TAX ID|SCHEDNO|NAME|SCH_NAME|CPTNO|CPT|MODIFIER|FULLAMT|PROFAMT|TECHAMT|ANESUNITS|BEGIN DATEDT
58-1155460|90|SH 70004|90-SH 70004|V2786|V2786 - OCCUPATIONAL MULTIFOCAL LENS||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2784|V2784 - LENS POLYCARB OR EQUAL||52.13|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2783|V2783 - LENS- >= 1.66 P/>=1.80 G||80.17|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2782|V2782 - LENS- 1.54-1.65 P/1.60-1.79G||71.09|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2780|V2780 - OVERSIZE LENS/ES||18.25|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2770|V2770 - OCCLUDER LENS/ES||22.59|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2762|V2762 - POLARIZATION- ANY LENS||65.85|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2760|V2760 - SCRATCH RESISTANT COATING||17.49|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2755|V2755 - UV LENS/ES||20.09|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2750|V2750 - ANTI-REFLECTIVE COATING||27.8|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2745|V2745 - TINT- ANY COLOR/SOLID/GRAD||13.55|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2744|V2744 - TINT PHOTOCHROMATIC LENS/ES||23.89|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2730|V2730 - SPECIAL BASE CURVE||23.03|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2718|V2718 - FRESNELL PRISM PRESS-ON LENS||31.18|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2715|V2715 - PRISM LENS/ES||12.7|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2710|V2710 - GLASS/PLASTIC SLAB OFF PRISM||70.02|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2700|V2700 - BALANCE LENS||47.84|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2632|V2632 - POST CHMBR INTRAOCULAR LENS||130|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2631|V2631 - IRIS SUPPORT INTRAOCLR LENS||130|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2630|V2630 - ANTER CHAMBER INTRAOCUL LENS||130|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2628|V2628 - FABRICATION & FITTING||357.64|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2627|V2627 - SCLERAL COVER SHELL||1564.21|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2626|V2626 - REDUCTION OF EYE PROSTHESIS||273.23|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2625|V2625 - ENLARGEMNT OF EYE PROSTHESIS||430.65|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2624|V2624 - POLISHING ARTIFICAL EYE||66.49|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2623|V2623 - PLASTIC EYE PROSTH CUSTOM||980.33|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2531|V2531 - CONTACT LENS GAS PERMEABLE||597.99|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2530|V2530 - CONTACT LENS GAS IMPERMEABLE||243.58|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2523|V2523 - CNTCT LENS HYDROPHIL EXTEND||164.45|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2522|V2522 - CNTCT LENS HYDROPHIL BIFOCL||192.98|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2521|V2521 - CNTCT LENS HYDROPHILIC TORIC||198.29|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2520|V2520 - CONTACT LENS HYDROPHILIC||113.9|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2513|V2513 - CONTACT LENS EXTENDED WEAR||172.72|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2512|V2512 - CNTCT LENS GAS PERMBL BIFOCL||205.74|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2511|V2511 - CNTCT TORIC PRISM BALLAST||174.11|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2510|V2510 - CNTCT GAS PERMEABLE SPHERICL||121.18|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2503|V2503 - CNTCT LENS PMMA COLOR VISION||159.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2502|V2502 - CONTACT LENS PMMA BIFOCAL||166.58|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2501|V2501 - CNTCT LENS PMMA-TORIC/PRISM||135.22|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2500|V2500 - CONTACT LENS PMMA SPHERICAL||88.77|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2430|V2430 - LENS VARIABLE ASPHERICITY BI||127.48|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2410|V2410 - LENS VARIAB ASPHERICITY SING||97.93|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2321|V2321 - LENTICULAR LENS- TRIFOCAL||171.26|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2320|V2320 - LENS TRIFOCAL ADD OVER 3.25D||57.21|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2319|V2319 - LENS TRIFOCAL SEG WIDTH > 28||54.23|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2318|V2318 - LENS ANISEIKONIC TRIFOCAL||160.21|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2315|V2315 - LENS LENTICULAR TRIFOCAL||173.75|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2314|V2314 - LENS SPHCYL TRIFOCAL OVER 12||156.5|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2313|V2313 - LENS SPHC TRIFO 7.25-12/4.25||142.88|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2312|V2312 - LENS SPHC TRIFO 7.25-12/2.25||104.67|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2311|V2311 - LENS SPHC TRIFO 7.25-12/.25-||118.75|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2310|V2310 - LENS SPHC TRIFOCAL 4.25-7/>6||124.68|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2309|V2309 - LENS SPHC TRIFOCAL 4.25-7/4.||113.36|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2308|V2308 - LENS SPHC TRIFOCAL 4.25-7/2.||96.9|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2307|V2307 - LENS SPHCY TRIFOCAL 4.25-7/.||90.8|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2306|V2306 - LENS SPHCYL TRIFOCAL 4.00/>6||91.57|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2305|V2305 - LENS SPHCY TRIFOCAL 4.0/4.25||98.21|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2304|V2304 - LENS SPHCY TRIFOCAL 4.0/2.25||80.09|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2303|V2303 - LENS SPHCY TRIFOCAL 4.0/.12-||76.53|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2302|V2302 - LENS SPHERE TRIFOCAL 7.12-20||92.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2301|V2301 - LENS SPHERE TRIFOCAL 4.12-7.||84.33|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2300|V2300 - LENS SPHERE TRIFOCAL 4.00D||72.71|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2221|V2221 - LENTICULAR LENS- BIFOCAL||105.36|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2220|V2220 - LENS BIFOCAL ADD OVER 3.25D||39.43|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2219|V2219 - LENS BIFOCAL SEG WIDTH OVER||48.63|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2218|V2218 - LENS ANISEIKONIC BIFOCAL||110.47|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2215|V2215 - LENS LENTICULAR BIFOCAL||107.97|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2214|V2214 - LENS SPHCYL BIFOCAL OVER 12.||99.79|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2213|V2213 - LENS SPHCYL BIFO 7.25-12/4.2||93.08|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2212|V2212 - LENS SPHCYL BIFO 7.25-12/2.2||90.78|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2211|V2211 - LENS SPHCY BIFO 7.25-12/.25-||83.42|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2210|V2210 - LENS SPHCY BIFOCAL 4.25-7/OV||97.83|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2209|V2209 - LENS SPHCY BIFOCAL 4.25-7/4.||76.04|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2208|V2208 - LENS SPHCY BIFOCAL 4.25-7/2.||69.13|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2207|V2207 - LENS SPHCY BIFOCAL 4.25-7D/.||68.29|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2206|V2206 - LENS SPHCY BIFOCAL 4.00D/OVE||81.81|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2205|V2205 - LENS SPHCY BIFOCAL 4.00D/4.2||67.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2204|V2204 - LENS SPHCY BIFOCAL 4.00D/2.1||61.25|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2203|V2203 - LENS SPHCYL BIFOCAL 4.00D/.1||56.49|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2202|V2202 - LENS SPHERE BIFOCAL 7.12-20.||71.81|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2201|V2201 - LENS SPHERE BIFOCAL 4.12-7.0||61.02|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2200|V2200 - LENS SPHER BIFOC PLANO 4.00D||55.99|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2121|V2121 - LENTICULAR LENS- SINGLE||82.69|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2118|V2118 - LENS ANISEIKONIC SINGLE||80.09|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2115|V2115 - LENS LENTICULAR BIFOCAL||80.79|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2114|V2114 - SPHEROCYLINDER OVER 12.00D||74.3|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2113|V2113 - SPHEROCYLINDR 7.25D/4.25-6D||84.01|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2112|V2112 - SPHEROCYLINDR 7.25D/2.25-4D||60.8|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2111|V2111 - SPHEROCYLINDR 7.25D/.25-2.25||61.62|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2110|V2110 - SPHEROCYLINDER 4.25D/OVER 6D||69.91|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2109|V2109 - SPHEROCYLINDER 4.25D/4.25-6D||59.89|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2108|V2108 - SPHEROCYLINDER 4.25D/2.12-4D||52.11|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2107|V2107 - SPHEROCYLINDER 4.25D/12-2D||53.72|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2106|V2106 - SPHEROCYLINDER 4.00D/>6.00D||51.12|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2105|V2105 - SPHEROCYLINDER 4.00D/4.25-6D||50.36|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2104|V2104 - SPHEROCYLINDR 4.00D/2.12-4D||41.14|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2103|V2103 - SPHEROCYLINDR 4.00D/12-2.00D||37.15|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2102|V2102 - SINGL VISN SPHERE 7.12-20.00||63.93|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2101|V2101 - SINGLE VISN SPHERE 4.12-7.00||45.08|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2100|V2100 - LENS SPHER SINGLE PLANO 4.00||42.78|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|V2020|V2020 - VISION SVCS FRAMES PURCHASES||88.02|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q9995|Q9995 - INJ.- EMICIZUMAB-KXWH 0.5 MG||54.4236|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q9993|Q9993 - INJ.- TRIAMCINOLONE EXT REL||20.7691|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q9992|Q9992 - INJ- BUPRENORPHINE XR OVER 100 MG||1842.28|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q9991|Q9991 - INJ-BUPRENORPHINE XR 100 MG OR LESS||1842.28|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q9989|Q9989 - USTEKINUMAB- IV INJECT-1 MG||14.16|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q9967|Q9967 - LOCM 300-399MG/ML IODINE-1ML||0.1342|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q9966|Q9966 - LOCM 200-299MG/ML IODINE-1ML||0.3696|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q9965|Q9965 - LOCM 100-199MG/ML IODINE-1ML||0.9845|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q9963|Q9963 - HOCM 350-399MG/ML IODINE-1ML||0.2277|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q9961|Q9961 - HOCM 250-299MG/ML IODINE-1ML||0.2926|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q9960|Q9960 - HOCM 200-249MG/ML IODINE-1ML||0.2651|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q9958|Q9958 - HOCM <=149 MG/ML IODINE- 1ML||0.0869|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q9957|Q9957 - INJ PERFLUTREN LIP MICROS-ML||54.5512|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q9956|Q9956 - INJ OCTAFLUOROPROPANE MIC-ML||36.3671|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q9950|Q9950 - INJ SULF HEXA LIPID MICROSPH||22.9515|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q5106|Q5106 - INJ RETACRIT NON-ESRD USE 1000 UN||12.8612|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q5105|Q5105 - INJ RETACRIT ESRD ON DIALYSI 100 UN||1.2859|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q5104|Q5104 - INJECTION- RENFLEXIS- 10 MG||76.1442|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q5103|Q5103 - INJECTION- INFLECTRA- 10 MG||71.4769|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q5102|Q5102 - INJ.- INFLIXIMAB BIOSIMILAR||88.21|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q5101|Q5101 - INJECTION- ZARXIO- 1 MCG||0.7183|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4172|Q4172 - PURAPLY OR PURAPLY AM||96.4326|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4133|Q4133 - GRAFIX STRAVIX PRIME PL SQCM||145.7346|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4132|Q4132 - GRAFIX CORE- GRAFIXPL CORE||147.2922|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4131|Q4131 - EPIFIX OR EPICORD||176.6864|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4123|Q4123 - ALLOSKIN||34.7765|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4121|Q4121 - THERASKIN||49.4054|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4116|Q4116 - ALLODERM||40.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4115|Q4115 - ALLOSKIN||11.0814|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4113|Q4113 - GRAFTJACKET XPRESS||1069.805|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4112|Q4112 - CYMETRA INJECTABLE||1069.805|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4111|Q4111 - GAMMAGRAFT||8.5338|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4110|Q4110 - PRIMATRIX||60.14|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4108|Q4108 - INTEGRA MATRIX||45.67|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4107|Q4107 - GRAFTJACKET||100.4102|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4106|Q4106 - DERMAGRAFT||36.355|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4105|Q4105 - INTEGRA DRT OR OMNIGRAFT||37.28|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4104|Q4104 - INTEGRA BMWD||48.48|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4102|Q4102 - OASIS WOUND MATRIX||12.3552|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4101|Q4101 - APLIGRAF||33.8822|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4081|Q4081 - EPOETIN ALFA- 100 UNITS ESRD||1.4399|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4074|Q4074 - ILOPROST NON-COMP UNIT DOSE||156.0163|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4049|Q4049 - FINGER SPLINT- STATIC||2.4|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4048|Q4048 - CAST SUP SHT LEG SPLNT PED F||10.61|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4047|Q4047 - CAST SUP SHT LEG SPLNT PED P||6.58|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4046|Q4046 - CAST SUP SHT LEG SPLNT FBRGL||21.22|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4045|Q4045 - CAST SUP SHT LEG SPLNT PLSTR||13.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4044|Q4044 - CAST SUP LNG LEG SPLNT PED F||19.4|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4043|Q4043 - CAST SUP LNG LEG SPLNT PED P||11.37|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4042|Q4042 - CAST SUP LNG LEG SPLNT FBRGL||38.79|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4041|Q4041 - CAST SUP LNG LEG SPLNT PLSTR||22.72|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4040|Q4040 - CAST SUP SHRT LEG PED FBRGLS||23.4|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4039|Q4039 - CAST SUP SHRT LEG PED PLSTER||9.36|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4038|Q4038 - CAST SUP SHRT LEG FIBERGLASS||46.82|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4037|Q4037 - CAST SUP SHRT LEG PLASTER||18.68|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4036|Q4036 - CAST SUP LNGLEG CYLNDR PED F||38.11|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4035|Q4035 - CAST SUP LNGLEG CYLNDR PED P||15.32|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4034|Q4034 - CAST SUP LNG LEG CYLINDER FB||76.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4033|Q4033 - CAST SUP LNG LEG CYLINDER PL||30.64|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4032|Q4032 - CAST SUP LNG LEG PED FBRGLS||43.23|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4031|Q4031 - CAST SUP LNG LEG PED PLASTER||16.41|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4030|Q4030 - CAST SUP LONG LEG FIBERGLASS||86.46|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4029|Q4029 - CAST SUP LONG LEG PLASTER||32.84|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4028|Q4028 - CAST SUP HIP SPICA PED FBRGL||67.08|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4027|Q4027 - CAST SUP HIP SPICA PED PLSTR||21.48|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4026|Q4026 - CAST SUP HIP SPICA FIBERGLAS||134.09|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4025|Q4025 - CAST SUP HIP SPICA PLASTER||42.94|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4024|Q4024 - CAST SUP SHT ARM SPLNT PED F||6.92|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4023|Q4023 - CAST SUP SHT ARM SPLNT PED P||3.85|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4022|Q4022 - CAST SUP SHT ARM SPLINT FBRG||13.82|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4021|Q4021 - CAST SUP SHT ARM SPLINT PLST||7.66|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4020|Q4020 - CAST SUP LNG ARM SPLNT PED F||8.27|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4019|Q4019 - CAST SUP LNG ARM SPLNT PED P||5.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4018|Q4018 - CAST SUP LNG ARM SPLINT FBRG||16.49|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4017|Q4017 - CAST SUP LNG ARM SPLINT PLST||10.35|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4016|Q4016 - CAST SUP GAUNTLET PED FBRGLS||15.09|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4015|Q4015 - CAST SUP GAUNTLET PED PLSTER||8.97|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4014|Q4014 - CAST SUP GAUNTLET FIBERGLASS||30.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4013|Q4013 - CAST SUP GAUNTLET PLASTER||17.91|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4012|Q4012 - CAST SUP SHT ARM PED FBRGLAS||11.07|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4011|Q4011 - CAST SUP SHT ARM PED PLASTER||4.9|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4010|Q4010 - CAST SUP SHT ARM ADULT FBRGL||22.14|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4009|Q4009 - CAST SUP SHT ARM ADULT PLSTR||9.84|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4008|Q4008 - CAST SUP LONG ARM PED FBRGLS||16.58|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4007|Q4007 - CAST SUP LONG ARM PED PLSTER||7.37|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4006|Q4006 - CAST SUP LONG ARM ADULT FBRG||33.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4005|Q4005 - CAST SUP LONG ARM ADULT PLST||14.73|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4004|Q4004 - CAST SUP SHOULDER CAST FBRGL||138.3|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4003|Q4003 - CAST SUP SHOULDER CAST PLSTR||39.95|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4002|Q4002 - CAST SUP BODY CAST FIBERGLAS||210.22|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q4001|Q4001 - CAST SUP BODY CAST PLASTER||55.64|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q3027|Q3027 - INJ BETA INTERFERON IM 1 MCG||59.5925|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q2050|Q2050 - DOXORUBICIN INJ 10MG||409.7412|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q2043|Q2043 - SIPULEUCEL-T AUTO CD54+||45685.8985|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q2038|Q2038 - FLUZONE VACC- 3 YRS & >- IM||15.06|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q2037|Q2037 - FLUVIRIN VACC- 3 YRS & >- IM||19.4535|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q2035|Q2035 - AFLURIA VACC- 3 YRS & >- IM||19.4535|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q0506|Q0506 - LITH-ION BATT ELEC/PNEUM VAD||943.31|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q0504|Q0504 - PWR ADPT PNEUM VAD- REP VEH||757.8|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q0503|Q0503 - BATTERY PNEUM VAD REPLACEMNT||1436.15|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q0502|Q0502 - MOBILITY CART PNEUM VAD- REP||718.06|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q0501|Q0501 - SHWR COV ELEC/COMBO VAD- REP||564.02|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q0500|Q0500 - FILTERS ELEC/COMBO VAD- REP||33.73|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q0499|Q0499 - BELT/VEST ELEC/COMBO VAD REP||184.32|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q0498|Q0498 - HOLSTER ELEC/COMBO VAD- REP||567.28|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q0497|Q0497 - BAT CLPS ELEC/COMB VAD- REP||517.01|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q0496|Q0496 - BATTERY ELEC/COMBO VAD- REP||1655.78|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q0495|Q0495 - CHARGER ELEC/COMBO VAD- REP||4613.27|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q0494|Q0494 - EMR HD PMP ELEC/COMBO- REP||236.96|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q0493|Q0493 - EMR PWR CBL COMBO VAD- REP||280|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q0492|Q0492 - EMR PWR CBL ELEC VAD- REP||98.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q0491|Q0491 - EMR PWR SOURCE COMBO VAD REP||1220.75|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q0490|Q0490 - EMR PWR SOURCE ELEC VAD- REP||776.53|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q0489|Q0489 - PWR PCK BASE COMBO VAD- REP||17952.09|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q0487|Q0487 - LEADS ANY TYPE VAD- REP ONLY||377|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q0486|Q0486 - MON CABLE ELEC/PNEUM VAD REP||323.13|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q0485|Q0485 - MONITOR CABLE ELEC VAD- REP||388.25|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q0484|Q0484 - MONITOR ELEC OR COMB VAD REP||4021.3|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q0483|Q0483 - MONITOR ELEC VAD- REP||20707.29|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q0482|Q0482 - MICROPRCSR CU COMBO VAD- REP||5026.59|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q0481|Q0481 - MICROPRCSR CU ELEC VAD- REP||16048.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q0480|Q0480 - DRIVER PNEUMATIC VAD- REP||99469.07|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q0479|Q0479 - POWER MODULE COMBO VAD- REP||13338.87|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q0478|Q0478 - POWER ADAPTER- COMBO VAD||202.95|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q0180|Q0180 - DOLASETRON MESYLATE ORAL||119.03|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q0169|Q0169 - PROMETHAZINE HCL 12.5MG ORAL||0.0231|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q0167|Q0167 - DRONABINOL 2.5MG ORAL||3.5211|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q0166|Q0166 - GRANISETRON HCL 1 MG ORAL||1.6203|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q0164|Q0164 - PROCHLORPERAZINE MALEATE 5MG||0.0341|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q0163|Q0163 - DIPHENHYDRAMINE HCL 50MG||0.2992|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q0162|Q0162 - ONDANSETRON ORAL||0.0462|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q0139|Q0139 - FERUMOXYTOL- ESRD USE||1.0571|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|Q0138|Q0138 - FERUMOXYTOL- NON-ESRD||1.0571|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|P9047|P9047 - ALBUMIN (HUMAN)- 25%- 50ML||58.7818|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|P9046|P9046 - ALBUMIN (HUMAN)- 25%- 20 ML||24.7368|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|P9045|P9045 - ALBUMIN (HUMAN)- 5%- 250 ML||60.192|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|P9041|P9041 - ALBUMIN (HUMAN)-5%- 50ML||12.9789|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8696|L8696 - EXT ANTENNA PHREN NERVE STIM||239.4|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8695|L8695 - EXTERNAL RECHARG SYS EXTERN||18.4|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8694|L8694 - AOI TRANSDUCER/ACTUATOR REPL||1061.86|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8693|L8693 - AUD OSSEO DEV- ABUTMENT||1674.66|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8691|L8691 - AOI SND PROC REPL EXCL ACTUA||2945|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8690|L8690 - AUD OSSEO DEV- INT/EXT COMP||5253.9|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8689|L8689 - EXTERNAL RECHARG SYS INTERN||1905.04|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8684|L8684 - RADIOF TRSMTR IMPLT SCRL NEU||761.07|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8683|L8683 - RADIOFQ TRSMTR FOR IMPLT NEU||5795.56|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8682|L8682 - IMPLT NEUROSTIM RADIOFQ REC||6584.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8681|L8681 - PT PRGRM FOR IMPLT NEUROSTIM||1247.41|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8679|L8679 - IMP NEUROSTI PLS GN ANY TYPE||9215.35|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8670|L8670 - VASCULAR GRAFT- SYNTHETIC||607.94|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8659|L8659 - INTERPHALANGEAL JOINT REPL||2131.17|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8658|L8658 - INTERPHALANGEAL JOINT SPACER||342.58|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8642|L8642 - HALLUX IMPLANT||327.81|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8641|L8641 - METATARSAL JOINT IMPLANT||399.35|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8631|L8631 - MCP JOINT REPL 2 PC OR MORE||2469.29|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8630|L8630 - METACARPOPHALANGEAL IMPLANT||367.94|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8629|L8629 - CID TRANSMIT COIL AND CABLE||197.75|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8628|L8628 - CID EXT CONTROLLER REPL||1366.27|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8627|L8627 - CID EXT SPEECH PROCESS REPL||7602.67|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8625|L8625 - CHARGER COCH IMPL/AOI BATTRY REP EA||212.36|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8624|L8624 - LITH ION BATT CID- EAR LEVEL||178.07|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8623|L8623 - LITH ION BATT CID-NON-EARLVL||71.44|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8622|L8622 - REPL ALKALINE BATTERY||0.36|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8621|L8621 - REPL ZINC AIR BATTERY||0.68|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8619|L8619 - COCH IMP EXT PROC/CONTR RPLC||8968.93|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8618|L8618 - COCH IMPLANT TRAN CABLE REPL||28.95|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8617|L8617 - COCH IMPLANT TRANS COIL REPL||101.36|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8616|L8616 - COCH IMPLANT MICROPHONE REPL||116.01|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8615|L8615 - COCH IMPLANT HEADSET REPLACE||498.11|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8614|L8614 - COCHLEAR DEVICE||20908.41|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8613|L8613 - OSSICULAR IMPLANT||330.33|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8612|L8612 - AQUEOUS SHUNT PROSTHESIS||737.81|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8610|L8610 - OCULAR IMPLANT||699.54|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8609|L8609 - ARTIFICIAL CORNEA||7195.79|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8607|L8607 - INJ VOCAL CORD BULKING AGENT||47.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8606|L8606 - SYNTHETIC IMPLNT URINARY 1ML||251.41|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8605|L8605 - INJ BULKING AGENT ANAL CANAL||791.03|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8603|L8603 - COLLAGEN IMP URINARY 2.5 ML||478.95|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8600|L8600 - IMPLANT BREAST SILICONE/EQ||681.97|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8515|L8515 - GEL CAP APP DEVICE FOR TRACH||69.7|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8514|L8514 - REPL TRACH PUNCTURE DILATOR||104.16|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8513|L8513 - TRACH PROS CLEANING DEVICE||5.75|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8512|L8512 - GEL CAP FOR TRACH VOICE PROS||2.43|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8511|L8511 - INDWELLING TRACH INSERT||80.33|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8510|L8510 - VOICE AMPLIFIER||279.11|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8509|L8509 - TRACH-ESOPH VOICE PROS MD IN||120.64|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8507|L8507 - TRACH-ESOPH VOICE PROS PT IN||46.26|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8501|L8501 - TRACHEOSTOMY SPEAKING VALVE||160.08|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8500|L8500 - ARTIFICIAL LARYNX||720.76|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8485|L8485 - PROS SOCK SINGLE PLY UPPER L||12.14|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8480|L8480 - PROS SOCK SINGLE PLY AK||10.05|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8470|L8470 - PROS SOCK SINGLE PLY BK||7.29|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8465|L8465 - SHRINKER UPPER LIMB||71.02|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8460|L8460 - SHRINKER ABOVE KNEE||79.68|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8440|L8440 - SHRINKER BELOW KNEE||57.26|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8435|L8435 - PROS SOCK MULTI PLY UPPER LM||27.01|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8430|L8430 - PROSTHETIC SOCK MULTI PLY AK||30.1|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8420|L8420 - PROSTHETIC SOCK MULTI PLY BK||27.37|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8417|L8417 - PROS SHEATH/SOCK W GEL CUSHN||83.04|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8415|L8415 - SHEATH UPPER LIMB||23.41|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8410|L8410 - SHEATH ABOVE KNEE||23.55|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8400|L8400 - SHEATH BELOW KNEE||20.7|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8330|L8330 - TRUSS ADD TO STD PAD SCROTAL||70.81|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8320|L8320 - TRUSS ADDITION TO STD PAD WA||71.44|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8310|L8310 - TRUSS DOUBLE W/ STANDARD PAD||163.54|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8300|L8300 - TRUSS SINGLE W/ STANDARD PAD||106.36|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8047|L8047 - NASAL SEPTAL PROSTHESIS||592.92|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8046|L8046 - PARTIAL FACIAL PROSTHESIS||1156.89|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8045|L8045 - AURICULAR PROSTHESIS||1122.95|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8044|L8044 - HEMI-FACIAL PROSTHESIS||1793.23|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8043|L8043 - UPPER FACIAL PROSTHESIS||1619.66|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8042|L8042 - ORBITAL PROSTHESIS||1446.13|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8041|L8041 - MIDFACIAL PROSTHESIS||1287.08|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8040|L8040 - NASAL PROSTHESIS||1067.84|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8035|L8035 - CUSTOM BREAST PROSTHESIS||4046.18|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8032|L8032 - REUSABLE NIPPLE PROSTHESIS||43.26|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8031|L8031 - BREAST PROSTHESIS W ADHESIVE||360.15|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8030|L8030 - BREAST PROSTHES W/O ADHESIVE||360.15|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8020|L8020 - MASTECTOMY FORM||248.97|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8015|L8015 - EXT BREASTPROSTHESIS GARMENT||66.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8002|L8002 - BRST PRSTH BRA & BILAT FORM||182.22|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8001|L8001 - BREAST PROSTHESIS BRA & FORM||138.53|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L8000|L8000 - MASTECTOMY BRA||48.04|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L7700|L7700 - PROS SOC INSERT GASKET/SEAL||125.49|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L7405|L7405 - ADD UE PROST S/D ACRYLIC||802.82|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L7404|L7404 - ADD UE PROST A/E ACRYLIC||613.82|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L7403|L7403 - ADD UE PROST B/E ACRYLIC||406.73|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L7402|L7402 - ADD UE PROST S/D ULTLITE MAT||409.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L7401|L7401 - ADD UE PROST A/E ULTLITE MAT||378.95|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L7400|L7400 - ADD UE PROST BE/WD- ULTLITE||338.5|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L7368|L7368 - LITHIUM ION BATTERY CHARGER||557.39|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L7367|L7367 - REPLACEMNT LITHIUM IONBATTER||429.96|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L7366|L7366 - BATTERY CHRGR 12 VOLT UTAH/E||586.21|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L7364|L7364 - TWELVE VOLT BATTERY UTAH/EQU||435.18|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L7362|L7362 - BATTERY CHRGR SIX VOLT OTTO||273.62|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L7360|L7360 - SIX VOLT BAT OTTO BOCK/EQ EA||260.59|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L7259|L7259 - ELECTRONIC WRIST ROTATOR ANY||3490.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L7191|L7191 - ELBOW CHILD MYOELECTRONIC CT||10094.58|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L7190|L7190 - ELBOW ADOLESCENT MYOELECTRON||8430.36|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L7186|L7186 - ELECTRON ELBOW CHILD SWITCH||9660.44|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L7185|L7185 - ELECTRON ELBOW ADOLESCENT SW||8026.31|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L7181|L7181 - ELECTRONIC ELBO SIMULTANEOUS||44251.93|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L7180|L7180 - ELECTRONIC ELBOW SEQUENTIAL||35676.52|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L7170|L7170 - ELECTRONIC ELBOW HOSMER SWIT||8127.81|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L7045|L7045 - PEDIATRIC ELECTRIC HOOK||1765.23|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L7040|L7040 - PREHENSILE ACTUATOR||3078.9|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L7009|L7009 - ADULT ELECTRIC HOOK||3834.42|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L7008|L7008 - PEDIATRIC ELECTRIC HAND||5914.81|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L7007|L7007 - ADULT ELECTRIC HAND||3758.07|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6975|L6975 - INTERSCAP-THOR MYOELECTRONIC||17958.84|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6970|L6970 - INTERSCAPULAR-THOR SWITCH CT||16420.6|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6965|L6965 - SHLDR DISARTIC MYOELECTRONIC||15758.48|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6960|L6960 - SHLDR DISARTIC SWITCH CONTRO||14775.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6955|L6955 - ABOVE ELBOW MYOELECTRONIC CT||13043.81|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6950|L6950 - ABOVE ELBOW SWITCH CONTROL||10891.29|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6945|L6945 - ELBOW DISART MYOELECTRONIC C||11708.06|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6940|L6940 - ELBOW DISARTICULATION SWITCH||9582|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6935|L6935 - BELOW ELBOW MYOELECTRONIC CT||9963.9|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6930|L6930 - BELOW ELBOW SWITCH CONTROL||7333.73|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6925|L6925 - WRIST DISART MYOELECTRONIC C||9811.64|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6920|L6920 - WRIST DISARTICUL SWITCH CTRL||7288.54|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6915|L6915 - HAND RESTORATION REPLACMNT G||835.97|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6910|L6910 - HAND RESTORATION NO FINGERS||1658.06|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6905|L6905 - HAND RESTORATION MULTIPLE FI||1939.03|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6900|L6900 - HAND RESTORAT THUMB/1 FINGER||1950.11|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6895|L6895 - CUSTOM GLOVE FOR TERM DEVICE||683.35|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6890|L6890 - PREFAB GLOVE FOR TERM DEVICE||185.76|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6885|L6885 - REPLC SOCKT SHLDR DIS/INTERC||3847.18|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6884|L6884 - REPLC SOCKT ABOVE ELBOW DISA||2572.24|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6883|L6883 - REPLC SOCKT BELOW E/W DISA||1733.07|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6882|L6882 - MICROPROCESSOR CONTROL UPLMB||3424.96|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6881|L6881 - TERM DEV AUTO GRASP FEATURE||4515.12|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6880|L6880 - ELEC HAND IND ART DIGITS||26387.37|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6810|L6810 - TERM DEV PRECISION PINCH DEV||210.61|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6805|L6805 - TERM DEV MODIFIER WRIST UNIT||371.58|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6722|L6722 - HOOK/HAND- HVY DTY- VOL CLOS||2239.28|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6721|L6721 - HOOK/HAND- HVY DTY- VOL OPEN||2597.57|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6715|L6715 - TERM DEVICE- MULTI ART DIGIT||3486.82|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6714|L6714 - PED TERM DEV- HAND- VOL CLOS||1461.45|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6713|L6713 - PED TERM DEV- HAND- VOL OPEN||1725.41|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6712|L6712 - PED TERM DEV- HOOK- VOL CLOS||1367.13|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6711|L6711 - PED TERM DEV- HOOK- VOL OPEN||742.51|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6709|L6709 - TERM DEV MECH HAND VOL CLOSE||1323.14|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6708|L6708 - TERM DEV MECH HAND VOL OPEN||918.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6707|L6707 - TERM DEV MECH HOOK VOL CLOSE||1404.54|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6706|L6706 - TERM DEV MECH HOOK VOL OPEN||381.06|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6704|L6704 - TERM DEV- SPORT/REC/WORK ATT||639.58|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6703|L6703 - TERM DEV- PASSIVE HAND MITT||397.03|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6698|L6698 - BELOW/ABOVE ELBOW LOCK MECH||627.99|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6697|L6697 - CUS ELBO SKT IN NOT CON/ATYP||1452.76|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6696|L6696 - CUS ELBO SKT IN FOR CON/ATYP||1452.76|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6695|L6695 - ELBOW SOCKET INS USE W/O LCK||647.11|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6694|L6694 - ELBOW SOCKET INS USE W/LOCK||776.56|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6693|L6693 - LOCKINGELBOW FOREARM CNTRBAL||3135.42|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6692|L6692 - SILICONE GEL INSERT OR EQUAL||610.74|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6691|L6691 - REMOVABLE INSERT EACH||378.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6690|L6690 - FRAME TYP SOCK INTERSCAP-THO||817.51|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6689|L6689 - FRAME TYP SOCKET SHOULDER DI||750.2|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6688|L6688 - FRAME TYP SOCK ABOVE ELB/DIS||626.15|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6687|L6687 - FRAME TYP SOCKET BEL ELBOW/W||629.95|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6686|L6686 - SUCTION SOCKET||859.67|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6684|L6684 - TEST SOCKET SHLDR DISART/THO||380.68|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6682|L6682 - TEST SOCK ELBW DISART/ABOVE||280.15|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6680|L6680 - TEST SOCK WRIST DISART/BEL E||253.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6677|L6677 - UE TRIPLE CONTROL HARNESS||327.67|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6676|L6676 - HARNESS FIGURE OF 8 DUAL CON||151.6|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6675|L6675 - HARNESS FIGURE OF 8 SING CON||131.16|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6672|L6672 - HARNESS CHEST/SHLDER SADDLE||220.7|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6670|L6670 - HOOK TO HAND CABLE ADAPTER||55.61|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6665|L6665 - TEFLON OR EQUAL CABLE LINING||50.3|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6660|L6660 - HEAVY DUTY CONTROL CABLE||100.25|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6655|L6655 - STANDARD CONTROL CABLE EXTRA||89.45|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6650|L6650 - SHOULDER UNIVERSAL JOINT||455.11|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6648|L6648 - EXT PWRD SHLDER LOCK/UNLOCK||3592.54|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6647|L6647 - SHOULDER LOCK ACTUATOR||573.46|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6646|L6646 - MULTIPO LOCKING SHOULDER JNT||3483.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6645|L6645 - SHOULDER FLEXION-ABDUCTION J||438.35|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6642|L6642 - EXCURSION AMPLIFIER LEVER TY||237.47|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6641|L6641 - EXCURSION AMPLIFIER PULLEY T||175.2|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6640|L6640 - SHOULDER ABDUCTION JOINT PAI||364.49|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6638|L6638 - ELEC LOCK ON MANUAL PW ELBOW||2761.85|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6637|L6637 - NUDGE CONTROL ELBOW LOCK||410.29|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6635|L6635 - LIFT ASSIST FOR ELBOW||192.36|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6632|L6632 - LATEX SUSPENSION SLEEVE EACH||81.74|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6630|L6630 - STAINLESS STEEL ANY WRIST||235.37|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6629|L6629 - LAMINATION COLLAR W/ COUPLIN||159.78|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6628|L6628 - QUICK DISCONN HOOK ADAPTER O||523.18|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6625|L6625 - ROTATION WRST W/ CABLE LOCK||663.68|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6624|L6624 - FLEX/EXT/ROTATION WRIST UNIT||4159.31|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6623|L6623 - SPRING-ASS ROT WRST W/ LATCH||934.08|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6621|L6621 - FLEX/EXT WRIST W/WO FRICTION||2526.1|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6620|L6620 - FLEXION/EXTENSION WRIST UNIT||334.86|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6616|L6616 - DISCONNECT INSERT LOCKING WR||77.56|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6615|L6615 - DISCONNECT LOCKING WRIST UNI||209.3|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6611|L6611 - ADDITIONAL SWITCH- EXT POWER||454.69|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6610|L6610 - FLEXIBLE METAL HINGE PAIR||194.25|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6605|L6605 - SINGLE PIVOT HINGE PAIR||202.27|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6600|L6600 - POLYCENTRIC HINGE PAIR||204.85|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6590|L6590 - SHDR FAIR LEAD CABLE DIRECT||3027.65|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6588|L6588 - SHDR FAIR LEAD CABLE MOLDED||3187.54|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6586|L6586 - ELBOW FAIR LEAD CABLE DIR FO||2425.87|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6584|L6584 - ELBOW FAIR LEAD CABLE MOLDED||2592.18|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6582|L6582 - WRIST/ELBOW BOWDEN CBL DIR F||1652.91|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6580|L6580 - WRIST/ELBOW BOWDEN CABLE MOL||1824.93|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6570|L6570 - SCAP THORAC PROSTH TISS SHAP||4780.09|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6550|L6550 - SHLDR DISAR PROSTH TISS SHAP||4257.55|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6500|L6500 - ABOVE ELBOW PROSTH TISS SHAP||3542.01|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6450|L6450 - ELB DISART PROSTH TISS SHAP||3385.57|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6400|L6400 - BELOW ELBOW PROSTH TISS SHAP||2534.16|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6388|L6388 - POSTOP APPLICAT RIGID DSG ON||480.13|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6386|L6386 - POSTOP EA CAST CHG & REALIGN||438.58|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6384|L6384 - POSTOP DSG CAST CHG SHLDER/T||2776.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6382|L6382 - POSTOP DSG CAST CHG ELB DIS/||2006.9|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6380|L6380 - POSTOP DSG CAST CHG WRST/ELB||1333.98|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6370|L6370 - THORACIC PASSIVE RESTOR CAP||2302.04|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6360|L6360 - THORACIC PASSIVE RESTOR COMP||3847.18|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6350|L6350 - THORACIC INTERN LOCK ELBOW||4277.77|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6320|L6320 - SHOULDER PASSIVE RESTOR CAP||1919.21|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6310|L6310 - SHOULDER PASSIVE RESTOR COMP||3513.26|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6300|L6300 - SHLDER DISART INT LOCK ELBOW||4068.85|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6250|L6250 - ELBOW INTER LOC ELBOW FORARM||3121.73|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6205|L6205 - ELBOW MOLDED W/ EXPAND INTER||3977.03|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6200|L6200 - ELBOW MOLD OUTSID LOCK HINGE||2979.41|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6130|L6130 - ELBOW STUMP ACTIVATED LOCK H||2827.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6120|L6120 - ELBOW MOLD DOUB SPLT SOC STE||2598.08|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6110|L6110 - ELBOW MOLD SOCK SUSPENSION T||2229.42|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6100|L6100 - ELB MOLD SOCK FLEX HINGE PAD||2101.91|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6055|L6055 - WRST MOLD SOCK W/EXP INTERFA||2891.49|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6050|L6050 - WRST MLD SCK FLX HNG TRI PAD||2074.61|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6026|L6026 - PART HAND MYO EXCLU TERM DEV||5459.44|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6020|L6020 - PART HAND NO FINGERS||1505.58|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6010|L6010 - PART HAND LITTLE/RING||1614.83|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L6000|L6000 - PART HAND THUMB REM||1451.09|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5990|L5990 - USER ADJUSTABLE HEEL HEIGHT||2003.65|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5988|L5988 - VERTICAL SHOCK REDUCING PYLO||2206.3|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5987|L5987 - SHANK FT W VERT LOAD PYLON||7944.91|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5986|L5986 - MULTI-AXIAL ROTATION UNIT||692.06|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5985|L5985 - LWR EXT DYNAMIC PROSTH PYLON||311.87|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5984|L5984 - ENDOSKELETAL AXIAL ROTATION||622.15|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5982|L5982 - EXOSKELETAL AXIAL ROTATION U||631.37|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5981|L5981 - FLEX-WALK SYS LOW EXT PROSTH||3271.27|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5980|L5980 - FLEX FOOT SYSTEM||4049.28|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5979|L5979 - MULTI-AXIAL ANKLE/FT PROSTH||2491.96|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5978|L5978 - FT PROSTH MULTIAXIAL ANKL/FT||318.71|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5976|L5976 - ENERGY STORING FOOT||611.62|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5975|L5975 - COMBO ANKLE/FOOT PROSTHESIS||512.03|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5974|L5974 - FOOT SINGLE AXIS ANKLE/FOOT||254.5|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5973|L5973 - ANK-FOOT SYS DORS-PLANT FLEX||19001.2|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5972|L5972 - FLEXIBLE KEEL FOOT||414.3|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5971|L5971 - SACH FOOT- REPLACEMENT||221.8|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5970|L5970 - FOOT EXTERNAL KEEL SACH FOOT||221.8|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5968|L5968 - MULTIAXIAL ANKLE W DORSIFLEX||4013.39|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5966|L5966 - HIP FLEXIBLE COVER SYSTEM||1303.3|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5964|L5964 - ABOVE KNEE FLEX COVER SYSTEM||1022.8|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5962|L5962 - BELOW KNEE FLEX COVER SYSTEM||692.89|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5961|L5961 - ENDO POLY HIP- PNEU/HYD/ROT||5020.43|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5960|L5960 - ENDO HIP ULTRA-LIGHT MATERIA||1052.85|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5950|L5950 - ENDO AK ULTRA-LIGHT MATERIAL||856.55|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5940|L5940 - ENDO BK ULTRA-LIGHT MATERIAL||547.81|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5930|L5930 - HIGH ACTIVITY KNEE FRAME||3717.35|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5925|L5925 - ABOVE KNEE MANUAL LOCK||489.28|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5920|L5920 - ENDO AK/HIP ALIGNABLE SYSTEM||579.47|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5910|L5910 - ENDO BELOW KNEE ALIGNABLE SY||395.54|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5859|L5859 - KNEE-SHIN PRO FLEX/EXT CONT||16024.39|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5858|L5858 - STANCE PHASE ONLY||20525.88|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5857|L5857 - ELEC KNEE-SHIN SWING ONLY||9407.62|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5856|L5856 - ELEC KNEE-SHIN SWING/STANCE||26512.55|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5855|L5855 - MECH HIP EXTENSION ASSIST||375.41|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5850|L5850 - ENDO AK/HIP KNEE EXTENS ASSI||139.71|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5848|L5848 - KNEE-SHIN SYS HYDRAUL STANCE||1187.58|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5845|L5845 - KNEE-SHIN SYS STANCE FLEXION||1979.55|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5840|L5840 - MULTI-AXIAL KNEE/SHIN SYSTEM||3831.78|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5830|L5830 - ENDO KNEE-SHIN PNEUM/SWG PHA||2072.35|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5828|L5828 - ENDO KNEE-SHIN FLUID SWG/STA||3084.09|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5826|L5826 - MINIATURE KNEE JOINT||3448.98|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5824|L5824 - ENDO KNEE-SHIN FLUID SWING P||1674.84|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5822|L5822 - ENDO KNEE-SHIN PNEUM SWG FRC||1859.78|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5818|L5818 - ENDO KNEE-SHIN FRCT SWG & ST||1048.79|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5816|L5816 - ENDO KNEE-SHIN POLYC MCH STA||934.39|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5814|L5814 - ENDO KNEE-SHIN HYDRAL SWG PH||4101.67|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5812|L5812 - ENDO KNEE-SHIN FRCT SWG & ST||617.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5811|L5811 - ENDO KNEE-SHIN MNL LCK ULTRA||796.5|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5810|L5810 - ENDOSKEL KNEE-SHIN MNL LOCK||531.71|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5795|L5795 - EXOSKEL HIP ULTRA-LIGHT MATE||1563.47|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5790|L5790 - EXOSKELETAL AK ULTRA-LIGHT M||785.27|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5785|L5785 - EXOSKELETAL BK ULTRALT MATER||702.87|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5782|L5782 - HD LOW LIMB PROS VACUUM PUMP||4658.62|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5781|L5781 - LOWER LIMB PROS VACUUM PUMP||4418.98|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5780|L5780 - KNEE-SHIN PNEUM/HYDRA PNEUM||1250.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5728|L5728 - KNEE-SHIN FLUID SWG & STANCE||2598.7|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5726|L5726 - KNEE-SHIN EXT JNTS FLD SWG E||1899.82|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5724|L5724 - KNEE-SHIN EXO FLUID SWING PH||1648.47|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5722|L5722 - KNEE-SHIN PNEUM SWG FRCT EXO||1051.07|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5718|L5718 - KNEE-SHIN EXO FRCT SWG & STA||994.9|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5716|L5716 - KNEE-SHIN EXO MECH STANCE PH||795.98|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5714|L5714 - KNEE-SHIN EXO VARIABLE FRICT||491.29|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5712|L5712 - KNEE-SHIN EXO FRICT SWG & ST||478.3|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5711|L5711 - KNEE-SHIN EXO MNL LOCK ULTRA||570.84|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5710|L5710 - KNE-SHIN EXO SNG AXI MNL LOC||408.43|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5707|L5707 - CUSTOM SHAPE CVR HIP DISART||1351.76|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5706|L5706 - CUSTOM SHAPE CVR KNEE DISART||1025.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5705|L5705 - CUSTOM SHAPE COVER AK||1045.99|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5704|L5704 - CUSTOM SHAPE COVER BK||585.4|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5703|L5703 - SYMES ANKLE W/O (SACH) FOOT||2460.37|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5702|L5702 - REPLACE SOCKET HIP||4754.25|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5701|L5701 - REPLACE SOCKET ABOVE KNEE||3757.87|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5700|L5700 - REPLACE SOCKET BELOW KNEE||3129.14|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5699|L5699 - SHOULDER HARNESS||258.27|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5698|L5698 - AK/KNEE DISARTIC SILESIAN BA||143.37|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5697|L5697 - AK/KNEE DISARTIC PELVIC BAND||87.68|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5696|L5696 - AK/KNEE DISARTIC PELVIC JOIN||202.07|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5695|L5695 - AK SLEEVE SUSP NEOPRENE/EQUA||182.91|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5694|L5694 - AK PELVIC CONTROL BELT PAD/L||198.12|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5692|L5692 - AK PELVIC CONTROL BELT LIGHT||145.12|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5690|L5690 - BK WAIST BELT PADDED AND LIN||106.87|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5688|L5688 - BK WAIST BELT WEBBING||66.71|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5686|L5686 - BK BACK CHECK||55.8|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5685|L5685 - BELOW KNEE SUS/SEAL SLEEVE||141.46|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5684|L5684 - BK FORK STRAP||52.57|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5683|L5683 - INITIAL CUSTOM SOCKET INSERT||1452.76|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5682|L5682 - BK THIGH LACER GLUT/ISCHIA M||683|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5681|L5681 - INTL CUSTM CONG/LATYP INSERT||1452.76|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5680|L5680 - BK THIGH LACER NON-MOLDED||361.99|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5679|L5679 - SOCKET INSERT W/O LOCK MECH||647.11|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5678|L5678 - BK JOINT COVERS PAIR||43.37|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5677|L5677 - BK KNEE JOINTS POLYCENTRIC P||538.48|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5676|L5676 - BK KNEE JOINTS SINGLE AXIS P||395.75|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5673|L5673 - SOCKET INSERT W LOCK MECH||776.56|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5672|L5672 - BK REMOVABLE MEDIAL BRIM SUS||325.66|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5671|L5671 - BK/AK LOCKING MECHANISM||627.99|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5670|L5670 - BK MOLDED SUPRACONDYLAR SUSP||296.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5668|L5668 - BK MOLDED DISTAL CUSHION||123.3|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5666|L5666 - BELOW KNEE CUFF SUSPENSION||76.45|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5665|L5665 - MULTI-DUROMETER BELOW KNEE||559.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5661|L5661 - MULTI-DUROMETER SYMES||664.61|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5658|L5658 - SOCKET INSERT ABOVE KNEE||397.1|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5656|L5656 - SOCKET INSERT KNEE ARTICULAT||411.75|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5655|L5655 - SOCKET INSERT BELOW KNEE||306.94|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5654|L5654 - SOCKET INSERT SYMES||362.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5653|L5653 - KNEE DISART EXPAND WALL SOCK||635.62|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5652|L5652 - SUCTION SUSP AK/KNEE DISART||476.15|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5651|L5651 - AK FLEX INNER SOCKET EXT FRA||1311.55|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5650|L5650 - TOT CONTACT AK/KNEE DISART S||533.16|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5649|L5649 - ISCH CONTAINMT/NARROW M-L SO||2605.44|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5648|L5648 - ABOVE KNEE CUSHION SOCKET||719.03|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5647|L5647 - BELOW KNEE SUCTION SOCKET||868.73|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5646|L5646 - BELOW KNEE CUSHION SOCKET||598.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5645|L5645 - BK FLEX INNER SOCKET EXT FRA||871.4|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5644|L5644 - ABOVE KNEE WOOD SOCKET||645.06|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5643|L5643 - HIP FLEX INNER SOCKET EXT FR||1699.83|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5642|L5642 - ABOVE KNEE LEATHER SOCKET||676.64|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5640|L5640 - KNEE DISARTICULAT LEATHER SO||698.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5639|L5639 - BELOW KNEE WOOD SOCKET||1224.47|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5638|L5638 - BELOW KNEE LEATHER SOCKET||549.6|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5637|L5637 - BELOW KNEE TOTAL CONTACT||315.5|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5636|L5636 - SYMES TYPE MEDIAL OPENING SO||278.28|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5634|L5634 - SYMES TYPE POSTER OPENING SO||332.21|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5632|L5632 - SYMES TYPE PTB BRIM DESIGN S||267.81|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5631|L5631 - AK/KNEE DISARTIC ACRYLIC SOC||479.86|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5630|L5630 - SYME TYP EXPANDABL WALL SCKT||490.14|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5629|L5629 - BELOW KNEE ACRYLIC SOCKET||347.07|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5628|L5628 - TEST SOCKET HEMIPELVECTOMY||556.77|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5626|L5626 - TEST SOCKET HIP DISARTICULAT||520.71|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5624|L5624 - TEST SOCKET ABOVE KNEE||397.05|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5622|L5622 - TEST SOCKET KNEE DISARTICULA||395.92|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5620|L5620 - TEST SOCKET BELOW KNEE||303.62|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5618|L5618 - TEST SOCKET SYMES||326.9|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5617|L5617 - AK/BK SELF-ALIGNING UNIT EA||617.93|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5616|L5616 - AK UNIV MULTIPLEX SYS FRICT||1486.66|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5614|L5614 - 4-BAR LINK ABOVE KNEE W/SWNG||1863.67|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5613|L5613 - AK 4 BAR LING W/HYDRAUL SWIG||2751.08|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5611|L5611 - AK 4 BAR LINK W/FRIC SWING||1759.6|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5610|L5610 - ABOVE KNEE HYDRACADENCE||2261.12|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5600|L5600 - HIP DISART SACH LAMINAT MOLD||4985.76|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5595|L5595 - HIP DISARTIC SACH THERMOPLS||4638.11|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5590|L5590 - PREP AK ISCHIAL LAMINATED||2625.39|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5585|L5585 - PREP AK ISCHIAL OPEN END||3170.52|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5580|L5580 - PREP AK ISCHIAL THERMO MOLD||2576.28|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5570|L5570 - PREP AK ISCHIAL DIRECT FORM||2206.79|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5560|L5560 - PREP AK ISCHIAL PLAST MOLDED||2122.64|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5540|L5540 - PREP BK PTB LAMINATED SOCKET||1976.7|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5535|L5535 - PREP BK PTB OPEN END SOCKET||1852.03|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5530|L5530 - PREP BK PTB THERMOPLS MOLDED||1886.36|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5520|L5520 - PERP BK PTB THERMOPLS DIRECT||1570.53|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5510|L5510 - PREP BK PTB PLASTER MOLDED||1589.99|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5505|L5505 - INIT AK ISCHAL PLSTR DIRECT||1939.9|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5500|L5500 - INIT BK PTB PLASTER DIRECT||1402.64|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5460|L5460 - POSTOP APP NON-WGT BEAR DSG||595.68|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5450|L5450 - POSTOP APP NON-WGT BEAR DSG||447.1|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5430|L5430 - POSTOP DSG AK EA ADD CAST CH||549.57|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5420|L5420 - POSTOP DSG & 1 CAST CHG AK/D||1822.62|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5410|L5410 - POSTOP DSG BK EA ADD CAST CH||456.31|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5400|L5400 - POSTOP DRESS & 1 CAST CHG BK||1487.3|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5341|L5341 - HEMIPELVECTOMY CANADIAN SACH||5776.08|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5331|L5331 - HIP DISART CANADIAN SACH FT||5548.57|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5321|L5321 - AK OPEN END SACH||4354.54|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5312|L5312 - KNEE DISART- SACH FT- ENDO||4300.18|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5301|L5301 - BK MOLD SOCKET SACH FT ENDO||3004.11|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5280|L5280 - HEMIPELVECT CANAD SING AXIS||5598.2|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5270|L5270 - TILT TABLE LOCKING HIP SING||5641.39|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5250|L5250 - HIP CANAD SING AXI CONS FRIC||5666.54|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5230|L5230 - FEM FOCAL DEFIC CONSTANT FRI||4154.63|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5220|L5220 - NO KNEE JOINT WITH ARTIC ALI||3012.36|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5210|L5210 - NO KNEE/ANKLE JOINTS W/ FT B||2650.13|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5200|L5200 - KNE SING AXIS FRIC SHIN SACH||3994.77|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5160|L5160 - MOLD SOCKET BENT KNEE SHIN S||4171.46|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5150|L5150 - MOLD SCKT EXT KNEE SHIN SACH||3835.