59,$160.,$673.44
,CDM,4143000095.10.4143,US RENAL,CDM Code,Outpatient,76770,$572.,$109.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$109.,$526.24
,CDM,4143000096.10.4143,US RENAL LTD,CDM Code,Outpatient,76775,$572.,$41.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$41.5,$526.24
,CDM,4143000097.10.4143,US SCROTUM/TESTICLE,CDM Code,Outpatient,76870,$572.,$51.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$51.,$526.24
,CDM,4143000098.10.4143,US THYROID/NECK,CDM Code,Outpatient,76536,$572.,$126.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$126.,$526.24
,CDM,4143000099.10.4143,US SPINAL CANAL AND CONTENTS,CDM Code,Outpatient,76800,$572.,$122.5,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$159.8262,$390.39,$122.5,$526.24
,CDM,4143000101.10.4143,US THORACENTESIS PUNCTURE,CDM Code,Outpatient,32555,$931.,$230.3201,"$1,826.6271",$744.8,$847.21,$244.1389,$884.45,$230.3201,$884.45,$884.45,"$1,826.6271",$635.4075,$413.,$856.52
,CDM,4143000110.10.4143,US FINE NEEDLE ASPIRATION,CDM Code,Outpatient,10022,$627.,$155.1135,"$1,439.4237",$501.6,$570.57,$164.4201,$595.65,$155.1135,$595.65,$595.65,"$1,439.4237",$427.9275,$551.76,$576.84
,CDM,4143000111.10.4143,US BONE BIOPSY NDL SUPERFICIAL,CDM Code,Outpatient,20220,"$2,113.",$238.5,"$3,301.7754","$1,690.4","$1,922.83",$554.0983,"$2,007.35",$522.7351,"$2,007.35","$2,007.35","$3,301.7754","$1,442.1225",$238.5,"$1,943.96"
,CDM,4143000115.10.4143,US ABD PARACENTESIS W/IMAGING,CDM Code,Outpatient,49083,"$3,717.",$919.5486,"$3,531.15","$2,973.6","$3,382.47",$974.7201,"$3,531.15",$919.5486,"$3,531.15","$3,531.15","$1,868.4393","$2,536.8525","$3,270.96","$3,419.64"
,CDM,4143000116.10.4143,US BIOPSY ABD MASS,CDM Code,Outpatient,49180,"$1,516.",$375.0432,"$3,301.7754","$1,212.8","$1,379.56",$397.5452,"$1,440.2",$375.0432,"$1,440.2","$1,440.2","$3,301.7754","$1,034.67","$1,334.08","$1,394.72"
,CDM,4143000120.10.4143,RF HSG CATHETER,CDM Code,Outpatient,58340,"$1,288.",$318.6383,"$1,223.6","$1,030.4","$1,172.08",$337.7561,"$1,223.6",$318.6383,"$1,223.6","$1,223.6",$128.8,$879.06,"$1,133.44","$1,184.96"
,CDM,4143000125.10.4143,US GUIDANCE NEEDLE PLCMNT,CDM Code,Outpatient,76942,"$1,142.",$46.,"$1,084.9",$913.6,"$1,039.22",$299.4701,"$1,084.9",$282.5194,"$1,084.9","$1,084.9",$114.2,$779.415,$46.,"$1,050.64"
,CDM,4143000135.10.4143,INJ SINGLE TENDON SHEATH/LIGMN,CDM Code,Outpatient,20550,"$1,224.",$75.5,"$1,162.8",$979.2,"$1,113.84",$320.9732,"$1,162.8",$302.8054,"$1,162.8","$1,162.8",$616.77,$835.38,$75.5,"$1,126.08"
,CDM,4143000163.10.4143,US BREAST UNILATERAL COMP,CDM Code,Outpatient,76641,$572.,$101.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$101.,$526.24
,CDM,4143000164.10.4143,US BREAST UNILATERAL LIMITED,CDM Code,Outpatient,76642,$311.,$76.9383,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$77.,$286.12
,CDM,4143000165.10.4143,US DRAIN/INJ JOINT/BURSA W/US,CDM Code,Outpatient,20611,$735.,$129.,$698.25,$588.,$668.85,$192.7413,$698.25,$181.8316,$698.25,$698.25,$616.77,$501.6375,$129.,$676.2
,CDM,4143000166.10.4143,US BIOP MUSCLE PERCUTANOUS NDL,CDM Code,Outpatient,20206,"$4,044.",$335.,"$3,841.8","$3,235.2","$3,680.04","$1,060.4703","$3,841.8","$1,000.4452","$3,841.8","$3,841.8","$3,301.7754","$2,760.03",$335.,"$3,720.48"
,CDM,4143000167.10.4143,US FNA BX W/US GDN 1ST LES,CDM Code,Outpatient,10005,"$2,897.",$179.5,"$2,752.15","$2,317.6","$2,636.27",$759.689,"$2,752.15",$716.6888,"$2,752.15","$2,752.15","$1,546.8378","$1,977.2025",$179.5,"$2,665.24"
,CDM,4143000168.10.4143,US FNA BX W/US GDN EA ADDL,CDM Code,Outpatient,10006,"$1,159.",$85.5,"$1,101.05",$927.2,"$1,054.69",$303.928,"$1,101.05",$286.725,"$1,101.05","$1,101.05",$115.9,$791.0175,$85.5,"$1,066.28"
,CDM,4143000169.10.4143,ASPIR/INJ THYROID CYST,CDM Code,Outpatient,60300,"$2,897.",$716.6888,"$2,752.15","$2,317.6","$2,636.27",$759.689,"$2,752.15",$716.6888,"$2,752.15","$2,752.15","$1,439.4237","$1,977.2025","$2,549.36","$2,665.24"
,CDM,4143008020.10.4143,US CAROTID DOPPLER LIMITED,CDM Code,Outpatient,93882,$806.,$150.,$765.7,$644.8,$733.46,$211.3598,$765.7,$199.3963,$765.7,$765.7,$300.9891,$550.095,$150.,$741.52
,CDM,4149000001.10.4149,DEXA BONE DENSITY LIMITED,CDM Code,Outpatient,77081,$311.,$24.5,$295.45,$248.8,$283.01,$81.5545,$295.45,$76.9383,$295.45,$295.45,$159.8262,$212.2575,$24.5,$286.12
,CDM,4149000002.10.4149,DEXA BONE DENSITY COMPLETE,CDM Code,Outpatient,77080,$572.,$45.,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$300.9891,$390.39,$45.,$526.24
,CDM,4160000001.10.4160,NM BONE SCAN LTD,CDM Code,Outpatient,78300,"$1,747.",$294.,"$1,659.65","$1,397.6","$1,589.77",$458.1211,"$1,659.65",$432.1903,"$1,659.65","$1,659.65",$889.3236,"$1,192.3275",$294.,"$1,607.24"
,CDM,4160000002.10.4160,NM BONE SCAN MULT. AREA,CDM Code,Outpatient,78305,$0.,$0.,$889.3236,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$889.3236,$0.,$354.,$0.
,CDM,4160000003.10.4160,NM BONE SCAN THREE PHASE,CDM Code,Outpatient,78315,"$1,747.",$432.1903,"$1,659.65","$1,397.6","$1,589.77",$458.1211,"$1,659.65",$432.1903,"$1,659.65","$1,659.65",$889.3236,"$1,192.3275",$436.5,"$1,607.24"
,CDM,4160000004.10.4160,NM BONE SCAN TOTAL BODY,CDM Code,Outpatient,78306,"$1,747.",$384.5,"$1,659.65","$1,397.6","$1,589.77",$458.1211,"$1,659.65",$432.1903,"$1,659.65","$1,659.65",$889.3236,"$1,192.3275",$384.5,"$1,607.24"
,CDM,4160000005.10.4160,NM BONE SCAN SPECT,CDM Code,Outpatient,78803,"$2,265.",$428.5,"$2,151.75","$1,812.","$2,061.15",$593.9577,"$2,151.75",$560.3383,"$2,151.75","$2,151.75","$1,145.7771","$1,545.8625",$428.5,"$2,083.8"
,CDM,4160000010.10.4160,NM EJECTION FRACT MUGA,CDM Code,Outpatient,78472,"$1,747.",$267.,"$1,659.65","$1,397.6","$1,589.77",$458.1211,"$1,659.65",$432.1903,"$1,659.65","$1,659.65",$889.3236,"$1,192.3275",$267.,"$1,607.24"
,CDM,4160000011.10.4160,NM MYOCARDIAL PERFUSION SINGLE,CDM Code,Outpatient,78453,"$6,013.",$375.5,"$5,712.35","$4,810.4","$5,471.83","$1,576.807","$5,712.35","$1,487.5561","$5,712.35","$5,712.35","$3,040.9698","$4,103.8725",$375.5,"$5,531.96"
,CDM,4160000012.10.4160,NM MPS STRESS/REST,CDM Code,Outpatient,78452,"$6,013.",$582.5,"$5,712.35","$4,810.4","$5,471.83","$1,576.807","$5,712.35","$1,487.5561","$5,712.35","$5,712.35","$3,040.9698","$4,103.8725",$582.5,"$5,531.96"
,CDM,4160000014.10.4160,NM GASTRIC EMPTYING STUDY,CDM Code,Outpatient,78264,"$2,094.",$437.5,"$1,989.3","$1,675.2","$1,905.54",$549.1159,"$1,989.3",$518.0347,"$1,989.3","$1,989.3",$889.3236,"$1,429.155",$437.5,"$1,926.48"
,CDM,4160000015.10.4160,NM GI BLOOD IMAGING,CDM Code,Outpatient,78278,"$1,747.",$432.1903,"$1,659.65","$1,397.6","$1,589.77",$458.1211,"$1,659.65",$432.1903,"$1,659.65","$1,659.65",$889.3236,"$1,192.3275",$442.,"$1,607.24"
,CDM,4160000016.10.4160,NM GASTRIC EMPTY SMALL BOWEL,CDM Code,Outpatient,78265,"$1,747.",$432.1903,"$1,659.65","$1,397.6","$1,589.77",$458.1211,"$1,659.65",$432.1903,"$1,659.65","$1,659.65",$889.3236,"$1,192.3275",$516.,"$1,607.24"
,CDM,4160000020.10.4160,NM HEPATOBILIARY W/RX (HIDA),CDM Code,Outpatient,78227,"$2,265.",$560.3383,"$2,151.75","$1,812.","$2,061.15",$593.9577,"$2,151.75",$560.3383,"$2,151.75","$2,151.75","$1,145.7771","$1,545.8625",$594.5,"$2,083.8"
,CDM,4160000021.10.4160,NM HEPATOBILIARY W/O RX (HIDA),CDM Code,Outpatient,78226,"$1,747.",$432.1903,"$1,659.65","$1,397.6","$1,589.77",$458.1211,"$1,659.65",$432.1903,"$1,659.65","$1,659.65",$889.3236,"$1,192.3275",$433.5,"$1,607.24"
,CDM,4160000022.10.4160,NM MECKLES SCAN,CDM Code,Outpatient,78290,"$1,361.",$336.6978,"$1,292.95","$1,088.8","$1,238.51",$356.8991,"$1,292.95",$336.6978,"$1,292.95","$1,292.95",$889.3236,$928.8825,$438.,"$1,252.12"
,CDM,4160000023.10.4160,NM KIDNEY FLOW/FUNCT RX,CDM Code,Outpatient,78708,"$2,265.",$172.5,"$2,151.75","$1,812.","$2,061.15",$593.9577,"$2,151.75",$560.3383,"$2,151.75","$2,151.75","$1,145.7771","$1,545.8625",$172.5,"$2,083.8"
,CDM,4160000024.10.4160,NM KIDNEY FLOW/FUNCT W/O RX,CDM Code,Outpatient,78707,"$1,914.",$274.5,"$1,818.3","$1,531.2","$1,741.74",$501.914,"$1,818.3",$473.5045,"$1,818.3","$1,818.3","$1,145.7771","$1,306.305",$274.5,"$1,760.88"
,CDM,4160000030.10.4160,NM LIVER/SPLEEN SCAN,CDM Code,Outpatient,78215,"$1,223.",$250.5,"$1,161.85",$978.4,"$1,112.93",$320.711,"$1,161.85",$302.558,"$1,161.85","$1,161.85",$889.3236,$834.6975,$250.5,"$1,125.16"
,CDM,4160000033.10.4160,NM THYROID MULT,CDM Code,Outpatient,78014,"$1,747.",$319.,"$1,659.65","$1,397.6","$1,589.77",$458.1211,"$1,659.65",$432.1903,"$1,659.65","$1,659.65",$889.3236,"$1,192.3275",$319.,"$1,607.24"
,CDM,4160000034.10.4160,NM THYROID SCAN ONLY,CDM Code,Outpatient,78013,"$1,747.",$255.5,"$1,659.65","$1,397.6","$1,589.77",$458.1211,"$1,659.65",$432.1903,"$1,659.65","$1,659.65",$889.3236,"$1,192.3275",$255.5,"$1,607.24"
,CDM,4160000035.10.4160,NM THYROID UPTAKE MULT,CDM Code,Outpatient,78012,"$1,747.",$105.,"$1,659.65","$1,397.6","$1,589.77",$458.1211,"$1,659.65",$432.1903,"$1,659.65","$1,659.65",$889.3236,"$1,192.3275",$105.,"$1,607.24"
,CDM,4160000036.10.4160,NM TRACING ONLY W/O INTER,CDM Code,Outpatient,93017,"$1,244.",$48.5,"$1,181.8",$995.2,"$1,132.04",$326.2179,"$1,181.8",$307.7532,"$1,181.8","$1,181.8",$620.2677,$849.03,$48.5,"$1,144.48"
,CDM,4160000041.10.4160,NM LYMPH GLAND IMAGING,CDM Code,Outpatient,78195,"$2,265.",$438.5,"$2,151.75","$1,812.","$2,061.15",$593.9577,"$2,151.75",$560.3383,"$2,151.75","$2,151.75","$1,145.7771","$1,545.8625",$438.5,"$2,083.8"
,CDM,4160000042.10.4160,NM PULMONARY PERFUSION,CDM Code,Outpatient,78580,"$1,747.",$298.,"$1,659.65","$1,397.6","$1,589.77",$458.1211,"$1,659.65",$432.1903,"$1,659.65","$1,659.65",$889.3236,"$1,192.3275",$298.,"$1,607.24"
,CDM,4160000043.10.4160,NM PULM PERF/VENT-VQ SCAN,CDM Code,Outpatient,78582,"$2,265.",$415.,"$2,151.75","$1,812.","$2,061.15",$593.9577,"$2,151.75",$560.3383,"$2,151.75","$2,151.75","$1,145.7771","$1,545.8625",$415.,"$2,083.8"
,CDM,4160000045.10.4160,NM PARATHYROID SPECT,CDM Code,Outpatient,78070,"$1,747.",$384.5,"$1,659.65","$1,397.6","$1,589.77",$458.1211,"$1,659.65",$432.1903,"$1,659.65","$1,659.65",$889.3236,"$1,192.3275",$384.5,"$1,607.24"
,CDM,4160000046.10.4160,NM PARA W/SPECT,CDM Code,Outpatient,78071,"$1,900.",$440.5,"$1,805.","$1,520.","$1,729.",$498.2427,"$1,805.",$470.041,"$1,805.","$1,805.",$889.3236,"$1,296.75",$440.5,"$1,748."
,CDM,4160000050.10.4160,F/ TC99M MAA,CDM Code,Outpatient,A9540,$323.,$79.907,$306.85,$258.4,$293.93,$84.7013,$306.85,$79.907,$306.85,$306.85,$32.3,$220.4475,$0.,$297.16
,CDM,4160000055.10.4160,F/ TC99M TC04,CDM Code,Outpatient,A9512,$234.,$57.8893,$222.3,$187.2,$212.94,$61.3625,$222.3,$57.8893,$222.3,$222.3,$23.4,$159.705,$0.,$215.28
,CDM,4160000060.10.4160,F/ TC99M SULFUR COLLOID,CDM Code,Outpatient,A9541,$600.,$148.434,$570.,$480.,$546.,$157.3398,$570.,$148.434,$570.,$570.,$60.,$409.5,$528.,$552.
,CDM,4160000065.10.4160,F/ TC99M MDP,CDM Code,Outpatient,A9503,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.
,CDM,4160000070.10.4160,F/ TC99M DTPA,CDM Code,Outpatient,A9539,$530.,$131.1167,$503.5,$424.,$482.3,$138.9835,$503.5,$131.1167,$503.5,$503.5,$53.,$361.725,$0.,$487.6
,CDM,4160000080.10.4160,F/ TC99 SESTAMIBI,CDM Code,Outpatient,A9500,$611.,$151.1553,$580.45,$488.8,$556.01,$160.2244,$580.45,$151.1553,$580.45,$580.45,$61.1,$417.0075,$0.,$562.12
,CDM,4160000085.10.4160,F/ TC99 MAG 3,CDM Code,Outpatient,A9562,$867.,$214.4871,$823.65,$693.6,$788.97,$227.356,$823.65,$214.4871,$823.65,$823.65,$86.7,$591.7275,$0.,$797.64
,CDM,4160000090.10.4160,F/ TC99 MEBROFENIN,CDM Code,Outpatient,A9537,$238.,$58.8788,$226.1,$190.4,$216.58,$62.4115,$226.1,$58.8788,$226.1,$226.1,$23.8,$162.435,$0.,$218.96
,CDM,4160000095.10.4160,F/ TC99 FILTERED SULFER COLLOI,CDM Code,Outpatient,A9541,$600.,$148.434,$570.,$480.,$546.,$157.3398,$570.,$148.434,$570.,$570.,$60.,$409.5,$0.,$552.
,CDM,4160000105.10.4160,F/ I123 (Na),CDM Code,Outpatient,A9509,$171.,$42.3037,$162.45,$136.8,$155.61,$44.8418,$162.45,$42.3037,$162.45,$162.45,$17.1,$116.7075,$150.48,$157.32
,CDM,4160000110.10.4160,F/ COLD PYROPHOSPHATE,CDM Code,Outpatient,A9538,$241.,$59.621,$228.95,$192.8,$219.31,$63.1982,$228.95,$59.621,$228.95,$228.95,$24.1,$164.4825,$0.,$221.72
,CDM,4160000115.10.4160,PROFEE CARDIOVAS STRESS TEST,CDM Code,Professional,,$192.,$19.2,$182.4,$153.6,$174.72,$50.3487,$182.4,$47.4989,$182.4,$182.4,$19.2,$131.04,$168.96,$176.64
,CDM,4160000116.10.4160,STRESS TEST SUPERVISION,CDM Code,Professional,93016,$113.,$11.3,$103.96,$90.4,$28.55,$13.8754,$28.05,$13.09,$32.9174,$32.76,$11.3,$77.1225,$31.5,$103.96
,CDM,4160000117.10.4160,STRESS TEST INTERP AND REPORT,CDM Code,Professional,93018,$76.,$7.6,$69.92,$60.8,$19.09,$9.328,$18.72,$8.8,$21.945,$21.84,$7.6,$51.87,$21.,$69.92
,CDM,4160000125.10.4160,NM NONCARD VASC FLOW,CDM Code,Outpatient,78445,"$1,398.",$238.5,"$1,328.1","$1,118.4","$1,272.18",$366.6017,"$1,328.1",$345.8512,"$1,328.1","$1,328.1",$889.3236,$954.135,$238.5,"$1,286.16"
,CDM,4170000001.10.4170,ACETAMINOPHEN 100MG/ML SOLN,CDM Code,Outpatient,A9270,$6.,$1.4843,$5.7,$4.8,$5.46,$1.5734,$5.7,$1.4843,$5.7,$5.7,$0.6,$4.095,$5.28,$5.52
,CDM,4170000002.10.4170,ACETAMINOPHEN 120MG SUPP,CDM Code,Outpatient,A9270,$4.4286,$1.0956,$4.2072,$3.5429,$4.03,$1.1613,$4.2072,$1.0956,$4.2072,$4.2072,$0.4429,$3.0225,$3.8972,$4.0743
,CDM,4170000005.10.4170,ACETAMINOPHEN 325MG SUPP,CDM Code,Outpatient,A9270,$5.,$1.237,$4.75,$4.,$4.55,$1.3112,$4.75,$1.237,$4.75,$4.75,$0.5,$3.4125,$4.4,$4.6
,CDM,4170000008.10.4170,ACETAMINOPHEN 650MG SUPP,CDM Code,Outpatient,A9270,$5.,$1.237,$4.75,$4.,$4.55,$1.3112,$4.75,$1.237,$4.75,$4.75,$0.5,$3.4125,$4.4,$4.6
,CDM,4170000068.10.4170,ASPIRIN EC 325MG TAB,CDM Code,Outpatient,A9270,$5.,$1.237,$4.75,$4.,$4.55,$1.3112,$4.75,$1.237,$4.75,$4.75,$0.5,$3.4125,$4.4,$4.6
,CDM,4170000070.10.4170,ASPIRIN/DIPYRIDA 25 MG/200 MG,CDM Code,Outpatient,A9270,$42.,$10.3904,$39.9,$33.6,$38.22,$11.0138,$39.9,$10.3904,$39.9,$39.9,$4.2,$28.665,$36.96,$38.64
,CDM,4170000090.10.4170,BALANCED SALT OPHTHALMIC SOLN,CDM Code,Outpatient,A9270,$83.,$20.5334,$78.85,$66.4,$75.53,$21.7653,$78.85,$20.5334,$78.85,$78.85,$8.3,$56.6475,$73.04,$76.36
,CDM,4170000096.10.4170,BENZOCAINE 20% SPRAY,CDM Code,Outpatient,A9270,$130.,$32.1607,$123.5,$104.,$118.3,$34.0903,$123.5,$32.1607,$123.5,$123.5,$13.,$88.725,$114.4,$119.6
,CDM,4170000113.10.4170,BISACODYL 10MG SUPP,CDM Code,Outpatient,A9270,$5.,$1.237,$4.75,$4.,$4.55,$1.3112,$4.75,$1.237,$4.75,$4.75,$0.5,$3.4125,$4.4,$4.6
,CDM,4170000127.10.4170,BUDESONIDE 180MCG FLEXHALER,CDM Code,Outpatient,A9270,$671.,$165.9987,$637.45,$536.8,$610.61,$175.9583,$637.45,$165.9987,$637.45,$637.45,$67.1,$457.9575,$590.48,$617.32
,CDM,4170000128.10.4170,BUDESONIDE 32MCG NASAL SPRAY,CDM Code,Outpatient,A9270,$76.,$18.8016,$72.2,$60.8,$69.16,$19.9297,$72.2,$18.8016,$72.2,$72.2,$7.6,$51.87,$66.88,$69.92
,CDM,4170000149.10.4170,CADEXOMER IODINE 0.9% GEL,CDM Code,Outpatient,A9270,$181.,$44.7776,$171.95,$144.8,$164.71,$47.4642,$171.95,$44.7776,$171.95,$171.95,$18.1,$123.5325,$159.28,$166.52
,CDM,4170000150.10.4170,CALAMINE LOTION,CDM Code,Outpatient,A9270,$9.,$2.2265,$8.55,$7.2,$8.19,$2.3601,$8.55,$2.2265,$8.55,$8.55,$0.9,$6.1425,$7.92,$8.28
,CDM,4170000152.10.4170,CALCITONIN NASAL SPRAY,CDM Code,Outpatient,A9270,$101.,$24.9864,$95.95,$80.8,$91.91,$26.4855,$95.95,$24.9864,$95.95,$95.95,$10.1,$68.9325,$88.88,$92.92
,CDM,4170000156.10.4170,CALCIUM CARBONATE 1.25G/5ML,CDM Code,Outpatient,A9270,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.
,CDM,4170000206.10.4170,CETACAINE AEROSOL,CDM Code,Outpatient,A9270,$169.,$41.8089,$160.55,$135.2,$153.79,$44.3174,$160.55,$41.8089,$160.55,$160.55,$16.9,$115.3425,$148.72,$155.48
,CDM,4170000209.10.4170,CHARCOAL ACTIVATED 25 GM,CDM Code,Outpatient,A9270,$125.,$30.9237,$118.75,$100.,$113.75,$32.7791,$118.75,$30.9237,$118.75,$118.75,$12.5,$85.3125,$110.,$115.
,CDM,4170000210.10.4170,CHARCOAL/SORBITOL 50 GM,CDM Code,Outpatient,A9270,$76.,$18.8016,$72.2,$60.8,$69.16,$19.9297,$72.2,$18.8016,$72.2,$72.2,$7.6,$51.87,$66.88,$69.92
,CDM,4170000241.10.4170,CLONIDINE 0.1MG PATCH,CDM Code,Outpatient,A9270,$47.,$11.6273,$44.65,$37.6,$42.77,$12.325,$44.65,$11.6273,$44.65,$44.65,$4.7,$32.0775,$41.36,$43.24
,CDM,4170000315.10.4170,DIBUCAINE 1% OINT,CDM Code,Outpatient,A9270,$21.,$5.1952,$19.95,$16.8,$19.11,$5.5069,$19.95,$5.1952,$19.95,$19.95,$2.1,$14.3325,$18.48,$19.32
,CDM,4170000376.10.4170,EMOLLIENT CREAM,CDM Code,Outpatient,A9270,$15.,$3.7108,$14.25,$12.,$13.65,$3.9335,$14.25,$3.7108,$14.25,$14.25,$1.5,$10.2375,$13.2,$13.8
,CDM,4170000415.10.4170,ESTRADIOL 0.05MG PATCH,CDM Code,Outpatient,A9270,$43.,$10.6378,$40.85,$34.4,$39.13,$11.276,$40.85,$10.6378,$40.85,$40.85,$4.3,$29.3475,$37.84,$39.56
,CDM,4170000422.10.4170,ETHYL CHLORIDE AEROSOL,CDM Code,Outpatient,A9270,$115.,$28.4499,$109.25,$92.,$104.65,$30.1568,$109.25,$28.4499,$109.25,$109.25,$11.5,$78.4875,$101.2,$105.8
,CDM,4170000434.10.4170,FENTANYL 100MCG/HR PATCH,CDM Code,Outpatient,A9270,$138.6667,$34.3048,$131.7334,$110.9334,$126.1867,$36.363,$131.7334,$34.3048,$131.7334,$131.7334,$13.8667,$94.64,$122.0267,$127.5734
,CDM,4170000435.10.4170,FENTANYL 12MCG/HR PATCH,CDM Code,Outpatient,A9270,$51.,$12.6169,$48.45,$40.8,$46.41,$13.3739,$48.45,$12.6169,$48.45,$48.45,$5.1,$34.8075,$44.88,$46.92
,CDM,4170000436.10.4170,FENTANYL 25MCG/HR PATCH,CDM Code,Outpatient,A9270,$25.,$6.1848,$23.75,$20.,$22.75,$6.5558,$23.75,$6.1848,$23.75,$23.75,$2.5,$17.0625,$22.,$23.
,CDM,4170000438.10.4170,FENTANYL 50MCG/HR PATCH,CDM Code,Outpatient,A9270,$71.,$17.5647,$67.45,$56.8,$64.61,$18.6185,$67.45,$17.5647,$67.45,$67.45,$7.1,$48.4575,$62.48,$65.32
,CDM,4170000445.10.4170,FERROUS SULFATE 300MG/5ML LIQ,CDM Code,Outpatient,A9270,$11.,$2.7213,$10.45,$8.8,$10.01,$2.8846,$10.45,$2.7213,$10.45,$10.45,$1.1,$7.5075,$9.68,$10.12
,CDM,4170000463.10.4170,FLUTICASONE HFA 110MCG INH,CDM Code,Outpatient,A9270,$581.,$143.7336,$551.95,$464.8,$528.71,$152.3574,$551.95,$143.7336,$551.95,$551.95,$58.1,$396.5325,$511.28,$534.52
,CDM,4170000464.10.4170,FLUTICASONE HFA 44 MCG INH,CDM Code,Outpatient,A9270,$589.,$145.7127,$559.55,$471.2,$535.99,$154.4552,$559.55,$145.7127,$559.55,$559.55,$58.9,$401.9925,$518.32,$541.88
,CDM,4170000465.10.4170,FLUTICASONE PROPIONATE NASAL,CDM Code,Outpatient,A9270,$21.,$5.1952,$19.95,$16.8,$19.11,$5.5069,$19.95,$5.1952,$19.95,$19.95,$2.1,$14.3325,$18.48,$19.32
,CDM,4170000466.10.4170,FLUTICASONE/SALMETEROL 250/50,CDM Code,Outpatient,A9270,$365.,$90.2973,$346.75,$292.,$332.15,$95.715,$346.75,$90.2973,$346.75,$346.75,$36.5,$249.1125,$321.2,$335.8
,CDM,4170000479.10.4170,FUROSEMIDE 40MG/4ML SOLN,CDM Code,Outpatient,A9270,$9.,$2.2265,$8.55,$7.2,$8.19,$2.3601,$8.55,$2.2265,$8.55,$8.55,$0.9,$6.1425,$7.92,$8.28
,CDM,4170000489.10.4170,GENTAMICIN 0.3% OPHTH OINT,CDM Code,Outpatient,A9270,$113.,$27.9551,$107.35,$90.4,$102.83,$29.6323,$107.35,$27.9551,$107.35,$107.35,$11.3,$77.1225,$99.44,$103.96
,CDM,4170000493.10.4170,GENTAMICIN 0.3% OPHTH DROPS,CDM Code,Outpatient,A9270,$26.,$6.4321,$24.7,$20.8,$23.66,$6.8181,$24.7,$6.4321,$24.7,$24.7,$2.6,$17.745,$22.88,$23.92
,CDM,4170000500.10.4170,GLYCERIN ADULT SUPP,CDM Code,Outpatient,A9270,$5.,$1.237,$4.75,$4.,$4.55,$1.3112,$4.75,$1.237,$4.75,$4.75,$0.5,$3.4125,$4.4,$4.6
,CDM,4170000501.10.4170,GLYCERIN INFANT SUPP,CDM Code,Outpatient,A9270,$5.,$1.237,$4.75,$4.,$4.55,$1.3112,$4.75,$1.237,$4.75,$4.75,$0.5,$3.4125,$4.4,$4.6
,CDM,4170000507.10.4170,GUAIFENESIN W/CODEINE SYRP,CDM Code,Outpatient,A9270,$16.,$3.9582,$15.2,$12.8,$14.56,$4.1957,$15.2,$3.9582,$15.2,$15.2,$1.6,$10.92,$14.08,$14.72
,CDM,4170000538.10.4170,HYDROCORTISONE 1% CREAM,CDM Code,Outpatient,A9270,$7.,$1.7317,$6.65,$5.6,$6.37,$1.8356,$6.65,$1.7317,$6.65,$6.65,$0.7,$4.7775,$6.16,$6.44
,CDM,4170000557.10.4170,IBUPROFEN 100MG/5ML SUSP,CDM Code,Outpatient,A9270,$48.,$11.8747,$45.6,$38.4,$43.68,$12.5872,$45.6,$11.8747,$45.6,$45.6,$4.8,$32.76,$42.24,$44.16
,CDM,4170000559.10.4170,IBUPROFEN 100MG/5ML SUSP,CDM Code,Outpatient,A9270,$8.7547,$2.1658,$8.317,$7.0038,$7.9668,$2.2958,$8.317,$2.1658,$8.317,$8.317,$0.8755,$5.9751,$7.7041,$8.0543
,CDM,4170000577.10.4170,INSULIN ASPART 100U/ML INJ,CDM Code,Outpatient,A9270,$19.,$4.7004,$18.05,$15.2,$17.29,$4.9824,$18.05,$4.7004,$18.05,$18.05,$1.9,$12.9675,$16.72,$17.48
,CDM,4170000578.10.4170,INSULIN ASPART 300U/3ML PEN,CDM Code,Outpatient,A9270,$45.,$11.1326,$42.75,$36.,$40.95,$11.8005,$42.75,$11.1326,$42.75,$42.75,$4.5,$30.7125,$39.6,$41.4
,CDM,4170000620.10.4170,LACTULOSE 10G/15ML SOLN,CDM Code,Outpatient,A9270,$8.9474,$2.2135,$8.5,$7.1579,$8.1421,$2.3463,$8.5,$2.2135,$8.5,$8.5,$0.8947,$6.1066,$7.8737,$8.2316
,CDM,4170000637.10.4170,LEVOBUNOLOL 0.5% OPHTH,CDM Code,Outpatient,A9270,$28.,$6.9269,$26.6,$22.4,$25.48,$7.3425,$26.6,$6.9269,$26.6,$26.6,$2.8,$19.11,$24.64,$25.76
,CDM,4170000638.10.4170,LEVOFLOXACIN 0.5% OPHTH,CDM Code,Outpatient,A9270,$111.,$27.4603,$105.45,$88.8,$101.01,$29.1079,$105.45,$27.4603,$105.45,$105.45,$11.1,$75.7575,$97.68,$102.12
,CDM,4170000652.10.4170,LIDOCAINE  2% JELLY,CDM Code,Outpatient,A9270,$67.,$16.5751,$63.65,$53.6,$60.97,$17.5696,$63.65,$16.5751,$63.65,$63.65,$6.7,$45.7275,$58.96,$61.64
,CDM,4170000669.10.4170,LIDOCAINE 5% OINT,CDM Code,Outpatient,A9270,$36.,$8.906,$34.2,$28.8,$32.76,$9.4404,$34.2,$8.906,$34.2,$34.2,$3.6,$24.57,$31.68,$33.12
,CDM,4170000670.10.4170,LIDOCAINE 5% PATCH,CDM Code,Outpatient,A9270,$15.4286,$3.8169,$14.6572,$12.3429,$14.04,$4.0459,$14.6572,$3.8169,$14.6572,$14.6572,$1.5429,$10.53,$13.5772,$14.1943
,CDM,4170000688.10.4170,LORAZEPAM 2MG/ML SOLN,CDM Code,Outpatient,A9270,$15.,$3.7108,$14.25,$12.,$13.65,$3.9335,$14.25,$3.7108,$14.25,$14.25,$1.5,$10.2375,$13.2,$13.8
,CDM,4170000695.10.4170,MAGNESIUM CHLORIDE 64MG TAB,CDM Code,Outpatient,A9270,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.
,CDM,4170000696.10.4170,MAGNESIUM CITRATE SOLN,CDM Code,Outpatient,A9270,$6.,$1.4843,$5.7,$4.8,$5.46,$1.5734,$5.7,$1.4843,$5.7,$5.7,$0.6,$4.095,$5.28,$5.52
,CDM,4170000748.10.4170,MICONAZOLE 2% OINT,CDM Code,Outpatient,A9270,$39.,$9.6482,$37.05,$31.2,$35.49,$10.2271,$37.05,$9.6482,$37.05,$37.05,$3.9,$26.6175,$34.32,$35.88
,CDM,4170000749.10.4170,MICONAZOLE 2% VAGINAL CREAM,CDM Code,Outpatient,A9270,$20.,$4.9478,$19.,$16.,$18.2,$5.2447,$19.,$4.9478,$19.,$19.,$2.,$13.65,$17.6,$18.4
,CDM,4170000750.10.4170,MICONAZOLE 200MG VAG SUPP,CDM Code,Outpatient,A9270,$52.,$12.8643,$49.4,$41.6,$47.32,$13.6361,$49.4,$12.8643,$49.4,$49.4,$5.2,$35.49,$45.76,$47.84
,CDM,4170000754.10.4170,MIDAZOLAM 2MG/ML SYRP,CDM Code,Outpatient,A9270,$35.8,$8.8566,$34.01,$28.64,$32.578,$9.3879,$34.01,$8.8566,$34.01,$34.01,$3.58,$24.4335,$31.504,$32.936
,CDM,4170000756.10.4170,MINERAL OIL 100% 30ML,CDM Code,Outpatient,A9270,$5.,$1.237,$4.75,$4.,$4.55,$1.3112,$4.75,$1.237,$4.75,$4.75,$0.5,$3.4125,$4.4,$4.6
,CDM,4170000757.10.4170,MINERAL OIL HEAVY 100% OIL,CDM Code,Outpatient,A9270,$0.0338,$0.0084,$0.0321,$0.027,$0.0308,$0.0089,$0.0321,$0.0084,$0.0321,$0.0321,$0.0034,$0.0231,$0.0297,$0.0311
,CDM,4170000759.10.4170,MINERAL OIL/PETROLAT OPHTH,CDM Code,Outpatient,A9270,$25.,$6.1848,$23.75,$20.,$22.75,$6.5558,$23.75,$6.1848,$23.75,$23.75,$2.5,$17.0625,$22.,$23.
,CDM,4170000895.10.4170,PILOCARPINE 2% OPHTH DROP,CDM Code,Outpatient,A9270,$395.,$97.719,$375.25,$316.,$359.45,$103.582,$375.25,$97.719,$375.25,$375.25,$39.5,$269.5875,$347.6,$363.4
,CDM,4170001147.10.4170,BARIUM SULFATE 450ML SUSPEN,CDM Code,Outpatient,A9270,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.
,CDM,4170001150.10.4170,BARIUM SULFATE 176GM SUSPENSIO,CDM Code,Outpatient,A9270,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.
,CDM,4170001158.10.4170,BARIUM SULFATE 397GM ENEMA,CDM Code,Outpatient,A9270,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.
,CDM,4170001160.10.4170,MAGIC MOUTHWASH,CDM Code,Outpatient,A9270,$28.,$6.9269,$26.6,$22.4,$25.48,$7.3425,$26.6,$6.9269,$26.6,$26.6,$2.8,$19.11,$24.64,$25.76
,CDM,4170001161.10.4170,GI COCKTAIL,CDM Code,Outpatient,A9270,$28.,$6.9269,$26.6,$22.4,$25.48,$7.3425,$26.6,$6.9269,$26.6,$26.6,$2.8,$19.11,$24.64,$25.76
,CDM,4170001163.10.4170,BACITRACIN ZINC OINTMENT,CDM Code,Outpatient,A9270,$7.,$1.7317,$6.65,$5.6,$6.37,$1.8356,$6.65,$1.7317,$6.65,$6.65,$0.7,$4.7775,$6.16,$6.44
,CDM,4170001167.10.4170,LIDO GARGLE 30ML,CDM Code,Outpatient,A9270,$34.,$8.4113,$32.3,$27.2,$30.94,$8.9159,$32.3,$8.4113,$32.3,$32.3,$3.4,$23.205,$29.92,$31.28
,CDM,4170001168.10.4170,LIDOCAINE LARYNGO-JET 4%,CDM Code,Outpatient,A9270,$21.,$5.1952,$19.95,$16.8,$19.11,$5.5069,$19.95,$5.1952,$19.95,$19.95,$2.1,$14.3325,$18.48,$19.32
,CDM,4170001175.10.4170,MAGNESIUM HYDROXIDE 30ML UDC,CDM Code,Outpatient,A9270,$8.,$1.9791,$7.6,$6.4,$7.28,$2.0979,$7.6,$1.9791,$7.6,$7.6,$0.8,$5.46,$7.04,$7.36
,CDM,4170001181.10.4170,LOPERAMIDE 2MG/10ML SOLUTION,CDM Code,Outpatient,A9270,$14.,$3.4635,$13.3,$11.2,$12.74,$3.6713,$13.3,$3.4635,$13.3,$13.3,$1.4,$9.555,$12.32,$12.88
,CDM,4170001182.10.4170,LIDOCAINE/PRILOCAINE 2.5 CREAM,CDM Code,Outpatient,A9270,$84.,$20.7808,$79.8,$67.2,$76.44,$22.0276,$79.8,$20.7808,$79.8,$79.8,$8.4,$57.33,$73.92,$77.28
,CDM,4170001228.10.4170,BARIUM SULFATE 135ML SUSP,CDM Code,Outpatient,A9270,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.
,CDM,4170001230.10.4170,MEDIHONEY 44ML GEL,CDM Code,Outpatient,A9270,$52.,$12.8643,$49.4,$41.6,$47.32,$13.6361,$49.4,$12.8643,$49.4,$49.4,$5.2,$35.49,$45.76,$47.84
,CDM,4170001235.10.4170,LUGOLS STRONG IODINE,CDM Code,Outpatient,A9270,$150.,$37.1085,$142.5,$120.,$136.5,$39.3349,$142.5,$37.1085,$142.5,$142.5,$15.,$102.375,$132.,$138.
,CDM,4170001251.10.4170,ANASTROZOLE 1 MG TAB,CDM Code,Outpatient,A9270,$11.,$2.7213,$10.45,$8.8,$10.01,$2.8846,$10.45,$2.7213,$10.45,$10.45,$1.1,$7.5075,$9.68,$10.12
,CDM,4170001254.10.4170,ENTACAPONE 200MG TAB,CDM Code,Outpatient,A9270,$16.,$3.9582,$15.2,$12.8,$14.56,$4.1957,$15.2,$3.9582,$15.2,$15.2,$1.6,$10.92,$14.08,$14.72
,CDM,4170001275.10.4170,ASCORBIC ACID CHEW 500MG TABLE,CDM Code,Outpatient,A9270,$9.,$2.2265,$8.55,$7.2,$8.19,$2.3601,$8.55,$2.2265,$8.55,$8.55,$0.9,$6.1425,$7.92,$8.28
,CDM,4170001288.10.4170,MITOMYCIN 40 MG INJECTION,CDM Code,Outpatient,J9280,"$2,002.",$495.2748,"$1,901.9","$1,601.6","$1,821.82",$524.9905,"$1,901.9",$495.2748,"$1,901.9","$1,901.9",$356.8455,"$1,366.365","$1,761.76","$1,841.84"
,CDM,4170001306.10.4170,DECITABINE 50MG INJECTION,CDM Code,Outpatient,J0894,"$5,215.","$1,290.1388","$4,954.25","$4,172.","$4,745.65","$1,367.5451","$4,954.25","$1,290.1388","$4,954.25","$4,954.25",$47.259,"$3,559.2375","$4,589.2","$4,797.8"
,CDM,4170001310.10.4170,IPRATROPIUM/ALBUTEROL INHALER,CDM Code,Outpatient,A9270,$793.,$196.1803,$753.35,$634.4,$721.63,$207.9508,$753.35,$196.1803,$753.35,$753.35,$79.3,$541.2225,$697.84,$729.56
,CDM,4170001376.10.4170,LANSOPRAZOLE 15MG CAPSULE,CDM Code,Outpatient,A9270,$8.5,$2.1028,$8.075,$6.8,$7.735,$2.229,$8.075,$2.1028,$8.075,$8.075,$0.85,$5.8012,$7.48,$7.82
,CDM,4170001377.10.4170,DOXORUBICIN 20MG/10ML INJECT,CDM Code,Outpatient,J9000,$100.6667,$24.9039,$95.6334,$80.5334,$91.6067,$26.3981,$95.6334,$24.9039,$95.6334,$95.6334,$4.9609,$68.705,$88.5867,$92.6134
,CDM,4170001404.10.4170,MINERAL OIL ENEMA 133ML BOTTLE,CDM Code,Outpatient,A9270,$9.,$2.2265,$8.55,$7.2,$8.19,$2.3601,$8.55,$2.2265,$8.55,$8.55,$0.9,$6.1425,$7.92,$8.28
,CDM,4170001405.10.4170,SALINE ENEMA 133ML BOTTLE,CDM Code,Outpatient,A9270,$7.,$1.7317,$6.65,$5.6,$6.37,$1.8356,$6.65,$1.7317,$6.65,$6.65,$0.7,$4.7775,$6.16,$6.44
,CDM,4170001406.10.4170,WITCH HAZEL PADS,CDM Code,Outpatient,A9270,$10.,$2.4739,$9.5,$8.,$9.1,$2.6223,$9.5,$2.4739,$9.5,$9.5,$1.,$6.825,$8.8,$9.2
,CDM,4170001407.10.4170,SOAP SUDS ENEMA,CDM Code,Outpatient,A9270,$6.,$1.4843,$5.7,$4.8,$5.46,$1.5734,$5.7,$1.4843,$5.7,$5.7,$0.6,$4.095,$5.28,$5.52
,CDM,4170001460.10.4170,HYDROCORTISONE 1% OINTMENT 28G,CDM Code,Outpatient,A9270,$7.,$1.7317,$6.65,$5.6,$6.37,$1.8356,$6.65,$1.7317,$6.65,$6.65,$0.7,$4.7775,$6.16,$6.44
,CDM,4170001468.10.4170,LIOTHYRONINE 25MCG TABLET,CDM Code,Outpatient,A9270,$9.,$2.2265,$8.55,$7.2,$8.19,$2.3601,$8.55,$2.2265,$8.55,$8.55,$0.9,$6.1425,$7.92,$8.28
,CDM,4170001469.10.4170,LIOTHYRONINE 5MCG TABLET,CDM Code,Outpatient,A9270,$9.,$2.2265,$8.55,$7.2,$8.19,$2.3601,$8.55,$2.2265,$8.55,$8.55,$0.9,$6.1425,$7.92,$8.28
,CDM,4170001497.10.4170,FLU VACCINE-PF 15-16 SYRINGE,CDM Code,Outpatient,90661,$41.,$10.143,$38.95,$32.8,$37.31,$10.7516,$38.95,$10.143,$38.95,$38.95,$4.1,$27.9825,$36.08,$37.72
,CDM,4170001503.10.4170,FLU VACC QS 15-16 60MCG/0.5ML,CDM Code,Outpatient,90688,$59.,$14.596,$56.05,$47.2,$53.69,$15.4717,$56.05,$14.596,$56.05,$56.05,$23.7272,$40.2675,$51.92,$54.28
,CDM,4170001506.10.4170,FLU VACC QS 15-16 60MCG/0.5ML,CDM Code,Outpatient,90686,$64.,$15.833,$60.8,$51.2,$58.24,$16.7829,$60.8,$15.833,$60.8,$60.8,$25.3099,$43.68,$56.32,$58.88
,CDM,4170001515.10.4170,PNEUMOCOCCAL VACCINE -13 0.5ML,CDM Code,Outpatient,90670,"$1,167.",$288.7041,"$1,108.65",$933.6,"$1,061.97",$306.0259,"$1,108.65",$288.7041,"$1,108.65","$1,108.65",$286.3889,$796.4775,"$1,026.96","$1,073.64"
,CDM,4170001552.10.4170,FLU VACC 16-17 60MCG/0.5ML SYR,CDM Code,Outpatient,90686,$72.,$17.8121,$68.4,$57.6,$65.52,$18.8808,$68.4,$17.8121,$68.4,$68.4,$25.3099,$49.14,$63.36,$66.24
,CDM,4170001731.10.4141,PHYTONADIONE 1 MG/0.5 ML AMP,CDM Code,Outpatient,J3430,$45.,$11.1326,$42.75,$36.,$40.95,$11.8005,$42.75,$11.1326,$42.75,$42.75,$5.6924,$30.7125,$39.6,$41.4
,CDM,4180000003.10.4180,"AEROSOL, CONT MONIT 1ST HR",CDM Code,Outpatient,94644,$126.,$31.1711,$267.0534,$100.8,$114.66,$33.0414,$119.7,$31.1711,$119.7,$119.7,$267.0534,$85.995,$64.,$115.92
,CDM,4180000006.10.4180,CONT AEROSOL EACH ADDNL HOUR,CDM Code,Outpatient,94645,$32.,$7.9165,$30.4,$25.6,$29.12,$8.3915,$30.4,$7.9165,$30.4,$30.4,$3.2,$21.84,$23.,$29.44
,CDM,4180000016.10.4180,PULM FUNC TEST A&P BRONCHODILA,CDM Code,Outpatient,94060,$347.,$67.5,$620.2677,$277.6,$315.77,$90.9949,$329.65,$85.8443,$329.65,$329.65,$620.2677,$236.8275,$67.5,$319.24
,CDM,4180000017.10.4180,1ST TX OF DAY VIA NEB/MDI OR I,CDM Code,Outpatient,94640,$112.,$26.5,$432.7536,$89.6,$101.92,$29.3701,$106.4,$27.7077,$106.4,$106.4,$432.7536,$76.44,$26.5,$103.04
,CDM,4180000018.10.4180,SUBSEQ TX VIA NEB/MDI OR IPPB,CDM Code,Outpatient,9464076,$108.,$26.5,$432.7536,$86.4,$98.28,$28.3212,$102.6,$26.7181,$102.6,$102.6,$432.7536,$73.71,$26.5,$99.36
,CDM,4180000019.10.4180,TEACHING ONLY NEB/MDI OR IPPB,CDM Code,Outpatient,94664,$0.,$0.,$432.7536,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$432.7536,$0.,$24.5,$0.
,CDM,4180000200.10.4180,VENTILATOR FIRST DAY,CDM Code,Outpatient,94002,$939.,$131.5,"$1,131.9465",$751.2,$854.49,$246.2368,$892.05,$232.2992,$892.05,$892.05,"$1,131.9465",$640.8675,$131.5,$863.88
,CDM,4180000205.10.4180,PFT W/ NITROGEN WASHOUT,CDM Code,Outpatient,94727,$150.,$37.1085,$339.357,$120.,$136.5,$39.3349,$142.5,$37.1085,$142.5,$142.5,$339.357,$102.375,$45.,$138.
,CDM,4180000206.10.4180,CO/MEMBRANE DIFFUSE CAPACITY,CDM Code,Outpatient,94729,$157.,$38.8402,$149.15,$125.6,$142.87,$41.1706,$149.15,$38.8402,$149.15,$149.15,$15.7,$107.1525,$64.5,$144.44
,CDM,4180000507.10.4180,EXPIRED CO2 W/INFRARED ANALYZE,CDM Code,Professional,94770,$0.,$0.,$232.31,$0.,$9.45,$4.558,$9.34,$4.3,$0.,$0.,$232.31,$0.,$10.5,$0.
,CDM,4180000900.10.4180,VENTILATOR SUBSEQUENT DAY,CDM Code,Outpatient,94003,$576.,$95.,"$1,131.9465",$460.8,$524.16,$151.0462,$547.2,$142.4966,$547.2,$547.2,"$1,131.9465",$393.12,$95.,$529.92
,CDM,4180001104.10.4180,ARTERIAL BLOOD GAS PUNCTURE,CDM Code,Outpatient,36600,$111.,$27.4603,$145.6485,$88.8,$101.01,$29.1079,$105.45,$27.4603,$105.45,$105.45,$145.6485,$75.7575,$46.5,$102.12
,CDM,4180001400.10.4180,PULSE OXY MULTIPLE(EG EXERCISE,CDM Code,Outpatient,94761,$108.,$6.5,$102.6,$86.4,$98.28,$28.3212,$102.6,$26.7181,$102.6,$102.6,$10.8,$73.71,$6.5,$99.36
,CDM,4180001403.10.4180,RHYTHM ECG 1-3 LEADS TRACING O,CDM Code,Outpatient,93041,$66.,$8.,$145.6485,$52.8,$60.06,$17.3074,$62.7,$16.3277,$62.7,$62.7,$145.6485,$45.045,$8.,$60.72
,CDM,4180002750.10.4180,CPT INITIAL,CDM Code,Outpatient,94667,$75.,$18.5542,$267.0534,$60.,$68.25,$19.6675,$71.25,$18.5542,$71.25,$71.25,$267.0534,$51.1875,$38.,$69.
,CDM,4180002751.10.4180,PFT BASELINE,CDM Code,Outpatient,94010,$265.,$39.,$339.357,$212.,$241.15,$69.4917,$251.75,$65.5584,$251.75,$251.75,$339.357,$180.8625,$39.,$243.8
,CDM,4180002805.10.4180,PEAK FLOW RATE,CDM Code,Outpatient,94150,$95.,$23.5021,$339.357,$76.,$86.45,$24.9121,$90.25,$23.5021,$90.25,$90.25,$339.357,$64.8375,$31.,$87.4
,CDM,4180002945.10.4180,CPAP/BIPAP,CDM Code,Outpatient,94660,$569.,$92.,$540.55,$455.2,$517.79,$149.2106,$540.55,$140.7649,$540.55,$540.55,$432.7536,$388.3425,$92.,$523.48
,CDM,4180002952.10.4180,CPT SUB,CDM Code,Outpatient,94668,$75.,$18.5542,$145.6485,$60.,$68.25,$19.6675,$71.25,$18.5542,$71.25,$71.25,$145.6485,$51.1875,$45.5,$69.
,CDM,4180002959.10.4180,CPR,CDM Code,Outpatient,92950,$812.,$200.8807,$771.4,$649.6,$738.92,$212.9332,$771.4,$200.8807,$771.4,$771.4,$620.2677,$554.19,$432.,$747.04
,CDM,4180002962.10.4180,NOCTURNAL OXYGEN SAT STUDY,CDM Code,Outpatient,94761,$142.,$6.5,$134.9,$113.6,$129.22,$37.2371,$134.9,$35.1294,$134.9,$134.9,$14.2,$96.915,$6.5,$130.64
,CDM,4180002964.10.4180,SMOKING CESSATION SHORT,CDM Code,Outpatient,99406,$0.,$0.,$67.3641,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$67.3641,$0.,$20.5,$0.
,CDM,4180004375.10.4180,FLOW VOLUME LOOF/FVC,CDM Code,Outpatient,94375,$119.,$29.4394,$620.2677,$95.2,$108.29,$31.2057,$113.05,$29.4394,$113.05,$113.05,$620.2677,$81.2175,$35.5,$109.48
,CDM,4200000100.10.4200,PT EVAL LOW COMPLEX 20 MIN,CDM Code,Outpatient,97161GP,$344.,$82.11,$326.8,$275.2,$313.04,$90.2082,$326.8,$85.1022,$326.8,$326.8,$220.3818,$234.78,$82.11,$316.48
,CDM,4200000101.10.4200,PT EVAL MOD COMPLEX 30 MIN,CDM Code,Outpatient,97162GP,$350.,$82.11,$332.5,$280.,$318.5,$91.7815,$332.5,$86.5865,$332.5,$332.5,$220.3818,$238.875,$82.11,$322.
,CDM,4200000102.10.4200,PT EVAL HIGH COMPLEX 45 MIN,CDM Code,Outpatient,97163GP,$360.,$82.11,$342.,$288.,$327.6,$94.4039,$342.,$89.0604,$342.,$342.,$220.3818,$245.7,$82.11,$331.2
,CDM,4200000103.10.4200,PT RE-EVAL EST PLAN CARE,CDM Code,Outpatient,97164GP,$233.,$55.55,$221.35,$186.4,$212.03,$61.1003,$221.35,$57.6419,$221.35,$221.35,$148.5321,$159.0225,$55.55,$214.36
,CDM,4200005001.10.4200,PT RE-EVALUATION 97002,CDM Code,Outpatient,97002,$364.,$90.05,$345.8,$291.2,$331.24,$95.4528,$345.8,$90.05,$345.8,$345.8,$36.4,$248.43,$320.32,$334.88
,CDM,4200005001.30.4200,PT RE-EVALUATION 97002,CDM Code,Outpatient,97002,$364.,$90.05,$345.8,$291.2,$331.24,$95.4528,$345.8,$90.05,$345.8,$345.8,$36.4,$248.43,$320.32,$334.88
,CDM,4200005002.10.4200,CANALITH REPOSITIONING,CDM Code,Outpatient,95992GP,$177.,$43.788,$168.15,$141.6,$161.07,$46.4152,$168.15,$43.788,$168.15,$168.15,$101.5668,$120.8025,$61.5,$162.84
,CDM,4200005003.10.4200,"TRACTION,MECHANICAL 97012",CDM Code,Outpatient,97012GP,$61.,$14.49,$57.95,$48.8,$55.51,$15.9962,$57.95,$15.0908,$57.95,$57.95,$44.0817,$41.6325,$14.49,$56.12
,CDM,4200005003.30.4200,"TRACTION,MECHANICAL 97012",CDM Code,Outpatient,97012,$61.,$14.49,$57.95,$48.8,$55.51,$15.9962,$57.95,$15.0908,$57.95,$57.95,$44.0817,$41.6325,$14.49,$56.12
,CDM,4200005004.10.4200,ELECTRICAL STIMULATION G0283,CDM Code,Outpatient,97014GP,$61.,$15.0908,$57.95,$48.8,$55.51,$15.9962,$57.95,$15.0908,$57.95,$57.95,$6.1,$41.6325,$15.18,$56.12
,CDM,4200005004.30.4200,ELECTRICAL STIMULATION G0283,CDM Code,Outpatient,97014,$61.,$15.0908,$57.95,$48.8,$55.51,$15.9962,$57.95,$15.0908,$57.95,$57.95,$6.1,$41.6325,$15.18,$56.12
,CDM,4200005009.10.4200,ELECT STIMULATION MANUAL 97032,CDM Code,Outpatient,97032GP,$64.,$15.18,$60.8,$51.2,$58.24,$16.7829,$60.8,$15.833,$60.8,$60.8,$51.7446,$43.68,$15.18,$58.88
,CDM,4200005009.30.4200,ELECT STIMULATION MANUAL 97032,CDM Code,Outpatient,97032,$64.,$15.18,$60.8,$51.2,$58.24,$16.7829,$60.8,$15.833,$60.8,$60.8,$51.7446,$43.68,$15.18,$58.88
,CDM,4200005010.10.4200,CONTRAST BATH 97034,CDM Code,Outpatient,97034GP,$143.,$14.84,$135.85,$114.4,$130.13,$37.4993,$135.85,$35.3768,$135.85,$135.85,$48.861,$97.5975,$14.84,$131.56
,CDM,4200005011.10.4200,ULTRASOUND 97035,CDM Code,Outpatient,97035GP,$55.,$13.11,$52.25,$44.,$50.05,$14.4228,$52.25,$13.6065,$52.25,$52.25,$34.4964,$37.5375,$13.11,$50.6
,CDM,4200005011.30.4200,ULTRASOUND 97035,CDM Code,Outpatient,97035,$55.,$13.11,$52.25,$44.,$50.05,$14.4228,$52.25,$13.6065,$52.25,$52.25,$34.4964,$37.5375,$13.11,$50.6
,CDM,4200005013.10.4200,THERAPEUTIC EXERCISES 97110,CDM Code,Outpatient,97110GP,$126.,$30.02,$119.7,$100.8,$114.66,$33.0414,$119.7,$31.1711,$119.7,$119.7,$88.1634,$85.995,$30.02,$115.92
,CDM,4200005013.30.4200,THERAPEUTIC EXERCISES 97110,CDM Code,Outpatient,97110,$126.,$30.02,$119.7,$100.8,$114.66,$33.0414,$119.7,$31.1711,$119.7,$119.7,$88.1634,$85.995,$30.02,$115.92
,CDM,4200005014.10.4200,NEUROMUSCULAR REEDUCATION 9711,CDM Code,Outpatient,97112GP,$143.,$34.16,$135.85,$114.4,$130.13,$37.4993,$135.85,$35.3768,$135.85,$135.85,$91.9815,$97.5975,$34.16,$131.56
,CDM,4200005014.30.4200,NEUROMUSCULAR REEDUCATION 9711,CDM Code,Outpatient,97112,$143.,$34.16,$135.85,$114.4,$130.13,$37.4993,$135.85,$35.3768,$135.85,$135.85,$91.9815,$97.5975,$34.16,$131.56
,CDM,4200005015.10.4200,AQUATIC THERAPY 97113,CDM Code,Outpatient,97113GP,$161.,$38.3,$152.95,$128.8,$146.51,$42.2195,$152.95,$39.8298,$152.95,$152.95,$116.8926,$109.8825,$38.3,$148.12
,CDM,4200005015.30.4200,AQUATIC THERAPY 97113,CDM Code,Outpatient,97113,$161.,$38.3,$152.95,$128.8,$146.51,$42.2195,$152.95,$39.8298,$152.95,$152.95,$116.8926,$109.8825,$38.3,$148.12
,CDM,4200005016.10.4200,GAIT TRAINING 97116,CDM Code,Outpatient,97116GP,$124.,$29.67,$117.8,$99.2,$112.84,$32.5169,$117.8,$30.6764,$117.8,$117.8,$76.6557,$84.63,$29.67,$114.08
,CDM,4200005016.30.4200,GAIT TRAINING 97116,CDM Code,Outpatient,97116,$124.,$29.67,$117.8,$99.2,$112.84,$32.5169,$117.8,$30.6764,$117.8,$117.8,$76.6557,$84.63,$29.67,$114.08
,CDM,4200005017.10.4200,MASSAGE 97124,CDM Code,Outpatient,97124GP,$126.,$30.02,$119.7,$100.8,$114.66,$33.0414,$119.7,$31.1711,$119.7,$119.7,$70.9152,$85.995,$30.02,$115.92
,CDM,4200005017.30.4200,MASSAGE 97124,CDM Code,Outpatient,97124,$151.,$30.02,$143.45,$120.8,$137.41,$39.5972,$143.45,$37.3559,$143.45,$143.45,$70.9152,$103.0575,$30.02,$138.92
,CDM,4200005019.10.4200,MANUAL THERAPY 97140,CDM Code,Outpatient,97140GP,$114.,$27.26,$108.3,$91.2,$103.74,$29.8946,$108.3,$28.2025,$108.3,$108.3,$81.4617,$77.805,$27.26,$104.88
,CDM,4200005019.30.4200,MANUAL THERAPY 97140,CDM Code,Outpatient,97140,$114.,$27.26,$108.3,$91.2,$103.74,$29.8946,$108.3,$28.2025,$108.3,$108.3,$81.4617,$77.805,$27.26,$104.88
,CDM,4200005023.10.4200,FUNCTIONAL ACTIVIES PER 15 MIN,CDM Code,Outpatient,97530GP,$166.,$39.68,$157.7,$132.8,$151.06,$43.5307,$157.7,$41.0667,$157.7,$157.7,$94.8651,$113.295,$39.68,$152.72
,CDM,4200005023.30.4200,FUNCTIONAL ACTIVIES PER 15 MIN,CDM Code,Outpatient,97530,$166.,$39.68,$157.7,$132.8,$151.06,$43.5307,$157.7,$41.0667,$157.7,$157.7,$94.8651,$113.295,$39.68,$152.72
,CDM,4200005024.10.4200,SELF CARE/HOME MGMT PER 15 MIN,CDM Code,Outpatient,97535GP,$142.,$33.81,$134.9,$113.6,$129.22,$37.2371,$134.9,$35.1294,$134.9,$134.9,$94.8651,$96.915,$33.81,$130.64
,CDM,4200005024.30.4200,SELF CARE/HOME MGMT PER 15 MIN,CDM Code,Outpatient,97535,$142.,$33.81,$134.9,$113.6,$129.22,$37.2371,$134.9,$35.1294,$134.9,$134.9,$94.8651,$96.915,$33.81,$130.64
,CDM,4200005025.10.4200,COMMUNITY REINTEGRATE PER 15 M,CDM Code,Outpatient,97537GP,$174.,$32.43,$165.3,$139.2,$158.34,$45.6285,$165.3,$43.0459,$165.3,$165.3,$82.3962,$118.755,$32.43,$160.08
,CDM,4200005026.10.4200,WHEELCHAIR MANAGEMENT PER 15 M,CDM Code,Outpatient,97542GP,$163.,$32.78,$154.85,$130.4,$148.33,$42.744,$154.85,$40.3246,$154.85,$154.85,$83.3574,$111.2475,$32.78,$149.96
,CDM,4200005081.10.4200,"PT IONTOPHORESIS 97033,PER 15",CDM Code,Outpatient,97033GP,$196.,$20.36,$186.2,$156.8,$178.36,$51.3977,$186.2,$48.4884,$186.2,$186.2,$59.4075,$133.77,$20.36,$180.32
,CDM,4200005104.10.4200,E-STIM UNATTENDED 97014(NON-ME,CDM Code,Outpatient,97014GP,$61.,$15.0908,$57.95,$48.8,$55.51,$15.9962,$57.95,$15.0908,$57.95,$57.95,$6.1,$41.6325,$15.18,$56.12
,CDM,4200005104.30.4200,E-STIM UNATTENDED 97014(NON-ME,CDM Code,Outpatient,97014,$61.,$15.0908,$57.95,$48.8,$55.51,$15.9962,$57.95,$15.0908,$57.95,$57.95,$6.1,$41.6325,$15.18,$56.12
,CDM,4200005105.10.4200,HOT/COLD PACK,CDM Code,Outpatient,97010GP,$0.,$0.,$16.287,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$16.287,$0.,$6.21,$0.
,CDM,4200005105.30.4200,HOT/COLD PACK,CDM Code,Outpatient,97010,$0.,$0.,$16.287,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$16.287,$0.,$6.21,$0.
