TAX ID|NPI |RAX_TABL|RAX_CODE|RAX_MODF|RAX_EFF|RAX_TRM|RAX_GLOB|RAX_PROF|RAX_TECH|RAX_ANES|RAX_STAT|RAX_DESC|RAX_ASC|RAX_FILL 58-1699775|1326041732|CHC13|0073T||11/01/2013|12/31/9999|$534.15|0|0|||DELIVERY| COMP IMRT|| 58-1699775|1326041732|CHC13|0291T||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|0292T||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|0293T||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|0294T||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|0295T||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|0296T||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|0297T||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|0298T||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|0299T||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|0300T||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|0301T||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|0302T||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|0303T||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|0304T||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|0305T||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|0306T||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|0307T||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|0308T||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|0309T||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|0310T||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|0311T||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|0312T||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|0313T||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|0314T||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|0315T||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|0316T||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|0317T||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|10021||11/01/2013|12/31/9999|$101.86|0|0|||FNA W/O IMAGE|| 58-1699775|1326041732|CHC13|10022||11/01/2013|12/31/9999|$93.94|0|0|||FNA W/IMAGE|| 58-1699775|1326041732|CHC13|10030||04/01/2014|12/31/9999|$231.50|0|0|||GUIDE CATHET FLUID DRAINAGE|| 58-1699775|1326041732|CHC13|10035||04/01/2016|12/31/9999|$129.97|0|0|0||PERQ DEV SOFT TISS 1ST IMAG|| 58-1699775|1326041732|CHC13|10036||04/01/2016|12/31/9999|$65.47|0|0|0||PERQ DEV SOFT TISS ADD IMAG|| 58-1699775|1326041732|CHC13|1003F||11/01/2013|12/31/9999|$0.00|0|0|||LEVEL OF ACTIVITY ASSESS|| 58-1699775|1326041732|CHC13|10040||11/01/2013|12/31/9999|$126.24|0|0|||ACNE SURGERY|| 58-1699775|1326041732|CHC13|1004F||11/01/2013|12/31/9999|$0.00|0|0|||CLIN SYMP VOL OVRLD ASSESS|| 58-1699775|1326041732|CHC13|1005F||11/01/2013|12/31/9999|$0.00|0|0|||ASTHMA SYMPTOMS EVALUATE|| 58-1699775|1326041732|CHC13|10060||11/01/2013|12/31/9999|$158.75|0|0|||DRAINAGE OF SKIN ABSCESS|| 58-1699775|1326041732|CHC13|10061||11/01/2013|12/31/9999|$279.60|0|0|||DRAINAGE OF SKIN ABSCESS|| 58-1699775|1326041732|CHC13|1006F||11/01/2013|12/31/9999|$0.00|0|0|||OSTEOARTHRITIS ASSESS|| 58-1699775|1326041732|CHC13|1007F||11/01/2013|12/31/9999|$0.00|0|0|||ANTI-INFLM/ANLGSC OTC ASSESS|| 58-1699775|1326041732|CHC13|10080||11/01/2013|12/31/9999|$142.83|0|0|||DRAINAGE OF PILONIDAL CYST|| 58-1699775|1326041732|CHC13|10081||11/01/2013|12/31/9999|$243.87|0|0|||DRAINAGE OF PILONIDAL CYST|| 58-1699775|1326041732|CHC13|1008F||11/01/2013|12/31/9999|$0.00|0|0|||GI/RENAL RISK ASSESS|| 58-1699775|1326041732|CHC13|1010F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|1011F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|10120||11/01/2013|12/31/9999|$131.46|0|0|||REMOVE FOREIGN BODY|| 58-1699775|1326041732|CHC13|10121||11/01/2013|12/31/9999|$264.31|0|0|||REMOVE FOREIGN BODY|| 58-1699775|1326041732|CHC13|1012F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|10140||11/01/2013|12/31/9999|$166.71|0|0|||DRAINAGE OF HEMATOMA/FLUID|| 58-1699775|1326041732|CHC13|1015F||11/01/2013|12/31/9999|$0.00|0|0|||COPD SYMPTOMS ASSESS|| 58-1699775|1326041732|CHC13|10160||11/01/2013|12/31/9999|$135.13|0|0|||PUNCTURE DRAINAGE OF LESION|| 58-1699775|1326041732|CHC13|10180||11/01/2013|12/31/9999|$253.42|0|0|||COMPLEX DRAINAGE| WOUND|| 58-1699775|1326041732|CHC13|1018F||11/01/2013|12/31/9999|$0.00|0|0|||ASSESS DYSPNEA NOT PRESENT|| 58-1699775|1326041732|CHC13|1040F||04/01/2014|12/31/9999|$0.00|0|0|||DSM-IV(TM) INFO MDD DOC'D|| 58-1699775|1326041732|CHC13|11000||11/01/2013|12/31/9999|$42.17|0|0|||DEBRIDE INFECTED SKIN|| 58-1699775|1326041732|CHC13|11001||11/01/2013|12/31/9999|$20.86|0|0|||DEBRIDE INFECTED SKIN ADD-ON|| 58-1699775|1326041732|CHC13|11004||11/01/2013|12/31/9999|$842.69|0|0|||DEBRIDE GENITALIA & PERINEUM|| 58-1699775|1326041732|CHC13|11005||11/01/2013|12/31/9999|$1|134.14|0|0|||DEBRIDE ABDOM WALL|| 58-1699775|1326041732|CHC13|11006||11/01/2013|12/31/9999|$1|026.37|0|0|||DEBRIDE GENIT/PER/ABDOM WALL|| 58-1699775|1326041732|CHC13|11008||11/01/2013|12/31/9999|$398.10|0|0|||REMOVE MESH FROM ABD WALL|| 58-1699775|1326041732|CHC13|11010||11/01/2013|12/31/9999|$403.07|0|0|||DEBRIDE SKIN| FX|| 58-1699775|1326041732|CHC13|11011||11/01/2013|12/31/9999|$433.45|0|0|||DEBRIDE SKIN/MUSCLE| FX|| 58-1699775|1326041732|CHC13|11012||11/01/2013|12/31/9999|$614.10|0|0|||DEBRIDE SKIN/MUSCLE/BONE| FX|| 58-1699775|1326041732|CHC13|1101F||11/01/2013|12/31/9999|$0.00|0|0|||PT FALLS ASSESSED-DOC'D<=1/YR|| 58-1699775|1326041732|CHC13|11042||11/01/2013|12/31/9999|$85.69|0|0|||DEBRIDE SKIN/TISSUE|| 58-1699775|1326041732|CHC13|11043||11/01/2013|12/31/9999|$227.95|0|0|||DEBRIDE TISSUE/MUSCLE|| 58-1699775|1326041732|CHC13|11044||11/01/2013|12/31/9999|$341.10|0|0|||DEBRIDE TISSUE/MUSCLE/BONE|| 58-1699775|1326041732|CHC13|11045||11/01/2013|12/31/9999|$38.99|0|0|||DEB SUBQ TISSUE ADD-ON|| 58-1699775|1326041732|CHC13|11046||11/01/2013|12/31/9999|$79.91|0|0|||DEB MUSC/FASCIA ADD-ON|| 58-1699775|1326041732|CHC13|11047||11/01/2013|12/31/9999|$141.47|0|0|||DEB BONE ADD-ON|| 58-1699775|1326041732|CHC13|11055||11/01/2013|12/31/9999|$29.34|0|0|||TRIM SKIN LESION|| 58-1699775|1326041732|CHC13|11056||11/01/2013|12/31/9999|$33.83|0|0|||TRIM SKIN LESIONS| 2 TO 4|| 58-1699775|1326041732|CHC13|11057||11/01/2013|12/31/9999|$53.25|0|0|||TRIM SKIN LESIONS| OVER 4|| 58-1699775|1326041732|CHC13|11100||11/01/2013|12/31/9999|$70.87|0|0|||BIOPSY| SKIN LESION|| 58-1699775|1326041732|CHC13|11101||11/01/2013|12/31/9999|$35.68|0|0|||BIOPSY| SKIN ADD-ON|| 58-1699775|1326041732|CHC13|1110F||11/01/2013|12/31/9999|$0.00|0|0|||PT LFT INPT FAC W/IN 60 DAYS|| 58-1699775|1326041732|CHC13|1111F||11/01/2013|12/31/9999|$0.00|0|0|||DSCHRG MED/CURRENT MED MERGE|| 58-1699775|1326041732|CHC13|1116F||11/01/2013|12/31/9999|$0.00|0|0|||AURIC/PERI PAIN ASSESSED|| 58-1699775|1326041732|CHC13|1118F||11/01/2013|12/31/9999|$0.00|0|0|||GERD SYMPS ASSESSED 12 MONTH|| 58-1699775|1326041732|CHC13|1119F||11/01/2013|12/31/9999|$0.00|0|0|||INIT. EVAL FOR CONDITION|| 58-1699775|1326041732|CHC13|11200||11/01/2013|12/31/9999|$101.64|0|0|||REMOVAL OF SKIN TAGS|| 58-1699775|1326041732|CHC13|11201||11/01/2013|12/31/9999|$24.04|0|0|||REMOVE SKIN TAGS ADD-ON|| 58-1699775|1326041732|CHC13|1121F||11/01/2013|12/31/9999|$0.00|0|0|||SUBS. EVAL FOR CONDITION|| 58-1699775|1326041732|CHC13|1123F||11/01/2013|12/31/9999|$0.00|0|0|||ACP DISCUSS/DSCN MKR DOC'D|| 58-1699775|1326041732|CHC13|1124F||11/01/2013|12/31/9999|$0.00|0|0|||ACP DISCUSS-NO DSCNMKR DOC'D|| 58-1699775|1326041732|CHC13|1125F||11/01/2013|12/31/9999|$0.00|0|0|||AMNT PAIN NOTED; PAIN PRSNT|| 58-1699775|1326041732|CHC13|1126F||11/01/2013|12/31/9999|$0.00|0|0|||AMNT PAIN NOTED; NONE PRSNT|| 58-1699775|1326041732|CHC13|1127F||11/01/2013|12/31/9999|$0.00|0|0|||NEW EPISODE FOR CONDITION|| 58-1699775|1326041732|CHC13|1128F||11/01/2013|12/31/9999|$0.00|0|0|||SUBS. EPISODE FOR CONDITION|| 58-1699775|1326041732|CHC13|11300||11/01/2013|12/31/9999|$43.11|0|0|||SHAVE SKIN LESION|| 58-1699775|1326041732|CHC13|11301||11/01/2013|12/31/9999|$72.91|0|0|||SHAVE SKIN LESION|| 58-1699775|1326041732|CHC13|11302||11/01/2013|12/31/9999|$90.50|0|0|||SHAVE SKIN LESION|| 58-1699775|1326041732|CHC13|11303||11/01/2013|12/31/9999|$107.14|0|0|||SHAVE SKIN LESION|| 58-1699775|1326041732|CHC13|11305||11/01/2013|12/31/9999|$48.04|0|0|||SHAVE SKIN LESION|| 58-1699775|1326041732|CHC13|11306||11/01/2013|12/31/9999|$77.31|0|0|||SHAVE SKIN LESION|| 58-1699775|1326041732|CHC13|11307||11/01/2013|12/31/9999|$92.35|0|0|||SHAVE SKIN LESION|| 58-1699775|1326041732|CHC13|11308||11/01/2013|12/31/9999|$106.59|0|0|||SHAVE SKIN LESION|| 58-1699775|1326041732|CHC13|1130F||11/01/2013|12/31/9999|$0.00|0|0|||BK PAIN + FXN ASSESSED|| 58-1699775|1326041732|CHC13|11310||11/01/2013|12/31/9999|$62.18|0|0|||SHAVE SKIN LESION|| 58-1699775|1326041732|CHC13|11311||11/01/2013|12/31/9999|$90.96|0|0|||SHAVE SKIN LESION|| 58-1699775|1326041732|CHC13|11312||11/01/2013|12/31/9999|$105.10|0|0|||SHAVE SKIN LESION|| 58-1699775|1326041732|CHC13|11313||11/01/2013|12/31/9999|$140.39|0|0|||SHAVE SKIN LESION|| 58-1699775|1326041732|CHC13|1134F||11/01/2013|12/31/9999|$0.00|0|0|||EPSD BK PAIN FOR =< 6 WKS|| 58-1699775|1326041732|CHC13|1135F||11/01/2013|12/31/9999|$0.00|0|0|||EPSD BK PAIN FOR > 6 WKS|| 58-1699775|1326041732|CHC13|1136F||11/01/2013|12/31/9999|$0.00|0|0|||EPSD BK PAIN FOR <= 12 WKS|| 58-1699775|1326041732|CHC13|1137F||11/01/2013|12/31/9999|$0.00|0|0|||EPSD BK PAIN FOR > 12 WKS|| 58-1699775|1326041732|CHC13|11400||11/01/2013|12/31/9999|$111.24|0|0|||EXC TR-EXT B9+MARG 0.5 < CM|| 58-1699775|1326041732|CHC13|11401||11/01/2013|12/31/9999|$205.50|0|0|||EXC TR-EXT B9+MARG 0.6-1 CM|| 58-1699775|1326041732|CHC13|11402||11/01/2013|12/31/9999|$228.91|0|0|||EXC TR-EXT B9+MARG 1.1-2 CM|| 58-1699775|1326041732|CHC13|11403||11/01/2013|12/31/9999|$264.52|0|0|||EXC TR-EXT B9+MARG 2.1-3 CM|| 58-1699775|1326041732|CHC13|11404||11/01/2013|12/31/9999|$227.96|0|0|||EXC TR-EXT B9+MARG 3.1-4 CM|| 58-1699775|1326041732|CHC13|11406||11/01/2013|12/31/9999|$346.26|0|0|||EXC TR-EXT B9+MARG > 4.0 CM|| 58-1699775|1326041732|CHC13|11420||11/01/2013|12/31/9999|$115.13|0|0|||EXC H-F-NK-SP B9+MARG 0.5 <|| 58-1699775|1326041732|CHC13|11421||11/01/2013|12/31/9999|$157.00|0|0|||EXC H-F-NK-SP B9+MARG 0.6-1|| 58-1699775|1326041732|CHC13|11422||11/01/2013|12/31/9999|$190.71|0|0|||EXC H-F-NK-SP B9+MARG 1.1-2|| 58-1699775|1326041732|CHC13|11423||11/01/2013|12/31/9999|$222.60|0|0|||EXC H-F-NK-SP B9+MARG 2.1-3|| 58-1699775|1326041732|CHC13|11424||11/01/2013|12/31/9999|$254.25|0|0|||EXC H-F-NK-SP B9+MARG 3.1-4|| 58-1699775|1326041732|CHC13|11426||11/01/2013|12/31/9999|$389.18|0|0|||EXC H-F-NK-SP B9+MARG > 4 CM|| 58-1699775|1326041732|CHC13|11440||11/01/2013|12/31/9999|$143.72|0|0|||EXC FACE-MM B9+MARG 0.5 < CM|| 58-1699775|1326041732|CHC13|11441||11/01/2013|12/31/9999|$185.31|0|0|||EXC FACE-MM B9+MARG 0.6-1 CM|| 58-1699775|1326041732|CHC13|11442||11/01/2013|12/31/9999|$262.29|0|0|||EXC FACE-MM B9+MARG 1.1-2 CM|| 58-1699775|1326041732|CHC13|11443||11/01/2013|12/31/9999|$253.47|0|0|||EXC FACE-MM B9+MARG 2.1-3 CM|| 58-1699775|1326041732|CHC13|11444||11/01/2013|12/31/9999|$323.68|0|0|||EXC FACE-MM B9+MARG 3.1-4 CM|| 58-1699775|1326041732|CHC13|11446||11/01/2013|12/31/9999|$461.78|0|0|||EXC FACE-MM B9+MARG > 4 CM|| 58-1699775|1326041732|CHC13|11450||11/01/2013|12/31/9999|$351.08|0|0|||REMOVAL| SWEAT GLAND LESION|| 58-1699775|1326041732|CHC13|11451||11/01/2013|12/31/9999|$455.43|0|0|||REMOVAL| SWEAT GLAND LESION|| 58-1699775|1326041732|CHC13|11462||11/01/2013|12/31/9999|$338.86|0|0|||REMOVAL| SWEAT GLAND LESION|| 58-1699775|1326041732|CHC13|11463||11/01/2013|12/31/9999|$459.06|0|0|||REMOVAL| SWEAT GLAND LESION|| 58-1699775|1326041732|CHC13|11470||11/01/2013|12/31/9999|$394.69|0|0|||REMOVAL| SWEAT GLAND LESION|| 58-1699775|1326041732|CHC13|11471||11/01/2013|12/31/9999|$492.22|0|0|||REMOVAL| SWEAT GLAND LESION|| 58-1699775|1326041732|CHC13|1150F||11/01/2013|12/31/9999|$0.00|0|0|||DOC PT RSK DEATH W/IN 1YR|| 58-1699775|1326041732|CHC13|1151F||11/01/2013|12/31/9999|$0.00|0|0|||DOC NO PT RSK DEATH W/IN 1YR|| 58-1699775|1326041732|CHC13|1152F||11/01/2013|12/31/9999|$0.00|0|0|||DOC ADVNCD DIS COMFORT 1ST|| 58-1699775|1326041732|CHC13|1153F||11/01/2013|12/31/9999|$0.00|0|0|||DOC ADVNCD DIS CMFRT NOT 1ST|| 58-1699775|1326041732|CHC13|1157F||11/01/2013|12/31/9999|$0.00|0|0|||ADVNC CARE PLAN IN RCRD|| 58-1699775|1326041732|CHC13|1158F||11/01/2013|12/31/9999|$0.00|0|0|||ADVNC CARE PLAN TLK DOCD|| 58-1699775|1326041732|CHC13|1159F||11/01/2013|12/31/9999|$0.00|0|0|||MED LIST DOCD IN RCRD|| 58-1699775|1326041732|CHC13|11600||11/01/2013|12/31/9999|$168.44|0|0|||EXC TR-EXT MLG+MARG 0.5 < CM|| 58-1699775|1326041732|CHC13|11601||11/01/2013|12/31/9999|$212.07|0|0|||EXC TR-EXT MLG+MARG 0.6-1 CM|| 58-1699775|1326041732|CHC13|11602||11/01/2013|12/31/9999|$233.33|0|0|||EXC TR-EXT MLG+MARG 1.1-2 CM|| 58-1699775|1326041732|CHC13|11603||11/01/2013|12/31/9999|$278.04|0|0|||EXC TR-EXT MLG+MARG 2.1-3 CM|| 58-1699775|1326041732|CHC13|11604||11/01/2013|12/31/9999|$306.61|0|0|||EXC TR-EXT MLG+MARG 3.1-4 CM|| 58-1699775|1326041732|CHC13|11606||11/01/2013|12/31/9999|$455.26|0|0|||EXC TR-EXT MLG+MARG > 4 CM|| 58-1699775|1326041732|CHC13|1160F||11/01/2013|12/31/9999|$0.00|0|0|||RVW MEDS BY RX/DR IN RCRD|| 58-1699775|1326041732|CHC13|11620||11/01/2013|12/31/9999|$170.78|0|0|||EXC H-F-NK-SP MLG+MARG 0.5 <|| 58-1699775|1326041732|CHC13|11621||11/01/2013|12/31/9999|$213.96|0|0|||EXC H-F-NK-SP MLG+MARG 0.6-1|| 58-1699775|1326041732|CHC13|11622||11/01/2013|12/31/9999|$245.57|0|0|||EXC H-F-NK-SP MLG+MARG 1.1-2|| 58-1699775|1326041732|CHC13|11623||11/01/2013|12/31/9999|$303.50|0|0|||EXC H-F-NK-SP MLG+MARG 2.1-3|| 58-1699775|1326041732|CHC13|11624||11/01/2013|12/31/9999|$344.38|0|0|||EXC H-F-NK-SP MLG+MARG 3.1-4|| 58-1699775|1326041732|CHC13|11626||11/01/2013|12/31/9999|$424.12|0|0|||EXC H-F-NK-SP MLG+MAR > 4 CM|| 58-1699775|1326041732|CHC13|11640||11/01/2013|12/31/9999|$177.82|0|0|||EXC FACE-MM MALIG+MARG 0.5 <|| 58-1699775|1326041732|CHC13|11641||11/01/2013|12/31/9999|$224.54|0|0|||EXC FACE-MM MALIG+MARG 0.6-1|| 58-1699775|1326041732|CHC13|11642||11/01/2013|12/31/9999|$264.12|0|0|||EXC FACE-MM MALIG+MARG 1.1-2|| 58-1699775|1326041732|CHC13|11643||11/01/2013|12/31/9999|$331.78|0|0|||EXC FACE-MM MALIG+MARG 2.1-3|| 58-1699775|1326041732|CHC13|11644||11/01/2013|12/31/9999|$412.03|0|0|||EXC FACE-MM MALIG+MARG 3.1-4|| 58-1699775|1326041732|CHC13|11646||11/01/2013|12/31/9999|$572.93|0|0|||EXC FACE-MM MLG+MARG > 4 CM|| 58-1699775|1326041732|CHC13|1170F||11/01/2013|12/31/9999|$0.00|0|0|||FXNL STATUS ASSESSED|| 58-1699775|1326041732|CHC13|11719||11/01/2013|12/31/9999|$11.45|0|0|||TRIM NAIL(S)|| 58-1699775|1326041732|CHC13|11720||11/01/2013|12/31/9999|$21.89|0|0|||DEBRIDE NAIL| 1-5|| 58-1699775|1326041732|CHC13|11721||11/01/2013|12/31/9999|$36.80|0|0|||DEBRIDE NAIL| 6 OR MORE|| 58-1699775|1326041732|CHC13|11730||11/01/2013|12/31/9999|$74.62|0|0|||REMOVAL OF NAIL PLATE|| 58-1699775|1326041732|CHC13|11732||11/01/2013|12/31/9999|$30.31|0|0|||REMOVE NAIL PLATE| ADD-ON|| 58-1699775|1326041732|CHC13|11740||11/01/2013|12/31/9999|$45.07|0|0|||DRAIN BLOOD FROM UNDER NAIL|| 58-1699775|1326041732|CHC13|11750||11/01/2013|12/31/9999|$306.79|0|0|||REMOVAL OF NAIL BED|| 58-1699775|1326041732|CHC13|11755||11/01/2013|12/31/9999|$113.82|0|0|||BIOPSY| NAIL UNIT|| 58-1699775|1326041732|CHC13|1175F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|11760||11/01/2013|12/31/9999|$189.53|0|0|||REPAIR OF NAIL BED|| 58-1699775|1326041732|CHC13|11762||11/01/2013|12/31/9999|$267.04|0|0|||RECONSTRUCTION OF NAIL BED|| 58-1699775|1326041732|CHC13|11765||11/01/2013|12/31/9999|$127.97|0|0|||EXCISION OF NAIL FOLD| TOE|| 58-1699775|1326041732|CHC13|11770||11/01/2013|12/31/9999|$259.48|0|0|||REMOVAL OF PILONIDAL LESION|| 58-1699775|1326041732|CHC13|11771||11/01/2013|12/31/9999|$610.39|0|0|||REMOVAL OF PILONIDAL LESION|| 58-1699775|1326041732|CHC13|11772||11/01/2013|12/31/9999|$804.83|0|0|||REMOVAL OF PILONIDAL LESION|| 58-1699775|1326041732|CHC13|1180F||11/01/2013|12/31/9999|$0.00|0|0|||THROMBOEMB RISK ASSESSED|| 58-1699775|1326041732|CHC13|1181F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|1182F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|1183F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|11900||11/01/2013|12/31/9999|$45.45|0|0|||INJECTION INTO SKIN LESIONS|| 58-1699775|1326041732|CHC13|11901||11/01/2013|12/31/9999|$70.36|0|0|||ADDED SKIN LESIONS INJECTION|| 58-1699775|1326041732|CHC13|11920||11/01/2013|12/31/9999|$167.04|0|0|||CORRECT SKIN COLOR DEFECTS|| 58-1699775|1326041732|CHC13|11921||11/01/2013|12/31/9999|$195.85|0|0|||CORRECT SKIN COLOR DEFECTS|| 58-1699775|1326041732|CHC13|11922||11/01/2013|12/31/9999|$43.02|0|0|||CORRECT SKIN COLOR DEFECTS|| 58-1699775|1326041732|CHC13|11950||11/01/2013|12/31/9999|$70.09|0|0|||THERAPY FOR CONTOUR DEFECTS|| 58-1699775|1326041732|CHC13|11951||11/01/2013|12/31/9999|$108.81|0|0|||THERAPY FOR CONTOUR DEFECTS|| 58-1699775|1326041732|CHC13|11952||11/01/2013|12/31/9999|$149.47|0|0|||THERAPY FOR CONTOUR DEFECTS|| 58-1699775|1326041732|CHC13|11954||11/01/2013|12/31/9999|$168.35|0|0|||THERAPY FOR CONTOUR DEFECTS|| 58-1699775|1326041732|CHC13|11960||11/01/2013|12/31/9999|$1|283.15|0|0|||INSERT TISSUE EXPANDER(S)|| 58-1699775|1326041732|CHC13|11970||11/01/2013|12/31/9999|$878.56|0|0|||REPLACE TISSUE EXPANDER|| 58-1699775|1326041732|CHC13|11971||11/01/2013|12/31/9999|$450.63|0|0|||REMOVE TISSUE EXPANDER(S)|| 58-1699775|1326041732|CHC13|11975||11/01/2013|12/31/9999|$204.47|0|0|||INSERT CONTRACEPTIVE CAP|| 58-1699775|1326041732|CHC13|11976||11/01/2013|12/31/9999|$139.94|0|0|||REMOVAL OF CONTRACEPTIVE CAP|| 58-1699775|1326041732|CHC13|11980||11/01/2013|12/31/9999|$117.18|0|0|||IMPLANT HORMONE PELLET(S)|| 58-1699775|1326041732|CHC13|11981||11/01/2013|12/31/9999|$118.57|0|0|||INSERT DRUG IMPLANT DEVICE|| 58-1699775|1326041732|CHC13|11982||11/01/2013|12/31/9999|$141.22|0|0|||REMOVE DRUG IMPLANT DEVICE|| 58-1699775|1326041732|CHC13|11983||11/01/2013|12/31/9999|$248.80|0|0|||REMOVE/INSERT DRUG IMPLANT|| 58-1699775|1326041732|CHC13|12001||11/01/2013|12/31/9999|$71.53|0|0|||REPAIR SUPERFICIAL WOUND(S)|| 58-1699775|1326041732|CHC13|12002||11/01/2013|12/31/9999|$93.34|0|0|||REPAIR SUPERFICIAL WOUND(S)|| 58-1699775|1326041732|CHC13|12004||11/01/2013|12/31/9999|$115.15|0|0|||REPAIR SUPERFICIAL WOUND(S)|| 58-1699775|1326041732|CHC13|12005||11/01/2013|12/31/9999|$153.81|0|0|||REPAIR SUPERFICIAL WOUND(S)|| 58-1699775|1326041732|CHC13|12006||11/01/2013|12/31/9999|$187.76|0|0|||REPAIR SUPERFICIAL WOUND(S)|| 58-1699775|1326041732|CHC13|12007||11/01/2013|12/31/9999|$229.06|0|0|||REPAIR SUPERFICIAL WOUND(S)|| 58-1699775|1326041732|CHC13|1200F||11/01/2013|12/31/9999|$0.00|0|0|||SEIZURE TYPE& FREQU DOCD|| 58-1699775|1326041732|CHC13|12011||11/01/2013|12/31/9999|$87.93|0|0|||REPAIR SUPERFICIAL WOUND(S)|| 58-1699775|1326041732|CHC13|12013||11/01/2013|12/31/9999|$98.82|0|0|||REPAIR SUPERFICIAL WOUND(S)|| 58-1699775|1326041732|CHC13|12014||11/01/2013|12/31/9999|$124.11|0|0|||REPAIR SUPERFICIAL WOUND(S)|| 58-1699775|1326041732|CHC13|12015||11/01/2013|12/31/9999|$153.41|0|0|||REPAIR SUPERFICIAL WOUND(S)|| 58-1699775|1326041732|CHC13|12016||11/01/2013|12/31/9999|$206.31|0|0|||REPAIR SUPERFICIAL WOUND(S)|| 58-1699775|1326041732|CHC13|12017||11/01/2013|12/31/9999|$237.03|0|0|||REPAIR SUPERFICIAL WOUND(S)|| 58-1699775|1326041732|CHC13|12018||11/01/2013|12/31/9999|$274.70|0|0|||REPAIR SUPERFICIAL WOUND(S)|| 58-1699775|1326041732|CHC13|12020||11/01/2013|12/31/9999|$266.26|0|0|||CLOSURE OF SPLIT WOUND|| 58-1699775|1326041732|CHC13|12021||11/01/2013|12/31/9999|$199.67|0|0|||CLOSURE OF SPLIT WOUND|| 58-1699775|1326041732|CHC13|12031||11/01/2013|12/31/9999|$217.22|0|0|||LAYER CLOSURE OF WOUND(S)|| 58-1699775|1326041732|CHC13|12032||11/01/2013|12/31/9999|$278.25|0|0|||LAYER CLOSURE OF WOUND(S)|| 58-1699775|1326041732|CHC13|12034||11/01/2013|12/31/9999|$294.08|0|0|||LAYER CLOSURE OF WOUND(S)|| 58-1699775|1326041732|CHC13|12035||11/01/2013|12/31/9999|$342.46|0|0|||LAYER CLOSURE OF WOUND(S)|| 58-1699775|1326041732|CHC13|12036||11/01/2013|12/31/9999|$401.98|0|0|||LAYER CLOSURE OF WOUND(S)|| 58-1699775|1326041732|CHC13|12037||11/01/2013|12/31/9999|$469.49|0|0|||LAYER CLOSURE OF WOUND(S)|| 58-1699775|1326041732|CHC13|12041||11/01/2013|12/31/9999|$222.79|0|0|||LAYER CLOSURE OF WOUND(S)|| 58-1699775|1326041732|CHC13|12042||11/01/2013|12/31/9999|$404.41|0|0|||LAYER CLOSURE OF WOUND(S)|| 58-1699775|1326041732|CHC13|12044||11/01/2013|12/31/9999|$306.26|0|0|||LAYER CLOSURE OF WOUND(S)|| 58-1699775|1326041732|CHC13|12045||11/01/2013|12/31/9999|$376.75|0|0|||LAYER CLOSURE OF WOUND(S)|| 58-1699775|1326041732|CHC13|12046||11/01/2013|12/31/9999|$430.82|0|0|||LAYER CLOSURE OF WOUND(S)|| 58-1699775|1326041732|CHC13|12047||11/01/2013|12/31/9999|$484.82|0|0|||LAYER CLOSURE OF WOUND(S)|| 58-1699775|1326041732|CHC13|12051||11/01/2013|12/31/9999|$362.05|0|0|||LAYER CLOSURE OF WOUND(S)|| 58-1699775|1326041732|CHC13|12052||11/01/2013|12/31/9999|$295.27|0|0|||LAYER CLOSURE OF WOUND(S)|| 58-1699775|1326041732|CHC13|12053||11/01/2013|12/31/9999|$311.16|0|0|||LAYER CLOSURE OF WOUND(S)|| 58-1699775|1326041732|CHC13|12054||11/01/2013|12/31/9999|$328.15|0|0|||LAYER CLOSURE OF WOUND(S)|| 58-1699775|1326041732|CHC13|12055||11/01/2013|12/31/9999|$424.35|0|0|||LAYER CLOSURE OF WOUND(S)|| 58-1699775|1326041732|CHC13|12056||11/01/2013|12/31/9999|$527.92|0|0|||LAYER CLOSURE OF WOUND(S)|| 58-1699775|1326041732|CHC13|12057||11/01/2013|12/31/9999|$574.34|0|0|||LAYER CLOSURE OF WOUND(S)|| 58-1699775|1326041732|CHC13|1205F||11/01/2013|12/31/9999|$0.00|0|0|||EPI ETIOL SYND RVWD AND DOCD|| 58-1699775|1326041732|CHC13|1220F||11/01/2013|12/31/9999|$0.00|0|0|||PT SCREENED FOR DEPRESSION|| 58-1699775|1326041732|CHC13|13100||11/01/2013|12/31/9999|$334.09|0|0|||REPAIR OF WOUND OR LESION|| 58-1699775|1326041732|CHC13|13101||11/01/2013|12/31/9999|$406.23|0|0|||REPAIR OF WOUND OR LESION|| 58-1699775|1326041732|CHC13|13102||11/01/2013|12/31/9999|$108.59|0|0|||REPAIR WOUND/LESION ADD-ON|| 58-1699775|1326041732|CHC13|13120||11/01/2013|12/31/9999|$350.19|0|0|||REPAIR OF WOUND OR LESION|| 58-1699775|1326041732|CHC13|13121||11/01/2013|12/31/9999|$467.40|0|0|||REPAIR OF WOUND OR LESION|| 58-1699775|1326041732|CHC13|13122||11/01/2013|12/31/9999|$124.35|0|0|||REPAIR WOUND/LESION ADD-ON|| 58-1699775|1326041732|CHC13|13131||11/01/2013|12/31/9999|$393.60|0|0|||REPAIR OF WOUND OR LESION|| 58-1699775|1326041732|CHC13|13132||11/01/2013|12/31/9999|$817.49|0|0|||REPAIR OF WOUND OR LESION|| 58-1699775|1326041732|CHC13|13133||11/01/2013|12/31/9999|$191.19|0|0|||REPAIR WOUND/LESION ADD-ON|| 58-1699775|1326041732|CHC13|13151||04/01/2014|12/31/9999|$419.76|0|0|||REPAIR OF WOUND OR LESION|| 58-1699775|1326041732|CHC13|13152||04/01/2014|12/31/9999|$509.37|0|0|||REPAIR OF WOUND OR LESION|| 58-1699775|1326041732|CHC13|13153||04/01/2014|12/31/9999|$209.85|0|0|||REPAIR WOUND/LESION ADD-ON|| 58-1699775|1326041732|CHC13|13160||11/01/2013|12/31/9999|$1|158.23|0|0|||LATE CLOSURE OF WOUND|| 58-1699775|1326041732|CHC13|14000||11/01/2013|12/31/9999|$722.18|0|0|||SKIN TISSUE REARRANGEMENT|| 58-1699775|1326041732|CHC13|14001||11/01/2013|12/31/9999|$944.42|0|0|||SKIN TISSUE REARRANGEMENT|| 58-1699775|1326041732|CHC13|1400F||11/01/2013|12/31/9999|$0.00|0|0|||PRKNS DIAG RVIEWED|| 58-1699775|1326041732|CHC13|14020||11/01/2013|12/31/9999|$819.80|0|0|||SKIN TISSUE REARRANGEMENT|| 58-1699775|1326041732|CHC13|14021||11/01/2013|12/31/9999|$1|041.95|0|0|||SKIN TISSUE REARRANGEMENT|| 58-1699775|1326041732|CHC13|14040||11/01/2013|12/31/9999|$918.85|0|0|||SKIN TISSUE REARRANGEMENT|| 58-1699775|1326041732|CHC13|14041||11/01/2013|12/31/9999|$1|128.99|0|0|||SKIN TISSUE REARRANGEMENT|| 58-1699775|1326041732|CHC13|14060||11/01/2013|12/31/9999|$974.09|0|0|||SKIN TISSUE REARRANGEMENT|| 58-1699775|1326041732|CHC13|14061||11/01/2013|12/31/9999|$1|204.95|0|0|||SKIN TISSUE REARRANGEMENT|| 58-1699775|1326041732|CHC13|14301||11/01/2013|12/31/9999|$1|290.11|0|0|||SKIN TISSUE REARRANGEMENT|| 58-1699775|1326041732|CHC13|14302||11/01/2013|12/31/9999|$325.28|0|0|||SKIN TISSUE REARRANGE ADD-ON|| 58-1699775|1326041732|CHC13|14350||11/01/2013|12/31/9999|$1|033.75|0|0|||SKIN TISSUE REARRANGEMENT|| 58-1699775|1326041732|CHC13|1450F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|1451F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|1460F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|1461F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|1490F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|1491F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|1493F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|1494F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|15002||11/01/2013|12/31/9999|$327.19|0|0|||WND PREP| CH/INF| TRK/ARM/LG|| 58-1699775|1326041732|CHC13|15003||11/01/2013|12/31/9999|$66.31|0|0|||WND PREP| CH/INF ADDL 100 CM|| 58-1699775|1326041732|CHC13|15004||11/01/2013|12/31/9999|$391.21|0|0|||WND PREP CH/INF| F/N/HF/G|| 58-1699775|1326041732|CHC13|15005||11/01/2013|12/31/9999|$132.60|0|0|||WND PREP| F/N/HF/G| ADDL CM|| 58-1699775|1326041732|CHC13|15040||11/01/2013|12/31/9999|$182.91|0|0|||HARVEST CULTURED SKIN GRAFT|| 58-1699775|1326041732|CHC13|15050||11/01/2013|12/31/9999|$637.88|0|0|||SKIN PINCH GRAFT|| 58-1699775|1326041732|CHC13|15100||11/01/2013|12/31/9999|$1|032.04|0|0|||SKIN SPLT GRFT| TRNK/ARM/LEG|| 58-1699775|1326041732|CHC13|15101||11/01/2013|12/31/9999|$159.86|0|0|||SKIN SPLT GRFT T/A/L| ADD-ON|| 58-1699775|1326041732|CHC13|15110||11/01/2013|12/31/9999|$1|076.89|0|0|||EPIDRM AUTOGRFT TRNK/ARM/LEG|| 58-1699775|1326041732|CHC13|15111||11/01/2013|12/31/9999|$148.22|0|0|||EPIDRM AUTOGRFT T/A/L ADD-ON|| 58-1699775|1326041732|CHC13|15115||11/01/2013|12/31/9999|$1|091.34|0|0|||EPIDRM A-GRFT FACE/NCK/HF/G|| 58-1699775|1326041732|CHC13|15116||11/01/2013|12/31/9999|$223.30|0|0|||EPIDRM A-GRFT F/N/HF/G ADDL|| 58-1699775|1326041732|CHC13|15120||11/01/2013|12/31/9999|$1|022.04|0|0|||SKN SPLT A-GRFT FAC/NCK/HF/G|| 58-1699775|1326041732|CHC13|15121||11/01/2013|12/31/9999|$194.38|0|0|||SKN SPLT A-GRFT F/N/HF/G ADD|| 58-1699775|1326041732|CHC13|15130||11/01/2013|12/31/9999|$810.82|0|0|||DERM AUTOGRAFT| TRNK/ARM/LEG|| 58-1699775|1326041732|CHC13|15131||11/01/2013|12/31/9999|$133.91|0|0|||DERM AUTOGRAFT T/A/L ADD-ON|| 58-1699775|1326041732|CHC13|15135||11/01/2013|12/31/9999|$1|100.63|0|0|||DERM AUTOGRAFT FACE/NCK/HF/G|| 58-1699775|1326041732|CHC13|15136||11/01/2013|12/31/9999|$116.17|0|0|||DERM AUTOGRAFT| F/N/HF/G ADD|| 58-1699775|1326041732|CHC13|15150||11/01/2013|12/31/9999|$905.19|0|0|||CULT EPIDERM GRFT T/ARM/LEG|| 58-1699775|1326041732|CHC13|15151||11/01/2013|12/31/9999|$160.53|0|0|||CULT EPIDERM GRFT T/A/L ADDL|| 58-1699775|1326041732|CHC13|15152||11/01/2013|12/31/9999|$224.67|0|0|||CULT EPIDERM GRAFT T/A/L +%|| 58-1699775|1326041732|CHC13|15155||11/01/2013|12/31/9999|$901.71|0|0|||CULT EPIDERM GRAFT| F/N/HF/G|| 58-1699775|1326041732|CHC13|15156||11/01/2013|12/31/9999|$244.47|0|0|||CULT EPIDRM GRFT F/N/HFG ADD|| 58-1699775|1326041732|CHC13|15157||11/01/2013|12/31/9999|$242.45|0|0|||CULT EPIDERM GRFT F/N/HFG +%|| 58-1699775|1326041732|CHC13|15200||11/01/2013|12/31/9999|$959.82|0|0|||SKIN FULL GRAFT| TRUNK|| 58-1699775|1326041732|CHC13|15201||11/01/2013|12/31/9999|$116.39|0|0|||SKIN FULL GRAFT TRUNK ADD-ON|| 58-1699775|1326041732|CHC13|15220||11/01/2013|12/31/9999|$886.96|0|0|||SKIN FULL GRAFT SCLP/ARM/LEG|| 58-1699775|1326041732|CHC13|15221||11/01/2013|12/31/9999|$105.12|0|0|||SKIN FULL GRAFT ADD-ON|| 58-1699775|1326041732|CHC13|15240||11/01/2013|12/31/9999|$1|150.77|0|0|||SKIN FULL GRFT FACE/GENIT/HF|| 58-1699775|1326041732|CHC13|15241||11/01/2013|12/31/9999|$163.33|0|0|||SKIN FULL GRAFT ADD-ON|| 58-1699775|1326041732|CHC13|15260||11/01/2013|12/31/9999|$1|238.43|0|0|||SKIN FULL GRAFT EEN & LIPS|| 58-1699775|1326041732|CHC13|15261||11/01/2013|12/31/9999|$206.12|0|0|||SKIN FULL GRAFT ADD-ON|| 58-1699775|1326041732|CHC13|15271||11/01/2013|12/31/9999|$126.48|0|0|||SKIN SUB GRAFT TRNK/ARM/LEG|| 58-1699775|1326041732|CHC13|15272||11/01/2013|12/31/9999|$25.16|0|0|||SKIN SUB GRAFT T/A/L ADD-ON|| 58-1699775|1326041732|CHC13|15273||11/01/2013|12/31/9999|$301.15|0|0|||SKIN SUB GRFT T/ARM/LG CHILD|| 58-1699775|1326041732|CHC13|15274||11/01/2013|12/31/9999|$63.92|0|0|||SKN SUB GRFT T/A/L CHILD ADD|| 58-1699775|1326041732|CHC13|15275||11/01/2013|12/31/9999|$147.09|0|0|||SKIN SUB GRAFT FACE/NK/HF/G|| 58-1699775|1326041732|CHC13|15276||11/01/2013|12/31/9999|$36.17|0|0|||SKIN SUB GRAFT F/N/HF/G ADDL|| 58-1699775|1326041732|CHC13|15277||11/01/2013|12/31/9999|$312.87|0|0|||SKN SUB GRFT F/N/HF/G CHILD|| 58-1699775|1326041732|CHC13|15278||11/01/2013|12/31/9999|$79.22|0|0|||SKN SUB GRFT F/N/HF/G CH ADD|| 58-1699775|1326041732|CHC13|15570||11/01/2013|12/31/9999|$1|053.55|0|0|||FORM SKIN PEDICLE FLAP|| 58-1699775|1326041732|CHC13|15572||11/01/2013|12/31/9999|$1|064.16|0|0|||FORM SKIN PEDICLE FLAP|| 58-1699775|1326041732|CHC13|15574||11/01/2013|12/31/9999|$1|102.03|0|0|||FORM SKIN PEDICLE FLAP|| 58-1699775|1326041732|CHC13|15576||11/01/2013|12/31/9999|$969.05|0|0|||FORM SKIN PEDICLE FLAP|| 58-1699775|1326041732|CHC13|15600||11/01/2013|12/31/9999|$295.31|0|0|||SKIN GRAFT|| 58-1699775|1326041732|CHC13|15610||11/01/2013|12/31/9999|$343.92|0|0|||SKIN GRAFT|| 58-1699775|1326041732|CHC13|15620||11/01/2013|12/31/9999|$463.36|0|0|||SKIN GRAFT|| 58-1699775|1326041732|CHC13|15630||11/01/2013|12/31/9999|$497.24|0|0|||SKIN GRAFT|| 58-1699775|1326041732|CHC13|15650||11/01/2013|12/31/9999|$553.30|0|0|||TRANSFER SKIN PEDICLE FLAP|| 58-1699775|1326041732|CHC13|15730||04/01/2018|12/31/9999|$2|238.38|0|0|0||MDFC FLAP W/PRSRV VASC PEDCL|| 58-1699775|1326041732|CHC13|15731||11/01/2013|12/31/9999|$1|472.38|0|0|||FOREHEAD FLAP W/VASC PEDICLE|| 58-1699775|1326041732|CHC13|15732||11/01/2013|12/31/9999|$1|648.61|0|0|||MUSCLE-SKIN GRAFT| HEAD/NECK|| 58-1699775|1326041732|CHC13|15733||04/01/2018|12/31/9999|$1|570.24|0|0|0||MUSC MYOQ/FSCQ FLP H&N PEDCL|| 58-1699775|1326041732|CHC13|15734||11/01/2013|12/31/9999|$1|931.56|0|0|||MUSCLE-SKIN GRAFT| TRUNK|| 58-1699775|1326041732|CHC13|15736||11/01/2013|12/31/9999|$1|671.54|0|0|||MUSCLE-SKIN GRAFT| ARM|| 58-1699775|1326041732|CHC13|15738||11/01/2013|12/31/9999|$1|811.94|0|0|||MUSCLE-SKIN GRAFT| LEG|| 58-1699775|1326041732|CHC13|15740||11/01/2013|12/31/9999|$1|235.14|0|0|||ISLAND PEDICLE FLAP GRAFT|| 58-1699775|1326041732|CHC13|15750||11/01/2013|12/31/9999|$1|316.71|0|0|||NEUROVASCULAR PEDICLE GRAFT|| 58-1699775|1326041732|CHC13|15756||11/01/2013|12/31/9999|$3|423.44|0|0|||FREE MYO/SKIN FLAP MICROVASC|| 58-1699775|1326041732|CHC13|15757||11/01/2013|12/31/9999|$3|366.09|0|0|||FREE SKIN FLAP| MICROVASC|| 58-1699775|1326041732|CHC13|15758||11/01/2013|12/31/9999|$3|371.21|0|0|||FREE FASCIAL FLAP| MICROVASC|| 58-1699775|1326041732|CHC13|15760||11/01/2013|12/31/9999|$1|024.38|0|0|||COMPOSITE SKIN GRAFT|| 58-1699775|1326041732|CHC13|15770||11/01/2013|12/31/9999|$964.30|0|0|||DERMA-FAT-FASCIA GRAFT|| 58-1699775|1326041732|CHC13|15775||11/01/2013|12/31/9999|$308.03|0|0|||HAIR TRANSPLANT PUNCH GRAFTS|| 58-1699775|1326041732|CHC13|15776||11/01/2013|12/31/9999|$426.43|0|0|||HAIR TRANSPLANT PUNCH GRAFTS|| 58-1699775|1326041732|CHC13|15777||04/01/2014|12/31/9999|$316.13|0|0|||ACELLULAR DERM MATRIX IMPLT|| 58-1699775|1326041732|CHC13|15780||11/01/2013|12/31/9999|$902.84|0|0|||ABRASION TREATMENT OF SKIN|| 58-1699775|1326041732|CHC13|15781||11/01/2013|12/31/9999|$613.71|0|0|||ABRASION TREATMENT OF SKIN|| 58-1699775|1326041732|CHC13|15782||11/01/2013|12/31/9999|$604.99|0|0|||ABRASION TREATMENT OF SKIN|| 58-1699775|1326041732|CHC13|15783||11/01/2013|12/31/9999|$532.39|0|0|||ABRASION TREATMENT OF SKIN|| 58-1699775|1326041732|CHC13|15786||11/01/2013|12/31/9999|$198.40|0|0|||ABRASION| LESION| SINGLE|| 58-1699775|1326041732|CHC13|15787||11/01/2013|12/31/9999|$25.62|0|0|||ABRASION| LESIONS| ADD-ON|| 58-1699775|1326041732|CHC13|15788||11/01/2013|12/31/9999|$349.78|0|0|||CHEMICAL PEEL| FACE| EPIDERM|| 58-1699775|1326041732|CHC13|15789||11/01/2013|12/31/9999|$600.18|0|0|||CHEMICAL PEEL| FACE| DERMAL|| 58-1699775|1326041732|CHC13|15792||11/01/2013|12/31/9999|$368.68|0|0|||CHEMICAL PEEL| NONFACIAL|| 58-1699775|1326041732|CHC13|15793||11/01/2013|12/31/9999|$516.19|0|0|||CHEMICAL PEEL| NONFACIAL|| 58-1699775|1326041732|CHC13|15819||11/01/2013|12/31/9999|$1|084.77|0|0|||PLASTIC SURGERY| NECK|| 58-1699775|1326041732|CHC13|15820||11/01/2013|12/31/9999|$730.99|0|0|||REVISION OF LOWER EYELID|| 58-1699775|1326041732|CHC13|15821||11/01/2013|12/31/9999|$778.11|0|0|||REVISION OF LOWER EYELID|| 58-1699775|1326041732|CHC13|15822||11/01/2013|12/31/9999|$553.49|0|0|||REVISION OF UPPER EYELID|| 58-1699775|1326041732|CHC13|15823||11/01/2013|12/31/9999|$788.41|0|0|||REVISION OF UPPER EYELID|| 58-1699775|1326041732|CHC13|15824||11/01/2013|12/31/9999|$1|636.99|0|0|||REMOVAL OF FOREHEAD WRINKLES|| 58-1699775|1326041732|CHC13|15825||11/01/2013|12/31/9999|$1|841.92|0|0|||REMOVAL OF NECK WRINKLES|| 58-1699775|1326041732|CHC13|15826||11/01/2013|12/31/9999|$1|330.34|0|0|||REMOVAL OF BROW WRINKLES|| 58-1699775|1326041732|CHC13|15828||11/01/2013|12/31/9999|$3|479.37|0|0|||REMOVAL OF FACE WRINKLES|| 58-1699775|1326041732|CHC13|15829||11/01/2013|12/31/9999|$3|888.26|0|0|||REMOVAL OF SKIN WRINKLES|| 58-1699775|1326041732|CHC13|15830||11/01/2013|12/31/9999|$1|682.49|0|0|||EXC SKIN ABD|| 58-1699775|1326041732|CHC13|15832||11/01/2013|12/31/9999|$1|300.52|0|0|||EXCISE EXCESSIVE SKIN TISSUE|| 58-1699775|1326041732|CHC13|15833||11/01/2013|12/31/9999|$1|256.69|0|0|||EXCISE EXCESSIVE SKIN TISSUE|| 58-1699775|1326041732|CHC13|15834||11/01/2013|12/31/9999|$1|274.25|0|0|||EXCISE EXCESSIVE SKIN TISSUE|| 58-1699775|1326041732|CHC13|15835||11/01/2013|12/31/9999|$1|226.04|0|0|||EXCISE EXCESSIVE SKIN TISSUE|| 58-1699775|1326041732|CHC13|15836||11/01/2013|12/31/9999|$1|078.57|0|0|||EXCISE EXCESSIVE SKIN TISSUE|| 58-1699775|1326041732|CHC13|15837||11/01/2013|12/31/9999|$1|013.80|0|0|||EXCISE EXCESSIVE SKIN TISSUE|| 58-1699775|1326041732|CHC13|15838||11/01/2013|12/31/9999|$826.31|0|0|||EXCISE EXCESSIVE SKIN TISSUE|| 58-1699775|1326041732|CHC13|15839||11/01/2013|12/31/9999|$1|052.55|0|0|||EXCISE EXCESSIVE SKIN TISSUE|| 58-1699775|1326041732|CHC13|15840||11/01/2013|12/31/9999|$1|471.87|0|0|||GRAFT FOR FACE NERVE PALSY|| 58-1699775|1326041732|CHC13|15841||11/01/2013|12/31/9999|$2|344.90|0|0|||GRAFT FOR FACE NERVE PALSY|| 58-1699775|1326041732|CHC13|15842||11/01/2013|12/31/9999|$3|601.16|0|0|||FLAP FOR FACE NERVE PALSY|| 58-1699775|1326041732|CHC13|15845||11/01/2013|12/31/9999|$1|413.42|0|0|||SKIN AND MUSCLE REPAIR| FACE|| 58-1699775|1326041732|CHC13|15847||11/01/2013|12/31/9999|$716.50|0|0|||EXC SKIN ABD ADD-ON|| 58-1699775|1326041732|CHC13|15850||11/01/2013|12/31/9999|$56.86|0|0|||REMOVAL OF SUTURES|| 58-1699775|1326041732|CHC13|15851||11/01/2013|12/31/9999|$67.02|0|0|||REMOVAL OF SUTURES|| 58-1699775|1326041732|CHC13|15852||11/01/2013|12/31/9999|$67.96|0|0|||DRESSING CHANGE NOT FOR BURN|| 58-1699775|1326041732|CHC13|15860||11/01/2013|12/31/9999|$160.66|0|0|||TEST FOR BLOOD FLOW IN GRAFT|| 58-1699775|1326041732|CHC13|15876||11/01/2013|12/31/9999|$0.00|0|0|||SUCTION ASSISTED LIPECTOMY|| 58-1699775|1326041732|CHC13|15877||11/01/2013|12/31/9999|$0.00|0|0|||SUCTION ASSISTED LIPECTOMY|| 58-1699775|1326041732|CHC13|15878||11/01/2013|12/31/9999|$0.00|0|0|||SUCTION ASSISTED LIPECTOMY|| 58-1699775|1326041732|CHC13|15879||11/01/2013|12/31/9999|$0.00|0|0|||SUCTION ASSISTED LIPECTOMY|| 58-1699775|1326041732|CHC13|15920||11/01/2013|12/31/9999|$871.07|0|0|||REMOVAL OF TAIL BONE ULCER|| 58-1699775|1326041732|CHC13|15922||11/01/2013|12/31/9999|$1|119.48|0|0|||REMOVAL OF TAIL BONE ULCER|| 58-1699775|1326041732|CHC13|15931||11/01/2013|12/31/9999|$970.75|0|0|||REMOVE SACRUM PRESSURE SORE|| 58-1699775|1326041732|CHC13|15933||11/01/2013|12/31/9999|$1|200.20|0|0|||REMOVE SACRUM PRESSURE SORE|| 58-1699775|1326041732|CHC13|15934||11/01/2013|12/31/9999|$1|323.50|0|0|||REMOVE SACRUM PRESSURE SORE|| 58-1699775|1326041732|CHC13|15935||11/01/2013|12/31/9999|$1|588.13|0|0|||REMOVE SACRUM PRESSURE SORE|| 58-1699775|1326041732|CHC13|15936||11/01/2013|12/31/9999|$1|286.70|0|0|||REMOVE SACRUM PRESSURE SORE|| 58-1699775|1326041732|CHC13|15937||11/01/2013|12/31/9999|$1|497.50|0|0|||REMOVE SACRUM PRESSURE SORE|| 58-1699775|1326041732|CHC13|15940||11/01/2013|12/31/9999|$994.35|0|0|||REMOVE HIP PRESSURE SORE|| 58-1699775|1326041732|CHC13|15941||11/01/2013|12/31/9999|$1|286.63|0|0|||REMOVE HIP PRESSURE SORE|| 58-1699775|1326041732|CHC13|15944||11/01/2013|12/31/9999|$1|287.73|0|0|||REMOVE HIP PRESSURE SORE|| 58-1699775|1326041732|CHC13|15945||11/01/2013|12/31/9999|$1|425.13|0|0|||REMOVE HIP PRESSURE SORE|| 58-1699775|1326041732|CHC13|15946||11/01/2013|12/31/9999|$2|367.66|0|0|||REMOVE HIP PRESSURE SORE|| 58-1699775|1326041732|CHC13|15950||11/01/2013|12/31/9999|$830.56|0|0|||REMOVE THIGH PRESSURE SORE|| 58-1699775|1326041732|CHC13|15951||11/01/2013|12/31/9999|$1|250.80|0|0|||REMOVE THIGH PRESSURE SORE|| 58-1699775|1326041732|CHC13|15952||11/01/2013|12/31/9999|$1|304.67|0|0|||REMOVE THIGH PRESSURE SORE|| 58-1699775|1326041732|CHC13|15953||11/01/2013|12/31/9999|$1|428.21|0|0|||REMOVE THIGH PRESSURE SORE|| 58-1699775|1326041732|CHC13|15956||11/01/2013|12/31/9999|$1|663.45|0|0|||REMOVE THIGH PRESSURE SORE|| 58-1699775|1326041732|CHC13|15958||11/01/2013|12/31/9999|$1|695.75|0|0|||REMOVE THIGH PRESSURE SORE|| 58-1699775|1326041732|CHC13|15999||11/01/2013|12/31/9999|$0.00|0|0|||REMOVAL OF PRESSURE SORE|| 58-1699775|1326041732|CHC13|16000||11/01/2013|12/31/9999|$66.71|0|0|||INITIAL TREATMENT OF BURN(S)|| 58-1699775|1326041732|CHC13|16020||11/01/2013|12/31/9999|$76.29|0|0|||DRESS/DEBRID P-THICK BURN| S|| 58-1699775|1326041732|CHC13|16025||11/01/2013|12/31/9999|$160.35|0|0|||DRESS/DEBRID P-THICK BURN| M|| 58-1699775|1326041732|CHC13|16030||11/01/2013|12/31/9999|$190.21|0|0|||DRESS/DEBRID P-THICK BURN| L|| 58-1699775|1326041732|CHC13|16035||11/01/2013|12/31/9999|$290.95|0|0|||INCISION OF BURN SCAB| INITI|| 58-1699775|1326041732|CHC13|16036||11/01/2013|12/31/9999|$121.01|0|0|||ESCHAROTOMY; ADD'L INCISION|| 58-1699775|1326041732|CHC13|17000||11/01/2013|12/31/9999|$79.16|0|0|||DESTROY BENIGN/PREMLG LESION|| 58-1699775|1326041732|CHC13|17003||11/01/2013|12/31/9999|$6.34|0|0|||DESTROY LESIONS| 2-14|| 58-1699775|1326041732|CHC13|17004||11/01/2013|12/31/9999|$188.86|0|0|||DESTROY LESIONS| 15 OR MORE|| 58-1699775|1326041732|CHC13|17106||11/01/2013|12/31/9999|$392.32|0|0|||DESTRUCTION OF SKIN LESIONS|| 58-1699775|1326041732|CHC13|17107||11/01/2013|12/31/9999|$503.35|0|0|||DESTRUCTION OF SKIN LESIONS|| 58-1699775|1326041732|CHC13|17108||11/01/2013|12/31/9999|$753.50|0|0|||DESTRUCTION OF SKIN LESIONS|| 58-1699775|1326041732|CHC13|17110||11/01/2013|12/31/9999|$97.76|0|0|||DESTRUCT LESION| 1-14|| 58-1699775|1326041732|CHC13|17111||11/01/2013|12/31/9999|$182.21|0|0|||DESTRUCT LESION| 15 OR MORE|| 58-1699775|1326041732|CHC13|17250||11/01/2013|12/31/9999|$51.77|0|0|||CHEMICAL CAUTERY| TISSUE|| 58-1699775|1326041732|CHC13|17260||11/01/2013|12/31/9999|$98.71|0|0|||DESTRUCTION OF SKIN LESIONS|| 58-1699775|1326041732|CHC13|17261||11/01/2013|12/31/9999|$131.34|0|0|||DESTRUCTION OF SKIN LESIONS|| 58-1699775|1326041732|CHC13|17262||11/01/2013|12/31/9999|$167.02|0|0|||DESTRUCTION OF SKIN LESIONS|| 58-1699775|1326041732|CHC13|17263||11/01/2013|12/31/9999|$185.58|0|0|||DESTRUCTION OF SKIN LESIONS|| 58-1699775|1326041732|CHC13|17264||11/01/2013|12/31/9999|$198.33|0|0|||DESTRUCTION OF SKIN LESIONS|| 58-1699775|1326041732|CHC13|17266||11/01/2013|12/31/9999|$231.21|0|0|||DESTRUCTION OF SKIN LESIONS|| 58-1699775|1326041732|CHC13|17270||11/01/2013|12/31/9999|$143.15|0|0|||DESTRUCTION OF SKIN LESIONS|| 58-1699775|1326041732|CHC13|17271||11/01/2013|12/31/9999|$159.67|0|0|||DESTRUCTION OF SKIN LESIONS|| 58-1699775|1326041732|CHC13|17272||11/01/2013|12/31/9999|$184.10|0|0|||DESTRUCTION OF SKIN LESIONS|| 58-1699775|1326041732|CHC13|17273||11/01/2013|12/31/9999|$208.09|0|0|||DESTRUCTION OF SKIN LESIONS|| 58-1699775|1326041732|CHC13|17274||11/01/2013|12/31/9999|$254.56|0|0|||DESTRUCTION OF SKIN LESIONS|| 58-1699775|1326041732|CHC13|17276||11/01/2013|12/31/9999|$306.51|0|0|||DESTRUCTION OF SKIN LESIONS|| 58-1699775|1326041732|CHC13|17280||11/01/2013|12/31/9999|$129.96|0|0|||DESTRUCTION OF SKIN LESIONS|| 58-1699775|1326041732|CHC13|17281||11/01/2013|12/31/9999|$179.71|0|0|||DESTRUCTION OF SKIN LESIONS|| 58-1699775|1326041732|CHC13|17282||11/01/2013|12/31/9999|$207.58|0|0|||DESTRUCTION OF SKIN LESIONS|| 58-1699775|1326041732|CHC13|17283||11/01/2013|12/31/9999|$259.42|0|0|||DESTRUCTION OF SKIN LESIONS|| 58-1699775|1326041732|CHC13|17284||11/01/2013|12/31/9999|$302.06|0|0|||DESTRUCTION OF SKIN LESIONS|| 58-1699775|1326041732|CHC13|17286||11/01/2013|12/31/9999|$414.07|0|0|||DESTRUCTION OF SKIN LESIONS|| 58-1699775|1326041732|CHC13|17311||11/01/2013|12/31/9999|$548.96|0|0|||MOHS| 1 STAGE| H/N/HF/G|| 58-1699775|1326041732|CHC13|17312||11/01/2013|12/31/9999|$291.59|0|0|||MOHS ADDL STAGE|| 58-1699775|1326041732|CHC13|17313||11/01/2013|12/31/9999|$492.30|0|0|||MOHS| 1 STAGE| T/A/L|| 58-1699775|1326041732|CHC13|17314||11/01/2013|12/31/9999|$270.58|0|0|||MOHS| ADDL STAGE| T/A/L|| 58-1699775|1326041732|CHC13|17315||11/01/2013|12/31/9999|$76.68|0|0|||MOHS SURG| ADDL BLOCK|| 58-1699775|1326041732|CHC13|17340||11/01/2013|12/31/9999|$68.81|0|0|||CRYOTHERAPY OF SKIN|| 58-1699775|1326041732|CHC13|17360||11/01/2013|12/31/9999|$141.82|0|0|||SKIN PEEL THERAPY|| 58-1699775|1326041732|CHC13|17380||11/01/2013|12/31/9999|$108.05|0|0|||HAIR REMOVAL BY ELECTROLYSIS|| 58-1699775|1326041732|CHC13|17999||11/01/2013|12/31/9999|$0.00|0|0|||SKIN TISSUE PROCEDURE|| 58-1699775|1326041732|CHC13|19000||11/01/2013|12/31/9999|$63.23|0|0|||DRAINAGE OF BREAST LESION|| 58-1699775|1326041732|CHC13|19001||11/01/2013|12/31/9999|$31.15|0|0|||DRAIN BREAST LESION ADD-ON|| 58-1699775|1326041732|CHC13|19020||11/01/2013|12/31/9999|$426.90|0|0|||INCISION OF BREAST LESION|| 58-1699775|1326041732|CHC13|19030||11/01/2013|12/31/9999|$111.34|0|0|||INJECTION FOR BREAST X-RAY|| 58-1699775|1326041732|CHC13|19081||04/01/2014|12/31/9999|$271.17|0|0|||BX BREAST 1ST LESION STRTCTC|| 58-1699775|1326041732|CHC13|19082||04/01/2014|12/31/9999|$129.47|0|0|||BX BREAST ADD LESION STRTCTC|| 58-1699775|1326041732|CHC13|19083||04/01/2014|12/31/9999|$254.13|0|0|||BX BREAST 1ST LESION US IMAG|| 58-1699775|1326041732|CHC13|19084||04/01/2014|12/31/9999|$121.65|0|0|||BX BREAST ADD LESION US IMAG|| 58-1699775|1326041732|CHC13|19085||04/01/2014|12/31/9999|$296.76|0|0|||BX BREAST 1ST LESION MR IMAG|| 58-1699775|1326041732|CHC13|19086||04/01/2014|12/31/9999|$133.11|0|0|||BX BREAST ADD LESION MR IMAG|| 58-1699775|1326041732|CHC13|19100||11/01/2013|12/31/9999|$100.08|0|0|||BX BREAST PERCUT W/O IMAGE|| 58-1699775|1326041732|CHC13|19101||11/01/2013|12/31/9999|$313.11|0|0|||BIOPSY OF BREAST| OPEN|| 58-1699775|1326041732|CHC13|19105||11/01/2013|12/31/9999|$285.74|0|0|||CRYOSURG ABLATE FA| EACH|| 58-1699775|1326041732|CHC13|19110||11/01/2013|12/31/9999|$477.99|0|0|||NIPPLE EXPLORATION|| 58-1699775|1326041732|CHC13|19112||11/01/2013|12/31/9999|$435.08|0|0|||EXCISE BREAST DUCT FISTULA|| 58-1699775|1326041732|CHC13|19120||11/01/2013|12/31/9999|$580.18|0|0|||REMOVAL OF BREAST LESION|| 58-1699775|1326041732|CHC13|19125||11/01/2013|12/31/9999|$644.97|0|0|||EXCISION| BREAST LESION|| 58-1699775|1326041732|CHC13|19126||11/01/2013|12/31/9999|$231.71|0|0|||EXCISION| ADDL BREAST LESION|| 58-1699775|1326041732|CHC13|19260||11/01/2013|12/31/9999|$1|724.91|0|0|||REMOVAL OF CHEST WALL LESION|| 58-1699775|1326041732|CHC13|19271||11/01/2013|12/31/9999|$2|340.99|0|0|||REVISION OF CHEST WALL|| 58-1699775|1326041732|CHC13|19272||11/01/2013|12/31/9999|$2|584.86|0|0|||EXTENSIVE CHEST WALL SURGERY|| 58-1699775|1326041732|CHC13|19281||04/01/2014|12/31/9999|$152.57|0|0|||PERQ DEVICE BREAST 1ST IMAG|| 58-1699775|1326041732|CHC13|19282||04/01/2014|12/31/9999|$73.08|0|0|||PERQ DEVICE BREAST EA IMAG|| 58-1699775|1326041732|CHC13|19283||04/01/2014|12/31/9999|$154.02|0|0|||PERQ DEV BREAST 1ST STRTCTC|| 58-1699775|1326041732|CHC13|19284||04/01/2014|12/31/9999|$73.56|0|0|||PERQ DEV BREAST ADD STRTCTC|| 58-1699775|1326041732|CHC13|19285||04/01/2014|12/31/9999|$130.62|0|0|||PERQ DEV BREAST 1ST US IMAG|| 58-1699775|1326041732|CHC13|19286||04/01/2014|12/31/9999|$63.09|0|0|||PERQ DEV BREAST ADD US IMAG|| 58-1699775|1326041732|CHC13|19287||04/01/2014|12/31/9999|$211.44|0|0|||PERQ DEV BREAST 1ST MR GUIDE|| 58-1699775|1326041732|CHC13|19288||04/01/2014|12/31/9999|$94.43|0|0|||PERQ DEV BREAST ADD MR GUIDE|| 58-1699775|1326041732|CHC13|19294||04/01/2018|12/31/9999|$250.76|0|0|0||PREP TUM CAV IORT PRTL MAST|| 58-1699775|1326041732|CHC13|19296||11/01/2013|12/31/9999|$300.62|0|0|||PLACE PO BREAST CATH FOR RAD|| 58-1699775|1326041732|CHC13|19297||11/01/2013|12/31/9999|$135.58|0|0|||PLACE BREAST CATH FOR RAD|| 58-1699775|1326041732|CHC13|19298||11/01/2013|12/31/9999|$462.47|0|0|||PLACE BREAST RAD TUBE/CATHS|| 58-1699775|1326041732|CHC13|19300||11/01/2013|12/31/9999|$573.61|0|0|||REMOVAL OF BREAST TISSUE|| 58-1699775|1326041732|CHC13|19301||11/01/2013|12/31/9999|$918.46|0|0|||PARTICAL MASTECTOMY|| 58-1699775|1326041732|CHC13|19302||11/01/2013|12/31/9999|$1|269.94|0|0|||P-MASTECTOMY W/LN REMOVAL|| 58-1699775|1326041732|CHC13|19303||11/01/2013|12/31/9999|$1|423.75|0|0|||MAST| SIMPLE| COMPLETE|| 58-1699775|1326041732|CHC13|19304||11/01/2013|12/31/9999|$806.88|0|0|||MAST| SUBQ|| 58-1699775|1326041732|CHC13|19305||11/01/2013|12/31/9999|$1|601.85|0|0|||MAST| RADICAL|| 58-1699775|1326041732|CHC13|19306||11/01/2013|12/31/9999|$1|693.13|0|0|||MAST| RAD| URBAN TYPE|| 58-1699775|1326041732|CHC13|19307||11/01/2013|12/31/9999|$1|688.60|0|0|||MAST| MOD RAD|| 58-1699775|1326041732|CHC13|19316||11/01/2013|12/31/9999|$1|115.17|0|0|||SUSPENSION OF BREAST|| 58-1699775|1326041732|CHC13|19318||11/01/2013|12/31/9999|$1|611.87|0|0|||REDUCTION OF LARGE BREAST|| 58-1699775|1326041732|CHC13|19324||11/01/2013|12/31/9999|$693.74|0|0|||ENLARGE BREAST|| 58-1699775|1326041732|CHC13|19325||11/01/2013|12/31/9999|$932.92|0|0|||ENLARGE BREAST WITH IMPLANT|| 58-1699775|1326041732|CHC13|19328||11/01/2013|12/31/9999|$713.35|0|0|||REMOVAL OF BREAST IMPLANT|| 58-1699775|1326041732|CHC13|19330||11/01/2013|12/31/9999|$912.18|0|0|||REMOVAL OF IMPLANT MATERIAL|| 58-1699775|1326041732|CHC13|19340||11/01/2013|12/31/9999|$1|365.42|0|0|||IMMEDIATE BREAST PROSTHESIS|| 58-1699775|1326041732|CHC13|19342||11/01/2013|12/31/9999|$1|336.31|0|0|||DELAYED BREAST PROSTHESIS|| 58-1699775|1326041732|CHC13|19350||11/01/2013|12/31/9999|$974.94|0|0|||BREAST RECONSTRUCTION|| 58-1699775|1326041732|CHC13|19355||11/01/2013|12/31/9999|$812.37|0|0|||CORRECT INVERTED NIPPLE(S)|| 58-1699775|1326041732|CHC13|19357||11/01/2013|12/31/9999|$2|155.45|0|0|||BREAST RECONSTRUCTION|| 58-1699775|1326041732|CHC13|19361||11/01/2013|12/31/9999|$2|326.68|0|0|||BREAST RECONSTRUCTION|| 58-1699775|1326041732|CHC13|19364||11/01/2013|12/31/9999|$4|036.15|0|0|||BREAST RECONSTRUCTION|| 58-1699775|1326041732|CHC13|19366||11/01/2013|12/31/9999|$1|993.49|0|0|||BREAST RECONSTRUCTION|| 58-1699775|1326041732|CHC13|19367||11/01/2013|12/31/9999|$2|616.59|0|0|||BREAST RECONSTRUCTION|| 58-1699775|1326041732|CHC13|19368||11/01/2013|12/31/9999|$3|231.57|0|0|||BREAST RECONSTRUCTION|| 58-1699775|1326041732|CHC13|19369||11/01/2013|12/31/9999|$2|991.25|0|0|||BREAST RECONSTRUCTION|| 58-1699775|1326041732|CHC13|19370||11/01/2013|12/31/9999|$990.87|0|0|||SURGERY OF BREAST CAPSULE|| 58-1699775|1326041732|CHC13|19371||11/01/2013|12/31/9999|$1|134.54|0|0|||REMOVAL OF BREAST CAPSULE|| 58-1699775|1326041732|CHC13|19380||11/01/2013|12/31/9999|$1|117.80|0|0|||REVISE BREAST RECONSTRUCTION|| 58-1699775|1326041732|CHC13|19396||11/01/2013|12/31/9999|$210.06|0|0|||DESIGN CUSTOM BREAST IMPLANT|| 58-1699775|1326041732|CHC13|19499||11/01/2013|12/31/9999|$0.00|0|0|||BREAST SURGERY PROCEDURE|| 58-1699775|1326041732|CHC13|20005||11/01/2013|12/31/9999|$330.86|0|0|||INCISION OF DEEP ABSCESS|| 58-1699775|1326041732|CHC13|2000F||11/01/2013|12/31/9999|$0.00|0|0|||BLOOD PRESSURE MEASURE|| 58-1699775|1326041732|CHC13|2001F||11/01/2013|12/31/9999|$0.00|0|0|||WEIGHT RECORD|| 58-1699775|1326041732|CHC13|2002F||11/01/2013|12/31/9999|$0.00|0|0|||CLIN SIGN VOL OVRLD ASSESS|| 58-1699775|1326041732|CHC13|2004F||11/01/2013|12/31/9999|$0.00|0|0|||INITIAL EXAM INVOLVED JOINTS|| 58-1699775|1326041732|CHC13|20100||11/01/2013|12/31/9999|$865.83|0|0|||EXPLORE WOUND| NECK|| 58-1699775|1326041732|CHC13|20101||11/01/2013|12/31/9999|$296.64|0|0|||EXPLORE WOUND| CHEST|| 58-1699775|1326041732|CHC13|20102||11/01/2013|12/31/9999|$360.77|0|0|||EXPLORE WOUND| ABDOMEN|| 58-1699775|1326041732|CHC13|20103||11/01/2013|12/31/9999|$504.32|0|0|||EXPLORE WOUND| EXTREMITY|| 58-1699775|1326041732|CHC13|2010F||11/01/2013|12/31/9999|$0.00|0|0|||VITAL SIGNS RECORDED|| 58-1699775|1326041732|CHC13|2014F||11/01/2013|12/31/9999|$0.00|0|0|||MENTAL STATUS ASSESS|| 58-1699775|1326041732|CHC13|20150||11/01/2013|12/31/9999|$1|424.67|0|0|||EXCISE EPIPHYSEAL BAR|| 58-1699775|1326041732|CHC13|2015F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|2016F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|2018F||11/01/2013|12/31/9999|$0.00|0|0|||HYDRATION STATUS ASSESS|| 58-1699775|1326041732|CHC13|2019F||11/01/2013|12/31/9999|$0.00|0|0|||DILATED MACUL EXAM DONE|| 58-1699775|1326041732|CHC13|20200||11/01/2013|12/31/9999|$136.03|0|0|||MUSCLE BIOPSY|| 58-1699775|1326041732|CHC13|20205||11/01/2013|12/31/9999|$218.96|0|0|||DEEP MUSCLE BIOPSY|| 58-1699775|1326041732|CHC13|20206||11/01/2013|12/31/9999|$85.09|0|0|||NEEDLE BIOPSY| MUSCLE|| 58-1699775|1326041732|CHC13|2020F||11/01/2013|12/31/9999|$0.00|0|0|||DILATED FUNDUS EVAL DONE|| 58-1699775|1326041732|CHC13|2021F||11/01/2013|12/31/9999|$0.00|0|0|||DILAT MACUL+ EXAM DONE|| 58-1699775|1326041732|CHC13|20220||11/01/2013|12/31/9999|$104.90|0|0|||BONE BIOPSY| TROCAR/NEEDLE|| 58-1699775|1326041732|CHC13|20225||11/01/2013|12/31/9999|$160.02|0|0|||BONE BIOPSY| TROCAR/NEEDLE|| 58-1699775|1326041732|CHC13|2022F||11/01/2013|12/31/9999|$0.00|0|0|||DIL RETINA EXAM INTERP REV|| 58-1699775|1326041732|CHC13|20240||11/01/2013|12/31/9999|$316.81|0|0|||BONE BIOPSY| EXCISIONAL|| 58-1699775|1326041732|CHC13|20245||11/01/2013|12/31/9999|$895.96|0|0|||BONE BIOPSY| EXCISIONAL|| 58-1699775|1326041732|CHC13|2024F||11/01/2013|12/31/9999|$0.00|0|0|||7 FIELD PHOTO INTERP DOC REV|| 58-1699775|1326041732|CHC13|20250||11/01/2013|12/31/9999|$544.69|0|0|||OPEN BONE BIOPSY|| 58-1699775|1326041732|CHC13|20251||11/01/2013|12/31/9999|$591.16|0|0|||OPEN BONE BIOPSY|| 58-1699775|1326041732|CHC13|2026F||11/01/2013|12/31/9999|$0.00|0|0|||EYE IMAGE VALID TO DX REV|| 58-1699775|1326041732|CHC13|2027F||11/01/2013|12/31/9999|$0.00|0|0|||OPTIC NERVE HEAD EVAL DONE|| 58-1699775|1326041732|CHC13|2028F||11/01/2013|12/31/9999|$0.00|0|0|||FOOT EXAM PERFORMED|| 58-1699775|1326041732|CHC13|2029F||11/01/2013|12/31/9999|$0.00|0|0|||COMPLETE PHYS SKIN EXAM DONE|| 58-1699775|1326041732|CHC13|2030F||11/01/2013|12/31/9999|$0.00|0|0|||H20 STAT DOC'D| NORMAL|| 58-1699775|1326041732|CHC13|2031F||11/01/2013|12/31/9999|$0.00|0|0|||H2O STAT DOC'D| DEHYDRATED|| 58-1699775|1326041732|CHC13|2035F||11/01/2013|12/31/9999|$0.00|0|0|||TYMP MEMB MOTION EXAM'D|| 58-1699775|1326041732|CHC13|2040F||11/01/2013|12/31/9999|$0.00|0|0|||BK PN XM ON INIT VISIT DATE|| 58-1699775|1326041732|CHC13|2044F||11/01/2013|12/31/9999|$0.00|0|0|||DOC MNTL TST B/4 BK TRXMNT|| 58-1699775|1326041732|CHC13|20500||11/01/2013|12/31/9999|$124.68|0|0|||INJECTION OF SINUS TRACT|| 58-1699775|1326041732|CHC13|20501||11/01/2013|12/31/9999|$55.42|0|0|||INJECT SINUS TRACT FOR X-RAY|| 58-1699775|1326041732|CHC13|2050F||11/01/2013|12/31/9999|$0.00|0|0|||WOUND CHAR SIZE ETC DOCD|| 58-1699775|1326041732|CHC13|20520||11/01/2013|12/31/9999|$207.04|0|0|||REMOVAL OF FOREIGN BODY|| 58-1699775|1326041732|CHC13|20525||11/01/2013|12/31/9999|$356.40|0|0|||REMOVAL OF FOREIGN BODY|| 58-1699775|1326041732|CHC13|20526||11/01/2013|12/31/9999|$81.22|0|0|||THER INJECTION| CARP TUNNEL|| 58-1699775|1326041732|CHC13|20527||11/01/2013|12/31/9999|$85.67|0|0|||INJ DUPUYTREN CORD W/ENZYME|| 58-1699775|1326041732|CHC13|20550||11/01/2013|12/31/9999|$59.05|0|0|||INJ TENDON SHEATH/LIGAMENT|| 58-1699775|1326041732|CHC13|20551||11/01/2013|12/31/9999|$60.88|0|0|||INJ TENDON ORIGIN/INSERTION|| 58-1699775|1326041732|CHC13|20552||11/01/2013|12/31/9999|$53.52|0|0|||INJ TRIGGER POINT| 1/2 MUSCL|| 58-1699775|1326041732|CHC13|20553||11/01/2013|12/31/9999|$60.41|0|0|||INJECT TRIGGER POINTS| =/> 3|| 58-1699775|1326041732|CHC13|20555||11/01/2013|12/31/9999|$476.84|0|0|||PLACE NDL MUSC/TIS FOR RT|| 58-1699775|1326041732|CHC13|20600||11/01/2013|12/31/9999|$55.35|0|0|||DRAIN/INJECT| JOINT/BURSA|| 58-1699775|1326041732|CHC13|20604||04/01/2015|12/31/9999|$68.62|0|0|0||DRAIN/INJ JOINT/BURSA W/US|| 58-1699775|1326041732|CHC13|20605||11/01/2013|12/31/9999|$58.22|0|0|||DRAIN/INJECT| JOINT/BURSA|| 58-1699775|1326041732|CHC13|20606||04/01/2015|12/31/9999|$78.40|0|0|0||DRAIN/INJ JOINT/BURSA W/US|| 58-1699775|1326041732|CHC13|2060F||11/01/2013|12/31/9999|$0.00|0|0|||PT TALK EVAL HLTHWKR RE MDD|| 58-1699775|1326041732|CHC13|20610||11/01/2013|12/31/9999|$98.29|0|0|||DRAIN/INJECT| JOINT/BURSA|| 58-1699775|1326041732|CHC13|20611||04/01/2015|12/31/9999|$92.00|0|0|0||DRAIN/INJ JOINT/BURSA W/US|| 58-1699775|1326041732|CHC13|20612||11/01/2013|12/31/9999|$83.09|0|0|||ASPIRATE/INJ GANGLION CYST|| 58-1699775|1326041732|CHC13|20615||11/01/2013|12/31/9999|$227.15|0|0|||TREATMENT OF BONE CYST|| 58-1699775|1326041732|CHC13|20650||11/01/2013|12/31/9999|$217.26|0|0|||INSERT AND REMOVE BONE PIN|| 58-1699775|1326041732|CHC13|20660||11/01/2013|12/31/9999|$350.79|0|0|||APPLY| REM FIXATION DEVICE|| 58-1699775|1326041732|CHC13|20661||11/01/2013|12/31/9999|$707.56|0|0|||APPLICATION OF HEAD BRACE|| 58-1699775|1326041732|CHC13|20662||11/01/2013|12/31/9999|$620.11|0|0|||APPLICATION OF PELVIS BRACE|| 58-1699775|1326041732|CHC13|20663||11/01/2013|12/31/9999|$580.91|0|0|||APPLICATION OF THIGH BRACE|| 58-1699775|1326041732|CHC13|20664||11/01/2013|12/31/9999|$1|221.10|0|0|||HALO BRACE APPLICATION|| 58-1699775|1326041732|CHC13|20665||11/01/2013|12/31/9999|$127.37|0|0|||REMOVAL OF FIXATION DEVICE|| 58-1699775|1326041732|CHC13|20670||11/01/2013|12/31/9999|$209.68|0|0|||REMOVAL OF SUPPORT IMPLANT|| 58-1699775|1326041732|CHC13|20680||11/01/2013|12/31/9999|$605.31|0|0|||REMOVAL OF SUPPORT IMPLANT|| 58-1699775|1326041732|CHC13|20690||11/01/2013|12/31/9999|$830.38|0|0|||APPLY BONE FIXATION DEVICE|| 58-1699775|1326041732|CHC13|20692||11/01/2013|12/31/9999|$1|569.01|0|0|||APPLY BONE FIXATION DEVICE|| 58-1699775|1326041732|CHC13|20693||11/01/2013|12/31/9999|$645.29|0|0|||ADJUST BONE FIXATION DEVICE|| 58-1699775|1326041732|CHC13|20694||11/01/2013|12/31/9999|$477.35|0|0|||REMOVE BONE FIXATION DEVICE|| 58-1699775|1326041732|CHC13|20696||11/01/2013|12/31/9999|$1|577.02|0|0|||COMP MULTIPLANE EXT FIXATION|| 58-1699775|1326041732|CHC13|20697||11/01/2013|12/31/9999|$2|623.02|0|0|||COMP EXT FIXATE STRUT CHANGE|| 58-1699775|1326041732|CHC13|20802||11/01/2013|12/31/9999|$3|319.12|0|0|||REPLANTATION| ARM| COMPLETE|| 58-1699775|1326041732|CHC13|20805||11/01/2013|12/31/9999|$4|169.65|0|0|||REPLANT FOREARM| COMPLETE|| 58-1699775|1326041732|CHC13|20808||11/01/2013|12/31/9999|$5|754.07|0|0|||REPLANTATION HAND| COMPLETE|| 58-1699775|1326041732|CHC13|20816||11/01/2013|12/31/9999|$3|035.75|0|0|||REPLANTATION DIGIT| COMPLETE|| 58-1699775|1326041732|CHC13|20822||11/01/2013|12/31/9999|$2|588.35|0|0|||REPLANTATION DIGIT| COMPLETE|| 58-1699775|1326041732|CHC13|20824||11/01/2013|12/31/9999|$3|144.26|0|0|||REPLANTATION THUMB| COMPLETE|| 58-1699775|1326041732|CHC13|20827||11/01/2013|12/31/9999|$2|673.09|0|0|||REPLANTATION THUMB| COMPLETE|| 58-1699775|1326041732|CHC13|20838||11/01/2013|12/31/9999|$3|680.40|0|0|||REPLANTATION FOOT| COMPLETE|| 58-1699775|1326041732|CHC13|20900||11/01/2013|12/31/9999|$314.50|0|0|||REMOVAL OF BONE FOR GRAFT|| 58-1699775|1326041732|CHC13|20902||11/01/2013|12/31/9999|$452.03|0|0|||REMOVAL OF BONE FOR GRAFT|| 58-1699775|1326041732|CHC13|20910||11/01/2013|12/31/9999|$638.76|0|0|||REMOVE CARTILAGE FOR GRAFT|| 58-1699775|1326041732|CHC13|20912||11/01/2013|12/31/9999|$695.34|0|0|||REMOVE CARTILAGE FOR GRAFT|| 58-1699775|1326041732|CHC13|20920||11/01/2013|12/31/9999|$572.60|0|0|||REMOVAL OF FASCIA FOR GRAFT|| 58-1699775|1326041732|CHC13|20922||11/01/2013|12/31/9999|$706.98|0|0|||REMOVAL OF FASCIA FOR GRAFT|| 58-1699775|1326041732|CHC13|20924||11/01/2013|12/31/9999|$719.31|0|0|||REMOVAL OF TENDON FOR GRAFT|| 58-1699775|1326041732|CHC13|20926||11/01/2013|12/31/9999|$622.93|0|0|||REMOVAL OF TISSUE FOR GRAFT|| 58-1699775|1326041732|CHC13|20930||11/01/2013|12/31/9999|$171.50|0|0|||SPINAL BONE ALLOGRAFT|| 58-1699775|1326041732|CHC13|20931||11/01/2013|12/31/9999|$162.96|0|0|||SPINAL BONE ALLOGRAFT|| 58-1699775|1326041732|CHC13|20936||11/01/2013|12/31/9999|$179.26|0|0|||SPINAL BONE AUTOGRAFT|| 58-1699775|1326041732|CHC13|20937||11/01/2013|12/31/9999|$243.90|0|0|||SPINAL BONE AUTOGRAFT|| 58-1699775|1326041732|CHC13|20938||11/01/2013|12/31/9999|$267.79|0|0|||SPINAL BONE AUTOGRAFT|| 58-1699775|1326041732|CHC13|20939||04/01/2018|12/31/9999|$102.29|0|0|0||BONE MARROW ASPIR BONE GRFG|| 58-1699775|1326041732|CHC13|20950||11/01/2013|12/31/9999|$129.33|0|0|||FLUID PRESSURE| MUSCLE|| 58-1699775|1326041732|CHC13|20955||11/01/2013|12/31/9999|$3|660.82|0|0|||FIBULA BONE GRAFT| MICROVASC|| 58-1699775|1326041732|CHC13|20956||11/01/2013|12/31/9999|$3|795.77|0|0|||ILIAC BONE GRAFT| MICROVASC|| 58-1699775|1326041732|CHC13|20957||11/01/2013|12/31/9999|$3|867.83|0|0|||MT BONE GRAFT| MICROVASC|| 58-1699775|1326041732|CHC13|20962||11/01/2013|12/31/9999|$3|280.10|0|0|||OTHER BONE GRAFT| MICROVASC|| 58-1699775|1326041732|CHC13|20969||11/01/2013|12/31/9999|$4|058.20|0|0|||BONE/SKIN GRAFT| MICROVASC|| 58-1699775|1326041732|CHC13|20970||11/01/2013|12/31/9999|$4|025.42|0|0|||BONE/SKIN GRAFT| ILIAC CREST|| 58-1699775|1326041732|CHC13|20972||11/01/2013|12/31/9999|$3|247.47|0|0|||BONE/SKIN GRAFT| METATARSAL|| 58-1699775|1326041732|CHC13|20973||11/01/2013|12/31/9999|$3|958.21|0|0|||BONE/SKIN GRAFT| GREAT TOE|| 58-1699775|1326041732|CHC13|20974||11/01/2013|12/31/9999|$69.89|0|0|||ELECTRICAL BONE STIMULATION|| 58-1699775|1326041732|CHC13|20975||11/01/2013|12/31/9999|$253.32|0|0|||ELECTRICAL BONE STIMULATION|| 58-1699775|1326041732|CHC13|20979||11/01/2013|12/31/9999|$48.28|0|0|||US BONE STIMULATION|| 58-1699775|1326041732|CHC13|20982||11/01/2013|12/31/9999|$552.59|0|0|||ABLATE| BONE TUMOR(S) PERQ|| 58-1699775|1326041732|CHC13|20983||04/01/2015|12/31/9999|$589.62|0|0|0||ABLATE BONE TUMOR(S) PERQ|| 58-1699775|1326041732|CHC13|20985||11/01/2013|12/31/9999|$213.21|0|0|||CPTR-ASST DIR MS PX|| 58-1699775|1326041732|CHC13|20999||11/01/2013|12/31/9999|$0.00|0|0|||MUSCULOSKELETAL SURGERY|| 58-1699775|1326041732|CHC13|21010||11/01/2013|12/31/9999|$1|054.13|0|0|||INCISION OF JAW JOINT|| 58-1699775|1326041732|CHC13|21011||11/01/2013|12/31/9999|$370.21|0|0|||EXC FACE LES SC < 2 CM|| 58-1699775|1326041732|CHC13|21012||11/01/2013|12/31/9999|$483.22|0|0|||EXC FACE LES SC = 2 CM|| 58-1699775|1326041732|CHC13|21013||11/01/2013|12/31/9999|$581.04|0|0|||EXC FACE TUM DEEP < 2 CM|| 58-1699775|1326041732|CHC13|21014||11/01/2013|12/31/9999|$750.02|0|0|||EXC FACE TUM DEEP = 2 CM|| 58-1699775|1326041732|CHC13|21015||04/01/2014|12/31/9999|$1|038.35|0|0|||RESECTION OF FACIAL TUMOR|| 58-1699775|1326041732|CHC13|21016||04/01/2014|12/31/9999|$1|518.63|0|0|||RESECT FACE TUM = 2 CM|| 58-1699775|1326041732|CHC13|21025||11/01/2013|12/31/9999|$1|064.49|0|0|||EXCISION OF BONE| LOWER JAW|| 58-1699775|1326041732|CHC13|21026||11/01/2013|12/31/9999|$702.64|0|0|||EXCISION OF FACIAL BONE(S)|| 58-1699775|1326041732|CHC13|21029||11/01/2013|12/31/9999|$925.14|0|0|||CONTOUR OF FACE BONE LESION|| 58-1699775|1326041732|CHC13|21030||11/01/2013|12/31/9999|$586.55|0|0|||EXCISE MAX/ZYGOMA B9 TUMOR|| 58-1699775|1326041732|CHC13|21031||11/01/2013|12/31/9999|$408.90|0|0|||REMOVE EXOSTOSIS| MANDIBLE|| 58-1699775|1326041732|CHC13|21032||11/01/2013|12/31/9999|$405.00|0|0|||REMOVE EXOSTOSIS| MAXILLA|| 58-1699775|1326041732|CHC13|21034||11/01/2013|12/31/9999|$1|683.82|0|0|||EXCISE MAX/ZYGOMA MLG TUMOR|| 58-1699775|1326041732|CHC13|21040||11/01/2013|12/31/9999|$586.53|0|0|||EXCISE MANDIBLE LESION|| 58-1699775|1326041732|CHC13|21044||11/01/2013|12/31/9999|$1|270.16|0|0|||REMOVAL OF JAW BONE LESION|| 58-1699775|1326041732|CHC13|21045||11/01/2013|12/31/9999|$1|774.84|0|0|||EXTENSIVE JAW SURGERY|| 58-1699775|1326041732|CHC13|21046||11/01/2013|12/31/9999|$1|559.99|0|0|||REMOVE MANDIBLE CYST COMPLEX|| 58-1699775|1326041732|CHC13|21047||11/01/2013|12/31/9999|$1|868.16|0|0|||EXCISE LWR JAW CYST W/REPAIR|| 58-1699775|1326041732|CHC13|21048||11/01/2013|12/31/9999|$1|598.01|0|0|||REMOVE MAXILLA CYST COMPLEX|| 58-1699775|1326041732|CHC13|21049||11/01/2013|12/31/9999|$1|781.07|0|0|||EXCIS UPPR JAW CYST W/REPAIR|| 58-1699775|1326041732|CHC13|21050||11/01/2013|12/31/9999|$1|254.54|0|0|||REMOVAL OF JAW JOINT|| 58-1699775|1326041732|CHC13|21060||11/01/2013|12/31/9999|$1|184.07|0|0|||REMOVE JAW JOINT CARTILAGE|| 58-1699775|1326041732|CHC13|21070||11/01/2013|12/31/9999|$892.02|0|0|||REMOVE CORONOID PROCESS|| 58-1699775|1326041732|CHC13|21073||11/01/2013|12/31/9999|$363.33|0|0|||MNPJ OF TMJ W/ANESTH|| 58-1699775|1326041732|CHC13|21076||11/01/2013|12/31/9999|$1|182.38|0|0|||PREPARE FACE/ORAL PROSTHESIS|| 58-1699775|1326041732|CHC13|21077||11/01/2013|12/31/9999|$2|984.86|0|0|||PREPARE FACE/ORAL PROSTHESIS|| 58-1699775|1326041732|CHC13|21079||11/01/2013|12/31/9999|$1|984.33|0|0|||PREPARE FACE/ORAL PROSTHESIS|| 58-1699775|1326041732|CHC13|21080||11/01/2013|12/31/9999|$2|211.02|0|0|||PREPARE FACE/ORAL PROSTHESIS|| 58-1699775|1326041732|CHC13|21081||11/01/2013|12/31/9999|$2|023.48|0|0|||PREPARE FACE/ORAL PROSTHESIS|| 58-1699775|1326041732|CHC13|21082||11/01/2013|12/31/9999|$1|892.46|0|0|||PREPARE FACE/ORAL PROSTHESIS|| 58-1699775|1326041732|CHC13|21083||11/01/2013|12/31/9999|$1|703.95|0|0|||PREPARE FACE/ORAL PROSTHESIS|| 58-1699775|1326041732|CHC13|21084||11/01/2013|12/31/9999|$2|038.90|0|0|||PREPARE FACE/ORAL PROSTHESIS|| 58-1699775|1326041732|CHC13|21085||11/01/2013|12/31/9999|$907.94|0|0|||PREPARE FACE/ORAL PROSTHESIS|| 58-1699775|1326041732|CHC13|21086||11/01/2013|12/31/9999|$2|194.91|0|0|||PREPARE FACE/ORAL PROSTHESIS|| 58-1699775|1326041732|CHC13|21087||11/01/2013|12/31/9999|$2|178.40|0|0|||PREPARE FACE/ORAL PROSTHESIS|| 58-1699775|1326041732|CHC13|21088||11/01/2013|12/31/9999|$2|374.28|0|0|||PREPARE FACE/ORAL PROSTHESIS|| 58-1699775|1326041732|CHC13|21089||11/01/2013|12/31/9999|$0.00|0|0|||PREPARE FACE/ORAL PROSTHESIS|| 58-1699775|1326041732|CHC13|21100||11/01/2013|12/31/9999|$550.12|0|0|||MAXILLOFACIAL FIXATION|| 58-1699775|1326041732|CHC13|21110||11/01/2013|12/31/9999|$925.03|0|0|||INTERDENTAL FIXATION|| 58-1699775|1326041732|CHC13|21116||11/01/2013|12/31/9999|$60.69|0|0|||INJECTION| JAW JOINT X-RAY|| 58-1699775|1326041732|CHC13|21120||11/01/2013|12/31/9999|$766.27|0|0|||RECONSTRUCTION OF CHIN|| 58-1699775|1326041732|CHC13|21121||11/01/2013|12/31/9999|$894.74|0|0|||RECONSTRUCTION OF CHIN|| 58-1699775|1326041732|CHC13|21122||11/01/2013|12/31/9999|$918.79|0|0|||RECONSTRUCTION OF CHIN|| 58-1699775|1326041732|CHC13|21123||11/01/2013|12/31/9999|$1|197.79|0|0|||RECONSTRUCTION OF CHIN|| 58-1699775|1326041732|CHC13|21125||11/01/2013|12/31/9999|$1|130.09|0|0|||AUGMENTATION| LOWER JAW BONE|| 58-1699775|1326041732|CHC13|21127||11/01/2013|12/31/9999|$1|222.61|0|0|||AUGMENTATION| LOWER JAW BONE|| 58-1699775|1326041732|CHC13|21137||11/01/2013|12/31/9999|$1|086.15|0|0|||REDUCTION OF FOREHEAD|| 58-1699775|1326041732|CHC13|21138||11/01/2013|12/31/9999|$1|276.55|0|0|||REDUCTION OF FOREHEAD|| 58-1699775|1326041732|CHC13|21139||11/01/2013|12/31/9999|$1|519.03|0|0|||REDUCTION OF FOREHEAD|| 58-1699775|1326041732|CHC13|21141||11/01/2013|12/31/9999|$1|991.28|0|0|||RECONSTRUCT MIDFACE| LEFORT|| 58-1699775|1326041732|CHC13|21142||11/01/2013|12/31/9999|$2|031.42|0|0|||RECONSTRUCT MIDFACE| LEFORT|| 58-1699775|1326041732|CHC13|21143||11/01/2013|12/31/9999|$2|107.71|0|0|||RECONSTRUCT MIDFACE| LEFORT|| 58-1699775|1326041732|CHC13|21145||11/01/2013|12/31/9999|$2|198.25|0|0|||RECONSTRUCT MIDFACE| LEFORT|| 58-1699775|1326041732|CHC13|21146||11/01/2013|12/31/9999|$2|505.10|0|0|||RECONSTRUCT MIDFACE| LEFORT|| 58-1699775|1326041732|CHC13|21147||11/01/2013|12/31/9999|$2|368.06|0|0|||RECONSTRUCT MIDFACE| LEFORT|| 58-1699775|1326041732|CHC13|21150||11/01/2013|12/31/9999|$2|370.38|0|0|||RECONSTRUCT MIDFACE| LEFORT|| 58-1699775|1326041732|CHC13|21151||11/01/2013|12/31/9999|$2|756.02|0|0|||RECONSTRUCT MIDFACE| LEFORT|| 58-1699775|1326041732|CHC13|21154||11/01/2013|12/31/9999|$3|104.78|0|0|||RECONSTRUCT MIDFACE| LEFORT|| 58-1699775|1326041732|CHC13|21155||11/01/2013|12/31/9999|$3|121.10|0|0|||RECONSTRUCT MIDFACE| LEFORT|| 58-1699775|1326041732|CHC13|21159||11/01/2013|12/31/9999|$3|623.64|0|0|||RECONSTRUCT MIDFACE| LEFORT|| 58-1699775|1326041732|CHC13|21160||11/01/2013|12/31/9999|$3|793.17|0|0|||RECONSTRUCT MIDFACE| LEFORT|| 58-1699775|1326041732|CHC13|21172||11/01/2013|12/31/9999|$2|603.93|0|0|||RECONSTRUCT ORBIT/FOREHEAD|| 58-1699775|1326041732|CHC13|21175||11/01/2013|12/31/9999|$3|295.78|0|0|||RECONSTRUCT ORBIT/FOREHEAD|| 58-1699775|1326041732|CHC13|21179||11/01/2013|12/31/9999|$2|087.57|0|0|||RECONSTRUCT ENTIRE FOREHEAD|| 58-1699775|1326041732|CHC13|21180||11/01/2013|12/31/9999|$2|264.26|0|0|||RECONSTRUCT ENTIRE FOREHEAD|| 58-1699775|1326041732|CHC13|21181||11/01/2013|12/31/9999|$1|016.07|0|0|||CONTOUR CRANIAL BONE LESION|| 58-1699775|1326041732|CHC13|21182||11/01/2013|12/31/9999|$2|827.04|0|0|||RECONSTRUCT CRANIAL BONE|| 58-1699775|1326041732|CHC13|21183||11/01/2013|12/31/9999|$3|356.10|0|0|||RECONSTRUCT CRANIAL BONE|| 58-1699775|1326041732|CHC13|21184||11/01/2013|12/31/9999|$3|438.71|0|0|||RECONSTRUCT CRANIAL BONE|| 58-1699775|1326041732|CHC13|21188||11/01/2013|12/31/9999|$2|297.43|0|0|||RECONSTRUCTION OF MIDFACE|| 58-1699775|1326041732|CHC13|21193||11/01/2013|12/31/9999|$1|885.83|0|0|||RECONST LWR JAW W/O GRAFT|| 58-1699775|1326041732|CHC13|21194||11/01/2013|12/31/9999|$1|998.17|0|0|||RECONST LWR JAW W/GRAFT|| 58-1699775|1326041732|CHC13|21195||11/01/2013|12/31/9999|$1|933.35|0|0|||RECONST LWR JAW W/O FIXATION|| 58-1699775|1326041732|CHC13|21196||11/01/2013|12/31/9999|$2|115.69|0|0|||RECONST LWR JAW W/FIXATION|| 58-1699775|1326041732|CHC13|21198||11/01/2013|12/31/9999|$1|661.43|0|0|||RECONSTR LWR JAW SEGMENT|| 58-1699775|1326041732|CHC13|21199||11/01/2013|12/31/9999|$1|470.92|0|0|||RECONSTR LWR JAW W/ADVANCE|| 58-1699775|1326041732|CHC13|21206||11/01/2013|12/31/9999|$1|709.42|0|0|||RECONSTRUCT UPPER JAW BONE|| 58-1699775|1326041732|CHC13|21208||11/01/2013|12/31/9999|$1|215.55|0|0|||AUGMENTATION OF FACIAL BONES|| 58-1699775|1326041732|CHC13|21209||11/01/2013|12/31/9999|$936.22|0|0|||REDUCTION OF FACIAL BONES|| 58-1699775|1326041732|CHC13|21210||11/01/2013|12/31/9999|$1|207.12|0|0|||FACE BONE GRAFT|| 58-1699775|1326041732|CHC13|21215||11/01/2013|12/31/9999|$1|292.90|0|0|||LOWER JAW BONE GRAFT|| 58-1699775|1326041732|CHC13|21230||11/01/2013|12/31/9999|$1|116.96|0|0|||RIB CARTILAGE GRAFT|| 58-1699775|1326041732|CHC13|21235||11/01/2013|12/31/9999|$820.17|0|0|||EAR CARTILAGE GRAFT|| 58-1699775|1326041732|CHC13|21240||11/01/2013|12/31/9999|$1|567.27|0|0|||RECONSTRUCTION OF JAW JOINT|| 58-1699775|1326041732|CHC13|21242||11/01/2013|12/31/9999|$1|437.81|0|0|||RECONSTRUCTION OF JAW JOINT|| 58-1699775|1326041732|CHC13|21243||11/01/2013|12/31/9999|$2|387.88|0|0|||RECONSTRUCTION OF JAW JOINT|| 58-1699775|1326041732|CHC13|21244||11/01/2013|12/31/9999|$1|520.41|0|0|||RECONSTRUCTION OF LOWER JAW|| 58-1699775|1326041732|CHC13|21245||11/01/2013|12/31/9999|$1|295.04|0|0|||RECONSTRUCTION OF JAW|| 58-1699775|1326041732|CHC13|21246||11/01/2013|12/31/9999|$1|199.06|0|0|||RECONSTRUCTION OF JAW|| 58-1699775|1326041732|CHC13|21247||11/01/2013|12/31/9999|$2|411.60|0|0|||RECONSTRUCT LOWER JAW BONE|| 58-1699775|1326041732|CHC13|21248||11/01/2013|12/31/9999|$1|267.79|0|0|||RECONSTRUCTION OF JAW|| 58-1699775|1326041732|CHC13|21249||11/01/2013|12/31/9999|$1|759.31|0|0|||RECONSTRUCTION OF JAW|| 58-1699775|1326041732|CHC13|21255||11/01/2013|12/31/9999|$1|992.37|0|0|||RECONSTRUCT LOWER JAW BONE|| 58-1699775|1326041732|CHC13|21256||11/01/2013|12/31/9999|$1|714.35|0|0|||RECONSTRUCTION OF ORBIT|| 58-1699775|1326041732|CHC13|21260||11/01/2013|12/31/9999|$1|760.39|0|0|||REVISE EYE SOCKETS|| 58-1699775|1326041732|CHC13|21261||11/01/2013|12/31/9999|$3|139.00|0|0|||REVISE EYE SOCKETS|| 58-1699775|1326041732|CHC13|21263||11/01/2013|12/31/9999|$2|697.08|0|0|||REVISE EYE SOCKETS|| 58-1699775|1326041732|CHC13|21267||11/01/2013|12/31/9999|$2|227.62|0|0|||REVISE EYE SOCKETS|| 58-1699775|1326041732|CHC13|21268||11/01/2013|12/31/9999|$2|594.26|0|0|||REVISE EYE SOCKETS|| 58-1699775|1326041732|CHC13|21270||11/01/2013|12/31/9999|$1|052.13|0|0|||AUGMENTATION| CHEEK BONE|| 58-1699775|1326041732|CHC13|21275||11/01/2013|12/31/9999|$1|214.19|0|0|||REVISION| ORBITOFACIAL BONES|| 58-1699775|1326041732|CHC13|21280||11/01/2013|12/31/9999|$818.24|0|0|||REVISION OF EYELID|| 58-1699775|1326041732|CHC13|21282||11/01/2013|12/31/9999|$537.40|0|0|||REVISION OF EYELID|| 58-1699775|1326041732|CHC13|21295||11/01/2013|12/31/9999|$260.34|0|0|||REVISION OF JAW MUSCLE/BONE|| 58-1699775|1326041732|CHC13|21296||11/01/2013|12/31/9999|$607.65|0|0|||REVISION OF JAW MUSCLE/BONE|| 58-1699775|1326041732|CHC13|21299||11/01/2013|12/31/9999|$0.00|0|0|||CRANIO/MAXILLOFACIAL SURGERY|| 58-1699775|1326041732|CHC13|21310||11/01/2013|12/31/9999|$40.77|0|0|||TREATMENT OF NOSE FRACTURE|| 58-1699775|1326041732|CHC13|21315||11/01/2013|12/31/9999|$219.04|0|0|||TREATMENT OF NOSE FRACTURE|| 58-1699775|1326041732|CHC13|21320||11/01/2013|12/31/9999|$196.35|0|0|||TREATMENT OF NOSE FRACTURE|| 58-1699775|1326041732|CHC13|21325||11/01/2013|12/31/9999|$669.72|0|0|||TREATMENT OF NOSE FRACTURE|| 58-1699775|1326041732|CHC13|21330||11/01/2013|12/31/9999|$813.45|0|0|||TREATMENT OF NOSE FRACTURE|| 58-1699775|1326041732|CHC13|21335||11/01/2013|12/31/9999|$1|049.72|0|0|||TREATMENT OF NOSE FRACTURE|| 58-1699775|1326041732|CHC13|21336||11/01/2013|12/31/9999|$926.11|0|0|||TREAT NASAL SEPTAL FRACTURE|| 58-1699775|1326041732|CHC13|21337||11/01/2013|12/31/9999|$422.38|0|0|||TREAT NASAL SEPTAL FRACTURE|| 58-1699775|1326041732|CHC13|21338||11/01/2013|12/31/9999|$1|074.04|0|0|||TREAT NASOETHMOID FRACTURE|| 58-1699775|1326041732|CHC13|21339||11/01/2013|12/31/9999|$1|132.96|0|0|||TREAT NASOETHMOID FRACTURE|| 58-1699775|1326041732|CHC13|21340||11/01/2013|12/31/9999|$1|174.85|0|0|||TREATMENT OF NOSE FRACTURE|| 58-1699775|1326041732|CHC13|21343||11/01/2013|12/31/9999|$1|745.51|0|0|||TREATMENT OF SINUS FRACTURE|| 58-1699775|1326041732|CHC13|21344||11/01/2013|12/31/9999|$2|281.82|0|0|||TREATMENT OF SINUS FRACTURE|| 58-1699775|1326041732|CHC13|21345||11/01/2013|12/31/9999|$918.72|0|0|||TREAT NOSE/JAW FRACTURE|| 58-1699775|1326041732|CHC13|21346||11/01/2013|12/31/9999|$1|322.73|0|0|||TREAT NOSE/JAW FRACTURE|| 58-1699775|1326041732|CHC13|21347||11/01/2013|12/31/9999|$1|593.42|0|0|||TREAT NOSE/JAW FRACTURE|| 58-1699775|1326041732|CHC13|21348||11/01/2013|12/31/9999|$1|592.56|0|0|||TREAT NOSE/JAW FRACTURE|| 58-1699775|1326041732|CHC13|21355||11/01/2013|12/31/9999|$466.01|0|0|||TREAT CHEEK BONE FRACTURE|| 58-1699775|1326041732|CHC13|21356||11/01/2013|12/31/9999|$540.66|0|0|||TREAT CHEEK BONE FRACTURE|| 58-1699775|1326041732|CHC13|21360||11/01/2013|12/31/9999|$762.33|0|0|||TREAT CHEEK BONE FRACTURE|| 58-1699775|1326041732|CHC13|21365||11/01/2013|12/31/9999|$1|610.13|0|0|||TREAT CHEEK BONE FRACTURE|| 58-1699775|1326041732|CHC13|21366||11/01/2013|12/31/9999|$1|741.12|0|0|||TREAT CHEEK BONE FRACTURE|| 58-1699775|1326041732|CHC13|21385||11/01/2013|12/31/9999|$995.73|0|0|||TREAT EYE SOCKET FRACTURE|| 58-1699775|1326041732|CHC13|21386||11/01/2013|12/31/9999|$947.68|0|0|||TREAT EYE SOCKET FRACTURE|| 58-1699775|1326041732|CHC13|21387||11/01/2013|12/31/9999|$1|070.30|0|0|||TREAT EYE SOCKET FRACTURE|| 58-1699775|1326041732|CHC13|21390||11/01/2013|12/31/9999|$1|147.07|0|0|||TREAT EYE SOCKET FRACTURE|| 58-1699775|1326041732|CHC13|21395||11/01/2013|12/31/9999|$1|416.84|0|0|||TREAT EYE SOCKET FRACTURE|| 58-1699775|1326041732|CHC13|21400||11/01/2013|12/31/9999|$218.21|0|0|||TREAT EYE SOCKET FRACTURE|| 58-1699775|1326041732|CHC13|21401||11/01/2013|12/31/9999|$435.20|0|0|||TREAT EYE SOCKET FRACTURE|| 58-1699775|1326041732|CHC13|21406||11/01/2013|12/31/9999|$800.27|0|0|||TREAT EYE SOCKET FRACTURE|| 58-1699775|1326041732|CHC13|21407||11/01/2013|12/31/9999|$934.75|0|0|||TREAT EYE SOCKET FRACTURE|| 58-1699775|1326041732|CHC13|21408||11/01/2013|12/31/9999|$1|308.79|0|0|||TREAT EYE SOCKET FRACTURE|| 58-1699775|1326041732|CHC13|21421||11/01/2013|12/31/9999|$927.67|0|0|||TREAT MOUTH ROOF FRACTURE|| 58-1699775|1326041732|CHC13|21422||11/01/2013|12/31/9999|$953.62|0|0|||TREAT MOUTH ROOF FRACTURE|| 58-1699775|1326041732|CHC13|21423||11/01/2013|12/31/9999|$1|150.06|0|0|||TREAT MOUTH ROOF FRACTURE|| 58-1699775|1326041732|CHC13|21431||11/01/2013|12/31/9999|$967.82|0|0|||TREAT CRANIOFACIAL FRACTURE|| 58-1699775|1326041732|CHC13|21432||11/01/2013|12/31/9999|$1|023.29|0|0|||TREAT CRANIOFACIAL FRACTURE|| 58-1699775|1326041732|CHC13|21433||11/01/2013|12/31/9999|$2|401.07|0|0|||TREAT CRANIOFACIAL FRACTURE|| 58-1699775|1326041732|CHC13|21435||11/01/2013|12/31/9999|$1|975.53|0|0|||TREAT CRANIOFACIAL FRACTURE|| 58-1699775|1326041732|CHC13|21436||11/01/2013|12/31/9999|$2|978.84|0|0|||TREAT CRANIOFACIAL FRACTURE|| 58-1699775|1326041732|CHC13|21440||11/01/2013|12/31/9999|$650.74|0|0|||TREAT DENTAL RIDGE FRACTURE|| 58-1699775|1326041732|CHC13|21445||11/01/2013|12/31/9999|$871.48|0|0|||TREAT DENTAL RIDGE FRACTURE|| 58-1699775|1326041732|CHC13|21450||11/01/2013|12/31/9999|$681.91|0|0|||TREAT LOWER JAW FRACTURE|| 58-1699775|1326041732|CHC13|21451||11/01/2013|12/31/9999|$884.23|0|0|||TREAT LOWER JAW FRACTURE|| 58-1699775|1326041732|CHC13|21452||11/01/2013|12/31/9999|$493.73|0|0|||TREAT LOWER JAW FRACTURE|| 58-1699775|1326041732|CHC13|21453||11/01/2013|12/31/9999|$1|092.08|0|0|||TREAT LOWER JAW FRACTURE|| 58-1699775|1326041732|CHC13|21454||11/01/2013|12/31/9999|$835.23|0|0|||TREAT LOWER JAW FRACTURE|| 58-1699775|1326041732|CHC13|21461||11/01/2013|12/31/9999|$1|333.93|0|0|||TREAT LOWER JAW FRACTURE|| 58-1699775|1326041732|CHC13|21462||11/01/2013|12/31/9999|$1|459.27|0|0|||TREAT LOWER JAW FRACTURE|| 58-1699775|1326041732|CHC13|21465||11/01/2013|12/31/9999|$1|362.93|0|0|||TREAT LOWER JAW FRACTURE|| 58-1699775|1326041732|CHC13|21470||11/01/2013|12/31/9999|$1|733.96|0|0|||TREAT LOWER JAW FRACTURE|| 58-1699775|1326041732|CHC13|21480||11/01/2013|12/31/9999|$46.89|0|0|||RESET DISLOCATED JAW|| 58-1699775|1326041732|CHC13|21485||11/01/2013|12/31/9999|$805.66|0|0|||RESET DISLOCATED JAW|| 58-1699775|1326041732|CHC13|21490||11/01/2013|12/31/9999|$1|329.91|0|0|||REPAIR DISLOCATED JAW|| 58-1699775|1326041732|CHC13|21497||11/01/2013|12/31/9999|$850.36|0|0|||INTERDENTAL WIRING|| 58-1699775|1326041732|CHC13|21499||11/01/2013|12/31/9999|$0.00|0|0|||HEAD SURGERY PROCEDURE|| 58-1699775|1326041732|CHC13|21501||11/01/2013|12/31/9999|$457.44|0|0|||DRAIN NECK/CHEST LESION|| 58-1699775|1326041732|CHC13|21502||11/01/2013|12/31/9999|$761.15|0|0|||DRAIN CHEST LESION|| 58-1699775|1326041732|CHC13|21510||11/01/2013|12/31/9999|$734.17|0|0|||DRAINAGE OF BONE LESION|| 58-1699775|1326041732|CHC13|21550||11/01/2013|12/31/9999|$225.10|0|0|||BIOPSY OF NECK/CHEST|| 58-1699775|1326041732|CHC13|21552||11/01/2013|12/31/9999|$640.50|0|0|||EXC NECK LES SC = 3 CM|| 58-1699775|1326041732|CHC13|21554||11/01/2013|12/31/9999|$1|050.56|0|0|||EXC NECK TUM DEEP = 5 CM|| 58-1699775|1326041732|CHC13|21555||11/01/2013|12/31/9999|$439.50|0|0|||REMOVE LESION| NECK/CHEST|| 58-1699775|1326041732|CHC13|21556||11/01/2013|12/31/9999|$754.59|0|0|||REMOVE LESION| NECK/CHEST|| 58-1699775|1326041732|CHC13|21557||04/01/2014|12/31/9999|$1|410.45|0|0|||REMOVE TUMOR| NECK/CHEST|| 58-1699775|1326041732|CHC13|21558||04/01/2014|12/31/9999|$1|980.99|0|0|||RESECT NECK TUM = 5 CM|| 58-1699775|1326041732|CHC13|21600||11/01/2013|12/31/9999|$814.14|0|0|||PARTIAL REMOVAL OF RIB|| 58-1699775|1326041732|CHC13|21610||11/01/2013|12/31/9999|$1|695.86|0|0|||PARTIAL REMOVAL OF RIB|| 58-1699775|1326041732|CHC13|21615||11/01/2013|12/31/9999|$943.53|0|0|||REMOVAL OF RIB|| 58-1699775|1326041732|CHC13|21616||11/01/2013|12/31/9999|$1|219.25|0|0|||REMOVAL OF RIB AND NERVES|| 58-1699775|1326041732|CHC13|21620||11/01/2013|12/31/9999|$744.63|0|0|||PARTIAL REMOVAL OF STERNUM|| 58-1699775|1326041732|CHC13|21627||11/01/2013|12/31/9999|$790.17|0|0|||STERNAL DEBRIDEMENT|| 58-1699775|1326041732|CHC13|21630||11/01/2013|12/31/9999|$1|810.27|0|0|||EXTENSIVE STERNUM SURGERY|| 58-1699775|1326041732|CHC13|21632||11/01/2013|12/31/9999|$1|788.57|0|0|||EXTENSIVE STERNUM SURGERY|| 58-1699775|1326041732|CHC13|21685||11/01/2013|12/31/9999|$1|445.55|0|0|||HYOID MYOTOMY & SUSPENSION|| 58-1699775|1326041732|CHC13|21700||11/01/2013|12/31/9999|$565.63|0|0|||REVISION OF NECK MUSCLE|| 58-1699775|1326041732|CHC13|21705||11/01/2013|12/31/9999|$903.45|0|0|||REVISION OF NECK MUSCLE/RIB|| 58-1699775|1326041732|CHC13|21720||11/01/2013|12/31/9999|$716.98|0|0|||REVISION OF NECK MUSCLE|| 58-1699775|1326041732|CHC13|21725||11/01/2013|12/31/9999|$686.08|0|0|||REVISION OF NECK MUSCLE|| 58-1699775|1326041732|CHC13|21740||11/01/2013|12/31/9999|$1|719.40|0|0|||RECONSTRUCTION OF STERNUM|| 58-1699775|1326041732|CHC13|21742||11/01/2013|12/31/9999|$2|153.41|0|0|||REPAIR STERN/NUSS W/O SCOPE|| 58-1699775|1326041732|CHC13|21743||11/01/2013|12/31/9999|$2|834.08|0|0|||REPAIR STERNUM/NUSS W/SCOPE|| 58-1699775|1326041732|CHC13|21750||11/01/2013|12/31/9999|$1|016.71|0|0|||REPAIR OF STERNUM SEPARATION|| 58-1699775|1326041732|CHC13|21811||04/01/2015|12/31/9999|$904.08|0|0|0||OPTX OF RIB FX W/FIXJ SCOPE|| 58-1699775|1326041732|CHC13|21812||04/01/2015|12/31/9999|$1|084.31|0|0|0||TREATMENT OF RIB FRACTURE|| 58-1699775|1326041732|CHC13|21813||04/01/2015|12/31/9999|$1|475.28|0|0|0||TREATMENT OF RIB FRACTURE|| 58-1699775|1326041732|CHC13|21820||11/01/2013|12/31/9999|$199.13|0|0|||TREAT STERNUM FRACTURE|| 58-1699775|1326041732|CHC13|21825||11/01/2013|12/31/9999|$797.87|0|0|||TREAT STERNUM FRACTURE|| 58-1699775|1326041732|CHC13|21899||11/01/2013|12/31/9999|$0.00|0|0|||NECK/CHEST SURGERY PROCEDURE|| 58-1699775|1326041732|CHC13|21920||11/01/2013|12/31/9999|$231.12|0|0|||BIOPSY SOFT TISSUE OF BACK|| 58-1699775|1326041732|CHC13|21925||11/01/2013|12/31/9999|$497.78|0|0|||BIOPSY SOFT TISSUE OF BACK|| 58-1699775|1326041732|CHC13|21930||11/01/2013|12/31/9999|$520.62|0|0|||REMOVE LESION| BACK OR FLANK|| 58-1699775|1326041732|CHC13|21931||11/01/2013|12/31/9999|$674.84|0|0|||EXC BACK LES SC = 3 CM|| 58-1699775|1326041732|CHC13|21932||11/01/2013|12/31/9999|$949.29|0|0|||EXC BACK TUM DEEP < 5 CM|| 58-1699775|1326041732|CHC13|21933||11/01/2013|12/31/9999|$1|063.35|0|0|||EXC BACK TUM DEEP = 5 CM|| 58-1699775|1326041732|CHC13|21935||04/01/2014|12/31/9999|$1|503.51|0|0|||REMOVE TUMOR| BACK|| 58-1699775|1326041732|CHC13|21936||04/01/2014|12/31/9999|$2|071.25|0|0|||RESECT BACK TUM = 5 CM|| 58-1699775|1326041732|CHC13|22010||11/01/2013|12/31/9999|$1|343.74|0|0|||I&D| P-SPINE| C/T/CERV-THOR|| 58-1699775|1326041732|CHC13|22015||11/01/2013|12/31/9999|$1|320.38|0|0|||I&D| P-SPINE| L/S/LS|| 58-1699775|1326041732|CHC13|22100||11/01/2013|12/31/9999|$1|299.89|0|0|||REMOVE PART OF NECK VERTEBRA|| 58-1699775|1326041732|CHC13|22101||11/01/2013|12/31/9999|$1|305.82|0|0|||REMOVE PART| THORAX VERTEBRA|| 58-1699775|1326041732|CHC13|22102||11/01/2013|12/31/9999|$1|164.91|0|0|||REMOVE PART| LUMBAR VERTEBRA|| 58-1699775|1326041732|CHC13|22103||11/01/2013|12/31/9999|$206.65|0|0|||REMOVE EXTRA SPINE SEGMENT|| 58-1699775|1326041732|CHC13|22110||11/01/2013|12/31/9999|$1|541.37|0|0|||REMOVE PART OF NECK VERTEBRA|| 58-1699775|1326041732|CHC13|22112||11/01/2013|12/31/9999|$1|515.15|0|0|||REMOVE PART| THORAX VERTEBRA|| 58-1699775|1326041732|CHC13|22114||11/01/2013|12/31/9999|$1|420.44|0|0|||REMOVE PART| LUMBAR VERTEBRA|| 58-1699775|1326041732|CHC13|22116||11/01/2013|12/31/9999|$203.73|0|0|||REMOVE EXTRA SPINE SEGMENT|| 58-1699775|1326041732|CHC13|22206||11/01/2013|12/31/9999|$3|383.52|0|0|||CUT SPINE 3 COL| THOR|| 58-1699775|1326041732|CHC13|22207||11/01/2013|12/31/9999|$3|434.23|0|0|||CUT SPINE 3 COL| LUMB|| 58-1699775|1326041732|CHC13|22208||11/01/2013|12/31/9999|$852.50|0|0|||CUT SPINE 3 COL| ADDL SEG|| 58-1699775|1326041732|CHC13|22210||11/01/2013|12/31/9999|$2|533.98|0|0|||REVISION OF NECK SPINE|| 58-1699775|1326041732|CHC13|22212||11/01/2013|12/31/9999|$2|100.34|0|0|||REVISION OF THORAX SPINE|| 58-1699775|1326041732|CHC13|22214||11/01/2013|12/31/9999|$2|115.85|0|0|||REVISION OF LUMBAR SPINE|| 58-1699775|1326041732|CHC13|22216||11/01/2013|12/31/9999|$529.34|0|0|||REVISE| EXTRA SPINE SEGMENT|| 58-1699775|1326041732|CHC13|22220||11/01/2013|12/31/9999|$2|315.82|0|0|||REVISION OF NECK SPINE|| 58-1699775|1326041732|CHC13|22222||11/01/2013|12/31/9999|$2|184.45|0|0|||REVISION OF THORAX SPINE|| 58-1699775|1326041732|CHC13|22224||11/01/2013|12/31/9999|$2|261.37|0|0|||REVISION OF LUMBAR SPINE|| 58-1699775|1326041732|CHC13|22226||11/01/2013|12/31/9999|$530.82|0|0|||REVISE| EXTRA SPINE SEGMENT|| 58-1699775|1326041732|CHC13|22305||11/01/2013|12/31/9999|$243.71|0|0|||TREAT SPINE PROCESS FRACTURE|| 58-1699775|1326041732|CHC13|22310||11/01/2013|12/31/9999|$397.87|0|0|||TREAT SPINE FRACTURE|| 58-1699775|1326041732|CHC13|22315||11/01/2013|12/31/9999|$1|096.86|0|0|||TREAT SPINE FRACTURE|| 58-1699775|1326041732|CHC13|22318||11/01/2013|12/31/9999|$2|340.91|0|0|||TREAT ODONTOID FX W/O GRAFT|| 58-1699775|1326041732|CHC13|22319||11/01/2013|12/31/9999|$2|614.36|0|0|||TREAT ODONTOID FX W/GRAFT|| 58-1699775|1326041732|CHC13|22325||11/01/2013|12/31/9999|$2|054.34|0|0|||TREAT SPINE FRACTURE|| 58-1699775|1326041732|CHC13|22326||11/01/2013|12/31/9999|$2|127.73|0|0|||TREAT NECK SPINE FRACTURE|| 58-1699775|1326041732|CHC13|22327||11/01/2013|12/31/9999|$2|116.69|0|0|||TREAT THORAX SPINE FRACTURE|| 58-1699775|1326041732|CHC13|22328||11/01/2013|12/31/9999|$412.08|0|0|||TREAT EACH ADD SPINE FX|| 58-1699775|1326041732|CHC13|22505||11/01/2013|12/31/9999|$170.65|0|0|||MANIPULATION OF SPINE|| 58-1699775|1326041732|CHC13|22510||04/01/2015|12/31/9999|$678.30|0|0|0||PERQ CERVICOTHORACIC INJECT|| 58-1699775|1326041732|CHC13|22511||04/01/2015|12/31/9999|$636.55|0|0|0||PERQ LUMBOSACRAL INJECTION|| 58-1699775|1326041732|CHC13|22512||04/01/2015|12/31/9999|$317.51|0|0|0||VERTEBROPLASTY ADDL INJECT|| 58-1699775|1326041732|CHC13|22513||04/01/2015|12/31/9999|$805.75|0|0|0||PERQ VERTEBRAL AUGMENTATION|| 58-1699775|1326041732|CHC13|22514||04/01/2015|12/31/9999|$750.45|0|0|0||PERQ VERTEBRAL AUGMENTATION|| 58-1699775|1326041732|CHC13|22515||04/01/2015|12/31/9999|$341.25|0|0|0||PERQ VERTEBRAL AUGMENTATION|| 58-1699775|1326041732|CHC13|22526||11/01/2013|12/31/9999|$479.16|0|0|||IDET| SINGLE LEVEL|| 58-1699775|1326041732|CHC13|22527||11/01/2013|12/31/9999|$216.51|0|0|||IDET| 1 OR MORE LEVELS|| 58-1699775|1326041732|CHC13|22532||11/01/2013|12/31/9999|$2|559.50|0|0|||LAT THORAX SPINE FUSION|| 58-1699775|1326041732|CHC13|22533||11/01/2013|12/31/9999|$2|411.13|0|0|||LAT LUMBAR SPINE FUSION|| 58-1699775|1326041732|CHC13|22534||11/01/2013|12/31/9999|$527.88|0|0|||LAT THOR/LUMB| ADD'L SEG|| 58-1699775|1326041732|CHC13|22548||11/01/2013|12/31/9999|$2|805.86|0|0|||NECK SPINE FUSION|| 58-1699775|1326041732|CHC13|22551||11/01/2013|12/31/9999|$2|481.45|0|0|||NECK SPINE FUSE&REMOVE ADDL|| 58-1699775|1326041732|CHC13|22552||11/01/2013|12/31/9999|$572.55|0|0|||ADDL NECK SPINE FUSION|| 58-1699775|1326041732|CHC13|22554||11/01/2013|12/31/9999|$1|830.83|0|0|||NECK SPINE FUSION|| 58-1699775|1326041732|CHC13|22556||11/01/2013|12/31/9999|$2|392.25|0|0|||THORAX SPINE FUSION|| 58-1699775|1326041732|CHC13|22558||11/01/2013|12/31/9999|$2|216.40|0|0|||LUMBAR SPINE FUSION|| 58-1699775|1326041732|CHC13|22585||11/01/2013|12/31/9999|$490.13|0|0|||ADDITIONAL SPINAL FUSION|| 58-1699775|1326041732|CHC13|22586||11/01/2013|12/31/9999|$2|230.49|0|0|||PRESCRL FUSE W/ INSTR L5/S1|| 58-1699775|1326041732|CHC13|22590||11/01/2013|12/31/9999|$2|261.12|0|0|||SPINE & SKULL SPINAL FUSION|| 58-1699775|1326041732|CHC13|22595||11/01/2013|12/31/9999|$2|152.77|0|0|||NECK SPINAL FUSION|| 58-1699775|1326041732|CHC13|22600||11/01/2013|12/31/9999|$1|841.01|0|0|||NECK SPINE FUSION|| 58-1699775|1326041732|CHC13|22610||11/01/2013|12/31/9999|$1|799.34|0|0|||THORAX SPINE FUSION|| 58-1699775|1326041732|CHC13|22612||11/01/2013|12/31/9999|$2|293.39|0|0|||LUMBAR SPINE FUSION|| 58-1699775|1326041732|CHC13|22614||11/01/2013|12/31/9999|$570.33|0|0|||SPINE FUSION| EXTRA SEGMENT|| 58-1699775|1326041732|CHC13|22630||11/01/2013|12/31/9999|$2|216.26|0|0|||LUMBAR SPINE FUSION|| 58-1699775|1326041732|CHC13|22632||11/01/2013|12/31/9999|$465.50|0|0|||SPINE FUSION| EXTRA SEGMENT|| 58-1699775|1326041732|CHC13|22633||11/01/2013|12/31/9999|$2|667.82|0|0|||LUMBAR SPINE FUSION COMBINED|| 58-1699775|1326041732|CHC13|22634||11/01/2013|12/31/9999|$723.58|0|0|||SPINE FUSION EXTRA SEGMENT|| 58-1699775|1326041732|CHC13|22800||11/01/2013|12/31/9999|$1|941.17|0|0|||FUSION OF SPINE|| 58-1699775|1326041732|CHC13|22802||11/01/2013|12/31/9999|$3|024.55|0|0|||FUSION OF SPINE|| 58-1699775|1326041732|CHC13|22804||11/01/2013|12/31/9999|$3|481.03|0|0|||FUSION OF SPINE|| 58-1699775|1326041732|CHC13|22808||11/01/2013|12/31/9999|$2|622.89|0|0|||FUSION OF SPINE|| 58-1699775|1326041732|CHC13|22810||11/01/2013|12/31/9999|$2|928.48|0|0|||FUSION OF SPINE|| 58-1699775|1326041732|CHC13|22812||11/01/2013|12/31/9999|$3|169.78|0|0|||FUSION OF SPINE|| 58-1699775|1326041732|CHC13|22818||11/01/2013|12/31/9999|$3|122.53|0|0|||KYPHECTOMY| 1-2 SEGMENTS|| 58-1699775|1326041732|CHC13|22819||11/01/2013|12/31/9999|$3|940.04|0|0|||KYPHECTOMY| 3 OR MORE|| 58-1699775|1326041732|CHC13|22830||11/01/2013|12/31/9999|$1|159.57|0|0|||EXPLORATION OF SPINAL FUSION|| 58-1699775|1326041732|CHC13|22840||11/01/2013|12/31/9999|$1|111.30|0|0|||INSERT SPINE FIXATION DEVICE|| 58-1699775|1326041732|CHC13|22841||11/01/2013|12/31/9999|$549.87|0|0|||INSERT SPINE FIXATION DEVICE|| 58-1699775|1326041732|CHC13|22842||11/01/2013|12/31/9999|$1|112.82|0|0|||INSERT SPINE FIXATION DEVICE|| 58-1699775|1326041732|CHC13|22843||11/01/2013|12/31/9999|$1|182.60|0|0|||INSERT SPINE FIXATION DEVICE|| 58-1699775|1326041732|CHC13|22844||11/01/2013|12/31/9999|$1|424.90|0|0|||INSERT SPINE FIXATION DEVICE|| 58-1699775|1326041732|CHC13|22845||11/01/2013|12/31/9999|$1|073.25|0|0|||INSERT SPINE FIXATION DEVICE|| 58-1699775|1326041732|CHC13|22846||11/01/2013|12/31/9999|$1|113.41|0|0|||INSERT SPINE FIXATION DEVICE|| 58-1699775|1326041732|CHC13|22847||11/01/2013|12/31/9999|$1|282.41|0|0|||INSERT SPINE FIXATION DEVICE|| 58-1699775|1326041732|CHC13|22848||11/01/2013|12/31/9999|$521.61|0|0|||INSERT PELV FIXATION DEVICE|| 58-1699775|1326041732|CHC13|22849||11/01/2013|12/31/9999|$1|871.50|0|0|||REINSERT SPINAL FIXATION|| 58-1699775|1326041732|CHC13|22850||11/01/2013|12/31/9999|$1|031.71|0|0|||REMOVE SPINE FIXATION DEVICE|| 58-1699775|1326041732|CHC13|22852||11/01/2013|12/31/9999|$985.97|0|0|||REMOVE SPINE FIXATION DEVICE|| 58-1699775|1326041732|CHC13|22853||04/01/2017|12/31/9999|$411.28|0|411.28|0||INSJ BIOMECHANICAL DEVICE|| 58-1699775|1326041732|CHC13|22854||04/01/2017|12/31/9999|$532.41|0|532.41|0||INSJ BIOMECHANICAL DEVICE|| 58-1699775|1326041732|CHC13|22855||11/01/2013|12/31/9999|$1|607.46|0|0|||REMOVE SPINE FIXATION DEVICE|| 58-1699775|1326041732|CHC13|22856||11/01/2013|12/31/9999|$2|392.15|0|0|||CERV ARTIFIC DISKECTOMY|| 58-1699775|1326041732|CHC13|22857||11/01/2013|12/31/9999|$2|392.14|0|0|||LUMBAR ARTIF DISKECTOMY|| 58-1699775|1326041732|CHC13|22858||04/01/2015|12/31/9999|$747.68|0|0|0||SECOND LEVEL CER DISKECTOMY|| 58-1699775|1326041732|CHC13|22859||04/01/2017|12/31/9999|$532.41|0|532.41|0||INSJ BIOMECHANICAL DEVICE|| 58-1699775|1326041732|CHC13|22861||11/01/2013|12/31/9999|$2|894.15|0|0|||REVISE CERV ARTIFIC DISC|| 58-1699775|1326041732|CHC13|22862||11/01/2013|12/31/9999|$3|017.34|0|0|||REVISE LUMBAR ARTIF DISC|| 58-1699775|1326041732|CHC13|22864||11/01/2013|12/31/9999|$2|765.96|0|0|||REMOVE CERV ARTIF DISC|| 58-1699775|1326041732|CHC13|22865||11/01/2013|12/31/9999|$2|956.10|0|0|||REMOVE LUMB ARTIF DISC|| 58-1699775|1326041732|CHC13|22867||04/01/2017|12/31/9999|$1|536.93|0|1536.93|0||INSJ STABLJ DEV W/DCMPRN|| 58-1699775|1326041732|CHC13|22868||04/01/2017|12/31/9999|$384.37|0|384.37|0||INSJ STABLJ DEV W/DCMPRN|| 58-1699775|1326041732|CHC13|22869||04/01/2017|12/31/9999|$845.18|0|845.18|0||INSJ STABLJ DEV W/O DCMPRN|| 58-1699775|1326041732|CHC13|22870||04/01/2017|12/31/9999|$223.95|0|223.95|0||INSJ STABLJ DEV W/O DCMPRN|| 58-1699775|1326041732|CHC13|22899||11/01/2013|12/31/9999|$0.00|0|0|||SPINE SURGERY PROCEDURE|| 58-1699775|1326041732|CHC13|22900||11/01/2013|12/31/9999|$784.11|0|0|||REMOVE ABDOMINAL WALL LESION|| 58-1699775|1326041732|CHC13|22901||11/01/2013|12/31/9999|$957.25|0|0|||EXC BACK TUM DEEP = 5 CM|| 58-1699775|1326041732|CHC13|22902||11/01/2013|12/31/9999|$464.25|0|0|||EXC ABD LES SC < 3 CM|| 58-1699775|1326041732|CHC13|22903||11/01/2013|12/31/9999|$624.29|0|0|||EXC ABD LES SC > 3 CM|| 58-1699775|1326041732|CHC13|22904||04/01/2014|12/31/9999|$1|535.64|0|0|||RESECT ABD TUM < 5 CM|| 58-1699775|1326041732|CHC13|22905||04/01/2014|12/31/9999|$1|958.25|0|0|||RESECT ABD TUM > 5 CM|| 58-1699775|1326041732|CHC13|22999||11/01/2013|12/31/9999|$0.00|0|0|||ABDOMEN SURGERY PROCEDURE|| 58-1699775|1326041732|CHC13|23000||11/01/2013|12/31/9999|$517.06|0|0|||REMOVAL OF CALCIUM DEPOSITS|| 58-1699775|1326041732|CHC13|23020||11/01/2013|12/31/9999|$979.48|0|0|||RELEASE SHOULDER JOINT|| 58-1699775|1326041732|CHC13|23030||11/01/2013|12/31/9999|$362.06|0|0|||DRAIN SHOULDER LESION|| 58-1699775|1326041732|CHC13|23031||11/01/2013|12/31/9999|$306.48|0|0|||DRAIN SHOULDER BURSA|| 58-1699775|1326041732|CHC13|23035||11/01/2013|12/31/9999|$967.43|0|0|||DRAIN SHOULDER BONE LESION|| 58-1699775|1326041732|CHC13|23040||11/01/2013|12/31/9999|$1|021.11|0|0|||EXPLORATORY SHOULDER SURGERY|| 58-1699775|1326041732|CHC13|23044||11/01/2013|12/31/9999|$813.46|0|0|||EXPLORATORY SHOULDER SURGERY|| 58-1699775|1326041732|CHC13|23065||11/01/2013|12/31/9999|$242.26|0|0|||BIOPSY SHOULDER TISSUES|| 58-1699775|1326041732|CHC13|23066||11/01/2013|12/31/9999|$492.71|0|0|||BIOPSY SHOULDER TISSUES|| 58-1699775|1326041732|CHC13|23071||11/01/2013|12/31/9999|$598.86|0|0|||EXC SHOULDER LES SC > 3 CM|| 58-1699775|1326041732|CHC13|23073||11/01/2013|12/31/9999|$993.48|0|0|||EXC SHOULDER TUM DEEP > 5 CM|| 58-1699775|1326041732|CHC13|23075||11/01/2013|12/31/9999|$440.92|0|0|||REMOVAL OF SHOULDER LESION|| 58-1699775|1326041732|CHC13|23076||11/01/2013|12/31/9999|$770.35|0|0|||REMOVAL OF SHOULDER LESION|| 58-1699775|1326041732|CHC13|23077||04/01/2014|12/31/9999|$1|675.73|0|0|||REMOVE TUMOR OF SHOULDER|| 58-1699775|1326041732|CHC13|23078||04/01/2014|12/31/9999|$2|117.33|0|0|||RESECT SHOULDER TUM > 5 CM|| 58-1699775|1326041732|CHC13|23100||11/01/2013|12/31/9999|$701.71|0|0|||BIOPSY OF SHOULDER JOINT|| 58-1699775|1326041732|CHC13|23101||11/01/2013|12/31/9999|$640.85|0|0|||SHOULDER JOINT SURGERY|| 58-1699775|1326041732|CHC13|23105||11/01/2013|12/31/9999|$903.62|0|0|||REMOVE SHOULDER JOINT LINING|| 58-1699775|1326041732|CHC13|23106||11/01/2013|12/31/9999|$693.54|0|0|||INCISION OF COLLARBONE JOINT|| 58-1699775|1326041732|CHC13|23107||11/01/2013|12/31/9999|$935.98|0|0|||EXPLORE TREAT SHOULDER JOINT|| 58-1699775|1326041732|CHC13|23120||11/01/2013|12/31/9999|$826.11|0|0|||PARTIAL REMOVAL| COLLAR BONE|| 58-1699775|1326041732|CHC13|23125||11/01/2013|12/31/9999|$1|001.71|0|0|||REMOVAL OF COLLAR BONE|| 58-1699775|1326041732|CHC13|23130||11/01/2013|12/31/9999|$859.36|0|0|||REMOVE SHOULDER BONE| PART|| 58-1699775|1326041732|CHC13|23140||11/01/2013|12/31/9999|$749.91|0|0|||REMOVAL OF BONE LESION|| 58-1699775|1326041732|CHC13|23145||11/01/2013|12/31/9999|$983.43|0|0|||REMOVAL OF BONE LESION|| 58-1699775|1326041732|CHC13|23146||11/01/2013|12/31/9999|$871.17|0|0|||REMOVAL OF BONE LESION|| 58-1699775|1326041732|CHC13|23150||11/01/2013|12/31/9999|$933.90|0|0|||REMOVAL OF HUMERUS LESION|| 58-1699775|1326041732|CHC13|23155||11/01/2013|12/31/9999|$1|123.52|0|0|||REMOVAL OF HUMERUS LESION|| 58-1699775|1326041732|CHC13|23156||11/01/2013|12/31/9999|$958.46|0|0|||REMOVAL OF HUMERUS LESION|| 58-1699775|1326041732|CHC13|23170||11/01/2013|12/31/9999|$782.01|0|0|||REMOVE COLLAR BONE LESION|| 58-1699775|1326041732|CHC13|23172||11/01/2013|12/31/9999|$794.97|0|0|||REMOVE SHOULDER BLADE LESION|| 58-1699775|1326041732|CHC13|23174||11/01/2013|12/31/9999|$1|071.36|0|0|||REMOVE HUMERUS LESION|| 58-1699775|1326041732|CHC13|23180||11/01/2013|12/31/9999|$956.93|0|0|||REMOVE COLLAR BONE LESION|| 58-1699775|1326041732|CHC13|23182||11/01/2013|12/31/9999|$932.31|0|0|||REMOVE SHOULDER BLADE LESION|| 58-1699775|1326041732|CHC13|23184||11/01/2013|12/31/9999|$1|045.27|0|0|||REMOVE HUMERUS LESION|| 58-1699775|1326041732|CHC13|23190||11/01/2013|12/31/9999|$801.80|0|0|||PARTIAL REMOVAL OF SCAPULA|| 58-1699775|1326041732|CHC13|23195||11/01/2013|12/31/9999|$1|069.40|0|0|||REMOVAL OF HEAD OF HUMERUS|| 58-1699775|1326041732|CHC13|23200||11/01/2013|12/31/9999|$2|095.70|0|0|||REMOVAL OF COLLAR BONE|| 58-1699775|1326041732|CHC13|23210||11/01/2013|12/31/9999|$2|459.77|0|0|||REMOVAL OF SHOULDER BLADE|| 58-1699775|1326041732|CHC13|23220||11/01/2013|12/31/9999|$2|699.13|0|0|||PARTIAL REMOVAL OF HUMERUS|| 58-1699775|1326041732|CHC13|23330||11/01/2013|12/31/9999|$214.92|0|0|||REMOVE SHOULDER FOREIGN BODY|| 58-1699775|1326041732|CHC13|23333||04/01/2014|12/31/9999|$662.06|0|0|||REMOVE SHOULDER FB DEEP|| 58-1699775|1326041732|CHC13|23334||04/01/2014|12/31/9999|$1|570.28|0|0|||SHOULDER PROSTHESIS REMOVAL|| 58-1699775|1326041732|CHC13|23335||04/01/2014|12/31/9999|$1|875.36|0|0|||SHOULDER PROSTHESIS REMOVAL|| 58-1699775|1326041732|CHC13|23350||11/01/2013|12/31/9999|$73.68|0|0|||INJECTION FOR SHOULDER X-RAY|| 58-1699775|1326041732|CHC13|23395||11/01/2013|12/31/9999|$1|836.50|0|0|||MUSCLE TRANSFER|SHOULDER/ARM|| 58-1699775|1326041732|CHC13|23397||11/01/2013|12/31/9999|$1|628.74|0|0|||MUSCLE TRANSFERS|| 58-1699775|1326041732|CHC13|23400||11/01/2013|12/31/9999|$1|382.66|0|0|||FIXATION OF SHOULDER BLADE|| 58-1699775|1326041732|CHC13|23405||11/01/2013|12/31/9999|$892.92|0|0|||INCISION OF TENDON & MUSCLE|| 58-1699775|1326041732|CHC13|23406||11/01/2013|12/31/9999|$1|107.83|0|0|||INCISE TENDON(S) & MUSCLE(S)|| 58-1699775|1326041732|CHC13|23410||11/01/2013|12/31/9999|$1|170.88|0|0|||REPAIR ROTATOR CUFF| ACUTE|| 58-1699775|1326041732|CHC13|23412||11/01/2013|12/31/9999|$1|216.93|0|0|||REPAIR ROTATOR CUFF| CHRONIC|| 58-1699775|1326041732|CHC13|23415||11/01/2013|12/31/9999|$985.69|0|0|||RELEASE OF SHOULDER LIGAMENT|| 58-1699775|1326041732|CHC13|23420||11/01/2013|12/31/9999|$1|381.26|0|0|||REPAIR OF SHOULDER|| 58-1699775|1326041732|CHC13|23430||11/01/2013|12/31/9999|$1|060.98|0|0|||REPAIR BICEPS TENDON|| 58-1699775|1326041732|CHC13|23440||11/01/2013|12/31/9999|$1|077.34|0|0|||REMOVE/TRANSPLANT TENDON|| 58-1699775|1326041732|CHC13|23450||11/01/2013|12/31/9999|$1|351.46|0|0|||REPAIR SHOULDER CAPSULE|| 58-1699775|1326041732|CHC13|23455||11/01/2013|12/31/9999|$1|433.31|0|0|||REPAIR SHOULDER CAPSULE|| 58-1699775|1326041732|CHC13|23460||11/01/2013|12/31/9999|$1|555.25|0|0|||REPAIR SHOULDER CAPSULE|| 58-1699775|1326041732|CHC13|23462||11/01/2013|12/31/9999|$1|530.88|0|0|||REPAIR SHOULDER CAPSULE|| 58-1699775|1326041732|CHC13|23465||11/01/2013|12/31/9999|$1|598.68|0|0|||REPAIR SHOULDER CAPSULE|| 58-1699775|1326041732|CHC13|23466||11/01/2013|12/31/9999|$1|599.61|0|0|||REPAIR SHOULDER CAPSULE|| 58-1699775|1326041732|CHC13|23470||11/01/2013|12/31/9999|$1|728.92|0|0|||RECONSTRUCT SHOULDER JOINT|| 58-1699775|1326041732|CHC13|23472||11/01/2013|12/31/9999|$2|143.90|0|0|||RECONSTRUCT SHOULDER JOINT|| 58-1699775|1326041732|CHC13|23473||11/01/2013|12/31/9999|$2|467.36|0|0|||REVIS RECONST SHOULDER JOINT|| 58-1699775|1326041732|CHC13|23474||11/01/2013|12/31/9999|$2|539.83|0|0|||REVIS RECONST SHOULDER JOINT|| 58-1699775|1326041732|CHC13|23480||11/01/2013|12/31/9999|$1|165.76|0|0|||REVISION OF COLLAR BONE|| 58-1699775|1326041732|CHC13|23485||11/01/2013|12/31/9999|$1|370.00|0|0|||REVISION OF COLLAR BONE|| 58-1699775|1326041732|CHC13|23490||11/01/2013|12/31/9999|$1|261.36|0|0|||REINFORCE CLAVICLE|| 58-1699775|1326041732|CHC13|23491||11/01/2013|12/31/9999|$1|444.57|0|0|||REINFORCE SHOULDER BONES|| 58-1699775|1326041732|CHC13|23500||11/01/2013|12/31/9999|$306.49|0|0|||TREAT CLAVICLE FRACTURE|| 58-1699775|1326041732|CHC13|23505||11/01/2013|12/31/9999|$459.82|0|0|||TREAT CLAVICLE FRACTURE|| 58-1699775|1326041732|CHC13|23515||11/01/2013|12/31/9999|$1|020.76|0|0|||TREAT CLAVICLE FRACTURE|| 58-1699775|1326041732|CHC13|23520||11/01/2013|12/31/9999|$321.16|0|0|||TREAT CLAVICLE DISLOCATION|| 58-1699775|1326041732|CHC13|23525||11/01/2013|12/31/9999|$483.93|0|0|||TREAT CLAVICLE DISLOCATION|| 58-1699775|1326041732|CHC13|23530||11/01/2013|12/31/9999|$798.64|0|0|||TREAT CLAVICLE DISLOCATION|| 58-1699775|1326041732|CHC13|23532||11/01/2013|12/31/9999|$880.99|0|0|||TREAT CLAVICLE DISLOCATION|| 58-1699775|1326041732|CHC13|23540||11/01/2013|12/31/9999|$313.70|0|0|||TREAT CLAVICLE DISLOCATION|| 58-1699775|1326041732|CHC13|23545||11/01/2013|12/31/9999|$426.38|0|0|||TREAT CLAVICLE DISLOCATION|| 58-1699775|1326041732|CHC13|23550||11/01/2013|12/31/9999|$807.45|0|0|||TREAT CLAVICLE DISLOCATION|| 58-1699775|1326041732|CHC13|23552||11/01/2013|12/31/9999|$932.96|0|0|||TREAT CLAVICLE DISLOCATION|| 58-1699775|1326041732|CHC13|23570||11/01/2013|12/31/9999|$329.32|0|0|||TREAT SHOULDER BLADE FX|| 58-1699775|1326041732|CHC13|23575||11/01/2013|12/31/9999|$520.30|0|0|||TREAT SHOULDER BLADE FX|| 58-1699775|1326041732|CHC13|23585||11/01/2013|12/31/9999|$1|398.32|0|0|||TREAT SCAPULA FRACTURE|| 58-1699775|1326041732|CHC13|23600||11/01/2013|12/31/9999|$420.58|0|0|||TREAT HUMERUS FRACTURE|| 58-1699775|1326041732|CHC13|23605||11/01/2013|12/31/9999|$598.21|0|0|||TREAT HUMERUS FRACTURE|| 58-1699775|1326041732|CHC13|23615||11/01/2013|12/31/9999|$1|258.42|0|0|||TREAT HUMERUS FRACTURE|| 58-1699775|1326041732|CHC13|23616||11/01/2013|12/31/9999|$1|784.71|0|0|||TREAT HUMERUS FRACTURE|| 58-1699775|1326041732|CHC13|23620||11/01/2013|12/31/9999|$354.69|0|0|||TREAT HUMERUS FRACTURE|| 58-1699775|1326041732|CHC13|23625||11/01/2013|12/31/9999|$492.04|0|0|||TREAT HUMERUS FRACTURE|| 58-1699775|1326041732|CHC13|23630||11/01/2013|12/31/9999|$1|105.86|0|0|||TREAT HUMERUS FRACTURE|| 58-1699775|1326041732|CHC13|23650||11/01/2013|12/31/9999|$395.74|0|0|||TREAT SHOULDER DISLOCATION|| 58-1699775|1326041732|CHC13|23655||11/01/2013|12/31/9999|$554.31|0|0|||TREAT SHOULDER DISLOCATION|| 58-1699775|1326041732|CHC13|23660||11/01/2013|12/31/9999|$825.74|0|0|||TREAT SHOULDER DISLOCATION|| 58-1699775|1326041732|CHC13|23665||11/01/2013|12/31/9999|$552.42|0|0|||TREAT DISLOCATION/FRACTURE|| 58-1699775|1326041732|CHC13|23670||11/01/2013|12/31/9999|$1|237.68|0|0|||TREAT DISLOCATION/FRACTURE|| 58-1699775|1326041732|CHC13|23675||11/01/2013|12/31/9999|$702.51|0|0|||TREAT DISLOCATION/FRACTURE|| 58-1699775|1326041732|CHC13|23680||11/01/2013|12/31/9999|$1|319.04|0|0|||TREAT DISLOCATION/FRACTURE|| 58-1699775|1326041732|CHC13|23700||11/01/2013|12/31/9999|$275.93|0|0|||FIXATION OF SHOULDER|| 58-1699775|1326041732|CHC13|23800||11/01/2013|12/31/9999|$1|461.24|0|0|||FUSION OF SHOULDER JOINT|| 58-1699775|1326041732|CHC13|23802||11/01/2013|12/31/9999|$1|818.50|0|0|||FUSION OF SHOULDER JOINT|| 58-1699775|1326041732|CHC13|23900||11/01/2013|12/31/9999|$1|960.97|0|0|||AMPUTATION OF ARM & GIRDLE|| 58-1699775|1326041732|CHC13|23920||11/01/2013|12/31/9999|$1|590.05|0|0|||AMPUTATION AT SHOULDER JOINT|| 58-1699775|1326041732|CHC13|23921||11/01/2013|12/31/9999|$604.52|0|0|||AMPUTATION FOLLOW-UP SURGERY|| 58-1699775|1326041732|CHC13|23929||11/01/2013|12/31/9999|$0.00|0|0|||SHOULDER SURGERY PROCEDURE|| 58-1699775|1326041732|CHC13|23930||11/01/2013|12/31/9999|$307.19|0|0|||DRAINAGE OF ARM LESION|| 58-1699775|1326041732|CHC13|23931||11/01/2013|12/31/9999|$224.67|0|0|||DRAINAGE OF ARM BURSA|| 58-1699775|1326041732|CHC13|23935||11/01/2013|12/31/9999|$712.77|0|0|||DRAIN ARM/ELBOW BONE LESION|| 58-1699775|1326041732|CHC13|24000||11/01/2013|12/31/9999|$673.50|0|0|||EXPLORATORY ELBOW SURGERY|| 58-1699775|1326041732|CHC13|24006||11/01/2013|12/31/9999|$1|011.75|0|0|||RELEASE ELBOW JOINT|| 58-1699775|1326041732|CHC13|24065||11/01/2013|12/31/9999|$239.48|0|0|||BIOPSY ARM/ELBOW SOFT TISSUE|| 58-1699775|1326041732|CHC13|24066||11/01/2013|12/31/9999|$579.70|0|0|||BIOPSY ARM/ELBOW SOFT TISSUE|| 58-1699775|1326041732|CHC13|24071||11/01/2013|12/31/9999|$582.10|0|0|||EXC ARM/ELBOW LES SC = 3 CM|| 58-1699775|1326041732|CHC13|24073||11/01/2013|12/31/9999|$994.36|0|0|||EX ARM/ELBOW TUM DEEP > 5 CM|| 58-1699775|1326041732|CHC13|24075||11/01/2013|12/31/9999|$465.81|0|0|||REMOVE ARM/ELBOW LESION|| 58-1699775|1326041732|CHC13|24076||11/01/2013|12/31/9999|$766.18|0|0|||REMOVE ARM/ELBOW LESION|| 58-1699775|1326041732|CHC13|24077||04/01/2014|12/31/9999|$1|516.53|0|0|||REMOVE TUMOR OF ARM/ELBOW|| 58-1699775|1326041732|CHC13|24079||04/01/2014|12/31/9999|$1|945.07|0|0|||RESECT ARM/ELBOW TUM > 5 CM|| 58-1699775|1326041732|CHC13|24100||11/01/2013|12/31/9999|$584.09|0|0|||BIOPSY ELBOW JOINT LINING|| 58-1699775|1326041732|CHC13|24101||11/01/2013|12/31/9999|$704.51|0|0|||EXPLORE/TREAT ELBOW JOINT|| 58-1699775|1326041732|CHC13|24102||11/01/2013|12/31/9999|$872.04|0|0|||REMOVE ELBOW JOINT LINING|| 58-1699775|1326041732|CHC13|24105||11/01/2013|12/31/9999|$487.07|0|0|||REMOVAL OF ELBOW BURSA|| 58-1699775|1326041732|CHC13|24110||11/01/2013|12/31/9999|$828.08|0|0|||REMOVE HUMERUS LESION|| 58-1699775|1326041732|CHC13|24115||11/01/2013|12/31/9999|$1|042.87|0|0|||REMOVE/GRAFT BONE LESION|| 58-1699775|1326041732|CHC13|24116||11/01/2013|12/31/9999|$1|225.06|0|0|||REMOVE/GRAFT BONE LESION|| 58-1699775|1326041732|CHC13|24120||11/01/2013|12/31/9999|$745.85|0|0|||REMOVE ELBOW LESION|| 58-1699775|1326041732|CHC13|24125||11/01/2013|12/31/9999|$872.85|0|0|||REMOVE/GRAFT BONE LESION|| 58-1699775|1326041732|CHC13|24126||11/01/2013|12/31/9999|$916.31|0|0|||REMOVE/GRAFT BONE LESION|| 58-1699775|1326041732|CHC13|24130||11/01/2013|12/31/9999|$717.04|0|0|||REMOVAL OF HEAD OF RADIUS|| 58-1699775|1326041732|CHC13|24134||11/01/2013|12/31/9999|$1|060.83|0|0|||REMOVAL OF ARM BONE LESION|| 58-1699775|1326041732|CHC13|24136||11/01/2013|12/31/9999|$880.26|0|0|||REMOVE RADIUS BONE LESION|| 58-1699775|1326041732|CHC13|24138||11/01/2013|12/31/9999|$948.65|0|0|||REMOVE ELBOW BONE LESION|| 58-1699775|1326041732|CHC13|24140||11/01/2013|12/31/9999|$1|002.44|0|0|||PARTIAL REMOVAL OF ARM BONE|| 58-1699775|1326041732|CHC13|24145||11/01/2013|12/31/9999|$841.26|0|0|||PARTIAL REMOVAL OF RADIUS|| 58-1699775|1326041732|CHC13|24147||11/01/2013|12/31/9999|$882.17|0|0|||PARTIAL REMOVAL OF ELBOW|| 58-1699775|1326041732|CHC13|24149||11/01/2013|12/31/9999|$1|665.77|0|0|||RADICAL RESECTION OF ELBOW|| 58-1699775|1326041732|CHC13|24150||11/01/2013|12/31/9999|$2|165.40|0|0|||EXTENSIVE HUMERUS SURGERY|| 58-1699775|1326041732|CHC13|24152||11/01/2013|12/31/9999|$1|861.08|0|0|||EXTENSIVE RADIUS SURGERY|| 58-1699775|1326041732|CHC13|24155||11/01/2013|12/31/9999|$1|211.45|0|0|||REMOVAL OF ELBOW JOINT|| 58-1699775|1326041732|CHC13|24160||04/01/2014|12/31/9999|$1|842.71|0|0|||REMOVE ELBOW JOINT IMPLANT|| 58-1699775|1326041732|CHC13|24164||04/01/2014|12/31/9999|$1|058.82|0|0|||REMOVE RADIUS HEAD IMPLANT|| 58-1699775|1326041732|CHC13|24200||11/01/2013|12/31/9999|$196.50|0|0|||REMOVAL OF ARM FOREIGN BODY|| 58-1699775|1326041732|CHC13|24201||11/01/2013|12/31/9999|$516.48|0|0|||REMOVAL OF ARM FOREIGN BODY|| 58-1699775|1326041732|CHC13|24220||11/01/2013|12/31/9999|$97.79|0|0|||INJECTION FOR ELBOW X-RAY|| 58-1699775|1326041732|CHC13|24300||11/01/2013|12/31/9999|$570.03|0|0|||MANIPULATE ELBOW W/ANESTH|| 58-1699775|1326041732|CHC13|24301||11/01/2013|12/31/9999|$1|069.96|0|0|||MUSCLE/TENDON TRANSFER|| 58-1699775|1326041732|CHC13|24305||11/01/2013|12/31/9999|$820.28|0|0|||ARM TENDON LENGTHENING|| 58-1699775|1326041732|CHC13|24310||11/01/2013|12/31/9999|$674.18|0|0|||REVISION OF ARM TENDON|| 58-1699775|1326041732|CHC13|24320||11/01/2013|12/31/9999|$1|106.56|0|0|||REPAIR OF ARM TENDON|| 58-1699775|1326041732|CHC13|24330||11/01/2013|12/31/9999|$1|016.29|0|0|||REVISION OF ARM MUSCLES|| 58-1699775|1326041732|CHC13|24331||11/01/2013|12/31/9999|$1|051.12|0|0|||REVISION OF ARM MUSCLES|| 58-1699775|1326041732|CHC13|24332||11/01/2013|12/31/9999|$862.88|0|0|||TENOLYSIS| TRICEPS|| 58-1699775|1326041732|CHC13|24340||11/01/2013|12/31/9999|$870.23|0|0|||REPAIR OF BICEPS TENDON|| 58-1699775|1326041732|CHC13|24341||11/01/2013|12/31/9999|$1|054.97|0|0|||REPAIR ARM TENDON/MUSCLE|| 58-1699775|1326041732|CHC13|24342||11/01/2013|12/31/9999|$1|107.37|0|0|||REPAIR OF RUPTURED TENDON|| 58-1699775|1326041732|CHC13|24343||11/01/2013|12/31/9999|$997.49|0|0|||REPR ELBOW LAT LIGMNT W/TISS|| 58-1699775|1326041732|CHC13|24344||11/01/2013|12/31/9999|$1|565.65|0|0|||RECONSTRUCT ELBOW LAT LIGMNT|| 58-1699775|1326041732|CHC13|24345||11/01/2013|12/31/9999|$991.99|0|0|||REPR ELBW MED LIGMNT W/TISSU|| 58-1699775|1326041732|CHC13|24346||11/01/2013|12/31/9999|$1|559.23|0|0|||RECONSTRUCT ELBOW MED LIGMNT|| 58-1699775|1326041732|CHC13|24357||11/01/2013|12/31/9999|$625.48|0|0|||REPAIR ELBOW| PERC|| 58-1699775|1326041732|CHC13|24358||11/01/2013|12/31/9999|$739.46|0|0|||REPAIR ELBOW W/DEB| OPEN|| 58-1699775|1326041732|CHC13|24359||11/01/2013|12/31/9999|$934.20|0|0|||REPAIR ELBOW DEB/ATTCH OPEN|| 58-1699775|1326041732|CHC13|24360||11/01/2013|12/31/9999|$1|277.89|0|0|||RECONSTRUCT ELBOW JOINT|| 58-1699775|1326041732|CHC13|24361||11/01/2013|12/31/9999|$1|433.30|0|0|||RECONSTRUCT ELBOW JOINT|| 58-1699775|1326041732|CHC13|24362||11/01/2013|12/31/9999|$1|510.33|0|0|||RECONSTRUCT ELBOW JOINT|| 58-1699775|1326041732|CHC13|24363||11/01/2013|12/31/9999|$2|142.66|0|0|||REPLACE ELBOW JOINT|| 58-1699775|1326041732|CHC13|24365||11/01/2013|12/31/9999|$904.85|0|0|||RECONSTRUCT HEAD OF RADIUS|| 58-1699775|1326041732|CHC13|24366||11/01/2013|12/31/9999|$967.97|0|0|||RECONSTRUCT HEAD OF RADIUS|| 58-1699775|1326041732|CHC13|24370||11/01/2013|12/31/9999|$2|220.01|0|0|||REVISE RECONST ELBOW JOINT|| 58-1699775|1326041732|CHC13|24371||11/01/2013|12/31/9999|$2|559.75|0|0|||REVISE RECONST ELBOW JOINT|| 58-1699775|1326041732|CHC13|24400||11/01/2013|12/31/9999|$1|167.77|0|0|||REVISION OF HUMERUS|| 58-1699775|1326041732|CHC13|24410||11/01/2013|12/31/9999|$1|367.95|0|0|||REVISION OF HUMERUS|| 58-1699775|1326041732|CHC13|24420||11/01/2013|12/31/9999|$1|407.10|0|0|||REVISION OF HUMERUS|| 58-1699775|1326041732|CHC13|24430||11/01/2013|12/31/9999|$1|508.91|0|0|||REPAIR OF HUMERUS|| 58-1699775|1326041732|CHC13|24435||11/01/2013|12/31/9999|$1|533.20|0|0|||REPAIR HUMERUS WITH GRAFT|| 58-1699775|1326041732|CHC13|24470||11/01/2013|12/31/9999|$936.39|0|0|||REVISION OF ELBOW JOINT|| 58-1699775|1326041732|CHC13|24495||11/01/2013|12/31/9999|$932.35|0|0|||DECOMPRESSION OF FOREARM|| 58-1699775|1326041732|CHC13|24498||11/01/2013|12/31/9999|$1|234.49|0|0|||REINFORCE HUMERUS|| 58-1699775|1326041732|CHC13|24500||11/01/2013|12/31/9999|$449.72|0|0|||TREAT HUMERUS FRACTURE|| 58-1699775|1326041732|CHC13|24505||11/01/2013|12/31/9999|$635.80|0|0|||TREAT HUMERUS FRACTURE|| 58-1699775|1326041732|CHC13|24515||11/01/2013|12/31/9999|$1|245.93|0|0|||TREAT HUMERUS FRACTURE|| 58-1699775|1326041732|CHC13|24516||11/01/2013|12/31/9999|$1|225.72|0|0|||TREAT HUMERUS FRACTURE|| 58-1699775|1326041732|CHC13|24530||11/01/2013|12/31/9999|$477.84|0|0|||TREAT HUMERUS FRACTURE|| 58-1699775|1326041732|CHC13|24535||11/01/2013|12/31/9999|$800.21|0|0|||TREAT HUMERUS FRACTURE|| 58-1699775|1326041732|CHC13|24538||11/01/2013|12/31/9999|$1|052.40|0|0|||TREAT HUMERUS FRACTURE|| 58-1699775|1326041732|CHC13|24545||11/01/2013|12/31/9999|$1|321.32|0|0|||TREAT HUMERUS FRACTURE|| 58-1699775|1326041732|CHC13|24546||11/01/2013|12/31/9999|$1|485.98|0|0|||TREAT HUMERUS FRACTURE|| 58-1699775|1326041732|CHC13|24560||11/01/2013|12/31/9999|$397.38|0|0|||TREAT HUMERUS FRACTURE|| 58-1699775|1326041732|CHC13|24565||11/01/2013|12/31/9999|$678.77|0|0|||TREAT HUMERUS FRACTURE|| 58-1699775|1326041732|CHC13|24566||11/01/2013|12/31/9999|$1|010.01|0|0|||TREAT HUMERUS FRACTURE|| 58-1699775|1326041732|CHC13|24575||11/01/2013|12/31/9999|$1|040.11|0|0|||TREAT HUMERUS FRACTURE|| 58-1699775|1326041732|CHC13|24576||11/01/2013|12/31/9999|$421.22|0|0|||TREAT HUMERUS FRACTURE|| 58-1699775|1326041732|CHC13|24577||11/01/2013|12/31/9999|$699.29|0|0|||TREAT HUMERUS FRACTURE|| 58-1699775|1326041732|CHC13|24579||11/01/2013|12/31/9999|$1|186.24|0|0|||TREAT HUMERUS FRACTURE|| 58-1699775|1326041732|CHC13|24582||11/01/2013|12/31/9999|$1|134.67|0|0|||TREAT HUMERUS FRACTURE|| 58-1699775|1326041732|CHC13|24586||11/01/2013|12/31/9999|$1|551.71|0|0|||TREAT ELBOW FRACTURE|| 58-1699775|1326041732|CHC13|24587||11/01/2013|12/31/9999|$1|544.71|0|0|||TREAT ELBOW FRACTURE|| 58-1699775|1326041732|CHC13|24600||11/01/2013|12/31/9999|$467.28|0|0|||TREAT ELBOW DISLOCATION|| 58-1699775|1326041732|CHC13|24605||11/01/2013|12/31/9999|$657.33|0|0|||TREAT ELBOW DISLOCATION|| 58-1699775|1326041732|CHC13|24615||11/01/2013|12/31/9999|$1|009.50|0|0|||TREAT ELBOW DISLOCATION|| 58-1699775|1326041732|CHC13|24620||11/01/2013|12/31/9999|$778.76|0|0|||TREAT ELBOW FRACTURE|| 58-1699775|1326041732|CHC13|24635||11/01/2013|12/31/9999|$974.07|0|0|||TREAT ELBOW FRACTURE|| 58-1699775|1326041732|CHC13|24640||11/01/2013|12/31/9999|$130.65|0|0|||TREAT ELBOW DISLOCATION|| 58-1699775|1326041732|CHC13|24650||11/01/2013|12/31/9999|$330.40|0|0|||TREAT RADIUS FRACTURE|| 58-1699775|1326041732|CHC13|24655||11/01/2013|12/31/9999|$560.89|0|0|||TREAT RADIUS FRACTURE|| 58-1699775|1326041732|CHC13|24665||11/01/2013|12/31/9999|$920.31|0|0|||TREAT RADIUS FRACTURE|| 58-1699775|1326041732|CHC13|24666||11/01/2013|12/31/9999|$1|039.03|0|0|||TREAT RADIUS FRACTURE|| 58-1699775|1326041732|CHC13|24670||11/01/2013|12/31/9999|$363.22|0|0|||TREAT ULNAR FRACTURE|| 58-1699775|1326041732|CHC13|24675||11/01/2013|12/31/9999|$585.43|0|0|||TREAT ULNAR FRACTURE|| 58-1699775|1326041732|CHC13|24685||11/01/2013|12/31/9999|$924.07|0|0|||TREAT ULNAR FRACTURE|| 58-1699775|1326041732|CHC13|24800||11/01/2013|12/31/9999|$1|166.90|0|0|||FUSION OF ELBOW JOINT|| 58-1699775|1326041732|CHC13|24802||11/01/2013|12/31/9999|$1|424.11|0|0|||FUSION/GRAFT OF ELBOW JOINT|| 58-1699775|1326041732|CHC13|24900||11/01/2013|12/31/9999|$1|033.13|0|0|||AMPUTATION OF UPPER ARM|| 58-1699775|1326041732|CHC13|24920||11/01/2013|12/31/9999|$965.90|0|0|||AMPUTATION OF UPPER ARM|| 58-1699775|1326041732|CHC13|24925||11/01/2013|12/31/9999|$796.72|0|0|||AMPUTATION FOLLOW-UP SURGERY|| 58-1699775|1326041732|CHC13|24930||11/01/2013|12/31/9999|$1|093.11|0|0|||AMPUTATION FOLLOW-UP SURGERY|| 58-1699775|1326041732|CHC13|24931||11/01/2013|12/31/9999|$1|102.12|0|0|||AMPUTATE UPPER ARM & IMPLANT|| 58-1699775|1326041732|CHC13|24935||11/01/2013|12/31/9999|$1|452.79|0|0|||REVISION OF AMPUTATION|| 58-1699775|1326041732|CHC13|24940||11/01/2013|12/31/9999|$1|523.62|0|0|||REVISION OF UPPER ARM|| 58-1699775|1326041732|CHC13|24999||11/01/2013|12/31/9999|$0.00|0|0|||UPPER ARM/ELBOW SURGERY|| 58-1699775|1326041732|CHC13|25000||11/01/2013|12/31/9999|$477.04|0|0|||INCISION OF TENDON SHEATH|| 58-1699775|1326041732|CHC13|25001||11/01/2013|12/31/9999|$479.25|0|0|||INCISE FLEXOR CARPI RADIALIS|| 58-1699775|1326041732|CHC13|25020||11/01/2013|12/31/9999|$813.07|0|0|||DECOMPRESS FOREARM 1 SPACE|| 58-1699775|1326041732|CHC13|25023||11/01/2013|12/31/9999|$1|568.14|0|0|||DECOMPRESS FOREARM 1 SPACE|| 58-1699775|1326041732|CHC13|25024||11/01/2013|12/31/9999|$1|113.04|0|0|||DECOMPRESS FOREARM 2 SPACES|| 58-1699775|1326041732|CHC13|25025||11/01/2013|12/31/9999|$1|737.48|0|0|||DECOMPRESS FOREARM 2 SPACES|| 58-1699775|1326041732|CHC13|25028||11/01/2013|12/31/9999|$732.05|0|0|||DRAINAGE OF FOREARM LESION|| 58-1699775|1326041732|CHC13|25031||11/01/2013|12/31/9999|$517.25|0|0|||DRAINAGE OF FOREARM BURSA|| 58-1699775|1326041732|CHC13|25035||11/01/2013|12/31/9999|$849.04|0|0|||TREAT FOREARM BONE LESION|| 58-1699775|1326041732|CHC13|25040||11/01/2013|12/31/9999|$801.77|0|0|||EXPLORE/TREAT WRIST JOINT|| 58-1699775|1326041732|CHC13|25065||11/01/2013|12/31/9999|$234.41|0|0|||BIOPSY FOREARM SOFT TISSUES|| 58-1699775|1326041732|CHC13|25066||11/01/2013|12/31/9999|$512.67|0|0|||BIOPSY FOREARM SOFT TISSUES|| 58-1699775|1326041732|CHC13|25071||11/01/2013|12/31/9999|$610.26|0|0|||EXC FOREARM LES SC > 3 CM|| 58-1699775|1326041732|CHC13|25073||11/01/2013|12/31/9999|$761.33|0|0|||EXC FOREARM TUM DEEP = 3 CM|| 58-1699775|1326041732|CHC13|25075||11/01/2013|12/31/9999|$455.51|0|0|||REMOVAL FOREARM LESION SUBCU|| 58-1699775|1326041732|CHC13|25076||11/01/2013|12/31/9999|$734.88|0|0|||REMOVAL FOREARM LESION DEEP|| 58-1699775|1326041732|CHC13|25077||04/01/2014|12/31/9999|$1|289.79|0|0|||REMOVE TUMOR| FOREARM/WRIST|| 58-1699775|1326041732|CHC13|25078||04/01/2014|12/31/9999|$1|711.31|0|0|||RESECT FOREARM/WRIST TUM=3CM|| 58-1699775|1326041732|CHC13|25085||11/01/2013|12/31/9999|$641.76|0|0|||INCISION OF WRIST CAPSULE|| 58-1699775|1326041732|CHC13|25100||11/01/2013|12/31/9999|$486.12|0|0|||BIOPSY OF WRIST JOINT|| 58-1699775|1326041732|CHC13|25101||11/01/2013|12/31/9999|$569.38|0|0|||EXPLORE/TREAT WRIST JOINT|| 58-1699775|1326041732|CHC13|25105||11/01/2013|12/31/9999|$684.54|0|0|||REMOVE WRIST JOINT LINING|| 58-1699775|1326041732|CHC13|25107||11/01/2013|12/31/9999|$872.50|0|0|||REMOVE WRIST JOINT CARTILAGE|| 58-1699775|1326041732|CHC13|25109||11/01/2013|12/31/9999|$756.49|0|0|||EXCISE TENDON FOREARM/WRIST|| 58-1699775|1326041732|CHC13|25110||11/01/2013|12/31/9999|$487.09|0|0|||REMOVE WRIST TENDON LESION|| 58-1699775|1326041732|CHC13|25111||11/01/2013|12/31/9999|$449.01|0|0|||REMOVE WRIST TENDON LESION|| 58-1699775|1326041732|CHC13|25112||11/01/2013|12/31/9999|$546.03|0|0|||REREMOVE WRIST TENDON LESION|| 58-1699775|1326041732|CHC13|25115||11/01/2013|12/31/9999|$1|096.53|0|0|||REMOVE WRIST/FOREARM LESION|| 58-1699775|1326041732|CHC13|25116||11/01/2013|12/31/9999|$868.52|0|0|||REMOVE WRIST/FOREARM LESION|| 58-1699775|1326041732|CHC13|25118||11/01/2013|12/31/9999|$539.13|0|0|||EXCISE WRIST TENDON SHEATH|| 58-1699775|1326041732|CHC13|25119||11/01/2013|12/31/9999|$710.93|0|0|||PARTIAL REMOVAL OF ULNA|| 58-1699775|1326041732|CHC13|25120||11/01/2013|12/31/9999|$724.01|0|0|||REMOVAL OF FOREARM LESION|| 58-1699775|1326041732|CHC13|25125||11/01/2013|12/31/9999|$874.87|0|0|||REMOVE/GRAFT FOREARM LESION|| 58-1699775|1326041732|CHC13|25126||11/01/2013|12/31/9999|$862.41|0|0|||REMOVE/GRAFT FOREARM LESION|| 58-1699775|1326041732|CHC13|25130||11/01/2013|12/31/9999|$633.16|0|0|||REMOVAL OF WRIST LESION|| 58-1699775|1326041732|CHC13|25135||11/01/2013|12/31/9999|$804.67|0|0|||REMOVE & GRAFT WRIST LESION|| 58-1699775|1326041732|CHC13|25136||11/01/2013|12/31/9999|$695.88|0|0|||REMOVE & GRAFT WRIST LESION|| 58-1699775|1326041732|CHC13|25145||11/01/2013|12/31/9999|$748.05|0|0|||REMOVE FOREARM BONE LESION|| 58-1699775|1326041732|CHC13|25150||11/01/2013|12/31/9999|$805.73|0|0|||PARTIAL REMOVAL OF ULNA|| 58-1699775|1326041732|CHC13|25151||11/01/2013|12/31/9999|$850.16|0|0|||PARTIAL REMOVAL OF RADIUS|| 58-1699775|1326041732|CHC13|25170||11/01/2013|12/31/9999|$2|067.72|0|0|||EXTENSIVE FOREARM SURGERY|| 58-1699775|1326041732|CHC13|25210||11/01/2013|12/31/9999|$693.29|0|0|||REMOVAL OF WRIST BONE|| 58-1699775|1326041732|CHC13|25215||11/01/2013|12/31/9999|$878.98|0|0|||REMOVAL OF WRIST BONES|| 58-1699775|1326041732|CHC13|25230||11/01/2013|12/31/9999|$610.25|0|0|||PARTIAL REMOVAL OF RADIUS|| 58-1699775|1326041732|CHC13|25240||11/01/2013|12/31/9999|$609.49|0|0|||PARTIAL REMOVAL OF ULNA|| 58-1699775|1326041732|CHC13|25246||11/01/2013|12/31/9999|$107.72|0|0|||INJECTION FOR WRIST X-RAY|| 58-1699775|1326041732|CHC13|25248||11/01/2013|12/31/9999|$600.08|0|0|||REMOVE FOREARM FOREIGN BODY|| 58-1699775|1326041732|CHC13|25250||11/01/2013|12/31/9999|$746.10|0|0|||REMOVAL OF WRIST PROSTHESIS|| 58-1699775|1326041732|CHC13|25251||11/01/2013|12/31/9999|$1|018.75|0|0|||REMOVAL OF WRIST PROSTHESIS|| 58-1699775|1326041732|CHC13|25259||11/01/2013|12/31/9999|$573.70|0|0|||MANIPULATE WRIST W/ANESTHES|| 58-1699775|1326041732|CHC13|25260||11/01/2013|12/31/9999|$912.97|0|0|||REPAIR FOREARM TENDON/MUSCLE|| 58-1699775|1326041732|CHC13|25263||11/01/2013|12/31/9999|$904.87|0|0|||REPAIR FOREARM TENDON/MUSCLE|| 58-1699775|1326041732|CHC13|25265||11/01/2013|12/31/9999|$1|079.87|0|0|||REPAIR FOREARM TENDON/MUSCLE|| 58-1699775|1326041732|CHC13|25270||11/01/2013|12/31/9999|$718.43|0|0|||REPAIR FOREARM TENDON/MUSCLE|| 58-1699775|1326041732|CHC13|25272||11/01/2013|12/31/9999|$807.99|0|0|||REPAIR FOREARM TENDON/MUSCLE|| 58-1699775|1326041732|CHC13|25274||11/01/2013|12/31/9999|$974.95|0|0|||REPAIR FOREARM TENDON/MUSCLE|| 58-1699775|1326041732|CHC13|25275||11/01/2013|12/31/9999|$962.22|0|0|||REPAIR FOREARM TENDON SHEATH|| 58-1699775|1326041732|CHC13|25280||11/01/2013|12/31/9999|$819.41|0|0|||REVISE WRIST/FOREARM TENDON|| 58-1699775|1326041732|CHC13|25290||11/01/2013|12/31/9999|$649.19|0|0|||INCISE WRIST/FOREARM TENDON|| 58-1699775|1326041732|CHC13|25295||11/01/2013|12/31/9999|$760.30|0|0|||RELEASE WRIST/FOREARM TENDON|| 58-1699775|1326041732|CHC13|25300||11/01/2013|12/31/9999|$990.51|0|0|||FUSION OF TENDONS AT WRIST|| 58-1699775|1326041732|CHC13|25301||11/01/2013|12/31/9999|$915.51|0|0|||FUSION OF TENDONS AT WRIST|| 58-1699775|1326041732|CHC13|25310||11/01/2013|12/31/9999|$896.53|0|0|||TRANSPLANT FOREARM TENDON|| 58-1699775|1326041732|CHC13|25312||11/01/2013|12/31/9999|$1|042.82|0|0|||TRANSPLANT FOREARM TENDON|| 58-1699775|1326041732|CHC13|25315||11/01/2013|12/31/9999|$1|115.19|0|0|||REVISE PALSY HAND TENDON(S)|| 58-1699775|1326041732|CHC13|25316||11/01/2013|12/31/9999|$1|272.71|0|0|||REVISE PALSY HAND TENDON(S)|| 58-1699775|1326041732|CHC13|25320||11/01/2013|12/31/9999|$1|399.47|0|0|||REPAIR/REVISE WRIST JOINT|| 58-1699775|1326041732|CHC13|25332||11/01/2013|12/31/9999|$1|204.28|0|0|||REVISE WRIST JOINT|| 58-1699775|1326041732|CHC13|25335||11/01/2013|12/31/9999|$1|266.46|0|0|||REALIGNMENT OF HAND|| 58-1699775|1326041732|CHC13|25337||11/01/2013|12/31/9999|$1|262.19|0|0|||RECONSTRUCT ULNA/RADIOULNAR|| 58-1699775|1326041732|CHC13|25350||11/01/2013|12/31/9999|$977.78|0|0|||REVISION OF RADIUS|| 58-1699775|1326041732|CHC13|25355||11/01/2013|12/31/9999|$1|107.94|0|0|||REVISION OF RADIUS|| 58-1699775|1326041732|CHC13|25360||11/01/2013|12/31/9999|$949.89|0|0|||REVISION OF ULNA|| 58-1699775|1326041732|CHC13|25365||11/01/2013|12/31/9999|$1|318.68|0|0|||REVISE RADIUS & ULNA|| 58-1699775|1326041732|CHC13|25370||11/01/2013|12/31/9999|$1|320.64|0|0|||REVISE RADIUS OR ULNA|| 58-1699775|1326041732|CHC13|25375||11/01/2013|12/31/9999|$1|141.67|0|0|||REVISE RADIUS & ULNA|| 58-1699775|1326041732|CHC13|25390||11/01/2013|12/31/9999|$1|114.96|0|0|||SHORTEN RADIUS OR ULNA|| 58-1699775|1326041732|CHC13|25391||11/01/2013|12/31/9999|$1|438.11|0|0|||LENGTHEN RADIUS OR ULNA|| 58-1699775|1326041732|CHC13|25392||11/01/2013|12/31/9999|$1|465.00|0|0|||SHORTEN RADIUS & ULNA|| 58-1699775|1326041732|CHC13|25393||11/01/2013|12/31/9999|$1|634.07|0|0|||LENGTHEN RADIUS & ULNA|| 58-1699775|1326041732|CHC13|25394||11/01/2013|12/31/9999|$1|110.63|0|0|||REPAIR CARPAL BONE| SHORTEN|| 58-1699775|1326041732|CHC13|25400||11/01/2013|12/31/9999|$1|167.32|0|0|||REPAIR RADIUS OR ULNA|| 58-1699775|1326041732|CHC13|25405||11/01/2013|12/31/9999|$1|499.09|0|0|||REPAIR/GRAFT RADIUS OR ULNA|| 58-1699775|1326041732|CHC13|25415||11/01/2013|12/31/9999|$1|401.06|0|0|||REPAIR RADIUS & ULNA|| 58-1699775|1326041732|CHC13|25420||11/01/2013|12/31/9999|$1|688.99|0|0|||REPAIR/GRAFT RADIUS & ULNA|| 58-1699775|1326041732|CHC13|25425||11/01/2013|12/31/9999|$1|407.50|0|0|||REPAIR/GRAFT RADIUS OR ULNA|| 58-1699775|1326041732|CHC13|25426||11/01/2013|12/31/9999|$1|599.51|0|0|||REPAIR/GRAFT RADIUS & ULNA|| 58-1699775|1326041732|CHC13|25430||11/01/2013|12/31/9999|$997.36|0|0|||VASC GRAFT INTO CARPAL BONE|| 58-1699775|1326041732|CHC13|25431||11/01/2013|12/31/9999|$1|116.36|0|0|||REPAIR NONUNION CARPAL BONE|| 58-1699775|1326041732|CHC13|25440||11/01/2013|12/31/9999|$1|096.99|0|0|||REPAIR/GRAFT WRIST BONE|| 58-1699775|1326041732|CHC13|25441||11/01/2013|12/31/9999|$1|287.19|0|0|||RECONSTRUCT WRIST JOINT|| 58-1699775|1326041732|CHC13|25442||11/01/2013|12/31/9999|$1|119.60|0|0|||RECONSTRUCT WRIST JOINT|| 58-1699775|1326041732|CHC13|25443||11/01/2013|12/31/9999|$1|107.75|0|0|||RECONSTRUCT WRIST JOINT|| 58-1699775|1326041732|CHC13|25444||11/01/2013|12/31/9999|$1|131.26|0|0|||RECONSTRUCT WRIST JOINT|| 58-1699775|1326041732|CHC13|25445||11/01/2013|12/31/9999|$1|023.45|0|0|||RECONSTRUCT WRIST JOINT|| 58-1699775|1326041732|CHC13|25446||11/01/2013|12/31/9999|$1|671.81|0|0|||WRIST REPLACEMENT|| 58-1699775|1326041732|CHC13|25447||11/01/2013|12/31/9999|$1|171.93|0|0|||REPAIR WRIST JOINT(S)|| 58-1699775|1326041732|CHC13|25449||11/01/2013|12/31/9999|$1|486.21|0|0|||REMOVE WRIST JOINT IMPLANT|| 58-1699775|1326041732|CHC13|25450||11/01/2013|12/31/9999|$866.92|0|0|||REVISION OF WRIST JOINT|| 58-1699775|1326041732|CHC13|25455||11/01/2013|12/31/9999|$962.62|0|0|||REVISION OF WRIST JOINT|| 58-1699775|1326041732|CHC13|25490||11/01/2013|12/31/9999|$965.43|0|0|||REINFORCE RADIUS|| 58-1699775|1326041732|CHC13|25491||11/01/2013|12/31/9999|$1|070.08|0|0|||REINFORCE ULNA|| 58-1699775|1326041732|CHC13|25492||11/01/2013|12/31/9999|$1|302.60|0|0|||REINFORCE RADIUS AND ULNA|| 58-1699775|1326041732|CHC13|25500||11/01/2013|12/31/9999|$343.42|0|0|||TREAT FRACTURE OF RADIUS|| 58-1699775|1326041732|CHC13|25505||11/01/2013|12/31/9999|$646.17|0|0|||TREAT FRACTURE OF RADIUS|| 58-1699775|1326041732|CHC13|25515||11/01/2013|12/31/9999|$946.10|0|0|||TREAT FRACTURE OF RADIUS|| 58-1699775|1326041732|CHC13|25520||11/01/2013|12/31/9999|$748.30|0|0|||TREAT FRACTURE OF RADIUS|| 58-1699775|1326041732|CHC13|25525||11/01/2013|12/31/9999|$1|116.21|0|0|||TREAT FRACTURE OF RADIUS|| 58-1699775|1326041732|CHC13|25526||11/01/2013|12/31/9999|$1|365.85|0|0|||TREAT FRACTURE OF RADIUS|| 58-1699775|1326041732|CHC13|25530||11/01/2013|12/31/9999|$325.44|0|0|||TREAT FRACTURE OF ULNA|| 58-1699775|1326041732|CHC13|25535||11/01/2013|12/31/9999|$636.05|0|0|||TREAT FRACTURE OF ULNA|| 58-1699775|1326041732|CHC13|25545||11/01/2013|12/31/9999|$881.32|0|0|||TREAT FRACTURE OF ULNA|| 58-1699775|1326041732|CHC13|25560||11/01/2013|12/31/9999|$342.96|0|0|||TREAT FRACTURE RADIUS & ULNA|| 58-1699775|1326041732|CHC13|25565||11/01/2013|12/31/9999|$665.32|0|0|||TREAT FRACTURE RADIUS & ULNA|| 58-1699775|1326041732|CHC13|25574||11/01/2013|12/31/9999|$948.90|0|0|||TREAT FRACTURE RADIUS & ULNA|| 58-1699775|1326041732|CHC13|25575||11/01/2013|12/31/9999|$1|275.24|0|0|||TREAT FRACTURE RADIUS/ULNA|| 58-1699775|1326041732|CHC13|25600||11/01/2013|12/31/9999|$414.16|0|0|||TREAT FRACTURE RADIUS/ULNA|| 58-1699775|1326041732|CHC13|25605||11/01/2013|12/31/9999|$734.95|0|0|||TREAT FRACTURE RADIUS/ULNA|| 58-1699775|1326041732|CHC13|25606||11/01/2013|12/31/9999|$936.58|0|0|||TREAT FX DISTAL RADIAL|| 58-1699775|1326041732|CHC13|25607||11/01/2013|12/31/9999|$1|036.03|0|0|||TREAT FX RAD EXTRA-ARTICUL|| 58-1699775|1326041732|CHC13|25608||11/01/2013|12/31/9999|$1|163.94|0|0|||TREAT FX RAD INTRA-ARTICUL|| 58-1699775|1326041732|CHC13|25609||11/01/2013|12/31/9999|$1|482.89|0|0|||TREAT FX RADIAL 3+ FRAG|| 58-1699775|1326041732|CHC13|25622||11/01/2013|12/31/9999|$382.57|0|0|||TREAT WRIST BONE FRACTURE|| 58-1699775|1326041732|CHC13|25624||11/01/2013|12/31/9999|$599.76|0|0|||TREAT WRIST BONE FRACTURE|| 58-1699775|1326041732|CHC13|25628||11/01/2013|12/31/9999|$1|020.43|0|0|||TREAT WRIST BONE FRACTURE|| 58-1699775|1326041732|CHC13|25630||11/01/2013|12/31/9999|$389.39|0|0|||TREAT WRIST BONE FRACTURE|| 58-1699775|1326041732|CHC13|25635||11/01/2013|12/31/9999|$570.53|0|0|||TREAT WRIST BONE FRACTURE|| 58-1699775|1326041732|CHC13|25645||11/01/2013|12/31/9999|$802.44|0|0|||TREAT WRIST BONE FRACTURE|| 58-1699775|1326041732|CHC13|25650||11/01/2013|12/31/9999|$416.62|0|0|||TREAT WRIST BONE FRACTURE|| 58-1699775|1326041732|CHC13|25651||11/01/2013|12/31/9999|$682.13|0|0|||PIN ULNAR STYLOID FRACTURE|| 58-1699775|1326041732|CHC13|25652||11/01/2013|12/31/9999|$879.13|0|0|||TREAT FRACTURE ULNAR STYLOID|| 58-1699775|1326041732|CHC13|25660||11/01/2013|12/31/9999|$572.45|0|0|||TREAT WRIST DISLOCATION|| 58-1699775|1326041732|CHC13|25670||11/01/2013|12/31/9999|$855.95|0|0|||TREAT WRIST DISLOCATION|| 58-1699775|1326041732|CHC13|25671||11/01/2013|12/31/9999|$743.95|0|0|||PIN RADIOULNAR DISLOCATION|| 58-1699775|1326041732|CHC13|25675||11/01/2013|12/31/9999|$561.39|0|0|||TREAT WRIST DISLOCATION|| 58-1699775|1326041732|CHC13|25676||11/01/2013|12/31/9999|$890.52|0|0|||TREAT WRIST DISLOCATION|| 58-1699775|1326041732|CHC13|25680||11/01/2013|12/31/9999|$666.81|0|0|||TREAT WRIST FRACTURE|| 58-1699775|1326041732|CHC13|25685||11/01/2013|12/31/9999|$1|040.39|0|0|||TREAT WRIST FRACTURE|| 58-1699775|1326041732|CHC13|25690||11/01/2013|12/31/9999|$670.21|0|0|||TREAT WRIST DISLOCATION|| 58-1699775|1326041732|CHC13|25695||11/01/2013|12/31/9999|$895.06|0|0|||TREAT WRIST DISLOCATION|| 58-1699775|1326041732|CHC13|25800||11/01/2013|12/31/9999|$1|042.34|0|0|||FUSION OF WRIST JOINT|| 58-1699775|1326041732|CHC13|25805||11/01/2013|12/31/9999|$1|203.03|0|0|||FUSION/GRAFT OF WRIST JOINT|| 58-1699775|1326041732|CHC13|25810||11/01/2013|12/31/9999|$1|235.54|0|0|||FUSION/GRAFT OF WRIST JOINT|| 58-1699775|1326041732|CHC13|25820||11/01/2013|12/31/9999|$869.91|0|0|||FUSION OF HAND BONES|| 58-1699775|1326041732|CHC13|25825||11/01/2013|12/31/9999|$1|072.27|0|0|||FUSE HAND BONES WITH GRAFT|| 58-1699775|1326041732|CHC13|25830||11/01/2013|12/31/9999|$1|342.34|0|0|||FUSION| RADIOULNAR JNT/ULNA|| 58-1699775|1326041732|CHC13|25900||11/01/2013|12/31/9999|$1|024.83|0|0|||AMPUTATION OF FOREARM|| 58-1699775|1326041732|CHC13|25905||11/01/2013|12/31/9999|$1|008.32|0|0|||AMPUTATION OF FOREARM|| 58-1699775|1326041732|CHC13|25907||11/01/2013|12/31/9999|$823.99|0|0|||AMPUTATION FOLLOW-UP SURGERY|| 58-1699775|1326041732|CHC13|25909||11/01/2013|12/31/9999|$985.70|0|0|||AMPUTATION FOLLOW-UP SURGERY|| 58-1699775|1326041732|CHC13|25915||11/01/2013|12/31/9999|$1|522.80|0|0|||AMPUTATION OF FOREARM|| 58-1699775|1326041732|CHC13|25920||11/01/2013|12/31/9999|$981.86|0|0|||AMPUTATE HAND AT WRIST|| 58-1699775|1326041732|CHC13|25922||11/01/2013|12/31/9999|$806.78|0|0|||AMPUTATE HAND AT WRIST|| 58-1699775|1326041732|CHC13|25924||11/01/2013|12/31/9999|$893.95|0|0|||AMPUTATION FOLLOW-UP SURGERY|| 58-1699775|1326041732|CHC13|25927||11/01/2013|12/31/9999|$1|132.12|0|0|||AMPUTATION OF HAND|| 58-1699775|1326041732|CHC13|25929||11/01/2013|12/31/9999|$849.56|0|0|||AMPUTATION FOLLOW-UP SURGERY|| 58-1699775|1326041732|CHC13|25931||11/01/2013|12/31/9999|$969.70|0|0|||AMPUTATION FOLLOW-UP SURGERY|| 58-1699775|1326041732|CHC13|25999||11/01/2013|12/31/9999|$0.00|0|0|||FOREARM OR WRIST SURGERY|| 58-1699775|1326041732|CHC13|26010||11/01/2013|12/31/9999|$192.55|0|0|||DRAINAGE OF FINGER ABSCESS|| 58-1699775|1326041732|CHC13|26011||11/01/2013|12/31/9999|$260.76|0|0|||DRAINAGE OF FINGER ABSCESS|| 58-1699775|1326041732|CHC13|26020||11/01/2013|12/31/9999|$609.70|0|0|||DRAIN HAND TENDON SHEATH|| 58-1699775|1326041732|CHC13|26025||11/01/2013|12/31/9999|$593.16|0|0|||DRAINAGE OF PALM BURSA|| 58-1699775|1326041732|CHC13|26030||11/01/2013|12/31/9999|$698.21|0|0|||DRAINAGE OF PALM BURSA(S)|| 58-1699775|1326041732|CHC13|26034||11/01/2013|12/31/9999|$758.05|0|0|||TREAT HAND BONE LESION|| 58-1699775|1326041732|CHC13|26035||11/01/2013|12/31/9999|$1|204.26|0|0|||DECOMPRESS FINGERS/HAND|| 58-1699775|1326041732|CHC13|26037||11/01/2013|12/31/9999|$810.05|0|0|||DECOMPRESS FINGERS/HAND|| 58-1699775|1326041732|CHC13|26040||11/01/2013|12/31/9999|$435.18|0|0|||RELEASE PALM CONTRACTURE|| 58-1699775|1326041732|CHC13|26045||11/01/2013|12/31/9999|$657.80|0|0|||RELEASE PALM CONTRACTURE|| 58-1699775|1326041732|CHC13|26055||11/01/2013|12/31/9999|$430.61|0|0|||INCISE FINGER TENDON SHEATH|| 58-1699775|1326041732|CHC13|26060||11/01/2013|12/31/9999|$373.60|0|0|||INCISION OF FINGER TENDON|| 58-1699775|1326041732|CHC13|26070||11/01/2013|12/31/9999|$438.06|0|0|||EXPLORE/TREAT HAND JOINT|| 58-1699775|1326041732|CHC13|26075||11/01/2013|12/31/9999|$456.95|0|0|||EXPLORE/TREAT FINGER JOINT|| 58-1699775|1326041732|CHC13|26080||11/01/2013|12/31/9999|$545.31|0|0|||EXPLORE/TREAT FINGER JOINT|| 58-1699775|1326041732|CHC13|26100||11/01/2013|12/31/9999|$464.67|0|0|||BIOPSY HAND JOINT LINING|| 58-1699775|1326041732|CHC13|26105||11/01/2013|12/31/9999|$470.87|0|0|||BIOPSY FINGER JOINT LINING|| 58-1699775|1326041732|CHC13|26110||11/01/2013|12/31/9999|$450.05|0|0|||BIOPSY FINGER JOINT LINING|| 58-1699775|1326041732|CHC13|26111||11/01/2013|12/31/9999|$598.27|0|0|||EXC HAND LES SC > 1.5 CM|| 58-1699775|1326041732|CHC13|26113||11/01/2013|12/31/9999|$784.54|0|0|||EXC HAND TUM DEEP > 1.5 CM|| 58-1699775|1326041732|CHC13|26115||11/01/2013|12/31/9999|$476.53|0|0|||REMOVAL HAND LESION SUBCUT|| 58-1699775|1326041732|CHC13|26116||11/01/2013|12/31/9999|$743.92|0|0|||REMOVAL HAND LESION| DEEP|| 58-1699775|1326041732|CHC13|26117||04/01/2014|12/31/9999|$1|081.19|0|0|||REMOVE TUMOR| HAND/FINGER|| 58-1699775|1326041732|CHC13|26118||04/01/2014|12/31/9999|$1|533.60|0|0|||EXC HAND TUM RA > 3 CM|| 58-1699775|1326041732|CHC13|26121||11/01/2013|12/31/9999|$845.21|0|0|||RELEASE PALM CONTRACTURE|| 58-1699775|1326041732|CHC13|26123||11/01/2013|12/31/9999|$1|177.39|0|0|||RELEASE PALM CONTRACTURE|| 58-1699775|1326041732|CHC13|26125||11/01/2013|12/31/9999|$397.96|0|0|||RELEASE PALM CONTRACTURE|| 58-1699775|1326041732|CHC13|26130||11/01/2013|12/31/9999|$648.77|0|0|||REMOVE WRIST JOINT LINING|| 58-1699775|1326041732|CHC13|26135||11/01/2013|12/31/9999|$779.07|0|0|||REVISE FINGER JOINT| EACH|| 58-1699775|1326041732|CHC13|26140||11/01/2013|12/31/9999|$712.86|0|0|||REVISE FINGER JOINT| EACH|| 58-1699775|1326041732|CHC13|26145||11/01/2013|12/31/9999|$723.79|0|0|||TENDON EXCISION| PALM/FINGER|| 58-1699775|1326041732|CHC13|26160||11/01/2013|12/31/9999|$465.69|0|0|||REMOVE TENDON SHEATH LESION|| 58-1699775|1326041732|CHC13|26170||11/01/2013|12/31/9999|$572.03|0|0|||REMOVAL OF PALM TENDON| EACH|| 58-1699775|1326041732|CHC13|26180||11/01/2013|12/31/9999|$624.36|0|0|||REMOVAL OF FINGER TENDON|| 58-1699775|1326041732|CHC13|26185||11/01/2013|12/31/9999|$780.96|0|0|||REMOVE FINGER BONE|| 58-1699775|1326041732|CHC13|26200||11/01/2013|12/31/9999|$636.66|0|0|||REMOVE HAND BONE LESION|| 58-1699775|1326041732|CHC13|26205||11/01/2013|12/31/9999|$850.64|0|0|||REMOVE/GRAFT BONE LESION|| 58-1699775|1326041732|CHC13|26210||11/01/2013|12/31/9999|$621.98|0|0|||REMOVAL OF FINGER LESION|| 58-1699775|1326041732|CHC13|26215||11/01/2013|12/31/9999|$792.44|0|0|||REMOVE/GRAFT FINGER LESION|| 58-1699775|1326041732|CHC13|26230||11/01/2013|12/31/9999|$705.73|0|0|||PARTIAL REMOVAL OF HAND BONE|| 58-1699775|1326041732|CHC13|26235||11/01/2013|12/31/9999|$697.16|0|0|||PARTIAL REMOVAL| FINGER BONE|| 58-1699775|1326041732|CHC13|26236||11/01/2013|12/31/9999|$621.84|0|0|||PARTIAL REMOVAL| FINGER BONE|| 58-1699775|1326041732|CHC13|26250||11/01/2013|12/31/9999|$1|467.99|0|0|||EXTENSIVE HAND SURGERY|| 58-1699775|1326041732|CHC13|26260||11/01/2013|12/31/9999|$1|111.41|0|0|||EXTENSIVE FINGER SURGERY|| 58-1699775|1326041732|CHC13|26262||11/01/2013|12/31/9999|$891.10|0|0|||PARTIAL REMOVAL OF FINGER|| 58-1699775|1326041732|CHC13|26320||11/01/2013|12/31/9999|$487.34|0|0|||REMOVAL OF IMPLANT FROM HAND|| 58-1699775|1326041732|CHC13|26340||11/01/2013|12/31/9999|$459.65|0|0|||MANIPULATE FINGER W/ANESTH|| 58-1699775|1326041732|CHC13|26341||11/01/2013|12/31/9999|$105.36|0|0|||MANIPULAT PALM CORD POST INJ|| 58-1699775|1326041732|CHC13|26350||11/01/2013|12/31/9999|$988.64|0|0|||REPAIR FINGER/HAND TENDON|| 58-1699775|1326041732|CHC13|26352||11/01/2013|12/31/9999|$1|130.89|0|0|||REPAIR/GRAFT HAND TENDON|| 58-1699775|1326041732|CHC13|26356||11/01/2013|12/31/9999|$1|522.65|0|0|||REPAIR FINGER/HAND TENDON|| 58-1699775|1326041732|CHC13|26357||11/01/2013|12/31/9999|$1|207.34|0|0|||REPAIR FINGER/HAND TENDON|| 58-1699775|1326041732|CHC13|26358||11/01/2013|12/31/9999|$1|276.20|0|0|||REPAIR/GRAFT HAND TENDON|| 58-1699775|1326041732|CHC13|26370||11/01/2013|12/31/9999|$1|061.50|0|0|||REPAIR FINGER/HAND TENDON|| 58-1699775|1326041732|CHC13|26372||11/01/2013|12/31/9999|$1|231.63|0|0|||REPAIR/GRAFT HAND TENDON|| 58-1699775|1326041732|CHC13|26373||11/01/2013|12/31/9999|$1|178.33|0|0|||REPAIR FINGER/HAND TENDON|| 58-1699775|1326041732|CHC13|26390||11/01/2013|12/31/9999|$1|164.25|0|0|||REVISE HAND/FINGER TENDON|| 58-1699775|1326041732|CHC13|26392||11/01/2013|12/31/9999|$1|371.42|0|0|||REPAIR/GRAFT HAND TENDON|| 58-1699775|1326041732|CHC13|26410||11/01/2013|12/31/9999|$783.59|0|0|||REPAIR HAND TENDON|| 58-1699775|1326041732|CHC13|26412||11/01/2013|12/31/9999|$951.12|0|0|||REPAIR/GRAFT HAND TENDON|| 58-1699775|1326041732|CHC13|26415||11/01/2013|12/31/9999|$959.87|0|0|||EXCISION| HAND/FINGER TENDON|| 58-1699775|1326041732|CHC13|26416||11/01/2013|12/31/9999|$1|200.26|0|0|||GRAFT HAND OR FINGER TENDON|| 58-1699775|1326041732|CHC13|26418||11/01/2013|12/31/9999|$798.46|0|0|||REPAIR FINGER TENDON|| 58-1699775|1326041732|CHC13|26420||11/01/2013|12/31/9999|$996.02|0|0|||REPAIR/GRAFT FINGER TENDON|| 58-1699775|1326041732|CHC13|26426||11/01/2013|12/31/9999|$732.48|0|0|||REPAIR FINGER/HAND TENDON|| 58-1699775|1326041732|CHC13|26428||11/01/2013|12/31/9999|$1|048.54|0|0|||REPAIR/GRAFT FINGER TENDON|| 58-1699775|1326041732|CHC13|26432||11/01/2013|12/31/9999|$689.42|0|0|||REPAIR FINGER TENDON|| 58-1699775|1326041732|CHC13|26433||11/01/2013|12/31/9999|$738.28|0|0|||REPAIR FINGER TENDON|| 58-1699775|1326041732|CHC13|26434||11/01/2013|12/31/9999|$894.62|0|0|||REPAIR/GRAFT FINGER TENDON|| 58-1699775|1326041732|CHC13|26437||11/01/2013|12/31/9999|$863.55|0|0|||REALIGNMENT OF TENDONS|| 58-1699775|1326041732|CHC13|26440||11/01/2013|12/31/9999|$861.78|0|0|||RELEASE PALM/FINGER TENDON|| 58-1699775|1326041732|CHC13|26442||11/01/2013|12/31/9999|$1|344.54|0|0|||RELEASE PALM & FINGER TENDON|| 58-1699775|1326041732|CHC13|26445||11/01/2013|12/31/9999|$799.67|0|0|||RELEASE HAND/FINGER TENDON|| 58-1699775|1326041732|CHC13|26449||11/01/2013|12/31/9999|$1|008.04|0|0|||RELEASE FOREARM/HAND TENDON|| 58-1699775|1326041732|CHC13|26450||11/01/2013|12/31/9999|$560.88|0|0|||INCISION OF PALM TENDON|| 58-1699775|1326041732|CHC13|26455||11/01/2013|12/31/9999|$560.28|0|0|||INCISION OF FINGER TENDON|| 58-1699775|1326041732|CHC13|26460||11/01/2013|12/31/9999|$544.58|0|0|||INCISE HAND/FINGER TENDON|| 58-1699775|1326041732|CHC13|26471||11/01/2013|12/31/9999|$853.91|0|0|||FUSION OF FINGER TENDONS|| 58-1699775|1326041732|CHC13|26474||11/01/2013|12/31/9999|$669.83|0|0|||FUSION OF FINGER TENDONS|| 58-1699775|1326041732|CHC13|26476||11/01/2013|12/31/9999|$813.96|0|0|||TENDON LENGTHENING|| 58-1699775|1326041732|CHC13|26477||11/01/2013|12/31/9999|$811.45|0|0|||TENDON SHORTENING|| 58-1699775|1326041732|CHC13|26478||11/01/2013|12/31/9999|$867.21|0|0|||LENGTHENING OF HAND TENDON|| 58-1699775|1326041732|CHC13|26479||11/01/2013|12/31/9999|$865.18|0|0|||SHORTENING OF HAND TENDON|| 58-1699775|1326041732|CHC13|26480||11/01/2013|12/31/9999|$1|047.37|0|0|||TRANSPLANT HAND TENDON|| 58-1699775|1326041732|CHC13|26483||11/01/2013|12/31/9999|$1|181.78|0|0|||TRANSPLANT/GRAFT HAND TENDON|| 58-1699775|1326041732|CHC13|26485||11/01/2013|12/31/9999|$1|127.10|0|0|||TRANSPLANT PALM TENDON|| 58-1699775|1326041732|CHC13|26489||11/01/2013|12/31/9999|$1|283.97|0|0|||TRANSPLANT/GRAFT PALM TENDON|| 58-1699775|1326041732|CHC13|26490||11/01/2013|12/31/9999|$1|105.10|0|0|||REVISE THUMB TENDON|| 58-1699775|1326041732|CHC13|26492||11/01/2013|12/31/9999|$1|227.47|0|0|||TENDON TRANSFER WITH GRAFT|| 58-1699775|1326041732|CHC13|26494||11/01/2013|12/31/9999|$1|110.92|0|0|||HAND TENDON/MUSCLE TRANSFER|| 58-1699775|1326041732|CHC13|26496||11/01/2013|12/31/9999|$1|199.68|0|0|||REVISE THUMB TENDON|| 58-1699775|1326041732|CHC13|26497||11/01/2013|12/31/9999|$1|205.49|0|0|||FINGER TENDON TRANSFER|| 58-1699775|1326041732|CHC13|26498||11/01/2013|12/31/9999|$1|602.30|0|0|||FINGER TENDON TRANSFER|| 58-1699775|1326041732|CHC13|26499||11/01/2013|12/31/9999|$1|155.02|0|0|||REVISION OF FINGER|| 58-1699775|1326041732|CHC13|26500||11/01/2013|12/31/9999|$874.53|0|0|||HAND TENDON RECONSTRUCTION|| 58-1699775|1326041732|CHC13|26502||11/01/2013|12/31/9999|$985.25|0|0|||HAND TENDON RECONSTRUCTION|| 58-1699775|1326041732|CHC13|26508||11/01/2013|12/31/9999|$865.56|0|0|||RELEASE THUMB CONTRACTURE|| 58-1699775|1326041732|CHC13|26510||11/01/2013|12/31/9999|$828.89|0|0|||THUMB TENDON TRANSFER|| 58-1699775|1326041732|CHC13|26516||11/01/2013|12/31/9999|$979.54|0|0|||FUSION OF KNUCKLE JOINT|| 58-1699775|1326041732|CHC13|26517||11/01/2013|12/31/9999|$1|164.17|0|0|||FUSION OF KNUCKLE JOINTS|| 58-1699775|1326041732|CHC13|26518||11/01/2013|12/31/9999|$1|164.27|0|0|||FUSION OF KNUCKLE JOINTS|| 58-1699775|1326041732|CHC13|26520||11/01/2013|12/31/9999|$903.42|0|0|||RELEASE KNUCKLE CONTRACTURE|| 58-1699775|1326041732|CHC13|26525||11/01/2013|12/31/9999|$904.89|0|0|||RELEASE FINGER CONTRACTURE|| 58-1699775|1326041732|CHC13|26530||11/01/2013|12/31/9999|$757.98|0|0|||REVISE KNUCKLE JOINT|| 58-1699775|1326041732|CHC13|26531||11/01/2013|12/31/9999|$881.21|0|0|||REVISE KNUCKLE WITH IMPLANT|| 58-1699775|1326041732|CHC13|26535||11/01/2013|12/31/9999|$581.00|0|0|||REVISE FINGER JOINT|| 58-1699775|1326041732|CHC13|26536||11/01/2013|12/31/9999|$974.87|0|0|||REVISE/IMPLANT FINGER JOINT|| 58-1699775|1326041732|CHC13|26540||11/01/2013|12/31/9999|$916.93|0|0|||REPAIR HAND JOINT|| 58-1699775|1326041732|CHC13|26541||11/01/2013|12/31/9999|$1|118.32|0|0|||REPAIR HAND JOINT WITH GRAFT|| 58-1699775|1326041732|CHC13|26542||11/01/2013|12/31/9999|$947.75|0|0|||REPAIR HAND JOINT WITH GRAFT|| 58-1699775|1326041732|CHC13|26545||11/01/2013|12/31/9999|$968.32|0|0|||RECONSTRUCT FINGER JOINT|| 58-1699775|1326041732|CHC13|26546||11/01/2013|12/31/9999|$1|384.72|0|0|||REPAIR NONUNION HAND|| 58-1699775|1326041732|CHC13|26548||11/01/2013|12/31/9999|$1|066.61|0|0|||RECONSTRUCT FINGER JOINT|| 58-1699775|1326041732|CHC13|26550||11/01/2013|12/31/9999|$2|266.98|0|0|||CONSTRUCT THUMB REPLACEMENT|| 58-1699775|1326041732|CHC13|26551||11/01/2013|12/31/9999|$4|259.60|0|0|||GREAT TOE-HAND TRANSFER|| 58-1699775|1326041732|CHC13|26553||11/01/2013|12/31/9999|$3|863.02|0|0|||SINGLE TRANSFER| TOE-HAND|| 58-1699775|1326041732|CHC13|26554||11/01/2013|12/31/9999|$4|595.92|0|0|||DOUBLE TRANSFER| TOE-HAND|| 58-1699775|1326041732|CHC13|26555||11/01/2013|12/31/9999|$1|924.40|0|0|||POSITIONAL CHANGE OF FINGER|| 58-1699775|1326041732|CHC13|26556||11/01/2013|12/31/9999|$4|126.52|0|0|||TOE JOINT TRANSFER|| 58-1699775|1326041732|CHC13|26560||11/01/2013|12/31/9999|$810.76|0|0|||REPAIR OF WEB FINGER|| 58-1699775|1326041732|CHC13|26561||11/01/2013|12/31/9999|$1|331.41|0|0|||REPAIR OF WEB FINGER|| 58-1699775|1326041732|CHC13|26562||11/01/2013|12/31/9999|$1|813.04|0|0|||REPAIR OF WEB FINGER|| 58-1699775|1326041732|CHC13|26565||11/01/2013|12/31/9999|$950.46|0|0|||CORRECT METACARPAL FLAW|| 58-1699775|1326041732|CHC13|26567||11/01/2013|12/31/9999|$947.48|0|0|||CORRECT FINGER DEFORMITY|| 58-1699775|1326041732|CHC13|26568||11/01/2013|12/31/9999|$1|249.55|0|0|||LENGTHEN METACARPAL/FINGER|| 58-1699775|1326041732|CHC13|26580||11/01/2013|12/31/9999|$2|138.99|0|0|||REPAIR HAND DEFORMITY|| 58-1699775|1326041732|CHC13|26587||11/01/2013|12/31/9999|$1|325.97|0|0|||RECONSTRUCT EXTRA FINGER|| 58-1699775|1326041732|CHC13|26590||11/01/2013|12/31/9999|$1|806.17|0|0|||REPAIR FINGER DEFORMITY|| 58-1699775|1326041732|CHC13|26591||11/01/2013|12/31/9999|$606.32|0|0|||REPAIR MUSCLES OF HAND|| 58-1699775|1326041732|CHC13|26593||11/01/2013|12/31/9999|$831.50|0|0|||RELEASE MUSCLES OF HAND|| 58-1699775|1326041732|CHC13|26596||11/01/2013|12/31/9999|$1|056.75|0|0|||EXCISION CONSTRICTING TISSUE|| 58-1699775|1326041732|CHC13|26600||11/01/2013|12/31/9999|$378.31|0|0|||TREAT METACARPAL FRACTURE|| 58-1699775|1326041732|CHC13|26605||11/01/2013|12/31/9999|$407.27|0|0|||TREAT METACARPAL FRACTURE|| 58-1699775|1326041732|CHC13|26607||11/01/2013|12/31/9999|$639.95|0|0|||TREAT METACARPAL FRACTURE|| 58-1699775|1326041732|CHC13|26608||11/01/2013|12/31/9999|$670.99|0|0|||TREAT METACARPAL FRACTURE|| 58-1699775|1326041732|CHC13|26615||11/01/2013|12/31/9999|$805.84|0|0|||TREAT METACARPAL FRACTURE|| 58-1699775|1326041732|CHC13|26641||11/01/2013|12/31/9999|$465.05|0|0|||TREAT THUMB DISLOCATION|| 58-1699775|1326041732|CHC13|26645||11/01/2013|12/31/9999|$542.83|0|0|||TREAT THUMB FRACTURE|| 58-1699775|1326041732|CHC13|26650||11/01/2013|12/31/9999|$670.85|0|0|||TREAT THUMB FRACTURE|| 58-1699775|1326041732|CHC13|26665||11/01/2013|12/31/9999|$883.09|0|0|||TREAT THUMB FRACTURE|| 58-1699775|1326041732|CHC13|26670||11/01/2013|12/31/9999|$421.69|0|0|||TREAT HAND DISLOCATION|| 58-1699775|1326041732|CHC13|26675||11/01/2013|12/31/9999|$578.63|0|0|||TREAT HAND DISLOCATION|| 58-1699775|1326041732|CHC13|26676||11/01/2013|12/31/9999|$704.12|0|0|||PIN HAND DISLOCATION|| 58-1699775|1326041732|CHC13|26685||11/01/2013|12/31/9999|$811.04|0|0|||TREAT HAND DISLOCATION|| 58-1699775|1326041732|CHC13|26686||11/01/2013|12/31/9999|$879.46|0|0|||TREAT HAND DISLOCATION|| 58-1699775|1326041732|CHC13|26700||11/01/2013|12/31/9999|$419.37|0|0|||TREAT KNUCKLE DISLOCATION|| 58-1699775|1326041732|CHC13|26705||11/01/2013|12/31/9999|$525.65|0|0|||TREAT KNUCKLE DISLOCATION|| 58-1699775|1326041732|CHC13|26706||11/01/2013|12/31/9999|$619.18|0|0|||PIN KNUCKLE DISLOCATION|| 58-1699775|1326041732|CHC13|26715||11/01/2013|12/31/9999|$805.66|0|0|||TREAT KNUCKLE DISLOCATION|| 58-1699775|1326041732|CHC13|26720||11/01/2013|12/31/9999|$253.59|0|0|||TREAT FINGER FRACTURE| EACH|| 58-1699775|1326041732|CHC13|26725||11/01/2013|12/31/9999|$426.24|0|0|||TREAT FINGER FRACTURE| EACH|| 58-1699775|1326041732|CHC13|26727||11/01/2013|12/31/9999|$659.70|0|0|||TREAT FINGER FRACTURE| EACH|| 58-1699775|1326041732|CHC13|26735||11/01/2013|12/31/9999|$838.05|0|0|||TREAT FINGER FRACTURE| EACH|| 58-1699775|1326041732|CHC13|26740||11/01/2013|12/31/9999|$296.04|0|0|||TREAT FINGER FRACTURE| EACH|| 58-1699775|1326041732|CHC13|26742||11/01/2013|12/31/9999|$469.36|0|0|||TREAT FINGER FRACTURE| EACH|| 58-1699775|1326041732|CHC13|26746||11/01/2013|12/31/9999|$1|043.63|0|0|||TREAT FINGER FRACTURE| EACH|| 58-1699775|1326041732|CHC13|26750||11/01/2013|12/31/9999|$253.34|0|0|||TREAT FINGER FRACTURE| EACH|| 58-1699775|1326041732|CHC13|26755||11/01/2013|12/31/9999|$383.14|0|0|||TREAT FINGER FRACTURE| EACH|| 58-1699775|1326041732|CHC13|26756||11/01/2013|12/31/9999|$586.31|0|0|||PIN FINGER FRACTURE| EACH|| 58-1699775|1326041732|CHC13|26765||11/01/2013|12/31/9999|$698.37|0|0|||TREAT FINGER FRACTURE| EACH|| 58-1699775|1326041732|CHC13|26770||11/01/2013|12/31/9999|$352.84|0|0|||TREAT FINGER DISLOCATION|| 58-1699775|1326041732|CHC13|26775||11/01/2013|12/31/9999|$483.06|0|0|||TREAT FINGER DISLOCATION|| 58-1699775|1326041732|CHC13|26776||11/01/2013|12/31/9999|$620.66|0|0|||PIN FINGER DISLOCATION|| 58-1699775|1326041732|CHC13|26785||11/01/2013|12/31/9999|$760.63|0|0|||TREAT FINGER DISLOCATION|| 58-1699775|1326041732|CHC13|26820||11/01/2013|12/31/9999|$1|095.11|0|0|||THUMB FUSION WITH GRAFT|| 58-1699775|1326041732|CHC13|26841||11/01/2013|12/31/9999|$1|012.86|0|0|||FUSION OF THUMB|| 58-1699775|1326041732|CHC13|26842||11/01/2013|12/31/9999|$1|101.28|0|0|||THUMB FUSION WITH GRAFT|| 58-1699775|1326041732|CHC13|26843||11/01/2013|12/31/9999|$1|024.95|0|0|||FUSION OF HAND JOINT|| 58-1699775|1326041732|CHC13|26844||11/01/2013|12/31/9999|$1|155.36|0|0|||FUSION/GRAFT OF HAND JOINT|| 58-1699775|1326041732|CHC13|26850||11/01/2013|12/31/9999|$964.31|0|0|||FUSION OF KNUCKLE|| 58-1699775|1326041732|CHC13|26852||11/01/2013|12/31/9999|$1|108.55|0|0|||FUSION OF KNUCKLE WITH GRAFT|| 58-1699775|1326041732|CHC13|26860||11/01/2013|12/31/9999|$779.54|0|0|||FUSION OF FINGER JOINT|| 58-1699775|1326041732|CHC13|26861||11/01/2013|12/31/9999|$149.83|0|0|||FUSION OF FINGER JNT| ADD-ON|| 58-1699775|1326041732|CHC13|26862||11/01/2013|12/31/9999|$1|012.91|0|0|||FUSION/GRAFT OF FINGER JOINT|| 58-1699775|1326041732|CHC13|26863||11/01/2013|12/31/9999|$332.72|0|0|||FUSE/GRAFT ADDED JOINT|| 58-1699775|1326041732|CHC13|26910||11/01/2013|12/31/9999|$1|004.77|0|0|||AMPUTATE METACARPAL BONE|| 58-1699775|1326041732|CHC13|26951||11/01/2013|12/31/9999|$899.28|0|0|||AMPUTATION OF FINGER/THUMB|| 58-1699775|1326041732|CHC13|26952||11/01/2013|12/31/9999|$902.14|0|0|||AMPUTATION OF FINGER/THUMB|| 58-1699775|1326041732|CHC13|26989||11/01/2013|12/31/9999|$0.00|0|0|||HAND/FINGER SURGERY|| 58-1699775|1326041732|CHC13|26990||11/01/2013|12/31/9999|$881.48|0|0|||DRAINAGE OF PELVIS LESION|| 58-1699775|1326041732|CHC13|26991||11/01/2013|12/31/9999|$744.96|0|0|||DRAINAGE OF PELVIS BURSA|| 58-1699775|1326041732|CHC13|26992||11/01/2013|12/31/9999|$1|362.64|0|0|||DRAINAGE OF BONE LESION|| 58-1699775|1326041732|CHC13|27000||11/01/2013|12/31/9999|$618.41|0|0|||INCISION OF HIP TENDON|| 58-1699775|1326041732|CHC13|27001||11/01/2013|12/31/9999|$766.95|0|0|||INCISION OF HIP TENDON|| 58-1699775|1326041732|CHC13|27003||11/01/2013|12/31/9999|$838.96|0|0|||INCISION OF HIP TENDON|| 58-1699775|1326041732|CHC13|27005||11/01/2013|12/31/9999|$1|033.41|0|0|||INCISION OF HIP TENDON|| 58-1699775|1326041732|CHC13|27006||11/01/2013|12/31/9999|$1|046.90|0|0|||INCISION OF HIP TENDONS|| 58-1699775|1326041732|CHC13|27025||11/01/2013|12/31/9999|$1|308.06|0|0|||INCISION OF HIP/THIGH FASCIA|| 58-1699775|1326041732|CHC13|27027||11/01/2013|12/31/9999|$1|197.64|0|0|||BUTTOCK FASCIOTOMY|| 58-1699775|1326041732|CHC13|27030||11/01/2013|12/31/9999|$1|333.72|0|0|||DRAINAGE OF HIP JOINT|| 58-1699775|1326041732|CHC13|27033||11/01/2013|12/31/9999|$1|389.93|0|0|||EXPLORATION OF HIP JOINT|| 58-1699775|1326041732|CHC13|27035||11/01/2013|12/31/9999|$1|481.72|0|0|||DENERVATION OF HIP JOINT|| 58-1699775|1326041732|CHC13|27036||11/01/2013|12/31/9999|$1|436.74|0|0|||EXCISION OF HIP JOINT/MUSCLE|| 58-1699775|1326041732|CHC13|27040||11/01/2013|12/31/9999|$285.53|0|0|||BIOPSY OF SOFT TISSUES|| 58-1699775|1326041732|CHC13|27041||11/01/2013|12/31/9999|$968.63|0|0|||BIOPSY OF SOFT TISSUES|| 58-1699775|1326041732|CHC13|27043||11/01/2013|12/31/9999|$675.30|0|0|||EXC HIP PELVIS LES SC > 3 CM|| 58-1699775|1326041732|CHC13|27045||11/01/2013|12/31/9999|$1|076.51|0|0|||EXC HIP/PELV TUM DEEP > 5 CM|| 58-1699775|1326041732|CHC13|27047||11/01/2013|12/31/9999|$531.17|0|0|||REMOVE HIP/PELVIS LESION|| 58-1699775|1326041732|CHC13|27048||11/01/2013|12/31/9999|$859.92|0|0|||REMOVE HIP/PELVIS LESION|| 58-1699775|1326041732|CHC13|27049||04/01/2014|12/31/9999|$2|004.23|0|0|||REMOVE TUMOR| HIP/PELVIS|| 58-1699775|1326041732|CHC13|27050||11/01/2013|12/31/9999|$549.70|0|0|||BIOPSY OF SACROILIAC JOINT|| 58-1699775|1326041732|CHC13|27052||11/01/2013|12/31/9999|$812.98|0|0|||BIOPSY OF HIP JOINT|| 58-1699775|1326041732|CHC13|27054||11/01/2013|12/31/9999|$970.00|0|0|||REMOVAL OF HIP JOINT LINING|| 58-1699775|1326041732|CHC13|27057||11/01/2013|12/31/9999|$1|346.07|0|0|||BUTTOCK FASCIOTOMY W/DBRDMT|| 58-1699775|1326041732|CHC13|27059||04/01/2014|12/31/9999|$2|657.96|0|0|||RESECT HIP/PELV TUM > 5 CM|| 58-1699775|1326041732|CHC13|27060||11/01/2013|12/31/9999|$646.73|0|0|||REMOVAL OF ISCHIAL BURSA|| 58-1699775|1326041732|CHC13|27062||11/01/2013|12/31/9999|$642.84|0|0|||REMOVE FEMUR LESION/BURSA|| 58-1699775|1326041732|CHC13|27065||11/01/2013|12/31/9999|$720.13|0|0|||REMOVAL OF HIP BONE LESION|| 58-1699775|1326041732|CHC13|27066||11/01/2013|12/31/9999|$1|152.89|0|0|||REMOVAL OF HIP BONE LESION|| 58-1699775|1326041732|CHC13|27067||11/01/2013|12/31/9999|$1|471.70|0|0|||REMOVE/GRAFT HIP BONE LESION|| 58-1699775|1326041732|CHC13|27070||11/01/2013|12/31/9999|$1|210.81|0|0|||PARTIAL REMOVAL OF HIP BONE|| 58-1699775|1326041732|CHC13|27071||11/01/2013|12/31/9999|$1|300.21|0|0|||PARTIAL REMOVAL OF HIP BONE|| 58-1699775|1326041732|CHC13|27075||11/01/2013|12/31/9999|$3|019.16|0|0|||EXTENSIVE HIP SURGERY|| 58-1699775|1326041732|CHC13|27076||11/01/2013|12/31/9999|$3|557.04|0|0|||EXTENSIVE HIP SURGERY|| 58-1699775|1326041732|CHC13|27077||11/01/2013|12/31/9999|$4|053.61|0|0|||EXTENSIVE HIP SURGERY|| 58-1699775|1326041732|CHC13|27078||11/01/2013|12/31/9999|$2|864.18|0|0|||EXTENSIVE HIP SURGERY|| 58-1699775|1326041732|CHC13|27080||11/01/2013|12/31/9999|$718.45|0|0|||REMOVAL OF TAIL BONE|| 58-1699775|1326041732|CHC13|27086||11/01/2013|12/31/9999|$210.83|0|0|||REMOVE HIP FOREIGN BODY|| 58-1699775|1326041732|CHC13|27087||11/01/2013|12/31/9999|$898.62|0|0|||REMOVE HIP FOREIGN BODY|| 58-1699775|1326041732|CHC13|27090||11/01/2013|12/31/9999|$1|181.72|0|0|||REMOVAL OF HIP PROSTHESIS|| 58-1699775|1326041732|CHC13|27091||11/01/2013|12/31/9999|$2|291.34|0|0|||REMOVAL OF HIP PROSTHESIS|| 58-1699775|1326041732|CHC13|27093||11/01/2013|12/31/9999|$101.43|0|0|||INJECTION FOR HIP X-RAY|| 58-1699775|1326041732|CHC13|27095||11/01/2013|12/31/9999|$118.12|0|0|||INJECTION FOR HIP X-RAY|| 58-1699775|1326041732|CHC13|27096||11/01/2013|12/31/9999|$118.40|0|0|||INJECT SACROILIAC JOINT|| 58-1699775|1326041732|CHC13|27097||11/01/2013|12/31/9999|$960.70|0|0|||REVISION OF HIP TENDON|| 58-1699775|1326041732|CHC13|27098||11/01/2013|12/31/9999|$964.20|0|0|||TRANSFER TENDON TO PELVIS|| 58-1699775|1326041732|CHC13|27100||11/01/2013|12/31/9999|$1|169.77|0|0|||TRANSFER OF ABDOMINAL MUSCLE|| 58-1699775|1326041732|CHC13|27105||11/01/2013|12/31/9999|$1|229.02|0|0|||TRANSFER OF SPINAL MUSCLE|| 58-1699775|1326041732|CHC13|27110||11/01/2013|12/31/9999|$1|374.31|0|0|||TRANSFER OF ILIOPSOAS MUSCLE|| 58-1699775|1326041732|CHC13|27111||11/01/2013|12/31/9999|$1|181.22|0|0|||TRANSFER OF ILIOPSOAS MUSCLE|| 58-1699775|1326041732|CHC13|27120||11/01/2013|12/31/9999|$1|846.48|0|0|||RECONSTRUCTION OF HIP SOCKET|| 58-1699775|1326041732|CHC13|27122||11/01/2013|12/31/9999|$1|574.13|0|0|||RECONSTRUCTION OF HIP SOCKET|| 58-1699775|1326041732|CHC13|27125||11/01/2013|12/31/9999|$1|617.98|0|0|||PARTIAL HIP REPLACEMENT|| 58-1699775|1326041732|CHC13|27130||11/01/2013|12/31/9999|$2|067.24|0|0|||TOTAL HIP ARTHROPLASTY|| 58-1699775|1326041732|CHC13|27132||11/01/2013|12/31/9999|$2|409.67|0|0|||TOTAL HIP ARTHROPLASTY|| 58-1699775|1326041732|CHC13|27134||11/01/2013|12/31/9999|$2|766.90|0|0|||REVISE HIP JOINT REPLACEMENT|| 58-1699775|1326041732|CHC13|27137||11/01/2013|12/31/9999|$2|119.92|0|0|||REVISE HIP JOINT REPLACEMENT|| 58-1699775|1326041732|CHC13|27138||11/01/2013|12/31/9999|$2|206.15|0|0|||REVISE HIP JOINT REPLACEMENT|| 58-1699775|1326041732|CHC13|27140||11/01/2013|12/31/9999|$1|276.23|0|0|||TRANSPLANT FEMUR RIDGE|| 58-1699775|1326041732|CHC13|27146||11/01/2013|12/31/9999|$1|828.63|0|0|||INCISION OF HIP BONE|| 58-1699775|1326041732|CHC13|27147||11/01/2013|12/31/9999|$2|101.79|0|0|||REVISION OF HIP BONE|| 58-1699775|1326041732|CHC13|27151||11/01/2013|12/31/9999|$2|255.24|0|0|||INCISION OF HIP BONES|| 58-1699775|1326041732|CHC13|27156||11/01/2013|12/31/9999|$2|453.90|0|0|||REVISION OF HIP BONES|| 58-1699775|1326041732|CHC13|27158||11/01/2013|12/31/9999|$1|997.10|0|0|||REVISION OF PELVIS|| 58-1699775|1326041732|CHC13|27161||11/01/2013|12/31/9999|$1|737.63|0|0|||INCISION OF NECK OF FEMUR|| 58-1699775|1326041732|CHC13|27165||11/01/2013|12/31/9999|$1|963.60|0|0|||INCISION/FIXATION OF FEMUR|| 58-1699775|1326041732|CHC13|27170||11/01/2013|12/31/9999|$1|684.76|0|0|||REPAIR/GRAFT FEMUR HEAD/NECK|| 58-1699775|1326041732|CHC13|27175||11/01/2013|12/31/9999|$946.65|0|0|||TREAT SLIPPED EPIPHYSIS|| 58-1699775|1326041732|CHC13|27176||11/01/2013|12/31/9999|$1|304.08|0|0|||TREAT SLIPPED EPIPHYSIS|| 58-1699775|1326041732|CHC13|27177||11/01/2013|12/31/9999|$1|586.52|0|0|||TREAT SLIPPED EPIPHYSIS|| 58-1699775|1326041732|CHC13|27178||11/01/2013|12/31/9999|$1|301.78|0|0|||TREAT SLIPPED EPIPHYSIS|| 58-1699775|1326041732|CHC13|27179||11/01/2013|12/31/9999|$1|388.24|0|0|||REVISE HEAD/NECK OF FEMUR|| 58-1699775|1326041732|CHC13|27181||11/01/2013|12/31/9999|$1|597.58|0|0|||TREAT SLIPPED EPIPHYSIS|| 58-1699775|1326041732|CHC13|27185||11/01/2013|12/31/9999|$942.88|0|0|||REVISION OF FEMUR EPIPHYSIS|| 58-1699775|1326041732|CHC13|27187||11/01/2013|12/31/9999|$1|414.88|0|0|||REINFORCE HIP BONES|| 58-1699775|1326041732|CHC13|27197||04/01/2017|12/31/9999|$180.34|0|180.34|0||CLSD TX PELVIC RING FX|| 58-1699775|1326041732|CHC13|27198||04/01/2017|12/31/9999|$459.73|0|459.73|0||CLSD TX PELVIC RING FX|| 58-1699775|1326041732|CHC13|27200||11/01/2013|12/31/9999|$258.12|0|0|||TREAT TAIL BONE FRACTURE|| 58-1699775|1326041732|CHC13|27202||11/01/2013|12/31/9999|$793.14|0|0|||TREAT TAIL BONE FRACTURE|| 58-1699775|1326041732|CHC13|27215||11/01/2013|12/31/9999|$881.27|0|0|||TREAT PELVIC FRACTURE(S)|| 58-1699775|1326041732|CHC13|27216||11/01/2013|12/31/9999|$1|305.97|0|0|||TREAT PELVIC RING FRACTURE|| 58-1699775|1326041732|CHC13|27217||11/01/2013|12/31/9999|$1|228.70|0|0|||TREAT PELVIC RING FRACTURE|| 58-1699775|1326041732|CHC13|27218||11/01/2013|12/31/9999|$1|691.70|0|0|||TREAT PELVIC RING FRACTURE|| 58-1699775|1326041732|CHC13|27220||11/01/2013|12/31/9999|$741.38|0|0|||TREAT HIP SOCKET FRACTURE|| 58-1699775|1326041732|CHC13|27222||11/01/2013|12/31/9999|$1|394.48|0|0|||TREAT HIP SOCKET FRACTURE|| 58-1699775|1326041732|CHC13|27226||11/01/2013|12/31/9999|$1|506.19|0|0|||TREAT HIP WALL FRACTURE|| 58-1699775|1326041732|CHC13|27227||11/01/2013|12/31/9999|$2|382.92|0|0|||TREAT HIP FRACTURE(S)|| 58-1699775|1326041732|CHC13|27228||11/01/2013|12/31/9999|$2|722.70|0|0|||TREAT HIP FRACTURE(S)|| 58-1699775|1326041732|CHC13|27230||11/01/2013|12/31/9999|$662.42|0|0|||TREAT THIGH FRACTURE|| 58-1699775|1326041732|CHC13|27232||11/01/2013|12/31/9999|$1|094.24|0|0|||TREAT THIGH FRACTURE|| 58-1699775|1326041732|CHC13|27235||11/01/2013|12/31/9999|$1|296.70|0|0|||TREAT THIGH FRACTURE|| 58-1699775|1326041732|CHC13|27236||11/01/2013|12/31/9999|$1|709.98|0|0|||TREAT THIGH FRACTURE|| 58-1699775|1326041732|CHC13|27238||11/01/2013|12/31/9999|$646.96|0|0|||TREAT THIGH FRACTURE|| 58-1699775|1326041732|CHC13|27240||11/01/2013|12/31/9999|$1|367.14|0|0|||TREAT THIGH FRACTURE|| 58-1699775|1326041732|CHC13|27244||11/01/2013|12/31/9999|$1|758.95|0|0|||TREAT THIGH FRACTURE|| 58-1699775|1326041732|CHC13|27245||11/01/2013|12/31/9999|$1|768.12|0|0|||TREAT THIGH FRACTURE|| 58-1699775|1326041732|CHC13|27246||11/01/2013|12/31/9999|$544.21|0|0|||TREAT THIGH FRACTURE|| 58-1699775|1326041732|CHC13|27248||11/01/2013|12/31/9999|$1|063.93|0|0|||TREAT THIGH FRACTURE|| 58-1699775|1326041732|CHC13|27250||11/01/2013|12/31/9999|$281.34|0|0|||TREAT HIP DISLOCATION|| 58-1699775|1326041732|CHC13|27252||11/01/2013|12/31/9999|$1|081.77|0|0|||TREAT HIP DISLOCATION|| 58-1699775|1326041732|CHC13|27253||11/01/2013|12/31/9999|$1|343.90|0|0|||TREAT HIP DISLOCATION|| 58-1699775|1326041732|CHC13|27254||11/01/2013|12/31/9999|$1|817.71|0|0|||TREAT HIP DISLOCATION|| 58-1699775|1326041732|CHC13|27256||11/01/2013|12/31/9999|$341.63|0|0|||TREAT HIP DISLOCATION|| 58-1699775|1326041732|CHC13|27257||11/01/2013|12/31/9999|$479.29|0|0|||TREAT HIP DISLOCATION|| 58-1699775|1326041732|CHC13|27258||11/01/2013|12/31/9999|$1|582.45|0|0|||TREAT HIP DISLOCATION|| 58-1699775|1326041732|CHC13|27259||11/01/2013|12/31/9999|$2|218.37|0|0|||TREAT HIP DISLOCATION|| 58-1699775|1326041732|CHC13|27265||11/01/2013|12/31/9999|$564.23|0|0|||TREAT HIP DISLOCATION|| 58-1699775|1326041732|CHC13|27266||11/01/2013|12/31/9999|$822.73|0|0|||TREAT HIP DISLOCATION|| 58-1699775|1326041732|CHC13|27267||11/01/2013|12/31/9999|$610.76|0|0|||CLTX THIGH FX|| 58-1699775|1326041732|CHC13|27268||11/01/2013|12/31/9999|$753.09|0|0|||CLTX THIGH FX W/MNPJ|| 58-1699775|1326041732|CHC13|27269||11/01/2013|12/31/9999|$1|768.81|0|0|||OPTX THIGH FX|| 58-1699775|1326041732|CHC13|27275||11/01/2013|12/31/9999|$253.84|0|0|||MANIPULATION OF HIP JOINT|| 58-1699775|1326041732|CHC13|27279||04/01/2015|12/31/9999|$824.64|0|0|0||ARTHRODESIS SACROILIAC JOINT|| 58-1699775|1326041732|CHC13|27280||11/01/2013|12/31/9999|$1|472.86|0|0|||FUSION OF SACROILIAC JOINT|| 58-1699775|1326041732|CHC13|27282||11/01/2013|12/31/9999|$1|198.17|0|0|||FUSION OF PUBIC BONES|| 58-1699775|1326041732|CHC13|27284||11/01/2013|12/31/9999|$2|296.64|0|0|||FUSION OF HIP JOINT|| 58-1699775|1326041732|CHC13|27286||11/01/2013|12/31/9999|$2|370.60|0|0|||FUSION OF HIP JOINT|| 58-1699775|1326041732|CHC13|27290||11/01/2013|12/31/9999|$2|308.96|0|0|||AMPUTATION OF LEG AT HIP|| 58-1699775|1326041732|CHC13|27295||11/01/2013|12/31/9999|$1|808.59|0|0|||AMPUTATION OF LEG AT HIP|| 58-1699775|1326041732|CHC13|27299||11/01/2013|12/31/9999|$0.00|0|0|||PELVIS/HIP JOINT SURGERY|| 58-1699775|1326041732|CHC13|27301||11/01/2013|12/31/9999|$710.92|0|0|||DRAIN THIGH/KNEE LESION|| 58-1699775|1326041732|CHC13|27303||11/01/2013|12/31/9999|$906.28|0|0|||DRAINAGE OF BONE LESION|| 58-1699775|1326041732|CHC13|27305||11/01/2013|12/31/9999|$675.48|0|0|||INCISE THIGH TENDON & FASCIA|| 58-1699775|1326041732|CHC13|27306||11/01/2013|12/31/9999|$505.23|0|0|||INCISION OF THIGH TENDON|| 58-1699775|1326041732|CHC13|27307||11/01/2013|12/31/9999|$672.53|0|0|||INCISION OF THIGH TENDONS|| 58-1699775|1326041732|CHC13|27310||11/01/2013|12/31/9999|$1|037.62|0|0|||EXPLORATION OF KNEE JOINT|| 58-1699775|1326041732|CHC13|27323||11/01/2013|12/31/9999|$253.93|0|0|||BIOPSY| THIGH SOFT TISSUES|| 