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5105|L5105 - PLAST SOCKET JTS/THGH LACER||3793.99|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5100|L5100 - MOLDED SOCKET SHIN SACH FOOT||2628.13|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5060|L5060 - SYMES MET FR LEATH SOCKET AR||3016.46|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5050|L5050 - ANK SYMES MOLD SCKT SACH FT||2622.33|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5020|L5020 - TIBIAL TUBERCLE HGT W/ TOE F||2370.62|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5010|L5010 - MOLD SOCKET ANK HGT W/ TOE F||1395.94|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L5000|L5000 - SHO INSERT W ARCH TOE FILLER||577.97|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L4631|L4631 - AFO- WALK BOOT TYPE- CUS FAB||1644.94|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L4398|L4398 - FOOT DROP SPLINT PRE OTS||85.15|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L4397|L4397 - STATIC OR DYNAMI AFO PRE OTS||185.01|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L4396|L4396 - STATIC OR DYNAMI AFO PRE CST||185.01|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L4394|L4394 - REPLACE FOOT DROP SPINT||18.94|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L4392|L4392 - REPLACE AFO SOFT INTERFACE||25.96|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L4387|L4387 - NON-PNEUM WALK BOOT PRE OTS||174.77|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L4386|L4386 - NON-PNEUM WALK BOOT PRE CST||174.77|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L4370|L4370 - PNEUM FULL LEG SPLNT PRE OTS||193.52|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L4361|L4361 - PNEUMA/VAC WALK BOOT PRE OTS||301.58|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L4360|L4360 - PNEUMAT WALKING BOOT PRE CST||301.58|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L4350|L4350 - ANKLE CONTROL ORTHO PRE OTS||107.79|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L4130|L4130 - REPLACE PRETIBIAL SHELL||598.31|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L4110|L4110 - REPL LEATH CUFF KAFO-AFO CAL||86.93|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L4100|L4100 - REPL LEATH CUFF KAFO PROX TH||109.39|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L4090|L4090 - REPL MET BAND KAFO-AFO CALF/||96.99|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L4080|L4080 - REPL MET BAND KAFO-AFO PROX||109.57|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L4070|L4070 - REPLACE PROX & DIST UPRIGHT||310.81|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L4060|L4060 - REPLACE HIGH ROLL CUFF||325.78|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L4055|L4055 - REPLACE NON-MOLDED CALF LACE||274.05|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L4050|L4050 - REPLACE MOLDED CALF LACER||423.21|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L4045|L4045 - REPLACE NON-MOLDED THIGH LAC||336.27|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L4040|L4040 - REPLACE MOLDED THIGH LACER||418.44|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L4030|L4030 - REPLACE SOCKET BRIM CUST FIT||517.56|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L4020|L4020 - REPLACE QUADLAT SOCKET BRIM||940|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L4010|L4010 - REPLACE TRILATERAL SOCKET BR||752.55|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L4002|L4002 - REPLACE STRAP- ANY ORTHOSIS||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L4000|L4000 - REPL GIRDLE MILWAUKEE ORTH||1337.29|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3995|L3995 - SOCK FRACTURE OR EQUAL EACH||34.32|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3984|L3984 - UPPER EXT FX ORTHOSIS WRIST||408.96|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3982|L3982 - UPPER EXT FX ORTHOSIS RAD/UL||383.13|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3981|L3981 - UE FX ORTH SHOUL CAP FOREARM||1009.73|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3980|L3980 - UP EXT FX ORTHOS HUMERAL NOS||310.11|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3978|L3978 - SEWHFO AIRPLANE W/JNT(S) CF||1989.91|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3977|L3977 - SEWHFO CAP DESGN W/JNT(S) CF||1888.86|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3976|L3976 - SEWHFO AIRPLANE W/O JNTS CF||1685.43|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3975|L3975 - SEWHFO CAP DESIGN W/O JNT CF||1685.43|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3973|L3973 - SEWHO AIRPLANE W/JNT(S) CF||1989.91|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3971|L3971 - SEWHO CAP DESIGN W/JNT(S) CF||1888.86|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3967|L3967 - SEWHO AIRPLANE W/O JNTS CF||1989.91|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3962|L3962 - SEWHO ERBS PALSEY DESIGN ABD||860.97|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3961|L3961 - SEWHO CAP DESIGN W/O JNTS CF||1685.43|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3960|L3960 - SEWHO AIRPLAN DESIG ABDU POS||826.88|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3956|L3956 - ADD JOINT UPPER EXT ORTHOSIS||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3935|L3935 - FO NONTORSION JOINT CF||221.65|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3933|L3933 - FO W/O JOINTS CF||214.05|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3931|L3931 - WHFO NONTORSION JOINT PREFAB||204.3|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3930|L3930 - HFO NONTORSION JNTS PRE OTS||84.46|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3929|L3929 - HFO NONTORSION JNTS PRE CST||84.46|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3927|L3927 - FO PIP DIP NO JT SPR PRE OTS||35.11|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3925|L3925 - FO PIP DIP JNT/SPRNG PRE OTS||52.99|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3924|L3924 - HFO WITHOUT JOINTS PRE OTS||87.26|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3923|L3923 - HFO WITHOUT JOINTS PRE CST||87.26|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3921|L3921 - HFO W/JOINT(S) CF||322.2|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3919|L3919 - HO W/O JOINTS CF||271.71|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3918|L3918 - METACARP FX ORTHOSIS PRE OTS||105.97|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3917|L3917 - METACARP FX ORTHOSIS PRE CST||105.97|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3916|L3916 - WHO NONTORSION JNTS PRE OTS||533.26|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3915|L3915 - WHO NONTORSION JNTS PRE CST||533.26|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3913|L3913 - HFO W/O JOINTS CF||271.71|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3912|L3912 - HFO FLEXION GLOVE PRE OTS||96.4|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3908|L3908 - WHO COCK-UP NONMOLDE PRE OTS||60.1|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3906|L3906 - WHO W/O JOINTS CF||423.18|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3905|L3905 - WHO W/NONTORSION JNT(S) CF||994.83|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3904|L3904 - WHFO ELECTRIC CUSTOM FITTED||3577.06|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3901|L3901 - HINGE EXT/FLEX WRIST FINGER||1757.14|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3900|L3900 - HINGE EXTENSION/FLEX WRIST/F||1567.12|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3809|L3809 - WHFO W/O JOINTS PRE OTS||250.85|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3808|L3808 - WHFO- RIGID W/O JOINTS||335.06|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3807|L3807 - WHFO W/O JOINTS PRE CST||250.85|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3806|L3806 - WHFO W/JOINT(S) CUSTOM FAB||455.68|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3766|L3766 - EWHFO W/JOINT(S) CF||1362.11|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3765|L3765 - EWHFO RIGID W/O JNTS CF||1286.3|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3764|L3764 - EWHO W/JOINT(S) CF||794.3|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3763|L3763 - EWHO RIGID W/O JNTS CF||796.46|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3762|L3762 - EO RIGID W/O JOINTS PRE OTS||107.87|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3761|L3761 - EO- ADJ LOCK JOINT PREFAB OT||510.73|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3760|L3760 - EO ADJ JT PREFAB CUSTOM FIT||501.66|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3740|L3740 - CUFFS ADJ LOCK W/ ACTIVE CON||1073.49|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3730|L3730 - FOREARM/ARM CUFFS EXT/FLEX A||955.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3720|L3720 - FOREARM/ARM CUFFS FREE MOTIO||725.63|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3710|L3710 - EO ELAS W/METAL JNTS PRE OTS||145.44|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3702|L3702 - EO W/O JOINTS CF||289.67|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3675|L3675 - SO VEST CANVAS/WEB PRE OTS||176.05|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3674|L3674 - SO AIRPLANE W/WO JOINT CF||1185.78|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3671|L3671 - SO CAP DESIGN W/O JNTS CF||903.89|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3670|L3670 - SO ACRO/CLAV CAN WEB PRE OTS||143.7|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3660|L3660 - SO 8 AB RSTR CAN/WEB PRE OTS||103.1|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3650|L3650 - SO 8 ABD RESTRAINT PRE OTS||60.04|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3640|L3640 - SHOE DENNIS BROWNE SPLINT BO||47.63|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3630|L3630 - TRANS SHOE SOLID STIRRUP NEW||110.75|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3620|L3620 - TRANS SHOE SOLID STIRRUP EXI||84.13|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3610|L3610 - TRANS SHOE CALIPER PLATE NEW||110.75|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3600|L3600 - TRANS SHOE CALIP PLATE EXIST||84.13|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3595|L3595 - ORTHO SHOE ADD MARCH BAR||46.25|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3590|L3590 - O SHOE CONVERT TO SOF COUNTE||58.88|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3580|L3580 - O SHOE ADD INSTEP VELCRO CLO||71.48|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3570|L3570 - O SHOE ADD INSTEP EXTENSION||93.95|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3560|L3560 - O SHOE ADD HORSESHOE TOE TAP||25.21|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3550|L3550 - O SHOE ADD STANDARD TOE TAP||9.83|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3540|L3540 - ORTHO SHOE ADD FULL SOLE||56.09|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3530|L3530 - ORTHO SHOE ADD HALF SOLE||35.05|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3520|L3520 - O SHOE ADD FELT W LEATH INSL||35.05|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3510|L3510 - ORTHOPEDIC SHOE ADD RUB INSL||32.27|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3500|L3500 - ORTHO SHOE ADD LEATHER INSOL||32.27|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3480|L3480 - SHOE HEEL PAD & DEPRESS FOR||68.67|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3470|L3470 - SHOE HEEL THOMAS EXTEND TO B||68.67|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3465|L3465 - SHOE HEEL THOMAS WITH WEDGE||64.48|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3460|L3460 - SHOE HEEL NEW RUBBER STANDAR||37.84|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3455|L3455 - SHOE HEEL NEW LEATHER STANDA||44.87|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3450|L3450 - SHOE HEEL SACH CUSHION TYPE||116.32|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3440|L3440 - HEEL LEATHER REINFORCED||84.13|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3430|L3430 - SHO HEEL COUNT PLAST REINFOR||176.63|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3420|L3420 - FULL SOLE/HEEL WEDGE BTWEEN||60.26|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3410|L3410 - SHOE METATARSAL BAR BETWEEN||102.36|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3400|L3400 - SHOE METATARSAL BAR WEDGE RO||44.87|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3390|L3390 - SHOE OUTFLARE WEDGE||54.68|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3380|L3380 - SHOE CLUBFOOT WEDGE||54.68|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3370|L3370 - SHOE SOLE WEDGE BETWEEN SOLE||54.68|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3360|L3360 - SHOE SOLE WEDGE OUTSIDE SOLE||39.25|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3350|L3350 - SHOE HEEL WEDGE||25.21|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3340|L3340 - SHOE WEDGE SACH||93.95|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3334|L3334 - SHOE LIFTS ELEVATION HEEL /I||42.04|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3332|L3332 - SHOE LIFTS TAPERED TO ONE-HA||81.31|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3330|L3330 - LIFTS ELEVATION METAL EXTENS||623.81|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3310|L3310 - SHOE LIFT ELEV HEEL/SOLE NEO||89.73|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3300|L3300 - SHO LIFT TAPER TO METATARSAL||57.47|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3260|L3260 - AMBULATORY SURGICAL BOOT EAC||15|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3225|L3225 - MAN'S SHOE OXFORD BRACE||69.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3224|L3224 - WOMAN'S SHOE OXFORD BRACE||60.28|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3170|L3170 - FOOT PLAS HEEL STABI PRE OTS||56.09|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3150|L3150 - ABDUCT ROTATION BAR W/O SHOE||89.73|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3140|L3140 - ABDUCTION ROTATION BAR SHOE||98.14|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3100|L3100 - HALLUS-VALGUS NT DYN PRE OTS||47.63|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3090|L3090 - ARCH SUPP ATT TO SHOE LONG/M||44.87|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3080|L3080 - ARCH SUPP ATT TO SHOE METATA||35.05|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3070|L3070 - ARCH SUPRT ATT TO SHO LONGIT||35.05|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3060|L3060 - FOOT ARCH SUPP LONGITUD/META||81.31|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3050|L3050 - FOOT ARCH SUPP PREMOLD METAT||51.88|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3040|L3040 - FT ARCH SUPRT PREMOLD LONGIT||51.88|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3031|L3031 - FOOT LAMIN/PREPREG COMPOSITE||134.99|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3030|L3030 - FOOT ARCH SUPPORT REMOV PREM||84.13|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3020|L3020 - FOOT LONGITUD/METATARSAL SUP||218.7|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3010|L3010 - FOOT LONGITUDINAL ARCH SUPPO||192.05|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3003|L3003 - FOOT INSERT SILICONE GEL EAC||192.05|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3002|L3002 - FOOT INSERT PLASTAZOTE OR EQ||178.03|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3001|L3001 - FOOT INSERT REMOV MOLDED SPE||145.77|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L3000|L3000 - FT INSERT UCB BERKELEY SHELL||346.26|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2850|L2850 - FEMORAL LGTH SOCK FX OR EQUA||63.47|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2840|L2840 - TIBIAL LENGTH SOCK FX OR EQU||55.87|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2830|L2830 - SOFT INTERFACE ABOVE KNEE SE||100.11|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2820|L2820 - SOFT INTERFACE BELOW KNEE SE||89.02|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2810|L2810 - KNEE CONTROL CONDYLAR PAD||80.06|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2800|L2800 - KNEE CAP MEDIAL OR LATERAL P||109.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2795|L2795 - KNEE CONTROL FULL KNEECAP||87.1|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2785|L2785 - DROP LOCK RETAINER EACH||43.32|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2780|L2780 - NON-CORROSIVE FINISH||73.68|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2768|L2768 - ORTHO SIDEBAR DISCONNECT||143.63|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2760|L2760 - EXTENSION PER EXTENSION PER||62.28|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2755|L2755 - CARBON GRAPHITE LAMINATION||144.06|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2750|L2750 - PLATING CHROME/NICKEL PR BAR||85.69|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2680|L2680 - THORAC CONT LAT SUPPORT UPRI||160.41|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2670|L2670 - THORAC CONT PARASPINAL UPRIG||174.87|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2660|L2660 - THORACIC CONTROL THORACIC BA||191.06|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2650|L2650 - PELV & THOR CONTROL GLUTEAL||123.02|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2640|L2640 - PELVIC CONTROL BAND & BELT B||344.49|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2630|L2630 - PELVIC CONTROL BAND & BELT U||253.84|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2628|L2628 - METAL FRAME RECIPRO HIP & CA||2068.28|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2627|L2627 - PLASTIC MOLD RECIPRO HIP & C||1760.71|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2624|L2624 - HIP ADJ FLEX EXT ABDUCT CONT||427.36|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2622|L2622 - HIP JOINT ADJUSTABLE FLEXION||314.36|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2620|L2620 - PELVIC CONTROL HIP HEAVY DUT||274.09|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2610|L2610 - HIP CLEVIS/THRUST BEARING LO||248.95|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2600|L2600 - HIP CLEVIS/THRUST BEARING FR||210.53|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2580|L2580 - PELVIC CONTROL PELVIC SLING||617.12|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2570|L2570 - HIP CLEVIS TYPE 2 POSIT JNT||651.03|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2550|L2550 - THIGH/WGHT BEAR HIGH ROLL CU||294.41|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2540|L2540 - THIGH/WGHT BEAR LACER MOLDED||433.4|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2530|L2530 - THIGH/WGHT BEAR LACER NON-MO||240.86|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2526|L2526 - TH/WGHT BEAR NAR M-L BRIM CU||873.29|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2525|L2525 - TH/WGHT BEAR NAR M-L BRIM MO||1620.17|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2520|L2520 - TH/WGHT BEAR QUAD-LAT BRIM C||472.24|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2510|L2510 - TH/WGHT BEAR QUAD-LAT BRIM M||865.86|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2500|L2500 - THI/GLUT/ISCHIA WGT BEARING||323.39|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2492|L2492 - KNEE LIFT LOOP DROP LOCK RIN||104.54|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2430|L2430 - KNEE JNT RATCHET LOCK EA JNT||158|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2425|L2425 - KNEE DISC/DIAL LOCK/ADJ FLEX||158|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2415|L2415 - KNEE JOINT CAM LOCK EACH JOI||133.91|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2405|L2405 - KNEE JOINT DROP LOCK EA JNT||96.11|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2397|L2397 - SUSPENSION SLEEVE LOWER EXT||120.14|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2395|L2395 - OFFSET KNEE JOINT HEAVY DUTY||171.33|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2390|L2390 - OFFSET KNEE JOINT EACH||112.22|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2387|L2387 - ADD LE POLY KNEE CUSTOM KAFO||186.35|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2385|L2385 - STRAIGHT KNEE JOINT HEAVY DU||137.31|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2380|L2380 - TORSION STRAIGHT KNEE JOINT||126.2|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2375|L2375 - TORSION ANK & HALF SOLID STI||115.83|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2370|L2370 - PATTEN BOTTOM||263.15|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2360|L2360 - EXTENDED STEEL SHANK||53.04|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2350|L2350 - PROSTHETIC TYPE SOCKET MOLDE||913.42|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2340|L2340 - PRE-TIBIAL SHELL MOLDED TO P||558.77|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2335|L2335 - ANTERIOR SWING BAND||236.8|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2330|L2330 - LACER MOLDED TO PATIENT MODE||402.52|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2320|L2320 - NON-MOLDED LACER||210.92|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2310|L2310 - ABDUCTION BAR-STRAIGHT||126.11|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2300|L2300 - ABDUCTION BAR JOINTED ADJUST||280.9|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2280|L2280 - MOLDED INNER BOOT||497.63|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2275|L2275 - PLASTIC MOD LOW EXT PAD/LINE||133.95|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2270|L2270 - VARUS/VALGUS STRAP PADDED/LI||55.05|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2265|L2265 - LONG TONGUE STIRRUP||120.73|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2260|L2260 - REINFORCED SOLID STIRRUP||205.49|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2250|L2250 - FOOT PLATE MOLDED STIRRUP AT||364.25|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2240|L2240 - ROUND CALIPER AND PLATE ATTA||85.73|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2232|L2232 - ROCKER BOTTOM- CONTACT AFO||106.49|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2230|L2230 - SPLIT FLAT CALIPER STIRR & P||78.65|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2220|L2220 - DORSI & PLANTAR FLEX ASS/RES||90.8|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2210|L2210 - DORSIFLEXION ASSIST EACH JOI||79.09|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2200|L2200 - LIMITED ANKLE MOTION EA JNT||48.74|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2192|L2192 - PELVIC BAND & BELT THIGH FLA||365.5|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2190|L2190 - WAIST BELT||106.33|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2188|L2188 - QUADRILATERAL BRIM||409.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2186|L2186 - ADJ MOTION KNEE JNT LERMAN T||187.62|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2184|L2184 - LIMITED MOTION KNEE JOINT||169.31|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2182|L2182 - DROP LOCK KNEE||93.95|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2180|L2180 - PLAS SHOE INSERT W ANK JOINT||120.05|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2136|L2136 - KAFO FEMORAL FX CAST RIGID||1212.3|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2134|L2134 - KAFO FEM FX CAST SEMI-RIGID||991.46|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2132|L2132 - KAFO FEMORAL FX CAST SOFT||826.93|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2128|L2128 - KAFO FEM FX CAST MOLDED TO P||1757.79|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2126|L2126 - KAFO FEM FX CAST THERMOPLAS||1394.82|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2116|L2116 - AFO TIBIAL FRACTURE RIGID||783.93|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2114|L2114 - AFO TIB FX SEMI-RIGID||595.01|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2112|L2112 - AFO TIBIAL FRACTURE SOFT||520.05|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2108|L2108 - AFO TIB FX CAST MOLDED TO PT||1095.28|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2106|L2106 - AFO TIB FX CAST PLASTER MOLD||696.99|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2090|L2090 - HKAFO UNILAT TORSION BALL BR||483.18|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2080|L2080 - HKAFO UNILAT TORSION CABLE||392|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2070|L2070 - HKAFO TORSION UNILAT ROT STR||183.82|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2060|L2060 - HKAFO TORSION BALL BEARING J||639.88|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2050|L2050 - HKAFO TORSION CABLE HIP PELV||498.57|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2040|L2040 - HKAFO TORSION BIL ROT STRAPS||187.22|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2038|L2038 - KAFO W/O JOINT MULTI-AXIS AN||1465.63|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2037|L2037 - KAFO PLAS SING FREE KNEE MOL||1752.71|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2036|L2036 - KAFO PLAS DOUB FREE KNEE MOL||1901.9|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2035|L2035 - KAFO PLASTIC PEDIATRIC SIZE||190.95|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2034|L2034 - KAFO PLA SIN UP W/WO K/A CUS||2263.3|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2030|L2030 - KAFO DBL SOLID STIRRUP W/O J||1038.48|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2020|L2020 - KAFO DBL SOLID STIRRUP BAND/||1196.97|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2010|L2010 - KAFO SNG SOLID STIRRUP W/O J||947.83|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2005|L2005 - KAFO SNG/DBL MECHANICAL ACT||4516.81|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L2000|L2000 - KAFO SING FRE STIRR THI/CALF||1039.75|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1990|L1990 - AFO DOUB SOLID STIRRUP CALF||483.39|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1980|L1980 - AFO SING SOLID STIRRUP CALF||376.22|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1971|L1971 - AFO W/ANKLE JOINT- PREFAB||516.66|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1970|L1970 - AFO PLASTIC MOLDED W/ANKLE J||840.41|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1960|L1960 - AFO POS SOLID ANK PLASTIC MO||568.2|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1951|L1951 - AFO SPIRAL PREFABRICATED||925.72|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1950|L1950 - AFO SPIRAL MOLDED TO PT PLAS||763.54|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1945|L1945 - AFO MOLDED PLAS RIG ANT TIB||1006.4|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1940|L1940 - AFO MOLDED TO PATIENT PLASTI||548.02|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1932|L1932 - AFO RIG ANT TIB PREFAB TCF/=||983.62|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1930|L1930 - AFO PLASTIC||242.5|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1920|L1920 - AFO SING UPRIGHT W/ ADJUST S||358.37|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1910|L1910 - AFO SING BAR CLASP ATTACH SH||274.14|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1907|L1907 - AFO SUPRAMALLEOLAR CUSTOM||620.23|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1906|L1906 - AFO MULTILIG ANK SUP PRE OTS||140.86|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1904|L1904 - AFO MOLDED ANKLE GAUNTLET||482.05|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1902|L1902 - AFO ANKLE GAUNTLET PRE OTS||84.21|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1900|L1900 - AFO SPRNG WIR DRSFLX CALF BD||310.04|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1860|L1860 - KO SUPRACONDYLAR SOCKET MOLD||1144.46|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1850|L1850 - KO SWEDISH TYPE PRE OTS||295.07|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1848|L1848 - KO DBL UPRIGHT W/AIR PRE OTS||634.01|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1847|L1847 - KO DBL UPRIGHT W/AIR PRE CST||634.01|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1846|L1846 - KO W ADJ FLEX/EXT ROTAT MOLD||1310|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1845|L1845 - KO DOUBLE UPRIGHT PRE CST||1032.45|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1844|L1844 - KO W/ADJ JT ROT CNTRL MOLDED||1713.74|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1843|L1843 - KO SINGLE UPRIGHT PRE CST||989.01|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1840|L1840 - KO DEROT ANT CRUCIATE CUSTOM||1027.65|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1836|L1836 - KO RIGID W/O JOINTS PRE OTS||147.06|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1834|L1834 - KO W/0 JOINT RIGID MOLDED TO||977.63|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1833|L1833 - KO ADJ JNT POS R SUP PRE OTS||830.98|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1832|L1832 - KO ADJ JNT POS R SUP PRE CST||830.98|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1831|L1831 - KNEE ORTH POS LOCKING JOINT||324.4|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1830|L1830 - KO IMMOB CANVAS LONG PRE OTS||111.18|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1820|L1820 - KO ELAS W/ CONDYLE PADS & JO||132.92|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1812|L1812 - KO ELASTIC W/JOINTS PRE OTS||133.45|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1810|L1810 - KO ELASTIC WITH JOINTS||133.45|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1755|L1755 - LEGG PERTHES PATTEN BOTTOM T||1690.88|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1730|L1730 - LEGG PERTHES ORTH SCOTTISH R||1161.7|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1720|L1720 - LEGG PERTHES ORTHOSIS TRILAT||1539.75|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1710|L1710 - LEGG PERTHES ORTH NEWINGTON||2084.39|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1700|L1700 - LEG PERTHES ORTH TORONTO TYP||1773.29|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1690|L1690 - COMBINATION BILATERAL HO||2131.53|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1686|L1686 - HO POST-OP HIP ABDUCTION||1020.98|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1685|L1685 - POST-OP HIP ABDUCT CUSTOM FA||1521.89|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1680|L1680 - PELVIC & HIP CONTROL THIGH C||1442.31|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1660|L1660 - HO ABDUCTION STATIC PLASTIC||175.43|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1652|L1652 - HO BI THIGHCUFFS W SPRDR BAR||392.94|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1650|L1650 - HO ABDUCTION HIP ADJUSTABLE||250.85|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1640|L1640 - PELV BAND/SPREAD BAR THIGH C||473.02|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1630|L1630 - ABDUCT CONTROL HIP SEMI-FLEX||176.85|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1620|L1620 - HO FLEX PAVLIK HARNS PRE CST||148.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1610|L1610 - HO FREJKA COV ONLY PRE CST||45|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1600|L1600 - HO FLEX FREJKA W/COV PRE CST||132.1|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1310|L1310 - POST-OPERATIVE BODY JACKET||1762.03|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1300|L1300 - BODY JACKET MOLD TO PATIENT||1712.37|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1290|L1290 - LATERAL TROCHANTERIC PAD||102.43|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1280|L1280 - RIB GUSSET (ELASTIC) EACH||90.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1270|L1270 - ABDOMINAL PAD||101.36|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1260|L1260 - ANTERIOR THORACIC DEROTATION||101.48|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1250|L1250 - ANTERIOR ASIS PAD||98.75|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1240|L1240 - LUMBAR DEROTATION PAD||100.28|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1230|L1230 - MILWAUKEE TYPE SUPERSTRUCTUR||582.73|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1220|L1220 - ANTERIOR THORACIC EXTENSION||227.1|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1210|L1210 - LATERAL THORACIC EXTENSION||268.23|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1200|L1200 - FURNSH INITIAL ORTHOSIS ONLY||1781.51|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1120|L1120 - COVERS FOR UPRIGHT EACH||44.76|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1110|L1110 - RING FLANGE PLAS/LEATHER MOL||280.94|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1100|L1100 - RING FLANGE PLASTIC/LEATHER||165.86|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1090|L1090 - LUMBAR SLING||93.97|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1085|L1085 - OUTRIGGER BIL W/ VERT EXTENS||201.16|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1080|L1080 - OUTRIGGER||72.42|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1070|L1070 - TRAPEZIUS SLING||104.5|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1060|L1060 - THORACIC PAD||102.21|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1050|L1050 - STERNAL PAD||90.61|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1040|L1040 - LUMBAR OR LUMBAR RIB PAD||104.65|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1030|L1030 - LUMBAR BOLSTER PAD||86.94|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1025|L1025 - KYPHOSIS PAD FLOATING||130.16|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1020|L1020 - KYPHOSIS PAD||114.52|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1010|L1010 - CTLSO AXILLA SLING||83.81|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1005|L1005 - TENSION BASED SCOLIOSIS ORTH||3527.99|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1001|L1001 - CTLSO INFANT IMMOBILIZER||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L1000|L1000 - CTLSO MILWAUKE INITIAL MODEL||2081.2|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0984|L0984 - PROTECT BODY SOCK EA PRE OTS||62.24|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0982|L0982 - STOCKING SUP GRIPS 4 PRE OTS||19.5|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0980|L0980 - PERONEAL STRAPS PAIR PRE OTS||17.91|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0978|L0978 - AXILLARY CRUTCH EXTENSION||197.33|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0976|L0976 - LSO FULL CORSET||218.55|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0974|L0974 - TLSO FULL CORSET||244.71|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0972|L0972 - LSO CORSET FRONT||119.76|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0970|L0970 - TLSO CORSET FRONT||117.16|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0861|L0861 - HALO REPL LINER/INTERFACE||237.58|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0859|L0859 - MRI COMPATIBLE SYSTEM||1248.82|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0830|L0830 - HALO CERV INTO MILWAUKEE TYP||3214.51|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0820|L0820 - HALO CERVICAL INTO BODY JACK||2226.28|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0810|L0810 - HALO CERVICAL INTO JCKT VEST||2752.04|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0710|L0710 - CTLSO A-P-L CONTROL W/ INTER||2590.51|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0700|L0700 - CTLSO A-P-L CONTROL MOLDED||2373.21|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0651|L0651 - LSO SAG-CO SHELL PNL PRE OTS||1500.59|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0650|L0650 - LSO SC R ANT/POS PNL PRE OTS||1500.59|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0649|L0649 - LSO SC R POS/LAT PNL PRE OTS||316.09|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0648|L0648 - LSO SAG R AN/POS PNL PRE OTS||1131.57|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0643|L0643 - LSO SAG CTR RIGI POS PRE OTS||178.49|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0642|L0642 - LO SAG RI AN/POS PNL PRE OTS||453.11|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0641|L0641 - LO RIG POS PNL L1-L5 PRE OTS||85.93|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0640|L0640 - LSO S/C SHELL/PANEL CUSTOM||1153.42|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0639|L0639 - LSO S/C SHELL/PANEL PREFAB||1500.59|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0638|L0638 - LSO SAG-CORONAL PANEL CUSTOM||1453.8|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0637|L0637 - LSO SC R ANT/POS PNL PRE CST||1500.59|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0636|L0636 - LSO SAGITTAL RIGID PANEL CUS||1729.52|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0635|L0635 - LSO SAGIT RIGID PANEL PREFAB||1172.11|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0634|L0634 - LSO FLEXION CONTROL CUSTOM||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0633|L0633 - LSO SC R POS/LAT PNL PRE CST||316.09|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0632|L0632 - LSO SAG RIGID FRAME CUST||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0631|L0631 - LSO SAG R AN/POS PNL PRE CST||1131.57|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0630|L0630 - LSO R POST PNL SJ-T9 PRE CST||178.49|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0629|L0629 - LSO FLEX W/RIGID STAYS CUST||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0628|L0628 - LSO FLEX NO RI STAYS PRE OTS||92.45|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0627|L0627 - LO SAG RI AN/POS PNL PRE CST||453.11|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0626|L0626 - LO SAG RIG PNL STAYS PRE CST||85.93|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0625|L0625 - LO FLEX L1-BELOW L5 PRE OTS||60.74|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0624|L0624 - SIO PANEL CUSTOM||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0623|L0623 - SIO RIG PNL PELV/SAC PRE OTS||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0622|L0622 - SIO FLEX PELVISACRAL CUSTOM||266.51|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0621|L0621 - SIO FLEX PELVIC/SACR PRE OTS||98.29|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0492|L0492 - TLSO 3 PIECE RIGID SHELL||548.63|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0491|L0491 - TLSO 2 PIECE RIGID SHELL||846.51|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0490|L0490 - TLSO RIGID PLASTIC PRE ONE||311.8|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0488|L0488 - TLSO RIGID LINED PRE ONE PIE||1106.51|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0486|L0486 - TLSO RIGIDLINED CUST FAB TWO||1932.78|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0484|L0484 - TLSO RIGID PLASTIC CUST FAB||1951.08|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0482|L0482 - TLSO RIGID LINED CUSTOM FAB||1673.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0480|L0480 - TLSO RIGID PLASTIC CUSTOM FA||1459.68|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0472|L0472 - TLSO RIGID FRAME HYPEREX PRE||472.05|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0470|L0470 - TLSO RIGID FRAME PRE SUBCLAV||752.03|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0469|L0469 - TLSO RIG FRAM PELVIC PRE OTS||528.22|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0468|L0468 - TLSO RIG FRAM PELVIC PRE CST||528.22|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0467|L0467 - TLSO R FRAM SOFT PRE OTS||421.31|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0466|L0466 - TLSO R FRAM SOFT ANT PRE CST||421.31|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0464|L0464 - TLSO 4MOD SACRO-SCAP PRE||1638.45|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0462|L0462 - TLSO 3MOD SACRO-SCAP PRE||1376.29|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0460|L0460 - TLSO 2 SHL SYMPHYS-STERN CST||1106.51|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0458|L0458 - TLSO 2MOD SYMPHIS-XIPHO PRE||983.04|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0457|L0457 - TLSO FLEX TRNK SJ-SS PRE OTS||1096.3|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0456|L0456 - TLSO FLEX TRNK SJ-SS PRE CST||1096.3|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0455|L0455 - TLSO FLEX TRNK SJ-T9 PRE OTS||382.28|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0454|L0454 - TLSO TRNK SJ-T9 PRE CST||382.28|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0452|L0452 - TLSO FLEX CUSTOM FAB THORACI||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0450|L0450 - TLSO FLEX TRUNK/THOR PRE OTS||207.26|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0220|L0220 - THOR RIB BELT CUSTOM FABRICA||125.55|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0200|L0200 - CERV COL SUPP ADJ BAR & THOR||529.37|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0190|L0190 - CERV COLLAR SUPP ADJ CERV BA||576.52|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0180|L0180 - CER POST COL OCC/MAN SUP ADJ||382.97|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0174|L0174 - CERV SR 2PC THOR EXT PRE OTS||281.6|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0172|L0172 - CERV COL SR FOAM 2PC PRE OTS||156.76|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0170|L0170 - CERVICAL COLLAR MOLDED TO PT||773.12|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0160|L0160 - CERV SR WIRE OCC/MAN PRE OTS||182.7|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0150|L0150 - CERV SEMI-RIG ADJ MOLDED CHN||128.32|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0140|L0140 - CERVICAL SEMI-RIGID ADJUSTAB||76.95|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0130|L0130 - FLEX THERMOPLASTIC COLLAR MO||223|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0120|L0120 - CERV FLEX N/ADJ FOAM PRE OTS||30.83|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0113|L0113 - CRANIAL CERVICAL TORTICOLLIS||314.35|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|L0112|L0112 - CRANIAL CERVICAL ORTHOSIS||1542.76|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0902|K0902 - KO DOUBLE UPRIGHT PRE OTS||1032.45|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0901|K0901 - KO SINGLE UPRIGHT PRE OTS||989.01|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0864|K0864 - PWC GP3 XHD MULT POW OPT S/B||0|1966.53||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0863|K0863 - PWC GP3 VHD MULT POW OPT S/B||0|1652.54||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0862|K0862 - PWC GP3 HD MULT POW OPT S/B||0|1156.74||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0861|K0861 - PWC GP3 STD MULT POW OPT S/B||0|1202.88||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0860|K0860 - PWC GP3 VHD SING POW OPT S/B||0|1652.54||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0859|K0859 - PWC GP3 HD SING POW OPT CAP||0|1103.17||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0858|K0858 - PWC GP3 HD SING POW OPT S/B||0|1156.74||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0857|K0857 - PWC GP3 STD SING POW OPT CAP||0|951||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0856|K0856 - PWC GP3 STD SING POW OPT S/B||0|932.32||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0855|K0855 - PWC GP 3 XHD CAP CHAIR||0|1496.54||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0854|K0854 - PWC GP 3 XHD SEAT/BACK||0|1584.23||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0853|K0853 - PWC GP 3 VHD CAP CHAIR||0|1195.84||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0852|K0852 - PWC GP 3 VHD SEAT/BACK||0|1164.11||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0851|K0851 - PWC GP 3 HD CAP CHAIR||0|968.73||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0850|K0850 - PWC GP 3 HD SEAT/BACK||0|1007.52||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0849|K0849 - PWC GP 3 STD CAP CHAIR||0|835.08||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0848|K0848 - PWC GP 3 STD SEAT/BACK||0|868.57||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0843|K0843 - PWC GP2 HD MULT POW OPT S/B||0|510.51||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0842|K0842 - PWC GP2 STD MULT POW OPT CAP||0|430.04||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0841|K0841 - PWC GP2 STD MULT POW OPT S/B||0|430.66||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0840|K0840 - PWC GP2 XHD SING POW OPT S/B||0|999.67||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0839|K0839 - PWC GP2 VHD SING POW OPT S/B||0|651.11||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0838|K0838 - PWC GP 2 HD SING POW OPT CAP||0|434.46||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0837|K0837 - PWC GP 2 HD SING POW OPT S/B||0|490.16||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0836|K0836 - PWC GP2 STD SING POW OPT CAP||0|396.38||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0835|K0835 - PWC GP2 STD SING POW OPT S/B||0|382.17||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0829|K0829 - PWC GP 2 XTRA HD CAP CHAIR||0|939.27||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0828|K0828 - PWC GP 2 XTRA HD SEAT/BACK||0|940.27||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0827|K0827 - PWC GP VHD CAP CHAIR||0|711.47||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0826|K0826 - PWC GP 2 VHD SEAT/BACK||0|810.07||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0825|K0825 - PWC GP 2 HD CAP CHAIR||0|450.47||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0824|K0824 - PWC GP 2 HD SEAT/BACK||0|495.55||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0823|K0823 - PWC GP 2 STD CAP CHAIR||0|323.21||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0822|K0822 - PWC GP 2 STD SEAT/BACK||0|343.83||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0821|K0821 - PWC GP 2 STD PORT CAP CHAIR||0|321.94||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0820|K0820 - PWC GP 2 STD PORT SEAT/BACK||0|298.54||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0816|K0816 - PWC GP 1 STD CAP CHAIR||0|321.49||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0815|K0815 - PWC GP 1 STD SEAT/BACK||0|298.54||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0814|K0814 - PWC GP 1 STD PORT CAP CHAIR||0|309.64||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0813|K0813 - PWC GP 1 STD PORT SEAT/BACK||0|289.85||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0808|K0808 - POV GROUP 2 VHD 451-600 LBS||3563.19|356.32||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0807|K0807 - POV GROUP 2 HD 301-450 LBS||2305.03|230.51||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0806|K0806 - POV GROUP 2 STD UP TO 300LBS||1487.35|148.74||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0802|K0802 - POV GROUP 1 VHD 451-600 LBS||2241.56|224.16||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0801|K0801 - POV GROUP 1 HD 301-450 LBS||1714.2|171.42||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0800|K0800 - POV GROUP 1 STD UP TO 300LBS||954.72|95.47||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0738|K0738 - PORTABLE GAS OXYGEN SYSTEM||0|43.46||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0733|K0733 - 12-24HR SEALED LEAD ACID||33.1|3.34||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0730|K0730 - CTRL DOSE INH DRUG DELIV SYS||0|219.18||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0672|K0672 - REMOVABLE SOFT INTERFACE LE||93.47|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0609|K0609 - REPL ELECTRODE FOR AED||1137.8|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0608|K0608 - REPL GARMENT FOR AED||171.11|17.14||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0607|K0607 - REPL BATT FOR AED||0|27.42||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0606|K0606 - AED GARMENT W ELEC ANALYSIS||0|3201.58||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0605|K0605 - REPL BATT LITHIUM 4.5 V||17.64|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0604|K0604 - REPL BATT LITHIUM 3.6 V||7.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0603|K0603 - REPL BATT ALKALINE 1.5 V||0.69|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0602|K0602 - REPL BATT SILVER OXIDE 3 V||7.66|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0601|K0601 - REPL BATT SILVER OXIDE 1.5 V||1.36|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0554|K0554 - THER CGM RECEIVER/MONITOR||286.32|28.64||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0553|K0553 - THER CGM SUPPLY ALLOWANCE||288.78|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0552|K0552 - SUP/EXT NON-INS INF PUMP SYR||2.99|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0455|K0455 - PUMP UNINTERRUPTED INFUSION||0|326.65||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0195|K0195 - ELEVATING WHLCHAIR LEG RESTS||0|12.49||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0105|K0105 - IV HANGER||126.41|12.64||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0098|K0098 - DRIVE BELT FOR PWC- REPL||29.82|2.99||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0077|K0077 - FR CSTR ASMB SOL TIRE REP EA||74.83|7.46||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0073|K0073 - CASTER PIN LOCK EACH||44.25|4.43||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0072|K0072 - FR CSTR SEMI-PNE TIRE REP EA||83.62|8.36||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0071|K0071 - FR CSTR COMP PNE TIRE REP EA||138.89|13.9||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0070|K0070 - RR WHL COMPL PNE TIRE REP EA||0|23.31||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0069|K0069 - RR WHL COMPL SOL TIRE REP EA||127.05|13.23||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0065|K0065 - SPOKE PROTECTORS||56.51|5.66||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0056|K0056 - SEAT HT <17 OR >=21 LTWT WC||120.91|12.1||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0053|K0053 - ELEVATE FOOTREST ARTICULATE||111.78|11.17||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0052|K0052 - SWINGAWAY DETACH FTREST REPL||101.3|10.12||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0051|K0051 - CAM REL ASM FT/LEGRST REP EA||57.64|5.8||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0050|K0050 - RATCHET ASSEMBLY REPLACEMENT||33.67|3.37||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0047|K0047 - ELEV LEGRST UPR HANGR REP EA||83.8|8.41||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0046|K0046 - ELEV LGRST LWR EXTEN REPL EA||21.39|2.13||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0045|K0045 - FTRST COMPL ASSEMBLY REPL EA||62.04|6.39||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0044|K0044 - FTRST UPR HANGER BRAC REP EA||18.24|1.83||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0043|K0043 - FTRST LOWR EXTEN TUBE REP EA||21.39|2.13||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0042|K0042 - STANDARD SIZE FTPLATE REP EA||39.93|3.99||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0041|K0041 - LARGE SIZE FOOTPLATE EACH||57.98|5.84||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0040|K0040 - ADJUSTABLE ANGLE FOOTPLATE||81.82|8.16||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0039|K0039 - LEG STRAP H STYLE EACH||59.03|5.93||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0038|K0038 - LEG STRAP EACH||26.6|2.66||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0037|K0037 - HI MOUNT FLIP-UP FOOTREST EA||52.77|4.7||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0020|K0020 - FIXED ADJUST ARMREST PAIR||50.91|5.09||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0019|K0019 - ARM PAD REPL- EACH||18.62|1.86||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0018|K0018 - DETACH ADJUST ARMRST UPPER||31.28|3.12||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0017|K0017 - DETACH ADJUST ARMREST BASE||55.99|5.6||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0015|K0015 - DETACH NON-ADJ HT ARMRST REP||0|19.91||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0012|K0012 - LTWT PORTBL POWER WHLCHR||0|400.67||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0011|K0011 - STND WT PWR WHLCHR W CONTROL||0|723.06||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0010|K0010 - STND WT FRAME POWER WHLCHR||0|460.33||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0009|K0009 - OTHER MANUAL WHEELCHAIR/BASE||0|94.53||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0007|K0007 - EXTRA HEAVY DUTY WHEELCHAIR||0|109.8||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0006|K0006 - HEAVY DUTY WHEELCHAIR||0|78.42||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0005|K0005 - ULTRALIGHTWEIGHT WHEELCHAIR||2350.4|235.01||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0004|K0004 - HIGH STRENGTH LTWT WHLCHR||0|53.82||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0003|K0003 - LIGHTWEIGHT WHEELCHAIR||0|43.37||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0002|K0002 - STND HEMI (LOW SEAT) WHLCHR||0|49.42||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|K0001|K0001 - STANDARD WHEELCHAIR||0|28.58||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9400|J9400 - INJ- ZIV-AFLIBERCEPT- 1 MG||8.8935|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9395|J9395 - INJECTION- FULVESTRANT||106.9662|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9390|J9390 - VINORELBINE TARTRATE INJ||18.9563|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9371|J9371 - INJ- VINCRISTINE SUL LIP 1 MG||3087.8595|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9370|J9370 - VINCRISTINE SULFATE 1 MG INJ||5.7365|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9360|J9360 - VINBLASTINE SULFATE INJ||4.1899|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9357|J9357 - VALRUBICIN INJECTION||1374.0914|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9355|J9355 - TRASTUZUMAB INJECTION||114.1008|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9354|J9354 - INJ- ADO-TRASTUZUMAB EMT 1 MG||33.7612|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9352|J9352 - INJECTION TRABECTEDIN 0.1MG||326.0609|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9351|J9351 - TOPOTECAN INJECTION||1.1396|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9330|J9330 - TEMSIROLIMUS INJECTION||81.1459|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9328|J9328 - TEMOZOLOMIDE INJECTION||11.6171|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9325|J9325 - INJ TALIMOGENE LAHERPAREPVEC||54.67|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9320|J9320 - STREPTOZOCIN INJECTION||378.3857|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9315|J9315 - ROMIDEPSIN INJECTION||361.9462|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9310|J9310 - RITUXIMAB INJECTION||1006.8256|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9308|J9308 - INJECTION- RAMUCIRUMAB||63.4326|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9307|J9307 - PRALATREXATE INJECTION||293.7847|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9306|J9306 - INJECTION- PERTUZUMAB- 1 MG||12.9877|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9305|J9305 - PEMETREXED INJECTION||74.2049|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9303|J9303 - PANITUMUMAB INJECTION||125.4396|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9302|J9302 - OFATUMUMAB INJECTION||64.284|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9301|J9301 - OBINUTUZUMAB INJ||69.1273|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9299|J9299 - INJECTION- NIVOLUMAB||29.8705|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9295|J9295 - INJECTION- NECITUMUMAB- 1 MG||6.0555|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9293|J9293 - MITOXANTRONE HYDROCHL / 5 MG||32.8647|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9285|J9285 - INJ- OLARATUMAB- 10 MG||56.1396|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9280|J9280 - MITOMYCIN INJECTION||158.4836|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9271|J9271 - INJ PEMBROLIZUMAB||53.4314|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9268|J9268 - PENTOSTATIN INJECTION||2205.7277|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9267|J9267 - PACLITAXEL INJECTION||0.1419|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9266|J9266 - PEGASPARGASE INJECTION||16533.1936|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9264|J9264 - PACLITAXEL PROTEIN BOUND||12.3508|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9263|J9263 - OXALIPLATIN||0.2255|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9261|J9261 - NELARABINE INJECTION||167.321|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9260|J9260 - METHOTREXATE SODIUM INJ||2.7038|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9250|J9250 - METHOTREXATE SODIUM INJ||0.2695|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9245|J9245 - INJ MELPHALAN HYDROCHL 50 MG||1161.5076|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9230|J9230 - MECHLORETHAMINE HCL INJ||354.9249|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9228|J9228 - IPILIMUMAB INJECTION||163.4941|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9226|J9226 - SUPPRELIN LA IMPLANT||33486.0878|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9225|J9225 - VANTAS IMPLANT||3797.563|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9218|J9218 - LEUPROLIDE ACETATE INJECITON||36.5156|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9217|J9217 - LEUPROLIDE ACETATE SUSPNSION||239.9914|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9214|J9214 - INTERFERON ALFA-2B INJ||37.818|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9211|J9211 - IDARUBICIN HCL INJECTION||38.9895|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9209|J9209 - MESNA INJECTION||2.7192|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9208|J9208 - IFOSFAMIDE INJECTION||28.9003|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9207|J9207 - IXABEPILONE INJECTION||77.6523|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9206|J9206 - IRINOTECAN INJECTION||3.3715|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9205|J9205 - INJ IRINOTECAN LIPOSOME 1 MG||50.1952|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9203|J9203 - GEMTUZUMAB OZOGAMICIN 0.1 MG||212.4716|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9202|J9202 - GOSERELIN ACETATE IMPLANT||514.3336|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9201|J9201 - GEMCITABINE HCL INJECTION||7.1489|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9200|J9200 - FLOXURIDINE INJECTION||98.131|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9190|J9190 - FLUOROURACIL INJECTION||1.9118|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9185|J9185 - FLUDARABINE PHOSPHATE INJ||81.7047|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9181|J9181 - ETOPOSIDE INJECTION||1.4861|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9179|J9179 - ERIBULIN MESYLATE INJECTION||124.2857|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9178|J9178 - INJ- EPIRUBICIN HCL- 2 MG||1.4179|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9176|J9176 - INJECTION- ELOTUZUMAB- 1 MG||7.0609|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9171|J9171 - DOCETAXEL INJECTION||1.9943|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9155|J9155 - DEGARELIX INJECTION||4.0205|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9150|J9150 - DAUNORUBICIN INJECTION||46.5322|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9145|J9145 - INJECTION- DARATUMUMAB 10 MG||56.0439|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9130|J9130 - DACARBAZINE 100 MG INJ||4.3241|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9120|J9120 - DACTINOMYCIN INJECTION||1731.4715|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9100|J9100 - CYTARABINE HCL 100 MG INJ||0.6567|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9098|J9098 - CYTARABINE LIPOSOME INJ||691.2048|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9070|J9070 - CYCLOPHOSPHAMIDE 100 MG INJ||46.0097|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9065|J9065 - INJ CLADRIBINE PER 1 MG||24.5003|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9060|J9060 - CISPLATIN 10 MG INJECTION||2.1824|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9055|J9055 - CETUXIMAB INJECTION||66.8569|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9050|J9050 - CARMUSTINE INJECTION||4313.6566|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9047|J9047 - INJECTION- CARFILZOMIB- 1 MG||38.7134|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9045|J9045 - CARBOPLATIN INJECTION||3.5662|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9043|J9043 - CABAZITAXEL INJECTION||179.9446|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9042|J9042 - BRENTUXIMAB VEDOTIN INJ||165.9009|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9041|J9041 - INJ.