,CDM,4200007376.10.4200,"PT ORTHOTIC MGMT & TRN,PER 15",CDM Code,Outpatient,97760GP,$183.,$45.2724,$173.85,$146.4,$166.53,$47.9886,$173.85,$45.2724,$173.85,$173.85,$103.4892,$124.8975,$45.89,$168.36
,CDM,4200007378.10.4200,PT C/O ORTHO/PROSTH USE PER 15,CDM Code,Outpatient,97763,$138.,$34.1398,$131.6844,$110.4,$125.58,$36.1882,$131.1,$34.1398,$131.1,$131.1,$131.6844,$94.185,$47.27,$126.96
,CDM,4200007379.10.4200,PT INITIAL EVAL VISIT,CDM Code,Outpatient,97001,$386.,$95.4925,$366.7,$308.8,$351.26,$101.2219,$366.7,$95.4925,$366.7,$366.7,$38.6,$263.445,$339.68,$355.12
,CDM,4200007379.30.4200,PT INITIAL EVAL VISIT,CDM Code,Outpatient,97001,$386.,$95.4925,$366.7,$308.8,$351.26,$101.2219,$366.7,$95.4925,$366.7,$366.7,$38.6,$263.445,$339.68,$355.12
,CDM,4200007380.10.4200,"TENS APPLICATION, UNATTENDED",CDM Code,Outpatient,64550,$157.,$38.8402,$149.15,$125.6,$142.87,$41.1706,$149.15,$38.8402,$149.15,$149.15,$23.9499,$107.1525,$138.16,$144.44
,CDM,4200007380.30.4200,"TENS APPLICATION, UNATTENDED",CDM Code,Outpatient,64550,$157.,$38.8402,$149.15,$125.6,$142.87,$41.1706,$149.15,$38.8402,$149.15,$149.15,$23.9499,$107.1525,$138.16,$144.44
,CDM,4200008020.30.4200,MOBILITY CURRENT STATUS,CDM Code,Outpatient,G8978,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008021.30.4200,MOBILITY GOAL STATUS,CDM Code,Outpatient,G8979,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008027.10.4200,CARRY GOAL STATUS,CDM Code,Outpatient,G8985GP,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008120.10.4200,MOBILITY CURRENT STATUS CH,CDM Code,Outpatient,G8978GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008120.30.4200,MOBILITY CURRENT STATUS CH,CDM Code,Outpatient,G8978,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008121.10.4200,MOBILITY GOAL STATUS CH,CDM Code,Outpatient,G8979GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008121.30.4200,MOBILITY GOAL STATUS CH,CDM Code,Outpatient,G8979,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008122.10.4200,MOBILITY D/C STATUS CH,CDM Code,Outpatient,G8980GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008122.30.4200,MOBILITY D/C STATUS CH,CDM Code,Outpatient,G8980,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008123.10.4200,BODY POS CURRENT STATUS CH,CDM Code,Outpatient,G8981GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008124.10.4200,BODY POS GOAL STATUS CH,CDM Code,Outpatient,G8982GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008124.30.4200,BODY POS GOAL STATUS CH,CDM Code,Outpatient,G8982,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008125.10.4200,BODY POS D/C STATUS CH,CDM Code,Outpatient,G8983GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008125.30.4200,BODY POS D/C STATUS CH,CDM Code,Outpatient,G8983,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008126.10.4200,CARRY CURRENT STATUS CH,CDM Code,Outpatient,G8984GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008127.10.4200,CARRY GOAL STATUS CH,CDM Code,Outpatient,G8985GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008127.30.4200,CARRY GOAL STATUS CH,CDM Code,Outpatient,G8985,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008128.10.4200,CARRY D/C STATUS CH,CDM Code,Outpatient,G8986GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008128.30.4200,CARRY D/C STATUS CH,CDM Code,Outpatient,G8986,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008129.30.4200,SELF CARE CURRENT STATUS CH,CDM Code,Outpatient,G8987,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.
,CDM,4200008130.10.4200,SELF CARE GOAL STATUS CH,CDM Code,Outpatient,G8988GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008133.10.4200,OTHER PT/OT GOAL STATUS CH,CDM Code,Outpatient,G8991GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008134.30.4200,OTHER PT/OT D/C STATUS CH,CDM Code,Outpatient,G8992,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.
,CDM,4200008137.30.4200,SUB PT/OT D/C STATUS CH,CDM Code,Outpatient,G8995,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.
,CDM,4200008220.10.4200,MOBILITY CURRENT STATUS CI,CDM Code,Outpatient,G8978GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008220.30.4200,MOBILITY CURRENT STATUS CI,CDM Code,Outpatient,G8978,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008221.10.4200,MOBILITY GOAL STATUS CI,CDM Code,Outpatient,G8979GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008221.30.4200,MOBILITY GOAL STATUS CI,CDM Code,Outpatient,G8979,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008222.10.4200,MOBILITY D/C STATUS CI,CDM Code,Outpatient,G8980GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008222.30.4200,MOBILITY D/C STATUS CI,CDM Code,Outpatient,G8980,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008223.10.4200,BODY POS CURRENT STATUS CI,CDM Code,Outpatient,G8981GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008223.30.4200,BODY POS CURRENT STATUS CI,CDM Code,Outpatient,G8981,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008224.10.4200,BODY POS GOAL STATUS CI,CDM Code,Outpatient,G8982GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008224.30.4200,BODY POS GOAL STATUS CI,CDM Code,Outpatient,G8982,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008225.10.4200,BODY POS D/C STATUS CI,CDM Code,Outpatient,G8983GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008225.30.4200,BODY POS D/C STATUS CI,CDM Code,Outpatient,G8983,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008226.10.4200,CARRY CURRENT STATUS CI,CDM Code,Outpatient,G8984GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008226.30.4200,CARRY CURRENT STATUS CI,CDM Code,Outpatient,G8984,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008227.10.4200,CARRY GOAL STATUS CI,CDM Code,Outpatient,G8985GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008227.30.4200,CARRY GOAL STATUS CI,CDM Code,Outpatient,G8985,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008228.10.4200,CARRY D/C STATUS CI,CDM Code,Outpatient,G8986GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008228.30.4200,CARRY D/C STATUS CI,CDM Code,Outpatient,G8986,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008229.30.4200,SELF CARE CURRENT STATUS CI,CDM Code,Outpatient,G8987,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008230.10.4200,SELF CARE GOAL STATUS CI,CDM Code,Outpatient,G8988GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008230.30.4200,SELF CARE GOAL STATUS CI,CDM Code,Outpatient,G8988,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008232.10.4200,OTHER PT/OT CURRENT STATUS CI,CDM Code,Outpatient,G8990GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008233.10.4200,OTHER PT/OT GOAL STATUS CI,CDM Code,Outpatient,G8991GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008233.30.4200,OTHER PT/OT GOAL STATUS CI,CDM Code,Outpatient,G8991,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008234.10.4200,OTHER PT/OT D/C STATUS CI,CDM Code,Outpatient,G8992GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008234.30.4200,OTHER PT/OT D/C STATUS CI,CDM Code,Outpatient,G8992,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008236.10.4200,SUN PT/OT GOAL STATUS CI,CDM Code,Outpatient,G8994GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008236.30.4200,SUN PT/OT GOAL STATUS CI,CDM Code,Outpatient,G8994,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008237.30.4200,SUB PT/OT D/C STATUS CI,CDM Code,Outpatient,G8995,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008320.10.4200,MOBILITY CURRENT STATUS CJ,CDM Code,Outpatient,G8978GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008320.30.4200,MOBILITY CURRENT STATUS CJ,CDM Code,Outpatient,G8978,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008321.10.4200,MOBILITY GOAL STATUS CJ,CDM Code,Outpatient,G8979GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008321.30.4200,MOBILITY GOAL STATUS CJ,CDM Code,Outpatient,G8979,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008322.10.4200,MOBILITY D/C STATUS CJ,CDM Code,Outpatient,G8980GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008322.30.4200,MOBILITY D/C STATUS CJ,CDM Code,Outpatient,G8980,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008323.10.4200,BODY POS CURRENT STATUS CJ,CDM Code,Outpatient,G8981GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008323.30.4200,BODY POS CURRENT STATUS CJ,CDM Code,Outpatient,G8981,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008324.10.4200,BODY POS GOAL STATUS CJ,CDM Code,Outpatient,G8982GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008324.30.4200,BODY POS GOAL STATUS CJ,CDM Code,Outpatient,G8982,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008325.10.4200,BODY POS D/C STATUS CJ,CDM Code,Outpatient,G8983GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008325.30.4200,BODY POS D/C STATUS CJ,CDM Code,Outpatient,G8983,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008326.10.4200,CARRY CURRENT STATUS CJ,CDM Code,Outpatient,G8984GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008326.30.4200,CARRY CURRENT STATUS CJ,CDM Code,Outpatient,G8984,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008327.10.4200,CARRY GOAL STATUS CJ,CDM Code,Outpatient,G8985GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008327.30.4200,CARRY GOAL STATUS CJ,CDM Code,Outpatient,G8985,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008328.10.4200,CARRY D/C STATUS CJ,CDM Code,Outpatient,G8986GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008328.30.4200,CARRY D/C STATUS CJ,CDM Code,Outpatient,G8986,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008329.10.4200,SELF CARE CURRENT STATUS CJ,CDM Code,Outpatient,G8987GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008329.30.4200,SELF CARE CURRENT STATUS CJ,CDM Code,Outpatient,G8987,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008330.10.4200,SELF CARE GOAL STATUS CJ,CDM Code,Outpatient,G8988GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008330.30.4200,SELF CARE GOAL STATUS CJ,CDM Code,Outpatient,G8988,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008331.10.4200,SELF CARE D/C STATUS CJ,CDM Code,Outpatient,G8989GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008331.30.4200,SELF CARE D/C STATUS CJ,CDM Code,Outpatient,G8989,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008332.10.4200,OTHER PT/OT CURRENT STATUS CJ,CDM Code,Outpatient,G8990GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008332.30.4200,OTHER PT/OT CURRENT STATUS CJ,CDM Code,Outpatient,G8990,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008333.10.4200,OTHER PT/OT GOAL STATUS CJ,CDM Code,Outpatient,G8991GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008333.30.4200,OTHER PT/OT GOAL STATUS CJ,CDM Code,Outpatient,G8991,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008334.10.4200,OTHER PT/OT D/C STATUS CJ,CDM Code,Outpatient,G8992GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008334.30.4200,OTHER PT/OT D/C STATUS CJ,CDM Code,Outpatient,G8992,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008335.10.4200,SUB PT/OT CURRENT STATUS CJ,CDM Code,Outpatient,G8993GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008336.30.4200,SUN PT/OT GOAL STATUS CJ,CDM Code,Outpatient,G8994,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.
,CDM,4200008337.10.4200,SUB PT/OT D/C STATUS CJ,CDM Code,Outpatient,G8995GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008420.10.4200,MOBILITY CURRENT STATUS CK,CDM Code,Outpatient,G8978GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008420.30.4200,MOBILITY CURRENT STATUS CK,CDM Code,Outpatient,G8978,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008421.10.4200,MOBILITY GOAL STATUS CK,CDM Code,Outpatient,G8979GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008421.30.4200,MOBILITY GOAL STATUS CK,CDM Code,Outpatient,G8979,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008422.10.4200,MOBILITY D/C STATUS CK,CDM Code,Outpatient,G8980GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008422.30.4200,MOBILITY D/C STATUS CK,CDM Code,Outpatient,G8980,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008423.10.4200,BODY POS CURRENT STATUS CK,CDM Code,Outpatient,G8981GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008423.30.4200,BODY POS CURRENT STATUS CK,CDM Code,Outpatient,G8981,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008424.10.4200,BODY POS GOAL STATUS CK,CDM Code,Outpatient,G8982GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008424.30.4200,BODY POS GOAL STATUS CK,CDM Code,Outpatient,G8982,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008425.10.4200,BODY POS D/C STATUS CK,CDM Code,Outpatient,G8983GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008425.30.4200,BODY POS D/C STATUS CK,CDM Code,Outpatient,G8983,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008426.10.4200,CARRY CURRENT STATUS CK,CDM Code,Outpatient,G8984GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008426.30.4200,CARRY CURRENT STATUS CK,CDM Code,Outpatient,G8984,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008427.10.4200,CARRY GOAL STATUS CK,CDM Code,Outpatient,G8985GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008427.30.4200,CARRY GOAL STATUS CK,CDM Code,Outpatient,G8985,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008428.10.4200,CARRY D/C STATUS CK,CDM Code,Outpatient,G8986GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008428.30.4200,CARRY D/C STATUS CK,CDM Code,Outpatient,G8986,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008429.10.4200,SELF CARE CURRENT STATUS CK,CDM Code,Outpatient,G8987GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008429.30.4200,SELF CARE CURRENT STATUS CK,CDM Code,Outpatient,G8987,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008430.10.4200,SELF CARE GOAL STATUS CK,CDM Code,Outpatient,G8988GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008431.10.4200,SELF CARE D/C STATUS CK,CDM Code,Outpatient,G8989GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008432.10.4200,OTHER PT/OT CURRENT STATUS CK,CDM Code,Outpatient,G8990GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008432.30.4200,OTHER PT/OT CURRENT STATUS CK,CDM Code,Outpatient,G8990,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008433.30.4200,OTHER PT/OT GOAL STATUS CK,CDM Code,Outpatient,G8991,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008434.10.4200,OTHER PT/OT D/C STATUS CK,CDM Code,Outpatient,G8992GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008435.10.4200,SUB PT/OT CURRENT STATUS CK,CDM Code,Outpatient,G8993GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008436.10.4200,SUN PT/OT GOAL STATUS CK,CDM Code,Outpatient,G8994GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008520.10.4200,MOBILITY CURRENT STATUS CL,CDM Code,Outpatient,G8978GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008520.30.4200,MOBILITY CURRENT STATUS CL,CDM Code,Outpatient,G8978,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008521.10.4200,MOBILITY GOAL STATUS CL,CDM Code,Outpatient,G8979GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008521.30.4200,MOBILITY GOAL STATUS CL,CDM Code,Outpatient,G8979,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008522.10.4200,MOBILITY D/C STATUS CL,CDM Code,Outpatient,G8980GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008522.30.4200,MOBILITY D/C STATUS CL,CDM Code,Outpatient,G8980,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008523.10.4200,BODY POS CURRENT STATUS CL,CDM Code,Outpatient,G8981GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008523.30.4200,BODY POS CURRENT STATUS CL,CDM Code,Outpatient,G8981,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008524.10.4200,BODY POS GOAL STATUS CL,CDM Code,Outpatient,G8982GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008524.30.4200,BODY POS GOAL STATUS CL,CDM Code,Outpatient,G8982,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008525.30.4200,BODY POS D/C STATUS CL,CDM Code,Outpatient,G8983,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008526.10.4200,CARRY CURRENT STATUS CL,CDM Code,Outpatient,G8984GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008526.30.4200,CARRY CURRENT STATUS CL,CDM Code,Outpatient,G8984,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008529.10.4200,SELF CARE CURRENT STATUS CL,CDM Code,Outpatient,G8987GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008529.30.4200,SELF CARE CURRENT STATUS CL,CDM Code,Outpatient,G8987,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008530.30.4200,SELF CARE GOAL STATUS CL,CDM Code,Outpatient,G8988,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008532.10.4200,OTHER PT/OT CURRENT STATUS CL,CDM Code,Outpatient,G8990GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008532.30.4200,OTHER PT/OT CURRENT STATUS CL,CDM Code,Outpatient,G8990,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008535.10.4200,SUB PT/OT CURRENT STATUS CL,CDM Code,Outpatient,G8993GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008620.10.4200,MOBILITY CURRENT STATUS CM,CDM Code,Outpatient,G8978GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008620.30.4200,MOBILITY CURRENT STATUS CM,CDM Code,Outpatient,G8978,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008621.10.4200,MOBILITY GOAL STATUS CM,CDM Code,Outpatient,G8979GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008621.30.4200,MOBILITY GOAL STATUS CM,CDM Code,Outpatient,G8979,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008622.10.4200,MOBILITY D/C STATUS CM,CDM Code,Outpatient,G8980GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008622.30.4200,MOBILITY D/C STATUS CM,CDM Code,Outpatient,G8980,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008623.10.4200,BODY POS CURRENT STATUS CM,CDM Code,Outpatient,G8981GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008623.30.4200,BODY POS CURRENT STATUS CM,CDM Code,Outpatient,G8981,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008624.10.4200,BODY POS GOAL STATUS CM,CDM Code,Outpatient,G8982GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008624.30.4200,BODY POS GOAL STATUS CM,CDM Code,Outpatient,G8982,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008625.10.4200,BODY POS D/C STATUS CM,CDM Code,Outpatient,G8983GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008625.30.4200,BODY POS D/C STATUS CM,CDM Code,Outpatient,G8983,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008626.10.4200,CARRY CURRENT STATUS CM,CDM Code,Outpatient,G8984GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008626.30.4200,CARRY CURRENT STATUS CM,CDM Code,Outpatient,G8984,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008627.10.4200,CARRY GOAL STATUS CM,CDM Code,Outpatient,G8985GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008628.10.4200,CARRY D/C STATUS CM,CDM Code,Outpatient,G8986GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008628.30.4200,CARRY D/C STATUS CM,CDM Code,Outpatient,G8986,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008631.10.4200,SELF CARE D/C STATUS CM,CDM Code,Outpatient,G8989GPC,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.
,CDM,4200008632.10.4200,OTHER PT/OT CURRENT STATUS CM,CDM Code,Outpatient,G8990GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008632.30.4200,OTHER PT/OT CURRENT STATUS CM,CDM Code,Outpatient,G8990,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008635.10.4200,SUB PT/OT CURRENT STATUS CM,CDM Code,Outpatient,G8993GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008635.30.4200,SUB PT/OT CURRENT STATUS CM,CDM Code,Outpatient,G8993,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.
,CDM,4200008636.10.4200,SUN PT/OT GOAL STATUS CM,CDM Code,Outpatient,G8994GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008637.10.4200,SUB PT/OT D/C STATUS CM,CDM Code,Outpatient,G8995GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008720.10.4200,MOBILITY CURRENT STATUS CN,CDM Code,Outpatient,G8978GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008720.30.4200,MOBILITY CURRENT STATUS CN,CDM Code,Outpatient,G8978,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008721.10.4200,MOBILITY GOAL STATUS CN,CDM Code,Outpatient,G8979GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008721.30.4200,MOBILITY GOAL STATUS CN,CDM Code,Outpatient,G8979,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008722.10.4200,MOBILITY D/C STATUS CN,CDM Code,Outpatient,G8980GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008722.30.4200,MOBILITY D/C STATUS CN,CDM Code,Outpatient,G8980,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008723.10.4200,BODY POS CURRENT STATUS CN,CDM Code,Outpatient,G8981GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008726.10.4200,CARRY CURRENT STATUS CN,CDM Code,Outpatient,G8984GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008728.10.4200,CARRY D/C STATUS CN,CDM Code,Outpatient,G8986GPC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4200008750.10.4200,ORTHC/PROSTC MGMT SBSQ ENC,CDM Code,Outpatient,97763GP,$199.,$47.27,$189.05,$159.2,$181.09,$52.1844,$189.05,$49.2306,$189.05,$189.05,$131.6844,$135.8175,$47.27,$183.08
,CDM,4200009015.10.4200,"TELE THERAPUTIC EXERCISES, 15M",CDM Code,Outpatient,97110GP9,$126.,$30.02,$119.7,$100.8,$114.66,$33.0414,$119.7,$31.1711,$119.7,$119.7,$88.1634,$85.995,$30.02,$115.92
,CDM,4210000002.10.4210,ACUPUNCTURE DETAILED HX 99203,CDM Code,Professional,9920325,$219.,$21.9,$201.48,$175.2,$141.89,$61.215,$96.32,$57.75,$166.155,$165.36,$21.9,$149.4675,$152.5,$201.48
,CDM,4210000005.10.4210,ACUPUNCTURE W/NEEDLES INITL 15,CDM Code,Professional,97810,$103.,$10.3,$94.76,$82.4,$42.75,$27.01,$38.69,$25.4812,$54.8625,$54.6,$10.3,$70.2975,$41.2,$94.76
,CDM,4210000011.10.4210,ACUPUNCT W/NEEDLESADDL 15MIN I,CDM Code,Professional,97811,$21.,$2.1,$41.2775,$16.8,$35.47,$5.5069,$32.04,$5.1952,$41.2775,$41.08,$2.1,$14.3325,$31.2,$19.32
,CDM,4210000012.10.4210,ACUPUNCTURE W ELECTRIC STIM,CDM Code,Professional,97813,$119.,$11.9,$109.48,$95.2,$46.11,$31.2057,$41.82,$29.4394,$58.52,$58.24,$11.9,$81.2175,$44.,$109.48
,CDM,4210000013.10.4210,ACUPUNC W ELECT STIM ADD'L 15,CDM Code,Professional,97814,$50.,$5.,$47.025,$40.,$39.,$13.1116,$35.16,$12.3695,$47.025,$46.8,$5.,$34.125,$35.2,$46.
,CDM,4215001111.10.4215,PULMONARY WELLNESS INTAKE COPD,CDM Code,Outpatient,99214,$482.,$119.242,$457.9,$385.6,$438.62,$126.3963,$457.9,$119.242,$457.9,$457.9,$48.2,$328.965,$152.,$443.44
,CDM,4215002222.10.4215,PULMONARY WELLNESS INTAKE,CDM Code,Outpatient,99213,$508.,$103.,$482.6,$406.4,$462.28,$133.2144,$482.6,$125.6741,$482.6,$482.6,$50.8,$346.71,$103.,$467.36
,CDM,4215003005.10.4215,PULMONARY GROUP EXERCISE-COPD,CDM Code,Outpatient,G0424,$391.,$96.7295,$371.45,$312.8,$355.81,$102.5331,$371.45,$96.7295,$371.45,$371.45,$145.6485,$266.8575,$344.08,$359.72
,CDM,4215003333.10.4215,PULMONARY GROUP EXERCISE,CDM Code,Outpatient,G0239,$391.,$96.7295,$371.45,$312.8,$355.81,$102.5331,$371.45,$96.7295,$371.45,$371.45,$75.7746,$266.8575,$344.08,$359.72
,CDM,4215005063.10.4215,CR SESSION DISCONTINUED,CDM Code,Outpatient,93798,$284.,$35.5,$294.2874,$227.2,$258.44,$74.4742,$269.8,$70.2588,$269.8,$269.8,$294.2874,$193.83,$35.5,$261.28
,CDM,4215005073.10.4215,CR GRP W/CONT ECG MONITOR 9379,CDM Code,Outpatient,93798,$284.,$35.5,$294.2874,$227.2,$258.44,$74.4742,$269.8,$70.2588,$269.8,$269.8,$294.2874,$193.83,$35.5,$261.28
,CDM,4215005083.10.4215,CR II W/CONT ECG MONITOR INTAK,CDM Code,Outpatient,93798,$284.,$35.5,$294.2874,$227.2,$258.44,$74.4742,$269.8,$70.2588,$269.8,$269.8,$294.2874,$193.83,$35.5,$261.28
,CDM,4230000002.10.4230,ER FEE I&D PILONIDAL CYST,CDM Code,Outpatient,10080,$826.,$204.3441,"$1,439.4237",$660.8,$751.66,$216.6045,$784.7,$204.3441,$784.7,$784.7,"$1,439.4237",$563.745,$256.,$759.92
,CDM,4230000003.10.4230,ER FEE PUNCT.ASP.CYST,CDM Code,Outpatient,10160,$242.,$59.8684,$781.2954,$193.6,$220.22,$63.4604,$229.9,$59.8684,$229.9,$229.9,$781.2954,$165.165,$185.5,$222.64
,CDM,4230000004.10.4230,ER FEE NAIL BED RECON SIMPLE,CDM Code,Outpatient,11760,$581.,$143.7336,"$1,209.777",$464.8,$528.71,$152.3574,$551.95,$143.7336,$551.95,$551.95,"$1,209.777",$396.5325,$267.5,$534.52
,CDM,4230000005.10.4230,ER FEE WEDGE EXC INGROWN TOENA,CDM Code,Outpatient,11765,$391.,$96.7295,$781.2954,$312.8,$355.81,$102.5331,$371.45,$96.7295,$371.45,$371.45,$781.2954,$266.8575,$238.5,$359.72
,CDM,4230000006.10.4230,ED FEE LAC RPR SCAL 20.1-30CM,CDM Code,Outpatient,12006,$826.,$204.3441,$784.7,$660.8,$751.66,$216.6045,$784.7,$204.3441,$784.7,$784.7,$781.2954,$563.745,$275.,$759.92
,CDM,4230000007.10.4230,ER FEE CLAVICAL FX,CDM Code,Outpatient,23500,$732.,$181.0895,$695.4,$585.6,$666.12,$191.9546,$695.4,$181.0895,$695.4,$695.4,$533.5461,$499.59,$313.5,$673.44
,CDM,4230000008.10.4230,ER FEE LAC RPR FACE 7.6-12.5CM,CDM Code,Outpatient,12015,$544.,$134.5802,$516.8,$435.2,$495.04,$142.6548,$516.8,$134.5802,$516.8,$516.8,$408.8304,$371.28,$232.5,$500.48
,CDM,4230000009.10.4230,ER FEE LAC RPR FACE 12.6-20CM,CDM Code,Outpatient,12016,$479.,$118.4998,$455.05,$383.2,$435.89,$125.6096,$455.05,$118.4998,$455.05,$455.05,$408.8304,$326.9175,$293.,$440.68
,CDM,4230000011.10.4230,ER FEE LAC RPR SCALP 20.1-30 I,CDM Code,Outpatient,12036,$545.,$134.8276,"$1,209.777",$436.,$495.95,$142.917,$517.75,$134.8276,$517.75,$517.75,"$1,209.777",$371.9625,$603.,$501.4
,CDM,4230000014.10.4230,ER FEE ELBOW REALIGNMENT,CDM Code,Outpatient,24640,$632.,$142.,$600.4,$505.6,$575.12,$165.7313,$600.4,$156.3505,$600.4,$600.4,$533.5461,$431.34,$142.,$581.44
,CDM,4230000015.10.4230,ER FEE EXT TENDON RPR FINGER,CDM Code,Outpatient,26418,"$5,577.",$817.,"$6,510.3678","$4,461.6","$5,075.07","$1,462.4734","$5,298.15","$1,379.694","$5,298.15","$5,298.15","$6,510.3678","$3,806.3025",$817.,"$5,130.84"
,CDM,4230000016.10.4230,ER FEE METACARPAL FX W/MANIP,CDM Code,Outpatient,26605,$591.,$146.2075,$561.45,$472.8,$537.81,$154.9797,$561.45,$146.2075,$561.45,$561.45,$533.5461,$403.3575,$460.5,$543.72
,CDM,4230000017.10.4230,ER FEE DISTAL TUFT FX (54),CDM Code,Outpatient,26750,$651.,$161.0509,$618.45,$520.8,$592.41,$170.7137,$618.45,$161.0509,$618.45,$618.45,$533.5461,$444.3075,$264.,$598.92
,CDM,4230000019.10.4230,ER FEE MED MALLEOL W/ MANIP,CDM Code,Outpatient,27762,"$1,565.",$387.1653,"$3,250.5114","$1,252.","$1,424.15",$410.3946,"$1,486.75",$387.1653,"$1,486.75","$1,486.75","$3,250.5114","$1,068.1125",$673.5,"$1,439.8"
,CDM,4230000020.10.4230,ER FEE N BLOCK INJ PLANTAR DIG,CDM Code,Outpatient,64455,$730.,$180.5947,$693.5,$584.,$664.3,$191.4301,$693.5,$180.5947,$693.5,$693.5,$616.77,$498.225,$642.4,$671.6
,CDM,4230000022.10.4230,ER FEE METATARSAL FX,CDM Code,Outpatient,28470,$572.,$141.5071,$543.4,$457.6,$520.52,$149.9973,$543.4,$141.5071,$543.4,$543.4,$533.5461,$390.39,$315.,$526.24
,CDM,4230000024.10.4230,ER FEE SHORT ARM SPLINT,CDM Code,Outpatient,29125,$396.,$93.,$376.2,$316.8,$360.36,$103.8443,$376.2,$97.9664,$376.2,$376.2,$267.0534,$270.27,$93.,$364.32
,CDM,4230000025.10.4230,ER FEE SHORT LEG SPLINT,CDM Code,Outpatient,29515,$410.,$101.4299,$389.5,$328.,$373.1,$107.5155,$389.5,$101.4299,$389.5,$389.5,$334.1505,$279.825,$103.,$377.2
,CDM,4230000026.10.4230,ER FEE ANT/NASL HEM COM,CDM Code,Outpatient,30903,$595.,$147.197,$565.25,$476.,$541.45,$156.0286,$565.25,$147.197,$565.25,$565.25,$267.0534,$406.0875,$297.5,$547.4
,CDM,4230000028.10.4230,ER FEE CUTDOWN >1YR,CDM Code,Outpatient,36425,$963.,$58.,$914.85,$770.4,$876.33,$252.5304,$914.85,$238.2366,$914.85,$914.85,$703.8387,$657.2475,$58.,$885.96
,CDM,4230000029.10.4230,ER FEE BLOOD TRANSFUSION,CDM Code,Outpatient,36430,"$1,247.",$50.,"$1,184.65",$997.6,"$1,134.77",$327.0046,"$1,184.65",$308.4953,"$1,184.65","$1,184.65",$946.6218,$851.0775,$50.,"$1,147.24"
,CDM,4230000030.10.4230,ER FEE DENTAL SURGERY PROC,CDM Code,Outpatient,41899,"$5,217.","$1,290.6336","$4,956.15","$4,173.6","$4,747.47","$1,368.0696","$4,956.15","$1,290.6336","$4,956.15","$4,956.15",$472.8303,"$3,560.6025","$4,590.96","$4,799.64"
,CDM,4230000031.10.4230,ER FEE MOUTH LAC <2.6,CDM Code,Outpatient,41250,$394.,$97.4717,$703.8387,$315.2,$358.54,$103.3198,$374.3,$97.4717,$374.3,$374.3,$703.8387,$268.905,$386.5,$362.48
,CDM,4230000032.10.4230,ER FEE TONGUE LAC >2.6,CDM Code,Outpatient,41252,"$2,362.",$453.,"$2,243.9","$1,889.6","$2,149.42",$619.3943,"$2,243.9",$584.3352,"$2,243.9","$2,243.9","$1,181.7954","$1,612.065",$453.,"$2,173.04"
,CDM,4230000033.10.4230,ER FEE DRAIN DENTAL ABSCESS,CDM Code,Outpatient,41800,$477.,$118.005,$453.15,$381.6,$434.07,$125.0851,$453.15,$118.005,$453.15,$453.15,$267.0534,$325.5525,$407.,$438.84
,CDM,4230000034.10.4230,ER FEE REMOVE FB PHARYNX,CDM Code,Outpatient,42809,$331.,$81.8861,$703.8387,$264.8,$301.21,$86.7991,$314.45,$81.8861,$314.45,$314.45,$703.8387,$225.9075,$288.,$304.52
,CDM,4230000040.10.4230,ER FEE REMOV FB EMBED CONJUNCT,CDM Code,Outpatient,65210,$520.,$128.6428,$703.8387,$416.,$473.2,$136.3612,$494.,$128.6428,$494.,$494.,$703.8387,$354.9,$457.6,$478.4
,CDM,4230000041.10.4230,ER FEE CORNEAL FB REM W/SLIT.L,CDM Code,Outpatient,65222,$591.,$146.2075,$561.45,$472.8,$537.81,$154.9797,$561.45,$146.2075,$561.45,$561.45,$267.0534,$403.3575,$520.08,$543.72
,CDM,4230000042.10.4230,ER FEE CORNEAL RUST RING,CDM Code,Outpatient,65435,"$1,647.",$407.4513,"$2,068.1019","$1,317.6","$1,498.77",$431.8978,"$1,564.65",$407.4513,"$1,564.65","$1,564.65","$2,068.1019","$1,124.0775","$1,449.36","$1,515.24"
,CDM,4230000043.10.4230,ER FEE TEMP TRANS PACING,CDM Code,Outpatient,92953,$887.,$1.5,"$1,285.1778",$709.6,$807.17,$232.6007,$842.65,$219.4349,$842.65,$842.65,"$1,285.1778",$605.3775,$1.5,$816.04
,CDM,4230000045.10.4230,ER FEE CONTROL VAG. HEMORRHAGE,CDM Code,Outpatient,57180,$702.,$173.6678,$666.9,$561.6,$638.82,$184.0876,$666.9,$173.6678,$666.9,$666.9,$406.4007,$479.115,$617.76,$645.84
,CDM,4230000046.10.4230,ER FEE LYSIS OF LABIAL ADHESIO,CDM Code,Outpatient,56441,"$4,123.","$1,019.989","$5,568.2049","$3,298.4","$3,751.93","$1,081.1867","$3,916.85","$1,019.989","$3,916.85","$3,916.85","$5,568.2049","$2,813.9475","$3,628.24","$3,793.16"
,CDM,4230000057.10.4230,ER FEE CRIT CARE,CDM Code,Outpatient,99291,"$4,595.",$388.,"$4,365.25","$3,676.","$4,181.45","$1,204.9606","$4,365.25","$1,136.757","$4,365.25","$4,365.25","$1,834.7439","$3,136.0875",$388.,"$4,227.4"
,CDM,4230000058.10.4230,ER FEE CRITICAL CARE ADD,CDM Code,Outpatient,99292,$701.,$173.4204,$665.95,$560.8,$637.91,$183.8253,$665.95,$173.4204,$665.95,$665.95,$70.1,$478.4325,$173.5,$644.92
,CDM,4230000060.10.4230,ER FEE APPLY LONG ARM SPLINT,CDM Code,Outpatient,29105,$577.,$126.,$548.15,$461.6,$525.07,$151.3084,$548.15,$142.744,$548.15,$548.15,$334.1505,$393.8025,$126.,$530.84
,CDM,4230000061.10.4230,ER FEE APPLY LONG LEG SPLINT,CDM Code,Outpatient,29505,$890.,$122.,$845.5,$712.,$809.9,$233.3874,$845.5,$220.1771,$845.5,$845.5,$334.1505,$607.425,$122.,$818.8
,CDM,4230000064.10.4230,ER FEE TX HIP DISLOCATION W/O,CDM Code,Outpatient,27250,$903.,$223.3932,$857.85,$722.4,$821.73,$236.7964,$857.85,$223.3932,$857.85,$857.85,$533.5461,$616.2975,$259.,$830.76
,CDM,4230000068.10.4230,ER FEE FINGER SPLINT,CDM Code,Outpatient,29130,$348.,$59.5,$330.6,$278.4,$316.68,$91.2571,$330.6,$86.0917,$330.6,$330.6,$145.6485,$237.51,$59.5,$320.16
,CDM,4230000073.10.4230,ER FEE ARTERIAL CATHETERIZATIO,CDM Code,Outpatient,36620,$214.,$52.9415,$203.3,$171.2,$194.74,$56.1179,$203.3,$52.9415,$203.3,$203.3,$21.4,$146.055,$63.5,$196.88
,CDM,4230000076.10.4230,ER FEE CL TX DIS RADIAL FX W/M,CDM Code,Outpatient,25605,"$2,866.",$709.0197,"$3,250.5114","$2,292.8","$2,608.06",$751.5598,"$2,722.7",$709.0197,"$2,722.7","$2,722.7","$3,250.5114","$1,956.045",$777.,"$2,636.72"
,CDM,4230000077.10.4230,ER FEE CLSD RX NASALBONE W/O S,CDM Code,Outpatient,21315,"$3,402.",$389.,"$3,231.9","$2,721.6","$3,095.82",$892.1167,"$3,231.9",$841.6208,"$3,231.9","$3,231.9","$2,772.9285","$2,321.865",$389.,"$3,129.84"
,CDM,4230000082.10.4230,ER FEE CL TX BIMALLEOLAR FX,CDM Code,Outpatient,27808,$705.,$174.41,$669.75,$564.,$641.55,$184.8743,$669.75,$174.41,$669.75,$669.75,$533.5461,$481.1625,$479.,$648.6
,CDM,4230000083.10.4230,ER FEE INC THROM HEMORRHOID EX,CDM Code,Outpatient,46083,"$1,005.",$248.6269,$954.75,$804.,$914.55,$263.5442,$954.75,$248.6269,$954.75,$954.75,$576.8268,$685.9125,$884.4,$924.6
,CDM,4230000084.10.4230,ER FEE CLSD TX GRT TOE NO MANI,CDM Code,Outpatient,28490,$607.,$150.1657,$576.65,$485.6,$552.37,$159.1754,$576.65,$150.1657,$576.65,$576.65,$533.5461,$414.2775,$210.5,$558.44
,CDM,4230000085.10.4230,ER FEE CL TX PAT DISLOC W/ANES,CDM Code,Outpatient,27562,"$4,000.",$695.5,"$3,800.","$3,200.","$3,640.","$1,048.932","$3,800.",$989.56,"$3,800.","$3,800.",$533.5461,"$2,730.",$695.5,"$3,680."
,CDM,4230000086.10.4230,ER FEE CARDIOVERSION,CDM Code,Outpatient,92960,"$1,493.",$226.5,"$1,418.35","$1,194.4","$1,358.63",$391.5139,"$1,418.35",$369.3533,"$1,418.35","$1,418.35","$1,285.1778","$1,018.9725",$226.5,"$1,373.56"
,CDM,4230000088.10.4230,ER FEE DENTAL BLOCK,CDM Code,Outpatient,64400,$788.,$194.9433,$748.6,$630.4,$717.08,$206.6396,$748.6,$194.9433,$748.6,$748.6,$616.77,$537.81,$693.44,$724.96
,CDM,4230000089.10.4230,ER FEE FOOT DIS O/T TT W/O ANE,CDM Code,Outpatient,28540,$304.,$75.2066,$533.5461,$243.2,$276.64,$79.7188,$288.8,$75.2066,$288.8,$288.8,$533.5461,$207.48,$276.,$279.68
,CDM,4230000090.10.4230,ER FEE DRAINAGE OF ARM LESION,CDM Code,Outpatient,23930,"$5,166.",$513.5,"$4,907.7","$4,132.8","$4,701.06","$1,354.6957","$4,907.7","$1,278.0167","$4,907.7","$4,907.7","$3,301.7754","$3,525.795",$513.5,"$4,752.72"
,CDM,4230000093.10.4230,ER FEE DRAIN FINGER ABSCESS CO,CDM Code,Outpatient,26011,"$2,495.",$559.,"$3,301.7754","$1,996.","$2,270.45",$654.2713,"$2,370.25",$617.2381,"$2,370.25","$2,370.25","$3,301.7754","$1,702.8375",$559.,"$2,295.4"
,CDM,4230000094.10.4230,ER FEE DEB SUBQ TIS 20SQ CM/<,CDM Code,Outpatient,11042,$741.,$167.5,$781.2954,$592.8,$674.31,$194.3147,$703.95,$183.316,$703.95,$703.95,$781.2954,$505.7325,$167.5,$681.72
,CDM,4230000096.10.4230,ER FEE I&D BARTHOLIN GLAND ABS,CDM Code,Outpatient,56420,$0.,$0.,$406.4007,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$406.4007,$0.,$0.,$0.
,CDM,4230000098.10.4230,ER FEE INSERTION NG TUBE,CDM Code,Outpatient,43752,$469.,$59.,$703.8387,$375.2,$426.79,$122.9873,$445.55,$116.0259,$445.55,$445.55,$703.8387,$320.0925,$59.,$431.48
,CDM,4230000099.10.4230,ER FEE INSERTION SUPRAPUBLIC C,CDM Code,Outpatient,51102,"$5,052.","$1,249.8143","$4,799.4","$4,041.6","$4,597.32","$1,324.8011","$4,799.4","$1,249.8143","$4,799.4","$4,799.4","$4,391.2422","$3,447.99","$4,445.76","$4,647.84"
,CDM,4230000102.10.4230,ED FEE I & D KNEE/THIGH BURSA,CDM Code,Outpatient,27301,"$2,414.",$597.1995,"$5,737.5897","$1,931.2","$2,196.74",$633.0305,"$2,293.3",$597.1995,"$2,293.3","$2,293.3","$5,737.5897","$1,647.555",$967.,"$2,220.88"
,CDM,4230000103.10.4230,ED FEE I&D OF INFECTED BURSA,CDM Code,Outpatient,23931,"$2,285.",$414.,"$3,301.7754","$1,828.","$2,079.35",$599.2024,"$2,170.75",$565.2862,"$2,170.75","$2,170.75","$3,301.7754","$1,559.5125",$414.,"$2,102.2"
,CDM,4230000104.10.4230,ED FEE FEMUR FRACTURE W/MANIP,CDM Code,Outpatient,27230,$891.,$220.4245,$846.45,$712.8,$810.81,$233.6496,$846.45,$220.4245,$846.45,$846.45,$533.5461,$608.1075,$683.5,$819.72
,CDM,4230000105.10.4230,"ED FEE I&D FINGER ABSCESS,SKIN",CDM Code,Outpatient,26010,$350.,$86.5865,$408.8304,$280.,$318.5,$91.7815,$332.5,$86.5865,$332.5,$332.5,$408.8304,$238.875,$379.,$322.
,CDM,4230000109.10.4230,ER FEE EXC BNGN LES 0.6 TO 1.0,CDM Code,Outpatient,11421,"$2,326.",$224.,"$2,209.7","$1,860.8","$2,116.66",$609.954,"$2,209.7",$575.4291,"$2,209.7","$2,209.7","$1,439.4237","$1,587.495",$224.,"$2,139.92"
,CDM,4230000113.10.4230,ED FEE EXCISIONAL BIOPSY LIP,CDM Code,Outpatient,40490,$807.,$184.,$766.65,$645.6,$734.37,$211.622,$766.65,$199.6437,$766.65,$766.65,$472.8303,$550.7775,$184.,$742.44
,CDM,4230000117.10.4230,ER FEE LAC RPR FACE<2.6CM SIMP,CDM Code,Outpatient,12011,$498.,$123.2002,$473.1,$398.4,$453.18,$130.592,$473.1,$123.2002,$473.1,$473.1,$408.8304,$339.885,$158.,$458.16
,CDM,4230000118.10.4230,ER FEE CHEMICAL CAUTERIZATION,CDM Code,Outpatient,17250,$393.,$97.2243,$408.8304,$314.4,$357.63,$103.0576,$373.35,$97.2243,$373.35,$373.35,$408.8304,$268.2225,$114.5,$361.56
,CDM,4230000119.10.4230,ER FEE SCAPULA FX,CDM Code,Outpatient,23570,$471.,$116.5207,$533.5461,$376.8,$428.61,$123.5117,$447.45,$116.5207,$447.45,$447.45,$533.5461,$321.4575,$333.5,$433.32
,CDM,4230000120.10.4230,ER FEE RABIES VACCINATION SHOT,CDM Code,Outpatient,90675,$0.,$0.,$718.5504,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$718.5504,$0.,$0.,$0.
,CDM,4230000122.10.4230,ER FEE EXPLOR PENETRAT WOUND E,CDM Code,Outpatient,20103,"$1,232.",$304.7845,"$1,439.4237",$985.6,"$1,121.12",$323.0711,"$1,170.4",$304.7845,"$1,170.4","$1,170.4","$1,439.4237",$840.84,$836.,"$1,133.44"
,CDM,4230000123.10.4230,ER FEE PLACEMENT OF CVP,CDM Code,Outpatient,36556,"$3,496.",$298.5,"$3,321.2","$2,796.8","$3,181.36",$916.7666,"$3,321.2",$864.8754,"$3,321.2","$3,321.2","$1,826.6271","$2,386.02",$298.5,"$3,216.32"
,CDM,4230000124.10.4230,ER FEE BIOPSY OF VAGINA,CDM Code,Outpatient,57105,"$4,285.","$1,060.0662","$5,568.2049","$3,428.","$3,899.35","$1,123.6684","$4,070.75","$1,060.0662","$4,070.75","$4,070.75","$5,568.2049","$2,924.5125","$3,770.8","$3,942.2"
,CDM,4230000125.10.4230,ER FEE CL TX THUMB DISLOCATION,CDM Code,Outpatient,26641,"$1,108.",$274.1081,"$1,052.6",$886.4,"$1,008.28",$290.5542,"$1,052.6",$274.1081,"$1,052.6","$1,052.6",$533.5461,$756.21,$548.5,"$1,019.36"
,CDM,4230000126.10.4230,ER FEE INCISION OF ANL ABSCESS,CDM Code,Outpatient,46050,"$1,294.",$320.1227,"$1,782.6789","$1,035.2","$1,177.54",$339.3295,"$1,229.3",$320.1227,"$1,229.3","$1,229.3","$1,782.6789",$883.155,"$1,138.72","$1,190.48"
,CDM,4230000130.10.4230,ER FEE REMOVAL OF NAIL BED,CDM Code,Outpatient,11750,$512.,$126.6637,$781.2954,$409.6,$465.92,$134.2633,$486.4,$126.6637,$486.4,$486.4,$781.2954,$349.44,$218.5,$471.04
,CDM,4230000131.10.4230,ER FEE REMOVAL OF NAIL TIP,CDM Code,Outpatient,11752,"$5,371.","$1,328.7317","$5,102.45","$4,296.8","$4,887.61","$1,408.4534","$5,102.45","$1,328.7317","$5,102.45","$5,102.45",$537.1,"$3,665.7075","$4,726.48","$4,941.32"
,CDM,4230000133.10.4230,ER FEE LAC RPR FACE 2.6-5.0 SI,CDM Code,Outpatient,12013,$623.,$154.124,$591.85,$498.4,$566.93,$163.3712,$591.85,$154.124,$591.85,$591.85,$408.8304,$425.1975,$165.5,$573.16
,CDM,4230000135.10.4230,ER FEE CHEST TUBE INSERTION,CDM Code,Outpatient,32551,"$1,230.",$227.,"$1,826.6271",$984.,"$1,119.3",$322.5466,"$1,168.5",$304.2897,"$1,168.5","$1,168.5","$1,826.6271",$839.475,$227.,"$1,131.6"
,CDM,4230000136.10.4230,ER FEE N BLOCK INJ OCCIPITAL,CDM Code,Outpatient,64405,$578.,$142.9914,$616.77,$462.4,$525.98,$151.5707,$549.1,$142.9914,$549.1,$549.1,$616.77,$394.485,$508.64,$531.76
,CDM,4230000141.10.4230,ER FEE LAC RPR FACE 5.1-7.5CM,CDM Code,Outpatient,12014,$581.,$143.7336,$551.95,$464.8,$528.71,$152.3574,$551.95,$143.7336,$551.95,$551.95,$408.8304,$396.5325,$193.,$534.52
,CDM,4230000150.10.4230,ER FEE EXC TR-EXT B9+MARG 1.1-,CDM Code,Outpatient,11402,"$1,433.",$238.,"$1,439.4237","$1,146.4","$1,304.03",$375.7799,"$1,361.35",$354.5099,"$1,361.35","$1,361.35","$1,439.4237",$978.0225,$238.,"$1,318.36"
,CDM,4230000151.10.4230,ER FEE WOUND(S) CARE NON-SELEC,CDM Code,Outpatient,97602,$423.,$37.95,$408.8304,$338.4,$384.93,$110.9246,$401.85,$104.646,$401.85,$401.85,$408.8304,$288.6975,$37.95,$389.16
,CDM,4230000152.10.4230,ER FEE THROMBOL THERAPY STROKE,CDM Code,Outpatient,37195,$744.,$184.0582,"$1,357.5",$595.2,$677.04,$195.1014,$706.8,$184.0582,$706.8,$706.8,$746.1315,$507.78,"$1,357.5",$684.48
,CDM,4230000208.10.4230,ER FEE THORACENTESIS W/O IMAG,CDM Code,Outpatient,32554,"$1,223.",$289.,"$1,826.6271",$978.4,"$1,112.93",$320.711,"$1,161.85",$302.558,"$1,161.85","$1,161.85","$1,826.6271",$834.6975,$289.,"$1,125.16"
,CDM,4230000253.10.4230,ER FEE BURN DRSG &/OR DEBRID M,CDM Code,Outpatient,16025,$325.,$80.4017,$408.8304,$260.,$295.75,$85.2257,$308.75,$80.4017,$308.75,$308.75,$408.8304,$221.8125,$211.,$299.
,CDM,4230000278.10.4230,ER FEE CLSD BIMALLEOLAR FX W/R,CDM Code,Outpatient,27810,$648.,$160.3087,"$3,250.5114",$518.4,$589.68,$169.927,$615.6,$160.3087,$615.6,$615.6,"$3,250.5114",$442.26,$667.5,$596.16
,CDM,4230000315.10.4230,ER FEE LAC RPR SCALP <2.6CM IN,CDM Code,Outpatient,12031,$374.,$92.5239,$781.2954,$299.2,$340.34,$98.0751,$355.3,$92.5239,$355.3,$355.3,$781.2954,$255.255,$339.,$344.08
,CDM,4230000323.10.4230,ER FEE LAC RPR NECK 2.6-7.5CM,CDM Code,Outpatient,12042,$407.,$100.6877,$781.2954,$325.6,$370.37,$106.7288,$386.65,$100.6877,$386.65,$386.65,$781.2954,$277.7775,$412.,$374.44
,CDM,4230000349.10.4230,ER FEE LAC RPR NECK 7.6-12.5 I,CDM Code,Outpatient,12044,$528.,$130.6219,"$1,209.777",$422.4,$480.48,$138.459,$501.6,$130.6219,$501.6,$501.6,"$1,209.777",$360.36,$513.,$485.76
,CDM,4230000414.10.4230,ER FEE LAC RPR NECK < 2.6CM IN,CDM Code,Outpatient,12041,$620.,$153.3818,$781.2954,$496.,$564.2,$162.5845,$589.,$153.3818,$589.,$589.,$781.2954,$423.15,$338.5,$570.4
,CDM,4230000416.10.4230,ER FEE ENDOMETRIAL BIOPSY,CDM Code,Outpatient,58100,$357.,$88.3182,$406.4007,$285.6,$324.87,$93.6172,$339.15,$88.3182,$339.15,$339.15,$406.4007,$243.6525,$314.16,$328.44
,CDM,4230000417.10.4230,"ER FEE EXCISION TUMOR, FOREARM",CDM Code,Outpatient,25075,"$3,576.",$685.5,"$3,397.2","$2,860.8","$3,254.16",$937.7452,"$3,397.2",$884.6666,"$3,397.2","$3,397.2","$3,301.7754","$2,440.62",$685.5,"$3,289.92"
,CDM,4230000420.10.4230,ER FEE REMOVE NAIL PLATE ADDON,CDM Code,Outpatient,11732,$120.,$29.6868,$114.,$96.,$109.2,$31.468,$114.,$29.6868,$114.,$114.,$12.,$81.9,$45.,$110.4
,CDM,4230000422.10.4230,ER FEE LAC RPR SCALP 2.6-7.5 I,CDM Code,Outpatient,12032,$493.,$121.9633,$781.2954,$394.4,$448.63,$129.2809,$468.35,$121.9633,$468.35,$468.35,$781.2954,$336.4725,$430.5,$453.56
,CDM,4230000448.10.4230,ER FEE LAC RPR SCALP 7.6-12.5,CDM Code,Outpatient,12034,$503.,$124.4372,$781.2954,$402.4,$457.73,$131.9032,$477.85,$124.4372,$477.85,$477.85,$781.2954,$343.2975,$446.,$462.76
,CDM,4230000455.10.4230,ER FEE LAC RPR SCALP 12.6-20 I,CDM Code,Outpatient,12035,$580.,$143.4862,$781.2954,$464.,$527.8,$152.0951,$551.,$143.4862,$551.,$551.,$781.2954,$395.85,$542.5,$533.6
,CDM,4230000471.10.4230,ER FEE ADMINISTRATION ONE VACC,CDM Code,Outpatient,90471,$113.,$27.9551,$141.9639,$90.4,$102.83,$29.6323,$107.35,$27.9551,$107.35,$107.35,$141.9639,$77.1225,$29.,$103.96
,CDM,4230000472.10.4230,ER FEE ADMIN EACH ADD L VACCIN,CDM Code,Outpatient,90472,$114.,$18.,$108.3,$91.2,$103.74,$29.8946,$108.3,$28.2025,$108.3,$108.3,$11.4,$77.805,$18.,$104.88
,CDM,4230000513.10.4230,ER FEE LAC RPR FACE < 2.6CM IN,CDM Code,Outpatient,12051,$419.,$103.6564,$408.8304,$335.2,$381.29,$109.8756,$398.05,$103.6564,$398.05,$398.05,$408.8304,$285.9675,$368.,$385.48
,CDM,4230000521.10.4230,ER FEE LAC RPR FACE 2.6-5CM IN,CDM Code,Outpatient,12052,$692.,$171.1939,$781.2954,$553.6,$629.72,$181.4652,$657.4,$171.1939,$657.4,$657.4,$781.2954,$472.29,$419.5,$636.64
,CDM,4230000539.10.4230,ER FEE LAC RPR FACE 5.1-7.5 IN,CDM Code,Outpatient,12053,$637.,$157.5874,$781.2954,$509.6,$579.67,$167.0424,$605.15,$157.5874,$605.15,$605.15,$781.2954,$434.7525,$492.5,$586.04
,CDM,4230000547.10.4230,ER FEE LAC RPR FACE 7.6-12.5IN,CDM Code,Outpatient,12054,$637.,$157.5874,$781.2954,$509.6,$579.67,$167.0424,$605.15,$157.5874,$605.15,$605.15,$781.2954,$434.7525,$513.5,$586.04
,CDM,4230000552.10.4230,ER FEE TRIGGER PT INJEC 1-2 MU,CDM Code,Outpatient,20552,$352.,$78.5,$616.77,$281.6,$320.32,$92.306,$334.4,$87.0813,$334.4,$334.4,$616.77,$240.24,$78.5,$323.84
,CDM,4230000583.10.4230,ER FEE REMOVE INTRAUTERINE DEV,CDM Code,Outpatient,58301,$468.,$115.7785,$736.2792,$374.4,$425.88,$122.725,$444.6,$115.7785,$444.6,$444.6,$736.2792,$319.41,$411.84,$430.56
,CDM,4230000584.10.4230,ER FEE REMOVAL FECAL IMPACT/FB,CDM Code,Outpatient,45915,"$2,783.",$688.4864,"$2,643.85","$2,226.4","$2,532.53",$729.7944,"$2,643.85",$688.4864,"$2,643.85","$2,643.85","$2,343.192","$1,899.3975","$2,449.04","$2,560.36"
,CDM,4230000586.10.4230,ER FEE DRAINAGE OF BREAST LESI,CDM Code,Outpatient,19000,"$1,525.",$160.,"$1,448.75","$1,220.","$1,387.75",$399.9053,"$1,448.75",$377.2697,"$1,448.75","$1,448.75","$1,439.4237","$1,040.8125",$160.,"$1,403."
,CDM,4230000600.10.4230,ER FEE ARTHROCENTESIS-SMALL,CDM Code,Outpatient,20600,$460.,$68.5,$616.77,$368.,$418.6,$120.6272,$437.,$113.7994,$437.,$437.,$616.77,$313.95,$68.5,$423.2
,CDM,4230000602.10.4230,ER FEE CL TX TOE DISLOC W/ANES,CDM Code,Outpatient,28665,"$2,852.",$224.,"$2,709.4","$2,281.6","$2,595.32",$747.8885,"$2,709.4",$705.5563,"$2,709.4","$2,709.4",$589.4025,"$1,946.49",$224.,"$2,623.84"
,CDM,4230000603.10.4230,ER FEE CLSD TX DISLOC TOE JOIN,CDM Code,Outpatient,28660,$554.,$137.0541,$533.5461,$443.2,$504.14,$145.2771,$526.3,$137.0541,$526.3,$526.3,$533.5461,$378.105,$167.,$509.68
,CDM,4230000604.10.4230,ER FEE ASPIR/INJECT GANGLION C,CDM Code,Outpatient,20612,$303.,$74.9592,$616.77,$242.4,$275.73,$79.4566,$287.85,$74.9592,$287.85,$287.85,$616.77,$206.7975,$86.,$278.76
,CDM,4230000605.10.4230,ER FEE ARTHROCENTESIS-MEDIUM,CDM Code,Outpatient,20605,$297.,$72.,$616.77,$237.6,$270.27,$77.8832,$282.15,$73.4748,$282.15,$282.15,$616.77,$202.7025,$72.,$273.24
,CDM,4230000614.10.4230,ER FEE I&D ABSCESS-SIMPLE,CDM Code,Outpatient,10060,$525.,$129.8798,$498.75,$420.,$477.75,$137.6723,$498.75,$129.8798,$498.75,$498.75,$408.8304,$358.3125,$169.,$483.
,CDM,4230000615.10.4230,ER FEE EXCISION SKIN TAG,CDM Code,Outpatient,11200,$115.,$28.4499,$408.8304,$92.,$104.65,$30.1568,$109.25,$28.4499,$109.25,$109.25,$408.8304,$78.4875,$127.5,$105.8
,CDM,4230000620.10.4230,ER FEE MONITOR FLUID PRESSURE,CDM Code,Outpatient,20950,$748.,$185.0477,"$1,439.4237",$598.4,$680.68,$196.1503,$710.6,$185.0477,$710.6,$710.6,"$1,439.4237",$510.51,$356.,$688.16
,CDM,4230000622.10.4230,ER FEE I&D ABSCESS-COMPLEX,CDM Code,Outpatient,10061,$579.,$143.2388,$781.2954,$463.2,$526.89,$151.8329,$550.05,$143.2388,$550.05,$550.05,$781.2954,$395.1675,$293.5,$532.68
,CDM,4230000624.10.4230,ER FEE REDUCT TOE FX W/MANIPUL,CDM Code,Outpatient,28515,$546.,$135.0749,$533.5461,$436.8,$496.86,$143.1792,$518.7,$135.0749,$518.7,$518.7,$533.5461,$372.645,$233.,$502.32
,CDM,4230000763.10.4230,"ER FEE CTRL NASAL HEMORR, SUBS",CDM Code,Outpatient,30906,$347.,$85.8443,$477.5,$277.6,$315.77,$90.9949,$329.65,$85.8443,$329.65,$329.65,$472.8303,$236.8275,$477.5,$319.24
,CDM,4230000765.10.4230,ER FEE CLSD TX PATELLA FX W/O,CDM Code,Outpatient,27520,$493.,$121.9633,$533.5461,$394.4,$448.63,$129.2809,$468.35,$121.9633,$468.35,$468.35,$533.5461,$336.4725,$463.5,$453.56
,CDM,4230000767.10.4230,ER FEE THER/PROPH/DX IVSEQ SAM,CDM Code,Outpatient,96376,$237.,$17.,$225.15,$189.6,$215.67,$62.1492,$225.15,$58.6314,$225.15,$225.15,$23.7,$161.7525,$17.,$218.04
,CDM,4230000772.10.4230,"ER FEE INJECTION,SC/1M",CDM Code,Outpatient,96372,$170.,$29.,$161.5,$136.,$154.7,$44.5796,$161.5,$42.0563,$161.5,$161.5,$141.9639,$116.025,$29.,$156.4
,CDM,4230000800.10.4230,ER FEE DRAIN ABSCESS MOUTH SIM,CDM Code,Outpatient,40800,$544.,$134.5802,"$1,439.4237",$435.2,$495.04,$142.6548,$516.8,$134.5802,$516.8,$516.8,"$1,439.4237",$371.28,$306.,$500.48
,CDM,4230000803.10.4230,ER FEE EXC H-F-NK-SP B9+MARG 1,CDM Code,Outpatient,11422,"$3,371.",$252.,"$3,301.7754","$2,696.8","$3,067.61",$883.9874,"$3,202.45",$833.9517,"$3,202.45","$3,202.45","$3,301.7754","$2,300.7075",$252.,"$3,101.32"
,CDM,4230000805.10.4230,ER FEE PARACENTESIS,CDM Code,Outpatient,49082,"$1,162.",$287.4672,"$1,868.4393",$929.6,"$1,057.42",$304.7147,"$1,103.9",$287.4672,"$1,103.9","$1,103.9","$1,868.4393",$793.065,"$1,022.56","$1,069.04"
,CDM,4230000808.10.4230,ER FEE INSERT PESSARY/OTH DVC,CDM Code,Outpatient,57160,$415.,$102.6668,$406.4007,$332.,$377.65,$108.8267,$394.25,$102.6668,$394.25,$394.25,$406.4007,$283.2375,$365.2,$381.8
,CDM,4230000810.10.4230,ER FEE TREAT HIP DISLOCATION,CDM Code,Outpatient,27266,"$3,375.",$834.9412,"$3,250.5114","$2,700.","$3,071.25",$885.0364,"$3,206.25",$834.9412,"$3,206.25","$3,206.25","$3,250.5114","$2,303.4375",$835.5,"$3,105."
,CDM,4230001005.10.4230,ER FEE LES EXC-BENIGN-0.5CM-LE,CDM Code,Outpatient,11400,"$1,348.",$179.,"$1,439.4237","$1,078.4","$1,226.68",$353.4901,"$1,280.6",$333.4817,"$1,280.6","$1,280.6","$1,439.4237",$920.01,$179.,"$1,240.16"
,CDM,4230001008.10.4230,"ER FEE,CMPLX REPR,TRNKADD 5CM<",CDM Code,Outpatient,13102,$800.,$173.5,$760.,$640.,$728.,$209.7864,$760.,$197.912,$760.,$760.,$80.,$546.,$173.5,$736.