58-1699775|1326041732|CHC13|27324||11/01/2013|12/31/9999|$553.28|0|0|||BIOPSY| THIGH SOFT TISSUES|| 58-1699775|1326041732|CHC13|27325||11/01/2013|12/31/9999|$726.48|0|0|||NEURECTOMY| HAMSTRING|| 58-1699775|1326041732|CHC13|27326||11/01/2013|12/31/9999|$716.03|0|0|||NEURECTOMY| POPLITEAL|| 58-1699775|1326041732|CHC13|27327||11/01/2013|12/31/9999|$446.87|0|0|||REMOVAL OF THIGH LESION|| 58-1699775|1326041732|CHC13|27328||11/01/2013|12/31/9999|$867.26|0|0|||REMOVAL OF THIGH LESION|| 58-1699775|1326041732|CHC13|27329||04/01/2014|12/31/9999|$1|520.40|0|0|||REMOVE TUMOR| THIGH/KNEE|| 58-1699775|1326041732|CHC13|27330||11/01/2013|12/31/9999|$577.33|0|0|||BIOPSY| KNEE JOINT LINING|| 58-1699775|1326041732|CHC13|27331||11/01/2013|12/31/9999|$671.37|0|0|||EXPLORE/TREAT KNEE JOINT|| 58-1699775|1326041732|CHC13|27332||11/01/2013|12/31/9999|$906.25|0|0|||REMOVAL OF KNEE CARTILAGE|| 58-1699775|1326041732|CHC13|27333||11/01/2013|12/31/9999|$826.09|0|0|||REMOVAL OF KNEE CARTILAGE|| 58-1699775|1326041732|CHC13|27334||11/01/2013|12/31/9999|$968.98|0|0|||REMOVE KNEE JOINT LINING|| 58-1699775|1326041732|CHC13|27335||11/01/2013|12/31/9999|$1|086.50|0|0|||REMOVE KNEE JOINT LINING|| 58-1699775|1326041732|CHC13|27337||11/01/2013|12/31/9999|$602.07|0|0|||EXC THIGH/KNEE LES SC > 3 CM|| 58-1699775|1326041732|CHC13|27339||11/01/2013|12/31/9999|$1|076.97|0|0|||EXC THIGH/KNEE TUM DEEP >5CM|| 58-1699775|1326041732|CHC13|27340||11/01/2013|12/31/9999|$520.32|0|0|||REMOVAL OF KNEECAP BURSA|| 58-1699775|1326041732|CHC13|27345||11/01/2013|12/31/9999|$680.94|0|0|||REMOVAL OF KNEE CYST|| 58-1699775|1326041732|CHC13|27347||11/01/2013|12/31/9999|$745.43|0|0|||REMOVE KNEE CYST|| 58-1699775|1326041732|CHC13|27350||11/01/2013|12/31/9999|$923.40|0|0|||REMOVAL OF KNEECAP|| 58-1699775|1326041732|CHC13|27355||11/01/2013|12/31/9999|$854.23|0|0|||REMOVE FEMUR LESION|| 58-1699775|1326041732|CHC13|27356||11/01/2013|12/31/9999|$1|046.35|0|0|||REMOVE FEMUR LESION/GRAFT|| 58-1699775|1326041732|CHC13|27357||11/01/2013|12/31/9999|$1|154.98|0|0|||REMOVE FEMUR LESION/GRAFT|| 58-1699775|1326041732|CHC13|27358||11/01/2013|12/31/9999|$404.28|0|0|||REMOVE FEMUR LESION/FIXATION|| 58-1699775|1326041732|CHC13|27360||11/01/2013|12/31/9999|$1|211.19|0|0|||PARTIAL REMOVAL| LEG BONE(S)|| 58-1699775|1326041732|CHC13|27364||04/01/2014|12/31/9999|$2|296.58|0|0|||RESECT THIGH/KNEE TUM >5 CM|| 58-1699775|1326041732|CHC13|27365||11/01/2013|12/31/9999|$2|885.76|0|0|||EXTENSIVE LEG SURGERY|| 58-1699775|1326041732|CHC13|27370||11/01/2013|12/31/9999|$75.79|0|0|||INJECTION FOR KNEE X-RAY|| 58-1699775|1326041732|CHC13|27372||11/01/2013|12/31/9999|$572.02|0|0|||REMOVAL OF FOREIGN BODY|| 58-1699775|1326041732|CHC13|27380||11/01/2013|12/31/9999|$839.73|0|0|||REPAIR OF KNEECAP TENDON|| 58-1699775|1326041732|CHC13|27381||11/01/2013|12/31/9999|$1|134.89|0|0|||REPAIR/GRAFT KNEECAP TENDON|| 58-1699775|1326041732|CHC13|27385||11/01/2013|12/31/9999|$815.31|0|0|||REPAIR OF THIGH MUSCLE|| 58-1699775|1326041732|CHC13|27386||11/01/2013|12/31/9999|$1|179.57|0|0|||REPAIR/GRAFT OF THIGH MUSCLE|| 58-1699775|1326041732|CHC13|27390||11/01/2013|12/31/9999|$629.25|0|0|||INCISION OF THIGH TENDON|| 58-1699775|1326041732|CHC13|27391||11/01/2013|12/31/9999|$813.36|0|0|||INCISION OF THIGH TENDONS|| 58-1699775|1326041732|CHC13|27392||11/01/2013|12/31/9999|$1|005.32|0|0|||INCISION OF THIGH TENDONS|| 58-1699775|1326041732|CHC13|27393||11/01/2013|12/31/9999|$719.44|0|0|||LENGTHENING OF THIGH TENDON|| 58-1699775|1326041732|CHC13|27394||11/01/2013|12/31/9999|$923.17|0|0|||LENGTHENING OF THIGH TENDONS|| 58-1699775|1326041732|CHC13|27395||11/01/2013|12/31/9999|$1|247.12|0|0|||LENGTHENING OF THIGH TENDONS|| 58-1699775|1326041732|CHC13|27396||11/01/2013|12/31/9999|$870.64|0|0|||TRANSPLANT OF THIGH TENDON|| 58-1699775|1326041732|CHC13|27397||11/01/2013|12/31/9999|$1|297.56|0|0|||TRANSPLANTS OF THIGH TENDONS|| 58-1699775|1326041732|CHC13|27400||11/01/2013|12/31/9999|$981.68|0|0|||REVISE THIGH MUSCLES/TENDONS|| 58-1699775|1326041732|CHC13|27403||11/01/2013|12/31/9999|$908.94|0|0|||REPAIR OF KNEE CARTILAGE|| 58-1699775|1326041732|CHC13|27405||11/01/2013|12/31/9999|$960.60|0|0|||REPAIR OF KNEE LIGAMENT|| 58-1699775|1326041732|CHC13|27407||11/01/2013|12/31/9999|$1|116.59|0|0|||REPAIR OF KNEE LIGAMENT|| 58-1699775|1326041732|CHC13|27409||11/01/2013|12/31/9999|$1|372.61|0|0|||REPAIR OF KNEE LIGAMENTS|| 58-1699775|1326041732|CHC13|27412||11/01/2013|12/31/9999|$2|363.20|0|0|||AUTOCHONDROCYTE IMPLANT KNEE|| 58-1699775|1326041732|CHC13|27415||11/01/2013|12/31/9999|$1|956.96|0|0|||OSTEOCHONDRAL KNEE ALLOGRAFT|| 58-1699775|1326041732|CHC13|27416||11/01/2013|12/31/9999|$1|391.12|0|0|||OSTEOCHONDRAL KNEE AUTOGRAFT|| 58-1699775|1326041732|CHC13|27418||11/01/2013|12/31/9999|$1|185.33|0|0|||REPAIR DEGENERATED KNEECAP|| 58-1699775|1326041732|CHC13|27420||11/01/2013|12/31/9999|$1|056.00|0|0|||REVISION OF UNSTABLE KNEECAP|| 58-1699775|1326041732|CHC13|27422||11/01/2013|12/31/9999|$1|056.64|0|0|||REVISION OF UNSTABLE KNEECAP|| 58-1699775|1326041732|CHC13|27424||11/01/2013|12/31/9999|$1|060.02|0|0|||REVISION/REMOVAL OF KNEECAP|| 58-1699775|1326041732|CHC13|27425||11/01/2013|12/31/9999|$628.48|0|0|||LAT RETINACULAR RELEASE OPEN|| 58-1699775|1326041732|CHC13|27427||11/01/2013|12/31/9999|$1|020.87|0|0|||RECONSTRUCTION| KNEE|| 58-1699775|1326041732|CHC13|27428||11/01/2013|12/31/9999|$1|585.12|0|0|||RECONSTRUCTION| KNEE|| 58-1699775|1326041732|CHC13|27429||11/01/2013|12/31/9999|$1|778.85|0|0|||RECONSTRUCTION| KNEE|| 58-1699775|1326041732|CHC13|27430||11/01/2013|12/31/9999|$1|051.79|0|0|||REVISION OF THIGH MUSCLES|| 58-1699775|1326041732|CHC13|27435||11/01/2013|12/31/9999|$1|146.11|0|0|||INCISION OF KNEE JOINT|| 58-1699775|1326041732|CHC13|27437||11/01/2013|12/31/9999|$936.85|0|0|||REVISE KNEECAP|| 58-1699775|1326041732|CHC13|27438||11/01/2013|12/31/9999|$1|197.95|0|0|||REVISE KNEECAP WITH IMPLANT|| 58-1699775|1326041732|CHC13|27440||11/01/2013|12/31/9999|$1|122.95|0|0|||REVISION OF KNEE JOINT|| 58-1699775|1326041732|CHC13|27441||11/01/2013|12/31/9999|$1|160.26|0|0|||REVISION OF KNEE JOINT|| 58-1699775|1326041732|CHC13|27442||11/01/2013|12/31/9999|$1|238.18|0|0|||REVISION OF KNEE JOINT|| 58-1699775|1326041732|CHC13|27443||11/01/2013|12/31/9999|$1|160.02|0|0|||REVISION OF KNEE JOINT|| 58-1699775|1326041732|CHC13|27445||11/01/2013|12/31/9999|$1|792.83|0|0|||REVISION OF KNEE JOINT|| 58-1699775|1326041732|CHC13|27446||11/01/2013|12/31/9999|$1|584.46|0|0|||REVISION OF KNEE JOINT|| 58-1699775|1326041732|CHC13|27447||11/01/2013|12/31/9999|$2|208.23|0|0|||TOTAL KNEE ARTHROPLASTY|| 58-1699775|1326041732|CHC13|27448||11/01/2013|12/31/9999|$1|167.04|0|0|||INCISION OF THIGH|| 58-1699775|1326041732|CHC13|27450||11/01/2013|12/31/9999|$1|450.94|0|0|||INCISION OF THIGH|| 58-1699775|1326041732|CHC13|27454||11/01/2013|12/31/9999|$1|850.16|0|0|||REALIGNMENT OF THIGH BONE|| 58-1699775|1326041732|CHC13|27455||11/01/2013|12/31/9999|$1|340.40|0|0|||REALIGNMENT OF KNEE|| 58-1699775|1326041732|CHC13|27457||11/01/2013|12/31/9999|$1|373.43|0|0|||REALIGNMENT OF KNEE|| 58-1699775|1326041732|CHC13|27465||11/01/2013|12/31/9999|$1|780.12|0|0|||SHORTENING OF THIGH BONE|| 58-1699775|1326041732|CHC13|27466||11/01/2013|12/31/9999|$1|687.55|0|0|||LENGTHENING OF THIGH BONE|| 58-1699775|1326041732|CHC13|27468||11/01/2013|12/31/9999|$1|915.54|0|0|||SHORTEN/LENGTHEN THIGHS|| 58-1699775|1326041732|CHC13|27470||11/01/2013|12/31/9999|$1|684.94|0|0|||REPAIR OF THIGH|| 58-1699775|1326041732|CHC13|27472||11/01/2013|12/31/9999|$1|813.31|0|0|||REPAIR/GRAFT OF THIGH|| 58-1699775|1326041732|CHC13|27475||11/01/2013|12/31/9999|$936.85|0|0|||SURGERY TO STOP LEG GROWTH|| 58-1699775|1326041732|CHC13|27477||11/01/2013|12/31/9999|$1|039.31|0|0|||SURGERY TO STOP LEG GROWTH|| 58-1699775|1326041732|CHC13|27479||11/01/2013|12/31/9999|$1|231.76|0|0|||SURGERY TO STOP LEG GROWTH|| 58-1699775|1326041732|CHC13|27485||11/01/2013|12/31/9999|$950.79|0|0|||SURGERY TO STOP LEG GROWTH|| 58-1699775|1326041732|CHC13|27486||11/01/2013|12/31/9999|$2|018.60|0|0|||REVISE/REPLACE KNEE JOINT|| 58-1699775|1326041732|CHC13|27487||11/01/2013|12/31/9999|$2|531.20|0|0|||REVISE/REPLACE KNEE JOINT|| 58-1699775|1326041732|CHC13|27488||11/01/2013|12/31/9999|$1|718.64|0|0|||REMOVAL OF KNEE PROSTHESIS|| 58-1699775|1326041732|CHC13|27495||11/01/2013|12/31/9999|$1|613.75|0|0|||REINFORCE THIGH|| 58-1699775|1326041732|CHC13|27496||11/01/2013|12/31/9999|$754.88|0|0|||DECOMPRESSION OF THIGH/KNEE|| 58-1699775|1326041732|CHC13|27497||11/01/2013|12/31/9999|$812.73|0|0|||DECOMPRESSION OF THIGH/KNEE|| 58-1699775|1326041732|CHC13|27498||11/01/2013|12/31/9999|$906.89|0|0|||DECOMPRESSION OF THIGH/KNEE|| 58-1699775|1326041732|CHC13|27499||11/01/2013|12/31/9999|$914.37|0|0|||DECOMPRESSION OF THIGH/KNEE|| 58-1699775|1326041732|CHC13|27500||11/01/2013|12/31/9999|$675.18|0|0|||TREATMENT OF THIGH FRACTURE|| 58-1699775|1326041732|CHC13|27501||11/01/2013|12/31/9999|$704.47|0|0|||TREATMENT OF THIGH FRACTURE|| 58-1699775|1326041732|CHC13|27502||11/01/2013|12/31/9999|$1|110.16|0|0|||TREATMENT OF THIGH FRACTURE|| 58-1699775|1326041732|CHC13|27503||11/01/2013|12/31/9999|$1|139.50|0|0|||TREATMENT OF THIGH FRACTURE|| 58-1699775|1326041732|CHC13|27506||11/01/2013|12/31/9999|$1|913.78|0|0|||TREATMENT OF THIGH FRACTURE|| 58-1699775|1326041732|CHC13|27507||11/01/2013|12/31/9999|$1|395.65|0|0|||TREATMENT OF THIGH FRACTURE|| 58-1699775|1326041732|CHC13|27508||11/01/2013|12/31/9999|$695.26|0|0|||TREATMENT OF THIGH FRACTURE|| 58-1699775|1326041732|CHC13|27509||11/01/2013|12/31/9999|$910.91|0|0|||TREATMENT OF THIGH FRACTURE|| 58-1699775|1326041732|CHC13|27510||11/01/2013|12/31/9999|$987.85|0|0|||TREATMENT OF THIGH FRACTURE|| 58-1699775|1326041732|CHC13|27511||11/01/2013|12/31/9999|$1|437.16|0|0|||TREATMENT OF THIGH FRACTURE|| 58-1699775|1326041732|CHC13|27513||11/01/2013|12/31/9999|$1|793.76|0|0|||TREATMENT OF THIGH FRACTURE|| 58-1699775|1326041732|CHC13|27514||11/01/2013|12/31/9999|$1|400.87|0|0|||TREATMENT OF THIGH FRACTURE|| 58-1699775|1326041732|CHC13|27516||11/01/2013|12/31/9999|$664.88|0|0|||TREAT THIGH FX GROWTH PLATE|| 58-1699775|1326041732|CHC13|27517||11/01/2013|12/31/9999|$969.52|0|0|||TREAT THIGH FX GROWTH PLATE|| 58-1699775|1326041732|CHC13|27519||11/01/2013|12/31/9999|$1|283.86|0|0|||TREAT THIGH FX GROWTH PLATE|| 58-1699775|1326041732|CHC13|27520||11/01/2013|12/31/9999|$409.20|0|0|||TREAT KNEECAP FRACTURE|| 58-1699775|1326041732|CHC13|27524||11/01/2013|12/31/9999|$1|070.83|0|0|||TREAT KNEECAP FRACTURE|| 58-1699775|1326041732|CHC13|27530||11/01/2013|12/31/9999|$397.42|0|0|||TREAT KNEE FRACTURE|| 58-1699775|1326041732|CHC13|27532||11/01/2013|12/31/9999|$816.89|0|0|||TREAT KNEE FRACTURE|| 58-1699775|1326041732|CHC13|27535||11/01/2013|12/31/9999|$1|290.23|0|0|||TREAT KNEE FRACTURE|| 58-1699775|1326041732|CHC13|27536||11/01/2013|12/31/9999|$1|701.89|0|0|||TREAT KNEE FRACTURE|| 58-1699775|1326041732|CHC13|27538||11/01/2013|12/31/9999|$620.39|0|0|||TREAT KNEE FRACTURE(S)|| 58-1699775|1326041732|CHC13|27540||11/01/2013|12/31/9999|$1|161.24|0|0|||TREAT KNEE FRACTURE|| 58-1699775|1326041732|CHC13|27550||11/01/2013|12/31/9999|$648.12|0|0|||TREAT KNEE DISLOCATION|| 58-1699775|1326041732|CHC13|27552||11/01/2013|12/31/9999|$885.47|0|0|||TREAT KNEE DISLOCATION|| 58-1699775|1326041732|CHC13|27556||11/01/2013|12/31/9999|$1|262.79|0|0|||TREAT KNEE DISLOCATION|| 58-1699775|1326041732|CHC13|27557||11/01/2013|12/31/9999|$1|511.67|0|0|||TREAT KNEE DISLOCATION|| 58-1699775|1326041732|CHC13|27558||11/01/2013|12/31/9999|$1|720.23|0|0|||TREAT KNEE DISLOCATION|| 58-1699775|1326041732|CHC13|27560||11/01/2013|12/31/9999|$488.68|0|0|||TREAT KNEECAP DISLOCATION|| 58-1699775|1326041732|CHC13|27562||11/01/2013|12/31/9999|$674.37|0|0|||TREAT KNEECAP DISLOCATION|| 58-1699775|1326041732|CHC13|27566||11/01/2013|12/31/9999|$1|270.80|0|0|||TREAT KNEECAP DISLOCATION|| 58-1699775|1326041732|CHC13|27570||11/01/2013|12/31/9999|$211.12|0|0|||FIXATION OF KNEE JOINT|| 58-1699775|1326041732|CHC13|27580||11/01/2013|12/31/9999|$2|058.85|0|0|||FUSION OF KNEE|| 58-1699775|1326041732|CHC13|27590||11/01/2013|12/31/9999|$1|193.37|0|0|||AMPUTATE LEG AT THIGH|| 58-1699775|1326041732|CHC13|27591||11/01/2013|12/31/9999|$1|266.83|0|0|||AMPUTATE LEG AT THIGH|| 58-1699775|1326041732|CHC13|27592||11/01/2013|12/31/9999|$1|008.92|0|0|||AMPUTATE LEG AT THIGH|| 58-1699775|1326041732|CHC13|27594||11/01/2013|12/31/9999|$743.20|0|0|||AMPUTATION FOLLOW-UP SURGERY|| 58-1699775|1326041732|CHC13|27596||11/01/2013|12/31/9999|$1|057.39|0|0|||AMPUTATION FOLLOW-UP SURGERY|| 58-1699775|1326041732|CHC13|27598||11/01/2013|12/31/9999|$1|073.42|0|0|||AMPUTATE LOWER LEG AT KNEE|| 58-1699775|1326041732|CHC13|27599||11/01/2013|12/31/9999|$0.00|0|0|||LEG SURGERY PROCEDURE|| 58-1699775|1326041732|CHC13|27600||11/01/2013|12/31/9999|$603.25|0|0|||DECOMPRESSION OF LOWER LEG|| 58-1699775|1326041732|CHC13|27601||11/01/2013|12/31/9999|$628.11|0|0|||DECOMPRESSION OF LOWER LEG|| 58-1699775|1326041732|CHC13|27602||11/01/2013|12/31/9999|$733.87|0|0|||DECOMPRESSION OF LOWER LEG|| 58-1699775|1326041732|CHC13|27603||11/01/2013|12/31/9999|$559.25|0|0|||DRAIN LOWER LEG LESION|| 58-1699775|1326041732|CHC13|27604||11/01/2013|12/31/9999|$479.46|0|0|||DRAIN LOWER LEG BURSA|| 58-1699775|1326041732|CHC13|27605||11/01/2013|12/31/9999|$268.35|0|0|||INCISION OF ACHILLES TENDON|| 58-1699775|1326041732|CHC13|27606||11/01/2013|12/31/9999|$410.75|0|0|||INCISION OF ACHILLES TENDON|| 58-1699775|1326041732|CHC13|27607||11/01/2013|12/31/9999|$875.34|0|0|||TREAT LOWER LEG BONE LESION|| 58-1699775|1326041732|CHC13|27610||11/01/2013|12/31/9999|$929.88|0|0|||EXPLORE/TREAT ANKLE JOINT|| 58-1699775|1326041732|CHC13|27612||11/01/2013|12/31/9999|$797.05|0|0|||EXPLORATION OF ANKLE JOINT|| 58-1699775|1326041732|CHC13|27613||11/01/2013|12/31/9999|$235.32|0|0|||BIOPSY LOWER LEG SOFT TISSUE|| 58-1699775|1326041732|CHC13|27614||11/01/2013|12/31/9999|$583.80|0|0|||BIOPSY LOWER LEG SOFT TISSUE|| 58-1699775|1326041732|CHC13|27615||04/01/2014|12/31/9999|$1|501.52|0|0|||REMOVE TUMOR| LOWER LEG|| 58-1699775|1326041732|CHC13|27616||04/01/2014|12/31/9999|$1|858.67|0|0|||RESECT LEG/ANKLE TUM > 5 CM|| 58-1699775|1326041732|CHC13|27618||11/01/2013|12/31/9999|$440.80|0|0|||REMOVE LOWER LEG LESION|| 58-1699775|1326041732|CHC13|27619||11/01/2013|12/31/9999|$695.32|0|0|||REMOVE LOWER LEG LESION|| 58-1699775|1326041732|CHC13|27620||11/01/2013|12/31/9999|$648.92|0|0|||EXPLORE/TREAT ANKLE JOINT|| 58-1699775|1326041732|CHC13|27625||11/01/2013|12/31/9999|$820.08|0|0|||REMOVE ANKLE JOINT LINING|| 58-1699775|1326041732|CHC13|27626||11/01/2013|12/31/9999|$905.25|0|0|||REMOVE ANKLE JOINT LINING|| 58-1699775|1326041732|CHC13|27630||11/01/2013|12/31/9999|$524.84|0|0|||REMOVAL OF TENDON LESION|| 58-1699775|1326041732|CHC13|27632||11/01/2013|12/31/9999|$599.20|0|0|||EXC LEG/ANKLE LES SC > 3 CM|| 58-1699775|1326041732|CHC13|27634||11/01/2013|12/31/9999|$988.53|0|0|||EXC LEG/ANKLE TUM DEEP >5 CM|| 58-1699775|1326041732|CHC13|27635||11/01/2013|12/31/9999|$842.34|0|0|||REMOVE LOWER LEG BONE LESION|| 58-1699775|1326041732|CHC13|27637||11/01/2013|12/31/9999|$1|080.11|0|0|||REMOVE/GRAFT LEG BONE LESION|| 58-1699775|1326041732|CHC13|27638||11/01/2013|12/31/9999|$1|104.06|0|0|||REMOVE/GRAFT LEG BONE LESION|| 58-1699775|1326041732|CHC13|27640||11/01/2013|12/31/9999|$1|202.33|0|0|||PARTIAL REMOVAL OF TIBIA|| 58-1699775|1326041732|CHC13|27641||11/01/2013|12/31/9999|$961.61|0|0|||PARTIAL REMOVAL OF FIBULA|| 58-1699775|1326041732|CHC13|27645||11/01/2013|12/31/9999|$2|479.02|0|0|||EXTENSIVE LOWER LEG SURGERY|| 58-1699775|1326041732|CHC13|27646||11/01/2013|12/31/9999|$2|144.30|0|0|||EXTENSIVE LOWER LEG SURGERY|| 58-1699775|1326041732|CHC13|27647||11/01/2013|12/31/9999|$1|508.84|0|0|||EXTENSIVE ANKLE/HEEL SURGERY|| 58-1699775|1326041732|CHC13|27648||11/01/2013|12/31/9999|$74.87|0|0|||INJECTION FOR ANKLE X-RAY|| 58-1699775|1326041732|CHC13|27650||11/01/2013|12/31/9999|$950.29|0|0|||REPAIR ACHILLES TENDON|| 58-1699775|1326041732|CHC13|27652||11/01/2013|12/31/9999|$1|000.18|0|0|||REPAIR/GRAFT ACHILLES TENDON|| 58-1699775|1326041732|CHC13|27654||11/01/2013|12/31/9999|$1|013.55|0|0|||REPAIR OF ACHILLES TENDON|| 58-1699775|1326041732|CHC13|27656||11/01/2013|12/31/9999|$545.39|0|0|||REPAIR LEG FASCIA DEFECT|| 58-1699775|1326041732|CHC13|27658||11/01/2013|12/31/9999|$533.11|0|0|||REPAIR OF LEG TENDON| EACH|| 58-1699775|1326041732|CHC13|27659||11/01/2013|12/31/9999|$700.09|0|0|||REPAIR OF LEG TENDON| EACH|| 58-1699775|1326041732|CHC13|27664||11/01/2013|12/31/9999|$515.90|0|0|||REPAIR OF LEG TENDON| EACH|| 58-1699775|1326041732|CHC13|27665||11/01/2013|12/31/9999|$591.08|0|0|||REPAIR OF LEG TENDON| EACH|| 58-1699775|1326041732|CHC13|27675||11/01/2013|12/31/9999|$701.44|0|0|||REPAIR LOWER LEG TENDONS|| 58-1699775|1326041732|CHC13|27676||11/01/2013|12/31/9999|$882.97|0|0|||REPAIR LOWER LEG TENDONS|| 58-1699775|1326041732|CHC13|27680||11/01/2013|12/31/9999|$614.86|0|0|||RELEASE OF LOWER LEG TENDON|| 58-1699775|1326041732|CHC13|27681||11/01/2013|12/31/9999|$765.09|0|0|||RELEASE OF LOWER LEG TENDONS|| 58-1699775|1326041732|CHC13|27685||11/01/2013|12/31/9999|$662.98|0|0|||REVISION OF LOWER LEG TENDON|| 58-1699775|1326041732|CHC13|27686||11/01/2013|12/31/9999|$794.25|0|0|||REVISE LOWER LEG TENDONS|| 58-1699775|1326041732|CHC13|27687||11/01/2013|12/31/9999|$651.56|0|0|||REVISION OF CALF TENDON|| 58-1699775|1326041732|CHC13|27690||11/01/2013|12/31/9999|$902.56|0|0|||REVISE LOWER LEG TENDON|| 58-1699775|1326041732|CHC13|27691||11/01/2013|12/31/9999|$1|071.13|0|0|||REVISE LOWER LEG TENDON|| 58-1699775|1326041732|CHC13|27692||11/01/2013|12/31/9999|$155.60|0|0|||REVISE ADDITIONAL LEG TENDON|| 58-1699775|1326041732|CHC13|27695||11/01/2013|12/31/9999|$689.43|0|0|||REPAIR OF ANKLE LIGAMENT|| 58-1699775|1326041732|CHC13|27696||11/01/2013|12/31/9999|$806.63|0|0|||REPAIR OF ANKLE LIGAMENTS|| 58-1699775|1326041732|CHC13|27698||11/01/2013|12/31/9999|$921.65|0|0|||REPAIR OF ANKLE LIGAMENT|| 58-1699775|1326041732|CHC13|27700||11/01/2013|12/31/9999|$853.12|0|0|||REVISION OF ANKLE JOINT|| 58-1699775|1326041732|CHC13|27702||11/01/2013|12/31/9999|$1|395.47|0|0|||RECONSTRUCT ANKLE JOINT|| 58-1699775|1326041732|CHC13|27703||11/01/2013|12/31/9999|$1|629.48|0|0|||RECONSTRUCTION| ANKLE JOINT|| 58-1699775|1326041732|CHC13|27704||11/01/2013|12/31/9999|$819.98|0|0|||REMOVAL OF ANKLE IMPLANT|| 58-1699775|1326041732|CHC13|27705||11/01/2013|12/31/9999|$1|088.94|0|0|||INCISION OF TIBIA|| 58-1699775|1326041732|CHC13|27707||11/01/2013|12/31/9999|$568.66|0|0|||INCISION OF FIBULA|| 58-1699775|1326041732|CHC13|27709||11/01/2013|12/31/9999|$1|675.69|0|0|||INCISION OF TIBIA & FIBULA|| 58-1699775|1326041732|CHC13|27712||11/01/2013|12/31/9999|$1|574.33|0|0|||REALIGNMENT OF LOWER LEG|| 58-1699775|1326041732|CHC13|27715||11/01/2013|12/31/9999|$1|518.67|0|0|||REVISION OF LOWER LEG|| 58-1699775|1326041732|CHC13|27720||11/01/2013|12/31/9999|$1|251.40|0|0|||REPAIR OF TIBIA|| 58-1699775|1326041732|CHC13|27722||11/01/2013|12/31/9999|$1|262.01|0|0|||REPAIR/GRAFT OF TIBIA|| 58-1699775|1326041732|CHC13|27724||11/01/2013|12/31/9999|$1|823.41|0|0|||REPAIR/GRAFT OF TIBIA|| 58-1699775|1326041732|CHC13|27725||11/01/2013|12/31/9999|$1|735.48|0|0|||REPAIR OF LOWER LEG|| 58-1699775|1326041732|CHC13|27726||11/01/2013|12/31/9999|$1|376.45|0|0|||REPAIR FIBULA NONUNION|| 58-1699775|1326041732|CHC13|27727||11/01/2013|12/31/9999|$1|456.33|0|0|||REPAIR OF LOWER LEG|| 58-1699775|1326041732|CHC13|27730||11/01/2013|12/31/9999|$827.36|0|0|||REPAIR OF TIBIA EPIPHYSIS|| 58-1699775|1326041732|CHC13|27732||11/01/2013|12/31/9999|$546.80|0|0|||REPAIR OF FIBULA EPIPHYSIS|| 58-1699775|1326041732|CHC13|27734||11/01/2013|12/31/9999|$859.39|0|0|||REPAIR LOWER LEG EPIPHYSES|| 58-1699775|1326041732|CHC13|27740||11/01/2013|12/31/9999|$892.89|0|0|||REPAIR OF LEG EPIPHYSES|| 58-1699775|1326041732|CHC13|27742||11/01/2013|12/31/9999|$1|077.76|0|0|||REPAIR OF LEG EPIPHYSES|| 58-1699775|1326041732|CHC13|27745||11/01/2013|12/31/9999|$1|077.43|0|0|||REINFORCE TIBIA|| 58-1699775|1326041732|CHC13|27750||11/01/2013|12/31/9999|$441.71|0|0|||TREATMENT OF TIBIA FRACTURE|| 58-1699775|1326041732|CHC13|27752||11/01/2013|12/31/9999|$702.52|0|0|||TREATMENT OF TIBIA FRACTURE|| 58-1699775|1326041732|CHC13|27756||11/01/2013|12/31/9999|$816.33|0|0|||TREATMENT OF TIBIA FRACTURE|| 58-1699775|1326041732|CHC13|27758||11/01/2013|12/31/9999|$1|269.38|0|0|||TREATMENT OF TIBIA FRACTURE|| 58-1699775|1326041732|CHC13|27759||11/01/2013|12/31/9999|$1|428.47|0|0|||TREATMENT OF TIBIA FRACTURE|| 58-1699775|1326041732|CHC13|27760||11/01/2013|12/31/9999|$424.30|0|0|||TREATMENT OF ANKLE FRACTURE|| 58-1699775|1326041732|CHC13|27762||11/01/2013|12/31/9999|$621.02|0|0|||TREATMENT OF ANKLE FRACTURE|| 58-1699775|1326041732|CHC13|27766||11/01/2013|12/31/9999|$864.55|0|0|||TREATMENT OF ANKLE FRACTURE|| 58-1699775|1326041732|CHC13|27767||11/01/2013|12/31/9999|$390.47|0|0|||CLTX POST ANKLE FX|| 58-1699775|1326041732|CHC13|27768||11/01/2013|12/31/9999|$608.77|0|0|||CLTX POST ANKLE FX W/MNPJ|| 58-1699775|1326041732|CHC13|27769||11/01/2013|12/31/9999|$1|033.81|0|0|||OPTX POST ANKLE FX|| 58-1699775|1326041732|CHC13|27780||11/01/2013|12/31/9999|$385.55|0|0|||TREATMENT OF FIBULA FRACTURE|| 58-1699775|1326041732|CHC13|27781||11/01/2013|12/31/9999|$554.33|0|0|||TREATMENT OF FIBULA FRACTURE|| 58-1699775|1326041732|CHC13|27784||11/01/2013|12/31/9999|$1|016.06|0|0|||TREATMENT OF FIBULA FRACTURE|| 58-1699775|1326041732|CHC13|27786||11/01/2013|12/31/9999|$398.02|0|0|||TREATMENT OF ANKLE FRACTURE|| 58-1699775|1326041732|CHC13|27788||11/01/2013|12/31/9999|$544.92|0|0|||TREATMENT OF ANKLE FRACTURE|| 58-1699775|1326041732|CHC13|27792||11/01/2013|12/31/9999|$932.53|0|0|||TREATMENT OF ANKLE FRACTURE|| 58-1699775|1326041732|CHC13|27808||11/01/2013|12/31/9999|$416.90|0|0|||TREATMENT OF ANKLE FRACTURE|| 58-1699775|1326041732|CHC13|27810||11/01/2013|12/31/9999|$606.49|0|0|||TREATMENT OF ANKLE FRACTURE|| 58-1699775|1326041732|CHC13|27814||11/01/2013|12/31/9999|$1|101.49|0|0|||TREATMENT OF ANKLE FRACTURE|| 58-1699775|1326041732|CHC13|27816||11/01/2013|12/31/9999|$397.36|0|0|||TREATMENT OF ANKLE FRACTURE|| 58-1699775|1326041732|CHC13|27818||11/01/2013|12/31/9999|$618.10|0|0|||TREATMENT OF ANKLE FRACTURE|| 58-1699775|1326041732|CHC13|27822||11/01/2013|12/31/9999|$1|201.48|0|0|||TREATMENT OF ANKLE FRACTURE|| 58-1699775|1326041732|CHC13|27823||11/01/2013|12/31/9999|$1|364.91|0|0|||TREATMENT OF ANKLE FRACTURE|| 58-1699775|1326041732|CHC13|27824||11/01/2013|12/31/9999|$423.02|0|0|||TREAT LOWER LEG FRACTURE|| 58-1699775|1326041732|CHC13|27825||11/01/2013|12/31/9999|$703.90|0|0|||TREAT LOWER LEG FRACTURE|| 58-1699775|1326041732|CHC13|27826||11/01/2013|12/31/9999|$1|183.46|0|0|||TREAT LOWER LEG FRACTURE|| 58-1699775|1326041732|CHC13|27827||11/01/2013|12/31/9999|$1|546.33|0|0|||TREAT LOWER LEG FRACTURE|| 58-1699775|1326041732|CHC13|27828||11/01/2013|12/31/9999|$1|853.81|0|0|||TREAT LOWER LEG FRACTURE|| 58-1699775|1326041732|CHC13|27829||11/01/2013|12/31/9999|$969.52|0|0|||TREAT LOWER LEG JOINT|| 58-1699775|1326041732|CHC13|27830||11/01/2013|12/31/9999|$488.98|0|0|||TREAT LOWER LEG DISLOCATION|| 58-1699775|1326041732|CHC13|27831||11/01/2013|12/31/9999|$555.58|0|0|||TREAT LOWER LEG DISLOCATION|| 58-1699775|1326041732|CHC13|27832||11/01/2013|12/31/9999|$1|061.01|0|0|||TREAT LOWER LEG DISLOCATION|| 58-1699775|1326041732|CHC13|27840||11/01/2013|12/31/9999|$516.23|0|0|||TREAT ANKLE DISLOCATION|| 58-1699775|1326041732|CHC13|27842||11/01/2013|12/31/9999|$698.47|0|0|||TREAT ANKLE DISLOCATION|| 58-1699775|1326041732|CHC13|27846||11/01/2013|12/31/9999|$1|048.23|0|0|||TREAT ANKLE DISLOCATION|| 58-1699775|1326041732|CHC13|27848||11/01/2013|12/31/9999|$1|168.77|0|0|||TREAT ANKLE DISLOCATION|| 58-1699775|1326041732|CHC13|27860||11/01/2013|12/31/9999|$251.46|0|0|||FIXATION OF ANKLE JOINT|| 58-1699775|1326041732|CHC13|27870||11/01/2013|12/31/9999|$1|488.88|0|0|||FUSION OF ANKLE JOINT| OPEN|| 58-1699775|1326041732|CHC13|27871||11/01/2013|12/31/9999|$988.29|0|0|||FUSION OF TIBIOFIBULAR JOINT|| 58-1699775|1326041732|CHC13|27880||11/01/2013|12/31/9999|$1|349.63|0|0|||AMPUTATION OF LOWER LEG|| 58-1699775|1326041732|CHC13|27881||11/01/2013|12/31/9999|$1|274.75|0|0|||AMPUTATION OF LOWER LEG|| 58-1699775|1326041732|CHC13|27882||11/01/2013|12/31/9999|$895.60|0|0|||AMPUTATION OF LOWER LEG|| 58-1699775|1326041732|CHC13|27884||11/01/2013|12/31/9999|$843.94|0|0|||AMPUTATION FOLLOW-UP SURGERY|| 58-1699775|1326041732|CHC13|27886||11/01/2013|12/31/9999|$969.22|0|0|||AMPUTATION FOLLOW-UP SURGERY|| 58-1699775|1326041732|CHC13|27888||11/01/2013|12/31/9999|$988.61|0|0|||AMPUTATION OF FOOT AT ANKLE|| 58-1699775|1326041732|CHC13|27889||11/01/2013|12/31/9999|$976.30|0|0|||AMPUTATION OF FOOT AT ANKLE|| 58-1699775|1326041732|CHC13|27892||11/01/2013|12/31/9999|$800.35|0|0|||DECOMPRESSION OF LEG|| 58-1699775|1326041732|CHC13|27893||11/01/2013|12/31/9999|$852.47|0|0|||DECOMPRESSION OF LEG|| 58-1699775|1326041732|CHC13|27894||11/01/2013|12/31/9999|$1|242.42|0|0|||DECOMPRESSION OF LEG|| 58-1699775|1326041732|CHC13|27899||11/01/2013|12/31/9999|$0.00|0|0|||LEG/ANKLE SURGERY PROCEDURE|| 58-1699775|1326041732|CHC13|28001||11/01/2013|12/31/9999|$243.16|0|0|||DRAINAGE OF BURSA OF FOOT|| 58-1699775|1326041732|CHC13|28002||11/01/2013|12/31/9999|$473.46|0|0|||TREATMENT OF FOOT INFECTION|| 58-1699775|1326041732|CHC13|28003||11/01/2013|12/31/9999|$810.35|0|0|||TREATMENT OF FOOT INFECTION|| 58-1699775|1326041732|CHC13|28005||11/01/2013|12/31/9999|$842.53|0|0|||TREAT FOOT BONE LESION|| 58-1699775|1326041732|CHC13|28008||11/01/2013|12/31/9999|$421.58|0|0|||INCISION OF FOOT FASCIA|| 58-1699775|1326041732|CHC13|28010||11/01/2013|12/31/9999|$299.23|0|0|||INCISION OF TOE TENDON|| 58-1699775|1326041732|CHC13|28011||11/01/2013|12/31/9999|$421.46|0|0|||INCISION OF TOE TENDONS|| 58-1699775|1326041732|CHC13|28020||11/01/2013|12/31/9999|$507.88|0|0|||EXPLORATION OF FOOT JOINT|| 58-1699775|1326041732|CHC13|28022||11/01/2013|12/31/9999|$460.44|0|0|||EXPLORATION OF FOOT JOINT|| 58-1699775|1326041732|CHC13|28024||11/01/2013|12/31/9999|$431.78|0|0|||EXPLORATION OF TOE JOINT|| 58-1699775|1326041732|CHC13|28035||11/01/2013|12/31/9999|$509.64|0|0|||DECOMPRESSION OF TIBIA NERVE|| 58-1699775|1326041732|CHC13|28039||11/01/2013|12/31/9999|$513.67|0|0|||EXC FOOT/TOE TUM SC > 1.5 CM|| 58-1699775|1326041732|CHC13|28041||11/01/2013|12/31/9999|$676.00|0|0|||EXC FOOT/TOE TUM DEEP >1.5CM|| 58-1699775|1326041732|CHC13|28043||11/01/2013|12/31/9999|$378.38|0|0|||EXCISION OF FOOT LESION|| 58-1699775|1326041732|CHC13|28045||11/01/2013|12/31/9999|$504.23|0|0|||EXCISION OF FOOT LESION|| 58-1699775|1326041732|CHC13|28046||04/01/2014|12/31/9999|$1|089.38|0|0|||RESECTION OF TUMOR| FOOT|| 58-1699775|1326041732|CHC13|28047||04/01/2014|12/31/9999|$1|519.95|0|0|||RESECT FOOT/TOE TUMOR > 3 CM|| 58-1699775|1326041732|CHC13|28050||11/01/2013|12/31/9999|$433.35|0|0|||BIOPSY OF FOOT JOINT LINING|| 58-1699775|1326041732|CHC13|28052||11/01/2013|12/31/9999|$399.69|0|0|||BIOPSY OF FOOT JOINT LINING|| 58-1699775|1326041732|CHC13|28054||11/01/2013|12/31/9999|$341.32|0|0|||BIOPSY OF TOE JOINT LINING|| 58-1699775|1326041732|CHC13|28055||11/01/2013|12/31/9999|$542.03|0|0|||NEURECTOMY| FOOT|| 58-1699775|1326041732|CHC13|28060||11/01/2013|12/31/9999|$506.23|0|0|||PARTIAL REMOVAL| FOOT FASCIA|| 58-1699775|1326041732|CHC13|28062||11/01/2013|12/31/9999|$585.03|0|0|||REMOVAL OF FOOT FASCIA|| 58-1699775|1326041732|CHC13|28070||11/01/2013|12/31/9999|$504.97|0|0|||REMOVAL OF FOOT JOINT LINING|| 58-1699775|1326041732|CHC13|28072||11/01/2013|12/31/9999|$484.96|0|0|||REMOVAL OF FOOT JOINT LINING|| 58-1699775|1326041732|CHC13|28080||11/01/2013|12/31/9999|$514.79|0|0|||REMOVAL OF FOOT LESION|| 58-1699775|1326041732|CHC13|28086||11/01/2013|12/31/9999|$511.35|0|0|||EXCISE FOOT TENDON SHEATH|| 58-1699775|1326041732|CHC13|28088||11/01/2013|12/31/9999|$423.65|0|0|||EXCISE FOOT TENDON SHEATH|| 58-1699775|1326041732|CHC13|28090||11/01/2013|12/31/9999|$439.82|0|0|||REMOVAL OF FOOT LESION|| 58-1699775|1326041732|CHC13|28092||11/01/2013|12/31/9999|$385.24|0|0|||REMOVAL OF TOE LESIONS|| 58-1699775|1326041732|CHC13|28100||11/01/2013|12/31/9999|$578.96|0|0|||REMOVAL OF ANKLE/HEEL LESION|| 58-1699775|1326041732|CHC13|28102||11/01/2013|12/31/9999|$680.39|0|0|||REMOVE/GRAFT FOOT LESION|| 58-1699775|1326041732|CHC13|28103||11/01/2013|12/31/9999|$574.68|0|0|||REMOVE/GRAFT FOOT LESION|| 58-1699775|1326041732|CHC13|28104||11/01/2013|12/31/9999|$495.42|0|0|||REMOVAL OF FOOT LESION|| 58-1699775|1326041732|CHC13|28106||11/01/2013|12/31/9999|$624.16|0|0|||REMOVE/GRAFT FOOT LESION|| 58-1699775|1326041732|CHC13|28107||11/01/2013|12/31/9999|$507.77|0|0|||REMOVE/GRAFT FOOT LESION|| 58-1699775|1326041732|CHC13|28108||11/01/2013|12/31/9999|$408.10|0|0|||REMOVAL OF TOE LESIONS|| 58-1699775|1326041732|CHC13|28110||11/01/2013|12/31/9999|$412.32|0|0|||PART REMOVAL OF METATARSAL|| 58-1699775|1326041732|CHC13|28111||11/01/2013|12/31/9999|$477.51|0|0|||PART REMOVAL OF METATARSAL|| 58-1699775|1326041732|CHC13|28112||11/01/2013|12/31/9999|$449.93|0|0|||PART REMOVAL OF METATARSAL|| 58-1699775|1326041732|CHC13|28113||11/01/2013|12/31/9999|$608.18|0|0|||PART REMOVAL OF METATARSAL|| 58-1699775|1326041732|CHC13|28114||11/01/2013|12/31/9999|$1|194.73|0|0|||REMOVAL OF METATARSAL HEADS|| 58-1699775|1326041732|CHC13|28116||11/01/2013|12/31/9999|$821.15|0|0|||REVISION OF FOOT|| 58-1699775|1326041732|CHC13|28118||11/01/2013|12/31/9999|$588.76|0|0|||REMOVAL OF HEEL BONE|| 58-1699775|1326041732|CHC13|28119||11/01/2013|12/31/9999|$516.68|0|0|||REMOVAL OF HEEL SPUR|| 58-1699775|1326041732|CHC13|28120||11/01/2013|12/31/9999|$700.29|0|0|||PART REMOVAL OF ANKLE/HEEL|| 58-1699775|1326041732|CHC13|28122||11/01/2013|12/31/9999|$640.13|0|0|||PARTIAL REMOVAL OF FOOT BONE|| 58-1699775|1326041732|CHC13|28124||11/01/2013|12/31/9999|$471.41|0|0|||PARTIAL REMOVAL OF TOE|| 58-1699775|1326041732|CHC13|28126||11/01/2013|12/31/9999|$356.01|0|0|||PARTIAL REMOVAL OF TOE|| 58-1699775|1326041732|CHC13|28130||11/01/2013|12/31/9999|$944.54|0|0|||REMOVAL OF ANKLE BONE|| 58-1699775|1326041732|CHC13|28140||11/01/2013|12/31/9999|$641.93|0|0|||REMOVAL OF METATARSAL|| 58-1699775|1326041732|CHC13|28150||11/01/2013|12/31/9999|$405.97|0|0|||REMOVAL OF TOE|| 58-1699775|1326041732|CHC13|28153||11/01/2013|12/31/9999|$377.98|0|0|||PARTIAL REMOVAL OF TOE|| 58-1699775|1326041732|CHC13|28160||11/01/2013|12/31/9999|$387.58|0|0|||PARTIAL REMOVAL OF TOE|| 58-1699775|1326041732|CHC13|28171||11/01/2013|12/31/9999|$1|220.75|0|0|||EXTENSIVE FOOT SURGERY|| 58-1699775|1326041732|CHC13|28173||11/01/2013|12/31/9999|$1|106.37|0|0|||EXTENSIVE FOOT SURGERY|| 58-1699775|1326041732|CHC13|28175||11/01/2013|12/31/9999|$695.45|0|0|||EXTENSIVE FOOT SURGERY|| 58-1699775|1326041732|CHC13|28190||11/01/2013|12/31/9999|$191.42|0|0|||REMOVAL OF FOOT FOREIGN BODY|| 58-1699775|1326041732|CHC13|28192||11/01/2013|12/31/9999|$452.49|0|0|||REMOVAL OF FOOT FOREIGN BODY|| 58-1699775|1326041732|CHC13|28193||11/01/2013|12/31/9999|$535.00|0|0|||REMOVAL OF FOOT FOREIGN BODY|| 58-1699775|1326041732|CHC13|28200||11/01/2013|12/31/9999|$451.77|0|0|||REPAIR OF FOOT TENDON|| 58-1699775|1326041732|CHC13|28202||11/01/2013|12/31/9999|$609.07|0|0|||REPAIR/GRAFT OF FOOT TENDON|| 58-1699775|1326041732|CHC13|28208||11/01/2013|12/31/9999|$438.71|0|0|||REPAIR OF FOOT TENDON|| 58-1699775|1326041732|CHC13|28210||11/01/2013|12/31/9999|$583.74|0|0|||REPAIR/GRAFT OF FOOT TENDON|| 58-1699775|1326041732|CHC13|28220||11/01/2013|12/31/9999|$432.54|0|0|||RELEASE OF FOOT TENDON|| 58-1699775|1326041732|CHC13|28222||11/01/2013|12/31/9999|$505.75|0|0|||RELEASE OF FOOT TENDONS|| 58-1699775|1326041732|CHC13|28225||11/01/2013|12/31/9999|$368.67|0|0|||RELEASE OF FOOT TENDON|| 58-1699775|1326041732|CHC13|28226||11/01/2013|12/31/9999|$443.91|0|0|||RELEASE OF FOOT TENDONS|| 58-1699775|1326041732|CHC13|28230||11/01/2013|12/31/9999|$405.68|0|0|||INCISION OF FOOT TENDON(S)|| 58-1699775|1326041732|CHC13|28232||11/01/2013|12/31/9999|$353.04|0|0|||INCISION OF TOE TENDON|| 58-1699775|1326041732|CHC13|28234||11/01/2013|12/31/9999|$378.42|0|0|||INCISION OF FOOT TENDON|| 58-1699775|1326041732|CHC13|28238||11/01/2013|12/31/9999|$708.95|0|0|||REVISION OF FOOT TENDON|| 58-1699775|1326041732|CHC13|28240||11/01/2013|12/31/9999|$417.39|0|0|||RELEASE OF BIG TOE|| 58-1699775|1326041732|CHC13|28250||11/01/2013|12/31/9999|$571.90|0|0|||REVISION OF FOOT FASCIA|| 58-1699775|1326041732|CHC13|28260||11/01/2013|12/31/9999|$745.71|0|0|||RELEASE OF MIDFOOT JOINT|| 58-1699775|1326041732|CHC13|28261||11/01/2013|12/31/9999|$1|110.08|0|0|||REVISION OF FOOT TENDON|| 58-1699775|1326041732|CHC13|28262||11/01/2013|12/31/9999|$1|659.97|0|0|||REVISION OF FOOT AND ANKLE|| 58-1699775|1326041732|CHC13|28264||11/01/2013|12/31/9999|$1|019.08|0|0|||RELEASE OF MIDFOOT JOINT|| 58-1699775|1326041732|CHC13|28270||11/01/2013|12/31/9999|$478.05|0|0|||RELEASE OF FOOT CONTRACTURE|| 58-1699775|1326041732|CHC13|28272||11/01/2013|12/31/9999|$363.84|0|0|||RELEASE OF TOE JOINT| EACH|| 58-1699775|1326041732|CHC13|28280||11/01/2013|12/31/9999|$512.38|0|0|||FUSION OF TOES|| 58-1699775|1326041732|CHC13|28285||11/01/2013|12/31/9999|$528.91|0|0|||REPAIR OF HAMMERTOE|| 58-1699775|1326041732|CHC13|28286||11/01/2013|12/31/9999|$431.75|0|0|||REPAIR OF HAMMERTOE|| 58-1699775|1326041732|CHC13|28288||11/01/2013|12/31/9999|$615.57|0|0|||PARTIAL REMOVAL OF FOOT BONE|| 58-1699775|1326041732|CHC13|28289||11/01/2013|12/31/9999|$787.11|0|0|||REPAIR HALLUX RIGIDUS|| 58-1699775|1326041732|CHC13|28291||04/01/2017|12/31/9999|$1|138.03|0|745.05|0||CORRJ HALUX RIGDUS W/IMPLT|| 58-1699775|1326041732|CHC13|28292||11/01/2013|12/31/9999|$857.69|0|0|||CORRECTION OF BUNION|| 58-1699775|1326041732|CHC13|28295||04/01/2017|12/31/9999|$1|458.88|0|830.11|0||CORRECTION HALLUX VALGUS|| 58-1699775|1326041732|CHC13|28296||11/01/2013|12/31/9999|$749.34|0|0|||CORRECTION OF BUNION|| 58-1699775|1326041732|CHC13|28297||11/01/2013|12/31/9999|$847.77|0|0|||CORRECTION OF BUNION|| 58-1699775|1326041732|CHC13|28298||11/01/2013|12/31/9999|$723.61|0|0|||CORRECTION OF BUNION|| 58-1699775|1326041732|CHC13|28299||11/01/2013|12/31/9999|$973.93|0|0|||CORRECTION OF BUNION|| 58-1699775|1326041732|CHC13|28300||11/01/2013|12/31/9999|$943.52|0|0|||INCISION OF HEEL BONE|| 58-1699775|1326041732|CHC13|28302||11/01/2013|12/31/9999|$1|003.65|0|0|||INCISION OF ANKLE BONE|| 58-1699775|1326041732|CHC13|28304||11/01/2013|12/31/9999|$854.13|0|0|||INCISION OF MIDFOOT BONES|| 58-1699775|1326041732|CHC13|28305||11/01/2013|12/31/9999|$927.09|0|0|||INCISE/GRAFT MIDFOOT BONES|| 58-1699775|1326041732|CHC13|28306||11/01/2013|12/31/9999|$581.33|0|0|||INCISION OF METATARSAL|| 58-1699775|1326041732|CHC13|28307||11/01/2013|12/31/9999|$662.10|0|0|||INCISION OF METATARSAL|| 58-1699775|1326041732|CHC13|28308||11/01/2013|12/31/9999|$533.81|0|0|||INCISION OF METATARSAL|| 58-1699775|1326041732|CHC13|28309||11/01/2013|12/31/9999|$1|272.69|0|0|||INCISION OF METATARSALS|| 58-1699775|1326041732|CHC13|28310||11/01/2013|12/31/9999|$506.20|0|0|||REVISION OF BIG TOE|| 58-1699775|1326041732|CHC13|28312||11/01/2013|12/31/9999|$456.17|0|0|||REVISION OF TOE|| 58-1699775|1326041732|CHC13|28313||11/01/2013|12/31/9999|$512.04|0|0|||REPAIR DEFORMITY OF TOE|| 58-1699775|1326041732|CHC13|28315||11/01/2013|12/31/9999|$464.19|0|0|||REMOVAL OF SESAMOID BONE|| 58-1699775|1326041732|CHC13|28320||11/01/2013|12/31/9999|$884.00|0|0|||REPAIR OF FOOT BONES|| 58-1699775|1326041732|CHC13|28322||11/01/2013|12/31/9999|$826.77|0|0|||REPAIR OF METATARSALS|| 58-1699775|1326041732|CHC13|28340||11/01/2013|12/31/9999|$600.17|0|0|||RESECT ENLARGED TOE TISSUE|| 58-1699775|1326041732|CHC13|28341||11/01/2013|12/31/9999|$713.99|0|0|||RESECT ENLARGED TOE|| 58-1699775|1326041732|CHC13|28344||11/01/2013|12/31/9999|$447.08|0|0|||REPAIR EXTRA TOE(S)|| 58-1699775|1326041732|CHC13|28345||11/01/2013|12/31/9999|$533.99|0|0|||REPAIR WEBBED TOE(S)|| 58-1699775|1326041732|CHC13|28360||11/01/2013|12/31/9999|$1|523.59|0|0|||RECONSTRUCT CLEFT FOOT|| 58-1699775|1326041732|CHC13|28400||11/01/2013|12/31/9999|$317.03|0|0|||TREATMENT OF HEEL FRACTURE|| 58-1699775|1326041732|CHC13|28405||11/01/2013|12/31/9999|$496.09|0|0|||TREATMENT OF HEEL FRACTURE|| 58-1699775|1326041732|CHC13|28406||11/01/2013|12/31/9999|$750.28|0|0|||TREATMENT OF HEEL FRACTURE|| 58-1699775|1326041732|CHC13|28415||11/01/2013|12/31/9999|$1|595.69|0|0|||TREAT HEEL FRACTURE|| 58-1699775|1326041732|CHC13|28420||11/01/2013|12/31/9999|$1|771.85|0|0|||TREAT/GRAFT HEEL FRACTURE|| 58-1699775|1326041732|CHC13|28430||11/01/2013|12/31/9999|$291.32|0|0|||TREATMENT OF ANKLE FRACTURE|| 58-1699775|1326041732|CHC13|28435||11/01/2013|12/31/9999|$370.23|0|0|||TREATMENT OF ANKLE FRACTURE|| 58-1699775|1326041732|CHC13|28436||11/01/2013|12/31/9999|$625.80|0|0|||TREATMENT OF ANKLE FRACTURE|| 58-1699775|1326041732|CHC13|28445||11/01/2013|12/31/9999|$1|531.94|0|0|||TREAT ANKLE FRACTURE|| 58-1699775|1326041732|CHC13|28446||11/01/2013|12/31/9999|$1|737.60|0|0|||OSTEOCHONDRAL TALUS AUTOGRFT|| 58-1699775|1326041732|CHC13|28450||11/01/2013|12/31/9999|$269.16|0|0|||TREAT MIDFOOT FRACTURE| EACH|| 58-1699775|1326041732|CHC13|28455||11/01/2013|12/31/9999|$368.75|0|0|||TREAT MIDFOOT FRACTURE| EACH|| 58-1699775|1326041732|CHC13|28456||11/01/2013|12/31/9999|$432.97|0|0|||TREAT MIDFOOT FRACTURE|| 58-1699775|1326041732|CHC13|28465||11/01/2013|12/31/9999|$881.76|0|0|||TREAT MIDFOOT FRACTURE| EACH|| 58-1699775|1326041732|CHC13|28470||11/01/2013|12/31/9999|$267.37|0|0|||TREAT METATARSAL FRACTURE|| 58-1699775|1326041732|CHC13|28475||11/01/2013|12/31/9999|$326.65|0|0|||TREAT METATARSAL FRACTURE|| 58-1699775|1326041732|CHC13|28476||11/01/2013|12/31/9999|$487.67|0|0|||TREAT METATARSAL FRACTURE|| 58-1699775|1326041732|CHC13|28485||11/01/2013|12/31/9999|$751.77|0|0|||TREAT METATARSAL FRACTURE|| 58-1699775|1326041732|CHC13|28490||11/01/2013|12/31/9999|$172.77|0|0|||TREAT BIG TOE FRACTURE|| 58-1699775|1326041732|CHC13|28495||11/01/2013|12/31/9999|$211.71|0|0|||TREAT BIG TOE FRACTURE|| 58-1699775|1326041732|CHC13|28496||11/01/2013|12/31/9999|$322.01|0|0|||TREAT BIG TOE FRACTURE|| 58-1699775|1326041732|CHC13|28505||11/01/2013|12/31/9999|$710.48|0|0|||TREAT BIG TOE FRACTURE|| 58-1699775|1326041732|CHC13|28510||11/01/2013|12/31/9999|$165.40|0|0|||TREATMENT OF TOE FRACTURE|| 58-1699775|1326041732|CHC13|28515||11/01/2013|12/31/9999|$198.21|0|0|||TREATMENT OF TOE FRACTURE|| 58-1699775|1326041732|CHC13|28525||11/01/2013|12/31/9999|$569.99|0|0|||TREAT TOE FRACTURE|| 58-1699775|1326041732|CHC13|28530||11/01/2013|12/31/9999|$142.12|0|0|||TREAT SESAMOID BONE FRACTURE|| 58-1699775|1326041732|CHC13|28531||11/01/2013|12/31/9999|$274.11|0|0|||TREAT SESAMOID BONE FRACTURE|| 58-1699775|1326041732|CHC13|28540||11/01/2013|12/31/9999|$258.41|0|0|||TREAT FOOT DISLOCATION|| 58-1699775|1326041732|CHC13|28545||11/01/2013|12/31/9999|$355.42|0|0|||TREAT FOOT DISLOCATION|| 58-1699775|1326041732|CHC13|28546||11/01/2013|12/31/9999|$465.30|0|0|||TREAT FOOT DISLOCATION|| 58-1699775|1326041732|CHC13|28555||11/01/2013|12/31/9999|$960.98|0|0|||REPAIR FOOT DISLOCATION|| 58-1699775|1326041732|CHC13|28570||11/01/2013|12/31/9999|$198.25|0|0|||TREAT FOOT DISLOCATION|| 58-1699775|1326041732|CHC13|28575||11/01/2013|12/31/9999|$455.70|0|0|||TREAT FOOT DISLOCATION|| 58-1699775|1326041732|CHC13|28576||11/01/2013|12/31/9999|$545.72|0|0|||TREAT FOOT DISLOCATION|| 58-1699775|1326041732|CHC13|28585||11/01/2013|12/31/9999|$1|006.81|0|0|||REPAIR FOOT DISLOCATION|| 58-1699775|1326041732|CHC13|28600||11/01/2013|12/31/9999|$262.21|0|0|||TREAT FOOT DISLOCATION|| 58-1699775|1326041732|CHC13|28605||11/01/2013|12/31/9999|$398.74|0|0|||TREAT FOOT DISLOCATION|| 58-1699775|1326041732|CHC13|28606||11/01/2013|12/31/9999|$557.80|0|0|||TREAT FOOT DISLOCATION|| 58-1699775|1326041732|CHC13|28615||11/01/2013|12/31/9999|$1|128.54|0|0|||REPAIR FOOT DISLOCATION|| 58-1699775|1326041732|CHC13|28630||11/01/2013|12/31/9999|$156.64|0|0|||TREAT TOE DISLOCATION|| 58-1699775|1326041732|CHC13|28635||11/01/2013|12/31/9999|$193.48|0|0|||TREAT TOE DISLOCATION|| 58-1699775|1326041732|CHC13|28636||11/01/2013|12/31/9999|$280.49|0|0|||TREAT TOE DISLOCATION|| 58-1699775|1326041732|CHC13|28645||11/01/2013|12/31/9999|$687.35|0|0|||REPAIR TOE DISLOCATION|| 58-1699775|1326041732|CHC13|28660||11/01/2013|12/31/9999|$125.72|0|0|||TREAT TOE DISLOCATION|| 58-1699775|1326041732|CHC13|28665||11/01/2013|12/31/9999|$188.98|0|0|||TREAT TOE DISLOCATION|| 58-1699775|1326041732|CHC13|28666||11/01/2013|12/31/9999|$271.86|0|0|||TREAT TOE DISLOCATION|| 58-1699775|1326041732|CHC13|28675||11/01/2013|12/31/9999|$584.27|0|0|||REPAIR OF TOE DISLOCATION|| 58-1699775|1326041732|CHC13|28705||11/01/2013|12/31/9999|$1|848.84|0|0|||FUSION OF FOOT BONES|| 58-1699775|1326041732|CHC13|28715||11/01/2013|12/31/9999|$1|339.26|0|0|||FUSION OF FOOT BONES|| 58-1699775|1326041732|CHC13|28725||11/01/2013|12/31/9999|$1|099.55|0|0|||FUSION OF FOOT BONES|| 58-1699775|1326041732|CHC13|28730||11/01/2013|12/31/9999|$1|060.96|0|0|||FUSION OF FOOT BONES|| 58-1699775|1326041732|CHC13|28735||11/01/2013|12/31/9999|$1|135.61|0|0|||FUSION OF FOOT BONES|| 58-1699775|1326041732|CHC13|28737||11/01/2013|12/31/9999|$980.50|0|0|||REVISION OF FOOT BONES|| 58-1699775|1326041732|CHC13|28740||11/01/2013|12/31/9999|$899.12|0|0|||FUSION OF FOOT BONES|| 58-1699775|1326041732|CHC13|28750||11/01/2013|12/31/9999|$856.78|0|0|||FUSION OF BIG TOE JOINT|| 58-1699775|1326041732|CHC13|28755||11/01/2013|12/31/9999|$470.94|0|0|||FUSION OF BIG TOE JOINT|| 58-1699775|1326041732|CHC13|28760||11/01/2013|12/31/9999|$827.26|0|0|||FUSION OF BIG TOE JOINT|| 58-1699775|1326041732|CHC13|28800||11/01/2013|12/31/9999|$797.87|0|0|||AMPUTATION OF MIDFOOT|| 58-1699775|1326041732|CHC13|28805||11/01/2013|12/31/9999|$1|089.60|0|0|||AMPUTATION THRU METATARSAL|| 58-1699775|1326041732|CHC13|28810||11/01/2013|12/31/9999|$636.09|0|0|||AMPUTATION TOE & METATARSAL|| 58-1699775|1326041732|CHC13|28820||11/01/2013|12/31/9999|$568.50|0|0|||AMPUTATION OF TOE|| 58-1699775|1326041732|CHC13|28825||11/01/2013|12/31/9999|$538.95|0|0|||PARTIAL AMPUTATION OF TOE|| 58-1699775|1326041732|CHC13|28890||11/01/2013|12/31/9999|$322.48|0|0|||HIGH ENERGY ESWT| PLANTAR F|| 58-1699775|1326041732|CHC13|28899||11/01/2013|12/31/9999|$0.00|0|0|||FOOT/TOES SURGERY PROCEDURE|| 58-1699775|1326041732|CHC13|29000||11/01/2013|12/31/9999|$247.20|0|0|||APPLICATION OF BODY CAST|| 58-1699775|1326041732|CHC13|29010||11/01/2013|12/31/9999|$201.60|0|0|||APPLICATION OF BODY CAST|| 58-1699775|1326041732|CHC13|29015||11/01/2013|12/31/9999|$249.30|0|0|||APPLICATION OF BODY CAST|| 58-1699775|1326041732|CHC13|29035||11/01/2013|12/31/9999|$202.76|0|0|||APPLICATION OF BODY CAST|| 58-1699775|1326041732|CHC13|29040||11/01/2013|12/31/9999|$213.94|0|0|||APPLICATION OF BODY CAST|| 58-1699775|1326041732|CHC13|29044||11/01/2013|12/31/9999|$236.33|0|0|||APPLICATION OF BODY CAST|| 58-1699775|1326041732|CHC13|29046||11/01/2013|12/31/9999|$256.28|0|0|||APPLICATION OF BODY CAST|| 58-1699775|1326041732|CHC13|29049||11/01/2013|12/31/9999|$96.61|0|0|||APPLICATION OF FIGURE EIGHT|| 58-1699775|1326041732|CHC13|29055||11/01/2013|12/31/9999|$195.03|0|0|||APPLICATION OF SHOULDER CAST|| 58-1699775|1326041732|CHC13|29058||11/01/2013|12/31/9999|$113.54|0|0|||APPLICATION OF SHOULDER CAST|| 58-1699775|1326041732|CHC13|29065||11/01/2013|12/31/9999|$96.93|0|0|||APPLICATION OF LONG ARM CAST|| 58-1699775|1326041732|CHC13|29075||11/01/2013|12/31/9999|$88.13|0|0|||APPLICATION OF FOREARM CAST|| 58-1699775|1326041732|CHC13|29085||11/01/2013|12/31/9999|$94.61|0|0|||APPLY HAND/WRIST CAST|| 58-1699775|1326041732|CHC13|29086||11/01/2013|12/31/9999|$71.67|0|0|||APPLY FINGER CAST|| 58-1699775|1326041732|CHC13|29105||11/01/2013|12/31/9999|$84.52|0|0|||APPLY LONG ARM SPLINT|| 58-1699775|1326041732|CHC13|29125||11/01/2013|12/31/9999|$55.45|0|0|||APPLY FOREARM SPLINT|| 58-1699775|1326041732|CHC13|29126||11/01/2013|12/31/9999|$69.26|0|0|||APPLY FOREARM SPLINT|| 58-1699775|1326041732|CHC13|29130||11/01/2013|12/31/9999|$40.77|0|0|||APPLICATION OF FINGER SPLINT|| 58-1699775|1326041732|CHC13|29131||11/01/2013|12/31/9999|$48.38|0|0|||APPLICATION OF FINGER SPLINT|| 58-1699775|1326041732|CHC13|29200||11/01/2013|12/31/9999|$56.19|0|0|||STRAPPING OF CHEST|| 58-1699775|1326041732|CHC13|29240||11/01/2013|12/31/9999|$61.54|0|0|||STRAPPING OF SHOULDER|| 58-1699775|1326041732|CHC13|29260||11/01/2013|12/31/9999|$52.92|0|0|||STRAPPING OF ELBOW OR WRIST|| 58-1699775|1326041732|CHC13|29280||11/01/2013|12/31/9999|$50.86|0|0|||STRAPPING OF HAND OR FINGER|| 58-1699775|1326041732|CHC13|29305||11/01/2013|12/31/9999|$224.82|0|0|||APPLICATION OF HIP CAST|| 58-1699775|1326041732|CHC13|29325||11/01/2013|12/31/9999|$253.02|0|0|||APPLICATION OF HIP CASTS|| 58-1699775|1326041732|CHC13|29345||11/01/2013|12/31/9999|$144.33|0|0|||APPLICATION OF LONG LEG CAST|| 58-1699775|1326041732|CHC13|29355||11/01/2013|12/31/9999|$153.75|0|0|||APPLICATION OF LONG LEG CAST|| 58-1699775|1326041732|CHC13|29358||11/01/2013|12/31/9999|$147.73|0|0|||APPLY LONG LEG CAST BRACE|| 58-1699775|1326041732|CHC13|29365||11/01/2013|12/31/9999|$125.25|0|0|||APPLICATION OF LONG LEG CAST|| 58-1699775|1326041732|CHC13|29405||11/01/2013|12/31/9999|$85.03|0|0|||APPLY SHORT LEG CAST|| 58-1699775|1326041732|CHC13|29425||11/01/2013|12/31/9999|$81.80|0|0|||APPLY SHORT LEG CAST|| 58-1699775|1326041732|CHC13|29435||11/01/2013|12/31/9999|$122.04|0|0|||APPLY SHORT LEG CAST|| 58-1699775|1326041732|CHC13|29440||11/01/2013|12/31/9999|$51.23|0|0|||ADDITION OF WALKER TO CAST|| 58-1699775|1326041732|CHC13|29445||11/01/2013|12/31/9999|$153.14|0|0|||APPLY RIGID LEG CAST|| 58-1699775|1326041732|CHC13|29450||11/01/2013|12/31/9999|$165.68|0|0|||APPLICATION OF LEG CAST|| 58-1699775|1326041732|CHC13|29505||11/01/2013|12/31/9999|$69.33|0|0|||APPLICATION| LONG LEG SPLINT|| 58-1699775|1326041732|CHC13|29515||11/01/2013|12/31/9999|$98.86|0|0|||APPLICATION LOWER LEG SPLINT|| 58-1699775|1326041732|CHC13|29520||11/01/2013|12/31/9999|$51.01|0|0|||STRAPPING OF HIP|| 58-1699775|1326041732|CHC13|29530||11/01/2013|12/31/9999|$53.48|0|0|||STRAPPING OF KNEE|| 58-1699775|1326041732|CHC13|29540||11/01/2013|12/31/9999|$37.38|0|0|||STRAPPING OF ANKLE AND/OR FT|| 58-1699775|1326041732|CHC13|29550||11/01/2013|12/31/9999|$27.91|0|0|||STRAPPING OF TOES|| 58-1699775|1326041732|CHC13|29580||11/01/2013|12/31/9999|$51.11|0|0|||APPLICATION OF PASTE BOOT|| 58-1699775|1326041732|CHC13|29581||11/01/2013|12/31/9999|$18.28|0|0|||APPLY MULTLAY COMPRS LWR LEG|| 58-1699775|1326041732|CHC13|29582||11/01/2013|12/31/9999|$22.47|0|0|||APPLY MULTLAY COMPRS UPR LEG|| 58-1699775|1326041732|CHC13|29583||11/01/2013|12/31/9999|$16.45|0|0|||APPLY MULTLAY COMPRS UPR ARM|| 58-1699775|1326041732|CHC13|29584||11/01/2013|12/31/9999|$22.47|0|0|||APPL MULTLAY COMPRS ARM/HAND|| 58-1699775|1326041732|CHC13|29700||11/01/2013|12/31/9999|$49.43|0|0|||REMOVAL/REVISION OF CAST|| 58-1699775|1326041732|CHC13|29705||11/01/2013|12/31/9999|$67.41|0|0|||REMOVAL/REVISION OF CAST|| 58-1699775|1326041732|CHC13|29710||11/01/2013|12/31/9999|$113.76|0|0|||REMOVAL/REVISION OF CAST|| 58-1699775|1326041732|CHC13|29720||11/01/2013|12/31/9999|$62.41|0|0|||REPAIR OF BODY CAST|| 58-1699775|1326041732|CHC13|29730||11/01/2013|12/31/9999|$64.59|0|0|||WINDOWING OF CAST|| 58-1699775|1326041732|CHC13|29740||11/01/2013|12/31/9999|$93.68|0|0|||WEDGING OF CAST|| 58-1699775|1326041732|CHC13|29750||11/01/2013|12/31/9999|$111.04|0|0|||WEDGING OF CLUBFOOT CAST|| 58-1699775|1326041732|CHC13|29799||11/01/2013|12/31/9999|$0.00|0|0|||CASTING/STRAPPING PROCEDURE|| 58-1699775|1326041732|CHC13|29800||11/01/2013|12/31/9999|$732.72|0|0|||JAW ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29804||11/01/2013|12/31/9999|$923.65|0|0|||JAW ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29805||11/01/2013|12/31/9999|$667.76|0|0|||SHOULDER ARTHROSCOPY| DX|| 58-1699775|1326041732|CHC13|29806||11/01/2013|12/31/9999|$1|516.18|0|0|||SHOULDER ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29807||11/01/2013|12/31/9999|$1|476.43|0|0|||SHOULDER ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29819||11/01/2013|12/31/9999|$832.87|0|0|||SHOULDER ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29820||11/01/2013|12/31/9999|$767.31|0|0|||SHOULDER ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29821||11/01/2013|12/31/9999|$841.23|0|0|||SHOULDER ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29822||11/01/2013|12/31/9999|$817.64|0|0|||SHOULDER ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29823||11/01/2013|12/31/9999|$893.32|0|0|||SHOULDER ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29824||11/01/2013|12/31/9999|$962.32|0|0|||SHOULDER ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29825||11/01/2013|12/31/9999|$832.41|0|0|||SHOULDER ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29826||11/01/2013|12/31/9999|$256.77|0|0|||SHOULDER ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29827||11/01/2013|12/31/9999|$1|540.68|0|0|||ARTHROSCOP ROTATOR CUFF REPR|| 58-1699775|1326041732|CHC13|29828||11/01/2013|12/31/9999|$1|316.37|0|0|||ARTHROSCOPY BICEPS TENODESIS|| 58-1699775|1326041732|CHC13|29830||11/01/2013|12/31/9999|$644.03|0|0|||ELBOW ARTHROSCOPY|| 58-1699775|1326041732|CHC13|29834||11/01/2013|12/31/9999|$699.19|0|0|||ELBOW ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29835||11/01/2013|12/31/9999|$717.76|0|0|||ELBOW ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29836||11/01/2013|12/31/9999|$828.38|0|0|||ELBOW ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29837||11/01/2013|12/31/9999|$752.45|0|0|||ELBOW ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29838||11/01/2013|12/31/9999|$840.18|0|0|||ELBOW ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29840||11/01/2013|12/31/9999|$643.85|0|0|||WRIST ARTHROSCOPY|| 58-1699775|1326041732|CHC13|29843||11/01/2013|12/31/9999|$683.56|0|0|||WRIST ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29844||11/01/2013|12/31/9999|$708.77|0|0|||WRIST ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29845||11/01/2013|12/31/9999|$817.91|0|0|||WRIST ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29846||11/01/2013|12/31/9999|$741.07|0|0|||WRIST ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29847||11/01/2013|12/31/9999|$770.14|0|0|||WRIST ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29848||11/01/2013|12/31/9999|$721.42|0|0|||WRIST ENDOSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29850||11/01/2013|12/31/9999|$797.01|0|0|||KNEE ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29851||11/01/2013|12/31/9999|$1|328.39|0|0|||KNEE ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29855||11/01/2013|12/31/9999|$1|118.84|0|0|||TIBIAL ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29856||11/01/2013|12/31/9999|$1|422.53|0|0|||TIBIAL ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29860||11/01/2013|12/31/9999|$943.19|0|0|||HIP ARTHROSCOPY| DX|| 58-1699775|1326041732|CHC13|29861||11/01/2013|12/31/9999|$1|033.57|0|0|||HIP ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29862||11/01/2013|12/31/9999|$1|163.27|0|0|||HIP ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29863||11/01/2013|12/31/9999|$1|163.28|0|0|||HIP ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29866||11/01/2013|12/31/9999|$1|493.45|0|0|||AUTGRFT IMPLNT| KNEE W/SCOPE|| 58-1699775|1326041732|CHC13|29867||11/01/2013|12/31/9999|$1|820.18|0|0|||ALLGRFT IMPLNT| KNEE W/SCOPE|| 58-1699775|1326041732|CHC13|29868||11/01/2013|12/31/9999|$2|394.51|0|0|||MENISCAL TRNSPL| KNEE W/SCPE|| 58-1699775|1326041732|CHC13|29870||11/01/2013|12/31/9999|$582.90|0|0|||KNEE ARTHROSCOPY| DX|| 58-1699775|1326041732|CHC13|29871||11/01/2013|12/31/9999|$728.24|0|0|||KNEE ARTHROSCOPY/DRAINAGE|| 58-1699775|1326041732|CHC13|29873||11/01/2013|12/31/9999|$737.68|0|0|||KNEE ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29874||11/01/2013|12/31/9999|$764.46|0|0|||KNEE ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29875||11/01/2013|12/31/9999|$703.09|0|0|||KNEE ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29876||11/01/2013|12/31/9999|$932.36|0|0|||KNEE ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29877||11/01/2013|12/31/9999|$884.28|0|0|||KNEE ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29879||11/01/2013|12/31/9999|$942.66|0|0|||KNEE ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29880||11/01/2013|12/31/9999|$813.26|0|0|||KNEE ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29881||11/01/2013|12/31/9999|$779.62|0|0|||KNEE ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29882||11/01/2013|12/31/9999|$994.16|0|0|||KNEE ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29883||11/01/2013|12/31/9999|$1|199.57|0|0|||KNEE ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29884||11/01/2013|12/31/9999|$882.34|0|0|||KNEE ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29885||11/01/2013|12/31/9999|$1|067.20|0|0|||KNEE ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29886||11/01/2013|12/31/9999|$900.92|0|0|||KNEE ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29887||11/01/2013|12/31/9999|$1|062.34|0|0|||KNEE ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29888||11/01/2013|12/31/9999|$1|414.33|0|0|||KNEE ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29889||11/01/2013|12/31/9999|$1|729.49|0|0|||KNEE ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29891||11/01/2013|12/31/9999|$980.40|0|0|||ANKLE ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29892||11/01/2013|12/31/9999|$918.52|0|0|||ANKLE ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29893||11/01/2013|12/31/9999|$607.25|0|0|||SCOPE| PLANTAR FASCIOTOMY|| 58-1699775|1326041732|CHC13|29894||11/01/2013|12/31/9999|$732.92|0|0|||ANKLE ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29895||11/01/2013|12/31/9999|$697.25|0|0|||ANKLE ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29897||11/01/2013|12/31/9999|$737.38|0|0|||ANKLE ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29898||11/01/2013|12/31/9999|$816.91|0|0|||ANKLE ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29899||11/01/2013|12/31/9999|$1|491.28|0|0|||ANKLE ARTHROSCOPY/SURGERY|| 58-1699775|1326041732|CHC13|29900||11/01/2013|12/31/9999|$663.04|0|0|||MCP JOINT ARTHROSCOPY| DX|| 58-1699775|1326041732|CHC13|29901||11/01/2013|12/31/9999|$757.04|0|0|||MCP JOINT ARTHROSCOPY| SURG|| 58-1699775|1326041732|CHC13|29902||11/01/2013|12/31/9999|$847.24|0|0|||MCP JOINT ARTHROSCOPY| SURG|| 58-1699775|1326041732|CHC13|29904||11/01/2013|12/31/9999|$900.88|0|0|||SUBTALAR ARTHRO W/FB RMVL|| 58-1699775|1326041732|CHC13|29905||11/01/2013|12/31/9999|$973.97|0|0|||SUBTALAR ARTHRO W/EXC|| 58-1699775|1326041732|CHC13|29906||11/01/2013|12/31/9999|$1|025.14|0|0|||SUBTALAR ARTHRO W/DEB|| 58-1699775|1326041732|CHC13|29907||11/01/2013|12/31/9999|$1|241.29|0|0|||SUBTALAR ARTHRO W/FUSION|| 58-1699775|1326041732|CHC13|29914||11/01/2013|12/31/9999|$1|459.52|0|0|||HIP ARTHRO W/FEMOROPLASTY|| 58-1699775|1326041732|CHC13|29915||11/01/2013|12/31/9999|$1|486.98|0|0|||HIP ARTHRO ACETABULOPLASTY|| 58-1699775|1326041732|CHC13|29916||11/01/2013|12/31/9999|$1|486.98|0|0|||HIP ARTHRO W/LABRAL REPAIR|| 58-1699775|1326041732|CHC13|29999||11/01/2013|12/31/9999|$0.00|0|0|||ARTHROSCOPY OF JOINT|| 58-1699775|1326041732|CHC13|30000||11/01/2013|12/31/9999|$171.27|0|0|||DRAINAGE OF NOSE LESION|| 58-1699775|1326041732|CHC13|30020||11/01/2013|12/31/9999|$171.23|0|0|||DRAINAGE OF NOSE LESION|| 58-1699775|1326041732|CHC13|3006F||11/01/2013|12/31/9999|$0.00|0|0|||CXR DOC REV|| 58-1699775|1326041732|CHC13|3008F||11/01/2013|12/31/9999|$0.00|0|0|||BODY MASS INDEX DOCD|| 58-1699775|1326041732|CHC13|30100||11/01/2013|12/31/9999|$99.51|0|0|||INTRANASAL BIOPSY|| 58-1699775|1326041732|CHC13|30110||11/01/2013|12/31/9999|$187.91|0|0|||REMOVAL OF NOSE POLYP(S)|| 58-1699775|1326041732|CHC13|30115||11/01/2013|12/31/9999|$614.97|0|0|||REMOVAL OF NOSE POLYP(S)|| 58-1699775|1326041732|CHC13|30117||11/01/2013|12/31/9999|$480.68|0|0|||REMOVAL OF INTRANASAL LESION|| 58-1699775|1326041732|CHC13|30118||11/01/2013|12/31/9999|$1|102.68|0|0|||REMOVAL OF INTRANASAL LESION|| 58-1699775|1326041732|CHC13|3011F||11/01/2013|12/31/9999|$0.00|0|0|||LIPID PANEL DOC REV|| 58-1699775|1326041732|CHC13|30120||11/01/2013|12/31/9999|$630.89|0|0|||REVISION OF NOSE|| 58-1699775|1326041732|CHC13|30124||11/01/2013|12/31/9999|$404.71|0|0|||REMOVAL OF NOSE LESION|| 58-1699775|1326041732|CHC13|30125||11/01/2013|12/31/9999|$874.34|0|0|||REMOVAL OF NOSE LESION|| 58-1699775|1326041732|CHC13|30130||11/01/2013|12/31/9999|$540.04|0|0|||EXCISE INFERIOR TURBINATE|| 58-1699775|1326041732|CHC13|30140||11/01/2013|12/31/9999|$623.57|0|0|||RESECT INFERIOR TURBINATE|| 58-1699775|1326041732|CHC13|3014F||11/01/2013|12/31/9999|$0.00|0|0|||SCREEN MAMMO DOC REV|| 58-1699775|1326041732|CHC13|30150||11/01/2013|12/31/9999|$1|110.10|0|0|||PARTIAL REMOVAL OF NOSE|| 58-1699775|1326041732|CHC13|3015F||11/01/2013|12/31/9999|$0.00|0|0|||CERV CANCER SCREEN DOCD|| 58-1699775|1326041732|CHC13|30160||11/01/2013|12/31/9999|$1|117.22|0|0|||REMOVAL OF NOSE|| 58-1699775|1326041732|CHC13|3016F||11/01/2013|12/31/9999|$0.00|0|0|||PT SCRND UNHLTHY OH USE|| 58-1699775|1326041732|CHC13|3017F||11/01/2013|12/31/9999|$0.00|0|0|||COLORECTAL CA SCREEN DOC REV|| 58-1699775|1326041732|CHC13|3018F||11/01/2013|12/31/9999|$0.00|0|0|||PRE-PRXD RSK ET AL DOCD|| 58-1699775|1326041732|CHC13|3019F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|30200||11/01/2013|12/31/9999|$86.28|0|0|||INJECTION TREATMENT OF NOSE|| 58-1699775|1326041732|CHC13|3020F||11/01/2013|12/31/9999|$0.00|0|0|||LVF ASSESS|| 58-1699775|1326041732|CHC13|30210||11/01/2013|12/31/9999|$142.73|0|0|||NASAL SINUS THERAPY|| 58-1699775|1326041732|CHC13|3021F||11/01/2013|12/31/9999|$0.00|0|0|||LVEF MOD/SEVER DEPRS SYST|| 58-1699775|1326041732|CHC13|30220||11/01/2013|12/31/9999|$181.01|0|0|||INSERT NASAL SEPTAL BUTTON|| 58-1699775|1326041732|CHC13|3022F||11/01/2013|12/31/9999|$0.00|0|0|||LVEF =40% SYSTOLIC|| 58-1699775|1326041732|CHC13|3023F||11/01/2013|12/31/9999|$0.00|0|0|||SPIROM DOC REV|| 58-1699775|1326041732|CHC13|3025F||11/01/2013|12/31/9999|$0.00|0|0|||SPIROM FEV/FVC<70% W COPD|| 58-1699775|1326041732|CHC13|3027F||11/01/2013|12/31/9999|$0.00|0|0|||SPIROM FEV/FVC=70%/ W/O COPD|| 58-1699775|1326041732|CHC13|3028F||11/01/2013|12/31/9999|$0.00|0|0|||O2 SATURATION DOC REV|| 58-1699775|1326041732|CHC13|30300||11/01/2013|12/31/9999|$178.74|0|0|||REMOVE NASAL FOREIGN BODY|| 58-1699775|1326041732|CHC13|30310||11/01/2013|12/31/9999|$294.21|0|0|||REMOVE NASAL FOREIGN BODY|| 58-1699775|1326041732|CHC13|30320||11/01/2013|12/31/9999|$645.87|0|0|||REMOVE NASAL FOREIGN BODY|| 58-1699775|1326041732|CHC13|3035F||11/01/2013|12/31/9999|$0.00|0|0|||O2 SATURATION =88% /PA0 =55|| 58-1699775|1326041732|CHC13|3037F||11/01/2013|12/31/9999|$0.00|0|0|||O2 SATURATION> 88% /PAO>55|| 58-1699775|1326041732|CHC13|3038F||11/01/2013|12/31/9999|$0.00|0|0|||PULM FX W/IN 12 MON B/4 SURG|| 58-1699775|1326041732|CHC13|30400||11/01/2013|12/31/9999|$1|452.94|0|0|||RECONSTRUCTION OF NOSE|| 58-1699775|1326041732|CHC13|3040F||11/01/2013|12/31/9999|$0.00|0|0|||FEV<40% PREDICTED VALUE|| 58-1699775|1326041732|CHC13|30410||11/01/2013|12/31/9999|$1|833.50|0|0|||RECONSTRUCTION OF NOSE|| 58-1699775|1326041732|CHC13|30420||11/01/2013|12/31/9999|$1|968.27|0|0|||RECONSTRUCTION OF NOSE|| 58-1699775|1326041732|CHC13|3042F||11/01/2013|12/31/9999|$0.00|0|0|||FEV= 40% PREDICTED VALUE|| 58-1699775|1326041732|CHC13|30430||11/01/2013|12/31/9999|$1|325.49|0|0|||REVISION OF NOSE|| 58-1699775|1326041732|CHC13|30435||11/01/2013|12/31/9999|$1|621.23|0|0|||REVISION OF NOSE|| 58-1699775|1326041732|CHC13|3044F||11/01/2013|12/31/9999|$0.00|0|0|||HG A1C LEVEL < 7.0%|| 58-1699775|1326041732|CHC13|30450||11/01/2013|12/31/9999|$2|176.77|0|0|||REVISION OF NOSE|| 58-1699775|1326041732|CHC13|3045F||11/01/2013|12/31/9999|$0.00|0|0|||HG A1C LEVEL 7.0-9.0%|| 58-1699775|1326041732|CHC13|30460||11/01/2013|12/31/9999|$1|091.63|0|0|||REVISION OF NOSE|| 58-1699775|1326041732|CHC13|30462||11/01/2013|12/31/9999|$2|255.62|0|0|||REVISION OF NOSE|| 58-1699775|1326041732|CHC13|30465||11/01/2013|12/31/9999|$1|410.86|0|0|||REPAIR NASAL STENOSIS|| 58-1699775|1326041732|CHC13|3046F||11/01/2013|12/31/9999|$0.00|0|0|||HEMOGLOBIN A1C LEVEL > 9.0%|| 58-1699775|1326041732|CHC13|3048F||11/01/2013|12/31/9999|$0.00|0|0|||LDL-C <100 MG/DL|| 58-1699775|1326041732|CHC13|3049F||11/01/2013|12/31/9999|$0.00|0|0|||LDL-C 100-129 MG/DL|| 58-1699775|1326041732|CHC13|3050F||11/01/2013|12/31/9999|$0.00|0|0|||LDL-C = 130 MG/DL|| 58-1699775|1326041732|CHC13|30520||11/01/2013|12/31/9999|$888.84|0|0|||REPAIR OF NASAL SEPTUM|| 58-1699775|1326041732|CHC13|30540||11/01/2013|12/31/9999|$979.95|0|0|||REPAIR NASAL DEFECT|| 58-1699775|1326041732|CHC13|30545||11/01/2013|12/31/9999|$1|321.23|0|0|||REPAIR NASAL DEFECT|| 58-1699775|1326041732|CHC13|3055F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|30560||11/01/2013|12/31/9999|$197.83|0|0|||RELEASE OF NASAL ADHESIONS|| 58-1699775|1326041732|CHC13|3056F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|30580||11/01/2013|12/31/9999|$712.97|0|0|||REPAIR UPPER JAW FISTULA|| 58-1699775|1326041732|CHC13|30600||11/01/2013|12/31/9999|$621.05|0|0|||REPAIR MOUTH/NOSE FISTULA|| 58-1699775|1326041732|CHC13|3060F||11/01/2013|12/31/9999|$0.00|0|0|||POS MICROALBUMINURIA REV|| 58-1699775|1326041732|CHC13|3061F||11/01/2013|12/31/9999|$0.00|0|0|||NEG MICROALBUMINURIA REV|| 58-1699775|1326041732|CHC13|30620||11/01/2013|12/31/9999|$887.59|0|0|||INTRANASAL RECONSTRUCTION|| 58-1699775|1326041732|CHC13|3062F||11/01/2013|12/31/9999|$0.00|0|0|||POS MACROALBUMINURIA REV|| 58-1699775|1326041732|CHC13|30630||11/01/2013|12/31/9999|$895.48|0|0|||REPAIR NASAL SEPTUM DEFECT|| 58-1699775|1326041732|CHC13|3066F||11/01/2013|12/31/9999|$0.00|0|0|||NEPHROPATHY DOC TX|| 58-1699775|1326041732|CHC13|3072F||11/01/2013|12/31/9999|$0.00|0|0|||LOW RISK FOR RETINOPATHY|| 58-1699775|1326041732|CHC13|3073F||11/01/2013|12/31/9999|$0.00|0|0|||PRE-SURG EYE MEASURES DOC'D|| 58-1699775|1326041732|CHC13|3074F||11/01/2013|12/31/9999|$0.00|0|0|||SYST BP < 130 MM HG|| 58-1699775|1326041732|CHC13|3075F||11/01/2013|12/31/9999|$0.00|0|0|||SYST BP >= 130 - 139MM HG|| 58-1699775|1326041732|CHC13|3077F||11/01/2013|12/31/9999|$0.00|0|0|||SYST BP = 140 MM HG6 IT|| 58-1699775|1326041732|CHC13|3078F||11/01/2013|12/31/9999|$0.00|0|0|||DIAST BP < 80 MM HG|| 58-1699775|1326041732|CHC13|3079F||11/01/2013|12/31/9999|$0.00|0|0|||DIAST BP 80-89 MM HG|| 58-1699775|1326041732|CHC13|30801||11/01/2013|12/31/9999|$193.67|0|0|||ABLATE INF TURBINATE| SUPERF|| 58-1699775|1326041732|CHC13|30802||11/01/2013|12/31/9999|$272.12|0|0|||CAUTERIZATION| INNER NOSE|| 58-1699775|1326041732|CHC13|3080F||11/01/2013|12/31/9999|$0.00|0|0|||DIAST BP = 90 MM HG|| 58-1699775|1326041732|CHC13|3082F||11/01/2013|12/31/9999|$0.00|0|0|||KT/V <1.2|| 58-1699775|1326041732|CHC13|3083F||11/01/2013|12/31/9999|$0.00|0|0|||KT/V >= 1.2 AND <1.7|| 58-1699775|1326041732|CHC13|3084F||11/01/2013|12/31/9999|$0.00|0|0|||KT/V >= 1.7|| 58-1699775|1326041732|CHC13|3085F||11/01/2013|12/31/9999|$0.00|0|0|||SUICIDE RISK ASSESSED|| 58-1699775|1326041732|CHC13|3088F||11/01/2013|12/31/9999|$0.00|0|0|||MDD| MILD|| 58-1699775|1326041732|CHC13|3089F||11/01/2013|12/31/9999|$0.00|0|0|||MDD| MODERATE|| 58-1699775|1326041732|CHC13|30901||11/01/2013|12/31/9999|$83.00|0|0|||CONTROL OF NOSEBLEED|| 58-1699775|1326041732|CHC13|30903||11/01/2013|12/31/9999|$117.49|0|0|||CONTROL OF NOSEBLEED|| 58-1699775|1326041732|CHC13|30905||11/01/2013|12/31/9999|$148.72|0|0|||CONTROL OF NOSEBLEED|| 58-1699775|1326041732|CHC13|30906||11/01/2013|12/31/9999|$193.45|0|0|||REPEAT CONTROL OF NOSEBLEED|| 58-1699775|1326041732|CHC13|3090F||11/01/2013|12/31/9999|$0.00|0|0|||MDD| SEVERE; W/O PSYCH|| 58-1699775|1326041732|CHC13|30915||11/01/2013|12/31/9999|$829.78|0|0|||LIGATION| NASAL SINUS ARTERY|| 58-1699775|1326041732|CHC13|3091F||11/01/2013|12/31/9999|$0.00|0|0|||MDD| SEVERE; W/ PSYCH|| 58-1699775|1326041732|CHC13|30920||11/01/2013|12/31/9999|$1|200.05|0|0|||LIGATION| UPPER JAW ARTERY|| 58-1699775|1326041732|CHC13|3092F||11/01/2013|12/31/9999|$0.00|0|0|||MDD| IN REMISSION|| 58-1699775|1326041732|CHC13|30930||11/01/2013|12/31/9999|$176.74|0|0|||THER FX| NASAL INF TURBINATE|| 58-1699775|1326041732|CHC13|3093F||11/01/2013|12/31/9999|$0.00|0|0|||DOC NEW DIAG 1ST/ADDL. MDD|| 58-1699775|1326041732|CHC13|3095F||11/01/2013|12/31/9999|$0.00|0|0|||CENTRAL DEXA RESULTS DOC'D|| 58-1699775|1326041732|CHC13|3096F||11/01/2013|12/31/9999|$0.00|0|0|||CENTRAL DEXA ORDERED|| 58-1699775|1326041732|CHC13|30999||11/01/2013|12/31/9999|$0.00|0|0|||NASAL SURGERY PROCEDURE|| 58-1699775|1326041732|CHC13|31000||11/01/2013|12/31/9999|$149.05|0|0|||IRRIGATION| MAXILLARY SINUS|| 58-1699775|1326041732|CHC13|31002||11/01/2013|12/31/9999|$285.24|0|0|||IRRIGATION| SPHENOID SINUS|| 58-1699775|1326041732|CHC13|3100F||11/01/2013|12/31/9999|$0.00|0|0|||CAROT BLK DOC'D W/ CAROT REF|| 58-1699775|1326041732|CHC13|31020||11/01/2013|12/31/9999|$507.17|0|0|||EXPLORATION| MAXILLARY SINUS|| 58-1699775|1326041732|CHC13|31030||11/01/2013|12/31/9999|$743.56|0|0|||EXPLORATION| MAXILLARY SINUS|| 58-1699775|1326041732|CHC13|31032||11/01/2013|12/31/9999|$817.43|0|0|||EXPLORE SINUS| REMOVE POLYPS|| 58-1699775|1326041732|CHC13|31040||11/01/2013|12/31/9999|$1|090.11|0|0|||EXPLORATION BEHIND UPPER JAW|| 58-1699775|1326041732|CHC13|31050||11/01/2013|12/31/9999|$694.73|0|0|||EXPLORATION| SPHENOID SINUS|| 58-1699775|1326041732|CHC13|31051||11/01/2013|12/31/9999|$922.19|0|0|||SPHENOID SINUS SURGERY|| 58-1699775|1326041732|CHC13|31070||11/01/2013|12/31/9999|$625.81|0|0|||EXPLORATION OF FRONTAL SINUS|| 58-1699775|1326041732|CHC13|31075||11/01/2013|12/31/9999|$1|121.50|0|0|||EXPLORATION OF FRONTAL SINUS|| 58-1699775|1326041732|CHC13|31080||11/01/2013|12/31/9999|$1|470.90|0|0|||REMOVAL OF FRONTAL SINUS|| 58-1699775|1326041732|CHC13|31081||11/01/2013|12/31/9999|$2|058.69|0|0|||REMOVAL OF FRONTAL SINUS|| 58-1699775|1326041732|CHC13|31084||11/01/2013|12/31/9999|$1|666.24|0|0|||REMOVAL OF FRONTAL SINUS|| 58-1699775|1326041732|CHC13|31085||11/01/2013|12/31/9999|$1|898.33|0|0|||REMOVAL OF FRONTAL SINUS|| 58-1699775|1326041732|CHC13|31086||11/01/2013|12/31/9999|$1|609.42|0|0|||REMOVAL OF FRONTAL SINUS|| 58-1699775|1326041732|CHC13|31087||11/01/2013|12/31/9999|$1|559.64|0|0|||REMOVAL OF FRONTAL SINUS|| 58-1699775|1326041732|CHC13|31090||11/01/2013|12/31/9999|$1|455.14|0|0|||EXPLORATION OF SINUSES|| 58-1699775|1326041732|CHC13|3110F||11/01/2013|12/31/9999|$0.00|0|0|||PRES/ABSN HMRHG/LESION DOC'D|| 58-1699775|1326041732|CHC13|3111F||11/01/2013|12/31/9999|$0.00|0|0|||CT/MRI BRAIN DONE W/IN 24 HRS|| 58-1699775|1326041732|CHC13|3112F||11/01/2013|12/31/9999|$0.00|0|0|||CT/MRI BRAIN DONE > 24 HRS|| 58-1699775|1326041732|CHC13|3115F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|3117F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|3118F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|3119F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|31200||11/01/2013|12/31/9999|$786.22|0|0|||REMOVAL OF ETHMOID SINUS|| 58-1699775|1326041732|CHC13|31201||11/01/2013|12/31/9999|$1|056.12|0|0|||REMOVAL OF ETHMOID SINUS|| 58-1699775|1326041732|CHC13|31205||11/01/2013|12/31/9999|$1|267.48|0|0|||REMOVAL OF ETHMOID SINUS|| 58-1699775|1326041732|CHC13|3120F||11/01/2013|12/31/9999|$0.00|0|0|||12-LEAD ECG PERFORMED|| 58-1699775|1326041732|CHC13|31225||11/01/2013|12/31/9999|$2|683.12|0|0|||REMOVAL OF UPPER JAW|| 58-1699775|1326041732|CHC13|31230||11/01/2013|12/31/9999|$2|993.60|0|0|||REMOVAL OF UPPER JAW|| 58-1699775|1326041732|CHC13|31231||11/01/2013|12/31/9999|$271.38|0|0|||NASAL ENDOSCOPY| DX|| 58-1699775|1326041732|CHC13|31233||11/01/2013|12/31/9999|$200.24|0|0|||NASAL/SINUS ENDOSCOPY| DX|| 58-1699775|1326041732|CHC13|31235||11/01/2013|12/31/9999|$235.70|0|0|||NASAL/SINUS ENDOSCOPY| DX|| 58-1699775|1326041732|CHC13|31237||11/01/2013|12/31/9999|$264.60|0|0|||NASAL/SINUS ENDOSCOPY| SURG|| 58-1699775|1326041732|CHC13|31238||11/01/2013|12/31/9999|$287.20|0|0|||NASAL/SINUS ENDOSCOPY| SURG|| 58-1699775|1326041732|CHC13|31239||11/01/2013|12/31/9999|$976.63|0|0|||NASAL/SINUS ENDOSCOPY| SURG|| 58-1699775|1326041732|CHC13|31240||11/01/2013|12/31/9999|$235.10|0|0|||NASAL/SINUS ENDOSCOPY| SURG|| 58-1699775|1326041732|CHC13|31241||04/01/2018|12/31/9999|$677.93|0|0|0||NSL/SINS NDSC W/ARTERY LIG|| 58-1699775|1326041732|CHC13|31253||04/01/2018|12/31/9999|$759.38|0|0|0||NSL/SINS NDSC TOTAL|| 58-1699775|1326041732|CHC13|31254||11/01/2013|12/31/9999|$400.12|0|0|||REVISION OF ETHMOID SINUS|| 58-1699775|1326041732|CHC13|31255||11/01/2013|12/31/9999|$586.81|0|0|||REMOVAL OF ETHMOID SINUS|| 58-1699775|1326041732|CHC13|31256||11/01/2013|12/31/9999|$289.19|0|0|||EXPLORATION MAXILLARY SINUS|| 58-1699775|1326041732|CHC13|31257||04/01/2018|12/31/9999|$675.72|0|0|0||NSL/SINS NDSC TOT W/SPHENDT|| 58-1699775|1326041732|CHC13|31259||04/01/2018|12/31/9999|$716.47|0|0|0||NSL/SINS NDSC SPHN TISS RMVL|| 58-1699775|1326041732|CHC13|31267||11/01/2013|12/31/9999|$465.00|0|0|||ENDOSCOPY| MAXILLARY SINUS|| 58-1699775|1326041732|CHC13|3126F||04/01/2015|12/31/9999|$0.00|0|0|0|||| 58-1699775|1326041732|CHC13|31276||11/01/2013|12/31/9999|$741.01|0|0|||SINUS ENDOSCOPY| SURGICAL|| 58-1699775|1326041732|CHC13|31287||11/01/2013|12/31/9999|$340.23|0|0|||NASAL/SINUS ENDOSCOPY| SURG|| 58-1699775|1326041732|CHC13|31288||11/01/2013|12/31/9999|$394.72|0|0|||NASAL/SINUS ENDOSCOPY| SURG|| 58-1699775|1326041732|CHC13|31290||11/01/2013|12/31/9999|$1|687.32|0|0|||NASAL/SINUS ENDOSCOPY| SURG|| 58-1699775|1326041732|CHC13|31291||11/01/2013|12/31/9999|$1|792.53|0|0|||NASAL/SINUS ENDOSCOPY| SURG|| 58-1699775|1326041732|CHC13|31292||11/01/2013|12/31/9999|$1|457.26|0|0|||NASAL/SINUS ENDOSCOPY| SURG|| 58-1699775|1326041732|CHC13|31293||11/01/2013|12/31/9999|$1|582.18|0|0|||NASAL/SINUS ENDOSCOPY| SURG|| 58-1699775|1326041732|CHC13|31294||11/01/2013|12/31/9999|$1|813.50|0|0|||NASAL/SINUS ENDOSCOPY| SURG|| 58-1699775|1326041732|CHC13|31295||05/14/2015|12/31/9999|$1|950.96|0|0|||SINUS ENDO W/BALLOON DIL|| 58-1699775|1326041732|CHC13|31296||05/14/2015|12/31/9999|$1|979.37|0|0|||SINUS ENDO W/BALLOON DIL|| 58-1699775|1326041732|CHC13|31297||05/14/2015|12/31/9999|$1|944.33|0|0|||SINUS ENDO W/BALLOON DIL|| 58-1699775|1326041732|CHC13|31298||04/01/2018|12/31/9999|$386.39|0|0|0||NSL/SINS NDSC W/SINS DILAT|| 58-1699775|1326041732|CHC13|31299||11/01/2013|12/31/9999|$0.00|0|0|||SINUS SURGERY PROCEDURE|| 58-1699775|1326041732|CHC13|31300||11/01/2013|12/31/9999|$1|814.92|0|0|||REMOVAL OF LARYNX LESION|| 58-1699775|1326041732|CHC13|3130F||11/01/2013|12/31/9999|$0.00|0|0|||UPPER GI ENDOSCOPY PERFORMED|| 58-1699775|1326041732|CHC13|31320||11/01/2013|12/31/9999|$935.08|0|0|||DIAGNOSTIC INCISION| LARYNX|| 58-1699775|1326041732|CHC13|3132F||11/01/2013|12/31/9999|$0.00|0|0|||DOC REF. UPPER GI ENDOSCOPY|| 58-1699775|1326041732|CHC13|31360||11/01/2013|12/31/9999|$2|991.55|0|0|||REMOVAL OF LARYNX|| 58-1699775|1326041732|CHC13|31365||11/01/2013|12/31/9999|$3|707.23|0|0|||REMOVAL OF LARYNX|| 58-1699775|1326041732|CHC13|31367||11/01/2013|12/31/9999|$3|173.87|0|0|||PARTIAL REMOVAL OF LARYNX|| 58-1699775|1326041732|CHC13|31368||11/01/2013|12/31/9999|$3|521.17|0|0|||PARTIAL REMOVAL OF LARYNX|| 58-1699775|1326041732|CHC13|31370||11/01/2013|12/31/9999|$2|978.78|0|0|||PARTIAL REMOVAL OF LARYNX|| 58-1699775|1326041732|CHC13|31375||11/01/2013|12/31/9999|$2|825.81|0|0|||PARTIAL REMOVAL OF LARYNX|| 58-1699775|1326041732|CHC13|31380||11/01/2013|12/31/9999|$2|784.13|0|0|||PARTIAL REMOVAL OF LARYNX|| 58-1699775|1326041732|CHC13|31382||11/01/2013|12/31/9999|$3|056.66|0|0|||PARTIAL REMOVAL OF LARYNX|| 58-1699775|1326041732|CHC13|31390||11/01/2013|12/31/9999|$4|130.67|0|0|||REMOVAL OF LARYNX & PHARYNX|| 58-1699775|1326041732|CHC13|31395||11/01/2013|12/31/9999|$4|334.22|0|0|||RECONSTRUCT LARYNX & PHARYNX|| 58-1699775|1326041732|CHC13|31400||11/01/2013|12/31/9999|$1|436.33|0|0|||REVISION OF LARYNX|| 58-1699775|1326041732|CHC13|3140F||11/01/2013|12/31/9999|$0.00|0|0|||FORCEPS ESOPH BIOPSY DONE|| 58-1699775|1326041732|CHC13|3141F||11/01/2013|12/31/9999|$0.00|0|0|||UPPER GI ENDO SHOWS BARRTT'S|| 58-1699775|1326041732|CHC13|31420||11/01/2013|12/31/9999|$1|206.16|0|0|||REMOVAL OF EPIGLOTTIS|| 58-1699775|1326041732|CHC13|3142F||11/01/2013|12/31/9999|$0.00|0|0|||UPPER GI ENDO NOT BARRTT'S|| 58-1699775|1326041732|CHC13|31500||11/01/2013|12/31/9999|$161.16|0|0|||INSERT EMERGENCY AIRWAY|| 58-1699775|1326041732|CHC13|31502||11/01/2013|12/31/9999|$50.72|0|0|||CHANGE OF WINDPIPE AIRWAY|| 58-1699775|1326041732|CHC13|31505||11/01/2013|12/31/9999|$70.68|0|0|||DIAGNOSTIC LARYNGOSCOPY|| 58-1699775|1326041732|CHC13|3150F||11/01/2013|12/31/9999|$0.00|0|0|||FORCEPS ESOPH BIOPSY DONE|| 58-1699775|1326041732|CHC13|31510||11/01/2013|12/31/9999|$176.83|0|0|||LARYNGOSCOPY WITH BIOPSY|| 58-1699775|1326041732|CHC13|31511||11/01/2013|12/31/9999|$189.16|0|0|||REMOVE FOREIGN BODY| LARYNX|| 58-1699775|1326041732|CHC13|31512||11/01/2013|12/31/9999|$190.92|0|0|||REMOVAL OF LARYNX LESION|| 58-1699775|1326041732|CHC13|31513||11/01/2013|12/31/9999|$193.37|0|0|||INJECTION INTO VOCAL CORD|| 58-1699775|1326041732|CHC13|31515||11/01/2013|12/31/9999|$161.04|0|0|||LARYNGOSCOPY FOR ASPIRATION|| 58-1699775|1326041732|CHC13|31520||11/01/2013|12/31/9999|$229.33|0|0|||DX LARYNGOSCOPY| NEWBORN|| 58-1699775|1326041732|CHC13|31525||11/01/2013|12/31/9999|$233.83|0|0|||DX LARYNGOSCOPY EXCL NB|| 58-1699775|1326041732|CHC13|31526||11/01/2013|12/31/9999|$231.21|0|0|||DX LARYNGOSCOPY W/OPER SCOPE|| 58-1699775|1326041732|CHC13|31527||11/01/2013|12/31/9999|$286.33|0|0|||LARYNGOSCOPY FOR TREATMENT|| 58-1699775|1326041732|CHC13|31528||11/01/2013|12/31/9999|$212.72|0|0|||LARYNGOSCOPY AND DILATION|| 58-1699775|1326041732|CHC13|31529||11/01/2013|12/31/9999|$237.76|0|0|||LARYNGOSCOPY AND DILATION|| 58-1699775|1326041732|CHC13|31530||11/01/2013|12/31/9999|$291.53|0|0|||LARYNGOSCOPY W/FB REMOVAL|| 58-1699775|1326041732|CHC13|31531||11/01/2013|12/31/9999|$312.76|0|0|||LARYNGOSCOPY W/FB & OP SCOPE|| 58-1699775|1326041732|CHC13|31535||11/01/2013|12/31/9999|$278.88|0|0|||LARYNGOSCOPY W/BIOPSY|| 58-1699775|1326041732|CHC13|31536||11/01/2013|12/31/9999|$310.77|0|0|||LARYNGOSCOPY W/BX & OP SCOPE|| 58-1699775|1326041732|CHC13|31540||11/01/2013|12/31/9999|$356.96|0|0|||LARYNGOSCOPY W/EXC OF TUMOR|| 58-1699775|1326041732|CHC13|31541||11/01/2013|12/31/9999|$390.31|0|0|||LARYNSCOP W/TUMR EXC + SCOPE|| 58-1699775|1326041732|CHC13|31545||11/01/2013|12/31/9999|$534.70|0|0|||REMOVE VC LESION W/SCOPE|| 58-1699775|1326041732|CHC13|31546||11/01/2013|12/31/9999|$811.84|0|0|||REMOVE VC LESION SCOPE/GRAFT|| 58-1699775|1326041732|CHC13|31551||04/01/2017|12/31/9999|$2|193.16|0|2193.16|0||LARYNGOPLASTY LARYNGEAL STEN|| 58-1699775|1326041732|CHC13|31552||04/01/2017|12/31/9999|$2|217.38|0|2217.38|0||LARYNGOPLASTY LARYNGEAL STEN|| 58-1699775|1326041732|CHC13|31553||04/01/2017|12/31/9999|$2|417.64|0|2417.64|0||LARYNGOPLASTY LARYNGEAL STEN|| 58-1699775|1326041732|CHC13|31554||04/01/2017|12/31/9999|$2|545.76|0|2545.76|0||LARYNGOPLASTY LARYNGEAL STEN|| 58-1699775|1326041732|CHC13|3155F||11/01/2013|12/31/9999|$0.00|0|0|||CYTOGEN TEST MARROW B/4 TX|| 58-1699775|1326041732|CHC13|31560||11/01/2013|12/31/9999|$462.71|0|0|||LARYNGOSCOP W/ARYTENOIDECTOM|| 58-1699775|1326041732|CHC13|31561||11/01/2013|12/31/9999|$505.52|0|0|||LARYNSCOP| REMVE CART + SCOP|| 58-1699775|1326041732|CHC13|31570||11/01/2013|12/31/9999|$336.35|0|0|||LARYNGOSCOPE W/VC INJ|| 58-1699775|1326041732|CHC13|31571||11/01/2013|12/31/9999|$367.79|0|0|||LARYNGOSCOP W/VC INJ + SCOPE|| 58-1699775|1326041732|CHC13|31572||04/01/2017|12/31/9999|$761.74|0|280.47|0||LARGSC W/LASER DSTRJ LES|| 58-1699775|1326041732|CHC13|31573||04/01/2017|12/31/9999|$405.36|0|231.48|0||LARGSC W/THER INJECTION|| 58-1699775|1326041732|CHC13|31574||04/01/2017|12/31/9999|$1|569.77|0|231.48|0||LARGSC W/NJX AUGMENTATION|| 58-1699775|1326041732|CHC13|31575||11/01/2013|12/31/9999|$110.45|0|0|||DIAGNOSTIC LARYNGOSCOPY|| 58-1699775|1326041732|CHC13|31576||11/01/2013|12/31/9999|$180.27|0|0|||LARYNGOSCOPY WITH BIOPSY|| 58-1699775|1326041732|CHC13|31577||11/01/2013|12/31/9999|$217.40|0|0|||REMOVE FOREIGN BODY| LARYNX|| 58-1699775|1326041732|CHC13|31578||11/01/2013|12/31/9999|$250.99|0|0|||REMOVAL OF LARYNX LESION|| 58-1699775|1326041732|CHC13|31579||11/01/2013|12/31/9999|$206.63|0|0|||DIAGNOSTIC LARYNGOSCOPY|| 58-1699775|1326041732|CHC13|31580||11/01/2013|12/31/9999|$1|753.16|0|0|||REVISION OF LARYNX|| 58-1699775|1326041732|CHC13|31584||11/01/2013|12/31/9999|$2|179.78|0|0|||TREAT LARYNX FRACTURE|| 58-1699775|1326041732|CHC13|31587||11/01/2013|12/31/9999|$1|449.72|0|0|||REVISION OF LARYNX|| 58-1699775|1326041732|CHC13|31590||11/01/2013|12/31/9999|$1|275.31|0|0|||REINNERVATE LARYNX|| 58-1699775|1326041732|CHC13|31591||04/01/2017|12/31/9999|$1|606.92|0|1606.92|0||LARYNGOPLASTY MEDIALIZATION|| 58-1699775|1326041732|CHC13|31592||04/01/2017|12/31/9999|$2|600.14|0|2600.14|0||CRICOTRACHEAL RESECTION|| 58-1699775|1326041732|CHC13|31595||11/01/2013|12/31/9999|$1|100.01|0|0|||LARYNX NERVE SURGERY|| 58-1699775|1326041732|CHC13|31599||11/01/2013|12/31/9999|$0.00|0|0|||LARYNX SURGERY PROCEDURE|| 58-1699775|1326041732|CHC13|31600||11/01/2013|12/31/9999|$580.76|0|0|||INCISION OF WINDPIPE|| 58-1699775|1326041732|CHC13|31601||11/01/2013|12/31/9999|$380.68|0|0|||INCISION OF WINDPIPE|| 58-1699775|1326041732|CHC13|31603||11/01/2013|12/31/9999|$326.59|0|0|||INCISION OF WINDPIPE|| 58-1699775|1326041732|CHC13|31605||11/01/2013|12/31/9999|$267.14|0|0|||INCISION OF WINDPIPE|| 58-1699775|1326041732|CHC13|3160F||11/01/2013|12/31/9999|$0.00|0|0|||DOC FE+ STORES B/4 EPO THX|| 58-1699775|1326041732|CHC13|31610||11/01/2013|12/31/9999|$1|028.36|0|0|||INCISION OF WINDPIPE|| 58-1699775|1326041732|CHC13|31611||11/01/2013|12/31/9999|$775.62|0|0|||SURGERY/SPEECH PROSTHESIS|| 58-1699775|1326041732|CHC13|31612||11/01/2013|12/31/9999|$69.55|0|0|||PUNCTURE/CLEAR WINDPIPE|| 58-1699775|1326041732|CHC13|31613||11/01/2013|12/31/9999|$647.34|0|0|||REPAIR WINDPIPE OPENING|| 58-1699775|1326041732|CHC13|31614||11/01/2013|12/31/9999|$1|081.10|0|0|||REPAIR WINDPIPE OPENING|| 58-1699775|1326041732|CHC13|31615||11/01/2013|12/31/9999|$186.88|0|0|||VISUALIZATION OF WINDPIPE|| 58-1699775|1326041732|CHC13|31622||11/01/2013|12/31/9999|$213.98|0|0|||DX BRONCHOSCOPE/WASH|| 58-1699775|1326041732|CHC13|31623||11/01/2013|12/31/9999|$213.92|0|0|||DX BRONCHOSCOPE/BRUSH|| 58-1699775|1326041732|CHC13|31624||11/01/2013|12/31/9999|$214.84|0|0|||DX BRONCHOSCOPE/LAVAGE|| 58-1699775|1326041732|CHC13|31625||11/01/2013|12/31/9999|$249.05|0|0|||BRONCHOSCOPY W/BIOPSY(S)|| 58-1699775|1326041732|CHC13|31626||11/01/2013|12/31/9999|$300.90|0|0|||BRONCHOSCOPY W/MARKERS|| 58-1699775|1326041732|CHC13|31627||11/01/2013|12/31/9999|$139.01|0|0|||NAVIGATIONAL BRONCHOSCOPY|| 58-1699775|1326041732|CHC13|31628||11/01/2013|12/31/9999|$276.54|0|0|||BRONCHOSCOPY/LUNG BX| EACH|| 58-1699775|1326041732|CHC13|31629||11/01/2013|12/31/9999|$297.83|0|0|||BRONCHOSCOPY/NEEDLE BX| EACH|| 58-1699775|1326041732|CHC13|31630||11/01/2013|12/31/9999|$296.60|0|0|||BRONCHOSCOPY DILATE/FX REPR|| 58-1699775|1326041732|CHC13|31631||11/01/2013|12/31/9999|$336.77|0|0|||BRONCHOSCOPY| DILATE W/STENT|| 58-1699775|1326041732|CHC13|31632||11/01/2013|12/31/9999|$71.95|0|0|||BRONCHOSCOPY/LUNG BX| ADD'L|| 58-1699775|1326041732|CHC13|31633||11/01/2013|12/31/9999|$92.31|0|0|||BRONCHOSCOPY/NEEDLE BX ADD'L|| 58-1699775|1326041732|CHC13|31634||11/01/2013|12/31/9999|$311.56|0|0|||BRONCH W/BALLOON OCCLUSION|| 58-1699775|1326041732|CHC13|31635||11/01/2013|12/31/9999|$276.00|0|0|||BRONCHOSCOPY W/FB REMOVAL|| 58-1699775|1326041732|CHC13|31636||11/01/2013|12/31/9999|$328.14|0|0|||BRONCHOSCOPY| BRONCH STENTS|| 58-1699775|1326041732|CHC13|31637||11/01/2013|12/31/9999|$111.56|0|0|||BRONCHOSCOPY| STENT ADD-ON|| 58-1699775|1326041732|CHC13|31638||11/01/2013|12/31/9999|$377.15|0|0|||BRONCHOSCOPY| REVISE STENT|| 58-1699775|1326041732|CHC13|31640||11/01/2013|12/31/9999|$378.31|0|0|||BRONCHOSCOPY W/TUMOR EXCISE|| 58-1699775|1326041732|CHC13|31641||11/01/2013|12/31/9999|$378.25|0|0|||BRONCHOSCOPY| TREAT BLOCKAGE|| 58-1699775|1326041732|CHC13|31643||11/01/2013|12/31/9999|$257.49|0|0|||DIAG BRONCHOSCOPE/CATHETER|| 58-1699775|1326041732|CHC13|31645||11/01/2013|12/31/9999|$234.68|0|0|||BRONCHOSCOPY| CLEAR AIRWAYS|| 58-1699775|1326041732|CHC13|31646||11/01/2013|12/31/9999|$203.92|0|0|||BRONCHOSCOPY| RECLEAR AIRWAY|| 58-1699775|1326041732|CHC13|31647||11/01/2013|12/31/9999|$328.08|0|0|||BRONCHIAL VALVE INIT INSERT|| 58-1699775|1326041732|CHC13|31648||11/01/2013|12/31/9999|$340.77|0|0|||BRONCHIAL VALVE REMOV INIT|| 58-1699775|1326041732|CHC13|31649||11/01/2013|12/31/9999|$107.55|0|0|||BRONCHIAL VALVE REMOV ADDL|| 58-1699775|1326041732|CHC13|31651||11/01/2013|12/31/9999|$114.25|0|0|||BRONCHIAL VALVE ADDL INSERT|| 58-1699775|1326041732|CHC13|31652||04/01/2016|12/31/9999|$351.57|0|0|0||BRONCH EBUS SAMPLNG 1/2 NODE|| 58-1699775|1326041732|CHC13|31653||04/01/2016|12/31/9999|$388.09|0|0|0||BRONCH EBUS SAMPLNG 3/> NODE|| 58-1699775|1326041732|CHC13|31654||04/01/2016|12/31/9999|$101.78|0|0|0||BRONCH EBUS IVNTJ PERPH LES|| 58-1699775|1326041732|CHC13|31660||11/01/2013|12/31/9999|$328.19|0|0|||BRONCH THERMOPLSTY 1 LOBE|| 58-1699775|1326041732|CHC13|31661||11/01/2013|12/31/9999|$346.51|0|0|||BRONCH THERMOPLSTY 2/> LOBES|| 58-1699775|1326041732|CHC13|3170F||11/01/2013|12/31/9999|$0.00|0|0|||FLOW CYTO DONE B/4 TX|| 58-1699775|1326041732|CHC13|31717||11/01/2013|12/31/9999|$159.38|0|0|||BRONCHIAL BRUSH BIOPSY|| 58-1699775|1326041732|CHC13|31720||11/01/2013|12/31/9999|$74.87|0|0|||CLEARANCE OF AIRWAYS|| 58-1699775|1326041732|CHC13|31725||11/01/2013|12/31/9999|$137.97|0|0|||CLEARANCE OF AIRWAYS|| 58-1699775|1326041732|CHC13|31730||11/01/2013|12/31/9999|$214.97|0|0|||INTRO| WINDPIPE WIRE/TUBE|| 58-1699775|1326041732|CHC13|31750||11/01/2013|12/31/9999|$1|955.17|0|0|||REPAIR OF WINDPIPE|| 58-1699775|1326041732|CHC13|31755||11/01/2013|12/31/9999|$2|473.42|0|0|||REPAIR OF WINDPIPE|| 58-1699775|1326041732|CHC13|31760||11/01/2013|12/31/9999|$2|027.43|0|0|||REPAIR OF WINDPIPE|| 58-1699775|1326041732|CHC13|31766||11/01/2013|12/31/9999|$2|727.28|0|0|||RECONSTRUCTION OF WINDPIPE|| 58-1699775|1326041732|CHC13|31770||11/01/2013|12/31/9999|$1|970.00|0|0|||REPAIR/GRAFT OF BRONCHUS|| 58-1699775|1326041732|CHC13|31775||11/01/2013|12/31/9999|$2|057.94|0|0|||RECONSTRUCT BRONCHUS|| 58-1699775|1326041732|CHC13|31780||11/01/2013|12/31/9999|$1|737.73|0|0|||RECONSTRUCT WINDPIPE|| 58-1699775|1326041732|CHC13|31781||11/01/2013|12/31/9999|$2|066.25|0|0|||RECONSTRUCT WINDPIPE|| 58-1699775|1326041732|CHC13|31785||11/01/2013|12/31/9999|$1|571.30|0|0|||REMOVE WINDPIPE LESION|| 58-1699775|1326041732|CHC13|31786||11/01/2013|12/31/9999|$2|146.93|0|0|||REMOVE WINDPIPE LESION|| 58-1699775|1326041732|CHC13|31800||11/01/2013|12/31/9999|$1|021.70|0|0|||REPAIR OF WINDPIPE INJURY|| 58-1699775|1326041732|CHC13|31805||11/01/2013|12/31/9999|$1|202.60|0|0|||REPAIR OF WINDPIPE INJURY|| 58-1699775|1326041732|CHC13|31820||11/01/2013|12/31/9999|$477.26|0|0|||CLOSURE OF WINDPIPE LESION|| 58-1699775|1326041732|CHC13|31825||11/01/2013|12/31/9999|$699.93|0|0|||REPAIR OF WINDPIPE DEFECT|| 58-1699775|1326041732|CHC13|31830||11/01/2013|12/31/9999|$494.64|0|0|||REVISE WINDPIPE SCAR|| 58-1699775|1326041732|CHC13|31899||11/01/2013|12/31/9999|$0.00|0|0|||AIRWAYS SURGICAL PROCEDURE|| 58-1699775|1326041732|CHC13|3200F||11/01/2013|12/31/9999|$0.00|0|0|||BARIUM SWALLOW TEST NOT REQ|| 58-1699775|1326041732|CHC13|32035||11/01/2013|12/31/9999|$1|053.52|0|0|||EXPLORATION OF CHEST|| 58-1699775|1326041732|CHC13|32036||11/01/2013|12/31/9999|$1|141.36|0|0|||EXPLORATION OF CHEST|| 58-1699775|1326041732|CHC13|32096||11/01/2013|12/31/9999|$1|188.37|0|0|||OPEN WEDGE/BX LUNG INFILTR|| 58-1699775|1326041732|CHC13|32097||11/01/2013|12/31/9999|$1|188.37|0|0|||OPEN WEDGE/BX LUNG NODULE|| 58-1699775|1326041732|CHC13|32098||11/01/2013|12/31/9999|$1|116.73|0|0|||OPEN BIOPSY OF LUNG PLEURA|| 58-1699775|1326041732|CHC13|32100||11/01/2013|12/31/9999|$1|221.26|0|0|||EXPLORATION/BIOPSY OF CHEST|| 58-1699775|1326041732|CHC13|3210F||11/01/2013|12/31/9999|$0.00|0|0|||GRP A STREP TEST PERFORMED|| 58-1699775|1326041732|CHC13|32110||11/01/2013|12/31/9999|$2|155.95|0|0|||EXPLORE/REPAIR CHEST|| 58-1699775|1326041732|CHC13|32120||11/01/2013|12/31/9999|$1|287.80|0|0|||RE-EXPLORATION OF CHEST|| 58-1699775|1326041732|CHC13|32124||11/01/2013|12/31/9999|$1|370.76|0|0|||EXPLORE CHEST FREE ADHESIONS|| 58-1699775|1326041732|CHC13|32141||11/01/2013|12/31/9999|$2|258.55|0|0|||REMOVE/TREAT LUNG LESIONS|| 58-1699775|1326041732|CHC13|32150||11/01/2013|12/31/9999|$1|478.70|0|0|||REMOVAL OF LUNG LESION(S)|| 58-1699775|1326041732|CHC13|32151||11/01/2013|12/31/9999|$1|488.56|0|0|||REMOVE LUNG FOREIGN BODY|| 58-1699775|1326041732|CHC13|3215F||11/01/2013|12/31/9999|$0.00|0|0|||PT IMMUNITY TO HEP A DOC'D|| 58-1699775|1326041732|CHC13|32160||11/01/2013|12/31/9999|$1|148.41|0|0|||OPEN CHEST HEART MASSAGE|| 58-1699775|1326041732|CHC13|3216F||11/01/2013|12/31/9999|$0.00|0|0|||PT IMMUNITY TO HEP B DOC'D|| 58-1699775|1326041732|CHC13|3218F||11/01/2013|12/31/9999|$0.00|0|0|||RNA TSTNG HEP C DOC'D-DONE|| 58-1699775|1326041732|CHC13|32200||11/01/2013|12/31/9999|$1|672.33|0|0|||DRAIN| OPEN| LUNG LESION|| 58-1699775|1326041732|CHC13|3220F||11/01/2013|12/31/9999|$0.00|0|0|||HEP C QUANT RNA TSTNG DOC'D|| 58-1699775|1326041732|CHC13|32215||11/01/2013|12/31/9999|$1|175.29|0|0|||TREAT CHEST LINING|| 58-1699775|1326041732|CHC13|32220||11/01/2013|12/31/9999|$2|345.96|0|0|||RELEASE OF LUNG|| 58-1699775|1326041732|CHC13|32225||11/01/2013|12/31/9999|$1|470.07|0|0|||PARTIAL RELEASE OF LUNG|| 58-1699775|1326041732|CHC13|3230F||11/01/2013|12/31/9999|$0.00|0|0|||NOTE HRING TST W/IN 6 MON|| 58-1699775|1326041732|CHC13|32310||11/01/2013|12/31/9999|$1|357.88|0|0|||REMOVAL OF CHEST LINING|| 58-1699775|1326041732|CHC13|32320||11/01/2013|12/31/9999|$2|358.30|0|0|||FREE/REMOVE CHEST LINING|| 58-1699775|1326041732|CHC13|32400||11/01/2013|12/31/9999|$127.73|0|0|||NEEDLE BIOPSY CHEST LINING|| 58-1699775|1326041732|CHC13|32405||11/01/2013|12/31/9999|$147.87|0|0|||BIOPSY| LUNG OR MEDIASTINUM|| 58-1699775|1326041732|CHC13|32440||11/01/2013|12/31/9999|$2|321.37|0|0|||REMOVAL OF LUNG|| 58-1699775|1326041732|CHC13|32442||11/01/2013|12/31/9999|$4|527.35|0|0|||SLEEVE PNEUMONECTOMY|| 58-1699775|1326041732|CHC13|32445||11/01/2013|12/31/9999|$5|206.59|0|0|||REMOVAL OF LUNG|| 58-1699775|1326041732|CHC13|32480||11/01/2013|12/31/9999|$2|195.47|0|0|||PARTIAL REMOVAL OF LUNG|| 58-1699775|1326041732|CHC13|32482||11/01/2013|12/31/9999|$2|347.97|0|0|||BILOBECTOMY|| 58-1699775|1326041732|CHC13|32484||11/01/2013|12/31/9999|$2|131.06|0|0|||SEGMENTECTOMY|| 58-1699775|1326041732|CHC13|32486||11/01/2013|12/31/9999|$3|495.01|0|0|||SLEEVE LOBECTOMY|| 58-1699775|1326041732|CHC13|32488||11/01/2013|12/31/9999|$3|534.97|0|0|||COMPLETION PNEUMONECTOMY|| 58-1699775|1326041732|CHC13|32491||11/01/2013|12/31/9999|$2|182.09|0|0|||LUNG VOLUME REDUCTION|| 58-1699775|1326041732|CHC13|32501||11/01/2013|12/31/9999|$366.24|0|0|||REPAIR BRONCHUS ADD-ON|| 58-1699775|1326041732|CHC13|32503||11/01/2013|12/31/9999|$2|697.08|0|0|||RESECT APICAL LUNG TUMOR|| 58-1699775|1326041732|CHC13|32504||11/01/2013|12/31/9999|$3|044.12|0|0|||RESECT APICAL LUNG TUM/CHEST|| 58-1699775|1326041732|CHC13|32505||11/01/2013|12/31/9999|$1|369.94|0|0|||WEDGE RESECT OF LUNG INITIAL|| 58-1699775|1326041732|CHC13|32506||11/01/2013|12/31/9999|$233.12|0|0|||WEDGE RESECT OF LUNG ADD-ON|| 58-1699775|1326041732|CHC13|32507||11/01/2013|12/31/9999|$233.12|0|0|||WEDGE RESECT OF LUNG DIAG|| 58-1699775|1326041732|CHC13|3250F||11/01/2013|12/31/9999|$0.00|0|0|||NONPRIM LOC ANAT BX SITE TUM|| 58-1699775|1326041732|CHC13|32540||11/01/2013|12/31/9999|$2|544.35|0|0|||REMOVAL OF LUNG LESION|| 58-1699775|1326041732|CHC13|32550||11/01/2013|12/31/9999|$329.04|0|0|||INSERT PLEURAL CATH|| 58-1699775|1326041732|CHC13|32551||11/01/2013|12/31/9999|$249.92|0|0|||INSERTION OF CHEST TUBE|| 58-1699775|1326041732|CHC13|32552||11/01/2013|12/31/9999|$240.59|0|0|||REMOVE LUNG CATHETER|| 58-1699775|1326041732|CHC13|32553||11/01/2013|12/31/9999|$303.11|0|0|||INS MARK THOR FOR RT PERQ|| 58-1699775|1326041732|CHC13|32554||11/01/2013|12/31/9999|$130.72|0|0|||ASPIRATE PLEURA W/O IMAGING|| 58-1699775|1326041732|CHC13|32555||11/01/2013|12/31/9999|$163.41|0|0|||ASPIRATE PLEURA W/ IMAGING|| 58-1699775|1326041732|CHC13|32556||11/01/2013|12/31/9999|$179.29|0|0|||INSERT CATH PLEURA W/O IMAGE|| 58-1699775|1326041732|CHC13|32557||11/01/2013|12/31/9999|$240.79|0|0|||INSERT CATH PLEURA W/ IMAGE|| 58-1699775|1326041732|CHC13|32560||11/01/2013|12/31/9999|$118.93|0|0|||TREAT LUNG LINING CHEMICALLY|| 58-1699775|1326041732|CHC13|32561||11/01/2013|12/31/9999|$103.89|0|0|||LYSE CHEST FIBRIN INIT DAY|| 58-1699775|1326041732|CHC13|32562||11/01/2013|12/31/9999|$93.01|0|0|||LYSE CHEST FIBRIN SUBQ DAY|| 58-1699775|1326041732|CHC13|32601||11/01/2013|12/31/9999|$459.29|0|0|||THORACOSCOPY| DIAGNOSTIC|| 58-1699775|1326041732|CHC13|32604||11/01/2013|12/31/9999|$716.35|0|0|||THORACOSCOPY| DIAGNOSTIC|| 58-1699775|1326041732|CHC13|32606||11/01/2013|12/31/9999|$686.70|0|0|||THORACOSCOPY| DIAGNOSTIC|| 58-1699775|1326041732|CHC13|32607||11/01/2013|12/31/9999|$456.54|0|0|||THORACOSCOPY W/BX INFILTRATE|| 58-1699775|1326041732|CHC13|32608||11/01/2013|12/31/9999|$561.20|0|0|||THORACOSCOPY W/BX NODULE|| 58-1699775|1326041732|CHC13|32609||11/01/2013|12/31/9999|$387.30|0|0|||THORACOSCOPY W/BX PLEURA|| 58-1699775|1326041732|CHC13|3260F||11/01/2013|12/31/9999|$0.00|0|0|||PT CAT/PN CAT/HIST GRD DOC'D|| 58-1699775|1326041732|CHC13|32650||11/01/2013|12/31/9999|$983.13|0|0|||THORACOSCOPY| SURGICAL|| 58-1699775|1326041732|CHC13|32651||11/01/2013|12/31/9999|$1|607.32|0|0|||THORACOSCOPY| SURGICAL|| 58-1699775|1326041732|CHC13|32652||11/01/2013|12/31/9999|$2|443.42|0|0|||THORACOSCOPY| SURGICAL|| 58-1699775|1326041732|CHC13|32653||11/01/2013|12/31/9999|$1|553.42|0|0|||THORACOSCOPY| SURGICAL|| 58-1699775|1326041732|CHC13|32654||11/01/2013|12/31/9999|$1|733.36|0|0|||THORACOSCOPY| SURGICAL|| 58-1699775|1326041732|CHC13|32655||11/01/2013|12/31/9999|$1|408.59|0|0|||THORACOSCOPY| SURGICAL|| 58-1699775|1326041732|CHC13|32656||11/01/2013|12/31/9999|$1|177.24|0|0|||THORACOSCOPY| SURGICAL|| 58-1699775|1326041732|CHC13|32658||11/01/2013|12/31/9999|$1|055.98|0|0|||THORACOSCOPY| SURGICAL|| 58-1699775|1326041732|CHC13|32659||11/01/2013|12/31/9999|$1|080.64|0|0|||THORACOSCOPY| SURGICAL|| 58-1699775|1326041732|CHC13|3265F||11/01/2013|12/31/9999|$0.00|0|0|||RNA TSTNG HEPC VIR ORD/DOC'D|| 58-1699775|1326041732|CHC13|32661||11/01/2013|12/31/9999|$1|181.46|0|0|||THORACOSCOPY| SURGICAL|| 58-1699775|1326041732|CHC13|32662||11/01/2013|12/31/9999|$1|321.80|0|0|||THORACOSCOPY| SURGICAL|| 58-1699775|1326041732|CHC13|32663||11/01/2013|12/31/9999|$2|075.59|0|0|||THORACOSCOPY| SURGICAL|| 58-1699775|1326041732|CHC13|32664||11/01/2013|12/31/9999|$1|253.70|0|0|||THORACOSCOPY| SURGICAL|| 58-1699775|1326041732|CHC13|32665||11/01/2013|12/31/9999|$1|799.52|0|0|||THORACOSCOPY| SURGICAL|| 58-1699775|1326041732|CHC13|32666||11/01/2013|12/31/9999|$1|280.11|0|0|||THORACOSCOPY W/WEDGE RESECT|| 58-1699775|1326041732|CHC13|32667||11/01/2013|12/31/9999|$233.12|0|0|||THORACOSCOPY W/W RESECT ADDL|| 58-1699775|1326041732|CHC13|32668||11/01/2013|12/31/9999|$234.52|0|0|||THORACOSCOPY W/W RESECT DIAG|| 58-1699775|1326041732|CHC13|32669||11/01/2013|12/31/9999|$1|978.63|0|0|||THORACOSCOPY REMOVE SEGMENT|| 58-1699775|1326041732|CHC13|3266F||11/01/2013|12/31/9999|$0.00|0|0|||HEPC GN TSTNG DOC'D B/4TXMNT|| 58-1699775|1326041732|CHC13|32670||11/01/2013|12/31/9999|$2|363.47|0|0|||THORACOSCOPY BILOBECTOMY|| 58-1699775|1326041732|CHC13|32671||11/01/2013|12/31/9999|$2|625.64|0|0|||THORACOSCOPY PNEUMONECTOMY|| 58-1699775|1326041732|CHC13|32672||11/01/2013|12/31/9999|$2|244.26|0|0|||THORACOSCOPY FOR LVRS|| 58-1699775|1326041732|CHC13|32673||11/01/2013|12/31/9999|$1|767.04|0|0|||THORACOSCOPY W/THYMUS RESECT|| 58-1699775|1326041732|CHC13|32674||11/01/2013|12/31/9999|$319.57|0|0|||THORACOSCOPY LYMPH NODE EXC|| 58-1699775|1326041732|CHC13|3267F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|3268F||11/01/2013|12/31/9999|$0.00|0|0|||PSA/T/GLSC DOC'D B/4 TXMNT|| 58-1699775|1326041732|CHC13|3269F||11/01/2013|12/31/9999|$0.00|0|0|||BONE SCN B/4 TXMNT/AFTR DX|| 58-1699775|1326041732|CHC13|32701||11/01/2013|12/31/9999|$323.55|0|0|||THORAX STEREO RAD TARGETW/TX|| 58-1699775|1326041732|CHC13|3270F||11/01/2013|12/31/9999|$0.00|0|0|||NO BONE SCN B/4 TXMNT/AFTRDX|| 58-1699775|1326041732|CHC13|3271F||11/01/2013|12/31/9999|$0.00|0|0|||LOW RISK| PROSTATE CANCER|| 58-1699775|1326041732|CHC13|3272F||11/01/2013|12/31/9999|$0.00|0|0|||MED. RISK| PROSTATE CANCER|| 58-1699775|1326041732|CHC13|3273F||11/01/2013|12/31/9999|$0.00|0|0|||HIGH RISK| PROSTATE CANCER|| 58-1699775|1326041732|CHC13|3274F||11/01/2013|12/31/9999|$0.00|0|0|||PROST CNCR RSK NOT LW/MD/HGH|| 58-1699775|1326041732|CHC13|3278F||11/01/2013|12/31/9999|$0.00|0|0|||SERUM LVLS CA/IPTH/LPD ORD|| 58-1699775|1326041732|CHC13|3279F||11/01/2013|12/31/9999|$0.00|0|0|||HGB LVL >/= 13 G/DL|| 58-1699775|1326041732|CHC13|32800||11/01/2013|12/31/9999|$1|388.19|0|0|||REPAIR LUNG HERNIA|| 58-1699775|1326041732|CHC13|3280F||11/01/2013|12/31/9999|$0.00|0|0|||HGB LVL 11-12.9 G/DL|| 58-1699775|1326041732|CHC13|32810||11/01/2013|12/31/9999|$1|329.86|0|0|||CLOSE CHEST AFTER DRAINAGE|| 58-1699775|1326041732|CHC13|32815||11/01/2013|12/31/9999|$4|129.60|0|0|||CLOSE BRONCHIAL FISTULA|| 58-1699775|1326041732|CHC13|3281F||11/01/2013|12/31/9999|$0.00|0|0|||HGB LVL < 11 G/DL|| 58-1699775|1326041732|CHC13|32820||11/01/2013|12/31/9999|$1|972.10|0|0|||RECONSTRUCT INJURED CHEST|| 58-1699775|1326041732|CHC13|3284F||11/01/2013|12/31/9999|$0.00|0|0|||IOP DOWN >15% OF PRE-SVC LVL|| 58-1699775|1326041732|CHC13|32850||11/01/2013|12/31/9999|$0.00|0|0|||DONOR PNEUMONECTOMY|| 58-1699775|1326041732|CHC13|32851||11/01/2013|12/31/9999|$4|895.43|0|0|||LUNG TRANSPLANT| SINGLE|| 58-1699775|1326041732|CHC13|32852||11/01/2013|12/31/9999|$5|366.25|0|0|||LUNG TRANSPLANT WITH BYPASS|| 58-1699775|1326041732|CHC13|32853||11/01/2013|12/31/9999|$6|777.07|0|0|||LUNG TRANSPLANT| DOUBLE|| 58-1699775|1326041732|CHC13|32854||11/01/2013|12/31/9999|$7|218.47|0|0|||LUNG TRANSPLANT WITH BYPASS|| 58-1699775|1326041732|CHC13|32855||11/01/2013|12/31/9999|$0.00|0|0|||PREPARE DONOR LUNG| SINGLE|| 58-1699775|1326041732|CHC13|32856||11/01/2013|12/31/9999|$0.00|0|0|||PREPARE DONOR LUNG| DOUBLE|| 58-1699775|1326041732|CHC13|3285F||11/01/2013|12/31/9999|$0.00|0|0|||IOP DOWN <15% OF PRE-SVC LVL|| 58-1699775|1326041732|CHC13|3288F||11/01/2013|12/31/9999|$0.00|0|0|||FALL RISK ASSESSMENT DOC'D|| 58-1699775|1326041732|CHC13|32900||11/01/2013|12/31/9999|$2|048.86|0|0|||REMOVAL OF RIB(S)|| 58-1699775|1326041732|CHC13|32905||11/01/2013|12/31/9999|$1|977.78|0|0|||REVISE & REPAIR CHEST WALL|| 58-1699775|1326041732|CHC13|32906||11/01/2013|12/31/9999|$2|448.21|0|0|||REVISE & REPAIR CHEST WALL|| 58-1699775|1326041732|CHC13|3290F||11/01/2013|12/31/9999|$0.00|0|0|||PT=D(RH)- AND UNSENSITIZED|| 58-1699775|1326041732|CHC13|3291F||11/01/2013|12/31/9999|$0.00|0|0|||PT=D(RH)+ OR SENSITIZED|| 58-1699775|1326041732|CHC13|3292F||11/01/2013|12/31/9999|$0.00|0|0|||HIV TSTNG ASKED/DOC'D/REVW'D|| 58-1699775|1326041732|CHC13|3293F||11/01/2013|12/31/9999|$0.00|0|0|||ABO RH BLOOD TYPING DOCD|| 58-1699775|1326041732|CHC13|32940||11/01/2013|12/31/9999|$1|823.00|0|0|||REVISION OF LUNG|| 58-1699775|1326041732|CHC13|3294F||11/01/2013|12/31/9999|$0.00|0|0|||GRP B STREP SCREENING DOCD|| 58-1699775|1326041732|CHC13|32960||11/01/2013|12/31/9999|$151.44|0|0|||THERAPEUTIC PNEUMOTHORAX|| 58-1699775|1326041732|CHC13|32994||04/01/2018|12/31/9999|$741.32|0|0|0||ABLATE PULM TUMOR PERQ CRYBL|| 58-1699775|1326041732|CHC13|32997||11/01/2013|12/31/9999|$520.41|0|0|||TOTAL LUNG LAVAGE|| 58-1699775|1326041732|CHC13|32998||11/01/2013|12/31/9999|$422.96|0|0|||PERQ RF ABLATE TX| PUL TUMOR|| 58-1699775|1326041732|CHC13|32999||11/01/2013|12/31/9999|$0.00|0|0|||CHEST SURGERY PROCEDURE|| 58-1699775|1326041732|CHC13|3300F||11/01/2013|12/31/9999|$0.00|0|0|||AJCC STAGE DOC'D B/4 THXPY|| 58-1699775|1326041732|CHC13|33010||11/01/2013|12/31/9999|$176.95|0|0|||DRAINAGE OF HEART SAC|| 58-1699775|1326041732|CHC13|33011||11/01/2013|12/31/9999|$178.39|0|0|||REPEAT DRAINAGE OF HEART SAC|| 58-1699775|1326041732|CHC13|33015||11/01/2013|12/31/9999|$750.70|0|0|||INCISION OF HEART SAC|| 58-1699775|1326041732|CHC13|3301F||11/01/2013|12/31/9999|$0.00|0|0|||CANCER STAGE DOC'D| METAST|| 58-1699775|1326041732|CHC13|33020||11/01/2013|12/31/9999|$1|296.85|0|0|||INCISION OF HEART SAC|| 58-1699775|1326041732|CHC13|33025||11/01/2013|12/31/9999|$1|185.86|0|0|||INCISION OF HEART SAC|| 58-1699775|1326041732|CHC13|33030||11/01/2013|12/31/9999|$2|927.65|0|0|||PARTIAL REMOVAL OF HEART SAC|| 58-1699775|1326041732|CHC13|33031||11/01/2013|12/31/9999|$3|604.77|0|0|||PARTIAL REMOVAL OF HEART SAC|| 58-1699775|1326041732|CHC13|33050||11/01/2013|12/31/9999|$1|485.50|0|0|||REMOVAL OF HEART SAC LESION|| 58-1699775|1326041732|CHC13|33120||11/01/2013|12/31/9999|$3|100.50|0|0|||REMOVAL OF HEART LESION|| 58-1699775|1326041732|CHC13|33130||11/01/2013|12/31/9999|$2|065.35|0|0|||REMOVAL OF HEART LESION|| 58-1699775|1326041732|CHC13|33140||11/01/2013|12/31/9999|$2|362.84|0|0|||HEART REVASCULARIZE (TMR)|| 58-1699775|1326041732|CHC13|33141||11/01/2013|12/31/9999|$201.68|0|0|||HEART TMR W/OTHER PROCEDURE|| 58-1699775|1326041732|CHC13|3315F||11/01/2013|12/31/9999|$0.00|0|0|||ER+ OR PR+ BREAST CANCER|| 58-1699775|1326041732|CHC13|3316F||11/01/2013|12/31/9999|$0.00|0|0|||ER_ OR PR_ BREAST CANCER|| 58-1699775|1326041732|CHC13|3317F||11/01/2013|12/31/9999|$0.00|0|0|||PATH RPT MALIG CANCER DOC'D|| 58-1699775|1326041732|CHC13|3318F||11/01/2013|12/31/9999|$0.00|0|0|||PATH RPT MALIG CANCER DOC'D|| 58-1699775|1326041732|CHC13|3319F||11/01/2013|12/31/9999|$0.00|0|0|||X-RAY/CT/ULTRSND ET AL ORD'D|| 58-1699775|1326041732|CHC13|33202||11/01/2013|12/31/9999|$1|151.03|0|0|||INSERT EPICARD ELTRD| OPEN|| 58-1699775|1326041732|CHC13|33203||11/01/2013|12/31/9999|$1|197.40|0|0|||INSERT EPICARD ELTRD| ENDO|| 58-1699775|1326041732|CHC13|33206||11/01/2013|12/31/9999|$670.93|0|0|||INSERTION OF HEART PACEMAKER|| 58-1699775|1326041732|CHC13|33207||11/01/2013|12/31/9999|$713.57|0|0|||INSERTION OF HEART PACEMAKER|| 58-1699775|1326041732|CHC13|33208||11/01/2013|12/31/9999|$771.19|0|0|||INSERTION OF HEART PACEMAKER|| 58-1699775|1326041732|CHC13|3320F||11/01/2013|12/31/9999|$0.00|0|0|||NO XRAY/CT/ ET AL ORD'D|| 58-1699775|1326041732|CHC13|33210||11/01/2013|12/31/9999|$265.40|0|0|||INSERTION OF HEART ELECTRODE|| 58-1699775|1326041732|CHC13|33211||11/01/2013|12/31/9999|$270.97|0|0|||INSERTION OF HEART ELECTRODE|| 58-1699775|1326041732|CHC13|33212||11/01/2013|12/31/9999|$486.27|0|0|||INSERTION OF PULSE GENERATOR|| 58-1699775|1326041732|CHC13|33213||11/01/2013|12/31/9999|$512.54|0|0|||INSERTION OF PULSE GENERATOR|| 58-1699775|1326041732|CHC13|33214||11/01/2013|12/31/9999|$707.32|0|0|||UPGRADE OF PACEMAKER SYSTEM|| 58-1699775|1326041732|CHC13|33215||11/01/2013|12/31/9999|$446.79|0|0|||REPOSITION PACING-DEFIB LEAD|| 58-1699775|1326041732|CHC13|33216||11/01/2013|12/31/9999|$549.70|0|0|||INSERT LEAD PACE-DEFIB| ONE|| 58-1699775|1326041732|CHC13|33217||11/01/2013|12/31/9999|$547.25|0|0|||INSERT LEAD PACE-DEFIB| DUAL|| 58-1699775|1326041732|CHC13|33218||11/01/2013|12/31/9999|$574.19|0|0|||REPAIR LEAD PACE-DEFIB| ONE|| 58-1699775|1326041732|CHC13|3321F||11/01/2013|12/31/9999|$0.00|0|0|||AJCC CNCR 0/IA MELAN DOCD|| 58-1699775|1326041732|CHC13|33220||11/01/2013|12/31/9999|$579.21|0|0|||REPAIR LEAD PACE-DEFIB| DUAL|| 58-1699775|1326041732|CHC13|33221||11/01/2013|12/31/9999|$514.51|0|0|||INSERT PULSE GEN MULT LEADS|| 58-1699775|1326041732|CHC13|33222||04/01/2014|12/31/9999|$509.81|0|0|||REVISE POCKET| PACEMAKER|| 58-1699775|1326041732|CHC13|33223||04/01/2014|12/31/9999|$616.52|0|0|||REVISE POCKET| PACING-DEFIB|| 58-1699775|1326041732|CHC13|33224||11/01/2013|12/31/9999|$748.40|0|0|||INSERT PACING LEAD & CONNECT|| 58-1699775|1326041732|CHC13|33225||11/01/2013|12/31/9999|$673.84|0|0|||L VENTRIC PACING LEAD ADD-ON|| 58-1699775|1326041732|CHC13|33226||11/01/2013|12/31/9999|$720.27|0|0|||REPOSITION L VENTRIC LEAD|| 58-1699775|1326041732|CHC13|33227||11/01/2013|12/31/9999|$490.85|0|0|||REMOVE&REPLACE PM GEN SINGL|| 58-1699775|1326041732|CHC13|33228||11/01/2013|12/31/9999|$512.06|0|0|||REMV PERM PACEMKR GEN & REPLAC|| 58-1699775|1326041732|CHC13|33229||11/01/2013|12/31/9999|$533.27|0|0|||REMV&REPLC PM GEN MULT LEADS|| 58-1699775|1326041732|CHC13|3322F||11/01/2013|12/31/9999|$0.00|0|0|||MELAN>AJCC STAGE 0 OR IA|| 58-1699775|1326041732|CHC13|33230||11/01/2013|12/31/9999|$554.08|0|0|||INSRT PULSE GEN W/DUAL LEADS|| 58-1699775|1326041732|CHC13|33231||11/01/2013|12/31/9999|$575.29|0|0|||INSRT PULSE GEN W/MULT LEADS|| 58-1699775|1326041732|CHC13|33233||11/01/2013|12/31/9999|$346.59|0|0|||REMOVAL OF PACEMAKER SYSTEM|| 58-1699775|1326041732|CHC13|33234||11/01/2013|12/31/9999|$713.71|0|0|||REMOVAL OF PACEMAKER SYSTEM|| 58-1699775|1326041732|CHC13|33235||11/01/2013|12/31/9999|$931.56|0|0|||REMOVAL PACEMAKER ELECTRODE|| 58-1699775|1326041732|CHC13|33236||11/01/2013|12/31/9999|$1|169.24|0|0|||REMOVE ELECTRODE/THORACOTOMY|| 58-1699775|1326041732|CHC13|33237||11/01/2013|12/31/9999|$1|226.92|0|0|||REMOVE ELECTRODE/THORACOTOMY|| 58-1699775|1326041732|CHC13|33238||11/01/2013|12/31/9999|$1|393.45|0|0|||REMOVE ELECTRODE/THORACOTOMY|| 58-1699775|1326041732|CHC13|3323F||11/01/2013|12/31/9999|$0.00|0|0|||CLIN NODE STGNG DOCDB/4 SURG|| 58-1699775|1326041732|CHC13|33240||11/01/2013|12/31/9999|$564.04|0|0|||INSERT PULSE GENERATOR|| 58-1699775|1326041732|CHC13|33241||11/01/2013|12/31/9999|$325.87|0|0|||REMOVE PULSE GENERATOR|| 58-1699775|1326041732|CHC13|33243||11/01/2013|12/31/9999|$2|030.33|0|0|||REMOVE ELTRD/THORACOTOMY|| 58-1699775|1326041732|CHC13|33244||11/01/2013|12/31/9999|$1|252.71|0|0|||REMOVE ELTRD| TRANSVEN|| 58-1699775|1326041732|CHC13|33249||11/01/2013|12/31/9999|$1|330.71|0|0|||ELTRD/INSERT PACE-DEFIB|| 58-1699775|1326041732|CHC13|3324F||11/01/2013|12/31/9999|$0.00|0|0|||MRI CT SCAN ORD RVWD RQSTD|| 58-1699775|1326041732|CHC13|33250||11/01/2013|12/31/9999|$2|185.04|0|0|||ABLATE HEART DYSRHYTHM FOCUS|| 58-1699775|1326041732|CHC13|33251||11/01/2013|12/31/9999|$2|427.64|0|0|||ABLATE HEART DYSRHYTHM FOCUS|| 58-1699775|1326041732|CHC13|33254||11/01/2013|12/31/9999|$2|040.31|0|0|||ABLATE ATRIA| LMTD|| 58-1699775|1326041732|CHC13|33255||11/01/2013|12/31/9999|$2|458.44|0|0|||ABLATE ATRIA W/O BYPASS| EXT|| 58-1699775|1326041732|CHC13|33256||11/01/2013|12/31/9999|$2|935.53|0|0|||ABLATE ATRIA W/BYPASS| EXTEN|| 58-1699775|1326041732|CHC13|33257||11/01/2013|12/31/9999|$867.96|0|0|||ABLATE ATRIA| LMTD| ADD-ON|| 58-1699775|1326041732|CHC13|33258||11/01/2013|12/31/9999|$975.08|0|0|||ABLATE ATRIA| X10SV| ADD-ON|| 58-1699775|1326041732|CHC13|33259||11/01/2013|12/31/9999|$1|261.33|0|0|||ABLATE ATRIA W/BYPASS ADD-ON|| 58-1699775|1326041732|CHC13|3325F||11/01/2013|12/31/9999|$0.00|0|0|||PREOP ASSES 4 CATARACT SURG|| 58-1699775|1326041732|CHC13|33261||11/01/2013|12/31/9999|$2|438.07|0|0|||ABLATE HEART DYSRHYTHM FOCUS|| 58-1699775|1326041732|CHC13|33262||11/01/2013|12/31/9999|$533.84|0|0|||REMV&REPLC CVD GEN SING LEAD|| 58-1699775|1326041732|CHC13|33263||11/01/2013|12/31/9999|$555.05|0|0|||REMV&REPLC CVD GEN DUAL LEAD|| 58-1699775|1326041732|CHC13|33264||11/01/2013|12/31/9999|$576.26|0|0|||REMV&REPLC CVD GEN MULT LEAD|| 58-1699775|1326041732|CHC13|33265||11/01/2013|12/31/9999|$2|019.26|0|0|||ABLATE ATRIA W/BYPASS| ENDO|| 58-1699775|1326041732|CHC13|33266||11/01/2013|12/31/9999|$2|760.52|0|0|||ABLATE ATRIA W/O BYPASS ENDO|| 58-1699775|1326041732|CHC13|33270||04/01/2015|12/31/9999|$874.06|0|0|0||INS/REP SUBQ DEFIBRILLATOR|| 58-1699775|1326041732|CHC13|33271||04/01/2015|12/31/9999|$734.37|0|0|0||INSJ SUBQ IMPLTBL DFB ELCTRD|| 58-1699775|1326041732|CHC13|33272||04/01/2015|12/31/9999|$539.87|0|0|0||RMVL OF SUBQ DEFIBRILLATOR|| 58-1699775|1326041732|CHC13|33273||04/01/2015|12/31/9999|$597.00|0|0|0||REPOS PREV IMPLTBL SUBQ DFB|| 58-1699775|1326041732|CHC13|33282||04/01/2014|12/31/9999|$347.67|0|0|||IMPLANT PAT-ACTIVE HT RECORD|| 58-1699775|1326041732|CHC13|33284||04/01/2014|12/31/9999|$306.21|0|0|||REMOVE PAT-ACTIVE HT RECORD|| 58-1699775|1326041732|CHC13|3328F||11/01/2013|12/31/9999|$0.00|0|0|||PRFRMNC DOCD 2 WKS B/4 SURG|| 58-1699775|1326041732|CHC13|33300||11/01/2013|12/31/9999|$3|636.57|0|0|||REPAIR OF HEART WOUND|| 58-1699775|1326041732|CHC13|33305||11/01/2013|12/31/9999|$6|109.97|0|0|||REPAIR OF HEART WOUND|| 58-1699775|1326041732|CHC13|3330F||11/01/2013|12/31/9999|$0.00|0|0|||IMAGING STUDY ORDERED (BKP)|| 58-1699775|1326041732|CHC13|33310||11/01/2013|12/31/9999|$1|732.18|0|0|||EXPLORATORY HEART SURGERY|| 58-1699775|1326041732|CHC13|33315||11/01/2013|12/31/9999|$2|841.08|0|0|||EXPLORATORY HEART SURGERY|| 58-1699775|1326041732|CHC13|3331F||11/01/2013|12/31/9999|$0.00|0|0|||BK IMAGING TST NOT ORDERED|| 58-1699775|1326041732|CHC13|33320||11/01/2013|12/31/9999|$1|584.05|0|0|||REPAIR MAJOR BLOOD VESSEL(S)|| 58-1699775|1326041732|CHC13|33321||11/01/2013|12/31/9999|$1|776.47|0|0|||REPAIR MAJOR VESSEL|| 58-1699775|1326041732|CHC13|33322||11/01/2013|12/31/9999|$2|072.81|0|0|||REPAIR MAJOR BLOOD VESSEL(S)|| 58-1699775|1326041732|CHC13|33330||11/01/2013|12/31/9999|$2|128.02|0|0|||INSERT MAJOR VESSEL GRAFT|| 58-1699775|1326041732|CHC13|33335||11/01/2013|12/31/9999|$2|818.54|0|0|||INSERT MAJOR VESSEL GRAFT|| 58-1699775|1326041732|CHC13|33340||04/01/2017|12/31/9999|$1|250.00|0|1250|0||PERQ CLSR TCAT L ATR APNDGE|| 58-1699775|1326041732|CHC13|33361||11/01/2013|12/31/9999|$1|961.10|0|0|||REPLACE AORTIC VALVE PERQ|| 58-1699775|1326041732|CHC13|33362||11/01/2013|12/31/9999|$2|145.76|0|0|||REPLACE AORTIC VALVE OPEN|| 58-1699775|1326041732|CHC13|33363||11/01/2013|12/31/9999|$2|221.77|0|0|||REPLACE AORTIC VALVE OPEN|| 58-1699775|1326041732|CHC13|33364||11/01/2013|12/31/9999|$2|362.09|0|0|||REPLACE AORTIC VALVE OPEN|| 58-1699775|1326041732|CHC13|33365||11/01/2013|12/31/9999|$2|592.41|0|0|||REPLACE AORTIC VALVE OPEN|| 58-1699775|1326041732|CHC13|33366||04/01/2014|12/31/9999|$2|892.45|0|0|||TRCATH REPLACE AORTIC VALVE|| 58-1699775|1326041732|CHC13|33367||11/01/2013|12/31/9999|$911.73|0|0|||REPLACE AORTIC VALVE W/BYP|| 58-1699775|1326041732|CHC13|33368||11/01/2013|12/31/9999|$1|104.93|0|0|||REPLACE AORTIC VALVE W/BYP|| 58-1699775|1326041732|CHC13|33369||11/01/2013|12/31/9999|$1|458.75|0|0|||REPLACE AORTIC VALVE W/BYP|| 58-1699775|1326041732|CHC13|33390||04/01/2017|12/31/9999|$2|980.74|0|2980.74|0||VALVULOPLASTY AORTIC VALVE|| 58-1699775|1326041732|CHC13|33391||04/01/2017|12/31/9999|$3|531.99|0|3531.99|0||VALVULOPLASTY AORTIC VALVE|| 58-1699775|1326041732|CHC13|33404||11/01/2013|12/31/9999|$2|626.60|0|0|||PREPARE HEART-AORTA CONDUIT|| 58-1699775|1326041732|CHC13|33405||11/01/2013|12/31/9999|$3|426.49|0|0|||REPLACEMENT OF AORTIC VALVE|| 58-1699775|1326041732|CHC13|33406||11/01/2013|12/31/9999|$4|306.58|0|0|||REPLACEMENT OF AORTIC VALVE|| 58-1699775|1326041732|CHC13|3340F||11/01/2013|12/31/9999|$0.00|0|0|||BRST IMAG-RPT/DATACAT 0 DOCD|| 58-1699775|1326041732|CHC13|33410||11/01/2013|12/31/9999|$3|807.00|0|0|||REPLACEMENT OF AORTIC VALVE|| 58-1699775|1326041732|CHC13|33411||11/01/2013|12/31/9999|$5|030.47|0|0|||REPLACEMENT OF AORTIC VALVE|| 58-1699775|1326041732|CHC13|33412||11/01/2013|12/31/9999|$4|756.57|0|0|||REPLACEMENT OF AORTIC VALVE|| 58-1699775|1326041732|CHC13|33413||11/01/2013|12/31/9999|$4|848.90|0|0|||REPLACEMENT OF AORTIC VALVE|| 58-1699775|1326041732|CHC13|33414||11/01/2013|12/31/9999|$3|236.94|0|0|||REPAIR OF AORTIC VALVE|| 58-1699775|1326041732|CHC13|33415||11/01/2013|12/31/9999|$3|066.72|0|0|||REVISION| SUBVALVULAR TISSUE|| 58-1699775|1326041732|CHC13|33416||11/01/2013|12/31/9999|$3|038.71|0|0|||REVISE VENTRICLE MUSCLE|| 58-1699775|1326041732|CHC13|33417||11/01/2013|12/31/9999|$2|485.76|0|0|||REPAIR OF AORTIC VALVE|| 58-1699775|1326041732|CHC13|33418||04/01/2015|12/31/9999|$2|785.51|0|0|0||REPAIR TCAT MITRAL VALVE|| 58-1699775|1326041732|CHC13|33419||04/01/2015|12/31/9999|$656.52|0|0|0||REPAIR TCAT MITRAL VALVE|| 58-1699775|1326041732|CHC13|3341F||11/01/2013|12/31/9999|$0.00|0|0|||BRST IMAG-RPT/DATACAT 1 DOCD|| 58-1699775|1326041732|CHC13|33420||11/01/2013|12/31/9999|$2|151.11|0|0|||REVISION OF MITRAL VALVE|| 58-1699775|1326041732|CHC13|33422||11/01/2013|12/31/9999|$2|520.06|0|0|||REVISION OF MITRAL VALVE|| 58-1699775|1326041732|CHC13|33425||11/01/2013|12/31/9999|$4|074.81|0|0|||REPAIR OF MITRAL VALVE|| 58-1699775|1326041732|CHC13|33426||11/01/2013|12/31/9999|$3|575.45|0|0|||REPAIR OF MITRAL VALVE|| 58-1699775|1326041732|CHC13|33427||11/01/2013|12/31/9999|$3|678.08|0|0|||REPAIR OF MITRAL VALVE|| 58-1699775|1326041732|CHC13|3342F||11/01/2013|12/31/9999|$0.00|0|0|||BRST IMAG-RPT/DATACAT 2 DOCD|| 58-1699775|1326041732|CHC13|33430||11/01/2013|12/31/9999|$4|202.23|0|0|||REPLACEMENT OF MITRAL VALVE|| 58-1699775|1326041732|CHC13|3343F||11/01/2013|12/31/9999|$0.00|0|0|||BRST IMAG-RPT/DATACAT 3 DOCD|| 58-1699775|1326041732|CHC13|3344F||11/01/2013|12/31/9999|$0.00|0|0|||BRST IMAG-RPT/DATACAT 4 DOCD|| 58-1699775|1326041732|CHC13|3345F||11/01/2013|12/31/9999|$0.00|0|0|||BRST IMAG-RPT/DATACAT 5 DOCD|| 58-1699775|1326041732|CHC13|33460||11/01/2013|12/31/9999|$3|633.53|0|0|||REVISION OF TRICUSPID VALVE|| 58-1699775|1326041732|CHC13|33463||11/01/2013|12/31/9999|$4|614.40|0|0|||VALVULOPLASTY| TRICUSPID|| 58-1699775|1326041732|CHC13|33464||11/01/2013|12/31/9999|$3|655.37|0|0|||VALVULOPLASTY| TRICUSPID|| 58-1699775|1326041732|CHC13|33465||11/01/2013|12/31/9999|$4|122.33|0|0|||REPLACE TRICUSPID VALVE|| 58-1699775|1326041732|CHC13|33468||11/01/2013|12/31/9999|$3|663.47|0|0|||REVISION OF TRICUSPID VALVE|| 58-1699775|1326041732|CHC13|33470||11/01/2013|12/31/9999|$1|837.40|0|0|||REVISION OF PULMONARY VALVE|| 58-1699775|1326041732|CHC13|33471||11/01/2013|12/31/9999|$1|980.68|0|0|||VALVOTOMY| PULMONARY VALVE|| 58-1699775|1326041732|CHC13|33474||11/01/2013|12/31/9999|$3|210.03|0|0|||REVISION OF PULMONARY VALVE|| 58-1699775|1326041732|CHC13|33475||11/01/2013|12/31/9999|$3|502.84|0|0|||REPLACEMENT| PULMONARY VALVE|| 58-1699775|1326041732|CHC13|33476||11/01/2013|12/31/9999|$2|269.04|0|0|||REVISION OF HEART CHAMBER|| 58-1699775|1326041732|CHC13|33477||04/01/2016|12/31/9999|$1|950.58|0|0|0||IMPLANT TCAT PULM VLV PERQ|| 58-1699775|1326041732|CHC13|33478||11/01/2013|12/31/9999|$2|355.17|0|0|||REVISION OF HEART CHAMBER|| 58-1699775|1326041732|CHC13|33496||11/01/2013|12/31/9999|$2|495.66|0|0|||REPAIR| PROSTH VALVE CLOT|| 58-1699775|1326041732|CHC13|33500||11/01/2013|12/31/9999|$2|360.60|0|0|||REPAIR HEART VESSEL FISTULA|| 58-1699775|1326041732|CHC13|33501||11/01/2013|12/31/9999|$1|681.24|0|0|||REPAIR HEART VESSEL FISTULA|| 58-1699775|1326041732|CHC13|33502||11/01/2013|12/31/9999|$1|903.83|0|0|||CORONARY ARTERY CORRECTION|| 58-1699775|1326041732|CHC13|33503||11/01/2013|12/31/9999|$1|944.51|0|0|||CORONARY ARTERY GRAFT|| 58-1699775|1326041732|CHC13|33504||11/01/2013|12/31/9999|$2|192.22|0|0|||CORONARY ARTERY GRAFT|| 58-1699775|1326041732|CHC13|33505||11/01/2013|12/31/9999|$3|097.64|0|0|||REPAIR ARTERY W/TUNNEL|| 58-1699775|1326041732|CHC13|33506||11/01/2013|12/31/9999|$3|066.61|0|0|||REPAIR ARTERY| TRANSLOCATION|| 58-1699775|1326041732|CHC13|33507||11/01/2013|12/31/9999|$2|571.29|0|0|||REPAIR ART| INTRAMURAL|| 58-1699775|1326041732|CHC13|33508||11/01/2013|12/31/9999|$24.19|0|0|||ENDOSCOPIC VEIN HARVEST|| 58-1699775|1326041732|CHC13|3350F||11/01/2013|12/31/9999|$0.00|0|0|||MAMM ASS CAT BIOPSY PRO MALIGN|| 58-1699775|1326041732|CHC13|33510||11/01/2013|12/31/9999|$2|908.83|0|0|||CABG| VEIN| SINGLE|| 58-1699775|1326041732|CHC13|33511||11/01/2013|12/31/9999|$3|193.19|0|0|||CABG| VEIN| TWO|| 58-1699775|1326041732|CHC13|33512||11/01/2013|12/31/9999|$3|626.61|0|0|||CABG| VEIN| THREE|| 58-1699775|1326041732|CHC13|33513||11/01/2013|12/31/9999|$3|725.20|0|0|||CABG| VEIN| FOUR|| 58-1699775|1326041732|CHC13|33514||11/01/2013|12/31/9999|$3|938.25|0|0|||CABG| VEIN| FIVE|| 58-1699775|1326041732|CHC13|33516||11/01/2013|12/31/9999|$4|104.70|0|0|||CABG| VEIN| SIX OR MORE|| 58-1699775|1326041732|CHC13|33517||11/01/2013|12/31/9999|$281.45|0|0|||CABG| ARTERY-VEIN| SINGLE|| 58-1699775|1326041732|CHC13|33518||11/01/2013|12/31/9999|$618.71|0|0|||CABG| ARTERY-VEIN| TWO|| 58-1699775|1326041732|CHC13|33519||11/01/2013|12/31/9999|$819.12|0|0|||CABG| ARTERY-VEIN| THREE|| 58-1699775|1326041732|CHC13|3351F||11/01/2013|12/31/9999|$0.00|0|0|||NEG SCRN DEP SYMP BY DEPTOOL|| 58-1699775|1326041732|CHC13|33521||11/01/2013|12/31/9999|$984.92|0|0|||CABG| ARTERY-VEIN| FOUR|| 58-1699775|1326041732|CHC13|33522||11/01/2013|12/31/9999|$1|107.73|0|0|||CABG| ARTERY-VEIN| FIVE|| 58-1699775|1326041732|CHC13|33523||11/01/2013|12/31/9999|$1|258.35|0|0|||CABG| ART-VEIN| SIX OR MORE|| 58-1699775|1326041732|CHC13|3352F||11/01/2013|12/31/9999|$0.00|0|0|||NO SIG DEP SYMP BY DEP TOOL|| 58-1699775|1326041732|CHC13|33530||11/01/2013|12/31/9999|$788.66|0|0|||CORONARY ARTERY| BYPASS/REOP|| 58-1699775|1326041732|CHC13|33533||11/01/2013|12/31/9999|$2|815.34|0|0|||CABG| ARTERIAL| SINGLE|| 58-1699775|1326041732|CHC13|33534||11/01/2013|12/31/9999|$3|305.68|0|0|||CABG| ARTERIAL| TWO|| 58-1699775|1326041732|CHC13|33535||11/01/2013|12/31/9999|$3|684.49|0|0|||CABG| ARTERIAL| THREE|| 58-1699775|1326041732|CHC13|33536||11/01/2013|12/31/9999|$3|971.04|0|0|||CABG| ARTERIAL| FOUR OR MORE|| 58-1699775|1326041732|CHC13|3353F||11/01/2013|12/31/9999|$0.00|0|0|||MILD-MOD DEP SYMP BY DEPTOOL|| 58-1699775|1326041732|CHC13|33542||11/01/2013|12/31/9999|$3|928.99|0|0|||REMOVAL OF HEART LESION|| 58-1699775|1326041732|CHC13|33545||11/01/2013|12/31/9999|$4|625.13|0|0|||REPAIR OF HEART DAMAGE|| 58-1699775|1326041732|CHC13|33548||11/01/2013|12/31/9999|$4|460.50|0|0|||RESTORE/REMODEL| VENTRICLE|| 58-1699775|1326041732|CHC13|3354F||11/01/2013|12/31/9999|$0.00|0|0|||CLIN SIG DEP SYM BY DEP TOOL|| 58-1699775|1326041732|CHC13|33572||11/01/2013|12/31/9999|$348.47|0|0|||OPEN CORONARY ENDARTERECTOMY|| 58-1699775|1326041732|CHC13|33600||11/01/2013|12/31/9999|$2|550.53|0|0|||CLOSURE OF VALVE|| 58-1699775|1326041732|CHC13|33602||11/01/2013|12/31/9999|$2|439.67|0|0|||CLOSURE OF VALVE|| 58-1699775|1326041732|CHC13|33606||11/01/2013|12/31/9999|$2|709.01|0|0|||ANASTOMOSIS/ARTERY-AORTA|| 58-1699775|1326041732|CHC13|33608||11/01/2013|12/31/9999|$2|679.41|0|0|||REPAIR ANOMALY W/CONDUIT|| 58-1699775|1326041732|CHC13|33610||11/01/2013|12/31/9999|$2|640.52|0|0|||REPAIR BY ENLARGEMENT|| 58-1699775|1326041732|CHC13|33611||11/01/2013|12/31/9999|$3|014.44|0|0|||REPAIR DOUBLE VENTRICLE|| 58-1699775|1326041732|CHC13|33612||11/01/2013|12/31/9999|$2|954.96|0|0|||REPAIR DOUBLE VENTRICLE|| 58-1699775|1326041732|CHC13|33615||11/01/2013|12/31/9999|$2|983.72|0|0|||REPAIR| MODIFIED FONTAN|| 58-1699775|1326041732|CHC13|33617||11/01/2013|12/31/9999|$3|216.10|0|0|||REPAIR SINGLE VENTRICLE|| 58-1699775|1326041732|CHC13|33619||11/01/2013|12/31/9999|$4|022.30|0|0|||REPAIR SINGLE VENTRICLE|| 58-1699775|1326041732|CHC13|33620||11/01/2013|12/31/9999|$2|461.53|0|0|||APPLY R&L PULM ART BANDS|| 58-1699775|1326041732|CHC13|33621||11/01/2013|12/31/9999|$1|321.97|0|0|||TRANSTHOR CATH FOR STENT|| 58-1699775|1326041732|CHC13|33622||11/01/2013|12/31/9999|$5|183.64|0|0|||REDO COMPL CARDIAC ANOMALY|| 58-1699775|1326041732|CHC13|33641||11/01/2013|12/31/9999|$2|445.00|0|0|||REPAIR HEART SEPTUM DEFECT|| 58-1699775|1326041732|CHC13|33645||11/01/2013|12/31/9999|$2|591.20|0|0|||REVISION OF HEART VEINS|| 58-1699775|1326041732|CHC13|33647||11/01/2013|12/31/9999|$2|738.72|0|0|||REPAIR HEART SEPTUM DEFECTS|| 58-1699775|1326041732|CHC13|33660||11/01/2013|12/31/9999|$2|637.28|0|0|||REPAIR OF HEART DEFECTS|| 58-1699775|1326041732|CHC13|33665||11/01/2013|12/31/9999|$2|878.86|0|0|||REPAIR OF HEART DEFECTS|| 58-1699775|1326041732|CHC13|33670||11/01/2013|12/31/9999|$2|975.90|0|0|||REPAIR OF HEART CHAMBERS|| 58-1699775|1326041732|CHC13|33675||11/01/2013|12/31/9999|$2|962.90|0|0|||CLOSE MULT VSD|| 58-1699775|1326041732|CHC13|33676||11/01/2013|12/31/9999|$3|137.87|0|0|||CLOSE MULT VSD W/RESECTION|| 58-1699775|1326041732|CHC13|33677||11/01/2013|12/31/9999|$3|260.90|0|0|||CL MULT VSD W/REM PUL BAND|| 58-1699775|1326041732|CHC13|33681||11/01/2013|12/31/9999|$2|738.72|0|0|||REPAIR HEART SEPTUM DEFECT|| 58-1699775|1326041732|CHC13|33684||11/01/2013|12/31/9999|$2|844.51|0|0|||REPAIR HEART SEPTUM DEFECT|| 58-1699775|1326041732|CHC13|33688||11/01/2013|12/31/9999|$2|831.97|0|0|||REPAIR HEART SEPTUM DEFECT|| 58-1699775|1326041732|CHC13|33690||11/01/2013|12/31/9999|$1|771.21|0|0|||REINFORCE PULMONARY ARTERY|| 58-1699775|1326041732|CHC13|33692||11/01/2013|12/31/9999|$2|945.80|0|0|||REPAIR OF HEART DEFECTS|| 58-1699775|1326041732|CHC13|33694||11/01/2013|12/31/9999|$2|940.16|0|0|||REPAIR OF HEART DEFECTS|| 58-1699775|1326041732|CHC13|33697||11/01/2013|12/31/9999|$3|080.16|0|0|||REPAIR OF HEART DEFECTS|| 58-1699775|1326041732|CHC13|33702||11/01/2013|12/31/9999|$2|316.80|0|0|||REPAIR OF HEART DEFECTS|| 58-1699775|1326041732|CHC13|3370F||11/01/2013|12/31/9999|$0.00|0|0|||AJCC BRST CNCR STAGE 0 DOCD|| 58-1699775|1326041732|CHC13|33710||11/01/2013|12/31/9999|$3|086.20|0|0|||REPAIR OF HEART DEFECTS|| 58-1699775|1326041732|CHC13|33720||11/01/2013|12/31/9999|$2|303.41|0|0|||REPAIR OF HEART DEFECT|| 58-1699775|1326041732|CHC13|33722||11/01/2013|12/31/9999|$2|494.69|0|0|||REPAIR OF HEART DEFECT|| 58-1699775|1326041732|CHC13|33724||11/01/2013|12/31/9999|$2|303.15|0|0|||REPAIR VENOUS ANOMALY|| 58-1699775|1326041732|CHC13|33726||11/01/2013|12/31/9999|$3|070.32|0|0|||REPAIR PUL VENOUS STENOSIS|| 58-1699775|1326041732|CHC13|3372F||11/01/2013|12/31/9999|$0.00|0|0|||AJCC BRST CNCR STAGE 1+DOCD|| 58-1699775|1326041732|CHC13|33730||11/01/2013|12/31/9999|$3|103.83|0|0|||REPAIR HEART-VEIN DEFECT(S)|| 58-1699775|1326041732|CHC13|33732||11/01/2013|12/31/9999|$2|473.14|0|0|||REPAIR HEART-VEIN DEFECT|| 58-1699775|1326041732|CHC13|33735||11/01/2013|12/31/9999|$1|908.11|0|0|||REVISION OF HEART CHAMBER|| 58-1699775|1326041732|CHC13|33736||11/01/2013|12/31/9999|$2|102.86|0|0|||REVISION OF HEART CHAMBER|| 58-1699775|1326041732|CHC13|33737||11/01/2013|12/31/9999|$1|963.62|0|0|||REVISION OF HEART CHAMBER|| 58-1699775|1326041732|CHC13|3374F||11/01/2013|12/31/9999|$0.00|0|0|||AJCC BRST CNCR STAGE 1+DOCD|| 58-1699775|1326041732|CHC13|33750||11/01/2013|12/31/9999|$2|039.83|0|0|||MAJOR VESSEL SHUNT|| 58-1699775|1326041732|CHC13|33755||11/01/2013|12/31/9999|$1|962.88|0|0|||MAJOR VESSEL SHUNT|| 58-1699775|1326041732|CHC13|33762||11/01/2013|12/31/9999|$2|000.76|0|0|||MAJOR VESSEL SHUNT|| 58-1699775|1326041732|CHC13|33764||11/01/2013|12/31/9999|$1|919.61|0|0|||MAJOR VESSEL SHUNT & GRAFT|| 58-1699775|1326041732|CHC13|33766||11/01/2013|12/31/9999|$2|026.90|0|0|||MAJOR VESSEL SHUNT|| 58-1699775|1326041732|CHC13|33767||11/01/2013|12/31/9999|$2|130.37|0|0|||MAJOR VESSEL SHUNT|| 58-1699775|1326041732|CHC13|33768||11/01/2013|12/31/9999|$652.66|0|0|||CAVOPULMONARY SHUNTING|| 58-1699775|1326041732|CHC13|3376F||11/01/2013|12/31/9999|$0.00|0|0|||AJCC BRSTCNCR STAGE 2 DOCD|| 58-1699775|1326041732|CHC13|33770||11/01/2013|12/31/9999|$3|250.39|0|0|||REPAIR GREAT VESSELS DEFECT|| 58-1699775|1326041732|CHC13|33771||11/01/2013|12/31/9999|$3|314.39|0|0|||REPAIR GREAT VESSELS DEFECT|| 58-1699775|1326041732|CHC13|33774||11/01/2013|12/31/9999|$2|702.27|0|0|||REPAIR GREAT VESSELS DEFECT|| 58-1699775|1326041732|CHC13|33775||11/01/2013|12/31/9999|$2|854.27|0|0|||REPAIR GREAT VESSELS DEFECT|| 58-1699775|1326041732|CHC13|33776||11/01/2013|12/31/9999|$3|013.56|0|0|||REPAIR GREAT VESSELS DEFECT|| 58-1699775|1326041732|CHC13|33777||11/01/2013|12/31/9999|$2|926.93|0|0|||REPAIR GREAT VESSELS DEFECT|| 58-1699775|1326041732|CHC13|33778||11/01/2013|12/31/9999|$3|544.02|0|0|||REPAIR GREAT VESSELS DEFECT|| 58-1699775|1326041732|CHC13|33779||11/01/2013|12/31/9999|$3|621.47|0|0|||REPAIR GREAT VESSELS DEFECT|| 58-1699775|1326041732|CHC13|33780||11/01/2013|12/31/9999|$3|696.25|0|0|||REPAIR GREAT VESSELS DEFECT|| 58-1699775|1326041732|CHC13|33781||11/01/2013|12/31/9999|$3|492.53|0|0|||REPAIR GREAT VESSELS DEFECT|| 58-1699775|1326041732|CHC13|33782||11/01/2013|12/31/9999|$4|775.33|0|0|||NIKAIDOH PROC|| 58-1699775|1326041732|CHC13|33783||11/01/2013|12/31/9999|$5|171.33|0|0|||NIKAIDOH PROC W/OSTIA IMPLT|| 58-1699775|1326041732|CHC13|33786||11/01/2013|12/31/9999|$3|433.14|0|0|||REPAIR ARTERIAL TRUNK|| 58-1699775|1326041732|CHC13|33788||11/01/2013|12/31/9999|$2|305.00|0|0|||REVISION OF PULMONARY ARTERY|| 58-1699775|1326041732|CHC13|3378F||11/01/2013|12/31/9999|$0.00|0|0|||AJCC BRSTCNCR STAGE 3 DOCD|| 58-1699775|1326041732|CHC13|33800||11/01/2013|12/31/9999|$1|397.78|0|0|||AORTIC SUSPENSION|| 58-1699775|1326041732|CHC13|33802||11/01/2013|12/31/9999|$1|614.80|0|0|||REPAIR VESSEL DEFECT|| 58-1699775|1326041732|CHC13|33803||11/01/2013|12/31/9999|$1|776.02|0|0|||REPAIR VESSEL DEFECT|| 58-1699775|1326041732|CHC13|3380F||11/01/2013|12/31/9999|$0.00|0|0|||AJCC BRSTCNCR STAGE 4 DOCD|| 58-1699775|1326041732|CHC13|33813||11/01/2013|12/31/9999|$1|862.54|0|0|||REPAIR SEPTAL DEFECT|| 58-1699775|1326041732|CHC13|33814||11/01/2013|12/31/9999|$2|368.99|0|0|||REPAIR SEPTAL DEFECT|| 58-1699775|1326041732|CHC13|33820||11/01/2013|12/31/9999|$1|453.65|0|0|||REVISE MAJOR VESSEL|| 58-1699775|1326041732|CHC13|33822||11/01/2013|12/31/9999|$1|564.83|0|0|||REVISE MAJOR VESSEL|| 58-1699775|1326041732|CHC13|33824||11/01/2013|12/31/9999|$1|747.12|0|0|||REVISE MAJOR VESSEL|| 58-1699775|1326041732|CHC13|3382F||11/01/2013|12/31/9999|$0.00|0|0|||AJCC CLN CNCR STAGE 0 DOCD|| 58-1699775|1326041732|CHC13|33840||11/01/2013|12/31/9999|$1|876.69|0|0|||REMOVE AORTA CONSTRICTION|| 58-1699775|1326041732|CHC13|33845||11/01/2013|12/31/9999|$2|012.57|0|0|||REMOVE AORTA CONSTRICTION|| 58-1699775|1326041732|CHC13|3384F||11/01/2013|12/31/9999|$0.00|0|0|||AJCC CLN CNCR STAGE 1 DOCD|| 58-1699775|1326041732|CHC13|33851||11/01/2013|12/31/9999|$1|971.48|0|0|||REMOVE AORTA CONSTRICTION|| 58-1699775|1326041732|CHC13|33852||11/01/2013|12/31/9999|$2|075.40|0|0|||REPAIR SEPTAL DEFECT|| 58-1699775|1326041732|CHC13|33853||11/01/2013|12/31/9999|$2|766.72|0|0|||REPAIR SEPTAL DEFECT|| 58-1699775|1326041732|CHC13|33860||11/01/2013|12/31/9999|$4|803.56|0|0|||ASCENDING AORTIC GRAFT|| 58-1699775|1326041732|CHC13|33863||11/01/2013|12/31/9999|$4|725.52|0|0|||ASCENDING AORTIC GRAFT|| 58-1699775|1326041732|CHC13|33864||11/01/2013|12/31/9999|$4|834.40|0|0|||ASCENDING AORTIC GRAFT|| 58-1699775|1326041732|CHC13|3386F||11/01/2013|12/31/9999|$0.00|0|0|||AJCC CLN CNCR STAGE 2 DOCD|| 58-1699775|1326041732|CHC13|33870||11/01/2013|12/31/9999|$3|779.27|0|0|||TRANSVERSE AORTIC ARCH GRAFT|| 58-1699775|1326041732|CHC13|33875||11/01/2013|12/31/9999|$4|099.14|0|0|||THORACIC AORTIC GRAFT|| 58-1699775|1326041732|CHC13|33877||11/01/2013|12/31/9999|$5|431.09|0|0|||THORACOABDOMINAL GRAFT|| 58-1699775|1326041732|CHC13|33880||11/01/2013|12/31/9999|$2|734.22|0|0|||ENDOVASC TAA REPR INCL SUBCL|| 58-1699775|1326041732|CHC13|33881||11/01/2013|12/31/9999|$2|352.97|0|0|||ENDOVASC TAA REPR W/O SUBCL|| 58-1699775|1326041732|CHC13|33883||11/01/2013|12/31/9999|$1|703.39|0|0|||INSERT ENDOVASC PROSTH| TAA|| 58-1699775|1326041732|CHC13|33884||11/01/2013|12/31/9999|$623.67|0|0|||ENDOVASC PROSTH| TAA| ADD-ON|| 58-1699775|1326041732|CHC13|33886||11/01/2013|12/31/9999|$1|478.09|0|0|||ENDOVASC PROSTH| DELAYED|| 58-1699775|1326041732|CHC13|33889||11/01/2013|12/31/9999|$1|217.03|0|0|||ARTERY TRANSPOSE/ENDOVAS TAA|| 58-1699775|1326041732|CHC13|3388F||11/01/2013|12/31/9999|$0.00|0|0|||AJCC CLN CNCR STAGE 3 DOCD|| 58-1699775|1326041732|CHC13|33891||11/01/2013|12/31/9999|$1|500.19|0|0|||CAR-CAR BP GRFT/ENDOVAS TAA|| 58-1699775|1326041732|CHC13|3390F||11/01/2013|12/31/9999|$0.00|0|0|||AJCC CLN CNCR STAGE 4 DOCD|| 58-1699775|1326041732|CHC13|33910||11/01/2013|12/31/9999|$3|882.38|0|0|||REMOVE LUNG ARTERY EMBOLI|| 58-1699775|1326041732|CHC13|33915||11/01/2013|12/31/9999|$2|044.19|0|0|||REMOVE LUNG ARTERY EMBOLI|| 58-1699775|1326041732|CHC13|33916||11/01/2013|12/31/9999|$6|121.75|0|0|||SURGERY OF GREAT VESSEL|| 58-1699775|1326041732|CHC13|33917||11/01/2013|12/31/9999|$2|179.71|0|0|||REPAIR PULMONARY ARTERY|| 58-1699775|1326041732|CHC13|33920||11/01/2013|12/31/9999|$2|718.92|0|0|||REPAIR PULMONARY ATRESIA|| 58-1699775|1326041732|CHC13|33922||11/01/2013|12/31/9999|$2|157.80|0|0|||TRANSECT PULMONARY ARTERY|| 58-1699775|1326041732|CHC13|33924||11/01/2013|12/31/9999|$427.14|0|0|||REMOVE PULMONARY SHUNT|| 58-1699775|1326041732|CHC13|33925||11/01/2013|12/31/9999|$2|569.81|0|0|||RPR PUL ART UNIFOCAL W/O CPB|| 58-1699775|1326041732|CHC13|33926||11/01/2013|12/31/9999|$3|626.35|0|0|||REPR PUL ART| UNIFOCAL W/CPB|| 58-1699775|1326041732|CHC13|33927||04/01/2018|12/31/9999|$3|958.28|0|0|0||IMPLTJ TOT RPLCMT HRT SYS|| 58-1699775|1326041732|CHC13|33930||11/01/2013|12/31/9999|$0.00|0|0|||REMOVAL OF DONOR HEART/LUNG|| 58-1699775|1326041732|CHC13|33933||11/01/2013|12/31/9999|$0.00|0|0|||PREPARE DONOR HEART/LUNG|| 58-1699775|1326041732|CHC13|33935||11/01/2013|12/31/9999|$7|368.85|0|0|||TRANSPLANTATION| HEART/LUNG|| 58-1699775|1326041732|CHC13|33940||11/01/2013|12/31/9999|$0.00|0|0|||REMOVAL OF DONOR HEART|| 58-1699775|1326041732|CHC13|33944||11/01/2013|12/31/9999|$0.00|0|0|||PREPARE DONOR HEART|| 58-1699775|1326041732|CHC13|33945||11/01/2013|12/31/9999|$7|237.61|0|0|||TRANSPLANTATION OF HEART|| 58-1699775|1326041732|CHC13|33946||04/01/2015|12/31/9999|$467.15|0|0|0||ECMO/ECLS INITIATION VENOUS|| 58-1699775|1326041732|CHC13|33947||04/01/2015|12/31/9999|$516.01|0|0|0||ECMO/ECLS INITIATION ARTERY|| 58-1699775|1326041732|CHC13|33948||04/01/2015|12/31/9999|$368.88|0|0|0||ECMO/ECLS DAILY MGMT-VENOUS|| 58-1699775|1326041732|CHC13|33949||04/01/2015|12/31/9999|$358.99|0|0|0||ECMO/ECLS DAILY MGMT ARTERY|| 58-1699775|1326041732|CHC13|3394F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|33951||04/01/2015|12/31/9999|$667.92|0|0|0||ECMO/ECLS INSJ PRPH CANNULA|| 58-1699775|1326041732|CHC13|33952||04/01/2015|12/31/9999|$650.51|0|0|0||ECMO/ECLS INSJ PRPH CANNULA|| 58-1699775|1326041732|CHC13|33953||04/01/2015|12/31/9999|$745.16|0|0|0||ECMO/ECLS INSJ PRPH CANNULA|| 58-1699775|1326041732|CHC13|33954||04/01/2015|12/31/9999|$726.79|0|0|0||ECMO/ECLS INSJ PRPH CANNULA|| 58-1699775|1326041732|CHC13|33955||04/01/2015|12/31/9999|$1|342.87|0|0|0||ECMO/ECLS INSJ CTR CANNULA|| 58-1699775|1326041732|CHC13|33956||04/01/2015|12/31/9999|$1|275.24|0|0|0||ECMO/ECLS INSJ CTR CANNULA|| 58-1699775|1326041732|CHC13|33957||04/01/2015|12/31/9999|$298.00|0|0|0||ECMO/ECLS REPOS PERPH CNULA|| 58-1699775|1326041732|CHC13|33958||04/01/2015|12/31/9999|$288.83|0|0|0||ECMO/ECLS REPOS PERPH CNULA|| 58-1699775|1326041732|CHC13|33959||04/01/2015|12/31/9999|$378.63|0|0|0||ECMO/ECLS REPOS PERPH CNULA|| 58-1699775|1326041732|CHC13|3395F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|33962||04/01/2015|12/31/9999|$356.90|0|0|0||ECMO/ECLS REPOS PERPH CNULA|| 58-1699775|1326041732|CHC13|33963||04/01/2015|12/31/9999|$756.63|0|0|0||ECMO/ECLS REPOS PERPH CNULA|| 58-1699775|1326041732|CHC13|33964||04/01/2015|12/31/9999|$776.29|0|0|0||ECMO/ECLS REPOS PERPH CNULA|| 58-1699775|1326041732|CHC13|33965||04/01/2015|12/31/9999|$298.00|0|0|0||ECMO/ECLS RMVL PERPH CANNULA|| 58-1699775|1326041732|CHC13|33966||04/01/2015|12/31/9999|$359.48|0|0|0||ECMO/ECLS RMVL PRPH CANNULA|| 58-1699775|1326041732|CHC13|33967||11/01/2013|12/31/9999|$390.90|0|0|||INSERT IA PERCUT DEVICE|| 58-1699775|1326041732|CHC13|33968||11/01/2013|12/31/9999|$50.77|0|0|||REMOVE AORTIC ASSIST DEVICE|| 58-1699775|1326041732|CHC13|33969||04/01/2015|12/31/9999|$439.26|0|0|0||ECMO/ECLS RMVL PERPH CANNULA|| 58-1699775|1326041732|CHC13|33970||11/01/2013|12/31/9999|$535.42|0|0|||AORTIC CIRCULATION ASSIST|| 58-1699775|1326041732|CHC13|33971||11/01/2013|12/31/9999|$1|059.81|0|0|||AORTIC CIRCULATION ASSIST|| 58-1699775|1326041732|CHC13|33973||11/01/2013|12/31/9999|$776.81|0|0|||INSERT BALLOON DEVICE|| 58-1699775|1326041732|CHC13|33974||11/01/2013|12/31/9999|$1|324.71|0|0|||REMOVE INTRA-AORTIC BALLOON|| 58-1699775|1326041732|CHC13|33975||11/01/2013|12/31/9999|$1|956.75|0|0|||IMPLANT VENTRICULAR DEVICE|| 58-1699775|1326041732|CHC13|33976||11/01/2013|12/31/9999|$2|396.02|0|0|||IMPLANT VENTRICULAR DEVICE|| 58-1699775|1326041732|CHC13|33977||11/01/2013|12/31/9999|$1|727.35|0|0|||REMOVE VENTRICULAR DEVICE|| 58-1699775|1326041732|CHC13|33978||11/01/2013|12/31/9999|$2|048.46|0|0|||REMOVE VENTRICULAR DEVICE|| 58-1699775|1326041732|CHC13|33979||11/01/2013|12/31/9999|$2|975.55|0|0|||INSERT INTRACORPOREAL DEVICE|| 58-1699775|1326041732|CHC13|33980||11/01/2013|12/31/9999|$2|875.86|0|0|||REMOVE INTRACORPOREAL DEVICE|| 58-1699775|1326041732|CHC13|33981||11/01/2013|12/31/9999|$1|254.15|0|0|||REPLACE VAD PUMP EXT|| 58-1699775|1326041732|CHC13|33982||11/01/2013|12/31/9999|$2|934.93|0|0|||REPLACE VAD INTRA W/O BP|| 58-1699775|1326041732|CHC13|33983||11/01/2013|12/31/9999|$3|446.24|0|0|||REPLACE VAD INTRA W/BP|| 58-1699775|1326041732|CHC13|33984||04/01/2015|12/31/9999|$432.85|0|0|0||ECMO/ECLS RMVL PRPH CANNULA|| 58-1699775|1326041732|CHC13|33985||04/01/2015|12/31/9999|$827.68|0|0|0||ECMO/ECLS RMVL CTR CANNULA|| 58-1699775|1326041732|CHC13|33986||04/01/2015|12/31/9999|$789.64|0|0|0||ECMO/ECLS RMVL CTR CANNULA|| 58-1699775|1326041732|CHC13|33987||04/01/2015|12/31/9999|$316.85|0|0|0||ARTERY EXPOS/GRAFT ARTERY|| 58-1699775|1326041732|CHC13|33988||04/01/2015|12/31/9999|$1|177.93|0|0|0||INSERTION OF LEFT HEART VENT|| 58-1699775|1326041732|CHC13|33989||04/01/2015|12/31/9999|$748.73|0|0|0||REMOVAL OF LEFT HEART VENT|| 58-1699775|1326041732|CHC13|33990||11/01/2013|12/31/9999|$637.78|0|0|||INSERT VAD ARTERY ACCESS|| 58-1699775|1326041732|CHC13|33991||11/01/2013|12/31/9999|$929.31|0|0|||INSERT VAD ART&VEIN ACCESS|| 58-1699775|1326041732|CHC13|33992||11/01/2013|12/31/9999|$304.04|0|0|||REMOVE VAD DIFFERENT SESSION|| 58-1699775|1326041732|CHC13|33993||11/01/2013|12/31/9999|$266.94|0|0|||REPOSITION VAD DIFF SESSION|| 58-1699775|1326041732|CHC13|33999||11/01/2013|12/31/9999|$0.00|0|0|||CARDIAC SURGERY PROCEDURE|| 58-1699775|1326041732|CHC13|34001||11/01/2013|12/31/9999|$1|475.27|0|0|||REMOVAL OF ARTERY CLOT|| 58-1699775|1326041732|CHC13|34051||11/01/2013|12/31/9999|$1|400.76|0|0|||REMOVAL OF ARTERY CLOT|| 58-1699775|1326041732|CHC13|34101||11/01/2013|12/31/9999|$922.18|0|0|||REMOVAL OF ARTERY CLOT|| 58-1699775|1326041732|CHC13|34111||11/01/2013|12/31/9999|$923.07|0|0|||REMOVAL OF ARM ARTERY CLOT|| 58-1699775|1326041732|CHC13|34151||11/01/2013|12/31/9999|$2|136.17|0|0|||REMOVAL OF ARTERY CLOT|| 58-1699775|1326041732|CHC13|34201||11/01/2013|12/31/9999|$1|574.55|0|0|||REMOVAL OF ARTERY CLOT|| 58-1699775|1326041732|CHC13|34203||11/01/2013|12/31/9999|$1|469.72|0|0|||REMOVAL OF LEG ARTERY CLOT|| 58-1699775|1326041732|CHC13|34401||11/01/2013|12/31/9999|$2|182.92|0|0|||REMOVAL OF VEIN CLOT|| 58-1699775|1326041732|CHC13|34421||11/01/2013|12/31/9999|$1|117.69|0|0|||REMOVAL OF VEIN CLOT|| 58-1699775|1326041732|CHC13|34451||11/01/2013|12/31/9999|$2|236.77|0|0|||REMOVAL OF VEIN CLOT|| 58-1699775|1326041732|CHC13|34471||11/01/2013|12/31/9999|$1|797.18|0|0|||REMOVAL OF VEIN CLOT|| 58-1699775|1326041732|CHC13|34490||11/01/2013|12/31/9999|$938.07|0|0|||REMOVAL OF VEIN CLOT|| 58-1699775|1326041732|CHC13|34501||11/01/2013|12/31/9999|$1|389.10|0|0|||REPAIR VALVE| FEMORAL VEIN|| 58-1699775|1326041732|CHC13|34502||11/01/2013|12/31/9999|$2|300.92|0|0|||RECONSTRUCT VENA CAVA|| 58-1699775|1326041732|CHC13|3450F||11/01/2013|12/31/9999|$0.00|0|0|||DYSPNEA SCRND NO-MILD DYSP|| 58-1699775|1326041732|CHC13|34510||11/01/2013|12/31/9999|$1|717.62|0|0|||TRANSPOSITION OF VEIN VALVE|| 58-1699775|1326041732|CHC13|3451F||11/01/2013|12/31/9999|$0.00|0|0|||DYSPNEA SCRND MOD-HIGH DYSP|| 58-1699775|1326041732|CHC13|34520||11/01/2013|12/31/9999|$1|537.33|0|0|||CROSS-OVER VEIN GRAFT|| 58-1699775|1326041732|CHC13|3452F||11/01/2013|12/31/9999|$0.00|0|0|||DYSPNEA NOT SCREENED|| 58-1699775|1326041732|CHC13|34530||11/01/2013|12/31/9999|$1|438.47|0|0|||LEG VEIN FUSION|| 58-1699775|1326041732|CHC13|3455F||11/01/2013|12/31/9999|$0.00|0|0|||TB SCRNG DONE-INTERPD 6MON|| 58-1699775|1326041732|CHC13|34701||04/01/2018|12/31/9999|$1|909.49|0|0|0||EVASC RPR A-AO NDGFT|| 58-1699775|1326041732|CHC13|34702||04/01/2018|12/31/9999|$2|854.85|0|0|0||EVASC RPR A-AO NDGFT RPT|| 58-1699775|1326041732|CHC13|34703||04/01/2018|12/31/9999|$2|154.50|0|0|0||EVASC RPR A-UNILAC NDGFT|| 58-1699775|1326041732|CHC13|34704||04/01/2018|12/31/9999|$3|586.87|0|0|0||EVASC RPR A-UNILAC NDGFT RPT|| 58-1699775|1326041732|CHC13|34705||04/01/2018|12/31/9999|$2|372.09|0|0|0||EVAC RPR A-BIILIAC NDGFT|| 58-1699775|1326041732|CHC13|34706||04/01/2018|12/31/9999|$3|573.67|0|0|0||EVASC RPR A-BIILIAC RPT|| 58-1699775|1326041732|CHC13|34707||04/01/2018|12/31/9999|$1|781.88|0|0|0||EVASC RPR ILIO-ILIAC NDGFT|| 58-1699775|1326041732|CHC13|34708||04/01/2018|12/31/9999|$2|871.31|0|0|0||EVASC RPR ILIO-ILIAC RPT|| 58-1699775|1326041732|CHC13|34709||04/01/2018|12/31/9999|$503.87|0|0|0||PLMT XTN PROSTH EVASC RPR|| 58-1699775|1326041732|CHC13|3470F||11/01/2013|12/31/9999|$0.00|0|0|||RA DISEASE ACTIVITY LOW|| 58-1699775|1326041732|CHC13|34710||04/01/2018|12/31/9999|$1|240.28|0|0|0||DLYD PLMT XTN PROSTH 1ST VSL|| 58-1699775|1326041732|CHC13|34711||04/01/2018|12/31/9999|$465.25|0|0|0||DLYD PLMT XTN PROSTH EA ADDL|| 58-1699775|1326041732|CHC13|34712||04/01/2018|12/31/9999|$1|052.41|0|0|0||TCAT DLVR ENHNCD FIXJ DEV|| 58-1699775|1326041732|CHC13|34713||04/01/2018|12/31/9999|$199.99|0|0|0||PERQ ACCESS & CLSR FEM ART|| 58-1699775|1326041732|CHC13|34714||04/01/2018|12/31/9999|$419.39|0|0|0||OPN FEM ART EXPOS CNDT CRTJ|| 58-1699775|1326041732|CHC13|34715||04/01/2018|12/31/9999|$468.99|0|0|0||OPN AX/SUBCLA ART EXPOS|| 58-1699775|1326041732|CHC13|34716||04/01/2018|12/31/9999|$581.03|0|0|0||OPN AX/SUBCLA ART EXPOS CNDT|| 58-1699775|1326041732|CHC13|3471F||11/01/2013|12/31/9999|$0.00|0|0|||RA DISEASE ACTIVITY MOD|| 58-1699775|1326041732|CHC13|3472F||11/01/2013|12/31/9999|$0.00|0|0|||RA DISEASE ACTIVITY HIGH|| 58-1699775|1326041732|CHC13|3475F||11/01/2013|12/31/9999|$0.00|0|0|||DISEASE PROGN RA POOR DOCD|| 58-1699775|1326041732|CHC13|3476F||11/01/2013|12/31/9999|$0.00|0|0|||DISEASE PROGN RA GOOD DOCD|| 58-1699775|1326041732|CHC13|34800||11/01/2013|12/31/9999|$1|719.29|0|0|||ENDOVAS AAA REPR W/SM TUBE|| 58-1699775|1326041732|CHC13|34802||11/01/2013|12/31/9999|$1|900.53|0|0|||ENDOVAS AAA REPR W/2-P PART|| 58-1699775|1326041732|CHC13|34803||11/01/2013|12/31/9999|$1|960.38|0|0|||ENDOVAS AAA REPR W/3-P PART|| 58-1699775|1326041732|CHC13|34804||11/01/2013|12/31/9999|$1|901.06|0|0|||ENDOVAS AAA REPR W/1-P PART|| 58-1699775|1326041732|CHC13|34805||11/01/2013|12/31/9999|$1|817.14|0|0|||ENDOVAS AAA REPR W/LONG TUBE|| 58-1699775|1326041732|CHC13|34806||11/01/2013|12/31/9999|$156.76|0|0|||ANEURYSM PRESS SENSOR ADD-ON|| 58-1699775|1326041732|CHC13|34808||11/01/2013|12/31/9999|$313.51|0|0|||ENDOVAS ILIAC A DEVICE ADDON|| 58-1699775|1326041732|CHC13|34812||11/01/2013|12/31/9999|$514.76|0|0|||XPOSE FOR ENDOPROSTH| FEMORL|| 58-1699775|1326041732|CHC13|34813||11/01/2013|12/31/9999|$362.70|0|0|||FEMORAL ENDOVAS GRAFT ADD-ON|| 58-1699775|1326041732|CHC13|34820||11/01/2013|12/31/9999|$741.33|0|0|||XPOSE FOR ENDOPROSTH| ILIAC|| 58-1699775|1326041732|CHC13|34825||11/01/2013|12/31/9999|$1|062.12|0|0|||ENDOVASC EXTEND PROSTH| INIT|| 58-1699775|1326041732|CHC13|34826||11/01/2013|12/31/9999|$313.48|0|0|||ENDOVASC EXTEN PROSTH| ADD'L|| 58-1699775|1326041732|CHC13|34830||11/01/2013|12/31/9999|$2|740.87|0|0|||OPEN AORTIC TUBE PROSTH REPR|| 58-1699775|1326041732|CHC13|34831||11/01/2013|12/31/9999|$2|936.85|0|0|||OPEN AORTOILIAC PROSTH REPR|| 58-1699775|1326041732|CHC13|34832||11/01/2013|12/31/9999|$2|947.40|0|0|||OPEN AORTOFEMOR PROSTH REPR|| 58-1699775|1326041732|CHC13|34833||11/01/2013|12/31/9999|$930.91|0|0|||XPOSE FOR ENDOPROSTH| ILIAC|| 58-1699775|1326041732|CHC13|34834||11/01/2013|12/31/9999|$419.42|0|0|||XPOSE| ENDOPROSTH| BRACHIAL|| 58-1699775|1326041732|CHC13|34839||04/01/2015|12/31/9999|$65.00|0|0|0|%|PLNNING PT SPEC FENEST GRAFT|| 58-1699775|1326041732|CHC13|34900||11/01/2013|12/31/9999|$1|360.03|0|0|||ENDOVASC ILIAC REPR W/GRAFT|| 58-1699775|1326041732|CHC13|3490F||11/01/2013|12/31/9999|$0.00|0|0|||HISTORY AIDS-DEFINING COND|| 58-1699775|1326041732|CHC13|3491F||11/01/2013|12/31/9999|$0.00|0|0|||HIV UNSURE BABY OF HIV+MOMS|| 58-1699775|1326041732|CHC13|3492F||11/01/2013|12/31/9999|$0.00|0|0|||HISTORY CD4+ CELL COUNT <350|| 58-1699775|1326041732|CHC13|3493F||11/01/2013|12/31/9999|$0.00|0|0|||NO HIST CD4+ CELL COUNT<350|| 58-1699775|1326041732|CHC13|3494F||11/01/2013|12/31/9999|$0.00|0|0|||CD4+CELL COUNT <200CELLS/MM3|| 58-1699775|1326041732|CHC13|3495F||11/01/2013|12/31/9999|$0.00|0|0|||CD4+CELL CNT 200-499 CELLS|| 58-1699775|1326041732|CHC13|3496F||11/01/2013|12/31/9999|$0.00|0|0|||CD4+ CELL COUNT + 500 CELLS|| 58-1699775|1326041732|CHC13|3497F||11/01/2013|12/31/9999|$0.00|0|0|||CD4+ CELL PERCENTAGE <15%|| 58-1699775|1326041732|CHC13|3498F||11/01/2013|12/31/9999|$0.00|0|0|||CD4+ CELL % >=15% (HIV)|| 58-1699775|1326041732|CHC13|35001||11/01/2013|12/31/9999|$1|730.55|0|0|||REPAIR DEFECT OF ARTERY|| 58-1699775|1326041732|CHC13|35002||11/01/2013|12/31/9999|$1|908.85|0|0|||REPAIR ARTERY RUPTURE| NECK|| 58-1699775|1326041732|CHC13|35005||11/01/2013|12/31/9999|$1|624.13|0|0|||REPAIR DEFECT OF ARTERY|| 58-1699775|1326041732|CHC13|3500F||11/01/2013|12/31/9999|$0.00|0|0|||CD4+CELL CNT/% DOCD AS DONE|| 58-1699775|1326041732|CHC13|35011||11/01/2013|12/31/9999|$1|525.91|0|0|||REPAIR DEFECT OF ARTERY|| 58-1699775|1326041732|CHC13|35013||11/01/2013|12/31/9999|$1|891.94|0|0|||REPAIR ARTERY RUPTURE| ARM|| 58-1699775|1326041732|CHC13|35021||11/01/2013|12/31/9999|$1|854.21|0|0|||REPAIR DEFECT OF ARTERY|| 58-1699775|1326041732|CHC13|35022||11/01/2013|12/31/9999|$2|144.81|0|0|||REPAIR ARTERY RUPTURE| CHEST|| 58-1699775|1326041732|CHC13|3502F||11/01/2013|12/31/9999|$0.00|0|0|||HIV RNA VRL LD 3 YRS|| 58-1699775|1326041732|CHC13|36415||11/01/2013|12/31/9999|$4.50|0|0|||ROUTINE VENIPUNCTURE|| 58-1699775|1326041732|CHC13|36416||11/01/2013|12/31/9999|$4.50|0|0|||CAPILLARY BLOOD DRAW|| 58-1699775|1326041732|CHC13|36420||11/01/2013|12/31/9999|$75.13|0|0|||VEIN ACCESS CUTDOWN < 1 YR|| 58-1699775|1326041732|CHC13|36425||11/01/2013|12/31/9999|$58.23|0|0|||VEIN ACCESS CUTDOWN > 1 YR|| 58-1699775|1326041732|CHC13|36430||11/01/2013|12/31/9999|$46.32|0|0|||BLOOD TRANSFUSION SERVICE|| 58-1699775|1326041732|CHC13|36440||11/01/2013|12/31/9999|$82.30|0|0|||BL PUSH TRANSFUSE| 2 YR OR <|| 58-1699775|1326041732|CHC13|36450||11/01/2013|12/31/9999|$158.50|0|0|||BL EXCHANGE/TRANSFUSE| NB|| 58-1699775|1326041732|CHC13|36455||11/01/2013|12/31/9999|$171.05|0|0|||BL EXCHANGE/TRANSFUSE NON-NB|| 58-1699775|1326041732|CHC13|36456||04/01/2017|12/31/9999|$166.34|0|166.34|0||PRTL EXCHANGE TRANSFUSE NB|| 58-1699775|1326041732|CHC13|36460||11/01/2013|12/31/9999|$521.03|0|0|||TRANSFUSION SERVICE| FETAL|| 58-1699775|1326041732|CHC13|36465||04/01/2018|12/31/9999|$185.29|0|0|0||NJX NONCMPND SCLRSNT 1 VEIN|| 58-1699775|1326041732|CHC13|36466||04/01/2018|12/31/9999|$235.60|0|0|0||NJX NONCMPND SCLRSNT MLT VN|| 58-1699775|1326041732|CHC13|36468||11/01/2013|12/31/9999|$0.00|0|0|||INJECTION(S)| SPIDER VEINS|| 58-1699775|1326041732|CHC13|36470||11/01/2013|12/31/9999|$118.39|0|0|||INJECTION THERAPY OF VEIN|| 58-1699775|1326041732|CHC13|36471||11/01/2013|12/31/9999|$148.02|0|0|||INJECTION THERAPY OF VEINS|| 58-1699775|1326041732|CHC13|36473||04/01/2017|12/31/9999|$2|283.60|0|269.7|0||ENDOVENOUS MCHNCHEM 1ST VEIN|| 58-1699775|1326041732|CHC13|36474||04/01/2017|12/31/9999|$418.28|0|135.12|0||ENDOVENOUS MCHNCHEM ADD-ON|| 58-1699775|1326041732|CHC13|36475||01/01/2017|12/31/9999|$2|118.46|0|527.29|||ENDOVENOUS RF| 1ST VEIN|| 58-1699775|1326041732|CHC13|36476||11/01/2013|12/31/9999|$259.41|0|0|||ENDOVENOUS RF| VEIN ADD-ON|| 58-1699775|1326041732|CHC13|36478||11/01/2013|12/31/9999|$525.31|0|0|||ENDOVENOUS LASER| 1ST VEIN|| 58-1699775|1326041732|CHC13|36479||11/01/2013|12/31/9999|$259.30|0|0|||ENDOVENOUS LASER VEIN ADDON|| 58-1699775|1326041732|CHC13|36481||11/01/2013|12/31/9999|$526.44|0|0|||INSERTION OF CATHETER| VEIN|| 58-1699775|1326041732|CHC13|36482||04/01/2018|12/31/9999|$274.70|0|0|0||ENDOVEN THER CHEM ADHES 1ST|| 58-1699775|1326041732|CHC13|36483||04/01/2018|12/31/9999|$137.02|0|0|0||ENDOVEN THER CHEM ADHES SBSQ|| 58-1699775|1326041732|CHC13|36500||11/01/2013|12/31/9999|$266.22|0|0|||INSERTION OF CATHETER| VEIN|| 58-1699775|1326041732|CHC13|3650F||11/01/2013|12/31/9999|$0.00|0|0|||EEG ORDERED RVWD REQSTD|| 58-1699775|1326041732|CHC13|36510||11/01/2013|12/31/9999|$89.03|0|0|||INSERTION OF CATHETER| VEIN|| 58-1699775|1326041732|CHC13|36511||11/01/2013|12/31/9999|$138.31|0|0|||APHERESIS WBC|| 58-1699775|1326041732|CHC13|36512||11/01/2013|12/31/9999|$133.56|0|0|||APHERESIS RBC|| 58-1699775|1326041732|CHC13|36513||11/01/2013|12/31/9999|$145.29|0|0|||APHERESIS PLATELETS|| 58-1699775|1326041732|CHC13|36514||11/01/2013|12/31/9999|$135.56|0|0|||APHERESIS PLASMA|| 58-1699775|1326041732|CHC13|36515||11/01/2013|12/31/9999|$135.97|0|0|||APHERESIS| ADSORP/REINFUSE|| 58-1699775|1326041732|CHC13|36516||11/01/2013|12/31/9999|$102.25|0|0|||APHERESIS| SELECTIVE|| 58-1699775|1326041732|CHC13|36522||11/01/2013|12/31/9999|$146.49|0|0|||PHOTOPHERESIS|| 58-1699775|1326041732|CHC13|36555||11/01/2013|12/31/9999|$179.35|0|0|||INSERT NON-TUNNEL CV CATH|| 58-1699775|1326041732|CHC13|36556||11/01/2013|12/31/9999|$178.55|0|0|||INSERT NON-TUNNEL CV CATH|| 58-1699775|1326041732|CHC13|36557||11/01/2013|12/31/9999|$472.25|0|0|||INSERT TUNNELED CV CATH|| 58-1699775|1326041732|CHC13|36558||11/01/2013|12/31/9999|$409.14|0|0|||INSERT TUNNELED CV CATH|| 58-1699775|1326041732|CHC13|36560||11/01/2013|12/31/9999|$527.45|0|0|||INSERT TUNNELED CV CATH|| 58-1699775|1326041732|CHC13|36561||11/01/2013|12/31/9999|$519.59|0|0|||INSERT TUNNELED CV CATH|| 58-1699775|1326041732|CHC13|36563||11/01/2013|12/31/9999|$551.68|0|0|||INSERT TUNNELED CV CATH|| 58-1699775|1326041732|CHC13|36565||11/01/2013|12/31/9999|$518.51|0|0|||INSERT TUNNELED CV CATH|| 58-1699775|1326041732|CHC13|36566||11/01/2013|12/31/9999|$558.22|0|0|||INSERT TUNNELED CV CATH|| 58-1699775|1326041732|CHC13|36568||11/01/2013|12/31/9999|$140.03|0|0|||INSERT PICC CATH|| 58-1699775|1326041732|CHC13|36569||11/01/2013|12/31/9999|$134.00|0|0|||INSERT PICC CATH|| 58-1699775|1326041732|CHC13|36570||11/01/2013|12/31/9999|$449.10|0|0|||INSERT PICVAD CATH|| 58-1699775|1326041732|CHC13|36571||11/01/2013|12/31/9999|$469.52|0|0|||INSERT PICVAD CATH|| 58-1699775|1326041732|CHC13|36575||11/01/2013|12/31/9999|$52.24|0|0|||REPAIR TUNNELED CV CATH|| 58-1699775|1326041732|CHC13|36576||11/01/2013|12/31/9999|$284.57|0|0|||REPAIR TUNNELED CV CATH|| 58-1699775|1326041732|CHC13|36578||11/01/2013|12/31/9999|$316.35|0|0|||REPLACE TUNNELED CV CATH|| 58-1699775|1326041732|CHC13|36580||11/01/2013|12/31/9999|$97.85|0|0|||REPLACE CVAD CATH|| 58-1699775|1326041732|CHC13|36581||11/01/2013|12/31/9999|$289.76|0|0|||REPLACE TUNNELED CV CATH|| 58-1699775|1326041732|CHC13|36582||11/01/2013|12/31/9999|$449.99|0|0|||REPLACE TUNNELED CV CATH|| 58-1699775|1326041732|CHC13|36583||11/01/2013|12/31/9999|$471.28|0|0|||REPLACE TUNNELED CV CATH|| 58-1699775|1326041732|CHC13|36584||11/01/2013|12/31/9999|$96.28|0|0|||REPLACE PICC CATH|| 58-1699775|1326041732|CHC13|36585||11/01/2013|12/31/9999|$410.44|0|0|||REPLACE PICVAD CATH|| 58-1699775|1326041732|CHC13|36589||11/01/2013|12/31/9999|$204.09|0|0|||REMOVAL TUNNELED CV CATH|| 58-1699775|1326041732|CHC13|36590||11/01/2013|12/31/9999|$299.00|0|0|||REMOVAL TUNNELED CV CATH|| 58-1699775|1326041732|CHC13|36591||11/01/2013|12/31/9999|$31.19|0|0|||DRAW BLOOD OFF VENOUS DEVICE|| 58-1699775|1326041732|CHC13|36592||11/01/2013|12/31/9999|$35.32|0|0|||COLLECT BLOOD FROM PICC|| 58-1699775|1326041732|CHC13|36593||11/01/2013|12/31/9999|$40.36|0|0|||DECLOT VASCULAR DEVICE|| 58-1699775|1326041732|CHC13|36595||11/01/2013|12/31/9999|$272.84|0|0|||MECH REMOV TUNNELED CV CATH|| 58-1699775|1326041732|CHC13|36596||11/01/2013|12/31/9999|$65.95|0|0|||MECH REMOV TUNNELED CV CATH|| 58-1699775|1326041732|CHC13|36597||11/01/2013|12/31/9999|$89.46|0|0|||REPOSITION VENOUS CATHETER|| 58-1699775|1326041732|CHC13|36598||11/01/2013|12/31/9999|$61.73|0|0|||INJ W/FLUOR| EVAL CV DEVICE|| 58-1699775|1326041732|CHC13|36600||11/01/2013|12/31/9999|$22.34|0|0|||WITHDRAWAL OF ARTERIAL BLOOD|| 58-1699775|1326041732|CHC13|36620||11/01/2013|12/31/9999|$75.37|0|0|||INSERTION CATHETER| ARTERY|| 58-1699775|1326041732|CHC13|36625||11/01/2013|12/31/9999|$158.35|0|0|||INSERTION CATHETER| ARTERY|| 58-1699775|1326041732|CHC13|36640||11/01/2013|12/31/9999|$188.10|0|0|||INSERTION CATHETER| ARTERY|| 58-1699775|1326041732|CHC13|36660||11/01/2013|12/31/9999|$111.43|0|0|||INSERTION CATHETER| ARTERY|| 58-1699775|1326041732|CHC13|36680||11/01/2013|12/31/9999|$87.74|0|0|||INSERT NEEDLE| BONE CAVITY|| 58-1699775|1326041732|CHC13|36800||11/01/2013|12/31/9999|$236.58|0|0|||INSERTION OF CANNULA|| 58-1699775|1326041732|CHC13|36810||11/01/2013|12/31/9999|$315.63|0|0|||INSERTION OF CANNULA|| 58-1699775|1326041732|CHC13|36815||11/01/2013|12/31/9999|$223.11|0|0|||INSERTION OF CANNULA|| 58-1699775|1326041732|CHC13|36818||11/01/2013|12/31/9999|$1|009.09|0|0|||AV FUSE| UPPR ARM| CEPHALIC|| 58-1699775|1326041732|CHC13|36819||11/01/2013|12/31/9999|$1|116.37|0|0|||AV FUSE| UPPR ARM| BASILIC|| 58-1699775|1326041732|CHC13|36820||11/01/2013|12/31/9999|$1|212.32|0|0|||AV FUSION/FOREARM VEIN|| 58-1699775|1326041732|CHC13|36821||11/01/2013|12/31/9999|$1|038.75|0|0|||AV FUSION DIRECT ANY SITE|| 58-1699775|1326041732|CHC13|36823||11/01/2013|12/31/9999|$1|952.58|0|0|||INSERTION OF CANNULA(S)|| 58-1699775|1326041732|CHC13|36825||11/01/2013|12/31/9999|$1|179.93|0|0|||ARTERY-VEIN AUTOGRAFT|| 58-1699775|1326041732|CHC13|36830||11/01/2013|12/31/9999|$992.48|0|0|||ARTERY-VEIN NONAUTOGRAFT|| 58-1699775|1326041732|CHC13|36831||11/01/2013|12/31/9999|$688.34|0|0|||OPEN THROMBECT AV FISTULA|| 58-1699775|1326041732|CHC13|36832||11/01/2013|12/31/9999|$874.99|0|0|||AV FISTULA REVISION| OPEN|| 58-1699775|1326041732|CHC13|36833||11/01/2013|12/31/9999|$989.44|0|0|||AV FISTULA REVISION|| 58-1699775|1326041732|CHC13|36835||11/01/2013|12/31/9999|$730.02|0|0|||ARTERY TO VEIN SHUNT|| 58-1699775|1326041732|CHC13|36838||11/01/2013|12/31/9999|$1|749.53|0|0|||DIST REVAS LIGATION| HEMO|| 58-1699775|1326041732|CHC13|36860||11/01/2013|12/31/9999|$159.42|0|0|||EXTERNAL CANNULA DECLOTTING|| 58-1699775|1326041732|CHC13|36861||11/01/2013|12/31/9999|$226.60|0|0|||CANNULA DECLOTTING|| 58-1699775|1326041732|CHC13|36901||04/01/2017|12/31/9999|$871.02|0|226.64|0||INTRO CATH DIALYSIS CIRCUIT|| 58-1699775|1326041732|CHC13|36902||04/01/2017|12/31/9999|$1|852.40|0|337.53|0||INTRO CATH DIALYSIS CIRCUIT|| 58-1699775|1326041732|CHC13|36903||04/01/2017|12/31/9999|$8|494.86|0|461.89|0||INTRO CATH DIALYSIS CIRCUIT|| 58-1699775|1326041732|CHC13|36904||04/01/2017|12/31/9999|$2|700.80|0|531.87|0||THRMBC/NFS DIALYSIS CIRCUIT|| 58-1699775|1326041732|CHC13|36905||04/01/2017|12/31/9999|$3|456.08|0|667.53|0||THRMBC/NFS DIALYSIS CIRCUIT|| 58-1699775|1326041732|CHC13|36906||04/01/2017|12/31/9999|$10|300.95|0|778.96|0||THRMBC/NFS DIALYSIS CIRCUIT|| 58-1699775|1326041732|CHC13|36907||04/01/2017|12/31/9999|$1|108.42|0|194.34|0||BALO ANGIOP CTR DIALYSIS SEG|| 58-1699775|1326041732|CHC13|36908||04/01/2017|12/31/9999|$4|082.70|0|291.24|0||STENT PLMT CTR DIALYSIS SEG|| 58-1699775|1326041732|CHC13|36909||04/01/2017|12/31/9999|$2|978.04|0|276.7|0||DIALYSIS CIRCUIT EMBOLJ|| 58-1699775|1326041732|CHC13|3700F||11/01/2013|12/31/9999|$0.00|0|0|||PSYCH DISORDERS ASSESSED|| 58-1699775|1326041732|CHC13|37140||11/01/2013|12/31/9999|$3|264.35|0|0|||REVISION OF CIRCULATION|| 58-1699775|1326041732|CHC13|37145||11/01/2013|12/31/9999|$3|057.75|0|0|||REVISION OF CIRCULATION|| 58-1699775|1326041732|CHC13|37160||11/01/2013|12/31/9999|$3|105.23|0|0|||REVISION OF CIRCULATION|| 58-1699775|1326041732|CHC13|37180||11/01/2013|12/31/9999|$2|999.71|0|0|||REVISION OF CIRCULATION|| 58-1699775|1326041732|CHC13|37181||11/01/2013|12/31/9999|$3|275.80|0|0|||SPLICE SPLEEN/KIDNEY VEINS|| 58-1699775|1326041732|CHC13|37182||11/01/2013|12/31/9999|$1|241.20|0|0|||INSERT HEPATIC SHUNT (TIPS)|| 58-1699775|1326041732|CHC13|37183||11/01/2013|12/31/9999|$586.03|0|0|||REMOVE HEPATIC SHUNT (TIPS)|| 58-1699775|1326041732|CHC13|37184||11/01/2013|12/31/9999|$676.46|0|0|||PRIM ART MECH THROMBECTOMY|| 58-1699775|1326041732|CHC13|37185||11/01/2013|12/31/9999|$250.47|0|0|||PRIM ART M-THROMBECT ADD-ON|| 58-1699775|1326041732|CHC13|37186||11/01/2013|12/31/9999|$381.03|0|0|||SEC ART M-THROMBECT ADD-ON|| 58-1699775|1326041732|CHC13|37187||11/01/2013|12/31/9999|$609.78|0|0|||VENOUS MECH THROMBECTOMY|| 58-1699775|1326041732|CHC13|37188||11/01/2013|12/31/9999|$433.80|0|0|||VENOUS M-THROMBECTOMY ADD-ON|| 58-1699775|1326041732|CHC13|37191||11/01/2013|12/31/9999|$350.19|0|0|||INS ENDOVAS VENA CAVA FILTR|| 58-1699775|1326041732|CHC13|37192||11/01/2013|12/31/9999|$542.43|0|0|||REDO ENDOVAS VENA CAVA FILTR|| 58-1699775|1326041732|CHC13|37193||11/01/2013|12/31/9999|$541.97|0|0|||REM ENDOVAS VENA CAVA FILTER|| 58-1699775|1326041732|CHC13|37195||11/01/2013|12/31/9999|$1|424.79|0|0|||THROMBOLYTIC THERAPY| STROKE|| 58-1699775|1326041732|CHC13|37197||11/01/2013|12/31/9999|$447.00|0|0|||REMOVE INTRVAS FOREIGN BODY|| 58-1699775|1326041732|CHC13|37200||11/01/2013|12/31/9999|$329.23|0|0|||TRANSCATHETER BIOPSY|| 58-1699775|1326041732|CHC13|37202||11/01/2013|12/31/9999|$488.90|0|0|||TRANSCATHETER THERAPY INFUSE|| 58-1699775|1326041732|CHC13|3720F||11/01/2013|12/31/9999|$0.00|0|0|||COGNIT IMPAIRMENT ASSESSED|| 58-1699775|1326041732|CHC13|37211||11/01/2013|12/31/9999|$591.43|0|0|||THROMBOLYTIC ART THERAPY|| 58-1699775|1326041732|CHC13|37212||11/01/2013|12/31/9999|$522.13|0|0|||THROMBOLYTIC VENOUS THERAPY|| 58-1699775|1326041732|CHC13|37213||11/01/2013|12/31/9999|$365.12|0|0|||THROMBLYTIC ART/VEN THERAPY|| 58-1699775|1326041732|CHC13|37214||11/01/2013|12/31/9999|$213.44|0|0|||CESSJ THERAPY CATH REMOVAL|| 58-1699775|1326041732|CHC13|37215||11/01/2013|12/31/9999|$1|630.62|0|0|||TRANSCATH STENT| CCA W/EPS|| 58-1699775|1326041732|CHC13|37216||11/01/2013|12/31/9999|$1|474.81|0|0|||TRANSCATH STENT| CCA W/O EPS|| 58-1699775|1326041732|CHC13|37217||04/01/2014|12/31/9999|$1|684.38|0|0|||STENT PLACEMT RETRO CAROTID|| 58-1699775|1326041732|CHC13|37218||04/01/2015|12/31/9999|$1|244.51|0|0|0||STENT PLACEMT ANTE CAROTID|| 58-1699775|1326041732|CHC13|37220||11/01/2013|12/31/9999|$621.32|0|0|||ILIAC REVASC|| 58-1699775|1326041732|CHC13|37221||11/01/2013|12/31/9999|$756.92|0|0|||ILIAC REVASC W/STENT|| 58-1699775|1326041732|CHC13|37222||11/01/2013|12/31/9999|$281.93|0|0|||ILIAC REVASC ADD-ON|| 58-1699775|1326041732|CHC13|37223||11/01/2013|12/31/9999|$320.06|0|0|||ILIAC REVASC W/STENT ADD-ON|| 58-1699775|1326041732|CHC13|37224||11/01/2013|12/31/9999|$684.19|0|0|||FEM/POPL REVAS W/TLA|| 58-1699775|1326041732|CHC13|37225||11/01/2013|12/31/9999|$923.72|0|0|||FEM/POPL REVAS W/ATHER|| 58-1699775|1326041732|CHC13|37226||11/01/2013|12/31/9999|$761.30|0|0|||FEM/POPL REVASC W/STENT|| 58-1699775|1326041732|CHC13|37227||11/01/2013|12/31/9999|$1|115.45|0|0|||FEM/POPL REVASC STNT & ATHER|| 58-1699775|1326041732|CHC13|37228||11/01/2013|12/31/9999|$836.96|0|0|||TIB/PER REVASC W/TLA|| 58-1699775|1326041732|CHC13|37229||11/01/2013|12/31/9999|$1|080.90|0|0|||TIB/PER REVASC W/ATHER|| 58-1699775|1326041732|CHC13|37230||11/01/2013|12/31/9999|$1|043.27|0|0|||TIB/PER REVASC W/STENT|| 58-1699775|1326041732|CHC13|37231||11/01/2013|12/31/9999|$1|133.78|0|0|||TIB/PER REVASC STENT & ATHER|| 58-1699775|1326041732|CHC13|37232||11/01/2013|12/31/9999|$302.68|0|0|||TIB/PER REVASC ADD-ON|| 58-1699775|1326041732|CHC13|37233||11/01/2013|12/31/9999|$497.64|0|0|||TIBPER REVASC W/ATHER ADD-ON|| 58-1699775|1326041732|CHC13|37234||11/01/2013|12/31/9999|$414.52|0|0|||REVSC OPN/PRQ TIB/PERO STENT|| 58-1699775|1326041732|CHC13|37235||11/01/2013|12/31/9999|$588.14|0|0|||TIB/PER REVASC STNT & ATHER|| 58-1699775|1326041732|CHC13|37236||04/01/2014|12/31/9999|$700.53|0|0|||OPEN/PERQ PLACE STENT 1ST|| 58-1699775|1326041732|CHC13|37237||04/01/2014|12/31/9999|$327.65|0|0|||OPEN/PERQ PLACE STENT EA ADD|| 58-1699775|1326041732|CHC13|37238||04/01/2014|12/31/9999|$490.71|0|0|||OPEN/PERQ PLACE STENT SAME|| 58-1699775|1326041732|CHC13|37239||04/01/2014|12/31/9999|$228.71|0|0|||OPEN/PERQ PLACE STENT EA ADD|| 58-1699775|1326041732|CHC13|37241||04/01/2014|12/31/9999|$675.38|0|0|||VASC EMBOLIZE/OCCLUDE VENOUS|| 58-1699775|1326041732|CHC13|37242||04/01/2014|12/31/9999|$754.14|0|0|||VASC EMBOLIZE/OCCLUDE ARTERY|| 58-1699775|1326041732|CHC13|37243||04/01/2014|12/31/9999|$899.18|0|0|||VASC EMBOLIZE/OCCLUDE ORGAN|| 58-1699775|1326041732|CHC13|37244||04/01/2014|12/31/9999|$1|048.94|0|0|||VASC EMBOLIZE/OCCLUDE BLEED|| 58-1699775|1326041732|CHC13|37246||04/01/2017|12/31/9999|$3|262.28|0|553.94|0||TRLUML BALO ANGIOP 1ST ART|| 58-1699775|1326041732|CHC13|37247||04/01/2017|12/31/9999|$1|319.99|0|274.55|0||TRLUML BALO ANGIOP ADDL ART|| 58-1699775|1326041732|CHC13|37248||04/01/2017|12/31/9999|$2|259.91|0|476.42|0||TRLUML BALO ANGIOP 1ST VEIN|| 58-1699775|1326041732|CHC13|37249||04/01/2017|12/31/9999|$968.46|0|233.64|0||TRLUML BALO ANGIOP ADDL VEIN|| 58-1699775|1326041732|CHC13|37252||04/01/2016|12/31/9999|$140.23|0|0|0||INTRVASC US NONCORONARY 1ST|| 58-1699775|1326041732|CHC13|37253||04/01/2016|12/31/9999|$112.19|0|0|0||INTRVASC US NONCORONARY ADDL|| 58-1699775|1326041732|CHC13|3725F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|37500||11/01/2013|12/31/9999|$1|037.25|0|0|||ENDOSCOPY LIGATE PERF VEINS|| 58-1699775|1326041732|CHC13|37501||11/01/2013|12/31/9999|$0.00|0|0|||VASCULAR ENDOSCOPY PROCEDURE|| 58-1699775|1326041732|CHC13|3750F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|37565||11/01/2013|12/31/9999|$1|075.36|0|0|||LIGATION OF NECK VEIN|| 58-1699775|1326041732|CHC13|37600||11/01/2013|12/31/9999|$1|055.71|0|0|||LIGATION OF NECK ARTERY|| 58-1699775|1326041732|CHC13|37605||11/01/2013|12/31/9999|$1|211.56|0|0|||LIGATION OF NECK ARTERY|| 58-1699775|1326041732|CHC13|37606||11/01/2013|12/31/9999|$827.27|0|0|||LIGATION OF NECK ARTERY|| 58-1699775|1326041732|CHC13|37607||11/01/2013|12/31/9999|$565.12|0|0|||LIGATION OF A-V FISTULA|| 58-1699775|1326041732|CHC13|37609||11/01/2013|12/31/9999|$303.42|0|0|||TEMPORAL ARTERY PROCEDURE|| 58-1699775|1326041732|CHC13|37615||11/01/2013|12/31/9999|$742.80|0|0|||LIGATION OF NECK ARTERY|| 58-1699775|1326041732|CHC13|37616||11/01/2013|12/31/9999|$1|618.02|0|0|||LIGATION OF CHEST ARTERY|| 58-1699775|1326041732|CHC13|37617||11/01/2013|12/31/9999|$1|959.57|0|0|||LIGATION OF ABDOMEN ARTERY|| 58-1699775|1326041732|CHC13|37618||11/01/2013|12/31/9999|$570.77|0|0|||LIGATION OF EXTREMITY ARTERY|| 58-1699775|1326041732|CHC13|37619||11/01/2013|12/31/9999|$2|403.74|0|0|||LIGATION OF INF VENA CAVA|| 58-1699775|1326041732|CHC13|37650||11/01/2013|12/31/9999|$796.72|0|0|||REVISION OF MAJOR VEIN|| 58-1699775|1326041732|CHC13|37660||11/01/2013|12/31/9999|$1|882.52|0|0|||REVISION OF MAJOR VEIN|| 58-1699775|1326041732|CHC13|37700||11/01/2013|12/31/9999|$376.97|0|0|||REVISE LEG VEIN|| 58-1699775|1326041732|CHC13|37718||11/01/2013|12/31/9999|$653.91|0|0|||LIGATE/STRIP SHORT LEG VEIN|| 58-1699775|1326041732|CHC13|37722||11/01/2013|12/31/9999|$726.12|0|0|||LIGATE/STRIP LONG LEG VEIN|| 58-1699775|1326041732|CHC13|37735||11/01/2013|12/31/9999|$944.40|0|0|||REMOVAL OF LEG VEINS/LESION|| 58-1699775|1326041732|CHC13|3775F||04/01/2015|12/31/9999|$0.00|0|0|0|||| 58-1699775|1326041732|CHC13|37760||11/01/2013|12/31/9999|$939.02|0|0|||LIGATION| LEG VEINS| OPEN|| 58-1699775|1326041732|CHC13|37761||11/01/2013|12/31/9999|$824.47|0|0|||LIGATE LEG VEINS OPEN|| 58-1699775|1326041732|CHC13|37765||11/01/2013|12/31/9999|$678.94|0|0|||PHLEB VEINS - EXTREM - TO 20|| 58-1699775|1326041732|CHC13|37766||11/01/2013|12/31/9999|$830.52|0|0|||PHLEB VEINS - EXTREM 20+|| 58-1699775|1326041732|CHC13|3776F||04/01/2015|12/31/9999|$0.00|0|0|0|||| 58-1699775|1326041732|CHC13|37780||11/01/2013|12/31/9999|$384.45|0|0|||REVISION OF LEG VEIN|| 58-1699775|1326041732|CHC13|37785||11/01/2013|12/31/9999|$389.49|0|0|||LIGATE/DIVIDE/EXCISE VEIN|| 58-1699775|1326041732|CHC13|37788||11/01/2013|12/31/9999|$2|015.80|0|0|||REVASCULARIZATION| PENIS|| 58-1699775|1326041732|CHC13|37790||11/01/2013|12/31/9999|$699.88|0|0|||PENILE VENOUS OCCLUSION|| 58-1699775|1326041732|CHC13|37799||11/01/2013|12/31/9999|$0.00|0|0|||VASCULAR SURGERY PROCEDURE|| 58-1699775|1326041732|CHC13|38100||11/01/2013|12/31/9999|$1|646.74|0|0|||REMOVAL OF SPLEEN| TOTAL|| 58-1699775|1326041732|CHC13|38101||11/01/2013|12/31/9999|$1|661.08|0|0|||REMOVAL OF SPLEEN| PARTIAL|| 58-1699775|1326041732|CHC13|38102||11/01/2013|12/31/9999|$378.12|0|0|||REMOVAL OF SPLEEN| TOTAL|| 58-1699775|1326041732|CHC13|38115||11/01/2013|12/31/9999|$1|817.83|0|0|||REPAIR OF RUPTURED SPLEEN|| 58-1699775|1326041732|CHC13|38120||11/01/2013|12/31/9999|$1|504.27|0|0|||LAPAROSCOPY| SPLENECTOMY|| 58-1699775|1326041732|CHC13|38129||11/01/2013|12/31/9999|$0.00|0|0|||LAPAROSCOPE PROC| SPLEEN|| 58-1699775|1326041732|CHC13|38200||11/01/2013|12/31/9999|$211.40|0|0|||INJECTION FOR SPLEEN X-RAY|| 58-1699775|1326041732|CHC13|38204||11/01/2013|12/31/9999|$146.34|0|0|||BL DONOR SEARCH MANAGEMENT|| 58-1699775|1326041732|CHC13|38205||11/01/2013|12/31/9999|$113.84|0|0|||HARVEST ALLOGENIC STEM CELLS|| 58-1699775|1326041732|CHC13|38206||11/01/2013|12/31/9999|$116.18|0|0|||HARVEST AUTO STEM CELLS|| 58-1699775|1326041732|CHC13|38207||11/01/2013|12/31/9999|$66.61|0|0|||CRYOPRESERVE STEM CELLS|| 58-1699775|1326041732|CHC13|38208||11/01/2013|12/31/9999|$42.41|0|0|||THAW PRESERVED STEM CELLS|| 58-1699775|1326041732|CHC13|38209||11/01/2013|12/31/9999|$17.77|0|0|||WASH HARVEST STEM CELLS|| 58-1699775|1326041732|CHC13|38210||11/01/2013|12/31/9999|$117.91|0|0|||T-CELL DEPLETION OF HARVEST|| 58-1699775|1326041732|CHC13|38211||11/01/2013|12/31/9999|$107.04|0|0|||TUMOR CELL DEPLETE OF HARVST|| 58-1699775|1326041732|CHC13|38212||11/01/2013|12/31/9999|$70.08|0|0|||RBC DEPLETION OF HARVEST|| 58-1699775|1326041732|CHC13|38213||11/01/2013|12/31/9999|$17.77|0|0|||PLATELET DEPLETE OF HARVEST|| 58-1699775|1326041732|CHC13|38214||11/01/2013|12/31/9999|$60.69|0|0|||VOLUME DEPLETE OF HARVEST|| 58-1699775|1326041732|CHC13|38215||11/01/2013|12/31/9999|$70.08|0|0|||HARVEST STEM CELL CONCENTRTE|| 58-1699775|1326041732|CHC13|38220||11/01/2013|12/31/9999|$87.40|0|0|||BONE MARROW ASPIRATION|| 58-1699775|1326041732|CHC13|38221||11/01/2013|12/31/9999|$107.67|0|0|||BONE MARROW BIOPSY|| 58-1699775|1326041732|CHC13|38222||01/01/2018|12/31/9999|$242.20|0|115.98|||DX BONE MARROW BX & ASPIR|| 58-1699775|1326041732|CHC13|38230||11/01/2013|12/31/9999|$267.04|0|0|||BONE MARROW COLLECTION|| 58-1699775|1326041732|CHC13|38232||11/01/2013|12/31/9999|$267.04|0|0|||BONE MARROW HARVEST AUTOLOG|| 58-1699775|1326041732|CHC13|38240||11/01/2013|12/31/9999|$178.80|0|0|||BONE MARROW/STEM TRANSPLANT|| 58-1699775|1326041732|CHC13|38241||11/01/2013|12/31/9999|$178.31|0|0|||BONE MARROW/STEM TRANSPLANT|| 58-1699775|1326041732|CHC13|38242||11/01/2013|12/31/9999|$136.06|0|0|||LYMPHOCYTE INFUSE TRANSPLANT|| 58-1699775|1326041732|CHC13|38243||11/01/2013|12/31/9999|$168.00|0|0|||TRANSPLJ HEMATOPOIETIC BOOST|| 58-1699775|1326041732|CHC13|38300||11/01/2013|12/31/9999|$264.63|0|0|||DRAINAGE| LYMPH NODE LESION|| 58-1699775|1326041732|CHC13|38305||11/01/2013|12/31/9999|$657.62|0|0|||DRAINAGE| LYMPH NODE LESION|| 58-1699775|1326041732|CHC13|38308||11/01/2013|12/31/9999|$641.99|0|0|||INCISION OF LYMPH CHANNELS|| 58-1699775|1326041732|CHC13|38380||11/01/2013|12/31/9999|$826.53|0|0|||THORACIC DUCT PROCEDURE|| 58-1699775|1326041732|CHC13|38381||11/01/2013|12/31/9999|$1|179.44|0|0|||THORACIC DUCT PROCEDURE|| 58-1699775|1326041732|CHC13|38382||11/01/2013|12/31/9999|$1|013.49|0|0|||THORACIC DUCT PROCEDURE|| 58-1699775|1326041732|CHC13|38500||11/01/2013|12/31/9999|$361.13|0|0|||BIOPSY/REMOVAL| LYMPH NODES|| 58-1699775|1326041732|CHC13|38505||11/01/2013|12/31/9999|$102.86|0|0|||NEEDLE BIOPSY| LYMPH NODES|| 58-1699775|1326041732|CHC13|38510||11/01/2013|12/31/9999|$606.39|0|0|||BIOPSY/REMOVAL| LYMPH NODES|| 58-1699775|1326041732|CHC13|38520||11/01/2013|12/31/9999|$667.37|0|0|||BIOPSY/REMOVAL| LYMPH NODES|| 58-1699775|1326041732|CHC13|38525||11/01/2013|12/31/9999|$616.93|0|0|||BIOPSY/REMOVAL| LYMPH NODES|| 58-1699775|1326041732|CHC13|38530||11/01/2013|12/31/9999|$785.76|0|0|||BIOPSY/REMOVAL| LYMPH NODES|| 58-1699775|1326041732|CHC13|38542||11/01/2013|12/31/9999|$748.13|0|0|||EXPLORE DEEP NODE(S)| NECK|| 58-1699775|1326041732|CHC13|38550||11/01/2013|12/31/9999|$716.08|0|0|||REMOVAL| NECK/ARMPIT LESION|| 58-1699775|1326041732|CHC13|38555||11/01/2013|12/31/9999|$1|433.35|0|0|||REMOVAL| NECK/ARMPIT LESION|| 58-1699775|1326041732|CHC13|38562||11/01/2013|12/31/9999|$1|002.79|0|0|||REMOVAL| PELVIC LYMPH NODES|| 58-1699775|1326041732|CHC13|38564||11/01/2013|12/31/9999|$1|006.28|0|0|||REMOVAL| ABDOMEN LYMPH NODES|| 58-1699775|1326041732|CHC13|38570||11/01/2013|12/31/9999|$770.56|0|0|||LAPAROSCOPY| LYMPH NODE BIOP|| 58-1699775|1326041732|CHC13|38571||11/01/2013|12/31/9999|$1|151.53|0|0|||LAPAROSCOPY| LYMPHADENECTOMY|| 58-1699775|1326041732|CHC13|38572||11/01/2013|12/31/9999|$1|370.16|0|0|||LAPAROSCOPY| LYMPHADENECTOMY|| 58-1699775|1326041732|CHC13|38573||04/01/2018|12/31/9999|$1|772.32|0|0|0||LAPS PELVIC LYMPHADEC|| 58-1699775|1326041732|CHC13|38589||11/01/2013|12/31/9999|$0.00|0|0|||LAPAROSCOPE PROC| LYMPHATIC|| 58-1699775|1326041732|CHC13|38700||11/01/2013|12/31/9999|$1|167.50|0|0|||REMOVAL OF LYMPH NODES| NECK|| 58-1699775|1326041732|CHC13|38720||11/01/2013|12/31/9999|$1|953.45|0|0|||REMOVAL OF LYMPH NODES| NECK|| 58-1699775|1326041732|CHC13|38724||11/01/2013|12/31/9999|$2|111.44|0|0|||REMOVAL OF LYMPH NODES| NECK|| 58-1699775|1326041732|CHC13|38740||11/01/2013|12/31/9999|$981.20|0|0|||REMOVE ARMPIT LYMPH NODES|| 58-1699775|1326041732|CHC13|38745||11/01/2013|12/31/9999|$1|244.97|0|0|||REMOVE ARMPIT LYMPH NODES|| 58-1699775|1326041732|CHC13|38746||11/01/2013|12/31/9999|$325.99|0|0|||REMOVE THORACIC LYMPH NODES|| 58-1699775|1326041732|CHC13|38747||11/01/2013|12/31/9999|$384.15|0|0|||REMOVE ABDOMINAL LYMPH NODES|| 58-1699775|1326041732|CHC13|38760||11/01/2013|12/31/9999|$1|205.37|0|0|||REMOVE GROIN LYMPH NODES|| 58-1699775|1326041732|CHC13|38765||11/01/2013|12/31/9999|$1|847.24|0|0|||REMOVE GROIN LYMPH NODES|| 58-1699775|1326041732|CHC13|38770||11/01/2013|12/31/9999|$1|157.50|0|0|||REMOVE PELVIS LYMPH NODES|| 58-1699775|1326041732|CHC13|38780||11/01/2013|12/31/9999|$1|483.94|0|0|||REMOVE ABDOMEN LYMPH NODES|| 58-1699775|1326041732|CHC13|38790||11/01/2013|12/31/9999|$120.33|0|0|||INJECT FOR LYMPHATIC X-RAY|| 58-1699775|1326041732|CHC13|38792||11/01/2013|12/31/9999|$57.85|0|0|||IDENTIFY SENTINEL NODE|| 58-1699775|1326041732|CHC13|38794||11/01/2013|12/31/9999|$421.75|0|0|||ACCESS THORACIC LYMPH DUCT|| 58-1699775|1326041732|CHC13|38900||11/01/2013|12/31/9999|$195.85|0|0|||IO MAP OF SENT LYMPH NODE|| 58-1699775|1326041732|CHC13|38999||11/01/2013|12/31/9999|$0.00|0|0|||BLOOD/LYMPH SYSTEM PROCEDURE|| 58-1699775|1326041732|CHC13|39000||11/01/2013|12/31/9999|$729.25|0|0|||EXPLORATION OF CHEST|| 58-1699775|1326041732|CHC13|39010||11/01/2013|12/31/9999|$1|172.48|0|0|||EXPLORATION OF CHEST|| 58-1699775|1326041732|CHC13|39200||11/01/2013|12/31/9999|$1|301.75|0|0|||REMOVAL CHEST LESION|| 58-1699775|1326041732|CHC13|39220||11/01/2013|12/31/9999|$1|679.85|0|0|||REMOVAL CHEST LESION|| 58-1699775|1326041732|CHC13|39401||04/01/2016|12/31/9999|$466.81|0|0|0||MEDIASTINOSCPY W/MEDSTNL BX|| 58-1699775|1326041732|CHC13|39402||04/01/2016|12/31/9999|$610.48|0|0|0||MEDIASTINOSCPY W/LMPH NOD BX|| 58-1699775|1326041732|CHC13|39499||11/01/2013|12/31/9999|$0.00|0|0|||CHEST PROCEDURE|| 58-1699775|1326041732|CHC13|39501||11/01/2013|12/31/9999|$1|226.75|0|0|||REPAIR DIAPHRAGM LACERATION|| 58-1699775|1326041732|CHC13|39503||11/01/2013|12/31/9999|$8|808.29|0|0|||REPAIR OF DIAPHRAGM HERNIA|| 58-1699775|1326041732|CHC13|39540||11/01/2013|12/31/9999|$1|253.92|0|0|||REPAIR OF DIAPHRAGM HERNIA|| 58-1699775|1326041732|CHC13|39541||11/01/2013|12/31/9999|$1|362.28|0|0|||REPAIR OF DIAPHRAGM HERNIA|| 58-1699775|1326041732|CHC13|39545||11/01/2013|12/31/9999|$1|317.72|0|0|||REVISION OF DIAPHRAGM|| 58-1699775|1326041732|CHC13|39560||11/01/2013|12/31/9999|$1|142.39|0|0|||RESECT DIAPHRAGM| SIMPLE|| 58-1699775|1326041732|CHC13|39561||11/01/2013|12/31/9999|$1|799.88|0|0|||RESECT DIAPHRAGM| COMPLEX|| 58-1699775|1326041732|CHC13|39599||11/01/2013|12/31/9999|$0.00|0|0|||DIAPHRAGM SURGERY PROCEDURE|| 58-1699775|1326041732|CHC13|4000F||11/01/2013|12/31/9999|$0.00|0|0|||TOBACCO USE TXMNT COUNSELING|| 58-1699775|1326041732|CHC13|4001F||11/01/2013|12/31/9999|$0.00|0|0|||TOBACCO USE TXMNT| PHARMACOL|| 58-1699775|1326041732|CHC13|4003F||11/01/2013|12/31/9999|$0.00|0|0|||PT ED WRITE/ORAL| PTS W/ HF|| 58-1699775|1326041732|CHC13|4004F||11/01/2013|12/31/9999|$0.00|0|0|||PT TOBACCO SCREEN RCVD TLK|| 58-1699775|1326041732|CHC13|4005F||11/01/2013|12/31/9999|$0.00|0|0|||PHARM THX FOR OP RX'D|| 58-1699775|1326041732|CHC13|4008F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|4010F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|4011F||11/01/2013|12/31/9999|$0.00|0|0|||ORAL ANTIPLATELET THERAPY RX|| 58-1699775|1326041732|CHC13|4012F||11/01/2013|12/31/9999|$0.00|0|0|||WARFARIN THERAPY RX|| 58-1699775|1326041732|CHC13|4013F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|4014F||11/01/2013|12/31/9999|$0.00|0|0|||WRITTEN DISCHARGE INSTR PRVD|| 58-1699775|1326041732|CHC13|4015F||11/01/2013|12/31/9999|$0.00|0|0|||PERSIST ASTHMA MEDICINE CTRL|| 58-1699775|1326041732|CHC13|4016F||11/01/2013|12/31/9999|$0.00|0|0|||ANTI-INFLM/ANLGSC AGENT RX|| 58-1699775|1326041732|CHC13|4017F||11/01/2013|12/31/9999|$0.00|0|0|||GI PROPHYLAXIS FOR NSAID RX|| 58-1699775|1326041732|CHC13|4018F||11/01/2013|12/31/9999|$0.00|0|0|||THERAPY EXERCISE JOINT RX|| 58-1699775|1326041732|CHC13|4019F||11/01/2013|12/31/9999|$0.00|0|0|||DOC RECPT COUNSL VIT D/CALC+|| 58-1699775|1326041732|CHC13|4025F||11/01/2013|12/31/9999|$0.00|0|0|||INHALED BRONCHODILATOR RX|| 58-1699775|1326041732|CHC13|4030F||11/01/2013|12/31/9999|$0.00|0|0|||OXYGEN THERAPY RX|| 58-1699775|1326041732|CHC13|4033F||11/01/2013|12/31/9999|$0.00|0|0|||PULMONARY REHAB REC|| 58-1699775|1326041732|CHC13|4035F||11/01/2013|12/31/9999|$0.00|0|0|||INFLUENZA IMM REC|| 58-1699775|1326041732|CHC13|4037F||11/01/2013|12/31/9999|$0.00|0|0|||INFLUENZA IMM ORDER/ADMIN|| 58-1699775|1326041732|CHC13|4040F||11/01/2013|12/31/9999|$0.00|0|0|||PNEUMOC IMM ORDER/ADMIN|| 58-1699775|1326041732|CHC13|4041F||11/01/2013|12/31/9999|$0.00|0|0|||DOC ORDER CEFAZOLIN/CEFUROX.