- VELCADE 0.1 MG||51.4195|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9040|J9040 - BLEOMYCIN SULFATE INJECTION||30.5998|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9039|J9039 - INJECTION- BLINATUMOMAB||120.9153|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9035|J9035 - BEVACIZUMAB INJECTION||86.7383|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9034|J9034 - INJ.- BENDEKA 1 MG||25.7895|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9033|J9033 - INJ.- TREANDA 1 MG||33.8217|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9032|J9032 - INJECTION- BELINOSTAT- 10MG||40.9805|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9031|J9031 - BCG LIVE INTRAVESICAL VAC||151.9232|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9027|J9027 - CLOFARABINE INJECTION||132.2618|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9025|J9025 - AZACITIDINE INJECTION||1.6599|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9023|J9023 - INJECTION- AVELUMAB- 10 MG||88.649|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9022|J9022 - INJ- ATEZOLIZUMAB-10 MG||84.5845|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9019|J9019 - ERWINAZE INJECTION||456.3075|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9017|J9017 - ARSENIC TRIOXIDE INJECTION||84.7704|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J9000|J9000 - DOXORUBICIN HCL INJECTION||3.3781|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J8705|J8705 - TOPOTECAN ORAL||114.2449|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J8700|J8700 - TEMOZOLOMIDE||1.0153|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J8670|J8670 - ROLAPITANT- ORAL- 1 MG||2.4475|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J8655|J8655 - ORAL NETUPITANT- PALONOSETRO||374.6864|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J8610|J8610 - METHOTREXATE ORAL 2.5 MG||1.2529|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J8600|J8600 - MELPHALAN ORAL 2 MG||12.8447|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J8560|J8560 - ETOPOSIDE ORAL 50 MG||83.3679|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J8540|J8540 - ORAL DEXAMETHASONE||0.0935|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J8530|J8530 - CYCLOPHOSPHAMIDE ORAL 25 MG||4.4506|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J8521|J8521 - CAPECITABINE- ORAL- 500 MG||5.896|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J8520|J8520 - CAPECITABINE- ORAL- 150 MG||1.9998|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J8510|J8510 - ORAL BUSULFAN||26.5408|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J8501|J8501 - ORAL APREPITANT||8.2401|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7686|J7686 - TREPROSTINIL- NON-COMP UNIT||642.7575|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7682|J7682 - TOBRAMYCIN NON-COMP UNIT||53.5161|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7674|J7674 - METHACHOLINE CHLORIDE- NEB||0.5918|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7644|J7644 - IPRATROPIUM BROMIDE NON-COMP||0.2387|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7639|J7639 - DORNASE ALFA NON-COMP UNIT||52.4975|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7631|J7631 - CROMOLYN SODIUM NONCOMP UNIT||8.4645|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7626|J7626 - BUDESONIDE NON-COMP UNIT||3.8775|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7620|J7620 - ALBUTEROL IPRATROP NON-COMP||0.1562|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7614|J7614 - LEVALBUTEROL NON-COMP UNIT||0.066|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7613|J7613 - ALBUTEROL NON-COMP UNIT||0.0506|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7612|J7612 - LEVALBUTEROL NON-COMP CON||0.2211|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7611|J7611 - ALBUTEROL NON-COMP CON||0.1749|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7608|J7608 - ACETYLCYSTEINE NON-COMP UNIT||4.8169|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7606|J7606 - FORMOTEROL FUMARATE- INH||11.9031|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7605|J7605 - ARFORMOTEROL NON-COMP UNIT||10.857|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7527|J7527 - ORAL EVEROLIMUS||9.4688|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7525|J7525 - TACROLIMUS INJECTION||226.9498|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7520|J7520 - SIROLIMUS- ORAL||8.0465|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7518|J7518 - MYCOPHENOLIC ACID||3.3902|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7517|J7517 - MYCOPHENOLATE MOFETIL ORAL||1.6819|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7516|J7516 - CYCLOSPORIN PARENTERAL 250MG||48.6167|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7515|J7515 - CYCLOSPORINE ORAL 25 MG||0.7876|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7512|J7512 - PREDNISONE IR OR DR ORAL 1 MG||0.0165|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7511|J7511 - ANTITHYMOCYTE GLOBULN RABBIT||798.2601|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7510|J7510 - PREDNISOLONE ORAL PER 5 MG||0.0715|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7509|J7509 - METHYLPREDNISOLONE ORAL||0.2926|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7508|J7508 - TACROL ASTAGRAF EX REL ORAL||0.5203|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7507|J7507 - TACROLIMUS IMME REL ORAL 1MG||0.5863|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7504|J7504 - LYMPHOCYTE IMMUNE GLOBULIN||2317.1588|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7503|J7503 - TACROL ENVARSUS EX REL ORAL||1.3794|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7502|J7502 - CYCLOSPORINE ORAL 100 MG||2.6653|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7500|J7500 - AZATHIOPRINE ORAL 50MG||0.66|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7336|J7336 - CAPSAICIN 8% PATCH||3.465|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7327|J7327 - MONOVISC INJ PER DOSE||876.2182|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7326|J7326 - GEL-ONE||560.2828|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7325|J7325 - SYNVISC OR SYNVISC-ONE||12.8689|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7324|J7324 - ORTHOVISC INJ PER DOSE||154.3751|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7323|J7323 - EUFLEXXA INJ PER DOSE||158.1074|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7321|J7321 - HYALGAN SUPARTZ VISCO-3 DOSE||91.4925|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7320|J7320 - GENVISC 850- INJ- 1 MG||6.8772|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7316|J7316 - INJ- OCRIPLASMIN- 0.125 MG||1120.5645|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7313|J7313 - FLUOCINOL ACET INTRAVIT IMP||539.2178|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7312|J7312 - DEXAMETHASONE INTRA IMPLANT||220.2156|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7311|J7311 - FLUOCINOLONE ACETONIDE IMPLT||22434.8234|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7308|J7308 - AMINOLEVULINIC ACID HCL TOP||445.0501|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7205|J7205 - FACTOR VIII FC FUSION RECOMB||2.2099|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7201|J7201 - FACTOR IX ALPROLIX RECOMB||3.2912|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7200|J7200 - FACTOR IX RECOMBINAN RIXUBIS||1.4828|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7198|J7198 - ANTI-INHIBITOR||2.3221|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7197|J7197 - ANTITHROMBIN III INJECTION||4.0524|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7195|J7195 - FACTOR IX RECOMBINANT NOS||1.6621|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7194|J7194 - FACTOR IX COMPLEX||1.5686|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7193|J7193 - FACTOR IX NON-RECOMBINANT||1.2507|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7192|J7192 - FACTOR VIII RECOMBINANT NOS||1.4894|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7190|J7190 - FACTOR VIII||1.2177|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7189|J7189 - FACTOR VIIA||2.2759|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7187|J7187 - HUMATE-P- INJ||1.2364|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7186|J7186 - ANTIHEMOPHILIC VIII/VWF COMP||1.0934|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7185|J7185 - XYNTHA INJ||1.3761|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7183|J7183 - WILATE INJECTION||1.1308|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7182|J7182 - FACTOR VIII RECOMB NOVOEIGHT||1.463|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7180|J7180 - FACTOR XIII ANTI-HEM FACTOR||9.0365|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7120|J7120 - RINGERS LACTATE INFUSION||2.9403|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7070|J7070 - D5W INFUSION||4.9368|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7060|J7060 - 5% DEXTROSE/WATER||2.5069|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7050|J7050 - NORMAL SALINE SOLUTION INFUS||0.6864|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7042|J7042 - 5% DEXTROSE/NORMAL SALINE||1.1066|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7040|J7040 - NORMAL SALINE SOLUTION INFUS||1.3816|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J7030|J7030 - NORMAL SALINE SOLUTION INFUS||2.7467|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J3489|J3489 - ZOLEDRONIC ACID 1MG||16.1876|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J3486|J3486 - ZIPRASIDONE MESYLATE||19.8781|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J3485|J3485 - ZIDOVUDINE||1.6654|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J3480|J3480 - INJ POTASSIUM CHLORIDE||0.1331|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J3475|J3475 - INJ MAGNESIUM SULFATE||0.5566|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J3473|J3473 - HYALURONIDASE RECOMBINANT||0.3938|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J3471|J3471 - OVINE- UP TO 999 USP UNITS||0.4455|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J3465|J3465 - INJECTION- VORICONAZOLE||2.134|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J3430|J3430 - VITAMIN K PHYTONADIONE INJ||4.7014|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J3420|J3420 - VITAMIN B12 INJECTION||2.0988|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J3415|J3415 - PYRIDOXINE HCL 100 MG||10.4753|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J3411|J3411 - THIAMINE HCL 100 MG||3.2054|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J3410|J3410 - HYDROXYZINE HCL INJECTION||7.9915|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J3396|J3396 - VERTEPORFIN INJECTION||11.9416|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J3385|J3385 - VELAGLUCERASE ALFA||379.775|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J3380|J3380 - INJECTION- VEDOLIZUMAB||21.5842|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J3370|J3370 - VANCOMYCIN HCL INJECTION||4.3043|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J3360|J3360 - DIAZEPAM INJECTION||7.6505|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J3358|J3358 - USTEKINUMAB- IV INJECT- 1 MG||13.8039|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J3357|J3357 - USTEKINUMAB SUB CU INJ- 1 MG||215.1017|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J3315|J3315 - TRIPTORELIN PAMOATE||288.3056|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J3303|J3303 - TRIAMCINOLONE HEXACETONL INJ||2.27|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J3301|J3301 - TRIAMCINOLONE ACET INJ NOS||1.9426|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J3300|J3300 - TRIAMCINOLONE A INJ PRS-FREE||4.2427|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J3285|J3285 - TREPROSTINIL INJECTION||67.3607|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J3262|J3262 - TOCILIZUMAB INJECTION||5.1909|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J3260|J3260 - TOBRAMYCIN SULFATE INJECTION||3.3033|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J3250|J3250 - TRIMETHOBENZAMIDE HCL INJ||35.4607|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J3243|J3243 - TIGECYCLINE INJECTION||2.4816|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J3240|J3240 - THYROTROPIN INJECTION||1769.5865|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J3230|J3230 - CHLORPROMAZINE HCL INJECTION||32.2795|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J3121|J3121 - INJ TESTOSTERO ENANTHATE 1MG||0.0418|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J3105|J3105 - TERBUTALINE SULFATE INJ||3.1845|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J3101|J3101 - TENECTEPLASE INJECTION||133.1275|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J3095|J3095 - TELAVANCIN INJECTION||6.0357|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J3090|J3090 - INJ TEDIZOLID PHOSPHATE||1.5807|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J3070|J3070 - PENTAZOCINE INJECTION||119.2235|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J3060|J3060 - INJ- TALIGLUCERASE ALFA 10 U||44.429|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J3010|J3010 - FENTANYL CITRATE INJECTION||0.6545|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J3000|J3000 - STREPTOMYCIN INJECTION||18.1049|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2997|J2997 - ALTEPLASE RECOMBINANT||96.382|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2930|J2930 - METHYLPREDNISOLONE INJECTION||7.6615|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2920|J2920 - METHYLPREDNISOLONE INJECTION||5.2855|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2916|J2916 - NA FERRIC GLUCONATE COMPLEX||2.3969|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2850|J2850 - INJ SECRETIN SYNTHETIC HUMAN||43.48|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2820|J2820 - SARGRAMOSTIM INJECTION||39.1776|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2810|J2810 - INJ THEOPHYLLINE PER 40 MG||0.3377|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2805|J2805 - SINCALIDE INJECTION||117.3139|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2800|J2800 - METHOCARBAMOL INJECTION||26.5397|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2796|J2796 - ROMIPLOSTIM INJECTION||77.6028|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2795|J2795 - ROPIVACAINE HCL INJECTION||0.0869|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2794|J2794 - RISPERIDONE- LONG ACTING||10.3422|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2792|J2792 - RHO(D) IMMUNE GLOBULIN H- SD||30.0476|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2791|J2791 - RHOPHYLAC INJECTION||5.3328|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2790|J2790 - RHO D IMMUNE GLOBULIN INJ||90.6851|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2788|J2788 - RHO D IMMUNE GLOBULIN 50 MCG||27.9125|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2785|J2785 - REGADENOSON INJECTION||62.1478|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2783|J2783 - RASBURICASE||298.8095|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2780|J2780 - RANITIDINE HYDROCHLORIDE INJ||5.9961|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2778|J2778 - RANIBIZUMAB INJECTION||410.85|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2770|J2770 - QUINUPRISTIN/DALFOPRISTIN||460.4501|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2765|J2765 - METOCLOPRAMIDE HCL INJECTION||0.9383|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2724|J2724 - PROTEIN C CONCENTRATE||16.8696|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2720|J2720 - INJ PROTAMINE SULFATE/10 MG||1.2595|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2704|J2704 - INJ- PROPOFOL- 10 MG||0.1298|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2700|J2700 - OXACILLIN SODIUM INJECITON||2.4926|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2690|J2690 - PROCAINAMIDE HCL INJECTION||76.1574|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2680|J2680 - FLUPHENAZINE DECANOATE 25 MG||15.3318|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2675|J2675 - INJ PROGESTERONE PER 50 MG||1.2122|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2597|J2597 - INJ DESMOPRESSIN ACETATE||14.1933|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2562|J2562 - PLERIXAFOR INJECTION||362.7943|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2560|J2560 - PHENOBARBITAL SODIUM INJ||41.9837|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2550|J2550 - PROMETHAZINE HCL INJECTION||2.1175|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2545|J2545 - PENTAMIDINE NON-COMP UNIT||127.0236|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2543|J2543 - PIPERACILLIN/TAZOBACTAM||2.9986|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2540|J2540 - PENICILLIN G POTASSIUM INJ||1.1935|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2515|J2515 - PENTOBARBITAL SODIUM INJ||54.1211|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2510|J2510 - PENICILLIN G PROCAINE INJ||32.2245|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2507|J2507 - PEGLOTICASE INJECTION||2554.2693|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2505|J2505 - INJECTION- PEGFILGRASTIM 6MG||5192.9273|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2504|J2504 - PEGADEMASE BOVINE- 25 IU||404.7571|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2503|J2503 - PEGAPTANIB SODIUM INJECTION||789.6515|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2501|J2501 - PARICALCITOL||0.8195|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2469|J2469 - PALONOSETRON HCL||24.8644|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2430|J2430 - PAMIDRONATE DISODIUM /30 MG||11.0539|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2426|J2426 - PALIPERIDONE PALMITATE INJ||11.9647|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2425|J2425 - PALIFERMIN INJECTION||22.3718|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2410|J2410 - OXYMORPHONE HCL INJECTION||3.59|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2407|J2407 - INJECTION- ORITAVANCIN||28.1787|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2405|J2405 - ONDANSETRON HCL INJECTION||0.0869|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2400|J2400 - CHLOROPROCAINE HCL INJECTION||20.6668|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2360|J2360 - ORPHENADRINE INJECTION||7.0268|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2358|J2358 - OLANZAPINE LONG-ACTING INJ||3.2087|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2357|J2357 - OMALIZUMAB INJECTION||39.9674|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2355|J2355 - OPRELVEKIN INJECTION||469.6065|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2354|J2354 - OCTREOTIDE INJ- NON-DEPOT||1.0219|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2353|J2353 - OCTREOTIDE INJECTION- DEPOT||218.9341|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2350|J2350 - INJECTION- OCRELIZUMAB- 1 MG||62.8914|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2323|J2323 - NATALIZUMAB INJECTION||21.8911|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2315|J2315 - NALTREXONE- DEPOT FORM||3.5893|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2310|J2310 - INJ NALOXONE HYDROCHLORIDE||26.2537|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2300|J2300 - INJ NALBUPHINE HYDROCHLORIDE||3.1933|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2280|J2280 - INJ- MOXIFLOXACIN 100 MG||10.703|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2278|J2278 - ZICONOTIDE INJECTION||8.3369|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2274|J2274 - INJ MORPHINE PF EPID ITHC||12.5675|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2270|J2270 - MORPHINE SULFATE INJECTION||2.6763|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2260|J2260 - INJ MILRINONE LACTATE / 5 MG||1.8227|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2250|J2250 - INJ MIDAZOLAM HYDROCHLORIDE||0.1364|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2248|J2248 - MICAFUNGIN SODIUM INJECTION||0.9504|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2210|J2210 - METHYLERGONOVIN MALEATE INJ||16.2866|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2185|J2185 - MEROPENEM||0.8954|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2175|J2175 - MEPERIDINE HYDROCHL /100 MG||4.1448|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2150|J2150 - MANNITOL INJECTION||2.5553|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2060|J2060 - LORAZEPAM INJECTION||0.8404|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2020|J2020 - LINEZOLID INJECTION||13.1087|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2010|J2010 - LINCOMYCIN INJECTION||14.3286|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J2001|J2001 - LIDOCAINE INJECTION||0.0242|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1980|J1980 - HYOSCYAMINE SULFATE INJ||33.3707|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1956|J1956 - LEVOFLOXACIN INJECTION||1.3794|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1955|J1955 - INJ LEVOCARNITINE PER 1 GM||35.2836|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1953|J1953 - LEVETIRACETAM INJECTION||0.1309|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1950|J1950 - LEUPROLIDE ACETATE /3.75 MG||1316.6021|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1942|J1942 - ARIPIPRAZOLE LAUROXIL 1MG||2.7038|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1940|J1940 - FUROSEMIDE INJECTION||0.9625|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1931|J1931 - LARONIDASE INJECTION||33.6765|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1930|J1930 - LANREOTIDE INJECTION||64.812|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1885|J1885 - KETOROLAC TROMETHAMINE INJ||0.6226|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1817|J1817 - INSULIN FOR INSULIN PUMP USE||12.3167|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1815|J1815 - INSULIN INJECTION||1.0318|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1800|J1800 - PROPRANOLOL INJECTION||4.9874|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1786|J1786 - IMUGLUCERASE INJECTION||45.4663|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1756|J1756 - IRON SUCROSE INJECTION||0.2574|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1750|J1750 - INJ IRON DEXTRAN||15.0359|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1745|J1745 - INFLIXIMAB NOT BIOSIMIL 10MG||92.2889|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1743|J1743 - IDURSULFASE INJECTION||597.2087|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1742|J1742 - IBUTILIDE FUMARATE INJECTION||328.5161|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1740|J1740 - IBANDRONATE SODIUM INJECTION||85.9199|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1720|J1720 - HYDROCORTISONE SODIUM SUCC I||14.4947|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1670|J1670 - TETANUS IMMUNE GLOBULIN INJ||305.3468|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1652|J1652 - FONDAPARINUX SODIUM||2.5113|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1650|J1650 - INJ ENOXAPARIN SODIUM||0.9592|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1645|J1645 - DALTEPARIN SODIUM||16.4802|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1644|J1644 - INJ HEPARIN SODIUM PER 1000U||0.2189|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1642|J1642 - INJ HEPARIN SODIUM PER 10 U||0.198|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1640|J1640 - HEMIN- 1 MG||25.3484|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1631|J1631 - HALOPERIDOL DECANOATE INJ||19.7824|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1630|J1630 - HALOPERIDOL INJECTION||1.0868|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1627|J1627 - INJ- GRANISETRON- XR- 0.1 MG||4.2735|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1626|J1626 - GRANISETRON HCL INJECTION||0.3509|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1610|J1610 - GLUCAGON HYDROCHLORIDE/1 MG||217.052|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1602|J1602 - GOLIMUMAB FOR IV USE 1MG||26.7311|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1580|J1580 - GARAMYCIN GENTAMICIN INJ||1.4949|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1575|J1575 - HYQVIA 100MG IMMUNEGLOBULIN||15.7773|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1572|J1572 - FLEBOGAMMA INJECTION||38.6771|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1571|J1571 - HEPAGAM B IM INJECTION||74.6768|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1570|J1570 - GANCICLOVIR SODIUM INJECTION||75.3819|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1569|J1569 - GAMMAGARD LIQUID INJECTION||50.9608|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1568|J1568 - OCTAGAM INJECTION||36.4749|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1566|J1566 - IMMUNE GLOBULIN- POWDER||44.0088|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1561|J1561 - GAMUNEX-C/GAMMAKED||44.2596|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1560|J1560 - GAMMA GLOBULIN > 10 CC INJ||423.291|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1559|J1559 - HIZENTRA INJECTION||10.835|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1557|J1557 - GAMMAPLEX INJECTION||61.3492|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1556|J1556 - INJ- IMM GLOB BIVIGAM- 500 MG||77.5676|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1555|J1555 - INJ CUVITRU- 100 MG||14.7367|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1460|J1460 - GAMMA GLOBULIN 1 CC INJ||42.3291|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1459|J1459 - INJ IVIG PRIVIGEN 500 MG||43.637|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1458|J1458 - GALSULFASE INJECTION||421.5343|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1453|J1453 - FOSAPREPITANT INJECTION||2.2858|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1450|J1450 - FLUCONAZOLE||4.9379|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1447|J1447 - INJ TBO FILGRASTIM 1 MICROG||0.6512|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1442|J1442 - INJ FILGRASTIM EXCL BIOSIMIL||1.1253|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1439|J1439 - INJ FERRIC CARBOXYMALTOS 1 MG||1.1759|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1438|J1438 - ETANERCEPT INJECTION||514.64|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1430|J1430 - ETHANOLAMINE OLEATE 100 MG||488.5089|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1410|J1410 - INJ ESTROGEN CONJUGATE 25 MG||341.4323|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1380|J1380 - ESTRADIOL VALERATE 10 MG INJ||17.3184|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1364|J1364 - ERYTHRO LACTOBIONATE /500 MG||86.7537|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1335|J1335 - ERTAPENEM INJECTION||69.0624|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1325|J1325 - EPOPROSTENOL INJECTION||17.6858|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1300|J1300 - ECULIZUMAB INJECTION||253.528|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1290|J1290 - ECALLANTIDE INJECTION||524.5537|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1270|J1270 - INJECTION- DOXERCALCIFEROL||0.517|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1267|J1267 - DORIPENEM INJECTION||0.9735|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1265|J1265 - DOPAMINE INJECTION||0.6633|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1260|J1260 - DOLASETRON MESYLATE||7.62|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1250|J1250 - INJ DOBUTAMINE HCL/250 MG||5.5616|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1245|J1245 - DIPYRIDAMOLE INJECTION||0.8833|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1240|J1240 - DIMENHYDRINATE INJECTION||7.755|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1230|J1230 - METHADONE INJECTION||19.7868|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1212|J1212 - DIMETHYL SULFOXIDE 50% 50 ML||584.7083|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1205|J1205 - CHLOROTHIAZIDE SODIUM INJ||82.8443|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1200|J1200 - DIPHENHYDRAMINE HCL INJECTIO||0.6457|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1190|J1190 - DEXRAZOXANE HCL INJECTION||260.1423|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1170|J1170 - HYDROMORPHONE INJECTION||1.5114|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1165|J1165 - PHENYTOIN SODIUM INJECTION||0.6567|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1162|J1162 - DIGOXIN IMMUNE FAB (OVINE)||3863.4013|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1160|J1160 - DIGOXIN INJECTION||7.6912|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1120|J1120 - ACETAZOLAMID SODIUM INJECTIO||16.6914|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1110|J1110 - INJ DIHYDROERGOTAMINE MESYLT||101.4068|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1100|J1100 - DEXAMETHASONE SODIUM PHOS||0.1331|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1071|J1071 - INJ TESTOSTERONE CYPIONATE||0.0275|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1050|J1050 - MEDROXYPROGESTERONE ACETATE||0.6193|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1040|J1040 - METHYLPREDNISOLONE 80 MG INJ||14.861|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1030|J1030 - METHYLPREDNISOLONE 40 MG INJ||7.7011|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1020|J1020 - METHYLPREDNISOLONE 20 MG INJ||4.5947|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J1000|J1000 - DEPO-ESTRADIOL CYPIONATE INJ||24.1648|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0897|J0897 - DENOSUMAB INJECTION||20.2158|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0895|J0895 - DEFEROXAMINE MESYLATE INJ||22.1771|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0894|J0894 - DECITABINE INJECTION||15.9445|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0888|J0888 - EPOETIN BETA NON ESRD||1.9657|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0887|J0887 - EPOETIN BETA ESRD USE||1.9657|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0885|J0885 - EPOETIN ALFA- NON-ESRD||14.399|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0882|J0882 - DARBEPOETIN ALFA- ESRD USE||4.2218|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0881|J0881 - DARBEPOETIN ALFA- NON-ESRD||4.2218|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0878|J0878 - DAPTOMYCIN INJECTION||0.3916|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0875|J0875 - INJECTION- DALBAVANCIN||16.1238|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0850|J0850 - CYTOMEGALOVIRUS IMM IV /VIAL||1242.032|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0840|J0840 - CROTALIDAE POLY IMMUNE FAB||3555.1318|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0834|J0834 - INJ.- COSYNTROPIN- 0.25 MG||36.4672|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0800|J0800 - CORTICOTROPIN INJECTION||4389.1848|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0795|J0795 - CORTICORELIN OVINE TRIFLUTAL||9.4644|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0780|J0780 - PROCHLORPERAZINE INJECTION||11.0572|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0775|J0775 - COLLAGENASE- CLOST HIST INJ||47.8522|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0770|J0770 - COLISTIMETHATE SODIUM INJ||17.7309|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0744|J0744 - CIPROFLOXACIN IV||3.5387|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0743|J0743 - CILASTATIN SODIUM INJECTION||7.656|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0740|J0740 - CIDOFOVIR INJECTION||513.2688|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0735|J0735 - CLONIDINE HYDROCHLORIDE||13.4255|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0725|J0725 - CHORIONIC GONADOTROPIN/1000U||26.5243|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0720|J0720 - CHLORAMPHENICOL SODIUM INJEC||43.7019|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0717|J0717 - CERTOLIZUMAB PEGOL INJ 1MG||8.8253|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0713|J0713 - INJ CEFTAZIDIME PER 500 MG||2.5509|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0712|J0712 - CEFTAROLINE FOSAMIL INJ||3.1878|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0702|J0702 - BETAMETHASONE ACET&SOD PHOSP||7.689|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0698|J0698 - CEFOTAXIME SODIUM INJECTION||0.67|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0697|J0697 - STERILE CEFUROXIME INJECTION||2.189|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0696|J0696 - CEFTRIAXONE SODIUM INJECTION||0.6501|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0694|J0694 - CEFOXITIN SODIUM INJECTION||4.2086|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0692|J0692 - CEFEPIME HCL FOR INJECTION||2.7445|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0690|J0690 - CEFAZOLIN SODIUM INJECTION||0.8536|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0670|J0670 - INJ MEPIVACAINE HCL/10 ML||2.7973|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0641|J0641 - LEVOLEUCOVORIN INJECTION||0.2563|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0640|J0640 - LEUCOVORIN CALCIUM INJECTION||3.4463|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0638|J0638 - CANAKINUMAB INJECTION||121.572|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0637|J0637 - CASPOFUNGIN ACETATE||14.9611|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0636|J0636 - INJ CALCITRIOL PER 0.1 MCG||0.6105|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0630|J0630 - CALCITONIN SALMON INJECTION||2866.7452|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0610|J0610 - CALCIUM GLUCONATE INJECTION||4.5771|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0600|J0600 - EDETATE CALCIUM DISODIUM INJ||6153.8642|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0598|J0598 - C-1 ESTERASE- CINRYZE||61.5351|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0597|J0597 - C-1 ESTERASE- BERINERT||53.8285|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0596|J0596 - INJECTION- RUCONEST||30.4876|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0595|J0595 - BUTORPHANOL TARTRATE 1 MG||2.6334|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0594|J0594 - BUSULFAN INJECTION||22.2981|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0592|J0592 - BUPRENORPHINE HYDROCHLORIDE||4.3065|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0588|J0588 - INCOBOTULINUMTOXIN A||5.5902|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0587|J0587 - INJ- RIMABOTULINUMTOXINB||13.2165|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0586|J0586 - ABOBOTULINUMTOXINA||9.2675|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0585|J0585 - INJECTION-ONABOTULINUMTOXINA||6.7738|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0583|J0583 - BIVALIRUDIN||1.0582|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0570|J0570 - BUPRENORPHINE IMPLANT 74.2MG||1376.0164|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0561|J0561 - PENICILLIN G BENZATHINE INJ||15.3307|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0558|J0558 - PENG BENZATHINE/PROCAINE INJ||12.0175|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0515|J0515 - INJ BENZTROPINE MESYLATE||18.3447|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0500|J0500 - DICYCLOMINE INJECTION||84.832|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0490|J0490 - BELIMUMAB INJECTION||47.9809|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0485|J0485 - BELATACEPT INJECTION||4.2119|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0480|J0480 - BASILIXIMAB||4021.6077|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0476|J0476 - BACLOFEN INTRATHECAL TRIAL||65.3312|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0475|J0475 - BACLOFEN 10 MG INJECTION||190.641|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0470|J0470 - DIMECAPROL INJECTION||55.4884|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0461|J0461 - ATROPINE SULFATE INJECTION||0.0726|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0456|J0456 - AZITHROMYCIN||3.3539|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0401|J0401 - INJ ARIPIPRAZOLE EXT REL 1MG||5.7607|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0400|J0400 - ARIPIPRAZOLE INJECTION||0.95|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0360|J0360 - HYDRALAZINE HCL INJECTION||3.1273|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0348|J0348 - ANIDULAFUNGIN INJECTION||0.6182|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0295|J0295 - AMPICILLIN SULBACTAM 1.5 GM||2.6301|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0290|J0290 - AMPICILLIN 500 MG INJ||1.2276|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0289|J0289 - AMPHOTERICIN B LIPOSOME INJ||52.8737|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0287|J0287 - AMPHOTERICIN B LIPID COMPLEX||21.2696|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0285|J0285 - AMPHOTERICIN B||37.048|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0280|J0280 - AMINOPHYLLIN 250 MG INJ||7.5097|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0278|J0278 - AMIKACIN SULFATE INJECTION||1.2309|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0257|J0257 - GLASSIA INJECTION||5.1887|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0256|J0256 - ALPHA 1 PROTEINASE INHIBITOR||4.9621|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0221|J0221 - LUMIZYME INJECTION||179.0976|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0220|J0220 - ALGLUCOSIDASE ALFA INJECTION||258.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0207|J0207 - AMIFOSTINE||1074.2138|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0202|J0202 - INJECTION- ALEMTUZUMAB||2027.6036|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0180|J0180 - AGALSIDASE BETA INJECTION||192.137|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0178|J0178 - AFLIBERCEPT INJECTION||1064.4403|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0171|J0171 - ADRENALIN EPINEPHRINE INJECT||0.6424|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0153|J0153 - ADENOSINE INJ 1MG||0.847|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0135|J0135 - ADALIMUMAB INJECTION||1061.3|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0133|J0133 - ACYCLOVIR INJECTION||0.0572|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0132|J0132 - ACETYLCYSTEINE INJECTION||1.3508|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0130|J0130 - ABCIXIMAB INJECTION||1414.2007|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|J0129|J0129 - ABATACEPT INJECTION||56.7908|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|G0454|G0454 - MD DOCUMENT VISIT BY NPP||15.26|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|G0415|G0415 - OPEN TX POST PELVIC FXCTURE||2429.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|G0414|G0414 - PELVIC RING FX TREAT INT FIX||1707.91|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|G0413|G0413 - PELVIC RING FRACTURE UNI/BIL||1886.47|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|G0412|G0412 - OPEN TX ILIAC SPINE UNI/BIL||1283.65|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|G0372|G0372 - MD SERVICE REQUIRED FOR PMD||21.46|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|G0289|G0289 - ARTHRO- LOOSE BODY + CHONDRO||156.1|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|G0283|G0283 - ELEC STIM OTHER THAN WOUND||17.15|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|G0281|G0281 - ELEC STIM UNATTEND FOR PRESS||21.1|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|G0180|G0180 - MD CERTIFICATION HHA PATIENT||86.27|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|G0179|G0179 - MD RECERTIFICATION HHA PT||65.58|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2633|E2633 - MOBILE ARM SUPPORT SUPINATOR||181.23|18.14||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2632|E2632 - OFFSET/LAT ROCKER ARM W/ELA||213.66|21.37||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2631|E2631 - ELEVAT PROXIMAL ARM SUPPORT||336.03|33.6||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2630|E2630 - MONOSUSPENSION ARM/HAND SUPP||840.03|84.01||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2629|E2629 - FRICTION DAMPENING ARM SUPP||1201.24|120.11||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2628|E2628 - MOBILE ARM SUPPORTS RECLININ||949.24|94.92||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2627|E2627 - ARM SUPP ATT TO WC RANCHO TY||1260.04|126.04||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2626|E2626 - SEO MOBILE ARM SUP ATT TO WC||789.66|78.94||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2625|E2625 - ADJ SKIN PRO/POS WC CUS>=22||463.58|46.34||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2624|E2624 - ADJ SKIN PRO/POS CUS<22IN||366.19|36.63||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2623|E2623 - ADJ SKIN PRO WC CUS WD>=22IN||462.17|46.23||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2622|E2622 - ADJ SKIN PRO W/C CUS WD<22IN||363.2|36.33||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2621|E2621 - WC PLANAR BACK CUSH WD>=22IN||629.81|62.99||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2620|E2620 - WC PLANAR BACK CUSH WD <22IN||600.14|60.02||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2619|E2619 - REPLACE COVER W/C SEAT CUSH||56.22|5.62||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2616|E2616 - POS BACK POST/LAT WDTH>=22IN||666.86|66.69||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2615|E2615 - POS BACK POST/LAT WDTH <22IN||495.63|49.58||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2614|E2614 - POSITION BACK CUSH WD>=22IN||596.03|59.6||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2613|E2613 - POSITION BACK CUSH WD <22IN||430.69|43.08||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2612|E2612 - GEN USE BACK CUSH WDTH>=22IN||463|46.3||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2611|E2611 - GEN USE BACK CUSH WDTH <22IN||342.26|34.21||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2608|E2608 - SKIN PRO/POS WC CUS WD>=22IN||381.42|38.13||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2607|E2607 - SKIN PRO/POS WC CUS WD <22IN||317.61|31.76||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2606|E2606 - POSITION WC CUSH WDTH>=22 IN||460.15|46.02||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2605|E2605 - POSITION WC CUSH WDTH <22 IN||294.95|29.51||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2604|E2604 - SKIN PROTECT WC CUS WD>=22IN||206.46|20.64||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2603|E2603 - SKIN PROTECT WC CUS WD <22IN||166.09|16.62||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2602|E2602 - GEN W/C CUSHION WDTH >=22 IN||130.82|13.09||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2601|E2601 - GEN W/C CUSHION WDTH < 22 IN||67.01|6.73||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2512|E2512 - SGD ACCESSORY- MOUNTING SYS||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2511|E2511 - SGD SFTWRE PRGRM FOR PC/PDA||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2510|E2510 - SGD W MULTI METHODS MSG/ACCS||8604.7|860.48||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2508|E2508 - SGD SPELLING PHYS CONTACT||4547.05|454.7||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2506|E2506 - SGD PREREC MSG > 40 MIN||2940.55|294.03||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2504|E2504 - SGD PREREC MSG>20MIN <=40MIN||2005.42|200.57||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2502|E2502 - SGD PREREC MSG >8MIN <=20MIN||1520.25|152.03||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2500|E2500 - SGD DIGITIZED PRE-REC <=8MIN||497.14|49.73||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2402|E2402 - NEG PRESS WOUND THERAPY PUMP||0|806.5||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2397|E2397 - PWC ACC- LITH-BASED BATTERY||526.5|52.66||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2396|E2396 - CASTER FORK||72.88|7.73||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2395|E2395 - CASTER WHEEL EXCLUDES TIRE||59.77|5.99||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2394|E2394 - DRIVE WHEEL EXCLUDES TIRE||84.12|8.43||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2392|E2392 - SOLID CASTER TIRE- INTEGRATE||59.03|5.93||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2391|E2391 - SOLID CASTER TIRE||22.45|2.25||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2390|E2390 - SOLID DRIVE WHEEL TIRE||46.89|4.68||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2389|E2389 - FOAM CASTER TIRE||29.99|3.01||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2388|E2388 - FOAM DRIVE WHEEL TIRE||55.2|5.53||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2387|E2387 - FOAM FILLED CASTER TIRE||73.94|7.39||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2386|E2386 - FOAM FILLED DRIVE WHEEL TIRE||164.91|16.49||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2385|E2385 - TUBE- PNEUMATIC CASTER TIRE||54.25|5.45||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2384|E2384 - PNEUMATIC CASTER TIRE||88.67|8.89||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2383|E2383 - INSERT- PNEUM WHEEL DRIVE||166.43|16.64||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2382|E2382 - TUBE- PNEUM WHEEL DRIVE TIRE||22.75|2.27||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2381|E2381 - PNEUM DRIVE WHEEL TIRE||83.47|8.37||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2378|E2378 - PW ACTUATOR REPLACEMENT||0|62.88||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2377|E2377 - EXPANDABLE CONTROLLER- INITL||0|53.21||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2376|E2376 - EXPANDABLE CONTROLLER- REPL||0|147.09||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2375|E2375 - NON-EXPANDABLE CONTROLLER||0|93.84||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2374|E2374 - HAND/CHIN CTRL STD JOYSTICK||0|58.53||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2373|E2373 - HAND/CHIN CTRL SPEC JOYSTICK||0|137.88||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2372|E2372 - GR27 NON-SEALED LEADACID||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2371|E2371 - GR27 SEALED LEADACID BATTERY||165.17|16.53||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2370|E2370 - PWR WC DR WH MOTOR/GEAR COMB||0|87.97||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2369|E2369 - PWR WC DRIVEWHEEL GEAR REPL||0|49.32||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2368|E2368 - PWR WC DRIVEWHEEL MOTOR REPL||0|56.6||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2367|E2367 - BATTERY CHARGER- DUAL MODE||459.21|45.92||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2366|E2366 - BATTERY CHARGER- SINGLE MODE||245.54|24.62||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2365|E2365 - U1 SEALED LEADACID BATTERY||122.91|12.28||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2364|E2364 - U1NONSEALED LEADACID BATTERY||121.41|12.2||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2363|E2363 - GR24 SEALED LEADACID BATTERY||203.83|20.38||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2362|E2362 - GR24 NONSEALED LEADACID||116.94|11.7||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2361|E2361 - 22NF SEALED LEADACID BATTERY||152.82|15.28||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2360|E2360 - 22NF NONSEALED LEADACID||121.41|12.2||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2359|E2359 - GR34 SEALED LEADACID BATTERY||221.4|22.15||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2351|E2351 - ELECTRONIC SGD INTERFACE||765.54|76.58||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2343|E2343 - W/C DPTH 22-25 IN SEAT FRAME||911.27|91.11||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2342|E2342 - W/C DPTH 20-21 IN SEAT FRAME||569.54|56.95||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2341|E2341 - W/C WDTH 24-27 IN SEAT FRAME||683.45|68.33||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2340|E2340 - W/C WDTH 20-23 IN SEAT FRAME||455.6|45.57||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2330|E2330 - HEAD CONTROL PROXIMITY SWITC||0|374.97||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2329|E2329 - HEAD CONTROL NONPROPORTIONAL||0|193.52||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2328|E2328 - HEAD/EXTREMITY CONTROL INTER||0|542.97||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2327|E2327 - HEAD CONTROL INTERFACE MECH||0|434.88||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2326|E2326 - BREATH TUBE KIT||0|38.05||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2325|E2325 - SIP AND PUFF INTERFACE||0|147.59||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2324|E2324 - CHIN CUP INTERFACE||48.01|4.77||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2323|E2323 - SPECIAL JOYSTICK HANDLE||75.8|7.57||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2322|E2322 - MULT MECH SWITCHES||0|300.37||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2321|E2321 - HAND INTERFACE JOYSTICK||0|283.66||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2313|E2313 - PWC HARNESS- EXPAND CONTROL||0|40.74||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2312|E2312 - MINI-PROP REMOTE JOYSTICK||0|326.98||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2311|E2311 - ELECTRO CONNECT BTW 2 SYS||0|259.61||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2310|E2310 - ELECTRO CONNECT BTW CONTROL||0|128.21||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2231|E2231 - SOLID SEAT SUPPORT BASE||155.92|15.59||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2228|E2228 - MWC ACC- WHEELCHAIR BRAKE||0|103.16||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2227|E2227 - GEAR REDUCTION DRIVE WHEEL||0|237.84||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2226|E2226 - CASTER FORK REPLACEMENT ONLY||42.58|4.25||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2225|E2225 - CASTER WHEEL EXCLUDES TIRE||19.96|2||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2224|E2224 - PROPULSION WHL EXCL TIRE REP||103.33|10.34||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2222|E2222 - SOLID CASTER INTEG WHL- REPL||24.35|2.44||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2221|E2221 - SOLID CASTER TIRE REPL- EACH||28.77|2.88||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2220|E2220 - SOLID PROPULS TIRE- REPL- EA||32.41|3.24||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2219|E2219 - FOAM CASTER TIRE ANY SIZE EA||43.44|4.35||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2218|E2218 - FOAM PROPULSION TIRE EACH||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2217|E2217 - FOAM FILLED CASTER TIRE EACH||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2216|E2216 - FOAM FILLED PROPULSION TIRE||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2215|E2215 - PNEUMATIC CASTER TIRE TUBE||10.98|1.1||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2214|E2214 - PNEUMATIC CASTER TIRE EACH||34.06|3.4||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2213|E2213 - PNEUMATIC PROP TIRE INSERT||32.17|3.22||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2212|E2212 - PNEUMATIC PROP TIRE TUBE||6.68|0.67||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2211|E2211 - PNEUMATIC PROPULSION TIRE||37.72|3.77||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2210|E2210 - WHEELCHAIR BEARINGS||7.16|0.72||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2209|E2209 - ARM TROUGH EACH||117.43|11.76||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2208|E2208 - CYLINDER TANK CARRIER||130.17|13.01||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2207|E2207 - CRUTCH AND CANE HOLDER||55.11|5.53||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2206|E2206 - MAN WC WHL LOCK COMP REPL EA||41.88|4.19||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2205|E2205 - MANUAL WC ACCESSORY- HANDRIM||38.18|3.82||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2204|E2204 - FRAME DEPTH 22 TO 25 IN||823.25|82.33||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2203|E2203 - FRAME DEPTH LESS THAN 22 IN||476.76|47.68||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2202|E2202 - SEAT WIDTH 24-27 IN||490.66|49.07||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2201|E2201 - MAN W/CH ACC SEAT W>=20''<24''||353|35.31||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2120|E2120 - PULSE GEN SYS TX ENDOLYMP FL||0|360.46||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2101|E2101 - BLD GLUCOSE MONITOR W LANCE||239.72|23.97||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2100|E2100 - BLD GLUCOSE MONITOR W VOICE||695.04|69.51||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E2000|E2000 - GASTRIC SUCTION PUMP HME MDL||0|63.89||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1841|E1841 - STATIC STR SHLDR DEV ROM ADJ||0|575.9||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1840|E1840 - ADJ SHOULDER EXT/FLEX DEVICE||0|470.46||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1831|E1831 - STATIC STR TOE DEV EXT/FLEX||0|84.01||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1830|E1830 - ADJUST TOE EXT/FLEX DEVICE||0|136.54||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1825|E1825 - ADJUST FINGER EXT/FLEX DEVC||0|136.54||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1821|E1821 - REPLACEMENT INTERFACE SPSD||133.8|13.35||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1820|E1820 - SOFT INTERFACE MATERIAL||103.93|10.38||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1818|E1818 - SPS FOREARM DEVICE||0|171.49||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1816|E1816 - SPS ANKLE DEVICE||0|167.99||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1815|E1815 - ADJUST ANKLE EXT/FLEX DEVICE||0|136.54||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1812|E1812 - KNEE EXT/FLEX W ACT RES CTRL||0|109.32||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1811|E1811 - SPS KNEE DEVICE||0|165.42||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1810|E1810 - ADJUST KNEE EXT/FLEX DEVICE||0|134.63||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1806|E1806 - SPS WRIST DEVICE||0|130.61||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1805|E1805 - ADJUST WRIST EXT/FLEX DEVICE||0|136.54||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1802|E1802 - ADJST FOREARM PRO/SUP DEVICE||0|415.48||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1801|E1801 - SPS ELBOW DEVICE||0|159.1||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1800|E1800 - ADJUST ELBOW EXT/FLEX DEVICE||0|132.39||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1702|E1702 - REPL MEASR SCALES JAW MOTION||25.71|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1701|E1701 - REPL CUSHIONS FOR JAW MOTION||12.81|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1700|E1700 - JAW MOTION REHAB SYSTEM||0|43.85||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1406|E1406 - O2/WATER VAPOR ENRICH W/O HE||0|99.65||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1405|E1405 - O2/WATER VAPOR ENRICH W/HEAT||0|126.07||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1392|E1392 - PORTABLE OXYGEN CONCENTRATOR||0|43.46||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1391|E1391 - OXYGEN CONCENTRATOR- DUAL||0|92.64||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1390|E1390 - OXYGEN CONCENTRATOR||0|92.64||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1372|E1372 - OXY SUPPL HEATER FOR NEBULIZ||145.94|14.59||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1355|E1355 - OXYGEN SUPPLIES STAND/RACK||27.13|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1353|E1353 - OXYGEN SUPPLIES REGULATOR||36.01|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1310|E1310 - WHIRLPOOL NON-PORTABLE||2730.07|233.5||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1298|E1298 - WHEELCHAIR SPEC SEAT DEPTH/W||538.61|55.11||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1297|E1297 - WHEELCHAIR SPECIAL SEAT DEPT||133|14.78||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1296|E1296 - WHEELCHAIR SPECIAL SEAT HEIG||625.06|63.5||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1295|E1295 - WHEELCHAIR HEAVY DUTY FIXED||0|154.42||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1280|E1280 - WHCHR H-DUTY DET ARM LEG RES||0|145.35||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1270|E1270 - WHEELCHAIR LIGHTWEIGHT LEG R||0|100.36||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1240|E1240 - WHCHR LITWT DET ARM LEG REST||0|130.97||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1238|E1238 - FLD PED WC ADJSTABL W/O SEAT||0|208.33||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1237|E1237 - RGD PED WC ADJSTABL W/O SEAT||0|210.16||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1236|E1236 - FOLDING PED WC ADJUSTABLE||0|208.33||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1235|E1235 - RIGID PED WC ADJUSTABLE||0|236.16||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1234|E1234 - FLD PED WC TLTNSPC W/O SEAT||0|245.25||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1233|E1233 - RIG PED WC TLTNSPC W/O SEAT||0|281.69||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1232|E1232 - FOLDING PED WC TILT-IN-SPACE||0|271.88||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1231|E1231 - RIGID PED W/C TILT-IN-SPACE||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1230|E1230 - POWER OPERATED VEHICLE||2875.51|282.81||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1228|E1228 - WHEELCHAIR SPEC SZ SPEC HT B||0|30.28||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1227|E1227 - WHEELCHAIR SPEC SZ SPEC HT A||352.8|35.29||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1226|E1226 - MANUAL FULLY RECLINING BACK||445.56|44.56||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1225|E1225 - MANUAL SEMI-RECLINING BACK||0|41.79||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1224|E1224 - WHEELCHAIR SPEC SIZE W/ LEG||0|103.17||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1223|E1223 - WHEELCHAIR SPEC SIZE W FOOT||0|94.09||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1222|E1222 - WHEELCHAIR SPEC SIZE W/ LEG||0|85.43||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1221|E1221 - WHEELCHAIR SPEC SIZE W FOOT||0|60.41||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1200|E1200 - WHEELCHAIR AMPUTEE FIXED ARM||0|94.02||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1195|E1195 - WHEELCHAIR AMPUTEE HEAVY DUT||0|135.76||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1190|E1190 - WHEELCHAIR AMPUTEE W/ LEG RE||0|126.52||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1180|E1180 - WHEELCHAIR AMPUTEE W/ FOOT R||0|109.51||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1172|E1172 - WHEELCHAIR AMPUTEE DETACH AR||0|124.55||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1171|E1171 - WHEELCHAIR AMPUTEE W/O LEG R||0|90.13||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1170|E1170 - WHLCHR AMPU FXD ARM LEG REST||0|96.53||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1161|E1161 - MANUAL ADULT WC W TILTINSPAC||0|300.81||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1160|E1160 - WHEELCHAIR FIXED ARMS||0|67.55||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1150|E1150 - WHEELCHAIR STANDARD W/ LEG R||0|95.13||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1110|E1110 - WHEELCHAIR SEMI-RECL DETACH||0|109.85||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1100|E1100 - WHCHR S-RECL FXD ARM LEG RES||0|112.17||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1093|E1093 - WHEELCHAIR WIDE W/ FOOT REST||0|119.43||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1092|E1092 - WHEELCHAIR WIDE W/ LEG RESTS||0|163.39||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1088|E1088 - WHEELCHAIR LIGHTWEIGHT DET A||0|175.03||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1087|E1087 - WHEELCHAIR LIGHTWT FIXED ARM||0|136.74||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1084|E1084 - HEMI-WHEELCHAIR DETACHABLE A||0|124.72||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1083|E1083 - HEMI-WHEELCHAIR FIXED ARMS||0|85.09||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1070|E1070 - WHEELCHAIR DETACHABLE FOOT R||0|118.37||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1060|E1060 - WHEELCHAIR DETACHABLE ARMS||0|136.23||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1050|E1050 - WHELCHR FXD FULL LENGTH ARMS||0|110.04||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1039|E1039 - TRANSPORT CHAIR PT WT >300LB||0|36.2||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1038|E1038 - TRANSPORT CHAIR PT WT<=300LB||0|17.07||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1037|E1037 - TRANSPORT CHAIR- PED SIZE||0|115.97||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1036|E1036 - PATIENT TRANSFER SYSTEM >300||0|927.77||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1035|E1035 - PATIENT TRANSFER SYSTEM <300||0|657.11||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1031|E1031 - ROLLABOUT CHAIR WITH CASTERS||0|47.21||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1030|E1030 - W/C VENT TRAY GIMBALED||0|127.68||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1029|E1029 - W/C VENT TRAY FIXED||0|40.48||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1028|E1028 - W/C MANUAL SWINGAWAY||0|22.62||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1020|E1020 - RESIDUAL LIMB