,CDM,4230001011.10.4230,ER FEE DRAINAGE OF SCROTUM ABS,CDM Code,Outpatient,55100,"$3,092.",$764.9299,"$3,301.7754","$2,473.6","$2,813.72",$810.8244,"$2,937.4",$764.9299,"$2,937.4","$2,937.4","$3,301.7754","$2,110.29","$2,720.96","$2,844.64"
,CDM,4230001014.10.4230,ER FEE I&D HEMATOMA/BLISTER,CDM Code,Outpatient,10140,"$3,029.",$234.5,"$3,301.7754","$2,423.2","$2,756.39",$794.3038,"$2,877.55",$749.3443,"$2,877.55","$2,877.55","$3,301.7754","$2,067.2925",$234.5,"$2,786.68"
,CDM,4230001015.10.4230,ER FEE LAC RPR TRUNK 2.6-7.5 C,CDM Code,Outpatient,13101,"$1,177.",$291.178,"$1,209.777",$941.6,"$1,071.07",$308.6482,"$1,118.15",$291.178,"$1,118.15","$1,118.15","$1,209.777",$803.3025,$563.5,"$1,082.84"
,CDM,4230001043.10.4230,ER FEE BLOOD PATCH,CDM Code,Outpatient,62273,"$1,662.",$411.1622,"$1,578.9","$1,329.6","$1,512.42",$435.8312,"$1,578.9",$411.1622,"$1,578.9","$1,578.9","$1,354.1973","$1,134.315","$1,462.56","$1,529.04"
,CDM,4230001105.10.4230,ER FEE PAR/CUT BEN HYPRK LES 1,CDM Code,Outpatient,11055,$383.,$68.5,$408.8304,$306.4,$348.53,$100.4352,$363.85,$94.7504,$363.85,$363.85,$408.8304,$261.3975,$68.5,$352.36
,CDM,4230001213.10.4230,ER FEE LAC RPR SCALP 2.6-7.5 C,CDM Code,Outpatient,13121,"$1,185.",$293.1572,"$1,209.777",$948.,"$1,078.35",$310.7461,"$1,125.75",$293.1572,"$1,125.75","$1,125.75","$1,209.777",$808.7625,$608.,"$1,090.2"
,CDM,4230001216.10.4230,ER FEE SQ INCIS FB REMOVAL SIM,CDM Code,Outpatient,10120,$617.,$152.6396,$781.2954,$493.6,$561.47,$161.7978,$586.15,$152.6396,$586.15,$586.15,$781.2954,$421.1025,$219.,$567.64
,CDM,4230001224.10.4230,ER FEE SQ INCIS FB REMOVAL COM,CDM Code,Outpatient,10121,"$4,365.",$391.5,"$4,146.75","$3,492.","$3,972.15","$1,144.647","$4,146.75","$1,079.8574","$4,146.75","$4,146.75","$3,301.7754","$2,979.1125",$391.5,"$4,015.8"
,CDM,4230001312.10.4230,ER FEE LAC RPR FACE 1.1-2.5 CO,CDM Code,Outpatient,13131,"$1,191.",$294.6415,"$1,131.45",$952.8,"$1,083.81",$312.3195,"$1,131.45",$294.6415,"$1,131.45","$1,131.45",$781.2954,$812.8575,$549.,"$1,095.72"
,CDM,4230001320.10.4230,ER FEE LAC RPR FACE 2.6-7.5 CO,CDM Code,Outpatient,13132,$760.,$188.0164,"$1,209.777",$608.,$691.6,$199.2971,$722.,$188.0164,$722.,$722.,"$1,209.777",$518.7,$678.,$699.2
,CDM,4230001410.10.4230,ER FEE DESTRUCT B9 LESION 1-14,CDM Code,Outpatient,17110,$383.,$94.7504,$408.8304,$306.4,$348.53,$100.4352,$363.85,$94.7504,$363.85,$363.85,$408.8304,$261.3975,$159.,$352.36
,CDM,4230001510.10.4230,ER FEE LAC RPR NOSE 1.1+2.5 CO,CDM Code,Outpatient,13151,$546.,$135.0749,"$1,209.777",$436.8,$496.86,$143.1792,$518.7,$135.0749,$518.7,$518.7,"$1,209.777",$372.645,$600.5,$502.32
,CDM,4230001528.10.4230,ER FEE LAC RPR NOSE 2.6-7.5 CO,CDM Code,Outpatient,13152,"$2,121.",$524.7142,"$2,014.95","$1,696.8","$1,930.11",$556.1962,"$2,014.95",$524.7142,"$2,014.95","$2,014.95","$1,209.777","$1,447.5825",$721.,"$1,951.32"
,CDM,4230001702.10.4230,ER FEE TEMP INDWELLING FOLEY S,CDM Code,Outpatient,51702,$286.,$70.7535,$271.7,$228.8,$260.26,$74.9986,$271.7,$70.7535,$271.7,$271.7,$267.0534,$195.195,$251.68,$263.12
,CDM,4230001703.10.4230,ER FEE TEMP INDWELLING FOLEY C,CDM Code,Outpatient,51703,$516.,$127.6532,$490.2,$412.8,$469.56,$135.3122,$490.2,$127.6532,$490.2,$490.2,$339.357,$352.17,$454.08,$474.72
,CDM,4230001704.10.4230,ER FEE GASTRIC LAVAGE,CDM Code,Outpatient,43753,$285.,$31.5,$620.2677,$228.,$259.35,$74.7364,$270.75,$70.5062,$270.75,$270.75,$620.2677,$194.5125,$31.5,$262.2
,CDM,4230001705.10.4230,"ER FEE RPR LIP,FULL THICK VERM",CDM Code,Outpatient,40650,"$2,280.",$564.0492,"$2,166.","$1,824.","$2,074.8",$597.8912,"$2,166.",$564.0492,"$2,166.","$2,166.","$1,181.7954","$1,556.1",$630.5,"$2,097.6"
,CDM,4230001715.10.4230,ER FEE ACNE SURGERY,CDM Code,Outpatient,10040,$442.,$109.3464,$419.9,$353.6,$402.22,$115.907,$419.9,$109.3464,$419.9,$419.9,$408.8304,$301.665,$156.5,$406.64
,CDM,4230001982.10.4230,ER FEE REMOVE DRUG IMPLANT DEV,CDM Code,Outpatient,11982,$659.,$163.03,$703.8387,$527.2,$599.69,$172.8115,$626.05,$163.03,$626.05,$626.05,$703.8387,$449.7675,$226.5,$606.28
,CDM,4230002004.10.4230,ER FEE BURN DRSG &/OR DEBRID S,CDM Code,Outpatient,16020,$542.,$117.5,$514.9,$433.6,$493.22,$142.1303,$514.9,$134.0854,$514.9,$514.9,$408.8304,$369.915,$117.5,$498.64
,CDM,4230002005.10.4230,ER FEE INJECT SINGLE TENDON,CDM Code,Outpatient,20551,$668.,$86.5,$634.6,$534.4,$607.88,$175.1716,$634.6,$165.2565,$634.6,$634.6,$616.77,$455.91,$86.5,$614.56
,CDM,4230002007.10.4230,ER FEE SIMPLE LAC RPR > 30 CM,CDM Code,Outpatient,12007,$691.,$170.9465,$656.45,$552.8,$628.81,$181.203,$656.45,$170.9465,$656.45,$656.45,$408.8304,$471.6075,$317.5,$635.72
,CDM,4230002009.10.4230,ER FEE EAR FB REMOVAL,CDM Code,Outpatient,69200,$166.,$41.0667,$267.0534,$132.8,$151.06,$43.5307,$157.7,$41.0667,$157.7,$157.7,$267.0534,$113.295,$146.08,$152.72
,CDM,4230002010.10.4230,"ER FEE IV INFUSION HYDRAT,1ST",CDM Code,Outpatient,96360,$510.,$66.,$484.5,$408.,$464.1,$133.7388,$484.5,$126.1689,$484.5,$484.5,$479.9859,$348.075,$66.,$469.2
,CDM,4230002011.10.4230,"ER FEE IV HYDRATION, EACH ADDL",CDM Code,Outpatient,96361,$259.,$19.5,$246.05,$207.2,$235.69,$67.9183,$246.05,$64.074,$246.05,$246.05,$92.8626,$176.7675,$19.5,$238.28
,CDM,4230002012.10.4230,ER FEE THER/PROPH/DIAG INFUS 1,CDM Code,Outpatient,96365,$678.,$103.,$644.1,$542.4,$616.98,$177.794,$644.1,$167.7304,$644.1,$644.1,$479.9859,$462.735,$103.,$623.76
,CDM,4230002013.10.4230,ER FEE THER/PROPH/DIAG INFUS T,CDM Code,Outpatient,96366,$436.,$31.,$414.2,$348.8,$396.76,$114.3336,$414.2,$107.862,$414.2,$414.2,$92.8626,$297.57,$31.,$401.12
,CDM,4230002014.10.4230,ER FEE TX/PROPH/DG SEQ INFUS 1,CDM Code,Outpatient,96367,$276.,$44.5,$262.2,$220.8,$251.16,$72.3763,$262.2,$68.2796,$262.2,$262.2,$141.9639,$188.37,$44.5,$253.92
,CDM,4230002015.10.4230,ER FEE THER/DIAG CONCURRENT IN,CDM Code,Outpatient,96368,$260.,$29.5,$247.,$208.,$236.6,$68.1806,$247.,$64.3214,$247.,$247.,$26.,$177.45,$29.5,$239.2
,CDM,4230002016.10.4230,ER FEE THER/PROPH/DG INJ IV PU,CDM Code,Outpatient,96374,$365.,$65.5,$479.9859,$292.,$332.15,$95.715,$346.75,$90.2973,$346.75,$346.75,$479.9859,$249.1125,$65.5,$335.8
,CDM,4230002017.10.4230,ER FEE THER/PROPH/DG INJ IV AD,CDM Code,Outpatient,96375,$231.,$25.5,$219.45,$184.8,$210.21,$60.5758,$219.45,$57.1471,$219.45,$219.45,$92.8626,$157.6575,$25.5,$212.52
,CDM,4230002022.10.4230,ER FEE LAC RPR SCALP<2.6CM SIM,CDM Code,Outpatient,12001,$436.,$107.862,$414.2,$348.8,$396.76,$114.3336,$414.2,$107.862,$414.2,$414.2,$408.8304,$297.57,$129.5,$401.12
,CDM,4230002030.10.4230,ER FEE LAC RPR SCALP2.6-7.5CM,CDM Code,Outpatient,12002,$571.,$141.2597,$542.45,$456.8,$519.61,$149.735,$542.45,$141.2597,$542.45,$542.45,$408.8304,$389.7075,$157.5,$525.32
,CDM,4230002048.10.4230,ER FEE LAC RPR SCALP7.6-12.5CM,CDM Code,Outpatient,12004,$691.,$170.9465,$656.45,$552.8,$628.81,$181.203,$656.45,$170.9465,$656.45,$656.45,$408.8304,$471.6075,$184.,$635.72
,CDM,4230002052.10.4230,ER FEE EYE CONJUNCT REMOVE FB,CDM Code,Outpatient,65205,$591.,$146.2075,$561.45,$472.8,$537.81,$154.9797,$561.45,$146.2075,$561.45,$561.45,$267.0534,$403.3575,$520.08,$543.72
,CDM,4230002055.10.4230,ER FEE LAC RPR SCALP12.6-20CM,CDM Code,Outpatient,12005,$598.,$147.9392,$781.2954,$478.4,$544.18,$156.8153,$568.1,$147.9392,$568.1,$568.1,$781.2954,$408.135,$231.5,$550.16
,CDM,4230002108.10.4230,ER FEE EAR REMOVE IMPACTED WAX,CDM Code,Outpatient,69210,$236.,$58.384,$224.2,$188.8,$214.76,$61.887,$224.2,$58.384,$224.2,$224.2,$145.6485,$161.07,$207.68,$217.12
,CDM,4230002110.10.4230,ER FEE IRRIGATE IMPACTD EARWAX,CDM Code,Outpatient,69209,$147.,$36.3663,$145.6485,$117.6,$133.77,$38.5483,$139.65,$36.3663,$139.65,$139.65,$145.6485,$100.3275,$129.36,$135.24
,CDM,4230002160.10.4230,ER FEE OPEN CHEST HEART MASSAG,CDM Code,Outpatient,32160,"$2,843.",$703.3298,"$2,700.85","$2,274.4","$2,587.13",$745.5284,"$2,700.85",$703.3298,"$2,700.85","$2,700.85",$284.3,"$1,940.3475","$1,140.5","$2,615.56"
,CDM,4230002201.10.4230,ER FEE CORNEA REMOVE FB,CDM Code,Outpatient,65220,$632.,$156.3505,$703.8387,$505.6,$575.12,$165.7313,$600.4,$156.3505,$600.4,$600.4,$703.8387,$431.34,$556.16,$581.44
,CDM,4230002366.10.4230,ER FEE CLSD TX SHOULDER DISLOC,CDM Code,Outpatient,23665,$949.,$234.7731,"$3,250.5114",$759.2,$863.59,$248.8591,$901.55,$234.7731,$901.55,$901.55,"$3,250.5114",$647.6925,$609.,$873.08
,CDM,4230002450.10.4230,ER FEE CL HUMERAL SHAFT FX NO,CDM Code,Outpatient,24500,$656.,$162.2878,$623.2,$524.8,$596.96,$172.0248,$623.2,$162.2878,$623.2,$623.2,$533.5461,$447.72,$514.,$603.52
,CDM,4230002460.10.4230,ER FEE REPAIR OF VAGINA,CDM Code,Outpatient,57200,"$3,456.",$854.9798,"$5,568.2049","$2,764.8","$3,144.96",$906.2772,"$3,283.2",$854.9798,"$3,283.2","$3,283.2","$5,568.2049","$2,358.72","$3,041.28","$3,179.52"
,CDM,4230002465.10.4230,ER FEE THROAT SURGERY PROCEDUR,CDM Code,Outpatient,42999,$510.,$126.1689,$484.5,$408.,$464.1,$133.7388,$484.5,$126.1689,$484.5,$484.5,$472.8303,$348.075,$448.8,$469.2
,CDM,4230002667.10.4230,ER FEE CL TX DISLOC CMC W/MANI,CDM Code,Outpatient,26670,$686.,$169.7095,$651.7,$548.8,$624.26,$179.8918,$651.7,$169.7095,$651.7,$651.7,$533.5461,$468.195,$489.5,$631.12
,CDM,4230002670.10.4230,ER FEE CL TX MP DIS W/MAN X1,CDM Code,Outpatient,26700,$499.,$123.4476,$533.5461,$399.2,$454.09,$130.8543,$474.05,$123.4476,$474.05,$474.05,$533.5461,$340.5675,$463.,$459.08
,CDM,4230002671.10.4230,ER FEE CLTX SUPRACONDYLR FR W/,CDM Code,Outpatient,24535,"$1,815.",$449.0129,"$3,250.5114","$1,452.","$1,651.65",$475.9529,"$1,724.25",$449.0129,"$1,724.25","$1,724.25","$3,250.5114","$1,238.7375",$885.,"$1,669.8"
,CDM,4230002672.10.4230,ER FEE CLSD PHALANX SHAFT W/MA,CDM Code,Outpatient,26725,$651.,$161.0509,$618.45,$520.8,$592.41,$170.7137,$618.45,$161.0509,$618.45,$618.45,$533.5461,$444.3075,$481.5,$598.92
,CDM,4230002673.10.4230,ER FEECLSD TX RAD/ULNA SHAFT F,CDM Code,Outpatient,25565,$711.,$175.8943,"$3,250.5114",$568.8,$647.01,$186.4477,$675.45,$175.8943,$675.45,$675.45,"$3,250.5114",$485.2575,$740.,$654.12
,CDM,4230002674.10.4230,ER FEE CLSD TX FX W MAN FING J,CDM Code,Outpatient,26742,$661.,$163.5248,"$3,250.5114",$528.8,$601.51,$173.336,$627.95,$163.5248,$627.95,$627.95,"$3,250.5114",$451.1325,$530.,$608.12
,CDM,4230002676.10.4230,ER FEE OPEN TX PHAL/FINGER FX,CDM Code,Outpatient,26765,"$8,117.",$718.5,"$7,711.15","$6,493.6","$7,386.47","$2,128.5453","$7,711.15","$2,008.0646","$7,711.15","$7,711.15","$6,510.3678","$5,539.8525",$718.5,"$7,467.64"
,CDM,4230002695.10.4230,ER FEE AMP FINGER W/DIRECT CLO,CDM Code,Outpatient,26951,"$4,597.",$924.,"$6,510.3678","$3,677.6","$4,183.27","$1,205.4851","$4,367.15","$1,137.2518","$4,367.15","$4,367.15","$6,510.3678","$3,137.4525",$924.,"$4,229.24"
,CDM,4230002700.10.4230,ER FEE F&D PERITONSILLAR ABSCE,CDM Code,Outpatient,42700,$676.,$167.2356,$642.2,$540.8,$615.16,$177.2695,$642.2,$167.2356,$642.2,$642.2,$472.8303,$461.37,$269.5,$621.92
,CDM,4230002701.10.4230,ED FEE REPLACE G/C TUBE PERC,CDM Code,Outpatient,49450,"$1,904.",$471.0306,"$1,868.4393","$1,523.2","$1,732.64",$499.2916,"$1,808.8",$471.0306,"$1,808.8","$1,808.8","$1,868.4393","$1,299.48","$1,675.52","$1,751.68"
,CDM,4230002709.10.4230,ER FEE LUMBAR PUNCTURE DX,CDM Code,Outpatient,62270,"$1,642.",$406.2144,"$1,559.9","$1,313.6","$1,494.22",$430.5866,"$1,559.9",$406.2144,"$1,559.9","$1,559.9","$1,354.1973","$1,120.665","$1,444.96","$1,510.64"
,CDM,4230002714.10.4230,ER FEE TREAT MOUTH ROOF FRACT,CDM Code,Outpatient,21421,"$5,578.","$1,057.5","$5,803.7523","$4,462.4","$5,075.98","$1,462.7357","$5,299.1","$1,379.9414","$5,299.1","$5,299.1","$5,803.7523","$3,806.985","$1,057.5","$5,131.76"
,CDM,4230002715.10.4230,ER FEE TREAT DISLOCATION/FRACT,CDM Code,Outpatient,23675,"$3,284.",$785.5,"$3,250.5114","$2,627.2","$2,988.44",$861.1732,"$3,119.8",$812.4288,"$3,119.8","$3,119.8","$3,250.5114","$2,241.33",$785.5,"$3,021.28"
,CDM,4230002721.10.4230,ER FEE I&D OF VULVA/PERINEUM,CDM Code,Outpatient,56405,$660.,$163.2774,$736.2792,$528.,$600.6,$173.0738,$627.,$163.2774,$627.,$627.,$736.2792,$450.45,$580.8,$607.2
,CDM,4230002722.10.4230,ER FEE INCISION OF RECTAL ABSC,CDM Code,Outpatient,46040,"$4,361.","$1,078.8678","$4,142.95","$3,488.8","$3,968.51","$1,143.5981","$4,142.95","$1,078.8678","$4,142.95","$4,142.95","$2,343.192","$2,976.3825","$3,837.68","$4,012.12"
,CDM,4230002725.10.4230,ER FEE THERAPEUTIC PHLEBOTOMY,CDM Code,Outpatient,99195,$267.,$66.0531,$253.65,$213.6,$242.97,$70.0162,$253.65,$66.0531,$253.65,$253.65,$145.6485,$182.2275,$144.5,$245.64
,CDM,4230002726.10.4230,ER FEE DRAINAGE OF MOUTH LESIO,CDM Code,Outpatient,41017,"$5,579.",$646.,"$5,803.7523","$4,463.2","$5,076.89","$1,462.9979","$5,300.05","$1,380.1888","$5,300.05","$5,300.05","$5,803.7523","$3,807.6675",$646.,"$5,132.68"
,CDM,4230002730.10.4230,ERFEE CLSDTX ULNARSHAFT FX W/M,CDM Code,Outpatient,25535,$500.,$123.695,$696.,$400.,$455.,$131.1165,$475.,$123.695,$475.,$475.,$533.5461,$341.25,$696.,$460.
,CDM,4230002775.10.4230,ER FEE CLSD DSTL TIB/FIB W MAN,CDM Code,Outpatient,27752,$609.,$150.6605,"$3,250.5114",$487.2,$554.19,$159.6999,$578.55,$150.6605,$578.55,$578.55,"$3,250.5114",$415.6425,$768.,$560.28
,CDM,4230002781.10.4230,ER FEE CLSD REDUCT TRIMALLEOL,CDM Code,Outpatient,27818,"$1,150.",$284.4985,"$3,250.5114",$920.,"$1,046.5",$301.568,"$1,092.5",$284.4985,"$1,092.5","$1,092.5","$3,250.5114",$784.875,$693.5,"$1,058."
,CDM,4230002819.10.4230,ER FEE REMOVE FB FOOT SUBQ,CDM Code,Outpatient,28190,"$1,022.",$252.8326,"$1,439.4237",$817.6,$930.02,$268.0021,$970.9,$252.8326,$970.9,$970.9,"$1,439.4237",$697.515,$373.5,$940.24
,CDM,4230002820.10.4230,"ER FEE RPR EXT TENDON FOOT, EA",CDM Code,Outpatient,28208,"$5,143.",$694.5,"$6,510.3678","$4,114.4","$4,680.13","$1,348.6643","$4,885.85","$1,272.3268","$4,885.85","$4,885.85","$6,510.3678","$3,510.0975",$694.5,"$4,731.56"
,CDM,4230002918.10.4230,ER FEE CRITICAL CARE,CDM Code,Outpatient,99291,"$4,595.",$388.,"$4,365.25","$3,676.","$4,181.45","$1,204.9606","$4,365.25","$1,136.757","$4,365.25","$4,365.25","$1,834.7439","$3,136.0875",$388.,"$4,227.4"
,CDM,4230003005.10.4230,ER FEE ASPIRATE PLEURA W/ IMAG,CDM Code,Outpatient,32555,"$1,269.",$313.9379,"$1,826.6271","$1,015.2","$1,154.79",$332.7737,"$1,205.55",$313.9379,"$1,205.55","$1,205.55","$1,826.6271",$866.0925,$413.,"$1,167.48"
,CDM,4230003006.10.4230,ER FEE NASAL FB REMOVAL,CDM Code,Outpatient,30300,$402.,$99.4508,$381.9,$321.6,$365.82,$105.4177,$381.9,$99.4508,$381.9,$381.9,$267.0534,$274.365,$251.,$369.84
,CDM,4230003014.10.4230,ORIGINATING SITE FEE,CDM Code,Outpatient,Q3014,$80.,$19.7912,$76.,$64.,$72.8,$20.9786,$76.,$19.7912,$76.,$76.,$8.,$54.6,$70.4,$73.6
,CDM,4230003020.10.4230,ER FEE CLSD TX HIP PROSTHES NO,CDM Code,Outpatient,27265,"$1,935.",$478.6997,"$1,838.25","$1,548.","$1,760.85",$507.4209,"$1,838.25",$478.6997,"$1,838.25","$1,838.25",$533.5461,"$1,320.6375",$572.5,"$1,780.2"
,CDM,4230003021.10.4230,ER FEE LTRL MALLEOLUS FX NO MA,CDM Code,Outpatient,27786,$686.,$169.7095,$651.7,$548.8,$624.26,$179.8918,$651.7,$169.7095,$651.7,$651.7,$533.5461,$468.195,$452.,$631.12
,CDM,4230003022.10.4230,ER FEE LAT MALLEOLUS FX W/MAN,CDM Code,Outpatient,27788,$686.,$169.7095,$651.7,$548.8,$624.26,$179.8918,$651.7,$169.7095,$651.7,$651.7,$533.5461,$468.195,$603.,$631.12
,CDM,4230003024.10.4230,ER FEE TOE FX 2-5 NO MANIP EAC,CDM Code,Outpatient,28510,$632.,$156.3505,$600.4,$505.6,$575.12,$165.7313,$600.4,$156.3505,$600.4,$600.4,$533.5461,$431.34,$178.5,$581.44
,CDM,4230003029.10.4230,ER FEE KNEE STRAPPING,CDM Code,Outpatient,29530,$147.,$36.3663,$145.6485,$117.6,$133.77,$38.5483,$139.65,$36.3663,$139.65,$139.65,$145.6485,$100.3275,$42.5,$135.24
,CDM,4230003031.10.4230,ER FEE IRRIG CORPORA CAVERN PR,CDM Code,Outpatient,54220,"$1,241.",$307.011,"$1,178.95",$992.8,"$1,129.31",$325.4312,"$1,178.95",$307.011,"$1,178.95","$1,178.95",$576.8268,$846.9825,"$1,092.08","$1,141.72"
,CDM,4230003037.10.4230,ER FEE PROX/MID PHALYNX SHAFT,CDM Code,Outpatient,26720,$227.,$56.1575,$533.5461,$181.6,$206.57,$59.5269,$215.65,$56.1575,$215.65,$215.65,$533.5461,$154.9275,$284.,$208.84
,CDM,4230003039.10.4230,ER FEE CHANGE GASTROSTOMY TUBE,CDM Code,Outpatient,43762,"$1,316.",$315.5,"$1,250.2","$1,052.8","$1,197.56",$345.0986,"$1,250.2",$325.5652,"$1,250.2","$1,250.2",$617.8914,$898.17,$315.5,"$1,210.72"
,CDM,4230003042.10.4230,ER FEE REMOVAL TUNNELED CV CAT,CDM Code,Outpatient,36590,"$1,550.",$316.5,"$1,826.6271","$1,240.","$1,410.5",$406.4611,"$1,472.5",$383.4545,"$1,472.5","$1,472.5","$1,826.6271","$1,057.875",$316.5,"$1,426."
,CDM,4230003045.10.4230,ED FEE ABD PARACENTESIS W/IMAG,CDM Code,Outpatient,49083,"$1,750.",$432.9325,"$1,868.4393","$1,400.","$1,592.5",$458.9077,"$1,662.5",$432.9325,"$1,662.5","$1,662.5","$1,868.4393","$1,194.375","$1,540.","$1,610."
,CDM,4230003104.10.4230,ER FEE NASAL FX,CDM Code,Outpatient,21310,$839.5,$193.5,$797.525,$671.6,$763.945,$220.1446,$797.525,$207.6839,$797.525,$797.525,$533.5461,$572.9588,$193.5,$772.34
,CDM,4230003122.10.4230,ER FEE LAC RPR SCALP EA ADD 5,CDM Code,Outpatient,13122,$309.,$76.4435,$293.55,$247.2,$281.19,$81.03,$293.55,$76.4435,$293.55,$293.55,$30.9,$210.8925,$189.5,$284.28
,CDM,4230003208.10.4230,ER FEE THROMBOSED HEMMORRHOID,CDM Code,Outpatient,46320,"$3,209.",$793.8745,"$3,048.55","$2,567.2","$2,920.19",$841.5057,"$3,048.55",$793.8745,"$3,048.55","$3,048.55","$2,343.192","$2,190.1425","$2,823.92","$2,952.28"
,CDM,4230003322.10.4230,ER FEE TRAUMA RESPONSE TEAM,CDM Code,Outpatient,G0390,"$2,803.",$693.4342,"$2,662.85","$2,242.4","$2,550.73",$735.0391,"$2,662.85",$693.4342,"$2,662.85","$2,662.85","$2,328.4269","$1,913.0475","$2,466.64","$2,578.76"
,CDM,4230003600.10.4230,ER FEE HUMERUS FX W/O MANIP (5,CDM Code,Outpatient,23600,"$1,577.",$390.134,"$1,498.15","$1,261.6","$1,435.07",$413.5414,"$1,498.15",$390.134,"$1,498.15","$1,498.15",$533.5461,"$1,076.3025",$468.,"$1,450.84"
,CDM,4230003605.10.4230,ER FEE HUMERAL NECK FX W/ MANI,CDM Code,Outpatient,23605,$818.,$202.365,"$3,250.5114",$654.4,$744.38,$214.5066,$777.1,$202.365,$777.1,$777.1,"$3,250.5114",$558.285,$663.5,$752.56
,CDM,4230004107.10.4230,ER FEE EXT TENDON HAND,CDM Code,Outpatient,26410,"$4,527.",$800.5,"$6,510.3678","$3,621.6","$4,119.57","$1,187.1288","$4,300.65","$1,119.9345","$4,300.65","$4,300.65","$6,510.3678","$3,089.6775",$800.5,"$4,164.84"
,CDM,4230004479.10.4230,ER FEE CHANGE JEJUNOSTOMY TUBE,CDM Code,Outpatient,44300,$767.,$189.7481,$728.65,$613.6,$697.97,$201.1327,$728.65,$189.7481,$728.65,$728.65,$76.7,$523.4775,$674.96,$705.64
,CDM,4230004505.10.4230,ER FEE PERIPHERAL NERVE BLOCK,CDM Code,Outpatient,64450,"$1,047.",$259.0173,"$1,354.1973",$837.6,$952.77,$274.558,$994.65,$259.0173,$994.65,$994.65,"$1,354.1973",$714.5775,$921.36,$963.24
,CDM,4230004600.10.4230,ER FEE DISLOC ELBOW W/O ANESTH,CDM Code,Outpatient,24600,$632.,$156.3505,$600.4,$505.6,$575.12,$165.7313,$600.4,$156.3505,$600.4,$600.4,$533.5461,$431.34,$523.,$581.44
,CDM,4230004805.10.4230,ER FEE TMJ DISLOCATION,CDM Code,Outpatient,21480,$423.,$104.646,$533.5461,$338.4,$384.93,$110.9246,$401.85,$104.646,$401.85,$401.85,$533.5461,$288.6975,$141.,$389.16
,CDM,4230004891.10.4230,ER FEE CENTRAL LINE,CDM Code,Outpatient,36569,"$3,074.",$351.5,"$2,920.3","$2,459.2","$2,797.34",$806.1042,"$2,920.3",$760.4769,"$2,920.3","$2,920.3","$1,826.6271","$2,098.005",$351.5,"$2,828.08"
,CDM,4230005000.10.4230,ER FEE ENDOTRACHEAL INTUBATION,CDM Code,Outpatient,31500,$840.,$203.,$798.,$672.,$764.4,$220.2757,$798.,$207.8076,$798.,$798.,$472.8303,$573.3,$203.,$772.8
,CDM,4230005054.10.4230,ER FEE CLSD TX KNEE DISLOCAT W,CDM Code,Outpatient,27550,$688.,$170.2043,$735.,$550.4,$626.08,$180.4163,$653.6,$170.2043,$653.6,$653.6,$533.5461,$469.56,$735.,$632.96
,CDM,4230005170.10.4230,ER FEE CHANGE CYSTOSTOMY TUBE,CDM Code,Outpatient,51705,$732.,$181.0895,$695.4,$585.6,$666.12,$191.9546,$695.4,$181.0895,$695.4,$695.4,$576.8268,$499.59,$644.16,$673.44
,CDM,4230005506.10.4230,ER FEE INJ TENDON/LIGAMENT,CDM Code,Outpatient,20550,$759.,$75.5,$721.05,$607.2,$690.69,$199.0348,$721.05,$187.769,$721.05,$721.05,$616.77,$518.0175,$75.5,$698.28
,CDM,4230005560.10.4230,ER FEE ULNAR/RADIAL FX (54),CDM Code,Outpatient,25560,$632.,$156.3505,$600.4,$505.6,$575.12,$165.7313,$600.4,$156.3505,$600.4,$600.4,$533.5461,$431.34,$399.,$581.44
,CDM,4230005600.10.4230,ER FEE DISTAL RADIAL FX (54),CDM Code,Outpatient,25600,"$1,091.",$269.9025,"$1,036.45",$872.8,$992.81,$286.0962,"$1,036.45",$269.9025,"$1,036.45","$1,036.45",$533.5461,$744.6075,$471.,"$1,003.72"
,CDM,4230005608.10.4230,ER FEE PATELLA DISLOC W/O ANES,CDM Code,Outpatient,27560,$604.,$149.4236,$573.8,$483.2,$549.64,$158.3887,$573.8,$149.4236,$573.8,$573.8,$533.5461,$412.23,$521.5,$555.68
,CDM,4230006040.10.4230,ER FEE LEVEL 1 SERVICE,CDM Code,Outpatient,99281,$354.,$87.5761,$336.3,$283.2,$322.14,$92.8305,$336.3,$87.5761,$336.3,$336.3,$163.8579,$241.605,$311.52,$325.68
,CDM,4230006041.10.4230,ER FEE LEVEL 2 SERVICE,CDM Code,Outpatient,99282,$471.,$116.5207,$447.45,$376.8,$428.61,$123.5117,$447.45,$116.5207,$447.45,$447.45,$297.6249,$321.4575,$414.48,$433.32
,CDM,4230006042.10.4230,ER FEE LEVEL 3 SERVICE,CDM Code,Outpatient,99283,$878.,$217.2084,$834.1,$702.4,$798.98,$230.2406,$834.1,$217.2084,$834.1,$834.1,$537.3375,$599.235,$772.64,$807.76
,CDM,4230006043.10.4230,ER FEE LEVEL 4 SERVICE,CDM Code,Outpatient,99284,"$1,905.",$471.2779,"$1,809.75","$1,524.","$1,733.55",$499.5539,"$1,809.75",$471.2779,"$1,809.75","$1,809.75",$887.5347,"$1,300.1625","$1,676.4","$1,752.6"
,CDM,4230006044.10.4230,ER FEE LEVEL 5 SERVICE,CDM Code,Outpatient,99285,"$2,888.",$714.4623,"$2,743.6","$2,310.4","$2,628.08",$757.3289,"$2,743.6",$714.4623,"$2,743.6","$2,743.6","$1,304.9358","$1,971.06","$2,541.44","$2,656.96"
,CDM,4230006108.10.4230,ER FEE ARTHROCENTESIS-LARGE,CDM Code,Outpatient,20610,$429.,$86.,$616.77,$343.2,$390.39,$112.498,$407.55,$106.1303,$407.55,$407.55,$616.77,$292.7925,$86.,$394.68
,CDM,4230006444.10.4230,ER FEE N BLOCK INJ FEM SINGLE,CDM Code,Outpatient,64447,"$1,268.",$313.6905,"$1,354.1973","$1,014.4","$1,153.88",$332.5114,"$1,204.6",$313.6905,"$1,204.6","$1,204.6","$1,354.1973",$865.41,"$1,115.84","$1,166.56"
,CDM,4230006450.10.4230,ER FEE N BLOCK SPENOPAL GANGL,CDM Code,Outpatient,64505,$578.,$142.9914,$616.77,$462.4,$525.98,$151.5707,$549.1,$142.9914,$549.1,$549.1,$616.77,$394.485,$508.64,$531.76
,CDM,4230006500.10.4230,ER FEE RADIAL HEAD FX,CDM Code,Outpatient,24650,$504.,$124.6846,$533.5461,$403.2,$458.64,$132.1654,$478.8,$124.6846,$478.8,$478.8,$533.5461,$343.98,$375.5,$463.68
,CDM,4230006501.10.4230,ER FEE DISLOC SHLDER W/MANIP (,CDM Code,Outpatient,23650,"$1,719.",$425.2634,"$1,633.05","$1,375.2","$1,564.29",$450.7785,"$1,633.05",$425.2634,"$1,633.05","$1,633.05",$533.5461,"$1,173.2175",$451.,"$1,581.48"
,CDM,4230006580.10.4230,ER FEE SKIN TEST TB INTRADERMA,CDM Code,Outpatient,86580,$93.,$11.5,$88.35,$74.4,$84.63,$24.3877,$88.35,$23.0073,$88.35,$88.35,$33.6951,$63.4725,$11.5,$85.56
,CDM,4230006601.10.4230,ER FEE METACARPAL FX (54),CDM Code,Outpatient,26600,$632.,$156.3505,$600.4,$505.6,$575.12,$165.7313,$600.4,$156.3505,$600.4,$600.4,$533.5461,$431.34,$421.5,$581.44
,CDM,4230006708.10.4230,ER FEE ULNAR FX (54),CDM Code,Outpatient,24670,$509.,$125.9215,$533.5461,$407.2,$463.19,$133.4766,$483.55,$125.9215,$483.55,$483.55,$533.5461,$347.3925,$417.,$468.28
,CDM,4230006709.10.4230,ER FEE DRAINAGE OF NOSE LESION,CDM Code,Outpatient,30000,$443.,$109.5938,$472.8303,$354.4,$403.13,$116.1692,$420.85,$109.5938,$420.85,$420.85,$472.8303,$302.3475,$322.5,$407.56
,CDM,4230006759.10.4230,ER FEE BLADDER IRRIGATION SIMP,CDM Code,Outpatient,51700,$761.,$188.2638,$722.95,$608.8,$692.51,$199.5593,$722.95,$188.2638,$722.95,$722.95,$576.8268,$519.3825,$669.68,$700.12
,CDM,4230006770.10.4230,ER FEE I&D EYELID ABSCESS,CDM Code,Outpatient,67700,$844.,$208.7972,$801.8,$675.2,$768.04,$221.3247,$801.8,$208.7972,$801.8,$801.8,$716.8683,$576.03,$742.72,$776.48
,CDM,4230006805.10.4230,ER FEE INTRAOSSEOUS INFUSION,CDM Code,Outpatient,36680,"$3,744.",$84.5,"$3,556.8","$2,995.2","$3,407.04",$981.8004,"$3,556.8",$926.2282,"$3,556.8","$3,556.8",$703.8387,"$2,555.28",$84.5,"$3,444.48"
,CDM,4230006900.10.4230,ER FEE I&D EXT EAR ABSCESS/HEM,CDM Code,Outpatient,69000,$549.,$135.8171,"$1,439.4237",$439.2,$499.59,$143.9659,$521.55,$135.8171,$521.55,$521.55,"$1,439.4237",$374.6925,$483.12,$505.08
,CDM,4230006926.10.4230,ER FEE DEBRIDE INFECTED SKIN,CDM Code,Outpatient,11000,"$1,208.",$78.,"$1,209.777",$966.4,"$1,099.28",$316.7775,"$1,147.6",$298.8471,"$1,147.6","$1,147.6","$1,209.777",$824.46,$78.,"$1,111.36"
,CDM,4230006937.10.4230,ER FEE TRIM NAIL(S) ANY NUMBER,CDM Code,Outpatient,11719,$140.,$20.5,$145.6485,$112.,$127.4,$36.7126,$133.,$34.6346,$133.,$133.,$145.6485,$95.55,$20.5,$128.8
,CDM,4230006938.10.4230,ER FEE DEBRIDE NAIL 1-5,CDM Code,Outpatient,11720,$140.,$34.6346,$145.6485,$112.,$127.4,$36.7126,$133.,$34.6346,$133.,$133.,$145.6485,$95.55,$47.,$128.8
,CDM,4230006942.10.4230,ER FEE CLOSURE OF SPLIT WOUND,CDM Code,Outpatient,12020,"$1,208.",$298.8471,"$1,209.777",$966.4,"$1,099.28",$316.7775,"$1,147.6",$298.8471,"$1,147.6","$1,147.6","$1,209.777",$824.46,$400.,"$1,111.36"
,CDM,4230006974.10.4230,ER FEE  CLOSED TX NOSE FX W/ S,CDM Code,Outpatient,21320,"$5,239.",$360.,"$5,803.7523","$4,191.2","$4,767.49","$1,373.8387","$4,977.05","$1,296.0762","$4,977.05","$4,977.05","$5,803.7523","$3,575.6175",$360.,"$4,819.88"
,CDM,4230007011.10.4230,ER FEE CLTX GREATERHUMERUS W/M,CDM Code,Outpatient,23625RT,"$3,389.",$541.5,"$3,250.5114","$2,711.2","$3,083.99",$888.7076,"$3,219.55",$838.4047,"$3,219.55","$3,219.55","$3,250.5114","$2,312.9925",$541.5,"$3,117.88"
,CDM,4230007014.10.4230,ER FEE TREAT SHOULDR DISLOC LT,CDM Code,Outpatient,23655LT,"$3,284.",$576.,"$3,250.5114","$2,627.2","$2,988.44",$861.1732,"$3,119.8",$812.4288,"$3,119.8","$3,119.8","$3,250.5114","$2,241.33",$576.,"$3,021.28"
,CDM,4230007015.10.4230,ER FEE TREAT SHOULDR DISLOC RT,CDM Code,Outpatient,23655RT,"$3,284.",$576.,"$3,250.5114","$2,627.2","$2,988.44",$861.1732,"$3,119.8",$812.4288,"$3,119.8","$3,119.8","$3,250.5114","$2,241.33",$576.,"$3,021.28"
,CDM,4230007044.10.4230,ER FEE RADIAL HEAD FX RT,CDM Code,Outpatient,24620RT,"$2,711.",$670.6743,"$3,250.5114","$2,168.8","$2,467.01",$710.9137,"$2,575.45",$670.6743,"$2,575.45","$2,575.45","$3,250.5114","$1,850.2575",$791.,"$2,494.12"
,CDM,4230007132.10.4230,ER FEE CLSD PHALANX SHAFT F3,CDM Code,Outpatient,26725F3,$651.,$161.0509,$618.45,$520.8,$592.41,$170.7137,$618.45,$161.0509,$618.45,$618.45,$533.5461,$444.3075,$481.5,$598.92
,CDM,4230007133.10.4230,ER FEE CLSD PHALANX SHAFT,CDM Code,Outpatient,26725F4,$651.,$161.0509,$618.45,$520.8,$592.41,$170.7137,$618.45,$161.0509,$618.45,$618.45,$533.5461,$444.3075,$481.5,$598.92
,CDM,4230007134.10.4230,ER FEE CLSD PHALX SHFT W/MA W/,CDM Code,Outpatient,26725F5,$651.,$161.0509,$618.45,$520.8,$592.41,$170.7137,$618.45,$161.0509,$618.45,$618.45,$533.5461,$444.3075,$481.5,$598.92
,CDM,4230007136.10.4230,ER FEE CLSD PHLNX SHFT W/MA F7,CDM Code,Outpatient,26725F7,$651.,$161.0509,$618.45,$520.8,$592.41,$170.7137,$618.45,$161.0509,$618.45,$618.45,$533.5461,$444.3075,$481.5,$598.92
,CDM,4230007137.10.4230,ER FEE CLSD PHALANX SHAFT W/MA,CDM Code,Outpatient,26725F8,$651.,$161.0509,$618.45,$520.8,$592.41,$170.7137,$618.45,$161.0509,$618.45,$618.45,$533.5461,$444.3075,$481.5,$598.92
,CDM,4230007138.10.4230,ER FEE CLSD PHALANX SHAFT W/MA,CDM Code,Outpatient,26725F9,$651.,$161.0509,$618.45,$520.8,$592.41,$170.7137,$618.45,$161.0509,$618.45,$618.45,$533.5461,$444.3075,$481.5,$598.92
,CDM,4230007139.10.4230,ER FEE CLSD PHLNX SHFT W/MA FA,CDM Code,Outpatient,26725FA,$651.,$161.0509,$618.45,$520.8,$592.41,$170.7137,$618.45,$161.0509,$618.45,$618.45,$533.5461,$444.3075,$481.5,$598.92
,CDM,4230007198.10.4230,ER FEEDIST PHAL FX W MANIPULAT,CDM Code,Outpatient,26755F8,$569.,$140.7649,$540.55,$455.2,$517.79,$149.2106,$540.55,$140.7649,$540.55,$540.55,$533.5461,$388.3425,$450.,$523.48
,CDM,4230007199.10.4230,ER FEEDIST PHAL FX W MANIP F9,CDM Code,Outpatient,26755F9,$569.,$140.7649,$540.55,$455.2,$517.79,$149.2106,$540.55,$140.7649,$540.55,$540.55,$533.5461,$388.3425,$450.,$523.48
,CDM,4230007212.10.4230,ER FEE TREAT FINGER DISLOCATIO,CDM Code,Outpatient,26770,$732.,$181.0895,$695.4,$585.6,$666.12,$191.9546,$695.4,$181.0895,$695.4,$695.4,$533.5461,$499.59,$395.,$673.44
,CDM,4230007218.10.4230,ER FEE CLSD TX IP JNT W/MN F8,CDM Code,Outpatient,26770F8,$732.,$181.0895,$695.4,$585.6,$666.12,$191.9546,$695.4,$181.0895,$695.4,$695.4,$533.5461,$499.59,$395.,$673.44
,CDM,4230007219.10.4230,ER FEE TREAT FINGER DISLOCATIO,CDM Code,Outpatient,26770,$732.,$181.0895,$695.4,$585.6,$666.12,$191.9546,$695.4,$181.0895,$695.4,$695.4,$533.5461,$499.59,$395.,$673.44
,CDM,4230007225.10.4230,ER FEE TREAT FINGER DISLOCATIO,CDM Code,Outpatient,26775F5,$589.,$145.7127,$589.4025,$471.2,$535.99,$154.4552,$559.55,$145.7127,$559.55,$559.55,$589.4025,$401.9925,$546.,$541.88
,CDM,4230007226.10.4230,ER FEE TREAT FINGER DISLOCATIO,CDM Code,Outpatient,26775F6,$589.,$145.7127,$589.4025,$471.2,$535.99,$154.4552,$559.55,$145.7127,$559.55,$559.55,$589.4025,$401.9925,$546.,$541.88
,CDM,4230007273.10.4230,ER FEE TRT HIP DISLOCATION RT,CDM Code,Outpatient,27257RT,$0.,$0.,"$3,250.5114",$0.,$0.,$0.,$0.,$0.,$0.,$0.,"$3,250.5114",$0.,$525.,$0.
,CDM,4230007282.10.4230,ER FEE REMOVAL OF FOREIGN BODY,CDM Code,Outpatient,27372,"$4,638.",$852.,"$5,737.5897","$3,710.4","$4,220.58","$1,216.2367","$4,406.1","$1,147.3948","$4,406.1","$4,406.1","$5,737.5897","$3,165.435",$852.,"$4,266.96"
,CDM,4230007303.10.4230,ER FEE NAIL AVULSION,CDM Code,Outpatient,11730,$239.,$59.1262,$408.8304,$191.2,$217.49,$62.6737,$227.05,$59.1262,$227.05,$227.05,$408.8304,$163.1175,$150.5,$219.88
,CDM,4230007402.10.4230,ER FEE EVACUAT SUBUNGUAL HEMAT,CDM Code,Outpatient,11740,$0.,$0.,$145.6485,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$145.6485,$0.,$71.5,$0.
,CDM,4230007505.10.4230,ER FEE TIBIA FX (54),CDM Code,Outpatient,27750,$613.,$151.6501,$582.35,$490.4,$557.83,$160.7488,$582.35,$151.6501,$582.35,$582.35,$533.5461,$418.3725,$497.,$563.96
,CDM,4230007597.10.4230,ER FEE DEBRIDE SHARP OPN WOUND,CDM Code,Outpatient,97597,$317.,$78.4226,$408.8304,$253.6,$288.47,$83.1279,$301.15,$78.4226,$301.15,$301.15,$408.8304,$216.3525,$118.5,$291.64
,CDM,4230007704.10.4230,ER FEE CLSD TX IP JOINT W/MANI,CDM Code,Outpatient,26770,$732.,$181.0895,$695.4,$585.6,$666.12,$191.9546,$695.4,$181.0895,$695.4,$695.4,$533.5461,$499.59,$395.,$673.44
,CDM,4230007768.10.4230,ER FEE CLTX POST ANKLE FX W/MN,CDM Code,Outpatient,27768,"$3,375.",$633.,"$3,250.5114","$2,700.","$3,071.25",$885.0364,"$3,206.25",$834.9412,"$3,206.25","$3,206.25","$3,250.5114","$2,303.4375",$633.,"$3,105."
,CDM,4230007769.10.4230,ER FEE PENILE INJECTION,CDM Code,Outpatient,54235,$579.,$143.2388,$576.8268,$463.2,$526.89,$151.8329,$550.05,$143.2388,$550.05,$550.05,$576.8268,$395.1675,$509.52,$532.68
,CDM,4230007770.10.4230,ER FEE EXPLORATION OF CHEST,CDM Code,Outpatient,32100,"$2,843.",$703.3298,"$2,700.85","$2,274.4","$2,587.13",$745.5284,"$2,700.85",$703.3298,"$2,700.85","$2,700.85",$284.3,"$1,940.3475","$1,168.","$2,615.56"
,CDM,4230007908.10.4230,ER FEE TREAT BIG TOE FRACTURE,CDM Code,Outpatient,28495TA,$0.,$0.,$533.5461,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$533.5461,$0.,$256.,$0.
,CDM,4230007922.10.4230,ER FEE REDUCT TOE FX W/MANIPUL,CDM Code,Outpatient,28515T4,$546.,$135.0749,$533.5461,$436.8,$496.86,$143.1792,$518.7,$135.0749,$518.7,$518.7,$533.5461,$372.645,$233.,$502.32
,CDM,4230007925.10.4230,ER FEE REDUCT TOE FX W/MANIPUL,CDM Code,Outpatient,28515T8,$546.,$135.0749,$533.5461,$436.8,$496.86,$143.1792,$518.7,$135.0749,$518.7,$518.7,$533.5461,$372.645,$233.,$502.32
,CDM,4230008020.10.4230,ER FEE FINGER SPLINT,CDM Code,Outpatient,29130F3,$348.,$59.5,$330.6,$278.4,$316.68,$91.2571,$330.6,$86.0917,$330.6,$330.6,$145.6485,$237.51,$59.5,$320.16
,CDM,4230008054.10.4230,ER FEE APPLY LONG LEG SPLINT,CDM Code,Outpatient,2950550,"$1,780.",$122.,"$1,691.","$1,424.","$1,619.8",$466.7747,"$1,691.",$440.3542,"$1,691.","$1,691.",$334.1505,"$1,214.85",$122.,"$1,637.6"
,CDM,4230008089.10.4230,ER FEE NASAL ANTERIOR BLEEDING,CDM Code,Outpatient,3090150,$704.,$174.1626,$668.8,$563.2,$640.64,$184.612,$668.8,$174.1626,$668.8,$668.8,$267.0534,$480.48,$193.5,$647.68
,CDM,4230008090.10.4230,ER FEE ANT/NASL HEM COM BI,CDM Code,Outpatient,3090350,"$1,190.",$294.3941,"$1,130.5",$952.,"$1,082.9",$312.0573,"$1,130.5",$294.3941,"$1,130.5","$1,130.5",$267.0534,$812.175,$297.5,"$1,094.8"
,CDM,4230008095.10.4230,ER FEE INCISION OF WINDPIPE,CDM Code,Outpatient,31605,$510.,$126.1689,"$1,181.7954",$408.,$464.1,$133.7388,$484.5,$126.1689,$484.5,$484.5,"$1,181.7954",$348.075,$481.5,$469.2
,CDM,4230008096.10.4230,ER FEE CHEST TUBE INSERTION BI,CDM Code,Outpatient,3255150,"$2,460.",$227.,"$2,337.","$1,968.","$2,238.6",$645.0932,"$2,337.",$608.5794,"$2,337.","$2,337.","$1,826.6271","$1,678.95",$227.,"$2,263.2"
,CDM,4230008103.10.4230,ER FEE TEMPORARY PACEMAKER,CDM Code,Outpatient,33210,"$7,556.",$239.,"$18,627.4419","$6,044.8","$6,875.96","$1,981.4325","$7,178.2","$1,869.2788","$7,178.2","$7,178.2","$18,627.4419","$5,156.97",$239.,"$6,951.52"
,CDM,4230008120.10.4230,ER FEE DRAINAGE MOUTH ROOF LES,CDM Code,Outpatient,42000,$408.,$100.9351,$472.8303,$326.4,$371.28,$106.9911,$387.6,$100.9351,$387.6,$387.6,$472.8303,$278.46,$218.5,$375.36
,CDM,4230008123.10.4230,ER FEE CHANGE GASTROSTOMY TUBE,CDM Code,Outpatient,43762,"$1,316.",$315.5,"$1,250.2","$1,052.8","$1,197.56",$345.0986,"$1,250.2",$325.5652,"$1,250.2","$1,250.2",$617.8914,$898.17,$315.5,"$1,210.72"
,CDM,4230008149.10.4230,ER FEE IRRGT IMPACTD EARWX BIL,CDM Code,Outpatient,6920950,$294.,$72.7327,$279.3,$235.2,$267.54,$77.0965,$279.3,$72.7327,$279.3,$279.3,$145.6485,$200.655,$258.72,$270.48
,CDM,4230008165.10.4230,ER FEE HEART/LUNG RESUSCITATIO,CDM Code,Outpatient,92950,$633.,$156.5979,$620.2677,$506.4,$576.03,$165.9935,$601.35,$156.5979,$601.35,$601.35,$620.2677,$432.0225,$432.,$582.36
,CDM,4230008178.10.4230,"ER FEE IV INFUSION HYDRAT,1ST",CDM Code,Outpatient,96360XU,$510.,$66.,$484.5,$408.,$464.1,$133.7388,$484.5,$126.1689,$484.5,$484.5,$479.9859,$348.075,$66.,$469.2
,CDM,4230008179.10.4230,"ER FEE IV HYDRATION, EACH ADD",CDM Code,Outpatient,96361XU,$259.,$19.5,$246.05,$207.2,$235.69,$67.9183,$246.05,$64.074,$246.05,$246.05,$92.8626,$176.7675,$19.5,$238.28
,CDM,4230008180.10.4230,ER FEE THER/PROPH/DIAG INFUS,CDM Code,Outpatient,96365XU,$678.,$103.,$644.1,$542.4,$616.98,$177.794,$644.1,$167.7304,$644.1,$644.1,$479.9859,$462.735,$103.,$623.76
,CDM,4230008181.10.4230,ER FEE THER/PROPH/DIAG INFUS,CDM Code,Outpatient,96366XU,$436.,$31.,$414.2,$348.8,$396.76,$114.3336,$414.2,$107.862,$414.2,$414.2,$92.8626,$297.57,$31.,$401.12
,CDM,4230008182.10.4230,ER FEE TX/PROPH/DG SEQ INFUS,CDM Code,Outpatient,96367XU,$276.,$44.5,$262.2,$220.8,$251.16,$72.3763,$262.2,$68.2796,$262.2,$262.2,$141.9639,$188.37,$44.5,$253.92
,CDM,4230008183.10.4230,ER FEE THER/DIAG CONCURRENT I,CDM Code,Outpatient,96368XU,$260.,$29.5,$247.,$208.,$236.6,$68.1806,$247.,$64.3214,$247.,$247.,$26.,$177.45,$29.5,$239.2
,CDM,4230008184.10.4230,"ER FEE INJECTION,SC/1M",CDM Code,Outpatient,96372XU,$170.,$29.,$161.5,$136.,$154.7,$44.5796,$161.5,$42.0563,$161.5,$161.5,$141.9639,$116.025,$29.,$156.4
,CDM,4230008185.10.4230,ER FEE THER/PROPH/DG INJ IV P,CDM Code,Outpatient,96374XU,$365.,$65.5,$479.9859,$292.,$332.15,$95.715,$346.75,$90.2973,$346.75,$346.75,$479.9859,$249.1125,$65.5,$335.8
,CDM,4230008186.10.4230,ER FEE THER/PROPH/DG INJ IV A,CDM Code,Outpatient,96375XU,$231.,$25.5,$219.45,$184.8,$210.21,$60.5758,$219.45,$57.1471,$219.45,$219.45,$92.8626,$157.6575,$25.5,$212.52
,CDM,4230008187.10.4230,ER FEE THER/PROPH/DX IVSEQ SA,CDM Code,Outpatient,96376XU,$237.,$17.,$225.15,$189.6,$215.67,$62.1492,$225.15,$58.6314,$225.15,$225.15,$23.7,$161.7525,$17.,$218.04
,CDM,4230008198.10.4230,ER FEE LEVEL 1 SERVICE W/PROC,CDM Code,Outpatient,9928125,$354.,$87.5761,$336.3,$283.2,$322.14,$92.8305,$336.3,$87.5761,$336.3,$336.3,$163.8579,$241.605,$311.52,$325.68
,CDM,4230008199.10.4230,ER FEE LEVEL 2 SERVICE W/PROC,CDM Code,Outpatient,9928225,$471.,$116.5207,$447.45,$376.8,$428.61,$123.5117,$447.45,$116.5207,$447.45,$447.45,$297.6249,$321.4575,$414.48,$433.32
,CDM,4230008200.10.4230,ER FEE LEVEL 3 SERVICE W/PROC,CDM Code,Outpatient,9928325,$878.,$217.2084,$834.1,$702.4,$798.98,$230.2406,$834.1,$217.2084,$834.1,$834.1,$537.3375,$599.235,$772.64,$807.76
,CDM,4230008201.10.4230,ER FEE LEVEL 4 SERVICE W/PROC,CDM Code,Outpatient,9928425,"$1,905.",$471.2779,"$1,809.75","$1,524.","$1,733.55",$499.5539,"$1,809.75",$471.2779,"$1,809.75","$1,809.75",$887.5347,"$1,300.1625","$1,676.4","$1,752.6"
,CDM,4230008202.10.4230,ER FEE LEVEL 5 SERVICE W/PROC,CDM Code,Outpatient,9928525,"$2,888.",$714.4623,"$2,743.6","$2,310.4","$2,628.08",$757.3289,"$2,743.6",$714.4623,"$2,743.6","$2,743.6","$1,304.9358","$1,971.06","$2,541.44","$2,656.96"
,CDM,4230008203.10.4230,ER FEE CRITICAL CARE W/PROC,CDM Code,Outpatient,9929125,"$4,595.",$388.,"$4,365.25","$3,676.","$4,181.45","$1,204.9606","$4,365.25","$1,136.757","$4,365.25","$4,365.25","$1,834.7439","$3,136.0875",$388.,"$4,227.4"
,CDM,4230008212.10.4230,ER ORIGINATING SITE FEE,CDM Code,Outpatient,Q3014,$80.,$19.7912,$76.,$64.,$72.8,$20.9786,$76.,$19.7912,$76.,$76.,$8.,$54.6,$70.4,$73.6
,CDM,4230008404.10.4230,ER FEE ANKLE DISLOCATION (54),CDM Code,Outpatient,27840,$632.,$156.3505,$600.4,$505.6,$575.12,$165.7313,$600.4,$156.3505,$600.4,$600.4,$533.5461,$431.34,$531.,$581.44
,CDM,4230009011.10.4230,ER FEE NASAL ANTERIOR BLEEDING,CDM Code,Outpatient,30901,$352.,$87.0813,$334.4,$281.6,$320.32,$92.306,$334.4,$87.0813,$334.4,$334.4,$267.0534,$240.24,$193.5,$323.84
,CDM,4230009052.10.4230,ER FEE NASAL POST BLEEDING,CDM Code,Outpatient,30905,$844.,$208.7972,$801.8,$675.2,$768.04,$221.3247,$801.8,$208.7972,$801.8,$801.8,$267.0534,$576.03,$460.,$776.48
,CDM,4230009143.10.4230,ER FEE CONSCIOUS SED<5YRS 1ST,CDM Code,Outpatient,99143,$607.,$150.1657,$576.65,$485.6,$552.37,$159.1754,$576.65,$150.1657,$576.65,$576.65,$60.7,$414.2775,$534.16,$558.44
,CDM,4230009144.10.4230,ER FEE CONSCIOUS SED 1ST 30 MI,CDM Code,Outpatient,99144,$363.,$89.8026,$344.85,$290.4,$330.33,$95.1906,$344.85,$89.8026,$344.85,$344.85,$36.3,$247.7475,$319.44,$333.96
,CDM,4230009145.10.4230,ER FEE SED EA ADD 15 MIN,CDM Code,Outpatient,99153,$177.,$15.5,$168.15,$141.6,$161.07,$46.4152,$168.15,$43.788,$168.15,$168.15,$17.7,$120.8025,$15.5,$162.84
,CDM,4230009151.10.4230,ER FEE MODSED <5 YRS 1ST 15MIN,CDM Code,Outpatient,99151,$335.,$82.8756,$318.25,$268.,$304.85,$87.8481,$318.25,$82.8756,$318.25,$318.25,$33.5,$228.6375,$110.,$308.2
,CDM,4230009152.10.4230,ER FEE MODSED >5 YRS 1ST 15MIN,CDM Code,Outpatient,99152,$177.,$43.788,$168.15,$141.6,$161.07,$46.4152,$168.15,$43.788,$168.15,$168.15,$17.7,$120.8025,$73.,$162.84
,CDM,4230009157.10.4230,ERFEE MODSED OTHR PHYS ADL15MN,CDM Code,Outpatient,99157,$147.,$36.3663,$139.65,$117.6,$133.77,$38.5483,$139.65,$36.3663,$139.65,$139.65,$14.7,$100.3275,$82.,$135.24
,CDM,4230009160.10.4230,ER FEE MOD SED OTH PHYS/QHP <5,CDM Code,Outpatient,99155,$607.,$137.,$576.65,$485.6,$552.37,$159.1754,$576.65,$150.1657,$576.65,$576.65,$60.7,$414.2775,$137.,$558.44
,CDM,4230009161.10.4230,ER FEE MOD SED OTH PHYS/QHP>5Y,CDM Code,Outpatient,99156,$512.,$107.5,$486.4,$409.6,$465.92,$134.2633,$486.4,$126.6637,$486.4,$486.4,$51.2,$349.44,$107.5,$471.04
,CDM,4230009612.10.4230,ER FEE URINARY CATH FOR SPECIM,CDM Code,Outpatient,51701,$405.,$100.193,$384.75,$324.,$368.55,$106.2044,$384.75,$100.193,$384.75,$384.75,$267.0534,$276.4125,$356.4,$372.6
,CDM,4230009620.10.4230,BLADDER SCAN POST VOID,CDM Code,Outpatient,51798,$152.,$37.6033,$145.6485,$121.6,$138.32,$39.8594,$144.4,$37.6033,$144.4,$144.4,$145.6485,$103.74,$133.76,$139.84
,CDM,4236000002.10.4236,ER FEE SEX ASSAULT LEV1 15-45M,CDM Code,Outpatient,0131C,$320.,$79.1648,$304.,$256.,$291.2,$83.9146,$304.,$79.1648,$304.,$304.,$32.,$218.4,$281.6,$294.4
,CDM,4236000003.10.4236,ER FEE SEX ASSAULT LEV2 46-119,CDM Code,Outpatient,0132C,$548.,$135.5697,$520.6,$438.4,$498.68,$143.7037,$520.6,$135.5697,$520.6,$520.6,$54.8,$374.01,$482.24,$504.16
,CDM,4236000004.10.4236,ER FEE SEX ASSAULT LEV3 120M+,CDM Code,Outpatient,0133C,$964.,$238.484,$915.8,$771.2,$877.24,$252.7926,$915.8,$238.484,$915.8,$915.8,$96.4,$657.93,$848.32,$886.88
,CDM,4239000002.10.4239,MD FEE I&D PILONIDAL CYST,CDM Code,Professional,10080,$319.,$110.88,$539.11,$255.2,$290.29,$117.5328,$131.05,$110.88,$303.05,$303.05,$539.11,$217.7175,$256.,$293.48
,CDM,4239000003.10.4239,MD FEE PUNCT ASP CYST (54),CDM Code,Professional,10160,$271.,$77.95,$292.62,$216.8,$246.61,$82.627,$121.65,$77.95,$257.45,$257.45,$292.62,$184.9575,$185.5,$249.32
,CDM,4239000004.10.4239,MD FEE NAIL BED RECON SIMPLE,CDM Code,Professional,11760,$480.,$115.38,$456.,$384.,$436.8,$122.3028,$145.23,$115.38,$456.,$456.,$453.1,$327.6,$267.5,$441.6
,CDM,4239000005.10.4239,MD FEE WEDGE EXC INGROWN TOENA,CDM Code,Professional,11765,$199.,$101.88,$292.62,$159.2,$181.09,$107.9928,$119.75,$101.88,$262.8175,$261.56,$292.62,$135.8175,$238.5,$183.08
,CDM,4239000006.10.4239,MD FEE LAC RPR SCALP20.1-30CM,CDM Code,Professional,12006,$871.,$116.,$827.45,$696.8,$792.61,$122.96,$147.59,$116.,$827.45,$827.45,$292.62,$594.4575,$275.,$801.32
,CDM,4239000007.10.4239,MD FEE CLAVICAL FX (54),CDM Code,Professional,23500,$791.,$131.1399,$751.45,$632.8,$719.81,$139.0083,$282.95,$131.1399,$751.45,$751.45,$199.83,$539.8575,$313.5,$727.72
,CDM,4239000008.10.4239,MD FEE LAC RPR FACE 7.6-12.5CM,CDM Code,Professional,12015,$741.,$98.4,$703.95,$592.8,$674.31,$104.304,$118.85,$98.4,$703.95,$703.95,$153.12,$505.7325,$232.5,$681.72
,CDM,4239000009.10.4239,MD FEE LAC RPR FACE 12.6-20CM,CDM Code,Professional,12016,$911.,$123.77,$865.45,$728.8,$829.01,$131.1962,$161.7,$123.77,$865.45,$865.45,$153.12,$621.7575,$293.,$838.12
,CDM,4239000011.10.4239,MD FEE LAC RPR SCALP 20.1-30 I,CDM Code,Professional,12036,"$1,095.",$254.29,"$1,040.25",$876.,$996.45,$269.5474,$358.22,$254.29,"$1,040.25","$1,040.25",$453.1,$747.3375,$603.,"$1,007.4"
,CDM,4239000013.10.4239,MD FEE LAC RPR FACE 12.6-20 IN,CDM Code,Professional,12055,"$1,107.",$285.8,"$1,051.65",$885.6,"$1,007.37",$302.948,$389.13,$285.8,"$1,051.65","$1,051.65",$292.62,$755.5275,$663.5,"$1,018.44"
,CDM,4239000014.10.4239,MD FEE NURSEMAID ELBOW (54),CDM Code,Professional,24640,$516.,$60.15,$490.2,$412.8,$469.56,$63.759,$99.02,$60.15,$490.2,$490.2,$199.83,$352.17,$142.,$474.72
,CDM,4239000015.10.4239,MD FEE EXT TENDON RPR (54),CDM Code,Professional,26418,"$2,723.",$343.08,"$2,586.85","$2,178.4","$2,477.93",$363.6648,$730.7,$343.08,"$2,586.85","$2,586.85","$2,438.34","$1,858.4475",$817.,"$2,505.16"
,CDM,4239000016.10.4239,MD FEE METACARPAL FX W/ (54),CDM Code,Professional,26605,"$1,208.",$194.56,"$1,147.6",$966.4,"$1,099.28",$206.2336,$373.22,$194.56,"$1,147.6","$1,147.6",$199.83,$824.46,$460.5,"$1,111.36"
,CDM,4239000017.10.4239,MD FEE DISTAL TUFT FX (54),CDM Code,Professional,26750,$636.,$110.47,$604.2,$508.8,$578.76,$117.0982,$235.,$110.47,$604.2,$604.2,$199.83,$434.07,$264.,$585.12
,CDM,4239000019.10.4239,MD FEE MED MALLEOLOUS W/MANIP(,CDM Code,Professional,27762,"$1,863.",$285.6,"$1,769.85","$1,490.4","$1,695.33",$302.736,$544.65,$285.6,"$1,769.85","$1,769.85","$1,217.42","$1,271.4975",$673.5,"$1,713.96"
,CDM,4239000020.10.4239,MD FEE N BLOCK INJ PLANTAR DIG,CDM Code,Professional,64455,$65.,$28.44,$231.,$52.,$59.15,$30.1464,$44.37,$28.44,$61.75,$61.75,$231.,$44.3625,$68.,$59.8
,CDM,4239000022.10.4239,MD FEE METATARSAL FX (54),CDM Code,Professional,28470,$827.,$131.95,$760.84,$661.6,$752.57,$139.867,$261.33,$131.95,$351.12,$349.44,$199.83,$564.4275,$315.,$760.84
,CDM,4239000024.10.4239,MD FEE SHORT ARM SPLINT,CDM Code,Professional,29125,$166.,$38.67,$152.72,$132.8,$151.06,$40.9902,$50.8,$38.67,$103.9775,$103.48,$100.02,$113.295,$93.,$152.72
,CDM,4239000025.10.4239,MD FEE SHORT LEG SPLINT,CDM Code,Professional,29515,$203.,$42.76,$186.76,$162.4,$184.73,$45.3256,$63.64,$42.76,$113.905,$113.36,$125.15,$138.5475,$103.,$186.76
,CDM,4239000026.10.4239,MD FEE ANT/NASL HEM COM (54),CDM Code,Professional,30903,$341.,$99.51,$323.95,$272.8,$310.31,$138.3512,$99.51,$130.52,$323.95,$323.95,$100.02,$232.7325,$297.5,$313.72
,CDM,4239000031.10.4239,MD FEE MOUTH LAC <2.6,CDM Code,Professional,41250,$611.,$166.12,$580.45,$488.8,$556.01,$176.0872,$198.79,$166.12,$580.45,$580.45,$263.61,$417.0075,$386.5,$562.12
,CDM,4239000033.10.4239,MD FEE DRAIN DENTAL ABCESS (54,CDM Code,Professional,41800,$432.,$100.02,$410.4,$345.6,$393.12,$187.143,$194.25,$176.55,$410.4,$410.4,$100.02,$294.84,$407.,$397.44
,CDM,4239000034.10.4239,MD FEE PHARYNGEAL FOREIGN (54),CDM Code,Professional,42809,$593.,$121.32,$563.35,$474.4,$539.63,$128.5992,$155.08,$121.32,$563.35,$563.35,$263.61,$404.7225,$288.,$545.56
,CDM,4239000040.10.4239,MD FEE EMBED CONJUNC FB,CDM Code,Professional,65210,$188.,$33.76,$263.61,$150.4,$171.08,$35.7856,$67.38,$33.76,$178.6,$178.6,$263.61,$128.31,$98.5,$172.96
,CDM,4239000041.10.4239,MD FEE CORNEAL FB REM W/SLIT L,CDM Code,Professional,65222,$198.,$40.71,$188.1,$158.4,$180.18,$43.1526,$66.48,$40.71,$188.1,$188.1,$100.02,$135.135,$96.5,$182.16
,CDM,4239000042.10.4239,MD FEE CORNEAL RUST RING,CDM Code,Professional,65435,$217.,$48.89,$774.57,$173.6,$197.47,$51.8234,$88.94,$48.89,$206.15,$206.15,$774.57,$148.1025,$116.,$199.64
,CDM,4239000043.10.4239,MD FEE TEMP TRANS PACIN,CDM Code,Professional,92953,$77.,$0.61,$481.34,$61.6,$1.25,$0.6466,$1.3,$0.61,$73.15,$73.15,$481.34,$52.5525,$1.5,$70.84
,CDM,4239000046.10.4239,MD FEE OBSERV CARE DISCHARGE,CDM Code,Professional,99217,$0.,$0.,$108.68,$0.,$94.3,$45.5376,$92.18,$42.96,$108.68,$108.16,$0.,$0.,$103.5,$0.