|| 58-1699775|1326041732|CHC13|4042F||11/01/2013|12/31/9999|$0.00|0|0|||DOC ANTIBIO NOT GIVEN|| 58-1699775|1326041732|CHC13|4043F||11/01/2013|12/31/9999|$0.00|0|0|||DOC ORDER GIVEN STOP ANTIBIO|| 58-1699775|1326041732|CHC13|4044F||11/01/2013|12/31/9999|$0.00|0|0|||DOC ORDER GIVEN VTE PROPHYLX|| 58-1699775|1326041732|CHC13|4045F||11/01/2013|12/31/9999|$0.00|0|0|||EMPIRIC ANTIBIOTIC RX|| 58-1699775|1326041732|CHC13|4046F||11/01/2013|12/31/9999|$0.00|0|0|||DOC ANTIBIO GIVEN B/4 SURG|| 58-1699775|1326041732|CHC13|4047F||11/01/2013|12/31/9999|$0.00|0|0|||DOC ANTIBIO GIVEN B/4 SURG|| 58-1699775|1326041732|CHC13|4048F||11/01/2013|12/31/9999|$0.00|0|0|||DOC ANTIBIO GIVEN B/4 SURG|| 58-1699775|1326041732|CHC13|40490||11/01/2013|12/31/9999|$107.50|0|0|||BIOPSY OF LIP|| 58-1699775|1326041732|CHC13|4049F||11/01/2013|12/31/9999|$0.00|0|0|||DOC ORDER GIVEN STOP ANTIBIO|| 58-1699775|1326041732|CHC13|40500||11/01/2013|12/31/9999|$524.97|0|0|||PARTIAL EXCISION OF LIP|| 58-1699775|1326041732|CHC13|4050F||11/01/2013|12/31/9999|$0.00|0|0|||HT CARE PLAN DOC|| 58-1699775|1326041732|CHC13|40510||11/01/2013|12/31/9999|$514.48|0|0|||PARTIAL EXCISION OF LIP|| 58-1699775|1326041732|CHC13|4051F||11/01/2013|12/31/9999|$0.00|0|0|||REFERRED FOR AN AV FISTULA|| 58-1699775|1326041732|CHC13|40520||11/01/2013|12/31/9999|$520.34|0|0|||PARTIAL EXCISION OF LIP|| 58-1699775|1326041732|CHC13|40525||11/01/2013|12/31/9999|$808.74|0|0|||RECONSTRUCT LIP WITH FLAP|| 58-1699775|1326041732|CHC13|40527||11/01/2013|12/31/9999|$912.33|0|0|||RECONSTRUCT LIP WITH FLAP|| 58-1699775|1326041732|CHC13|4052F||11/01/2013|12/31/9999|$0.00|0|0|||HEMODIALYSIS VIA AV FISTULA|| 58-1699775|1326041732|CHC13|40530||11/01/2013|12/31/9999|$587.69|0|0|||PARTIAL REMOVAL OF LIP|| 58-1699775|1326041732|CHC13|4053F||11/01/2013|12/31/9999|$0.00|0|0|||HEMODIALYSIS VIA AV GRAFT|| 58-1699775|1326041732|CHC13|4054F||11/01/2013|12/31/9999|$0.00|0|0|||HEMODIALYSIS VIA CATHETER|| 58-1699775|1326041732|CHC13|4055F||11/01/2013|12/31/9999|$0.00|0|0|||PT. RCVNG PERITON DIALYSIS|| 58-1699775|1326041732|CHC13|4056F||11/01/2013|12/31/9999|$0.00|0|0|||APPROP. ORAL REHYD. RECOMM'D|| 58-1699775|1326041732|CHC13|4058F||11/01/2013|12/31/9999|$0.00|0|0|||PED GASTRO ED GIVEN| CAREGVR|| 58-1699775|1326041732|CHC13|4060F||11/01/2013|12/31/9999|$0.00|0|0|||PSYCH SVCS PROVIDED|| 58-1699775|1326041732|CHC13|4062F||11/01/2013|12/31/9999|$0.00|0|0|||PT REFERRAL PSYCH DOC'D|| 58-1699775|1326041732|CHC13|4063F||11/01/2013|12/31/9999|$0.00|0|0|||ANTIDEPRES RXTHXPY NOT RXD|| 58-1699775|1326041732|CHC13|4064F||11/01/2013|12/31/9999|$0.00|0|0|||ANTIDEPRESSANT RX|| 58-1699775|1326041732|CHC13|40650||11/01/2013|12/31/9999|$425.07|0|0|||REPAIR LIP|| 58-1699775|1326041732|CHC13|40652||11/01/2013|12/31/9999|$512.52|0|0|||REPAIR LIP|| 58-1699775|1326041732|CHC13|40654||11/01/2013|12/31/9999|$615.91|0|0|||REPAIR LIP|| 58-1699775|1326041732|CHC13|4065F||11/01/2013|12/31/9999|$0.00|0|0|||ANTIPSYCHOTIC RX|| 58-1699775|1326041732|CHC13|4066F||11/01/2013|12/31/9999|$0.00|0|0|||ECT PROVIDED|| 58-1699775|1326041732|CHC13|4067F||11/01/2013|12/31/9999|$0.00|0|0|||PT REFERRAL FOR ECT DOC'D|| 58-1699775|1326041732|CHC13|4069F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|40700||11/01/2013|12/31/9999|$1|378.22|0|0|||REPAIR CLEFT LIP/NASAL|| 58-1699775|1326041732|CHC13|40701||11/01/2013|12/31/9999|$1|690.01|0|0|||REPAIR CLEFT LIP/NASAL|| 58-1699775|1326041732|CHC13|40702||11/01/2013|12/31/9999|$1|187.25|0|0|||REPAIR CLEFT LIP/NASAL|| 58-1699775|1326041732|CHC13|4070F||11/01/2013|12/31/9999|$0.00|0|0|||DVT PROPHYLX RECV'D DAY 2|| 58-1699775|1326041732|CHC13|40720||11/01/2013|12/31/9999|$1|499.67|0|0|||REPAIR CLEFT LIP/NASAL|| 58-1699775|1326041732|CHC13|4073F||11/01/2013|12/31/9999|$0.00|0|0|||ORAL ANTIPLAT THX RX DISCHRG|| 58-1699775|1326041732|CHC13|4075F||11/01/2013|12/31/9999|$0.00|0|0|||ANTICOAG THX RX AT DISCHRG|| 58-1699775|1326041732|CHC13|40761||11/01/2013|12/31/9999|$1|500.80|0|0|||REPAIR CLEFT LIP/NASAL|| 58-1699775|1326041732|CHC13|4077F||11/01/2013|12/31/9999|$0.00|0|0|||DOC T-PA ADMIN CONSIDERED|| 58-1699775|1326041732|CHC13|40799||11/01/2013|12/31/9999|$0.00|0|0|||LIP SURGERY PROCEDURE|| 58-1699775|1326041732|CHC13|4079F||11/01/2013|12/31/9999|$0.00|0|0|||DOC REHAB SVCS CONSIDERED|| 58-1699775|1326041732|CHC13|40800||11/01/2013|12/31/9999|$185.95|0|0|||DRAINAGE OF MOUTH LESION|| 58-1699775|1326041732|CHC13|40801||11/01/2013|12/31/9999|$315.95|0|0|||DRAINAGE OF MOUTH LESION|| 58-1699775|1326041732|CHC13|40804||11/01/2013|12/31/9999|$190.41|0|0|||REMOVAL| FOREIGN BODY| MOUTH|| 58-1699775|1326041732|CHC13|40805||11/01/2013|12/31/9999|$322.71|0|0|||REMOVAL| FOREIGN BODY| MOUTH|| 58-1699775|1326041732|CHC13|40806||11/01/2013|12/31/9999|$53.48|0|0|||INCISION OF LIP FOLD|| 58-1699775|1326041732|CHC13|40808||11/01/2013|12/31/9999|$153.99|0|0|||BIOPSY OF MOUTH LESION|| 58-1699775|1326041732|CHC13|40810||11/01/2013|12/31/9999|$183.42|0|0|||EXCISION OF MOUTH LESION|| 58-1699775|1326041732|CHC13|40812||11/01/2013|12/31/9999|$281.03|0|0|||EXCISE/REPAIR MOUTH LESION|| 58-1699775|1326041732|CHC13|40814||11/01/2013|12/31/9999|$435.37|0|0|||EXCISE/REPAIR MOUTH LESION|| 58-1699775|1326041732|CHC13|40816||11/01/2013|12/31/9999|$455.99|0|0|||EXCISION OF MOUTH LESION|| 58-1699775|1326041732|CHC13|40818||11/01/2013|12/31/9999|$386.22|0|0|||EXCISE ORAL MUCOSA FOR GRAFT|| 58-1699775|1326041732|CHC13|40819||11/01/2013|12/31/9999|$334.98|0|0|||EXCISE LIP OR CHEEK FOLD|| 58-1699775|1326041732|CHC13|40820||11/01/2013|12/31/9999|$246.13|0|0|||TREATMENT OF MOUTH LESION|| 58-1699775|1326041732|CHC13|40830||11/01/2013|12/31/9999|$236.90|0|0|||REPAIR MOUTH LACERATION|| 58-1699775|1326041732|CHC13|40831||11/01/2013|12/31/9999|$322.59|0|0|||REPAIR MOUTH LACERATION|| 58-1699775|1326041732|CHC13|40840||11/01/2013|12/31/9999|$886.20|0|0|||RECONSTRUCTION OF MOUTH|| 58-1699775|1326041732|CHC13|40842||11/01/2013|12/31/9999|$910.95|0|0|||RECONSTRUCTION OF MOUTH|| 58-1699775|1326041732|CHC13|40843||11/01/2013|12/31/9999|$1|241.44|0|0|||RECONSTRUCTION OF MOUTH|| 58-1699775|1326041732|CHC13|40844||11/01/2013|12/31/9999|$1|615.21|0|0|||RECONSTRUCTION OF MOUTH|| 58-1699775|1326041732|CHC13|40845||11/01/2013|12/31/9999|$1|784.97|0|0|||RECONSTRUCTION OF MOUTH|| 58-1699775|1326041732|CHC13|4084F||11/01/2013|12/31/9999|$0.00|0|0|||ASPIRIN RECV'D W/IN 24 HRS|| 58-1699775|1326041732|CHC13|4086F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|40899||11/01/2013|12/31/9999|$0.00|0|0|||MOUTH SURGERY PROCEDURE|| 58-1699775|1326041732|CHC13|4090F||11/01/2013|12/31/9999|$0.00|0|0|||PT RCVNG EPO THXPY|| 58-1699775|1326041732|CHC13|4095F||11/01/2013|12/31/9999|$0.00|0|0|||PT NOT RCVNG EPO THXPY|| 58-1699775|1326041732|CHC13|41000||11/01/2013|12/31/9999|$160.90|0|0|||DRAINAGE OF MOUTH LESION|| 58-1699775|1326041732|CHC13|41005||11/01/2013|12/31/9999|$181.75|0|0|||DRAINAGE OF MOUTH LESION|| 58-1699775|1326041732|CHC13|41006||11/01/2013|12/31/9999|$375.20|0|0|||DRAINAGE OF MOUTH LESION|| 58-1699775|1326041732|CHC13|41007||11/01/2013|12/31/9999|$358.87|0|0|||DRAINAGE OF MOUTH LESION|| 58-1699775|1326041732|CHC13|41008||11/01/2013|12/31/9999|$384.11|0|0|||DRAINAGE OF MOUTH LESION|| 58-1699775|1326041732|CHC13|41009||11/01/2013|12/31/9999|$417.56|0|0|||DRAINAGE OF MOUTH LESION|| 58-1699775|1326041732|CHC13|4100F||11/01/2013|12/31/9999|$0.00|0|0|||BIPHOS THXPY VEIN ORD/REC'VD|| 58-1699775|1326041732|CHC13|41010||11/01/2013|12/31/9999|$158.67|0|0|||INCISION OF TONGUE FOLD|| 58-1699775|1326041732|CHC13|41015||11/01/2013|12/31/9999|$485.57|0|0|||DRAINAGE OF MOUTH LESION|| 58-1699775|1326041732|CHC13|41016||11/01/2013|12/31/9999|$499.00|0|0|||DRAINAGE OF MOUTH LESION|| 58-1699775|1326041732|CHC13|41017||11/01/2013|12/31/9999|$500.38|0|0|||DRAINAGE OF MOUTH LESION|| 58-1699775|1326041732|CHC13|41018||11/01/2013|12/31/9999|$587.56|0|0|||DRAINAGE OF MOUTH LESION|| 58-1699775|1326041732|CHC13|41019||11/01/2013|12/31/9999|$664.26|0|0|||PLACE NEEDLES H&N FOR RT|| 58-1699775|1326041732|CHC13|41100||11/01/2013|12/31/9999|$157.17|0|0|||BIOPSY OF TONGUE|| 58-1699775|1326041732|CHC13|41105||11/01/2013|12/31/9999|$161.55|0|0|||BIOPSY OF TONGUE|| 58-1699775|1326041732|CHC13|41108||11/01/2013|12/31/9999|$130.65|0|0|||BIOPSY OF FLOOR OF MOUTH|| 58-1699775|1326041732|CHC13|4110F||11/01/2013|12/31/9999|$0.00|0|0|||INT. MAM ART USED FOR CABG|| 58-1699775|1326041732|CHC13|41110||11/01/2013|12/31/9999|$191.86|0|0|||EXCISION OF TONGUE LESION|| 58-1699775|1326041732|CHC13|41112||11/01/2013|12/31/9999|$362.84|0|0|||EXCISION OF TONGUE LESION|| 58-1699775|1326041732|CHC13|41113||11/01/2013|12/31/9999|$401.07|0|0|||EXCISION OF TONGUE LESION|| 58-1699775|1326041732|CHC13|41114||11/01/2013|12/31/9999|$918.85|0|0|||EXCISION OF TONGUE LESION|| 58-1699775|1326041732|CHC13|41115||11/01/2013|12/31/9999|$213.24|0|0|||EXCISION OF TONGUE FOLD|| 58-1699775|1326041732|CHC13|41116||11/01/2013|12/31/9999|$317.62|0|0|||EXCISION OF MOUTH LESION|| 58-1699775|1326041732|CHC13|41120||11/01/2013|12/31/9999|$1|517.35|0|0|||PARTIAL REMOVAL OF TONGUE|| 58-1699775|1326041732|CHC13|41130||11/01/2013|12/31/9999|$1|886.09|0|0|||PARTIAL REMOVAL OF TONGUE|| 58-1699775|1326041732|CHC13|41135||11/01/2013|12/31/9999|$3|117.18|0|0|||TONGUE AND NECK SURGERY|| 58-1699775|1326041732|CHC13|41140||11/01/2013|12/31/9999|$3|172.57|0|0|||REMOVAL OF TONGUE|| 58-1699775|1326041732|CHC13|41145||11/01/2013|12/31/9999|$4|005.84|0|0|||TONGUE REMOVAL| NECK SURGERY|| 58-1699775|1326041732|CHC13|41150||11/01/2013|12/31/9999|$3|179.33|0|0|||TONGUE| MOUTH| JAW SURGERY|| 58-1699775|1326041732|CHC13|41153||11/01/2013|12/31/9999|$3|446.11|0|0|||TONGUE| MOUTH| NECK SURGERY|| 58-1699775|1326041732|CHC13|41155||11/01/2013|12/31/9999|$4|332.68|0|0|||TONGUE| JAW| & NECK SURGERY|| 58-1699775|1326041732|CHC13|4115F||11/01/2013|12/31/9999|$0.00|0|0|||BETA BLCKR ADMIN W/IN 24 HRS|| 58-1699775|1326041732|CHC13|4120F||11/01/2013|12/31/9999|$0.00|0|0|||ANTIBIOT RX'D/GIVEN|| 58-1699775|1326041732|CHC13|4124F||11/01/2013|12/31/9999|$0.00|0|0|||ANTIBIOT NOT RX'D/GIVEN|| 58-1699775|1326041732|CHC13|41250||11/01/2013|12/31/9999|$217.49|0|0|||REPAIR TONGUE LACERATION|| 58-1699775|1326041732|CHC13|41251||11/01/2013|12/31/9999|$252.79|0|0|||REPAIR TONGUE LACERATION|| 58-1699775|1326041732|CHC13|41252||11/01/2013|12/31/9999|$308.06|0|0|||REPAIR TONGUE LACERATION|| 58-1699775|1326041732|CHC13|4130F||11/01/2013|12/31/9999|$0.00|0|0|||TOPICAL PREP RX| AOE|| 58-1699775|1326041732|CHC13|4131F||11/01/2013|12/31/9999|$0.00|0|0|||SYST ANTIMICROBIAL THX RX|| 58-1699775|1326041732|CHC13|4132F||11/01/2013|12/31/9999|$0.00|0|0|||NO SYST ANTIMICROBIAL THX RX|| 58-1699775|1326041732|CHC13|4133F||11/01/2013|12/31/9999|$0.00|0|0|||ANTIHIST/DECONG RX/RECOM|| 58-1699775|1326041732|CHC13|4134F||11/01/2013|12/31/9999|$0.00|0|0|||NO ANTIHIST/DECONG RX/RECOM|| 58-1699775|1326041732|CHC13|4135F||11/01/2013|12/31/9999|$0.00|0|0|||SYSTEMIC CORTICOSTEROIDS RX|| 58-1699775|1326041732|CHC13|4136F||11/01/2013|12/31/9999|$0.00|0|0|||SYST CORTICOSTEROIDS NOT RX|| 58-1699775|1326041732|CHC13|4140F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|4142F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|4144F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|4145F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|4148F||11/01/2013|12/31/9999|$0.00|0|0|||HEP A VAC INJXN ADMIN/RECVD|| 58-1699775|1326041732|CHC13|4149F||11/01/2013|12/31/9999|$0.00|0|0|||HEP B VAC INJXN ADMIN/RECVD|| 58-1699775|1326041732|CHC13|41500||11/01/2013|12/31/9999|$658.29|0|0|||FIXATION OF TONGUE|| 58-1699775|1326041732|CHC13|4150F||11/01/2013|12/31/9999|$0.00|0|0|||PT RECVNG ANTIVIR TXMNT HEPC|| 58-1699775|1326041732|CHC13|41510||11/01/2013|12/31/9999|$592.52|0|0|||TONGUE TO LIP SURGERY|| 58-1699775|1326041732|CHC13|41512||11/01/2013|12/31/9999|$900.26|0|0|||TONGUE SUSPENSION|| 58-1699775|1326041732|CHC13|4151F||11/01/2013|12/31/9999|$0.00|0|0|||PT NOT RECVNG ANTIV HEP C|| 58-1699775|1326041732|CHC13|41520||11/01/2013|12/31/9999|$363.27|0|0|||RECONSTRUCTION| TONGUE FOLD|| 58-1699775|1326041732|CHC13|41530||06/18/2015|12/31/9999|$4|768.17|0|0|||TONGUE BASE VOL REDUCTION|| 58-1699775|1326041732|CHC13|4153F||11/01/2013|12/31/9999|$0.00|0|0|||COMBO PEGINTF/RIB RX|| 58-1699775|1326041732|CHC13|4155F||11/01/2013|12/31/9999|$0.00|0|0|||HEP A VAC SERIES PREV RECVD|| 58-1699775|1326041732|CHC13|4157F||11/01/2013|12/31/9999|$0.00|0|0|||HEP B VAC SERIES PREV RECVD|| 58-1699775|1326041732|CHC13|4158F||11/01/2013|12/31/9999|$0.00|0|0|||PT EDU RE: ALCOH DRNKNG DONE|| 58-1699775|1326041732|CHC13|41599||11/01/2013|12/31/9999|$0.00|0|0|||TONGUE AND MOUTH SURGERY|| 58-1699775|1326041732|CHC13|4159F||11/01/2013|12/31/9999|$0.00|0|0|||CONTRCP TALK B/4 ANTIV TXMNT|| 58-1699775|1326041732|CHC13|4163F||11/01/2013|12/31/9999|$0.00|0|0|||PT COUNS. 4 TXMNT OPT| PROST|| 58-1699775|1326041732|CHC13|4164F||11/01/2013|12/31/9999|$0.00|0|0|||ADJV HRMNL THXPY RX'D|| 58-1699775|1326041732|CHC13|4165F||11/01/2013|12/31/9999|$0.00|0|0|||3D-CRT/IMRT) RECEIVED|| 58-1699775|1326041732|CHC13|4167F||11/01/2013|12/31/9999|$0.00|0|0|||HD BED TILTED| 1ST DAY VENT|| 58-1699775|1326041732|CHC13|4168F||11/01/2013|12/31/9999|$0.00|0|0|||PT CARE| ICU&VENT W/IN 24HRS|| 58-1699775|1326041732|CHC13|4169F||11/01/2013|12/31/9999|$0.00|0|0|||NO PT CARE ICU/VENT IN 24HRS|| 58-1699775|1326041732|CHC13|4171F||11/01/2013|12/31/9999|$0.00|0|0|||PT. RCVNG ESA THXPY|| 58-1699775|1326041732|CHC13|4172F||11/01/2013|12/31/9999|$0.00|0|0|||PT. NOT RCVNG ESA THXPY|| 58-1699775|1326041732|CHC13|4174F||11/01/2013|12/31/9999|$0.00|0|0|||COUNS.| POTENT. GLAUC IMPCT|| 58-1699775|1326041732|CHC13|4175F||11/01/2013|12/31/9999|$0.00|0|0|||VIS OF >= 20/40 W/IN 90 DAYS|| 58-1699775|1326041732|CHC13|4176F||11/01/2013|12/31/9999|$0.00|0|0|||TALK RE UV LIGHT| PT/CRGVR|| 58-1699775|1326041732|CHC13|4177F||11/01/2013|12/31/9999|$0.00|0|0|||TALK PT/CRGVR RE: AREDS|PREV|| 58-1699775|1326041732|CHC13|4178F||11/01/2013|12/31/9999|$0.00|0|0|||ANTID GLBLN RCV'D W/IN 26WKS|| 58-1699775|1326041732|CHC13|4179F||11/01/2013|12/31/9999|$0.00|0|0|||TAMOXIFEN/AI PRESCRIBED|| 58-1699775|1326041732|CHC13|41800||11/01/2013|12/31/9999|$204.10|0|0|||DRAINAGE OF GUM LESION|| 58-1699775|1326041732|CHC13|41805||11/01/2013|12/31/9999|$238.79|0|0|||REMOVAL FOREIGN BODY| GUM|| 58-1699775|1326041732|CHC13|41806||11/01/2013|12/31/9999|$375.73|0|0|||REMOVAL FOREIGN BODY|JAWBONE|| 58-1699775|1326041732|CHC13|4180F||11/01/2013|12/31/9999|$0.00|0|0|||ADJV THXPYRX'D/RCV'D STG3A-C|| 58-1699775|1326041732|CHC13|4181F||11/01/2013|12/31/9999|$0.00|0|0|||CONFORMAL RAD'N THXPY RCV'D|| 58-1699775|1326041732|CHC13|41820||11/01/2013|12/31/9999|$367.23|0|0|||EXCISION| GUM| EACH QUADRANT|| 58-1699775|1326041732|CHC13|41821||11/01/2013|12/31/9999|$82.83|0|0|||EXCISION OF GUM FLAP|| 58-1699775|1326041732|CHC13|41822||11/01/2013|12/31/9999|$258.32|0|0|||EXCISION OF GUM LESION|| 58-1699775|1326041732|CHC13|41823||11/01/2013|12/31/9999|$458.22|0|0|||EXCISION OF GUM LESION|| 58-1699775|1326041732|CHC13|41825||11/01/2013|12/31/9999|$176.83|0|0|||EXCISION OF GUM LESION|| 58-1699775|1326041732|CHC13|41826||11/01/2013|12/31/9999|$299.12|0|0|||EXCISION OF GUM LESION|| 58-1699775|1326041732|CHC13|41827||11/01/2013|12/31/9999|$439.75|0|0|||EXCISION OF GUM LESION|| 58-1699775|1326041732|CHC13|41828||11/01/2013|12/31/9999|$304.88|0|0|||EXCISION OF GUM LESION|| 58-1699775|1326041732|CHC13|4182F||11/01/2013|12/31/9999|$0.00|0|0|||NO CONFORMAL RAD'N THXPY|| 58-1699775|1326041732|CHC13|41830||11/01/2013|12/31/9999|$401.48|0|0|||REMOVAL OF GUM TISSUE|| 58-1699775|1326041732|CHC13|41850||11/01/2013|12/31/9999|$183.62|0|0|||TREATMENT OF GUM LESION|| 58-1699775|1326041732|CHC13|4185F||11/01/2013|12/31/9999|$0.00|0|0|||CONTINUOUS PPI OR H2RA RCV'D|| 58-1699775|1326041732|CHC13|4186F||11/01/2013|12/31/9999|$0.00|0|0|||NO CONT. PPI OR H2RA RCV'D|| 58-1699775|1326041732|CHC13|41870||11/01/2013|12/31/9999|$459.25|0|0|||GUM GRAFT|| 58-1699775|1326041732|CHC13|41872||11/01/2013|12/31/9999|$415.48|0|0|||REPAIR GUM|| 58-1699775|1326041732|CHC13|41874||11/01/2013|12/31/9999|$361.53|0|0|||REPAIR TOOTH SOCKET|| 58-1699775|1326041732|CHC13|4187F||11/01/2013|12/31/9999|$0.00|0|0|||ANTI RHEUM DRUGTHXPYRX'D/GVN|| 58-1699775|1326041732|CHC13|4188F||11/01/2013|12/31/9999|$0.00|0|0|||APPROP ACE/ARB TSTNG DONE|| 58-1699775|1326041732|CHC13|41899||11/01/2013|12/31/9999|$0.00|0|0|||DENTAL SURGERY PROCEDURE|| 58-1699775|1326041732|CHC13|4189F||11/01/2013|12/31/9999|$0.00|0|0|||APPROP DIGOXIN TSTNG DONE|| 58-1699775|1326041732|CHC13|4190F||11/01/2013|12/31/9999|$0.00|0|0|||APPROP DIURETIC TSTNG DONE|| 58-1699775|1326041732|CHC13|4191F||11/01/2013|12/31/9999|$0.00|0|0|||APPROP ANTICONVULS TSTNG|| 58-1699775|1326041732|CHC13|4192F||11/01/2013|12/31/9999|$0.00|0|0|||PT NOT RCVNG GLUCOCO THXPY|| 58-1699775|1326041732|CHC13|4193F||11/01/2013|12/31/9999|$0.00|0|0|||PT RCVNG<10MG DAILY PREDNISO|| 58-1699775|1326041732|CHC13|4194F||11/01/2013|12/31/9999|$0.00|0|0|||PT RCVNG>10MG DAILY PREDNISO|| 58-1699775|1326041732|CHC13|4195F||11/01/2013|12/31/9999|$0.00|0|0|||PT RCVNG ANTI-RHEUM THXPY RA|| 58-1699775|1326041732|CHC13|4196F||11/01/2013|12/31/9999|$0.00|0|0|||PTNOT RCVNG ANTI-RHM THXPYRA|| 58-1699775|1326041732|CHC13|42000||11/01/2013|12/31/9999|$150.42|0|0|||DRAINAGE MOUTH ROOF LESION|| 58-1699775|1326041732|CHC13|4200F||11/01/2013|12/31/9999|$0.00|0|0|||EXTERNAL BEAM TO PROST ONLY|| 58-1699775|1326041732|CHC13|4201F||11/01/2013|12/31/9999|$0.00|0|0|||EXTRNL BEAM OTHER THAN PROST|| 58-1699775|1326041732|CHC13|42100||11/01/2013|12/31/9999|$158.20|0|0|||BIOPSY ROOF OF MOUTH|| 58-1699775|1326041732|CHC13|42104||11/01/2013|12/31/9999|$201.26|0|0|||EXCISION LESION| MOUTH ROOF|| 58-1699775|1326041732|CHC13|42106||11/01/2013|12/31/9999|$256.01|0|0|||EXCISION LESION| MOUTH ROOF|| 58-1699775|1326041732|CHC13|42107||11/01/2013|12/31/9999|$500.56|0|0|||EXCISION LESION| MOUTH ROOF|| 58-1699775|1326041732|CHC13|4210F||11/01/2013|12/31/9999|$0.00|0|0|||ACE/ARB THXPY FOR >= 6 MONS|| 58-1699775|1326041732|CHC13|42120||11/01/2013|12/31/9999|$1|439.17|0|0|||REMOVE PALATE/LESION|| 58-1699775|1326041732|CHC13|42140||11/01/2013|12/31/9999|$226.53|0|0|||EXCISION OF UVULA|| 58-1699775|1326041732|CHC13|42145||11/01/2013|12/31/9999|$1|028.05|0|0|||REPAIR PALATE| PHARYNX/UVULA|| 58-1699775|1326041732|CHC13|42160||11/01/2013|12/31/9999|$215.40|0|0|||TREATMENT MOUTH ROOF LESION|| 58-1699775|1326041732|CHC13|42180||11/01/2013|12/31/9999|$268.70|0|0|||REPAIR PALATE|| 58-1699775|1326041732|CHC13|42182||11/01/2013|12/31/9999|$377.61|0|0|||REPAIR PALATE|| 58-1699775|1326041732|CHC13|42200||11/01/2013|12/31/9999|$1|252.45|0|0|||RECONSTRUCT CLEFT PALATE|| 58-1699775|1326041732|CHC13|42205||11/01/2013|12/31/9999|$1|271.87|0|0|||RECONSTRUCT CLEFT PALATE|| 58-1699775|1326041732|CHC13|4220F||11/01/2013|12/31/9999|$0.00|0|0|||DIGOXIN THXPY FOR >= 6 MONS|| 58-1699775|1326041732|CHC13|42210||11/01/2013|12/31/9999|$1|606.83|0|0|||RECONSTRUCT CLEFT PALATE|| 58-1699775|1326041732|CHC13|42215||11/01/2013|12/31/9999|$984.86|0|0|||RECONSTRUCT CLEFT PALATE|| 58-1699775|1326041732|CHC13|4221F||11/01/2013|12/31/9999|$0.00|0|0|||DIURETIC THXPY FOR >= 6 MONS|| 58-1699775|1326041732|CHC13|42220||11/01/2013|12/31/9999|$758.79|0|0|||RECONSTRUCT CLEFT PALATE|| 58-1699775|1326041732|CHC13|42225||11/01/2013|12/31/9999|$1|297.13|0|0|||RECONSTRUCT CLEFT PALATE|| 58-1699775|1326041732|CHC13|42226||11/01/2013|12/31/9999|$1|311.26|0|0|||LENGTHENING OF PALATE|| 58-1699775|1326041732|CHC13|42227||11/01/2013|12/31/9999|$1|240.98|0|0|||LENGTHENING OF PALATE|| 58-1699775|1326041732|CHC13|42235||11/01/2013|12/31/9999|$1|069.38|0|0|||REPAIR PALATE|| 58-1699775|1326041732|CHC13|42260||11/01/2013|12/31/9999|$968.99|0|0|||REPAIR NOSE TO LIP FISTULA|| 58-1699775|1326041732|CHC13|42280||11/01/2013|12/31/9999|$160.56|0|0|||PREPARATION| PALATE MOLD|| 58-1699775|1326041732|CHC13|42281||11/01/2013|12/31/9999|$221.61|0|0|||INSERTION| PALATE PROSTHESIS|| 58-1699775|1326041732|CHC13|42299||11/01/2013|12/31/9999|$0.00|0|0|||PALATE/UVULA SURGERY|| 58-1699775|1326041732|CHC13|42300||11/01/2013|12/31/9999|$223.00|0|0|||DRAINAGE OF SALIVARY GLAND|| 58-1699775|1326041732|CHC13|42305||11/01/2013|12/31/9999|$626.08|0|0|||DRAINAGE OF SALIVARY GLAND|| 58-1699775|1326041732|CHC13|4230F||11/01/2013|12/31/9999|$0.00|0|0|||ANTICONV THXPY FOR >= 6 MONS|| 58-1699775|1326041732|CHC13|42310||11/01/2013|12/31/9999|$182.49|0|0|||DRAINAGE OF SALIVARY GLAND|| 58-1699775|1326041732|CHC13|42320||11/01/2013|12/31/9999|$257.35|0|0|||DRAINAGE OF SALIVARY GLAND|| 58-1699775|1326041732|CHC13|42330||11/01/2013|12/31/9999|$240.56|0|0|||REMOVAL OF SALIVARY STONE|| 58-1699775|1326041732|CHC13|42335||11/01/2013|12/31/9999|$375.10|0|0|||REMOVAL OF SALIVARY STONE|| 58-1699775|1326041732|CHC13|42340||11/01/2013|12/31/9999|$492.71|0|0|||REMOVAL OF SALIVARY STONE|| 58-1699775|1326041732|CHC13|42400||11/01/2013|12/31/9999|$80.75|0|0|||BIOPSY OF SALIVARY GLAND|| 58-1699775|1326041732|CHC13|42405||11/01/2013|12/31/9999|$328.89|0|0|||BIOPSY OF SALIVARY GLAND|| 58-1699775|1326041732|CHC13|42408||11/01/2013|12/31/9999|$477.71|0|0|||EXCISION OF SALIVARY CYST|| 58-1699775|1326041732|CHC13|42409||11/01/2013|12/31/9999|$325.20|0|0|||DRAINAGE OF SALIVARY CYST|| 58-1699775|1326041732|CHC13|4240F||11/01/2013|12/31/9999|$0.00|0|0|||INSTR XRCZ 4BK PN >12 WEEKS|| 58-1699775|1326041732|CHC13|42410||11/01/2013|12/31/9999|$908.96|0|0|||EXCISE PAROTID GLAND/LESION|| 58-1699775|1326041732|CHC13|42415||11/01/2013|12/31/9999|$1|554.53|0|0|||EXCISE PAROTID GLAND/LESION|| 58-1699775|1326041732|CHC13|42420||11/01/2013|12/31/9999|$1|750.33|0|0|||EXCISE PAROTID GLAND/LESION|| 58-1699775|1326041732|CHC13|42425||11/01/2013|12/31/9999|$1|227.18|0|0|||EXCISE PAROTID GLAND/LESION|| 58-1699775|1326041732|CHC13|42426||11/01/2013|12/31/9999|$1|985.62|0|0|||EXCISE PAROTID GLAND/LESION|| 58-1699775|1326041732|CHC13|4242F||11/01/2013|12/31/9999|$0.00|0|0|||SPRVSD XRCZ BK PN >12 WEEKS|| 58-1699775|1326041732|CHC13|42440||11/01/2013|12/31/9999|$607.26|0|0|||EXCISE SUBMAXILLARY GLAND|| 58-1699775|1326041732|CHC13|42450||11/01/2013|12/31/9999|$522.66|0|0|||EXCISE SUBLINGUAL GLAND|| 58-1699775|1326041732|CHC13|4245F||11/01/2013|12/31/9999|$0.00|0|0|||PT INSTR| RESUME NRML LIFEST|| 58-1699775|1326041732|CHC13|4248F||11/01/2013|12/31/9999|$0.00|0|0|||PT INSTR-NO BD REST>= 4 DAYS|| 58-1699775|1326041732|CHC13|42500||11/01/2013|12/31/9999|$497.55|0|0|||REPAIR SALIVARY DUCT|| 58-1699775|1326041732|CHC13|42505||11/01/2013|12/31/9999|$659.51|0|0|||REPAIR SALIVARY DUCT|| 58-1699775|1326041732|CHC13|42507||11/01/2013|12/31/9999|$749.01|0|0|||PAROTID DUCT DIVERSION|| 58-1699775|1326041732|CHC13|42509||11/01/2013|12/31/9999|$1|269.21|0|0|||PAROTID DUCT DIVERSION|| 58-1699775|1326041732|CHC13|4250F||11/01/2013|12/31/9999|$0.00|0|0|||WRMNG 4 SURG - NORMOTHERMIA|| 58-1699775|1326041732|CHC13|42510||11/01/2013|12/31/9999|$919.01|0|0|||PAROTID DUCT DIVERSION|| 58-1699775|1326041732|CHC13|42550||11/01/2013|12/31/9999|$91.04|0|0|||INJECTION FOR SALIVARY X-RAY|| 58-1699775|1326041732|CHC13|4255F||11/01/2013|12/31/9999|$0.00|0|0|||ANESTH 60+ MIN AS DOCD|| 58-1699775|1326041732|CHC13|4256F||11/01/2013|12/31/9999|$0.00|0|0|||ANESTHE <60 MIN AS DOCD|| 58-1699775|1326041732|CHC13|42600||11/01/2013|12/31/9999|$511.79|0|0|||CLOSURE OF SALIVARY FISTULA|| 58-1699775|1326041732|CHC13|4260F||11/01/2013|12/31/9999|$0.00|0|0|||WOUND SRFC CULTURETECH USED|| 58-1699775|1326041732|CHC13|4261F||11/01/2013|12/31/9999|$0.00|0|0|||TECH OTHER THAN SURFC CULTR|| 58-1699775|1326041732|CHC13|42650||11/01/2013|12/31/9999|$85.32|0|0|||DILATION OF SALIVARY DUCT|| 58-1699775|1326041732|CHC13|4265F||11/01/2013|12/31/9999|$0.00|0|0|||WET-DRY DRESSINGS RX RECMD|| 58-1699775|1326041732|CHC13|42660||11/01/2013|12/31/9999|$112.47|0|0|||DILATION OF SALIVARY DUCT|| 58-1699775|1326041732|CHC13|42665||11/01/2013|12/31/9999|$302.61|0|0|||LIGATION OF SALIVARY DUCT|| 58-1699775|1326041732|CHC13|4266F||11/01/2013|12/31/9999|$0.00|0|0|||NO WET-DRY DRSSINGS RX RECMD|| 58-1699775|1326041732|CHC13|4267F||11/01/2013|12/31/9999|$0.00|0|0|||COMPRSSION THXPY PRESCRIBED|| 58-1699775|1326041732|CHC13|4268F||11/01/2013|12/31/9999|$0.00|0|0|||PT ED RE COMP THXPY RCVD|| 58-1699775|1326041732|CHC13|42699||11/01/2013|12/31/9999|$0.00|0|0|||SALIVARY SURGERY PROCEDURE|| 58-1699775|1326041732|CHC13|4269F||11/01/2013|12/31/9999|$0.00|0|0|||APPROPOS MTHD OFFLOADING RXD|| 58-1699775|1326041732|CHC13|42700||11/01/2013|12/31/9999|$198.86|0|0|||DRAINAGE OF TONSIL ABSCESS|| 58-1699775|1326041732|CHC13|4270F||11/01/2013|12/31/9999|$0.00|0|0|||PT RCVNG ANTI R-VIRAL THXPY|| 58-1699775|1326041732|CHC13|4271F||11/01/2013|12/31/9999|$0.00|0|0|||PT RCVNG ANTI R-VIRAL THXPY|| 58-1699775|1326041732|CHC13|42720||11/01/2013|12/31/9999|$575.60|0|0|||DRAINAGE OF THROAT ABSCESS|| 58-1699775|1326041732|CHC13|42725||11/01/2013|12/31/9999|$1|182.56|0|0|||DRAINAGE OF THROAT ABSCESS|| 58-1699775|1326041732|CHC13|4274F||11/01/2013|12/31/9999|$0.00|0|0|||FLU IMMUNO ADMIN'D RCVD|| 58-1699775|1326041732|CHC13|4276F||11/01/2013|12/31/9999|$0.00|0|0|||POTENT ANTIVIR THXPY RXD|| 58-1699775|1326041732|CHC13|4279F||11/01/2013|12/31/9999|$0.00|0|0|||PCP PROPHYLAXIS RXD|| 58-1699775|1326041732|CHC13|42800||11/01/2013|12/31/9999|$164.15|0|0|||BIOPSY OF THROAT|| 58-1699775|1326041732|CHC13|42804||11/01/2013|12/31/9999|$166.06|0|0|||BIOPSY OF UPPER NOSE/THROAT|| 58-1699775|1326041732|CHC13|42806||11/01/2013|12/31/9999|$194.51|0|0|||BIOPSY OF UPPER NOSE/THROAT|| 58-1699775|1326041732|CHC13|42808||11/01/2013|12/31/9999|$237.81|0|0|||EXCISE PHARYNX LESION|| 58-1699775|1326041732|CHC13|42809||11/01/2013|12/31/9999|$191.66|0|0|||REMOVE PHARYNX FOREIGN BODY|| 58-1699775|1326041732|CHC13|4280F||11/01/2013|12/31/9999|$0.00|0|0|||PCP PROPHYLAX RXD 3MON LOW %|| 58-1699775|1326041732|CHC13|42810||11/01/2013|12/31/9999|$420.80|0|0|||EXCISION OF NECK CYST|| 58-1699775|1326041732|CHC13|42815||11/01/2013|12/31/9999|$813.54|0|0|||EXCISION OF NECK CYST|| 58-1699775|1326041732|CHC13|42820||11/01/2013|12/31/9999|$424.88|0|0|||REMOVE TONSILS AND ADENOIDS|| 58-1699775|1326041732|CHC13|42821||11/01/2013|12/31/9999|$441.24|0|0|||REMOVE TONSILS AND ADENOIDS|| 58-1699775|1326041732|CHC13|42825||11/01/2013|12/31/9999|$355.02|0|0|||REMOVAL OF TONSILS|| 58-1699775|1326041732|CHC13|42826||11/01/2013|12/31/9999|$368.01|0|0|||REMOVAL OF TONSILS|| 58-1699775|1326041732|CHC13|42830||11/01/2013|12/31/9999|$303.17|0|0|||REMOVAL OF ADENOIDS|| 58-1699775|1326041732|CHC13|42831||11/01/2013|12/31/9999|$326.02|0|0|||REMOVAL OF ADENOIDS|| 58-1699775|1326041732|CHC13|42835||11/01/2013|12/31/9999|$278.78|0|0|||REMOVAL OF ADENOIDS|| 58-1699775|1326041732|CHC13|42836||11/01/2013|12/31/9999|$352.30|0|0|||REMOVAL OF ADENOIDS|| 58-1699775|1326041732|CHC13|42842||11/01/2013|12/31/9999|$1|440.19|0|0|||EXTENSIVE SURGERY OF THROAT|| 58-1699775|1326041732|CHC13|42844||11/01/2013|12/31/9999|$1|989.16|0|0|||EXTENSIVE SURGERY OF THROAT|| 58-1699775|1326041732|CHC13|42845||11/01/2013|12/31/9999|$3|236.82|0|0|||EXTENSIVE SURGERY OF THROAT|| 58-1699775|1326041732|CHC13|42860||11/01/2013|12/31/9999|$275.15|0|0|||EXCISION OF TONSIL TAGS|| 58-1699775|1326041732|CHC13|42870||11/01/2013|12/31/9999|$838.15|0|0|||EXCISION OF LINGUAL TONSIL|| 58-1699775|1326041732|CHC13|42890||11/01/2013|12/31/9999|$2|053.43|0|0|||PARTIAL REMOVAL OF PHARYNX|| 58-1699775|1326041732|CHC13|42892||11/01/2013|12/31/9999|$2|727.58|0|0|||REVISION OF PHARYNGEAL WALLS|| 58-1699775|1326041732|CHC13|42894||11/01/2013|12/31/9999|$3|441.88|0|0|||REVISION OF PHARYNGEAL WALLS|| 58-1699775|1326041732|CHC13|42900||11/01/2013|12/31/9999|$498.08|0|0|||REPAIR THROAT WOUND|| 58-1699775|1326041732|CHC13|4290F||11/01/2013|12/31/9999|$0.00|0|0|||PT SCRNED FOR INJ DRUG USE|| 58-1699775|1326041732|CHC13|4293F||11/01/2013|12/31/9999|$0.00|0|0|||PT SCRND - HIGH-RSK SEX BEHAV|| 58-1699775|1326041732|CHC13|42950||11/01/2013|12/31/9999|$1|150.23|0|0|||RECONSTRUCTION OF THROAT|| 58-1699775|1326041732|CHC13|42953||11/01/2013|12/31/9999|$1|390.92|0|0|||REPAIR THROAT| ESOPHAGUS|| 58-1699775|1326041732|CHC13|42955||11/01/2013|12/31/9999|$1|089.56|0|0|||SURGICAL OPENING OF THROAT|| 58-1699775|1326041732|CHC13|42960||11/01/2013|12/31/9999|$246.70|0|0|||CONTROL THROAT BLEEDING|| 58-1699775|1326041732|CHC13|42961||11/01/2013|12/31/9999|$613.90|0|0|||CONTROL THROAT BLEEDING|| 58-1699775|1326041732|CHC13|42962||11/01/2013|12/31/9999|$758.44|0|0|||CONTROL THROAT BLEEDING|| 58-1699775|1326041732|CHC13|42970||11/01/2013|12/31/9999|$586.36|0|0|||CONTROL NOSE/THROAT BLEEDING|| 58-1699775|1326041732|CHC13|42971||11/01/2013|12/31/9999|$669.29|0|0|||CONTROL NOSE/THROAT BLEEDING|| 58-1699775|1326041732|CHC13|42972||11/01/2013|12/31/9999|$749.85|0|0|||CONTROL NOSE/THROAT BLEEDING|| 58-1699775|1326041732|CHC13|42999||11/01/2013|12/31/9999|$0.00|0|0|||THROAT SURGERY PROCEDURE|| 58-1699775|1326041732|CHC13|4300F||11/01/2013|12/31/9999|$0.00|0|0|||PT RCVNG WARF THXPY|| 58-1699775|1326041732|CHC13|4301F||11/01/2013|12/31/9999|$0.00|0|0|||PT NOT RCVNG WARF THXPY|| 58-1699775|1326041732|CHC13|43020||11/01/2013|12/31/9999|$784.02|0|0|||INCISION OF ESOPHAGUS|| 58-1699775|1326041732|CHC13|43030||11/01/2013|12/31/9999|$759.10|0|0|||THROAT MUSCLE SURGERY|| 58-1699775|1326041732|CHC13|43045||11/01/2013|12/31/9999|$1|919.51|0|0|||INCISION OF ESOPHAGUS|| 58-1699775|1326041732|CHC13|4305F||11/01/2013|12/31/9999|$0.00|0|0|||PT ED RE FT CARE INSPCT RCVD|| 58-1699775|1326041732|CHC13|4306F||11/01/2013|12/31/9999|$0.00|0|0|||PT TLK PSYCH & RX OPD ADDIC|| 58-1699775|1326041732|CHC13|43100||11/01/2013|12/31/9999|$915.54|0|0|||EXCISION OF ESOPHAGUS LESION|| 58-1699775|1326041732|CHC13|43101||11/01/2013|12/31/9999|$1|485.15|0|0|||EXCISION OF ESOPHAGUS LESION|| 58-1699775|1326041732|CHC13|43107||11/01/2013|12/31/9999|$3|715.02|0|0|||REMOVAL OF ESOPHAGUS|| 58-1699775|1326041732|CHC13|43108||11/01/2013|12/31/9999|$6|478.10|0|0|||REMOVAL OF ESOPHAGUS|| 58-1699775|1326041732|CHC13|43112||11/01/2013|12/31/9999|$3|954.12|0|0|||REMOVAL OF ESOPHAGUS|| 58-1699775|1326041732|CHC13|43113||11/01/2013|12/31/9999|$6|593.69|0|0|||REMOVAL OF ESOPHAGUS|| 58-1699775|1326041732|CHC13|43116||11/01/2013|12/31/9999|$7|578.38|0|0|||PARTIAL REMOVAL OF ESOPHAGUS|| 58-1699775|1326041732|CHC13|43117||11/01/2013|12/31/9999|$3|615.06|0|0|||PARTIAL REMOVAL OF ESOPHAGUS|| 58-1699775|1326041732|CHC13|43118||11/01/2013|12/31/9999|$5|481.48|0|0|||PARTIAL REMOVAL OF ESOPHAGUS|| 58-1699775|1326041732|CHC13|43121||11/01/2013|12/31/9999|$4|215.49|0|0|||PARTIAL REMOVAL OF ESOPHAGUS|| 58-1699775|1326041732|CHC13|43122||11/01/2013|12/31/9999|$3|709.63|0|0|||PARTIAL REMOVAL OF ESOPHAGUS|| 58-1699775|1326041732|CHC13|43123||11/01/2013|12/31/9999|$6|792.15|0|0|||PARTIAL REMOVAL OF ESOPHAGUS|| 58-1699775|1326041732|CHC13|43124||11/01/2013|12/31/9999|$5|615.00|0|0|||REMOVAL OF ESOPHAGUS|| 58-1699775|1326041732|CHC13|43130||11/01/2013|12/31/9999|$1|152.16|0|0|||REMOVAL OF ESOPHAGUS POUCH|| 58-1699775|1326041732|CHC13|43135||11/01/2013|12/31/9999|$2|178.82|0|0|||REMOVAL OF ESOPHAGUS POUCH|| 58-1699775|1326041732|CHC13|43180||04/01/2015|12/31/9999|$831.03|0|0|0||ESOPHAGOSCOPY RIGID TRNSO|| 58-1699775|1326041732|CHC13|43191||04/01/2014|12/31/9999|$186.89|0|0|||ESOPHAGOSCOPY RIGID TRNSO DX|| 58-1699775|1326041732|CHC13|43192||04/01/2014|12/31/9999|$223.19|0|0|||ESOPHAGOSCP RIG TRNSO INJECT|| 58-1699775|1326041732|CHC13|43193||04/01/2014|12/31/9999|$266.33|0|0|||ESOPHAGOSCP RIG TRNSO BIOPSY|| 58-1699775|1326041732|CHC13|43194||04/01/2014|12/31/9999|$243.14|0|0|||ESOPHAGOSCP RIG TRNSO REM FB|| 58-1699775|1326041732|CHC13|43195||04/01/2014|12/31/9999|$266.81|0|0|||ESOPHAGOSCOPY RIGID BALLOON|| 58-1699775|1326041732|CHC13|43196||04/01/2014|12/31/9999|$292.68|0|0|||ESOPHAGOSCP GUIDE WIRE DILAT|| 58-1699775|1326041732|CHC13|43197||04/01/2014|12/31/9999|$119.76|0|0|||ESOPHAGOSCOPY FLEX DX BRUSH|| 58-1699775|1326041732|CHC13|43198||04/01/2014|12/31/9999|$142.67|0|0|||ESOPHAGOSC FLEX TRNSN BIOPSY|| 58-1699775|1326041732|CHC13|43200||04/01/2014|12/31/9999|$139.25|0|0|||ESOPHAGUS ENDOSCOPY|| 58-1699775|1326041732|CHC13|43201||04/01/2014|12/31/9999|$163.62|0|0|||ESOPH SCOPE W/SUBMUCOUS INJ|| 58-1699775|1326041732|CHC13|43202||04/01/2014|12/31/9999|$164.12|0|0|||ESOPHAGUS ENDOSCOPY| BIOPSY|| 58-1699775|1326041732|CHC13|43204||04/01/2014|12/31/9999|$216.24|0|0|||ESOPH SCOPE W/SCLEROSIS INJ|| 58-1699775|1326041732|CHC13|43205||04/01/2014|12/31/9999|$223.59|0|0|||ESOPHAGUS ENDOSCOPY/LIGATION|| 58-1699775|1326041732|CHC13|43206||04/01/2014|12/31/9999|$213.75|0|0|||ESOPH OPTICAL ENDOMICROSCOPY|| 58-1699775|1326041732|CHC13|4320F||11/01/2013|12/31/9999|$0.00|0|0|||PT TALK PSYCHSOC+RX OH DPND|| 58-1699775|1326041732|CHC13|43210||04/01/2016|12/31/9999|$641.00|0|0|0||EGD ESOPHAGOGASTRC FNDOPLSTY|| 58-1699775|1326041732|CHC13|43211||04/01/2014|12/31/9999|$364.41|0|0|||ESOPHAGOSCOP MUCOSAL RESECT|| 58-1699775|1326041732|CHC13|43212||04/01/2014|12/31/9999|$287.91|0|0|||ESOPHAGOSCOP STENT PLACEMENT|| 58-1699775|1326041732|CHC13|43213||04/01/2014|12/31/9999|$405.50|0|0|||ESOPHAGOSCOPY RETRO BALLOON|| 58-1699775|1326041732|CHC13|43214||04/01/2014|12/31/9999|$293.16|0|0|||ESOPHAGOSC DILATE BALLOON 30|| 58-1699775|1326041732|CHC13|43215||04/01/2014|12/31/9999|$221.21|0|0|||ESOPHAGUS ENDOSCOPY|| 58-1699775|1326041732|CHC13|43216||04/01/2014|12/31/9999|$214.77|0|0|||ESOPHAGUS ENDOSCOPY/LESION|| 58-1699775|1326041732|CHC13|43217||04/01/2014|12/31/9999|$256.26|0|0|||ESOPHAGUS ENDOSCOPY|| 58-1699775|1326041732|CHC13|43220||04/01/2014|12/31/9999|$188.48|0|0|||ESOPH ENDOSCOPY| DILATION|| 58-1699775|1326041732|CHC13|43226||04/01/2014|12/31/9999|$207.69|0|0|||ESOPH ENDOSCOPY| DILATION|| 58-1699775|1326041732|CHC13|43227||04/01/2014|12/31/9999|$262.98|0|0|||ESOPH ENDOSCOPY| REPAIR|| 58-1699775|1326041732|CHC13|43229||04/01/2014|12/31/9999|$309.56|0|0|||ESOPHAGOSCOPY LESION ABLATE|| 58-1699775|1326041732|CHC13|4322F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|43231||04/01/2014|12/31/9999|$256.22|0|0|||ESOPH ENDOSCOPY W/US EXAM|| 58-1699775|1326041732|CHC13|43232||04/01/2014|12/31/9999|$305.67|0|0|||ESOPH ENDOSCOPY W/US FN BX|| 58-1699775|1326041732|CHC13|43235||04/01/2014|12/31/9999|$195.65|0|0|||UPPR GI ENDOSCOPY| DIAGNOSIS|| 58-1699775|1326041732|CHC13|43236||04/01/2014|12/31/9999|$219.99|0|0|||UPPR GI SCOPE W/SUBMUC INJ|| 58-1699775|1326041732|CHC13|43237||04/01/2014|12/31/9999|$310.17|0|0|||ENDOSCOPIC US EXAM| ESOPH|| 58-1699775|1326041732|CHC13|43238||04/01/2014|12/31/9999|$354.23|0|0|||UPPR GI ENDOSCOPY W/US FN BX|| 58-1699775|1326041732|CHC13|43239||04/01/2014|12/31/9999|$219.02|0|0|||UPPER GI ENDOSCOPY| BIOPSY|| 58-1699775|1326041732|CHC13|43240||04/01/2014|12/31/9999|$617.09|0|0|||ESOPH ENDOSCOPE W/DRAIN CYST|| 58-1699775|1326041732|CHC13|43241||04/01/2014|12/31/9999|$226.95|0|0|||UPPER GI ENDOSCOPY WITH TUBE|| 58-1699775|1326041732|CHC13|43242||04/01/2014|10/31/2017|$39.27|0|0|||UPPR GI ENDOSCOPY W/US FN BX|| 58-1699775|1326041732|CHC13|43242||11/01/2017|12/31/9999|$401.49|0|0|||UPPR GI ENDOSCOPY W/US FN BX|| 58-1699775|1326041732|CHC13|43243||04/01/2014|12/31/9999|$374.51|0|0|||UPPER GI ENDOSCOPY & INJECT|| 58-1699775|1326041732|CHC13|43244||04/01/2014|12/31/9999|$387.78|0|0|||UPPER GI ENDOSCOPY/LIGATION|| 58-1699775|1326041732|CHC13|43245||04/01/2014|12/31/9999|$277.59|0|0|||UPPR GI SCOPE DILATE STRICTR|| 58-1699775|1326041732|CHC13|43246||04/01/2014|12/31/9999|$318.50|0|0|||PLACE GASTROSTOMY TUBE|| 58-1699775|1326041732|CHC13|43247||04/01/2014|12/31/9999|$278.07|0|0|||OPERATIVE UPPER GI ENDOSCOPY|| 58-1699775|1326041732|CHC13|43248||04/01/2014|12/31/9999|$264.53|0|0|||UPPR GI ENDOSCOPY/GUIDE WIRE|| 58-1699775|1326041732|CHC13|43249||04/01/2014|12/31/9999|$243.87|0|0|||ESOPH ENDOSCOPY| DILATION|| 58-1699775|1326041732|CHC13|4324F||11/01/2013|12/31/9999|$0.00|0|0|||PT QUERIED PRKNS COMPLIC|| 58-1699775|1326041732|CHC13|43250||04/01/2014|12/31/9999|$268.79|0|0|||UPPER GI ENDOSCOPY/TUMOR|| 58-1699775|1326041732|CHC13|43251||04/01/2014|12/31/9999|$311.15|0|0|||OPERATIVE UPPER GI ENDOSCOPY|| 58-1699775|1326041732|CHC13|43252||04/01/2014|12/31/9999|$267.71|0|0|||UPPR GI OPTICL ENDOMICRSCOPY|| 58-1699775|1326041732|CHC13|43253||04/01/2014|12/31/9999|$403.77|0|0|||EGD US TRANSMURAL INJXN/MARK|| 58-1699775|1326041732|CHC13|43254||04/01/2014|12/31/9999|$419.39|0|0|||EGD ENDO MUCOSAL RESECTION|| 58-1699775|1326041732|CHC13|43255||04/01/2014|12/31/9999|$318.87|0|0|||OPERATIVE UPPER GI ENDOSCOPY|| 58-1699775|1326041732|CHC13|43256||11/01/2013|12/31/9999|$371.63|0|0|||UPPR GI ENDOSCOPY W/STENT|| 58-1699775|1326041732|CHC13|43257||04/01/2014|12/31/9999|$356.63|0|0|||UPPR GI SCOPE W/THRML TXMNT|| 58-1699775|1326041732|CHC13|43259||04/01/2014|12/31/9999|$358.25|0|0|||ENDOSCOPIC ULTRASOUND EXAM|| 58-1699775|1326041732|CHC13|4325F||11/01/2013|12/31/9999|$0.00|0|0|||MED TXMNT OPTIONS RVWD W/PT|| 58-1699775|1326041732|CHC13|43260||04/01/2014|12/31/9999|$508.40|0|0|||ENDO CHOLANGIOPANCREATOGRAPH|| 58-1699775|1326041732|CHC13|43261||11/01/2013|12/31/9999|$531.91|0|0|||ENDO CHOLANGIOPANCREATOGRAPH|| 58-1699775|1326041732|CHC13|43262||11/01/2013|12/31/9999|$625.13|0|0|||ENDO CHOLANGIOPANCREATOGRAPH|| 58-1699775|1326041732|CHC13|43263||04/01/2014|12/31/9999|$563.22|0|0|||ENDO CHOLANGIOPANCREATOGRAPH|| 58-1699775|1326041732|CHC13|43264||04/01/2014|12/31/9999|$906.15|0|0|||ENDO CHOLANGIOPANCREATOGRAPH|| 58-1699775|1326041732|CHC13|43265||04/01/2014|12/31/9999|$573.60|0|0|||ENDO CHOLANGIOPANCREATOGRAPH|| 58-1699775|1326041732|CHC13|43266||04/01/2014|12/31/9999|$347.15|0|0|||EGD ENDOSCOPIC STENT PLACE|| 58-1699775|1326041732|CHC13|43268||11/01/2013|12/31/9999|$633.38|0|0|||ENDO CHOLANGIOPANCREATOGRAPH|| 58-1699775|1326041732|CHC13|4326F||11/01/2013|12/31/9999|$0.00|0|0|||PT ASKED RE SYMP AUTO DYSFXN|| 58-1699775|1326041732|CHC13|43270||04/01/2014|12/31/9999|$364.44|0|0|||EGD LESION ABLATION|| 58-1699775|1326041732|CHC13|43273||04/01/2014|12/31/9999|$681.32|0|0|||ENDOSCOPIC PANCREATOSCOPY|| 58-1699775|1326041732|CHC13|43274||04/01/2014|12/31/9999|$719.07|0|0|||ERCP DUCT STENT PLACEMENT|| 58-1699775|1326041732|CHC13|43275||04/01/2014|12/31/9999|$592.76|0|0|||ERCP REMOVE FORGN BODY DUCT|| 58-1699775|1326041732|CHC13|43276||04/01/2014|12/31/9999|$748.11|0|0|||ERCP STENT EXCHANGE W/DILATE|| 58-1699775|1326041732|CHC13|43277||04/01/2014|12/31/9999|$596.36|0|0|||ERCP EA DUCT/AMPULLA DILATE|| 58-1699775|1326041732|CHC13|43278||04/01/2014|12/31/9999|$678.18|0|0|||ERCP LESION ABLATE W/DILATE|| 58-1699775|1326041732|CHC13|43279||11/01/2013|12/31/9999|$1|860.43|0|0|||LAP MYOTOMY| HELLER|| 58-1699775|1326041732|CHC13|43280||11/01/2013|12/31/9999|$1|552.64|0|0|||LAPAROSCOPY| FUNDOPLASTY|| 58-1699775|1326041732|CHC13|43281||11/01/2013|12/31/9999|$2|241.56|0|0|||LAP PARAESOPHAG HERN REPAIR|| 58-1699775|1326041732|CHC13|43282||11/01/2013|12/31/9999|$2|521.31|0|0|||LAP PARAESOPH HER RPR W/MESH|| 58-1699775|1326041732|CHC13|43283||11/01/2013|12/31/9999|$233.60|0|0|||LAP ESOPH LENGTHENING|| 58-1699775|1326041732|CHC13|43284||04/01/2017|12/31/9999|$1|011.52|0|1011.52|0||LAPS ESOPHGL SPHNCTR AGMNTJ|| 58-1699775|1326041732|CHC13|43285||04/01/2017|12/31/9999|$1|023.37|0|1023.37|0||RMVL ESOPHGL SPHNCTR DEV|| 58-1699775|1326041732|CHC13|43286||04/01/2018|12/31/9999|$4|821.43|0|0|0||ESPHG TOT W/LAPS MOBLJ|| 58-1699775|1326041732|CHC13|43287||04/01/2018|12/31/9999|$5|513.06|0|0|0||ESPHG DSTL 2/3 W/LAPS MOBLJ|| 58-1699775|1326041732|CHC13|43288||04/01/2018|12/31/9999|$5|749.53|0|0|0||ESPHG THRSC MOBLJ|| 58-1699775|1326041732|CHC13|43289||11/01/2013|12/31/9999|$0.00|0|0|||LAPAROSCOPE PROC| ESOPH|| 58-1699775|1326041732|CHC13|4328F||11/01/2013|12/31/9999|$0.00|0|0|||PT ASKED RE SLEEP DISTURB|| 58-1699775|1326041732|CHC13|43300||11/01/2013|12/31/9999|$899.54|0|0|||REPAIR OF ESOPHAGUS|| 58-1699775|1326041732|CHC13|43305||11/01/2013|12/31/9999|$1|603.47|0|0|||REPAIR ESOPHAGUS AND FISTULA|| 58-1699775|1326041732|CHC13|4330F||11/01/2013|12/31/9999|$0.00|0|0|||CNSLNG EPI SPEC SFTY ISSUES|| 58-1699775|1326041732|CHC13|43310||11/01/2013|12/31/9999|$2|199.72|0|0|||REPAIR OF ESOPHAGUS|| 58-1699775|1326041732|CHC13|43312||11/01/2013|12/31/9999|$2|386.04|0|0|||REPAIR ESOPHAGUS AND FISTULA|| 58-1699775|1326041732|CHC13|43313||11/01/2013|12/31/9999|$4|168.67|0|0|||ESOPHAGOPLASTY CONGENITAL|| 58-1699775|1326041732|CHC13|43314||11/01/2013|12/31/9999|$4|236.80|0|0|||TRACHEO-ESOPHAGOPLASTY CONG|| 58-1699775|1326041732|CHC13|43320||11/01/2013|12/31/9999|$1|996.44|0|0|||FUSE ESOPHAGUS & STOMACH|| 58-1699775|1326041732|CHC13|43325||11/01/2013|12/31/9999|$1|941.62|0|0|||REVISE ESOPHAGUS & STOMACH|| 58-1699775|1326041732|CHC13|43327||11/01/2013|12/31/9999|$1|182.04|0|0|||ESOPH FUNDOPLASTY LAP|| 58-1699775|1326041732|CHC13|43328||11/01/2013|12/31/9999|$1|733.44|0|0|||ESOPH FUNDOPLASTY THOR|| 58-1699775|1326041732|CHC13|43330||11/01/2013|12/31/9999|$1|884.39|0|0|||REPAIR OF ESOPHAGUS|| 58-1699775|1326041732|CHC13|43331||11/01/2013|12/31/9999|$1|983.40|0|0|||REPAIR OF ESOPHAGUS|| 58-1699775|1326041732|CHC13|43332||11/01/2013|12/31/9999|$1|686.23|0|0|||TRANSAB ESOPH HIAT HERN RPR|| 58-1699775|1326041732|CHC13|43333||11/01/2013|12/31/9999|$1|830.72|0|0|||TRANSAB ESOPH HIAT HERN RPR|| 58-1699775|1326041732|CHC13|43334||11/01/2013|12/31/9999|$1|848.61|0|0|||TRANSTHOR DIAPHRAG HERN RPR|| 58-1699775|1326041732|CHC13|43335||11/01/2013|12/31/9999|$1|991.31|0|0|||TRANSTHOR DIAPHRAG HERN RPR|| 58-1699775|1326041732|CHC13|43336||11/01/2013|12/31/9999|$2|183.18|0|0|||THORABD DIAPHR HERN REPAIR|| 58-1699775|1326041732|CHC13|43337||11/01/2013|12/31/9999|$2|386.43|0|0|||THORABD DIAPHR HERN REPAIR|| 58-1699775|1326041732|CHC13|43338||11/01/2013|12/31/9999|$190.63|0|0|||ESOPH LENGTHENING|| 58-1699775|1326041732|CHC13|43340||11/01/2013|12/31/9999|$1|974.93|0|0|||FUSE ESOPHAGUS & INTESTINE|| 58-1699775|1326041732|CHC13|43341||11/01/2013|12/31/9999|$2|080.24|0|0|||FUSE ESOPHAGUS & INTESTINE|| 58-1699775|1326041732|CHC13|43351||11/01/2013|12/31/9999|$1|937.88|0|0|||SURGICAL OPENING| ESOPHAGUS|| 58-1699775|1326041732|CHC13|43352||11/01/2013|12/31/9999|$1|573.16|0|0|||SURGICAL OPENING| ESOPHAGUS|| 58-1699775|1326041732|CHC13|43360||11/01/2013|12/31/9999|$3|462.03|0|0|||GASTROINTESTINAL REPAIR|| 58-1699775|1326041732|CHC13|43361||11/01/2013|12/31/9999|$3|866.14|0|0|||GASTROINTESTINAL REPAIR|| 58-1699775|1326041732|CHC13|43400||11/01/2013|12/31/9999|$2|156.43|0|0|||LIGATE ESOPHAGUS VEINS|| 58-1699775|1326041732|CHC13|43401||11/01/2013|12/31/9999|$2|219.88|0|0|||ESOPHAGUS SURGERY FOR VEINS|| 58-1699775|1326041732|CHC13|43405||11/01/2013|12/31/9999|$2|118.91|0|0|||LIGATE/STAPLE ESOPHAGUS|| 58-1699775|1326041732|CHC13|4340F||11/01/2013|12/31/9999|$0.00|0|0|||CNSLNG CHLDBRNG WOMEN EPI|| 58-1699775|1326041732|CHC13|43410||11/01/2013|12/31/9999|$1|575.92|0|0|||REPAIR ESOPHAGUS WOUND|| 58-1699775|1326041732|CHC13|43415||11/01/2013|12/31/9999|$3|698.62|0|0|||REPAIR ESOPHAGUS WOUND|| 58-1699775|1326041732|CHC13|43420||11/01/2013|12/31/9999|$1|484.48|0|0|||REPAIR ESOPHAGUS OPENING|| 58-1699775|1326041732|CHC13|43425||11/01/2013|12/31/9999|$2|117.42|0|0|||REPAIR ESOPHAGUS OPENING|| 58-1699775|1326041732|CHC13|43450||11/01/2013|12/31/9999|$129.94|0|0|||DILATE ESOPHAGUS|| 58-1699775|1326041732|CHC13|43453||11/01/2013|12/31/9999|$140.26|0|0|||DILATE ESOPHAGUS|| 58-1699775|1326041732|CHC13|43460||11/01/2013|12/31/9999|$325.46|0|0|||PRESSURE TREATMENT ESOPHAGUS|| 58-1699775|1326041732|CHC13|43496||11/01/2013|12/31/9999|$7|131.85|0|0|||FREE JEJUNUM FLAP| MICROVASC|| 58-1699775|1326041732|CHC13|43499||11/01/2013|12/31/9999|$0.00|0|0|||ESOPHAGUS SURGERY PROCEDURE|| 58-1699775|1326041732|CHC13|43500||11/01/2013|12/31/9999|$1|122.53|0|0|||SURGICAL OPENING OF STOMACH|| 58-1699775|1326041732|CHC13|43501||11/01/2013|12/31/9999|$1|928.24|0|0|||SURGICAL REPAIR OF STOMACH|| 58-1699775|1326041732|CHC13|43502||11/01/2013|12/31/9999|$2|179.68|0|0|||SURGICAL REPAIR OF STOMACH|| 58-1699775|1326041732|CHC13|4350F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|43510||11/01/2013|12/31/9999|$1|371.05|0|0|||SURGICAL OPENING OF STOMACH|| 58-1699775|1326041732|CHC13|43520||11/01/2013|12/31/9999|$993.81|0|0|||INCISION OF PYLORIC MUSCLE|| 58-1699775|1326041732|CHC13|43605||11/01/2013|12/31/9999|$1|194.55|0|0|||BIOPSY OF STOMACH|| 58-1699775|1326041732|CHC13|43610||11/01/2013|12/31/9999|$1|401.67|0|0|||EXCISION OF STOMACH LESION|| 58-1699775|1326041732|CHC13|43611||11/01/2013|12/31/9999|$1|740.35|0|0|||EXCISION OF STOMACH LESION|| 58-1699775|1326041732|CHC13|43620||11/01/2013|12/31/9999|$2|821.01|0|0|||REMOVAL OF STOMACH|| 58-1699775|1326041732|CHC13|43621||11/01/2013|12/31/9999|$3|244.30|0|0|||REMOVAL OF STOMACH|| 58-1699775|1326041732|CHC13|43622||11/01/2013|12/31/9999|$3|295.26|0|0|||REMOVAL OF STOMACH|| 58-1699775|1326041732|CHC13|43631||11/01/2013|12/31/9999|$2|076.84|0|0|||REMOVAL OF STOMACH| PARTIAL|| 58-1699775|1326041732|CHC13|43632||11/01/2013|12/31/9999|$2|899.44|0|0|||REMOVAL OF STOMACH| PARTIAL|| 58-1699775|1326041732|CHC13|43633||11/01/2013|12/31/9999|$2|744.41|0|0|||REMOVAL OF STOMACH| PARTIAL|| 58-1699775|1326041732|CHC13|43634||11/01/2013|12/31/9999|$3|038.97|0|0|||REMOVAL OF STOMACH| PARTIAL|| 58-1699775|1326041732|CHC13|43635||11/01/2013|12/31/9999|$161.75|0|0|||REMOVAL OF STOMACH| PARTIAL|| 58-1699775|1326041732|CHC13|43640||11/01/2013|12/31/9999|$1|683.08|0|0|||VAGOTOMY & PYLORUS REPAIR|| 58-1699775|1326041732|CHC13|43641||11/01/2013|12/31/9999|$1|712.50|0|0|||VAGOTOMY & PYLORUS REPAIR|| 58-1699775|1326041732|CHC13|43644||11/01/2013|12/31/9999|$2|482.58|0|0|||LAP GASTRIC BYPASS/ROUX-EN-Y|| 58-1699775|1326041732|CHC13|43645||11/01/2013|12/31/9999|$2|656.77|0|0|||LAP GASTR BYPASS INCL SMLL I|| 58-1699775|1326041732|CHC13|43647||11/01/2013|12/31/9999|$1|021.61|0|0|||LAP IMPL ELECTRODE| ANTRUM|| 58-1699775|1326041732|CHC13|43648||11/01/2013|12/31/9999|$0.00|0|0|||LAP REVISE/REMV ELTRD ANTRUM|| 58-1699775|1326041732|CHC13|43651||11/01/2013|12/31/9999|$931.31|0|0|||LAPAROSCOPY| VAGUS NERVE|| 58-1699775|1326041732|CHC13|43652||11/01/2013|12/31/9999|$1|089.56|0|0|||LAPAROSCOPY| VAGUS NERVE|| 58-1699775|1326041732|CHC13|43653||11/01/2013|12/31/9999|$811.69|0|0|||LAPAROSCOPY| GASTROSTOMY|| 58-1699775|1326041732|CHC13|43659||11/01/2013|12/31/9999|$0.00|0|0|||LAPAROSCOPE PROC| STOM|| 58-1699775|1326041732|CHC13|43752||11/01/2013|12/31/9999|$58.90|0|0|||NASAL/OROGASTRIC W/STENT|| 58-1699775|1326041732|CHC13|43753||11/01/2013|12/31/9999|$29.90|0|0|||TX GASTRO INTUB W/ASP|| 58-1699775|1326041732|CHC13|43754||11/01/2013|12/31/9999|$45.50|0|0|||DX GASTR INTUB W/ASP SPEC|| 58-1699775|1326041732|CHC13|43755||11/01/2013|12/31/9999|$82.96|0|0|||DX GASTR INTUB W/ASP SPECS|| 58-1699775|1326041732|CHC13|43756||11/01/2013|12/31/9999|$74.23|0|0|||DX DUOD INTUB W/ASP SPEC|| 58-1699775|1326041732|CHC13|43757||11/01/2013|12/31/9999|$113.05|0|0|||DX DUOD INTUB W/ASP SPECS|| 58-1699775|1326041732|CHC13|43760||11/01/2013|12/31/9999|$71.38|0|0|||CHANGE GASTROSTOMY TUBE|| 58-1699775|1326041732|CHC13|43761||11/01/2013|12/31/9999|$150.67|0|0|||REPOSITION GASTROSTOMY TUBE|| 58-1699775|1326041732|CHC13|43770||11/01/2013|12/31/9999|$1|595.62|0|0|||LAP| PLACE GASTR ADJUST BAND|| 58-1699775|1326041732|CHC13|43771||11/01/2013|12/31/9999|$1|815.60|0|0|||LAP| REVISE ADJUST GAST BAND|| 58-1699775|1326041732|CHC13|43772||11/01/2013|12/31/9999|$1|365.63|0|0|||LAP| REMOVE ADJUST GAST BAND|| 58-1699775|1326041732|CHC13|43773||11/01/2013|12/31/9999|$1|814.68|0|0|||LAP| CHANGE ADJUST GAST BAND|| 58-1699775|1326041732|CHC13|43774||11/01/2013|12/31/9999|$1|374.19|0|0|||LAP REMOV ADJ GAST BAND/PORT|| 58-1699775|1326041732|CHC13|43775||11/01/2013|12/31/9999|$1|850.11|0|0|||LAP SLEEVE GASTRECTOMY|| 58-1699775|1326041732|CHC13|43800||11/01/2013|12/31/9999|$1|329.76|0|0|||RECONSTRUCTION OF PYLORUS|| 58-1699775|1326041732|CHC13|43810||11/01/2013|12/31/9999|$1|451.90|0|0|||FUSION OF STOMACH AND BOWEL|| 58-1699775|1326041732|CHC13|43820||11/01/2013|12/31/9999|$1|909.51|0|0|||FUSION OF STOMACH AND BOWEL|| 58-1699775|1326041732|CHC13|43825||11/01/2013|12/31/9999|$1|863.59|0|0|||FUSION OF STOMACH AND BOWEL|| 58-1699775|1326041732|CHC13|43830||11/01/2013|12/31/9999|$994.77|0|0|||PLACE GASTROSTOMY TUBE|| 58-1699775|1326041732|CHC13|43831||11/01/2013|12/31/9999|$842.46|0|0|||PLACE GASTROSTOMY TUBE|| 58-1699775|1326041732|CHC13|43832||11/01/2013|12/31/9999|$1|506.55|0|0|||PLACE GASTROSTOMY TUBE|| 58-1699775|1326041732|CHC13|43840||11/01/2013|12/31/9999|$1|938.21|0|0|||REPAIR OF STOMACH LESION|| 58-1699775|1326041732|CHC13|43842||11/01/2013|12/31/9999|$1|652.33|0|0|||V-BAND GASTROPLASTY|| 58-1699775|1326041732|CHC13|43843||11/01/2013|12/31/9999|$1|826.16|0|0|||GASTROPLASTY W/O V-BAND|| 58-1699775|1326041732|CHC13|43845||11/01/2013|12/31/9999|$2|799.44|0|0|||GASTROPLASTY DUODENAL SWITCH|| 58-1699775|1326041732|CHC13|43846||11/01/2013|12/31/9999|$2|329.44|0|0|||GASTRIC BYPASS FOR OBESITY|| 58-1699775|1326041732|CHC13|43847||11/01/2013|12/31/9999|$2|571.87|0|0|||GASTRIC BYPASS INCL SMALL I|| 58-1699775|1326041732|CHC13|43848||11/01/2013|12/31/9999|$2|761.55|0|0|||REVISION GASTROPLASTY|| 58-1699775|1326041732|CHC13|43850||11/01/2013|12/31/9999|$2|326.78|0|0|||REVISE STOMACH-BOWEL FUSION|| 58-1699775|1326041732|CHC13|43855||11/01/2013|12/31/9999|$2|417.27|0|0|||REVISE STOMACH-BOWEL FUSION|| 58-1699775|1326041732|CHC13|43860||11/01/2013|12/31/9999|$2|338.02|0|0|||REVISE STOMACH-BOWEL FUSION|| 58-1699775|1326041732|CHC13|43865||11/01/2013|12/31/9999|$2|445.40|0|0|||REVISE STOMACH-BOWEL FUSION|| 58-1699775|1326041732|CHC13|43870||11/01/2013|12/31/9999|$1|015.45|0|0|||REPAIR STOMACH OPENING|| 58-1699775|1326041732|CHC13|43880||11/01/2013|12/31/9999|$2|284.53|0|0|||REPAIR STOMACH-BOWEL FISTULA|| 58-1699775|1326041732|CHC13|43881||11/01/2013|12/31/9999|$1|021.61|0|0|||IMPL/REDO ELECTRD| ANTRUM|| 58-1699775|1326041732|CHC13|43882||11/01/2013|12/31/9999|$0.00|0|0|||REVISE/REMOVE ELECTRD ANTRUM|| 58-1699775|1326041732|CHC13|43886||11/01/2013|12/31/9999|$508.01|0|0|||REVISE GASTRIC PORT| OPEN|| 58-1699775|1326041732|CHC13|43887||11/01/2013|12/31/9999|$460.83|0|0|||REMOVE GASTRIC PORT| OPEN|| 58-1699775|1326041732|CHC13|43888||11/01/2013|12/31/9999|$648.63|0|0|||CHANGE GASTRIC PORT| OPEN|| 58-1699775|1326041732|CHC13|43999||11/01/2013|12/31/9999|$0.00|0|0|||STOMACH SURGERY PROCEDURE|| 58-1699775|1326041732|CHC13|44005||11/01/2013|12/31/9999|$1|565.96|0|0|||FREEING OF BOWEL ADHESION|| 58-1699775|1326041732|CHC13|4400F||11/01/2013|12/31/9999|$0.00|0|0|||REHAB THXPY OPTIONS W/PT|| 58-1699775|1326041732|CHC13|44010||11/01/2013|12/31/9999|$1|237.93|0|0|||INCISION OF SMALL BOWEL|| 58-1699775|1326041732|CHC13|44015||11/01/2013|12/31/9999|$206.15|0|0|||INSERT NEEDLE CATH BOWEL|| 58-1699775|1326041732|CHC13|44020||11/01/2013|12/31/9999|$1|392.24|0|0|||EXPLORE SMALL INTESTINE|| 58-1699775|1326041732|CHC13|44021||11/01/2013|12/31/9999|$1|403.77|0|0|||DECOMPRESS SMALL BOWEL|| 58-1699775|1326041732|CHC13|44025||11/01/2013|12/31/9999|$1|414.43|0|0|||INCISION OF LARGE BOWEL|| 58-1699775|1326041732|CHC13|44050||11/01/2013|12/31/9999|$1|337.00|0|0|||REDUCE BOWEL OBSTRUCTION|| 58-1699775|1326041732|CHC13|44055||11/01/2013|12/31/9999|$2|144.90|0|0|||CORRECT MALROTATION OF BOWEL|| 58-1699775|1326041732|CHC13|44100||11/01/2013|12/31/9999|$165.91|0|0|||BIOPSY OF BOWEL|| 58-1699775|1326041732|CHC13|44110||11/01/2013|12/31/9999|$1|214.15|0|0|||EXCISE INTESTINE LESION(S)|| 58-1699775|1326041732|CHC13|44111||11/01/2013|12/31/9999|$1|407.62|0|0|||EXCISION OF BOWEL LESION(S)|| 58-1699775|1326041732|CHC13|44120||11/01/2013|12/31/9999|$1|750.48|0|0|||REMOVAL OF SMALL INTESTINE|| 58-1699775|1326041732|CHC13|44121||11/01/2013|12/31/9999|$349.11|0|0|||REMOVAL OF SMALL INTESTINE|| 58-1699775|1326041732|CHC13|44125||11/01/2013|12/31/9999|$1|691.41|0|0|||REMOVAL OF SMALL INTESTINE|| 58-1699775|1326041732|CHC13|44126||11/01/2013|12/31/9999|$3|526.56|0|0|||ENTERECTOMY W/O TAPER| CONG|| 58-1699775|1326041732|CHC13|44127||11/01/2013|12/31/9999|$4|081.95|0|0|||ENTERECTOMY W/TAPER| CONG|| 58-1699775|1326041732|CHC13|44128||11/01/2013|12/31/9999|$350.99|0|0|||ENTERECTOMY CONG| ADD-ON|| 58-1699775|1326041732|CHC13|44130||11/01/2013|12/31/9999|$1|871.71|0|0|||BOWEL TO BOWEL FUSION|| 58-1699775|1326041732|CHC13|44132||11/01/2013|12/31/9999|$0.00|0|0|||ENTERECTOMY| CADAVER DONOR|| 58-1699775|1326041732|CHC13|44133||11/01/2013|12/31/9999|$0.00|0|0|||ENTERECTOMY| LIVE DONOR|| 58-1699775|1326041732|CHC13|44135||11/01/2013|12/31/9999|$0.00|0|0|||INTESTINE TRANSPLNT| CADAVER|| 58-1699775|1326041732|CHC13|44136||11/01/2013|12/31/9999|$0.00|0|0|||INTESTINE TRANSPLANT| LIVE|| 58-1699775|1326041732|CHC13|44137||11/01/2013|12/31/9999|$0.00|0|0|||REMOVE INTESTINAL ALLOGRAFT|| 58-1699775|1326041732|CHC13|44139||11/01/2013|12/31/9999|$174.59|0|0|||MOBILIZATION OF COLON|| 58-1699775|1326041732|CHC13|44140||11/01/2013|12/31/9999|$1|921.10|0|0|||PARTIAL REMOVAL OF COLON|| 58-1699775|1326041732|CHC13|44141||11/01/2013|12/31/9999|$2|603.46|0|0|||PARTIAL REMOVAL OF COLON|| 58-1699775|1326041732|CHC13|44143||11/01/2013|12/31/9999|$2|384.05|0|0|||PARTIAL REMOVAL OF COLON|| 58-1699775|1326041732|CHC13|44144||11/01/2013|12/31/9999|$2|532.85|0|0|||PARTIAL REMOVAL OF COLON|| 58-1699775|1326041732|CHC13|44145||11/01/2013|12/31/9999|$2|383.00|0|0|||PARTIAL REMOVAL OF COLON|| 58-1699775|1326041732|CHC13|44146||11/01/2013|12/31/9999|$3|030.55|0|0|||PARTIAL REMOVAL OF COLON|| 58-1699775|1326041732|CHC13|44147||11/01/2013|12/31/9999|$2|773.99|0|0|||PARTIAL REMOVAL OF COLON|| 58-1699775|1326041732|CHC13|44150||11/01/2013|12/31/9999|$2|672.63|0|0|||REMOVAL OF COLON|| 58-1699775|1326041732|CHC13|44151||11/01/2013|12/31/9999|$3|057.87|0|0|||REMOVAL OF COLON/ILEOSTOMY|| 58-1699775|1326041732|CHC13|44155||11/01/2013|12/31/9999|$2|981.33|0|0|||REMOVAL OF COLON/ILEOSTOMY|| 58-1699775|1326041732|CHC13|44156||11/01/2013|12/31/9999|$3|298.23|0|0|||REMOVAL OF COLON/ILEOSTOMY|| 58-1699775|1326041732|CHC13|44157||11/01/2013|12/31/9999|$3|112.65|0|0|||COLECTOMY W/ILEOANAL ANAST|| 58-1699775|1326041732|CHC13|44158||11/01/2013|12/31/9999|$3|192.45|0|0|||COLECTOMY W/NEO-RECTUM POUCH|| 58-1699775|1326041732|CHC13|44160||11/01/2013|12/31/9999|$1|778.25|0|0|||REMOVAL OF COLON|| 58-1699775|1326041732|CHC13|44180||11/01/2013|12/31/9999|$1|317.25|0|0|||LAP| ENTEROLYSIS|| 58-1699775|1326041732|CHC13|44186||11/01/2013|12/31/9999|$932.71|0|0|||LAP| JEJUNOSTOMY|| 58-1699775|1326041732|CHC13|44187||11/01/2013|12/31/9999|$1|580.72|0|0|||LAP| ILEO/JEJUNO-STOMY|| 58-1699775|1326041732|CHC13|44188||11/01/2013|12/31/9999|$1|750.78|0|0|||LAP| COLOSTOMY|| 58-1699775|1326041732|CHC13|44202||11/01/2013|12/31/9999|$1|987.94|0|0|||LAP| ENTERECTOMY|| 58-1699775|1326041732|CHC13|44203||11/01/2013|12/31/9999|$350.07|0|0|||LAP RESECT S/INTESTINE| ADDL|| 58-1699775|1326041732|CHC13|44204||11/01/2013|12/31/9999|$2|211.54|0|0|||LAPARO PARTIAL COLECTOMY|| 58-1699775|1326041732|CHC13|44205||11/01/2013|12/31/9999|$1|923.68|0|0|||LAP COLECTOMY PART W/ILEUM|| 58-1699775|1326041732|CHC13|44206||11/01/2013|12/31/9999|$2|521.50|0|0|||LAP PART COLECTOMY W/STOMA|| 58-1699775|1326041732|CHC13|44207||11/01/2013|12/31/9999|$2|629.98|0|0|||L COLECTOMY/COLOPROCTOSTOMY|| 58-1699775|1326041732|CHC13|44208||11/01/2013|12/31/9999|$2|857.50|0|0|||L COLECTOMY/COLOPROCTOSTOMY|| 58-1699775|1326041732|CHC13|44210||11/01/2013|12/31/9999|$2|576.78|0|0|||LAPARO TOTAL PROCTOCOLECTOMY|| 58-1699775|1326041732|CHC13|44211||11/01/2013|12/31/9999|$3|219.78|0|0|||LAPARO TOTAL PROCTOCOLECTOMY|| 58-1699775|1326041732|CHC13|44212||11/01/2013|12/31/9999|$2|962.31|0|0|||LAPARO TOTAL PROCTOCOLECTOMY|| 58-1699775|1326041732|CHC13|44213||11/01/2013|12/31/9999|$273.25|0|0|||LAP| MOBIL SPLENIC FL ADD-ON|| 58-1699775|1326041732|CHC13|44227||11/01/2013|12/31/9999|$2|398.61|0|0|||LAP| CLOSE ENTEROSTOMY|| 58-1699775|1326041732|CHC13|44300||11/01/2013|12/31/9999|$1|204.86|0|0|||OPEN BOWEL TO SKIN|| 58-1699775|1326041732|CHC13|44310||11/01/2013|12/31/9999|$1|496.20|0|0|||ILEOSTOMY/JEJUNOSTOMY|| 58-1699775|1326041732|CHC13|44312||11/01/2013|12/31/9999|$846.29|0|0|||REVISION OF ILEOSTOMY|| 58-1699775|1326041732|CHC13|44314||11/01/2013|12/31/9999|$1|444.55|0|0|||REVISION OF ILEOSTOMY|| 58-1699775|1326041732|CHC13|44316||11/01/2013|12/31/9999|$2|019.53|0|0|||DEVISE BOWEL POUCH|| 58-1699775|1326041732|CHC13|44320||11/01/2013|12/31/9999|$1|720.58|0|0|||COLOSTOMY|| 58-1699775|1326041732|CHC13|44322||11/01/2013|12/31/9999|$1|411.58|0|0|||COLOSTOMY WITH BIOPSIES|| 58-1699775|1326041732|CHC13|44340||11/01/2013|12/31/9999|$884.28|0|0|||REVISION OF COLOSTOMY|| 58-1699775|1326041732|CHC13|44345||11/01/2013|12/31/9999|$1|505.71|0|0|||REVISION OF COLOSTOMY|| 58-1699775|1326041732|CHC13|44346||11/01/2013|12/31/9999|$1|692.24|0|0|||REVISION OF COLOSTOMY|| 58-1699775|1326041732|CHC13|44360||11/01/2013|12/31/9999|$229.56|0|0|||SMALL BOWEL ENDOSCOPY|| 58-1699775|1326041732|CHC13|44361||11/01/2013|12/31/9999|$252.61|0|0|||SMALL BOWEL ENDOSCOPY/BIOPSY|| 58-1699775|1326041732|CHC13|44363||11/01/2013|12/31/9999|$302.32|0|0|||SMALL BOWEL ENDOSCOPY|| 58-1699775|1326041732|CHC13|44364||11/01/2013|12/31/9999|$322.85|0|0|||SMALL BOWEL ENDOSCOPY|| 58-1699775|1326041732|CHC13|44365||11/01/2013|12/31/9999|$288.95|0|0|||SMALL BOWEL ENDOSCOPY|| 58-1699775|1326041732|CHC13|44366||11/01/2013|12/31/9999|$379.22|0|0|||SMALL BOWEL ENDOSCOPY|| 58-1699775|1326041732|CHC13|44369||11/01/2013|12/31/9999|$388.06|0|0|||SMALL BOWEL ENDOSCOPY|| 58-1699775|1326041732|CHC13|44370||11/01/2013|12/31/9999|$418.01|0|0|||SMALL BOWEL ENDOSCOPY/STENT|| 58-1699775|1326041732|CHC13|44372||11/01/2013|12/31/9999|$374.25|0|0|||SMALL BOWEL ENDOSCOPY|| 58-1699775|1326041732|CHC13|44373||11/01/2013|12/31/9999|$300.96|0|0|||SMALL BOWEL ENDOSCOPY|| 58-1699775|1326041732|CHC13|44376||11/01/2013|12/31/9999|$444.44|0|0|||SMALL BOWEL ENDOSCOPY|| 58-1699775|1326041732|CHC13|44377||11/01/2013|12/31/9999|$469.69|0|0|||SMALL BOWEL ENDOSCOPY/BIOPSY|| 58-1699775|1326041732|CHC13|44378||11/01/2013|12/31/9999|$602.63|0|0|||SMALL BOWEL ENDOSCOPY|| 58-1699775|1326041732|CHC13|44379||11/01/2013|12/31/9999|$640.22|0|0|||S BOWEL ENDOSCOPE W/STENT|| 58-1699775|1326041732|CHC13|44380||11/01/2013|12/31/9999|$99.21|0|0|||SMALL BOWEL ENDOSCOPY|| 58-1699775|1326041732|CHC13|44381||04/01/2015|12/31/9999|$65.00|0|0|0|%|SMALL BOWEL ENDOSCOPY BR/WA|| 58-1699775|1326041732|CHC13|44382||11/01/2013|12/31/9999|$119.71|0|0|||SMALL BOWEL ENDOSCOPY|| 58-1699775|1326041732|CHC13|44384||04/01/2015|12/31/9999|$65.00|0|0|0|%|SMALL BOWEL ENDOSCOPY|| 58-1699775|1326041732|CHC13|44385||11/01/2013|12/31/9999|$154.76|0|0|||ENDOSCOPY OF BOWEL POUCH|| 58-1699775|1326041732|CHC13|44386||11/01/2013|12/31/9999|$184.85|0|0|||ENDOSCOPY| BOWEL POUCH/BIOP|| 58-1699775|1326041732|CHC13|44388||11/01/2013|12/31/9999|$242.78|0|0|||COLONOSCOPY|| 58-1699775|1326041732|CHC13|44389||11/01/2013|12/31/9999|$270.59|0|0|||COLONOSCOPY WITH BIOPSY|| 58-1699775|1326041732|CHC13|44390||11/01/2013|12/31/9999|$319.23|0|0|||COLONOSCOPY FOR FOREIGN BODY|| 58-1699775|1326041732|CHC13|44391||11/01/2013|12/31/9999|$366.85|0|0|||COLONOSCOPY FOR BLEEDING|| 58-1699775|1326041732|CHC13|44392||11/01/2013|12/31/9999|$321.12|0|0|||COLONOSCOPY & POLYPECTOMY|| 58-1699775|1326041732|CHC13|44393||11/01/2013|12/31/9999|$406.40|0|0|||COLONOSCOPY| LESION REMOVAL|| 58-1699775|1326041732|CHC13|44394||11/01/2013|12/31/9999|$374.36|0|0|||COLONOSCOPY W/SNARE|| 58-1699775|1326041732|CHC13|44401||04/01/2015|12/31/9999|$65.00|0|0|0|%|COLONOSCOPY WITH ABLATION|| 58-1699775|1326041732|CHC13|44402||04/01/2015|12/31/9999|$65.00|0|0|0|%|COLONOSCOPY W/STENT PLCMT|| 58-1699775|1326041732|CHC13|44403||04/01/2015|12/31/9999|$65.00|0|0|0|%|COLONOSCOPY W/RESECTION|| 58-1699775|1326041732|CHC13|44404||04/01/2015|12/31/9999|$65.00|0|0|0|%|COLONOSCOPY W/INJECTION|| 58-1699775|1326041732|CHC13|44405||04/01/2015|12/31/9999|$65.00|0|0|0|%|COLONOSCOPY W/DILATION|| 58-1699775|1326041732|CHC13|44406||04/01/2015|12/31/9999|$65.00|0|0|0|%|COLONOSCOPY W/ULTRASOUND|| 58-1699775|1326041732|CHC13|44407||04/01/2015|12/31/9999|$65.00|0|0|0|%|COLONOSCOPY W/NDL ASPIR/BX|| 58-1699775|1326041732|CHC13|44408||04/01/2015|12/31/9999|$65.00|0|0|0|%|COLONOSCOPY W/DECOMPRESSION|| 58-1699775|1326041732|CHC13|44500||11/01/2013|12/31/9999|$35.62|0|0|||INTRO| GASTROINTESTINAL TUBE|| 58-1699775|1326041732|CHC13|4450F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|44602||11/01/2013|12/31/9999|$2|016.80|0|0|||SUTURE| SMALL INTESTINE|| 58-1699775|1326041732|CHC13|44603||11/01/2013|12/31/9999|$2|315.40|0|0|||SUTURE| SMALL INTESTINE|| 58-1699775|1326041732|CHC13|44604||11/01/2013|12/31/9999|$1|515.62|0|0|||SUTURE| LARGE INTESTINE|| 58-1699775|1326041732|CHC13|44605||11/01/2013|12/31/9999|$1|877.52|0|0|||REPAIR OF BOWEL LESION|| 58-1699775|1326041732|CHC13|44615||11/01/2013|12/31/9999|$1|542.23|0|0|||INTESTINAL STRICTUROPLASTY|| 58-1699775|1326041732|CHC13|44620||11/01/2013|12/31/9999|$1|241.29|0|0|||REPAIR BOWEL OPENING|| 58-1699775|1326041732|CHC13|44625||11/01/2013|12/31/9999|$1|463.26|0|0|||REPAIR BOWEL OPENING|| 58-1699775|1326041732|CHC13|44626||11/01/2013|12/31/9999|$2|306.62|0|0|||REPAIR BOWEL OPENING|| 58-1699775|1326041732|CHC13|44640||11/01/2013|12/31/9999|$2|014.69|0|0|||REPAIR BOWEL-SKIN FISTULA|| 58-1699775|1326041732|CHC13|44650||11/01/2013|12/31/9999|$2|084.39|0|0|||REPAIR BOWEL FISTULA|| 58-1699775|1326041732|CHC13|44660||11/01/2013|12/31/9999|$1|929.52|0|0|||REPAIR BOWEL-BLADDER FISTULA|| 58-1699775|1326041732|CHC13|44661||11/01/2013|12/31/9999|$2|235.90|0|0|||REPAIR BOWEL-BLADDER FISTULA|| 58-1699775|1326041732|CHC13|44680||11/01/2013|12/31/9999|$1|539.98|0|0|||SURGICAL REVISION| INTESTINE|| 58-1699775|1326041732|CHC13|44700||11/01/2013|12/31/9999|$1|461.98|0|0|||SUSPEND BOWEL W/PROSTHESIS|| 58-1699775|1326041732|CHC13|44701||11/01/2013|12/31/9999|$242.16|0|0|||INTRAOP COLON LAVAGE ADD-ON|| 58-1699775|1326041732|CHC13|44705||11/01/2013|12/31/9999|$0.00|0|0|||PREPARE FECAL MICROBIOTA|| 58-1699775|1326041732|CHC13|4470F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|44715||11/01/2013|12/31/9999|$0.00|0|0|||PREPARE DONOR INTESTINE|| 58-1699775|1326041732|CHC13|44720||11/01/2013|12/31/9999|$358.06|0|0|||PREP DONOR INTESTINE/VENOUS|| 58-1699775|1326041732|CHC13|44721||11/01/2013|12/31/9999|$555.92|0|0|||PREP DONOR INTESTINE/ARTERY|| 58-1699775|1326041732|CHC13|44799||11/01/2013|12/31/9999|$0.00|0|0|||UNLISTED PROCEDURE INTESTINE|| 58-1699775|1326041732|CHC13|44800||11/01/2013|12/31/9999|$1|089.37|0|0|||EXCISION OF BOWEL POUCH|| 58-1699775|1326041732|CHC13|4480F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|4481F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|44820||11/01/2013|12/31/9999|$1|200.50|0|0|||EXCISION OF MESENTERY LESION|| 58-1699775|1326041732|CHC13|44850||11/01/2013|12/31/9999|$1|070.55|0|0|||REPAIR OF MESENTERY|| 58-1699775|1326041732|CHC13|44899||11/01/2013|12/31/9999|$0.00|0|0|||BOWEL SURGERY PROCEDURE|| 58-1699775|1326041732|CHC13|44900||11/01/2013|12/31/9999|$1|103.39|0|0|||DRAIN APP ABSCESS| OPEN|| 58-1699775|1326041732|CHC13|44950||11/01/2013|12/31/9999|$918.28|0|0|||APPENDECTOMY|| 58-1699775|1326041732|CHC13|44955||11/01/2013|12/31/9999|$121.23|0|0|||APPENDECTOMY ADD-ON|| 58-1699775|1326041732|CHC13|44960||11/01/2013|12/31/9999|$1|249.37|0|0|||APPENDECTOMY|| 58-1699775|1326041732|CHC13|44970||11/01/2013|12/31/9999|$853.67|0|0|||LAPAROSCOPY| APPENDECTOMY|| 58-1699775|1326041732|CHC13|44979||11/01/2013|12/31/9999|$0.00|0|0|||LAPAROSCOPE PROC| APP|| 58-1699775|1326041732|CHC13|45000||11/01/2013|12/31/9999|$600.25|0|0|||DRAINAGE OF PELVIC ABSCESS|| 58-1699775|1326041732|CHC13|45005||11/01/2013|12/31/9999|$223.84|0|0|||DRAINAGE OF RECTAL ABSCESS|| 58-1699775|1326041732|CHC13|4500F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|45020||11/01/2013|12/31/9999|$807.23|0|0|||DRAINAGE OF RECTAL ABSCESS|| 58-1699775|1326041732|CHC13|45100||11/01/2013|12/31/9999|$421.94|0|0|||BIOPSY OF RECTUM|| 58-1699775|1326041732|CHC13|45108||11/01/2013|12/31/9999|$519.83|0|0|||REMOVAL OF ANORECTAL LESION|| 58-1699775|1326041732|CHC13|4510F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|45110||11/01/2013|12/31/9999|$2|654.12|0|0|||REMOVAL OF RECTUM|| 58-1699775|1326041732|CHC13|45111||11/01/2013|12/31/9999|$1|560.43|0|0|||PARTIAL REMOVAL OF RECTUM|| 58-1699775|1326041732|CHC13|45112||11/01/2013|12/31/9999|$2|711.58|0|0|||REMOVAL OF RECTUM|| 58-1699775|1326041732|CHC13|45113||11/01/2013|12/31/9999|$2|842.15|0|0|||PARTIAL PROCTECTOMY|| 58-1699775|1326041732|CHC13|45114||11/01/2013|12/31/9999|$2|595.34|0|0|||PARTIAL REMOVAL OF RECTUM|| 58-1699775|1326041732|CHC13|45116||11/01/2013|12/31/9999|$2|257.17|0|0|||PARTIAL REMOVAL OF RECTUM|| 58-1699775|1326041732|CHC13|45119||11/01/2013|12/31/9999|$2|800.39|0|0|||REMOVE RECTUM W/RESERVOIR|| 58-1699775|1326041732|CHC13|45120||11/01/2013|12/31/9999|$2|261.56|0|0|||REMOVAL OF RECTUM|| 58-1699775|1326041732|CHC13|45121||11/01/2013|12/31/9999|$2|481.32|0|0|||REMOVAL OF RECTUM AND COLON|| 58-1699775|1326041732|CHC13|45123||11/01/2013|12/31/9999|$1|598.66|0|0|||PARTIAL PROCTECTOMY|| 58-1699775|1326041732|CHC13|45126||11/01/2013|12/31/9999|$4|125.32|0|0|||PELVIC EXENTERATION|| 58-1699775|1326041732|CHC13|45130||11/01/2013|12/31/9999|$1|563.25|0|0|||EXCISION OF RECTAL PROLAPSE|| 58-1699775|1326041732|CHC13|45135||11/01/2013|12/31/9999|$1|947.60|0|0|||EXCISION OF RECTAL PROLAPSE|| 58-1699775|1326041732|CHC13|45136||11/01/2013|12/31/9999|$2|603.20|0|0|||EXCISE ILEOANAL RESERVIOR|| 58-1699775|1326041732|CHC13|45150||11/01/2013|12/31/9999|$559.00|0|0|||EXCISION OF RECTAL STRICTURE|| 58-1699775|1326041732|CHC13|45160||11/01/2013|12/31/9999|$1|447.49|0|0|||EXCISION OF RECTAL LESION|| 58-1699775|1326041732|CHC13|45171||11/01/2013|12/31/9999|$863.05|0|0|||EXC RECT TUM TRANSANAL PART|| 58-1699775|1326041732|CHC13|45172||11/01/2013|12/31/9999|$1|172.91|0|0|||EXC RECT TUM TRANSANAL FULL|| 58-1699775|1326041732|CHC13|45190||11/01/2013|12/31/9999|$980.05|0|0|||DESTRUCTION| RECTAL TUMOR|| 58-1699775|1326041732|CHC13|4525F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|4526F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|45300||11/01/2013|12/31/9999|$76.33|0|0|||PROCTOSIGMOIDOSCOPY DX|| 58-1699775|1326041732|CHC13|45303||11/01/2013|12/31/9999|$131.08|0|0|||PROCTOSIGMOIDOSCOPY DILATE|| 58-1699775|1326041732|CHC13|45305||11/01/2013|12/31/9999|$113.69|0|0|||PROCTOSIGMOIDOSCOPY W/BX|| 58-1699775|1326041732|CHC13|45307||11/01/2013|12/31/9999|$148.74|0|0|||PROCTOSIGMOIDOSCOPY FB|| 58-1699775|1326041732|CHC13|45308||11/01/2013|12/31/9999|$125.06|0|0|||PROCTOSIGMOIDOSCOPY REMOVAL|| 58-1699775|1326041732|CHC13|45309||11/01/2013|12/31/9999|$133.85|0|0|||PROCTOSIGMOIDOSCOPY REMOVAL|| 58-1699775|1326041732|CHC13|45315||11/01/2013|12/31/9999|$158.43|0|0|||PROCTOSIGMOIDOSCOPY REMOVAL|| 58-1699775|1326041732|CHC13|45317||11/01/2013|12/31/9999|$170.02|0|0|||PROCTOSIGMOIDOSCOPY BLEED|| 58-1699775|1326041732|CHC13|45320||11/01/2013|12/31/9999|$155.54|0|0|||PROCTOSIGMOIDOSCOPY ABLATE|| 58-1699775|1326041732|CHC13|45321||11/01/2013|12/31/9999|$155.42|0|0|||PROCTOSIGMOIDOSCOPY VOLVUL|| 58-1699775|1326041732|CHC13|45327||11/01/2013|12/31/9999|$176.57|0|0|||PROCTOSIGMOIDOSCOPY W/STENT|| 58-1699775|1326041732|CHC13|45330||11/01/2013|12/31/9999|$91.87|0|0|||DIAGNOSTIC SIGMOIDOSCOPY|| 58-1699775|1326041732|CHC13|45331||11/01/2013|12/31/9999|$110.34|0|0|||SIGMOIDOSCOPY AND BIOPSY|| 58-1699775|1326041732|CHC13|45332||11/01/2013|12/31/9999|$161.98|0|0|||SIGMOIDOSCOPY W/FB REMOVAL|| 58-1699775|1326041732|CHC13|45333||11/01/2013|12/31/9999|$160.61|0|0|||SIGMOIDOSCOPY & POLYPECTOMY|| 58-1699775|1326041732|CHC13|45334||11/01/2013|12/31/9999|$239.01|0|0|||SIGMOIDOSCOPY FOR BLEEDING|| 58-1699775|1326041732|CHC13|45335||11/01/2013|12/31/9999|$134.50|0|0|||SIGMOIDOSCOPY W/SUBMUC INJ|| 58-1699775|1326041732|CHC13|45337||11/01/2013|12/31/9999|$207.27|0|0|||SIGMOIDOSCOPY & DECOMPRESS|| 58-1699775|1326041732|CHC13|45338||11/01/2013|12/31/9999|$206.20|0|0|||SIGMOIDOSCOPY W/TUMR REMOVE|| 58-1699775|1326041732|CHC13|45340||11/01/2013|12/31/9999|$169.40|0|0|||SIG W/BALLOON DILATION|| 58-1699775|1326041732|CHC13|45341||11/01/2013|12/31/9999|$228.69|0|0|||SIGMOIDOSCOPY W/ULTRASOUND|| 58-1699775|1326041732|CHC13|45342||11/01/2013|12/31/9999|$349.83|0|0|||SIGMOIDOSCOPY W/US GUIDE BX|| 58-1699775|1326041732|CHC13|45346||04/01/2015|12/31/9999|$65.00|0|0|0|%|SIGMOIDOSCOPY W/ABLATION|| 58-1699775|1326041732|CHC13|45347||04/01/2015|12/31/9999|$65.00|0|0|0|%|SIGMOIDOSCOPY W/PLCMT STENT|| 58-1699775|1326041732|CHC13|45349||04/01/2015|12/31/9999|$65.00|0|0|0|%|SIGMOIDOSCOPY W/RESECTION|| 58-1699775|1326041732|CHC13|45350||04/01/2015|12/31/9999|$65.00|0|0|0|%|SGMDSC W/BAND LIGATION|| 58-1699775|1326041732|CHC13|45378||11/01/2013|12/31/9999|$317.22|0|0|||DIAGNOSTIC COLONOSCOPY|| 58-1699775|1326041732|CHC13|45379||11/01/2013|12/31/9999|$396.85|0|0|||COLONOSCOPY W/FB REMOVAL|| 58-1699775|1326041732|CHC13|45380||11/01/2013|12/31/9999|$379.42|0|0|||COLONOSCOPY AND BIOPSY|| 58-1699775|1326041732|CHC13|45381||11/01/2013|12/31/9999|$359.77|0|0|||COLONOSCOPY| SUBMUCOUS INJ|| 58-1699775|1326041732|CHC13|45382||11/01/2013|12/31/9999|$483.39|0|0|||COLONOSCOPY/CONTROL BLEEDING|| 58-1699775|1326041732|CHC13|45384||11/01/2013|12/31/9999|$396.00|0|0|||LESION REMOVE COLONOSCOPY|| 58-1699775|1326041732|CHC13|45385||11/01/2013|12/31/9999|$450.18|0|0|||LESION REMOVAL COLONOSCOPY|| 58-1699775|1326041732|CHC13|45386||11/01/2013|12/31/9999|$388.94|0|0|||COLONOSCOPY DILATE STRICTURE|| 58-1699775|1326041732|CHC13|45388||04/01/2015|12/31/9999|$65.00|0|0|0|%|COLONOSCOPY W/ABLATION|| 58-1699775|1326041732|CHC13|45389||04/01/2015|12/31/9999|$65.00|0|0|0|%|COLONOSCOPY W/STENT PLCMT|| 58-1699775|1326041732|CHC13|45390||04/01/2015|12/31/9999|$65.00|0|0|0|%|COLONOSCOPY W/RESECTION|| 58-1699775|1326041732|CHC13|45391||11/01/2013|12/31/9999|$431.55|0|0|||COLONOSCOPY W/ENDOSCOPE US|| 58-1699775|1326041732|CHC13|45392||11/01/2013|12/31/9999|$555.54|0|0|||COLONOSCOPY W/ENDOSCOPIC FNB|| 58-1699775|1326041732|CHC13|45393||04/01/2015|12/31/9999|$65.00|0|0|0|%|COLONOSCOPY W/DECOMPRESSION|| 58-1699775|1326041732|CHC13|45395||11/01/2013|12/31/9999|$2|851.71|0|0|||LAP| REMOVAL OF RECTUM|| 58-1699775|1326041732|CHC13|45397||11/01/2013|12/31/9999|$3|081.35|0|0|||LAP| REMOVE RECTUM W/POUCH|| 58-1699775|1326041732|CHC13|45398||04/01/2015|12/31/9999|$65.00|0|0|0|%|COLONOSCOPY W/BAND LIGATION|| 58-1699775|1326041732|CHC13|45399||04/01/2015|12/31/9999|$0.00|0|0|0||UNLISTED PROCEDURE COLON|| 58-1699775|1326041732|CHC13|45400||11/01/2013|12/31/9999|$1|655.02|0|0|||LAPAROSCOPIC PROCTOPEXY|| 58-1699775|1326041732|CHC13|45402||11/01/2013|12/31/9999|$2|199.00|0|0|||LAP PROCTOPEXY W/SIG RESECT|| 58-1699775|1326041732|CHC13|45499||11/01/2013|12/31/9999|$0.00|0|0|||LAPAROSCOPE PROC| RECTUM|| 58-1699775|1326041732|CHC13|45500||11/01/2013|12/31/9999|$743.59|0|0|||REPAIR OF RECTUM|| 58-1699775|1326041732|CHC13|45505||11/01/2013|12/31/9999|$832.61|0|0|||REPAIR OF RECTUM|| 58-1699775|1326041732|CHC13|45520||11/01/2013|12/31/9999|$56.61|0|0|||TREATMENT OF RECTAL PROLAPSE|| 58-1699775|1326041732|CHC13|45540||11/01/2013|12/31/9999|$1|519.08|0|0|||CORRECT RECTAL PROLAPSE|| 58-1699775|1326041732|CHC13|45541||11/01/2013|12/31/9999|$1|322.88|0|0|||CORRECT RECTAL PROLAPSE|| 58-1699775|1326041732|CHC13|45550||11/01/2013|12/31/9999|$2|099.71|0|0|||REPAIR RECTUM/REMOVE SIGMOID|| 58-1699775|1326041732|CHC13|45560||11/01/2013|12/31/9999|$1|005.29|0|0|||REPAIR OF RECTOCELE|| 58-1699775|1326041732|CHC13|45562||11/01/2013|12/31/9999|$1|586.60|0|0|||EXPLORATION/REPAIR OF RECTUM|| 58-1699775|1326041732|CHC13|45563||11/01/2013|12/31/9999|$2|342.61|0|0|||EXPLORATION/REPAIR OF RECTUM|| 58-1699775|1326041732|CHC13|45800||11/01/2013|12/31/9999|$1|721.62|0|0|||REPAIR RECT/BLADDER FISTULA|| 58-1699775|1326041732|CHC13|45805||11/01/2013|12/31/9999|$2|078.56|0|0|||REPAIR FISTULA W/COLOSTOMY|| 58-1699775|1326041732|CHC13|45820||11/01/2013|12/31/9999|$1|681.23|0|0|||REPAIR RECTOURETHRAL FISTULA|| 58-1699775|1326041732|CHC13|45825||11/01/2013|12/31/9999|$2|094.41|0|0|||REPAIR FISTULA W/COLOSTOMY|| 58-1699775|1326041732|CHC13|45900||11/01/2013|12/31/9999|$286.94|0|0|||REDUCTION OF RECTAL PROLAPSE|| 58-1699775|1326041732|CHC13|45905||11/01/2013|12/31/9999|$239.36|0|0|||DILATION OF ANAL SPHINCTER|| 58-1699775|1326041732|CHC13|45910||11/01/2013|12/31/9999|$278.75|0|0|||DILATION OF RECTAL NARROWING|| 58-1699775|1326041732|CHC13|45915||11/01/2013|12/31/9999|$319.09|0|0|||REMOVE RECTAL OBSTRUCTION|| 58-1699775|1326041732|CHC13|45990||11/01/2013|12/31/9999|$153.81|0|0|||SURG DX EXAM| ANORECTAL|| 58-1699775|1326041732|CHC13|45999||11/01/2013|12/31/9999|$0.00|0|0|||RECTUM SURGERY PROCEDURE|| 58-1699775|1326041732|CHC13|46020||11/01/2013|12/31/9999|$328.22|0|0|||PLACEMENT OF SETON|| 58-1699775|1326041732|CHC13|46030||11/01/2013|12/31/9999|$127.95|0|0|||REMOVAL OF RECTAL MARKER|| 58-1699775|1326041732|CHC13|46040||11/01/2013|12/31/9999|$580.22|0|0|||INCISION OF RECTAL ABSCESS|| 58-1699775|1326041732|CHC13|46045||11/01/2013|12/31/9999|$605.93|0|0|||INCISION OF RECTAL ABSCESS|| 58-1699775|1326041732|CHC13|46050||11/01/2013|12/31/9999|$137.49|0|0|||INCISION OF ANAL ABSCESS|| 58-1699775|1326041732|CHC13|46060||11/01/2013|12/31/9999|$666.78|0|0|||INCISION OF RECTAL ABSCESS|| 58-1699775|1326041732|CHC13|46070||11/01/2013|12/31/9999|$333.48|0|0|||INCISION OF ANAL SEPTUM|| 58-1699775|1326041732|CHC13|46080||11/01/2013|12/31/9999|$227.53|0|0|||INCISION OF ANAL SPHINCTER|| 58-1699775|1326041732|CHC13|46083||11/01/2013|12/31/9999|$151.43|0|0|||INCISE EXTERNAL HEMORRHOID|| 58-1699775|1326041732|CHC13|46200||11/01/2013|12/31/9999|$450.18|0|0|||REMOVAL OF ANAL FISSURE|| 58-1699775|1326041732|CHC13|46220||11/01/2013|12/31/9999|$167.94|0|0|||REMOVAL OF ANAL TAG|| 58-1699775|1326041732|CHC13|46221||11/01/2013|12/31/9999|$268.30|0|0|||LIGATION OF HEMORRHOID(S)|| 58-1699775|1326041732|CHC13|46230||11/01/2013|12/31/9999|$245.92|0|0|||REMOVAL OF ANAL TAGS|| 58-1699775|1326041732|CHC13|46250||11/01/2013|12/31/9999|$441.53|0|0|||HEMORRHOIDECTOMY|| 58-1699775|1326041732|CHC13|46255||11/01/2013|12/31/9999|$498.61|0|0|||HEMORRHOIDECTOMY|| 58-1699775|1326041732|CHC13|46257||11/01/2013|12/31/9999|$591.92|0|0|||REMOVE HEMORRHOIDS & FISSURE|| 58-1699775|1326041732|CHC13|46258||11/01/2013|12/31/9999|$654.90|0|0|||REMOVE HEMORRHOIDS & FISTULA|| 58-1699775|1326041732|CHC13|46260||11/01/2013|12/31/9999|$667.87|0|0|||HEMORRHOIDECTOMY|| 58-1699775|1326041732|CHC13|46261||11/01/2013|12/31/9999|$741.73|0|0|||REMOVE HEMORRHOIDS & FISSURE|| 58-1699775|1326041732|CHC13|46262||11/01/2013|12/31/9999|$780.19|0|0|||REMOVE HEMORRHOIDS & FISTULA|| 58-1699775|1326041732|CHC13|46270||11/01/2013|12/31/9999|$546.13|0|0|||REMOVAL OF ANAL FISTULA|| 58-1699775|1326041732|CHC13|46275||11/01/2013|12/31/9999|$578.99|0|0|||REMOVAL OF ANAL FISTULA|| 58-1699775|1326041732|CHC13|46280||11/01/2013|12/31/9999|$658.09|0|0|||REMOVAL OF ANAL FISTULA|| 58-1699775|1326041732|CHC13|46285||11/01/2013|12/31/9999|$575.68|0|0|||REMOVAL OF ANAL FISTULA|| 58-1699775|1326041732|CHC13|46288||11/01/2013|12/31/9999|$770.33|0|0|||REPAIR ANAL FISTULA|| 58-1699775|1326041732|CHC13|46320||11/01/2013|12/31/9999|$157.55|0|0|||REMOVAL OF HEMORRHOID CLOT|| 58-1699775|1326041732|CHC13|46500||11/01/2013|12/31/9999|$182.09|0|0|||INJECTION INTO HEMORRHOID(S)|| 58-1699775|1326041732|CHC13|46505||11/01/2013|12/31/9999|$338.40|0|0|||CHEMODENERVATION ANAL MUSC|| 58-1699775|1326041732|CHC13|46600||11/01/2013|12/31/9999|$57.09|0|0|||DIAGNOSTIC ANOSCOPY|| 58-1699775|1326041732|CHC13|46601||04/01/2015|12/31/9999|$65.00|0|0|0|%|DIAGNOSTIC ANOSCOPY|| 58-1699775|1326041732|CHC13|46604||11/01/2013|12/31/9999|$94.56|0|0|||ANOSCOPY AND DILATION|| 58-1699775|1326041732|CHC13|46606||11/01/2013|12/31/9999|$109.76|0|0|||ANOSCOPY AND BIOPSY|| 58-1699775|1326041732|CHC13|46607||04/01/2015|12/31/9999|$65.00|0|0|0|%|DIAGNOSTIC ANOSCOPY & BIOPSY|| 58-1699775|1326041732|CHC13|46608||11/01/2013|12/31/9999|$115.34|0|0|||ANOSCOPY| REMOVE FOR BODY|| 58-1699775|1326041732|CHC13|46610||11/01/2013|12/31/9999|$116.15|0|0|||ANOSCOPY| REMOVE LESION|| 58-1699775|1326041732|CHC13|46611||11/01/2013|12/31/9999|$118.08|0|0|||ANOSCOPY|| 58-1699775|1326041732|CHC13|46612||11/01/2013|12/31/9999|$135.75|0|0|||ANOSCOPY| REMOVE LESIONS|| 58-1699775|1326041732|CHC13|46614||11/01/2013|12/31/9999|$92.99|0|0|||ANOSCOPY| CONTROL BLEEDING|| 58-1699775|1326041732|CHC13|46615||11/01/2013|12/31/9999|$135.26|0|0|||ANOSCOPY|| 58-1699775|1326041732|CHC13|46700||11/01/2013|12/31/9999|$923.33|0|0|||REPAIR OF ANAL STRICTURE|| 58-1699775|1326041732|CHC13|46705||11/01/2013|12/31/9999|$721.26|0|0|||REPAIR OF ANAL STRICTURE|| 58-1699775|1326041732|CHC13|46706||11/01/2013|12/31/9999|$236.17|0|0|||REPR OF ANAL FISTULA W/GLUE|| 58-1699775|1326041732|CHC13|46707||11/01/2013|12/31/9999|$662.78|0|0|||REPAIR ANORECTAL FIST W/PLUG|| 58-1699775|1326041732|CHC13|46710||11/01/2013|12/31/9999|$1|560.20|0|0|||REPR PER/VAG POUCH SNGL PROC|| 58-1699775|1326041732|CHC13|46712||11/01/2013|12/31/9999|$2|914.45|0|0|||REPR PER/VAG POUCH DBL PROC|| 58-1699775|1326041732|CHC13|46715||11/01/2013|12/31/9999|$697.51|0|0|||REP PERF ANOPER FISTU|| 58-1699775|1326041732|CHC13|46716||11/01/2013|12/31/9999|$1|624.59|0|0|||REP PERF ANOPER/VESTIB FISTU|| 58-1699775|1326041732|CHC13|46730||11/01/2013|12/31/9999|$2|565.43|0|0|||CONSTRUCTION OF ABSENT ANUS|| 58-1699775|1326041732|CHC13|46735||11/01/2013|12/31/9999|$2|912.80|0|0|||CONSTRUCTION OF ABSENT ANUS|| 58-1699775|1326041732|CHC13|46740||11/01/2013|12/31/9999|$3|042.15|0|0|||CONSTRUCTION OF ABSENT ANUS|| 58-1699775|1326041732|CHC13|46742||11/01/2013|12/31/9999|$3|465.94|0|0|||REPAIR OF IMPERFORATED ANUS|| 58-1699775|1326041732|CHC13|46744||11/01/2013|12/31/9999|$4|797.42|0|0|||REPAIR OF CLOACAL ANOMALY|| 58-1699775|1326041732|CHC13|46746||11/01/2013|12/31/9999|$5|067.56|0|0|||REPAIR OF CLOACAL ANOMALY|| 58-1699775|1326041732|CHC13|46748||11/01/2013|12/31/9999|$5|493.68|0|0|||REPAIR OF CLOACAL ANOMALY|| 58-1699775|1326041732|CHC13|46750||11/01/2013|12/31/9999|$1|089.17|0|0|||REPAIR OF ANAL SPHINCTER|| 58-1699775|1326041732|CHC13|46751||11/01/2013|12/31/9999|$863.73|0|0|||REPAIR OF ANAL SPHINCTER|| 58-1699775|1326041732|CHC13|46753||11/01/2013|12/31/9999|$830.79|0|0|||RECONSTRUCTION OF ANUS|| 58-1699775|1326041732|CHC13|46754||11/01/2013|12/31/9999|$324.88|0|0|||REMOVAL OF SUTURE FROM ANUS|| 58-1699775|1326041732|CHC13|46760||11/01/2013|12/31/9999|$1|551.74|0|0|||REPAIR OF ANAL SPHINCTER|| 58-1699775|1326041732|CHC13|46761||11/01/2013|12/31/9999|$1|332.25|0|0|||REPAIR OF ANAL SPHINCTER|| 58-1699775|1326041732|CHC13|46762||11/01/2013|12/31/9999|$1|313.75|0|0|||IMPLANT ARTIFICIAL SPHINCTER|| 58-1699775|1326041732|CHC13|46900||11/01/2013|12/31/9999|$196.09|0|0|||DESTRUCTION| ANAL LESION(S)|| 58-1699775|1326041732|CHC13|46910||11/01/2013|12/31/9999|$191.57|0|0|||DESTRUCTION| ANAL LESION(S)|| 58-1699775|1326041732|CHC13|46916||11/01/2013|12/31/9999|$206.13|0|0|||CRYOSURGERY| ANAL LESION(S)|| 58-1699775|1326041732|CHC13|46917||11/01/2013|12/31/9999|$190.18|0|0|||LASER SURGERY| ANAL LESIONS|| 58-1699775|1326041732|CHC13|46922||11/01/2013|12/31/9999|$191.59|0|0|||EXCISION OF ANAL LESION(S)|| 58-1699775|1326041732|CHC13|46924||11/01/2013|12/31/9999|$263.36|0|0|||DESTRUCTION| ANAL LESION(S)|| 58-1699775|1326041732|CHC13|46930||11/01/2013|12/31/9999|$210.52|0|0|||DESTROY INTERNAL HEMORRHOIDS|| 58-1699775|1326041732|CHC13|46940||11/01/2013|12/31/9999|$209.50|0|0|||TREATMENT OF ANAL FISSURE|| 58-1699775|1326041732|CHC13|46942||11/01/2013|12/31/9999|$187.34|0|0|||TREATMENT OF ANAL FISSURE|| 58-1699775|1326041732|CHC13|46945||11/01/2013|12/31/9999|$313.32|0|0|||LIGATION OF HEMORRHOIDS|| 58-1699775|1326041732|CHC13|46946||11/01/2013|12/31/9999|$316.05|0|0|||LIGATION OF HEMORRHOIDS|| 58-1699775|1326041732|CHC13|46947||11/01/2013|12/31/9999|$540.97|0|0|||HEMORRHOIDOPEXY BY STAPLING|| 58-1699775|1326041732|CHC13|46999||11/01/2013|12/31/9999|$65.00|0|0||%|ANUS SURGERY PROCEDURE|| 58-1699775|1326041732|CHC13|47000||11/01/2013|12/31/9999|$148.21|0|0|||NEEDLE BIOPSY OF LIVER|| 58-1699775|1326041732|CHC13|47001||11/01/2013|12/31/9999|$148.94|0|0|||NEEDLE BIOPSY| LIVER ADD-ON|| 58-1699775|1326041732|CHC13|47010||11/01/2013|12/31/9999|$1|709.05|0|0|||OPEN DRAINAGE| LIVER LESION|| 58-1699775|1326041732|CHC13|47015||11/01/2013|12/31/9999|$1|653.42|0|0|||INJECT/ASPIRATE LIVER CYST|| 58-1699775|1326041732|CHC13|47100||11/01/2013|12/31/9999|$1|197.85|0|0|||WEDGE BIOPSY OF LIVER|| 58-1699775|1326041732|CHC13|47120||11/01/2013|12/31/9999|$3|318.38|0|0|||PARTIAL REMOVAL OF LIVER|| 58-1699775|1326041732|CHC13|47122||11/01/2013|12/31/9999|$4|901.14|0|0|||EXTENSIVE REMOVAL OF LIVER|| 58-1699775|1326041732|CHC13|47125||11/01/2013|12/31/9999|$4|386.74|0|0|||PARTIAL REMOVAL OF LIVER|| 58-1699775|1326041732|CHC13|47130||11/01/2013|12/31/9999|$4|716.37|0|0|||PARTIAL REMOVAL OF LIVER|| 58-1699775|1326041732|CHC13|47135||11/01/2013|12/31/9999|$7|011.26|0|0|||TRANSPLANTATION OF LIVER|| 58-1699775|1326041732|CHC13|47140||11/01/2013|12/31/9999|$5|016.77|0|0|||PARTIAL REMOVAL| DONOR LIVER|| 58-1699775|1326041732|CHC13|47141||11/01/2013|12/31/9999|$5|613.76|0|0|||PARTIAL REMOVAL| DONOR LIVER|| 58-1699775|1326041732|CHC13|47142||11/01/2013|12/31/9999|$6|723.65|0|0|||PARTIAL REMOVAL| DONOR LIVER|| 58-1699775|1326041732|CHC13|47146||11/01/2013|12/31/9999|$475.19|0|0|||PREP DONOR LIVER/VENOUS|| 58-1699775|1326041732|CHC13|47147||11/01/2013|12/31/9999|$554.06|0|0|||PREP DONOR LIVER/ARTERIAL|| 58-1699775|1326041732|CHC13|47300||11/01/2013|12/31/9999|$1|613.81|0|0|||SURGERY FOR LIVER LESION|| 58-1699775|1326041732|CHC13|47350||11/01/2013|12/31/9999|$1|959.18|0|0|||REPAIR LIVER WOUND|| 58-1699775|1326041732|CHC13|47360||11/01/2013|12/31/9999|$2|661.94|0|0|||REPAIR LIVER WOUND|| 58-1699775|1326041732|CHC13|47361||11/01/2013|12/31/9999|$4|318.58|0|0|||REPAIR LIVER WOUND|| 58-1699775|1326041732|CHC13|47362||11/01/2013|12/31/9999|$2|060.39|0|0|||REPAIR LIVER WOUND|| 58-1699775|1326041732|CHC13|47370||11/01/2013|12/31/9999|$1|763.50|0|0|||LAPARO ABLATE LIVER TUMOR RF|| 58-1699775|1326041732|CHC13|47371||11/01/2013|12/31/9999|$1|800.98|0|0|||LAPARO ABLATE LIVER CRYOSURG|| 58-1699775|1326041732|CHC13|47380||11/01/2013|12/31/9999|$2|048.29|0|0|||OPEN ABLATE LIVER TUMOR RF|| 58-1699775|1326041732|CHC13|47381||11/01/2013|12/31/9999|$2|122.03|0|0|||OPEN ABLATE LIVER TUMOR CRYO|| 58-1699775|1326041732|CHC13|47382||11/01/2013|12/31/9999|$1|140.63|0|0|||PERCUT ABLATE LIVER RF|| 58-1699775|1326041732|CHC13|47383||04/01/2015|12/31/9999|$719.82|0|0|0||PERQ ABLTJ LVR CRYOABLATION|| 58-1699775|1326041732|CHC13|47400||11/01/2013|12/31/9999|$3|080.96|0|0|||INCISION OF LIVER DUCT|| 58-1699775|1326041732|CHC13|47420||11/01/2013|12/31/9999|$1|915.48|0|0|||INCISION OF BILE DUCT|| 58-1699775|1326041732|CHC13|47425||11/01/2013|12/31/9999|$1|948.71|0|0|||INCISION OF BILE DUCT|| 58-1699775|1326041732|CHC13|47460||11/01/2013|12/31/9999|$1|816.83|0|0|||INCISE BILE DUCT SPHINCTER|| 58-1699775|1326041732|CHC13|47480||11/01/2013|12/31/9999|$1|238.69|0|0|||INCISION OF GALLBLADDER|| 58-1699775|1326041732|CHC13|47490||11/01/2013|12/31/9999|$491.74|0|0|||INCISION OF GALLBLADDER|| 58-1699775|1326041732|CHC13|47531||04/01/2016|12/31/9999|$144.03|0|0|0||INJECTION FOR CHOLANGIOGRAM|| 58-1699775|1326041732|CHC13|47532||04/01/2016|12/31/9999|$325.90|0|0|0||INJECTION FOR CHOLANGIOGRAM|| 58-1699775|1326041732|CHC13|47533||04/01/2016|12/31/9999|$461.48|0|0|0||PLMT BILIARY DRAINAGE CATH|| 58-1699775|1326041732|CHC13|47534||04/01/2016|12/31/9999|$612.57|0|0|0||PLMT BILIARY DRAINAGE CATH|| 58-1699775|1326041732|CHC13|47535||04/01/2016|12/31/9999|$351.92|0|0|0||CONVERSION EXT BIL DRG CATH|| 58-1699775|1326041732|CHC13|47536||04/01/2016|12/31/9999|$222.34|0|0|0||EXCHANGE BILIARY DRG CATH|| 58-1699775|1326041732|CHC13|47537||04/01/2016|12/31/9999|$149.53|0|0|0||REMOVAL BILIARY DRG CATH|| 58-1699775|1326041732|CHC13|47538||04/01/2016|12/31/9999|$497.05|0|0|0||PERQ PLMT BILE DUCT STENT|| 58-1699775|1326041732|CHC13|47539||04/01/2016|12/31/9999|$672.35|0|0|0||PERQ PLMT BILE DUCT STENT|| 58-1699775|1326041732|CHC13|47540||04/01/2016|12/31/9999|$802.59|0|0|0||PERQ PLMT BILE DUCT STENT|| 58-1699775|1326041732|CHC13|47541||04/01/2016|12/31/9999|$426.98|0|0|0||PLMT ACCESS BIL TREE SM BWL|| 58-1699775|1326041732|CHC13|47542||04/01/2016|12/31/9999|$201.05|0|0|0||DILATE BILIARY DUCT/AMPULLA|| 58-1699775|1326041732|CHC13|47544||04/01/2016|12/31/9999|$325.18|0|0|0||REMOVAL DUCT GLBLDR CALCULI|| 58-1699775|1326041732|CHC13|47550||11/01/2013|12/31/9999|$238.60|0|0|||BILE DUCT ENDOSCOPY ADD-ON|| 58-1699775|1326041732|CHC13|47552||04/01/2014|12/31/9999|$185.87|0|0|||BILIARY ENDOSCOPY THRU SKIN|| 58-1699775|1326041732|CHC13|47553||11/01/2013|12/31/9999|$461.75|0|0|||BILIARY ENDOSCOPY THRU SKIN|| 58-1699775|1326041732|CHC13|47554||11/01/2013|12/31/9999|$712.41|0|0|||BILIARY ENDOSCOPY THRU SKIN|| 58-1699775|1326041732|CHC13|47555||11/01/2013|12/31/9999|$547.03|0|0|||BILIARY ENDOSCOPY THRU SKIN|| 58-1699775|1326041732|CHC13|47556||11/01/2013|12/31/9999|$619.78|0|0|||BILIARY ENDOSCOPY THRU SKIN|| 58-1699775|1326041732|CHC13|47562||11/01/2013|12/31/9999|$1|066.83|0|0|||LAPAROSCOPIC CHOLECYSTECTOMY|| 58-1699775|1326041732|CHC13|47563||11/01/2013|12/31/9999|$1|023.07|0|0|||LAPARO CHOLECYSTECTOMY/GRAPH|| 58-1699775|1326041732|CHC13|47564||11/01/2013|12/31/9999|$1|562.19|0|0|||LAPARO CHOLECYSTECTOMY/EXPLR|| 58-1699775|1326041732|CHC13|47570||11/01/2013|12/31/9999|$1|105.68|0|0|||LAPARO CHOLECYSTOENTEROSTOMY|| 58-1699775|1326041732|CHC13|47579||11/01/2013|12/31/9999|$0.00|0|0|||LAPAROSCOPE PROC| BILIARY|| 58-1699775|1326041732|CHC13|47600||11/01/2013|12/31/9999|$1|542.77|0|0|||REMOVAL OF GALLBLADDER|| 58-1699775|1326041732|CHC13|47605||11/01/2013|12/31/9999|$1|401.53|0|0|||REMOVAL OF GALLBLADDER|| 58-1699775|1326041732|CHC13|47610||11/01/2013|12/31/9999|$1|792.91|0|0|||REMOVAL OF GALLBLADDER|| 58-1699775|1326041732|CHC13|47612||11/01/2013|12/31/9999|$1|811.92|0|0|||REMOVAL OF GALLBLADDER|| 58-1699775|1326041732|CHC13|47620||11/01/2013|12/31/9999|$1|959.82|0|0|||REMOVAL OF GALLBLADDER|| 58-1699775|1326041732|CHC13|47700||11/01/2013|12/31/9999|$1|498.87|0|0|||EXPLORATION OF BILE DUCTS|| 58-1699775|1326041732|CHC13|47701||11/01/2013|12/31/9999|$2|496.80|0|0|||BILE DUCT REVISION|| 58-1699775|1326041732|CHC13|47711||11/01/2013|12/31/9999|$2|223.43|0|0|||EXCISION OF BILE DUCT TUMOR|| 58-1699775|1326041732|CHC13|47712||11/01/2013|12/31/9999|$2|858.69|0|0|||EXCISION OF BILE DUCT TUMOR|| 58-1699775|1326041732|CHC13|47715||11/01/2013|12/31/9999|$1|894.53|0|0|||EXCISION OF BILE DUCT CYST|| 58-1699775|1326041732|CHC13|47720||11/01/2013|12/31/9999|$1|639.68|0|0|||FUSE GALLBLADDER & BOWEL|| 58-1699775|1326041732|CHC13|47721||11/01/2013|12/31/9999|$1|929.99|0|0|||FUSE UPPER GI STRUCTURES|| 58-1699775|1326041732|CHC13|47740||11/01/2013|12/31/9999|$1|868.44|0|0|||FUSE GALLBLADDER & BOWEL|| 58-1699775|1326041732|CHC13|47741||11/01/2013|12/31/9999|$2|105.48|0|0|||FUSE GALLBLADDER & BOWEL|| 58-1699775|1326041732|CHC13|47760||11/01/2013|12/31/9999|$3|209.11|0|0|||FUSE BILE DUCTS AND BOWEL|| 58-1699775|1326041732|CHC13|47765||11/01/2013|12/31/9999|$4|329.48|0|0|||FUSE LIVER DUCTS & BOWEL|| 58-1699775|1326041732|CHC13|47780||11/01/2013|12/31/9999|$3|520.58|0|0|||FUSE BILE DUCTS AND BOWEL|| 58-1699775|1326041732|CHC13|47785||11/01/2013|12/31/9999|$4|625.35|0|0|||FUSE BILE DUCTS AND BOWEL|| 58-1699775|1326041732|CHC13|47800||11/01/2013|12/31/9999|$2|256.64|0|0|||RECONSTRUCTION OF BILE DUCTS|| 58-1699775|1326041732|CHC13|47801||11/01/2013|12/31/9999|$1|472.23|0|0|||PLACEMENT| BILE DUCT SUPPORT|| 58-1699775|1326041732|CHC13|47802||11/01/2013|12/31/9999|$2|176.87|0|0|||FUSE LIVER DUCT & INTESTINE|| 58-1699775|1326041732|CHC13|47900||11/01/2013|12/31/9999|$1|944.28|0|0|||SUTURE BILE DUCT INJURY|| 58-1699775|1326041732|CHC13|47999||11/01/2013|12/31/9999|$0.00|0|0|||BILE TRACT SURGERY PROCEDURE|| 58-1699775|1326041732|CHC13|48000||11/01/2013|12/31/9999|$2|648.01|0|0|||DRAINAGE OF ABDOMEN|| 58-1699775|1326041732|CHC13|48001||11/01/2013|12/31/9999|$3|308.05|0|0|||PLACEMENT OF DRAIN| PANCREAS|| 58-1699775|1326041732|CHC13|48020||11/01/2013|12/31/9999|$1|679.65|0|0|||REMOVAL OF PANCREATIC STONE|| 58-1699775|1326041732|CHC13|48100||11/01/2013|12/31/9999|$1|264.61|0|0|||BIOPSY OF PANCREAS| OPEN|| 58-1699775|1326041732|CHC13|48102||11/01/2013|12/31/9999|$353.89|0|0|||NEEDLE BIOPSY| PANCREAS|| 58-1699775|1326041732|CHC13|48105||11/01/2013|12/31/9999|$4|086.92|0|0|||RESECT/DEBRIDE PANCREAS|| 58-1699775|1326041732|CHC13|48120||11/01/2013|12/31/9999|$1|574.98|0|0|||REMOVAL OF PANCREAS LESION|| 58-1699775|1326041732|CHC13|48140||11/01/2013|12/31/9999|$2|227.60|0|0|||PARTIAL REMOVAL OF PANCREAS|| 58-1699775|1326041732|CHC13|48145||11/01/2013|12/31/9999|$2|332.13|0|0|||PARTIAL REMOVAL OF PANCREAS|| 58-1699775|1326041732|CHC13|48146||11/01/2013|12/31/9999|$2|677.72|0|0|||PANCREATECTOMY|| 58-1699775|1326041732|CHC13|48148||11/01/2013|12/31/9999|$1|778.97|0|0|||REMOVAL OF PANCREATIC DUCT|| 58-1699775|1326041732|CHC13|48150||11/01/2013|12/31/9999|$4|429.30|0|0|||PARTIAL REMOVAL OF PANCREAS|| 58-1699775|1326041732|CHC13|48152||11/01/2013|12/31/9999|$4|129.25|0|0|||PANCREATECTOMY|| 58-1699775|1326041732|CHC13|48153||11/01/2013|12/31/9999|$4|423.05|0|0|||PANCREATECTOMY|| 58-1699775|1326041732|CHC13|48154||11/01/2013|12/31/9999|$4|145.66|0|0|||PANCREATECTOMY|| 58-1699775|1326041732|CHC13|48155||11/01/2013|12/31/9999|$2|586.07|0|0|||REMOVAL OF PANCREAS|| 58-1699775|1326041732|CHC13|48160||11/01/2013|12/31/9999|$4|479.29|0|0|||PANCREAS REMOVAL/TRANSPLANT|| 58-1699775|1326041732|CHC13|48400||11/01/2013|12/31/9999|$159.15|0|0|||INJECTION| INTRAOP ADD-ON|| 58-1699775|1326041732|CHC13|48500||11/01/2013|12/31/9999|$1|636.43|0|0|||SURGERY OF PANCREATIC CYST|| 58-1699775|1326041732|CHC13|48510||11/01/2013|12/31/9999|$1|540.17|0|0|||DRAIN PANCREATIC PSEUDOCYST|| 58-1699775|1326041732|CHC13|48520||11/01/2013|12/31/9999|$1|564.81|0|0|||FUSE PANCREAS CYST AND BOWEL|| 58-1699775|1326041732|CHC13|48540||11/01/2013|12/31/9999|$1|871.00|0|0|||FUSE PANCREAS CYST AND BOWEL|| 58-1699775|1326041732|CHC13|48545||11/01/2013|12/31/9999|$1|917.56|0|0|||PANCREATORRHAPHY|| 58-1699775|1326041732|CHC13|48547||11/01/2013|12/31/9999|$2|561.41|0|0|||DUODENAL EXCLUSION|| 58-1699775|1326041732|CHC13|48548||11/01/2013|12/31/9999|$2|380.01|0|0|||FUSE PANCREAS AND BOWEL|| 58-1699775|1326041732|CHC13|48550||11/01/2013|12/31/9999|$0.00|0|0|||DONOR PANCREATECTOMY|| 58-1699775|1326041732|CHC13|48551||11/01/2013|12/31/9999|$0.00|0|0|||PREP DONOR PANCREAS|| 58-1699775|1326041732|CHC13|48552||11/01/2013|12/31/9999|$340.13|0|0|||PREP DONOR PANCREAS/VENOUS|| 58-1699775|1326041732|CHC13|48554||11/01/2013|12/31/9999|$3|628.79|0|0|||TRANSPL ALLOGRAFT PANCREAS|| 58-1699775|1326041732|CHC13|48556||11/01/2013|12/31/9999|$1|808.74|0|0|||REMOVAL| ALLOGRAFT PANCREAS|| 58-1699775|1326041732|CHC13|48999||11/01/2013|12/31/9999|$0.00|0|0|||PANCREAS SURGERY PROCEDURE|| 58-1699775|1326041732|CHC13|49000||11/01/2013|12/31/9999|$1|101.29|0|0|||EXPLORATION OF ABDOMEN|| 58-1699775|1326041732|CHC13|49002||11/01/2013|12/31/9999|$1|492.59|0|0|||REOPENING OF ABDOMEN|| 58-1699775|1326041732|CHC13|49010||11/01/2013|12/31/9999|$1|353.50|0|0|||EXPLORATION BEHIND ABDOMEN|| 58-1699775|1326041732|CHC13|49020||11/01/2013|12/31/9999|$2|274.11|0|0|||DRAIN ABDOMINAL ABSCESS|| 58-1699775|1326041732|CHC13|49040||11/01/2013|12/31/9999|$1|433.21|0|0|||DRAIN| OPEN| ABDOM ABSCESS|| 58-1699775|1326041732|CHC13|49060||11/01/2013|12/31/9999|$1|579.85|0|0|||DRAIN| OPEN| RETROP ABSCESS|| 58-1699775|1326041732|CHC13|49062||11/01/2013|12/31/9999|$1|065.53|0|0|||DRAIN TO PERITONEAL CAVITY|| 58-1699775|1326041732|CHC13|49082||11/01/2013|12/31/9999|$100.62|0|0|||ABD PARACENTESIS|| 58-1699775|1326041732|CHC13|49083||11/01/2013|12/31/9999|$155.57|0|0|||ABD PARACENTESIS W/IMAGING|| 58-1699775|1326041732|CHC13|49084||11/01/2013|12/31/9999|$143.19|0|0|||PERITONEAL LAVAGE|| 58-1699775|1326041732|CHC13|49180||11/01/2013|12/31/9999|$125.71|0|0|||BIOPSY| ABDOMINAL MASS|| 58-1699775|1326041732|CHC13|49185||04/01/2016|12/31/9999|$185.18|0|0|0||SCLEROTX FLUID COLLECTION|| 58-1699775|1326041732|CHC13|49203||11/01/2013|12/31/9999|$1|710.97|0|0|||EXC ABD TUM 5 CM OR LESS|| 58-1699775|1326041732|CHC13|49204||11/01/2013|12/31/9999|$2|181.83|0|0|||EXC ABD TUM OVER 5 CM|| 58-1699775|1326041732|CHC13|49205||11/01/2013|12/31/9999|$2|504.89|0|0|||EXC ABD TUM OVER 10 CM|| 58-1699775|1326041732|CHC13|49215||11/01/2013|12/31/9999|$3|156.52|0|0|||EXCISE SACRAL SPINE TUMOR|| 58-1699775|1326041732|CHC13|49220||11/01/2013|12/31/9999|$1|387.69|0|0|||MULTIPLE SURGERY| ABDOMEN|| 58-1699775|1326041732|CHC13|49250||11/01/2013|12/31/9999|$830.54|0|0|||EXCISION OF UMBILICUS|| 58-1699775|1326041732|CHC13|49255||11/01/2013|12/31/9999|$1|128.88|0|0|||REMOVAL OF OMENTUM|| 58-1699775|1326041732|CHC13|49320||11/01/2013|12/31/9999|$468.03|0|0|||DIAG LAPARO SEPARATE PROC|| 58-1699775|1326041732|CHC13|49321||11/01/2013|12/31/9999|$495.42|0|0|||LAPAROSCOPY| BIOPSY|| 58-1699775|1326041732|CHC13|49322||11/01/2013|12/31/9999|$532.37|0|0|||LAPAROSCOPY| ASPIRATION|| 58-1699775|1326041732|CHC13|49323||11/01/2013|12/31/9999|$923.55|0|0|||LAPARO DRAIN LYMPHOCELE|| 58-1699775|1326041732|CHC13|49324||11/01/2013|12/31/9999|$564.50|0|0|||LAP INSERTION PERM IP CATH|| 58-1699775|1326041732|CHC13|49325||11/01/2013|12/31/9999|$603.08|0|0|||LAP REVISION PERM IP CATH|| 58-1699775|1326041732|CHC13|49326||11/01/2013|12/31/9999|$272.89|0|0|||LAP W/OMENTOPEXY ADD-ON|| 58-1699775|1326041732|CHC13|49327||11/01/2013|12/31/9999|$188.73|0|0|||LAP INS DEVICE FOR RT|| 58-1699775|1326041732|CHC13|49329||09/21/2016|12/31/9999|$482.50|0|0|||LAPARO PROC| ABDM/PER/OMENT|| 58-1699775|1326041732|CHC13|49400||11/01/2013|12/31/9999|$139.45|0|0|||AIR INJECTION INTO ABDOMEN|| 58-1699775|1326041732|CHC13|49402||11/01/2013|12/31/9999|$1|220.83|0|0|||REMOVE FOREIGN BODY| ADBOMEN|| 58-1699775|1326041732|CHC13|49405||04/01/2014|12/31/9999|$320.49|0|0|||IMAGE CATH FLUID COLXN VISC|| 58-1699775|1326041732|CHC13|49406||04/01/2014|12/31/9999|$320.97|0|0|||IMAGE CATH FLUID PERI/RETRO|| 58-1699775|1326041732|CHC13|49407||04/01/2014|12/31/9999|$341.69|0|0|||IMAGE CATH FLUID TRNS/VGNL|| 58-1699775|1326041732|CHC13|49411||11/01/2013|12/31/9999|$281.77|0|0|||INS MARK ABD/PEL FOR RT PERQ|| 58-1699775|1326041732|CHC13|49412||11/01/2013|12/31/9999|$117.39|0|0|||INS DEVICE FOR RT GUIDE OPEN|| 58-1699775|1326041732|CHC13|49418||11/01/2013|12/31/9999|$333.28|0|0|||INSERT TUN IP CATH PERC|| 58-1699775|1326041732|CHC13|49419||11/01/2013|12/31/9999|$632.94|0|0|||INSRT ABDOM CATH FOR CHEMOTX|| 58-1699775|1326041732|CHC13|49421||11/01/2013|12/31/9999|$359.73|0|0|||INSERT ABDOM DRAIN| PERM|| 58-1699775|1326041732|CHC13|49422||11/01/2013|12/31/9999|$549.61|0|0|||REMOVE PERM CANNULA/CATHETER|| 58-1699775|1326041732|CHC13|49423||11/01/2013|12/31/9999|$106.82|0|0|||EXCHANGE DRAINAGE CATHETER|| 58-1699775|1326041732|CHC13|49424||11/01/2013|12/31/9999|$56.79|0|0|||ASSESS CYST| CONTRAST INJECT|| 58-1699775|1326041732|CHC13|49425||11/01/2013|12/31/9999|$1|081.90|0|0|||INSERT ABDOMEN-VENOUS DRAIN|| 58-1699775|1326041732|CHC13|49426||11/01/2013|12/31/9999|$909.71|0|0|||REVISE ABDOMEN-VENOUS SHUNT|| 58-1699775|1326041732|CHC13|49427||11/01/2013|12/31/9999|$65.77|0|0|||INJECTION| ABDOMINAL SHUNT|| 58-1699775|1326041732|CHC13|49428||11/01/2013|12/31/9999|$684.95|0|0|||LIGATION OF SHUNT|| 58-1699775|1326041732|CHC13|49429||11/01/2013|12/31/9999|$640.42|0|0|||REMOVAL OF SHUNT|| 58-1699775|1326041732|CHC13|49435||11/01/2013|12/31/9999|$174.25|0|0|||INSERT SUBQ EXTEN TO IP CATH|| 58-1699775|1326041732|CHC13|49436||11/01/2013|12/31/9999|$264.49|0|0|||EMBEDDED IP CATH EXIT-SITE|| 58-1699775|1326041732|CHC13|49440||11/01/2013|12/31/9999|$328.31|0|0|||PLACE GASTROSTOMY TUBE PERC|| 58-1699775|1326041732|CHC13|49441||11/01/2013|12/31/9999|$373.66|0|0|||PLACE DUOD/JEJ TUBE PERC|| 58-1699775|1326041732|CHC13|49442||11/01/2013|12/31/9999|$313.45|0|0|||PLACE CECOSTOMY TUBE PERC|| 58-1699775|1326041732|CHC13|49446||11/01/2013|12/31/9999|$240.54|0|0|||CHANGE G-TUBE TO G-J PERC|| 58-1699775|1326041732|CHC13|49450||11/01/2013|12/31/9999|$98.05|0|0|||REPLACE G/C TUBE PERC|| 58-1699775|1326041732|CHC13|49451||11/01/2013|12/31/9999|$135.06|0|0|||REPLACE DUOD/JEJ TUBE PERC|| 58-1699775|1326041732|CHC13|49452||11/01/2013|12/31/9999|$207.87|0|0|||REPLACE G-J TUBE PERC|| 58-1699775|1326041732|CHC13|49460||11/01/2013|12/31/9999|$70.72|0|0|||FIX G/COLON TUBE W/DEVICE|| 58-1699775|1326041732|CHC13|49465||11/01/2013|12/31/9999|$44.57|0|0|||FLUORO EXAM OF G/COLON TUBE|| 58-1699775|1326041732|CHC13|49491||11/01/2013|12/31/9999|$1|099.10|0|0|||RPR HERN PREEMIE REDUC|| 58-1699775|1326041732|CHC13|49492||11/01/2013|12/31/9999|$1|362.28|0|0|||RPR ING HERN PREMIE| BLOCKED|| 58-1699775|1326041732|CHC13|49495||11/01/2013|12/31/9999|$578.99|0|0|||RPR ING HERNIA BABY| REDUC|| 58-1699775|1326041732|CHC13|49496||11/01/2013|12/31/9999|$854.32|0|0|||RPR ING HERNIA BABY| BLOCKED|| 58-1699775|1326041732|CHC13|49500||11/01/2013|12/31/9999|$579.29|0|0|||RPR ING HERNIA| INIT| REDUCE|| 58-1699775|1326041732|CHC13|49501||11/01/2013|12/31/9999|$859.19|0|0|||RPR ING HERNIA| INIT BLOCKED|| 58-1699775|1326041732|CHC13|49505||11/01/2013|12/31/9999|$738.60|0|0|||PRP I/HERN INIT REDUC >5 YR|| 58-1699775|1326041732|CHC13|49507||11/01/2013|12/31/9999|$836.13|0|0|||PRP I/HERN INIT BLOCK >5 YR|| 58-1699775|1326041732|CHC13|49520||11/01/2013|12/31/9999|$899.32|0|0|||REREPAIR ING HERNIA| REDUCE|| 58-1699775|1326041732|CHC13|49521||11/01/2013|12/31/9999|$1|022.63|0|0|||REREPAIR ING HERNIA| BLOCKED|| 58-1699775|1326041732|CHC13|49525||11/01/2013|12/31/9999|$815.03|0|0|||REPAIR ING HERNIA| SLIDING|| 58-1699775|1326041732|CHC13|49540||11/01/2013|12/31/9999|$957.57|0|0|||REPAIR LUMBAR HERNIA|| 58-1699775|1326041732|CHC13|49550||11/01/2013|12/31/9999|$819.05|0|0|||RPR REM HERNIA| INIT| REDUCE|| 58-1699775|1326041732|CHC13|49553||11/01/2013|12/31/9999|$898.49|0|0|||RPR FEM HERNIA| INIT BLOCKED|| 58-1699775|1326041732|CHC13|49555||11/01/2013|12/31/9999|$852.44|0|0|||REREPAIR FEM HERNIA| REDUCE|| 58-1699775|1326041732|CHC13|49557||11/01/2013|12/31/9999|$1|030.76|0|0|||REREPAIR FEM HERNIA| BLOCKED|| 58-1699775|1326041732|CHC13|49560||11/01/2013|12/31/9999|$1|051.16|0|0|||RPR VENTRAL HERN INIT| REDUC|| 58-1699775|1326041732|CHC13|49561||11/01/2013|12/31/9999|$1|328.01|0|0|||RPR VENTRAL HERN INIT| BLOCK|| 58-1699775|1326041732|CHC13|49565||11/01/2013|12/31/9999|$1|095.41|0|0|||REREPAIR VENTRL HERN| REDUCE|| 58-1699775|1326041732|CHC13|49566||11/01/2013|12/31/9999|$1|343.09|0|0|||REREPAIR VENTRL HERN| BLOCK|| 58-1699775|1326041732|CHC13|49568||11/01/2013|12/31/9999|$385.99|0|0|||HERNIA REPAIR W/MESH|| 58-1699775|1326041732|CHC13|49570||11/01/2013|12/31/9999|$589.61|0|0|||RPR EPIGASTRIC HERN| REDUCE|| 58-1699775|1326041732|CHC13|49572||11/01/2013|12/31/9999|$730.78|0|0|||RPR EPIGASTRIC HERN| BLOCKED|| 58-1699775|1326041732|CHC13|49580||11/01/2013|12/31/9999|$467.63|0|0|||RPR UMBIL HERN| REDUC < 5 YR|| 58-1699775|1326041732|CHC13|49582||11/01/2013|12/31/9999|$682.72|0|0|||RPR UMBIL HERN| BLOCK < 5 YR|| 58-1699775|1326041732|CHC13|49585||11/01/2013|12/31/9999|$629.70|0|0|||RPR UMBIL HERN| REDUC > 5 YR|| 58-1699775|1326041732|CHC13|49587||11/01/2013|12/31/9999|$676.45|0|0|||RPR UMBIL HERN| BLOCK > 5 YR|| 58-1699775|1326041732|CHC13|49590||11/01/2013|12/31/9999|$813.07|0|0|||REPAIR SPIGELIAN HERNIA|| 58-1699775|1326041732|CHC13|49600||11/01/2013|12/31/9999|$1|042.31|0|0|||REPAIR UMBILICAL LESION|| 58-1699775|1326041732|CHC13|49605||11/01/2013|12/31/9999|$7|110.34|0|0|||REPAIR UMBILICAL LESION|| 58-1699775|1326041732|CHC13|49606||11/01/2013|12/31/9999|$1|620.01|0|0|||REPAIR UMBILICAL LESION|| 58-1699775|1326041732|CHC13|49610||11/01/2013|12/31/9999|$979.62|0|0|||REPAIR UMBILICAL LESION|| 58-1699775|1326041732|CHC13|49611||11/01/2013|12/31/9999|$780.46|0|0|||REPAIR UMBILICAL LESION|| 58-1699775|1326041732|CHC13|49650||11/01/2013|12/31/9999|$606.43|0|0|||LAPARO HERNIA REPAIR INITIAL|| 58-1699775|1326041732|CHC13|49651||11/01/2013|12/31/9999|$790.03|0|0|||LAPARO HERNIA REPAIR RECUR|| 58-1699775|1326041732|CHC13|49652||11/01/2013|12/31/9999|$984.45|0|0|||LAP VENT/ABD HERNIA REPAIR|| 58-1699775|1326041732|CHC13|49653||11/01/2013|12/31/9999|$1|229.79|0|0|||LAP VENT/ABD HERN PROC COMP|| 58-1699775|1326041732|CHC13|49654||11/01/2013|12/31/9999|$1|119.41|0|0|||LAP INC HERNIA REPAIR|| 58-1699775|1326041732|CHC13|49655||11/01/2013|12/31/9999|$1|366.86|0|0|||LAP INC HERN REPAIR COMP|| 58-1699775|1326041732|CHC13|49656||11/01/2013|12/31/9999|$1|211.27|0|0|||LAP INC HERNIA REPAIR RECUR|| 58-1699775|1326041732|CHC13|49657||11/01/2013|12/31/9999|$1|741.97|0|0|||LAP INC HERN RECUR COMP|| 58-1699775|1326041732|CHC13|49659||11/01/2013|12/31/9999|$0.00|0|0|||LAPARO PROC| HERNIA REPAIR|| 58-1699775|1326041732|CHC13|49900||11/01/2013|12/31/9999|$1|159.27|0|0|||REPAIR OF ABDOMINAL WALL|| 58-1699775|1326041732|CHC13|49904||11/01/2013|12/31/9999|$2|094.24|0|0|||OMENTAL FLAP| EXTRA-ABDOM|| 58-1699775|1326041732|CHC13|49905||11/01/2013|12/31/9999|$509.57|0|0|||OMENTAL FLAP| INTRA-ABDOM|| 58-1699775|1326041732|CHC13|49906||11/01/2013|12/31/9999|$6|013.99|0|0|||FREE OMENTAL FLAP| MICROVASC|| 58-1699775|1326041732|CHC13|49999||11/01/2013|12/31/9999|$0.00|0|0|||ABDOMEN SURGERY PROCEDURE|| 58-1699775|1326041732|CHC13|50010||11/01/2013|12/31/9999|$1|060.25|0|0|||EXPLORATION OF KIDNEY|| 58-1699775|1326041732|CHC13|50020||11/01/2013|12/31/9999|$1|516.86|0|0|||RENAL ABSCESS| OPEN DRAIN|| 58-1699775|1326041732|CHC13|50040||11/01/2013|12/31/9999|$1|345.71|0|0|||DRAINAGE OF KIDNEY|| 58-1699775|1326041732|CHC13|50045||11/01/2013|12/31/9999|$1|351.83|0|0|||EXPLORATION OF KIDNEY|| 58-1699775|1326041732|CHC13|5005F||11/01/2013|12/31/9999|$0.00|0|0|||PT COUNSLD ON EXAM FOR MOLES|| 58-1699775|1326041732|CHC13|50060||11/01/2013|12/31/9999|$1|658.20|0|0|||REMOVAL OF KIDNEY STONE|| 58-1699775|1326041732|CHC13|50065||11/01/2013|12/31/9999|$1|754.51|0|0|||INCISION OF KIDNEY|| 58-1699775|1326041732|CHC13|50070||11/01/2013|12/31/9999|$1|769.42|0|0|||INCISION OF KIDNEY|| 58-1699775|1326041732|CHC13|50075||11/01/2013|12/31/9999|$2|124.85|0|0|||REMOVAL OF KIDNEY STONE|| 58-1699775|1326041732|CHC13|50080||11/01/2013|12/31/9999|$1|266.32|0|0|||REMOVAL OF KIDNEY STONE|| 58-1699775|1326041732|CHC13|50081||11/01/2013|12/31/9999|$1|860.83|0|0|||REMOVAL OF KIDNEY STONE|| 58-1699775|1326041732|CHC13|50100||11/01/2013|12/31/9999|$1|311.12|0|0|||REVISE KIDNEY BLOOD VESSELS|| 58-1699775|1326041732|CHC13|5010F||11/01/2013|12/31/9999|$0.00|0|0|||MACUL+ FNDNGS TO DR MNG DM|| 58-1699775|1326041732|CHC13|50120||11/01/2013|12/31/9999|$1|377.76|0|0|||EXPLORATION OF KIDNEY|| 58-1699775|1326041732|CHC13|50125||11/01/2013|12/31/9999|$1|490.14|0|0|||EXPLORE AND DRAIN KIDNEY|| 58-1699775|1326041732|CHC13|50130||11/01/2013|12/31/9999|$1|502.85|0|0|||REMOVAL OF KIDNEY STONE|| 58-1699775|1326041732|CHC13|50135||11/01/2013|12/31/9999|$1|631.53|0|0|||EXPLORATION OF KIDNEY|| 58-1699775|1326041732|CHC13|5015F||11/01/2013|12/31/9999|$0.00|0|0|||DOC FX & TEST/TXMNT FOR OP|| 58-1699775|1326041732|CHC13|50200||11/01/2013|12/31/9999|$209.49|0|0|||BIOPSY OF KIDNEY|| 58-1699775|1326041732|CHC13|50205||11/01/2013|12/31/9999|$1|077.27|0|0|||BIOPSY OF KIDNEY|| 58-1699775|1326041732|CHC13|5020F||11/01/2013|12/31/9999|$0.00|0|0|||TXMNTS 2 MAIN DR BY 1 MON|| 58-1699775|1326041732|CHC13|50220||11/01/2013|12/31/9999|$1|516.99|0|0|||REMOVE KIDNEY| OPEN|| 58-1699775|1326041732|CHC13|50225||11/01/2013|12/31/9999|$1|739.72|0|0|||REMOVAL KIDNEY OPEN| COMPLEX|| 58-1699775|1326041732|CHC13|50230||11/01/2013|12/31/9999|$1|866.33|0|0|||REMOVAL KIDNEY OPEN| RADICAL|| 58-1699775|1326041732|CHC13|50234||11/01/2013|12/31/9999|$1|894.16|0|0|||REMOVAL OF KIDNEY & URETER|| 58-1699775|1326041732|CHC13|50236||11/01/2013|12/31/9999|$2|134.63|0|0|||REMOVAL OF KIDNEY & URETER|| 58-1699775|1326041732|CHC13|50240||11/01/2013|12/31/9999|$1|926.59|0|0|||PARTIAL REMOVAL OF KIDNEY|| 58-1699775|1326041732|CHC13|50250||11/01/2013|12/31/9999|$1|777.40|0|0|||CRYOABLATE RENAL MASS OPEN|| 58-1699775|1326041732|CHC13|50280||11/01/2013|12/31/9999|$1|387.99|0|0|||REMOVAL OF KIDNEY LESION|| 58-1699775|1326041732|CHC13|50290||11/01/2013|12/31/9999|$1|291.41|0|0|||REMOVAL OF KIDNEY LESION|| 58-1699775|1326041732|CHC13|50300||11/01/2013|12/31/9999|$0.00|0|0|||REMOVE CADAVER DONOR KIDNEY|| 58-1699775|1326041732|CHC13|50320||11/01/2013|12/31/9999|$2|049.77|0|0|||REMOVE KIDNEY| LIVING DONOR|| 58-1699775|1326041732|CHC13|50323||11/01/2013|12/31/9999|$268.27|0|0|||PREP CADAVER RENAL ALLOGRAFT|| 58-1699775|1326041732|CHC13|50325||11/01/2013|12/31/9999|$389.40|0|0|||PREP DONOR RENAL GRAFT|| 58-1699775|1326041732|CHC13|50327||11/01/2013|12/31/9999|$312.71|0|0|||PREP RENAL GRAFT/VENOUS|| 58-1699775|1326041732|CHC13|50328||11/01/2013|12/31/9999|$273.25|0|0|||PREP RENAL GRAFT/ARTERIAL|| 58-1699775|1326041732|CHC13|50329||11/01/2013|12/31/9999|$254.25|0|0|||PREP RENAL GRAFT/URETERAL|| 58-1699775|1326041732|CHC13|50340||11/01/2013|12/31/9999|$1|343.15|0|0|||REMOVAL OF KIDNEY|| 58-1699775|1326041732|CHC13|50360||11/01/2013|12/31/9999|$3|658.86|0|0|||TRANSPLANTATION OF KIDNEY|| 58-1699775|1326041732|CHC13|50365||11/01/2013|12/31/9999|$4|106.59|0|0|||TRANSPLANTATION OF KIDNEY|| 58-1699775|1326041732|CHC13|50370||11/01/2013|12/31/9999|$1|704.20|0|0|||REMOVE TRANSPLANTED KIDNEY|| 58-1699775|1326041732|CHC13|50380||11/01/2013|12/31/9999|$2|864.82|0|0|||REIMPLANTATION OF KIDNEY|| 58-1699775|1326041732|CHC13|50382||11/01/2013|12/31/9999|$401.27|0|0|||CHANGE URETER STENT| PERCUT|| 58-1699775|1326041732|CHC13|50384||11/01/2013|12/31/9999|$365.14|0|0|||REMOVE URETER STENT| PERCUT|| 58-1699775|1326041732|CHC13|50385||11/01/2013|12/31/9999|$341.04|0|0|||CHANGE STENT VIA TRANSURETH|| 58-1699775|1326041732|CHC13|50386||11/01/2013|12/31/9999|$257.45|0|0|||REMOVE STENT VIA TRANSURETH|| 58-1699775|1326041732|CHC13|50387||11/01/2013|12/31/9999|$145.52|0|0|||CHANGE EXT/INT URETER STENT|| 58-1699775|1326041732|CHC13|50389||11/01/2013|12/31/9999|$79.70|0|0|||REMOVE RENAL TUBE W/FLUORO|| 58-1699775|1326041732|CHC13|50390||11/01/2013|12/31/9999|$142.07|0|0|||DRAINAGE OF KIDNEY LESION|| 58-1699775|1326041732|CHC13|50391||11/01/2013|12/31/9999|$144.85|0|0|||INSTLL RX AGNT INTO RNAL TUB|| 58-1699775|1326041732|CHC13|50395||11/01/2013|12/31/9999|$262.89|0|0|||CREATE PASSAGE TO KIDNEY|| 58-1699775|1326041732|CHC13|50396||11/01/2013|12/31/9999|$169.37|0|0|||MEASURE KIDNEY PRESSURE|| 58-1699775|1326041732|CHC13|50400||11/01/2013|12/31/9999|$1|684.30|0|0|||REVISION OF KIDNEY/URETER|| 58-1699775|1326041732|CHC13|50405||11/01/2013|12/31/9999|$2|033.88|0|0|||REVISION OF KIDNEY/URETER|| 58-1699775|1326041732|CHC13|50430||04/01/2016|12/31/9999|$250.85|0|0|0||NJX PX NFROSGRM &/URTRGRM|| 58-1699775|1326041732|CHC13|50431||04/01/2016|12/31/9999|$98.70|0|0|0||NJX PX NFROSGRM &/URTRGRM|| 58-1699775|1326041732|CHC13|50432||04/01/2016|12/31/9999|$332.16|0|0|0||PLMT NEPHROSTOMY CATHETER|| 58-1699775|1326041732|CHC13|50433||04/01/2016|12/31/9999|$409.82|0|0|0||PLMT NEPHROURETERAL CATHETER|| 58-1699775|1326041732|CHC13|50434||04/01/2016|12/31/9999|$313.90|0|0|0||CONVERT NEPHROSTOMY CATHETER|| 58-1699775|1326041732|CHC13|50435||04/01/2016|12/31/9999|$151.86|0|0|0||EXCHANGE NEPHROSTOMY CATH|| 58-1699775|1326041732|CHC13|50500||11/01/2013|12/31/9999|$1|835.38|0|0|||REPAIR OF KIDNEY WOUND|| 58-1699775|1326041732|CHC13|5050F||11/01/2013|12/31/9999|$0.00|0|0|||PLAN 2 MAIN DR. BY 1 MONTH|| 58-1699775|1326041732|CHC13|50520||11/01/2013|12/31/9999|$1|504.11|0|0|||CLOSE KIDNEY-SKIN FISTULA|| 58-1699775|1326041732|CHC13|50525||11/01/2013|12/31/9999|$2|041.37|0|0|||REPAIR RENAL-ABDOMEN FISTULA|| 58-1699775|1326041732|CHC13|50526||11/01/2013|12/31/9999|$2|049.92|0|0|||REPAIR RENAL-ABDOMEN FISTULA|| 58-1699775|1326041732|CHC13|50540||11/01/2013|12/31/9999|$1|661.76|0|0|||REVISION OF HORSESHOE KIDNEY|| 58-1699775|1326041732|CHC13|50541||11/01/2013|12/31/9999|$1|339.32|0|0|||LAPARO ABLATE RENAL CYST|| 58-1699775|1326041732|CHC13|50542||11/01/2013|12/31/9999|$1|698.52|0|0|||LAPARO ABLATE RENAL MASS|| 58-1699775|1326041732|CHC13|50543||11/01/2013|12/31/9999|$2|169.75|0|0|||LAPARO PARTIAL NEPHRECTOMY|| 58-1699775|1326041732|CHC13|50544||11/01/2013|12/31/9999|$1|819.81|0|0|||LAPAROSCOPY| PYELOPLASTY|| 58-1699775|1326041732|CHC13|50545||11/01/2013|12/31/9999|$1|957.81|0|0|||LAPARO RADICAL NEPHRECTOMY|| 58-1699775|1326041732|CHC13|50546||11/01/2013|12/31/9999|$1|748.71|0|0|||LAPAROSCOPIC NEPHRECTOMY|| 58-1699775|1326041732|CHC13|50547||11/01/2013|12/31/9999|$2|303.12|0|0|||LAPARO REMOVAL DONOR KIDNEY|| 58-1699775|1326041732|CHC13|50548||11/01/2013|12/31/9999|$1|965.72|0|0|||LAPARO REMOVE W/URETER|| 58-1699775|1326041732|CHC13|50549||11/01/2013|12/31/9999|$0.00|0|0|||LAPAROSCOPE PROC| RENAL|| 58-1699775|1326041732|CHC13|50551||11/01/2013|12/31/9999|$430.66|0|0|||KIDNEY ENDOSCOPY|| 58-1699775|1326041732|CHC13|50553||11/01/2013|12/31/9999|$461.28|0|0|||KIDNEY ENDOSCOPY|| 58-1699775|1326041732|CHC13|50555||11/01/2013|12/31/9999|$499.37|0|0|||KIDNEY ENDOSCOPY & BIOPSY|| 58-1699775|1326041732|CHC13|50557||11/01/2013|12/31/9999|$506.27|0|0|||KIDNEY ENDOSCOPY & TREATMENT|| 58-1699775|1326041732|CHC13|50561||11/01/2013|12/31/9999|$577.97|0|0|||KIDNEY ENDOSCOPY & TREATMENT|| 58-1699775|1326041732|CHC13|50562||11/01/2013|12/31/9999|$850.19|0|0|||RENAL SCOPE W/TUMOR RESECT|| 58-1699775|1326041732|CHC13|50570||11/01/2013|12/31/9999|$719.50|0|0|||KIDNEY ENDOSCOPY|| 58-1699775|1326041732|CHC13|50572||11/01/2013|12/31/9999|$779.75|0|0|||KIDNEY ENDOSCOPY|| 58-1699775|1326041732|CHC13|50574||11/01/2013|12/31/9999|$829.20|0|0|||KIDNEY ENDOSCOPY & BIOPSY|| 58-1699775|1326041732|CHC13|50575||11/01/2013|12/31/9999|$1|047.69|0|0|||KIDNEY ENDOSCOPY|| 58-1699775|1326041732|CHC13|50576||11/01/2013|12/31/9999|$826.26|0|0|||KIDNEY ENDOSCOPY & TREATMENT|| 58-1699775|1326041732|CHC13|50580||11/01/2013|12/31/9999|$890.09|0|0|||KIDNEY ENDOSCOPY & TREATMENT|| 58-1699775|1326041732|CHC13|50590||11/01/2013|12/31/9999|$819.84|0|0|||FRAGMENTING OF KIDNEY STONE|| 58-1699775|1326041732|CHC13|50592||11/01/2013|12/31/9999|$526.97|0|0|||PERC RF ABLATE RENAL TUMOR|| 58-1699775|1326041732|CHC13|50593||11/01/2013|12/31/9999|$695.33|0|0|||PERC CRYO ABLATE RENAL TUM|| 58-1699775|1326041732|CHC13|50600||11/01/2013|12/31/9999|$1|363.80|0|0|||EXPLORATION OF URETER|| 58-1699775|1326041732|CHC13|50605||11/01/2013|12/31/9999|$1|408.73|0|0|||INSERT URETERAL SUPPORT|| 58-1699775|1326041732|CHC13|50606||04/01/2016|12/31/9999|$237.40|0|0|0||ENDOLUMINAL BX URTR RNL PLVS|| 58-1699775|1326041732|CHC13|5060F||11/01/2013|12/31/9999|$0.00|0|0|||FNDNGS MAMMO 2PT W/IN 3 DAYS|| 58-1699775|1326041732|CHC13|50610||11/01/2013|12/31/9999|$1|374.76|0|0|||REMOVAL OF URETER STONE|| 58-1699775|1326041732|CHC13|50620||11/01/2013|12/31/9999|$1|314.91|0|0|||REMOVAL OF URETER STONE|| 58-1699775|1326041732|CHC13|5062F||11/01/2013|12/31/9999|$0.00|0|0|||DOC F2FMAMMO FNDNG IN 3 DAYS|| 58-1699775|1326041732|CHC13|50630||11/01/2013|12/31/9999|$1|294.02|0|0|||REMOVAL OF URETER STONE|| 58-1699775|1326041732|CHC13|50650||11/01/2013|12/31/9999|$1|506.62|0|0|||REMOVAL OF URETER|| 58-1699775|1326041732|CHC13|50660||11/01/2013|12/31/9999|$1|661.80|0|0|||REMOVAL OF URETER|| 58-1699775|1326041732|CHC13|50684||11/01/2013|12/31/9999|$71.92|0|0|||INJECTION FOR URETER X-RAY|| 58-1699775|1326041732|CHC13|50686||11/01/2013|12/31/9999|$132.45|0|0|||MEASURE URETER PRESSURE|| 58-1699775|1326041732|CHC13|50688||11/01/2013|12/31/9999|$114.62|0|0|||CHANGE OF URETER TUBE/STENT|| 58-1699775|1326041732|CHC13|50690||11/01/2013|12/31/9999|$100.64|0|0|||INJECTION FOR URETER X-RAY|| 58-1699775|1326041732|CHC13|50693||04/01/2016|12/31/9999|$328.56|0|0|0||PLMT URETERAL STENT PRQ|| 58-1699775|1326041732|CHC13|50694||04/01/2016|12/31/9999|$424.91|0|0|0||PLMT URETERAL STENT PRQ|| 58-1699775|1326041732|CHC13|50695||09/01/2017|12/31/9999|$1|556.90|0|0|||PLMT URETERAL STENT PRQ|| 58-1699775|1326041732|CHC13|50700||11/01/2013|12/31/9999|$1|344.28|0|0|||REVISION OF URETER|| 58-1699775|1326041732|CHC13|50705||04/01/2016|12/31/9999|$303.95|0|0|0||URETERAL EMBOLIZATION/OCCL|| 58-1699775|1326041732|CHC13|50706||04/01/2016|12/31/9999|$282.88|0|0|0||BALLOON DILATE URTRL STRIX|| 58-1699775|1326041732|CHC13|50715||11/01/2013|12/31/9999|$1|714.51|0|0|||RELEASE OF URETER|| 58-1699775|1326041732|CHC13|50722||11/01/2013|12/31/9999|$1|524.50|0|0|||RELEASE OF URETER|| 58-1699775|1326041732|CHC13|50725||11/01/2013|12/31/9999|$1|594.60|0|0|||RELEASE/REVISE URETER|| 58-1699775|1326041732|CHC13|50727||11/01/2013|12/31/9999|$732.60|0|0|||REVISE URETER|| 58-1699775|1326041732|CHC13|50728||11/01/2013|12/31/9999|$1|008.34|0|0|||REVISE URETER|| 58-1699775|1326041732|CHC13|50740||11/01/2013|12/31/9999|$1|758.43|0|0|||FUSION OF URETER & KIDNEY|| 58-1699775|1326041732|CHC13|50750||11/01/2013|12/31/9999|$1|680.28|0|0|||FUSION OF URETER & KIDNEY|| 58-1699775|1326041732|CHC13|50760||11/01/2013|12/31/9999|$1|636.74|0|0|||FUSION OF URETERS|| 58-1699775|1326041732|CHC13|50770||11/01/2013|12/31/9999|$1|665.15|0|0|||SPLICING OF URETERS|| 58-1699775|1326041732|CHC13|50780||11/01/2013|12/31/9999|$1|608.06|0|0|||REIMPLANT URETER IN BLADDER|| 58-1699775|1326041732|CHC13|50782||11/01/2013|12/31/9999|$1|665.36|0|0|||REIMPLANT URETER IN BLADDER|| 58-1699775|1326041732|CHC13|50783||11/01/2013|12/31/9999|$1|625.70|0|0|||REIMPLANT URETER IN BLADDER|| 58-1699775|1326041732|CHC13|50785||11/01/2013|12/31/9999|$1|761.05|0|0|||REIMPLANT URETER IN BLADDER|| 58-1699775|1326041732|CHC13|50800||11/01/2013|12/31/9999|$1|344.38|0|0|||IMPLANT URETER IN BOWEL|| 58-1699775|1326041732|CHC13|50810||11/01/2013|12/31/9999|$2|001.27|0|0|||FUSION OF URETER & BOWEL|| 58-1699775|1326041732|CHC13|50815||11/01/2013|12/31/9999|$1|776.66|0|0|||URINE SHUNT TO INTESTINE|| 58-1699775|1326041732|CHC13|50820||11/01/2013|12/31/9999|$1|915.21|0|0|||CONSTRUCT BOWEL BLADDER|| 58-1699775|1326041732|CHC13|50825||11/01/2013|12/31/9999|$2|415.34|0|0|||CONSTRUCT BOWEL BLADDER|| 58-1699775|1326041732|CHC13|50830||11/01/2013|12/31/9999|$2|618.22|0|0|||REVISE URINE FLOW|| 58-1699775|1326041732|CHC13|50840||11/01/2013|12/31/9999|$1|787.91|0|0|||REPLACE URETER BY BOWEL|| 58-1699775|1326041732|CHC13|50845||11/01/2013|12/31/9999|$1|815.79|0|0|||APPENDICO-VESICOSTOMY|| 58-1699775|1326041732|CHC13|50860||11/01/2013|12/31/9999|$1|372.03|0|0|||TRANSPLANT URETER TO SKIN|| 58-1699775|1326041732|CHC13|50900||11/01/2013|12/31/9999|$1|227.71|0|0|||REPAIR OF URETER|| 58-1699775|1326041732|CHC13|50920||11/01/2013|12/31/9999|$1|280.43|0|0|||CLOSURE URETER/SKIN FISTULA|| 58-1699775|1326041732|CHC13|50930||11/01/2013|12/31/9999|$1|769.16|0|0|||CLOSURE URETER/BOWEL FISTULA|| 58-1699775|1326041732|CHC13|50940||11/01/2013|12/31/9999|$1|286.57|0|0|||RELEASE OF URETER|| 58-1699775|1326041732|CHC13|50945||11/01/2013|12/31/9999|$1|416.69|0|0|||LAPAROSCOPY URETEROLITHOTOMY|| 58-1699775|1326041732|CHC13|50947||11/01/2013|12/31/9999|$2|011.46|0|0|||LAPARO NEW URETER/BLADDER|| 58-1699775|1326041732|CHC13|50948||11/01/2013|12/31/9999|$1|860.19|0|0|||LAPARO NEW URETER/BLADDER|| 58-1699775|1326041732|CHC13|50949||11/01/2013|12/31/9999|$0.00|0|0|||LAPAROSCOPE PROC| URETER|| 58-1699775|1326041732|CHC13|50951||11/01/2013|12/31/9999|$448.90|0|0|||ENDOSCOPY OF URETER|| 58-1699775|1326041732|CHC13|50953||11/01/2013|12/31/9999|$495.53|0|0|||ENDOSCOPY OF URETER|| 58-1699775|1326041732|CHC13|50955||11/01/2013|12/31/9999|$533.55|0|0|||URETER ENDOSCOPY & BIOPSY|| 58-1699775|1326041732|CHC13|50957||11/01/2013|12/31/9999|$518.17|0|0|||URETER ENDOSCOPY & TREATMENT|| 58-1699775|1326041732|CHC13|50961||11/01/2013|12/31/9999|$464.71|0|0|||URETER ENDOSCOPY & TREATMENT|| 58-1699775|1326041732|CHC13|50970||11/01/2013|12/31/9999|$542.51|0|0|||URETER ENDOSCOPY|| 58-1699775|1326041732|CHC13|50972||11/01/2013|12/31/9999|$524.23|0|0|||URETER ENDOSCOPY & CATHETER|| 58-1699775|1326041732|CHC13|50974||11/01/2013|12/31/9999|$692.77|0|0|||URETER ENDOSCOPY & BIOPSY|| 58-1699775|1326041732|CHC13|50976||11/01/2013|12/31/9999|$682.45|0|0|||URETER ENDOSCOPY & TREATMENT|| 58-1699775|1326041732|CHC13|50980||11/01/2013|12/31/9999|$521.24|0|0|||URETER ENDOSCOPY & TREATMENT|| 58-1699775|1326041732|CHC13|5100F||11/01/2013|12/31/9999|$0.00|0|0|||RSK FX REF W/N 24 HRS XRAY|| 58-1699775|1326041732|CHC13|51020||11/01/2013|12/31/9999|$679.46|0|0|||INCISE & TREAT BLADDER|| 58-1699775|1326041732|CHC13|51030||11/01/2013|12/31/9999|$672.24|0|0|||INCISE & TREAT BLADDER|| 58-1699775|1326041732|CHC13|51040||11/01/2013|12/31/9999|$418.36|0|0|||INCISE & DRAIN BLADDER|| 58-1699775|1326041732|CHC13|51045||11/01/2013|12/31/9999|$707.10|0|0|||INCISE BLADDER/DRAIN URETER|| 58-1699775|1326041732|CHC13|51050||11/01/2013|12/31/9999|$684.58|0|0|||REMOVAL OF BLADDER STONE|| 58-1699775|1326041732|CHC13|51060||11/01/2013|12/31/9999|$843.29|0|0|||REMOVAL OF URETER STONE|| 58-1699775|1326041732|CHC13|51065||11/01/2013|12/31/9999|$838.71|0|0|||REMOVE URETER CALCULUS|| 58-1699775|1326041732|CHC13|51080||11/01/2013|12/31/9999|$589.79|0|0|||DRAINAGE OF BLADDER ABSCESS|| 58-1699775|1326041732|CHC13|51100||11/01/2013|12/31/9999|$56.91|0|0|||DRAIN BLADDER BY NEEDLE|| 58-1699775|1326041732|CHC13|51101||11/01/2013|12/31/9999|$77.02|0|0|||DRAIN BLADDER BY TROCAR/CATH|| 58-1699775|1326041732|CHC13|51102||11/01/2013|12/31/9999|$213.49|0|0|||DRAIN BL W/CATH INSERTION|| 58-1699775|1326041732|CHC13|51500||11/01/2013|12/31/9999|$968.84|0|0|||REMOVAL OF BLADDER CYST|| 58-1699775|1326041732|CHC13|51520||11/01/2013|12/31/9999|$857.50|0|0|||REMOVAL OF BLADDER LESION|| 58-1699775|1326041732|CHC13|51525||11/01/2013|12/31/9999|$1|250.93|0|0|||REMOVAL OF BLADDER LESION|| 58-1699775|1326041732|CHC13|51530||11/01/2013|12/31/9999|$1|139.91|0|0|||REMOVAL OF BLADDER LESION|| 58-1699775|1326041732|CHC13|51535||11/01/2013|12/31/9999|$1|127.11|0|0|||REPAIR OF URETER LESION|| 58-1699775|1326041732|CHC13|51550||11/01/2013|12/31/9999|$1|405.20|0|0|||PARTIAL REMOVAL OF BLADDER|| 58-1699775|1326041732|CHC13|51555||11/01/2013|12/31/9999|$1|848.15|0|0|||PARTIAL REMOVAL OF BLADDER|| 58-1699775|1326041732|CHC13|51565||11/01/2013|12/31/9999|$1|883.95|0|0|||REVISE BLADDER & URETER(S)|| 58-1699775|1326041732|CHC13|51570||11/01/2013|12/31/9999|$2|149.50|0|0|||REMOVAL OF BLADDER|| 58-1699775|1326041732|CHC13|51575||11/01/2013|12/31/9999|$2|654.83|0|0|||REMOVAL OF BLADDER & NODES|| 58-1699775|1326041732|CHC13|51580||11/01/2013|12/31/9999|$2|763.87|0|0|||REMOVE BLADDER/REVISE TRACT|| 58-1699775|1326041732|CHC13|51585||11/01/2013|12/31/9999|$3|078.33|0|0|||REMOVAL OF BLADDER & NODES|| 58-1699775|1326041732|CHC13|51590||11/01/2013|12/31/9999|$2|818.28|0|0|||REMOVE BLADDER/REVISE TRACT|| 58-1699775|1326041732|CHC13|51595||11/01/2013|12/31/9999|$3|194.76|0|0|||REMOVE BLADDER/REVISE TRACT|| 58-1699775|1326041732|CHC13|51596||11/01/2013|12/31/9999|$3|430.50|0|0|||REMOVE BLADDER/CREATE POUCH|| 58-1699775|1326041732|CHC13|51597||11/01/2013|12/31/9999|$3|343.72|0|0|||REMOVAL OF PELVIC STRUCTURES|| 58-1699775|1326041732|CHC13|51600||11/01/2013|12/31/9999|$64.31|0|0|||INJECTION FOR BLADDER X-RAY|| 58-1699775|1326041732|CHC13|51605||11/01/2013|12/31/9999|$55.22|0|0|||PREPARATION FOR BLADDER XRAY|| 58-1699775|1326041732|CHC13|51610||11/01/2013|12/31/9999|$92.28|0|0|||INJECTION FOR BLADDER X-RAY|| 58-1699775|1326041732|CHC13|51700||11/01/2013|12/31/9999|$64.77|0|0|||IRRIGATION OF BLADDER|| 58-1699775|1326041732|CHC13|51701||11/01/2013|12/31/9999|$39.82|0|0|||INSERT BLADDER CATHETER|| 58-1699775|1326041732|CHC13|51702||11/01/2013|12/31/9999|$43.49|0|0|||INSERT TEMP BLADDER CATH|| 58-1699775|1326041732|CHC13|51703||11/01/2013|12/31/9999|$118.37|0|0|||INSERT BLADDER CATH| COMPLEX|| 58-1699775|1326041732|CHC13|51705||11/01/2013|12/31/9999|$74.06|0|0|||CHANGE OF BLADDER TUBE|| 58-1699775|1326041732|CHC13|51710||11/01/2013|12/31/9999|$113.12|0|0|||CHANGE OF BLADDER TUBE|| 58-1699775|1326041732|CHC13|51715||11/01/2013|12/31/9999|$291.90|0|0|||ENDOSCOPIC INJECTION/IMPLANT|| 58-1699775|1326041732|CHC13|51720||11/01/2013|12/31/9999|$117.15|0|0|||TREATMENT OF BLADDER LESION|| 58-1699775|1326041732|CHC13|51725||11/01/2013|12/31/9999|$277.19|0|0|||SIMPLE CYSTOMETROGRAM|| 58-1699775|1326041732|CHC13|51725|26|11/01/2013|12/31/9999|$122.33|0|0|||SIMPLE CYSTOMETROGRAM|| 58-1699775|1326041732|CHC13|51725|TC|11/01/2013|12/31/9999|$182.59|0|0|||SIMPLE CYSTOMETROGRAM|| 58-1699775|1326041732|CHC13|51726||11/01/2013|12/31/9999|$403.92|0|0|||COMPLEX CYSTOMETROGRAM|| 58-1699775|1326041732|CHC13|51726|26|11/01/2013|12/31/9999|$138.13|0|0|||COMPLEX CYSTOMETROGRAM|| 58-1699775|1326041732|CHC13|51726|TC|11/01/2013|12/31/9999|$306.18|0|0|||COMPLEX CYSTOMETROGRAM|| 58-1699775|1326041732|CHC13|51727||11/01/2013|12/31/9999|$436.82|0|0|||CYSTOMETROGRAM W/UP|| 58-1699775|1326041732|CHC13|51727|26|11/01/2013|12/31/9999|$173.34|0|0|||CYSTOMETROGRAM W/UP|| 58-1699775|1326041732|CHC13|51727|TC|11/01/2013|12/31/9999|$307.16|0|0|||CYSTOMETROGRAM W/UP|| 58-1699775|1326041732|CHC13|51728||11/01/2013|12/31/9999|$434.92|0|0|||CYSTOMETROGRAM W/VP|| 58-1699775|1326041732|CHC13|51728|26|11/01/2013|12/31/9999|$167.22|0|0|||CYSTOMETROGRAM W/VP|| 58-1699775|1326041732|CHC13|51728|TC|11/01/2013|12/31/9999|$311.19|0|0|||CYSTOMETROGRAM W/VP|| 58-1699775|1326041732|CHC13|51729||11/01/2013|12/31/9999|$475.61|0|0|||CYSTOMETROGRAM W/VP&UP|| 58-1699775|1326041732|CHC13|51729|26|11/01/2013|12/31/9999|$203.40|0|0|||CYSTOMETROGRAM W/VP&UP|| 58-1699775|1326041732|CHC13|51729|TC|11/01/2013|12/31/9999|$319.77|0|0|||CYSTOMETROGRAM W/VP&UP|| 58-1699775|1326041732|CHC13|51736||11/01/2013|12/31/9999|$30.26|0|0|||URINE FLOW MEASUREMENT|| 58-1699775|1326041732|CHC13|51736|26|11/01/2013|12/31/9999|$16.12|0|0|||URINE FLOW MEASUREMENT|| 58-1699775|1326041732|CHC13|51736|TC|11/01/2013|12/31/9999|$17.16|0|0|||URINE FLOW MEASUREMENT|| 58-1699775|1326041732|CHC13|51741||11/01/2013|12/31/9999|$34.84|0|0|||ELECTRO-UROFLOWMETRY| FIRST|| 58-1699775|1326041732|CHC13|51741|26|11/01/2013|12/31/9999|$19.15|0|0|||ELECTRO-UROFLOWMETRY| FIRST|| 58-1699775|1326041732|CHC13|51741|TC|11/01/2013|12/31/9999|$19.18|0|0|||ELECTRO-UROFLOWMETRY| FIRST|| 58-1699775|1326041732|CHC13|51784||11/01/2013|12/31/9999|$279.59|0|0|||ANAL/URINARY MUSCLE STUDY|| 58-1699775|1326041732|CHC13|51784|26|11/01/2013|12/31/9999|$123.45|0|0|||ANAL/URINARY MUSCLE STUDY|| 58-1699775|1326041732|CHC13|51784|TC|11/01/2013|12/31/9999|$184.10|0|0|||ANAL/URINARY MUSCLE STUDY|| 58-1699775|1326041732|CHC13|51785||11/01/2013|12/31/9999|$329.57|0|0|||ANAL/URINARY MUSCLE STUDY|| 58-1699775|1326041732|CHC13|51785|26|11/01/2013|12/31/9999|$124.96|0|0|||ANAL/URINARY MUSCLE STUDY|| 58-1699775|1326041732|CHC13|51785|TC|11/01/2013|12/31/9999|$237.56|0|0|||ANAL/URINARY MUSCLE STUDY|| 58-1699775|1326041732|CHC13|51792||11/01/2013|12/31/9999|$308.50|0|0|||URINARY REFLEX STUDY|| 58-1699775|1326041732|CHC13|51792|26|11/01/2013|12/31/9999|$89.69|0|0|||URINARY REFLEX STUDY|| 58-1699775|1326041732|CHC13|51792|TC|11/01/2013|12/31/9999|$249.66|0|0|||URINARY REFLEX STUDY|| 58-1699775|1326041732|CHC13|51797||11/01/2013|12/31/9999|$170.69|0|0|||INTRAABDOMINAL PRESSURE TEST|| 58-1699775|1326041732|CHC13|51797|26|11/01/2013|12/31/9999|$64.68|0|0|||INTRAABDOMINAL PRESSURE TEST|| 58-1699775|1326041732|CHC13|51797|TC|11/01/2013|12/31/9999|$123.07|0|0|||INTRAABDOMINAL PRESSURE TEST|| 58-1699775|1326041732|CHC13|51798||11/01/2013|12/31/9999|$26.15|0|0|||US URINE CAPACITY MEASURE|| 58-1699775|1326041732|CHC13|51800||11/01/2013|12/31/9999|$1|519.46|0|0|||REVISION OF BLADDER/URETHRA|| 58-1699775|1326041732|CHC13|51820||11/01/2013|12/31/9999|$1|561.53|0|0|||REVISION OF URINARY TRACT|| 58-1699775|1326041732|CHC13|51840||11/01/2013|12/31/9999|$963.30|0|0|||ATTACH BLADDER/URETHRA|| 58-1699775|1326041732|CHC13|51841||11/01/2013|12/31/9999|$1|145.54|0|0|||ATTACH BLADDER/URETHRA|| 58-1699775|1326041732|CHC13|51845||11/01/2013|12/31/9999|$857.05|0|0|||REPAIR BLADDER NECK|| 58-1699775|1326041732|CHC13|51860||11/01/2013|12/31/9999|$1|084.46|0|0|||REPAIR OF BLADDER WOUND|| 58-1699775|1326041732|CHC13|51865||11/01/2013|12/31/9999|$1|302.50|0|0|||REPAIR OF BLADDER WOUND|| 58-1699775|1326041732|CHC13|51880||11/01/2013|12/31/9999|$680.71|0|0|||REPAIR OF BLADDER OPENING|| 58-1699775|1326041732|CHC13|51900||11/01/2013|12/31/9999|$1|202.11|0|0|||REPAIR BLADDER/VAGINA LESION|| 58-1699775|1326041732|CHC13|51920||11/01/2013|12/31/9999|$1|100.20|0|0|||CLOSE BLADDER-UTERUS FISTULA|| 58-1699775|1326041732|CHC13|51925||11/01/2013|12/31/9999|$1|481.39|0|0|||HYSTERECTOMY/BLADDER REPAIR|| 58-1699775|1326041732|CHC13|51940||11/01/2013|12/31/9999|$2|372.30|0|0|||CORRECTION OF BLADDER DEFECT|| 58-1699775|1326041732|CHC13|51960||11/01/2013|12/31/9999|$2|025.30|0|0|||REVISION OF BLADDER & BOWEL|| 58-1699775|1326041732|CHC13|51980||11/01/2013|12/31/9999|$1|033.82|0|0|||CONSTRUCT BLADDER OPENING|| 58-1699775|1326041732|CHC13|51990||11/01/2013|12/31/9999|$1|103.88|0|0|||LAPARO URETHRAL SUSPENSION|| 58-1699775|1326041732|CHC13|51992||11/01/2013|12/31/9999|$1|244.95|0|0|||LAPARO SLING OPERATION|| 58-1699775|1326041732|CHC13|51999||11/01/2013|12/31/9999|$0.00|0|0|||LAPAROSCOPE PROC| BLADDER|| 58-1699775|1326041732|CHC13|52000||11/01/2013|12/31/9999|$291.18|0|0|||CYSTOSCOPY|| 58-1699775|1326041732|CHC13|52001||11/01/2013|12/31/9999|$419.77|0|0|||CYSTOSCOPY| REMOVAL OF CLOTS|| 58-1699775|1326041732|CHC13|52005||11/01/2013|12/31/9999|$193.81|0|0|||CYSTOSCOPY & URETER CATHETER|| 58-1699775|1326041732|CHC13|52007||11/01/2013|12/31/9999|$241.76|0|0|||CYSTOSCOPY AND BIOPSY|| 58-1699775|1326041732|CHC13|5200F||11/01/2013|12/31/9999|$0.00|0|0|||EVAL APPROS SURG THXPY EPI|| 58-1699775|1326041732|CHC13|52010||11/01/2013|12/31/9999|$239.93|0|0|||CYSTOSCOPY & DUCT CATHETER|| 58-1699775|1326041732|CHC13|52204||11/01/2013|12/31/9999|$206.45|0|0|||CYSTOSCOPY|| 58-1699775|1326041732|CHC13|52214||11/01/2013|12/31/9999|$295.36|0|0|||CYSTOSCOPY AND TREATMENT|| 58-1699775|1326041732|CHC13|52224||11/01/2013|12/31/9999|$246.99|0|0|||CYSTOSCOPY AND TREATMENT|| 58-1699775|1326041732|CHC13|52234||11/01/2013|12/31/9999|$359.43|0|0|||CYSTOSCOPY AND TREATMENT|| 58-1699775|1326041732|CHC13|52235||11/01/2013|12/31/9999|$421.61|0|0|||CYSTOSCOPY AND TREATMENT|| 58-1699775|1326041732|CHC13|52240||11/01/2013|12/31/9999|$737.46|0|0|||CYSTOSCOPY AND TREATMENT|| 58-1699775|1326041732|CHC13|52250||11/01/2013|12/31/9999|$354.18|0|0|||CYSTOSCOPY AND RADIOTRACER|| 58-1699775|1326041732|CHC13|52260||11/01/2013|12/31/9999|$307.06|0|0|||CYSTOSCOPY AND TREATMENT|| 58-1699775|1326041732|CHC13|52265||11/01/2013|12/31/9999|$238.67|0|0|||CYSTOSCOPY AND TREATMENT|| 58-1699775|1326041732|CHC13|52270||11/01/2013|12/31/9999|$265.59|0|0|||CYSTOSCOPY & REVISE URETHRA|| 58-1699775|1326041732|CHC13|52275||11/01/2013|12/31/9999|$363.02|0|0|||CYSTOSCOPY & REVISE URETHRA|| 58-1699775|1326041732|CHC13|52276||11/01/2013|12/31/9999|$388.48|0|0|||CYSTOSCOPY AND TREATMENT|| 58-1699775|1326041732|CHC13|52277||11/01/2013|12/31/9999|$476.36|0|0|||CYSTOSCOPY AND TREATMENT|| 58-1699775|1326041732|CHC13|52281||11/01/2013|12/31/9999|$222.92|0|0|||CYSTOSCOPY AND TREATMENT|| 58-1699775|1326041732|CHC13|52282||11/01/2013|12/31/9999|$494.14|0|0|||CYSTOSCOPY| IMPLANT STENT|| 58-1699775|1326041732|CHC13|52283||11/01/2013|12/31/9999|$293.71|0|0|||CYSTOSCOPY AND TREATMENT|| 58-1699775|1326041732|CHC13|52285||11/01/2013|12/31/9999|$286.15|0|0|||CYSTOSCOPY AND TREATMENT|| 58-1699775|1326041732|CHC13|52287||11/01/2013|12/31/9999|$240.81|0|0|||CYSTOSCOPY CHEMODENERVATION|| 58-1699775|1326041732|CHC13|52290||11/01/2013|12/31/9999|$356.93|0|0|||CYSTOSCOPY AND TREATMENT|| 58-1699775|1326041732|CHC13|52300||11/01/2013|12/31/9999|$415.88|0|0|||CYSTOSCOPY AND TREATMENT|| 58-1699775|1326041732|CHC13|52301||11/01/2013|12/31/9999|$427.88|0|0|||CYSTOSCOPY AND TREATMENT|| 58-1699775|1326041732|CHC13|52305||11/01/2013|12/31/9999|$408.02|0|0|||CYSTOSCOPY AND TREATMENT|| 58-1699775|1326041732|CHC13|52310||11/01/2013|12/31/9999|$221.86|0|0|||CYSTOSCOPY AND TREATMENT|| 58-1699775|1326041732|CHC13|52315||11/01/2013|12/31/9999|$401.05|0|0|||CYSTOSCOPY AND TREATMENT|| 58-1699775|1326041732|CHC13|52317||11/01/2013|12/31/9999|$508.64|0|0|||REMOVE BLADDER STONE|| 58-1699775|1326041732|CHC13|52318||11/01/2013|12/31/9999|$693.33|0|0|||REMOVE BLADDER STONE|| 58-1699775|1326041732|CHC13|52320||11/01/2013|12/31/9999|$360.27|0|0|||CYSTOSCOPY AND TREATMENT|| 58-1699775|1326041732|CHC13|52325||11/01/2013|12/31/9999|$469.88|0|0|||CYSTOSCOPY| STONE REMOVAL|| 58-1699775|1326041732|CHC13|52327||11/01/2013|12/31/9999|$385.39|0|0|||CYSTOSCOPY| INJECT MATERIAL|| 58-1699775|1326041732|CHC13|52330||11/01/2013|12/31/9999|$385.94|0|0|||CYSTOSCOPY AND TREATMENT|| 58-1699775|1326041732|CHC13|52332||11/01/2013|12/31/9999|$226.94|0|0|||CYSTOSCOPY AND TREATMENT|| 58-1699775|1326041732|CHC13|52334||11/01/2013|12/31/9999|$375.20|0|0|||CREATE PASSAGE TO KIDNEY|| 58-1699775|1326041732|CHC13|52341||11/01/2013|12/31/9999|$422.50|0|0|||CYSTO W/URETER STRICTURE TX|| 58-1699775|1326041732|CHC13|52342||11/01/2013|12/31/9999|$459.09|0|0|||CYSTO W/UP STRICTURE TX|| 58-1699775|1326041732|CHC13|52343||11/01/2013|12/31/9999|$511.46|0|0|||CYSTO W/RENAL STRICTURE TX|| 58-1699775|1326041732|CHC13|52344||11/01/2013|12/31/9999|$555.39|0|0|||CYSTO/URETERO| STRICTURE TX|| 58-1699775|1326041732|CHC13|52345||11/01/2013|12/31/9999|$591.98|0|0|||CYSTO/URETERO W/UP STRICTURE|| 58-1699775|1326041732|CHC13|52346||11/01/2013|12/31/9999|$669.50|0|0|||CYSTOURETERO W/RENAL STRICT|| 58-1699775|1326041732|CHC13|52351||11/01/2013|12/31/9999|$458.63|0|0|||CYSTOURETERO & OR PYELOSCOPE|| 58-1699775|1326041732|CHC13|52352||11/01/2013|12/31/9999|$538.85|0|0|||CYSTOURETERO W/STONE REMOVE|| 58-1699775|1326041732|CHC13|52353||11/01/2013|12/31/9999|$618.48|0|0|||CYSTOURETERO W/LITHOTRIPSY|| 58-1699775|1326041732|CHC13|52354||11/01/2013|12/31/9999|$572.48|0|0|||CYSTOURETERO W/BIOPSY|| 58-1699775|1326041732|CHC13|52355||11/01/2013|12/31/9999|$682.20|0|0|||CYSTOURETERO W/EXCISE TUMOR|| 58-1699775|1326041732|CHC13|52356||04/01/2014|12/31/9999|$615.57|0|0|||CYSTO/URETERO W/LITHOTRIPSY|| 58-1699775|1326041732|CHC13|52400||11/01/2013|12/31/9999|$697.59|0|0|||CYSTOURETERO W/CONGEN REPR|| 58-1699775|1326041732|CHC13|52402||11/01/2013|12/31/9999|$390.87|0|0|||CYSTOURETHRO CUT EJACUL DUCT|| 58-1699775|1326041732|CHC13|52441||04/01/2015|12/31/9999|$340.49|0|0|0||CYSTOURETHRO W/IMPLANT|| 58-1699775|1326041732|CHC13|52442||04/01/2015|12/31/9999|$91.09|0|0|0||CYSTOURETHRO W/ADDL IMPLANT|| 58-1699775|1326041732|CHC13|52450||11/01/2013|12/31/9999|$679.88|0|0|||INCISION OF PROSTATE|| 58-1699775|1326041732|CHC13|52500||11/01/2013|12/31/9999|$707.02|0|0|||REVISION OF BLADDER NECK|| 58-1699775|1326041732|CHC13|5250F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|52601||11/01/2013|12/31/9999|$1|223.40|0|0|||PROSTATECTOMY (TURP)|| 58-1699775|1326041732|CHC13|52630||11/01/2013|12/31/9999|$579.31|0|0|||REMOVE PROSTATE REGROWTH|| 58-1699775|1326041732|CHC13|52640||11/01/2013|12/31/9999|$448.36|0|0|||RELIEVE BLADDER CONTRACTURE|| 58-1699775|1326041732|CHC13|52647||11/01/2013|12/31/9999|$938.99|0|0|||LASER SURGERY OF PROSTATE|| 58-1699775|1326041732|CHC13|52648||11/01/2013|12/31/9999|$1|002.72|0|0|||LASER SURGERY OF PROSTATE|| 58-1699775|1326041732|CHC13|52649||11/01/2013|12/31/9999|$1|210.45|0|0|||PROSTATE LASER ENUCLEATION|| 58-1699775|1326041732|CHC13|52700||11/01/2013|12/31/9999|$641.64|0|0|||DRAINAGE OF PROSTATE ABSCESS|| 58-1699775|1326041732|CHC13|53000||11/01/2013|12/31/9999|$214.69|0|0|||INCISION OF URETHRA|| 58-1699775|1326041732|CHC13|53010||11/01/2013|12/31/9999|$424.08|0|0|||INCISION OF URETHRA|| 58-1699775|1326041732|CHC13|53020||11/01/2013|12/31/9999|$141.54|0|0|||INCISION OF URETHRA|| 58-1699775|1326041732|CHC13|53025||11/01/2013|12/31/9999|$98.15|0|0|||INCISION OF URETHRA|| 58-1699775|1326041732|CHC13|53040||11/01/2013|12/31/9999|$567.85|0|0|||DRAINAGE OF URETHRA ABSCESS|| 58-1699775|1326041732|CHC13|53060||11/01/2013|12/31/9999|$243.42|0|0|||DRAINAGE OF URETHRA ABSCESS|| 58-1699775|1326041732|CHC13|53080||11/01/2013|12/31/9999|$613.38|0|0|||DRAINAGE OF URINARY LEAKAGE|| 58-1699775|1326041732|CHC13|53085||11/01/2013|12/31/9999|$943.96|0|0|||DRAINAGE OF URINARY LEAKAGE|| 58-1699775|1326041732|CHC13|53200||11/01/2013|12/31/9999|$206.47|0|0|||BIOPSY OF URETHRA|| 58-1699775|1326041732|CHC13|53210||11/01/2013|12/31/9999|$1|124.32|0|0|||REMOVAL OF URETHRA|| 58-1699775|1326041732|CHC13|53215||11/01/2013|12/31/9999|$1|350.63|0|0|||REMOVAL OF URETHRA|| 58-1699775|1326041732|CHC13|53220||11/01/2013|12/31/9999|$659.35|0|0|||TREATMENT OF URETHRA LESION|| 58-1699775|1326041732|CHC13|53230||11/01/2013|12/31/9999|$885.10|0|0|||REMOVAL OF URETHRA LESION|| 58-1699775|1326041732|CHC13|53235||11/01/2013|12/31/9999|$919.44|0|0|||REMOVAL OF URETHRA LESION|| 58-1699775|1326041732|CHC13|53240||11/01/2013|12/31/9999|$616.06|0|0|||SURGERY FOR URETHRA POUCH|| 58-1699775|1326041732|CHC13|53250||11/01/2013|12/31/9999|$610.61|0|0|||REMOVAL OF URETHRA GLAND|| 58-1699775|1326041732|CHC13|53260||11/01/2013|12/31/9999|$262.06|0|0|||TREATMENT OF URETHRA LESION|| 58-1699775|1326041732|CHC13|53265||11/01/2013|12/31/9999|$270.11|0|0|||TREATMENT OF URETHRA LESION|| 58-1699775|1326041732|CHC13|53270||11/01/2013|12/31/9999|$274.38|0|0|||REMOVAL OF URETHRA GLAND|| 58-1699775|1326041732|CHC13|53275||11/01/2013|12/31/9999|$382.11|0|0|||REPAIR OF URETHRA DEFECT|| 58-1699775|1326041732|CHC13|53400||11/01/2013|12/31/9999|$1|167.42|0|0|||REVISE URETHRA| STAGE 1|| 58-1699775|1326041732|CHC13|53405||11/01/2013|12/31/9999|$1|271.36|0|0|||REVISE URETHRA| STAGE 2|| 58-1699775|1326041732|CHC13|53410||11/01/2013|12/31/9999|$1|422.47|0|0|||RECONSTRUCTION OF URETHRA|| 58-1699775|1326041732|CHC13|53415||11/01/2013|12/31/9999|$1|646.85|0|0|||RECONSTRUCTION OF URETHRA|| 58-1699775|1326041732|CHC13|53420||11/01/2013|12/31/9999|$1|208.69|0|0|||RECONSTRUCT URETHRA| STAGE 1|| 58-1699775|1326041732|CHC13|53425||11/01/2013|12/31/9999|$1|365.10|0|0|||RECONSTRUCT URETHRA| STAGE 2|| 58-1699775|1326041732|CHC13|53430||11/01/2013|12/31/9999|$1|406.89|0|0|||RECONSTRUCTION OF URETHRA|| 58-1699775|1326041732|CHC13|53431||11/01/2013|12/31/9999|$1|678.70|0|0|||RECONSTRUCT URETHRA/BLADDER|| 58-1699775|1326041732|CHC13|53440||11/01/2013|12/31/9999|$1|112.35|0|0|||MALE SLING PROCEDURE|| 58-1699775|1326041732|CHC13|53442||11/01/2013|12/31/9999|$1|132.74|0|0|||REMOVE/REVISE MALE SLING|| 58-1699775|1326041732|CHC13|53444||11/01/2013|12/31/9999|$1|153.44|0|0|||INSERT TANDEM CUFF|| 58-1699775|1326041732|CHC13|53445||11/01/2013|12/31/9999|$1|109.05|0|0|||INSERT URO/VES NCK SPHINCTER|| 58-1699775|1326041732|CHC13|53446||11/01/2013|12/31/9999|$932.93|0|0|||REMOVE URO SPHINCTER|| 58-1699775|1326041732|CHC13|53447||11/01/2013|12/31/9999|$1|176.42|0|0|||REMOVE/REPLACE UR SPHINCTER|| 58-1699775|1326041732|CHC13|53448||11/01/2013|12/31/9999|$1|863.65|0|0|||REMOV/REPLC UR SPHINCTR COMP|| 58-1699775|1326041732|CHC13|53449||11/01/2013|12/31/9999|$888.76|0|0|||REPAIR URO SPHINCTER|| 58-1699775|1326041732|CHC13|53450||11/01/2013|12/31/9999|$591.94|0|0|||REVISION OF URETHRA|| 58-1699775|1326041732|CHC13|53460||11/01/2013|12/31/9999|$662.73|0|0|||REVISION OF URETHRA|| 58-1699775|1326041732|CHC13|53500||11/01/2013|12/31/9999|$1|092.42|0|0|||URETHRLYS| TRANSVAG W/ SCOPE|| 58-1699775|1326041732|CHC13|53502||11/01/2013|12/31/9999|$703.54|0|0|||REPAIR OF URETHRA INJURY|| 58-1699775|1326041732|CHC13|53505||11/01/2013|12/31/9999|$704.92|0|0|||REPAIR OF URETHRA INJURY|| 58-1699775|1326041732|CHC13|53510||11/01/2013|12/31/9999|$916.07|0|0|||REPAIR OF URETHRA INJURY|| 58-1699775|1326041732|CHC13|53515||11/01/2013|12/31/9999|$1|154.51|0|0|||REPAIR OF URETHRA INJURY|| 58-1699775|1326041732|CHC13|53520||11/01/2013|12/31/9999|$806.35|0|0|||REPAIR OF URETHRA DEFECT|| 58-1699775|1326041732|CHC13|53600||11/01/2013|12/31/9999|$93.12|0|0|||DILATE URETHRA STRICTURE|| 58-1699775|1326041732|CHC13|53601||11/01/2013|12/31/9999|$77.21|0|0|||DILATE URETHRA STRICTURE|| 58-1699775|1326041732|CHC13|53605||11/01/2013|12/31/9999|$93.96|0|0|||DILATE URETHRA STRICTURE|| 58-1699775|1326041732|CHC13|53620||11/01/2013|12/31/9999|$127.43|0|0|||DILATE URETHRA STRICTURE|| 58-1699775|1326041732|CHC13|53621||11/01/2013|12/31/9999|$104.87|0|0|||DILATE URETHRA STRICTURE|| 58-1699775|1326041732|CHC13|53660||11/01/2013|12/31/9999|$60.20|0|0|||DILATION OF URETHRA|| 58-1699775|1326041732|CHC13|53661||11/01/2013|12/31/9999|$58.88|0|0|||DILATION OF URETHRA|| 58-1699775|1326041732|CHC13|53665||11/01/2013|12/31/9999|$56.35|0|0|||DILATION OF URETHRA|| 58-1699775|1326041732|CHC13|53850||11/01/2013|12/31/9999|$826.10|0|0|||PROSTATIC MICROWAVE THERMOTX|| 58-1699775|1326041732|CHC13|53852||11/01/2013|12/31/9999|$903.01|0|0|||PROSTATIC RF THERMOTX|| 58-1699775|1326041732|CHC13|53855||11/01/2013|12/31/9999|$118.36|0|0|||INSERT PROST URETHRAL STENT|| 58-1699775|1326041732|CHC13|53860||11/01/2013|12/31/9999|$337.16|0|0|||TRANSURETHRAL RF TREATMENT|| 58-1699775|1326041732|CHC13|53899||11/01/2013|12/31/9999|$0.00|0|0|||UROLOGY SURGERY PROCEDURE|| 58-1699775|1326041732|CHC13|54000||11/01/2013|12/31/9999|$154.75|0|0|||SLITTING OF PREPUCE|| 58-1699775|1326041732|CHC13|54001||11/01/2013|12/31/9999|$200.91|0|0|||SLITTING OF PREPUCE|| 58-1699775|1326041732|CHC13|54015||11/01/2013|12/31/9999|$446.91|0|0|||DRAIN PENIS LESION|| 58-1699775|1326041732|CHC13|54050||11/01/2013|12/31/9999|$148.18|0|0|||DESTRUCTION| PENIS LESION(S)|| 58-1699775|1326041732|CHC13|54055||11/01/2013|12/31/9999|$131.43|0|0|||DESTRUCTION| PENIS LESION(S)|| 58-1699775|1326041732|CHC13|54056||11/01/2013|12/31/9999|$157.38|0|0|||CRYOSURGERY| PENIS LESION(S)|| 58-1699775|1326041732|CHC13|54057||11/01/2013|12/31/9999|$134.36|0|0|||LASER SURG| PENIS LESION(S)|| 58-1699775|1326041732|CHC13|54060||11/01/2013|12/31/9999|$188.08|0|0|||EXCISION OF PENIS LESION(S)|| 58-1699775|1326041732|CHC13|54065||11/01/2013|12/31/9999|$246.71|0|0|||DESTRUCTION| PENIS LESION(S)|| 58-1699775|1326041732|CHC13|54100||11/01/2013|12/31/9999|$181.74|0|0|||BIOPSY OF PENIS|| 58-1699775|1326041732|CHC13|54105||11/01/2013|12/31/9999|$308.28|0|0|||BIOPSY OF PENIS|| 58-1699775|1326041732|CHC13|54110||11/01/2013|12/31/9999|$905.78|0|0|||TREATMENT OF PENIS LESION|| 58-1699775|1326041732|CHC13|54111||11/01/2013|12/31/9999|$1|164.77|0|0|||TREAT PENIS LESION| GRAFT|| 58-1699775|1326041732|CHC13|54112||11/01/2013|12/31/9999|$1|365.06|0|0|||TREAT PENIS LESION| GRAFT|| 58-1699775|1326041732|CHC13|54115||11/01/2013|12/31/9999|$613.08|0|0|||TREATMENT OF PENIS LESION|| 58-1699775|1326041732|CHC13|54120||11/01/2013|12/31/9999|$917.75|0|0|||PARTIAL REMOVAL OF PENIS|| 58-1699775|1326041732|CHC13|54125||11/01/2013|12/31/9999|$1|182.59|0|0|||REMOVAL OF PENIS|| 58-1699775|1326041732|CHC13|54130||11/01/2013|12/31/9999|$1|737.73|0|0|||REMOVE PENIS & NODES|| 58-1699775|1326041732|CHC13|54135||11/01/2013|12/31/9999|$2|257.19|0|0|||REMOVE PENIS & NODES|| 58-1699775|1326041732|CHC13|54150||11/01/2013|12/31/9999|$144.13|0|0|||CIRCUMCISION|| 58-1699775|1326041732|CHC13|54160||11/01/2013|12/31/9999|$208.86|0|0|||CIRCUMCISION|| 58-1699775|1326041732|CHC13|54161||11/01/2013|12/31/9999|$286.03|0|0|||CIRCUMCISION|| 58-1699775|1326041732|CHC13|54162||11/01/2013|12/31/9999|$287.84|0|0|||LYSIS PENIL CIRCUMIC LESION|| 58-1699775|1326041732|CHC13|54163||11/01/2013|12/31/9999|$315.81|0|0|||REPAIR OF CIRCUMCISION|| 58-1699775|1326041732|CHC13|54164||11/01/2013|12/31/9999|$278.30|0|0|||FRENULOTOMY OF PENIS|| 58-1699775|1326041732|CHC13|54200||11/01/2013|12/31/9999|$120.56|0|0|||TREATMENT OF PENIS LESION|| 58-1699775|1326041732|CHC13|54205||11/01/2013|12/31/9999|$773.36|0|0|||TREATMENT OF PENIS LESION|| 58-1699775|1326041732|CHC13|54220||11/01/2013|12/31/9999|$196.40|0|0|||TREATMENT OF PENIS LESION|| 58-1699775|1326041732|CHC13|54230||11/01/2013|12/31/9999|$115.36|0|0|||PREPARE PENIS STUDY|| 58-1699775|1326041732|CHC13|54231||11/01/2013|12/31/9999|$169.57|0|0|||DYNAMIC CAVERNOSOMETRY|| 58-1699775|1326041732|CHC13|54235||11/01/2013|12/31/9999|$106.32|0|0|||PENILE INJECTION|| 58-1699775|1326041732|CHC13|54240||11/01/2013|12/31/9999|$141.76|0|0|||PENIS STUDY|| 58-1699775|1326041732|CHC13|54240|26|11/01/2013|12/31/9999|$103.46|0|0|||PENIS STUDY|| 58-1699775|1326041732|CHC13|54240|TC|11/01/2013|12/31/9999|$52.47|0|0|||PENIS STUDY|| 58-1699775|1326041732|CHC13|54250||11/01/2013|12/31/9999|$175.93|0|0|||PENIS STUDY|| 58-1699775|1326041732|CHC13|54250|26|11/01/2013|12/31/9999|$176.36|0|0|||PENIS STUDY|| 58-1699775|1326041732|CHC13|54250|TC|11/01/2013|12/31/9999|$17.16|0|0|||PENIS STUDY|| 58-1699775|1326041732|CHC13|54300||11/01/2013|12/31/9999|$934.33|0|0|||REVISION OF PENIS|| 58-1699775|1326041732|CHC13|54304||11/01/2013|12/31/9999|$1|092.63|0|0|||REVISION OF PENIS|| 58-1699775|1326041732|CHC13|54308||11/01/2013|12/31/9999|$1|068.47|0|0|||RECONSTRUCTION OF URETHRA|| 58-1699775|1326041732|CHC13|54312||11/01/2013|12/31/9999|$1|192.75|0|0|||RECONSTRUCTION OF URETHRA|| 58-1699775|1326041732|CHC13|54316||11/01/2013|12/31/9999|$1|491.38|0|0|||RECONSTRUCTION OF URETHRA|| 58-1699775|1326041732|CHC13|54318||11/01/2013|12/31/9999|$1|018.80|0|0|||RECONSTRUCTION OF URETHRA|| 58-1699775|1326041732|CHC13|54322||11/01/2013|12/31/9999|$1|139.03|0|0|||RECONSTRUCTION OF URETHRA|| 58-1699775|1326041732|CHC13|54324||11/01/2013|12/31/9999|$1|413.51|0|0|||RECONSTRUCTION OF URETHRA|| 58-1699775|1326041732|CHC13|54326||11/01/2013|12/31/9999|$1|366.21|0|0|||RECONSTRUCTION OF URETHRA|| 58-1699775|1326041732|CHC13|54328||11/01/2013|12/31/9999|$1|365.51|0|0|||REVISE PENIS/URETHRA|| 58-1699775|1326041732|CHC13|54332||11/01/2013|12/31/9999|$1|478.44|0|0|||REVISE PENIS/URETHRA|| 58-1699775|1326041732|CHC13|54336||11/01/2013|12/31/9999|$1|711.80|0|0|||REVISE PENIS/URETHRA|| 58-1699775|1326041732|CHC13|54340||11/01/2013|12/31/9999|$824.08|0|0|||SECONDARY URETHRAL SURGERY|| 58-1699775|1326041732|CHC13|54344||11/01/2013|12/31/9999|$1|382.47|0|0|||SECONDARY URETHRAL SURGERY|| 58-1699775|1326041732|CHC13|54348||11/01/2013|12/31/9999|$1|457.25|0|0|||SECONDARY URETHRAL SURGERY|| 58-1699775|1326041732|CHC13|54352||11/01/2013|12/31/9999|$2|070.67|0|0|||RECONSTRUCT URETHRA/PENIS|| 58-1699775|1326041732|CHC13|54360||11/01/2013|12/31/9999|$1|050.99|0|0|||PENIS PLASTIC SURGERY|| 58-1699775|1326041732|CHC13|54380||11/01/2013|12/31/9999|$1|279.01|0|0|||REPAIR PENIS|| 58-1699775|1326041732|CHC13|54385||11/01/2013|12/31/9999|$1|442.94|0|0|||REPAIR PENIS|| 58-1699775|1326041732|CHC13|54390||11/01/2013|12/31/9999|$1|826.14|0|0|||REPAIR PENIS AND BLADDER|| 58-1699775|1326041732|CHC13|54400||11/01/2013|12/31/9999|$769.84|0|0|||INSERT SEMI-RIGID PROSTHESIS|| 58-1699775|1326041732|CHC13|54401||11/01/2013|12/31/9999|$949.54|0|0|||INSERT SELF-CONTD PROSTHESIS|| 58-1699775|1326041732|CHC13|54405||11/01/2013|12/31/9999|$1|176.78|0|0|||INSERT MULTI-COMP PENIS PROS|| 58-1699775|1326041732|CHC13|54406||11/01/2013|12/31/9999|$1|061.21|0|0|||REMOVE MUTI-COMP PENIS PROS|| 58-1699775|1326041732|CHC13|54408||11/01/2013|12/31/9999|$1|148.31|0|0|||REPAIR MULTI-COMP PENIS PROS|| 58-1699775|1326041732|CHC13|54410||11/01/2013|12/31/9999|$1|250.00|0|0|||REMOVE/REPLACE PENIS PROSTH|| 58-1699775|1326041732|CHC13|54411||11/01/2013|12/31/9999|$1|490.25|0|0|||REMOV/REPLC PENIS PROS| COMP|| 58-1699775|1326041732|CHC13|54415||11/01/2013|12/31/9999|$766.01|0|0|||REMOVE SELF-CONTD PENIS PROS|| 58-1699775|1326041732|CHC13|54416||11/01/2013|12/31/9999|$1|030.29|0|0|||REMV/REPL PENIS CONTAIN PROS|| 58-1699775|1326041732|CHC13|54417||11/01/2013|12/31/9999|$1|306.74|0|0|||REMV/REPLC PENIS PROS| COMPL|| 58-1699775|1326041732|CHC13|54420||11/01/2013|12/31/9999|$1|025.99|0|0|||REVISION OF PENIS|| 58-1699775|1326041732|CHC13|54430||11/01/2013|12/31/9999|$930.83|0|0|||REVISION OF PENIS|| 58-1699775|1326041732|CHC13|54435||11/01/2013|12/31/9999|$603.61|0|0|||REVISION OF PENIS|| 58-1699775|1326041732|CHC13|54437||04/01/2016|12/31/9999|$1|008.13|0|0|0||REPAIR CORPOREAL TEAR|| 58-1699775|1326041732|CHC13|54438||04/01/2016|12/31/9999|$2|039.49|0|0|0||REPLANTATION OF PENIS|| 58-1699775|1326041732|CHC13|54440||11/01/2013|12/31/9999|$792.09|0|0|||REPAIR OF PENIS|| 58-1699775|1326041732|CHC13|54450||11/01/2013|12/31/9999|$83.93|0|0|||PREPUTIAL STRETCHING|| 58-1699775|1326041732|CHC13|54500||11/01/2013|12/31/9999|$108.33|0|0|||BIOPSY OF TESTIS|| 58-1699775|1326041732|CHC13|54505||11/01/2013|12/31/9999|$304.84|0|0|||BIOPSY OF TESTIS|| 58-1699775|1326041732|CHC13|54512||11/01/2013|12/31/9999|$783.13|0|0|||EXCISE LESION TESTIS|| 58-1699775|1326041732|CHC13|54520||11/01/2013|12/31/9999|$473.73|0|0|||REMOVAL OF TESTIS|| 58-1699775|1326041732|CHC13|54522||11/01/2013|12/31/9999|$851.32|0|0|||ORCHIECTOMY| PARTIAL|| 58-1699775|1326041732|CHC13|54530||11/01/2013|12/31/9999|$733.58|0|0|||REMOVAL OF TESTIS|| 58-1699775|1326041732|CHC13|54535||11/01/2013|12/31/9999|$1|076.57|0|0|||EXTENSIVE TESTIS SURGERY|| 58-1699775|1326041732|CHC13|54550||11/01/2013|12/31/9999|$712.15|0|0|||EXPLORATION FOR TESTIS|| 58-1699775|1326041732|CHC13|54560||11/01/2013|12/31/9999|$1|042.77|0|0|||EXPLORATION FOR TESTIS|| 58-1699775|1326041732|CHC13|54600||11/01/2013|12/31/9999|$655.74|0|0|||REDUCE TESTIS TORSION|| 58-1699775|1326041732|CHC13|54620||11/01/2013|12/31/9999|$435.95|0|0|||SUSPENSION OF TESTIS|| 58-1699775|1326041732|CHC13|54640||11/01/2013|12/31/9999|$691.26|0|0|||SUSPENSION OF TESTIS|| 58-1699775|1326041732|CHC13|54650||11/01/2013|12/31/9999|$1|029.66|0|0|||ORCHIOPEXY (FOWLER-STEPHENS)|| 58-1699775|1326041732|CHC13|54660||11/01/2013|12/31/9999|$514.88|0|0|||REVISION OF TESTIS|| 58-1699775|1326041732|CHC13|54670||11/01/2013|12/31/9999|$585.80|0|0|||REPAIR TESTIS INJURY|| 58-1699775|1326041732|CHC13|54680||11/01/2013|12/31/9999|$1|139.81|0|0|||RELOCATION OF TESTIS(ES)|| 58-1699775|1326041732|CHC13|54690||11/01/2013|12/31/9999|$1|056.44|0|0|||LAPAROSCOPY| ORCHIECTOMY|| 58-1699775|1326041732|CHC13|54692||11/01/2013|12/31/9999|$1|104.71|0|0|||LAPAROSCOPY| ORCHIOPEXY|| 58-1699775|1326041732|CHC13|54699||11/01/2013|12/31/9999|$0.00|0|0|||LAPAROSCOPE PROC| TESTIS|| 58-1699775|1326041732|CHC13|54700||11/01/2013|12/31/9999|$309.35|0|0|||DRAINAGE OF SCROTUM|| 58-1699775|1326041732|CHC13|54800||11/01/2013|12/31/9999|$190.07|0|0|||BIOPSY OF EPIDIDYMIS|| 58-1699775|1326041732|CHC13|54830||11/01/2013|12/31/9999|$539.35|0|0|||REMOVE EPIDIDYMIS LESION|| 58-1699775|1326041732|CHC13|54840||11/01/2013|12/31/9999|$465.64|0|0|||REMOVE EPIDIDYMIS LESION|| 58-1699775|1326041732|CHC13|54860||11/01/2013|12/31/9999|$606.22|0|0|||REMOVAL OF EPIDIDYMIS|| 58-1699775|1326041732|CHC13|54861||11/01/2013|12/31/9999|$819.90|0|0|||REMOVAL OF EPIDIDYMIS|| 58-1699775|1326041732|CHC13|54865||11/01/2013|12/31/9999|$517.82|0|0|||EXPLORE EPIDIDYMIS|| 58-1699775|1326041732|CHC13|54900||11/01/2013|12/31/9999|$1|127.74|0|0|||FUSION OF SPERMATIC DUCTS|| 58-1699775|1326041732|CHC13|54901||11/01/2013|12/31/9999|$1|514.15|0|0|||FUSION OF SPERMATIC DUCTS|| 58-1699775|1326041732|CHC13|55000||11/01/2013|12/31/9999|$122.74|0|0|||DRAINAGE OF HYDROCELE|| 58-1699775|1326041732|CHC13|55040||11/01/2013|12/31/9999|$490.55|0|0|||REMOVAL OF HYDROCELE|| 58-1699775|1326041732|CHC13|55041||11/01/2013|12/31/9999|$739.54|0|0|||REMOVAL OF HYDROCELES|| 58-1699775|1326041732|CHC13|55060||11/01/2013|12/31/9999|$550.69|0|0|||REPAIR OF HYDROCELE|| 58-1699775|1326041732|CHC13|55100||11/01/2013|12/31/9999|$239.71|0|0|||DRAINAGE OF SCROTUM ABSCESS|| 58-1699775|1326041732|CHC13|55110||11/01/2013|12/31/9999|$562.18|0|0|||EXPLORE SCROTUM|| 58-1699775|1326041732|CHC13|55120||11/01/2013|12/31/9999|$519.47|0|0|||REMOVAL OF SCROTUM LESION|| 58-1699775|1326041732|CHC13|55150||11/01/2013|12/31/9999|$711.72|0|0|||REMOVAL OF SCROTUM|| 58-1699775|1326041732|CHC13|55175||11/01/2013|12/31/9999|$525.74|0|0|||REVISION OF SCROTUM|| 58-1699775|1326041732|CHC13|55180||11/01/2013|12/31/9999|$1|006.89|0|0|||REVISION OF SCROTUM|| 58-1699775|1326041732|CHC13|55200||11/01/2013|12/31/9999|$401.25|0|0|||INCISION OF SPERM DUCT|| 58-1699775|1326041732|CHC13|55250||11/01/2013|12/31/9999|$327.08|0|0|||REMOVAL OF SPERM DUCT(S)|| 58-1699775|1326041732|CHC13|55300||11/01/2013|12/31/9999|$270.00|0|0|||PREPARE| SPERM DUCT X-RAY|| 58-1699775|1326041732|CHC13|55400||11/01/2013|12/31/9999|$724.21|0|0|||REPAIR OF SPERM DUCT|| 58-1699775|1326041732|CHC13|55450||11/01/2013|12/31/9999|$371.70|0|0|||LIGATION OF SPERM DUCT|| 58-1699775|1326041732|CHC13|55500||11/01/2013|12/31/9999|$571.54|0|0|||REMOVAL