SUPPORT SYSTEM||0|26.66||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1018|E1018 - HD SHCK ABSRBER FOR HD POWWC||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1017|E1017 - HD SHCK ABSRBR FOR HD MAN WC||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1016|E1016 - SHOCK ABSORBER FOR POWER W/C||143.9|14.41||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1015|E1015 - SHOCK ABSORBER FOR MAN W/C||130.78|13.08||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1014|E1014 - RECLINING BACK ADD PED W/C||0|46.44||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1012|E1012 - CTR MOUNT PWR ELEV LEG REST||0|125.34||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1011|E1011 - PED WC MODIFY WIDTH ADJUSTM||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1010|E1010 - ADD PWR LEG ELEVATION||0|125.34||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1009|E1009 - ADD MECH LEG ELEVATION||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1008|E1008 - PWR SEAT COMBO PWR SHEAR||0|957.92||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1007|E1007 - PWR SEAT COMBO W/SHEAR||0|957.85||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1006|E1006 - PWR SEAT COMBO W/O SHEAR||0|707.38||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1005|E1005 - PWR SEAT RECLINE PWR||0|577.5||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1004|E1004 - PWR SEAT RECLINE MECH||0|533.52||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1003|E1003 - PWR SEAT RECLINE||0|481.19||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E1002|E1002 - PWR SEAT TILT||0|444.12||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0995|E0995 - WC CALF REST- PAD REPLACEMNT||33.3|3.35||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0994|E0994 - WHEELCHAIR ARM REST||19.04|1.92||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0992|E0992 - WHEELCHAIR SOLID SEAT INSERT||90.71|9.07||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0990|E0990 - WHEELCHAIR ELEVATING LEG RES||128.67|12.88||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0988|E0988 - LEVER-ACTIVATED WHEEL DRIVE||0|380.57||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0986|E0986 - MAN W/C PUSH-RIM POWR SYSTEM||0|618.42||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0985|E0985 - W/C SEAT LIFT MECHANISM||0|25.81||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0984|E0984 - ADD PWR TILLER||0|242.88||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0983|E0983 - ADD PWR JOYSTICK||0|308.82||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0982|E0982 - BACK UPHOLSTERY- REPLACEMENT||56.45|5.65||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0981|E0981 - SEAT UPHOLSTERY- REPLACEMENT||49.97|4.99||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0980|E0980 - WHEELCHAIR SAFETY VEST||35.72|3.58||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0978|E0978 - W/C ACC-SAF BELT PELV STRAP||46.79|4.68||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0974|E0974 - W/CH ACCESS ANTI-ROLLBACK||80.17|8.02||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0973|E0973 - W/CH ACCESS DET ADJ ARMREST||125.98|11.99||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0971|E0971 - WHEELCHAIR ANTI-TIPPING DEVI||34.73|3.47||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0969|E0969 - WHEELCHAIR NARROWING DEVICE||199.13|19.71||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0968|E0968 - WHEELCHAIR COMMODE SEAT||0|21.91||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0967|E0967 - MAN WC RIM/PROJECTION REP EA||78.84|7.89||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0966|E0966 - WHEELCHAIR HEAD REST EXTENSI||75.58|7.56||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0961|E0961 - WHEELCHAIR BRAKE EXTENSION||22.15|2.22||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0960|E0960 - W/C SHOULDER HARNESS/STRAPS||99.69|9.99||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0959|E0959 - AMPUTEE ADAPTER||47.3|4.73||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0958|E0958 - WHLCHR ATT- CONV 1 ARM DRIVE||0|45.31||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0957|E0957 - W/C MEDIAL THIGH SUPPORT||151.14|15.12||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0956|E0956 - W/C LATERAL TRUNK/HIP SUPPOR||108.01|10.8||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0955|E0955 - CUSHIONED HEADREST||0|22.17||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0954|E0954 - FOOT BOX- ANY TYPE EACH FOOT||58.28|5.85||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0953|E0953 - W/C LATERAL THIGH/KNEE SUP EACH||83.84|8.38||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0952|E0952 - TOE LOOP/HOLDER- EACH||17.55|1.82||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0951|E0951 - LOOP HEEL||20.8|2.14||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0950|E0950 - TRAY||96.82|9.71||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0948|E0948 - FRACTURE FRAME ATTACHMNTS CE||683.03|68.31||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0947|E0947 - FRACTURE FRAME ATTACHMNTS PE||683.03|69.15||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0946|E0946 - FRACTURE FRAME DUAL W CROSS||0|63.94||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0945|E0945 - BELT/HARNESS EXTREMITY||47.9|4.8||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0944|E0944 - PELVIC BELT/HARNESS/BOOT||56.98|5.7||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0942|E0942 - CERVICAL HEAD HARNESS/HALTER||21.86|2.54||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0941|E0941 - GRAVITY ASSISTED TRACTION DE||0|55.18||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0940|E0940 - TRAPEZE BAR FREE STANDING||0|23.54||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0935|E0935 - CONT PAS MOTION EXERCISE DEV||0|24.58||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0930|E0930 - FRACTURE FRAME FREE STANDING||0|49.37||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0920|E0920 - FRACTURE FRAME ATTACHED TO B||0|52.13||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0912|E0912 - HD TRAPEZE BAR FREE STANDING||0|95.51||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0911|E0911 - HD TRAPEZE BAR ATTACH TO BED||0|47.41||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0910|E0910 - TRAPEZE BAR ATTACHED TO BED||0|12.62||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0900|E0900 - TRAC STAND FREE STAND PELVIC||138.46|29.85||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0890|E0890 - TRACTION FRAME ATTACH PELVIC||130.11|41.52||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0880|E0880 - TRAC STAND FREE STAND EXTREM||135.67|21.3||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0870|E0870 - TRACT FRAME ATTACH FOOTBOARD||125.69|14.5||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0860|E0860 - TRACT EQUIP CERVICAL TRACT||46|7.04||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0856|E0856 - CERVIC COLLAR W AIR BLADDERS||0|19.56||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0855|E0855 - CERVICAL TRACTION EQUIPMENT||0|63.89||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0850|E0850 - TRACTION STAND FREE STANDING||113.52|15.59||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0849|E0849 - CERVICAL PNEUM TRAC EQUIP||0|65.53||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0840|E0840 - TRACT FRAME ATTACH HEADBOARD||90.33|20.76||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0791|E0791 - PARENTERAL INFUSION PUMP STA||0|316.89||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0786|E0786 - IMPLANTABLE PUMP REPLACEMENT||10152.65|1015.24||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0785|E0785 - REPLACEMENT IMPL PUMP CATHET||600.71|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0784|E0784 - EXT AMB INFUSN PUMP INSULIN||0|480.96||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0783|E0783 - PROGRAMMABLE INFUSION PUMP||10408.29|1040.85||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0782|E0782 - NON-PROGRAMBLE INFUSION PUMP||5458.37|545.86||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0781|E0781 - EXTERNAL AMBULATORY INFUS PU||0|266.74||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0780|E0780 - MECH AMB INFUSION PUMP <8HRS||13.06|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0779|E0779 - AMB INFUSION PUMP MECHANICAL||0|20.55||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0776|E0776 - IV POLE||154.71|15.85||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0765|E0765 - NERVE STIMULATOR FOR TX N&V||106.96|10.71||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0764|E0764 - FUNCTIONAL NEUROMUSCULARSTIM||0|1406.94||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0762|E0762 - TRANS ELEC JT STIM DEV SYS||0|139.78||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0760|E0760 - OSTEOGEN ULTRASOUND STIMLTOR||4110.36|411.04||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0749|E0749 - ELEC OSTEOGEN STIM IMPLANTED||0|307.29||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0748|E0748 - ELEC OSTEOGEN STIM SPINAL||4946.39|494.62||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0747|E0747 - ELEC OSTEOGEN STIM NOT SPINE||4978.64|494.73||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0745|E0745 - NEUROMUSCULAR STIM FOR SHOCK||0|113.8||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0744|E0744 - NEUROMUSCULAR STIM FOR SCOLI||0|116.41||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0740|E0740 - NON-IMPLANT PELV FLR E-STIM||0|66.49||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0731|E0731 - CONDUCTIVE GARMENT FOR TENS/||114.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0730|E0730 - TENS FOUR LEAD||90.77|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0720|E0720 - TENS TWO LEAD||98.81|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0705|E0705 - TRANSFER DEVICE||70.08|7.13||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0694|E0694 - UVL MD CABINET SYS 6 FT||5628.63|562.86||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0693|E0693 - UVL SYS PANEL 6 FT||1768.4|176.85||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0692|E0692 - UVL SYS PANEL 4 FT||1434.56|143.44||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0691|E0691 - UVL PNL 2 SQ FT OR LESS||1142.41|114.23||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0675|E0675 - PNEUMATIC COMPRESSION DEVICE||0|488.89||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0673|E0673 - PRESSURE PNEUM APPL HALF LEG||340.93|34.1||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0672|E0672 - PRESSURE PNEUM APPL FULL ARM||410.29|41.04||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0671|E0671 - PRESSURE PNEUM APPL FULL LEG||528.06|52.83||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0670|E0670 - SEG PNEUM INT LEGS/TRUNK||1598.13|171.09||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0669|E0669 - SEG PNEUMATIC APPLI HALF LEG||230.15|23.03||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0668|E0668 - SEG PNEUMATIC APPL FULL ARM||561.77|55.44||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0667|E0667 - SEG PNEUMATIC APPL FULL LEG||411.62|46.48||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0666|E0666 - PNEUMATIC APPLIANCE HALF LEG||175.57|18.09||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0665|E0665 - PNEUMATIC APPLIANCE FULL ARM||170.41|17.05||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0660|E0660 - PNEUMATIC APPLIANCE FULL LEG||203.09|20.71||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0657|E0657 - SEGMENTAL PNEUMATIC CHEST||0|69.01||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0656|E0656 - SEGMENTAL PNEUMATIC TRUNK||0|73.46||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0655|E0655 - PNEUMATIC APPLIANCE HALF ARM||120.01|13.71||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0652|E0652 - PNEUM COMPRES W/CAL PRESSURE||6739.91|666.1||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0651|E0651 - PNEUM COMPRESSOR SEGMENTAL||1167.61|119.28||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0650|E0650 - PNEUMA COMPRESOR NON-SEGMENT||778.29|101.52||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0640|E0640 - FIXED PATIENT LIFT SYSTEM||0|139.66||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0639|E0639 - MOVEABLE PATIENT LIFT SYSTEM||0|139.66||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0636|E0636 - PT SUPPORT & POSITIONING SYS||0|1099.71||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0635|E0635 - PATIENT LIFT ELECTRIC||0|129.49||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0630|E0630 - PATIENT LIFT HYDRAULIC||0|67.16||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0629|E0629 - SEAT LIFT MECH- NON-ELECTRIC||301.07|30.11||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0628|E0628 - SEAT LIFT FOR PT FURN-ELECTR||316.5|31.65||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0627|E0627 - SEAT LIFT MECH- ELECTRIC ANY||291.03|29.11||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0621|E0621 - PATIENT LIFT SLING OR SEAT||89.06|8.9||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0620|E0620 - CAP BLD SKIN PIERCING LASER||0|111.15||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0619|E0619 - APNEA MONITOR W RECORDER||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0618|E0618 - APNEA MONITOR||0|356.44||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0617|E0617 - AUTOMATIC EXT DEFIBRILLATOR||0|429.18||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0615|E0615 - PACEMAKER MONITR DIGITAL/VIS||608.72|74.37||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0610|E0610 - PACEMAKER MONITR AUDIBLE/VIS||267.5|27.11||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0607|E0607 - BLOOD GLUCOSE MONITOR HOME||84.94|8.49||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0606|E0606 - DRAINAGE BOARD POSTURAL||0|29.19||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0605|E0605 - VAPORIZER ROOM TYPE||28.57|3.32||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0602|E0602 - MANUAL BREAST PUMP||37.52|3.77||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0601|E0601 - CONT AIRWAY PRESSURE DEVICE||0|47.85||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0600|E0600 - SUCTION PUMP PORTAB HOM MODL||0|51.77||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0585|E0585 - NEBULIZER W/ COMPRESSOR & HE||0|33.42||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0580|E0580 - NEBULIZER FOR USE W/ REGULAT||146.59|14.66||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0575|E0575 - NEBULIZER ULTRASONIC||0|128.12||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0574|E0574 - ULTRASONIC GENERATOR W SVNEB||0|49.94||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0572|E0572 - AEROSOL COMPRESSOR ADJUST PR||0|35.21||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0570|E0570 - NEBULIZER WITH COMPRESSION||0|7||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0565|E0565 - COMPRESSOR AIR POWER SOURCE||0|47.03||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0562|E0562 - HUMIDIFIER HEATED USED W PAP||159.33|15.93||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0561|E0561 - HUMIDIFIER NONHEATED W PAP||82.73|8.27||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0560|E0560 - HUMIDIFIER SUPPLEMENTAL W/ I||159.75|20.17||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0550|E0550 - HUMIDIF EXTENS SUPPLE W IPPB||0|63.73||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0500|E0500 - IPPB ALL TYPES||0|118.61||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0486|E0486 - ORAL DEVICE/APPLIANCE CUSFAB||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0485|E0485 - ORAL DEVICE/APPLIANCE PREFAB||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0484|E0484 - NON-ELEC OSCILLATORY PEP DVC||46.95|4.68||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0483|E0483 - HI FREQ CHEST WALL OSCIL SYS||0|1351.6||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0482|E0482 - COUGH STIMULATING DEVICE||0|530.29||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0480|E0480 - PERCUSSOR ELECT/PNEUM HOME M||0|54.92||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0472|E0472 - RAD W BACKUP INVASIVE INTRFC||0|450.67||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0471|E0471 - RAD W/BACKUP NON INV INTRFC||0|302.35||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0470|E0470 - RAD W/O BACKUP NON-INV INTFC||0|123.46||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0466|E0466 - HOME VENT NON-INVASIVE INTER||0|1213.51||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0465|E0465 - HOME VENT INVASIVE INTERFACE||0|1213.51||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0462|E0462 - ROCKING BED W/ OR W/O SIDE R||0|370.47||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0444|E0444 - PORTABLE 02 CONTENTS- LIQUID||56.13|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0443|E0443 - PORTABLE 02 CONTENTS- GAS||56.13|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0442|E0442 - STATIONARY O2 CONTENTS- LIQ||62.16|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0441|E0441 - STATIONARY O2 CONTENTS- GAS||62.16|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0439|E0439 - STATIONARY LIQUID 02||0|92.64||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0434|E0434 - PORTABLE LIQUID 02||0|20.17||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0433|E0433 - PORTABLE LIQUID OXYGEN SYS||0|43.46||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0431|E0431 - PORTABLE GASEOUS 02||0|20.17||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0424|E0424 - STATIONARY COMPRESSED GAS 02||0|92.64||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0373|E0373 - NONPOWERED PRESSURE MATTRESS||0|413.88||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0372|E0372 - POWERED AIR MATTRESS OVERLAY||0|302.31||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0371|E0371 - NONPOWER MATTRESS OVERLAY||0|321.23||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0326|E0326 - URINAL FEMALE JUG-TYPE||10.53|1.06||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0325|E0325 - URINAL MALE JUG-TYPE||9.8|0.98||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0316|E0316 - BED SAFETY ENCLOSURE||0|197.18||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0310|E0310 - RAILS BED SIDE FULL LENGTH||130.58|13.06||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0305|E0305 - RAILS BED SIDE HALF LENGTH||0|12.17||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0304|E0304 - HOSP BED XTRA HVY DTY X WIDE||0|561.43||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0303|E0303 - HOSP BED HVY DTY XTRA WIDE||0|191.88||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0302|E0302 - EX HD HOSP BED > 600 LBS||0|541.73||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0301|E0301 - HD HOSP BED- 350-600 LBS||0|193.27||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0300|E0300 - ENCLOSED PED CRIB HOSP GRADE||0|272.08||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0297|E0297 - HOSP BED TOTAL ELECT W/O MAT||0|107.76||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0296|E0296 - HOSP BED TOTAL ELECT W/ MATT||0|122.1||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0295|E0295 - HOSP BED SEMI-ELECT W/O MATT||0|77.15||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0294|E0294 - HOSP BED SEMI-ELECT W/ MATTR||0|78.74||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0293|E0293 - HOSP BED VAR HT NO SR NO MAT||0|60.34||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0292|E0292 - HOSP BED VAR HT NO SR W/MATT||0|68.32||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0291|E0291 - HOSP BED FX HT W/O RAIL W/O||0|47.66||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0290|E0290 - HOSP BED FX HT W/O RAILS W/M||0|62.5||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0280|E0280 - BED CRADLE||34.1|3.42||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0277|E0277 - POWERED PRES-REDU AIR MATTRS||0|229.7||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0276|E0276 - BED PAN FRACTURE||12.68|1.26||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0275|E0275 - BED PAN STANDARD||15.2|1.52||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0272|E0272 - MATTRESS FOAM RUBBER||158.27|15.82||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0271|E0271 - MATTRESS INNERSPRING||142.61|14.26||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0266|E0266 - HOSP BED TOTAL ELEC W/O MATT||0|136.17||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0265|E0265 - HOSP BED TOTAL ELECTR W/ MAT||0|156.49||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0261|E0261 - HOSP BED SEMI-ELECTR W/O MAT||0|68.22||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0260|E0260 - HOSP BED SEMI-ELECTR W/ MATT||0|71.71||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0256|E0256 - HOSPITAL BED VAR HT W/O MATT||0|65.65||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0255|E0255 - HOSPITAL BED VAR HT W/ MATTR||0|75.56||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0251|E0251 - HOSP BED FIXD HT W/O MATTRES||0|62.91||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0250|E0250 - HOSP BED FIXED HT W/ MATTRES||0|71.3||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0249|E0249 - PAD WATER CIRCULATING HEAT U||126.64|13.93||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0239|E0239 - HYDROCOLLATOR UNIT PORTABLE||571.88|57.2||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0236|E0236 - PUMP FOR WATER CIRCULATING P||0|50.09||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0235|E0235 - PARAFFIN BATH UNIT PORTABLE||0|21.93||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0225|E0225 - HYDROCOLLATOR UNIT||494.1|48.7||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0217|E0217 - WATER CIRC HEAT PAD W PUMP||627.74|62.74||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0215|E0215 - ELECTRIC HEAT PAD MOIST||76.56|8||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0210|E0210 - ELECTRIC HEAT PAD STANDARD||37.04|3.69||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0205|E0205 - HEAT LAMP WITH STAND||246.72|27.14||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0202|E0202 - PHOTOTHERAPY LIGHT W/ PHOTOM||0|67.67||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0200|E0200 - HEAT LAMP WITHOUT STAND||100.8|13.69||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0199|E0199 - DRY PRESSURE PAD FOR MATTRES||33.09|3.31||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0198|E0198 - WATER PRESSURE PAD FOR MATTR||0|23.95||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0197|E0197 - AIR PRESSURE PAD FOR MATTRES||0|18.73||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0196|E0196 - GEL PRESSURE MATTRESS||0|33.5||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0194|E0194 - AIR FLUIDIZED BED||0|3516.76||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0193|E0193 - POWERED AIR FLOTATION BED||0|763.63||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0191|E0191 - PROTECTOR HEEL OR ELBOW||10.8|1.12||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0189|E0189 - LAMBSWOOL SHEEPSKIN PAD||55.14|5.52||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0188|E0188 - SYNTHETIC SHEEPSKIN PAD||26.43|2.65||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0187|E0187 - WATER PRESSURE MATTRESS||0|21.64||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0186|E0186 - AIR PRESSURE MATTRESS||0|20.02||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0185|E0185 - GEL PRESSURE MATTRESS PAD||196.76|19.68||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0184|E0184 - DRY PRESSURE MATTRESS||182.42|18.24||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0182|E0182 - REPLACE PUMP- ALT PRESS PAD||0|21.46||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0181|E0181 - PRESS PAD ALTERNATING W/ PUM||0|18.23||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0175|E0175 - COMMODE CHAIR FOOT REST||84.21|8.42||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0171|E0171 - COMMODE CHAIR NON-ELECTRIC||0|32.99||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0170|E0170 - COMMODE CHAIR ELECTRIC||0|180.11||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0168|E0168 - HEAVYDUTY/WIDE COMMODE CHAIR||136.79|13.69||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0167|E0167 - COMMODE CHAIR PAIL OR PAN||11.12|1.12||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0165|E0165 - COMMODE CHAIR WITH DETACHARM||0|14.13||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0163|E0163 - COMMODE CHAIR WITH FIXED ARM||63.23|6.33||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0162|E0162 - SITZ BATH CHAIR||157.46|16.51||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0161|E0161 - SITZ BATH/EQUIPMENT W/FAUCET||27.88|2.79||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0160|E0160 - SITZ TYPE BATH OR EQUIPMENT||29.69|2.97||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0159|E0159 - BRAKE FOR WHEELED WALKER||16.66|1.67||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0158|E0158 - WALKER LEG EXTENDERS SET OF4||23.86|2.39||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0157|E0157 - WALKER CRUTCH ATTACHMENT||63.35|6.34||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0156|E0156 - WALKER SEAT ATTACHMENT||18.04|1.81||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0155|E0155 - WALKER WHEEL ATTACHMENT-PAIR||22.77|2.28||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0154|E0154 - WALKER PLATFORM ATTACHMENT||52.33|5.23||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0153|E0153 - FOREARM CRUTCH PLATFORM ATTA||76.75|8.48||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0149|E0149 - HEAVY DUTY WHEELED WALKER||0|14.16||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0148|E0148 - HEAVYDUTY WALKER NO WHEELS||94.35|9.43||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0147|E0147 - WALKER VARIABLE WHEEL RESIST||430.02|43||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0144|E0144 - ENCLOSED WALKER W REAR SEAT||0|29.22||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0143|E0143 - WALKER FOLDING WHEELED W/O S||55.73|5.58||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0141|E0141 - RIGID WHEELED WALKER ADJ/FIX||89.5|8.95||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0140|E0140 - WALKER W TRUNK SUPPORT||0|31.87||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0135|E0135 - WALKER FOLDING ADJUST/FIXED||50.83|5.08||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0130|E0130 - WALKER RIGID ADJUST/FIXED HT||55.63|5.57||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0117|E0117 - UNDERARM SPRINGASSIST CRUTCH||0|24.48||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0116|E0116 - CRUTCH UNDERARM EACH NO WOOD||29.99|5.84||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0114|E0114 - CRUTCH UNDERARM PAIR NO WOOD||50.99|9.26||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0113|E0113 - CRUTCH UNDERARM EACH WOOD||22.84|5.57||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0112|E0112 - CRUTCH UNDERARM PAIR WOOD||39.99|10.74||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0111|E0111 - CRUTCH FOREARM EACH||62.54|9.1||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0110|E0110 - CRUTCH FOREARM PAIR||83.85|17.27||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0105|E0105 - CANE ADJUST/FIXED QUAD/3 PRO||62.45|9.58||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|E0100|E0100 - CANE ADJUST/FIXED WITH TIP||26.8|6.42||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|CMMT|||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A9606|A9606 - RADIUM RA223 DICHLORIDE THER||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A9585|A9585 - GADOBUTROL INJECTION||0.4312|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A9583|A9583 - GADOFOSVESET TRISODIUM INJ||22.25|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A9581|A9581 - GADOXETATE DISODIUM INJ||16.2778|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A9579|A9579 - GAD-BASE MR CONTRAST NOS-1ML||1.9558|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A9578|A9578 - INJ MULTIHANCE MULTIPACK||2.1472|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A9577|A9577 - INJ MULTIHANCE||2.2308|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A9576|A9576 - INJ PROHANCE MULTIPACK||1.7765|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A9575|A9575 - INJ GADOTERATE MEGLUMI 0.1ML||0.2189|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A8004|A8004 - REPL SOFT INTERFACE- HELMET||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A8003|A8003 - HARD PROTECT HELMET CUSTOM||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A8002|A8002 - SOFT PROTECT HELMET CUSTOM||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A8001|A8001 - HARD PROTECT HELMET PREFAB||194.97|19.49||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A8000|A8000 - SOFT PROTECT HELMET PREFAB||194.97|19.49||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7527|A7527 - TRACH/LARYN TUBE PLUG/STOP||4.55|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7526|A7526 - TRACHEOSTOMY TUBE COLLAR||4.3|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7525|A7525 - TRACHEOSTOMY MASK||2.62|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7524|A7524 - TRACHEOSTOMA STENT/STUD/BTTN||98.42|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7522|A7522 - TRACH/LARYN TUBE STAINLESS||57.42|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7521|A7521 - TRACH/LARYN TUBE CUFFED||59.8|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7520|A7520 - TRACH/LARYN TUBE NON-CUFFED||60.36|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7509|A7509 - HEAT & MOISTURE EXCHANGE SYS||1.79|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7508|A7508 - HOUSING & INTEGRATED ADHESIV||3.65|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7507|A7507 - INTEGRATED FILTER & HOLDER||3.16|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7506|A7506 - HMES/TRACHVALVE ADHESIVEDISK||0.43|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7505|A7505 - HMES OR TRACH VALVE HOUSING||5.96|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7504|A7504 - TRACHEOSTOMA HMES FILTER||0.86|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7503|A7503 - HMES FILTER HOLDER OR CAP||14.42|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7502|A7502 - REPLACEMENT DIAPHRAGM/FPLATE||63.47|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7501|A7501 - TRACHEOSTOMA VALVE W DIAPHRA||133.51|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7048|A7048 - VACUUM DRAIN BOTTLE/TUBE KIT||54.08|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7047|A7047 - RESP SUCTION ORAL INTERFACE||153.71|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7046|A7046 - REPL WATER CHAMBER- PAP DEV||15.23|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7045|A7045 - REPL EXHALATION PORT FOR PAP||13.4|1.35||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7044|A7044 - PAP ORAL INTERFACE||95.14|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7041|A7041 - WATER SEAL DRAIN CONTAINER||97.16|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7040|A7040 - ONE WAY CHEST DRAIN VALVE||51.72|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7039|A7039 - FILTER- NON DISPOSABLE W PAP||7|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7038|A7038 - POS AIRWAY PRESSURE FILTER||2.4|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7037|A7037 - POS AIRWAY PRESSURE TUBING||14.09|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7036|A7036 - POS AIRWAY PRESS CHINSTRAP||11.95|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7035|A7035 - POS AIRWAY PRESS HEADGEAR||20.99|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7034|A7034 - NASAL APPLICATION DEVICE||64.4|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7033|A7033 - REPLACEMENT NASAL PILLOWS||17.61|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7032|A7032 - REPLACEMENT NASAL CUSHION||22.22|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7031|A7031 - REPLACEMENT FACEMASK INTERFA||39.58|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7030|A7030 - CPAP FULL FACE MASK||102.4|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7029|A7029 - REPL NASAL PILLOW COMB MASK||17.61|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7028|A7028 - REPL ORAL CUSHION COMBO MASK||39.41|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7027|A7027 - COMBINATION ORAL/NASAL MASK||140.43|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7026|A7026 - REPLACE CHST CMPRSS SYS HOSE||36.55|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7025|A7025 - REPLACE CHEST COMPRESS VEST||0|55.3||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7020|A7020 - INTERFACE- COUGH STIM DEVICE||18.41|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7018|A7018 - WATER DISTILLED W/NEBULIZER||0.37|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7017|A7017 - NEBULIZER NOT USED W OXYGEN||140.15|14.02||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7016|A7016 - NEBULIZER DOME & MOUTHPIECE||8.59|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7015|A7015 - AEROSOL MASK USED W NEBULIZE||1.48|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7014|A7014 - COMPRESSOR NONDISPOS FILTER||3.7|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7013|A7013 - DISPOSABLE COMPRESSOR FILTER||0.66|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7012|A7012 - NEBULIZER WATER COLLEC DEVIC||3.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7010|A7010 - DISPOSABLE CORRUGATED TUBING||18.18|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7009|A7009 - NEBULIZER RESERVOIR BOTTLE||51.63|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7008|A7008 - DISPOSABLE NEBULIZER PREFILL||11.89|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7007|A7007 - LG VOL NEBULIZER DISPOSABLE||3.76|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7006|A7006 - FILTERED NEBULIZER ADMIN SET||8.59|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7005|A7005 - NONDISPOSABLE NEBULIZER SET||14.2|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7004|A7004 - DISPOSABLE NEBULIZER SML VOL||1.44|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7003|A7003 - NEBULIZER ADMINISTRATION SET||1.75|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7002|A7002 - TUBING USED W SUCTION PUMP||4.14|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7001|A7001 - NONDISPOSABLE PUMP CANISTER||36.78|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A7000|A7000 - DISPOSABLE CANISTER FOR PUMP||9.4|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6550|A6550 - NEG PRES WOUND THER DRSG SET||28.21|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6545|A6545 - GRAD COMP NON-ELASTIC BK||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6532|A6532 - COMPRESSION STOCKING BK40-50||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6531|A6531 - COMPRESSION STOCKING BK30-40||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6513|A6513 - COMPRESS BURN MASK FACE/NECK||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6511|A6511 - COMPRES BURN GARMENT PANTY||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6510|A6510 - COMPRES BURN GARMENT LEOTARD||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6509|A6509 - COMPRES BURN GARMENT JACKET||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6508|A6508 - CMPRS BURNGARMENT FOOT-THIGH||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6507|A6507 - CMPRS BURNGARMENT FOOT-KNEE||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6506|A6506 - CMPRSBURNGRMNT GLOVE-AXILLA||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6505|A6505 - CMPRSBURNGARMENT GLOVE-ELBOW||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6504|A6504 - CMPRSBURNGARMENT GLOVE-WRIST||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6503|A6503 - COMPRES BURNGARMENT FACEHOOD||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6502|A6502 - COMPRES BURNGARMENT CHINSTRP||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6501|A6501 - COMPRES BURNGARMENT BODYSUIT||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6457|A6457 - TUBULAR DRESSING||1.45|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6456|A6456 - ZINC PASTE BAND W >=3''<5''/YD||1.61|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6455|A6455 - SELF-ADHER BAND >=5''/YD||1.77|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6454|A6454 - SELF-ADHER BAND W>=3'' <5''/YD||0.99|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6453|A6453 - SELF-ADHER BAND W <3''/YD||0.79|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6452|A6452 - HIGH COMPRES BAND W>=3''<5''YD||7.51|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6451|A6451 - MOD COMPRES BAND W>=3''<5''/YD||2.23|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6450|A6450 - LT COMPRES BAND >=5''/YD||2.23|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6449|A6449 - LT COMPRES BAND >=3'' <5''/YD||2.23|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6448|A6448 - LT COMPRES BAND <3''/YD||1.47|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6447|A6447 - CONFORM BAND S W >=5''/YD||0.86|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6446|A6446 - CONFORM BAND S W>=3'' <5''/YD||0.52|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6445|A6445 - CONFORM BAND S W <3''/YD||0.41|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6444|A6444 - CONFORM BAND N/S W>=5''/YD||0.71|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6443|A6443 - CONFORM BAND N/S W>=3''<5''/YD||0.36|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6442|A6442 - CONFORM BAND N/S W<3''/YD||0.21|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6441|A6441 - PAD BAND W>=3'' <5''/YD||0.86|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6411|A6411 - NON-STERILE EYE PAD||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6410|A6410 - STERILE EYE PAD||0.49|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6407|A6407 - PACKING STRIPS- NON-IMPREG||2.39|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6403|A6403 - STERILE GAUZE>16 <= 48 SQ IN||0.54|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6402|A6402 - STERILE GAUZE <= 16 SQ IN||0.15|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6266|A6266 - IMPREG GAUZE NO H20/SAL/YARD||2.45|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6259|A6259 - TRANSPARENT FILM > 48 SQ IN||13.91|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6258|A6258 - TRANSPARENT FILM >16<=48 IN||5.49|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6257|A6257 - TRANSPARENT FILM <= 16 SQ IN||1.96|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6255|A6255 - ABSORPT DRG >16<=48 IN W/BDR||3.86|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6254|A6254 - ABSORPT DRG <=16 SQ IN W/BDR||1.53|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6253|A6253 - ABSORPT DRG > 48 SQ IN W/O B||8.05|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6252|A6252 - ABSORPT DRG >16 <=48 W/O BDR||4.14|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6251|A6251 - ABSORPT DRG <=16 SQ IN W/O B||2.53|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6248|A6248 - HYDROGEL DRSG GEL FILLER||20.65|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6247|A6247 - HYDROGEL DRG > 48 SQ IN W/B||30.23|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6246|A6246 - HYDROGEL DRG >16<=48 IN W/B||12.63|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6245|A6245 - HYDROGEL DRG <= 16 IN W/BDR||9.23|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6244|A6244 - HYDROGEL DRG >48 IN W/O BDR||49.94|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6243|A6243 - HYDROGEL DRG >16<=48 W/O BDR||15.66|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6242|A6242 - HYDROGEL DRG <=16 IN W/O BDR||7.71|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6241|A6241 - HYDROCOLLOID DRG FILLER DRY||3.27|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6240|A6240 - HYDROCOLLD DRG FILLER PASTE||15.57|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6238|A6238 - HYDROCOLLD DRG >16<=48 W/BDR||28.98|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6237|A6237 - HYDROCOLLD DRG <=16 IN W/BDR||10.06|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6236|A6236 - HYDROCOLLD DRG > 48 IN W/O B||34.65|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6235|A6235 - HYDROCOLLD DRG >16<=48 W/O B||21.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6234|A6234 - HYDROCOLLD DRG <=16 W/O BDR||8.31|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6233|A6233 - HYDROGEL DRESSING >48 SQ IN||24.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6232|A6232 - HYDROGEL DSG>16<=48 SQ IN||8.73|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6231|A6231 - HYDROGEL DSG<=16 SQ IN||5.96|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6229|A6229 - GAUZE >16<=48 SQ IN WATR/SAL||4.59|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6224|A6224 - GAUZE > 48 IN NO W/SAL W/O B||4.59|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6223|A6223 - GAUZE >16<=48 NO W/SAL W/O B||3.08|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6222|A6222 - GAUZE <=16 IN NO W/SAL W/O B||2.7|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6220|A6220 - GAUZE >16 <=48 SQ IN W/BORDR||3.29|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6219|A6219 - GAUZE <= 16 SQ IN W/BORDER||1.22|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6217|A6217 - NON-STERILE GAUZE>16<=48 SQ||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6216|A6216 - NON-STERILE GAUZE<=16 SQ IN||0.06|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6214|A6214 - FOAM DRG > 48 SQ IN W/BORDER||13.08|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6212|A6212 - FOAM DRG <=16 SQ IN W/BORDER||12.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6211|A6211 - FOAM DRG > 48 SQ IN W/O BRDR||37.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6210|A6210 - FOAM DRG >16<=48 SQ IN W/O B||25.33|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6209|A6209 - FOAM DRSG <=16 SQ IN W/O BDR||9.5|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6207|A6207 - CONTACT LAYER >16<= 48 SQ IN||9.33|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6204|A6204 - COMPOSITE DRSG >16<=48 SQ IN||7.91|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6203|A6203 - COMPOSITE DRSG <= 16 SQ IN||4.28|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6199|A6199 - ALGINATE DRSG WOUND FILLER||6.73|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6197|A6197 - ALGINATE DRSG >16 <=48 SQ IN||20.9|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6196|A6196 - ALGINATE DRESSING <=16 SQ IN||9.35|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6154|A6154 - WOUND POUCH EACH||18.29|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6024|A6024 - COLLAGEN DSG WOUND FILLER||7.87|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6023|A6023 - COLLAGEN DRESSING >48 SQ IN||241.95|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6022|A6022 - COLLAGEN DRSG>16<=48 SQ IN||26.73|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6021|A6021 - COLLAGEN DRESSING <=16 SQ IN||26.73|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6011|A6011 - COLLAGEN GEL/PASTE WOUND FIL||2.9|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A6010|A6010 - COLLAGEN BASED WOUND FILLER||39.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A5513|A5513 - MULTI DEN INSERT CUSTOM MOLD||49.21|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A5512|A5512 - MULTI DEN INSERT DIRECT FORM||32.97|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A5507|A5507 - MODIFICATION DIABETIC SHOE||39.73|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A5506|A5506 - DIABETIC SHOE W/OFF SET HEEL||39.73|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A5505|A5505 - DIAB SHOE W/METATARSAL BAR||39.73|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A5504|A5504 - DIABETIC SHOE WITH WEDGE||39.73|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A5503|A5503 - DIABETIC SHOE W/ROLLER/ROCKR||39.73|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A5501|A5501 - DIABETIC CUSTOM MOLDED SHOE||242.45|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A5500|A5500 - DIAB SHOE FOR DENSITY INSERT||80.83|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A5200|A5200 - PERCUTANEOUS CATHETER ANCHOR||14.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A5131|A5131 - APPLIANCE CLEANER||20.16|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A5126|A5126 - DISK/FOAM PAD +OR- ADHESIVE||1.67|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A5122|A5122 - SOLID SKIN BARRIER 8X8||16.33|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A5121|A5121 - SOLID SKIN BARRIER 6X6||8.05|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A5120|A5120 - SKIN BARRIER- WIPE OR SWAB||0.3|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A5114|A5114 - FOAM/FABRIC LEG STRAP||9.68|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A5113|A5113 - LATEX LEG STRAP||5.99|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A5112|A5112 - URINARY LEG BAG||44.01|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A5105|A5105 - URINARY SUSPENSORY||51.83|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A5102|A5102 - BEDSIDE DRAIN BTL W/WO TUBE||28.7|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A5093|A5093 - OSTOMY ACCESSORY CONVEX INSE||2.48|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A5083|A5083 - STOMA ABSORPTIVE COVER||0.82|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A5082|A5082 - CONTINENT STOMA CATHETER||15.12|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A5081|A5081 - STOMA PLUG OR SEAL- ANY TYPE||3.58|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A5073|A5073 - URINARY POUCH ON BARR W/FLNG||4.05|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A5072|A5072 - URINARY POUCH W/O BARRIER||4.49|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A5071|A5071 - URINARY POUCH W/BARRIER||7.64|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A5063|A5063 - DRAIN OSTOMY POUCH W/FLANGE||3.44|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A5062|A5062 - DRNBLE OSTOMY POUCH W/O BARR||2.83|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A5061|A5061 - POUCH DRAINABLE W BARRIER AT||4.49|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A5057|A5057 - 1 PC OST POU W BUILT-IN CONV||12.21|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A5056|A5056 - 1 PC OST POUCH W FILTER||5.93|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A5055|A5055 - STOMA CAP||1.83|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A5054|A5054 - CLSD OSTOMY POUCH W/FLANGE||2.29|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A5053|A5053 - CLSD OSTOMY POUCH FACEPLATE||1.89|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A5052|A5052 - CLSD OSTOMY POUCH W/O BARR||1.89|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A5051|A5051 - POUCH CLSD W BARR ATTACHED||2.62|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4640|A4640 - ALTERNATING PRESSURE PAD||55.66|5.57||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4639|A4639 - INFRARED HT SYS REPLCMNT PAD||0|36.52||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4638|A4638 - REPL BATT PULSE GEN SYS||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4637|A4637 - REPL TIP CANE/CRUTCH/WALKER||1.87|0.18||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4636|A4636 - HANDGRIP FOR CANE ETC||3.37|0.34||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4635|A4635 - UNDERARM CRUTCH PAD||5.53|0.75||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4633|A4633 - UVL REPLACEMENT BULB||52.16|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4630|A4630 - REPL BAT T.E.N.S. OWN BY PT||6.75|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4629|A4629 - TRACHEOSTOMY CARE KIT||5.9|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4628|A4628 - OROPHARYNGEAL SUCTION CATH||4.75|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4626|A4626 - TRACHEOSTOMY CLEANING BRUSH||4.06|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4625|A4625 - TRACH CARE KIT FOR NEW TRACH||8.81|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4624|A4624 - TRACHEAL SUCTION TUBE||3.35|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4623|A4623 - TRACHEOSTOMY INNER CANNULA||7.96|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4620|A4620 - VARIABLE CONCENTRATION MASK||0.81|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4619|A4619 - FACE TENT||2.25|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4618|A4618 - BREATHING CIRCUITS||10.4|1.12||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4617|A4617 - MOUTH PIECE||3.94|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4616|A4616 - TUBING (OXYGEN) PER FOOT||0.08|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4615|A4615 - CANNULA NASAL||0.92|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4614|A4614 - HAND-HELD PEFR METER||30.23|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4608|A4608 - TRANSTRACHEAL OXYGEN CATH||63.72|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4605|A4605 - TRACH SUCTION CATH CLOSE SYS||20.85|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4604|A4604 - TUBING WITH HEATING ELEMENT||45.41|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4602|A4602 - REPLACE LITHIUM BATTERY 1.5V||4.73|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4595|A4595 - TENS SUPPL 2 LEAD PER MONTH||12.78|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4590|A4590 - SPECIAL CASTING MATERIAL||30.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4565|A4565 - SLINGS||9.79|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4562|A4562 - PESSARY- NON RUBBER- ANY TYPE||65.07|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4561|A4561 - PESSARY RUBBER- ANY TYPE||26.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4559|A4559 - COUPLING GEL OR PASTE||0.13|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4558|A4558 - CONDUCTIVE GEL OR PASTE||6.93|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4557|A4557 - LEAD WIRES- PAIR||12.72|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4556|A4556 - ELECTRODES- PAIR||15.44|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4483|A4483 - MOISTURE EXCHANGER||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4481|A4481 - TRACHEOSTOMA FILTER||0.48|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4463|A4463 - SURGICAL DRESS HOLDER REUSE||16.93|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4461|A4461 - SURGICL DRESS HOLD NON-REUSE||4.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4456|A4456 - ADHESIVE REMOVER- WIPES||0.31|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4455|A4455 - ADHESIVE REMOVER PER OUNCE||1.82|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4452|A4452 - WATERPROOF TAPE||0.46|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4450|A4450 - NON-WATERPROOF TAPE||0.1|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4435|A4435 - 1PC OST PCH DRAIN HGH OUTPUT||7.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4434|A4434 - OST PCH URINE W LOCK FLNG/FT||4.77|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4433|A4433 - URINE OST PCH BAR W LOCK FLN||4.25|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4432|A4432 - OS PCH URINE W BAR/FANGE/TAP||4.57|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4431|A4431 - OST PCH URINE W BARRIER/TAPV||7.9|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4430|A4430 - OST URINE PCH W B/BLTIN CONV||10.82|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4429|A4429 - URINE OST POUCH W BLTINCONV||10.49|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4428|A4428 - URINE OST POUCH W FAUCET/TAP||8.28|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4427|A4427 - OST PCH DRAIN/BARR LK FLNG/F||3.54|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4426|A4426 - OST PCH DRAIN 2 PIECE SYSTEM||3.47|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4425|A4425 - OST PCH DRAIN FOR BARRIER FL||4.55|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4424|A4424 - OST PCH DRAIN W BAR & FILTER||6.05|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4423|A4423 - OST PCH FOR BAR W LK FL/FLTR||2.37|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4422|A4422 - OST POUCH ABSORBENT MATERIAL||0.15|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4420|A4420 - OST PCH CLSD FOR BAR W LK FL||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4419|A4419 - OST PCH FOR BAR W FLANGE/FLT||2.21|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4418|A4418 - OST PCH CLSD W/O BAR W FILTR||2.31|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4417|A4417 - OST PCH W BAR/BLTINCONV/FLTR||4.73|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4416|A4416 - OST PCH CLSD W BARRIER/FILTR||3.51|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4415|A4415 - OST SKN BARR W/O CONV >4 SQI||7.61|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4414|A4414 - OST SKNBAR W/O CONV<=4 SQ IN||6.26|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4413|A4413 - 2 PC DRAINABLE OST POUCH||7|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4412|A4412 - OST POUCH DRAIN HIGH OUTPUT||3.44|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4411|A4411 - OST SKN BARR EXTND =4SQ||6.49|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4410|A4410 - OST SKN BARR EXTND >4 SQ||11.5|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4409|A4409 - OST SKN BARR CONVEX <=4 SQ I||7.9|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4408|A4408 - EXT WEAR OST SKN BARR >4SQ''||12.55|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4407|A4407 - EXT WEAR OST SKN BARR <=4SQ''||11.13|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4406|A4406 - PECTIN BASED OSTOMY PASTE||7.28|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4405|A4405 - NONPECTIN BASED OSTOMY PASTE||4.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4404|A4404 - OSTOMY RING EACH||2.14|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4402|A4402 - LUBRICANT PER OUNCE||1.73|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4400|A4400 - OSTOMY IRRIGATION SET||52.81|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4399|A4399 - OSTOMY IRRIG CONE/CATH W BRS||13.54|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4398|A4398 - OSTOMY IRRIGATION BAG||16.1|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4397|A4397 - IRRIGATION SUPPLY SLEEVE||5.61|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4396|A4396 - PERISTOMAL HERNIA SUPPRT BLT||51.46|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4395|A4395 - OSTOMY POUCH SOLID DEODORANT||0.06|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4394|A4394 - OSTOMY POUCH LIQ DEODORANT||3.29|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4393|A4393 - URINE PCH W EX WEAR BAR CONV||11.5|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4392|A4392 - URINARY POUCH W ST WEAR BARR||10.4|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4391|A4391 - URINARY POUCH W EX WEAR BARR||8.99|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4390|A4390 - DRAINABLE PCH EX WEAR CONVEX||12.21|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4389|A4389 - DRAINABLE PCH W ST WEAR BARR||7.9|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4388|A4388 - DRAINABLE PCH W EX WEAR BARR||5.55|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4387|A4387 - OST CLSD POUCH W ATT ST BARR||2.85|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4385|A4385 - OST SKN BARRIER SLD EXT WEAR||6.49|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4384|A4384 - OSTOMY FACEPLT/SILICONE RING||12.22|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4383|A4383 - URINARY RUBBER POUCH W/O FP||35.83|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4382|A4382 - URINARY HVY PLSTC PCH W/O FP||31.29|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4381|A4381 - URINARY PLASTIC POUCH W/O FP||5.88|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4380|A4380 - URINARY RUBBER POUCH W FCPLT||47.45|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4379|A4379 - URINARY PLASTIC POUCH W FCPL||19.09|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4378|A4378 - DRAINABLE RUBBER PCH W/O FP||39.08|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4377|A4377 - DRAINABLE PLSTIC PCH W/O FP||5.46|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4376|A4376 - DRAINABLE RUBBER PCH W FCPLT||60.5|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4375|A4375 - DRAINABLE PLASTIC PCH W FCPL||21.84|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4373|A4373 - SKIN BARRIER WITH FLANGE||7.97|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4372|A4372 - SKIN BARRIER SOLID 4X4 EQUIV||5.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4371|A4371 - SKIN BARRIER POWDER PER OZ||4.63|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4369|A4369 - SKIN BARRIER LIQUID PER OZ||3.08|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4368|A4368 - OSTOMY FILTER||0.32|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4367|A4367 - OSTOMY BELT||8.57|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4366|A4366 - OSTOMY VENT||1.64|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4364|A4364 - ADHESIVE- LIQUID OR EQUAL||3.17|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4363|A4363 - OSTOMY CLAMP- REPLACEMENT||2.56|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4362|A4362 - SOLID SKIN BARRIER||3.75|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4361|A4361 - OSTOMY FACE PLATE||20.5|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4360|A4360 - DISPOSABLE EXT URETHRAL DEV||0.62|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4358|A4358 - URINARY LEG OR ABDOMEN BAG||8.25|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4357|A4357 - BEDSIDE DRAINAGE BAG||10.49|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4356|A4356 - EXT URETH CLMP OR COMPR DVC||58.01|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4355|A4355 - BLADDER IRRIGATION TUBING||10.33|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4354|A4354 - CATH INSERTION TRAY W/BAG||12.75|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4353|A4353 - INTERMITTENT URINARY CATH||8.9|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4352|A4352 - COUDE TIP URINARY CATHETER||8.02|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4351|A4351 - STRAIGHT TIP URINE CATHETER||2.3|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4349|A4349 - DISPOSABLE MALE EXTERNAL CAT||2.56|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4346|A4346 - CATH INDW FOLEY 3 WAY||21.16|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4344|A4344 - CATH INDW FOLEY 2 WAY SILICN||17.31|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4340|A4340 - INDWELLING CATHETER SPECIAL||34.47|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4338|A4338 - INDWELLING CATHETER LATEX||13.26|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4336|A4336 - URETHRAL INSERT||1.83|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4334|A4334 - URINARY CATH LEG STRAP||6.26|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4333|A4333 - URINARY CATH ANCHOR DEVICE||2.81|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4332|A4332 - LUBE STERILE PACKET||0.15|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4331|A4331 - EXTENSION DRAINAGE TUBING||4.05|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4330|A4330 - STOOL COLLECTION POUCH||9.1|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4328|A4328 - FEM URINARY COLLECT POUCH||13.01|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4327|A4327 - FEM URINARY COLLECT DEV CUP||56.71|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4326|A4326 - MALE EXTERNAL CATHETER||13.72|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4322|A4322 - IRRIGATION SYRINGE||3.77|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4321|A4321 - CATH THERAPEUTIC IRRIG AGENT||0|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4320|A4320 - IRRIGATION TRAY||6|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4316|A4316 - CATH W/DRAINAGE 3-WAY||36.1|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4315|A4315 - CATH W/DRAINAGE 2-WAY SILCNE||28.51|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4314|A4314 - CATH W/DRAINAGE 2-WAY LATEX||29.67|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4313|A4313 - CATHETER W/BAG 3-WAY||20.02|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4312|A4312 - CATH W/O BAG 2-WAY SILICONE||19.49|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4311|A4311 - CATHETER W/O BAG 2-WAY LATEX||18.85|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4310|A4310 - INSERT TRAY W/O BAG/CATH||8.82|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4280|A4280 - BRST PRSTHS ADHSV ATTCHMNT||6.79|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4265|A4265 - PARAFFIN||4.32|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4259|A4259 - LANCETS PER BOX||1.63|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4258|A4258 - LANCET DEVICE EACH||2.44|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4257|A4257 - REPLACE LENSSHIELD CARTRIDGE||16.22|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4256|A4256 - CALIBRATOR SOLUTION/CHIPS||3.89|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4255|A4255 - GLUCOSE MONITOR PLATFORMS||5.14|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4253|A4253 - BLOOD GLUCOSE/REAGENT STRIPS||9.57|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4236|A4236 - SILVR OXIDE BATT GLUCOSE MON||1.33|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4235|A4235 - LITHIUM BATT FOR GLUCOSE MON||1.15|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4234|A4234 - J-CELL BATT FOR GLUCOSE MON||2.71|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4233|A4233 - ALKALIN BATT FOR GLUCOSE MON||0.59|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4222|A4222 - INFUSION SUPPLIES WITH PUMP||42.31|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4221|A4221 - SUPP NON-INSULIN INF CATH/WK||22.31|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4217|A4217 - STERILE WATER/SALINE- 500 ML||3.99|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|A4216|A4216 - STERILE WATER/SALINE- 10 ML||0.56|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|99494|99494 - 1ST/SBSQ PSYCH COLLAB CARE MGMT EA ADDL 30 MINS||82.12|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|99493|99493 - SBSQ PSYCHIATRIC COLLAB CARE MGMT 1ST 60 MINS||158.67|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|99492|99492 - 1ST PSYCHIATRIC COLLAB CARE MGMT 1ST 70 MINS||197.42|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|99484|99484 - CARE MGMT SERVICES BEHAVIORAL HLTH COND 20 MINS||60.01|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|99483|99483 - ASSMT & CARE PLANNING PT W/COGNITIVE IMPAIRMENT||300.62|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|99343|99343 - HOME VST NEW PATIENT MOD-HI SEVERITY 45 MINUTES||165.26|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|99342|99342 - HOME VISIT NEW PATIENT MOD SEVERITY 30 MINUTES||101.27|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|99341|99341 - HOME VISIT NEW PATIENT LOW SEVERITY 20 MINUTES||69.45|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|99315|99315 - NURSING FACILITY DISCHARGE MANAGEMENT 30 MINUTES||92.14|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|99307|99307 - SBSQ NURSING FACILITY CARE/DAY E/M STABLE 10 MIN||56.09|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|99304|99304 - INITIAL NURSING FACILITY CARE/DAY 25 MINUTES||116.12|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|99292|99292 - CRITICAL CARE ILL/INJURED PATIENT ADDL 30 MIN||155.96|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|99291|99291 - CRITICAL CARE ILL/INJURED PATIENT INIT 30-74 MIN||347.63|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|99285|99285 - EMERGENCY DEPT VISIT HIGH SEVERITY&THREAT FUNCJ||225.06|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|99284|99284 - EMERGENCY DEPARTMENT VISIT HIGH/URGENT SEVERITY||151.98|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|99283|99283 - EMERGENCY DEPARTMENT VISIT MODERATE SEVERITY||79.85|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|99282|99282 - EMERGENCY DEPARTMENT VISIT LOW/MODER SEVERITY||52.88|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|99281|99281 - EMERGENCY DEPARTMENT VISIT LIMITED/MINOR PROB||26.91|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|99239|99239 - HOSPITAL DISCHARGE DAY MANAGEMENT > 30 MIN||136.24|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|99238|99238 - HOSPITAL DISCHARGE DAY MANAGEMENT 30 MIN/<||92.57|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|99236|99236 - OBSERVATION/INPATIENT HOSPITAL CARE 55 MINUTES||278.16|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|99235|99235 - OBSERVATION/INPATIENT HOSPITAL CARE 50 MINUTES||215.66|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|99234|99234 - OBSERVATION/INPATIENT HOSPITAL CARE 40 MINUTES||170.87|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|99233|99233 - SBSQ HOSPITAL CARE/DAY 35 MINUTES||132.94|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|99232|99232 - SBSQ HOSPITAL CARE/DAY 25 MINUTES||92.25|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|99231|99231 - SBSQ HOSPITAL CARE/DAY 15 MINUTES||49.79|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|99223|99223 - INITIAL HOSPITAL CARE/DAY 70 MINUTES||258.92|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|99222|99222 - INITIAL HOSPITAL CARE/DAY 50 MINUTES||174.89|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|99221|99221 - INITIAL HOSPITAL CARE/DAY 30 MINUTES||129.64|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|99220|99220 - INITIAL OBSERVATION CARE/DAY 70 MINUTES||237.33|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|99219|99219 - INITIAL OBSERVATION CARE/DAY 50 MINUTES||173.15|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|99218|99218 - INITIAL OBSERVATION CARE/DAY 30 MINUTES||127.95|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|99217|99217 - OBSERVATION CARE DISCHARGE MANAGEMENT||92.16|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|99215|99215 - OFFICE OUTPATIENT VISIT 40 MINUTES||181.75|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|99214|99214 - OFFICE OUTPATIENT VISIT 25 MINUTES||134.