SCHEDNO|NAME|SCH_NAME|CPTNO|CPT|MODIFIER|LFKEY_FULLAMT|PROFAMT|TECHAMT|ANESUNITS|BEGIN DATEDT
102|SH LGP13|102-SH LGP13|0295T|0295T - EXT ECG > 48HR TO 21 DAY RCRD SCAN ANLYS REP R&I||0|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|34707|34707 - EVASC RPR DPLMNT ILIO-ILIAC NDGFT||3573.67||||10/01/2019
102|SH LGP13|102-SH LGP13|76641|76641 - US BREAST UNI REAL TIME WITH IMAGE COMPLETE||0|60.17||0|10/01/2019
102|SH LGP13|102-SH LGP13|78013|78013 - THYROID IMAGING WITH VASCULAR FLOW||0|29.83||0|10/01/2019
102|SH LGP13|102-SH LGP13|81274|81274 - HTT GENE ANALYSIS CHARACTERIZATION ALLELES||458.47||||10/01/2019
102|SH LGP13|102-SH LGP13|81336|81336 - SMN1 GENE ANALYSIS FULL GENE SEQUENCE||497.23||||10/01/2019
102|SH LGP13|102-SH LGP13|81337|81337 - SMN1 GENE ANALYSIS KNOWN FAMILIAL SEQ VARIANTS||305.58||||10/01/2019
102|SH LGP13|102-SH LGP13|81343|81343 - PPP2R2B GENE ANALYSIS EVAL DETC ABNORMAL ALLELES||226.05||||10/01/2019
102|SH LGP13|102-SH LGP13|90620|90620 - MENB-4C RECOMBNT PROT & OUTER MEMB VESIC VACC IM||174|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|90621|90621 - MENB-FHBP RECOMBNT LIPOPROTEIN VACC 2/3 DOSE IM||0|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|90649|90649 - 4VHPV VACCINE 3 DOSE SCHEDULE FOR IM USE||138|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|90651|90651 - 9VHPV VACC 2/3 DOSE SCHED IM USE||0|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|90680|90680 - RV5 VACCINE 3 DOSE SCHEDULE LIVE FOR ORAL USE||96|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|90681|90681 - RV1 VACCINE 2 DOSE SCHEDULE LIVE FOR ORAL USE||66.08|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|90707|90707 - MEASLES MUMPS RUBELLA VIRUS VACCINE LIVE SUBQ||57|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|90716|90716 - VAR VACCINE LIVE FOR SUBCUTANEOUS USE||92|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|90868|90868 - THERAP REPETITIVE TMS TX SUBSEQ DELIVERY & MNG||27.7|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|93299|93299 - REM INTERROG ICPMS/SCRMS <30 D TECH REVIEW||0|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|98966|98966 - NONPHYSICIAN TELEPHONE ASSESSMENT 5-10 MIN||16.38|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|98967|98967 - NONPHYSICIAN TELEPHONE ASSESSMENT 11-20 MIN||31.63|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|98968|98968 - NONPHYSICIAN TELEPHONE ASSESSMENT 21-30 MIN||46.87|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|99441|99441 - PHYS/QHP TELEPHONE EVALUATION 5-10 MIN||15.73|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|99442|99442 - PHYS/QHP TELEPHONE EVALUATION 11-20 MIN||30.36|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|99443|99443 - PHYS/QHP TELEPHONE EVALUATION 21-30 MIN||45|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|A9575|A9575 - INJ GADOTERATE MEGLUMI 0.1ML||0.2488|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0100|E0100 - CANE ADJUST/FIXED WITH TIP||29.65|7.1||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0105|E0105 - CANE ADJUST/FIXED QUAD/3 PRO||69.1|10.6||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0110|E0110 - CRUTCH FOREARM PAIR||88.55|18.24||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0111|E0111 - CRUTCH FOREARM EACH||66.05|9.61||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0112|E0112 - CRUTCH UNDERARM PAIR WOOD||42.22|11.34||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0113|E0113 - CRUTCH UNDERARM EACH WOOD||24.12|5.87||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0114|E0114 - CRUTCH UNDERARM PAIR NO WOOD||53.86|9.79||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0116|E0116 - CRUTCH UNDERARM EACH NO WOOD||31.66|6.16||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0117|E0117 - UNDERARM SPRINGASSIST CRUTCH||258.75|25.85||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0118|E0118 - CRUTCH SUBSTITUTE||490|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0130|E0130 - WALKER RIGID ADJUST/FIXED HT||81.27|19.45||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0135|E0135 - WALKER FOLDING ADJUST/FIXED||87.45|19.96||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0140|E0140 - WALKER W TRUNK SUPPORT||417.43|41.75||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0141|E0141 - RIGID WHEELED WALKER ADJ/FIX||128.94|22||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0143|E0143 - WALKER FOLDING WHEELED W/O S||59.44|5.95||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0144|E0144 - ENCLOSED WALKER W REAR SEAT||368.53|36.86||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0147|E0147 - WALKER VARIABLE WHEEL RESIST||665.19|66.53||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0148|E0148 - HEAVYDUTY WALKER NO WHEELS||147.04|14.72||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0149|E0149 - HEAVY DUTY WHEELED WALKER||258.3|25.82||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0153|E0153 - FOREARM CRUTCH PLATFORM ATTA||81.06|8.95||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0154|E0154 - WALKER PLATFORM ATTACHMENT||81.6|8.42||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0155|E0155 - WALKER WHEEL ATTACHMENT-PAIR||35.41|3.79||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0156|E0156 - WALKER SEAT ATTACHMENT||19.6|1.96||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0157|E0157 - WALKER CRUTCH ATTACHMENT||83.74|8.85||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0158|E0158 - WALKER LEG EXTENDERS SET OF4||37.24|4.11||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0161|E0161 - SITZ BATH/EQUIPMENT W/FAUCET||35.21|4.07||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0162|E0162 - SITZ BATH CHAIR||166.29|17.44||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0163|E0163 - COMMODE CHAIR