OF HYDROCELE|| 58-1699775|1326041732|CHC13|55520||11/01/2013|12/31/9999|$642.43|0|0|||REMOVAL OF SPERM CORD LESION|| 58-1699775|1326041732|CHC13|55530||11/01/2013|12/31/9999|$512.78|0|0|||REVISE SPERMATIC CORD VEINS|| 58-1699775|1326041732|CHC13|55535||11/01/2013|12/31/9999|$621.70|0|0|||REVISE SPERMATIC CORD VEINS|| 58-1699775|1326041732|CHC13|55540||11/01/2013|12/31/9999|$767.41|0|0|||REVISE HERNIA & SPERM VEINS|| 58-1699775|1326041732|CHC13|55550||11/01/2013|12/31/9999|$617.16|0|0|||LAPARO LIGATE SPERMATIC VEIN|| 58-1699775|1326041732|CHC13|55559||11/01/2013|12/31/9999|$0.00|0|0|||LAPARO PROC| SPERMATIC CORD|| 58-1699775|1326041732|CHC13|55600||11/01/2013|12/31/9999|$610.66|0|0|||INCISE SPERM DUCT POUCH|| 58-1699775|1326041732|CHC13|55605||11/01/2013|12/31/9999|$747.02|0|0|||INCISE SPERM DUCT POUCH|| 58-1699775|1326041732|CHC13|55650||11/01/2013|12/31/9999|$1|039.74|0|0|||REMOVE SPERM DUCT POUCH|| 58-1699775|1326041732|CHC13|55680||11/01/2013|12/31/9999|$497.09|0|0|||REMOVE SPERM POUCH LESION|| 58-1699775|1326041732|CHC13|55700||11/01/2013|12/31/9999|$202.73|0|0|||BIOPSY OF PROSTATE|| 58-1699775|1326041732|CHC13|55705||11/01/2013|12/31/9999|$387.36|0|0|||BIOPSY OF PROSTATE|| 58-1699775|1326041732|CHC13|55706||11/01/2013|12/31/9999|$536.80|0|0|||PROSTATE SATURATION SAMPLING|| 58-1699775|1326041732|CHC13|55720||11/01/2013|12/31/9999|$654.37|0|0|||DRAINAGE OF PROSTATE ABSCESS|| 58-1699775|1326041732|CHC13|55725||11/01/2013|12/31/9999|$858.02|0|0|||DRAINAGE OF PROSTATE ABSCESS|| 58-1699775|1326041732|CHC13|55801||11/01/2013|12/31/9999|$1|587.42|0|0|||REMOVAL OF PROSTATE|| 58-1699775|1326041732|CHC13|55810||11/01/2013|12/31/9999|$1|918.39|0|0|||EXTENSIVE PROSTATE SURGERY|| 58-1699775|1326041732|CHC13|55812||11/01/2013|12/31/9999|$2|344.35|0|0|||EXTENSIVE PROSTATE SURGERY|| 58-1699775|1326041732|CHC13|55815||11/01/2013|12/31/9999|$2|570.71|0|0|||EXTENSIVE PROSTATE SURGERY|| 58-1699775|1326041732|CHC13|55821||11/01/2013|12/31/9999|$1|271.93|0|0|||REMOVAL OF PROSTATE|| 58-1699775|1326041732|CHC13|55831||11/01/2013|12/31/9999|$1|375.83|0|0|||REMOVAL OF PROSTATE|| 58-1699775|1326041732|CHC13|55840||11/01/2013|12/31/9999|$1|948.48|0|0|||EXTENSIVE PROSTATE SURGERY|| 58-1699775|1326041732|CHC13|55842||11/01/2013|12/31/9999|$2|088.21|0|0|||EXTENSIVE PROSTATE SURGERY|| 58-1699775|1326041732|CHC13|55845||11/01/2013|12/31/9999|$2|385.75|0|0|||EXTENSIVE PROSTATE SURGERY|| 58-1699775|1326041732|CHC13|55860||11/01/2013|12/31/9999|$1|271.84|0|0|||SURGICAL EXPOSURE| PROSTATE|| 58-1699775|1326041732|CHC13|55862||11/01/2013|12/31/9999|$1|597.86|0|0|||EXTENSIVE PROSTATE SURGERY|| 58-1699775|1326041732|CHC13|55865||11/01/2013|12/31/9999|$1|944.46|0|0|||EXTENSIVE PROSTATE SURGERY|| 58-1699775|1326041732|CHC13|55866||11/01/2013|12/31/9999|$2|527.08|0|0|||LAPARO RADICAL PROSTATECTOMY|| 58-1699775|1326041732|CHC13|55870||11/01/2013|12/31/9999|$208.23|0|0|||ELECTROEJACULATION|| 58-1699775|1326041732|CHC13|55873||11/01/2013|12/31/9999|$1|162.73|0|0|||CRYOABLATE PROSTATE|| 58-1699775|1326041732|CHC13|55874||04/01/2018|12/31/9999|$253.69|0|0|0||TPRNL PLMT BIODEGRDABL MATRL|| 58-1699775|1326041732|CHC13|55875||11/01/2013|12/31/9999|$1|106.42|0|0|||TRANSPERI NEEDLE PLACE| PROS|| 58-1699775|1326041732|CHC13|55876||11/01/2013|12/31/9999|$145.88|0|0|||PLACE RT DEVICE/MARKER| PROS|| 58-1699775|1326041732|CHC13|55899||11/01/2013|12/31/9999|$0.00|0|0|||GENITAL SURGERY PROCEDURE|| 58-1699775|1326041732|CHC13|55920||11/01/2013|12/31/9999|$631.82|0|0|||PLACE NEEDLES PELVIC FOR RT|| 58-1699775|1326041732|CHC13|55970||11/01/2013|12/31/9999|$0.00|0|0|||SEX TRANSFORMATION| M TO F|| 58-1699775|1326041732|CHC13|55980||11/01/2013|12/31/9999|$0.00|0|0|||SEX TRANSFORMATION| F TO M|| 58-1699775|1326041732|CHC13|56405||11/01/2013|12/31/9999|$156.25|0|0|||I & D OF VULVA/PERINEUM|| 58-1699775|1326041732|CHC13|56420||11/01/2013|12/31/9999|$133.03|0|0|||DRAINAGE OF GLAND ABSCESS|| 58-1699775|1326041732|CHC13|56440||11/01/2013|12/31/9999|$266.13|0|0|||SURGERY FOR VULVA LESION|| 58-1699775|1326041732|CHC13|56441||11/01/2013|12/31/9999|$199.86|0|0|||LYSIS OF LABIAL LESION(S)|| 58-1699775|1326041732|CHC13|56442||11/01/2013|12/31/9999|$69.73|0|0|||HYMENOTOMY|| 58-1699775|1326041732|CHC13|56501||11/01/2013|12/31/9999|$165.44|0|0|||DESTROY| VULVA LESIONS| SIM|| 58-1699775|1326041732|CHC13|56515||11/01/2013|12/31/9999|$288.69|0|0|||DESTROY VULVA LESION/S COMPL|| 58-1699775|1326041732|CHC13|56605||11/01/2013|12/31/9999|$88.53|0|0|||BIOPSY OF VULVA/PERINEUM|| 58-1699775|1326041732|CHC13|56606||11/01/2013|12/31/9999|$42.88|0|0|||BIOPSY OF VULVA/PERINEUM|| 58-1699775|1326041732|CHC13|56620||11/01/2013|12/31/9999|$730.72|0|0|||PARTIAL REMOVAL OF VULVA|| 58-1699775|1326041732|CHC13|56625||11/01/2013|12/31/9999|$877.71|0|0|||COMPLETE REMOVAL OF VULVA|| 58-1699775|1326041732|CHC13|56630||11/01/2013|12/31/9999|$1|295.53|0|0|||EXTENSIVE VULVA SURGERY|| 58-1699775|1326041732|CHC13|56631||11/01/2013|12/31/9999|$1|643.87|0|0|||EXTENSIVE VULVA SURGERY|| 58-1699775|1326041732|CHC13|56632||11/01/2013|12/31/9999|$1|909.44|0|0|||EXTENSIVE VULVA SURGERY|| 58-1699775|1326041732|CHC13|56633||11/01/2013|12/31/9999|$1|685.37|0|0|||EXTENSIVE VULVA SURGERY|| 58-1699775|1326041732|CHC13|56634||11/01/2013|12/31/9999|$1|786.89|0|0|||EXTENSIVE VULVA SURGERY|| 58-1699775|1326041732|CHC13|56637||11/01/2013|12/31/9999|$2|096.70|0|0|||EXTENSIVE VULVA SURGERY|| 58-1699775|1326041732|CHC13|56640||11/01/2013|12/31/9999|$2|091.35|0|0|||EXTENSIVE VULVA SURGERY|| 58-1699775|1326041732|CHC13|56700||11/01/2013|12/31/9999|$272.28|0|0|||PARTIAL REMOVAL OF HYMEN|| 58-1699775|1326041732|CHC13|56740||11/01/2013|12/31/9999|$433.82|0|0|||REMOVE VAGINA GLAND LESION|| 58-1699775|1326041732|CHC13|56800||11/01/2013|12/31/9999|$350.64|0|0|||REPAIR OF VAGINA|| 58-1699775|1326041732|CHC13|56805||11/01/2013|12/31/9999|$1|680.40|0|0|||REPAIR CLITORIS|| 58-1699775|1326041732|CHC13|56810||11/01/2013|12/31/9999|$378.27|0|0|||REPAIR OF PERINEUM|| 58-1699775|1326041732|CHC13|56820||11/01/2013|12/31/9999|$125.12|0|0|||EXAM OF VULVA W/SCOPE|| 58-1699775|1326041732|CHC13|56821||11/01/2013|12/31/9999|$168.00|0|0|||EXAM/BIOPSY OF VULVA W/SCOPE|| 58-1699775|1326041732|CHC13|57000||11/01/2013|12/31/9999|$269.12|0|0|||EXPLORATION OF VAGINA|| 58-1699775|1326041732|CHC13|57010||11/01/2013|12/31/9999|$632.05|0|0|||DRAINAGE OF PELVIC ABSCESS|| 58-1699775|1326041732|CHC13|57020||11/01/2013|12/31/9999|$120.08|0|0|||DRAINAGE OF PELVIC FLUID|| 58-1699775|1326041732|CHC13|57022||11/01/2013|12/31/9999|$244.61|0|0|||I & D VAGINAL HEMATOMA| PP|| 58-1699775|1326041732|CHC13|57023||11/01/2013|12/31/9999|$454.24|0|0|||I & D VAG HEMATOMA| NON-OB|| 58-1699775|1326041732|CHC13|57061||11/01/2013|12/31/9999|$141.44|0|0|||DESTROY VAG LESIONS| SIMPLE|| 58-1699775|1326041732|CHC13|57065||11/01/2013|12/31/9999|$248.81|0|0|||DESTROY VAG LESIONS| COMPLEX|| 58-1699775|1326041732|CHC13|57100||11/01/2013|12/31/9999|$96.42|0|0|||BIOPSY OF VAGINA|| 58-1699775|1326041732|CHC13|57105||11/01/2013|12/31/9999|$180.52|0|0|||BIOPSY OF VAGINA|| 58-1699775|1326041732|CHC13|57106||11/01/2013|12/31/9999|$699.76|0|0|||REMOVE VAGINA WALL| PARTIAL|| 58-1699775|1326041732|CHC13|57107||11/01/2013|12/31/9999|$2|053.94|0|0|||REMOVE VAGINA TISSUE| PART|| 58-1699775|1326041732|CHC13|57109||11/01/2013|12/31/9999|$2|350.49|0|0|||VAGINECTOMY PARTIAL W/NODES|| 58-1699775|1326041732|CHC13|57110||11/01/2013|12/31/9999|$1|312.87|0|0|||REMOVE VAGINA WALL| COMPLETE|| 58-1699775|1326041732|CHC13|57111||11/01/2013|12/31/9999|$2|356.90|0|0|||REMOVE VAGINA TISSUE| COMPL|| 58-1699775|1326041732|CHC13|57112||11/01/2013|12/31/9999|$2|391.81|0|0|||VAGINECTOMY W/NODES| COMPL|| 58-1699775|1326041732|CHC13|57120||11/01/2013|12/31/9999|$743.94|0|0|||CLOSURE OF VAGINA|| 58-1699775|1326041732|CHC13|57130||11/01/2013|12/31/9999|$232.14|0|0|||REMOVE VAGINA LESION|| 58-1699775|1326041732|CHC13|57135||11/01/2013|12/31/9999|$250.40|0|0|||REMOVE VAGINA LESION|| 58-1699775|1326041732|CHC13|57150||11/01/2013|12/31/9999|$42.88|0|0|||TREAT VAGINA INFECTION|| 58-1699775|1326041732|CHC13|57155||11/01/2013|12/31/9999|$404.82|0|0|||INSERT UTERI TANDEMS/OVOIDS|| 58-1699775|1326041732|CHC13|57156||11/01/2013|12/31/9999|$205.09|0|0|||INS VAG BRACHYTX DEVICE|| 58-1699775|1326041732|CHC13|57160||11/01/2013|12/31/9999|$69.50|0|0|||INSERT PESSARY/OTHER DEVICE|| 58-1699775|1326041732|CHC13|57170||11/01/2013|12/31/9999|$70.98|0|0|||FITTING OF DIAPHRAGM/CAP|| 58-1699775|1326041732|CHC13|57180||11/01/2013|12/31/9999|$153.78|0|0|||TREAT VAGINAL BLEEDING|| 58-1699775|1326041732|CHC13|57200||11/01/2013|12/31/9999|$431.24|0|0|||REPAIR OF VAGINA|| 58-1699775|1326041732|CHC13|57210||11/01/2013|12/31/9999|$531.34|0|0|||REPAIR VAGINA/PERINEUM|| 58-1699775|1326041732|CHC13|57220||11/01/2013|12/31/9999|$463.42|0|0|||REVISION OF URETHRA|| 58-1699775|1326041732|CHC13|57230||11/01/2013|12/31/9999|$579.11|0|0|||REPAIR OF URETHRAL LESION|| 58-1699775|1326041732|CHC13|57240||11/01/2013|12/31/9999|$970.19|0|0|||REPAIR BLADDER & VAGINA|| 58-1699775|1326041732|CHC13|57250||11/01/2013|12/31/9999|$982.00|0|0|||REPAIR RECTUM & VAGINA|| 58-1699775|1326041732|CHC13|57260||11/01/2013|12/31/9999|$1|212.16|0|0|||REPAIR OF VAGINA|| 58-1699775|1326041732|CHC13|57265||11/01/2013|12/31/9999|$1|331.74|0|0|||EXTENSIVE REPAIR OF VAGINA|| 58-1699775|1326041732|CHC13|57267||11/01/2013|12/31/9999|$378.18|0|0|||INSERT MESH/PELVIC FLR ADDON|| 58-1699775|1326041732|CHC13|57268||11/01/2013|12/31/9999|$700.59|0|0|||REPAIR OF BOWEL BULGE|| 58-1699775|1326041732|CHC13|57270||11/01/2013|12/31/9999|$1|165.83|0|0|||REPAIR OF BOWEL POUCH|| 58-1699775|1326041732|CHC13|57280||11/01/2013|12/31/9999|$1|394.53|0|0|||SUSPENSION OF VAGINA|| 58-1699775|1326041732|CHC13|57282||11/01/2013|12/31/9999|$727.93|0|0|||COLPOPEXY| EXTRAPERITONEAL|| 58-1699775|1326041732|CHC13|57283||11/01/2013|12/31/9999|$1|007.69|0|0|||COLPOPEXY| INTRAPERITONEAL|| 58-1699775|1326041732|CHC13|57284||11/01/2013|12/31/9999|$1|194.35|0|0|||REPAIR PARAVAGINAL DEFECT|| 58-1699775|1326041732|CHC13|57285||11/01/2013|12/31/9999|$983.81|0|0|||REPAIR PARAVAG DEFECT| VAG|| 58-1699775|1326041732|CHC13|57287||11/01/2013|12/31/9999|$987.84|0|0|||REVISE/REMOVE SLING REPAIR|| 58-1699775|1326041732|CHC13|57288||11/01/2013|12/31/9999|$1|035.76|0|0|||REPAIR BLADDER DEFECT|| 58-1699775|1326041732|CHC13|57289||11/01/2013|12/31/9999|$1|047.89|0|0|||REPAIR BLADDER & VAGINA|| 58-1699775|1326041732|CHC13|57291||11/01/2013|12/31/9999|$886.28|0|0|||CONSTRUCTION OF VAGINA|| 58-1699775|1326041732|CHC13|57292||11/01/2013|12/31/9999|$1|199.38|0|0|||CONSTRUCT VAGINA WITH GRAFT|| 58-1699775|1326041732|CHC13|57295||11/01/2013|12/31/9999|$697.74|0|0|||CHANGE VAGINAL GRAFT|| 58-1699775|1326041732|CHC13|57296||11/01/2013|12/31/9999|$1|392.16|0|0|||REVISE VAG GRAFT| OPEN ABD|| 58-1699775|1326041732|CHC13|57300||11/01/2013|12/31/9999|$801.44|0|0|||REPAIR RECTUM-VAGINA FISTULA|| 58-1699775|1326041732|CHC13|57305||11/01/2013|12/31/9999|$1|336.61|0|0|||REPAIR RECTUM-VAGINA FISTULA|| 58-1699775|1326041732|CHC13|57307||11/01/2013|12/31/9999|$1|523.22|0|0|||FISTULA REPAIR & COLOSTOMY|| 58-1699775|1326041732|CHC13|57308||11/01/2013|12/31/9999|$933.62|0|0|||FISTULA REPAIR| TRANSPERINE|| 58-1699775|1326041732|CHC13|57310||11/01/2013|12/31/9999|$663.12|0|0|||REPAIR URETHROVAGINAL LESION|| 58-1699775|1326041732|CHC13|57311||11/01/2013|12/31/9999|$755.62|0|0|||REPAIR URETHROVAGINAL LESION|| 58-1699775|1326041732|CHC13|57320||11/01/2013|12/31/9999|$771.34|0|0|||REPAIR BLADDER-VAGINA LESION|| 58-1699775|1326041732|CHC13|57330||11/01/2013|12/31/9999|$1|067.50|0|0|||REPAIR BLADDER-VAGINA LESION|| 58-1699775|1326041732|CHC13|57335||11/01/2013|12/31/9999|$1|648.59|0|0|||REPAIR VAGINA|| 58-1699775|1326041732|CHC13|57400||11/01/2013|12/31/9999|$194.88|0|0|||DILATION OF VAGINA|| 58-1699775|1326041732|CHC13|57410||11/01/2013|12/31/9999|$155.81|0|0|||PELVIC EXAMINATION|| 58-1699775|1326041732|CHC13|57415||11/01/2013|12/31/9999|$231.32|0|0|||REMOVE VAGINAL FOREIGN BODY|| 58-1699775|1326041732|CHC13|57420||11/01/2013|12/31/9999|$131.61|0|0|||EXAM OF VAGINA W/SCOPE|| 58-1699775|1326041732|CHC13|57421||11/01/2013|12/31/9999|$179.83|0|0|||EXAM/BIOPSY OF VAG W/SCOPE|| 58-1699775|1326041732|CHC13|57423||11/01/2013|12/31/9999|$1|346.91|0|0|||REPAIR PARAVAG DEFECT| LAP|| 58-1699775|1326041732|CHC13|57425||11/01/2013|12/31/9999|$1|418.26|0|0|||LAPAROSCOPY| SURG| COLPOPEXY|| 58-1699775|1326041732|CHC13|57426||11/01/2013|12/31/9999|$1|244.55|0|0|||REVISE PROSTH VAG GRAFT LAP|| 58-1699775|1326041732|CHC13|57452||11/01/2013|12/31/9999|$133.35|0|0|||EXAM OF CERVIX W/SCOPE|| 58-1699775|1326041732|CHC13|57454||11/01/2013|12/31/9999|$198.86|0|0|||BX/CURETT OF CERVIX W/SCOPE|| 58-1699775|1326041732|CHC13|57455||11/01/2013|12/31/9999|$162.63|0|0|||BIOPSY OF CERVIX W/SCOPE|| 58-1699775|1326041732|CHC13|57456||11/01/2013|12/31/9999|$151.78|0|0|||ENDOCERV CURETTAGE W/SCOPE|| 58-1699775|1326041732|CHC13|57460||11/01/2013|12/31/9999|$239.21|0|0|||BX OF CERVIX W/SCOPE| LEEP|| 58-1699775|1326041732|CHC13|57461||11/01/2013|12/31/9999|$276.89|0|0|||CONZ OF CERVIX W/SCOPE| LEEP|| 58-1699775|1326041732|CHC13|57500||11/01/2013|12/31/9999|$110.17|0|0|||BIOPSY OF CERVIX|| 58-1699775|1326041732|CHC13|57505||11/01/2013|12/31/9999|$132.13|0|0|||ENDOCERVICAL CURETTAGE|| 58-1699775|1326041732|CHC13|57510||11/01/2013|12/31/9999|$168.09|0|0|||CAUTERIZATION OF CERVIX|| 58-1699775|1326041732|CHC13|57511||11/01/2013|12/31/9999|$191.76|0|0|||CRYOCAUTERY OF CERVIX|| 58-1699775|1326041732|CHC13|57513||11/01/2013|12/31/9999|$192.68|0|0|||LASER SURGERY OF CERVIX|| 58-1699775|1326041732|CHC13|57520||11/01/2013|12/31/9999|$395.19|0|0|||CONIZATION OF CERVIX|| 58-1699775|1326041732|CHC13|57522||11/01/2013|12/31/9999|$353.40|0|0|||CONIZATION OF CERVIX|| 58-1699775|1326041732|CHC13|57530||11/01/2013|12/31/9999|$500.10|0|0|||REMOVAL OF CERVIX|| 58-1699775|1326041732|CHC13|57531||11/01/2013|12/31/9999|$2|528.14|0|0|||REMOVAL OF CERVIX| RADICAL|| 58-1699775|1326041732|CHC13|57540||11/01/2013|12/31/9999|$1|139.07|0|0|||REMOVAL OF RESIDUAL CERVIX|| 58-1699775|1326041732|CHC13|57545||11/01/2013|12/31/9999|$1|202.15|0|0|||REMOVE CERVIX/REPAIR PELVIS|| 58-1699775|1326041732|CHC13|57550||11/01/2013|12/31/9999|$594.02|0|0|||REMOVAL OF RESIDUAL CERVIX|| 58-1699775|1326041732|CHC13|57555||11/01/2013|12/31/9999|$876.83|0|0|||REMOVE CERVIX/REPAIR VAGINA|| 58-1699775|1326041732|CHC13|57556||11/01/2013|12/31/9999|$823.99|0|0|||REMOVE CERVIX| REPAIR BOWEL|| 58-1699775|1326041732|CHC13|57558||11/01/2013|12/31/9999|$165.29|0|0|||D&C OF CERVICAL STUMP|| 58-1699775|1326041732|CHC13|57700||11/01/2013|12/31/9999|$449.69|0|0|||REVISION OF CERVIX|| 58-1699775|1326041732|CHC13|57720||11/01/2013|12/31/9999|$446.06|0|0|||REVISION OF CERVIX|| 58-1699775|1326041732|CHC13|57800||11/01/2013|12/31/9999|$70.22|0|0|||DILATION OF CERVICAL CANAL|| 58-1699775|1326041732|CHC13|58100||11/01/2013|12/31/9999|$128.49|0|0|||BIOPSY OF UTERUS LINING|| 58-1699775|1326041732|CHC13|58110||11/01/2013|12/31/9999|$60.13|0|0|||BX DONE W/COLPOSCOPY ADD-ON|| 58-1699775|1326041732|CHC13|58120||11/01/2013|12/31/9999|$317.65|0|0|||DILATION AND CURETTAGE|| 58-1699775|1326041732|CHC13|58140||11/01/2013|12/31/9999|$1|343.69|0|0|||MYOMECTOMY ABDOM METHOD|| 58-1699775|1326041732|CHC13|58145||11/01/2013|12/31/9999|$793.28|0|0|||MYOMECTOMY VAG METHOD|| 58-1699775|1326041732|CHC13|58146||11/01/2013|12/31/9999|$1|692.97|0|0|||MYOMECTOMY ABDOM COMPLEX|| 58-1699775|1326041732|CHC13|58150||11/01/2013|12/31/9999|$1|457.73|0|0|||TOTAL HYSTERECTOMY|| 58-1699775|1326041732|CHC13|58152||11/01/2013|12/31/9999|$1|826.52|0|0|||TOTAL HYSTERECTOMY|| 58-1699775|1326041732|CHC13|58180||11/01/2013|12/31/9999|$1|399.72|0|0|||PARTIAL HYSTERECTOMY|| 58-1699775|1326041732|CHC13|58200||11/01/2013|12/31/9999|$1|924.90|0|0|||EXTENSIVE HYSTERECTOMY|| 58-1699775|1326041732|CHC13|58210||11/01/2013|12/31/9999|$2|578.39|0|0|||EXTENSIVE HYSTERECTOMY|| 58-1699775|1326041732|CHC13|58240||11/01/2013|12/31/9999|$4|092.06|0|0|||REMOVAL OF PELVIS CONTENTS|| 58-1699775|1326041732|CHC13|58260||11/01/2013|12/31/9999|$1|209.34|0|0|||VAGINAL HYSTERECTOMY|| 58-1699775|1326041732|CHC13|58262||11/01/2013|12/31/9999|$1|349.80|0|0|||VAG HYST INCLUDING T/O|| 58-1699775|1326041732|CHC13|58263||11/01/2013|12/31/9999|$1|451.77|0|0|||VAG HYST W/T/O & VAG REPAIR|| 58-1699775|1326041732|CHC13|58267||11/01/2013|12/31/9999|$1|546.92|0|0|||VAG HYST W/URINARY REPAIR|| 58-1699775|1326041732|CHC13|58270||11/01/2013|12/31/9999|$1|290.35|0|0|||VAG HYST W/ENTEROCELE REPAIR|| 58-1699775|1326041732|CHC13|58275||11/01/2013|12/31/9999|$1|441.08|0|0|||HYSTERECTOMY/REVISE VAGINA|| 58-1699775|1326041732|CHC13|58280||11/01/2013|12/31/9999|$1|542.12|0|0|||HYSTERECTOMY/REVISE VAGINA|| 58-1699775|1326041732|CHC13|58285||11/01/2013|12/31/9999|$1|923.67|0|0|||EXTENSIVE HYSTERECTOMY|| 58-1699775|1326041732|CHC13|58290||11/01/2013|12/31/9999|$1|686.17|0|0|||VAG HYST COMPLEX|| 58-1699775|1326041732|CHC13|58291||11/01/2013|12/31/9999|$1|827.54|0|0|||VAG HYST INCL T/O| COMPLEX|| 58-1699775|1326041732|CHC13|58292||11/01/2013|12/31/9999|$1|929.01|0|0|||VAG HYST T/O & REPAIR| COMPL|| 58-1699775|1326041732|CHC13|58293||11/01/2013|12/31/9999|$2|005.92|0|0|||VAG HYST W/URO REPAIR| COMPL|| 58-1699775|1326041732|CHC13|58294||11/01/2013|12/31/9999|$1|787.64|0|0|||VAG HYST W/ENTEROCELE| COMPL|| 58-1699775|1326041732|CHC13|58300||11/01/2013|12/31/9999|$100.73|0|0|||INSERT INTRAUTERINE DEVICE|| 58-1699775|1326041732|CHC13|58301||11/01/2013|12/31/9999|$100.02|0|0|||REMOVE INTRAUTERINE DEVICE|| 58-1699775|1326041732|CHC13|58321||11/01/2013|12/31/9999|$67.68|0|0|||ARTIFICIAL INSEMINATION|| 58-1699775|1326041732|CHC13|58322||11/01/2013|12/31/9999|$86.24|0|0|||ARTIFICIAL INSEMINATION|| 58-1699775|1326041732|CHC13|58323||11/01/2013|12/31/9999|$18.22|0|0|||SPERM WASHING|| 58-1699775|1326041732|CHC13|58340||11/01/2013|12/31/9999|$83.63|0|0|||CATHETER FOR HYSTEROGRAPHY|| 58-1699775|1326041732|CHC13|58345||11/01/2013|12/31/9999|$408.51|0|0|||REOPEN FALLOPIAN TUBE|| 58-1699775|1326041732|CHC13|58346||11/01/2013|12/31/9999|$646.00|0|0|||INSERT HEYMAN UTERI CAPSULE|| 58-1699775|1326041732|CHC13|58350||11/01/2013|12/31/9999|$114.00|0|0|||REOPEN FALLOPIAN TUBE|| 58-1699775|1326041732|CHC13|58353||11/01/2013|12/31/9999|$1|446.95|0|0|||ENDOMETR ABLATE| THERMAL|| 58-1699775|1326041732|CHC13|58356||11/01/2013|12/31/9999|$510.03|0|0|||ENDOMETRIAL CRYOABLATION|| 58-1699775|1326041732|CHC13|58400||11/01/2013|12/31/9999|$639.00|0|0|||SUSPENSION OF UTERUS|| 58-1699775|1326041732|CHC13|58410||11/01/2013|12/31/9999|$1|175.77|0|0|||SUSPENSION OF UTERUS|| 58-1699775|1326041732|CHC13|58520||11/01/2013|12/31/9999|$1|180.05|0|0|||REPAIR OF RUPTURED UTERUS|| 58-1699775|1326041732|CHC13|58540||11/01/2013|12/31/9999|$1|329.75|0|0|||REVISION OF UTERUS|| 58-1699775|1326041732|CHC13|58541||11/01/2013|12/31/9999|$1|260.47|0|0|||LSH| UTERUS 250 G OR LESS|| 58-1699775|1326041732|CHC13|58542||11/01/2013|12/31/9999|$1|408.68|0|0|||LSH W/T/O UT 250 G OR LESS|| 58-1699775|1326041732|CHC13|58543||11/01/2013|12/31/9999|$1|432.39|0|0|||LSH UTERUS ABOVE 250 G|| 58-1699775|1326041732|CHC13|58544||11/01/2013|12/31/9999|$1|551.10|0|0|||LSH W/T/O UTERUS ABOVE 250 G|| 58-1699775|1326041732|CHC13|58545||11/01/2013|12/31/9999|$1|309.69|0|0|||LAPAROSCOPIC MYOMECTOMY|| 58-1699775|1326041732|CHC13|58546||11/01/2013|12/31/9999|$1|652.76|0|0|||LAPARO-MYOMECTOMY| COMPLEX|| 58-1699775|1326041732|CHC13|58548||11/01/2013|12/31/9999|$2|639.53|0|0|||LAP RADICAL HYST|| 58-1699775|1326041732|CHC13|58550||11/01/2013|12/31/9999|$1|291.13|0|0|||LAPARO-ASST VAG HYSTERECTOMY|| 58-1699775|1326041732|CHC13|58552||11/01/2013|12/31/9999|$1|434.91|0|0|||LAPARO-VAG HYST INCL T/O|| 58-1699775|1326041732|CHC13|58553||11/01/2013|12/31/9999|$1|663.94|0|0|||LAPARO-VAG HYST| COMPLEX|| 58-1699775|1326041732|CHC13|58554||11/01/2013|12/31/9999|$1|924.10|0|0|||LAPARO-VAG HYST W/T/O| COMPL|| 58-1699775|1326041732|CHC13|58555||11/01/2013|12/31/9999|$278.16|0|0|||HYSTEROSCOPY| DX| SEP PROC|| 58-1699775|1326041732|CHC13|58558||11/01/2013|12/31/9999|$391.32|0|0|||HYSTEROSCOPY| BIOPSY|| 58-1699775|1326041732|CHC13|58559||11/01/2013|12/31/9999|$504.10|0|0|||HYSTEROSCOPY| LYSIS|| 58-1699775|1326041732|CHC13|58560||11/01/2013|12/31/9999|$568.68|0|0|||HYSTEROSCOPY| RESECT SEPTUM|| 58-1699775|1326041732|CHC13|58561||11/01/2013|12/31/9999|$804.67|0|0|||HYSTEROSCOPY| REMOVE MYOMA|| 58-1699775|1326041732|CHC13|58562||11/01/2013|12/31/9999|$425.46|0|0|||HYSTEROSCOPY| REMOVE FB|| 58-1699775|1326041732|CHC13|58563||11/01/2013|12/31/9999|$503.64|0|0|||HYSTEROSCOPY| ABLATION|| 58-1699775|1326041732|CHC13|58565||11/01/2013|12/31/9999|$633.12|0|0|||HYSTEROSCOPY| STERILIZATION|| 58-1699775|1326041732|CHC13|58570||11/01/2013|12/31/9999|$1|355.91|0|0|||TLH| UTERUS 250 G OR LESS|| 58-1699775|1326041732|CHC13|58571||11/01/2013|12/31/9999|$1|507.50|0|0|||TLH W/T/O 250 G OR LESS|| 58-1699775|1326041732|CHC13|58572||11/01/2013|12/31/9999|$1|689.78|0|0|||TLH| UTERUS OVER 250 G|| 58-1699775|1326041732|CHC13|58573||11/01/2013|12/31/9999|$1|932.75|0|0|||TLH W/T/O UTERUS OVER 250 G|| 58-1699775|1326041732|CHC13|58575||04/01/2018|12/31/9999|$2|827.97|0|0|0||LAPS TOT HYST RESJ MAL|| 58-1699775|1326041732|CHC13|58578||11/01/2013|12/31/9999|$0.00|0|0|||LAPARO PROC| UTERUS|| 58-1699775|1326041732|CHC13|58579||11/01/2013|12/31/9999|$0.00|0|0|||HYSTEROSCOPE PROCEDURE|| 58-1699775|1326041732|CHC13|58600||11/01/2013|12/31/9999|$531.62|0|0|||DIVISION OF FALLOPIAN TUBE|| 58-1699775|1326041732|CHC13|58605||11/01/2013|12/31/9999|$479.54|0|0|||DIVISION OF FALLOPIAN TUBE|| 58-1699775|1326041732|CHC13|58611||11/01/2013|12/31/9999|$113.83|0|0|||LIGATE OVIDUCT(S) ADD-ON|| 58-1699775|1326041732|CHC13|58615||11/01/2013|12/31/9999|$357.62|0|0|||OCCLUDE FALLOPIAN TUBE(S)|| 58-1699775|1326041732|CHC13|58660||11/01/2013|12/31/9999|$983.21|0|0|||LAPAROSCOPY| LYSIS|| 58-1699775|1326041732|CHC13|58661||11/01/2013|12/31/9999|$942.36|0|0|||LAPAROSCOPY| REMOVE ADNEXA|| 58-1699775|1326041732|CHC13|58662||11/01/2013|12/31/9999|$1|031.10|0|0|||LAPAROSCOPY| EXCISE LESIONS|| 58-1699775|1326041732|CHC13|58670||11/01/2013|12/31/9999|$532.99|0|0|||LAPAROSCOPY| TUBAL CAUTERY|| 58-1699775|1326041732|CHC13|58671||11/01/2013|12/31/9999|$532.53|0|0|||LAPAROSCOPY| TUBAL BLOCK|| 58-1699775|1326041732|CHC13|58672||11/01/2013|12/31/9999|$1|078.32|0|0|||LAPAROSCOPY| FIMBRIOPLASTY|| 58-1699775|1326041732|CHC13|58673||11/01/2013|12/31/9999|$1|172.04|0|0|||LAPAROSCOPY| SALPINGOSTOMY|| 58-1699775|1326041732|CHC13|58674||04/01/2017|12/31/9999|$1|250.54|0|1250.54|0||LAPS ABLTJ UTERINE FIBROIDS|| 58-1699775|1326041732|CHC13|58679||11/01/2013|12/31/9999|$0.00|0|0|||LAPARO PROC| OVIDUCT-OVARY|| 58-1699775|1326041732|CHC13|58700||11/01/2013|12/31/9999|$1|130.24|0|0|||REMOVAL OF FALLOPIAN TUBE|| 58-1699775|1326041732|CHC13|58720||11/01/2013|12/31/9999|$1|053.74|0|0|||REMOVAL OF OVARY/TUBE(S)|| 58-1699775|1326041732|CHC13|58740||11/01/2013|12/31/9999|$1|280.12|0|0|||REVISE FALLOPIAN TUBE(S)|| 58-1699775|1326041732|CHC13|58750||11/01/2013|12/31/9999|$1|320.66|0|0|||REPAIR OVIDUCT|| 58-1699775|1326041732|CHC13|58752||11/01/2013|12/31/9999|$1|248.15|0|0|||REVISE OVARIAN TUBE(S)|| 58-1699775|1326041732|CHC13|58760||11/01/2013|12/31/9999|$1|186.58|0|0|||REMOVE TUBAL OBSTRUCTION|| 58-1699775|1326041732|CHC13|58770||11/01/2013|12/31/9999|$1|242.98|0|0|||CREATE NEW TUBAL OPENING|| 58-1699775|1326041732|CHC13|58800||11/01/2013|12/31/9999|$434.19|0|0|||DRAINAGE OF OVARIAN CYST(S)|| 58-1699775|1326041732|CHC13|58805||11/01/2013|12/31/9999|$586.20|0|0|||DRAINAGE OF OVARIAN CYST(S)|| 58-1699775|1326041732|CHC13|58820||11/01/2013|12/31/9999|$453.90|0|0|||DRAIN OVARY ABSCESS| OPEN|| 58-1699775|1326041732|CHC13|58822||11/01/2013|12/31/9999|$1|074.03|0|0|||DRAIN OVARY ABSCESS| PERCUT|| 58-1699775|1326041732|CHC13|58825||11/01/2013|12/31/9999|$1|033.15|0|0|||TRANSPOSITION| OVARY(S)|| 58-1699775|1326041732|CHC13|58900||11/01/2013|12/31/9999|$641.67|0|0|||BIOPSY OF OVARY(S)|| 58-1699775|1326041732|CHC13|58920||11/01/2013|12/31/9999|$1|022.62|0|0|||PARTIAL REMOVAL OF OVARY(S)|| 58-1699775|1326041732|CHC13|58925||11/01/2013|12/31/9999|$1|079.11|0|0|||REMOVAL OF OVARIAN CYST(S)|| 58-1699775|1326041732|CHC13|58940||11/01/2013|12/31/9999|$752.15|0|0|||REMOVAL OF OVARY(S)|| 58-1699775|1326041732|CHC13|58943||11/01/2013|12/31/9999|$1|654.44|0|0|||REMOVAL OF OVARY(S)|| 58-1699775|1326041732|CHC13|58950||11/01/2013|12/31/9999|$1|580.64|0|0|||RESECT OVARIAN MALIGNANCY|| 58-1699775|1326041732|CHC13|58951||11/01/2013|12/31/9999|$2|033.17|0|0|||RESECT OVARIAN MALIGNANCY|| 58-1699775|1326041732|CHC13|58952||11/01/2013|12/31/9999|$2|296.93|0|0|||RESECT OVARIAN MALIGNANCY|| 58-1699775|1326041732|CHC13|58953||11/01/2013|12/31/9999|$2|842.76|0|0|||TAH| RAD DISSECT FOR DEBULK|| 58-1699775|1326041732|CHC13|58954||11/01/2013|12/31/9999|$3|081.48|0|0|||TAH RAD DEBULK/LYMPH REMOVE|| 58-1699775|1326041732|CHC13|58956||11/01/2013|12/31/9999|$1|939.54|0|0|||BSO| OMENTECTOMY W/TAH|| 58-1699775|1326041732|CHC13|58957||11/01/2013|12/31/9999|$2|217.18|0|0|||RESECT RECURRENT GYN MAL|| 58-1699775|1326041732|CHC13|58958||11/01/2013|12/31/9999|$2|437.96|0|0|||RESECT RECUR GYN MAL W/LYM|| 58-1699775|1326041732|CHC13|58960||11/01/2013|12/31/9999|$1|355.55|0|0|||EXPLORATION OF ABDOMEN|| 58-1699775|1326041732|CHC13|58970||11/01/2013|12/31/9999|$277.77|0|0|||RETRIEVAL OF OOCYTE|| 58-1699775|1326041732|CHC13|58974||11/01/2013|12/31/9999|$211.69|0|0|||TRANSFER OF EMBRYO|| 58-1699775|1326041732|CHC13|58976||11/01/2013|12/31/9999|$299.53|0|0|||TRANSFER OF EMBRYO|| 58-1699775|1326041732|CHC13|58999||11/01/2013|12/31/9999|$0.00|0|0|||GENITAL SURGERY PROCEDURE|| 58-1699775|1326041732|CHC13|59000||11/01/2013|12/31/9999|$119.21|0|0|||AMNIOCENTESIS| DIAGNOSTIC|| 58-1699775|1326041732|CHC13|59001||11/01/2013|12/31/9999|$267.27|0|0|||AMNIOCENTESIS| THERAPEUTIC|| 58-1699775|1326041732|CHC13|59012||11/01/2013|12/31/9999|$296.82|0|0|||FETAL CORD PUNCTURE|PRENATAL|| 58-1699775|1326041732|CHC13|59015||11/01/2013|12/31/9999|$195.36|0|0|||CHORION BIOPSY|| 58-1699775|1326041732|CHC13|59020||11/01/2013|12/31/9999|$99.98|0|0|||FETAL CONTRACT STRESS TEST|| 58-1699775|1326041732|CHC13|59020|26|11/01/2013|12/31/9999|$59.53|0|0|||FETAL CONTRACT STRESS TEST|| 58-1699775|1326041732|CHC13|59020|TC|11/01/2013|12/31/9999|$50.45|0|0|||FETAL CONTRACT STRESS TEST|| 58-1699775|1326041732|CHC13|59025||11/01/2013|12/31/9999|$68.06|0|0|||FETAL NON-STRESS TEST|| 58-1699775|1326041732|CHC13|59025|26|11/01/2013|12/31/9999|$47.62|0|0|||FETAL NON-STRESS TEST|| 58-1699775|1326041732|CHC13|59025|TC|11/01/2013|12/31/9999|$27.25|0|0|||FETAL NON-STRESS TEST|| 58-1699775|1326041732|CHC13|59030||11/01/2013|12/31/9999|$143.97|0|0|||FETAL SCALP BLOOD SAMPLE|| 58-1699775|1326041732|CHC13|59050||11/01/2013|12/31/9999|$75.18|0|0|||FETAL MONITOR W/REPORT|| 58-1699775|1326041732|CHC13|59051||11/01/2013|12/31/9999|$62.42|0|0|||FETAL MONITOR/INTERPRET ONLY|| 58-1699775|1326041732|CHC13|59070||11/01/2013|12/31/9999|$461.50|0|0|||TRANSABDOM AMNIOINFUS W/US|| 58-1699775|1326041732|CHC13|59072||11/01/2013|12/31/9999|$768.77|0|0|||UMBILICAL CORD OCCLUD W/US|| 58-1699775|1326041732|CHC13|59074||11/01/2013|12/31/9999|$468.83|0|0|||FETAL FLUID DRAINAGE W/US|| 58-1699775|1326041732|CHC13|59076||11/01/2013|12/31/9999|$765.11|0|0|||FETAL SHUNT PLACEMENT| W/US|| 58-1699775|1326041732|CHC13|59100||11/01/2013|12/31/9999|$1|224.48|0|0|||REMOVE UTERUS LESION|| 58-1699775|1326041732|CHC13|59120||11/01/2013|12/31/9999|$1|168.29|0|0|||TREAT ECTOPIC PREGNANCY|| 58-1699775|1326041732|CHC13|59121||11/01/2013|12/31/9999|$1|169.58|0|0|||TREAT ECTOPIC PREGNANCY|| 58-1699775|1326041732|CHC13|59130||11/01/2013|12/31/9999|$1|201.65|0|0|||TREAT ECTOPIC PREGNANCY|| 58-1699775|1326041732|CHC13|59135||11/01/2013|12/31/9999|$1|219.58|0|0|||TREAT ECTOPIC PREGNANCY|| 58-1699775|1326041732|CHC13|59136||11/01/2013|12/31/9999|$1|284.48|0|0|||TREAT ECTOPIC PREGNANCY|| 58-1699775|1326041732|CHC13|59140||11/01/2013|12/31/9999|$523.06|0|0|||TREAT ECTOPIC PREGNANCY|| 58-1699775|1326041732|CHC13|59150||11/01/2013|12/31/9999|$1|130.82|0|0|||TREAT ECTOPIC PREGNANCY|| 58-1699775|1326041732|CHC13|59151||11/01/2013|12/31/9999|$1|101.37|0|0|||TREAT ECTOPIC PREGNANCY|| 58-1699775|1326041732|CHC13|59160||11/01/2013|12/31/9999|$256.73|0|0|||D & C AFTER DELIVERY|| 58-1699775|1326041732|CHC13|59200||11/01/2013|12/31/9999|$66.82|0|0|||INSERT CERVICAL DILATOR|| 58-1699775|1326041732|CHC13|59300||11/01/2013|12/31/9999|$217.62|0|0|||EPISIOTOMY OR VAGINAL REPAIR|| 58-1699775|1326041732|CHC13|59320||11/01/2013|12/31/9999|$224.42|0|0|||REVISION OF CERVIX|| 58-1699775|1326041732|CHC13|59325||11/01/2013|12/31/9999|$317.31|0|0|||REVISION OF CERVIX|| 58-1699775|1326041732|CHC13|59350||11/01/2013|12/31/9999|$415.32|0|0|||REPAIR OF UTERUS|| 58-1699775|1326041732|CHC13|59400||11/01/2013|12/31/9999|$3|037.58|0|0|||OBSTETRICAL CARE|| 58-1699775|1326041732|CHC13|59409||11/01/2013|12/31/9999|$1|204.22|0|0|||OBSTETRICAL CARE|| 58-1699775|1326041732|CHC13|59410||11/01/2013|12/31/9999|$1|529.16|0|0|||OBSTETRICAL CARE|| 58-1699775|1326041732|CHC13|59412||11/01/2013|12/31/9999|$152.70|0|0|||ANTEPARTUM MANIPULATION|| 58-1699775|1326041732|CHC13|59414||11/01/2013|12/31/9999|$135.63|0|0|||DELIVER PLACENTA|| 58-1699775|1326041732|CHC13|59425||11/01/2013|12/31/9999|$526.57|0|0|||ANTEPARTUM CARE ONLY|| 58-1699775|1326041732|CHC13|59426||11/01/2013|12/31/9999|$928.81|0|0|||ANTEPARTUM CARE ONLY|| 58-1699775|1326041732|CHC13|59430||11/01/2013|12/31/9999|$206.91|0|0|||CARE AFTER DELIVERY|| 58-1699775|1326041732|CHC13|59510||11/01/2013|12/31/9999|$3|368.38|0|0|||CESAREAN DELIVERY|| 58-1699775|1326041732|CHC13|59514||11/01/2013|12/31/9999|$1|359.63|0|0|||CESAREAN DELIVERY ONLY|| 58-1699775|1326041732|CHC13|59515||11/01/2013|12/31/9999|$1|850.55|0|0|||CESAREAN DELIVERY|| 58-1699775|1326041732|CHC13|59525||11/01/2013|12/31/9999|$719.38|0|0|||REMOVE UTERUS AFTER CESAREAN|| 58-1699775|1326041732|CHC13|59610||11/01/2013|12/31/9999|$3|192.57|0|0|||VBAC DELIVERY|| 58-1699775|1326041732|CHC13|59612||11/01/2013|12/31/9999|$1|354.92|0|0|||VBAC DELIVERY ONLY|| 58-1699775|1326041732|CHC13|59614||11/01/2013|12/31/9999|$1|675.32|0|0|||VBAC CARE AFTER DELIVERY|| 58-1699775|1326041732|CHC13|59618||11/01/2013|12/31/9999|$3|422.36|0|0|||ATTEMPTED VBAC DELIVERY|| 58-1699775|1326041732|CHC13|59620||11/01/2013|12/31/9999|$1|410.87|0|0|||ATTEMPTED VBAC DELIVERY ONLY|| 58-1699775|1326041732|CHC13|59622||11/01/2013|12/31/9999|$1|907.78|0|0|||ATTEMPTED VBAC AFTER CARE|| 58-1699775|1326041732|CHC13|59812||11/01/2013|12/31/9999|$431.26|0|0|||TREATMENT OF MISCARRIAGE|| 58-1699775|1326041732|CHC13|59820||11/01/2013|12/31/9999|$517.92|0|0|||CARE OF MISCARRIAGE|| 58-1699775|1326041732|CHC13|59821||11/01/2013|12/31/9999|$521.17|0|0|||TREATMENT OF MISCARRIAGE|| 58-1699775|1326041732|CHC13|59830||11/01/2013|12/31/9999|$639.21|0|0|||TREAT UTERUS INFECTION|| 58-1699775|1326041732|CHC13|59840||11/01/2013|12/31/9999|$301.62|0|0|||ABORTION|| 58-1699775|1326041732|CHC13|59841||11/01/2013|12/31/9999|$528.90|0|0|||ABORTION|| 58-1699775|1326041732|CHC13|59850||11/01/2013|12/31/9999|$498.55|0|0|||ABORTION|| 58-1699775|1326041732|CHC13|59851||11/01/2013|12/31/9999|$584.06|0|0|||ABORTION|| 58-1699775|1326041732|CHC13|59852||11/01/2013|12/31/9999|$720.49|0|0|||ABORTION|| 58-1699775|1326041732|CHC13|59855||11/01/2013|12/31/9999|$608.97|0|0|||ABORTION|| 58-1699775|1326041732|CHC13|59856||11/01/2013|12/31/9999|$717.04|0|0|||ABORTION|| 58-1699775|1326041732|CHC13|59857||11/01/2013|12/31/9999|$744.65|0|0|||ABORTION|| 58-1699775|1326041732|CHC13|59866||11/01/2013|12/31/9999|$310.99|0|0|||ABORTION (MPR)|| 58-1699775|1326041732|CHC13|59870||11/01/2013|12/31/9999|$689.08|0|0|||EVACUATE MOLE OF UTERUS|| 58-1699775|1326041732|CHC13|59871||11/01/2013|12/31/9999|$197.26|0|0|||REMOVE CERCLAGE SUTURE|| 58-1699775|1326041732|CHC13|59897||11/01/2013|12/31/9999|$0.00|0|0|||FETAL INVAS PX W/US|| 58-1699775|1326041732|CHC13|59898||11/01/2013|12/31/9999|$0.00|0|0|||LAPARO PROC| OB CARE/DELIVER|| 58-1699775|1326041732|CHC13|59899||11/01/2013|12/31/9999|$0.00|0|0|||MATERNITY CARE PROCEDURE|| 58-1699775|1326041732|CHC13|60000||11/01/2013|12/31/9999|$209.69|0|0|||DRAIN THYROID/TONGUE CYST|| 58-1699775|1326041732|CHC13|6005F||11/01/2013|12/31/9999|$0.00|0|0|||CARE LEVEL RATIONALE DOC|| 58-1699775|1326041732|CHC13|60100||11/01/2013|12/31/9999|$114.74|0|0|||BIOPSY OF THYROID|| 58-1699775|1326041732|CHC13|6010F||11/01/2013|12/31/9999|$0.00|0|0|||DYSPHAG TEST DONE B/4 EATING|| 58-1699775|1326041732|CHC13|6015F||11/01/2013|12/31/9999|$0.00|0|0|||PT RECVNG/OK FOR EATING/SWALLO|| 58-1699775|1326041732|CHC13|60200||11/01/2013|12/31/9999|$950.67|0|0|||REMOVE THYROID LESION|| 58-1699775|1326041732|CHC13|6020F||11/01/2013|12/31/9999|$0.00|0|0|||NPO (NOTHING-MOUTH) ORDERED|| 58-1699775|1326041732|CHC13|60210||11/01/2013|12/31/9999|$1|020.35|0|0|||PARTIAL THYROID EXCISION|| 58-1699775|1326041732|CHC13|60212||11/01/2013|12/31/9999|$1|460.21|0|0|||PARTIAL THYROID EXCISION|| 58-1699775|1326041732|CHC13|60220||11/01/2013|12/31/9999|$1|024.98|0|0|||PARTIAL REMOVAL OF THYROID|| 58-1699775|1326041732|CHC13|60225||11/01/2013|12/31/9999|$1|339.61|0|0|||PARTIAL REMOVAL OF THYROID|| 58-1699775|1326041732|CHC13|60240||11/01/2013|12/31/9999|$1|328.69|0|0|||REMOVAL OF THYROID|| 58-1699775|1326041732|CHC13|60252||11/01/2013|12/31/9999|$1|902.70|0|0|||REMOVAL OF THYROID|| 58-1699775|1326041732|CHC13|60254||11/01/2013|12/31/9999|$2|421.24|0|0|||EXTENSIVE THYROID SURGERY|| 58-1699775|1326041732|CHC13|60260||11/01/2013|12/31/9999|$1|584.93|0|0|||REPEAT THYROID SURGERY|| 58-1699775|1326041732|CHC13|60270||11/01/2013|12/31/9999|$1|982.56|0|0|||REMOVAL OF THYROID|| 58-1699775|1326041732|CHC13|60271||11/01/2013|12/31/9999|$1|528.68|0|0|||REMOVAL OF THYROID|| 58-1699775|1326041732|CHC13|60280||11/01/2013|12/31/9999|$639.94|0|0|||REMOVE THYROID DUCT LESION|| 58-1699775|1326041732|CHC13|60281||11/01/2013|12/31/9999|$854.16|0|0|||REMOVE THYROID DUCT LESION|| 58-1699775|1326041732|CHC13|60300||11/01/2013|12/31/9999|$71.70|0|0|||ASPIR/INJ THYROID CYST|| 58-1699775|1326041732|CHC13|6030F||11/01/2013|12/31/9999|$0.00|0|0|||MAX STERILE BARRIERS FOLLW'D|| 58-1699775|1326041732|CHC13|6040F||11/01/2013|12/31/9999|$0.00|0|0|||APPRO RAD DS DVCS TECHS DOCD|| 58-1699775|1326041732|CHC13|6045F||11/01/2013|12/31/9999|$0.00|0|0|||RADXPS IN END RPRT4FLURO PXD|| 58-1699775|1326041732|CHC13|60500||11/01/2013|12/31/9999|$1|387.95|0|0|||EXPLORE PARATHYROID GLANDS|| 58-1699775|1326041732|CHC13|60502||11/01/2013|12/31/9999|$1|842.24|0|0|||RE-EXPLORE PARATHYROIDS|| 58-1699775|1326041732|CHC13|60505||11/01/2013|12/31/9999|$2|021.65|0|0|||EXPLORE PARATHYROID GLANDS|| 58-1699775|1326041732|CHC13|60512||11/01/2013|12/31/9999|$352.21|0|0|||AUTOTRANSPLANT PARATHYROID|| 58-1699775|1326041732|CHC13|60520||11/01/2013|12/31/9999|$1|490.77|0|0|||REMOVAL OF THYMUS GLAND|| 58-1699775|1326041732|CHC13|60521||11/01/2013|12/31/9999|$1|661.55|0|0|||REMOVAL OF THYMUS GLAND|| 58-1699775|1326041732|CHC13|60522||11/01/2013|12/31/9999|$2|020.98|0|0|||REMOVAL OF THYMUS GLAND|| 58-1699775|1326041732|CHC13|60540||11/01/2013|12/31/9999|$1|522.56|0|0|||EXPLORE ADRENAL GLAND|| 58-1699775|1326041732|CHC13|60545||11/01/2013|12/31/9999|$1|748.70|0|0|||EXPLORE ADRENAL GLAND|| 58-1699775|1326041732|CHC13|60600||11/01/2013|12/31/9999|$2|085.53|0|0|||REMOVE CAROTID BODY LESION|| 58-1699775|1326041732|CHC13|60605||11/01/2013|12/31/9999|$2|382.64|0|0|||REMOVE CAROTID BODY LESION|| 58-1699775|1326041732|CHC13|60650||11/01/2013|12/31/9999|$1|717.93|0|0|||LAPAROSCOPY ADRENALECTOMY|| 58-1699775|1326041732|CHC13|60659||11/01/2013|12/31/9999|$0.00|0|0|||LAPARO PROC| ENDOCRINE|| 58-1699775|1326041732|CHC13|60699||11/01/2013|12/31/9999|$0.00|0|0|||ENDOCRINE SURGERY PROCEDURE|| 58-1699775|1326041732|CHC13|6070F||11/01/2013|12/31/9999|$0.00|0|0|||PT ASKED/CNSLD AED EFFECTS|| 58-1699775|1326041732|CHC13|6080F||11/01/2013|12/31/9999|$0.00|0|0|||PT/CAREGIVER QUERIED FALLS|| 58-1699775|1326041732|CHC13|6090F||11/01/2013|12/31/9999|$0.00|0|0|||PT/CAREGIVER COUNSEL SAFETY|| 58-1699775|1326041732|CHC13|61000||11/01/2013|12/31/9999|$156.53|0|0|||REMOVE CRANIAL CAVITY FLUID|| 58-1699775|1326041732|CHC13|61001||11/01/2013|12/31/9999|$166.29|0|0|||REMOVE CRANIAL CAVITY FLUID|| 58-1699775|1326041732|CHC13|6100F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|6101F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|61020||11/01/2013|12/31/9999|$195.23|0|0|||REMOVE BRAIN CAVITY FLUID|| 58-1699775|1326041732|CHC13|61026||11/01/2013|12/31/9999|$184.07|0|0|||INJECTION INTO BRAIN CANAL|| 58-1699775|1326041732|CHC13|6102F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|61050||11/01/2013|12/31/9999|$148.80|0|0|||REMOVE BRAIN CANAL FLUID|| 58-1699775|1326041732|CHC13|61055||11/01/2013|12/31/9999|$194.78|0|0|||INJECTION INTO BRAIN CANAL|| 58-1699775|1326041732|CHC13|61070||11/01/2013|12/31/9999|$120.94|0|0|||BRAIN CANAL SHUNT PROCEDURE|| 58-1699775|1326041732|CHC13|61105||11/01/2013|12/31/9999|$656.70|0|0|||TWIST DRILL HOLE|| 58-1699775|1326041732|CHC13|61107||11/01/2013|12/31/9999|$458.31|0|0|||DRILL SKULL FOR IMPLANTATION|| 58-1699775|1326041732|CHC13|61108||11/01/2013|12/31/9999|$1|293.41|0|0|||DRILL SKULL FOR DRAINAGE|| 58-1699775|1326041732|CHC13|6110F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|61120||11/01/2013|12/31/9999|$1|063.96|0|0|||BURR HOLE FOR PUNCTURE|| 58-1699775|1326041732|CHC13|61140||11/01/2013|12/31/9999|$1|809.24|0|0|||PIERCE SKULL FOR BIOPSY|| 58-1699775|1326041732|CHC13|61150||11/01/2013|12/31/9999|$1|945.97|0|0|||PIERCE SKULL FOR DRAINAGE|| 58-1699775|1326041732|CHC13|61151||11/01/2013|12/31/9999|$1|424.26|0|0|||PIERCE SKULL FOR DRAINAGE|| 58-1699775|1326041732|CHC13|61154||11/01/2013|12/31/9999|$1|820.31|0|0|||PIERCE SKULL & REMOVE CLOT|| 58-1699775|1326041732|CHC13|61156||11/01/2013|12/31/9999|$1|789.53|0|0|||PIERCE SKULL FOR DRAINAGE|| 58-1699775|1326041732|CHC13|61210||11/01/2013|12/31/9999|$535.59|0|0|||PIERCE SKULL| IMPLANT DEVICE|| 58-1699775|1326041732|CHC13|61215||11/01/2013|12/31/9999|$719.99|0|0|||INSERT BRAIN-FLUID DEVICE|| 58-1699775|1326041732|CHC13|61250||11/01/2013|12/31/9999|$1|238.96|0|0|||PIERCE SKULL & EXPLORE|| 58-1699775|1326041732|CHC13|61253||11/01/2013|12/31/9999|$1|201.67|0|0|||PIERCE SKULL & EXPLORE|| 58-1699775|1326041732|CHC13|61304||11/01/2013|12/31/9999|$2|361.72|0|0|||OPEN SKULL FOR EXPLORATION|| 58-1699775|1326041732|CHC13|61305||11/01/2013|12/31/9999|$2|892.89|0|0|||OPEN SKULL FOR EXPLORATION|| 58-1699775|1326041732|CHC13|61312||11/01/2013|12/31/9999|$2|997.00|0|0|||OPEN SKULL FOR DRAINAGE|| 58-1699775|1326041732|CHC13|61313||11/01/2013|12/31/9999|$2|855.26|0|0|||OPEN SKULL FOR DRAINAGE|| 58-1699775|1326041732|CHC13|61314||11/01/2013|12/31/9999|$2|629.03|0|0|||OPEN SKULL FOR DRAINAGE|| 58-1699775|1326041732|CHC13|61315||11/01/2013|12/31/9999|$2|981.26|0|0|||OPEN SKULL FOR DRAINAGE|| 58-1699775|1326041732|CHC13|61316||11/01/2013|12/31/9999|$127.20|0|0|||IMPLT CRAN BONE FLAP TO ABDO|| 58-1699775|1326041732|CHC13|61320||11/01/2013|12/31/9999|$2|742.13|0|0|||OPEN SKULL FOR DRAINAGE|| 58-1699775|1326041732|CHC13|61321||11/01/2013|12/31/9999|$3|060.13|0|0|||OPEN SKULL FOR DRAINAGE|| 58-1699775|1326041732|CHC13|61322||11/01/2013|12/31/9999|$3|412.99|0|0|||DECOMPRESSIVE CRANIOTOMY|| 58-1699775|1326041732|CHC13|61323||11/01/2013|12/31/9999|$3|437.19|0|0|||DECOMPRESSIVE LOBECTOMY|| 58-1699775|1326041732|CHC13|61330||11/01/2013|12/31/9999|$2|584.37|0|0|||DECOMPRESS EYE SOCKET|| 58-1699775|1326041732|CHC13|61332||11/01/2013|12/31/9999|$2|888.98|0|0|||EXPLORE/BIOPSY EYE SOCKET|| 58-1699775|1326041732|CHC13|61333||11/01/2013|12/31/9999|$2|956.13|0|0|||EXPLORE ORBIT/REMOVE LESION|| 58-1699775|1326041732|CHC13|61340||11/01/2013|12/31/9999|$2|075.37|0|0|||SUBTEMPORAL DECOMPRESSION|| 58-1699775|1326041732|CHC13|61343||11/01/2013|12/31/9999|$3|162.55|0|0|||INCISE SKULL (PRESS RELIEF)|| 58-1699775|1326041732|CHC13|61345||11/01/2013|12/31/9999|$2|938.47|0|0|||RELIEVE CRANIAL PRESSURE|| 58-1699775|1326041732|CHC13|61450||11/01/2013|12/31/9999|$2|767.30|0|0|||INCISE SKULL FOR SURGERY|| 58-1699775|1326041732|CHC13|61458||11/01/2013|12/31/9999|$2|890.22|0|0|||INCISE SKULL FOR BRAIN WOUND|| 58-1699775|1326041732|CHC13|61460||11/01/2013|12/31/9999|$3|022.22|0|0|||INCISE SKULL FOR SURGERY|| 58-1699775|1326041732|CHC13|61470||11/01/2013|12/31/9999|$2|578.45|0|0|||INCISE SKULL FOR SURGERY|| 58-1699775|1326041732|CHC13|61480||11/01/2013|12/31/9999|$2|379.17|0|0|||INCISE SKULL FOR SURGERY|| 58-1699775|1326041732|CHC13|61500||11/01/2013|12/31/9999|$1|922.97|0|0|||REMOVAL OF SKULL LESION|| 58-1699775|1326041732|CHC13|61501||11/01/2013|12/31/9999|$1|662.16|0|0|||REMOVE INFECTED SKULL BONE|| 58-1699775|1326041732|CHC13|6150F||11/01/2013|12/31/9999|$0.00|0|0||||| 58-1699775|1326041732|CHC13|61510||11/01/2013|12/31/9999|$3|144.74|0|0|||REMOVAL OF BRAIN LESION|| 58-1699775|1326041732|CHC13|61512||11/01/2013|12/31/9999|$3|680.37|0|0|||REMOVE BRAIN LINING LESION|| 58-1699775|1326041732|CHC13|61514||11/01/2013|12/31/9999|$2|743.93|0|0|||REMOVAL OF BRAIN ABSCESS|| 58-1699775|1326041732|CHC13|61516||11/01/2013|12/31/9999|$2|672.40|0|0|||REMOVAL OF BRAIN LESION|| 58-1699775|1326041732|CHC13|61517||11/01/2013|12/31/9999|$126.69|0|0|||IMPLT BRAIN CHEMOTX ADD-ON|| 58-1699775|1326041732|CHC13|61518||11/01/2013|12/31/9999|$3|977.31|0|0|||REMOVAL OF BRAIN LESION|| 58-1699775|1326041732|CHC13|61519||11/01/2013|12/31/9999|$4|254.78|0|0|||REMOVE BRAIN LINING LESION|| 58-1699775|1326041732|CHC13|61520||11/01/2013|12/31/9999|$5|423.66|0|0|||REMOVAL OF BRAIN LESION|| 58-1699775|1326041732|CHC13|61521||11/01/2013|12/31/9999|$4|592.23|0|0|||REMOVAL OF BRAIN LESION|| 58-1699775|1326041732|CHC13|61522||11/01/2013|12/31/9999|$3|152.13|0|0|||REMOVAL OF BRAIN ABSCESS|| 58-1699775|1326041732|CHC13|61524||11/01/2013|12/31/9999|$2|995.93|0|0|||REMOVAL OF BRAIN LESION|| 58-1699775|1326041732|CHC13|61526||11/01/2013|12/31/9999|$5|249.72|0|0|||REMOVAL OF BRAIN LESION|| 58-1699775|1326041732|CHC13|61530||11/01/2013|12/31/9999|$4|351.58|0|0|||REMOVAL OF BRAIN LESION|| 58-1699775|1326041732|CHC13|61531||11/01/2013|12/31/9999|$1|752.83|0|0|||IMPLANT BRAIN ELECTRODES|| 58-1699775|1326041732|CHC13|61533||11/01/2013|12/31/9999|$2|190.85|0|0|||IMPLANT BRAIN ELECTRODES|| 58-1699775|1326041732|CHC13|61534||11/01/2013|12/31/9999|$2|365.31|0|0|||REMOVAL OF BRAIN LESION|| 58-1699775|1326041732|CHC13|61535||11/01/2013|12/31/9999|$1|431.46|0|0|||REMOVE BRAIN ELECTRODES|| 58-1699775|1326041732|CHC13|61536||11/01/2013|12/31/9999|$3|722.76|0|0|||REMOVAL OF BRAIN LESION|| 58-1699775|1326041732|CHC13|61537||11/01/2013|12/31/9999|$3|541.57|0|0|||REMOVAL OF BRAIN TISSUE|| 58-1699775|1326041732|CHC13|61538||11/01/2013|12/31/9999|$3|838.20|0|0|||REMOVAL OF BRAIN TISSUE|| 58-1699775|1326041732|CHC13|61539||11/01/2013|12/31/9999|$3|398.51|0|0|||REMOVAL OF BRAIN TISSUE|| 58-1699775|1326041732|CHC13|61540||11/01/2013|12/31/9999|$3|146.91|0|0|||REMOVAL OF BRAIN TISSUE|| 58-1699775|1326041732|CHC13|61541||11/01/2013|12/31/9999|$3|094.12|0|0|||INCISION OF BRAIN TISSUE|| 58-1699775|1326041732|CHC13|61543||11/01/2013|12/31/9999|$3|120.99|0|0|||REMOVAL OF BRAIN TISSUE|| 58-1699775|1326041732|CHC13|61544||11/01/2013|12/31/9999|$2|703.06|0|0|||REMOVE & TREAT BRAIN LESION|| 58-1699775|1326041732|CHC13|61545||11/01/2013|12/31/9999|$4|588.09|0|0|||EXCISION OF BRAIN TUMOR|| 58-1699775|1326041732|CHC13|61546||11/01/2013|12/31/9999|$3|323.06|0|0|||REMOVAL OF PITUITARY GLAND|| 58-1699775|1326041732|CHC13|61548||11/01/2013|12/31/9999|$2|248.30|0|0|||REMOVAL OF PITUITARY GLAND|| 58-1699775|1326041732|CHC13|61550||11/01/2013|12/31/9999|$1|462.46|0|0|||RELEASE OF SKULL SEAMS|| 58-1699775|1326041732|CHC13|61552||11/01/2013|12/31/9999|$1|841.09|0|0|||RELEASE OF SKULL SEAMS|| 58-1699775|1326041732|CHC13|61556||11/01/2013|12/31/9999|$2|441.70|0|0|||INCISE SKULL/SUTURES|| 58-1699775|1326041732|CHC13|61557||11/01/2013|12/31/9999|$2|419.77|0|0|||INCISE SKULL/SUTURES|| 58-1699775|1326041732|CHC13|61558||11/01/2013|12/31/9999|$2|702.67|0|0|||EXCISION OF SKULL/SUTURES|| 58-1699775|1326041732|CHC13|61559||11/01/2013|12/31/9999|$2|706.66|0|0|||EXCISION OF SKULL/SUTURES|| 58-1699775|1326041732|CHC13|61563||11/01/2013|12/31/9999|$2|852.77|0|0|||EXCISION OF SKULL TUMOR|| 58-1699775|1326041732|CHC13|61564||11/01/2013|12/31/9999|$3|469.00|0|0|||EXCISION OF SKULL TUMOR|| 58-1699775|1326041732|CHC13|61566||11/01/2013|12/31/9999|$3|243.09|0|0|||REMOVAL OF BRAIN TISSUE|| 58-1699775|1326041732|CHC13|61567||11/01/2013|12/31/9999|$3|700.31|0|0|||INCISION OF BRAIN TISSUE|| 58-1699775|1326041732|CHC13|61570||11/01/2013|12/31/9999|$2|682.09|0|0|||REMOVE FOREIGN BODY| BRAIN|| 58-1699775|1326041732|CHC13|61571||11/01/2013|12/31/9999|$2|865.01|0|0|||INCISE SKULL FOR BRAIN WOUND|| 58-1699775|1326041732|CHC13|61575||11/01/2013|12/31/9999|$3|596.87|0|0|||SKULL BASE/BRAINSTEM SURGERY|| 58-1699775|1326041732|CHC13|61576||11/01/2013|12/31/9999|$5|369.32|0|0|||SKULL BASE/BRAINSTEM SURGERY|| 58-1699775|1326041732|CHC13|61580||11/01/2013|12/31/9999|$3|563.20|0|0|||CRANIOFACIAL APPROACH| SKULL|| 58-1699775|1326041732|CHC13|61581||11/01/2013|12/31/9999|$3|894.52|0|0|||CRANIOFACIAL APPROACH| SKULL|| 58-1699775|1326041732|CHC13|61582||11/01/2013|12/31/9999|$4|332.38|0|0|||CRANIOFACIAL APPROACH| SKULL|| 58-1699775|1326041732|CHC13|61583||11/01/2013|12/31/9999|$4|160.09|0|0|||CRANIOFACIAL APPROACH| SKULL|| 58-1699775|1326041732|CHC13|61584||11/01/2013|12/31/9999|$4|096.41|0|0|||ORBITOCRANIAL APPROACH/SKULL|| 58-1699775|1326041732|CHC13|61585||11/01/2013|12/31/9999|$4|607.60|0|0|||ORBITOCRANIAL APPROACH/SKULL|| 58-1699775|1326041732|CHC13|61586||11/01/2013|12/31/9999|$3|440.99|0|0|||RESECT NASOPHARYNX| SKULL|| 58-1699775|1326041732|CHC13|61590||11/01/2013|12/31/9999|$4|429.23|0|0|||INFRATEMPORAL APPROACH/SKULL|| 58-1699775|1326041732|CHC13|61591||11/01/2013|12/31/9999|$4|488.65|0|0|||INFRATEMPORAL APPROACH/SKULL|| 58-1699775|1326041732|CHC13|61592||11/01/2013|12/31/9999|$4|554.06|0|0|||ORBITOCRANIAL APPROACH/SKULL|| 58-1699775|1326041732|CHC13|61595||11/01/2013|12/31/9999|$3|408.90|0|0|||TRANSTEMPORAL APPROACH/SKULL|| 58-1699775|1326041732|CHC13|61596||11/01/2013|12/31/9999|$3|598.10|0|0|||TRANSCOCHLEAR APPROACH/SKULL|| 58-1699775|1326041732|CHC13|61597||11/01/2013|12/31/9999|$4|185.35|0|0|||TRANSCONDYLAR APPROACH/SKULL|| 58-1699775|1326041732|CHC13|61598||11/01/2013|12/31/9999|$4|012.09|0|0|||TRANSPETROSAL APPROACH/SKULL|| 58-1699775|1326041732|CHC13|61600||11/01/2013|12/31/9999|$3|079.03|0|0|||RESECT/EXCISE CRANIAL LESION|| 58-1699775|1326041732|CHC13|61601||11/01/2013|12/31/9999|$3|437.59|0|0|||RESECT/EXCISE CRANIAL LESION|| 58-1699775|1326041732|CHC13|61605||11/01/2013|12/31/9999|$3|168.82|0|0|||RESECT/EXCISE CRANIAL LESION|| 58-1699775|1326041732|CHC13|61606||11/01/2013|12/31/9999|$4|316.34|0|0|||RESECT/EXCISE CRANIAL LESION|| 58-1699775|1326041732|CHC13|61607||11/01/2013|12/31/9999|$4|152.96|0|0|||RESECT/EXCISE CRANIAL LESION|| 58-1699775|1326041732|CHC13|61608||11/01/2013|12/31/9999|$4|667.23|0|0|||RESECT/EXCISE CRANIAL LESION|| 58-1699775|1326041732|CHC13|61610||11/01/2013|12/31/9999|$2|601.50|0|0|||TRANSECT ARTERY| SINUS|| 58-1699775|1326041732|CHC13|61611||11/01/2013|12/31/9999|$551.06|0|0|||TRANSECT ARTERY| SINUS|| 58-1699775|1326041732|CHC13|61612||11/01/2013|12/31/9999|$2|057.58|0|0|||TRANSECT ARTERY| SINUS|| 58-1699775|1326041732|CHC13|61613||11/01/2013|12/31/9999|$4|709.80|0|0|||REMOVE ANEURYSM| SINUS|| 58-1699775|1326041732|CHC13|61615||11/01/2013|12/31/9999|$3|323.41|0|0|||RESECT/EXCISE LESION| SKULL|| 58-1699775|1326041732|CHC13|61616||11/01/2013|12/31/9999|$4|779.28|0|0|||RESECT/EXCISE LESION| SKULL|| 58-1699775|1326041732|CHC13|61618||11/01/2013|12/31/9999|$1|873.62|0|0|||REPAIR DURA|| 58-1699775|1326041732|CHC13|61619||11/01/2013|12/31/9999|$2|138.92|0|0|||REPAIR DURA|| 58-1699775|1326041732|CHC13|61623||11/01/2013|12/31/9999|$807.03|0|0|||ENDOVASC TEMPORY VESSEL OCCL|| 58-1699775|1326041732|CHC13|61624||11/01/2013|12/31/9999|$1|601.55|0|0|||TRANSCATH OCCLUSION| CNS|| 58-1699775|1326041732|CHC13|61626||11/01/2013|12/31/9999|$1|244.65|0|0|||TRANSCATH OCCLUSION| NON-CNS|| 58-1699775|1326041732|CHC13|61630||11/01/2013|12/31/9999|$1|819.57|0|0|||INTRACRANIAL ANGIOPLASTY|| 58-1699775|1326041732|CHC13|61635||11/01/2013|12/31/9999|$1|993.22|0|0|||INTRACRAN ANGIOPLSTY W/STENT|| 58-1699775|1326041732|CHC13|61640||11/01/2013|12/31/9999|$900.85|0|0|||DILATE IC VASOSPASM| INIT|| 58-1699775|1326041732|CHC13|61641||11/01/2013|12/31/9999|$316.91|0|0|||DILATE IC VASOSPASM ADD-ON|| 58-1699775|1326041732|CHC13|61642||11/01/2013|12/31/9999|$633.35|0|0|||DILATE IC VASOSPASM ADD-ON|| 58-1699775|1326041732|CHC13|61645||04/01/2016|12/31/9999|$1|172.87|0|0|0||PERQ ART M-THROMBECT &/NFS|| 58-1699775|1326041732|CHC13|61650||04/01/2016|12/31/9999|$782.34|0|0|0||EVASC PRLNG ADMN RX AGNT 1ST|| 58-1699775|1326041732|CHC13|61651||04/01/2016|12/31/9999|$332.27|0|0|0||EVASC PRLNG ADMN RX AGNT ADD|| 58-1699775|1326041732|CHC13|61680||11/01/2013|12/31/9999|$3|259.26|0|0|||INTRACRANIAL VESSEL SURGERY|| 58-1699775|1326041732|CHC13|61682||11/01/2013|12/31/9999|$6|060.86|0|0|||INTRACRANIAL VESSEL SURGERY|| 58-1699775|1326041732|CHC13|61684||11/01/2013|12/31/9999|$4|095.15|0|0|||INTRACRANIAL VESSEL SURGERY|| 58-1699775|1326041732|CHC13|61686||11/01/2013|12/31/9999|$6|509.90|0|0|||INTRACRANIAL VESSEL SURGERY|| 58-1699775|1326041732|CHC13|61690||11/01/2013|12/31/9999|$3|146.87|0|0|||INTRACRANIAL VESSEL SURGERY|| 58-1699775|1326041732|CHC13|61692||11/01/2013|12/31/9999|$5|286.60|0|0|||INTRACRANIAL VESSEL SURGERY|| 58-1699775|1326041732|CHC13|61697||11/01/2013|12/31/9999|$6|094.83|0|0|||BRAIN ANEURYSM REPR| COMPLX|| 58-1699775|1326041732|CHC13|61698||11/01/2013|12/31/9999|$6|676.20|0|0|||BRAIN ANEURYSM REPR| COMPLX|| 58-1699775|1326041732|CHC13|61700||11/01/2013|12/31/9999|$4|940.33|0|0|||BRAIN ANEURYSM REPR| SIMPLE|| 58-1699775|1326041732|CHC13|61702||11/01/2013|12/31/9999|$5|800.74|0|0|||INNER SKULL VESSEL SURGERY|| 58-1699775|1326041732|CHC13|61703||11/01/2013|12/31/9999|$1|953.65|0|0|||CLAMP NECK ARTERY|| 58-1699775|1326041732|CHC13|61705||11/01/2013|12/31/9999|$3|742.84|0|0|||REVISE CIRCULATION TO HEAD|| 58-1699775|1326041732|CHC13|61708||11/01/2013|12/31/9999|$2|996.59|0|0|||REVISE CIRCULATION TO HEAD|| 58-1699775|1326041732|CHC13|61710||11/01/2013|12/31/9999|$2|861.04|0|0|||REVISE CIRCULATION TO HEAD|| 58-1699775|1326041732|CHC13|61711||11/01/2013|12/31/9999|$3|761.92|0|0|||FUSION OF SKULL ARTERIES|| 58-1699775|1326041732|CHC13|61720||11/01/2013|12/31/9999|$1|807.94|0|0|||INCISE SKULL/BRAIN SURGERY|| 58-1699775|1326041732|CHC13|61735||11/01/2013|12/31/9999|$2|262.01|0|0|||INCISE SKULL/BRAIN SURGERY|| 58-1699775|1326041732|CHC13|61750||11/01/2013|12/31/9999|$2|020.93|0|0|||INCISE SKULL/BRAIN BIOPSY|| 58-1699775|1326041732|CHC13|61751||11/01/2013|12/31/9999|$1|973.70|0|0|||BRAIN BIOPSY W/CT/MR GUIDE|| 58-1699775|1326041732|CHC13|61760||11/01/2013|12/31/9999|$2|262.70|0|0|||IMPLANT BRAIN ELECTRODES|| 58-1699775|1326041732|CHC13|61770||11/01/2013|12/31/9999|$2|316.62|0|0|||INCISE SKULL FOR TREATMENT|| 58-1699775|1326041732|CHC13|61781||11/01/2013|12/31/9999|$341.47|0|0|||SCAN PROC CRANIAL INTRA|| 58-1699775|1326041732|CHC13|61782||11/01/2013|12/31/9999|$280.61|0|0|||SCAN PROC CRANIAL EXTRA|| 58-1699775|1326041732|CHC13|61783||11/01/2013|12/31/9999|$341.47|0|0|||SCAN PROC SPINAL|| 58-1699775|1326041732|CHC13|61790||11/01/2013|12/31/9999|$1|245.87|0|0|||TREAT TRIGEMINAL NERVE|| 58-1699775|1326041732|CHC13|61791||11/01/2013|12/31/9999|$1|596.64|0|0|||TREAT TRIGEMINAL TRACT|| 58-1699775|1326041732|CHC13|61796||11/01/2013|12/31/9999|$1|420.71|0|0|||SRS| CRANIAL LESION SIMPLE|| 58-1699775|1326041732|CHC13|61797||11/01/2013|12/31/9999|$314.71|0|0|||SRS| CRAN LES SIMPLE| ADDL|| 58-1699775|1326041732|CHC13|61798||11/01/2013|12/31/9999|$1|921.30|0|0|||SRS| CRANIAL LESION COMPLEX|| 58-1699775|1326041732|CHC13|61799||11/01/2013|12/31/9999|$434.62|0|0|||SRS| CRAN LES COMPLEX| ADDL|| 58-1699775|1326041732|CHC13|61800||11/01/2013|12/31/9999|$218.70|0|0|||APPLY SRS HEADFRAME ADD-ON|| 58-1699775|1326041732|CHC13|61850||11/01/2013|12/31/9999|$1|410.56|0|0|||IMPLANT NEUROELECTRODES|| 58-1699775|1326041732|CHC13|61860||11/01/2013|12/31/9999|$2|253.25|0|0|||IMPLANT NEUROELECTRODES|| 58-1699775|1326041732|CHC13|61863||11/01/2013|12/31/9999|$2|160.37|0|0|||IMPLANT NEUROELECTRODE|| 58-1699775|1326041732|CHC13|61864||11/01/2013|12/31/9999|$413.73|0|0|||IMPLANT NEUROELECTRDE| ADDL|| 58-1699775|1326041732|CHC13|61867||11/01/2013|12/31/9999|$3|292.25|0|0|||IMPLANT NEUROELECTRODE|| 58-1699775|1326041732|CHC13|61868||11/01/2013|12/31/9999|$728.23|0|0|||IMPLANT NEUROELECTRDE| ADD'L|| 58-1699775|1326041732|CHC13|61870||11/01/2013|12/31/9999|$1|703.37|0|0|||IMPLANT NEUROELECTRODES|| 58-1699775|1326041732|CHC13|61880||11/01/2013|12/31/9999|$810.68|0|0|||REVISE/REMOVE NEUROELECTRODE|| 58-1699775|1326041732|CHC13|61885||11/01/2013|12/31/9999|$754.04|0|0|||INSRT/REDO NEUROSTIM 1 ARRAY|| 58-1699775|1326041732|CHC13|61886||11/01/2013|12/31/9999|$1|203.32|0|0|||IMPLANT NEUROSTIM ARRAYS|| 58-1699775|1326041732|CHC13|61888||11/01/2013|12/31/9999|$557.57|0|0|||REVISE/REMOVE NEURORECEIVER|| 58-1699775|1326041732|CHC13|62000||11/01/2013|12/31/9999|$1|282.37|0|0|||TREAT SKULL FRACTURE|| 58-1699775|1326041732|CHC13|62005||11/01/2013|12/31/9999|$1|821.29|0|0|||TREAT SKULL FRACTURE|| 58-1699775|1326041732|CHC13|62010||11/01/2013|12/31/9999|$2|198.03|0|0|||TREATMENT OF HEAD INJURY|| 58-1699775|1326041732|CHC13|62100||11/01/2013|12/31/9999|$2|313.69|0|0|||REPAIR BRAIN FLUID LEAKAGE|| 58-1699775|1326041732|CHC13|62115||11/01/2013|12/31/9999|$1|791.60|0|0|||REDUCTION OF SKULL DEFECT|| 58-1699775|1326041732|CHC13|62117||11/01/2013|12/31/9999|$2|309.05|0|0|||REDUCTION OF SKULL DEFECT|| 58-1699775|1326041732|CHC13|62120||11/01/2013|12/31/9999|$2|445.06|0|0|||REPAIR SKULL CAVITY LESION|| 58-1699775|1326041732|CHC13|62121||11/01/2013|12/31/9999|$2|416.32|0|0|||INCISE SKULL REPAIR|| 58-1699775|1326041732|CHC13|62140||11/01/2013|12/31/9999|$1|498.40|0|0|||REPAIR OF SKULL DEFECT|| 58-1699775|1326041732|CHC13|62141||11/01/2013|12/31/9999|$1|644.26|0|0|||REPAIR OF SKULL DEFECT|| 58-1699775|1326041732|CHC13|62142||11/01/2013|12/31/9999|$1|275.05|0|0|||REMOVE SKULL PLATE/FLAP|| 58-1699775|1326041732|CHC13|62143||11/01/2013|12/31/9999|$1|495.79|0|0|||REPLACE SKULL PLATE/FLAP|| 58-1699775|1326041732|CHC13|62145||11/01/2013|12/31/9999|$2|035.81|0|0|||REPAIR OF SKULL & BRAIN|| 58-1699775|1326041732|CHC13|62146||11/01/2013|12/31/9999|$1|788.11|0|0|||REPAIR OF SKULL WITH GRAFT|| 58-1699775|1326041732|CHC13|62147||11/01/2013|12/31/9999|$2|101.93|0|0|||REPAIR OF SKULL WITH GRAFT|| 58-1699775|1326041732|CHC13|62148||11/01/2013|12/31/9999|$183.44|0|0|||RETR BONE FLAP TO FIX SKULL|| 58-1699775|1326041732|CHC13|62160||11/01/2013|12/31/9999|$275.86|0|0|||NEUROENDOSCOPY ADD-ON|| 58-1699775|1326041732|CHC13|62161||11/01/2013|12/31/9999|$2|178.54|0|0|||DISSECT BRAIN W/SCOPE|| 58-1699775|1326041732|CHC13|62162||11/01/2013|12/31/9999|$2|722.73|0|0|||REMOVE COLLOID CYST W/SCOPE|| 58-1699775|1326041732|CHC13|62163||11/01/2013|12/31/9999|$1|758.54|0|0|||NEUROENDOSCOPY W/FB REMOVAL|| 58-1699775|1326041732|CHC13|62164||11/01/2013|12/31/9999|$2|996.02|0|0|||REMOVE BRAIN TUMOR W/SCOPE|| 58-1699775|1326041732|CHC13|62165||11/01/2013|12/31/9999|$2|240.23|0|0|||REMOVE PITUIT TUMOR W/SCOPE|| 58-1699775|1326041732|CHC13|62180||11/01/2013|12/31/9999|$2|303.70|0|0|||ESTABLISH BRAIN CAVITY SHUNT|| 58-1699775|1326041732|CHC13|62190||11/01/2013|12/31/9999|$1|322.66|0|0|||ESTABLISH BRAIN CAVITY SHUNT|| 58-1699775|1326041732|CHC13|62192||11/01/2013|12/31/9999|$1|401.18|0|0|||ESTABLISH BRAIN CAVITY SHUNT|| 58-1699775|1326041732|CHC13|62194||11/01/2013|12/31/9999|$594.73|0|0|||REPLACE/IRRIGATE CATHETER|| 58-1699775|1326041732|CHC13|62200||11/01/2013|12/31/9999|$1|979.40|0|0|||ESTABLISH BRAIN CAVITY SHUNT|| 58-1699775|1326041732|CHC13|62201||11/01/2013|12/31/9999|$1|723.60|0|0|||BRAIN CAVITY SHUNT W/SCOPE|| 58-1699775|1326041732|CHC13|62220||11/01/2013|12/31/9999|$1|467.29|0|0|||ESTABLISH BRAIN CAVITY SHUNT|| 58-1699775|1326041732|CHC13|62223||11/01/2013|12/31/9999|$1|513.83|0|0|||ESTABLISH BRAIN CAVITY SHUNT|| 58-1699775|1326041732|CHC13|62225||11/01/2013|12/31/9999|$742.59|0|0|||REPLACE/IRRIGATE CATHETER|| 58-1699775|1326041732|CHC13|62230||11/01/2013|12/31/9999|$1|209.07|0|0|||REPLACE/REVISE BRAIN SHUNT|| 58-1699775|1326041732|CHC13|62252||11/01/2013|12/31/9999|$126.19|0|0|||CSF SHUNT REPROGRAM|| 58-1699775|1326041732|CHC13|62252|26|11/01/2013|12/31/9999|$73.23|0|0|||CSF SHUNT REPROGRAM|| 58-1699775|1326041732|CHC13|62252|TC|11/01/2013|12/31/9999|$65.58|0|0|||CSF SHUNT REPROGRAM|| 58-1699775|1326041732|CHC13|62256||11/01/2013|12/31/9999|$854.44|0|0|||REMOVE BRAIN CAVITY SHUNT|| 58-1699775|1326041732|CHC13|62258||11/01/2013|12/31/9999|$1|617.90|0|0|||REPLACE BRAIN CAVITY SHUNT|| 58-1699775|1326041732|CHC13|62263||11/01/2013|12/31/9999|$485.60|0|0|||EPIDURAL LYSIS MULT SESSIONS|| 58-1699775|1326041732|CHC13|62264||11/01/2013|12/31/9999|$345.41|0|0|||EPIDURAL LYSIS ON SINGLE DAY|| 58-1699775|1326041732|CHC13|62267||11/01/2013|12/31/9999|$228.82|0|0|||INTERDISCAL PERQ ASPIR| DX|| 58-1699775|1326041732|CHC13|62268||11/01/2013|12/31/9999|$375.61|0|0|||DRAIN SPINAL CORD CYST|| 58-1699775|1326041732|CHC13|62269||11/01/2013|12/31/9999|$383.65|0|0|||NEEDLE BIOPSY| SPINAL CORD|| 58-1699775|1326041732|CHC13|62270||11/01/2013|12/31/9999|$112.94|0|0|||SPINAL FLUID TAP| DIAGNOSTIC|| 58-1699775|1326041732|CHC13|62272||11/01/2013|12/31/9999|$122.16|0|0|||DRAIN CEREBRO SPINAL FLUID|| 58-1699775|1326041732|CHC13|62273||11/01/2013|12/31/9999|$164.18|0|0|||INJECT EPIDURAL PATCH|| 58-1699775|1326041732|CHC13|62280||11/01/2013|12/31/9999|$240.50|0|0|||TREAT SPINAL CORD LESION|| 58-1699775|1326041732|CHC13|62281||11/01/2013|12/31/9999|$220.13|0|0|||TREAT SPINAL CORD LESION|| 58-1699775|1326041732|CHC13|62282||11/01/2013|12/31/9999|$204.23|0|0|||TREAT SPINAL CANAL LESION|| 58-1699775|1326041732|CHC13|62284||11/01/2013|12/31/9999|$123.83|0|0|||INJECTION FOR MYELOGRAM|| 58-1699775|1326041732|CHC13|62287||11/01/2013|12/31/9999|$802.95|0|0|||PERCUTANEOUS DISKECTOMY|| 58-1699775|1326041732|CHC13|62290||11/01/2013|12/31/9999|$248.99|0|0|||INJECT FOR SPINE DISK X-RAY|| 58-1699775|1326041732|CHC13|62291||11/01/2013|12/31/9999|$239.77|0|0|||INJECT FOR SPINE DISK X-RAY|| 58-1699775|1326041732|CHC13|62292||11/01/2013|12/31/9999|$820.44|0|0|||INJECTION INTO DISK LESION|| 58-1699775|1326041732|CHC13|62294||11/01/2013|12/31/9999|$1|160.70|0|0|||INJECTION INTO SPINAL ARTERY|| 58-1699775|1326041732|CHC13|62302||04/01/2015|12/31/9999|$186.89|0|0|0||MYELOGRAPHY LUMBAR INJECTION|| 58-1699775|1326041732|CHC13|62303||04/01/2015|12/31/9999|$189.30|0|0|0||MYELOGRAPHY LUMBAR INJECTION|| 58-1699775|1326041732|CHC13|62304||04/01/2015|12/31/9999|$183.77|0|0|0||MYELOGRAPHY LUMBAR INJECTION|| 58-1699775|1326041732|CHC13|62305||04/01/2015|12/31/9999|$192.53|0|0|0||MYELOGRAPHY LUMBAR INJECTION|| 58-1699775|1326041732|CHC13|62320||04/01/2017|12/31/9999|$255.71|0|158.27|0||NJX INTERLAMINAR CRV/THRC|| 58-1699775|1326041732|CHC13|62321||04/01/2017|12/31/9999|$380.06|0|170.65|0||NJX INTERLAMINAR CRV/THRC|| 58-1699775|1326041732|CHC13|62322||04/01/2017|12/31/9999|$238.48|0|136.2|0||NJX INTERLAMINAR LMBR/SAC|| 58-1699775|1326041732|CHC13|62323||04/01/2017|12/31/9999|$373.06|0|155.58|0||NJX INTERLAMINAR LMBR/SAC|| 58-1699775|1326041732|CHC13|62324||04/01/2017|12/31/9999|$223.41|0|144.27|0||NJX INTERLAMINAR CRV/THRC|| 58-1699775|1326041732|CHC13|62325||04/01/2017|12/31/9999|$336.99|0|165.81|0||NJX INTERLAMINAR CRV/THRC|| 58-1699775|1326041732|CHC13|62326||04/01/2017|12/31/9999|$234.71|0|141.58|0||NJX INTERLAMINAR LMBR/SAC|| 58-1699775|1326041732|CHC13|62327||04/01/2017|12/31/9999|$343.45|0|150.73|0||NJX INTERLAMINAR LMBR/SAC|| 58-1699775|1326041732|CHC13|62350||11/01/2013|12/31/9999|$570.92|0|0|||IMPLANT SPINAL CANAL CATH|| 58-1699775|1326041732|CHC13|62351||11/01/2013|12/31/9999|$1|247.89|0|0|||IMPLANT SPINAL CANAL CATH|| 58-1699775|1326041732|CHC13|62355||11/01/2013|12/31/9999|$371.07|0|0|||REMOVE SPINAL CANAL CATHETER|| 58-1699775|1326041732|CHC13|62360||11/01/2013|12/31/9999|$440.65|0|0|||INSERT SPINE INFUSION DEVICE|| 58-1699775|1326041732|CHC13|62361||11/01/2013|12/31/9999|$499.31|0|0|||IMPLANT SPINE INFUSION PUMP|| 58-1699775|1326041732|CHC13|62362||11/01/2013|12/31/9999|$555.39|0|0|||IMPLANT SPINE INFUSION PUMP|| 58-1699775|1326041732|CHC13|62365||11/01/2013|12/31/9999|$418.19|0|0|||REMOVE SPINE INFUSION DEVICE|| 58-1699775|1326041732|CHC13|62367||11/01/2013|12/31/9999|$36.05|0|0|||ANALYZE SPINE INFUSION PUMP|| 58-1699775|1326041732|CHC13|62368||11/01/2013|12/31/9999|$49.40|0|0|||ANALYZE SPINE INFUSION PUMP|| 58-1699775|1326041732|CHC13|62369||11/01/2013|12/31/9999|$50.77|0|0|||ANAL SP INF PMP W/REPRG&FILL|| 58-1699775|1326041732|CHC13|62370||11/01/2013|12/31/9999|$68.05|0|0|||ANL SP INF PMP W/MDREPRG&FIL|| 58-1699775|1326041732|CHC13|63001||11/01/2013|12/31/9999|$1|777.57|0|0|||REMOVAL OF SPINAL LAMINA|| 58-1699775|1326041732|CHC13|63003||11/01/2013|12/31/9999|$1|780.44|0|0|||REMOVAL OF SPINAL LAMINA|| 58-1699775|1326041732|CHC13|63005||11/01/2013|12/31/9999|$1|690.25|0|0|||REMOVAL OF SPINAL LAMINA|| 58-1699775|1326041732|CHC13|63011||11/01/2013|12/31/9999|$1|557.99|0|0|||REMOVAL OF SPINAL LAMINA|| 58-1699775|1326041732|CHC13|63012||11/01/2013|12/31/9999|$1|711.73|0|0|||REMOVAL OF SPINAL LAMINA|| 58-1699775|1326041732|CHC13|63015||11/01/2013|12/31/9999|$2|133.45|0|0|||REMOVAL OF SPINAL LAMINA|| 58-1699775|1326041732|CHC13|63016||11/01/2013|12/31/9999|$2|180.51|0|0|||REMOVAL OF SPINAL LAMINA|| 58-1699775|1326041732|CHC13|63017||11/01/2013|12/31/9999|$1|792.89|0|0|||REMOVAL OF SPINAL LAMINA|| 58-1699775|1326041732|CHC13|63020||11/01/2013|12/31/9999|$1|678.94|0|0|||NECK SPINE DISK SURGERY|| 58-1699775|1326041732|CHC13|63030||11/01/2013|12/31/9999|$1|387.21|0|0|||LOW BACK DISK SURGERY|| 58-1699775|1326041732|CHC13|63035||11/01/2013|12/31/9999|$279.55|0|0|||SPINAL DISK SURGERY ADD-ON|| 58-1699775|1326041732|CHC13|63040||11/01/2013|12/31/9999|$2|023.59|0|0|||LAMINOTOMY| SINGLE CERVICAL|| 58-1699775|1326041732|CHC13|63042||11/01/2013|12/31/9999|$1|869.92|0|0|||LAMINOTOMY| SINGLE LUMBAR|| 58-1699775|1326041732|CHC13|63043||11/01/2013|12/31/9999|$848.28|0|0|||LAMINOTOMY| ADD'L CERVICAL|| 58-1699775|1326041732|CHC13|63044||11/01/2013|12/31/9999|$805.17|0|0|||LAMINOTOMY| ADD'L LUMBAR|| 58-1699775|1326041732|CHC13|63045||11/01/2013|12/31/9999|$1|830.29|0|0|||REMOVAL OF SPINAL LAMINA|| 58-1699775|1326041732|CHC13|63046||11/01/2013|12/31/9999|$1|739.55|0|0|||REMOVAL OF SPINAL LAMINA|| 58-1699775|1326041732|CHC13|63047||11/01/2013|12/31/9999|$1|581.92|0|0|||REMOVAL OF SPINAL LAMINA|| 58-1699775|1326041732|CHC13|63048||11/01/2013|12/31/9999|$309.38|0|0|||REMOVE SPINAL LAMINA ADD-ON|| 58-1699775|1326041732|CHC13|63050||11/01/2013|12/31/9999|$2|232.57|0|0|||CERVICAL LAMINOPLASTY|| 58-1699775|1326041732|CHC13|63051||11/01/2013|12/31/9999|$2|467.55|0|0|||C-LAMINOPLASTY W/GRAFT/PLATE|| 58-1699775|1326041732|CHC13|63055||11/01/2013|12/31/9999|$2|341.07|0|0|||DECOMPRESS SPINAL CORD|| 58-1699775|1326041732|CHC13|63056||11/01/2013|12/31/9999|$2|131.49|0|0|||DECOMPRESS SPINAL CORD|| 58-1699775|1326041732|CHC13|63057||11/01/2013|12/31/9999|$467.97|0|0|||DECOMPRESS SPINE CORD ADD-ON|| 58-1699775|1326041732|CHC13|63064||11/01/2013|12/31/9999|$2|548.90|0|0|||DECOMPRESS SPINAL CORD|| 58-1699775|1326041732|CHC13|63066||11/01/2013|12/31/9999|$300.74|0|0|||DECOMPRESS SPINE CORD ADD-ON|| 58-1699775|1326041732|CHC13|63075||11/01/2013|12/31/9999|$1|978.85|0|0|||NECK SPINE DISK SURGERY|| 58-1699775|1326041732|CHC13|63076||11/01/2013|12/31/9999|$363.61|0|0|||NECK SPINE DISK SURGERY|| 58-1699775|1326041732|CHC13|63077||11/01/2013|12/31/9999|$2|156.03|0|0|||SPINE DISK SURGERY| THORAX|| 58-1699775|1326041732|CHC13|63078||11/01/2013|12/31/9999|$281.86|0|0|||SPINE DISK SURGERY| THORAX|| 58-1699775|1326041732|CHC13|63081||11/01/2013|12/31/9999|$2|550.93|0|0|||REMOVAL OF VERTEBRAL BODY|| 58-1699775|1326041732|CHC13|63082||11/01/2013|12/31/9999|$391.04|0|0|||REMOVE VERTEBRAL BODY ADD-ON|| 58-1699775|1326041732|CHC13|63085||11/01/2013|12/31/9999|$2|736.81|0|0|||REMOVAL OF VERTEBRAL BODY|| 58-1699775|1326041732|CHC13|63086||11/01/2013|12/31/9999|$278.82|0|0|||REMOVE VERTEBRAL BODY ADD-ON|| 58-1699775|1326041732|CHC13|63087||11/01/2013|12/31/9999|$3|445.43|0|0|||REMOVAL OF VERTEBRAL BODY|| 58-1699775|1326041732|CHC13|63088||11/01/2013|12/31/9999|$374.86|0|0|||REMOVE VERTEBRAL BODY ADD-ON|| 58-1699775|1326041732|CHC13|63090||11/01/2013|12/31/9999|$2|832.70|0|0|||REMOVAL OF VERTEBRAL BODY|| 58-1699775|1326041732|CHC13|63091||11/01/2013|12/31/9999|$259.36|0|0|||REMOVE VERTEBRAL BODY ADD-ON|| 58-1699775|1326041732|CHC13|63101||11/01/2013|12/31/9999|$3|343.21|0|0|||REMOVAL OF VERTEBRAL BODY|| 58-1699775|1326041732|CHC13|63102||11/01/2013|12/31/9999|$3|226.40|0|0|||REMOVAL OF VERTEBRAL BODY|| 58-1699775|1326041732|CHC13|63103||11/01/2013|12/31/9999|$424.13|0|0|||REMOVE VERTEBRAL BODY ADD-ON|| 58-1699775|1326041732|CHC13|63170||11/01/2013|12/31/9999|$2|281.86|0|0|||INCISE SPINAL CORD TRACT(S)|| 58-1699775|1326041732|CHC13|63172||11/01/2013|12/31/9999|$2|024.72|0|0|||DRAINAGE OF SPINAL CYST|| 58-1699775|1326041732|CHC13|63173||11/01/2013|12/31/9999|$2|484.24|0|0|||DRAINAGE OF SPINAL CYST|| 58-1699775|1326041732|CHC13|63180||11/01/2013|12/31/9999|$2|118.11|0|0|||REVISE SPINAL CORD LIGAMENTS|| 58-1699775|1326041732|CHC13|63182||11/01/2013|12/31/9999|$2|305.53|0|0|||REVISE SPINAL CORD LIGAMENTS|| 58-1699775|1326041732|CHC13|63185||11/01/2013|12/31/9999|$1|704.69|0|0|||INCISE SPINAL COLUMN/NERVES|| 58-1699775|1326041732|CHC13|63190||11/01/2013|12/31/9999|$1|816.48|0|0|||INCISE SPINAL COLUMN/NERVES|| 58-1699775|1326041732|CHC13|63191||11/01/2013|12/31/9999|$1|778.65|0|0|||INCISE SPINAL COLUMN/NERVES|| 58-1699775|1326041732|CHC13|63194||11/01/2013|12/31/9999|$1|834.64|0|0|||INCISE SPINAL COLUMN & CORD|| 58-1699775|1326041732|CHC13|63195||11/01/2013|12/31/9999|$2|205.21|0|0|||INCISE SPINAL COLUMN & CORD|| 58-1699775|1326041732|CHC13|63196||11/01/2013|12/31/9999|$2|011.40|0|0|||INCISE SPINAL COLUMN & CORD|| 58-1699775|1326041732|CHC13|63197||11/01/2013|12/31/9999|$2|460.90|0|0|||INCISE SPINAL COLUMN & CORD|| 58-1699775|1326041732|CHC13|63198||11/01/2013|12/31/9999|$2|300.09|0|0|||INCISE SPINAL COLUMN & CORD|| 58-1699775|1326041732|CHC13|63199||11/01/2013|12/31/9999|$2|715.11|0|0|||INCISE SPINAL COLUMN & CORD|| 58-1699775|1326041732|CHC13|63200||11/01/2013|12/31/9999|$2|196.08|0|0|||RELEASE OF SPINAL CORD|| 58-1699775|1326041732|CHC13|63250||11/01/2013|12/31/9999|$4|279.42|0|0|||REVISE SPINAL CORD VESSELS|| 58-1699775|1326041732|CHC13|63251||11/01/2013|12/31/9999|$4|377.90|0|0|||REVISE SPINAL CORD VESSELS|| 58-1699775|1326041732|CHC13|63252||11/01/2013|12/31/9999|$4|376.02|0|0|||REVISE SPINAL CORD VESSELS|| 58-1699775|1326041732|CHC13|63265||11/01/2013|12/31/9999|$2|402.72|0|0|||EXCISE INTRASPINAL LESION|| 58-1699775|1326041732|CHC13|63266||11/01/2013|12/31/9999|$2|477.38|0|0|||EXCISE INTRASPINAL LESION|| 58-1699775|1326041732|CHC13|63267||11/01/2013|12/31/9999|$1|981.05|0|0|||EXCISE INTRASPINAL LESION|| 58-1699775|1326041732|CHC13|63268||11/01/2013|12/31/9999|$2|083.55|0|0|||EXCISE INTRASPINAL LESION|| 58-1699775|1326041732|CHC13|63270||11/01/2013|12/31/9999|$2|988.08|0|0|||EXCISE INTRASPINAL LESION|| 58-1699775|1326041732|CHC13|63271||11/01/2013|12/31/9999|$2|981.61|0|0|||EXCISE INTRASPINAL LESION|| 58-1699775|1326041732|CHC13|63272||11/01/2013|12/31/9999|$2|743.58|0|0|||EXCISE INTRASPINAL LESION|| 58-1699775|1326041732|CHC13|63273||11/01/2013|12/31/9999|$2|669.49|0|0|||EXCISE INTRASPINAL LESION|| 58-1699775|1326041732|CHC13|63275||11/01/2013|12/31/9999|$2|588.71|0|0|||BIOPSY/EXCISE SPINAL TUMOR|| 58-1699775|1326041732|CHC13|63276||11/01/2013|12/31/9999|$2|569.77|0|0|||BIOPSY/EXCISE SPINAL TUMOR|| 58-1699775|1326041732|CHC13|63277||11/01/2013|12/31/9999|$2|234.99|0|0|||BIOPSY/EXCISE SPINAL TUMOR|| 58-1699775|1326041732|CHC13|63278||11/01/2013|12/31/9999|$2|277.22|0|0|||BIOPSY/EXCISE SPINAL TUMOR|| 58-1699775|1326041732|CHC13|63280||11/01/2013|12/31/9999|$3|042.16|0|0|||BIOPSY/EXCISE SPINAL TUMOR|| 58-1699775|1326041732|CHC13|63281||11/01/2013|12/31/9999|$3|018.35|0|0|||BIOPSY/EXCISE SPINAL TUMOR|| 58-1699775|1326041732|CHC13|63282||11/01/2013|12/31/9999|$2|839.86|0|0|||BIOPSY/EXCISE SPINAL TUMOR|| 58-1699775|1326041732|CHC13|63283||11/01/2013|12/31/9999|$2|729.38|0|0|||BIOPSY/EXCISE SPINAL TUMOR|| 58-1699775|1326041732|CHC13|63285||11/01/2013|12/31/9999|$3|765.93|0|0|||BIOPSY/EXCISE SPINAL TUMOR|| 58-1699775|1326041732|CHC13|63286||11/01/2013|12/31/9999|$3|698.34|0|0|||BIOPSY/EXCISE SPINAL TUMOR|| 58-1699775|1326041732|CHC13|63287||11/01/2013|12/31/9999|$3|956.44|0|0|||BIOPSY/EXCISE SPINAL TUMOR|| 58-1699775|1326041732|CHC13|63290||11/01/2013|12/31/9999|$4|024.43|0|0|||BIOPSY/EXCISE SPINAL TUMOR|| 58-1699775|1326041732|CHC13|63295||11/01/2013|12/31/9999|$481.83|0|0|||REPAIR OF LAMINECTOMY DEFECT|| 58-1699775|1326041732|CHC13|63300||11/01/2013|12/31/9999|$2|645.20|0|0|||REMOVAL OF VERTEBRAL BODY|| 58-1699775|1326041732|CHC13|63301||11/01/2013|12/31/9999|$3|153.69|0|0|||REMOVAL OF VERTEBRAL BODY|| 58-1699775|1326041732|CHC13|63302||11/01/2013|12/31/9999|$3|116.39|0|0|||REMOVAL OF VERTEBRAL BODY|| 58-1699775|1326041732|CHC13|63303||11/01/2013|12/31/9999|$3|201.73|0|0|||REMOVAL OF VERTEBRAL BODY|| 58-1699775|1326041732|CHC13|63304||11/01/2013|12/31/9999|$3|380.44|0|0|||REMOVAL OF VERTEBRAL BODY|| 58-1699775|1326041732|CHC13|63305||11/01/2013|12/31/9999|$3|576.24|0|0|||REMOVAL OF VERTEBRAL BODY|| 58-1699775|1326041732|CHC13|63306||11/01/2013|12/31/9999|$3|199.99|0|0|||REMOVAL OF VERTEBRAL BODY|| 58-1699775|1326041732|CHC13|63307||11/01/2013|12/31/9999|$3|459.76|0|0|||REMOVAL OF VERTEBRAL BODY|| 58-1699775|1326041732|CHC13|63308||11/01/2013|12/31/9999|$466.17|0|0|||REMOVE VERTEBRAL BODY ADD-ON|| 58-1699775|1326041732|CHC13|63600||11/01/2013|12/31/9999|$1|327.79|0|0|||REMOVE SPINAL CORD LESION|| 58-1699775|1326041732|CHC13|63610||11/01/2013|12/31/9999|$631.94|0|0|||STIMULATION OF SPINAL CORD|| 58-1699775|1326041732|CHC13|63615||11/01/2013|12/31/9999|$1|765.39|0|0|||REMOVE LESION OF SPINAL CORD|| 58-1699775|1326041732|CHC13|63620||11/01/2013|12/31/9999|$1|561.39|0|0|||SRS| SPINAL LESION|| 58-1699775|1326041732|CHC13|63621||11/01/2013|12/31/9999|$361.22|0|0|||SRS| SPINAL LESION| ADDL|| 58-1699775|1326041732|CHC13|63650||11/01/2013|12/31/9999|$613.62|0|0|||IMPLANT NEUROELECTRODES|| 58-1699775|1326041732|CHC13|63655||11/01/2013|12/31/9999|$1|184.94|0|0|||IMPLANT NEUROELECTRODES|| 58-1699775|1326041732|CHC13|63661||11/01/2013|12/31/9999|$465.86|0|0|||REMOVE SPINE ELTRD PERQ ARAY|| 58-1699775|1326041732|CHC13|63662||11/01/2013|12/31/9999|$1|119.68|0|0|||REMOVE SPINE ELTRD PLATE|| 58-1699775|1326041732|CHC13|63663||11/01/2013|12/31/9999|$681.62|0|0|||REVISE SPINE ELTRD PERQ ARAY|| 58-1699775|1326041732|CHC13|63664||11/01/2013|12/31/9999|$1|147.70|0|0|||REVISE SPINE ELTRD PLATE|| 58-1699775|1326041732|CHC13|63685||11/01/2013|12/31/9999|$517.67|0|0|||INSRT/REDO SPINE N GENERATOR|| 58-1699775|1326041732|CHC13|63688||11/01/2013|12/31/9999|$525.23|0|0|||REVISE/REMOVE NEURORECEIVER|| 58-1699775|1326041732|CHC13|63700||11/01/2013|12/31/9999|$1|852.44|0|0|||REPAIR OF SPINAL HERNIATION|| 58-1699775|1326041732|CHC13|63702||11/01/2013|12/31/9999|$2|040.15|0|0|||REPAIR OF SPINAL HERNIATION|| 58-1699775|1326041732|CHC13|63704||11/01/2013|12/31/9999|$2|346.37|0|0|||REPAIR OF SPINAL HERNIATION|| 58-1699775|1326041732|CHC13|63706||11/01/2013|12/31/9999|$2|630.07|0|0|||REPAIR OF SPINAL HERNIATION|| 58-1699775|1326041732|CHC13|63707||11/01/2013|12/31/9999|$1|307.32|0|0|||REPAIR SPINAL FLUID LEAKAGE|| 58-1699775|1326041732|CHC13|63709||11/01/2013|12/31/9999|$1|579.39|0|0|||REPAIR SPINAL FLUID LEAKAGE|| 58-1699775|1326041732|CHC13|63710||11/01/2013|12/31/9999|$1|586.89|0|0|||GRAFT REPAIR OF SPINE DEFECT|| 58-1699775|1326041732|CHC13|63740||11/01/2013|12/31/9999|$1|355.14|0|0|||INSTALL SPINAL SHUNT|| 58-1699775|1326041732|CHC13|63741||11/01/2013|12/31/9999|$905.47|0|0|||INSTALL SPINAL SHUNT|| 58-1699775|1326041732|CHC13|63744||11/01/2013|12/31/9999|$965.47|0|0|||REVISION OF SPINAL SHUNT|| 58-1699775|1326041732|CHC13|63746||11/01/2013|12/31/9999|$850.51|0|0|||REMOVAL OF SPINAL SHUNT|| 58-1699775|1326041732|CHC13|64400||11/01/2013|12/31/9999|$97.75|0|0|||N BLOCK INJ| TRIGEMINAL|| 58-1699775|1326041732|CHC13|64402||11/01/2013|12/31/9999|$107.65|0|0|||N BLOCK INJ| FACIAL|| 58-1699775|1326041732|CHC13|64405||11/01/2013|12/31/9999|$135.85|0|0|||N BLOCK INJ| OCCIPITAL|| 58-1699775|1326041732|CHC13|64408||11/01/2013|12/31/9999|$113.50|0|0|||N BLOCK INJ| VAGUS|| 58-1699775|1326041732|CHC13|64410||11/01/2013|12/31/9999|$125.78|0|0|||N BLOCK INJ| PHRENIC|| 58-1699775|1326041732|CHC13|64413||11/01/2013|12/31/9999|$115.80|0|0|||N BLOCK INJ| CERVICAL PLEXUS|| 58-1699775|1326041732|CHC13|64415||11/01/2013|12/31/9999|$97.74|0|0|||N BLOCK INJ| BRACHIAL PLEXUS|| 58-1699775|1326041732|CHC13|64416||11/01/2013|12/31/9999|$118.76|0|0|||N BLOCK CONT INFUSE| B PLEX|| 58-1699775|1326041732|CHC13|64417||11/01/2013|12/31/9999|$103.49|0|0|||N BLOCK INJ| AXILLARY|| 58-1699775|1326041732|CHC13|64418||11/01/2013|12/31/9999|$107.01|0|0|||N BLOCK INJ| SUPRASCAPULAR|| 58-1699775|1326041732|CHC13|64420||11/01/2013|12/31/9999|$98.03|0|0|||N BLOCK INJ| INTERCOST| SNG|| 58-1699775|1326041732|CHC13|64421||11/01/2013|12/31/9999|$136.06|0|0|||N BLOCK INJ| INTERCOST| MLT|| 58-1699775|1326041732|CHC13|64425||11/01/2013|12/31/9999|$137.80|0|0|||N BLOCK INJ| ILIO-ING/HYPOGI|| 58-1699775|1326041732|CHC13|64430||11/01/2013|12/31/9999|$119.23|0|0|||N BLOCK INJ| PUDENDAL|| 58-1699775|1326041732|CHC13|64435||11/01/2013|12/31/9999|$121.17|0|0|||N BLOCK INJ| PARACERVICAL|| 58-1699775|1326041732|CHC13|64445||11/01/2013|12/31/9999|$107.90|0|0|||N BLOCK INJ| SCIATIC| SNG|| 58-1699775|1326041732|CHC13|64446||11/01/2013|12/31/9999|$119.68|0|0|||N BLK INJ| SCIATIC| CONT INF|| 58-1699775|1326041732|CHC13|64447||11/01/2013|12/31/9999|$97.38|0|0|||N BLOCK INJ FEM| SINGLE|| 58-1699775|1326041732|CHC13|64448||11/01/2013|12/31/9999|$106.79|0|0|||N BLOCK INJ FEM| CONT INF|| 58-1699775|1326041732|CHC13|64449||11/01/2013|12/31/9999|$123.35|0|0|||N BLOCK INJ| LUMBAR PLEXUS|| 58-1699775|1326041732|CHC13|64450||11/01/2013|12/31/9999|$148.91|0|0|||N BLOCK| OTHER PERIPHERAL|| 58-1699775|1326041732|CHC13|64455||11/01/2013|12/31/9999|$52.63|0|0|||N BLOCK INJ| PLANTAR DIGIT|| 58-1699775|1326041732|CHC13|64461||04/01/2016|12/31/9999|$129.76|0|0|0||PVB THORACIC SINGLE INJ SITE|| 58-1699775|1326041732|CHC13|64462||04/01/2016|12/31/9999|$81.80|0|0|0||PVB THORACIC 2ND+ INJ SITE|| 58-1699775|1326041732|CHC13|64463||04/01/2016|12/31/9999|$126.22|0|0|0||PVB THORACIC CONT INFUSION|| 58-1699775|1326041732|CHC13|64479||11/01/2013|12/31/9999|$192.98|0|0|||INJ FORAMEN EPIDURAL C/T|| 58-1699775|1326041732|CHC13|64480||11/01/2013|12/31/9999|$96.39|0|0|||INJ FORAMEN EPIDURAL ADD-ON|| 58-1699775|1326041732|CHC13|64483||11/01/2013|12/31/9999|$336.12|0|0|||INJ FORAMEN EPIDURAL L/S|| 58-1699775|1326041732|CHC13|64484||11/01/2013|12/31/9999|$76.40|0|0|||INJ FORAMEN EPIDURAL ADD-ON|| 58-1699775|1326041732|CHC13|64486||04/01/2015|12/31/9999|$94.36|0|0|0||TAP BLOCK UNIL BY INJECTION|| 58-1699775|1326041732|CHC13|64487||04/01/2015|12/31/9999|$108.54|0|0|0||TAP BLOCK UNI BY INFUSION|| 58-1699775|1326041732|CHC13|64488||04/01/2015|12/31/9999|$118.37|0|0|0||TAP BLOCK BI INJECTION|| 58-1699775|1326041732|CHC13|64489||04/01/2015|12/31/9999|$132.99|0|0|0||TAP BLOCK BI BY INFUSION|| 58-1699775|1326041732|CHC13|64490||11/01/2013|12/31/9999|$159.25|0|0|||INJ PARAVERT F JNT C/T 1 LEV|| 58-1699775|1326041732|CHC13|64491||11/01/2013|12/31/9999|$89.65|0|0|||INJ PARAVERT F JNT C/T 2 LEV|| 58-1699775|1326041732|CHC13|64492||11/01/2013|12/31/9999|$90.57|0|0|||INJ PARAVERT F JNT C/T 3 LEV|| 58-1699775|1326041732|CHC13|64493||11/01/2013|12/31/9999|$133.76|0|0|||INJ PARAVERT F JNT L/S 1 LEV|| 58-1699775|1326041732|CHC13|64494||11/01/2013|12/31/9999|$75.94|0|0|||INJ PARAVERT F JNT L/S 2 LEV|| 58-1699775|1326041732|CHC13|64495||11/01/2013|12/31/9999|$77.31|0|0|||INJ PARAVERT F JNT L/S 3 LEV|| 58-1699775|1326041732|CHC13|64505||11/01/2013|12/31/9999|$120.02|0|0|||N BLOCK| SPENOPALATINE GANGL|| 58-1699775|1326041732|CHC13|64508||11/01/2013|12/31/9999|$109.82|0|0|||N BLOCK| CAROTID SINUS S/P|| 58-1699775|1326041732|CHC13|64510||11/01/2013|12/31/9999|$104.16|0|0|||N BLOCK| STELLATE GANGLION|| 58-1699775|1326041732|CHC13|64517||11/01/2013|12/31/9999|$180.91|0|0|||N BLOCK INJ| HYPOGAS PLXS|| 58-1699775|1326041732|CHC13|64520||11/01/2013|12/31/9999|$115.40|0|0|||N BLOCK| LUMBAR/THORACIC|| 58-1699775|1326041732|CHC13|64530||11/01/2013|12/31/9999|$133.61|0|0|||N BLOCK INJ| CELIAC PELUS|| 58-1699775|1326041732|CHC13|64550||11/01/2013|12/31/9999|$12.87|0|0|||APPLY NEUROSTIMULATOR|| 58-1699775|1326041732|CHC13|64553||11/01/2013|12/31/9999|$237.53|0|0|||IMPLANT NEUROELECTRODES|| 58-1699775|1326041732|CHC13|64555||11/01/2013|12/31/9999|$211.00|0|0|||IMPLANT NEUROELECTRODES|| 58-1699775|1326041732|CHC13|64561||11/01/2013|12/31/9999|$580.82|0|0|||IMPLANT NEUROELECTRODES|| 58-1699775|1326041732|CHC13|64565||11/01/2013|12/31/9999|$180.35|0|0|||IMPLANT NEUROELECTRODES|| 58-1699775|1326041732|CHC13|64566||11/01/2013|12/31/9999|$43.09|0|0|||NEUROELTRD STIM POST TIBIAL|| 58-1699775|1326041732|CHC13|64568||11/01/2013|12/31/9999|$908.45|0|0|||INC FOR VAGUS N ELECT IMPL|| 58-1699775|1326041732|CHC13|64569||11/01/2013|12/31/9999|$1|004.77|0|0|||REVISE/REPL VAGUS N ELTRD|| 58-1699775|1326041732|CHC13|64570||11/01/2013|12/31/9999|$813.03|0|0|||REMOVE VAGUS N ELTRD|| 58-1699775|1326041732|CHC13|64575||11/01/2013|12/31/9999|$427.62|0|0|||IMPLANT NEUROELECTRODES|| 58-1699775|1326041732|CHC13|64580||11/01/2013|12/31/9999|$434.43|0|0|||IMPLANT NEUROELECTRODES|| 58-1699775|1326041732|CHC13|64581||11/01/2013|12/31/9999|$987.51|0|0|||IMPLANT NEUROELECTRODES|| 58-1699775|1326041732|CHC13|64585||11/01/2013|12/31/9999|$211.76|0|0|||REVISE/REMOVE NEUROELECTRODE|| 58-1699775|1326041732|CHC13|64590||11/01/2013|12/31/9999|$234.65|0|0|||INSRT/REDO PERPH N GENERATOR|| 58-1699775|1326041732|CHC13|64595||11/01/2013|12/31/9999|$185.21|0|0|||REVISE/REMOVE NEURORECEIVER|| 58-1699775|1326041732|CHC13|64600||11/01/2013|12/31/9999|$315.17|0|0|||INJECTION TREATMENT OF NERVE|| 58-1699775|1326041732|CHC13|64605||11/01/2013|12/31/9999|$483.54|0|0|||INJECTION TREATMENT OF NERVE|| 58-1699775|1326041732|CHC13|64610||11/01/2013|12/31/9999|$699.63|0|0|||INJECTION TREATMENT OF NERVE|| 58-1699775|1326041732|CHC13|64611||11/01/2013|12/31/9999|$128.68|0|0|||CHEMODENERV SALIV GLANDS|| 58-1699775|1326041732|CHC13|64612||11/01/2013|12/31/9999|$227.41|0|0|||DESTROY NERVE| FACE MUSCLE|| 58-1699775|1326041732|CHC13|64615||11/01/2013|12/31/9999|$185.16|0|0|||CHEMODENERV MUSC MIGRAINE|| 58-1699775|1326041732|CHC13|64616||04/01/2014|12/31/9999|$157.01|0|0|||CHEMODENERV MUSC NECK DYSTON|| 58-1699775|1326041732|CHC13|64617||04/01/2014|12/31/9999|$168.00|0|0|||CHEMODENER MUSCLE LARYNX EMG|| 58-1699775|1326041732|CHC13|64620||11/01/2013|12/31/9999|$248.86|0|0|||INJECTION TREATMENT OF NERVE|| 58-1699775|1326041732|CHC13|64630||11/01/2013|12/31/9999|$273.16|0|0|||INJECTION TREATMENT OF NERVE|| 58-1699775|1326041732|CHC13|64632||11/01/2013|12/31/9999|$100.09|0|0|||N BLOCK INJ| COMMON DIGIT|| 58-1699775|1326041732|CHC13|64633||11/01/2013|12/31/9999|$337.78|0|0|||DESTROY CERV/THOR FACET JNT|| 58-1699775|1326041732|CHC13|64634||11/01/2013|12/31/9999|$101.95|0|0|||DESTROY C/TH FACET JNT ADDL|| 58-1699775|1326041732|CHC13|64635||11/01/2013|12/31/9999|$331.03|0|0|||DESTROY LUMB/SAC FACET JNT|| 58-1699775|1326041732|CHC13|64636||11/01/2013|12/31/9999|$88.71|0|0|||DESTROY L/S FACET JNT ADDL|| 58-1699775|1326041732|CHC13|64640||11/01/2013|12/31/9999|$243.79|0|0|||INJECTION TREATMENT OF NERVE|| 58-1699775|1326041732|CHC13|64642||04/01/2014|12/31/9999|$157.07|0|0|||CHEMODENERV 1 EXTREMITY 1-4|| 58-1699775|1326041732|CHC13|64643||04/01/2014|12/31/9999|$105.86|0|0|||CHEMODENERV 1 EXTREM 1-4 EA|| 58-1699775|1326041732|CHC13|64644||04/01/2014|12/31/9999|$171.53|0|0|||CHEMODENERV 1 EXTREM 5/> MUS|| 58-1699775|1326041732|CHC13|64645||04/01/2014|12/31/9999|$121.31|0|0|||CHEMODENERV 1 EXTREM 5/> EA|| 58-1699775|1326041732|CHC13|64646||04/01/2014|12/31/9999|$169.97|0|0|||CHEMODENERV TRUNK MUSC 1-5|| 58-1699775|1326041732|CHC13|64647||04/01/2014|12/31/9999|$196.34|0|0|||CHEMODENERV TRUNK MUSC 6/>|| 58-1699775|1326041732|CHC13|64650||11/01/2013|12/31/9999|$57.92|0|0|||CHEMODENERV ECCRINE GLANDS|| 58-1699775|1326041732|CHC13|64653||11/01/2013|12/31/9999|$76.02|0|0|||CHEMODENERV ECCRINE GLANDS|| 58-1699775|1326041732|CHC13|64680||11/01/2013|12/31/9999|$238.56|0|0|||INJECTION TREATMENT OF NERVE|| 58-1699775|1326041732|CHC13|64681||11/01/2013|12/31/9999|$288.82|0|0|||INJECTION TREATMENT OF NERVE|| 58-1699775|1326041732|CHC13|64702||11/01/2013|12/31/9999|$704.07|0|0|||REVISE FINGER/TOE NERVE|| 58-1699775|1326041732|CHC13|64704||11/01/2013|12/31/9999|$451.19|0|0|||REVISE HAND/FOOT NERVE|| 58-1699775|1326041732|CHC13|64708||11/01/2013|12/31/9999|$701.54|0|0|||REVISE ARM/LEG NERVE|| 58-1699775|1326041732|CHC13|64712||11/01/2013|12/31/9999|$795.52|0|0|||REVISION OF SCIATIC NERVE|| 58-1699775|1326041732|CHC13|64713||11/01/2013|12/31/9999|$1|089.96|0|0|||REVISION OF ARM NERVE(S)|| 58-1699775|1326041732|CHC13|64714||11/01/2013|12/31/9999|$957.11|0|0|||REVISE LOW BACK NERVE(S)|| 58-1699775|1326041732|CHC13|64716||11/01/2013|12/31/9999|$765.75|0|0|||REVISION OF CRANIAL NERVE|| 58-1699775|1326041732|CHC13|64718||11/01/2013|12/31/9999|$836.01|0|0|||REVISE ULNAR NERVE AT ELBOW|| 58-1699775|1326041732|CHC13|64719||11/01/2013|12/31/9999|$563.74|0|0|||REVISE ULNAR NERVE AT WRIST|| 58-1699775|1326041732|CHC13|64721||11/01/2013|12/31/9999|$600.03|0|0|||CARPAL TUNNEL SURGERY|| 58-1699775|1326041732|CHC13|64722||11/01/2013|12/31/9999|$508.26|0|0|||RELIEVE PRESSURE ON NERVE(S)|| 58-1699775|1326041732|CHC13|64726||11/01/2013|12/31/9999|$388.25|0|0|||RELEASE FOOT/TOE NERVE|| 58-1699775|1326041732|CHC13|64727||11/01/2013|12/31/9999|$267.40|0|0|||INTERNAL NERVE REVISION|| 58-1699775|1326041732|CHC13|64732||11/01/2013|12/31/9999|$616.87|0|0|||INCISION OF BROW NERVE|| 58-1699775|1326041732|CHC13|64734||11/01/2013|12/31/9999|$632.44|0|0|||INCISION OF CHEEK NERVE|| 58-1699775|1326041732|CHC13|64736||11/01/2013|12/31/9999|$666.04|0|0|||INCISION OF CHIN NERVE|| 58-1699775|1326041732|CHC13|64738||11/01/2013|12/31/9999|$716.53|0|0|||INCISION OF JAW NERVE|| 58-1699775|1326041732|CHC13|64740||11/01/2013|12/31/9999|$659.91|0|0|||INCISION OF TONGUE NERVE|| 58-1699775|1326041732|CHC13|64742||11/01/2013|12/31/9999|$665.13|0|0|||INCISION OF FACIAL NERVE|| 58-1699775|1326041732|CHC13|64744||11/01/2013|12/31/9999|$684.88|0|0|||INCISE NERVE| BACK OF HEAD|| 58-1699775|1326041732|CHC13|64746||11/01/2013|12/31/9999|$630.72|0|0|||INCISE DIAPHRAGM NERVE|| 58-1699775|1326041732|CHC13|64755||11/01/2013|12/31/9999|$1|310.66|0|0|||INCISION OF STOMACH NERVES|| 58-1699775|1326041732|CHC13|64760||11/01/2013|12/31/9999|$723.76|0|0|||INCISION OF VAGUS NERVE|| 58-1699775|1326041732|CHC13|64763||11/01/2013|12/31/9999|$741.03|0|0|||INCISE HIP/THIGH NERVE|| 58-1699775|1326041732|CHC13|64766||11/01/2013|12/31/9999|$846.64|0|0|||INCISE HIP/THIGH NERVE|| 58-1699775|1326041732|CHC13|64771||11/01/2013|12/31/9999|$850.07|0|0|||SEVER CRANIAL NERVE|| 58-1699775|1326041732|CHC13|64772||11/01/2013|12/31/9999|$827.61|0|0|||INCISION OF SPINAL NERVE|| 58-1699775|1326041732|CHC13|64774||11/01/2013|12/31/9999|$594.38|0|0|||REMOVE SKIN NERVE LESION|| 58-1699775|1326041732|CHC13|64776||11/01/2013|12/31/9999|$557.71|0|0|||REMOVE DIGIT NERVE LESION|| 58-1699775|1326041732|CHC13|64778||11/01/2013|12/31/9999|$264.71|0|0|||DIGIT NERVE SURGERY ADD-ON|| 58-1699775|1326041732|CHC13|64782||11/01/2013|12/31/9999|$645.99|0|0|||REMOVE LIMB NERVE LESION|| 58-1699775|1326041732|CHC13|64783||11/01/2013|12/31/9999|$314.82|0|0|||LIMB NERVE SURGERY ADD-ON|| 58-1699775|1326041732|CHC13|64784||11/01/2013|12/31/9999|$1|049.16|0|0|||REMOVE NERVE LESION|| 58-1699775|1326041732|CHC13|64786||11/01/2013|12/31/9999|$1|540.19|0|0|||REMOVE SCIATIC NERVE LESION|| 58-1699775|1326041732|CHC13|64787||11/01/2013|12/31/9999|$354.41|0|0|||IMPLANT NERVE END|| 58-1699775|1326041732|CHC13|64788||11/01/2013|12/31/9999|$564.00|0|0|||REMOVE SKIN NERVE LESION|| 58-1699775|1326041732|CHC13|64790||11/01/2013|12/31/9999|$1|189.14|0|0|||REMOVAL OF NERVE LESION|| 58-1699775|1326041732|CHC13|64792||11/01/2013|12/31/9999|$1|690.97|0|0|||REMOVAL OF NERVE LESION|| 58-1699775|1326041732|CHC13|64795||11/01/2013|12/31/9999|$279.19|0|0|||BIOPSY OF NERVE|| 58-1699775|1326041732|CHC13|64802||11/01/2013|12/31/9999|$785.63|0|0|||REMOVE SYMPATHETIC NERVES|| 58-1699775|1326041732|CHC13|64804||11/01/2013|12/31/9999|$1|158.58|0|0|||REMOVE SYMPATHETIC NERVES|| 58-1699775|1326041732|CHC13|64809||11/01/2013|12/31/9999|$1|077.90|0|0|||REMOVE SYMPATHETIC NERVES|| 58-1699775|1326041732|CHC13|64818||11/01/2013|12/31/9999|$970.03|0|0|||REMOVE SYMPATHETIC NERVES|| 58-1699775|1326041732|CHC13|64820||11/01/2013|12/31/9999|$1|083.57|0|0|||REMOVE SYMPATHETIC NERVES|| 58-1699775|1326041732|CHC13|64821||11/01/2013|12/31/9999|$1|003.22|0|0|||REMOVE SYMPATHETIC NERVES|| 58-1699775|1326041732|CHC13|64822||11/01/2013|12/31/9999|$977.55|0|0|||REMOVE SYMPATHETIC NERVES|| 58-1699775|1326041732|CHC13|64823||11/01/2013|12/31/9999|$1|112.03|0|0|||REMOVE SYMPATHETIC NERVES|| 58-1699775|1326041732|CHC13|64831||11/01/2013|12/31/9999|$974.05|0|0|||REPAIR OF DIGIT NERVE|| 58-1699775|1326041732|CHC13|64832||11/01/2013|12/31/9999|$494.04|0|0|||REPAIR NERVE ADD-ON|| 58-1699775|1326041732|CHC13|64834||11/01/2013|12/31/9999|$1|058.17|0|0|||REPAIR OF HAND OR FOOT NERVE|| 58-1699775|1326041732|CHC13|64835||11/01/2013|12/31/9999|$1|157.64|0|0|||REPAIR OF HAND OR FOOT NERVE|| 58-1699775|1326041732|CHC13|64836||11/01/2013|12/31/9999|$1|157.64|0|0|||REPAIR OF HAND OR FOOT NERVE|| 58-1699775|1326041732|CHC13|64837||11/01/2013|12/31/9999|$513.29|0|0|||REPAIR NERVE ADD-ON|| 58-1699775|1326041732|CHC13|64840||11/01/2013|12/31/9999|$1|259.40|0|0|||REPAIR OF LEG NERVE|| 58-1699775|1326041732|CHC13|64856||11/01/2013|12/31/9999|$1|455.54|0|0|||REPAIR/TRANSPOSE NERVE|| 58-1699775|1326041732|CHC13|64857||11/01/2013|12/31/9999|$1|514.11|0|0|||REPAIR ARM/LEG NERVE|| 58-1699775|1326041732|CHC13|64858||11/01/2013|12/31/9999|$1|569.46|0|0|||REPAIR SCIATIC NERVE|| 58-1699775|1326041732|CHC13|64859||11/01/2013|12/31/9999|$381.94|0|0|||NERVE SURGERY|| 58-1699775|1326041732|CHC13|64861||11/01/2013|12/31/9999|$1|909.62|0|0|||REPAIR OF ARM NERVES|| 58-1699775|1326041732|CHC13|64862||11/01/2013|12/31/9999|$2|184.62|0|0|||REPAIR OF LOW BACK NERVES|| 58-1699775|1326041732|CHC13|64864||11/01/2013|12/31/9999|$1|263.13|0|0|||REPAIR OF FACIAL NERVE|| 58-1699775|1326041732|CHC13|64865||11/01/2013|12/31/9999|$1|625.60|0|0|||REPAIR OF FACIAL NERVE|| 58-1699775|1326041732|CHC13|64866||11/01/2013|12/31/9999|$1|640.64|0|0|||FUSION OF FACIAL/OTHER NERVE|| 58-1699775|1326041732|CHC13|64868||11/01/2013|12/31/9999|$1|486.70|0|0|||FUSION OF FACIAL/OTHER NERVE|| 58-1699775|1326041732|CHC13|64872||11/01/2013|12/31/9999|$170.77|0|0|||SUBSEQUENT REPAIR OF NERVE|| 58-1699775|1326041732|CHC13|64874||11/01/2013|12/31/9999|$244.41|0|0|||REPAIR & REVISE NERVE ADD-ON|| 58-1699775|1326041732|CHC13|64876||11/01/2013|12/31/9999|$267.96|0|0|||REPAIR NERVE/SHORTEN BONE|| 58-1699775|1326041732|CHC13|64885||11/01/2013|12/31/9999|$1|597.56|0|0|||NERVE GRAFT| HEAD OR NECK|| 58-1699775|1326041732|CHC13|64886||11/01/2013|12/31/9999|$1|868.06|0|0|||NERVE GRAFT| HEAD OR NECK|| 58-1699775|1326041732|CHC13|64890||11/01/2013|12/31/9999|$1|602.48|0|0|||NERVE GRAFT| HAND OR FOOT|| 58-1699775|1326041732|CHC13|64891||11/01/2013|12/31/9999|$1|605.40|0|0|||NERVE GRAFT| HAND OR FOOT|| 58-1699775|1326041732|CHC13|64892||11/01/2013|12/31/9999|$1|556.20|0|0|||NERVE GRAFT| ARM OR LEG|| 58-1699775|1326041732|CHC13|64893||11/01/2013|12/31/9999|$1|657.34|0|0|||NERVE GRAFT| ARM OR LEG|| 58-1699775|1326041732|CHC13|64895||11/01/2013|12/31/9999|$1|968.74|0|0|||NERVE GRAFT| HAND OR FOOT|| 58-1699775|1326041732|CHC13|64896||11/01/2013|12/31/9999|$2|300.13|0|0|||NERVE GRAFT| HAND OR FOOT|| 58-1699775|1326041732|CHC13|64897||11/01/2013|12/31/9999|$1|884.33|0|0|||NERVE GRAFT| ARM OR LEG|| 58-1699775|1326041732|CHC13|64898||11/01/2013|12/31/9999|$2|044.86|0|0|||NERVE GRAFT| ARM OR LEG|| 58-1699775|1326041732|CHC13|64901||11/01/2013|12/31/9999|$914.01|0|0|||NERVE GRAFT ADD-ON|| 58-1699775|1326041732|CHC13|64902||11/01/2013|12/31/9999|$1|056.75|0|0|||NERVE GRAFT ADD-ON|| 58-1699775|1326041732|CHC13|64905||11/01/2013|12/31/9999|$1|490.81|0|0|||NERVE PEDICLE TRANSFER|| 58-1699775|1326041732|CHC13|64907||11/01/2013|12/31/9999|$1|609.40|0|0|||NERVE PEDICLE TRANSFER|| 58-1699775|1326041732|CHC13|64910||11/01/2013|12/31/9999|$1|181.50|0|0|||NERVE REPAIR W/ALLOGRAFT|| 58-1699775|1326041732|CHC13|64911||11/01/2013|12/31/9999|$1|477.21|0|0|||NEURORRAPHY W/VEIN AUTOGRAFT|| 58-1699775|1326041732|CHC13|64912||04/01/2018|12/31/9999|$1|168.92|0|0|0||NRV RPR W/NRV ALGRFT 1ST|| 58-1699775|1326041732|CHC13|64913||04/01/2018|12/31/9999|$241.08|0|0|0||NRV RPR W/NRV ALGRFT EA ADDL|| 58-1699775|1326041732|CHC13|64999||11/01/2013|12/31/9999|$0.00|0|0|||NERVOUS SYSTEM SURGERY|| 58-1699775|1326041732|CHC13|65091||11/01/2013|12/31/9999|$750.49|0|0|||REVISE EYE|| 58-1699775|1326041732|CHC13|65093||11/01/2013|12/31/9999|$744.51|0|0|||REVISE EYE WITH IMPLANT|| 58-1699775|1326041732|CHC13|65101||11/01/2013|12/31/9999|$872.55|0|0|||REMOVAL OF EYE|| 58-1699775|1326041732|CHC13|65103||11/01/2013|12/31/9999|$911.71|0|0|||REMOVE EYE/INSERT IMPLANT|| 58-1699775|1326041732|CHC13|65105||11/01/2013|12/31/9999|$1|006.88|0|0|||REMOVE EYE/ATTACH IMPLANT|| 58-1699775|1326041732|CHC13|65110||11/01/2013|12/31/9999|$1|415.58|0|0|||REMOVAL OF EYE|| 58-1699775|1326041732|CHC13|65112||11/01/2013|12/31/9999|$1|650.59|0|0|||REMOVE EYE/REVISE SOCKET|| 58-1699775|1326041732|CHC13|65114||11/01/2013|12/31/9999|$1|731.79|0|0|||REMOVE EYE/REVISE SOCKET|| 58-1699775|1326041732|CHC13|65125||11/01/2013|12/31/9999|$345.50|0|0|||REVISE OCULAR IMPLANT|| 58-1699775|1326041732|CHC13|65130||11/01/2013|12/31/9999|$866.22|0|0|||INSERT OCULAR IMPLANT|| 58-1699775|1326041732|CHC13|65135||11/01/2013|12/31/9999|$879.25|0|0|||INSERT OCULAR IMPLANT|| 58-1699775|1326041732|CHC13|65140||11/01/2013|12/31/9999|$933.22|0|0|||ATTACH OCULAR IMPLANT|| 58-1699775|1326041732|CHC13|65150||11/01/2013|12/31/9999|$651.64|0|0|||REVISE OCULAR IMPLANT|| 58-1699775|1326041732|CHC13|65155||11/01/2013|12/31/9999|$1|005.73|0|0|||REINSERT OCULAR IMPLANT|| 58-1699775|1326041732|CHC13|65175||11/01/2013|12/31/9999|$757.35|0|0|||REMOVAL OF OCULAR IMPLANT|| 58-1699775|1326041732|CHC13|65205||11/01/2013|12/31/9999|$51.73|0|0|||REMOVE FOREIGN BODY FROM EYE|| 58-1699775|1326041732|CHC13|65210||11/01/2013|12/31/9999|$63.78|0|0|||REMOVE FOREIGN BODY FROM EYE|| 58-1699775|1326041732|CHC13|65220||11/01/2013|12/31/9999|$50.60|0|0|||REMOVE FOREIGN BODY FROM EYE|| 58-1699775|1326041732|CHC13|65222||11/01/2013|12/31/9999|$69.55|0|0|||REMOVE FOREIGN BODY FROM EYE|| 58-1699775|1326041732|CHC13|65235||11/01/2013|12/31/9999|$825.46|0|0|||REMOVE FOREIGN BODY FROM EYE|| 58-1699775|1326041732|CHC13|65260||11/01/2013|12/31/9999|$1|085.23|0|0|||REMOVE FOREIGN BODY FROM EYE|| 58-1699775|1326041732|CHC13|65265||11/01/2013|12/31/9999|$1|305.22|0|0|||REMOVE FOREIGN BODY FROM EYE|| 58-1699775|1326041732|CHC13|65270||11/01/2013|12/31/9999|$165.46|0|0|||REPAIR OF EYE WOUND|| 58-1699775|1326041732|CHC13|65272||11/01/2013|12/31/9999|$397.96|0|0|||REPAIR OF EYE WOUND|| 58-1699775|1326041732|CHC13|65273||11/01/2013|12/31/9999|$432.83|0|0|||REPAIR OF EYE WOUND|| 58-1699775|1326041732|CHC13|65275||11/01/2013|12/31/9999|$539.23|0|0|||REPAIR OF EYE WOUND|| 58-1699775|1326041732|CHC13|65280||11/01/2013|12/31/9999|$805.93|0|0|||REPAIR OF EYE WOUND|| 58-1699775|1326041732|CHC13|65285||11/01/2013|12/31/9999|$1|313.76|0|0|||REPAIR OF EYE WOUND|| 58-1699775|1326041732|CHC13|65286||11/01/2013|12/31/9999|$579.34|0|0|||REPAIR OF EYE WOUND|| 58-1699775|1326041732|CHC13|65290||11/01/2013|12/31/9999|$589.33|0|0|||REPAIR OF EYE SOCKET WOUND|| 58-1699775|1326041732|CHC13|65400||11/01/2013|12/31/9999|$701.34|0|0|||REMOVAL OF EYE LESION|| 58-1699775|1326041732|CHC13|65410||11/01/2013|12/31/9999|$126.75|0|0|||BIOPSY OF CORNEA|| 58-1699775|1326041732|CHC13|65420||11/01/2013|12/31/9999|$434.95|0|0|||REMOVAL OF EYE LESION|| 58-1699775|1326041732|CHC13|65426||11/01/2013|12/31/9999|$557.63|0|0|||REMOVAL OF EYE LESION|| 58-1699775|1326041732|CHC13|65430||11/01/2013|12/31/9999|$122.81|0|0|||CORNEAL SMEAR|| 58-1699775|1326041732|CHC13|65435||11/01/2013|12/31/9999|$82.90|0|0|||CURETTE/TREAT CORNEA|| 58-1699775|1326041732|CHC13|65436||11/01/2013|12/31/9999|$440.74|0|0|||CURETTE/TREAT CORNEA|| 58-1699775|1326041732|CHC13|65450||11/01/2013|12/31/9999|$370.62|0|0|||TREATMENT OF CORNEAL LESION|| 58-1699775|1326041732|CHC13|65600||11/01/2013|12/31/9999|$400.30|0|0|||REVISION OF CORNEA|| 58-1699775|1326041732|CHC13|65710||11/01/2013|12/31/9999|$1|293.20|0|0|||CORNEAL TRANSPLANT|| 58-1699775|1326041732|CHC13|65730||11/01/2013|12/31/9999|$1|436.27|0|0|||CORNEAL TRANSPLANT|| 58-1699775|1326041732|CHC13|65750||11/01/2013|12/31/9999|$1|442.01|0|0|||CORNEAL TRANSPLANT|| 58-1699775|1326041732|CHC13|65755||11/01/2013|12/31/9999|$1|440.17|0|0|||CORNEAL TRANSPLANT|| 58-1699775|1326041732|CHC13|65756||11/01/2013|12/31/9999|$1|347.68|0|0|||CORNEAL TRNSPL| ENDOTHELIAL|| 58-1699775|1326041732|CHC13|65757||11/01/2013|12/31/9999|$171.19|0|0|||PREP CORNEAL ENDO ALLOGRAFT|| 58-1699775|1326041732|CHC13|65760||11/01/2013|12/31/9999|$1|456.61|0|0|||REVISION OF CORNEA|| 58-1699775|1326041732|CHC13|65765||11/01/2013|12/31/9999|$2|112.25|0|0|||REVISION OF CORNEA|| 58-1699775|1326041732|CHC13|65767||11/01/2013|12/31/9999|$1|966.49|0|0|||CORNEAL TISSUE TRANSPLANT|| 58-1699775|1326041732|CHC13|65770||11/01/2013|12/31/9999|$1|825.49|0|0|||REVISE CORNEA WITH IMPLANT|| 58-1699775|1326041732|CHC13|65771||11/01/2013|12/31/9999|$800.98|0|0|||RADIAL KERATOTOMY|| 58-1699775|1326041732|CHC13|65772||11/01/2013|12/31/9999|$470.71|0|0|||CORRECTION OF ASTIGMATISM|| 58-1699775|1326041732|CHC13|65775||11/01/2013|12/31/9999|$624.74|0|0|||CORRECTION OF ASTIGMATISM|| 58-1699775|1326041732|CHC13|65778||04/01/2014|12/31/9999|$90.45|0|0|||COVER EYE W/MEMBRANE|| 58-1699775|1326041732|CHC13|65779||04/01/2014|12/31/9999|$352.66|0|0|||COVER EYE W/MEMBRANE STENT|| 58-1699775|1326041732|CHC13|65780||11/01/2013|12/31/9999|$1|030.65|0|0|||OCULAR RECONST| TRANSPLANT|| 58-1699775|1326041732|CHC13|65781||11/01/2013|12/31/9999|$1|518.09|0|0|||OCULAR RECONST| TRANSPLANT|| 58-1699775|1326041732|CHC13|65782||11/01/2013|12/31/9999|$1|386.73|0|0|||OCULAR RECONST| TRANSPLANT|| 58-1699775|1326041732|CHC13|65785||04/01/2016|12/31/9999|$561.99|0|0|0||IMPLTJ NTRSTRML CRNL RNG SEG|| 58-1699775|1326041732|CHC13|65800||11/01/2013|12/31/9999|$154.59|0|0|||DRAINAGE OF EYE|| 58-1699775|1326041732|CHC13|65810||11/01/2013|12/31/9999|$543.66|0|0|||DRAINAGE OF EYE|| 58-1699775|1326041732|CHC13|65815||11/01/2013|12/31/9999|$564.97|0|0|||DRAINAGE OF EYE|| 58-1699775|1326041732|CHC13|65820||11/01/2013|12/31/9999|$845.64|0|0|||RELIEVE INNER EYE PRESSURE|| 58-1699775|1326041732|CHC13|65850||11/01/2013|12/31/9999|$1|001.42|0|0|||INCISION OF EYE|| 58-1699775|1326041732|CHC13|65855||11/01/2013|12/31/9999|$352.05|0|0|||LASER SURGERY OF EYE|| 58-1699775|1326041732|CHC13|65860||11/01/2013|12/31/9999|$331.33|0|0|||INCISE INNER EYE ADHESIONS|| 58-1699775|1326041732|CHC13|65865||11/01/2013|12/31/9999|$534.84|0|0|||INCISE INNER EYE ADHESIONS|| 58-1699775|1326041732|CHC13|65870||11/01/2013|12/31/9999|$699.29|0|0|||INCISE INNER EYE ADHESIONS|| 58-1699775|1326041732|CHC13|65875||11/01/2013|12/31/9999|$733.32|0|0|||INCISE INNER EYE ADHESIONS|| 58-1699775|1326041732|CHC13|65880||11/01/2013|12/31/9999|$750.76|0|0|||INCISE INNER EYE ADHESIONS|| 58-1699775|1326041732|CHC13|65900||11/01/2013|12/31/9999|$1|093.12|0|0|||REMOVE EYE LESION|| 58-1699775|1326041732|CHC13|65920||11/01/2013|12/31/9999|$914.98|0|0|||REMOVE IMPLANT OF EYE|| 58-1699775|1326041732|CHC13|65930||11/01/2013|12/31/9999|$758.89|0|0|||REMOVE BLOOD CLOT FROM EYE|| 58-1699775|1326041732|CHC13|66020||11/01/2013|12/31/9999|$148.62|0|0|||INJECTION TREATMENT OF EYE|| 58-1699775|1326041732|CHC13|66030||11/01/2013|12/31/9999|$128.52|0|0|||INJECTION TREATMENT OF EYE|| 58-1699775|1326041732|CHC13|66130||11/01/2013|12/31/9999|$691.35|0|0|||REMOVE EYE LESION|| 58-1699775|1326041732|CHC13|66150||11/01/2013|12/31/9999|$988.06|0|0|||GLAUCOMA SURGERY|| 58-1699775|1326041732|CHC13|66155||11/01/2013|12/31/9999|$987.25|0|0|||GLAUCOMA SURGERY|| 58-1699775|1326041732|CHC13|66160||11/01/2013|12/31/9999|$1|116.66|0|0|||GLAUCOMA SURGERY|| 58-1699775|1326041732|CHC13|66170||11/01/2013|12/31/9999|$1|390.75|0|0|||GLAUCOMA SURGERY|| 58-1699775|1326041732|CHC13|66172||11/01/2013|12/31/9999|$1|753.43|0|0|||INCISION OF EYE|| 58-1699775|1326041732|CHC13|66174||11/01/2013|12/31/9999|$1|155.59|0|0|||TRANSLUM DIL EYE CANAL|| 58-1699775|1326041732|CHC13|66175||11/01/2013|12/31/9999|$1|309.26|0|0|||TRNSLUM DIL EYE CANAL W/STNT|| 58-1699775|1326041732|CHC13|66179||04/01/2015|12/31/9999|$1|548.66|0|0|0||AQUEOUS SHUNT EYE W/O GRAFT|| 58-1699775|1326041732|CHC13|66180||11/01/2013|12/31/9999|$1|363.70|0|0|||IMPLANT EYE SHUNT|| 58-1699775|1326041732|CHC13|66183||04/01/2014|12/31/9999|$1|285.96|0|0|||INSERT ANT DRAINAGE DEVICE|| 58-1699775|1326041732|CHC13|66184||04/01/2015|12/31/9999|$1|124.12|0|0|0||REVISION OF AQUEOUS SHUNT|| 58-1699775|1326041732|CHC13|66185||11/01/2013|12/31/9999|$887.32|0|0|||REVISE EYE SHUNT|| 58-1699775|1326041732|CHC13|66220||11/01/2013|12/31/9999|$861.90|0|0|||REPAIR EYE LESION|| 58-1699775|1326041732|CHC13|66225||11/01/2013|12/31/9999|$1|120.52|0|0|||REPAIR/GRAFT EYE LESION|| 58-1699775|1326041732|CHC13|66250||11/01/2013|12/31/9999|$665.31|0|0|||FOLLOW-UP SURGERY OF EYE|| 58-1699775|1326041732|CHC13|66500||11/01/2013|12/31/9999|$397.89|0|0|||INCISION OF IRIS|| 58-1699775|1326041732|CHC13|66505||11/01/2013|12/31/9999|$436.30|0|0|||INCISION OF IRIS|| 58-1699775|1326041732|CHC13|66600||11/01/2013|12/31/9999|$938.94|0|0|||REMOVE IRIS AND LESION|| 58-1699775|1326041732|CHC13|66605||11/01/2013|12/31/9999|$1|198.91|0|0|||REMOVAL OF IRIS|| 58-1699775|1326041732|CHC13|66625||11/01/2013|12/31/9999|$499.22|0|0|||REMOVAL OF IRIS|| 58-1699775|1326041732|CHC13|66630||11/01/2013|12/31/9999|$672.36|0|0|||REMOVAL OF IRIS|| 58-1699775|1326041732|CHC13|66635||11/01/2013|12/31/9999|$650.08|0|0|||REMOVAL OF IRIS|| 58-1699775|1326041732|CHC13|66680||11/01/2013|12/31/9999|$619.77|0|0|||REPAIR IRIS & CILIARY BODY|| 58-1699775|1326041732|CHC13|66682||11/01/2013|12/31/9999|$752.35|0|0|||REPAIR IRIS & CILIARY BODY|| 58-1699775|1326041732|CHC13|66700||11/01/2013|12/31/9999|$450.85|0|0|||DESTRUCTION| CILIARY BODY|| 58-1699775|1326041732|CHC13|66710||11/01/2013|12/31/9999|$471.40|0|0|||CILIARY TRANSSLERAL THERAPY|| 58-1699775|1326041732|CHC13|66711||11/01/2013|12/31/9999|$720.95|0|0|||CILIARY ENDOSCOPIC ABLATION|| 58-1699775|1326041732|CHC13|66720||11/01/2013|12/31/9999|$488.69|0|0|||DESTRUCTION| CILIARY BODY|| 58-1699775|1326041732|CHC13|66740||11/01/2013|12/31/9999|$445.32|0|0|||DESTRUCTION| CILIARY BODY|| 58-1699775|1326041732|CHC13|66761||11/01/2013|12/31/9999|$299.38|0|0|||REVISION OF IRIS|| 58-1699775|1326041732|CHC13|66762||11/01/2013|12/31/9999|$493.78|0|0|||REVISION OF IRIS|| 58-1699775|1326041732|CHC13|66770||11/01/2013|12/31/9999|$545.61|0|0|||REMOVAL OF INNER EYE LESION|| 58-1699775|1326041732|CHC13|66820||11/01/2013|12/31/9999|$457.64|0|0|||INCISION| SECONDARY CATARACT|| 58-1699775|1326041732|CHC13|66821||11/01/2013|12/31/9999|$360.91|0|0|||AFTER CATARACT LASER SURGERY|| 58-1699775|1326041732|CHC13|66825||11/01/2013|12/31/9999|$879.24|0|0|||REPOSITION INTRAOCULAR LENS|| 58-1699775|1326041732|CHC13|66830||11/01/2013|12/31/9999|$808.39|0|0|||REMOVAL OF LENS LESION|| 58-1699775|1326041732|CHC13|66840||11/01/2013|12/31/9999|$834.95|0|0|||REMOVAL OF LENS MATERIAL|| 58-1699775|1326041732|CHC13|66850||11/01/2013|12/31/9999|$927.18|0|0|||REMOVAL OF LENS MATERIAL|| 58-1699775|1326041732|CHC13|66852||11/01/2013|12/31/9999|$1|006.10|0|0|||REMOVAL OF LENS MATERIAL|| 58-1699775|1326041732|CHC13|66920||11/01/2013|12/31/9999|$855.63|0|0|||EXTRACTION OF LENS|| 58-1699775|1326041732|CHC13|66930||11/01/2013|12/31/9999|$972.99|0|0|||EXTRACTION OF LENS|| 58-1699775|1326041732|CHC13|66940||11/01/2013|12/31/9999|$926.37|0|0|||EXTRACTION OF LENS|| 58-1699775|1326041732|CHC13|66982||11/01/2013|12/31/9999|$1|251.82|0|0|||CATARACT SURGERY| COMPLEX|| 58-1699775|1326041732|CHC13|66983||11/01/2013|12/31/9999|$850.97|0|0|||CATARACT SURG W/IOL| 1 STAGE|| 58-1699775|1326041732|CHC13|66984||11/01/2013|12/31/9999|$901.69|0|0|||CATARACT SURG W/IOL| 1 STAGE|| 58-1699775|1326041732|CHC13|66985||11/01/2013|12/31/9999|$895.83|0|0|||INSERT LENS PROSTHESIS|| 58-1699775|1326041732|CHC13|66986||11/01/2013|12/31/9999|$1|061.59|0|0|||EXCHANGE LENS PROSTHESIS|| 58-1699775|1326041732|CHC13|66990||11/01/2013|12/31/9999|$104.11|0|0|||OPHTHALMIC ENDOSCOPE ADD-ON|| 58-1699775|1326041732|CHC13|66999||11/01/2013|12/31/9999|$0.00|0|0|||EYE SURGERY PROCEDURE|| 58-1699775|1326041732|CHC13|67005||11/01/2013|12/31/9999|$566.64|0|0|||PARTIAL REMOVAL OF EYE FLUID|| 58-1699775|1326041732|CHC13|67010||11/01/2013|12/31/9999|$633.65|0|0|||PARTIAL REMOVAL OF EYE FLUID|| 58-1699775|1326041732|CHC13|67015||11/01/2013|12/31/9999|$675.28|0|0|||RELEASE OF EYE FLUID|| 58-1699775|1326041732|CHC13|67025||11/01/2013|12/31/9999|$749.60|0|0|||REPLACE EYE FLUID|| 58-1699775|1326041732|CHC13|67027||11/01/2013|12/31/9999|$1|015.08|0|0|||IMPLANT EYE DRUG SYSTEM|| 58-1699775|1326041732|CHC13|67028||11/01/2013|12/31/9999|$123.42|0|0|||INJECTION EYE DRUG|| 58-1699775|1326041732|CHC13|67030||11/01/2013|12/31/9999|$597.87|0|0|||INCISE INNER EYE STRANDS|| 58-1699775|1326041732|CHC13|67031||11/01/2013|12/31/9999|$414.07|0|0|||LASER SURGERY| EYE STRANDS|| 58-1699775|1326041732|CHC13|67036||11/01/2013|12/31/9999|$1|125.35|0|0|||REMOVAL OF INNER EYE FLUID|| 58-1699775|1326041732|CHC13|67039||11/01/2013|12/31/9999|$1|472.53|0|0|||LASER TREATMENT OF RETINA|| 58-1699775|1326041732|CHC13|67040||11/01/2013|12/31/9999|$1|666.11|0|0|||LASER TREATMENT OF RETINA|| 58-1699775|1326041732|CHC13|67041||11/01/2013|12/31/9999|$1|558.27|0|0|||VIT FOR MACULAR PUCKER|| 58-1699775|1326041732|CHC13|67042||11/01/2013|12/31/9999|$1|782.95|0|0|||VIT FOR MACULAR HOLE|| 58-1699775|1326041732|CHC13|67043||11/01/2013|12/31/9999|$1|907.94|0|0|||VIT FOR MEMBRANE DISSECT|| 58-1699775|1326041732|CHC13|67101||11/01/2013|12/31/9999|$800.11|0|0|||REPAIR DETACHED RETINA|| 58-1699775|1326041732|CHC13|67105||11/01/2013|12/31/9999|$752.60|0|0|||REPAIR DETACHED RETINA|| 58-1699775|1326041732|CHC13|67107||11/01/2013|12/31/9999|$1|450.60|0|0|||REPAIR DETACHED RETINA|| 58-1699775|1326041732|CHC13|67108||11/01/2013|12/31/9999|$1|887.62|0|0|||REPAIR DETACHED RETINA|| 58-1699775|1326041732|CHC13|67110||11/01/2013|12/31/9999|$901.23|0|0|||REPAIR DETACHED RETINA|| 58-1699775|1326041732|CHC13|67113||11/01/2013|12/31/9999|$2|052.71|0|0|||REPAIR RETINAL DETACH| CPLX|| 58-1699775|1326041732|CHC13|67115||11/01/2013|12/31/9999|$577.31|0|0|||RELEASE ENCIRCLING MATERIAL|| 58-1699775|1326041732|CHC13|67120||11/01/2013|12/31/9999|$666.84|0|0|||REMOVE EYE IMPLANT MATERIAL|| 58-1699775|1326041732|CHC13|67121||11/01/2013|12/31/9999|$1|081.78|0|0|||REMOVE EYE IMPLANT MATERIAL|| 58-1699775|1326041732|CHC13|67141||11/01/2013|12/31/9999|$577.12|0|0|||TREATMENT OF RETINA|| 58-1699775|1326041732|CHC13|67145||11/01/2013|12/31/9999|$579.09|0|0|||TREATMENT OF RETINA|| 58-1699775|1326041732|CHC13|67208||11/01/2013|12/31/9999|$654.74|0|0|||TREATMENT OF RETINAL LESION|| 58-1699775|1326041732|CHC13|67210||11/01/2013|12/31/9999|$594.65|0|0|||TREATMENT OF RETINAL LESION|| 58-1699775|1326041732|CHC13|67218||11/01/2013|12/31/9999|$1|577.63|0|0|||TREATMENT OF RETINAL LESION|| 58-1699775|1326041732|CHC13|67220||11/01/2013|12/31/9999|$636.16|0|0|||TREATMENT OF CHOROID LESION|| 58-1699775|1326041732|CHC13|67221||11/01/2013|12/31/9999|$255.14|0|0|||OCULAR PHOTODYNAMIC THER|| 58-1699775|1326041732|CHC13|67225||11/01/2013|12/31/9999|$32.26|0|0|||EYE PHOTODYNAMIC THER ADD-ON|| 58-1699775|1326041732|CHC13|67227||11/01/2013|12/31/9999|$646.58|0|0|||TREATMENT OF RETINAL LESION|| 58-1699775|1326041732|CHC13|67228||11/01/2013|12/31/9999|$1|148.89|0|0|||TREATMENT OF RETINAL LESION|| 58-1699775|1326041732|CHC13|67229||11/01/2013|12/31/9999|$1|276.91|0|0|||TR RETINAL LES PRETERM INF|| 58-1699775|1326041732|CHC13|67250||11/01/2013|12/31/9999|$920.63|0|0|||REINFORCE EYE WALL|| 58-1699775|1326041732|CHC13|67255||11/01/2013|12/31/9999|$1|001.09|0|0|||REINFORCE/GRAFT EYE WALL|| 58-1699775|1326041732|CHC13|67299||11/01/2013|12/31/9999|$0.00|0|0|||EYE SURGERY PROCEDURE|| 58-1699775|1326041732|CHC13|67311||11/01/2013|12/31/9999|$707.46|0|0|||REVISE EYE MUSCLE|| 58-1699775|1326041732|CHC13|67312||11/01/2013|12/31/9999|$857.03|0|0|||REVISE TWO EYE MUSCLES|| 58-1699775|1326041732|CHC13|67314||11/01/2013|12/31/9999|$796.54|0|0|||REVISE EYE MUSCLE|| 58-1699775|1326041732|CHC13|67316||11/01/2013|12/31/9999|$964.48|0|0|||REVISE TWO EYE MUSCLES|| 58-1699775|1326041732|CHC13|67318||11/01/2013|12/31/9999|$797.28|0|0|||REVISE EYE MUSCLE(S)|| 58-1699775|1326041732|CHC13|67320||11/01/2013|12/31/9999|$371.22|0|0|||REVISE EYE MUSCLE(S) ADD-ON|| 58-1699775|1326041732|CHC13|67331||11/01/2013|12/31/9999|$371.05|0|0|||EYE SURGERY FOLLOW-UP ADD-ON|| 58-1699775|1326041732|CHC13|67332||11/01/2013|12/31/9999|$403.19|0|0|||REREVISE EYE MUSCLES ADD-ON|| 58-1699775|1326041732|CHC13|67334||11/01/2013|12/31/9999|$346.74|0|0|||REVISE EYE MUSCLE W/SUTURE|| 58-1699775|1326041732|CHC13|67335||11/01/2013|12/31/9999|$180.97|0|0|||EYE SUTURE DURING SURGERY|| 58-1699775|1326041732|CHC13|67340||11/01/2013|12/31/9999|$412.47|0|0|||REVISE EYE MUSCLE ADD-ON|| 58-1699775|1326041732|CHC13|67343||11/01/2013|12/31/9999|$780.86|0|0|||RELEASE EYE TISSUE|| 58-1699775|1326041732|CHC13|67345||11/01/2013|12/31/9999|$263.58|0|0|||DESTROY NERVE OF EYE MUSCLE|| 58-1699775|1326041732|CHC13|67346||11/01/2013|12/31/9999|$244.77|0|0|||BIOPSY| EYE MUSCLE|| 58-1699775|1326041732|CHC13|67399||11/01/2013|12/31/9999|$0.00|0|0|||EYE MUSCLE SURGERY PROCEDURE|| 58-1699775|1326041732|CHC13|67400||11/01/2013|12/31/9999|$1|103.09|0|0|||EXPLORE/BIOPSY EYE SOCKET|| 58-1699775|1326041732|CHC13|67405||11/01/2013|12/31/9999|$917.91|0|0|||EXPLORE/DRAIN EYE SOCKET|| 58-1699775|1326041732|CHC13|67412||11/01/2013|12/31/9999|$1|009.13|0|0|||EXPLORE/TREAT EYE SOCKET|| 58-1699775|1326041732|CHC13|67413||11/01/2013|12/31/9999|$1|018.98|0|0|||EXPLORE/TREAT EYE SOCKET|| 58-1699775|1326041732|CHC13|67414||11/01/2013|12/31/9999|$1|542.20|0|0|||EXPLR/DECOMPRESS EYE SOCKET|| 58-1699775|1326041732|CHC13|67415||11/01/2013|12/31/9999|$125.62|0|0|||ASPIRATION| ORBITAL CONTENTS|| 58-1699775|1326041732|CHC13|67420||11/01/2013|12/31/9999|$1|944.29|0|0|||EXPLORE/TREAT EYE SOCKET|| 58-1699775|1326041732|CHC13|67430||11/01/2013|12/31/9999|$1|411.49|0|0|||EXPLORE/TREAT EYE SOCKET|| 58-1699775|1326041732|CHC13|67440||11/01/2013|12/31/9999|$1|398.74|0|0|||EXPLORE/DRAIN EYE SOCKET|| 58-1699775|1326041732|CHC13|67445||11/01/2013|12/31/9999|$1|685.61|0|0|||EXPLR/DECOMPRESS EYE SOCKET|| 58-1699775|1326041732|CHC13|67450||11/01/2013|12/31/9999|$1|453.64|0|0|||EXPLORE/BIOPSY EYE SOCKET|| 58-1699775|1326041732|CHC13|67500||11/01/2013|12/31/9999|$89.68|0|0|||INJECT/TREAT EYE SOCKET|| 58-1699775|1326041732|CHC13|67505||11/01/2013|12/31/9999|$99.07|0|0|||INJECT/TREAT EYE SOCKET|| 58-1699775|1326041732|CHC13|67515||11/01/2013|12/31/9999|$107.66|0|0|||INJECT/TREAT EYE SOCKET|| 58-1699775|1326041732|CHC13|67550||11/01/2013|12/31/9999|$1|151.71|0|0|||INSERT EYE SOCKET IMPLANT|| 58-1699775|1326041732|CHC13|67560||11/01/2013|12/31/9999|$1|145.68|0|0|||REVISE EYE SOCKET IMPLANT|| 58-1699775|1326041732|CHC13|67570||11/01/2013|12/31/9999|$1|456.38|0|0|||DECOMPRESS OPTIC NERVE|| 58-1699775|1326041732|CHC13|67599||11/01/2013|12/31/9999|$0.00|0|0|||ORBIT SURGERY PROCEDURE|| 58-1699775|1326041732|CHC13|67700||11/01/2013|12/31/9999|$136.27|0|0|||DRAINAGE OF EYELID ABSCESS|| 58-1699775|1326041732|CHC13|67710||11/01/2013|12/31/9999|$115.34|0|0|||INCISION OF EYELID|| 58-1699775|1326041732|CHC13|67715||11/01/2013|12/31/9999|$130.02|0|0|||INCISION OF EYELID FOLD|| 58-1699775|1326041732|CHC13|67800||11/01/2013|12/31/9999|$123.34|0|0|||REMOVE EYELID LESION|| 58-1699775|1326041732|CHC13|67801||11/01/2013|12/31/9999|$161.59|0|0|||REMOVE EYELID LESIONS|| 58-1699775|1326041732|CHC13|67805||11/01/2013|12/31/9999|$198.77|0|0|||REMOVE EYELID LESIONS|| 58-1699775|1326041732|CHC13|67808||11/01/2013|12/31/9999|$438.72|0|0|||REMOVE EYELID LESION(S)|| 58-1699775|1326041732|CHC13|67810||11/01/2013|12/31/9999|$108.72|0|0|||BIOPSY OF EYELID|| 58-1699775|1326041732|CHC13|67820||11/01/2013|12/31/9999|$63.21|0|0|||REVISE EYELASHES|| 58-1699775|1326041732|CHC13|67825||11/01/2013|12/31/9999|$144.10|0|0|||REVISE EYELASHES|| 58-1699775|1326041732|CHC13|67830||11/01/2013|12/31/9999|$165.06|0|0|||REVISE EYELASHES|| 58-1699775|1326041732|CHC13|67835||11/01/2013|12/31/9999|$526.69|0|0|||REVISE EYELASHES|| 58-1699775|1326041732|CHC13|67840||11/01/2013|12/31/9999|$187.55|0|0|||REMOVE EYELID LESION|| 58-1699775|1326041732|CHC13|67850||11/01/2013|12/31/9999|$161.07|0|0|||TREAT EYELID LESION|| 58-1699775|1326041732|CHC13|67875||11/01/2013|12/31/9999|$116.58|0|0|||CLOSURE OF EYELID BY SUTURE|| 58-1699775|1326041732|CHC13|67880||11/01/2013|12/31/9999|$436.32|0|0|||REVISION OF EYELID|| 58-1699775|1326041732|CHC13|67882||11/01/2013|12/31/9999|$564.44|0|0|||REVISION OF EYELID|| 58-1699775|1326041732|CHC13|67900||11/01/2013|12/31/9999|$608.47|0|0|||REPAIR BROW DEFECT|| 58-1699775|1326041732|CHC13|67901||11/01/2013|12/31/9999|$690.87|0|0|||REPAIR EYELID DEFECT|| 58-1699775|1326041732|CHC13|67902||11/01/2013|12/31/9999|$867.68|0|0|||REPAIR EYELID DEFECT|| 58-1699775|1326041732|CHC13|67903||11/01/2013|12/31/9999|$583.88|0|0|||REPAIR EYELID DEFECT|| 58-1699775|1326041732|CHC13|67904||11/01/2013|12/31/9999|$714.32|0|0|||REPAIR EYELID DEFECT|| 58-1699775|1326041732|CHC13|67906||11/01/2013|12/31/9999|$578.59|0|0|||REPAIR EYELID DEFECT|| 58-1699775|1326041732|CHC13|67908||11/01/2013|12/31/9999|$509.57|0|0|||REPAIR EYELID DEFECT|| 58-1699775|1326041732|CHC13|67909||11/01/2013|12/31/9999|$525.71|0|0|||REVISE EYELID DEFECT|| 58-1699775|1326041732|CHC13|67911||11/01/2013|12/31/9999|$670.87|0|0|||REVISE EYELID DEFECT|| 58-1699775|1326041732|CHC13|67912||11/01/2013|12/31/9999|$578.97|0|0|||CORRECTION EYELID W/IMPLANT|| 58-1699775|1326041732|CHC13|67914||11/01/2013|12/31/9999|$343.81|0|0|||REPAIR EYELID DEFECT|| 58-1699775|1326041732|CHC13|67915||11/01/2013|12/31/9999|$298.22|0|0|||REPAIR EYELID DEFECT|| 58-1699775|1326041732|CHC13|67916||11/01/2013|12/31/9999|$512.52|0|0|||REPAIR EYELID DEFECT|| 58-1699775|1326041732|CHC13|67917||11/01/2013|12/31/9999|$567.83|0|0|||REPAIR EYELID DEFECT|| 58-1699775|1326041732|CHC13|67921||11/01/2013|12/31/9999|$324.64|0|0|||REPAIR EYELID DEFECT|| 58-1699775|1326041732|CHC13|67922||11/01/2013|12/31/9999|$286.58|0|0|||REPAIR EYELID DEFECT|| 58-1699775|1326041732|CHC13|67923||11/01/2013|12/31/9999|$556.87|0|0|||REPAIR EYELID DEFECT|| 58-1699775|1326041732|CHC13|67924||11/01/2013|12/31/9999|$537.63|0|0|||REPAIR EYELID DEFECT|| 58-1699775|1326041732|CHC13|67930||11/01/2013|12/31/9999|$294.13|0|0|||REPAIR EYELID WOUND|| 58-1699775|1326041732|CHC13|67935||11/01/2013|12/31/9999|$537.35|0|0|||REPAIR EYELID WOUND|| 58-1699775|1326041732|CHC13|67938||11/01/2013|12/31/9999|$136.17|0|0|||REMOVE EYELID FOREIGN BODY|| 58-1699775|1326041732|CHC13|67950||11/01/2013|12/31/9999|$553.89|0|0|||REVISION OF EYELID|| 58-1699775|1326041732|CHC13|67961||11/01/2013|12/31/9999|$544.16|0|0|||REVISION OF EYELID|| 58-1699775|1326041732|CHC13|67966||11/01/2013|12/31/9999|$787.67|0|0|||REVISION OF EYELID|| 58-1699775|1326041732|CHC13|67971||11/01/2013|12/31/9999|$874.28|0|0|||RECONSTRUCTION OF EYELID|| 58-1699775|1326041732|CHC13|67973||11/01/2013|12/31/9999|$1|128.94|0|0|||RECONSTRUCTION OF EYELID|| 58-1699775|1326041732|CHC13|67974||11/01/2013|12/31/9999|$1|126.14|0|0|||RECONSTRUCTION OF EYELID|| 58-1699775|1326041732|CHC13|67975||11/01/2013|12/31/9999|$826.56|0|0|||RECONSTRUCTION OF EYELID|| 58-1699775|1326041732|CHC13|67999||11/01/2013|12/31/9999|$0.00|0|0|||REVISION OF EYELID|| 58-1699775|1326041732|CHC13|68020||11/01/2013|12/31/9999|$129.83|0|0|||INCISE/DRAIN EYELID LINING|| 58-1699775|1326041732|CHC13|68040||11/01/2013|12/31/9999|$64.64|0|0|||TREATMENT OF EYELID LESIONS|| 58-1699775|1326041732|CHC13|68100||11/01/2013|12/31/9999|$115.77|0|0|||BIOPSY OF EYELID LINING|| 58-1699775|1326041732|CHC13|68110||11/01/2013|12/31/9999|$176.84|0|0|||REMOVE EYELID LINING LESION|| 58-1699775|1326041732|CHC13|68115||11/01/2013|12/31/9999|$214.12|0|0|||REMOVE EYELID LINING LESION|| 58-1699775|1326041732|CHC13|68130||11/01/2013|12/31/9999|$466.17|0|0|||REMOVE EYELID LINING LESION|| 58-1699775|1326041732|CHC13|68135||11/01/2013|12/31/9999|$176.26|0|0|||REMOVE EYELID LINING LESION|| 58-1699775|1326041732|CHC13|68200||11/01/2013|12/31/9999|$41.58|0|0|||TREAT EYELID BY INJECTION|| 58-1699775|1326041732|CHC13|68320||11/01/2013|12/31/9999|$641.40|0|0|||REVISE/GRAFT EYELID LINING|| 58-1699775|1326041732|CHC13|68325||11/01/2013|12/31/9999|$790.38|0|0|||REVISE/GRAFT EYELID LINING|| 58-1699775|1326041732|CHC13|68326||11/01/2013|12/31/9999|$773.75|0|0|||REVISE/GRAFT EYELID LINING|| 58-1699775|1326041732|CHC13|68328||11/01/2013|12/31/9999|$853.76|0|0|||REVISE/GRAFT EYELID LINING|| 58-1699775|1326041732|CHC13|68330||11/01/2013|12/31/9999|$550.36|0|0|||REVISE EYELID LINING|| 58-1699775|1326041732|CHC13|68335||11/01/2013|12/31/9999|$776.23|0|0|||REVISE/GRAFT EYELID LINING|| 58-1699775|1326041732|CHC13|68340||11/01/2013|12/31/9999|$476.35|0|0|||SEPARATE EYELID ADHESIONS|| 58-1699775|1326041732|CHC13|68360||11/01/2013|12/31/9999|$491.39|0|0|||REVISE EYELID LINING|| 58-1699775|1326041732|CHC13|68362||11/01/2013|12/31/9999|$786.86|0|0|||REVISE EYELID LINING|| 58-1699775|1326041732|CHC13|68371||11/01/2013|12/31/9999|$467.65|0|0|||HARVEST EYE TISSUE| ALOGRAFT|| 58-1699775|1326041732|CHC13|68399||11/01/2013|12/31/9999|$0.00|0|0|||EYELID LINING SURGERY|| 58-1699775|1326041732|CHC13|68400||11/01/2013|12/31/9999|$159.29|0|0|||INCISE/DRAIN TEAR GLAND|| 58-1699775|1326041732|CHC13|68420||11/01/2013|12/31/9999|$198.56|0|0|||INCISE/DRAIN TEAR SAC|| 58-1699775|1326041732|CHC13|68440||11/01/2013|12/31/9999|$116.12|0|0|||INCISE TEAR DUCT OPENING|| 58-1699775|1326041732|CHC13|68500||11/01/2013|12/31/9999|$1|187.88|0|0|||REMOVAL OF TEAR GLAND|| 58-1699775|1326041732|CHC13|68505||11/01/2013|12/31/9999|$1|165.48|0|0|||PARTIAL REMOVAL| TEAR GLAND|| 58-1699775|1326041732|CHC13|68510||11/01/2013|12/31/9999|$358.10|0|0|||BIOPSY OF TEAR GLAND|| 58-1699775|1326041732|CHC13|68520||11/01/2013|12/31/9999|$802.56|0|0|||REMOVAL OF TEAR SAC|| 58-1699775|1326041732|CHC13|68525||11/01/2013|12/31/9999|$326.32|0|0|||BIOPSY OF TEAR SAC|| 58-1699775|1326041732|CHC13|68530||11/01/2013|12/31/9999|$312.32|0|0|||CLEARANCE OF TEAR DUCT|| 58-1699775|1326041732|CHC13|68540||11/01/2013|12/31/9999|$1|081.87|0|0|||REMOVE TEAR GLAND LESION|| 58-1699775|1326041732|CHC13|68550||11/01/2013|12/31/9999|$1|144.17|0|0|||REMOVE TEAR GLAND LESION|| 58-1699775|1326041732|CHC13|68700||11/01/2013|12/31/9999|$723.85|0|0|||REPAIR TEAR DUCTS|| 58-1699775|1326041732|CHC13|68705||11/01/2013|12/31/9999|$198.42|0|0|||REVISE TEAR DUCT OPENING|| 58-1699775|1326041732|CHC13|68720||11/01/2013|12/31/9999|$896.60|0|0|||CREATE TEAR SAC DRAIN|| 58-1699775|1326041732|CHC13|68745||11/01/2013|12/31/9999|$911.61|0|0|||CREATE TEAR DUCT DRAIN|| 58-1699775|1326041732|CHC13|68750||11/01/2013|12/31/9999|$942.31|0|0|||CREATE TEAR DUCT DRAIN|| 58-1699775|1326041732|CHC13|68760||11/01/2013|12/31/9999|$173.60|0|0|||CLOSE TEAR DUCT OPENING|| 58-1699775|1326041732|CHC13|68761||11/01/2013|12/31/9999|$139.74|0|0|||CLOSE TEAR DUCT OPENING|| 58-1699775|1326041732|CHC13|68770||11/01/2013|12/31/9999|$745.64|0|0|||CLOSE TEAR SYSTEM FISTULA|| 58-1699775|1326041732|CHC13|68801||11/01/2013|12/31/9999|$124.51|0|0|||DILATE TEAR DUCT OPENING|| 58-1699775|1326041732|CHC13|68810||11/01/2013|12/31/9999|$222.26|0|0|||PROBE NASOLACRIMAL DUCT|| 58-1699775|1326041732|CHC13|68811||11/01/2013|12/31/9999|$245.84|0|0|||PROBE NASOLACRIMAL DUCT|| 58-1699775|1326041732|CHC13|68815||11/01/2013|12/31/9999|$306.21|0|0|||PROBE NASOLACRIMAL DUCT|| 58-1699775|1326041732|CHC13|68816||11/01/2013|12/31/9999|$299.07|0|0|||PROBE NL DUCT W/BALLOON|| 58-1699775|1326041732|CHC13|68840||11/01/2013|12/31/9999|$136.62|0|0|||EXPLORE/IRRIGATE TEAR DUCTS|| 58-1699775|1326041732|CHC13|68850||11/01/2013|12/31/9999|$63.93|0|0|||INJECTION FOR TEAR SAC X-RAY|| 58-1699775|1326041732|CHC13|68899||11/01/2013|12/31/9999|$0.00|0|0|||TEAR DUCT SYSTEM SURGERY|| 58-1699775|1326041732|CHC13|69000||11/01/2013|12/31/9999|$171.83|0|0|||DRAIN EXTERNAL EAR LESION|| 58-1699775|1326041732|CHC13|69005||11/01/2013|12/31/9999|$228.10|0|0|||DRAIN EXTERNAL EAR LESION|| 58-1699775|1326041732|CHC13|69020||11/01/2013|12/31/9999|$206.34|0|0|||DRAIN OUTER EAR CANAL LESION|| 58-1699775|1326041732|CHC13|69090||11/01/2013|12/31/9999|$46.53|0|0|||PIERCE EARLOBES|| 58-1699775|1326041732|CHC13|69100||11/01/2013|12/31/9999|$71.33|0|0|||BIOPSY OF EXTERNAL EAR|| 58-1699775|1326041732|CHC13|69105||11/01/2013|12/31/9999|$92.15|0|0|||BIOPSY OF EXTERNAL EAR CANAL|| 58-1699775|1326041732|CHC13|69110||11/01/2013|12/31/9999|$467.59|0|0|||REMOVE EXTERNAL EAR| PARTIAL|| 58-1699775|1326041732|CHC13|69120||11/01/2013|12/31/9999|$577.71|0|0|||REMOVAL OF EXTERNAL EAR|| 58-1699775|1326041732|CHC13|69140||11/01/2013|12/31/9999|$1|260.82|0|0|||REMOVE EAR CANAL LESION(S)|| 58-1699775|1326041732|CHC13|69145||11/01/2013|12/31/9999|$359.84|0|0|||REMOVE EAR CANAL LESION(S)|| 58-1699775|1326041732|CHC13|69150||11/01/2013|12/31/9999|$1|517.18|0|0|||EXTENSIVE EAR CANAL SURGERY|| 58-1699775|1326041732|CHC13|69155||11/01/2013|12/31/9999|$2|428.27|0|0|||EXTENSIVE EAR/NECK SURGERY|| 58-1699775|1326041732|CHC13|69200||11/01/2013|12/31/9999|$83.02|0|0|||CLEAR OUTER EAR CANAL|| 58-1699775|1326041732|CHC13|69205||11/01/2013|12/31/9999|$145.93|0|0|||CLEAR OUTER EAR CANAL|| 58-1699775|1326041732|CHC13|69209||04/01/2016|12/31/9999|$17.38|0|0|0||REMOVE IMPACTED EAR WAX UNI|| 58-1699775|1326041732|CHC13|69210||04/01/2014|12/31/9999|$49.26|0|0|||REMOVE IMPACTED EAR WAX|| 58-1699775|1326041732|CHC13|69220||11/01/2013|12/31/9999|$89.75|0|0|||CLEAN OUT MASTOID CAVITY|| 58-1699775|1326041732|CHC13|69222||11/01/2013|12/31/9999|$198.10|0|0|||CLEAN OUT MASTOID CAVITY|| 58-1699775|1326041732|CHC13|69300||11/01/2013|12/31/9999|$689.96|0|0|||REVISE EXTERNAL EAR|| 58-1699775|1326041732|CHC13|69310||11/01/2013|12/31/9999|$1|564.55|0|0|||REBUILD OUTER EAR CANAL|| 58-1699775|1326041732|CHC13|69320||11/01/2013|12/31/9999|$2|211.96|0|0|||REBUILD OUTER EAR CANAL|| 58-1699775|1326041732|CHC13|69399||11/01/2013|12/31/9999|$0.00|0|0|||OUTER EAR SURGERY PROCEDURE|| 58-1699775|1326041732|CHC13|69420||11/01/2013|12/31/9999|$174.35|0|0|||INCISION OF EARDRUM|| 58-1699775|1326041732|CHC13|69421||11/01/2013|12/31/9999|$216.86|0|0|||INCISION OF EARDRUM|| 58-1699775|1326041732|CHC13|69424||11/01/2013|12/31/9999|$90.32|0|0|||REMOVE VENTILATING TUBE|| 58-1699775|1326041732|CHC13|69433||11/01/2013|12/31/9999|$189.16|0|0|||CREATE EARDRUM OPENING|| 58-1699775|1326041732|CHC13|69436||11/01/2013|12/31/9999|$234.15|0|0|||CREATE EARDRUM OPENING|| 58-1699775|1326041732|CHC13|69440||11/01/2013|12/31/9999|$995.32|0|0|||EXPLORATION OF MIDDLE EAR|| 58-1699775|1326041732|CHC13|69450||11/01/2013|12/31/9999|$784.95|0|0|||EARDRUM REVISION|| 58-1699775|1326041732|CHC13|69501||11/01/2013|12/31/9999|$1|060.73|0|0|||MASTOIDECTOMY|| 58-1699775|1326041732|CHC13|69502||11/01/2013|12/31/9999|$1|409.07|0|0|||MASTOIDECTOMY|| 58-1699775|1326041732|CHC13|69505||11/01/2013|12/31/9999|$1|739.16|0|0|||REMOVE MASTOID STRUCTURES|| 58-1699775|1326041732|CHC13|69511||11/01/2013|12/31/9999|$1|783.29|0|0|||EXTENSIVE MASTOID SURGERY|| 58-1699775|1326041732|CHC13|69530||11/01/2013|12/31/9999|$2|396.15|0|0|||EXTENSIVE MASTOID SURGERY|| 58-1699775|1326041732|CHC13|69535||11/01/2013|12/31/9999|$3|880.40|0|0|||REMOVE PART OF TEMPORAL BONE|| 58-1699775|1326041732|CHC13|69540||11/01/2013|12/31/9999|$184.19|0|0|||REMOVE EAR LESION|| 58-1699775|1326041732|CHC13|69550||11/01/2013|12/31/9999|$1|504.05|0|0|||REMOVE EAR LESION|| 58-1699775|1326041732|CHC13|69552||11/01/2013|12/31/9999|$2|277.09|0|0|||REMOVE EAR LESION|| 58-1699775|1326041732|CHC13|69554||11/01/2013|12/31/9999|$3|654.12|0|0|||REMOVE EAR LESION|| 58-1699775|1326041732|CHC13|69601||11/01/2013|12/31/9999|$1|518.27|0|0|||MASTOID SURGERY REVISION|| 58-1699775|1326041732|CHC13|69602||11/01/2013|12/31/9999|$1|579.58|0|0|||MASTOID SURGERY REVISION|| 58-1699775|1326041732|CHC13|69603||11/01/2013|12/31/9999|$1|825.41|0|0|||MASTOID SURGERY REVISION|| 58-1699775|1326041732|CHC13|69604||11/01/2013|12/31/9999|$1|617.71|0|0|||MASTOID SURGERY REVISION|| 58-1699775|1326041732|CHC13|69605||11/01/2013|12/31/9999|$2|260.02|0|0|||MASTOID SURGERY REVISION|| 58-1699775|1326041732|CHC13|69610||11/01/2013|12/31/9999|$426.73|0|0|||REPAIR OF EARDRUM|| 58-1699775|1326041732|CHC13|69620||11/01/2013|12/31/9999|$707.00|0|0|||REPAIR OF EARDRUM|| 58-1699775|1326041732|CHC13|69631||11/01/2013|12/31/9999|$1|278.01|0|0|||REPAIR EARDRUM STRUCTURES|| 58-1699775|1326041732|CHC13|69632||11/01/2013|12/31/9999|$1|561.49|0|0|||REBUILD EARDRUM STRUCTURES|| 58-1699775|1326041732|CHC13|69633||11/01/2013|12/31/9999|$1|508.48|0|0|||REBUILD EARDRUM STRUCTURES|| 58-1699775|1326041732|CHC13|69635||11/01/2013|12/31/9999|$1|765.30|0|0|||REPAIR EARDRUM STRUCTURES|| 58-1699775|1326041732|CHC13|69636||11/01/2013|12/31/9999|$1|994.80|0|0|||REBUILD EARDRUM STRUCTURES|| 58-1699775|1326041732|CHC13|69637||11/01/2013|12/31/9999|$1|988.32|0|0|||REBUILD EARDRUM STRUCTURES|| 58-1699775|1326041732|CHC13|69641||11/01/2013|12/31/9999|$1|510.25|0|0|||REVISE MIDDLE EAR & MASTOID|| 58-1699775|1326041732|CHC13|69642||11/01/2013|12/31/9999|$1|939.90|0|0|||REVISE MIDDLE EAR & MASTOID|| 58-1699775|1326041732|CHC13|69643||11/01/2013|12/31/9999|$1|774.23|0|0|||REVISE MIDDLE EAR & MASTOID|| 58-1699775|1326041732|CHC13|69644||11/01/2013|12/31/9999|$2|141.65|0|0|||REVISE MIDDLE EAR & MASTOID|| 58-1699775|1326041732|CHC13|69645||11/01/2013|12/31/9999|$2|101.74|0|0|||REVISE MIDDLE EAR & MASTOID|| 58-1699775|1326041732|CHC13|69646||11/01/2013|12/31/9999|$2|231.69|0|0|||REVISE MIDDLE EAR & MASTOID|| 58-1699775|1326041732|CHC13|69650||11/01/2013|12/31/9999|$1|161.57|0|0|||RELEASE MIDDLE EAR BONE|| 58-1699775|1326041732|CHC13|69660||11/01/2013|12/31/9999|$1|346.49|0|0|||REVISE MIDDLE EAR BONE|| 58-1699775|1326041732|CHC13|69661||11/01/2013|12/31/9999|$1|753.49|0|0|||REVISE MIDDLE EAR BONE|| 58-1699775|1326041732|CHC13|69662||11/01/2013|12/31/9999|$1|680.75|0|0|||REVISE MIDDLE EAR BONE|| 58-1699775|1326041732|CHC13|69666||11/01/2013|12/31/9999|$1|166.67|0|0|||REPAIR MIDDLE EAR STRUCTURES|| 58-1699775|1326041732|CHC13|69667||11/01/2013|12/31/9999|$1|169.47|0|0|||REPAIR MIDDLE EAR STRUCTURES|| 58-1699775|1326041732|CHC13|69670||11/01/2013|12/31/9999|$1|368.25|0|0|||REMOVE MASTOID AIR CELLS|| 58-1699775|1326041732|CHC13|69676||11/01/2013|12/31/9999|$1|204.08|0|0|||REMOVE MIDDLE EAR NERVE|| 58-1699775|1326041732|CHC13|69700||11/01/2013|12/31/9999|$996.60|0|0|||CLOSE MASTOID FISTULA|| 58-1699775|1326041732|CHC13|69710||11/01/2013|12/31/9999|$0.00|0|0|||IMPLANT/REPLACE HEARING AID|| 58-1699775|1326041732|CHC13|69711||11/01/2013|12/31/9999|$1|252.21|0|0|||REMOVE/REPAIR HEARING AID|| 58-1699775|1326041732|CHC13|69714||11/01/2013|12/31/9999|$1|561.76|0|0|||IMPLANT TEMPLE BONE W/STIMUL|| 58-1699775|1326041732|CHC13|69715||11/01/2013|12/31/9999|$1|936.39|0|0|||TEMPLE BNE IMPLNT W/STIMULAT|| 58-1699775|1326041732|CHC13|69717||11/01/2013|12/31/9999|$1|647.73|0|0|||TEMPLE BONE IMPLANT REVISION|| 58-1699775|1326041732|CHC13|69718||11/01/2013|12/31/9999|$1|957.45|0|0|||REVISE TEMPLE BONE IMPLANT|| 58-1699775|1326041732|CHC13|69720||11/01/2013|12/31/9999|$1|718.13|0|0|||RELEASE FACIAL NERVE|| 58-1699775|1326041732|CHC13|69725||11/01/2013|12/31/9999|$2|742.58|0|0|||RELEASE FACIAL NERVE|| 58-1699775|1326041732|CHC13|69740||11/01/2013|12/31/9999|$1|699.95|0|0|||REPAIR FACIAL NERVE|| 58-1699775|1326041732|CHC13|69745||11/01/2013|12/31/9999|$1|809.92|0|0|||REPAIR FACIAL NERVE|| 58-1699775|1326041732|CHC13|69799||11/01/2013|12/31/9999|$0.00|0|0|||MIDDLE EAR SURGERY PROCEDURE|| 58-1699775|1326041732|CHC13|69801||11/01/2013|12/31/9999|$301.36|0|0|||INCISE INNER EAR|| 58-1699775|1326041732|CHC13|69805||11/01/2013|12/31/9999|$1|534.28|0|0|||EXPLORE INNER EAR|| 58-1699775|1326041732|CHC13|69806||11/01/2013|12/31/9999|$1|373.12|0|0|||EXPLORE INNER EAR|| 58-1699775|1326041732|CHC13|69820||11/01/2013|12/31/9999|$1|245.27|0|0|||ESTABLISH INNER EAR WINDOW|| 58-1699775|1326041732|CHC13|69840||11/01/2013|12/31/9999|$1|284.69|0|0|||REVISE INNER EAR WINDOW|| 58-1699775|1326041732|CHC13|69905||11/01/2013|12/31/9999|$1|332.72|0|0|||REMOVE INNER EAR|| 58-1699775|1326041732|CHC13|69910||11/01/2013|12/31/9999|$1|481.83|0|0|||REMOVE INNER EAR & MASTOID|| 58-1699775|1326041732|CHC13|69915||11/01/2013|12/31/9999|$2|245.46|0|0|||INCISE INNER EAR NERVE|| 58-1699775|1326041732|CHC13|69930||11/01/2013|12/31/9999|$1|788.08|0|0|||IMPLANT COCHLEAR DEVICE|| 58-1699775|1326041732|CHC13|69949||11/01/2013|12/31/9999|$0.00|0|0|||INNER EAR SURGERY PROCEDURE|| 58-1699775|1326041732|CHC13|69950||11/01/2013|12/31/9999|$2|613.23|0|0|||INCISE INNER EAR NERVE|| 58-1699775|1326041732|CHC13|69955||11/01/2013|12/31/9999|$2|888.83|0|0|||RELEASE FACIAL NERVE|| 58-1699775|1326041732|CHC13|69960||11/01/2013|12/31/9999|$2|811.80|0|0|||RELEASE INNER EAR CANAL|| 58-1699775|1326041732|CHC13|69970||11/01/2013|12/31/9999|$3|131.02|0|0|||REMOVE INNER EAR LESION|| 58-1699775|1326041732|CHC13|69979||11/01/2013|12/31/9999|$0.00|0|0|||TEMPORAL BONE SURGERY|| 58-1699775|1326041732|CHC13|69990||11/01/2013|12/31/9999|$315.06|0|0|||MICROSURGERY ADD-ON|| 58-1699775|1326041732|CHC13|70010||11/01/2013|12/31/9999|$147.39|0|0|||CONTRAST X-RAY OF BRAIN|| 58-1699775|1326041732|CHC13|70015||11/01/2013|12/31/9999|$238.95|0|0|||CONTRAST X-RAY OF BRAIN|| 58-1699775|1326041732|CHC13|70015|26|11/01/2013|12/31/9999|$94.69|0|0|||CONTRAST X-RAY OF BRAIN|| 58-1699775|1326041732|CHC13|70015|TC|11/01/2013|12/31/9999|$144.26|0|0|||CONTRAST X-RAY OF BRAIN|| 58-1699775|1326041732|CHC13|70030||11/01/2013|12/31/9999|$44.38|0|0|||X-RAY EYE FOR FOREIGN BODY|| 58-1699775|1326041732|CHC13|70030|26|11/01/2013|12/31/9999|$13.09|0|0|||X-RAY EYE FOR FOREIGN BODY|| 58-1699775|1326041732|CHC13|70030|TC|11/01/2013|12/31/9999|$31.29|0|0|||X-RAY EYE FOR FOREIGN BODY|| 58-1699775|1326041732|CHC13|70100||11/01/2013|12/31/9999|$53.01|0|0|||X-RAY EXAM OF JAW|| 58-1699775|1326041732|CHC13|70100|26|11/01/2013|12/31/9999|$14.16|0|0|||X-RAY EXAM OF JAW|| 58-1699775|1326041732|CHC13|70100|TC|11/01/2013|12/31/9999|$38.85|0|0|||X-RAY EXAM OF JAW|| 58-1699775|1326041732|CHC13|7010F||11/01/2013|12/31/9999|$0.00|0|0|||PT INFO INTO RECALL SYSTEM|| 58-1699775|1326041732|CHC13|70110||11/01/2013|12/31/9999|$61.48|0|0|||X-RAY EXAM OF JAW|| 58-1699775|1326041732|CHC13|70110|26|11/01/2013|12/31/9999|$19.61|0|0|||X-RAY EXAM OF JAW|| 58-1699775|1326041732|CHC13|70110|TC|11/01/2013|12/31/9999|$41.88|0|0|||X-RAY EXAM OF JAW|| 58-1699775|1326041732|CHC13|70120||11/01/2013|12/31/9999|$56.04|0|0|||X-RAY EXAM OF MASTOIDS|| 58-1699775|1326041732|CHC13|70120|26|11/01/2013|12/31/9999|$14.67|0|0|||X-RAY EXAM OF MASTOIDS|| 58-1699775|1326041732|CHC13|70120|TC|11/01/2013|12/31/9999|$41.37|0|0|||X-RAY EXAM OF MASTOIDS|| 58-1699775|1326041732|CHC13|70130||11/01/2013|12/31/9999|$88.22|0|0|||X-RAY EXAM OF MASTOIDS|| 58-1699775|1326041732|CHC13|70130|26|11/01/2013|12/31/9999|$26.68|0|0|||X-RAY EXAM OF MASTOIDS|| 58-1699775|1326041732|CHC13|70130|TC|11/01/2013|12/31/9999|$61.55|0|0|||X-RAY EXAM OF MASTOIDS|| 58-1699775|1326041732|CHC13|70134||11/01/2013|12/31/9999|$86.71|0|0|||X-RAY EXAM OF MIDDLE EAR|| 58-1699775|1326041732|CHC13|70134|26|11/01/2013|12/31/9999|$28.19|0|0|||X-RAY EXAM OF MIDDLE EAR|| 58-1699775|1326041732|CHC13|70134|TC|11/01/2013|12/31/9999|$58.52|0|0|||X-RAY EXAM OF MIDDLE EAR|| 58-1699775|1326041732|CHC13|70140||11/01/2013|12/31/9999|$47.02|0|0|||X-RAY EXAM OF FACIAL BONES|| 58-1699775|1326041732|CHC13|70140|26|11/01/2013|12/31/9999|$15.73|0|0|||X-RAY EXAM OF FACIAL BONES|| 58-1699775|1326041732|CHC13|70140|TC|11/01/2013|12/31/9999|$31.29|0|0|||X-RAY EXAM OF FACIAL BONES|| 58-1699775|1326041732|CHC13|70150||11/01/2013|12/31/9999|$66.08|0|0|||X-RAY EXAM OF FACIAL BONES|| 58-1699775|1326041732|CHC13|70150|26|11/01/2013|12/31/9999|$20.17|0|0|||X-RAY EXAM OF FACIAL BONES|| 58-1699775|1326041732|CHC13|70150|TC|11/01/2013|12/31/9999|$45.91|0|0|||X-RAY EXAM OF FACIAL BONES|| 58-1699775|1326041732|CHC13|70160||11/01/2013|12/31/9999|$51.44|0|0|||X-RAY EXAM OF NASAL BONES|| 58-1699775|1326041732|CHC13|70160|26|11/01/2013|12/31/9999|$13.60|0|0|||X-RAY EXAM OF NASAL BONES|| 58-1699775|1326041732|CHC13|70160|TC|11/01/2013|12/31/9999|$37.84|0|0|||X-RAY EXAM OF NASAL BONES|| 58-1699775|1326041732|CHC13|70170||11/01/2013|12/31/9999|$78.47|0|0|||X-RAY EXAM OF TEAR DUCT|| 58-1699775|1326041732|CHC13|70170|26|11/01/2013|12/31/9999|$23.96|0|0|||X-RAY EXAM OF TEAR DUCT|| 58-1699775|1326041732|CHC13|70170|TC|11/01/2013|12/31/9999|$54.53|0|0|||X-RAY EXAM OF TEAR DUCT|| 58-1699775|1326041732|CHC13|70190||11/01/2013|12/31/9999|$55.70|0|0|||X-RAY EXAM OF EYE SOCKETS|| 58-1699775|1326041732|CHC13|70190|26|11/01/2013|12/31/9999|$16.85|0|0|||X-RAY EXAM OF EYE SOCKETS|| 58-1699775|1326041732|CHC13|70190|TC|11/01/2013|12/31/9999|$38.85|0|0|||X-RAY EXAM OF EYE SOCKETS|| 58-1699775|1326041732|CHC13|70200||11/01/2013|12/31/9999|$67.71|0|0|||X-RAY EXAM OF EYE SOCKETS|| 58-1699775|1326041732|CHC13|70200|26|11/01/2013|12/31/9999|$21.79|0|0|||X-RAY EXAM OF EYE SOCKETS|| 58-1699775|1326041732|CHC13|70200|TC|11/01/2013|12/31/9999|$45.91|0|0|||X-RAY EXAM OF EYE SOCKETS|| 58-1699775|1326041732|CHC13|7020F||11/01/2013|12/31/9999|$0.00|0|0|||BRST IMAG-RPT/DATACAT DOCD|| 58-1699775|1326041732|CHC13|70210||11/01/2013|12/31/9999|$48.42|0|0|||X-RAY EXAM OF SINUSES|| 58-1699775|1326041732|CHC13|70210|26|11/01/2013|12/31/9999|$13.60|0|0|||X-RAY EXAM OF SINUSES|| 58-1699775|1326041732|CHC13|70210|TC|11/01/2013|12/31/9999|$34.82|0|0|||X-RAY EXAM OF SINUSES|| 58-1699775|1326041732|CHC13|70220||11/01/2013|12/31/9999|$60.98|0|0|||X-RAY EXAM OF SINUSES|| 58-1699775|1326041732|CHC13|70220|26|11/01/2013|12/31/9999|$19.61|0|0|||X-RAY EXAM OF SINUSES|| 58-1699775|1326041732|CHC13|70220|TC|11/01/2013|12/31/9999|$41.37|0|0|||X-RAY EXAM OF SINUSES|| 58-1699775|1326041732|CHC13|70240||11/01/2013|12/31/9999|$46.51|0|0|||X-RAY EXAM| PITUITARY SADDLE|| 58-1699775|1326041732|CHC13|70240|26|11/01/2013|12/31/9999|$15.23|0|0|||X-RAY EXAM| PITUITARY SADDLE|| 58-1699775|1326041732|CHC13|70240|TC|11/01/2013|12/31/9999|$31.29|0|0|||X-RAY EXAM| PITUITARY SADDLE|| 58-1699775|1326041732|CHC13|70250||11/01/2013|12/31/9999|$57.39|0|0|||X-RAY EXAM OF SKULL|| 58-1699775|1326041732|CHC13|70250|26|11/01/2013|12/31/9999|$19.04|0|0|||X-RAY EXAM OF SKULL|| 58-1699775|1326041732|CHC13|70250|TC|11/01/2013|12/31/9999|$38.35|0|0|||X-RAY EXAM OF SKULL|| 58-1699775|1326041732|CHC13|7025F||11/01/2013|12/31/9999|$0.00|0|0|||PT INFOSYS ALARM 4 NXT MAMMO|| 58-1699775|1326041732|CHC13|70260||11/01/2013|12/31/9999|$73.60|0|0|||X-RAY EXAM OF SKULL|| 58-1699775|1326041732|CHC13|70260|26|11/01/2013|12/31/9999|$26.68|0|0|||X-RAY EXAM OF SKULL|| 58-1699775|1326041732|CHC13|70260|TC|11/01/2013|12/31/9999|$46.92|0|0|||X-RAY EXAM OF SKULL|| 58-1699775|1326041732|CHC13|70300||11/01/2013|12/31/9999|$22.80|0|0|||X-RAY EXAM OF TEETH|| 58-1699775|1326041732|CHC13|70300|26|11/01/2013|12/31/9999|$9.16|0|0|||X-RAY EXAM OF TEETH|| 58-1699775|1326041732|CHC13|70300|TC|11/01/2013|12/31/9999|$13.63|0|0|||X-RAY EXAM OF TEETH|| 58-1699775|1326041732|CHC13|70310||11/01/2013|12/31/9999|$57.94|0|0|||X-RAY EXAM OF TEETH|| 58-1699775|1326041732|CHC13|70310|26|11/01/2013|12/31/9999|$13.04|0|0|||X-RAY EXAM OF TEETH|| 58-1699775|1326041732|CHC13|70310|TC|11/01/2013|12/31/9999|$44.90|0|0|||X-RAY EXAM OF TEETH|| 58-1699775|1326041732|CHC13|70320||11/01/2013|12/31/9999|$78.96|0|0|||FULL MOUTH X-RAY OF TEETH|| 58-1699775|1326041732|CHC13|70320|26|11/01/2013|12/31/9999|$18.42|0|0|||FULL MOUTH X-RAY OF TEETH|| 58-1699775|1326041732|CHC13|70320|TC|11/01/2013|12/31/9999|$60.54|0|0|||FULL MOUTH X-RAY OF TEETH|| 58-1699775|1326041732|CHC13|70328||11/01/2013|12/31/9999|$47.97|0|0|||X-RAY EXAM OF JAW JOINT|| 58-1699775|1326041732|CHC13|70328|26|11/01/2013|12/31/9999|$14.16|0|0|||X-RAY EXAM OF JAW JOINT|| 58-1699775|1326041732|CHC13|70328|TC|11/01/2013|12/31/9999|$33.81|0|0|||X-RAY EXAM OF JAW JOINT|| 58-1699775|1326041732|CHC13|70330||11/01/2013|12/31/9999|$75.04|0|0|||X-RAY EXAM OF JAW JOINTS|| 58-1699775|1326041732|CHC13|70330|26|11/01/2013|12/31/9999|$19.55|0|0|||X-RAY EXAM OF JAW JOINTS|| 58-1699775|1326041732|CHC13|70330|TC|11/01/2013|12/31/9999|$55.49|0|0|||X-RAY EXAM OF JAW JOINTS|| 58-1699775|1326041732|CHC13|70332||11/01/2013|12/31/9999|$116.64|0|0|||X-RAY EXAM OF JAW JOINT|| 58-1699775|1326041732|CHC13|70332|26|11/01/2013|12/31/9999|$41.98|0|0|||X-RAY EXAM OF JAW JOINT|| 58-1699775|1326041732|CHC13|70332|TC|11/01/2013|12/31/9999|$74.66|0|0|||X-RAY EXAM OF JAW JOINT|| 58-1699775|1326041732|CHC13|70336||11/01/2013|12/31/9999|$623.41|0|0|||MAGNETIC IMAGE| JAW JOINT|| 58-1699775|1326041732|CHC13|70336|26|11/01/2013|12/31/9999|$114.52|0|0|||MAGNETIC IMAGE| JAW JOINT|| 58-1699775|1326041732|CHC13|70336|TC|11/01/2013|12/31/9999|$508.89|0|0|||MAGNETIC IMAGE| JAW JOINT|| 58-1699775|1326041732|CHC13|70350||11/01/2013|12/31/9999|$33.28|0|0|||X-RAY HEAD FOR ORTHODONTIA|| 58-1699775|1326041732|CHC13|70350|26|11/01/2013|12/31/9999|$15.11|0|0|||X-RAY HEAD FOR ORTHODONTIA|| 58-1699775|1326041732|CHC13|70350|TC|11/01/2013|12/31/9999|$18.17|0|0|||X-RAY HEAD FOR ORTHODONTIA|| 58-1699775|1326041732|CHC13|70355||11/01/2013|12/31/9999|$32.95|0|0|||PANORAMIC X-RAY OF JAWS|| 58-1699775|1326041732|CHC13|70355|26|11/01/2013|12/31/9999|$16.80|0|0|||PANORAMIC X-RAY OF JAWS|| 58-1699775|1326041732|CHC13|70355|TC|11/01/2013|12/31/9999|$16.16|0|0|||PANORAMIC X-RAY OF JAWS|| 58-1699775|1326041732|CHC13|70360||11/01/2013|12/31/9999|$41.86|0|0|||X-RAY EXAM OF NECK|| 58-1699775|1326041732|CHC13|70360|26|11/01/2013|12/31/9999|$13.09|0|0|||X-RAY EXAM OF NECK|| 58-1699775|1326041732|CHC13|70360|TC|11/01/2013|12/31/9999|$28.76|0|0|||X-RAY EXAM OF NECK|| 58-1699775|1326041732|CHC13|70370||11/01/2013|12/31/9999|$131.99|0|0|||THROAT X-RAY & FLUOROSCOPY|| 58-1699775|1326041732|CHC13|70370|26|11/01/2013|12/31/9999|$25.05|0|0|||THROAT X-RAY & FLUOROSCOPY|| 58-1699775|1326041732|CHC13|70370|TC|11/01/2013|12/31/9999|$106.94|0|0|||THROAT X-RAY & FLUOROSCOPY|| 58-1699775|1326041732|CHC13|70371||11/01/2013|12/31/9999|$146.09|0|0|||SPEECH EVALUATION| COMPLEX|| 58-1699775|1326041732|CHC13|70371|26|11/01/2013|12/31/9999|$65.38|0|0|||SPEECH EVALUATION| COMPLEX|| 58-1699775|1326041732|CHC13|70371|TC|11/01/2013|12/31/9999|$80.71|0|0|||SPEECH EVALUATION| COMPLEX|| 58-1699775|1326041732|CHC13|70380||11/01/2013|12/31/9999|$62.03|0|0|||X-RAY EXAM OF SALIVARY GLAND|| 58-1699775|1326041732|CHC13|70380|26|11/01/2013|12/31/9999|$14.61|0|0|||X-RAY EXAM OF SALIVARY GLAND|| 58-1699775|1326041732|CHC13|70380|TC|11/01/2013|12/31/9999|$47.42|0|0|||X-RAY EXAM OF SALIVARY GLAND|| 58-1699775|1326041732|CHC13|70390||11/01/2013|12/31/9999|$157.08|0|0|||X-RAY EXAM OF SALIVARY DUCT|| 58-1699775|1326041732|CHC13|70390|26|11/01/2013|12/31/9999|$29.97|0|0|||X-RAY EXAM OF SALIVARY DUCT|| 58-1699775|1326041732|CHC13|70390|TC|11/01/2013|12/31/9999|$127.11|0|0|||X-RAY EXAM OF SALIVARY DUCT|| 58-1699775|1326041732|CHC13|70450||11/01/2013|12/31/9999|$278.30|0|0|||CT HEAD/BRAIN W/O DYE|| 58-1699775|1326041732|CHC13|70450|26|11/01/2013|12/31/9999|$65.96|0|0|||CT HEAD/BRAIN W/O DYE|| 58-1699775|1326041732|CHC13|70450|TC|11/01/2013|12/31/9999|$212.34|0|0|||CT HEAD/BRAIN W/O DYE|| 58-1699775|1326041732|CHC13|70460||11/01/2013|12/31/9999|$363.64|0|0|||CT HEAD/BRAIN W/DYE|| 58-1699775|1326041732|CHC13|70460|26|11/01/2013|12/31/9999|$87.76|0|0|||CT HEAD/BRAIN W/DYE|| 58-1699775|1326041732|CHC13|70460|TC|11/01/2013|12/31/9999|$275.89|0|0|||CT HEAD/BRAIN W/DYE|| 58-1699775|1326041732|CHC13|70470||11/01/2013|12/31/9999|$389.19|0|0|||CT HEAD/BRAIN W/O & W/DYE|| 58-1699775|1326041732|CHC13|70470|26|11/01/2013|12/31/9999|$99.18|0|0|||CT HEAD/BRAIN W/O & W/DYE|| 58-1699775|1326041732|CHC13|70470|TC|11/01/2013|12/31/9999|$290.01|0|0|||CT HEAD/BRAIN W/O & W/DYE|| 58-1699775|1326041732|CHC13|70480||11/01/2013|12/31/9999|$456.33|0|0|||CT ORBIT/EAR/FOSSA W/O DYE|| 58-1699775|1326041732|CHC13|70480|26|11/01/2013|12/31/9999|$100.25|0|0|||CT ORBIT/EAR/FOSSA W/O DYE|| 58-1699775|1326041732|CHC13|70480|TC|11/01/2013|12/31/9999|$356.08|0|0|||CT ORBIT/EAR/FOSSA W/O DYE|| 58-1699775|1326041732|CHC13|70481||11/01/2013|12/31/9999|$528.53|0|0|||CT ORBIT/EAR/FOSSA W/DYE|| 58-1699775|1326041732|CHC13|70481|26|11/01/2013|12/31/9999|$107.90|0|0|||CT ORBIT/EAR/FOSSA W/DYE|| 58-1699775|1326041732|CHC13|70481|TC|11/01/2013|12/31/9999|$420.63|0|0|||CT ORBIT/EAR/FOSSA W/DYE|| 58-1699775|1326041732|CHC13|70482||11/01/2013|12/31/9999|$590.97|0|0|||CT ORBIT/EAR/FOSSA W/O&W/DYE|| 58-1699775|1326041732|CHC13|70482|26|11/01/2013|12/31/9999|$112.84|0|0|||CT ORBIT/EAR/FOSSA W/O&W/DYE|| 58-1699775|1326041732|CHC13|70482|TC|11/01/2013|12/31/9999|$478.13|0|0|||CT ORBIT/EAR/FOSSA W/O&W/DYE|| 58-1699775|1326041732|CHC13|70486||11/01/2013|12/31/9999|$378.33|0|0|||CT MAXILLOFACIAL W/O DYE|| 58-1699775|1326041732|CHC13|70486|26|11/01/2013|12/31/9999|$88.82|0|0|||CT MAXILLOFACIAL W/O DYE|| 58-1699775|1326041732|CHC13|70486|TC|11/01/2013|12/31/9999|$289.51|0|0|||CT MAXILLOFACIAL W/O DYE|| 58-1699775|1326041732|CHC13|70487||11/01/2013|12/31/9999|$454.93|0|0|||CT MAXILLOFACIAL W/DYE|| 58-1699775|1326041732|CHC13|70487|26|11/01/2013|12/31/9999|$101.37|0|0|||CT MAXILLOFACIAL W/DYE|| 58-1699775|1326041732|CHC13|70487|TC|11/01/2013|12/31/9999|$353.56|0|0|||CT MAXILLOFACIAL W/DYE|| 58-1699775|1326041732|CHC13|70488||11/01/2013|12/31/9999|$549.44|0|0|||CT MAXILLOFACIAL W/O & W/DYE|| 58-1699775|1326041732|CHC13|70488|26|11/01/2013|12/31/9999|$110.65|0|0|||CT MAXILLOFACIAL W/O & W/DYE|| 58-1699775|1326041732|CHC13|70488|TC|11/01/2013|12/31/9999|$438.79|0|0|||CT MAXILLOFACIAL W/O & W/DYE|| 58-1699775|1326041732|CHC13|70490||11/01/2013|12/31/9999|$370.08|0|0|||CT SOFT TISSUE NECK W/O DYE|| 58-1699775|1326041732|CHC13|70490|26|11/01/2013|12/31/9999|$100.25|0|0|||CT SOFT TISSUE NECK W/O DYE|| 58-1699775|1326041732|CHC13|70490|TC|11/01/2013|12/31/9999|$269.84|0|0|||CT SOFT TISSUE NECK W/O DYE|| 58-1699775|1326041732|CHC13|70491||11/01/2013|12/31/9999|$445.30|0|0|||CT SOFT TISSUE NECK W/DYE|| 58-1699775|1326041732|CHC13|70491|26|11/01/2013|12/31/9999|$107.88|0|0|||CT SOFT TISSUE NECK W/DYE|| 58-1699775|1326041732|CHC13|70491|TC|11/01/2013|12/31/9999|$337.42|0|0|||CT SOFT TISSUE NECK W/DYE|| 58-1699775|1326041732|CHC13|70492||11/01/2013|12/31/9999|$533.98|0|0|||CT SFT TSUE NCK W/O & W/DYE|| 58-1699775|1326041732|CHC13|70492|26|11/01/2013|12/31/9999|$112.84|0|0|||CT SFT TSUE NCK W/O & W/DYE|| 58-1699775|1326041732|CHC13|70492|TC|11/01/2013|12/31/9999|$421.14|0|0|||CT SFT TSUE NCK W/O & W/DYE|| 58-1699775|1326041732|CHC13|70496||11/01/2013|12/31/9999|$842.87|0|0|||CT ANGIOGRAPHY| HEAD|| 58-1699775|1326041732|CHC13|70496|26|11/01/2013|12/31/9999|$136.78|0|0|||CT ANGIOGRAPHY| HEAD|| 58-1699775|1326041732|CHC13|70496|TC|11/01/2013|12/31/9999|$706.09|0|0|||CT ANGIOGRAPHY| HEAD|| 58-1699775|1326041732|CHC13|70498||11/01/2013|12/31/9999|$865.06|0|0|||CT ANGIOGRAPHY| NECK|| 58-1699775|1326041732|CHC13|70498|26|11/01/2013|12/31/9999|$136.78|0|0|||CT ANGIOGRAPHY| NECK|| 58-1699775|1326041732|CHC13|70498|TC|11/01/2013|12/31/9999|$728.28|0|0|||CT ANGIOGRAPHY| NECK|| 58-1699775|1326041732|CHC13|70540||11/01/2013|12/31/9999|$696.81|0|0|||MRI ORBIT/FACE/NECK W/O DYE|| 58-1699775|1326041732|CHC13|70540|26|11/01/2013|12/31/9999|$105.20|0|0|||MRI ORBIT/FACE/NECK W/O DYE|| 58-1699775|1326041732|CHC13|70540|TC|11/01/2013|12/31/9999|$591.60|0|0|||MRI ORBIT/FACE/NECK W/O DYE|| 58-1699775|1326041732|CHC13|70542||11/01/2013|12/31/9999|$783.12|0|0|||MRI ORBIT/FACE/NECK W/DYE|| 58-1699775|1326041732|CHC13|70542|26|11/01/2013|12/31/9999|$126.45|0|0|||MRI ORBIT/FACE/NECK W/DYE|| 58-1699775|1326041732|CHC13|70542|TC|11/01/2013|12/31/9999|$656.66|0|0|||MRI ORBIT/FACE/NECK W/DYE|| 58-1699775|1326041732|CHC13|70543||11/01/2013|12/31/9999|$990.95|0|0|||MRI ORBT/FAC/NCK W/O & W/DYE|| 58-1699775|1326041732|CHC13|70543|26|11/01/2013|12/31/9999|$166.85|0|0|||MRI ORBT/FAC/NCK W/O & W/DYE|| 58-1699775|1326041732|CHC13|70543|TC|11/01/2013|12/31/9999|$824.10|0|0|||MRI ORBT/FAC/NCK W/O & W/DYE|| 58-1699775|1326041732|CHC13|70544||11/01/2013|12/31/9999|$773.60|0|0|||MR ANGIOGRAPHY HEAD W/O DYE|| 58-1699775|1326041732|CHC13|70544|26|11/01/2013|12/31/9999|$93.74|0|0|||MR ANGIOGRAPHY HEAD W/O DYE|| 58-1699775|1326041732|CHC13|70544|TC|11/01/2013|12/31/9999|$679.86|0|0|||MR ANGIOGRAPHY HEAD W/O DYE|| 58-1699775|1326041732|CHC13|70545||11/01/2013|12/31/9999|$760.49|0|0|||MR ANGIOGRAPHY HEAD W/DYE|| 58-1699775|1326041732|CHC13|70545|26|11/01/2013|12/31/9999|$93.23|0|0|||MR ANGIOGRAPHY HEAD W/DYE|| 58-1699775|1326041732|CHC13|70545|TC|11/01/2013|12/31/9999|$667.25|0|0|||MR ANGIOGRAPHY HEAD W/DYE|| 58-1699775|1326041732|CHC13|70546||11/01/2013|12/31/9999|$1|187.63|0|0|||MR ANGIOGRAPH HEAD W/O&W/DYE|| 58-1699775|1326041732|CHC13|70546|26|11/01/2013|12/31/9999|$140.62|0|0|||MR ANGIOGRAPH HEAD W/O&W/DYE|| 58-1699775|1326041732|CHC13|70546|TC|11/01/2013|12/31/9999|$1|047.02|0|0|||MR ANGIOGRAPH HEAD W/O&W/DYE|| 58-1699775|1326041732|CHC13|70547||11/01/2013|12/31/9999|$772.09|0|0|||MR ANGIOGRAPHY NECK W/O DYE|| 58-1699775|1326041732|CHC13|70547|26|11/01/2013|12/31/9999|$93.74|0|0|||MR ANGIOGRAPHY NECK W/O DYE|| 58-1699775|1326041732|CHC13|70547|TC|11/01/2013|12/31/9999|$678.35|0|0|||MR ANGIOGRAPHY NECK W/O DYE|| 58-1699775|1326041732|CHC13|70548||11/01/2013|12/31/9999|$815.46|0|0|||MR ANGIOGRAPHY NECK W/DYE|| 58-1699775|1326041732|CHC13|70548|26|11/01/2013|12/31/9999|$93.74|0|0|||MR ANGIOGRAPHY NECK W/DYE|| 58-1699775|1326041732|CHC13|70548|TC|11/01/2013|12/31/9999|$721.72|0|0|||MR ANGIOGRAPHY NECK W/DYE|| 58-1699775|1326041732|CHC13|70549||11/01/2013|12/31/9999|$1|190.64|0|0|||MR ANGIOGRAPH NECK W/O&W/DYE|| 58-1699775|1326041732|CHC13|70549|26|11/01/2013|12/31/9999|$140.09|0|0|||MR ANGIOGRAPH NECK W/O&W/DYE|| 58-1699775|1326041732|CHC13|70549|TC|11/01/2013|12/31/9999|$1|050.55|0|0|||MR ANGIOGRAPH NECK W/O&W/DYE|| 58-1699775|1326041732|CHC13|70551||11/01/2013|12/31/9999|$727.31|0|0|||MRI BRAIN W/O DYE|| 58-1699775|1326041732|CHC13|70551|26|11/01/2013|12/31/9999|$115.03|0|0|||MRI BRAIN W/O DYE|| 58-1699775|1326041732|CHC13|70551|TC|11/01/2013|12/31/9999|$612.28|0|0|||MRI BRAIN W/O DYE|| 58-1699775|1326041732|CHC13|70552||11/01/2013|12/31/9999|$813.30|0|0|||MRI BRAIN W/DYE|| 58-1699775|1326041732|CHC13|70552|26|11/01/2013|12/31/9999|$139.49|0|0|||MRI BRAIN W/DYE|| 58-1699775|1326041732|CHC13|70552|TC|11/01/2013|12/31/9999|$673.81|0|0|||MRI BRAIN W/DYE|| 58-1699775|1326041732|CHC13|70553||11/01/2013|12/31/9999|$989.16|0|0|||MRI BRAIN W/O & W/DYE|| 58-1699775|1326041732|CHC13|70553|26|11/01/2013|12/31/9999|$184.22|0|0|||MRI BRAIN W/O & W/DYE|| 58-1699775|1326041732|CHC13|70553|TC|11/01/2013|12/31/9999|$804.94|0|0|||MRI BRAIN W/O & W/DYE|| 58-1699775|1326041732|CHC13|70554||11/01/2013|12/31/9999|$814.70|0|0|||FMRI BRAIN BY TECH|| 58-1699775|1326041732|CHC13|70554|26|11/01/2013|12/31/9999|$165.61|0|0|||FMRI BRAIN BY TECH|| 58-1699775|1326041732|CHC13|70554|TC|11/01/2013|12/31/9999|$649.10|0|0|||FMRI BRAIN BY TECH|| 58-1699775|1326041732|CHC13|70555||11/01/2013|12/31/9999|$1|116.47|0|0|||FMRI BRAIN BY PHYS/PSYCH|| 58-1699775|1326041732|CHC13|70555|26|11/01/2013|12/31/9999|$204.58|0|0|||FMRI BRAIN BY PHYS/PSYCH|| 58-1699775|1326041732|CHC13|70555|TC|11/01/2013|12/31/9999|$914.50|0|0|||FMRI BRAIN BY PHYS/PSYCH|| 58-1699775|1326041732|CHC13|70557||11/01/2013|12/31/9999|$2|313.00|0|0|||MRI BRAIN W/O DYE|| 58-1699775|1326041732|CHC13|70557|26|11/01/2013|12/31/9999|$274.08|0|0|||MRI BRAIN W/O DYE|| 58-1699775|1326041732|CHC13|70557|TC|11/01/2013|12/31/9999|$2|042.57|0|0|||MRI BRAIN W/O DYE|| 58-1699775|1326041732|CHC13|70558||11/01/2013|12/31/9999|$2|161.99|0|0|||MRI BRAIN W/DYE|| 58-1699775|1326041732|CHC13|70558|26|11/01/2013|12/31/9999|$256.38|0|0|||MRI BRAIN W/DYE|| 58-1699775|1326041732|CHC13|70558|TC|11/01/2013|12/31/9999|$1|907.75|0|0|||MRI BRAIN W/DYE|| 58-1699775|1326041732|CHC13|70559||11/01/2013|12/31/9999|$2|167.04|0|0|||MRI BRAIN W/O & W/DYE|| 58-1699775|1326041732|CHC13|70559|26|11/01/2013|12/31/9999|$258.40|0|0|||MRI BRAIN W/O & W/DYE|| 58-1699775|1326041732|CHC13|70559|TC|11/01/2013|12/31/9999|$1|912.28|0|0|||MRI BRAIN W/O & W/DYE|| 58-1699775|1326041732|CHC13|71010||11/01/2013|12/31/9999|$36.37|0|0|||CHEST X-RAY|| 58-1699775|1326041732|CHC13|71010|26|11/01/2013|12/31/9999|$14.16|0|0|||CHEST X-RAY|| 58-1699775|1326041732|CHC13|71010|TC|11/01/2013|12/31/9999|$22.21|0|0|||CHEST X-RAY|| 58-1699775|1326041732|CHC13|71015||11/01/2013|12/31/9999|$47.13|0|0|||CHEST X-RAY|| 58-1699775|1326041732|CHC13|71015|26|11/01/2013|12/31/9999|$16.35|0|0|||CHEST X-RAY|| 58-1699775|1326041732|CHC13|71015|TC|11/01/2013|12/31/9999|$30.78|0|0|||CHEST X-RAY|| 58-1699775|1326041732|CHC13|71020||11/01/2013|12/31/9999|$47.19|0|0|||CHEST X-RAY|| 58-1699775|1326041732|CHC13|71020|26|11/01/2013|12/31/9999|$16.91|0|0|||CHEST X-RAY|| 58-1699775|1326041732|CHC13|71020|TC|11/01/2013|12/31/9999|$30.28|0|0|||CHEST X-RAY|| 58-1699775|1326041732|CHC13|71021||11/01/2013|12/31/9999|$58.57|0|0|||CHEST X-RAY|| 58-1699775|1326041732|CHC13|71021|26|11/01/2013|12/31/9999|$21.23|0|0|||CHEST X-RAY|| 58-1699775|1326041732|CHC13|71021|TC|11/01/2013|12/31/9999|$37.34|0|0|||CHEST X-RAY|| 58-1699775|1326041732|CHC13|71022||11/01/2013|12/31/9999|$73.43|0|0|||CHEST X-RAY|| 58-1699775|1326041732|CHC13|71022|26|11/01/2013|12/31/9999|$24.49|0|0|||CHEST X-RAY|| 58-1699775|1326041732|CHC13|71022|TC|11/01/2013|12/31/9999|$48.94|0|0|||CHEST X-RAY|| 58-1699775|1326041732|CHC13|71023||11/01/2013|12/31/9999|$104.59|0|0|||CHEST X-RAY AND FLUOROSCOPY|| 58-1699775|1326041732|CHC13|71023|26|11/01/2013|12/31/9999|$29.43|0|0|||CHEST X-RAY AND FLUOROSCOPY|| 58-1699775|1326041732|CHC13|71023|TC|11/01/2013|12/31/9999|$75.16|0|0|||CHEST X-RAY AND FLUOROSCOPY|| 58-1699775|1326041732|CHC13|71030||11/01/2013|12/31/9999|$71.41|0|0|||CHEST X-RAY|| 58-1699775|1326041732|CHC13|71030|26|11/01/2013|12/31/9999|$23.98|0|0|||CHEST X-RAY|| 58-1699775|1326041732|CHC13|71030|TC|11/01/2013|12/31/9999|$47.42|0|0|||CHEST X-RAY|| 58-1699775|1326041732|CHC13|71034||11/01/2013|12/31/9999|$134.30|0|0|||CHEST X-RAY AND FLUOROSCOPY|| 58-1699775|1326041732|CHC13|71034|26|11/01/2013|12/31/9999|$35.94|0|0|||CHEST X-RAY AND FLUOROSCOPY|| 58-1699775|1326041732|CHC13|71034|TC|11/01/2013|12/31/9999|$98.36|0|0|||CHEST X-RAY AND FLUOROSCOPY|| 58-1699775|1326041732|CHC13|71035||11/01/2013|12/31/9999|$55.03|0|0|||CHEST X-RAY|| 58-1699775|1326041732|CHC13|71035|26|11/01/2013|12/31/9999|$14.16|0|0|||CHEST X-RAY|| 58-1699775|1326041732|CHC13|71035|TC|11/01/2013|12/31/9999|$40.87|0|0|||CHEST X-RAY|| 58-1699775|1326041732|CHC13|71040|26|11/01/2013|12/31/9999|$43.69|0|0|||CONTRAST X-RAY OF BRONCHI|| 58-1699775|1326041732|CHC13|71040|TC|11/01/2013|12/31/9999|$104.92|0|0|||CONTRAST X-RAY OF BRONCHI|| 58-1699775|1326041732|CHC13|71045||01/01/2018|12/31/9999|$30.98|0|0||||| 58-1699775|1326041732|CHC13|71045|26|01/01/2018|12/31/9999|$14.85|0|0||||| 58-1699775|1326041732|CHC13|71045|TC|01/01/2018|12/31/9999|$16.12|0|0||||| 58-1699775|1326041732|CHC13|71046||01/01/2018|12/31/9999|$47.19|0|0||||| 58-1699775|1326041732|CHC13|71046|26|01/01/2018|12/31/9999|$17.72|0|0||||| 58-1699775|1326041732|CHC13|71046|TC|01/01/2018|12/31/9999|$29.47|0|0||||| 58-1699775|1326041732|CHC13|71047||04/01/2018|12/31/9999|$60.57|0|0|0||X-RAY EXAM CHEST 3 VIEWS|| 58-1699775|1326041732|CHC13|71047|26|04/01/2018|12/31/9999|$23.08|0|0|0||X-RAY EXAM CHEST 3 VIEWS|| 58-1699775|1326041732|CHC13|71047|TC|04/01/2018|12/31/9999|$37.48|0|0|0||X-RAY EXAM CHEST 3 VIEWS|| 58-1699775|1326041732|CHC13|71048||04/01/2018|12/31/9999|$65.08|0|0|0||X-RAY EXAM CHEST 4+ VIEWS|| 58-1699775|1326041732|CHC13|71048|26|04/01/2018|12/31/9999|$26.53|0|0|0||X-RAY EXAM CHEST 4+ VIEWS|| 58-1699775|1326041732|CHC13|71048|TC|04/01/2018|12/31/9999|$38.55|0|0|0||X-RAY EXAM CHEST 4+ VIEWS|| 58-1699775|1326041732|CHC13|71060|26|11/01/2013|12/31/9999|$57.77|0|0|||CONTRAST X-RAY OF BRONCHI|| 58-1699775|1326041732|CHC13|71060|TC|11/01/2013|12/31/9999|$160.90|0|0|||CONTRAST X-RAY OF BRONCHI|| 58-1699775|1326041732|CHC13|71100||11/01/2013|12/31/9999|$50.72|0|0|||X-RAY EXAM OF RIBS|| 58-1699775|1326041732|CHC13|71100|26|11/01/2013|12/31/9999|$17.42|0|0|||X-RAY EXAM OF RIBS|| 58-1699775|1326041732|CHC13|71100|TC|11/01/2013|12/31/9999|$33.30|0|0|||X-RAY EXAM OF RIBS|| 58-1699775|1326041732|CHC13|71101||11/01/2013|12/31/9999|$61.09|0|0|||X-RAY EXAM OF RIBS/CHEST|| 58-1699775|1326041732|CHC13|71101|26|11/01/2013|12/31/9999|$20.73|0|0|||X-RAY EXAM OF RIBS/CHEST|| 58-1699775|1326041732|CHC13|71101|TC|11/01/2013|12/31/9999|$40.36|0|0|||X-RAY EXAM OF RIBS/CHEST|| 58-1699775|1326041732|CHC13|71110||11/01/2013|12/31/9999|$63.11|0|0|||X-RAY EXAM OF RIBS|| 58-1699775|1326041732|CHC13|71110|26|11/01/2013|12/31/9999|$21.23|0|0|||X-RAY EXAM OF RIBS|| 58-1699775|1326041732|CHC13|71110|TC|11/01/2013|12/31/9999|$41.88|0|0|||X-RAY EXAM OF RIBS|| 58-1699775|1326041732|CHC13|71111||11/01/2013|12/31/9999|$82.06|0|0|||X-RAY EXAM OF RIBS/CHEST|| 58-1699775|1326041732|CHC13|71111|26|11/01/2013|12/31/9999|$25.05|0|0|||X-RAY EXAM OF RIBS/CHEST|| 58-1699775|1326041732|CHC13|71111|TC|11/01/2013|12/31/9999|$57.01|0|0|||X-RAY EXAM OF RIBS/CHEST|| 58-1699775|1326041732|CHC13|71120||11/01/2013|12/31/9999|$49.09|0|0|||X-RAY EXAM OF BREASTBONE|| 58-1699775|1326041732|CHC13|71120|26|11/01/2013|12/31/9999|$15.79|0|0|||X-RAY EXAM OF BREASTBONE|| 58-1699775|1326041732|CHC13|71120|TC|11/01/2013|12/31/9999|$33.30|0|0|||X-RAY EXAM OF BREASTBONE|| 58-1699775|1326041732|CHC13|71130||11/01/2013|12/31/9999|$57.78|0|0|||X-RAY EXAM OF BREASTBONE|| 58-1699775|1326041732|CHC13|71130|26|11/01/2013|12/31/9999|$17.42|0|0|||X-RAY EXAM OF BREASTBONE|| 58-1699775|1326041732|CHC13|71130|TC|11/01/2013|12/31/9999|$40.36|0|0|||X-RAY EXAM OF BREASTBONE|| 58-1699775|1326041732|CHC13|71250||11/01/2013|12/31/9999|$355.45|0|0|||CT THORAX W/O DYE|| 58-1699775|1326041732|CHC13|71250|26|11/01/2013|12/31/9999|$80.06|0|0|||CT THORAX W/O DYE|| 58-1699775|1326041732|CHC13|71250|TC|11/01/2013|12/31/9999|$275.38|0|0|||CT THORAX W/O DYE|| 58-1699775|1326041732|CHC13|71260||11/01/2013|12/31/9999|$440.97|0|0|||CT THORAX W/DYE|| 58-1699775|1326041732|CHC13|71260|26|11/01/2013|12/31/9999|$96.99|0|0|||CT THORAX W/DYE|| 58-1699775|1326041732|CHC13|71260|TC|11/01/2013|12/31/9999|$343.97|0|0|||CT THORAX W/DYE|| 58-1699775|1326041732|CHC13|71270||11/01/2013|12/31/9999|$538.60|0|0|||CT THORAX W/O & W/DYE|| 58-1699775|1326041732|CHC13|71270|26|11/01/2013|12/31/9999|$107.38|0|0|||CT THORAX W/O & W/DYE|| 58-1699775|1326041732|CHC13|71270|TC|11/01/2013|12/31/9999|$431.22|0|0|||CT THORAX W/O & W/DYE|| 58-1699775|1326041732|CHC13|71275||11/01/2013|12/31/9999|$672.89|0|0|||CT ANGIOGRAPHY| CHEST|| 58-1699775|1326041732|CHC13|71275|26|11/01/2013|12/31/9999|$149.88|0|0|||CT ANGIOGRAPHY| CHEST|| 58-1699775|1326041732|CHC13|71275|TC|11/01/2013|12/31/9999|$523.01|0|0|||CT ANGIOGRAPHY| CHEST|| 58-1699775|1326041732|CHC13|71550||11/01/2013|12/31/9999|$799.82|0|0|||MRI CHEST W/O DYE|| 58-1699775|1326041732|CHC13|71550|26|11/01/2013|12/31/9999|$113.40|0|0|||MRI CHEST W/O DYE|| 58-1699775|1326041732|CHC13|71550|TC|11/01/2013|12/31/9999|$686.42|0|0|||MRI CHEST W/O DYE|| 58-1699775|1326041732|CHC13|71551||11/01/2013|12/31/9999|$895.71|0|0|||MRI CHEST W/DYE|| 58-1699775|1326041732|CHC13|71551|26|11/01/2013|12/31/9999|$135.15|0|0|||MRI CHEST W/DYE|| 58-1699775|1326041732|CHC13|71551|TC|11/01/2013|12/31/9999|$760.55|0|0|||MRI CHEST W/DYE|| 58-1699775|1326041732|CHC13|71552||11/01/2013|12/31/9999|$1|150.44|0|0|||MRI CHEST W/O & W/DYE|| 58-1699775|1326041732|CHC13|71552|26|11/01/2013|12/31/9999|$176.05|0|0|||MRI CHEST W/O & W/DYE|| 58-1699775|1326041732|CHC13|71552|TC|11/01/2013|12/31/9999|$974.39|0|0|||MRI CHEST W/O & W/DYE|| 58-1699775|1326041732|CHC13|71555||11/01/2013|12/31/9999|$784.20|0|0|||MRI ANGIO CHEST W OR W/O DYE|| 58-1699775|1326041732|CHC13|71555|26|11/01/2013|12/31/9999|$141.66|0|0|||MRI ANGIO CHEST W OR W/O DYE|| 58-1699775|1326041732|CHC13|71555|TC|11/01/2013|12/31/9999|$642.54|0|0|||MRI ANGIO CHEST W OR W/O DYE|| 58-1699775|1326041732|CHC13|72020||11/01/2013|12/31/9999|$36.70|0|0|||X-RAY EXAM OF SPINE|| 58-1699775|1326041732|CHC13|72020|26|11/01/2013|12/31/9999|$11.97|0|0|||X-RAY EXAM OF SPINE|| 58-1699775|1326041732|CHC13|72020|TC|11/01/2013|12/31/9999|$24.73|0|0|||X-RAY EXAM OF SPINE|| 58-1699775|1326041732|CHC13|72040||04/01/2014|12/31/9999|$56.08|0|0|||X-RAY EXAM OF NECK SPINE|| 58-1699775|1326041732|CHC13|72040|26|04/01/2014|12/31/9999|$19.40|0|0|||X-RAY EXAM OF NECK SPINE|| 58-1699775|1326041732|CHC13|72040|TC|04/01/2014|12/31/9999|$36.68|0|0|||X-RAY EXAM OF NECK SPINE|| 58-1699775|1326041732|CHC13|72050||11/01/2013|12/31/9999|$82.54|0|0|||X-RAY EXAM OF NECK SPINE|| 58-1699775|1326041732|CHC13|72050|26|11/01/2013|12/31/9999|$25.03|0|0|||X-RAY EXAM OF NECK SPINE|| 58-1699775|1326041732|CHC13|72050|TC|11/01/2013|12/31/9999|$57.51|0|0|||X-RAY EXAM OF NECK SPINE|| 58-1699775|1326041732|CHC13|72052||11/01/2013|12/31/9999|$105.52|0|0|||X-RAY EXAM OF NECK SPINE|| 58-1699775|1326041732|CHC13|72052|26|11/01/2013|12/31/9999|$29.35|0|0|||X-RAY EXAM OF NECK SPINE|| 58-1699775|1326041732|CHC13|72052|TC|11/01/2013|12/31/9999|$76.17|0|0|||X-RAY EXAM OF NECK SPINE|| 58-1699775|1326041732|CHC13|72070||11/01/2013|12/31/9999|$52.23|0|0|||X-RAY EXAM OF THORACIC SPINE|| 58-1699775|1326041732|CHC13|72070|26|11/01/2013|12/31/9999|$17.42|0|0|||X-RAY EXAM OF THORACIC SPINE|| 58-1699775|1326041732|CHC13|72070|TC|11/01/2013|12/31/9999|$34.82|0|0|||X-RAY EXAM OF THORACIC SPINE|| 58-1699775|1326041732|CHC13|72072||11/01/2013|12/31/9999|$57.78|0|0|||X-RAY EXAM OF THORACIC SPINE|| 58-1699775|1326041732|CHC13|72072|26|11/01/2013|12/31/9999|$16.91|0|0|||X-RAY EXAM OF THORACIC SPINE|| 58-1699775|1326041732|CHC13|72072|TC|11/01/2013|12/31/9999|$40.87|0|0|||X-RAY EXAM OF THORACIC SPINE|| 58-1699775|1326041732|CHC13|72074||11/01/2013|12/31/9999|$68.37|0|0|||X-RAY EXAM OF THORACIC SPINE|| 58-1699775|1326041732|CHC13|72074|26|11/01/2013|12/31/9999|$16.91|0|0|||X-RAY EXAM OF THORACIC SPINE|| 58-1699775|1326041732|CHC13|72074|TC|11/01/2013|12/31/9999|$51.46|0|0|||X-RAY EXAM OF THORACIC SPINE|| 58-1699775|1326041732|CHC13|72080||11/01/2013|12/31/9999|$56.80|0|0|||X-RAY EXAM OF TRUNK SPINE|| 58-1699775|1326041732|CHC13|72080|26|11/01/2013|12/31/9999|$18.46|0|0|||X-RAY EXAM OF TRUNK SPINE|| 58-1699775|1326041732|CHC13|72080|TC|11/01/2013|12/31/9999|$38.35|0|0|||X-RAY EXAM OF TRUNK SPINE|| 58-1699775|1326041732|CHC13|72081||04/01/2016|12/31/9999|$59.45|0|0|0||X-RAY EXAM ENTIRE SPI 1 VW|| 58-1699775|1326041732|CHC13|72081|26|04/01/2016|12/31/9999|$21.74|0|0|0||X-RAY EXAM ENTIRE SPI 1 VW|| 58-1699775|1326041732|CHC13|72081|TC|04/01/2016|12/31/9999|$37.71|0|0|0||X-RAY EXAM ENTIRE SPI 1 VW|| 58-1699775|1326041732|CHC13|72082||04/01/2016|12/31/9999|$94.80|0|0|0||X-RAY EXAM ENTIRE SPI 2/3 VW|| 58-1699775|1326041732|CHC13|72082|26|04/01/2016|12/31/9999|$26.29|0|0|0||X-RAY EXAM ENTIRE SPI 2/3 VW|| 58-1699775|1326041732|CHC13|72082|TC|04/01/2016|12/31/9999|$68.52|0|0|0||X-RAY EXAM ENTIRE SPI 2/3 VW|| 58-1699775|1326041732|CHC13|72083||04/01/2016|12/31/9999|$103.01|0|0|0||X-RAY EXAM ENTIRE SPI 4/5 VW|| 58-1699775|1326041732|CHC13|72083|26|04/01/2016|12/31/9999|$28.65|0|0|0||X-RAY EXAM ENTIRE SPI 4/5 VW|| 58-1699775|1326041732|CHC13|72083|TC|04/01/2016|12/31/9999|$74.36|0|0|0||X-RAY EXAM ENTIRE SPI 4/5 VW|| 58-1699775|1326041732|CHC13|72084||04/01/2016|12/31/9999|$123.02|0|0|0||X-RAY EXAM ENTIRE SPI 6/> VW|| 58-1699775|1326041732|CHC13|72084|26|04/01/2016|12/31/9999|$33.26|0|0|0||X-RAY EXAM ENTIRE SPI 6/> VW|| 58-1699775|1326041732|CHC13|72084|TC|04/01/2016|12/31/9999|$89.76|0|0|0||X-RAY EXAM ENTIRE SPI 6/> VW|| 58-1699775|1326041732|CHC13|72100||11/01/2013|12/31/9999|$57.31|0|0|||X-RAY EXAM OF LOWER SPINE|| 58-1699775|1326041732|CHC13|72100|26|11/01/2013|12/31/9999|$18.46|0|0|||X-RAY EXAM OF LOWER SPINE|| 58-1699775|1326041732|CHC13|72100|TC|11/01/2013|12/31/9999|$38.85|0|0|||X-RAY EXAM OF LOWER SPINE|| 58-1699775|1326041732|CHC13|72110||11/01/2013|12/31/9999|$78.00|0|0|||X-RAY EXAM OF LOWER SPINE|| 58-1699775|1326041732|CHC13|72110|26|11/01/2013|12/31/9999|$25.03|0|0|||X-RAY EXAM OF LOWER SPINE|| 