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|99213|99213 - OFFICE OUTPATIENT VISIT 15 MINUTES||90.26|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|99212|99212 - OFFICE OUTPATIENT VISIT 10 MINUTES||53.92|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|99211|99211 - OFFICE OUTPATIENT VISIT 5 MINUTES||24.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|99205|99205 - OFFICE OUTPATIENT NEW 60 MINUTES||259.86|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|99204|99204 - OFFICE OUTPATIENT NEW 45 MINUTES||206.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|99203|99203 - OFFICE OUTPATIENT NEW 30 MINUTES||134.82|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|99202|99202 - OFFICE OUTPATIENT NEW 20 MINUTES||92.6|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|99201|99201 - OFFICE OUTPATIENT NEW 10 MINUTES||53.92|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|98929|98929 - OSTEOPATHIC MANIPULATIVE TX 9-10 BODY REGIONS||135.12|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|98928|98928 - OSTEOPATHIC MANIPULATIVE TX 7-8 BODY REGIONS||112.99|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|98927|98927 - OSTEOPATHIC MANIPULATIVE TX 5-6 BODY REGIONS||91.9|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|98926|98926 - OSTEOPATHIC MANIPULATIVE TX 3-4 BODY REGIONS||70.29|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|98925|98925 - OSTEOPATHIC MANIPULATIVE TX 1-2 BODY REGIONS||48.16|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|97763|97763 - ORTHOTICS/PROSTH MGMT &/TRAING SBSQ ENCTR 15 MIN||73.93|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|97760|97760 - ORTHOTICS MGMT & TRAING INITIAL ENCTR EA 15 MINS||57.92|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|97750|97750 - PHYSICAL PERFORMANCE TEST/MEAS W/REPRT EA 15 MIN||50.69|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|97606|97606 - NEGATIVE PRESSURE WOUND THERAPY DME >50 SQ CM||78.98|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|97605|97605 - NEGATIVE PRESSURE WOUND THERAPY DME </= 50 SQ CM||66.8|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|97598|97598 - DEBRIDEMENT OPEN WOUND EACH ADDITIONAL 20 SQ CM||38.1|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|97597|97597 - DEBRIDEMENT OPEN WOUND 20 SQ CM/<||114.1|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|97542|97542 - WHEELCHAIR MGMT EA 15 MIN||47.07|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|97537|97537 - COMMUNITY/WORK REINTEGRATION TRAING EA 15 MIN||46.54|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|97535|97535 - SELF-CARE/HOME MGMT TRAINING EACH 15 MINUTES||53.26|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|97533|97533 - SENSORY INTEGRATIVE TECHNIQUES EACH 15 MINUTES||44.94|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|97532|97532 - DEVELOPMENT OF COGNITIVE SKILLS EACH 15 MINUTES||41.33|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|97530|97530 - THERAPEUT ACTVITY DIRECT PT CONTACT EACH 15 MIN||53.22|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|97168|97168 - OCCUPATIONAL THER RE-EVAL EST PLAN CARE 30 MINS||99.91|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|97167|97167 - OCCUPATIONAL THERAPY EVAL HIGH COMPLEX 60 MINS||150.45|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|97166|97166 - OCCUPATIONAL THERAPY EVAL MOD COMPLEX 45 MINS||150.45|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|97165|97165 - OCCUPATIONAL THERAPY EVAL LOW COMPLEX 30 MINS||150.45|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|97164|97164 - PHYSICAL THERAPY RE-EVAL EST PLAN CARE 20 MINS||89|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|97163|97163 - PHYSICAL THERAPY EVALUATION HIGH COMPLEX 45 MINS||132.07|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|97162|97162 - PHYSICAL THERAPY EVALUATION MOD COMPLEX 30 MINS||132.07|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|97161|97161 - PHYSICAL THERAPY EVALUATION LOW COMPLEX 20 MINS||132.07|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|97150|97150 - THERAPEUTIC PROCEDURES GROUP 2/> INDIVIDUALS||27.01|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|97140|97140 - MANUAL THERAPY TQS 1/> REGIONS EACH 15 MINUTES||45.92|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|97124|97124 - THER PX 1/> AREAS EACH 15 MINUTES MASSAGE||40.8|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|97116|97116 - THER PX 1/> AREAS EA 15 MIN GAIT TRAING W/STAIR||43.68|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|97113|97113 - THER PX 1/> AREAS EACH 15 MIN AQUA THER W/XERSS||65.1|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|97112|97112 - THER PX 1/> AREAS EACH 15 MIN NEUROMUSC REEDUCA||51.2|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|97110|97110 - THERAPEUTIC PX 1/> AREAS EACH 15 MIN EXERCISES||49.65|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|97035|97035 - APPL MODALITY 1/> AREAS ULTRASOUND EA 15 MIN||19.82|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|97033|97033 - APPL MODALITY 1/> AREAS IONTOPHORESIS EA 15 MIN||49.07|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|97032|97032 - APPL MODALITY 1/> AREAS ELEC STIMJ EA 15 MIN||29.36|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|97022|97022 - APPLICATION MODALITY 1/> AREAS WHIRLPOOL||35.1|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|97018|97018 - APPL MODALITY 1/> AREAS PARAFFIN BATH||16.37|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|97014|97014 - APPL MODALITY 1/> AREAS ELEC STIMJ UNATTENDED||24.31|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|97012|97012 - APPL MODALITY 1/> AREAS TRACTION MECHANICAL||24.72|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|96574|96574 - DEBRIDEMENT PRMLG HYPERKERATOTIC LES W/PDT||364.71|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|96573|96573 - PDT DSTR PRMLG LES SKN ILLUM/ACTIVJ BY PHYS/QHP||281.16|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|96372|96372 - THERAPEUTIC PROPHYLACTIC/DX INJECTION SUBQ/IM||37.5|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|96161|96161 - CAREGIVER HLTH RISK ASSMT SCORE DOC STND INSTRM||5.6|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|96160|96160 - PT-FOCUSED HLTH RISK ASSMT SCORE DOC STND INSTRM||5.6|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|96103|96103 - PSYCHOLOGICAL TESTING COMPUTER W/PROF I&R||58.46|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|96102|96102 - PSYCHOLOGICAL TESTING ADMN BY TECH PR HR||94.96|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|96101|96101 - PSYCHOLOGICAL TESTING PR HR WITH PATIENT||129.41|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|96002|96002 - DYN SURF EMG WALKG/FUNCJAL ACTV 1-12 MUSC||34.26|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|95972|95972 - ELEC ALYS IMPLT NPGT CPLX SP/PN PRGRMG||151.15|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|95971|95971 - ELEC ALYS IMPLT NPGT SMPL SP/PN NPGT PRGRMG||87.84|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|95970|95970 - ELEC ALYS IMPLT NPGT PHYS/QHP W/O PROGRAMMING||99.81|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|95937|95937 - NEUROMUSCULAR JUNCT TSTG EA NRV ANY 1 METH||124.11|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|95926|95926 - SHORT-LATENCY SOMATOSENS EP STD LWR LIMBS||211.94|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|95925|95925 - SHORT-LATENCY SOMATOSENS EP STD UPR LIMBS||230.96|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|95913|95913 - NERVE CONDUCTION STUDIES 13/> STUDIES||502.26|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|95912|95912 - NERVE CONDUCTION STUDIES 11-12 STUDIES||432.8|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|95911|95911 - NERVE CONDUCTION STUDIES 9-10 STUDIES||369.14|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|95910|95910 - NERVE CONDUCTION STUDIES 7-8 STUDIES||304.42|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|95909|95909 - NERVE CONDUCTION STUDIES 5-6 STUDIES||231.12|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|95908|95908 - NERVE CONDUCTION STUDIES 3-4 STUDIES||192.86|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|95907|95907 - NERVE CONDUCTION STUDIES 1-2 STUDIES||156.22|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|95905|95905 - MOTOR &/SENS NRV CNDJ PRECONF ELTRD ARRAY LIMB||112.75|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|95887|95887 - NEEDLE EMG NONEXTREMTY MSCLES W/NERVE CONDUCTION||122.4|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|95886|95886 - NEEDLE EMG EA EXTREMTY W/PARASPINL AREA COMPLETE||137.15|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|95885|95885 - NEEDLE EMG EA EXTREMITY W/PARASPINL AREA LIMITED||86.88|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|95872|95872 - NEEDLE EMG W/1 FIBER ELECTRODE QUAN MEAS JITTER||304.18|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|95869|95869 - NEEDLE EMG THRC PARASPI MUSC EXCLUDING T1/T12||120.43|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|95868|95868 - NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE BI||198.67|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|95867|95867 - NEEDLE ELECTROMYOGRAPHY CRANIAL NRV MUSCLE UNI||139.84|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|95864|95864 - NDL EMG 4 XTR W/WO RELATED PARASPINAL AREAS||363.31|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|95863|95863 - NDL EMG 3 XTR W/WO RELATED PARASPINAL AREAS||320.45|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|95861|95861 - NDL EMG 2 XTR W/WO RELATED PARASPINAL AREAS||259.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|95860|95860 - NDL EMG 1 XTR W/WO RELATED PARASPINAL AREAS||184.02|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|95852|95852 - ROM MEAS&REPRT HAND W/WO COMPARISON NORMAL SID||24.3|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|95851|95851 - ROM MEAS&REPRT EA XTR EX HAND/EA TRNK SCTJ SPI||27.66|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|95834|95834 - MUSC TSTG MNL W/REPRT TOTAL EVAL BODY W/HANDS||77.02|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|95249|95249 - CONT GLUC MONITORING PATIENT PROVIDED EQUIPTMENT||81.08|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|95115|95115 - PROF SVCS ALLG IMMNTX X W/PRV ALLGIC XTRCS 1 NJX||17.66|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|95004|95004 - PERCUTANEOUS TESTS W/ALLERGENIC EXTRACTS||9.31|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|94760|94760 - NONINVASIVE EAR/PULSE OXIMETRY SINGLE DETER||4.62|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|94664|94664 - DEMO&/EVAL OF PT UTILIZ AERSL GEN/NEB/INHLR/IP||25.2|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|94620|94620 - PULMONARY STRESS TESTING SIMPLE||128.91|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|94618|94618 - PULMONARY STRESS TESTING||53.32|36.65||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|94617|94617 - EXERCISE TEST FOR BRONCHOSPASM||144.38|53.57||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|94060|94060 - BRNCDILAT RSPSE SPMTRY PRE&POST-BRNCDILAT ADMN||90.03|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|93793|93793 - ANTICOAGULANT MGMT FOR PT TAKING WARFARIN||18.75|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|93792|93792 - PT/CAREGIVER TRAING FOR INITIATION HOME INR MNTR||79.43|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|93040|93040 - RHYTHM ECG 1-3 LEADS W/INTERPRETATION & REPORT||20.32|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|93000|93000 - ECG ROUTINE ECG W/LEAST 12 LDS W/I&R||25.68|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|92950|92950 - CARDIOPULMONARY RESUSCITATION||467.06|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|92552|92552 - PURE TONE AUDIOMETRY AIR ONLY||45.26|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|90756|90756 - CCIIV4 VACCINE ANTIBIOTIC FREE 0.5 ML DOS IM USE||25.0723|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|90747|90747 - HEPB VACCINE DIALYSIS/IMMUNSUP PAT 4 DOSE IM||143.2695|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|90746|90746 - HEPB VACCINE ADULT 3 DOSE SCHEDULE FOR IM USE||71.6353|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|90744|90744 - HEPB VACCINE PED/ADOLESC 3 DOSE SCHEDULE IM||28.7485|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|90743|90743 - HEPB VACCINE ADOLESCENT 2 DOSE SCHEDULE IM||28.7485|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|90740|90740 - HEPB VACCINE DIALYSIS/IMMUNSUP PAT 3 DOSE IM||143.2695|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|90739|90739 - HEPB VACCINE ADULT 2 DOSE SCHEDULE FOR IM USE||144.21|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|90732|90732 - PPSV23 VACCINE 2 YRS OR OLDER FOR SUBQ/IM USE||118.5206|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|90715|90715 - TDAP VACCINE 7 YRS/> IM||34.0494|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|90714|90714 - TD VACCINE PRSRV FREE 7 YRS OR OLDER FOR IM USE||26.0898|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|90691|90691 - TYPHOID VACCINE VI CAPSULAR POLYSACCHARIDE IM||122.6753|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|90688|90688 - IIV4 VACC SPLIT VIRUS 0.5 ML DOS FOR IM USE||19.6185|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|90687|90687 - IIV4 VACC SPLIT VIRUS 0.25 ML DOS FOR IM USE||10.3433|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|90686|90686 - IIV4 VACC PRESRV FREE 0.5 ML DOS FOR IM USE||20.9352|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|90685|90685 - IIV4 VACC PRSRV FREE 0.25 ML DOS FOR IM USE||23.3178|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|90682|90682 - RIV4 VACC RECOMBINANT DNA PRSRV ANTIBIO FREE IM||50.9443|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|90675|90675 - RABIES VACCINE INTRAMUSCULAR||317.8527|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|90674|90674 - CCIIV4 VACCINE PRESERVATIVE FREE 0.5 ML IM USE||26.4517|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|90673|90673 - RIV3 VACCINE PRESERVATIVE FREE FOR IM USE||44.6743|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|90672|90672 - LAIV4 VACCINE FOR INTRANASAL USE||33.59|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|90670|90670 - PCV13 VACCINE FOR INTRAMUSCULAR USE||225.6243|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|90662|90662 - IIV VACCINE PRESERV FREE INCREASED AG CONTENT IM||53.9275|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|90661|90661 - CCIIV3 VACCINE PRESERVATIVE FREE 0.5 ML IM USE||27.86|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|90657|90657 - IIV3 VACCINE SPLIT VIRUS 0.25 ML DOSAGE IM USE||7.53|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|90656|90656 - IIV3 VACC PRESERVATIVE FREE 0.5 ML DOSAGE IM USE||21.1717|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|90653|90653 - IIV ADJUVANTED VACCINE FOR INTRAMUSCULAR USE||55.2387|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|90632|90632 - HEPA VACCINE ADULT DOSE FOR INTRAMUSCULAR USE||62.3634|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|90630|90630 - INFLUENZA VACC IIV4 SPLIT VIRUS PRSRV FREE ID||22.3773|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|90586|90586 - BACILLUS CALMETTE-GUERIN VACCINE INTRAVESICAL||151.9232|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|90585|90585 - BACILLUS CALMETTE-GUERIN VACC FOR TB LIVE PERQ||151.9232|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|90472|90472 - IM ADM PRQ ID SUBQ/IM NJXS EA VACCINE||19.39|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|90471|90471 - IM ADM PRQ ID SUBQ/IM NJXS 1 VACCINE||37.5|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|90376|90376 - RABIES IG HEAT-TREATED HUMAN IM/SUBQ||335.9851|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|90375|90375 - RABIES IMMUNE GLOBULIN RIG HUMAN IM/SUBQ||325.4042|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|90371|90371 - HEPATITIS B IMMUNE GLOBULIN HBIG HUMAN IM||128.8276|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|86580|86580 - SKIN TEST TUBERCULOSIS INTRADERMAL||11.31|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|78315|78315 - BONE &/JOINT IMAGING 3 PHASE STUDY||510.48|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|78306|78306 - BONE &/JOINT IMAGING WHOLE BODY||370.88|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|77080|77080 - DXA BONE DENSITY STUDY 1/> SITES AXIAL SKEL||59.21|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|77077|77077 - JOINT SURVEY SINGLE VIEW 2 OR MORE JOINTS||54.84|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|77073|77073 - BONE LENGTH STUDIES||52.61|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|77072|77072 - BONE AGE STUDIES||33.62|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|77071|77071 - MANUAL APPL STRESS PFRMD PHYS/QHP JOINT FILMS||70.42|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|77067|77067 - SCREENING MAMMOGRAPHY BI 2-VIEW BREAST INC CAD||214.16|58.4||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|77066|77066 - DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ BI||265.34|76.77||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|77065|77065 - DIAGNOSTIC MAMMOGRAPHY COMPUTER-AIDED DETCJ UNI||209.17|61.75||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|77012|77012 - CT GUIDANCE NEEDLE PLACEMENT||181.8|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|77003|77003 - FLUOR NEEDLE/CATH SPINE/PARASPINAL DX/THER ADDON||123.55|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|77002|77002 - FLUOROSCOPIC GUIDANCE NEEDLE PLACEMENT ADD ON||132.73|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|76942|76942 - US GUIDANCE NEEDLE PLACEMENT IMG S&I||88.91|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|76882|76882 - US LMTD JOINT/OTH NONVASC XTR STRUX R-T W/IMG||53.85|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|76881|76881 - US COMPL JOINT R-T W/IMAGE DOCUMENTATION||168.28|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|76706|76706 - US ABDOMINAL AORTA REAL TIME SCREEN STUDY AAA||147.97|43.95||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|76102|76102 - RADEX CPLX MOTION BDY SCTJ OTH/THN UROGRAPY BI||248.14|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|76101|76101 - RADEX CPLX MOTION BDY SCTJ OTH/THN UROGRAPY UNI||189.55|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|76100|76100 - RADEX 1 PLNE BODY SECTION OTH/THN W/UROGRAPY||133.47|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|76080|76080 - RADEX ABSCESS/FISTULA/SINUS TRACT RS&I||80.66|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|76000|76000 - FLUOROSCOPY UP TO 1 HOUR PHYSICIAN/QHP TIME||67.05|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|74185|74185 - MRA ABDOMEN W/WO CONTRAST MATERIAL||575.96|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|74183|74183 - MRI ABDOMEN W/O & W/CONTRAST MATERIAL||724.78|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|74182|74182 - MRI ABDOMEN W/CONTRAST MATERIAL||648.18|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|74181|74181 - MRI ABDOMEN W/O CONTRAST MATERIAL||474.9|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|74175|74175 - CT ANGIOGRAPHY ABDOMEN W/CONTRAST/NONCONTRAST||440.88|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|74160|74160 - CT ABDOMEN W/CONTRAST MATERIAL||330.63|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|74022|74022 - RADIOLOGIC EXAM COMPLETE ACUTE ABDOMEN SERIES||63.4|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|74021|74021 - RADIOLOGIC EXAM ABDOMEN 3+ VIEWS||56.99|21.28||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|74019|74019 - RADIOLOGIC EXAM ABDOMEN 2 VIEWS||48.64|17.95||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|74018|74018 - RADIOLOGIC EXAM ABDOMEN 1 VIEW||39.83|14.15||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|74000|74000 - RADEX ABDOMEN 1 ANTEROPOSTERIOR VIEW||34.07|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73725|73725 - MRA LOWER EXTREMITY W/WO CONTRAST MATERIAL||576.07|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73723|73723 - MRI ANY JT LOWER EXTREM W/O & W/CONTRAST MATRL||673.58|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73722|73722 - MRI ANY JT LOWER EXTREM W/CONTRAST MATERIAL||544.9|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73721|73721 - MRI ANY JT LOWER EXTREM W/O CONTRAST MATRL||337.59|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73720|73720 - MRI LOWER EXTREM OTH/THN JT W/O & W/CONTR MATR||717.63|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73719|73719 - MRI LOWER EXTREM OTH/THN JT W/CONTRAST MATRL||576.96|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73718|73718 - MRI LOWER EXTREM OTH/THN JT W/O CONTR MATRL||519.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73706|73706 - CT ANGIOGRAPHY LOWER EXTREMITY||503.42|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73702|73702 - CT LOWER EXTREMITY W/O & W/CONTRAST MATRL||389.93|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73701|73701 - CT LOWER EXTREMITY W/CONTRAST MATERIAL||323|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73700|73700 - CT LOWER EXTREMITY W/O CONTRAST MATERIAL||256.49|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73660|73660 - RADEX TOE MINIMUM 2 VIEWS||39.79|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73650|73650 - RADEX CALCANEUS MINIMUM 2 VIEWS||38.46|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73630|73630 - RADEX FOOT COMPLETE MINIMUM 3 VIEWS||41.52|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73620|73620 - RADIOLOGIC EXAMINATION FOOT 2 VIEWS||36.95|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73615|73615 - RADEX ANKLE ARTHROGRAPHY RS&I||141.75|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73610|73610 - RADEX ANKLE COMPLETE MINIMUM 3 VIEWS||45.03|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73600|73600 - RADIOLOGIC EXAMINATION ANKLE 2 VIEWS||38.97|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73592|73592 - RADEX LOWER EXTREMITY INFANT MINIMUM 2 VIEWS||38.97|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73590|73590 - RADIOLOGIC EXAMINATION TIBIA & FIBULA 2 VIEWS||38.02|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73580|73580 - RADIOLOGIC EXAM KNEE ARTHROGRAPHY RS&I||164.28|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73565|73565 - RADIOLOGIC EXAM BOTH KNEES STANDING ANTEROPOST||47.03|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73564|73564 - RADIOLOGIC EXAM KNEE COMPLETE 4/MORE VIEWS||57.33|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73562|73562 - RADIOLOGIC EXAMINATION KNEE 3 VIEWS||49.09|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73560|73560 - RADIOLOGIC EXAMINATION KNEE 1/2 VIEWS||42.02|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73550|73550 - X-RAY EXAM OF THIGH||39.01|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73540|73540 - X-RAY EXAM OF PELVIS & HIPS||56.22|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73525|73525 - RADEX HIP ARTHROGRAPHY RS&I||145.76|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73520|73520 - X-RAY EXAM OF HIPS||57.06|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73510|73510 - X-RAY EXAM OF HIP||53.26|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73502|73502 - RADEX HIP UNILATERAL WITH PELVIS 2-3 VIEWS||59.11|17.2||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73500|73500 - X-RAY EXAM OF HIP||38.02|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73225|73225 - MRA UPPER EXTREMITY W/WO CONTRAST MATERIAL||576.58|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73223|73223 - MRI ANY JT UPPER EXTREMITY W/O & W/CONTR MATRL||670.58|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73222|73222 - MRI ANY JT UPPER EXTREMITY W/CONTRAST MATRL||540.41|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73221|73221 - MRI ANY JT UPPER EXTREMITY W/O CONTRAST MATRL||338.09|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73220|73220 - MRI UPPER EXTREM OTHER THAN JT W/O & W/CONTRAS||713.14|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73219|73219 - MRI UPPER EXTREMITY OTH THAN JT W/CONTR MATRL||575.96|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73218|73218 - MRI UPPER EXTREMITY OTH THAN JT W/O CONTR MATRL||518.35|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73206|73206 - CT ANGIOGRAPHY UPPER EXTREMITY||468.36|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73202|73202 - CT UPPER EXTREMITY W/O & W/CONTRAST MATERIAL||396.44|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73201|73201 - CT UPPER EXTREMITY W/CONTRAST MATERIAL||318.49|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73200|73200 - CT UPPER EXTREMITY W/O CONTRAST MATERIAL||256.49|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73140|73140 - RADEX FINGR MINIMUM 2 VIEWS||44.3|10.75||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73130|73130 - RADEX HAND MINIMUM 3 VIEWS||43.52|13.48||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73120|73120 - RADEX HAND 2 VIEWS||37.46|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73115|73115 - RADEX WRIST ARTHROGRAPHY RS&I||153.26|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73110|73110 - RADEX WRIST COMPLETE MINIMUM 3 VIEWS||50.53|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73100|73100 - RADEX WRIST 2 VIEWS||41.97|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73092|73092 - RADEX UPPER EXTREMITY INFANT MINIMUM 2 VIEWS||38.97|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73090|73090 - RADEX FOREARM 2 VIEWS||36.95|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73085|73085 - RADEX ELBOW ARTHROGRAPHY RS&I||141.25|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73080|73080 - RADEX ELBOW COMPLETE MINIMUM 3 VIEWS||45.03|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73070|73070 - RADEX ELBOW 2 VIEWS||39.4|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73060|73060 - RADEX HUMERUS MINIMUM 2 VIEWS||38.52|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73050|73050 - RADEX A-C JOINTS BI W/WO WEIGHTED DISTRCJ||51.21|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73040|73040 - RADEX SHOULDER ARTHROGRAPHY RS&I||144.26|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73030|73030 - RADEX SHOULDER COMPLETE MINIMUM 2 VIEWS||41.59|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73020|73020 - RADEX SHOULDER 1 VIEW||33.4|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73010|73010 - RADEX SCAPULA COMPLETE||43.03|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|73000|73000 - RADEX CLAVICLE COMPLETE||39.96|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72295|72295 - DISKOGRAPY LUMBAR RS&I||142.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72285|72285 - DISKOGRAPY CERVICAL/THORACIC RS&I||167.28|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72275|72275 - EPIDUROGRAPY RS&I||166.52|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72270|72270 - MYELOGRAPY 2/MORE REGIONS RS&I||186.26|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72265|72265 - MYELOGRAPY LUMBOSACRAL RS&I||133.87|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72255|72255 - MYELOGRAPHY THORACIC RS&I||142.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72240|72240 - MYELOGRAPHY CERVICAL RS&I||143.33|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72220|72220 - RADEX SACRUM & COCCYX MINIMUM 2 VIEWS||40.02|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72202|72202 - RADIOLOGIC EXAM SACROILIAC JOINTS 3/MORE VIEWS||47.14|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72200|72200 - RADIOLOGIC EXAMINATION SACROILIAC JNTS <3 VIEWS||40.52|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72198|72198 - MRA PELVIS W/WO CONTRAST MATERIAL||574.46|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72197|72197 - MRI PELVIS W/O & W/CONTRAST MATERIAL||723.28|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72196|72196 - MRI PELVIS W/CONTRAST MATERIAL||587.09|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72195|72195 - MRI PELVIS W/O CONTRAST MATERIAL||535.49|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72194|72194 - CT PELVIS W/O & W/CONTRAST MATERIAL||371.91|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72193|72193 - CT PELVIS W/CONTRAST MATERIAL||323|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72192|72192 - CT PELVIS W/O CONTRAST MATERIAL||211.44|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72191|72191 - CT ANGIOGRAPHY PELVIS W/CONTRAST/NONCONTRAST||437.33|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72190|72190 - RADIOLOGIC EXAM PELVIS COMPL MINIMUM 3 VIEWS||54.76|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72170|72170 - RADIOLOGIC EXAMINATION PELVIS 1/2 VIEWS||39.52|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72159|72159 - MRA SPINAL CANAL W/WO CONTRAST MATERIAL||596.5|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72158|72158 - MRI SPINAL CANAL LUMBAR W/O & W/CONTR MATRL||544.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72157|72157 - MRI SPINAL CANAL THORACIC W/O & W/CONTR MATRL||547.2|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72156|72156 - MRI SPINAL CANAL CERVICAL W/O & W/CONTR MATRL||545.68|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72149|72149 - MRI SPINAL CANAL LUMBAR W/CONTRAST MATERIAL||458.69|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72148|72148 - MRI SPINAL CANAL LUMBAR W/O CONTRAST MATERIAL||319.8|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72147|72147 - MRI SPINAL CANAL THORACIC W/CONTRAST MATRL||461.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72146|72146 - MRI SPINAL CANAL THORACIC W/O CONTRAST MATRL||321.3|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72142|72142 - MRI SPINAL CANAL CERVICAL W/CONTRAST MATRL||464.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72141|72141 - MRI SPINAL CANAL CERVICAL W/O CONTRAST MATRL||321.3|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72133|72133 - CT LUMBAR SPINE W/O & W/CONTRAST MATERIAL||386.71|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72132|72132 - CT LUMBAR SPINE W/CONTRAST MATERIAL||327.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72131|72131 - CT LUMBAR SPINE W/O CONTRAST MATERIAL||256.49|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72130|72130 - CT THORACIC SPINE W/O & W/CONTRAST MATERIAL||386.71|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72129|72129 - CT THORACIC SPINE W/CONTRAST MATERIAL||328.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72128|72128 - CT THORACIC SPINE W/O CONTRAST MATERIAL||258|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72127|72127 - CT CERVICAL SPINE W/O &W/CONTRAST MATERIAL||386.2|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72126|72126 - CT CERVICAL SPINE W/CONTRAST MATERIAL||328.35|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72125|72125 - CT CERVICAL SPINE W/O CONTRAST MATERIAL||264.4|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72120|72120 - RADEX SPINE LUMBOSACRAL ONLY BENDING 2/3 VIEWS||57.83|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72114|72114 - RADEX SPINE LUMBSCRL COMPL W/BENDING VIEWS MIN 6||89.44|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72110|72110 - RADEX SPINE LUMBOSACRAL MINIMUM 4 VIEWS||70.35|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72100|72100 - RADEX SPINE LUMBOSACRAL 2/3 VIEWS||50.31|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72090|72090 - X-RAY EXAM SCLOIOSIS ERECT||61.67|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72080|72080 - RADEX SPINE THORACOLUMBAR JUNCTION MIN 2 VIEWS||48.31|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72074|72074 - RADEX SPINE THORACIC MINIMUM 4 VIEWS||55.82|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72070|72070 - RADEX SPINE THORACIC 2 VIEWS||45.31|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72069|72069 - X-RAY EXAM TRUNK SPINE STAND||46.31|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72052|72052 - RADEX SPINE CERVICAL 6 OR MORE VIEWS||80.65|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72050|72050 - RADEX SPINE CERVICAL 4 OR 5 VIEWS||64.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72040|72040 - RADEX SPINE CERVICAL 2 OR 3 VIEWS||47.82|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72020|72020 - RADEX SPINE 1 VIEW SPECIFY LEVEL||31.39|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|72010|72010 - X-RAY EXAM SPINE AP&LAT||101.18|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|71552|71552 - MRI CHEST W/O & W/CONTRAST MATERIAL||826.92|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|71551|71551 - MRI CHEST W/CONTRAST MATERIAL||652.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|71550|71550 - MRI CHEST W/O CONTRAST MATERIAL||589.57|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|71275|71275 - CT ANGIOGRAPHY CHEST W/CONTRAST/NONCONTRAST||431.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|71270|71270 - CT THORAX W/O & W/CONTRAST MATERIAL||393.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|71260|71260 - CT THORAX W/CONTRAST MATERIAL||328.46|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|71250|71250 - CT THORAX W/O CONTRAST MATERIAL||258.12|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|71130|71130 - RADEX STERNOCLAVICULAR JT/JTS MINIMUM 3 VIEWS||51.82|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|71120|71120 - RADEX STERNUM MINIMUM 2 VIEWS||42.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|71111|71111 - RADEX RIBS BI W/POSTEROANT CH MINIMUM 4 VIEWS||67.91|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|71110|71110 - RADEX RIBS BILATERAL 3 VIEWS||53.6|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|71101|71101 - RADEX RIBS UNI W/POSTEROANT CH MINIMUM 3 VIEWS||52.1|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|71100|71100 - RADEX RIBS UNILATERAL 2 VIEWS||43.8|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|71048|71048 - RADIOLOGIC EXAM CHEST 4+ VIEWS||61.13|24.92||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|71047|71047 - RADIOLOGIC EXAM CHEST 3 VIEWS||56.9|21.68||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|71046|71046 - RADIOLOGIC EXAM CHEST 2 VIEWS||44.57|16.89||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|71045|71045 - RADIOLOGIC EXAM CHEST SINGLE VIEW||29.3|14.15||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|71035|71035 - RADEX CHEST SPECIAL VIEWS||46.58|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|71020|71020 - RADIOLOGIC EXAM CHEST 2 VIEWS FRONTAL&LATERAL||40.3|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|71010|71010 - RADIOLOGIC EXAMINATION CHEST SINGLE VIEW FRONTAL||32.57|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|70553|70553 - MRI BRAIN BRAIN STEM W/O W/CONTRAST MATERIAL||542.67|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|70552|70552 - MRI BRAIN BRAIN STEM W/CONTRAST MATERIAL||459.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|70551|70551 - MRI BRAIN BRAIN STEM W/O CONTRAST MATERIAL||330.8|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|70549|70549 - MRA NECK W/O &W/CONTRAST MATERIAL||855.86|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|70548|70548 - MRA NECK W/CONTRAST MATERIAL||587.11|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|70547|70547 - MRA NECK W/O CONTRST MATERIAL||559.57|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|70546|70546 - MRA HEAD W/O & W/CONTRAST MATERIAL||852.36|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|70545|70545 - MRA HEAD W/CONTRAST MATERIAL||548.54|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|70544|70544 - MRA HEAD W/O CONTRST MATERIAL||557.57|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|70543|70543 - MRI ORBIT FACE & NECK W/O & W/CONTRAST MATRL||702.62|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|70542|70542 - MRI ORBIT FACE & NECK W/CONTRAST MATERIAL||574.45|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|70540|70540 - MRI ORBIT FACE &/NECK W/O CONTRAST||509.84|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|70498|70498 - CT ANGIOGRAPHY NECK W/CONTRAST/NONCONTRAST||421.97|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|70496|70496 - CT ANGIOGRAPHY HEAD W/CONTRAST/NONCONTRAST||424.47|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|70486|70486 - CT MAXILLOFACIAL W/O CONTRAST MATERIAL||201.08|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|70482|70482 - CT ORBIT SELLA/POST FOSSA/EAR W/O & W/CONTR MATR||431.29|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|70481|70481 - CT ORBIT SELLA/POST FOSSA/EAR W/CONTRAST MATRL||394.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|70480|70480 - CT ORBIT SELLA/POST FOSSA/EAR W/O CONTRAST MATRL||334.18|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|70470|70470 - CT HEAD/BRAIN W/O & W/CONTRAST MATERIAL||276.06|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|70450|70450 - CT HEAD/BRAIN W/O CONTRAST MATERIAL||167.52|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|70336|70336 - MRI TEMPOROMANDIBULAR JOINT||457.48|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|70260|70260 - RADIOLOGIC EXAM SKULL COMPLETE MINIMUM 4 VIEWS||65.01|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|70250|70250 - RADIOLOGIC EXAMINATION SKULL 4/> VIEWS||51.43|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|70220|70220 - RADEX SINUSES PARANASAL COMPL MINIMUM 3 VIEWS||53.49|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|70210|70210 - RADEX SINUSES PARANASAL <3 VIEWS||42.52|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|70160|70160 - RADEX NASAL BONES COMPLETE MINIMUM 3 VIEWS||46.53|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|70140|70140 - RADEX FACIAL BONES < 3 VIEWS||42.64|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|70110|70110 - RADIOLOG EXAM MANDIBLE COMPL MINIMUM 4 VIEWS||54.48|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|70100|70100 - RADIOLOGIC EXAMINATION MANDIPLE PRTL <4 VIEWS||46.86|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|70030|70030 - RADIOLOGIC EXAMINATION EYE DETECT FOREIGN BODY||39.32|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|69990|69990 - MICROSURG TQS REQ USE OPERATING MICROSCOPE||401.6|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|69210|69210 - REMOVAL IMPACTED CERUMEN INSTRUMENTATION UNILAT||85.41|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64913|64913 - NERVE REPAIR W/NERVE ALLOGRAFT EA ADDL STRAND||289.3|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64912|64912 - NERVE REPAIR W/NERVE ALLOGRAFT FIRST STRAND||1402.7|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64910|64910 - NERVE REPAIR W/CONDUIT EACH NERVE||1455.5|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64902|64902 - NERVE GRAFT EACH NERVE MULTIPLE STRANDS||1169.73|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64901|64901 - NERVE GRAFT EACH NERVE 1 STRAND||1010.27|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64898|64898 - NERVE GRAFT MLT STRANDS ARM/LEG >4 CM||2444.27|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64897|64897 - NERVE GRAFT MLT STRANDS ARM/LEG </4 CM||2251.71|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64896|64896 - NERVE GRAFT MLT STRANDS HAND/FOOT > 4 CM||2877.7|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64895|64895 - NERVE GRAFT MLT STRANDS HAND/FOOT </4 CM||2397.42|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64893|64893 - NERVE GRAFT 1 STRAND ARM/LEG >4 CM||2013.14|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64892|64892 - NERVE GRAFT 1 STRAND ARM/LEG <4 CM||1872.16|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64890|64890 - NERVE GRAFT 1 STRAND HAND/FOOT </4 CM||1938.62|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64874|64874 - SUTURE NERVE REQ XTNSV MOBIL/TRPOS NERVE||296.98|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64859|64859 - SUTURE EACH ADDITIONAL PERIPHERAL NERVE||453.04|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64857|64857 - SUTR PRPH NRV ARM/LEG XCP SCIATIC W/O TRPOS||1864.44|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64856|64856 - SUTR PRPH NRV ARM/LEG XCP SCIATIC W/TRPOS||1797.3|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64840|64840 - SUTURE POSTERIOR TIBIAL NERVE||1714.09|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64837|64837 - SUTURE EACH ADDITIONAL NERVE HAND/FOOT||679.05|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64836|64836 - SUTURE 1 NERVE ULNAR MOTOR||1448.96|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64835|64835 - SUTURE 1 NERVE MEDIAN MOTOR THENAR||1446.8|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64834|64834 - SUTURE 1 NERVE HAND/FOOT COMMON SENSORY NERVE||1304.51|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64832|64832 - SUTR DIGITAL NRV HAND/FOOT EA DGTAL NRV||604.75|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64831|64831 - SUTURE DIGITAL NERVE HAND/FOOT 1 NERVE||1204.72|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64820|64820 - SYMPATHECTOMY DIGITAL ARTERIES EACH DIGIT||1287.16|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64795|64795 - BIOPSY NERVE||343.8|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64790|64790 - EXC NEUROFIBROMA/NEUROLEMMOMA MAJOR PRPH NRV||1495.96|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64788|64788 - EXC NEUROFIBROMA/NEUROLEMMOMA CUTAN NRV||719.03|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64787|64787 - IMPLANTATION NERVE END BONE/MUSCLE||439.92|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64786|64786 - EXCISION NEUROMA SCIATIC NERVE||1926.7|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64784|64784 - EXC NEUROMA MAJOR PERIPHERAL NRV XCP SCIATIC||1288.75|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64783|64783 - EXC NEUROMA HAND/FOOT EA NRV XCP SM DGT||393.66|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64782|64782 - EXC NEUROMA HAND/FOOT XCP DIGITAL NERVE||797.54|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64778|64778 - EXCISION NEUROMA DIGITAL NRV EA ADDL DIGIT||258.8|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64776|64776 - EXC NEUROMA DIGITAL NERVE 1 OR BOTH SAME DIGIT||685.76|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64774|64774 - EXC NEUROMA CUTAN NRV SURGLY IDENTIFIABLE||734.87|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64772|64772 - TRANSECTION/AVULSION OTH SPINAL NRV XDRL||1005.41|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64766|64766 - TRNSXJ/AVLSN OBTURAT NRV INPELV W/WO TENOTOMY||1012.97|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64727|64727 - INTERNAL NEUROLYSIS REQ OPERATING MICROSCOPE||331.56|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64726|64726 - DECOMPRESSION PLANTAR DIGITAL NERVE||487.98|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64722|64722 - DECOMPRESSION UNSPECIFIED NERVE||652.82|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64721|64721 - NEUROPLASTY &/TRANSPOS MEDIAN NRV CARPAL TUNNE||749.75|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64719|64719 - NEUROPLASTY &/TRANSPOSITION ULNAR NERVE WRIST||699.73|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64718|64718 - NEUROPLASTY &/TRANSPOSITION ULNAR NERVE ELBOW||1036.42|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64714|64714 - NEURP MAJOR PRPH NRV OPN ARM/LEG LMBR PLEXUS||1152.68|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64713|64713 - NEURP MAJOR PRPH NRV OPN ARM/LEG BRACH PLEXUS||1283.45|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64712|64712 - NEURP MAJOR PRPH NRV OPN ARM/LEG SCIATIC NRV||1009.75|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64708|64708 - NEURP MAJOR PRPH NRV ARM/LEG OPN OTH/THN SPEC||875.77|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64704|64704 - NEUROPLASTY NERVE HAND/FOOT||558.2|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64702|64702 - NEUROPLASTY DIGITAL 1/BOTH SAME DIGIT||874.49|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64640|64640 - DSTRJ NEUROLYTIC AGENT OTHER PERIPHERAL NERVE||228.44|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64632|64632 - DSTRJ NEUROLYTIC PLANTAR COMMON DIGITAL NERVE||149.94|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64595|64595 - REVISION/RMVL PERIPHERAL/GASTRIC NPGR||418.16|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64590|64590 - INSERTION/RPLCMT PERIPHERAL/GASTRIC NPGR||454.54|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64550|64550 - APPLICATION OF SURFACE NEUROSTIMULATOR||27.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64520|64520 - INJECTION ANES LMBR/THRC PARAVERTBRL SYMPATHETIC||315.88|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64510|64510 - NJX ANES STELLATE GANGLION CRV SYMPATHETIC||218.5|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64495|64495 - NJX DX/THER AGT PVRT FACET JT LMBR/SAC 3+ LEVEL||150.77|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64494|64494 - NJX DX/THER AGT PVRT FACET JT LMBR/SAC 2ND LEVEL||150.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64493|64493 - NJX DX/THER AGT PVRT FACET JT LMBR/SAC 1 LEVEL||294.89|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64492|64492 - NJX DX/THER AGT PVRT FACET JT CRV/THRC 3+ LEVEL||164.03|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64491|64491 - NJX DX/THER AGT PVRT FACET JT CRV/THRC 2ND LEVEL||163.44|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64490|64490 - NJX DX/THER AGT PVRT FACET JT CRV/THRC 1 LEVEL||326.52|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64484|64484 - NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC EA LV||150.77|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64483|64483 - NJX ANES&/STRD W/IMG TFRML EDRL LMBR/SAC 1 LVL||374.15|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64480|64480 - NJX ANES&/STRD W/IMG TFRML EDRL CRV/THRC EA LV||194.53|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64479|64479 - NJX ANES&/STRD W/IMG TFRML EDRL CRV/THRC 1 LVL||404.62|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64455|64455 - NJX ANES&/STEROID PLANTAR COMMON DIGITAL NERVE||83.41|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64450|64450 - INJECTION AA&/STRD OTHER PERIPHERAL NERVE/BRANCH||137.5|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64445|64445 - INJECTION AA&/STRD SCIATIC NERVE||233.01|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64421|64421 - INJECTION AA&/STRD INTERCOSTAL NRV EA ADDL LVL||258.73|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64420|64420 - INJECTION AA&/STRD INTERCOSTAL NRV SINGLE LVL||193.82|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64417|64417 - INJECTION AA&/STRD AXILLARY NERVE||222.84|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64413|64413 - INJECTION ANESTHETIC AGENT CERVICAL PLEXUS||223.2|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|64405|64405 - INJECTION AA&/STRD GREATER OCCIPITAL NERVE||173.66|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63740|63740 - CRTJ SHUNT LMBR SARACH-PRTL-PLEURAL/OTH W/LAM||1728.09|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63710|63710 - DURAL GRAFT SPINAL||1939|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63709|63709 - RPR DURAL/CSF LEAK/PSEUDOMENINGOCELE W/LAM||1974.44|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63707|63707 - RPR DURAL/CEREBROSPINAL FLUID LEAK X REQ LAM||1643.45|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63706|63706 - REPAIR MYELOMENINGOCELE > 5 CM DIAMETER||3011.9|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63704|63704 - REPAIR MYELOMENINGOCELE < 5 CM DIAMETER||2655.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63702|63702 - REPAIR MENINGOCELE > 5 CM DIAMETER||2540.29|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63700|63700 - REPAIR MENINGOCELE < 5 CM DIAMETER||2085.35|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63688|63688 - REVJ/RMVL IMPLANTED SPINAL NEUROSTIM GENERATOR||659.5|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63685|63685 - INSJ/RPLCMT SPI NPGR DIR/INDUXIVE COUPLING||652.97|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63664|63664 - REVJ INCL RPLCMT NSTIM ELTRD PLT/PDLE INCL FLUOR||1534.25|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63663|63663 - REVJ INCL RPLCMT NSTIM ELTRD PRQ RA INCL FLUOR||1357.51|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63662|63662 - RMVL SPINAL NSTIM ELTRD PLATE/PADDLE INCL FLUOR||1498.28|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63661|63661 - RMVL SPINAL NSTIM ELTRD PRQ ARRAY INCL FLUOR||994.61|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63655|63655 - LAM IMPLTJ NSTIM ELTRDS PLATE/PADDLE EDRL||1479.13|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63650|63650 - PRQ IMPLTJ NSTIM ELECTRODE ARRAY EPIDURAL||2242.01|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63308|63308 - VERTEBRAL CORPECTOMY EXC INDRL LES EACH SEG||591.3|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63301|63301 - VCRPEC LES 1 SGM XDRL THORACIC TTHRC||3934.96|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63300|63300 - VCRPEC LES 1 SGM XDRL CERVICAL||3327.57|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63295|63295 - OSTPL RCNSTJ DORSAL SPI ELMNTS FLWG ISPI PX||615.35|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63290|63290 - LAM BX/EXC ISPI NEO XDRL-IDRL LES ANY LVL||5106.71|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63287|63287 - LAM BX/EXC ISPI NEO IDRL IMED THORACOLMBR||5020.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63286|63286 - LAM BX/EXC ISPI NEO IDRL IMED THORACIC||4728.92|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63285|63285 - LAM BX/EXC ISPI NEO IDRL IMED CERVICAL||4782.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63283|63283 - LAM BX/EXC ISPI NEO IDRL SACRAL||3461.53|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63282|63282 - LAM BX/EXC ISPI NEO IDRL XMED LUMBAR||3571.15|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63281|63281 - LAM BX/EXC ISPI NEO IDRL XMED THORACIC||3796.87|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63280|63280 - LAM BX/EXC ISPI NEO IDRL XMED CERVICAL||3853.04|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63278|63278 - LAMINECTOMY BX/EXC ISPI NEO XDRL SACRAL||2892.13|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63277|63277 - LAMINECTOMY BX/EXC ISPI NEO XDRL LUMBAR||2802.08|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63276|63276 - LAMINECTOMY BX/EXC ISPI NEO XDRL THORACIC||3236.58|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63275|63275 - LAMINECTOMY BX/EXC ISPI NEO XDRL CERVICAL||3266.84|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63273|63273 - LAM EXC ISPI LES OTH/THN NEO IDRL SACRAL||3401.46|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63272|63272 - LAM EXC ISPI LES OTH/THN NEO IDRL LUMBAR||3420.05|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63271|63271 - LAM EXC ISPI LES OTH/THN NEO IDRL THORACIC||3765.6|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63270|63270 - LAM EXC ISPI LES OTH/THN NEO IDRL CERVICAL||3790.01|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63268|63268 - LAM EXC/EVAC ISPI LES OTH/THN NEO XDRL SACRAL||2618.78|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63267|63267 - LAM EXC/EVAC ISPI LESION OTH/THN NEO XDRL LUMBAR||2467.94|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63266|63266 - LAM EXC/EVAC ISPI LES OTH/THN NEO XDRL THORACIC||3110.02|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63265|63265 - LAM EXC/EVAC ISPI LES OTH/THN NEO XDRL CERVICAL||3015.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63252|63252 - LAM EXC/OCCLUSION AVM SPI CORD THORACOLUMBAR||5552.53|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63251|63251 - LAM EXC/OCCLUSION AVM SPINAL CORD THORACIC||5553.18|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63250|63250 - LAM EXC/OCCLUSION AVM SPINAL CORD CERVICAL||5434.6|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63200|63200 - LAMINECTOMY RELEASE TETHERED SPINAL CORD LUMBAR||2771.69|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63195|63195 - LAM CORDOTOMY SCTJ 1 SPINOTHALMIC TRACT THORACIC||2099.11|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63194|63194 - LAM CORDOTOMY SCTJ 1 SPINOTHALMIC TRACT CERVICAL||2906.53|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63185|63185 - LAMINECTOMY W/RHIZOTOMY 1/2 SEGMENTS||2049.05|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63172|63172 - LAM W/DRG INTRMEDULLARY CYST/SYRINX SUBARACHNOID||2581.58|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63091|63091 - VCRPEC TRANSPRTL/RPR DCMPRN THRC LMBR/SAC EA SEG||321.23|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63090|63090 - VCRPEC TRANSPRTL/RPR DCMPRN THRC LMBR/SAC 1 SEG||3507.79|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63088|63088 - VCRPEC THORACOLMBR DCMPRN LWR THRC/LMBR EA SEG||476.98|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63087|63087 - VCRPEC THORACOLMBR DCMPRN LWR THRC/LMBR 1 SEG||4352.35|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63086|63086 - VERTEBRAL CORPECTOMY DCMPRN CORD THORACIC EA SEG||347.36|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63085|63085 - VERTEBRAL CORPECTOMY DCMPRN CORD THORACIC 1 SEG||3454.65|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63082|63082 - VERTEBRAL CORPECTOMY DCMPRN CERVICAL EA SEG||485.39|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63081|63081 - VERTEBRAL CORPECTOMY ANT DCMPRN CERVICAL 1 SEG||3164.89|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63078|63078 - DISCECTOMY ANT DCMPRN CORD THORACIC EA NTRSPC||344.95|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63077|63077 - DISCECTOMY ANT DCMPRN CORD THORACIC 1 NTRSPC||2706.08|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63076|63076 - DISCECTOMY ANT DCMPRN CORD CERVICAL EA NTRSPC||449.55|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63075|63075 - DISCECTOMY ANT DCMPRN CORD CERVICAL 1 NTRSPC||2435.06|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63066|63066 - COSTOVERTEBRAL DCMPRN SPINE CORD THORACIC EA SEG||380.52|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63064|63064 - COSTOVERTEBRAL DCMPRN SPINAL CORD THORACIC 1 SEG||3197.27|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63057|63057 - TRANSPEDICULAR DCMPRN 1 SEG EA THORACIC/LUMBAR||581.99|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63056|63056 - TRANSPEDICULAR DCMPRN SPINAL CORD 1 SEG LUMBAR||2669.8|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63055|63055 - TRANSPEDICULAR DCMPRN SPINAL CORD 1 SEG THORACIC||2946.6|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63051|63051 - LAMOPLASTY CERVICAL DCMPRN CORD 2/> SEG RCNSTJ||3082.39|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63050|63050 - LAMOP CERVICAL W/DCMPRN SPI CORD 2/> VERT SEG||2674.17|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63048|63048 - LAM FACETECTOMY&FORAMTOMY 1 SGM EA CRV THRC/LMBR||385.87|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63047|63047 - LAM FACETECTOMY & FORAMOTOMY 1 SEGMENT LUMBAR||1977.25|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63046|63046 - LAM FACETECTOMY & FORAMOTOMY 1 SEGMENT THORACIC||2169.43|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63045|63045 - LAM FACETECTOMY & FORAMOTOMY 1 SEGMENT CERVICAL||2294.06|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63042|63042 - LAMOT PRTL FFD EXC DISC REEXPL 1 NTRSPC LUMBAR||2324.05|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63040|63040 - LAMOT PRTL FFD EXC DISC REEXPL 1 NTRSPC CERVICAL||2507.22|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63035|63035 - LAMNOTMY W/DCMPRSN NRV EACH ADDL CRVCL/LMBR||348.84|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63030|63030 - LAMNOTMY INCL W/DCMPRSN NRV ROOT 1 INTRSPC LUMBR||1732.45|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63020|63020 - LAMNOTMY INCL W/DCMPRSN NRV ROOT 1 INTRSPC CERVC||2092.75|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63017|63017 - LAMINECTOMY W/O FFD > 2 VERT SEG LUMBAR||2255.09|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63016|63016 - LAMINECTOMY W/O FFD > 2 VERT SEG THORACIC||2742.14|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63015|63015 - LAMINECTOMY W/O FFD > 2 VERT SEG CERVICAL||2678.08|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63012|63012 - LAMINECTOMY W/RMVL ABNORMAL FACETS LUMBAR||2136.58|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63005|63005 - LAMINECTOMY W/O FFD 1/2 VERT SEG LUMBAR||2124.02|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63003|63003 - LAMINECTOMY W/O FFD 1/2 VERT SEG THORACIC||2232.76|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|63001|63001 - LAM W/O FACETEC FORAMOT/DSKC 1/2 VRT SEG CRV||2241.31|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|62365|62365 - RMVL SUBQ RSVR/PUMP INTRATHECAL/EPIDURAL INFUS||528.97|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|62362|62362 - IMPLTJ/RPLCMT ITHCL/EDRL DRUG NFS PRGRBL PUMP||689.4|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|62351|62351 - IMPLTJ REVJ/RPSG ITHCL/EDRL CATH W/LAM||1540.33|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|62350|62350 - IMPLTJ REVJ/RPSG ITHCL/EDRL CATH PMP W/O LAM||715|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|62327|62327 - NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN||412.15|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|62326|62326 - NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN||281.65|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|62325|62325 - NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN||404.39|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|62324|62324 - NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN||268.09|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|62323|62323 - NJX DX/THER SBST INTRLMNR LMBR/SAC W/IMG GDN||447.68|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|62322|62322 - NJX DX/THER SBST INTRLMNR LMBR/SAC W/O IMG GDN||286.18|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|62321|62321 - NJX DX/THER SBST INTRLMNR CRV/THRC W/IMG GDN||456.07|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|62320|62320 - NJX DX/THER SBST INTRLMNR CRV/THRC W/O IMG GDN||306.85|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|62292|62292 - INJECTION PX CHEMONUCLEOLYSIS 1/MLT LUMBAR||1036.91|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|62291|62291 - INJECTION PX DISCOGRPHY EA LVL CERVICAL/THORACIC||577.89|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|62290|62290 - INJECTION PX DISCOGRAPHY EACH LEVEL LUMBAR||573.26|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|62287|62287 - DCMPRN PERQ NUCLEUS PULPOSUS 1/> LEVELS LUMBAR||1018.8|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|62284|62284 - INJECTION PROCEDURE MYELOGRAPHY/CT LUMBAR||313.07|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|62282|62282 - INJX/INFUS NEUROLYT SBST EPIDURAL LUMBAR/SACRAL||503.17|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|62281|62281 - INJX/INFUS NEUROLYT SUBST EPIDURAL CERV/THORACIC||404.75|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|62273|62273 - INJECTION EPIDURAL BLOOD/CLOT PATCH||301.36|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|62272|62272 - THERAPEUTIC SPINAL PUNCTURE DRAINAGE CSF||343.26|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|62270|62270 - DIAGNOSTIC LUMBAR SPINAL PUNCTURE||274.18|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|58674|58674 - LAPS ABLTJ UTERINE FIBROIDS W/INTRAOP US GDN||1500.65|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|58575|58575 - LAPS TOT HYSTERECTOMY RESJ MALIGNANCY W/OMNTC||3393.57|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|58301|58301 - REMOVAL INTRAUTERINE DEVICE IUD||164.77|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|55874|55874 - TRANSPERINEAL PLMT BIODEGRADABLE MATRL 1/MLT NJX||6168.92|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|49060|49060 - DRAINAGE OF RETROPERITONEAL ABSCESS OPEN||1970.87|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|43288|43288 - ESOPHAGECTOMY TOTAL NEAR TOTAL W/THRSC MOBLJ||6899.43|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|43287|43287 - ESOPHAGECTOMY DISTAL 2/3 W/LAPAROSCOPIC MOBLJ||6615.68|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|43286|43286 - ESOPHAGECTOMY TOTAL NEAR TOTAL W/LAPS MOBLJ||5785.71|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|43285|43285 - REMOVAL ESOPHAGEAL SPHINCTER AGMNTJ DEVICE||1228.04|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|43284|43284 - LAPS ESOPHGL SPHNCTR AGMNTJ PLMT DEV CRRPL||1213.83|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|42182|42182 - REPAIR LACERATION PALATE >2 CM/COMPLEX||563.9|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|38573|38573 - LAPS W/BI TOT PEL LMPHADEC & OMNTC LYMPH BX||2126.79|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|38510|38510 - BX/EXC LYMPH NODE OPEN DEEP CERVICAL NODE||912.02|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|38500|38500 - BX/EXC LYMPH NODE OPEN SUPERFICIAL||576.86|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|38230|38230 - BONE MARROW HARVEST TRANSPLANTATION ALLOGENEIC||354.46|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|38222|38222 - DIAGNOSTIC BONE MARROW BIOPSIES & ASPIRATIONS||292.5|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|38221|38221 - DIAGNOSTIC BONE MARROW BIOPSIES||285.77|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|38220|38220 - DIAGNOSTIC BONE MARROW ASPIRATIONS||278.66|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|37785|37785 - LIGJ DIVJ &/EXCJ VARICOSE VEIN CLUSTER 1 LEG||628.96|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|37650|37650 - LIGATION OF FEMORAL VEIN||848.09|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|37618|37618 - LIGATION MAJOR ARTERY EXTREMITY||689.35|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|37249|37249 - TRLML BALO ANGIOP OPEN/PERQ W/IMG S&I ADDL VEIN||1162.15|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|37248|37248 - TRLML BALO ANGIOP OPEN/PERQ W/IMG S&I 1ST VEIN||2711.89|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|37247|37247 - TRLML BALO ANGIOP OPEN/PERQ IMG S&I EA ADDL ART||1583.98|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|37246|37246 - TRLML BALO ANGIOP OPEN/PERQ IMG S&I 1ST ART||3914.74|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|37202|37202 - TRANSCATHETER THERAPY INFUSE||547.99|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|36909|36909 - DIALYIS CIRCUIT VASC EMBOLI OCCLS EVASC IMG S&I||3573.65|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|36908|36908 - STENT PLMT CENTRAL DIAYLSIS SEG PFRMD DIAL CIR||4899.24|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|36907|36907 - TRLUML BALO ANGIOP CTR DIALYSIS SEG W/IMG S&I||1330.11|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|36906|36906 - PERQ THRMBC/NFS DIAL CIRCUIT TCAT PLMT IV STENT||12361.14|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|36905|36905 - PERQ THRMBC/NFS DIAL CIRCUIT TRLUML BALO ANGIOP||4147.3|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|36904|36904 - PERQ THRMBC/NFS DIALYSIS CIRCUIT IMG DX ANGRPH||3240.96|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|36903|36903 - INTRO CATH DIALYSIS CIRCUIT W/TCAT PLMT IV STENT||10193.83|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|36902|36902 - INTRO CATH DIALYSIS CIRCUIT W/TRLUML BALO ANGIOP||2222.87|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|36901|36901 - INTRO CATH DIALYSIS CIRCUIT DX ANGRPH FLUOR S&I||1045.22|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|36831|36831 - THRMBC OPN ARVEN FSTL W/O REVJ DIAL GRF||1133.89|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|36821|36821 - ARTERIOVENOUS ANASTOMOSIS OPEN DIRECT||1219.48|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|36483|36483 - ENDOVEN ABLTI THER CHEM ADHESIVE SBSQ VEIN||252.97|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|36482|36482 - ENDOVEN ABLTI THER CHEM ADHESIVE 1ST VEIN||3529.57|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|36474|36474 - ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM SBSQ VEINS||501.94|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|36473|36473 - ENDOVEN ABLTJ INCMPTNT VEIN MCHNCHEM 1ST VEIN||2740.32|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|36466|36466 - NJX NONCMPND SCLEROSANT MULTIPLE INCMPTNT VEINS||2772.52|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|36465|36465 - NJX NONCMPND SCLEROSANT SINGLE INCMPTNT VEIN||2649.24|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|36456|36456 - PRTL EXCHANGE TRANSFUSE BLOOD/PLSM/CRYST NEWBORN||199.61|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|36410|36410 - VNPNXR 3 YEARS/> PHYS/QHP SKILL||29.09|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|36262|36262 - REMOVAL IMPLANTED INTRA-ARTERIAL INFUSION PUMP||541.