WITH FIXED ARM||66.61|6.66||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0165|E0165 - COMMODE CHAIR WITH DETACHARM||0|15.34||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0167|E0167 - COMMODE CHAIR PAIL OR PAN||13.7|1.44||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0168|E0168 - HEAVYDUTY/WIDE COMMODE CHAIR||146.91|14.69||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0175|E0175 - COMMODE CHAIR FOOT REST||88.92|8.89||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0184|E0184 - DRY PRESSURE MATTRESS||261.42|30.35||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0185|E0185 - GEL PRESSURE MATTRESS PAD||389.76|51.29||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0188|E0188 - SYNTHETIC SHEEPSKIN PAD||35.49|4.17||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0189|E0189 - LAMBSWOOL SHEEPSKIN PAD||69.77|7.55||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0191|E0191 - PROTECTOR HEEL OR ELBOW||11.4|1.17||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0197|E0197 - AIR PRESSURE PAD FOR MATTRES||252.89|34.89||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0198|E0198 - WATER PRESSURE PAD FOR MATTR||252.89|26.2||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0199|E0199 - DRY PRESSURE PAD FOR MATTRES||43.04|4.29||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0200|E0200 - HEAT LAMP WITHOUT STAND||106.45|14.45||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0205|E0205 - HEAT LAMP WITH STAND||260.56|28.66||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0210|E0210 - ELECTRIC HEAT PAD STANDARD||39.11|3.9||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0215|E0215 - ELECTRIC HEAT PAD MOIST||80.85|8.46||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0217|E0217 - WATER CIRC HEAT PAD W PUMP||662.95|66.28||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0225|E0225 - HYDROCOLLATOR UNIT||521.81|51.44||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0239|E0239 - HYDROCOLLATOR UNIT PORTABLE||603.96|60.4||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0249|E0249 - PAD WATER CIRCULATING HEAT U||133.74|14.71||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0470|E0470 - RAD W/O BACKUP NON-INV INTFC||0|130.75||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0471|E0471 - RAD W/BACKUP NON INV INTRFC||4803.06|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0570|E0570 - NEBULIZER WITH COMPRESSION||0|7.19||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0601|E0601 - CONT AIRWAY PRESSURE DEVICE||0|50.7||0|10/01/2019
102|SH LGP13|102-SH LGP13|E0603|E0603 - ELECTRIC BREAST PUMP||153|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|E1390|E1390 - OXYGEN CONCENTRATOR||0|87.79||0|10/01/2019
102|SH LGP13|102-SH LGP13|E1392|E1392 - PORTABLE OXYGEN CONCENTRATOR||463|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|G0406|G0406 - INPT/TELE FOLLOW UP 15||46.15|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|G0407|G0407 - INPT/TELE FOLLOW UP 25||84.46|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|G0408|G0408 - INPT/TELE FOLLOW UP 35||121.16|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|G0425|G0425 - INPT/ED TELECONSULT30||120.13|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|G0426|G0426 - INPT/ED TELECONSULT50||162.91|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|G0427|G0427 - INPT/ED TELECONSULT70||239.49|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|H0031|H0031 - MH HEALTH ASSESS BY NON-MD||0|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|H0049|H0049 - ALCOHOL/DRUG SCREENING||0|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|J1267|J1267 - DORIPENEM INJECTION||1.1061|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|J2355|J2355 - OPRELVEKIN INJECTION||533.6438|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|J7297|J7297 - LILETTA- 52 MG||0|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|J7298|J7298 - MIRENA- 52 MG||0|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|J7300|J7300 - INTRAUT COPPER CONTRACEPTIVE||616|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|J7301|J7301 - SKYLA- 13.5 MG||0|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|J7307|J7307 - ETONOGESTREL IMPLANT SYSTEM||887.25|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|J9203|J9203 - GEMTUZUMAB OZOGAMICIN 0.1 MG||241.4444|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|K0195|K0195 - ELEVATING WHLCHAIR LEG RESTS||0|13.28||0|10/01/2019
102|SH LGP13|102-SH LGP13|K0609|K0609 - REPL ELECTRODE FOR AED||1082.29|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|K0822|K0822 - PWC GP 2 STD SEAT/BACK||0|366||0|10/01/2019
102|SH LGP13|102-SH LGP13|K0823|K0823 - PWC GP 2 STD CAP CHAIR||0|341.95||0|10/01/2019
102|SH LGP13|102-SH LGP13|K0861|K0861 - PWC GP3 STD MULT POW OPT S/B||0|127.04||0|10/01/2019
102|SH LGP13|102-SH LGP13|L3650|L3650 - SO 8 ABD RESTRAINT PRE OTS||63.41|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|L8040|L8040 - NASAL PROSTHESIS||2819.34|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|L8041|L8041 - MIDFACIAL PROSTHESIS||3398.18|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|L8042|L8042 - ORBITAL PROSTHESIS||3818.15|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|L8043|L8043 - UPPER FACIAL PROSTHESIS||4276.35|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|L8044|L8044 - HEMI-FACIAL PROSTHESIS||4734.51|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|L8045|L8045 - AURICULAR PROSTHESIS||2964.87|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|L8046|L8046 - PARTIAL FACIAL PROSTHESIS||3054.53|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|L8047|L8047 - NASAL SEPTAL PROSTHESIS||1565.44|0||0|10/01/2019
102|SH LGP13|102-SH LGP13|Q4116|Q4116 - ALLODERM||39.29|0||0|10/01/2019