58-1699775|1326041732|CHC13|72110|TC|11/01/2013|12/31/9999|$52.97|0|0|||X-RAY EXAM OF LOWER SPINE|| 58-1699775|1326041732|CHC13|72114||11/01/2013|12/31/9999|$101.78|0|0|||X-RAY EXAM OF LOWER SPINE|| 58-1699775|1326041732|CHC13|72114|26|11/01/2013|12/31/9999|$27.12|0|0|||X-RAY EXAM OF LOWER SPINE|| 58-1699775|1326041732|CHC13|72114|TC|11/01/2013|12/31/9999|$74.66|0|0|||X-RAY EXAM OF LOWER SPINE|| 58-1699775|1326041732|CHC13|72120||11/01/2013|12/31/9999|$67.90|0|0|||X-RAY EXAM OF LOWER SPINE|| 58-1699775|1326041732|CHC13|72120|26|11/01/2013|12/31/9999|$18.96|0|0|||X-RAY EXAM OF LOWER SPINE|| 58-1699775|1326041732|CHC13|72120|TC|11/01/2013|12/31/9999|$48.94|0|0|||X-RAY EXAM OF LOWER SPINE|| 58-1699775|1326041732|CHC13|72125||11/01/2013|12/31/9999|$361.28|0|0|||CT NECK SPINE W/O DYE|| 58-1699775|1326041732|CHC13|72125|26|11/01/2013|12/31/9999|$83.38|0|0|||CT NECK SPINE W/O DYE|| 58-1699775|1326041732|CHC13|72125|TC|11/01/2013|12/31/9999|$277.91|0|0|||CT NECK SPINE W/O DYE|| 58-1699775|1326041732|CHC13|72126||11/01/2013|12/31/9999|$441.36|0|0|||CT NECK SPINE W/DYE|| 58-1699775|1326041732|CHC13|72126|26|11/01/2013|12/31/9999|$95.37|0|0|||CT NECK SPINE W/DYE|| 58-1699775|1326041732|CHC13|72126|TC|11/01/2013|12/31/9999|$345.99|0|0|||CT NECK SPINE W/DYE|| 58-1699775|1326041732|CHC13|72127||11/01/2013|12/31/9999|$528.39|0|0|||CT NECK SPINE W/O & W/DYE|| 58-1699775|1326041732|CHC13|72127|26|11/01/2013|12/31/9999|$98.68|0|0|||CT NECK SPINE W/O & W/DYE|| 58-1699775|1326041732|CHC13|72127|TC|11/01/2013|12/31/9999|$429.71|0|0|||CT NECK SPINE W/O & W/DYE|| 58-1699775|1326041732|CHC13|72128||11/01/2013|12/31/9999|$355.33|0|0|||CT CHEST SPINE W/O DYE|| 58-1699775|1326041732|CHC13|72128|26|11/01/2013|12/31/9999|$78.44|0|0|||CT CHEST SPINE W/O DYE|| 58-1699775|1326041732|CHC13|72128|TC|11/01/2013|12/31/9999|$276.90|0|0|||CT CHEST SPINE W/O DYE|| 58-1699775|1326041732|CHC13|72129||11/01/2013|12/31/9999|$441.36|0|0|||CT CHEST SPINE W/DYE|| 58-1699775|1326041732|CHC13|72129|26|11/01/2013|12/31/9999|$95.37|0|0|||CT CHEST SPINE W/DYE|| 58-1699775|1326041732|CHC13|72129|TC|11/01/2013|12/31/9999|$345.99|0|0|||CT CHEST SPINE W/DYE|| 58-1699775|1326041732|CHC13|72130||11/01/2013|12/31/9999|$532.42|0|0|||CT CHEST SPINE W/O & W/DYE|| 58-1699775|1326041732|CHC13|72130|26|11/01/2013|12/31/9999|$99.18|0|0|||CT CHEST SPINE W/O & W/DYE|| 58-1699775|1326041732|CHC13|72130|TC|11/01/2013|12/31/9999|$433.24|0|0|||CT CHEST SPINE W/O & W/DYE|| 58-1699775|1326041732|CHC13|72131||11/01/2013|12/31/9999|$354.33|0|0|||CT LUMBAR SPINE W/O DYE|| 58-1699775|1326041732|CHC13|72131|26|11/01/2013|12/31/9999|$78.44|0|0|||CT LUMBAR SPINE W/O DYE|| 58-1699775|1326041732|CHC13|72131|TC|11/01/2013|12/31/9999|$275.89|0|0|||CT LUMBAR SPINE W/O DYE|| 58-1699775|1326041732|CHC13|72132||11/01/2013|12/31/9999|$440.35|0|0|||CT LUMBAR SPINE W/DYE|| 58-1699775|1326041732|CHC13|72132|26|11/01/2013|12/31/9999|$95.37|0|0|||CT LUMBAR SPINE W/DYE|| 58-1699775|1326041732|CHC13|72132|TC|11/01/2013|12/31/9999|$344.98|0|0|||CT LUMBAR SPINE W/DYE|| 58-1699775|1326041732|CHC13|72133||11/01/2013|12/31/9999|$531.41|0|0|||CT LUMBAR SPINE W/O & W/DYE|| 58-1699775|1326041732|CHC13|72133|26|11/01/2013|12/31/9999|$99.18|0|0|||CT LUMBAR SPINE W/O & W/DYE|| 58-1699775|1326041732|CHC13|72133|TC|11/01/2013|12/31/9999|$432.23|0|0|||CT LUMBAR SPINE W/O & W/DYE|| 58-1699775|1326041732|CHC13|72141||11/01/2013|12/31/9999|$652.88|0|0|||MRI NECK SPINE W/O DYE|| 58-1699775|1326041732|CHC13|72141|26|11/01/2013|12/31/9999|$125.33|0|0|||MRI NECK SPINE W/O DYE|| 58-1699775|1326041732|CHC13|72141|TC|11/01/2013|12/31/9999|$527.55|0|0|||MRI NECK SPINE W/O DYE|| 58-1699775|1326041732|CHC13|72142||11/01/2013|12/31/9999|$826.71|0|0|||MRI NECK SPINE W/DYE|| 58-1699775|1326041732|CHC13|72142|26|11/01/2013|12/31/9999|$150.38|0|0|||MRI NECK SPINE W/DYE|| 58-1699775|1326041732|CHC13|72142|TC|11/01/2013|12/31/9999|$676.33|0|0|||MRI NECK SPINE W/DYE|| 58-1699775|1326041732|CHC13|72146||11/01/2013|12/31/9999|$657.93|0|0|||MRI CHEST SPINE W/O DYE|| 58-1699775|1326041732|CHC13|72146|26|11/01/2013|12/31/9999|$125.33|0|0|||MRI CHEST SPINE W/O DYE|| 58-1699775|1326041732|CHC13|72146|TC|11/01/2013|12/31/9999|$532.59|0|0|||MRI CHEST SPINE W/O DYE|| 58-1699775|1326041732|CHC13|72147||11/01/2013|12/31/9999|$738.96|0|0|||MRI CHEST SPINE W/DYE|| 58-1699775|1326041732|CHC13|72147|26|11/01/2013|12/31/9999|$150.38|0|0|||MRI CHEST SPINE W/DYE|| 58-1699775|1326041732|CHC13|72147|TC|11/01/2013|12/31/9999|$588.58|0|0|||MRI CHEST SPINE W/DYE|| 58-1699775|1326041732|CHC13|72148||11/01/2013|12/31/9999|$648.66|0|0|||MRI LUMBAR SPINE W/O DYE|| 58-1699775|1326041732|CHC13|72148|26|11/01/2013|12/31/9999|$116.57|0|0|||MRI LUMBAR SPINE W/O DYE|| 58-1699775|1326041732|CHC13|72148|TC|11/01/2013|12/31/9999|$532.09|0|0|||MRI LUMBAR SPINE W/O DYE|| 58-1699775|1326041732|CHC13|72149||11/01/2013|12/31/9999|$806.24|0|0|||MRI LUMBAR SPINE W/DYE|| 58-1699775|1326041732|CHC13|72149|26|11/01/2013|12/31/9999|$140.00|0|0|||MRI LUMBAR SPINE W/DYE|| 58-1699775|1326041732|CHC13|72149|TC|11/01/2013|12/31/9999|$666.24|0|0|||MRI LUMBAR SPINE W/DYE|| 58-1699775|1326041732|CHC13|72156||11/01/2013|12/31/9999|$989.38|0|0|||MRI NECK SPINE W/O & W/DYE|| 58-1699775|1326041732|CHC13|72156|26|11/01/2013|12/31/9999|$201.09|0|0|||MRI NECK SPINE W/O & W/DYE|| 58-1699775|1326041732|CHC13|72156|TC|11/01/2013|12/31/9999|$788.29|0|0|||MRI NECK SPINE W/O & W/DYE|| 58-1699775|1326041732|CHC13|72157||11/01/2013|12/31/9999|$927.86|0|0|||MRI CHEST SPINE W/O & W/DYE|| 58-1699775|1326041732|CHC13|72157|26|11/01/2013|12/31/9999|$201.09|0|0|||MRI CHEST SPINE W/O & W/DYE|| 58-1699775|1326041732|CHC13|72157|TC|11/01/2013|12/31/9999|$726.76|0|0|||MRI CHEST SPINE W/O & W/DYE|| 58-1699775|1326041732|CHC13|72158||11/01/2013|12/31/9999|$972.55|0|0|||MRI LUMBAR SPINE W/O & W/DYE|| 58-1699775|1326041732|CHC13|72158|26|11/01/2013|12/31/9999|$185.77|0|0|||MRI LUMBAR SPINE W/O & W/DYE|| 58-1699775|1326041732|CHC13|72158|TC|11/01/2013|12/31/9999|$786.78|0|0|||MRI LUMBAR SPINE W/O & W/DYE|| 58-1699775|1326041732|CHC13|72159||11/01/2013|12/31/9999|$814.86|0|0|||MR ANGIO SPINE W/O&W/DYE|| 58-1699775|1326041732|CHC13|72159|26|11/01/2013|12/31/9999|$138.53|0|0|||MR ANGIO SPINE W/O&W/DYE|| 58-1699775|1326041732|CHC13|72159|TC|11/01/2013|12/31/9999|$676.33|0|0|||MR ANGIO SPINE W/O&W/DYE|| 58-1699775|1326041732|CHC13|72170||11/01/2013|12/31/9999|$41.39|0|0|||X-RAY EXAM OF PELVIS|| 58-1699775|1326041732|CHC13|72170|26|11/01/2013|12/31/9999|$14.64|0|0|||X-RAY EXAM OF PELVIS|| 58-1699775|1326041732|CHC13|72170|TC|11/01/2013|12/31/9999|$26.75|0|0|||X-RAY EXAM OF PELVIS|| 58-1699775|1326041732|CHC13|72190||11/01/2013|12/31/9999|$66.33|0|0|||X-RAY EXAM OF PELVIS|| 58-1699775|1326041732|CHC13|72190|26|11/01/2013|12/31/9999|$17.90|0|0|||X-RAY EXAM OF PELVIS|| 58-1699775|1326041732|CHC13|72190|TC|11/01/2013|12/31/9999|$48.43|0|0|||X-RAY EXAM OF PELVIS|| 58-1699775|1326041732|CHC13|72191||11/01/2013|12/31/9999|$691.94|0|0|||CT ANGIOGRAPH PELV W/O&W/DYE|| 58-1699775|1326041732|CHC13|72191|26|11/01/2013|12/31/9999|$142.20|0|0|||CT ANGIOGRAPH PELV W/O&W/DYE|| 58-1699775|1326041732|CHC13|72191|TC|11/01/2013|12/31/9999|$549.74|0|0|||CT ANGIOGRAPH PELV W/O&W/DYE|| 58-1699775|1326041732|CHC13|72192||11/01/2013|12/31/9999|$343.75|0|0|||CT PELVIS W/O DYE|| 58-1699775|1326041732|CHC13|72192|26|11/01/2013|12/31/9999|$84.50|0|0|||CT PELVIS W/O DYE|| 58-1699775|1326041732|CHC13|72192|TC|11/01/2013|12/31/9999|$259.25|0|0|||CT PELVIS W/O DYE|| 58-1699775|1326041732|CHC13|72193||11/01/2013|12/31/9999|$417.31|0|0|||CT PELVIS W/DYE|| 58-1699775|1326041732|CHC13|72193|26|11/01/2013|12/31/9999|$90.99|0|0|||CT PELVIS W/DYE|| 58-1699775|1326041732|CHC13|72193|TC|11/01/2013|12/31/9999|$326.32|0|0|||CT PELVIS W/DYE|| 58-1699775|1326041732|CHC13|72194||11/01/2013|12/31/9999|$533.65|0|0|||CT PELVIS W/O & W/DYE|| 58-1699775|1326041732|CHC13|72194|26|11/01/2013|12/31/9999|$95.37|0|0|||CT PELVIS W/O & W/DYE|| 58-1699775|1326041732|CHC13|72194|TC|11/01/2013|12/31/9999|$438.28|0|0|||CT PELVIS W/O & W/DYE|| 58-1699775|1326041732|CHC13|72195||11/01/2013|12/31/9999|$722.69|0|0|||MRI PELVIS W/O DYE|| 58-1699775|1326041732|CHC13|72195|26|11/01/2013|12/31/9999|$114.95|0|0|||MRI PELVIS W/O DYE|| 58-1699775|1326041732|CHC13|72195|TC|11/01/2013|12/31/9999|$607.74|0|0|||MRI PELVIS W/O DYE|| 58-1699775|1326041732|CHC13|72196||11/01/2013|12/31/9999|$803.41|0|0|||MRI PELVIS W/DYE|| 58-1699775|1326041732|CHC13|72196|26|11/01/2013|12/31/9999|$135.66|0|0|||MRI PELVIS W/DYE|| 58-1699775|1326041732|CHC13|72196|TC|11/01/2013|12/31/9999|$667.76|0|0|||MRI PELVIS W/DYE|| 58-1699775|1326041732|CHC13|72197||11/01/2013|12/31/9999|$1|012.76|0|0|||MRI PELVIS W/O & W/DYE|| 58-1699775|1326041732|CHC13|72197|26|11/01/2013|12/31/9999|$175.54|0|0|||MRI PELVIS W/O & W/DYE|| 58-1699775|1326041732|CHC13|72197|TC|11/01/2013|12/31/9999|$837.21|0|0|||MRI PELVIS W/O & W/DYE|| 58-1699775|1326041732|CHC13|72198||11/01/2013|12/31/9999|$784.65|0|0|||MR ANGIO PELVIS W/O & W/DYE|| 58-1699775|1326041732|CHC13|72198|26|11/01/2013|12/31/9999|$140.09|0|0|||MR ANGIO PELVIS W/O & W/DYE|| 58-1699775|1326041732|CHC13|72198|TC|11/01/2013|12/31/9999|$644.56|0|0|||MR ANGIO PELVIS W/O & W/DYE|| 58-1699775|1326041732|CHC13|72200||11/01/2013|12/31/9999|$46.40|0|0|||X-RAY EXAM SACROILIAC JOINTS|| 58-1699775|1326041732|CHC13|72200|26|11/01/2013|12/31/9999|$13.60|0|0|||X-RAY EXAM SACROILIAC JOINTS|| 58-1699775|1326041732|CHC13|72200|TC|11/01/2013|12/31/9999|$32.80|0|0|||X-RAY EXAM SACROILIAC JOINTS|| 58-1699775|1326041732|CHC13|72202||11/01/2013|12/31/9999|$53.57|0|0|||X-RAY EXAM SACROILIAC JOINTS|| 58-1699775|1326041732|CHC13|72202|26|11/01/2013|12/31/9999|$14.72|0|0|||X-RAY EXAM SACROILIAC JOINTS|| 58-1699775|1326041732|CHC13|72202|TC|11/01/2013|12/31/9999|$38.85|0|0|||X-RAY EXAM SACROILIAC JOINTS|| 58-1699775|1326041732|CHC13|72220||11/01/2013|12/31/9999|$44.88|0|0|||X-RAY EXAM OF TAILBONE|| 58-1699775|1326041732|CHC13|72220|26|11/01/2013|12/31/9999|$13.60|0|0|||X-RAY EXAM OF TAILBONE|| 58-1699775|1326041732|CHC13|72220|TC|11/01/2013|12/31/9999|$31.29|0|0|||X-RAY EXAM OF TAILBONE|| 58-1699775|1326041732|CHC13|72240||11/01/2013|12/31/9999|$212.60|0|0|||CONTRAST X-RAY OF NECK SPINE|| 58-1699775|1326041732|CHC13|72240|26|11/01/2013|12/31/9999|$71.37|0|0|||CONTRAST X-RAY OF NECK SPINE|| 58-1699775|1326041732|CHC13|72240|TC|11/01/2013|12/31/9999|$141.23|0|0|||CONTRAST X-RAY OF NECK SPINE|| 58-1699775|1326041732|CHC13|72255||11/01/2013|12/31/9999|$201.99|0|0|||CONTRAST X-RAY| THORAX SPINE|| 58-1699775|1326041732|CHC13|72255|26|11/01/2013|12/31/9999|$70.84|0|0|||CONTRAST X-RAY| THORAX SPINE|| 58-1699775|1326041732|CHC13|72255|TC|11/01/2013|12/31/9999|$131.14|0|0|||CONTRAST X-RAY| THORAX SPINE|| 58-1699775|1326041732|CHC13|72265||11/01/2013|12/31/9999|$204.05|0|0|||CONTRAST X-RAY| LOWER SPINE|| 58-1699775|1326041732|CHC13|72265|26|11/01/2013|12/31/9999|$64.84|0|0|||CONTRAST X-RAY| LOWER SPINE|| 58-1699775|1326041732|CHC13|72265|TC|11/01/2013|12/31/9999|$139.21|0|0|||CONTRAST X-RAY| LOWER SPINE|| 58-1699775|1326041732|CHC13|72270||11/01/2013|12/31/9999|$319.43|0|0|||CONTRAST X-RAY| SPINE|| 58-1699775|1326041732|CHC13|72270|26|11/01/2013|12/31/9999|$104.06|0|0|||CONTRAST X-RAY| SPINE|| 58-1699775|1326041732|CHC13|72270|TC|11/01/2013|12/31/9999|$215.37|0|0|||CONTRAST X-RAY| SPINE|| 58-1699775|1326041732|CHC13|72275||11/01/2013|12/31/9999|$182.97|0|0|||EPIDUROGRAPHY|| 58-1699775|1326041732|CHC13|72275|26|11/01/2013|12/31/9999|$61.41|0|0|||EPIDUROGRAPHY|| 58-1699775|1326041732|CHC13|72275|TC|11/01/2013|12/31/9999|$121.56|0|0|||EPIDUROGRAPHY|| 58-1699775|1326041732|CHC13|72285||11/01/2013|12/31/9999|$206.97|0|0|||X-RAY C/T SPINE DISK|| 58-1699775|1326041732|CHC13|72285|26|11/01/2013|12/31/9999|$93.47|0|0|||X-RAY C/T SPINE DISK|| 58-1699775|1326041732|CHC13|72285|TC|11/01/2013|12/31/9999|$113.49|0|0|||X-RAY C/T SPINE DISK|| 58-1699775|1326041732|CHC13|72295||11/01/2013|12/31/9999|$181.86|0|0|||X-RAY OF LOWER SPINE DISK|| 58-1699775|1326041732|CHC13|72295|26|11/01/2013|12/31/9999|$67.86|0|0|||X-RAY OF LOWER SPINE DISK|| 58-1699775|1326041732|CHC13|72295|TC|11/01/2013|12/31/9999|$114.00|0|0|||X-RAY OF LOWER SPINE DISK|| 58-1699775|1326041732|CHC13|73000||11/01/2013|12/31/9999|$44.83|0|0|||X-RAY EXAM OF COLLAR BONE|| 58-1699775|1326041732|CHC13|73000|26|11/01/2013|12/31/9999|$13.04|0|0|||X-RAY EXAM OF COLLAR BONE|| 58-1699775|1326041732|CHC13|73000|TC|11/01/2013|12/31/9999|$31.79|0|0|||X-RAY EXAM OF COLLAR BONE|| 58-1699775|1326041732|CHC13|73010||11/01/2013|12/31/9999|$48.95|0|0|||X-RAY EXAM OF SHOULDER BLADE|| 58-1699775|1326041732|CHC13|73010|26|11/01/2013|12/31/9999|$15.15|0|0|||X-RAY EXAM OF SHOULDER BLADE|| 58-1699775|1326041732|CHC13|73010|TC|11/01/2013|12/31/9999|$33.81|0|0|||X-RAY EXAM OF SHOULDER BLADE|| 58-1699775|1326041732|CHC13|73020||11/01/2013|12/31/9999|$37.21|0|0|||X-RAY EXAM OF SHOULDER|| 58-1699775|1326041732|CHC13|73020|26|11/01/2013|12/31/9999|$11.97|0|0|||X-RAY EXAM OF SHOULDER|| 58-1699775|1326041732|CHC13|73020|TC|11/01/2013|12/31/9999|$25.23|0|0|||X-RAY EXAM OF SHOULDER|| 58-1699775|1326041732|CHC13|73030||11/01/2013|12/31/9999|$48.00|0|0|||X-RAY EXAM OF SHOULDER|| 58-1699775|1326041732|CHC13|73030|26|11/01/2013|12/31/9999|$15.71|0|0|||X-RAY EXAM OF SHOULDER|| 58-1699775|1326041732|CHC13|73030|TC|11/01/2013|12/31/9999|$32.29|0|0|||X-RAY EXAM OF SHOULDER|| 58-1699775|1326041732|CHC13|73040||11/01/2013|12/31/9999|$167.09|0|0|||CONTRAST X-RAY OF SHOULDER|| 58-1699775|1326041732|CHC13|73040|26|11/01/2013|12/31/9999|$43.51|0|0|||CONTRAST X-RAY OF SHOULDER|| 58-1699775|1326041732|CHC13|73040|TC|11/01/2013|12/31/9999|$123.58|0|0|||CONTRAST X-RAY OF SHOULDER|| 58-1699775|1326041732|CHC13|73050||11/01/2013|12/31/9999|$62.24|0|0|||X-RAY EXAM OF SHOULDERS|| 58-1699775|1326041732|CHC13|73050|26|11/01/2013|12/31/9999|$17.84|0|0|||X-RAY EXAM OF SHOULDERS|| 58-1699775|1326041732|CHC13|73050|TC|11/01/2013|12/31/9999|$44.40|0|0|||X-RAY EXAM OF SHOULDERS|| 58-1699775|1326041732|CHC13|73060||11/01/2013|12/31/9999|$45.39|0|0|||X-RAY EXAM OF HUMERUS|| 58-1699775|1326041732|CHC13|73060|26|11/01/2013|12/31/9999|$13.60|0|0|||X-RAY EXAM OF HUMERUS|| 58-1699775|1326041732|CHC13|73060|TC|11/01/2013|12/31/9999|$31.79|0|0|||X-RAY EXAM OF HUMERUS|| 58-1699775|1326041732|CHC13|73070||11/01/2013|12/31/9999|$44.27|0|0|||X-RAY EXAM OF ELBOW|| 58-1699775|1326041732|CHC13|73070|26|11/01/2013|12/31/9999|$12.48|0|0|||X-RAY EXAM OF ELBOW|| 58-1699775|1326041732|CHC13|73070|TC|11/01/2013|12/31/9999|$31.79|0|0|||X-RAY EXAM OF ELBOW|| 58-1699775|1326041732|CHC13|73080||11/01/2013|12/31/9999|$52.45|0|0|||X-RAY EXAM OF ELBOW|| 58-1699775|1326041732|CHC13|73080|26|11/01/2013|12/31/9999|$13.60|0|0|||X-RAY EXAM OF ELBOW|| 58-1699775|1326041732|CHC13|73080|TC|11/01/2013|12/31/9999|$38.85|0|0|||X-RAY EXAM OF ELBOW|| 58-1699775|1326041732|CHC13|73085||11/01/2013|12/31/9999|$155.97|0|0|||CONTRAST X-RAY OF ELBOW|| 58-1699775|1326041732|CHC13|73085|26|11/01/2013|12/31/9999|$44.00|0|0|||CONTRAST X-RAY OF ELBOW|| 58-1699775|1326041732|CHC13|73085|TC|11/01/2013|12/31/9999|$111.98|0|0|||CONTRAST X-RAY OF ELBOW|| 58-1699775|1326041732|CHC13|73090||11/01/2013|12/31/9999|$42.81|0|0|||X-RAY EXAM OF FOREARM|| 58-1699775|1326041732|CHC13|73090|26|11/01/2013|12/31/9999|$12.53|0|0|||X-RAY EXAM OF FOREARM|| 58-1699775|1326041732|CHC13|73090|TC|11/01/2013|12/31/9999|$30.28|0|0|||X-RAY EXAM OF FOREARM|| 58-1699775|1326041732|CHC13|73092||11/01/2013|12/31/9999|$43.31|0|0|||X-RAY EXAM OF ARM| INFANT|| 58-1699775|1326041732|CHC13|73092|26|11/01/2013|12/31/9999|$12.53|0|0|||X-RAY EXAM OF ARM| INFANT|| 58-1699775|1326041732|CHC13|73092|TC|11/01/2013|12/31/9999|$30.78|0|0|||X-RAY EXAM OF ARM| INFANT|| 58-1699775|1326041732|CHC13|73100||11/01/2013|12/31/9999|$49.40|0|0|||X-RAY EXAM OF WRIST|| 58-1699775|1326041732|CHC13|73100|26|11/01/2013|12/31/9999|$14.58|0|0|||X-RAY EXAM OF WRIST|| 58-1699775|1326041732|CHC13|73100|TC|11/01/2013|12/31/9999|$34.82|0|0|||X-RAY EXAM OF WRIST|| 58-1699775|1326041732|CHC13|73110||11/01/2013|12/31/9999|$57.49|0|0|||X-RAY EXAM OF WRIST|| 58-1699775|1326041732|CHC13|73110|26|11/01/2013|12/31/9999|$13.60|0|0|||X-RAY EXAM OF WRIST|| 58-1699775|1326041732|CHC13|73110|TC|11/01/2013|12/31/9999|$43.89|0|0|||X-RAY EXAM OF WRIST|| 58-1699775|1326041732|CHC13|73115||11/01/2013|12/31/9999|$174.65|0|0|||CONTRAST X-RAY OF WRIST|| 58-1699775|1326041732|CHC13|73115|26|11/01/2013|12/31/9999|$44.52|0|0|||CONTRAST X-RAY OF WRIST|| 58-1699775|1326041732|CHC13|73115|TC|11/01/2013|12/31/9999|$130.14|0|0|||CONTRAST X-RAY OF WRIST|| 58-1699775|1326041732|CHC13|73120||11/01/2013|12/31/9999|$43.31|0|0|||X-RAY EXAM OF HAND|| 58-1699775|1326041732|CHC13|73120|26|11/01/2013|12/31/9999|$13.04|0|0|||X-RAY EXAM OF HAND|| 58-1699775|1326041732|CHC13|73120|TC|11/01/2013|12/31/9999|$30.28|0|0|||X-RAY EXAM OF HAND|| 58-1699775|1326041732|CHC13|73130||11/01/2013|12/31/9999|$49.93|0|0|||X-RAY EXAM OF HAND|| 58-1699775|1326041732|CHC13|73130|26|11/01/2013|12/31/9999|$13.60|0|0|||X-RAY EXAM OF HAND|| 58-1699775|1326041732|CHC13|73130|TC|11/01/2013|12/31/9999|$36.33|0|0|||X-RAY EXAM OF HAND|| 58-1699775|1326041732|CHC13|73140||11/01/2013|12/31/9999|$50.71|0|0|||X-RAY EXAM OF FINGER(S)|| 58-1699775|1326041732|CHC13|73140|26|11/01/2013|12/31/9999|$10.85|0|0|||X-RAY EXAM OF FINGER(S)|| 58-1699775|1326041732|CHC13|73140|TC|11/01/2013|12/31/9999|$39.86|0|0|||X-RAY EXAM OF FINGER(S)|| 58-1699775|1326041732|CHC13|73200||11/01/2013|12/31/9999|$349.82|0|0|||CT UPPER EXTREMITY W/O DYE|| 58-1699775|1326041732|CHC13|73200|26|11/01/2013|12/31/9999|$79.48|0|0|||CT UPPER EXTREMITY W/O DYE|| 58-1699775|1326041732|CHC13|73200|TC|11/01/2013|12/31/9999|$270.34|0|0|||CT UPPER EXTREMITY W/O DYE|| 58-1699775|1326041732|CHC13|73201||11/01/2013|12/31/9999|$428.40|0|0|||CT UPPER EXTREMITY W/DYE|| 58-1699775|1326041732|CHC13|73201|26|11/01/2013|12/31/9999|$90.99|0|0|||CT UPPER EXTREMITY W/DYE|| 58-1699775|1326041732|CHC13|73201|TC|11/01/2013|12/31/9999|$337.42|0|0|||CT UPPER EXTREMITY W/DYE|| 58-1699775|1326041732|CHC13|73202||11/01/2013|12/31/9999|$548.28|0|0|||CT UPPR EXTREMITY W/O&W/DYE|| 58-1699775|1326041732|CHC13|73202|26|11/01/2013|12/31/9999|$95.37|0|0|||CT UPPR EXTREMITY W/O&W/DYE|| 58-1699775|1326041732|CHC13|73202|TC|11/01/2013|12/31/9999|$452.91|0|0|||CT UPPR EXTREMITY W/O&W/DYE|| 58-1699775|1326041732|CHC13|73206||11/01/2013|12/31/9999|$613.20|0|0|||CT ANGIO UPR EXTRM W/O&W/DYE|| 58-1699775|1326041732|CHC13|73206|26|11/01/2013|12/31/9999|$140.62|0|0|||CT ANGIO UPR EXTRM W/O&W/DYE|| 58-1699775|1326041732|CHC13|73206|TC|11/01/2013|12/31/9999|$472.58|0|0|||CT ANGIO UPR EXTRM W/O&W/DYE|| 58-1699775|1326041732|CHC13|73218||11/01/2013|12/31/9999|$715.95|0|0|||MRI UPPER EXTREMITY W/O DYE|| 58-1699775|1326041732|CHC13|73218|26|11/01/2013|12/31/9999|$105.19|0|0|||MRI UPPER EXTREMITY W/O DYE|| 58-1699775|1326041732|CHC13|73218|TC|11/01/2013|12/31/9999|$610.77|0|0|||MRI UPPER EXTREMITY W/O DYE|| 58-1699775|1326041732|CHC13|73219||11/01/2013|12/31/9999|$790.68|0|0|||MRI UPPER EXTREMITY W/DYE|| 58-1699775|1326041732|CHC13|73219|26|11/01/2013|12/31/9999|$126.96|0|0|||MRI UPPER EXTREMITY W/DYE|| 58-1699775|1326041732|CHC13|73219|TC|11/01/2013|12/31/9999|$663.72|0|0|||MRI UPPER EXTREMITY W/DYE|| 58-1699775|1326041732|CHC13|73220||11/01/2013|12/31/9999|$1|006.58|0|0|||MRI UPPR EXTREMITY W/O&W/DYE|| 58-1699775|1326041732|CHC13|73220|26|11/01/2013|12/31/9999|$167.85|0|0|||MRI UPPR EXTREMITY W/O&W/DYE|| 58-1699775|1326041732|CHC13|73220|TC|11/01/2013|12/31/9999|$838.73|0|0|||MRI UPPR EXTREMITY W/O&W/DYE|| 58-1699775|1326041732|CHC13|73221||11/01/2013|12/31/9999|$682.72|0|0|||MRI JOINT UPR EXTREM W/O DYE|| 58-1699775|1326041732|CHC13|73221|26|11/01/2013|12/31/9999|$107.26|0|0|||MRI JOINT UPR EXTREM W/O DYE|| 58-1699775|1326041732|CHC13|73221|TC|11/01/2013|12/31/9999|$575.46|0|0|||MRI JOINT UPR EXTREM W/O DYE|| 58-1699775|1326041732|CHC13|73222||11/01/2013|12/31/9999|$741.26|0|0|||MRI JOINT UPR EXTREM W/DYE|| 58-1699775|1326041732|CHC13|73222|26|11/01/2013|12/31/9999|$126.96|0|0|||MRI JOINT UPR EXTREM W/DYE|| 58-1699775|1326041732|CHC13|73222|TC|11/01/2013|12/31/9999|$614.30|0|0|||MRI JOINT UPR EXTREM W/DYE|| 58-1699775|1326041732|CHC13|73223||11/01/2013|12/31/9999|$951.10|0|0|||MRI JOINT UPR EXTR W/O&W/DYE|| 58-1699775|1326041732|CHC13|73223|26|11/01/2013|12/31/9999|$167.85|0|0|||MRI JOINT UPR EXTR W/O&W/DYE|| 58-1699775|1326041732|CHC13|73223|TC|11/01/2013|12/31/9999|$783.25|0|0|||MRI JOINT UPR EXTR W/O&W/DYE|| 58-1699775|1326041732|CHC13|73225||11/01/2013|12/31/9999|$783.70|0|0|||MR ANGIO UPR EXTR W/O&W/DYE|| 58-1699775|1326041732|CHC13|73225|26|11/01/2013|12/31/9999|$132.58|0|0|||MR ANGIO UPR EXTR W/O&W/DYE|| 58-1699775|1326041732|CHC13|73225|TC|11/01/2013|12/31/9999|$651.11|0|0|||MR ANGIO UPR EXTR W/O&W/DYE|| 58-1699775|1326041732|CHC13|73501||04/01/2016|12/31/9999|$45.16|0|0|0||X-RAY EXAM HIP UNI 1 VIEW|| 58-1699775|1326041732|CHC13|73501|26|04/01/2016|12/31/9999|$15.42|0|0|0||X-RAY EXAM HIP UNI 1 VIEW|| 58-1699775|1326041732|CHC13|73501|TC|04/01/2016|12/31/9999|$29.74|0|0|0||X-RAY EXAM HIP UNI 1 VIEW|| 58-1699775|1326041732|CHC13|73502||04/01/2016|12/31/9999|$62.93|0|0|0||X-RAY EXAM HIP UNI 2-3 VIEWS|| 58-1699775|1326041732|CHC13|73502|26|04/01/2016|12/31/9999|$18.31|0|0|0||X-RAY EXAM HIP UNI 2-3 VIEWS|| 58-1699775|1326041732|CHC13|73502|TC|04/01/2016|12/31/9999|$44.62|0|0|0||X-RAY EXAM HIP UNI 2-3 VIEWS|| 58-1699775|1326041732|CHC13|73503||04/01/2016|12/31/9999|$78.63|0|0|0||X-RAY EXAM HIP UNI 4/> VIEWS|| 58-1699775|1326041732|CHC13|73503|26|04/01/2016|12/31/9999|$23.39|0|0|0||X-RAY EXAM HIP UNI 4/> VIEWS|| 58-1699775|1326041732|CHC13|73503|TC|04/01/2016|12/31/9999|$55.24|0|0|0||X-RAY EXAM HIP UNI 4/> VIEWS|| 58-1699775|1326041732|CHC13|73521||04/01/2016|12/31/9999|$60.27|0|0|0||X-RAY EXAM HIPS BI 2 VIEWS|| 58-1699775|1326041732|CHC13|73521|26|04/01/2016|12/31/9999|$18.84|0|0|0||X-RAY EXAM HIPS BI 2 VIEWS|| 58-1699775|1326041732|CHC13|73521|TC|04/01/2016|12/31/9999|$41.43|0|0|0||X-RAY EXAM HIPS BI 2 VIEWS|| 58-1699775|1326041732|CHC13|73522||04/01/2016|12/31/9999|$74.50|0|0|0||X-RAY EXAM HIPS BI 3-4 VIEWS|| 58-1699775|1326041732|CHC13|73522|26|04/01/2016|12/31/9999|$24.57|0|0|0||X-RAY EXAM HIPS BI 3-4 VIEWS|| 58-1699775|1326041732|CHC13|73522|TC|04/01/2016|12/31/9999|$49.93|0|0|0||X-RAY EXAM HIPS BI 3-4 VIEWS|| 58-1699775|1326041732|CHC13|73523||04/01/2016|12/31/9999|$86.30|0|0|0||X-RAY EXAM HIPS BI 5/> VIEWS|| 58-1699775|1326041732|CHC13|73523|26|04/01/2016|12/31/9999|$26.29|0|0|0||X-RAY EXAM HIPS BI 5/> VIEWS|| 58-1699775|1326041732|CHC13|73523|TC|04/01/2016|12/31/9999|$60.02|0|0|0||X-RAY EXAM HIPS BI 5/> VIEWS|| 58-1699775|1326041732|CHC13|73525||11/01/2013|12/31/9999|$161.03|0|0|||CONTRAST X-RAY OF HIP|| 58-1699775|1326041732|CHC13|73525|26|11/01/2013|12/31/9999|$45.02|0|0|||CONTRAST X-RAY OF HIP|| 58-1699775|1326041732|CHC13|73525|TC|11/01/2013|12/31/9999|$116.01|0|0|||CONTRAST X-RAY OF HIP|| 58-1699775|1326041732|CHC13|73551||04/01/2016|12/31/9999|$42.39|0|0|0||X-RAY EXAM OF FEMUR 1|| 58-1699775|1326041732|CHC13|73551|26|04/01/2016|12/31/9999|$13.70|0|0|0||X-RAY EXAM OF FEMUR 1|| 58-1699775|1326041732|CHC13|73551|TC|04/01/2016|12/31/9999|$28.68|0|0|0||X-RAY EXAM OF FEMUR 1|| 58-1699775|1326041732|CHC13|73552||04/01/2016|12/31/9999|$49.41|0|0|0||X-RAY EXAM OF FEMUR 2/>|| 58-1699775|1326041732|CHC13|73552|26|04/01/2016|12/31/9999|$15.42|0|0|0||X-RAY EXAM OF FEMUR 2/>|| 58-1699775|1326041732|CHC13|73552|TC|04/01/2016|12/31/9999|$33.99|0|0|0||X-RAY EXAM OF FEMUR 2/>|| 58-1699775|1326041732|CHC13|73560||11/01/2013|12/31/9999|$48.45|0|0|||X-RAY EXAM OF KNEE| 1 OR 2|| 58-1699775|1326041732|CHC13|73560|26|11/01/2013|12/31/9999|$15.15|0|0|||X-RAY EXAM OF KNEE| 1 OR 2|| 58-1699775|1326041732|CHC13|73560|TC|11/01/2013|12/31/9999|$33.30|0|0|||X-RAY EXAM OF KNEE| 1 OR 2|| 58-1699775|1326041732|CHC13|73562||11/01/2013|12/31/9999|$57.58|0|0|||X-RAY EXAM OF KNEE| 3|| 58-1699775|1326041732|CHC13|73562|26|11/01/2013|12/31/9999|$15.71|0|0|||X-RAY EXAM OF KNEE| 3|| 58-1699775|1326041732|CHC13|73562|TC|11/01/2013|12/31/9999|$41.88|0|0|||X-RAY EXAM OF KNEE| 3|| 58-1699775|1326041732|CHC13|73564||11/01/2013|12/31/9999|$67.40|0|0|||X-RAY EXAM| KNEE| 4 OR MORE|| 58-1699775|1326041732|CHC13|73564|26|11/01/2013|12/31/9999|$18.96|0|0|||X-RAY EXAM| KNEE| 4 OR MORE|| 58-1699775|1326041732|CHC13|73564|TC|11/01/2013|12/31/9999|$48.43|0|0|||X-RAY EXAM| KNEE| 4 OR MORE|| 58-1699775|1326041732|CHC13|73565||11/01/2013|12/31/9999|$55.01|0|0|||X-RAY EXAM OF KNEES|| 58-1699775|1326041732|CHC13|73565|26|11/01/2013|12/31/9999|$15.65|0|0|||X-RAY EXAM OF KNEES|| 58-1699775|1326041732|CHC13|73565|TC|11/01/2013|12/31/9999|$39.35|0|0|||X-RAY EXAM OF KNEES|| 58-1699775|1326041732|CHC13|73580||11/01/2013|12/31/9999|$208.46|0|0|||CONTRAST X-RAY OF KNEE JOINT|| 58-1699775|1326041732|CHC13|73580|26|11/01/2013|12/31/9999|$46.05|0|0|||CONTRAST X-RAY OF KNEE JOINT|| 58-1699775|1326041732|CHC13|73580|TC|11/01/2013|12/31/9999|$162.41|0|0|||CONTRAST X-RAY OF KNEE JOINT|| 58-1699775|1326041732|CHC13|73590||11/01/2013|12/31/9999|$42.87|0|0|||X-RAY EXAM OF LOWER LEG|| 58-1699775|1326041732|CHC13|73590|26|11/01/2013|12/31/9999|$13.60|0|0|||X-RAY EXAM OF LOWER LEG|| 58-1699775|1326041732|CHC13|73590|TC|11/01/2013|12/31/9999|$29.27|0|0|||X-RAY EXAM OF LOWER LEG|| 58-1699775|1326041732|CHC13|73592||11/01/2013|12/31/9999|$49.87|0|0|||X-RAY EXAM OF LEG| INFANT|| 58-1699775|1326041732|CHC13|73592|26|11/01/2013|12/31/9999|$13.04|0|0|||X-RAY EXAM OF LEG| INFANT|| 58-1699775|1326041732|CHC13|73592|TC|11/01/2013|12/31/9999|$36.83|0|0|||X-RAY EXAM OF LEG| INFANT|| 58-1699775|1326041732|CHC13|73600||11/01/2013|12/31/9999|$44.83|0|0|||X-RAY EXAM OF ANKLE|| 58-1699775|1326041732|CHC13|73600|26|11/01/2013|12/31/9999|$13.04|0|0|||X-RAY EXAM OF ANKLE|| 58-1699775|1326041732|CHC13|73600|TC|11/01/2013|12/31/9999|$31.79|0|0|||X-RAY EXAM OF ANKLE|| 58-1699775|1326041732|CHC13|73610||11/01/2013|12/31/9999|$51.44|0|0|||X-RAY EXAM OF ANKLE|| 58-1699775|1326041732|CHC13|73610|26|11/01/2013|12/31/9999|$13.60|0|0|||X-RAY EXAM OF ANKLE|| 58-1699775|1326041732|CHC13|73610|TC|11/01/2013|12/31/9999|$37.84|0|0|||X-RAY EXAM OF ANKLE|| 58-1699775|1326041732|CHC13|73615||11/01/2013|12/31/9999|$167.59|0|0|||CONTRAST X-RAY OF ANKLE|| 58-1699775|1326041732|CHC13|73615|26|11/01/2013|12/31/9999|$45.02|0|0|||CONTRAST X-RAY OF ANKLE|| 58-1699775|1326041732|CHC13|73615|TC|11/01/2013|12/31/9999|$122.57|0|0|||CONTRAST X-RAY OF ANKLE|| 58-1699775|1326041732|CHC13|73620||11/01/2013|12/31/9999|$42.31|0|0|||X-RAY EXAM OF FOOT|| 58-1699775|1326041732|CHC13|73620|26|11/01/2013|12/31/9999|$12.03|0|0|||X-RAY EXAM OF FOOT|| 58-1699775|1326041732|CHC13|73620|TC|11/01/2013|12/31/9999|$30.28|0|0|||X-RAY EXAM OF FOOT|| 58-1699775|1326041732|CHC13|73630||11/01/2013|12/31/9999|$48.92|0|0|||X-RAY EXAM OF FOOT|| 58-1699775|1326041732|CHC13|73630|26|11/01/2013|12/31/9999|$13.09|0|0|||X-RAY EXAM OF FOOT|| 58-1699775|1326041732|CHC13|73630|TC|11/01/2013|12/31/9999|$35.82|0|0|||X-RAY EXAM OF FOOT|| 58-1699775|1326041732|CHC13|73650||11/01/2013|12/31/9999|$43.82|0|0|||X-RAY EXAM OF HEEL|| 58-1699775|1326041732|CHC13|73650|26|11/01/2013|12/31/9999|$12.53|0|0|||X-RAY EXAM OF HEEL|| 58-1699775|1326041732|CHC13|73650|TC|11/01/2013|12/31/9999|$31.29|0|0|||X-RAY EXAM OF HEEL|| 58-1699775|1326041732|CHC13|73660||11/01/2013|12/31/9999|$46.17|0|0|||X-RAY EXAM OF TOE(S)|| 58-1699775|1326041732|CHC13|73660|26|11/01/2013|12/31/9999|$10.34|0|0|||X-RAY EXAM OF TOE(S)|| 58-1699775|1326041732|CHC13|73660|TC|11/01/2013|12/31/9999|$35.82|0|0|||X-RAY EXAM OF TOE(S)|| 58-1699775|1326041732|CHC13|73700||11/01/2013|12/31/9999|$350.32|0|0|||CT LOWER EXTREMITY W/O DYE|| 58-1699775|1326041732|CHC13|73700|26|11/01/2013|12/31/9999|$78.98|0|0|||CT LOWER EXTREMITY W/O DYE|| 58-1699775|1326041732|CHC13|73700|TC|11/01/2013|12/31/9999|$271.35|0|0|||CT LOWER EXTREMITY W/O DYE|| 58-1699775|1326041732|CHC13|73701||11/01/2013|12/31/9999|$432.94|0|0|||CT LOWER EXTREMITY W/DYE|| 58-1699775|1326041732|CHC13|73701|26|11/01/2013|12/31/9999|$90.99|0|0|||CT LOWER EXTREMITY W/DYE|| 58-1699775|1326041732|CHC13|73701|TC|11/01/2013|12/31/9999|$341.96|0|0|||CT LOWER EXTREMITY W/DYE|| 58-1699775|1326041732|CHC13|73702||11/01/2013|12/31/9999|$548.28|0|0|||CT LWR EXTREMITY W/O&W/DYE|| 58-1699775|1326041732|CHC13|73702|26|11/01/2013|12/31/9999|$95.37|0|0|||CT LWR EXTREMITY W/O&W/DYE|| 58-1699775|1326041732|CHC13|73702|TC|11/01/2013|12/31/9999|$452.91|0|0|||CT LWR EXTREMITY W/O&W/DYE|| 58-1699775|1326041732|CHC13|73706||11/01/2013|12/31/9999|$678.83|0|0|||CT ANGIO LWR EXTR W/O&W/DYE|| 58-1699775|1326041732|CHC13|73706|26|11/01/2013|12/31/9999|$148.75|0|0|||CT ANGIO LWR EXTR W/O&W/DYE|| 58-1699775|1326041732|CHC13|73706|TC|11/01/2013|12/31/9999|$530.07|0|0|||CT ANGIO LWR EXTR W/O&W/DYE|| 58-1699775|1326041732|CHC13|73718||11/01/2013|12/31/9999|$706.89|0|0|||MRI LOWER EXTREMITY W/O DYE|| 58-1699775|1326041732|CHC13|73718|26|11/01/2013|12/31/9999|$105.20|0|0|||MRI LOWER EXTREMITY W/O DYE|| 58-1699775|1326041732|CHC13|73718|TC|11/01/2013|12/31/9999|$601.69|0|0|||MRI LOWER EXTREMITY W/O DYE|| 58-1699775|1326041732|CHC13|73719||11/01/2013|12/31/9999|$792.70|0|0|||MRI LOWER EXTREMITY W/DYE|| 58-1699775|1326041732|CHC13|73719|26|11/01/2013|12/31/9999|$126.96|0|0|||MRI LOWER EXTREMITY W/DYE|| 58-1699775|1326041732|CHC13|73719|TC|11/01/2013|12/31/9999|$665.74|0|0|||MRI LOWER EXTREMITY W/DYE|| 58-1699775|1326041732|CHC13|73720||11/01/2013|12/31/9999|$1|011.12|0|0|||MRI LWR EXTREMITY W/O&W/DYE|| 58-1699775|1326041732|CHC13|73720|26|11/01/2013|12/31/9999|$167.35|0|0|||MRI LWR EXTREMITY W/O&W/DYE|| 58-1699775|1326041732|CHC13|73720|TC|11/01/2013|12/31/9999|$843.77|0|0|||MRI LWR EXTREMITY W/O&W/DYE|| 58-1699775|1326041732|CHC13|73721||11/01/2013|12/31/9999|$697.85|0|0|||MRI JNT OF LWR EXTRE W/O DYE|| 58-1699775|1326041732|CHC13|73721|26|11/01/2013|12/31/9999|$107.26|0|0|||MRI JNT OF LWR EXTRE W/O DYE|| 58-1699775|1326041732|CHC13|73721|TC|11/01/2013|12/31/9999|$590.59|0|0|||MRI JNT OF LWR EXTRE W/O DYE|| 58-1699775|1326041732|CHC13|73722||11/01/2013|12/31/9999|$757.92|0|0|||MRI JOINT OF LWR EXTR W/DYE|| 58-1699775|1326041732|CHC13|73722|26|11/01/2013|12/31/9999|$127.98|0|0|||MRI JOINT OF LWR EXTR W/DYE|| 58-1699775|1326041732|CHC13|73722|TC|11/01/2013|12/31/9999|$629.93|0|0|||MRI JOINT OF LWR EXTR W/DYE|| 58-1699775|1326041732|CHC13|73723||11/01/2013|12/31/9999|$952.11|0|0|||MRI JOINT LWR EXTR W/O&W/DYE|| 58-1699775|1326041732|CHC13|73723|26|11/01/2013|12/31/9999|$167.35|0|0|||MRI JOINT LWR EXTR W/O&W/DYE|| 58-1699775|1326041732|CHC13|73723|TC|11/01/2013|12/31/9999|$784.76|0|0|||MRI JOINT LWR EXTR W/O&W/DYE|| 58-1699775|1326041732|CHC13|73725||11/01/2013|12/31/9999|$786.78|0|0|||MR ANG LWR EXT W OR W/O DYE|| 58-1699775|1326041732|CHC13|73725|26|11/01/2013|12/31/9999|$141.72|0|0|||MR ANG LWR EXT W OR W/O DYE|| 58-1699775|1326041732|CHC13|73725|TC|11/01/2013|12/31/9999|$645.06|0|0|||MR ANG LWR EXT W OR W/O DYE|| 58-1699775|1326041732|CHC13|74000||11/01/2013|12/31/9999|$38.39|0|0|||X-RAY EXAM OF ABDOMEN|| 58-1699775|1326041732|CHC13|74000|26|11/01/2013|12/31/9999|$14.16|0|0|||X-RAY EXAM OF ABDOMEN|| 58-1699775|1326041732|CHC13|74000|TC|11/01/2013|12/31/9999|$24.22|0|0|||X-RAY EXAM OF ABDOMEN|| 58-1699775|1326041732|CHC13|74010||11/01/2013|12/31/9999|$59.35|0|0|||X-RAY EXAM OF ABDOMEN|| 58-1699775|1326041732|CHC13|74010|26|11/01/2013|12/31/9999|$17.98|0|0|||X-RAY EXAM OF ABDOMEN|| 58-1699775|1326041732|CHC13|74010|TC|11/01/2013|12/31/9999|$41.37|0|0|||X-RAY EXAM OF ABDOMEN|| 58-1699775|1326041732|CHC13|74018||01/01/2018|12/31/9999|$42.19|0|0|||X-RAY EXAM ABDOMEN 1 VIEW|| 58-1699775|1326041732|CHC13|74018|26|01/01/2018|12/31/9999|$14.85|0|0|||X-RAY EXAM ABDOMEN 1 VIEW|| 58-1699775|1326041732|CHC13|74018|TC|01/01/2018|12/31/9999|$27.34|0|0|||X-RAY EXAM ABDOMEN 1 VIEW|| 58-1699775|1326041732|CHC13|74019||01/01/2018|12/31/9999|$51.51|0|0||||| 58-1699775|1326041732|CHC13|74019|26|01/01/2018|12/31/9999|$18.83|0|0||||| 58-1699775|1326041732|CHC13|74019|TC|01/01/2018|12/31/9999|$32.68|0|0||||| 58-1699775|1326041732|CHC13|74020||11/01/2013|12/31/9999|$62.10|0|0|||X-RAY EXAM OF ABDOMEN|| 58-1699775|1326041732|CHC13|74020|26|11/01/2013|12/31/9999|$20.73|0|0|||X-RAY EXAM OF ABDOMEN|| 58-1699775|1326041732|CHC13|74020|TC|11/01/2013|12/31/9999|$41.37|0|0|||X-RAY EXAM OF ABDOMEN|| 58-1699775|1326041732|CHC13|74021||01/01/2018|12/31/9999|$60.35|0|0|||X-RAY EXAM ABDOMEN 3+ VIEWS|| 58-1699775|1326041732|CHC13|74021|26|01/01/2018|12/31/9999|$23.33|0|0|||X-RAY EXAM ABDOMEN 3+ VIEWS|| 58-1699775|1326041732|CHC13|74021|TC|01/01/2018|12/31/9999|$38.02|0|0|||X-RAY EXAM ABDOMEN 3+ VIEWS|| 58-1699775|1326041732|CHC13|74022||11/01/2013|12/31/9999|$74.49|0|0|||X-RAY EXAM SERIES| ABDOMEN|| 58-1699775|1326041732|CHC13|74022|26|11/01/2013|12/31/9999|$24.55|0|0|||X-RAY EXAM SERIES| ABDOMEN|| 58-1699775|1326041732|CHC13|74022|TC|11/01/2013|12/31/9999|$49.95|0|0|||X-RAY EXAM SERIES| ABDOMEN|| 58-1699775|1326041732|CHC13|74150||11/01/2013|12/31/9999|$351.41|0|0|||CT ABDOMEN W/O DYE|| 58-1699775|1326041732|CHC13|74150|26|11/01/2013|12/31/9999|$93.18|0|0|||CT ABDOMEN W/O DYE|| 58-1699775|1326041732|CHC13|74150|TC|11/01/2013|12/31/9999|$258.24|0|0|||CT ABDOMEN W/O DYE|| 58-1699775|1326041732|CHC13|74160||11/01/2013|12/31/9999|$476.44|0|0|||CT ABDOMEN W/DYE|| 58-1699775|1326041732|CHC13|74160|26|11/01/2013|12/31/9999|$99.18|0|0|||CT ABDOMEN W/DYE|| 58-1699775|1326041732|CHC13|74160|TC|11/01/2013|12/31/9999|$377.26|0|0|||CT ABDOMEN W/DYE|| 58-1699775|1326041732|CHC13|74170||11/01/2013|12/31/9999|$629.51|0|0|||CT ABDOMEN W/O & W/DYE|| 58-1699775|1326041732|CHC13|74170|26|11/01/2013|12/31/9999|$109.53|0|0|||CT ABDOMEN W/O & W/DYE|| 58-1699775|1326041732|CHC13|74170|TC|11/01/2013|12/31/9999|$519.99|0|0|||CT ABDOMEN W/O & W/DYE|| 58-1699775|1326041732|CHC13|74174||11/01/2013|12/31/9999|$846.02|0|0|||CT ANGIO ABD&PELV W/O&W/DYE|| 58-1699775|1326041732|CHC13|74174|26|11/01/2013|12/31/9999|$169.18|0|0|||CT ANGIO ABD&PELV W/O&W/DYE|| 58-1699775|1326041732|CHC13|74174|TC|11/01/2013|12/31/9999|$676.83|0|0|||CT ANGIO ABD&PELV W/O&W/DYE|| 58-1699775|1326041732|CHC13|74175||11/01/2013|12/31/9999|$735.33|0|0|||CT ANGIO ABDOM W/O & W/DYE|| 58-1699775|1326041732|CHC13|74175|26|11/01/2013|12/31/9999|$148.77|0|0|||CT ANGIO ABDOM W/O & W/DYE|| 58-1699775|1326041732|CHC13|74175|TC|11/01/2013|12/31/9999|$586.56|0|0|||CT ANGIO ABDOM W/O & W/DYE|| 58-1699775|1326041732|CHC13|74176||11/01/2013|12/31/9999|$345.54|0|0|||CT ANGIO ABD & PELVIS|| 58-1699775|1326041732|CHC13|74176|26|11/01/2013|12/31/9999|$133.70|0|0|||CT ANGIO ABD & PELVIS|| 58-1699775|1326041732|CHC13|74176|TC|11/01/2013|12/31/9999|$211.84|0|0|||CT ANGIO ABD & PELVIS|| 58-1699775|1326041732|CHC13|74177||11/01/2013|12/31/9999|$540.67|0|0|||CT ANGIO ABD&PELV W/CONTRAST|| 58-1699775|1326041732|CHC13|74177|26|11/01/2013|12/31/9999|$139.70|0|0|||CT ANGIO ABD&PELV W/CONTRAST|| 58-1699775|1326041732|CHC13|74177|TC|11/01/2013|12/31/9999|$400.96|0|0|||CT ANGIO ABD&PELV W/CONTRAST|| 58-1699775|1326041732|CHC13|74178||11/01/2013|12/31/9999|$685.02|0|0|||CT ANGIO ABD & PELV 1+ REGNS|| 58-1699775|1326041732|CHC13|74178|26|11/01/2013|12/31/9999|$154.95|0|0|||CT ANGIO ABD & PELV 1+ REGNS|| 58-1699775|1326041732|CHC13|74178|TC|11/01/2013|12/31/9999|$530.07|0|0|||CT ANGIO ABD & PELV 1+ REGNS|| 58-1699775|1326041732|CHC13|74181||11/01/2013|12/31/9999|$644.48|0|0|||MRI ABDOMEN W/O DYE|| 58-1699775|1326041732|CHC13|74181|26|11/01/2013|12/31/9999|$113.90|0|0|||MRI ABDOMEN W/O DYE|| 58-1699775|1326041732|CHC13|74181|TC|11/01/2013|12/31/9999|$530.58|0|0|||MRI ABDOMEN W/O DYE|| 58-1699775|1326041732|CHC13|74182||11/01/2013|12/31/9999|$876.54|0|0|||MRI ABDOMEN W/DYE|| 58-1699775|1326041732|CHC13|74182|26|11/01/2013|12/31/9999|$135.15|0|0|||MRI ABDOMEN W/DYE|| 58-1699775|1326041732|CHC13|74182|TC|11/01/2013|12/31/9999|$741.39|0|0|||MRI ABDOMEN W/DYE|| 58-1699775|1326041732|CHC13|74183||11/01/2013|12/31/9999|$1|015.28|0|0|||MRI ABDOMEN W/O & W/DYE|| 58-1699775|1326041732|CHC13|74183|26|11/01/2013|12/31/9999|$175.54|0|0|||MRI ABDOMEN W/O & W/DYE|| 58-1699775|1326041732|CHC13|74183|TC|11/01/2013|12/31/9999|$839.73|0|0|||MRI ABDOMEN W/O & W/DYE|| 58-1699775|1326041732|CHC13|74185||11/01/2013|12/31/9999|$783.64|0|0|||MRI ANGIO| ABDOM W ORW/O DYE|| 58-1699775|1326041732|CHC13|74185|26|11/01/2013|12/31/9999|$140.09|0|0|||MRI ANGIO| ABDOM W ORW/O DYE|| 58-1699775|1326041732|CHC13|74185|TC|11/01/2013|12/31/9999|$643.55|0|0|||MRI ANGIO| ABDOM W ORW/O DYE|| 58-1699775|1326041732|CHC13|74190||11/01/2013|12/31/9999|$90.11|0|0|||X-RAY EXAM OF PERITONEUM|| 58-1699775|1326041732|CHC13|74190|26|11/01/2013|12/31/9999|$38.12|0|0|||X-RAY EXAM OF PERITONEUM|| 58-1699775|1326041732|CHC13|74190|TC|11/01/2013|12/31/9999|$52.51|0|0|||X-RAY EXAM OF PERITONEUM|| 58-1699775|1326041732|CHC13|74210||11/01/2013|12/31/9999|$121.62|0|0|||CONTRST X-RAY EXAM OF THROAT|| 58-1699775|1326041732|CHC13|74210|26|11/01/2013|12/31/9999|$27.80|0|0|||CONTRST X-RAY EXAM OF THROAT|| 58-1699775|1326041732|CHC13|74210|TC|11/01/2013|12/31/9999|$93.82|0|0|||CONTRST X-RAY EXAM OF THROAT|| 58-1699775|1326041732|CHC13|74220||11/01/2013|12/31/9999|$139.88|0|0|||CONTRAST X-RAY| ESOPHAGUS|| 58-1699775|1326041732|CHC13|74220|26|11/01/2013|12/31/9999|$35.97|0|0|||CONTRAST X-RAY| ESOPHAGUS|| 58-1699775|1326041732|CHC13|74220|TC|11/01/2013|12/31/9999|$103.91|0|0|||CONTRAST X-RAY| ESOPHAGUS|| 58-1699775|1326041732|CHC13|74230||11/01/2013|12/31/9999|$142.30|0|0|||CINE/VID X-RAY| THROAT/ESOPH|| 58-1699775|1326041732|CHC13|74230|26|11/01/2013|12/31/9999|$41.42|0|0|||CINE/VID X-RAY| THROAT/ESOPH|| 58-1699775|1326041732|CHC13|74230|TC|11/01/2013|12/31/9999|$100.88|0|0|||CINE/VID X-RAY| THROAT/ESOPH|| 58-1699775|1326041732|CHC13|74235||11/01/2013|12/31/9999|$284.05|0|0|||REMOVE ESOPHAGUS OBSTRUCTION|| 58-1699775|1326041732|CHC13|74235|26|11/01/2013|12/31/9999|$103.31|0|0|||REMOVE ESOPHAGUS OBSTRUCTION|| 58-1699775|1326041732|CHC13|74235|TC|11/01/2013|12/31/9999|$52.51|0|0|||REMOVE ESOPHAGUS OBSTRUCTION|| 58-1699775|1326041732|CHC13|74240||11/01/2013|12/31/9999|$177.02|0|0|||X-RAY EXAM| UPPER GI TRACT|| 58-1699775|1326041732|CHC13|74240|26|11/01/2013|12/31/9999|$54.45|0|0|||X-RAY EXAM| UPPER GI TRACT|| 58-1699775|1326041732|CHC13|74240|TC|11/01/2013|12/31/9999|$122.57|0|0|||X-RAY EXAM| UPPER GI TRACT|| 58-1699775|1326041732|CHC13|74241||11/01/2013|12/31/9999|$185.08|0|0|||X-RAY EXAM| UPPER GI TRACT|| 58-1699775|1326041732|CHC13|74241|26|11/01/2013|12/31/9999|$53.43|0|0|||X-RAY EXAM| UPPER GI TRACT|| 58-1699775|1326041732|CHC13|74241|TC|11/01/2013|12/31/9999|$131.65|0|0|||X-RAY EXAM| UPPER GI TRACT|| 58-1699775|1326041732|CHC13|74245||11/01/2013|12/31/9999|$275.13|0|0|||X-RAY EXAM| UPPER GI TRACT|| 58-1699775|1326041732|CHC13|74245|26|11/01/2013|12/31/9999|$70.86|0|0|||X-RAY EXAM| UPPER GI TRACT|| 58-1699775|1326041732|CHC13|74245|TC|11/01/2013|12/31/9999|$204.27|0|0|||X-RAY EXAM| UPPER GI TRACT|| 58-1699775|1326041732|CHC13|74246||11/01/2013|12/31/9999|$198.21|0|0|||CONTRST X-RAY UPPR GI TRACT|| 58-1699775|1326041732|CHC13|74246|26|11/01/2013|12/31/9999|$53.95|0|0|||CONTRST X-RAY UPPR GI TRACT|| 58-1699775|1326041732|CHC13|74246|TC|11/01/2013|12/31/9999|$144.26|0|0|||CONTRST X-RAY UPPR GI TRACT|| 58-1699775|1326041732|CHC13|74247||11/01/2013|12/31/9999|$219.89|0|0|||CONTRST X-RAY UPPR GI TRACT|| 58-1699775|1326041732|CHC13|74247|26|11/01/2013|12/31/9999|$53.95|0|0|||CONTRST X-RAY UPPR GI TRACT|| 58-1699775|1326041732|CHC13|74247|TC|11/01/2013|12/31/9999|$165.94|0|0|||CONTRST X-RAY UPPR GI TRACT|| 58-1699775|1326041732|CHC13|74249||11/01/2013|12/31/9999|$296.82|0|0|||CONTRST X-RAY UPPR GI TRACT|| 58-1699775|1326041732|CHC13|74249|26|11/01/2013|12/31/9999|$70.86|0|0|||CONTRST X-RAY UPPR GI TRACT|| 58-1699775|1326041732|CHC13|74249|TC|11/01/2013|12/31/9999|$225.96|0|0|||CONTRST X-RAY UPPR GI TRACT|| 58-1699775|1326041732|CHC13|74250||11/01/2013|12/31/9999|$166.67|0|0|||X-RAY EXAM OF SMALL BOWEL|| 58-1699775|1326041732|CHC13|74250|26|11/01/2013|12/31/9999|$37.04|0|0|||X-RAY EXAM OF SMALL BOWEL|| 58-1699775|1326041732|CHC13|74250|TC|11/01/2013|12/31/9999|$129.63|0|0|||X-RAY EXAM OF SMALL BOWEL|| 58-1699775|1326041732|CHC13|74251||11/01/2013|12/31/9999|$588.56|0|0|||X-RAY EXAM OF SMALL BOWEL|| 58-1699775|1326041732|CHC13|74251|26|11/01/2013|12/31/9999|$53.95|0|0|||X-RAY EXAM OF SMALL BOWEL|| 58-1699775|1326041732|CHC13|74251|TC|11/01/2013|12/31/9999|$534.61|0|0|||X-RAY EXAM OF SMALL BOWEL|| 58-1699775|1326041732|CHC13|74260||11/01/2013|12/31/9999|$489.11|0|0|||X-RAY EXAM OF SMALL BOWEL|| 58-1699775|1326041732|CHC13|74260|26|11/01/2013|12/31/9999|$39.23|0|0|||X-RAY EXAM OF SMALL BOWEL|| 58-1699775|1326041732|CHC13|74260|TC|11/01/2013|12/31/9999|$449.88|0|0|||X-RAY EXAM OF SMALL BOWEL|| 58-1699775|1326041732|CHC13|74261||11/01/2013|12/31/9999|$815.86|0|0|||CT COLONOGRAPHY| W/O DYE|| 58-1699775|1326041732|CHC13|74261|26|11/01/2013|12/31/9999|$183.91|0|0|||CT COLONOGRAPHY| W/O DYE|| 58-1699775|1326041732|CHC13|74261|TC|11/01/2013|12/31/9999|$631.95|0|0|||CT COLONOGRAPHY| W/O DYE|| 58-1699775|1326041732|CHC13|74262||11/01/2013|12/31/9999|$950.12|0|0|||CT COLONOGRAPHY| W/DYE|| 58-1699775|1326041732|CHC13|74262|26|11/01/2013|12/31/9999|$195.11|0|0|||CT COLONOGRAPHY| W/DYE|| 58-1699775|1326041732|CHC13|74262|TC|11/01/2013|12/31/9999|$755.01|0|0|||CT COLONOGRAPHY| W/DYE|| 58-1699775|1326041732|CHC13|74263||11/01/2013|12/31/9999|$1|212.08|0|0|||CT COLONOGRAPHY| SCREEN|| 58-1699775|1326041732|CHC13|74263|26|11/01/2013|12/31/9999|$181.21|0|0|||CT COLONOGRAPHY| SCREEN|| 58-1699775|1326041732|CHC13|74263|TC|11/01/2013|12/31/9999|$1|030.88|0|0|||CT COLONOGRAPHY| SCREEN|| 58-1699775|1326041732|CHC13|74270||11/01/2013|12/31/9999|$240.07|0|0|||CONTRAST X-RAY EXAM OF COLON|| 58-1699775|1326041732|CHC13|74270|26|11/01/2013|12/31/9999|$53.95|0|0|||CONTRAST X-RAY EXAM OF COLON|| 58-1699775|1326041732|CHC13|74270|TC|11/01/2013|12/31/9999|$186.12|0|0|||CONTRAST X-RAY EXAM OF COLON|| 58-1699775|1326041732|CHC13|74280||11/01/2013|12/31/9999|$332.58|0|0|||CONTRAST X-RAY EXAM OF COLON|| 58-1699775|1326041732|CHC13|74280|26|11/01/2013|12/31/9999|$76.87|0|0|||CONTRAST X-RAY EXAM OF COLON|| 58-1699775|1326041732|CHC13|74280|TC|11/01/2013|12/31/9999|$255.71|0|0|||CONTRAST X-RAY EXAM OF COLON|| 58-1699775|1326041732|CHC13|74283||11/01/2013|12/31/9999|$318.31|0|0|||CONTRAST X-RAY EXAM OF COLON|| 58-1699775|1326041732|CHC13|74283|26|11/01/2013|12/31/9999|$154.89|0|0|||CONTRAST X-RAY EXAM OF COLON|| 58-1699775|1326041732|CHC13|74283|TC|11/01/2013|12/31/9999|$163.42|0|0|||CONTRAST X-RAY EXAM OF COLON|| 58-1699775|1326041732|CHC13|74290||11/01/2013|12/31/9999|$107.27|0|0|||CONTRAST X-RAY| GALLBLADDER|| 58-1699775|1326041732|CHC13|74290|26|11/01/2013|12/31/9999|$24.55|0|0|||CONTRAST X-RAY| GALLBLADDER|| 58-1699775|1326041732|CHC13|74290|TC|11/01/2013|12/31/9999|$82.73|0|0|||CONTRAST X-RAY| GALLBLADDER|| 58-1699775|1326041732|CHC13|74300||11/01/2013|12/31/9999|$28.33|0|0|||X-RAY BILE DUCTS/PANCREAS|| 58-1699775|1326041732|CHC13|74300|26|11/01/2013|12/31/9999|$28.84|0|0|||X-RAY BILE DUCTS/PANCREAS|| 58-1699775|1326041732|CHC13|74300|TC|11/01/2013|12/31/9999|$48.99|0|0|||X-RAY BILE DUCTS/PANCREAS|| 58-1699775|1326041732|CHC13|74301||11/01/2013|12/31/9999|$46.17|0|0|||X-RAYS AT SURGERY ADD-ON|| 58-1699775|1326041732|CHC13|74301|26|11/01/2013|12/31/9999|$17.39|0|0|||X-RAYS AT SURGERY ADD-ON|| 58-1699775|1326041732|CHC13|74301|TC|11/01/2013|12/31/9999|$29.29|0|0|||X-RAYS AT SURGERY ADD-ON|| 58-1699775|1326041732|CHC13|74328||11/01/2013|12/31/9999|$177.21|0|0|||X-RAY BILE DUCT ENDOSCOPY|| 58-1699775|1326041732|CHC13|74328|26|11/01/2013|12/31/9999|$56.55|0|0|||X-RAY BILE DUCT ENDOSCOPY|| 58-1699775|1326041732|CHC13|74328|TC|11/01/2013|12/31/9999|$121.19|0|0|||X-RAY BILE DUCT ENDOSCOPY|| 58-1699775|1326041732|CHC13|74329||11/01/2013|12/31/9999|$153.98|0|0|||X-RAY FOR PANCREAS ENDOSCOPY|| 58-1699775|1326041732|CHC13|74329|26|11/01/2013|12/31/9999|$56.55|0|0|||X-RAY FOR PANCREAS ENDOSCOPY|| 58-1699775|1326041732|CHC13|74329|TC|11/01/2013|12/31/9999|$97.47|0|0|||X-RAY FOR PANCREAS ENDOSCOPY|| 58-1699775|1326041732|CHC13|74330||11/01/2013|12/31/9999|$180.28|0|0|||X-RAY BILE/PANC ENDOSCOPY|| 58-1699775|1326041732|CHC13|74330|26|11/01/2013|12/31/9999|$72.35|0|0|||X-RAY BILE/PANC ENDOSCOPY|| 58-1699775|1326041732|CHC13|74330|TC|11/01/2013|12/31/9999|$180.28|0|0|||X-RAY BILE/PANC ENDOSCOPY|| 58-1699775|1326041732|CHC13|74340||11/01/2013|12/31/9999|$160.64|0|0|||X-RAY GUIDE FOR GI TUBE|| 58-1699775|1326041732|CHC13|74340|26|11/01/2013|12/31/9999|$42.50|0|0|||X-RAY GUIDE FOR GI TUBE|| 58-1699775|1326041732|CHC13|74340|TC|11/01/2013|12/31/9999|$118.17|0|0|||X-RAY GUIDE FOR GI TUBE|| 58-1699775|1326041732|CHC13|74355||11/01/2013|12/31/9999|$211.91|0|0|||X-RAY GUIDE| INTESTINAL TUBE|| 58-1699775|1326041732|CHC13|74355|26|11/01/2013|12/31/9999|$62.47|0|0|||X-RAY GUIDE| INTESTINAL TUBE|| 58-1699775|1326041732|CHC13|74355|TC|11/01/2013|12/31/9999|$151.49|0|0|||X-RAY GUIDE| INTESTINAL TUBE|| 58-1699775|1326041732|CHC13|74360||11/01/2013|12/31/9999|$177.80|0|0|||X-RAY GUIDE| GI DILATION|| 58-1699775|1326041732|CHC13|74360|26|11/01/2013|12/31/9999|$46.03|0|0|||X-RAY GUIDE| GI DILATION|| 58-1699775|1326041732|CHC13|74360|TC|11/01/2013|12/31/9999|$132.81|0|0|||X-RAY GUIDE| GI DILATION|| 58-1699775|1326041732|CHC13|74363||11/01/2013|12/31/9999|$186.86|0|0|||X-RAY| BILE DUCT DILATION|| 58-1699775|1326041732|CHC13|74363|26|11/01/2013|12/31/9999|$70.24|0|0|||X-RAY| BILE DUCT DILATION|| 58-1699775|1326041732|CHC13|74363|TC|11/01/2013|12/31/9999|$118.17|0|0|||X-RAY| BILE DUCT DILATION|| 58-1699775|1326041732|CHC13|74400||11/01/2013|12/31/9999|$172.84|0|0|||CONTRST X-RAY| URINARY TRACT|| 58-1699775|1326041732|CHC13|74400|26|11/01/2013|12/31/9999|$38.16|0|0|||CONTRST X-RAY| URINARY TRACT|| 58-1699775|1326041732|CHC13|74400|TC|11/01/2013|12/31/9999|$134.67|0|0|||CONTRST X-RAY| URINARY TRACT|| 58-1699775|1326041732|CHC13|74410||11/01/2013|12/31/9999|$174.85|0|0|||CONTRST X-RAY| URINARY TRACT|| 58-1699775|1326041732|CHC13|74410|26|11/01/2013|12/31/9999|$38.67|0|0|||CONTRST X-RAY| URINARY TRACT|| 58-1699775|1326041732|CHC13|74410|TC|11/01/2013|12/31/9999|$136.19|0|0|||CONTRST X-RAY| URINARY TRACT|| 58-1699775|1326041732|CHC13|74415||11/01/2013|12/31/9999|$210.66|0|0|||CONTRST X-RAY| URINARY TRACT|| 58-1699775|1326041732|CHC13|74415|26|11/01/2013|12/31/9999|$38.16|0|0|||CONTRST X-RAY| URINARY TRACT|| 58-1699775|1326041732|CHC13|74415|TC|11/01/2013|12/31/9999|$172.50|0|0|||CONTRST X-RAY| URINARY TRACT|| 58-1699775|1326041732|CHC13|74420||11/01/2013|12/31/9999|$177.29|0|0|||CONTRST X-RAY| URINARY TRACT|| 58-1699775|1326041732|CHC13|74420|26|11/01/2013|12/31/9999|$28.84|0|0|||CONTRST X-RAY| URINARY TRACT|| 58-1699775|1326041732|CHC13|74420|TC|11/01/2013|12/31/9999|$148.96|0|0|||CONTRST X-RAY| URINARY TRACT|| 58-1699775|1326041732|CHC13|74425||11/01/2013|12/31/9999|$97.52|0|0|||CONTRST X-RAY| URINARY TRACT|| 58-1699775|1326041732|CHC13|74425|26|11/01/2013|12/31/9999|$28.34|0|0|||CONTRST X-RAY| URINARY TRACT|| 58-1699775|1326041732|CHC13|74425|TC|11/01/2013|12/31/9999|$69.68|0|0|||CONTRST X-RAY| URINARY TRACT|| 58-1699775|1326041732|CHC13|74430||11/01/2013|12/31/9999|$78.02|0|0|||CONTRAST X-RAY| BLADDER|| 58-1699775|1326041732|CHC13|74430|26|11/01/2013|12/31/9999|$24.55|0|0|||CONTRAST X-RAY| BLADDER|| 58-1699775|1326041732|CHC13|74430|TC|11/01/2013|12/31/9999|$53.48|0|0|||CONTRAST X-RAY| BLADDER|| 58-1699775|1326041732|CHC13|74440||11/01/2013|12/31/9999|$127.82|0|0|||X-RAY| MALE GENITAL TRACT|| 58-1699775|1326041732|CHC13|74440|26|11/01/2013|12/31/9999|$29.97|0|0|||X-RAY| MALE GENITAL TRACT|| 58-1699775|1326041732|CHC13|74440|TC|11/01/2013|12/31/9999|$97.86|0|0|||X-RAY| MALE GENITAL TRACT|| 58-1699775|1326041732|CHC13|74445||11/01/2013|12/31/9999|$151.98|0|0|||X-RAY EXAM OF PENIS|| 58-1699775|1326041732|CHC13|74445|26|11/01/2013|12/31/9999|$91.93|0|0|||X-RAY EXAM OF PENIS|| 58-1699775|1326041732|CHC13|74445|TC|11/01/2013|12/31/9999|$62.61|0|0|||X-RAY EXAM OF PENIS|| 58-1699775|1326041732|CHC13|74450||11/01/2013|12/31/9999|$107.44|0|0|||X-RAY| URETHRA/BLADDER|| 58-1699775|1326041732|CHC13|74450|26|11/01/2013|12/31/9999|$26.65|0|0|||X-RAY| URETHRA/BLADDER|| 58-1699775|1326041732|CHC13|74450|TC|11/01/2013|12/31/9999|$81.30|0|0|||X-RAY| URETHRA/BLADDER|| 58-1699775|1326041732|CHC13|74455||11/01/2013|12/31/9999|$135.57|0|0|||X-RAY| URETHRA/BLADDER|| 58-1699775|1326041732|CHC13|74455|26|11/01/2013|12/31/9999|$25.61|0|0|||X-RAY| URETHRA/BLADDER|| 58-1699775|1326041732|CHC13|74455|TC|11/01/2013|12/31/9999|$109.96|0|0|||X-RAY| URETHRA/BLADDER|| 58-1699775|1326041732|CHC13|74470||11/01/2013|12/31/9999|$111.16|0|0|||X-RAY EXAM OF KIDNEY LESION|| 58-1699775|1326041732|CHC13|74470|26|11/01/2013|12/31/9999|$42.50|0|0|||X-RAY EXAM OF KIDNEY LESION|| 58-1699775|1326041732|CHC13|74470|TC|11/01/2013|12/31/9999|$69.18|0|0|||X-RAY EXAM OF KIDNEY LESION|| 58-1699775|1326041732|CHC13|74485||11/01/2013|12/31/9999|$162.03|0|0|||X-RAY GUIDE| GU DILATION|| 58-1699775|1326041732|CHC13|74485|26|11/01/2013|12/31/9999|$41.98|0|0|||X-RAY GUIDE| GU DILATION|| 58-1699775|1326041732|CHC13|74485|TC|11/01/2013|12/31/9999|$120.05|0|0|||X-RAY GUIDE| GU DILATION|| 58-1699775|1326041732|CHC13|74710||11/01/2013|12/31/9999|$58.97|0|0|||X-RAY MEASUREMENT OF PELVIS|| 58-1699775|1326041732|CHC13|74710|26|11/01/2013|12/31/9999|$26.17|0|0|||X-RAY MEASUREMENT OF PELVIS|| 58-1699775|1326041732|CHC13|74710|TC|11/01/2013|12/31/9999|$32.80|0|0|||X-RAY MEASUREMENT OF PELVIS|| 58-1699775|1326041732|CHC13|74712||04/01/2016|12/31/9999|$650.50|0|0|0||MRI FETAL SNGL/1ST GESTATION|| 58-1699775|1326041732|CHC13|74712|26|04/01/2016|12/31/9999|$245.79|0|0|0||MRI FETAL SNGL/1ST GESTATION|| 58-1699775|1326041732|CHC13|74712|TC|04/01/2016|12/31/9999|$404.71|0|0|0||MRI FETAL SNGL/1ST GESTATION|| 58-1699775|1326041732|CHC13|74713||04/01/2016|12/31/9999|$356.93|0|0|0||MRI FETAL EA ADDL GESTATION|| 58-1699775|1326041732|CHC13|74713|26|04/01/2016|12/31/9999|$146.08|0|0|0||MRI FETAL EA ADDL GESTATION|| 58-1699775|1326041732|CHC13|74713|TC|04/01/2016|12/31/9999|$210.85|0|0|0||MRI FETAL EA ADDL GESTATION|| 58-1699775|1326041732|CHC13|74740||11/01/2013|12/31/9999|$122.24|0|0|||X-RAY| FEMALE GENITAL TRACT|| 58-1699775|1326041732|CHC13|74740|26|11/01/2013|12/31/9999|$29.43|0|0|||X-RAY| FEMALE GENITAL TRACT|| 58-1699775|1326041732|CHC13|74740|TC|11/01/2013|12/31/9999|$92.81|0|0|||X-RAY| FEMALE GENITAL TRACT|| 58-1699775|1326041732|CHC13|74742||11/01/2013|12/31/9999|$131.76|0|0|||X-RAY| FALLOPIAN TUBE|| 58-1699775|1326041732|CHC13|74742|26|11/01/2013|12/31/9999|$48.97|0|0|||X-RAY| FALLOPIAN TUBE|| 58-1699775|1326041732|CHC13|74742|TC|11/01/2013|12/31/9999|$83.31|0|0|||X-RAY| FALLOPIAN TUBE|| 58-1699775|1326041732|CHC13|74775||11/01/2013|12/31/9999|$129.80|0|0|||X-RAY EXAM OF PERINEUM|| 58-1699775|1326041732|CHC13|74775|26|11/01/2013|12/31/9999|$49.03|0|0|||X-RAY EXAM OF PERINEUM|| 58-1699775|1326041732|CHC13|74775|TC|11/01/2013|12/31/9999|$80.79|0|0|||X-RAY EXAM OF PERINEUM|| 58-1699775|1326041732|CHC13|75557||11/01/2013|12/31/9999|$628.43|0|0|||CARDIAC MRI FOR MORPH|| 58-1699775|1326041732|CHC13|75557|26|11/01/2013|12/31/9999|$184.60|0|0|||CARDIAC MRI FOR MORPH|| 58-1699775|1326041732|CHC13|75557|TC|11/01/2013|12/31/9999|$443.83|0|0|||CARDIAC MRI FOR MORPH|| 58-1699775|1326041732|CHC13|75559||11/01/2013|12/31/9999|$888.10|0|0|||CARDIAC MRI W/STRESS IMG|| 58-1699775|1326041732|CHC13|75559|26|11/01/2013|12/31/9999|$232.45|0|0|||CARDIAC MRI W/STRESS IMG|| 58-1699775|1326041732|CHC13|75559|TC|11/01/2013|12/31/9999|$655.65|0|0|||CARDIAC MRI W/STRESS IMG|| 58-1699775|1326041732|CHC13|75561||11/01/2013|12/31/9999|$843.72|0|0|||CARDIAC MRI FOR MORPH W/DYE|| 58-1699775|1326041732|CHC13|75561|26|11/01/2013|12/31/9999|$204.21|0|0|||CARDIAC MRI FOR MORPH W/DYE|| 58-1699775|1326041732|CHC13|75561|TC|11/01/2013|12/31/9999|$639.51|0|0|||CARDIAC MRI FOR MORPH W/DYE|| 58-1699775|1326041732|CHC13|75563||11/01/2013|12/31/9999|$1|013.45|0|0|||CARD MRI W/STRESS IMG & DYE|| 58-1699775|1326041732|CHC13|75563|26|11/01/2013|12/31/9999|$237.77|0|0|||CARD MRI W/STRESS IMG & DYE|| 58-1699775|1326041732|CHC13|75563|TC|11/01/2013|12/31/9999|$775.68|0|0|||CARD MRI W/STRESS IMG & DYE|| 58-1699775|1326041732|CHC13|75565||11/01/2013|12/31/9999|$99.31|0|0|||CARD MRI VEL FLW MAP ADD-ON|| 58-1699775|1326041732|CHC13|75565|26|11/01/2013|12/31/9999|$19.10|0|0|||CARD MRI VEL FLW MAP ADD-ON|| 58-1699775|1326041732|CHC13|75565|TC|11/01/2013|12/31/9999|$80.21|0|0|||CARD MRI VEL FLW MAP ADD-ON|| 58-1699775|1326041732|CHC13|75571||11/01/2013|12/31/9999|$172.81|0|0|||CT HRT W/O DYE W/CA TEST|| 58-1699775|1326041732|CHC13|75571|26|11/01/2013|12/31/9999|$43.69|0|0|||CT HRT W/O DYE W/CA TEST|| 58-1699775|1326041732|CHC13|75571|TC|11/01/2013|12/31/9999|$129.13|0|0|||CT HRT W/O DYE W/CA TEST|| 58-1699775|1326041732|CHC13|75572||11/01/2013|12/31/9999|$474.62|0|0|||CT HRT W/3D IMAGE|| 58-1699775|1326041732|CHC13|75572|26|11/01/2013|12/31/9999|$132.66|0|0|||CT HRT W/3D IMAGE|| 58-1699775|1326041732|CHC13|75572|TC|11/01/2013|12/31/9999|$341.96|0|0|||CT HRT W/3D IMAGE|| 58-1699775|1326041732|CHC13|75573||11/01/2013|12/31/9999|$652.24|0|0|||CT HRT W/3D IMAGE| CONGEN|| 58-1699775|1326041732|CHC13|75573|26|11/01/2013|12/31/9999|$193.78|0|0|||CT HRT W/3D IMAGE| CONGEN|| 58-1699775|1326041732|CHC13|75573|TC|11/01/2013|12/31/9999|$458.46|0|0|||CT HRT W/3D IMAGE| CONGEN|| 58-1699775|1326041732|CHC13|75574||11/01/2013|12/31/9999|$701.81|0|0|||CT ANGIO HRT W/3D IMAGE|| 58-1699775|1326041732|CHC13|75574|26|11/01/2013|12/31/9999|$182.33|0|0|||CT ANGIO HRT W/3D IMAGE|| 58-1699775|1326041732|CHC13|75574|TC|11/01/2013|12/31/9999|$519.48|0|0|||CT ANGIO HRT W/3D IMAGE|| 58-1699775|1326041732|CHC13|75600||11/01/2013|12/31/9999|$366.50|0|0|||CONTRAST X-RAY EXAM OF AORTA|| 58-1699775|1326041732|CHC13|75600|26|11/01/2013|12/31/9999|$39.17|0|0|||CONTRAST X-RAY EXAM OF AORTA|| 58-1699775|1326041732|CHC13|75600|TC|11/01/2013|12/31/9999|$327.33|0|0|||CONTRAST X-RAY EXAM OF AORTA|| 58-1699775|1326041732|CHC13|75605||11/01/2013|12/31/9999|$283.04|0|0|||CONTRAST X-RAY EXAM OF AORTA|| 58-1699775|1326041732|CHC13|75605|26|11/01/2013|12/31/9999|$89.86|0|0|||CONTRAST X-RAY EXAM OF AORTA|| 58-1699775|1326041732|CHC13|75605|TC|11/01/2013|12/31/9999|$193.18|0|0|||CONTRAST X-RAY EXAM OF AORTA|| 58-1699775|1326041732|CHC13|75625||11/01/2013|12/31/9999|$285.61|0|0|||CONTRAST X-RAY EXAM OF AORTA|| 58-1699775|1326041732|CHC13|75625|26|11/01/2013|12/31/9999|$89.91|0|0|||CONTRAST X-RAY EXAM OF AORTA|| 58-1699775|1326041732|CHC13|75625|TC|11/01/2013|12/31/9999|$195.70|0|0|||CONTRAST X-RAY EXAM OF AORTA|| 58-1699775|1326041732|CHC13|75630||11/01/2013|12/31/9999|$337.75|0|0|||X-RAY AORTA| LEG ARTERIES|| 58-1699775|1326041732|CHC13|75630|26|11/01/2013|12/31/9999|$139.53|0|0|||X-RAY AORTA| LEG ARTERIES|| 58-1699775|1326041732|CHC13|75630|TC|11/01/2013|12/31/9999|$198.22|0|0|||X-RAY AORTA| LEG ARTERIES|| 58-1699775|1326041732|CHC13|75635||11/01/2013|12/31/9999|$758.90|0|0|||CT ANGIO ABDOMINAL ARTERIES|| 58-1699775|1326041732|CHC13|75635|26|11/01/2013|12/31/9999|$187.44|0|0|||CT ANGIO ABDOMINAL ARTERIES|| 58-1699775|1326041732|CHC13|75635|TC|11/01/2013|12/31/9999|$571.46|0|0|||CT ANGIO ABDOMINAL ARTERIES|| 58-1699775|1326041732|CHC13|75650|26|11/01/2013|12/31/9999|$117.14|0|0|||ARTERY X-RAYS| HEAD & NECK|| 58-1699775|1326041732|CHC13|75650|TC|11/01/2013|12/31/9999|$198.72|0|0|||ARTERY X-RAYS| HEAD & NECK|| 58-1699775|1326041732|CHC13|75658||11/01/2013|12/31/9999|$323.87|0|0|||ARTERY X-RAYS| ARM|| 58-1699775|1326041732|CHC13|75658|26|11/01/2013|12/31/9999|$100.44|0|0|||ARTERY X-RAYS| ARM|| 58-1699775|1326041732|CHC13|75658|TC|11/01/2013|12/31/9999|$223.44|0|0|||ARTERY X-RAYS| ARM|| 58-1699775|1326041732|CHC13|75660|26|11/01/2013|12/31/9999|$102.39|0|0|||ARTERY X-RAYS| HEAD & NECK|| 58-1699775|1326041732|CHC13|75660|TC|11/01/2013|12/31/9999|$242.10|0|0|||ARTERY X-RAYS| HEAD & NECK|| 58-1699775|1326041732|CHC13|75662|26|11/01/2013|12/31/9999|$131.17|0|0|||ARTERY X-RAYS| HEAD & NECK|| 58-1699775|1326041732|CHC13|75662|TC|11/01/2013|12/31/9999|$277.94|0|0|||ARTERY X-RAYS| HEAD & NECK|| 58-1699775|1326041732|CHC13|75665|26|11/01/2013|12/31/9999|$105.53|0|0|||ARTERY X-RAYS| HEAD & NECK|| 58-1699775|1326041732|CHC13|75665|TC|11/01/2013|12/31/9999|$251.18|0|0|||ARTERY X-RAYS| HEAD & NECK|| 58-1699775|1326041732|CHC13|75671|26|11/01/2013|12/31/9999|$131.22|0|0|||ARTERY X-RAYS| HEAD & NECK|| 58-1699775|1326041732|CHC13|75671|TC|11/01/2013|12/31/9999|$290.04|0|0|||ARTERY X-RAYS| HEAD & NECK|| 58-1699775|1326041732|CHC13|75676|26|11/01/2013|12/31/9999|$105.03|0|0|||ARTERY X-RAYS| NECK|| 58-1699775|1326041732|CHC13|75676|TC|11/01/2013|12/31/9999|$232.01|0|0|||ARTERY X-RAYS| NECK|| 58-1699775|1326041732|CHC13|75680|26|11/01/2013|12/31/9999|$131.22|0|0|||ARTERY X-RAYS| NECK|| 58-1699775|1326041732|CHC13|75680|TC|11/01/2013|12/31/9999|$254.71|0|0|||ARTERY X-RAYS| NECK|| 58-1699775|1326041732|CHC13|75685|26|11/01/2013|12/31/9999|$104.47|0|0|||ARTERY X-RAYS| SPINE|| 58-1699775|1326041732|CHC13|75685|TC|11/01/2013|12/31/9999|$237.56|0|0|||ARTERY X-RAYS| SPINE|| 58-1699775|1326041732|CHC13|75705||11/01/2013|12/31/9999|$414.07|0|0|||ARTERY X-RAYS| SPINE|| 58-1699775|1326041732|CHC13|75705|26|11/01/2013|12/31/9999|$170.46|0|0|||ARTERY X-RAYS| SPINE|| 58-1699775|1326041732|CHC13|75705|TC|11/01/2013|12/31/9999|$243.61|0|0|||ARTERY X-RAYS| SPINE|| 58-1699775|1326041732|CHC13|75710||11/01/2013|12/31/9999|$315.79|0|0|||ARTERY X-RAYS| ARM/LEG|| 58-1699775|1326041732|CHC13|75710|26|11/01/2013|12/31/9999|$87.81|0|0|||ARTERY X-RAYS| ARM/LEG|| 58-1699775|1326041732|CHC13|75710|TC|11/01/2013|12/31/9999|$227.98|0|0|||ARTERY X-RAYS| ARM/LEG|| 58-1699775|1326041732|CHC13|75716||11/01/2013|12/31/9999|$371.85|0|0|||ARTERY X-RAYS| ARMS/LEGS|| 58-1699775|1326041732|CHC13|75716|26|11/01/2013|12/31/9999|$102.99|0|0|||ARTERY X-RAYS| ARMS/LEGS|| 58-1699775|1326041732|CHC13|75716|TC|11/01/2013|12/31/9999|$268.86|0|0|||ARTERY X-RAYS| ARMS/LEGS|| 58-1699775|1326041732|CHC13|75726||11/01/2013|12/31/9999|$314.83|0|0|||ARTERY X-RAYS| ABDOMEN|| 58-1699775|1326041732|CHC13|75726|26|11/01/2013|12/31/9999|$89.38|0|0|||ARTERY X-RAYS| ABDOMEN|| 58-1699775|1326041732|CHC13|75726|TC|11/01/2013|12/31/9999|$225.45|0|0|||ARTERY X-RAYS| ABDOMEN|| 58-1699775|1326041732|CHC13|75731||11/01/2013|12/31/9999|$304.17|0|0|||ARTERY X-RAYS| ADRENAL GLAND|| 58-1699775|1326041732|CHC13|75731|26|11/01/2013|12/31/9999|$89.81|0|0|||ARTERY X-RAYS| ADRENAL GLAND|| 58-1699775|1326041732|CHC13|75731|TC|11/01/2013|12/31/9999|$214.36|0|0|||ARTERY X-RAYS| ADRENAL GLAND|| 58-1699775|1326041732|CHC13|75733||11/01/2013|12/31/9999|$364.69|0|0|||ARTERY X-RAYS| ADRENALS|| 58-1699775|1326041732|CHC13|75733|26|11/01/2013|12/31/9999|$103.40|0|0|||ARTERY X-RAYS| ADRENALS|| 58-1699775|1326041732|CHC13|75733|TC|11/01/2013|12/31/9999|$261.30|0|0|||ARTERY X-RAYS| ADRENALS|| 58-1699775|1326041732|CHC13|75736||11/01/2013|12/31/9999|$310.24|0|0|||ARTERY X-RAYS| PELVIS|| 58-1699775|1326041732|CHC13|75736|26|11/01/2013|12/31/9999|$87.81|0|0|||ARTERY X-RAYS| PELVIS|| 58-1699775|1326041732|CHC13|75736|TC|11/01/2013|12/31/9999|$222.43|0|0|||ARTERY X-RAYS| PELVIS|| 58-1699775|1326041732|CHC13|75741||11/01/2013|12/31/9999|$293.11|0|0|||ARTERY X-RAYS| LUNG|| 58-1699775|1326041732|CHC13|75741|26|11/01/2013|12/31/9999|$101.95|0|0|||ARTERY X-RAYS| LUNG|| 58-1699775|1326041732|CHC13|75741|TC|11/01/2013|12/31/9999|$191.16|0|0|||ARTERY X-RAYS| LUNG|| 58-1699775|1326041732|CHC13|75743||11/01/2013|12/31/9999|$334.99|0|0|||ARTERY X-RAYS| LUNGS|| 58-1699775|1326041732|CHC13|75743|26|11/01/2013|12/31/9999|$129.71|0|0|||ARTERY X-RAYS| LUNGS|| 58-1699775|1326041732|CHC13|75743|TC|11/01/2013|12/31/9999|$205.28|0|0|||ARTERY X-RAYS| LUNGS|| 58-1699775|1326041732|CHC13|75746||11/01/2013|12/31/9999|$303.72|0|0|||ARTERY X-RAYS| LUNG|| 58-1699775|1326041732|CHC13|75746|26|11/01/2013|12/31/9999|$89.36|0|0|||ARTERY X-RAYS| LUNG|| 58-1699775|1326041732|CHC13|75746|TC|11/01/2013|12/31/9999|$214.36|0|0|||ARTERY X-RAYS| LUNG|| 58-1699775|1326041732|CHC13|75756||11/01/2013|12/31/9999|$332.72|0|0|||ARTERY X-RAYS| CHEST|| 58-1699775|1326041732|CHC13|75756|26|11/01/2013|12/31/9999|$98.19|0|0|||ARTERY X-RAYS| CHEST|| 58-1699775|1326041732|CHC13|75756|TC|11/01/2013|12/31/9999|$234.53|0|0|||ARTERY X-RAYS| CHEST|| 58-1699775|1326041732|CHC13|75774||11/01/2013|12/31/9999|$198.32|0|0|||ARTERY X-RAY| EACH VESSEL|| 58-1699775|1326041732|CHC13|75774|26|11/01/2013|12/31/9999|$28.34|0|0|||ARTERY X-RAY| EACH VESSEL|| 58-1699775|1326041732|CHC13|75774|TC|11/01/2013|12/31/9999|$169.98|0|0|||ARTERY X-RAY| EACH VESSEL|| 58-1699775|1326041732|CHC13|75801||11/01/2013|12/31/9999|$394.15|0|0|||LYMPH VESSEL X-RAY| ARM/LEG|| 58-1699775|1326041732|CHC13|75801|26|11/01/2013|12/31/9999|$71.01|0|0|||LYMPH VESSEL X-RAY| ARM/LEG|| 58-1699775|1326041732|CHC13|75801|TC|11/01/2013|12/31/9999|$323.17|0|0|||LYMPH VESSEL X-RAY| ARM/LEG|| 58-1699775|1326041732|CHC13|75803||11/01/2013|12/31/9999|$397.06|0|0|||LYMPH VESSEL X-RAY|ARMS/LEGS|| 58-1699775|1326041732|CHC13|75803|26|11/01/2013|12/31/9999|$93.62|0|0|||LYMPH VESSEL X-RAY|ARMS/LEGS|| 58-1699775|1326041732|CHC13|75803|TC|11/01/2013|12/31/9999|$304.49|0|0|||LYMPH VESSEL X-RAY|ARMS/LEGS|| 58-1699775|1326041732|CHC13|75805||11/01/2013|12/31/9999|$402.06|0|0|||LYMPH VESSEL X-RAY| TRUNK|| 58-1699775|1326041732|CHC13|75805|26|11/01/2013|12/31/9999|$64.77|0|0|||LYMPH VESSEL X-RAY| TRUNK|| 58-1699775|1326041732|CHC13|75805|TC|11/01/2013|12/31/9999|$337.80|0|0|||LYMPH VESSEL X-RAY| TRUNK|| 58-1699775|1326041732|CHC13|75807||11/01/2013|12/31/9999|$435.95|0|0|||LYMPH VESSEL X-RAY| TRUNK|| 58-1699775|1326041732|CHC13|75807|26|11/01/2013|12/31/9999|$93.62|0|0|||LYMPH VESSEL X-RAY| TRUNK|| 58-1699775|1326041732|CHC13|75807|TC|11/01/2013|12/31/9999|$343.38|0|0|||LYMPH VESSEL X-RAY| TRUNK|| 58-1699775|1326041732|CHC13|75809||11/01/2013|12/31/9999|$158.60|0|0|||NONVASCULAR SHUNT| X-RAY|| 58-1699775|1326041732|CHC13|75809|26|11/01/2013|12/31/9999|$37.54|0|0|||NONVASCULAR SHUNT| X-RAY|| 58-1699775|1326041732|CHC13|75809|TC|11/01/2013|12/31/9999|$121.06|0|0|||NONVASCULAR SHUNT| X-RAY|| 58-1699775|1326041732|CHC13|75810||11/01/2013|12/31/9999|$764.00|0|0|||VEIN X-RAY| SPLEEN/LIVER|| 58-1699775|1326041732|CHC13|75810|26|11/01/2013|12/31/9999|$91.43|0|0|||VEIN X-RAY| SPLEEN/LIVER|| 58-1699775|1326041732|CHC13|75810|TC|11/01/2013|12/31/9999|$674.12|0|0|||VEIN X-RAY| SPLEEN/LIVER|| 58-1699775|1326041732|CHC13|75820||11/01/2013|12/31/9999|$194.73|0|0|||VEIN X-RAY| ARM/LEG|| 58-1699775|1326041732|CHC13|75820|26|11/01/2013|12/31/9999|$55.02|0|0|||VEIN X-RAY| ARM/LEG|| 58-1699775|1326041732|CHC13|75820|TC|11/01/2013|12/31/9999|$139.72|0|0|||VEIN X-RAY| ARM/LEG|| 58-1699775|1326041732|CHC13|75822||11/01/2013|12/31/9999|$240.72|0|0|||VEIN X-RAY| ARMS/LEGS|| 58-1699775|1326041732|CHC13|75822|26|11/01/2013|12/31/9999|$82.85|0|0|||VEIN X-RAY| ARMS/LEGS|| 58-1699775|1326041732|CHC13|75822|TC|11/01/2013|12/31/9999|$157.87|0|0|||VEIN X-RAY| ARMS/LEGS|| 58-1699775|1326041732|CHC13|75825||11/01/2013|12/31/9999|$274.48|0|0|||VEIN X-RAY| TRUNK|| 58-1699775|1326041732|CHC13|75825|26|11/01/2013|12/31/9999|$88.87|0|0|||VEIN X-RAY| TRUNK|| 58-1699775|1326041732|CHC13|75825|TC|11/01/2013|12/31/9999|$185.61|0|0|||VEIN X-RAY| TRUNK|| 58-1699775|1326041732|CHC13|75827||11/01/2013|12/31/9999|$279.51|0|0|||VEIN X-RAY| CHEST|| 58-1699775|1326041732|CHC13|75827|26|11/01/2013|12/31/9999|$87.85|0|0|||VEIN X-RAY| CHEST|| 58-1699775|1326041732|CHC13|75827|TC|11/01/2013|12/31/9999|$191.66|0|0|||VEIN X-RAY| CHEST|| 58-1699775|1326041732|CHC13|75831||11/01/2013|12/31/9999|$288.88|0|0|||VEIN X-RAY| KIDNEY|| 58-1699775|1326041732|CHC13|75831|26|11/01/2013|12/31/9999|$97.21|0|0|||VEIN X-RAY| KIDNEY|| 58-1699775|1326041732|CHC13|75831|TC|11/01/2013|12/31/9999|$191.66|0|0|||VEIN X-RAY| KIDNEY|| 58-1699775|1326041732|CHC13|75833||11/01/2013|12/31/9999|$329.44|0|0|||VEIN X-RAY| KIDNEYS|| 58-1699775|1326041732|CHC13|75833|26|11/01/2013|12/31/9999|$113.57|0|0|||VEIN X-RAY| KIDNEYS|| 58-1699775|1326041732|CHC13|75833|TC|11/01/2013|12/31/9999|$215.87|0|0|||VEIN X-RAY| KIDNEYS|| 58-1699775|1326041732|CHC13|75840||11/01/2013|12/31/9999|$286.86|0|0|||VEIN X-RAY| ADRENAL GLAND|| 58-1699775|1326041732|CHC13|75840|26|11/01/2013|12/31/9999|$97.72|0|0|||VEIN X-RAY| ADRENAL GLAND|| 58-1699775|1326041732|CHC13|75840|TC|11/01/2013|12/31/9999|$189.14|0|0|||VEIN X-RAY| ADRENAL GLAND|| 58-1699775|1326041732|CHC13|75842||11/01/2013|12/31/9999|$333.98|0|0|||VEIN X-RAY| ADRENAL GLANDS|| 58-1699775|1326041732|CHC13|75842|26|11/01/2013|12/31/9999|$116.60|0|0|||VEIN X-RAY| ADRENAL GLANDS|| 58-1699775|1326041732|CHC13|75842|TC|11/01/2013|12/31/9999|$217.39|0|0|||VEIN X-RAY| ADRENAL GLANDS|| 58-1699775|1326041732|CHC13|75860||11/01/2013|12/31/9999|$283.06|0|0|||VEIN X-RAY| NECK|| 58-1699775|1326041732|CHC13|75860|26|11/01/2013|12/31/9999|$90.38|0|0|||VEIN X-RAY| NECK|| 58-1699775|1326041732|CHC13|75860|TC|11/01/2013|12/31/9999|$192.67|0|0|||VEIN X-RAY| NECK|| 58-1699775|1326041732|CHC13|75870||11/01/2013|12/31/9999|$280.01|0|0|||VEIN X-RAY| SKULL|| 58-1699775|1326041732|CHC13|75870|26|11/01/2013|12/31/9999|$89.36|0|0|||VEIN X-RAY| SKULL|| 58-1699775|1326041732|CHC13|75870|TC|11/01/2013|12/31/9999|$190.66|0|0|||VEIN X-RAY| SKULL|| 58-1699775|1326041732|CHC13|75872||11/01/2013|12/31/9999|$419.72|0|0|||VEIN X-RAY| SKULL|| 58-1699775|1326041732|CHC13|75872|26|11/01/2013|12/31/9999|$96.42|0|0|||VEIN X-RAY| SKULL|| 58-1699775|1326041732|CHC13|75872|TC|11/01/2013|12/31/9999|$323.30|0|0|||VEIN X-RAY| SKULL|| 58-1699775|1326041732|CHC13|75880||11/01/2013|12/31/9999|$202.80|0|0|||VEIN X-RAY| EYE SOCKET|| 58-1699775|1326041732|CHC13|75880|26|11/01/2013|12/31/9999|$54.51|0|0|||VEIN X-RAY| EYE SOCKET|| 58-1699775|1326041732|CHC13|75880|TC|11/01/2013|12/31/9999|$148.29|0|0|||VEIN X-RAY| EYE SOCKET|| 58-1699775|1326041732|CHC13|75885||11/01/2013|12/31/9999|$302.93|0|0|||VEIN X-RAY| LIVER|| 58-1699775|1326041732|CHC13|75885|26|11/01/2013|12/31/9999|$112.28|0|0|||VEIN X-RAY| LIVER|| 58-1699775|1326041732|CHC13|75885|TC|11/01/2013|12/31/9999|$190.66|0|0|||VEIN X-RAY| LIVER|| 58-1699775|1326041732|CHC13|75887||11/01/2013|12/31/9999|$302.88|0|0|||VEIN X-RAY| LIVER|| 58-1699775|1326041732|CHC13|75887|26|11/01/2013|12/31/9999|$110.21|0|0|||VEIN X-RAY| LIVER|| 58-1699775|1326041732|CHC13|75887|TC|11/01/2013|12/31/9999|$192.67|0|0|||VEIN X-RAY| LIVER|| 58-1699775|1326041732|CHC13|75889||11/01/2013|12/31/9999|$280.52|0|0|||VEIN X-RAY| LIVER|| 58-1699775|1326041732|CHC13|75889|26|11/01/2013|12/31/9999|$88.86|0|0|||VEIN X-RAY| LIVER|| 58-1699775|1326041732|CHC13|75889|TC|11/01/2013|12/31/9999|$191.66|0|0|||VEIN X-RAY| LIVER|| 58-1699775|1326041732|CHC13|75891||11/01/2013|12/31/9999|$281.02|0|0|||VEIN X-RAY| LIVER|| 58-1699775|1326041732|CHC13|75891|26|11/01/2013|12/31/9999|$88.86|0|0|||VEIN X-RAY| LIVER|| 58-1699775|1326041732|CHC13|75891|TC|11/01/2013|12/31/9999|$192.17|0|0|||VEIN X-RAY| LIVER|| 58-1699775|1326041732|CHC13|75893||11/01/2013|12/31/9999|$231.59|0|0|||VENOUS SAMPLING BY CATHETER|| 58-1699775|1326041732|CHC13|75893|26|11/01/2013|12/31/9999|$40.94|0|0|||VENOUS SAMPLING BY CATHETER|| 58-1699775|1326041732|CHC13|75893|TC|11/01/2013|12/31/9999|$190.66|0|0|||VENOUS SAMPLING BY CATHETER|| 58-1699775|1326041732|CHC13|75894||11/01/2013|12/31/9999|$1|392.73|0|0|||X-RAYS| TRANSCATH THERAPY|| 58-1699775|1326041732|CHC13|75894|26|11/01/2013|12/31/9999|$106.12|0|0|||X-RAYS| TRANSCATH THERAPY|| 58-1699775|1326041732|CHC13|75894|TC|11/01/2013|12/31/9999|$1|288.15|0|0|||X-RAYS| TRANSCATH THERAPY|| 58-1699775|1326041732|CHC13|75898||11/01/2013|12/31/9999|$193.38|0|0|||FOLLOW-UP ANGIOGRAPHY|| 58-1699775|1326041732|CHC13|75898|26|11/01/2013|12/31/9999|$134.86|0|0|||FOLLOW-UP ANGIOGRAPHY|| 58-1699775|1326041732|CHC13|75898|TC|11/01/2013|12/31/9999|$60.59|0|0|||FOLLOW-UP ANGIOGRAPHY|| 58-1699775|1326041732|CHC13|75900|26|11/01/2013|12/31/9999|$38.70|0|0|||INTRAVASCULAR CATH EXCHANGE|| 58-1699775|1326041732|CHC13|75900|TC|11/01/2013|12/31/9999|$60.59|0|0|||INTRAVASCULAR CATH EXCHANGE|| 58-1699775|1326041732|CHC13|75901||11/01/2013|12/31/9999|$264.12|0|0|||REMOVE CVA DEVICE OBSTRUCT|| 58-1699775|1326041732|CHC13|75901|26|11/01/2013|12/31/9999|$38.16|0|0|||REMOVE CVA DEVICE OBSTRUCT|| 58-1699775|1326041732|CHC13|75901|TC|11/01/2013|12/31/9999|$225.96|0|0|||REMOVE CVA DEVICE OBSTRUCT|| 58-1699775|1326041732|CHC13|75902||11/01/2013|12/31/9999|$118.82|0|0|||REMOVE CVA LUMEN OBSTRUCT|| 58-1699775|1326041732|CHC13|75902|26|11/01/2013|12/31/9999|$31.05|0|0|||REMOVE CVA LUMEN OBSTRUCT|| 58-1699775|1326041732|CHC13|75902|TC|11/01/2013|12/31/9999|$87.77|0|0|||REMOVE CVA LUMEN OBSTRUCT|| 58-1699775|1326041732|CHC13|75952||11/01/2013|12/31/9999|$363.41|0|0|||ENDOVASC REPAIR ABDOM AORTA|| 58-1699775|1326041732|CHC13|75952|26|11/01/2013|12/31/9999|$371.13|0|0|||ENDOVASC REPAIR ABDOM AORTA|| 58-1699775|1326041732|CHC13|75952|TC|11/01/2013|12/31/9999|$363.41|0|0|||ENDOVASC REPAIR ABDOM AORTA|| 58-1699775|1326041732|CHC13|75953||11/01/2013|12/31/9999|$110.58|0|0|||ABDOM ANEURYSM ENDOVAS RPR|| 58-1699775|1326041732|CHC13|75953|26|11/01/2013|12/31/9999|$113.15|0|0|||ABDOM ANEURYSM ENDOVAS RPR|| 58-1699775|1326041732|CHC13|75953|TC|11/01/2013|12/31/9999|$110.58|0|0|||ABDOM ANEURYSM ENDOVAS RPR|| 58-1699775|1326041732|CHC13|75954||11/01/2013|12/31/9999|$181.45|0|0|||ILIAC ANEURYSM ENDOVAS RPR|| 58-1699775|1326041732|CHC13|75954|26|11/01/2013|12/31/9999|$185.05|0|0|||ILIAC ANEURYSM ENDOVAS RPR|| 58-1699775|1326041732|CHC13|75954|TC|11/01/2013|12/31/9999|$181.45|0|0|||ILIAC ANEURYSM ENDOVAS RPR|| 58-1699775|1326041732|CHC13|75956||11/01/2013|12/31/9999|$570.82|0|0|||XRAY| ENDOVASC THOR AO REPR|| 58-1699775|1326041732|CHC13|75956|26|11/01/2013|12/31/9999|$582.16|0|0|||XRAY| ENDOVASC THOR AO REPR|| 58-1699775|1326041732|CHC13|75956|TC|11/01/2013|12/31/9999|$570.82|0|0|||XRAY| ENDOVASC THOR AO REPR|| 58-1699775|1326041732|CHC13|75957||11/01/2013|12/31/9999|$487.08|0|0|||XRAY| ENDOVASC THOR AO REPR|| 58-1699775|1326041732|CHC13|75957|26|11/01/2013|12/31/9999|$498.38|0|0|||XRAY| ENDOVASC THOR AO REPR|| 58-1699775|1326041732|CHC13|75957|TC|11/01/2013|12/31/9999|$487.08|0|0|||XRAY| ENDOVASC THOR AO REPR|| 58-1699775|1326041732|CHC13|75958||11/01/2013|12/31/9999|$324.74|0|0|||XRAY| PLACE PROX EXT THOR AO|| 58-1699775|1326041732|CHC13|75958|26|11/01/2013|12/31/9999|$331.94|0|0|||XRAY| PLACE PROX EXT THOR AO|| 58-1699775|1326041732|CHC13|75958|TC|11/01/2013|12/31/9999|$324.74|0|0|||XRAY| PLACE PROX EXT THOR AO|| 58-1699775|1326041732|CHC13|75959||11/01/2013|12/31/9999|$282.58|0|0|||XRAY| PLACE DIST EXT THOR AO|| 58-1699775|1326041732|CHC13|75959|26|11/01/2013|12/31/9999|$290.76|0|0|||XRAY| PLACE DIST EXT THOR AO|| 58-1699775|1326041732|CHC13|75959|TC|11/01/2013|12/31/9999|$282.58|0|0|||XRAY| PLACE DIST EXT THOR AO|| 58-1699775|1326041732|CHC13|75960|26|11/01/2013|12/31/9999|$63.79|0|0|||TRANSCATH IV STENT RS&I|| 58-1699775|1326041732|CHC13|75960|TC|11/01/2013|12/31/9999|$179.56|0|0|||TRANSCATH IV STENT RS&I|| 58-1699775|1326041732|CHC13|75961|26|11/01/2013|12/31/9999|$329.36|0|0|||RETRIEVAL| BROKEN CATHETER|| 58-1699775|1326041732|CHC13|75961|TC|11/01/2013|12/31/9999|$207.30|0|0|||RETRIEVAL| BROKEN CATHETER|| 58-1699775|1326041732|CHC13|75970||11/01/2013|12/31/9999|$666.78|0|0|||VASCULAR BIOPSY|| 58-1699775|1326041732|CHC13|75970|26|11/01/2013|12/31/9999|$65.90|0|0|||VASCULAR BIOPSY|| 58-1699775|1326041732|CHC13|75970|TC|11/01/2013|12/31/9999|$602.43|0|0|||VASCULAR BIOPSY|| 58-1699775|1326041732|CHC13|75984||11/01/2013|12/31/9999|$175.68|0|0|||XRAY CONTROL CATHETER CHANGE|| 58-1699775|1326041732|CHC13|75984|26|11/01/2013|12/31/9999|$56.14|0|0|||XRAY CONTROL CATHETER CHANGE|| 58-1699775|1326041732|CHC13|75984|TC|11/01/2013|12/31/9999|$119.54|0|0|||XRAY CONTROL CATHETER CHANGE|| 58-1699775|1326041732|CHC13|75989||11/01/2013|12/31/9999|$203.10|0|0|||ABSCESS DRAINAGE UNDER X-RAY|| 58-1699775|1326041732|CHC13|75989|26|11/01/2013|12/31/9999|$91.63|0|0|||ABSCESS DRAINAGE UNDER X-RAY|| 58-1699775|1326041732|CHC13|75989|TC|11/01/2013|12/31/9999|$111.47|0|0|||ABSCESS DRAINAGE UNDER X-RAY|| 58-1699775|1326041732|CHC13|76000||11/01/2013|12/31/9999|$98.34|0|0|||FLUOROSCOPE EXAMINATION|| 58-1699775|1326041732|CHC13|76000|26|11/01/2013|12/31/9999|$13.60|0|0|||FLUOROSCOPE EXAMINATION|| 58-1699775|1326041732|CHC13|76000|TC|11/01/2013|12/31/9999|$84.75|0|0|||FLUOROSCOPE EXAMINATION|| 58-1699775|1326041732|CHC13|76001||11/01/2013|12/31/9999|$211.93|0|0|||FLUOROSCOPE EXAM| EXTENSIVE|| 58-1699775|1326041732|CHC13|76001|26|11/01/2013|12/31/9999|$55.92|0|0|||FLUOROSCOPE EXAM| EXTENSIVE|| 58-1699775|1326041732|CHC13|76001|TC|11/01/2013|12/31/9999|$156.02|0|0|||FLUOROSCOPE EXAM| EXTENSIVE|| 58-1699775|1326041732|CHC13|76010||11/01/2013|12/31/9999|$41.92|0|0|||X-RAY| NOSE TO RECTUM|| 58-1699775|1326041732|CHC13|76010|26|11/01/2013|12/31/9999|$14.16|0|0|||X-RAY| NOSE TO RECTUM|| 58-1699775|1326041732|CHC13|76010|TC|11/01/2013|12/31/9999|$27.76|0|0|||X-RAY| NOSE TO RECTUM|| 58-1699775|1326041732|CHC13|76080||11/01/2013|12/31/9999|$94.95|0|0|||X-RAY EXAM OF FISTULA|| 58-1699775|1326041732|CHC13|76080|26|11/01/2013|12/31/9999|$41.98|0|0|||X-RAY EXAM OF FISTULA|| 58-1699775|1326041732|CHC13|76080|TC|11/01/2013|12/31/9999|$52.97|0|0|||X-RAY EXAM OF FISTULA|| 58-1699775|1326041732|CHC13|76098||11/01/2013|12/31/9999|$28.69|0|0|||X-RAY EXAM| BREAST SPECIMEN|| 58-1699775|1326041732|CHC13|76098|26|11/01/2013|12/31/9999|$12.53|0|0|||X-RAY EXAM| BREAST SPECIMEN|| 58-1699775|1326041732|CHC13|76098|TC|11/01/2013|12/31/9999|$16.16|0|0|||X-RAY EXAM| BREAST SPECIMEN|| 58-1699775|1326041732|CHC13|76100||11/01/2013|12/31/9999|$172.38|0|0|||X-RAY EXAM OF BODY SECTION|| 58-1699775|1326041732|CHC13|76100|26|11/01/2013|12/31/9999|$49.30|0|0|||X-RAY EXAM OF BODY SECTION|| 58-1699775|1326041732|CHC13|76100|TC|11/01/2013|12/31/9999|$123.07|0|0|||X-RAY EXAM OF BODY SECTION|| 58-1699775|1326041732|CHC13|76101||11/01/2013|12/31/9999|$251.61|0|0|||COMPLEX BODY SECTION X-RAY|| 58-1699775|1326041732|CHC13|76101|26|11/01/2013|12/31/9999|$54.40|0|0|||COMPLEX BODY SECTION X-RAY|| 58-1699775|1326041732|CHC13|76101|TC|11/01/2013|12/31/9999|$197.21|0|0|||COMPLEX BODY SECTION X-RAY|| 58-1699775|1326041732|CHC13|76102||11/01/2013|12/31/9999|$338.39|0|0|||COMPLEX BODY SECTION X-RAYS|| 58-1699775|1326041732|CHC13|76102|26|11/01/2013|12/31/9999|$54.93|0|0|||COMPLEX BODY SECTION X-RAYS|| 58-1699775|1326041732|CHC13|76102|TC|11/01/2013|12/31/9999|$283.45|0|0|||COMPLEX BODY SECTION X-RAYS|| 58-1699775|1326041732|CHC13|76120||11/01/2013|12/31/9999|$117.74|0|0|||CINE/VIDEO X-RAYS|| 58-1699775|1326041732|CHC13|76120|26|11/01/2013|12/31/9999|$29.97|0|0|||CINE/VIDEO X-RAYS|| 58-1699775|1326041732|CHC13|76120|TC|11/01/2013|12/31/9999|$87.77|0|0|||CINE/VIDEO X-RAYS|| 58-1699775|1326041732|CHC13|76125||11/01/2013|12/31/9999|$68.23|0|0|||CINE/VIDEO X-RAYS ADD-ON|| 58-1699775|1326041732|CHC13|76125|26|11/01/2013|12/31/9999|$22.78|0|0|||CINE/VIDEO X-RAYS ADD-ON|| 58-1699775|1326041732|CHC13|76125|TC|11/01/2013|12/31/9999|$45.95|0|0|||CINE/VIDEO X-RAYS ADD-ON|| 58-1699775|1326041732|CHC13|76140||11/01/2013|12/31/9999|$90.40|0|0|||X-RAY CONSULTATION|| 58-1699775|1326041732|CHC13|76376||11/01/2013|12/31/9999|$100.03|0|0|||3D RENDER W/O POSTPROCESS|| 58-1699775|1326041732|CHC13|76376|26|11/01/2013|12/31/9999|$15.79|0|0|||3D RENDER W/O POSTPROCESS|| 58-1699775|1326041732|CHC13|76376|TC|11/01/2013|12/31/9999|$84.24|0|0|||3D RENDER W/O POSTPROCESS|| 58-1699775|1326041732|CHC13|76377||11/01/2013|12/31/9999|$134.22|0|0|||3D RENDERING W/POSTPROCESS|| 58-1699775|1326041732|CHC13|76377|26|11/01/2013|12/31/9999|$61.58|0|0|||3D RENDERING W/POSTPROCESS|| 58-1699775|1326041732|CHC13|76377|TC|11/01/2013|12/31/9999|$72.64|0|0|||3D RENDERING W/POSTPROCESS|| 58-1699775|1326041732|CHC13|76380||11/01/2013|12/31/9999|$274.00|0|0|||CAT SCAN FOLLOW-UP STUDY|| 58-1699775|1326041732|CHC13|76380|26|11/01/2013|12/31/9999|$76.29|0|0|||CAT SCAN FOLLOW-UP STUDY|| 58-1699775|1326041732|CHC13|76380|TC|11/01/2013|12/31/9999|$197.72|0|0|||CAT SCAN FOLLOW-UP STUDY|| 58-1699775|1326041732|CHC13|76390||11/01/2013|12/31/9999|$726.80|0|0|||MR SPECTROSCOPY|| 58-1699775|1326041732|CHC13|76390|26|11/01/2013|12/31/9999|$109.98|0|0|||MR SPECTROSCOPY|| 58-1699775|1326041732|CHC13|76390|TC|11/01/2013|12/31/9999|$616.82|0|0|||MR SPECTROSCOPY|| 58-1699775|1326041732|CHC13|76496|26|11/01/2013|12/31/9999|$81.96|0|0|||FLUOROSCOPIC PROCEDURE|| 58-1699775|1326041732|CHC13|76496|TC|11/01/2013|12/31/9999|$122.92|0|0|||FLUOROSCOPIC PROCEDURE|| 58-1699775|1326041732|CHC13|76497|26|11/01/2013|12/31/9999|$103.69|0|0|||CT PROCEDURE|| 58-1699775|1326041732|CHC13|76497|TC|11/01/2013|12/31/9999|$155.53|0|0|||CT PROCEDURE|| 58-1699775|1326041732|CHC13|76498|26|11/01/2013|12/31/9999|$343.81|0|0|||MRI PROCEDURE|| 58-1699775|1326041732|CHC13|76498|TC|11/01/2013|12/31/9999|$515.71|0|0|||MRI PROCEDURE|| 58-1699775|1326041732|CHC13|76499||11/01/2013|12/31/9999|$0.00|0|0|||RADIOGRAPHIC PROCEDURE|| 58-1699775|1326041732|CHC13|76499|26|11/01/2013|12/31/9999|$0.00|0|0|||RADIOGRAPHIC PROCEDURE|| 58-1699775|1326041732|CHC13|76499|TC|11/01/2013|12/31/9999|$0.00|0|0|||RADIOGRAPHIC PROCEDURE|| 58-1699775|1326041732|CHC13|76506||11/01/2013|12/31/9999|$190.80|0|0|||ECHO EXAM OF HEAD|| 58-1699775|1326041732|CHC13|76506|26|11/01/2013|12/31/9999|$49.57|0|0|||ECHO EXAM OF HEAD|| 58-1699775|1326041732|CHC13|76506|TC|11/01/2013|12/31/9999|$141.23|0|0|||ECHO EXAM OF HEAD|| 58-1699775|1326041732|CHC13|76510||11/01/2013|12/31/9999|$265.03|0|0|||OPHTH US| B & QUANT A|| 58-1699775|1326041732|CHC13|76510|26|11/01/2013|12/31/9999|$148.01|0|0|||OPHTH US| B & QUANT A|| 58-1699775|1326041732|CHC13|76510|TC|11/01/2013|12/31/9999|$117.02|0|0|||OPHTH US| B & QUANT A|| 58-1699775|1326041732|CHC13|76511||11/01/2013|12/31/9999|$155.21|0|0|||OPHTH US| QUANT A ONLY|| 58-1699775|1326041732|CHC13|76511|26|11/01/2013|12/31/9999|$81.56|0|0|||OPHTH US| QUANT A ONLY|| 58-1699775|1326041732|CHC13|76511|TC|11/01/2013|12/31/9999|$73.65|0|0|||OPHTH US| QUANT A ONLY|| 58-1699775|1326041732|CHC13|76512||11/01/2013|12/31/9999|$143.15|0|0|||OPHTH US| B W/NON-QUANT A|| 58-1699775|1326041732|CHC13|76512|26|11/01/2013|12/31/9999|$83.12|0|0|||OPHTH US| B W/NON-QUANT A|| 58-1699775|1326041732|CHC13|76512|TC|11/01/2013|12/31/9999|$60.03|0|0|||OPHTH US| B W/NON-QUANT A|| 58-1699775|1326041732|CHC13|76513||11/01/2013|12/31/9999|$139.99|0|0|||ECHO EXAM OF EYE| WATER BATH|| 58-1699775|1326041732|CHC13|76513|26|11/01/2013|12/31/9999|$54.74|0|0|||ECHO EXAM OF EYE| WATER BATH|| 58-1699775|1326041732|CHC13|76513|TC|11/01/2013|12/31/9999|$85.25|0|0|||ECHO EXAM OF EYE| WATER BATH|| 58-1699775|1326041732|CHC13|76514||11/01/2013|12/31/9999|$22.69|0|0|||ECHO EXAM OF EYE| THICKNESS|| 58-1699775|1326041732|CHC13|76514|26|11/01/2013|12/31/9999|$15.11|0|0|||ECHO EXAM OF EYE| THICKNESS|| 58-1699775|1326041732|CHC13|76514|TC|11/01/2013|12/31/9999|$7.58|0|0|||ECHO EXAM OF EYE| THICKNESS|| 58-1699775|1326041732|CHC13|76516||11/01/2013|12/31/9999|$115.09|0|0|||ECHO EXAM OF EYE|| 58-1699775|1326041732|CHC13|76516|26|11/01/2013|12/31/9999|$46.99|0|0|||ECHO EXAM OF EYE|| 58-1699775|1326041732|CHC13|76516|TC|11/01/2013|12/31/9999|$68.10|0|0|||ECHO EXAM OF EYE|| 58-1699775|1326041732|CHC13|76519||11/01/2013|12/31/9999|$124.20|0|0|||ECHO EXAM OF EYE|| 58-1699775|1326041732|CHC13|76519|26|11/01/2013|12/31/9999|$48.53|0|0|||ECHO EXAM OF EYE|| 58-1699775|1326041732|CHC13|76519|TC|11/01/2013|12/31/9999|$75.67|0|0|||ECHO EXAM OF EYE|| 58-1699775|1326041732|CHC13|76529||11/01/2013|12/31/9999|$117.82|0|0|||ECHO EXAM OF EYE|| 58-1699775|1326041732|CHC13|76529|26|11/01/2013|12/31/9999|$51.23|0|0|||ECHO EXAM OF EYE|| 58-1699775|1326041732|CHC13|76529|TC|11/01/2013|12/31/9999|$66.59|0|0|||ECHO EXAM OF EYE|| 58-1699775|1326041732|CHC13|76536||11/01/2013|12/31/9999|$185.84|0|0|||US EXAM OF HEAD AND NECK|| 58-1699775|1326041732|CHC13|76536|26|11/01/2013|12/31/9999|$43.61|0|0|||US EXAM OF HEAD AND NECK|| 58-1699775|1326041732|CHC13|76536|TC|11/01/2013|12/31/9999|$142.24|0|0|||US EXAM OF HEAD AND NECK|| 58-1699775|1326041732|CHC13|76604||11/01/2013|12/31/9999|$135.86|0|0|||US EXAM| CHEST| B-SCAN|| 58-1699775|1326041732|CHC13|76604|26|11/01/2013|12/31/9999|$42.54|0|0|||US EXAM| CHEST| B-SCAN|| 58-1699775|1326041732|CHC13|76604|TC|11/01/2013|12/31/9999|$93.32|0|0|||US EXAM| CHEST| B-SCAN|| 58-1699775|1326041732|CHC13|76641||02/01/2015|12/31/9999|$166.98|0|0|0||ULTRASOUND BREAST COMPLETE|| 58-1699775|1326041732|CHC13|76641|26|04/01/2015|12/31/9999|$60.17|0|0|0||ULTRASOUND BREAST COMPLETE|| 58-1699775|1326041732|CHC13|76641|TC|04/01/2015|12/31/9999|$106.81|0|0|0||ULTRASOUND BREAST COMPLETE|| 58-1699775|1326041732|CHC13|76642||04/01/2015|12/31/9999|$137.98|0|0|0||ULTRASOUND BREAST LIMITED|| 58-1699775|1326041732|CHC13|76642|26|04/01/2015|12/31/9999|$56.15|0|0|0||ULTRASOUND BREAST LIMITED|| 58-1699775|1326041732|CHC13|76642|TC|04/01/2015|12/31/9999|$81.84|0|0|0||ULTRASOUND BREAST LIMITED|| 58-1699775|1326041732|CHC13|76700||11/01/2013|12/31/9999|$217.55|0|0|||US EXAM| ABDOM| COMPLETE|| 58-1699775|1326041732|CHC13|76700|26|11/01/2013|12/31/9999|$63.21|0|0|||US EXAM| ABDOM| COMPLETE|| 58-1699775|1326041732|CHC13|76700|TC|11/01/2013|12/31/9999|$154.34|0|0|||US EXAM| ABDOM| COMPLETE|| 58-1699775|1326041732|CHC13|76705||11/01/2013|12/31/9999|$166.35|0|0|||ECHO EXAM OF ABDOMEN|| 58-1699775|1326041732|CHC13|76705|26|11/01/2013|12/31/9999|$45.79|0|0|||ECHO EXAM OF ABDOMEN|| 58-1699775|1326041732|CHC13|76705|TC|11/01/2013|12/31/9999|$120.55|0|0|||ECHO EXAM OF ABDOMEN|| 58-1699775|1326041732|CHC13|76706||04/01/2017|12/31/9999|$157.52|0|157.52|0||US ABDL AORTA SCREEN AAA|| 58-1699775|1326041732|CHC13|76706|26|04/01/2017|12/31/9999|$46.78|0|46.78|0||US ABDL AORTA SCREEN AAA|| 58-1699775|1326041732|CHC13|76706|TC|04/01/2017|12/31/9999|$110.73|0|110.73|0||US ABDL AORTA SCREEN AAA|| 58-1699775|1326041732|CHC13|76770||11/01/2013|12/31/9999|$206.06|0|0|||US EXAM ABDO BACK WALL| COMP|| 58-1699775|1326041732|CHC13|76770|26|11/01/2013|12/31/9999|$57.77|0|0|||US EXAM ABDO BACK WALL| COMP|| 58-1699775|1326041732|CHC13|76770|TC|11/01/2013|12/31/9999|$148.29|0|0|||US EXAM ABDO BACK WALL| COMP|| 58-1699775|1326041732|CHC13|76775||11/01/2013|12/31/9999|$169.82|0|0|||US EXAM ABDO BACK WALL| LIM|| 58-1699775|1326041732|CHC13|76775|26|11/01/2013|12/31/9999|$45.23|0|0|||US EXAM ABDO BACK WALL| LIM|| 58-1699775|1326041732|CHC13|76775|TC|11/01/2013|12/31/9999|$124.59|0|0|||US EXAM ABDO BACK WALL| LIM|| 58-1699775|1326041732|CHC13|76776||11/01/2013|12/31/9999|$235.93|0|0|||US EXAM K TRANSPL W/DOPPLER|| 58-1699775|1326041732|CHC13|76776|26|11/01/2013|12/31/9999|$58.89|0|0|||US EXAM K TRANSPL W/DOPPLER|| 58-1699775|1326041732|CHC13|76776|TC|11/01/2013|12/31/9999|$177.04|0|0|||US EXAM K TRANSPL W/DOPPLER|| 58-1699775|1326041732|CHC13|76800||11/01/2013|12/31/9999|$205.27|0|0|||US EXAM| SPINAL CANAL|| 58-1699775|1326041732|CHC13|76800|26|11/01/2013|12/31/9999|$86.73|0|0|||US EXAM| SPINAL CANAL|| 58-1699775|1326041732|CHC13|76800|TC|11/01/2013|12/31/9999|$118.54|0|0|||US EXAM| SPINAL CANAL|| 58-1699775|1326041732|CHC13|76801||11/01/2013|12/31/9999|$200.92|0|0|||OB US < 14 WKS| SINGLE FETUS|| 58-1699775|1326041732|CHC13|76801|26|11/01/2013|12/31/9999|$77.34|0|0|||OB US < 14 WKS| SINGLE FETUS|| 58-1699775|1326041732|CHC13|76801|TC|11/01/2013|12/31/9999|$123.58|0|0|||OB US < 14 WKS| SINGLE FETUS|| 58-1699775|1326041732|CHC13|76802||11/01/2013|12/31/9999|$107.71|0|0|||OB US < 14 WKS| ADD'L FETUS|| 58-1699775|1326041732|CHC13|76802|26|11/01/2013|12/31/9999|$64.82|0|0|||OB US < 14 WKS| ADD'L FETUS|| 58-1699775|1326041732|CHC13|76802|TC|11/01/2013|12/31/9999|$42.89|0|0|||OB US < 14 WKS| ADD'L FETUS|| 58-1699775|1326041732|CHC13|76805||11/01/2013|12/31/9999|$231.68|0|0|||OB US >/= 14 WKS| SNGL FETUS|| 58-1699775|1326041732|CHC13|76805|26|11/01/2013|12/31/9999|$77.34|0|0|||OB US >/= 14 WKS| SNGL FETUS|| 58-1699775|1326041732|CHC13|76805|TC|11/01/2013|12/31/9999|$154.34|0|0|||OB US >/= 14 WKS| SNGL FETUS|| 58-1699775|1326041732|CHC13|76810||11/01/2013|12/31/9999|$153.45|0|0|||OB US >/= 14 WKS| ADDL FETUS|| 58-1699775|1326041732|CHC13|76810|26|11/01/2013|12/31/9999|$76.78|0|0|||OB US >/= 14 WKS| ADDL FETUS|| 58-1699775|1326041732|CHC13|76810|TC|11/01/2013|12/31/9999|$76.68|0|0|||OB US >/= 14 WKS| ADDL FETUS|| 58-1699775|1326041732|CHC13|76811||11/01/2013|12/31/9999|$297.45|0|0|||OB US| DETAILED| SNGL FETUS|| 58-1699775|1326041732|CHC13|76811|26|11/01/2013|12/31/9999|$150.16|0|0|||OB US| DETAILED| SNGL FETUS|| 58-1699775|1326041732|CHC13|76811|TC|11/01/2013|12/31/9999|$147.28|0|0|||OB US| DETAILED| SNGL FETUS|| 58-1699775|1326041732|CHC13|76812||11/01/2013|12/31/9999|$326.01|0|0|||OB US| DETAILED| ADDL FETUS|| 58-1699775|1326041732|CHC13|76812|26|11/01/2013|12/31/9999|$140.40|0|0|||OB US| DETAILED| ADDL FETUS|| 58-1699775|1326041732|CHC13|76812|TC|11/01/2013|12/31/9999|$185.61|0|0|||OB US| DETAILED| ADDL FETUS|| 58-1699775|1326041732|CHC13|76813||11/01/2013|12/31/9999|$196.47|0|0|||OB US NUCHAL MEAS| 1 GEST|| 58-1699775|1326041732|CHC13|76813|26|11/01/2013|12/31/9999|$93.07|0|0|||OB US NUCHAL MEAS| 1 GEST|| 58-1699775|1326041732|CHC13|76813|TC|11/01/2013|12/31/9999|$103.41|0|0|||OB US NUCHAL MEAS| 1 GEST|| 58-1699775|1326041732|CHC13|76814||11/01/2013|12/31/9999|$127.79|0|0|||OB US NUCHAL MEAS| ADD-ON|| 58-1699775|1326041732|CHC13|76814|26|11/01/2013|12/31/9999|$78.35|0|0|||OB US NUCHAL MEAS| ADD-ON|| 58-1699775|1326041732|CHC13|76814|TC|11/01/2013|12/31/9999|$49.44|0|0|||OB US NUCHAL MEAS| ADD-ON|| 58-1699775|1326041732|CHC13|76815||11/01/2013|12/31/9999|$141.95|0|0|||OB US| LIMITED| FETUS(S)|| 58-1699775|1326041732|CHC13|76815|26|11/01/2013|12/31/9999|$50.14|0|0|||OB US| LIMITED| FETUS(S)|| 58-1699775|1326041732|CHC13|76815|TC|11/01/2013|12/31/9999|$91.81|0|0|||OB US| LIMITED| FETUS(S)|| 58-1699775|1326041732|CHC13|76816||11/01/2013|12/31/9999|$185.49|0|0|||OB US| FOLLOW-UP| PER FETUS|| 58-1699775|1326041732|CHC13|76816|26|11/01/2013|12/31/9999|$67.46|0|0|||OB US| FOLLOW-UP| PER FETUS|| 58-1699775|1326041732|CHC13|76816|TC|11/01/2013|12/31/9999|$118.03|0|0|||OB US| FOLLOW-UP| PER FETUS|| 58-1699775|1326041732|CHC13|76817||11/01/2013|12/31/9999|$160.20|0|0|||TRANSVAGINAL US| OBSTETRIC|| 58-1699775|1326041732|CHC13|76817|26|11/01/2013|12/31/9999|$58.82|0|0|||TRANSVAGINAL US| OBSTETRIC|| 58-1699775|1326041732|CHC13|76817|TC|11/01/2013|12/31/9999|$101.39|0|0|||TRANSVAGINAL US| OBSTETRIC|| 58-1699775|1326041732|CHC13|76818||11/01/2013|12/31/9999|$192.18|0|0|||FETAL BIOPHYS PROFILE W/NST|| 58-1699775|1326041732|CHC13|76818|26|11/01/2013|12/31/9999|$83.23|0|0|||FETAL BIOPHYS PROFILE W/NST|| 58-1699775|1326041732|CHC13|76818|TC|11/01/2013|12/31/9999|$108.95|0|0|||FETAL BIOPHYS PROFILE W/NST|| 58-1699775|1326041732|CHC13|76819||11/01/2013|12/31/9999|$142.16|0|0|||FETAL BIOPHYS PROFIL W/O NST|| 58-1699775|1326041732|CHC13|76819|26|11/01/2013|12/31/9999|$60.95|0|0|||FETAL BIOPHYS PROFIL W/O NST|| 58-1699775|1326041732|CHC13|76819|TC|11/01/2013|12/31/9999|$81.21|0|0|||FETAL BIOPHYS PROFIL W/O NST|| 58-1699775|1326041732|CHC13|76820||11/01/2013|12/31/9999|$68.46|0|0|||UMBILICAL ARTERY ECHO|| 58-1699775|1326041732|CHC13|76820|26|11/01/2013|12/31/9999|$39.19|0|0|||UMBILICAL ARTERY ECHO|| 58-1699775|1326041732|CHC13|76820|TC|11/01/2013|12/31/9999|$29.27|0|0|||UMBILICAL ARTERY ECHO|| 58-1699775|1326041732|CHC13|76821||11/01/2013|12/31/9999|$151.34|0|0|||MIDDLE CEREBRAL ARTERY ECHO|| 58-1699775|1326041732|CHC13|76821|26|11/01/2013|12/31/9999|$56.01|0|0|||MIDDLE CEREBRAL ARTERY ECHO|| 58-1699775|1326041732|CHC13|76821|TC|11/01/2013|12/31/9999|$95.34|0|0|||MIDDLE CEREBRAL ARTERY ECHO|| 58-1699775|1326041732|CHC13|76825||11/01/2013|12/31/9999|$341.50|0|0|||ECHO EXAM OF FETAL HEART|| 58-1699775|1326041732|CHC13|76825|26|11/01/2013|12/31/9999|$130.67|0|0|||ECHO EXAM OF FETAL HEART|| 58-1699775|1326041732|CHC13|76825|TC|11/01/2013|12/31/9999|$210.83|0|0|||ECHO EXAM OF FETAL HEART|| 58-1699775|1326041732|CHC13|76826||11/01/2013|12/31/9999|$200.00|0|0|||ECHO EXAM OF FETAL HEART|| 58-1699775|1326041732|CHC13|76826|26|11/01/2013|12/31/9999|$65.33|0|0|||ECHO EXAM OF FETAL HEART|| 58-1699775|1326041732|CHC13|76826|TC|11/01/2013|12/31/9999|$134.67|0|0|||ECHO EXAM OF FETAL HEART|| 58-1699775|1326041732|CHC13|76827||11/01/2013|12/31/9999|$99.68|0|0|||ECHO EXAM OF FETAL HEART|| 58-1699775|1326041732|CHC13|76827|26|11/01/2013|12/31/9999|$45.20|0|0|||ECHO EXAM OF FETAL HEART|| 58-1699775|1326041732|CHC13|76827|TC|11/01/2013|12/31/9999|$54.49|0|0|||ECHO EXAM OF FETAL HEART|| 58-1699775|1326041732|CHC13|76828||11/01/2013|12/31/9999|$73.34|0|0|||ECHO EXAM OF FETAL HEART|| 58-1699775|1326041732|CHC13|76828|26|11/01/2013|12/31/9999|$43.57|0|0|||ECHO EXAM OF FETAL HEART|| 58-1699775|1326041732|CHC13|76828|TC|11/01/2013|12/31/9999|$29.77|0|0|||ECHO EXAM OF FETAL HEART|| 58-1699775|1326041732|CHC13|76830||11/01/2013|12/31/9999|$195.16|0|0|||TRANSVAGINAL US| NON-OB|| 58-1699775|1326041732|CHC13|76830|26|11/01/2013|12/31/9999|$53.93|0|0|||TRANSVAGINAL US| NON-OB|| 58-1699775|1326041732|CHC13|76830|TC|11/01/2013|12/31/9999|$141.23|0|0|||TRANSVAGINAL US| NON-OB|| 58-1699775|1326041732|CHC13|76831||11/01/2013|12/31/9999|$197.35|0|0|||ECHO EXAM| UTERUS|| 58-1699775|1326041732|CHC13|76831|26|11/01/2013|12/31/9999|$57.13|0|0|||ECHO EXAM| UTERUS|| 58-1699775|1326041732|CHC13|76831|TC|11/01/2013|12/31/9999|$140.22|0|0|||ECHO EXAM| UTERUS|| 58-1699775|1326041732|CHC13|76856||11/01/2013|12/31/9999|$193.15|0|0|||US EXAM| PELVIC| COMPLETE|| 58-1699775|1326041732|CHC13|76856|26|11/01/2013|12/31/9999|$53.43|0|0|||US EXAM| PELVIC| COMPLETE|| 58-1699775|1326041732|CHC13|76856|TC|11/01/2013|12/31/9999|$139.72|0|0|||US EXAM| PELVIC| COMPLETE|| 58-1699775|1326041732|CHC13|76857||11/01/2013|12/31/9999|$152.03|0|0|||US EXAM| PELVIC| LIMITED|| 58-1699775|1326041732|CHC13|76857|26|11/01/2013|12/31/9999|$30.47|0|0|||US EXAM| PELVIC| LIMITED|| 58-1699775|1326041732|CHC13|76857|TC|11/01/2013|12/31/9999|$121.56|0|0|||US EXAM| PELVIC| LIMITED|| 58-1699775|1326041732|CHC13|76870||11/01/2013|12/31/9999|$191.87|0|0|||US EXAM| SCROTUM|| 58-1699775|1326041732|CHC13|76870|26|11/01/2013|12/31/9999|$50.13|0|0|||US EXAM| SCROTUM|| 58-1699775|1326041732|CHC13|76870|TC|11/01/2013|12/31/9999|$141.74|0|0|||US EXAM| SCROTUM|| 58-1699775|1326041732|CHC13|76872||11/01/2013|12/31/9999|$210.31|0|0|||US| TRANSRECTAL|| 58-1699775|1326041732|CHC13|76872|26|11/01/2013|12/31/9999|$54.45|0|0|||US| TRANSRECTAL|| 58-1699775|1326041732|CHC13|76872|TC|11/01/2013|12/31/9999|$155.86|0|0|||US| TRANSRECTAL|| 58-1699775|1326041732|CHC13|76873||11/01/2013|12/31/9999|$270.78|0|0|||ECHOGRAP TRANS R| PROS STUDY|| 58-1699775|1326041732|CHC13|76873|26|11/01/2013|12/31/9999|$121.99|0|0|||ECHOGRAP TRANS R| PROS STUDY|| 58-1699775|1326041732|CHC13|76873|TC|11/01/2013|12/31/9999|$148.80|0|0|||ECHOGRAP TRANS R| PROS STUDY|| 58-1699775|1326041732|CHC13|76881||11/01/2013|12/31/9999|$186.26|0|0|||US XTR NON-VASC COMPLETE|| 58-1699775|1326041732|CHC13|76881|26|11/01/2013|12/31/9999|$48.56|0|0|||US XTR NON-VASC COMPLETE|| 58-1699775|1326041732|CHC13|76881|TC|11/01/2013|12/31/9999|$137.70|0|0|||US XTR NON-VASC COMPLETE|| 58-1699775|1326041732|CHC13|76882||11/01/2013|12/31/9999|$54.33|0|0|||US XTR NON-VASC LMTD|| 58-1699775|1326041732|CHC13|76882|26|11/01/2013|12/31/9999|$38.18|0|0|||US XTR NON-VASC LMTD|| 58-1699775|1326041732|CHC13|76882|TC|11/01/2013|12/31/9999|$16.16|0|0|||US XTR NON-VASC LMTD|| 58-1699775|1326041732|CHC13|76885||11/01/2013|12/31/9999|$229.26|0|0|||US EXAM INFANT HIPS| DYNAMIC|| 58-1699775|1326041732|CHC13|76885|26|11/01/2013|12/31/9999|$58.27|0|0|||US EXAM INFANT HIPS| DYNAMIC|| 58-1699775|1326041732|CHC13|76885|TC|11/01/2013|12/31/9999|$170.99|0|0|||US EXAM INFANT HIPS| DYNAMIC|| 58-1699775|1326041732|CHC13|76886||11/01/2013|12/31/9999|$160.94|0|0|||US EXAM INFANT HIPS| STATIC|| 58-1699775|1326041732|CHC13|76886|26|11/01/2013|12/31/9999|$46.94|0|0|||US EXAM INFANT HIPS| STATIC|| 58-1699775|1326041732|CHC13|76886|TC|11/01/2013|12/31/9999|$114.00|0|0|||US EXAM INFANT HIPS| STATIC|| 58-1699775|1326041732|CHC13|76930||11/01/2013|12/31/9999|$133.49|0|0|||ECHO GUIDE| CARDIOCENTESIS|| 58-1699775|1326041732|CHC13|76930|26|11/01/2013|12/31/9999|$52.27|0|0|||ECHO GUIDE| CARDIOCENTESIS|| 58-1699775|1326041732|CHC13|76930|TC|11/01/2013|12/31/9999|$81.21|0|0|||ECHO GUIDE| CARDIOCENTESIS|| 58-1699775|1326041732|CHC13|76932||11/01/2013|12/31/9999|$133.60|0|0|||ECHO GUIDE FOR HEART BIOPSY|| 58-1699775|1326041732|CHC13|76932|26|11/01/2013|12/31/9999|$53.83|0|0|||ECHO GUIDE FOR HEART BIOPSY|| 58-1699775|1326041732|CHC13|76932|TC|11/01/2013|12/31/9999|$81.81|0|0|||ECHO GUIDE FOR HEART BIOPSY|| 58-1699775|1326041732|CHC13|76936||11/01/2013|12/31/9999|$461.67|0|0|||ECHO GUIDE FOR ARTERY REPAIR|| 58-1699775|1326041732|CHC13|76936|26|11/01/2013|12/31/9999|$159.05|0|0|||ECHO GUIDE FOR ARTERY REPAIR|| 58-1699775|1326041732|CHC13|76936|TC|11/01/2013|12/31/9999|$302.62|0|0|||ECHO GUIDE FOR ARTERY REPAIR|| 58-1699775|1326041732|CHC13|76937||11/01/2013|12/31/9999|$54.24|0|0|||US GUIDE| VASCULAR ACCESS|| 58-1699775|1326041732|CHC13|76937|26|11/01/2013|12/31/9999|$23.96|0|0|||US GUIDE| VASCULAR ACCESS|| 58-1699775|1326041732|CHC13|76937|TC|11/01/2013|12/31/9999|$30.28|0|0|||US GUIDE| VASCULAR ACCESS|| 58-1699775|1326041732|CHC13|76940||11/01/2013|12/31/9999|$257.60|0|0|||US GUIDE| TISSUE ABLATION|| 58-1699775|1326041732|CHC13|76940|26|11/01/2013|12/31/9999|$165.77|0|0|||US GUIDE| TISSUE ABLATION|| 58-1699775|1326041732|CHC13|76940|TC|11/01/2013|12/31/9999|$93.41|0|0|||US GUIDE| TISSUE ABLATION|| 58-1699775|1326041732|CHC13|76941||11/01/2013|12/31/9999|$196.55|0|0|||ECHO GUIDE FOR TRANSFUSION|| 58-1699775|1326041732|CHC13|76941|26|11/01/2013|12/31/9999|$106.21|0|0|||ECHO GUIDE FOR TRANSFUSION|| 58-1699775|1326041732|CHC13|76941|TC|11/01/2013|12/31/9999|$86.86|0|0|||ECHO GUIDE FOR TRANSFUSION|| 58-1699775|1326041732|CHC13|76942||11/01/2013|12/31/9999|$310.05|0|0|||ECHO GUIDE FOR BIOPSY|| 58-1699775|1326041732|CHC13|76942|26|11/01/2013|12/31/9999|$52.83|0|0|||ECHO GUIDE FOR BIOPSY|| 58-1699775|1326041732|CHC13|76942|TC|11/01/2013|12/31/9999|$257.23|0|0|||ECHO GUIDE FOR BIOPSY|| 58-1699775|1326041732|CHC13|76945||11/01/2013|12/31/9999|$144.19|0|0|||ECHO GUIDE| VILLUS SAMPLING|| 58-1699775|1326041732|CHC13|76945|26|11/01/2013|12/31/9999|$54.34|0|0|||ECHO GUIDE| VILLUS SAMPLING|| 58-1699775|1326041732|CHC13|76945|TC|11/01/2013|12/31/9999|$89.89|0|0|||ECHO GUIDE| VILLUS SAMPLING|| 58-1699775|1326041732|CHC13|76946||11/01/2013|12/31/9999|$54.66|0|0|||ECHO GUIDE FOR AMNIOCENTESIS|| 58-1699775|1326041732|CHC13|76946|26|11/01/2013|12/31/9999|$29.93|0|0|||ECHO GUIDE FOR AMNIOCENTESIS|| 58-1699775|1326041732|CHC13|76946|TC|11/01/2013|12/31/9999|$24.73|0|0|||ECHO GUIDE FOR AMNIOCENTESIS|| 58-1699775|1326041732|CHC13|76948||11/01/2013|12/31/9999|$55.70|0|0|||ECHO GUIDE| OVA ASPIRATION|| 58-1699775|1326041732|CHC13|76948|26|11/01/2013|12/31/9999|$30.97|0|0|||ECHO GUIDE| OVA ASPIRATION|| 58-1699775|1326041732|CHC13|76948|TC|11/01/2013|12/31/9999|$24.73|0|0|||ECHO GUIDE| OVA ASPIRATION|| 58-1699775|1326041732|CHC13|76965||11/01/2013|12/31/9999|$161.15|0|0|||ECHO GUIDANCE RADIOTHERAPY|| 58-1699775|1326041732|CHC13|76965|26|11/01/2013|12/31/9999|$106.16|0|0|||ECHO GUIDANCE RADIOTHERAPY|| 58-1699775|1326041732|CHC13|76965|TC|11/01/2013|12/31/9999|$54.99|0|0|||ECHO GUIDANCE RADIOTHERAPY|| 58-1699775|1326041732|CHC13|76970||11/01/2013|12/31/9999|$155.19|0|0|||ULTRASOUND EXAM FOLLOW-UP|| 58-1699775|1326041732|CHC13|76970|26|11/01/2013|12/31/9999|$32.11|0|0|||ULTRASOUND EXAM FOLLOW-UP|| 58-1699775|1326041732|CHC13|76970|TC|11/01/2013|12/31/9999|$123.07|0|0|||ULTRASOUND EXAM FOLLOW-UP|| 58-1699775|1326041732|CHC13|76975||11/01/2013|12/31/9999|$161.21|0|0|||GI ENDOSCOPIC ULTRASOUND|| 58-1699775|1326041732|CHC13|76975|26|11/01/2013|12/31/9999|$68.83|0|0|||GI ENDOSCOPIC ULTRASOUND|| 58-1699775|1326041732|CHC13|76975|TC|11/01/2013|12/31/9999|$92.40|0|0|||GI ENDOSCOPIC ULTRASOUND|| 58-1699775|1326041732|CHC13|76977||11/01/2013|12/31/9999|$13.43|0|0|||US BONE DENSITY MEASURE|| 58-1699775|1326041732|CHC13|76977|26|11/01/2013|12/31/9999|$4.34|0|0|||US BONE DENSITY MEASURE|| 58-1699775|1326041732|CHC13|76977|TC|11/01/2013|12/31/9999|$9.09|0|0|||US BONE DENSITY MEASURE|| 58-1699775|1326041732|CHC13|76998||11/01/2013|12/31/9999|$102.09|0|0|||US GUIDE| INTRAOP|| 58-1699775|1326041732|CHC13|76998|26|11/01/2013|12/31/9999|$103.64|0|0|||US GUIDE| INTRAOP|| 58-1699775|1326041732|CHC13|76998|TC|11/01/2013|12/31/9999|$157.71|0|0|||US GUIDE| INTRAOP|| 58-1699775|1326041732|CHC13|76999||11/01/2013|12/31/9999|$0.00|0|0|||ECHO EXAMINATION PROCEDURE|| 58-1699775|1326041732|CHC13|76999|26|11/01/2013|12/31/9999|$0.00|0|0|||ECHO EXAMINATION PROCEDURE|| 58-1699775|1326041732|CHC13|76999|TC|11/01/2013|12/31/9999|$0.00|0|0|||ECHO EXAMINATION PROCEDURE|| 58-1699775|1326041732|CHC13|77001||11/01/2013|12/31/9999|$179.27|0|0|||FLUOROGUIDE FOR VEIN DEVICE|| 58-1699775|1326041732|CHC13|77001|26|11/01/2013|12/31/9999|$29.97|0|0|||FLUOROGUIDE FOR VEIN DEVICE|| 58-1699775|1326041732|CHC13|77001|TC|11/01/2013|12/31/9999|$149.30|0|0|||FLUOROGUIDE FOR VEIN DEVICE|| 58-1699775|1326041732|CHC13|77002||11/01/2013|12/31/9999|$119.16|0|0|||NEEDLE LOCALIZATION BY XRAY|| 58-1699775|1326041732|CHC13|77002|26|11/01/2013|12/31/9999|$43.49|0|0|||NEEDLE LOCALIZATION BY XRAY|| 58-1699775|1326041732|CHC13|77002|TC|11/01/2013|12/31/9999|$75.67|0|0|||NEEDLE LOCALIZATION BY XRAY|| 58-1699775|1326041732|CHC13|77003||11/01/2013|12/31/9999|$99.33|0|0|||FLUOROGUIDE FOR SPINE INJECT|| 58-1699775|1326041732|CHC13|77003|26|11/01/2013|12/31/9999|$47.87|0|0|||FLUOROGUIDE FOR SPINE INJECT|| 58-1699775|1326041732|CHC13|77003|TC|11/01/2013|12/31/9999|$51.46|0|0|||FLUOROGUIDE FOR SPINE INJECT|| 58-1699775|1326041732|CHC13|77011||11/01/2013|12/31/9999|$542.12|0|0|||CT SCAN FOR LOCALIZATION|| 58-1699775|1326041732|CHC13|77011|26|11/01/2013|12/31/9999|$95.76|0|0|||CT SCAN FOR LOCALIZATION|| 58-1699775|1326041732|CHC13|77011|TC|11/01/2013|12/31/9999|$446.35|0|0|||CT SCAN FOR LOCALIZATION|| 58-1699775|1326041732|CHC13|77012||11/01/2013|12/31/9999|$224.60|0|0|||CT SCAN FOR NEEDLE BIOPSY|| 58-1699775|1326041732|CHC13|77012|26|11/01/2013|12/31/9999|$88.92|0|0|||CT SCAN FOR NEEDLE BIOPSY|| 58-1699775|1326041732|CHC13|77012|TC|11/01/2013|12/31/9999|$135.68|0|0|||CT SCAN FOR NEEDLE BIOPSY|| 58-1699775|1326041732|CHC13|77013||11/01/2013|12/31/9999|$827.89|0|0|||CT GUIDE FOR TISSUE ABLATION|| 58-1699775|1326041732|CHC13|77013|26|11/01/2013|12/31/9999|$318.01|0|0|||CT GUIDE FOR TISSUE ABLATION|| 58-1699775|1326041732|CHC13|77013|TC|11/01/2013|12/31/9999|$515.06|0|0|||CT GUIDE FOR TISSUE ABLATION|| 58-1699775|1326041732|CHC13|77014||11/01/2013|12/31/9999|$217.78|0|0|||CT SCAN FOR THERAPY GUIDE|| 58-1699775|1326041732|CHC13|77014|26|11/01/2013|12/31/9999|$66.97|0|0|||CT SCAN FOR THERAPY GUIDE|| 58-1699775|1326041732|CHC13|77014|TC|11/01/2013|12/31/9999|$150.81|0|0|||CT SCAN FOR THERAPY GUIDE|| 58-1699775|1326041732|CHC13|77021||11/01/2013|12/31/9999|$626.62|0|0|||MR GUIDANCE FOR NEEDLE PLACE|| 58-1699775|1326041732|CHC13|77021|26|11/01/2013|12/31/9999|$118.74|0|0|||MR GUIDANCE FOR NEEDLE PLACE|| 58-1699775|1326041732|CHC13|77021|TC|11/01/2013|12/31/9999|$507.88|0|0|||MR GUIDANCE FOR NEEDLE PLACE|| 58-1699775|1326041732|CHC13|77022||11/01/2013|12/31/9999|$1|013.13|0|0|||MRI FOR TISSUE ABLATION|| 58-1699775|1326041732|CHC13|77022|26|11/01/2013|12/31/9999|$334.59|0|0|||MRI FOR TISSUE ABLATION|| 58-1699775|1326041732|CHC13|77022|TC|11/01/2013|12/31/9999|$682.21|0|0|||MRI FOR TISSUE ABLATION|| 58-1699775|1326041732|CHC13|77031|26|11/01/2013|12/31/9999|$125.81|0|0|||STEREOTACT GUIDE FOR BRST BX|| 58-1699775|1326041732|CHC13|77031|TC|11/01/2013|12/31/9999|$99.88|0|0|||STEREOTACT GUIDE FOR BRST BX|| 58-1699775|1326041732|CHC13|77032|26|11/01/2013|12/31/9999|$43.61|0|0|||GUIDANCE FOR NEEDLE| BREAST|| 58-1699775|1326041732|CHC13|77032|TC|11/01/2013|12/31/9999|$39.86|0|0|||GUIDANCE FOR NEEDLE| BREAST|| 58-1699775|1326041732|CHC13|77053||11/01/2013|12/31/9999|$96.41|0|0|||X-RAY OF MAMMARY DUCT|| 58-1699775|1326041732|CHC13|77053|26|11/01/2013|12/31/9999|$27.30|0|0|||X-RAY OF MAMMARY DUCT|| 58-1699775|1326041732|CHC13|77053|TC|11/01/2013|12/31/9999|$69.11|0|0|||X-RAY OF MAMMARY DUCT|| 58-1699775|1326041732|CHC13|77054||11/01/2013|12/31/9999|$131.25|0|0|||X-RAY OF MAMMARY DUCTS|| 58-1699775|1326041732|CHC13|77054|26|11/01/2013|12/31/9999|$35.41|0|0|||X-RAY OF MAMMARY DUCTS|| 58-1699775|1326041732|CHC13|77054|TC|11/01/2013|12/31/9999|$95.84|0|0|||X-RAY OF MAMMARY DUCTS|| 58-1699775|1326041732|CHC13|77058||11/01/2013|12/31/9999|$1|051.98|0|0|||MRI| ONE BREAST|| 58-1699775|1326041732|CHC13|77058|26|11/01/2013|12/31/9999|$127.52|0|0|||MRI| ONE BREAST|| 58-1699775|1326041732|CHC13|77058|TC|11/01/2013|12/31/9999|$924.46|0|0|||MRI| ONE BREAST|| 58-1699775|1326041732|CHC13|77059||11/01/2013|12/31/9999|$1|071.65|0|0|||MRI| BOTH BREASTS|| 58-1699775|1326041732|CHC13|77059|26|11/01/2013|12/31/9999|$127.02|0|0|||MRI| BOTH BREASTS|| 58-1699775|1326041732|CHC13|77059|TC|11/01/2013|12/31/9999|$944.64|0|0|||MRI| BOTH BREASTS|| 58-1699775|1326041732|CHC13|77061||04/01/2015|12/31/9999|$65.00|0|0|0|%|BREAST TOMOSYNTHESIS UNI|| 58-1699775|1326041732|CHC13|77061|26|04/01/2015|12/31/9999|$65.00|0|0|0|%|BREAST TOMOSYNTHESIS UNI|| 58-1699775|1326041732|CHC13|77061|TC|04/01/2015|12/31/9999|$65.00|0|0|0|%|BREAST TOMOSYNTHESIS UNI|| 58-1699775|1326041732|CHC13|77062||04/01/2015|12/31/9999|$65.00|0|0|0|%|BREAST TOMOSYNTHESIS BI|| 58-1699775|1326041732|CHC13|77062|26|04/01/2015|12/31/9999|$65.00|0|0|0|%|BREAST TOMOSYNTHESIS BI|| 58-1699775|1326041732|CHC13|77062|TC|04/01/2015|12/31/9999|$65.00|0|0|0|%|BREAST TOMOSYNTHESIS BI|| 58-1699775|1326041732|CHC13|77063||04/01/2015|12/31/9999|$87.02|0|0|0||BREAST TOMOSYNTHESIS BI|| 58-1699775|1326041732|CHC13|77063|26|04/01/2015|12/31/9999|$48.76|0|0|0||BREAST TOMOSYNTHESIS BI|| 58-1699775|1326041732|CHC13|77063|TC|04/01/2015|12/31/9999|$38.26|0|0|0||BREAST TOMOSYNTHESIS BI|| 58-1699775|1326041732|CHC13|77065||04/01/2017|12/31/9999|$222.67|0|222.67|0||DX MAMMO INCL CAD UNI|| 58-1699775|1326041732|CHC13|77065|26|04/01/2017|12/31/9999|$65.74|0|65.74|0||DX MAMMO INCL CAD UNI|| 58-1699775|1326041732|CHC13|77065|TC|04/01/2017|12/31/9999|$156.93|0|156.93|0||DX MAMMO INCL CAD UNI|| 58-1699775|1326041732|CHC13|77066||04/01/2017|12/31/9999|$282.46|0|282.46|0||DX MAMMO INCL CAD BI|| 58-1699775|1326041732|CHC13|77066|26|04/01/2017|12/31/9999|$81.72|0|81.72|0||DX MAMMO INCL CAD BI|| 58-1699775|1326041732|CHC13|77066|TC|04/01/2017|12/31/9999|$200.74|0|200.74|0||DX MAMMO INCL CAD BI|| 58-1699775|1326041732|CHC13|77067||04/01/2017|12/31/9999|$227.98|0|227.98|0||SCR MAMMO BI INCL CAD|| 58-1699775|1326041732|CHC13|77067|26|04/01/2017|12/31/9999|$62.17|0|62.17|0||SCR MAMMO BI INCL CAD|| 58-1699775|1326041732|CHC13|77067|TC|04/01/2017|12/31/9999|$165.81|0|165.81|0||SCR MAMMO BI INCL CAD|| 58-1699775|1326041732|CHC13|77071||11/01/2013|12/31/9999|$77.11|0|0|||X-RAY STRESS VIEW|| 58-1699775|1326041732|CHC13|77072||11/01/2013|12/31/9999|$35.92|0|0|||X-RAYS FOR BONE AGE|| 58-1699775|1326041732|CHC13|77072|26|11/01/2013|12/31/9999|$14.72|0|0|||X-RAYS FOR BONE AGE|| 58-1699775|1326041732|CHC13|77072|TC|11/01/2013|12/31/9999|$21.20|0|0|||X-RAYS FOR BONE AGE|| 58-1699775|1326041732|CHC13|77073||11/01/2013|12/31/9999|$60.13|0|0|||X-RAYS| BONE LENGTH STUDIES|| 58-1699775|1326041732|CHC13|77073|26|11/01/2013|12/31/9999|$23.30|0|0|||X-RAYS| BONE LENGTH STUDIES|| 58-1699775|1326041732|CHC13|77073|TC|11/01/2013|12/31/9999|$36.83|0|0|||X-RAYS| BONE LENGTH STUDIES|| 58-1699775|1326041732|CHC13|77074||11/01/2013|12/31/9999|$107.55|0|0|||X-RAYS| BONE SURVEY| LIMITED|| 58-1699775|1326041732|CHC13|77074|26|11/01/2013|12/31/9999|$35.41|0|0|||X-RAYS| BONE SURVEY| LIMITED|| 58-1699775|1326041732|CHC13|77074|TC|11/01/2013|12/31/9999|$72.14|0|0|||X-RAYS| BONE SURVEY| LIMITED|| 58-1699775|1326041732|CHC13|77075||11/01/2013|12/31/9999|$160.01|0|0|||X-RAYS| BONE SURVEY COMPLETE|| 58-1699775|1326041732|CHC13|77075|26|11/01/2013|12/31/9999|$42.48|0|0|||X-RAYS| BONE SURVEY COMPLETE|| 58-1699775|1326041732|CHC13|77075|TC|11/01/2013|12/31/9999|$117.53|0|0|||X-RAYS| BONE SURVEY COMPLETE|| 58-1699775|1326041732|CHC13|77076||11/01/2013|12/31/9999|$166.49|0|0|||X-RAYS| BONE SURVEY| INFANT|| 58-1699775|1326041732|CHC13|77076|26|11/01/2013|12/31/9999|$55.02|0|0|||X-RAYS| BONE SURVEY| INFANT|| 58-1699775|1326041732|CHC13|77076|TC|11/01/2013|12/31/9999|$111.47|0|0|||X-RAYS| BONE SURVEY| INFANT|| 58-1699775|1326041732|CHC13|77077||11/01/2013|12/31/9999|$64.90|0|0|||JOINT SURVEY| SINGLE VIEW|| 58-1699775|1326041732|CHC13|77077|26|11/01/2013|12/31/9999|$26.56|0|0|||JOINT SURVEY| SINGLE VIEW|| 58-1699775|1326041732|CHC13|77077|TC|11/01/2013|12/31/9999|$38.35|0|0|||JOINT SURVEY| SINGLE VIEW|| 58-1699775|1326041732|CHC13|77078||11/01/2013|12/31/9999|$222.87|0|0|||CT BONE DENSITY| AXIAL|| 58-1699775|1326041732|CHC13|77078|26|11/01/2013|12/31/9999|$19.10|0|0|||CT BONE DENSITY| AXIAL|| 58-1699775|1326041732|CHC13|77078|TC|11/01/2013|12/31/9999|$203.77|0|0|||CT BONE DENSITY| AXIAL|| 58-1699775|1326041732|CHC13|77080||11/01/2013|12/31/9999|$146.30|0|0|||DXA BONE DENSITY| AXIAL|| 58-1699775|1326041732|CHC13|77080|26|11/01/2013|12/31/9999|$17.47|0|0|||DXA BONE DENSITY| AXIAL|| 58-1699775|1326041732|CHC13|77080|TC|11/01/2013|12/31/9999|$128.82|0|0|||DXA BONE DENSITY| AXIAL|| 58-1699775|1326041732|CHC13|77081||11/01/2013|12/31/9999|$44.16|0|0|||DXA BONE DENSITY/PERIPHERAL|| 58-1699775|1326041732|CHC13|77081|26|11/01/2013|12/31/9999|$17.42|0|0|||DXA BONE DENSITY/PERIPHERAL|| 58-1699775|1326041732|CHC13|77081|TC|11/01/2013|12/31/9999|$26.75|0|0|||DXA BONE DENSITY/PERIPHERAL|| 58-1699775|1326041732|CHC13|77084||11/01/2013|12/31/9999|$738.12|0|0|||MAGNETIC IMAGE| BONE MARROW|| 58-1699775|1326041732|CHC13|77084|26|11/01/2013|12/31/9999|$125.33|0|0|||MAGNETIC IMAGE| BONE MARROW|| 58-1699775|1326041732|CHC13|77084|TC|11/01/2013|12/31/9999|$612.78|0|0|||MAGNETIC IMAGE| BONE MARROW|| 58-1699775|1326041732|CHC13|77085||04/01/2015|12/31/9999|$85.75|0|0|0||DXA BONE DENSITY STUDY|| 58-1699775|1326041732|CHC13|77085|26|04/01/2015|12/31/9999|$24.64|0|0|0||DXA BONE DENSITY STUDY|| 58-1699775|1326041732|CHC13|77085|TC|04/01/2015|12/31/9999|$61.11|0|0|0||DXA BONE DENSITY STUDY|| 58-1699775|1326041732|CHC13|77086||04/01/2015|12/31/9999|$54.16|0|0|0||FRACTURE ASSESSMENT VIA DXA|| 58-1699775|1326041732|CHC13|77086|26|04/01/2015|12/31/9999|$14.30|0|0|0||FRACTURE ASSESSMENT VIA DXA|| 58-1699775|1326041732|CHC13|77086|TC|04/01/2015|12/31/9999|$39.86|0|0|0||FRACTURE ASSESSMENT VIA DXA|| 58-1699775|1326041732|CHC13|77261||11/01/2013|12/31/9999|$113.54|0|0|||RADIATION THERAPY PLANNING|| 58-1699775|1326041732|CHC13|77262||11/01/2013|12/31/9999|$170.75|0|0|||RADIATION THERAPY PLANNING|| 58-1699775|1326041732|CHC13|77263||11/01/2013|12/31/9999|$252.94|0|0|||RADIATION THERAPY PLANNING|| 58-1699775|1326041732|CHC13|77280||11/01/2013|12/31/9999|$281.97|0|0|||SET RADIATION THERAPY FIELD|| 58-1699775|1326041732|CHC13|77280|26|11/01/2013|12/31/9999|$55.00|0|0|||SET RADIATION THERAPY FIELD|| 58-1699775|1326041732|CHC13|77280|TC|11/01/2013|12/31/9999|$226.97|0|0|||SET RADIATION THERAPY FIELD|| 58-1699775|1326041732|CHC13|77285||11/01/2013|12/31/9999|$496.83|0|0|||SET RADIATION THERAPY FIELD|| 58-1699775|1326041732|CHC13|77285|26|11/01/2013|12/31/9999|$82.76|0|0|||SET RADIATION THERAPY FIELD|| 58-1699775|1326041732|CHC13|77285|TC|11/01/2013|12/31/9999|$414.08|0|0|||SET RADIATION THERAPY FIELD|| 58-1699775|1326041732|CHC13|77290||11/01/2013|12/31/9999|$803.40|0|0|||SET RADIATION THERAPY FIELD|| 58-1699775|1326041732|CHC13|77290|26|11/01/2013|12/31/9999|$122.53|0|0|||SET RADIATION THERAPY FIELD|| 58-1699775|1326041732|CHC13|77290|TC|11/01/2013|12/31/9999|$680.87|0|0|||SET RADIATION THERAPY FIELD|| 58-1699775|1326041732|CHC13|77293||04/01/2014|12/31/9999|$653.42|0|0|||RESPIRATOR MOTION MGMT SIMUL|| 58-1699775|1326041732|CHC13|77293|26|04/01/2014|12/31/9999|$166.14|0|0|||RESPIRATOR MOTION MGMT SIMUL|| 58-1699775|1326041732|CHC13|77293|TC|04/01/2014|12/31/9999|$487.28|0|0|||RESPIRATOR MOTION MGMT SIMUL|| 58-1699775|1326041732|CHC13|77295||04/01/2014|12/31/9999|$745.35|0|0|||SET RADIATION THERAPY FIELD|| 58-1699775|1326041732|CHC13|77295|26|04/01/2014|12/31/9999|$356.33|0|0|||SET RADIATION THERAPY FIELD|| 58-1699775|1326041732|CHC13|77295|TC|04/01/2014|12/31/9999|$389.00|0|0|||SET RADIATION THERAPY FIELD|| 58-1699775|1326041732|CHC13|77299||11/01/2013|12/31/9999|$0.00|0|0|||RADIATION THERAPY PLANNING|| 58-1699775|1326041732|CHC13|77299|26|11/01/2013|12/31/9999|$0.00|0|0|||RADIATION THERAPY PLANNING|| 58-1699775|1326041732|CHC13|77299|TC|11/01/2013|12/31/9999|$0.00|0|0|||RADIATION THERAPY PLANNING|| 58-1699775|1326041732|CHC13|77300||11/01/2013|12/31/9999|$103.98|0|0|||RADIATION THERAPY DOSE PLAN|| 58-1699775|1326041732|CHC13|77300|26|11/01/2013|12/31/9999|$48.99|0|0|||RADIATION THERAPY DOSE PLAN|| 58-1699775|1326041732|CHC13|77300|TC|11/01/2013|12/31/9999|$54.99|0|0|||RADIATION THERAPY DOSE PLAN|| 58-1699775|1326041732|CHC13|77301||11/01/2013|12/31/9999|$2|987.61|0|0|||RADIOTHERAPY DOSE PLAN| IMRT|| 58-1699775|1326041732|CHC13|77301|26|11/01/2013|12/31/9999|$629.98|0|0|||RADIOTHERAPY DOSE PLAN| IMRT|| 58-1699775|1326041732|CHC13|77301|TC|11/01/2013|12/31/9999|$2|357.63|0|0|||RADIOTHERAPY DOSE PLAN| IMRT|| 58-1699775|1326041732|CHC13|77306||04/01/2015|12/31/9999|$224.65|0|0|0||TELETHX ISODOSE PLAN SIMPLE|| 58-1699775|1326041732|CHC13|77306|26|04/01/2015|12/31/9999|$115.71|0|0|0||TELETHX ISODOSE PLAN SIMPLE|| 58-1699775|1326041732|CHC13|77306|TC|04/01/2015|12/31/9999|$108.94|0|0|0||TELETHX ISODOSE PLAN SIMPLE|| 58-1699775|1326041732|CHC13|77307||04/01/2015|12/31/9999|$440.87|0|0|0||TELETHX ISODOSE PLAN CPLX|| 58-1699775|1326041732|CHC13|77307|26|04/01/2015|12/31/9999|$241.06|0|0|0||TELETHX ISODOSE PLAN CPLX|| 58-1699775|1326041732|CHC13|77307|TC|04/01/2015|12/31/9999|$199.81|0|0|0||TELETHX ISODOSE PLAN CPLX|| 58-1699775|1326041732|CHC13|77316||04/01/2015|12/31/9999|$285.76|0|0|0||BRACHYTX ISODOSE PLAN SIMPLE|| 58-1699775|1326041732|CHC13|77316|26|04/01/2015|12/31/9999|$115.71|0|0|0||BRACHYTX ISODOSE PLAN SIMPLE|| 58-1699775|1326041732|CHC13|77316|TC|04/01/2015|12/31/9999|$170.05|0|0|0||BRACHYTX ISODOSE PLAN SIMPLE|| 58-1699775|1326041732|CHC13|77317||04/01/2015|12/31/9999|$373.89|0|0|0||BRACHYTX ISODOSE INTERMED|| 58-1699775|1326041732|CHC13|77317|26|04/01/2015|12/31/9999|$152.30|0|0|0||BRACHYTX ISODOSE INTERMED|| 58-1699775|1326041732|CHC13|77317|TC|04/01/2015|12/31/9999|$221.60|0|0|0||BRACHYTX ISODOSE INTERMED|| 58-1699775|1326041732|CHC13|77318||04/01/2015|12/31/9999|$541.84|0|0|0||BRACHYTX ISODOSE COMPLEX|| 58-1699775|1326041732|CHC13|77318|26|04/01/2015|12/31/9999|$241.06|0|0|0||BRACHYTX ISODOSE COMPLEX|| 58-1699775|1326041732|CHC13|77318|TC|04/01/2015|12/31/9999|$300.77|0|0|0||BRACHYTX ISODOSE COMPLEX|| 58-1699775|1326041732|CHC13|77321||11/01/2013|12/31/9999|$151.28|0|0|||SPECIAL TELETX PORT PLAN|| 58-1699775|1326041732|CHC13|77321|26|11/01/2013|12/31/9999|$74.60|0|0|||SPECIAL TELETX PORT PLAN|| 58-1699775|1326041732|CHC13|77321|TC|11/01/2013|12/31/9999|$76.68|0|0|||SPECIAL TELETX PORT PLAN|| 58-1699775|1326041732|CHC13|77331||11/01/2013|12/31/9999|$96.86|0|0|||SPECIAL RADIATION DOSIMETRY|| 58-1699775|1326041732|CHC13|77331|26|11/01/2013|12/31/9999|$68.60|0|0|||SPECIAL RADIATION DOSIMETRY|| 58-1699775|1326041732|CHC13|77331|TC|11/01/2013|12/31/9999|$28.26|0|0|||SPECIAL RADIATION DOSIMETRY|| 58-1699775|1326041732|CHC13|77332||11/01/2013|12/31/9999|$117.64|0|0|||RADIATION TREATMENT AID(S)|| 58-1699775|1326041732|CHC13|77332|26|11/01/2013|12/31/9999|$42.48|0|0|||RADIATION TREATMENT AID(S)|| 58-1699775|1326041732|CHC13|77332|TC|11/01/2013|12/31/9999|$75.16|0|0|||RADIATION TREATMENT AID(S)|| 58-1699775|1326041732|CHC13|77333||11/01/2013|12/31/9999|$85.59|0|0|||RADIATION TREATMENT AID(S)|| 58-1699775|1326041732|CHC13|77333|26|11/01/2013|12/31/9999|$65.90|0|0|||RADIATION TREATMENT AID(S)|| 58-1699775|1326041732|CHC13|77333|TC|11/01/2013|12/31/9999|$19.69|0|0|||RADIATION TREATMENT AID(S)|| 58-1699775|1326041732|CHC13|77334||11/01/2013|12/31/9999|$227.09|0|0|||RADIATION TREATMENT AID(S)|| 58-1699775|1326041732|CHC13|77334|26|11/01/2013|12/31/9999|$96.96|0|0|||RADIATION TREATMENT AID(S)|| 58-1699775|1326041732|CHC13|77334|TC|11/01/2013|12/31/9999|$130.14|0|0|||RADIATION TREATMENT AID(S)|| 58-1699775|1326041732|CHC13|77336||11/01/2013|12/31/9999|$69.11|0|0|||RADIATION PHYSICS CONSULT|| 58-1699775|1326041732|CHC13|77338||11/01/2013|12/31/9999|$753.29|0|0|||DESIGN MLC DEVICE FOR IMRT|| 58-1699775|1326041732|CHC13|77338|26|11/01/2013|12/31/9999|$337.15|0|0|||DESIGN MLC DEVICE FOR IMRT|| 58-1699775|1326041732|CHC13|77338|TC|11/01/2013|12/31/9999|$416.14|0|0|||DESIGN MLC DEVICE FOR IMRT|| 58-1699775|1326041732|CHC13|77370||11/01/2013|12/31/9999|$168.01|0|0|||RADIATION PHYSICS CONSULT|| 58-1699775|1326041732|CHC13|77371||11/01/2013|12/31/9999|$1|991.34|0|0|||SRS| MULTISOURCE|| 58-1699775|1326041732|CHC13|77372||11/01/2013|12/31/9999|$1|241.25|0|0|||SRS| LINEAR BASED|| 58-1699775|1326041732|CHC13|77373||11/01/2013|12/31/9999|$2|364.95|0|0|||SBRT DELIVERY|| 58-1699775|1326041732|CHC13|77385||04/01/2015|12/31/9999|$65.00|0|0|0|%|NTSTY MODUL RAD TX DLVR SMPL|| 58-1699775|1326041732|CHC13|77386||04/01/2015|12/31/9999|$65.00|0|0|0|%|NTSTY MODUL RAD TX DLVR CPLX|| 58-1699775|1326041732|CHC13|77387||04/01/2015|12/31/9999|$65.00|0|0|0|%|GUIDANCE FOR RADIAJ TX DLVR|| 58-1699775|1326041732|CHC13|77399||11/01/2013|12/31/9999|$0.00|0|0|||EXTERNAL RADIATION DOSIMETRY|| 58-1699775|1326041732|CHC13|77399|26|11/01/2013|12/31/9999|$0.00|0|0|||EXTERNAL RADIATION DOSIMETRY|| 58-1699775|1326041732|CHC13|77399|TC|11/01/2013|12/31/9999|$0.00|0|0|||EXTERNAL RADIATION DOSIMETRY|| 58-1699775|1326041732|CHC13|77401||11/01/2013|12/31/9999|$32.80|0|0|||RADIATION TREATMENT DELIVERY|| 58-1699775|1326041732|CHC13|77402||11/01/2013|12/31/9999|$271.35|0|0|||RADIATION TREATMENT DELIVERY|| 58-1699775|1326041732|CHC13|77407||11/01/2013|12/31/9999|$374.74|0|0|||RADIATION TREATMENT DELIVERY|| 58-1699775|1326041732|CHC13|77412||11/01/2013|12/31/9999|$360.62|0|0|||RADIATION TREATMENT DELIVERY|| 58-1699775|1326041732|CHC13|77417||11/01/2013|12/31/9999|$21.20|0|0|||RADIOLOGY PORT FILM(S)|| 58-1699775|1326041732|CHC13|77422||11/01/2013|12/31/9999|$374.74|0|0|||NEUTRON BEAM TX| SIMPLE|| 58-1699775|1326041732|CHC13|77423||11/01/2013|12/31/9999|$387.85|0|0|||NEUTRON BEAM TX| COMPLEX|| 58-1699775|1326041732|CHC13|77424||11/01/2013|12/31/9999|$0.00|0|0|||IO RAD TX DELIVERY BY X-RAY|| 58-1699775|1326041732|CHC13|77425||11/01/2013|12/31/9999|$0.00|0|0|||WEEKLY RADIATION THERAPY|| 58-1699775|1326041732|CHC13|77427||11/01/2013|12/31/9999|$282.01|0|0|||RADIATION TX MANAGEMENT| X5|| 58-1699775|1326041732|CHC13|77431||11/01/2013|12/31/9999|$154.84|0|0|||RADIATION THERAPY MANAGEMENT|| 58-1699775|1326041732|CHC13|77432||11/01/2013|12/31/9999|$639.06|0|0|||STEREOTACTIC RADIATION TRMT|| 58-1699775|1326041732|CHC13|77435||11/01/2013|12/31/9999|$958.30|0|0|||SBRT MANAGEMENT|| 58-1699775|1326041732|CHC13|77469||11/01/2013|12/31/9999|$474.52|0|0|||IO RADIATION TX MANAGEMENT|| 58-1699775|1326041732|CHC13|77470||11/01/2013|12/31/9999|$269.37|0|0|||SPECIAL RADIATION TREATMENT|| 58-1699775|1326041732|CHC13|77470|26|11/01/2013|12/31/9999|$164.45|0|0|||SPECIAL RADIATION TREATMENT|| 58-1699775|1326041732|CHC13|77470|TC|11/01/2013|12/31/9999|$104.92|0|0|||SPECIAL RADIATION TREATMENT|| 58-1699775|1326041732|CHC13|77499||11/01/2013|12/31/9999|$0.00|0|0|||RADIATION THERAPY MANAGEMENT|| 58-1699775|1326041732|CHC13|77499|26|11/01/2013|12/31/9999|$0.00|0|0|||RADIATION THERAPY MANAGEMENT|| 58-1699775|1326041732|CHC13|77499|TC|11/01/2013|12/31/9999|$0.00|0|0|||RADIATION THERAPY MANAGEMENT|| 58-1699775|1326041732|CHC13|77520||11/01/2013|12/31/9999|$0.00|0|0|||PROTON TRMT| SIMPLE W/O COMP|| 58-1699775|1326041732|CHC13|77522||11/01/2013|12/31/9999|$0.00|0|0|||PROTON TRMT| SIMPLE W/COMP|| 58-1699775|1326041732|CHC13|77523||11/01/2013|12/31/9999|$0.00|0|0|||PROTON TRMT| INTERMEDIATE|| 58-1699775|1326041732|CHC13|77525||11/01/2013|12/31/9999|$0.00|0|0|||PROTON TREATMENT| COMPLEX|| 58-1699775|1326041732|CHC13|77600||11/01/2013|12/31/9999|$626.41|0|0|||HYPERTHERMIA TREATMENT|| 58-1699775|1326041732|CHC13|77600|26|11/01/2013|12/31/9999|$122.53|0|0|||HYPERTHERMIA TREATMENT|| 58-1699775|1326041732|CHC13|77600|TC|11/01/2013|12/31/9999|$503.88|0|0|||HYPERTHERMIA TREATMENT|| 58-1699775|1326041732|CHC13|77605||11/01/2013|12/31/9999|$1|057.14|0|0|||HYPERTHERMIA TREATMENT|| 58-1699775|1326041732|CHC13|77605|26|11/01/2013|12/31/9999|$177.53|0|0|||HYPERTHERMIA TREATMENT|| 58-1699775|1326041732|CHC13|77605|TC|11/01/2013|12/31/9999|$879.61|0|0|||HYPERTHERMIA TREATMENT|| 58-1699775|1326041732|CHC13|77610||11/01/2013|12/31/9999|$991.55|0|0|||HYPERTHERMIA TREATMENT|| 58-1699775|1326041732|CHC13|77610|26|11/01/2013|12/31/9999|$121.52|0|0|||HYPERTHERMIA TREATMENT|| 58-1699775|1326041732|CHC13|77610|TC|11/01/2013|12/31/9999|$870.03|0|0|||HYPERTHERMIA TREATMENT|| 58-1699775|1326041732|CHC13|77615||11/01/2013|12/31/9999|$1|479.37|0|0|||HYPERTHERMIA TREATMENT|| 58-1699775|1326041732|CHC13|77615|26|11/01/2013|12/31/9999|$164.45|0|0|||HYPERTHERMIA TREATMENT|| 58-1699775|1326041732|CHC13|77615|TC|11/01/2013|12/31/9999|$1|314.92|0|0|||HYPERTHERMIA TREATMENT|| 58-1699775|1326041732|CHC13|77620||11/01/2013|12/31/9999|$821.05|0|0|||HYPERTHERMIA TREATMENT|| 58-1699775|1326041732|CHC13|77620|26|11/01/2013|12/31/9999|$120.97|0|0|||HYPERTHERMIA TREATMENT|| 58-1699775|1326041732|CHC13|77620|TC|11/01/2013|12/31/9999|$700.08|0|0|||HYPERTHERMIA TREATMENT|| 58-1699775|1326041732|CHC13|77750||11/01/2013|12/31/9999|$548.09|0|0|||INFUSE RADIOACTIVE MATERIALS|| 58-1699775|1326041732|CHC13|77750|26|11/01/2013|12/31/9999|$394.22|0|0|||INFUSE RADIOACTIVE MATERIALS|| 58-1699775|1326041732|CHC13|77750|TC|11/01/2013|12/31/9999|$153.87|0|0|||INFUSE RADIOACTIVE MATERIALS|| 58-1699775|1326041732|CHC13|77761||11/01/2013|12/31/9999|$568.15|0|0|||APPLY INTRCAV RADIAT SIMPLE|| 58-1699775|1326041732|CHC13|77761|26|11/01/2013|12/31/9999|$302.30|0|0|||APPLY INTRCAV RADIAT SIMPLE|| 58-1699775|1326041732|CHC13|77761|TC|11/01/2013|12/31/9999|$265.85|0|0|||APPLY INTRCAV RADIAT SIMPLE|| 58-1699775|1326041732|CHC13|77762||11/01/2013|12/31/9999|$760.84|0|0|||APPLY INTRCAV RADIAT INTERM|| 58-1699775|1326041732|CHC13|77762|26|11/01/2013|12/31/9999|$454.12|0|0|||APPLY INTRCAV RADIAT INTERM|| 58-1699775|1326041732|CHC13|77762|TC|11/01/2013|12/31/9999|$306.72|0|0|||APPLY INTRCAV RADIAT INTERM|| 58-1699775|1326041732|CHC13|77763||11/01/2013|12/31/9999|$1|080.32|0|0|||APPLY INTRCAV RADIAT COMPL|| 58-1699775|1326041732|CHC13|77763|26|11/01/2013|12/31/9999|$681.78|0|0|||APPLY INTRCAV RADIAT COMPL|| 58-1699775|1326041732|CHC13|77763|TC|11/01/2013|12/31/9999|$398.54|0|0|||APPLY INTRCAV RADIAT COMPL|| 58-1699775|1326041732|CHC13|77767||04/01/2016|12/31/9999|$343.54|0|0|0||HDR RDNCL SKN SURF BRACHYTX|| 58-1699775|1326041732|CHC13|77767|26|04/01/2016|12/31/9999|$88.07|0|0|0||HDR RDNCL SKN SURF BRACHYTX|| 58-1699775|1326041732|CHC13|77767|TC|04/01/2016|12/31/9999|$255.47|0|0|0||HDR RDNCL SKN SURF BRACHYTX|| 58-1699775|1326041732|CHC13|77768||04/01/2016|12/31/9999|$536.83|0|0|0||HDR RDNCL SKN SURF BRACHYTX|| 58-1699775|1326041732|CHC13|77768|26|04/01/2016|12/31/9999|$116.72|0|0|0||HDR RDNCL SKN SURF BRACHYTX|| 58-1699775|1326041732|CHC13|77768|TC|04/01/2016|12/31/9999|$420.12|0|0|0||HDR RDNCL SKN SURF BRACHYTX|| 58-1699775|1326041732|CHC13|77770||04/01/2016|12/31/9999|$492.85|0|0|0||HDR RDNCL NTRSTL/ICAV BRCHTX|| 58-1699775|1326041732|CHC13|77770|26|04/01/2016|12/31/9999|$163.02|0|0|0||HDR RDNCL NTRSTL/ICAV BRCHTX|| 58-1699775|1326041732|CHC13|77770|TC|04/01/2016|12/31/9999|$329.83|0|0|0||HDR RDNCL NTRSTL/ICAV BRCHTX|| 58-1699775|1326041732|CHC13|77771||04/01/2016|12/31/9999|$918.18|0|0|0||HDR RDNCL NTRSTL/ICAV BRCHTX|| 58-1699775|1326041732|CHC13|77771|26|04/01/2016|12/31/9999|$317.48|0|0|0||HDR RDNCL NTRSTL/ICAV BRCHTX|| 58-1699775|1326041732|CHC13|77771|TC|04/01/2016|12/31/9999|$600.70|0|0|0||HDR RDNCL NTRSTL/ICAV BRCHTX|| 58-1699775|1326041732|CHC13|77772||04/01/2016|12/31/9999|$1|400.45|0|0|0||HDR RDNCL NTRSTL/ICAV BRCHTX|| 58-1699775|1326041732|CHC13|77772|26|04/01/2016|12/31/9999|$450.80|0|0|0||HDR RDNCL NTRSTL/ICAV BRCHTX|| 58-1699775|1326041732|CHC13|77772|TC|04/01/2016|12/31/9999|$949.65|0|0|0||HDR RDNCL NTRSTL/ICAV BRCHTX|| 58-1699775|1326041732|CHC13|77778||11/01/2013|12/31/9999|$1|299.60|0|0|||APPLY INTERSTIT RADIAT COMPL|| 58-1699775|1326041732|CHC13|77778|26|11/01/2013|12/31/9999|$891.45|0|0|||APPLY INTERSTIT RADIAT COMPL|| 58-1699775|1326041732|CHC13|77778|TC|11/01/2013|12/31/9999|$408.14|0|0|||APPLY INTERSTIT RADIAT COMPL|| 58-1699775|1326041732|CHC13|77789||11/01/2013|12/31/9999|$172.05|0|0|||APPLY SURFACE RADIATION|| 58-1699775|1326041732|CHC13|77789|26|11/01/2013|12/31/9999|$89.83|0|0|||APPLY SURFACE RADIATION|| 58-1699775|1326041732|CHC13|77789|TC|11/01/2013|12/31/9999|$82.22|0|0|||APPLY SURFACE RADIATION|| 58-1699775|1326041732|CHC13|77790||11/01/2013|12/31/9999|$140.76|0|0|||RADIATION HANDLING|| 58-1699775|1326041732|CHC13|77790|26|11/01/2013|12/31/9999|$81.73|0|0|||RADIATION HANDLING|| 58-1699775|1326041732|CHC13|77790|TC|11/01/2013|12/31/9999|$59.02|0|0|||RADIATION HANDLING|| 58-1699775|1326041732|CHC13|77799||11/01/2013|12/31/9999|$0.00|0|0|||RADIUM/RADIOISOTOPE THERAPY|| 58-1699775|1326041732|CHC13|77799|26|11/01/2013|12/31/9999|$0.00|0|0|||RADIUM/RADIOISOTOPE THERAPY|| 58-1699775|1326041732|CHC13|77799|TC|11/01/2013|12/31/9999|$0.00|0|0|||RADIUM/RADIOISOTOPE THERAPY|| 58-1699775|1326041732|CHC13|78000|26|11/01/2013|12/31/9999|$14.72|0|0|||THYROID| SINGLE UPTAKE|| 58-1699775|1326041732|CHC13|78000|TC|11/01/2013|12/31/9999|$96.85|0|0|||THYROID| SINGLE UPTAKE|| 58-1699775|1326041732|CHC13|78001|26|11/01/2013|12/31/9999|$20.17|0|0|||THYROID| MULTIPLE UPTAKES|| 58-1699775|1326041732|CHC13|78001|TC|11/01/2013|12/31/9999|$122.10|0|0|||THYROID| MULTIPLE UPTAKES|| 58-1699775|1326041732|CHC13|78003|26|11/01/2013|12/31/9999|$25.61|0|0|||THYROID SUPPRESS/STIMUL|| 58-1699775|1326041732|CHC13|78003|TC|11/01/2013|12/31/9999|$99.88|0|0|||THYROID SUPPRESS/STIMUL|| 58-1699775|1326041732|CHC13|78006|26|11/01/2013|12/31/9999|$38.16|0|0|||THYROID IMAGING WITH UPTAKE|| 58-1699775|1326041732|CHC13|78006|TC|11/01/2013|12/31/9999|$329.89|0|0|||THYROID IMAGING WITH UPTAKE|| 58-1699775|1326041732|CHC13|78007|26|11/01/2013|12/31/9999|$38.72|0|0|||THYROID IMAGE| MULT UPTAKES|| 58-1699775|1326041732|CHC13|78007|TC|11/01/2013|12/31/9999|$311.23|0|0|||THYROID IMAGE| MULT UPTAKES|| 58-1699775|1326041732|CHC13|78010|26|11/01/2013|12/31/9999|$29.49|0|0|||THYROID IMAGING|| 58-1699775|1326041732|CHC13|78010|TC|11/01/2013|12/31/9999|$225.99|0|0|||THYROID IMAGING|| 58-1699775|1326041732|CHC13|78011|26|11/01/2013|12/31/9999|$35.41|0|0|||THYROID IMAGING WITH FLOW|| 58-1699775|1326041732|CHC13|78011|TC|11/01/2013|12/31/9999|$238.10|0|0|||THYROID IMAGING WITH FLOW|| 58-1699775|1326041732|CHC13|78012||06/01/2016|12/31/9999|$93.41|0|0|||THYROID UPTAKE MEASUREMENT|| 58-1699775|1326041732|CHC13|78012|26|06/01/2016|12/31/9999|$11.72|0|0|||THYROID UPTAKE MEASUREMENT|| 58-1699775|1326041732|CHC13|78012|TC|06/01/2016|12/31/9999|$81.68|0|0|||THYROID UPTAKE MEASUREMENT|| 58-1699775|1326041732|CHC13|78013||11/01/2013|12/31/9999|$313.22|0|0|||THYROID IMAGING W/BLOOD FLOW|| 58-1699775|1326041732|CHC13|78013|26|10/01/2016|09/30/2017|$29.83|0|0|||THYROID IMAGING W/BLOOD FLOW|| 58-1699775|1326041732|CHC13|78013|TC|10/01/2016|09/30/2017|$267.68|0|0|||THYROID IMAGING W/BLOOD FLOW|| 58-1699775|1326041732|CHC13|78014||11/01/2013|12/31/9999|$362.41|0|0|||THYROID IMAGING W/BLOOD FLOW|| 58-1699775|1326041732|CHC13|78014|26|11/01/2013|12/31/9999|$38.20|0|0|||THYROID IMAGING W/BLOOD FLOW|| 58-1699775|1326041732|CHC13|78014|TC|11/01/2013|12/31/9999|$324.19|0|0|||THYROID IMAGING W/BLOOD FLOW|| 58-1699775|1326041732|CHC13|78015||11/01/2013|12/31/9999|$332.28|0|0|||THYROID MET IMAGING|| 58-1699775|1326041732|CHC13|78015|26|11/01/2013|12/31/9999|$51.31|0|0|||THYROID MET IMAGING|| 58-1699775|1326041732|CHC13|78015|TC|11/01/2013|12/31/9999|$280.97|0|0|||THYROID MET IMAGING|| 58-1699775|1326041732|CHC13|78016||11/01/2013|12/31/9999|$454.16|0|0|||THYROID MET IMAGING/STUDIES|| 58-1699775|1326041732|CHC13|78016|26|11/01/2013|12/31/9999|$57.70|0|0|||THYROID MET IMAGING/STUDIES|| 58-1699775|1326041732|CHC13|78016|TC|11/01/2013|12/31/9999|$396.46|0|0|||THYROID MET IMAGING/STUDIES|| 58-1699775|1326041732|CHC13|78018||11/01/2013|12/31/9999|$483.66|0|0|||THYROID MET IMAGING| BODY|| 58-1699775|1326041732|CHC13|78018|26|11/01/2013|12/31/9999|$65.01|0|0|||THYROID MET IMAGING| BODY|| 58-1699775|1326041732|CHC13|78018|TC|11/01/2013|12/31/9999|$418.65|0|0|||THYROID MET IMAGING| BODY|| 58-1699775|1326041732|CHC13|78020||11/01/2013|12/31/9999|$129.59|0|0|||THYROID MET UPTAKE|| 58-1699775|1326041732|CHC13|78020|26|11/01/2013|12/31/9999|$44.84|0|0|||THYROID MET UPTAKE|| 58-1699775|1326041732|CHC13|78020|TC|11/01/2013|12/31/9999|$84.75|0|0|||THYROID MET UPTAKE|| 58-1699775|1326041732|CHC13|78070||11/01/2013|12/31/9999|$243.87|0|0|||PARATHYROID NUCLEAR IMAGING|| 58-1699775|1326041732|CHC13|78070|26|11/01/2013|12/31/9999|$62.76|0|0|||PARATHYROID NUCLEAR IMAGING|| 58-1699775|1326041732|CHC13|78070|TC|11/01/2013|12/31/9999|$181.11|0|0|||PARATHYROID NUCLEAR IMAGING|| 58-1699775|1326041732|CHC13|78071||11/01/2013|12/31/9999|$678.63|0|0|||PARATHYRD PLANAR W/WO SUBTRJ|| 58-1699775|1326041732|CHC13|78071|26|11/01/2013|12/31/9999|$125.19|0|0|||PARATHYRD PLANAR W/WO SUBTRJ|| 58-1699775|1326041732|CHC13|78072|26|11/01/2013|12/31/9999|$125.19|0|0|||PARATHYRD PLANAR W/SPECT&CT|| 58-1699775|1326041732|CHC13|78075||11/01/2013|12/31/9999|$646.90|0|0|||ADRENAL NUCLEAR IMAGING|| 58-1699775|1326041732|CHC13|78075|26|11/01/2013|12/31/9999|$55.75|0|0|||ADRENAL NUCLEAR IMAGING|| 58-1699775|1326041732|CHC13|78075|TC|11/01/2013|12/31/9999|$591.15|0|0|||ADRENAL NUCLEAR IMAGING|| 58-1699775|1326041732|CHC13|78099||11/01/2013|12/31/9999|$0.00|0|0|||ENDOCRINE NUCLEAR PROCEDURE|| 58-1699775|1326041732|CHC13|78099|26|11/01/2013|12/31/9999|$0.00|0|0|||ENDOCRINE NUCLEAR PROCEDURE|| 58-1699775|1326041732|CHC13|78099|TC|11/01/2013|12/31/9999|$0.00|0|0|||ENDOCRINE NUCLEAR PROCEDURE|| 58-1699775|1326041732|CHC13|78102||11/01/2013|12/31/9999|$256.43|0|0|||BONE MARROW IMAGING| LTD|| 58-1699775|1326041732|CHC13|78102|26|11/01/2013|12/31/9999|$42.04|0|0|||BONE MARROW IMAGING| LTD|| 58-1699775|1326041732|CHC13|78102|TC|11/01/2013|12/31/9999|$214.39|0|0|||BONE MARROW IMAGING| LTD|| 58-1699775|1326041732|CHC13|78103||11/01/2013|12/31/9999|$338.28|0|0|||BONE MARROW IMAGING| MULT|| 58-1699775|1326041732|CHC13|78103|26|11/01/2013|12/31/9999|$56.81|0|0|||BONE MARROW IMAGING| MULT|| 58-1699775|1326041732|CHC13|78103|TC|11/01/2013|12/31/9999|$281.47|0|0|||BONE MARROW IMAGING| MULT|| 58-1699775|1326041732|CHC13|78104||11/01/2013|12/31/9999|$378.41|0|0|||BONE MARROW IMAGING| BODY|| 58-1699775|1326041732|CHC13|78104|26|11/01/2013|12/31/9999|$61.14|0|0|||BONE MARROW IMAGING| BODY|| 58-1699775|1326041732|CHC13|78104|TC|11/01/2013|12/31/9999|$317.28|0|0|||BONE MARROW IMAGING| BODY|| 58-1699775|1326041732|CHC13|78110||11/01/2013|12/31/9999|$128.75|0|0|||PLASMA VOLUME| SINGLE|| 58-1699775|1326041732|CHC13|78110|26|11/01/2013|12/31/9999|$14.72|0|0|||PLASMA VOLUME| SINGLE|| 58-1699775|1326041732|CHC13|78110|TC|11/01/2013|12/31/9999|$114.03|0|0|||PLASMA VOLUME| SINGLE|| 58-1699775|1326041732|CHC13|78111||11/01/2013|12/31/9999|$126.40|0|0|||PLASMA VOLUME| MULTIPLE|| 58-1699775|1326041732|CHC13|78111|26|11/01/2013|12/31/9999|$15.90|0|0|||PLASMA VOLUME| MULTIPLE|| 58-1699775|1326041732|CHC13|78111|TC|11/01/2013|12/31/9999|$110.50|0|0|||PLASMA VOLUME| MULTIPLE|| 58-1699775|1326041732|CHC13|78120||11/01/2013|12/31/9999|$133.52|0|0|||RED CELL MASS| SINGLE|| 58-1699775|1326041732|CHC13|78120|26|11/01/2013|12/31/9999|$17.98|0|0|||RED CELL MASS| SINGLE|| 58-1699775|1326041732|CHC13|78120|TC|11/01/2013|12/31/9999|$115.54|0|0|||RED CELL MASS| SINGLE|| 58-1699775|1326041732|CHC13|78121||11/01/2013|12/31/9999|$149.17|0|0|||RED CELL MASS| MULTIPLE|| 58-1699775|1326041732|CHC13|78121|26|11/01/2013|12/31/9999|$24.55|0|0|||RED CELL MASS| MULTIPLE|| 58-1699775|1326041732|CHC13|78121|TC|11/01/2013|12/31/9999|$124.62|0|0|||RED CELL MASS| MULTIPLE|| 58-1699775|1326041732|CHC13|78122||11/01/2013|12/31/9999|$156.47|0|0|||BLOOD VOLUME|| 58-1699775|1326041732|CHC13|78122|26|11/01/2013|12/31/9999|$33.36|0|0|||BLOOD VOLUME|| 58-1699775|1326041732|CHC13|78122|TC|11/01/2013|12/31/9999|$123.11|0|0|||BLOOD VOLUME|| 58-1699775|1326041732|CHC13|78130||11/01/2013|12/31/9999|$237.14|0|0|||RED CELL SURVIVAL STUDY|| 58-1699775|1326041732|CHC13|78130|26|11/01/2013|12/31/9999|$48.45|0|0|||RED CELL SURVIVAL STUDY|| 58-1699775|1326041732|CHC13|78130|TC|11/01/2013|12/31/9999|$188.69|0|0|||RED CELL SURVIVAL STUDY|| 58-1699775|1326041732|CHC13|78135||11/01/2013|12/31/9999|$546.45|0|0|||RED CELL SURVIVAL KINETICS|| 58-1699775|1326041732|CHC13|78135|26|11/01/2013|12/31/9999|$50.64|0|0|||RED CELL SURVIVAL KINETICS|| 58-1699775|1326041732|CHC13|78135|TC|11/01/2013|12/31/9999|$495.81|0|0|||RED CELL SURVIVAL KINETICS|| 58-1699775|1326041732|CHC13|78140||11/01/2013|12/31/9999|$206.86|0|0|||RED CELL SEQUESTRATION|| 58-1699775|1326041732|CHC13|78140|26|11/01/2013|12/31/9999|$47.94|0|0|||RED CELL SEQUESTRATION|| 58-1699775|1326041732|CHC13|78140|TC|11/01/2013|12/31/9999|$158.92|0|0|||RED CELL SEQUESTRATION|| 58-1699775|1326041732|CHC13|78185||11/01/2013|12/31/9999|$316.06|0|0|||SPLEEN IMAGING|| 58-1699775|1326041732|CHC13|78185|26|11/01/2013|12/31/9999|$30.55|0|0|||SPLEEN IMAGING|| 58-1699775|1326041732|CHC13|78185|TC|11/01/2013|12/31/9999|$285.50|0|0|||SPLEEN IMAGING|| 58-1699775|1326041732|CHC13|78190||11/01/2013|12/31/9999|$624.17|0|0|||PLATELET SURVIVAL| KINETICS|| 58-1699775|1326041732|CHC13|78190|26|11/01/2013|12/31/9999|$86.00|0|0|||PLATELET SURVIVAL| KINETICS|| 58-1699775|1326041732|CHC13|78190|TC|11/01/2013|12/31/9999|$538.18|0|0|||PLATELET SURVIVAL| KINETICS|| 58-1699775|1326041732|CHC13|78191||11/01/2013|12/31/9999|$253.28|0|0|||PLATELET SURVIVAL|| 58-1699775|1326041732|CHC13|78191|26|11/01/2013|12/31/9999|$47.94|0|0|||PLATELET SURVIVAL|| 58-1699775|1326041732|CHC13|78191|TC|11/01/2013|12/31/9999|$205.33|0|0|||PLATELET SURVIVAL|| 58-1699775|1326041732|CHC13|78195||11/01/2013|12/31/9999|$546.68|0|0|||LYMPH SYSTEM IMAGING|| 58-1699775|1326041732|CHC13|78195|26|11/01/2013|12/31/9999|$92.73|0|0|||LYMPH SYSTEM IMAGING|| 58-1699775|1326041732|CHC13|78195|TC|11/01/2013|12/31/9999|$453.95|0|0|||LYMPH SYSTEM IMAGING|| 58-1699775|1326041732|CHC13|78199||11/01/2013|12/31/9999|$0.00|0|0|||BLOOD/LYMPH NUCLEAR EXAM|| 58-1699775|1326041732|CHC13|78199|26|11/01/2013|12/31/9999|$0.00|0|0|||BLOOD/LYMPH NUCLEAR EXAM|| 58-1699775|1326041732|CHC13|78199|TC|11/01/2013|12/31/9999|$0.00|0|0|||BLOOD/LYMPH NUCLEAR EXAM|| 58-1699775|1326041732|CHC13|78201||11/01/2013|12/31/9999|$282.04|0|0|||LIVER IMAGING|| 58-1699775|1326041732|CHC13|78201|26|11/01/2013|12/31/9999|$33.86|0|0|||LIVER IMAGING|| 58-1699775|1326041732|CHC13|78201|TC|11/01/2013|12/31/9999|$248.18|0|0|||LIVER IMAGING|| 58-1699775|1326041732|CHC13|78202||11/01/2013|12/31/9999|$313.66|0|0|||LIVER IMAGING WITH FLOW|| 58-1699775|1326041732|CHC13|78202|26|11/01/2013|12/31/9999|$37.23|0|0|||LIVER IMAGING WITH FLOW|| 58-1699775|1326041732|CHC13|78202|TC|11/01/2013|12/31/9999|$276.43|0|0|||LIVER IMAGING WITH FLOW|| 58-1699775|1326041732|CHC13|78205||11/01/2013|12/31/9999|$336.04|0|0|||LIVER IMAGING (3D)|| 58-1699775|1326041732|CHC13|78205|26|11/01/2013|12/31/9999|$54.06|0|0|||LIVER IMAGING (3D)|| 58-1699775|1326041732|CHC13|78205|TC|11/01/2013|12/31/9999|$281.97|0|0|||LIVER IMAGING (3D)|| 58-1699775|1326041732|CHC13|78206||11/01/2013|12/31/9999|$529.12|0|0|||LIVER IMAGE (3D) WITH FLOW|| 58-1699775|1326041732|CHC13|78206|26|11/01/2013|12/31/9999|$73.15|0|0|||LIVER IMAGE (3D) WITH FLOW|| 58-1699775|1326041732|CHC13|78206|TC|11/01/2013|12/31/9999|$455.97|0|0|||LIVER IMAGE (3D) WITH FLOW|| 58-1699775|1326041732|CHC13|78215||11/01/2013|12/31/9999|$295.42|0|0|||LIVER AND SPLEEN IMAGING|| 58-1699775|1326041732|CHC13|78215|26|11/01/2013|12/31/9999|$38.16|0|0|||LIVER AND SPLEEN IMAGING|| 58-1699775|1326041732|CHC13|78215|TC|11/01/2013|12/31/9999|$257.26|0|0|||LIVER AND SPLEEN IMAGING|| 58-1699775|1326041732|CHC13|78216||11/01/2013|12/31/9999|$191.48|0|0|||LIVER & SPLEEN IMAGE/FLOW|| 58-1699775|1326041732|CHC13|78216|26|11/01/2013|12/31/9999|$43.16|0|0|||LIVER & SPLEEN IMAGE/FLOW|| 58-1699775|1326041732|CHC13|78216|TC|11/01/2013|12/31/9999|$148.33|0|0|||LIVER & SPLEEN IMAGE/FLOW|| 58-1699775|1326041732|CHC13|78226||11/01/2013|12/31/9999|$491.04|0|0|||HEPATOBILIARY SYSTEM IMAGING|| 58-1699775|1326041732|CHC13|78226|26|11/01/2013|12/31/9999|$56.25|0|0|||HEPATOBILIARY SYSTEM IMAGING|| 58-1699775|1326041732|CHC13|78226|TC|11/01/2013|12/31/9999|$434.79|0|0|||HEPATOBILIARY SYSTEM IMAGING|| 58-1699775|1326041732|CHC13|78227||11/01/2013|12/31/9999|$671.52|0|0|||HEPATOBIL SYST IMAGE W/DRUG|| 58-1699775|1326041732|CHC13|78227|26|11/01/2013|12/31/9999|$67.76|0|0|||HEPATOBIL SYST IMAGE W/DRUG|| 58-1699775|1326041732|CHC13|78227|TC|11/01/2013|12/31/9999|$603.76|0|0|||HEPATOBIL SYST IMAGE W/DRUG|| 58-1699775|1326041732|CHC13|78230||11/01/2013|12/31/9999|$259.39|0|0|||SALIVARY GLAND IMAGING|| 58-1699775|1326041732|CHC13|78230|26|11/01/2013|12/31/9999|$35.41|0|0|||SALIVARY GLAND IMAGING|| 58-1699775|1326041732|CHC13|78230|TC|11/01/2013|12/31/9999|$223.98|0|0|||SALIVARY GLAND IMAGING|| 58-1699775|1326041732|CHC13|78231||11/01/2013|12/31/9999|$192.68|0|0|||SERIAL SALIVARY IMAGING|| 58-1699775|1326041732|CHC13|78231|26|11/01/2013|12/31/9999|$39.81|0|0|||SERIAL SALIVARY IMAGING|| 58-1699775|1326041732|CHC13|78231|TC|11/01/2013|12/31/9999|$152.86|0|0|||SERIAL SALIVARY IMAGING|| 58-1699775|1326041732|CHC13|78232||11/01/2013|12/31/9999|$162.67|0|0|||SALIVARY GLAND FUNCTION EXAM|| 58-1699775|1326041732|CHC13|78232|26|11/01/2013|12/31/9999|$33.51|0|0|||SALIVARY GLAND FUNCTION EXAM|| 58-1699775|1326041732|CHC13|78232|TC|11/01/2013|12/31/9999|$129.16|0|0|||SALIVARY GLAND FUNCTION EXAM|| 58-1699775|1326041732|CHC13|78258||11/01/2013|12/31/9999|$354.85|0|0|||ESOPHAGEAL MOTILITY STUDY|| 58-1699775|1326041732|CHC13|78258|26|11/01/2013|12/31/9999|$57.24|0|0|||ESOPHAGEAL MOTILITY STUDY|| 58-1699775|1326041732|CHC13|78258|TC|11/01/2013|12/31/9999|$297.61|0|0|||ESOPHAGEAL MOTILITY STUDY|| 58-1699775|1326041732|CHC13|78261||11/01/2013|12/31/9999|$384.84|0|0|||GASTRIC MUCOSA IMAGING|| 58-1699775|1326041732|CHC13|78261|26|11/01/2013|12/31/9999|$53.95|0|0|||GASTRIC MUCOSA IMAGING|| 58-1699775|1326041732|CHC13|78261|TC|11/01/2013|12/31/9999|$330.89|0|0|||GASTRIC MUCOSA IMAGING|| 58-1699775|1326041732|CHC13|78262||11/01/2013|12/31/9999|$381.71|0|0|||GASTROESOPHAGEAL REFLUX EXAM|| 58-1699775|1326041732|CHC13|78262|26|11/01/2013|12/31/9999|$51.32|0|0|||GASTROESOPHAGEAL REFLUX EXAM|| 58-1699775|1326041732|CHC13|78262|TC|11/01/2013|12/31/9999|$330.39|0|0|||GASTROESOPHAGEAL REFLUX EXAM|| 58-1699775|1326041732|CHC13|78264||11/01/2013|12/31/9999|$441.96|0|0|||GASTRIC EMPTYING STUDY|| 58-1699775|1326041732|CHC13|78264|26|11/01/2013|12/31/9999|$61.64|0|0|||GASTRIC EMPTYING STUDY|| 58-1699775|1326041732|CHC13|78264|TC|11/01/2013|12/31/9999|$380.32|0|0|||GASTRIC EMPTYING STUDY|| 58-1699775|1326041732|CHC13|78265||04/01/2016|12/31/9999|$570.97|0|0|0||GASTRIC EMPTYING IMAG STUDY|| 58-1699775|1326041732|CHC13|78265|26|04/01/2016|12/31/9999|$78.62|0|0|0||GASTRIC EMPTYING IMAG STUDY|| 58-1699775|1326041732|CHC13|78265|TC|04/01/2016|12/31/9999|$492.34|0|0|0||GASTRIC EMPTYING IMAG STUDY|| 58-1699775|1326041732|CHC13|78266||04/01/2016|12/31/9999|$739.40|0|0|0||GASTRIC EMPTYING IMAG STUDY|| 58-1699775|1326041732|CHC13|78266|26|04/01/2016|12/31/9999|$87.19|0|0|0||GASTRIC EMPTYING IMAG STUDY|| 58-1699775|1326041732|CHC13|78266|TC|04/01/2016|12/31/9999|$652.21|0|0|0||GASTRIC EMPTYING IMAG STUDY|| 58-1699775|1326041732|CHC13|78267||11/01/2013|12/31/9999|$18.38|0|0|||BREATH TST ATTAIN/ANAL C-14|| 58-1699775|1326041732|CHC13|78267|TC|11/01/2013|12/31/9999|$16.14|0|0|||BREATH TST ATTAIN/ANAL C-14|| 58-1699775|1326041732|CHC13|78268||11/01/2013|12/31/9999|$31.60|0|0|||BREATH TEST ANALYSIS| C-14|| 58-1699775|1326041732|CHC13|78270||11/01/2013|12/31/9999|$125.25|0|0|||VIT B-12 ABSORPTION EXAM|| 58-1699775|1326041732|CHC13|78270|26|11/01/2013|12/31/9999|$15.79|0|0|||VIT B-12 ABSORPTION EXAM|| 58-1699775|1326041732|CHC13|78270|TC|11/01/2013|12/31/9999|$109.46|0|0|||VIT B-12 ABSORPTION EXAM|| 58-1699775|1326041732|CHC13|78271||11/01/2013|12/31/9999|$134.32|0|0|||VIT B-12 ABSRP EXAM| INT FAC|| 58-1699775|1326041732|CHC13|78271|26|11/01/2013|12/31/9999|$15.79|0|0|||VIT B-12 ABSRP EXAM| INT FAC|| 58-1699775|1326041732|CHC13|78271|TC|11/01/2013|12/31/9999|$118.54|0|0|||VIT B-12 ABSRP EXAM| INT FAC|| 58-1699775|1326041732|CHC13|78272||11/01/2013|12/31/9999|$136.78|0|0|||VIT B-12 ABSORP| COMBINED|| 58-1699775|1326041732|CHC13|78272|26|11/01/2013|12/31/9999|$20.73|0|0|||VIT B-12 ABSORP| COMBINED|| 58-1699775|1326041732|CHC13|78272|TC|11/01/2013|12/31/9999|$116.05|0|0|||VIT B-12 ABSORP| COMBINED|| 58-1699775|1326041732|CHC13|78278||11/01/2013|12/31/9999|$532.84|0|0|||ACUTE GI BLOOD LOSS IMAGING|| 58-1699775|1326041732|CHC13|78278|26|11/01/2013|12/31/9999|$76.36|0|0|||ACUTE GI BLOOD LOSS IMAGING|| 58-1699775|1326041732|CHC13|78278|TC|11/01/2013|12/31/9999|$456.47|0|0|||ACUTE GI BLOOD LOSS IMAGING|| 58-1699775|1326041732|CHC13|78282||11/01/2013|12/31/9999|$113.27|0|0|||GI PROTEIN LOSS EXAM|| 58-1699775|1326041732|CHC13|78282|26|11/01/2013|12/31/9999|$29.97|0|0|||GI PROTEIN LOSS EXAM|| 58-1699775|1326041732|CHC13|78282|TC|11/01/2013|12/31/9999|$83.31|0|0|||GI PROTEIN LOSS EXAM|| 58-1699775|1326041732|CHC13|78290||11/01/2013|12/31/9999|$503.31|0|0|||MECKEL'S DIVERT EXAM|| 58-1699775|1326041732|CHC13|78290|26|11/01/2013|12/31/9999|$52.88|0|0|||MECKEL'S DIVERT EXAM|| 58-1699775|1326041732|CHC13|78290|TC|11/01/2013|12/31/9999|$450.42|0|0|||MECKEL'S DIVERT EXAM|| 58-1699775|1326041732|CHC13|78291||11/01/2013|12/31/9999|$388.97|0|0|||LEVEEN/SHUNT PATENCY EXAM|| 58-1699775|1326041732|CHC13|78291|26|11/01/2013|12/31/9999|$67.66|0|0|||LEVEEN/SHUNT PATENCY EXAM|| 58-1699775|1326041732|CHC13|78291|TC|11/01/2013|12/31/9999|$321.31|0|0|||LEVEEN/SHUNT PATENCY EXAM|| 58-1699775|1326041732|CHC13|78299||11/01/2013|12/31/9999|$0.00|0|0|||GI NUCLEAR PROCEDURE|| 58-1699775|1326041732|CHC13|78299|26|11/01/2013|12/31/9999|$0.00|0|0|||GI NUCLEAR PROCEDURE|| 58-1699775|1326041732|CHC13|78299|TC|11/01/2013|12/31/9999|$0.00|0|0|||GI NUCLEAR PROCEDURE|| 58-1699775|1326041732|CHC13|78300||11/01/2013|12/31/9999|$272.46|0|0|||BONE IMAGING| LIMITED AREA|| 58-1699775|1326041732|CHC13|78300|26|11/01/2013|12/31/9999|$47.98|0|0|||BONE IMAGING| LIMITED AREA|| 58-1699775|1326041732|CHC13|78300|TC|11/01/2013|12/31/9999|$224.48|0|0|||BONE IMAGING| LIMITED AREA|| 58-1699775|1326041732|CHC13|78305||11/01/2013|12/31/9999|$359.42|0|0|||BONE IMAGING| MULTIPLE AREAS|| 58-1699775|1326041732|CHC13|78305|26|11/01/2013|12/31/9999|$63.83|0|0|||BONE IMAGING| MULTIPLE AREAS|| 58-1699775|1326041732|CHC13|78305|TC|11/01/2013|12/31/9999|$295.59|0|0|||BONE IMAGING| MULTIPLE AREAS|| 58-1699775|1326041732|CHC13|78306||11/01/2013|12/31/9999|$386.83|0|0|||BONE IMAGING| WHOLE BODY|| 58-1699775|1326041732|CHC13|78306|26|11/01/2013|12/31/9999|$66.02|0|0|||BONE IMAGING| WHOLE BODY|| 58-1699775|1326041732|CHC13|78306|TC|11/01/2013|12/31/9999|$320.81|0|0|||BONE IMAGING| WHOLE BODY|| 58-1699775|1326041732|CHC13|78315||11/01/2013|12/31/9999|$532.50|0|0|||BONE IMAGING| 3 PHASE|| 58-1699775|1326041732|CHC13|78315|26|11/01/2013|12/31/9999|$78.55|0|0|||BONE IMAGING| 3 PHASE|| 58-1699775|1326041732|CHC13|78315|TC|11/01/2013|12/31/9999|$453.95|0|0|||BONE IMAGING| 3 PHASE|| 58-1699775|1326041732|CHC13|78320||11/01/2013|12/31/9999|$361.14|0|0|||BONE IMAGING (3D)|| 58-1699775|1326041732|CHC13|78320|26|11/01/2013|12/31/9999|$79.17|0|0|||BONE IMAGING (3D)|| 58-1699775|1326041732|CHC13|78320|TC|11/01/2013|12/31/9999|$281.97|0|0|||BONE IMAGING (3D)|| 58-1699775|1326041732|CHC13|78350||11/01/2013|12/31/9999|$50.72|0|0|||BONE MINERAL| SINGLE PHOTON|| 58-1699775|1326041732|CHC13|78350|26|11/01/2013|12/31/9999|$17.42|0|0|||BONE MINERAL| SINGLE PHOTON|| 58-1699775|1326041732|CHC13|78350|TC|11/01/2013|12/31/9999|$33.30|0|0|||BONE MINERAL| SINGLE PHOTON|| 58-1699775|1326041732|CHC13|78351||11/01/2013|12/31/9999|$23.93|0|0|||BONE MINERAL| DUAL PHOTON|| 58-1699775|1326041732|CHC13|78399||11/01/2013|12/31/9999|$0.00|0|0|||MUSCULOSKELETAL NUCLEAR EXAM|| 58-1699775|1326041732|CHC13|78399|26|11/01/2013|12/31/9999|$0.00|0|0|||MUSCULOSKELETAL NUCLEAR EXAM|| 58-1699775|1326041732|CHC13|78399|TC|11/01/2013|12/31/9999|$0.00|0|0|||MUSCULOSKELETAL NUCLEAR EXAM|| 58-1699775|1326041732|CHC13|78414||11/01/2013|12/31/9999|$113.67|0|0|||NON-IMAGING HEART FUNCTION|| 58-1699775|1326041732|CHC13|78414|26|11/01/2013|12/31/9999|$36.42|0|0|||NON-IMAGING HEART FUNCTION|| 58-1699775|1326041732|CHC13|78414|TC|11/01/2013|12/31/9999|$77.76|0|0|||NON-IMAGING HEART FUNCTION|| 58-1699775|1326041732|CHC13|78428||11/01/2013|12/31/9999|$289.52|0|0|||CARDIAC SHUNT IMAGING|| 58-1699775|1326041732|CHC13|78428|26|11/01/2013|12/31/9999|$60.50|0|0|||CARDIAC SHUNT IMAGING|| 58-1699775|1326041732|CHC13|78428|TC|11/01/2013|12/31/9999|$229.02|0|0|||CARDIAC SHUNT IMAGING|| 58-1699775|1326041732|CHC13|78445||11/01/2013|12/31/9999|$264.62|0|0|||VASCULAR FLOW IMAGING|| 58-1699775|1326041732|CHC13|78445|26|11/01/2013|12/31/9999|$36.11|0|0|||VASCULAR FLOW IMAGING|| 58-1699775|1326041732|CHC13|78445|TC|11/01/2013|12/31/9999|$228.51|0|0|||VASCULAR FLOW IMAGING|| 58-1699775|1326041732|CHC13|78451||11/01/2013|12/31/9999|$542.64|0|0|||HT MUSCLE IMAGE SPECT| SING|| 58-1699775|1326041732|CHC13|78451|26|11/01/2013|12/31/9999|$104.82|0|0|||HT MUSCLE IMAGE SPECT| SING|| 58-1699775|1326041732|CHC13|78451|TC|11/01/2013|12/31/9999|$437.81|0|0|||HT MUSCLE IMAGE SPECT| SING|| 58-1699775|1326041732|CHC13|78452||11/01/2013|12/31/9999|$755.34|0|0|||HT MUSCLE IMAGE SPECT| MULT|| 58-1699775|1326041732|CHC13|78452|26|11/01/2013|12/31/9999|$122.84|0|0|||HT MUSCLE IMAGE SPECT| MULT|| 58-1699775|1326041732|CHC13|78452|TC|11/01/2013|12/31/9999|$632.50|0|0|||HT MUSCLE IMAGE SPECT| MULT|| 58-1699775|1326041732|CHC13|78453||11/01/2013|12/31/9999|$466.83|0|0|||HT MUSCLE IMAGE|PLANAR|SING|| 58-1699775|1326041732|CHC13|78453|26|11/01/2013|12/31/9999|$75.92|0|0|||HT MUSCLE IMAGE|PLANAR|SING|| 58-1699775|1326041732|CHC13|78453|TC|11/01/2013|12/31/9999|$390.91|0|0|||HT MUSCLE IMAGE|PLANAR|SING|| 58-1699775|1326041732|CHC13|78454||11/01/2013|12/31/9999|$666.49|0|0|||HT MUSC IMAGE| PLANAR| MULT|| 58-1699775|1326041732|CHC13|78454|26|11/01/2013|12/31/9999|$101.06|0|0|||HT MUSC IMAGE| PLANAR| MULT|| 58-1699775|1326041732|CHC13|78454|TC|11/01/2013|12/31/9999|$565.43|0|0|||HT MUSC IMAGE| PLANAR| MULT|| 58-1699775|1326041732|CHC13|78456||11/01/2013|12/31/9999|$577.24|0|0|||ACUTE VENOUS THROMBUS IMAGE|| 58-1699775|1326041732|CHC13|78456|26|11/01/2013|12/31/9999|$79.41|0|0|||ACUTE VENOUS THROMBUS IMAGE|| 58-1699775|1326041732|CHC13|78456|TC|11/01/2013|12/31/9999|$497.83|0|0|||ACUTE VENOUS THROMBUS IMAGE|| 58-1699775|1326041732|CHC13|78457||11/01/2013|12/31/9999|$310.66|0|0|||VENOUS THROMBOSIS IMAGING|| 58-1699775|1326041732|CHC13|78457|26|11/01/2013|12/31/9999|$59.45|0|0|||VENOUS THROMBOSIS IMAGING|| 58-1699775|1326041732|CHC13|78457|TC|11/01/2013|12/31/9999|$251.21|0|0|||VENOUS THROMBOSIS IMAGING|| 58-1699775|1326041732|CHC13|78458||11/01/2013|12/31/9999|$291.25|0|0|||VEN THROMBOSIS IMAGES| BILAT|| 58-1699775|1326041732|CHC13|78458|26|11/01/2013|12/31/9999|$66.26|0|0|||VEN THROMBOSIS IMAGES| BILAT|| 58-1699775|1326041732|CHC13|78458|TC|11/01/2013|12/31/9999|$224.98|0|0|||VEN THROMBOSIS IMAGES| BILAT|| 58-1699775|1326041732|CHC13|78459||11/01/2013|12/31/9999|$620.60|0|0|||HEART MUSCLE IMAGING (PET)|| 58-1699775|1326041732|CHC13|78459|26|11/01/2013|12/31/9999|$116.18|0|0|||HEART MUSCLE IMAGING (PET)|| 58-1699775|1326041732|CHC13|78459|TC|11/01/2013|12/31/9999|$507.99|0|0|||HEART MUSCLE IMAGING (PET)|| 58-1699775|1326041732|CHC13|78466||11/01/2013|12/31/9999|$269.33|0|0|||HEART INFARCT IMAGE|| 58-1699775|1326041732|CHC13|78466|26|11/01/2013|12/31/9999|$53.93|0|0|||HEART INFARCT IMAGE|| 58-1699775|1326041732|CHC13|78466|TC|11/01/2013|12/31/9999|$215.40|0|0|||HEART INFARCT IMAGE|| 58-1699775|1326041732|CHC13|78468||11/01/2013|12/31/9999|$326.45|0|0|||HEART INFARCT IMAGE (EF)|| 58-1699775|1326041732|CHC13|78468|26|11/01/2013|12/31/9999|$63.14|0|0|||HEART INFARCT IMAGE (EF)|| 58-1699775|1326041732|CHC13|78468|TC|11/01/2013|12/31/9999|$263.31|0|0|||HEART INFARCT IMAGE (EF)|| 58-1699775|1326041732|CHC13|78469||11/01/2013|12/31/9999|$370.51|0|0|||HEART INFARCT IMAGE (3D)|| 58-1699775|1326041732|CHC13|78469|26|11/01/2013|12/31/9999|$71.89|0|0|||HEART INFARCT IMAGE (3D)|| 58-1699775|1326041732|CHC13|78469|TC|11/01/2013|12/31/9999|$298.62|0|0|||HEART INFARCT IMAGE (3D)|| 58-1699775|1326041732|CHC13|78472||11/01/2013|12/31/9999|$373.39|0|0|||GATED HEART| PLANAR| SINGLE|| 58-1699775|1326041732|CHC13|78472|26|11/01/2013|12/31/9999|$76.29|0|0|||GATED HEART| PLANAR| SINGLE|| 58-1699775|1326041732|CHC13|78472|TC|11/01/2013|12/31/9999|$297.10|0|0|||GATED HEART| PLANAR| SINGLE|| 58-1699775|1326041732|CHC13|78473||11/01/2013|12/31/9999|$483.14|0|0|||GATED HEART| MULTIPLE|| 58-1699775|1326041732|CHC13|78473|26|11/01/2013|12/31/9999|$114.92|0|0|||GATED HEART| MULTIPLE|| 58-1699775|1326041732|CHC13|78473|TC|11/01/2013|12/31/9999|$368.22|0|0|||GATED HEART| MULTIPLE|| 58-1699775|1326041732|CHC13|78481||11/01/2013|12/31/9999|$305.26|0|0|||HEART FIRST PASS| SINGLE|| 58-1699775|1326041732|CHC13|78481|26|11/01/2013|12/31/9999|$77.28|0|0|||HEART FIRST PASS| SINGLE|| 58-1699775|1326041732|CHC13|78481|TC|11/01/2013|12/31/9999|$227.98|0|0|||HEART FIRST PASS| SINGLE|| 58-1699775|1326041732|CHC13|78483||11/01/2013|12/31/9999|$416.56|0|0|||HEART FIRST PASS| MULTIPLE|| 58-1699775|1326041732|CHC13|78483|26|11/01/2013|12/31/9999|$115.93|0|0|||HEART FIRST PASS| MULTIPLE|| 58-1699775|1326041732|CHC13|78483|TC|11/01/2013|12/31/9999|$300.63|0|0|||HEART FIRST PASS| MULTIPLE|| 58-1699775|1326041732|CHC13|78491||11/01/2013|12/31/9999|$671.60|0|0|||HEART IMAGE (PET)| SINGLE|| 58-1699775|1326041732|CHC13|78491|26|11/01/2013|12/31/9999|$117.70|0|0|||HEART IMAGE (PET)| SINGLE|| 58-1699775|1326041732|CHC13|78491|TC|11/01/2013|12/31/9999|$556.97|0|0|||HEART IMAGE (PET)| SINGLE|| 58-1699775|1326041732|CHC13|78492||11/01/2013|12/31/9999|$834.80|0|0|||HEART IMAGE (PET)| MULTIPLE|| 58-1699775|1326041732|CHC13|78492|26|11/01/2013|12/31/9999|$148.60|0|0|||HEART IMAGE (PET)| MULTIPLE|| 58-1699775|1326041732|CHC13|78492|TC|11/01/2013|12/31/9999|$692.31|0|0|||HEART IMAGE (PET)| MULTIPLE|| 58-1699775|1326041732|CHC13|78494||11/01/2013|12/31/9999|$379.13|0|0|||HEART IMAGE| SPECT|| 58-1699775|1326041732|CHC13|78494|26|11/01/2013|12/31/9999|$92.62|0|0|||HEART IMAGE| SPECT|| 58-1699775|1326041732|CHC13|78494|TC|11/01/2013|12/31/9999|$286.51|0|0|||HEART IMAGE| SPECT|| 58-1699775|1326041732|CHC13|78496||11/01/2013|12/31/9999|$97.21|0|0|||HEART FIRST PASS ADD-ON|| 58-1699775|1326041732|CHC13|78496|26|11/01/2013|12/31/9999|$39.19|0|0|||HEART FIRST PASS ADD-ON|| 58-1699775|1326041732|CHC13|78496|TC|11/01/2013|12/31/9999|$58.02|0|0|||HEART FIRST PASS ADD-ON|| 58-1699775|1326041732|CHC13|78499||11/01/2013|12/31/9999|$0.00|0|0|||CARDIOVASCULAR NUCLEAR EXAM|| 58-1699775|1326041732|CHC13|78499|26|11/01/2013|12/31/9999|$0.00|0|0|||CARDIOVASCULAR NUCLEAR EXAM|| 58-1699775|1326041732|CHC13|78499|TC|11/01/2013|12/31/9999|$0.00|0|0|||CARDIOVASCULAR NUCLEAR EXAM|| 58-1699775|1326041732|CHC13|78579||11/01/2013|12/31/9999|$261.62|0|0|||LUNG VENTILATION IMAGING|| 58-1699775|1326041732|CHC13|78579|26|11/01/2013|12/31/9999|$37.15|0|0|||LUNG VENTILATION IMAGING|| 58-1699775|1326041732|CHC13|78579|TC|11/01/2013|12/31/9999|$224.46|0|0|||LUNG VENTILATION IMAGING|| 58-1699775|1326041732|CHC13|78580||11/01/2013|12/31/9999|$338.21|0|0|||LUNG PERFUSION IMAGING|| 58-1699775|1326041732|CHC13|78580|26|11/01/2013|12/31/9999|$56.74|0|0|||LUNG PERFUSION IMAGING|| 58-1699775|1326041732|CHC13|78580|TC|11/01/2013|12/31/9999|$281.47|0|0|||LUNG PERFUSION IMAGING|| 58-1699775|1326041732|CHC13|78582||11/01/2013|12/31/9999|$483.37|0|0|||LUNG VENTILAT&PERFUS IMAGING|| 58-1699775|1326041732|CHC13|78582|26|11/01/2013|12/31/9999|$80.35|0|0|||LUNG VENTILAT&PERFUS IMAGING|| 58-1699775|1326041732|CHC13|78582|TC|11/01/2013|12/31/9999|$403.01|0|0|||LUNG VENTILAT&PERFUS IMAGING|| 58-1699775|1326041732|CHC13|78597||11/01/2013|12/31/9999|$295.87|0|0|||LUNG PERFUSION DIFFERENTIAL|| 58-1699775|1326041732|CHC13|78597|26|11/01/2013|12/31/9999|$55.27|0|0|||LUNG PERFUSION DIFFERENTIAL|| 58-1699775|1326041732|CHC13|78597|TC|11/01/2013|12/31/9999|$240.60|0|0|||LUNG PERFUSION DIFFERENTIAL|| 58-1699775|1326041732|CHC13|78598||11/01/2013|12/31/9999|$452.82|0|0|||LUNG PERF&VENTILAT DIFERENTL|| 58-1699775|1326041732|CHC13|78598|26|11/01/2013|12/31/9999|$62.92|0|0|||LUNG PERF&VENTILAT DIFERENTL|| 58-1699775|1326041732|CHC13|78598|TC|11/01/2013|12/31/9999|$389.90|0|0|||LUNG PERF&VENTILAT DIFERENTL|| 58-1699775|1326041732|CHC13|78599||11/01/2013|12/31/9999|$0.00|0|0|||RESPIRATORY NUCLEAR EXAM|| 58-1699775|1326041732|CHC13|78599|26|11/01/2013|12/31/9999|$0.00|0|0|||RESPIRATORY NUCLEAR EXAM|| 58-1699775|1326041732|CHC13|78599|TC|11/01/2013|12/31/9999|$0.00|0|0|||RESPIRATORY NUCLEAR EXAM|| 58-1699775|1326041732|CHC13|78600||11/01/2013|12/31/9999|$276.44|0|0|||BRAIN IMAGING| LTD STATIC|| 58-1699775|1326041732|CHC13|78600|26|11/01/2013|12/31/9999|$33.81|0|0|||BRAIN IMAGING| LTD STATIC|| 58-1699775|1326041732|CHC13|78600|TC|11/01/2013|12/31/9999|$242.64|0|0|||BRAIN IMAGING| LTD STATIC|| 58-1699775|1326041732|CHC13|78601||11/01/2013|12/31/9999|$326.30|0|0|||BRAIN IMAGING| LTD W/FLOW|| 58-1699775|1326041732|CHC13|78601|26|11/01/2013|12/31/9999|$39.28|0|0|||BRAIN IMAGING| LTD W/FLOW|| 58-1699775|1326041732|CHC13|78601|TC|11/01/2013|12/31/9999|$287.02|0|0|||BRAIN IMAGING| LTD W/FLOW|| 58-1699775|1326041732|CHC13|78605||11/01/2013|12/31/9999|$302.71|0|0|||BRAIN IMAGING| COMPLETE|| 58-1699775|1326041732|CHC13|78605|26|11/01/2013|12/31/9999|$41.42|0|0|||BRAIN IMAGING| COMPLETE|| 58-1699775|1326041732|CHC13|78605|TC|11/01/2013|12/31/9999|$261.30|0|0|||BRAIN IMAGING| COMPLETE|| 58-1699775|1326041732|CHC13|78606||11/01/2013|12/31/9999|$506.56|0|0|||BRAIN IMAGING| COMPL W/FLOW|| 58-1699775|1326041732|CHC13|78606|26|11/01/2013|12/31/9999|$48.57|0|0|||BRAIN IMAGING| COMPL W/FLOW|| 58-1699775|1326041732|CHC13|78606|TC|11/01/2013|12/31/9999|$457.99|0|0|||BRAIN IMAGING| COMPL W/FLOW|| 58-1699775|1326041732|CHC13|78607||11/01/2013|12/31/9999|$557.41|0|0|||BRAIN IMAGING (3D)|| 58-1699775|1326041732|CHC13|78607|26|11/01/2013|12/31/9999|$92.87|0|0|||BRAIN IMAGING (3D)|| 58-1699775|1326041732|CHC13|78607|TC|11/01/2013|12/31/9999|$464.54|0|0|||BRAIN IMAGING (3D)|| 58-1699775|1326041732|CHC13|78608||11/01/2013|12/31/9999|$879.66|0|0|||BRAIN IMAGING (PET)|| 58-1699775|1326041732|CHC13|78608|26|11/01/2013|12/31/9999|$115.19|0|0|||BRAIN IMAGING (PET)|| 58-1699775|1326041732|CHC13|78608|TC|11/01/2013|12/31/9999|$766.53|0|0|||BRAIN IMAGING (PET)|| 58-1699775|1326041732|CHC13|78609||11/01/2013|12/31/9999|$120.22|0|0|||BRAIN IMAGING (PET)|| 58-1699775|1326041732|CHC13|78609|26|11/01/2013|12/31/9999|$120.22|0|0|||BRAIN IMAGING (PET)|| 58-1699775|1326041732|CHC13|78609|TC|11/01/2013|12/31/9999|$120.17|0|0|||BRAIN IMAGING (PET)|| 58-1699775|1326041732|CHC13|78610||11/01/2013|12/31/9999|$269.59|0|0|||BRAIN FLOW IMAGING ONLY|| 58-1699775|1326041732|CHC13|78610|26|11/01/2013|12/31/9999|$23.42|0|0|||BRAIN FLOW IMAGING ONLY|| 58-1699775|1326041732|CHC13|78610|TC|11/01/2013|12/31/9999|$246.17|0|0|||BRAIN FLOW IMAGING ONLY|| 58-1699775|1326041732|CHC13|78630||11/01/2013|12/31/9999|$521.95|0|0|||CEREBROSPINAL FLUID SCAN|| 58-1699775|1326041732|CHC13|78630|26|11/01/2013|12/31/9999|$52.36|0|0|||CEREBROSPINAL FLUID SCAN|| 58-1699775|1326041732|CHC13|78630|TC|11/01/2013|12/31/9999|$469.59|0|0|||CEREBROSPINAL FLUID SCAN|| 58-1699775|1326041732|CHC13|78635||11/01/2013|12/31/9999|$506.89|0|0|||CSF VENTRICULOGRAPHY|| 58-1699775|1326041732|CHC13|78635|26|11/01/2013|12/31/9999|$46.88|0|0|||CSF VENTRICULOGRAPHY|| 58-1699775|1326041732|CHC13|78635|TC|11/01/2013|12/31/9999|$460.00|0|0|||CSF VENTRICULOGRAPHY|| 58-1699775|1326041732|CHC13|78645||11/01/2013|12/31/9999|$489.55|0|0|||CSF SHUNT EVALUATION|| 58-1699775|1326041732|CHC13|78645|26|11/01/2013|12/31/9999|$43.66|0|0|||CSF SHUNT EVALUATION|| 58-1699775|1326041732|CHC13|78645|TC|11/01/2013|12/31/9999|$445.88|0|0|||CSF SHUNT EVALUATION|| 58-1699775|1326041732|CHC13|78647||11/01/2013|12/31/9999|$525.26|0|0|||CEREBROSPINAL FLUID SCAN|| 58-1699775|1326041732|CHC13|78647|26|11/01/2013|12/31/9999|$68.28|0|0|||CEREBROSPINAL FLUID SCAN|| 58-1699775|1326041732|CHC13|78647|TC|11/01/2013|12/31/9999|$456.98|0|0|||CEREBROSPINAL FLUID SCAN|| 58-1699775|1326041732|CHC13|78650||11/01/2013|12/31/9999|$505.93|0|0|||CSF LEAKAGE IMAGING|| 58-1699775|1326041732|CHC13|78650|26|11/01/2013|12/31/9999|$46.93|0|0|||CSF LEAKAGE IMAGING|| 58-1699775|1326041732|CHC13|78650|TC|11/01/2013|12/31/9999|$459.00|0|0|||CSF LEAKAGE IMAGING|| 58-1699775|1326041732|CHC13|78660||11/01/2013|12/31/9999|$283.55|0|0|||NUCLEAR EXAM OF TEAR FLOW|| 58-1699775|1326041732|CHC13|78660|26|11/01/2013|12/31/9999|$42.93|0|0|||NUCLEAR EXAM OF TEAR FLOW|| 58-1699775|1326041732|CHC13|78660|TC|11/01/2013|12/31/9999|$240.62|0|0|||NUCLEAR EXAM OF TEAR FLOW|| 58-1699775|1326041732|CHC13|78699||11/01/2013|12/31/9999|$0.00|0|0|||NERVOUS SYSTEM NUCLEAR EXAM|| 58-1699775|1326041732|CHC13|78699|26|11/01/2013|12/31/9999|$0.00|0|0|||NERVOUS SYSTEM NUCLEAR EXAM|| 58-1699775|1326041732|CHC13|78699|TC|11/01/2013|12/31/9999|$0.00|0|0|||NERVOUS SYSTEM NUCLEAR EXAM|| 58-1699775|1326041732|CHC13|78700||11/01/2013|12/31/9999|$269.98|0|0|||KIDNEY IMAGING| STATIC|| 58-1699775|1326041732|CHC13|78700|26|11/01/2013|12/31/9999|$35.41|0|0|||KIDNEY IMAGING| STATIC|| 58-1699775|1326041732|CHC13|78700|TC|11/01/2013|12/31/9999|$234.57|0|0|||KIDNEY IMAGING| STATIC|| 58-1699775|1326041732|CHC13|78701||11/01/2013|12/31/9999|$326.69|0|0|||KIDNEY IMAGING WITH FLOW|| 58-1699775|1326041732|CHC13|78701|26|11/01/2013|12/31/9999|$38.16|0|0|||KIDNEY IMAGING WITH FLOW|| 58-1699775|1326041732|CHC13|78701|TC|11/01/2013|12/31/9999|$288.53|0|0|||KIDNEY IMAGING WITH FLOW|| 58-1699775|1326041732|CHC13|78707||11/01/2013|12/31/9999|$360.67|0|0|||KIDNEY FLOW/FUNCTION IMAGE|| 58-1699775|1326041732|CHC13|78707|26|11/01/2013|12/31/9999|$73.15|0|0|||KIDNEY FLOW/FUNCTION IMAGE|| 58-1699775|1326041732|CHC13|78707|TC|11/01/2013|12/31/9999|$287.52|0|0|||KIDNEY FLOW/FUNCTION IMAGE|| 58-1699775|1326041732|CHC13|78708||11/01/2013|12/31/9999|$266.29|0|0|||KIDNEY FLOW/FUNCTION IMAGE|| 58-1699775|1326041732|CHC13|78708|26|11/01/2013|12/31/9999|$92.25|0|0|||KIDNEY FLOW/FUNCTION IMAGE|| 58-1699775|1326041732|CHC13|78708|TC|11/01/2013|12/31/9999|$174.05|0|0|||KIDNEY FLOW/FUNCTION IMAGE|| 58-1699775|1326041732|CHC13|78709||11/01/2013|12/31/9999|$565.54|0|0|||KIDNEY FLOW/FUNCTION IMAGE|| 58-1699775|1326041732|CHC13|78709|26|11/01/2013|12/31/9999|$108.05|0|0|||KIDNEY FLOW/FUNCTION IMAGE|| 58-1699775|1326041732|CHC13|78709|TC|11/01/2013|12/31/9999|$457.48|0|0|||KIDNEY FLOW/FUNCTION IMAGE|| 58-1699775|1326041732|CHC13|78710||11/01/2013|12/31/9999|$325.11|0|0|||KIDNEY IMAGING (3D)|| 58-1699775|1326041732|CHC13|78710|26|11/01/2013|12/31/9999|$48.18|0|0|||KIDNEY IMAGING (3D)|| 58-1699775|1326041732|CHC13|78710|TC|11/01/2013|12/31/9999|$276.93|0|0|||KIDNEY IMAGING (3D)|| 58-1699775|1326041732|CHC13|78725||11/01/2013|12/31/9999|$159.60|0|0|||KIDNEY FUNCTION STUDY|| 58-1699775|1326041732|CHC13|78725|26|11/01/2013|12/31/9999|$28.42|0|0|||KIDNEY FUNCTION STUDY|| 58-1699775|1326041732|CHC13|78725|TC|11/01/2013|12/31/9999|$131.18|0|0|||KIDNEY FUNCTION STUDY|| 58-1699775|1326041732|CHC13|78730||11/01/2013|12/31/9999|$116.39|0|0|||URINARY BLADDER RETENTION|| 58-1699775|1326041732|CHC13|78730|26|11/01/2013|12/31/9999|$12.48|0|0|||URINARY BLADDER RETENTION|| 58-1699775|1326041732|CHC13|78730|TC|11/01/2013|12/31/9999|$103.91|0|0|||URINARY BLADDER RETENTION|| 58-1699775|1326041732|CHC13|78740||11/01/2013|12/31/9999|$351.36|0|0|||URETERAL REFLUX STUDY|| 58-1699775|1326041732|CHC13|78740|26|11/01/2013|12/31/9999|$45.18|0|0|||URETERAL REFLUX STUDY|| 58-1699775|1326041732|CHC13|78740|TC|11/01/2013|12/31/9999|$306.18|0|0|||URETERAL REFLUX STUDY|| 58-1699775|1326041732|CHC13|78761||11/01/2013|12/31/9999|$325.95|0|0|||TESTICULAR IMAGING/FLOW|| 58-1699775|1326041732|CHC13|78761|26|11/01/2013|12/31/9999|$55.58|0|0|||TESTICULAR IMAGING/FLOW|| 58-1699775|1326041732|CHC13|78761|TC|11/01/2013|12/31/9999|$270.37|0|0|||TESTICULAR IMAGING/FLOW|| 58-1699775|1326041732|CHC13|78799||11/01/2013|12/31/9999|$0.00|0|0|||GENITOURINARY NUCLEAR EXAM|| 58-1699775|1326041732|CHC13|78799|26|11/01/2013|12/31/9999|$0.00|0|0|||GENITOURINARY NUCLEAR EXAM|| 58-1699775|1326041732|CHC13|78799|TC|11/01/2013|12/31/9999|$0.00|0|0|||GENITOURINARY NUCLEAR EXAM|| 58-1699775|1326041732|CHC13|78800||11/01/2013|12/31/9999|$289.86|0|0|||TUMOR IMAGING| LIMITED AREA|| 58-1699775|1326041732|CHC13|78800|26|11/01/2013|12/31/9999|$51.76|0|0|||TUMOR IMAGING| LIMITED AREA|| 58-1699775|1326041732|CHC13|78800|TC|11/01/2013|12/31/9999|$238.10|0|0|||TUMOR