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|36260|36260 - INSJ IMPLANTABLE INTRA-ARTERIAL INFUSION PUM||1153.44|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|36245|36245 - SLCTV CATHJ EA 1ST ORD ABDL PEL/LXTR ART BRNCH||2297.14|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|35860|35860 - EXPL PO HEMRRG THROMBOSIS/INFCTJ XTR||1540.51|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|35761|35761 - EXPL N/FLWD SURG RPR W/WO LYSIS OTHER ARTERY||706.7|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|35236|35236 - REPAIR BLOOD VESSEL W/VEIN GRAFT UPPER EXTREMITY||1801.24|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|35226|35226 - RPR BLOOD VESSEL DIRECT LOWER EXTREMITY||1528.61|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|35221|35221 - RPR BLOOD VESSEL DIRECT INTRA-ABDOMINAL||2657.05|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|35207|35207 - REPAIR BLOOD VESSEL DIRECT HAND FINGER||1337.4|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|35206|35206 - REPAIR BLOOD VESSEL DIRECT UPPER EXTREMITY||1417.77|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|35152|35152 - DIR RPR RUPTD ANEURYSM & GRF POPLITEAL ARTERY||2593.03|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|35045|35045 - DIR RPR RUPTD ANEURYSM RADIAL/ULNAR ARTERY||1824.44|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|34716|34716 - OPN AXILLARY/SUBCLAVIAN ART EXPOS W/CNDT CRTJ||697.23|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|34715|34715 - OPN AX/SUBCLA ART EXPOS DLVR EVASC PROSTH UNI||562.79|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|34714|34714 - OPN FEM ART EXPOS W/CNDT CRTJ DLVR EVASC PROSTH||503.27|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|34713|34713 - PERQ ACCESS & CLOSURE FEM ART FOR DELIVERY NDGFT||239.98|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|34712|34712 - TRANSCATHETER DLVR ENHNCD FIXATION DEVICES RS&I||1262.89|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|34711|34711 - DLYD PLACEMENT XTN PROSTH FOR EVASC RPR EA ADDL||558.3|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|34710|34710 - DLYD PLACEMENT XTN PROSTH FOR EVASC RPR 1ST VSL||1488.33|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|34709|34709 - PLACEMENT XTN PROSTH FOR ENDOVASCULAR RPR||604.64|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|34708|34708 - EVASC RPR DPLMNT ILIO-ILIAC NDGFT RPT||3445.57|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|34707|34707 - EVASC RPR DPLMNT ILIO-ILIAC NDGFT||2138.25|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|34706|34706 - EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT RPT||4288.41|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|34705|34705 - EVASC RPR DPLMNT AORTO-BI-ILIAC NDGFT||2846.51|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|34704|34704 - EVASC RPR DPLMNT AORTO-UN-ILIAC NDGFT RPT||4304.25|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|34703|34703 - EVASC RPR DPLMNT AORTO-UN-ILIAC NDGFT||2585.4|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|34702|34702 - EVASC RPR DPLMNT AORTO-AORTIC NDGFT RPT||3425.82|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|34701|34701 - EVASC RPR DPLMNT AORTO-AORTIC NDGFT||2291.39|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|33927|33927 - IMPLTJ TOTAL RPLCMT HEART SYS W/RCP CARDIECTOMY||4749.94|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|33391|33391 - VALVULOPLASTY AORTIC VALVE OPEN CARD BYP COMPLEX||4238.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|33390|33390 - VALVULOPLASTY AORTIC VALVE OPEN CARD BYP SIMPLE||3576.88|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|33340|33340 - PERQ CLSR TCAT L ATR APNDGE W/ENDOCARDIAL IMPLNT||1500|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|32994|32994 - ABLATION THER 1+ PULM TUMORS PERQ CRYOABLATION||10277.3|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|32905|32905 - THORACOPLASTY SCHEDE TYPE/EXTRAPLEURAL||2423.45|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|32900|32900 - RESECTION RIBS EXTRAPLEURAL ALL STAGES||2568.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|32100|32100 - THORACOTOMY WITH EXPLORATION||1456.74|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|31592|31592 - CRICOTRACHEAL RESECTION||3120.16|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|31591|31591 - LARYNGOPLASTY MEDIALIZATION UNLIATERAL||1928.3|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|31574|31574 - LARYNGOSCOPY FLEXIBLE W/INJECTION AGMNTJ UNI||1883.73|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|31573|31573 - LARYNGOSCOPY FLEXIBLE THERAPEUTIC INJECTION UNI||486.44|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|31572|31572 - LARYNGOSCOPY FLEXIBLE ABLATJ DESTJ LESION(S) UNI||914.09|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|31554|31554 - LARYNGOPLASTY LARYNGEAL STEN W/STENT 12 YRS >||3054.92|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|31553|31553 - LARYNGOPLASTY LARYNGEAL STEN W/STENT < 12 YRS||2901.17|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|31552|31552 - LARYNGOPLASTY LARYNGEAL STEN W/O STENT 12 YRS >||2660.86|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|31551|31551 - LARYNGOPLASTY LARYNGEAL STEN W/O STENT < 12 YRS||2631.79|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|31298|31298 - NASAL/SINUS NDSC SURG W/DILATION FRNT&SPHN SINUS||6435.35|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|31259|31259 - NASAL/SINUS NDSC TOT W/SPHENDT W/SPHEN TISS RMVL||859.77|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|31257|31257 - NASAL/SINUS NDSC TOTAL WITH SPHENOIDOTOMY||810.87|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|31253|31253 - NASAL/SINUS NDSC TOT W/FRNT SINS EXPL TISS RMVL||911.26|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|31241|31241 - NASAL/SINUS NDSC W/LIG SPHENOPALATINE ARTERY||813.52|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|30901|30901 - CONTROL NASAL HEMORRHAGE ANTERIOR SIMPLE||165.4|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29916|29916 - ARTHROSCOPY HIP W/LABRAL REPAIR||1794.37|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29915|29915 - ARTHROSCOPY HIP W/ACETABULOPLASTY||1789.7|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29914|29914 - ARTHROSCOPY HIP W/FEMOROPLASTY||1756.73|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29907|29907 - ARTHROSCOPY SUBTALAR JOINT SUBTALAR ARTHRODESIS||1552.7|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29906|29906 - ARTHROSCOPY SUBTALAR JOINT WITH DEBRIDEMENT||1249.9|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29905|29905 - ARTHROSCOPY SUBTALAR JOINT WITH SYNOVECTOMY||1147.55|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29904|29904 - ARTHRS SUBTALAR JOINT REMOVE LOOSE/FOREIGN BODY||1129.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29902|29902 - ARTHRS MTCARPHLNGL JT W/RDCTJ UR COLTRL LIGM||857.66|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29901|29901 - ARTHRS METACARPOPHALANGEAL JOINT DEBRIDEMENT||920.25|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29900|29900 - ARTHROSCOPY METACARPOPHALANGEAL SYNOVIAL BIOPSY||736.9|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29899|29899 - ARTHROSCOPY ANKLE SURGICAL W/ANKLE ARTHRODESIS||1855.35|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29898|29898 - ARTHROSCOPY ANKLE SURGICAL DEBRIDEMENT EXTENSIVE||1004.85|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29897|29897 - ARTHROSCOPY ANKLE SURGICAL DEBRIDEMENT LIMITED||898.33|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29895|29895 - ARTHROSCOPY ANKLE SURGICAL SYNOVECTOMY PARTIAL||856.93|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29894|29894 - ARTHROSCOPY ANKLE W/REMOVAL LOOSE/FOREIGN BODY||888.62|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29893|29893 - ENDOSCOPIC PLANTAR FASCIOTOMY||1067.17|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29892|29892 - ARTHRS AID RPR LES/TALAR DOME FX/TIBL PLAFOND FX||1114|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29891|29891 - ARTHRS ANKLE EXC OSTCHNDRL DFCT W/DRLG DFCT||1202.8|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29889|29889 - ARTHRS AIDED PST CRUCIATE LIGM RPR/AGMNTJ/RCNSTJ||2172.17|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29888|29888 - ARTHRS AIDED ANT CRUCIATE LIGM RPR/AGMNTJ/RCNSTJ||1746.31|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29887|29887 - ARTHRS KNEE DRLG OSTEOCHOND DISSECANS INT FIXJ||1318.36|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29886|29886 - ARTHRS KNEE DRILLING OSTEOCHOND DISSECANS LESION||1125.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29885|29885 - ARTHRS KNEE DRILL OSTEOCHONDRITIS DISSECANS GRFG||1331.51|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29884|29884 - ARTHROSCOPY KNEE W/LYSIS ADHESIONS W/WO MANJ SPX||1082.03|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29883|29883 - ARTHROSCOPY KNEE W/MENISCUS RPR MEDIAL&LATERAL||1492.97|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29882|29882 - ARTHROSCOPY KNEE W/MENISCUS RPR MEDIAL/LATERAL||1238.53|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29881|29881 - ARTHRS KNE SURG W/MENISCECTOMY MED/LAT W/SHVG||952.88|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29880|29880 - ARTHRS KNEE W/MENISCECTOMY MED&LAT W/SHAVING||991.33|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29879|29879 - ARTHRS KNEE ABRASION ARTHRP/MLT DRLG/MICROFX||1170.5|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29877|29877 - ARTHRS KNEE DEBRIDEMENT/SHAVING ARTCLR CRTLG||1097.35|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29876|29876 - ARTHROSCOPY KNEE SYNOVECTOMY 2/>COMPARTMENTS||1162.76|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29875|29875 - ARTHROSCOPY KNEE SYNOVECTOMY LIMITED SPX||872.32|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29874|29874 - ARTHROSCOPY KNEE REMOVAL LOOSE/FOREIGN BODY||948.15|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29873|29873 - ARTHROSCOPY KNEE LATERAL RELEASE||919.8|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29871|29871 - ARTHROSCOPY KNEE INFECTION LAVAGE & DRAINAGE||905.9|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29870|29870 - ARTHROSCOPY KNEE DIAGNOSTIC W/WO SYNOVIAL BX SPX||1009.96|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29868|29868 - ARTHROSCOPY KNEE MENISCAL TRNSPLJ MED/LAT||2985.25|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29867|29867 - ARTHROSCOPY KNEE OSTEOCHONDRAL ALLOGRAFT||2273.44|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29866|29866 - ARTHROSCOPY KNEE OSTEOCHONDRAL AGRFT MOSAICPLAST||1861.04|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29863|29863 - ARTHROSCOPY HIP SURGICAL W/SYNOVECTOMY||1418.53|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29862|29862 - ARTHRS HIP DEBRIDEMENT/SHAVING ARTICULAR CRTLG||1422.02|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29861|29861 - ARTHROSCOPY HIP SURGICAL W/REMOVAL LOOSE/FB||1264.37|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29860|29860 - ARTHROSCOPY HIP DIAGNOSTIC W/WO SYNOVIAL BYP SPX||1179.32|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29856|29856 - ARTHRS AID TIBIAL FX PROX UNICONDYLAR BICONDYLAR||1769.49|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29855|29855 - ARTHRS AID TIBIAL FRACTURE PROXIMAL UNICONDYLAR||1387.46|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29851|29851 - ARTHROSCOPY AID TX SPINE&/FX KNEE W/FIXJ||1654.6|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29850|29850 - ARTHROSCOPY AID TX SPINE&/FX KNEE W/O FIXJ||1101.82|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29848|29848 - NDSC WRST SURG W/RLS TRANSVRS CARPL LIGM||894.01|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29847|29847 - ARTHROSCOPY WRIST SURG INT FIXJ FX/INSTABILITY||959.42|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29846|29846 - ARTHRS WRST EXC&/RPR TRIANG FIBROCART&/JOINT||912.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29845|29845 - ARTHROSCOPY WRIST SURGICAL SYNOVECTOMY COMPLETE||1011.26|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29844|29844 - ARTHROSCOPY WRIST SURGICAL SYNOVECTOMY PARTIAL||866.83|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29843|29843 - ARTHROSCOPY WRIST INFECTION LAVAGE&DRAINAGE||851.76|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29840|29840 - ARTHROSCOPY WRIST DIAG W/WO SYNOVIAL BIOPSY SPX||795.15|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29838|29838 - ARTHROSCOPY ELBOW SURGICAL DEBRIDEMENT EXTENSIVE||1031.72|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29837|29837 - ARTHROSCOPY ELBOW SURGICAL DEBRIDEMENT LIMITED||921.89|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29836|29836 - ARTHROSCOPY ELBOW SURGICAL SYNOVECTOMY COMPLETE||1018.53|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29835|29835 - ARTHROSCOPY ELBOW SURGICAL SYNOVECTOMY PARTIAL||886.82|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29834|29834 - ARTHROSCOPY ELBOW SURGICAL W/REMOVAL LOOSE/FB||852.86|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29830|29830 - ARTHROSCOPY ELBOW DIAG W/WO SYNOVIAL BIOPSY SPX||804.02|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29828|29828 - ARTHROSCOPY SHOULDER BICEPS TENODESIS||1606.66|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29827|29827 - ARTHROSCOPY SHOULDER ROTATOR CUFF REPAIR||1866.28|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29826|29826 - ARTHROSCOPY SHOULDER W/CORACOACRM LIGMNT RELEASE||965.98|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29825|29825 - ARTHROSCOPY SHOULDER AHESIOLYSIS W/WO MANIPJ||1016.55|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29824|29824 - ARTHROSCOPY SHOULDER DISTAL CLAVICULECTOMY||1172.66|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29823|29823 - ARTHROSCOPY SHOULDER SURG DEBRIDEMENT EXTENSIVE||1086.59|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29822|29822 - ARTHROSCOPY SHOULDER SURG DEBRIDEMENT LIMITED||996.7|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29821|29821 - ARTHROSCOPY SHOULDER SURG SYNOVECTOMY COMPLETE||1026.52|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29820|29820 - ARTHROSCOPY SHOULDER SURG SYNOVECTOMY PARTIAL||941.24|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29819|29819 - ARTHROSCOPY SHOULDER SURGICAL REMOVAL LOOSE/FB||1034.69|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29807|29807 - ARTHROSCOPY SHOULDER SURGICAL REPAIR SLAP LESION||1836.02|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29806|29806 - ARTHROSCOPY SHOULDER SURGICAL CAPSULORRHAPHY||1880.98|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29805|29805 - ARTHROSCOPY SHOULDER DX W/WO SYNOVIAL BIOPSY SPX||830.61|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29804|29804 - ARTHROSCOPY TEMPOROMANDIBULAR JOINT SURGICAL||1133.57|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29800|29800 - ARTHRS TEMPOROMANDIBULR JT DX W/WO SYNVAL BX SPX||912.62|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29750|29750 - WEDGING CLUBFOOT CAST||139.97|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29740|29740 - WEDGING CAST EXCEPT CLUBFOOT CASTS||132.41|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29730|29730 - WINDOWING CAST||90.67|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29720|29720 - REPAIR SPICA BODY CAST/JACKET||108.42|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29715|29715 - REMOVAL/REVISION OF CAST||122.84|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29710|29710 - RMVL/BIVALV SHO/HIP SPICA MINERVA/RISSER JACKET||164.22|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29705|29705 - REMOVAL/BIVALVING FULL ARM/FULL LEG CAST||92.96|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29700|29700 - REMOVAL/BIVALVING GAUNTLET BOOT/BODY CAST||86.66|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29581|29581 - APPL MLTLAYR COMPRES LEG BELOW KNEE W/ANKLE FOOT||136.5|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29580|29580 - STRAPPING UNNA BOOT||71.59|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29550|29550 - STRAPPING TOES||56.15|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29540|29540 - STRAPPING ANKLE &/FOOT||58.11|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29530|29530 - STRAPPING KNEE||73.94|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29520|29520 - STRAPPING HIP||73.23|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29515|29515 - APPLICATION SHORT LEG SPLINT CALF FOOT||95.45|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29505|29505 - APPLICATION LONG LEG SPLINT THIGH ANKLE/TOES||105.15|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29450|29450 - APPL CLUBFOOT CAST MOLDING/MANJ LONG/SHORT LEG||214.52|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29445|29445 - APPLICATION RIGID TOTAL CONTACT LEG CAST||206.45|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29440|29440 - ADDING WALKER PREVIOUSLY APPLIED CAST||72.86|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29435|29435 - APPLICATION PATELLAR TENDON BEARING CAST||161.5|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29425|29425 - APPLICATION SHORT LEG CAST WALKING/AMBULATORY||132.18|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29405|29405 - APPLICATION SHORT LEG CAST BELOW KNEE-TOE||122.35|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29365|29365 - APPLICATION CYLINDER CAST THIGH ANKLE||165.92|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29358|29358 - APPLICATION LONG LEG CAST BRACE||205.71|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29355|29355 - APPLICATION LONG LEG CAST WALKER/AMBULATORY TYPE||190.95|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29345|29345 - APPLICATION LONG LEG CAST THIGH-TOE||185.61|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29325|29325 - APPL HIP SPICA CAST ONE&ONE-HALF SPICA/BOTH LEGS||339.8|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29305|29305 - APPLICATION HIP SPICA CAST 1 LEG||314.67|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29280|29280 - STRAPPING HAND/FINGER||70.24|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29260|29260 - STRAPPING ELBOW/WRIST||72.14|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29240|29240 - STRAPPING SHOULDER||84.88|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29200|29200 - STRAPPING THORAX||74.46|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29131|29131 - APPLICATION FINGER SPLINT DYNAMIC||68.26|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29130|29130 - APPLICATION FINGER SPLINT STATIC||55.84|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29126|29126 - APPLICATION SHORT ARM SPLINT DYNAMIC||107.89|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29125|29125 - APPLICATION SHORT ARM SPLINT FOREARM-HAND STATIC||91.21|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29105|29105 - APPLICATION LONG ARM SPLINT SHOULDER HAND||119.1|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29086|29086 - APPLICATION CAST FINGER||94.76|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29085|29085 - APPLICATION CAST HAND & LOWER FOREARM GAUNTLET||126.29|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29075|29075 - APPLICATION CAST ELBOW FINGER SHORT ARM||118.97|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29065|29065 - APPLICATION CAST SHOULDER HAND LONG ARM||128.5|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29058|29058 - APPLICATION CAST PLASTER VELPEAU||216.81|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29055|29055 - APPLICATION CAST SHOULDER SPICA||382.73|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29049|29049 - APPLICATION CAST FIGURE-OF-8||127.98|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29046|29046 - APPLICATION BODY CAST SHOULDER HIPS BOTH THIGHS||410.04|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29044|29044 - APPLICATION BODY CAST SHOULDER HIPS W/ONE THIGH||444.17|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29040|29040 - APPLICATION BODY CAST SHOULDER HIPS HEAD MINERVA||380.3|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29035|29035 - APPLICATION BODY CAST SHOULDER HIPS||383.83|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29025|29025 - APPLICATION OF BODY CAST||475.85|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29020|29020 - APPLICATION OF BODY CAST||475.85|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29015|29015 - APPLICATION RISSER JACKET LOCALIZER BODY W/HEAD||475.85|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29010|29010 - APPLICATION RISSER JACKET LOCALIZER BODY ONLY||381.69|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|29000|29000 - APPLICATION HALO TYPE BODY CAST||522.05|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28825|28825 - AMPUTATION TOE INTERPHALANGEAL JOINT||944.15|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28820|28820 - AMPUTATION TOE METATARSOPHALANGEAL JOINT||990.16|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28810|28810 - AMPUTATION METATARSAL W/TOE SINGLE||770|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28805|28805 - AMPUTATION FOOT TRANSMETARSAL||1315.78|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28800|28800 - AMPUTATION FOOT MIDTARSAL||972.47|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28760|28760 - ARTHRD W/XTNSR HALLUCIS LONGUS TR 1ST METAR NCK||1389.29|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28755|28755 - ARTHRODESIS GREAT TOE INTERPHALANGEAL JOINT||885.65|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28750|28750 - ARTHRODESIS GREAT TOE METATARSOPHALANGEAL JOINT||1426.91|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28740|28740 - ARTHRODESIS MIDTARSOMETATARSAL SINGLE JOINT||1483.4|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28737|28737 - ARTHRD W/TDN LNGTH&ADVMNT TARSL NVCLR-CUNEIFOR||1232.53|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28735|28735 - ARTHRD MIDTARSL/TARS MLT/TRANSVRS W/OSTEOT||1390.52|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28730|28730 - ARTHRD MIDTARSL/TARSOMETATARSAL MULT/TRANSVRS||1295.6|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28725|28725 - ARTHRODESIS SUBTALAR||1377.56|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28715|28715 - ARTHRODESIS TRIPLE||1663.06|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28705|28705 - ARTHRODESIS PANTALAR||2243.45|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28675|28675 - OPEN TREATMENT INTERPHALANGEAL JOINT DISLOCATION||1029.55|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28666|28666 - PRQ SKEL FIXJ INTERPHALANGEAL JOINT DISLC W/MANJ||339.12|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28665|28665 - CLTX INTERPHALANGEAL JOINT DISLOCATION REQ ANES||271.69|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28660|28660 - CLTX INTERPHALANGEAL JOINT DISLOCATION W/O ANES||203.22|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28645|28645 - OPEN TX METATARSOPHALANGEAL JOINT DISLOCATION||1148.44|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28636|28636 - PRQ SKEL FIXJ METATARSOPHLNGL JT DISLC W/MANJ||605.57|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28635|28635 - CLTX METATARSOPHLNGL JT DISLC REQ ANES||299.54|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28630|28630 - CLTX METATARSOPHLNGL JT DISLC W/O ANES||272.59|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28615|28615 - OPEN TREATMENT TARSOMETATARSAL JOINT DISLOCATION||1391|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28606|28606 - PRQ SKEL FIXJ TARS JT DISLC W/MANJ||692.33|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28605|28605 - CLOSED TX TARSOMETATARSAL DISLOCATION W/ANES||566.24|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28600|28600 - CLOSED TX TARSOMETATARSAL DISLOCATION W/O ANES||374.96|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28585|28585 - OPEN TREATMENT TALOTARSAL JOINT DISLOCATION||1504.66|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28576|28576 - PRQ SKEL FIXJ TALOTARSAL JT DISLC W/MANJ||693.25|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28575|28575 - CLOSED TX TALOTARSAL JOINT DISLOCATION W/ANES||628.94|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28570|28570 - CLOSED TX TALOTARSAL JOINT DISLC W/O ANES||297.13|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28555|28555 - OPEN TREATMENT TARSAL BONE DISLOCATION||1545.16|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28546|28546 - PRQ SKEL FIXJ TARSL DISLC XCP TALOTARSAL W/MANJ||991.76|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28545|28545 - CLTX TARSAL DISLC OTH/THN TALOTARSAL W/ANES||511.42|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28540|28540 - CLTX TARSAL DISLC OTH/THN TALOTARSAL W/O ANES||335.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28531|28531 - OPEN TX SESAMOID FRACTURE W/WO INTERNAL FIXATION||591.35|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28530|28530 - CLOSED TREATMENT SESAMOID FRACTURE||199.76|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28525|28525 - OPEN TX FRACTURE PHALANX/PHALANGES NOT GREAT TOE||974.84|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28515|28515 - CLTX FX PHLX/PHLG OTH/THN GRT TOE W/MANJ||281.79|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28510|28510 - CLTX FX PHLX/PHLG OTH/THN GRT TOE W/O MANJ||214.69|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28505|28505 - OPEN TX FRACTURE GREAT TOE/PHALANX/PHALANGES||1182.8|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28496|28496 - PRQ SKEL FIXJ FX GRT TOE PHLX/PHLG W/MANJ||759.49|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28495|28495 - CLTX FX GRT TOE PHLX/PHLG W/MANJ||311.08|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28490|28490 - CLTX FX GRT TOE PHLX/PHLG W/O MANJ||250.74|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28485|28485 - OPEN TREATMENT METATARSAL FRACTURE EACH||929.84|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28476|28476 - PRQ SKEL FIXJ METAR FX W/MANJ||610.42|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28475|28475 - CLTX METAR FX W/MANJ||447.17|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28470|28470 - CLOSED TX METATARSAL FRACTURE W/O MANIPULATION||378.52|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28465|28465 - OPEN TX TARSAL FRACTURE XCP TALUS & CALCANEUS EA||1091.2|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28456|28456 - PRQ SKEL FIXJ TARSL FX XCP TALUS&CALCNS W/MANJ||552.67|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28455|28455 - TX TARSAL BONE FX XCP TALUS&CALCN W/MANJ||502.16|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28450|28450 - TX TARSAL BONE FX XCP TALUS&CALCN W/O MANJ||372.71|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28446|28446 - OPEN OSTEOCHONDRAL AUTOGRAFT TALUS||2175.32|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28445|28445 - OPEN TREATMENT TALUS FRACTURE||1895.4|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28436|28436 - PRQ SKELETAL FIXATION TALUS FRACTURE W/MANJ||784.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28435|28435 - CLOSED TX TALUS FRACTURE W/MANIPULATION||562.97|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28430|28430 - CLOSED TX TALUS FRACTURE W/O MANIPULATION||409.45|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28420|28420 - OPEN TREATMENT CALCANEAL FRACTURE W BONE GRAFT||2223.49|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28415|28415 - OPEN TREATMENT CALCANEAL FRACTURE||1962.16|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28406|28406 - PRQ SKELETAL FIXJ CALCANEAL FRACTURE W/MANJ||924.77|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28405|28405 - CLOSED TX CALCANEAL FRACTURE W/MANIPULATION||694.67|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28400|28400 - CLOSED TX CALCANEAL FRACTURE W/O MANIPULATION||429.21|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28345|28345 - RCNSTJ TOE SYNDACTYLY W/WO SKIN GRAFT EACH WEB||917.96|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28344|28344 - RECONSTRUCTION TOE POLYDACTYLY||959.99|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28341|28341 - RCNSTJ TOE MACRODACTYLY REQUIRING BONE RESECTION||1184.65|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28340|28340 - RCNSTJ TOE MACRODACTYLY SOFT TISSUE RESECTION||1019.11|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28322|28322 - RPR NON/MALUNION METARSAL W/WO BONE GRAFT||1383.07|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28320|28320 - REPAIR NONUNION/MALUNION TARSAL BONES||1079.21|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28315|28315 - SESAMOIDECTOMY FIRST TOE SPX||844.56|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28313|28313 - RCNSTJ ANGULAR DFRM TOE SOFT TISS PX ONLY||924.1|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28312|28312 - OSTEOT SHRT CORRJ OTH PHALANGES ANY TOE||901.85|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28310|28310 - OSTEOT SHRT CORRJ PROX PHALANX 1ST TOE||957.62|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28309|28309 - OSTEOT W/WO LNGTH SHRT/ANGULAR CORRJ METAR MLT||1621.33|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28308|28308 - OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST EA||984.96|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28307|28307 - OSTEOT W/WO LNGTH SHRT/CORRJ METAR XCP 1ST TOE||1236.67|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28306|28306 - OSTEOT W/WO LNGTH SHRT/CORRJ 1ST METAR||1071.58|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28305|28305 - OSTEOT TARSAL OTH/THN CALCANEUS/TALUS W/AGRFT||1162.62|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28304|28304 - OSTEOTOMY TARSAL BONES OTH/THN CALCANEUS/TALUS||1455.1|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28302|28302 - OSTEOTOMY TALUS||1264.45|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28300|28300 - OSTEOTOMY CALCANEUS W/WO INTERNAL FIXATION||1158.98|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28299|28299 - CORRJ HALLUX VALGUS W/SESMDC W/2 OSTEOT||1584.31|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28298|28298 - CORRJ HALLUX VALGUS W/SESMDC W/PROX PHLNX OSTEOT||1262.29|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28297|28297 - CORRJ HALLUX VALGUS W/SESMDC W/1METAR MEDIAL CNF||1424.36|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28296|28296 - CORRJ HALLUX VALGUS W/SESMDC W/DIST METAR OSTEOT||1252.64|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28295|28295 - CORRJ HALLUX VALGUS W/SESMDC W/PROX METAR OSTEOT||1750.65|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28292|28292 - CORRJ HALLUX VALGUS W/SESMDC W/RESCJ PROX PHAL||1385.75|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28291|28291 - HALLUX RIGIDUS W/CHEILECTOMY 1ST MP JT W/IMPLT||1365.64|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28289|28289 - HALLUX RIGIDUS W/CHEILECTOMY 1ST MP JT W/O IMPLT||1286.75|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28288|28288 - OSTC PRTL EXOSTC/CONDYLC METAR HEAD||1052.46|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28286|28286 - CORRECTION COCK-UP 5TH TOE W/PLASTIC CLOSURE||786.15|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28285|28285 - CORRECTION HAMMERTOE||935.26|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28280|28280 - SYNDACTYLIZATION TOES||899.06|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28272|28272 - CAPSULOTOMY IPHAL JOINT EACH JOINT SPX||689.76|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28270|28270 - CAPSUL MTTARPHLNGL JT W/WO TENORRHAPHY EA JT SPX||859.81|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28264|28264 - CAPSULOTOMY MIDTARSAL||1487.47|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28262|28262 - CAPSUL MIDFOOT W/PST TALOTIBL CAPSUL&TDN LNGTH||2587.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28261|28261 - CAPSULOTOMY MIDFOOT W/TENDON LENGTHENING||1762.52|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28260|28260 - CAPSULOTOMY MIDFOOT MEDIAL RELEASE ONLY SPX||1208.03|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28250|28250 - DIVISION PLANTAR FASCIA & MUSCLE SPX||1016.14|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28240|28240 - TENOTOMY LENGTHENING/RLS ABDUCTOR HALLUCIS MUSC||770.78|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28238|28238 - RCNSTJ PST TIBL TDN W/EXC ACCESSORY TARSL NAVCLR||1189.64|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28234|28234 - TENOTOMY OPEN EXTENSOR FOOT/TOE EACH TENDON||712.28|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28232|28232 - TX OPEN TENDON FLEXOR TOE 1 TENDON SPX||674.28|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28230|28230 - TX OPN TENDON FLEXOR FOOT SINGLE/MULT TENDON SPX||763.6|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28226|28226 - TENOLYSIS EXTENSOR FOOT MULTIPLE TENDON||770.83|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28225|28225 - TENOLYSIS EXTENSOR FOOT SINGLE TENDON||709.79|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28222|28222 - TENOLYSIS FLEXOR FOOT MULTIPLE TENDONS||882.67|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28220|28220 - TENOLYSIS FLEXOR FOOT SINGLE TENDON||788.89|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28210|28210 - RPR TENDON XTNSR FOOT SEC W/FREE GRAFT EA TENDON||1021.37|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28208|28208 - REPAIR TENDON EXTENSOR FOOT 1/2 EACH TENDON||827.98|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28202|28202 - RPR TENDON FLXR FOOT SEC W/FREE GRAFT EA TENDON||1041.88|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28200|28200 - RPR TDN FLXR FOOT 1/2 W/O FREE GRAFG EACH TENDON||852.75|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28193|28193 - REMOVAL FOREIGN BODY FOOT COMPLICATED||934.78|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28192|28192 - REMOVAL FOREIGN BODY FOOT DEEP||820.44|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28190|28190 - REMOVAL FOREIGN BODY FOOT SUBCUTANEOUS||443.48|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28175|28175 - RADICAL RESECTION TUMOR PHALANX OR TOE||873.65|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28173|28173 - RADICAL RESECTION TUMOR METATARSAL||1368.68|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28171|28171 - RAD RESCJ TUMOR TARSAL EXCEPT TALUS/CALCANEUS||1528.13|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28160|28160 - HEMIPHALANGECTOMY/INTERPHALANGEAL JOINT EXC TOE||734.87|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28153|28153 - RESECTION CONDYLE DISTAL END PHALANX EACH TOE||718.06|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28150|28150 - PHALANGECTOMY TOE EACH TOE||746.48|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28140|28140 - METATARSECTOMY||1047.08|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28130|28130 - TALECTOMY ASTRAGALECTOMY||1083.37|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28126|28126 - RESECTION PARTIAL/COMPLETE PHALANGEAL BASE EACH||688.52|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28124|28124 - PARTICAL EXCISION BONE PHALANX TOE||833.49|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28122|28122 - PRTL EXC B1 TARSAL/METAR B1 XCP TALUS/CALCANEUS||1050.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28120|28120 - PARTIAL EXCISION BONE TALUS/CALCANEUS||1184.85|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28119|28119 - OSTECTOMY CALCANEUS SPUR W/WO PLNTAR FASCIAL RLS||919.17|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28118|28118 - OSTECTOMY CALCANEUS||1037.52|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28116|28116 - OSTECTOMY TARSAL COALITION||1327.64|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28114|28114 - OSTC COMPL ALL METAR HEADS W/PRTL PROX PHALANGC||1893.71|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28113|28113 - OSTECTOMY COMPLETE 5TH METATARSAL HEAD||1039.09|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28112|28112 - OSTECTOMY COMPLETE OTHER METATARSAL HEAD 2/3/4||856.1|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28111|28111 - OSTECTOMY COMPLETE 1ST METATARSAL HEAD||866.5|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28110|28110 - OSTECTOMY PRTL 5TH METAR HEAD SPX||807.46|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28108|28108 - EXC/CURTG CST/B9 TUM PHALANGES FOOT||773.08|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28107|28107 - EXC/CURTG CST/B9 TUM TARSAL/METAR W/ALGRFT||904.55|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28106|28106 - EXC/CURTG CST/B9 TUM TARSAL/METAR W/ILIAC/AGRFT||764.57|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28104|28104 - EXC/CURTG BONE CYST/B9 TUMORTARSAL/METATARSAL||929.45|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28103|28103 - EXC/CURETTAGE CYST/TUMOR TALUS/CALCANEUS ALGRFT||697.9|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28102|28102 - EXC/CURTG CST/B9 TUM TALUS/CLCNS W/ILIAC/AGRFT||1068.7|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28100|28100 - EXCISION/CURETTAGE CYST/TUMOR TALUS/CALCANEUS||1064.65|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28092|28092 - EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT TOE EA||735.37|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28090|28090 - EXC LESION TENDON SHEATH/CAPSULE W/SYNVCT FOOT||821.84|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28088|28088 - SYNOVECTOMY TENDON SHEATH FOOT EXTENSOR||762.25|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28086|28086 - SYNOVECTOMY TENDON SHEATH FOOT FLEXOR||959.26|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28080|28080 - EXCISION INTERDIGITAL MORTON NEUROMA SINGLE EACH||916.33|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28072|28072 - SYNOVECTOMY METATARSOPHALANGEAL JOINT EACH||897.43|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28070|28070 - SYNVCT INTERTARSAL/TARSOMETATARSAL JT EA SPX||922.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28062|28062 - FASCIOTOMY PLANTAR FASCIA RADICAL SPX||1021.93|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28060|28060 - FASCIECTOMY PLANTAR FASCIA PARTIAL SPX||904.18|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28054|28054 - ARTHRTOMY W/BX INTERPHALANGEAL JOINT||653.72|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28052|28052 - ARTHRTOMY W/BX METATARSOPHALANGEAL JOINT||764.51|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28050|28050 - ARTHRT W/BX INTERTARSAL/TARSOMETATARSAL JOINT||835.87|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28046|28046 - RAD RESECTION TUMOR SOFT TISSUE FOOT/TOE <3CM||1304.77|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28045|28045 - EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC <1.5CM||865.53|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28043|28043 - EXCISION TUMOR SOFT TISSUE FOOT/TOE SUBQ <1.5CM||696.42|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28041|28041 - EXC TUMOR SOFT TISSUE FOOT/TOE SUBFASC 1.5 CM/>||813.82|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28039|28039 - EXCISION TUMOR SOFT TIS FOOT/TOE SUBQ 1.5 CM/>||889.24|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28035|28035 - RELEASE TARSAL TUNNEL||920.54|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28024|28024 - ARTHRT W/EXPL DRG/RMVL LOOSE/FB IPHAL JT||807.1|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28022|28022 - ARTHRT W/EXPL DRG/RMVL LOOSE/FB MTTARPHLNGL JT||854.37|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28020|28020 - ARTHRT W/EXPL DRG/RMVL LOOSE/FB NTRTRSL/TARS JT||950.27|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28011|28011 - TENOTOMY PERCUTANEOUS TOE MULTIPLE TENDON||567.72|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28010|28010 - TENOTOMY PERCUTANEOUS TOE SINGLE TENDON||407.32|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28008|28008 - FASCIOTOMY FOOT&/TOE||756.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28005|28005 - INCISION BONE CORTEX FOOT||1031.89|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28003|28003 - I&D BELOW FASCIA FOOT MULTIPLE AREAS||1243.98|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28002|28002 - I&D BELOW FASCIA FOOT 1 BURSAL SPACE||774.68|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|28001|28001 - INCISION&DRAINAGE BURSA FOOT||487.49|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27894|27894 - DCMPRN FASCT LEG ANT&/LAT&PST W/DBRDMT MUS||1533.82|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27893|27893 - DCMPRN FASCT LEG PST W/DBRDMT MUSC&/NRV||1073.21|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27892|27892 - DCMPRN FASCT LEG ANT&/LAT W/DBRDMT MUSC&/NERVE||969.95|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27889|27889 - ANKLE DISARTICULATION||1168.99|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27888|27888 - AMP ANKLE-MALLI TIBFIB W/PLSTC CLSR&RESCJ NRV||1226.7|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27886|27886 - AMP LEG THRU TIBIA&FIBULA RE-AMPUTATION||1182.62|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27884|27884 - AMP LEG THRU TIBIA&FIBULA SEC CLOSURE/SCAR REV||1033.58|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27882|27882 - AMPUTATION LEG THRU TIBIA&FIBULA OPEN CIRCULAR||1082.83|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27881|27881 - AMP LEG THRU TIBFIB W/IMMT FITG TQ W/1ST CST||1551.92|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27880|27880 - AMPUTATION LEG THROUGH TIBIA&FIBULA||1661.04|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27871|27871 - ARTHRODESIS TIBIOFIBULAR JOINT PROXIMAL/DISTAL||1210.16|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27870|27870 - ARTHRODESIS ANKLE OPEN||1832.04|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27860|27860 - MANIPULATION ANKLE UNDER GENERAL ANESTHESIA||305.89|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27848|27848 - OPTX ANKLE DISLOCATION W/REPAIR/INT/XTRNL FIXJ||1441.75|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27846|27846 - OPTX ANKLE DISLOCATION W/O REPAIR/INTERNAL FIXJ||1295.87|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27842|27842 - CLTX ANKLE DISLC REQ ANES W/WO PRQ SKEL FIXJ||872.96|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27840|27840 - CLOSED TX ANKLE DISLOCATION W/O ANESTHESIA||642.55|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27832|27832 - OPEN TX PROX TIBFIB JOINT DISLOCATE EXC PROX FIB||1335.33|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27830|27830 - CLTX PROX TIBFIB JT DISLC W/O ANES||652.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27829|27829 - OPEN TX DISTAL TIBIOFIBULAR JOINT DISRUPTION||1203.55|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27828|27828 - OPEN TREATMENT FRACTURE DISTAL TIBIA & FIBULA||2293.97|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27827|27827 - OPEN TREATMENT FRACTURE DISTAL TIBIA ONLY||1910.03|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27826|27826 - OPEN TREATMENT FRACTURE DISTAL TIBIA FIBULA||1466.42|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27825|27825 - CLTX FX W8 BRG ARTCLR PRTN DSTL TIB W/SKEL TRACJ||953.55|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27824|27824 - CLTX FX W8 BRG ARTCLR PRTN DSTL TIBIA W/O MANJ||540.49|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27823|27823 - OPEN TX TRIMALLEOLAR ANKLE FX W/FIXJ PST LIP||1689.35|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27822|27822 - OPEN TX TRIMALLEOLAR ANKLE FX W/O FIXJ PST LIP||1480.52|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27818|27818 - CLTX TRIMALLEOLAR ANKLE FX W/MANIPULATION||841.09|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27816|27816 - CLTX TRIMALLEOLAR ANKLE FX W/O MANIPULATION||552.85|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27814|27814 - OPEN TREATMENT BIMALLEOLAR ANKLE FRACTURE||1364.42|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27810|27810 - CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/MANJ||812.5|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27808|27808 - CLOSED TX BIMALLEOLAR ANKLE FRACTURE W/O MANJ||574.11|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27792|27792 - OPEN TX DISTAL FIBULAR FRACTURE LAT MALLEOLUS||1152.63|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27788|27788 - CLTX DSTL FIBULAR FX LAT MALLS W/MANJ||730.1|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27786|27786 - CLTX DSTL FIBULAR FX LAT MALLS W/O MANJ||544.97|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27784|27784 - OPEN TREATMENT PROXIMAL FIBULA/SHAFT FRACTURE||1265.13|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27781|27781 - CLTX PROX FIBULA/SHFT FX W/MANJ||734.44|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27780|27780 - CLTX PROX FIBULA/SHFT FX W/O MANJ||525.69|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27769|27769 - OPEN TREATMENT POSTERIOR MALLEOLUS FRACTURE||1282.79|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27768|27768 - CLOSED TREATMENT PST MALLEOLUS FRACTURE W/MANJ||770.08|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27767|27767 - CLOSED TREATMENT PST MALLEOLUS FRACTURE W/O MANJ||484.9|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27766|27766 - OPEN TREATMENT MEDIAL MALLEOLUS FRACTURE||1077.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27762|27762 - CLTX MEDIAL MALLS FX W/MANJ W/WO SKN/SKEL TRACJ||823.95|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27760|27760 - CLTX MEDIAL MALLEOLUS FX W/O MANIPULATION||574.13|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27759|27759 - TX TIBL SHFT FX IMED IMPLT W/WO SCREWS&/CERCLA||1769.99|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27758|27758 - OPTX TIBIAL SHFT FX W/PLATE/SCREWS W/WO CERCLAGE||1577.12|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27756|27756 - PRQ SKELETAL FIXATION TIBIAL SHAFT FRACTURE||1014.98|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27752|27752 - CLTX TIBIAL SHAFT FX W/MANJ W/WO SKEL TRACJ||936.25|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27750|27750 - CLTX TIBIAL SHAFT FX W/O MANIPULATION||597.89|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27745|27745 - PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE TIBIA||1340.89|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27732|27732 - ARREST EPIPHYSEAL OPEN DISTAL FIBULA||783.81|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27726|27726 - REPAIR FIBULA NONUNION/MALUNION W/INT FIXATION||1715.76|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27725|27725 - RPR NON/MAL TIBIA SYNOSTOSIS W/FIBULA ANY METH||2165.78|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27724|27724 - RPR NON/MAL TIBIA W/ILIAC/OTH AGRFT||2255.02|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27722|27722 - REPAIR NONUNION/MALUNION TIBIA W/SLIDING GRAFT||1576.57|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27720|27720 - REPAIR NONUNION/MALUNION TIBIA W/O GRAFT||1548.59|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27715|27715 - OSTEOPLASTY TIBIA & FIBULA LENGTHENING/SHORTENIN||1865.93|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27712|27712 - OSTEOT MLT W/RELIGNMT IMED ROD||1961.98|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27709|27709 - OSTEOTOMY TIBIA & FIBULA||2084.78|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27707|27707 - OSTEOTOMY FIBULA||704.88|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27705|27705 - OSTEOTOMY TIBIA||1330.49|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27704|27704 - REMOVAL ANKLE IMPLANT||1016.17|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27702|27702 - ARTHROPLASTY ANKLE W/IMPLANT||1722.04|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27700|27700 - ARTHROPLASTY ANKLE||1037.9|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27698|27698 - REPAIR SECONDARY DISRUPTED LIGAMENT ANKLE COLTRL||1132.6|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27696|27696 - RPR PRIM DISRUPTED LIGM ANKLE BTH COLTRL LIGMS||977.47|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27695|27695 - RPR PRIMARY DISRUPTED LIGAMENT ANKLE COLLATERAL||840.71|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27692|27692 - TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING EA TDN||187.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27691|27691 - TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING DP||1325.68|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27690|27690 - TR/TRNSPL 1 TDN W/MUSC REDIRION/REROUTING SUPFC||1112.2|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27687|27687 - GASTROCNEMIUS RECESSION||803.92|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27686|27686 - LNGTH/SHRT TDN LEG/ANKLE MLT TDN SAME INC EA||994.25|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27685|27685 - LNGTH/SHRT TENDON LEG/ANKLE 1 TENDON SPX||1149.37|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27681|27681 - TNOLS FLXR/XTNSR TDN LEG&/ANKLE MLT TDN||962.37|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27680|27680 - TENOLYSIS FLXR/XTNSR TENDON LEG&/ANKLE 1 EACH||759.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27676|27676 - REPAIR DISLOCATING PERONEAL TENDON W/FIB OSTEOT||1048.3|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27675|27675 - RPR DISLOC PERONEAL TENDON W/O FIBULAR OSTEOTOMY||854.24|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27665|27665 - RPR EXTENSOR TENDON LEG SECONDRY W/WO GRAFT EACH||720.47|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27664|27664 - RPR EXTENSOR TENDON LEG PRIMARY W/O GRAFT EACH||638.78|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27659|27659 - RPR FLEXOR TENDON LEG SECONDARY W/O GRAFT EACH||848.56|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27658|27658 - REPAIR FLEXOR TENDON LEG PRIMARY W/O GRAFT EACH||658.78|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27656|27656 - REPAIR FASCIAL DEFECT LEG||1090.53|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27654|27654 - REPAIR SECONDARY ACHILLES TENDON W/WO GRAFT||1253.16|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27652|27652 - RPR PRIMARY OPEN/PRQ RUPTURED ACHILLES W/GRAFT||1219.9|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27650|27650 - REPAIR PRIMARY OPEN/PRQ RUPTURED ACHILLES TENDON||1163.12|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27648|27648 - INJECTION ANKLE ARTHROGRAPHY||274.95|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27647|27647 - RADICAL RESECTION OF TUMOR TALUS OR CALCANEUS||1848.76|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27646|27646 - RADICAL RESECTION TUMOR BONE FIBULA||2754.14|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27645|27645 - RADICAL RESECTION OF TUMOR TIBIA||3178.28|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27641|27641 - PARTIAL EXCISION BONE FIBULA||1184.76|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27640|27640 - PARTIAL EXCISION BONE TIBIA||1483.24|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27638|27638 - EXC/CURETTAGE CYST/TUMOR TIBIA/FIBULA W/ALGRAFT||1375.06|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27637|27637 - EXC/CURETTAGE CYST/TUMOR TIBIA/FIBULA W/AGRAFT||1349.05|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27635|27635 - EXCISION/CURETTAGE BONE CYST/TUMOR TIBIA/FIBULA||1036.8|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27632|27632 - EXCISION TUMOR SOFT TISSUE LEG/ANKLE SUBQ 3 CM/>||732.13|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27630|27630 - EXCISION LESION TENDON SHEATH/CAPSULE LEG&/ANK||966.37|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27626|27626 - ARTHROTOMY W/SYNOVECTOMY ANKLE TENOSYNOVECTOMY||1092.04|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27625|27625 - ARTHROTOMY W/SYNOVECTOMY ANKLE||1032.77|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27620|27620 - ARTHRT ANKLE W/EXPL W/WO BX W/WO RMVL LOOSE/FB||807.48|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27619|27619 - EXC TUMOR SOFT TISSUE LEG/ANKLE SUBFASCIAL <5CM||835.74|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27618|27618 - EXC TUMOR SOFT TISSUE LEG/ANKLE SUBQ <3CM||775.06|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27616|27616 - RAD RESECTION TUMOR SOFT TISSUE LEG/ANKLE 5 CM/>||2256.61|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27615|27615 - RAD RESECTION TUMOR SOFT TISSUE LEG/ANKLE <5CM||1813.25|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27614|27614 - BIOPSY SOFT TISSUE LEG/ANKLE AREA DEEP||991.22|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27613|27613 - BIOPSY SOFT TISSUE LEG/ANKLE AREA SUPERFICIAL||429.77|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27612|27612 - ARTHRT PST CAPSUL RLS ANKLE W/WO ACHLL TDN LNGTH||998.53|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27610|27610 - ARTHROTOMY ANKLE W/EXPL DRAINAGE/REMOVAL FB||1151.62|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27607|27607 - INCISION LEG/ANKLE||1079.66|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27606|27606 - TENOTOMY PRQ ACHILLES TENDON SPX GENERAL ANES||505.51|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27605|27605 - TENOTOMY PRQ ACHILLES TENDON SPX LOCAL ANES||584.37|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27604|27604 - INCISION & DRAINAGE LEG/ANKLE INFECTED BURSA||846.05|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27603|27603 - INCISION & DRAINAGE LEG/ANKLE ABSCESS/HEMATOMA||916.02|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27602|27602 - DCMPRN FASCT LEG ANT&/LAT&PST CMPRT||880.25|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27601|27601 - DCMPRN FASCT LEG POST COMPARTMENT ONLY||790.04|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27600|27600 - DCMPRN FASCT LEG ANT&/LAT COMPARTMENTS ONLY||735.25|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27598|27598 - DISARTICULATION KNEE||1288.22|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27596|27596 - AMPUTATION THIGH THROUGH FEMUR RE-AMPUTATION||1291.03|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27594|27594 - AMP THIGH THRU FEMUR SEC CLOSURE/SCAR REVISION||900.59|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27592|27592 - AMPUTATION THIGH THRU FEMUR OPEN CIRCULAR||1229.67|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27591|27591 - AMP THI THRU FEMUR LVL IMMT FITG TQ W/1ST CST||1714.32|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27590|27590 - AMPUTATION THIGH THROUGH FEMUR ANY LEVEL||1450.8|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27580|27580 - ARTHRODESIS KNEE ANY TECHNIQUE||2547.11|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27570|27570 - MANIPULATION KNEE JOINT UNDER GENERAL ANESTHESIA||264.76|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27566|27566 - OPTX PATELLAR DISLC W/WO PRTL/TOT PATELLECTOMY||1582.94|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27562|27562 - CLOSED TX PATELLAR DISLOCATION W/ANESTHESIA||848.3|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27560|27560 - CLOSED TX PATELLAR DISLOCATION W/O ANESTHESIA||623.47|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27558|27558 - OPEN TX KNEE DISLOCATION W/REPAIR/RECONSTRUCTION||2132.14|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27557|27557 - OPEN TX KNEE DISLOCATION W/LIGAMENTOUS REPAIR||1866.82|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27556|27556 - OPEN TX KNEE DISLOCATION W/O LIGAMENTOUS REPAIR||1558.69|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27552|27552 - CLOSED TX KNEE DISLOCATION W/ANESTHESIA||1100.03|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27550|27550 - CLOSED TX KNEE DISLOCATION W/O ANESTHESIA||877.