,CDM,4239000060.10.4239,MD FEE APPLY LONG ARM SPLINT,CDM Code,Professional,29105,$236.,$49.1,$217.12,$188.8,$214.76,$52.046,$75.55,$49.1,$138.985,$138.32,$125.15,$161.07,$126.,$217.12
,CDM,4239000061.10.4239,MD FEE LONG LEG SPLINT,CDM Code,Professional,29505,$196.,$51.35,$180.32,$156.8,$178.36,$54.431,$64.57,$51.35,$133.2374,$132.6,$125.15,$133.77,$122.,$180.32
,CDM,4239000064.10.4239,MD FEE TX HIP DISLOCATION W/O,CDM Code,Professional,27250,"$2,257.",$106.18,"$2,144.15","$1,805.6","$2,053.87",$112.5508,$228.57,$106.18,"$2,144.15","$2,144.15",$199.83,"$1,540.4025",$259.,"$2,076.44"
,CDM,4239000068.10.4239,MD FEE FINGER SPLINT,CDM Code,Professional,29130,$115.,$24.55,$105.8,$92.,$104.65,$26.023,$36.81,$24.55,$64.2675,$63.96,$54.55,$78.4875,$59.5,$105.8
,CDM,4239000073.10.4239,MD FEE ARTERIAL CATHETERIZATIO,CDM Code,Professional,36620,$227.,$22.7,$215.65,$181.6,$206.57,$27.9734,$56.3,$26.39,$215.65,$215.65,$22.7,$154.9275,$63.5,$208.84
,CDM,4239000076.10.4239,MD FEE CL TX DIS RADIAL FX W/M,CDM Code,Professional,25605,"$2,022.",$323.65,"$1,920.9","$1,617.6","$1,840.02",$343.069,$648.75,$323.65,"$1,920.9","$1,920.9","$1,217.42","$1,380.015",$777.,"$1,860.24"
,CDM,4239000078.10.4239,MD FEE CLSDREDUX NASALBONE W/O,CDM Code,Professional,21315,"$1,029.",$166.12,"$1,038.55",$823.2,$936.39,$176.0872,$191.65,$166.12,$977.55,$977.55,"$1,038.55",$702.2925,$389.,$946.68
,CDM,4239000082.10.4239,MD FEE CL TX BIMALLEOLAR FX,CDM Code,Professional,27808,"$1,181.",$199.83,"$1,121.95",$944.8,"$1,074.71",$212.7314,$382.3,$200.69,"$1,121.95","$1,121.95",$199.83,$806.0325,$479.,"$1,086.52"
,CDM,4239000083.10.4239,MD FEE INC THROM HEMERRHOID EX,CDM Code,Professional,46083,$499.,$110.68,$459.08,$399.2,$454.09,$117.3208,$136.93,$110.68,$282.15,$280.8,$216.04,$340.5675,$256.,$459.08
,CDM,4239000084.10.4239,MD FEE CL TX FX GRT TOE NO MAN,CDM Code,Professional,28490,$503.,$87.15,$477.85,$402.4,$457.73,$92.379,$160.56,$87.15,$477.85,$477.85,$199.83,$343.2975,$210.5,$462.76
,CDM,4239000085.10.4239,MD FEE CL TX PAT DISLOC W/ANES,CDM Code,Professional,27562,$921.,$199.83,$874.95,$736.8,$838.11,$307.506,$618.09,$290.1,$874.95,$874.95,$199.83,$628.5825,$695.5,$847.32
,CDM,4239000088.10.4239,MD FEE DENTAL BLOCK,CDM Code,Professional,64400,$227.,$81.83,$231.,$181.6,$206.57,$86.7398,$91.56,$81.83,$215.65,$215.65,$231.,$154.9275,$187.,$208.84
,CDM,4239000089.10.4239,MD FEE FOOT DIS O/T TT W/O ANE,CDM Code,Professional,28540,$318.,$117.22,$302.1,$254.4,$289.38,$124.2532,$223.1,$117.22,$302.1,$302.1,$199.83,$217.035,$276.,$292.56
,CDM,4239000093.10.4239,MD FEE DRAIN FINGER ABSCESS CO,CDM Code,Professional,26011,"$1,464.",$236.39,"$1,390.8","$1,171.2","$1,332.24",$258.7142,$236.39,$244.07,"$1,390.8","$1,390.8","$1,236.62",$999.18,$559.,"$1,346.88"
,CDM,4239000094.10.4239,MD FEE DEB SUBQ TIS 20SQ CM/<,CDM Code,Professional,11042,$123.,$73.24,$292.62,$98.4,$111.93,$77.6344,$79.12,$73.24,$116.85,$116.85,$292.62,$83.9475,$167.5,$113.16
,CDM,4239000102.10.4239,MD FEE I & D KNEE/THIGH BURSA,CDM Code,Professional,27301,$567.,$386.9775,"$2,148.91",$453.6,$515.97,$430.89,$642.8,$406.5,$538.65,$538.65,"$2,148.91",$386.9775,$967.,$521.64
,CDM,4239000103.10.4239,MD FEE I&D OF INFECTED BURSA,CDM Code,Professional,23931,$320.,$173.48,"$1,236.62",$256.,$291.2,$183.8888,$204.44,$173.48,$304.,$304.,"$1,236.62",$218.4,$414.,$294.4
,CDM,4239000104.10.4239,MD FEE FEMUR FRACTURE W/ MANIP,CDM Code,Professional,27230,$550.,$199.83,$683.5,$440.,$500.5,$304.4638,$601.99,$287.23,$522.5,$522.5,$199.83,$375.375,$683.5,$506.
,CDM,4239000105.10.4239,"MD FEE I&D FINGER ABSCESS,SKIN",CDM Code,Professional,26010,$276.,$153.12,$379.,$220.8,$251.16,$174.3488,$175.7,$164.48,$262.2,$262.2,$153.12,$188.37,$379.,$253.92
,CDM,4239000109.10.4239,MD FEE EXC BNGN LES 0.6 TO 1.0,CDM Code,Professional,11421,$370.,$94.72,$539.11,$296.,$336.7,$100.4032,$140.27,$94.72,$351.5,$351.5,$539.11,$252.525,$224.,$340.4
,CDM,4239000113.10.4239,MD FEE EXCISIONAL BIOPSY LIP,CDM Code,Professional,40490,$147.,$75.69,$184.,$117.6,$133.77,$80.2314,$93.64,$75.69,$139.65,$139.65,$177.09,$100.3275,$184.,$135.24
,CDM,4239000117.10.4239,MD FEE LAC RPR FACE<2.6CM SIM,CDM Code,Professional,12011,$365.,$65.06,$335.8,$292.,$332.15,$68.9636,$69.96,$65.06,$173.47,$172.64,$153.12,$249.1125,$158.,$335.8
,CDM,4239000118.10.4239,MD FEE CHEMICAL CAUTERIZATION,CDM Code,Professional,17250,$106.,$47.64,$153.12,$84.8,$96.46,$52.046,$47.64,$49.1,$100.7,$100.7,$153.12,$72.345,$114.5,$97.52
,CDM,4239000119.10.4239,MD FEE RT SCAPULA FX,CDM Code,Professional,23570,$756.,$139.12,$718.2,$604.8,$687.96,$147.4672,$305.08,$139.12,$718.2,$718.2,$199.83,$515.97,$333.5,$695.52
,CDM,4239000120.10.4239,MD FEE PLACEMENT OF CVP,CDM Code,Professional,36556,$499.,$125.2,$684.13,$399.2,$454.09,$134.2384,$125.2,$126.64,$370.4525,$368.68,$684.13,$340.5675,$298.5,$459.08
,CDM,4239000122.10.4239,MD FEE EXPLOR PENETRAT WOUND E,CDM Code,Professional,20103,"$1,426.",$349.83,"$1,354.7","$1,140.8","$1,297.66",$370.8198,$445.25,$349.83,"$1,354.7","$1,354.7",$539.11,$973.245,$836.,"$1,311.92"
,CDM,4239000125.10.4239,MD FEE CL TX THUMB DISLOCATION,CDM Code,Professional,26641,$657.,$199.83,$624.15,$525.6,$597.87,$238.977,$442.78,$225.45,$624.15,$624.15,$199.83,$448.4025,$548.5,$604.44
,CDM,4239000126.10.4239,MD FEE INCISION OF ANL ABSCESS,CDM Code,Professional,46050,$255.,$124.92,$667.67,$204.,$232.05,$134.4504,$124.92,$126.84,$242.25,$242.25,$667.67,$174.0375,$291.5,$234.6
,CDM,4239000130.10.4239,MD FEE REMOVAL OF NAIL BED,CDM Code,Professional,11750,$339.,$93.08,$322.05,$271.2,$308.49,$98.6648,$129.76,$93.08,$322.05,$322.05,$292.62,$231.3675,$218.5,$311.88
,CDM,4239000133.10.4239,MD FEE LAC RPR FACE 2.6-5.0CM,CDM Code,Professional,12013,$493.,$67.92,$468.35,$394.4,$448.63,$71.9952,$73.33,$67.92,$468.35,$468.35,$153.12,$336.4725,$165.5,$453.56
,CDM,4239000135.10.4239,MD FEE CHEST TUBE,CDM Code,Professional,32551,$527.,$93.29,$684.13,$421.6,$479.57,$98.8874,$200.56,$93.29,$500.65,$500.65,$684.13,$359.6775,$227.,$484.84
,CDM,4239000136.10.4239,MD FEE N BLOCK INJ OCCIPITAL,CDM Code,Professional,64405,$158.,$49.51,$231.,$126.4,$143.78,$52.4806,$81.03,$49.51,$150.1,$150.1,$231.,$107.835,$146.5,$145.36
,CDM,4239000141.10.4239,MD FEE LAC RPR FACE 5.1-7.5CM,CDM Code,Professional,12014,$588.,$81.42,$558.6,$470.4,$535.08,$86.3052,$94.53,$81.42,$558.6,$558.6,$153.12,$401.31,$193.,$540.96
,CDM,4239000150.10.4239,MD FEE EXC TR-EXT B9+MARG 1.1-,CDM Code,Professional,11402,$430.,$100.86,$539.11,$344.,$391.3,$106.9116,$146.45,$100.86,$261.25,$260.,$539.11,$293.475,$238.,$395.6
,CDM,4239000151.10.4239,MD FEE WOUND(S) CARE NON-SELEC,CDM Code,Professional,97602,$92.,$19.72,$153.12,$73.6,$49.23,$20.9032,$34.5,$19.72,$87.4,$87.4,$153.12,$62.79,$37.95,$84.64
,CDM,4239000190.10.4239,MD FEE DRAINAGE OF ARM LESION,CDM Code,Professional,23930,$369.,$214.2,"$1,236.62",$295.2,$335.79,$227.052,$277.18,$214.2,$350.55,$350.55,"$1,236.62",$251.8425,$513.5,$339.48
,CDM,4239000208.10.4239,MD FEE THORACENTESIS W/O IMAG,CDM Code,Professional,32554,$907.,$114.83,$861.65,$725.6,$825.37,$134.6624,$114.83,$127.04,$861.65,$861.65,$684.13,$619.0275,$289.,$834.44
,CDM,4239000210.10.4239,MD FEE TEMPORARY PACEMAKER,CDM Code,Professional,33210,$809.,$97.79,"$6,976.57",$647.2,$736.19,$103.6574,$210.61,$97.79,$768.55,$768.55,"$6,976.57",$552.1425,$239.,$744.28
,CDM,4239000253.10.4239,MD FEE BURN DRSG & OR DEBRIDE,CDM Code,Professional,16025,$423.,$89.4,$401.85,$338.4,$384.93,$94.764,$142.52,$89.4,$401.85,$401.85,$153.12,$288.6975,$211.,$389.16
,CDM,4239000278.10.4239,MD FEE CLSD BIMALLEOLAR FX W/R,CDM Code,Professional,27810,"$1,784.",$280.69,"$1,694.8","$1,427.2","$1,623.44",$297.5314,$537.42,$280.69,"$1,694.8","$1,694.8","$1,217.42","$1,217.58",$667.5,"$1,641.28"
,CDM,4239000315.10.4239,MD FEE LAC RPR SCALP<2.6CM INT,CDM Code,Professional,12031,$627.,$147.5,$576.84,$501.6,$570.57,$156.35,$196.32,$147.5,$375.6775,$373.88,$292.62,$427.9275,$339.,$576.84
,CDM,4239000323.10.4239,MD FEE LAC RPR NECK 2.6-7.5CM,CDM Code,Professional,12042,$695.,$177.1699,$660.25,$556.,$632.45,$187.8001,$256.66,$177.1699,$660.25,$660.25,$292.62,$474.3375,$412.,$639.4
,CDM,4239000349.10.4239,MD FEE LAC RPR NECK 7.6-12.5 I,CDM Code,Professional,12044,$794.,$219.72,$754.3,$635.2,$722.54,$232.9032,$275.43,$219.72,$754.3,$754.3,$453.1,$541.905,$513.,$730.48
,CDM,4239000414.10.4239,MD FEE LAC RPR NECK<2.6CM INTE,CDM Code,Professional,12041,$486.,$147.09,$447.12,$388.8,$442.26,$155.9154,$192.64,$147.09,$381.425,$379.6,$292.62,$331.695,$338.5,$447.12
,CDM,4239000420.10.4239,MD FEE REMOVE NAIL PLATE ADDON,CDM Code,Professional,11732,$46.,$4.6,$45.,$36.8,$41.86,$20.8184,$22.63,$19.64,$43.7,$43.7,$4.6,$31.395,$45.,$42.32
,CDM,4239000422.10.4239,MD FEE LAC RPR SCALP 2.6-7.5 I,CDM Code,Professional,12032,$629.,$182.69,$578.68,$503.2,$572.39,$193.6514,$249.81,$182.69,$480.1774,$477.88,$292.62,$429.2925,$430.5,$578.68
,CDM,4239000448.10.4239,MD FEE LAC RPR SCALP 7.6-12.5,CDM Code,Professional,12034,$730.,$191.08,$671.6,$584.,$664.3,$202.5448,$266.14,$191.08,$490.6275,$488.28,$292.62,$498.225,$446.,$671.6
,CDM,4239000455.10.4239,MD FEE LAC RPR SCALP 12.6-20 I,CDM Code,Professional,12035,$856.,$230.15,$813.2,$684.8,$778.96,$243.959,$307.25,$230.15,$813.2,$813.2,$292.62,$584.22,$542.5,$787.52
,CDM,4239000513.10.4239,MD FEE LAC RPR FACE < 2.6CM IN,CDM Code,Professional,12051,$651.,$153.12,$618.45,$520.8,$592.41,$168.9322,$219.79,$159.37,$618.45,$618.45,$153.12,$444.3075,$368.,$598.92
,CDM,4239000521.10.4239,MD FEE LAC RPR FACE 2.6-5CM IN,CDM Code,Professional,12052,$696.,$180.03,$661.2,$556.8,$633.36,$190.8318,$261.48,$180.03,$661.2,$661.2,$292.62,$475.02,$419.5,$640.32
,CDM,4239000539.10.4239,MD FEE LAC RPR FACE 5.1-7.5 IN,CDM Code,Professional,12053,$781.,$210.92,$741.95,$624.8,$710.71,$223.5752,$279.55,$210.92,$741.95,$741.95,$292.62,$533.0325,$492.5,$718.52
,CDM,4239000547.10.4239,MD FEE LAC RPR FACE 7.6-12.5IN,CDM Code,Professional,12054,$853.,$220.33,$810.35,$682.4,$776.23,$233.5498,$284.57,$220.33,$810.35,$810.35,$292.62,$582.1725,$513.5,$784.76
,CDM,4239000552.10.4239,MD FEE TRIGGER PT INJEC 1-2 MU,CDM Code,Professional,20552,$129.,$32.94,$231.,$103.2,$117.39,$34.9164,$48.44,$32.94,$85.69,$85.28,$231.,$88.0425,$78.5,$118.68
,CDM,4239000583.10.4239,MD FEE REMOVE INTRAUTERINE DEV,CDM Code,Professional,58301,$299.,$56.46,$275.76,$239.2,$272.09,$59.8476,$85.13,$56.46,$149.435,$148.72,$275.76,$204.0675,$135.,$275.08
,CDM,4239000586.10.4239,MD FEE DRAINAGE OF BREAST LESI,CDM Code,Professional,19000,$113.,$55.8,$539.11,$90.4,$102.83,$70.0448,$55.8,$66.08,$107.35,$107.35,$539.11,$77.1225,$160.,$103.96
,CDM,4239000600.10.4239,MD FEE ARTHROCENTESIS-SMALL,CDM Code,Professional,20600,$173.,$28.85,$231.,$138.4,$157.43,$30.581,$45.28,$28.85,$72.6275,$72.28,$231.,$118.0725,$68.5,$159.16
,CDM,4239000602.10.4239,MD FEE CL TX TOE DISLOC W/ANES,CDM Code,Professional,28665,$273.,$93.29,$259.35,$218.4,$248.43,$98.8874,$168.79,$93.29,$259.35,$259.35,$220.75,$186.3225,$224.,$251.16
,CDM,4239000603.10.4239,MD FEE CLSD TX DISLOC TOE JOIN,CDM Code,Professional,28660,$319.,$70.99,$303.05,$255.2,$290.29,$75.2494,$113.,$70.99,$303.05,$303.05,$199.83,$217.7175,$167.,$293.48
,CDM,4239000604.10.4239,MD FEE ASPIR/INJECT GANGLION C,CDM Code,Professional,20612,$171.,$35.8,$231.,$136.8,$155.61,$37.948,$53.73,$35.8,$93.5275,$93.08,$231.,$116.7075,$86.,$157.32
,CDM,4239000605.10.4239,MD FEE ARTHROCENTESIS-MEDIUM,CDM Code,Professional,20605,$176.,$30.07,$231.,$140.8,$160.16,$31.8742,$47.93,$30.07,$100.3199,$99.84,$231.,$120.12,$72.,$161.92
,CDM,4239000614.10.4239,MD FEE I&D ABSCESS - SIMPLE,CDM Code,Professional,10060,$309.,$70.99,$284.28,$247.2,$281.19,$75.2494,$124.52,$70.99,$181.83,$180.96,$153.12,$210.8925,$169.,$284.28
,CDM,4239000615.10.4239,MD FEE EXCISION SKIN TAG,CDM Code,Professional,11200,$81.,$20.0386,$153.12,$64.8,$73.71,$21.2409,$94.18,$20.0386,$137.94,$137.28,$153.12,$55.2825,$127.5,$74.52
,CDM,4239000616.10.4239,MD FEE LYSIS OF LABIAL ADHESIO,CDM Code,Professional,56441,$506.,$90.63,"$2,085.47",$404.8,$460.46,$96.0678,$175.84,$90.63,$480.7,$480.7,"$2,085.47",$345.345,$206.,$465.52
,CDM,4239000620.10.4239,MD FEE MONITOR FLUID PRESSURE,CDM Code,Professional,20950,$174.,$115.88,$539.11,$139.2,$158.34,$166.9818,$115.88,$157.53,$165.3,$165.3,$539.11,$118.755,$356.,$160.08
,CDM,4239000622.10.4239,MD FEE I&D ADSCESS - COMPLEX,CDM Code,Professional,10061,$640.,$123.16,$588.8,$512.,$582.4,$130.5496,$229.03,$123.16,$319.77,$318.24,$292.62,$436.8,$293.5,$588.8
,CDM,4239000624.10.4239,MD FEE REDUCT TOE FX W/MANIPUL,CDM Code,Professional,28515,$634.,$98.61,$602.3,$507.2,$576.94,$104.5266,$182.38,$98.61,$602.3,$602.3,$199.83,$432.705,$233.,$583.28
,CDM,4239000765.10.4239,MD FEE CLSD TX PATELLA FX W/O,CDM Code,Professional,27520,$966.,$193.74,$888.72,$772.8,$879.06,$205.3644,$375.87,$193.74,$511.0049,$508.56,$199.83,$659.295,$463.5,$888.72
,CDM,4239000800.10.4239,MD FEE DRAIN ABSCESS MOUTH SIM,CDM Code,Professional,40800,$272.,$129.09,$539.11,$217.6,$247.52,$136.8354,$170.21,$129.09,$258.4,$258.4,$539.11,$185.64,$306.,$250.24
,CDM,4239000803.10.4239,MD FEE EXC H-F-NK-SP B9+MARG,CDM Code,Professional,11422,$353.,$106.59,"$1,236.62",$282.4,$321.23,$112.9854,$174.6,$106.59,$275.3574,$274.04,"$1,236.62",$240.9225,$252.,$324.76
,CDM,4239000805.10.4239,MD FEE PARACENTESIS,CDM Code,Professional,49082,$299.,$95.03,$699.79,$239.2,$272.09,$127.5074,$95.03,$120.29,$284.05,$284.05,$699.79,$204.0675,$278.,$275.08
,CDM,4239000808.10.4239,MD FEE INSERT PESSARY/OTH DVC,CDM Code,Professional,57160,$120.,$37.44,$152.21,$96.,$109.2,$39.6864,$58.98,$37.44,$120.175,$119.6,$152.21,$81.9,$107.5,$110.4
,CDM,4239000810.10.4239,MD FEE TREAT HIP DISLOCATION,CDM Code,Professional,27266,"$1,498.",$348.81,"$1,423.1","$1,198.4","$1,363.18",$369.7386,$741.73,$348.81,"$1,423.1","$1,423.1","$1,217.42","$1,022.385",$835.5,"$1,378.16"
,CDM,4239000926.10.4239,MD FEE SEX ASSAULT LEV1 15-45M,CDM Code,Professional,0131C,$175.,$17.5,$166.25,$140.,$159.25,$45.8908,$166.25,$43.2932,$166.25,$166.25,$17.5,$119.4375,$154.,$161.
,CDM,4239000927.10.4239,MD FEE SEX ASSAULT LEV2 46-119,CDM Code,Professional,0132C,$280.,$28.,$266.,$224.,$254.8,$73.4252,$266.,$69.2692,$266.,$266.,$28.,$191.1,$246.4,$257.6
,CDM,4239000928.10.4239,MD FEE SEX ASSAULT LEV3 120MIN,CDM Code,Professional,0133C,$488.,$48.8,$463.6,$390.4,$444.08,$127.9697,$463.6,$120.7263,$463.6,$463.6,$48.8,$333.06,$429.44,$448.96
,CDM,4239001000.10.4239,ED TELECONSULT 30 MIN,CDM Code,Professional,G0425GT,$300.,$30.,$285.,$240.,$273.,$61.8086,$285.,$58.31,$285.,$285.,$30.,$204.75,$141.,$276.
,CDM,4239001001.10.4239,ED TELECONSULT 50 MIN,CDM Code,Professional,G0426GT,$408.,$40.8,$387.6,$326.4,$371.28,$84.1428,$387.6,$79.38,$387.6,$387.6,$40.8,$278.46,$191.,$375.36
,CDM,4239001002.10.4239,ED TELECONSULT 70 MIN,CDM Code,Professional,G0427GT,$607.,$60.7,$576.65,$485.6,$552.37,$124.9104,$576.65,$117.84,$576.65,$576.65,$60.7,$414.2775,$285.,$558.44
,CDM,4239001005.10.4239,MD FEE LES EXC-BENIGN-0.5CM-LE,CDM Code,Professional,11400,$206.,$74.67,$539.11,$164.8,$187.46,$79.1502,$103.51,$74.67,$195.9375,$195.,$539.11,$140.595,$179.,$189.52
,CDM,4239001011.10.4239,MD FEE DRAINAGE OF SCROTUM ABS,CDM Code,Professional,55100,$423.,$131.95,"$1,236.62",$338.4,$384.93,$139.867,$214.09,$131.95,$401.85,$401.85,"$1,236.62",$288.6975,$311.5,$389.16
,CDM,4239001014.10.4239,MD FEE I&D HEMATOMA/BLISTER,CDM Code,Professional,10140,$407.,$100.65,"$1,236.62",$325.6,$370.37,$106.689,$151.48,$100.65,$179.2175,$178.36,"$1,236.62",$277.7775,$234.5,$374.44
,CDM,4239001105.10.4239,MD FEE PAR/CUT BEN HYPRK LES 1,CDM Code,Professional,11055,$41.,$20.44,$153.12,$32.8,$37.31,$35.7856,$20.44,$33.76,$74.7175,$74.36,$153.12,$27.9825,$68.5,$37.72
,CDM,4239001213.10.4239,MD FEE LAC RPR SCALP EA ADD 5,CDM Code,Professional,13121,"$1,122.",$258.39,"$1,065.9",$897.6,"$1,021.02",$273.8934,$342.59,$258.39,"$1,065.9","$1,065.9",$453.1,$765.765,$608.,"$1,032.24"
,CDM,4239001216.10.4239,MD FEE SQ INCIS FB REMOVAL SIM,CDM Code,Professional,10120,$261.,$91.45,$292.62,$208.8,$237.51,$96.937,$132.59,$91.45,$240.8725,$239.72,$292.62,$178.1325,$219.,$240.12
,CDM,4239001224.10.4239,MD FEE SQ INCIS FB REMOVAL COM,CDM Code,Professional,10121,$683.,$163.46,"$1,236.62",$546.4,$621.53,$173.2676,$236.03,$163.46,$648.85,$648.85,"$1,236.62",$466.1475,$391.5,$628.36
,CDM,4239001312.10.4239,MD FEE LAC RPR FACE 1.1-2.5 CO,CDM Code,Professional,13131,"$1,002.",$233.63,$951.9,$801.6,$911.82,$247.6478,$320.79,$233.63,$951.9,$951.9,$292.62,$683.865,$549.,$921.84
,CDM,4239001320.10.4239,MD FEE LAC RPR FACE 2.6-7.5 CO,CDM Code,Professional,13132,"$1,525.",$287.44,"$1,448.75","$1,220.","$1,387.75",$304.6864,$403.34,$287.44,"$1,448.75","$1,448.75",$453.1,"$1,040.8125",$678.,"$1,403."
,CDM,4239001410.10.4239,MD FEE DESTRUCT B9 LESION 1-14,CDM Code,Professional,17110,$179.,$66.49,$176.605,$143.2,$162.89,$70.4794,$89.39,$66.49,$176.605,$175.76,$153.12,$122.1675,$159.,$164.68
,CDM,4239001421.10.4239,MD FEEDIST PHAL FX W MANIPULAT,CDM Code,Professional,26755,$999.,$189.03,$949.05,$799.2,$909.09,$200.3718,$347.07,$189.03,$949.05,$949.05,$199.83,$681.8175,$450.,$919.08
,CDM,4239001510.10.4239,MD FEE LAC RPR NOSE 1.1-2.5 CO,CDM Code,Professional,13151,"$1,257.",$255.11,"$1,194.15","$1,005.6","$1,143.87",$270.4166,$367.81,$255.11,"$1,194.15","$1,194.15",$453.1,$857.9025,$600.5,"$1,156.44"
,CDM,4239001528.10.4239,MD FEE LAC RPR NOSE 2.6-7.5 CO,CDM Code,Professional,13152,"$1,718.",$304.42,"$1,632.1","$1,374.4","$1,563.38",$322.6852,$445.88,$304.42,"$1,632.1","$1,632.1",$453.1,"$1,172.535",$721.,"$1,580.56"
,CDM,4239001701.10.4239,MD FEE STRAIGHT CATH RESID URI,CDM Code,Professional,51701,$94.,$26.8,$100.02,$75.2,$85.54,$28.408,$32.79,$26.8,$89.3,$89.3,$100.02,$64.155,$67.5,$86.48
,CDM,4239001702.10.4239,MD FEE TEMP INDWELLING FOLEY S,CDM Code,Professional,51702,$94.,$33.24,$100.02,$75.2,$85.54,$39.4637,$33.24,$37.2299,$89.3,$89.3,$100.02,$64.155,$91.5,$86.48
,CDM,4239001705.10.4239,"MD FEE RPR LIP, FULL THICK VER",CDM Code,Professional,40650,$989.,$274.96,$939.55,$791.2,$899.99,$291.4576,$383.94,$274.96,$939.55,$939.55,$442.62,$674.9925,$630.5,$909.88
,CDM,4239001715.10.4239,MD FEE ACNE SURGERY,CDM Code,Professional,10040,$150.,$65.26,$156.5,$120.,$136.5,$69.1756,$91.32,$65.26,$142.5,$142.5,$153.12,$102.375,$156.5,$138.
,CDM,4239001982.10.4239,MD FEE REMOVE DRUG IMPLANT DEV,CDM Code,Professional,11982,$253.,$94.11,$263.61,$202.4,$230.23,$99.7566,$127.,$94.11,$239.8275,$238.68,$263.61,$172.6725,$226.5,$232.76
,CDM,4239002004.10.4239,MD FEE BURNS 1-2 DEGREE SMALL,CDM Code,Professional,16020,$176.,$48.89,$167.2,$140.8,$160.16,$51.8234,$69.92,$48.89,$167.2,$167.2,$153.12,$120.12,$117.5,$161.92
,CDM,4239002005.10.4239,MD FEE INECT SINGLE TENDON,CDM Code,Professional,20551,$176.,$31.91,$231.,$140.8,$160.16,$33.8246,$54.65,$31.91,$167.2,$167.2,$231.,$120.12,$86.5,$161.92
,CDM,4239002006.10.4239,MD FEE INSERTION SUPRAPUBIC CA,CDM Code,Professional,51102,$746.,$138.71,"$1,644.66",$596.8,$678.86,$147.0326,$185.55,$138.71,$349.5525,$347.88,"$1,644.66",$509.145,$325.5,$686.32
,CDM,4239002007.10.4239,MD FEE SIMPLE LAC RPR > 30 CM,CDM Code,Professional,12007,$889.,$133.18,$844.55,$711.2,$808.99,$141.1708,$185.5,$133.18,$844.55,$844.55,$153.12,$606.7425,$317.5,$817.88
,CDM,4239002009.10.4239,MD FEE EAR FB REMOVAL,CDM Code,Professional,69200,$255.,$48.89,$234.6,$204.,$232.05,$51.8234,$59.96,$48.89,$200.1175,$199.16,$100.02,$174.0375,$116.5,$234.6
,CDM,4239002022.10.4239,MD FEE LAC RPR SCALP<2.6CM SIM,CDM Code,Professional,12001,$352.,$53.4,$323.84,$281.6,$320.32,$56.604,$56.26,$53.4,$142.12,$141.44,$153.12,$240.24,$129.5,$323.84
,CDM,4239002030.10.4239,MD FEE LAC RPR SCALP2.6-7.5CM,CDM Code,Professional,12002,$467.,$64.85,$429.64,$373.6,$424.97,$68.741,$74.38,$64.85,$171.9025,$171.08,$153.12,$318.7275,$157.5,$429.64
,CDM,4239002048.10.4239,MD FEE LAC RPR SCALP7.6-12.5CM,CDM Code,Professional,12004,$545.,$75.9,$501.4,$436.,$495.95,$80.454,$92.5,$75.9,$201.1625,$200.2,$153.12,$371.9625,$184.,$501.4
,CDM,4239002052.10.4239,MD FEE EYE CONJUNCT REMOVE FB,CDM Code,Professional,65205,$147.,$27.62,$139.65,$117.6,$133.77,$29.2772,$56.23,$27.62,$139.65,$139.65,$100.02,$100.3275,$81.,$135.24
,CDM,4239002055.10.4239,MD FEE LAC RPR SCALP 12.6-20CM,CDM Code,Professional,12005,$680.,$98.4,$646.,$544.,$618.8,$104.304,$120.21,$98.4,$646.,$646.,$292.62,$464.1,$231.5,$625.6
,CDM,4239002108.10.4239,MD FEE EAR REMOVE IMPACTED WAX,CDM Code,Professional,69210,$141.,$28.03,$129.72,$112.8,$128.31,$29.7118,$41.7,$28.03,$81.51,$81.12,$54.55,$96.2325,$69.,$129.72
,CDM,4239002110.10.4239,MD FEE IRRIGATE IMPACTD EARWAX,CDM Code,Professional,69209,$35.,$8.59,$54.55,$28.,$31.85,$9.1054,$18.,$8.59,$18.81,$18.72,$54.55,$23.8875,$20.,$32.2
,CDM,4239002201.10.4239,MD FEE CORNEA REMOVE FB,CDM Code,Professional,65220,$149.,$35.39,$263.61,$119.2,$135.59,$37.5134,$53.77,$35.39,$141.55,$141.55,$263.61,$101.6925,$84.5,$137.08
,CDM,4239002366.10.4239,MD FEE CLSD TX SHOULDER DISLOC,CDM Code,Professional,23665,"$1,799.",$256.75,"$1,709.05","$1,439.2","$1,637.09",$272.155,$503.28,$256.75,"$1,709.05","$1,709.05","$1,217.42","$1,227.8175",$609.,"$1,655.08"
,CDM,4239002450.10.4239,MD FEE CL HUMERAL SHAFT FX NO,CDM Code,Professional,24500,"$1,010.",$199.83,$959.5,$808.,$919.1,$227.6986,$415.92,$214.81,$959.5,$959.5,$199.83,$689.325,$514.,$929.2
,CDM,4239002465.10.4239,MD FEE THROAT SURGERY PROCEDUR,CDM Code,Professional,42999,$204.,$0.,$193.8,$163.2,$185.64,$53.4955,$0.,$50.4676,$193.8,$193.8,$177.09,$139.23,$179.52,$187.68
,CDM,4239002667.10.4239,MD FEE CL TX DISLOC CMC W/MANI,CDM Code,Professional,26670,"$1,443.",$199.83,"$1,370.85","$1,154.4","$1,313.13",$219.4624,$393.24,$207.04,"$1,370.85","$1,370.85",$199.83,$984.8475,$489.5,"$1,327.56"
,CDM,4239002670.10.4239,MD FEE CL TX MP DIS W/MAN X1,CDM Code,Professional,26700,"$1,066.",$196.6,"$1,012.7",$852.8,$970.06,$208.396,$385.66,$196.6,"$1,012.7","$1,012.7",$199.83,$727.545,$463.,$980.72
,CDM,4239002672.10.4239,MD FEE CLSD PHALANX SHAFT W/MA,CDM Code,Professional,26725F1,"$1,166.",$199.83,"$1,107.7",$932.8,"$1,061.06",$215.1164,$385.78,$202.94,"$1,107.7","$1,107.7",$199.83,$795.795,$481.5,"$1,072.72"
,CDM,4239002673.10.4239,MD FEECLSD TX RAD/ULNA SHAFT F,CDM Code,Professional,25565,"$1,829.",$308.51,"$1,737.55","$1,463.2","$1,664.39",$327.0206,$592.97,$308.51,"$1,737.55","$1,737.55","$1,217.42","$1,248.2925",$740.,"$1,682.68"
,CDM,4239002674.10.4239,MD FEE CLSD TX FX W MAN FING J,CDM Code,Professional,26742,"$1,444.",$222.79,"$1,371.8","$1,155.2","$1,314.04",$236.1574,$426.45,$222.79,"$1,371.8","$1,371.8","$1,217.42",$985.53,$530.,"$1,328.48"
,CDM,4239002676.10.4239,MD FEE OPEN TX PHAL/FINGER FX,CDM Code,Professional,26765,$866.,$300.94,"$2,438.34",$692.8,$788.06,$318.9964,$639.71,$300.94,$778.525,$774.8,"$2,438.34",$591.045,$718.5,$796.72
,CDM,4239002709.10.4239,MD FEE LUMBAR PUNCTURE DX,CDM Code,Professional,62270,$262.,$88.99,$507.19,$209.6,$238.42,$94.3294,$99.76,$88.99,$251.845,$250.64,$507.19,$178.815,$225.5,$241.04
,CDM,4239002721.10.4239,MD FEE I&D OF VULVA/PERINEUM,CDM Code,Professional,56405,$282.,$68.13,$275.76,$225.6,$256.62,$72.2178,$137.15,$68.13,$267.9,$267.9,$275.76,$192.465,$155.,$259.44
,CDM,4239002722.10.4239,MD FEE INCISION OF RECTAL ABSC,CDM Code,Professional,46040,"$1,075.",$325.2799,"$1,021.25",$860.,$978.25,$344.7967,$532.31,$325.2799,"$1,021.25","$1,021.25",$877.6,$733.6875,$772.5,$989.
,CDM,4239002725.10.4239,MD FEE THERAPEUTIC PHLEBOTOMY,CDM Code,Professional,99195,$350.,$54.55,$332.5,$280.,$139.73,$65.0522,$130.14,$61.37,$332.5,$332.5,$54.55,$238.875,$144.5,$322.
,CDM,4239002726.10.4239,MD FEE DRAINAGE OF MOUTH LESIO,CDM Code,Professional,41017,$916.,$274.14,"$2,173.69",$732.8,$833.56,$290.5884,$458.87,$274.14,$870.2,$870.2,"$2,173.69",$625.17,$646.,$842.72
,CDM,4239002730.10.4239,MDFEE CLSDTX ULNARSHAFT FX W/M,CDM Code,Professional,25535,"$1,137.",$199.83,"$1,080.15",$909.6,"$1,034.67",$311.8414,$573.61,$294.19,"$1,080.15","$1,080.15",$199.83,$776.0025,$696.,"$1,046.04"
,CDM,4239002780.10.4239,MD FEE CLSD REDUCT TRIMALLEOL,CDM Code,Professional,27818,$831.,$291.32,"$1,217.42",$664.8,$756.21,$308.7992,$551.44,$291.32,$789.45,$789.45,"$1,217.42",$567.1575,$693.5,$764.52
,CDM,4239002819.10.4239,MD FEE REMOVE FB FOOT SUBQ,CDM Code,Professional,28190,$585.,$155.69,$539.11,$468.,$532.35,$165.0314,$172.07,$155.69,$413.2975,$411.32,$539.11,$399.2625,$373.5,$538.2
,CDM,4239002918.10.4239,MD FEE CRITICAL CARE 30-74 MIN,CDM Code,Professional,99291,$859.,$163.05,$790.28,$687.2,$355.52,$172.833,$279.66,$163.05,$417.4775,$415.48,$687.17,$586.2675,$388.,$790.28
,CDM,4239002926.10.4239,MD FEE CRIT CARE EA ADD 30MIN,CDM Code,Professional,99292,$429.,$42.9,$394.68,$343.2,$157.42,$76.1186,$140.23,$71.81,$184.965,$184.08,$42.9,$292.7925,$173.5,$394.68
,CDM,4239003005.10.4239,MD FEE ASPIRATE PLEURA W/ IMAG,CDM Code,Professional,32555,$298.,$142.98,$684.13,$238.4,$271.18,$191.2664,$142.98,$180.44,$283.1,$283.1,$684.13,$203.385,$413.,$274.16
,CDM,4239003006.10.4239,MD FEE NASAL FB REMOVAL,CDM Code,Professional,30300,$231.,$100.02,$251.,$184.8,$210.21,$118.402,$134.03,$111.7,$219.45,$219.45,$100.02,$157.6575,$251.,$212.52
,CDM,4239003020.10.4239,MD FEE TX HIP ARTHRO DISLOC NO,CDM Code,Professional,27265,"$1,883.",$199.83,"$1,732.36","$1,506.4","$1,713.53",$255.2374,$509.43,$240.79,$627.,$624.,$199.83,"$1,285.1475",$572.5,"$1,732.36"
,CDM,4239003021.10.4239,MD FEE LAT MALLEOL FX NO MANIP,CDM Code,Professional,27786,"$1,120.",$188.83,"$1,030.4",$896.,"$1,019.2",$200.1598,$363.94,$188.83,$501.0775,$498.68,$199.83,$764.4,$452.,"$1,030.4"
,CDM,4239003022.10.4239,MD FEE LAT MALLEOL FX W/MANIPU,CDM Code,Professional,27788,"$1,538.",$199.83,"$1,461.1","$1,230.4","$1,399.58",$269.1234,$488.74,$253.89,"$1,461.1","$1,461.1",$199.83,"$1,049.685",$603.,"$1,414.96"
,CDM,4239003024.10.4239,MD FEE CL TX TOE FX NO MANIPUL,CDM Code,Professional,28510,$561.,$74.06,$532.95,$448.8,$510.51,$78.5036,$153.89,$74.06,$532.95,$532.95,$199.83,$382.8825,$178.5,$516.12
,CDM,4239003029.10.4239,MD FEE KNEE STRAPPING,CDM Code,Professional,29530,$154.,$18.,$146.3,$123.2,$140.14,$19.08,$24.03,$18.,$146.3,$146.3,$54.55,$105.105,$42.5,$141.68
,CDM,4239003031.10.4239,MD FEE IRRIG CORPORA CAVERN PR,CDM Code,Professional,54220,$476.,$125.41,$452.2,$380.8,$433.16,$132.9346,$172.18,$125.41,$452.2,$452.2,$216.04,$324.87,$296.5,$437.92
,CDM,4239003037.10.4239,MD FEE PROX PHALYNX FX,CDM Code,Professional,26720F1,$570.,$118.45,$541.5,$456.,$518.7,$125.557,$234.97,$118.45,$541.5,$541.5,$199.83,$389.025,$284.,$524.4
,CDM,4239003039.10.4239,MD FEE CHANGE GASTROSTOMY-TUBE,CDM Code,Professional,43762,$426.,$48.19,$404.7,$340.8,$387.66,$142.6866,$48.19,$134.61,$404.7,$404.7,$231.42,$290.745,$315.5,$391.92
,CDM,4239003045.10.4239,MD FEE ABD PARACENTESIS W/IMAG,CDM Code,Professional,49083,$335.,$139.13,$699.79,$268.,$304.85,$189.9626,$139.13,$179.21,$318.25,$318.25,$699.79,$228.6375,$420.,$308.2
,CDM,4239003104.10.4239,MD FEE NASAL FX,CDM Code,Professional,21310,$109.,$34.45,$199.83,$87.2,$99.19,$85.012,$34.45,$80.2,$103.55,$103.55,$199.83,$74.3925,$193.5,$100.28
,CDM,4239003122.10.4239,MD FEE LAC RPR SCALP EA ADD 5C,CDM Code,Professional,13122,$350.,$35.,$332.5,$280.,$318.5,$84.1428,$109.86,$79.38,$332.5,$332.5,$35.,$238.875,$189.5,$322.
,CDM,4239003208.10.4239,MD FEE THROMBOSED HEMMORRHOID,CDM Code,Professional,46320,$530.,$114.36,$877.6,$424.,$482.3,$121.2216,$141.98,$114.36,$293.1225,$291.72,$877.6,$361.725,$265.5,$487.6
,CDM,4239003600.10.4239,MD FEE HUMERUS FRX W/O MANIP,CDM Code,Professional,2360054,"$1,069.",$197.22,$983.48,$855.2,$972.79,$209.0532,$392.15,$197.22,$516.23,$513.76,$199.83,$729.5925,$468.,$983.48
,CDM,4239004107.10.4239,MD FEE EXTENSOR TENDON RPR (54,CDM Code,Professional,26410,"$3,521.",$334.69,"$3,344.95","$2,816.8","$3,204.11",$354.7714,$715.33,$334.69,"$3,344.95","$3,344.95","$2,438.34","$2,403.0825",$800.5,"$3,239.32"
,CDM,4239004131.10.4239,MD FEE VENIPUNCTURE,CDM Code,Professional,36410,$38.,$3.8,$36.1,$30.4,$34.58,$10.8438,$11.98,$10.23,$36.1,$36.1,$3.8,$25.935,$24.,$34.96
,CDM,4239004302.10.4239,MD FEE L&I PROCESSING,CDM Code,Professional,1040M,$56.,$5.6,$53.2,$44.8,$50.96,$14.685,$53.2,$13.8538,$53.2,$53.2,$5.6,$38.22,$49.28,$51.52
,CDM,4239004479.10.4239,MD FEE CHANGE JEJUNOSTOMY TUBE,CDM Code,Professional,44799,$163.,$0.,$699.79,$130.4,$148.33,$42.744,$0.,$40.3246,$154.85,$154.85,$699.79,$111.2475,$143.44,$149.96
,CDM,4239004505.10.4239,MD FEE PERIPHERAL NERVE BLOCK,CDM Code,Professional,64450,$261.,$46.24,$507.19,$208.8,$237.51,$49.0144,$57.86,$46.24,$247.95,$247.95,$507.19,$178.1325,$114.,$240.12
,CDM,4239004600.10.4239,MD FEE DSLCT ELBOW W/O ANESTHE,CDM Code,Professional,24600,"$1,573.",$199.83,"$1,494.35","$1,258.4","$1,431.43",$234.6416,$424.51,$221.36,"$1,494.35","$1,494.35",$199.83,"$1,073.5725",$523.,"$1,447.16"
,CDM,4239004805.10.4239,MD FEE TMJ DISLOCATION (54),CDM Code,Professional,21480,$131.,$40.7,$199.83,$104.8,$119.21,$69.1756,$40.7,$65.26,$124.45,$124.45,$199.83,$89.4075,$141.,$120.52
,CDM,4239004891.10.4239,MD FEE CENTRAL LINE,CDM Code,Professional,36569,$578.,$56.26,$684.13,$462.4,$525.98,$59.6356,$109.23,$56.26,$390.83,$388.96,$684.13,$394.485,$351.5,$531.76
,CDM,4239005000.10.4239,MD FEE ENDOTRACHEAL INTUBATION,CDM Code,Professional,31500,$494.,$83.88,$454.48,$395.2,$449.54,$88.9128,$179.65,$83.88,$166.6775,$165.88,$177.09,$337.155,$203.,$454.48
,CDM,4239005001.10.4239,MD FEE LEVEL 1 SERVICE,CDM Code,Professional,99281,$132.,$12.48,$125.4,$105.6,$26.79,$13.2288,$26.6,$12.48,$125.4,$125.4,$61.37,$90.09,$30.,$121.44
,CDM,4239005050.10.4239,MD FEE LEVEL 2 SERVICE,CDM Code,Professional,99282,$175.,$24.14,$161.,$140.,$52.18,$25.5884,$51.86,$24.14,$61.1324,$60.84,$111.47,$119.4375,$58.5,$161.
,CDM,4239005054.10.4239,MD FEE CL TX KNEE DISLOC NO AN,CDM Code,Professional,27550,"$1,944.",$199.83,"$1,846.8","$1,555.2","$1,769.04",$330.7094,$605.19,$311.99,"$1,846.8","$1,846.8",$199.83,"$1,326.78",$735.,"$1,788.48"
,CDM,4239005100.10.4239,MD FEE LEVEL 3 SERVICE,CDM Code,Professional,99283,$280.,$36.01,$257.6,$224.,$77.91,$38.1706,$77.56,$36.01,$91.4375,$91.,$201.25,$191.1,$87.5,$257.6
,CDM,4239005159.10.4239,MD FEE LEVEL 4 SERVICE,CDM Code,Professional,99284,$488.,$68.53,$448.96,$390.4,$147.67,$72.6418,$147.11,$68.53,$175.0375,$174.2,$332.41,$333.06,$166.,$448.96
,CDM,4239005170.10.4239,MD FEE CHANGE CYSTOSTOMY TUBE,CDM Code,Professional,51705,$251.,$56.26,$238.45,$200.8,$228.41,$59.6356,$67.1,$56.26,$238.45,$238.45,$216.04,$171.3075,$131.,$230.92
,CDM,4239005175.10.4239,MD FEE LEVEL 5 SERVICE,CDM Code,Professional,99285,$677.,$100.86,$622.84,$541.6,$217.63,$106.9116,$216.66,$100.86,$256.025,$254.8,$488.74,$462.0525,$244.5,$622.84
,CDM,4239005183.10.4239,MD FEE NO CHARGE SERVICE,CDM Code,Professional,,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.
,CDM,4239005506.10.4239,MD FEE INJ TENDON/LIGAMENT,CDM Code,Professional,20550,$160.,$31.51,$231.,$128.,$145.6,$33.4006,$50.09,$31.51,$152.,$152.,$231.,$109.2,$75.5,$147.2
,CDM,4239005560.10.4239,MD FEE ULNAR/RADIAL FX,CDM Code,Professional,25560,$902.,$169.19,$856.9,$721.6,$820.82,$179.3414,$320.78,$169.19,$856.9,$856.9,$199.83,$615.615,$399.,$829.84
,CDM,4239005600.10.4239,MD FEE DIST RAD/ULNA FX WO MNP,CDM Code,Professional,25600,$617.,$198.24,$567.64,$493.6,$561.47,$210.1344,$396.59,$198.24,$518.8425,$516.36,$199.83,$421.1025,$471.,$567.64
,CDM,4239005608.10.4239,MD FEE PATELLA DISLOC W/O ANES,CDM Code,Professional,27560,$930.,$199.83,$883.5,$744.,$846.3,$233.5498,$427.05,$220.33,$883.5,$883.5,$199.83,$634.725,$521.5,$855.6
,CDM,4239005678.10.4239,MD FEE I&D PERITONSILLAR ABSCE,CDM Code,Professional,42700,$536.,$114.57,$509.2,$428.8,$487.76,$121.4442,$172.9,$114.57,$509.2,$509.2,$177.09,$365.82,$269.5,$493.12
,CDM,4239006108.10.4239,MD FEE ARTHROCENTESIS - LARGE,CDM Code,Professional,20610,$206.,$35.8,$231.,$164.8,$187.46,$37.948,$58.95,$35.8,$92.4825,$92.04,$231.,$140.595,$86.,$189.52
,CDM,4239006420.10.4239,MD FEE I&D BARTHOLIN GLAND ABS,CDM Code,Professional,56420,$0.,$0.,$191.7575,$0.,$0.,$86.0932,$114.66,$81.22,$191.7575,$190.84,$152.21,$0.,$173.5,$0.
,CDM,4239006444.10.4239,MD FEE N BLOCK INJ FEM SINGLE,CDM Code,Professional,64447,$168.,$72.83,$507.19,$134.4,$152.88,$77.1998,$84.68,$72.83,$187.055,$186.16,$507.19,$114.66,$173.,$154.56
,CDM,4239006450.10.4239,MD FEE N BLOCK SPENOPAL GANGL,CDM Code,Professional,64505,$223.,$70.38,$231.,$178.4,$202.93,$74.6028,$115.42,$70.38,$211.85,$211.85,$231.,$152.1975,$156.,$205.16
,CDM,4239006500.10.4239,MD FEE RADIAL HEAD FX (54),CDM Code,Professional,24650,$778.,$156.91,$715.76,$622.4,$707.98,$166.3246,$306.21,$156.91,$413.2975,$411.32,$199.83,$530.985,$375.5,$715.76
,CDM,4239006501.10.4239,MD FEE DSCLT SHLDR W/O ANES (5,CDM Code,Professional,23650,$864.,$191.08,$820.8,$691.2,$786.24,$202.5448,$367.09,$191.08,$820.8,$820.8,$199.83,$589.68,$451.,$794.88
,CDM,4239006601.10.4239,MD FEE METACARPAL FX,CDM Code,Professional,26600,$809.,$176.96,$744.28,$647.2,$736.19,$187.5776,$353.22,$176.96,$464.5025,$462.28,$199.83,$552.1425,$421.5,$744.28
,CDM,4239006708.10.4239,MD FEE ULNAR FX (54),CDM Code,Professional,24670,$909.,$174.3,$863.55,$727.2,$827.19,$184.758,$334.46,$174.3,$863.55,$863.55,$199.83,$620.3925,$417.,$836.28
,CDM,4239006709.10.4239,MD FEE DRAINAGE OF NOSE LESION,CDM Code,Professional,30000,$297.,$144.84,$322.5,$237.6,$270.27,$153.5304,$148.74,$144.84,$282.15,$282.15,$177.09,$202.7025,$322.5,$273.24
,CDM,4239006759.10.4239,MD FEE BLADDER IRRIGATION SIMP,CDM Code,Professional,51700,$193.,$39.05,$216.04,$154.4,$175.63,$47.488,$39.05,$44.8,$128.0125,$127.4,$216.04,$131.7225,$105.5,$177.56
,CDM,4239006770.10.4239,MD FEE I&D EYELID ABSCESS,CDM Code,Professional,67700,$318.,$148.87,$384.,$254.4,$289.38,$176.5218,$148.87,$166.53,$302.1,$302.1,$268.49,$217.035,$384.,$292.56
,CDM,4239006805.10.4239,MD FEE INTRAOSSEOUS INFUSION,CDM Code,Professional,36680,$306.,$34.78,$290.7,$244.8,$278.46,$36.8668,$74.64,$34.78,$290.7,$290.7,$263.61,$208.845,$84.5,$281.52
,CDM,4239006900.10.4239,MD FEE I&D EXT EAR ABSCESS/HEM,CDM Code,Professional,69000,$596.,$111.91,$566.2,$476.8,$542.36,$118.6246,$151.13,$111.91,$566.2,$566.2,$539.11,$406.77,$265.,$548.32
,CDM,4239006921.10.4239,MD FEE MOD SED OTH PHYS/QHP <5,CDM Code,Professional,99155,$247.,$24.7,$234.65,$197.6,$117.42,$55.5122,$121.79,$52.37,$234.65,$234.65,$24.7,$168.5775,$137.,$227.24
,CDM,4239006926.10.4230,MD FEE DEBRIDE INFECTED SKIN,CDM Code,Professional,11000,$74.,$33.14,$453.1,$59.2,$67.34,$35.1284,$36.39,$33.14,$70.3,$70.3,$453.1,$50.505,$78.,$68.08
,CDM,4239006937.10.4239,MD FEE TRIM NAIL(S) ANY NUMBER,CDM Code,Professional,11719,$20.,$8.59,$54.55,$16.,$18.2,$9.1054,$9.77,$8.59,$19.,$19.,$54.55,$13.65,$20.5,$18.4
,CDM,4239006938.10.4239,MD FEE DEBRIDE NAIL 1-5,CDM Code,Professional,11720,$38.,$18.66,$54.55,$30.4,$34.58,$21.0304,$18.66,$19.84,$36.1,$36.1,$54.55,$25.935,$47.,$34.96
,CDM,4239006942.10.4239,MD FEE CLOSURE OF SPLIT WOUND,CDM Code,Professional,12020,$487.,$172.05,$462.65,$389.6,$443.17,$182.373,$240.54,$172.05,$462.65,$462.65,$453.1,$332.3775,$400.,$448.04
,CDM,4239006974.10.4239,MD FEE CLOSED TX NOSE FX W/ ST,CDM Code,Professional,21320,$343.,$153.03,"$2,173.69",$274.4,$312.13,$162.2118,$169.91,$153.03,$325.85,$325.85,"$2,173.69",$234.0975,$360.,$315.56
,CDM,4239007014.10.4239,MD FEE TREAT SHOULDER DISLO LT,CDM Code,Professional,23655LT,"$1,041.",$242.02,"$1,217.42",$832.8,$947.31,$256.5412,$512.5,$242.02,$988.95,$988.95,"$1,217.42",$710.4825,$576.,$957.72
,CDM,4239007015.10.4239,MD FEE TREAT SHOULDER DISLO RT,CDM Code,Professional,23655RT,"$1,041.",$242.02,"$1,217.42",$832.8,$947.31,$256.5412,$512.5,$242.02,$988.95,$988.95,"$1,217.42",$710.4825,$576.,$957.72
,CDM,4239007044.10.4239,MD FEE TREAT ELBOW FRACTURE RT,CDM Code,Professional,24620RT,"$1,429.",$331.42,"$1,357.55","$1,143.2","$1,300.39",$351.3052,$703.22,$331.42,"$1,357.55","$1,357.55","$1,217.42",$975.2925,$791.,"$1,314.68"
,CDM,4239007174.10.4239,MD FEE CLSD PHALANX SHAFT W/MA,CDM Code,Professional,26725F3,$778.,$199.83,$739.1,$622.4,$707.98,$215.1164,$385.78,$202.94,$739.1,$739.1,$199.83,$530.985,$481.5,$715.76
,CDM,4239007175.10.4239,MD FEE CLSD PHALANX SHAFT W/MA,CDM Code,Professional,26725F4,$778.,$199.83,$739.1,$622.4,$707.98,$215.1164,$385.78,$202.94,$739.1,$739.1,$199.83,$530.985,$481.5,$715.76
,CDM,4239007176.10.4239,MD FEE CLSD PHALX SHFT W/MA W/,CDM Code,Professional,26725F5,$780.,$199.83,$741.,$624.,$709.8,$215.1164,$385.78,$202.94,$741.,$741.,$199.83,$532.35,$481.5,$717.6
,CDM,4239007178.10.4239,MD FEE CLSD PHLNX SHFT W/MA F7,CDM Code,Professional,26725F7,$778.,$199.83,$739.1,$622.4,$707.98,$215.1164,$385.78,$202.94,$739.1,$739.1,$199.83,$530.985,$481.5,$715.76
,CDM,4239007179.10.4239,MD FEE CLSD PHALANX SHAFT W/MA,CDM Code,Professional,26725F8,$778.,$199.83,$739.1,$622.4,$707.98,$215.1164,$385.78,$202.94,$739.1,$739.1,$199.83,$530.985,$481.5,$715.76
,CDM,4239007180.10.4239,MD FEE CLSD PHALANX SHAFT W/MA,CDM Code,Professional,26725F9,$778.,$199.83,$739.1,$622.4,$707.98,$215.1164,$385.78,$202.94,$739.1,$739.1,$199.83,$530.985,$481.5,$715.76
,CDM,4239007181.10.4239,MD FEE CLSD PHLNX SHFT W/MA FA,CDM Code,Professional,26725FA,$778.,$199.83,$739.1,$622.4,$707.98,$215.1164,$385.78,$202.94,$739.1,$739.1,$199.83,$530.985,$481.5,$715.76
,CDM,4239007225.10.4239,MD FEE TREAT FINGER DISLOCATIO,CDM Code,Professional,26775F5,$714.,$220.75,$678.3,$571.2,$649.74,$244.8282,$439.79,$230.97,$678.3,$678.3,$220.75,$487.305,$546.,$656.88
,CDM,4239007226.10.4239,MD FEE TREAT FINGER DISLOCATIO,CDM Code,Professional,26775F6,$714.,$220.75,$678.3,$571.2,$649.74,$244.8282,$439.79,$230.97,$678.3,$678.3,$220.75,$487.305,$546.,$656.88
,CDM,4239007273.10.4239,MD FEE TREAT HIP DISLOC RT,CDM Code,Professional,27257RT,$0.,$0.,"$1,217.42",$0.,$0.,$230.0836,$465.16,$217.06,$0.,$0.,"$1,217.42",$0.,$525.,$0.
,CDM,4239007282.10.4239,MD FEE REMOVAL OF FOREIGN BODY,CDM Code,Professional,27372,$829.,$359.65,"$2,148.91",$663.2,$754.39,$381.229,$508.12,$359.65,$787.55,$787.55,"$2,148.91",$565.7925,$852.,$762.68
,CDM,4239007303.10.4239,MD FEE NAIL AVULSION,CDM Code,Professional,11730,$262.,$65.26,$241.04,$209.6,$238.42,$69.1756,$70.71,$65.26,$153.615,$152.88,$153.12,$178.815,$150.5,$241.04
,CDM,4239007402.10.4239,MD FEE EVACUAT SUBUNGUAL HEMAT,CDM Code,Professional,11740,$0.,$0.,$71.5,$0.,$0.,$32.7434,$42.05,$30.89,$0.,$0.,$54.55,$0.,$71.5,$0.
,CDM,4239007505.10.4239,MD FEE TIBIA FX (54),CDM Code,Professional,27750,"$1,217.",$199.83,"$1,156.15",$973.6,"$1,107.47",$219.897,$405.11,$207.45,"$1,156.15","$1,156.15",$199.83,$830.6025,$497.,"$1,119.64"
,CDM,4239007597.10.4239,MD FEE DEBRIDE SHARP OPN WOUND,CDM Code,Professional,97597,$50.,$21.22,$153.12,$40.,$102.89,$56.816,$21.22,$53.6,$47.5,$47.5,$153.12,$34.125,$118.5,$46.
,CDM,4239007704.10.4239,MD FEE CLSD TX IP JOINT W/MANI,CDM Code,Professional,26770,$970.,$166.73,$921.5,$776.,$882.7,$176.7338,$323.99,$166.73,$921.5,$921.5,$199.83,$662.025,$395.,$892.4
,CDM,4239007768.10.4239,MD FEE CLTX POST ANKLE FX W/MN,CDM Code,Professional,27768,"$1,137.",$264.93,"$1,217.42",$909.6,"$1,034.67",$280.8258,$563.03,$264.93,"$1,080.15","$1,080.15","$1,217.42",$776.0025,$633.,"$1,046.04"
,CDM,4239007769.10.4239,MD FEE PENILE INJECTION,CDM Code,Professional,54235,$190.,$53.6,$216.04,$152.,$172.9,$56.816,$94.75,$53.6,$180.5,$180.5,$216.04,$129.675,$131.5,$174.8
,CDM,4239007908.10.4239,MD FEE TREAT BIG TOE FRACTURE,CDM Code,Professional,28495TA,$0.,$0.,$256.,$0.,$0.,$114.7132,$191.23,$108.22,$0.,$0.,$199.83,$0.,$256.,$0.
,CDM,4239008020.10.4239,MD FEE FINGER SPLINT,CDM Code,Professional,29130F3,$115.,$24.55,$105.8,$92.,$104.65,$26.023,$36.81,$24.55,$64.2675,$63.96,$54.55,$78.4875,$59.5,$105.8
,CDM,4239008089.10.4239,MD FEE NASAL ANTERIOR BLEED BI,CDM Code,Professional,3090150,$510.,$71.65,$469.2,$408.,$464.1,$87.609,$71.65,$82.65,$151.0025,$150.28,$100.02,$348.075,$193.5,$469.2
,CDM,4239008090.10.4239,MD FEE ANT/NASL HEM COM BI,CDM Code,Professional,3090350,$682.,$99.51,$647.9,$545.6,$620.62,$138.3512,$99.51,$130.52,$647.9,$647.9,$100.02,$465.465,$297.5,$627.44
,CDM,4239008095.10.4239,MD FEE INCISION OF WINDPIPE,CDM Code,Professional,31605,$858.,$197.63,$815.1,$686.4,$780.78,$209.4878,$424.83,$197.63,$815.1,$815.1,$442.62,$585.585,$481.5,$789.36
,CDM,4239008096.10.4239,MD FEE CHEST TUBE INSERTION BI,CDM Code,Outpatient,3255150,"$1,054.",$227.,"$1,826.6271",$843.2,$959.14,$276.3936,"$1,001.3",$260.7491,"$1,001.3","$1,001.3","$1,826.6271",$719.355,$227.,$969.68
,CDM,4239008120.10.4239,MD FEE DRAINAGE MOUTH ROOF LES,CDM Code,Professional,42000,$268.,$93.9,$254.6,$214.4,$243.88,$99.534,$131.41,$93.9,$254.6,$254.6,$177.09,$182.91,$218.5,$246.56
,CDM,4239008123.10.4239,MD FEE CHANGE GASTROSTOMY-TUBE,CDM Code,Professional,43762,$426.,$48.19,$404.7,$340.8,$387.66,$142.6866,$48.19,$134.61,$404.7,$404.7,$231.42,$290.745,$315.5,$391.92
,CDM,4239008149.10.4239,MD FEE IRRGT IMPACTD EARWX BIL,CDM Code,Professional,6920950,$70.,$8.59,$64.4,$56.,$63.7,$9.1054,$18.,$8.59,$18.81,$18.72,$54.55,$47.775,$20.,$64.4
,CDM,4239008198.10.4239,MD FEE LEVEL 1 SERVICE W/PROC,CDM Code,Professional,9928125,$132.,$12.48,$125.4,$105.6,$26.79,$13.2288,$26.6,$12.48,$125.4,$125.4,$61.37,$90.09,$30.,$121.44
,CDM,4239008199.10.4239,MD FEE LEVEL 2 SERVICE W/PROC,CDM Code,Professional,9928225,$175.,$24.14,$161.,$140.,$52.18,$25.5884,$51.86,$24.14,$61.1324,$60.84,$111.47,$119.4375,$58.5,$161.