IMAGING| LIMITED AREA|| 58-1699775|1326041732|CHC13|78801||11/01/2013|12/31/9999|$377.35|0|0|||TUMOR IMAGING| MULT AREAS|| 58-1699775|1326041732|CHC13|78801|26|11/01/2013|12/31/9999|$61.08|0|0|||TUMOR IMAGING| MULT AREAS|| 58-1699775|1326041732|CHC13|78801|TC|11/01/2013|12/31/9999|$316.27|0|0|||TUMOR IMAGING| MULT AREAS|| 58-1699775|1326041732|CHC13|78802||11/01/2013|12/31/9999|$497.28|0|0|||TUMOR IMAGING| WHOLE BODY|| 58-1699775|1326041732|CHC13|78802|26|11/01/2013|12/31/9999|$65.51|0|0|||TUMOR IMAGING| WHOLE BODY|| 58-1699775|1326041732|CHC13|78802|TC|11/01/2013|12/31/9999|$431.76|0|0|||TUMOR IMAGING| WHOLE BODY|| 58-1699775|1326041732|CHC13|78803||11/01/2013|12/31/9999|$530.38|0|0|||TUMOR IMAGING (3D)|| 58-1699775|1326041732|CHC13|78803|26|11/01/2013|12/31/9999|$81.98|0|0|||TUMOR IMAGING (3D)|| 58-1699775|1326041732|CHC13|78803|TC|11/01/2013|12/31/9999|$448.40|0|0|||TUMOR IMAGING (3D)|| 58-1699775|1326041732|CHC13|78804||11/01/2013|12/31/9999|$880.82|0|0|||TUMOR IMAGING| WHOLE BODY|| 58-1699775|1326041732|CHC13|78804|26|11/01/2013|12/31/9999|$81.36|0|0|||TUMOR IMAGING| WHOLE BODY|| 58-1699775|1326041732|CHC13|78804|TC|11/01/2013|12/31/9999|$799.46|0|0|||TUMOR IMAGING| WHOLE BODY|| 58-1699775|1326041732|CHC13|78805||11/01/2013|12/31/9999|$280.68|0|0|||ABSCESS IMAGING| LTD AREA|| 58-1699775|1326041732|CHC13|78805|26|11/01/2013|12/31/9999|$56.20|0|0|||ABSCESS IMAGING| LTD AREA|| 58-1699775|1326041732|CHC13|78805|TC|11/01/2013|12/31/9999|$224.48|0|0|||ABSCESS IMAGING| LTD AREA|| 58-1699775|1326041732|CHC13|78806||11/01/2013|12/31/9999|$513.92|0|0|||ABSCESS IMAGING| WHOLE BODY|| 58-1699775|1326041732|CHC13|78806|26|11/01/2013|12/31/9999|$65.51|0|0|||ABSCESS IMAGING| WHOLE BODY|| 58-1699775|1326041732|CHC13|78806|TC|11/01/2013|12/31/9999|$448.40|0|0|||ABSCESS IMAGING| WHOLE BODY|| 58-1699775|1326041732|CHC13|78807||11/01/2013|12/31/9999|$531.88|0|0|||NUCLEAR LOCALIZATION/ABSCESS|| 58-1699775|1326041732|CHC13|78807|26|11/01/2013|12/31/9999|$81.46|0|0|||NUCLEAR LOCALIZATION/ABSCESS|| 58-1699775|1326041732|CHC13|78807|TC|11/01/2013|12/31/9999|$450.42|0|0|||NUCLEAR LOCALIZATION/ABSCESS|| 58-1699775|1326041732|CHC13|78808||11/01/2013|12/31/9999|$64.63|0|0|||IV INJ RA DRUG DX STUDY|| 58-1699775|1326041732|CHC13|78811||11/01/2013|12/31/9999|$956.24|0|0|||TUMOR IMAGING (PET)| LIMITED|| 58-1699775|1326041732|CHC13|78811|26|11/01/2013|12/31/9999|$124.11|0|0|||TUMOR IMAGING (PET)| LIMITED|| 58-1699775|1326041732|CHC13|78811|TC|11/01/2013|12/31/9999|$833.70|0|0|||TUMOR IMAGING (PET)| LIMITED|| 58-1699775|1326041732|CHC13|78812||11/01/2013|12/31/9999|$1|159.87|0|0|||TUMOR IMAGE (PET)/SKUL-THIGH|| 58-1699775|1326041732|CHC13|78812|26|11/01/2013|12/31/9999|$151.53|0|0|||TUMOR IMAGE (PET)/SKUL-THIGH|| 58-1699775|1326041732|CHC13|78812|TC|11/01/2013|12/31/9999|$1|010.92|0|0|||TUMOR IMAGE (PET)/SKUL-THIGH|| 58-1699775|1326041732|CHC13|78813||11/01/2013|12/31/9999|$1|206.76|0|0|||TUMOR IMAGE (PET) FULL BODY|| 58-1699775|1326041732|CHC13|78813|26|11/01/2013|12/31/9999|$158.52|0|0|||TUMOR IMAGE (PET) FULL BODY|| 58-1699775|1326041732|CHC13|78813|TC|11/01/2013|12/31/9999|$1|051.83|0|0|||TUMOR IMAGE (PET) FULL BODY|| 58-1699775|1326041732|CHC13|78814||11/01/2013|12/31/9999|$1|334.16|0|0|||TUMOR IMAGE PET/CT| LIMITED|| 58-1699775|1326041732|CHC13|78814|26|11/01/2013|12/31/9999|$173.82|0|0|||TUMOR IMAGE PET/CT| LIMITED|| 58-1699775|1326041732|CHC13|78814|TC|11/01/2013|12/31/9999|$1|162.92|0|0|||TUMOR IMAGE PET/CT| LIMITED|| 58-1699775|1326041732|CHC13|78815||11/01/2013|12/31/9999|$1|474.39|0|0|||TUMORIMAGE PET/CT SKUL-THIGH|| 58-1699775|1326041732|CHC13|78815|26|11/01/2013|12/31/9999|$192.38|0|0|||TUMORIMAGE PET/CT SKUL-THIGH|| 58-1699775|1326041732|CHC13|78815|TC|11/01/2013|12/31/9999|$1|285.12|0|0|||TUMORIMAGE PET/CT SKUL-THIGH|| 58-1699775|1326041732|CHC13|78816||11/01/2013|12/31/9999|$1|487.36|0|0|||TUMOR IMAGE PET/CT FULL BODY|| 58-1699775|1326041732|CHC13|78816|26|11/01/2013|12/31/9999|$194.24|0|0|||TUMOR IMAGE PET/CT FULL BODY|| 58-1699775|1326041732|CHC13|78816|TC|11/01/2013|12/31/9999|$1|296.22|0|0|||TUMOR IMAGE PET/CT FULL BODY|| 58-1699775|1326041732|CHC13|78999||11/01/2013|12/31/9999|$0.00|0|0|||NUCLEAR DIAGNOSTIC EXAM|| 58-1699775|1326041732|CHC13|78999|26|11/01/2013|12/31/9999|$0.00|0|0|||NUCLEAR DIAGNOSTIC EXAM|| 58-1699775|1326041732|CHC13|78999|TC|11/01/2013|12/31/9999|$0.00|0|0|||NUCLEAR DIAGNOSTIC EXAM|| 58-1699775|1326041732|CHC13|79005||11/01/2013|12/31/9999|$213.69|0|0|||NUCLEAR RX| ORAL ADMIN|| 58-1699775|1326041732|CHC13|79005|26|11/01/2013|12/31/9999|$137.52|0|0|||NUCLEAR RX| ORAL ADMIN|| 58-1699775|1326041732|CHC13|79005|TC|11/01/2013|12/31/9999|$76.17|0|0|||NUCLEAR RX| ORAL ADMIN|| 58-1699775|1326041732|CHC13|79101||11/01/2013|12/31/9999|$241.34|0|0|||NUCLEAR RX| IV ADMIN|| 58-1699775|1326041732|CHC13|79101|26|11/01/2013|12/31/9999|$159.12|0|0|||NUCLEAR RX| IV ADMIN|| 58-1699775|1326041732|CHC13|79101|TC|11/01/2013|12/31/9999|$82.22|0|0|||NUCLEAR RX| IV ADMIN|| 58-1699775|1326041732|CHC13|79200||11/01/2013|12/31/9999|$255.20|0|0|||NUCLEAR RX| INTRACAV ADMIN|| 58-1699775|1326041732|CHC13|79200|26|11/01/2013|12/31/9999|$156.33|0|0|||NUCLEAR RX| INTRACAV ADMIN|| 58-1699775|1326041732|CHC13|79200|TC|11/01/2013|12/31/9999|$98.87|0|0|||NUCLEAR RX| INTRACAV ADMIN|| 58-1699775|1326041732|CHC13|79300||11/01/2013|12/31/9999|$205.13|0|0|||NUCLR RX| INTERSTIT COLLOID|| 58-1699775|1326041732|CHC13|79300|26|11/01/2013|12/31/9999|$133.97|0|0|||NUCLR RX| INTERSTIT COLLOID|| 58-1699775|1326041732|CHC13|79300|TC|11/01/2013|12/31/9999|$78.28|0|0|||NUCLR RX| INTERSTIT COLLOID|| 58-1699775|1326041732|CHC13|79403||11/01/2013|12/31/9999|$299.08|0|0|||HEMATOPOIETIC NUCLEAR TX|| 58-1699775|1326041732|CHC13|79403|26|11/01/2013|12/31/9999|$172.95|0|0|||HEMATOPOIETIC NUCLEAR TX|| 58-1699775|1326041732|CHC13|79403|TC|11/01/2013|12/31/9999|$126.13|0|0|||HEMATOPOIETIC NUCLEAR TX|| 58-1699775|1326041732|CHC13|79440||11/01/2013|12/31/9999|$243.50|0|0|||NUCLEAR RX| INTRA-ARTICULAR|| 58-1699775|1326041732|CHC13|79440|26|11/01/2013|12/31/9999|$158.75|0|0|||NUCLEAR RX| INTRA-ARTICULAR|| 58-1699775|1326041732|CHC13|79440|TC|11/01/2013|12/31/9999|$84.75|0|0|||NUCLEAR RX| INTRA-ARTICULAR|| 58-1699775|1326041732|CHC13|79445||11/01/2013|12/31/9999|$318.80|0|0|||NUCLEAR RX| INTRA-ARTERIAL|| 58-1699775|1326041732|CHC13|79445|26|11/01/2013|12/31/9999|$186.57|0|0|||NUCLEAR RX| INTRA-ARTERIAL|| 58-1699775|1326041732|CHC13|79445|TC|11/01/2013|12/31/9999|$137.36|0|0|||NUCLEAR RX| INTRA-ARTERIAL|| 58-1699775|1326041732|CHC13|79999||11/01/2013|12/31/9999|$0.00|0|0|||NUCLEAR MEDICINE THERAPY|| 58-1699775|1326041732|CHC13|79999|26|11/01/2013|12/31/9999|$0.00|0|0|||NUCLEAR MEDICINE THERAPY|| 58-1699775|1326041732|CHC13|79999|TC|11/01/2013|12/31/9999|$0.00|0|0|||NUCLEAR MEDICINE THERAPY|| 58-1699775|1326041732|CHC13|80047||11/01/2013|12/31/9999|$15.57|0|0|||METABOLIC PANEL IONIZED CA|| 58-1699775|1326041732|CHC13|80048||11/01/2013|12/31/9999|$15.57|0|0|||BASIC METABOLIC PANEL|| 58-1699775|1326041732|CHC13|80050||11/01/2013|12/31/9999|$52.10|0|0|||GENERAL HEALTH PANEL|| 58-1699775|1326041732|CHC13|80051||11/01/2013|12/31/9999|$12.92|0|0|||ELECTROLYTE PANEL|| 58-1699775|1326041732|CHC13|80053||11/01/2013|12/31/9999|$19.46|0|0|||COMPREHEN METABOLIC PANEL|| 58-1699775|1326041732|CHC13|80055||11/01/2013|12/31/9999|$75.91|0|0|||OBSTETRIC PANEL|| 58-1699775|1326041732|CHC13|80061||11/01/2013|12/31/9999|$24.66|0|0|||LIPID PANEL|| 58-1699775|1326041732|CHC13|80069||11/01/2013|12/31/9999|$15.99|0|0|||RENAL FUNCTION PANEL|| 58-1699775|1326041732|CHC13|80074||11/01/2013|12/31/9999|$87.71|0|0|||ACUTE HEPATITIS PANEL|| 58-1699775|1326041732|CHC13|80076||11/01/2013|12/31/9999|$15.04|0|0|||HEPATIC FUNCTION PANEL|| 58-1699775|1326041732|CHC13|80081||04/01/2016|12/31/9999|$132.56|0|0|0||OBSTETRIC PANEL|| 58-1699775|1326041732|CHC13|80150||11/01/2013|12/31/9999|$27.76|0|0|||ASSAY OF AMIKACIN|| 58-1699775|1326041732|CHC13|80155||04/01/2014|12/31/9999|$25.09|0|0|||DRUG SCREEN QUANT CAFFEINE|| 58-1699775|1326041732|CHC13|80156||11/01/2013|12/31/9999|$26.81|0|0|||ASSAY| CARBAMAZEPINE| TOTAL|| 58-1699775|1326041732|CHC13|80157||11/01/2013|12/31/9999|$24.40|0|0|||ASSAY| CARBAMAZEPINE| FREE|| 58-1699775|1326041732|CHC13|80158||11/01/2013|12/31/9999|$10.96|0|0|||ASSAY OF CYCLOSPORINE|| 58-1699775|1326041732|CHC13|80159||04/01/2014|12/31/9999|$32.80|0|0|||DRUG SCREEN QUANT CLOZAPINE|| 58-1699775|1326041732|CHC13|80162||11/01/2013|12/31/9999|$24.44|0|0|||ASSAY OF DIGOXIN|| 58-1699775|1326041732|CHC13|80163||04/01/2015|12/31/9999|$23.49|0|0|0||ASSAY OF DIGOXIN FREE|| 58-1699775|1326041732|CHC13|80164||11/01/2013|12/31/9999|$20.90|0|0|||ASSAY| DIPROPYLACETIC ACID|| 58-1699775|1326041732|CHC13|80165||04/01/2015|12/31/9999|$20.08|0|0|0||DIPROPYLACETIC ACID FREE|| 58-1699775|1326041732|CHC13|80168||11/01/2013|12/31/9999|$30.09|0|0|||ASSAY OF ETHOSUXIMIDE|| 58-1699775|1326041732|CHC13|80169||04/01/2014|12/31/9999|$24.35|0|0|||DRUG SCREEN QUANT EVEROLIMUS|| 58-1699775|1326041732|CHC13|80170||11/01/2013|12/31/9999|$30.17|0|0|||ASSAY OF GENTAMICIN|| 58-1699775|1326041732|CHC13|80171||04/01/2014|12/31/9999|$23.52|0|0|||DRUG SCREEN QUANT GABAPENTIN|| 58-1699775|1326041732|CHC13|80173||11/01/2013|12/31/9999|$26.81|0|0|||ASSAY OF HALOPERIDOL|| 58-1699775|1326041732|CHC13|80175||04/01/2014|12/31/9999|$23.52|0|0|||DRUG SCREEN QUAN LAMOTRIGINE|| 58-1699775|1326041732|CHC13|80176||11/01/2013|12/31/9999|$27.04|0|0|||ASSAY OF LIDOCAINE|| 58-1699775|1326041732|CHC13|80177||04/01/2014|12/31/9999|$23.52|0|0|||DRUG SCRN QUAN LEVETIRACETAM|| 58-1699775|1326041732|CHC13|80178||11/01/2013|12/31/9999|$12.17|0|0|||ASSAY OF LITHIUM|| 58-1699775|1326041732|CHC13|80180||04/01/2014|12/31/9999|$10.56|0|0|||DRUG SCRN QUAN MYCOPHENOLATE|| 58-1699775|1326041732|CHC13|80182||11/01/2013|12/31/9999|$20.90|0|0|||ASSAY OF NORTRIPTYLINE|| 58-1699775|1326041732|CHC13|80183||04/01/2014|12/31/9999|$25.83|0|0|||DRUG SCRN QUANT OXCARBAZEPIN|| 58-1699775|1326041732|CHC13|80184||11/01/2013|12/31/9999|$21.09|0|0|||ASSAY OF PHENOBARBITAL|| 58-1699775|1326041732|CHC13|80185||11/01/2013|12/31/9999|$24.40|0|0|||ASSAY OF PHENYTOIN| TOTAL|| 58-1699775|1326041732|CHC13|80186||11/01/2013|12/31/9999|$25.35|0|0|||ASSAY OF PHENYTOIN| FREE|| 58-1699775|1326041732|CHC13|80188||11/01/2013|12/31/9999|$30.56|0|0|||ASSAY OF PRIMIDONE|| 58-1699775|1326041732|CHC13|80190||11/01/2013|12/31/9999|$30.84|0|0|||ASSAY OF PROCAINAMIDE|| 58-1699775|1326041732|CHC13|80192||11/01/2013|12/31/9999|$30.84|0|0|||ASSAY OF PROCAINAMIDE|| 58-1699775|1326041732|CHC13|80194||11/01/2013|12/31/9999|$26.88|0|0|||ASSAY OF QUINIDINE|| 58-1699775|1326041732|CHC13|80195||11/01/2013|12/31/9999|$25.29|0|0|||ASSAY OF SIROLIMUS|| 58-1699775|1326041732|CHC13|80197||11/01/2013|12/31/9999|$25.29|0|0|||ASSAY OF TACROLIMUS|| 58-1699775|1326041732|CHC13|80198||11/01/2013|12/31/9999|$26.05|0|0|||ASSAY OF THEOPHYLLINE|| 58-1699775|1326041732|CHC13|80199||04/01/2014|12/31/9999|$10.65|0|0|||DRUG SCREEN QUANT TIAGABINE|| 58-1699775|1326041732|CHC13|80200||11/01/2013|12/31/9999|$27.57|0|0|||ASSAY OF TOBRAMYCIN|| 58-1699775|1326041732|CHC13|80201||11/01/2013|12/31/9999|$21.96|0|0|||ASSAY OF TOPIRAMATE|| 58-1699775|1326041732|CHC13|80202||11/01/2013|12/31/9999|$20.90|0|0|||ASSAY OF VANCOMYCIN|| 58-1699775|1326041732|CHC13|80203||04/01/2014|12/31/9999|$23.52|0|0|||DRUG SCREEN QUANT ZONISAMIDE|| 58-1699775|1326041732|CHC13|80299||11/01/2013|12/31/9999|$22.18|0|0|||QUANTITATIVE ASSAY| DRUG|| 58-1699775|1326041732|CHC13|80303||04/01/2015|12/31/9999|$65.00|0|0|0|%|DRUG SCREEN ONE/MULT CLASS|| 58-1699775|1326041732|CHC13|80305||04/01/2017|12/31/9999|$18.64|0|18.64|0||DRUG TEST PRSMV DIR OPT OBS|| 58-1699775|1326041732|CHC13|80306||04/01/2017|12/31/9999|$24.84|0|24.84|0||DRUG TEST PRSMV INSTRMNT|| 58-1699775|1326041732|CHC13|80307||04/01/2017|12/31/9999|$99.38|0|99.38|0||DRUG TEST PRSMV CHEM ANLYZR|| 58-1699775|1326041732|CHC13|80320||04/01/2015|12/31/9999|$65.00|0|0|0|%|DRUG SCREEN QUANTALCOHOLS|| 58-1699775|1326041732|CHC13|80321||04/01/2015|12/31/9999|$65.00|0|0|0|%|ALCOHOLS BIOMARKERS 1OR 2|| 58-1699775|1326041732|CHC13|80322||04/01/2015|12/31/9999|$65.00|0|0|0|%|ALCOHOLS BIOMARKERS 3/MORE|| 58-1699775|1326041732|CHC13|80323||04/01/2015|12/31/9999|$65.00|0|0|0|%|ALKALOIDS NOS|| 58-1699775|1326041732|CHC13|80324||04/01/2015|12/31/9999|$65.00|0|0|0|%|DRUG SCREEN AMPHETAMINES 1/2|| 58-1699775|1326041732|CHC13|80325||04/01/2015|12/31/9999|$65.00|0|0|0|%|AMPHETAMINES 3OR 4|| 58-1699775|1326041732|CHC13|80326||04/01/2015|12/31/9999|$65.00|0|0|0|%|AMPHETAMINES 5 OR MORE|| 58-1699775|1326041732|CHC13|80327||04/01/2015|12/31/9999|$65.00|0|0|0|%|ANABOLIC STEROID 1 OR 2|| 58-1699775|1326041732|CHC13|80328||04/01/2015|12/31/9999|$65.00|0|0|0|%|ANABOLIC STEROID 3 OR MORE|| 58-1699775|1326041732|CHC13|80329||04/01/2015|12/31/9999|$65.00|0|0|0|%|ANALGESICS NON-OPIOID 1 OR 2|| 58-1699775|1326041732|CHC13|80330||04/01/2015|12/31/9999|$65.00|0|0|0|%|ANALGESICS NON-OPIOID 3-5|| 58-1699775|1326041732|CHC13|80331||04/01/2015|12/31/9999|$65.00|0|0|0|%|ANALGESICS NON-OPIOID 6/MORE|| 58-1699775|1326041732|CHC13|80332||04/01/2015|12/31/9999|$65.00|0|0|0|%|ANTIDEPRESSANTS CLASS 1 OR 2|| 58-1699775|1326041732|CHC13|80333||04/01/2015|12/31/9999|$65.00|0|0|0|%|ANTIDEPRESSANTS CLASS 3-5|| 58-1699775|1326041732|CHC13|80334||04/01/2015|12/31/9999|$65.00|0|0|0|%|ANTIDEPRESSANTS CLASS 6/MORE|| 58-1699775|1326041732|CHC13|80335||04/01/2015|12/31/9999|$65.00|0|0|0|%|ANTIDEPRESSANT TRICYCLIC 1/2|| 58-1699775|1326041732|CHC13|80336||04/01/2015|12/31/9999|$65.00|0|0|0|%|ANTIDEPRESSANT TRICYCLIC 3-5|| 58-1699775|1326041732|CHC13|80337||04/01/2015|12/31/9999|$65.00|0|0|0|%|TRICYCLIC & CYCLICALS 6/MORE|| 58-1699775|1326041732|CHC13|80338||04/01/2015|12/31/9999|$65.00|0|0|0|%|ANTIDEPRESSANT NOT SPECIFIED|| 58-1699775|1326041732|CHC13|80339||04/01/2015|12/31/9999|$65.00|0|0|0|%|ANTIEPILEPTICS NOS 1-3|| 58-1699775|1326041732|CHC13|80340||04/01/2015|12/31/9999|$65.00|0|0|0|%|ANTIEPILEPTICS NOS 4-6|| 58-1699775|1326041732|CHC13|80341||04/01/2015|12/31/9999|$65.00|0|0|0|%|ANTIEPILEPTICS NOS 7/MORE|| 58-1699775|1326041732|CHC13|80342||04/01/2015|12/31/9999|$65.00|0|0|0|%|ANTIPSYCHOTICS NOS 1-3|| 58-1699775|1326041732|CHC13|80343||04/01/2015|12/31/9999|$65.00|0|0|0|%|ANTIPSYCHOTICS NOS 4-6|| 58-1699775|1326041732|CHC13|80344||04/01/2015|12/31/9999|$65.00|0|0|0|%|ANTIPSYCHOTICS NOS 7/MORE|| 58-1699775|1326041732|CHC13|80345||04/01/2015|12/31/9999|$65.00|0|0|0|%|DRUG SCREENING BARBITURATES|| 58-1699775|1326041732|CHC13|80346||04/01/2015|12/31/9999|$65.00|0|0|0|%|BENZODIAZEPINES1-12|| 58-1699775|1326041732|CHC13|80347||04/01/2015|12/31/9999|$65.00|0|0||%|BENZODIAZEPINES 13 OR MORE|| 58-1699775|1326041732|CHC13|80348||04/01/2015|12/31/9999|$65.00|0|0|0|%|DRUG SCREENING BUPRENORPHINE|| 58-1699775|1326041732|CHC13|80349||04/01/2015|12/31/9999|$65.00|0|0|0|%|CANNABINOIDS NATURAL|| 58-1699775|1326041732|CHC13|80350||04/01/2015|12/31/9999|$65.00|0|0|0|%|CANNABINOIDS SYNTHETIC 1-3|| 58-1699775|1326041732|CHC13|80351||04/01/2015|12/31/9999|$65.00|0|0|0|%|CANNABINOIDS SYNTHETIC 4-6|| 58-1699775|1326041732|CHC13|80352||04/01/2015|12/31/9999|$65.00|0|0|0|%|CANNABINOID SYNTHETIC 7/MORE|| 58-1699775|1326041732|CHC13|80353||04/01/2015|12/31/9999|$65.00|0|0|0|%|DRUG SCREENING COCAINE|| 58-1699775|1326041732|CHC13|80354||04/01/2015|12/31/9999|$65.00|0|0|0|%|DRUG SCREENING FENTANYL|| 58-1699775|1326041732|CHC13|80355||04/01/2015|12/31/9999|$65.00|0|0|0|%|GABAPENTIN NON-BLOOD|| 58-1699775|1326041732|CHC13|80356||04/01/2015|12/31/9999|$65.00|0|0|0|%|HEROIN METABOLITE|| 58-1699775|1326041732|CHC13|80357||04/01/2015|12/31/9999|$65.00|0|0|0|%|KETAMINE AND NORKETAMINE|| 58-1699775|1326041732|CHC13|80358||04/01/2015|12/31/9999|$65.00|0|0|0|%|DRUG SCREENING METHADONE|| 58-1699775|1326041732|CHC13|80359||04/01/2015|12/31/9999|$65.00|0|0|0|%|METHYLENEDIOXYAMPHETAMINES|| 58-1699775|1326041732|CHC13|80360||04/01/2015|12/31/9999|$65.00|0|0|0|%|METHYLPHENIDATE|| 58-1699775|1326041732|CHC13|80361||04/01/2015|12/31/9999|$65.00|0|0|0|%|OPIATES 1 OR MORE|| 58-1699775|1326041732|CHC13|80362||04/01/2015|12/31/9999|$65.00|0|0|0|%|OPIOIDS & OPIATE ANALOGS 1/2|| 58-1699775|1326041732|CHC13|80363||04/01/2015|12/31/9999|$65.00|0|0|0|%|OPIOIDS & OPIATE ANALOGS 3/4|| 58-1699775|1326041732|CHC13|80364||04/01/2015|12/31/9999|$65.00|0|0|0|%|OPIOID &OPIATE ANALOG 5/MORE|| 58-1699775|1326041732|CHC13|80365||04/01/2015|12/31/9999|$65.00|0|0|0|%|DRUG SCREENING OXYCODONE|| 58-1699775|1326041732|CHC13|80366||04/01/2015|12/31/9999|$65.00|0|0|0|%|DRUG SCREENING PREGABALIN|| 58-1699775|1326041732|CHC13|80367||04/01/2015|12/31/9999|$65.00|0|0|0|%|DRUG SCREENING PROPOXYPHENE|| 58-1699775|1326041732|CHC13|80368||04/01/2015|12/31/9999|$65.00|0|0|0|%|SEDATIVE HYPNOTICS|| 58-1699775|1326041732|CHC13|80369||04/01/2015|12/31/9999|$65.00|0|0|0|%|SKELETAL MUSCLE RELAXANT 1/2|| 58-1699775|1326041732|CHC13|80370||04/01/2015|12/31/9999|$65.00|0|0|0|%|SKEL MUSC RELAXANT 3 OR MORE|| 58-1699775|1326041732|CHC13|80371||04/01/2015|12/31/9999|$65.00|0|0|0|%|STIMULANTS SYNTHETIC|| 58-1699775|1326041732|CHC13|80372||04/01/2015|12/31/9999|$65.00|0|0|0|%|DRUG SCREENING TAPENTADOL|| 58-1699775|1326041732|CHC13|80373||04/01/2015|12/31/9999|$65.00|0|0|0|%|DRUG SCREENING TRAMADOL|| 58-1699775|1326041732|CHC13|80374||04/01/2015|12/31/9999|$65.00|0|0|0|%|STEREOISOMER ANALYSIS|| 58-1699775|1326041732|CHC13|80375||04/01/2015|12/31/9999|$65.00|0|0|0|%|DRUG/SUBSTANCE NOS 1-3|| 58-1699775|1326041732|CHC13|80376||04/01/2015|12/31/9999|$65.00|0|0|0|%|DRUG/SUBSTANCE NOS 4-6|| 58-1699775|1326041732|CHC13|80377||04/01/2015|12/31/9999|$65.00|0|0|0|%|DRUG/SUBSTANCE NOS 7/MORE|| 58-1699775|1326041732|CHC13|80400||11/01/2013|12/31/9999|$60.06|0|0|||ACTH STIMULATION PANEL|| 58-1699775|1326041732|CHC13|80402||11/01/2013|12/31/9999|$160.11|0|0|||ACTH STIMULATION PANEL|| 58-1699775|1326041732|CHC13|80406||11/01/2013|12/31/9999|$144.09|0|0|||ACTH STIMULATION PANEL|| 58-1699775|1326041732|CHC13|80408||11/01/2013|12/31/9999|$231.06|0|0|||ALDOSTERONE SUPPRESSION EVAL|| 58-1699775|1326041732|CHC13|80410||11/01/2013|12/31/9999|$147.93|0|0|||CALCITONIN STIMUL PANEL|| 58-1699775|1326041732|CHC13|80412||11/01/2013|12/31/9999|$606.92|0|0|||CRH STIMULATION PANEL|| 58-1699775|1326041732|CHC13|80414||11/01/2013|12/31/9999|$95.08|0|0|||TESTOSTERONE RESPONSE|| 58-1699775|1326041732|CHC13|80415||11/01/2013|12/31/9999|$102.91|0|0|||ESTRADIOL RESPONSE PANEL|| 58-1699775|1326041732|CHC13|80416||11/01/2013|12/31/9999|$242.97|0|0|||RENIN STIMULATION PANEL|| 58-1699775|1326041732|CHC13|80417||11/01/2013|12/31/9999|$80.99|0|0|||RENIN STIMULATION PANEL|| 58-1699775|1326041732|CHC13|80418||11/01/2013|12/31/9999|$1|049.20|0|0|||PITUITARY EVALUATION PANEL|| 58-1699775|1326041732|CHC13|80420||11/01/2013|12/31/9999|$132.65|0|0|||DEXAMETHASONE PANEL|| 58-1699775|1326041732|CHC13|80422||11/01/2013|12/31/9999|$84.83|0|0|||GLUCAGON TOLERANCE PANEL|| 58-1699775|1326041732|CHC13|80424||11/01/2013|12/31/9999|$92.98|0|0|||GLUCAGON TOLERANCE PANEL|| 58-1699775|1326041732|CHC13|80426||11/01/2013|12/31/9999|$273.26|0|0|||GONADOTROPIN HORMONE PANEL|| 58-1699775|1326041732|CHC13|80428||11/01/2013|12/31/9999|$104.83|0|0|||GROWTH HORMONE PANEL|| 58-1699775|1326041732|CHC13|80430||11/01/2013|12/31/9999|$126.52|0|0|||GROWTH HORMONE PANEL|| 58-1699775|1326041732|CHC13|80432||11/01/2013|12/31/9999|$203.50|0|0|||INSULIN SUPPRESSION PANEL|| 58-1699775|1326041732|CHC13|80434||11/01/2013|12/31/9999|$186.29|0|0|||INSULIN TOLERANCE PANEL|| 58-1699775|1326041732|CHC13|80435||11/01/2013|12/31/9999|$167.18|0|0|||INSULIN TOLERANCE PANEL|| 58-1699775|1326041732|CHC13|80436||11/01/2013|12/31/9999|$167.86|0|0|||METYRAPONE PANEL|| 58-1699775|1326041732|CHC13|80438||11/01/2013|12/31/9999|$92.82|0|0|||TRH STIMULATION PANEL|| 58-1699775|1326041732|CHC13|80439||11/01/2013|12/31/9999|$123.76|0|0|||TRH STIMULATION PANEL|| 58-1699775|1326041732|CHC13|80500||11/01/2013|12/31/9999|$22.37|0|0|||LAB PATHOLOGY CONSULTATION|| 58-1699775|1326041732|CHC13|80502||11/01/2013|12/31/9999|$77.62|0|0|||LAB PATHOLOGY CONSULTATION|| 58-1699775|1326041732|CHC13|81000||11/01/2013|12/31/9999|$5.82|0|0|||URINALYSIS| NONAUTO W/SCOPE|| 58-1699775|1326041732|CHC13|81001||11/01/2013|12/31/9999|$5.82|0|0|||URINALYSIS| AUTO W/SCOPE|| 58-1699775|1326041732|CHC13|81002||11/01/2013|12/31/9999|$4.71|0|0|||URINALYSIS NONAUTO W/O SCOPE|| 58-1699775|1326041732|CHC13|81003||11/01/2013|12/31/9999|$4.13|0|0|||URINALYSIS| AUTO| W/O SCOPE|| 58-1699775|1326041732|CHC13|81005||11/01/2013|12/31/9999|$3.99|0|0|||URINALYSIS|| 58-1699775|1326041732|CHC13|81007||11/01/2013|12/31/9999|$4.72|0|0|||URINE SCREEN FOR BACTERIA|| 58-1699775|1326041732|CHC13|81015||11/01/2013|12/31/9999|$5.60|0|0|||MICROSCOPIC EXAM OF URINE|| 58-1699775|1326041732|CHC13|81020||11/01/2013|12/31/9999|$6.79|0|0|||URINALYSIS| GLASS TEST|| 58-1699775|1326041732|CHC13|81025||11/01/2013|12/31/9999|$11.65|0|0|||URINE PREGNANCY TEST|| 58-1699775|1326041732|CHC13|81050||11/01/2013|12/31/9999|$5.53|0|0|||URINALYSIS| VOLUME MEASURE|| 58-1699775|1326041732|CHC13|81099||11/01/2013|12/31/9999|$0.00|0|0|||URINALYSIS TEST PROCEDURE|| 58-1699775|1326041732|CHC13|81105||04/01/2018|12/31/9999|$248.97|0|0|0||HPA-1 GENOTYPING|| 58-1699775|1326041732|CHC13|81106||04/01/2018|12/31/9999|$248.97|0|0|0||HPA-2 GENOTYPING|| 58-1699775|1326041732|CHC13|81107||04/01/2018|12/31/9999|$248.97|0|0|0||HPA-3 GENOTYPING|| 58-1699775|1326041732|CHC13|81108||04/01/2018|12/31/9999|$248.97|0|0|0||HPA-4 GENOTYPING|| 58-1699775|1326041732|CHC13|81109||04/01/2018|12/31/9999|$248.97|0|0|0||HPA-5 GENOTYPING|| 58-1699775|1326041732|CHC13|81110||04/01/2018|12/31/9999|$248.97|0|0|0||HPA-6 GENOTYPING|| 58-1699775|1326041732|CHC13|81111||04/01/2018|12/31/9999|$248.97|0|0|0||HPA-9 GENOTYPING|| 58-1699775|1326041732|CHC13|81112||04/01/2018|12/31/9999|$248.97|0|0|0||HPA-15 GENOTYPING|| 58-1699775|1326041732|CHC13|81120||04/01/2018|12/31/9999|$318.86|0|0|0||IDH1 COMMON VARIANTS|| 58-1699775|1326041732|CHC13|81121||04/01/2018|12/31/9999|$488.05|0|0|0||IDH2 COMMON VARIANTS|| 58-1699775|1326041732|CHC13|81162||04/01/2016|12/31/9999|$158.46|0|0|0||BRCA1&2 SEQ & FULL DUP/DEL|| 58-1699775|1326041732|CHC13|81170||04/01/2016|12/31/9999|$3|231.62|0|0|0||ABL1 GENE|| 58-1699775|1326041732|CHC13|81175||04/01/2018|12/31/9999|$1|166.58|0|0|0||ASXL1 FULL GENE SEQUENCE|| 58-1699775|1326041732|CHC13|81176||04/01/2018|12/31/9999|$492.76|0|0|0||ASXL1 GENE TARGET SEQ ALYS|| 58-1699775|1326041732|CHC13|81200||11/01/2013|12/31/9999|$159.90|0|0|||ASPA GENE|| 58-1699775|1326041732|CHC13|81201||11/01/2013|12/31/9999|$159.90|0|0|||APC GENE FULL SEQUENCE|| 58-1699775|1326041732|CHC13|81202||11/01/2013|12/31/9999|$159.90|0|0|||APC GENE KNOWN FAM VARIANTS|| 58-1699775|1326041732|CHC13|81203||11/01/2013|12/31/9999|$159.90|0|0|||APC GENE DUP/DELET VARIANTS|| 58-1699775|1326041732|CHC13|81218||04/01/2016|12/31/9999|$158.46|0|0|0||CEBPA GENE FULL SEQUENCE|| 58-1699775|1326041732|CHC13|81219||04/01/2016|12/31/9999|$158.46|0|0|0||CALR GENE COM VARIANTS|| 58-1699775|1326041732|CHC13|81220||01/01/2017|12/31/9999|$600.00|0|0|||CFTR GENE COM VARIANTS|| 58-1699775|1326041732|CHC13|81230||04/01/2018|12/31/9999|$288.44|0|0|0||CYP3A4 GENE COMMON VARIANTS|| 58-1699775|1326041732|CHC13|81231||04/01/2018|12/31/9999|$288.44|0|0|0||CYP3A5 GENE COMMON VARIANTS|| 58-1699775|1326041732|CHC13|81232||04/01/2018|12/31/9999|$288.44|0|0|0||DPYD GENE COMMON VARIANTS|| 58-1699775|1326041732|CHC13|81235||11/01/2013|12/31/9999|$159.90|0|0|||EGFR GENE COM VARIANTS|| 58-1699775|1326041732|CHC13|81238||04/01/2018|12/31/9999|$990.00|0|0|0||F9 FULL GENE SEQUENCE|| 58-1699775|1326041732|CHC13|81246||04/01/2015|12/31/9999|$65.00|0|0|0|%|FLT3 GENE ANALYSIS|| 58-1699775|1326041732|CHC13|81247||04/01/2018|12/31/9999|$288.44|0|0|0||G6PD GENE ALYS CMN VARIANT|| 58-1699775|1326041732|CHC13|81248||04/01/2018|12/31/9999|$619.16|0|0|0||G6PD KNOWN FAMILIAL VARIANT|| 58-1699775|1326041732|CHC13|81249||04/01/2018|12/31/9999|$990.00|0|0|0||G6PD FULL GENE SEQUENCE|| 58-1699775|1326041732|CHC13|81252||11/01/2013|12/31/9999|$159.90|0|0|||GJB2 GENE FULL SEQUENCE|| 58-1699775|1326041732|CHC13|81253||11/01/2013|12/31/9999|$159.90|0|0|||GJB2 GENE KNOWN FAM VARIANTS|| 58-1699775|1326041732|CHC13|81254||11/01/2013|12/31/9999|$159.90|0|0|||GJB6 GENE COM VARIANTS|| 58-1699775|1326041732|CHC13|81258||04/01/2018|12/31/9999|$619.16|0|0|0||HBA1/HBA2 GENE FAM VRNT|| 58-1699775|1326041732|CHC13|81259||04/01/2018|12/31/9999|$990.00|0|0|0||HBA1/HBA2 FULL GENE SEQUENCE|| 58-1699775|1326041732|CHC13|81269||04/01/2018|12/31/9999|$333.96|0|0|0||HBA1/HBA2 GENE DUP/DEL VRNTS|| 58-1699775|1326041732|CHC13|81272||04/01/2016|12/31/9999|$158.46|0|0|0||KIT GENE TARGETED SEQ ANALYS|| 58-1699775|1326041732|CHC13|81273||04/01/2016|12/31/9999|$115.96|0|0|0||KIT GENE ANALYS D816 VARIANT|| 58-1699775|1326041732|CHC13|81276||04/01/2016|12/31/9999|$256.35|0|0|0||KRAS GENE ADDL VARIANTS|| 58-1699775|1326041732|CHC13|81283||04/01/2018|12/31/9999|$124.48|0|0|0||IFNL3 GENE|| 58-1699775|1326041732|CHC13|81287||04/01/2014|12/31/9999|$78.00|0|0|||MGMT GENE METHYLATION ANAL|| 58-1699775|1326041732|CHC13|81288||04/01/2015|12/31/9999|$65.00|0|0|0|%|MLH1 GENE|| 58-1699775|1326041732|CHC13|81311||04/01/2016|12/31/9999|$384.53|0|0|0||NRAS GENE VARIANTS EXON 2&3|| 58-1699775|1326041732|CHC13|81313||04/01/2015|12/31/9999|$65.00|0|0|0|%|PCA3/KLK3 ANTIGEN|| 58-1699775|1326041732|CHC13|81314||04/01/2016|12/31/9999|$158.46|0|0|0||PDGFRA GENE|| 58-1699775|1326041732|CHC13|81321||11/01/2013|12/31/9999|$159.90|0|0|||PTEN GENE FULL SEQUENCE|| 58-1699775|1326041732|CHC13|81322||11/01/2013|12/31/9999|$159.90|0|0|||PTEN GENE KNOWN FAM VARIANT|| 58-1699775|1326041732|CHC13|81327||04/01/2017|12/31/9999|$108.77|0|108.77|0||SEPT9 METHYLATION ANALYSIS|| 58-1699775|1326041732|CHC13|81328||04/01/2018|12/31/9999|$288.44|0|0|0||SLCO1B1 GENE COM VARIANTS|| 58-1699775|1326041732|CHC13|81334||04/01/2018|12/31/9999|$543.69|0|0|0||RUNX1 GENE TARGETED SEQ ALYS|| 58-1699775|1326041732|CHC13|81335||04/01/2018|12/31/9999|$288.44|0|0|0||TPMT GENE COM VARIANTS|| 58-1699775|1326041732|CHC13|81346||04/01/2018|12/31/9999|$288.44|0|0|0||TYMS GENE COM VARIANTS|| 58-1699775|1326041732|CHC13|81361||04/01/2018|12/31/9999|$288.44|0|0|0||HBB GENE COM VARIANTS|| 58-1699775|1326041732|CHC13|81362||04/01/2018|12/31/9999|$619.16|0|0|0||HBB GENE KNOWN FAM VARIANT|| 58-1699775|1326041732|CHC13|81363||04/01/2018|12/31/9999|$333.96|0|0|0||HBB GENE DUP/DEL VARIANTS|| 58-1699775|1326041732|CHC13|81364||04/01/2018|12/31/9999|$535.56|0|0|0||HBB FULL GENE SEQUENCE|| 58-1699775|1326041732|CHC13|81371||04/01/2014|12/31/9999|$426.87|0|0|||HLA I & II TYPE VERIFY LR|| 58-1699775|1326041732|CHC13|81376||04/01/2014|12/31/9999|$216.76|0|0|||HLA II TYPING 1 LOCUS LR|| 58-1699775|1326041732|CHC13|81382||04/01/2014|12/31/9999|$219.35|0|0|||HLA II TYPING 1 LOC HR|| 58-1699775|1326041732|CHC13|81400||04/01/2014|12/31/9999|$159.90|0|0|||MOPATH PROCEDURE LEVEL 1|| 58-1699775|1326041732|CHC13|81401||04/01/2014|12/31/9999|$182.00|0|0|||MOPATH PROCEDURE LEVEL 2|| 58-1699775|1326041732|CHC13|81402||04/01/2014|12/31/9999|$266.50|0|0|||MOPATH PROCEDURE LEVEL 3|| 58-1699775|1326041732|CHC13|81403||04/01/2014|12/31/9999|$305.50|0|0|||MOPATH PROCEDURE LEVEL 4|| 58-1699775|1326041732|CHC13|81405||04/01/2014|12/31/9999|$585.00|0|0|||MOPATH PROCEDURE LEVEL 6|| 58-1699775|1326041732|CHC13|81406||04/01/2014|12/31/9999|$845.00|0|0|||MOPATH PROCEDURE LEVEL 7|| 58-1699775|1326041732|CHC13|81407||04/01/2014|12/31/9999|$1|235.00|0|0|||MOPATH PROCEDURE LEVEL 8|| 58-1699775|1326041732|CHC13|81408||04/01/2014|12/31/9999|$2|145.00|0|0|||MOPATH PROCEDURE LEVEL 9|| 58-1699775|1326041732|CHC13|81410||04/01/2015|12/31/9999|$65.00|0|0|0|%|AORTIC DYSFUNCTION/DILATION|| 58-1699775|1326041732|CHC13|81411||04/01/2015|12/31/9999|$65.00|0|0|0|%|AORTIC DYSFUNCTION/DILATION|| 58-1699775|1326041732|CHC13|81412||04/01/2016|12/31/9999|$0.00|0|0|0||ASHKENAZI JEWISH ASSOC DIS|| 58-1699775|1326041732|CHC13|81413||04/01/2017|12/31/9999|$1|043.03|0|1043.03|0||CAR ION CHNNLPATH INC 10 GNS|| 58-1699775|1326041732|CHC13|81414||04/01/2017|12/31/9999|$1|043.03|0|1043.03|0||CAR ION CHNNLPATH INC 2 GNS|| 58-1699775|1326041732|CHC13|81415||04/01/2015|12/31/9999|$65.00|0|0|0|%|EXOME SEQUENCE ANALYSIS|| 58-1699775|1326041732|CHC13|81416||04/01/2015|12/31/9999|$65.00|0|0|0|%|EXOME SEQUENCE ANALYSIS|| 58-1699775|1326041732|CHC13|81417||04/01/2015|12/31/9999|$65.00|0|0|0|%|EXOME RE-EVALUATION|| 58-1699775|1326041732|CHC13|81420||04/01/2015|12/31/9999|$65.00|0|0|0|%|FETAL CHRMOML ANEUPLOIDY|| 58-1699775|1326041732|CHC13|81422||04/01/2017|12/31/9999|$1|043.03|0|1043.03|0||FETAL CHRMOML MICRODELTJ|| 58-1699775|1326041732|CHC13|81425||04/01/2015|12/31/9999|$65.00|0|0|0|%|GENOME SEQUENCE ANALYSIS|| 58-1699775|1326041732|CHC13|81426||04/01/2015|12/31/9999|$65.00|0|0|0|%|GENOME SEQUENCE ANALYSIS|| 58-1699775|1326041732|CHC13|81427||04/01/2015|12/31/9999|$65.00|0|0|0|%|GENOME RE-EVALUATION|| 58-1699775|1326041732|CHC13|81430||04/01/2015|12/31/9999|$65.00|0|0|0|%|HEARING LOSS SEQUENCE ANALYS|| 58-1699775|1326041732|CHC13|81431||04/01/2015|12/31/9999|$65.00|0|0|0|%|HEARING LOSS DUP/DEL ANALYS|| 58-1699775|1326041732|CHC13|81432||04/01/2016|12/31/9999|$0.00|0|0|0||HRDTRY BRST CA-RLATD DSORDRS|| 58-1699775|1326041732|CHC13|81433||04/01/2016|12/31/9999|$0.00|0|0|0||HRDTRY BRST CA-RLATD DSORDRS|| 58-1699775|1326041732|CHC13|81434||04/01/2016|12/31/9999|$0.00|0|0|0||HEREDITARY RETINAL DISORDERS|| 58-1699775|1326041732|CHC13|81435||04/01/2015|12/31/9999|$65.00|0|0|0|%|HEREDITARY COLON CANCER|| 58-1699775|1326041732|CHC13|81436||04/01/2015|12/31/9999|$65.00|0|0|0|%|HEREDITARY COLON CA SYND|| 58-1699775|1326041732|CHC13|81437||04/01/2016|12/31/9999|$0.00|0|0|0||HEREDTRY NURONDCRN TUM DSRDR|| 58-1699775|1326041732|CHC13|81438||04/01/2016|12/31/9999|$0.00|0|0|0||HEREDTRY NURONDCRN TUM DSRDR|| 58-1699775|1326041732|CHC13|81439||04/01/2017|12/31/9999|$1|043.03|0|1043.03|0||INHERITED CARDMYPTHY 5 GNS|| 58-1699775|1326041732|CHC13|81440||04/01/2015|12/31/9999|$65.00|0|0|0|%|MITOCHONDRIAL GENE|| 58-1699775|1326041732|CHC13|81442||04/01/2016|12/31/9999|$0.00|0|0|0||NOONAN SPECTRUM DISORDERS|| 58-1699775|1326041732|CHC13|81445||04/01/2015|12/31/9999|$65.00|0|0|0|%|TARGETED GENOMIC SEQ ANALYS|| 58-1699775|1326041732|CHC13|81448||04/01/2018|12/31/9999|$1|191.47|0|0|0||HRDTRY PERPH NEURPHY PANEL|| 58-1699775|1326041732|CHC13|81450||04/01/2015|12/31/9999|$65.00|0|0|0|%|TARGETED GENOMIC SEQ ANALYS|| 58-1699775|1326041732|CHC13|81455||04/01/2015|12/31/9999|$65.00|0|0|0|%|TARGETED GENOMIC SEQ ANALYS|| 58-1699775|1326041732|CHC13|81460||04/01/2015|12/31/9999|$65.00|0|0|0|%|WHOLE MITOCHONDRIAL GENOME|| 58-1699775|1326041732|CHC13|81465||04/01/2015|12/31/9999|$65.00|0|0|0|%|WHOLE MITOCHONDRIAL GENOME|| 58-1699775|1326041732|CHC13|81470||04/01/2015|12/31/9999|$65.00|0|0|0|%|X-LINKED INTELLECTUAL DBLT|| 58-1699775|1326041732|CHC13|81471||04/01/2015|12/31/9999|$65.00|0|0|0|%|X-LINKED INTELLECTUAL DBLT|| 58-1699775|1326041732|CHC13|81490||04/01/2016|12/31/9999|$0.00|0|0|0||AUTOIMMUNE RHEUMATOID ARTHR|| 58-1699775|1326041732|CHC13|81493||04/01/2016|12/31/9999|$0.00|0|0|0||COR ARTERY DISEASE MRNA|| 58-1699775|1326041732|CHC13|81519||04/01/2015|12/31/9999|$65.00|0|0|0|%|ONCOLOGY BREAST MRNA|| 58-1699775|1326041732|CHC13|81520||04/01/2018|12/31/9999|$5|113.38|0|0|0||ONC BREAST MRNA 58 GENES|| 58-1699775|1326041732|CHC13|81521||04/01/2018|12/31/9999|$6|390.45|0|0|0||ONC BREAST MRNA 70 GENES|| 58-1699775|1326041732|CHC13|81525||04/01/2016|12/31/9999|$0.00|0|0|0||ONCOLOGY COLON MRNA|| 58-1699775|1326041732|CHC13|81528||04/01/2016|12/31/9999|$499.28|0|0|0||ONCOLOGY COLORECTAL SCR|| 58-1699775|1326041732|CHC13|81535||04/01/2016|12/31/9999|$753.30|0|0|0||ONCOLOGY GYNECOLOGIC|| 58-1699775|1326041732|CHC13|81536||04/01/2016|12/31/9999|$195.75|0|0|0||ONCOLOGY GYNECOLOGIC|| 58-1699775|1326041732|CHC13|81538||04/01/2016|12/31/9999|$0.00|0|0|0||ONCOLOGY LUNG|| 58-1699775|1326041732|CHC13|81539||04/01/2017|12/31/9999|$782.73|0|782.73|0||ONCOLOGY PROSTATE PROB SCORE|| 58-1699775|1326041732|CHC13|81540||04/01/2016|12/31/9999|$0.00|0|0|0||ONCOLOGY TUM UNKNOWN ORIGIN|| 58-1699775|1326041732|CHC13|81541||04/01/2018|12/31/9999|$6|390.45|0|0|0||ONC PROSTATE MRNA 46 GENES|| 58-1699775|1326041732|CHC13|81545||04/01/2016|12/31/9999|$0.00|0|0|0||ONCOLOGY THYROID|| 58-1699775|1326041732|CHC13|81595||04/01/2016|12/31/9999|$0.00|0|0|0||CARDIOLOGY HRT TRNSPL MRNA|| 58-1699775|1326041732|CHC13|82009||11/01/2013|12/31/9999|$6.06|0|0|||TEST FOR ACETONE/KETONES|| 58-1699775|1326041732|CHC13|82010||11/01/2013|12/31/9999|$15.04|0|0|||ACETONE ASSAY|| 58-1699775|1326041732|CHC13|82013||11/01/2013|12/31/9999|$20.57|0|0|||ACETYLCHOLINESTERASE ASSAY|| 58-1699775|1326041732|CHC13|82016||11/01/2013|12/31/9999|$25.52|0|0|||ACYLCARNITINES| QUAL|| 58-1699775|1326041732|CHC13|82017||11/01/2013|12/31/9999|$31.06|0|0|||ACYLCARNITINES| QUANT|| 58-1699775|1326041732|CHC13|82024||11/01/2013|12/31/9999|$71.12|0|0|||ASSAY OF ACTH|| 58-1699775|1326041732|CHC13|82030||11/01/2013|12/31/9999|$47.50|0|0|||ASSAY OF ADP & AMP|| 58-1699775|1326041732|CHC13|82040||11/01/2013|12/31/9999|$5.30|0|0|||ASSAY OF SERUM ALBUMIN|| 58-1699775|1326041732|CHC13|82042||11/01/2013|12/31/9999|$9.53|0|0|||ASSAY OF URINE ALBUMIN|| 58-1699775|1326041732|CHC13|82043||11/01/2013|12/31/9999|$10.65|0|0|||MICROALBUMIN| QUANTITATIVE|| 58-1699775|1326041732|CHC13|82044||11/01/2013|12/31/9999|$8.42|0|0|||MICROALBUMIN| SEMIQUANT|| 58-1699775|1326041732|CHC13|82045||11/01/2013|12/31/9999|$62.50|0|0|||ALBUMIN| ISCHEMIA MODIFIED|| 58-1699775|1326041732|CHC13|82075||11/01/2013|12/31/9999|$22.19|0|0|||ASSAY OF BREATH ETHANOL|| 58-1699775|1326041732|CHC13|82085||11/01/2013|12/31/9999|$17.88|0|0|||ASSAY OF ALDOLASE|| 58-1699775|1326041732|CHC13|82088||11/01/2013|12/31/9999|$75.04|0|0|||ASSAY OF ALDOSTERONE|| 58-1699775|1326041732|CHC13|82103||11/01/2013|12/31/9999|$24.74|0|0|||ALPHA-1-ANTITRYPSIN| TOTAL|| 58-1699775|1326041732|CHC13|82104||11/01/2013|12/31/9999|$26.62|0|0|||ALPHA-1-ANTITRYPSIN| PHENO|| 58-1699775|1326041732|CHC13|82105||11/01/2013|12/31/9999|$30.89|0|0|||ALPHA-FETOPROTEIN| SERUM|| 58-1699775|1326041732|CHC13|82106||11/01/2013|12/31/9999|$30.89|0|0|||ALPHA-FETOPROTEIN| AMNIOTIC|| 58-1699775|1326041732|CHC13|82107||11/01/2013|12/31/9999|$118.60|0|0|||ALPHA-FETOPROTEIN L3|| 58-1699775|1326041732|CHC13|82108||11/01/2013|12/31/9999|$31.03|0|0|||ASSAY OF ALUMINUM|| 58-1699775|1326041732|CHC13|82120||11/01/2013|12/31/9999|$4.45|0|0|||AMINES| VAGINAL FLUID QUAL|| 58-1699775|1326041732|CHC13|82127||11/01/2013|12/31/9999|$25.52|0|0|||AMINO ACID| SINGLE QUAL|| 58-1699775|1326041732|CHC13|82128||11/01/2013|12/31/9999|$25.52|0|0|||AMINO ACIDS| MULT QUAL|| 58-1699775|1326041732|CHC13|82131||11/01/2013|12/31/9999|$31.06|0|0|||AMINO ACIDS| SINGLE QUANT|| 58-1699775|1326041732|CHC13|82135||11/01/2013|12/31/9999|$30.30|0|0|||ASSAY| AMINOLEVULINIC ACID|| 58-1699775|1326041732|CHC13|82136||11/01/2013|12/31/9999|$31.06|0|0|||AMINO ACIDS| QUANT| 2-5|| 58-1699775|1326041732|CHC13|82139||11/01/2013|12/31/9999|$31.06|0|0|||AMINO ACIDS| QUAN| 6 OR MORE|| 58-1699775|1326041732|CHC13|82140||11/01/2013|12/31/9999|$18.21|0|0|||ASSAY OF AMMONIA|| 58-1699775|1326041732|CHC13|82143||11/01/2013|12/31/9999|$12.65|0|0|||AMNIOTIC FLUID SCAN|| 58-1699775|1326041732|CHC13|82150||11/01/2013|12/31/9999|$11.93|0|0|||ASSAY OF AMYLASE|| 58-1699775|1326041732|CHC13|82154||11/01/2013|12/31/9999|$53.09|0|0|||ANDROSTANEDIOL GLUCURONIDE|| 58-1699775|1326041732|CHC13|82157||11/01/2013|12/31/9999|$53.90|0|0|||ASSAY OF ANDROSTENEDIONE|| 58-1699775|1326041732|CHC13|82160||11/01/2013|12/31/9999|$46.05|0|0|||ASSAY OF ANDROSTERONE|| 58-1699775|1326041732|CHC13|82163||11/01/2013|12/31/9999|$37.79|0|0|||ASSAY OF ANGIOTENSIN II|| 58-1699775|1326041732|CHC13|82164||11/01/2013|12/31/9999|$26.88|0|0|||ANGIOTENSIN I ENZYME TEST|| 58-1699775|1326041732|CHC13|82172||11/01/2013|12/31/9999|$28.54|0|0|||ASSAY OF APOLIPOPROTEIN|| 58-1699775|1326041732|CHC13|82175||11/01/2013|12/31/9999|$34.93|0|0|||ASSAY OF ARSENIC|| 58-1699775|1326041732|CHC13|82180||11/01/2013|12/31/9999|$16.26|0|0|||ASSAY OF ASCORBIC ACID|| 58-1699775|1326041732|CHC13|82190||11/01/2013|12/31/9999|$27.44|0|0|||ATOMIC ABSORPTION|| 58-1699775|1326041732|CHC13|82232||11/01/2013|12/31/9999|$29.78|0|0|||ASSAY OF BETA-2 PROTEIN|| 58-1699775|1326041732|CHC13|82239||11/01/2013|12/31/9999|$31.54|0|0|||BILE ACIDS| TOTAL|| 58-1699775|1326041732|CHC13|82240||11/01/2013|12/31/9999|$48.93|0|0|||BILE ACIDS| CHOLYLGLYCINE|| 58-1699775|1326041732|CHC13|82247||11/01/2013|12/31/9999|$9.23|0|0|||BILIRUBIN| TOTAL|| 58-1699775|1326041732|CHC13|82248||11/01/2013|12/31/9999|$9.23|0|0|||BILIRUBIN| DIRECT|| 58-1699775|1326041732|CHC13|82252||11/01/2013|12/31/9999|$8.38|0|0|||FECAL BILIRUBIN TEST|| 58-1699775|1326041732|CHC13|82261||11/01/2013|12/31/9999|$31.06|0|0|||ASSAY OF BIOTINIDASE|| 58-1699775|1326041732|CHC13|82270||11/01/2013|12/31/9999|$5.92|0|0|||OCCULT BLOOD| OTHER SOURCES|| 58-1699775|1326041732|CHC13|82271||11/01/2013|12/31/9999|$5.92|0|0|||OCCULT BLOOD| FECES| SINGLE|| 58-1699775|1326041732|CHC13|82272||11/01/2013|12/31/9999|$5.92|0|0|||BLOOD OCCULT PEROXIDASE|| 58-1699775|1326041732|CHC13|82274||11/01/2013|12/31/9999|$29.29|0|0|||ASSAY TEST FOR BLOOD| FECAL|| 58-1699775|1326041732|CHC13|82286||11/01/2013|12/31/9999|$12.69|0|0|||ASSAY OF BRADYKININ|| 58-1699775|1326041732|CHC13|82300||11/01/2013|12/31/9999|$42.61|0|0|||ASSAY OF CADMIUM|| 58-1699775|1326041732|CHC13|82306||11/01/2013|12/31/9999|$54.52|0|0|||ASSAY OF VITAMIN D|| 58-1699775|1326041732|CHC13|82308||11/01/2013|12/31/9999|$49.31|0|0|||ASSAY OF CALCITONIN|| 58-1699775|1326041732|CHC13|82310||11/01/2013|12/31/9999|$9.49|0|0|||ASSAY OF CALCIUM|| 58-1699775|1326041732|CHC13|82330||11/01/2013|12/31/9999|$25.17|0|0|||ASSAY OF CALCIUM|| 58-1699775|1326041732|CHC13|82331||11/01/2013|12/31/9999|$9.53|0|0|||CALCIUM INFUSION TEST|| 58-1699775|1326041732|CHC13|82340||11/01/2013|12/31/9999|$11.10|0|0|||ASSAY OF CALCIUM IN URINE|| 58-1699775|1326041732|CHC13|82355||11/01/2013|12/31/9999|$21.31|0|0|||CALCULUS ANALYSIS| QUAL|| 58-1699775|1326041732|CHC13|82360||11/01/2013|12/31/9999|$23.70|0|0|||CALCULUS ASSAY| QUANT|| 58-1699775|1326041732|CHC13|82365||11/01/2013|12/31/9999|$23.74|0|0|||CALCULUS SPECTROSCOPY|| 58-1699775|1326041732|CHC13|82370||11/01/2013|12/31/9999|$23.07|0|0|||X-RAY ASSAY| CALCULUS|| 58-1699775|1326041732|CHC13|82373||11/01/2013|12/31/9999|$11.05|0|0|||ASSAY| C-D TRANSFER MEASURE|| 58-1699775|1326041732|CHC13|82374||11/01/2013|12/31/9999|$9.01|0|0|||ASSAY| BLOOD CARBON DIOXIDE|| 58-1699775|1326041732|CHC13|82375||11/01/2013|12/31/9999|$5.30|0|0|||ASSAY| BLOOD CARBON MONOXIDE|| 58-1699775|1326041732|CHC13|82376||11/01/2013|12/31/9999|$11.04|0|0|||TEST FOR CARBON MONOXIDE|| 58-1699775|1326041732|CHC13|82378||11/01/2013|12/31/9999|$34.93|0|0|||CARCINOEMBRYONIC ANTIGEN|| 58-1699775|1326041732|CHC13|82379||11/01/2013|12/31/9999|$31.06|0|0|||ASSAY OF CARNITINE|| 58-1699775|1326041732|CHC13|82380||11/01/2013|12/31/9999|$16.98|0|0|||ASSAY OF CAROTENE|| 58-1699775|1326041732|CHC13|82382||11/01/2013|12/31/9999|$31.66|0|0|||ASSAY| URINE CATECHOLAMINES|| 58-1699775|1326041732|CHC13|82383||11/01/2013|12/31/9999|$46.14|0|0|||ASSAY| BLOOD CATECHOLAMINES|| 58-1699775|1326041732|CHC13|82384||11/01/2013|12/31/9999|$46.49|0|0|||ASSAY| THREE CATECHOLAMINES|| 58-1699775|1326041732|CHC13|82387||11/01/2013|12/31/9999|$38.31|0|0|||ASSAY OF CATHEPSIN-D|| 58-1699775|1326041732|CHC13|82390||11/01/2013|12/31/9999|$19.77|0|0|||ASSAY OF CERULOPLASMIN|| 58-1699775|1326041732|CHC13|82397||11/01/2013|12/31/9999|$26.01|0|0|||CHEMILUMINESCENT ASSAY|| 58-1699775|1326041732|CHC13|82415||11/01/2013|12/31/9999|$23.34|0|0|||ASSAY OF CHLORAMPHENICOL|| 58-1699775|1326041732|CHC13|82435||11/01/2013|12/31/9999|$8.46|0|0|||ASSAY OF BLOOD CHLORIDE|| 58-1699775|1326041732|CHC13|82436||11/01/2013|12/31/9999|$9.26|0|0|||ASSAY OF URINE CHLORIDE|| 58-1699775|1326041732|CHC13|82438||11/01/2013|12/31/9999|$9.01|0|0|||ASSAY| OTHER FLUID CHLORIDES|| 58-1699775|1326041732|CHC13|82441||11/01/2013|12/31/9999|$11.05|0|0|||TEST FOR CHLOROHYDROCARBONS|| 58-1699775|1326041732|CHC13|82465||11/01/2013|12/31/9999|$8.01|0|0|||ASSAY| BLD/SERUM CHOLESTEROL|| 58-1699775|1326041732|CHC13|82480||11/01/2013|12/31/9999|$14.51|0|0|||ASSAY| SERUM CHOLINESTERASE|| 58-1699775|1326041732|CHC13|82482||11/01/2013|12/31/9999|$14.14|0|0|||ASSAY| RBC CHOLINESTERASE|| 58-1699775|1326041732|CHC13|82485||11/01/2013|12/31/9999|$38.02|0|0|||ASSAY| CHONDROITIN SULFATE|| 58-1699775|1326041732|CHC13|82495||11/01/2013|12/31/9999|$37.35|0|0|||ASSAY OF CHROMIUM|| 58-1699775|1326041732|CHC13|82507||11/01/2013|12/31/9999|$51.19|0|0|||ASSAY OF CITRATE|| 58-1699775|1326041732|CHC13|82523||11/01/2013|12/31/9999|$34.42|0|0|||COLLAGEN CROSSLINKS|| 58-1699775|1326041732|CHC13|82525||11/01/2013|12/31/9999|$22.85|0|0|||ASSAY OF COPPER|| 58-1699775|1326041732|CHC13|82528||11/01/2013|12/31/9999|$41.46|0|0|||ASSAY OF CORTICOSTERONE|| 58-1699775|1326041732|CHC13|82530||11/01/2013|12/31/9999|$30.77|0|0|||CORTISOL| FREE|| 58-1699775|1326041732|CHC13|82533||11/01/2013|12/31/9999|$30.03|0|0|||TOTAL CORTISOL|| 58-1699775|1326041732|CHC13|82540||11/01/2013|12/31/9999|$8.53|0|0|||ASSAY OF CREATINE|| 58-1699775|1326041732|CHC13|82542||11/01/2013|12/31/9999|$11.05|0|0|||COLUMN CHROMOTOGRAPHY| QUANT|| 58-1699775|1326041732|CHC13|82550||11/01/2013|12/31/9999|$12.00|0|0|||ASSAY OF CK (CPK)|| 58-1699775|1326041732|CHC13|82552||11/01/2013|12/31/9999|$24.67|0|0|||ASSAY OF CPK IN BLOOD|| 58-1699775|1326041732|CHC13|82553||11/01/2013|12/31/9999|$21.26|0|0|||CREATINE| MB FRACTION|| 58-1699775|1326041732|CHC13|82554||11/01/2013|12/31/9999|$21.85|0|0|||CREATINE| ISOFORMS|| 58-1699775|1326041732|CHC13|82565||11/01/2013|12/31/9999|$9.44|0|0|||ASSAY OF CREATININE|| 58-1699775|1326041732|CHC13|82570||11/01/2013|12/31/9999|$9.53|0|0|||ASSAY OF URINE CREATININE|| 58-1699775|1326041732|CHC13|82575||11/01/2013|12/31/9999|$17.41|0|0|||CREATININE CLEARANCE TEST|| 58-1699775|1326041732|CHC13|82585||11/01/2013|12/31/9999|$15.79|0|0|||ASSAY OF CRYOFIBRINOGEN|| 58-1699775|1326041732|CHC13|82595||11/01/2013|12/31/9999|$11.92|0|0|||ASSAY OF CRYOGLOBULIN|| 58-1699775|1326041732|CHC13|82600||11/01/2013|12/31/9999|$35.72|0|0|||ASSAY OF CYANIDE|| 58-1699775|1326041732|CHC13|82607||11/01/2013|12/31/9999|$27.76|0|0|||VITAMIN B-12|| 58-1699775|1326041732|CHC13|82608||11/01/2013|12/31/9999|$26.36|0|0|||B-12 BINDING CAPACITY|| 58-1699775|1326041732|CHC13|82610||11/01/2013|12/31/9999|$25.02|0|0|||CYSTATIN C|| 58-1699775|1326041732|CHC13|82615||11/01/2013|12/31/9999|$15.03|0|0|||TEST FOR URINE CYSTINES|| 58-1699775|1326041732|CHC13|82626||11/01/2013|12/31/9999|$46.53|0|0|||DEHYDROEPIANDROSTERONE|| 58-1699775|1326041732|CHC13|82627||11/01/2013|12/31/9999|$40.94|0|0|||DEHYDROEPIANDROSTERONE|| 58-1699775|1326041732|CHC13|82633||11/01/2013|12/31/9999|$57.03|0|0|||DESOXYCORTICOSTERONE|| 58-1699775|1326041732|CHC13|82634||11/01/2013|12/31/9999|$53.90|0|0|||DEOXYCORTISOL|| 58-1699775|1326041732|CHC13|82638||11/01/2013|12/31/9999|$22.56|0|0|||ASSAY OF DIBUCAINE NUMBER|| 58-1699775|1326041732|CHC13|82652||11/01/2013|12/31/9999|$70.89|0|0|||ASSAY OF DIHYDROXYVITAMIN D|| 58-1699775|1326041732|CHC13|82656||11/01/2013|12/31/9999|$19.68|0|0|||PANCREATIC ELASTASE| FECAL|| 58-1699775|1326041732|CHC13|82657||11/01/2013|12/31/9999|$11.05|0|0|||ENZYME CELL ACTIVITY|| 58-1699775|1326041732|CHC13|82658||11/01/2013|12/31/9999|$11.05|0|0|||ENZYME CELL ACTIVITY| RA|| 58-1699775|1326041732|CHC13|82664||11/01/2013|12/31/9999|$63.26|0|0|||ELECTROPHORETIC TEST|| 58-1699775|1326041732|CHC13|82668||11/01/2013|12/31/9999|$34.62|0|0|||ASSAY OF ERYTHROPOIETIN|| 58-1699775|1326041732|CHC13|82670||11/01/2013|12/31/9999|$51.45|0|0|||ASSAY OF ESTRADIOL|| 58-1699775|1326041732|CHC13|82671||11/01/2013|12/31/9999|$59.48|0|0|||ASSAY OF ESTROGENS|| 58-1699775|1326041732|CHC13|82672||11/01/2013|12/31/9999|$30.67|0|0|||ASSAY OF ESTROGEN|| 58-1699775|1326041732|CHC13|82677||11/01/2013|12/31/9999|$44.52|0|0|||ASSAY OF ESTRIOL|| 58-1699775|1326041732|CHC13|82679||11/01/2013|12/31/9999|$45.95|0|0|||ASSAY OF ESTRONE|| 58-1699775|1326041732|CHC13|82693||11/01/2013|12/31/9999|$27.43|0|0|||ASSAY OF ETHYLENE GLYCOL|| 58-1699775|1326041732|CHC13|82696||11/01/2013|12/31/9999|$43.42|0|0|||ASSAY OF ETIOCHOLANOLONE|| 58-1699775|1326041732|CHC13|82705||11/01/2013|12/31/9999|$9.37|0|0|||FATS/LIPIDS| FECES| QUAL|| 58-1699775|1326041732|CHC13|82710||11/01/2013|12/31/9999|$30.94|0|0|||FATS/LIPIDS| FECES| QUANT|| 58-1699775|1326041732|CHC13|82715||11/01/2013|12/31/9999|$31.69|0|0|||ASSAY OF FECAL FAT|| 58-1699775|1326041732|CHC13|82725||11/01/2013|12/31/9999|$24.52|0|0|||ASSAY OF BLOOD FATTY ACIDS|| 58-1699775|1326041732|CHC13|82726||11/01/2013|12/31/9999|$11.05|0|0|||LONG CHAIN FATTY ACIDS|| 58-1699775|1326041732|CHC13|82728||11/01/2013|12/31/9999|$25.09|0|0|||ASSAY OF FERRITIN|| 58-1699775|1326041732|CHC13|82731||11/01/2013|12/31/9999|$118.60|0|0|||ASSAY OF FETAL FIBRONECTIN|| 58-1699775|1326041732|CHC13|82735||11/01/2013|12/31/9999|$34.14|0|0|||ASSAY OF FLUORIDE|| 58-1699775|1326041732|CHC13|82746||11/01/2013|12/31/9999|$27.07|0|0|||BLOOD FOLIC ACID SERUM|| 58-1699775|1326041732|CHC13|82747||11/01/2013|12/31/9999|$31.89|0|0|||ASSAY OF FOLIC ACID| RBC|| 58-1699775|1326041732|CHC13|82757||11/01/2013|12/31/9999|$31.93|0|0|||ASSAY OF SEMEN FRUCTOSE|| 58-1699775|1326041732|CHC13|82759||11/01/2013|12/31/9999|$39.56|0|0|||ASSAY OF RBC GALACTOKINASE|| 58-1699775|1326041732|CHC13|82760||11/01/2013|12/31/9999|$20.62|0|0|||ASSAY OF GALACTOSE|| 58-1699775|1326041732|CHC13|82775||11/01/2013|12/31/9999|$38.79|0|0|||ASSAY GALACTOSE TRANSFERASE|| 58-1699775|1326041732|CHC13|82776||11/01/2013|12/31/9999|$15.44|0|0|||GALACTOSE TRANSFERASE TEST|| 58-1699775|1326041732|CHC13|82777||11/01/2013|12/31/9999|$23.14|0|0|||GALECTIN 3|| 58-1699775|1326041732|CHC13|82784||11/01/2013|12/31/9999|$17.12|0|0|||ASSAY OF GAMMAGLOBULIN IGM|| 58-1699775|1326041732|CHC13|82785||11/01/2013|12/31/9999|$30.32|0|0|||ASSAY OF GAMMAGLOBULIN IGE|| 58-1699775|1326041732|CHC13|82787||11/01/2013|12/31/9999|$14.78|0|0|||IGG 1| 2| 3 OR 4| EACH|| 58-1699775|1326041732|CHC13|82800||11/01/2013|12/31/9999|$15.59|0|0|||BLOOD PH|| 58-1699775|1326041732|CHC13|82803||11/01/2013|12/31/9999|$35.62|0|0|||BLOOD GASES: PH| PO2 & PCO2|| 58-1699775|1326041732|CHC13|82805||11/01/2013|12/31/9999|$52.26|0|0|||BLOOD GASES W/02 SATURATION|| 58-1699775|1326041732|CHC13|82810||11/01/2013|12/31/9999|$16.07|0|0|||BLOOD GASES| O2 SAT ONLY|| 58-1699775|1326041732|CHC13|82820||11/01/2013|12/31/9999|$18.41|0|0|||HEMOGLOBIN-OXYGEN AFFINITY|| 58-1699775|1326041732|CHC13|82930||11/01/2013|12/31/9999|$10.05|0|0|||GASTRIC ANALY W/PH EA SPEC|| 58-1699775|1326041732|CHC13|82938||11/01/2013|12/31/9999|$32.58|0|0|||GASTRIN TEST|| 58-1699775|1326041732|CHC13|82941||11/01/2013|12/31/9999|$32.47|0|0|||ASSAY OF GASTRIN|| 58-1699775|1326041732|CHC13|82943||11/01/2013|12/31/9999|$26.31|0|0|||ASSAY OF GLUCAGON|| 58-1699775|1326041732|CHC13|82945||11/01/2013|12/31/9999|$7.23|0|0|||GLUCOSE OTHER FLUID|| 58-1699775|1326041732|CHC13|82946||11/01/2013|12/31/9999|$27.76|0|0|||GLUCAGON TOLERANCE TEST|| 58-1699775|1326041732|CHC13|82947||11/01/2013|12/31/9999|$7.23|0|0|||ASSAY| GLUCOSE| BLOOD QUANT|| 58-1699775|1326041732|CHC13|82948||11/01/2013|12/31/9999|$5.82|0|0|||REAGENT STRIP/BLOOD GLUCOSE|| 58-1699775|1326041732|CHC13|82950||11/01/2013|12/31/9999|$8.75|0|0|||GLUCOSE TEST|| 58-1699775|1326041732|CHC13|82951||11/01/2013|12/31/9999|$23.70|0|0|||GLUCOSE TOLERANCE TEST (GTT)|| 58-1699775|1326041732|CHC13|82952||11/01/2013|12/31/9999|$7.22|0|0|||GTT-ADDED SAMPLES|| 58-1699775|1326041732|CHC13|82955||11/01/2013|12/31/9999|$14.37|0|0|||ASSAY OF G6PD ENZYME|| 58-1699775|1326041732|CHC13|82960||11/01/2013|12/31/9999|$11.14|0|0|||TEST FOR G6PD ENZYME|| 58-1699775|1326041732|CHC13|82962||11/01/2013|12/31/9999|$4.32|0|0|||GLUCOSE BLOOD TEST|| 58-1699775|1326041732|CHC13|82963||11/01/2013|12/31/9999|$39.56|0|0|||ASSAY OF GLUCOSIDASE|| 58-1699775|1326041732|CHC13|82965||11/01/2013|12/31/9999|$14.23|0|0|||ASSAY OF GDH ENZYME|| 58-1699775|1326041732|CHC13|82977||11/01/2013|12/31/9999|$13.26|0|0|||ASSAY OF GGT|| 58-1699775|1326041732|CHC13|82978||11/01/2013|12/31/9999|$26.25|0|0|||ASSAY OF GLUTATHIONE|| 58-1699775|1326041732|CHC13|82979||11/01/2013|12/31/9999|$12.69|0|0|||ASSAY| RBC GLUTATHIONE|| 58-1699775|1326041732|CHC13|82985||11/01/2013|12/31/9999|$27.76|0|0|||GLYCATED PROTEIN|| 58-1699775|1326041732|CHC13|83001||11/01/2013|12/31/9999|$34.22|0|0|||GONADOTROPIN (FSH)|| 58-1699775|1326041732|CHC13|83002||11/01/2013|12/31/9999|$34.10|0|0|||GONADOTROPIN (LH)|| 58-1699775|1326041732|CHC13|83003||11/01/2013|12/31/9999|$26.21|0|0|||ASSAY| GROWTH HORMONE (HGH)|| 58-1699775|1326041732|CHC13|83006||04/01/2015|12/31/9999|$38.91|0|0|0||GROWTH STIMULATION GENE 2|| 58-1699775|1326041732|CHC13|83009||11/01/2013|12/31/9999|$24.89|0|0|||H PYLORI (C-13)| BLOOD|| 58-1699775|1326041732|CHC13|83010||11/01/2013|12/31/9999|$6.86|0|0|||ASSAY OF HAPTOGLOBIN| QUANT|| 58-1699775|1326041732|CHC13|83012||11/01/2013|12/31/9999|$31.66|0|0|||ASSAY OF HAPTOGLOBINS|| 58-1699775|1326041732|CHC13|83013||11/01/2013|12/31/9999|$124.02|0|0|||H PYLORI (C-13)| BREATH|| 58-1699775|1326041732|CHC13|83014||11/01/2013|12/31/9999|$14.48|0|0|||H PYLORI DRUG ADMIN|| 58-1699775|1326041732|CHC13|83015||11/01/2013|12/31/9999|$34.67|0|0|||HEAVY METAL SCREEN|| 58-1699775|1326041732|CHC13|83018||11/01/2013|12/31/9999|$40.44|0|0|||QUANTITATIVE SCREEN| METALS|| 58-1699775|1326041732|CHC13|83020||11/01/2013|12/31/9999|$18.01|0|0|||HEMOGLOBIN ELECTROPHORESIS|| 58-1699775|1326041732|CHC13|83020|26|11/01/2013|12/31/9999|$30.92|0|0|||HEMOGLOBIN ELECTROPHORESIS|| 58-1699775|1326041732|CHC13|83021||11/01/2013|12/31/9999|$11.05|0|0|||HEMOGLOBIN CHROMOTOGRAPHY|| 58-1699775|1326041732|CHC13|83026||11/01/2013|12/31/9999|$4.34|0|0|||HEMOGLOBIN| COPPER SULFATE|| 58-1699775|1326041732|CHC13|83030||11/01/2013|12/31/9999|$15.22|0|0|||FETAL HEMOGLOBIN| CHEMICAL|| 58-1699775|1326041732|CHC13|83033||11/01/2013|12/31/9999|$10.97|0|0|||FETAL HEMOGLOBIN ASSAY| QUAL|| 58-1699775|1326041732|CHC13|83036||11/01/2013|12/31/9999|$17.88|0|0|||GLYCOSYLATED HEMOGLOBIN TEST|| 58-1699775|1326041732|CHC13|83037||11/01/2013|12/31/9999|$17.88|0|0|||GLYCOSYLATED HB| HOME DEVICE|| 58-1699775|1326041732|CHC13|83045||11/01/2013|12/31/9999|$7.57|0|0|||BLOOD METHEMOGLOBIN TEST|| 58-1699775|1326041732|CHC13|83050||11/01/2013|12/31/9999|$13.48|0|0|||BLOOD METHEMOGLOBIN ASSAY|| 58-1699775|1326041732|CHC13|83051||11/01/2013|12/31/9999|$13.46|0|0|||ASSAY OF PLASMA HEMOGLOBIN|| 58-1699775|1326041732|CHC13|83060||11/01/2013|12/31/9999|$15.22|0|0|||BLOOD SULFHEMOGLOBIN ASSAY|| 58-1699775|1326041732|CHC13|83065||11/01/2013|12/31/9999|$12.69|0|0|||ASSAY OF HEMOGLOBIN HEAT|| 58-1699775|1326041732|CHC13|83068||11/01/2013|12/31/9999|$15.59|0|0|||HEMOGLOBIN STABILITY SCREEN|| 58-1699775|1326041732|CHC13|83069||11/01/2013|12/31/9999|$7.27|0|0|||ASSAY OF URINE HEMOGLOBIN|| 58-1699775|1326041732|CHC13|83070||11/01/2013|12/31/9999|$8.75|0|0|||ASSAY OF HEMOSIDERIN| QUAL|| 58-1699775|1326041732|CHC13|83080||11/01/2013|12/31/9999|$31.06|0|0|||ASSAY OF B HEXOSAMINIDASE|| 58-1699775|1326041732|CHC13|83088||11/01/2013|12/31/9999|$54.38|0|0|||ASSAY OF HISTAMINE|| 58-1699775|1326041732|CHC13|83090||11/01/2013|12/31/9999|$31.06|0|0|||ASSAY OF HOMOCYSTINE|| 58-1699775|1326041732|CHC13|83150||11/01/2013|12/31/9999|$35.62|0|0|||ASSAY OF FOR HVA|| 58-1699775|1326041732|CHC13|83491||11/01/2013|12/31/9999|$32.25|0|0|||ASSAY OF CORTICOSTEROIDS|| 58-1699775|1326041732|CHC13|83497||11/01/2013|12/31/9999|$23.74|0|0|||ASSAY OF 5-HIAA|| 58-1699775|1326041732|CHC13|83498||11/01/2013|12/31/9999|$50.02|0|0|||ASSAY OF PROGESTERONE|| 58-1699775|1326041732|CHC13|83499||11/01/2013|12/31/9999|$46.42|0|0|||ASSAY OF PROGESTERONE|| 58-1699775|1326041732|CHC13|83500||11/01/2013|12/31/9999|$41.70|0|0|||ASSAY| FREE HYDROXYPROLINE|| 58-1699775|1326041732|CHC13|83505||11/01/2013|12/31/9999|$44.76|0|0|||ASSAY| TOTAL HYDROXYPROLINE|| 58-1699775|1326041732|CHC13|83516||11/01/2013|12/31/9999|$19.68|0|0|||IMMUNOASSAY| NONANTIBODY|| 58-1699775|1326041732|CHC13|83518||11/01/2013|12/31/9999|$15.60|0|0|||IMMUNOASSAY| DIPSTICK|| 58-1699775|1326041732|CHC13|83519||11/01/2013|12/31/9999|$24.88|0|0|||IMMUNOASSAY| NONANTIBODY|| 58-1699775|1326041732|CHC13|83520||11/01/2013|12/31/9999|$23.84|0|0|||IMMUNOASSAY| RIA|| 58-1699775|1326041732|CHC13|83525||11/01/2013|12/31/9999|$21.05|0|0|||ASSAY OF INSULIN|| 58-1699775|1326041732|CHC13|83527||11/01/2013|12/31/9999|$23.84|0|0|||ASSAY OF INSULIN|| 58-1699775|1326041732|CHC13|83528||11/01/2013|12/31/9999|$29.29|0|0|||ASSAY OF INTRINSIC FACTOR|| 58-1699775|1326041732|CHC13|83540||11/01/2013|12/31/9999|$11.93|0|0|||ASSAY OF IRON|| 58-1699775|1326041732|CHC13|83550||11/01/2013|12/31/9999|$16.09|0|0|||IRON BINDING TEST|| 58-1699775|1326041732|CHC13|83570||11/01/2013|12/31/9999|$16.29|0|0|||ASSAY OF IDH ENZYME|| 58-1699775|1326041732|CHC13|83582||11/01/2013|12/31/9999|$26.10|0|0|||ASSAY OF KETOGENIC STEROIDS|| 58-1699775|1326041732|CHC13|83586||11/01/2013|12/31/9999|$23.13|0|0|||ASSAY 17- KETOSTEROIDS|| 58-1699775|1326041732|CHC13|83593||11/01/2013|12/31/9999|$48.42|0|0|||FRACTIONATION| KETOSTEROIDS|| 58-1699775|1326041732|CHC13|83605||11/01/2013|12/31/9999|$19.67|0|0|||ASSAY OF LACTIC ACID|| 58-1699775|1326041732|CHC13|83615||11/01/2013|12/31/9999|$11.12|0|0|||LACTATE (LD) (LDH) ENZYME|| 58-1699775|1326041732|CHC13|83625||11/01/2013|12/31/9999|$21.32|0|0|||ASSAY OF LDH ENZYMES|| 58-1699775|1326041732|CHC13|83630||11/01/2013|12/31/9999|$36.14|0|0|||LACTOFERRIN| FECAL (QUAL)|| 58-1699775|1326041732|CHC13|83631||11/01/2013|12/31/9999|$36.14|0|0|||LACTOFERRIN| FECAL (QUANT)|| 58-1699775|1326041732|CHC13|83632||11/01/2013|12/31/9999|$37.22|0|0|||PLACENTAL LACTOGEN|| 58-1699775|1326041732|CHC13|83633||11/01/2013|12/31/9999|$10.13|0|0|||TEST URINE FOR LACTOSE|| 58-1699775|1326041732|CHC13|83655||11/01/2013|12/31/9999|$22.29|0|0|||ASSAY OF LEAD|| 58-1699775|1326041732|CHC13|83661||11/01/2013|12/31/9999|$40.48|0|0|||L/S RATIO| FETAL LUNG|| 58-1699775|1326041732|CHC13|83662||11/01/2013|12/31/9999|$34.84|0|0|||FOAM STABILITY| FETAL LUNG|| 58-1699775|1326041732|CHC13|83663||11/01/2013|12/31/9999|$34.84|0|0|||FLUORO POLARIZE| FETAL LUNG|| 58-1699775|1326041732|CHC13|83664||11/01/2013|12/31/9999|$34.84|0|0|||LAMELLAR BDY| FETAL LUNG|| 58-1699775|1326041732|CHC13|83670||11/01/2013|12/31/9999|$16.87|0|0|||ASSAY OF LAP ENZYME|| 58-1699775|1326041732|CHC13|83690||11/01/2013|12/31/9999|$12.69|0|0|||ASSAY OF LIPASE|| 58-1699775|1326041732|CHC13|83695||11/01/2013|12/31/9999|$23.84|0|0|||ASSAY OF LIPOPROTEIN(A)|| 58-1699775|1326041732|CHC13|83698||11/01/2013|12/31/9999|$62.50|0|0|||ASSAY LIPOPROTEIN PLA2|| 58-1699775|1326041732|CHC13|83700||11/01/2013|12/31/9999|$16.11|0|0|||LIPOPRO BLD| ELECTROPHORETIC|| 58-1699775|1326041732|CHC13|83701||11/01/2013|12/31/9999|$45.71|0|0|||LIPOPROTEIN BLD| HR FRACTION|| 58-1699775|1326041732|CHC13|83704||11/01/2013|12/31/9999|$58.10|0|0|||LIPOPROTEIN| BLD| BY NMR|| 58-1699775|1326041732|CHC13|83718||11/01/2013|12/31/9999|$15.08|0|0|||ASSAY OF LIPOPROTEIN|| 58-1699775|1326041732|CHC13|83719||11/01/2013|12/31/9999|$21.42|0|0|||ASSAY OF BLOOD LIPOPROTEIN|| 58-1699775|1326041732|CHC13|83721||11/01/2013|12/31/9999|$17.56|0|0|||ASSAY OF BLOOD LIPOPROTEIN|| 58-1699775|1326041732|CHC13|83727||11/01/2013|12/31/9999|$31.66|0|0|||ASSAY OF LRH HORMONE|| 58-1699775|1326041732|CHC13|83735||11/01/2013|12/31/9999|$12.34|0|0|||ASSAY OF MAGNESIUM|| 58-1699775|1326041732|CHC13|83775||11/01/2013|12/31/9999|$13.57|0|0|||ASSAY OF MD ENZYME|| 58-1699775|1326041732|CHC13|83785||11/01/2013|12/31/9999|$45.28|0|0|||ASSAY OF MANGANESE|| 58-1699775|1326041732|CHC13|83789||11/01/2013|12/31/9999|$11.05|0|0|||MASS SPECTROMETRY QUANT|| 58-1699775|1326041732|CHC13|83825||11/01/2013|12/31/9999|$29.94|0|0|||ASSAY OF MERCURY|| 58-1699775|1326041732|CHC13|83835||11/01/2013|12/31/9999|$31.20|0|0|||ASSAY OF METANEPHRINES|| 58-1699775|1326041732|CHC13|83857||11/01/2013|12/31/9999|$19.77|0|0|||ASSAY OF METHEMALBUMIN|| 58-1699775|1326041732|CHC13|83861||11/01/2013|12/31/9999|$30.42|0|0|||MICROFLUID ANALY TEARS|| 58-1699775|1326041732|CHC13|83864||11/01/2013|12/31/9999|$36.66|0|0|||MUCOPOLYSACCHARIDES|| 58-1699775|1326041732|CHC13|83872||11/01/2013|12/31/9999|$10.79|0|0|||ASSAY SYNOVIAL FLUID MUCIN|| 58-1699775|1326041732|CHC13|83873||11/01/2013|12/31/9999|$31.68|0|0|||ASSAY OF CSF PROTEIN|| 58-1699775|1326041732|CHC13|83874||11/01/2013|12/31/9999|$23.78|0|0|||ASSAY OF MYOGLOBIN|| 58-1699775|1326041732|CHC13|83876||11/01/2013|12/31/9999|$62.50|0|0|||ASSAY| MYELOPEROXIDASE|| 58-1699775|1326041732|CHC13|83880||11/01/2013|12/31/9999|$62.50|0|0|||NATRIURETIC PEPTIDE|| 58-1699775|1326041732|CHC13|83883||11/01/2013|12/31/9999|$25.02|0|0|||ASSAY| NEPHELOMETRY NOT SPEC|| 58-1699775|1326041732|CHC13|83885||11/01/2013|12/31/9999|$45.11|0|0|||ASSAY OF NICKEL|| 58-1699775|1326041732|CHC13|83912|26|11/01/2013|12/31/9999|$29.40|0|0|||GENETIC EXAMINATION|| 58-1699775|1326041732|CHC13|83915||11/01/2013|12/31/9999|$20.54|0|0|||ASSAY OF NUCLEOTIDASE|| 58-1699775|1326041732|CHC13|83916||11/01/2013|12/31/9999|$37.02|0|0|||OLIGOCLONAL BANDS|| 58-1699775|1326041732|CHC13|83918||11/01/2013|12/31/9999|$30.30|0|0|||ORGANIC ACIDS| TOTAL| QUANT|| 58-1699775|1326041732|CHC13|83919||11/01/2013|12/31/9999|$30.30|0|0|||ORGANIC ACIDS| QUAL| EACH|| 58-1699775|1326041732|CHC13|83921||11/01/2013|12/31/9999|$30.30|0|0|||ORGANIC ACID| SINGLE| QUANT|| 58-1699775|1326041732|CHC13|83930||11/01/2013|12/31/9999|$12.17|0|0|||ASSAY OF BLOOD OSMOLALITY|| 58-1699775|1326041732|CHC13|83935||11/01/2013|12/31/9999|$12.54|0|0|||ASSAY OF URINE OSMOLALITY|| 58-1699775|1326041732|CHC13|83937||11/01/2013|12/31/9999|$54.96|0|0|||ASSAY OF OSTEOCALCIN|| 58-1699775|1326041732|CHC13|83945||11/01/2013|12/31/9999|$23.70|0|0|||ASSAY OF OXALATE|| 58-1699775|1326041732|CHC13|83950||11/01/2013|12/31/9999|$118.60|0|0|||ONCOPROTEIN| HER-2/NEU|| 58-1699775|1326041732|CHC13|83951||11/01/2013|12/31/9999|$118.60|0|0|||ONCOPROTEIN| DCP|| 58-1699775|1326041732|CHC13|83970||11/01/2013|12/31/9999|$76.00|0|0|||ASSAY OF PARATHORMONE|| 58-1699775|1326041732|CHC13|83986||11/01/2013|12/31/9999|$6.59|0|0|||ASSAY OF BODY FLUID ACIDITY|| 58-1699775|1326041732|CHC13|83987||11/01/2013|12/31/9999|$29.24|0|0|||EXHALED BREATH CONDENSATE|| 58-1699775|1326041732|CHC13|83992||11/01/2013|12/31/9999|$27.07|0|0|||ASSAY FOR PHENCYCLIDINE|| 58-1699775|1326041732|CHC13|83993||11/01/2013|12/31/9999|$36.14|0|0|||ASSAY FOR CALPROTECTIN FECAL|| 58-1699775|1326041732|CHC13|84030||11/01/2013|12/31/9999|$10.13|0|0|||ASSAY OF BLOOD PKU|| 58-1699775|1326041732|CHC13|84035||11/01/2013|12/31/9999|$6.75|0|0|||ASSAY OF PHENYLKETONES|| 58-1699775|1326041732|CHC13|84060||11/01/2013|12/31/9999|$13.60|0|0|||ASSAY ACID PHOSPHATASE|| 58-1699775|1326041732|CHC13|84061||11/01/2013|12/31/9999|$14.56|0|0|||PHOSPHATASE| FORENSIC EXAM|| 58-1699775|1326041732|CHC13|84066||11/01/2013|12/31/9999|$17.78|0|0|||ASSAY PROSTATE PHOSPHATASE|| 58-1699775|1326041732|CHC13|84075||11/01/2013|12/31/9999|$9.53|0|0|||ASSAY ALKALINE PHOSPHATASE|| 58-1699775|1326041732|CHC13|84078||11/01/2013|12/31/9999|$13.44|0|0|||ASSAY ALKALINE PHOSPHATASE|| 58-1699775|1326041732|CHC13|84080||11/01/2013|12/31/9999|$27.24|0|0|||ASSAY ALKALINE PHOSPHATASES|| 58-1699775|1326041732|CHC13|84081||11/01/2013|12/31/9999|$30.42|0|0|||AMNIOTIC FLUID ENZYME TEST|| 58-1699775|1326041732|CHC13|84085||11/01/2013|12/31/9999|$12.42|0|0|||ASSAY OF RBC PG6D ENZYME|| 58-1699775|1326041732|CHC13|84087||11/01/2013|12/31/9999|$19.01|0|0|||ASSAY PHOSPHOHEXOSE ENZYMES|| 58-1699775|1326041732|CHC13|84100||11/01/2013|12/31/9999|$8.74|0|0|||ASSAY OF PHOSPHORUS|| 58-1699775|1326041732|CHC13|84105||11/01/2013|12/31/9999|$9.53|0|0|||ASSAY OF URINE PHOSPHORUS|| 58-1699775|1326041732|CHC13|84106||11/01/2013|12/31/9999|$7.88|0|0|||TEST FOR PORPHOBILINOGEN|| 58-1699775|1326041732|CHC13|84110||11/01/2013|12/31/9999|$15.55|0|0|||ASSAY OF PORPHOBILINOGEN|| 58-1699775|1326041732|CHC13|84112||04/01/2014|12/31/9999|$114.24|0|0|||PLACENTA ALPHA MICRO IG C/V|| 58-1699775|1326041732|CHC13|84119||11/01/2013|12/31/9999|$15.86|0|0|||TEST URINE FOR PORPHYRINS|| 58-1699775|1326041732|CHC13|84120||11/01/2013|12/31/9999|$27.08|0|0|||ASSAY OF URINE PORPHYRINS|| 58-1699775|1326041732|CHC13|84126||11/01/2013|12/31/9999|$46.90|0|0|||ASSAY OF FECES PORPHYRINS|| 58-1699775|1326041732|CHC13|84132||11/01/2013|12/31/9999|$8.46|0|0|||ASSAY OF SERUM POTASSIUM|| 58-1699775|1326041732|CHC13|84133||11/01/2013|12/31/9999|$7.92|0|0|||ASSAY OF URINE POTASSIUM|| 58-1699775|1326041732|CHC13|84134||11/01/2013|12/31/9999|$26.84|0|0|||ASSAY OF PREALBUMIN|| 58-1699775|1326041732|CHC13|84135||11/01/2013|12/31/9999|$35.23|0|0|||ASSAY OF PREGNANEDIOL|| 58-1699775|1326041732|CHC13|84138||11/01/2013|12/31/9999|$34.87|0|0|||ASSAY OF PREGNANETRIOL|| 58-1699775|1326041732|CHC13|84140||11/01/2013|12/31/9999|$38.08|0|0|||ASSAY OF PREGNENOLONE|| 58-1699775|1326041732|CHC13|84143||11/01/2013|12/31/9999|$42.02|0|0|||ASSAY OF 17-HYDROXYPREGNENO|| 58-1699775|1326041732|CHC13|84144||11/01/2013|12/31/9999|$37.51|0|0|||ASSAY OF PROGESTERONE|| 58-1699775|1326041732|CHC13|84145||11/01/2013|12/31/9999|$49.31|0|0|||PROCALCITONIN (PCT)|| 58-1699775|1326041732|CHC13|84146||11/01/2013|12/31/9999|$35.69|0|0|||ASSAY OF PROLACTIN|| 58-1699775|1326041732|CHC13|84150||11/01/2013|12/31/9999|$45.95|0|0|||ASSAY OF PROSTAGLANDIN|| 58-1699775|1326041732|CHC13|84152||11/01/2013|12/31/9999|$33.88|0|0|||ASSAY OF PSA| COMPLEXED|| 58-1699775|1326041732|CHC13|84153||11/01/2013|12/31/9999|$33.88|0|0|||ASSAY OF PSA| TOTAL|| 58-1699775|1326041732|CHC13|84154||11/01/2013|12/31/9999|$33.88|0|0|||ASSAY OF PSA| FREE|| 58-1699775|1326041732|CHC13|84155||11/01/2013|12/31/9999|$6.75|0|0|||ASSAY OF PROTEIN| SERUM|| 58-1699775|1326041732|CHC13|84156||11/01/2013|12/31/9999|$6.75|0|0|||ASSAY OF PROTEIN| URINE|| 58-1699775|1326041732|CHC13|84157||11/01/2013|12/31/9999|$6.75|0|0|||ASSAY OF PROTEIN| OTHER|| 58-1699775|1326041732|CHC13|84160||11/01/2013|12/31/9999|$9.53|0|0|||ASSAY OF PROTEIN| ANY SOURCE|| 58-1699775|1326041732|CHC13|84163||11/01/2013|12/31/9999|$11.82|0|0|||PAPPA| SERUM|| 58-1699775|1326041732|CHC13|84165||11/01/2013|12/31/9999|$19.77|0|0|||PROTEIN E-PHORESIS| SERUM|| 58-1699775|1326041732|CHC13|84165|26|11/01/2013|12/31/9999|$30.41|0|0|||PROTEIN E-PHORESIS| SERUM|| 58-1699775|1326041732|CHC13|84166||11/01/2013|12/31/9999|$32.84|0|0|||PROTEIN E-PHORESIS/URINE/CSF|| 58-1699775|1326041732|CHC13|84166|26|11/01/2013|12/31/9999|$30.41|0|0|||PROTEIN E-PHORESIS/URINE/CSF|| 58-1699775|1326041732|CHC13|84181||11/01/2013|12/31/9999|$31.36|0|0|||WESTERN BLOT TEST|| 58-1699775|1326041732|CHC13|84181|26|11/01/2013|12/31/9999|$30.41|0|0|||WESTERN BLOT TEST|| 58-1699775|1326041732|CHC13|84182||11/01/2013|12/31/9999|$33.14|0|0|||PROTEIN| WESTERN BLOT TEST|| 58-1699775|1326041732|CHC13|84182|26|11/01/2013|12/31/9999|$28.90|0|0|||PROTEIN| WESTERN BLOT TEST|| 58-1699775|1326041732|CHC13|84202||11/01/2013|12/31/9999|$26.42|0|0|||ASSAY RBC PROTOPORPHYRIN|| 58-1699775|1326041732|CHC13|84203||11/01/2013|12/31/9999|$15.86|0|0|||TEST RBC PROTOPORPHYRIN|| 58-1699775|1326041732|CHC13|84206||11/01/2013|12/31/9999|$32.80|0|0|||ASSAY OF PROINSULIN|| 58-1699775|1326041732|CHC13|84207||11/01/2013|12/31/9999|$51.74|0|0|||ASSAY OF VITAMIN B-6|| 58-1699775|1326041732|CHC13|84210||11/01/2013|12/31/9999|$19.98|0|0|||ASSAY OF PYRUVATE|| 58-1699775|1326041732|CHC13|84220||11/01/2013|12/31/9999|$17.37|0|0|||ASSAY OF PYRUVATE KINASE|| 58-1699775|1326041732|CHC13|84228||11/01/2013|12/31/9999|$21.42|0|0|||ASSAY OF QUININE|| 58-1699775|1326041732|CHC13|84233||11/01/2013|12/31/9999|$118.60|0|0|||ASSAY OF ESTROGEN|| 58-1699775|1326041732|CHC13|84234||11/01/2013|12/31/9999|$119.46|0|0|||ASSAY OF PROGESTERONE|| 58-1699775|1326041732|CHC13|84235||11/01/2013|12/31/9999|$96.37|0|0|||ASSAY OF ENDOCRINE HORMONE|| 58-1699775|1326041732|CHC13|84238||11/01/2013|12/31/9999|$67.33|0|0|||ASSAY| NONENDOCRINE RECEPTOR|| 58-1699775|1326041732|CHC13|84244||11/01/2013|12/31/9999|$40.49|0|0|||ASSAY OF RENIN|| 58-1699775|1326041732|CHC13|84252||11/01/2013|12/31/9999|$37.26|0|0|||ASSAY OF VITAMIN B-2|| 58-1699775|1326041732|CHC13|84255||11/01/2013|12/31/9999|$47.01|0|0|||ASSAY OF SELENIUM|| 58-1699775|1326041732|CHC13|84260||11/01/2013|12/31/9999|$57.03|0|0|||ASSAY OF SEROTONIN|| 58-1699775|1326041732|CHC13|84270||11/01/2013|12/31/9999|$40.01|0|0|||ASSAY OF SEX HORMONE GLOBUL|| 58-1699775|1326041732|CHC13|84275||11/01/2013|12/31/9999|$24.74|0|0|||ASSAY OF SIALIC ACID|| 58-1699775|1326041732|CHC13|84285||11/01/2013|12/31/9999|$43.35|0|0|||ASSAY OF SILICA|| 58-1699775|1326041732|CHC13|84295||11/01/2013|12/31/9999|$8.87|0|0|||ASSAY OF SERUM SODIUM|| 58-1699775|1326041732|CHC13|84300||11/01/2013|12/31/9999|$6.36|0|0|||ASSAY OF URINE SODIUM|| 58-1699775|1326041732|CHC13|84302||11/01/2013|12/31/9999|$6.36|0|0|||ASSAY OF SWEAT SODIUM|| 58-1699775|1326041732|CHC13|84305||11/01/2013|12/31/9999|$39.14|0|0|||ASSAY OF SOMATOMEDIN|| 58-1699775|1326041732|CHC13|84307||11/01/2013|12/31/9999|$33.67|0|0|||ASSAY OF SOMATOSTATIN|| 58-1699775|1326041732|CHC13|84311||11/01/2013|12/31/9999|$12.87|0|0|||SPECTROPHOTOMETRY|| 58-1699775|1326041732|CHC13|84315||11/01/2013|12/31/9999|$4.61|0|0|||BODY FLUID SPECIFIC GRAVITY|| 58-1699775|1326041732|CHC13|84375||11/01/2013|12/31/9999|$36.10|0|0|||CHROMATOGRAM ASSAY| SUGARS|| 58-1699775|1326041732|CHC13|84376||11/01/2013|12/31/9999|$10.13|0|0|||SUGARS| SINGLE| QUAL|| 58-1699775|1326041732|CHC13|84377||11/01/2013|12/31/9999|$10.13|0|0|||SUGARS| MULTIPLE| QUAL|| 58-1699775|1326041732|CHC13|84378||11/01/2013|12/31/9999|$21.22|0|0|||SUGARS| SINGLE| QUANT|| 58-1699775|1326041732|CHC13|84379||11/01/2013|12/31/9999|$21.22|0|0|||SUGARS MULTIPLE QUANT|| 58-1699775|1326041732|CHC13|84392||11/01/2013|12/31/9999|$8.75|0|0|||ASSAY OF URINE SULFATE|| 58-1699775|1326041732|CHC13|84402||11/01/2013|12/31/9999|$46.89|0|0|||ASSAY OF TESTOSTERONE|| 58-1699775|1326041732|CHC13|84403||11/01/2013|12/31/9999|$47.54|0|0|||ASSAY OF TOTAL TESTOSTERONE|| 58-1699775|1326041732|CHC13|84410||04/01/2017|12/31/9999|$94.32|0|94.32|0||TESTOSTERONE BIOAVAILABLE|| 58-1699775|1326041732|CHC13|84425||11/01/2013|12/31/9999|$39.09|0|0|||ASSAY OF VITAMIN B-1|| 58-1699775|1326041732|CHC13|84430||11/01/2013|12/31/9999|$10.62|0|0|||ASSAY OF THIOCYANATE|| 58-1699775|1326041732|CHC13|84431||11/01/2013|12/31/9999|$30.94|0|0|||THROMBOXANE| URINE|| 58-1699775|1326041732|CHC13|84432||11/01/2013|12/31/9999|$29.59|0|0|||ASSAY OF THYROGLOBULIN|| 58-1699775|1326041732|CHC13|84436||11/01/2013|12/31/9999|$12.65|0|0|||ASSAY OF TOTAL THYROXINE|| 58-1699775|1326041732|CHC13|84437||11/01/2013|12/31/9999|$11.92|0|0|||ASSAY OF NEONATAL THYROXINE|| 58-1699775|1326041732|CHC13|84439||11/01/2013|12/31/9999|$16.60|0|0|||ASSAY OF FREE THYROXINE|| 58-1699775|1326041732|CHC13|84442||11/01/2013|12/31/9999|$21.44|0|0|||ASSAY OF THYROID ACTIVITY|| 58-1699775|1326041732|CHC13|84443||11/01/2013|12/31/9999|$30.94|0|0|||ASSAY THYROID STIM HORMONE|| 58-1699775|1326041732|CHC13|84445||11/01/2013|12/31/9999|$15.60|0|0|||ASSAY OF TSI|| 58-1699775|1326041732|CHC13|84446||11/01/2013|12/31/9999|$26.10|0|0|||ASSAY OF VITAMIN E|| 58-1699775|1326041732|CHC13|84449||11/01/2013|12/31/9999|$33.14|0|0|||ASSAY OF TRANSCORTIN|| 58-1699775|1326041732|CHC13|84450||11/01/2013|12/31/9999|$9.53|0|0|||TRANSFERASE (AST) (SGOT)|| 58-1699775|1326041732|CHC13|84460||11/01/2013|12/31/9999|$9.75|0|0|||ALANINE AMINO (ALT) (SGPT)|| 58-1699775|1326041732|CHC13|84466||11/01/2013|12/31/9999|$23.52|0|0|||ASSAY OF TRANSFERRIN|| 58-1699775|1326041732|CHC13|84478||11/01/2013|12/31/9999|$10.59|0|0|||ASSAY OF TRIGLYCERIDES|| 58-1699775|1326041732|CHC13|84479||11/01/2013|12/31/9999|$11.92|0|0|||ASSAY OF THYROID (T3 OR T4)|| 58-1699775|1326041732|CHC13|84480||11/01/2013|12/31/9999|$23.48|0|0|||ASSAY| TRIIODOTHYRONINE (T3)|| 58-1699775|1326041732|CHC13|84481||11/01/2013|12/31/9999|$31.20|0|0|||FREE ASSAY (FT-3)|| 58-1699775|1326041732|CHC13|84482||11/01/2013|12/31/9999|$29.03|0|0|||T3 REVERSE|| 58-1699775|1326041732|CHC13|84484||11/01/2013|12/31/9999|$18.12|0|0|||ASSAY OF TROPONIN| QUANT|| 58-1699775|1326041732|CHC13|84485||11/01/2013|12/31/9999|$13.82|0|0|||ASSAY DUODENAL FLUID TRYPSIN|| 58-1699775|1326041732|CHC13|84488||11/01/2013|12/31/9999|$13.44|0|0|||TEST FECES FOR TRYPSIN|| 58-1699775|1326041732|CHC13|84490||11/01/2013|12/31/9999|$14.00|0|0|||ASSAY OF FECES FOR TRYPSIN|| 58-1699775|1326041732|CHC13|84510||11/01/2013|12/31/9999|$19.15|0|0|||ASSAY OF TYROSINE|| 58-1699775|1326041732|CHC13|84512||11/01/2013|12/31/9999|$13.60|0|0|||ASSAY OF TROPONIN| QUAL|| 58-1699775|1326041732|CHC13|84520||11/01/2013|12/31/9999|$7.27|0|0|||ASSAY OF UREA NITROGEN|| 58-1699775|1326041732|CHC13|84525||11/01/2013|12/31/9999|$4.45|0|0|||UREA NITROGEN SEMI-QUANT|| 58-1699775|1326041732|CHC13|84540||11/01/2013|12/31/9999|$8.75|0|0|||ASSAY OF URINE/UREA-N|| 58-1699775|1326041732|CHC13|84545||11/01/2013|12/31/9999|$12.16|0|0|||UREA-N CLEARANCE TEST|| 58-1699775|1326041732|CHC13|84550||11/01/2013|12/31/9999|$8.32|0|0|||ASSAY OF BLOOD/URIC ACID|| 58-1699775|1326041732|CHC13|84560||11/01/2013|12/31/9999|$8.75|0|0|||ASSAY OF URINE/URIC ACID|| 58-1699775|1326041732|CHC13|84577||11/01/2013|12/31/9999|$12.87|0|0|||ASSAY OF FECES/UROBILINOGEN|| 58-1699775|1326041732|CHC13|84578||11/01/2013|12/31/9999|$5.98|0|0|||TEST URINE UROBILINOGEN|| 58-1699775|1326041732|CHC13|84580||11/01/2013|12/31/9999|$13.07|0|0|||ASSAY OF URINE UROBILINOGEN|| 58-1699775|1326041732|CHC13|84583||11/01/2013|12/31/9999|$9.26|0|0|||ASSAY OF URINE UROBILINOGEN|| 58-1699775|1326041732|CHC13|84585||11/01/2013|12/31/9999|$28.55|0|0|||ASSAY OF URINE VMA|| 58-1699775|1326041732|CHC13|84586||11/01/2013|12/31/9999|$65.06|0|0|||ASSAY OF VIP|| 58-1699775|1326041732|CHC13|84588||11/01/2013|12/31/9999|$62.50|0|0|||ASSAY OF VASOPRESSIN|| 58-1699775|1326041732|CHC13|84590||11/01/2013|12/31/9999|$21.36|0|0|||ASSAY OF VITAMIN A|| 58-1699775|1326041732|CHC13|84591||11/01/2013|12/31/9999|$21.36|0|0|||ASSAY OF NOS VITAMIN|| 58-1699775|1326041732|CHC13|84597||11/01/2013|12/31/9999|$25.25|0|0|||ASSAY OF VITAMIN K|| 58-1699775|1326041732|CHC13|84600||11/01/2013|12/31/9999|$29.60|0|0|||ASSAY OF VOLATILES|| 58-1699775|1326041732|CHC13|84620||11/01/2013|12/31/9999|$21.81|0|0|||XYLOSE TOLERANCE TEST|| 58-1699775|1326041732|CHC13|84630||11/01/2013|12/31/9999|$20.96|0|0|||ASSAY OF ZINC|| 58-1699775|1326041732|CHC13|84681||11/01/2013|12/31/9999|$29.26|0|0|||ASSAY OF C-PEPTIDE|| 58-1699775|1326041732|CHC13|84702||11/01/2013|12/31/9999|$11.82|0|0|||CHORIONIC GONADOTROPIN TEST|| 58-1699775|1326041732|CHC13|84703||11/01/2013|12/31/9999|$11.82|0|0|||CHORIONIC GONADOTROPIN ASSAY|| 58-1699775|1326041732|CHC13|84704||11/01/2013|12/31/9999|$11.82|0|0|||HCG| FREE BETACHAIN TEST|| 58-1699775|1326041732|CHC13|84830||11/01/2013|12/31/9999|$18.47|0|0|||OVULATION TESTS|| 58-1699775|1326041732|CHC13|85002||11/01/2013|12/31/9999|$8.29|0|0|||BLEEDING TIME TEST|| 58-1699775|1326041732|CHC13|85004||11/01/2013|12/31/9999|$11.92|0|0|||AUTOMATED DIFF WBC COUNT|| 58-1699775|1326041732|CHC13|85007||11/01/2013|12/31/9999|$6.33|0|0|||BL SMEAR W/DIFF WBC COUNT|| 58-1699775|1326041732|CHC13|85008||11/01/2013|12/31/9999|$6.33|0|0|||BL SMEAR W/O DIFF WBC COUNT|| 58-1699775|1326041732|CHC13|85009||11/01/2013|12/31/9999|$6.85|0|0|||MANUAL DIFF WBC COUNT B-COAT|| 58-1699775|1326041732|CHC13|85013||11/01/2013|12/31/9999|$4.35|0|0|||SPUN MICROHEMATOCRIT|| 58-1699775|1326041732|CHC13|85014||11/01/2013|12/31/9999|$4.35|0|0|||HEMATOCRIT|| 58-1699775|1326041732|CHC13|85018||11/01/2013|12/31/9999|$4.35|0|0|||HEMOGLOBIN|| 58-1699775|1326041732|CHC13|85025||11/01/2013|12/31/9999|$14.33|0|0|||COMPLETE CBC W/AUTO DIFF WBC|| 58-1699775|1326041732|CHC13|85027||11/01/2013|12/31/9999|$11.92|0|0|||COMPLETE CBC| AUTOMATED|| 58-1699775|1326041732|CHC13|85032||11/01/2013|12/31/9999|$7.92|0|0|||MANUAL CELL COUNT| EACH|| 58-1699775|1326041732|CHC13|85041||11/01/2013|12/31/9999|$5.55|0|0|||AUTOMATED RBC COUNT|| 58-1699775|1326041732|CHC13|85044||11/01/2013|12/31/9999|$7.92|0|0|||MANUAL RETICULOCYTE COUNT|| 58-1699775|1326041732|CHC13|85045||11/01/2013|12/31/9999|$7.37|0|0|||AUTOMATED RETICULOCYTE COUNT|| 58-1699775|1326041732|CHC13|85046||11/01/2013|12/31/9999|$10.27|0|0|||RETICYTE/HGB CONCENTRATE|| 58-1699775|1326041732|CHC13|85048||11/01/2013|12/31/9999|$4.68|0|0|||AUTOMATED LEUKOCYTE COUNT|| 58-1699775|1326041732|CHC13|85049||11/01/2013|12/31/9999|$8.23|0|0|||AUTOMATED PLATELET COUNT|| 58-1699775|1326041732|CHC13|85055||11/01/2013|12/31/9999|$48.07|0|0|||RETICULATED PLATELET ASSAY|| 58-1699775|1326041732|CHC13|85060||11/01/2013|12/31/9999|$29.09|0|0|||BLOOD SMEAR INTERPRETATION|| 58-1699775|1326041732|CHC13|85097||11/01/2013|12/31/9999|$58.35|0|0|||BONE MARROW INTERPRETATION|| 58-1699775|1326041732|CHC13|85130||11/01/2013|12/31/9999|$21.91|0|0|||CHROMOGENIC SUBSTRATE ASSAY|| 58-1699775|1326041732|CHC13|85170||11/01/2013|12/31/9999|$6.66|0|0|||BLOOD CLOT RETRACTION|| 58-1699775|1326041732|CHC13|85175||11/01/2013|12/31/9999|$8.38|0|0|||BLOOD CLOT LYSIS TIME|| 58-1699775|1326041732|CHC13|85210||11/01/2013|12/31/9999|$23.91|0|0|||BLOOD CLOT FACTOR II TEST|| 58-1699775|1326041732|CHC13|85220||11/01/2013|12/31/9999|$32.50|0|0|||BLOOD CLOT FACTOR V TEST|| 58-1699775|1326041732|CHC13|85230||11/01/2013|12/31/9999|$32.97|0|0|||BLOOD CLOT FACTOR VII TEST|| 58-1699775|1326041732|CHC13|85240||11/01/2013|12/31/9999|$32.97|0|0|||BLOOD CLOT FACTOR VIII TEST|| 58-1699775|1326041732|CHC13|85244||11/01/2013|12/31/9999|$37.58|0|0|||BLOOD CLOT FACTOR VIII TEST|| 58-1699775|1326041732|CHC13|85245||11/01/2013|12/31/9999|$42.25|0|0|||BLOOD CLOT FACTOR VIII TEST|| 58-1699775|1326041732|CHC13|85246||11/01/2013|12/31/9999|$42.25|0|0|||BLOOD CLOT FACTOR VIII TEST|| 58-1699775|1326041732|CHC13|85247||11/01/2013|12/31/9999|$42.25|0|0|||BLOOD CLOT FACTOR VIII TEST|| 58-1699775|1326041732|CHC13|85250||11/01/2013|12/31/9999|$35.06|0|0|||BLOOD CLOT FACTOR IX TEST|| 58-1699775|1326041732|CHC13|85260||11/01/2013|12/31/9999|$32.97|0|0|||BLOOD CLOT FACTOR X TEST|| 58-1699775|1326041732|CHC13|85270||11/01/2013|12/31/9999|$32.97|0|0|||BLOOD CLOT FACTOR XI TEST|| 58-1699775|1326041732|CHC13|85280||11/01/2013|12/31/9999|$35.62|0|0|||BLOOD CLOT FACTOR XII TEST|| 58-1699775|1326041732|CHC13|85290||11/01/2013|12/31/9999|$30.09|0|0|||BLOOD CLOT FACTOR XIII TEST|| 58-1699775|1326041732|CHC13|85291||11/01/2013|12/31/9999|$16.37|0|0|||BLOOD CLOT FACTOR XIII TEST|| 58-1699775|1326041732|CHC13|85292||11/01/2013|12/31/9999|$34.88|0|0|||BLOOD CLOT FACTOR ASSAY|| 58-1699775|1326041732|CHC13|85293||11/01/2013|12/31/9999|$34.88|0|0|||BLOOD CLOT FACTOR ASSAY|| 58-1699775|1326041732|CHC13|85300||11/01/2013|12/31/9999|$21.83|0|0|||ANTITHROMBIN III TEST|| 58-1699775|1326041732|CHC13|85301||11/01/2013|12/31/9999|$19.90|0|0|||ANTITHROMBIN III TEST|| 58-1699775|1326041732|CHC13|85302||11/01/2013|12/31/9999|$22.14|0|0|||BLOOD CLOT INHIBITOR ANTIGEN|| 58-1699775|1326041732|CHC13|85303||11/01/2013|12/31/9999|$25.47|0|0|||BLOOD CLOT INHIBITOR TEST|| 58-1699775|1326041732|CHC13|85305||11/01/2013|12/31/9999|$21.36|0|0|||BLOOD CLOT INHIBITOR ASSAY|| 58-1699775|1326041732|CHC13|85306||11/01/2013|12/31/9999|$28.21|0|0|||BLOOD CLOT INHIBITOR TEST|| 58-1699775|1326041732|CHC13|85307||11/01/2013|12/31/9999|$28.21|0|0|||ASSAY ACTIVATED PROTEIN C|| 58-1699775|1326041732|CHC13|85335||11/01/2013|12/31/9999|$23.70|0|0|||FACTOR INHIBITOR TEST|| 58-1699775|1326041732|CHC13|85337||11/01/2013|12/31/9999|$19.20|0|0|||THROMBOMODULIN|| 58-1699775|1326041732|CHC13|85345||11/01/2013|12/31/9999|$6.36|0|0|||COAGULATION TIME|| 58-1699775|1326041732|CHC13|85347||11/01/2013|12/31/9999|$7.84|0|0|||COAGULATION TIME|| 58-1699775|1326041732|CHC13|85348||11/01/2013|12/31/9999|$6.36|0|0|||COAGULATION TIME|| 58-1699775|1326041732|CHC13|85360||11/01/2013|12/31/9999|$15.47|0|0|||EUGLOBULIN LYSIS|| 58-1699775|1326041732|CHC13|85362||11/01/2013|12/31/9999|$12.69|0|0|||FIBRIN DEGRADATION PRODUCTS|| 58-1699775|1326041732|CHC13|85366||11/01/2013|12/31/9999|$15.86|0|0|||FIBRINOGEN TEST|| 58-1699775|1326041732|CHC13|85370||11/01/2013|12/31/9999|$20.90|0|0|||FIBRINOGEN TEST|| 58-1699775|1326041732|CHC13|85378||11/01/2013|12/31/9999|$13.13|0|0|||FIBRIN DEGRADE| SEMIQUANT|| 58-1699775|1326041732|CHC13|85379||11/01/2013|12/31/9999|$18.75|0|0|||FIBRIN DEGRADATION| QUANT|| 58-1699775|1326041732|CHC13|85380||11/01/2013|12/31/9999|$18.75|0|0|||FIBRIN DEGRADATION| VTE|| 58-1699775|1326041732|CHC13|85384||11/01/2013|12/31/9999|$15.64|0|0|||FIBRINOGEN|| 58-1699775|1326041732|CHC13|85385||11/01/2013|12/31/9999|$15.64|0|0|||FIBRINOGEN|| 58-1699775|1326041732|CHC13|85390||11/01/2013|12/31/9999|$9.52|0|0|||FIBRINOLYSINS SCREEN|| 58-1699775|1326041732|CHC13|85390|26|11/01/2013|12/31/9999|$30.92|0|0|||FIBRINOLYSINS SCREEN|| 58-1699775|1326041732|CHC13|85396||11/01/2013|12/31/9999|$23.96|0|0|||CLOTTING ASSAY| WHOLE BLOOD|| 58-1699775|1326041732|CHC13|85397||11/01/2013|12/31/9999|$42.25|0|0|||CLOTTING FUNCT ACTIVITY|| 58-1699775|1326041732|CHC13|85400||11/01/2013|12/31/9999|$16.29|0|0|||FIBRINOLYTIC PLASMIN|| 58-1699775|1326041732|CHC13|85410||11/01/2013|12/31/9999|$14.21|0|0|||FIBRINOLYTIC ANTIPLASMIN|| 58-1699775|1326041732|CHC13|85415||11/01/2013|12/31/9999|$31.66|0|0|||FIBRINOLYTIC PLASMINOGEN|| 58-1699775|1326041732|CHC13|85420||11/01/2013|12/31/9999|$12.04|0|0|||FIBRINOLYTIC PLASMINOGEN|| 58-1699775|1326041732|CHC13|85421||11/01/2013|12/31/9999|$18.76|0|0|||FIBRINOLYTIC PLASMINOGEN|| 58-1699775|1326041732|CHC13|85441||11/01/2013|12/31/9999|$7.75|0|0|||HEINZ BODIES| DIRECT|| 58-1699775|1326041732|CHC13|85445||11/01/2013|12/31/9999|$12.54|0|0|||HEINZ BODIES| INDUCED|| 58-1699775|1326041732|CHC13|85460||11/01/2013|12/31/9999|$4.45|0|0|||HEMOGLOBIN| FETAL|| 58-1699775|1326041732|CHC13|85461||11/01/2013|12/31/9999|$12.22|0|0|||HEMOGLOBIN| FETAL|| 58-1699775|1326041732|CHC13|85475||11/01/2013|12/31/9999|$9.61|0|0|||HEMOLYSIN|| 58-1699775|1326041732|CHC13|85520||11/01/2013|12/31/9999|$24.10|0|0|||HEPARIN ASSAY|| 58-1699775|1326041732|CHC13|85525||11/01/2013|12/31/9999|$21.81|0|0|||HEPARIN NEUTRALIZATION|| 58-1699775|1326041732|CHC13|85530||11/01/2013|12/31/9999|$26.10|0|0|||HEPARIN-PROTAMINE TOLERANCE|| 58-1699775|1326041732|CHC13|85536||11/01/2013|12/31/9999|$11.92|0|0|||IRON STAIN PERIPHERAL BLOOD|| 58-1699775|1326041732|CHC13|85540||11/01/2013|12/31/9999|$11.13|0|0|||WBC ALKALINE PHOSPHATASE|| 58-1699775|1326041732|CHC13|85547||11/01/2013|12/31/9999|$11.13|0|0|||RBC MECHANICAL FRAGILITY|| 58-1699775|1326041732|CHC13|85549||11/01/2013|12/31/9999|$34.54|0|0|||MURAMIDASE|| 58-1699775|1326041732|CHC13|85555||11/01/2013|12/31/9999|$12.30|0|0|||RBC OSMOTIC FRAGILITY|| 58-1699775|1326041732|CHC13|85557||11/01/2013|12/31/9999|$24.60|0|0|||RBC OSMOTIC FRAGILITY|| 58-1699775|1326041732|CHC13|85576||11/01/2013|12/31/9999|$39.56|0|0|||BLOOD PLATELET AGGREGATION|| 58-1699775|1326041732|CHC13|85576|26|11/01/2013|12/31/9999|$30.92|0|0|||BLOOD PLATELET AGGREGATION|| 58-1699775|1326041732|CHC13|85597||11/01/2013|12/31/9999|$33.10|0|0|||PLATELET NEUTRALIZATION|| 58-1699775|1326041732|CHC13|85598||11/01/2013|12/31/9999|$33.10|0|0|||HEXAGNAL PHOSPH PLTLT NEUTRL|| 58-1699775|1326041732|CHC13|85610||11/01/2013|12/31/9999|$7.23|0|0|||PROTHROMBIN TIME|| 58-1699775|1326041732|CHC13|85611||11/01/2013|12/31/9999|$7.25|0|0|||PROTHROMBIN TEST|| 58-1699775|1326041732|CHC13|85612||11/01/2013|12/31/9999|$17.63|0|0|||VIPER VENOM PROTHROMBIN TIME|| 58-1699775|1326041732|CHC13|85613||11/01/2013|12/31/9999|$17.63|0|0|||RUSSELL VIPER VENOM| DILUTED|| 58-1699775|1326041732|CHC13|85635||11/01/2013|12/31/9999|$18.13|0|0|||REPTILASE TEST|| 58-1699775|1326041732|CHC13|85651||11/01/2013|12/31/9999|$6.53|0|0|||RBC SED RATE| NONAUTOMATED|| 58-1699775|1326041732|CHC13|85652||11/01/2013|12/31/9999|$4.98|0|0|||RBC SED RATE| AUTOMATED|| 58-1699775|1326041732|CHC13|85660||11/01/2013|12/31/9999|$10.15|0|0|||RBC SICKLE CELL TEST|| 58-1699775|1326041732|CHC13|85670||11/01/2013|12/31/9999|$10.63|0|0|||THROMBIN TIME| PLASMA|| 58-1699775|1326041732|CHC13|85675||11/01/2013|12/31/9999|$11.13|0|0|||THROMBIN TIME| TITER|| 58-1699775|1326041732|CHC13|85705||11/01/2013|12/31/9999|$17.73|0|0|||THROMBOPLASTIN INHIBITION|| 58-1699775|1326041732|CHC13|85730||11/01/2013|12/31/9999|$11.05|0|0|||THROMBOPLASTIN TIME| PARTIAL|| 58-1699775|1326041732|CHC13|85732||11/01/2013|12/31/9999|$11.92|0|0|||THROMBOPLASTIN TIME| PARTIAL|| 58-1699775|1326041732|CHC13|85810||11/01/2013|12/31/9999|$21.49|0|0|||BLOOD VISCOSITY EXAMINATION|| 58-1699775|1326041732|CHC13|86000||11/01/2013|12/31/9999|$12.86|0|0|||AGGLUTININS| FEBRILE|| 58-1699775|1326041732|CHC13|86001||11/01/2013|12/31/9999|$9.61|0|0|||ALLERGEN SPECIFIC IGG|| 58-1699775|1326041732|CHC13|86003||11/01/2013|12/31/9999|$9.61|0|0|||ALLERGEN SPECIFIC IGE|| 58-1699775|1326041732|CHC13|86005||11/01/2013|12/31/9999|$10.14|0|0|||ALLERGEN SPECIFIC IGE|| 58-1699775|1326041732|CHC13|86008||04/01/2018|12/31/9999|$36.53|0|0|0||ALLG SPEC IGE RECOMB EA|| 58-1699775|1326041732|CHC13|86021||11/01/2013|12/31/9999|$27.73|0|0|||WBC ANTIBODY IDENTIFICATION|| 58-1699775|1326041732|CHC13|86022||11/01/2013|12/31/9999|$33.83|0|0|||PLATELET ANTIBODIES|| 58-1699775|1326041732|CHC13|86023||11/01/2013|12/31/9999|$22.93|0|0|||IMMUNOGLOBULIN ASSAY|| 58-1699775|1326041732|CHC13|86038||11/01/2013|12/31/9999|$22.26|0|0|||ANTINUCLEAR ANTIBODIES|| 58-1699775|1326041732|CHC13|86039||11/01/2013|12/31/9999|$20.55|0|0|||ANTINUCLEAR ANTIBODIES (ANA)|| 58-1699775|1326041732|CHC13|86060||11/01/2013|12/31/9999|$12.87|0|0|||ANTISTREPTOLYSIN O| TITER|| 58-1699775|1326041732|CHC13|86063||11/01/2013|12/31/9999|$10.63|0|0|||ANTISTREPTOLYSIN O| SCREEN|| 58-1699775|1326041732|CHC13|86077||11/01/2013|12/31/9999|$59.94|0|0|||PHYSICIAN BLOOD BANK SERVICE|| 58-1699775|1326041732|CHC13|86078||11/01/2013|12/31/9999|$60.34|0|0|||PHYSICIAN BLOOD BANK SERVICE|| 58-1699775|1326041732|CHC13|86079||11/01/2013|12/31/9999|$60.34|0|0|||PHYSICIAN BLOOD BANK SERVICE|| 58-1699775|1326041732|CHC13|86140||11/01/2013|12/31/9999|$9.53|0|0|||C-REACTIVE PROTEIN|| 58-1699775|1326041732|CHC13|86141||11/01/2013|12/31/9999|$23.84|0|0|||C-REACTIVE PROTEIN| HS|| 58-1699775|1326041732|CHC13|86146||11/01/2013|12/31/9999|$46.85|0|0|||GLYCOPROTEIN ANTIBODY|| 58-1699775|1326041732|CHC13|86147||11/01/2013|12/31/9999|$46.85|0|0|||CARDIOLIPIN ANTIBODY|| 58-1699775|1326041732|CHC13|86148||11/01/2013|12/31/9999|$29.59|0|0|||PHOSPHOLIPID ANTIBODY|| 58-1699775|1326041732|CHC13|86152||11/01/2013|12/31/9999|$42.46|0|0|||CELL ENUMERATION & ID|| 58-1699775|1326041732|CHC13|86153||11/01/2013|12/31/9999|$42.46|0|0|||CELL ENUMERATION PHYS INTERP|| 58-1699775|1326041732|CHC13|86155||11/01/2013|12/31/9999|$29.43|0|0|||CHEMOTAXIS ASSAY|| 58-1699775|1326041732|CHC13|86156||11/01/2013|12/31/9999|$12.34|0|0|||COLD AGGLUTININ| SCREEN|| 58-1699775|1326041732|CHC13|86157||11/01/2013|12/31/9999|$14.86|0|0|||COLD AGGLUTININ| TITER|| 58-1699775|1326041732|CHC13|86160||11/01/2013|12/31/9999|$22.11|0|0|||COMPLEMENT| ANTIGEN|| 58-1699775|1326041732|CHC13|86161||11/01/2013|12/31/9999|$22.11|0|0|||COMPLEMENT/FUNCTION ACTIVITY|| 58-1699775|1326041732|CHC13|86162||11/01/2013|12/31/9999|$37.41|0|0|||COMPLEMENT| TOTAL (CH50)|| 58-1699775|1326041732|CHC13|86171||11/01/2013|12/31/9999|$12.87|0|0|||COMPLEMENT FIXATION| EACH|| 58-1699775|1326041732|CHC13|86185||11/01/2013|12/31/9999|$16.47|0|0|||COUNTERIMMUNOELECTROPHORESIS|| 58-1699775|1326041732|CHC13|86200||11/01/2013|12/31/9999|$23.84|0|0|||CCP ANTIBODY|| 58-1699775|1326041732|CHC13|86215||11/01/2013|12/31/9999|$24.40|0|0|||DEOXYRIBONUCLEASE| ANTIBODY|| 58-1699775|1326041732|CHC13|86225||11/01/2013|12/31/9999|$25.29|0|0|||DNA ANTIBODY|| 58-1699775|1326041732|CHC13|86226||11/01/2013|12/31/9999|$22.29|0|0|||DNA ANTIBODY| SINGLE STRAND|| 58-1699775|1326041732|CHC13|86235||11/01/2013|12/31/9999|$33.02|0|0|||NUCLEAR ANTIGEN ANTIBODY|| 58-1699775|1326041732|CHC13|86243||11/01/2013|12/31/9999|$37.78|0|0|||FC RECEPTOR|| 58-1699775|1326041732|CHC13|86255||11/01/2013|12/31/9999|$22.19|0|0|||FLUORESCENT ANTIBODY| SCREEN|| 58-1699775|1326041732|CHC13|86255|26|11/01/2013|12/31/9999|$30.92|0|0|||FLUORESCENT ANTIBODY| SCREEN|| 58-1699775|1326041732|CHC13|86256||11/01/2013|12/31/9999|$22.19|0|0|||FLUORESCENT ANTIBODY| TITER|| 58-1699775|1326041732|CHC13|86256|26|11/01/2013|12/31/9999|$29.37|0|0|||FLUORESCENT ANTIBODY| TITER|| 58-1699775|1326041732|CHC13|86277||11/01/2013|12/31/9999|$28.98|0|0|||GROWTH HORMONE ANTIBODY|| 58-1699775|1326041732|CHC13|86280||11/01/2013|12/31/9999|$15.08|0|0|||HEMAGGLUTINATION INHIBITION|| 58-1699775|1326041732|CHC13|86294||11/01/2013|12/31/9999|$21.33|0|0|||IMMUNOASSAY| TUMOR| QUAL|| 58-1699775|1326041732|CHC13|86300||11/01/2013|12/31/9999|$38.32|0|0|||IMMUNOASSAY| TUMOR| CA 15-3|| 58-1699775|1326041732|CHC13|86301||11/01/2013|12/31/9999|$38.32|0|0|||IMMUNOASSAY| TUMOR| CA 19-9|| 58-1699775|1326041732|CHC13|86304||11/01/2013|12/31/9999|$38.32|0|0|||IMMUNOASSAY| TUMOR| CA 125|| 58-1699775|1326041732|CHC13|86305||11/01/2013|12/31/9999|$38.32|0|0|||HUMAN EPIDIDYMIS PROTEIN 4|| 58-1699775|1326041732|CHC13|86308||11/01/2013|12/31/9999|$9.53|0|0|||HETEROPHILE ANTIBODIES|| 58-1699775|1326041732|CHC13|86309||11/01/2013|12/31/9999|$11.92|0|0|||HETEROPHILE ANTIBODIES|| 58-1699775|1326041732|CHC13|86310||11/01/2013|12/31/9999|$13.56|0|0|||HETEROPHILE ANTIBODIES|| 58-1699775|1326041732|CHC13|86316||11/01/2013|12/31/9999|$38.32|0|0|||IMMUNOASSAY| TUMOR OTHER|| 58-1699775|1326041732|CHC13|86317||11/01/2013|12/31/9999|$22.10|0|0|||IMMUNOASSAY|INFECTIOUS AGENT|| 58-1699775|1326041732|CHC13|86318||11/01/2013|12/31/9999|$23.84|0|0|||IMMUNOASSAY|INFECTIOUS AGENT|| 58-1699775|1326041732|CHC13|86320||11/01/2013|12/31/9999|$41.27|0|0|||SERUM IMMUNOELECTROPHORESIS|| 58-1699775|1326041732|CHC13|86320|26|11/01/2013|12/31/9999|$29.37|0|0|||SERUM IMMUNOELECTROPHORESIS|| 58-1699775|1326041732|CHC13|86325||11/01/2013|12/31/9999|$41.17|0|0|||OTHER IMMUNOELECTROPHORESIS|| 58-1699775|1326041732|CHC13|86325|26|11/01/2013|12/31/9999|$29.37|0|0|||OTHER IMMUNOELECTROPHORESIS|| 58-1699775|1326041732|CHC13|86327||11/01/2013|12/31/9999|$41.78|0|0|||IMMUNOELECTROPHORESIS ASSAY|| 58-1699775|1326041732|CHC13|86327|26|11/01/2013|12/31/9999|$34.73|0|0|||IMMUNOELECTROPHORESIS ASSAY|| 58-1699775|1326041732|CHC13|86329||11/01/2013|12/31/9999|$25.86|0|0|||IMMUNODIFFUSION|| 58-1699775|1326041732|CHC13|86331||11/01/2013|12/31/9999|$22.07|0|0|||IMMUNODIFFUSION OUCHTERLONY|| 58-1699775|1326041732|CHC13|86332||11/01/2013|12/31/9999|$44.88|0|0|||IMMUNE COMPLEX ASSAY|| 58-1699775|1326041732|CHC13|86334||11/01/2013|12/31/9999|$41.13|0|0|||IMMUNOFIX E-PHORESIS| SERUM|| 58-1699775|1326041732|CHC13|86334|26|11/01/2013|12/31/9999|$30.41|0|0|||IMMUNOFIX E-PHORESIS| SERUM|| 58-1699775|1326041732|CHC13|86335||11/01/2013|12/31/9999|$54.04|0|0|||IMMUNFIX E-PHORSIS/URINE/CSF|| 58-1699775|1326041732|CHC13|86335|26|11/01/2013|12/31/9999|$30.41|0|0|||IMMUNFIX E-PHORSIS/URINE/CSF|| 58-1699775|1326041732|CHC13|86336||11/01/2013|12/31/9999|$23.84|0|0|||INHIBIN A|| 58-1699775|1326041732|CHC13|86337||11/01/2013|12/31/9999|$39.43|0|0|||INSULIN ANTIBODIES|| 58-1699775|1326041732|CHC13|86340||11/01/2013|12/31/9999|$27.76|0|0|||INTRINSIC FACTOR ANTIBODY|| 58-1699775|1326041732|CHC13|86341||11/01/2013|12/31/9999|$36.43|0|0|||ISLET CELL ANTIBODY|| 58-1699775|1326041732|CHC13|86343||11/01/2013|12/31/9999|$22.94|0|0|||LEUKOCYTE HISTAMINE RELEASE|| 58-1699775|1326041732|CHC13|86344||11/01/2013|12/31/9999|$14.70|0|0|||LEUKOCYTE PHAGOCYTOSIS|| 58-1699775|1326041732|CHC13|86352||11/01/2013|12/31/9999|$250.16|0|0|||CELL FUNCTION ASSAY W/STIM|| 58-1699775|1326041732|CHC13|86353||11/01/2013|12/31/9999|$90.27|0|0|||LYMPHOCYTE TRANSFORMATION|| 58-1699775|1326041732|CHC13|86355||11/01/2013|12/31/9999|$43.38|0|0|||B CELLS| TOTAL COUNT|| 58-1699775|1326041732|CHC13|86356||11/01/2013|12/31/9999|$48.07|0|0|||MONONUCLEAR CELL ANTIGEN|| 58-1699775|1326041732|CHC13|86357||11/01/2013|12/31/9999|$43.38|0|0|||NK CELLS| TOTAL COUNT|| 58-1699775|1326041732|CHC13|86359||11/01/2013|12/31/9999|$43.38|0|0|||T CELLS| TOTAL COUNT|| 58-1699775|1326041732|CHC13|86360||11/01/2013|12/31/9999|$86.52|0|0|||T CELL| ABSOLUTE COUNT/RATIO|| 58-1699775|1326041732|CHC13|86361||11/01/2013|12/31/9999|$48.07|0|0|||T CELL| ABSOLUTE COUNT|| 58-1699775|1326041732|CHC13|86367||11/01/2013|12/31/9999|$43.38|0|0|||STEM CELLS| TOTAL COUNT|| 58-1699775|1326041732|CHC13|86376||11/01/2013|12/31/9999|$26.79|0|0|||MICROSOMAL ANTIBODY|| 58-1699775|1326041732|CHC13|86378||11/01/2013|12/31/9999|$36.24|0|0|||MIGRATION INHIBITORY FACTOR|| 58-1699775|1326041732|CHC13|86382||11/01/2013|12/31/9999|$31.14|0|0|||NEUTRALIZATION TEST| VIRAL|| 58-1699775|1326041732|CHC13|86384||11/01/2013|12/31/9999|$20.96|0|0|||NITROBLUE TETRAZOLIUM DYE|| 58-1699775|1326041732|CHC13|86386||11/01/2013|12/31/9999|$29.39|0|0|||NUCLEAR MATRIX PROTEIN 22|| 58-1699775|1326041732|CHC13|86403||11/01/2013|12/31/9999|$18.77|0|0|||PARTICLE AGGLUTINATION TEST|| 58-1699775|1326041732|CHC13|86406||11/01/2013|12/31/9999|$19.59|0|0|||PARTICLE AGGLUTINATION TEST|| 58-1699775|1326041732|CHC13|86430||11/01/2013|12/31/9999|$10.45|0|0|||RHEUMATOID FACTOR TEST|| 58-1699775|1326041732|CHC13|86431||11/01/2013|12/31/9999|$10.45|0|0|||RHEUMATOID FACTOR| QUANT|| 58-1699775|1326041732|CHC13|86480||11/01/2013|12/31/9999|$114.13|0|0|||TB TEST| CELL IMMUN MEASURE|| 58-1699775|1326041732|CHC13|86481||11/01/2013|12/31/9999|$137.96|0|0|||TB AG RESPONSE T-CELL SUSP|| 58-1699775|1326041732|CHC13|86486||11/01/2013|12/31/9999|$6.37|0|0|||SKIN TEST| NOS ANTIGEN|| 58-1699775|1326041732|CHC13|86490||11/01/2013|12/31/9999|$7.56|0|0|||COCCIDIOIDOMYCOSIS SKIN TEST|| 58-1699775|1326041732|CHC13|86510||11/01/2013|12/31/9999|$7.56|0|0|||HISTOPLASMOSIS SKIN TEST|| 58-1699775|1326041732|CHC13|86580||11/01/2013|12/31/9999|$9.15|0|0|||TB INTRADERMAL TEST|| 58-1699775|1326041732|CHC13|86590||11/01/2013|12/31/9999|$20.33|0|0|||STREPTOKINASE| ANTIBODY|| 58-1699775|1326041732|CHC13|86592||11/01/2013|12/31/9999|$7.87|0|0|||BLOOD SEROLOGY| QUALITATIVE|| 58-1699775|1326041732|CHC13|86593||11/01/2013|12/31/9999|$8.10|0|0|||BLOOD SEROLOGY| QUANTITATIVE|| 58-1699775|1326041732|CHC13|86602||11/01/2013|12/31/9999|$18.75|0|0|||ANTINOMYCES ANTIBODY|| 58-1699775|1326041732|CHC13|86603||11/01/2013|12/31/9999|$23.70|0|0|||ADENOVIRUS ANTIBODY|| 58-1699775|1326041732|CHC13|86606||11/01/2013|12/31/9999|$27.73|0|0|||ASPERGILLUS ANTIBODY|| 58-1699775|1326041732|CHC13|86609||11/01/2013|12/31/9999|$23.73|0|0|||BACTERIUM ANTIBODY|| 58-1699775|1326041732|CHC13|86611||11/01/2013|12/31/9999|$18.75|0|0|||BARTONELLA ANTIBODY|| 58-1699775|1326041732|CHC13|86612||11/01/2013|12/31/9999|$23.76|0|0|||BLASTOMYCES ANTIBODY|| 58-1699775|1326041732|CHC13|86615||11/01/2013|12/31/9999|$24.28|0|0|||BORDETELLA ANTIBODY|| 58-1699775|1326041732|CHC13|86617||11/01/2013|12/31/9999|$28.52|0|0|||LYME DISEASE ANTIBODY|| 58-1699775|1326041732|CHC13|86618||11/01/2013|12/31/9999|$31.36|0|0|||LYME DISEASE ANTIBODY|| 58-1699775|1326041732|CHC13|86619||11/01/2013|12/31/9999|$24.64|0|0|||BORRELIA ANTIBODY|| 58-1699775|1326041732|CHC13|86622||11/01/2013|12/31/9999|$16.44|0|0|||BRUCELLA ANTIBODY|| 58-1699775|1326041732|CHC13|86625||11/01/2013|12/31/9999|$24.15|0|0|||CAMPYLOBACTER ANTIBODY|| 58-1699775|1326041732|CHC13|86628||11/01/2013|12/31/9999|$22.11|0|0|||CANDIDA ANTIBODY|| 58-1699775|1326041732|CHC13|86631||11/01/2013|12/31/9999|$21.77|0|0|||CHLAMYDIA ANTIBODY|| 58-1699775|1326041732|CHC13|86632||11/01/2013|12/31/9999|$23.36|0|0|||CHLAMYDIA IGM ANTIBODY|| 58-1699775|1326041732|CHC13|86635||11/01/2013|12/31/9999|$21.12|0|0|||COCCIDIOIDES ANTIBODY|| 58-1699775|1326041732|CHC13|86638||11/01/2013|12/31/9999|$22.33|0|0|||Q FEVER ANTIBODY|| 58-1699775|1326041732|CHC13|86641||11/01/2013|12/31/9999|$26.55|0|0|||CRYPTOCOCCUS ANTIBODY|| 58-1699775|1326041732|CHC13|86644||11/01/2013|12/31/9999|$21.44|0|0|||CMV ANTIBODY|| 58-1699775|1326041732|CHC13|86645||11/01/2013|12/31/9999|$31.02|0|0|||CMV ANTIBODY| IGM|| 58-1699775|1326041732|CHC13|86648||11/01/2013|12/31/9999|$28.00|0|0|||DIPHTHERIA ANTIBODY|| 58-1699775|1326041732|CHC13|86651||11/01/2013|12/31/9999|$24.28|0|0|||ENCEPHALITIS ANTIBODY|| 58-1699775|1326041732|CHC13|86652||11/01/2013|12/31/9999|$24.28|0|0|||ENCEPHALITIS ANTIBODY|| 58-1699775|1326041732|CHC13|86653||11/01/2013|12/31/9999|$24.28|0|0|||ENCEPHALITIS ANTIBODY|| 58-1699775|1326041732|CHC13|86654||11/01/2013|12/31/9999|$24.28|0|0|||ENCEPHALITIS ANTIBODY|| 58-1699775|1326041732|CHC13|86658||11/01/2013|12/31/9999|$24.00|0|0|||ENTEROVIRUS ANTIBODY|| 58-1699775|1326041732|CHC13|86663||11/01/2013|12/31/9999|$24.15|0|0|||EPSTEIN-BARR ANTIBODY|| 58-1699775|1326041732|CHC13|86664||11/01/2013|12/31/9999|$28.17|0|0|||EPSTEIN-BARR ANTIBODY|| 58-1699775|1326041732|CHC13|86665||11/01/2013|12/31/9999|$33.40|0|0|||EPSTEIN-BARR ANTIBODY|| 58-1699775|1326041732|CHC13|86666||11/01/2013|12/31/9999|$18.75|0|0|||EHRLICHIA ANTIBODY|| 58-1699775|1326041732|CHC13|86668||11/01/2013|12/31/9999|$19.15|0|0|||FRANCISELLA TULARENSIS|| 58-1699775|1326041732|CHC13|86671||11/01/2013|12/31/9999|$22.57|0|0|||FUNGUS ANTIBODY|| 58-1699775|1326041732|CHC13|86674||11/01/2013|12/31/9999|$27.11|0|0|||GIARDIA LAMBLIA ANTIBODY|| 58-1699775|1326041732|CHC13|86677||11/01/2013|12/31/9999|$26.73|0|0|||HELICOBACTER PYLORI|| 58-1699775|1326041732|CHC13|86682||11/01/2013|12/31/9999|$23.96|0|0|||HELMINTH ANTIBODY|| 58-1699775|1326041732|CHC13|86684||11/01/2013|12/31/9999|$29.17|0|0|||HEMOPHILUS INFLUENZA|| 58-1699775|1326041732|CHC13|86687||11/01/2013|12/31/9999|$15.44|0|0|||HTLV-I ANTIBODY|| 58-1699775|1326041732|CHC13|86688||11/01/2013|12/31/9999|$25.79|0|0|||HTLV-II ANTIBODY|| 58-1699775|1326041732|CHC13|86689||11/01/2013|12/31/9999|$35.63|0|0|||HTLV/HIV CONFIRMATORY TEST|| 58-1699775|1326041732|CHC13|86692||11/01/2013|12/31/9999|$31.60|0|0|||HEPATITIS| DELTA AGENT|| 58-1699775|1326041732|CHC13|86694||11/01/2013|12/31/9999|$21.44|0|0|||HERPES SIMPLEX TEST|| 58-1699775|1326041732|CHC13|86695||11/01/2013|12/31/9999|$24.28|0|0|||HERPES SIMPLEX TEST|| 58-1699775|1326041732|CHC13|86696||11/01/2013|12/31/9999|$35.63|0|0|||HERPES SIMPLEX TYPE 2|| 58-1699775|1326041732|CHC13|86698||11/01/2013|12/31/9999|$23.02|0|0|||HISTOPLASMA|| 58-1699775|1326041732|CHC13|86701||11/01/2013|12/31/9999|$16.35|0|0|||HIV-1|| 58-1699775|1326041732|CHC13|86702||11/01/2013|12/31/9999|$24.88|0|0|||HIV-2|| 58-1699775|1326041732|CHC13|86703||11/01/2013|12/31/9999|$25.26|0|0|||HIV-1/HIV-2| SINGLE ASSAY|| 58-1699775|1326041732|CHC13|86704||11/01/2013|12/31/9999|$22.19|0|0|||HEP B CORE ANTIBODY| TOTAL|| 58-1699775|1326041732|CHC13|86705||11/01/2013|12/31/9999|$21.67|0|0|||HEP B CORE ANTIBODY| IGM|| 58-1699775|1326041732|CHC13|86706||11/01/2013|12/31/9999|$19.77|0|0|||HEP B SURFACE ANTIBODY|| 58-1699775|1326041732|CHC13|86707||11/01/2013|12/31/9999|$21.29|0|0|||HEP BE ANTIBODY|| 58-1699775|1326041732|CHC13|86708||11/01/2013|12/31/9999|$22.81|0|0|||HEP A ANTIBODY| TOTAL|| 58-1699775|1326041732|CHC13|86709||11/01/2013|12/31/9999|$20.73|0|0|||HEP A ANTIBODY| IGM|| 58-1699775|1326041732|CHC13|86710||11/01/2013|12/31/9999|$24.96|0|0|||INFLUENZA VIRUS ANTIBODY|| 58-1699775|1326041732|CHC13|86711||11/01/2013|12/31/9999|$25.73|0|0|||JOHN CUNNINGHAM ANTIBODY|| 58-1699775|1326041732|CHC13|86713||11/01/2013|12/31/9999|$28.17|0|0|||LEGIONELLA ANTIBODY|| 58-1699775|1326041732|CHC13|86717||11/01/2013|12/31/9999|$22.56|0|0|||LEISHMANIA ANTIBODY|| 58-1699775|1326041732|CHC13|86720||11/01/2013|12/31/9999|$24.28|0|0|||LEPTOSPIRA ANTIBODY|| 58-1699775|1326041732|CHC13|86723||11/01/2013|12/31/9999|$24.28|0|0|||LISTERIA MONOCYTOGENES AB|| 58-1699775|1326041732|CHC13|86727||11/01/2013|12/31/9999|$23.70|0|0|||LYMPH CHORIOMENINGITIS AB|| 58-1699775|1326041732|CHC13|86729||11/01/2013|12/31/9999|$22.00|0|0|||LYMPHO VENEREUM ANTIBODY|| 58-1699775|1326041732|CHC13|86732||11/01/2013|12/31/9999|$24.28|0|0|||MUCORMYCOSIS ANTIBODY|| 58-1699775|1326041732|CHC13|86735||11/01/2013|12/31/9999|$24.04|0|0|||MUMPS ANTIBODY|| 58-1699775|1326041732|CHC13|86738||11/01/2013|12/31/9999|$24.39|0|0|||MYCOPLASMA ANTIBODY|| 58-1699775|1326041732|CHC13|86741||11/01/2013|12/31/9999|$24.28|0|0|||NEISSERIA MENINGITIDIS|| 58-1699775|1326041732|CHC13|86744||11/01/2013|12/31/9999|$24.28|0|0|||NOCARDIA ANTIBODY|| 58-1699775|1326041732|CHC13|86747||11/01/2013|12/31/9999|$27.69|0|0|||PARVOVIRUS ANTIBODY|| 58-1699775|1326041732|CHC13|86750||11/01/2013|12/31/9999|$24.28|0|0|||MALARIA ANTIBODY|| 58-1699775|1326041732|CHC13|86753||11/01/2013|12/31/9999|$22.81|0|0|||PROTOZOA ANTIBODY NOS|| 58-1699775|1326041732|CHC13|86756||11/01/2013|12/31/9999|$23.74|0|0|||RESPIRATORY VIRUS ANTIBODY|| 58-1699775|1326041732|CHC13|86757||11/01/2013|12/31/9999|$35.63|0|0|||RICKETTSIA ANTIBODY|| 58-1699775|1326041732|CHC13|86759||11/01/2013|12/31/9999|$24.28|0|0|||ROTAVIRUS ANTIBODY|| 58-1699775|1326041732|CHC13|86762||11/01/2013|12/31/9999|$21.44|0|0|||RUBELLA ANTIBODY|| 58-1699775|1326041732|CHC13|86765||11/01/2013|12/31/9999|$23.73|0|0|||RUBEOLA ANTIBODY|| 58-1699775|1326041732|CHC13|86768||11/01/2013|12/31/9999|$24.28|0|0|||SALMONELLA ANTIBODY|| 58-1699775|1326041732|CHC13|86771||11/01/2013|12/31/9999|$24.28|0|0|||SHIGELLA ANTIBODY|| 58-1699775|1326041732|CHC13|86774||11/01/2013|12/31/9999|$27.25|0|0|||TETANUS ANTIBODY|| 58-1699775|1326041732|CHC13|86777||11/01/2013|12/31/9999|$21.44|0|0|||TOXOPLASMA ANTIBODY|| 58-1699775|1326041732|CHC13|86778||11/01/2013|12/31/9999|$26.52|0|0|||TOXOPLASMA ANTIBODY| IGM|| 58-1699775|1326041732|CHC13|86780||11/01/2013|12/31/9999|$24.38|0|0|||TREPONEMA PALLIDUM|| 58-1699775|1326041732|CHC13|86784||11/01/2013|12/31/9999|$23.14|0|0|||TRICHINELLA ANTIBODY|| 58-1699775|1326041732|CHC13|86787||11/01/2013|12/31/9999|$23.73|0|0|||VARICELLA-ZOSTER ANTIBODY|| 58-1699775|1326041732|CHC13|86788||11/01/2013|12/31/9999|$31.02|0|0|||WEST NILE VIRUS AB| IGM|| 58-1699775|1326041732|CHC13|86789||11/01/2013|12/31/9999|$21.44|0|0|||WEST NILE VIRUS ANTIBODY|| 58-1699775|1326041732|CHC13|86790||11/01/2013|12/31/9999|$23.73|0|0|||VIRUS ANTIBODY NOS|| 58-1699775|1326041732|CHC13|86793||11/01/2013|12/31/9999|$24.28|0|0|||YERSINIA ANTIBODY|| 58-1699775|1326041732|CHC13|86794||04/01/2018|12/31/9999|$34.32|0|0|0||ZIKA VIRUS IGM ANTIBODY|| 58-1699775|1326041732|CHC13|86800||11/01/2013|12/31/9999|$29.29|0|0|||THYROGLOBULIN ANTIBODY|| 58-1699775|1326041732|CHC13|86803||11/01/2013|12/31/9999|$26.29|0|0|||HEPATITIS C AB TEST|| 58-1699775|1326041732|CHC13|86804||11/01/2013|12/31/9999|$28.52|0|0|||HEP C AB TEST| CONFIRM|| 58-1699775|1326041732|CHC13|86805||11/01/2013|12/31/9999|$96.28|0|0|||LYMPHOCYTOTOXICITY ASSAY|| 58-1699775|1326041732|CHC13|86806||11/01/2013|12/31/9999|$87.63|0|0|||LYMPHOCYTOTOXICITY ASSAY|| 58-1699775|1326041732|CHC13|86807||11/01/2013|12/31/9999|$72.86|0|0|||CYTOTOXIC ANTIBODY SCREENING|| 58-1699775|1326041732|CHC13|86808||11/01/2013|12/31/9999|$54.65|0|0|||CYTOTOXIC ANTIBODY SCREENING|| 58-1699775|1326041732|CHC13|86812||11/01/2013|12/31/9999|$47.53|0|0|||HLA TYPING| A| B| OR C|| 58-1699775|1326041732|CHC13|86813||11/01/2013|12/31/9999|$106.78|0|0|||HLA TYPING| A| B| OR C|| 58-1699775|1326041732|CHC13|86816||11/01/2013|12/31/9999|$51.30|0|0|||HLA TYPING| DR/DQ|| 58-1699775|1326041732|CHC13|86817||11/01/2013|12/31/9999|$118.56|0|0|||HLA TYPING| DR/DQ|| 58-1699775|1326041732|CHC13|86821||11/01/2013|12/31/9999|$103.96|0|0|||LYMPHOCYTE CULTURE| MIXED|| 58-1699775|1326041732|CHC13|86822||11/01/2013|12/31/9999|$67.31|0|0|||LYMPHOCYTE CULTURE| PRIMED|| 58-1699775|1326041732|CHC13|86825||11/01/2013|12/31/9999|$144.21|0|0|||HLA X-MATCH| NON-CYTOTOXIC|| 58-1699775|1326041732|CHC13|86826||11/01/2013|12/31/9999|$48.07|0|0|||HLA X-MATCH| NON-CYT ADD-ON|| 58-1699775|1326041732|CHC13|86828||11/01/2013|12/31/9999|$57.10|0|0|||HLA CLASS I&II ANTIBODY QUAL|| 58-1699775|1326041732|CHC13|86829||11/01/2013|12/31/9999|$51.88|0|0|||HLA CLASS I/II ANTIBODY QUAL|| 58-1699775|1326041732|CHC13|86830||11/01/2013|12/31/9999|$144.29|0|0|||HLA CLASS I PHENOTYPE QUAL|| 58-1699775|1326041732|CHC13|86831||11/01/2013|12/31/9999|$123.67|0|0|||HLA CLASS II PHENOTYPE QUAL|| 58-1699775|1326041732|CHC13|86832||11/01/2013|12/31/9999|$226.72|0|0|||HLA CLASS I HIGH DEFIN QUAL|| 58-1699775|1326041732|CHC13|86833||11/01/2013|12/31/9999|$206.12|0|0|||HLA CLASS II HIGH DEFIN QUAL|| 58-1699775|1326041732|CHC13|86834||11/01/2013|12/31/9999|$638.94|0|0|||HLA CLASS I SEMIQUANT PANEL|| 58-1699775|1326041732|CHC13|86835||11/01/2013|12/31/9999|$577.11|0|0|||HLA CLASS II SEMIQUANT PANEL|| 58-1699775|1326041732|CHC13|86850||11/01/2013|12/31/9999|$21.55|0|0|||RBC ANTIBODY SCREEN|| 58-1699775|1326041732|CHC13|86880||11/01/2013|12/31/9999|$9.89|0|0|||COOMBS TEST| DIRECT|| 58-1699775|1326041732|CHC13|86885||11/01/2013|12/31/9999|$10.54|0|0|||COOMBS TEST| INDIRECT| QUAL|| 58-1699775|1326041732|CHC13|86886||11/01/2013|12/31/9999|$8.55|0|0|||COOMBS TEST| INDIRECT| TITER|| 58-1699775|1326041732|CHC13|86900||11/01/2013|12/31/9999|$5.50|0|0|||BLOOD TYPING| ABO|| 58-1699775|1326041732|CHC13|86901||11/01/2013|12/31/9999|$5.50|0|0|||BLOOD TYPING| RH (D)|| 58-1699775|1326041732|CHC13|86902||11/01/2013|12/31/9999|$7.05|0|0|||BLOOD TYPE ANTIGEN DONOR EA|| 58-1699775|1326041732|CHC13|86904||11/01/2013|12/31/9999|$17.51|0|0|||BLOOD TYPING| PATIENT SERUM|| 58-1699775|1326041732|CHC13|86905||11/01/2013|12/31/9999|$7.05|0|0|||BLOOD TYPING| RBC ANTIGENS|| 58-1699775|1326041732|CHC13|86906||11/01/2013|12/31/9999|$14.27|0|0|||BLOOD TYPING| RH PHENOTYPE|| 58-1699775|1326041732|CHC13|86940||11/01/2013|12/31/9999|$15.09|0|0|||HEMOLYSINS/AGGLUTININS| AUTO|| 58-1699775|1326041732|CHC13|86941||11/01/2013|12/31/9999|$22.29|0|0|||HEMOLYSINS/AGGLUTININS|| 58-1699775|1326041732|CHC13|87003||11/01/2013|12/31/9999|$30.99|0|0|||SMALL ANIMAL INOCULATION|| 58-1699775|1326041732|CHC13|87015||11/01/2013|12/31/9999|$12.30|0|0|||SPECIMEN CONCENTRATION|| 58-1699775|1326041732|CHC13|87040||11/01/2013|12/31/9999|$19.01|0|0|||BLOOD CULTURE FOR BACTERIA|| 58-1699775|1326041732|CHC13|87045||11/01/2013|12/31/9999|$17.37|0|0|||FECES CULTURE| BACTERIA|| 58-1699775|1326041732|CHC13|87046||11/01/2013|12/31/9999|$17.37|0|0|||STOOL CULTR| BACTERIA| EACH|| 58-1699775|1326041732|CHC13|87070||11/01/2013|12/31/9999|$15.86|0|0|||CULTURE| BACTERIA| OTHER|| 58-1699775|1326041732|CHC13|87071||11/01/2013|12/31/9999|$17.37|0|0|||CULTURE BACTERI AEROBIC OTHR|| 58-1699775|1326041732|CHC13|87073||11/01/2013|12/31/9999|$17.37|0|0|||CULTURE BACTERIA ANAEROBIC|| 58-1699775|1326041732|CHC13|87075||11/01/2013|12/31/9999|$17.42|0|0|||CULTR BACTERIA| EXCEPT BLOOD|| 58-1699775|1326041732|CHC13|87076||11/01/2013|12/31/9999|$14.88|0|0|||CULTURE ANAEROBE IDENT| EACH|| 58-1699775|1326041732|CHC13|87077||11/01/2013|12/31/9999|$14.88|0|0|||CULTURE AEROBIC IDENTIFY|| 58-1699775|1326041732|CHC13|87081||11/01/2013|12/31/9999|$12.21|0|0|||CULTURE SCREEN ONLY|| 58-1699775|1326041732|CHC13|87084||11/01/2013|12/31/9999|$15.86|0|0|||CULTURE OF SPECIMEN BY KIT|| 58-1699775|1326041732|CHC13|87085||11/01/2013|12/31/9999|$20.00|0|0|||CULTURE OF SPECIMEN BY KIT|| 58-1699775|1326041732|CHC13|87086||11/01/2013|12/31/9999|$14.86|0|0|||URINE CULTURE/COLONY COUNT|| 58-1699775|1326041732|CHC13|87088||11/01/2013|12/31/9999|$14.91|0|0|||URINE BACTERIA CULTURE|| 58-1699775|1326041732|CHC13|87101||11/01/2013|12/31/9999|$14.21|0|0|||SKIN FUNGI CULTURE|| 58-1699775|1326041732|CHC13|87102||11/01/2013|12/31/9999|$15.47|0|0|||FUNGUS ISOLATION CULTURE|| 58-1699775|1326041732|CHC13|87103||11/01/2013|12/31/9999|$16.60|0|0|||BLOOD FUNGUS CULTURE|| 58-1699775|1326041732|CHC13|87106||11/01/2013|12/31/9999|$19.01|0|0|||FUNGI IDENTIFICATION| YEAST|| 58-1699775|1326041732|CHC13|87107||11/01/2013|12/31/9999|$19.01|0|0|||FUNGI IDENTIFICATION| MOLD|| 58-1699775|1326041732|CHC13|87109||11/01/2013|12/31/9999|$28.33|0|0|||MYCOPLASMA|| 58-1699775|1326041732|CHC13|87110||11/01/2013|12/31/9999|$36.08|0|0|||CHLAMYDIA CULTURE|| 58-1699775|1326041732|CHC13|87116||11/01/2013|12/31/9999|$13.38|0|0|||MYCOBACTERIA CULTURE|| 58-1699775|1326041732|CHC13|87118||11/01/2013|12/31/9999|$20.15|0|0|||MYCOBACTERIC IDENTIFICATION|| 58-1699775|1326041732|CHC13|87140||11/01/2013|12/31/9999|$10.27|0|0|||CULTURE TYPE IMMUNOFLUORESC|| 58-1699775|1326041732|CHC13|87143||11/01/2013|12/31/9999|$23.07|0|0|||CULTURE TYPING| GLC/HPLC|| 58-1699775|1326041732|CHC13|87147||11/01/2013|12/31/9999|$8.22|0|0|||CULTURE TYPE| IMMUNOLOGIC|| 58-1699775|1326041732|CHC13|87149||11/01/2013|12/31/9999|$36.31|0|0|||CULTURE TYPE| NUCLEIC ACID|| 58-1699775|1326041732|CHC13|87150||11/01/2013|12/31/9999|$36.13|0|0|||DNA/RNA| AMPLIFIED PROBE|| 58-1699775|1326041732|CHC13|87152||11/01/2013|12/31/9999|$9.62|0|0|||CULTURE TYPE PULSE FIELD GEL|| 58-1699775|1326041732|CHC13|87153||11/01/2013|12/31/9999|$130.44|0|0|||DNA/RNA SEQUENCING|| 58-1699775|1326041732|CHC13|87158||11/01/2013|12/31/9999|$9.62|0|0|||CULTURE TYPING| ADDED METHOD|| 58-1699775|1326041732|CHC13|87164||11/01/2013|12/31/9999|$16.11|0|0|||DARK FIELD EXAMINATION|| 58-1699775|1326041732|CHC13|87164|26|11/01/2013|12/31/9999|$30.41|0|0|||DARK FIELD EXAMINATION|| 58-1699775|1326041732|CHC13|87166||11/01/2013|12/31/9999|$20.80|0|0|||DARK FIELD EXAMINATION|| 58-1699775|1326041732|CHC13|87168||11/01/2013|12/31/9999|$7.87|0|0|||MACROSCOPIC EXAM ARTHROPOD|| 58-1699775|1326041732|CHC13|87169||11/01/2013|12/31/9999|$7.87|0|0|||MACROSCOPIC EXAM PARASITE|| 58-1699775|1326041732|CHC13|87172||11/01/2013|12/31/9999|$7.87|0|0|||PINWORM EXAM|| 58-1699775|1326041732|CHC13|87176||11/01/2013|12/31/9999|$10.83|0|0|||TISSUE HOMOGENIZATION| CULTR|| 58-1699775|1326041732|CHC13|87177||11/01/2013|12/31/9999|$16.38|0|0|||OVA AND PARASITES SMEARS|| 58-1699775|1326041732|CHC13|87181||11/01/2013|12/31/9999|$8.75|0|0|||MICROBE SUSCEPTIBLE| DIFFUSE|| 58-1699775|1326041732|CHC13|87184||11/01/2013|12/31/9999|$12.71|0|0|||MICROBE SUSCEPTIBLE| DISK|| 58-1699775|1326041732|CHC13|87185||11/01/2013|12/31/9999|$8.75|0|0|||MICROBE SUSCEPTIBLE| ENZYME|| 58-1699775|1326041732|CHC13|87186||11/01/2013|12/31/9999|$15.93|0|0|||MICROBE SUSCEPTIBLE| MIC|| 58-1699775|1326041732|CHC13|87187||11/01/2013|12/31/9999|$19.08|0|0|||MICROBE SUSCEPTIBLE| MLC|| 58-1699775|1326041732|CHC13|87188||11/01/2013|12/31/9999|$12.22|0|0|||MICROBE SUSCEPT| MACROBROTH|| 58-1699775|1326041732|CHC13|87190||11/01/2013|12/31/9999|$10.41|0|0|||MICROBE SUSCEPT| MYCOBACTERI|| 58-1699775|1326041732|CHC13|87197||11/01/2013|12/31/9999|$27.66|0|0|||BACTERICIDAL LEVEL| SERUM|| 58-1699775|1326041732|CHC13|87205||11/01/2013|12/31/9999|$4.32|0|0|||SMEAR| GRAM STAIN|| 58-1699775|1326041732|CHC13|87206||11/01/2013|12/31/9999|$9.89|0|0|||SMEAR| FLUORESCENT/ACID STAI|| 58-1699775|1326041732|CHC13|87207||11/01/2013|12/31/9999|$11.04|0|0|||SMEAR| SPECIAL STAIN|| 58-1699775|1326041732|CHC13|87207|26|11/01/2013|12/31/9999|$30.92|0|0|||SMEAR| SPECIAL STAIN|| 58-1699775|1326041732|CHC13|87209||11/01/2013|12/31/9999|$33.10|0|0|||SMEAR| COMPLEX STAIN|| 58-1699775|1326041732|CHC13|87210||11/01/2013|12/31/9999|$7.87|0|0|||SMEAR| WET MOUNT| SALINE/INK|| 58-1699775|1326041732|CHC13|87220||11/01/2013|12/31/9999|$7.87|0|0|||TISSUE EXAM FOR FUNGI|| 58-1699775|1326041732|CHC13|87230||11/01/2013|12/31/9999|$36.35|0|0|||ASSAY| TOXIN OR ANTITOXIN|| 58-1699775|1326041732|CHC13|87250||11/01/2013|12/31/9999|$36.01|0|0|||VIRUS INOCULATE| EGGS/ANIMAL|| 58-1699775|1326041732|CHC13|87252||11/01/2013|12/31/9999|$40.72|0|0|||VIRUS INOCULATION| TISSUE|| 58-1699775|1326041732|CHC13|87253||11/01/2013|12/31/9999|$29.99|0|0|||VIRUS INOCULATE TISSUE| ADDL|| 58-1699775|1326041732|CHC13|87254||11/01/2013|12/31/9999|$36.01|0|0|||VIRUS INOCULATION| SHELL VIA|| 58-1699775|1326041732|CHC13|87255||11/01/2013|12/31/9999|$55.70|0|0|||GENET VIRUS ISOLATE| HSV|| 58-1699775|1326041732|CHC13|87260||11/01/2013|12/31/9999|$22.09|0|0|||ADENOVIRUS AG| IF|| 58-1699775|1326041732|CHC13|87265||11/01/2013|12/31/9999|$22.09|0|0|||PERTUSSIS AG| IF|| 58-1699775|1326041732|CHC13|87267||11/01/2013|12/31/9999|$22.09|0|0|||ENTEROVIRUS ANTIBODY| DFA|| 58-1699775|1326041732|CHC13|87269||11/01/2013|12/31/9999|$22.09|0|0|||GIARDIA AG| IF|| 58-1699775|1326041732|CHC13|87270||11/01/2013|12/31/9999|$22.09|0|0|||CHLAMYDIA TRACHOMATIS AG| IF|| 58-1699775|1326041732|CHC13|87271||11/01/2013|12/31/9999|$22.09|0|0|||CRYPTOSPORIDUM/GARDIA AG| IF|| 58-1699775|1326041732|CHC13|87272||11/01/2013|12/31/9999|$22.09|0|0|||CRYPTOSPORIDIUM AG| IF|| 58-1699775|1326041732|CHC13|87273||11/01/2013|12/31/9999|$22.09|0|0|||HERPES SIMPLEX 2| AG| IF|| 58-1699775|1326041732|CHC13|87274||11/01/2013|12/31/9999|$22.09|0|0|||HERPES SIMPLEX 1| AG| IF|| 58-1699775|1326041732|CHC13|87275||11/01/2013|12/31/9999|$22.09|0|0|||INFLUENZA B| AG| IF|| 58-1699775|1326041732|CHC13|87276||11/01/2013|12/31/9999|$22.09|0|0|||INFLUENZA A| AG| IF|| 58-1699775|1326041732|CHC13|87277||11/01/2013|12/31/9999|$22.09|0|0|||LEGIONELLA MICDADEI| AG| IF|| 58-1699775|1326041732|CHC13|87278||11/01/2013|12/31/9999|$22.09|0|0|||LEGION PNEUMOPHILIA AG| IF|| 58-1699775|1326041732|CHC13|87279||11/01/2013|12/31/9999|$22.09|0|0|||PARAINFLUENZA| AG| IF|| 58-1699775|1326041732|CHC13|87280||11/01/2013|12/31/9999|$22.09|0|0|||RESPIRATORY SYNCYTIAL AG| IF|| 58-1699775|1326041732|CHC13|87281||11/01/2013|12/31/9999|$22.09|0|0|||PNEUMOCYSTIS CARINII| AG| IF|| 58-1699775|1326041732|CHC13|87283||11/01/2013|12/31/9999|$22.09|0|0|||RUBEOLA| AG| IF|| 58-1699775|1326041732|CHC13|87285||11/01/2013|12/31/9999|$22.09|0|0|||TREPONEMA PALLIDUM| AG| IF|| 58-1699775|1326041732|CHC13|87290||11/01/2013|12/31/9999|$22.09|0|0|||VARICELLA ZOSTER| AG| IF|| 58-1699775|1326041732|CHC13|87299||11/01/2013|12/31/9999|$22.09|0|0|||ANTIBODY DETECTION| NOS| IF|| 58-1699775|1326041732|CHC13|87300||11/01/2013|12/31/9999|$22.09|0|0|||AG DETECTION| POLYVAL| IF|| 58-1699775|1326041732|CHC13|87301||11/01/2013|12/31/9999|$22.09|0|0|||ADENOVIRUS AG| EIA|| 58-1699775|1326041732|CHC13|87305||11/01/2013|12/31/9999|$22.09|0|0|||ASPERGILLUS AG| EIA|| 58-1699775|1326041732|CHC13|87320||11/01/2013|12/31/9999|$22.09|0|0|||CHYLMD TRACH AG| EIA|| 58-1699775|1326041732|CHC13|87324||11/01/2013|12/31/9999|$22.09|0|0|||CLOSTRIDIUM AG| EIA|| 58-1699775|1326041732|CHC13|87327||11/01/2013|12/31/9999|$22.09|0|0|||CRYPTOCOCCUS NEOFORM AG| EIA|| 58-1699775|1326041732|CHC13|87328||11/01/2013|12/31/9999|$22.09|0|0|||CRYPTOSPORIDIUM AG| EIA|| 58-1699775|1326041732|CHC13|87329||11/01/2013|12/31/9999|$22.09|0|0|||GIARDIA AG| EIA|| 58-1699775|1326041732|CHC13|87332||11/01/2013|12/31/9999|$22.09|0|0|||CYTOMEGALOVIRUS AG| EIA|| 58-1699775|1326041732|CHC13|87335||11/01/2013|12/31/9999|$22.09|0|0|||E COLI 0157 AG| EIA|| 58-1699775|1326041732|CHC13|87336||11/01/2013|12/31/9999|$22.09|0|0|||ENTAMOEB HIST DISPR| AG| EIA|| 58-1699775|1326041732|CHC13|87337||11/01/2013|12/31/9999|$22.09|0|0|||ENTAMOEB HIST GROUP| AG| EIA|| 58-1699775|1326041732|CHC13|87338||11/01/2013|12/31/9999|$26.48|0|0|||HPYLORI| STOOL| EIA|| 58-1699775|1326041732|CHC13|87339||11/01/2013|12/31/9999|$22.09|0|0|||H PYLORI AG| EIA|| 58-1699775|1326041732|CHC13|87340||11/01/2013|12/31/9999|$19.02|0|0|||HEPATITIS B SURFACE AG| EIA|| 58-1699775|1326041732|CHC13|87341||11/01/2013|12/31/9999|$19.02|0|0|||HEPATITIS B SURFACE| AG| EIA|| 58-1699775|1326041732|CHC13|87350||11/01/2013|12/31/9999|$21.22|0|0|||HEPATITIS BE AG| EIA|| 58-1699775|1326041732|CHC13|87380||11/01/2013|12/31/9999|$30.23|0|0|||HEPATITIS DELTA AG| EIA|| 58-1699775|1326041732|CHC13|87385||11/01/2013|12/31/9999|$22.09|0|0|||HISTOPLASMA CAPSUL AG| EIA|| 58-1699775|1326041732|CHC13|87389||11/01/2013|12/31/9999|$44.36|0|0|||HIV-1 AG W/HIV-1 & HIV-2 AB|| 58-1699775|1326041732|CHC13|87390||11/01/2013|12/31/9999|$32.49|0|0|||HIV-1 AG| EIA|| 58-1699775|1326041732|CHC13|87391||11/01/2013|12/31/9999|$32.49|0|0|||HIV-2 AG| EIA|| 58-1699775|1326041732|CHC13|87400||11/01/2013|12/31/9999|$22.09|0|0|||INFLUENZA A/B| AG| EIA|| 58-1699775|1326041732|CHC13|87420||11/01/2013|12/31/9999|$22.09|0|0|||RESP SYNCYTIAL AG| EIA|| 58-1699775|1326041732|CHC13|87425||11/01/2013|12/31/9999|$22.09|0|0|||ROTAVIRUS AG| EIA|| 58-1699775|1326041732|CHC13|87427||11/01/2013|12/31/9999|$22.09|0|0|||SHIGA-LIKE TOXIN AG| EIA|| 58-1699775|1326041732|CHC13|87430||11/01/2013|12/31/9999|$22.09|0|0|||STREP A AG| EIA|| 58-1699775|1326041732|CHC13|87449||11/01/2013|12/31/9999|$22.09|0|0|||AG DETECT NOS| EIA| MULT|| 58-1699775|1326041732|CHC13|87450||11/01/2013|12/31/9999|$17.65|0|0|||AG DETECT NOS| EIA| SINGLE|| 58-1699775|1326041732|CHC13|87451||11/01/2013|12/31/9999|$17.65|0|0|||AG DETECT POLYVAL| EIA| MULT|| 58-1699775|1326041732|CHC13|87470||11/01/2013|12/31/9999|$36.31|0|0|||BARTONELLA| DNA| DIR PROBE|| 58-1699775|1326041732|CHC13|87471||11/01/2013|12/31/9999|$36.13|0|0|||BARTONELLA| DNA| AMP PROBE|| 58-1699775|1326041732|CHC13|87472||11/01/2013|12/31/9999|$78.87|0|0|||BARTONELLA| DNA| QUANT|| 58-1699775|1326041732|CHC13|87475||11/01/2013|12/31/9999|$36.31|0|0|||LYME DIS| DNA| DIR PROBE|| 58-1699775|1326041732|CHC13|87476||11/01/2013|12/31/9999|$36.13|0|0|||LYME DIS| DNA| AMP PROBE|| 58-1699775|1326041732|CHC13|87477||11/01/2013|12/31/9999|$78.87|0|0|||LYME DIS| DNA| QUANT|| 58-1699775|1326041732|CHC13|87480||11/01/2013|12/31/9999|$36.31|0|0|||CANDIDA| DNA| DIR PROBE|| 58-1699775|1326041732|CHC13|87481||11/01/2013|12/31/9999|$36.13|0|0|||CANDIDA| DNA| AMP PROBE|| 58-1699775|1326041732|CHC13|87482||11/01/2013|12/31/9999|$76.87|0|0|||CANDIDA| DNA| QUANT|| 58-1699775|1326041732|CHC13|87483||04/01/2017|12/31/9999|$314.44|0|314.44|0||CNS DNA AMP PROBE TYPE 12-25|| 58-1699775|1326041732|CHC13|87485||11/01/2013|12/31/9999|$36.31|0|0|||CHYLMD PNEUM| DNA| DIR PROBE|| 58-1699775|1326041732|CHC13|87486||11/01/2013|12/31/9999|$36.13|0|0|||CHYLMD PNEUM| DNA| AMP PROBE|| 58-1699775|1326041732|CHC13|87487||11/01/2013|12/31/9999|$78.87|0|0|||CHYLMD PNEUM| DNA| QUANT|| 58-1699775|1326041732|CHC13|87490||11/01/2013|12/31/9999|$36.31|0|0|||CHYLMD TRACH| DNA| DIR PROBE|| 58-1699775|1326041732|CHC13|87491||11/01/2013|12/31/9999|$36.13|0|0|||CHYLMD TRACH| DNA| AMP PROBE|| 58-1699775|1326041732|CHC13|87492||11/01/2013|12/31/9999|$64.36|0|0|||CHYLMD TRACH| DNA| QUANT|| 58-1699775|1326041732|CHC13|87493||11/01/2013|12/31/9999|$36.13|0|0|||C DIFF AMPLIFIED PROBE|| 58-1699775|1326041732|CHC13|87495||11/01/2013|12/31/9999|$36.31|0|0|||CYTOMEG| DNA| DIR PROBE|| 58-1699775|1326041732|CHC13|87496||11/01/2013|12/31/9999|$36.13|0|0|||CYTOMEG| DNA| AMP PROBE|| 58-1699775|1326041732|CHC13|87497||11/01/2013|12/31/9999|$78.87|0|0|||CYTOMEG| DNA| QUANT|| 58-1699775|1326041732|CHC13|87498||04/01/2014|12/31/9999|$34.80|0|0|||ENTEROVIRUS| DNA| AMP PROBE|| 58-1699775|1326041732|CHC13|87500||11/01/2013|12/31/9999|$36.13|0|0|||VANOMYCIN| DNA| AMP PROBE|| 58-1699775|1326041732|CHC13|87501||11/01/2013|12/31/9999|$59.45|0|0|||INFLUENZA DNA AMP PROB 1+|| 58-1699775|1326041732|CHC13|87502||11/01/2013|12/31/9999|$95.56|0|0|||INFLUENZA DNA AMP PROBE|| 58-1699775|1326041732|CHC13|87503||11/01/2013|12/31/9999|$14.33|0|0|||INFLUENZA DNA AMP PROB ADDL|| 58-1699775|1326041732|CHC13|87505||04/01/2015|12/31/9999|$119.33|0|0|0||NFCT AGENT DETECTION GI|| 58-1699775|1326041732|CHC13|87506||04/01/2015|12/31/9999|$174.36|0|0|0||IADNA-DNA/RNA PROBE TQ 6-11|| 58-1699775|1326041732|CHC13|87507||04/01/2015|12/31/9999|$311.95|0|0|0||IADNA-DNA/RNA PROBE TQ 12-25|| 58-1699775|1326041732|CHC13|87510||11/01/2013|12/31/9999|$36.31|0|0|||GARDNER VAG| DNA| DIR PROBE|| 58-1699775|1326041732|CHC13|87511||11/01/2013|12/31/9999|$36.13|0|0|||GARDNER VAG| DNA| AMP PROBE|| 58-1699775|1326041732|CHC13|87512||11/01/2013|12/31/9999|$76.87|0|0|||GARDNER VAG| DNA| QUANT|| 58-1699775|1326041732|CHC13|87515||11/01/2013|12/31/9999|$36.31|0|0|||HEPATITIS B| DNA| DIR PROBE|| 58-1699775|1326041732|CHC13|87516||11/01/2013|12/31/9999|$36.13|0|0|||HEPATITIS B| DNA| AMP PROBE|| 58-1699775|1326041732|CHC13|87517||11/01/2013|12/31/9999|$78.87|0|0|||HEPATITIS B| DNA| QUANT|| 58-1699775|1326041732|CHC13|87520||11/01/2013|12/31/9999|$36.31|0|0|||HEPATITIS C| RNA| DIR PROBE|| 58-1699775|1326041732|CHC13|87521||04/01/2014|12/31/9999|$34.80|0|0|||HEPATITIS C| RNA| AMP PROBE|| 58-1699775|1326041732|CHC13|87522||04/01/2014|12/31/9999|$75.97|0|0|||HEPATITIS C| RNA| QUANT|| 58-1699775|1326041732|CHC13|87525||11/01/2013|12/31/9999|$36.31|0|0|||HEPATITIS G| DNA| DIR PROBE|| 58-1699775|1326041732|CHC13|87526||11/01/2013|12/31/9999|$36.13|0|0|||HEPATITIS G| DNA| AMP PROBE|| 58-1699775|1326041732|CHC13|87527||11/01/2013|12/31/9999|$76.87|0|0|||HEPATITIS G| DNA| QUANT|| 58-1699775|1326041732|CHC13|87528||11/01/2013|12/31/9999|$36.31|0|0|||HSV| DNA| DIR PROBE|| 58-1699775|1326041732|CHC13|87529||11/01/2013|12/31/9999|$36.13|0|0|||HSV| DNA| AMP PROBE|| 58-1699775|1326041732|CHC13|87530||11/01/2013|12/31/9999|$78.87|0|0|||HSV| DNA| QUANT|| 58-1699775|1326041732|CHC13|87531||11/01/2013|12/31/9999|$36.31|0|0|||HHV-6| DNA| DIR PROBE|| 58-1699775|1326041732|CHC13|87532||11/01/2013|12/31/9999|$36.13|0|0|||HHV-6| DNA| AMP PROBE|| 58-1699775|1326041732|CHC13|87533||11/01/2013|12/31/9999|$76.87|0|0|||HHV-6| DNA| QUANT|| 58-1699775|1326041732|CHC13|87534||11/01/2013|12/31/9999|$36.31|0|0|||HIV-1| DNA| DIR PROBE|| 58-1699775|1326041732|CHC13|87535||04/01/2014|12/31/9999|$34.80|0|0|||HIV-1| DNA| AMP PROBE|| 58-1699775|1326041732|CHC13|87536||04/01/2014|12/31/9999|$92.04|0|0|||HIV-1| DNA| QUANT|| 58-1699775|1326041732|CHC13|87537||11/01/2013|12/31/9999|$36.31|0|0|||HIV-2| DNA| DIR PROBE|| 58-1699775|1326041732|CHC13|87538||04/01/2014|12/31/9999|$34.80|0|0|||HIV-2| DNA| AMP PROBE|| 58-1699775|1326041732|CHC13|87539||04/01/2014|12/31/9999|$75.97|0|0|||HIV-2| DNA| QUANT|| 58-1699775|1326041732|CHC13|87540||11/01/2013|12/31/9999|$36.31|0|0|||LEGION PNEUMO| DNA| DIR PROB|| 58-1699775|1326041732|CHC13|87541||11/01/2013|12/31/9999|$36.13|0|0|||LEGION PNEUMO| DNA| AMP PROB|| 58-1699775|1326041732|CHC13|87542||11/01/2013|12/31/9999|$76.87|0|0|||LEGION PNEUMO| DNA| QUANT|| 58-1699775|1326041732|CHC13|87550||11/01/2013|12/31/9999|$36.31|0|0|||MYCOBACTERIA| DNA| DIR PROBE|| 58-1699775|1326041732|CHC13|87551||11/01/2013|12/31/9999|$36.13|0|0|||MYCOBACTERIA| DNA| AMP PROBE|| 58-1699775|1326041732|CHC13|87552||11/01/2013|12/31/9999|$78.87|0|0|||MYCOBACTERIA| DNA| QUANT|| 58-1699775|1326041732|CHC13|87555||11/01/2013|12/31/9999|$36.31|0|0|||M.TUBERCULO| DNA| DIR PROBE|| 58-1699775|1326041732|CHC13|87556||11/01/2013|12/31/9999|$36.13|0|0|||M.TUBERCULO| DNA| AMP PROBE|| 58-1699775|1326041732|CHC13|87557||11/01/2013|12/31/9999|$78.87|0|0|||M.TUBERCULO| DNA| QUANT|| 58-1699775|1326041732|CHC13|87560||11/01/2013|12/31/9999|$36.31|0|0|||M.AVIUM-INTRA| DNA| DIR PROB|| 58-1699775|1326041732|CHC13|87561||11/01/2013|12/31/9999|$36.13|0|0|||M.AVIUM-INTRA| DNA| AMP PROB|| 58-1699775|1326041732|CHC13|87562||11/01/2013|12/31/9999|$78.87|0|0|||M.AVIUM-INTRA| DNA| QUANT|| 58-1699775|1326041732|CHC13|87580||11/01/2013|12/31/9999|$36.31|0|0|||M.PNEUMON| DNA| DIR PROBE|| 58-1699775|1326041732|CHC13|87581||11/01/2013|12/31/9999|$36.13|0|0|||M.PNEUMON| DNA| AMP PROBE|| 58-1699775|1326041732|CHC13|87582||11/01/2013|12/31/9999|$76.87|0|0|||M.PNEUMON| DNA| QUANT|| 58-1699775|1326041732|CHC13|87590||11/01/2013|12/31/9999|$36.31|0|0|||N.GONORRHOEAE| DNA| DIR PROB|| 58-1699775|1326041732|CHC13|87591||11/01/2013|12/31/9999|$36.13|0|0|||N.GONORRHOEAE| DNA| AMP PROB|| 58-1699775|1326041732|CHC13|87592||11/01/2013|12/31/9999|$78.87|0|0|||N.GONORRHOEAE| DNA| QUANT|| 58-1699775|1326041732|CHC13|87621||11/01/2013|12/31/9999|$36.13|0|0|||HPV| DNA| AMP PROBE|| 58-1699775|1326041732|CHC13|87623||04/01/2015|12/31/9999|$34.71|0|0|0||HPV LOW-RISK TYPES|| 58-1699775|1326041732|CHC13|87624||04/01/2015|12/31/9999|$34.71|0|0|||HPV HIGH-RISK TYPES|| 58-1699775|1326041732|CHC13|87625||04/01/2015|12/31/9999|$34.71|0|0|||HPV TYPES 16 & 18 ONLY|| 58-1699775|1326041732|CHC13|87631||11/01/2013|12/31/9999|$189.88|0|0|||RESP VIRUS 3-5 TARGETS|| 58-1699775|1326041732|CHC13|87632||11/01/2013|12/31/9999|$319.05|0|0|||RESP VIRUS 6-11 TARGETS|| 58-1699775|1326041732|CHC13|87633||11/01/2013|12/31/9999|$641.97|0|0|||RESP VIRUS 12-25 TARGETS|| 58-1699775|1326041732|CHC13|87634||04/01/2018|12/31/9999|$142.99|0|0|0||RSV DNA/RNA AMP PROBE|| 58-1699775|1326041732|CHC13|87640||11/01/2013|12/31/9999|$36.13|0|0|||STAPH A| DNA| AMP PROBE|| 58-1699775|1326041732|CHC13|87641||11/01/2013|12/31/9999|$36.13|0|0|||MR-STAPH| DNA| AMP PROBE|| 58-1699775|1326041732|CHC13|87650||11/01/2013|12/31/9999|$36.31|0|0|||STREP A| DNA| DIR PROBE|| 58-1699775|1326041732|CHC13|87651||11/01/2013|12/31/9999|$36.13|0|0|||STREP A| DNA| AMP PROBE|| 58-1699775|1326041732|CHC13|87652||11/01/2013|12/31/9999|$76.87|0|0|||STREP A| DNA| QUANT|| 58-1699775|1326041732|CHC13|87653||11/01/2013|12/31/9999|$36.13|0|0|||STREP B| DNA| AMP PROBE|| 58-1699775|1326041732|CHC13|87660||11/01/2013|12/31/9999|$36.31|0|0|||TRICHOMONAS VAGIN| DIR PROBE|| 58-1699775|1326041732|CHC13|87661||11/01/2013|12/31/9999|$142.50|0|0|||TRICHOMONAS VAGINALIS AMPLIF|| 58-1699775|1326041732|CHC13|87662||04/01/2018|12/31/9999|$104.53|0|0|0||ZIKA VIRUS DNA/RNA AMP PROBE|| 58-1699775|1326041732|CHC13|87797||11/01/2013|12/31/9999|$36.31|0|0|||DETECT AGENT NOS| DNA| DIR|| 58-1699775|1326041732|CHC13|87798||11/01/2013|12/31/9999|$36.13|0|0|||DETECT AGENT NOS| DNA| AMP|| 58-1699775|1326041732|CHC13|87799||11/01/2013|12/31/9999|$78.87|0|0|||DETECT AGENT NOS| DNA| QUANT|| 58-1699775|1326041732|CHC13|87800||11/01/2013|12/31/9999|$72.62|0|0|||DETECT AGNT MULT| DNA| DIREC|| 58-1699775|1326041732|CHC13|87801||11/01/2013|12/31/9999|$72.25|0|0|||DETECT AGNT MULT| DNA| AMPLI|| 58-1699775|1326041732|CHC13|87802||11/01/2013|12/31/9999|$22.09|0|0|||STREP B ASSAY W/OPTIC|| 58-1699775|1326041732|CHC13|87803||11/01/2013|12/31/9999|$22.09|0|0|||CLOSTRIDIUM TOXIN A W/OPTIC|| 58-1699775|1326041732|CHC13|87804||11/01/2013|12/31/9999|$22.09|0|0|||INFLUENZA ASSAY W/OPTIC|| 58-1699775|1326041732|CHC13|87806||04/01/2015|12/31/9999|$42.60|0|0|0||HIV ANTIGEN W/HIV ANTIBODIES|| 58-1699775|1326041732|CHC13|87807||11/01/2013|12/31/9999|$22.09|0|0|||RSV ASSAY W/OPTIC|| 58-1699775|1326041732|CHC13|87808||11/01/2013|12/31/9999|$22.09|0|0|||TRICHOMONAS ASSAY W/OPTIC|| 58-1699775|1326041732|CHC13|87809||11/01/2013|12/31/9999|$22.09|0|0|||ADENOVIRUS ASSAY W/OPTIC|| 58-1699775|1326041732|CHC13|87810||11/01/2013|12/31/9999|$22.09|0|0|||CHYLMD TRACH ASSAY W/OPTIC|| 58-1699775|1326041732|CHC13|87850||11/01/2013|12/31/9999|$22.09|0|0|||N. GONORRHOEAE ASSAY W/OPTIC|| 58-1699775|1326041732|CHC13|87880||11/01/2013|12/31/9999|$22.09|0|0|||STREP A ASSAY W/OPTIC|| 58-1699775|1326041732|CHC13|87899||11/01/2013|12/31/9999|$22.09|0|0|||AGENT NOS ASSAY W/OPTIC|| 58-1699775|1326041732|CHC13|87900||11/01/2013|12/31/9999|$203.54|0|0|||PHENOTYPE| INFECT AGENT DRUG|| 58-1699775|1326041732|CHC13|87901||11/01/2013|12/31/9999|$160.58|0|0|||GENOTYPE| DNA| HIV REVERSE T|| 58-1699775|1326041732|CHC13|87902||11/01/2013|12/31/9999|$160.58|0|0|||GENOTYPE| DNA| HEPATITIS C|| 58-1699775|1326041732|CHC13|87903||11/01/2013|12/31/9999|$622.78|0|0|||PHENOTYPE| DNA HIV W/CULTURE|| 58-1699775|1326041732|CHC13|87904||11/01/2013|12/31/9999|$40.72|0|0|||PHENOTYPE| DNA HIV W/CLT ADD|| 58-1699775|1326041732|CHC13|87905||11/01/2013|12/31/9999|$22.50|0|0|||SIALIDASE ENZYME ASSAY|| 58-1699775|1326041732|CHC13|87906||11/01/2013|12/31/9999|$80.29|0|0|||GENOTYPE DNA HIV REVERSE T|| 58-1699775|1326041732|CHC13|87910||11/01/2013|12/31/9999|$394.97|0|0|||GENOTYPE CYTOMEGALOVIRUS|| 58-1699775|1326041732|CHC13|87912||11/01/2013|12/31/9999|$394.97|0|0|||GENOTYPE DNA HEPATITIS B|| 58-1699775|1326041732|CHC13|88104||11/01/2013|12/31/9999|$103.60|0|0|||CYTOPATHOLOGY| FLUIDS|| 58-1699775|1326041732|CHC13|88104|26|11/01/2013|12/31/9999|$43.57|0|0|||CYTOPATHOLOGY| FLUIDS|| 58-1699775|1326041732|CHC13|88104|TC|11/01/2013|12/31/9999|$60.03|0|0|||CYTOPATHOLOGY| FLUIDS|| 58-1699775|1326041732|CHC13|88106||11/01/2013|12/31/9999|$110.08|0|0|||CYTOPATHOLOGY| FLUIDS|| 58-1699775|1326041732|CHC13|88106|26|11/01/2013|12/31/9999|$29.87|0|0|||CYTOPATHOLOGY| FLUIDS|| 58-1699775|1326041732|CHC13|88106|TC|11/01/2013|12/31/9999|$80.21|0|0|||CYTOPATHOLOGY| FLUIDS|| 58-1699775|1326041732|CHC13|88108||11/01/2013|12/31/9999|$107.46|0|0|||CYTOPATH| CONCENTRATE TECH|| 58-1699775|1326041732|CHC13|88108|26|11/01/2013|12/31/9999|$34.31|0|0|||CYTOPATH| CONCENTRATE TECH|| 58-1699775|1326041732|CHC13|88108|TC|11/01/2013|12/31/9999|$73.15|0|0|||CYTOPATH| CONCENTRATE TECH|| 58-1699775|1326041732|CHC13|88112||11/01/2013|12/31/9999|$158.65|0|0|||CYTOPATH| CELL ENHANCE TECH|| 58-1699775|1326041732|CHC13|88112|26|11/01/2013|12/31/9999|$90.04|0|0|||CYTOPATH| CELL ENHANCE TECH|| 58-1699775|1326041732|CHC13|88112|TC|11/01/2013|12/31/9999|$68.61|0|0|||CYTOPATH| CELL ENHANCE TECH|| 58-1699775|1326041732|CHC13|88120||11/01/2013|12/31/9999|$708.51|0|0|||CYTP URNE 3-5 PROBES EA SPEC|| 58-1699775|1326041732|CHC13|88120|26|11/01/2013|12/31/9999|$83.58|0|0|||CYTP URNE 3-5 PROBES EA SPEC|| 58-1699775|1326041732|CHC13|88120|TC|11/01/2013|12/31/9999|$624.92|0|0|||CYTP URNE 3-5 PROBES EA SPEC|| 58-1699775|1326041732|CHC13|88121||11/01/2013|12/31/9999|$610.49|0|0|||CYTP URINE 3-5 PROBES CMPTR|| 58-1699775|1326041732|CHC13|88121|26|11/01/2013|12/31/9999|$73.86|0|0|||CYTP URINE 3-5 PROBES CMPTR|| 58-1699775|1326041732|CHC13|88121|TC|11/01/2013|12/31/9999|$536.63|0|0|||CYTP URINE 3-5 PROBES CMPTR|| 58-1699775|1326041732|CHC13|88125||11/01/2013|12/31/9999|$34.30|0|0|||FORENSIC CYTOPATHOLOGY|| 58-1699775|1326041732|CHC13|88125|26|11/01/2013|12/31/9999|$20.67|0|0|||FORENSIC CYTOPATHOLOGY|| 58-1699775|1326041732|CHC13|88125|TC|11/01/2013|12/31/9999|$13.63|0|0|||FORENSIC CYTOPATHOLOGY|| 58-1699775|1326041732|CHC13|88130||11/01/2013|12/31/9999|$35.18|0|0|||SEX CHROMATIN IDENTIFICATION|| 58-1699775|1326041732|CHC13|88140||11/01/2013|12/31/9999|$18.68|0|0|||SEX CHROMATIN IDENTIFICATION|| 58-1699775|1326041732|CHC13|88141||11/01/2013|12/31/9999|$45.83|0|0|||CYTOPATH| C/V| INTERPRET|| 58-1699775|1326041732|CHC13|88142||11/01/2013|12/31/9999|$47.36|0|0|||CYTOPATH| C/V| THIN LAYER|| 58-1699775|1326041732|CHC13|88143||11/01/2013|12/31/9999|$47.36|0|0|||CYTOPATH C/V THIN LAYER REDO|| 58-1699775|1326041732|CHC13|88147||11/01/2013|12/31/9999|$24.70|0|0|||CYTOPATH| C/V| AUTOMATED|| 58-1699775|1326041732|CHC13|88148||11/01/2013|12/31/9999|$24.70|0|0|||CYTOPATH| C/V| AUTO RESCREEN|| 58-1699775|1326041732|CHC13|88150||11/01/2013|12/31/9999|$24.70|0|0|||CYTOPATH| C/V| MANUAL|| 58-1699775|1326041732|CHC13|88150|26|11/01/2013|12/31/9999|$14.34|0|0|||CYTOPATH| C/V| MANUAL|| 58-1699775|1326041732|CHC13|88152||11/01/2013|12/31/9999|$24.70|0|0|||CYTOPATH| C/V| AUTO REDO|| 58-1699775|1326041732|CHC13|88153||11/01/2013|12/31/9999|$24.70|0|0|||CYTOPATH| C/V| REDO|| 58-1699775|1326041732|CHC13|88154||11/01/2013|12/31/9999|$24.70|0|0|||CYTOPATH| C/V| SELECT|| 58-1699775|1326041732|CHC13|88155||11/01/2013|12/31/9999|$14.01|0|0|||CYTOPATH| C/V| INDEX ADD-ON|| 58-1699775|1326041732|CHC13|88160||11/01/2013|12/31/9999|$85.61|0|0|||CYTOPATH SMEAR| OTHER SOURCE|| 58-1699775|1326041732|CHC13|88160|26|11/01/2013|12/31/9999|$38.69|0|0|||CYTOPATH SMEAR| OTHER SOURCE|| 58-1699775|1326041732|CHC13|88160|TC|11/01/2013|12/31/9999|$46.92|0|0|||CYTOPATH SMEAR| OTHER SOURCE|| 58-1699775|1326041732|CHC13|88161||11/01/2013|12/31/9999|$87.63|0|0|||CYTOPATH SMEAR| OTHER SOURCE|| 58-1699775|1326041732|CHC13|88161|26|11/01/2013|12/31/9999|$38.18|0|0|||CYTOPATH SMEAR| OTHER SOURCE|| 58-1699775|1326041732|CHC13|88161|TC|11/01/2013|12/31/9999|$49.44|0|0|||CYTOPATH SMEAR| OTHER SOURCE|| 58-1699775|1326041732|CHC13|88162||11/01/2013|12/31/9999|$131.51|0|0|||CYTOPATH SMEAR| OTHER SOURCE|| 58-1699775|1326041732|CHC13|88162|26|11/01/2013|12/31/9999|$60.39|0|0|||CYTOPATH SMEAR| OTHER SOURCE|| 58-1699775|1326041732|CHC13|88162|TC|11/01/2013|12/31/9999|$71.13|0|0|||CYTOPATH SMEAR| OTHER SOURCE|| 58-1699775|1326041732|CHC13|88164||11/01/2013|12/31/9999|$24.70|0|0|||CYTOPATH TBS| C/V| MANUAL|| 58-1699775|1326041732|CHC13|88165||11/01/2013|12/31/9999|$24.70|0|0|||CYTOPATH TBS| C/V| REDO|| 58-1699775|1326041732|CHC13|88166||11/01/2013|12/31/9999|$24.70|0|0|||CYTOPATH TBS| C/V| AUTO REDO|| 58-1699775|1326041732|CHC13|88167||11/01/2013|12/31/9999|$24.70|0|0|||CYTOPATH TBS| C/V| SELECT|| 58-1699775|1326041732|CHC13|88172||11/01/2013|12/31/9999|$82.16|0|0|||CYTOPATHOLOGY EVAL OF FNA|| 58-1699775|1326041732|CHC13|88172|26|11/01/2013|12/31/9999|$53.90|0|0|||CYTOPATHOLOGY EVAL OF FNA|| 58-1699775|1326041732|CHC13|88172|TC|11/01/2013|12/31/9999|$28.26|0|0|||CYTOPATHOLOGY EVAL OF FNA|| 58-1699775|1326041732|CHC13|88173||11/01/2013|12/31/9999|$213.82|0|0|||CYTOPATH EVAL| FNA| REPORT|| 58-1699775|1326041732|CHC13|88173|26|11/01/2013|12/31/9999|$108.39|0|0|||CYTOPATH EVAL| FNA| REPORT|| 58-1699775|1326041732|CHC13|88173|TC|11/01/2013|12/31/9999|$105.42|0|0|||CYTOPATH EVAL| FNA| REPORT|| 58-1699775|1326041732|CHC13|88174||11/01/2013|12/31/9999|$49.93|0|0|||CYTOPATH| C/V AUTO| IN FLUID|| 58-1699775|1326041732|CHC13|88175||11/01/2013|12/31/9999|$61.86|0|0|||CYTOPATH C/V AUTO FLUID REDO|| 58-1699775|1326041732|CHC13|88177||11/01/2013|12/31/9999|$43.29|0|0|||CYTP C/V AUTO THIN LYR ADDL|| 58-1699775|1326041732|CHC13|88177|26|11/01/2013|12/31/9999|$33.19|0|0|||CYTP C/V AUTO THIN LYR ADDL|| 58-1699775|1326041732|CHC13|88177|TC|11/01/2013|12/31/9999|$10.10|0|0|||CYTP C/V AUTO THIN LYR ADDL|| 58-1699775|1326041732|CHC13|88182||11/01/2013|12/31/9999|$155.81|0|0|||CELL MARKER STUDY|| 58-1699775|1326041732|CHC13|88182|26|11/01/2013|12/31/9999|$54.90|0|0|||CELL MARKER STUDY|| 58-1699775|1326041732|CHC13|88182|TC|11/01/2013|12/31/9999|$100.92|0|0|||CELL MARKER STUDY|| 58-1699775|1326041732|CHC13|88184||11/01/2013|12/31/9999|$122.57|0|0|||FLOWCYTOMETRY/ TC| 1 MARKER|| 58-1699775|1326041732|CHC13|88185||11/01/2013|12/31/9999|$74.15|0|0|||FLOWCYTOMETRY/TC| ADD-ON|| 58-1699775|1326041732|CHC13|88187||11/01/2013|12/31/9999|$106.78|0|0|||FLOWCYTOMETRY/READ| 2-8|| 58-1699775|1326041732|CHC13|88188||11/01/2013|12/31/9999|$133.92|0|0|||FLOWCYTOMETRY/READ| 9-15|| 58-1699775|1326041732|CHC13|88189||11/01/2013|12/31/9999|$164.78|0|0|||FLOWCYTOMETRY/READ| 16 & >|| 58-1699775|1326041732|CHC13|88199|26|11/01/2013|12/31/9999|$0.00|0|0|||CYTOPATHOLOGY PROCEDURE|| 58-1699775|1326041732|CHC13|88199|TC|11/01/2013|12/31/9999|$0.00|0|0|||CYTOPATHOLOGY PROCEDURE|| 58-1699775|1326041732|CHC13|88230||11/01/2013|12/31/9999|$272.27|0|0|||TISSUE CULTURE| LYMPHOCYTE|| 58-1699775|1326041732|CHC13|88233||11/01/2013|12/31/9999|$328.89|0|0|||TISSUE CULTURE| SKIN/BIOPSY|| 58-1699775|1326041732|CHC13|88235||11/01/2013|12/31/9999|$344.14|0|0|||TISSUE CULTURE| PLACENTA|| 58-1699775|1326041732|CHC13|88237||11/01/2013|12/31/9999|$206.33|0|0|||TISSUE CULTURE| BONE MARROW|| 58-1699775|1326041732|CHC13|88239||11/01/2013|12/31/9999|$344.77|0|0|||TISSUE CULTURE| TUMOR|| 58-1699775|1326041732|CHC13|88240||11/01/2013|12/31/9999|$19.02|0|0|||CELL CRYOPRESERVE/STORAGE|| 58-1699775|1326041732|CHC13|88241||11/01/2013|12/31/9999|$19.02|0|0|||FROZEN CELL PREPARATION|| 58-1699775|1326041732|CHC13|88245||11/01/2013|12/31/9999|$347.90|0|0|||CHROMOSOME ANALYSIS| 20-25|| 58-1699775|1326041732|CHC13|88248||11/01/2013|12/31/9999|$404.71|0|0|||CHROMOSOME ANALYSIS| 50-100|| 58-1699775|1326041732|CHC13|88249||11/01/2013|12/31/9999|$404.71|0|0|||CHROMOSOME ANALYSIS| 100|| 58-1699775|1326041732|CHC13|88261||11/01/2013|12/31/9999|$413.03|0|0|||CHROMOSOME ANALYSIS| 5|| 58-1699775|1326041732|CHC13|88262||11/01/2013|12/31/9999|$291.29|0|0|||CHROMOSOME ANALYSIS| 15-20|| 58-1699775|1326041732|CHC13|88263||11/01/2013|12/31/9999|$351.22|0|0|||CHROMOSOME ANALYSIS| 45|| 58-1699775|1326041732|CHC13|88264||11/01/2013|12/31/9999|$291.29|0|0|||CHROMOSOME ANALYSIS| 20-25|| 58-1699775|1326041732|CHC13|88267||11/01/2013|12/31/9999|$420.12|0|0|||CHROMOSOME ANALYS| PLACENTA|| 58-1699775|1326041732|CHC13|88269||11/01/2013|12/31/9999|$388.71|0|0|||CHROMOSOME ANALYS| AMNIOTIC|| 58-1699775|1326041732|CHC13|88271||11/01/2013|12/31/9999|$50.04|0|0|||CYTOGENETICS| DNA PROBE|| 58-1699775|1326041732|CHC13|88272||11/01/2013|12/31/9999|$62.57|0|0|||CYTOGENETICS| 3-5|| 58-1699775|1326041732|CHC13|88273||11/01/2013|12/31/9999|$75.09|0|0|||CYTOGENETICS| 10-30|| 58-1699775|1326041732|CHC13|88274||11/01/2013|12/31/9999|$81.36|0|0|||CYTOGENETICS| 25-99|| 58-1699775|1326041732|CHC13|88275||11/01/2013|12/31/9999|$93.85|0|0|||CYTOGENETICS| 100-300|| 58-1699775|1326041732|CHC13|88280||11/01/2013|12/31/9999|$58.66|0|0|||CHROMOSOME KARYOTYPE STUDY|| 58-1699775|1326041732|CHC13|88283||11/01/2013|12/31/9999|$83.34|0|0|||CHROMOSOME BANDING STUDY|| 58-1699775|1326041732|CHC13|88285||11/01/2013|12/31/9999|$44.40|0|0|||CHROMOSOME COUNT| ADDITIONAL|| 58-1699775|1326041732|CHC13|88289||11/01/2013|12/31/9999|$80.47|0|0|||CHROMOSOME STUDY| ADDITIONAL|| 58-1699775|1326041732|CHC13|88291||11/01/2013|12/31/9999|$46.40|0|0|||CYTO/MOLECULAR REPORT|| 58-1699775|1326041732|CHC13|88300||11/01/2013|12/31/9999|$42.35|0|0|||SURGICAL PATH| GROSS|| 58-1699775|1326041732|CHC13|88300|26|11/01/2013|12/31/9999|$7.03|0|0|||SURGICAL PATH| GROSS|| 58-1699775|1326041732|CHC13|88300|TC|11/01/2013|12/31/9999|$35.32|0|0|||SURGICAL PATH| GROSS|| 58-1699775|1326041732|CHC13|88302||11/01/2013|12/31/9999|$83.49|0|0|||TISSUE EXAM BY PATHOLOGIST|| 58-1699775|1326041732|CHC13|88302|26|11/01/2013|12/31/9999|$10.34|0|0|||TISSUE EXAM BY PATHOLOGIST|| 58-1699775|1326041732|CHC13|88302|TC|11/01/2013|12/31/9999|$73.15|0|0|||TISSUE EXAM BY PATHOLOGIST|| 58-1699775|1326041732|CHC13|88304||11/01/2013|12/31/9999|$93.08|0|0|||TISSUE EXAM BY PATHOLOGIST|| 58-1699775|1326041732|CHC13|88304|26|11/01/2013|12/31/9999|$17.42|0|0|||TISSUE EXAM BY PATHOLOGIST|| 58-1699775|1326041732|CHC13|88304|TC|11/01/2013|12/31/9999|$75.67|0|0|||TISSUE EXAM BY PATHOLOGIST|| 58-1699775|1326041732|CHC13|88305||11/01/2013|12/31/9999|$161.18|0|0|||TISSUE EXAM BY PATHOLOGIST|| 58-1699775|1326041732|CHC13|88305|26|11/01/2013|12/31/9999|$57.77|0|0|||TISSUE EXAM BY PATHOLOGIST|| 58-1699775|1326041732|CHC13|88305|TC|11/01/2013|12/31/9999|$103.41|0|0|||TISSUE EXAM BY PATHOLOGIST|| 58-1699775|1326041732|CHC13|88307||11/01/2013|12/31/9999|$356.68|0|0|||TISSUE EXAM BY PATHOLOGIST|| 58-1699775|1326041732|CHC13|88307|26|11/01/2013|12/31/9999|$126.18|0|0|||TISSUE EXAM BY PATHOLOGIST|| 58-1699775|1326041732|CHC13|88307|TC|11/01/2013|12/31/9999|$230.50|0|0|||TISSUE EXAM BY PATHOLOGIST|| 58-1699775|1326041732|CHC13|88309||11/01/2013|12/31/9999|$542.75|0|0|||TISSUE EXAM BY PATHOLOGIST|| 58-1699775|1326041732|CHC13|88309|26|11/01/2013|12/31/9999|$221.94|0|0|||TISSUE EXAM BY PATHOLOGIST|| 58-1699775|1326041732|CHC13|88309|TC|11/01/2013|12/31/9999|$320.81|0|0|||TISSUE EXAM BY PATHOLOGIST|| 58-1699775|1326041732|CHC13|88311||11/01/2013|12/31/9999|$29.65|0|0|||DECALCIFY TISSUE|| 58-1699775|1326041732|CHC13|88311|26|11/01/2013|12/31/9999|$19.04|0|0|||DECALCIFY TISSUE|| 58-1699775|1326041732|CHC13|88311|TC|11/01/2013|12/31/9999|$10.61|0|0|||DECALCIFY TISSUE|| 58-1699775|1326041732|CHC13|88312||11/01/2013|12/31/9999|$141.82|0|0|||SPECIAL STAINS|| 58-1699775|1326041732|CHC13|88312|26|11/01/2013|12/31/9999|$41.44|0|0|||SPECIAL STAINS|| 58-1699775|1326041732|CHC13|88312|TC|11/01/2013|12/31/9999|$100.38|0|0|||SPECIAL STAINS|| 58-1699775|1326041732|CHC13|88313||11/01/2013|12/31/9999|$98.75|0|0|||SPECIAL STAINS|| 58-1699775|1326041732|CHC13|88313|26|11/01/2013|12/31/9999|$18.54|0|0|||SPECIAL STAINS|| 58-1699775|1326041732|CHC13|88313|TC|11/01/2013|12/31/9999|$80.21|0|0|||SPECIAL STAINS|| 58-1699775|1326041732|CHC13|88314||11/01/2013|12/31/9999|$121.13|0|0|||HISTOCHEMICAL STAIN|| 58-1699775|1326041732|CHC13|88314|26|11/01/2013|12/31/9999|$34.87|0|0|||HISTOCHEMICAL STAIN|| 58-1699775|1326041732|CHC13|88314|TC|11/01/2013|12/31/9999|$86.26|0|0|||HISTOCHEMICAL STAIN|| 58-1699775|1326041732|CHC13|88319||11/01/2013|12/31/9999|$148.35|0|0|||ENZYME HISTOCHEMISTRY|| 58-1699775|1326041732|CHC13|88319|26|11/01/2013|12/31/9999|$41.92|0|0|||ENZYME HISTOCHEMISTRY|| 58-1699775|1326041732|CHC13|88319|TC|11/01/2013|12/31/9999|$106.43|0|0|||ENZYME HISTOCHEMISTRY|| 58-1699775|1326041732|CHC13|88321||11/01/2013|12/31/9999|$129.03|0|0|||MICROSLIDE CONSULTATION|| 58-1699775|1326041732|CHC13|88323||11/01/2013|12/31/9999|$213.81|0|0|||MICROSLIDE CONSULTATION|| 58-1699775|1326041732|CHC13|88323|26|11/01/2013|12/31/9999|$131.09|0|0|||MICROSLIDE CONSULTATION|| 58-1699775|1326041732|CHC13|88323|TC|11/01/2013|12/31/9999|$82.73|0|0|||MICROSLIDE CONSULTATION|| 58-1699775|1326041732|CHC13|88325||11/01/2013|12/31/9999|$199.11|0|0|||COMPREHENSIVE REVIEW OF DATA|| 58-1699775|1326041732|CHC13|88329||11/01/2013|12/31/9999|$54.84|0|0|||PATH CONSULT INTROP|| 58-1699775|1326041732|CHC13|88331||11/01/2013|12/31/9999|$144.03|0|0|||PATH CONSULT INTRAOP| 1 BLOC|| 58-1699775|1326041732|CHC13|88331|26|11/01/2013|12/31/9999|$94.08|0|0|||PATH CONSULT INTRAOP| 1 BLOC|| 58-1699775|1326041732|CHC13|88331|TC|11/01/2013|12/31/9999|$49.95|0|0|||PATH CONSULT INTRAOP| 1 BLOC|| 58-1699775|1326041732|CHC13|88332||11/01/2013|12/31/9999|$63.93|0|0|||PATH CONSULT INTRAOP| ADD'L|| 58-1699775|1326041732|CHC13|88332|26|11/01/2013|12/31/9999|$46.77|0|0|||PATH CONSULT INTRAOP| ADD'L|| 58-1699775|1326041732|CHC13|88332|TC|11/01/2013|12/31/9999|$17.16|0|0|||PATH CONSULT INTRAOP| ADD'L|| 58-1699775|1326041732|CHC13|88333||11/01/2013|12/31/9999|$150.69|0|0|||INTRAOP CYTO PATH CONSULT| 1|| 58-1699775|1326041732|CHC13|88333|26|11/01/2013|12/31/9999|$95.70|0|0|||INTRAOP CYTO PATH CONSULT| 1|| 58-1699775|1326041732|CHC13|88333|TC|11/01/2013|12/31/9999|$54.99|0|0|||INTRAOP CYTO PATH CONSULT| 1|| 58-1699775|1326041732|CHC13|88334||11/01/2013|12/31/9999|$93.52|0|0|||INTRAOP CYTO PATH CONSULT| 2|| 58-1699775|1326041732|CHC13|88334|26|11/01/2013|12/31/9999|$58.70|0|0|||INTRAOP CYTO PATH CONSULT| 2|| 58-1699775|1326041732|CHC13|88334|TC|11/01/2013|12/31/9999|$34.82|0|0|||INTRAOP CYTO PATH CONSULT| 2|| 58-1699775|1326041732|CHC13|88341||04/01/2015|12/31/9999|$80.95|0|0|||IMMUNOHISTO ANTIBODY SLIDE|| 58-1699775|1326041732|CHC13|88341|26|04/01/2015|12/31/9999|$27.46|0|0|0||IMMUNOHISTO ANTIBODY SLIDE|| 58-1699775|1326041732|CHC13|88341|TC|04/01/2015|12/31/9999|$53.49|0|0|0||IMMUNOHISTO ANTIBODY SLIDE|| 58-1699775|1326041732|CHC13|88342||04/01/2014|12/31/9999|$161.28|0|0|||IMMUNOHISTOCHEMISTRY|| 58-1699775|1326041732|CHC13|88342|26|11/01/2013|12/31/9999|$65.44|0|0|||IMMUNOHISTOCHEMISTRY|| 58-1699775|1326041732|CHC13|88342|TC|11/01/2013|12/31/9999|$95.84|0|0|||IMMUNOHISTOCHEMISTRY|| 58-1699775|1326041732|CHC13|88344||04/01/2015|12/31/9999|$140.26|0|0|0||IMMUNOHISTO ANTIBODY SLIDE|| 58-1699775|1326041732|CHC13|88344|26|04/01/2015|12/31/9999|$50.42|0|0|0||IMMUNOHISTO ANTIBODY SLIDE|| 58-1699775|1326041732|CHC13|88344|TC|04/01/2015|12/31/9999|$89.84|0|0|0||IMMUNOHISTO ANTIBODY SLIDE|| 58-1699775|1326041732|CHC13|88346||11/01/2013|12/31/9999|$158.28|0|0|||IMMUNOFLUORESCENT STUDY|| 58-1699775|1326041732|CHC13|88346|26|11/01/2013|12/31/9999|$65.97|0|0|||IMMUNOFLUORESCENT STUDY|| 58-1699775|1326041732|CHC13|88346|TC|11/01/2013|12/31/9999|$92.31|0|0|||IMMUNOFLUORESCENT STUDY|| 58-1699775|1326041732|CHC13|88347||11/01/2013|12/31/9999|$114.40|0|0|||IMMUNOFLUORESCENT STUDY|| 58-1699775|1326041732|CHC13|88347|26|11/01/2013|12/31/9999|$59.41|0|0|||IMMUNOFLUORESCENT STUDY|| 58-1699775|1326041732|CHC13|88347|TC|11/01/2013|12/31/9999|$54.99|0|0|||IMMUNOFLUORESCENT STUDY|| 58-1699775|1326041732|CHC13|88348||11/01/2013|12/31/9999|$1|050.81|0|0|||ELECTRON MICROSCOPY|| 58-1699775|1326041732|CHC13|88348|26|11/01/2013|12/31/9999|$115.64|0|0|||ELECTRON MICROSCOPY|| 58-1699775|1326041732|CHC13|88348|TC|11/01/2013|12/31/9999|$935.17|0|0|||ELECTRON MICROSCOPY|| 58-1699775|1326041732|CHC13|88349||11/01/2013|12/31/9999|$586.47|0|0|||SCANNING ELECTRON MICROSCOPY|| 58-1699775|1326041732|CHC13|88349|26|11/01/2013|12/31/9999|$61.39|0|0|||SCANNING ELECTRON MICROSCOPY|| 58-1699775|1326041732|CHC13|88349|TC|11/01/2013|12/31/9999|$525.08|0|0|||SCANNING ELECTRON MICROSCOPY|| 58-1699775|1326041732|CHC13|88350||04/01/2016|12/31/9999|$87.16|0|0|0||IMMUNOFLUOR ANTB ADDL STAIN|| 58-1699775|1326041732|CHC13|88350|26|04/01/2016|12/31/9999|$36.11|0|0|0||IMMUNOFLUOR ANTB ADDL STAIN|| 58-1699775|1326041732|CHC13|88350|TC|04/01/2016|12/31/9999|$51.05|0|0|0||IMMUNOFLUOR ANTB ADDL STAIN|| 58-1699775|1326041732|CHC13|88355||11/01/2013|12/31/9999|$298.17|0|0|||ANALYSIS| SKELETAL MUSCLE|| 58-1699775|1326041732|CHC13|88355|26|11/01/2013|12/31/9999|$132.23|0|0|||ANALYSIS| SKELETAL MUSCLE|| 58-1699775|1326041732|CHC13|88355|TC|11/01/2013|12/31/9999|$165.94|0|0|||ANALYSIS| SKELETAL MUSCLE|| 58-1699775|1326041732|CHC13|88356||11/01/2013|12/31/9999|$421.58|0|0|||ANALYSIS| NERVE|| 58-1699775|1326041732|CHC13|88356|26|11/01/2013|12/31/9999|$205.65|0|0|||ANALYSIS| NERVE|| 58-1699775|1326041732|CHC13|88356|TC|11/01/2013|12/31/9999|$215.92|0|0|||ANALYSIS| NERVE|| 58-1699775|1326041732|CHC13|88358||11/01/2013|12/31/9999|$117.47|0|0|||ANALYSIS| TUMOR|| 58-1699775|1326041732|CHC13|88358|26|11/01/2013|12/31/9999|$67.53|0|0|||ANALYSIS| TUMOR|| 58-1699775|1326041732|CHC13|88358|TC|11/01/2013|12/31/9999|$49.95|0|0|||ANALYSIS| TUMOR|| 58-1699775|1326041732|CHC13|88360||11/01/2013|12/31/9999|$184.90|0|0|||TUMOR IMMUNOHISTOCHEM/MANUAL|| 58-1699775|1326041732|CHC13|88360|26|11/01/2013|12/31/9999|$82.00|0|0|||TUMOR IMMUNOHISTOCHEM/MANUAL|| 58-1699775|1326041732|CHC13|88360|TC|11/01/2013|12/31/9999|$102.90|0|0|||TUMOR IMMUNOHISTOCHEM/MANUAL|| 58-1699775|1326041732|CHC13|88361||11/01/2013|12/31/9999|$231.27|0|0|||TUMOR IMMUNOHISTOCHEM/COMPUT|| 58-1699775|1326041732|CHC13|88361|26|11/01/2013|12/31/9999|$89.54|0|0|||TUMOR IMMUNOHISTOCHEM/COMPUT|| 58-1699775|1326041732|CHC13|88361|TC|11/01/2013|12/31/9999|$141.74|0|0|||TUMOR IMMUNOHISTOCHEM/COMPUT|| 58-1699775|1326041732|CHC13|88362||11/01/2013|12/31/9999|$460.52|0|0|||NERVE TEASING PREPARATIONS|| 58-1699775|1326041732|CHC13|88362|26|11/01/2013|12/31/9999|$171.46|0|0|||NERVE TEASING PREPARATIONS|| 58-1699775|1326041732|CHC13|88362|TC|11/01/2013|12/31/9999|$289.05|0|0|||NERVE TEASING PREPARATIONS|| 58-1699775|1326041732|CHC13|88363||11/01/2013|12/31/9999|$25.37|0|0|||XM ARCHIVE TISSUE MOLEC ANAL|| 58-1699775|1326041732|CHC13|88364||04/01/2015|12/31/9999|$116.15|0|0|0||INSITU HYBRIDIZATION (FISH)|| 58-1699775|1326041732|CHC13|88364|26|04/01/2015|12/31/9999|$34.25|0|0|0||INSITU HYBRIDIZATION (FISH)|| 58-1699775|1326041732|CHC13|88364|TC|04/01/2015|12/31/9999|$81.90|0|0|0||INSITU HYBRIDIZATION (FISH)|| 58-1699775|1326041732|CHC13|88365||11/01/2013|12/31/9999|$252.55|0|0|||INSITU HYBRIDIZATION (FISH)|| 58-1699775|1326041732|CHC13|88365|26|11/01/2013|12/31/9999|$90.64|0|0|||INSITU HYBRIDIZATION (FISH)|| 58-1699775|1326041732|CHC13|88365|TC|11/01/2013|12/31/9999|$161.91|0|0|||INSITU HYBRIDIZATION (FISH)|| 58-1699775|1326041732|CHC13|88366||04/01/2015|12/31/9999|$180.49|0|0|0||INSITU HYBRIDIZATION (FISH)|| 58-1699775|1326041732|CHC13|88366|26|04/01/2015|12/31/9999|$79.37|0|0|0||INSITU HYBRIDIZATION (FISH)|| 58-1699775|1326041732|CHC13|88366|TC|04/01/2015|12/31/9999|$101.13|0|0|0||INSITU HYBRIDIZATION (FISH)|| 58-1699775|1326041732|CHC13|88367||11/01/2013|12/31/9999|$398.91|0|0|||INSITU HYBRIDIZATION| AUTO|| 58-1699775|1326041732|CHC13|88367|26|11/01/2013|12/31/9999|$96.80|0|0|||INSITU HYBRIDIZATION| AUTO|| 58-1699775|1326041732|CHC13|88367|TC|11/01/2013|12/31/9999|$302.11|0|0|||INSITU HYBRIDIZATION| AUTO|| 58-1699775|1326041732|CHC13|88368||11/01/2013|12/31/9999|$335.92|0|0|||INSITU HYBRIDIZATION| MANUAL|| 58-1699775|1326041732|CHC13|88368|26|11/01/2013|12/31/9999|$98.87|0|0|||INSITU HYBRIDIZATION| MANUAL|| 58-1699775|1326041732|CHC13|88368|TC|11/01/2013|12/31/9999|$237.05|0|0|||INSITU HYBRIDIZATION| MANUAL|| 58-1699775|1326041732|CHC13|88369||04/01/2015|12/31/9999|$88.57|0|0|0||M/PHMTRC ALYSISHQUANT/SEMIQ|| 58-1699775|1326041732|CHC13|88369|26|04/01/2015|12/31/9999|$31.74|0|0|0||M/PHMTRC ALYSISHQUANT/SEMIQ|| 58-1699775|1326041732|CHC13|88369|TC|04/01/2015|12/31/9999|$56.83|0|0|0||M/PHMTRC ALYSISHQUANT/SEMIQ|| 58-1699775|1326041732|CHC13|88371||11/01/2013|12/31/9999|$51.94|0|0|||PROTEIN| WESTERN BLOT TISSUE|| 58-1699775|1326041732|CHC13|88371|26|11/01/2013|12/31/9999|$29.91|0|0|||PROTEIN| WESTERN BLOT TISSUE|| 58-1699775|1326041732|CHC13|88372||11/01/2013|12/31/9999|$53.16|0|0|||PROTEIN ANALYSIS W/PROBE|| 58-1699775|1326041732|CHC13|88372|26|11/01/2013|12/31/9999|$26.38|0|0|||PROTEIN ANALYSIS W/PROBE|| 58-1699775|1326041732|CHC13|88373||04/01/2015|12/31/9999|$72.64|0|0|0||M/PHMTRC ALYS ISHQUANT/SEMIQ|| 58-1699775|1326041732|CHC13|88373|26|04/01/2015|12/31/9999|$26.68|0|0|0||M/PHMTRC ALYS ISHQUANT/SEMIQ|| 58-1699775|1326041732|CHC13|88373|TC|04/01/2015|12/31/9999|$45.97|0|0|0||M/PHMTRC ALYS ISHQUANT/SEMIQ|| 58-1699775|1326041732|CHC13|88374||04/01/2015|12/31/9999|$243.39|0|0|0||M/PHMTRC ALYS ISHQUANT/SEMIQ|| 58-1699775|1326041732|CHC13|88374|26|04/01/2015|12/31/9999|$57.02|0|0|0||M/PHMTRC ALYS ISHQUANT/SEMIQ|| 58-1699775|1326041732|CHC13|88374|TC|04/01/2015|12/31/9999|$186.37|0|0|0||M/PHMTRC ALYS ISHQUANT/SEMIQ|| 58-1699775|1326041732|CHC13|88375||11/01/2013|12/31/9999|$0.00|0|0|||OPTICAL ENDOMICROSCPY INTERP|| 58-1699775|1326041732|CHC13|88377||04/01/2015|12/31/9999|$256.46|0|0|0||M/PHMTRC ALYS ISHQUANT/SEMIQ|| 58-1699775|1326041732|CHC13|88377|26|04/01/2015|12/31/9999|$83.04|0|0|0||M/PHMTRC ALYS ISHQUANT/SEMIQ|| 58-1699775|1326041732|CHC13|88377|TC|04/01/2015|12/31/9999|$173.42|0|0|0||M/PHMTRC ALYS ISHQUANT/SEMIQ|| 58-1699775|1326041732|CHC13|88380||11/01/2013|12/31/9999|$279.34|0|0|||MICRODISSECTION|| 58-1699775|1326041732|CHC13|88380|26|11/01/2013|12/31/9999|$119.45|0|0|||MICRODISSECTION|| 58-1699775|1326041732|CHC13|88380|TC|11/01/2013|12/31/9999|$159.89|0|0|||MICRODISSECTION|| 58-1699775|1326041732|CHC13|88381||11/01/2013|12/31/9999|$245.88|0|0|||MICRODISSECTION| MANUAL|| 58-1699775|1326041732|CHC13|88381|26|11/01/2013|12/31/9999|$81.96|0|0|||MICRODISSECTION| MANUAL|| 58-1699775|1326041732|CHC13|88381|TC|11/01/2013|12/31/9999|$163.93|0|0|||MICRODISSECTION| MANUAL|| 58-1699775|1326041732|CHC13|88384|TC|11/01/2013|12/31/9999|$178.46|0|0|||EVAL MOLECULAR PROBES| 11-50|| 58-1699775|1326041732|CHC13|88385|26|11/01/2013|12/31/9999|$100.95|0|0|||EVAL MOLECUL PROBES| 51-250|| 58-1699775|1326041732|CHC13|88385|TC|11/01/2013|12/31/9999|$723.27|0|0|||EVAL MOLECUL PROBES| 51-250|| 58-1699775|1326041732|CHC13|88386|26|11/01/2013|12/31/9999|$134.42|0|0|||EVAL MOLECUL PROBES| 251-500|| 58-1699775|1326041732|CHC13|88386|TC|11/01/2013|12/31/9999|$799.93|0|0|||EVAL MOLECUL PROBES| 251-500|| 58-1699775|1326041732|CHC13|88387||11/01/2013|12/31/9999|$55.03|0|0|||TISS EXAM MOLECULAR STUDY|| 58-1699775|1326041732|CHC13|88387|26|11/01/2013|12/31/9999|$45.43|0|0|||TISS EXAM MOLECULAR STUDY|| 58-1699775|1326041732|CHC13|88387|TC|11/01/2013|12/31/9999|$9.60|0|0|||TISS EXAM MOLECULAR STUDY|| 58-1699775|1326041732|CHC13|88388||11/01/2013|12/31/9999|$48.00|0|0|||TISS EX MOLECUL STUDY ADD-ON|| 58-1699775|1326041732|CHC13|88388|26|11/01/2013|12/31/9999|$35.88|0|0|||TISS EX MOLECUL STUDY ADD-ON|| 58-1699775|1326041732|CHC13|88388|TC|11/01/2013|12/31/9999|$12.12|0|0|||TISS EX MOLECUL STUDY ADD-ON|| 58-1699775|1326041732|CHC13|88399|26|11/01/2013|12/31/9999|$0.00|0|0|||SURGICAL PATHOLOGY PROCEDURE|| 58-1699775|1326041732|CHC13|88399|TC|11/01/2013|12/31/9999|$0.00|0|0|||SURGICAL PATHOLOGY PROCEDURE|| 58-1699775|1326041732|CHC13|88720||11/01/2013|12/31/9999|$11.71|0|0|||BILIRUBIN TOTAL TRANSCUT|| 58-1699775|1326041732|CHC13|88738||11/01/2013|12/31/9999|$11.71|0|0|||HGB QUANT TRANSCUTANEOUS|| 58-1699775|1326041732|CHC13|88740||11/01/2013|12/31/9999|$11.71|0|0|||TRANSCUTANEOUS CARBOXYHB|| 58-1699775|1326041732|CHC13|88741||11/01/2013|12/31/9999|$11.71|0|0|||TRANSCUTANEOUS METHB|| 58-1699775|1326041732|CHC13|89049||11/01/2013|12/31/9999|$104.52|0|0|||CHCT FOR MAL HYPERTHERMIA|| 58-1699775|1326041732|CHC13|89050||11/01/2013|12/31/9999|$11.05|0|0|||BODY FLUID CELL COUNT|| 58-1699775|1326041732|CHC13|89051||11/01/2013|12/31/9999|$4.12|0|0|||BODY FLUID CELL COUNT|| 58-1699775|1326041732|CHC13|89055||11/01/2013|12/31/9999|$5.48|0|0|||LEUKOCYTE ASSESSMENT| FECAL|| 58-1699775|1326041732|CHC13|89060||11/01/2013|12/31/9999|$16.71|0|0|||EXAM|SYNOVIAL FLUID CRYSTALS|| 58-1699775|1326041732|CHC13|89060|26|11/01/2013|12/31/9999|$30.41|0|0|||EXAM|SYNOVIAL FLUID CRYSTALS|| 58-1699775|1326041732|CHC13|89125||11/01/2013|12/31/9999|$10.08|0|0|||SPECIMEN FAT STAIN|| 58-1699775|1326041732|CHC13|89160||11/01/2013|12/31/9999|$8.61|0|0|||EXAM FECES FOR MEAT FIBERS|| 58-1699775|1326041732|CHC13|89190||11/01/2013|12/31/9999|$11.10|0|0|||NASAL SMEAR FOR EOSINOPHILS|| 58-1699775|1326041732|CHC13|89220||11/01/2013|12/31/9999|$24.22|0|0|||SPUTUM SPECIMEN COLLECTION|| 58-1699775|1326041732|CHC13|89230||11/01/2013|12/31/9999|$4.05|0|0|||COLLECT SWEAT FOR TEST|| 58-1699775|1326041732|CHC13|89300||11/01/2013|12/31/9999|$20.84|0|0|||SEMEN ANALYSIS W/HUHNER|| 58-1699775|1326041732|CHC13|89310||11/01/2013|12/31/9999|$20.13|0|0|||SEMEN ANALYSIS W/COUNT|| 58-1699775|1326041732|CHC13|89320||11/01/2013|12/31/9999|$13.48|0|0|||SEMEN ANALYSIS| COMPLETE|| 58-1699775|1326041732|CHC13|89321||11/01/2013|12/31/9999|$13.48|0|0|||SEMEN ANALYSIS & MOTILITY|| 58-1699775|1326041732|CHC13|89322||11/01/2013|12/31/9999|$26.98|0|0|||SEMEN ANAL| STRICT CRITERIA|| 58-1699775|1326041732|CHC13|89325||11/01/2013|12/31/9999|$24.95|0|0|||SPERM ANTIBODY TEST|| 58-1699775|1326041732|CHC13|89329||11/01/2013|12/31/9999|$49.01|0|0|||SPERM EVALUATION TEST|| 58-1699775|1326041732|CHC13|89330||11/01/2013|12/31/9999|$23.13|0|0|||EVALUATION| CERVICAL MUCUS|| 58-1699775|1326041732|CHC13|89331||11/01/2013|12/31/9999|$36.53|0|0|||RETROGRADE EJACULATION ANAL|| 58-1699775|1326041732|CHC13|89337||04/01/2015|12/31/9999|$65.00|0|0|0|%|CRYOPRESERVATION OOCYTE(S)|| 58-1699775|1326041732|CHC13|90281||11/01/2013|12/31/9999|$0.00|0|0|||HUMAN IG| IM|| 58-1699775|1326041732|CHC13|90283||11/01/2013|12/31/9999|$0.00|0|0|||HUMAN IG| IV|| 58-1699775|1326041732|CHC13|90284||11/01/2013|12/31/9999|$0.00|0|0|||HUMAN IG| SC|| 58-1699775|1326041732|CHC13|90287||11/01/2013|12/31/9999|$0.00|0|0|||BOTULINUM ANTITOXIN|| 58-1699775|1326041732|CHC13|90288||11/01/2013|12/31/9999|$0.00|0|0|||BOTULISM IG| IV|| 58-1699775|1326041732|CHC13|90291||11/01/2013|12/31/9999|$0.00|0|0|||CMV IG| IV|| 58-1699775|1326041732|CHC13|90296||11/01/2013|12/31/9999|$0.00|0|0|||DIPHTHERIA ANTITOXIN|| 58-1699775|1326041732|CHC13|90371||10/01/2016|09/30/2017|$143.04|0|0|0||HEP B IG| IM|| 58-1699775|1326041732|CHC13|90371||10/01/2017|09/30/2018|$135.30|0|0|0||HEP B IG| IM|| 58-1699775|1326041732|CHC13|90375||10/01/2016|09/30/2017|$354.54|0|0|0||RABIES IG| IM/SC|| 58-1699775|1326041732|CHC13|90375||10/01/2017|09/30/2018|$359.11|0|0|0||RABIES IG| IM/SC|| 58-1699775|1326041732|CHC13|90376||10/01/2016|09/30/2017|$340.10|0|0|0||RABIES IG| HEAT TREATED|| 58-1699775|1326041732|CHC13|90376||10/01/2017|09/30/2018|$392.46|0|0|0||RABIES IG| HEAT TREATED|| 58-1699775|1326041732|CHC13|90378||11/01/2013|12/31/9999|$1|720.85|0|0|||RSV IG| IM| 50MG|| 58-1699775|1326041732|CHC13|90384||11/01/2013|12/31/9999|$103.21|0|0|||RH IG| FULL-DOSE| IM|| 58-1699775|1326041732|CHC13|90385||10/01/2014|12/31/9999|$34.66|0|0|||RH IG| MINIDOSE| IM|| 58-1699775|1326041732|CHC13|90386||11/01/2013|12/31/9999|$38.45|0|0|||RH IG| IV|| 58-1699775|1326041732|CHC13|90389||11/01/2013|12/31/9999|$157.06|0|0|||TETANUS IG| IM|| 58-1699775|1326041732|CHC13|90396||11/01/2013|12/31/9999|$173.76|0|0|||VARICELLA-ZOSTER IG| IM|| 58-1699775|1326041732|CHC13|90460||11/01/2013|12/31/9999|$28.26|0|0|||IMADM ANY ROUTE 1ST VAC/TOX|| 58-1699775|1326041732|CHC13|90461||11/01/2013|12/31/9999|$14.80|0|0|||INADM ANY ROUTE ADDL VAC/TOX|| 58-1699775|1326041732|CHC13|90465||11/01/2013|12/31/9999|$30.98|0|0|||IMMUNE ADMIN 1 INJ| < 8 YRS|| 58-1699775|1326041732|CHC13|90466||11/01/2013|12/31/9999|$32.23|0|0|||IMMUNE ADMIN ADDL INJ| < 8 Y|| 58-1699775|1326041732|CHC13|90467||11/01/2013|12/31/9999|$33.48|0|0|||IMMUNE ADMIN O OR N| < 8 YRS|| 58-1699775|1326041732|CHC13|90468||11/01/2013|12/31/9999|$34.73|0|0|||IMMUNE ADMIN O/N| ADDL < 8 Y|| 58-1699775|1326041732|CHC13|90471||11/01/2013|12/31/9999|$27.88|0|0|||IMMUNIZATION ADMIN|| 58-1699775|1326041732|CHC13|90472||11/01/2013|12/31/9999|$14.04|0|0|||IMMUNIZATION ADMIN| EACH ADD|| 58-1699775|1326041732|CHC13|90473||11/01/2013|12/31/9999|$25.59|0|0|||IMMUNE ADMIN ORAL/NASAL|| 58-1699775|1326041732|CHC13|90474||11/01/2013|12/31/9999|$13.65|0|0|||IMMUNE ADMIN ORAL/NASAL ADDL|| 58-1699775|1326041732|CHC13|90581||11/01/2013|12/31/9999|$160.79|0|0|||ANTHRAX VACCINE| SC|| 58-1699775|1326041732|CHC13|90585||10/01/2016|09/30/2017|$154.24|0|0|0||BCG VACCINE| PERCUT|| 58-1699775|1326041732|CHC13|90585||10/01/2017|09/30/2018|$160.85|0|0|0||BCG VACCINE| PERCUT|| 58-1699775|1326041732|CHC13|90586||10/01/2016|09/30/2017|$154.24|0|0|0||BCG VACCINE| INTRAVESICAL|| 58-1699775|1326041732|CHC13|90586||10/01/2017|09/30/2018|$160.85|0|0|0||BCG VACCINE| INTRAVESICAL|| 58-1699775|1326041732|CHC13|90620||05/01/2016|12/31/9999|$65.00|0|0||%|MENB RP W/OMV VACCINE IM|| 58-1699775|1326041732|CHC13|90621||04/01/2015|12/31/9999|$65.00|0|0||%|MENB RLP VACCINE IM|| 58-1699775|1326041732|CHC13|90625||04/01/2016|12/31/9999|$0.00|0|0|0||CHOLERA VACCINE LIVE ORAL|| 58-1699775|1326041732|CHC13|90630||10/01/2016|09/30/2017|$29.33|0|0|0||FLU VACC IIV4 NO PRESERV ID|| 58-1699775|1326041732|CHC13|90630||10/01/2017|09/30/2018|$25.43|0|0|0||FLU VACC IIV4 NO PRESERV ID|| 58-1699775|1326041732|CHC13|90632||10/01/2016|09/30/2017|$63.55|0|0|0||HEP A VACCINE| ADULT IM|| 58-1699775|1326041732|CHC13|90632||10/01/2017|09/30/2018|$68.72|0|0|0||HEP A VACCINE| ADULT IM|| 58-1699775|1326041732|CHC13|90633||11/01/2013|12/31/9999|$29.36|0|0|||HEP A VACC| PED/ADOL| 2 DOSE|| 58-1699775|1326041732|CHC13|90634||11/01/2013|12/31/9999|$40.48|0|0|||HEP A VACC| PED/ADOL| 3 DOSE|| 58-1699775|1326041732|CHC13|90636||11/01/2013|12/31/9999|$137.05|0|0|||HEP A/HEP B VACC| ADULT IM|| 58-1699775|1326041732|CHC13|90644||11/01/2013|12/31/9999|$30.93|0|0|||HIB/MEN/TT VACCINE| IM|| 58-1699775|1326041732|CHC13|90645||11/01/2013|12/31/9999|$30.93|0|0|||HIB VACCINE| HBOC| IM|| 58-1699775|1326041732|CHC13|90646||11/01/2013|12/31/9999|$30.93|0|0|||HIB VACCINE| PRP-D| IM|| 58-1699775|1326041732|CHC13|90647||11/01/2013|12/31/9999|$25.05|0|0|||HIB VACCINE| PRP-OMP| IM|| 58-1699775|1326041732|CHC13|90648||11/01/2013|12/31/9999|$23.75|0|0|||HIB VACCINE| PRP-T| IM|| 58-1699775|1326041732|CHC13|90649||11/01/2013|12/31/9999|$111.85|0|0|||H PAPILLOMA VACC 3 DOSE IM|| 58-1699775|1326041732|CHC13|90651||04/01/2015|12/31/9999|$65.00|0|0|0|%|HPV VACCINE NON VALENT IM|| 58-1699775|1326041732|CHC13|90653||09/01/2017|09/30/2018|$46.73|0|0|0||FLU VACCINE ADJUVANT IM|| 58-1699775|1326041732|CHC13|90654||10/01/2015|12/31/9999|$23.65|0|0|0||FLU VACCINE NO PRESERV| ID|| 58-1699775|1326041732|CHC13|90655||10/01/2014|12/31/9999|$17.24|0|0|||FLU VACCINE NO PRESERV 6-35M|| 58-1699775|1326041732|CHC13|90656||10/01/2016|09/30/2017|$17.35|0|0|0||FLU VACCINE NO PRESERV 3 & >|| 58-1699775|1326041732|CHC13|90656||10/01/2017|09/30/2018|$22.15|0|0|0||FLU VACCINE NO PRESERV 3 & >|| 58-1699775|1326041732|CHC13|90657||10/01/2016|12/31/9999|$7.53|0|0|0||FLU VACCINE| 6-35 MO| IM|| 58-1699775|1326041732|CHC13|90658||11/01/2013|12/31/9999|$13.82|0|0|||FLU VACCINE AGE 3 & OVER| IM|| 58-1699775|1326041732|CHC13|90660||11/01/2013|12/31/9999|$29.32|0|0|||FLU VACCINE| NASAL|| 58-1699775|1326041732|CHC13|90661||10/01/2016|12/31/9999|$27.86|0|0|0||FLU VACC CELL CULT PRSV FREE|| 58-1699775|1326041732|CHC13|90662||10/01/2016|09/30/2017|$45.39|0|0|0||FLU VACC PRSV FREE INC ANTIG|| 58-1699775|1326041732|CHC13|90662||10/01/2017|09/30/2018|$53.40|0|0|0||FLU VACC PRSV FREE INC ANTIG|| 58-1699775|1326041732|CHC13|90669||11/01/2013|12/31/9999|$119.36|0|0|||PNEUMOCOCCAL VACC| PED <5|| 58-1699775|1326041732|CHC13|90670||10/01/2016|09/30/2017|$226.33|0|0|0||PNEUMOCOCCAL VACC| 13 VAL IM|| 58-1699775|1326041732|CHC13|90670||10/01/2017|09/30/2018|$240.80|0|0|0||PNEUMOCOCCAL VACC| 13 VAL IM|| 58-1699775|1326041732|CHC13|90672||10/01/2016|09/30/2017|$33.59|0|0|0||FLU VACCINE 4 VALENT NASAL|| 58-1699775|1326041732|CHC13|90672||10/01/2017|09/30/2018|$33.59|0|0|0||FLU VACCINE 4 VALENT NASAL|| 58-1699775|1326041732|CHC13|90673||10/01/2016|09/30/2017|$46.49|0|0|0||FLU VACC RIV3 NO PRESERV|| 58-1699775|1326041732|CHC13|90673||10/01/2017|09/30/2018|$50.77|0|0|0||FLU VACC RIV3 NO PRESERV|| 58-1699775|1326041732|CHC13|90674||08/01/2017|09/30/2018|$28.67|0|0|0||CCIIV4 VAC NO PRSV 0.5 ML IM|| 58-1699775|1326041732|CHC13|90675||10/01/2016|09/30/2017|$323.42|0|0|0||RABIES VACCINE| IM|| 58-1699775|1326041732|CHC13|90675||10/01/2017|09/30/2018|$353.77|0|0|0||RABIES VACCINE| IM|| 58-1699775|1326041732|CHC13|90680||11/01/2013|12/31/9999|$66.08|0|0|||ROTOVIRUS VACC 3 DOSE| ORAL|| 58-1699775|1326041732|CHC13|90681||11/01/2013|12/31/9999|$66.08|0|0|||ROTAVIRUS VACC 2 DOSE ORAL|| 58-1699775|1326041732|CHC13|90685||10/01/2016|09/30/2017|$30.74|0|0|0||FLU VAC NO PRSV 4 VAL 6-35 M|| 58-1699775|1326041732|CHC13|90685||10/01/2017|09/30/2018|$32.84|0|0|0||FLU VAC NO PRSV 4 VAL 6-35 M|| 58-1699775|1326041732|CHC13|90686||10/01/2016|09/30/2017|$22.69|0|0|0||FLU VAC NO PRSV 4 VAL 3 YRS+|| 58-1699775|1326041732|CHC13|90686||10/01/2017|09/30/2018|$23.79|0|0|0||FLU VAC NO PRSV 4 VAL 3 YRS+|| 58-1699775|1326041732|CHC13|90687||10/01/2016|09/30/2017|$11.42|0|0|0||FLU VACCINE 4 VAL 6-35 MO IM|| 58-1699775|1326041732|CHC13|90687||10/01/2017|09/30/2018|$11.75|0|0|0||FLU VACCINE 4 VAL 6-35 MO IM|| 58-1699775|1326041732|CHC13|90688||10/01/2016|09/30/2017|$22.84|0|0|0||FLU