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27540|27540 - OPEN TX INTERCONDYLAR SPINE/TUBRST FRACTURE KNEE||1434.04|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27538|27538 - CLTX INTERCONDYLAR SPI&/TUBRST FX KNE W/WO MAN||823.21|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27536|27536 - OPTX TIBIAL FX PROX BICONDYLAR W/WO INT FIXJ||2112.7|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27535|27535 - OPEN TX TIBIAL FRACTURE PROXIMAL UNICONDYLAR||1593.92|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27532|27532 - CLTX TIBIAL FX PROXIMAL W/WO MANJ W/SKEL TRACJ||1080.79|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27530|27530 - CLTX TIBIAL FX PROXIMAL W/O MANIPULATION||518.71|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27524|27524 - OPTX PATLLR FX W/INT FIXJ/PATLLC&SOFT TISS RPR||1330.22|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27520|27520 - CLOSED TX PATELLAR FRACTURE W/O MANIPULATION||556.16|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27519|27519 - OPEN TX DISTAL FEMORAL EPIPHYSEAL SEPARATION||1586.5|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27517|27517 - CLTX DSTL FEM EPIPHYSL SEP W/MANJ W/WO SKIN/SKEL||1209.78|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27516|27516 - CLTX DISTAL FEMORAL EPIPHYSL SEPARATION W/O MANJ||885.85|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27514|27514 - OPEN TX FEMORAL FRACTURE DISTAL MED/LAT CONDYLE||1719.81|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27513|27513 - OPEN TX FEMORAL SUPRACONDYLAR FRACTURE W/XTN||2212.18|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27511|27511 - OPEN TX FEMORAL SUPRACONDYLAR FRACTURE W/O XTN||1773.76|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27510|27510 - CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/MANJ||1208.97|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27509|27509 - PRQ SKELETAL FIXJ FEMORAL FX DISTAL END||1129.43|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27508|27508 - CLTX FEM FX DSTL END MEDIAL/LAT CONDYLE W/O MANJ||916.02|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27507|27507 - OPTX FEM SHFT FX W/PLATE/SCREWS W/WO CERCLAGE||1727.15|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27506|27506 - OPTX FEM SHFT FX W/INSJ IMED IMPLT W/WO SCREW||2375.89|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27503|27503 - CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/MANJ||1417.57|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27502|27502 - CLTX FEM SHFT FX W/MANJ W/WO SKIN/SKELETAL TRACJ||1357.06|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27501|27501 - CLTX SPRCNDYLR/TRNSCNDYLR FEM FX W/O MANJ||882.79|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27500|27500 - CLOSED TX FEMORAL SHAFT FX W/O MANIPULATION||909.13|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27498|27498 - DCMPRN FASCIOTOMY THIGH&/KNEE MLT COMPARTMENTS||1154.41|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27496|27496 - DECOMPRESSION FASCIOTOMY THIGH&/KNEE 1 COMPONENT||955.35|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27495|27495 - PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE FEMUR||2001.26|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27488|27488 - RMVL PROSTH TOT KNEE PROSTH MMA W/WO INSJ SPACER||2131.51|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27487|27487 - REVJ TOT KNEE ARTHRP FEM&ENTIRE TIBIAL COMPONE||3131.57|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27486|27486 - REVJ TOTAL KNEE ARTHRP W/WO ALGRFT 1 COMPONENT||2500.69|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27485|27485 - ARRST HEMIEPIPHYSL DSTL FEMUR/PROX TIBIA/FIBULA||1184.26|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27479|27479 - ARRST EPIPHYSL CMBN DSTL FEMUR PROX TIBFIB||1632.44|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27477|27477 - ARREST EPIPHYSEAL TIBIA & FIBULA PROXIMAL||1296.16|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27475|27475 - ARREST EPIPHYSEAL DISTAL FEMUR||1167.82|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27472|27472 - RPR NON/MAL FEMUR DSTL H/N W/ILIAC/AUTOG BONE||2246.49|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27470|27470 - RPR NON/MAL FEMUR DSTL H/N W/O GRF||2085.44|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27466|27466 - OSTEOPLASTY FEMUR LENGTHENING||2104.45|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27465|27465 - OSTEOPLASTY FEMUR SHORTENING EXCLUDING 64876||2221.33|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27457|27457 - OSTEOT PROX TIBIA FIB EXC/OSTEOT AFTER EPIPHYSL||1704.46|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27455|27455 - OSTEOT PROX TIBIA FIB EXC/OSTEOT BEFORE EPIPHYSL||1669.81|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27454|27454 - OSTEOT MLT W/RELIGNMT IMED ROD FEM SHFT||2312.3|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27450|27450 - OSTEOTOMY FEMUR SHAFT/SUPRACONDYLAR W/FIXATION||1787.9|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27448|27448 - OSTEOTOMY FEMUR SHAFT/SUPRACONDYLAR W/O FIXATION||1357.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27447|27447 - ARTHRP KNE CONDYLE&PLATU MEDIAL&LAT COMPARTMENTS||2414.32|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27446|27446 - ARTHRP KNEE CONDYLE&PLATEAU MEDIAL/LAT CMPRT||2062.1|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27445|27445 - ARTHROPLASTY KNEE HINGE PROSTHESIS||2225.74|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27443|27443 - ARTHRP FEM CONDYLES/TIBL PLATU KNE DBRDMT&PRTL||1444.68|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27442|27442 - ARTHROPLASTY FEM CONDYLES/TIBIAL PLATEAU KNEE||1538.21|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27441|27441 - ARTHRP KNEE TIBIAL PLATEAU DBRDMT&PRTL SYNVCT||1458.92|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27440|27440 - ARTHROPLASTY KNEE TIBIAL PLATEAU||1411.18|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27438|27438 - ARTHROPLASTY PATELLA W/PROSTHESIS||1486.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27437|27437 - ARTHROPLASTY PATELLA W/O PROSTHESIS||1166.65|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27435|27435 - CAPSULOTOMY POSTERIOR CAPSULAR RELEASE KNEE||1420.22|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27430|27430 - QUADRICEPSPLASTY||1299.73|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27429|27429 - LIGMOUS RCNSTJ AGMNTJ KNE INTRA-ARTICULAR XTR||2216.65|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27428|27428 - LIGAMENTOUS RECONSTRUCTION KNEE INTRA-ARTICULAR||1972.87|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27427|27427 - LIGAMENTOUS RECONSTRUCTION KNEE EXTRA-ARTICULAR||1259.51|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27425|27425 - LATERAL RETINACULAR RELEASE OPEN||784.51|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27424|27424 - RCNSTJ DISLC PATELLA W/PATELLECTOMY||1321.83|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27422|27422 - RCNSTJ DISLC PATELLA W/XTNSR RELIGNMT&/MUSC RL||1310.54|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27420|27420 - RCNSTJ DISLOCATING PATELLA||1305.65|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27418|27418 - ANTERIOR TIBIAL TUBERCLEPLASTY||1461.01|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27416|27416 - OSTEOCHONDRAL AUTOGRAFT KNEE OPEN MOSAICPLASTY||1739.03|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27415|27415 - OSTEOCHONDRAL ALLOGRAFT KNEE OPEN||2443.95|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27412|27412 - AUTOLOGOUS CHONDROCYTE IMPLANTATION KNEE||2945.65|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27409|27409 - RPR 1 TORN LIGM&/CAPSL KNE COLTRL&CRUCIATE||1709.32|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27407|27407 - REPAIR PRIMARY TORN LIGM&/CAPSULE KNEE CRUCIAT||1399.72|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27405|27405 - RPR PRIMARY TORN LIGM&/CAPSULE KNEE COLLATERAL||1192.05|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27403|27403 - ARTHROTOMY W/MENISCUS REPAIR KNEE||1129.12|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27400|27400 - TRANSFER TENDON/MUSCLE HAMSTRINGS FEMUR||1226.29|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27396|27396 - TRANSPLANT/TRANSFER THIGH XTNSR TO FLXR 1 TENDON||1084.75|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27395|27395 - LENGTHENING HAMSTRING TENDON MULTIPLE BILATERAL||1553.67|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27394|27394 - LENGTHENING HAMSTRING TENDON MULTIPLE 1 LEG||1146.51|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27393|27393 - LENGTHENING HAMSTRING TENDON SINGLE||896.53|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27392|27392 - TENOTOMY OPEN HAMSTRING KNEE HIP MULTIPLE BI||1257.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27391|27391 - TENOTOMY OPN HAMSTRING KNEE HIP MULTIPLE 1 LEG||1015.27|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27390|27390 - TENOTOMY OPEN HAMSTRING KNEE HIP SINGLE TENDON||786.02|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27386|27386 - SUTR QUADRICEPS/HAMSTRING MUSC RPT RCNSTJ||1459.08|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27385|27385 - SUTURE QUADRICEPS/HAMSTRING RUPTURE PRIMARY||1005.16|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27381|27381 - SUTR INFRAPATELLAR TDN 2 RCNSTJ W/FSCAL/TDN GRF||1401.98|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27380|27380 - SUTURE INFRAPATELLAR TENDON PRIMARY||1041.16|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27372|27372 - REMOVAL FOREIGN BODY DEEP THIGH/KNEE||1044.97|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27370|27370 - INJECTION KNEE ARTHROGRAPHY||262.15|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27365|27365 - RADICAL RESECTION TUMOR FEMOR OR KNEE||3687.44|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27360|27360 - PRTL EXC BONE FEMUR PROX TIBIA&/FIBULA||1500.23|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27358|27358 - EXCISION/CURETTAGE CYST/TUMOR FEMUR INT FIXATION||502.79|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27357|27357 - EXCISION/CURETTAGE CYST/TUMOR FEMUR W/AUTOGRAFT||1435.46|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27356|27356 - EXCISION/CURETTAGE CYST/TUMOR FEMUR W/ALLOGRAFT||1303.97|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27355|27355 - EXCISION/CURETTAGE CYST/TUMOR FEMUR||1062.23|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27350|27350 - PATELLECTOMY/HEMIPATELLECTOMY||1146.24|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27347|27347 - EXCISION LESION MENISCUS/CAPSULE KNEE||928.24|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27345|27345 - EXCISION SYNOVIAL CYST POPLITEAL SPACE||843.79|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27340|27340 - EXCISION PREPATELLAR BURSA||648.36|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27339|27339 - EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC 5 CM/>||1335.28|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27337|27337 - EXCISON TUMOR SOFT TISSUE THIGH/KNEE SUBQ 3 CM/>||737.39|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27335|27335 - ARTHRT W/SYNVCT KNE ANT&POST W/POP AREA||1347.68|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27334|27334 - ARTHROTOMY W/SYNOVECTOMY KNEE ANTERIOR/POSTERIOR||1204.97|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27333|27333 - ARTHRT W/EXC SEMILUNAR CRTLG KNEE MEDIAL&LAT||1030.21|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27332|27332 - ARTHRT W/EXC SEMILUNAR CRTLG KNEE MEDIAL/LAT||1132.15|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27331|27331 - ARTHRT KNE W/JT EXPL BX/RMVL LOOSE/FB||834.61|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27330|27330 - ARTHROTOMY KNEE W/SYNOVIAL BIOPSY ONLY||727.43|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27329|27329 - RAD RESECT TUMOR SOFT TISSUE THIGH/KNEE <5CM||1838.32|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27328|27328 - EXC TUMOR SOFT TISSUE THIGH/KNEE SUBFASC <5CM||1098.13|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27327|27327 - EXCISION TUMOR SOFT TISSUE THIGH/KNEE SUBQ <3CM||789.03|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27326|27326 - NEURECTOMY POPLITEAL||901.55|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27325|27325 - NEURECTOMY HAMSTRING MUSCLE||900.04|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27324|27324 - BIOPSY SOFT TISSUE THIGH/KNEE AREA DEEP||695.59|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27323|27323 - BIOPSY SOFT TISSUE THIGH/KNEE AREA SUPERFICIAL||461.92|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27310|27310 - ARTHRT KNE W/EXPL DRG/RMVL FB||1289.41|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27307|27307 - TENOTOMY PRQ ADDUCTOR/HAMSTRING MULTIPLE TENDON||842.44|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27306|27306 - TENOTOMY PRQ ADDUCTOR/HAMSTRING 1 TENDON SPX||630.68|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27305|27305 - FASCIOTOMY ILIOTIBIAL OPEN||844.94|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27303|27303 - INC DEEP W/OPNG BONE CORTEX FEMUR/KNEE||1122.21|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27301|27301 - I&D DEEP ABSC BURSA/HEMATOMA THIGH/KNEE REGION||1145.48|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27295|27295 - DISARTICULATION HIP||2242.85|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27290|27290 - INTERPELVIABDOMINAL AMPUTATION||2896.72|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27286|27286 - ARTHRD HIP JT W/OBTG GRF W/SUBTRCHNTRIC OSTEOT||2949.66|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27284|27284 - ARTHRODESIS HIP JOINT W/OBTAINING GRAFT||2734.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27282|27282 - ARTHRODESIS SYMPHYSIS PUBIS W/OBTAINING GRAFT||1328.4|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27280|27280 - ARTHRODESIS SACROILIAC JOINT W/OBTAINING GRAFT||1908.31|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27275|27275 - MANIPULATION HIP JOINT GENERAL ANESTHESIA||320.58|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27269|27269 - OPEN TX FEMORAL FRACTURE PROXIMAL END HEAD||2215.04|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27268|27268 - CLOSED TX FEMORAL FRACTURE PROX HEAD W/MANJ||948.87|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27267|27267 - CLOSED TX FEMORAL FRACTURE PROX HEAD W/O MANJ||759.06|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27266|27266 - CLTX POST HIP ARTHRP DISLC REQ ANES||1024.74|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27265|27265 - CLTX POST HIP ARTHRP DISLC W/O ANES||696.22|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27258|27258 - OPTX SPON HIP DISLC RPLCMT FEM HEAD ACTBLM||1971.59|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27257|27257 - TX SPON HIP DISLC ABDCT SPLNT/TRCJ W/MANJ ANES||608.22|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27256|27256 - TX SPONTAN HIP DISLC ABDCT SPLNT/TRCJ W/O ANES||531.18|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27254|27254 - OPTX HIP DISLC TRAUMTC W/ACTBLR WALL&FEM HEAD||2263.1|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27253|27253 - OPTX HIP DISLOCATION TRAUMATIC W/O INTERNAL FIXJ||1667.14|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27252|27252 - CLTX HIP DISLOCATION TRAUMATIC REQ ANESTHESIA||1346.8|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27250|27250 - CLTX HIP DISLOCATION TRAUMATIC W/O ANESTHESIA||329.27|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27248|27248 - OPEN TREATMENT GREATER TROCHANTERIC FRACTURE||1317.8|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27246|27246 - CLTX GREATER TROCHANTERIC FX W/O MANJ||674.41|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27245|27245 - TX INTER/PR/SUBTRCHNTRIC FEM FX IMED IMPLTSCREW||2187.11|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27244|27244 - TX INTER/PR/SUBTRCHNTRIC FEMORAL FX SCREW IMPLT||2187.68|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27240|27240 - CLTX INTR/PERI/SBTRCHNTC FEMORAL FX W/MANJ||1696|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27238|27238 - CLTX INTER/PERI/SUBTROCHANTERIC FEM FX W/O MANJ||806.06|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27236|27236 - OPTX FEM FX PROX END NCK INT FIXJ/PROSTC RPLCMT||2124.61|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27235|27235 - PRQ SKEL FIXJ FEMORAL FX PROX END NECK||1611.59|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27232|27232 - CLTX FEM FX PROX END NCK W/MANJ W/WO SKEL TRACJ||1341.41|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27230|27230 - CLTX FEM FX PROX END NCK W/O MANJ||829.71|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27228|27228 - OPTX ACTBLR FX INVG ANT&POST 2 COLUMNS FX W/INT||3375.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27227|27227 - OPTX ACTBLR FX INVG ANT/PST 1 COLUMN/FX W/INT||2958.16|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27226|27226 - OPTX PST/ANT ACTBLR WALL FX W/INT FIXJ||1879.15|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27222|27222 - CLTX ACETABULM HIP/SOCKT FX MANJ W/WO SKEL TRACJ||1732.88|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27220|27220 - CLTX ACETABULUM HIP/SOCKT FX W/O MANJ||930.65|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27200|27200 - CLOSED TREATMENT COCCYGEAL FRACTURE||312.7|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27198|27198 - CLSD TX PELVIC RING FX W/MANIPULATION W/ANES||551.68|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27197|27197 - CLSD TX PELVIC RING FX W/O MANIPULATION||216.41|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27187|27187 - PROPH TX N/P/PLTWR W/WO MMA FEM NCK & PROX FEMUR||1756.91|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27185|27185 - EPIPHYSL ARRST EPIPHYSIOD/STAPLING TRCHNTR FEMUR||1041.64|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27181|27181 - OPTX SLP FEM EPIPHYSIS OSTEOT&INT FIXJ||1993.68|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27179|27179 - OPTX SLP FEM EPIPHYSIS OSTPL FEM NCK HEYMAN PX||1730.81|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27178|27178 - OPTX SLP FEM EPIPHYSIS CLSD MANJ SINGL/MLTPL PIN||1625.62|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27177|27177 - OPTX SLP FEM EPIPHYSIS SINGLE/MULT PIN/BONE GRFT||1977.39|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27176|27176 - TX SLP FEM EPIPHYSIS SINGLE/MULTIPL PINNING SITU||1625.62|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27175|27175 - TX SLP FEMORAL EPIPHYSIS TRCJ W/O REDUCTION||1181.25|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27170|27170 - B1 GRF FEM H/N INTERTRCHNTRIC/SUBTRCHNTRIC AREA||2093.8|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27165|27165 - OSTEOT INTERTRCHNTRIC/SUBTRCHNTRIC W/INT/XTRNL||2435.9|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27161|27161 - OSTEOTOMY FEMORAL NECK SEPARATE PROCEDURE||2159.01|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27158|27158 - OSTEOTOMY PELVIS BILATERAL||2498.51|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27156|27156 - OSTEOT ILIAC ACTBLR/INNOMINATE BONE OSTEOT RDCTJ||3061.91|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27151|27151 - OSTEOTOMY ILIAC ACETABULAR/INNOMINATE FEM OSTEOT||2838.06|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27147|27147 - OSTEOTOMY ILIAC ACETABULAR/INNOMINATE HIP RDCTJ||2620.44|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27146|27146 - OSTEOTOMY ILIAC ACETABULAR/INNOMINATE BONE||2279.25|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27140|27140 - OSTEOTOMY&TRANSFER GREATER TROCHANTER SPX||1589.22|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27138|27138 - REVJ TOT HIP ARTHRP FEM ONLY W/WO ALGRFT||2727.63|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27137|27137 - REVJ TOT HIP ARTHRP ACTBLR W/WO AGRFT/ALGRFT||2625.08|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27134|27134 - REVJ TOT HIP ARTHRP BTH W/WO AGRFT/ALGRFT||3420.54|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27132|27132 - CONV PREV HIP TOT HIP ARTHRP W/WO AGRFT/ALGRFT||2983.81|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27130|27130 - ARTHRP ACETBLR/PROX FEM PROSTC AGRFT/ALGRFT||2414.9|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27125|27125 - HEMIARTHROPLASTY HIP PARTIAL||2012.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27122|27122 - ACETABULOPLASTY RESECTION FEMORAL HEAD||1947.69|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27120|27120 - ACETABULOPLASTY||2313.41|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27110|27110 - TRANSFER ILIOPSOAS GREATER TROCHANTER FEMUR||1715.53|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27100|27100 - TR XTRNL OBLQ MUSC TRCHNTR W/FSCAL/TDN XTN GRF||1458.83|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27097|27097 - RELEASE/RECESSION HAMSTRING PROXIMAL||1203.79|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27096|27096 - INJECT SI JOINT ARTHRGRPHY&/ANES/STEROID W/IMA||274.86|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27095|27095 - INJECTION HIP ARTHROGRAPHY W/ANESTHESIA||409.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27093|27093 - INJECTION HIP ARTHROGRAPHY W/O ANESTHESIA||318.47|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27091|27091 - RMVL HIP PROSTH COMP W/TOT HIP PROSTH MMA||2843.57|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27090|27090 - REMOVAL HIP PROSTHESIS SEPARATE PROCEDURE||1461.02|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27087|27087 - REMOVAL FOREIGN BODY PELVIS/HIP DEEP||1103.74|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27086|27086 - RMVL FOREIGN BODY PELVIS/HIP SUBCUTANEOUS TISS||502.85|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27080|27080 - COCCYGECTOMY PRIMARY||904.93|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27078|27078 - RAD RESCT TUMOR ISCHIAL TUBEROSITY&GRT TRCHNTR||3704.36|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27077|27077 - RADICAL RESCTION TUMOR INNOMINATE BONE TOTAL||5085.13|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27076|27076 - RAD RESCT TUMOR ILIUM ACETABULUM BOTH PUBIC||4553.21|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27075|27075 - RAD RESCT TUMOR WING OF ILIUM 1 PUBIC/ISCHIAL||3756.51|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27071|27071 - PARTIAL EXCISION DEEP PELVIS||1611.63|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27070|27070 - PARTIAL EXCISION SUPERFICIAL PELVIS||1495.66|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27067|27067 - EXC B1 CST/B9 TUM W/AGRFT REQ SEP INC||1833.44|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27066|27066 - EXCISION BONE CYST/BENIGN TUMOR DEEP||1435.14|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27065|27065 - EXCISION BONE CYST/BNIGN TUMOR SUPERFICIAL||909.04|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27062|27062 - EXCISION TROCHANTERIC BURSA/CALCIFICATION||801.43|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27060|27060 - EXCISION ISCHIAL BURSA||816.17|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27059|27059 - RAD RESECTION TUMOR SOFT TISS PELVIS&HIP 5 CM/>||3249.92|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27057|27057 - DCMPRN FASCIOTOMY PELVIC CMPRT DBRDMT MUSCLE UNI||1801.57|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27054|27054 - ARTHROTOMY W/SYNOVECTOMY HIP JOINT||1205.1|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27052|27052 - ARTHROTOMY W/BIOPSY HIP JOINT||1018.87|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27050|27050 - ARTHROTOMY W/BIOPSY SACROILIAC JOINT||702.31|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27049|27049 - RAD RESECT TUMOR SOFT TISSUE PELVIS & HIP <5 CM||2385.56|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27048|27048 - EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC <5CM||1078.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27047|27047 - EXC TUMOR SOFT TISSUE PELVIS & HIP SUBQ <3CM||814.12|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27045|27045 - EXC TUMOR SOFT TISSUE PELVIS & HIP SUBFASC 5CM/>||1328.29|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27041|27041 - BIOPSY SOFT TISSUE PELVIS&HIP DEEP/SUBFSCAL/IM||1216.12|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27040|27040 - BIOPSY SOFT TISSUE PELVIS&HIP AREA SUPERFICIAL||590.81|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27036|27036 - CAPSLCTOMY/CAPSUL HIP W/RLS HIP FLXR MUSC||1789.87|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27033|27033 - ARTHROTOMY HIP EXPLORATION/REMOVAL FOREIGN BODY||1721.23|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27030|27030 - ARTHROTOMY HIP W/DRAINAGE||1661.22|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27027|27027 - DECOMPRESSION FASCIOTOMY PELVIC COMPARTMENT UNI||1572.25|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27025|27025 - FASCIOTOMY HIP/THIGH ANY TYPE||1609.04|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27006|27006 - TENOTOMY ABDUCTORS&/EXTENSOR HIP OPEN SPX||1297.67|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27005|27005 - TENOTOMY HIP FLEXOR OPEN SEPARATE PROCEDURE||1279.98|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27003|27003 - TX ADDUXOR SUBQ OPN W/OBTURATOR NEURECTOMY||1049.36|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27001|27001 - TENOTOMY ADDUCTOR HIP OPEN||949.57|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|27000|27000 - TENOTOMY ADDUCTOR HIP PERCUTANEOUS SPX||732.1|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26992|26992 - INCISION BONE CORTEX PELVIS&/HIP JOINT||1688.51|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26991|26991 - I&D PELVIS/HIP JOINT AREA INFECTED BURSA||1214.75|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26990|26990 - I&D PELVIS/HIP JT AREA DEEP ABSCESS/HEMATOMA||1098.56|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26952|26952 - AMP F/TH 1/2 JT/PHALANX W/NEURECT LOCAL FLAP||1097.51|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26951|26951 - AMP F/TH 1/2 JT/PHALANX W/NEURECT W/DIR CLSR||1108.58|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26910|26910 - AMP MTCRPL W/FINGER/THUMB W/WO INTEROSS TRANSFER||1225.96|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26863|26863 - ARTHRODESIS IPHAL JT W/WO INT FIXJ W/AGRFT EA JT||409.97|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26862|26862 - ARTHRODESIS IPHAL JT W/WO INT FIXJ W/AUTOGRAFT||1237.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26861|26861 - ARTHRODESIS IPHAL JT W/WO INT FIXJ EA IPHAL JT||185.33|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26860|26860 - ARTHRODESIS INTERPHALANGEAL JT W/WO INT FIXJ||954.4|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26852|26852 - ARTHRODESIS MTCRPL JT W/WO INT FIXJ W/AUTOGRAFT||1358.75|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26850|26850 - ARTHRODESIS METACARPOPHALANGEAL JT W/WO INT FIXJ||1177.43|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26844|26844 - ARTHRD CARP/MTCRPL JT DGT OTH/THN THMB W/AGRFT||1381.39|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26843|26843 - ARTHRD CARP/MTCRPL JT DGT OTHER THAN THUMB EACH||1267.79|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26842|26842 - ARTHRD CRP/MTACRPL JT THMB W/WO INT FIXJ W/AGRFT||1342.78|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26841|26841 - ARTHRD CARPO/METACARPAL JT THUMB W/WO INT FIXJ||1236.98|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26820|26820 - FUSION OPPOSITION THUMB W/AUTOGENOUS GRAFT||1354.21|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26785|26785 - OPEN TX INTERPHALANGEAL JOINT DISLOCATION||952.36|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26776|26776 - PRQ SKEL FIXJ IPHAL JT DISLC W/MANJ||767.9|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26775|26775 - CLTX IPHAL JT DISLC W/MANJ REQ ANES||659.5|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26770|26770 - CLTX IPHAL JT DISLC W/MANJ W/O ANES||474.86|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26765|26765 - OPEN TX DISTAL PHALANGEAL FRACTURE EACH||871.31|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26756|26756 - PRQ SKEL FIXJ DSTL PHLNGL FX FNGR/THMB EA||721.57|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26755|26755 - CLTX DSTL PHLNGL FX FNGR/THMB W/MANJ EA||539.95|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26750|26750 - CLTX DSTL PHLNGL FX FNGR/THMB W/O MANJ EA||315.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26746|26746 - OPEN TX ARTICULAR FRACTURE MCP/IP JOINT EA||1299.08|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26742|26742 - CLTX ARTCLR FX INVG MTCARPHLNGL/IPHAL JT W/MANJ||632.2|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26740|26740 - CLTX ARTCLR FX INVG MTCRPHLNGL/IPHAL JT W/O MANJ||392.18|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26735|26735 - OPEN TX PHALANGEAL SHAFT FRACTURE PROX/MIDDLE EA||1042.09|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26727|26727 - PRQ SKEL FIXJ PHLNGL SHFT FX PROX/MIDDLE PX/F/T||814.91|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26725|26725 - CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/MANJ EA||580|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26720|26720 - CLTX PHLNGL FX PROX/MIDDLE PX/F/T W/O MANJ EA||338.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26715|26715 - OPEN TREATMENT METACARPOPHALANGEAL DISLOCATION||997.63|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26706|26706 - PRQ SKEL FIXJ METACARPOPHALANGEAL DISLC W/MANJ||758.3|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26705|26705 - CLTX METACARPOPHALANGEAL DISLC W/MANJ W/ANES||720.29|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26700|26700 - CLTX METACARPOPHALANGEAL DISLC W/MANJ W/O ANES||556.69|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26686|26686 - OPTX CARP/MTCRPL DISLC THMB CPLX MLT/DLYD RDCTJ||1097.1|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26685|26685 - OPEN TX CARPOMETACARPAL DISLOCATE NOT THUMB||1006.63|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26676|26676 - PRQ SKEL FIXJ CARPO/MTCRPL DISLC THMB MANJ EA JT||869.36|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26675|26675 - CLTX CARPO/MTCRPL DISLC THUMB MANJ EA JT W/ANES||788.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26670|26670 - CLTX CARPO/METACARPL DISLC THMB MANJ EA W/O ANES||582.26|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26665|26665 - OPEN TX CARPOMETACARPAL FRACTURE DISLOCATE THUMB||1100.77|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26650|26650 - PRQ SKELETAL FIX CARPO/METACARPAL FX DISLC THUMB||831.33|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26645|26645 - CLTX CARPO/METACARPAL FX DISLC THUMB W/MANJ||741.96|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26641|26641 - CLTX CARPO/METACARPAL DISLOCATION THUMB W/MANJ||651.71|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26615|26615 - OPEN TX METACARPAL FRACTURE SINGLE EA BONE||1006.06|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26608|26608 - PRQ SKELETAL FIXJ METACARPAL FX EACH BONE||827.41|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26607|26607 - CLTX METACARPAL FX W/MANJ W/XTRNL FIXJ EA BONE||798.48|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26605|26605 - CLTX METACARPAL FX W/MANIPULATION EACH BONE||552.6|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26600|26600 - CLTX METACARPAL FX W/O MANIPULATION EACH BONE||502.67|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26596|26596 - EXC CONSTRICTING RING FNGR W/MLT Z-PLASTIES||1297.55|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26593|26593 - RELEASE INTRINSIC MUSCLES HAND EACH MUSCLE||1016.6|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26591|26591 - REPAIR INTRINSIC MUSCLES HAND EACH MUSCLE||730.51|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26587|26587 - RCNSTJ POLYDACTYLOUS DIGIT SOFT TISSUE & BONE||1696.07|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26580|26580 - REPAIR CLEFT HAND||2641.75|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26568|26568 - OSTEOPLASTY LENGTHENING METACARPAL/PHALANX||1546.27|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26567|26567 - OSTEOTOMY PHALANX FINGER EACH||1156.68|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26565|26565 - OSTEOTOMY METACARPAL EACH||1162.04|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26562|26562 - REPAIR SYNDACTYLY EACH SPACE COMPLEX||2299.72|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26561|26561 - REPAIR SYNDACTYLY EACH SPACE W/SKIN FLAPS&GRAFT||1600.07|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26560|26560 - REPAIR SYNDACTYLY EACH SPACE W/SKIN FLAPS||1007.5|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26555|26555 - TR FNGR AXH POS W/O MVASC ANAST||2386.89|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26548|26548 - RPR & RCNSTJ FINGER VOLAR PLATE INTERPHALANGEAL||1297.37|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26546|26546 - RPR NON-UNION MTCRPL/PHALANX||1705.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26545|26545 - RCNSTJ COLTRL LIGM IPHAL JT 1 W/GRF EA JT||1212.21|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26542|26542 - RCNSTJ COLTRL LIGM MTCARPHLNGL 1 W/LOCAL TISS||1157|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26541|26541 - RCNSTJ COLTRL LIGM MTCARPHLNGL 1 W/TDN/FSCAL GRF||1371.04|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26540|26540 - RPR COLTRL LIGM MTCARPHLNGL/IPHAL JT||1116.9|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26536|26536 - ARTHROPLASTY INTERPHALANGEAL JT W/PROSTHETIC EA||1205.59|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26535|26535 - ARTHROPLASTY INTERPHALANGEAL JOINT EACH||735.14|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26531|26531 - ARTHRP MTCARPHLNGL JT W/PROSTC IMPLT EA JT||1090.94|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26530|26530 - ARTHROPLASTY METACARPOPHALANGEAL JOINT EACH||939.08|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26525|26525 - CAPSULECTOMY/CAPSULOTOMY IPHAL JOINT EACH||1099.76|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26520|26520 - CAPSULECTOMY/CAPSULOTOMY MTCARPHLNGL JOINT EACH||1098.99|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26518|26518 - CAPSULODESIS MTCARPHLNGL JOINT 3/4 DIGITS||1410.05|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26516|26516 - CAPSULODESIS MTCARPHLNGL JOINT SINGLE DIGIT||1191.4|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26510|26510 - CROSS INTRINSIC TRANSFER EACH TENDON||1007.37|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26508|26508 - RELEASE THENAR MUSCLE||1074.65|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26502|26502 - RCNSTJ TDN PULLEY EA TDN W/TDN/FSCAL GRF SPX||1217.59|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26500|26500 - RCNSTJ TENDON PULLEY EACH W/LOCAL TISSUES SPX||1059.16|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26498|26498 - TR TDN RESTORE INTRNSC FUNCJ ALL 4 FNGRS||1998.13|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26497|26497 - TR TDN RESTORE INTRNSC FUNCJ RING&SM FNGR||1493.1|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26494|26494 - OPPONENSPLASTY HYPOTHENAR MUSC TR||1335.71|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26492|26492 - OPPONENSPLASTY TDN TR W/GRF EA TDN||1521.54|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26490|26490 - OPPONENSPLASTY SUPFCIS TDN TR TYP EA TDN||1369.73|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26489|26489 - TRANSFER/TRANSPLANT TENDON PALMAR W/GRAFT EACH||1608.89|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26485|26485 - TRANSFER/TRANSPLANT TENDON PALMAR W/O GRAFT EACH||1371.94|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26483|26483 - TENDON TRANSFER TRANSPLANT CARP/MTCRPL GRAFT||1433.99|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26480|26480 - TR/TRNSPL TDN CARP/MTCRPL HAND W/O FR GRF EA TDN||1272.37|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26479|26479 - SHORTENING TENDON FLEXOR HAND/FINGER EACH||1038.46|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26478|26478 - LENGTHENING TENDON FLEXOR HAND/FINGER EACH||1048.77|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26476|26476 - LENGTHENING TENDON EXTENSOR HAND/FINGER EACH||995.33|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26474|26474 - TENODESIS DISTAL JOINT EACH||1024.74|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26471|26471 - TENODESIS PROXIMAL INTERPHALANGEAL JOINT EACH||1041.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26460|26460 - TENOTOMY EXTENSOR HAND/FINGER OPEN EACH TENDON||664.96|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26455|26455 - TENOTOMY FLEXOR FINGER OPEN EACH TENDON||685.91|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26450|26450 - TENOTOMY FLEXOR PALM OPEN EACH TENDON||690.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26449|26449 - TENOLYSIS CPLX XTNSR TENDON FINGER W/FOREARM EA||1212.59|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26445|26445 - TENOLYSIS EXTENSOR TENDON HAND/FINGER EACH||968.42|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26442|26442 - TENOLYSIS FLEXOR TENDON PALM&FINGER EACH TENDO||1645.31|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26440|26440 - TENOLYSIS FLEXOR TENDON PALM/FINGER EACH TENDON||1045.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26437|26437 - REALIGNMENT EXTENSOR TENDON HAND EACH TENDON||1058.81|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26433|26433 - REPAIR EXTENSOR TENDON DISTAL INSERTION W/O GRF||899.12|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26432|26432 - CLTX DSTL XTNSR TDN INSJ W/WO PERCUTAN PINNING||844.99|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26428|26428 - RPR XTNSR TDN CNTRL SLIP SEC W/FR GRFT EA FINGER||1258.76|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26426|26426 - RPR XTNSR TDN CNTRL SLIP TISS W/LAT BAND EA FNGR||874.35|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26420|26420 - REPAIR EXTENSOR TENDON FINGER W/GRAFT EACH||1203.46|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26418|26418 - REPAIR EXTENSOR TENDON FINGER W/O GRAFT EACH||972.63|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26416|26416 - RMVL SYNTH ROD & INSJ XTNSR TDN GRF H/F EA ROD||1525.52|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26415|26415 - EXC XTNSR TDN W/IMPLTJ SYNTH ROD DLYD GRF H/F EA||1175.13|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26412|26412 - REPAIR EXTENSOR TENDON HAND W/GRAFT EACH||1181.3|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26410|26410 - REPAIR EXTENSOR TENDON HAND W/O GRAFT EACH||953.68|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26392|26392 - RMVL SYNTH ROD & INSJ FLXR TDN GRF H/F EA ROD||1677.08|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26390|26390 - EXC FLXR TDN W/IMPLTJ SYNTH ROD DLYD TDN GRF H/F||1443.26|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26373|26373 - RPR/ADVMNT TDN W/NTC SUPFCIS TDN W/O FREE GRF EA||1415.43|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26372|26372 - RPR/ADVMNT TDN W/NTC SUPFCIS TDN W/FREE GRAFT EA||1518.98|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26370|26370 - RPR/ADVMNT TDN W/NTC SUPFCIS TDN PRIM EA TDN||1290.6|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26358|26358 - RPR/ADVMNT FLXR TDN ZONE 2 W/FR GRAFT EA TENDON||1535.65|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26357|26357 - RPR/ADVMNT FLXR TDN ZONE 2 W/O FR GRFT EA TENDON||1493.55|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26356|26356 - RPR/ADVMNT FLXR TDN ZONE 2 W/O FR GRFT EA TENDON||1866.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26352|26352 - RPR/ADVMNT FLXR TDN N/Z/2 W/FR GRAFT EA TENDON||1382.94|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26350|26350 - RPR/ADVMNT FLXR TDN N/Z/2 W/O FR GRAFT EA TENDON||1205.05|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26341|26341 - MANIPLATN PALAR FASCIAL CRD POST INJ SINGLE CORD||169.97|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26340|26340 - MANIPULATION FINGER JOINT UNDER ANES EACH JOINT||570.28|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26320|26320 - REMOVAL IMPLANT FROM FINGER/HAND||602.1|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26262|26262 - RADICAL RESECTION TUMOR DISTAL PHALANX FINGER||1115.91|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26260|26260 - RAD RESECTION TUMOR PROX/MIDDLE PHALANX FINGER||1420.94|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26250|26250 - RADICAL RESECTION TUMOR METACARPAL||1896.37|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26236|26236 - PARTIAL EXCISION DISTAL PHALANX FINGER||767.48|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26235|26235 - PARTIAL EXCISION PROXIMAL/MIDDLE PHALANX FINGER||861.61|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26230|26230 - PARTIAL EXCISION BONE METACARPAL||872.39|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26215|26215 - EXC/CURETTAGE CYST/TUMOR PHALANX FINGER W/AGRAFT||989.41|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26210|26210 - EXCISION/CURETTAGE CYST/TUMOR PHALANX FINGER||768.89|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26205|26205 - EXC/CURETTAGE CYST/TUMOR METACARPAL W/AUTOGRAFT||1059.46|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26200|26200 - EXCISION/CURETTAGE CYST/TUMOR METACARPAL||782.69|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26185|26185 - SESAMOIDECTOMY THUMB/FINGER SEPARATE PROCEDURE||943.61|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26180|26180 - EXCISION TENDON FINGER FLEXOR/EXTENSOR EACH||771.39|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26170|26170 - EXCISION TENDON PALM FLEXOR/EXTENSOR SINGLE EACH||706.86|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26160|26160 - EXC LESION TDN SHTH/JT CAPSL HAND/FNGR||971.93|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26145|26145 - SYNVCT TDN SHTH RAD FLXR TDN PALM&/FNGR EA TDN||894.65|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26140|26140 - SYNVCT PROX IPHAL JT W/XTNSR RCNSTJ EA IPHAL JT||879.12|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26135|26135 - SYNVCT MTCARPHLNGL JT W/INTRNSC RLS&XTNSR HOOD||959.31|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26130|26130 - SYNOVECTOMY CARPOMETACARPAL JOINT||809.1|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26125|26125 - FASCT PRTL PALMR ADDL DGT PROX IPHAL JT W/WO RPR||490.27|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26123|26123 - FASCT PRTL PALMAR 1 DGT PROX IPHAL JT W/WO RPR||1459.13|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26121|26121 - FASCT PALM W/WO Z-PLASTY TISSUE REARGMT/SKN GRFT||1045.3|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26118|26118 - RAD RESCJ TUM SOFT TISSUE HAND/FINGER 3 CM/>||1862.42|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26117|26117 - RAD RESECT TUMOR SOFT TISSUE HAND/FINGER <3CM||1309.39|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26116|26116 - EXC TUM/VAS MAL SFT TIS HAND/FNGR SUBFASC<1.5CM||921.29|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26115|26115 - EXC TUM/VASC MAL SFT TISS HAND/FNGR SUBQ <1.5CM||860.53|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26113|26113 - EX TUM/VASC MAL SFT TIS HAND/FNGR SUBFSC 1.5CM/>||958.75|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26111|26111 - EX TUM/VASC MALF SFT TISS HAND/FNGR SUBQ 1.5CM/>||732.35|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26110|26110 - ARTHROTOMY BIOPSY INTERPHALANGEAL JOINT EACH||557.28|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26105|26105 - ARTHROTOMY BIOPSY MTCARPHLNGL JOINT EACH||587.57|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26100|26100 - ARTHROTOMY BIOPSY CARP/MTCRPL JOINT EACH||583.81|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26080|26080 - ARTHRT EXPL DRG/RMVL LOOSE/FB IPHAL JT EA||676.66|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26075|26075 - ARTHRT EXPL DRG/RMVL LOOSE/FB MTCARPHLNGL JT EA||579.92|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26070|26070 - ARTHRT EXPL DRG/RMVL LOOSE/FB CARP/MTCRPL JT||550.17|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26060|26060 - TENOTOMY PERCUTANEOUS SINGLE EACH DIGIT||454.7|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26055|26055 - TENDON SHEATH INCISION||942.73|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26045|26045 - FASCIOTOMY PALMAR OPEN PARTIAL||816.98|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26040|26040 - FASCIOTOMY PALMAR PERCUTANEOUS||539.15|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26037|26037 - DECOMPRESSIVE FASCIOTOMY HAND||990.14|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26035|26035 - DECOMPRESSION FINGERS&/HAND INJECTION INJURY||1510.13|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26034|26034 - INCISION BONE CORTEX HAND/FINGER||940.36|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26030|26030 - DRAINAGE OF PALMAR BURSA MULTIPLE BURSA||859.32|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26025|26025 - DRAINAGE OF PALMAR BURSA SINGLE BURSA||736.49|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26020|26020 - DRAINAGE TENDON SHEATH DIGIT&/PALM EACH||754.52|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26011|26011 - DRAINAGE FINGER ABSCESS COMPLICATED||658.46|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|26010|26010 - DRAINAGE FINGER ABSCESS SIMPLE||445.99|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25931|25931 - TRANSMETACARPAL AMPUTATION RE-AMPUTATION||1295.1|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25927|25927 - TRANSMETACARPAL AMPUTATION||1413.68|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25922|25922 - DISARTICULATION THRU WRIST SEC CLOSURE/SCAR REVJ||1072.73|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25920|25920 - DISARTICULATION THROUGH WRIST||1225.46|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25909|25909 - AMP FOREARM THRU RADIUS&ULNA RE-AMPUTATION||1209.29|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25905|25905 - AMP FOREARM THRU RADIUS & ULNA OPEN CIRCULAR||1238.45|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25900|25900 - AMPUTATION FOREARM THROUGH RADIUS & ULNA||1240.88|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25830|25830 - ARTHRD DSTL RAD/ULN JT SGMTL RSCJ ULNA W/WO BONE||1662.16|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25825|25825 - ARTHRODESIS WRIST LIMITED W/AUTOGRAFT||1323.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25820|25820 - ARTHRODESIS WRIST LIMITED W/O BONE GRAFT||1073.75|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25810|25810 - ARTHRODESIS WRIST W/ILIAC/OTHER AUTOGRAFT||1524.31|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25805|25805 - ARTHRODESIS WRIST W/SLIDING GRAFT||1492.74|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25800|25800 - ARTHRODESIS WRIST COMPLETE W/O BONE GRAFT||1286.32|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25695|25695 - OPEN TREATMENT LUNATE DISLOCATION||1116.2|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25690|25690 - CLOSED TX LUNATE DISLOCATION W/MANIPULATION||840.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25685|25685 - OPEN TX TRANS-SCAPHOPERILUNAR FRACTURE DISLC||1299.91|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25680|25680 - CLTX TRANS-SCAPHOPRILUNAR TYP FX DISLC W/MANJ||818.46|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25676|25676 - OPEN TX DISTAL RADIOULNAR DISLC ACUTE/CHRONIC||1106.03|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25675|25675 - CLOSED TX DISTAL RADIOULNAR DISLOCATION W/MANJ||756.14|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25671|25671 - PRQ SKELETAL FIXJ DISTAL RADIOULNAR DISLOCATION||927.65|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25670|25670 - OPEN TX RADIOCARPAL/INTERCARPAL DISLC 1/> BONES||1061.62|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25660|25660 - CLTX RDCRPL/INTERCARPL DISLC 1/> BONES W/MANJ||712.55|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25652|25652 - OPEN TREATMENT ULNAR STYLOID FRACTURE||1094|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25651|25651 - PRQ SKELETAL FIXATION ULNAR STYLOID FRACTURE||843.7|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25650|25650 - CLOSED TREATMENT ULNAR STYLOID FRACTURE||549.25|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25645|25645 - OPEN TX CARPAL BONE FRACTURE OTH/THN SCAPHOID EA||1002.01|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25635|25635 - CLTX CARPAL BONE FX W/MANJ EACH BONE||771.23|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25630|25630 - CLTX CARPAL BONE FX W/O MANJ EACH BONE||524.68|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25628|25628 - OPEN TX CARPAL SCAPHOID NAVICULAR FRACTURE||1265.08|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25624|25624 - CLOSED TX CARPAL SCAPHOID FRACTURE W/MANJ||827.53|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25622|25622 - CLOSED TX CARPAL SCAPHOID FRACTURE W/O MANJ||520.2|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25609|25609 - OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 3 FRAG||1843.33|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25608|25608 - OPTX DSTL RADL I-ARTIC FX/EPIPHYSL SEP 2 FRAG||1448.78|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25607|25607 - OPTX DSTL RADL X-ARTIC FX/EPIPHYSL SEP||1288.8|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25606|25606 - PERQ SKEL FIXJ DISTAL RADIAL FX/EPIPHYSL SEP||1162.55|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25605|25605 - CLTX DSTL RDL FX/EPIPHYSL SEP W/MANJ WHEN PERF||947.14|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25600|25600 - CLTX DSTL RADIAL FX/EPIPHYSL SEP W/O MANJ||560.84|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25575|25575 - OPEN TX RADIAL&ULNAR SHAFT FX W/FIXJ RADIUS&ULNA||1585.94|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25574|25574 - OPEN TX RADIAL&ULNAR SHAFT FX W/FIXJ RADIUS/ULNA||1184.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25565|25565 - CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/MANJ||900.9|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25560|25560 - CLOSED TX RADIAL&ULNAR SHAFT FRACTURES W/O MAN||475.85|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25545|25545 - OPEN TREATMENT OF ULNAR SHAFT FRACTURE||1092.64|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25535|25535 - CLOSED TX ULNAR SHAFT FRACTURE W/MANIPULATION||848.84|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25530|25530 - CLOSED TX ULNAR SHAFT FRACTURE W/O MANIPULATION||448.54|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25526|25526 - OPEN RDL SHAFT FX OPEN RAD/ULN JT DISLOCATE||1689.35|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25525|25525 - OPEN RDL SHAFT FX CLOSED RAD/ULN JT DISLOCATE||1381.41|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25520|25520 - CLTX RDL SHFT FX&CLTX DISLC DSTL RAD/ULN JT||988.96|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25515|25515 - OPEN TREATMENT RADIAL SHAFT FRACTURE||1177.4|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25505|25505 - CLOSED TX RADIAL SHAFT FRACTURE W/MANIPULATION||868.59|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25500|25500 - CLOSED TX RADIAL SHAFT FRACTURE W/O MANIPULATION||467.77|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25491|25491 - PROPH TX N/P/PLTWR W/WO METHYLMETHACRYLATE ULNA||1306.71|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25455|25455 - EPIPHYSL ARRST EPIPHYSIOD/STAPLING DSTL RDS&ULNA||1048.09|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25450|25450 - EPIPHYSL ARRST EPIPHYSIOD/STAPLING DSTL RDS/U||883.76|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25449|25449 - REVJ ARTHRP W/REMOVAL IMPLANT WRIST JOINT||1817.28|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25447|25447 - ARTHRP INTERPOS INTERCARPAL/METACARPAL JOINTS||1452.11|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25445|25445 - ARTHROPLASTY W/PROSTHETIC REPLACEMENT TRAPEZIUM||1268.8|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25444|25444 - ARTHROPLASTY W/PROSTHETIC REPLACEMENT LUNATE||1458.7|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25443|25443 - ARTHROPLASTY W/PROSTHETIC RPLCMT SCAPHOID CARPAL||1379.27|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25442|25442 - ARTHROPLASTY W/PROSTHETIC RPLCMT DISTAL ULNA||1400.71|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25440|25440 - RPR NONUNION SCAPHOID CARPAL BNE W/WO RDL STYLEC||1351.39|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25431|25431 - REPAIR NONUNION CARPAL BONE EACH BONE||1376.51|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25430|25430 - INSERTION VASCULAR PEDICLE CARPAL BONE||1289.27|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25426|25426 - REPAIR DEFECT W/AUTOGRAFT RADIUS&ULNA||1994.89|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25425|25425 - REPAIR DEFECT W/AUTOGRAFT RADIUS/ULNA||1704.15|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25420|25420 - RPR NONUNION/MALUNION RADIUS&ULNA W/AUTOGRAFT||2073.2|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25415|25415 - RPR NONUNION/MALUNION RADIUS&ULNA W/O AUTOGRAF||1713.4|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25405|25405 - RPR NONUNION/MALUNION RADIUS/ULNA W/AUTOGRAFT||1827.7|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25400|25400 - RPR NONUNION/MALUNION RADIUS/ULNA W/O AUTOGRAFT||1414.67|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25394|25394 - OSTEOPLASTY CARPAL BONE SHORTENING||1403.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25392|25392 - OSTEOPLASTY RADIUS & ULNA SHORTENING||1779.35|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25391|25391 - OSTEOPLASTY RADIUS/ULNA LENGTHENING W/AUTOGRAFT||1764.25|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25390|25390 - OSTEOPLASTY RADIUS/ULNA SHORTENING||1353.26|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25365|25365 - OSTEOTOMY RADIUS & ULNA||1617.98|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25360|25360 - OSTEOTOMY ULNA||1149.07|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25355|25355 - OSTEOTOMY RADIUS MIDDLE/PROXIMAL THIRD||1353.4|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25350|25350 - OSTEOTOMY RADIUS DISTAL THIRD||1183.32|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25337|25337 - RCNSTJ STABLJ DSTL U/DSTL JT 2 SOFT TISS STABLJ||1557.18|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25332|25332 - ARTHRP WRST W/WO INTERPOS W/WO XTRNL/INT FIXJ||1477.57|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25320|25320 - CAPSL-RHPHY/RCNSTJ WRST OPN CARPL INS||1727.89|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25315|25315 - FLEXOR ORIGIN SLIDE FOREARM &/WRIST||1363.12|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25312|25312 - TDN TRNSPLJ/TR FLXR/XTNSR F/ARM&/WRST 1/TDN GR||1262|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25310|25310 - TDN TRNSPLJ/TR FLXR/XTNSR F/ARM&/WRST 1 EA TDN||1084.21|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25301|25301 - TENODESIS WRIST EXTENSORS FINGERS||1127.7|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25300|25300 - TENODESIS WRIST FLEXORS FINGERS||1205.62|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25295|25295 - TNOLS FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA||913.61|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25290|25290 - TNOT FLXR/XTNSR TENDON FOREARM&/WRIST 1 EA||760.9|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25280|25280 - LNGTH/SHRT FLXR/XTNSR TDN F/ARM&/WRIST 1 EA TDN||984.29|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25275|25275 - RPR TENDON SHEATH EXTENSOR F/ARM&/WRIST W/GRAFT||1176.07|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25274|25274 - RPR TDN/MUSC XTNSR F/ARM&/WRST SEC FR GRF EA TDN||1181.84|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25272|25272 - RPR TDN/MUSC XTNSR F/ARM&/WRIST SEC 1 EA TDN/MU||974.47|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25270|25270 - RPR TDN/MUSC XTNSR F/ARM&/WRIST PRIM 1 EA TDN||854.73|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25265|25265 - RPR TDN/MUSC FLXR F/ARM&/WRISTSEC FR GRF EA||1320.91|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25263|25263 - RPR TDN/MUSC FLXR F/ARM&/WRIST SEC 1 EA TDN/MUS||1101.47|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25260|25260 - RPR TDN/MUSC FLXR F/ARM&/WRST PRIM 1 EA TDN/MU||1102.57|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25259|25259 - MANIPULATION WRIST UNDER ANESTHESIA||718.6|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25251|25251 - REMOVAL WRIST PROSTH COMPLICATED W/TOTAL WRIST||1246.25|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25250|25250 - REMOVAL WRIST PROSTHESIS SEPARATE PROCEDURE||930.85|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25248|25248 - EXPL W/REMOVAL DEEP FOREIGN BODY FOREARM/WRIST||725.26|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25240|25240 - EXCISION DISTAL ULNA PARTIAL/COMPLETE||744.97|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25230|25230 - RADICAL STYLOIDECTOMY SEPARATE PROCEDURE||755.28|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25215|25215 - CARPECTOMY ALL BONES PROXIMAL ROW||1082.29|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25210|25210 - CARPECTOMY 1 BONE||849.74|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25151|25151 - PARTIAL EXCISION BONE RADIUS||1032.23|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25150|25150 - PARTIAL EXCISION BONE ULNA||997.09|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25145|25145 - SEQUESTRECTOMY FOREARM &/WRIST||906.66|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25136|25136 - EXC/CURTG CYST/TUMOR CARPAL BONES W/ALLOGRAFT||864.49|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25135|25135 - EXC/CURTG CYST/TUMOR CARPAL BONES W/AUTOGRAFT||980.01|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25130|25130 - EXCISION/CURETTAGE CYST/TUMOR CARPAL BONES||776.59|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25126|25126 - EXC/CURTG CYST/TUMOR RADIUS/ULNA W/ALLOGRAFT||1050.07|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25125|25125 - EXC/CURTG CYST/TUMOR RADIUS/ULNA W/AUTOGRAFT||1051.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25120|25120 - EXCISION/CURETTAGE CYST/TUMOR RADIUS/ULNA||868.79|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25119|25119 - SYNVCT XTNSR TDN SHTH WRST 1 RESCJ DSTL ULNA||872.5|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25118|25118 - SYNOVECTOMY EXTENSOR TENDON SHTH WRIST 1 CMPRT||662.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25116|25116 - RAD EXC BURSA SYNVA WRST/F/ARM TDN SHTHS XTNSRS||1046.47|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25115|25115 - RAD EXC BURSA SYNVA WRST/F/ARM TDN SHTHS FLXRS||1329.48|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25112|25112 - EXCISION GANGLION WRIST DORSAL/VOLAR RECURRENT||671|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25111|25111 - EXCISION GANGLION WRIST DORSAL/VOLAR PRIMARY||555.