,CDM,4239008200.10.4239,MD FEE LEVEL 3 SERVICE W/PROC,CDM Code,Professional,9928325,$280.,$36.01,$257.6,$224.,$77.91,$38.1706,$77.56,$36.01,$91.4375,$91.,$201.25,$191.1,$87.5,$257.6
,CDM,4239008201.10.4239,MD FEE LEVEL 4 SERVICE W/PROC,CDM Code,Professional,9928425,$488.,$68.53,$448.96,$390.4,$147.67,$72.6418,$147.11,$68.53,$175.0375,$174.2,$332.41,$333.06,$166.,$448.96
,CDM,4239008202.10.4239,MD FEE LEVEL 5 SERVICE W/PROC,CDM Code,Professional,9928525,$677.,$100.86,$622.84,$541.6,$217.63,$106.9116,$216.66,$100.86,$256.025,$254.8,$488.74,$462.0525,$244.5,$622.84
,CDM,4239008203.10.4239,MD FEE CRITCL CARE 30-74M W/PR,CDM Code,Professional,9929125,$859.,$163.05,$790.28,$687.2,$355.52,$172.833,$279.66,$163.05,$417.4775,$415.48,$687.17,$586.2675,$388.,$790.28
,CDM,4239008204.10.4239,MD FEE CRTICAL CARE ADD W/PR,CDM Code,Professional,9929225,$429.,$42.9,$394.68,$343.2,$157.42,$76.1186,$140.23,$71.81,$184.965,$184.08,$42.9,$292.7925,$173.5,$394.68
,CDM,4239008404.10.4239,MD FEE ANKLE DISLOCATION (54),CDM Code,Professional,27840,"$1,809.",$199.83,"$1,718.55","$1,447.2","$1,646.19",$237.4612,$472.75,$224.02,"$1,718.55","$1,718.55",$199.83,"$1,234.6425",$531.,"$1,664.28"
,CDM,4239009011.10.4239,MD FEE NASAL ANTERIOR BLEEDING,CDM Code,Professional,30901,$255.,$71.65,$234.6,$204.,$232.05,$87.609,$71.65,$82.65,$151.0025,$150.28,$100.02,$174.0375,$193.5,$234.6
,CDM,4239009052.10.4239,MD FEE NASAL POST BLEEDING,CDM Code,Professional,30905,$456.,$100.02,$460.,$364.8,$414.96,$210.569,$133.3,$198.65,$433.2,$433.2,$100.02,$311.22,$460.,$419.52
,CDM,4239009143.10.4239,MD FEE CONSCIOUS SED<5YRS 1ST,CDM Code,Professional,99151,$195.,$19.5,$185.25,$156.,$104.86,$47.7106,$31.04,$45.01,$185.25,$185.25,$19.5,$133.0875,$110.,$179.4
,CDM,4239009145.10.4239,MD FEE CONSCIOUS SED EA ADDL 1,CDM Code,Professional,99153,$83.,$6.34,$78.85,$66.4,$15.24,$6.7204,$13.94,$6.34,$78.85,$78.85,$8.3,$56.6475,$15.5,$76.36
,CDM,4239009152.10.4239,MD FEE MODSED >5 YRS 1ST 15MIN,CDM Code,Professional,99152,$31.,$3.1,$73.,$24.8,$70.44,$32.5314,$15.94,$30.69,$29.45,$29.45,$3.1,$21.1575,$73.,$28.52
,CDM,4239009157.10.4239,MDFEE MODSED OTHR PHYS ADL15MN,CDM Code,Professional,99157,$83.,$8.3,$82.,$66.4,$72.29,$40.121,$72.7,$37.85,$78.85,$78.85,$8.3,$56.6475,$82.,$76.36
,CDM,4239009160.10.4239,MD FEE MOD SED OTH PHYS/QHP <5,CDM Code,Professional,99155,$247.,$24.7,$234.65,$197.6,$117.42,$55.5122,$121.79,$52.37,$234.65,$234.65,$24.7,$168.5775,$137.,$227.24
,CDM,4239009161.10.4239,MD FEE MOD SED OTH PHYS/QHP>5Y,CDM Code,Professional,99156,$208.,$20.8,$197.6,$166.4,$95.26,$49.0144,$95.27,$46.24,$197.6,$197.6,$20.8,$141.96,$107.5,$191.36
,CDM,4239009301.10.4239,MD FEE EKG INTERPRETATION,CDM Code,Professional,93010,$40.,$4.,$36.8,$32.,$10.84,$5.2046,$10.68,$4.91,$12.5399,$12.48,$4.,$27.3,$12.,$36.8
,CDM,4239009506.10.4239,MD FEE CPR,CDM Code,Professional,92950,$809.,$187.19,$744.28,$647.2,$400.13,$198.4214,$236.79,$187.19,$473.385,$471.12,$232.31,$552.1425,$432.,$744.28
,CDM,4239009605.10.4239,MD FEE CARDIOVERSION,CDM Code,Professional,92960,$512.,$94.72,$481.34,$409.6,$210.03,$100.4032,$139.78,$94.72,$316.635,$315.12,$481.34,$349.44,$226.5,$471.04
,CDM,4239009800.10.4239,MD FEE INSERTION NG TUBE,CDM Code,Professional,43752,$166.,$24.14,$263.61,$132.8,$151.06,$25.5884,$52.36,$24.14,$157.7,$157.7,$263.61,$113.295,$59.,$152.72
,CDM,4250000007.10.4250,THERAPEUTIC PHLEBOTOMY,CDM Code,Outpatient,99195,$350.,$86.5865,$332.5,$280.,$318.5,$91.7815,$332.5,$86.5865,$332.5,$332.5,$145.6485,$238.875,$144.5,$322.
,CDM,4250000018.10.4250,ALLERGY SHOT (X2),CDM Code,Outpatient,95117,$111.,$14.5,$105.45,$88.8,$101.01,$29.1079,$105.45,$27.4603,$105.45,$105.45,$92.8626,$75.7575,$14.5,$102.12
,CDM,4250000049.10.4250,MAC VISIT LEVEL 1,CDM Code,Outpatient,99211,$151.,$30.5,$143.45,$120.8,$137.41,$39.5972,$143.45,$37.3559,$143.45,$143.45,$15.1,$103.0575,$30.5,$138.92
,CDM,4250000049.20.4250,MAC VISIT LEVEL 1,CDM Code,Outpatient,99211,$151.,$30.5,$143.45,$120.8,$137.41,$39.5972,$143.45,$37.3559,$143.45,$143.45,$15.1,$103.0575,$30.5,$138.92
,CDM,4250000050.10.4250,MAC VISIT LEVEL 2,CDM Code,Outpatient,99212,$181.,$44.7776,$171.95,$144.8,$164.71,$47.4642,$171.95,$44.7776,$171.95,$171.95,$18.1,$123.5325,$62.,$166.52
,CDM,4250000050.20.4250,MAC VISIT LEVEL 2,CDM Code,Outpatient,99212,$181.,$44.7776,$171.95,$144.8,$164.71,$47.4642,$171.95,$44.7776,$171.95,$171.95,$18.1,$123.5325,$62.,$166.52
,CDM,4250000051.10.4250,MAC VISIT LEVEL 3,CDM Code,Outpatient,99213,$217.,$53.6836,$206.15,$173.6,$197.47,$56.9046,$206.15,$53.6836,$206.15,$206.15,$21.7,$148.1025,$103.,$199.64
,CDM,4250000051.20.4250,MAC VISIT LEVEL 3,CDM Code,Outpatient,99213,$206.,$50.9623,$195.7,$164.8,$187.46,$54.02,$195.7,$50.9623,$195.7,$195.7,$20.6,$140.595,$103.,$189.52
,CDM,4250000052.10.4250,MAC VISIT LEVEL 4,CDM Code,Outpatient,99214,$261.,$64.5688,$247.95,$208.8,$237.51,$68.4428,$247.95,$64.5688,$247.95,$247.95,$26.1,$178.1325,$152.,$240.12
,CDM,4250000052.20.4250,MAC VISIT LEVEL 4,CDM Code,Outpatient,99214,$248.,$61.3527,$235.6,$198.4,$225.68,$65.0338,$235.6,$61.3527,$235.6,$235.6,$24.8,$169.26,$152.,$228.16
,CDM,4250000053.10.4250,MAC VISIT LEVEL 5,CDM Code,Outpatient,99215,$370.,$91.5343,$351.5,$296.,$336.7,$97.0262,$351.5,$91.5343,$351.5,$351.5,$37.,$252.525,$205.,$340.4
,CDM,4250000100.10.4250,ONC/INF PATIENT PHONE CALL,CDM Code,Professional,,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.
,CDM,4250000101.10.4250,WOC PATIENT PHONE CALL,CDM Code,Professional,,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.
,CDM,4250000102.10.4250,DIABETES PATIENT PHONE CALL,CDM Code,Professional,,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.
,CDM,4250000103.10.4250,NOTIFICATION/PROVIDER COMMUNIC,CDM Code,Professional,,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.
,CDM,4250000290.10.4250,BLADDER INSTALLATION (NON CHEM,CDM Code,Outpatient,51700,$481.,$118.9946,$576.8268,$384.8,$437.71,$126.1341,$456.95,$118.9946,$456.95,$456.95,$576.8268,$328.2825,$423.28,$442.52
,CDM,4250000471.10.4250,ADMINISTRATION ONE VACCINE,CDM Code,Outpatient,90471,$113.,$27.9551,$141.9639,$90.4,$102.83,$29.6323,$107.35,$27.9551,$107.35,$107.35,$141.9639,$77.1225,$29.,$103.96
,CDM,4250000472.10.4250,ADMIN EACH ADD L VACCINATION,CDM Code,Outpatient,90472,$60.,$14.8434,$57.,$48.,$54.6,$15.734,$57.,$14.8434,$57.,$57.,$6.,$40.95,$18.,$55.2
,CDM,4250000802.10.4250,URINARY CATHERIZATION,CDM Code,Outpatient,51702,$258.,$63.8266,$267.0534,$206.4,$234.78,$67.6561,$245.1,$63.8266,$245.1,$245.1,$267.0534,$176.085,$227.04,$237.36
,CDM,4250000809.10.4250,BLOOD DRAW,CDM Code,Outpatient,36415,$47.,$3.3,$44.65,$37.6,$42.77,$12.325,$44.65,$11.6273,$44.65,$44.65,$3.,$32.0775,$3.3,$43.24
,CDM,4250000810.10.4250,DX BONE MARROW BX & ASPIR,CDM Code,Outpatient,38222,"$2,696.",$242.,"$3,599.2401","$2,156.8","$2,453.36",$706.9802,"$2,561.2",$666.9634,"$2,561.2","$2,561.2","$3,599.2401","$1,840.02",$242.,"$2,480.32"
,CDM,4250000811.10.4250,BONE MARROW ASPIRATION,CDM Code,Outpatient,38220,$765.,$189.2534,"$3,301.7754",$612.,$696.15,$200.6082,$726.75,$189.2534,$726.75,$726.75,"$3,301.7754",$522.1125,$242.,$703.8
,CDM,4250000812.10.4250,"BONE MARROW BIOPSY,NEEDLE/TROC",CDM Code,Outpatient,38221,$765.,$189.2534,"$3,301.7754",$612.,$696.15,$200.6082,$726.75,$189.2534,$726.75,$726.75,"$3,301.7754",$522.1125,$218.,$703.8
,CDM,4250000813.10.4250,IV HYDRATION INITIAL 1ST HR 20,CDM Code,Outpatient,96360,$408.,$66.,$479.9859,$326.4,$371.28,$106.9911,$387.6,$100.9351,$387.6,$387.6,$479.9859,$278.46,$66.,$375.36
,CDM,4250000814.10.4250,IV HYDRATION EA ADD'L HR,CDM Code,Outpatient,96361,$206.,$19.5,$195.7,$164.8,$187.46,$54.02,$195.7,$50.9623,$195.7,$195.7,$92.8626,$140.595,$19.5,$189.52
,CDM,4250000815.10.4250,THER/PROPH/DIAG IV INFUS 1ST H,CDM Code,Outpatient,96365,$527.,$103.,$500.65,$421.6,$479.57,$138.1968,$500.65,$130.3745,$500.65,$500.65,$479.9859,$359.6775,$103.,$484.84
,CDM,4250000816.10.4250,THER/PROPH/DX IV INFUS EA ADDL,CDM Code,Outpatient,96366,$339.,$31.,$322.05,$271.2,$308.49,$88.897,$322.05,$83.8652,$322.05,$322.05,$92.8626,$231.3675,$31.,$311.88
,CDM,4250000817.10.4250,THER/PROPH/DX IV INFUS ADDL SE,CDM Code,Outpatient,96367,$210.,$44.5,$199.5,$168.,$191.1,$55.0689,$199.5,$51.9519,$199.5,$199.5,$141.9639,$143.325,$44.5,$193.2
,CDM,4250000818.10.4250,THER/PROPH/DX IV INFUS CONCURR,CDM Code,Outpatient,96368,$207.,$29.5,$196.65,$165.6,$188.37,$54.2822,$196.65,$51.2097,$196.65,$196.65,$20.7,$141.2775,$29.5,$190.44
,CDM,4250000819.10.4250,CHEMO IV PUSH SINGLE DRUG,CDM Code,Outpatient,96409,$481.,$118.9946,$479.9859,$384.8,$437.71,$126.1341,$456.95,$118.9946,$456.95,$456.95,$479.9859,$328.2825,$155.,$442.52
,CDM,4250000820.10.4250,CHEMO IV PUSH ADD'L DRUG,CDM Code,Outpatient,96411,$328.,$81.1439,$311.6,$262.4,$298.48,$86.0124,$311.6,$81.1439,$311.6,$311.6,$141.9639,$223.86,$83.,$301.76
,CDM,4250000821.10.4250,CHEMO IV INFUSION 1ST HR,CDM Code,Outpatient,96413,$873.,$201.,$829.35,$698.4,$794.43,$228.9294,$829.35,$215.9715,$829.35,$829.35,$746.1315,$595.8225,$201.,$803.16
,CDM,4250000822.10.4250,CHEMO IV INFUSION EA ADDL HR,CDM Code,Outpatient,96415,$554.,$44.,$526.3,$443.2,$504.14,$145.2771,$526.3,$137.0541,$526.3,$526.3,$141.9639,$378.105,$44.,$509.68
,CDM,4250000823.10.4250,CHEMO IV INFUSION ADDL SEQ,CDM Code,Outpatient,96417,$516.,$96.5,$490.2,$412.8,$469.56,$135.3122,$490.2,$127.6532,$490.2,$490.2,$141.9639,$352.17,$96.5,$474.72
,CDM,4250000824.10.4250,THER/DIAG SC/IM INJECTION,CDM Code,Outpatient,96372,$130.,$29.,$141.9639,$104.,$118.3,$34.0903,$123.5,$32.1607,$123.5,$123.5,$141.9639,$88.725,$29.,$119.6
,CDM,4250000824.20.4250,THER/DIAG SC/IM INJECTION,CDM Code,Outpatient,96372,$130.,$29.,$141.9639,$104.,$118.3,$34.0903,$123.5,$32.1607,$123.5,$123.5,$141.9639,$88.725,$29.,$119.6
,CDM,4250000825.10.4250,"IVP,SINGLE,INITIAL DRUG",CDM Code,Outpatient,96374,$278.,$65.5,$479.9859,$222.4,$252.98,$72.9008,$264.1,$68.7744,$264.1,$264.1,$479.9859,$189.735,$65.5,$255.76
,CDM,4250000826.10.4250,IVP EA ADDL SEQ DRUG,CDM Code,Outpatient,96375,$145.,$25.5,$137.75,$116.,$131.95,$38.0238,$137.75,$35.8715,$137.75,$137.75,$92.8626,$98.9625,$25.5,$133.4
,CDM,4250000828.10.4250,"THER/PROPH/DX IVP,SEQ SAME MED",CDM Code,Outpatient,96376,$183.,$17.,$173.85,$146.4,$166.53,$47.9886,$173.85,$45.2724,$173.85,$173.85,$18.3,$124.8975,$17.,$168.36
,CDM,4250000829.10.4250,APPLICATON ON-BODY INJECTOR,CDM Code,Outpatient,96377,$137.,$29.,$130.15,$109.6,$124.67,$35.9259,$130.15,$33.8924,$130.15,$130.15,$13.7,$93.5025,$29.,$126.04
,CDM,4250000830.10.4250,CHEMOTHERAPY UNSPECIFIED,CDM Code,Outpatient,96549,$214.,$52.9415,$203.3,$171.2,$194.74,$56.1179,$203.3,$52.9415,$203.3,$203.3,$92.8626,$146.055,$188.32,$196.88
,CDM,4250001701.10.4250,STRAIGHT CATH RESIDUAL URINE,CDM Code,Outpatient,51701,$135.,$33.3976,$267.0534,$108.,$122.85,$35.4015,$128.25,$33.3976,$128.25,$128.25,$267.0534,$92.1375,$118.8,$124.2
,CDM,4250001705.10.4250,"CHANGE OF CYSTOSTOMY TUBE, SIM",CDM Code,Outpatient,51705,$501.,$123.9424,$576.8268,$400.8,$455.91,$131.3787,$475.95,$123.9424,$475.95,$475.95,$576.8268,$341.9325,$440.88,$460.92
,CDM,4250001781.10.4250,COLLECTION OF BLOOD FROM PICC,CDM Code,Outpatient,36592,$283.,$38.,$268.85,$226.4,$257.53,$74.2119,$268.85,$70.0114,$268.85,$268.85,$267.0534,$193.1475,$38.,$260.36
,CDM,4250001781.20.4250,COLLECTION OF BLOOD FROM PICC,CDM Code,Outpatient,36592,$269.,$38.,$267.0534,$215.2,$244.79,$70.5407,$255.55,$66.5479,$255.55,$255.55,$267.0534,$183.5925,$38.,$247.48
,CDM,4250001797.10.4250,BLADDER INSTILLAT ANTI CA AGEN,CDM Code,Outpatient,51720,$522.,$129.1376,$576.8268,$417.6,$475.02,$136.8856,$495.9,$129.1376,$495.9,$495.9,$576.8268,$356.265,$459.36,$480.24
,CDM,4250002010.10.4250,DECLOTTING VENOUS ACCESS DEV 2,CDM Code,Outpatient,36593,"$1,021.",$45.,$969.95,$816.8,$929.11,$267.7399,$969.95,$252.5852,$969.95,$969.95,$746.1315,$696.8325,$45.,$939.32
,CDM,4250003655.10.4250,COLLECTION OF BLOOD FROM VAD,CDM Code,Outpatient,36591,$263.,$34.,$267.0534,$210.4,$239.33,$68.9673,$249.85,$65.0636,$249.85,$249.85,$267.0534,$179.4975,$34.,$241.96
,CDM,4250003655.20.4250,COLLECTION OF BLOOD FROM VAD,CDM Code,Outpatient,36591,$250.,$34.,$267.0534,$200.,$227.5,$65.5583,$237.5,$61.8475,$237.5,$237.5,$267.0534,$170.625,$34.,$230.
,CDM,4250007400.10.4250,INDWELLING BLADDER CATH COMPLE,CDM Code,Outpatient,51703,$461.,$114.0468,$437.95,$368.8,$419.51,$120.8894,$437.95,$114.0468,$437.95,$437.95,$339.357,$314.6325,$405.68,$424.12
,CDM,4250007402.10.4250,BLOOD ADMINISTRATION-1 HR,CDM Code,Outpatient,36430,"$1,247.",$50.,"$1,184.65",$997.6,"$1,134.77",$327.0046,"$1,184.65",$308.4953,"$1,184.65","$1,184.65",$946.6218,$851.0775,$50.,"$1,147.24"
,CDM,4250007403.10.4250,BLOOD ADMINISTRATION-2 HRS,CDM Code,Outpatient,36430,"$1,247.",$50.,"$1,184.65",$997.6,"$1,134.77",$327.0046,"$1,184.65",$308.4953,"$1,184.65","$1,184.65",$946.6218,$851.0775,$50.,"$1,147.24"
,CDM,4250007404.10.4250,BLOOD ADMINISTRATION-3 HRS,CDM Code,Outpatient,36430,"$1,247.",$50.,"$1,184.65",$997.6,"$1,134.77",$327.0046,"$1,184.65",$308.4953,"$1,184.65","$1,184.65",$946.6218,$851.0775,$50.,"$1,147.24"
,CDM,4250007405.10.4250,BLOOD ADMINISTRATION-4 HRS,CDM Code,Outpatient,36430,"$1,247.",$50.,"$1,184.65",$997.6,"$1,134.77",$327.0046,"$1,184.65",$308.4953,"$1,184.65","$1,184.65",$946.6218,$851.0775,$50.,"$1,147.24"
,CDM,4250007406.10.4250,BLOOD ADMINISTRATION-5 HRS,CDM Code,Outpatient,36430,"$1,247.",$50.,"$1,184.65",$997.6,"$1,134.77",$327.0046,"$1,184.65",$308.4953,"$1,184.65","$1,184.65",$946.6218,$851.0775,$50.,"$1,147.24"
,CDM,4250007407.10.4250,BLOOD ADMINISTRATION-6 HRS,CDM Code,Outpatient,36430,"$1,247.",$50.,"$1,184.65",$997.6,"$1,134.77",$327.0046,"$1,184.65",$308.4953,"$1,184.65","$1,184.65",$946.6218,$851.0775,$50.,"$1,147.24"
,CDM,4250007408.10.4250,BLOOD ADMINISTRATION-7 HRS,CDM Code,Outpatient,36430,"$1,500.",$50.,"$1,425.","$1,200.","$1,365.",$393.3495,"$1,425.",$371.085,"$1,425.","$1,425.",$946.6218,"$1,023.75",$50.,"$1,380."
,CDM,4250007410.10.4250,BLOOD ADMINISTRATION-9 HRS,CDM Code,Outpatient,36430,"$1,623.",$50.,"$1,541.85","$1,298.4","$1,476.93",$425.6042,"$1,541.85",$401.514,"$1,541.85","$1,541.85",$946.6218,"$1,107.6975",$50.,"$1,493.16"
,CDM,4250007415.10.4250,IM/SQ NONHORMONAL CHEMO,CDM Code,Outpatient,96401,$340.,$84.1126,$323.,$272.,$309.4,$89.1592,$323.,$84.1126,$323.,$323.,$141.9639,$232.05,$113.5,$312.8
,CDM,4250007416.10.4250,IM/SQ HORMONAL CHEMO,CDM Code,Outpatient,96402,$247.,$43.5,$234.65,$197.6,$224.77,$64.7716,$234.65,$61.1053,$234.65,$234.65,$141.9639,$168.5775,$43.5,$227.24
,CDM,4250007420.10.4250,CHEMO PUMP INITIATION > 8 HRS,CDM Code,Outpatient,96416,$768.,$189.9955,$746.1315,$614.4,$698.88,$201.3949,$729.6,$189.9955,$729.6,$729.6,$746.1315,$524.16,$204.5,$706.56
,CDM,4250007421.10.4250,VAD FLUSH AND MAINTENANCE,CDM Code,Outpatient,96523,$143.,$35.3768,$145.6485,$114.4,$130.13,$37.4993,$135.85,$35.3768,$135.85,$135.85,$145.6485,$97.5975,$39.5,$131.56
,CDM,4250007421.20.4250,VAD FLUSH AND MAINTENANCE,CDM Code,Outpatient,96523,$136.,$33.645,$145.6485,$108.8,$123.76,$35.6637,$129.2,$33.645,$129.2,$129.2,$145.6485,$92.82,$39.5,$125.12
,CDM,4250009002.10.4250,ALLERGY SHOT,CDM Code,Outpatient,95115,$76.,$12.5,$92.8626,$60.8,$69.16,$19.9297,$72.2,$18.8016,$72.2,$72.2,$92.8626,$51.87,$12.5,$69.92
,CDM,4251000852.10.4251,PHYSICIAN OP VISIT NEW LEVEL 3,CDM Code,Professional,99203,$319.,$31.9,$293.48,$255.2,$141.89,$61.215,$96.32,$57.75,$166.155,$165.36,$31.9,$217.7175,$152.5,$293.48
,CDM,4251000853.10.4251,PHYSICIAN OP VISIT NEW LEVEL 4,CDM Code,Professional,99204,$477.,$47.7,$438.84,$381.6,$214.04,$92.8136,$162.59,$87.56,$252.3675,$251.16,$47.7,$325.5525,$232.5,$438.84
,CDM,4251000854.10.4251,PHYSICIAN OP VISIT NEW LEVEL 5,CDM Code,Professional,99205,$597.,$59.7,$549.24,$477.6,$268.68,$116.5576,$212.33,$109.96,$312.455,$310.96,$59.7,$407.4525,$292.5,$549.24
,CDM,4251000855.10.4251,PHYSICIAN OP VISIT EST LEVEL 1,CDM Code,Professional,99211,$54.,$5.4,$49.68,$43.2,$27.32,$12.9532,$11.57,$12.22,$31.35,$31.2,$5.4,$36.855,$30.5,$49.68
,CDM,4251000856.10.4251,PHYSICIAN OP VISIT EST LEVEL 2,CDM Code,Professional,99212,$107.,$10.7,$98.44,$85.6,$58.11,$25.705,$32.,$24.25,$67.4025,$67.08,$10.7,$73.0275,$62.,$98.44
,CDM,4251000857.10.4251,PHYSICIAN OP VISIT EST LEVEL 3,CDM Code,Professional,99213,$173.,$17.3,$159.16,$138.4,$96.37,$42.188,$64.49,$39.8,$111.815,$111.28,$17.3,$118.0725,$103.,$159.16
,CDM,4251000858.10.4251,PHYSICIAN OP VISIT EST LEVEL 4,CDM Code,Professional,99214,$252.,$25.2,$231.84,$201.6,$141.4,$61.6072,$98.77,$58.12,$164.065,$163.28,$25.2,$171.99,$152.,$231.84
,CDM,4251000859.10.4251,PHYSICIAN OP VISIT EST LEVEL 5,CDM Code,Professional,99215,$345.,$34.5,$317.4,$276.,$189.62,$82.415,$139.66,$77.75,$219.45,$218.4,$34.5,$235.4625,$205.,$317.4
,CDM,4251000877.10.4251,PROFEE BEHAV CHG SMKING 3-10MN,CDM Code,Professional,99406,$26.,$6.4321,$25.23,$20.8,$18.89,$6.8181,$15.55,$6.4321,$24.7,$24.7,$25.23,$17.745,$20.5,$23.92
,CDM,4251000878.10.4251,PROFEE BEHAV CHG SMOKING >10MN,CDM Code,Professional,99407,$53.,$16.57,$50.35,$42.4,$36.16,$17.5642,$32.44,$16.57,$50.35,$50.35,$25.23,$36.1725,$39.5,$48.76
,CDM,4251001090.10.4251,MAC MD IP FOLLOW UP LVL 1,CDM Code,Professional,99231,$154.,$15.4,$141.68,$123.2,$50.21,$24.5072,$49.33,$23.12,$58.52,$58.24,$15.4,$105.105,$55.5,$141.68
,CDM,4251001091.10.4251,MAC MD IP FOLLOW UP LVL 2,CDM Code,Professional,99232,$237.,$23.7,$218.04,$189.6,$92.71,$45.103,$91.61,$42.55,$107.635,$107.12,$23.7,$161.7525,$103.,$218.04
,CDM,4251001092.10.4251,MAC MD IP FOLLOW UP LVL 3,CDM Code,Professional,99233,$323.,$32.3,$297.16,$258.4,$133.93,$64.4056,$131.2,$60.76,$154.66,$153.92,$32.3,$220.4475,$147.5,$297.16
,CDM,4251001095.10.4251,MAC MD IP NEW/EST INITIAL LVL,CDM Code,Professional,99223,$404.,$40.4,$371.68,$323.2,$259.93,$125.557,$255.23,$118.45,$303.05,$301.6,$40.4,$275.73,$287.,$371.68
,CDM,4251001096.10.4251,MAC PHONE E/M PHYS/QHP 5-10MIN,CDM Code,Professional,99441,$27.,$2.7,$25.65,$21.6,$17.95,$8.6708,$16.04,$8.18,$25.65,$25.65,$2.7,$18.4275,$20.,$24.84
,CDM,4251001097.10.4251,MAC PHONE E/M PHYS/QHP 11-20MI,CDM Code,Professional,99442,$54.,$5.4,$51.3,$43.2,$34.7,$16.695,$32.04,$15.75,$51.3,$51.3,$5.4,$36.855,$38.,$49.68
,CDM,4251001098.10.4251,MAC PHONE E/M PHYS/QHP 21-30MI,CDM Code,Professional,99443,$81.,$8.1,$76.95,$64.8,$51.15,$24.7192,$48.08,$23.32,$76.95,$76.95,$8.1,$55.2825,$56.,$74.52
,CDM,4251002007.10.4251,PROV OP VISIT EST LEVEL3  TELE,CDM Code,Professional,99213GT,$173.,$17.3,$159.16,$138.4,$96.37,$42.188,$64.49,$39.8,$111.815,$111.28,$17.3,$118.0725,$103.,$159.16
,CDM,4251002008.10.4251,PROV OP VISIT EST LEVEL4  TELE,CDM Code,Professional,99214GT,$252.,$25.2,$231.84,$201.6,$141.4,$61.6072,$98.77,$58.12,$164.065,$163.28,$25.2,$171.99,$152.,$231.84
,CDM,4251002009.10.4251,PROV OP VISIT EST LEVEL5  TELE,CDM Code,Professional,99215GT,$345.,$34.5,$317.4,$276.,$189.62,$82.415,$139.66,$77.75,$219.45,$218.4,$34.5,$235.4625,$205.,$317.4
,CDM,4252000016.10.4252,DIAB EDU INDIV PER 30 MIN,CDM Code,Outpatient,G0108,$116.,$28.6972,$144.6873,$92.8,$105.56,$30.419,$110.2,$28.6972,$110.2,$110.2,$144.6873,$79.17,$102.08,$106.72
,CDM,4252000017.10.4252,DIAB EDU GRP PER 30 MIN,CDM Code,Outpatient,G0109,$55.,$13.6065,$52.25,$44.,$50.05,$14.4228,$52.25,$13.6065,$52.25,$52.25,$39.2757,$37.5375,$48.4,$50.6
,CDM,4252000512.10.4252,GLUCOSE PUMP MAINTENANCE,CDM Code,Outpatient,95250,$352.,$87.0813,$334.4,$281.6,$320.32,$92.306,$334.4,$87.0813,$334.4,$334.4,$284.6487,$240.24,$217.5,$323.84
,CDM,4253000285.10.4253,ANKLE BRACHIAL INDEX TEST BILA,CDM Code,Outpatient,93922,$355.,$87.8234,$337.25,$284.,$323.05,$93.0927,$337.25,$87.8234,$337.25,$337.25,$267.0534,$242.2875,$107.5,$326.6
,CDM,4253000286.10.4253,CHEMICAL CAUTERY,CDM Code,Outpatient,17250,$352.,$87.0813,$408.8304,$281.6,$320.32,$92.306,$334.4,$87.0813,$334.4,$334.4,$408.8304,$240.24,$114.5,$323.84
,CDM,4253000287.10.4253,COMPRESSION THERAPY,CDM Code,Outpatient,29580,$387.,$87.5,$367.65,$309.6,$352.17,$101.4842,$367.65,$95.7399,$367.65,$367.65,$334.1505,$264.1275,$87.5,$356.04
,CDM,4253000290.10.4253,DEB SUBQ TISSUE 20 SQ CM/<,CDM Code,Outpatient,11042,$629.,$155.6083,$781.2954,$503.2,$572.39,$164.9446,$597.55,$155.6083,$597.55,$597.55,$781.2954,$429.2925,$167.5,$578.68
,CDM,4253000291.10.4253,DRAINAGE OF SKIN ABSCESS,CDM Code,Outpatient,10060,$525.,$129.8798,$498.75,$420.,$477.75,$137.6723,$498.75,$129.8798,$498.75,$498.75,$408.8304,$358.3125,$169.,$483.
,CDM,4253000911.10.4253,BIOFEEDBACK TRAINING,CDM Code,Outpatient,90912,$262.,$64.8162,$248.9,$209.6,$238.42,$68.705,$248.9,$64.8162,$248.9,$248.9,$26.2,$178.815,$230.56,$241.04
,CDM,4253001784.10.4253,EMG STUDIES,CDM Code,Outpatient,51784,$462.,$114.2942,$438.9,$369.6,$420.42,$121.1516,$438.9,$114.2942,$438.9,$438.9,$339.357,$315.315,$406.56,$425.04
,CDM,4253007597.10.4253,ACTIVE WOUND CARE/20 CM OR LES,CDM Code,Outpatient,97597,$301.,$74.4644,$408.8304,$240.8,$273.91,$78.9321,$285.95,$74.4644,$285.95,$285.95,$408.8304,$205.4325,$118.5,$276.92
,CDM,4253007598.10.4253,ACTIVE WOUND CARE/MORE THAN 20,CDM Code,Outpatient,97598,$405.,$39.5,$384.75,$324.,$368.55,$106.2044,$384.75,$100.193,$384.75,$384.75,$40.5,$276.4125,$39.5,$372.6
,CDM,4253007602.10.4253,DEBRIDEMENT-NON SELECTIVE,CDM Code,Outpatient,97602,$216.,$37.95,$408.8304,$172.8,$196.56,$56.6423,$205.2,$53.4362,$205.2,$205.2,$408.8304,$147.42,$37.95,$198.72
,CDM,4253007603.10.4253,"DEBRIDE SKIN,SC TISSUE, MUSCLE",CDM Code,Outpatient,11043,$529.,$130.8693,"$1,209.777",$423.2,$481.39,$138.7213,$502.55,$130.8693,$502.55,$502.55,"$1,209.777",$361.0425,$326.5,$486.68
,CDM,4253007605.10.4253,NEG PRESSURE WOUND CARE 50CM O,CDM Code,Outpatient,97605,$210.,$51.9519,$408.8304,$168.,$191.1,$55.0689,$199.5,$51.9519,$199.5,$199.5,$408.8304,$143.325,$62.5,$193.2
,CDM,4253007606.10.4253,NEG PRESSURE WOUND CARE >50 CM,CDM Code,Outpatient,97606,$254.,$62.8371,$781.2954,$203.2,$231.14,$66.6072,$241.3,$62.8371,$241.3,$241.3,$781.2954,$173.355,$74.,$233.68
,CDM,4253007612.10.4253,WOC VISIT LEVEL 1,CDM Code,Outpatient,99211,$151.,$30.5,$143.45,$120.8,$137.41,$39.5972,$143.45,$37.3559,$143.45,$143.45,$15.1,$103.0575,$30.5,$138.92
,CDM,4253007613.10.4253,WOC VISIT LEVEL 2,CDM Code,Outpatient,99212,$181.,$44.7776,$171.95,$144.8,$164.71,$47.4642,$171.95,$44.7776,$171.95,$171.95,$18.1,$123.5325,$62.,$166.52
,CDM,4253007614.10.4253,WOC VISIT LEVEL 3,CDM Code,Outpatient,99213,$217.,$53.6836,$206.15,$173.6,$197.47,$56.9046,$206.15,$53.6836,$206.15,$206.15,$21.7,$148.1025,$103.,$199.64
,CDM,4253007615.10.4253,WOC VISIT LEVEL 4,CDM Code,Outpatient,99214,$261.,$64.5688,$247.95,$208.8,$237.51,$68.4428,$247.95,$64.5688,$247.95,$247.95,$26.1,$178.1325,$152.,$240.12
,CDM,4253007622.10.4253,COMPRESSION DRESSING VENOUS,CDM Code,Outpatient,29581,$522.,$121.,$495.9,$417.6,$475.02,$136.8856,$495.9,$129.1376,$495.9,$495.9,$334.1505,$356.265,$121.,$480.24
,CDM,4253009003.10.4253,"PRO WC VISIT,NEW,INTERME",CDM Code,Professional,99203,$0.,$0.,$166.155,$0.,$141.89,$61.215,$96.32,$57.75,$166.155,$165.36,$0.,$0.,$152.5,$0.
,CDM,4253009004.10.4253,"PRO WC VISIT,NEW,EXTEND",CDM Code,Professional,99204,$0.,$0.,$252.3675,$0.,$214.04,$92.8136,$162.59,$87.56,$252.3675,$251.16,$0.,$0.,$232.5,$0.
,CDM,4253009005.10.4253,"PRO WC VISIT,NEW,COMPLEX",CDM Code,Professional,99205,$0.,$0.,$312.455,$0.,$268.68,$116.5576,$212.33,$109.96,$312.455,$310.96,$0.,$0.,$292.5,$0.
,CDM,4253009007.10.4253,"PRO WC VISIT,EST,LIMITED",CDM Code,Professional,99212,$0.,$0.,$67.4025,$0.,$58.11,$25.705,$32.,$24.25,$67.4025,$67.08,$0.,$0.,$62.,$0.
,CDM,4253009008.10.4253,"PRO WC VISIT,EST,INTERM",CDM Code,Professional,99213,$173.,$17.3,$159.16,$138.4,$96.37,$42.188,$64.49,$39.8,$111.815,$111.28,$17.3,$118.0725,$103.,$159.16
,CDM,4253009009.10.4253,"PRO WC VISIT,EST,EXTEND",CDM Code,Professional,99214,$252.,$25.2,$231.84,$201.6,$141.4,$61.6072,$98.77,$58.12,$164.065,$163.28,$25.2,$171.99,$152.,$231.84
,CDM,4253009011.10.4253,"PR DEBRIDMNT,SUBQ (FIRST 20SQ)",CDM Code,Professional,11042,$127.,$73.24,$292.62,$101.6,$115.57,$77.6344,$79.12,$73.24,$120.65,$120.65,$292.62,$86.6775,$167.5,$116.84
,CDM,4253009012.10.4253,"PR DEBRIDMNT,SUBQ (EA AD L 20)",CDM Code,Professional,11045,$55.,$5.5,$59.,$44.,$50.05,$26.235,$33.6,$24.75,$52.25,$52.25,$5.5,$37.5375,$59.,$50.6
,CDM,4253009013.10.4253,"PR DEBRIDMNT,MUSC(1ST 20 SQCM)",CDM Code,Professional,11043,$320.,$137.68,$453.1,$256.,$291.2,$145.9408,$198.2,$137.68,$304.,$304.,$453.1,$218.4,$326.5,$294.4
,CDM,4253009020.10.4253,"PRO INCISION  DRAIN ABSCS,SIMP",CDM Code,Professional,10060,$203.,$70.99,$186.76,$162.4,$184.73,$75.2494,$124.52,$70.99,$181.83,$180.96,$153.12,$138.5475,$169.,$186.76
,CDM,4253009028.10.4253,PRO MULTI LAYER COMPRESN SYSTE,CDM Code,Professional,29581,$58.,$35.63,$125.15,$46.4,$52.78,$55.7348,$35.63,$52.58,$55.1,$55.1,$125.15,$39.585,$121.,$53.36
,CDM,4253009033.10.4253,PRO SEL DEBRIDMENT 1st 20 SQCM,CDM Code,Professional,97597,$49.,$21.22,$153.12,$39.2,$102.89,$56.816,$21.22,$53.6,$46.55,$46.55,$153.12,$33.4425,$118.5,$45.08
,CDM,4253009034.10.4253,PRO RMVL DEVITAL TIS ADDL 20CM,CDM Code,Professional,97598,$24.,$2.4,$39.5,$19.2,$33.36,$17.7868,$9.98,$16.78,$22.8,$22.8,$2.4,$16.38,$39.5,$22.08
,CDM,4275000009.20.4276,PNEUMOVAX,CDM Code,Outpatient,90732,$110.,$27.2129,$151.8993,$88.,$100.1,$28.8456,$104.5,$27.2129,$104.5,$104.5,$151.8993,$75.075,$96.8,$101.2
,CDM,4275000009.30.4275,PNEUMOVAX,CDM Code,Outpatient,90732,$110.,$27.2129,$151.8993,$88.,$100.1,$28.8456,$104.5,$27.2129,$104.5,$104.5,$151.8993,$75.075,$96.8,$101.2
,CDM,4275000043.30.4275,LI FINAL REPORT,CDM Code,Outpatient,1026M,$26.35,$6.5187,$25.0325,$21.08,$23.9785,$6.9098,$25.0325,$6.5187,$25.0325,$25.0325,$2.635,$17.9839,$23.188,$24.242
,CDM,4275000048.30.4275,LI REPORT OF ACCIDENT,CDM Code,Outpatient,1040M,$39.88,$9.8659,$37.886,$31.904,$36.2908,$10.4579,$37.886,$9.8659,$37.886,$37.886,$3.988,$27.2181,$35.0944,$36.6896
,CDM,4275000049.30.4275,LI REOPENING APPLICATION,CDM Code,Outpatient,1041M,$51.84,$12.8247,$49.248,$41.472,$47.1744,$13.5942,$49.248,$12.8247,$49.248,$49.248,$5.184,$35.3808,$45.6192,$47.6928
,CDM,4275000050.30.4275,LI ACTIVITY PRESCRIPTION FORM,CDM Code,Outpatient,1073M,$51.84,$12.8247,$49.248,$41.472,$47.1744,$13.5942,$49.248,$12.8247,$49.248,$49.248,$5.184,$35.3808,$45.6192,$47.6928
,CDM,4275000123.30.4275,HOME VISIT,CDM Code,Outpatient,99348,$140.,$34.6346,$133.,$112.,$127.4,$36.7126,$133.,$34.6346,$133.,$133.,$14.,$95.55,$119.,$128.8
,CDM,4275000207.20.4276,"MAA ENCOUNTER, PROB FOCUS",CDM Code,Professional,T1015,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.
,CDM,4275000207.30.4275,"MAA ENCOUNTER, PROB FOCUS",CDM Code,Professional,T1015,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.
,CDM,4275000300.20.4276,DOH VACCINE ADMINISTRATION,CDM Code,Outpatient,90471,$23.44,$5.7988,$141.9639,$18.752,$21.3304,$6.1467,$22.268,$5.7988,$22.268,$22.268,$141.9639,$15.9978,$29.,$21.5648
,CDM,4275000300.30.4275,DOH VACCINE ADMINISTRATION,CDM Code,Outpatient,90471,$23.44,$5.7988,$141.9639,$18.752,$21.3304,$6.1467,$22.268,$5.7988,$22.268,$22.268,$141.9639,$15.9978,$29.,$21.5648
,CDM,4275000301.20.4276,DOH ADDITIONAL VACCINE ADMIN,CDM Code,Outpatient,90472,$23.44,$5.7988,$22.268,$18.752,$21.3304,$6.1467,$22.268,$5.7988,$22.268,$22.268,$2.344,$15.9978,$18.,$21.5648
,CDM,4275000301.30.4275,DOH ADDITIONAL VACCINE ADMIN,CDM Code,Outpatient,90472,$23.44,$5.7988,$22.268,$18.752,$21.3304,$6.1467,$22.268,$5.7988,$22.268,$22.268,$2.344,$15.9978,$18.,$21.5648
,CDM,4275000405.30.4275,SPORTS PHYSICAL,CDM Code,Outpatient,99212,$75.,$18.5542,$71.25,$60.,$68.25,$19.6675,$71.25,$18.5542,$71.25,$71.25,$7.5,$51.1875,$62.,$69.
,CDM,4275000460.20.4276,PEDS VACCINE ADMIN 1ST,CDM Code,Outpatient,90460,$23.44,$5.7988,$29.,$18.752,$21.3304,$6.1467,$22.268,$5.7988,$22.268,$22.268,$2.344,$15.9978,$29.,$21.5648
,CDM,4275000460.30.4275,PEDS VACCINE ADMIN 1ST,CDM Code,Outpatient,90460,$23.44,$5.7988,$29.,$18.752,$21.3304,$6.1467,$22.268,$5.7988,$22.268,$22.268,$2.344,$15.9978,$29.,$21.5648
,CDM,4275000461.20.4276,PEDS VACCINE ADMIN EA ADD,CDM Code,Outpatient,90461,$23.44,$5.7988,$22.268,$18.752,$21.3304,$6.1467,$22.268,$5.7988,$22.268,$22.268,$2.344,$15.9978,$18.,$21.5648
,CDM,4275000461.30.4275,PEDS VACCINE ADMIN EA ADD,CDM Code,Outpatient,90461,$23.44,$5.7988,$22.268,$18.752,$21.3304,$6.1467,$22.268,$5.7988,$22.268,$22.268,$2.344,$15.9978,$18.,$21.5648
,CDM,4275000471.20.4276,1ST VACCINATION,CDM Code,Outpatient,90471,$45.,$11.1326,$141.9639,$36.,$40.95,$11.8005,$42.75,$11.1326,$42.75,$42.75,$141.9639,$30.7125,$29.,$41.4
,CDM,4275000471.30.4275,1ST VACCINATION,CDM Code,Outpatient,90471,$42.,$10.3904,$141.9639,$33.6,$38.22,$11.0138,$39.9,$10.3904,$39.9,$39.9,$141.9639,$28.665,$29.,$38.64
,CDM,4275000472.20.4276,VACC EA ADD,CDM Code,Outpatient,90472,$15.,$3.7108,$18.,$12.,$13.65,$3.9335,$14.25,$3.7108,$14.25,$14.25,$1.5,$10.2375,$18.,$13.8
,CDM,4275000472.30.4275,VACC EA ADD,CDM Code,Outpatient,90472,$24.,$5.9374,$22.8,$19.2,$21.84,$6.2936,$22.8,$5.9374,$22.8,$22.8,$2.4,$16.38,$18.,$22.08
,CDM,4275000473.30.4275,ORAL/NASAL VACCINE ADMIN,CDM Code,Outpatient,90473,$24.22,$5.9918,$141.9639,$19.376,$22.0402,$6.3513,$23.009,$5.9918,$23.009,$23.009,$141.9639,$16.5301,$29.,$22.2824
,CDM,4275000501.20.4276,NEBULIZER TREATMENT,CDM Code,Outpatient,94640,$34.,$8.4113,$432.7536,$27.2,$30.94,$8.9159,$32.3,$8.4113,$32.3,$32.3,$432.7536,$23.205,$26.5,$31.28
,CDM,4275000550.20.4276,TENDON SHEATH THERAPEUTIC INJE,CDM Code,Outpatient,20550,$104.,$25.7286,$616.77,$83.2,$94.64,$27.2722,$98.8,$25.7286,$98.8,$98.8,$616.77,$70.98,$75.5,$95.68
,CDM,4275000550.30.4275,TENDON SHEATH THERAPEUTIC INJE,CDM Code,Outpatient,20550,$130.,$32.1607,$616.77,$104.,$118.3,$34.0903,$123.5,$32.1607,$123.5,$123.5,$616.77,$88.725,$75.5,$119.6
,CDM,4275000600.30.4275,ASP. /INJ SM JOINT,CDM Code,Outpatient,20600,$92.,$22.7599,$616.77,$73.6,$83.72,$24.1254,$87.4,$22.7599,$87.4,$87.4,$616.77,$62.79,$68.5,$84.64
,CDM,4275000605.20.4276,ASP. /INJ MED JOINT,CDM Code,Outpatient,20605,$121.,$29.9342,$616.77,$96.8,$110.11,$31.7302,$114.95,$29.9342,$114.95,$114.95,$616.77,$82.5825,$72.,$111.32
,CDM,4275000605.30.4275,ASP. /INJ MED JOINT,CDM Code,Outpatient,20605,$0.,$0.,$616.77,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$616.77,$0.,$72.,$0.
,CDM,4275000610.30.4275,ASP. /INJ LARGE JOINT,CDM Code,Outpatient,20610,$125.,$30.9237,$616.77,$100.,$113.75,$32.7791,$118.75,$30.9237,$118.75,$118.75,$616.77,$85.3125,$86.,$115.
,CDM,4275000632.20.4276,"HEPATITIS A VAC,ADULT",CDM Code,Outpatient,90632,$95.,$23.5021,$90.25,$76.,$86.45,$24.9121,$90.25,$23.5021,$90.25,$90.25,$78.3503,$64.8375,$83.6,$87.4
,CDM,4275000632.30.4275,"HEPATITIS A VAC,ADULT",CDM Code,Outpatient,90632,$95.,$23.5021,$90.25,$76.,$86.45,$24.9121,$90.25,$23.5021,$90.25,$90.25,$78.3503,$64.8375,$83.6,$87.4
,CDM,4275000634.20.4276,HEP A,CDM Code,Outpatient,90634,$49.,$12.1221,$46.55,$39.2,$44.59,$12.8494,$46.55,$12.1221,$46.55,$46.55,$4.9,$33.4425,$0.,$45.08
,CDM,4275000634.30.4275,HEP A,CDM Code,Outpatient,90634,$49.,$12.1221,$46.55,$39.2,$44.59,$12.8494,$46.55,$12.1221,$46.55,$46.55,$4.9,$33.4425,$0.,$45.08
,CDM,4275000649.20.4276,HPV,CDM Code,Outpatient,90649,$291.,$71.9905,$276.45,$232.8,$264.81,$76.3098,$276.45,$71.9905,$276.45,$276.45,$29.1,$198.6075,$256.08,$267.72
,CDM,4275000649.30.4275,HPV,CDM Code,Outpatient,90649,$223.,$55.168,$211.85,$178.4,$202.93,$58.478,$211.85,$55.168,$211.85,$211.85,$22.3,$152.1975,$196.24,$205.16
,CDM,4275000657.20.4276,INFLUENZA VAC-PEDS,CDM Code,Outpatient,90657,$29.,$7.1743,$27.55,$23.2,$26.39,$7.6048,$27.55,$7.1743,$27.55,$27.55,$2.9,$19.7925,$25.52,$26.68
,CDM,4275000657.30.4275,INFLUENZA VAC-PEDS,CDM Code,Outpatient,90657,$9.,$2.2265,$8.55,$7.2,$8.19,$2.3601,$8.55,$2.2265,$8.55,$8.55,$0.9,$6.1425,$7.92,$8.28
,CDM,4275000660.20.4276,FLU MIST-PEDS,CDM Code,Outpatient,90660,$29.,$7.1743,$27.55,$23.2,$26.39,$7.6048,$27.55,$7.1743,$27.55,$27.55,$2.9,$19.7925,$25.52,$26.68
,CDM,4275000660.30.4275,FLU MIST-PEDS,CDM Code,Outpatient,90660,$29.,$7.1743,$27.55,$23.2,$26.39,$7.6048,$27.55,$7.1743,$27.55,$27.55,$2.9,$19.7925,$25.52,$26.68
,CDM,4275000680.20.4276,ROTOVIRUS VAC,CDM Code,Outpatient,90680,$93.,$23.0073,$88.35,$74.4,$84.63,$24.3877,$88.35,$23.0073,$88.35,$88.35,$9.3,$63.4725,$81.84,$85.56
,CDM,4275000688.20.4276,FLUZONE QUAD 3YRS-OLDER,CDM Code,Outpatient,90688,$32.,$7.9165,$30.4,$25.6,$29.12,$8.3915,$30.4,$7.9165,$30.4,$30.4,$23.7272,$21.84,$28.16,$29.44
,CDM,4275000698.20.4276,DTAP-IPV-HIB,CDM Code,Outpatient,90698,$140.,$34.6346,$133.,$112.,$127.4,$36.7126,$133.,$34.6346,$133.,$133.,$14.,$95.55,$0.,$128.8
,CDM,4275000698.30.4275,DTAP-IPV-HIB,CDM Code,Outpatient,90698,$175.,$43.2932,$166.25,$140.,$159.25,$45.8908,$166.25,$43.2932,$166.25,$166.25,$17.5,$119.4375,$0.,$161.
,CDM,4275000700.20.4276,DTAP VACCINATION,CDM Code,Outpatient,90700,$32.,$7.9165,$30.4,$25.6,$29.12,$8.3915,$30.4,$7.9165,$30.4,$30.4,$3.2,$21.84,$28.16,$29.44
,CDM,4275000700.30.4275,DTAP VACCINATION,CDM Code,Outpatient,90700,$100.,$24.739,$95.,$80.,$91.,$26.2233,$95.,$24.739,$95.,$95.,$10.,$68.25,$0.,$92.
,CDM,4275000702.30.4275,DT IMMUNIZATION,CDM Code,Outpatient,90702,$60.,$14.8434,$57.,$48.,$54.6,$15.734,$57.,$14.8434,$57.,$57.,$6.,$40.95,$0.,$55.2
,CDM,4275000707.20.4276,MMR VACCINE,CDM Code,Outpatient,90707,$162.,$40.0772,$153.9,$129.6,$147.42,$42.4817,$153.9,$40.0772,$153.9,$153.9,$16.2,$110.565,$0.,$149.04
,CDM,4275000707.30.4275,MMR VACCINE,CDM Code,Outpatient,90707,$162.,$40.0772,$153.9,$129.6,$147.42,$42.4817,$153.9,$40.0772,$153.9,$153.9,$16.2,$110.565,$0.,$149.04
,CDM,4275000713.20.4276,INACTIVE. POLIO VIRUS,CDM Code,Outpatient,90713,$44.,$10.8852,$41.8,$35.2,$40.04,$11.5383,$41.8,$10.8852,$41.8,$41.8,$4.4,$30.03,$0.,$40.48
,CDM,4275000713.30.4275,INACTIVE. POLIO VIRUS,CDM Code,Outpatient,90713,$104.,$25.7286,$98.8,$83.2,$94.64,$27.2722,$98.8,$25.7286,$98.8,$98.8,$10.4,$70.98,$0.,$95.68
,CDM,4275000715.20.4276,TDAP,CDM Code,Outpatient,90715,$212.,$52.4467,$201.4,$169.6,$192.92,$55.5934,$201.4,$52.4467,$201.4,$201.4,$43.7038,$144.69,$186.56,$195.04
,CDM,4275000715.30.4275,TDAP,CDM Code,Outpatient,90715,$59.,$14.596,$56.05,$47.2,$53.69,$15.4717,$56.05,$14.596,$56.05,$56.05,$43.7038,$40.2675,$51.92,$54.28
,CDM,4275000716.20.4276,VARICELLA VACCINATION,CDM Code,Outpatient,90716,$186.,$46.0145,$176.7,$148.8,$169.26,$48.7753,$176.7,$46.0145,$176.7,$176.7,$18.6,$126.945,$163.68,$171.12
,CDM,4275000716.30.4275,VARICELLA VACCINATION,CDM Code,Outpatient,90716,$233.,$57.6419,$221.35,$186.4,$212.03,$61.1003,$221.35,$57.6419,$221.35,$221.35,$23.3,$159.0225,$205.04,$214.36
,CDM,4275000718.20.4276,"TD, ADULT VACCINE",CDM Code,Outpatient,90714,$150.,$37.1085,$142.5,$120.,$136.5,$39.3349,$142.5,$37.1085,$142.5,$142.5,$32.2658,$102.375,$132.,$138.
,CDM,4275000718.30.4275,"TD, ADULT VACCINE",CDM Code,Outpatient,90714,$33.,$8.1639,$32.2658,$26.4,$30.03,$8.6537,$31.35,$8.1639,$31.35,$31.35,$32.2658,$22.5225,$29.04,$30.36
,CDM,4275000723.20.4276,DTAP-IPV-HEPB,CDM Code,Outpatient,90723,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.
,CDM,4275000724.20.4276,INFLUENZA VACCINE,CDM Code,Outpatient,90673,$38.,$9.4008,$36.1,$30.4,$34.58,$9.9649,$36.1,$9.4008,$36.1,$36.1,$3.8,$25.935,$33.44,$34.96
,CDM,4275000724.30.4275,INFLUENZA VACCINE,CDM Code,Outpatient,90673,$39.3333,$9.7307,$37.3666,$31.4666,$35.7933,$10.3145,$37.3666,$9.7307,$37.3666,$37.3666,$3.9333,$26.845,$34.6133,$36.1866
,CDM,4275000734.20.4276,MENINGIOCOCCAL VAC,CDM Code,Outpatient,90734,$274.,$67.7849,$260.3,$219.2,$249.34,$71.8518,$260.3,$67.7849,$260.3,$260.3,$27.4,$187.005,$241.12,$252.08
,CDM,4275000734.30.4275,MENINGIOCOCCAL VAC,CDM Code,Outpatient,90734,$274.,$67.7849,$260.3,$219.2,$249.34,$71.8518,$260.3,$67.7849,$260.3,$260.3,$27.4,$187.005,$241.12,$252.08
,CDM,4275000744.20.4276,HBV PEDIATRIC/ADOLESCENT IM,CDM Code,Outpatient,90744,$66.,$16.3277,$62.7,$52.8,$60.06,$17.3074,$62.7,$16.3277,$62.7,$62.7,$35.777,$45.045,$58.08,$60.72
,CDM,4275000744.30.4275,HBV PEDIATRIC/ADOLESCENT IM,CDM Code,Outpatient,90744,$62.,$15.3382,$58.9,$49.6,$56.42,$16.2584,$58.9,$15.3382,$58.9,$58.9,$35.777,$42.315,$54.56,$57.04
,CDM,4275000746.20.4276,HBV >20 YR,CDM Code,Outpatient,90746,$158.,$39.0876,$150.1,$126.4,$143.78,$41.4328,$150.1,$39.0876,$150.1,$150.1,$89.1898,$107.835,$0.,$145.36
,CDM,4275000746.30.4275,HBV >20 YR,CDM Code,Outpatient,90746,$158.,$39.0876,$150.1,$126.4,$143.78,$41.4328,$150.1,$39.0876,$150.1,$150.1,$89.1898,$107.835,$139.04,$145.36
,CDM,4275000782.20.4276,THERAPEUTIC INJECTION,CDM Code,Outpatient,96372,$45.,$11.1326,$141.9639,$36.,$40.95,$11.8005,$42.75,$11.1326,$42.75,$42.75,$141.9639,$30.7125,$29.,$41.4
,CDM,4275000782.30.4275,THERAPEUTIC INJECTION,CDM Code,Outpatient,96372,$45.,$11.1326,$141.9639,$36.,$40.95,$11.8005,$42.75,$11.1326,$42.75,$42.75,$141.9639,$30.7125,$29.,$41.4
,CDM,4275001006.20.4276,I & D ABCESS/PARONYC,CDM Code,Outpatient,10060,$203.,$50.2202,$408.8304,$162.4,$184.73,$53.2333,$192.85,$50.2202,$192.85,$192.85,$408.8304,$138.5475,$169.,$186.76
,CDM,4275001006.30.4275,I & D ABCESS/PARONYC,CDM Code,Outpatient,10060,$203.,$50.2202,$408.8304,$162.4,$184.73,$53.2333,$192.85,$50.2202,$192.85,$192.85,$408.8304,$138.5475,$169.,$186.76
,CDM,4275001008.30.4275,I & D PILONIDAL CYST,CDM Code,Outpatient,10080,$313.,$77.4331,"$1,439.4237",$250.4,$284.83,$82.0789,$297.35,$77.4331,$297.35,$297.35,"$1,439.4237",$213.6225,$256.,$287.96
,CDM,4275001014.20.4276,I & D HEMATOMA,CDM Code,Outpatient,10140,$0.,$0.,"$3,301.7754",$0.,$0.,$0.,$0.,$0.,$0.,$0.,"$3,301.7754",$0.,$234.5,$0.
,CDM,4275001014.30.4275,I & D HEMATOMA,CDM Code,Outpatient,10140,$271.,$67.0427,"$3,301.7754",$216.8,$246.61,$71.0651,$257.45,$67.0427,$257.45,$257.45,"$3,301.7754",$184.9575,$234.5,$249.32
,CDM,4275001015.30.4275,ASPIRATE/INJ GANGLION CYST,CDM Code,Outpatient,20612,$105.,$25.976,$616.77,$84.,$95.55,$27.5345,$99.75,$25.976,$99.75,$99.75,$616.77,$71.6625,$86.,$96.6
,CDM,4275001016.20.4276,ASPIR. HEMATOMA/CYST,CDM Code,Outpatient,10160,$139.,$34.3872,$781.2954,$111.2,$126.49,$36.4504,$132.05,$34.3872,$132.05,$132.05,$781.2954,$94.8675,$185.5,$127.88
,CDM,4275001016.30.4275,ASPIR. HEMATOMA/CYST,CDM Code,Outpatient,10160,$213.,$52.6941,$781.2954,$170.4,$193.83,$55.8556,$202.35,$52.6941,$202.35,$202.35,$781.2954,$145.3725,$185.5,$195.96
,CDM,4275001055.30.4275,PARING/CUTTING SINGLE LESION,CDM Code,Outpatient,11055,$89.,$22.0177,$408.8304,$71.2,$80.99,$23.3387,$84.55,$22.0177,$84.55,$84.55,$408.8304,$60.7425,$68.5,$81.88
,CDM,4275001100.20.4276,"DEBRIDEMENT, INF. SKIN",CDM Code,Outpatient,11000,$95.,$23.5021,"$1,209.777",$76.,$86.45,$24.9121,$90.25,$23.5021,$90.25,$90.25,"$1,209.777",$64.8375,$78.,$87.4
,CDM,4275001100.30.4275,"DEBRIDEMENT, INF. SKIN",CDM Code,Outpatient,11000,$95.,$23.5021,"$1,209.777",$76.,$86.45,$24.9121,$90.25,$23.5021,$90.25,$90.25,"$1,209.777",$64.8375,$78.,$87.4
,CDM,4275001101.30.4275,"BIOPSY, ADDL LESION",CDM Code,Outpatient,11101,$63.,$15.5856,$59.85,$50.4,$57.33,$16.5207,$59.85,$15.5856,$59.85,$59.85,$6.3,$42.9975,$55.44,$57.96
,CDM,4275001110.20.4276,"BIOPSY, SKIN 1 LESION",CDM Code,Outpatient,11100,$208.,$51.4571,$781.2954,$166.4,$189.28,$54.5445,$197.6,$51.4571,$197.6,$197.6,$781.2954,$141.96,$183.04,$191.36
,CDM,4275001110.30.4275,"BIOPSY, SKIN 1 LESION",CDM Code,Outpatient,11100,$186.,$46.0145,$781.2954,$148.8,$169.26,$48.7753,$176.7,$46.0145,$176.7,$176.7,$781.2954,$126.945,$163.68,$171.12
,CDM,4275001111.20.4276,GAU EXAM,CDM Code,Outpatient,99199,$141.,$34.882,$133.95,$112.8,$128.31,$36.9749,$133.95,$34.882,$133.95,$133.95,$14.1,$96.2325,$124.08,$129.72
,CDM,4275001111.30.4275,GAU EXAM,CDM Code,Outpatient,99199,$141.,$34.882,$133.95,$112.8,$128.31,$36.9749,$133.95,$34.882,$133.95,$133.95,$14.1,$96.2325,$124.08,$129.72
,CDM,4275001120.20.4276,"EXCISION, SKIN TAG <15",CDM Code,Outpatient,11200,$155.,$38.3454,$408.8304,$124.,$141.05,$40.6461,$147.25,$38.3454,$147.25,$147.25,$408.8304,$105.7875,$127.5,$142.6
,CDM,4275001120.30.4275,"EXCISION, SKIN TAG <15",CDM Code,Outpatient,11200,$155.,$38.3454,$408.8304,$124.,$141.05,$40.6461,$147.25,$38.3454,$147.25,$147.25,$408.8304,$105.7875,$127.5,$142.6
,CDM,4275001130.30.4275,"DEMAL SHAVE, <0.5CM",CDM Code,Outpatient,11300,$170.,$42.0563,$408.8304,$136.,$154.7,$44.5796,$161.5,$42.0563,$161.5,$161.5,$408.8304,$116.025,$139.5,$156.4
,CDM,4275001131.20.4276,"SHAVE BX,TRUNK,ARM,LEG 1.1-2CM",CDM Code,Outpatient,11302,$245.,$60.6105,$408.8304,$196.,$222.95,$64.2471,$232.75,$60.6105,$232.75,$232.75,$408.8304,$167.2125,$201.5,$225.4
,CDM,4275001131.30.4275,"SHAVE BX,TRUNK,ARM,LEG 1.1-2CM",CDM Code,Outpatient,11302,$245.,$60.6105,$408.8304,$196.,$222.95,$64.2471,$232.75,$60.6105,$232.75,$232.75,$408.8304,$167.2125,$201.5,$225.4
,CDM,4275001132.30.4275,"SHAVE BX,FACE,EAR .5CM OR LESS",CDM Code,Outpatient,11310,$196.,$48.4884,$408.8304,$156.8,$178.36,$51.3977,$186.2,$48.4884,$186.2,$186.2,$408.8304,$133.77,$162.5,$180.32
,CDM,4275001133.20.4276,"SHAVE BX,TRUNK,ARM,LEG, .6-1CM",CDM Code,Outpatient,11301,$207.,$51.2097,$408.8304,$165.6,$188.37,$54.2822,$196.65,$51.2097,$196.65,$196.65,$408.8304,$141.2775,$171.,$190.44
,CDM,4275001133.30.4275,"SHAVE BX,TRUNK,ARM,LEG, .6-1CM",CDM Code,Outpatient,11301,$0.,$0.,$408.8304,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$408.8304,$0.,$171.,$0.