VACC 4 VAL 3 YRS PLUS IM|| 58-1699775|1326041732|CHC13|90688||10/01/2017|09/30/2018|$22.29|0|0|0||FLU VACC 4 VAL 3 YRS PLUS IM|| 58-1699775|1326041732|CHC13|90690||11/01/2013|12/31/9999|$83.00|0|0|||TYPHOID VACCINE| ORAL|| 58-1699775|1326041732|CHC13|90691||10/01/2016|09/30/2017|$112.60|0|0|0||TYPHOID VACCINE| IM|| 58-1699775|1326041732|CHC13|90691||10/01/2017|09/30/2018|$100.07|0|0|0||TYPHOID VACCINE| IM|| 58-1699775|1326041732|CHC13|90696||11/01/2013|12/31/9999|$66.08|0|0|||DTAP-IPV VACC 4-6 YR IM|| 58-1699775|1326041732|CHC13|90697||04/01/2016|12/31/9999|$0.00|0|0|0||DTAP-IPV-HIB-HEPB VACCINE IM|| 58-1699775|1326041732|CHC13|90698||11/01/2013|12/31/9999|$66.08|0|0|||DTAP-HIB-IP VACCINE| IM|| 58-1699775|1326041732|CHC13|90700||11/01/2013|12/31/9999|$22.02|0|0|||DTAP VACCINE| < 7 YRS| IM|| 58-1699775|1326041732|CHC13|90702||11/01/2013|12/31/9999|$55.00|0|0|||DT VACCINE < 7| IM|| 58-1699775|1326041732|CHC13|90707||11/01/2013|12/31/9999|$44.05|0|0|||MMR VACCINE| SC|| 58-1699775|1326041732|CHC13|90710||11/01/2013|12/31/9999|$117.90|0|0|||MMRV VACCINE| SC|| 58-1699775|1326041732|CHC13|90713||11/01/2013|12/31/9999|$25.05|0|0|||POLIOVIRUS| IPV| SC/IM|| 58-1699775|1326041732|CHC13|90714||10/01/2016|09/30/2017|$29.00|0|0|0||TD VACCINE NO PRSRV >/= 7 IM|| 58-1699775|1326041732|CHC13|90714||10/01/2017|09/30/2018|$26.93|0|0|0||TD VACCINE NO PRSRV >/= 7 IM|| 58-1699775|1326041732|CHC13|90715||10/01/2016|09/30/2017|$38.29|0|0|0||TDAP VACCINE >7 IM|| 58-1699775|1326041732|CHC13|90715||10/01/2017|09/30/2018|$37.62|0|0|0||TDAP VACCINE >7 IM|| 58-1699775|1326041732|CHC13|90716||11/01/2013|12/31/9999|$64.78|0|0|||CHICKEN POX VACCINE| SC|| 58-1699775|1326041732|CHC13|90717||11/01/2013|12/31/9999|$93.83|0|0|||YELLOW FEVER VACCINE| SC|| 58-1699775|1326041732|CHC13|90723||11/01/2013|12/31/9999|$64.78|0|0|||DTAP-HEP B-IPV VACCINE| IM|| 58-1699775|1326041732|CHC13|90732||10/01/2016|09/30/2017|$112.43|0|0|0||PNEUMOCOCCAL VACCINE|| 58-1699775|1326041732|CHC13|90732||10/01/2017|09/30/2018|$123.56|0|0|0||PNEUMOCOCCAL VACCINE|| 58-1699775|1326041732|CHC13|90733||10/01/2014|12/31/9999|$106.49|0|0|||MENINGOCOCCAL VACCINE| SC|| 58-1699775|1326041732|CHC13|90734||11/01/2013|12/31/9999|$83.78|0|0|||MENINGOCOCCAL VACCINE| IM|| 58-1699775|1326041732|CHC13|90736||11/01/2013|12/31/9999|$244.85|0|0|||ZOSTER VACC| SC|| 58-1699775|1326041732|CHC13|90738||11/01/2013|12/31/9999|$76.76|0|0|||INACTIVATED JE VACC IM|| 58-1699775|1326041732|CHC13|90739||11/01/2013|12/31/9999|$0.00|0|0|||HEP B VACC ADULT 2 DOSE IM|| 58-1699775|1326041732|CHC13|90740||10/01/2016|09/30/2017|$153.70|0|0|0||HEPB VACC| ILL PAT 3 DOSE IM|| 58-1699775|1326041732|CHC13|90740||10/01/2017|09/30/2018|$158.25|0|0|0||HEPB VACC| ILL PAT 3 DOSE IM|| 58-1699775|1326041732|CHC13|90741||11/01/2014|12/31/9999|$12.00|0|0|||PASSIVE IMMUNIZATION| ISG|| 58-1699775|1326041732|CHC13|90743||10/01/2016|09/30/2017|$31.74|0|0|0||HEP B VACC| ADOL| 2 DOSE| IM|| 58-1699775|1326041732|CHC13|90743||10/01/2017|09/30/2018|$32.67|0|0|0||HEP B VACC| ADOL| 2 DOSE| IM|| 58-1699775|1326041732|CHC13|90744||10/01/2016|09/30/2017|$31.74|0|0|0||HEPB VACC PED/ADOL 3 DOSE IM|| 58-1699775|1326041732|CHC13|90744||10/01/2017|09/30/2018|$32.67|0|0|0||HEPB VACC PED/ADOL 3 DOSE IM|| 58-1699775|1326041732|CHC13|90746||10/01/2016|09/30/2017|$76.84|0|0|0||HEP B VACCINE| ADULT| IM|| 58-1699775|1326041732|CHC13|90746||10/01/2017|09/30/2018|$79.12|0|0|0||HEP B VACCINE| ADULT| IM|| 58-1699775|1326041732|CHC13|90747||10/01/2016|09/30/2017|$153.70|0|0|0||HEPB VACC| ILL PAT 4 DOSE IM|| 58-1699775|1326041732|CHC13|90747||10/01/2017|09/30/2018|$158.25|0|0|0||HEPB VACC| ILL PAT 4 DOSE IM|| 58-1699775|1326041732|CHC13|90748||11/01/2013|12/31/9999|$65.34|0|0|||HEP B/HIB VACCINE| IM|| 58-1699775|1326041732|CHC13|90750||01/01/2018|12/31/9999|$244.85|0|0|||HZV VACC RECOMBINANT IM NJX|| 58-1699775|1326041732|CHC13|90785||11/01/2013|12/31/9999|$5.60|0|0|||INTERACTIVE COMPLEXITY|| 58-1699775|1326041732|CHC13|90791||11/01/2013|12/31/9999|$137.92|0|0|||PSYCHIATRIC DIAGNOSTIC EVAL|| 58-1699775|1326041732|CHC13|90792||11/01/2013|12/31/9999|$142.62|0|0|||PSYCHIATRIC DIAG EVAL W/MED SV|| 58-1699775|1326041732|CHC13|90808||11/01/2013|12/31/9999|$266.16|0|0|||PSYTX| OFFICE| 75-80 MIN|| 58-1699775|1326041732|CHC13|90832||11/01/2013|12/31/9999|$58.06|0|0|||PSYTX PT&/FAMILY 30 MINUTES|| 58-1699775|1326041732|CHC13|90833||11/01/2013|12/31/9999|$48.49|0|0|||PSYTX PT&/FAM W/E&M 30 MIN|| 58-1699775|1326041732|CHC13|90834||11/01/2013|12/31/9999|$87.14|0|0|||PSYTX PT&/FAMILY 45 MINUTES|| 58-1699775|1326041732|CHC13|90835||11/01/2013|12/31/9999|$176.00|0|0|||NARCOSYNTHESIS-PSYCH DX & THER|| 58-1699775|1326041732|CHC13|90836||11/01/2013|12/31/9999|$79.33|0|0|||PSYTX PT&/FAM W/E&M 45 MIN|| 58-1699775|1326041732|CHC13|90837||11/01/2013|12/31/9999|$131.45|0|0|||PSYTX PT&/FAMILY 60 MINUTES|| 58-1699775|1326041732|CHC13|90838||11/01/2013|12/31/9999|$127.37|0|0|||PSYTX PT&/FAM W/E&M 60 MIN|| 58-1699775|1326041732|CHC13|90839||01/01/2014|12/31/9999|$158.59|0|0|||PSYTX CRISIS INITIAL 60 MIN|| 58-1699775|1326041732|CHC13|90840||04/01/2015|12/31/9999|$76.12|0|0|||PSYTX CRISIS EA ADDL 30 MIN|| 58-1699775|1326041732|CHC13|90845||11/01/2013|12/31/9999|$88.97|0|0|||PSYCHOANALYSIS|| 58-1699775|1326041732|CHC13|90846||11/01/2013|12/31/9999|$92.44|0|0|||FAMILY PSYTX W/O PATIENT|| 58-1699775|1326041732|CHC13|90847||11/01/2013|12/31/9999|$110.17|0|0|||FAMILY PSYTX W/PATIENT|| 58-1699775|1326041732|CHC13|90849||11/01/2013|12/31/9999|$32.57|0|0|||MULTIPLE FAMILY GROUP PSYTX|| 58-1699775|1326041732|CHC13|90853||11/01/2013|12/31/9999|$33.31|0|0|||GROUP PSYCHOTHERAPY|| 58-1699775|1326041732|CHC13|90863||11/01/2013|12/31/9999|$0.00|0|0|||PHARMACOLOGIC MANAGEMENT|| 58-1699775|1326041732|CHC13|90865||11/01/2013|12/31/9999|$145.84|0|0|||NARCOSYNTHESIS|| 58-1699775|1326041732|CHC13|90867||11/01/2013|12/31/9999|$201.91|0|0|||TCRANIAL MAGN STIM TX PLAN|| 58-1699775|1326041732|CHC13|90868||11/01/2013|12/31/9999|$27.70|0|0|||TCRANIAL MAGN STIM TX DELI|| 58-1699775|1326041732|CHC13|90869||11/01/2013|12/31/9999|$137.37|0|0|||TCRAN MAGN STIM REDETEMINE|| 58-1699775|1326041732|CHC13|90870||11/01/2013|12/31/9999|$125.36|0|0|||ELECTROCONVULSIVE THERAPY|| 58-1699775|1326041732|CHC13|90875||11/01/2013|12/31/9999|$70.39|0|0|||PSYCHOPHYSIOLOGICAL THERAPY|| 58-1699775|1326041732|CHC13|90876||11/01/2013|12/31/9999|$110.76|0|0|||PSYCHOPHYSIOLOGICAL THERAPY|| 58-1699775|1326041732|CHC13|90880||11/01/2013|12/31/9999|$106.42|0|0|||HYPNOTHERAPY|| 58-1699775|1326041732|CHC13|90885||11/01/2013|12/31/9999|$56.94|0|0|||PSY EVALUATION OF RECORDS|| 58-1699775|1326041732|CHC13|90887||11/01/2013|12/31/9999|$86.62|0|0|||CONSULTATION WITH FAMILY|| 58-1699775|1326041732|CHC13|90889||11/01/2013|12/31/9999|$75.79|0|0|||PREPARATION OF REPORT|| 58-1699775|1326041732|CHC13|90899||11/01/2013|12/31/9999|$0.00|0|0|||PSYCHIATRIC SERVICE/THERAPY|| 58-1699775|1326041732|CHC13|90901||11/01/2013|12/31/9999|$24.72|0|0|||BIOFEEDBACK TRAIN| ANY METH|| 58-1699775|1326041732|CHC13|90911||11/01/2013|12/31/9999|$54.00|0|0|||BIOFEEDBACK PERI/URO/RECTAL|| 58-1699775|1326041732|CHC13|90935||11/01/2013|12/31/9999|$105.95|0|0|||HEMODIALYSIS| ONE EVALUATION|| 58-1699775|1326041732|CHC13|90937||11/01/2013|12/31/9999|$151.00|0|0|||HEMODIALYSIS| REPEATED EVAL|| 58-1699775|1326041732|CHC13|90940||11/01/2013|12/31/9999|$31.73|0|0|||HEMODIALYSIS ACCESS STUDY|| 58-1699775|1326041732|CHC13|90945||11/01/2013|12/31/9999|$120.58|0|0|||DIALYSIS| ONE EVALUATION|| 58-1699775|1326041732|CHC13|90947||11/01/2013|12/31/9999|$178.87|0|0|||DIALYSIS| REPEATED EVAL|| 58-1699775|1326041732|CHC13|90951||11/01/2013|12/31/9999|$1|351.66|0|0|||ESRD SERV| 4 VISITS P MO| <2|| 58-1699775|1326041732|CHC13|90952||11/01/2013|12/31/9999|$1|000.30|0|0|||ESRD SERV| 2-3 VSTS P MO| <2|| 58-1699775|1326041732|CHC13|90953||11/01/2013|12/31/9999|$666.40|0|0|||ESRD SERV| 1 VISIT P MO| <2|| 58-1699775|1326041732|CHC13|90954||11/01/2013|12/31/9999|$1|154.25|0|0|||ESRD SERV| 4 VSTS P MO| 2-11|| 58-1699775|1326041732|CHC13|90955||11/01/2013|12/31/9999|$651.27|0|0|||ESRD SRV 2-3 VSTS P MO| 2-11|| 58-1699775|1326041732|CHC13|90956||11/01/2013|12/31/9999|$449.65|0|0|||ESRD SRV| 1 VISIT P MO| 2-11|| 58-1699775|1326041732|CHC13|90957||11/01/2013|12/31/9999|$921.38|0|0|||ESRD SRV| 4 VSTS P MO| 12-19|| 58-1699775|1326041732|CHC13|90958||11/01/2013|12/31/9999|$623.69|0|0|||ESRD SRV 2-3 VSTS P MO 12-19|| 58-1699775|1326041732|CHC13|90959||11/01/2013|12/31/9999|$418.37|0|0|||ESRD SERV| 1 VST P MO| 12-19|| 58-1699775|1326041732|CHC13|90960||11/01/2013|12/31/9999|$407.54|0|0|||ESRD SRV| 4 VISITS P MO| 20+|| 58-1699775|1326041732|CHC13|90961||11/01/2013|12/31/9999|$338.94|0|0|||ESRD SRV| 2-3 VSTS P MO| 20+|| 58-1699775|1326041732|CHC13|90962||11/01/2013|12/31/9999|$257.42|0|0|||ESRD SERV| 1 VISIT P MO| 20+|| 58-1699775|1326041732|CHC13|90963||11/01/2013|12/31/9999|$781.24|0|0|||ESRD HOME PT| SERV P MO| <2|| 58-1699775|1326041732|CHC13|90964||11/01/2013|12/31/9999|$672.40|0|0|||ESRD HOME PT SERV P MO| 2-11|| 58-1699775|1326041732|CHC13|90965||11/01/2013|12/31/9999|$640.66|0|0|||ESRD HOME PT SERV P MO 12-19|| 58-1699775|1326041732|CHC13|90966||11/01/2013|12/31/9999|$337.56|0|0|||ESRD HOME PT| SERV P MO| 20+|| 58-1699775|1326041732|CHC13|90967||11/01/2013|12/31/9999|$26.14|0|0|||ESRD HOME PT SERV P DAY| <2|| 58-1699775|1326041732|CHC13|90968||11/01/2013|12/31/9999|$21.75|0|0|||ESRD HOME PT SRV P DAY| 2-11|| 58-1699775|1326041732|CHC13|90969||11/01/2013|12/31/9999|$21.24|0|0|||ESRD HOME PT SRV P DAY 12-19|| 58-1699775|1326041732|CHC13|90970||11/01/2013|12/31/9999|$11.29|0|0|||ESRD HOME PT SERV P DAY| 20+|| 58-1699775|1326041732|CHC13|90989||11/01/2013|12/31/9999|$500.15|0|0|||DIALYSIS TRAINING| COMPLETE|| 58-1699775|1326041732|CHC13|90993||11/01/2013|12/31/9999|$108.45|0|0|||DIALYSIS TRAINING| INCOMPL|| 58-1699775|1326041732|CHC13|90997||11/01/2013|12/31/9999|$128.48|0|0|||HEMOPERFUSION|| 58-1699775|1326041732|CHC13|90999||11/01/2013|12/31/9999|$0.00|0|0|||DIALYSIS PROCEDURE|| 58-1699775|1326041732|CHC13|91010||11/01/2013|12/31/9999|$215.80|0|0|||ESOPHAGUS MOTILITY STUDY|| 58-1699775|1326041732|CHC13|91010|26|11/01/2013|12/31/9999|$108.82|0|0|||ESOPHAGUS MOTILITY STUDY|| 58-1699775|1326041732|CHC13|91010|TC|11/01/2013|12/31/9999|$176.03|0|0|||ESOPHAGUS MOTILITY STUDY|| 58-1699775|1326041732|CHC13|91013||11/01/2013|12/31/9999|$27.93|0|0|||ESOPHGL MOTIL W/STIM/PERFUS|| 58-1699775|1326041732|CHC13|91013|26|11/01/2013|12/31/9999|$15.17|0|0|||ESOPHGL MOTIL W/STIM/PERFUS|| 58-1699775|1326041732|CHC13|91013|TC|11/01/2013|12/31/9999|$21.70|0|0|||ESOPHGL MOTIL W/STIM/PERFUS|| 58-1699775|1326041732|CHC13|91020||11/01/2013|12/31/9999|$281.83|0|0|||GASTRIC MOTILITY STUDIES|| 58-1699775|1326041732|CHC13|91020|26|11/01/2013|12/31/9999|$122.35|0|0|||GASTRIC MOTILITY STUDIES|| 58-1699775|1326041732|CHC13|91020|TC|11/01/2013|12/31/9999|$249.66|0|0|||GASTRIC MOTILITY STUDIES|| 58-1699775|1326041732|CHC13|91022||11/01/2013|12/31/9999|$211.12|0|0|||DUODENAL MOTILITY STUDY|| 58-1699775|1326041732|CHC13|91022|26|11/01/2013|12/31/9999|$122.82|0|0|||DUODENAL MOTILITY STUDY|| 58-1699775|1326041732|CHC13|91022|TC|11/01/2013|12/31/9999|$155.86|0|0|||DUODENAL MOTILITY STUDY|| 58-1699775|1326041732|CHC13|91030||11/01/2013|12/31/9999|$165.63|0|0|||ACID PERFUSION OF ESOPHAGUS|| 58-1699775|1326041732|CHC13|91030|26|11/01/2013|12/31/9999|$77.90|0|0|||ACID PERFUSION OF ESOPHAGUS|| 58-1699775|1326041732|CHC13|91030|TC|11/01/2013|12/31/9999|$140.73|0|0|||ACID PERFUSION OF ESOPHAGUS|| 58-1699775|1326041732|CHC13|91034||11/01/2013|12/31/9999|$228.55|0|0|||GASTROESOPHAGEAL REFLUX TEST|| 58-1699775|1326041732|CHC13|91034|26|11/01/2013|12/31/9999|$81.78|0|0|||GASTROESOPHAGEAL REFLUX TEST|| 58-1699775|1326041732|CHC13|91034|TC|11/01/2013|12/31/9999|$219.91|0|0|||GASTROESOPHAGEAL REFLUX TEST|| 58-1699775|1326041732|CHC13|91035||11/01/2013|12/31/9999|$572.09|0|0|||G-ESOPH REFLX TST W/ELECTROD|| 58-1699775|1326041732|CHC13|91035|26|11/01/2013|12/31/9999|$134.30|0|0|||G-ESOPH REFLX TST W/ELECTROD|| 58-1699775|1326041732|CHC13|91035|TC|11/01/2013|12/31/9999|$620.85|0|0|||G-ESOPH REFLX TST W/ELECTROD|| 58-1699775|1326041732|CHC13|91037||11/01/2013|12/31/9999|$193.06|0|0|||ESOPH IMPED FUNCTION TEST|| 58-1699775|1326041732|CHC13|91037|26|11/01/2013|12/31/9999|$83.85|0|0|||ESOPH IMPED FUNCTION TEST|| 58-1699775|1326041732|CHC13|91037|TC|11/01/2013|12/31/9999|$170.99|0|0|||ESOPH IMPED FUNCTION TEST|| 58-1699775|1326041732|CHC13|91038||11/01/2013|12/31/9999|$454.93|0|0|||ESOPH IMPED FUNCT TEST > 1H|| 58-1699775|1326041732|CHC13|91038|26|11/01/2013|12/31/9999|$93.64|0|0|||ESOPH IMPED FUNCT TEST > 1H|| 58-1699775|1326041732|CHC13|91038|TC|11/01/2013|12/31/9999|$506.87|0|0|||ESOPH IMPED FUNCT TEST > 1H|| 58-1699775|1326041732|CHC13|91040||11/01/2013|12/31/9999|$363.41|0|0|||ESOPH BALLOON DISTENSION TST|| 58-1699775|1326041732|CHC13|91040|26|11/01/2013|12/31/9999|$76.72|0|0|||ESOPH BALLOON DISTENSION TST|| 58-1699775|1326041732|CHC13|91040|TC|11/01/2013|12/31/9999|$402.98|0|0|||ESOPH BALLOON DISTENSION TST|| 58-1699775|1326041732|CHC13|91065||04/01/2014|12/31/9999|$94.31|0|0|||BREATH HYDROGEN TEST|| 58-1699775|1326041732|CHC13|91065|26|11/01/2013|12/31/9999|$16.80|0|0|||BREATH HYDROGEN TEST|| 58-1699775|1326041732|CHC13|91065|TC|04/01/2014|12/31/9999|$107.35|0|0|||BREATH HYDROGEN TEST|| 58-1699775|1326041732|CHC13|91110||11/01/2013|12/31/9999|$1|071.30|0|0|||GI TRACT CAPSULE ENDOSCOPY|| 58-1699775|1326041732|CHC13|91110|26|11/01/2013|12/31/9999|$310.61|0|0|||GI TRACT CAPSULE ENDOSCOPY|| 58-1699775|1326041732|CHC13|91110|TC|11/01/2013|12/31/9999|$1|103.50|0|0|||GI TRACT CAPSULE ENDOSCOPY|| 58-1699775|1326041732|CHC13|91111||11/01/2013|12/31/9999|$864.07|0|0|||ESOPHAGEAL CAPSULE ENDOSCOPY|| 58-1699775|1326041732|CHC13|91111|26|11/01/2013|12/31/9999|$85.48|0|0|||ESOPHAGEAL CAPSULE ENDOSCOPY|| 58-1699775|1326041732|CHC13|91111|TC|11/01/2013|12/31/9999|$1|055.09|0|0|||ESOPHAGEAL CAPSULE ENDOSCOPY|| 58-1699775|1326041732|CHC13|91112||11/01/2013|12/31/9999|$1|341.71|0|0|||GI WIRELESS CAPSULE MEASURE|| 58-1699775|1326041732|CHC13|91117||11/01/2013|12/31/9999|$180.76|0|0|||COLON MOTILITY 6 HR STUDY|| 58-1699775|1326041732|CHC13|91120||11/01/2013|12/31/9999|$462.81|0|0|||RECTAL SENSATION TEST|| 58-1699775|1326041732|CHC13|91120|26|11/01/2013|12/31/9999|$80.33|0|0|||RECTAL SENSATION TEST|| 58-1699775|1326041732|CHC13|91120|TC|11/01/2013|12/31/9999|$530.58|0|0|||RECTAL SENSATION TEST|| 58-1699775|1326041732|CHC13|91122||11/01/2013|12/31/9999|$262.28|0|0|||ANAL PRESSURE RECORD|| 58-1699775|1326041732|CHC13|91122|26|11/01/2013|12/31/9999|$141.94|0|0|||ANAL PRESSURE RECORD|| 58-1699775|1326041732|CHC13|91122|TC|11/01/2013|12/31/9999|$204.27|0|0|||ANAL PRESSURE RECORD|| 58-1699775|1326041732|CHC13|91132||11/01/2013|12/31/9999|$181.88|0|0|||ELECTROGASTROGRAPHY|| 58-1699775|1326041732|CHC13|91132|26|11/01/2013|12/31/9999|$44.89|0|0|||ELECTROGASTROGRAPHY|| 58-1699775|1326041732|CHC13|91132|TC|11/01/2013|12/31/9999|$195.19|0|0|||ELECTROGASTROGRAPHY|| 58-1699775|1326041732|CHC13|91133||11/01/2013|12/31/9999|$211.54|0|0|||ELECTROGASTROGRAPHY W/TEST|| 58-1699775|1326041732|CHC13|91133|26|11/01/2013|12/31/9999|$57.31|0|0|||ELECTROGASTROGRAPHY W/TEST|| 58-1699775|1326041732|CHC13|91133|TC|11/01/2013|12/31/9999|$221.92|0|0|||ELECTROGASTROGRAPHY W/TEST|| 58-1699775|1326041732|CHC13|91200||04/01/2015|12/31/9999|$41.94|0|0|0||LIVER ELASTOGRAPHY|| 58-1699775|1326041732|CHC13|91200|26|04/01/2015|12/31/9999|$17.83|0|0|0||LIVER ELASTOGRAPHY|| 58-1699775|1326041732|CHC13|91200|TC|04/01/2015|12/31/9999|$24.11|0|0|0||LIVER ELASTOGRAPHY|| 58-1699775|1326041732|CHC13|91299||11/01/2013|12/31/9999|$0.00|0|0|||GASTROENTEROLOGY PROCEDURE|| 58-1699775|1326041732|CHC13|91299|26|11/01/2013|12/31/9999|$0.00|0|0|||GASTROENTEROLOGY PROCEDURE|| 58-1699775|1326041732|CHC13|91299|TC|11/01/2013|12/31/9999|$0.00|0|0|||GASTROENTEROLOGY PROCEDURE|| 58-1699775|1326041732|CHC13|92002||11/01/2013|12/31/9999|$59.30|0|0|||EYE EXAM| NEW PATIENT|| 58-1699775|1326041732|CHC13|92004||11/01/2013|12/31/9999|$122.81|0|0|||EYE EXAM| NEW PATIENT|| 58-1699775|1326041732|CHC13|92012||11/01/2013|10/31/2017|$64.25|0|0|||EYE EXAM ESTABLISHED PAT|| 58-1699775|1326041732|CHC13|92012||11/01/2017|12/31/9999|$105.59|0|0|||EYE EXAM ESTABLISHED PAT|| 58-1699775|1326041732|CHC13|92014||11/01/2013|12/31/9999|$97.93|0|0|||EYE EXAM & TREATMENT|| 58-1699775|1326041732|CHC13|92015||11/01/2013|10/31/2017|$24.40|0|0|||REFRACTION|| 58-1699775|1326041732|CHC13|92015||11/01/2017|12/31/9999|$25.36|0|0|||REFRACTION|| 58-1699775|1326041732|CHC13|92018||11/01/2013|12/31/9999|$174.41|0|0|||NEW EYE EXAM & TREATMENT|| 58-1699775|1326041732|CHC13|92019||11/01/2013|12/31/9999|$84.28|0|0|||EYE EXAM & TREATMENT|| 58-1699775|1326041732|CHC13|92020||11/01/2013|12/31/9999|$25.95|0|0|||SPECIAL EYE EVALUATION|| 58-1699775|1326041732|CHC13|92025||11/01/2013|12/31/9999|$44.12|0|0|||CORNEAL TOPOGRAPHY|| 58-1699775|1326041732|CHC13|92025|26|11/01/2013|12/31/9999|$30.26|0|0|||CORNEAL TOPOGRAPHY|| 58-1699775|1326041732|CHC13|92025|TC|11/01/2013|12/31/9999|$25.74|0|0|||CORNEAL TOPOGRAPHY|| 58-1699775|1326041732|CHC13|92060||11/01/2013|12/31/9999|$76.28|0|0|||SPECIAL EYE EVALUATION|| 58-1699775|1326041732|CHC13|92060|26|11/01/2013|12/31/9999|$59.48|0|0|||SPECIAL EYE EVALUATION|| 58-1699775|1326041732|CHC13|92060|TC|11/01/2013|12/31/9999|$37.34|0|0|||SPECIAL EYE EVALUATION|| 58-1699775|1326041732|CHC13|92065||11/01/2013|12/31/9999|$62.09|0|0|||ORTHOPTIC/PLEOPTIC TRAINING|| 58-1699775|1326041732|CHC13|92065|26|11/01/2013|12/31/9999|$28.36|0|0|||ORTHOPTIC/PLEOPTIC TRAINING|| 58-1699775|1326041732|CHC13|92065|TC|11/01/2013|12/31/9999|$50.45|0|0|||ORTHOPTIC/PLEOPTIC TRAINING|| 58-1699775|1326041732|CHC13|92070||11/01/2013|12/31/9999|$48.97|0|0|||FITTING OF CONTACT LENS|| 58-1699775|1326041732|CHC13|92071||11/01/2013|12/31/9999|$41.73|0|0|||CONTACT LENS FITTING FOR TX|| 58-1699775|1326041732|CHC13|92072||11/01/2013|12/31/9999|$120.69|0|0|||FIT CONTAC LENS FOR MANAGMNT|| 58-1699775|1326041732|CHC13|92081||11/01/2013|12/31/9999|$58.63|0|0|||VISUAL FIELD EXAMINATION(S)|| 58-1699775|1326041732|CHC13|92081|26|11/01/2013|12/31/9999|$26.48|0|0|||VISUAL FIELD EXAMINATION(S)|| 58-1699775|1326041732|CHC13|92081|TC|11/01/2013|12/31/9999|$47.93|0|0|||VISUAL FIELD EXAMINATION(S)|| 58-1699775|1326041732|CHC13|92082||11/01/2013|12/31/9999|$83.33|0|0|||VISUAL FIELD EXAMINATION(S)|| 58-1699775|1326041732|CHC13|92082|26|11/01/2013|12/31/9999|$35.14|0|0|||VISUAL FIELD EXAMINATION(S)|| 58-1699775|1326041732|CHC13|92082|TC|11/01/2013|12/31/9999|$70.62|0|0|||VISUAL FIELD EXAMINATION(S)|| 58-1699775|1326041732|CHC13|92083||11/01/2013|12/31/9999|$106.81|0|0|||VISUAL FIELD EXAMINATION(S)|| 58-1699775|1326041732|CHC13|92083|26|11/01/2013|12/31/9999|$43.77|0|0|||VISUAL FIELD EXAMINATION(S)|| 58-1699775|1326041732|CHC13|92083|TC|11/01/2013|12/31/9999|$91.81|0|0|||VISUAL FIELD EXAMINATION(S)|| 58-1699775|1326041732|CHC13|92100||11/01/2013|12/31/9999|$61.84|0|0|||SERIAL TONOMETRY EXAM(S)|| 58-1699775|1326041732|CHC13|92132||11/01/2013|12/31/9999|$44.94|0|0|||CMPTR OPHTH DX IMG ANT SEGMT|| 58-1699775|1326041732|CHC13|92132|26|11/01/2013|12/31/9999|$32.32|0|0|||CMPTR OPHTH DX IMG ANT SEGMT|| 58-1699775|1326041732|CHC13|92132|TC|11/01/2013|12/31/9999|$24.73|0|0|||CMPTR OPHTH DX IMG ANT SEGMT|| 58-1699775|1326041732|CHC13|92133||11/01/2013|12/31/9999|$54.76|0|0|||CMPTR OPHTH IMG OPTIC NERVE|| 58-1699775|1326041732|CHC13|92133|26|11/01/2013|12/31/9999|$45.28|0|0|||CMPTR OPHTH IMG OPTIC NERVE|| 58-1699775|1326041732|CHC13|92133|TC|11/01/2013|12/31/9999|$24.22|0|0|||CMPTR OPHTH IMG OPTIC NERVE|| 58-1699775|1326041732|CHC13|92134||11/01/2013|12/31/9999|$54.76|0|0|||CPTR OPHTH DX IMG POST SEGMT|| 58-1699775|1326041732|CHC13|92134|26|11/01/2013|12/31/9999|$45.28|0|0|||CPTR OPHTH DX IMG POST SEGMT|| 58-1699775|1326041732|CHC13|92134|TC|11/01/2013|12/31/9999|$24.22|0|0|||CPTR OPHTH DX IMG POST SEGMT|| 58-1699775|1326041732|CHC13|92136||11/01/2013|12/31/9999|$104.19|0|0|||OPHTHALMIC BIOMETRY|| 58-1699775|1326041732|CHC13|92136|26|11/01/2013|12/31/9999|$47.49|0|0|||OPHTHALMIC BIOMETRY|| 58-1699775|1326041732|CHC13|92136|TC|11/01/2013|12/31/9999|$84.75|0|0|||OPHTHALMIC BIOMETRY|| 58-1699775|1326041732|CHC13|92145||04/01/2015|12/31/9999|$19.19|0|0|0||CORNEAL HYSTERESIS DETER|| 58-1699775|1326041732|CHC13|92145|26|04/01/2015|12/31/9999|$11.25|0|0|0||CORNEAL HYSTERESIS DETER|| 58-1699775|1326041732|CHC13|92145|TC|04/01/2015|12/31/9999|$7.94|0|0|0||CORNEAL HYSTERESIS DETER|| 58-1699775|1326041732|CHC13|92225||11/01/2013|12/31/9999|$26.39|0|0|||SPECIAL EYE EXAM| INITIAL|| 58-1699775|1326041732|CHC13|92226||11/01/2013|12/31/9999|$22.96|0|0|||SPECIAL EYE EXAM| SUBSEQUENT|| 58-1699775|1326041732|CHC13|92227||11/01/2013|12/31/9999|$14.32|0|0|||REMOTE DX RETINAL IMAGING|| 58-1699775|1326041732|CHC13|92228||11/01/2013|12/31/9999|$41.83|0|0|||REMOTE RETINAL IMAGING MGMT|| 58-1699775|1326041732|CHC13|92228|26|11/01/2013|12/31/9999|$32.90|0|0|||REMOTE RETINAL IMAGING MGMT|| 58-1699775|1326041732|CHC13|92228|TC|11/01/2013|12/31/9999|$20.19|0|0|||REMOTE RETINAL IMAGING MGMT|| 58-1699775|1326041732|CHC13|92230||11/01/2013|12/31/9999|$40.51|0|0|||EYE EXAM WITH PHOTOS|| 58-1699775|1326041732|CHC13|92235||11/01/2013|12/31/9999|$163.84|0|0|||EYE EXAM WITH PHOTOS|| 58-1699775|1326041732|CHC13|92235|26|11/01/2013|12/31/9999|$72.27|0|0|||EYE EXAM WITH PHOTOS|| 58-1699775|1326041732|CHC13|92235|TC|11/01/2013|12/31/9999|$135.68|0|0|||EYE EXAM WITH PHOTOS|| 58-1699775|1326041732|CHC13|92240||11/01/2013|12/31/9999|$295.09|0|0|||ICG ANGIOGRAPHY|| 58-1699775|1326041732|CHC13|92240|26|11/01/2013|12/31/9999|$97.64|0|0|||ICG ANGIOGRAPHY|| 58-1699775|1326041732|CHC13|92240|TC|11/01/2013|12/31/9999|$276.90|0|0|||ICG ANGIOGRAPHY|| 58-1699775|1326041732|CHC13|92242||04/01/2017|12/31/9999|$298.59|0|298.59|0||FLUORESCEIN ICG ANGIOGRAPHY|| 58-1699775|1326041732|CHC13|92242|26|04/01/2017|12/31/9999|$225.35|0|225.35|0||FLUORESCEIN ICG ANGIOGRAPHY|| 58-1699775|1326041732|CHC13|92242|TC|04/01/2017|12/31/9999|$73.25|0|73.25|0||FLUORESCEIN ICG ANGIOGRAPHY|| 58-1699775|1326041732|CHC13|92250||11/01/2013|12/31/9999|$91.42|0|0|||EYE EXAM WITH PHOTOS|| 58-1699775|1326041732|CHC13|92250|26|11/01/2013|12/31/9999|$36.83|0|0|||EYE EXAM WITH PHOTOS|| 58-1699775|1326041732|CHC13|92250|TC|11/01/2013|12/31/9999|$79.20|0|0|||EYE EXAM WITH PHOTOS|| 58-1699775|1326041732|CHC13|92260||11/01/2013|12/31/9999|$13.63|0|0|||OPHTHALMOSCOPY/DYNAMOMETRY|| 58-1699775|1326041732|CHC13|92265||11/01/2013|12/31/9999|$99.44|0|0|||EYE MUSCLE EVALUATION|| 58-1699775|1326041732|CHC13|92265|26|11/01/2013|12/31/9999|$70.22|0|0|||EYE MUSCLE EVALUATION|| 58-1699775|1326041732|CHC13|92265|TC|11/01/2013|12/31/9999|$56.00|0|0|||EYE MUSCLE EVALUATION|| 58-1699775|1326041732|CHC13|92270||11/01/2013|12/31/9999|$110.99|0|0|||ELECTRO-OCULOGRAPHY|| 58-1699775|1326041732|CHC13|92270|26|11/01/2013|12/31/9999|$65.21|0|0|||ELECTRO-OCULOGRAPHY|| 58-1699775|1326041732|CHC13|92270|TC|11/01/2013|12/31/9999|$75.67|0|0|||ELECTRO-OCULOGRAPHY|| 58-1699775|1326041732|CHC13|92275||11/01/2013|12/31/9999|$181.45|0|0|||ELECTRORETINOGRAPHY|| 58-1699775|1326041732|CHC13|92275|26|11/01/2013|12/31/9999|$89.57|0|0|||ELECTRORETINOGRAPHY|| 58-1699775|1326041732|CHC13|92275|TC|11/01/2013|12/31/9999|$140.73|0|0|||ELECTRORETINOGRAPHY|| 58-1699775|1326041732|CHC13|92283||11/01/2013|12/31/9999|$61.99|0|0|||COLOR VISION EXAMINATION|| 58-1699775|1326041732|CHC13|92283|26|11/01/2013|12/31/9999|$14.10|0|0|||COLOR VISION EXAMINATION|| 58-1699775|1326041732|CHC13|92283|TC|11/01/2013|12/31/9999|$64.57|0|0|||COLOR VISION EXAMINATION|| 58-1699775|1326041732|CHC13|92284||11/01/2013|12/31/9999|$72.24|0|0|||DARK ADAPTATION EYE EXAM|| 58-1699775|1326041732|CHC13|92284|26|11/01/2013|12/31/9999|$19.04|0|0|||DARK ADAPTATION EYE EXAM|| 58-1699775|1326041732|CHC13|92284|TC|11/01/2013|12/31/9999|$72.64|0|0|||DARK ADAPTATION EYE EXAM|| 58-1699775|1326041732|CHC13|92285||11/01/2013|12/31/9999|$28.86|0|0|||EYE PHOTOGRAPHY|| 58-1699775|1326041732|CHC13|92285|26|11/01/2013|12/31/9999|$5.85|0|0|||EYE PHOTOGRAPHY|| 58-1699775|1326041732|CHC13|92285|TC|11/01/2013|12/31/9999|$30.78|0|0|||EYE PHOTOGRAPHY|| 58-1699775|1326041732|CHC13|92286||11/01/2013|12/31/9999|$146.05|0|0|||INTERNAL EYE PHOTOGRAPHY|| 58-1699775|1326041732|CHC13|92286|26|11/01/2013|12/31/9999|$55.74|0|0|||INTERNAL EYE PHOTOGRAPHY|| 58-1699775|1326041732|CHC13|92286|TC|11/01/2013|12/31/9999|$129.63|0|0|||INTERNAL EYE PHOTOGRAPHY|| 58-1699775|1326041732|CHC13|92287||11/01/2013|12/31/9999|$56.95|0|0|||INTERNAL EYE PHOTOGRAPHY|| 58-1699775|1326041732|CHC13|92310||11/01/2013|12/31/9999|$74.13|0|0|||CONTACT LENS FITTING|| 58-1699775|1326041732|CHC13|92311||11/01/2013|12/31/9999|$70.54|0|0|||CONTACT LENS FITTING|| 58-1699775|1326041732|CHC13|92312||11/01/2013|12/31/9999|$80.06|0|0|||CONTACT LENS FITTING|| 58-1699775|1326041732|CHC13|92313||11/01/2013|12/31/9999|$62.63|0|0|||CONTACT LENS FITTING|| 58-1699775|1326041732|CHC13|92314||11/01/2013|12/31/9999|$43.30|0|0|||PRESCRIPTION OF CONTACT LENS|| 58-1699775|1326041732|CHC13|92315||11/01/2013|12/31/9999|$29.50|0|0|||PRESCRIPTION OF CONTACT LENS|| 58-1699775|1326041732|CHC13|92316||11/01/2013|12/31/9999|$48.02|0|0|||PRESCRIPTION OF CONTACT LENS|| 58-1699775|1326041732|CHC13|92317||11/01/2013|12/31/9999|$26.68|0|0|||PRESCRIPTION OF CONTACT LENS|| 58-1699775|1326041732|CHC13|92325||11/01/2013|12/31/9999|$43.72|0|0|||MODIFICATION OF CONTACT LENS|| 58-1699775|1326041732|CHC13|92326||11/01/2013|12/31/9999|$41.74|0|0|||REPLACEMENT OF CONTACT LENS|| 58-1699775|1326041732|CHC13|92340||11/01/2013|12/31/9999|$23.56|0|0|||FITTING OF SPECTACLES|| 58-1699775|1326041732|CHC13|92341||11/01/2013|12/31/9999|$29.58|0|0|||FITTING OF SPECTACLES|| 58-1699775|1326041732|CHC13|92342||11/01/2013|12/31/9999|$33.84|0|0|||FITTING OF SPECTACLES|| 58-1699775|1326041732|CHC13|92352||11/01/2013|12/31/9999|$23.56|0|0|||SPECIAL SPECTACLES FITTING|| 58-1699775|1326041732|CHC13|92353||11/01/2013|12/31/9999|$31.30|0|0|||SPECIAL SPECTACLES FITTING|| 58-1699775|1326041732|CHC13|92354||11/01/2013|12/31/9999|$40.94|0|0|||SPECIAL SPECTACLES FITTING|| 58-1699775|1326041732|CHC13|92355||11/01/2013|12/31/9999|$35.78|0|0|||SPECIAL SPECTACLES FITTING|| 58-1699775|1326041732|CHC13|92358||11/01/2013|12/31/9999|$15.11|0|0|||EYE PROSTHESIS SERVICE|| 58-1699775|1326041732|CHC13|92370||11/01/2013|12/31/9999|$20.56|0|0|||REPAIR & ADJUST SPECTACLES|| 58-1699775|1326041732|CHC13|92371||11/01/2013|12/31/9999|$14.32|0|0|||REPAIR & ADJUST SPECTACLES|| 58-1699775|1326041732|CHC13|92499||11/01/2013|12/31/9999|$0.00|0|0|||EYE SERVICE OR PROCEDURE|| 58-1699775|1326041732|CHC13|92499|26|11/01/2013|12/31/9999|$0.00|0|0|||EYE SERVICE OR PROCEDURE|| 58-1699775|1326041732|CHC13|92499|TC|11/01/2013|12/31/9999|$0.00|0|0|||EYE SERVICE OR PROCEDURE|| 58-1699775|1326041732|CHC13|92502||11/01/2013|12/31/9999|$120.55|0|0|||EAR AND THROAT EXAMINATION|| 58-1699775|1326041732|CHC13|92504||11/01/2013|12/31/9999|$11.95|0|0|||EAR MICROSCOPY EXAMINATION|| 58-1699775|1326041732|CHC13|92507||11/01/2013|12/31/9999|$93.38|0|0|||SPEECH/HEARING THERAPY|| 58-1699775|1326041732|CHC13|92508||11/01/2013|12/31/9999|$27.73|0|0|||SPEECH/HEARING THERAPY|| 58-1699775|1326041732|CHC13|92511||11/01/2013|12/31/9999|$60.81|0|0|||NASOPHARYNGOSCOPY|| 58-1699775|1326041732|CHC13|92512||11/01/2013|12/31/9999|$35.50|0|0|||NASAL FUNCTION STUDIES|| 58-1699775|1326041732|CHC13|92516||11/01/2013|12/31/9999|$29.00|0|0|||FACIAL NERVE FUNCTION TEST|| 58-1699775|1326041732|CHC13|92520||11/01/2013|12/31/9999|$50.72|0|0|||LARYNGEAL FUNCTION STUDIES|| 58-1699775|1326041732|CHC13|92521||04/01/2014|12/31/9999|$141.82|0|0|||EVALUATION OF SPEECH FLUENCY|| 58-1699775|1326041732|CHC13|92522||04/01/2014|12/31/9999|$115.52|0|0|||EVALUATE SPEECH PRODUCTION|| 58-1699775|1326041732|CHC13|92523||04/01/2014|12/31/9999|$239.41|0|0|||SPEECH SOUND LANG COMPREHEN|| 58-1699775|1326041732|CHC13|92524||04/01/2014|12/31/9999|$120.16|0|0|||BEHAVRAL QUALIT ANALYS VOICE|| 58-1699775|1326041732|CHC13|92526||11/01/2013|12/31/9999|$103.10|0|0|||ORAL FUNCTION THERAPY|| 58-1699775|1326041732|CHC13|92531||11/01/2013|12/31/9999|$20.12|0|0|||SPONTANEOUS NYSTAGMUS STUDY|| 58-1699775|1326041732|CHC13|92532||11/01/2013|12/31/9999|$22.59|0|0|||POSITIONAL NYSTAGMUS TEST|| 58-1699775|1326041732|CHC13|92533||11/01/2013|12/31/9999|$32.41|0|0|||CALORIC VESTIBULAR TEST|| 58-1699775|1326041732|CHC13|92534||11/01/2013|12/31/9999|$24.62|0|0|||OPTOKINETIC NYSTAGMUS TEST|| 58-1699775|1326041732|CHC13|92537||04/01/2016|12/31/9999|$46.64|0|0|0||CALORIC VSTBLR TEST W/REC|| 58-1699775|1326041732|CHC13|92537|26|04/01/2016|12/31/9999|$37.37|0|0|0||CALORIC VSTBLR TEST W/REC|| 58-1699775|1326041732|CHC13|92537|TC|04/01/2016|12/31/9999|$9.27|0|0|0||CALORIC VSTBLR TEST W/REC|| 58-1699775|1326041732|CHC13|92538||04/01/2016|12/31/9999|$23.71|0|0|0||CALORIC VSTBLR TEST W/REC|| 58-1699775|1326041732|CHC13|92538|26|04/01/2016|12/31/9999|$18.69|0|0|0||CALORIC VSTBLR TEST W/REC|| 58-1699775|1326041732|CHC13|92538|TC|04/01/2016|12/31/9999|$5.02|0|0|0||CALORIC VSTBLR TEST W/REC|| 58-1699775|1326041732|CHC13|92540||11/01/2013|12/31/9999|$123.66|0|0|||BASIC VESTIBULAR EVALUATION|| 58-1699775|1326041732|CHC13|92540|26|11/01/2013|12/31/9999|$124.15|0|0|||BASIC VESTIBULAR EVALUATION|| 58-1699775|1326041732|CHC13|92540|TC|11/01/2013|12/31/9999|$32.80|0|0|||BASIC VESTIBULAR EVALUATION|| 58-1699775|1326041732|CHC13|92541||11/01/2013|12/31/9999|$45.54|0|0|||SPONTANEOUS NYSTAGMUS TEST|| 58-1699775|1326041732|CHC13|92541|26|11/01/2013|12/31/9999|$32.06|0|0|||SPONTANEOUS NYSTAGMUS TEST|| 58-1699775|1326041732|CHC13|92541|TC|11/01/2013|12/31/9999|$25.74|0|0|||SPONTANEOUS NYSTAGMUS TEST|| 58-1699775|1326041732|CHC13|92542||11/01/2013|12/31/9999|$43.64|0|0|||POSITIONAL NYSTAGMUS TEST|| 58-1699775|1326041732|CHC13|92542|26|11/01/2013|12/31/9999|$27.12|0|0|||POSITIONAL NYSTAGMUS TEST|| 58-1699775|1326041732|CHC13|92542|TC|11/01/2013|12/31/9999|$28.26|0|0|||POSITIONAL NYSTAGMUS TEST|| 58-1699775|1326041732|CHC13|92543||11/01/2013|12/31/9999|$23.13|0|0|||CALORIC VESTIBULAR TEST|| 58-1699775|1326041732|CHC13|92543|26|11/01/2013|12/31/9999|$8.66|0|0|||CALORIC VESTIBULAR TEST|| 58-1699775|1326041732|CHC13|92543|TC|11/01/2013|12/31/9999|$20.69|0|0|||CALORIC VESTIBULAR TEST|| 58-1699775|1326041732|CHC13|92544||11/01/2013|12/31/9999|$36.17|0|0|||OPTOKINETIC NYSTAGMUS TEST|| 58-1699775|1326041732|CHC13|92544|26|11/01/2013|12/31/9999|$21.18|0|0|||OPTOKINETIC NYSTAGMUS TEST|| 58-1699775|1326041732|CHC13|92544|TC|11/01/2013|12/31/9999|$24.73|0|0|||OPTOKINETIC NYSTAGMUS TEST|| 58-1699775|1326041732|CHC13|92545||11/01/2013|12/31/9999|$33.65|0|0|||OSCILLATING TRACKING TEST|| 58-1699775|1326041732|CHC13|92545|26|11/01/2013|12/31/9999|$18.99|0|0|||OSCILLATING TRACKING TEST|| 58-1699775|1326041732|CHC13|92545|TC|11/01/2013|12/31/9999|$23.72|0|0|||OSCILLATING TRACKING TEST|| 58-1699775|1326041732|CHC13|92546||11/01/2013|12/31/9999|$119.75|0|0|||SINUSOIDAL ROTATIONAL TEST|| 58-1699775|1326041732|CHC13|92546|26|11/01/2013|12/31/9999|$23.36|0|0|||SINUSOIDAL ROTATIONAL TEST|| 58-1699775|1326041732|CHC13|92546|TC|11/01/2013|12/31/9999|$128.62|0|0|||SINUSOIDAL ROTATIONAL TEST|| 58-1699775|1326041732|CHC13|92547||11/01/2013|12/31/9999|$6.77|0|0|||SUPPLEMENTAL ELECTRICAL TEST|| 58-1699775|1326041732|CHC13|92548||11/01/2013|12/31/9999|$125.46|0|0|||POSTUROGRAPHY|| 58-1699775|1326041732|CHC13|92548|26|11/01/2013|12/31/9999|$40.20|0|0|||POSTUROGRAPHY|| 58-1699775|1326041732|CHC13|92548|TC|11/01/2013|12/31/9999|$119.04|0|0|||POSTUROGRAPHY|| 58-1699775|1326041732|CHC13|92550||11/01/2013|12/31/9999|$25.83|0|0|||TYMPANOMETRY & REFLEX THRESH|| 58-1699775|1326041732|CHC13|92551||11/01/2013|12/31/9999|$13.92|0|0|||PURE TONE HEARING TEST| AIR|| 58-1699775|1326041732|CHC13|92552||11/01/2013|12/31/9999|$34.58|0|0|||PURE TONE AUDIOMETRY| AIR|| 58-1699775|1326041732|CHC13|92553||11/01/2013|12/31/9999|$42.13|0|0|||AUDIOMETRY| AIR & BONE|| 58-1699775|1326041732|CHC13|92555||11/01/2013|12/31/9999|$25.44|0|0|||SPEECH THRESHOLD AUDIOMETRY|| 58-1699775|1326041732|CHC13|92556||11/01/2013|12/31/9999|$39.75|0|0|||SPEECH AUDIOMETRY| COMPLETE|| 58-1699775|1326041732|CHC13|92557||11/01/2013|12/31/9999|$42.88|0|0|||COMPREHENSIVE HEARING TEST|| 58-1699775|1326041732|CHC13|92558||11/01/2013|12/31/9999|$11.53|0|0|||EVOKED AUDITORY TEST QUAL|| 58-1699775|1326041732|CHC13|92559||11/01/2013|12/31/9999|$34.88|0|0|||GROUP AUDIOMETRIC TESTING|| 58-1699775|1326041732|CHC13|92560||11/01/2013|12/31/9999|$24.62|0|0|||BEKESY AUDIOMETRY| SCREEN|| 58-1699775|1326041732|CHC13|92561||11/01/2013|12/31/9999|$42.13|0|0|||BEKESY AUDIOMETRY| DIAGNOSIS|| 58-1699775|1326041732|CHC13|92562||11/01/2013|12/31/9999|$45.31|0|0|||LOUDNESS BALANCE TEST|| 58-1699775|1326041732|CHC13|92563||11/01/2013|12/31/9999|$34.58|0|0|||TONE DECAY HEARING TEST|| 58-1699775|1326041732|CHC13|92564||11/01/2013|12/31/9999|$29.81|0|0|||SISI HEARING TEST|| 58-1699775|1326041732|CHC13|92565||11/01/2013|12/31/9999|$18.29|0|0|||STENGER TEST| PURE TONE|| 58-1699775|1326041732|CHC13|92567||11/01/2013|12/31/9999|$14.43|0|0|||TYMPANOMETRY|| 58-1699775|1326041732|CHC13|92568||11/01/2013|12/31/9999|$20.00|0|0|||ACOUSTIC REFL THRESHOLD TST|| 58-1699775|1326041732|CHC13|92570||11/01/2013|12/31/9999|$37.09|0|0|||ACOUSTIC IMMITTANCE TESTING|| 58-1699775|1326041732|CHC13|92571||11/01/2013|12/31/9999|$28.62|0|0|||FILTERED SPEECH HEARING TEST|| 58-1699775|1326041732|CHC13|92572||11/01/2013|12/31/9999|$36.97|0|0|||STAGGERED SPONDAIC WORD TEST|| 58-1699775|1326041732|CHC13|92575||11/01/2013|12/31/9999|$76.31|0|0|||SENSORINEURAL ACUITY TEST|| 58-1699775|1326041732|CHC13|92576||11/01/2013|12/31/9999|$39.75|0|0|||SYNTHETIC SENTENCE TEST|| 58-1699775|1326041732|CHC13|92577||11/01/2013|12/31/9999|$20.68|0|0|||STENGER TEST| SPEECH|| 58-1699775|1326041732|CHC13|92579||11/01/2013|12/31/9999|$47.70|0|0|||VISUAL AUDIOMETRY (VRA)|| 58-1699775|1326041732|CHC13|92582||11/01/2013|12/31/9999|$74.32|0|0|||CONDITIONING PLAY AUDIOMETRY|| 58-1699775|1326041732|CHC13|92583||11/01/2013|12/31/9999|$54.45|0|0|||SELECT PICTURE AUDIOMETRY|| 58-1699775|1326041732|CHC13|92584||11/01/2013|12/31/9999|$83.06|0|0|||ELECTROCOCHLEOGRAPHY|| 58-1699775|1326041732|CHC13|92585||11/01/2013|12/31/9999|$147.32|0|0|||AUDITOR EVOKE POTENT| COMPRE|| 58-1699775|1326041732|CHC13|92585|26|11/01/2013|12/31/9999|$40.71|0|0|||AUDITOR EVOKE POTENT| COMPRE|| 58-1699775|1326041732|CHC13|92585|TC|11/01/2013|12/31/9999|$146.27|0|0|||AUDITOR EVOKE POTENT| COMPRE|| 58-1699775|1326041732|CHC13|92586||11/01/2013|12/31/9999|$93.79|0|0|||AUDITOR EVOKE POTENT| LIMIT|| 58-1699775|1326041732|CHC13|92587||11/01/2013|12/31/9999|$34.61|0|0|||EVOKED AUDITORY TEST|| 58-1699775|1326041732|CHC13|92587|26|11/01/2013|12/31/9999|$28.79|0|0|||EVOKED AUDITORY TEST|| 58-1699775|1326041732|CHC13|92587|TC|11/01/2013|12/31/9999|$15.15|0|0|||EVOKED AUDITORY TEST|| 58-1699775|1326041732|CHC13|92588||11/01/2013|12/31/9999|$52.59|0|0|||EVOKED AUDITORY TEST|| 58-1699775|1326041732|CHC13|92588|26|11/01/2013|12/31/9999|$45.04|0|0|||EVOKED AUDITORY TEST|| 58-1699775|1326041732|CHC13|92588|TC|11/01/2013|12/31/9999|$21.70|0|0|||EVOKED AUDITORY TEST|| 58-1699775|1326041732|CHC13|92590||11/01/2013|12/31/9999|$64.86|0|0|||HEARING AID EXAM| ONE EAR|| 58-1699775|1326041732|CHC13|92591||11/01/2013|12/31/9999|$82.50|0|0|||HEARING AID EXAM| BOTH EARS|| 58-1699775|1326041732|CHC13|92592||11/01/2013|12/31/9999|$25.86|0|0|||HEARING AID CHECK| ONE EAR|| 58-1699775|1326041732|CHC13|92593||11/01/2013|12/31/9999|$43.11|0|0|||HEARING AID CHECK| BOTH EARS|| 58-1699775|1326041732|CHC13|92594||11/01/2013|12/31/9999|$24.62|0|0|||ELECTRO HEARNG AID TEST| ONE|| 58-1699775|1326041732|CHC13|92595||11/01/2013|12/31/9999|$53.37|0|0|||ELECTRO HEARNG AID TST| BOTH|| 58-1699775|1326041732|CHC13|92596||11/01/2013|12/31/9999|$50.48|0|0|||EAR PROTECTOR EVALUATION|| 58-1699775|1326041732|CHC13|92597||11/01/2013|12/31/9999|$102.73|0|0|||ORAL SPEECH DEVICE EVAL|| 58-1699775|1326041732|CHC13|92601||11/01/2013|12/31/9999|$156.36|0|0|||COCHLEAR IMPLT F/UP EXAM < 7|| 58-1699775|1326041732|CHC13|92602||11/01/2013|12/31/9999|$89.80|0|0|||REPROGRAM COCHLEAR IMPLT < 7|| 58-1699775|1326041732|CHC13|92603||11/01/2013|12/31/9999|$153.75|0|0|||COCHLEAR IMPLT F/UP EXAM 7 >|| 58-1699775|1326041732|CHC13|92604||11/01/2013|12/31/9999|$85.18|0|0|||REPROGRAM COCHLEAR IMPLT 7 >|| 58-1699775|1326041732|CHC13|92605||11/01/2013|12/31/9999|$109.34|0|0|||EVAL FOR NONSPEECH DEVICE RX|| 58-1699775|1326041732|CHC13|92606||11/01/2013|12/31/9999|$87.47|0|0|||NON-SPEECH DEVICE SERVICE|| 58-1699775|1326041732|CHC13|92607||11/01/2013|12/31/9999|$174.97|0|0|||EX FOR SPEECH DEVICE RX| 1HR|| 58-1699775|1326041732|CHC13|92608||11/01/2013|12/31/9999|$56.86|0|0|||EX FOR SPEECH DEVICE RX ADDL|| 58-1699775|1326041732|CHC13|92609||11/01/2013|12/31/9999|$124.88|0|0|||USE OF SPEECH DEVICE SERVICE|| 58-1699775|1326041732|CHC13|92610||11/01/2013|12/31/9999|$84.24|0|0|||EVALUATE SWALLOWING FUNCTION|| 58-1699775|1326041732|CHC13|92611||11/01/2013|12/31/9999|$120.99|0|0|||MOTION FLUOROSCOPY/SWALLOW|| 58-1699775|1326041732|CHC13|92612||11/01/2013|12/31/9999|$84.50|0|0|||ENDOSCOPY SWALLOW TST (FEES)|| 58-1699775|1326041732|CHC13|92613||11/01/2013|12/31/9999|$47.36|0|0|||ENDOSCOPY SWALLOW TST (FEES)|| 58-1699775|1326041732|CHC13|92614||11/01/2013|12/31/9999|$85.30|0|0|||LARYNGOSCOPIC SENSORY TEST|| 58-1699775|1326041732|CHC13|92615||11/01/2013|12/31/9999|$42.22|0|0|||EVAL LARYNGOSCOPY SENSE TST|| 58-1699775|1326041732|CHC13|92616||11/01/2013|12/31/9999|$124.65|0|0|||FEES W/LARYNGEAL SENSE TEST|| 58-1699775|1326041732|CHC13|92617||11/01/2013|12/31/9999|$52.10|0|0|||INTERPRT FEES/LARYNGEAL TEST|| 58-1699775|1326041732|CHC13|92618||11/01/2013|12/31/9999|$40.32|0|0|||EX FOR NONSPEECH DEV RX ADD|| 58-1699775|1326041732|CHC13|92620||11/01/2013|12/31/9999|$99.84|0|0|||AUDITORY FUNCTION| 60 MIN|| 58-1699775|1326041732|CHC13|92621||11/01/2013|12/31/9999|$22.65|0|0|||AUDITORY FUNCTION| + 15 MIN|| 58-1699775|1326041732|CHC13|92625||11/01/2013|12/31/9999|$75.99|0|0|||TINNITUS ASSESSMENT|| 58-1699775|1326041732|CHC13|92626||11/01/2013|12/31/9999|$95.82|0|0|||EVAL AUD REHAB STATUS|| 58-1699775|1326041732|CHC13|92627||11/01/2013|12/31/9999|$22.56|0|0|||EVAL AUD STATUS REHAB ADD-ON|| 58-1699775|1326041732|CHC13|92630||11/01/2013|12/31/9999|$0.00|0|0|||AUD REHAB PRE-LING HEAR LOSS|| 58-1699775|1326041732|CHC13|92633||11/01/2013|12/31/9999|$0.00|0|0|||AUD REHAB POSTLING HEAR LOSS|| 58-1699775|1326041732|CHC13|92640||11/01/2013|12/31/9999|$124.07|0|0|||AUD BRAINSTEM IMPLT PROGRAMG|| 58-1699775|1326041732|CHC13|92700||11/01/2013|12/31/9999|$0.00|0|0|||ENT PROCEDURE/SERVICE|| 58-1699775|1326041732|CHC13|92920||11/01/2013|12/31/9999|$683.57|0|0|||PRQ CARDIAC ANGIOPLAST 1 ART|| 58-1699775|1326041732|CHC13|92924||11/01/2013|12/31/9999|$812.60|0|0|||PRQ CARD ANGIO/ATHRECT 1 ART|| 58-1699775|1326041732|CHC13|92928||11/01/2013|12/31/9999|$759.22|0|0|||PRQ CARD STENT W/ANGIO 1 VSL|| 58-1699775|1326041732|CHC13|92933||11/01/2013|12/31/9999|$849.02|0|0|||PRQ CARD STENT/ATH/ANGIO|| 58-1699775|1326041732|CHC13|92937||11/01/2013|12/31/9999|$758.38|0|0|||PRQ REVASC BYP GRAFT 1 VSL|| 58-1699775|1326041732|CHC13|92941||11/01/2013|12/31/9999|$850.71|0|0|||PRQ CARD REVASC MI 1 VSL|| 58-1699775|1326041732|CHC13|92943||11/01/2013|12/31/9999|$850.71|0|0|||PRQ CARD REVASC CHRONIC 1VSL|| 58-1699775|1326041732|CHC13|92950||11/01/2013|12/31/9999|$536.89|0|0|||HEART/LUNG RESUSCITATION CPR|| 58-1699775|1326041732|CHC13|92953||11/01/2013|12/31/9999|$31.77|0|0|||TEMPORARY EXTERNAL PACING|| 58-1699775|1326041732|CHC13|92960||11/01/2013|12/31/9999|$356.72|0|0|||CARDIOVERSION ELECTRIC| EXT|| 58-1699775|1326041732|CHC13|92961||11/01/2013|12/31/9999|$712.13|0|0|||CARDIOVERSION| ELECTRIC| INT|| 58-1699775|1326041732|CHC13|92970||11/01/2013|12/31/9999|$513.20|0|0|||CARDIOASSIST| INTERNAL|| 58-1699775|1326041732|CHC13|92971||11/01/2013|12/31/9999|$274.61|0|0|||CARDIOASSIST| EXTERNAL|| 58-1699775|1326041732|CHC13|92973||11/01/2013|12/31/9999|$530.59|0|0|||PERCUT CORONARY THROMBECTOMY|| 58-1699775|1326041732|CHC13|92974||11/01/2013|12/31/9999|$485.31|0|0|||CATH PLACE| CARDIO BRACHYTX|| 58-1699775|1326041732|CHC13|92975||11/01/2013|12/31/9999|$1|173.28|0|0|||DISSOLVE CLOT| HEART VESSEL|| 58-1699775|1326041732|CHC13|92977||11/01/2013|12/31/9999|$329.29|0|0|||DISSOLVE CLOT| HEART VESSEL|| 58-1699775|1326041732|CHC13|92978||11/01/2013|12/31/9999|$695.36|0|0|||INTRAVASC US| HEART ADD-ON|| 58-1699775|1326041732|CHC13|92978|26|11/01/2013|12/31/9999|$146.18|0|0|||INTRAVASC US| HEART ADD-ON|| 58-1699775|1326041732|CHC13|92978|TC|11/01/2013|12/31/9999|$241.87|0|0|||INTRAVASC US| HEART ADD-ON|| 58-1699775|1326041732|CHC13|92979||11/01/2013|12/31/9999|$428.13|0|0|||INTRAVASC US| HEART ADD-ON|| 58-1699775|1326041732|CHC13|92979|26|11/01/2013|12/31/9999|$117.35|0|0|||INTRAVASC US| HEART ADD-ON|| 58-1699775|1326041732|CHC13|92979|TC|11/01/2013|12/31/9999|$122.71|0|0|||INTRAVASC US| HEART ADD-ON|| 58-1699775|1326041732|CHC13|92986||11/01/2013|12/31/9999|$3|989.00|0|0|||REVISION OF AORTIC VALVE|| 58-1699775|1326041732|CHC13|92987||11/01/2013|12/31/9999|$4|111.32|0|0|||REVISION OF MITRAL VALVE|| 58-1699775|1326041732|CHC13|92990||11/01/2013|12/31/9999|$3|212.94|0|0|||REVISION OF PULMONARY VALVE|| 58-1699775|1326041732|CHC13|92992||11/01/2013|12/31/9999|$2|999.97|0|0|||REVISION OF HEART CHAMBER|| 58-1699775|1326041732|CHC13|92993||11/01/2013|12/31/9999|$2|372.91|0|0|||REVISION OF HEART CHAMBER|| 58-1699775|1326041732|CHC13|92995||11/01/2013|12/31/9999|$1|975.05|0|0|||CORONARY ATHERECTOMY|| 58-1699775|1326041732|CHC13|92997||11/01/2013|12/31/9999|$1|930.04|0|0|||PUL ART BALLOON REPR| PERCUT|| 58-1699775|1326041732|CHC13|92998||11/01/2013|12/31/9999|$963.20|0|0|||PUL ART BALLOON REPR| PERCUT|| 58-1699775|1326041732|CHC13|93000||11/01/2013|12/31/9999|$53.18|0|0|||ELECTROCARDIOGRAM| COMPLETE|| 58-1699775|1326041732|CHC13|93005||11/01/2013|12/31/9999|$28.46|0|0|||ELECTROCARDIOGRAM| TRACING|| 58-1699775|1326041732|CHC13|93010||11/01/2013|12/31/9999|$24.73|0|0|||ELECTROCARDIOGRAM REPORT|| 58-1699775|1326041732|CHC13|93015||11/01/2013|12/31/9999|$246.32|0|0|||CARDIOVASCULAR STRESS TEST|| 58-1699775|1326041732|CHC13|93016||11/01/2013|12/31/9999|$64.32|0|0|||CARDIOVASCULAR STRESS TEST|| 58-1699775|1326041732|CHC13|93016|26|11/01/2013|12/31/9999|$38.59|0|0|||CARDIOVASCULAR STRESS TEST|| 58-1699775|1326041732|CHC13|93017||11/01/2013|12/31/9999|$138.49|0|0|||CARDIOVASCULAR STRESS TEST|| 58-1699775|1326041732|CHC13|93018||11/01/2013|12/31/9999|$43.50|0|0|||CARDIOVASCULAR STRESS TEST|| 58-1699775|1326041732|CHC13|93024||11/01/2013|12/31/9999|$320.44|0|0|||CARDIAC DRUG STRESS TEST|| 58-1699775|1326041732|CHC13|93024|26|11/01/2013|12/31/9999|$92.51|0|0|||CARDIAC DRUG STRESS TEST|| 58-1699775|1326041732|CHC13|93024|TC|11/01/2013|12/31/9999|$83.74|0|0|||CARDIAC DRUG STRESS TEST|| 58-1699775|1326041732|CHC13|93025||11/01/2013|12/31/9999|$494.85|0|0|||MICROVOLT T-WAVE ASSESS|| 58-1699775|1326041732|CHC13|93025|26|11/01/2013|12/31/9999|$59.82|0|0|||MICROVOLT T-WAVE ASSESS|| 58-1699775|1326041732|CHC13|93025|TC|11/01/2013|12/31/9999|$212.34|0|0|||MICROVOLT T-WAVE ASSESS|| 58-1699775|1326041732|CHC13|93040||11/01/2013|12/31/9999|$36.47|0|0|||RHYTHM ECG WITH REPORT|| 58-1699775|1326041732|CHC13|93041||11/01/2013|12/31/9999|$15.62|0|0|||RHYTHM ECG| TRACING|| 58-1699775|1326041732|CHC13|93042||11/01/2013|12/31/9999|$20.85|0|0|||RHYTHM ECG| REPORT|| 58-1699775|1326041732|CHC13|93050||04/01/2016|12/31/9999|$19.67|0|0|0||ART PRESSURE WAVEFORM ANALYS|| 58-1699775|1326041732|CHC13|93050|26|04/01/2016|12/31/9999|$10.01|0|0|0||ART PRESSURE WAVEFORM ANALYS|| 58-1699775|1326041732|CHC13|93050|TC|04/01/2016|12/31/9999|$9.66|0|0|0||ART PRESSURE WAVEFORM ANALYS|| 58-1699775|1326041732|CHC13|93224||11/01/2013|12/31/9999|$272.35|0|0|||ECG MONITOR/REPORT| 24 HRS|| 58-1699775|1326041732|CHC13|93225||11/01/2013|12/31/9999|$78.89|0|0|||ECG MONITOR/RECORD| 24 HRS|| 58-1699775|1326041732|CHC13|93226||11/01/2013|12/31/9999|$116.49|0|0|||ECG MONITOR/REPORT| 24 HRS|| 58-1699775|1326041732|CHC13|93227||11/01/2013|12/31/9999|$76.97|0|0|||ECG MONITOR/REVIEW| 24 HRS|| 58-1699775|1326041732|CHC13|93227|26|11/01/2013|12/31/9999|$30.78|0|0|||ECG MONITOR/REVIEW| 24 HRS|| 58-1699775|1326041732|CHC13|93228||11/01/2013|12/31/9999|$74.28|0|0|||REMOTE 30 DAY ECG REV/REPORT|| 58-1699775|1326041732|CHC13|93229||11/01/2013|12/31/9999|$1|869.74|0|0|||REMOTE 30 DAY ECG TECH SUPP|| 58-1699775|1326041732|CHC13|93230||11/01/2013|12/31/9999|$300.72|0|0|||ECG MONITOR/REPORT| 24 HRS|| 58-1699775|1326041732|CHC13|93260||04/01/2015|12/31/9999|$82.98|0|0|0||PRGRMG DEV EVAL IMPLTBL SYS|| 58-1699775|1326041732|CHC13|93260|26|04/01/2015|12/31/9999|$56.65|0|0|0||PRGRMG DEV EVAL IMPLTBL SYS|| 58-1699775|1326041732|CHC13|93260|TC|04/01/2015|12/31/9999|$26.33|0|0|0||PRGRMG DEV EVAL IMPLTBL SYS|| 58-1699775|1326041732|CHC13|93261||04/01/2015|12/31/9999|$67.98|0|0|0||INTERROGATE SUBQ DEFIB|| 58-1699775|1326041732|CHC13|93261|26|04/01/2015|12/31/9999|$49.45|0|0|0||INTERROGATE SUBQ DEFIB|| 58-1699775|1326041732|CHC13|93261|TC|04/01/2015|12/31/9999|$26.33|0|0|0||INTERROGATE SUBQ DEFIB|| 58-1699775|1326041732|CHC13|93268||11/01/2013|12/31/9999|$647.39|0|0|||ECG RECORD/REVIEW|| 58-1699775|1326041732|CHC13|93270||11/01/2013|12/31/9999|$33.04|0|0|||ECG RECORDING|| 58-1699775|1326041732|CHC13|93271||11/01/2013|12/31/9999|$541.96|0|0|||ECG/MONITORING AND ANALYSIS|| 58-1699775|1326041732|CHC13|93272||11/01/2013|12/31/9999|$72.39|0|0|||ECG/REVIEW| INTERPRET ONLY|| 58-1699775|1326041732|CHC13|93272|26|11/01/2013|12/31/9999|$43.43|0|0|||ECG/REVIEW| INTERPRET ONLY|| 58-1699775|1326041732|CHC13|93278||11/01/2013|12/31/9999|$91.61|0|0|||ECG/SIGNAL-AVERAGED|| 58-1699775|1326041732|CHC13|93278|26|11/01/2013|12/31/9999|$20.11|0|0|||ECG/SIGNAL-AVERAGED|| 58-1699775|1326041732|CHC13|93278|TC|11/01/2013|12/31/9999|$30.28|0|0|||ECG/SIGNAL-AVERAGED|| 58-1699775|1326041732|CHC13|93279||11/01/2013|12/31/9999|$143.52|0|0|||PM DEVICE PROGR EVAL| SNGL|| 58-1699775|1326041732|CHC13|93279|26|11/01/2013|12/31/9999|$52.19|0|0|||PM DEVICE PROGR EVAL| SNGL|| 58-1699775|1326041732|CHC13|93279|TC|11/01/2013|12/31/9999|$26.75|0|0|||PM DEVICE PROGR EVAL| SNGL|| 58-1699775|1326041732|CHC13|93280||11/01/2013|12/31/9999|$167.70|0|0|||PM DEVICE PROGR EVAL| DUAL|| 58-1699775|1326041732|CHC13|93280|26|11/01/2013|12/31/9999|$61.96|0|0|||PM DEVICE PROGR EVAL| DUAL|| 58-1699775|1326041732|CHC13|93280|TC|11/01/2013|12/31/9999|$30.28|0|0|||PM DEVICE PROGR EVAL| DUAL|| 58-1699775|1326041732|CHC13|93281||11/01/2013|12/31/9999|$193.81|0|0|||PM DEVICE PROGR EVAL| MULTI|| 58-1699775|1326041732|CHC13|93281|26|11/01/2013|12/31/9999|$71.78|0|0|||PM DEVICE PROGR EVAL| MULTI|| 58-1699775|1326041732|CHC13|93281|TC|11/01/2013|12/31/9999|$34.82|0|0|||PM DEVICE PROGR EVAL| MULTI|| 58-1699775|1326041732|CHC13|93282||11/01/2013|12/31/9999|$179.53|0|0|||ICD DEVICE PROG EVAL| 1 SNGL|| 58-1699775|1326041732|CHC13|93282|26|11/01/2013|12/31/9999|$67.46|0|0|||ICD DEVICE PROG EVAL| 1 SNGL|| 58-1699775|1326041732|CHC13|93282|TC|11/01/2013|12/31/9999|$31.29|0|0|||ICD DEVICE PROG EVAL| 1 SNGL|| 58-1699775|1326041732|CHC13|93283||11/01/2013|12/31/9999|$231.29|0|0|||ICD DEVICE PROGR EVAL| DUAL|| 58-1699775|1326041732|CHC13|93283|26|11/01/2013|12/31/9999|$91.38|0|0|||ICD DEVICE PROGR EVAL| DUAL|| 58-1699775|1326041732|CHC13|93283|TC|11/01/2013|12/31/9999|$35.82|0|0|||ICD DEVICE PROGR EVAL| DUAL|| 58-1699775|1326041732|CHC13|93284||11/01/2013|12/31/9999|$256.17|0|0|||ICD DEVICE PROGR EVAL| MULT|| 58-1699775|1326041732|CHC13|93284|26|11/01/2013|12/31/9999|$100.03|0|0|||ICD DEVICE PROGR EVAL| MULT|| 58-1699775|1326041732|CHC13|93284|TC|11/01/2013|12/31/9999|$40.87|0|0|||ICD DEVICE PROGR EVAL| MULT|| 58-1699775|1326041732|CHC13|93285||11/01/2013|12/31/9999|$119.18|0|0|||ILR DEVICE EVAL PROGR|| 58-1699775|1326041732|CHC13|93285|26|11/01/2013|12/31/9999|$41.33|0|0|||ILR DEVICE EVAL PROGR|| 58-1699775|1326041732|CHC13|93285|TC|11/01/2013|12/31/9999|$24.22|0|0|||ILR DEVICE EVAL PROGR|| 58-1699775|1326041732|CHC13|93286||11/01/2013|12/31/9999|$72.88|0|0|||PRE-OP PM DEVICE EVAL|| 58-1699775|1326041732|CHC13|93286|26|11/01/2013|12/31/9999|$22.92|0|0|||PRE-OP PM DEVICE EVAL|| 58-1699775|1326041732|CHC13|93286|TC|11/01/2013|12/31/9999|$17.16|0|0|||PRE-OP PM DEVICE EVAL|| 58-1699775|1326041732|CHC13|93287||11/01/2013|12/31/9999|$97.36|0|0|||PRE-OP ICD DEVICE EVAL|| 58-1699775|1326041732|CHC13|93287|26|11/01/2013|12/31/9999|$34.37|0|0|||PRE-OP ICD DEVICE EVAL|| 58-1699775|1326041732|CHC13|93287|TC|11/01/2013|12/31/9999|$19.18|0|0|||PRE-OP ICD DEVICE EVAL|| 58-1699775|1326041732|CHC13|93288||11/01/2013|12/31/9999|$107.24|0|0|||PM DEVICE EVAL IN PERSON|| 58-1699775|1326041732|CHC13|93288|26|11/01/2013|12/31/9999|$34.25|0|0|||PM DEVICE EVAL IN PERSON|| 58-1699775|1326041732|CHC13|93288|TC|11/01/2013|12/31/9999|$24.73|0|0|||PM DEVICE EVAL IN PERSON|| 58-1699775|1326041732|CHC13|93289||11/01/2013|12/31/9999|$186.68|0|0|||ICD DEVICE INTERROGATE|| 58-1699775|1326041732|CHC13|93289|26|11/01/2013|12/31/9999|$72.40|0|0|||ICD DEVICE INTERROGATE|| 58-1699775|1326041732|CHC13|93289|TC|11/01/2013|12/31/9999|$30.28|0|0|||ICD DEVICE INTERROGATE|| 58-1699775|1326041732|CHC13|93290||11/01/2013|12/31/9999|$85.23|0|0|||ICM DEVICE EVAL|| 58-1699775|1326041732|CHC13|93290|26|11/01/2013|12/31/9999|$32.74|0|0|||ICM DEVICE EVAL|| 58-1699775|1326041732|CHC13|93290|TC|11/01/2013|12/31/9999|$14.14|0|0|||ICM DEVICE EVAL|| 58-1699775|1326041732|CHC13|93291||11/01/2013|12/31/9999|$102.66|0|0|||ILR DEVICE INTERROGATE|| 58-1699775|1326041732|CHC13|93291|26|11/01/2013|12/31/9999|$34.25|0|0|||ILR DEVICE INTERROGATE|| 58-1699775|1326041732|CHC13|93291|TC|11/01/2013|12/31/9999|$22.21|0|0|||ILR DEVICE INTERROGATE|| 58-1699775|1326041732|CHC13|93292||11/01/2013|12/31/9999|$92.57|0|0|||WCD DEVICE INTERROGATE|| 58-1699775|1326041732|CHC13|93292|26|11/01/2013|12/31/9999|$34.25|0|0|||WCD DEVICE INTERROGATE|| 58-1699775|1326041732|CHC13|93292|TC|11/01/2013|12/31/9999|$16.66|0|0|||WCD DEVICE INTERROGATE|| 58-1699775|1326041732|CHC13|93293||11/01/2013|12/31/9999|$150.11|0|0|||PM PHONE R-STRIP DEVICE EVAL|| 58-1699775|1326041732|CHC13|93293|26|11/01/2013|12/31/9999|$24.55|0|0|||PM PHONE R-STRIP DEVICE EVAL|| 58-1699775|1326041732|CHC13|93293|TC|11/01/2013|12/31/9999|$58.02|0|0|||PM PHONE R-STRIP DEVICE EVAL|| 58-1699775|1326041732|CHC13|93294||11/01/2013|12/31/9999|$95.84|0|0|||PM DEVICE INTERROGATE REMOTE|| 58-1699775|1326041732|CHC13|93295||11/01/2013|12/31/9999|$189.74|0|0|||ICD DEVICE INTERROGAT REMOTE|| 58-1699775|1326041732|CHC13|93296||11/01/2013|12/31/9999|$79.81|0|0|||PM/ICD REMOTE TECH SERV|| 58-1699775|1326041732|CHC13|93297||11/01/2013|12/31/9999|$73.36|0|0|||ICM DEVICE INTERROGAT REMOTE|| 58-1699775|1326041732|CHC13|93298||11/01/2013|12/31/9999|$77.03|0|0|||ILR DEVICE INTERROGAT REMOTE|| 58-1699775|1326041732|CHC13|93299||11/01/2013|12/31/9999|$0.00|0|0|||ICM/ILR REMOTE TECH SERV|| 58-1699775|1326041732|CHC13|93303||11/01/2013|12/31/9999|$573.96|0|0|||ECHO TRANSTHORACIC|| 58-1699775|1326041732|CHC13|93303|26|11/01/2013|12/31/9999|$102.83|0|0|||ECHO TRANSTHORACIC|| 58-1699775|1326041732|CHC13|93303|TC|11/01/2013|12/31/9999|$212.85|0|0|||ECHO TRANSTHORACIC|| 58-1699775|1326041732|CHC13|93304||11/01/2013|12/31/9999|$371.06|0|0|||ECHO TRANSTHORACIC|| 58-1699775|1326041732|CHC13|93304|26|11/01/2013|12/31/9999|$58.82|0|0|||ECHO TRANSTHORACIC|| 58-1699775|1326041732|CHC13|93304|TC|11/01/2013|12/31/9999|$145.27|0|0|||ECHO TRANSTHORACIC|| 58-1699775|1326041732|CHC13|93306||11/01/2013|12/31/9999|$587.72|0|0|||TTE W/DOPPLER| COMPLETE|| 58-1699775|1326041732|CHC13|93306|26|11/01/2013|12/31/9999|$103.34|0|0|||TTE W/DOPPLER| COMPLETE|| 58-1699775|1326041732|CHC13|93306|TC|11/01/2013|12/31/9999|$219.91|0|0|||TTE W/DOPPLER| COMPLETE|| 58-1699775|1326041732|CHC13|93307||11/01/2013|12/31/9999|$366.41|0|0|||ECHO EXAM OF HEART|| 58-1699775|1326041732|CHC13|93307|26|11/01/2013|12/31/9999|$73.41|0|0|||ECHO EXAM OF HEART|| 58-1699775|1326041732|CHC13|93307|TC|11/01/2013|12/31/9999|$128.12|0|0|||ECHO EXAM OF HEART|| 58-1699775|1326041732|CHC13|93308||11/01/2013|12/31/9999|$279.76|0|0|||ECHO EXAM OF HEART|| 58-1699775|1326041732|CHC13|93308|26|11/01/2013|12/31/9999|$41.38|0|0|||ECHO EXAM OF HEART|| 58-1699775|1326041732|CHC13|93308|TC|11/01/2013|12/31/9999|$112.48|0|0|||ECHO EXAM OF HEART|| 58-1699775|1326041732|CHC13|93312||11/01/2013|12/31/9999|$873.25|0|0|||ECHO TRANSESOPHAGEAL|| 58-1699775|1326041732|CHC13|93312|26|11/01/2013|12/31/9999|$170.07|0|0|||ECHO TRANSESOPHAGEAL|| 58-1699775|1326041732|CHC13|93312|TC|11/01/2013|12/31/9999|$310.22|0|0|||ECHO TRANSESOPHAGEAL|| 58-1699775|1326041732|CHC13|93313||11/01/2013|12/31/9999|$122.90|0|0|||ECHO TRANSESOPHAGEAL|| 58-1699775|1326041732|CHC13|93314||11/01/2013|12/31/9999|$785.33|0|0|||ECHO TRANSESOPHAGEAL|| 58-1699775|1326041732|CHC13|93314|26|11/01/2013|12/31/9999|$97.00|0|0|||ECHO TRANSESOPHAGEAL|| 58-1699775|1326041732|CHC13|93314|TC|11/01/2013|12/31/9999|$334.93|0|0|||ECHO TRANSESOPHAGEAL|| 58-1699775|1326041732|CHC13|93315||11/01/2013|12/31/9999|$761.69|0|0|||ECHO TRANSESOPHAGEAL|| 58-1699775|1326041732|CHC13|93315|26|11/01/2013|12/31/9999|$225.11|0|0|||ECHO TRANSESOPHAGEAL|| 58-1699775|1326041732|CHC13|93315|TC|11/01/2013|12/31/9999|$201.48|0|0|||ECHO TRANSESOPHAGEAL|| 58-1699775|1326041732|CHC13|93316||11/01/2013|12/31/9999|$128.40|0|0|||ECHO TRANSESOPHAGEAL|| 58-1699775|1326041732|CHC13|93317||11/01/2013|12/31/9999|$513.27|0|0|||ECHO TRANSESOPHAGEAL|| 58-1699775|1326041732|CHC13|93317|26|11/01/2013|12/31/9999|$148.05|0|0|||ECHO TRANSESOPHAGEAL|| 58-1699775|1326041732|CHC13|93317|TC|11/01/2013|12/31/9999|$135.83|0|0|||ECHO TRANSESOPHAGEAL|| 58-1699775|1326041732|CHC13|93318||11/01/2013|12/31/9999|$318.99|0|0|||ECHO TRANSESOPHAGEAL INTRAOP|| 58-1699775|1326041732|CHC13|93318|26|11/01/2013|12/31/9999|$179.05|0|0|||ECHO TRANSESOPHAGEAL INTRAOP|| 58-1699775|1326041732|CHC13|93318|TC|11/01/2013|12/31/9999|$162.59|0|0|||ECHO TRANSESOPHAGEAL INTRAOP|| 58-1699775|1326041732|CHC13|93320||11/01/2013|12/31/9999|$149.82|0|0|||DOPPLER ECHO EXAM| HEART|| 58-1699775|1326041732|CHC13|93320|26|11/01/2013|12/31/9999|$29.93|0|0|||DOPPLER ECHO EXAM| HEART|| 58-1699775|1326041732|CHC13|93320|TC|11/01/2013|12/31/9999|$52.47|0|0|||DOPPLER ECHO EXAM| HEART|| 58-1699775|1326041732|CHC13|93321||11/01/2013|12/31/9999|$74.06|0|0|||DOPPLER ECHO EXAM| HEART|| 58-1699775|1326041732|CHC13|93321|26|11/01/2013|12/31/9999|$11.97|0|0|||DOPPLER ECHO EXAM| HEART|| 58-1699775|1326041732|CHC13|93321|TC|11/01/2013|12/31/9999|$28.76|0|0|||DOPPLER ECHO EXAM| HEART|| 58-1699775|1326041732|CHC13|93325||11/01/2013|12/31/9999|$76.90|0|0|||DOPPLER COLOR FLOW ADD-ON|| 58-1699775|1326041732|CHC13|93325|26|11/01/2013|12/31/9999|$5.97|0|0|||DOPPLER COLOR FLOW ADD-ON|| 58-1699775|1326041732|CHC13|93325|TC|11/01/2013|12/31/9999|$36.33|0|0|||DOPPLER COLOR FLOW ADD-ON|| 58-1699775|1326041732|CHC13|93350||11/01/2013|12/31/9999|$574.74|0|0|||ECHO TRANSTHORACIC|| 58-1699775|1326041732|CHC13|93350|26|11/01/2013|12/31/9999|$116.38|0|0|||ECHO TRANSTHORACIC|| 58-1699775|1326041732|CHC13|93350|TC|11/01/2013|12/31/9999|$199.73|0|0|||ECHO TRANSTHORACIC|| 58-1699775|1326041732|CHC13|93351||11/01/2013|12/31/9999|$672.27|0|0|||STRESS TTE COMPLETE|| 58-1699775|1326041732|CHC13|93351|26|11/01/2013|12/31/9999|$139.72|0|0|||STRESS TTE COMPLETE|| 58-1699775|1326041732|CHC13|93351|TC|11/01/2013|12/31/9999|$230.03|0|0|||STRESS TTE COMPLETE|| 58-1699775|1326041732|CHC13|93352||11/01/2013|12/31/9999|$96.46|0|0|||ADMIN ECG CONTRAST AGENT|| 58-1699775|1326041732|CHC13|93355||04/01/2015|12/31/9999|$290.64|0|0|0||ECHO TRANSESOPHAGEAL (TEE)|| 58-1699775|1326041732|CHC13|93451||11/01/2013|12/31/9999|$2|190.62|0|0|||RIGHT HEART CATH|| 58-1699775|1326041732|CHC13|93451|26|11/01/2013|12/31/9999|$233.94|0|0|||RIGHT HEART CATH|| 58-1699775|1326041732|CHC13|93451|TC|11/01/2013|12/31/9999|$970.90|0|0|||RIGHT HEART CATH|| 58-1699775|1326041732|CHC13|93452||11/01/2013|12/31/9999|$2|430.52|0|0|||LEFT HRT CATH W/VENTRCLGRPHY|| 58-1699775|1326041732|CHC13|93452|26|11/01/2013|12/31/9999|$409.77|0|0|||LEFT HRT CATH W/VENTRCLGRPHY|| 58-1699775|1326041732|CHC13|93452|TC|11/01/2013|12/31/9999|$927.02|0|0|||LEFT HRT CATH W/VENTRCLGRPHY|| 58-1699775|1326041732|CHC13|93453||11/01/2013|12/31/9999|$3|182.44|0|0|||R&L HRT CATH W/VENTRICLGRPHY|| 58-1699775|1326041732|CHC13|93453|26|11/01/2013|12/31/9999|$536.84|0|0|||R&L HRT CATH W/VENTRICLGRPHY|| 58-1699775|1326041732|CHC13|93453|TC|11/01/2013|12/31/9999|$1|213.50|0|0|||R&L HRT CATH W/VENTRICLGRPHY|| 58-1699775|1326041732|CHC13|93454||11/01/2013|12/31/9999|$2|504.30|0|0|||CORONARY ARTERY ANGIO S&I|| 58-1699775|1326041732|CHC13|93454|26|11/01/2013|12/31/9999|$412.52|0|0|||CORONARY ARTERY ANGIO S&I|| 58-1699775|1326041732|CHC13|93454|TC|11/01/2013|12/31/9999|$964.84|0|0|||CORONARY ARTERY ANGIO S&I|| 58-1699775|1326041732|CHC13|93455||11/01/2013|12/31/9999|$2|923.40|0|0|||CORONARY ART/GRFT ANGIO S&I|| 58-1699775|1326041732|CHC13|93455|26|11/01/2013|12/31/9999|$476.58|0|0|||CORONARY ART/GRFT ANGIO S&I|| 58-1699775|1326041732|CHC13|93455|TC|11/01/2013|12/31/9999|$1|131.29|0|0|||CORONARY ART/GRFT ANGIO S&I|| 58-1699775|1326041732|CHC13|93456||11/01/2013|12/31/9999|$3|134.61|0|0|||R HRT CORONARY ARTERY ANGIO|| 58-1699775|1326041732|CHC13|93456|26|11/01/2013|12/31/9999|$528.19|0|0|||R HRT CORONARY ARTERY ANGIO|| 58-1699775|1326041732|CHC13|93456|TC|11/01/2013|12/31/9999|$1|195.85|0|0|||R HRT CORONARY ARTERY ANGIO|| 58-1699775|1326041732|CHC13|93457||11/01/2013|12/31/9999|$3|552.72|0|0|||R HRT ART/GRFT ANGIO|| 58-1699775|1326041732|CHC13|93457|26|11/01/2013|12/31/9999|$592.23|0|0|||R HRT ART/GRFT ANGIO|| 58-1699775|1326041732|CHC13|93457|TC|11/01/2013|12/31/9999|$1|361.77|0|0|||R HRT ART/GRFT ANGIO|| 58-1699775|1326041732|CHC13|93458||11/01/2013|12/31/9999|$3|023.16|0|0|||L HRT ARTERY/VENTRICLE ANGIO|| 58-1699775|1326041732|CHC13|93458|26|11/01/2013|12/31/9999|$503.71|0|0|||L HRT ARTERY/VENTRICLE ANGIO|| 58-1699775|1326041732|CHC13|93458|TC|11/01/2013|12/31/9999|$1|159.03|0|0|||L HRT ARTERY/VENTRICLE ANGIO|| 58-1699775|1326041732|CHC13|93459||11/01/2013|12/31/9999|$3|339.50|0|0|||L HRT ART/GRFT ANGIO|| 58-1699775|1326041732|CHC13|93459|26|11/01/2013|12/31/9999|$567.25|0|0|||L HRT ART/GRFT ANGIO|| 58-1699775|1326041732|CHC13|93459|TC|11/01/2013|12/31/9999|$1|269.48|0|0|||L HRT ART/GRFT ANGIO|| 58-1699775|1326041732|CHC13|93460||11/01/2013|12/31/9999|$3|573.38|0|0|||R&L HRT ART/VENTRICLE ANGIO|| 58-1699775|1326041732|CHC13|93460|26|11/01/2013|12/31/9999|$631.33|0|0|||R&L HRT ART/VENTRICLE ANGIO|| 58-1699775|1326041732|CHC13|93460|TC|11/01/2013|12/31/9999|$1|334.03|0|0|||R&L HRT ART/VENTRICLE ANGIO|| 58-1699775|1326041732|CHC13|93461||11/01/2013|12/31/9999|$4|095.28|0|0|||R&L HRT ART/VENTRICLE ANGIO|| 58-1699775|1326041732|CHC13|93461|26|11/01/2013|12/31/9999|$696.95|0|0|||R&L HRT ART/VENTRICLE ANGIO|| 58-1699775|1326041732|CHC13|93461|TC|11/01/2013|12/31/9999|$1|555.45|0|0|||R&L HRT ART/VENTRICLE ANGIO|| 58-1699775|1326041732|CHC13|93462||11/01/2013|12/31/9999|$584.15|0|0|||L HRT CATH TRNSPTL PUNCTURE|| 58-1699775|1326041732|CHC13|93463||11/01/2013|12/31/9999|$309.04|0|0|||DRUG ADMIN & HEMODYNMIC MEAS|| 58-1699775|1326041732|CHC13|93464||11/01/2013|12/31/9999|$738.76|0|0|||EXERCISE W/HEMODYNAMIC MEAS|| 58-1699775|1326041732|CHC13|93464|26|11/01/2013|12/31/9999|$149.59|0|0|||EXERCISE W/HEMODYNAMIC MEAS|| 58-1699775|1326041732|CHC13|93464|TC|11/01/2013|12/31/9999|$256.72|0|0|||EXERCISE W/HEMODYNAMIC MEAS|| 58-1699775|1326041732|CHC13|93503||11/01/2013|12/31/9999|$392.42|0|0|||INSERT/PLACE HEART CATHETER|| 58-1699775|1326041732|CHC13|93505||11/01/2013|12/31/9999|$2|226.88|0|0|||BIOPSY OF HEART LINING|| 58-1699775|1326041732|CHC13|93505|26|11/01/2013|12/31/9999|$381.99|0|0|||BIOPSY OF HEART LINING|| 58-1699775|1326041732|CHC13|93505|TC|11/01/2013|12/31/9999|$842.79|0|0|||BIOPSY OF HEART LINING|| 58-1699775|1326041732|CHC13|93530||11/01/2013|12/31/9999|$2|400.66|0|0|||RT HEART CATH| CONGENITAL|| 58-1699775|1326041732|CHC13|93530|26|11/01/2013|12/31/9999|$374.20|0|0|||RT HEART CATH| CONGENITAL|| 58-1699775|1326041732|CHC13|93530|TC|11/01/2013|12/31/9999|$958.42|0|0|||RT HEART CATH| CONGENITAL|| 58-1699775|1326041732|CHC13|93531||11/01/2013|12/31/9999|$4|938.00|0|0|||R & L HEART CATH| CONGENITAL|| 58-1699775|1326041732|CHC13|93531|26|11/01/2013|12/31/9999|$736.74|0|0|||R & L HEART CATH| CONGENITAL|| 58-1699775|1326041732|CHC13|93531|TC|11/01/2013|12/31/9999|$1|999.65|0|0|||R & L HEART CATH| CONGENITAL|| 58-1699775|1326041732|CHC13|93532||11/01/2013|12/31/9999|$5|910.72|0|0|||R & L HEART CATH| CONGENITAL|| 58-1699775|1326041732|CHC13|93532|26|11/01/2013|12/31/9999|$880.45|0|0|||R & L HEART CATH| CONGENITAL|| 58-1699775|1326041732|CHC13|93532|TC|11/01/2013|12/31/9999|$2|393.51|0|0|||R & L HEART CATH| CONGENITAL|| 58-1699775|1326041732|CHC13|93533||11/01/2013|12/31/9999|$4|933.92|0|0|||R & L HEART CATH| CONGENITAL|| 58-1699775|1326041732|CHC13|93533|26|11/01/2013|12/31/9999|$590.53|0|0|||R & L HEART CATH| CONGENITAL|| 58-1699775|1326041732|CHC13|93533|TC|11/01/2013|12/31/9999|$2|139.01|0|0|||R & L HEART CATH| CONGENITAL|| 58-1699775|1326041732|CHC13|93561||11/01/2013|12/31/9999|$124.59|0|0|||CARDIAC OUTPUT MEASUREMENT|| 58-1699775|1326041732|CHC13|93561|26|11/01/2013|12/31/9999|$39.75|0|0|||CARDIAC OUTPUT MEASUREMENT|| 58-1699775|1326041732|CHC13|93561|TC|11/01/2013|12/31/9999|$30.29|0|0|||CARDIAC OUTPUT MEASUREMENT|| 58-1699775|1326041732|CHC13|93562||11/01/2013|12/31/9999|$54.93|0|0|||CARDIAC OUTPUT MEASUREMENT|| 58-1699775|1326041732|CHC13|93562|26|11/01/2013|12/31/9999|$12.03|0|0|||CARDIAC OUTPUT MEASUREMENT|| 58-1699775|1326041732|CHC13|93562|TC|11/01/2013|12/31/9999|$18.18|0|0|||CARDIAC OUTPUT MEASUREMENT|| 58-1699775|1326041732|CHC13|93563||11/01/2013|12/31/9999|$160.42|0|0|||INJECT CONGENITAL CARD CATH|| 58-1699775|1326041732|CHC13|93564||11/01/2013|12/31/9999|$164.32|0|0|||INJECT HRT CONGNTL ART/GRFT|| 58-1699775|1326041732|CHC13|93565||11/01/2013|12/31/9999|$124.74|0|0|||INJECT L VENTR/ATRIAL ANGIO|| 58-1699775|1326041732|CHC13|93566||11/01/2013|12/31/9999|$123.82|0|0|||INJECT R VENTR/ATRIAL ANGIO|| 58-1699775|1326041732|CHC13|93567||11/01/2013|12/31/9999|$139.64|0|0|||INJECT SUPRVLV AORTOGRAPHY|| 58-1699775|1326041732|CHC13|93568||11/01/2013|12/31/9999|$127.70|0|0|||INJECT PULM ART HRT CATH|| 58-1699775|1326041732|CHC13|93571||11/01/2013|12/31/9999|$692.58|0|0|||HEART FLOW RESERVE MEASURE|| 58-1699775|1326041732|CHC13|93571|26|11/01/2013|12/31/9999|$145.66|0|0|||HEART FLOW RESERVE MEASURE|| 58-1699775|1326041732|CHC13|93571|TC|11/01/2013|12/31/9999|$240.87|0|0|||HEART FLOW RESERVE MEASURE|| 58-1699775|1326041732|CHC13|93572||11/01/2013|12/31/9999|$421.74|0|0|||HEART FLOW RESERVE MEASURE|| 58-1699775|1326041732|CHC13|93572|26|11/01/2013|12/31/9999|$116.87|0|0|||HEART FLOW RESERVE MEASURE|| 58-1699775|1326041732|CHC13|93572|TC|11/01/2013|12/31/9999|$118.67|0|0|||HEART FLOW RESERVE MEASURE|| 58-1699775|1326041732|CHC13|93580||11/01/2013|12/31/9999|$2|939.09|0|0|||TRANSCATH CLOSURE OF ASD|| 58-1699775|1326041732|CHC13|93581||11/01/2013|12/31/9999|$3|935.47|0|0|||TRANSCATH CLOSURE OF VSD|| 58-1699775|1326041732|CHC13|93582||04/01/2014|12/31/9999|$2|022.18|0|0|||PERQ TRANSCATH CLOSURE PDA|| 58-1699775|1326041732|CHC13|93583||04/01/2014|12/31/9999|$2|250.93|0|0|||PERQ TRANSCATH SEPTAL REDUXN|| 58-1699775|1326041732|CHC13|93590||04/01/2017|12/31/9999|$1|618.94|0|1618.94|0||PERQ TRANSCATH CLS MITRAL|| 58-1699775|1326041732|CHC13|93591||04/01/2017|12/31/9999|$1|343.67|0|1343.67|0||PERQ TRANSCATH CLS AORTIC|| 58-1699775|1326041732|CHC13|93592||04/01/2017|12/31/9999|$592.06|0|592.06|0||PERQ TRANSCATH CLOSURE EACH|| 58-1699775|1326041732|CHC13|93600||11/01/2013|12/31/9999|$544.41|0|0|||BUNDLE OF HIS RECORDING|| 58-1699775|1326041732|CHC13|93600|26|11/01/2013|12/31/9999|$187.40|0|0|||BUNDLE OF HIS RECORDING|| 58-1699775|1326041732|CHC13|93600|TC|11/01/2013|12/31/9999|$114.63|0|0|||BUNDLE OF HIS RECORDING|| 58-1699775|1326041732|CHC13|93602||11/01/2013|12/31/9999|$456.30|0|0|||INTRA-ATRIAL RECORDING|| 58-1699775|1326041732|CHC13|93602|26|11/01/2013|12/31/9999|$187.40|0|0|||INTRA-ATRIAL RECORDING|| 58-1699775|1326041732|CHC13|93602|TC|11/01/2013|12/31/9999|$66.66|0|0|||INTRA-ATRIAL RECORDING|| 58-1699775|1326041732|CHC13|93603||11/01/2013|12/31/9999|$516.87|0|0|||RIGHT VENTRICULAR RECORDING|| 58-1699775|1326041732|CHC13|93603|26|11/01/2013|12/31/9999|$187.40|0|0|||RIGHT VENTRICULAR RECORDING|| 58-1699775|1326041732|CHC13|93603|TC|11/01/2013|12/31/9999|$100.48|0|0|||RIGHT VENTRICULAR RECORDING|| 58-1699775|1326041732|CHC13|93609||11/01/2013|12/31/9999|$1|077.75|0|0|||MAP TACHYCARDIA| ADD-ON|| 58-1699775|1326041732|CHC13|93609|26|11/01/2013|12/31/9999|$443.98|0|0|||MAP TACHYCARDIA| ADD-ON|| 58-1699775|1326041732|CHC13|93609|TC|11/01/2013|12/31/9999|$157.56|0|0|||MAP TACHYCARDIA| ADD-ON|| 58-1699775|1326041732|CHC13|93610||11/01/2013|12/31/9999|$623.94|0|0|||INTRA-ATRIAL PACING|| 58-1699775|1326041732|CHC13|93610|26|11/01/2013|12/31/9999|$267.03|0|0|||INTRA-ATRIAL PACING|| 58-1699775|1326041732|CHC13|93610|TC|11/01/2013|12/31/9999|$81.30|0|0|||INTRA-ATRIAL PACING|| 58-1699775|1326041732|CHC13|93612||11/01/2013|12/31/9999|$645.06|0|0|||INTRAVENTRICULAR PACING|| 58-1699775|1326041732|CHC13|93612|26|11/01/2013|12/31/9999|$266.02|0|0|||INTRAVENTRICULAR PACING|| 58-1699775|1326041732|CHC13|93612|TC|11/01/2013|12/31/9999|$94.43|0|0|||INTRAVENTRICULAR PACING|| 58-1699775|1326041732|CHC13|93613||11/01/2013|12/31/9999|$1|131.06|0|0|||ELECTROPHYS MAP 3D| ADD-ON|| 58-1699775|1326041732|CHC13|93615||11/01/2013|12/31/9999|$172.77|0|0|||ESOPHAGEAL RECORDING|| 58-1699775|1326041732|CHC13|93615|26|11/01/2013|12/31/9999|$78.88|0|0|||ESOPHAGEAL RECORDING|| 58-1699775|1326041732|CHC13|93615|TC|11/01/2013|12/31/9999|$171.75|0|0|||ESOPHAGEAL RECORDING|| 58-1699775|1326041732|CHC13|93616||11/01/2013|12/31/9999|$246.93|0|0|||ESOPHAGEAL RECORDING|| 58-1699775|1326041732|CHC13|93616|26|11/01/2013|12/31/9999|$107.57|0|0|||ESOPHAGEAL RECORDING|| 58-1699775|1326041732|CHC13|93616|TC|11/01/2013|12/31/9999|$31.81|0|0|||ESOPHAGEAL RECORDING|| 58-1699775|1326041732|CHC13|93618||11/01/2013|12/31/9999|$1|092.63|0|0|||HEART RHYTHM PACING|| 58-1699775|1326041732|CHC13|93618|26|11/01/2013|12/31/9999|$377.91|0|0|||HEART RHYTHM PACING|| 58-1699775|1326041732|CHC13|93618|TC|11/01/2013|12/31/9999|$230.26|0|0|||HEART RHYTHM PACING|| 58-1699775|1326041732|CHC13|93619||11/01/2013|12/31/9999|$1|971.39|0|0|||ELECTROPHYSIOLOGY EVALUATION|| 58-1699775|1326041732|CHC13|93619|26|11/01/2013|12/31/9999|$652.78|0|0|||ELECTROPHYSIOLOGY EVALUATION|| 58-1699775|1326041732|CHC13|93619|TC|11/01/2013|12/31/9999|$447.40|0|0|||ELECTROPHYSIOLOGY EVALUATION|| 58-1699775|1326041732|CHC13|93620||11/01/2013|12/31/9999|$2|405.91|0|0|||ELECTROPHYSIOLOGY EVALUATION|| 58-1699775|1326041732|CHC13|93620|26|11/01/2013|12/31/9999|$1|030.78|0|0|||ELECTROPHYSIOLOGY EVALUATION|| 58-1699775|1326041732|CHC13|93620|TC|11/01/2013|12/31/9999|$313.58|0|0|||ELECTROPHYSIOLOGY EVALUATION|| 58-1699775|1326041732|CHC13|93621||11/01/2013|12/31/9999|$436.80|0|0|||ELECTROPHYSIOLOGY EVALUATION|| 58-1699775|1326041732|CHC13|93621|26|11/01/2013|12/31/9999|$186.28|0|0|||ELECTROPHYSIOLOGY EVALUATION|| 58-1699775|1326041732|CHC13|93621|TC|11/01/2013|12/31/9999|$57.07|0|0|||ELECTROPHYSIOLOGY EVALUATION|| 58-1699775|1326041732|CHC13|93622||11/01/2013|12/31/9999|$644.10|0|0|||ELECTROPHYSIOLOGY EVALUATION|| 58-1699775|1326041732|CHC13|93622|26|11/01/2013|12/31/9999|$275.09|0|0|||ELECTROPHYSIOLOGY EVALUATION|| 58-1699775|1326041732|CHC13|93622|TC|11/01/2013|12/31/9999|$83.82|0|0|||ELECTROPHYSIOLOGY EVALUATION|| 58-1699775|1326041732|CHC13|93623||11/01/2013|12/31/9999|$593.70|0|0|||STIMULATION| PACING HEART|| 58-1699775|1326041732|CHC13|93623|26|11/01/2013|12/31/9999|$253.92|0|0|||STIMULATION| PACING HEART|| 58-1699775|1326041732|CHC13|93623|TC|11/01/2013|12/31/9999|$77.27|0|0|||STIMULATION| PACING HEART|| 58-1699775|1326041732|CHC13|93624||11/01/2013|12/31/9999|$954.51|0|0|||ELECTROPHYSIOLOGIC STUDY|| 58-1699775|1326041732|CHC13|93624|26|11/01/2013|12/31/9999|$428.20|0|0|||ELECTROPHYSIOLOGIC STUDY|| 58-1699775|1326041732|CHC13|93624|TC|11/01/2013|12/31/9999|$109.08|0|0|||ELECTROPHYSIOLOGIC STUDY|| 58-1699775|1326041732|CHC13|93631||11/01/2013|12/31/9999|$1|537.05|0|0|||HEART PACING| MAPPING|| 58-1699775|1326041732|CHC13|93631|26|11/01/2013|12/31/9999|$660.30|0|0|||HEART PACING| MAPPING|| 58-1699775|1326041732|CHC13|93631|TC|11/01/2013|12/31/9999|$199.96|0|0|||HEART PACING| MAPPING|| 58-1699775|1326041732|CHC13|93640||11/01/2013|12/31/9999|$1|323.36|0|0|||EVALUATION HEART DEVICE|| 58-1699775|1326041732|CHC13|93640|26|11/01/2013|12/31/9999|$311.88|0|0|||EVALUATION HEART DEVICE|| 58-1699775|1326041732|CHC13|93640|TC|11/01/2013|12/31/9999|$424.17|0|0|||EVALUATION HEART DEVICE|| 58-1699775|1326041732|CHC13|93641||11/01/2013|12/31/9999|$1|709.37|0|0|||ELECTROPHYSIOLOGY EVALUATION|| 58-1699775|1326041732|CHC13|93641|26|11/01/2013|12/31/9999|$526.80|0|0|||ELECTROPHYSIOLOGY EVALUATION|| 58-1699775|1326041732|CHC13|93641|TC|11/01/2013|12/31/9999|$425.17|0|0|||ELECTROPHYSIOLOGY EVALUATION|| 58-1699775|1326041732|CHC13|93642||11/01/2013|12/31/9999|$1|134.42|0|0|||ELECTROPHYSIOLOGY EVALUATION|| 58-1699775|1326041732|CHC13|93642|26|11/01/2013|12/31/9999|$389.87|0|0|||ELECTROPHYSIOLOGY EVALUATION|| 58-1699775|1326041732|CHC13|93642|TC|11/01/2013|12/31/9999|$234.06|0|0|||ELECTROPHYSIOLOGY EVALUATION|| 58-1699775|1326041732|CHC13|93644||04/01/2015|12/31/9999|$369.95|0|0|0||ELECTROPHYSIOLOGY EVALUATION|| 58-1699775|1326041732|CHC13|93644|26|04/01/2015|12/31/9999|$245.01|0|0|0||ELECTROPHYSIOLOGY EVALUATION|| 58-1699775|1326041732|CHC13|93644|TC|04/01/2015|12/31/9999|$124.94|0|0|0||ELECTROPHYSIOLOGY EVALUATION|| 58-1699775|1326041732|CHC13|93650||11/01/2013|12/31/9999|$1|722.75|0|0|||ABLATE HEART DYSRHYTHM FOCUS|| 58-1699775|1326041732|CHC13|93651||11/01/2013|12/31/9999|$2|625.45|0|0|||ABLATE HEART DYSRHYTHM FOCUS|| 58-1699775|1326041732|CHC13|93653||04/01/2014|12/31/9999|$2|501.76|0|0|||EP & ABLATE SUPRAVENT ARRHYT|| 58-1699775|1326041732|CHC13|93654||04/01/2014|12/31/9999|$3|331.80|0|0|||EP & ABLATE VENTRIC TACHY|| 58-1699775|1326041732|CHC13|93655||11/01/2013|12/31/9999|$1|489.02|0|0|||ABLATE ARRHYTHMIA ADD ON|| 58-1699775|1326041732|CHC13|93656||04/01/2014|12/31/9999|$3|335.91|0|0|||TX ATRIAL FIB PULM VEIN ISOL|| 58-1699775|1326041732|CHC13|93657||11/01/2013|12/31/9999|$1|191.21|0|0|||TX L/R ATRIAL FIB ADDL|| 58-1699775|1326041732|CHC13|93660||11/01/2013|12/31/9999|$445.41|0|0|||TILT TABLE EVALUATION|| 58-1699775|1326041732|CHC13|93660|26|11/01/2013|12/31/9999|$150.65|0|0|||TILT TABLE EVALUATION|| 58-1699775|1326041732|CHC13|93660|TC|11/01/2013|12/31/9999|$94.33|0|0|||TILT TABLE EVALUATION|| 58-1699775|1326041732|CHC13|93662|26|11/01/2013|12/31/9999|$227.69|0|0|||INTRACARDIAC ECG (ICE)|| 58-1699775|1326041732|CHC13|93662|TC|11/01/2013|12/31/9999|$69.18|0|0|||INTRACARDIAC ECG (ICE)|| 58-1699775|1326041732|CHC13|93668||11/01/2013|12/31/9999|$51.38|0|0|||PERIPHERAL VASCULAR REHAB|| 58-1699775|1326041732|CHC13|93701||11/01/2013|12/31/9999|$69.72|0|0|||BIOIMPEDANCE| THORACIC|| 58-1699775|1326041732|CHC13|93702||04/01/2015|12/31/9999|$133.72|0|0|0||BIS XTRACELL FLUID ANALYSIS|| 58-1699775|1326041732|CHC13|93724||11/01/2013|12/31/9999|$806.08|0|0|||ANALYZE PACEMAKER SYSTEM|| 58-1699775|1326041732|CHC13|93724|26|11/01/2013|12/31/9999|$388.35|0|0|||ANALYZE PACEMAKER SYSTEM|| 58-1699775|1326041732|CHC13|93724|TC|11/01/2013|12/31/9999|$54.99|0|0|||ANALYZE PACEMAKER SYSTEM|| 58-1699775|1326041732|CHC13|93740||11/01/2013|12/31/9999|$26.52|0|0|||TEMPERATURE GRADIENT STUDIES|| 58-1699775|1326041732|CHC13|93745||11/01/2013|12/31/9999|$0.00|0|0|||SET-UP CARDIOVERT-DEFIBRILL|| 58-1699775|1326041732|CHC13|93745|26|11/01/2013|12/31/9999|$0.00|0|0|||SET-UP CARDIOVERT-DEFIBRILL|| 58-1699775|1326041732|CHC13|93745|TC|11/01/2013|12/31/9999|$0.00|0|0|||SET-UP CARDIOVERT-DEFIBRILL|| 58-1699775|1326041732|CHC13|93750||11/01/2013|12/31/9999|$128.94|0|0|||INTERROGATION VAD| IN PERSON|| 58-1699775|1326041732|CHC13|93770||11/01/2013|12/31/9999|$25.60|0|0|||MEASURE VENOUS PRESSURE|| 58-1699775|1326041732|CHC13|93784||11/01/2013|12/31/9999|$162.69|0|0|||AMBULATORY BP MONITORING|| 58-1699775|1326041732|CHC13|93786||11/01/2013|12/31/9999|$84.39|0|0|||AMBULATORY BP RECORDING|| 58-1699775|1326041732|CHC13|93788||11/01/2013|12/31/9999|$23.87|0|0|||AMBULATORY BP ANALYSIS|| 58-1699775|1326041732|CHC13|93790||11/01/2013|12/31/9999|$54.42|0|0|||REVIEW/REPORT BP RECORDING|| 58-1699775|1326041732|CHC13|93792||04/01/2018|12/31/9999|$62.05|0|0|0||PT/CAREGIVER TRAINJ HOME INR|| 58-1699775|1326041732|CHC13|93793||04/01/2018|12/31/9999|$14.65|0|0|0||ANTICOAG MGMT PT WARFARIN|| 58-1699775|1326041732|CHC13|93797||11/01/2013|12/31/9999|$26.66|0|0|||CARDIAC REHAB|| 58-1699775|1326041732|CHC13|93798||11/01/2013|12/31/9999|$40.54|0|0|||CARDIAC REHAB/MONITOR|| 58-1699775|1326041732|CHC13|93799||11/01/2013|12/31/9999|$0.00|0|0|||CARDIOVASCULAR PROCEDURE|| 58-1699775|1326041732|CHC13|93799|26|11/01/2013|12/31/9999|$0.00|0|0|||CARDIOVASCULAR PROCEDURE|| 58-1699775|1326041732|CHC13|93799|TC|11/01/2013|12/31/9999|$0.00|0|0|||CARDIOVASCULAR PROCEDURE|| 58-1699775|1326041732|CHC13|93880||11/01/2013|12/31/9999|$377.23|0|0|||EXTRACRANIAL STUDY|| 58-1699775|1326041732|CHC13|93880|26|11/01/2013|12/31/9999|$47.38|0|0|||EXTRACRANIAL STUDY|| 58-1699775|1326041732|CHC13|93880|TC|11/01/2013|12/31/9999|$329.85|0|0|||EXTRACRANIAL STUDY|| 58-1699775|1326041732|CHC13|93882||11/01/2013|12/31/9999|$267.17|0|0|||EXTRACRANIAL STUDY|| 58-1699775|1326041732|CHC13|93882|26|11/01/2013|12/31/9999|$32.13|0|0|||EXTRACRANIAL STUDY|| 58-1699775|1326041732|CHC13|93882|TC|11/01/2013|12/31/9999|$235.04|0|0|||EXTRACRANIAL STUDY|| 58-1699775|1326041732|CHC13|93886||11/01/2013|12/31/9999|$533.51|0|0|||INTRACRANIAL STUDY|| 58-1699775|1326041732|CHC13|93886|26|11/01/2013|12/31/9999|$74.04|0|0|||INTRACRANIAL STUDY|| 58-1699775|1326041732|CHC13|93886|TC|11/01/2013|12/31/9999|$459.47|0|0|||INTRACRANIAL STUDY|| 58-1699775|1326041732|CHC13|93888||11/01/2013|12/31/9999|$326.41|0|0|||INTRACRANIAL STUDY|| 58-1699775|1326041732|CHC13|93888|26|11/01/2013|12/31/9999|$49.51|0|0|||INTRACRANIAL STUDY|| 58-1699775|1326041732|CHC13|93888|TC|11/01/2013|12/31/9999|$276.90|0|0|||INTRACRANIAL STUDY|| 58-1699775|1326041732|CHC13|93890||11/01/2013|12/31/9999|$427.94|0|0|||TCD| VASOREACTIVITY STUDY|| 58-1699775|1326041732|CHC13|93890|26|11/01/2013|12/31/9999|$78.42|0|0|||TCD| VASOREACTIVITY STUDY|| 58-1699775|1326041732|CHC13|93890|TC|11/01/2013|12/31/9999|$349.52|0|0|||TCD| VASOREACTIVITY STUDY|| 58-1699775|1326041732|CHC13|93892||11/01/2013|12/31/9999|$491.35|0|0|||TCD| EMBOLI DETECT W/O INJ|| 58-1699775|1326041732|CHC13|93892|26|11/01/2013|12/31/9999|$90.39|0|0|||TCD| EMBOLI DETECT W/O INJ|| 58-1699775|1326041732|CHC13|93892|TC|11/01/2013|12/31/9999|$400.96|0|0|||TCD| EMBOLI DETECT W/O INJ|| 58-1699775|1326041732|CHC13|93893||11/01/2013|12/31/9999|$495.89|0|0|||TCD| EMBOLI DETECT W/INJ|| 58-1699775|1326041732|CHC13|93893|26|11/01/2013|12/31/9999|$90.90|0|0|||TCD| EMBOLI DETECT W/INJ|| 58-1699775|1326041732|CHC13|93893|TC|11/01/2013|12/31/9999|$405.00|0|0|||TCD| EMBOLI DETECT W/INJ|| 58-1699775|1326041732|CHC13|93895||04/01/2015|12/31/9999|$65.00|0|0|0|%|CAROTID INTIMA ATHEROMA EVAL|| 58-1699775|1326041732|CHC13|93895|26|04/01/2015|12/31/9999|$65.00|0|0|0|%|CAROTID INTIMA ATHEROMA EVAL|| 58-1699775|1326041732|CHC13|93895|TC|04/01/2015|12/31/9999|$65.00|0|0|0|%|CAROTID INTIMA ATHEROMA EVAL|| 58-1699775|1326041732|CHC13|93922||11/01/2013|12/31/9999|$155.79|0|0|||EXTREMITY STUDY|| 58-1699775|1326041732|CHC13|93922|26|11/01/2013|12/31/9999|$19.10|0|0|||EXTREMITY STUDY|| 58-1699775|1326041732|CHC13|93922|TC|11/01/2013|12/31/9999|$136.69|0|0|||EXTREMITY STUDY|| 58-1699775|1326041732|CHC13|93923||11/01/2013|12/31/9999|$241.72|0|0|||EXTREMITY STUDY|| 58-1699775|1326041732|CHC13|93923|26|11/01/2013|12/31/9999|$35.43|0|0|||EXTREMITY STUDY|| 58-1699775|1326041732|CHC13|93923|TC|11/01/2013|12/31/9999|$206.29|0|0|||EXTREMITY STUDY|| 58-1699775|1326041732|CHC13|93924||11/01/2013|12/31/9999|$304.04|0|0|||EXTREMITY STUDY|| 58-1699775|1326041732|CHC13|93924|26|11/01/2013|12/31/9999|$39.75|0|0|||EXTREMITY STUDY|| 58-1699775|1326041732|CHC13|93924|TC|11/01/2013|12/31/9999|$264.29|0|0|||EXTREMITY STUDY|| 58-1699775|1326041732|CHC13|93925||11/01/2013|12/31/9999|$473.99|0|0|||LOWER EXTREMITY STUDY|| 58-1699775|1326041732|CHC13|93925|26|11/01/2013|12/31/9999|$45.25|0|0|||LOWER EXTREMITY STUDY|| 58-1699775|1326041732|CHC13|93925|TC|11/01/2013|12/31/9999|$428.74|0|0|||LOWER EXTREMITY STUDY|| 58-1699775|1326041732|CHC13|93926||11/01/2013|12/31/9999|$309.48|0|0|||LOWER EXTREMITY STUDY|| 58-1699775|1326041732|CHC13|93926|26|11/01/2013|12/31/9999|$31.07|0|0|||LOWER EXTREMITY STUDY|| 58-1699775|1326041732|CHC13|93926|TC|11/01/2013|12/31/9999|$278.41|0|0|||LOWER EXTREMITY STUDY|| 58-1699775|1326041732|CHC13|93930||11/01/2013|12/31/9999|$378.45|0|0|||UPPER EXTREMITY STUDY|| 58-1699775|1326041732|CHC13|93930|26|11/01/2013|12/31/9999|$36.49|0|0|||UPPER EXTREMITY STUDY|| 58-1699775|1326041732|CHC13|93930|TC|11/01/2013|12/31/9999|$341.96|0|0|||UPPER EXTREMITY STUDY|| 58-1699775|1326041732|CHC13|93931||11/01/2013|12/31/9999|$251.49|0|0|||UPPER EXTREMITY STUDY|| 58-1699775|1326041732|CHC13|93931|26|11/01/2013|12/31/9999|$24.52|0|0|||UPPER EXTREMITY STUDY|| 58-1699775|1326041732|CHC13|93931|TC|11/01/2013|12/31/9999|$226.97|0|0|||UPPER EXTREMITY STUDY|| 58-1699775|1326041732|CHC13|93970||11/01/2013|12/31/9999|$390.86|0|0|||EXTREMITY STUDY|| 58-1699775|1326041732|CHC13|93970|26|11/01/2013|12/31/9999|$53.94|0|0|||EXTREMITY STUDY|| 58-1699775|1326041732|CHC13|93970|TC|11/01/2013|12/31/9999|$336.91|0|0|||EXTREMITY STUDY|| 58-1699775|1326041732|CHC13|93971||11/01/2013|12/31/9999|$232.64|0|0|||EXTREMITY STUDY|| 58-1699775|1326041732|CHC13|93971|26|11/01/2013|12/31/9999|$35.43|0|0|||EXTREMITY STUDY|| 58-1699775|1326041732|CHC13|93971|TC|11/01/2013|12/31/9999|$197.21|0|0|||EXTREMITY STUDY|| 58-1699775|1326041732|CHC13|93975||11/01/2013|12/31/9999|$575.45|0|0|||VASCULAR STUDY|| 58-1699775|1326041732|CHC13|93975|26|11/01/2013|12/31/9999|$142.18|0|0|||VASCULAR STUDY|| 58-1699775|1326041732|CHC13|93975|TC|11/01/2013|12/31/9999|$433.27|0|0|||VASCULAR STUDY|| 58-1699775|1326041732|CHC13|93976||11/01/2013|12/31/9999|$330.36|0|0|||VASCULAR STUDY|| 58-1699775|1326041732|CHC13|93976|26|11/01/2013|12/31/9999|$94.82|0|0|||VASCULAR STUDY|| 58-1699775|1326041732|CHC13|93976|TC|11/01/2013|12/31/9999|$235.54|0|0|||VASCULAR STUDY|| 58-1699775|1326041732|CHC13|93978||11/01/2013|12/31/9999|$365.47|0|0|||VASCULAR STUDY|| 58-1699775|1326041732|CHC13|93978|26|11/01/2013|12/31/9999|$51.75|0|0|||VASCULAR STUDY|| 58-1699775|1326041732|CHC13|93978|TC|11/01/2013|12/31/9999|$313.71|0|0|||VASCULAR STUDY|| 58-1699775|1326041732|CHC13|93979||11/01/2013|12/31/9999|$254.77|0|0|||VASCULAR STUDY|| 58-1699775|1326041732|CHC13|93979|26|11/01/2013|12/31/9999|$34.87|0|0|||VASCULAR STUDY|| 58-1699775|1326041732|CHC13|93979|TC|11/01/2013|12/31/9999|$219.91|0|0|||VASCULAR STUDY|| 58-1699775|1326041732|CHC13|93980||11/01/2013|12/31/9999|$264.51|0|0|||PENILE VASCULAR STUDY|| 58-1699775|1326041732|CHC13|93980|26|11/01/2013|12/31/9999|$98.56|0|0|||PENILE VASCULAR STUDY|| 58-1699775|1326041732|CHC13|93980|TC|11/01/2013|12/31/9999|$165.94|0|0|||PENILE VASCULAR STUDY|| 58-1699775|1326041732|CHC13|93981||11/01/2013|12/31/9999|$176.58|0|0|||PENILE VASCULAR STUDY|| 58-1699775|1326041732|CHC13|93981|26|11/01/2013|12/31/9999|$34.85|0|0|||PENILE VASCULAR STUDY|| 58-1699775|1326041732|CHC13|93981|TC|11/01/2013|12/31/9999|$141.74|0|0|||PENILE VASCULAR STUDY|| 58-1699775|1326041732|CHC13|93982||11/01/2013|12/31/9999|$66.36|0|0|||ANEURYSM PRESSURE SENS STUDY|| 58-1699775|1326041732|CHC13|93990||11/01/2013|12/31/9999|$322.27|0|0|||DOPPLER FLOW TESTING|| 58-1699775|1326041732|CHC13|93990|26|11/01/2013|12/31/9999|$20.16|0|0|||DOPPLER FLOW TESTING|| 58-1699775|1326041732|CHC13|93990|TC|11/01/2013|12/31/9999|$302.11|0|0|||DOPPLER FLOW TESTING|| 58-1699775|1326041732|CHC13|93998||11/01/2013|12/31/9999|$0.00|0|0|||NONINVAS VASC DX STUDY PROC|| 58-1699775|1326041732|CHC13|94002||11/01/2013|12/31/9999|$116.08|0|0|||VENT MGMT INPAT| INIT DAY|| 58-1699775|1326041732|CHC13|94003||11/01/2013|12/31/9999|$83.01|0|0|||VENT MGMT INPAT| SUBQ DAY|| 58-1699775|1326041732|CHC13|94004||11/01/2013|12/31/9999|$60.63|0|0|||VENT MGMT NF PER DAY|| 58-1699775|1326041732|CHC13|94005||11/01/2013|12/31/9999|$113.39|0|0|||HOME VENT MGMT SUPERVISION|| 58-1699775|1326041732|CHC13|94010||11/01/2013|12/31/9999|$42.91|0|0|||BREATHING CAPACITY TEST|| 58-1699775|1326041732|CHC13|94010|26|11/01/2013|12/31/9999|$13.09|0|0|||BREATHING CAPACITY TEST|| 58-1699775|1326041732|CHC13|94010|TC|11/01/2013|12/31/9999|$41.37|0|0|||BREATHING CAPACITY TEST|| 58-1699775|1326041732|CHC13|94011||11/01/2013|12/31/9999|$126.43|0|0|||UP TO 2 YRS OLD| SPIROMETRY|| 58-1699775|1326041732|CHC13|94012||11/01/2013|12/31/9999|$199.86|0|0|||= 2 YRS| SPIROMTRY W/DILATOR|| 58-1699775|1326041732|CHC13|94013||11/01/2013|12/31/9999|$41.58|0|0|||= 2 YRS| LUNG VOLUMES|| 58-1699775|1326041732|CHC13|94014||11/01/2013|12/31/9999|$57.61|0|0|||PATIENT RECORDED SPIROMETRY|| 58-1699775|1326041732|CHC13|94015||11/01/2013|12/31/9999|$27.43|0|0|||PATIENT RECORDED SPIROMETRY|| 58-1699775|1326041732|CHC13|94016||11/01/2013|12/31/9999|$30.18|0|0|||REVIEW PATIENT SPIROMETRY|| 58-1699775|1326041732|CHC13|94016|26|11/01/2013|12/31/9999|$30.18|0|0|||REVIEW PATIENT SPIROMETRY|| 58-1699775|1326041732|CHC13|94060||11/01/2013|12/31/9999|$72.33|0|0|||EVALUATION OF WHEEZING|| 58-1699775|1326041732|CHC13|94060|26|11/01/2013|12/31/9999|$20.17|0|0|||EVALUATION OF WHEEZING|| 58-1699775|1326041732|CHC13|94060|TC|11/01/2013|12/31/9999|$71.63|0|0|||EVALUATION OF WHEEZING|| 58-1699775|1326041732|CHC13|94070||11/01/2013|12/31/9999|$73.89|0|0|||EVALUATION OF WHEEZING|| 58-1699775|1326041732|CHC13|94070|26|11/01/2013|12/31/9999|$45.85|0|0|||EVALUATION OF WHEEZING|| 58-1699775|1326041732|CHC13|94070|TC|11/01/2013|12/31/9999|$47.93|0|0|||EVALUATION OF WHEEZING|| 58-1699775|1326041732|CHC13|94150||11/01/2013|12/31/9999|$29.75|0|0|||VITAL CAPACITY TEST|| 58-1699775|1326041732|CHC13|94150|26|11/01/2013|12/31/9999|$5.97|0|0|||VITAL CAPACITY TEST|| 58-1699775|1326041732|CHC13|94150|TC|11/01/2013|12/31/9999|$31.79|0|0|||VITAL CAPACITY TEST|| 58-1699775|1326041732|CHC13|94200||11/01/2013|12/31/9999|$29.93|0|0|||LUNG FUNCTION TEST (MBC/MVV)|| 58-1699775|1326041732|CHC13|94200|26|11/01/2013|12/31/9999|$8.72|0|0|||LUNG FUNCTION TEST (MBC/MVV)|| 58-1699775|1326041732|CHC13|94200|TC|11/01/2013|12/31/9999|$29.27|0|0|||LUNG FUNCTION TEST (MBC/MVV)|| 58-1699775|1326041732|CHC13|94240||11/01/2013|12/31/9999|$70.72|0|0|||RESIDUAL LUNG CAPACITY|| 58-1699775|1326041732|CHC13|94250||11/01/2013|12/31/9999|$31.52|0|0|||EXPIRED GAS COLLECTION|| 58-1699775|1326041732|CHC13|94250|26|11/01/2013|12/31/9999|$8.72|0|0|||EXPIRED GAS COLLECTION|| 58-1699775|1326041732|CHC13|94250|TC|11/01/2013|12/31/9999|$31.29|0|0|||EXPIRED GAS COLLECTION|| 58-1699775|1326041732|CHC13|94260||11/01/2013|12/31/9999|$72.02|0|0|||THORACIC GAS VOLUME|| 58-1699775|1326041732|CHC13|94350||11/01/2013|12/31/9999|$73.32|0|0|||LUNG NITROGEN WASHOUT CURVE|| 58-1699775|1326041732|CHC13|94360||11/01/2013|12/31/9999|$73.32|0|0|||MEASURE AIRFLOW RESISTANCE|| 58-1699775|1326041732|CHC13|94370||11/01/2013|12/31/9999|$73.32|0|0|||BREATH AIRWAY CLOSING VOLUME|| 58-1699775|1326041732|CHC13|94375||11/01/2013|12/31/9999|$47.12|0|0|||RESPIRATORY FLOW VOLUME LOOP|| 58-1699775|1326041732|CHC13|94375|26|11/01/2013|12/31/9999|$23.48|0|0|||RESPIRATORY FLOW VOLUME LOOP|| 58-1699775|1326041732|CHC13|94375|TC|11/01/2013|12/31/9999|$36.33|0|0|||RESPIRATORY FLOW VOLUME LOOP|| 58-1699775|1326041732|CHC13|94400||11/01/2013|12/31/9999|$68.19|0|0|||CO2 BREATHING RESPONSE CURVE|| 58-1699775|1326041732|CHC13|94400|26|11/01/2013|12/31/9999|$30.05|0|0|||CO2 BREATHING RESPONSE CURVE|| 58-1699775|1326041732|CHC13|94400|TC|11/01/2013|12/31/9999|$56.50|0|0|||CO2 BREATHING RESPONSE CURVE|| 58-1699775|1326041732|CHC13|94450||11/01/2013|12/31/9999|$76.53|0|0|||HYPOXIA RESPONSE CURVE|| 58-1699775|1326041732|CHC13|94450|26|11/01/2013|12/31/9999|$30.55|0|0|||HYPOXIA RESPONSE CURVE|| 58-1699775|1326041732|CHC13|94450|TC|11/01/2013|12/31/9999|$66.59|0|0|||HYPOXIA RESPONSE CURVE|| 58-1699775|1326041732|CHC13|94452||11/01/2013|12/31/9999|$69.37|0|0|||HAST W/REPORT|| 58-1699775|1326041732|CHC13|94452|26|11/01/2013|12/31/9999|$22.97|0|0|||HAST W/REPORT|| 58-1699775|1326041732|CHC13|94452|TC|11/01/2013|12/31/9999|$65.08|0|0|||HAST W/REPORT|| 58-1699775|1326041732|CHC13|94453||11/01/2013|12/31/9999|$94.42|0|0|||HAST W/OXYGEN TITRATE|| 58-1699775|1326041732|CHC13|94453|26|11/01/2013|12/31/9999|$29.54|0|0|||HAST W/OXYGEN TITRATE|| 58-1699775|1326041732|CHC13|94453|TC|11/01/2013|12/31/9999|$90.29|0|0|||HAST W/OXYGEN TITRATE|| 58-1699775|1326041732|CHC13|94610||11/01/2013|12/31/9999|$74.87|0|0|||SURFACTANT ADMIN THRU TUBE|| 58-1699775|1326041732|CHC13|94617||04/01/2018|12/31/9999|$117.31|0|0|0||EXERCISE TST BRNCSPSM|| 58-1699775|1326041732|CHC13|94617|26|04/01/2018|12/31/9999|$55.24|0|0|0||EXERCISE TST BRNCSPSM|| 58-1699775|1326041732|CHC13|94617|TC|04/01/2018|12/31/9999|$93.66|0|0|0||EXERCISE TST BRNCSPSM|| 58-1699775|1326041732|CHC13|94618||04/01/2018|12/31/9999|$43.32|0|0|0||PULMONARY STRESS TESTING|| 58-1699775|1326041732|CHC13|94618|26|04/01/2018|12/31/9999|$37.80|0|0|0||PULMONARY STRESS TESTING|| 58-1699775|1326041732|CHC13|94618|TC|04/01/2018|12/31/9999|$17.19|0|0|0||PULMONARY STRESS TESTING|| 58-1699775|1326041732|CHC13|94620||11/01/2013|12/31/9999|$72.88|0|0|||PULMONARY STRESS TEST/SIMPLE|| 58-1699775|1326041732|CHC13|94620|26|11/01/2013|12/31/9999|$48.60|0|0|||PULMONARY STRESS TEST/SIMPLE|| 58-1699775|1326041732|CHC13|94620|TC|11/01/2013|12/31/9999|$43.89|0|0|||PULMONARY STRESS TEST/SIMPLE|| 58-1699775|1326041732|CHC13|94621||11/01/2013|12/31/9999|$197.62|0|0|||PULM STRESS TEST/COMPLEX|| 58-1699775|1326041732|CHC13|94621|26|11/01/2013|12/31/9999|$109.09|0|0|||PULM STRESS TEST/COMPLEX|| 58-1699775|1326041732|CHC13|94621|TC|11/01/2013|12/31/9999|$141.74|0|0|||PULM STRESS TEST/COMPLEX|| 58-1699775|1326041732|CHC13|94640||11/01/2013|12/31/9999|$20.68|0|0|||AIRWAY INHALATION TREATMENT|| 58-1699775|1326041732|CHC13|94642||11/01/2013|12/31/9999|$54.61|0|0|||AEROSOL INHALATION TREATMENT|| 58-1699775|1326041732|CHC13|94644||11/01/2013|12/31/9999|$50.87|0|0|||CBT| 1ST HOUR|| 58-1699775|1326041732|CHC13|94645||11/01/2013|12/31/9999|$16.70|0|0|||CBT| EACH ADDL HOUR|| 58-1699775|1326041732|CHC13|94660||11/01/2013|12/31/9999|$46.81|0|0|||POS AIRWAY PRESSURE| CPAP|| 58-1699775|1326041732|CHC13|94662||11/01/2013|12/31/9999|$45.62|0|0|||NEG PRESS VENTILATION| CNP|| 58-1699775|1326041732|CHC13|94664||11/01/2013|12/31/9999|$19.88|0|0|||EVALUATE PT USE OF INHALER|| 58-1699775|1326041732|CHC13|94667||11/01/2013|12/31/9999|$28.23|0|0|||CHEST WALL MANIPULATION|| 58-1699775|1326041732|CHC13|94668||11/01/2013|12/31/9999|$27.83|0|0|||CHEST WALL MANIPULATION|| 58-1699775|1326041732|CHC13|94669||04/01/2014|12/31/9999|$41.46|0|0|||MECHANICAL CHEST WALL OSCILL|| 58-1699775|1326041732|CHC13|94680||11/01/2013|12/31/9999|$70.74|0|0|||EXHALED AIR ANALYSIS| O2|| 58-1699775|1326041732|CHC13|94680|26|11/01/2013|12/31/9999|$20.17|0|0|||EXHALED AIR ANALYSIS| O2|| 58-1699775|1326041732|CHC13|94680|TC|11/01/2013|12/31/9999|$69.62|0|0|||EXHALED AIR ANALYSIS| O2|| 58-1699775|1326041732|CHC13|94681||11/01/2013|12/31/9999|$64.11|0|0|||EXHALED AIR ANALYSIS| O2/CO2|| 58-1699775|1326041732|CHC13|94681|26|11/01/2013|12/31/9999|$15.28|0|0|||EXHALED AIR ANALYSIS| O2/CO2|| 58-1699775|1326041732|CHC13|94681|TC|11/01/2013|12/31/9999|$66.08|0|0|||EXHALED AIR ANALYSIS| O2/CO2|| 58-1699775|1326041732|CHC13|94690||11/01/2013|12/31/9999|$61.14|0|0|||EXHALED AIR ANALYSIS|| 58-1699775|1326041732|CHC13|94690|26|11/01/2013|12/31/9999|$5.97|0|0|||EXHALED AIR ANALYSIS|| 58-1699775|1326041732|CHC13|94690|TC|11/01/2013|12/31/9999|$71.63|0|0|||EXHALED AIR ANALYSIS|| 58-1699775|1326041732|CHC13|94720||11/01/2013|12/31/9999|$70.36|0|0|||MONOXIDE DIFFUSING CAPACITY|| 58-1699775|1326041732|CHC13|94726||11/01/2013|12/31/9999|$64.00|0|0|||PULM FUNCT TST PLETHYSMOGRAP|| 58-1699775|1326041732|CHC13|94726|26|11/01/2013|12/31/9999|$19.66|0|0|||PULM FUNCT TST PLETHYSMOGRAP|| 58-1699775|1326041732|CHC13|94726|TC|11/01/2013|12/31/9999|$61.56|0|0|||PULM FUNCT TST PLETHYSMOGRAP|| 58-1699775|1326041732|CHC13|94727||11/01/2013|12/31/9999|$50.47|0|0|||PULM FUNCTION TEST BY GAS|| 58-1699775|1326041732|CHC13|94727|26|11/01/2013|12/31/9999|$19.66|0|0|||PULM FUNCTION TEST BY GAS|| 58-1699775|1326041732|CHC13|94727|TC|11/01/2013|12/31/9999|$44.40|0|0|||PULM FUNCTION TEST BY GAS|| 58-1699775|1326041732|CHC13|94728||11/01/2013|12/31/9999|$50.47|0|0|||PULM FUNCT TEST OSCILLOMETRY|| 58-1699775|1326041732|CHC13|94728|26|11/01/2013|12/31/9999|$19.66|0|0|||PULM FUNCT TEST OSCILLOMETRY|| 58-1699775|1326041732|CHC13|94728|TC|11/01/2013|12/31/9999|$44.40|0|0|||PULM FUNCT TEST OSCILLOMETRY|| 58-1699775|1326041732|CHC13|94729||11/01/2013|12/31/9999|$63.18|0|0|||C0/MEMBANE DIFFUSE CAPACITY|| 58-1699775|1326041732|CHC13|94729|26|11/01/2013|12/31/9999|$13.09|0|0|||C0/MEMBANE DIFFUSE CAPACITY|| 58-1699775|1326041732|CHC13|94729|TC|11/01/2013|12/31/9999|$67.09|0|0|||C0/MEMBANE DIFFUSE CAPACITY|| 58-1699775|1326041732|CHC13|94750||11/01/2013|12/31/9999|$94.44|0|0|||PULMONARY COMPLIANCE STUDY|| 58-1699775|1326041732|CHC13|94750|26|11/01/2013|12/31/9999|$17.47|0|0|||PULMONARY COMPLIANCE STUDY|| 58-1699775|1326041732|CHC13|94750|TC|11/01/2013|12/31/9999|$102.40|0|0|||PULMONARY COMPLIANCE STUDY|| 58-1699775|1326041732|CHC13|94760||11/01/2013|12/31/9999|$3.59|0|0|||MEASURE BLOOD OXYGEN LEVEL|| 58-1699775|1326041732|CHC13|94760|26|11/01/2013|12/31/9999|$3.59|0|0|||MEASURE BLOOD OXYGEN LEVEL|| 58-1699775|1326041732|CHC13|94761||11/01/2013|12/31/9999|$5.58|0|0|||MEASURE BLOOD OXYGEN LEVEL|| 58-1699775|1326041732|CHC13|94762||11/01/2013|12/31/9999|$17.89|0|0|||MEASURE BLOOD OXYGEN LEVEL|| 58-1699775|1326041732|CHC13|94770||11/01/2013|12/31/9999|$19.00|0|0|||EXHALED CARBON DIOXIDE TEST|| 58-1699775|1326041732|CHC13|94772||11/01/2013|12/31/9999|$0.00|0|0|||BREATH RECORDING| INFANT|| 58-1699775|1326041732|CHC13|94772|26|11/01/2013|12/31/9999|$0.00|0|0|||BREATH RECORDING| INFANT|| 58-1699775|1326041732|CHC13|94772|TC|11/01/2013|12/31/9999|$0.00|0|0|||BREATH RECORDING| INFANT|| 58-1699775|1326041732|CHC13|94774||11/01/2013|12/31/9999|$0.00|0|0|||PED HOME APNEA REC| COMPL|| 58-1699775|1326041732|CHC13|94775||11/01/2013|12/31/9999|$0.00|0|0|||PED HOME APNEA REC| HK-UP|| 58-1699775|1326041732|CHC13|94776||11/01/2013|12/31/9999|$0.00|0|0|||PED HOME APNEA REC| DOWNLD|| 58-1699775|1326041732|CHC13|94777||11/01/2013|12/31/9999|$0.00|0|0|||PED HOME APNEA REC| REPORT|| 58-1699775|1326041732|CHC13|94780||11/01/2013|12/31/9999|$29.62|0|0|||CAR SEAT/BED TEST 60 MIN|| 58-1699775|1326041732|CHC13|94781||11/01/2013|12/31/9999|$10.32|0|0|||CAR SEAT/BED TEST + 30 MIN|| 58-1699775|1326041732|CHC13|94799||11/01/2013|12/31/9999|$0.00|0|0|||PULMONARY SERVICE/PROCEDURE|| 58-1699775|1326041732|CHC13|94799|26|11/01/2013|12/31/9999|$0.00|0|0|||PULMONARY SERVICE/PROCEDURE|| 58-1699775|1326041732|CHC13|94799|TC|11/01/2013|12/31/9999|$0.00|0|0|||PULMONARY SERVICE/PROCEDURE|| 58-1699775|1326041732|CHC13|95004||11/01/2013|12/31/9999|$7.61|0|0|||PERCUT ALLERGY SKIN TESTS|| 58-1699775|1326041732|CHC13|95012||11/01/2013|12/31/9999|$23.85|0|0|||EXHALED NITRIC OXIDE MEAS|| 58-1699775|1326041732|CHC13|95018||05/16/2014|12/31/9999|$24.12|0|0|||PERQ&IC ALLG TEST DRUGS/BIOL|| 58-1699775|1326041732|CHC13|95024||11/01/2013|12/31/9999|$1.25|0|0|||ID ALLERGY TEST| DRUG/BUG|| 58-1699775|1326041732|CHC13|95027||11/01/2013|12/31/9999|$6.02|0|0|||ID ALLERGY TITRATE-AIRBORNE|| 58-1699775|1326041732|CHC13|95028||11/01/2013|12/31/9999|$15.91|0|0|||ID ALLERGY TEST-DELAYED TYPE|| 58-1699775|1326041732|CHC13|95044||11/01/2013|12/31/9999|$7.17|0|0|||ALLERGY PATCH TESTS|| 58-1699775|1326041732|CHC13|95052||11/01/2013|12/31/9999|$7.96|0|0|||PHOTO PATCH TEST|| 58-1699775|1326041732|CHC13|95056||11/01/2013|12/31/9999|$51.27|0|0|||PHOTOSENSITIVITY TESTS|| 58-1699775|1326041732|CHC13|95060||11/01/2013|12/31/9999|$37.36|0|0|||EYE ALLERGY TESTS|| 58-1699775|1326041732|CHC13|95065||11/01/2013|12/31/9999|$29.42|0|0|||NOSE ALLERGY TEST|| 58-1699775|1326041732|CHC13|95070||11/01/2013|12/31/9999|$40.15|0|0|||BRONCHIAL ALLERGY TESTS|| 58-1699775|1326041732|CHC13|95071||11/01/2013|12/31/9999|$79.48|0|0|||BRONCHIAL ALLERGY TESTS|| 58-1699775|1326041732|CHC13|95076||11/01/2013|12/31/9999|$90.64|0|0|||INGEST CHALLENGE INI 120 MIN|| 58-1699775|1326041732|CHC13|95079||11/01/2013|12/31/9999|$83.35|0|0|||INGEST CHALLENGE ADDL 60 MIN|| 58-1699775|1326041732|CHC13|95115||11/01/2013|12/31/9999|$11.54|0|0|||IMMUNOTHERAPY| ONE INJECTION|| 58-1699775|1326041732|CHC13|95117||11/01/2013|12/31/9999|$13.92|0|0|||IMMUNOTHERAPY INJECTIONS|| 58-1699775|1326041732|CHC13|95144||11/01/2013|12/31/9999|$3.86|0|0|||ANTIGEN THERAPY SERVICES|| 58-1699775|1326041732|CHC13|95145||11/01/2013|12/31/9999|$3.86|0|0|||ANTIGEN THERAPY SERVICES|| 58-1699775|1326041732|CHC13|95146||11/01/2013|12/31/9999|$3.86|0|0|||ANTIGEN THERAPY SERVICES|| 58-1699775|1326041732|CHC13|95147||11/01/2013|12/31/9999|$3.86|0|0|||ANTIGEN THERAPY SERVICES|| 58-1699775|1326041732|CHC13|95148||11/01/2013|12/31/9999|$3.86|0|0|||ANTIGEN THERAPY SERVICES|| 58-1699775|1326041732|CHC13|95149||11/01/2013|12/31/9999|$3.86|0|0|||ANTIGEN THERAPY SERVICES|| 58-1699775|1326041732|CHC13|95165||11/01/2013|12/31/9999|$4.26|0|0|||ANTIGEN THERAPY SERVICES|| 58-1699775|1326041732|CHC13|95170||11/01/2013|12/31/9999|$3.86|0|0|||ANTIGEN THERAPY SERVICES|| 58-1699775|1326041732|CHC13|95180||11/01/2013|12/31/9999|$127.97|0|0|||RAPID DESENSITIZATION|| 58-1699775|1326041732|CHC13|95199||11/01/2013|12/31/9999|$0.00|0|0|||ALLERGY IMMUNOLOGY SERVICES|| 58-1699775|1326041732|CHC13|95249||04/01/2018|12/31/9999|$65.88|0|0|0||CONT GLUC MNTR PT PROV EQP|| 58-1699775|1326041732|CHC13|95250||11/01/2013|12/31/9999|$184.39|0|0|||GLUCOSE MONITORING| CONT|| 58-1699775|1326041732|CHC13|95251||11/01/2013|12/31/9999|$52.76|0|0|||GLUC MONITOR| CONT| PHYS I&R|| 58-1699775|1326041732|CHC13|95782||11/01/2013|12/31/9999|$160.81|0|0|||POLYSOM <6 YRS 4/> PARAMTRS|| 58-1699775|1326041732|CHC13|95783||11/01/2013|12/31/9999|$175.77|0|0|||POLYSOM <6 YRS CPAP/BILVL|| 58-1699775|1326041732|CHC13|95800||11/01/2013|12/31/9999|$192.75|0|0|||SLP STDY UNATTENDED|| 58-1699775|1326041732|CHC13|95800|26|11/01/2013|12/31/9999|$80.72|0|0|||SLP STDY UNATTENDED|| 58-1699775|1326041732|CHC13|95800|TC|11/01/2013|12/31/9999|$163.93|0|0|||SLP STDY UNATTENDED|| 58-1699775|1326041732|CHC13|95801||11/01/2013|12/31/9999|$105.51|0|0|||SLP STDY UNATND W/ANAL|| 58-1699775|1326041732|CHC13|95801|26|11/01/2013|12/31/9999|$76.91|0|0|||SLP STDY UNATND W/ANAL|| 58-1699775|1326041732|CHC13|95801|TC|11/01/2013|12/31/9999|$57.01|0|0|||SLP STDY UNATND W/ANAL|| 58-1699775|1326041732|CHC13|95803||11/01/2013|12/31/9999|$197.24|0|0|||ACTIGRAPHY TESTING|| 58-1699775|1326041732|CHC13|95803|26|11/01/2013|12/31/9999|$70.28|0|0|||ACTIGRAPHY TESTING|| 58-1699775|1326041732|CHC13|95803|TC|11/01/2013|12/31/9999|$180.06|0|0|||ACTIGRAPHY TESTING|| 58-1699775|1326041732|CHC13|95805||11/01/2013|12/31/9999|$493.08|0|0|||MULTIPLE SLEEP LATENCY TEST|| 58-1699775|1326041732|CHC13|95805|26|11/01/2013|12/31/9999|$94.70|0|0|||MULTIPLE SLEEP LATENCY TEST|| 58-1699775|1326041732|CHC13|95805|TC|11/01/2013|12/31/9999|$531.13|0|0|||MULTIPLE SLEEP LATENCY TEST|| 58-1699775|1326041732|CHC13|95806||11/01/2013|12/31/9999|$220.32|0|0|||SLEEP STUDY| UNATTENDED|| 58-1699775|1326041732|CHC13|95806|26|11/01/2013|12/31/9999|$99.03|0|0|||SLEEP STUDY| UNATTENDED|| 58-1699775|1326041732|CHC13|95806|TC|11/01/2013|12/31/9999|$180.60|0|0|||SLEEP STUDY| UNATTENDED|| 58-1699775|1326041732|CHC13|95807||11/01/2013|12/31/9999|$587.70|0|0|||SLEEP STUDY| ATTENDED|| 58-1699775|1326041732|CHC13|95807|26|11/01/2013|12/31/9999|$99.21|0|0|||SLEEP STUDY| ATTENDED|| 58-1699775|1326041732|CHC13|95807|TC|11/01/2013|12/31/9999|$646.73|0|0|||SLEEP STUDY| ATTENDED|| 58-1699775|1326041732|CHC13|95808||11/01/2013|12/31/9999|$792.06|0|0|||POLYSOMNOGRAPHY| 1-3|| 58-1699775|1326041732|CHC13|95808|26|11/01/2013|12/31/9999|$139.20|0|0|||POLYSOMNOGRAPHY| 1-3|| 58-1699775|1326041732|CHC13|95808|TC|11/01/2013|12/31/9999|$866.11|0|0|||POLYSOMNOGRAPHY| 1-3|| 58-1699775|1326041732|CHC13|95810||11/01/2013|12/31/9999|$785.21|0|0|||POLYSOMNOGRAPHY| 4 OR MORE|| 58-1699775|1326041732|CHC13|95810|26|11/01/2013|12/31/9999|$194.54|0|0|||POLYSOMNOGRAPHY| 4 OR MORE|| 58-1699775|1326041732|CHC13|95810|TC|11/01/2013|12/31/9999|$802.08|0|0|||POLYSOMNOGRAPHY| 4 OR MORE|| 58-1699775|1326041732|CHC13|95811||11/01/2013|12/31/9999|$836.95|0|0|||POLYSOMNOGRAPHY W/CPAP|| 58-1699775|1326041732|CHC13|95811|26|11/01/2013|12/31/9999|$202.69|0|0|||POLYSOMNOGRAPHY W/CPAP|| 58-1699775|1326041732|CHC13|95811|TC|11/01/2013|12/31/9999|$859.59|0|0|||POLYSOMNOGRAPHY W/CPAP|| 58-1699775|1326041732|CHC13|95812||11/01/2013|12/31/9999|$433.32|0|0|||EEG| 41-60 MINUTES|| 58-1699775|1326041732|CHC13|95812|26|11/01/2013|12/31/9999|$86.44|0|0|||EEG| 41-60 MINUTES|| 58-1699775|1326041732|CHC13|95812|TC|11/01/2013|12/31/9999|$463.53|0|0|||EEG| 41-60 MINUTES|| 58-1699775|1326041732|CHC13|95813||11/01/2013|12/31/9999|$504.25|0|0|||EEG| OVER 1 HOUR|| 58-1699775|1326041732|CHC13|95813|26|11/01/2013|12/31/9999|$138.13|0|0|||EEG| OVER 1 HOUR|| 58-1699775|1326041732|CHC13|95813|TC|11/01/2013|12/31/9999|$501.88|0|0|||EEG| OVER 1 HOUR|| 58-1699775|1326041732|CHC13|95816||11/01/2013|12/31/9999|$398.36|0|0|||EEG| AWAKE AND DROWSY|| 58-1699775|1326041732|CHC13|95816|26|11/01/2013|12/31/9999|$86.96|0|0|||EEG| AWAKE AND DROWSY|| 58-1699775|1326041732|CHC13|95816|TC|11/01/2013|12/31/9999|$418.65|0|0|||EEG| AWAKE AND DROWSY|| 58-1699775|1326041732|CHC13|95819||11/01/2013|12/31/9999|$451.59|0|0|||EEG| AWAKE AND ASLEEP|| 58-1699775|1326041732|CHC13|95819|26|11/01/2013|12/31/9999|$86.44|0|0|||EEG| AWAKE AND ASLEEP|| 58-1699775|1326041732|CHC13|95819|TC|11/01/2013|12/31/9999|$486.73|0|0|||EEG| AWAKE AND ASLEEP|| 58-1699775|1326041732|CHC13|95822||11/01/2013|12/31/9999|$412.26|0|0|||EEG| COMA OR SLEEP ONLY|| 58-1699775|1326041732|CHC13|95822|26|11/01/2013|12/31/9999|$86.44|0|0|||EEG| COMA OR SLEEP ONLY|| 58-1699775|1326041732|CHC13|95822|TC|11/01/2013|12/31/9999|$436.80|0|0|||EEG| COMA OR SLEEP ONLY|| 58-1699775|1326041732|CHC13|95824||11/01/2013|12/31/9999|$120.69|0|0|||EEG| CEREBRAL DEATH ONLY|| 58-1699775|1326041732|CHC13|95824|26|11/01/2013|12/31/9999|$60.30|0|0|||EEG| CEREBRAL DEATH ONLY|| 58-1699775|1326041732|CHC13|95824|TC|11/01/2013|12/31/9999|$153.19|0|0|||EEG| CEREBRAL DEATH ONLY|| 58-1699775|1326041732|CHC13|95827||11/01/2013|12/31/9999|$788.63|0|0|||EEG| ALL NIGHT RECORDING|| 58-1699775|1326041732|CHC13|95827|26|11/01/2013|12/31/9999|$86.96|0|0|||EEG| ALL NIGHT RECORDING|| 58-1699775|1326041732|CHC13|95827|TC|11/01/2013|12/31/9999|$913.99|0|0|||EEG| ALL NIGHT RECORDING|| 58-1699775|1326041732|CHC13|95829||11/01/2013|12/31/9999|$1|981.26|0|0|||SURGERY ELECTROCORTICOGRAM|| 58-1699775|1326041732|CHC13|95829|26|11/01/2013|12/31/9999|$493.72|0|0|||SURGERY ELECTROCORTICOGRAM|| 58-1699775|1326041732|CHC13|95829|TC|11/01/2013|12/31/9999|$2|020.96|0|0|||SURGERY ELECTROCORTICOGRAM|| 58-1699775|1326041732|CHC13|95830||11/01/2013|12/31/9999|$108.79|0|0|||INSERT ELECTRODES FOR EEG|| 58-1699775|1326041732|CHC13|95831||11/01/2013|12/31/9999|$18.39|0|0|||LIMB MUSCLE TESTING| MANUAL|| 58-1699775|1326041732|CHC13|95832||11/01/2013|12/31/9999|$19.23|0|0|||HAND MUSCLE TESTING| MANUAL|| 58-1699775|1326041732|CHC13|95833||11/01/2013|12/31/9999|$27.17|0|0|||BODY MUSCLE TESTING| MANUAL|| 58-1699775|1326041732|CHC13|95834||11/01/2013|12/31/9999|$37.32|0|0|||BODY MUSCLE TESTING| MANUAL|| 58-1699775|1326041732|CHC13|95851||11/01/2013|12/31/9999|$9.48|0|0|||RANGE OF MOTION MEASUREMENTS|| 58-1699775|1326041732|CHC13|95852||11/01/2013|12/31/9999|$7.26|0|0|||RANGE OF MOTION MEASUREMENTS|| 58-1699775|1326041732|CHC13|95857||11/01/2013|12/31/9999|$35.43|0|0|||TENSILON TEST|| 58-1699775|1326041732|CHC13|95860||11/01/2013|12/31/9999|$116.44|0|0|||MUSCLE TEST| ONE LIMB|| 58-1699775|1326041732|CHC13|95860|26|11/01/2013|12/31/9999|$78.68|0|0|||MUSCLE TEST| ONE LIMB|| 58-1699775|1326041732|CHC13|95860|TC|11/01/2013|12/31/9999|$69.11|0|0|||MUSCLE TEST| ONE LIMB|| 58-1699775|1326041732|CHC13|95861||11/01/2013|12/31/9999|$169.95|0|0|||MUSCLE TEST| 2 LIMBS|| 58-1699775|1326041732|CHC13|95861|26|11/01/2013|12/31/9999|$125.41|0|0|||MUSCLE TEST| 2 LIMBS|| 58-1699775|1326041732|CHC13|95861|TC|11/01/2013|12/31/9999|$90.29|0|0|||MUSCLE TEST| 2 LIMBS|| 58-1699775|1326041732|CHC13|95863||11/01/2013|12/31/9999|$205.63|0|0|||MUSCLE TEST| 3 LIMBS|| 58-1699775|1326041732|CHC13|95863|26|11/01/2013|12/31/9999|$151.54|0|0|||MUSCLE TEST| 3 LIMBS|| 58-1699775|1326041732|CHC13|95863|TC|11/01/2013|12/31/9999|$109.46|0|0|||MUSCLE TEST| 3 LIMBS|| 58-1699775|1326041732|CHC13|95864||11/01/2013|12/31/9999|$222.47|0|0|||MUSCLE TEST| 4 LIMBS|| 58-1699775|1326041732|CHC13|95864|26|11/01/2013|12/31/9999|$161.31|0|0|||MUSCLE TEST| 4 LIMBS|| 58-1699775|1326041732|CHC13|95864|TC|11/01/2013|12/31/9999|$121.06|0|0|||MUSCLE TEST| 4 LIMBS|| 58-1699775|1326041732|CHC13|95865||11/01/2013|12/31/9999|$152.19|0|0|||MUSCLE TEST| LARYNX|| 58-1699775|1326041732|CHC13|95865|26|11/01/2013|12/31/9999|$128.08|0|0|||MUSCLE TEST| LARYNX|| 58-1699775|1326041732|CHC13|95865|TC|11/01/2013|12/31/9999|$65.08|0|0|||MUSCLE TEST| LARYNX|| 58-1699775|1326041732|CHC13|95866||11/01/2013|12/31/9999|$135.66|0|0|||MUSCLE TEST| HEMIDIAPHRAGM|| 58-1699775|1326041732|CHC13|95866|26|11/01/2013|12/31/9999|$101.05|0|0|||MUSCLE TEST| HEMIDIAPHRAGM|| 58-1699775|1326041732|CHC13|95866|TC|11/01/2013|12/31/9999|$71.13|0|0|||MUSCLE TEST| HEMIDIAPHRAGM|| 58-1699775|1326041732|CHC13|95867||11/01/2013|12/31/9999|$110.51|0|0|||MUSCLE TEST CRAN NERV UNILAT|| 58-1699775|1326041732|CHC13|95867|26|11/01/2013|12/31/9999|$63.58|0|0|||MUSCLE TEST CRAN NERV UNILAT|| 58-1699775|1326041732|CHC13|95867|TC|11/01/2013|12/31/9999|$76.68|0|0|||MUSCLE TEST CRAN NERV UNILAT|| 58-1699775|1326041732|CHC13|95868||11/01/2013|12/31/9999|$148.44|0|0|||MUSCLE TEST CRAN NERVE BILAT|| 58-1699775|1326041732|CHC13|95868|26|11/01/2013|12/31/9999|$94.58|0|0|||MUSCLE TEST CRAN NERVE BILAT|| 58-1699775|1326041732|CHC13|95868|TC|11/01/2013|12/31/9999|$93.82|0|0|||MUSCLE TEST CRAN NERVE BILAT|| 58-1699775|1326041732|CHC13|95869||11/01/2013|12/31/9999|$81.17|0|0|||MUSCLE TEST| THOR PARASPINAL|| 58-1699775|1326041732|CHC13|95869|26|11/01/2013|12/31/9999|$29.37|0|0|||MUSCLE TEST| THOR PARASPINAL|| 58-1699775|1326041732|CHC13|95869|TC|11/01/2013|12/31/9999|$73.65|0|0|||MUSCLE TEST| THOR PARASPINAL|| 58-1699775|1326041732|CHC13|95870||11/01/2013|12/31/9999|$77.99|0|0|||MUSCLE TEST| NONPARASPINAL|| 58-1699775|1326041732|CHC13|95870|26|11/01/2013|12/31/9999|$29.87|0|0|||MUSCLE TEST| NONPARASPINAL|| 58-1699775|1326041732|CHC13|95870|TC|11/01/2013|12/31/9999|$69.11|0|0|||MUSCLE TEST| NONPARASPINAL|| 58-1699775|1326041732|CHC13|95872||11/01/2013|12/31/9999|$229.32|0|0|||MUSCLE TEST| ONE FIBER|| 58-1699775|1326041732|CHC13|95872|26|11/01/2013|12/31/9999|$229.51|0|0|||MUSCLE TEST| ONE FIBER|| 58-1699775|1326041732|CHC13|95872|TC|11/01/2013|12/31/9999|$61.55|0|0|||MUSCLE TEST| ONE FIBER|| 58-1699775|1326041732|CHC13|95873||11/01/2013|12/31/9999|$79.58|0|0|||GUIDE NERV DESTR| ELEC STIM|| 58-1699775|1326041732|CHC13|95873|26|11/01/2013|12/31/9999|$31.39|0|0|||GUIDE NERV DESTR| ELEC STIM|| 58-1699775|1326041732|CHC13|95873|TC|11/01/2013|12/31/9999|$69.62|0|0|||GUIDE NERV DESTR| ELEC STIM|| 58-1699775|1326041732|CHC13|95874||11/01/2013|12/31/9999|$75.60|0|0|||GUIDE NERV DESTR| NEEDLE EMG|| 58-1699775|1326041732|CHC13|95874|26|11/01/2013|12/31/9999|$30.38|0|0|||GUIDE NERV DESTR| NEEDLE EMG|| 58-1699775|1326041732|CHC13|95874|TC|11/01/2013|12/31/9999|$65.58|0|0|||GUIDE NERV DESTR| NEEDLE EMG|| 58-1699775|1326041732|CHC13|95875||11/01/2013|12/31/9999|$135.38|0|0|||LIMB EXERCISE TEST|| 58-1699775|1326041732|CHC13|95875|26|11/01/2013|12/31/9999|$88.59|0|0|||LIMB EXERCISE TEST|| 58-1699775|1326041732|CHC13|95875|TC|11/01/2013|12/31/9999|$83.23|0|0|||LIMB EXERCISE TEST|| 58-1699775|1326041732|CHC13|95885||11/01/2013|12/31/9999|$66.77|0|0|||MUSC TST DONE W/NERV TST LIM|| 58-1699775|1326041732|CHC13|95885|26|11/01/2013|12/31/9999|$28.25|0|0|||MUSC TST DONE W/NERV TST LIM|| 58-1699775|1326041732|CHC13|95885|TC|11/01/2013|12/31/9999|$56.50|0|0|||MUSC TST DONE W/NERV TST LIM|| 58-1699775|1326041732|CHC13|95886||11/01/2013|12/31/9999|$106.33|0|0|||MUSC TEST DONE W/N TEST COMP|| 58-1699775|1326041732|CHC13|95886|26|11/01/2013|12/31/9999|$75.42|0|0|||MUSC TEST DONE W/N TEST COMP|| 58-1699775|1326041732|CHC13|95886|TC|11/01/2013|12/31/9999|$59.53|0|0|||MUSC TEST DONE W/N TEST COMP|| 58-1699775|1326041732|CHC13|95887||11/01/2013|12/31/9999|$94.33|0|0|||MUSC TST DONE W/N TST NONEXT|| 58-1699775|1326041732|CHC13|95887|26|11/01/2013|12/31/9999|$59.19|0|0|||MUSC TST DONE W/N TST NONEXT|| 58-1699775|1326041732|CHC13|95887|TC|11/01/2013|12/31/9999|$60.54|0|0|||MUSC TST DONE W/N TST NONEXT|| 58-1699775|1326041732|CHC13|95900|26|11/01/2013|12/31/9999|$34.20|0|0|||MOTOR NERVE CONDUCTION TEST|| 58-1699775|1326041732|CHC13|95900|TC|11/01/2013|12/31/9999|$63.56|0|0|||MOTOR NERVE CONDUCTION TEST|| 58-1699775|1326041732|CHC13|95903|26|11/01/2013|12/31/9999|$48.88|0|0|||MOTOR NERVE CONDUCTION TEST|| 58-1699775|1326041732|CHC13|95903|TC|11/01/2013|12/31/9999|$66.08|0|0|||MOTOR NERVE CONDUCTION TEST|| 58-1699775|1326041732|CHC13|95904|26|11/01/2013|12/31/9999|$27.69|0|0|||SENSE NERVE CONDUCTION TEST|| 58-1699775|1326041732|CHC13|95904|TC|11/01/2013|12/31/9999|$58.52|0|0|||SENSE NERVE CONDUCTION TEST|| 58-1699775|1326041732|CHC13|95905||11/01/2013|12/31/9999|$78.93|0|0|||MOTOR/SENS NRVE CONDUCT TEST|| 58-1699775|1326041732|CHC13|95905|26|11/01/2013|12/31/9999|$4.34|0|0|||MOTOR/SENS NRVE CONDUCT TEST|| 58-1699775|1326041732|CHC13|95905|TC|11/01/2013|12/31/9999|$95.84|0|0|||MOTOR/SENS NRVE CONDUCT TEST|| 58-1699775|1326041732|CHC13|95907||11/01/2013|12/31/9999|$115.01|0|0|||NVR CNDJ TST 1-2 STUDIES|| 58-1699775|1326041732|CHC13|95908||11/01/2013|12/31/9999|$141.96|0|0|||NVR CNDJ TST 3-4 STUDIES|| 58-1699775|1326041732|CHC13|95909||11/01/2013|12/31/9999|$170.13|0|0|||NVR CNDJ TST 5-6 STUDIES|| 58-1699775|1326041732|CHC13|95910||11/01/2013|12/31/9999|$224.06|0|0|||NVR CNDJ TST 7-8 STUDIES|| 58-1699775|1326041732|CHC13|95911||11/01/2013|12/31/9999|$271.63|0|0|||NVR CNDJ TST 9-10 STUDIES|| 58-1699775|1326041732|CHC13|95912||11/01/2013|12/31/9999|$318.41|0|0|||NVR CNDJ TST 11-12 STUDIES|| 58-1699775|1326041732|CHC13|95913||11/01/2013|12/31/9999|$369.43|0|0|||NVR CNDJ TST 13/> STUDIES|| 58-1699775|1326041732|CHC13|95920|26|11/01/2013|12/31/9999|$170.08|0|0|||INTRAOP NERVE TEST ADD-ON|| 58-1699775|1326041732|CHC13|95920|TC|11/01/2013|12/31/9999|$88.78|0|0|||INTRAOP NERVE TEST ADD-ON|| 58-1699775|1326041732|CHC13|95921||11/01/2013|12/31/9999|$102.26|0|0|||AUTONOMIC NERV FUNCTION TEST|| 58-1699775|1326041732|CHC13|95921|26|11/01/2013|12/31/9999|$71.27|0|0|||AUTONOMIC NERV FUNCTION TEST|| 58-1699775|1326041732|CHC13|95921|TC|11/01/2013|12/31/9999|$58.52|0|0|||AUTONOMIC NERV FUNCTION TEST|| 58-1699775|1326041732|CHC13|95922||11/01/2013|12/31/9999|$127.57|0|0|||AUTONOMIC NERV FUNCTION TEST|| 58-1699775|1326041732|CHC13|95922|26|11/01/2013|12/31/9999|$76.16|0|0|||AUTONOMIC NERV FUNCTION TEST|| 58-1699775|1326041732|CHC13|95922|TC|11/01/2013|12/31/9999|$85.75|0|0|||AUTONOMIC NERV FUNCTION TEST|| 58-1699775|1326041732|CHC13|95923||11/01/2013|12/31/9999|$188.50|0|0|||AUTONOMIC NERV FUNCTION TEST|| 58-1699775|1326041732|CHC13|95923|26|11/01/2013|12/31/9999|$72.80|0|0|||AUTONOMIC NERV FUNCTION TEST|| 58-1699775|1326041732|CHC13|95923|TC|11/01/2013|12/31/9999|$166.45|0|0|||AUTONOMIC NERV FUNCTION TEST|| 58-1699775|1326041732|CHC13|95925||11/01/2013|12/31/9999|$196.77|0|0|||SOMATOSENSORY TESTING|| 58-1699775|1326041732|CHC13|95925|26|11/01/2013|12/31/9999|$42.95|0|0|||SOMATOSENSORY TESTING|| 58-1699775|1326041732|CHC13|95925|TC|11/01/2013|12/31/9999|$206.79|0|0|||SOMATOSENSORY TESTING|| 58-1699775|1326041732|CHC13|95926||11/01/2013|12/31/9999|$190.84|0|0|||SOMATOSENSORY TESTING|| 58-1699775|1326041732|CHC13|95926|26|11/01/2013|12/31/9999|$43.49|0|0|||SOMATOSENSORY TESTING|| 58-1699775|1326041732|CHC13|95926|TC|11/01/2013|12/31/9999|$198.72|0|0|||SOMATOSENSORY TESTING|| 58-1699775|1326041732|CHC13|95927||11/01/2013|12/31/9999|$193.19|0|0|||SOMATOSENSORY TESTING|| 58-1699775|1326041732|CHC13|95927|26|11/01/2013|12/31/9999|$42.95|0|0|||SOMATOSENSORY TESTING|| 58-1699775|1326041732|CHC13|95927|TC|11/01/2013|12/31/9999|$202.26|0|0|||SOMATOSENSORY TESTING|| 58-1699775|1326041732|CHC13|95928||11/01/2013|12/31/9999|$304.52|0|0|||C MOTOR EVOKED| UPPR LIMBS|| 58-1699775|1326041732|CHC13|95928|26|11/01/2013|12/31/9999|$121.18|0|0|||C MOTOR EVOKED| UPPR LIMBS|| 58-1699775|1326041732|CHC13|95928|TC|11/01/2013|12/31/9999|$265.33|0|0|||C MOTOR EVOKED| UPPR LIMBS|| 58-1699775|1326041732|CHC13|95929||11/01/2013|12/31/9999|$309.29|0|0|||C MOTOR EVOKED| LWR LIMBS|| 58-1699775|1326041732|CHC13|95929|26|11/01/2013|12/31/9999|$121.18|0|0|||C MOTOR EVOKED| LWR LIMBS|| 58-1699775|1326041732|CHC13|95929|TC|11/01/2013|12/31/9999|$271.38|0|0|||C MOTOR EVOKED| LWR LIMBS|| 58-1699775|1326041732|CHC13|95930||11/01/2013|12/31/9999|$178.03|0|0|||VISUAL EVOKED POTENTIAL TEST|| 58-1699775|1326041732|CHC13|95930|26|11/01/2013|12/31/9999|$28.25|0|0|||VISUAL EVOKED POTENTIAL TEST|| 58-1699775|1326041732|CHC13|95930|TC|11/01/2013|12/31/9999|$197.72|0|0|||VISUAL EVOKED POTENTIAL TEST|| 58-1699775|1326041732|CHC13|95933||11/01/2013|12/31/9999|$97.29|0|0|||BLINK REFLEX TEST|| 58-1699775|1326041732|CHC13|95933|26|11/01/2013|12/31/9999|$47.81|0|0|||BLINK REFLEX TEST|| 58-1699775|1326041732|CHC13|95933|TC|11/01/2013|12/31/9999|$75.67|0|0|||BLINK REFLEX TEST|| 58-1699775|1326041732|CHC13|95934|26|11/01/2013|12/31/9999|$40.76|0|0|||H-REFLEX TEST|| 58-1699775|1326041732|CHC13|95934|TC|11/01/2013|12/31/9999|$53.48|0|0|||H-REFLEX TEST|| 58-1699775|1326041732|CHC13|95936|26|11/01/2013|12/31/9999|$44.02|0|0|||H-REFLEX TEST|| 58-1699775|1326041732|CHC13|95936|TC|11/01/2013|12/31/9999|$32.80|0|0|||H-REFLEX TEST|| 58-1699775|1326041732|CHC13|95937||11/01/2013|12/31/9999|$84.06|0|0|||NEUROMUSCULAR JUNCTION TEST|| 58-1699775|1326041732|CHC13|95937|26|11/01/2013|12/31/9999|$52.71|0|0|||NEUROMUSCULAR JUNCTION TEST|| 58-1699775|1326041732|CHC13|95937|TC|11/01/2013|12/31/9999|$53.98|0|0|||NEUROMUSCULAR JUNCTION TEST|| 58-1699775|1326041732|CHC13|95938||11/01/2013|12/31/9999|$349.28|0|0|||SOMATOSENSORY TESTING|| 58-1699775|1326041732|CHC13|95938|26|11/01/2013|12/31/9999|$69.55|0|0|||SOMATOSENSORY TESTING|| 58-1699775|1326041732|CHC13|95938|TC|11/01/2013|12/31/9999|$373.76|0|0|||SOMATOSENSORY TESTING|| 58-1699775|1326041732|CHC13|95939||11/01/2013|12/31/9999|$550.76|0|0|||C MOTOR EVOKED UPR&LWR LIMBS|| 58-1699775|1326041732|CHC13|95939|26|11/01/2013|12/31/9999|$183.04|0|0|||C MOTOR EVOKED UPR&LWR LIMBS|| 58-1699775|1326041732|CHC13|95939|TC|11/01/2013|12/31/9999|$516.00|0|0|||C MOTOR EVOKED UPR&LWR LIMBS|| 58-1699775|1326041732|CHC13|95940||11/01/2013|12/31/9999|$50.10|0|0|||IONM IN OPERATNG ROOM 15 MIN|| 58-1699775|1326041732|CHC13|95943||11/01/2013|12/31/9999|$134.00|0|0|||PARASYMP&SYMP HRT RATE TEST|| 58-1699775|1326041732|CHC13|95950||11/01/2013|12/31/9999|$355.03|0|0|||AMBULATORY EEG MONITORING|| 58-1699775|1326041732|CHC13|95950|26|11/01/2013|12/31/9999|$121.23|0|0|||AMBULATORY EEG MONITORING|| 58-1699775|1326041732|CHC13|95950|TC|11/01/2013|12/31/9999|$329.38|0|0|||AMBULATORY EEG MONITORING|| 58-1699775|1326041732|CHC13|95951|26|11/01/2013|12/31/9999|$493.06|0|0|||EEG MONITORING/VIDEORECORD|| 58-1699775|1326041732|CHC13|95951|TC|11/01/2013|12/31/9999|$713.01|0|0|||EEG MONITORING/VIDEORECORD|| 58-1699775|1326041732|CHC13|95953||11/01/2013|12/31/9999|$515.60|0|0|||EEG MONITORING/COMPUTER|| 58-1699775|1326041732|CHC13|95953|26|11/01/2013|12/31/9999|$248.88|0|0|||EEG MONITORING/COMPUTER|| 58-1699775|1326041732|CHC13|95953|TC|11/01/2013|12/31/9999|$405.54|0|0|||EEG MONITORING/COMPUTER|| 58-1699775|1326041732|CHC13|95954||11/01/2013|12/31/9999|$484.90|0|0|||EEG MONITORING/GIVING DRUGS|| 58-1699775|1326041732|CHC13|95954|26|11/01/2013|12/31/9999|$188.72|0|0|||EEG MONITORING/GIVING DRUGS|| 58-1699775|1326041732|CHC13|95954|TC|11/01/2013|12/31/9999|$426.73|0|0|||EEG MONITORING/GIVING DRUGS|| 58-1699775|1326041732|CHC13|95955||11/01/2013|12/31/9999|$231.12|0|0|||EEG DURING SURGERY|| 58-1699775|1326041732|CHC13|95955|26|11/01/2013|12/31/9999|$81.00|0|0|||EEG DURING SURGERY|| 58-1699775|1326041732|CHC13|95955|TC|11/01/2013|12/31/9999|$212.34|0|0|||EEG DURING SURGERY|| 58-1699775|1326041732|CHC13|95956||11/01/2013|12/31/9999|$1|393.16|0|0|||EEG MONITORING| CABLE/RADIO|| 58-1699775|1326041732|CHC13|95956|26|11/01/2013|12/31/9999|$283.71|0|0|||EEG MONITORING| CABLE/RADIO|| 58-1699775|1326041732|CHC13|95956|TC|11/01/2013|12/31/9999|$1|484.53|0|0|||EEG MONITORING| CABLE/RADIO|| 58-1699775|1326041732|CHC13|95957||11/01/2013|12/31/9999|$460.48|0|0|||EEG DIGITAL ANALYSIS|| 58-1699775|1326041732|CHC13|95957|26|11/01/2013|12/31/9999|$159.28|0|0|||EEG DIGITAL ANALYSIS|| 58-1699775|1326041732|CHC13|95957|TC|11/01/2013|12/31/9999|$425.17|0|0|||EEG DIGITAL ANALYSIS|| 58-1699775|1326041732|CHC13|95958||11/01/2013|12/31/9999|$597.63|0|0|||EEG MONITORING/FUNCTION TEST|| 58-1699775|1326041732|CHC13|95958|26|11/01/2013|12/31/9999|$340.88|0|0|||EEG MONITORING/FUNCTION TEST|| 58-1699775|1326041732|CHC13|95958|TC|11/01/2013|12/31/9999|$417.66|0|0|||EEG MONITORING/FUNCTION TEST|| 58-1699775|1326041732|CHC13|95961||11/01/2013|12/31/9999|$329.90|0|0|||ELECTRODE STIMULATION| BRAIN|| 58-1699775|1326041732|CHC13|95961|26|11/01/2013|12/31/9999|$241.17|0|0|||ELECTRODE STIMULATION| BRAIN|| 58-1699775|1326041732|CHC13|95961|TC|11/01/2013|12/31/9999|$177.54|0|0|||ELECTRODE STIMULATION| BRAIN|| 58-1699775|1326041732|CHC13|95962||11/01/2013|12/31/9999|$290.45|0|0|||ELECTRODE STIM| BRAIN ADD-ON|| 58-1699775|1326041732|CHC13|95962|26|11/01/2013|12/31/9999|$258.18|0|0|||ELECTRODE STIM| BRAIN ADD-ON|| 58-1699775|1326041732|CHC13|95962|TC|11/01/2013|12/31/9999|$110.47|0|0|||ELECTRODE STIM| BRAIN ADD-ON|| 58-1699775|1326041732|CHC13|95965||11/01/2013|12/31/9999|$2|536.53|0|0|||MEG| SPONTANEOUS|| 58-1699775|1326041732|CHC13|95965|26|11/01/2013|12/31/9999|$661.13|0|0|||MEG| SPONTANEOUS|| 58-1699775|1326041732|CHC13|95965|TC|11/01/2013|12/31/9999|$2|538.94|0|0|||MEG| SPONTANEOUS|| 58-1699775|1326041732|CHC13|95966||11/01/2013|12/31/9999|$1|161.85|0|0|||MEG| EVOKED| SINGLE|| 58-1699775|1326041732|CHC13|95966|26|11/01/2013|12/31/9999|$330.01|0|0|||MEG| EVOKED| SINGLE|| 58-1699775|1326041732|CHC13|95966|TC|11/01/2013|12/31/9999|$1|161.40|0|0|||MEG| EVOKED| SINGLE|| 58-1699775|1326041732|CHC13|95967||11/01/2013|12/31/9999|$1|020.36|0|0|||MEG| EVOKED| EACH ADD'L|| 58-1699775|1326041732|CHC13|95967|26|11/01/2013|12/31/9999|$287.78|0|0|||MEG| EVOKED| EACH ADD'L|| 58-1699775|1326041732|CHC13|95967|TC|11/01/2013|12/31/9999|$1|020.01|0|0|||MEG| EVOKED| EACH ADD'L|| 58-1699775|1326041732|CHC13|95970||11/01/2013|12/31/9999|$29.10|0|0|||ANALYZE NEUROSTIM| NO PROG|| 58-1699775|1326041732|CHC13|95971||11/01/2013|12/31/9999|$50.10|0|0|||ANALYZE NEUROSTIM| SIMPLE|| 58-1699775|1326041732|CHC13|95972||11/01/2013|12/31/9999|$97.55|0|0|||ANALYZE NEUROSTIM| COMPLEX|| 58-1699775|1326041732|CHC13|95973||11/01/2013|12/31/9999|$60.29|0|0|||ANALYZE NEUROSTIM| COMPLEX|| 58-1699775|1326041732|CHC13|95974||11/01/2013|12/31/9999|$193.49|0|0|||CRANIAL NEUROSTIM| COMPLEX|| 58-1699775|1326041732|CHC13|95975||11/01/2013|12/31/9999|$109.55|0|0|||CRANIAL NEUROSTIM| COMPLEX|| 58-1699775|1326041732|CHC13|95978||11/01/2013|12/31/9999|$231.27|0|0|||ANALYZE NEUROSTIM BRAIN/1H|| 58-1699775|1326041732|CHC13|95979||11/01/2013|12/31/9999|$106.93|0|0|||ANALYZ NEUROSTIM BRAIN ADDON|| 58-1699775|1326041732|CHC13|95980||11/01/2013|12/31/9999|$57.07|0|0|||IO ANAL GAST N-STIM INIT|| 58-1699775|1326041732|CHC13|95981||11/01/2013|12/31/9999|$21.66|0|0|||IO ANAL GAST N-STIM SUBSQ|| 58-1699775|1326041732|CHC13|95982||11/01/2013|12/31/9999|$43.93|0|0|||IO GA N-STIM SUBSQ W/REPROG|| 58-1699775|1326041732|CHC13|95990||11/01/2013|12/31/9999|$100.17|0|0|||SPIN/BRAIN PUMP REFIL & MAIN|| 58-1699775|1326041732|CHC13|95991||11/01/2013|12/31/9999|$48.84|0|0|||SPIN/BRAIN PUMP REFIL & MAIN|| 58-1699775|1326041732|CHC13|95992||11/01/2013|12/31/9999|$47.56|0|0|||CANALITH REPOSITIONING PROC|| 58-1699775|1326041732|CHC13|95999||11/01/2013|12/31/9999|$0.00|0|0|||NEUROLOGICAL PROCEDURE|| 58-1699775|1326041732|CHC13|96000||11/01/2013|12/31/9999|$119.53|0|0|||MOTION ANALYSIS| VIDEO/3D|| 58-1699775|1326041732|CHC13|96001||11/01/2013|12/31/9999|$125.10|0|0|||MOTION TEST W/FT PRESS MEAS|| 58-1699775|1326041732|CHC13|96002||11/01/2013|12/31/9999|$26.53|0|0|||DYNAMIC SURFACE EMG|| 58-1699775|1326041732|CHC13|96003||11/01/2013|12/31/9999|$23.56|0|0|||DYNAMIC FINE WIRE EMG|| 58-1699775|1326041732|CHC13|96004||11/01/2013|12/31/9999|$139.78|0|0|||PHYS REVIEW OF MOTION TESTS|| 58-1699775|1326041732|CHC13|96020|26|11/01/2013|12/31/9999|$274.86|0|0|||FUNCTIONAL BRAIN MAPPING|| 58-1699775|1326041732|CHC13|96020|TC|11/01/2013|12/31/9999|$263.65|0|0|||FUNCTIONAL BRAIN MAPPING|| 58-1699775|1326041732|CHC13|96040||11/01/2013|12/31/9999|$52.00|0|0|||GENETIC COUNSELING| 30 MIN|| 58-1699775|1326041732|CHC13|96101||11/01/2013|12/31/9999|$93.75|0|0|||PSYCHO TESTING BY PSYCH/PHYS|| 58-1699775|1326041732|CHC13|96102||11/01/2013|12/31/9999|$27.42|0|0|||PSYCHO TESTING BY TECHNICIAN|| 58-1699775|1326041732|CHC13|96103||11/01/2013|12/31/9999|$29.38|0|0|||PSYCHO TESTING ADMIN BY COMP|| 58-1699775|1326041732|CHC13|96105||11/01/2013|12/31/9999|$121.89|0|0|||ASSESSMENT OF APHASIA|| 58-1699775|1326041732|CHC13|96110||11/01/2013|12/31/9999|$11.09|0|0|||DEVELOPMENTAL TEST| LIM|| 58-1699775|1326041732|CHC13|96111||11/01/2013|12/31/9999|$144.83|0|0|||DEVELOPMENTAL TEST| EXTEND|| 58-1699775|1326041732|CHC13|96116||11/01/2013|12/31/9999|$101.81|0|0|||NEUROBEHAVIORAL STATUS EXAM|| 58-1699775|1326041732|CHC13|96118||11/01/2013|12/31/9999|$92.98|0|0|||NEUROPSYCH TST BY PSYCH/PHYS|| 58-1699775|1326041732|CHC13|96119||11/01/2013|12/31/9999|$27.62|0|0|||NEUROPSYCH TESTING BY TECH|| 58-1699775|1326041732|CHC13|96120||11/01/2013|12/31/9999|$29.38|0|0|||NEUROPSYCH TST ADMIN W/COMP|| 58-1699775|1326041732|CHC13|96125||11/01/2013|12/31/9999|$118.65|0|0|||COGNITIVE TEST BY HC PRO|| 58-1699775|1326041732|CHC13|96127||04/01/2015|12/31/9999|$6.03|0|0|0||BRIEF EMOTIONAL/BEHAV ASSMT|| 58-1699775|1326041732|CHC13|96150||11/01/2013|12/31/9999|$24.72|0|0|||ASSESS HLTH/BEHAVE| INIT|| 58-1699775|1326041732|CHC13|96151||11/01/2013|12/31/9999|$23.87|0|0|||ASSESS HLTH/BEHAVE| SUBSEQ|| 58-1699775|1326041732|CHC13|96152||11/01/2013|12/31/9999|$22.64|0|0|||INTERVENE HLTH/BEHAVE| INDIV|| 58-1699775|1326041732|CHC13|96153||11/01/2013|12/31/9999|$5.41|0|0|||INTERVENE HLTH/BEHAVE| GROUP|| 58-1699775|1326041732|CHC13|96154||11/01/2013|12/31/9999|$22.22|0|0|||INTERV HLTH/BEHAV| FAM W/PT|| 58-1699775|1326041732|CHC13|96155||11/01/2013|12/31/9999|$26.78|0|0|||INTERV HLTH/BEHAV FAM NO PT|| 58-1699775|1326041732|CHC13|96160||04/01/2017|12/31/9999|$6.07|0|6.07|0||PT-FOCUSED HLTH RISK ASSMT|| 58-1699775|1326041732|CHC13|96161||04/01/2017|12/31/9999|$6.07|0|6.07|0||CAREGIVER HEALTH RISK ASSMT|| 58-1699775|1326041732|CHC13|96360||11/01/2013|12/31/9999|$64.96|0|0|||HYDRATION IV INFUSION| INIT|| 58-1699775|1326041732|CHC13|96361||11/01/2013|12/31/9999|$17.60|0|0|||HYDRATE IV INFUSION| ADD-ON|| 58-1699775|1326041732|CHC13|96365||11/01/2013|12/31/9999|$82.33|0|0|||THER/PROPH/DIAG IV INF| INIT|| 58-1699775|1326041732|CHC13|96366||11/01/2013|12/31/9999|$24.86|0|0|||THER/PROPH/DIAG IV INF ADDON|| 58-1699775|1326041732|CHC13|96367||11/01/2013|12/31/9999|$37.13|0|0|||TX/PROPH/DG ADDL SEQ IV INF|| 58-1699775|1326041732|CHC13|96368||11/01/2013|12/31/9999|$22.15|0|0|||THER/DIAG CONCURRENT INF|| 58-1699775|1326041732|CHC13|96369||11/01/2013|12/31/9999|$211.09|0|0|||SC THER INFUSION| UP TO 1 HR|| 58-1699775|1326041732|CHC13|96370||11/01/2013|12/31/9999|$18.37|0|0|||SC THER INFUSION| ADDL HR|| 58-1699775|1326041732|CHC13|96371||11/01/2013|12/31/9999|$96.68|0|0|||SC THER INFUSION| RESET PUMP|| 58-1699775|1326041732|CHC13|96372||11/01/2013|12/31/9999|$27.88|0|0|||THER/PROPH/DIAG INJ| SC/IM|| 58-1699775|1326041732|CHC13|96373||11/01/2013|12/31/9999|$22.91|0|0|||THER/PROPH/DIAG INJ| IA|| 58-1699775|1326041732|CHC13|96374||11/01/2013|12/31/9999|$63.48|0|0|||THER/PROPH/DIAG INJ| IV PUSH|| 58-1699775|1326041732|CHC13|96375||11/01/2013|12/31/9999|$25.66|0|0|||TX/PRO/DX INJ NEW DRUG ADDON|| 58-1699775|1326041732|CHC13|96376||11/01/2013|12/31/9999|$16.96|0|0|||TX/PRO/DX INJ NEW DRUG ADON|| 58-1699775|1326041732|CHC13|96377||01/01/2017|12/31/9999|$59.50|0|0|||APPLICATON ON-BODY INJECTOR|| 58-1699775|1326041732|CHC13|96379||11/01/2013|12/31/9999|$0.00|0|0|||THER/PROP/DIAG INJ/INF PROC|| 58-1699775|1326041732|CHC13|96401||11/01/2013|12/31/9999|$83.11|0|0|||CHEMO| ANTI-NEOPL| SQ/IM|| 58-1699775|1326041732|CHC13|96402||11/01/2013|12/31/9999|$38.66|0|0|||CHEMO HORMON ANTINEOPL SQ/IM|| 58-1699775|1326041732|CHC13|96405||11/01/2013|12/31/9999|$36.30|0|0|||CHEMO INTRALESIONAL| UP TO 7|| 58-1699775|1326041732|CHC13|96406||11/01/2013|12/31/9999|$53.19|0|0|||CHEMO INTRALESIONAL OVER 7|| 58-1699775|1326041732|CHC13|96409||11/01/2013|12/31/9999|$125.66|0|0|||CHEMO| IV PUSH| SNGL DRUG|| 58-1699775|1326041732|CHC13|96411||11/01/2013|12/31/9999|$70.83|0|0|||CHEMO| IV PUSH| ADDL DRUG|| 58-1699775|1326041732|CHC13|96413||11/01/2013|12/31/9999|$156.78|0|0|||CHEMO| IV INFUSION| 1 HR|| 58-1699775|1326041732|CHC13|96415||11/01/2013|12/31/9999|$35.22|0|0|||CHEMO| IV INFUSION| ADDL HR|| 58-1699775|1326041732|CHC13|96416||11/01/2013|12/31/9999|$156.12|0|0|||CHEMO PROLONG INFUSE W/PUMP|| 58-1699775|1326041732|CHC13|96417||11/01/2013|12/31/9999|$80.80|0|0|||CHEMO IV INFUS EACH ADDL SEQ|| 58-1699775|1326041732|CHC13|96420||11/01/2013|12/31/9999|$121.19|0|0|||CHEMO| IA| PUSH TECNIQUE|| 58-1699775|1326041732|CHC13|96422||11/01/2013|12/31/9999|$193.79|0|0|||CHEMO IA INFUSION UP TO 1 HR|| 58-1699775|1326041732|CHC13|96423||11/01/2013|12/31/9999|$89.43|0|0|||CHEMO IA INFUSE EACH ADDL HR|| 58-1699775|1326041732|CHC13|96425||11/01/2013|12/31/9999|$203.36|0|0|||CHEMOTHERAPY|INFUSION METHOD|| 58-1699775|1326041732|CHC13|96440||11/01/2013|12/31/9999|$169.53|0|0|||CHEMOTHERAPY| INTRACAVITARY|| 58-1699775|1326041732|CHC13|96446||11/01/2013|12/31/9999|$25.38|0|0|||CHEMOTX ADMN PRTL CAVITY|| 58-1699775|1326041732|CHC13|96450||11/01/2013|12/31/9999|$98.48|0|0|||CHEMOTHERAPY| INTO CNS|| 58-1699775|1326041732|CHC13|96521||11/01/2013|12/31/9999|$154.57|0|0|||REFILL/MAINT| PORTABLE PUMP|| 58-1699775|1326041732|CHC13|96522||11/01/2013|12/31/9999|$125.53|0|0|||REFILL/MAINT PUMP/RESVR SYST|| 58-1699775|1326041732|CHC13|96523||11/01/2013|12/31/9999|$28.46|0|0|||IRRIG DRUG DELIVERY DEVICE|| 58-1699775|1326041732|CHC13|96542||11/01/2013|12/31/9999|$50.30|0|0|||CHEMOTHERAPY INJECTION|| 58-1699775|1326041732|CHC13|96549||11/01/2013|12/31/9999|$6.00|0|0|||CHEMOTHERAPY| UNSPECIFIED|| 58-1699775|1326041732|CHC13|96567||11/01/2013|12/31/9999|$153.22|0|0|||PHOTODYNAMIC TX| SKIN|| 58-1699775|1326041732|CHC13|96570||11/01/2013|12/31/9999|$69.96|0|0|||PHOTODYNAMIC TX| 30 MIN|| 58-1699775|1326041732|CHC13|96571||11/01/2013|12/31/9999|$32.24|0|0|||PHOTODYNAMIC TX| ADDL 15 MIN|| 58-1699775|1326041732|CHC13|96573||01/01/2018|12/31/9999|$219.66|0|0|||PDT DSTR PRMLG LES PHYS/QHP|| 58-1699775|1326041732|CHC13|96574||04/01/2018|12/31/9999|$284.93|0|0|0||DBRDMT PRMLG LES W/PDT|| 58-1699775|1326041732|CHC13|96900||11/01/2013|12/31/9999|$24.08|0|0|||ULTRAVIOLET LIGHT THERAPY|| 58-1699775|1326041732|CHC13|96902||11/01/2013|12/31/9999|$25.12|0|0|||TRICHOGRAM|| 58-1699775|1326041732|CHC13|96904||11/01/2013|12/31/9999|$79.87|0|0|||WHOLE BODY PHOTOGRAPHY|| 58-1699775|1326041732|CHC13|96910||11/01/2013|12/31/9999|$81.01|0|0|||PHOTOCHEMOTHERAPY WITH UV-B|| 58-1699775|1326041732|CHC13|96912||11/01/2013|12/31/9999|$103.94|0|0|||PHOTOCHEMOTHERAPY WITH UV-A|| 58-1699775|1326041732|CHC13|96913||11/01/2013|12/31/9999|$144.82|0|0|||PHOTOCHEMOTHERAPY| UV-A OR B|| 58-1699775|1326041732|CHC13|96920||11/01/2013|12/31/9999|$79.93|0|0|||LASER TX| SKIN < 250 SQ CM|| 58-1699775|1326041732|CHC13|96921||11/01/2013|12/31/9999|$80.40|0|0|||LASER TX| SKIN 250-500 SQ CM|| 58-1699775|1326041732|CHC13|96922||11/01/2013|12/31/9999|$144.47|0|0|||LASER TX| SKIN > 500 SQ CM|| 58-1699775|1326041732|CHC13|96931||04/01/2016|12/31/9999|$0.00|0|0|0||RCM CELULR SUBCELULR IMG SKN|| 58-1699775|1326041732|CHC13|96932||04/01/2016|12/31/9999|$0.00|0|0|0||RCM CELULR SUBCELULR IMG SKN|| 58-1699775|1326041732|CHC13|96933||04/01/2016|12/31/9999|$0.00|0|0|0||RCM CELULR SUBCELULR IMG SKN|| 58-1699775|1326041732|CHC13|96934||04/01/2016|12/31/9999|$0.00|0|0|0||RCM CELULR SUBCELULR IMG SKN|| 58-1699775|1326041732|CHC13|96935||04/01/2016|12/31/9999|$0.00|0|0|0||RCM CELULR SUBCELULR IMG SKN|| 58-1699775|1326041732|CHC13|96936||04/01/2016|12/31/9999|$0.00|0|0|0||RCM CELULR SUBCELULR IMG SKN|| 58-1699775|1326041732|CHC13|96999||11/01/2013|12/31/9999|$0.00|0|0|||DERMATOLOGICAL PROCEDURE|| 58-1699775|1326041732|CHC13|97003||11/01/2013|12/31/9999|$101.64|0|0|||OT EVALUATION|| 58-1699775|1326041732|CHC13|97010||11/01/2013|12/31/9999|$7.04|0|0|||HOT OR COLD PACKS THERAPY|| 58-1699775|1326041732|CHC13|97012||11/01/2013|12/31/9999|$19.42|0|0|||MECHANICAL TRACTION THERAPY|| 58-1699775|1326041732|CHC13|97014||11/01/2013|12/31/9999|$18.71|0|0|||ELECTRIC STIMULATION THERAPY|| 58-1699775|1326041732|CHC13|97016||11/01/2013|12/31/9999|$22.28|0|0|||VASOPNEUMATIC DEVICE THERAPY|| 58-1699775|1326041732|CHC13|97018||11/01/2013|12/31/9999|$12.20|0|0|||PARAFFIN BATH THERAPY|| 58-1699775|1326041732|CHC13|97022||11/01/2013|12/31/9999|$26.61|0|0|||WHIRLPOOL THERAPY|| 58-1699775|1326041732|CHC13|97024||11/01/2013|12/31/9999|$7.83|0|0|||DIATHERMY EG| MICROWAVE|| 58-1699775|1326041732|CHC13|97026||11/01/2013|12/31/9999|$7.04|0|0|||INFRARED THERAPY|| 58-1699775|1326041732|CHC13|97028||11/01/2013|12/31/9999|$8.72|0|0|||ULTRAVIOLET THERAPY|| 58-1699775|1326041732|CHC13|97032||11/01/2013|12/31/9999|$22.60|0|0|||ELECTRICAL STIMULATION|| 58-1699775|1326041732|CHC13|97033||11/01/2013|12/31/9999|$36.95|0|0|||ELECTRIC CURRENT THERAPY|| 58-1699775|1326041732|CHC13|97034||11/01/2013|12/31/9999|$20.83|0|0|||CONTRAST BATH THERAPY|| 58-1699775|1326041732|CHC13|97035||11/01/2013|12/31/9999|$15.27|0|0|||ULTRASOUND THERAPY|| 58-1699775|1326041732|CHC13|97036||11/01/2013|12/31/9999|$37.44|0|0|||HYDROTHERAPY|| 58-1699775|1326041732|CHC13|97039||11/01/2013|12/31/9999|$0.00|0|0|||PHYSICAL THERAPY TREATMENT|| 58-1699775|1326041732|CHC13|97110||11/01/2013|12/31/9999|$37.81|0|0|||THERAPEUTIC EXERCISES|| 58-1699775|1326041732|CHC13|97112||11/01/2013|12/31/9999|$39.40|0|0|||NEUROMUSCULAR REEDUCATION|| 58-1699775|1326041732|CHC13|97113||11/01/2013|12/31/9999|$49.68|0|0|||AQUATIC THERAPY/EXERCISES|| 58-1699775|1326041732|CHC13|97116||11/01/2013|12/31/9999|$33.61|0|0|||GAIT TRAINING THERAPY|| 58-1699775|1326041732|CHC13|97124||11/01/2013|12/31/9999|$52.00|0|0|||MASSAGE THERAPY|| 58-1699775|1326041732|CHC13|97139||11/01/2013|12/31/9999|$0.00|0|0|||PHYSICAL MEDICINE PROCEDURE|| 58-1699775|1326041732|CHC13|97140||11/01/2013|12/31/9999|$35.33|0|0|||MANUAL THERAPY|| 58-1699775|1326041732|CHC13|97150||11/01/2013|12/31/9999|$24.28|0|0|||GROUP THERAPEUTIC PROCEDURES|| 58-1699775|1326041732|CHC13|97161||04/01/2017|12/31/9999|$106.37|0|106.37|0||PT EVAL LOW COMPLEX 20 MIN|| 58-1699775|1326041732|CHC13|97162||04/01/2017|12/31/9999|$106.37|0|106.37|0||PT EVAL MOD COMPLEX 30 MIN|| 58-1699775|1326041732|CHC13|97163||04/01/2017|12/31/9999|$106.37|0|106.37|0||PT EVAL HIGH COMPLEX 45 MIN|| 58-1699775|1326041732|CHC13|97164||04/01/2017|12/31/9999|$72.32|0|72.32|0||PT RE-EVAL EST PLAN CARE|| 58-1699775|1326041732|CHC13|97165||04/01/2017|12/31/9999|$103.11|0|103.11|0||OT EVAL LOW COMPLEX 30 MIN|| 58-1699775|1326041732|CHC13|97166||04/01/2017|12/31/9999|$103.11|0|103.11|0||OT EVAL MOD COMPLEX 45 MIN|| 58-1699775|1326041732|CHC13|97167||04/01/2017|12/31/9999|$103.11|0|103.11|0||OT EVAL HIGH COMPLEX 60 MIN|| 58-1699775|1326041732|CHC13|97168||04/01/2017|12/31/9999|$68.12|0|68.12|0||OT RE-EVAL EST PLAN CARE|| 58-1699775|1326041732|CHC13|97530||11/01/2013|12/31/9999|$41.34|0|0|||THERAPEUTIC ACTIVITIES|| 58-1699775|1326041732|CHC13|97532||11/01/2013|12/31/9999|$31.80|0|0|||COGNITIVE SKILLS DEVELOPMENT|| 58-1699775|1326041732|CHC13|97533||11/01/2013|12/31/9999|$34.98|0|0|||SENSORY INTEGRATION|| 58-1699775|1326041732|CHC13|97535||11/01/2013|12/31/9999|$40.99|0|0|||SELF CARE MNGMENT TRAINING|| 58-1699775|1326041732|CHC13|97537||11/01/2013|12/31/9999|$35.82|0|0|||COMMUNITY/WORK REINTEGRATION|| 58-1699775|1326041732|CHC13|97542||11/01/2013|12/31/9999|$36.61|0|0|||WHEELCHAIR MNGMENT TRAINING|| 58-1699775|1326041732|CHC13|97597||11/01/2013|12/31/9999|$30.18|0|0|||ACTIVE WOUND CARE/20 CM OR <|| 58-1699775|1326041732|CHC13|97598||11/01/2013|12/31/9999|$14.24|0|0|||ACTIVE WOUND CARE > 20 CM|| 58-1699775|1326041732|CHC13|97602||04/01/2015|12/31/9999|$65.00|0|0||%|WOUND(S) CARE NON-SELECTIVE|| 58-1699775|1326041732|CHC13|97605||11/01/2013|12/31/9999|$33.98|0|0|||NEG PRESS WOUND TX| < 50 CM|| 58-1699775|1326041732|CHC13|97606||11/01/2013|12/31/9999|$37.41|0|0|||NEG PRESS WOUND TX| > 50 CM|| 58-1699775|1326041732|CHC13|97607||04/01/2015|12/31/9999|$65.00|0|0|0|%|NEG PRESS WND TX 50 CM|| 58-1699775|1326041732|CHC13|97750||11/01/2013|12/31/9999|$39.82|0|0|||PHYSICAL PERFORMANCE TEST|| 58-1699775|1326041732|CHC13|97755||11/01/2013|12/31/9999|$43.77|0|0|||ASSISTIVE TECHNOLOGY ASSESS|| 58-1699775|1326041732|CHC13|97760||11/01/2013|12/31/9999|$44.99|0|0|||ORTHOTIC MGMT AND TRAINING|| 58-1699775|1326041732|CHC13|97761||11/01/2013|12/31/9999|$39.42|0|0|||PROSTHETIC TRAINING|| 58-1699775|1326041732|CHC13|97762||11/01/2013|12/31/9999|$52.80|0|0|||C/O FOR ORTHOTIC/PROSTH USE|| 58-1699775|1326041732|CHC13|97763||04/01/2018|12/31/9999|$60.07|0|0|0||ORTHC/PROSTC MGMT SBSQ ENC|| 58-1699775|1326041732|CHC13|97802||11/01/2013|12/31/9999|$39.39|0|0|||MEDICAL NUTRITION| INDIV| IN|| 58-1699775|1326041732|CHC13|97803||11/01/2013|12/31/9999|$33.86|0|0|||MED NUTRITION| INDIV| SUBSEQ|| 58-1699775|1326041732|CHC13|97804||11/01/2013|12/31/9999|$18.23|0|0|||MEDICAL NUTRITION| GROUP|| 58-1699775|1326041732|CHC13|97810||11/01/2013|12/31/9999|$42.77|0|0|||ACUPUNCT W/O STIMUL 15 MIN|| 58-1699775|1326041732|CHC13|97811||11/01/2013|12/31/9999|$32.39|0|0|||ACUPUNCT W/O STIMUL ADDL 15M|| 58-1699775|1326041732|CHC13|97813||11/01/2013|12/31/9999|$45.66|0|0|||ACUPUNCT W/STIMUL 15 MIN|| 58-1699775|1326041732|CHC13|97814||11/01/2013|12/31/9999|$36.82|0|0|||ACUPUNCT W/STIMUL ADDL 15M|| 58-1699775|1326041732|CHC13|98925||11/01/2013|12/31/9999|$36.42|0|0|||OSTEOPATHIC MANIPULATION|| 58-1699775|1326041732|CHC13|98926||11/01/2013|12/31/9999|$52.02|0|0|||OSTEOPATHIC MANIPULATION|| 58-1699775|1326041732|CHC13|98927||11/01/2013|12/31/9999|$68.41|0|0|||OSTEOPATHIC MANIPULATION|| 58-1699775|1326041732|CHC13|98928||11/01/2013|12/31/9999|$84.03|0|0|||OSTEOPATHIC MANIPULATION|| 58-1699775|1326041732|CHC13|98929||11/01/2013|12/31/9999|$100.44|0|0|||OSTEOPATHIC MANIPULATION|| 58-1699775|1326041732|CHC13|98940||11/01/2013|12/31/9999|$31.00|0|0|||CHIROPRACTIC MANIPULATION|| 58-1699775|1326041732|CHC13|98941||11/01/2013|12/31/9999|$43.36|0|0|||CHIROPRACTIC MANIPULATION|| 58-1699775|1326041732|CHC13|98942||11/01/2013|12/31/9999|$55.39|0|0|||CHIROPRACTIC MANIPULATION|| 58-1699775|1326041732|CHC13|98943||11/01/2013|12/31/9999|$28.52|0|0|||CHIROPRACTIC MANIPULATION|| 58-1699775|1326041732|CHC13|98960||11/01/2013|12/31/9999|$30.58|0|0|||SELF-MGMT EDUC & TRAIN| 1 PT|| 58-1699775|1326041732|CHC13|98961||11/01/2013|12/31/9999|$14.91|0|0|||SELF-MGMT EDUC/TRAIN| 2-4 PT|| 58-1699775|1326041732|CHC13|98962||11/01/2013|12/31/9999|$11.09|0|0|||SELF-MGMT EDUC/TRAIN| 5-8 PT|| 58-1699775|1326041732|CHC13|98966||11/01/2013|12/31/9999|$16.38|0|0|||HC PRO PHONE CALL 5-10 MIN|| 58-1699775|1326041732|CHC13|98967||11/01/2013|12/31/9999|$31.63|0|0|||HC PRO PHONE CALL 11-20 MIN|| 58-1699775|1326041732|CHC13|98968||11/01/2013|12/31/9999|$46.87|0|0|||HC PRO PHONE CALL 21-30 MIN|| 58-1699775|1326041732|CHC13|99002||11/01/2013|12/31/9999|$23.89|0|0|||DEVICE HANDLING|| 58-1699775|1326041732|CHC13|99024||11/01/2013|12/31/9999|$24.00|0|0|||POSTOP FOLLOW-UP VISIT|| 58-1699775|1326041732|CHC13|99050||01/01/1996|12/31/9999|$20.00|0|0|||MEDICAL SERVICES AFTER HRS|| 58-1699775|1326041732|CHC13|99051||01/01/1996|12/31/9999|$20.20|0|0|||MED SERV| EVE/WKEND/HOLIDAY|| 58-1699775|1326041732|CHC13|99058||11/01/2013|12/31/9999|$54.00|0|0|||OFFICE EMERGENCY CARE|| 58-1699775|1326041732|CHC13|99080||01/01/1996|12/31/9999|$20.00|0|0|||SPECIAL REPORTS OR FORMS|| 58-1699775|1326041732|CHC13|99091||11/01/2013|12/31/9999|$66.76|0|0|||COLLECT/REVIEW DATA FROM PT|| 58-1699775|1326041732|CHC13|99151||04/01/2017|12/31/9999|$101.71|0|31.26|0||MODERATE SEDATION SERVICES|| 58-1699775|1326041732|CHC13|99152||04/01/2017|12/31/9999|$67.65|0|16.33|0||MODERATE SEDATION SERVICES|| 58-1699775|1326041732|CHC13|99153||04/01/2017|12/31/9999|$14.46|0|14.46|0||MOD SED SAME PHYS/QHP EA|| 58-1699775|1326041732|CHC13|99155||04/01/2017|12/31/9999|$122.70|0|122.7|0||MOD SED OTH PHYS/QHP <5 YRS|| 58-1699775|1326041732|CHC13|99156||04/01/2017|12/31/9999|$100.31|0|100.31|0||MOD SED OTH PHYS/QHP 5/>YRS|| 58-1699775|1326041732|CHC13|99157||04/01/2017|12/31/9999|$76.05|0|76.05|0||MOD SED OTHER PHYS/QHP EA|| 58-1699775|1326041732|CHC13|99170||04/01/2014|12/31/9999|$109.85|0|0|||ANOGENITAL EXAM| CHILD|| 58-1699775|1326041732|CHC13|99173||11/01/2013|12/31/9999|$3.45|0|0|||VISUAL ACUITY SCREEN|| 58-1699775|1326041732|CHC13|99174||11/01/2013|12/31/9999|$32.49|0|0|||OCULAR PHOTOSCREENING|| 58-1699775|1326041732|CHC13|99175||11/01/2013|12/31/9999|$21.41|0|0|||INDUCTION OF VOMITING|| 58-1699775|1326041732|CHC13|99177||08/01/2016|12/31/9999|$32.49|0|0|||OCULAR INSTRUMNT SCREEN BIL|| 58-1699775|1326041732|CHC13|99183||11/01/2013|12/31/9999|$144.59|0|0|||HYPERBARIC OXYGEN THERAPY|| 58-1699775|1326041732|CHC13|99184||04/01/2015|12/31/9999|$286.39|0|0|0||HYPOTHERMIA ILL NEONATE|| 58-1699775|1326041732|CHC13|99188||04/01/2015|12/31/9999|$65.00|0|0|0|%|APP TOPICAL FLUORIDE VARNISH|| 58-1699775|1326041732|CHC13|99195||11/01/2013|12/31/9999|$104.75|0|0|||PHLEBOTOMY|| 58-1699775|1326041732|CHC13|99201||11/01/2013|12/31/9999|$47.90|0|0|||OFFICE/OUTPATIENT VISIT| NEW|| 58-1699775|1326041732|CHC13|99202||11/01/2013|12/31/9999|$82.09|0|0|||OFFICE/OUTPATIENT VISIT| NEW|| 58-1699775|1326041732|CHC13|99203||11/01/2013|12/31/9999|$119.43|0|0|||OFFICE/OUTPATIENT VISIT| NEW|| 58-1699775|1326041732|CHC13|99204||11/01/2013|12/31/9999|$183.53|0|0|||OFFICE/OUTPATIENT VISIT| NEW|| 58-1699775|1326041732|CHC13|99205||11/01/2013|12/31/9999|$228.48|0|0|||OFFICE/OUTPATIENT VISIT| NEW|| 58-1699775|1326041732|CHC13|99211||11/01/2013|12/31/9999|$22.04|0|0|||OFFICE/OUTPATIENT VISIT| EST|| 58-1699775|1326041732|CHC13|99211|25|11/01/2013|12/31/9999|$22.04|0|0|||OFFICE/OUTPATIENT VISIT| EST|| 58-1699775|1326041732|CHC13|99212||11/01/2013|12/31/9999|$47.90|0|0|||OFFICE/OUTPATIENT VISIT| EST|| 58-1699775|1326041732|CHC13|99213||11/01/2013|12/31/9999|$80.05|0|0|||OFFICE/OUTPATIENT VISIT| EST|| 58-1699775|1326041732|CHC13|99213|25|11/01/2013|12/31/9999|$80.05|0|0|||OFFICE/OUTPATIENT VISIT| EST|| 58-1699775|1326041732|CHC13|99213|26|11/01/2013|12/31/9999|$80.05|0|0|||OFFICE/OUTPATIENT VISIT| EST|| 58-1699775|1326041732|CHC13|99214||11/01/2013|12/31/9999|$118.61|0|0|||OFFICE/OUTPATIENT VISIT| EST|| 58-1699775|1326041732|CHC13|99215||11/01/2013|12/31/9999|$159.71|0|0|||OFFICE/OUTPATIENT VISIT| EST|| 58-1699775|1326041732|CHC13|99217||11/01/2013|12/31/9999|$80.99|0|0|||OBSERVATION CARE DISCHARGE|| 58-1699775|1326041732|CHC13|99218||11/01/2013|12/31/9999|$109.75|0|0|||OBSERVATION CARE|| 58-1699775|1326041732|CHC13|99219||11/01/2013|12/31/9999|$150.79|0|0|||OBSERVATION CARE|| 58-1699775|1326041732|CHC13|99220||11/01/2013|12/31/9999|$206.96|0|0|||OBSERVATION CARE|| 58-1699775|1326041732|CHC13|99221||11/01/2013|12/31/9999|$114.22|0|0|||INITIAL HOSPITAL CARE|| 58-1699775|1326041732|CHC13|99222||11/01/2013|12/31/9999|$154.56|0|0|||INITIAL HOSPITAL CARE|| 58-1699775|1326041732|CHC13|99223||11/01/2013|12/31/9999|$226.97|0|0|||INITIAL HOSPITAL CARE|| 58-1699775|1326041732|CHC13|99224||11/01/2013|12/31/9999|$45.05|0|0|||SUBSEQUENT OBSERVATION CARE|| 58-1699775|1326041732|CHC13|99225||11/01/2013|12/31/9999|$81.44|0|0|||SUBSEQUENT OBSERVATION CARE|| 58-1699775|1326041732|CHC13|99226||11/01/2013|12/31/9999|$117.04|0|0|||SUBSEQUENT OBSERVATION CARE|| 58-1699775|1326041732|CHC13|99231||11/01/2013|12/31/9999|$44.31|0|0|||SUBSEQUENT HOSPITAL CARE|| 58-1699775|1326041732|CHC13|99232||11/01/2013|12/31/9999|$81.08|0|0|||SUBSEQUENT HOSPITAL CARE|| 58-1699775|1326041732|CHC13|99233||11/01/2013|12/31/9999|$116.32|0|0|||SUBSEQUENT HOSPITAL CARE|| 58-1699775|1326041732|CHC13|99234||11/01/2013|12/31/9999|$152.52|0|0|||OBSERV/HOSP SAME DATE|| 58-1699775|1326041732|CHC13|99235||11/01/2013|12/31/9999|$191.29|0|0|||OBSERV/HOSP SAME DATE|| 58-1699775|1326041732|CHC13|99236||11/01/2013|12/31/9999|$246.36|0|0|||OBSERV/HOSP SAME DATE|| 58-1699775|1326041732|CHC13|99238||11/01/2013|12/31/9999|$80.61|0|0|||HOSPITAL DISCHARGE DAY|| 58-1699775|1326041732|CHC13|99239||11/01/2013|12/31/9999|$119.19|0|0|||HOSPITAL DISCHARGE DAY|| 58-1699775|1326041732|CHC13|99241||11/01/2013|12/31/9999|$53.00|0|0|||OFFICE CONSULTATION|| 58-1699775|1326041732|CHC13|99242||11/01/2013|12/31/9999|$100.39|0|0|||OFFICE CONSULTATION|| 58-1699775|1326041732|CHC13|99243||11/01/2013|12/31/9999|$137.16|0|0|||OFFICE CONSULTATION|| 58-1699775|1326041732|CHC13|99244||11/01/2013|12/31/9999|$203.58|0|0|||OFFICE CONSULTATION|| 58-1699775|1326041732|CHC13|99245||11/01/2013|12/31/9999|$249.34|0|0|||OFFICE CONSULTATION|| 58-1699775|1326041732|CHC13|99251||11/01/2013|12/31/9999|$55.24|0|0|||INITIAL INPATIENT CONSULT|| 58-1699775|1326041732|CHC13|99252||11/01/2013|12/31/9999|$84.89|0|0|||INITIAL INPATIENT CONSULT|| 58-1699775|1326041732|CHC13|99253||11/01/2013|12/31/9999|$129.21|0|0|||INITIAL INPATIENT CONSULT|| 58-1699775|1326041732|CHC13|99254||11/01/2013|12/31/9999|$186.32|0|0|||INITIAL INPATIENT CONSULT|| 58-1699775|1326041732|CHC13|99255||11/01/2013|12/31/9999|$225.30|0|0|||INITIAL INPATIENT CONSULT|| 58-1699775|1326041732|CHC13|99281||11/01/2013|12/31/9999|$39.86|0|0|||EMERGENCY DEPT VISIT|| 58-1699775|1326041732|CHC13|99282||11/01/2013|12/31/9999|$78.39|0|0|||EMERGENCY DEPT VISIT|| 58-1699775|1326041732|CHC13|99283||11/01/2013|12/31/9999|$117.71|0|0|||EMERGENCY DEPT VISIT|| 58-1699775|1326041732|CHC13|99284||11/01/2013|12/31/9999|$224.24|0|0|||EMERGENCY DEPT VISIT|| 58-1699775|1326041732|CHC13|99285||11/01/2013|12/31/9999|$328.99|0|0|||EMERGENCY DEPT VISIT|| 58-1699775|1326041732|CHC13|99288||11/01/2013|12/31/9999|$0.00|0|0|||DIRECT ADVANCED LIFE SUPPORT|| 58-1699775|1326041732|CHC13|99291||11/01/2013|12/31/9999|$253.18|0|0|||CRITICAL CARE| FIRST HOUR|| 58-1699775|1326041732|CHC13|99292||11/01/2013|12/31/9999|$126.97|0|0|||CRITICAL CARE| ADD'L 30 MIN|| 58-1699775|1326041732|CHC13|99304||11/01/2013|12/31/9999|$103.84|0|0|||NURSING FACILITY CARE| INIT|| 58-1699775|1326041732|CHC13|99305||11/01/2013|12/31/9999|$146.85|0|0|||NURSING FACILITY CARE| INIT|| 58-1699775|1326041732|CHC13|99306||11/01/2013|12/31/9999|$186.52|0|0|||NURSING FACILITY CARE| INIT|| 58-1699775|1326041732|CHC13|99307||11/01/2013|12/31/9999|$49.06|0|0|||NURSING FAC CARE| SUBSEQ|| 58-1699775|1326041732|CHC13|99308||11/01/2013|12/31/9999|$76.08|0|0|||NURSING FAC CARE| SUBSEQ|| 58-1699775|1326041732|CHC13|99309||11/01/2013|12/31/9999|$100.09|0|0|||NURSING FAC CARE| SUBSEQ|| 58-1699775|1326041732|CHC13|99310||11/01/2013|12/31/9999|$148.98|0|0|||NURSING FAC CARE| SUBSEQ|| 58-1699775|1326041732|CHC13|99315||11/01/2013|12/31/9999|$80.62|0|0|||NURSING FAC DISCHARGE DAY|| 58-1699775|1326041732|CHC13|99316||11/01/2013|12/31/9999|$115.87|0|0|||NURSING FAC DISCHARGE DAY|| 58-1699775|1326041732|CHC13|99318||11/01/2013|12/31/9999|$106.28|0|0|||ANNUAL NURSING FAC ASSESSMNT|| 58-1699775|1326041732|CHC13|99324||11/01/2013|12/31/9999|$63.35|0|0|||DOMICIL/R-HOME VISIT NEW PAT|| 58-1699775|1326041732|CHC13|99325||11/01/2013|12/31/9999|$91.55|0|0|||DOMICIL/R-HOME VISIT NEW PAT|| 58-1699775|1326041732|CHC13|99326||11/01/2013|12/31/9999|$156.77|0|0|||DOMICIL/R-HOME VISIT NEW PAT|| 58-1699775|1326041732|CHC13|99327||11/01/2013|12/31/9999|$207.98|0|0|||DOMICIL/R-HOME VISIT NEW PAT|| 58-1699775|1326041732|CHC13|99328||11/01/2013|12/31/9999|$241.81|0|0|||DOMICIL/R-HOME VISIT NEW PAT|| 58-1699775|1326041732|CHC13|99334||11/01/2013|12/31/9999|$67.63|0|0|||DOMICIL/R-HOME VISIT EST PAT|| 58-1699775|1326041732|CHC13|99335||11/01/2013|12/31/9999|$105.59|0|0|||DOMICIL/R-HOME VISIT EST PAT|| 58-1699775|1326041732|CHC13|99336||11/01/2013|12/31/9999|$149.43|0|0|||DOMICIL/R-HOME VISIT EST PAT|| 58-1699775|1326041732|CHC13|99337||11/01/2013|12/31/9999|$215.10|0|0|||DOMICIL/R-HOME VISIT EST PAT|| 58-1699775|1326041732|CHC13|99339||11/01/2013|12/31/9999|$87.10|0|0|||DOMICIL/R-HOME CARE SUPERVIS|| 58-1699775|1326041732|CHC13|99340||11/01/2013|12/31/9999|$122.08|0|0|||DOMICIL/R-HOME CARE SUPERVIS|| 58-1699775|1326041732|CHC13|99341||11/01/2013|12/31/9999|$62.61|0|0|||HOME VISIT| NEW PATIENT|| 58-1699775|1326041732|CHC13|99342||11/01/2013|12/31/9999|$91.20|0|0|||HOME VISIT| NEW PATIENT|| 58-1699775|1326041732|CHC13|99343||11/01/2013|12/31/9999|$149.41|0|0|||HOME VISIT| NEW PATIENT|| 58-1699775|1326041732|CHC13|99344||11/01/2013|12/31/9999|$204.35|0|0|||HOME VISIT| NEW PATIENT|| 58-1699775|1326041732|CHC13|99345||11/01/2013|12/31/9999|$244.40|0|0|||HOME VISIT| NEW PATIENT|| 58-1699775|1326041732|CHC13|99347||11/01/2013|12/31/9999|$62.94|0|0|||HOME VISIT| EST PATIENT|| 58-1699775|1326041732|CHC13|99348||11/01/2013|12/31/9999|$95.02|0|0|||HOME VISIT| EST PATIENT|| 58-1699775|1326041732|CHC13|99349||11/01/2013|12/31/9999|$142.66|0|0|||HOME VISIT| EST PATIENT|| 58-1699775|1326041732|CHC13|99350||11/01/2013|12/31/9999|$198.43|0|0|||HOME VISIT| EST PATIENT|| 58-1699775|1326041732|CHC13|99354||11/01/2013|12/31/9999|$111.31|0|0|||PROLONGED SERVICE| OFFICE|| 58-1699775|1326041732|CHC13|99355||11/01/2013|12/31/9999|$109.48|0|0|||PROLONGED SERVICE| OFFICE|| 58-1699775|1326041732|CHC13|99356||11/01/2013|12/31/9999|$102.62|0|0|||PROLONGED SERVICE| INPATIENT|| 58-1699775|1326041732|CHC13|99357||11/01/2013|12/31/9999|$102.26|0|0|||PROLONGED SERVICE| INPATIENT|| 58-1699775|1326041732|CHC13|99358||11/01/2013|12/31/9999|$124.09|0|0|||PROLONGED SERV| W/O CONTACT|| 58-1699775|1326041732|CHC13|99359||11/01/2013|12/31/9999|$60.00|0|0|||PROLONGED SERV| W/O CONTACT|| 58-1699775|1326041732|CHC13|99360||11/01/2013|12/31/9999|$70.02|0|0|||PHYSICIAN STANDBY SERVICES|| 58-1699775|1326041732|CHC13|99363||11/01/2013|12/31/9999|$96.14|0|0|||ANTICOAG MGMT| INIT|| 58-1699775|1326041732|CHC13|99364||11/01/2013|12/31/9999|$36.79|0|0|||ANTICOAG MGMT| SUBSEQ|| 58-1699775|1326041732|CHC13|99366||11/01/2013|12/31/9999|$47.49|0|0|||TEAM CONF W/PAT BY HC PRO|| 58-1699775|1326041732|CHC13|99367||11/01/2013|12/31/9999|$64.09|0|0|||TEAM CONF W/O PAT BY PHYS|| 58-1699775|1326041732|CHC13|99368||11/01/2013|12/31/9999|$41.56|0|0|||TEAM CONF W/O PAT BY HC PRO|| 58-1699775|1326041732|CHC13|99374||11/01/2013|12/31/9999|$78.39|0|0|||HOME HEALTH CARE SUPERVISION|| 58-1699775|1326041732|CHC13|99375||11/01/2013|12/31/9999|$119.58|0|0|||HOME HEALTH CARE SUPERVISION|| 58-1699775|1326041732|CHC13|99377||11/01/2013|12/31/9999|$78.39|0|0|||HOSPICE CARE SUPERVISION|| 58-1699775|1326041732|CHC13|99378||11/01/2013|12/31/9999|$120.68|0|0|||HOSPICE CARE SUPERVISION|| 58-1699775|1326041732|CHC13|99379||11/01/2013|12/31/9999|$78.39|0|0|||NURSING FAC CARE SUPERVISION|| 58-1699775|1326041732|CHC13|99380||11/01/2013|12/31/9999|$118.11|0|0|||NURSING FAC CARE SUPERVISION|| 58-1699775|1326041732|CHC13|99381||11/01/2013|12/31/9999|$122.64|0|0|||PREV VISIT| NEW| INFANT|| 58-1699775|1326041732|CHC13|99382||11/01/2013|12/31/9999|$128.18|0|0|||PREV VISIT| NEW| AGE 1-4|| 58-1699775|1326041732|CHC13|99383||11/01/2013|12/31/9999|$133.01|0|0|||PREV VISIT| NEW| AGE 5-11|| 58-1699775|1326041732|CHC13|99384||11/01/2013|12/31/9999|$150.44|0|0|||PREV VISIT| NEW| AGE 12-17|| 58-1699775|1326041732|CHC13|99385||11/01/2013|12/31/9999|$146.44|0|0|||PREV VISIT| NEW| AGE 18-39|| 58-1699775|1326041732|CHC13|99386||11/01/2013|12/31/9999|$170.18|0|0|||PREV VISIT| NEW| AGE 40-64|| 58-1699775|1326041732|CHC13|99387||11/01/2013|12/31/9999|$184.48|0|0|||PREV VISIT| NEW| 65 & OVER|| 58-1699775|1326041732|CHC13|99391||11/01/2013|12/31/9999|$109.25|0|0|||PREV VISIT| EST| INFANT|| 58-1699775|1326041732|CHC13|99392||11/01/2013|12/31/9999|$117.14|0|0|||PREV VISIT| EST| AGE 1-4|| 58-1699775|1326041732|CHC13|99393||11/01/2013|12/31/9999|$116.78|0|0|||PREV VISIT| EST| AGE 5-11|| 58-1699775|1326041732|CHC13|99394||11/01/2013|12/31/9999|$127.88|0|0|||PREV VISIT| EST| AGE 12-17|| 58-1699775|1326041732|CHC13|99395||11/01/2013|12/31/9999|$130.65|0|0|||PREV VISIT| EST| AGE 18-39|| 58-1699775|1326041732|CHC13|99396||11/01/2013|12/31/9999|$139.74|0|0|||PREV VISIT| EST| AGE 40-64|| 58-1699775|1326041732|CHC13|99397||11/01/2013|12/31/9999|$150.81|0|0|||PREV VISIT| EST| 65 & OVER|| 58-1699775|1326041732|CHC13|99401||11/01/2013|12/31/9999|$40.55|0|0|||PREVENTIVE COUNSELING| INDIV|| 58-1699775|1326041732|CHC13|99402||11/01/2013|12/31/9999|$70.19|0|0|||PREVENTIVE COUNSELING| INDIV|| 58-1699775|1326041732|CHC13|99403||11/01/2013|12/31/9999|$98.64|0|0|||PREVENTIVE COUNSELING| INDIV|| 58-1699775|1326041732|CHC13|99404||11/01/2013|12/31/9999|$126.74|0|0|||PREVENTIVE COUNSELING| INDIV|| 58-1699775|1326041732|CHC13|99406||11/01/2013|12/31/9999|$15.68|0|0|||BEHAV CHNG SMOKING 3-10 MIN|| 58-1699775|1326041732|CHC13|99407||11/01/2013|12/31/9999|$30.73|0|0|||BEHAV CHNG SMOKING < 10 MIN|| 58-1699775|1326041732|CHC13|99408||11/01/2013|12/31/9999|$39.80|0|0|||AUDIT/DAST| 15-30 MIN|| 58-1699775|1326041732|CHC13|99409||11/01/2013|12/31/9999|$77.77|0|0|||AUDIT/DAST| OVER 30 MIN|| 58-1699775|1326041732|CHC13|99411||11/01/2013|12/31/9999|$17.88|0|0|||PREVENTIVE COUNSELING| GROUP|| 58-1699775|1326041732|CHC13|99412||11/01/2013|12/31/9999|$23.43|0|0|||PREVENTIVE COUNSELING| GROUP|| 58-1699775|1326041732|CHC13|99415||04/01/2016|12/31/9999|$9.66|0|0|0||PROLONG CLINCL STAFF SVC|| 58-1699775|1326041732|CHC13|99416||04/01/2016|12/31/9999|$5.41|0|0|0||PROLONG CLINCL STAFF SVC ADD|| 58-1699775|1326041732|CHC13|99420||04/01/2017|12/31/9999|$11.38|0|0|||HEALTH RISK ASSESSMENT TEST|| 58-1699775|1326041732|CHC13|99429||11/01/2013|12/31/9999|$0.00|0|0|||UNLISTED PREVENTIVE SERVICE|| 58-1699775|1326041732|CHC13|99441||11/01/2013|12/31/9999|$15.73|0|0|||PHONE E/M BY PHYS 5-10 MIN|| 58-1699775|1326041732|CHC13|99442||11/01/2013|12/31/9999|$30.36|0|0|||PHONE E/M BY PHYS 11-20 MIN|| 58-1699775|1326041732|CHC13|99443||11/01/2013|12/31/9999|$45.00|0|0|||PHONE E/M BY PHYS 21-30 MIN|| 58-1699775|1326041732|CHC13|99460||11/01/2013|12/31/9999|$108.60|0|0|||INIT NB EM PER DAY| HOSP|| 58-1699775|1326041732|CHC13|99461||11/01/2013|12/31/9999|$106.21|0|0|||INIT NB EM PER DAY| NON-FAC|| 58-1699775|1326041732|CHC13|99462||11/01/2013|12/31/9999|$48.68|0|0|||SBSQ NB EM PER DAY| HOSP|| 58-1699775|1326041732|CHC13|99463||11/01/2013|12/31/9999|$127.85|0|0|||SAME DAY NB DISCHARGE|| 58-1699775|1326041732|CHC13|99464||11/01/2013|12/31/9999|$83.73|0|0|||ATTENDANCE AT DELIVERY|| 58-1699775|1326041732|CHC13|99465||11/01/2013|12/31/9999|$168.36|0|0|||NB RESUSCITATION|| 58-1699775|1326041732|CHC13|99466||11/01/2013|12/31/9999|$308.04|0|0|||PED CRIT CARE TRANSPORT|| 58-1699775|1326041732|CHC13|99467||11/01/2013|12/31/9999|$138.18|0|0|||PED CRIT CARE TRANSPORT ADDL|| 58-1699775|1326041732|CHC13|99468||11/01/2013|12/31/9999|$1|048.19|0|0|||NEONATE CRIT CARE| INITIAL|| 58-1699775|1326041732|CHC13|99469||11/01/2013|12/31/9999|$470.28|0|0|||NEONATE CRIT CARE| SUBSQ|| 58-1699775|1326041732|CHC13|99471||11/01/2013|12/31/9999|$896.59|0|0|||PED CRITICAL CARE| INITIAL|| 58-1699775|1326041732|CHC13|99472||11/01/2013|12/31/9999|$455.32|0|0|||PED CRITICAL CARE| SUBSQ|| 58-1699775|1326041732|CHC13|99475||11/01/2013|12/31/9999|$637.35|0|0|||PED CRIT CARE AGE 2-5| INIT|| 58-1699775|1326041732|CHC13|99476||11/01/2013|12/31/9999|$386.38|0|0|||PED CRIT CARE AGE 2-5| SUBSQ|| 58-1699775|1326041732|CHC13|99477||11/01/2013|12/31/9999|$393.85|0|0|||INIT DAY HOSP NEONATE CARE|| 58-1699775|1326041732|CHC13|99478||11/01/2013|12/31/9999|$156.93|0|0|||IC| LBW INF < 1500 GM SUBSQ|| 58-1699775|1326041732|CHC13|99479||11/01/2013|12/31/9999|$144.12|0|0|||IC LBW INF 1500-2500 G SUBSQ|| 58-1699775|1326041732|CHC13|99480||11/01/2013|12/31/9999|$136.00|0|0|||IC INF PBW 2501-5000 G SUBSQ|| 58-1699775|1326041732|CHC13|99483||04/01/2018|12/31/9999|$277.49|0|0|0||ASSMT & CARE PLN PT COG IMP|| 58-1699775|1326041732|CHC13|99484||04/01/2018|12/31/9999|$55.39|0|0|0||CARE MGMT SVC BHVL HLTH COND|| 58-1699775|1326041732|CHC13|99490||04/01/2015|12/31/9999|$38.14|0|0|0||CHRON CARE MGMT SRVC 20 MIN|| 58-1699775|1326041732|CHC13|99492||04/01/2018|12/31/9999|$182.23|0|0|0||1ST PSYC COLLAB CARE MGMT|| 58-1699775|1326041732|CHC13|99493||04/01/2018|12/31/9999|$146.46|0|0|0||SBSQ PSYC COLLAB CARE MGMT|| 58-1699775|1326041732|CHC13|99494||04/01/2018|12/31/9999|$75.80|0|0|0||1ST/SBSQ PSYC COLLAB CARE|| 58-1699775|1326041732|CHC13|99495||11/01/2013|12/31/9999|$192.67|0|0|||TRANS CARE MGMT 14 DAY DISCH|| 58-1699775|1326041732|CHC13|99496||11/01/2013|12/31/9999|$282.46|0|0|||TRANS CARE MGMT 7 DAY DISCH|| 58-1699775|1326041732|CHC13|99497||04/01/2015|12/31/9999|$65.00|0|0|0|%|ADVNCD CARE PLAN 30 MIN|| 58-1699775|1326041732|CHC13|99498||04/01/2015|12/31/9999|$65.00|0|0|0|%|ADVNCD CARE PLAN ADDL 30 MIN|| 58-1699775|1326041732|CHC13|A1390|NU|01/01/2015|12/31/9999|$1|625.00|0|0||||| 58-1699775|1326041732|CHC13|A4208||11/01/2013|12/31/9999|$0.44|0|0|||3 CC STERILE SYRINGE&NEEDLE|| 58-1699775|1326041732|CHC13|A4212||11/01/2013|12/31/9999|$12.00|0|0|||NON CORING NEEDLE OR STYLET|| 58-1699775|1326041732|CHC13|A4216||11/01/2013|12/31/9999|$0.60|0|0|||STERILE WATER/SALINE| 10 ML|| 58-1699775|1326041732|CHC13|A4217||11/01/2013|12/31/9999|$4.21|0|0|||STERILE WATER/SALINE| 500 ML|| 58-1699775|1326041732|CHC13|A4221||11/01/2013|12/31/9999|$30.40|0|0|||MAINT DRUG INFUS CATH PER WK|| 58-1699775|1326041732|CHC13|A4222||11/01/2013|12/31/9999|$62.75|0|0|||INFUSION SUPPLIES WITH PUMP|| 58-1699775|1326041732|CHC13|A4223||11/01/2013|12/31/9999|$124.87|0|0|||INFUSION SUPPLIES W/O PUMP|| 58-1699775|1326041732|CHC13|A4233|NU|11/01/2013|12/31/9999|$0.93|0|0|||ALKALIN BATT FOR GLUCOSE MON|| 58-1699775|1326041732|CHC13|A4234|NU|11/01/2013|12/31/9999|$4.21|0|0|||J-CELL BATT FOR GLUCOSE MON|| 58-1699775|1326041732|CHC13|A4235|NU|11/01/2013|12/31/9999|$2.71|0|0|||LITHIUM BATT FOR GLUCOSE MON|| 58-1699775|1326041732|CHC13|A4236|NU|11/01/2013|12/31/9999|$1.95|0|0|||SILVR OXIDE BATT GLUCOSE MON|| 58-1699775|1326041732|CHC13|A4253|NU|11/01/2013|12/31/9999|$41.09|0|0|||BLOOD GLUCOSE/REAGENT STRIPS|| 58-1699775|1326041732|CHC13|A4255||11/01/2013|12/31/9999|$5.44|0|0|||GLUCOSE MONITOR PLATFORMS|| 58-1699775|1326041732|CHC13|A4256|NU|11/01/2013|12/31/9999|$11.25|0|0|||CALIBRATOR SOLUTION/CHIPS|| 58-1699775|1326041732|CHC13|A4257||11/01/2013|12/31/9999|$17.12|0|0|||REPLACE LENSSHIELD CARTRIDGE|| 58-1699775|1326041732|CHC13|A4258|NU|11/01/2013|12/31/9999|$20.89|0|0|||LANCET DEVICE EACH|| 58-1699775|1326041732|CHC13|A4259|NU|11/01/2013|12/31/9999|$13.95|0|0|||LANCETS PER BOX|| 58-1699775|1326041732|CHC13|A4265||11/01/2013|12/31/9999|$4.56|0|0|||PARAFFIN|| 58-1699775|1326041732|CHC13|A4280||11/01/2013|12/31/9999|$7.15|0|0|||BRST PRSTHS ADHSV ATTCHMNT|| 58-1699775|1326041732|CHC13|A4281|NU|01/01/2018|12/31/9999|$12.00|0|0|||REPLACEMENT BREASTPUMP TUBE|| 58-1699775|1326041732|CHC13|A4282||04/01/2016|12/31/9999|$23.10|0|0|||REPLACEMENT BREASTPUMP ADPT|| 58-1699775|1326041732|CHC13|A4282|NU|04/01/2016|12/31/9999|$23.10|0|0|||REPLACEMENT BREASTPUMP ADPT|| 58-1699775|1326041732|CHC13|A4283||04/01/2016|12/31/9999|$3.50|0|0|||REPLACEMENT BREASTPUMP CAP|| 58-1699775|1326041732|CHC13|A4283|NU|04/01/2016|12/31/9999|$3.50|0|0|||REPLACEMENT BREASTPUMP CAP|| 58-1699775|1326041732|CHC13|A4284||04/01/2016|12/31/9999|$7.00|0|0|||REPLCMNT BREAST PUMP SHIELD|| 58-1699775|1326041732|CHC13|A4284|NU|04/01/2016|12/31/9999|$36.00|0|0|||REPLCMNT BREAST PUMP SHIELD|| 58-1699775|1326041732|CHC13|A4285|NU|05/01/2014|12/31/9999|$36.00|0|0|||REPLCMNT BREAST PUMP BOTTLE|| 58-1699775|1326041732|CHC13|A4286|NU|01/01/2018|12/31/9999|$9.00|0|0|||REPLCMNT BREASTPUMP LOK RING|| 58-1699775|1326041732|CHC13|A4310||11/01/2013|12/31/9999|$9.31|0|0|||INSERT TRAY W/O BAG/CATH|| 58-1699775|1326041732|CHC13|A4311||11/01/2013|12/31/9999|$19.91|0|0|||CATHETER W/O BAG 2-WAY LATEX|| 58-1699775|1326041732|CHC13|A4312||11/01/2013|12/31/9999|$20.57|0|0|||CATH W/O BAG 2-WAY SILICONE|| 58-1699775|1326041732|CHC13|A4313||11/01/2013|12/31/9999|$21.15|0|0|||CATHETER W/BAG 3-WAY|| 58-1699775|1326041732|CHC13|A4314||11/01/2013|12/31/9999|$31.34|0|0|||CATH W/DRAINAGE 2-WAY LATEX|| 58-1699775|1326041732|CHC13|A4315||11/01/2013|12/31/9999|$30.11|0|0|||CATH W/DRAINAGE 2-WAY SILCNE|| 58-1699775|1326041732|CHC13|A4316||11/01/2013|12/31/9999|$38.12|0|0|||CATH W/DRAINAGE 3-WAY|| 58-1699775|1326041732|CHC13|A4320||11/01/2013|12/31/9999|$6.34|0|0|||IRRIGATION TRAY|| 58-1699775|1326041732|CHC13|A4321||11/01/2013|12/31/9999|$0.00|0|0|||CATH THERAPEUTIC IRRIG AGENT|| 58-1699775|1326041732|CHC13|A4322||11/01/2013|12/31/9999|$3.98|0|0|||IRRIGATION SYRINGE|| 58-1699775|1326041732|CHC13|A4326||11/01/2013|12/31/9999|$14.49|0|0|||MALE EXTERNAL CATHETER|| 58-1699775|1326041732|CHC13|A4327||11/01/2013|12/31/9999|$59.90|0|0|||FEM URINARY COLLECT DEV CUP|| 58-1699775|1326041732|CHC13|A4328||11/01/2013|12/31/9999|$13.74|0|0|||FEM URINARY COLLECT POUCH|| 58-1699775|1326041732|CHC13|A4330||11/01/2013|12/31/9999|$9.60|0|0|||STOOL COLLECTION POUCH|| 58-1699775|1326041732|CHC13|A4331||11/01/2013|12/31/9999|$4.28|0|0|||EXTENSION DRAINAGE TUBING|| 58-1699775|1326041732|CHC13|A4332||11/01/2013|12/31/9999|$0.16|0|0|||LUBE STERILE PACKET|| 58-1699775|1326041732|CHC13|A4333||11/01/2013|12/31/9999|$2.96|0|0|||URINARY CATH ANCHOR DEVICE|| 58-1699775|1326041732|CHC13|A4334||11/01/2013|12/31/9999|$6.61|0|0|||URINARY CATH LEG STRAP|| 58-1699775|1326041732|CHC13|A4336||11/01/2013|12/31/9999|$1.94|0|0|||URETHRAL INSERT|| 58-1699775|1326041732|CHC13|A4338||11/01/2013|12/31/9999|$13.99|0|0|||INDWELLING CATHETER LATEX|| 58-1699775|1326041732|CHC13|A4340||11/01/2013|12/31/9999|$36.41|0|0|||INDWELLING CATHETER SPECIAL|| 58-1699775|1326041732|CHC13|A4344||11/01/2013|12/31/9999|$18.27|0|0|||CATH INDW FOLEY 2 WAY SILICN|| 58-1699775|1326041732|CHC13|A4346||11/01/2013|12/31/9999|$22.35|0|0|||CATH INDW FOLEY 3 WAY|| 58-1699775|1326041732|CHC13|A4349||11/01/2013|12/31/9999|$2.71|0|0|||DISPOSABLE MALE EXTERNAL CAT|| 58-1699775|1326041732|CHC13|A4351||11/01/2013|12/31/9999|$2.43|0|0|||STRAIGHT TIP URINE CATHETER|| 58-1699775|1326041732|CHC13|A4352||11/01/2013|12/31/9999|$8.48|0|0|||COUDE TIP URINARY CATHETER|| 58-1699775|1326041732|CHC13|A4353||11/01/2013|12/31/9999|$9.40|0|0|||INTERMITTENT URINARY CATH|| 58-1699775|1326041732|CHC13|A4354||11/01/2013|12/31/9999|$13.47|0|0|||CATH INSERTION TRAY W/BAG|| 58-1699775|1326041732|CHC13|A4355||11/01/2013|12/31/9999|$10.91|0|0|||BLADDER IRRIGATION TUBING|| 58-1699775|1326041732|CHC13|A4356||11/01/2013|12/31/9999|$61.26|0|0|||EXT URETH CLMP OR COMPR DVC|| 58-1699775|1326041732|CHC13|A4357||11/01/2013|12/31/9999|$11.07|0|0|||BEDSIDE DRAINAGE BAG|| 58-1699775|1326041732|CHC13|A4358||11/01/2013|12/31/9999|$8.70|0|0|||URINARY LEG OR ABDOMEN BAG|| 58-1699775|1326041732|CHC13|A4360||11/01/2013|12/31/9999|$0.65|0|0|||ADULT INCONTINENCE GARMENT | E|| 58-1699775|1326041732|CHC13|A4361||11/01/2013|12/31/9999|$21.66|0|0|||OSTOMY FACE PLATE|| 58-1699775|1326041732|CHC13|A4362||11/01/2013|12/31/9999|$3.95|0|0|||SOLID SKIN BARRIER|| 58-1699775|1326041732|CHC13|A4363||11/01/2013|12/31/9999|$2.70|0|0|||OSTOMY CLAMP| REPLACEMENT|| 58-1699775|1326041732|CHC13|A4364||11/01/2013|12/31/9999|$3.35|0|0|||ADHESIVE| LIQUID OR EQUAL|| 58-1699775|1326041732|CHC13|A4366||11/01/2013|12/31/9999|$1.75|0|0|||OSTOMY VENT|| 58-1699775|1326041732|CHC13|A4367||11/01/2013|12/31/9999|$9.05|0|0|||OSTOMY BELT|| 58-1699775|1326041732|CHC13|A4368||11/01/2013|12/31/9999|$0.35|0|0|||OSTOMY FILTER|| 58-1699775|1326041732|CHC13|A4369||11/01/2013|12/31/9999|$3.25|0|0|||SKIN BARRIER LIQUID PER OZ|| 58-1699775|1326041732|CHC13|A4371||11/01/2013|12/31/9999|$4.90|0|0|||SKIN BARRIER POWDER PER OZ|| 58-1699775|1326041732|CHC13|A4372||11/01/2013|12/31/9999|$5.62|0|0|||SKIN BARRIER SOLID 4X4 EQUIV|| 58-1699775|1326041732|CHC13|A4373||11/01/2013|12/31/9999|$8.42|0|0|||SKIN BARRIER WITH FLANGE|| 58-1699775|1326041732|CHC13|A4375||11/01/2013|12/31/9999|$23.06|0|0|||DRAINABLE