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25110|25110 - EXCISION LESION TENDON SHEATH FOREARM&/WRIST||593.59|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25109|25109 - EXC TENDON FOREARM&/WRIST FLEXOR/EXTENSOR EA||940.05|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25107|25107 - ARTHROTOMY DSTL RADIOULNAR JOINT RPR CARTILAGE||1078.81|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25105|25105 - ARTHROTOMY WRIST JOINT WITH SYNOVECTOMY||839.79|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25101|25101 - ARTHRT WRST W/JT EXPL W/WO BX W/WO RMVL LOOSE/FB||703.46|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25100|25100 - ARTHROTOMY WRIST JOINT WITH BIOPSY||603.36|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25085|25085 - CAPSULOTOMY WRIST||790.24|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25078|25078 - RAD RESCJ TUM SOFT TISSUE FOREARM&/WRIST 3 CM/>||2065.86|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25077|25077 - RAD RESECT TUMOR SOFT TISS FOREARM&/WRIST <3 CM||1566.36|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25076|25076 - EXC TUMOR SOFT TISS FOREARM&/WRIST SUBFASC <3CM||905.04|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25075|25075 - EXC TUMOR SOFT TISSUE FOREARM &/WRIST SUBQ <3CM||817.52|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25073|25073 - EXC TUMOR SFT TISS FOREARM&/WRIST SUBFASC 3CM/>||935.53|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25066|25066 - BIOPSY SOFT TISSUE FOREARM&/WRIST DEEP||627.08|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25065|25065 - BIOPSY SOFT TISSUE FOREARM&/WRIST SUPERFICIAL||434.41|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25040|25040 - ARTHRT RDCRPL/MIDCARPL JT W/EXPL DRG/RMVL FB||986.78|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25035|25035 - INCISION DEEP BONE CORTEX FOREARM&/WRIST||1021.52|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25028|25028 - I&D FOREARM&/WRIST DEEP ABSCESS/HEMATOMA||906.62|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25025|25025 - DCMPRN FASCT F/ARM&/WRST FLXR&XTNSR DBRDMT||2178.58|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25024|25024 - DCMPRN FASCT F/ARM&/WRST FLXR&XTNSR W/O DB||1370.77|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25023|25023 - DCMPRN FASCT F/ARM&/WRST FLXR/XTNSR W/DBRDMT||1926.92|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25020|25020 - DCMPRN FASCT F/ARM&WRST FLXR/XTNSR W/O DBRDMT||993.58|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25001|25001 - INCISION FLEXOR TENDON SHEATH WRIST||596.57|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|25000|25000 - INCISION EXTENSOR TENDON SHEATH WRIST||582.21|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24935|24935 - STUMP ELONGATION UPPER EXTREMITY||1624.63|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24930|24930 - AMPUTATION ARM THRU HUMERUS RE-AMPUTATION||1370.5|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24925|24925 - AMP ARM THRU HUMERUS SECONDARY CLSR/SCAR REVJ||901.21|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24920|24920 - AMPUTATION ARM THRU HUMERUS OPEN CIRCULAR||1294.94|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24900|24900 - AMPUTATION ARM THRU HUMERUS W/PRIMARY CLOSURE||1278.4|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24802|24802 - ARTHRODESIS ELBOW JOINT W/AUTOGENOUS GRAFT||1774.4|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24800|24800 - ARTHRODESIS ELBOW JOINT LOCAL||1465.04|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24685|24685 - OPEN TREATMENT ULNAR FRACTURE PROXIMAL END||1147.81|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24675|24675 - CLOSED TX ULNAR FRACTURE PROXIMAL END W/MANJ||788.89|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24670|24670 - CLOSED TX ULNAR FRACTURE PROXIMAL END W/O MANJ||499.77|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24666|24666 - OPEN TX RADIAL HEAD/NECK FRACTURE PROSTHETIC||1290.78|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24665|24665 - OPEN TX RADIAL HEAD/NECK FRACTURE||1143.67|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24655|24655 - CLOSED TX RADIAL HEAD/NECK FX W/MANIPULATION||750.91|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24650|24650 - CLOSED TX RADIAL HEAD/NECK FX W/O MANIPULATION||447.26|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24640|24640 - CLTX RDL HEAD SUBLXTJ CHLD NURSEMAID ELBW W/MANJ||239.67|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24635|24635 - OPEN TX MONTEGGIA FRACTURE DISLOCATION ELBOW||1182.04|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24620|24620 - CLOSED TX MONTEGGIA FX DISLOCATION ELBOW W/MANJ||955.85|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24615|24615 - OPEN TX ACUTE/CHRONIC ELBOW DISLOCATION||1251.63|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24605|24605 - TREATMENT CLOSED ELBOW DISLOCATION REQ ANES||821.03|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24600|24600 - TREATMENT CLOSED ELBOW DISLOCATION W/O ANES||631.76|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24587|24587 - OPTX PRIARTICULAR FX&/DISLC ELBW W/IMPLT ARTHR||1930.64|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24586|24586 - OPTX PERIARTICULAR FRACTURE &/DISLOCATION ELBO||1919.45|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24582|24582 - PRQ SKEL FIXJ HUMRL CNDYLR FX MEDIAL/LAT W/MANJ||1418.85|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24579|24579 - OPEN TREATMENT HUMERAL CONDYLAR FRACTURE||1472.76|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24577|24577 - CLTX HUMERAL CONDYLAR FX MEDIAL/LATERAL W/MANJ||954.92|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24576|24576 - CLTX HUMERAL CONDYLAR FX MEDIAL/LAT W/O MANJ||584.21|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24575|24575 - OPEN TX HUMERAL EPICONDYLAR FRACTURE||1291.55|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24566|24566 - PRQ SKEL FIXJ HUMRL EPCNDYLR FX MEDIAL/LAT MANJ||1259.96|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24565|24565 - CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/MANJ||926.06|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24560|24560 - CLTX HUMERAL EPICONDYLAR FX MEDIAL/LAT W/O MANJ||549.36|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24546|24546 - OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W/XTN||1838.12|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24545|24545 - OPEN TX HUMERAL SUPRACONDYLAR FRACTURE W/O XTN||1643.36|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24538|24538 - PRQ SKEL FIXJ SPRCNDYLR/TRANSCNDYLR HUMERAL FX||1309.43|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24535|24535 - CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/MANJ||1066.81|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24530|24530 - CLTX SPRCNDYLR/TRANSCNDYLR HUMERAL FX W/WO MANJ||654.07|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24516|24516 - TX HUMRAL SHAFT FX W/INSJ IMED IMPLT W/W CERCLGE||1520.75|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24515|24515 - OPTX HUMERAL SHFT FX W/PLATE/SCREWS W/WOCERCLAGE||1545.86|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24505|24505 - CLTX HUMERAL SHFT FX W/MANJ W/WO SKELETAL TRACJ||865.31|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24500|24500 - CLSD TX HUMERAL SHAFT FRACTURE W/O MANIPULATION||616.75|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24498|24498 - PROPH TX W/WO METHYLMETHACRYLATE HUMERAL SHAFT||1536.5|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24495|24495 - DECOMPRESSION FASCT F/ARM W/BRACH ART EXPL||953.96|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24435|24435 - REPAIR NON/MALUNION HUMERUS W/ILIAC/OTH AGRFT||1903.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24430|24430 - REPAIR NON/MALUNION HUMERUS W/O GRAFT||1871.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24420|24420 - OSTEOPLASTY HUMERUS||1755.4|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24400|24400 - OSTEOTOMY HUMERUS W/WO INTERNAL FIXATION||1444.12|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24371|24371 - REVIS ELBOW ARTHRPLSTY HUMERAL&ULNA COMPNT||3198.8|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24370|24370 - REVIS ELBOW ARTHRPLSTY HUMERAL/ULNA COMPNT||2759.17|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24366|24366 - ARTHROPLASTY RADIAL HEAD W/IMPLANT||1199.68|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24365|24365 - ARTHROPLASTY RADIAL HEAD||1127.39|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24363|24363 - ARTHRP ELBOW W/DISTAL HUM&PROX UR PROSTC RPLCM||2586.11|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24361|24361 - ARTHROPLASTY ELBOW W/DISTAL HUMRL PROSTC RPLCMT||1783.13|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24360|24360 - ARTHROPLASTY ELBOW W/MEMBRANE||1592.57|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24359|24359 - TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN TDN RPR||1158.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24358|24358 - TNOT ELBOW LATERAL/MEDIAL DEBRIDE OPEN||915.55|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24357|24357 - TENOTOMY ELBOW LATERAL/MEDIAL PERCUTANEOUS||755.71|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24346|24346 - RCNSTJ MEDIAL COLTRL LIGM ELBW W/TDN GRF||1943.1|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24345|24345 - REPAIR MEDIAL COLLATERAL LIGAMENT ELBOW||1246.09|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24344|24344 - RCNSTJ LAT COLTRL LIGM ELBOW W/TENDON GRAFT||1943.1|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24343|24343 - REPAIR LATERAL COLLATERAL LIGAMENT ELBOW||1239.64|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24342|24342 - RINSJ RPTD BICEPS/TRICEPS TDN DSTL W/WO TDN GRF||1368.9|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24341|24341 - REPAIR TENDON/MUSCLE UPPER ARM/ELBOW EA||1308.71|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24340|24340 - TENODESIS BICEPS TENDON ELBOW SEPARATE PROCEDURE||1075.54|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24332|24332 - TENOLYSIS TRICEPS||1077.35|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24330|24330 - FLEXOR-PLASTY ELBOW||1267.69|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24320|24320 - TENOPLASTY ELBOW TO SHOULDER SINGLE||1381.18|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24310|24310 - TENOTOMY OPEN ELBOW TO SHOULDER EACH TENDON||828.23|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24305|24305 - TENDON LENGTHENING UPPER ARM/ELBOW EA TENDON||1009.06|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24301|24301 - MUSCLE/TENDON TRANSFER UPPER ARM/ELBOW SINGLE||1313.95|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24300|24300 - MANIPULATION ELBOW UNDER ANESTHESIA||721.49|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24220|24220 - INJECTION ELBOW ARTHROGRAPHY||274.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24201|24201 - REMOVAL FOREIGN BODY UPPER ARM/ELBOW DEEP||958.48|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24200|24200 - RMVL FOREIGN BODY UPPER ARM/ELBOW SUBCUTANEOUS||355.57|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24164|24164 - PROSTHESIS REMOVAL RADIAL HEAD||1283.58|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24160|24160 - PROSTHESIS REMOVAL HUMERAL AND ULNAR COMPONENTS||2234.2|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24155|24155 - RESECTION ELBOW JOINT ARTHRECTOMY||1510.81|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24150|24150 - RADICAL RESECTION TUMOR SHAFT/DISTAL HUMERUS||2773.82|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24149|24149 - RAD RESCJ CAPSL TISS&HTRTPC BONE ELBW CONTRCT||2068.85|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24147|24147 - PARTIAL EXCISION BONE OLECRANON PROCESS||1093.16|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24145|24145 - PARTIAL EXCISION BONE RADIAL HEAD/NECK||1042.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24140|24140 - PARTIAL EXCISION BONE HUMERUS||1239.91|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24138|24138 - SEQUESTRECTOMY OLECRANON PROCESS||1185.91|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24136|24136 - SEQUESTRECTOMY RADIAL HEAD OR NECK||1023.68|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24134|24134 - SEQUESTRECTOMY SHAFT/DISTAL HUMERUS||1320.53|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24130|24130 - EXCISION RADIAL HEAD||888.39|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24126|24126 - EXC/CURTG BONE CST/B9 TUM H/N RDS/OLECRN W/ALGRT||1143.09|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24125|24125 - EXC/CURTG BONE CST/B9 TUM H/N RDS/OLECRN W/AGRFT||1092.83|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24120|24120 - EXC/CURTG BONE CYST/BENIGN TUMOR H/N RDS/OLECRN||924.75|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24116|24116 - EXC/CURTG BONE CYST/BENIGN TUM HUMERUS W/ALGRFT||1526.85|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24115|24115 - EXC/CURTG BONE CYST/BENIGN TUMOR HUMERUS W/AGRFT||1303.02|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24110|24110 - EXCISION/CURTG BONE CYST/BENIGN TUMOR HUMERUS||1033.31|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24105|24105 - EXCISION OLECRANON BURSA||608.74|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24102|24102 - ARTHROTOMY ELBOW W/SYNOVECTOMY||1081.37|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24101|24101 - ARTHRT ELBOW W/JNT EXPL W/WOBX W/WORMVL LOOSE/FB||875.97|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24100|24100 - ARTHROTOMY ELBOW W/SYNOVIAL BIOPSY ONLY||731.23|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24077|24077 - RAD RESECT TUMOR SOFT TISS UPPER ARM/ELBOW <5CM||1834.25|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24076|24076 - EXC TUMOR SOFT TISS UPR ARM/ELBOW SUBFASC <5CM||953.69|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24075|24075 - EXC TUMOR SOFT TISS UPPER ARM/ELBOW SUBQ <3CM||841.46|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24073|24073 - EXC TUMOR SOFT TISS UPPER ARM/ELBW SUBFASC 5CM/>||1229.24|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24071|24071 - EXC TUMOR SOFT TISSUE UPPER ARM/ELBOW SUBQ 3CM/>||715.07|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24066|24066 - BIOPSY SOFT TISSUE UPPER ARM/ELBOW AREA DEEP||1074.44|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24006|24006 - ARTHRT ELBOW CAPSULAR EXCISION CAPSULAR RLS SPX||1253.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|24000|24000 - ARTHRT ELBOW W/EXPLORATION DRAINAGE/REMOVAL FB||837.31|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23935|23935 - INC DEEP W/OPENING BONE CORTEX HUMERUS/ELBOW||886.39|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23931|23931 - INCISION&DRAINAGE UPPER ARM/ELBOW BURSA||487.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23930|23930 - I&D UPPER ARM/ELBOW DEEP ABSCESS/HEMATOMA||602.37|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23920|23920 - DISARTICULATION SHOULDER||2000.41|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23802|23802 - ARTHRODESIS GLENOHUMERAL JT W/AUTOGENOUS GRAFT||2279.45|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23800|23800 - ARTHRODESIS GLENOHUMERAL JOINT||1818.97|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23700|23700 - MANJ W/ANES SHOULDER JOINT W/FIXATION APPARATUS||346.07|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23680|23680 - OPEN TX SHOULDER DISLOCATION W/NECK FRACTURE||1643.96|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23675|23675 - CLTX SHOULDER DISLC W/SURG/ANTMCL NECK FX W/MANJ||961.25|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23670|23670 - OPEN TX SHOULDER DISLC W/HUMERAL TUBEROSITY FX||1550.99|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23665|23665 - CLTX SHOULDER DISLC W/FX HUMERAL TUBRST W/MANJ||735.48|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23660|23660 - OPEN TX ACUTE SHOULDER DISLOCATION||1019.27|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23655|23655 - CLSD TX SHOULDER DISLC W/MANIPULATION REQ ANES||699.52|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23650|23650 - CLSD TX SHOULDER DISLC W/MANIPULATION W/O ANES||541.91|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23630|23630 - OPEN TREATMENT GRTER HUMERAL TUBEROSITY FRACTURE||1376.89|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23625|23625 - CLTX GRTER HUMERAL TUBEROSITY FX W/MANIPULATION||658.53|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23620|23620 - CLTX GREATER HUMERAL TUBEROSITY FX W/O MANJ||463.97|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23616|23616 - OPEN PROX HUMERAL FRACTURE PROSTHETIC RPLCMT||2203.45|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23615|23615 - OPEN TREATMENT PROXIMAL HUMERAL FRACTURE||1561.59|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23605|23605 - CLTX PROX HUMRL FX W/MANJ W/WO SKELETAL TRACJ||803.83|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23600|23600 - CLTX PROXIMAL HUMERAL FRACTURE W/O MANIPULATION||559.39|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23585|23585 - OPEN TX SCAPULAR FX W/INTERNAL FIXATION IF PFRMD||1735.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23575|23575 - CLTX SCAPULAR FX W/MANJ W/WO SKELETAL TRACTION||694.87|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23570|23570 - CLOSED TX SCAPULAR FRACTURE W/O MANIPULATION||399.92|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23552|23552 - OPTX ACROMCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF||1149.01|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23550|23550 - OPEN TX ACROMIOCLAVICULAR DISLC ACUTE/CHRONIC||997.27|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23545|23545 - CLSD TX ACROMIOCLAVICULAR DISLC W/MANIPULATION||586.62|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23540|23540 - CLSD TX ACROMIOCLAVICULAR DISLC W/O MANIPULATION||388.28|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23532|23532 - OPTX STRNCLAV DISLC ACUTE/CHRONIC W/FASCIAL GRF||1099.04|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23530|23530 - OPEN TX STERNOCLAVICULAR DISLC ACUTE/CHRONIC||1008.23|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23525|23525 - CLOSED TX STERNOCLAVICULAR DISLC W/MANIPULATION||665.23|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23520|23520 - CLSD TX STERNOCLAVICULAR DISLC W/O MANIPULATION||399.47|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23515|23515 - OPEN TX CLAVICULAR FRACTURE INTERNAL FIXATION||1268.15|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23505|23505 - CLSD TX CLAVICULAR FRACTURE W/MANIPULATION||610.81|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23500|23500 - CLSD TX CLAVICULAR FRACTURE W/O MANIPULATION||375.08|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23491|23491 - PROPH TX W/WO METHYLMETHACRYLATE PROX HUMERUS||1794.46|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23490|23490 - PROPH TX W/WO METHYLMETHACRYLATE CLAVICLE||1526.4|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23485|23485 - OSTEOTOMY CLAV W/WO INT FIXJ W/BONE GRF NON/MAL||1690.25|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23480|23480 - OSTEOTOMY CLAVICLE W/WO INTERNAL FIXATION||1453.1|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23474|23474 - REVIS SHOULDER ARTHRPLSTY HUMERAL&GLENOID COMPNT||3133.39|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23473|23473 - REVIS SHOULDER ARTHRPLSTY HUMERAL/GLENOID COMPNT||2896.09|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23472|23472 - ARTHROPLASTY GLENOHUMERAL JOINT TOTAL SHOULDER||2591.06|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23470|23470 - ARTHROPLASTY GLENOHUMRL JT HEMIARTHROPLASTY||2135.74|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23466|23466 - CAPSULORRHAPHY GLENOHUMRL JT MULTI-DIRIONAL INS||1987.69|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23465|23465 - CAPSULORRHAPHY GLENOHUMERAL JT PST W/WO BONE BLK||1989.25|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23462|23462 - CAPSULORRHAPHY ANTERIOR W/CORACOID PROCESS TR||1891.22|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23460|23460 - CAPSULORRHAPHY ANTERIOR WITH BONE BLOCK||1934.33|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23455|23455 - CAPSULORRHAPHY ANTERIOR W/LABRAL REPAIR||1774.93|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23450|23450 - CAPSULORRHAPHY ANTERIOR PUTTI-PLATT/MAGNUSON||1682.51|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23440|23440 - RESECTION/TRANSPLANTATION LONG TENDON BICEPS||1335.47|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23430|23430 - TENODESIS LONG TENDON BICEPS||1316.68|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23420|23420 - RECONSTRUCTION ROTATOR CUFF AVULSION CHRONIC||1711.06|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23415|23415 - CORACOACROMIAL LIGAMENT RELEAS W/WOACROMIOPLASTY||1229.11|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23412|23412 - OPEN REPAIR OF ROTATOR CUFF CHRONIC||1505.07|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23410|23410 - OPEN REPAIR OF ROTATOR CUFF ACUTE||1451.5|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23406|23406 - TENOTOMY SHOULDER MULTIPLE THRU SAME INCISION||1362.33|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23405|23405 - TENOTOMY SHOULDER AREA 1 TENDON||1101.24|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23397|23397 - MUSCLE TRANSFER SHOULDER/UPPER ARM MULTIPLE||2028.33|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23395|23395 - MUSCLE TRANSFER SHOULDER/UPPER ARM SINGLE||2273.74|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23350|23350 - INJECTION SHOULDER ARTHROGRAPHY/ CT/MRI ARTHG||223.45|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23330|23330 - REMOVAL FOREIGN BODY SHOULDER SUBCUTANEOUS||412.6|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23220|23220 - RADICAL RESECTION BONE TUMOR PROXIMAL HUMERUS||3486.49|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23195|23195 - RESECTION HUMERAL HEAD||1334.83|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23190|23190 - OSTECTOMY SCAPULA PARTIAL||1005.84|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23184|23184 - PARTIAL EXCISION BONE PROXIMAL HUMERUS||1295.73|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23182|23182 - PARTIAL EXCISION BONE SCAPULA||1159.88|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23180|23180 - PARTIAL EXCISION BONE CLAVICLE||1176.95|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23174|23174 - SEQUESTRECTOMY HUMERAL HEAD SURGERY NECK||1336.28|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23172|23172 - SEQUESTRECTOMY SCAPULA||995.47|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23156|23156 - EXC/CURTG BONE CYST/BENIGN TUM PROX HUM W/ALGRFT||1196.33|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23150|23150 - EXC/CURTG BONE CYST/BENIGN TUMOR PROX HUMERUS||1167.68|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23146|23146 - EXC/CURTG BONE CST/B9 TUM CLAV/SCAPULA W/ALGRFT||1093.59|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23140|23140 - EXC/CURTG BONE CYST/BENIGN TUMOR CLAV/SCAPULA||929.68|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23130|23130 - PARTIAL REPAIR OR REMOVAL OF SHOULDER BONE||1071.77|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23120|23120 - CLAVICULECTOMY PARTIAL||1025.64|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23107|23107 - ARTHRT GLENOHMRL JT W/JT EXPL W/WO RMVL LOOSE/FB||1161.58|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23106|23106 - ARTHRT GLENOHUMRL JT STRNCLAV JT W/SYNVCT W/WOBX||870.8|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23105|23105 - ARTHRT GLENOHUMRL JT W/SYNOVECTOMY W/WO BIOPSY||1121.22|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23101|23101 - ARTHRT ACROMCLAV/STRNCLAV JT W/BX&/EXC CRTLG||788.44|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23100|23100 - ARTHROTOMY GLENOHUMERAL JOINT W/BIOPSY||877.66|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23077|23077 - RAD RESECTION TUMOR SOFT TISSUE SHOULDER <5CM||2026.75|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23076|23076 - EXC TUMOR SOFT TISS SHOULDER SUBFASC <5CM||950.22|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23075|23075 - EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ <3CM||805.81|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23073|23073 - EXC TUMOR SOFT TISSUE SHOULDER SUBFASCIAL 5 CM/>||1227.51|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23071|23071 - EXCISION TUMOR SOFT TISSUE SHOULDER SUBQ 3 CM/>||739.71|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23066|23066 - BIOPSY SOFT TISSUE SHOULDER DEEP||953.51|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23065|23065 - BIOPSY SOFT TISSUE SHOULDER SUPERFICIAL||373.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23044|23044 - ARTHRT ACROMCLAV STRNCLAV JT EXPL/DRG/RMVL FB||1007.21|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23040|23040 - ARTHROTOMY GLENOHUMERAL JT EXPL/DRG/RMVL FB||1267.99|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23035|23035 - INCISION BONE CORTEX SHOULDER AREA||1199.56|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23031|23031 - I&D SHOULDER INFECTED BURSA||728.39|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23030|23030 - I&D SHOULDER DEEP ABSCESS/HEMATOMA||756.72|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23020|23020 - CAPSULAR CONTRACTURE RELEASE||1214.82|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|23000|23000 - REMOVAL SUBDELTOID CALCAREOUS DEPOSITS OPEN||1006.45|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22870|22870 - INSJ STABLJ DEV W/O DCMPRN LUMBAR SECOND LEVEL||268.73|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22869|22869 - INSJ STABLJ DEV W/O DCMPRN LUMBAR SINGLE LEVEL||1014.21|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22868|22868 - INSJ STABLJ DEV W/DCMPRN LUMBAR SECOND LEVEL||461.24|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22867|22867 - INSJ STABLJ DEV W/DCMPRN LUMBAR SINGLE LEVEL||1844.32|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22865|22865 - RMVL DISC ARTHROPLASTY ANT 1 INTERSPACE LUMBAR||3668.78|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22864|22864 - RMVL DISC ARTHROPLASTY ANT 1 INTERSPACE CERVICAL||3778.02|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22862|22862 - REVJ RPLCMT DISC ARTHROPLASTY ANT 1 NTRSPC LMBR||3162.56|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22861|22861 - REVJ RPLCMT DISC ARTHROPLASTY ANT 1 NTRSPC CRV||3472.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22859|22859 - INSJ BIOMCHN DEV NTRVRT DISC SPACE W/O ARTHRD||638.89|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22857|22857 - TOT DISC ARTHRP ART DISC ANT APPRO 1 NTRSPC LMBR||3176.59|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22856|22856 - TOT DISC ARTHRP ART DISC ANT APPRO 1 NTRSPC CRV||2860.96|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22855|22855 - REMOVAL ANTERIOR INSTRUMENTATION||1986.86|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22854|22854 - INSJ BIOMCHN DEV VRT CORPECTOMY DEFECT W/ARTHRD||638.89|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22853|22853 - INSJ BIOMCHN DEV INTERVERTEBRAL DSC SPC W/ARTHRD||493.54|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22852|22852 - REMOVAL POSTERIOR SEGMENTAL INSTRUMENTATION||1236.08|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22850|22850 - REMOVAL POSTERIOR NONSEGMENTAL INSTRUMENTATION||1290.24|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22849|22849 - REINSERTION SPINAL FIXATION DEVICE||2336.08|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22848|22848 - PELVIC FIXATION OTHER THAN SACRUM||653.69|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22847|22847 - ANTERIOR INSTRUMENTATION 8/> VERTEBRAL SEGMENTS||1449.29|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22846|22846 - ANTERIOR INSTRUMENTATION 4-7 VERTEBRAL SEGMENTS||1383.66|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22845|22845 - ANTERIOR INSTRUMENTATION 2-3 VERTEBRAL SEGMENTS||1332.94|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22844|22844 - POSTERIOR SEGMENTAL INSTRUMENTATION 13/> VRT SE||1791.5|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22843|22843 - POSTERIOR SEGMENTAL INSTRUMENTATION 7-12 VRT SEG||1484.64|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22842|22842 - POSTERIOR SEGMENTAL INSTRUMENTATION 3-6 VRT SEG||1387.53|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22840|22840 - POSTERIOR NON-SEGMENTAL INSTRUMENTATION||1383.77|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22830|22830 - EXPLORATION SPINAL FUSION||1449.5|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22812|22812 - ARTHRODESIS ANTERIOR SPINAL DFRM 8/> VRT SEG||3958.56|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22810|22810 - ARTHRODESIS ANTERIOR SPINAL DFRM 4-7 VRT SEG||3634.02|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22808|22808 - ARTHRODESIS ANTERIOR SPINAL DFRM 2-3 VRT SEG||3315.94|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22804|22804 - ARTHRODESIS POSTERIOR SPINAL DFRM 13/> VRT SEG||4366.76|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22802|22802 - ARTHRODESIS POSTERIOR SPINAL DFRM 7-12 VRT SEG||3765.2|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22800|22800 - ARTHRODESIS POSTERIOR SPINAL DFRM UP 6 VRT SEG||2417.17|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22634|22634 - ARTHDSIS POST/POSTERLATRL/POSTINTRBDYADL SPC/SEG||903.08|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22633|22633 - ARTHDSIS POST/POSTEROLATRL/POSTINTERBODY LUMBAR||3335|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22632|22632 - ARTHRODESIS POSTERIOR INTERBODY EA ADDL||584.73|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22630|22630 - ARTHRODESIS POSTERIOR INTERBODY LUMBAR||2815.72|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22614|22614 - ARTHRODESIS POSTERIOR/POSTEROLATERAL EA ADDL||713.66|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22612|22612 - ARTHRODESIS POSTERIOR/POSTEROLATERAL LUMBAR||2848.07|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22610|22610 - ARTHRODESIS POSTERIOR/POSTEROLATERAL THORACIC||2259.13|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22600|22600 - ARTHRODESIS PST/PSTLAT CERVICAL BELW C2 SGM||2309.51|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22595|22595 - ARTHRODESIS POSTERIOR ATLAS-AXIS C1-C2||2709.14|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22590|22590 - ARTHRODESIS POSTERIOR CRANIOCERVICAL||2834.62|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22586|22586 - ARTHRODESIS PRESACRAL INTRBDY W/INSTRUMENT L5-S1||3624.12|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22585|22585 - ARTHRODESIS ANTERIOR INTERBODY EA ADDL NTRSPC||598.86|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22558|22558 - ARTHRODESIS ANTERIOR INTERBODY LUMBAR||2764.21|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22556|22556 - ARTHRD ANT MIN DISCECTOMY INTERBODY THORACIC||3004.88|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22554|22554 - ARTHRD ANT MIN DISCECT INTERBODY CERV BELOW C2||2252.57|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22552|22552 - ARTHRD ANT INTERDY CERVCL BELW C2 EA ADDL NTRSPC||727.56|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22551|22551 - ARTHRD ANT INTERBODY DECOMPRESS CERVICAL BELW C2||3086.21|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22548|22548 - ARTHRD ANT TRANSORL/XTRORAL C1-C2 W/WO EXC ODNTD||3562.4|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22534|22534 - ARTHRODESIS LAT EXTRACAVITARY EA ADDL THRC/LMBR||653.13|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22533|22533 - ARTHRODESIS LATERAL EXTRACAVITARY LUMBAR||2951.48|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22525|22525 - PERCUT KYPHOPLASTY ADD-ON||7347.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22524|22524 - PERCUT KYPHOPLASTY LUMBAR||7347.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22523|22523 - PERCUT KYPHOPLASTY THOR||7347.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22522|22522 - PERCUT VERTEBROPLASTY ADDL||7347.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22521|22521 - PERCUT VERTEBROPLASTY LUMB||7347.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22520|22520 - PERCUT VERTEBROPLASTY THOR||7347.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22328|22328 - OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM EA||514.91|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22327|22327 - OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM TH||2689.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22326|22326 - OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM CR||2681.86|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22325|22325 - OPTX&/RDCTJ VRT FX&/DISLC PST 1 VRT SGM LM||2557.1|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22318|22318 - OPTX&/RDCTJ ODNTD FX&/DISLC ANT FIXJ W/O GRAFT||2947.01|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22315|22315 - CLTX VRT FX&/DISLC CSTING/BRACING MANJ/TRCJ||1553.15|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22310|22310 - CLTX VRT BDY FX W/O MANJ REQ&W/CSTING/BRACING||538.54|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22305|22305 - CLOSED TX SPINE PROCESS FX||332.12|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22226|22226 - OSTEOT SPI W/DSKC ANT APPR 1 VRT SGM EA VRT SGM||655.7|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22224|22224 - OSTEOTOMY SPINE W/DSKC ANT APPR 1 VRT SGM LMBR||2821.07|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22216|22216 - OSTEOT SPI PST/PSTLAT APPR 1 VRT SGM EA VRT SGM||659.2|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22214|22214 - OSTEOTOMY SPINE PST/PSTLAT APPR 1 VRT SGM LMBR||2648.21|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22208|22208 - OSTEOTOMY SPINE POSTERIOR 3 COLUMN EA ADDL SGM||1037.83|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22207|22207 - OSTEOTOMY SPINE POSTERIOR 3 COLUMN LUMBAR||4300.4|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22206|22206 - OSTEOTOMY SPINE POSTERIOR 3 COLUMN THORACIC||4392.31|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22116|22116 - PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM EA||256.12|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22114|22114 - PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM LMBR||1764.61|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22112|22112 - PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM THRC||2013.89|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22110|22110 - PRTL EXC VRT BDY B1Y LES W/O SPI CORD 1 SGM CRV||1861.72|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22103|22103 - PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM EA||253.89|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22102|22102 - PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM LMBR||1412.91|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22101|22101 - PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM THRC||1456.47|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22100|22100 - PRTL EXC PST VRT INTRNSC B1Y LES 1 VRT SGM CRV||1654.99|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22015|22015 - I&D DEEP ABSCESS PST SPINE LUMBAR SAC/LUMBOSAC||1607.09|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|22010|22010 - I&D DEEP ABSCESS PST SPINE CRV THRC/CERVICOTHR||1688.76|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|21930|21930 - EXCISION TUMOR SOFT TISSUE BACK/FLANK SUBQ <3CM||817.6|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|21925|21925 - BIOPSY SOFT TISSUE BACK/FLANK DEEP||774.27|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|21920|21920 - BIOPSY SOFT TISSUE BACK/FLANK SUPERFICIAL||438.37|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|21820|21820 - CLOSED TREATMENT STERNUM FRACTURE||245.63|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|21810|21810 - TREATMENT OF RIB FRACTURE(S)||473.15|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|21800|21800 - TREATMENT OF RIB FRACTURE||1226.05|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|21720|21720 - DIVISION STERNOCLEIDOMASTOID OPEN W/O CAST||842.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|21600|21600 - EXCISION RIB PARTIAL||981.77|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|21557|21557 - RAD RESECT TUMOR SOFT TISS NECK/ANT THORAX <5CM||1703.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|21556|21556 - EXC TUMOR SOFT TISS NECK/THORAX SUBFASCIAL <5CM||937.28|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|21555|21555 - EXC TUMOR SOFT TISSUE NECK/ANT THORAX SUBQ <3CM||716.92|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|21550|21550 - BIOPSY SOFT TISSUE NECK/THORAX||449.41|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|21501|21501 - I&D DEEP ABSC/HMTMA SOFT TISSUE NECK/THORAX||779.27|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|21137|21137 - REDUCTION FOREHEAD CONTOURING ONLY||1227.15|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20985|20985 - CPTR-ASST SURGICAL NAVIGATION IMAGE-LESS||264.78|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20975|20975 - ELECTRICAL STIMULATION BONE HEALING INVASIVE||319|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20974|20974 - ELECTRICAL STIMULATION BONE HEALING NONINVASIVE||131.44|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20962|20962 - BONE GRF W/MVASC ANAST OTH/THN ILIAC CREST/METAR||3651.73|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20956|20956 - BONE GRAFT MICROVASCULAR ANAST ILIAC CREST||4734.05|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20950|20950 - MNTR INTERSTITIAL FLUID PRESSURE CMPRT SYNDROME||416.5|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20939|20939 - BONE MARROW ASPIRATION BONE GRFG SPI SURG ONLY||122.75|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20938|20938 - AUTOGRAFT SPINE SURGERY BICORT/TRICORT SEP INC||336.37|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20937|20937 - AUTOGRAFT SPINE SURGERY MORSELIZED SEP INCISION||303.97|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20931|20931 - ALLOGRAFT FOR SPINE SURGERY ONLY STRUCTURAL||204.5|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20926|20926 - TISSUE GRAFTS OTHER||756.29|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20924|20924 - TENDON GRAFT FROM A DISTANCE||893|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20922|20922 - FASCIA LATA GRAFT INCISION & AREA EXPOSURE||1052.33|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20920|20920 - FASCIA LATA GRAFT BY STRIPPER||693.9|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20910|20910 - CARTILAGE GRAFT COSTOCHONDRAL||798.75|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20902|20902 - BONE GRAFT ANY DONOR AREA MAJOR/LARGE||511.67|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20900|20900 - BONE GRAFT ANY DONOR AREA MINOR/SMALL||716.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20822|20822 - RPLJ DGT EXCLUDING THMB SUBLIMIS TDN COMPL AMP||3183.01|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20816|20816 - RPLJ DGT EXCEPT THMB MTCARPHLNGL JT COMPL AMP||3728.39|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20697|20697 - XTRNL FIXJ W/STRTCTC ADJUSTMENT EXCHANGE STRUT||3487.7|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20696|20696 - XTRNL FIXJ W/STEREOTACTIC ADJUSTMENT 1ST & SUBQ||2142.86|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20694|20694 - REMOVAL EXTERNAL FIXATION SYSTEM UNDER ANES||734.71|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20693|20693 - ADJUSTMENT/REVJ XTRNL FIXATION SYSTEM REQ ANES||788.29|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20692|20692 - APPLICATION MULTIPLANE EXTERNAL FIXATION SYSTEM||1978.99|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20690|20690 - APPLICATION UNIPLANE EXTERNAL FIXATION SYSTEM||1054.57|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20680|20680 - REMOVAL IMPLANT DEEP||1066.16|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20670|20670 - REMOVAL IMPLANT SUPERFICIAL SEPARATE PROCEDURE||640.94|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20663|20663 - APPLICATION HALO FEMORAL INCLUDING REMOVAL||694.82|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20662|20662 - APPLICATION HALO PELVIC INCLUDING REMOVAL||817.79|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20661|20661 - APPLICATION HALO CRANIAL INCLUDING REMOVAL||886.27|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20660|20660 - APPL CRANIAL TONG/STRTCTC FRAME W/REMOVAL SPX||444.64|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20650|20650 - INSERTION WIRE/PIN W/APPL SKELETAL TRACTION SPX||356.33|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20615|20615 - ASPIRATION & INJECTION TREATMENT BONE CYST||424.1|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20612|20612 - ASPIRATION&/INJECTION GANGLION CYST ANY LOCATJ||105.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20610|20610 - ARTHROCENTESIS ASPIR&/INJ MAJOR JT/BURSA W/O US||104.63|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20605|20605 - ARTHROCENTESIS ASPIR&/INJ INTERM JT/BURS W/O US||86.45|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20600|20600 - ARTHROCENTESIS ASPIR&/INJ SMALL JT/BURSA W/O US||82.84|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20553|20553 - INJECTION SINGLE/MLT TRIGGER POINT 3/> MUSCLES||110.18|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20552|20552 - INJECTION SINGLE/MLT TRIGGER POINT 1/2 MUSCLES||95.04|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20551|20551 - INJECTION SINGLE TENDON ORIGIN/INSERTION||104.94|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20550|20550 - INJECTION 1 TENDON SHEATH/LIGAMENT APONEUROSIS||102.62|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20527|20527 - INJECTION ENZYME PALMAR FASCIAL CORD||146.14|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20526|20526 - INJECTION THERAPEUTIC CARPAL TUNNEL||134.12|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20525|20525 - RMVL FOREIGN BODY MUSCLE/TENDON SHEATH DEEP/COMP||819.95|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20520|20520 - REMOVAL FOREIGN BODY MUSCLE/TENDON SHEATH SIMPLE||349.18|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20501|20501 - INJECTION SINUS TRACT DIAGNOSTIC||200.36|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20251|20251 - BIOPSY VERTEBRAL BODY OPEN LUMBAR/CERVICAL||743.78|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20250|20250 - BIOPSY VERTEBRAL BODY OPEN THORACIC||694.35|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20245|20245 - BIOPSY BONE OPEN DEEP||1088.17|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20240|20240 - BIOPSY BONE OPEN SUPERFICIAL||383.85|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20225|20225 - BIOPSY BONE TROCAR/NEEDLE DEEP||881.01|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20220|20220 - BIOPSY BONE TROCAR/NEEDLE SUPERFICIAL||286.87|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20206|20206 - BIOPSY MUSCLE PERCUTANEOUS NEEDLE||396.67|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20205|20205 - BIOPSY MUSCLE DEEP||494.69|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20200|20200 - BIOPSY MUSCLE SUPERFICIAL||353.3|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20103|20103 - EXPLORATION PENETRATING WOUND SPX EXTREMITY||998.69|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20102|20102 - EXPL PENETRATING WOUND SPX ABDOMEN/FLANK/BACK||838.6|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20101|20101 - EXPLORATION PENETRATING WOUND SPX CHEST||769.72|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20100|20100 - EXPLORATION PENETRATING WOUND SPX NECK||1089.58|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|20005|20005 - I&D SOFT TISSUE ABSCESS SUBFASC||532.94|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|19294|19294 - PREP TUMOR CAVITY IORT W/PARTIAL MASTECTOMY||300.91|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|19120|19120 - EXC CYST/ABERRANT BREAST TISSUE OPEN 1/> LESION||856.67|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|19000|19000 - PUNCTURE ASPIRATION CYST BREAST||192.17|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|17340|17340 - CRYOTHERAPY CO2 SLUSH LIQUID N2 ACNE||90.54|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|17250|17250 - CHEMICAL CAUTERIZATION OF GRANULATION TISSUE||133.54|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|17110|17110 - DESTRUCTION BENIGN LESIONS UP TO 14||186.01|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|17003|17003 - DESTRUCTION PREMALIGNANT LESION 2-14 EA||9.58|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|17000|17000 - DESTRUCTION PREMALIGNANT LESION 1ST||112.75|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|16035|16035 - ESCHAROTOMY FIRST INCISION||349.65|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|16030|16030 - DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ LARGE||315.49|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|16025|16025 - DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ MEDIUM||256.25|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|16020|16020 - DRS&/DBRDMT PRTL-THKNS BURNS 1ST/SBSQ SMALL||139.57|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|16000|16000 - INITIAL TX 1ST DEGREE BURN LOCAL TX||119.23|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|15931|15931 - EXCISION SACRAL PRESSURE ULCER W/PRIMARY SUTURE||1212.01|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|15920|15920 - EXC COCCYGEAL PR ULC W/COCCYGECTOMY W/PRIM SUTR||1055.45|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|15852|15852 - DRESSING CHANGE UNDER ANESTHESIA||84.74|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|15851|15851 - REMOVAL SUTURES UNDER ANESTHESIA OTHER SURGEON||168.46|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|15786|15786 - ABRASION 1 LESION||412.56|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|15770|15770 - GRAFT DERMA-FAT-FASCIA||1176.61|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|15757|15757 - FREE SKIN FLAP W/MICROVASCULAR ANASTOMOSIS||4099.18|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|15750|15750 - FLAP NEUROVASCULAR PEDICLE||1624|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|15740|15740 - FLAP ISLAND PEDICLE ANATOMIC NAMED AXIAL ARTERY||1760.44|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|15738|15738 - MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP LXTR||2449.08|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|15736|15736 - MUSC MYOCUTANEOUS/FASCIOCUTANEOUS FLAP UXTR||2296.33|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|15733|15733 - MUSC MYOQ/FSCQ FLAP HEAD&NECK W/NAMED VASC PEDCL||1884.29|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|15730|15730 - MIDFACE FLAP W/PRESERVATION OF VASCULAR PEDICLES||2686.06|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|15620|15620 - DELAY FLAP/SECTIONING FLAP F/C/C/N/AX/G/H/F||748.62|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|15610|15610 - DELAY FLAP/SECTIONING FLAP SCALP ARMS/LEGS||603.9|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|15574|15574 - FRMJ DIR/TUBE PEDCL W/WOTR FH/CH/CH/M/N/AX/G/H/F||1580.54|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|15572|15572 - FRMJ DIRECT/TUBE PEDICLE W/WO TR SCALP ARMS/LEGS||1531.39|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|15241|15241 - FTH/GT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F EA20CM/<||318.1|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|15240|15240 - FTH/GFT FR W/DIR CLSR F/C/C/M/N/AX/G/H/F 20 CM/<||1607.69|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|15221|15221 - FTH/GFT FR W/DIR CLSR S/A/L EA ADDL 20 CM/<||234.04|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|15220|15220 - FTH/GFT FREE W/DIRECT CLOSURE S/A/L 20 CM/<||1323.79|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|15200|15200 - FTH/GFT FREE W/DIRECT CLOSURE TRUNK 20 CM/<||1429.65|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|15120|15120 - SPLIT AGRFT F/S/N/H/F/G/M/D GT 1ST 100 CM/</1 %||1473.44|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|15110|15110 - EPIDRM AGRFT T/A/L 1ST 100 CM/&/1% BDY INFT/CHLD||1424.77|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|15101|15101 - SPLIT AGRFT T/A/L EA 100 CM/EA 1% BDY INFT/CHLD||318.94|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|15100|15100 - SPLIT AGRFT T/A/L 1ST 100 CM/&/1% BDY INFT/CHLD||1486.4|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|15050|15050 - PINCH GRAFT 1/MLT SM ULCER TIP/OTH AREA 2CM||975.17|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|15005|15005 - PREP SITE F/S/N/H/F/G/M/D GT ADDL 100 SQ CM/1PCT||216.97|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|15004|15004 - PREP SITE F/S/N/H/F/G/M/D GT 1ST 100 SQ CM/1PCT||694.17|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|15002|15002 - PREP SITE TRUNK/ARM/LEG 1ST 100 SQ CM/1PCT||596.81|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|14350|14350 - FILLETED FINGER/TOE FLAP W/PREPJ RECIPIENT SITE||1226.81|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|14041|14041 - ADJT/REARGMT F/C/C/M/N/AX/G/H/F 10.1-30.0 SQ CM||1623.2|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|14040|14040 - ADJT TIS TRNS/REARGMT F/C/C/M/N/A/G/H/F 10SQCM/<||1310.81|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|14021|14021 - ADJT/REARRGMT SCALP/ARM/LEG 10.1-30.0 SQ CM||1498.46|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|14020|14020 - ADJT TIS TRNSFR/REARGMT SCALP/ARM/LEG 10 SQ CM/<||1194.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|14000|14000 - ADJACENT TISSUE TRANSFER/REARGMT TRUNK 10 SQCM/<||1067.09|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|13160|13160 - SECONDARY CLOSURE SURG WOUND/DEHSN EXTSV/COMPLIC||1427.24|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|13133|13133 - REPAIR COMPLEX F/C/C/M/N/AX/G/H/F EA ADDL 5 CM/<||308.63|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|13132|13132 - REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 2.6-7.5 CM||813.53|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|13131|13131 - REPAIR COMPLEX F/C/C/M/N/AX/G/H/F 1.1-2.5 CM||656.6|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|13122|13122 - REPAIR COMPLEX SCALP/ARM/LEG EA ADDL 5 CM/<||229.28|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|13121|13121 - REPAIR COMPLEX SCALP/ARM/LEG 2.6-7.5 CM||725.81|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|13120|13120 - REPAIR COMPLEX SCALP/ARM/LEG 1.1-2.5 CM||595.17|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|13102|13102 - REPAIR COMPLEX TRUNK EACH ADDITIONAL 5 CM/<||208.78|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|13101|13101 - REPAIR COMPLEX TRUNK 2.6-7.5 CM||671.96|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|13100|13100 - REPAIR COMPLEX TRUNK 1.1-2.5 CM||568.66|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|12054|12054 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 7.6-12.5 CM||626.6|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|12053|12053 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 5.1-7.5 CM||587.79|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|12052|12052 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.6-5.0 CM||500.92|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|12051|12051 - REPAIR INTERMEDIATE F/E/E/N/L&/MUC 2.5 CM/<||438.07|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|12047|12047 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT >30.0 CM||953.66|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|12046|12046 - RPR INTERMEDIATE N/H/F/XTRNL GENT 20.1-30.0 CM||823.3|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|12045|12045 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 12.6-20 CM||689.9|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|12044|12044 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 7.6-12.5CM||611.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|12042|12042 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.6-7.5 CM||491.67|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|12041|12041 - REPAIR INTERMEDIATE N/H/F/XTRNL GENT 2.5CM/<||410.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|12037|12037 - REPAIR INTERMEDIATE S/A/T/E >30.0 CM||826.11|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|12036|12036 - REPAIR INTERMEDIATE S/A/T/E 20.1-30.0 CM||718.09|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|12035|12035 - REPAIR INTERMEDIATE S/A/T/E 12.6-20.0CM||651.04|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|12034|12034 - REPAIR INTERMEDIATE S/A/T/E 7.6-12.5 CM||531.25|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|12032|12032 - REPAIR INTERMEDIATE S/A/T/E 2.6-7.5 CM||513.16|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|12031|12031 - REPAIR INTERMEDIATE S/A/T/E 2.5 CM/<||401.58|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|12021|12021 - TX SUPERFICIAL WOUND DEHISCENCE W/PACKING||282.83|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|12020|12020 - TX SUPERFICIAL WOUND DEHISCENCE SIMPLE CLOSURE||479.84|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|12017|12017 - SIMPLE REPAIR F/E/E/N/L/M 20.1CM-30.0 CM||277.96|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|12016|12016 - SIMPLE REPAIR F/E/E/N/L/M 12.6CM-20.0 CM||368.86|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|12015|12015 - SIMPLE REPAIR F/E/E/N/L/M 7.6CM-12.5 CM||295.63|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|12014|12014 - SIMPLE REPAIR F/E/E/N/L/M 5.1CM-7.5 CM||244.08|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|12013|12013 - SIMPLE REPAIR F/E/E/N/L/M 2.6CM-5.0 CM||205.72|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|12011|12011 - SIMPLE REPAIR F/E/E/N/L/M 2.5CM/<||187.29|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|12007|12007 - SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK >30.0CM||400.55|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|12006|12006 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 20.1-30.0CM||343.67|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|12005|12005 - SMPL RPR SCALP/NECK/AX/GENIT/TRUNK 12.6-20.0CM||287.42|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|12004|12004 - SIMPLE RPR SCALP/NECK/AX/GENIT/TRUNK 7.6-12.5CM||221.13|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|12002|12002 - SMPL REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.6-7.5CM||187.18|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|12001|12001 - SIMPLE REPAIR SCALP/NECK/AX/GENIT/TRUNK 2.5CM/<||152.64|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11983|11983 - RMVL W/RINSJ NON-BIODEGRADABLE DRUG DLVR IMPLT||389.2|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11982|11982 - REMOVAL NON-BIODEGRADABLE DRUG DELIVERY IMPLANT||275.72|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11981|11981 - INSJ NON-BIODEGRADABLE DRUG DELIVERY IMPLANT||242.93|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11900|11900 - INJECTION INTRALESIONAL UP TO & INCLUD 7 LESIONS||94.12|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11772|11772 - EXCISION PILONIDAL CYST/SINUS COMPLICATED||1200.44|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11771|11771 - EXCISION PILONIDAL CYST/SINUS EXTENSIVE||987.44|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11770|11770 - EXCISION PILONIDAL CYST/SINUS SIMPLE||473.44|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11765|11765 - WEDGE EXCISION SKIN NAIL FOLD||283.03|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11762|11762 - RECONSTRUCTION NAIL BED W/GRAFT||484.49|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11760|11760 - REPAIR NAIL BED||386.93|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11755|11755 - BIOPSY NAIL UNIT SEPARATE PROCEDURE||227.81|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11750|11750 - EXCISION NAIL MATRIX PERMANENT REMOVAL||383.31|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11740|11740 - EVACUATION SUBUNGUAL HEMATOMA||83.83|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11732|11732 - AVULSION NAIL PLATE PARTIAL/COMP SIMPLE EA ADDL||61.61|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11730|11730 - AVULSION NAIL PLATE PARTIAL/COMPLETE SIMPLE 1||169.43|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11720|11720 - DEBRIDEMENT NAIL ANY METHOD 1-5||55.01|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11719|11719 - TRIMMING NONDYSTROPHIC NAILS ANY NUMBER||23.8|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11644|11644 - EXCISION MALIGNANT LESION F/E/E/N/L 3.1-4.0 CM||678.08|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11643|11643 - EXCISION MALIGNANT LESION F/E/E/N/L 2.1-3.0 CM||548.15|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11642|11642 - EXCISION MALIGNANT LESION F/E/E/N/L 1.1-2.0 CM||462.06|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11641|11641 - EXCISION MALIGNANT LESION F/E/E/N/L 0.6-1.0 CM||404.44|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11640|11640 - EXCISION MALIGNANT LESION F/E/E/N/L 0.5 CM/<||339.52|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11626|11626 - EXCISION MALIGNANT LESION S/N/H/F/G >4.0 CM||703.13|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11624|11624 - EXCISION MALIGNANT LESION S/N/H/F/G 3.1-4.0 CM||580.3|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11623|11623 - EXCISION MALIGNANT LESION S/N/H/F/G 2.1-3.0 CM||514.13|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11622|11622 - EXCISION MALIGNANT LESION S/N/H/F/G 1.1-2.0 CM||436.27|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11620|11620 - EXCISION MALIGNANT LESION S/N/H/F/G 0.5 CM/<||330.03|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11606|11606 - EXCISION MALIGNANT LESION TRUNK/ARM/LEG > 4.0 CM||774.45|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11604|11604 - EXCISION MAL LESION TRUNK/ARM/LEG 3.1-4.0 CM||537.8|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11603|11603 - EXCISION MAL LESION TRUNK/ARM/LEG 2.1-3.0 CM||483.16|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11602|11602 - EXCISION MAL LESION TRUNK/ARM/LEG 1.1-2.0 CM||420.8|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11601|11601 - EXCISION MAL LESION TRUNK/ARM/LEG 0.6-1.0 CM||388.67|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11600|11600 - EXCISION MAL LESION TRUNK/ARM/LEG 0.5 CM/<||326.47|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11471|11471 - EXCISION H/P/P/U COMPLEX REPAIR||868.39|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11470|11470 - EXCISION H/P/P/U SIMPLE/INTERMEDIATE REPAIR||702.09|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11463|11463 - EXCISION HIDRADENITIS INGUINAL COMPLEX REPAIR||843.3|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11462|11462 - EXCISION HIDRADENITIS INGUINAL SMPL/INTRM RPR||631.51|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11451|11451 - EXCISION HIDRADENITIS AXILLARY COMPLEX REPAIR||827.6|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11450|11450 - EXCISION HIDRADENITIS AXILLARY SMPL/INTRM RPR||653.33|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11446|11446 - EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M > 4.0CM||675.88|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11444|11444 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 3.1-4.0CM||483.86|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11443|11443 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 2.1-3.0CM||383.47|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11442|11442 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 1.1-2.0CM||320.42|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11441|11441 - EXC B9 LES MRGN XCP SK TG F/E/E/N/L/M 0.6-1.0CM||286.85|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11440|11440 - EXC B9 LESION MRGN XCP SK TG F/E/E/N/L/M 0.5CM/<||227.86|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11426|11426 - EXC B9 LESION MRGN XCP SK TG S/N/H/F/G > 4.0CM||576.45|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11424|11424 - EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 3.1-4.0CM||400.7|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11423|11423 - EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 2.1-3.0CM||346.16|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11422|11422 - EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 1.1-2.0CM||299.47|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11421|11421 - EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.6-1.0CM||267.84|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11420|11420 - EXC B9 LESION MRGN XCP SK TG S/N/H/F/G 0.5 CM/<||207.95|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11406|11406 - EXC B9 LESION MRGN XCP SK TG T/A/L >4.0 CM||539.57|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11404|11404 - EXC B9 LESION MRGN XCP SK TG T/A/L 3.1-4.0 CM||370.93|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11403|11403 - EXC B9 LESION MRGN XCP SK TG T/A/L 2.1-3.0 CM||327.28|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11402|11402 - EXC B9 LESION MRGN XCP SK TG T/A/L 1.1-2.0 CM||281.68|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11401|11401 - EXC B9 LESION MRGN XCP SK TG T/A/L 0.6-1.0 CM||253.22|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11400|11400 - EXC B9 LESION MRGN XCP SK TG T/A/L 0.5 CM/<||210.02|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11313|11313 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM >2.0 CM||315.16|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11312|11312 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 1.1-2.0 CM||271.37|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11311|11311 - SHVG SKIN LESION 1 F/E/E/N/L/M DIAM 0.6-1.0 CM||189.81|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11310|11310 - SHAVING SKIN LESION 1 F/E/E/N/L/M DIAM 0.5 CM/<||191.32|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11308|11308 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM >2.0 CM||257.29|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11307|11307 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 1.1-2.0 CM||243.38|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11306|11306 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.6-1.0 CM||205.76|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11305|11305 - SHAVING SKIN LESION 1 S/N/H/F/G DIAM 0.5 CM/<||166.9|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11303|11303 - SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM >2.0 CM||263.48|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11302|11302 - SHVG SKN LESION 1 TRUNK/ARM/LEG DIAM 1.1-2.0 CM||238.34|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11301|11301 - SHVG SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.6-1.0 CM||202.45|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11300|11300 - SHAVING SKIN LESION 1 TRUNK/ARM/LEG DIAM 0.5CM/<||163.26|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11201|11201 - REMOVAL SK TGS MLT FIBRQ TAGS ANY AREA EA 10||32.72|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11200|11200 - REMOVAL SKN TAGS MLT FIBRQ TAGS ANY AREA UPW/15||150.17|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11100|11100 - BX SKIN SUBCUTANEOUS&/MUCOUS MEMBRANE 1 LESION||175.12|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11057|11057 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION >4||111.83|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11056|11056 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 2-4||99.22|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11055|11055 - PARING/CUTTING BENIGN HYPERKERATOTIC LESION 1||80.78|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11044|11044 - DEBRIDEMENT BONE MUSCLE &/FASCIA 20 SQ CM/<||548.01|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11043|11043 - DEBRIDEMENT MUSCLE & FASCIA 20 SQ CM/<||394.56|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11042|11042 - DEBRIDEMENT SUBCUTANEOUS TISSUE 20 SQ CM/<||199.1|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11012|11012 - DBRDMT FX&/DISLC SUBQ T/M/F BONE||1217|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11011|11011 - DBRDMT W/RMVL FM FX&/DISLC SKN SUBQ T/M/F MUSC||903.62|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11010|11010 - DBRDMT W/RMVL FM FX&/DISLC SKIN&SUBQ TISSUS||838.19|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11001|11001 - DBRDMT EXTNSVE ECZEMA/INFECT SKN EA 10% BDY SURF||36.27|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|11000|11000 - DBRDMT EXTENSV ECZEMA/INFECT SKN UP 10% BDY SURF||93.49|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|10180|10180 - INCISION & DRAINAGE COMPLEX PO WOUND INFECTION||421.63|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|10160|10160 - PUNCTURE ASPIRATION ABSCESS HEMATOMA BULLA/CYST||222.79|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|10140|10140 - I&D HEMATOMA SEROMA/FLUID COLLECTION||279.02|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|10121|10121 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS COMPL||468.67|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|10120|10120 - INCISION & REMOVAL FOREIGN BODY SUBQ TISS SIMPLE||259.22|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|10081|10081 - INCISION & DRAINAGE PILONIDAL CYST COMPLICATED||458.95|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|10080|10080 - INCISION & DRAINAGE PILONIDAL CYST SIMPLE||303.43|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|10061|10061 - INCISION & DRAINAGE ABSCESS COMPLICATED/MULTIPLE||356.27|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|10060|10060 - INCISION & DRAINAGE ABSCESS SIMPLE/SINGLE||200.48|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|10022|10022 - FINE NEEDLE ASPIRATION WITH IMAGING GUIDANCE||242.1|0||0|10/01/2018
58-1155460|90|SH 70004|90-SH 70004|10021|10021 - FINE NEEDLE ASPIRATION BX W/O IMG GDN 1ST LESION||254.32|0||0|10/01/2018