,CDM,4275001135.20.4276,"SHAVE, SCALP ETC UP TO.5CM",CDM Code,Outpatient,11305,$169.,$41.8089,$408.8304,$135.2,$153.79,$44.3174,$160.55,$41.8089,$160.55,$160.55,$408.8304,$115.3425,$141.,$155.48
,CDM,4275001135.30.4275,"SHAVE, SCALP ETC UP TO.5CM",CDM Code,Outpatient,11305,$169.,$41.8089,$408.8304,$135.2,$153.79,$44.3174,$160.55,$41.8089,$160.55,$160.55,$408.8304,$115.3425,$141.,$155.48
,CDM,4275001201.20.4276,DOH HEPATITIS A VIRUS VACC,CDM Code,Outpatient,90633,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4275001201.30.4275,DOH HEPATITIS A VIRUS VACC,CDM Code,Outpatient,90633,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4275001202.20.4276,DOH HIB,CDM Code,Outpatient,90648,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4275001202.30.4275,DOH HIB,CDM Code,Outpatient,90648,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4275001203.20.4276,DOH HPV,CDM Code,Outpatient,90651,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4275001203.30.4275,DOH HPV,CDM Code,Outpatient,90651,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4275001204.20.4276,DOH PNEUMOCOCCAL,CDM Code,Outpatient,90670,$0.01,$0.0025,$286.3889,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$286.3889,$0.0068,$0.0088,$0.0092
,CDM,4275001204.30.4275,DOH PNEUMOCOCCAL,CDM Code,Outpatient,90670,$0.01,$0.0025,$286.3889,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$286.3889,$0.0068,$0.0088,$0.0092
,CDM,4275001205.20.4276,DOH DTAP/IPV,CDM Code,Outpatient,90696,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4275001205.30.4275,DOH DTAP/IPV,CDM Code,Outpatient,90696,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4275001206.20.4276,DOH DTAP,CDM Code,Outpatient,90700,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4275001206.30.4275,DOH DTAP,CDM Code,Outpatient,90700,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4275001207.20.4276,DOH MMR,CDM Code,Outpatient,90707,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4275001207.30.4275,DOH MMR,CDM Code,Outpatient,90707,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4275001208.20.4276,DOH MMR/V,CDM Code,Outpatient,90710,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4275001208.30.4275,DOH MMR/V,CDM Code,Outpatient,90710,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4275001209.20.4276,DOH TDAP,CDM Code,Outpatient,90715,$0.01,$0.0025,$43.7038,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$43.7038,$0.0068,$0.0088,$0.0092
,CDM,4275001209.30.4275,DOH TDAP,CDM Code,Outpatient,90715,$0.01,$0.0025,$43.7038,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$43.7038,$0.0068,$0.0088,$0.0092
,CDM,4275001210.20.4276,DOH VARICELLA,CDM Code,Outpatient,90716,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4275001210.30.4275,DOH VARICELLA,CDM Code,Outpatient,90716,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4275001211.20.4276,DOH DTAP/HEPB/IPV,CDM Code,Outpatient,90723,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4275001211.30.4275,DOH DTAP/HEPB/IPV,CDM Code,Outpatient,90723,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4275001213.20.4276,DOH MENINGOCOCCAL,CDM Code,Outpatient,90734,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4275001213.30.4275,DOH MENINGOCOCCAL,CDM Code,Outpatient,90734,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4275001214.20.4276,DOH INFLUENZA PEDS,CDM Code,Outpatient,90657,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4275001214.30.4275,DOH INFLUENZA PEDS,CDM Code,Outpatient,90657,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4275001215.20.4276,DOH FLU MIST PEDS,CDM Code,Outpatient,90660,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4275001215.30.4275,DOH FLU MIST PEDS,CDM Code,Outpatient,90660,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4275001216.20.4276,DOH FLU 6-35 MO,CDM Code,Outpatient,90685,$0.01,$0.0025,$27.0522,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$27.0522,$0.0068,$0.0088,$0.0092
,CDM,4275001216.30.4275,DOH FLU 6-35 MO,CDM Code,Outpatient,90685,$0.01,$0.0025,$27.0522,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$27.0522,$0.0068,$0.0088,$0.0092
,CDM,4275001217.30.4275,DOH FLU 3-18YR PRESERV FREE,CDM Code,Outpatient,90686,$0.01,$0.0025,$25.3099,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$25.3099,$0.0068,$0.0088,$0.0092
,CDM,4275001218.20.4276,DOH FLU 3-18YR,CDM Code,Outpatient,90688,$0.01,$0.0025,$23.7272,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$23.7272,$0.0068,$0.0088,$0.0092
,CDM,4275001219.20.4276,DOH IPV,CDM Code,Outpatient,90713,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4275001220.20.4276,DOH HEP B,CDM Code,Outpatient,90744,$0.01,$0.0025,$35.777,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$35.777,$0.0068,$0.0088,$0.0092
,CDM,4275001220.30.4275,DOH HEP B,CDM Code,Outpatient,90744,$0.01,$0.0025,$35.777,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$35.777,$0.0068,$0.0088,$0.0092
,CDM,4275001221.20.4276,DOH DTAP/HIB/IPV,CDM Code,Outpatient,90698,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4275001221.30.4275,DOH DTAP/HIB/IPV,CDM Code,Outpatient,90698,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4275001402.20.4276,EXC LES 1.1-2.0 CM,CDM Code,Outpatient,11402,$294.,$72.7327,"$1,439.4237",$235.2,$267.54,$77.0965,$279.3,$72.7327,$279.3,$279.3,"$1,439.4237",$200.655,$238.,$270.48
,CDM,4275001402.30.4275,EXC LES 1.1-2.0 CM,CDM Code,Outpatient,11402,$294.,$72.7327,"$1,439.4237",$235.2,$267.54,$77.0965,$279.3,$72.7327,$279.3,$279.3,"$1,439.4237",$200.655,$238.,$270.48
,CDM,4275001730.30.4275,"AVULSION, NAIL PLATE",CDM Code,Outpatient,11730,$163.,$40.3246,$408.8304,$130.4,$148.33,$42.744,$154.85,$40.3246,$154.85,$154.85,$408.8304,$111.2475,$150.5,$149.96
,CDM,4275002044.20.4276,"URINE, MICROALBUMIN",CDM Code,Outpatient,82044,$11.,$2.7213,$10.45,$8.8,$10.01,$2.8846,$10.45,$2.7213,$10.45,$10.45,$6.23,$7.5075,$6.853,$10.12
,CDM,4275002948.20.4276,"CHEMSTRIP, REAGENT",CDM Code,Outpatient,82948,$34.,$5.544,$32.3,$27.2,$30.94,$8.9159,$32.3,$8.4113,$32.3,$32.3,$5.04,$23.205,$5.544,$31.28
,CDM,4275002948.30.4275,"CHEMSTRIP, REAGENT",CDM Code,Outpatient,82948,$34.,$5.544,$32.3,$27.2,$30.94,$8.9159,$32.3,$8.4113,$32.3,$32.3,$5.04,$23.205,$5.544,$31.28
,CDM,4275004050.20.4276,"DSTRUCT LESION, PENIS",CDM Code,Outpatient,54050,$121.,$29.9342,$781.2954,$96.8,$110.11,$31.7302,$114.95,$29.9342,$114.95,$114.95,$781.2954,$82.5825,$106.48,$111.32
,CDM,4275006501.20.4276,"DSTRUCT LESION, VULVA",CDM Code,Outpatient,56501,$238.,$58.8788,"$3,812.1459",$190.4,$216.58,$62.4115,$226.1,$58.8788,$226.1,$226.1,"$3,812.1459",$162.435,$209.44,$218.96
,CDM,4275006580.20.4276,"PPD, INCL READING",CDM Code,Outpatient,86580,$25.,$6.1848,$33.6951,$20.,$22.75,$6.5558,$23.75,$6.1848,$23.75,$23.75,$33.6951,$17.0625,$11.5,$23.
,CDM,4275006580.30.4275,"PPD, INCL READING",CDM Code,Outpatient,86580,$25.,$6.1848,$33.6951,$20.,$22.75,$6.5558,$23.75,$6.1848,$23.75,$23.75,$33.6951,$17.0625,$11.5,$23.
,CDM,4275007000.20.4276,"DESTRUCT PREMALG LESION, 1ST",CDM Code,Outpatient,17000,$145.,$35.8715,$408.8304,$116.,$131.95,$38.0238,$137.75,$35.8715,$137.75,$137.75,$408.8304,$98.9625,$94.,$133.4
,CDM,4275007000.30.4275,"DESTRUCT PREMALG LESION, 1ST",CDM Code,Outpatient,17000,$145.,$35.8715,$408.8304,$116.,$131.95,$38.0238,$137.75,$35.8715,$137.75,$137.75,$408.8304,$98.9625,$94.,$133.4
,CDM,4275007001.20.4276,"DESTRUCT PREMALG LESIONS, 2-14",CDM Code,Outpatient,17003,$18.,$4.453,$17.1,$14.4,$16.38,$4.7202,$17.1,$4.453,$17.1,$17.1,$1.8,$12.285,$7.5,$16.56
,CDM,4275007001.30.4275,"DESTRUCT PREMALG LESIONS, 2-14",CDM Code,Outpatient,17003,$18.,$4.453,$17.1,$14.4,$16.38,$4.7202,$17.1,$4.453,$17.1,$17.1,$1.8,$12.285,$7.5,$16.56
,CDM,4275007081.20.4276,STREPTEST,CDM Code,Outpatient,87081,$41.,$7.293,$38.95,$32.8,$37.31,$10.7516,$38.95,$10.143,$38.95,$38.95,$6.63,$27.9825,$7.293,$37.72
,CDM,4275007081.30.4275,STREPTEST,CDM Code,Outpatient,87081,$52.,$7.293,$49.4,$41.6,$47.32,$13.6361,$49.4,$12.8643,$49.4,$49.4,$6.63,$35.49,$7.293,$47.84
,CDM,4275007110.20.4276,WART TREATMENT <15,CDM Code,Outpatient,17110,$199.,$49.2306,$408.8304,$159.2,$181.09,$52.1844,$189.05,$49.2306,$189.05,$189.05,$408.8304,$135.8175,$159.,$183.08
,CDM,4275007110.30.4275,WART TREATMENT <15,CDM Code,Outpatient,17110,$199.,$49.2306,$408.8304,$159.2,$181.09,$52.1844,$189.05,$49.2306,$189.05,$189.05,$408.8304,$135.8175,$159.,$183.08
,CDM,4275007111.20.4276,CRYOSURGERY GENITAL WARTS MALE,CDM Code,Outpatient,54056,$256.,$63.3318,$408.8304,$204.8,$232.96,$67.1316,$243.2,$63.3318,$243.2,$243.2,$408.8304,$174.72,$225.28,$235.52
,CDM,4275007111.30.4275,CRYOSURGERY GENITAL WARTS MALE,CDM Code,Outpatient,54056,$243.,$60.1158,$408.8304,$194.4,$221.13,$63.7226,$230.85,$60.1158,$230.85,$230.85,$408.8304,$165.8475,$213.84,$223.56
,CDM,4275007210.20.4276,WET MOUNT,CDM Code,Outpatient,87210,$12.,$2.9687,$11.4,$9.6,$10.92,$3.1468,$11.4,$2.9687,$11.4,$11.4,$5.82,$8.19,$6.402,$11.04
,CDM,4275007220.20.4276,KOH PREP,CDM Code,Outpatient,87220,$10.,$2.4739,$9.5,$8.,$9.1,$2.6223,$9.5,$2.4739,$9.5,$9.5,$4.27,$6.825,$4.697,$9.2
,CDM,4275009000.20.4276,NO CHARGE VISIT,CDM Code,Professional,,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.
,CDM,4275009000.30.4275,NO CHARGE VISIT,CDM Code,Professional,,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.
,CDM,4275009201.20.4276,LVL 1 OFF VISIT NEW FOCUSED,CDM Code,Outpatient,99201,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$63.,$0.
,CDM,4275009201.30.4275,LVL 1 OFF VISIT NEW FOCUSED,CDM Code,Outpatient,99201,$83.,$20.5334,$78.85,$66.4,$75.53,$21.7653,$78.85,$20.5334,$78.85,$78.85,$8.3,$56.6475,$63.,$76.36
,CDM,4275009202.20.4276,LVL 2 OFF VISIT NEW EXPANDED,CDM Code,Outpatient,99202,$130.,$32.1607,$123.5,$104.,$118.3,$34.0903,$123.5,$32.1607,$123.5,$123.5,$13.,$88.725,$106.,$119.6
,CDM,4275009202.30.4275,LVL 2 OFF VISIT NEW EXPANDED,CDM Code,Outpatient,99202,$130.,$32.1607,$123.5,$104.,$118.3,$34.0903,$123.5,$32.1607,$123.5,$123.5,$13.,$88.725,$106.,$119.6
,CDM,4275009203.20.4276,LVL 3 OFF VISIT NEW DETAILED,CDM Code,Outpatient,99203,$224.,$55.4154,$212.8,$179.2,$203.84,$58.7402,$212.8,$55.4154,$212.8,$212.8,$22.4,$152.88,$152.5,$206.08
,CDM,4275009203.30.4275,LVL 3 OFF VISIT NEW DETAILED,CDM Code,Outpatient,99203,$188.,$46.5093,$178.6,$150.4,$171.08,$49.2998,$178.6,$46.5093,$178.6,$178.6,$18.8,$128.31,$152.5,$172.96
,CDM,4275009204.20.4276,LVL 4 OFF VISIT NEW COMPREHENS,CDM Code,Outpatient,99204,$281.,$69.5166,$266.95,$224.8,$255.71,$73.6875,$266.95,$69.5166,$266.95,$266.95,$28.1,$191.7825,$232.5,$258.52
,CDM,4275009204.30.4275,LVL 4 OFF VISIT NEW COMPREHENS,CDM Code,Outpatient,99204,$164.,$40.572,$232.5,$131.2,$149.24,$43.0062,$155.8,$40.572,$155.8,$155.8,$16.4,$111.93,$232.5,$150.88
,CDM,4275009205.20.4276,LVL 5 OFF VISIT NEW COMPLEX,CDM Code,Outpatient,99205,$356.,$88.0708,$338.2,$284.8,$323.96,$93.3549,$338.2,$88.0708,$338.2,$338.2,$35.6,$242.97,$292.5,$327.52
,CDM,4275009205.30.4275,LVL 5 OFF VISIT NEW COMPLEX,CDM Code,Outpatient,99205,$356.,$88.0708,$338.2,$284.8,$323.96,$93.3549,$338.2,$88.0708,$338.2,$338.2,$35.6,$242.97,$292.5,$327.52
,CDM,4275009210.20.4276,REMOVAL IMPACTED EAR WAX,CDM Code,Outpatient,69210,$77.,$19.049,$145.6485,$61.6,$70.07,$20.1919,$73.15,$19.049,$73.15,$73.15,$145.6485,$52.5525,$67.76,$70.84
,CDM,4275009210.30.4275,REMOVAL IMPACTED EAR WAX,CDM Code,Outpatient,69210,$79.,$19.5438,$145.6485,$63.2,$71.89,$20.7164,$75.05,$19.5438,$75.05,$75.05,$145.6485,$53.9175,$69.52,$72.68
,CDM,4275009211.30.4275,LVL1 OFF VISIT EST MINIMAL,CDM Code,Outpatient,99211,$44.,$10.8852,$41.8,$35.2,$40.04,$11.5383,$41.8,$10.8852,$41.8,$41.8,$4.4,$30.03,$30.5,$40.48
,CDM,4275009212.20.4276,LVL 2 OFF VISIT EST FOCUSED,CDM Code,Outpatient,99212,$76.,$18.8016,$72.2,$60.8,$69.16,$19.9297,$72.2,$18.8016,$72.2,$72.2,$7.6,$51.87,$62.,$69.92
,CDM,4275009212.30.4275,LVL 2 OFF VISIT EST FOCUSED,CDM Code,Outpatient,99212,$76.,$18.8016,$72.2,$60.8,$69.16,$19.9297,$72.2,$18.8016,$72.2,$72.2,$7.6,$51.87,$62.,$69.92
,CDM,4275009213.20.4276,LVL 3 OFF VISIT EST EXPANDED,CDM Code,Outpatient,99213,$159.,$39.335,$151.05,$127.2,$144.69,$41.695,$151.05,$39.335,$151.05,$151.05,$15.9,$108.5175,$103.,$146.28
,CDM,4275009213.30.4275,LVL 3 OFF VISIT EST EXPANDED,CDM Code,Outpatient,99213,$126.,$31.1711,$119.7,$100.8,$114.66,$33.0414,$119.7,$31.1711,$119.7,$119.7,$12.6,$85.995,$103.,$115.92
,CDM,4275009214.20.4276,LVL 4 OFF VISIT EST DETAILED,CDM Code,Outpatient,99214,$186.,$46.0145,$176.7,$148.8,$169.26,$48.7753,$176.7,$46.0145,$176.7,$176.7,$18.6,$126.945,$152.,$171.12
,CDM,4275009214.30.4275,LVL 4 OFF VISIT EST DETAILED,CDM Code,Outpatient,99214,$193.,$47.7463,$183.35,$154.4,$175.63,$50.611,$183.35,$47.7463,$183.35,$183.35,$19.3,$131.7225,$152.,$177.56
,CDM,4275009215.20.4276,LVL 5 OFF VISIT EST COMPLEX,CDM Code,Outpatient,99215,$250.,$61.8475,$237.5,$200.,$227.5,$65.5583,$237.5,$61.8475,$237.5,$237.5,$25.,$170.625,$205.,$230.
,CDM,4275009215.30.4275,LVL 5 OFF VISIT EST COMPLEX,CDM Code,Outpatient,99215,$250.,$61.8475,$237.5,$200.,$227.5,$65.5583,$237.5,$61.8475,$237.5,$237.5,$25.,$170.625,$205.,$230.
,CDM,4275009381.20.4276,"PMDSV AGE <1, NEW",CDM Code,Outpatient,99381,$193.,$47.7463,$183.35,$154.4,$175.63,$50.611,$183.35,$47.7463,$183.35,$183.35,$19.3,$131.7225,$156.5,$177.56
,CDM,4275009381.30.4275,"PMDSV AGE <1, NEW",CDM Code,Outpatient,99381,$132.,$32.6555,$156.5,$105.6,$120.12,$34.6148,$125.4,$32.6555,$125.4,$125.4,$13.2,$90.09,$156.5,$121.44
,CDM,4275009382.20.4276,"PMDSV AGE 1-4, NEW",CDM Code,Outpatient,99382,$202.,$49.9728,$191.9,$161.6,$183.82,$52.9711,$191.9,$49.9728,$191.9,$191.9,$20.2,$137.865,$163.5,$185.84
,CDM,4275009382.30.4275,"PMDSV AGE 1-4, NEW",CDM Code,Outpatient,99382,$202.,$49.9728,$191.9,$161.6,$183.82,$52.9711,$191.9,$49.9728,$191.9,$191.9,$20.2,$137.865,$163.5,$185.84
,CDM,4275009383.20.4276,"PMDSV AGE 5-11, NEW",CDM Code,Outpatient,99383,$209.,$51.7045,$198.55,$167.2,$190.19,$54.8067,$198.55,$51.7045,$198.55,$198.55,$20.9,$142.6425,$170.,$192.28
,CDM,4275009383.30.4275,"PMDSV AGE 5-11, NEW",CDM Code,Outpatient,99383,$209.,$51.7045,$198.55,$167.2,$190.19,$54.8067,$198.55,$51.7045,$198.55,$198.55,$20.9,$142.6425,$170.,$192.28
,CDM,4275009384.20.4276,PMDSV AGE 12-17 NEW,CDM Code,Outpatient,99384,$236.,$58.384,$224.2,$188.8,$214.76,$61.887,$224.2,$58.384,$224.2,$224.2,$23.6,$161.07,$192.,$217.12
,CDM,4275009384.30.4275,PMDSV AGE 12-17 NEW,CDM Code,Outpatient,99384,$236.,$58.384,$224.2,$188.8,$214.76,$61.887,$224.2,$58.384,$224.2,$224.2,$23.6,$161.07,$192.,$217.12
,CDM,4275009385.20.4276,"PMDSV AGE 18-39, NEW",CDM Code,Outpatient,99385,$229.,$56.6523,$217.55,$183.2,$208.39,$60.0514,$217.55,$56.6523,$217.55,$217.55,$22.9,$156.2925,$186.,$210.68
,CDM,4275009385.30.4275,"PMDSV AGE 18-39, NEW",CDM Code,Outpatient,99385,$229.,$56.6523,$217.55,$183.2,$208.39,$60.0514,$217.55,$56.6523,$217.55,$217.55,$22.9,$156.2925,$186.,$210.68
,CDM,4275009386.20.4276,"PMDSV AGE 40-64, NEW",CDM Code,Outpatient,99386,$253.,$62.5897,$240.35,$202.4,$230.23,$66.3449,$240.35,$62.5897,$240.35,$240.35,$25.3,$172.6725,$216.,$232.76
,CDM,4275009386.30.4275,"PMDSV AGE 40-64, NEW",CDM Code,Outpatient,99386,$268.6,$66.449,$255.17,$214.88,$244.426,$70.4358,$255.17,$66.449,$255.17,$255.17,$26.86,$183.3195,$216.,$247.112
,CDM,4275009387.20.4276,PMDSV AGE 65+ NEW,CDM Code,Outpatient,99387,$163.,$40.3246,$234.,$130.4,$148.33,$42.744,$154.85,$40.3246,$154.85,$154.85,$16.3,$111.2475,$234.,$149.96
,CDM,4275009387.30.4275,PMDSV AGE 65+ NEW,CDM Code,Outpatient,99387,$172.,$42.5511,$234.,$137.6,$156.52,$45.1041,$163.4,$42.5511,$163.4,$163.4,$17.2,$117.39,$234.,$158.24
,CDM,4275009391.20.4276,"PMDSV AGE <1, ESTAB",CDM Code,Outpatient,99391,$184.,$45.5198,$174.8,$147.2,$167.44,$48.2509,$174.8,$45.5198,$174.8,$174.8,$18.4,$125.58,$140.5,$169.28
,CDM,4275009391.30.4275,"PMDSV AGE <1, ESTAB",CDM Code,Outpatient,99391,$175.,$43.2932,$166.25,$140.,$159.25,$45.8908,$166.25,$43.2932,$166.25,$166.25,$17.5,$119.4375,$140.5,$161.
,CDM,4275009392.20.4276,PMDSV AGE 1-4 ESTAB,CDM Code,Outpatient,99392,$183.,$45.2724,$173.85,$146.4,$166.53,$47.9886,$173.85,$45.2724,$173.85,$173.85,$18.3,$124.8975,$150.,$168.36
,CDM,4275009392.30.4275,PMDSV AGE 1-4 ESTAB,CDM Code,Outpatient,99392,$183.,$45.2724,$173.85,$146.4,$166.53,$47.9886,$173.85,$45.2724,$173.85,$173.85,$18.3,$124.8975,$150.,$168.36
,CDM,4275009393.20.4276,PMDSV AGE 5-11 ESTAB,CDM Code,Outpatient,99393,$200.,$49.478,$190.,$160.,$182.,$52.4466,$190.,$49.478,$190.,$190.,$20.,$136.5,$149.5,$184.
,CDM,4275009393.30.4275,PMDSV AGE 5-11 ESTAB,CDM Code,Outpatient,99393,$200.,$49.478,$190.,$160.,$182.,$52.4466,$190.,$49.478,$190.,$190.,$20.,$136.5,$149.5,$184.
,CDM,4275009394.20.4276,PMDSV AGE 12-17 ESTAB,CDM Code,Outpatient,99394,$205.,$50.715,$194.75,$164.,$186.55,$53.7578,$194.75,$50.715,$194.75,$194.75,$20.5,$139.9125,$164.,$188.6
,CDM,4275009394.30.4275,PMDSV AGE 12-17 ESTAB,CDM Code,Outpatient,99394,$205.,$50.715,$194.75,$164.,$186.55,$53.7578,$194.75,$50.715,$194.75,$194.75,$20.5,$139.9125,$164.,$188.6
,CDM,4275009395.20.4276,PMDSV AGE 18-39 ESTAB,CDM Code,Outpatient,99395,$224.,$55.4154,$212.8,$179.2,$203.84,$58.7402,$212.8,$55.4154,$212.8,$212.8,$22.4,$152.88,$167.5,$206.08
,CDM,4275009395.30.4275,PMDSV AGE 18-39 ESTAB,CDM Code,Outpatient,99395,$224.,$55.4154,$212.8,$179.2,$203.84,$58.7402,$212.8,$55.4154,$212.8,$212.8,$22.4,$152.88,$167.5,$206.08
,CDM,4275009396.20.4276,PMDSV AGE 40-64 ESTAB,CDM Code,Outpatient,99396,$208.,$51.4571,$197.6,$166.4,$189.28,$54.5445,$197.6,$51.4571,$197.6,$197.6,$20.8,$141.96,$178.5,$191.36
,CDM,4275009396.30.4275,PMDSV AGE 40-64 ESTAB,CDM Code,Outpatient,99396,$203.5714,$50.3615,$193.3928,$162.8571,$185.25,$53.3831,$193.3928,$50.3615,$193.3928,$193.3928,$20.3571,$138.9375,$178.5,$187.2857
,CDM,4275009397.20.4276,PMDSV AGE 65+ ESTAB,CDM Code,Outpatient,99397,$237.,$58.6314,$225.15,$189.6,$215.67,$62.1492,$225.15,$58.6314,$225.15,$225.15,$23.7,$161.7525,$192.5,$218.04
,CDM,4275009397.30.4275,PMDSV AGE 65+ ESTAB,CDM Code,Outpatient,99397,$237.,$58.6314,$225.15,$189.6,$215.67,$62.1492,$225.15,$58.6314,$225.15,$225.15,$23.7,$161.7525,$192.5,$218.04
,CDM,4280000007.30.4280,NPSG-POLYSOMNOGRAPHY TEST,CDM Code,Outpatient,95810,"$4,867.",$501.67,"$4,623.65","$3,893.6","$4,428.97","$1,276.288","$4,623.65","$1,204.0471","$4,623.65","$4,623.65","$2,308.3218","$3,321.7275",$501.67,"$4,477.64"
,CDM,4280003005.30.4280,MD NPSG-POLYSOMNOGRAPHY TEST,CDM Code,Professional,95810,"$1,171.",$71.6,"$1,077.32",$936.8,$858.26,$75.896,$798.48,$71.6,$183.9199,$183.04,$864.54,$799.2075,$501.67,"$1,077.32"
,CDM,4280003008.30.4280,NPSG-WCPAP TITRATION STUDY,CDM Code,Outpatient,95811,"$5,050.",$525.92,"$4,797.5","$4,040.","$4,595.5","$1,324.2766","$4,797.5","$1,249.3195","$4,797.5","$4,797.5","$2,308.3218","$3,446.625",$525.92,"$4,646."
,CDM,4280003009.30.4280,MD NPSG-WCPAP TITRATION STUDY,CDM Code,Professional,95811,"$1,171.",$74.47,"$1,077.32",$936.8,$901.64,$78.9382,$838.54,$74.47,$191.235,$190.32,$864.54,$799.2075,$525.92,"$1,077.32"
,CDM,4280003010.30.4280,MSLT-NAP STUDY,CDM Code,Outpatient,95805,"$2,653.",$326.88,"$2,520.35","$2,122.4","$2,414.23",$695.7041,"$2,520.35",$656.3257,"$2,520.35","$2,520.35","$2,308.3218","$1,810.6725",$326.88,"$2,440.76"
,CDM,4280003011.30.4280,MD MSLT - NAP STUDY,CDM Code,Professional,95805,$744.,$34.9799,$864.54,$595.2,$593.03,$37.0787,$551.06,$34.9799,$88.3025,$87.88,$864.54,$507.78,$326.88,$684.48
,CDM,4280003031.30.4280,MD SPLIT NIGHT STUDY,CDM Code,Professional,95811,"$1,095.",$74.47,"$1,007.4",$876.,$901.64,$78.9382,$838.54,$74.47,$191.235,$190.32,$864.54,$747.3375,$525.92,"$1,007.4"
,CDM,4280003032.30.4280,SPLIT NIGHT STUDY,CDM Code,Outpatient,95811,"$4,721.",$525.92,"$4,484.95","$3,776.8","$4,296.11","$1,238.002","$4,484.95","$1,167.9282","$4,484.95","$4,484.95","$2,308.3218","$3,222.0825",$525.92,"$4,343.32"
,CDM,4280003037.30.4280,MWT - NAP STUDY,CDM Code,Outpatient,95805,"$2,786.",$326.88,"$2,646.7","$2,228.8","$2,535.26",$730.5811,"$2,646.7",$689.2285,"$2,646.7","$2,646.7","$2,308.3218","$1,901.445",$326.88,"$2,563.12"
,CDM,4280003038.30.4280,MD MWT - NAP STUDY,CDM Code,Professional,95805,$648.,$34.9799,$864.54,$518.4,$593.03,$37.0787,$551.06,$34.9799,$88.3025,$87.88,$864.54,$442.26,$326.88,$596.16
,CDM,4281003003.30.4281,MD PT FOLLOW UP/LEVEL 3,CDM Code,Professional,99213,$103.,$10.3,$111.815,$82.4,$96.37,$42.188,$64.49,$39.8,$111.815,$111.28,$10.3,$70.2975,$103.,$94.76
,CDM,4281003004.30.4281,MD PT FOLLOW UP/LEVEL 4,CDM Code,Professional,99214,$172.,$17.2,$164.065,$137.6,$141.4,$61.6072,$98.77,$58.12,$164.065,$163.28,$17.2,$117.39,$152.,$158.24
,CDM,4281003020.30.4281,FACILITY PT VISIT,CDM Code,Outpatient,99212,$34.,$8.4113,$62.,$27.2,$30.94,$8.9159,$32.3,$8.4113,$32.3,$32.3,$3.4,$23.205,$62.,$31.28
,CDM,4281003025.30.4281,MD PT FOLLOW UP/LEVEL 5,CDM Code,Professional,99215,$284.,$28.4,$261.28,$227.2,$189.62,$82.415,$139.66,$77.75,$219.45,$218.4,$28.4,$193.83,$205.,$261.28
,CDM,4281003026.30.4281,MD PT FOLLOW UP/LEVEL 2,CDM Code,Professional,99212,$69.,$6.9,$67.4025,$55.2,$58.11,$25.705,$32.,$24.25,$67.4025,$67.08,$6.9,$47.0925,$62.,$63.48
,CDM,4281003027.30.4281,MD NEW PT VISIT LEVEL 3,CDM Code,Professional,99203,$438.,$43.8,$402.96,$350.4,$141.89,$61.215,$96.32,$57.75,$166.155,$165.36,$43.8,$298.935,$152.5,$402.96
,CDM,4281003034.30.4281,MD NEW PT VISIT LEVEL 4,CDM Code,Professional,99204,$497.,$49.7,$457.24,$397.6,$214.04,$92.8136,$162.59,$87.56,$252.3675,$251.16,$49.7,$339.2025,$232.5,$457.24
,CDM,4281003035.30.4281,MD NEW PT VISIT LEVEL 5,CDM Code,Professional,99205,$562.,$56.2,$517.04,$449.6,$268.68,$116.5576,$212.33,$109.96,$312.455,$310.96,$56.2,$383.565,$292.5,$517.04
,CDM,4281009000.30.4281,NO CHARGE VISIT,CDM Code,Professional,,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.
,CDM,4310000100.10.4310,OT EVAL LOW COMPLEX 30 MIN,CDM Code,Outpatient,97165GO,$371.,$88.67,$352.45,$296.8,$337.61,$97.2884,$352.45,$91.7817,$352.45,$352.45,$251.0601,$253.2075,$88.67,$341.32
,CDM,4310000101.10.4310,OT EVAL MOD COMPLEX 45 MIN,CDM Code,Outpatient,97166GO,$371.,$88.67,$352.45,$296.8,$337.61,$97.2884,$352.45,$91.7817,$352.45,$352.45,$251.0601,$253.2075,$88.67,$341.32
,CDM,4310000102.10.4310,OT EVAL HIGH COMPLEX 60 MIN,CDM Code,Outpatient,97167GO,$371.,$88.67,$352.45,$296.8,$337.61,$97.2884,$352.45,$91.7817,$352.45,$352.45,$251.0601,$253.2075,$88.67,$341.32
,CDM,4310000103.10.4310,OT RE-EVAL EST PLAN CARE,CDM Code,Outpatient,97168GO,$253.,$60.38,$240.35,$202.4,$230.23,$66.3449,$240.35,$62.5897,$240.35,$240.35,$166.7415,$172.6725,$60.38,$232.76
,CDM,4310000105.10.4310,OT GROUP THERAPY,CDM Code,Outpatient,97150GO,$75.,$17.94,$71.25,$60.,$68.25,$19.6675,$71.25,$18.5542,$71.25,$71.25,$46.9653,$51.1875,$17.94,$69.
,CDM,4310001311.10.4310,"OT ORTHOTIC MGMT & TRN,PER 15",CDM Code,Outpatient,97760GO,$193.,$45.89,$183.35,$154.4,$175.63,$50.611,$183.35,$47.7463,$183.35,$183.35,$103.4892,$131.7225,$45.89,$177.56
,CDM,4310001311.30.4310,"OT ORTHOTIC MGMT & TRN,PER 15",CDM Code,Outpatient,97760,$193.,$45.89,$183.35,$154.4,$175.63,$50.611,$183.35,$47.7463,$183.35,$183.35,$103.4892,$131.7225,$45.89,$177.56
,CDM,4310001312.10.4310,"OT PROSTHETIC TRN, PER 15 MIN",CDM Code,Outpatient,97761GO,$166.,$39.68,$157.7,$132.8,$151.06,$43.5307,$157.7,$41.0667,$157.7,$157.7,$90.0858,$113.295,$39.68,$152.72
,CDM,4310001313.10.4310,OT C/O ORTHO/PROSTH USE PER 15,CDM Code,Outpatient,97763,$161.,$39.8298,$152.95,$128.8,$146.51,$42.2195,$152.95,$39.8298,$152.95,$152.95,$131.6844,$109.8825,$47.27,$148.12
,CDM,4310001313.30.4310,OT C/O ORTHO/PROSTH USE PER 15,CDM Code,Outpatient,97762,$161.,$39.8298,$152.95,$128.8,$146.51,$42.2195,$152.95,$39.8298,$152.95,$152.95,$130.3227,$109.8825,$141.68,$148.12
,CDM,4310001314.10.4310,"FO PIP/DIP W/ JOINT/SPRING,PER",CDM Code,Outpatient,L3925,$69.,$17.0699,$145.5417,$55.2,$62.79,$18.0941,$65.55,$17.0699,$65.55,$65.55,$145.5417,$47.0925,$60.72,$63.48
,CDM,4310001315.10.4310,"FO PIP/DIP W/O JOINT/SPRING,PE",CDM Code,Outpatient,L3927,$38.,$9.4008,$79.5927,$30.4,$34.58,$9.9649,$36.1,$9.4008,$36.1,$36.1,$79.5927,$25.935,$0.,$34.96
,CDM,4310001316.10.4310,FO W/O JOINTS CF PER EACH,CDM Code,Outpatient,L3933,$67.,$16.5751,$485.7531,$53.6,$60.97,$17.5696,$63.65,$16.5751,$63.65,$63.65,$485.7531,$45.7275,$0.,$61.64
,CDM,4310001317.10.4310,HFO W/O JOINTS CF,CDM Code,Outpatient,L3919,$361.,$89.3078,$616.6632,$288.8,$328.51,$94.6661,$342.95,$89.3078,$342.95,$342.95,$616.6632,$246.3825,$317.68,$332.12
,CDM,4310001318.10.4310,HFO W/ JOINT(S) CF,CDM Code,Outpatient,L3921,$541.,$133.838,$731.3397,$432.8,$492.31,$141.8681,$513.95,$133.838,$513.95,$513.95,$731.3397,$369.2325,$476.08,$497.72
,CDM,4310001319.10.4310,WHFO W/ JOINT(S) CF,CDM Code,Outpatient,L3806,$490.,$121.2211,"$1,034.2512",$392.,$445.9,$128.4942,$465.5,$121.2211,$465.5,$465.5,"$1,034.2512",$334.425,$431.2,$450.8
,CDM,4310001320.10.4310,"WHFO, RIGID W/O JOINTS CF",CDM Code,Outpatient,L3808,$388.,$95.9873,$820.4373,$310.4,$353.08,$101.7464,$368.6,$95.9873,$368.6,$368.6,$820.4373,$264.81,$341.44,$356.96
,CDM,4310001321.10.4310,E-STIM UNATTENDED 97014 NON-ME,CDM Code,Outpatient,97014GO,$180.,$15.18,$171.,$144.,$163.8,$47.2019,$171.,$44.5302,$171.,$171.,$18.,$122.85,$15.18,$165.6
,CDM,4310001321.30.4310,E-STIM UNATTENDED 97014 NON-ME,CDM Code,Outpatient,97014,$180.,$15.18,$171.,$144.,$163.8,$47.2019,$171.,$44.5302,$171.,$171.,$18.,$122.85,$15.18,$165.6
,CDM,4310001322.10.4310,WHFO RIGID W/O JOINTS PF,CDM Code,Outpatient,L3807,$269.,$66.5479,$569.3241,$215.2,$244.79,$70.5407,$255.55,$66.5479,$255.55,$255.55,$569.3241,$183.5925,$236.72,$247.48
,CDM,4310001323.10.4310,WHO COCK-UP NONMOLDE PRE OTS,CDM Code,Outpatient,L3908,$89.,$22.0177,$187.3539,$71.2,$80.99,$23.3387,$84.55,$22.0177,$84.55,$84.55,$187.3539,$60.7425,$0.,$81.88
,CDM,4310001324.10.4310,WHO W/O JOINTS CF,CDM Code,Outpatient,L3906,$461.,$114.0468,$971.9334,$368.8,$419.51,$120.8894,$437.95,$114.0468,$437.95,$437.95,$971.9334,$314.6325,$0.,$424.12
,CDM,4310001325.10.4310,HFO WITHOUT JOINTS PRE CST,CDM Code,Outpatient,L3923,$107.,$26.4707,$224.2266,$85.6,$97.37,$28.0589,$101.65,$26.4707,$101.65,$101.65,$224.2266,$73.0275,$0.,$98.44
,CDM,4310001326.10.4310,HFO WITHOUT JOINTS PRE OTS,CDM Code,Outpatient,L3924,$107.,$26.4707,$224.2266,$85.6,$97.37,$28.0589,$101.65,$26.4707,$101.65,$101.65,$224.2266,$73.0275,$0.,$98.44
,CDM,4310005030.10.4310,OT RE-EVAL 97004,CDM Code,Outpatient,97004,$324.,$80.1544,$307.8,$259.2,$294.84,$84.9635,$307.8,$80.1544,$307.8,$307.8,$32.4,$221.13,$285.12,$298.08
,CDM,4310005030.30.4310,OT RE-EVAL 97004,CDM Code,Outpatient,97004,$324.,$80.1544,$307.8,$259.2,$294.84,$84.9635,$307.8,$80.1544,$307.8,$307.8,$32.4,$221.13,$285.12,$298.08
,CDM,4310005032.10.4310,OT ELECTRICAL STIMULATION G028,CDM Code,Outpatient,G0283GO,$61.,$15.0908,$57.95,$48.8,$55.51,$15.9962,$57.95,$15.0908,$57.95,$57.95,$37.38,$41.6325,$53.68,$56.12
,CDM,4310005033.10.4310,OT PARAFIN BATH 97018,CDM Code,Outpatient,97018GO,$36.,$8.63,$34.2,$28.8,$32.76,$9.4404,$34.2,$8.906,$34.2,$34.2,$29.7171,$24.57,$8.63,$33.12
,CDM,4310005033.30.4310,OT PARAFIN BATH 97018,CDM Code,Outpatient,97018,$36.,$8.63,$34.2,$28.8,$32.76,$9.4404,$34.2,$8.906,$34.2,$34.2,$29.7171,$24.57,$8.63,$33.12
,CDM,4310005035.10.4310,OT ELEC STIMULATION MANUAL 970,CDM Code,Outpatient,97032GO,$64.,$15.18,$60.8,$51.2,$58.24,$16.7829,$60.8,$15.833,$60.8,$60.8,$51.7446,$43.68,$15.18,$58.88
,CDM,4310005035.30.4310,OT ELEC STIMULATION MANUAL 970,CDM Code,Outpatient,97032,$64.,$15.18,$60.8,$51.2,$58.24,$16.7829,$60.8,$15.833,$60.8,$60.8,$51.7446,$43.68,$15.18,$58.88
,CDM,4310005037.10.4310,OT ULTRASOUND 97035,CDM Code,Outpatient,97035GO,$55.,$13.11,$52.25,$44.,$50.05,$14.4228,$52.25,$13.6065,$52.25,$52.25,$34.4964,$37.5375,$13.11,$50.6
,CDM,4310005037.30.4310,OT ULTRASOUND 97035,CDM Code,Outpatient,97035,$55.,$13.11,$52.25,$44.,$50.05,$14.4228,$52.25,$13.6065,$52.25,$52.25,$34.4964,$37.5375,$13.11,$50.6
,CDM,4310005039.10.4310,OT THERAPUTIC EXERCISES 97110,CDM Code,Outpatient,97110GO,$126.,$30.02,$119.7,$100.8,$114.66,$33.0414,$119.7,$31.1711,$119.7,$119.7,$88.1634,$85.995,$30.02,$115.92
,CDM,4310005039.30.4310,OT THERAPUTIC EXERCISES 97110,CDM Code,Outpatient,97110,$126.,$30.02,$119.7,$100.8,$114.66,$33.0414,$119.7,$31.1711,$119.7,$119.7,$88.1634,$85.995,$30.02,$115.92
,CDM,4310005040.10.4310,OT NEUROMUSCLAR RE-EDUCATE 971,CDM Code,Outpatient,97112GO,$143.,$34.16,$135.85,$114.4,$130.13,$37.4993,$135.85,$35.3768,$135.85,$135.85,$91.9815,$97.5975,$34.16,$131.56
,CDM,4310005040.30.4310,OT NEUROMUSCLAR RE-EDUCATE 971,CDM Code,Outpatient,97112,$143.,$34.16,$135.85,$114.4,$130.13,$37.4993,$135.85,$35.3768,$135.85,$135.85,$91.9815,$97.5975,$34.16,$131.56
,CDM,4310005041.10.4310,OT AQUATIC THERAPY 97113,CDM Code,Outpatient,97113GO,$125.,$30.9237,$118.75,$100.,$113.75,$32.7791,$118.75,$30.9237,$118.75,$118.75,$116.8926,$85.3125,$38.3,$115.
,CDM,4310005044.10.4310,OT MANUAL THERAPY 97140,CDM Code,Outpatient,97140GO,$114.,$27.26,$108.3,$91.2,$103.74,$29.8946,$108.3,$28.2025,$108.3,$108.3,$81.4617,$77.805,$27.26,$104.88
,CDM,4310005044.30.4310,OT MANUAL THERAPY 97140,CDM Code,Outpatient,97140,$114.,$27.26,$108.3,$91.2,$103.74,$29.8946,$108.3,$28.2025,$108.3,$108.3,$81.4617,$77.805,$27.26,$104.88
,CDM,4310005047.10.4310,OTFUNCTIONAL ACTIVITIES PER 15,CDM Code,Outpatient,97530GO,$166.,$39.68,$157.7,$132.8,$151.06,$43.5307,$157.7,$41.0667,$157.7,$157.7,$94.8651,$113.295,$39.68,$152.72
,CDM,4310005047.30.4310,OTFUNCTIONAL ACTIVITIES PER 15,CDM Code,Outpatient,97530,$166.,$39.68,$157.7,$132.8,$151.06,$43.5307,$157.7,$41.0667,$157.7,$157.7,$94.8651,$113.295,$39.68,$152.72
,CDM,4310005048.10.4310,OT SELF CARE/HOME MGMT PER 15,CDM Code,Outpatient,97535GO,$142.,$33.81,$134.9,$113.6,$129.22,$37.2371,$134.9,$35.1294,$134.9,$134.9,$94.8651,$96.915,$33.81,$130.64
,CDM,4310005049.30.4310,OT COMM REINTEGRATE PER 15 MIN,CDM Code,Outpatient,97537,$133.,$32.43,$126.35,$106.4,$121.03,$34.877,$126.35,$32.9029,$126.35,$126.35,$82.3962,$90.7725,$32.43,$122.36
,CDM,4310007148.10.4310,U/LIMB ORTHOS NOT SPECIFIED L3,CDM Code,Outpatient,L3999,$218.,$53.931,$207.1,$174.4,$198.38,$57.1668,$207.1,$53.931,$207.1,$207.1,$21.8,$148.785,$191.84,$200.56
,CDM,4310007149.10.4310,"HFO, W/JOINT(S) PF",CDM Code,Outpatient,L3929,$214.,$52.9415,$222.144,$171.2,$194.74,$56.1179,$203.3,$52.9415,$203.3,$203.3,$222.144,$146.055,$188.32,$196.88
,CDM,4310007150.10.4310,HOT/COLD PACK,CDM Code,Outpatient,97010GO,$0.,$0.,$16.287,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$16.287,$0.,$6.21,$0.
,CDM,4310007150.30.4310,HOT/COLD PACK,CDM Code,Outpatient,97010,$0.,$0.,$16.287,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$16.287,$0.,$6.21,$0.
,CDM,4310007151.10.4310,HFO W/O JOINTS CF UPPER LIMB,CDM Code,Outpatient,L3913,$299.,$73.9696,$616.6632,$239.2,$272.09,$78.4077,$284.05,$73.9696,$284.05,$284.05,$616.6632,$204.0675,$0.,$275.08
,CDM,4310007200.10.4310,OT INITIAL EVAL VISIT,CDM Code,Outpatient,97003,$389.,$96.2347,$369.55,$311.2,$353.99,$102.0086,$369.55,$96.2347,$369.55,$369.55,$38.9,$265.4925,$342.32,$357.88
,CDM,4310007200.30.4310,OT INITIAL EVAL VISIT,CDM Code,Outpatient,97003,$389.,$96.2347,$369.55,$311.2,$353.99,$102.0086,$369.55,$96.2347,$369.55,$369.55,$38.9,$265.4925,$342.32,$357.88
,CDM,4310007339.10.4310,ADD OF JNT TO UPP EXT ORTHO L3,CDM Code,Outpatient,L3956,$36.,$8.906,$34.2,$28.8,$32.76,$9.4404,$34.2,$8.906,$34.2,$34.2,$3.6,$24.57,$31.68,$33.12
,CDM,4310008015.10.4310,TELE OT SELFCRE/HOME MGMT PR15,CDM Code,Outpatient,97535GO9,$142.,$33.81,$134.9,$113.6,$129.22,$37.2371,$134.9,$35.1294,$134.9,$134.9,$94.8651,$96.915,$33.81,$130.64
,CDM,4310008020.10.4310,TELE OT THERAPUTIC EXERCISES,CDM Code,Outpatient,97110GO9,$126.,$30.02,$119.7,$100.8,$114.66,$33.0414,$119.7,$31.1711,$119.7,$119.7,$88.1634,$85.995,$30.02,$115.92
,CDM,4310008025.10.4310,TELE OT NEUROMUSCLAR RE-EDUCAT,CDM Code,Outpatient,97112GO9,$143.,$34.16,$135.85,$114.4,$130.13,$37.4993,$135.85,$35.3768,$135.85,$135.85,$91.9815,$97.5975,$34.16,$131.56
,CDM,4310008030.10.4310,TELE OT FUNC ACTIV 15MIN,CDM Code,Outpatient,97530GO9,$166.,$39.68,$157.7,$132.8,$151.06,$43.5307,$157.7,$41.0667,$157.7,$157.7,$94.8651,$113.295,$39.68,$152.72
,CDM,4310009105.10.4310,OT MOBILITY CURRENT STATUS CH,CDM Code,Outpatient,G8978GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009111.10.4310,OT CARRY CURRENT STATUS CH,CDM Code,Outpatient,G8984GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009111.30.4310,OT CARRY CURRENT STATUS CH,CDM Code,Outpatient,G8984,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009112.10.4310,OT CARRY GOAL STATUS CH,CDM Code,Outpatient,G8985GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009112.30.4310,OT CARRY GOAL STATUS CH,CDM Code,Outpatient,G8985,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009113.10.4310,OT CARRY DC STATUS CH,CDM Code,Outpatient,G8986GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009113.30.4310,OT CARRY DC STATUS CH,CDM Code,Outpatient,G8986,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009114.10.4310,OT SELF CARE CURRENT STATUS CH,CDM Code,Outpatient,G8987GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009114.30.4310,OT SELF CARE CURRENT STATUS CH,CDM Code,Outpatient,G8987,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009115.10.4310,OT SELF CARE GOAL STATUS CH,CDM Code,Outpatient,G8988GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009115.30.4310,OT SELF CARE GOAL STATUS CH,CDM Code,Outpatient,G8988,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009116.10.4310,OT SELF CARE DC STATUS CH,CDM Code,Outpatient,G8989GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009121.10.4310,OT SUB PT/OT GOAL STATUS CH,CDM Code,Outpatient,G8994GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009206.30.4310,OT MOBILITY GOAL STATUS CI,CDM Code,Outpatient,G8979,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009209.30.4310,OT BODY POS GOAL STATUS CI,CDM Code,Outpatient,G8982,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009210.10.4310,OT BODY POS DC STATUS CI,CDM Code,Outpatient,G8983GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009211.10.4310,OT CARRY CURRENT STATUS CI,CDM Code,Outpatient,G8984GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009211.30.4310,OT CARRY CURRENT STATUS CI,CDM Code,Outpatient,G8984,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009212.10.4310,OT CARRY GOAL STATUS CI,CDM Code,Outpatient,G8985GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009212.30.4310,OT CARRY GOAL STATUS CI,CDM Code,Outpatient,G8985,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009213.10.4310,OT CARRY DC STATUS CI,CDM Code,Outpatient,G8986GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009213.30.4310,OT CARRY DC STATUS CI,CDM Code,Outpatient,G8986,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009214.10.4310,OT SELF CARE CURRENT STATUS CI,CDM Code,Outpatient,G8987GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009214.30.4310,OT SELF CARE CURRENT STATUS CI,CDM Code,Outpatient,G8987,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009215.10.4310,OT SELF CARE GOAL STATUS CI,CDM Code,Outpatient,G8988GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009215.30.4310,OT SELF CARE GOAL STATUS CI,CDM Code,Outpatient,G8988,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009216.10.4310,OT SELF CARE DC STATUS CI,CDM Code,Outpatient,G8989GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009217.10.4310,OT OTHER CURRENT STATUS CI,CDM Code,Outpatient,G8990GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009217.30.4310,OT OTHER CURRENT STATUS CI,CDM Code,Outpatient,G8990,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009218.10.4310,OT OTHER GOAL STATUS CI,CDM Code,Outpatient,G8991GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009218.30.4310,OT OTHER GOAL STATUS CI,CDM Code,Outpatient,G8991,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009219.10.4310,OT OTHER DC STATUS CI,CDM Code,Outpatient,G8992GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009306.10.4310,OT MOBILITY GOAL STATUS CJ,CDM Code,Outpatient,G8979GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009306.30.4310,OT MOBILITY GOAL STATUS CJ,CDM Code,Outpatient,G8979,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009308.30.4310,OT BODY POS CURRENT STATUS CJ,CDM Code,Outpatient,G8981,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009309.10.4310,OT BODY POS GOAL STATUS CJ,CDM Code,Outpatient,G8982GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009309.30.4310,OT BODY POS GOAL STATUS CJ,CDM Code,Outpatient,G8982,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009311.10.4310,OT CARRY CURRENT STATUS CJ,CDM Code,Outpatient,G8984GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009312.10.4310,OT CARRY GOAL STATUS CJ,CDM Code,Outpatient,G8985GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009312.30.4310,OT CARRY GOAL STATUS CJ,CDM Code,Outpatient,G8985,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009313.10.4310,OT CARRY DC STATUS CJ,CDM Code,Outpatient,G8986GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009313.30.4310,OT CARRY DC STATUS CJ,CDM Code,Outpatient,G8986,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009314.10.4310,OT SELF CARE CURRENT STATUS CJ,CDM Code,Outpatient,G8987GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009314.30.4310,OT SELF CARE CURRENT STATUS CJ,CDM Code,Outpatient,G8987,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009315.10.4310,OT SELF CARE GOAL STATUS CJ,CDM Code,Outpatient,G8988GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009315.30.4310,OT SELF CARE GOAL STATUS CJ,CDM Code,Outpatient,G8988,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009316.10.4310,OT SELF CARE DC STATUS CJ,CDM Code,Outpatient,G8989GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009317.10.4310,OT OTHER CURRENT STATUS CJ,CDM Code,Outpatient,G8990GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009318.10.4310,OT OTHER GOAL STATUS CJ,CDM Code,Outpatient,G8991GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009405.10.4310,OT MOBILITY CURRENT STATUS CK,CDM Code,Outpatient,G8978GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009405.30.4310,OT MOBILITY CURRENT STATUS CK,CDM Code,Outpatient,G8978,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009409.10.4310,OT BODY POS GOAL STATUS CK,CDM Code,Outpatient,G8982GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009410.10.4310,OT BODY POS DC STATUS CK,CDM Code,Outpatient,G8983GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009411.10.4310,OT CARRY CURRENT STATUS CK,CDM Code,Outpatient,G8984GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009411.30.4310,OT CARRY CURRENT STATUS CK,CDM Code,Outpatient,G8984,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009412.10.4310,OT CARRY GOAL STATUS CK,CDM Code,Outpatient,G8985GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009412.30.4310,OT CARRY GOAL STATUS CK,CDM Code,Outpatient,G8985,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009413.10.4310,OT CARRY DC STATUS CK,CDM Code,Outpatient,G8986GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009413.30.4310,OT CARRY DC STATUS CK,CDM Code,Outpatient,G8986,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009414.10.4310,OT SELF CARE CURRENT STATUS CK,CDM Code,Outpatient,G8987GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009414.30.4310,OT SELF CARE CURRENT STATUS CK,CDM Code,Outpatient,G8987,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009415.10.4310,OT SELF CARE GOAL STATUS CK,CDM Code,Outpatient,G8988GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009415.30.4310,OT SELF CARE GOAL STATUS CK,CDM Code,Outpatient,G8988,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009416.10.4310,OT SELF CARE DC STATUS CK,CDM Code,Outpatient,G8989GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009417.10.4310,OT OTHER CURRENT STATUS CK,CDM Code,Outpatient,G8990GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009418.10.4310,OT OTHER GOAL STATUS CK,CDM Code,Outpatient,G8991GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009505.10.4310,OT MOBILITY CURRENT STATUS CL,CDM Code,Outpatient,G8978GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009508.30.4310,OT BODY POS CURRENT STATUS CL,CDM Code,Outpatient,G8981,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009509.10.4310,OT BODY POS GOAL STATUS CL,CDM Code,Outpatient,G8982GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009511.10.4310,OT CARRY CURRENT STATUS CL,CDM Code,Outpatient,G8984GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009511.30.4310,OT CARRY CURRENT STATUS CL,CDM Code,Outpatient,G8984,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009512.10.4310,OT CARRY GOAL STATUS CL,CDM Code,Outpatient,G8985GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009512.30.4310,OT CARRY GOAL STATUS CL,CDM Code,Outpatient,G8985,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009513.10.4310,OT CARRY DC STATUS CL,CDM Code,Outpatient,G8986GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009513.30.4310,OT CARRY DC STATUS CL,CDM Code,Outpatient,G8986,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009514.10.4310,OT SELF CARE CURRENT STATUS CL,CDM Code,Outpatient,G8987GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009514.30.4310,OT SELF CARE CURRENT STATUS CL,CDM Code,Outpatient,G8987,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009515.10.4310,OT SELF CARE GOAL STATUS CL,CDM Code,Outpatient,G8988GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009515.30.4310,OT SELF CARE GOAL STATUS CL,CDM Code,Outpatient,G8988,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009516.10.4310,OT SELF CARE DC STATUS CL,CDM Code,Outpatient,G8989GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009517.10.4310,OT OTHER CURRENT STATUS CL,CDM Code,Outpatient,G8990GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009517.30.4310,OT OTHER CURRENT STATUS CL,CDM Code,Outpatient,G8990,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009605.10.4310,OT MOBILITY CURRENT STATUS CM,CDM Code,Outpatient,G8978GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009605.30.4310,OT MOBILITY CURRENT STATUS CM,CDM Code,Outpatient,G8978,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009608.10.4310,OT BODY POS CURRENT STATUS CM,CDM Code,Outpatient,G8981GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009611.10.4310,OT CARRY CURRENT STATUS CM,CDM Code,Outpatient,G8984GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009611.30.4310,OT CARRY CURRENT STATUS CM,CDM Code,Outpatient,G8984,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009613.10.4310,OT CARRY DC STATUS CM,CDM Code,Outpatient,G8986GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009614.10.4310,OT SELF CARE CURRENT STATUS CM,CDM Code,Outpatient,G8987GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009614.30.4310,OT SELF CARE CURRENT STATUS CM,CDM Code,Outpatient,G8987,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009615.10.4310,OT SELF CARE GOAL STATUS CM,CDM Code,Outpatient,G8988GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009616.10.4310,OT SELF CARE DC STATUS CM,CDM Code,Outpatient,G8989GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009620.10.4310,OT SUB PT/OT CURRENT STATUS CM,CDM Code,Outpatient,G8993GOC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009711.30.4310,OT CARRY CURRENT STATUS CN,CDM Code,Outpatient,G8984,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4310009750.10.4310,ORTHC/PROSTC MGMT SBSQ ENC,CDM Code,Outpatient,97763GO,$198.,$47.27,$188.1,$158.4,$180.18,$51.9221,$188.1,$48.9832,$188.1,$188.1,$131.6844,$135.135,$47.27,$182.16
,CDM,4310009755.10.4310,OT THER IVNTJ COG FUNCJ 1ST 15,CDM Code,Outpatient,97129GO,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.
,CDM,4310009760.10.4310,OT THER IVNTJ EA ADDL 15 MIN,CDM Code,Outpatient,97130GO,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.
,CDM,4320000100.10.4320,EVALUATION SPEECH FLUENCY,CDM Code,Outpatient,92521GN,$361.,$89.3078,$342.95,$288.8,$328.51,$94.6661,$342.95,$89.3078,$342.95,$342.95,$300.8823,$246.3825,$111.44,$332.12
,CDM,4320000101.10.4320,SPEECH THER LANGUAGE EVAL,CDM Code,Outpatient,92523GN,$809.,$193.2,$768.55,$647.2,$736.19,$212.1465,$768.55,$200.1385,$768.55,$768.55,$531.8106,$552.1425,$193.2,$744.28
,CDM,4320000101.30.4320,SPEECH THER LANGUAGE EVAL,CDM Code,Outpatient,92523,$809.,$193.2,$768.55,$647.2,$736.19,$212.1465,$768.55,$200.1385,$768.55,$768.55,$531.8106,$552.1425,$193.2,$744.28
,CDM,4320000102.10.4320,SPEECH THER SPEECH PRODUCTION,CDM Code,Outpatient,92522GN,$375.,$89.7,$356.25,$300.,$341.25,$98.3374,$356.25,$92.7712,$356.25,$356.25,$249.1377,$255.9375,$89.7,$345.
,CDM,4320000102.30.4320,SPEECH THER SPEECH PRODUCTION,CDM Code,Outpatient,92522,$375.,$89.7,$356.25,$300.,$341.25,$98.3374,$356.25,$92.7712,$356.25,$356.25,$249.1377,$255.9375,$89.7,$345.
,CDM,4320000103.10.4320,EVALUATION OF SPEECH BEHAVIOR,CDM Code,Outpatient,92524GN,$359.,$85.91,$341.05,$287.2,$326.69,$94.1416,$341.05,$88.813,$341.05,$341.05,$240.5136,$245.0175,$85.91,$330.28
,CDM,4320000103.30.4320,EVALUATION OF SPEECH BEHAVIOR,CDM Code,Outpatient,92524,$359.,$85.91,$341.05,$287.2,$326.69,$94.1416,$341.05,$88.813,$341.05,$341.05,$240.5136,$245.0175,$85.91,$330.28
,CDM,4320002111.10.4320,"STD COGN,PERFORMANCE TEST,PER",CDM Code,Outpatient,96125GN,$485.,$119.9842,$460.75,$388.,$441.35,$127.183,$460.75,$119.9842,$460.75,$460.75,$314.2857,$331.0125,$168.,$446.2
,CDM,4320002111.30.4320,"STD COGN,PERFORMANCE TEST,PER",CDM Code,Outpatient,96125,$343.,$84.8548,$325.85,$274.4,$312.13,$89.9459,$325.85,$84.8548,$325.85,$325.85,$314.2857,$234.0975,$168.,$315.56
,CDM,4320003100.10.4320,SWALLOW CURRENT STATUS CH,CDM Code,Outpatient,G8996GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003101.10.4320,SWALLOW GOAL STATUS CH,CDM Code,Outpatient,G8997GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003101.30.4320,SWALLOW GOAL STATUS CH,CDM Code,Outpatient,G8997,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003102.10.4320,SWALLOW DC STATUS CH,CDM Code,Outpatient,G8998GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003102.30.4320,SWALLOW DC STATUS CH,CDM Code,Outpatient,G8998,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003104.10.4320,MOTOR SPEECH GOAL STATUS CH,CDM Code,Outpatient,G9186GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003105.10.4320,MOTOR SPEECH DC STATUS CH,CDM Code,Outpatient,G9158GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003109.10.4320,LANG EXPRESS CURRENT STATUS CH,CDM Code,Outpatient,G9162GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003109.30.4320,LANG EXPRESS CURRENT STATUS CH,CDM Code,Outpatient,G9162,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003110.10.4320,LANG EXPRESS GOAL STATUS CH,CDM Code,Outpatient,G9163GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003110.30.4320,LANG EXPRESS GOAL STATUS CH,CDM Code,Outpatient,G9163,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003111.10.4320,LANG EXPRESS DC STATUS CH,CDM Code,Outpatient,G9164GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003111.30.4320,LANG EXPRESS DC STATUS CH,CDM Code,Outpatient,G9164,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003113.10.4320,ATTN GOAL STATUS CH,CDM Code,Outpatient,G9166GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003114.10.4320,ATTN DC STATUS CH,CDM Code,Outpatient,G9167GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003115.10.4320,MEMORY CURRENT STATUS CH,CDM Code,Outpatient,G9168GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003116.10.4320,MEMORY GOAL STATUS CH,CDM Code,Outpatient,G9169GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003117.10.4320,MEMORY DC STATUS CI,CDM Code,Outpatient,G9170GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003118.10.4320,VOICE CURRENT STATUS CH,CDM Code,Outpatient,G9171GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003119.10.4320,VOICE GOAL STATUS CH,CDM Code,Outpatient,G9172GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003120.10.4320,VOICE DC STATUS CH,CDM Code,Outpatient,G9173GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003200.10.4320,SWALLOW CURRENT STATUS CI,CDM Code,Outpatient,G8996GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003200.30.4320,SWALLOW CURRENT STATUS CI,CDM Code,Outpatient,G8996,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003201.10.4320,SWALLOW GOAL STATUS CI,CDM Code,Outpatient,G8997GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003202.10.4320,SWALLOW DC STATUS CI,CDM Code,Outpatient,G8998GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003202.30.4320,SWALLOW DC STATUS CI,CDM Code,Outpatient,G8998,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003203.10.4320,MOTOR SPEECH CURRENT STATUS CI,CDM Code,Outpatient,G8999GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003204.10.4320,MOTOR SPEECH GOAL STATUS CI,CDM Code,Outpatient,G9186GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003204.30.4320,MOTOR SPEECH GOAL STATUS CI,CDM Code,Outpatient,G9186,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003205.10.4320,MOTOR SPEECH DC STATUS CI,CDM Code,Outpatient,G9158GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003206.10.4320,LANG COMP CURRENT STATUS CI,CDM Code,Outpatient,G9159GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003207.10.4320,LANG COMP GOAL STATUS CI,CDM Code,Outpatient,G9160GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003209.10.4320,LANG EXPRESS CURRENT STATUS CI,CDM Code,Outpatient,G9162GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003210.10.4320,LANG EXPRESS GOAL STATUS CI,CDM Code,Outpatient,G9163GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003210.30.4320,LANG EXPRESS GOAL STATUS CI,CDM Code,Outpatient,G9163,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003211.10.4320,LANG EXPRESS DC STATUS CI,CDM Code,Outpatient,G9164GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003211.30.4320,LANG EXPRESS DC STATUS CI,CDM Code,Outpatient,G9164,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003213.10.4320,ATTN GOAL STATUS CI,CDM Code,Outpatient,G9166GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003214.10.4320,ATTN DC STATUS CI,CDM Code,Outpatient,G9167GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003215.10.4320,MEMORY CURRENT STATUS CI,CDM Code,Outpatient,G9168GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003216.10.4320,MEMORY GOAL STATUS CI,CDM Code,Outpatient,G9169GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003216.30.4320,MEMORY GOAL STATUS CI,CDM Code,Outpatient,G9169,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003217.10.4320,MEMORY DC STATUS CI,CDM Code,Outpatient,G9170GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003217.30.4320,MEMORY DC STATUS CI,CDM Code,Outpatient,G9170,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003219.10.4320,VOICE GOAL STATUS CI,CDM Code,Outpatient,G9172GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003219.30.4320,VOICE GOAL STATUS CI,CDM Code,Outpatient,G9172,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003220.10.4320,VOICE DC STATUS CI,CDM Code,Outpatient,G9173GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003220.30.4320,VOICE DC STATUS CI,CDM Code,Outpatient,G9173,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003222.10.4320,SPEECH LANG GOAL STATUS CI,CDM Code,Outpatient,G9175GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003223.10.4320,SPEECH LANG DC STATUS CI,CDM Code,Outpatient,G9176GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003300.10.4320,SWALLOW CURRENT STATUS CJ,CDM Code,Outpatient,G8996GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003301.10.4320,SWALLOW GOAL STATUS CJ,CDM Code,Outpatient,G8997GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003302.10.4320,SWALLOW DC STATUS CJ,CDM Code,Outpatient,G8998GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003304.10.4320,MOTOR SPEECH GOAL STATUS CJ,CDM Code,Outpatient,G9186GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003305.10.4320,MOTOR SPEECH DC STATUS CJ,CDM Code,Outpatient,G9158GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003305.30.4320,MOTOR SPEECH DC STATUS CJ,CDM Code,Outpatient,G9158,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003309.10.4320,LANG EXPRESS CURRENT STATUS CJ,CDM Code,Outpatient,G9162GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003310.10.4320,LANG EXPRESS GOAL STATUS CJ,CDM Code,Outpatient,G9163GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003311.10.4320,LANG EXPRESS DC STATUS CJ,CDM Code,Outpatient,G9164GNC,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.,$0.
,CDM,4320003312.10.4320,ATTN CURRENT STATUS CJ,CDM Code,Outpatient,G9165GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003313.10.4320,ATTN GOAL STATUS CJ,CDM Code,Outpatient,G9166GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003315.10.4320,MEMORY CURRENT STATUS CJ,CDM Code,Outpatient,G9168GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003316.10.4320,MEMORY GOAL STATUS CL,CDM Code,Outpatient,G9169GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003317.10.4320,MEMORY DC STATUS CJ,CDM Code,Outpatient,G9170GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003318.10.4320,VOICE CURRENT STATUS CJ,CDM Code,Outpatient,G9171GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003319.10.4320,VOICE GOAL STATUS CJ,CDM Code,Outpatient,G9172GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003320.10.4320,VOICE DC STATUS CJ,CDM Code,Outpatient,G9173GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003322.10.4320,SPEECH LANG GOAL STATUS CJ,CDM Code,Outpatient,G9175GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003323.10.4320,SPEECH LANG DC STATUS CJ,CDM Code,Outpatient,G9176GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003400.10.4320,SWALLOW CURRENT STATUS CK,CDM Code,Outpatient,G8996GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003400.30.4320,SWALLOW CURRENT STATUS CK,CDM Code,Outpatient,G8996,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003401.10.4320,SWALLOW GOAL STATUS CK,CDM Code,Outpatient,G8997GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003402.10.4320,SWALLOW DC STATUS CK,CDM Code,Outpatient,G8998GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003403.10.4320,MOTOR SPEECH CURRENT STATUS CK,CDM Code,Outpatient,G8999GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003403.30.4320,MOTOR SPEECH CURRENT STATUS CK,CDM Code,Outpatient,G8999,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003406.10.4320,LANG COMP CURRENT STATUS CK,CDM Code,Outpatient,G9159GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003409.10.4320,LANG EXPRESS CURRENT STATUS CK,CDM Code,Outpatient,G9162GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003409.30.4320,LANG EXPRESS CURRENT STATUS CK,CDM Code,Outpatient,G9162,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003410.10.4320,LANG EXPRESS GOAL STATUS CK,CDM Code,Outpatient,G9163GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003411.10.4320,LANG EXPRESS DC STATUS CK,CDM Code,Outpatient,G9164GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003412.10.4320,ATTN CURRENT STATUS CK,CDM Code,Outpatient,G9165GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003413.10.4320,ATTN GOAL STATUS CK,CDM Code,Outpatient,G9166GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003415.10.4320,MEMORY CURRENT STATUS CK,CDM Code,Outpatient,G9168GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003415.30.4320,MEMORY CURRENT STATUS CK,CDM Code,Outpatient,G9168,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003416.10.4320,MEMORY GOAL STATUS CK,CDM Code,Outpatient,G9169GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003417.10.4320,MEMORY DC STATUS CK,CDM Code,Outpatient,G9170GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003418.10.4320,VOICE CURRENT STATUS CK,CDM Code,Outpatient,G9171GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003418.30.4320,VOICE CURRENT STATUS CK,CDM Code,Outpatient,G9171,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003421.10.4320,SPEECH LANG CURRENT STATUS CK,CDM Code,Outpatient,G9174GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003422.10.4320,SPEECH LANG GOAL STATUS CK,CDM Code,Outpatient,G9175GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003500.10.4320,SWALLOW CURRENT STATUS CL,CDM Code,Outpatient,G8996GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003500.30.4320,SWALLOW CURRENT STATUS CL,CDM Code,Outpatient,G8996,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003501.10.4320,SWALLOW GOAL STATUS CL,CDM Code,Outpatient,G8997GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003502.10.4320,SWALLOW DC STATUS CL,CDM Code,Outpatient,G8998GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003503.10.4320,MOTOR SPEECH CURRENT STATUS CL,CDM Code,Outpatient,G8999GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003503.30.4320,MOTOR SPEECH CURRENT STATUS CL,CDM Code,Outpatient,G8999,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003509.10.4320,LANG EXPRESS CURRENT STATUS CL,CDM Code,Outpatient,G9162GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003510.10.4320,LANG EXPRESS GOAL STATUS CL,CDM Code,Outpatient,G9163GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003512.10.4320,ATTN CURRENT STATUS CL,CDM Code,Outpatient,G9165GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003515.10.4320,MEMORY CURRENT STATUS CL,CDM Code,Outpatient,G9168GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003515.30.4320,MEMORY CURRENT STATUS CL,CDM Code,Outpatient,G9168,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003516.10.4320,MEMORY GOAL STATUS CL,CDM Code,Outpatient,G9169GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003517.10.4320,MEMORY DC STATUS CL,CDM Code,Outpatient,G9170GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003518.10.4320,VOICE CURRENT STATUS CL,CDM Code,Outpatient,G9171GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003521.10.4320,SPEECH LANG CURRENT STATUS CL,CDM Code,Outpatient,G9174GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003522.10.4320,SPEECH LANG GOAL STATUS CL,CDM Code,Outpatient,G9175GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003600.10.4320,SWALLOW CURRENT STATUS CM,CDM Code,Outpatient,G8996GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003601.10.4320,SWALLOW GOAL STATUS CM,CDM Code,Outpatient,G8997GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003602.10.4320,SWALLOW DC STATUS CM,CDM Code,Outpatient,G8998GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003603.10.4320,MOTOR SPEECH CURRENT STATUS CM,CDM Code,Outpatient,G8999GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003609.10.4320,LANG EXPRESS CURRENT STATUS CM,CDM Code,Outpatient,G9162GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003611.10.4320,LANG EXPRESS DC STATUS CM,CDM Code,Outpatient,G9164GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003612.10.4320,ATTN CURRENT STATUS CM,CDM Code,Outpatient,G9165GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003615.10.4320,MEMORY CURRENT STATUS CM,CDM Code,Outpatient,G9168GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003618.10.4320,VOICE CURRENT STATUS CM,CDM Code,Outpatient,G9171GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003620.10.4320,VOICE DC STATUS CM,CDM Code,Outpatient,G9173GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003621.10.4320,SPEECH LANG CURRENT STATUS CM,CDM Code,Outpatient,G9174GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003700.10.4320,SWALLOW CURRENT STATUS CN,CDM Code,Outpatient,G8996GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003701.10.4320,SWALLOW GOAL STATUS CN,CDM Code,Outpatient,G8997GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003703.10.4320,MOTOR SPEECH CURRENT STATUS CN,CDM Code,Outpatient,G8999GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003709.10.4320,LANG EXPRESS CURRENT STATUS CN,CDM Code,Outpatient,G9162GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320003718.10.4320,VOICE CURRENT STATUS CN,CDM Code,Outpatient,G9171GNC,$0.01,$0.0025,$0.0095,$0.008,$0.0091,$0.,$0.0095,$0.,$0.0095,$0.0095,$0.001,$0.0068,$0.0088,$0.0092
,CDM,4320005058.10.4320,ST MODIFIED BARIUM SWALLOW 926,CDM Code,Outpatient,92611GN,$358.,$88.5656,$340.1,$286.4,$325.78,$93.8794,$340.1,$88.5656,$340.1,$340.1,$235.7343,$244.335,$124.,$329.36
,CDM,4320005058.30.4320,ST MODIFIED BARIUM SWALLOW 926,CDM Code,Outpatient,92611,$358.,$88.5656,$340.1,$286.4,$325.78,$93.8794,$340.1,$88.5656,$340.1,$340.1,$235.7343,$244.335,$124.,$329.36
,CDM,4320005062.10.4320,ST TREAT OF SPEECH 92507,CDM Code,Outpatient,92507GN,$320.,$79.1648,$304.,$256.,$291.2,$83.9146,$304.,$79.1648,$304.,$304.,$213.6801,$218.4,$111.,$294.4
,CDM,4320005062.30.4320,ST TREAT OF SPEECH 92507,CDM Code,Outpatient,92507,$320.,$79.1648,$304.,$256.,$291.2,$83.9146,$304.,$79.1648,$304.,$304.,$213.6801,$218.4,$111.,$294.4
,CDM,4320005066.10.4320,ST TREAT OF SWALLOW 92526,CDM Code,Outpatient,92526GN,$351.,$86.8339,$333.45,$280.8,$319.41,$92.0438,$333.45,$86.8339,$333.45,$333.45,$232.8504,$239.5575,$121.5,$322.92
,CDM,4320005066.30.4320,ST TREAT OF SWALLOW 92526,CDM Code,Outpatient,92526,$351.,$86.8339,$333.45,$280.8,$319.41,$92.0438,$333.45,$86.8339,$333.45,$333.45,$232.8504,$239.5575,$121.5,$322.92
,CDM,4320005088.10.4320,ST SWALLOWING EVAL 92610,CDM Code,Outpatient,92610GN,$351.,$86.8339,$333.45,$280.8,$319.41,$92.0438,$333.45,$86.8339,$333.45,$333.45,$198.3543,$239.5575,$121.5,$322.92
,CDM,4320005088.30.4320,ST SWALLOWING EVAL 92610,CDM Code,Outpatient,92610,$351.,$86.8339,$333.45,$280.8,$319.41,$92.0438,$333.45,$86.8339,$333.45,$333.45,$198.3543,$239.5575,$121.5,$322.92
,CDM,4320005091.10.4320,ST GROUP THERAPY92508,CDM Code,Outpatient,92508GN,$94.,$23.2547,$89.3,$75.2,$85.54,$24.6499,$89.3,$23.2547,$89.3,$89.3,$62.2908,$64.155,$32.5,$86.48
,CDM,4320005095.10.4320,ST USE OF GEN DEVICE 92609,CDM Code,Outpatient,92609GN,$450.,$111.3255,$427.5,$360.,$409.5,$118.0048,$427.5,$111.3255,$427.5,$427.5,$298.9599,$307.125,$155.5,$414.
,CDM,4320005097.10.4320,ST COGNITIVE TEST BY HC PRO,CDM Code,Outpatient,96125GN,$486.,$120.2315,$461.7,$388.8,$442.26,$127.4452,$461.7,$120.2315,$461.7,$461.7,$314.2857,$331.695,$168.,$447.12
,CDM,4320005098.10.4320,ST THER IVNTJ W/FOCUS COG FUNC,CDM Code,Outpatient,97127GN,$117.,$28.9446,$111.15,$93.6,$106.47,$30.6813,$111.15,$28.9446,$111.15,$111.15,$11.7,$79.8525,$102.96,$107.64
,CDM,4320005105.10.4320,THER IVNTJ EA ADDL 15 MIN,CDM Code,Outpatient,97130GN,$30.,$7.4217,$28.5,$24.,$27.3,$7.867,$28.5,$7.4217,$28.5,$28.5,$3.,$20.475,$26.4,$27.6
,CDM,4320008005.10.4320,TELE SPEECH THER LANGUAGE EVAL,CDM Code,Outpatient,92523GN9,$809.,$193.2,$768.55,$647.2,$736.19,$212.1465,$768.55,$200.1385,$768.55,$768.55,$531.8106,$552.1425,$193.2,$744.28
,CDM,4320008010.10.4320,TELE TREAT OF SPEECH 92507,CDM Code,Outpatient,92507GN9,$320.,$79.1648,$304.,$256.,$291.2,$83.9146,$304.,$79.1648,$304.,$304.,$213.6801,$218.4,$111.,$294.4
,CDM,4407000203.10.4407,PC OP NEW CONSULT 30 MIN,CDM Code,Professional,99203,$208.,$20.8,$191.36,$166.4,$141.89,$61.215,$96.32,$57.75,$166.155,$165.36,$20.8,$141.96,$152.5,$191.36
,CDM,4407000204.10.4407,PC OP NEW CONSULT 45 MIN,CDM Code,Professional,99204,$320.,$32.,$294.4,$256.,$214.04,$92.8136,$162.59,$87.56,$252.3675,$251.16,$32.,$218.4,$232.5,$294.4
,CDM,4407000205.10.4407,PC OP NEW CONSULT 50 MIN,CDM Code,Professional,99205,$396.,$39.6,$364.32,$316.8,$268.68,$116.5576,$212.33,$109.96,$312.455,$310.96,$39.6,$270.27,$292.5,$364.32
,CDM,4407000213.10.4407,PC OP VISIT 15 MIN,CDM Code,Professional,99213,$142.,$14.2,$130.64,$113.6,$96.37,$42.188,$64.49,$39.8,$111.815,$111.28,$14.2,$96.915,$103.,$130.64
,CDM,4407000214.10.4407,PC OP VISIT 25 MIN,CDM Code,Professional,99214,$208.,$20.8,$191.36,$166.4,$141.4,$61.6072,$98.77,$58.12,$164.065,$163.28,$20.8,$141.96,$152.,$191.36
,CDM,4407000215.10.4407,PC OP VISIT 40 MIN,CDM Code,Professional,99215,$279.,$27.9,$256.68,$223.2,$189.62,$82.415,$139.66,$77.75,$219.45,$218.4,$27.9,$190.4175,$205.,$256.68
,CDM,4407000216.10.4407,PC OP VISIT PROLNG 30 - 74 MIN,CDM Code,Professional,99354,$184.,$18.4,$184.5,$147.2,$167.25,$80.8886,$153.47,$76.31,$174.8,$174.8,$18.4,$125.58,$184.5,$169.28
,CDM,4407000221.10.4407,PC IP NEW CONSULT C/SF 30 MIN,CDM Code,Professional,99221,$195.,$19.5,$179.4,$156.,$129.41,$62.8898,$127.4,$59.33,$151.525,$150.8,$19.5,$133.0875,$143.5,$179.4
,CDM,4407000222.10.4407,PC IP NEW CONSULT C/MOD 50 MIN,CDM Code,Professional,99222,$265.,$26.5,$243.8,$212.,$175.27,$85.012,$172.,$80.2,$205.865,$204.88,$26.5,$180.8625,$193.5,$243.8
,CDM,4407000223.10.4407,PC IP NEW CNSLT C/HIGH 70 MIN,CDM Code,Professional,99223,$390.,$39.,$358.8,$312.,$259.93,$125.557,$255.23,$118.45,$303.05,$301.6,$39.,$266.175,$287.,$358.8
,CDM,4407000231.10.4407,PC IP VISIT PF/SF 15 MIN,CDM Code,Professional,99231,$77.,$7.7,$70.84,$61.6,$50.21,$24.5072,$49.33,$23.12,$58.52,$58.24,$7.7,$52.5525,$55.5,$70.84
,CDM,4407000232.10.4407,PC IP VISIT EDF/M 25 MIN,CDM Code,Professional,99232,$140.,$14.,$128.8,$112.,$92.71,$45.103,$91.61,$42.55,$107.635,$107.12,$14.,$95.55,$103.,$128.8
,CDM,4407000233.10.4407,PC IP VISIT D/HIGH 35 MIN,CDM Code,Professional,99233,$201.,$20.1,$184.92,$160.8,$133.93,$64.4056,$131.2,$60.76,$154.66,$153.92,$20.1,$137.1825,$147.5,$184.92
,CDM,4407000234.10.4407,PC IP VISIT PROLNG 30-74 MIN,CDM Code,Professional,99356,$179.,$17.9,$170.05,$143.2,$118.58,$57.2506,$116.19,$54.01,$170.05,$170.05,$17.9,$122.1675,$130.5,$164.68
,CDM,4407000235.10.4407,PC IP VISIT EA ADDTL 30 MIN,CDM Code,Professional,99357,$84.,$8.4,$131.,$67.2,$118.58,$57.4626,$116.64,$54.21,$79.8,$79.8,$8.4,$57.33,$131.,$77.28
,CDM,4407000304.10.4407,PC NFB NEW CONSULT 25 MIN,CDM Code,Professional,99304,$180.,$18.,$171.,$144.,$117.96,$55.9468,$114.88,$52.78,$171.,$171.,$18.,$122.85,$129.,$165.6
,CDM,4407000306.10.4407,PC NFB NEW CONSULT 45 MIN,CDM Code,Professional,99306,$323.,$32.3,$297.16,$258.4,$215.19,$103.6574,$210.18,$97.79,$251.845,$250.64,$32.3,$220.4475,$236.,$297.16
,CDM,4407000308.10.4407,PC NFB VISIT 15 MIN,CDM Code,Professional,99308,$135.,$13.5,$124.2,$108.,$89.65,$42.9406,$87.34,$40.51,$103.9775,$103.48,$13.5,$92.1375,$98.,$124.2
,CDM,4407000309.10.4407,PC NFB VISIT 25 MIN,CDM Code,Professional,99309,$176.,$17.6,$161.92,$140.8,$118.64,$57.028,$115.38,$53.8,$136.3725,$135.72,$17.6,$120.12,$129.5,$161.92
,CDM,4407000310.10.4407,PC NFB VISIT 35 MIN,CDM Code,Professional,99310,$261.,$26.1,$240.12,$208.8,$176.13,$84.3548,$171.51,$79.58,$203.2525,$202.28,$26.1,$178.1325,$192.5,$240.12
,CDM,4407000311.10.4407,PC NFB VISIT FIRST HOUR,CDM Code,Professional,99356,$170.,$17.,$161.5,$136.,$118.58,$57.2506,$116.19,$54.01,$161.5,$161.5,$17.,$116.025,$130.5,$156.4
,CDM,4407000324.10.4407,PC AL NEW CONSULT 20 MIN,CDM Code,Professional,99324,$108.,$10.8,$102.6,$86.4,$71.16,$34.4818,$69.43,$32.53,$102.6,$102.6,$10.8,$73.71,$78.,$99.36
,CDM,4407000326.10.4407,PC AL NEW CONSULT 45 MIN,CDM Code,Professional,99326,$269.,$26.9,$247.48,$215.2,$179.42,$86.3052,$175.34,$81.42,$208.4775,$207.48,$26.9,$183.5925,$197.,$247.48
,CDM,4407000327.10.4407,PC AL NEW CONSULT 60 MIN,CDM Code,Professional,99327,$360.,$36.,$331.2,$288.,$239.44,$116.017,$234.56,$109.45,$278.4925,$277.16,$36.,$245.7,$263.5,$331.2
,CDM,4407000328.10.4407,PC AL NEW CONSULT 75 MIN,CDM Code,Professional,99328,$416.,$41.6,$382.72,$332.8,$280.06,$136.4008,$274.63,$128.68,$323.4275,$321.88,$41.6,$283.92,$308.5,$382.72
,CDM,4407000334.10.4407,PC AL VISIT 15 MIN,CDM Code,Professional,99334,$118.,$11.8,$112.1,$94.4,$77.83,$37.5134,$75.71,$35.39,$112.1,$112.1,$11.8,$80.535,$85.,$108.56
,CDM,4407000335.10.4407,PC AL VISIT 25 MIN,CDM Code,Professional,99335,$184.,$18.4,$169.28,$147.2,$122.52,$59.201,$119.34,$55.85,$142.12,$141.44,$18.4,$125.58,$134.,$169.28
,CDM,4407000336.10.4407,PC AL VISIT 40 MIN,CDM Code,Professional,99336,$259.,$25.9,$238.28,$207.2,$174.04,$84.3548,$170.49,$79.58,$201.685,$200.72,$25.9,$176.7675,$191.5,$238.28
,CDM,4407000337.10.4407,PC AL VISIT 60 MIN,CDM Code,Professional,99337,$371.,$37.1,$341.32,$296.8,$248.41,$120.575,$243.46,$113.75,$288.4199,$287.04,$37.1,$253.2075,$273.5,$341.32
,CDM,4407000338.10.4407,PC AL VISIT PROLNG F2F 30 MIN,CDM Code,Professional,99354,$194.,$19.4,$184.5,$155.2,$167.25,$80.8886,$153.47,$76.31,$184.3,$184.3,$19.4,$132.405,$184.5,$178.48
,CDM,4407000343.10.4407,PC HOME NEW CONSULT 45 MIN,CDM Code,Professional,99343,$251.,$25.1,$238.45,$200.8,$166.97,$80.666,$164.07,$76.1,$238.45,$238.45,$25.1,$171.3075,$184.5,$230.92
,CDM,4407000344.10.4407,PC HOME NEW CONSULT 60 MIN,CDM Code,Professional,99344,$351.,$35.1,$322.92,$280.8,$235.19,$113.1974,$230.09,$106.79,$272.745,$271.44,$35.1,$239.5575,$258.5,$322.92
,CDM,4407000345.10.4407,PC HOME NEW CONSULT 75 MIN,CDM Code,Professional,99345,$424.,$42.4,$390.08,$339.2,$284.67,$137.7046,$279.45,$129.91,$328.6524,$327.08,$42.4,$289.38,$314.,$390.08
,CDM,4407000347.10.4407,PC HOME VISIT 15 MIN,CDM Code,Professional,99347,$108.,$10.8,$102.6,$86.4,$71.21,$34.4818,$69.44,$32.53,$102.6,$102.6,$10.8,$73.71,$78.,$99.36
,CDM,4407000348.10.4407,PC HOME VISIT 25 MIN,CDM Code,Professional,99348,$163.,$16.3,$149.96,$130.4,$108.4,$52.258,$105.9,$49.3,$126.445,$125.84,$16.3,$111.2475,$119.,$149.96
,CDM,4407000349.10.4407,PC HOME VISIT 40 MIN,CDM Code,Professional,99349,$247.,$24.7,$227.24,$197.6,$165.75,$80.2314,$162.04,$75.69,$191.7575,$190.84,$24.7,$168.5775,$182.,$227.24
,CDM,4407000350.10.4407,PC HOME VISIT 60 MIN,CDM Code,Professional,99350,$343.,$34.3,$315.56,$274.4,$229.23,$111.247,$225.19,$104.95,$265.9525,$264.68,$34.3,$234.0975,$253.,$315.56
,CDM,4407000351.10.4407,PC HOME VIST PROLNG F2F 30 MIN,CDM Code,Professional,99354,$194.,$19.4,$184.5,$155.2,$167.25,$80.8886,$153.47,$76.31,$184.3,$184.3,$19.4,$132.405,$184.5,$178.48
,CDM,4407000352.10.4407,PC HOME VISIT EA ADDTL 30 MIN,CDM Code,Professional,99355,$189.,$18.9,$179.55,$151.2,$126.06,$61.8086,$115.2,$58.31,$179.55,$179.55,$18.9,$128.9925,$139.5,$173.88
,CDM,4407000361.10.4407,PC OP NEW CONSULT 20 MIN TELE,CDM Code,Professional,99202GT,$144.,$14.4,$132.48,$115.2,$98.89,$43.3645,$63.57,$40.9099,$114.4275,$113.88,$14.4,$98.28,$106.,$132.48
,CDM,4407000367.10.4407,PC OP VISIT 15 MIN TELE,CDM Code,Professional,99213GT,$142.,$14.2,$130.64,$113.6,$96.37,$42.188,$64.49,$39.8,$111.815,$111.28,$14.2,$96.915,$103.,$130.64
,CDM,4407000368.10.4407,PC OP VISIT 25 MIN TELE,CDM Code,Professional,99214GT,$208.,$20.8,$191.36,$166.4,$141.4,$61.6072,$98.77,$58.12,$164.065,$163.28,$20.8,$141.96,$152.,$191.36
,CDM,4407000369.10.4407,PC OP VISIT 40 MIN TELE,CDM Code,Professional,99215GT,$279.,$27.9,$256.68,$223.2,$189.62,$82.415,$139.66,$77.75,$219.45,$218.4,$27.9,$190.4175,$205.,$256.68
,CDM,4407000370.10.4407,PC BRIEF CHCKIN BY MD/QHP,CDM Code,Professional,99441CR,$27.,$2.7,$25.65,$21.6,$17.95,$8.6708,$16.04,$8.18,$25.65,$25.65,$2.7,$18.4275,$20.,$24.84
,CDM,4407000374.10.4407,PC PHONE E/M PHYS/QHP 11-20MIN,CDM Code,Professional,99442CR,$54.,$5.4,$51.3,$43.2,$34.7,$16.695,$32.04,$15.75,$51.3,$51.3,$5.4,$36.855,$38.,$49.68
,CDM,4407000375.10.4407,PC PHONE E/M PHYS/QHP 21-30MIN,CDM Code,Professional,99443CR,$81.,$8.1,$76.95,$64.8,$51.15,$24.7192,$48.08,$23.32,$76.95,$76.95,$8.1,$55.2825,$56.,$74.52
,CDM,4407000380.10.4407,PC ADVNCD CARE PLAN 30 MIN,CDM Code,Professional,99497,$163.,$49.92,$154.85,$130.4,$105.61,$52.9152,$99.67,$49.92,$154.85,$154.85,$70.26,$111.2475,$119.5,$149.96
,CDM,4407000381.10.4407,PC ADVCD CR PLAN ADDL 30 MIN,CDM Code,Professional,99498,$144.,$14.4,$136.8,$115.2,$91.84,$46.4068,$93.46,$43.78,$136.8,$136.8,$14.4,$98.28,$105.5,$132.48
,CDM,4407000382.10.4407,PC PROLONG SERVICE W/O CONTACT,CDM Code,Professional,99358,$227.,$22.7,$215.65,$181.6,$143.69,$59.5269,$140.57,$56.1575,$215.65,$215.65,$22.7,$154.9275,$158.,$208.84
,CDM,4410005301.10.4020,F/ URO LITHO SERVICE,CDM Code,Outpatient,50590,"$12,360.","$3,057.7404","$11,742.","$9,888.","$11,247.6","$3,241.1999","$11,742.","$3,057.7404","$11,742.","$11,742.","$9,302.3067","$8,435.7","$10,876.8","$11,371.2"
,CDM,4410005306.10.4020,F/ URO LITHOTRIPSY SERVICE REP,CDM Code,Outpatient,50590,"$6,180.","$1,528.8702","$9,302.3067","$4,944.","$5,623.8","$1,620.5999","$5,871.","$1,528.8702","$5,871.","$5,871.","$9,302.3067","$4,217.85","$5,438.4","$5,685.6"
,CDM,4415003005.10.4415,TELE MED NUTRITION TX/15MN F/U,CDM Code,Outpatient,97803GT,$57.,$14.1012,$74.7333,$45.6,$51.87,$14.9473,$54.15,$14.1012,$54.15,$54.15,$74.7333,$38.9025,$42.5,$52.44
,CDM,4415003010.10.4415,TELE MED NUTRITTIN TX/15MN INT,CDM Code,Outpatient,97802GT,$57.,$14.1012,$88.1634,$45.6,$51.87,$14.9473,$54.15,$14.1012,$54.15,$54.15,$88.1634,$38.9025,$49.,$52.44
,CDM,4415003015.10.4415,TELE DIAB EDU INDIV PER 30 MIN,CDM Code,Outpatient,G0108GT,$116.,$28.6972,$144.6873,$92.8,$105.56,$30.419,$110.2,$28.6972,$110.2,$110.2,$144.6873,$79.17,$102.08,$106.72
,CDM,4415003022.10.4415,MED NUTRITION TX/15MIN FOLLOW,CDM Code,Outpatient,97803,$57.,$14.1012,$74.7333,$45.6,$51.87,$14.9473,$54.15,$14.1012,$54.15,$54.15,$74.7333,$38.9025,$42.5,$52.44
,CDM,4415003027.10.4415,MED NUTRITTION TX/15MIN INITIA,CDM Code,Outpatient,97802,$57.,$14.1012,$88.1634,$45.6,$51.87,$14.9473,$54.15,$14.1012,$54.15,$54.15,$88.1634,$38.9025,$49.,$52.44
,MS-DRG,041,PERIPH/CRANIAL NERVE & OTHER NERV SYST PROC W CC OR PERIPH NEUROSTIM,Service Package,Inpatient,,"$36,873.","$14,276.5","$35,524.16","$29,498.4","$33,772.54","$19,477.66","$34,320.38","$18,375.01","$35,524.16","$35,521.79","$14,681.03","$14,276.5","$26,922.82","$33,923.16"
,MS-DRG,052,SPINAL DISORDERS & INJURIES W CC/MCC,Service Package,Inpatient,,"$30,318.","$5,400.74","$29,058.12","$24,254.4","$27,807.01","$16,073.85","$28,375.61","$15,163.88","$29,058.12","$29,056.9","$5,400.74","$7,674.75","$23,314.58","$27,892.56"
,MS-DRG,056,DEGENERATIVE NERVOUS SYSTEM DISORDERS W MCC,Service Package,Inpatient,,"$43,933.62","$17,823.","$42,056.19","$35,146.896","$40,500.68","$23,385.975","$41,557.12","$22,061.785","$42,056.19","$42,054.66","$17,823.","$20,876.8725","$22,417.12","$40,418.93"
,MS-DRG,057,DEGENERATIVE NERVOUS SYSTEM DISORDERS W/O MCC,Service Package,Inpatient,,"$40,246.5","$18,431.5825","$38,564.1325","$32,197.2","$36,905.43","$21,425.68","$37,818.93","$20,212.615","$38,564.1325","$38,562.555","$29,935.105","$19,237.5","$18,431.5825","$37,026.78"
,MS-DRG,061,ACUTE ISCHEMIC STROKE W USE OF THROMBOLYTIC AGENT W MCC,Service Package,Inpatient,,"$92,292.","$22,933.44","$87,933.42","$73,833.6","$84,216.2","$49,469.56","$87,275.97","$46,669.22","$87,933.42","$87,932.2","$22,933.44","$54,741.75","$77,426.66","$84,908.64"
,MS-DRG,064,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W MCC,Service Package,Inpatient,,"$29,144.9768","$10,366.6646","$28,041.1289","$23,315.9815","$26,932.9968","$15,419.2795","$27,345.4605","$14,546.3063","$28,041.1289","$28,039.44","$16,866.3768","$10,366.6646","$15,209.2732","$26,813.3784"
,MS-DRG,065,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W CC OR TPA IN 24 HRS,Service Package,Inpatient,,"$27,514.8019","$8,688.7104","$26,392.9365","$22,011.8415","$25,304.1795","$14,591.5974","$25,803.5153","$13,765.553","$26,392.9365","$26,391.7214","$12,050.1774","$8,688.7104","$20,838.7279","$25,313.6177"
,MS-DRG,066,INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION W/O CC/MCC,Service Package,Inpatient,,"$18,963.0133","$6,075.","$18,257.3033","$15,170.4107","$17,521.3767","$9,976.7217","$17,666.4067","$9,411.8667","$18,257.3033","$18,256.1433","$11,718.535","$6,075.","$10,868.275","$17,445.9717"
,MS-DRG,069,TRANSIENT ISCHEMIA,Service Package,Inpatient,,"$22,083.08","$5,062.5","$21,194.4575","$17,666.464","$20,450.175","$11,643.9425","$20,746.3375","$10,984.705","$21,194.4575","$21,193.4275","$10,216.4875","$5,062.5","$15,330.1575","$20,316.4325"
,MS-DRG,070,NONSPECIFIC CEREBROVASCULAR DISORDERS W MCC,Service Package,Inpatient,,"$33,660.3333","$14,337.5013","$32,325.8642","$26,928.2667","$30,931.8633","$17,856.2175","$31,525.3192","$16,845.1992","$32,325.8642","$32,324.2","$20,388.2625","$14,337.5013","$19,117.1933","$30,967.5067"
,MS-DRG,071,NONSPECIFIC CEREBROVASCULAR DISORDERS W CC,Service Package,Inpatient,,"$18,717.3333","$5,737.5","$17,961.2917","$14,973.8667","$17,221.09","$9,887.8883","$17,497.7583","$9,328.0517","$17,961.2917","$17,960.4333","$11,744.9167","$5,737.5","$10,135.9333","$17,219.9467"
,MS-DRG,073,CRANIAL & PERIPHERAL NERVE DISORDERS W MCC,Service Package,Inpatient,,"$38,561.3333","$12,303.75","$36,835.3","$30,849.0667","$35,266.0867","$20,560.0067","$36,282.4467","$19,396.0267","$36,835.3","$36,834.3333","$12,303.75","$17,859.05","$27,496.55","$35,476.4267"
,MS-DRG,074,CRANIAL & PERIPHERAL NERVE DISORDERS W/O MCC,Service Package,Inpatient,,"$26,705.016","$7,563.747","$25,612.206","$21,364.0128","$24,509.322","$14,131.486","$24,950.99","$13,331.346","$25,612.206","$25,611.046","$14,959.394","$7,563.747","$17,443.13","$24,568.614"
,MS-DRG,077,HYPERTENSIVE ENCEPHALOPATHY W MCC,Service Package,Inpatient,,"$30,820.","$5,675.25","$29,696.48","$24,656.","$28,401.72","$16,309.96","$28,742.61","$15,386.68","$29,696.48","$29,694.48","$9,596.33","$5,675.25","$27,144.2","$28,354.4"
,MS-DRG,078,HYPERTENSIVE ENCEPHALOPATHY W CC,Service Package,Inpatient,,"$17,781.","$2,346.","$17,147.97","$14,224.8","$16,398.34","$9,319.16","$16,465.46","$8,791.63","$17,147.97","$17,146.75","$4,718.02","$2,346.","$15,304.21","$16,358.52"
,MS-DRG,087,"TRAUMATIC STUPOR & COMA, COMA <1 HR W/O CC/MCC",Service Package,Inpatient,,"$35,010.","$5,451.41","$35,192.92","$28,008.","$32,006.77","$18,670.29","$32,943.01","$17,613.37","$33,434.54","$33,433.7","$5,451.41","$10,711.5","$35,192.92","$32,209.2"
,MS-DRG,091,OTHER DISORDERS OF NERVOUS SYSTEM W MCC,Service Package,Inpatient,,"$22,857.","$2,092.6162","$22,519.865","$18,285.6","$21,000.095","$12,098.745","$21,372.39","$11,413.775","$21,929.68","$21,928.65","$6,606.305","$2,092.6162","$22,519.865","$21,028.44"
,MS-DRG,092,OTHER DISORDERS OF NERVOUS SYSTEM W CC,Service Package,Inpatient,,"$50,804.","$25,144.5","$48,519.82","$40,643.2","$46,449.27","$27,111.26","$47,837.31","$25,576.3","$48,519.82","$48,518.6","$26,387.88","$25,144.5","$34,393.25","$46,739.68"
,MS-DRG,098,NON-BACTERIAL INFECT OF NERVOUS SYS EXC VIRAL MENINGITIS W CC,Service Package,Inpatient,,"$39,053.","$7,692.93","$37,608.21","$31,242.4","$35,768.71","$20,741.89","$36,549.78","$19,567.72","$37,608.21","$37,605.79","$7,692.93","$13,555.6275","$30,032.72","$35,928.76"
,MS-DRG,100,SEIZURES W MCC,Service Package,Inpatient,,"$34,383.6","$12,672.45","$33,124.742","$27,506.88","$31,764.842","$18,119.508","$32,111.4","$17,093.658","$33,124.742","$33,122.54","$18,208.88","$12,672.45","$26,825.474","$31,632.912"
,MS-DRG,101,SEIZURES W/O MCC,Service Package,Inpatient,,"$23,564.28","$6,193.4085","$22,707.614","$18,851.424","$21,692.758","$12,417.366","$21,908.566","$11,714.384","$22,707.614","$22,706.074","$12,033.086","$6,193.4085","$15,285.57","$21,679.138"
,MS-DRG,103,HEADACHES W/O MCC,Service Package,Inpatient,,"$25,618.","$8,100.","$24,512.14","$20,494.4","$23,460.05","$13,610.15","$24,020.61","$12,839.47","$24,512.14","$24,511.3","$15,883.81","$8,100.","$14,170.65","$23,568.56"
,MS-DRG,129,MAJOR HEAD & NECK PROCEDURES W CC/MCC OR MAJOR DEVICE,Service Package,Inpatient,,"$85,576.","$31,980.","$81,472.24","$68,460.8","$78,034.68","$45,921.7","$81,005.77","$43,321.78","$81,472.24","$81,471.4","$31,980.","$48,600.25","$53,470.56","$78,729.92"
,MS-DRG,138,MOUTH PROCEDURES W/O CC/MCC,Service Package,Inpatient,,"$17,900.","$6,853.","$17,180.04","$14,320.","$16,436.67","$9,453.88","$16,688.51","$8,918.57","$17,180.04","$17,179.2","$9,865.","$6,853.",$0.,"$16,468."
,MS-DRG,149,DYSEQUILIBRIUM,Service Package,Inpatient,,"$20,854.03","$6,075.","$20,067.35","$16,683.224","$19,194.8","$10,974.92","$19,384.84","$10,353.38","$20,067.35","$20,066.13","$11,894.84","$6,075.","$13,761.07","$19,185.71"
,MS-DRG,152,OTITIS MEDIA & URI W MCC,Service Package,Inpatient,,"$11,791.","$2,025.","$11,457.47","$9,432.8","$10,947.44","$6,094.9","$10,774.96","$5,749.84","$11,457.47","$11,456.25","$5,230.74","$2,025.","$7,630.34","$10,847.72"
,MS-DRG,153,OTITIS MEDIA & URI W/O MCC,Service Package,Inpatient,,"$10,539.","$2,025.","$10,187.09","$8,431.2","$9,738.16","$5,487.89","$9,695.56","$5,177.23","$10,187.09","$10,186.25","$5,164.41","$2,025.","$6,783.6","$9,695.88"
,MS-DRG,155,"""OTHER EAR, NOSE, MOUTH & THROAT DIAGNOSES W CC""",Service Package,Inpatient,,"$13,147.","$4,050.","$12,664.69","$10,517.6","$12,191.33","$6,906.94","$12,035.58","$6,515.85","$12,664.69","$12,663.85","$8,339.5","$4,050.","$6,619.42","$12,095.24"
,MS-DRG,157,DENTAL & ORAL DISEASES W MCC,Service Package,Inpatient,,"$9,109.","$2,025.","$9,148.36","$7,287.2","$8,446.31","$4,423.55","$7,827.78","$4,173.07","$9,148.36","$9,145.99","$5,388.19","$2,025.","$6,134.89","$8,380.28"
,MS-DRG,158,DENTAL & ORAL DISEASES W CC,Service Package,Inpatient,,"$23,990.","$4,050.","$22,965.54","$19,192.","$22,192.84","$12,697.86","$22,605.27","$11,978.98","$22,965.54","$22,964.7","$9,664.","$4,050.",$0.,"$22,070.8"
,MS-DRG,175,PULMONARY EMBOLISM W MCC,Service Package,Inpatient,,"$23,025.5","$4,725.","$22,103.2517","$18,420.4","$21,147.515","$12,169.6217","$21,484.4017","$11,480.7","$22,103.2517","$22,102.1583","$9,634.","$4,725.","$13,809.6833","$21,183.46"
,MS-DRG,176,PULMONARY EMBOLISM W/O MCC,Service Package,Inpatient,,"$18,720.7143","$5,159.7204","$17,969.3471","$14,976.5714","$17,192.1171","$9,908.0843","$17,481.9871","$9,347.1829","$17,969.3471","$17,968.4614","$8,423.2429","$5,159.7204","$13,642.1329","$17,223.0571"
,MS-DRG,177,RESPIRATORY INFECTIONS & INFLAMMATIONS W MCC,Service Package,Inpatient,,"$33,888.0564","$15,776.7675","$32,475.8273","$27,110.4451","$31,095.5586","$18,029.1973","$31,841.12","$17,008.2445","$32,475.8273","$32,474.4773","$24,760.8055","$15,776.7675","$16,708.0918","$31,177.0118"
,MS-DRG,178,RESPIRATORY INFECTIONS & INFLAMMATIONS W CC,Service Package,Inpatient,,"$28,242.4167","$9,322.9225","$27,039.6008","$22,593.9333","$25,895.0767","$15,003.0117","$26,495.7392","$14,153.5358","$27,039.6008","$27,038.5992","$22,227.4766999999","$13,831.625","$9,322.9225","$25,983.0233"
,MS-DRG,180,RESPIRATORY NEOPLASMS W MCC,Service Package,Inpatient,,"$29,080.5","$6,481.16","$27,922.735","$23,264.4","$26,867.61","$15,437.295","$27,272.445","$14,563.3","$27,922.735","$27,921.315","$19,005.83","$13,978.0088","$6,481.16","$26,754.06"
,MS-DRG,181,RESPIRATORY NEOPLASMS W CC,Service Package,Inpatient,,"$23,821.","$6,075.","$23,067.29","$19,056.8","$22,051.42","$12,311.87","$21,796.33","$11,614.86","$23,067.29","$23,065.19","$11,707.41","$6,075.","$11,329.04","$21,915.32"
,MS-DRG,183,MAJOR CHEST TRAUMA W MCC,Service Package,Inpatient,,"$8,175.","$2,025.","$8,022.27","$6,540.","$7,680.51","$4,141.54","$7,357.44","$3,907.08","$8,022.27","$8,021.05","$4,396.56","$2,025.","$6,100.54","$7,521."
,MS-DRG,184,MAJOR CHEST TRAUMA W CC,Service Package,Inpatient,,"$17,944.3333","$4,939.","$17,346.3333","$14,355.4667","$16,675.6067","$9,402.5633","$16,710.4567","$8,870.21","$17,346.3333","$17,344.9033","$9,359.44","$4,939.","$10,646.06","$16,508.7867"
,MS-DRG,185,MAJOR CHEST TRAUMA W/O CC/MCC,Service Package,Inpatient,,"$13,979.","$4,050.","$13,536.07","$11,183.2","$12,938.52","$7,270.78","$12,853.56","$6,859.03","$13,536.07","$13,534.85","$8,467.3","$4,050.","$11,451.8","$12,860.68"
,MS-DRG,187,PLEURAL EFFUSION W CC,Service Package,Inpatient,,"$22,803.3333","$6,964.","$21,838.2067","$18,242.6667","$20,969.53","$12,022.59","$21,304.3133","$11,341.88","$21,838.2067","$21,837.3667","$13,487.73","$6,964.","$10,475.0533","$20,979.0667"
,MS-DRG,189,PULMONARY EDEMA & RESPIRATORY FAILURE,Service Package,Inpatient,,"$27,970.841","$10,609.3137","$26,795.0462","$22,376.6728","$25,657.5557","$14,852.8569","$26,222.4981","$14,011.8717","$26,795.0462","$26,793.9802","$15,786.6002","$10,609.3137","$17,539.6388","$25,733.1733"
,MS-DRG,190,CHRONIC OBSTRUCTIVE PULMONARY DISEASE W MCC,Service Package,Inpatient,,"$32,428.2345","$13,884.1145","$31,065.6268","$25,942.5876","$29,729.9682","$17,236.7818","$30,410.3245","$16,260.6555","$31,065.6268","$31,064.3886","$18,215.9432","$13,884.1145","$20,210.38","$29,833.9755"
,MS-DRG,191,CHRONIC OBSTRUCTIVE PULMONARY DISEASE W CC,Service Package,Inpatient,,"$23,342.","$7,929.7909","$22,410.4955","$18,673.6","$21,442.6015","$12,363.883","$21,819.871","$11,663.753","$22,410.4955","$22,409.368","$13,824.9145","$7,929.7909","$15,450.4115","$21,474.64"
,MS-DRG,192,CHRONIC OBSTRUCTIVE PULMONARY DISEASE W/O CC/MCC,Service Package,Inpatient,,"$18,708.6","$6,075.","$17,980.602","$14,966.88","$17,205.206","$9,860.056","$17,416.216","$9,301.66","$17,980.602","$17,979.61","$12,200.798","$6,075.","$10,483.154","$17,211.912"
,MS-DRG,193,SIMPLE PNEUMONIA & PLEURISY W MCC,Service Package,Inpatient,,"$22,880.1026","$8,048.1277","$21,968.73","$18,304.0820999999","$21,034.8446","$12,104.6259","$21,382.4469","$11,419.2295","$21,968.73","$21,967.6174","$14,172.49","$8,048.1277","$12,095.1492","$21,049.6944"
,MS-DRG,194,SIMPLE PNEUMONIA & PLEURISY W CC,Service Package,Inpatient,,"$23,411.072","$8,682.558","$22,496.0033","$18,728.8576","$21,537.447","$12,384.121","$21,878.3027","$11,682.8777","$22,496.0033","$22,494.781","$15,963.6047","$8,682.558","$10,550.268","$21,538.1863"
,MS-DRG,195,SIMPLE PNEUMONIA & PLEURISY W/O CC/MCC,Service Package,Inpatient,,"$15,915.0833","$4,583.","$15,300.0275","$12,732.0667","$14,635.58","$8,382.1308","$14,801.7133","$7,907.4975","$15,300.0275","$15,299.1625","$9,581.8383","$4,583.","$9,416.6325","$14,641.8767"
,MS-DRG,196,INTERSTITIAL LUNG DISEASE W MCC,Service Package,Inpatient,,"$24,192.","$10,125.","$23,238.42","$19,353.6","$22,232.35","$12,776.28","$22,555.91","$12,053.03","$23,238.42","$23,237.2","$19,804.74","$10,125.","$11,201.23","$22,256.64"
,MS-DRG,199,PNEUMOTHORAX W MCC,Service Package,Inpatient,,"$34,401.","$12,496.5","$33,098.43","$27,520.8","$31,753.17","$18,085.56","$31,865.36","$17,061.78","$33,098.43","$33,096.43","$16,326.3","$12,496.5","$25,724.88","$31,648.92"
,MS-DRG,200,PNEUMOTHORAX W CC,Service Package,Inpatient,,"$11,458.","$2,025.","$11,126.755","$9,166.4","$10,987.92","$5,870.915","$10,787.945","$5,538.56","$11,126.755","$11,125.6","$5,578.385","$2,025.","$8,402.81","$10,541.36"
,MS-DRG,201,PNEUMOTHORAX W/O CC/MCC,Service Package,Inpatient,,"$11,058.5","$4,050.","$10,680.615","$8,846.8","$10,234.535","$5,681.965","$10,077.62","$5,360.3","$10,680.615","$10,679.775","$8,369.375","$4,050.","$5,678.865","$10,173.82"
,MS-DRG,202,BRONCHITIS & ASTHMA W CC/MCC,Service Package,Inpatient,,"$17,935.25","$4,636.5","$17,271.6525","$14,348.2","$16,518.59","$9,443.2575","$16,680.035","$8,908.5175","$17,271.6525","$17,270.5375","$9,875.0925","$4,636.5","$11,068.985","$16,500.43"
,MS-DRG,205,OTHER RESPIRATORY SYSTEM DIAGNOSES W MCC,Service Package,Inpatient,,"$18,618.","$5,034.48","$17,862.14","$14,894.4","$17,090.05","$9,840.68","$17,370.61","$9,283.38","$17,862.14","$17,861.3","$11,272.","$6,075.","$5,034.48","$17,128.56"
,MS-DRG,206,OTHER RESPIRATORY SYSTEM DIAGNOSES W/O MCC,Service Package,Inpatient,,"$45,867.5","$21,460.6237","$43,661.645","$36,694.","$41,813.26","$24,616.225","$43,415.88","$23,222.75","$43,661.645","$43,661.225","$28,269.355","$21,460.6237","$36,634.465","$42,198.1"
,MS-DRG,207,RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT >96 HOURS,Service Package,Inpatient,,"$105,723.89","$53,052.2375","$100,860.7925","$84,579.112","$96,622.8925","$56,649.055","$99,995.7275","$53,442.11","$100,860.7925","$100,858.7675","$53,052.2375","$68,788.3256","$58,707.8275","$97,265.9775"
,MS-DRG,208,RESPIRATORY SYSTEM DIAGNOSIS W VENTILATOR SUPPORT <=96 HOURS,Service Package,Inpatient,,"$39,274.8473","$15,595.1025","$37,640.6145","$31,419.8778","$36,083.0809","$20,841.6","$36,860.5018","$19,661.7082","$37,640.6145","$37,639.0364","$17,649.7855","$15,595.1025","$29,379.9336","$36,132.8591"
,MS-DRG,264,OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,Service Package,Inpatient,,"$31,001.","$10,681.","$29,625.99","$24,800.8","$28,358.58","$16,512.4","$29,134.46","$15,577.55","$29,625.99","$29,625.15","$18,934.61","$10,681.","$23,820.93","$28,520.92"
,MS-DRG,280,"""ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W MCC""",Service Package,Inpatient,,"$23,113.5967","$7,379.0197","$22,228.1362","$18,490.8773","$21,280.9221","$12,214.1746","$21,574.1517","$11,522.6183","$22,228.1362","$22,226.8438","$14,151.715","$7,379.0197","$12,586.0488","$21,264.5088"
,MS-DRG,281,"""ACUTE MYOCARDIAL INFARCTION, DISCHARGED ALIVE W CC""",Service Package,Inpatient,,"$22,187.8333","$5,327.925","$21,237.805","$17,750.2667","$20,333.0133","$11,786.07","$20,807.8567","$11,118.8833","$21,237.805","$21,237.0417","$6,919.0117","$5,327.925","$15,290.1067","$20,412.8067"
,MS-DRG,283,"""ACUTE MYOCARDIAL INFARCTION, EXPIRED W MCC""",Service Package,Inpatient,,"$27,286.1333","$9,537.3","$26,354.1067","$21,828.9067","$25,236.5133","$14,394.5267","$25,427.7","$13,579.5167","$26,354.1067","$26,352.04","$16,215.2233","$9,537.3","$12,896.1267","$25,103.2433"
,MS-DRG,291,HEART FAILURE & SHOCK W MCC,Service Package,Inpatient,,"$22,027.6379","$7,226.0423","$21,160.5621","$17,622.1103","$20,253.0114","$11,652.0857","$20,575.8543","$10,992.3853","$21,160.5621","$21,159.4409","$13,202.3938","$7,226.0423","$13,056.6926","$20,265.4264"
,MS-DRG,292,HEART FAILURE & SHOCK W CC,Service Package,Inpatient,,"$20,175.381","$6,021.99","$19,362.1771","$16,140.3048","$18,530.4762","$10,680.62","$18,861.2224","$10,075.9148","$19,362.1771","$19,361.2405","$11,233.761","$6,021.99","$12,296.1224","$18,561.3505"
,MS-DRG,293,HEART FAILURE & SHOCK W/O CC/MCC,Service Package,Inpatient,,"$16,393.4444","$4,346.3333","$15,853.6","$13,114.7556","$15,174.9766999999","$8,590.2178","$15,194.7756","$8,103.9122","$15,853.6","$15,852.2611","$9,028.9722","$4,346.3333","$10,319.2411","$15,081.9689"
,MS-DRG,296,"""CARDIAC ARREST, UNEXPLAINED W MCC""",Service Package,Inpatient,,"$25,788.","$4,357.5","$25,638.17","$20,630.4","$24,389.23","$13,091.45","$23,337.18","$12,350.4","$25,638.17","$25,632.72","$7,946.39","$4,357.5","$20,150.24","$23,724.96"
,MS-DRG,298,"""CARDIAC ARREST, UNEXPLAINED W/O CC/MCC""",Service Package,Inpatient,,"$16,092.","$2,346.","$15,462.44","$12,873.6","$14,791.39","$8,479.71","$14,970.91","$7,999.73","$15,462.44","$15,461.6","$4,032.41","$2,346.","$15,326.71","$14,804.64"
,MS-DRG,299,PERIPHERAL VASCULAR DISORDERS W MCC,Service Package,Inpatient,,"$32,385.5","$13,556.3962","$30,899.465","$25,908.4","$29,583.595","$17,296.105","$30,513.76","$16,316.77","$30,899.465","$30,898.825","$14,257.83","$13,556.3962","$23,544.595","$29,794.66"
,MS-DRG,300,PERIPHERAL VASCULAR DISORDERS W CC,Service Package,Inpatient,,"$19,280.","$3,433.46","$18,449.24","$15,424.","$17,747.04","$10,227.76","$18,123.025","$9,648.7","$18,449.24","$18,448.6","$13,380.83","$7,087.5","$3,433.46","$17,737.6"
,MS-DRG,303,ATHEROSCLEROSIS W/O MCC,Service Package,Inpatient,,"$21,008.5","$2,185.5","$20,173.605","$16,806.8","$19,300.385","$11,094.83","$19,586.585","$10,466.8","$20,173.605","$20,172.575","$4,659.575","$2,185.5","$16,332.57","$19,327.82"
,MS-DRG,304,HYPERTENSION W MCC,Service Package,Inpatient,,"$23,172.","$6,717.","$22,188.44","$18,537.6","$21,247.04","$12,297.75","$21,721.97","$11,601.53","$22,188.44","$22,187.6","$11,840.41","$6,717.","$17,712.18","$21,318.24"
,MS-DRG,305,HYPERTENSION W/O MCC,Service Package,Inpatient,,"$18,963.4","$3,837.6","$18,396.344","$15,170.72","$17,583.63","$9,948.702","$17,545.148","$9,385.502","$18,396.344","$18,394.518","$8,393.338","$3,837.6","$13,364.744","$17,446.328"
,MS-DRG,306,CARDIAC CONGENITAL & VALVULAR DISORDERS W MCC,Service Package,Inpatient,,"$14,066.","$2,025.","$13,618.72","$11,252.8","$13,017.69","$7,317.63","$12,936.21","$6,903.36","$13,618.72","$13,617.5","$4,520.54","$2,025.","$9,665.63","$12,940.72"
,MS-DRG,308,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W MCC,Service Package,Inpatient,,"$24,314.7143","$6,982.5","$23,318.2814","$19,451.7714","$22,314.1857","$12,907.6729","$22,768.4529","$12,176.9129","$23,318.2814","$23,317.23","$12,966.37","$6,982.5","$13,936.8186","$22,369.5371"
,MS-DRG,309,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W CC,Service Package,Inpatient,,"$22,798.7371","$6,976.0714","$21,833.4657","$18,238.9897","$20,914.5729","$12,088.55","$21,358.1186","$11,404.14","$21,833.4657","$21,832.6286","$12,310.5786","$6,976.0714","$15,154.4986","$20,974.8386"
,MS-DRG,310,CARDIAC ARRHYTHMIA & CONDUCTION DISORDERS W/O CC/MCC,Service Package,Inpatient,,"$12,609.5","$3,117.75","$12,173.9175","$10,087.6","$11,602.8875","$6,600.9525","$11,644.96","$6,227.27","$12,173.9175","$12,172.985","$6,353.5575","$3,117.75","$7,810.8575","$11,600.74"
,MS-DRG,311,ANGINA PECTORIS,Service Package,Inpatient,,"$19,195.3333","$3,988.5","$18,352.26","$15,356.2667","$17,566.2","$10,215.16","$18,024.5733","$9,636.9133","$18,352.26","$18,351.7","$6,555.3367","$3,988.5","$12,389.4067","$17,659.7067"
,MS-DRG,312,SYNCOPE & COLLAPSE,Service Package,Inpatient,,"$22,800.3077","$5,168.9965","$21,876.8485","$18,240.2462","$20,922.8492","$12,064.5754","$21,299.3069","$11,381.5038","$21,876.8485","$21,875.8123","$8,521.3592","$5,168.9965","$17,843.5269","$20,976.2831"
,MS-DRG,313,CHEST PAIN,Service Package,Inpatient,,"$24,785.","$6,075.","$23,720.79","$19,828.","$22,702.02","$13,161.32","$23,229.26","$12,416.03","$23,720.79","$23,719.95","$12,005.41","$6,075.","$18,824.33","$22,802.2"
,MS-DRG,314,OTHER CIRCULATORY SYSTEM DIAGNOSES W MCC,Service Package,Inpatient,,"$34,585.375","$16,192.6444","$33,142.045","$27,668.3","$31,679.51","$18,411.815","$32,475.6125","$17,369.3963","$33,142.045","$33,140.6762","$20,364.1975","$16,192.6444","$17,952.4138","$31,818.545"
,MS-DRG,315,OTHER CIRCULATORY SYSTEM DIAGNOSES W CC,Service Package,Inpatient,,"$20,309.76","$4,192.395","$19,488.9712","$16,247.808","$18,645.4275","$10,768.5888","$19,020.7363","$10,158.8262","$19,488.9712","$19,488.0375","$9,417.9175","$4,192.395","$12,862.6275","$18,684.9787"
,MS-DRG,316,OTHER CIRCULATORY SYSTEM DIAGNOSES W/O CC/MCC,Service Package,Inpatient,,"$22,384.","$4,050.","$21,439.84","$17,907.2","$20,517.11","$11,867.66","$20,948.31","$11,195.75","$21,439.84","$21,439.","$10,295.41","$4,050.","$14,935.04","$20,593.28"
,MS-DRG,326,"""STOMACH, ESOPHAGEAL & DUODENAL PROC W MCC""",Service Package,Inpatient,,"$143,604.","$65,140.49","$136,598.84","$114,883.2","$130,849.61","$77,190.91","$136,141.71","$72,820.41","$136,598.84","$136,598.","$65,140.49","$97,674.25","$120,700.48","$132,115.68"
,MS-DRG,328,"""STOMACH, ESOPHAGEAL & DUODENAL PROC W/O CC/MCC""",Service Package,Inpatient,,"$19,046.","$6,853.","$18,268.74","$15,236.8","$17,768.47","$10,023.7","$18,013.38","$9,456.26","$18,268.74","$18,267.9","$10,233.31","$6,853.","$14,024.63","$17,522.32"
,MS-DRG,329,MAJOR SMALL & LARGE BOWEL PROCEDURES W MCC,Service Package,Inpatient,,"$71,088.77","$32,119.5967","$67,804.55","$56,871.016","$64,978.0608","$38,062.72","$67,211.5825","$35,907.8142","$67,804.55","$67,803.2583","$32,119.5967","$40,493.0525","$44,943.3842","$65,401.6683"
,MS-DRG,330,MAJOR SMALL & LARGE BOWEL PROCEDURES W CC,Service Package,Inpatient,,"$43,371.2222","$18,076.3606","$41,270.3544","$34,696.9778","$39,527.48","$23,306.555","$41,105.4861","$21,987.0656","$41,270.3544","$41,270.03","$18,076.3606","$18,961.2342","$29,391.7044","$39,901.5244"
,MS-DRG,331,MAJOR SMALL & LARGE BOWEL PROCEDURES W/O CC/MCC,Service Package,Inpatient,,"$46,042.0833","$15,910.775","$43,798.3258","$36,833.6667","$41,972.7808","$24,738.1717","$43,654.2775","$23,337.6508","$43,798.3258","$43,798.0458","$15,910.775","$20,607.5106","$32,720.675","$42,358.7167"
,MS-DRG,335,PERITONEAL ADHESIOLYSIS W MCC,Service Package,Inpatient,,"$85,954.6933","$43,442.4367","$81,912.8133","$68,763.7547","$78,686.62","$46,049.42","$81,482.26","$43,442.4367","$81,912.8133","$81,911.5867","$45,784.3767","$52,441.935","$58,233.5867","$79,078.3167"
,MS-DRG,336,PERITONEAL ADHESIOLYSIS W CC,Service Package,Inpatient,,"$52,937.6667","$24,022.94","$50,517.3767","$42,350.1333","$48,372.89","$28,294.2967","$49,927.2567","$26,692.56","$50,517.3767","$50,516.29","$25,783.45","$24,022.94","$38,669.2467","$48,702.6533"
,MS-DRG,337,PERITONEAL ADHESIOLYSIS W/O CC/MCC,Service Package,Inpatient,,"$39,119.3333","$13,533.97","$37,364.88","$31,295.4667","$35,858.2917","$20,868.0683","$36,904.795","$19,686.615","$37,364.88","$37,363.9133","$13,533.97","$15,733.91","$29,122.2","$35,989.7867"
,MS-DRG,339,APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W CC,Service Package,Inpatient,,"$50,393.","$20,063.74","$48,129.37","$40,314.4","$46,075.26","$26,889.9","$47,446.86","$25,367.48","$48,129.37","$48,128.15","$20,063.74","$22,742.4025","$34,546.02","$46,361.56"
,MS-DRG,340,APPENDECTOMY W COMPLICATED PRINCIPAL DIAG W/O CC/MCC,Service Package,Inpatient,,"$51,695.25","$17,465.1325","$49,305.7725","$41,356.2","$47,277.81","$27,632.75","$48,823.17","$26,068.33","$49,305.7725","$49,304.8375","$17,465.1325","$25,632.4375","$43,551.795","$47,559.63"
,MS-DRG,342,APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W CC,Service Package,Inpatient,,"$43,853.","$15,941.15","$42,091.41","$35,082.4","$40,271.53","$23,173.98","$40,917.37","$21,861.95","$42,091.41","$42,089.35","$15,941.15","$19,033.","$33,123.62","$40,344.76"
,MS-DRG,343,APPENDECTOMY W/O COMPLICATED PRINCIPAL DIAG W/O CC/MCC,Service Package,Inpatient,,"$44,890.","$16,860.32","$42,901.52","$35,912.","$41,067.53","$23,928.06","$42,219.01","$22,573.235","$42,901.52","$42,900.3","$16,860.32","$16,884.565","$27,170.41","$41,298.8"
,MS-DRG,345,MINOR SMALL & LARGE BOWEL PROCEDURES W CC,Service Package,Inpatient,,"$69,263.","$34,923.35","$66,008.8","$55,410.4","$63,819.13","$37,019.47","$66,008.8","$34,923.35","$65,974.89","$65,974.05","$53,645.52","$40,501.","$41,271.94","$63,721.96"
,MS-DRG,352,INGUINAL & FEMORAL HERNIA PROCEDURES W/O CC/MCC,Service Package,Inpatient,,"$43,809.","$18,114.955","$41,874.57","$35,047.2","$40,083.82","$23,345.54","$41,192.06","$22,023.94","$41,874.57","$41,873.35","$18,978.74","$18,114.955","$30,272.2","$40,304.28"
,MS-DRG,354,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL W CC,Service Package,Inpatient,,"$52,530.5","$19,049.18","$50,183.51","$42,024.4","$48,319.175","$28,081.91","$49,857.055","$26,492.115","$50,183.51","$50,182.175","$19,049.18","$24,828.4938","$37,281.48","$48,328.06"
,MS-DRG,355,HERNIA PROCEDURES EXCEPT INGUINAL & FEMORAL W/O CC/MCC,Service Package,Inpatient,,"$38,529.16","$14,506.12","$36,777.74","$30,823.328","$35,209.21","$20,566.37","$36,286.22","$19,401.89","$36,777.74","$36,776.9","$15,000.81","$14,506.12","$28,491.37","$35,446.83"
,MS-DRG,357,OTHER DIGESTIVE SYSTEM O.R. PROCEDURES W CC,Service Package,Inpatient,,"$52,657.","$25,436.455","$50,280.17","$42,125.6","$48,135.5","$28,109.63","$49,597.66","$26,518.37","$50,280.17","$50,278.95","$28,303.02","$25,436.455","$35,312.04","$48,444.44"
,MS-DRG,368,MAJOR ESOPHAGEAL DISORDERS W MCC,Service Package,Inpatient,,"$50,824.5","$22,684.79","$48,539.295","$40,659.6","$46,631.67","$27,094.635","$47,985.385","$25,560.645","$48,539.295","$48,538.075","$24,574.08","$23,432.2612","$22,684.79","$46,758.54"
,MS-DRG,369,MAJOR ESOPHAGEAL DISORDERS W CC,Service Package,Inpatient,,"$47,177.","$19,321.575","$45,190.75","$37,741.6","$43,945.49","$25,096.04","$45,190.75","$23,675.23","$44,993.19","$44,992.35","$31,552.45","$19,321.575","$34,207.46","$43,402.84"
,MS-DRG,371,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W MCC,Service Package,Inpatient,,"$26,415.","$8,007.3125","$25,456.52","$21,132.","$24,316.6067","$13,967.4467","$24,620.78","$13,176.5667","$25,456.52","$25,454.7833","$15,702.8667","$8,007.3125","$17,290.21","$24,301.8"
,MS-DRG,372,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W CC,Service Package,Inpatient,,"$19,280.","$6,581.25","$18,528.135","$15,424.","$17,731.7025","$10,187.4575","$17,971.4575","$9,610.5675","$18,528.135","$18,527.12","$13,377.7875","$6,581.25","$10,446.9675","$17,737.6"
,MS-DRG,373,MAJOR GASTROINTESTINAL DISORDERS & PERITONEAL INFECTIONS W/O CC/MCC,Service Package,Inpatient,,"$27,226.25","$7,489.3125","$26,060.2225","$21,781.","$25,017.445","$14,449.615","$25,585.6375","$13,631.47","$26,060.2225","$26,059.2875","$10,395.46","$7,489.3125","$19,740.2575","$25,048.15"
,MS-DRG,374,DIGESTIVE MALIGNANCY W MCC,Service Package,Inpatient,,"$18,970.","$4,050.","$18,196.54","$15,176.","$17,476.07","$10,047.23","$17,808.63","$9,478.41","$18,196.54","$18,195.7","$8,276.62","$4,050.","$12,882.24","$17,452.4"
,MS-DRG,375,DIGESTIVE MALIGNANCY W CC,Service Package,Inpatient,,"$15,913.","$6,075.","$15,292.39","$12,730.4","$14,628.5","$8,381.21","$14,800.86","$7,906.73","$15,292.39","$15,291.55","$11,976.41","$6,075.","$8,940.55","$14,639.96"
,MS-DRG,377,G.I. HEMORRHAGE W MCC,Service Package,Inpatient,,"$39,380.7778","$16,922.0225","$37,644.8322","$31,504.6222","$36,200.55","$20,971.33","$37,190.9311","$19,783.9211","$37,644.8322","$37,643.7167","$20,862.9289","$16,922.0225","$19,789.5522","$36,230.3156"
,MS-DRG,378,G.I. HEMORRHAGE W CC,Service Package,Inpatient,,"$22,642.4987","$5,354.0465","$21,689.068","$18,113.9989","$20,759.336","$12,006.7127","$21,194.0093","$11,326.946","$21,689.068","$21,688.2133","$8,607.0727","$5,354.0465","$14,703.2793","$20,831.0987"
,MS-DRG,379,G.I. HEMORRHAGE W/O CC/MCC,Service Package,Inpatient,,"$13,960.","$2,025.","$13,437.04","$11,168.","$12,851.27","$7,330.06","$12,945.51","$6,915.055","$13,437.04","$13,436.2","$5,327.07","$2,025.","$11,270.69","$12,843.2"
,MS-DRG,380,COMPLICATED PEPTIC ULCER W MCC,Service Package,Inpatient,,"$45,543.2","$21,339.566","$43,501.166","$36,434.56","$41,785.448","$24,308.37","$43,045.916","$22,932.118","$43,501.166","$43,500.04","$21,339.566","$21,813.765","$29,774.254","$41,899.744"
,MS-DRG,381,COMPLICATED PEPTIC ULCER W CC,Service Package,Inpatient,,"$30,100.","$4,249.9425","$28,770.04","$24,080.","$27,538.67","$16,026.99","$28,278.51","$15,119.56","$28,770.04","$28,769.2","$9,316.41","$4,249.9425","$21,179.76","$27,692."
,MS-DRG,386,INFLAMMATORY BOWEL DISEASE W CC,Service Package,Inpatient,,"$37,089.6667","$13,988.25","$35,518.03","$29,671.7333","$34,308.82","$19,681.8533","$35,064.22","$18,567.4433","$35,518.03","$35,516.6767","$15,705.7133","$13,988.25","$24,139.72","$34,122.4933"
,MS-DRG,387,INFLAMMATORY BOWEL DISEASE W/O CC/MCC,Service Package,Inpatient,,"$17,129.5","$4,050.","$16,448.065","$13,703.6","$15,735.515","$9,037.715","$15,956.535","$8,526.01","$16,448.065","$16,447.225","$8,694.91","$4,050.","$10,069.08","$15,759.14"
,MS-DRG,388,G.I. OBSTRUCTION W MCC,Service Package,Inpatient,,"$27,890.3","$10,041.4185","$26,799.409","$22,312.24","$25,738.344","$14,764.201","$26,159.161","$13,928.264","$26,799.409","$26,797.957","$16,430.163","$10,041.4185","$16,323.713","$25,659.076"
,MS-DRG,389,G.I. OBSTRUCTION W CC,Service Package,Inpatient,,"$24,773.6316","$9,586.9232","$23,763.3926","$19,818.9053","$22,817.8089","$13,123.8521","$23,257.1068","$12,380.8405","$23,763.3926","$23,762.2995","$14,760.4563","$9,586.9232","$15,532.8168","$22,791.7411"
,MS-DRG,390,G.I. OBSTRUCTION W/O CC/MCC,Service Package,Inpatient,,"$16,167.4737","$3,347.1316","$15,558.3095","$12,933.9789","$14,930.0216","$8,509.6453","$15,077.9621","$8,027.8858","$15,558.3095","$15,557.3568","$7,096.3247","$3,347.1316","$11,196.5368","$14,874.0758"
,MS-DRG,391,"""ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W MCC""",Service Package,Inpatient,,"$27,226.5714","$8,186.3132","$26,076.4829","$21,781.2571","$24,954.9686","$14,442.7314","$25,490.4043","$13,624.9814","$26,076.4829","$26,075.4714","$14,281.8","$8,186.3132","$17,761.1471","$25,048.4457"
,MS-DRG,392,"""ESOPHAGITIS, GASTROENT & MISC DIGEST DISORDERS W/O MCC""",Service Package,Inpatient,,"$20,917.7407","$5,488.6456","$20,042.7315","$16,734.1926","$19,249.0141","$11,073.1233","$19,619.7815","$10,446.1544","$20,042.7315","$20,041.913","$10,820.6793","$5,488.6456","$12,740.0896","$19,244.3215"
,MS-DRG,393,OTHER DIGESTIVE SYSTEM DIAGNOSES W MCC,Service Package,Inpatient,,"$23,914.816","$6,845.6385","$22,930.688","$19,131.8528","$22,001.046","$12,691.722","$22,468.764","$11,973.118","$22,930.688","$22,929.676","$12,505.188","$6,845.6385","$14,441.148","$22,001.63"
,MS-DRG,394,OTHER DIGESTIVE SYSTEM DIAGNOSES W CC,Service Package,Inpatient,,"$29,036.","$6,753.6056","$27,779.485","$23,228.8","$26,587.92","$15,436.295","$27,240.21","$14,562.395","$27,779.485","$27,778.55","$9,943.6475","$6,753.6056","$17,496.83","$26,713.12"
,MS-DRG,395,OTHER DIGESTIVE SYSTEM DIAGNOSES W/O CC/MCC,Service Package,Inpatient,,"$17,459.","$5,062.5","$16,801.58","$13,967.2","$16,136.04","$9,199.385","$16,318.18","$8,678.555","$16,801.58","$16,800.55","$9,917.87","$5,062.5","$7,885.61","$16,062.28"
,MS-DRG,405,"""PANCREAS, LIVER & SHUNT PROCEDURES W MCC""",Service Package,Inpatient,,"$68,408.","$34,775.68","$65,012.66","$54,726.4","$62,264.13","$36,862.37","$65,012.66","$34,775.68","$64,987.6","$64,987.6","$40,320.","$40,798.75","$42,875.36","$62,935.36"
,MS-DRG,417,LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W MCC,Service Package,Inpatient,,"$60,275.","$23,883.","$57,436.29","$48,220.","$54,997.92","$32,284.7","$56,944.76","$30,456.73","$57,436.29","$57,435.45","$23,883.","$30,964.1425","$38,402.32","$55,453."
,MS-DRG,418,LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W CC,Service Package,Inpatient,,"$43,429.7778","$14,669.1211","$41,433.0378","$34,743.8222","$39,668.79","$23,209.3867","$40,943.8044","$21,895.36","$41,433.0378","$41,432.2","$14,669.1211","$18,046.1483","$26,644.2022","$39,955.3956"
,MS-DRG,419,LAPAROSCOPIC CHOLECYSTECTOMY W/O C.D.E. W/O CC/MCC,Service Package,Inpatient,,"$29,617.5","$9,425.5","$28,311.665","$23,694.","$27,099.595","$15,767.04","$27,820.135","$14,874.385","$28,311.665","$28,310.825","$9,943.91","$9,425.5","$21,456.72","$27,248.1"
,MS-DRG,432,CIRRHOSIS & ALCOHOLIC HEPATITIS W MCC,Service Package,Inpatient,,"$30,565.27","$13,990.3125","$29,505.165","$24,452.216","$28,296.5175","$16,149.995","$28,661.655","$15,235.6175","$29,505.165","$29,502.9275","$22,332.6275","$13,990.3125","$16,056.86","$28,120.0475"
,MS-DRG,433,CIRRHOSIS & ALCOHOLIC HEPATITIS W CC,Service Package,Inpatient,,"$30,377.032","$12,289.203","$29,163.005","$24,301.6256","$27,902.603","$16,116.483","$28,471.744","$15,203.989","$29,163.005","$29,161.548","$15,257.671","$12,289.203","$20,044.485","$27,946.869"
,MS-DRG,435,MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS W MCC,Service Package,Inpatient,,"$63,010.","$31,763.59","$60,276.98","$50,408.","$57,720.32","$33,669.69","$59,373.23","$31,763.59","$60,276.98","$60,274.98","$34,682.17","$36,645.","$42,830.4","$57,969.2"
,MS-DRG,438,DISORDERS OF PANCREAS EXCEPT MALIGNANCY W MCC,Service Package,Inpatient,,"$41,390.7143","$17,241.5657","$39,577.1271","$33,112.5714","$37,882.89","$22,056.9086","$38,910.4171","$20,808.0514","$39,577.1271","$39,575.9043","$19,120.8671","$17,241.5657","$28,142.8371","$38,079.4570999999"
,MS-DRG,439,DISORDERS OF PANCREAS EXCEPT MALIGNANCY W CC,Service Package,Inpatient,,"$23,933.4545","$7,573.5095","$22,949.5818","$19,146.7636","$22,004.4127","$12,658.5827","$22,396.3073","$11,941.8718","$22,949.5818","$22,948.5636","$14,168.69","$7,573.5095","$14,333.6582","$22,018.7782"
,MS-DRG,440,DISORDERS OF PANCREAS EXCEPT MALIGNANCY W/O CC/MCC,Service Package,Inpatient,,"$15,587.4533","$4,275.","$15,001.1167","$12,469.9627","$14,399.9056","$8,183.8456","$14,510.4678","$7,720.4922","$15,001.1167","$15,000.1922","$9,574.5333","$4,275.","$9,317.67","$14,340.4567"
,MS-DRG,441,"""DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W MCC""",Service Package,Inpatient,,"$31,108.27","$12,188.3512","$29,788.6325","$24,886.616","$28,508.665","$16,517.5075","$29,153.8675","$15,582.4425","$29,788.6325","$29,787.5075","$15,523.7175","$12,188.3512","$20,285.765","$28,619.6075"
,MS-DRG,442,"""DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W CC""",Service Package,Inpatient,,"$22,858.6","$9,456.","$21,887.57","$18,286.88","$20,952.844","$12,125.534","$21,402.328","$11,439.052","$21,887.57","$21,886.75","$16,789.34","$9,456.","$10,165.474","$21,029.912"
,MS-DRG,443,"""DISORDERS OF LIVER EXCEPT MALIG,CIRR,ALC HEPA W/O CC/MCC""",Service Package,Inpatient,,"$13,375.","$4,050.","$12,881.29","$10,700.","$12,318.92","$7,015.89","$12,389.76","$6,618.71","$12,881.29","$12,880.45","$7,958.41","$4,050.","$5,607.04","$12,305."
,MS-DRG,446,DISORDERS OF THE BILIARY TRACT W/O CC/MCC,Service Package,Inpatient,,"$15,065.","$2,025.","$14,567.77","$12,052.","$14,015.44","$7,840.18","$13,952.5","$7,396.3","$14,567.77","$14,566.55","$4,923.11","$2,025.","$7,423.68","$13,859.8"
,MS-DRG,463,"""WND DEBRID & SKN GRFT EXC HAND, FOR MUSCULO-CONN TISS DIS W MCC""",Service Package,Inpatient,,"$32,812.","$14,509.","$31,346.44","$26,249.6","$30,006.59","$17,486.09","$30,854.91","$16,495.8","$31,346.44","$31,345.6","$27,776.51","$14,509.","$17,181.94","$30,187.04"
,MS-DRG,469,MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W MCC,Service Package,Inpatient,,"$70,662.","$1,457.0575","$67,319.0925","$56,529.6","$64,484.2925","$37,876.795","$66,846.175","$35,732.5525","$67,319.0925","$67,318.18","$1,457.0575","$41,316.3675","$50,963.9475","$65,009.04"
,MS-DRG,470,MAJOR JOINT REPLACEMENT OR REATTACHMENT OF LOWER EXTREMITY W/O MCC,Service Package,Inpatient,,"$68,070.","$24,599.6083","$64,803.9178","$54,456.","$62,080.927","$36,532.5283","$64,456.6009","$34,464.4639","$64,803.9178","$64,803.26","$24,599.6083","$38,994.3705","$51,522.7022","$62,624.4"
,MS-DRG,477,BIOPSIES OF MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W MCC,Service Package,Inpatient,,"$57,433.","$18,056.","$54,736.39","$45,946.4","$52,411.7","$30,751.27","$54,244.86","$29,010.47","$54,736.39","$54,735.55","$18,056.","$28,693.7425","$38,216.64","$52,838.36"
,MS-DRG,480,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W MCC,Service Package,Inpatient,,"$58,990.1111","$22,751.8611","$56,224.3522","$47,192.0889","$53,836.4667","$31,584.6789","$55,713.8989","$29,796.5478","$56,224.3522","$56,223.4722","$22,751.8611","$30,561.2617","$41,009.3467","$54,270.9022"
,MS-DRG,481,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W CC,Service Package,Inpatient,,"$55,521.","$19,509.0086","$52,954.8452","$44,416.8","$50,714.7419","$29,697.1786","$52,408.7095","$28,015.9595","$52,954.8452","$52,953.8414","$19,509.0086","$27,980.7579","$36,880.7586","$51,079.32"
,MS-DRG,482,HIP & FEMUR PROCEDURES EXCEPT MAJOR JOINT W/O CC/MCC,Service Package,Inpatient,,"$48,673.52","$16,919.4373","$46,464.3273","$38,938.816","$44,483.24","$25,995.3691","$45,868.4282","$24,523.7582","$46,464.3273","$46,463.2555","$16,919.4373","$21,808.4916","$34,739.7291","$44,779.6373"
,MS-DRG,483,MAJOR JOINT/LIMB REATTACHMENT PROCEDURE OF UPPER EXTREMITIES,Service Package,Inpatient,,"$70,854.6667","$7,466.6667","$67,311.9333","$56,683.7333","$64,477.7467","$38,174.8867","$67,311.9333","$36,013.9133","$67,311.9333","$67,311.9333","$7,466.6667","$38,352.75","$59,040.96","$65,186.2933"
,MS-DRG,489,KNEE PROCEDURES W/O PDX OF INFECTION W/O CC/MCC,Service Package,Inpatient,,"$60,242.","$8,960.","$57,229.9","$48,193.6","$54,820.22","$32,457.01","$57,229.9","$30,619.79","$57,229.9","$57,229.9","$8,960.","$31,324.75","$49,404.96","$55,422.64"
,MS-DRG,493,"""LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W CC""",Service Package,Inpatient,,"$64,653.","$20,451.015","$61,595.39","$51,722.4","$58,981.9","$34,608.5725","$61,044.3575","$32,649.34","$61,595.39","$61,594.55","$20,451.015","$34,691.6087","$47,720.7475","$59,480.76"
,MS-DRG,494,"""LOWER EXTREM & HUMER PROC EXCEPT HIP,FOOT,FEMUR W/O CC/MCC""",Service Package,Inpatient,,"$59,483.3333","$8,487.43","$56,642.4067","$47,586.6667","$54,205.0267","$31,928.96","$56,300.3133","$30,121.5133","$56,642.4067","$56,641.7667","$8,487.43","$30,014.0025","$49,031.8367","$54,724.6667"
,MS-DRG,500,SOFT TISSUE PROCEDURES W MCC,Service Package,Inpatient,,"$56,943.04","$26,312.465","$54,584.165","$45,554.432","$52,241.13","$30,399.155","$53,537.985","$28,678.115","$54,584.165","$54,581.83","$38,852.37","$33,632.1513","$26,312.465","$52,387.595"
,MS-DRG,504,FOOT PROCEDURES W CC,Service Package,Inpatient,,"$29,762.","$13,853.95","$28,468.535","$23,809.6","$27,379.77","$15,826.15","$28,098.85","$14,929.935","$28,468.535","$28,467.6","$27,327.71","$14,509.","$13,853.95","$27,381.04"
,MS-DRG,505,FOOT PROCEDURES W/O CC/MCC,Service Package,Inpatient,,"$27,200.","$10,681.","$26,015.04","$21,760.","$24,899.67","$14,464.47","$25,523.51","$13,645.28","$26,015.04","$26,014.2","$19,265.41","$10,681.","$14,372.72","$25,024."
,MS-DRG,509,ARTHROSCOPY,Service Package,Inpatient,,"$30,362.","$4,512.98","$28,843.9","$24,289.6","$27,629.42","$16,358.35","$28,843.9","$15,432.37","$28,843.9","$28,843.9","$4,512.98","$8,436.25","$24,876.72","$27,933.04"
,MS-DRG,511,"""SHOULDER,ELBOW OR FOREARM PROC,EXC MAJOR JOINT PROC W CC""",Service Package,Inpatient,,"$41,157.","$11,717.16","$39,274.19","$32,925.6","$37,695.67","$21,885.35","$38,573.93","$20,646.5","$39,274.19","$39,273.35","$11,717.16","$16,641.1","$32,012.51","$37,864.44"
,MS-DRG,517,OTHER MUSCULOSKELET SYS & CONN TISS O.R. PROC W/O CC/MCC,Service Package,Inpatient,,"$31,788.","$8,848.0525","$30,373.64","$25,430.4","$29,074.75","$16,936.41","$29,882.11","$15,977.59","$30,373.64","$30,372.8","$14,044.41","$8,848.0525","$21,750.89","$29,244.96"
,MS-DRG,535,FRACTURES OF HIP & PELVIS W MCC,Service Package,Inpatient,,"$75,600.","$23,371.46","$72,404.16","$60,480.","$69,186.67","$40,192.87","$70,913.77","$37,917.35","$72,404.16","$72,401.36","$23,371.46","$42,110.37","$62,267.06","$69,552."
,MS-DRG,536,FRACTURES OF HIP & PELVIS W/O MCC,Service Package,Inpatient,,"$16,112.8","$6,885.","$15,568.412","$12,890.24","$14,884.422","$8,448.992","$14,916.412","$7,970.652","$15,568.412","$15,567.16","$13,035.906","$6,885.","$7,473.932","$14,823.776"
,MS-DRG,539,OSTEOMYELITIS W MCC,Service Package,Inpatient,,"$80,907.","$37,336.04","$76,953.09","$64,725.6","$73,754.68","$43,489.26","$76,717.39","$41,026.5","$76,953.09","$76,952.65","$60,144.51","$53,210.25","$37,336.04","$74,434.44"
,MS-DRG,543,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG W CC,Service Package,Inpatient,,"$15,781.75","$5,062.5","$15,264.6225","$12,625.4","$14,593.5675","$8,274.555","$14,623.31","$7,806.08","$15,264.6225","$15,263.3225","$10,598.7075","$5,062.5","$8,968.2675","$14,519.21"
,MS-DRG,544,PATHOLOGICAL FRACTURES & MUSCULOSKELET & CONN TISS MALIG W/O CC/MCC,Service Package,Inpatient,,"$22,197.","$6,075.","$21,262.19","$17,757.6","$20,346.94","$11,769.","$20,770.66","$11,102.55","$21,262.19","$21,261.35","$11,935.81","$6,075.","$14,145.51","$20,421.24"
,MS-DRG,545,CONNECTIVE TISSUE DISORDERS W MCC,Service Package,Inpatient,,"$22,965.","$6,075.","$21,991.79","$18,372.","$21,045.82","$12,182.79","$21,500.26","$11,493.04","$21,991.79","$21,990.95","$11,534.57","$6,075.","$14,280.21","$21,127.8"
,MS-DRG,549,SEPTIC ARTHRITIS W CC,Service Package,Inpatient,,"$24,602.","$8,100.","$23,639.42","$19,681.6","$22,535.49","$12,991.7","$22,918.66","$12,256.03","$23,639.42","$23,638.14","$17,070.41","$8,100.","$11,675.28","$22,633.84"
,MS-DRG,552,MEDICAL BACK PROBLEMS W/O MCC,Service Package,Inpatient,,"$22,547.51","$4,050.","$21,635.665","$18,038.008","$20,700.885","$11,922.595","$21,048.645","$11,247.45","$21,635.665","$21,634.635","$8,519.055","$4,050.","$16,168.46","$20,743.71"
,MS-DRG,553,BONE DISEASES & ARTHROPATHIES W MCC,Service Package,Inpatient,,"$25,204.","$6,075.","$24,118.84","$20,163.2","$23,083.31","$13,387.13","$23,627.31","$12,629.1","$24,118.84","$24,118.","$12,853.73","$6,075.","$21,735.98","$23,187.68"
,MS-DRG,557,"""TENDONITIS, MYOSITIS & BURSITIS W MCC""",Service Package,Inpatient,,"$23,411.","$9,112.5","$22,469.31","$18,728.8","$21,498.035","$12,406.91","$21,903.265","$11,704.315","$22,469.31","$22,468.21","$18,025.91","$9,112.5","$10,405.57","$21,538.12"
,MS-DRG,558,"""TENDONITIS, MYOSITIS & BURSITIS W/O MCC""",Service Package,Inpatient,,"$16,561.8","$5,670.","$15,938.426","$13,249.44","$15,379.77","$8,719.994","$15,520.43","$8,226.252","$15,938.426","$15,937.446","$11,600.854","$5,670.","$7,670.206","$15,236.856"
,MS-DRG,560,"""AFTERCARE, MUSCULOSKELETAL SYSTEM & CONNECTIVE TISSUE W CC""",Service Package,Inpatient,,"$19,889.","$6,075.","$19,610.33","$15,911.2","$18,246.66","$10,523.36","$18,578.06","$9,927.53","$19,069.59","$19,068.75","$11,716.27","$6,075.","$19,610.33","$18,297.88"
,MS-DRG,563,"""FX, SPRN, STRN & DISL EXCEPT FEMUR, HIP, PELVIS & THIGH W/O MCC""",Service Package,Inpatient,,"$18,839.","$6,075.","$18,482.515","$15,071.2","$17,525.05","$9,775.515","$17,213.09","$9,222.04","$18,482.515","$18,479.71","$12,152.275","$6,075.","$10,102.035","$17,331.88"
,MS-DRG,564,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W MCC,Service Package,Inpatient,,"$22,135.","$2,346.","$21,456.17","$17,708.","$20,360.48","$11,485.19","$20,232.49","$10,834.98","$21,456.17","$21,454.13","$7,052.26","$2,346.","$20,263.89","$20,364.2"
,MS-DRG,565,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W CC,Service Package,Inpatient,,"$20,816.448","$5,265.","$19,989.224","$16,653.1584","$19,361.13","$10,973.064","$19,639.156","$10,351.74","$19,989.224","$19,988.202","$10,972.696","$5,265.","$14,385.284","$19,151.132"
,MS-DRG,566,OTHER MUSCULOSKELETAL SYS & CONNECTIVE TISSUE DIAGNOSES W/O CC/MCC,Service Package,Inpatient,,"$35,060.75","$14,045.765","$33,374.3325","$28,048.6","$31,961.6775","$18,813.495","$33,181.48","$17,748.4275","$33,374.3325","$33,374.0125","$14,045.765","$17,643.8419","$25,488.6","$32,255.89"
,MS-DRG,571,SKIN DEBRIDEMENT W CC,Service Package,Inpatient,,"$33,612.","$9,552.2575","$32,187.42","$26,889.6","$30,804.55","$17,851.6","$31,504.91","$16,840.93","$32,187.42","$32,186.2","$15,417.74","$9,552.2575","$23,560.22","$30,923.04"
,MS-DRG,581,"""OTHER SKIN, SUBCUT TISS & BREAST PROC W/O CC/MCC""",Service Package,Inpatient,,"$40,587.","$15,469.17","$38,975.13","$32,469.6","$37,289.69","$21,572.2","$38,021.26","$20,351.07","$38,975.13","$38,973.13","$15,469.17","$17,062.","$28,157.28","$37,340.04"
,MS-DRG,593,SKIN ULCERS W CC,Service Package,Inpatient,,"$17,186.","$4,050.","$16,582.72","$13,748.8","$15,856.89","$8,998.67","$15,900.21","$8,489.15","$16,582.72","$16,581.5","$8,743.34","$4,050.","$10,584.2","$15,811.12"
,MS-DRG,596,MAJOR SKIN DISORDERS W/O MCC,Service Package,Inpatient,,"$19,667.","$4,050.","$18,858.69","$15,733.6","$18,311.68","$10,362.93","$18,586.84","$9,776.08","$18,858.69","$18,857.85","$8,965.89","$4,050.","$14,020.05","$18,093.64"
,MS-DRG,602,CELLULITIS W MCC,Service Package,Inpatient,,"$27,217.75","$8,184.4116","$26,146.0013","$21,774.2","$25,018.11","$14,432.1975","$25,444.2888","$13,615.0312","$26,146.0013","$26,144.6175","$16,237.31","$8,184.4116","$15,728.6312","$25,040.33"
,MS-DRG,603,CELLULITIS W/O MCC,Service Package,Inpatient,,"$21,190.5484","$7,077.9336","$20,333.701","$16,952.4387","$19,450.9032","$11,212.7035","$19,803.9532","$10,577.7735","$20,333.701","$20,332.7306","$13,815.9606","$7,077.9336","$10,417.6419","$19,495.3045"
,MS-DRG,637,DIABETES W MCC,Service Package,Inpatient,,"$37,044.125","$14,066.3006","$35,407.3863","$29,635.3","$33,900.1062","$19,749.7475","$34,847.9062","$18,631.4725","$35,407.3863","$35,406.3538","$18,691.4437","$14,066.3006","$22,927.6562","$34,080.595"
,MS-DRG,638,DIABETES W CC,Service Package,Inpatient,,"$22,137.3673","$6,416.6455","$21,255.1982","$17,709.8938","$20,329.5273","$11,720.715","$20,685.4786","$11,057.0882","$21,255.1982","$21,254.1227","$12,213.5455","$6,416.6455","$13,999.9823","$20,366.3777"
,MS-DRG,639,DIABETES W/O CC/MCC,Service Package,Inpatient,,"$20,191.6667","$5,594.4167","$19,473.9278","$16,153.3333","$18,625.3189","$10,623.7789","$18,746.2933","$10,022.2578","$19,473.9278","$19,472.5322","$10,041.9467","$5,594.4167","$15,114.0778","$18,576.3333"
,MS-DRG,640,"""MISC DISORDERS OF NUTRITION,METABOLISM,FLUIDS/ELECTROLYTES W MCC""",Service Package,Inpatient,,"$25,169.5714","$8,310.7414","$24,131.3643","$20,135.6571","$23,091.1014","$13,344.2829","$23,554.6386","$12,588.7657","$24,131.3643","$24,130.31","$13,839.83","$8,310.7414","$18,100.3329","$23,156.0057"
,MS-DRG,641,"""MISC DISORDERS OF NUTRITION,METABOLISM,FLUIDS/ELECTROLYTES W/O MCC""",Service Package,Inpatient,,"$28,244.1105","$11,181.7275","$27,043.8167","$22,595.2884","$25,926.0367","$14,987.77","$26,497.7138","$14,139.0686","$27,043.8167","$27,042.8024","$17,522.4867","$11,181.7275","$15,827.9967","$25,984.5814"
,MS-DRG,642,INBORN AND OTHER DISORDERS OF METABOLISM,Service Package,Inpatient,,"$15,082.","$4,050.","$14,502.94","$12,065.6","$13,872.29","$7,933.53","$14,011.41","$7,484.25","$14,502.94","$14,502.1","$8,392.41","$4,050.","$8,825.86","$13,875.44"
,MS-DRG,644,ENDOCRINE DISORDERS W CC,Service Package,Inpatient,,"$19,921.","$6,396.","$19,342.43","$15,936.8","$18,483.63","$10,437.78","$18,388.56","$9,846.87","$19,342.43","$19,340.43","$12,248.17","$6,396.","$12,943.25","$18,327.32"
,MS-DRG,682,RENAL FAILURE W MCC,Service Package,Inpatient,,"$27,174.2778","$11,051.0133","$26,150.7756","$21,739.4222","$25,021.9083","$14,386.3611","$25,418.5578","$13,571.7944","$26,150.7756","$26,149.1728","$18,839.4172","$11,051.0133","$14,797.885","$25,000.3356"
,MS-DRG,683,RENAL FAILURE W CC,Service Package,Inpatient,,"$17,244.2083","$5,697.4372","$16,622.435","$13,795.3667","$15,928.1996","$9,072.2142","$16,075.3371","$8,558.5338","$16,622.435","$16,621.2846","$11,150.5833","$5,697.4372","$9,352.0012","$15,864.6717"
,MS-DRG,684,RENAL FAILURE W/O CC/MCC,Service Package,Inpatient,,"$19,758.","$4,050.","$18,945.14","$15,806.4","$18,127.45","$10,454.945","$18,453.61","$9,863.005","$18,945.14","$18,944.3","$8,720.41","$4,050.","$12,215.35","$18,177.36"
,MS-DRG,689,KIDNEY & URINARY TRACT INFECTIONS W MCC,Service Package,Inpatient,,"$22,622.2353","$7,924.4559","$21,743.3053","$18,097.7882","$20,809.9641","$11,960.7729","$21,126.9153","$11,283.5124","$21,743.3053","$21,742.1","$15,395.2129","$7,924.4559","$12,152.3029","$20,812.4565"
,MS-DRG,690,KIDNEY & URINARY TRACT INFECTIONS W/O MCC,Service Package,Inpatient,,"$18,480.7632","$6,211.77","$17,756.2572","$14,784.6106","$16,987.8144","$9,754.4364","$17,223.6252","$9,202.1024","$17,756.2572","$17,755.3028","$12,165.7856","$6,211.77","$10,299.168","$17,002.302"
,MS-DRG,693,URINARY STONES W/O ESW LITHOTRIPSY W MCC,Service Package,Inpatient,,"$26,964.","$6,075.","$25,790.84","$21,571.2","$24,684.91","$14,335.31","$25,299.31","$13,523.6","$25,790.84","$25,790.","$12,341.41","$6,075.","$17,896.69","$24,806.88"
,MS-DRG,698,OTHER KIDNEY & URINARY TRACT DIAGNOSES W MCC,Service Package,Inpatient,,"$35,867.7143","$18,010.6171","$34,316.3571","$28,694.1714","$32,951.7457","$19,091.5914","$33,804.2964","$18,010.6171","$34,316.3571","$34,315.2","$21,769.7907","$18,137.625","$23,306.4121","$32,998.2971"
,MS-DRG,699,OTHER KIDNEY & URINARY TRACT DIAGNOSES W CC,Service Package,Inpatient,,"$18,656.","$5,265.","$17,900.956","$14,924.8","$17,188.826","$9,856.558","$17,463.722","$9,298.374","$17,900.956","$17,900.104","$11,362.874","$5,265.","$10,035.27","$17,163.52"
,MS-DRG,742,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W CC/MCC,Service Package,Inpatient,,"$43,989.1111","$7,466.6667","$41,795.2244","$35,191.2889","$40,032.9467","$23,701.6033","$41,795.2244","$22,359.8789","$41,789.6556","$41,789.6556","$7,466.6667","$18,900.0833","$34,519.1733","$40,469.9822"
,MS-DRG,743,UTERINE & ADNEXA PROC FOR NON-MALIGNANCY W/O CC/MCC,Service Package,Inpatient,,"$34,366.4","$5,095.026","$32,648.08","$27,493.12","$31,273.424","$18,515.8573","$32,648.08","$17,467.6873","$32,648.08","$32,648.08","$5,095.026","$11,587.8","$27,567.8773","$31,617.088"
,MS-DRG,745,"""D&C, CONIZATION, LAPAROSCOPY & TUBAL INTERRUPTION W/O CC/MCC""",Service Package,Inpatient,,"$29,804.","$8,496.25","$28,488.84","$23,843.2","$27,269.31","$15,865.39","$27,997.31","$14,967.18","$28,488.84","$28,488.","$10,847.41","$8,496.25","$21,479.6","$27,419.68"
,MS-DRG,748,FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,Service Package,Inpatient,,"$18,082.","$4,480.","$17,177.9","$14,465.6","$16,454.62","$9,742.18","$17,177.9","$9,190.69","$17,177.9","$17,177.9","$4,480.","$4,939.","$13,991.12","$16,635.44"
,MS-DRG,754,"""MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM W MCC""",Service Package,Inpatient,,"$27,462.","$6,039.","$26,263.94","$21,969.6","$25,138.09","$14,603.63","$25,772.41","$13,776.8","$26,263.94","$26,263.1","$8,718.41","$6,039.","$19,026.16","$25,265.04"
,MS-DRG,759,"""INFECTIONS, FEMALE REPRODUCTIVE SYSTEM W/O CC/MCC""",Service Package,Inpatient,,"$16,390.6667","$3,375.","$15,785.36","$13,112.5333","$15,347.7367","$8,605.7833","$15,466.41","$8,118.5633","$15,785.36","$15,784.3333","$7,914.2733","$3,375.","$6,356.9067","$15,079.4133"
,MS-DRG,760,MENSTRUAL & OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS W CC/MCC,Service Package,Inpatient,,"$14,237.","$2,025.","$13,616.59","$11,389.6","$13,300.62","$7,514.93","$13,556.39","$7,089.47","$13,616.59","$13,616.15","$5,165.29","$2,025.","$6,947.34","$13,098.04"
,MS-DRG,768,VAGINAL DELIVERY W O.R. PROC EXCEPT STERIL &/OR D&C,Service Package,Inpatient,,"$15,695.625","$7,570.75","$14,910.8438","$12,556.5","$14,283.0187","$8,456.4625","$14,910.8438","$7,977.6862","$14,910.8438","$14,910.8438","$10,640.","$7,570.75","$8,897.79","$14,439.975"
,MS-DRG,769,POSTPARTUM & POST ABORTION DIAGNOSES W O.R. PROCEDURE,Service Package,Inpatient,,"$52,415.","$8,994.41","$49,969.29","$41,932.","$47,845.32","$28,047.77","$49,477.76","$26,459.86","$49,969.29","$49,968.45","$8,994.41","$24,976.","$39,448.32","$48,221.8"
,MS-DRG,770,"""ABORTION W D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY""",Service Package,Inpatient,,"$41,270.","$17,574.25","$39,381.54","$33,016.","$37,703.37","$22,045.05","$38,890.01","$20,797.02","$39,381.54","$39,380.7","$19,191.41","$17,574.25","$26,735.84","$37,968.4"
,MS-DRG,776,POSTPARTUM & POST ABORTION DIAGNOSES W/O O.R. PROCEDURE,Service Package,Inpatient,,"$7,948.5","$3,037.5","$7,555.0837","$6,358.8","$7,236.3475","$4,282.6313","$7,555.0837","$4,040.1338","$7,551.075","$7,551.075","$5,105.6462","$3,037.5","$3,835.2","$7,312.62"
,MS-DRG,784,CESAREAN SECTION W STERILIZATION W CC,Service Package,Inpatient,,"$32,154.25","$9,950.7938","$30,546.5375","$25,723.4","$29,260.3675","$17,324.0025","$30,546.5375","$16,343.235","$30,546.5375","$30,546.5375","$11,467.61","$9,950.7938","$21,099.42","$29,581.91"
,MS-DRG,785,CESAREAN SECTION W STERILIZATION W/O CC/MCC,Service Package,Inpatient,,"$27,133.8","$6,352.2","$25,778.759","$21,707.04","$24,693.948","$14,618.612","$25,778.759","$13,791.028","$25,777.11","$25,777.11","$8,302.308","$6,352.2","$19,334.916","$24,963.096"
,MS-DRG,786,CESAREAN SECTION W/O STERILIZATION W MCC,Service Package,Inpatient,,"$28,308.3846","$9,003.3081","$26,894.5831","$22,646.7077","$25,763.5954","$15,250.8669","$26,894.5831","$14,387.4","$26,892.9654","$26,892.9654","$13,902.0092","$9,003.3081","$17,608.8923","$26,043.7138"
,MS-DRG,787,CESAREAN SECTION W/O STERILIZATION W CC,Service Package,Inpatient,,"$24,261.4167","$6,614.75","$23,048.3458","$19,409.1333","$22,077.8892","$13,071.5108","$23,048.3458","$12,331.4558","$23,048.3458","$23,048.3458","$11,408.3333","$6,614.75","$14,967.48","$22,320.5033"
,MS-DRG,788,CESAREAN SECTION W/O STERILIZATION W/O CC/MCC,Service Package,Inpatient,,"$21,635.2075","$5,365.3281","$20,555.5598","$17,308.166","$19,691.1719","$11,656.3723","$20,555.5598","$10,996.4419","$20,553.4472","$20,553.4472","$8,806.0155","$5,365.3281","$13,660.2083","$19,904.3908999999"
,MS-DRG,789,"""NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY""",Service Package,Inpatient,,"$2,612.6667",$268.4,"$2,612.6667","$2,090.1333","$2,377.5267","$1,407.6467","$2,482.0333","$1,327.97","$2,482.0333","$2,482.0333","$2,612.6667",$617.,$268.4,"$2,403.6533"
,MS-DRG,791,PREMATURITY W MAJOR PROBLEMS,Service Package,Inpatient,,"$4,438.",$772.64,"$4,438.","$3,550.4","$4,038.58","$2,391.08","$4,216.1","$2,255.75","$4,216.1","$4,216.1","$4,438.","$1,234.",$772.64,"$4,082.96"
,MS-DRG,792,PREMATURITY W/O MAJOR PROBLEMS,Service Package,Inpatient,,"$3,887.",$265.76,"$3,887.","$3,109.6","$3,537.17","$2,094.2211","$3,692.65","$1,975.6911","$3,692.65","$3,692.65","$3,887.","$1,390.4444",$265.76,"$3,576.04"
,MS-DRG,793,FULL TERM NEONATE W MAJOR PROBLEMS,Service Package,Inpatient,,"$4,987.",$539.894,"$4,987.","$3,989.6","$4,543.103","$2,685.437","$4,740.82","$2,533.443","$4,737.65","$4,737.65","$4,987.","$1,542.5",$539.894,"$4,588.04"
,MS-DRG,794,NEONATE W OTHER SIGNIFICANT PROBLEMS,Service Package,Inpatient,,"$4,034.8311",$417.7713,"$3,981.8128","$3,227.8648","$3,683.7505","$2,170.5416","$3,826.9469","$2,047.6908","$3,838.0521","$3,838.0283","$3,981.8128","$1,303.9269",$417.7713,"$3,712.0446"
,MS-DRG,795,NORMAL NEWBORN,Service Package,Inpatient,,"$3,466.7864",$316.0644,"$3,465.1962","$2,773.4291","$3,175.7746","$1,861.2499","$3,280.8781","$1,755.9048","$3,302.6543","$3,302.6102","$3,465.1962","$1,128.2476",$316.0644,"$3,189.4435"
,MS-DRG,797,VAGINAL DELIVERY W STERILIZATION/D&C W CC,Service Package,Inpatient,,"$28,098.","$8,100.","$26,693.1","$22,478.4","$25,569.18","$15,138.63","$26,693.1","$14,281.49","$26,693.1","$26,693.1","$11,100.","$8,100.","$17,719.68","$25,850.16"
,MS-DRG,798,VAGINAL DELIVERY W STERILIZATION/D&C WO CC/MCC,Service Package,Inpatient,,"$21,767.3333","$3,753.75","$20,678.9667","$17,413.8667","$19,808.2733","$11,727.76","$20,678.9667","$11,063.8167","$20,678.9667","$20,678.9667","$6,166.6667","$3,753.75","$15,441.6533","$20,025.9467"
,MS-DRG,801,SPLENECTOMY W/O CC/MCC,Service Package,Inpatient,,"$40,973.","$13,440.","$38,924.35","$32,778.4","$37,285.43","$22,075.37","$38,924.35","$20,825.64","$38,924.35","$38,924.35","$13,440.","$16,816.06","$29,827.6","$37,695.16"
,MS-DRG,805,VAGINAL DELIVERY W/O STERILIZATION/D&C W MCC,Service Package,Inpatient,,"$13,490.6667","$4,628.5714","$12,816.1333","$10,792.5333","$12,276.5067","$7,268.4767","$12,816.1333","$6,856.951","$12,816.1333","$12,816.1333","$8,297.369","$4,628.5714","$7,051.0629","$12,411.4133"
,MS-DRG,806,VAGINAL DELIVERY W/O STERILIZATION/D&C W CC,Service Package,Inpatient,,"$13,360.7241","$4,903.9267","$12,694.4986","$10,688.5793","$12,160.8583","$7,197.8274","$12,694.4986","$6,790.2924","$12,692.6879","$12,692.6879","$8,567.0514","$4,903.9267","$6,917.2748","$12,291.8662"
,MS-DRG,807,VAGINAL DELIVERY W/O STERILIZATION/D&C W/O CC/MCC,Service Package,Inpatient,,"$11,298.3974","$3,881.9869","$10,733.8768","$9,038.7179","$10,281.9775","$6,086.8186","$10,732.7266","$5,742.2006","$10,733.8768","$10,733.8749","$6,715.9705","$3,881.9869","$6,194.1987","$10,394.5256"
,MS-DRG,808,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W MCC,Service Package,Inpatient,,"$17,012.","$6,075.","$16,294.64","$13,609.6","$15,593.71","$9,014.23","$15,908.935","$8,503.78","$16,294.64","$16,294.","$12,025.73","$6,075.","$8,436.785","$15,651.04"
,MS-DRG,809,MAJOR HEMATOL/IMMUN DIAG EXC SICKLE CELL CRISIS & COAGUL W CC,Service Package,Inpatient,,"$18,606.5714","$5,866.8214","$17,907.04","$14,885.2571","$17,127.91","$9,792.4829","$17,293.8529","$9,237.9514","$17,907.04","$17,905.9343","$12,067.3143","$5,866.8214","$9,827.9814","$17,118.0457"
,MS-DRG,811,RED BLOOD CELL DISORDERS W MCC,Service Package,Inpatient,,"$28,354.7778","$7,745.0625","$27,265.2278","$22,683.8222","$26,081.8478","$15,020.3367","$26,507.5222","$14,169.9667","$27,265.2278","$27,263.6567","$10,963.17","$7,745.0625","$14,904.8211","$26,086.3956"
,MS-DRG,812,RED BLOOD CELL DISORDERS W/O MCC,Service Package,Inpatient,,"$27,179.1667","$7,324.75","$25,993.0683","$21,743.3333","$24,886.0267","$14,451.6967","$25,504.5017","$13,633.55","$25,993.0683","$25,992.2417","$9,179.8533","$7,324.75","$16,651.35","$25,004.8333"
,MS-DRG,813,COAGULATION DISORDERS,Service Package,Inpatient,,"$32,649.75","$6,180.6581","$31,293.9275","$26,119.8","$29,914.1675","$17,334.605","$30,584.1625","$16,353.29","$31,293.9275","$31,292.6025","$15,404.68","$6,180.6581","$23,555.95","$30,037.77"
,MS-DRG,815,RETICULOENDOTHELIAL & IMMUNITY DISORDERS W CC,Service Package,Inpatient,,"$18,048.","$6,075.","$17,320.64","$14,438.4","$16,571.35","$9,531.56","$16,829.11","$8,991.84","$17,320.64","$17,319.8","$13,835.41","$6,075.","$9,644.52","$16,604.16"
,MS-DRG,818,OTHER ANTEPARTUM DIAGNOSES W O.R. PROCEDURE W CC,Service Package,Inpatient,,"$22,894.","$2,106.75","$21,749.3","$18,315.2","$20,833.54","$12,334.77","$21,749.3","$11,636.49","$21,749.3","$21,749.3","$4,011.98","$2,106.75","$17,632.56","$21,062.48"
,MS-DRG,829,MYELOPROLIF DISORD OR POORLY DIFF NEOPL W OTHER O.R. PROC W CC/MCC,Service Package,Inpatient,,"$44,205.","$17,920.","$41,994.75","$35,364.","$40,226.55","$23,816.71","$41,994.75","$22,468.37","$41,994.75","$41,994.75","$17,920.","$19,801.285","$27,287.92","$40,668.6"
,MS-DRG,831,OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W MCC,Service Package,Inpatient,,"$10,637.5","$4,050.","$10,105.625","$8,510.","$9,680.125","$5,731.245","$10,105.625","$5,406.78","$10,105.625","$10,105.625","$7,400.","$4,050.","$5,429.16","$9,786.5"
,MS-DRG,832,OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W CC,Service Package,Inpatient,,"$6,198.5",$575.3,"$5,925.485","$4,958.8","$5,687.39","$3,331.0275","$5,925.485","$3,142.39","$5,888.575","$5,888.575","$4,391.5","$2,531.25",$575.3,"$5,702.62"
,MS-DRG,833,OTHER ANTEPARTUM DIAGNOSES W/O O.R. PROCEDURE W/O CC/MCC,Service Package,Inpatient,,"$9,577.7273","$4,477.9091","$9,114.7536","$7,662.1818","$8,729.1564","$5,142.9809","$9,070.0691","$4,851.81","$9,114.7536","$9,114.6773","$6,054.4918","$4,477.9091","$5,049.8909","$8,811.5091"
,MS-DRG,841,LYMPHOMA & NON-ACUTE LEUKEMIA W CC,Service Package,Inpatient,,"$23,908.","$10,125.","$22,968.62","$19,126.4","$21,973.91","$12,623.26","$22,286.11","$11,908.35","$22,968.62","$22,967.4","$19,418.74","$10,125.","$13,445.11","$21,995.36"
,MS-DRG,853,INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W MCC,Service Package,Inpatient,,"$68,618.25","$28,239.1142","$65,488.1242","$54,894.6","$62,740.76","$36,712.5033","$64,819.5933","$34,634.0758","$65,488.1242","$65,486.6842","$28,239.1142","$38,408.2656","$49,722.9992","$63,128.79"
,MS-DRG,854,INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W CC,Service Package,Inpatient,,"$43,126.1667","$20,201.6988","$41,188.7","$34,500.9333","$39,426.705","$23,014.1367","$40,628.8383","$21,711.08","$41,188.7","$41,187.6517","$26,786.6583","$20,201.6988","$21,603.5833","$39,676.0733"
,MS-DRG,855,INFECTIOUS & PARASITIC DISEASES W O.R. PROCEDURE W/O CC/MCC,Service Package,Inpatient,,"$16,166.","$6,853.","$15,532.74","$12,932.8","$14,858.73","$8,517.59","$15,041.21","$8,035.32","$15,532.74","$15,531.9","$9,846.41","$6,853.","$9,836.32","$14,872.72"
,MS-DRG,857,POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS W O.R. PROC W CC,Service Package,Inpatient,,"$33,070.","$12,595.","$31,672.52","$26,456.","$30,311.33","$17,559.66","$30,990.01","$16,565.14","$31,672.52","$31,671.3","$23,430.74","$12,595.","$18,676.88","$30,424.4"
,MS-DRG,863,POSTOPERATIVE & POST-TRAUMATIC INFECTIONS W/O MCC,Service Package,Inpatient,,"$20,467.5","$4,050.","$19,629.6125","$16,374.","$18,783.6325","$10,861.1525","$19,164.2475","$10,246.17","$19,629.6125","$19,628.725","$9,679.8","$4,050.","$12,625.4775","$18,830.1"
,MS-DRG,864,FEVER,Service Package,Inpatient,,"$11,575.","$2,346.","$11,252.27","$9,260.","$10,750.88","$5,975.57","$10,569.76","$5,637.2","$11,252.27","$11,251.05","$5,375.74","$2,346.","$4,890.02","$10,649."
,MS-DRG,870,SEPTICEMIA OR SEVERE SEPSIS W MV >96 HOURS,Service Package,Inpatient,,"$75,573.","$35,467.83","$72,217.05","$60,458.4","$69,053.31","$40,310.16","$71,203.51","$38,028.3","$72,217.05","$72,215.03","$35,467.83","$45,511.215","$62,346.87","$69,527.16"
,MS-DRG,871,SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W MCC,Service Package,Inpatient,,"$30,726.5653","$12,122.2818","$29,480.5378","$24,581.2522","$28,214.1155","$16,318.0755","$28,810.1028","$15,394.1153","$29,480.5378","$29,479.1485","$17,441.1047","$12,122.2818","$19,060.5839","$28,268.4399"
,MS-DRG,872,SEPTICEMIA OR SEVERE SEPSIS W/O MV >96 HOURS W/O MCC,Service Package,Inpatient,,"$21,299.7939","$6,709.8616","$20,477.2364","$17,039.8351","$19,620.7426","$11,247.5907","$19,896.295","$10,610.7396","$20,477.2364","$20,476.0771","$12,730.6081","$6,709.8616","$12,135.334","$19,595.8103"
,MS-DRG,884,ORGANIC DISTURBANCES & INTELLECTUAL DISABILITY,Service Package,Inpatient,,"$36,746.5","$13,107.8025","$35,242.525","$29,397.2","$33,723.91","$19,516.965","$34,452.81","$18,412.1","$35,242.525","$35,240.935","$14,440.74","$13,107.8025","$29,853.16","$33,806.78"
,MS-DRG,885,PSYCHOSES,Service Package,Inpatient,,"$28,394.","$8,742.","$27,558.46","$22,715.2","$26,317.97","$14,816.22","$26,254.23","$13,977.5","$27,558.46","$27,555.66","$17,168.22","$8,742.","$19,067.24","$26,122.48"
,MS-DRG,896,ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W MCC,Service Package,Inpatient,,"$34,933.8333","$15,378.","$33,421.7433","$27,947.0667","$31,983.3025","$18,567.9408","$32,776.7783","$17,516.6308","$33,421.7433","$33,420.6217","$18,268.6925","$15,378.","$22,706.7375","$32,139.1267"
,MS-DRG,897,ALCOHOL/DRUG ABUSE OR DEPENDENCE W/O REHABILITATION THERAPY W/O MCC,Service Package,Inpatient,,"$30,329.3333","$11,797.4325","$29,023.8422","$24,263.4667","$27,778.2311","$16,130.1489","$28,459.7211","$15,216.7822","$29,023.8422","$29,022.8311","$18,194.2411","$11,797.4325","$20,495.8878","$27,902.9867"
,MS-DRG,907,OTHER O.R. PROCEDURES FOR INJURIES W MCC,Service Package,Inpatient,,"$143,573.24","$60,743.8012","$136,812.06","$114,858.592","$131,020.02","$77,070.17","$135,883.26","$72,706.95","$136,812.06","$136,810.06","$60,743.8012","$94,388.08","$121,213.73","$132,087.38"
,MS-DRG,908,OTHER O.R. PROCEDURES FOR INJURIES W CC,Service Package,Inpatient,,"$50,850.5","$17,785.63","$48,483.015","$40,680.4","$46,682.205","$27,171.705","$48,197.95","$25,633.475","$48,483.015","$48,482.175","$17,785.63","$24,020.0462","$36,069.37","$46,782.46"
,MS-DRG,913,TRAUMATIC INJURY W MCC,Service Package,Inpatient,,"$9,298.","$4,050.","$9,180.04","$7,438.4","$8,608.85","$4,636.37","$8,147.34","$4,373.96","$9,180.04","$9,178.38","$7,497.","$4,050.",$0.,"$8,554.16"
,MS-DRG,914,TRAUMATIC INJURY W/O MCC,Service Package,Inpatient,,"$17,399.","$2,025.","$19,506.68","$13,919.2","$15,980.76","$9,181.89","$16,212.56","$8,662.09","$16,704.09","$16,703.25","$5,828.85","$2,025.","$19,506.68","$16,007.08"
,MS-DRG,915,ALLERGIC REACTIONS W MCC,Service Package,Inpatient,,"$16,944.","$4,371.","$16,271.84","$13,555.2","$15,566.71","$8,938.79","$15,780.31","$8,432.65","$16,271.84","$16,271.","$8,207.41","$4,371.","$11,994.96","$15,588.48"
,MS-DRG,916,ALLERGIC REACTIONS W/O MCC,Service Package,Inpatient,,"$17,881.","$2,025.","$17,161.99","$14,304.8","$16,419.38","$9,441.59","$16,670.46","$8,906.98","$17,161.99","$17,161.15","$5,505.79","$2,025.","$16,340.04","$16,450.52"
,MS-DRG,917,POISONING & TOXIC EFFECTS OF DRUGS W MCC,Service Package,Inpatient,,"$33,315.6283","$13,408.2812","$32,039.4362","$26,652.5027","$30,600.9604","$17,636.8454","$31,126.6458","$16,638.3854","$32,039.4362","$32,037.5721","$15,702.3138","$13,408.2812","$23,214.9562","$30,650.3779"
,MS-DRG,918,POISONING & TOXIC EFFECTS OF DRUGS W/O MCC,Service Package,Inpatient,,"$20,698.5","$5,425.0179","$19,873.0979","$16,558.8","$19,020.415","$10,938.64","$19,314.2079","$10,319.3429","$19,873.0979","$19,872.095","$10,291.475","$5,425.0179","$11,661.1371","$19,042.62"
,MS-DRG,919,COMPLICATIONS OF TREATMENT W MCC,Service Package,Inpatient,,"$39,991.","$16,920.7233","$38,193.4833","$31,992.8","$36,651.58","$21,321.03","$37,714.8933","$20,113.87","$38,193.4833","$38,192.5167","$16,920.7233","$17,256.2975","$23,954.8267","$36,791.72"
,MS-DRG,920,COMPLICATIONS OF TREATMENT W CC,Service Package,Inpatient,,"$12,266.","$3,037.5","$11,868.23","$9,812.8","$11,344.71","$6,384.61","$11,281.21","$6,023.15","$11,868.23","$11,867.2","$6,420.575","$3,037.5","$6,307.9","$11,284.72"
,MS-DRG,921,COMPLICATIONS OF TREATMENT W/O CC/MCC,Service Package,Inpatient,,"$17,197.","$4,050.","$16,593.17","$13,757.6","$16,047.6","$8,972.22","$16,052.33","$8,464.23","$16,593.17","$16,591.95","$8,385.85","$4,050.","$12,912.6","$15,821.24"
,MS-DRG,941,O.R. PROC W DIAGNOSES OF OTHER CONTACT W HEALTH SERVICES W/O CC/MCC,Service Package,Inpatient,,"$30,910.5","$4,480.","$29,364.975","$24,728.4","$28,128.555","$16,653.87","$29,364.975","$15,711.115","$29,364.975","$29,364.975","$4,480.","$8,847.625","$25,008.28","$28,437.66"
,MS-DRG,947,SIGNS & SYMPTOMS W MCC,Service Package,Inpatient,,"$31,133.3333","$11,230.0967","$29,989.44","$24,906.6667","$28,872.07","$16,485.1733","$29,305.9433","$15,551.8833","$29,989.44","$29,987.4667","$11,230.0967","$12,763.","$22,365.3233","$28,642.6667"
,MS-DRG,948,SIGNS & SYMPTOMS W/O MCC,Service Package,Inpatient,,"$39,337.75","$11,755.08","$37,542.6325","$31,470.2","$35,943.085","$21,017.8225","$37,078.495","$19,827.78","$37,542.6325","$37,541.8125","$29,169.7775","$19,880.1413","$11,755.08","$36,190.73"
,MS-DRG,951,OTHER FACTORS INFLUENCING HEALTH STATUS,Service Package,Inpatient,,"$11,153.","$4,050.","$10,595.35","$8,922.4","$10,149.23","$6,009.01","$10,595.35","$5,668.82","$10,595.35","$10,595.35","$7,400.","$4,050.","$5,545.76","$10,260.76"
,MS-DRG,964,OTHER MULTIPLE SIGNIFICANT TRAUMA W CC,Service Package,Inpatient,,"$32,294.","$10,125.","$30,856.28","$25,835.2","$30,153.2","$17,110.53","$30,856.28","$16,141.73","$30,854.34","$30,853.5","$20,526.94","$10,125.","$20,380.76","$29,710.48"
,MS-DRG,981,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W MCC,Service Package,Inpatient,,"$88,206.83","$42,369.4125","$84,183.53","$70,565.464","$80,656.3225","$47,236.2975","$83,399.955","$44,561.815","$84,183.53","$84,181.6775","$61,548.7775","$57,206.0312","$42,369.4125","$81,150.285"
,MS-DRG,982,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W CC,Service Package,Inpatient,,"$48,972.75","$23,163.2425","$46,795.16","$39,178.2","$44,801.77","$26,159.2875","$46,163.835","$24,678.1475","$46,795.16","$46,793.8625","$23,163.2425","$23,951.9744","$31,253.07","$45,054.93"
,MS-DRG,983,EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS W/O CC/MCC,Service Package,Inpatient,,"$26,133.","$4,480.","$24,826.35","$20,906.4","$23,781.03","$14,079.9","$24,826.35","$13,282.835","$24,826.35","$24,826.35","$4,480.","$5,300.875","$20,628.52","$24,042.36"
,MS-DRG,988,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W CC,Service Package,Inpatient,,"$22,402.","$8,767.","$21,456.94","$17,921.6","$20,533.49","$11,879.53","$20,965.41","$11,206.79","$21,456.94","$21,456.1","$16,271.41","$8,767.","$12,986.72","$20,609.84"
,MS-DRG,989,NON-EXTENSIVE O.R. PROC UNRELATED TO PRINCIPAL DIAGNOSIS W/O CC/MCC,Service Package,Inpatient,,"$20,461.","$8,767.","$19,437.95","$16,368.8","$18,619.51","$11,023.87","$19,437.95","$10,399.75","$19,437.95","$19,437.95","$13,440.","$8,767.","$11,894.96","$18,824.12"
,MS-DRG,998,PRINCIPAL DIAGNOSIS INVALID AS DISCHARGE DIAGNOSIS,Service Package,Inpatient,,"$41,245.","$19,344.16","$39,182.75","$32,996.","$37,532.95","$22,221.89","$39,182.75","$20,963.63","$39,182.75","$39,182.75","$29,600.","$19,494.","$19,344.16","$37,945.4"
,RevCode,120,MED/SURG IN ICU,Revenue Code,Inpatient,,"$2,050.","$1,041.974","$2,025.","$1,640.","$1,865.5","$1,104.4924","$1,947.5","$1,041.974","$1,947.5","$1,947.5",$0.,"$2,025.","$1,804.","$1,886."
,RevCode,120,MED/SURG IN OB,Revenue Code,Inpatient,,"$2,050.","$1,041.974","$2,025.","$1,640.","$1,865.5","$1,104.4924","$1,947.5","$1,041.974","$1,947.5","$1,947.5",$0.,"$2,025.","$1,804.","$1,886."
,RevCode,120,MED/SURG ISOLATION,Revenue Code,Inpatient,,"$2,150.","$1,092.802","$2,042.5","$1,720.","$1,956.5","$1,158.3701","$2,042.5","$1,092.802","$2,042.5","$2,042.5",$0.,"$2,025.","$1,892.","$1,978."
,RevCode,120,MED/SURG ISOLATION & TELEMETRY,Revenue Code,Inpatient,,"$2,250.","$1,143.63","$2,137.5","$1,800.","$2,047.5","$1,212.2478","$2,137.5","$1,143.63","$2,137.5","$2,137.5",$0.,"$2,025.","$1,980.","$2,070."
,RevCode,120,MED/SURG ROOM AND BOARD,Revenue Code,Inpatient,,"$2,050.","$1,041.974","$2,025.","$1,640.","$1,865.5","$1,104.4924","$1,947.5","$1,041.974","$1,947.5","$1,947.5",$0.,"$2,025.","$1,804.","$1,886."
,RevCode,120,MED/SURG TELEMETRY,Revenue Code,Inpatient,,"$2,150.","$1,092.802","$2,042.5","$1,720.","$1,956.5","$1,158.3701","$2,042.5","$1,092.802","$2,042.5","$2,042.5",$0.,"$2,025.","$1,892.","$1,978."
,RevCode,120,SWING BED ROOM AND BOARD,Revenue Code,Inpatient,,"$1,950.",$991.146,"$2,025.","$1,560.","$1,774.5","$1,050.6148","$1,852.5",$991.146,"$1,852.5","$1,852.5",$0.,"$2,025.","$1,716.","$1,794."
,RevCode,122,OBSTETRICS ROOM & BOARD,Revenue Code,Inpatient,,"$2,050.","$1,041.974","$2,025.","$1,640.","$1,865.5","$1,104.4924","$1,947.5","$1,041.974","$1,947.5","$1,947.5",$0.,"$2,025.","$1,804.","$1,886."
,RevCode,170,NURSERY,Revenue Code,Inpatient,,"$1,615.",$820.8722,"$2,025.","$1,292.","$1,469.65",$870.1245,"$1,534.25",$820.8722,"$1,534.25","$1,534.25",$0.,"$2,025.","$1,421.2","$1,485.8"
,RevCode,170,NURSERY BOARDER,Revenue Code,Inpatient,,"$1,275.",$648.057,"$2,025.","$1,020.","$1,160.25",$686.9404,"$1,211.25",$648.057,"$1,211.25","$1,211.25",$0.,"$2,025.","$1,122.","$1,173."
,RevCode,172,NURSERY PROGRESSIVE CARE LEVEL,Revenue Code,Inpatient,,"$1,860.",$945.4008,"$2,025.","$1,488.","$1,692.6","$1,002.1248","$1,767.",$945.4008,"$1,767.","$1,767.",$0.,"$2,025.","$1,636.8","$1,711.2"
,RevCode,173,NURSERY SICK NEWBORN LEVEL III,Revenue Code,Inpatient,,"$2,035.","$1,034.3498","$2,025.","$1,628.","$1,851.85","$1,096.4108","$1,933.25","$1,034.3498","$1,933.25","$1,933.25",$0.,"$2,025.","$1,790.8","$1,872.2"
,RevCode,191,MED/SURG ADMIN DAY,Revenue Code,Inpatient,,"$1,495.",$759.8786,"$2,025.","$1,196.","$1,360.45",$805.4713,"$1,420.25",$759.8786,"$1,420.25","$1,420.25",$0.,"$2,025.","$1,315.6","$1,375.4"
,RevCode,191,OB ADMIN DAY,Revenue Code,Inpatient,,"$1,495.",$759.8786,"$2,025.","$1,196.","$1,360.45",$805.4713,"$1,420.25",$759.8786,"$1,420.25","$1,420.25",$0.,"$2,025.","$1,315.6","$1,375.4"
,RevCode,200,ICU ROOM CHARGE,Revenue Code,Inpatient,,"$4,045.","$2,055.9926","$3,842.75","$3,236.","$3,680.95","$2,179.3522","$3,842.75","$2,055.9926","$3,842.75","$3,842.75",$0.,"$2,346.","$3,559.6","$3,721.4"
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