PLASTIC PCH W FCPL|| 58-1699775|1326041732|CHC13|A4376||11/01/2013|12/31/9999|$63.89|0|0|||DRAINABLE RUBBER PCH W FCPLT|| 58-1699775|1326041732|CHC13|A4377||11/01/2013|12/31/9999|$5.76|0|0|||DRAINABLE PLSTIC PCH W/O FP|| 58-1699775|1326041732|CHC13|A4378||11/01/2013|12/31/9999|$41.29|0|0|||DRAINABLE RUBBER PCH W/O FP|| 58-1699775|1326041732|CHC13|A4379||11/01/2013|12/31/9999|$20.16|0|0|||URINARY PLASTIC POUCH W FCPL|| 58-1699775|1326041732|CHC13|A4380||11/01/2013|12/31/9999|$50.12|0|0|||URINARY RUBBER POUCH W FCPLT|| 58-1699775|1326041732|CHC13|A4381||11/01/2013|12/31/9999|$6.20|0|0|||URINARY PLASTIC POUCH W/O FP|| 58-1699775|1326041732|CHC13|A4382||11/01/2013|12/31/9999|$33.05|0|0|||URINARY HVY PLSTC PCH W/O FP|| 58-1699775|1326041732|CHC13|A4383||11/01/2013|12/31/9999|$37.85|0|0|||URINARY RUBBER POUCH W/O FP|| 58-1699775|1326041732|CHC13|A4384||11/01/2013|12/31/9999|$12.91|0|0|||OSTOMY FACEPLT/SILICONE RING|| 58-1699775|1326041732|CHC13|A4385||11/01/2013|12/31/9999|$6.85|0|0|||OST SKN BARRIER SLD EXT WEAR|| 58-1699775|1326041732|CHC13|A4387||11/01/2013|12/31/9999|$0.00|0|0|||OST CLSD POUCH W ATT ST BARR|| 58-1699775|1326041732|CHC13|A4388||11/01/2013|12/31/9999|$5.86|0|0|||DRAINABLE PCH W EX WEAR BARR|| 58-1699775|1326041732|CHC13|A4389||11/01/2013|12/31/9999|$8.35|0|0|||DRAINABLE PCH W ST WEAR BARR|| 58-1699775|1326041732|CHC13|A4390||11/01/2013|12/31/9999|$12.90|0|0|||DRAINABLE PCH EX WEAR CONVEX|| 58-1699775|1326041732|CHC13|A4391||11/01/2013|12/31/9999|$9.49|0|0|||URINARY POUCH W EX WEAR BARR|| 58-1699775|1326041732|CHC13|A4392||11/01/2013|12/31/9999|$10.99|0|0|||URINARY POUCH W ST WEAR BARR|| 58-1699775|1326041732|CHC13|A4393||11/01/2013|12/31/9999|$12.14|0|0|||URINE PCH W EX WEAR BAR CONV|| 58-1699775|1326041732|CHC13|A4394||11/01/2013|12/31/9999|$3.47|0|0|||OSTOMY POUCH LIQ DEODORANT|| 58-1699775|1326041732|CHC13|A4395||11/01/2013|12/31/9999|$0.06|0|0|||OSTOMY POUCH SOLID DEODORANT|| 58-1699775|1326041732|CHC13|A4396||11/01/2013|12/31/9999|$54.35|0|0|||PERISTOMAL HERNIA SUPPRT BLT|| 58-1699775|1326041732|CHC13|A4397||11/01/2013|12/31/9999|$5.92|0|0|||IRRIGATION SUPPLY SLEEVE|| 58-1699775|1326041732|CHC13|A4398||11/01/2013|12/31/9999|$17.00|0|0|||OSTOMY IRRIGATION BAG|| 58-1699775|1326041732|CHC13|A4399||11/01/2013|12/31/9999|$14.30|0|0|||OSTOMY IRRIG CONE/CATH W BRS|| 58-1699775|1326041732|CHC13|A4400||11/01/2013|12/31/9999|$55.77|0|0|||OSTOMY IRRIGATION SET|| 58-1699775|1326041732|CHC13|A4402||11/01/2013|12/31/9999|$1.83|0|0|||LUBRICANT PER OUNCE|| 58-1699775|1326041732|CHC13|A4404||11/01/2013|12/31/9999|$2.26|0|0|||OSTOMY RING EACH|| 58-1699775|1326041732|CHC13|A4405||11/01/2013|12/31/9999|$4.58|0|0|||NONPECTIN BASED OSTOMY PASTE|| 58-1699775|1326041732|CHC13|A4406||11/01/2013|12/31/9999|$7.70|0|0|||PECTIN BASED OSTOMY PASTE|| 58-1699775|1326041732|CHC13|A4407||11/01/2013|12/31/9999|$11.76|0|0|||EXT WEAR OST SKN BARR <=4SQ|| 58-1699775|1326041732|CHC13|A4408||11/01/2013|12/31/9999|$13.25|0|0|||EXT WEAR OST SKN BARR >4SQ|| 58-1699775|1326041732|CHC13|A4409||11/01/2013|12/31/9999|$8.35|0|0|||OST SKN BARR CONVEX <=4 SQ I|| 58-1699775|1326041732|CHC13|A4410||11/01/2013|12/31/9999|$12.14|0|0|||OST SKN BARR EXTND >4 SQ|| 58-1699775|1326041732|CHC13|A4411||11/01/2013|12/31/9999|$6.85|0|0|||OST SKN BARR EXTND =4SQ|| 58-1699775|1326041732|CHC13|A4412||11/01/2013|12/31/9999|$3.64|0|0|||OST POUCH DRAIN HIGH OUTPUT|| 58-1699775|1326041732|CHC13|A4413||11/01/2013|12/31/9999|$7.39|0|0|||2 PC DRAINABLE OST POUCH|| 58-1699775|1326041732|CHC13|A4414||11/01/2013|12/31/9999|$6.61|0|0|||OST SKNBAR W/O CONV<=4 SQ IN|| 58-1699775|1326041732|CHC13|A4415||11/01/2013|12/31/9999|$8.05|0|0|||OST SKN BARR W/O CONV >4 SQI|| 58-1699775|1326041732|CHC13|A4416||11/01/2013|12/31/9999|$3.70|0|0|||OST PCH CLSD W BARRIER/FILTR|| 58-1699775|1326041732|CHC13|A4417||11/01/2013|12/31/9999|$5.00|0|0|||OST PCH W BAR/BLTINCONV/FLTR|| 58-1699775|1326041732|CHC13|A4418||11/01/2013|12/31/9999|$2.44|0|0|||OST PCH CLSD W/O BAR W FILTR|| 58-1699775|1326041732|CHC13|A4419||11/01/2013|12/31/9999|$2.34|0|0|||OST PCH FOR BAR W FLANGE/FLT|| 58-1699775|1326041732|CHC13|A4420||11/01/2013|12/31/9999|$0.00|0|0|||OST PCH CLSD FOR BAR W LK FL|| 58-1699775|1326041732|CHC13|A4422||11/01/2013|12/31/9999|$0.16|0|0|||OST POUCH ABSORBENT MATERIAL|| 58-1699775|1326041732|CHC13|A4423||11/01/2013|12/31/9999|$2.50|0|0|||OST PCH FOR BAR W LK FL/FLTR|| 58-1699775|1326041732|CHC13|A4424||11/01/2013|12/31/9999|$6.39|0|0|||OST PCH DRAIN W BAR & FILTER|| 58-1699775|1326041732|CHC13|A4425||11/01/2013|12/31/9999|$4.81|0|0|||OST PCH DRAIN FOR BARRIER FL|| 58-1699775|1326041732|CHC13|A4426||11/01/2013|12/31/9999|$3.68|0|0|||OST PCH DRAIN 2 PIECE SYSTEM|| 58-1699775|1326041732|CHC13|A4427||11/01/2013|12/31/9999|$3.74|0|0|||OST PCH DRAIN/BARR LK FLNG/F|| 58-1699775|1326041732|CHC13|A4428||11/01/2013|12/31/9999|$8.74|0|0|||URINE OST POUCH W FAUCET/TAP|| 58-1699775|1326041732|CHC13|A4429||11/01/2013|12/31/9999|$11.07|0|0|||URINE OST POUCH W BLTINCONV|| 58-1699775|1326041732|CHC13|A4430||11/01/2013|12/31/9999|$11.44|0|0|||OST URINE PCH W B/BLTIN CONV|| 58-1699775|1326041732|CHC13|A4431||11/01/2013|12/31/9999|$8.35|0|0|||OST PCH URINE W BARRIER/TAPV|| 58-1699775|1326041732|CHC13|A4432||11/01/2013|12/31/9999|$4.82|0|0|||OS PCH URINE W BAR/FANGE/TAP|| 58-1699775|1326041732|CHC13|A4433||11/01/2013|12/31/9999|$4.49|0|0|||URINE OST PCH BAR W LOCK FLN|| 58-1699775|1326041732|CHC13|A4434||11/01/2013|12/31/9999|$5.05|0|0|||OST PCH URINE W LOCK FLNG/FT|| 58-1699775|1326041732|CHC13|A4450|NU|11/01/2013|12/31/9999|$0.15|0|0|||NON-WATERPROOF TAPE|| 58-1699775|1326041732|CHC13|A4450|RR|11/01/2013|12/31/9999|$0.11|0|0|||NON-WATERPROOF TAPE|| 58-1699775|1326041732|CHC13|A4450|UE|11/01/2013|12/31/9999|$0.11|0|0|||NON-WATERPROOF TAPE|| 58-1699775|1326041732|CHC13|A4452|NU|11/01/2013|12/31/9999|$0.54|0|0|||WATERPROOF TAPE|| 58-1699775|1326041732|CHC13|A4452|RR|11/01/2013|12/31/9999|$0.49|0|0|||WATERPROOF TAPE|| 58-1699775|1326041732|CHC13|A4452|UE|11/01/2013|12/31/9999|$0.49|0|0|||WATERPROOF TAPE|| 58-1699775|1326041732|CHC13|A4455||11/01/2013|12/31/9999|$1.92|0|0|||ADHESIVE REMOVER PER OUNCE|| 58-1699775|1326041732|CHC13|A4456||11/01/2013|12/31/9999|$0.34|0|0|||ADHESIVE REMOVER| WIPES|| 58-1699775|1326041732|CHC13|A4461||11/01/2013|12/31/9999|$4.41|0|0|||SURGICL DRESS HOLD NON-REUSE|| 58-1699775|1326041732|CHC13|A4463||11/01/2013|12/31/9999|$17.89|0|0|||SURGICAL DRESS HOLDER REUSE|| 58-1699775|1326041732|CHC13|A4466||11/01/2013|12/31/9999|$0.00|0|0|||ELASTIC GARMENT/COVERING|| 58-1699775|1326041732|CHC13|A4481||11/01/2013|12/31/9999|$0.51|0|0|||TRACHEOSTOMA FILTER|| 58-1699775|1326041732|CHC13|A4483||11/01/2013|12/31/9999|$0.00|0|0|||MOISTURE EXCHANGER|| 58-1699775|1326041732|CHC13|A4550||11/01/2013|12/31/9999|$25.48|0|0|||SURGICAL TRAYS|| 58-1699775|1326041732|CHC13|A4556||11/01/2013|12/31/9999|$16.31|0|0|||ELECTRODES| PAIR|| 58-1699775|1326041732|CHC13|A4557||11/01/2013|12/31/9999|$28.34|0|0|||LEAD WIRES| PAIR|| 58-1699775|1326041732|CHC13|A4558||11/01/2013|12/31/9999|$7.31|0|0|||CONDUCTIVE PASTE OR GEL|| 58-1699775|1326041732|CHC13|A4559||11/01/2013|12/31/9999|$0.14|0|0|||COUPLING GEL OR PASTE|| 58-1699775|1326041732|CHC13|A4561||11/01/2013|12/31/9999|$27.65|0|0|||PESSARY RUBBER| ANY TYPE|| 58-1699775|1326041732|CHC13|A4562||11/01/2013|12/31/9999|$68.72|0|0|||PESSARY| NON RUBBER|ANY TYPE|| 58-1699775|1326041732|CHC13|A4565||11/01/2013|12/31/9999|$6.05|0|0|||SLINGS|| 58-1699775|1326041732|CHC13|A4565|NU|11/01/2013|12/31/9999|$6.05|0|0|||SLINGS|| 58-1699775|1326041732|CHC13|A4570||11/01/2013|12/31/9999|$15.11|0|0|||SPLINT|| 58-1699775|1326041732|CHC13|A4590||11/01/2013|12/31/9999|$33.69|0|0|||SPECIAL CASTING MATERIAL|| 58-1699775|1326041732|CHC13|A4595||11/01/2013|12/31/9999|$38.69|0|0|||TENS SUPPL 2 LEAD PER MONTH|| 58-1699775|1326041732|CHC13|A4604||11/01/2013|12/31/9999|$77.31|0|0|||TUBING WITH HEATING ELEMENT|| 58-1699775|1326041732|CHC13|A4604|NU|11/01/2013|12/31/9999|$77.31|0|0|||TUBING WITH HEATING ELEMENT|| 58-1699775|1326041732|CHC13|A4605||11/01/2013|12/31/9999|$22.01|0|0|||TRACH SUCTION CATH CLOSE SYS|| 58-1699775|1326041732|CHC13|A4608||11/01/2013|12/31/9999|$67.30|0|0|||TRANSTRACHEAL OXYGEN CATH|| 58-1699775|1326041732|CHC13|A4611|NU|11/01/2013|12/31/9999|$224.20|0|0|||HEAVY DUTY BATTERY|| 58-1699775|1326041732|CHC13|A4611|RR|11/01/2013|12/31/9999|$23.25|0|0|||HEAVY DUTY BATTERY|| 58-1699775|1326041732|CHC13|A4611|UE|11/01/2013|12/31/9999|$168.16|0|0|||HEAVY DUTY BATTERY|| 58-1699775|1326041732|CHC13|A4612|NU|11/01/2013|12/31/9999|$102.69|0|0|||BATTERY CABLES|| 58-1699775|1326041732|CHC13|A4612|RR|11/01/2013|12/31/9999|$10.28|0|0|||BATTERY CABLES|| 58-1699775|1326041732|CHC13|A4612|UE|11/01/2013|12/31/9999|$76.99|0|0|||BATTERY CABLES|| 58-1699775|1326041732|CHC13|A4613|NU|11/01/2013|12/31/9999|$164.59|0|0|||BATTERY CHARGER|| 58-1699775|1326041732|CHC13|A4613|RR|11/01/2013|12/31/9999|$16.46|0|0|||BATTERY CHARGER|| 58-1699775|1326041732|CHC13|A4613|UE|11/01/2013|12/31/9999|$119.03|0|0|||BATTERY CHARGER|| 58-1699775|1326041732|CHC13|A4614||11/01/2013|12/31/9999|$31.94|0|0|||HAND-HELD PEFR METER|| 58-1699775|1326041732|CHC13|A4615||11/01/2013|12/31/9999|$0.96|0|0|||CANNULA NASAL|| 58-1699775|1326041732|CHC13|A4616||11/01/2013|12/31/9999|$0.09|0|0|||TUBING (OXYGEN) PER FOOT|| 58-1699775|1326041732|CHC13|A4617||11/01/2013|12/31/9999|$4.16|0|0|||MOUTH PIECE|| 58-1699775|1326041732|CHC13|A4618|NU|11/01/2013|12/31/9999|$10.99|0|0|||BREATHING CIRCUITS|| 58-1699775|1326041732|CHC13|A4618|RR|11/01/2013|12/31/9999|$1.17|0|0|||BREATHING CIRCUITS|| 58-1699775|1326041732|CHC13|A4618|UE|11/01/2013|12/31/9999|$8.29|0|0|||BREATHING CIRCUITS|| 58-1699775|1326041732|CHC13|A4619||11/01/2013|12/31/9999|$2.49|0|0|||FACE TENT|| 58-1699775|1326041732|CHC13|A4620||11/01/2013|12/31/9999|$0.84|0|0|||VARIABLE CONCENTRATION MASK|| 58-1699775|1326041732|CHC13|A4623||11/01/2013|12/31/9999|$8.41|0|0|||TRACHEOSTOMY INNER CANNULA|| 58-1699775|1326041732|CHC13|A4625||11/01/2013|12/31/9999|$9.30|0|0|||TRACH CARE KIT FOR NEW TRACH|| 58-1699775|1326041732|CHC13|A4626||11/01/2013|12/31/9999|$4.29|0|0|||TRACHEOSTOMY CLEANING BRUSH|| 58-1699775|1326041732|CHC13|A4628||11/01/2013|12/31/9999|$5.02|0|0|||OROPHARYNGEAL SUCTION CATH|| 58-1699775|1326041732|CHC13|A4629||11/01/2013|12/31/9999|$6.23|0|0|||TRACHEOSTOMY CARE KIT|| 58-1699775|1326041732|CHC13|A4630||11/01/2013|12/31/9999|$7.12|0|0|||REPL BAT T.E.N.S. OWN BY PT|| 58-1699775|1326041732|CHC13|A4633||11/01/2013|12/31/9999|$55.10|0|0|||UVL REPLACEMENT BULB|| 58-1699775|1326041732|CHC13|A4635|NU|11/01/2013|12/31/9999|$5.85|0|0|||UNDERARM CRUTCH PAD|| 58-1699775|1326041732|CHC13|A4635|RR|11/01/2013|12/31/9999|$0.79|0|0|||UNDERARM CRUTCH PAD|| 58-1699775|1326041732|CHC13|A4635|UE|11/01/2013|12/31/9999|$3.87|0|0|||UNDERARM CRUTCH PAD|| 58-1699775|1326041732|CHC13|A4636|NU|11/01/2013|12/31/9999|$4.15|0|0|||HANDGRIP FOR CANE ETC|| 58-1699775|1326041732|CHC13|A4636|RR|11/01/2013|12/31/9999|$0.43|0|0|||HANDGRIP FOR CANE ETC|| 58-1699775|1326041732|CHC13|A4636|UE|11/01/2013|12/31/9999|$3.03|0|0|||HANDGRIP FOR CANE ETC|| 58-1699775|1326041732|CHC13|A4637|NU|11/01/2013|12/31/9999|$2.10|0|0|||REPL TIP CANE/CRUTCH/WALKER|| 58-1699775|1326041732|CHC13|A4637|RR|11/01/2013|12/31/9999|$0.30|0|0|||REPL TIP CANE/CRUTCH/WALKER|| 58-1699775|1326041732|CHC13|A4637|UE|11/01/2013|12/31/9999|$1.60|0|0|||REPL TIP CANE/CRUTCH/WALKER|| 58-1699775|1326041732|CHC13|A4638||11/01/2013|12/31/9999|$0.00|0|0|||REPL BATT PULSE GEN SYS|| 58-1699775|1326041732|CHC13|A4639||11/01/2013|12/31/9999|$385.62|0|0|||INFRARED HT SYS REPLCMNT PAD|| 58-1699775|1326041732|CHC13|A4640|NU|11/01/2013|12/31/9999|$85.01|0|0|||ALTERNATING PRESSURE PAD|| 58-1699775|1326041732|CHC13|A4640|RR|11/01/2013|12/31/9999|$8.65|0|0|||ALTERNATING PRESSURE PAD|| 58-1699775|1326041732|CHC13|A4640|UE|11/01/2013|12/31/9999|$60.23|0|0|||ALTERNATING PRESSURE PAD|| 58-1699775|1326041732|CHC13|A4649||11/01/2013|12/31/9999|$2.26|0|0|||SURGICAL SUPPLIES|| 58-1699775|1326041732|CHC13|A4927||11/01/2013|12/31/9999|$3.45|0|0|||NON-STERILE GLOVES|| 58-1699775|1326041732|CHC13|A5051||11/01/2013|12/31/9999|$2.78|0|0|||POUCH CLSD W BARR ATTACHED|| 58-1699775|1326041732|CHC13|A5052||11/01/2013|12/31/9999|$2.00|0|0|||CLSD OSTOMY POUCH W/O BARR|| 58-1699775|1326041732|CHC13|A5053||11/01/2013|12/31/9999|$2.00|0|0|||CLSD OSTOMY POUCH FACEPLATE|| 58-1699775|1326041732|CHC13|A5054||11/01/2013|12/31/9999|$2.41|0|0|||CLSD OSTOMY POUCH W/FLANGE|| 58-1699775|1326041732|CHC13|A5055||11/01/2013|12/31/9999|$1.94|0|0|||STOMA CAP|| 58-1699775|1326041732|CHC13|A5056||11/01/2013|12/31/9999|$6.26|0|0|||1 PC OST POUCH W FILTER|| 58-1699775|1326041732|CHC13|A5057||11/01/2013|12/31/9999|$12.90|0|0|||1 PC OST POU W BUILT-IN CONV|| 58-1699775|1326041732|CHC13|A5061||11/01/2013|12/31/9999|$4.74|0|0|||POUCH DRAINABLE W BARRIER AT|| 58-1699775|1326041732|CHC13|A5062||11/01/2013|12/31/9999|$2.99|0|0|||DRNBLE OSTOMY POUCH W/O BARR|| 58-1699775|1326041732|CHC13|A5063||11/01/2013|12/31/9999|$3.64|0|0|||DRAIN OSTOMY POUCH W/FLANGE|| 58-1699775|1326041732|CHC13|A5071||11/01/2013|12/31/9999|$8.06|0|0|||URINARY POUCH W/BARRIER|| 58-1699775|1326041732|CHC13|A5072||11/01/2013|12/31/9999|$4.74|0|0|||URINARY POUCH W/O BARRIER|| 58-1699775|1326041732|CHC13|A5073||11/01/2013|12/31/9999|$4.28|0|0|||URINARY POUCH ON BARR W/FLNG|| 58-1699775|1326041732|CHC13|A5081||11/01/2013|12/31/9999|$3.77|0|0|||CONTINENT STOMA PLUG|| 58-1699775|1326041732|CHC13|A5082||11/01/2013|12/31/9999|$15.96|0|0|||CONTINENT STOMA CATHETER|| 58-1699775|1326041732|CHC13|A5083||11/01/2013|12/31/9999|$0.85|0|0|||STOMA ABSORPTIVE COVER|| 58-1699775|1326041732|CHC13|A5093||11/01/2013|12/31/9999|$2.62|0|0|||OSTOMY ACCESSORY CONVEX INSE|| 58-1699775|1326041732|CHC13|A5102||11/01/2013|12/31/9999|$30.33|0|0|||BEDSIDE DRAIN BTL W/WO TUBE|| 58-1699775|1326041732|CHC13|A5105||11/01/2013|12/31/9999|$54.74|0|0|||URINARY SUSPENSORY|| 58-1699775|1326041732|CHC13|A5112||11/01/2013|12/31/9999|$46.48|0|0|||URINARY LEG BAG|| 58-1699775|1326041732|CHC13|A5113||11/01/2013|12/31/9999|$6.32|0|0|||LATEX LEG STRAP|| 58-1699775|1326041732|CHC13|A5114||11/01/2013|12/31/9999|$10.21|0|0|||FOAM/FABRIC LEG STRAP|| 58-1699775|1326041732|CHC13|A5120||11/01/2013|12/31/9999|$0.32|0|0|||SKIN BARRIER| WIPE OR SWAB|| 58-1699775|1326041732|CHC13|A5121||11/01/2013|12/31/9999|$8.51|0|0|||SOLID SKIN BARRIER 6X6|| 58-1699775|1326041732|CHC13|A5122||11/01/2013|12/31/9999|$17.25|0|0|||SOLID SKIN BARRIER 8X8|| 58-1699775|1326041732|CHC13|A5126||11/01/2013|12/31/9999|$1.77|0|0|||DISK/FOAM PAD +OR- ADHESIVE|| 58-1699775|1326041732|CHC13|A5131||11/01/2013|12/31/9999|$21.29|0|0|||APPLIANCE CLEANER|| 58-1699775|1326041732|CHC13|A5200||11/01/2013|12/31/9999|$15.18|0|0|||PERCUTANEOUS CATHETER ANCHOR|| 58-1699775|1326041732|CHC13|A5500||11/01/2013|12/31/9999|$85.36|0|0|||DIAB SHOE FOR DENSITY INSERT|| 58-1699775|1326041732|CHC13|A5500|NU|11/01/2013|12/31/9999|$85.36|0|0|||DIAB SHOE FOR DENSITY INSERT|| 58-1699775|1326041732|CHC13|A5501||11/01/2013|12/31/9999|$256.06|0|0|||DIABETIC CUSTOM MOLDED SHOE|| 58-1699775|1326041732|CHC13|A5503||11/01/2013|12/31/9999|$41.91|0|0|||DIABETIC SHOE W/ROLLER/ROCKR|| 58-1699775|1326041732|CHC13|A5504||11/01/2013|12/31/9999|$41.91|0|0|||DIABETIC SHOE WITH WEDGE|| 58-1699775|1326041732|CHC13|A5505||11/01/2013|12/31/9999|$41.91|0|0|||DIAB SHOE W/METATARSAL BAR|| 58-1699775|1326041732|CHC13|A5506||11/01/2013|12/31/9999|$41.91|0|0|||DIABETIC SHOE W/OFF SET HEEL|| 58-1699775|1326041732|CHC13|A5507||11/01/2013|12/31/9999|$41.91|0|0|||MODIFICATION DIABETIC SHOE|| 58-1699775|1326041732|CHC13|A5512||11/01/2013|12/31/9999|$34.83|0|0|||MULTI DEN INSERT DIRECT FORM|| 58-1699775|1326041732|CHC13|A5512|NU|11/01/2013|12/31/9999|$34.83|0|0|||MULTI DEN INSERT DIRECT FORM|| 58-1699775|1326041732|CHC13|A5513||11/01/2013|12/31/9999|$51.98|0|0|||MULTI DEN INSERT CUSTOM MOLD|| 58-1699775|1326041732|CHC13|A6010||11/01/2013|12/31/9999|$41.57|0|0|||COLLAGEN BASED WOUND FILLER|| 58-1699775|1326041732|CHC13|A6011||11/01/2013|12/31/9999|$3.06|0|0|||COLLAGEN GEL/PASTE WOUND FIL|| 58-1699775|1326041732|CHC13|A6021||11/01/2013|12/31/9999|$28.22|0|0|||COLLAGEN DRESSING <=16 SQ IN|| 58-1699775|1326041732|CHC13|A6022||11/01/2013|12/31/9999|$28.22|0|0|||COLLAGEN DRSG>6<=48 SQ IN|| 58-1699775|1326041732|CHC13|A6023||11/01/2013|12/31/9999|$255.51|0|0|||COLLAGEN DRESSING >48 SQ IN|| 58-1699775|1326041732|CHC13|A6024||11/01/2013|12/31/9999|$8.31|0|0|||COLLAGEN DSG WOUND FILLER|| 58-1699775|1326041732|CHC13|A6154||11/01/2013|12/31/9999|$19.30|0|0|||WOUND POUCH EACH|| 58-1699775|1326041732|CHC13|A6196||11/01/2013|12/31/9999|$9.88|0|0|||ALGINATE DRESSING <=16 SQ IN|| 58-1699775|1326041732|CHC13|A6197||11/01/2013|12/31/9999|$22.06|0|0|||ALGINATE DRSG >16 <=48 SQ IN|| 58-1699775|1326041732|CHC13|A6199||11/01/2013|12/31/9999|$7.09|0|0|||ALGINATE DRSG WOUND FILLER|| 58-1699775|1326041732|CHC13|A6203||11/01/2013|12/31/9999|$4.50|0|0|||COMPOSITE DRSG <= 16 SQ IN|| 58-1699775|1326041732|CHC13|A6204||11/01/2013|12/31/9999|$8.36|0|0|||COMPOSITE DRSG >16<=48 SQ IN|| 58-1699775|1326041732|CHC13|A6207||11/01/2013|12/31/9999|$9.85|0|0|||CONTACT LAYER >16<= 48 SQ IN|| 58-1699775|1326041732|CHC13|A6209||11/01/2013|12/31/9999|$10.04|0|0|||FOAM DRSG <=16 SQ IN W/O BDR|| 58-1699775|1326041732|CHC13|A6210||11/01/2013|12/31/9999|$26.75|0|0|||FOAM DRG >16<=48 SQ IN W/O B|| 58-1699775|1326041732|CHC13|A6211||11/01/2013|12/31/9999|$39.44|0|0|||FOAM DRG > 48 SQ IN W/O BRDR|| 58-1699775|1326041732|CHC13|A6212||11/01/2013|12/31/9999|$13.03|0|0|||FOAM DRG <=16 SQ IN W/BORDER|| 58-1699775|1326041732|CHC13|A6214||11/01/2013|12/31/9999|$13.81|0|0|||FOAM DRG > 48 SQ IN W/BORDER|| 58-1699775|1326041732|CHC13|A6216||11/01/2013|12/31/9999|$0.06|0|0|||NON-STERILE GAUZE<=16 SQ IN|| 58-1699775|1326041732|CHC13|A6217||11/01/2013|12/31/9999|$0.00|0|0|||NON-STERILE GAUZE>16<=48 SQ|| 58-1699775|1326041732|CHC13|A6219||11/01/2013|12/31/9999|$1.27|0|0|||GAUZE <= 16 SQ IN W/BORDER|| 58-1699775|1326041732|CHC13|A6220||11/01/2013|12/31/9999|$3.47|0|0|||GAUZE >16 <=48 SQ IN W/BORDR|| 58-1699775|1326041732|CHC13|A6222||11/01/2013|12/31/9999|$2.86|0|0|||GAUZE <=16 IN NO W/SAL W/O B|| 58-1699775|1326041732|CHC13|A6223||11/01/2013|12/31/9999|$3.25|0|0|||GAUZE >16<=48 NO W/SAL W/O B|| 58-1699775|1326041732|CHC13|A6224||11/01/2013|12/31/9999|$4.85|0|0|||GAUZE > 48 IN NO W/SAL W/O B|| 58-1699775|1326041732|CHC13|A6229||11/01/2013|12/31/9999|$4.85|0|0|||GAUZE >16<=48 SQ IN WATR/SAL|| 58-1699775|1326041732|CHC13|A6231||11/01/2013|12/31/9999|$6.29|0|0|||HYDROGEL DSG<=16 SQ IN|| 58-1699775|1326041732|CHC13|A6232||11/01/2013|12/31/9999|$9.23|0|0|||HYDROGEL DSG>16<=48 SQ IN|| 58-1699775|1326041732|CHC13|A6233||11/01/2013|12/31/9999|$25.76|0|0|||HYDROGEL DRESSING >48 SQ IN|| 58-1699775|1326041732|CHC13|A6234||11/01/2013|12/31/9999|$8.77|0|0|||HYDROCOLLD DRG <=16 W/O BDR|| 58-1699775|1326041732|CHC13|A6235||11/01/2013|12/31/9999|$22.57|0|0|||HYDROCOLLD DRG >16<=48 W/O B|| 58-1699775|1326041732|CHC13|A6236||11/01/2013|12/31/9999|$36.59|0|0|||HYDROCOLLD DRG > 48 IN W/O B|| 58-1699775|1326041732|CHC13|A6237||11/01/2013|12/31/9999|$10.62|0|0|||HYDROCOLLD DRG <=16 IN W/BDR|| 58-1699775|1326041732|CHC13|A6238||11/01/2013|12/31/9999|$30.60|0|0|||HYDROCOLLD DRG >16<=48 W/BDR|| 58-1699775|1326041732|CHC13|A6240||11/01/2013|12/31/9999|$16.44|0|0|||HYDROCOLLD DRG FILLER PASTE|| 58-1699775|1326041732|CHC13|A6241||11/01/2013|12/31/9999|$3.45|0|0|||HYDROCOLLOID DRG FILLER DRY|| 58-1699775|1326041732|CHC13|A6242||11/01/2013|12/31/9999|$8.14|0|0|||HYDROGEL DRG <=16 IN W/O BDR|| 58-1699775|1326041732|CHC13|A6243||11/01/2013|12/31/9999|$16.54|0|0|||HYDROGEL DRG >16<=48 W/O BDR|| 58-1699775|1326041732|CHC13|A6244||11/01/2013|12/31/9999|$52.74|0|0|||HYDROGEL DRG >48 IN W/O BDR|| 58-1699775|1326041732|CHC13|A6245||11/01/2013|12/31/9999|$9.75|0|0|||HYDROGEL DRG <= 16 IN W/BDR|| 58-1699775|1326041732|CHC13|A6246||11/01/2013|12/31/9999|$13.32|0|0|||HYDROGEL DRG >16<=48 IN W/B|| 58-1699775|1326041732|CHC13|A6247||11/01/2013|12/31/9999|$31.94|0|0|||HYDROGEL DRG > 48 SQ IN W/B|| 58-1699775|1326041732|CHC13|A6248||11/01/2013|12/31/9999|$21.80|0|0|||HYDROGEL DRSG GEL FILLER|| 58-1699775|1326041732|CHC13|A6251||11/01/2013|12/31/9999|$2.68|0|0|||ABSORPT DRG <=16 SQ IN W/O B|| 58-1699775|1326041732|CHC13|A6252||11/01/2013|12/31/9999|$4.36|0|0|||ABSORPT DRG >16 <=48 W/O BDR|| 58-1699775|1326041732|CHC13|A6253||11/01/2013|12/31/9999|$8.51|0|0|||ABSORPT DRG > 48 SQ IN W/O B|| 58-1699775|1326041732|CHC13|A6254||11/01/2013|12/31/9999|$1.62|0|0|||ABSORPT DRG <=16 SQ IN W/BDR|| 58-1699775|1326041732|CHC13|A6255||11/01/2013|12/31/9999|$4.07|0|0|||ABSORPT DRG >16<=48 IN W/BDR|| 58-1699775|1326041732|CHC13|A6257||11/01/2013|12/31/9999|$2.06|0|0|||TRANSPARENT FILM <= 16 SQ IN|| 58-1699775|1326041732|CHC13|A6258||11/01/2013|12/31/9999|$5.79|0|0|||TRANSPARENT FILM >16<=48 IN|| 58-1699775|1326041732|CHC13|A6259||11/01/2013|12/31/9999|$14.70|0|0|||TRANSPARENT FILM > 48 SQ IN|| 58-1699775|1326041732|CHC13|A6266||11/01/2013|12/31/9999|$2.59|0|0|||IMPREG GAUZE NO H20/SAL/YARD|| 58-1699775|1326041732|CHC13|A6402||11/01/2013|12/31/9999|$0.16|0|0|||STERILE GAUZE <= 16 SQ IN|| 58-1699775|1326041732|CHC13|A6403||11/01/2013|12/31/9999|$0.58|0|0|||STERILE GAUZE>16 <= 48 SQ IN|| 58-1699775|1326041732|CHC13|A6407||11/01/2013|12/31/9999|$2.52|0|0|||PACKING STRIPS| NON-IMPREG|| 58-1699775|1326041732|CHC13|A6410||11/01/2013|12/31/9999|$0.52|0|0|||STERILE EYE PAD|| 58-1699775|1326041732|CHC13|A6411||11/01/2013|12/31/9999|$0.00|0|0|||NON-STERILE EYE PAD|| 58-1699775|1326041732|CHC13|A6441||11/01/2013|12/31/9999|$0.90|0|0|||PAD BAND W>=3 IN <5 IN /YD|| 58-1699775|1326041732|CHC13|A6442||11/01/2013|12/31/9999|$0.23|0|0|||CONFORM BAND N/S W<3 IN/YD|| 58-1699775|1326041732|CHC13|A6443||11/01/2013|12/31/9999|$0.39|0|0|||CONFORM BAND N/S W>=3<5/YD|| 58-1699775|1326041732|CHC13|A6444||11/01/2013|12/31/9999|$0.75|0|0|||CONFORM BAND N/S W>=5 IN/YD|| 58-1699775|1326041732|CHC13|A6445||11/01/2013|12/31/9999|$0.44|0|0|||CONFORM BAND S W <3 IN/YD|| 58-1699775|1326041732|CHC13|A6446||11/01/2013|12/31/9999|$0.55|0|0|||CONFORM BAND S W>=3 <5/YD|| 58-1699775|1326041732|CHC13|A6447||11/01/2013|12/31/9999|$0.90|0|0|||CONFORM BAND S W >=5 IN/YD|| 58-1699775|1326041732|CHC13|A6448||11/01/2013|12/31/9999|$1.56|0|0|||LT COMPRES BAND <3 IN/YD|| 58-1699775|1326041732|CHC13|A6449||11/01/2013|12/31/9999|$2.35|0|0|||LT COMPRES BAND >=3 <5/YD|| 58-1699775|1326041732|CHC13|A6450||11/01/2013|12/31/9999|$0.00|0|0|||LT COMPRES BAND >=5 IN/YD|| 58-1699775|1326041732|CHC13|A6451||11/01/2013|12/31/9999|$0.00|0|0|||MOD COMPRES BAND W>=3<5/YD|| 58-1699775|1326041732|CHC13|A6452||11/01/2013|12/31/9999|$7.94|0|0|||HIGH COMPRES BAND W>=3<5YD|| 58-1699775|1326041732|CHC13|A6453||11/01/2013|12/31/9999|$0.83|0|0|||SELF-ADHER BAND W <3 IN/YD|| 58-1699775|1326041732|CHC13|A6454||11/01/2013|12/31/9999|$1.04|0|0|||SELF-ADHER BAND W>=3 <5/YD|| 58-1699775|1326041732|CHC13|A6455||11/01/2013|12/31/9999|$1.88|0|0|||SELF-ADHER BAND >=5 IN/YD|| 58-1699775|1326041732|CHC13|A6456||11/01/2013|12/31/9999|$1.71|0|0|||ZINC PASTE BAND W >=3<5/YD|| 58-1699775|1326041732|CHC13|A6457||11/01/2013|12/31/9999|$1.54|0|0|||TUBULAR DRESSING|| 58-1699775|1326041732|CHC13|A6501||11/01/2013|12/31/9999|$0.00|0|0|||COMPRES BURNGARMENT BODYSUIT|| 58-1699775|1326041732|CHC13|A6502||11/01/2013|12/31/9999|$0.00|0|0|||COMPRES BURNGARMENT CHINSTRP|| 58-1699775|1326041732|CHC13|A6503||11/01/2013|12/31/9999|$0.00|0|0|||COMPRES BURNGARMENT FACEHOOD|| 58-1699775|1326041732|CHC13|A6504||11/01/2013|12/31/9999|$0.00|0|0|||CMPRSBURNGARMENT GLOVE-WRIST|| 58-1699775|1326041732|CHC13|A6505||11/01/2013|12/31/9999|$0.00|0|0|||CMPRSBURNGARMENT GLOVE-ELBOW|| 58-1699775|1326041732|CHC13|A6506||11/01/2013|12/31/9999|$0.00|0|0|||CMPRSBURNGRMNT GLOVE-AXILLA|| 58-1699775|1326041732|CHC13|A6507||11/01/2013|12/31/9999|$0.00|0|0|||CMPRS BURNGARMENT FOOT-KNEE|| 58-1699775|1326041732|CHC13|A6508||11/01/2013|12/31/9999|$0.00|0|0|||CMPRS BURNGARMENT FOOT-THIGH|| 58-1699775|1326041732|CHC13|A6509||11/01/2013|12/31/9999|$0.00|0|0|||COMPRES BURN GARMENT JACKET|| 58-1699775|1326041732|CHC13|A6510||11/01/2013|12/31/9999|$0.00|0|0|||COMPRES BURN GARMENT LEOTARD|| 58-1699775|1326041732|CHC13|A6511||11/01/2013|12/31/9999|$0.00|0|0|||COMPRES BURN GARMENT PANTY|| 58-1699775|1326041732|CHC13|A6513||11/01/2013|12/31/9999|$0.00|0|0|||COMPRESS BURN MASK FACE/NECK|| 58-1699775|1326041732|CHC13|A6530||01/01/2015|12/31/9999|$51.25|0|0|||COMPRESSION STOCKING BK18-30|| 58-1699775|1326041732|CHC13|A6530|NU|01/01/2015|12/31/9999|$51.25|0|0|||COMPRESSION STOCKING BK18-30|| 58-1699775|1326041732|CHC13|A6531||11/01/2013|12/31/9999|$58.09|0|0|||COMPRESSION STOCKING BK30-40|| 58-1699775|1326041732|CHC13|A6532||11/01/2013|12/31/9999|$81.85|0|0|||COMPRESSION STOCKING BK40-50|| 58-1699775|1326041732|CHC13|A6533||04/01/2016|12/31/9999|$86.10|0|0|||GC STOCKING THIGHLNGTH 18-30|| 58-1699775|1326041732|CHC13|A6534||01/01/2016|12/31/9999|$52.00|0|0|||GC STOCKING THIGHLNGTH 30-40|| 58-1699775|1326041732|CHC13|A6535||04/01/2016|12/31/9999|$48.30|0|0|||GC STOCKING THIGHLNGTH 40-50|| 58-1699775|1326041732|CHC13|A6536||04/01/2016|12/31/9999|$59.50|0|0|||GC STOCKING FULL LNGTH 18-30|| 58-1699775|1326041732|CHC13|A6537||04/01/2016|12/31/9999|$61.25|0|0|||GC STOCKING FULL LNGTH 30-40|| 58-1699775|1326041732|CHC13|A6538||04/01/2016|12/31/9999|$70.00|0|0|||GC STOCKING FULL LNGTH 40-50|| 58-1699775|1326041732|CHC13|A6539||04/01/2016|12/31/9999|$96.88|0|0|||GC STOCKING WAISTLNGTH 18-30|| 58-1699775|1326041732|CHC13|A6540||04/01/2016|12/31/9999|$95.90|0|0|||GC STOCKING WAISTLNGTH 30-40|| 58-1699775|1326041732|CHC13|A6541||04/01/2016|12/31/9999|$2.80|0|0|||GC STOCKING WAISTLNGTH 40-50|| 58-1699775|1326041732|CHC13|A6545||11/01/2013|12/31/9999|$114.38|0|0|||GRAD COMP NON-ELASTIC BK|| 58-1699775|1326041732|CHC13|A6550||11/01/2013|12/31/9999|$31.75|0|0|||NEG PRES WOUND THER DRSG SET|| 58-1699775|1326041732|CHC13|A7000|NU|11/01/2013|12/31/9999|$10.95|0|0|||DISPOSABLE CANISTER FOR PUMP|| 58-1699775|1326041732|CHC13|A7001||11/01/2013|12/31/9999|$38.85|0|0|||NONDISPOSABLE PUMP CANISTER|| 58-1699775|1326041732|CHC13|A7002||11/01/2013|12/31/9999|$4.38|0|0|||TUBING USED W SUCTION PUMP|| 58-1699775|1326041732|CHC13|A7003||11/01/2013|12/31/9999|$3.64|0|0|||NEBULIZER ADMINISTRATION SET|| 58-1699775|1326041732|CHC13|A7003|NU|11/01/2013|12/31/9999|$3.64|0|0|||NEBULIZER ADMINISTRATION SET|| 58-1699775|1326041732|CHC13|A7004||11/01/2013|12/31/9999|$2.06|0|0|||DISPOSABLE NEBULIZER SML VOL|| 58-1699775|1326041732|CHC13|A7005||11/01/2013|12/31/9999|$35.19|0|0|||NONDISPOSABLE NEBULIZER SET|| 58-1699775|1326041732|CHC13|A7005|NU|11/01/2013|12/31/9999|$35.19|0|0|||NONDISPOSABLE NEBULIZER SET|| 58-1699775|1326041732|CHC13|A7006||11/01/2013|12/31/9999|$12.81|0|0|||FILTERED NEBULIZER ADMIN SET|| 58-1699775|1326041732|CHC13|A7007||11/01/2013|12/31/9999|$5.80|0|0|||LG VOL NEBULIZER DISPOSABLE|| 58-1699775|1326041732|CHC13|A7008||11/01/2013|12/31/9999|$12.56|0|0|||DISPOSABLE NEBULIZER PREFILL|| 58-1699775|1326041732|CHC13|A7009||11/01/2013|12/31/9999|$54.52|0|0|||NEBULIZER RESERVOIR BOTTLE|| 58-1699775|1326041732|CHC13|A7010||11/01/2013|12/31/9999|$26.93|0|0|||DISPOSABLE CORRUGATED TUBING|| 58-1699775|1326041732|CHC13|A7012||11/01/2013|12/31/9999|$5.04|0|0|||NEBULIZER WATER COLLEC DEVIC|| 58-1699775|1326041732|CHC13|A7013||11/01/2013|12/31/9999|$0.95|0|0|||DISPOSABLE COMPRESSOR FILTER|| 58-1699775|1326041732|CHC13|A7014||11/01/2013|12/31/9999|$6.03|0|0|||COMPRESSOR NONDISPOS FILTER|| 58-1699775|1326041732|CHC13|A7015||11/01/2013|12/31/9999|$2.52|0|0|||AEROSOL MASK USED W NEBULIZE|| 58-1699775|1326041732|CHC13|A7015|NU|11/01/2013|12/31/9999|$2.52|0|0|||AEROSOL MASK USED W NEBULIZE|| 58-1699775|1326041732|CHC13|A7016||11/01/2013|12/31/9999|$9.08|0|0|||NEBULIZER DOME & MOUTHPIECE|| 58-1699775|1326041732|CHC13|A7017|NU|11/01/2013|12/31/9999|$179.96|0|0|||NEBULIZER NOT USED W OXYGEN|| 58-1699775|1326041732|CHC13|A7017|RR|11/01/2013|12/31/9999|$18.00|0|0|||NEBULIZER NOT USED W OXYGEN|| 58-1699775|1326041732|CHC13|A7017|UE|11/01/2013|12/31/9999|$134.96|0|0|||NEBULIZER NOT USED W OXYGEN|| 58-1699775|1326041732|CHC13|A7018||11/01/2013|12/31/9999|$0.44|0|0|||WATER DISTILLED W/NEBULIZER|| 58-1699775|1326041732|CHC13|A7020||11/01/2013|12/31/9999|$19.44|0|0|||STERL WATR/SALINE 1000 ML W/LG|| 58-1699775|1326041732|CHC13|A7025||11/01/2013|12/31/9999|$583.97|0|0|||REPLACE CHEST COMPRESS VEST|| 58-1699775|1326041732|CHC13|A7026||11/01/2013|12/31/9999|$38.60|0|0|||REPLACE CHST CMPRSS SYS HOSE|| 58-1699775|1326041732|CHC13|A7027||11/01/2013|12/31/9999|$250.44|0|0|||COMBINATION ORAL/NASAL MASK|| 58-1699775|1326041732|CHC13|A7028||11/01/2013|12/31/9999|$66.53|0|0|||REPL ORAL CUSHION COMBO MASK|| 58-1699775|1326041732|CHC13|A7029||11/01/2013|12/31/9999|$27.17|0|0|||REPL NASAL PILLOW COMB MASK|| 58-1699775|1326041732|CHC13|A7030||11/01/2013|12/31/9999|$218.30|0|0|||CPAP FULL FACE MASK|| 58-1699775|1326041732|CHC13|A7030|NU|11/01/2013|12/31/9999|$218.30|0|0|||CPAP FULL FACE MASK|| 58-1699775|1326041732|CHC13|A7031||11/01/2013|12/31/9999|$80.74|0|0|||REPLACEMENT FACEMASK INTERFA|| 58-1699775|1326041732|CHC13|A7031|NU|11/01/2013|12/31/9999|$80.74|0|0|||REPLACEMENT FACEMASK INTERFA|| 58-1699775|1326041732|CHC13|A7032||11/01/2013|12/31/9999|$46.90|0|0|||REPLACEMENT NASAL CUSHION|| 58-1699775|1326041732|CHC13|A7032|NU|11/01/2013|12/31/9999|$46.90|0|0|||REPLACEMENT NASAL CUSHION|| 58-1699775|1326041732|CHC13|A7033||11/01/2013|12/31/9999|$32.87|0|0|||REPLACEMENT NASAL PILLOWS|| 58-1699775|1326041732|CHC13|A7033|NU|11/01/2013|12/31/9999|$32.87|0|0|||REPLACEMENT NASAL PILLOWS|| 58-1699775|1326041732|CHC13|A7034||11/01/2013|12/31/9999|$136.13|0|0|||NASAL APPLICATION DEVICE|| 58-1699775|1326041732|CHC13|A7034|NU|11/01/2013|12/31/9999|$136.13|0|0|||NASAL APPLICATION DEVICE|| 58-1699775|1326041732|CHC13|A7035||11/01/2013|12/31/9999|$41.76|0|0|||POS AIRWAY PRESS HEADGEAR|| 58-1699775|1326041732|CHC13|A7035|NU|11/01/2013|12/31/9999|$41.76|0|0|||POS AIRWAY PRESS HEADGEAR|| 58-1699775|1326041732|CHC13|A7036||11/01/2013|12/31/9999|$17.90|0|0|||POS AIRWAY PRESS CHINSTRAP|| 58-1699775|1326041732|CHC13|A7036|NU|11/01/2013|12/31/9999|$17.90|0|0|||POS AIRWAY PRESS CHINSTRAP|| 58-1699775|1326041732|CHC13|A7037||11/01/2013|12/31/9999|$46.15|0|0|||POS AIRWAY PRESSURE TUBING|| 58-1699775|1326041732|CHC13|A7037|NU|11/01/2013|12/31/9999|$46.15|0|0|||POS AIRWAY PRESSURE TUBING|| 58-1699775|1326041732|CHC13|A7038||11/01/2013|12/31/9999|$6.19|0|0|||POS AIRWAY PRESSURE FILTER|| 58-1699775|1326041732|CHC13|A7038|NU|11/01/2013|12/31/9999|$6.19|0|0|||POS AIRWAY PRESSURE FILTER|| 58-1699775|1326041732|CHC13|A7039||11/01/2013|12/31/9999|$15.08|0|0|||FILTER| NON DISPOSABLE W PAP|| 58-1699775|1326041732|CHC13|A7039|NU|11/01/2013|12/31/9999|$15.08|0|0|||FILTER| NON DISPOSABLE W PAP|| 58-1699775|1326041732|CHC13|A7040||11/01/2013|12/31/9999|$54.61|0|0|||ONE WAY CHEST DRAIN VALVE|| 58-1699775|1326041732|CHC13|A7041||11/01/2013|12/31/9999|$102.61|0|0|||WATER SEAL DRAIN CONTAINER|| 58-1699775|1326041732|CHC13|A7042||11/01/2013|12/31/9999|$243.80|0|0|||IMPLANTED PLEURAL CATHETER|| 58-1699775|1326041732|CHC13|A7043||11/01/2013|12/31/9999|$38.84|0|0|||VACUUM DRAINAGEBOTTLE/TUBING|| 58-1699775|1326041732|CHC13|A7044||11/01/2013|12/31/9999|$139.91|0|0|||PAP ORAL INTERFACE|| 58-1699775|1326041732|CHC13|A7045|NU|11/01/2013|12/31/9999|$22.53|0|0|||REPL EXHALATION PORT FOR PAP|| 58-1699775|1326041732|CHC13|A7045|RR|11/01/2013|12/31/9999|$2.25|0|0|||REPL EXHALATION PORT FOR PAP|| 58-1699775|1326041732|CHC13|A7045|UE|11/01/2013|12/31/9999|$16.90|0|0|||REPL EXHALATION PORT FOR PAP|| 58-1699775|1326041732|CHC13|A7046||11/01/2013|12/31/9999|$22.57|0|0|||REPL WATER CHAMBER| PAP DEV|| 58-1699775|1326041732|CHC13|A7046|NU|11/01/2013|12/31/9999|$22.57|0|0|||REPL WATER CHAMBER| PAP DEV|| 58-1699775|1326041732|CHC13|A7501||11/01/2013|12/31/9999|$141.01|0|0|||TRACHEOSTOMA VALVE W DIAPHRA|| 58-1699775|1326041732|CHC13|A7502||11/01/2013|12/31/9999|$67.02|0|0|||REPLACEMENT DIAPHRAGM/FPLATE|| 58-1699775|1326041732|CHC13|A7503||11/01/2013|12/31/9999|$15.23|0|0|||HMES FILTER HOLDER OR CAP|| 58-1699775|1326041732|CHC13|A7504||11/01/2013|12/31/9999|$0.90|0|0|||TRACHEOSTOMA HMES FILTER|| 58-1699775|1326041732|CHC13|A7505||11/01/2013|12/31/9999|$6.29|0|0|||HMES OR TRACH VALVE HOUSING|| 58-1699775|1326041732|CHC13|A7506||11/01/2013|12/31/9999|$0.45|0|0|||HMES/TRACHVALVE ADHESIVEDISK|| 58-1699775|1326041732|CHC13|A7507||11/01/2013|12/31/9999|$3.34|0|0|||INTEGRATED FILTER & HOLDER|| 58-1699775|1326041732|CHC13|A7508||11/01/2013|12/31/9999|$3.85|0|0|||HOUSING & INTEGRATED ADHESIV|| 58-1699775|1326041732|CHC13|A7509||11/01/2013|12/31/9999|$1.90|0|0|||HEAT & MOISTURE EXCHANGE SYS|| 58-1699775|1326041732|CHC13|A7520||11/01/2013|12/31/9999|$63.75|0|0|||TRACH/LARYN TUBE NON-CUFFED|| 58-1699775|1326041732|CHC13|A7521||11/01/2013|12/31/9999|$63.16|0|0|||TRACH/LARYN TUBE CUFFED|| 58-1699775|1326041732|CHC13|A7522||11/01/2013|12/31/9999|$60.64|0|0|||TRACH/LARYN TUBE STAINLESS|| 58-1699775|1326041732|CHC13|A7524||11/01/2013|12/31/9999|$103.92|0|0|||TRACHEOSTOMA STENT/STUD/BTTN|| 58-1699775|1326041732|CHC13|A7525||11/01/2013|12/31/9999|$2.78|0|0|||TRACHEOSTOMY MASK|| 58-1699775|1326041732|CHC13|A7526||11/01/2013|12/31/9999|$4.52|0|0|||TRACHEOSTOMY TUBE COLLAR|| 58-1699775|1326041732|CHC13|A7527||11/01/2013|12/31/9999|$4.81|0|0|||TRACH/LARYN TUBE PLUG/STOP|| 58-1699775|1326041732|CHC13|A8000|NU|11/01/2013|12/31/9999|$205.90|0|0|||SOFT PROTECT HELMET PREFAB|| 58-1699775|1326041732|CHC13|A8000|RR|11/01/2013|12/31/9999|$20.59|0|0|||SOFT PROTECT HELMET PREFAB|| 58-1699775|1326041732|CHC13|A8000|UE|11/01/2013|12/31/9999|$154.45|0|0|||SOFT PROTECT HELMET PREFAB|| 58-1699775|1326041732|CHC13|A8001|NU|11/01/2013|12/31/9999|$205.90|0|0|||HARD PROTECT HELMET PREFAB|| 58-1699775|1326041732|CHC13|A8001|RR|11/01/2013|12/31/9999|$20.59|0|0|||HARD PROTECT HELMET PREFAB|| 58-1699775|1326041732|CHC13|A8001|UE|11/01/2013|12/31/9999|$154.45|0|0|||HARD PROTECT HELMET PREFAB|| 58-1699775|1326041732|CHC13|A8002||11/01/2013|12/31/9999|$0.00|0|0|||SOFT PROTECT HELMET CUSTOM|| 58-1699775|1326041732|CHC13|A8003||11/01/2013|12/31/9999|$0.00|0|0|||HARD PROTECT HELMET CUSTOM|| 58-1699775|1326041732|CHC13|A8004||11/01/2013|12/31/9999|$0.00|0|0|||REPL SOFT INTERFACE| HELMET|| 58-1699775|1326041732|CHC13|A9150||11/01/2013|12/31/9999|$0.00|0|0|||MISC/EXPER NON-PRESCRIPT DRU|| 58-1699775|1326041732|CHC13|A9282||04/01/2016|12/31/9999|$280.00|0|0|||WIG ANY TYPE|| 58-1699775|1326041732|CHC13|A9500||11/01/2013|12/31/9999|$152.12|0|0|||TC99M SESTAMIBI|| 58-1699775|1326041732|CHC13|A9502||11/01/2013|12/31/9999|$144.11|0|0|||TC99M TETROFOSMIN|| 58-1699775|1326041732|CHC13|A9503||11/01/2013|12/31/9999|$22.09|0|0|||TC99M MEDRONATE|| 58-1699775|1326041732|CHC13|A9505||11/01/2013|12/31/9999|$114.11|0|0|||TL201 THALLIUM|| 58-1699775|1326041732|CHC13|A9560||01/01/2017|12/31/9999|$127.80|0|0|||TC99M LABELED RBC|| 58-1699775|1326041732|CHC13|A9575||10/01/2016|09/30/2017|$0.26|0|0|0||INJ GADOTERATE MEGLUMI 0.1ML|| 58-1699775|1326041732|CHC13|A9575||10/01/2017|09/30/2018|$0.29|0|0|0||INJ GADOTERATE MEGLUMI 0.1ML|| 58-1699775|1326041732|CHC13|A9576||10/01/2016|09/30/2017|$2.25|0|0|0||INJ PROHANCE MULTIPACK|| 58-1699775|1326041732|CHC13|A9576||10/01/2017|09/30/2018|$2.19|0|0|0||INJ PROHANCE MULTIPACK|| 58-1699775|1326041732|CHC13|A9577||10/01/2016|09/30/2017|$2.62|0|0|0||INJ MULTIHANCE|| 58-1699775|1326041732|CHC13|A9577||10/01/2017|09/30/2018|$2.60|0|0|0||INJ MULTIHANCE|| 58-1699775|1326041732|CHC13|A9578||10/01/2016|09/30/2017|$2.50|0|0|0||INJ MULTIHANCE MULTIPACK|| 58-1699775|1326041732|CHC13|A9578||10/01/2017|09/30/2018|$2.57|0|0|0||INJ MULTIHANCE MULTIPACK|| 58-1699775|1326041732|CHC13|A9579||10/01/2016|09/30/2017|$2.36|0|0|0||GAD-BASE MR CONTRAST NOS|1ML|| 58-1699775|1326041732|CHC13|A9579||10/01/2017|09/30/2018|$2.33|0|0|0||GAD-BASE MR CONTRAST NOS|1ML|| 58-1699775|1326041732|CHC13|A9581||10/01/2016|09/30/2017|$17.47|0|0|0||GADOXETATE DISODIUM INJ|| 58-1699775|1326041732|CHC13|A9581||10/01/2017|09/30/2018|$17.43|0|0|0||GADOXETATE DISODIUM INJ|| 58-1699775|1326041732|CHC13|A9583||10/01/2016|09/30/2017|$22.25|0|0|0||GADOFOSVESET TRISODIUM INJ|| 58-1699775|1326041732|CHC13|A9585||10/01/2016|09/30/2017|$0.48|0|0|0||GADOBUTROL INJECTION|| 58-1699775|1326041732|CHC13|A9585||10/01/2017|09/30/2018|$0.47|0|0|0||GADOBUTROL INJECTION|| 58-1699775|1326041732|CHC13|A9606||10/01/2016|09/30/2017|$0.00|0|0|0||RADIUM RA223 DICHLORIDE THER|| 58-1699775|1326041732|CHC13|A9606||10/01/2017|09/30/2018|$0.00|0|0|0||RADIUM RA223 DICHLORIDE THER|| 58-1699775|1326041732|CHC13|ANEST||11/01/2013|12/31/9999|$48.40|15|1||||| 58-1699775|1326041732|CHC13|ATP02||11/01/2013|12/31/9999|$9.21|0|0||||| 58-1699775|1326041732|CHC13|ATP03||11/01/2013|12/31/9999|$11.76|0|0||||| 58-1699775|1326041732|CHC13|ATP04||11/01/2013|12/31/9999|$12.42|0|0||||| 58-1699775|1326041732|CHC13|ATP05||11/01/2013|12/31/9999|$13.86|0|0||||| 58-1699775|1326041732|CHC13|ATP06||11/01/2013|12/31/9999|$13.89|0|0||||| 58-1699775|1326041732|CHC13|ATP07||11/01/2013|12/31/9999|$14.46|0|0||||| 58-1699775|1326041732|CHC13|ATP08||11/01/2013|12/31/9999|$14.97|0|0||||| 58-1699775|1326041732|CHC13|ATP09||11/01/2013|12/31/9999|$15.38|0|0||||| 58-1699775|1326041732|CHC13|ATP10||11/01/2013|12/31/9999|$15.38|0|0||||| 58-1699775|1326041732|CHC13|ATP11||11/01/2013|12/31/9999|$15.64|0|0||||| 58-1699775|1326041732|CHC13|ATP12||11/01/2013|12/31/9999|$15.99|0|0||||| 58-1699775|1326041732|CHC13|ATP16||11/01/2013|12/31/9999|$18.71|0|0||||| 58-1699775|1326041732|CHC13|ATP18||11/01/2013|12/31/9999|$18.84|0|0||||| 58-1699775|1326041732|CHC13|ATP19||11/01/2013|12/31/9999|$19.59|0|0||||| 58-1699775|1326041732|CHC13|ATP20||11/01/2013|12/31/9999|$20.20|0|0||||| 58-1699775|1326041732|CHC13|ATP21||11/01/2013|12/31/9999|$20.85|0|0||||| 58-1699775|1326041732|CHC13|ATP22||11/01/2013|12/31/9999|$21.49|0|0||||| 58-1699775|1326041732|CHC13|ATP23||11/01/2013|12/31/9999|$21.49|0|0||||| 58-1699775|1326041732|CHC13|B1460|NU|01/01/2016|12/31/9999|$1.75|0|0||||| 58-1699775|1326041732|CHC13|B4034|NU|01/01/2015|12/31/9999|$8.45|0|0|||ENTER FEED SUPKIT SYR BY DAY|| 58-1699775|1326041732|CHC13|B4035|NU|01/01/2015|12/31/9999|$16.25|0|0|||ENTERAL FEED SUPP PUMP PER D|| 58-1699775|1326041732|CHC13|B4160|NU|01/01/2015|12/31/9999|$1.75|0|0|||EF PED CALORIC DENSE>/=0.7KC|| 58-1699775|1326041732|CHC13|B4161|NU|01/01/2015|12/31/9999|$3.96|0|0|||EF PED HYDROLYZED/AMINO ACID|| 58-1699775|1326041732|CHC13|B9002|RR|01/01/2015|12/31/9999|$289.09|0|0|||ENTERAL INFUSION PUMP W/ ALA|| 58-1699775|1326041732|CHC13|E0100|NU|11/01/2013|12/31/2017|$28.29|0|0|||CANE ADJUST/FIXED WITH TIP|| 58-1699775|1326041732|CHC13|E0100|NU|01/01/2018|12/31/9999|$29.65|0|0|||CANE ADJUST/FIXED WITH TIP|| 58-1699775|1326041732|CHC13|E0100|RR|11/01/2013|12/31/2017|$6.78|0|0|||CANE ADJUST/FIXED WITH TIP|| 58-1699775|1326041732|CHC13|E0100|RR|01/01/2018|12/31/9999|$7.10|0|0|||CANE ADJUST/FIXED WITH TIP|| 58-1699775|1326041732|CHC13|E0100|UE|11/01/2013|12/31/9999|$22.44|0|0|||CANE ADJUST/FIXED WITH TIP|| 58-1699775|1326041732|CHC13|E0105|NU|11/01/2013|12/31/2017|$65.95|0|0|||CANE ADJUST/FIXED QUAD/3 PRO|| 58-1699775|1326041732|CHC13|E0105|NU|01/01/2018|12/31/9999|$69.10|0|0|||CANE ADJUST/FIXED QUAD/3 PRO|| 58-1699775|1326041732|CHC13|E0105|RR|11/01/2013|12/31/2017|$10.10|0|0|||CANE ADJUST/FIXED QUAD/3 PRO|| 58-1699775|1326041732|CHC13|E0105|RR|01/01/2018|12/31/9999|$10.60|0|0|||CANE ADJUST/FIXED QUAD/3 PRO|| 58-1699775|1326041732|CHC13|E0105|UE|11/01/2013|12/31/9999|$50.82|0|0|||CANE ADJUST/FIXED QUAD/3 PRO|| 58-1699775|1326041732|CHC13|E0110|NU|11/01/2013|12/31/9999|$88.55|0|0|||CRUTCH FOREARM PAIR|| 58-1699775|1326041732|CHC13|E0110|RR|11/01/2013|12/31/9999|$18.24|0|0|||CRUTCH FOREARM PAIR|| 58-1699775|1326041732|CHC13|E0110|UE|11/01/2013|12/31/9999|$66.40|0|0|||CRUTCH FOREARM PAIR|| 58-1699775|1326041732|CHC13|E0111|NU|11/01/2013|12/31/9999|$66.05|0|0|||CRUTCH FOREARM EACH|| 58-1699775|1326041732|CHC13|E0111|RR|11/01/2013|12/31/9999|$9.61|0|0|||CRUTCH FOREARM EACH|| 58-1699775|1326041732|CHC13|E0111|UE|11/01/2013|12/31/9999|$49.52|0|0|||CRUTCH FOREARM EACH|| 58-1699775|1326041732|CHC13|E0112|NU|11/01/2013|12/31/9999|$42.22|0|0|||CRUTCH UNDERARM PAIR WOOD|| 58-1699775|1326041732|CHC13|E0112|RR|11/01/2013|12/31/9999|$11.34|0|0|||CRUTCH UNDERARM PAIR WOOD|| 58-1699775|1326041732|CHC13|E0112|UE|11/01/2013|12/31/9999|$32.21|0|0|||CRUTCH UNDERARM PAIR WOOD|| 58-1699775|1326041732|CHC13|E0113|NU|11/01/2013|12/31/9999|$24.12|0|0|||CRUTCH UNDERARM EACH WOOD|| 58-1699775|1326041732|CHC13|E0113|RR|11/01/2013|12/31/9999|$5.87|0|0|||CRUTCH UNDERARM EACH WOOD|| 58-1699775|1326041732|CHC13|E0113|UE|11/01/2013|12/31/9999|$18.10|0|0|||CRUTCH UNDERARM EACH WOOD|| 58-1699775|1326041732|CHC13|E0114||11/01/2013|12/31/9999|$53.86|0|0|||CRUTCH UNDERARM PAIR NO WOOD|| 58-1699775|1326041732|CHC13|E0114|KX|11/01/2013|12/31/9999|$53.86|0|0|||CRUTCH UNDERARM PAIR NO WOOD|| 58-1699775|1326041732|CHC13|E0114|NU|11/01/2013|12/31/9999|$53.86|0|0|||CRUTCH UNDERARM PAIR NO WOOD|| 58-1699775|1326041732|CHC13|E0114|RR|11/01/2013|12/31/9999|$9.79|0|0|||CRUTCH UNDERARM PAIR NO WOOD|| 58-1699775|1326041732|CHC13|E0114|UE|11/01/2013|12/31/9999|$40.70|0|0|||CRUTCH UNDERARM PAIR NO WOOD|| 58-1699775|1326041732|CHC13|E0116|NU|11/01/2013|12/31/9999|$31.66|0|0|||CRUTCH UNDERARM EACH NO WOOD|| 58-1699775|1326041732|CHC13|E0116|RR|11/01/2013|12/31/9999|$6.16|0|0|||CRUTCH UNDERARM EACH NO WOOD|| 58-1699775|1326041732|CHC13|E0116|UE|11/01/2013|12/31/9999|$23.84|0|0|||CRUTCH UNDERARM EACH NO WOOD|| 58-1699775|1326041732|CHC13|E0117|NU|11/01/2013|12/31/9999|$258.75|0|0|||UNDERARM SPRINGASSIST CRUTCH|| 58-1699775|1326041732|CHC13|E0117|RR|11/01/2013|12/31/9999|$25.85|0|0|||UNDERARM SPRINGASSIST CRUTCH|| 58-1699775|1326041732|CHC13|E0117|UE|11/01/2013|12/31/9999|$194.09|0|0|||UNDERARM SPRINGASSIST CRUTCH|| 58-1699775|1326041732|CHC13|E0118|NU|01/01/2015|12/31/9999|$490.00|0|0|||CRUTCH SUBSTITUTE|| 58-1699775|1326041732|CHC13|E0118|RR|11/01/2013|12/31/9999|$21.06|0|0|||CRUTCH SUBSTITUTE|| 58-1699775|1326041732|CHC13|E0130|NU|11/01/2013|12/31/9999|$81.27|0|0|||WALKER RIGID ADJUST/FIXED HT|| 58-1699775|1326041732|CHC13|E0130|RR|11/01/2013|12/31/9999|$19.45|0|0|||WALKER RIGID ADJUST/FIXED HT|| 58-1699775|1326041732|CHC13|E0130|UE|11/01/2013|12/31/9999|$63.34|0|0|||WALKER RIGID ADJUST/FIXED HT|| 58-1699775|1326041732|CHC13|E0135|NU|11/01/2013|12/31/9999|$87.45|0|0|||WALKER FOLDING ADJUST/FIXED|| 58-1699775|1326041732|CHC13|E0135|RR|11/01/2013|12/31/9999|$19.96|0|0|||WALKER FOLDING ADJUST/FIXED|| 58-1699775|1326041732|CHC13|E0135|UE|11/01/2013|12/31/9999|$68.70|0|0|||WALKER FOLDING ADJUST/FIXED|| 58-1699775|1326041732|CHC13|E0140|NU|11/01/2013|12/31/9999|$417.43|0|0|||WALKER W TRUNK SUPPORT|| 58-1699775|1326041732|CHC13|E0140|RR|11/01/2013|12/31/9999|$41.75|0|0|||WALKER W TRUNK SUPPORT|| 58-1699775|1326041732|CHC13|E0140|UE|11/01/2013|12/31/9999|$313.09|0|0|||WALKER W TRUNK SUPPORT|| 58-1699775|1326041732|CHC13|E0141|NU|11/01/2013|12/31/9999|$128.94|0|0|||RIGID WHEELED WALKER ADJ/FIX|| 58-1699775|1326041732|CHC13|E0141|RR|11/01/2013|12/31/9999|$22.00|0|0|||RIGID WHEELED WALKER ADJ/FIX|| 58-1699775|1326041732|CHC13|E0141|UE|11/01/2013|12/31/9999|$96.70|0|0|||RIGID WHEELED WALKER ADJ/FIX|| 58-1699775|1326041732|CHC13|E0143|NU|11/01/2013|12/31/2017|$128.94|0|0|||WALKER FOLDING WHEELED W/O S|| 58-1699775|1326041732|CHC13|E0143|NU|01/01/2018|12/31/9999|$59.44|0|0|||WALKER FOLDING WHEELED W/O S|| 58-1699775|1326041732|CHC13|E0143|RR|11/01/2013|12/31/2017|$21.24|0|0|||WALKER FOLDING WHEELED W/O S|| 58-1699775|1326041732|CHC13|E0143|RR|01/01/2018|12/31/9999|$5.95|0|0|||WALKER FOLDING WHEELED W/O S|| 58-1699775|1326041732|CHC13|E0143|UE|11/01/2013|12/31/9999|$96.70|0|0|||WALKER FOLDING WHEELED W/O S|| 58-1699775|1326041732|CHC13|E0144|NU|11/01/2013|12/31/9999|$368.53|0|0|||ENCLOSED WALKER W REAR SEAT|| 58-1699775|1326041732|CHC13|E0144|RR|11/01/2013|12/31/9999|$36.86|0|0|||ENCLOSED WALKER W REAR SEAT|| 58-1699775|1326041732|CHC13|E0144|UE|11/01/2013|12/31/9999|$276.38|0|0|||ENCLOSED WALKER W REAR SEAT|| 58-1699775|1326041732|CHC13|E0147|NU|11/01/2013|12/31/9999|$665.19|0|0|||WALKER VARIABLE WHEEL RESIST|| 58-1699775|1326041732|CHC13|E0147|RR|11/01/2013|12/31/9999|$66.53|0|0|||WALKER VARIABLE WHEEL RESIST|| 58-1699775|1326041732|CHC13|E0147|UE|11/01/2013|12/31/9999|$498.91|0|0|||WALKER VARIABLE WHEEL RESIST|| 58-1699775|1326041732|CHC13|E0148|NU|11/01/2013|12/31/9999|$147.04|0|0|||HEAVYDUTY WALKER NO WHEELS|| 58-1699775|1326041732|CHC13|E0148|RR|11/01/2013|12/31/9999|$14.72|0|0|||HEAVYDUTY WALKER NO WHEELS|| 58-1699775|1326041732|CHC13|E0148|UE|11/01/2013|12/31/9999|$110.26|0|0|||HEAVYDUTY WALKER NO WHEELS|| 58-1699775|1326041732|CHC13|E0149|NU|11/01/2013|12/31/9999|$258.30|0|0|||HEAVY DUTY WHEELED WALKER|| 58-1699775|1326041732|CHC13|E0149|RR|11/01/2013|12/31/9999|$25.82|0|0|||HEAVY DUTY WHEELED WALKER|| 58-1699775|1326041732|CHC13|E0149|UE|11/01/2013|12/31/9999|$193.71|0|0|||HEAVY DUTY WHEELED WALKER|| 58-1699775|1326041732|CHC13|E0153|NU|11/01/2013|12/31/9999|$81.06|0|0|||FOREARM CRUTCH PLATFORM ATTA|| 58-1699775|1326041732|CHC13|E0153|RR|11/01/2013|12/31/9999|$8.95|0|0|||FOREARM CRUTCH PLATFORM ATTA|| 58-1699775|1326041732|CHC13|E0153|UE|11/01/2013|12/31/9999|$60.76|0|0|||FOREARM CRUTCH PLATFORM ATTA|| 58-1699775|1326041732|CHC13|E0154|NU|11/01/2013|12/31/9999|$81.60|0|0|||WALKER PLATFORM ATTACHMENT|| 58-1699775|1326041732|CHC13|E0154|RR|11/01/2013|12/31/9999|$8.42|0|0|||WALKER PLATFORM ATTACHMENT|| 58-1699775|1326041732|CHC13|E0154|UE|11/01/2013|12/31/9999|$61.20|0|0|||WALKER PLATFORM ATTACHMENT|| 58-1699775|1326041732|CHC13|E0155|NU|11/01/2013|12/31/9999|$35.41|0|0|||WALKER WHEEL ATTACHMENT|PAIR|| 58-1699775|1326041732|CHC13|E0155|RR|11/01/2013|12/31/9999|$3.79|0|0|||WALKER WHEEL ATTACHMENT|PAIR|| 58-1699775|1326041732|CHC13|E0155|UE|11/01/2013|12/31/9999|$26.54|0|0|||WALKER WHEEL ATTACHMENT|PAIR|| 58-1699775|1326041732|CHC13|E0156|NU|11/01/2013|12/31/2017|$30.59|0|0|||WALKER SEAT ATTACHMENT|| 58-1699775|1326041732|CHC13|E0156|NU|01/01/2018|12/31/9999|$19.60|0|0|||WALKER SEAT ATTACHMENT|| 58-1699775|1326041732|CHC13|E0156|RR|11/01/2013|12/31/2017|$3.91|0|0|||WALKER SEAT ATTACHMENT|| 58-1699775|1326041732|CHC13|E0156|RR|01/01/2018|12/31/9999|$1.96|0|0|||WALKER SEAT ATTACHMENT|| 58-1699775|1326041732|CHC13|E0156|UE|11/01/2013|12/31/9999|$22.96|0|0|||WALKER SEAT ATTACHMENT|| 58-1699775|1326041732|CHC13|E0157|NU|11/01/2013|12/31/9999|$83.74|0|0|||WALKER CRUTCH ATTACHMENT|| 58-1699775|1326041732|CHC13|E0157|RR|11/01/2013|12/31/9999|$8.85|0|0|||WALKER CRUTCH ATTACHMENT|| 58-1699775|1326041732|CHC13|E0157|UE|11/01/2013|12/31/9999|$62.80|0|0|||WALKER CRUTCH ATTACHMENT|| 58-1699775|1326041732|CHC13|E0158|NU|11/01/2013|12/31/9999|$37.24|0|0|||WALKER LEG EXTENDERS SET OF4|| 58-1699775|1326041732|CHC13|E0158|RR|11/01/2013|12/31/9999|$4.11|0|0|||WALKER LEG EXTENDERS SET OF4|| 58-1699775|1326041732|CHC13|E0158|UE|11/01/2013|12/31/9999|$28.11|0|0|||WALKER LEG EXTENDERS SET OF4|| 58-1699775|1326041732|CHC13|E0159|NU|11/01/2013|12/31/9999|$20.68|0|0|||BRAKE FOR WHEELED WALKER|| 58-1699775|1326041732|CHC13|E0159|RR|11/01/2013|12/31/9999|$2.14|0|0|||BRAKE FOR WHEELED WALKER|| 58-1699775|1326041732|CHC13|E0159|UE|11/01/2013|12/31/9999|$15.51|0|0|||BRAKE FOR WHEELED WALKER|| 58-1699775|1326041732|CHC13|E0160|NU|11/01/2013|12/31/9999|$37.73|0|0|||SITZ TYPE BATH OR EQUIPMENT|| 58-1699775|1326041732|CHC13|E0160|RR|11/01/2013|12/31/9999|$4.95|0|0|||SITZ TYPE BATH OR EQUIPMENT|| 58-1699775|1326041732|CHC13|E0160|UE|11/01/2013|12/31/9999|$28.26|0|0|||SITZ TYPE BATH OR EQUIPMENT|| 58-1699775|1326041732|CHC13|E0161|NU|11/01/2013|12/31/9999|$35.21|0|0|||SITZ BATH/EQUIPMENT W/FAUCET|| 58-1699775|1326041732|CHC13|E0161|RR|11/01/2013|12/31/9999|$4.07|0|0|||SITZ BATH/EQUIPMENT W/FAUCET|| 58-1699775|1326041732|CHC13|E0161|UE|11/01/2013|12/31/9999|$26.36|0|0|||SITZ BATH/EQUIPMENT W/FAUCET|| 58-1699775|1326041732|CHC13|E0162|NU|11/01/2013|12/31/9999|$166.29|0|0|||SITZ BATH CHAIR|| 58-1699775|1326041732|CHC13|E0162|RR|11/01/2013|12/31/9999|$17.44|0|0|||SITZ BATH CHAIR|| 58-1699775|1326041732|CHC13|E0162|UE|11/01/2013|12/31/9999|$128.95|0|0|||SITZ BATH CHAIR|| 58-1699775|1326041732|CHC13|E0163|NU|11/01/2013|12/31/2017|$148.07|0|0|||COMMODE CHAIR STATIONRY FXD|| 58-1699775|1326041732|CHC13|E0163|NU|01/01/2018|12/31/9999|$66.61|0|0|||COMMODE CHAIR STATIONRY FXD|| 58-1699775|1326041732|CHC13|E0163|RR|11/01/2013|12/31/2017|$31.22|0|0|||COMMODE CHAIR STATIONRY FXD|| 58-1699775|1326041732|CHC13|E0163|RR|01/01/2018|12/31/9999|$6.66|0|0|||COMMODE CHAIR STATIONRY FXD|| 58-1699775|1326041732|CHC13|E0163|UE|11/01/2013|12/31/9999|$107.79|0|0|||COMMODE CHAIR STATIONRY FXD|| 58-1699775|1326041732|CHC13|E0165|RR|11/01/2013|12/31/2017|$24.95|0|0|||COMMODE CHAIR STATIONRY DET|| 58-1699775|1326041732|CHC13|E0165|RR|01/01/2018|12/31/9999|$15.34|0|0|||COMMODE CHAIR STATIONRY DET|| 58-1699775|1326041732|CHC13|E0167|NU|11/01/2013|12/31/9999|$13.70|0|0|||COMMODE CHAIR PAIL OR PAN|| 58-1699775|1326041732|CHC13|E0167|RR|11/01/2013|12/31/9999|$1.44|0|0|||COMMODE CHAIR PAIL OR PAN|| 58-1699775|1326041732|CHC13|E0167|UE|11/01/2013|12/31/9999|$11.33|0|0|||COMMODE CHAIR PAIL OR PAN|| 58-1699775|1326041732|CHC13|E0168|NU|11/01/2013|12/31/2017|$202.64|0|0|||HEAVYDUTY/WIDE COMMODE CHAIR|| 58-1699775|1326041732|CHC13|E0168|NU|01/01/2018|12/31/9999|$146.91|0|0|||HEAVYDUTY/WIDE COMMODE CHAIR|| 58-1699775|1326041732|CHC13|E0168|RR|11/01/2013|12/31/2017|$20.36|0|0|||HEAVYDUTY/WIDE COMMODE CHAIR|| 58-1699775|1326041732|CHC13|E0168|RR|01/01/2018|12/31/9999|$14.69|0|0|||HEAVYDUTY/WIDE COMMODE CHAIR|| 58-1699775|1326041732|CHC13|E0168|UE|11/01/2013|12/31/9999|$151.96|0|0|||HEAVYDUTY/WIDE COMMODE CHAIR|| 58-1699775|1326041732|CHC13|E0170||11/01/2013|12/31/9999|$215.80|0|0|||COMMODE CHAIR ELECTRIC|| 58-1699775|1326041732|CHC13|E0171||11/01/2013|12/31/9999|$38.84|0|0|||COMMODE CHAIR NON-ELECTRIC|| 58-1699775|1326041732|CHC13|E0175|NU|11/01/2013|12/31/9999|$88.92|0|0|||COMMODE CHAIR FOOT REST|| 58-1699775|1326041732|CHC13|E0175|RR|11/01/2013|12/31/9999|$8.89|0|0|||COMMODE CHAIR FOOT REST|| 58-1699775|1326041732|CHC13|E0175|UE|11/01/2013|12/31/9999|$65.45|0|0|||COMMODE CHAIR FOOT REST|| 58-1699775|1326041732|CHC13|E0181||11/01/2013|12/31/9999|$34.99|0|0|||PRESS PAD ALTERNATING W/ PUM|| 58-1699775|1326041732|CHC13|E0182||11/01/2013|12/31/9999|$29.87|0|0|||PRESSURE PAD ALTERNATING PUM|| 58-1699775|1326041732|CHC13|E0184|NU|11/01/2013|12/31/9999|$261.42|0|0|||DRY PRESSURE MATTRESS|| 58-1699775|1326041732|CHC13|E0184|RR|11/01/2013|12/31/9999|$30.35|0|0|||DRY PRESSURE MATTRESS|| 58-1699775|1326041732|CHC13|E0184|UE|11/01/2013|12/31/9999|$200.49|0|0|||DRY PRESSURE MATTRESS|| 58-1699775|1326041732|CHC13|E0185|NU|11/01/2013|12/31/9999|$389.76|0|0|||GEL PRESSURE MATTRESS PAD|| 58-1699775|1326041732|CHC13|E0185|RR|11/01/2013|12/31/9999|$51.29|0|0|||GEL PRESSURE MATTRESS PAD|| 58-1699775|1326041732|CHC13|E0185|UE|11/01/2013|12/31/9999|$292.31|0|0|||GEL PRESSURE MATTRESS PAD|| 58-1699775|1326041732|CHC13|E0186||11/01/2013|12/31/9999|$23.18|0|0|||AIR PRESSURE MATTRESS|| 58-1699775|1326041732|CHC13|E0187||11/01/2013|12/31/9999|$26.49|0|0|||WATER PRESSURE MATTRESS|| 58-1699775|1326041732|CHC13|E0188|NU|11/01/2013|12/31/9999|$35.49|0|0|||SYNTHETIC SHEEPSKIN PAD|| 58-1699775|1326041732|CHC13|E0188|RR|11/01/2013|12/31/9999|$4.17|0|0|||SYNTHETIC SHEEPSKIN PAD|| 58-1699775|1326041732|CHC13|E0188|UE|11/01/2013|12/31/9999|$26.65|0|0|||SYNTHETIC SHEEPSKIN PAD|| 58-1699775|1326041732|CHC13|E0189|NU|11/01/2013|12/31/9999|$69.77|0|0|||LAMBSWOOL SHEEPSKIN PAD|| 58-1699775|1326041732|CHC13|E0189|RR|11/01/2013|12/31/9999|$7.55|0|0|||LAMBSWOOL SHEEPSKIN PAD|| 58-1699775|1326041732|CHC13|E0189|UE|11/01/2013|12/31/9999|$52.34|0|0|||LAMBSWOOL SHEEPSKIN PAD|| 58-1699775|1326041732|CHC13|E0191|NU|11/01/2013|12/31/9999|$11.40|0|0|||PROTECTOR HEEL OR ELBOW|| 58-1699775|1326041732|CHC13|E0191|RR|11/01/2013|12/31/9999|$1.17|0|0|||PROTECTOR HEEL OR ELBOW|| 58-1699775|1326041732|CHC13|E0191|UE|11/01/2013|12/31/9999|$8.51|0|0|||PROTECTOR HEEL OR ELBOW|| 58-1699775|1326041732|CHC13|E0193||11/01/2013|12/31/9999|$986.59|0|0|||POWERED AIR FLOTATION BED|| 58-1699775|1326041732|CHC13|E0194||11/01/2013|12/31/9999|$3|714.04|0|0|||AIR FLUIDIZED BED|| 58-1699775|1326041732|CHC13|E0196||11/01/2013|12/31/9999|$37.09|0|0|||GEL PRESSURE MATTRESS|| 58-1699775|1326041732|CHC13|E0197|NU|11/01/2013|12/31/9999|$252.89|0|0|||AIR PRESSURE PAD FOR MATTRES|| 58-1699775|1326041732|CHC13|E0197|RR|11/01/2013|12/31/9999|$34.89|0|0|||AIR PRESSURE PAD FOR MATTRES|| 58-1699775|1326041732|CHC13|E0197|UE|11/01/2013|12/31/9999|$222.14|0|0|||AIR PRESSURE PAD FOR MATTRES|| 58-1699775|1326041732|CHC13|E0198|NU|11/01/2013|12/31/9999|$252.89|0|0|||WATER PRESSURE PAD FOR MATTR|| 58-1699775|1326041732|CHC13|E0198|RR|11/01/2013|12/31/9999|$26.20|0|0|||WATER PRESSURE PAD FOR MATTR|| 58-1699775|1326041732|CHC13|E0198|UE|11/01/2013|12/31/9999|$191.89|0|0|||WATER PRESSURE PAD FOR MATTR|| 58-1699775|1326041732|CHC13|E0199|NU|11/01/2013|12/31/9999|$43.04|0|0|||DRY PRESSURE PAD FOR MATTRES|| 58-1699775|1326041732|CHC13|E0199|RR|11/01/2013|12/31/9999|$4.29|0|0|||DRY PRESSURE PAD FOR MATTRES|| 58-1699775|1326041732|CHC13|E0199|UE|11/01/2013|12/31/9999|$32.27|0|0|||DRY PRESSURE PAD FOR MATTRES|| 58-1699775|1326041732|CHC13|E0200|NU|11/01/2013|12/31/9999|$106.45|0|0|||HEAT LAMP WITHOUT STAND|| 58-1699775|1326041732|CHC13|E0200|RR|11/01/2013|12/31/9999|$14.45|0|0|||HEAT LAMP WITHOUT STAND|| 58-1699775|1326041732|CHC13|E0200|UE|11/01/2013|12/31/9999|$79.88|0|0|||HEAT LAMP WITHOUT STAND|| 58-1699775|1326041732|CHC13|E0202||11/01/2013|12/31/9999|$71.45|0|0|||PHOTOTHERAPY LIGHT W/ PHOTOM|| 58-1699775|1326041732|CHC13|E0205|NU|11/01/2013|12/31/9999|$260.56|0|0|||HEAT LAMP WITH STAND|| 58-1699775|1326041732|CHC13|E0205|RR|11/01/2013|12/31/9999|$28.66|0|0|||HEAT LAMP WITH STAND|| 58-1699775|1326041732|CHC13|E0205|UE|11/01/2013|12/31/9999|$195.41|0|0|||HEAT LAMP WITH STAND|| 58-1699775|1326041732|CHC13|E0210|NU|11/01/2013|12/31/9999|$39.11|0|0|||ELECTRIC HEAT PAD STANDARD|| 58-1699775|1326041732|CHC13|E0210|RR|11/01/2013|12/31/9999|$3.90|0|0|||ELECTRIC HEAT PAD STANDARD|| 58-1699775|1326041732|CHC13|E0210|UE|11/01/2013|12/31/9999|$29.31|0|0|||ELECTRIC HEAT PAD STANDARD|| 58-1699775|1326041732|CHC13|E0215|NU|11/01/2013|12/31/9999|$80.85|0|0|||ELECTRIC HEAT PAD MOIST|| 58-1699775|1326041732|CHC13|E0215|RR|11/01/2013|12/31/9999|$8.46|0|0|||ELECTRIC HEAT PAD MOIST|| 58-1699775|1326041732|CHC13|E0215|UE|11/01/2013|12/31/9999|$60.65|0|0|||ELECTRIC HEAT PAD MOIST|| 58-1699775|1326041732|CHC13|E0217|NU|11/01/2013|12/31/9999|$662.95|0|0|||WATER CIRC HEAT PAD W PUMP|| 58-1699775|1326041732|CHC13|E0217|RR|11/01/2013|12/31/9999|$66.28|0|0|||WATER CIRC HEAT PAD W PUMP|| 58-1699775|1326041732|CHC13|E0217|UE|11/01/2013|12/31/9999|$497.20|0|0|||WATER CIRC HEAT PAD W PUMP|| 58-1699775|1326041732|CHC13|E0225|NU|11/01/2013|12/31/9999|$521.81|0|0|||HYDROCOLLATOR UNIT|| 58-1699775|1326041732|CHC13|E0225|RR|11/01/2013|12/31/9999|$51.44|0|0|||HYDROCOLLATOR UNIT|| 58-1699775|1326041732|CHC13|E0225|UE|11/01/2013|12/31/9999|$391.35|0|0|||HYDROCOLLATOR UNIT|| 58-1699775|1326041732|CHC13|E0235||11/01/2013|12/31/9999|$23.16|0|0|||PARAFFIN BATH UNIT PORTABLE|| 58-1699775|1326041732|CHC13|E0236||11/01/2013|12/31/9999|$52.89|0|0|||PUMP FOR WATER CIRCULATING P|| 58-1699775|1326041732|CHC13|E0239|NU|11/01/2013|12/31/9999|$603.96|0|0|||HYDROCOLLATOR UNIT PORTABLE|| 58-1699775|1326041732|CHC13|E0239|RR|11/01/2013|12/31/9999|$60.40|0|0|||HYDROCOLLATOR UNIT PORTABLE|| 58-1699775|1326041732|CHC13|E0239|UE|11/01/2013|12/31/9999|$453.00|0|0|||HYDROCOLLATOR UNIT PORTABLE|| 58-1699775|1326041732|CHC13|E0249|NU|11/01/2013|12/31/9999|$133.74|0|0|||PAD WATER CIRCULATING HEAT U|| 58-1699775|1326041732|CHC13|E0249|RR|11/01/2013|12/31/9999|$14.71|0|0|||PAD WATER CIRCULATING HEAT U|| 58-1699775|1326041732|CHC13|E0249|UE|11/01/2013|12/31/9999|$100.30|0|0|||PAD WATER CIRCULATING HEAT U|| 58-1699775|1326041732|CHC13|E0250||11/01/2013|12/31/9999|$98.49|0|0|||HOSP BED FIXED HT W/ MATTRES|| 58-1699775|1326041732|CHC13|E0251||11/01/2013|12/31/9999|$73.83|0|0|||HOSP BED FIXD HT W/O MATTRES|| 58-1699775|1326041732|CHC13|E0255||11/01/2013|12/31/9999|$116.53|0|0|||HOSPITAL BED VAR HT W/ MATTR|| 58-1699775|1326041732|CHC13|E0256||11/01/2013|12/31/9999|$81.99|0|0|||HOSPITAL BED VAR HT W/O MATT|| 58-1699775|1326041732|CHC13|E0260||11/01/2013|12/31/9999|$162.55|0|0|||HOSP BED SEMI-ELECTR W/ MATT|| 58-1699775|1326041732|CHC13|E0261||11/01/2013|12/31/9999|$134.70|0|0|||HOSP BED SEMI-ELECTR W/O MAT|| 58-1699775|1326041732|CHC13|E0265||11/01/2013|12/31/9999|$196.61|0|0|||HOSP BED TOTAL ELECTR W/ MAT|| 58-1699775|1326041732|CHC13|E0266||11/01/2013|12/31/9999|$174.69|0|0|||HOSP BED TOTAL ELEC W/O MATT|| 58-1699775|1326041732|CHC13|E0271|NU|11/01/2013|12/31/9999|$234.97|0|0|||MATTRESS INNERSPRING|| 58-1699775|1326041732|CHC13|E0271|RR|11/01/2013|12/31/9999|$23.51|0|0|||MATTRESS INNERSPRING|| 58-1699775|1326041732|CHC13|E0271|UE|11/01/2013|12/31/9999|$176.24|0|0|||MATTRESS INNERSPRING|| 58-1699775|1326041732|CHC13|E0272|NU|11/01/2013|12/31/9999|$234.19|0|0|||MATTRESS FOAM RUBBER|| 58-1699775|1326041732|CHC13|E0272|RR|11/01/2013|12/31/9999|$24.45|0|0|||MATTRESS FOAM RUBBER|| 58-1699775|1326041732|CHC13|E0272|UE|11/01/2013|12/31/9999|$174.80|0|0|||MATTRESS FOAM RUBBER|| 58-1699775|1326041732|CHC13|E0275|NU|11/01/2013|12/31/9999|$20.56|0|0|||BED PAN STANDARD|| 58-1699775|1326041732|CHC13|E0275|RR|11/01/2013|12/31/9999|$2.15|0|0|||BED PAN STANDARD|| 58-1699775|1326041732|CHC13|E0275|UE|11/01/2013|12/31/9999|$15.41|0|0|||BED PAN STANDARD|| 58-1699775|1326041732|CHC13|E0276|NU|11/01/2013|12/31/9999|$17.88|0|0|||BED PAN FRACTURE|| 58-1699775|1326041732|CHC13|E0276|RR|11/01/2013|12/31/9999|$2.11|0|0|||BED PAN FRACTURE|| 58-1699775|1326041732|CHC13|E0276|UE|11/01/2013|12/31/9999|$14.13|0|0|||BED PAN FRACTURE|| 58-1699775|1326041732|CHC13|E0277||11/01/2013|12/31/9999|$814.09|0|0|||POWERED PRES-REDU AIR MATTRS|| 58-1699775|1326041732|CHC13|E0280|NU|11/01/2013|12/31/9999|$44.21|0|0|||BED CRADLE|| 58-1699775|1326041732|CHC13|E0280|RR|11/01/2013|12/31/9999|$4.76|0|0|||BED CRADLE|| 58-1699775|1326041732|CHC13|E0280|UE|11/01/2013|12/31/9999|$33.15|0|0|||BED CRADLE|| 58-1699775|1326041732|CHC13|E0290||11/01/2013|12/31/9999|$73.51|0|0|||HOSP BED FX HT W/O RAILS W/M|| 58-1699775|1326041732|CHC13|E0291||11/01/2013|12/31/9999|$53.41|0|0|||HOSP BED FX HT W/O RAIL W/O|| 58-1699775|1326041732|CHC13|E0292||11/01/2013|12/31/9999|$82.66|0|0|||HOSP BED VAR HT W/O RAIL W/O|| 58-1699775|1326041732|CHC13|E0293||11/01/2013|12/31/9999|$70.35|0|0|||HOSP BED VAR HT W/O RAIL W/|| 58-1699775|1326041732|CHC13|E0294||11/01/2013|12/31/9999|$128.51|0|0|||HOSP BED SEMI-ELECT W/ MATTR|| 58-1699775|1326041732|CHC13|E0295||11/01/2013|12/31/9999|$125.26|0|0|||HOSP BED SEMI-ELECT W/O MATT|| 58-1699775|1326041732|CHC13|E0296||11/01/2013|12/31/9999|$161.51|0|0|||HOSP BED TOTAL ELECT W/ MATT|| 58-1699775|1326041732|CHC13|E0297||11/01/2013|12/31/9999|$138.37|0|0|||HOSP BED TOTAL ELECT W/O MAT|| 58-1699775|1326041732|CHC13|E0300|NU|11/01/2013|12/31/9999|$3|284.96|0|0|||ENCLOSED PED CRIB HOSP GRADE|| 58-1699775|1326041732|CHC13|E0300|RR|11/01/2013|12/31/9999|$328.49|0|0|||ENCLOSED PED CRIB HOSP GRADE|| 58-1699775|1326041732|CHC13|E0300|UE|11/01/2013|12/31/9999|$2|463.71|0|0|||ENCLOSED PED CRIB HOSP GRADE|| 58-1699775|1326041732|CHC13|E0301||11/01/2013|12/31/9999|$303.43|0|0|||HD HOSP BED| 350-600 LBS|| 58-1699775|1326041732|CHC13|E0302||11/01/2013|12/31/9999|$827.93|0|0|||EX HD HOSP BED > 600 LBS|| 58-1699775|1326041732|CHC13|E0303||11/01/2013|12/31/9999|$341.89|0|0|||HOSP BED HVY DTY XTRA WIDE|| 58-1699775|1326041732|CHC13|E0304||11/01/2013|12/31/9999|$891.85|0|0|||HOSP BED XTRA HVY DTY X WIDE|| 58-1699775|1326041732|CHC13|E0305||11/01/2013|12/31/9999|$17.50|0|0|||RAILS BED SIDE HALF LENGTH|| 58-1699775|1326041732|CHC13|E0310|NU|11/01/2013|12/31/9999|$224.66|0|0|||RAILS BED SIDE FULL LENGTH|| 58-1699775|1326041732|CHC13|E0310|RR|11/01/2013|12/31/9999|$25.15|0|0|||RAILS BED SIDE FULL LENGTH|| 58-1699775|1326041732|CHC13|E0310|UE|11/01/2013|12/31/9999|$168.54|0|0|||RAILS BED SIDE FULL LENGTH|| 58-1699775|1326041732|CHC13|E0316||11/01/2013|12/31/9999|$244.50|0|0|||BED SAFETY ENCLOSURE|| 58-1699775|1326041732|CHC13|E0325|NU|11/01/2013|12/31/9999|$11.54|0|0|||URINAL MALE JUG-TYPE|| 58-1699775|1326041732|CHC13|E0325|RR|11/01/2013|12/31/9999|$1.74|0|0|||URINAL MALE JUG-TYPE|| 58-1699775|1326041732|CHC13|E0325|UE|11/01/2013|12/31/9999|$7.62|0|0|||URINAL MALE JUG-TYPE|| 58-1699775|1326041732|CHC13|E0326|NU|11/01/2013|12/31/9999|$12.37|0|0|||URINAL FEMALE JUG-TYPE|| 58-1699775|1326041732|CHC13|E0326|RR|11/01/2013|12/31/9999|$1.36|0|0|||URINAL FEMALE JUG-TYPE|| 58-1699775|1326041732|CHC13|E0326|UE|11/01/2013|12/31/9999|$9.29|0|0|||URINAL FEMALE JUG-TYPE|| 58-1699775|1326041732|CHC13|E0371||11/01/2013|12/31/9999|$498.91|0|0|||NONPOWER MATTRESS OVERLAY|| 58-1699775|1326041732|CHC13|E0372||11/01/2013|12/31/9999|$605.39|0|0|||POWERED AIR MATTRESS OVERLAY|| 58-1699775|1326041732|CHC13|E0373||11/01/2013|12/31/9999|$693.46|0|0|||NONPOWERED PRESSURE MATTRESS|| 58-1699775|1326041732|CHC13|E0424||11/01/2013|12/31/9999|$220.07|0|0|||STATIONARY COMPRESSED GAS 02|| 58-1699775|1326041732|CHC13|E0431||11/01/2013|12/31/9999|$36.79|0|0|||PORTABLE GASEOUS 02|| 58-1699775|1326041732|CHC13|E0433||11/01/2013|12/31/9999|$64.54|0|0|||PORTABLE LIQUID OXYGEN SYS|| 58-1699775|1326041732|CHC13|E0434||11/01/2013|12/31/9999|$36.79|0|0|||PORTABLE LIQUID 02|| 58-1699775|1326041732|CHC13|E0439||11/01/2013|12/31/9999|$220.07|0|0|||STATIONARY LIQUID 02|| 58-1699775|1326041732|CHC13|E0441||11/01/2013|12/31/9999|$96.81|0|0|||OXYGEN CONTENTS| GASEOUS|| 58-1699775|1326041732|CHC13|E0442||11/01/2013|12/31/9999|$96.81|0|0|||OXYGEN CONTENTS| LIQUID|| 58-1699775|1326041732|CHC13|E0443||11/01/2013|12/31/9999|$96.81|0|0|||PORTABLE 02 CONTENTS| GAS|| 58-1699775|1326041732|CHC13|E0444||11/01/2013|12/31/9999|$96.81|0|0|||PORTABLE 02 CONTENTS| LIQUID|| 58-1699775|1326041732|CHC13|E0450||11/01/2013|12/31/9999|$1|281.60|0|0|||VOL CONTROL VENT INVASIV INT|| 58-1699775|1326041732|CHC13|E0457|NU|11/01/2013|12/31/9999|$825.07|0|0|||CHEST SHELL|| 58-1699775|1326041732|CHC13|E0457|RR|11/01/2013|12/31/9999|$82.51|0|0|||CHEST SHELL|| 58-1699775|1326041732|CHC13|E0457|UE|11/01/2013|12/31/9999|$618.76|0|0|||CHEST SHELL|| 58-1699775|1326041732|CHC13|E0459||11/01/2013|12/31/9999|$64.25|0|0|||CHEST WRAP|| 58-1699775|1326041732|CHC13|E0460||11/01/2013|12/31/9999|$984.94|0|0|||NEG PRESS VENT PORTABL/STATN|| 58-1699775|1326041732|CHC13|E0461||11/01/2013|12/31/9999|$1|281.60|0|0|||VOL CONTROL VENT NONINV INT|| 58-1699775|1326041732|CHC13|E0462||11/01/2013|12/31/9999|$391.25|0|0|||ROCKING BED W/ OR W/O SIDE R|| 58-1699775|1326041732|CHC13|E0463||11/01/2013|12/31/9999|$1|888.29|0|0|||PRESS SUPP VENT INVASIVE INT|| 58-1699775|1326041732|CHC13|E0464||11/01/2013|12/31/9999|$1|888.29|0|0|||PRESS SUPP VENT NONINV INT|| 58-1699775|1326041732|CHC13|E0470|NU|03/01/2016|12/31/9999|$2|145.23|0|0|||RAD W/O BACKUP NON-INV INTFC|| 58-1699775|1326041732|CHC13|E0470|RR|03/01/2016|12/31/2017|$296.95|0|0|||RAD W/O BACKUP NON-INV INTFC|| 58-1699775|1326041732|CHC13|E0470|RR|01/01/2018|12/31/9999|$130.75|0|0|||RAD W/O BACKUP NON-INV INTFC|| 58-1699775|1326041732|CHC13|E0471|NU|05/01/2016|12/31/9999|$4|803.06|0|4803.06|||RAD W/BACKUP NON INV INTRFC|| 58-1699775|1326041732|CHC13|E0471|RR|11/01/2013|12/31/9999|$743.14|0|743.14|||RAD W/BACKUP NON INV INTRFC|| 58-1699775|1326041732|CHC13|E0472||11/01/2013|12/31/9999|$743.14|0|0|||RAD W BACKUP INVASIVE INTRFC|| 58-1699775|1326041732|CHC13|E0480||11/01/2013|12/31/9999|$58.00|0|0|||PERCUSSOR ELECT/PNEUM HOME M|| 58-1699775|1326041732|CHC13|E0482||11/01/2013|12/31/9999|$560.04|0|0|||COUGH STIMULATING DEVICE|| 58-1699775|1326041732|CHC13|E0483||11/01/2013|12/31/9999|$1|427.41|0|0|||CHEST COMPRESSION GEN SYSTEM|| 58-1699775|1326041732|CHC13|E0484|NU|11/01/2013|12/31/9999|$49.57|0|0|||NON-ELEC OSCILLATORY PEP DVC|| 58-1699775|1326041732|CHC13|E0484|RR|11/01/2013|12/31/9999|$4.95|0|0|||NON-ELEC OSCILLATORY PEP DVC|| 58-1699775|1326041732|CHC13|E0484|UE|11/01/2013|12/31/9999|$37.20|0|0|||NON-ELEC OSCILLATORY PEP DVC|| 58-1699775|1326041732|CHC13|E0485||11/01/2013|12/31/9999|$0.00|0|0|||ORAL DEVICE/APPLIANCE PREFAB|| 58-1699775|1326041732|CHC13|E0486||11/01/2013|12/31/9999|$0.00|0|0|||ORAL DEVICE/APPLIANCE CUSFAB|| 58-1699775|1326041732|CHC13|E0500||11/01/2013|12/31/9999|$125.28|0|0|||IPPB ALL TYPES|| 58-1699775|1326041732|CHC13|E0550||11/01/2013|12/31/9999|$67.31|0|0|||HUMIDIF EXTENS SUPPLE W IPPB|| 58-1699775|1326041732|CHC13|E0560|NU|11/01/2013|12/31/9999|$168.71|0|0|||HUMIDIFIER SUPPLEMENTAL W/ I|| 58-1699775|1326041732|CHC13|E0560|RR|11/01/2013|12/31/9999|$21.30|0|0|||HUMIDIFIER SUPPLEMENTAL W/ I|| 58-1699775|1326041732|CHC13|E0560|UE|11/01/2013|12/31/9999|$126.54|0|0|||HUMIDIFIER SUPPLEMENTAL W/ I|| 58-1699775|1326041732|CHC13|E0561|NU|11/01/2013|12/31/9999|$123.82|0|0|||HUMIDIFIER NONHEATED W PAP|| 58-1699775|1326041732|CHC13|E0561|RR|11/01/2013|12/31/9999|$12.36|0|0|||HUMIDIFIER NONHEATED W PAP|| 58-1699775|1326041732|CHC13|E0561|UE|11/01/2013|12/31/9999|$92.86|0|0|||HUMIDIFIER NONHEATED W PAP|| 58-1699775|1326041732|CHC13|E0562|NU|11/01/2013|12/31/2017|$348.59|0|0|||HUMIDIFIER HEATED USED W PAP|| 58-1699775|1326041732|CHC13|E0562|NU|01/01/2018|12/31/9999|$169.68|0|0|||HUMIDIFIER HEATED USED W PAP|| 58-1699775|1326041732|CHC13|E0562|RR|11/01/2013|12/31/2017|$34.84|0|0|||HUMIDIFIER HEATED USED W PAP|| 58-1699775|1326041732|CHC13|E0562|RR|01/01/2018|12/31/9999|$16.96|0|0|||HUMIDIFIER HEATED USED W PAP|| 58-1699775|1326041732|CHC13|E0562|UE|11/01/2013|12/31/9999|$261.44|0|0|||HUMIDIFIER HEATED USED W PAP|| 58-1699775|1326041732|CHC13|E0565||11/01/2013|12/31/9999|$81.93|0|0|||COMPRESSOR AIR POWER SOURCE|| 58-1699775|1326041732|CHC13|E0570|NU|03/01/2016|12/31/9999|$147.77|0|0|||NEBULIZER WITH COMPRESSION|| 58-1699775|1326041732|CHC13|E0570|RR|11/01/2013|12/31/2017|$21.62|0|0|||NEBULIZER WITH COMPRESSION|| 58-1699775|1326041732|CHC13|E0570|RR|01/01/2018|12/31/9999|$7.19|0|0|||NEBULIZER WITH COMPRESSION|| 58-1699775|1326041732|CHC13|E0572||11/01/2013|12/31/9999|$49.89|0|0|||AEROSOL COMPRESSOR ADJUST PR|| 58-1699775|1326041732|CHC13|E0574||11/01/2013|12/31/9999|$52.74|0|0|||ULTRASONIC GENERATOR W SVNEB|| 58-1699775|1326041732|CHC13|E0575||11/01/2013|12/31/9999|$135.31|0|0|||NEBULIZER ULTRASONIC|| 58-1699775|1326041732|CHC13|E0580|NU|11/01/2013|12/31/9999|$155.12|0|0|||NEBULIZER FOR USE W/ REGULAT|| 58-1699775|1326041732|CHC13|E0580|RR|11/01/2013|12/31/9999|$15.51|0|0|||NEBULIZER FOR USE W/ REGULAT|| 58-1699775|1326041732|CHC13|E0580|UE|11/01/2013|12/31/9999|$116.32|0|0|||NEBULIZER FOR USE W/ REGULAT|| 58-1699775|1326041732|CHC13|E0585||11/01/2013|12/31/9999|$40.01|0|0|||NEBULIZER W/ COMPRESSOR & HE|| 58-1699775|1326041732|CHC13|E0600||11/01/2013|12/31/9999|$54.68|0|0|||SUCTION PUMP PORTAB HOM MODL|| 58-1699775|1326041732|CHC13|E0601|NU|11/01/2013|12/31/9999|$1|124.56|0|0|||CONT AIRWAY PRESSURE DEVICE|| 58-1699775|1326041732|CHC13|E0601|RR|11/01/2013|12/31/2017|$131.61|0|0|||CONT AIRWAY PRESSURE DEVICE|| 58-1699775|1326041732|CHC13|E0601|RR|01/01/2018|12/31/9999|$50.70|0|0|||CONT AIRWAY PRESSURE DEVICE|| 58-1699775|1326041732|CHC13|E0602|NU|11/01/2013|12/31/9999|$39.64|0|0|||MANUAL BREAST PUMP|| 58-1699775|1326041732|CHC13|E0602|RR|11/01/2013|12/31/9999|$3.98|0|0|||MANUAL BREAST PUMP|| 58-1699775|1326041732|CHC13|E0602|UE|11/01/2013|12/31/9999|$29.74|0|0|||MANUAL BREAST PUMP|| 58-1699775|1326041732|CHC13|E0603|NU|05/01/2014|12/31/9999|$153.00|0|0|||ELECTRIC BREAST PUMP|| 58-1699775|1326041732|CHC13|E0605|NU|11/01/2013|12/31/9999|$30.16|0|0|||VAPORIZER ROOM TYPE|| 58-1699775|1326041732|CHC13|E0605|RR|11/01/2013|12/31/9999|$3.51|0|0|||VAPORIZER ROOM TYPE|| 58-1699775|1326041732|CHC13|E0605|UE|11/01/2013|12/31/9999|$24.85|0|0|||VAPORIZER ROOM TYPE|| 58-1699775|1326041732|CHC13|E0606||11/01/2013|12/31/9999|$30.81|0|0|||DRAINAGE BOARD POSTURAL|| 58-1699775|1326041732|CHC13|E0607|NU|11/01/2013|12/31/9999|$89.71|0|0|||BLOOD GLUCOSE MONITOR HOME|| 58-1699775|1326041732|CHC13|E0607|RR|11/01/2013|12/31/9999|$8.96|0|0|||BLOOD GLUCOSE MONITOR HOME|| 58-1699775|1326041732|CHC13|E0607|UE|11/01/2013|12/31/9999|$67.27|0|0|||BLOOD GLUCOSE MONITOR HOME|| 58-1699775|1326041732|CHC13|E0610|NU|11/01/2013|12/31/9999|$282.50|0|0|||PACEMAKER MONITR AUDIBLE/VIS|| 58-1699775|1326041732|CHC13|E0610|RR|11/01/2013|12/31/9999|$28.62|0|0|||PACEMAKER MONITR AUDIBLE/VIS|| 58-1699775|1326041732|CHC13|E0610|UE|11/01/2013|12/31/9999|$211.85|0|0|||PACEMAKER MONITR AUDIBLE/VIS|| 58-1699775|1326041732|CHC13|E0615|NU|11/01/2013|12/31/9999|$642.89|0|0|||PACEMAKER MONITR DIGITAL/VIS|| 58-1699775|1326041732|CHC13|E0615|RR|11/01/2013|12/31/9999|$78.55|0|0|||PACEMAKER MONITR DIGITAL/VIS|| 58-1699775|1326041732|CHC13|E0615|UE|11/01/2013|12/31/9999|$482.17|0|0|||PACEMAKER MONITR DIGITAL/VIS|| 58-1699775|1326041732|CHC13|E0617|RR|11/01/2013|12/31/9999|$408.22|0|0|||AUTOMATIC EXT DEFIBRILLATOR|| 58-1699775|1326041732|CHC13|E0618||11/01/2013|12/31/9999|$376.43|0|0|||APNEA MONITOR|| 58-1699775|1326041732|CHC13|E0619||11/01/2013|12/31/9999|$0.00|0|0|||APNEA MONITOR W RECORDER|| 58-1699775|1326041732|CHC13|E0620|NU|11/01/2013|12/31/9999|$1|174.00|0|0|||CAP BLD SKIN PIERCING LASER|| 58-1699775|1326041732|CHC13|E0620|RR|11/01/2013|12/31/9999|$117.39|0|0|||CAP BLD SKIN PIERCING LASER|| 58-1699775|1326041732|CHC13|E0620|UE|11/01/2013|12/31/9999|$880.50|0|0|||CAP BLD SKIN PIERCING LASER|| 58-1699775|1326041732|CHC13|E0621|NU|11/01/2013|12/31/9999|$109.55|0|0|||PATIENT LIFT SLING OR SEAT|| 58-1699775|1326041732|CHC13|E0621|RR|11/01/2013|12/31/9999|$10.55|0|0|||PATIENT LIFT SLING OR SEAT|| 58-1699775|1326041732|CHC13|E0621|UE|11/01/2013|12/31/9999|$82.57|0|0|||PATIENT LIFT SLING OR SEAT|| 58-1699775|1326041732|CHC13|E0627|NU|11/01/2013|12/31/2017|$452.91|0|0|||SEAT LIFT INCORP LIFT-CHAIR|| 58-1699775|1326041732|CHC13|E0627|NU|01/01/2018|12/31/9999|$316.41|0|0|||SEAT LIFT INCORP LIFT-CHAIR|| 58-1699775|1326041732|CHC13|E0627|RR|11/01/2013|12/31/2017|$45.30|0|0|||SEAT LIFT INCORP LIFT-CHAIR|| 58-1699775|1326041732|CHC13|E0627|RR|01/01/2018|12/31/9999|$31.64|0|0|||SEAT LIFT INCORP LIFT-CHAIR|| 58-1699775|1326041732|CHC13|E0627|UE|11/01/2013|12/31/9999|$339.69|0|0|||SEAT LIFT INCORP LIFT-CHAIR|| 58-1699775|1326041732|CHC13|E0628|NU|11/01/2013|12/31/9999|$452.91|0|0|||SEAT LIFT FOR PT FURN-ELECTR|| 58-1699775|1326041732|CHC13|E0628|RR|11/01/2013|12/31/9999|$45.30|0|0|||SEAT LIFT FOR PT FURN-ELECTR|| 58-1699775|1326041732|CHC13|E0628|UE|11/01/2013|12/31/9999|$339.69|0|0|||SEAT LIFT FOR PT FURN-ELECTR|| 58-1699775|1326041732|CHC13|E0629|NU|11/01/2013|12/31/9999|$444.04|0|0|||SEAT LIFT FOR PT FURN-NON-EL|| 58-1699775|1326041732|CHC13|E0629|RR|11/01/2013|12/31/9999|$44.41|0|0|||SEAT LIFT FOR PT FURN-NON-EL|| 58-1699775|1326041732|CHC13|E0629|UE|11/01/2013|12/31/9999|$332.99|0|0|||SEAT LIFT FOR PT FURN-NON-EL|| 58-1699775|1326041732|CHC13|E0630||11/01/2013|12/31/9999|$123.29|0|0|||PATIENT LIFT HYDRAULIC|| 58-1699775|1326041732|CHC13|E0635|NU|05/01/2015|12/31/9999|$65.00|0|0||%|PATIENT LIFT ELECTRIC|| 58-1699775|1326041732|CHC13|E0635|RR|05/01/2015|12/31/9999|$164.29|0|0|||PATIENT LIFT ELECTRIC|| 58-1699775|1326041732|CHC13|E0636||11/01/2013|12/31/9999|$1|415.91|0|0|||PT SUPPORT & POSITIONING SYS|| 58-1699775|1326041732|CHC13|E0650|NU|11/01/2013|12/31/9999|$821.95|0|0|||PNEUMA COMPRESOR NON-SEGMENT|| 58-1699775|1326041732|CHC13|E0650|RR|11/01/2013|12/31/9999|$107.21|0|0|||PNEUMA COMPRESOR NON-SEGMENT|| 58-1699775|1326041732|CHC13|E0650|UE|11/01/2013|12/31/9999|$616.46|0|0|||PNEUMA COMPRESOR NON-SEGMENT|| 58-1699775|1326041732|CHC13|E0651|NU|11/01/2013|12/31/9999|$1|233.12|0|0|||PNEUM COMPRESSOR SEGMENTAL|| 58-1699775|1326041732|CHC13|E0651|RR|11/01/2013|12/31/9999|$125.96|0|0|||PNEUM COMPRESSOR SEGMENTAL|| 58-1699775|1326041732|CHC13|E0651|UE|11/01/2013|12/31/9999|$924.85|0|0|||PNEUM COMPRESSOR SEGMENTAL|| 58-1699775|1326041732|CHC13|E0652|NU|11/01/2013|12/31/9999|$7|118.01|0|0|||PNEUM COMPRES W/CAL PRESSURE|| 58-1699775|1326041732|CHC13|E0652|RR|11/01/2013|12/31/9999|$703.49|0|0|||PNEUM COMPRES W/CAL PRESSURE|| 58-1699775|1326041732|CHC13|E0652|UE|11/01/2013|12/31/9999|$5|333.75|0|0|||PNEUM COMPRES W/CAL PRESSURE|| 58-1699775|1326041732|CHC13|E0655|NU|11/01/2013|12/31/9999|$126.75|0|0|||PNEUMATIC APPLIANCE HALF ARM|| 58-1699775|1326041732|CHC13|E0655|RR|11/01/2013|12/31/9999|$14.47|0|0|||PNEUMATIC APPLIANCE HALF ARM|| 58-1699775|1326041732|CHC13|E0655|UE|11/01/2013|12/31/9999|$108.81|0|0|||PNEUMATIC APPLIANCE HALF ARM|| 58-1699775|1326041732|CHC13|E0656|NU|11/01/2013|12/31/9999|$775.66|0|0|||SEGMENTAL PNEUMATIC TRUNK|| 58-1699775|1326041732|CHC13|E0656|RR|11/01/2013|12/31/9999|$77.47|0|0|||SEGMENTAL PNEUMATIC TRUNK|| 58-1699775|1326041732|CHC13|E0656|UE|11/01/2013|12/31/9999|$581.82|0|0|||SEGMENTAL PNEUMATIC TRUNK|| 58-1699775|1326041732|CHC13|E0657|NU|11/01/2013|12/31/9999|$728.71|0|0|||SEGMENTAL PNEUMATIC CHEST|| 58-1699775|1326041732|CHC13|E0657|RR|11/01/2013|12/31/9999|$72.74|0|0|||SEGMENTAL PNEUMATIC CHEST|| 58-1699775|1326041732|CHC13|E0657|UE|11/01/2013|12/31/9999|$546.58|0|0|||SEGMENTAL PNEUMATIC CHEST|| 58-1699775|1326041732|CHC13|E0660|NU|11/01/2013|12/31/9999|$214.49|0|0|||PNEUMATIC APPLIANCE FULL LEG|| 58-1699775|1326041732|CHC13|E0660|RR|11/01/2013|12/31/9999|$21.86|0|0|||PNEUMATIC APPLIANCE FULL LEG|| 58-1699775|1326041732|CHC13|E0660|UE|11/01/2013|12/31/9999|$160.85|0|0|||PNEUMATIC APPLIANCE FULL LEG|| 58-1699775|1326041732|CHC13|E0665|NU|11/01/2013|12/31/9999|$179.97|0|0|||PNEUMATIC APPLIANCE FULL ARM|| 58-1699775|1326041732|CHC13|E0665|RR|11/01/2013|12/31/9999|$18.00|0|0|||PNEUMATIC APPLIANCE FULL ARM|| 58-1699775|1326041732|CHC13|E0665|UE|11/01/2013|12/31/9999|$138.12|0|0|||PNEUMATIC APPLIANCE FULL ARM|| 58-1699775|1326041732|CHC13|E0666|NU|11/01/2013|12/31/9999|$185.40|0|0|||PNEUMATIC APPLIANCE HALF LEG|| 58-1699775|1326041732|CHC13|E0666|RR|11/01/2013|12/31/9999|$19.11|0|0|||PNEUMATIC APPLIANCE HALF LEG|| 58-1699775|1326041732|CHC13|E0666|UE|11/01/2013|12/31/9999|$139.09|0|0|||PNEUMATIC APPLIANCE HALF LEG|| 58-1699775|1326041732|CHC13|E0667|NU|11/01/2013|12/31/9999|$434.71|0|0|||SEG PNEUMATIC APPL FULL LEG|| 58-1699775|1326041732|CHC13|E0667|RR|11/01/2013|12/31/9999|$49.09|0|0|||SEG PNEUMATIC APPL FULL LEG|| 58-1699775|1326041732|CHC13|E0667|UE|11/01/2013|12/31/9999|$326.04|0|0|||SEG PNEUMATIC APPL FULL LEG|| 58-1699775|1326041732|CHC13|E0668|NU|11/01/2013|12/31/9999|$593.29|0|0|||SEG PNEUMATIC APPL FULL ARM|| 58-1699775|1326041732|CHC13|E0668|RR|11/01/2013|12/31/9999|$58.55|0|0|||SEG PNEUMATIC APPL FULL ARM|| 58-1699775|1326041732|CHC13|E0668|UE|11/01/2013|12/31/9999|$444.98|0|0|||SEG PNEUMATIC APPL FULL ARM|| 58-1699775|1326041732|CHC13|E0669|NU|11/01/2013|12/31/9999|$243.05|0|0|||SEG PNEUMATIC APPLI HALF LEG|| 58-1699775|1326041732|CHC13|E0669|RR|11/01/2013|12/31/9999|$24.31|0|0|||SEG PNEUMATIC APPLI HALF LEG|| 58-1699775|1326041732|CHC13|E0669|UE|11/01/2013|12/31/9999|$182.31|0|0|||SEG PNEUMATIC APPLI HALF LEG|| 58-1699775|1326041732|CHC13|E0670|NU|11/01/2013|12/31/9999|$557.68|0|0|||SEG PNEUM INT LEGS/TRUNK|| 58-1699775|1326041732|CHC13|E0670|RR|11/01/2013|12/31/9999|$55.79|0|0|||SEG PNEUM INT LEGS/TRUNK|| 58-1699775|1326041732|CHC13|E0670|UE|11/01/2013|12/31/9999|$418.24|0|0|||SEG PNEUM INT LEGS/TRUNK|| 58-1699775|1326041732|CHC13|E0671|NU|11/01/2013|12/31/9999|$433.31|0|0|||PRESSURE PNEUM APPL FULL LEG|| 58-1699775|1326041732|CHC13|E0671|RR|11/01/2013|12/31/9999|$43.34|0|0|||PRESSURE PNEUM APPL FULL LEG|| 58-1699775|1326041732|CHC13|E0671|UE|11/01/2013|12/31/9999|$325.00|0|0|||PRESSURE PNEUM APPL FULL LEG|| 58-1699775|1326041732|CHC13|E0672|NU|11/01/2013|12/31/9999|$360.06|0|0|||PRESSURE PNEUM APPL FULL ARM|| 58-1699775|1326041732|CHC13|E0672|RR|11/01/2013|12/31/9999|$36.01|0|0|||PRESSURE PNEUM APPL FULL ARM|| 58-1699775|1326041732|CHC13|E0672|UE|11/01/2013|12/31/9999|$270.07|0|0|||PRESSURE PNEUM APPL FULL ARM|| 58-1699775|1326041732|CHC13|E0673|NU|11/01/2013|12/31/9999|$1|206.50|0|0|||PRESSURE PNEUM APPL HALF LEG|| 58-1699775|1326041732|CHC13|E0673|RR|11/01/2013|12/31/9999|$120.65|0|0|||PRESSURE PNEUM APPL HALF LEG|| 58-1699775|1326041732|CHC13|E0673|UE|11/01/2013|12/31/9999|$516.32|0|0|||PRESSURE PNEUM APPL HALF LEG|| 58-1699775|1326041732|CHC13|E0675|RR|11/01/2013|12/31/9999|$904.88|0|0|||PNEUMATIC COMPRESSION DEVICE|| 58-1699775|1326041732|CHC13|E0691|NU|11/01/2013|12/31/9999|$1|515.03|0|0|||UVL PNL 2 SQ FT OR LESS|| 58-1699775|1326041732|CHC13|E0691|RR|11/01/2013|12/31/9999|$151.49|0|0|||UVL PNL 2 SQ FT OR LESS|| 58-1699775|1326041732|CHC13|E0691|UE|11/01/2013|12/31/9999|$1|136.28|0|0|||UVL PNL 2 SQ FT OR LESS|| 58-1699775|1326041732|CHC13|E0692|NU|11/01/2013|12/31/9999|$1|867.61|0|0|||UVL SYS PANEL 4 FT|| 58-1699775|1326041732|CHC13|E0692|RR|11/01/2013|12/31/9999|$186.76|0|0|||UVL SYS PANEL 4 FT|| 58-1699775|1326041732|CHC13|E0692|UE|11/01/2013|12/31/9999|$1|400.70|0|0|||UVL SYS PANEL 4 FT|| 58-1699775|1326041732|CHC13|E0693|NU|11/01/2013|12/31/9999|$5|944.40|0|0|||UVL SYS PANEL 6 FT|| 58-1699775|1326041732|CHC13|E0693|RR|11/01/2013|12/31/9999|$594.45|0|0|||UVL SYS PANEL 6 FT|| 58-1699775|1326041732|CHC13|E0693|UE|11/01/2013|12/31/9999|$4|458.32|0|0|||UVL SYS PANEL 6 FT|| 58-1699775|1326041732|CHC13|E0694|NU|11/01/2013|12/31/9999|$74.01|0|0|||UVL MD CABINET SYS 6 FT|| 58-1699775|1326041732|CHC13|E0694|RR|11/01/2013|12/31/9999|$7.52|0|0|||UVL MD CABINET SYS 6 FT|| 58-1699775|1326041732|CHC13|E0694|UE|11/01/2013|12/31/9999|$54.20|0|0|||UVL MD CABINET SYS 6 FT|| 58-1699775|1326041732|CHC13|E0705|NU|11/01/2013|12/31/9999|$497.54|0|0|||TRANSFER BOARD OR DEVICE|| 58-1699775|1326041732|CHC13|E0705|RR|11/01/2013|12/31/9999|$478.91|0|0|||TRANSFER BOARD OR DEVICE|| 58-1699775|1326041732|CHC13|E0705|UE|11/01/2013|12/31/9999|$493.53|0|0|||TRANSFER BOARD OR DEVICE|| 58-1699775|1326041732|CHC13|E0720||11/01/2013|12/31/9999|$702.02|0|0|||TENS TWO LEAD|| 58-1699775|1326041732|CHC13|E0730||11/01/2013|12/31/9999|$70.21|0|0|||TENS FOUR LEAD|| 58-1699775|1326041732|CHC13|E0730|NU|11/01/2013|12/31/9999|$70.21|0|0|||TENS FOUR LEAD|| 58-1699775|1326041732|CHC13|E0731||11/01/2013|12/31/9999|$526.56|0|0|||CONDUCTIVE GARMENT FOR TENS/|| 58-1699775|1326041732|CHC13|E0740|NU|11/01/2013|12/31/9999|$5|257.94|0|0|||INCONTINENCE TREATMENT SYSTM|| 58-1699775|1326041732|CHC13|E0740|RR|11/01/2013|12/31/9999|$120.19|0|0|||INCONTINENCE TREATMENT SYSTM|| 58-1699775|1326041732|CHC13|E0740|UE|11/01/2013|12/31/9999|$122.95|0|0|||INCONTINENCE TREATMENT SYSTM|| 58-1699775|1326041732|CHC13|E0744||11/01/2013|12/31/9999|$522.50|0|0|||NEUROMUSCULAR STIM FOR SCOLI|| 58-1699775|1326041732|CHC13|E0745||11/01/2013|12/31/9999|$3|906.55|0|0|||NEUROMUSCULAR STIM FOR SHOCK|| 58-1699775|1326041732|CHC13|E0747|NU|11/01/2013|12/31/9999|$5|223.88|0|0|||ELEC OSTEOGEN STIM NOT SPINE|| 58-1699775|1326041732|CHC13|E0747|RR|11/01/2013|12/31/9999|$522.37|0|0|||ELEC OSTEOGEN STIM NOT SPINE|| 58-1699775|1326041732|CHC13|E0747|UE|11/01/2013|12/31/9999|$3|917.93|0|0|||ELEC OSTEOGEN STIM NOT SPINE|| 58-1699775|1326041732|CHC13|E0748|NU|11/01/2013|12/31/9999|$4|340.95|0|0|||ELEC OSTEOGEN STIM SPINAL|| 58-1699775|1326041732|CHC13|E0748|RR|11/01/2013|12/31/9999|$324.54|0|0|||ELEC OSTEOGEN STIM SPINAL|| 58-1699775|1326041732|CHC13|E0748|UE|11/01/2013|12/31/9999|$434.11|0|0|||ELEC OSTEOGEN STIM SPINAL|| 58-1699775|1326041732|CHC13|E0749||11/01/2013|12/31/9999|$3|255.70|0|0|||ELEC OSTEOGEN STIM IMPLANTED|| 58-1699775|1326041732|CHC13|E0760|NU|11/01/2013|12/31/9999|$1|476.34|0|0|||OSTEOGEN ULTRASOUND STIMLTOR|| 58-1699775|1326041732|CHC13|E0760|RR|11/01/2013|12/31/9999|$147.64|0|0|||OSTEOGEN ULTRASOUND STIMLTOR|| 58-1699775|1326041732|CHC13|E0760|UE|11/01/2013|12/31/9999|$1|107.21|0|0|||OSTEOGEN ULTRASOUND STIMLTOR|| 58-1699775|1326041732|CHC13|E0762|NU|11/01/2013|12/31/9999|$14|858.92|0|0|||TRANS ELEC JT STIM DEV SYS|| 58-1699775|1326041732|CHC13|E0762|RR|11/01/2013|12/31/9999|$1|485.87|0|0|||TRANS ELEC JT STIM DEV SYS|| 58-1699775|1326041732|CHC13|E0762|UE|11/01/2013|12/31/9999|$11|144.20|0|0|||TRANS ELEC JT STIM DEV SYS|| 58-1699775|1326041732|CHC13|E0764|NU|11/01/2013|12/31/9999|$112.96|0|0|||FUNCTIONAL NEUROMUSCULARSTIM|| 58-1699775|1326041732|CHC13|E0764|RR|11/01/2013|12/31/9999|$11.31|0|0|||FUNCTIONAL NEUROMUSCULARSTIM|| 58-1699775|1326041732|CHC13|E0764|UE|11/01/2013|12/31/9999|$84.75|0|0|||FUNCTIONAL NEUROMUSCULARSTIM|| 58-1699775|1326041732|CHC13|E0765|NU|11/01/2013|12/31/9999|$163.37|0|0|||NERVE STIMULATOR FOR TX N&V|| 58-1699775|1326041732|CHC13|E0765|RR|11/01/2013|12/31/9999|$21.29|0|0|||NERVE STIMULATOR FOR TX N&V|| 58-1699775|1326041732|CHC13|E0765|UE|11/01/2013|12/31/9999|$120.21|0|0|||NERVE STIMULATOR FOR TX N&V|| 58-1699775|1326041732|CHC13|E0776|NU|11/01/2013|12/31/9999|$344.98|0|0|||IV POLE|| 58-1699775|1326041732|CHC13|E0776|RR|11/01/2013|12/31/9999|$13.93|0|0|||IV POLE|| 58-1699775|1326041732|CHC13|E0776|UE|11/01/2013|12/31/9999|$21.91|0|0|||IV POLE|| 58-1699775|1326041732|CHC13|E0779||11/01/2013|12/31/9999|$5|764.58|0|0|||AMB INFUSION PUMP MECHANICAL|| 58-1699775|1326041732|CHC13|E0780||11/01/2013|12/31/9999|$576.49|0|0|||MECH AMB INFUSION PUMP <8HRS|| 58-1699775|1326041732|CHC13|E0781|NU|11/01/2013|12/31/9999|$4|323.44|0|0|||EXTERNAL AMBULATORY INFUS PU|| 58-1699775|1326041732|CHC13|E0781|RR|11/01/2013|12/31/9999|$434.68|0|0|||EXTERNAL AMBULATORY INFUS PU|| 58-1699775|1326041732|CHC13|E0782|NU|11/01/2013|12/31/9999|$10|992.20|0|0|||NON-PROGRAMBLE INFUSION PUMP|| 58-1699775|1326041732|CHC13|E0782|RR|11/01/2013|12/31/9999|$1|099.24|0|0|||NON-PROGRAMBLE INFUSION PUMP|| 58-1699775|1326041732|CHC13|E0782|UE|11/01/2013|12/31/9999|$8|244.16|0|0|||NON-PROGRAMBLE INFUSION PUMP|| 58-1699775|1326041732|CHC13|E0783|NU|11/01/2013|12/31/9999|$10|722.23|0|0|||PROGRAMMABLE INFUSION PUMP|| 58-1699775|1326041732|CHC13|E0783|RR|11/01/2013|12/31/9999|$560.65|0|0|||PROGRAMMABLE INFUSION PUMP|| 58-1699775|1326041732|CHC13|E0783|UE|11/01/2013|12/31/9999|$634.41|0|0|||PROGRAMMABLE INFUSION PUMP|| 58-1699775|1326041732|CHC13|E0784||11/01/2013|12/31/9999|$1|072.20|0|0|||EXT AMB INFUSN PUMP INSULIN|| 58-1699775|1326041732|CHC13|E0785||11/01/2013|12/31/9999|$8|041.66|0|0|||REPLACEMENT IMPL PUMP CATHET|| 58-1699775|1326041732|CHC13|E0786||11/01/2013|12/31/9999|$360.86|0|0|||IMPLANTABLE PUMP REPLACEMENT|| 58-1699775|1326041732|CHC13|E0786|RR|11/01/2013|12/31/9999|$21.91|0|0|||IMPLANTABLE PUMP REPLACEMENT|| 58-1699775|1326041732|CHC13|E0786|UE|11/01/2013|12/31/9999|$95.40|0|0|||IMPLANTABLE PUMP REPLACEMENT|| 58-1699775|1326041732|CHC13|E0791||11/01/2013|12/31/9999|$71.53|0|0|||PARENTERAL INFUSION PUMP STA|| 58-1699775|1326041732|CHC13|E0840|NU|11/01/2013|12/31/9999|$691.89|0|0|||TRACT FRAME ATTACH HEADBOARD|| 58-1699775|1326041732|CHC13|E0840|RR|11/01/2013|12/31/9999|$69.20|0|0|||TRACT FRAME ATTACH HEADBOARD|| 58-1699775|1326041732|CHC13|E0840|UE|11/01/2013|12/31/9999|$518.88|0|0|||TRACT FRAME ATTACH HEADBOARD|| 58-1699775|1326041732|CHC13|E0849|NU|11/01/2013|12/31/9999|$119.89|0|0|||CERVICAL PNEUM TRAC EQUIP|| 58-1699775|1326041732|CHC13|E0849|RR|11/01/2013|12/31/9999|$16.46|0|0|||CERVICAL PNEUM TRAC EQUIP|| 58-1699775|1326041732|CHC13|E0849|UE|11/01/2013|12/31/9999|$89.93|0|0|||CERVICAL PNEUM TRAC EQUIP|| 58-1699775|1326041732|CHC13|E0850|NU|11/01/2013|12/31/9999|$674.85|0|0|||TRACTION STAND FREE STANDING|| 58-1699775|1326041732|CHC13|E0850|RR|11/01/2013|12/31/9999|$67.49|0|0|||TRACTION STAND FREE STANDING|| 58-1699775|1326041732|CHC13|E0850|UE|11/01/2013|12/31/9999|$506.12|0|0|||TRACTION STAND FREE STANDING|| 58-1699775|1326041732|CHC13|E0855|NU|11/01/2013|12/31/9999|$206.81|0|0|||CERVICAL TRACTION EQUIPMENT|| 58-1699775|1326041732|CHC13|E0855|RR|11/01/2013|12/31/9999|$20.70|0|0|||CERVICAL TRACTION EQUIPMENT|| 58-1699775|1326041732|CHC13|E0855|UE|11/01/2013|12/31/9999|$155.12|0|0|||CERVICAL TRACTION EQUIPMENT|| 58-1699775|1326041732|CHC13|E0856|NU|11/01/2013|12/31/9999|$48.59|0|0|||CERVIC COLLAR W AIR BLADDER|| 58-1699775|1326041732|CHC13|E0856|RR|11/01/2013|12/31/9999|$7.43|0|0|||CERVIC COLLAR W AIR BLADDER|| 58-1699775|1326041732|CHC13|E0856|UE|11/01/2013|12/31/9999|$36.42|0|0|||CERVIC COLLAR W AIR BLADDER|| 58-1699775|1326041732|CHC13|E0860|NU|11/01/2013|12/31/9999|$132.75|0|0|||TRACT EQUIP CERVICAL TRACT|| 58-1699775|1326041732|CHC13|E0860|RR|11/01/2013|12/31/9999|$15.30|0|0|||TRACT EQUIP CERVICAL TRACT|| 58-1699775|1326041732|CHC13|E0860|UE|11/01/2013|12/31/9999|$100.00|0|0|||TRACT EQUIP CERVICAL TRACT|| 58-1699775|1326041732|CHC13|E0870|NU|11/01/2013|12/31/9999|$143.28|0|0|||TRACT FRAME ATTACH FOOTBOARD|| 58-1699775|1326041732|CHC13|E0870|RR|11/01/2013|12/31/9999|$22.50|0|0|||TRACT FRAME ATTACH FOOTBOARD|| 58-1699775|1326041732|CHC13|E0870|UE|11/01/2013|12/31/9999|$108.44|0|0|||TRACT FRAME ATTACH FOOTBOARD|| 58-1699775|1326041732|CHC13|E0880|NU|11/01/2013|12/31/9999|$137.41|0|0|||TRAC STAND FREE STAND EXTREM|| 58-1699775|1326041732|CHC13|E0880|RR|11/01/2013|12/31/9999|$43.84|0|0|||TRAC STAND FREE STAND EXTREM|| 58-1699775|1326041732|CHC13|E0880|UE|11/01/2013|12/31/9999|$110.69|0|0|||TRAC STAND FREE STAND EXTREM|| 58-1699775|1326041732|CHC13|E0890|NU|11/01/2013|12/31/9999|$146.24|0|0|||TRACTION FRAME ATTACH PELVIC|| 58-1699775|1326041732|CHC13|E0890|RR|11/01/2013|12/31/9999|$31.52|0|0|||TRACTION FRAME ATTACH PELVIC|| 58-1699775|1326041732|CHC13|E0890|UE|11/01/2013|12/31/9999|$109.70|0|0|||TRACTION FRAME ATTACH PELVIC|| 58-1699775|1326041732|CHC13|E0900|NU|11/01/2013|12/31/9999|$132.48|0|0|||TRAC STAND FREE STAND PELVIC|| 58-1699775|1326041732|CHC13|E0900|RR|11/01/2013|12/31/9999|$21.75|0|0|||TRAC STAND FREE STAND PELVIC|| 58-1699775|1326041732|CHC13|E0900|UE|11/01/2013|12/31/9999|$57.67|0|0|||TRAC STAND FREE STAND PELVIC|| 58-1699775|1326041732|CHC13|E0910|RR|11/01/2013|12/31/9999|$55.06|0|0|||TRAPEZE BAR ATTACHED TO BED|| 58-1699775|1326041732|CHC13|E0911||11/01/2013|12/31/9999|$52.14|0|0|||HD TRAPEZE BAR ATTACH TO BED|| 58-1699775|1326041732|CHC13|E0912||11/01/2013|12/31/9999|$25.95|0|0|||HD TRAPEZE BAR FREE STANDING|| 58-1699775|1326041732|CHC13|E0920||11/01/2013|12/31/9999|$34.20|0|0|||FRACTURE FRAME ATTACHED TO B|| 58-1699775|1326041732|CHC13|E0930||11/01/2013|12/31/9999|$58.27|0|0|||FRACTURE FRAME FREE STANDING|| 58-1699775|1326041732|CHC13|E0935||11/01/2013|12/31/9999|$23.09|0|0|||CONT PAS MOTION EXERCISE DEV|| 58-1699775|1326041732|CHC13|E0940||11/01/2013|12/31/9999|$2.68|0|0|||TRAPEZE BAR FREE STANDING|| 58-1699775|1326041732|CHC13|E0941||11/01/2013|12/31/9999|$17.29|0|0|||GRAVITY ASSISTED TRACTION DE|| 58-1699775|1326041732|CHC13|E0942|NU|11/01/2013|12/31/9999|$60.16|0|0|||CERVICAL HEAD HARNESS/HALTER|| 58-1699775|1326041732|CHC13|E0942|RR|11/01/2013|12/31/9999|$6.03|0|0|||CERVICAL HEAD HARNESS/HALTER|| 58-1699775|1326041732|CHC13|E0942|UE|11/01/2013|12/31/9999|$45.14|0|0|||CERVICAL HEAD HARNESS/HALTER|| 58-1699775|1326041732|CHC13|E0944|NU|11/01/2013|12/31/9999|$50.59|0|0|||PELVIC BELT/HARNESS/BOOT|| 58-1699775|1326041732|CHC13|E0944|RR|11/01/2013|12/31/9999|$5.06|0|0|||PELVIC BELT/HARNESS/BOOT|| 58-1699775|1326041732|CHC13|E0944|UE|11/01/2013|12/31/9999|$39.15|0|0|||PELVIC BELT/HARNESS/BOOT|| 58-1699775|1326041732|CHC13|E0945|NU|11/01/2013|12/31/9999|$721.35|0|0|||BELT/HARNESS EXTREMITY|| 58-1699775|1326041732|CHC13|E0945|RR|11/01/2013|12/31/9999|$67.53|0|0|||BELT/HARNESS EXTREMITY|| 58-1699775|1326041732|CHC13|E0945|UE|11/01/2013|12/31/9999|$73.02|0|0|||BELT/HARNESS EXTREMITY|| 58-1699775|1326041732|CHC13|E0946|RR|11/01/2013|12/31/9999|$541.00|0|0|||FRACTURE FRAME DUAL W CROSS|| 58-1699775|1326041732|CHC13|E0947|NU|11/01/2013|12/31/9999|$721.35|0|0|||FRACTURE FRAME ATTACHMNTS PE|| 58-1699775|1326041732|CHC13|E0947|RR|11/01/2013|12/31/9999|$72.15|0|0|||FRACTURE FRAME ATTACHMNTS PE|| 58-1699775|1326041732|CHC13|E0947|UE|11/01/2013|12/31/9999|$541.00|0|0|||FRACTURE FRAME ATTACHMNTS PE|| 58-1699775|1326041732|CHC13|E0948|NU|11/01/2013|12/31/9999|$118.64|0|0|||FRACTURE FRAME ATTACHMNTS CE|| 58-1699775|1326041732|CHC13|E0948|RR|11/01/2013|12/31/9999|$10.24|0|0|||FRACTURE FRAME ATTACHMNTS CE|| 58-1699775|1326041732|CHC13|E0948|UE|11/01/2013|12/31/9999|$102.25|0|0|||FRACTURE FRAME ATTACHMNTS CE|| 58-1699775|1326041732|CHC13|E0950|NU|11/01/2013|12/31/9999|$76.69|0|0|||TRAY|| 58-1699775|1326041732|CHC13|E0950|RR|11/01/2013|12/31/9999|$2.26|0|0|||TRAY|| 58-1699775|1326041732|CHC13|E0950|UE|11/01/2013|12/31/9999|$21.96|0|0|||TRAY|| 58-1699775|1326041732|CHC13|E0951|NU|11/01/2013|12/31/9999|$19.10|0|0|||LOOP HEEL|| 58-1699775|1326041732|CHC13|E0951|RR|11/01/2013|12/31/9999|$1.92|0|0|||LOOP HEEL|| 58-1699775|1326041732|CHC13|E0951|UE|11/01/2013|12/31/9999|$16.46|0|0|||LOOP HEEL|| 58-1699775|1326041732|CHC13|E0952|NU|11/01/2013|12/31/9999|$233.97|0|0|||TOE LOOP/HOLDER| EACH|| 58-1699775|1326041732|CHC13|E0952|RR|11/01/2013|12/31/9999|$2.24|0|0|||TOE LOOP/HOLDER| EACH|| 58-1699775|1326041732|CHC13|E0952|UE|11/01/2013|12/31/9999|$16.14|0|0|||TOE LOOP/HOLDER| EACH|| 58-1699775|1326041732|CHC13|E0953|NU|04/01/2018|12/31/9999|$91.12|0|0|0||PNEUMATIC TIRE EACH|| 58-1699775|1326041732|CHC13|E0953|RR|04/01/2018|12/31/9999|$9.11|0|0|0||PNEUMATIC TIRE EACH|| 58-1699775|1326041732|CHC13|E0954|NU|04/01/2018|12/31/9999|$63.35|0|0|0||SEMI-PNEUMATIC CASTER EACH|| 58-1699775|1326041732|CHC13|E0954|RR|04/01/2018|12/31/9999|$6.36|0|0|0||SEMI-PNEUMATIC CASTER EACH|| 58-1699775|1326041732|CHC13|E0955|NU|11/01/2013|12/31/9999|$175.48|0|0|||CUSHIONED HEADREST|| 58-1699775|1326041732|CHC13|E0955|RR|11/01/2013|12/31/9999|$11.41|0|0|||CUSHIONED HEADREST|| 58-1699775|1326041732|CHC13|E0955|UE|11/01/2013|12/31/9999|$114.08|0|0|||CUSHIONED HEADREST|| 58-1699775|1326041732|CHC13|E0956|NU|11/01/2013|12/31/9999|$159.62|0|0|||W/C LATERAL TRUNK/HIP SUPPOR|| 58-1699775|1326041732|CHC13|E0956|RR|11/01/2013|12/31/9999|$13.25|0|0|||W/C LATERAL TRUNK/HIP SUPPOR|| 58-1699775|1326041732|CHC13|E0956|UE|11/01/2013|12/31/9999|$85.55|0|0|||W/C LATERAL TRUNK/HIP SUPPOR|| 58-1699775|1326041732|CHC13|E0957|NU|11/01/2013|12/31/9999|$119.71|0|0|||W/C MEDIAL THIGH SUPPORT|| 58-1699775|1326041732|CHC13|E0957|RR|11/01/2013|12/31/9999|$5.16|0|0|||W/C MEDIAL THIGH SUPPORT|| 58-1699775|1326041732|CHC13|E0957|UE|11/01/2013|12/31/9999|$51.70|0|0|||W/C MEDIAL THIGH SUPPORT|| 58-1699775|1326041732|CHC13|E0958|RR|11/01/2013|12/31/9999|$38.74|0|0|||WHLCHR ATT- CONV 1 ARM DRIVE|| 58-1699775|1326041732|CHC13|E0959|NU|11/01/2013|12/31/9999|$122.15|0|0|||AMPUTEE ADAPTER|| 58-1699775|1326041732|CHC13|E0959|RR|11/01/2013|12/31/9999|$10.54|0|0|||AMPUTEE ADAPTER|| 58-1699775|1326041732|CHC13|E0959|UE|11/01/2013|12/31/9999|$105.29|0|0|||AMPUTEE ADAPTER|| 58-1699775|1326041732|CHC13|E0960|NU|11/01/2013|12/31/9999|$78.98|0|0|||W/C SHOULDER HARNESS/STRAPS|| 58-1699775|1326041732|CHC13|E0960|RR|11/01/2013|12/31/9999|$3.55|0|0|||W/C SHOULDER HARNESS/STRAPS|| 58-1699775|1326041732|CHC13|E0960|UE|11/01/2013|12/31/9999|$19.94|0|0|||W/C SHOULDER HARNESS/STRAPS|| 58-1699775|1326041732|CHC13|E0961|NU|11/01/2013|12/31/9999|$88.02|0|0|||WHEELCHAIR BRAKE EXTENSION|| 58-1699775|1326041732|CHC13|E0961|RR|11/01/2013|12/31/9999|$8.79|0|0|||WHEELCHAIR BRAKE EXTENSION|| 58-1699775|1326041732|CHC13|E0961|UE|11/01/2013|12/31/9999|$66.05|0|0|||WHEELCHAIR BRAKE EXTENSION|| 58-1699775|1326041732|CHC13|E0966|NU|11/01/2013|12/31/9999|$88.19|0|0|||WHEELCHAIR HEAD REST EXTENSI|| 58-1699775|1326041732|CHC13|E0966|RR|11/01/2013|12/31/9999|$8.82|0|0|||WHEELCHAIR HEAD REST EXTENSI|| 58-1699775|1326041732|CHC13|E0966|UE|11/01/2013|12/31/9999|$66.13|0|0|||WHEELCHAIR HEAD REST EXTENSI|| 58-1699775|1326041732|CHC13|E0967|NU|11/01/2013|12/31/9999|$210.30|0|0|||WHEELCHAIR HAND RIMS|| 58-1699775|1326041732|CHC13|E0967|RR|11/01/2013|12/31/9999|$20.82|0|0|||WHEELCHAIR HAND RIMS|| 58-1699775|1326041732|CHC13|E0967|UE|11/01/2013|12/31/9999|$23.14|0|0|||WHEELCHAIR HAND RIMS|| 58-1699775|1326041732|CHC13|E0968||11/01/2013|12/31/9999|$157.74|0|0|||WHEELCHAIR COMMODE SEAT|| 58-1699775|1326041732|CHC13|E0969|NU|11/01/2013|12/31/9999|$58.25|0|0|||WHEELCHAIR NARROWING DEVICE|| 58-1699775|1326041732|CHC13|E0969|RR|11/01/2013|12/31/9999|$5.84|0|0|||WHEELCHAIR NARROWING DEVICE|| 58-1699775|1326041732|CHC13|E0969|UE|11/01/2013|12/31/9999|$43.72|0|0|||WHEELCHAIR NARROWING DEVICE|| 58-1699775|1326041732|CHC13|E0971|NU|11/01/2013|12/31/9999|$154.36|0|0|||WHEELCHAIR ANTI-TIPPING DEVI|| 58-1699775|1326041732|CHC13|E0971|RR|11/01/2013|12/31/9999|$12.68|0|0|||WHEELCHAIR ANTI-TIPPING DEVI|| 58-1699775|1326041732|CHC13|E0971|UE|11/01/2013|12/31/9999|$133.05|0|0|||WHEELCHAIR ANTI-TIPPING DEVI|| 58-1699775|1326041732|CHC13|E0973|NU|11/01/2013|12/31/9999|$105.28|0|0|||W/CH ACCESS DET ADJ ARMREST|| 58-1699775|1326041732|CHC13|E0973|RR|11/01/2013|12/31/9999|$11.16|0|0|||W/CH ACCESS DET ADJ ARMREST|| 58-1699775|1326041732|CHC13|E0973|UE|11/01/2013|12/31/9999|$79.55|0|0|||W/CH ACCESS DET ADJ ARMREST|| 58-1699775|1326041732|CHC13|E0974|NU|11/01/2013|12/31/9999|$57.35|0|0|||W/CH ACCESS ANTI-ROLLBACK|| 58-1699775|1326041732|CHC13|E0974|RR|11/01/2013|12/31/9999|$4.95|0|0|||W/CH ACCESS ANTI-ROLLBACK|| 58-1699775|1326041732|CHC13|E0974|UE|11/01/2013|12/31/9999|$49.41|0|0|||W/CH ACCESS ANTI-ROLLBACK|| 58-1699775|1326041732|CHC13|E0978|NU|11/01/2013|12/31/9999|$37.73|0|0|||W/C ACC|SAF BELT PELV STRAP|| 58-1699775|1326041732|CHC13|E0978|RR|11/01/2013|12/31/9999|$3.77|0|0|||W/C ACC|SAF BELT PELV STRAP|| 58-1699775|1326041732|CHC13|E0978|UE|11/01/2013|12/31/9999|$28.14|0|0|||W/C ACC|SAF BELT PELV STRAP|| 58-1699775|1326041732|CHC13|E0980|NU|11/01/2013|12/31/9999|$61.21|0|0|||WHEELCHAIR SAFETY VEST|| 58-1699775|1326041732|CHC13|E0980|RR|11/01/2013|12/31/9999|$5.29|0|0|||WHEELCHAIR SAFETY VEST|| 58-1699775|1326041732|CHC13|E0980|UE|11/01/2013|12/31/9999|$52.76|0|0|||WHEELCHAIR SAFETY VEST|| 58-1699775|1326041732|CHC13|E0981|NU|11/01/2013|12/31/9999|$59.63|0|0|||SEAT UPHOLSTERY| REPLACEMENT|| 58-1699775|1326041732|CHC13|E0981|RR|11/01/2013|12/31/9999|$5.96|0|0|||SEAT UPHOLSTERY| REPLACEMENT|| 58-1699775|1326041732|CHC13|E0981|UE|11/01/2013|12/31/9999|$41.19|0|0|||SEAT UPHOLSTERY| REPLACEMENT|| 58-1699775|1326041732|CHC13|E0982|NU|11/01/2013|12/31/9999|$326.15|0|0|||BACK UPHOLSTERY| REPLACEMENT|| 58-1699775|1326041732|CHC13|E0982|RR|11/01/2013|12/31/9999|$6.91|0|0|||BACK UPHOLSTERY| REPLACEMENT|| 58-1699775|1326041732|CHC13|E0982|UE|11/01/2013|12/31/9999|$51.88|0|0|||BACK UPHOLSTERY| REPLACEMENT|| 58-1699775|1326041732|CHC13|E0983|RR|11/01/2013|12/31/9999|$1|979.43|0|0|||ADD PWR JOYSTICK|| 58-1699775|1326041732|CHC13|E0984|NU|11/01/2013|12/31/9999|$272.36|0|0|||ADD PWR TILLER|| 58-1699775|1326041732|CHC13|E0984|RR|11/01/2013|12/31/9999|$27.26|0|0|||ADD PWR TILLER|| 58-1699775|1326041732|CHC13|E0984|UE|11/01/2013|12/31/9999|$204.25|0|0|||ADD PWR TILLER|| 58-1699775|1326041732|CHC13|E0985|NU|11/01/2013|12/31/9999|$6|531.00|0|0|||W/C SEAT LIFT MECHANISM|| 58-1699775|1326041732|CHC13|E0985|RR|11/01/2013|12/31/9999|$653.11|0|0|||W/C SEAT LIFT MECHANISM|| 58-1699775|1326041732|CHC13|E0985|UE|11/01/2013|12/31/9999|$4|898.28|0|0|||W/C SEAT LIFT MECHANISM|| 58-1699775|1326041732|CHC13|E0986|NU|07/01/2016|12/31/9999|$5|915.36|0|0|||MAN W/C PUSH-RIM POW ASSIST|| 58-1699775|1326041732|CHC13|E0986|RR|07/01/2016|12/31/9999|$591.54|0|0|||MAN W/C PUSH-RIM POW ASSIST|| 58-1699775|1326041732|CHC13|E0986|UE|07/01/2016|12/31/9999|$4|436.52|0|0|||MAN W/C PUSH-RIM POW ASSIST|| 58-1699775|1326041732|CHC13|E0988||11/01/2013|12/31/9999|$13.59|0|0|||LEVER-ACTIVATED WHEEL DRIVE|| 58-1699775|1326041732|CHC13|E0990|NU|11/01/2013|12/31/9999|$108.60|0|0|||WHELLCHAIR ELEVATING LEG RES|| 58-1699775|1326041732|CHC13|E0990|RR|11/01/2013|12/31/9999|$10.75|0|0|||WHELLCHAIR ELEVATING LEG RES|| 58-1699775|1326041732|CHC13|E0990|UE|11/01/2013|12/31/9999|$81.46|0|0|||WHELLCHAIR ELEVATING LEG RES|| 58-1699775|1326041732|CHC13|E0992|NU|11/01/2013|12/31/9999|$20.11|0|0|||WHEELCHAIR SOLID SEAT INSERT|| 58-1699775|1326041732|CHC13|E0992|RR|11/01/2013|12/31/9999|$2.03|0|0|||WHEELCHAIR SOLID SEAT INSERT|| 58-1699775|1326041732|CHC13|E0992|UE|11/01/2013|12/31/9999|$15.10|0|0|||WHEELCHAIR SOLID SEAT INSERT|| 58-1699775|1326041732|CHC13|E0994|NU|11/01/2013|12/31/9999|$40.82|0|0|||WHEELCHAIR ARM REST|| 58-1699775|1326041732|CHC13|E0994|RR|11/01/2013|12/31/9999|$3.54|0|0|||WHEELCHAIR ARM REST|| 58-1699775|1326041732|CHC13|E0994|UE|11/01/2013|12/31/9999|$35.17|0|0|||WHEELCHAIR ARM REST|| 58-1699775|1326041732|CHC13|E0995|NU|11/01/2013|12/31/9999|$4|690.55|0|0|||WHEELCHAIR CALF REST|| 58-1699775|1326041732|CHC13|E0995|RR|11/01/2013|12/31/9999|$4.10|0|0|||WHEELCHAIR CALF REST|| 58-1699775|1326041732|CHC13|E0995|UE|11/01/2013|12/31/9999|$30.59|0|0|||WHEELCHAIR CALF REST|| 58-1699775|1326041732|CHC13|E1002|NU|11/01/2013|12/31/9999|$5|081.80|0|0|||PWR SEAT TILT|| 58-1699775|1326041732|CHC13|E1002|RR|11/01/2013|12/31/9999|$508.19|0|0|||PWR SEAT TILT|| 58-1699775|1326041732|CHC13|E1002|UE|11/01/2013|12/31/9999|$3|517.90|0|0|||PWR SEAT TILT|| 58-1699775|1326041732|CHC13|E1003|NU|11/01/2013|12/31/9999|$5|634.66|0|0|||PWR SEAT RECLINE|| 58-1699775|1326041732|CHC13|E1003|RR|11/01/2013|12/31/9999|$563.45|0|0|||PWR SEAT RECLINE|| 58-1699775|1326041732|CHC13|E1003|UE|11/01/2013|12/31/9999|$3|811.35|0|0|||PWR SEAT RECLINE|| 58-1699775|1326041732|CHC13|E1004|NU|11/01/2013|12/31/9999|$6|099.09|0|0|||PWR SEAT RECLINE MECH|| 58-1699775|1326041732|CHC13|E1004|RR|11/01/2013|12/31/9999|$609.90|0|0|||PWR SEAT RECLINE MECH|| 58-1699775|1326041732|CHC13|E1004|UE|11/01/2013|12/31/9999|$4|225.99|0|0|||PWR SEAT RECLINE MECH|| 58-1699775|1326041732|CHC13|E1005|NU|11/01/2013|12/31/9999|$7|470.81|0|0|||PWR SEAT RECLINE PWR|| 58-1699775|1326041732|CHC13|E1005|RR|11/01/2013|12/31/9999|$707.62|0|0|||PWR SEAT RECLINE PWR|| 58-1699775|1326041732|CHC13|E1005|UE|11/01/2013|12/31/9999|$4|574.32|0|0|||PWR SEAT RECLINE PWR|| 58-1699775|1326041732|CHC13|E1006|NU|11/01/2013|12/31/9999|$10|115.76|0|0|||PWR SEAT COMBO W/O SHEAR|| 58-1699775|1326041732|CHC13|E1006|RR|11/01/2013|12/31/9999|$866.75|0|0|||PWR SEAT COMBO W/O SHEAR|| 58-1699775|1326041732|CHC13|E1006|UE|11/01/2013|12/31/9999|$5|603.11|0|0|||PWR SEAT COMBO W/O SHEAR|| 58-1699775|1326041732|CHC13|E1007|NU|11/01/2013|12/31/9999|$10|116.67|0|0|||PWR SEAT COMBO W/SHEAR|| 58-1699775|1326041732|CHC13|E1007|RR|11/01/2013|12/31/9999|$1|011.66|0|0|||PWR SEAT COMBO W/SHEAR|| 58-1699775|1326041732|CHC13|E1007|UE|11/01/2013|12/31/9999|$7|586.81|0|0|||PWR SEAT COMBO W/SHEAR|| 58-1699775|1326041732|CHC13|E1008|NU|11/01/2013|12/31/9999|$9|560.28|0|0|||PWR SEAT COMBO PWR SHEAR|| 58-1699775|1326041732|CHC13|E1008|RR|11/01/2013|12/31/9999|$1|173.75|0|0|||PWR SEAT COMBO PWR SHEAR|| 58-1699775|1326041732|CHC13|E1008|UE|11/01/2013|12/31/9999|$7|587.53|0|0|||PWR SEAT COMBO PWR SHEAR|| 58-1699775|1326041732|CHC13|E1009|NU|11/01/2013|12/31/9999|$1|535.71|0|0|||ADD MECH LEG ELEVATION|| 58-1699775|1326041732|CHC13|E1009|RR|11/01/2013|12/31/9999|$132.36|0|0|||ADD MECH LEG ELEVATION|| 58-1699775|1326041732|CHC13|E1009|UE|11/01/2013|12/31/9999|$1|323.64|0|0|||ADD MECH LEG ELEVATION|| 58-1699775|1326041732|CHC13|E1010|NU|11/01/2013|12/31/9999|$1|250.84|0|0|||ADD PWR LEG ELEVATION|| 58-1699775|1326041732|CHC13|E1010|RR|11/01/2013|12/31/9999|$153.58|0|0|||ADD PWR LEG ELEVATION|| 58-1699775|1326041732|CHC13|E1010|UE|11/01/2013|12/31/9999|$992.74|0|0|||ADD PWR LEG ELEVATION|| 58-1699775|1326041732|CHC13|E1011|NU|11/01/2013|12/31/9999|$490.26|0|0|||PED WC MODIFY WIDTH ADJUSTM|| 58-1699775|1326041732|CHC13|E1011|RR|11/01/2013|12/31/9999|$49.04|0|0|||PED WC MODIFY WIDTH ADJUSTM|| 58-1699775|1326041732|CHC13|E1011|UE|11/01/2013|12/31/9999|$367.68|0|0|||PED WC MODIFY WIDTH ADJUSTM|| 58-1699775|1326041732|CHC13|E1014|NU|11/01/2013|12/31/9999|$154.01|0|0|||RECLINING BACK ADD PED W/C|| 58-1699775|1326041732|CHC13|E1014|RR|11/01/2013|12/31/9999|$15.39|0|0|||RECLINING BACK ADD PED W/C|| 58-1699775|1326041732|CHC13|E1014|UE|11/01/2013|12/31/9999|$115.50|0|0|||RECLINING BACK ADD PED W/C|| 58-1699775|1326041732|CHC13|E1015|NU|11/01/2013|12/31/9999|$176.31|0|0|||SHOCK ABSORBER FOR MAN W/C|| 58-1699775|1326041732|CHC13|E1015|RR|11/01/2013|12/31/9999|$15.21|0|0|||SHOCK ABSORBER FOR MAN W/C|| 58-1699775|1326041732|CHC13|E1015|UE|11/01/2013|12/31/9999|$151.96|0|0|||SHOCK ABSORBER FOR MAN W/C|| 58-1699775|1326041732|CHC13|E1016|NU|11/01/2013|12/31/9999|$143.59|0|0|||SHOCK ABSORBER FOR POWER W/C|| 58-1699775|1326041732|CHC13|E1016|RR|11/01/2013|12/31/9999|$17.65|0|0|||SHOCK ABSORBER FOR POWER W/C|| 58-1699775|1326041732|CHC13|E1016|UE|11/01/2013|12/31/9999|$113.96|0|0|||SHOCK ABSORBER FOR POWER W/C|| 58-1699775|1326041732|CHC13|E1017||11/01/2013|12/31/9999|$0.00|0|0|||HD SHCK ABSRBR FOR HD MAN WC|| 58-1699775|1326041732|CHC13|E1018|NU|11/01/2013|12/31/9999|$326.81|0|0|||HD SHCK ABSRBER FOR HD POWWC|| 58-1699775|1326041732|CHC13|E1018|RR|11/01/2013|12/31/9999|$28.15|0|0|||HD SHCK ABSRBER FOR HD POWWC|| 58-1699775|1326041732|CHC13|E1018|UE|11/01/2013|12/31/9999|$281.69|0|0|||HD SHCK ABSRBER FOR HD POWWC|| 58-1699775|1326041732|CHC13|E1020|NU|11/01/2013|12/31/9999|$245.11|0|0|||RESIDUAL LIMB SUPPORT SYSTEM|| 58-1699775|1326041732|CHC13|E1020|RR|11/01/2013|12/31/9999|$23.90|0|0|||RESIDUAL LIMB SUPPORT SYSTEM|| 58-1699775|1326041732|CHC13|E1020|UE|11/01/2013|12/31/9999|$211.25|0|0|||RESIDUAL LIMB SUPPORT SYSTEM|| 58-1699775|1326041732|CHC13|E1028|NU|11/01/2013|12/31/9999|$427.65|0|0|||W/C MANUAL SWINGAWAY|| 58-1699775|1326041732|CHC13|E1028|RR|11/01/2013|12/31/9999|$27.73|0|0|||W/C MANUAL SWINGAWAY|| 58-1699775|1326041732|CHC13|E1028|UE|11/01/2013|12/31/9999|$179.25|0|0|||W/C MANUAL SWINGAWAY|| 58-1699775|1326041732|CHC13|E1029|NU|11/01/2013|12/31/9999|$1|348.50|0|0|||W/C VENT TRAY FIXED|| 58-1699775|1326041732|CHC13|E1029|RR|11/01/2013|12/31/9999|$49.61|0|0|||W/C VENT TRAY FIXED|| 58-1699775|1326041732|CHC13|E1029|UE|11/01/2013|12/31/9999|$320.72|0|0|||W/C VENT TRAY FIXED|| 58-1699775|1326041732|CHC13|E1030|NU|11/01/2013|12/31/9999|$1|154.21|0|0|||W/C VENT TRAY GIMBALED|| 58-1699775|1326041732|CHC13|E1030|RR|11/01/2013|12/31/9999|$57.65|0|0|||W/C VENT TRAY GIMBALED|| 58-1699775|1326041732|CHC13|E1030|UE|11/01/2013|12/31/9999|$823.32|0|0|||W/C VENT TRAY GIMBALED|| 58-1699775|1326041732|CHC13|E1031||11/01/2013|12/31/9999|$145.66|0|0|||ROLLABOUT CHAIR WITH CASTERS|| 58-1699775|1326041732|CHC13|E1035||11/01/2013|12/31/9999|$24.20|0|0|||PATIENT TRANSFER SYSTEM|| 58-1699775|1326041732|CHC13|E1036||11/01/2013|12/31/9999|$45.91|0|0|||PATIENT TRANSFER SYSTEM >300|| 58-1699775|1326041732|CHC13|E1037||11/01/2013|12/31/9999|$116.21|0|0|||TRANSPORT CHAIR| PED SIZE|| 58-1699775|1326041732|CHC13|E1038||11/01/2013|12/31/9999|$143.87|0|0|||TRANSPORT CHAIR PT WT<=300LB|| 58-1699775|1326041732|CHC13|E1039||11/01/2013|12/31/9999|$125.00|0|0|||TRANSPORT CHAIR PT WT >300LB|| 58-1699775|1326041732|CHC13|E1050||11/01/2013|12/31/9999|$89.86|0|0|||WHELCHR FXD FULL LENGTH ARMS|| 58-1699775|1326041732|CHC13|E1060||11/01/2013|12/31/9999|$131.72|0|0|||WHEELCHAIR DETACHABLE ARMS|| 58-1699775|1326041732|CHC13|E1070||11/01/2013|12/31/9999|$144.40|0|0|||WHEELCHAIR DETACHABLE FOOT R|| 58-1699775|1326041732|CHC13|E1083||11/01/2013|12/31/9999|$184.85|0|0|||HEMI-WHEELCHAIR FIXED ARMS|| 58-1699775|1326041732|CHC13|E1084||11/01/2013|12/31/9999|$172.56|0|0|||HEMI-WHEELCHAIR DETACHABLE A|| 58-1699775|1326041732|CHC13|E1087||11/01/2013|12/31/9999|$126.13|0|0|||WHEELCHAIR LIGHTWT FIXED ARM|| 58-1699775|1326041732|CHC13|E1088||11/01/2013|12/31/9999|$118.47|0|0|||WHEELCHAIR LIGHTWEIGHT DET A|| 58-1699775|1326041732|CHC13|E1092||11/01/2013|12/31/9999|$116.01|0|0|||WHEELCHAIR WIDE W/ LEG RESTS|| 58-1699775|1326041732|CHC13|E1093||11/01/2013|12/31/9999|$100.46|0|0|||WHEELCHAIR WIDE W/ FOOT REST|| 58-1699775|1326041732|CHC13|E1100||11/01/2013|12/31/9999|$71.33|0|0|||WHCHR S-RECL FXD ARM LEG RES|| 58-1699775|1326041732|CHC13|E1110||11/01/2013|12/31/9999|$3|176.85|0|0|||WHEELCHAIR SEMI-RECL DETACH|| 58-1699775|1326041732|CHC13|E1150||11/01/2013|12/31/9999|$317.69|0|0|||WHEELCHAIR STANDARD W/ LEG R|| 58-1699775|1326041732|CHC13|E1160||11/01/2013|12/31/9999|$2|382.68|0|0|||WHEELCHAIR FIXED ARMS|| 58-1699775|1326041732|CHC13|E1161|NU|11/01/2013|12/31/9999|$131.53|0|0|||MANUAL ADULT WC W TILTINSPAC|| 58-1699775|1326041732|CHC13|E1161|RR|11/01/2013|12/31/9999|$95.17|0|0|||MANUAL ADULT WC W TILTINSPAC|| 58-1699775|1326041732|CHC13|E1161|UE|11/01/2013|12/31/9999|$101.94|0|0|||MANUAL ADULT WC W TILTINSPAC|| 58-1699775|1326041732|CHC13|E1170||11/01/2013|12/31/9999|$115.65|0|0|||WHLCHR AMPU FXD ARM LEG REST|| 58-1699775|1326041732|CHC13|E1171||11/01/2013|12/31/9999|$133.61|0|0|||WHEELCHAIR AMPUTEE W/O LEG R|| 58-1699775|1326041732|CHC13|E1172||11/01/2013|12/31/9999|$143.37|0|0|||WHEELCHAIR AMPUTEE DETACH AR|| 58-1699775|1326041732|CHC13|E1180||11/01/2013|12/31/9999|$99.30|0|0|||WHEELCHAIR AMPUTEE W/ FOOT R|| 58-1699775|1326041732|CHC13|E1190||11/01/2013|12/31/9999|$63.80|0|0|||WHEELCHAIR AMPUTEE W/ LEG RE|| 58-1699775|1326041732|CHC13|E1195||11/01/2013|12/31/9999|$90.23|0|0|||WHEELCHAIR AMPUTEE HEAVY DUT|| 58-1699775|1326041732|CHC13|E1200||11/01/2013|12/31/9999|$99.38|0|0|||WHEELCHAIR AMPUTEE FIXED ARM|| 58-1699775|1326041732|CHC13|E1221||11/01/2013|12/31/9999|$108.95|0|0|||WHEELCHAIR SPEC SIZE W FOOT|| 58-1699775|1326041732|CHC13|E1222||11/01/2013|12/31/9999|$54.52|0|0|||WHEELCHAIR SPEC SIZE W/ LEG|| 58-1699775|1326041732|CHC13|E1223||11/01/2013|12/31/9999|$732.62|0|0|||WHEELCHAIR SPEC SIZE W FOOT|| 58-1699775|1326041732|CHC13|E1224||11/01/2013|12/31/9999|$75.40|0|0|||WHEELCHAIR SPEC SIZE W/ LEG|| 58-1699775|1326041732|CHC13|E1225||11/01/2013|12/31/9999|$549.41|0|0|||MANUAL SEMI-RECLINING BACK|| 58-1699775|1326041732|CHC13|E1226|NU|11/01/2013|12/31/9999|$372.60|0|0|||MANUAL FULLY RECLINING BACK|| 58-1699775|1326041732|CHC13|E1226|RR|11/01/2013|12/31/9999|$37.26|0|0|||MANUAL FULLY RECLINING BACK|| 58-1699775|1326041732|CHC13|E1226|UE|11/01/2013|12/31/9999|$279.48|0|0|||MANUAL FULLY RECLINING BACK|| 58-1699775|1326041732|CHC13|E1227|NU|11/01/2013|12/31/9999|$3|036.81|0|0|||WHEELCHAIR SPEC SZ SPEC HT A|| 58-1699775|1326041732|CHC13|E1227|RR|11/01/2013|12/31/9999|$31.99|0|0|||WHEELCHAIR SPEC SZ SPEC HT A|| 58-1699775|1326041732|CHC13|E1227|UE|11/01/2013|12/31/9999|$298.68|0|0|||WHEELCHAIR SPEC SZ SPEC HT A|| 58-1699775|1326041732|CHC13|E1228||11/01/2013|12/31/9999|$2|299.70|0|0|||WHEELCHAIR SPEC SZ SPEC HT B|| 58-1699775|1326041732|CHC13|E1230|NU|11/01/2013|12/31/9999|$3|826.39|0|0|||POWER OPERATED VEHICLE|| 58-1699775|1326041732|CHC13|E1230|RR|11/01/2013|12/31/9999|$376.33|0|0|||POWER OPERATED VEHICLE|| 58-1699775|1326041732|CHC13|E1230|UE|11/01/2013|12/31/9999|$2|897.62|0|0|||POWER OPERATED VEHICLE|| 58-1699775|1326041732|CHC13|E1231|NU|11/01/2013|12/31/9999|$2|871.14|0|0|||RIGID PED W/C TILT-IN-SPACE|| 58-1699775|1326041732|CHC13|E1231|RR|11/01/2013|12/31/9999|$287.12|0|0|||RIGID PED W/C TILT-IN-SPACE|| 58-1699775|1326041732|CHC13|E1231|UE|11/01/2013|12/31/9999|$2|153.39|0|0|||RIGID PED W/C TILT-IN-SPACE|| 58-1699775|1326041732|CHC13|E1232|NU|11/01/2013|12/31/9999|$2|974.96|0|0|||FOLDING PED WC TILT-IN-SPACE|| 58-1699775|1326041732|CHC13|E1232|RR|11/01/2013|12/31/9999|$297.50|0|0|||FOLDING PED WC TILT-IN-SPACE|| 58-1699775|1326041732|CHC13|E1232|UE|11/01/2013|12/31/9999|$2|231.22|0|0|||FOLDING PED WC TILT-IN-SPACE|| 58-1699775|1326041732|CHC13|E1233|NU|11/01/2013|12/31/9999|$2|589.91|0|0|||RIG PED WC TLTNSPC W/O SEAT|| 58-1699775|1326041732|CHC13|E1233|RR|11/01/2013|12/31/9999|$259.03|0|0|||RIG PED WC TLTNSPC W/O SEAT|| 58-1699775|1326041732|CHC13|E1233|UE|11/01/2013|12/31/9999|$1|942.42|0|0|||RIG PED WC TLTNSPC W/O SEAT|| 58-1699775|1326041732|CHC13|E1234|NU|11/01/2013|12/31/9999|$2|493.89|0|0|||FLD PED WC TLTNSPC W/O SEAT|| 58-1699775|1326041732|CHC13|E1234|RR|11/01/2013|12/31/9999|$249.40|0|0|||FLD PED WC TLTNSPC W/O SEAT|| 58-1699775|1326041732|CHC13|E1234|UE|11/01/2013|12/31/9999|$1|870.41|0|0|||FLD PED WC TLTNSPC W/O SEAT|| 58-1699775|1326041732|CHC13|E1235|NU|11/01/2013|12/31/9999|$2|200.25|0|0|||RIGID PED WC ADJUSTABLE|| 58-1699775|1326041732|CHC13|E1235|RR|11/01/2013|12/31/9999|$220.03|0|0|||RIGID PED WC ADJUSTABLE|| 58-1699775|1326041732|CHC13|E1235|UE|11/01/2013|12/31/9999|$1|650.19|0|0|||RIGID PED WC ADJUSTABLE|| 58-1699775|1326041732|CHC13|E1236|NU|11/01/2013|12/31/9999|$2|219.47|0|0|||FOLDING PED WC ADJUSTABLE|| 58-1699775|1326041732|CHC13|E1236|RR|11/01/2013|12/31/9999|$221.95|0|0|||FOLDING PED WC ADJUSTABLE|| 58-1699775|1326041732|CHC13|E1236|UE|11/01/2013|12/31/9999|$1|664.62|0|0|||FOLDING PED WC ADJUSTABLE|| 58-1699775|1326041732|CHC13|E1237|NU|11/01/2013|12/31/9999|$2|200.25|0|0|||RGD PED WC ADJSTABL W/O SEAT|| 58-1699775|1326041732|CHC13|E1237|RR|11/01/2013|12/31/9999|$220.03|0|0|||RGD PED WC ADJSTABL W/O SEAT|| 58-1699775|1326041732|CHC13|E1237|UE|11/01/2013|12/31/9999|$1|650.19|0|0|||RGD PED WC ADJSTABL W/O SEAT|| 58-1699775|1326041732|CHC13|E1238|NU|11/01/2013|12/31/9999|$153.50|0|0|||FLD PED WC ADJSTABL W/O SEAT|| 58-1699775|1326041732|CHC13|E1238|RR|11/01/2013|12/31/9999|$106.00|0|0|||FLD PED WC ADJSTABL W/O SEAT|| 58-1699775|1326041732|CHC13|E1238|UE|11/01/2013|12/31/9999|$138.31|0|0|||FLD PED WC ADJSTABL W/O SEAT|| 58-1699775|1326041732|CHC13|E1240||11/01/2013|12/31/9999|$163.09|0|0|||WHCHR LITWT DET ARM LEG REST|| 58-1699775|1326041732|CHC13|E1270||11/01/2013|12/31/9999|$660.14|0|0|||WHEELCHAIR LIGHTWEIGHT LEG R|| 58-1699775|1326041732|CHC13|E1280||11/01/2013|12/31/9999|$67.06|0|0|||WHCHR H-DUTY DET ARM LEG RES|| 58-1699775|1326041732|CHC13|E1295||11/01/2013|12/31/9999|$495.10|0|0|||WHEELCHAIR HEAVY DUTY FIXED|| 58-1699775|1326041732|CHC13|E1296|NU|11/01/2013|12/31/9999|$140.45|0|0|||WHEELCHAIR SPECIAL SEAT HEIG|| 58-1699775|1326041732|CHC13|E1296|RR|11/01/2013|12/31/9999|$15.60|0|0|||WHEELCHAIR SPECIAL SEAT HEIG|| 58-1699775|1326041732|CHC13|E1296|UE|11/01/2013|12/31/9999|$105.33|0|0|||WHEELCHAIR SPECIAL SEAT HEIG|| 58-1699775|1326041732|CHC13|E1297|NU|11/01/2013|12/31/9999|$568.82|0|0|||WHEELCHAIR SPECIAL SEAT DEPT|| 58-1699775|1326041732|CHC13|E1297|RR|11/01/2013|12/31/9999|$58.20|0|0|||WHEELCHAIR SPECIAL SEAT DEPT|| 58-1699775|1326041732|CHC13|E1297|UE|11/01/2013|12/31/9999|$426.61|0|0|||WHEELCHAIR SPECIAL SEAT DEPT|| 58-1699775|1326041732|CHC13|E1298|NU|11/01/2013|12/31/9999|$2|883.23|0|0|||WHEELCHAIR SPEC SEAT DEPTH/W|| 58-1699775|1326041732|CHC13|E1298|RR|11/01/2013|12/31/9999|$246.60|0|0|||WHEELCHAIR SPEC SEAT DEPTH/W|| 58-1699775|1326041732|CHC13|E1298|UE|11/01/2013|12/31/9999|$2|162.42|0|0|||WHEELCHAIR SPEC SEAT DEPTH/W|| 58-1699775|1326041732|CHC13|E1310|NU|11/01/2013|12/31/9999|$186.05|0|0|||WHIRLPOOL NON-PORTABLE|| 58-1699775|1326041732|CHC13|E1310|RR|11/01/2013|12/31/9999|$28.65|0|0|||WHIRLPOOL NON-PORTABLE|| 58-1699775|1326041732|CHC13|E1310|UE|11/01/2013|12/31/9999|$38.04|0|0|||WHIRLPOOL NON-PORTABLE|| 58-1699775|1326041732|CHC13|E1353||11/01/2013|12/31/9999|$27.04|0|0|||OXYGEN SUPPLIES REGULATOR|| 58-1699775|1326041732|CHC13|E1355||11/01/2013|12/31/9999|$137.73|0|0|||OXYGEN SUPPLIES STAND/RACK|| 58-1699775|1326041732|CHC13|E1372|NU|11/01/2013|12/31/9999|$220.07|0|0|||OXY SUPPL HEATER FOR NEBULIZ|| 58-1699775|1326041732|CHC13|E1372|RR|11/01/2013|12/31/9999|$64.54|0|0|||OXY SUPPL HEATER FOR NEBULIZ|| 58-1699775|1326041732|CHC13|E1372|UE|11/01/2013|12/31/9999|$220.07|0|0|||OXY SUPPL HEATER FOR NEBULIZ|| 58-1699775|1326041732|CHC13|E1390|NU|11/01/2013|12/31/9999|$1|625.00|0|0|||OXYGEN CONCENTRATOR|| 58-1699775|1326041732|CHC13|E1390|RR|11/01/2013|12/31/2017|$260.09|0|0|||OXYGEN CONCENTRATOR|| 58-1699775|1326041732|CHC13|E1390|RR|01/01/2018|12/31/9999|$87.79|0|0|||OXYGEN CONCENTRATOR|| 58-1699775|1326041732|CHC13|E1391||11/01/2013|12/31/9999|$241.70|0|0|||OXYGEN CONCENTRATOR| DUAL|| 58-1699775|1326041732|CHC13|E1392||11/01/2013|12/31/9999|$463.00|0|0|||PORTABLE OXYGEN CONCENTRATOR|| 58-1699775|1326041732|CHC13|E1405||11/01/2013|12/31/9999|$45.40|0|0|||O2/WATER VAPOR ENRICH W/HEAT|| 58-1699775|1326041732|CHC13|E1406||11/01/2013|12/31/9999|$347.25|0|0|||O2/WATER VAPOR ENRICH W/O HE|| 58-1699775|1326041732|CHC13|E1700|NU|11/01/2013|12/31/9999|$139.80|0|0|||JAW MOTION REHAB SYSTEM|| 58-1699775|1326041732|CHC13|E1700|RR|11/01/2013|12/31/9999|$13.51|0|0|||JAW MOTION REHAB SYSTEM|| 58-1699775|1326041732|CHC13|E1700|UE|11/01/2013|12/31/9999|$27.16|0|0|||JAW MOTION REHAB SYSTEM|| 58-1699775|1326041732|CHC13|E1701||11/01/2013|12/31/9999|$168.02|0|0|||REPL CUSHIONS FOR JAW MOTION|| 58-1699775|1326041732|CHC13|E1702||11/01/2013|12/31/9999|$438.79|0|0|||REPL MEASR SCALES JAW MOTION|| 58-1699775|1326041732|CHC13|E1800||11/01/2013|12/31/9999|$144.19|0|0|||ADJUST ELBOW EXT/FLEX DEVICE|| 58-1699775|1326041732|CHC13|E1801||11/01/2013|12/31/9999|$137.94|0|0|||SPS ELBOW DEVICE|| 58-1699775|1326041732|CHC13|E1802||11/01/2013|12/31/9999|$142.19|0|0|||ADJST FOREARM PRO/SUP DEVICE|| 58-1699775|1326041732|CHC13|E1805||11/01/2013|12/31/9999|$174.70|0|0|||ADJUST WRIST EXT/FLEX DEVICE|| 58-1699775|1326041732|CHC13|E1806||11/01/2013|12/31/9999|$115.45|0|0|||SPS WRIST DEVICE|| 58-1699775|1326041732|CHC13|E1810||11/01/2013|12/31/9999|$144.19|0|0|||ADJUST KNEE EXT/FLEX DEVICE|| 58-1699775|1326041732|CHC13|E1811||11/01/2013|12/31/9999|$177.41|0|0|||SPS KNEE DEVICE|| 58-1699775|1326041732|CHC13|E1812||11/01/2013|12/31/9999|$181.11|0|0|||KNEE EXT/FLEX W ACT RES CTRL|| 58-1699775|1326041732|CHC13|E1815||11/01/2013|12/31/9999|$109.75|0|0|||ADJUST ANKLE EXT/FLEX DEVICE|| 58-1699775|1326041732|CHC13|E1816||11/01/2013|12/31/9999|$10.97|0|0|||SPS ANKLE DEVICE|| 58-1699775|1326041732|CHC13|E1818||11/01/2013|12/31/9999|$82.33|0|0|||SPS FOREARM DEVICE|| 58-1699775|1326041732|CHC13|E1820|NU|11/01/2013|12/31/9999|$141.31|0|0|||SOFT INTERFACE MATERIAL|| 58-1699775|1326041732|CHC13|E1820|RR|11/01/2013|12/31/9999|$14.11|0|0|||SOFT INTERFACE MATERIAL|| 58-1699775|1326041732|CHC13|E1820|UE|11/01/2013|12/31/9999|$106.01|0|0|||SOFT INTERFACE MATERIAL|| 58-1699775|1326041732|CHC13|E1821|NU|11/01/2013|12/31/9999|$144.19|0|0|||REPLACEMENT INTERFACE SPSD|| 58-1699775|1326041732|CHC13|E1821|RR|11/01/2013|12/31/9999|$88.71|0|0|||REPLACEMENT INTERFACE SPSD|| 58-1699775|1326041732|CHC13|E1821|UE|11/01/2013|12/31/9999|$144.19|0|0|||REPLACEMENT INTERFACE SPSD|| 58-1699775|1326041732|CHC13|E1825||11/01/2013|12/31/9999|$496.85|0|0|||ADJUST FINGER EXT/FLEX DEVC|| 58-1699775|1326041732|CHC13|E1830||11/01/2013|12/31/9999|$608.21|0|0|||ADJUST TOE EXT/FLEX DEVICE|| 58-1699775|1326041732|CHC13|E1831||11/01/2013|12/31/9999|$67.49|0|0|||STATIC STR TOE DEV EXT/FLEX|| 58-1699775|1326041732|CHC13|E1840||11/01/2013|12/31/9999|$734.04|0|0|||ADJ SHOULDER EXT/FLEX DEVICE|| 58-1699775|1326041732|CHC13|E1841||11/01/2013|12/31/9999|$73.41|0|0|||STATIC STR SHLDR DEV ROM ADJ|| 58-1699775|1326041732|CHC13|E2000||11/01/2013|12/31/9999|$550.54|0|0|||GASTRIC SUCTION PUMP HME MDL|| 58-1699775|1326041732|CHC13|E2100|NU|11/01/2013|12/31/9999|$253.17|0|0|||BLD GLUCOSE MONITOR W VOICE|| 58-1699775|1326041732|CHC13|E2100|RR|11/01/2013|12/31/9999|$25.31|0|0|||BLD GLUCOSE MONITOR W VOICE|| 58-1699775|1326041732|CHC13|E2100|UE|11/01/2013|12/31/9999|$189.87|0|0|||BLD GLUCOSE MONITOR W VOICE|| 58-1699775|1326041732|CHC13|E2101|NU|11/01/2013|12/31/9999|$500.95|0|0|||BLD GLUCOSE MONITOR W LANCE|| 58-1699775|1326041732|CHC13|E2101|RR|11/01/2013|12/31/9999|$50.10|0|0|||BLD GLUCOSE MONITOR W LANCE|| 58-1699775|1326041732|CHC13|E2101|UE|11/01/2013|12/31/9999|$380.68|0|0|||BLD GLUCOSE MONITOR W LANCE|| 58-1699775|1326041732|CHC13|E2120||11/01/2013|12/31/9999|$375.71|0|0|||PULSE GEN SYS TX ENDOLYMP FL|| 58-1699775|1326041732|CHC13|E2201|NU|11/01/2013|12/31/9999|$636.39|0|0|||MAN W/CH ACC SEAT W>=20<24|| 58-1699775|1326041732|CHC13|E2201|RR|11/01/2013|12/31/9999|$63.64|0|0|||MAN W/CH ACC SEAT W>=20<24|| 58-1699775|1326041732|CHC13|E2201|UE|11/01/2013|12/31/9999|$477.32|0|0|||MAN W/CH ACC SEAT W>=20<24|| 58-1699775|1326041732|CHC13|E2202|NU|11/01/2013|12/31/9999|$643.20|0|0|||SEAT WIDTH 24-27 IN|| 58-1699775|1326041732|CHC13|E2202|RR|11/01/2013|12/31/9999|$64.30|0|0|||SEAT WIDTH 24-27 IN|| 58-1699775|1326041732|CHC13|E2202|UE|11/01/2013|12/31/9999|$482.37|0|0|||SEAT WIDTH 24-27 IN|| 58-1699775|1326041732|CHC13|E2203|NU|11/01/2013|12/31/9999|$1|092.13|0|0|||FRAME DEPTH LESS THAN 22 IN|| 58-1699775|1326041732|CHC13|E2203|RR|11/01/2013|12/31/9999|$109.22|0|0|||FRAME DEPTH LESS THAN 22 IN|| 58-1699775|1326041732|CHC13|E2203|UE|11/01/2013|12/31/9999|$819.09|0|0|||FRAME DEPTH LESS THAN 22 IN|| 58-1699775|1326041732|CHC13|E2204|NU|11/01/2013|12/31/9999|$43.86|0|0|||FRAME DEPTH 22 TO 25 IN|| 58-1699775|1326041732|CHC13|E2204|RR|11/01/2013|12/31/9999|$4.36|0|0|||FRAME DEPTH 22 TO 25 IN|| 58-1699775|1326041732|CHC13|E2204|UE|11/01/2013|12/31/9999|$32.93|0|0|||FRAME DEPTH 22 TO 25 IN|| 58-1699775|1326041732|CHC13|E2205|NU|11/01/2013|12/31/9999|$54.61|0|0|||MANUAL WC ACCESSORY| HANDRIM|| 58-1699775|1326041732|CHC13|E2205|RR|11/01/2013|12/31/9999|$5.45|0|0|||MANUAL WC ACCESSORY| HANDRIM|| 58-1699775|1326041732|CHC13|E2205|UE|11/01/2013|12/31/9999|$40.96|0|0|||MANUAL WC ACCESSORY| HANDRIM|| 58-1699775|1326041732|CHC13|E2206|NU|11/01/2013|12/31/9999|$58.20|0|0|||COMPLETE WHEEL LOCK ASSEMBLY|| 58-1699775|1326041732|CHC13|E2206|RR|11/01/2013|12/31/9999|$5.84|0|0|||COMPLETE WHEEL LOCK ASSEMBLY|| 58-1699775|1326041732|CHC13|E2206|UE|11/01/2013|12/31/9999|$43.66|0|0|||COMPLETE WHEEL LOCK ASSEMBLY|| 58-1699775|1326041732|CHC13|E2207|NU|11/01/2013|12/31/9999|$159.49|0|0|||CRUTCH AND CANE HOLDER|| 58-1699775|1326041732|CHC13|E2207|RR|11/01/2013|12/31/9999|$13.74|0|0|||CRUTCH AND CANE HOLDER|| 58-1699775|1326041732|CHC13|E2207|UE|11/01/2013|12/31/9999|$137.46|0|0|||CRUTCH AND CANE HOLDER|| 58-1699775|1326041732|CHC13|E2208|NU|11/01/2013|12/31/9999|$124.01|0|0|||CYLINDER TANK CARRIER|| 58-1699775|1326041732|CHC13|E2208|RR|11/01/2013|12/31/9999|$12.42|0|0|||CYLINDER TANK CARRIER|| 58-1699775|1326041732|CHC13|E2208|UE|11/01/2013|12/31/9999|$103.10|0|0|||CYLINDER TANK CARRIER|| 58-1699775|1326041732|CHC13|E2209|NU|11/01/2013|12/31/9999|$93.01|0|0|||ARM TROUGH EACH|| 58-1699775|1326041732|CHC13|E2209|RR|11/01/2013|12/31/9999|$0.76|0|0|||ARM TROUGH EACH|| 58-1699775|1326041732|CHC13|E2209|UE|11/01/2013|12/31/9999|$8.79|0|0|||ARM TROUGH EACH|| 58-1699775|1326041732|CHC13|E2210|NU|11/01/2013|12/31/9999|$34.56|0|0|||WHEELCHAIR BEARINGS|| 58-1699775|1326041732|CHC13|E2210|RR|11/01/2013|12/31/9999|$0.89|0|0|||WHEELCHAIR BEARINGS|| 58-1699775|1326041732|CHC13|E2210|UE|11/01/2013|12/31/9999|$5.70|0|0|||WHEELCHAIR BEARINGS|| 58-1699775|1326041732|CHC13|E2211|NU|11/01/2013|12/31/9999|$7.89|0|0|||PNEUMATIC PROPULSION TIRE|| 58-1699775|1326041732|CHC13|E2211|RR|11/01/2013|12/31/9999|$0.83|0|0|||PNEUMATIC PROPULSION TIRE|| 58-1699775|1326041732|CHC13|E2211|UE|11/01/2013|12/31/9999|$5.94|0|0|||PNEUMATIC PROPULSION TIRE|| 58-1699775|1326041732|CHC13|E2212|NU|11/01/2013|12/31/9999|$40.84|0|0|||PNEUMATIC PROP TIRE TUBE|| 58-1699775|1326041732|CHC13|E2212|RR|11/01/2013|12/31/9999|$4.10|0|0|||PNEUMATIC PROP TIRE TUBE|| 58-1699775|1326041732|CHC13|E2212|UE|11/01/2013|12/31/9999|$30.60|0|0|||PNEUMATIC PROP TIRE TUBE|| 58-1699775|1326041732|CHC13|E2213|NU|11/01/2013|12/31/9999|$41.09|0|0|||PNEUMATIC PROP TIRE INSERT|| 58-1699775|1326041732|CHC13|E2213|RR|11/01/2013|12/31/9999|$4.52|0|0|||PNEUMATIC PROP TIRE INSERT|| 58-1699775|1326041732|CHC13|E2213|UE|11/01/2013|12/31/9999|$30.80|0|0|||PNEUMATIC PROP TIRE INSERT|| 58-1699775|1326041732|CHC13|E2214|NU|11/01/2013|12/31/9999|$12.89|0|0|||PNEUMATIC CASTER TIRE EACH|| 58-1699775|1326041732|CHC13|E2214|RR|11/01/2013|12/31/9999|$1.27|0|0|||PNEUMATIC CASTER TIRE EACH|| 58-1699775|1326041732|CHC13|E2214|UE|11/01/2013|12/31/9999|$9.64|0|0|||PNEUMATIC CASTER TIRE EACH|| 58-1699775|1326041732|CHC13|E2215|NU|11/01/2013|12/31/9999|$16.23|0|0|||PNEUMATIC CASTER TIRE TUBE|| 58-1699775|1326041732|CHC13|E2215|RR|11/01/2013|12/31/9999|$1.61|0|0|||PNEUMATIC CASTER TIRE TUBE|| 58-1699775|1326041732|CHC13|E2215|UE|11/01/2013|12/31/9999|$12.14|0|0|||PNEUMATIC CASTER TIRE TUBE|| 58-1699775|1326041732|CHC13|E2216||11/01/2013|12/31/9999|$0.00|0|0|||FOAM FILLED PROPULSION TIRE|| 58-1699775|1326041732|CHC13|E2217||11/01/2013|12/31/9999|$0.00|0|0|||FOAM FILLED CASTER TIRE EACH|| 58-1699775|1326041732|CHC13|E2218|NU|11/01/2013|12/31/9999|$56.19|0|0|||FOAM PROPULSION TIRE EACH|| 58-1699775|1326041732|CHC13|E2218|RR|11/01/2013|12/31/9999|$6.35|0|0|||FOAM PROPULSION TIRE EACH|| 58-1699775|1326041732|CHC13|E2218|UE|11/01/2013|12/31/9999|$42.15|0|0|||FOAM PROPULSION TIRE EACH|| 58-1699775|1326041732|CHC13|E2219|NU|11/01/2013|12/31/9999|$38.30|0|0|||FOAM CASTER TIRE ANY SIZE EA|| 58-1699775|1326041732|CHC13|E2219|RR|11/01/2013|12/31/9999|$3.70|0|0|||FOAM CASTER TIRE ANY SIZE EA|| 58-1699775|1326041732|CHC13|E2219|UE|11/01/2013|12/31/9999|$29.29|0|0|||FOAM CASTER TIRE ANY SIZE EA|| 58-1699775|1326041732|CHC13|E2220|NU|11/01/2013|12/31/9999|$34.30|0|0|||SOLID PROPULSION TIRE EACH|| 58-1699775|1326041732|CHC13|E2220|RR|11/01/2013|12/31/9999|$3.47|0|0|||SOLID PROPULSION TIRE EACH|| 58-1699775|1326041732|CHC13|E2220|UE|11/01/2013|12/31/9999|$25.75|0|0|||SOLID PROPULSION TIRE EACH|| 58-1699775|1326041732|CHC13|E2221|NU|11/01/2013|12/31/9999|$28.28|0|0|||SOLID CASTER TIRE EACH|| 58-1699775|1326041732|CHC13|E2221|RR|11/01/2013|12/31/9999|$2.80|0|0|||SOLID CASTER TIRE EACH|| 58-1699775|1326041732|CHC13|E2221|UE|11/01/2013|12/31/9999|$21.22|0|0|||SOLID CASTER TIRE EACH|| 58-1699775|1326041732|CHC13|E2222|NU|11/01/2013|12/31/9999|$111.91|0|0|||SOLID CASTER INTEGRATED WHL|| 58-1699775|1326041732|CHC13|E2222|RR|11/01/2013|12/31/9999|$11.74|0|0|||SOLID CASTER INTEGRATED WHL|| 58-1699775|1326041732|CHC13|E2222|UE|11/01/2013|12/31/9999|$83.94|0|0|||SOLID CASTER INTEGRATED WHL|| 58-1699775|1326041732|CHC13|E2224|NU|11/01/2013|12/31/9999|$23.36|0|0|||PROPULSION WHL EXCLUDES TIRE|| 58-1699775|1326041732|CHC13|E2224|RR|11/01/2013|12/31/9999|$2.34|0|0|||PROPULSION WHL EXCLUDES TIRE|| 58-1699775|1326041732|CHC13|E2224|UE|11/01/2013|12/31/9999|$17.51|0|0|||PROPULSION WHL EXCLUDES TIRE|| 58-1699775|1326041732|CHC13|E2225|NU|11/01/2013|12/31/9999|$50.95|0|0|||CASTER WHEEL EXCLUDES TIRE|| 58-1699775|1326041732|CHC13|E2225|RR|11/01/2013|12/31/9999|$5.10|0|0|||CASTER WHEEL EXCLUDES TIRE|| 58-1699775|1326041732|CHC13|E2225|UE|11/01/2013|12/31/9999|$38.21|0|0|||CASTER WHEEL EXCLUDES TIRE|| 58-1699775|1326041732|CHC13|E2226|NU|11/01/2013|12/31/9999|$2|511.64|0|0|||CASTER FORK REPLACEMENT ONLY|| 58-1699775|1326041732|CHC13|E2226|RR|11/01/2013|12/31/9999|$251.18|0|0|||CASTER FORK REPLACEMENT ONLY|| 58-1699775|1326041732|CHC13|E2226|UE|11/01/2013|12/31/9999|$1|883.75|0|0|||CASTER FORK REPLACEMENT ONLY|| 58-1699775|1326041732|CHC13|E2227|NU|11/01/2013|12/31/9999|$1|257.07|0|0|||GEAR REDUCTION DRIVE WHEEL|| 58-1699775|1326041732|CHC13|E2227|RR|11/01/2013|12/31/9999|$125.70|0|0|||GEAR REDUCTION DRIVE WHEEL|| 58-1699775|1326041732|CHC13|E2227|UE|11/01/2013|12/31/9999|$942.84|0|0|||GEAR REDUCTION DRIVE WHEEL|| 58-1699775|1326041732|CHC13|E2228|NU|11/01/2013|12/31/9999|$206.34|0|0|||MWC ACC| WHEELCHAIR BRAKE|| 58-1699775|1326041732|CHC13|E2228|RR|11/01/2013|12/31/9999|$20.64|0|0|||MWC ACC| WHEELCHAIR BRAKE|| 58-1699775|1326041732|CHC13|E2228|UE|11/01/2013|12/31/9999|$154.74|0|0|||MWC ACC| WHEELCHAIR BRAKE|| 58-1699775|1326041732|CHC13|E2231|NU|11/01/2013|12/31/9999|$1|571.22|0|0|||SOLID SEAT SUPPORT BASE|| 58-1699775|1326041732|CHC13|E2231|RR|11/01/2013|12/31/9999|$135.41|0|0|||SOLID SEAT SUPPORT BASE|| 58-1699775|1326041732|CHC13|E2231|UE|11/01/2013|12/31/9999|$1|354.25|0|0|||SOLID SEAT SUPPORT BASE|| 58-1699775|1326041732|CHC13|E2293|NU|04/01/2016|12/31/9999|$399.36|0|0|||CONTOUR BACK FOR PED SIZE WC|| 58-1699775|1326041732|CHC13|E2294|NU|04/01/2016|12/31/9999|$345.80|0|0|||CONTOUR SEAT FOR PED SIZE WC|| 58-1699775|1326041732|CHC13|E2300|NU|01/01/2016|12/31/9999|$2|011.00|0|0|||PWR SEAT ELEVATION SYS|| 58-1699775|1326041732|CHC13|E2300|RR|01/01/2016|12/31/9999|$201.10|0|0|||PWR SEAT ELEVATION SYS|| 58-1699775|1326041732|CHC13|E2300|UE|01/01/2016|12/31/9999|$1|508.25|0|0|||PWR SEAT ELEVATION SYS|| 58-1699775|1326041732|CHC13|E2310|NU|11/01/2013|12/31/9999|$2|741.75|0|0|||ELECTRO CONNECT BTW CONTROL|| 58-1699775|1326041732|CHC13|E2310|RR|11/01/2013|12/31/9999|$157.12|0|0|||ELECTRO CONNECT BTW CONTROL|| 58-1699775|1326041732|CHC13|E2310|UE|11/01/2013|12/31/9999|$1|015.69|0|0|||ELECTRO CONNECT BTW CONTROL|| 58-1699775|1326041732|CHC13|E2311|NU|11/01/2013|12/31/9999|$2|707.75|0|0|||ELECTRO CONNECT BTW 2 SYS|| 58-1699775|1326041732|CHC13|E2311|RR|11/01/2013|12/31/9999|$270.77|0|0|||ELECTRO CONNECT BTW 2 SYS|| 58-1699775|1326041732|CHC13|E2311|UE|11/01/2013|12/31/9999|$2|056.30|0|0|||ELECTRO CONNECT BTW 2 SYS|| 58-1699775|1326041732|CHC13|E2312|NU|11/01/2013|12/31/9999|$2|030.85|0|0|||MINI-PROP REMOTE JOYSTICK|| 58-1699775|1326041732|CHC13|E2312|RR|11/01/2013|12/31/9999|$43.01|0|0|||MINI-PROP REMOTE JOYSTICK|| 58-1699775|1326041732|CHC13|E2312|UE|11/01/2013|12/31/9999|$345.33|0|0|||MINI-PROP REMOTE JOYSTICK|| 58-1699775|1326041732|CHC13|E2313|NU|11/01/2013|12/31/9999|$2|995.47|0|0|||PWC HARNESS| EXPAND CONTROL|| 58-1699775|1326041732|CHC13|E2313|RR|11/01/2013|12/31/9999|$1|838.98|0|0|||PWC HARNESS| EXPAND CONTROL|| 58-1699775|1326041732|CHC13|E2313|UE|11/01/2013|12/31/9999|$2|133.63|0|0|||PWC HARNESS| EXPAND CONTROL|| 58-1699775|1326041732|CHC13|E2321|NU|11/01/2013|12/31/9999|$1|893.64|0|0|||HAND INTERFACE JOYSTICK|| 58-1699775|1326041732|CHC13|E2321|RR|11/01/2013|12/31/9999|$183.91|0|0|||HAND INTERFACE JOYSTICK|| 58-1699775|1326041732|CHC13|E2321|UE|11/01/2013|12/31/9999|$1|379.25|0|0|||HAND INTERFACE JOYSTICK|| 58-1699775|1326041732|CHC13|E2322|NU|11/01/2013|12/31/9999|$1|224.10|0|0|||MULT MECH SWITCHES|| 58-1699775|1326041732|CHC13|E2322|RR|11/01/2013|12/31/9999|$8.00|0|0|||MULT MECH SWITCHES|| 58-1699775|1326041732|CHC13|E2322|UE|11/01/2013|12/31/9999|$163.20|0|0|||MULT MECH SWITCHES|| 58-1699775|1326041732|CHC13|E2323|NU|11/01/2013|12/31/9999|$60.03|0|0|||SPECIAL JOYSTICK HANDLE|| 58-1699775|1326041732|CHC13|E2323|RR|11/01/2013|12/31/9999|$5.05|0|0|||SPECIAL JOYSTICK HANDLE|| 58-1699775|1326041732|CHC13|E2323|UE|11/01/2013|12/31/9999|$50.71|0|0|||SPECIAL JOYSTICK HANDLE|| 58-1699775|1326041732|CHC13|E2324|NU|11/01/2013|12/31/9999|$1|558.60|0|0|||CHIN CUP INTERFACE|| 58-1699775|1326041732|CHC13|E2324|RR|11/01/2013|12/31/9999|$5.87|0|0|||CHIN CUP INTERFACE|| 58-1699775|1326041732|CHC13|E2324|UE|11/01/2013|12/31/9999|$44.14|0|0|||CHIN CUP INTERFACE|| 58-1699775|1326041732|CHC13|E2325|NU|11/01/2013|12/31/9999|$1|168.97|0|0|||SIP AND PUFF INTERFACE|| 58-1699775|1326041732|CHC13|E2325|RR|11/01/2013|12/31/9999|$40.19|0|0|||SIP AND PUFF INTERFACE|| 58-1699775|1326041732|CHC13|E2325|UE|11/01/2013|12/31/9999|$401.73|0|0|||SIP AND PUFF INTERFACE|| 58-1699775|1326041732|CHC13|E2326|NU|11/01/2013|12/31/9999|$3|507.54|0|0|||BREATH TUBE KIT|| 58-1699775|1326041732|CHC13|E2326|RR|11/01/2013|12/31/9999|$46.62|0|0|||BREATH TUBE KIT|| 58-1699775|1326041732|CHC13|E2326|UE|11/01/2013|12/31/9999|$349.55|0|0|||BREATH TUBE KIT|| 58-1699775|1326041732|CHC13|E2327|NU|11/01/2013|12/31/9999|$3|444.69|0|0|||HEAD CONTROL INTERFACE MECH|| 58-1699775|1326041732|CHC13|E2327|RR|11/01/2013|12/31/9999|$302.31|0|0|||HEAD CONTROL INTERFACE MECH|| 58-1699775|1326041732|CHC13|E2327|UE|11/01/2013|12/31/9999|$573.44|0|0|||HEAD CONTROL INTERFACE MECH|| 58-1699775|1326041732|CHC13|E2328|NU|11/01/2013|12/31/9999|$4|300.89|0|0|||HEAD/EXTREMITY CONTROL INTER|| 58-1699775|1326041732|CHC13|E2328|RR|11/01/2013|12/31/9999|$204.38|0|0|||HEAD/EXTREMITY CONTROL INTER|| 58-1699775|1326041732|CHC13|E2328|UE|11/01/2013|12/31/9999|$2|043.84|0|0|||HEAD/EXTREMITY CONTROL INTER|| 58-1699775|1326041732|CHC13|E2329|NU|11/01/2013|12/31/9999|$3|960.17|0|0|||HEAD CONTROL NONPROPORTIONAL|| 58-1699775|1326041732|CHC13|E2329|RR|11/01/2013|12/31/9999|$237.12|0|0|||HEAD CONTROL NONPROPORTIONAL|| 58-1699775|1326041732|CHC13|E2329|UE|11/01/2013|12/31/9999|$1|532.88|0|0|||HEAD CONTROL NONPROPORTIONAL|| 58-1699775|1326041732|CHC13|E2330|NU|11/01/2013|12/31/9999|$2|970.15|0|0|||HEAD CONTROL PROXIMITY SWITC|| 58-1699775|1326041732|CHC13|E2330|RR|11/01/2013|12/31/9999|$48.12|0|0|||HEAD CONTROL PROXIMITY SWITC|| 58-1699775|1326041732|CHC13|E2330|UE|11/01/2013|12/31/9999|$459.45|0|0|||HEAD CONTROL PROXIMITY SWITC|| 58-1699775|1326041732|CHC13|E2340|NU|11/01/2013|12/31/9999|$721.79|0|0|||W/C WDTH 20-23 IN SEAT FRAME|| 58-1699775|1326041732|CHC13|E2340|RR|11/01/2013|12/31/9999|$72.18|0|0|||W/C WDTH 20-23 IN SEAT FRAME|| 58-1699775|1326041732|CHC13|E2340|UE|11/01/2013|12/31/9999|$541.35|0|0|||W/C WDTH 20-23 IN SEAT FRAME|| 58-1699775|1326041732|CHC13|E2341|NU|11/01/2013|12/31/9999|$601.49|0|0|||W/C WDTH 24-27 IN SEAT FRAME|| 58-1699775|1326041732|CHC13|E2341|RR|11/01/2013|12/31/9999|$60.15|0|0|||W/C WDTH 24-27 IN SEAT FRAME|| 58-1699775|1326041732|CHC13|E2341|UE|11/01/2013|12/31/9999|$451.12|0|0|||W/C WDTH 24-27 IN SEAT FRAME|| 58-1699775|1326041732|CHC13|E2342|NU|11/01/2013|12/31/9999|$962.39|0|0|||W/C DPTH 20-21 IN SEAT FRAME|| 58-1699775|1326041732|CHC13|E2342|RR|11/01/2013|12/31/9999|$96.21|0|0|||W/C DPTH 20-21 IN SEAT FRAME|| 58-1699775|1326041732|CHC13|E2342|UE|11/01/2013|12/31/9999|$721.79|0|0|||W/C DPTH 20-21 IN SEAT FRAME|| 58-1699775|1326041732|CHC13|E2343|NU|11/01/2013|12/31/9999|$938.02|0|0|||W/C DPTH 22-25 IN SEAT FRAME|| 58-1699775|1326041732|CHC13|E2343|RR|11/01/2013|12/31/9999|$80.87|0|0|||W/C DPTH 22-25 IN SEAT FRAME|| 58-1699775|1326041732|CHC13|E2343|UE|11/01/2013|12/31/9999|$808.49|0|0|||W/C DPTH 22-25 IN SEAT FRAME|| 58-1699775|1326041732|CHC13|E2351|NU|11/01/2013|12/31/9999|$606.35|0|0|||ELECTRONIC SGD INTERFACE|| 58-1699775|1326041732|CHC13|E2351|RR|11/01/2013|12/31/9999|$23.39|0|0|||ELECTRONIC SGD INTERFACE|| 58-1699775|1326041732|CHC13|E2351|UE|11/01/2013|12/31/9999|$175.35|0|0|||ELECTRONIC SGD INTERFACE|| 58-1699775|1326041732|CHC13|E2359|NU|11/01/2013|12/31/9999|$128.21|0|0|||GR34 SEALED LEADACID BATTERY|| 58-1699775|1326041732|CHC13|E2359|RR|11/01/2013|12/31/9999|$12.88|0|0|||GR34 SEALED LEADACID BATTERY|| 58-1699775|1326041732|CHC13|E2359|UE|11/01/2013|12/31/9999|$96.16|0|0|||GR34 SEALED LEADACID BATTERY|| 58-1699775|1326041732|CHC13|E2360|NU|11/01/2013|12/31/9999|$187.25|0|0|||22NF NONSEALED LEADACID|| 58-1699775|1326041732|CHC13|E2360|RR|11/01/2013|12/31/9999|$16.14|0|0|||22NF NONSEALED LEADACID|| 58-1699775|1326041732|CHC13|E2360|UE|11/01/2013|12/31/9999|$161.40|0|0|||22NF NONSEALED LEADACID|| 58-1699775|1326041732|CHC13|E2361|NU|11/01/2013|12/31/9999|$123.50|0|0|||22NF SEALED LEADACID BATTERY|| 58-1699775|1326041732|CHC13|E2361|RR|11/01/2013|12/31/9999|$12.35|0|0|||22NF SEALED LEADACID BATTERY|| 58-1699775|1326041732|CHC13|E2361|UE|11/01/2013|12/31/9999|$92.62|0|0|||22NF SEALED LEADACID BATTERY|| 58-1699775|1326041732|CHC13|E2362|NU|11/01/2013|12/31/9999|$249.72|0|0|||GR24 NONSEALED LEADACID|| 58-1699775|1326041732|CHC13|E2362|RR|11/01/2013|12/31/9999|$21.52|0|0|||GR24 NONSEALED LEADACID|| 58-1699775|1326041732|CHC13|E2362|UE|11/01/2013|12/31/9999|$215.25|0|0|||GR24 NONSEALED LEADACID|| 58-1699775|1326041732|CHC13|E2363|NU|11/01/2013|12/31/9999|$161.44|0|0|||GR24 SEALED LEADACID BATTERY|| 58-1699775|1326041732|CHC13|E2363|RR|11/01/2013|12/31/9999|$12.88|0|0|||GR24 SEALED LEADACID BATTERY|| 58-1699775|1326041732|CHC13|E2363|UE|11/01/2013|12/31/9999|$96.16|0|0|||GR24 SEALED LEADACID BATTERY|| 58-1699775|1326041732|CHC13|E2364|NU|11/01/2013|12/31/9999|$150.60|0|0|||U1NONSEALED LEADACID BATTERY|| 58-1699775|1326041732|CHC13|E2364|RR|11/01/2013|12/31/9999|$12.98|0|0|||U1NONSEALED LEADACID BATTERY|| 58-1699775|1326041732|CHC13|E2364|UE|11/01/2013|12/31/9999|$129.80|0|0|||U1NONSEALED LEADACID BATTERY|| 58-1699775|1326041732|CHC13|E2365|NU|11/01/2013|12/31/9999|$259.31|0|0|||U1 SEALED LEADACID BATTERY|| 58-1699775|1326041732|CHC13|E2365|RR|11/01/2013|12/31/9999|$15.06|0|0|||U1 SEALED LEADACID BATTERY|| 58-1699775|1326041732|CHC13|E2365|UE|11/01/2013|12/31/9999|$97.39|0|0|||U1 SEALED LEADACID BATTERY|| 58-1699775|1326041732|CHC13|E2366|NU|11/01/2013|12/31/9999|$484.98|0|0|||BATTERY CHARGER| SINGLE MODE|| 58-1699775|1326041732|CHC13|E2366|RR|11/01/2013|12/31/9999|$30.16|0|0|||BATTERY CHARGER| SINGLE MODE|| 58-1699775|1326041732|CHC13|E2366|UE|11/01/2013|12/31/9999|$194.49|0|0|||BATTERY CHARGER| SINGLE MODE|| 58-1699775|1326041732|CHC13|E2367|NU|11/01/2013|12/31/9999|$597.80|0|0|||BATTERY CHARGER| DUAL MODE|| 58-1699775|1326041732|CHC13|E2367|RR|11/01/2013|12/31/9999|$56.29|0|0|||BATTERY CHARGER| DUAL MODE|| 58-1699775|1326041732|CHC13|E2367|UE|11/01/2013|12/31/9999|$363.74|0|0|||BATTERY CHARGER| DUAL MODE|| 58-1699775|1326041732|CHC13|E2368|NU|11/01/2013|12/31/9999|$520.69|0|0|||POWER WC MOTOR REPLACEMENT|| 58-1699775|1326041732|CHC13|E2368|RR|11/01/2013|12/31/9999|$52.09|0|0|||POWER WC MOTOR REPLACEMENT|| 58-1699775|1326041732|CHC13|E2368|UE|11/01/2013|12/31/9999|$448.36|0|0|||POWER WC MOTOR REPLACEMENT|| 58-1699775|1326041732|CHC13|E2369|NU|11/01/2013|12/31/9999|$929.08|0|0|||PWR WC GEAR BOX REPLACEMENT|| 58-1699775|1326041732|CHC13|E2369|RR|11/01/2013|12/31/9999|$60.41|0|0|||PWR WC GEAR BOX REPLACEMENT|| 58-1699775|1326041732|CHC13|E2369|UE|11/01/2013|12/31/9999|$390.50|0|0|||PWR WC GEAR BOX REPLACEMENT|| 58-1699775|1326041732|CHC13|E2370|NU|11/01/2013|12/31/9999|$696.81|0|0|||PWR WC MOTOR/GEAR BOX COMBO|| 58-1699775|1326041732|CHC13|E2370|RR|11/01/2013|12/31/9999|$17.46|0|0|||PWR WC MOTOR/GEAR BOX COMBO|| 58-1699775|1326041732|CHC13|E2370|UE|11/01/2013|12/31/9999|$174.44|0|0|||PWR WC MOTOR/GEAR BOX COMBO|| 58-1699775|1326041732|CHC13|E2371|NU|11/01/2013|12/31/9999|$164.86|0|0|||GR27 SEALED LEADACID BATTERY|| 58-1699775|1326041732|CHC13|E2371|RR|11/01/2013|12/31/9999|$20.24|0|0|||GR27 SEALED LEADACID BATTERY|| 58-1699775|1326041732|CHC13|E2371|UE|11/01/2013|12/31/9999|$130.84|0|0|||GR27 SEALED LEADACID BATTERY|| 58-1699775|1326041732|CHC13|E2372|NU|11/01/2013|12/31/9999|$1|456.21|0|0|||GR27 NON-SEALED LEADACID|| 58-1699775|1326041732|CHC13|E2372|RR|11/01/2013|12/31/9999|$943.86|0|0|||GR27 NON-SEALED LEADACID|| 58-1699775|1326041732|CHC13|E2372|UE|11/01/2013|12/31/9999|$943.86|0|0|||GR27 NON-SEALED LEADACID|| 58-1699775|1326041732|CHC13|E2373|NU|11/01/2013|12/31/9999|$707.90|0|0|||HAND/CHIN CTRL SPEC JOYSTICK|| 58-1699775|1326041732|CHC13|E2373|RR|11/01/2013|12/31/9999|$61.80|0|0|||HAND/CHIN CTRL SPEC JOYSTICK|| 58-1699775|1326041732|CHC13|E2373|UE|11/01/2013|12/31/9999|$145.62|0|0|||HAND/CHIN CTRL SPEC JOYSTICK|| 58-1699775|1326041732|CHC13|E2374|NU|11/01/2013|12/31/9999|$991.25|0|0|||HAND/CHIN CTRL STD JOYSTICK|| 58-1699775|1326041732|CHC13|E2374|RR|11/01/2013|12/31/9999|$71.69|0|0|||HAND/CHIN CTRL STD JOYSTICK|| 58-1699775|1326041732|CHC13|E2374|UE|11/01/2013|12/31/9999|$463.51|0|0|||HAND/CHIN CTRL STD JOYSTICK|| 58-1699775|1326041732|CHC13|E2375|NU|11/01/2013|12/31/9999|$1|553.33|0|0|||NON-EXPANDABLE CONTROLLER|| 58-1699775|1326041732|CHC13|E2375|RR|11/01/2013|12/31/9999|$115.00|0|0|||NON-EXPANDABLE CONTROLLER|| 58-1699775|1326041732|CHC13|E2375|UE|11/01/2013|12/31/9999|$743.41|0|0|||NON-EXPANDABLE CONTROLLER|| 58-1699775|1326041732|CHC13|E2376|NU|11/01/2013|12/31/9999|$1|165.01|0|0|||EXPANDABLE CONTROLLER| REPL|| 58-1699775|1326041732|CHC13|E2376|RR|11/01/2013|12/31/9999|$56.20|0|0|||EXPANDABLE CONTROLLER| REPL|| 58-1699775|1326041732|CHC13|E2376|UE|11/01/2013|12/31/9999|$562.09|0|0|||EXPANDABLE CONTROLLER| REPL|| 58-1699775|1326041732|CHC13|E2377|NU|11/01/2013|12/31/9999|$421.58|0|0|||EXPANDABLE CONTROLLER| INITL|| 58-1699775|1326041732|CHC13|E2377|RR|11/01/2013|12/31/9999|$8.84|0|0|||EXPANDABLE CONTROLLER| INITL|| 58-1699775|1326041732|CHC13|E2377|UE|11/01/2013|12/31/9999|$88.15|0|0|||EXPANDABLE CONTROLLER| INITL|| 58-1699775|1326041732|CHC13|E2378|NU|11/01/2013|12/31/9999|$76.73|0|0|||PW ACTUATOR REPLACEMENT|| 58-1699775|1326041732|CHC13|E2378|RR|11/01/2013|12/31/9999|$10.24|0|0|||PW ACTUATOR REPLACEMENT|| 58-1699775|1326041732|CHC13|E2378|UE|11/01/2013|12/31/9999|$66.13|0|0|||PW ACTUATOR REPLACEMENT|| 58-1699775|1326041732|CHC13|E2381|NU|11/01/2013|12/31/9999|$24.04|0|0|||PNEUM DRIVE WHEEL TIRE|| 58-1699775|1326041732|CHC13|E2381|RR|11/01/2013|12/31/9999|$2.39|0|0|||PNEUM DRIVE WHEEL TIRE|| 58-1699775|1326041732|CHC13|E2381|UE|11/01/2013|12/31/9999|$18.03|0|0|||PNEUM DRIVE WHEEL TIRE|| 58-1699775|1326041732|CHC13|E2382|NU|11/01/2013|12/31/9999|$175.76|0|0|||TUBE| PNEUM WHEEL DRIVE TIRE|| 58-1699775|1326041732|CHC13|E2382|RR|11/01/2013|12/31/9999|$17.59|0|0|||TUBE| PNEUM WHEEL DRIVE TIRE|| 58-1699775|1326041732|CHC13|E2382|UE|11/01/2013|12/31/9999|$131.82|0|0|||TUBE| PNEUM WHEEL DRIVE TIRE|| 58-1699775|1326041732|CHC13|E2383|NU|11/01/2013|12/31/9999|$93.64|0|0|||INSERT| PNEUM WHEEL DRIVE|| 58-1699775|1326041732|CHC13|E2383|RR|11/01/2013|12/31/9999|$9.39|0|0|||INSERT| PNEUM WHEEL DRIVE|| 58-1699775|1326041732|CHC13|E2383|UE|11/01/2013|12/31/9999|$70.24|0|0|||INSERT| PNEUM WHEEL DRIVE|| 58-1699775|1326041732|CHC13|E2384|NU|11/01/2013|12/31/9999|$57.29|0|0|||PNEUMATIC CASTER TIRE|| 58-1699775|1326041732|CHC13|E2384|RR|11/01/2013|12/31/9999|$5.75|0|0|||PNEUMATIC CASTER TIRE|| 58-1699775|1326041732|CHC13|E2384|UE|11/01/2013|12/31/9999|$42.95|0|0|||PNEUMATIC CASTER TIRE|| 58-1699775|1326041732|CHC13|E2385|NU|11/01/2013|12/31/9999|$174.17|0|0|||TUBE| PNEUMATIC CASTER TIRE|| 58-1699775|1326041732|CHC13|E2385|RR|11/01/2013|12/31/9999|$17.42|0|0|||TUBE| PNEUMATIC CASTER TIRE|| 58-1699775|1326041732|CHC13|E2385|UE|11/01/2013|12/31/9999|$130.62|0|0|||TUBE| PNEUMATIC CASTER TIRE|| 58-1699775|1326041732|CHC13|E2386|NU|11/01/2013|12/31/9999|$78.10|0|0|||FOAM FILLED DRIVE WHEEL TIRE|| 58-1699775|1326041732|CHC13|E2386|RR|11/01/2013|12/31/9999|$7.81|0|0|||FOAM FILLED DRIVE WHEEL TIRE|| 58-1699775|1326041732|CHC13|E2386|UE|11/01/2013|12/31/9999|$58.61|0|0|||FOAM FILLED DRIVE WHEEL TIRE|| 58-1699775|1326041732|CHC13|E2387|NU|11/01/2013|12/31/9999|$58.30|0|0|||FOAM FILLED CASTER TIRE|| 58-1699775|1326041732|CHC13|E2387|RR|11/01/2013|12/31/9999|$5.84|0|0|||FOAM FILLED CASTER TIRE|| 58-1699775|1326041732|CHC13|E2387|UE|11/01/2013|12/31/9999|$43.75|0|0|||FOAM FILLED CASTER TIRE|| 58-1699775|1326041732|CHC13|E2388|NU|11/01/2013|12/31/9999|$31.66|0|0|||FOAM DRIVE WHEEL TIRE|| 58-1699775|1326041732|CHC13|E2388|RR|11/01/2013|12/31/9999|$3.17|0|0|||FOAM DRIVE WHEEL TIRE|| 58-1699775|1326041732|CHC13|E2388|UE|11/01/2013|12/31/9999|$23.72|0|0|||FOAM DRIVE WHEEL TIRE|| 58-1699775|1326041732|CHC13|E2389|NU|11/01/2013|12/31/9999|$49.51|0|0|||FOAM CASTER TIRE|| 58-1699775|1326041732|CHC13|E2389|RR|11/01/2013|12/31/9999|$4.95|0|0|||FOAM CASTER TIRE|| 58-1699775|1326041732|CHC13|E2389|UE|11/01/2013|12/31/9999|$37.11|0|0|||FOAM CASTER TIRE|| 58-1699775|1326041732|CHC13|E2390|NU|11/01/2013|12/31/9999|$23.71|0|0|||SOLID DRIVE WHEEL TIRE|| 58-1699775|1326041732|CHC13|E2390|RR|11/01/2013|12/31/9999|$2.37|0|0|||SOLID DRIVE WHEEL TIRE|| 58-1699775|1326041732|CHC13|E2390|UE|11/01/2013|12/31/9999|$17.80|0|0|||SOLID DRIVE WHEEL TIRE|| 58-1699775|1326041732|CHC13|E2391|NU|11/01/2013|12/31/9999|$62.35|0|0|||SOLID CASTER TIRE|| 58-1699775|1326041732|CHC13|E2391|RR|11/01/2013|12/31/9999|$6.26|0|0|||SOLID CASTER TIRE|| 58-1699775|1326041732|CHC13|E2391|UE|11/01/2013|12/31/9999|$46.76|0|0|||SOLID CASTER TIRE|| 58-1699775|1326041732|CHC13|E2392|NU|11/01/2013|12/31/9999|$88.82|0|0|||SOLID CASTER TIRE| INTEGRATE|| 58-1699775|1326041732|CHC13|E2392|RR|11/01/2013|12/31/9999|$8.90|0|0|||SOLID CASTER TIRE| INTEGRATE|| 58-1699775|1326041732|CHC13|E2392|UE|11/01/2013|12/31/9999|$66.62|0|0|||SOLID CASTER TIRE| INTEGRATE|| 58-1699775|1326041732|CHC13|E2394|NU|11/01/2013|12/31/9999|$63.12|0|0|||DRIVE WHEEL EXCLUDES TIRE|| 58-1699775|1326041732|CHC13|E2394|RR|11/01/2013|12/31/9999|$6.32|0|0|||DRIVE WHEEL EXCLUDES TIRE|| 58-1699775|1326041732|CHC13|E2394|UE|11/01/2013|12/31/9999|$47.36|0|0|||DRIVE WHEEL EXCLUDES TIRE|| 58-1699775|1326041732|CHC13|E2395|NU|11/01/2013|12/31/9999|$76.96|0|0|||CASTER WHEEL EXCLUDES TIRE|| 58-1699775|1326041732|CHC13|E2395|RR|11/01/2013|12/31/9999|$8.16|0|0|||CASTER WHEEL EXCLUDES TIRE|| 58-1699775|1326041732|CHC13|E2395|UE|11/01/2013|12/31/9999|$57.73|0|0|||CASTER WHEEL EXCLUDES TIRE|| 58-1699775|1326041732|CHC13|E2396|NU|11/01/2013|12/31/9999|$556.05|0|0|||CASTER FORK|| 58-1699775|1326041732|CHC13|E2396|RR|11/01/2013|12/31/9999|$52.51|0|0|||CASTER FORK|| 58-1699775|1326041732|CHC13|E2396|UE|11/01/2013|12/31/9999|$417.01|0|0|||CASTER FORK|| 58-1699775|1326041732|CHC13|E2397|NU|11/01/2013|12/31/9999|$1|605.54|0|0|||PWC ACC| LITH-BASED BATTERY|| 58-1699775|1326041732|CHC13|E2397|RR|11/01/2013|12/31/9999|$160.56|0|0|||PWC ACC| LITH-BASED BATTERY|| 58-1699775|1326041732|CHC13|E2397|UE|11/01/2013|12/31/9999|$393.77|0|0|||PWC ACC| LITH-BASED BATTERY|| 58-1699775|1326041732|CHC13|E2402|RR|11/01/2013|12/31/9999|$1|204.18|0|0|||NEG PRESS WOUND THERAPY PUMP|| 58-1699775|1326041732|CHC13|E2500|NU|11/01/2013|12/31/9999|$2|117.92|0|0|||SGD DIGITIZED PRE-REC <=8MIN|| 58-1699775|1326041732|CHC13|E2500|RR|11/01/2013|12/31/9999|$211.81|0|0|||SGD DIGITIZED PRE-REC <=8MIN|| 58-1699775|1326041732|CHC13|E2500|UE|11/01/2013|12/31/9999|$1|588.42|0|0|||SGD DIGITIZED PRE-REC <=8MIN|| 58-1699775|1326041732|CHC13|E2502|NU|11/01/2013|12/31/9999|$3|105.51|0|0|||SGD PREREC MSG >8MIN <=20MIN|| 58-1699775|1326041732|CHC13|E2502|RR|11/01/2013|12/31/9999|$310.54|0|0|||SGD PREREC MSG >8MIN <=20MIN|| 58-1699775|1326041732|CHC13|E2502|UE|11/01/2013|12/31/9999|$2|329.09|0|0|||SGD PREREC MSG >8MIN <=20MIN|| 58-1699775|1326041732|CHC13|E2504|NU|11/01/2013|12/31/9999|$4|802.15|0|0|||SGD PREREC MSG>20MIN <=40MIN|| 58-1699775|1326041732|CHC13|E2504|RR|11/01/2013|12/31/9999|$480.21|0|0|||SGD PREREC MSG>20MIN <=40MIN|| 58-1699775|1326041732|CHC13|E2504|UE|11/01/2013|12/31/9999|$3|601.63|0|0|||SGD PREREC MSG>20MIN <=40MIN|| 58-1699775|1326041732|CHC13|E2506|NU|11/01/2013|12/31/9999|$9|087.42|0|0|||SGD PREREC MSG > 40 MIN|| 58-1699775|1326041732|CHC13|E2506|RR|11/01/2013|12/31/9999|$908.74|0|0|||SGD PREREC MSG > 40 MIN|| 58-1699775|1326041732|CHC13|E2506|UE|11/01/2013|12/31/9999|$6|815.56|0|0|||SGD PREREC MSG > 40 MIN|| 58-1699775|1326041732|CHC13|E2508|NU|11/01/2013|12/31/9999|$6|050.70|0|0|||SGD SPELLING PHYS CONTACT|| 58-1699775|1326041732|CHC13|E2508|RR|11/01/2013|12/31/9999|$605.06|0|0|||SGD SPELLING PHYS CONTACT|| 58-1699775|1326041732|CHC13|E2508|UE|11/01/2013|12/31/9999|$4|538.05|0|0|||SGD SPELLING PHYS CONTACT|| 58-1699775|1326041732|CHC13|E2510|NU|11/01/2013|12/31/9999|$11|450.16|0|0|||SGD W MULTI METHODS MSG/ACCS|| 58-1699775|1326041732|CHC13|E2510|RR|11/01/2013|12/31/9999|$1|145.02|0|0|||SGD W MULTI METHODS MSG/ACCS|| 58-1699775|1326041732|CHC13|E2510|UE|11/01/2013|12/31/9999|$8|587.61|0|0|||SGD W MULTI METHODS MSG/ACCS|| 58-1699775|1326041732|CHC13|E2511|NU|11/01/2013|12/31/9999|$82.12|0|0|||SGD SFTWRE PRGRM FOR PC/PDA|| 58-1699775|1326041732|CHC13|E2511|RR|11/01/2013|12/31/9999|$7.09|0|0|||SGD SFTWRE PRGRM FOR PC/PDA|| 58-1699775|1326041732|CHC13|E2511|UE|11/01/2013|12/31/9999|$70.77|0|0|||SGD SFTWRE PRGRM FOR PC/PDA|| 58-1699775|1326041732|CHC13|E2512|NU|11/01/2013|12/31/9999|$61.57|0|0|||SGD ACCESSORY| MOUNTING SYS|| 58-1699775|1326041732|CHC13|E2512|RR|11/01/2013|12/31/9999|$8.22|0|0|||SGD ACCESSORY| MOUNTING SYS|| 58-1699775|1326041732|CHC13|E2512|UE|11/01/2013|12/31/9999|$53.09|0|0|||SGD ACCESSORY| MOUNTING SYS|| 58-1699775|1326041732|CHC13|E2601|NU|11/01/2013|12/31/9999|$138.18|0|0|||GEN W/C CUSHION WDTH < 22 IN|| 58-1699775|1326041732|CHC13|E2601|RR|11/01/2013|12/31/9999|$13.83|0|0|||GEN W/C CUSHION WDTH < 22 IN|| 58-1699775|1326041732|CHC13|E2601|UE|11/01/2013|12/31/9999|$103.63|0|0|||GEN W/C CUSHION WDTH < 22 IN|| 58-1699775|1326041732|CHC13|E2602|NU|11/01/2013|12/31/9999|$175.42|0|0|||GEN W/C CUSHION WDTH >=22 IN|| 58-1699775|1326041732|CHC13|E2602|RR|11/01/2013|12/31/9999|$17.56|0|0|||GEN W/C CUSHION WDTH >=22 IN|| 58-1699775|1326041732|CHC13|E2602|UE|11/01/2013|12/31/9999|$131.58|0|0|||GEN W/C CUSHION WDTH >=22 IN|| 58-1699775|1326041732|CHC13|E2603|NU|11/01/2013|12/31/9999|$218.04|0|0|||SKIN PROTECT WC CUS WD <22IN|| 58-1699775|1326041732|CHC13|E2603|RR|11/01/2013|12/31/9999|$21.79|0|0|||SKIN PROTECT WC CUS WD <22IN|| 58-1699775|1326041732|CHC13|E2603|UE|11/01/2013|12/31/9999|$163.55|0|0|||SKIN PROTECT WC CUS WD <22IN|| 58-1699775|1326041732|CHC13|E2604|NU|11/01/2013|12/31/9999|$311.50|0|0|||SKIN PROTECT WC CUS WD>=22IN|| 58-1699775|1326041732|CHC13|E2604|RR|11/01/2013|12/31/9999|$31.16|0|0|||SKIN PROTECT WC CUS WD>=22IN|| 58-1699775|1326041732|CHC13|E2604|UE|11/01/2013|12/31/9999|$233.66|0|0|||SKIN PROTECT WC CUS WD>=22IN|| 58-1699775|1326041732|CHC13|E2605|NU|11/01/2013|12/31/9999|$485.96|0|0|||POSITION WC CUSH WDTH <22 IN|| 58-1699775|1326041732|CHC13|E2605|RR|11/01/2013|12/31/9999|$48.61|0|0|||POSITION WC CUSH WDTH <22 IN|| 58-1699775|1326041732|CHC13|E2605|UE|11/01/2013|12/31/9999|$364.45|0|0|||POSITION WC CUSH WDTH <22 IN|| 58-1699775|1326041732|CHC13|E2606|NU|11/01/2013|12/31/9999|$335.42|0|0|||POSITION WC CUSH WDTH>=22 IN|| 58-1699775|1326041732|CHC13|E2606|RR|11/01/2013|12/31/9999|$33.55|0|0|||POSITION WC CUSH WDTH>=22 IN|| 58-1699775|1326041732|CHC13|E2606|UE|11/01/2013|12/31/9999|$251.57|0|0|||POSITION WC CUSH WDTH>=22 IN|| 58-1699775|1326041732|CHC13|E2607|NU|11/01/2013|12/31/9999|$402.81|0|0|||SKIN PRO/POS WC CUS WD <22IN|| 58-1699775|1326041732|CHC13|E2607|RR|11/01/2013|12/31/9999|$40.28|0|0|||SKIN PRO/POS WC CUS WD <22IN|| 58-1699775|1326041732|CHC13|E2607|UE|11/01/2013|12/31/9999|$302.11|0|0|||SKIN PRO/POS WC CUS WD <22IN|| 58-1699775|1326041732|CHC13|E2608|NU|11/01/2013|12/31/9999|$361.47|0|0|||SKIN PRO/POS WC CUS WD>=22IN|| 58-1699775|1326041732|CHC13|E2608|RR|11/01/2013|12/31/9999|$36.14|0|0|||SKIN PRO/POS WC CUS WD>=22IN|| 58-1699775|1326041732|CHC13|E2608|UE|11/01/2013|12/31/9999|$271.12|0|0|||SKIN PRO/POS WC CUS WD>=22IN|| 58-1699775|1326041732|CHC13|E2609|NU|11/01/2013|12/31/9999|$65.00|0|0||%|CUSTOM FABRICATE W/C CUSHION|| 58-1699775|1326041732|CHC13|E2611|NU|11/01/2013|12/31/9999|$488.99|0|0|||GEN USE BACK CUSH WDTH <22IN|| 58-1699775|1326041732|CHC13|E2611|RR|11/01/2013|12/31/9999|$48.90|0|0|||GEN USE BACK CUSH WDTH <22IN|| 58-1699775|1326041732|CHC13|E2611|UE|11/01/2013|12/31/9999|$366.73|0|0|||GEN USE BACK CUSH WDTH <22IN|| 58-1699775|1326041732|CHC13|E2612|NU|11/01/2013|12/31/9999|$454.84|0|0|||GEN USE BACK CUSH WDTH>=22IN|| 58-1699775|1326041732|CHC13|E2612|RR|11/01/2013|12/31/9999|$45.49|0|0|||GEN USE BACK CUSH WDTH>=22IN|| 58-1699775|1326041732|CHC13|E2612|UE|11/01/2013|12/31/9999|$341.14|0|0|||GEN USE BACK CUSH WDTH>=22IN|| 58-1699775|1326041732|CHC13|E2613|NU|11/01/2013|12/31/9999|$629.46|0|0|||POSITION BACK CUSH WD <22IN|| 58-1699775|1326041732|CHC13|E2613|RR|11/01/2013|12/31/9999|$62.95|0|0|||POSITION BACK CUSH WD <22IN|| 58-1699775|1326041732|CHC13|E2613|UE|11/01/2013|12/31/9999|$472.11|0|0|||POSITION BACK CUSH WD <22IN|| 58-1699775|1326041732|CHC13|E2614|NU|11/01/2013|12/31/9999|$523.44|0|0|||POSITION BACK CUSH WD>=22IN|| 58-1699775|1326041732|CHC13|E2614|RR|11/01/2013|12/31/9999|$52.35|0|0|||POSITION BACK CUSH WD>=22IN|| 58-1699775|1326041732|CHC13|E2614|UE|11/01/2013|12/31/9999|$392.56|0|0|||POSITION BACK CUSH WD>=22IN|| 58-1699775|1326041732|CHC13|E2615|NU|11/01/2013|12/31/9999|$704.27|0|0|||POS BACK POST/LAT WDTH <22IN|| 58-1699775|1326041732|CHC13|E2615|RR|11/01/2013|12/31/9999|$70.43|0|0|||POS BACK POST/LAT WDTH <22IN|| 58-1699775|1326041732|CHC13|E2615|UE|11/01/2013|12/31/9999|$528.22|0|0|||POS BACK POST/LAT WDTH <22IN|| 58-1699775|1326041732|CHC13|E2616|NU|11/01/2013|12/31/9999|$59.38|0|0|||POS BACK POST/LAT WDTH>=22IN|| 58-1699775|1326041732|CHC13|E2616|RR|11/01/2013|12/31/9999|$5.94|0|0|||POS BACK POST/LAT WDTH>=22IN|| 58-1699775|1326041732|CHC13|E2616|UE|11/01/2013|12/31/9999|$44.57|0|0|||POS BACK POST/LAT WDTH>=22IN|| 58-1699775|1326041732|CHC13|E2617|NU|11/01/2013|12/31/9999|$65.00|0|0||%|CUSTOM FAB W/C BACK CUSHION|| 58-1699775|1326041732|CHC13|E2619|NU|11/01/2013|12/31/9999|$633.81|0|0|||REPLACE COVER W/C SEAT CUSH|| 58-1699775|1326041732|CHC13|E2619|RR|11/01/2013|12/31/9999|$63.39|0|0|||REPLACE COVER W/C SEAT CUSH|| 58-1699775|1326041732|CHC13|E2619|UE|11/01/2013|12/31/9999|$475.37|0|0|||REPLACE COVER W/C SEAT CUSH|| 58-1699775|1326041732|CHC13|E2620|NU|11/01/2013|12/31/9999|$665.14|0|0|||WC PLANAR BACK CUSH WD <22IN|| 58-1699775|1326041732|CHC13|E2620|RR|11/01/2013|12/31/9999|$66.51|0|0|||WC PLANAR BACK CUSH WD <22IN|| 58-1699775|1326041732|CHC13|E2620|UE|11/01/2013|12/31/9999|$498.86|0|0|||WC PLANAR BACK CUSH WD <22IN|| 58-1699775|1326041732|CHC13|E2621|NU|11/01/2013|12/31/9999|$383.59|0|0|||WC PLANAR BACK CUSH WD>=22IN|| 58-1699775|1326041732|CHC13|E2621|RR|11/01/2013|12/31/9999|$38.36|0|0|||WC PLANAR BACK CUSH WD>=22IN|| 58-1699775|1326041732|CHC13|E2621|UE|11/01/2013|12/31/9999|$287.69|0|0|||WC PLANAR BACK CUSH WD>=22IN|| 58-1699775|1326041732|CHC13|E2622|NU|11/01/2013|12/31/9999|$488.10|0|0|||ADJ SKIN PRO W/C CUS WD<22IN|| 58-1699775|1326041732|CHC13|E2622|RR|11/01/2013|12/31/9999|$48.83|0|0|||ADJ SKIN PRO W/C CUS WD<22IN|| 58-1699775|1326041732|CHC13|E2622|UE|11/01/2013|12/31/9999|$366.06|0|0|||ADJ SKIN PRO W/C CUS WD<22IN|| 58-1699775|1326041732|CHC13|E2623|NU|11/01/2013|12/31/9999|$386.74|0|0|||ADJ SKIN PRO WC CUS WD>=22IN|| 58-1699775|1326041732|CHC13|E2623|RR|11/01/2013|12/31/9999|$38.69|0|0|||ADJ SKIN PRO WC CUS WD>=22IN|| 58-1699775|1326041732|CHC13|E2623|UE|11/01/2013|12/31/9999|$290.07|0|0|||ADJ SKIN PRO WC CUS WD>=22IN|| 58-1699775|1326041732|CHC13|E2624|NU|11/01/2013|12/31/9999|$489.59|0|0|||ADJ SKIN PRO/POS CUS<22IN|| 58-1699775|1326041732|CHC13|E2624|RR|11/01/2013|12/31/9999|$48.95|0|0|||ADJ SKIN PRO/POS CUS<22IN|| 58-1699775|1326041732|CHC13|E2624|UE|11/01/2013|12/31/9999|$367.17|0|0|||ADJ SKIN PRO/POS CUS<22IN|| 58-1699775|1326041732|CHC13|E2625|NU|11/01/2013|12/31/9999|$998.04|0|0|||ADJ SKIN PRO/POS WC CUS>=22|| 58-1699775|1326041732|CHC13|E2625|RR|11/01/2013|12/31/9999|$83.37|0|0|||ADJ SKIN PRO/POS WC CUS>=22|| 58-1699775|1326041732|CHC13|E2625|UE|11/01/2013|12/31/9999|$625.41|0|0|||ADJ SKIN PRO/POS WC CUS>=22|| 58-1699775|1326041732|CHC13|E2626|NU|11/01/2013|12/31/9999|$1|002.49|0|0|||SEO MOBILE ARM SUP ATT TO WC|| 58-1699775|1326041732|CHC13|E2626|RR|11/01/2013|12/31/9999|$100.25|0|0|||SEO MOBILE ARM SUP ATT TO WC|| 58-1699775|1326041732|CHC13|E2626|UE|11/01/2013|12/31/9999|$751.86|0|0|||SEO MOBILE ARM SUP ATT TO WC|| 58-1699775|1326041732|CHC13|E2627|NU|11/01/2013|12/31/9999|$1|268.63|0|0|||ARM SUPP ATT TO WC RANCHO TY|| 58-1699775|1326041732|CHC13|E2627|RR|11/01/2013|12/31/9999|$126.85|0|0|||ARM SUPP ATT TO WC RANCHO TY|| 58-1699775|1326041732|CHC13|E2627|UE|11/01/2013|12/31/9999|$951.47|0|0|||ARM SUPP ATT TO WC RANCHO TY|| 58-1699775|1326041732|CHC13|E2628|NU|11/01/2013|12/31/9999|$887.15|0|0|||MOBILE ARM SUPPORTS RECLININ|| 58-1699775|1326041732|CHC13|E2628|RR|11/01/2013|12/31/9999|$88.71|0|0|||MOBILE ARM SUPPORTS RECLININ|| 58-1699775|1326041732|CHC13|E2628|UE|11/01/2013|12/31/9999|$665.35|0|0|||MOBILE ARM SUPPORTS RECLININ|| 58-1699775|1326041732|CHC13|E2629|NU|11/01/2013|12/31/9999|$354.87|0|0|||FRICTION DAMPENING ARM SUPP|| 58-1699775|1326041732|CHC13|E2629|RR|11/01/2013|12/31/9999|$35.49|0|0|||FRICTION DAMPENING ARM SUPP|| 58-1699775|1326041732|CHC13|E2629|UE|11/01/2013|12/31/9999|$266.15|0|0|||FRICTION DAMPENING ARM SUPP|| 58-1699775|1326041732|CHC13|E2630|NU|11/01/2013|12/31/9999|$225.65|0|0|||MONOSUSPENSION ARM/HAND SUPP|| 58-1699775|1326041732|CHC13|E2630|RR|11/01/2013|12/31/9999|$22.56|0|0|||MONOSUSPENSION ARM/HAND SUPP|| 58-1699775|1326041732|CHC13|E2630|UE|11/01/2013|12/31/9999|$169.24|0|0|||MONOSUSPENSION ARM/HAND SUPP|| 58-1699775|1326041732|CHC13|E2631|NU|11/01/2013|12/31/9999|$191.40|0|0|||ELEVAT PROXIMAL ARM SUPPORT|| 58-1699775|1326041732|CHC13|E2631|RR|11/01/2013|12/31/9999|$19.16|0|0|||ELEVAT PROXIMAL ARM SUPPORT|| 58-1699775|1326041732|CHC13|E2631|UE|11/01/2013|12/31/9999|$143.55|0|0|||ELEVAT PROXIMAL ARM SUPPORT|| 58-1699775|1326041732|CHC13|E2632|NU|11/01/2013|12/31/9999|$30.54|0|0|||OFFSET/LAT ROCKER ARM W/ELA|| 58-1699775|1326041732|CHC13|E2632|RR|11/01/2013|12/31/9999|$30.54|0|0|||OFFSET/LAT ROCKER ARM W/ELA|| 58-1699775|1326041732|CHC13|E2632|UE|11/01/2013|12/31/9999|$30.54|0|0|||OFFSET/LAT ROCKER ARM W/ELA|| 58-1699775|1326041732|CHC13|E2633|NU|11/01/2013|12/31/9999|$192.93|0|0|||MOBILE ARM SUPPORT SUPINATOR|| 58-1699775|1326041732|CHC13|E2633|RR|11/01/2013|12/31/9999|$11.51|0|0|||MOBILE ARM SUPPORT SUPINATOR|| 58-1699775|1326041732|CHC13|E2633|UE|11/01/2013|12/31/9999|$44.02|0|0|||MOBILE ARM SUPPORT SUPINATOR|| 58-1699775|1326041732|CHC13|G0008||11/01/2013|12/31/9999|$28.00|0|0|||ADMIN INFLUENZA VIRUS VAC|| 58-1699775|1326041732|CHC13|G0009||11/01/2013|12/31/9999|$28.00|0|0|||ADMIN PNEUMOCOCCAL VACCINE|| 58-1699775|1326041732|CHC13|G0101||11/01/2013|12/31/9999|$49.20|0|0|||CA SCREEN;PELVIC/BREAST EXAM|| 58-1699775|1326041732|CHC13|G0102||11/01/2013|12/31/9999|$22.53|0|0|||PROSTATE CA SCREENING; DRE|| 58-1699775|1326041732|CHC13|G0103||11/01/2013|12/31/9999|$33.25|0|0|||PSA| TOTAL SCREENING|| 58-1699775|1326041732|CHC13|G0104||11/01/2013|12/31/9999|$76.56|0|0|||CA SCREEN;FLEXI SIGMOIDSCOPE|| 58-1699775|1326041732|CHC13|G0105||11/01/2013|12/31/9999|$264.35|0|0|||COLORECTAL SCRN; HI RISK IND|| 58-1699775|1326041732|CHC13|G0106||11/01/2013|12/31/9999|$251.17|0|0|||COLON CA SCREEN;BARIUM ENEMA|| 58-1699775|1326041732|CHC13|G0106|26|11/01/2013|12/31/9999|$75.82|0|0|||COLON CA SCREEN;BARIUM ENEMA|| 58-1699775|1326041732|CHC13|G0106|TC|11/01/2013|12/31/9999|$255.71|0|0|||COLON CA SCREEN;BARIUM ENEMA|| 58-1699775|1326041732|CHC13|G0108||11/01/2013|12/31/9999|$63.95|0|0|||DIAB MANAGE TRN PER INDIV|| 58-1699775|1326041732|CHC13|G0109||11/01/2013|12/31/9999|$19.44|0|0|||DIAB MANAGE TRN IND/GROUP|| 58-1699775|1326041732|CHC13|G0117||11/01/2013|12/31/9999|$60.07|0|0|||GLAUCOMA SCRN HGH RISK DIREC|| 58-1699775|1326041732|CHC13|G0118||11/01/2013|12/31/9999|$41.63|0|0|||GLAUCOMA SCRN HGH RISK DIREC|| 58-1699775|1326041732|CHC13|G0120||11/01/2013|12/31/9999|$251.17|0|0|||COLON CA SCRN; BARIUM ENEMA|| 58-1699775|1326041732|CHC13|G0120|26|11/01/2013|12/31/9999|$75.82|0|0|||COLON CA SCRN; BARIUM ENEMA|| 58-1699775|1326041732|CHC13|G0120|TC|11/01/2013|12/31/9999|$255.71|0|0|||COLON CA SCRN; BARIUM ENEMA|| 58-1699775|1326041732|CHC13|G0121||11/01/2013|12/31/9999|$264.35|0|0|||COLON CA SCRN NOT HI RSK IND|| 58-1699775|1326041732|CHC13|G0122||11/01/2013|12/31/9999|$325.30|0|0|||COLON CA SCRN; BARIUM ENEMA|| 58-1699775|1326041732|CHC13|G0122|26|11/01/2013|12/31/9999|$78.36|0|0|||COLON CA SCRN; BARIUM ENEMA|| 58-1699775|1326041732|CHC13|G0122|TC|11/01/2013|12/31/9999|$351.03|0|0|||COLON CA SCRN; BARIUM ENEMA|| 58-1699775|1326041732|CHC13|G0123||11/01/2013|12/31/9999|$33.76|0|0|||SCREEN CERV/VAG THIN LAYER|| 58-1699775|1326041732|CHC13|G0124||11/01/2013|12/31/9999|$34.72|0|0|||SCREEN C/V THIN LAYER BY MD|| 58-1699775|1326041732|CHC13|G0127||11/01/2013|12/31/9999|$9.54|0|0|||TRIM NAIL(S)|| 58-1699775|1326041732|CHC13|G0128||11/01/2013|12/31/9999|$11.44|0|0|||CORF SKILLED NURSING SERVICE|| 58-1699775|1326041732|CHC13|G0130||11/01/2013|12/31/9999|$39.19|0|0|||SINGLE ENERGY X-RAY STUDY|| 58-1699775|1326041732|CHC13|G0130|26|11/01/2013|12/31/9999|$17.42|0|0|||SINGLE ENERGY X-RAY STUDY|| 58-1699775|1326041732|CHC13|G0130|TC|11/01/2013|12/31/9999|$34.31|0|0|||SINGLE ENERGY X-RAY STUDY|| 58-1699775|1326041732|CHC13|G0141||11/01/2013|12/31/9999|$34.72|0|0|||SCR C/V CYTO|AUTOSYS AND MD|| 58-1699775|1326041732|CHC13|G0143||11/01/2013|12/31/9999|$36.28|0|0|||SCR C/V CYTO|THINLAYER|RESCR|| 58-1699775|1326041732|CHC13|G0144||11/01/2013|12/31/9999|$38.43|0|0|||SCR C/V CYTO|THINLAYER|RESCR|| 58-1699775|1326041732|CHC13|G0145||11/01/2013|12/31/9999|$47.50|0|0|||SCR C/V CYTO|THINLAYER|RESCR|| 58-1699775|1326041732|CHC13|G0147||11/01/2013|12/31/9999|$20.30|0|0|||SCR C/V CYTO| AUTOMATED SYS|| 58-1699775|1326041732|CHC13|G0148||11/01/2013|12/31/9999|$27.21|0|0|||SCR C/V CYTO| AUTOSYS| RESCR|| 58-1699775|1326041732|CHC13|G0155||11/01/2013|12/31/9999|$0.00|0|0|||HHCP-SVS OF CSW|EA 15 MIN|| 58-1699775|1326041732|CHC13|G0157||11/01/2013|12/31/9999|$0.00|0|0|||HHC PT ASSISTANT EA 15|| 58-1699775|1326041732|CHC13|G0158||11/01/2013|12/31/9999|$0.00|0|0|||HHC OT ASSISTANT EA 15|| 58-1699775|1326041732|CHC13|G0159||11/01/2013|12/31/9999|$0.00|0|0|||HHC PT MAINT EA 15 MIN|| 58-1699775|1326041732|CHC13|G0160||11/01/2013|12/31/9999|$0.00|0|0|||HHC OCCUP THERAPY EA 15|| 58-1699775|1326041732|CHC13|G0161||11/01/2013|12/31/9999|$0.00|0|0|||HHC SLP EA 15 MIN|| 58-1699775|1326041732|CHC13|G0162||11/01/2013|12/31/9999|$0.00|0|0|||HHC RN E&M PLAN SVS| 15 MIN|| 58-1699775|1326041732|CHC13|G0163||11/01/2013|12/31/9999|$0.00|0|0|||PET FOR REC OF COLORECTAL CA|| 58-1699775|1326041732|CHC13|G0164||11/01/2013|12/31/9999|$0.00|0|0|||PET FOR LYMPHOMA STAGING|| 58-1699775|1326041732|CHC13|G0166||11/01/2013|12/31/9999|$191.19|0|0|||EXTRNL COUNTERPULSE| PER TX|| 58-1699775|1326041732|CHC13|G0168||11/01/2013|12/31/9999|$31.79|0|0|||WOUND CLOSURE BY ADHESIVE|| 58-1699775|1326041732|CHC13|G0173||11/01/2013|12/31/9999|$0.00|0|0|||LINEAR ACC STEREO RADSUR COM|| 58-1699775|1326041732|CHC13|G0175||11/01/2013|12/31/9999|$0.00|0|0|||OPPS SERVICE|SCHED TEAM CONF|| 58-1699775|1326041732|CHC13|G0176||11/01/2013|12/31/9999|$0.00|0|0|||OPPS/PHP;ACTIVITY THERAPY|| 58-1699775|1326041732|CHC13|G0177||11/01/2013|12/31/9999|$0.00|0|0|||OPPS/PHP; TRAIN & EDUC SERV|| 58-1699775|1326041732|CHC13|G0179||11/01/2013|12/31/9999|$47.84|0|0|||MD RECERTIFICATION HHA PT|| 58-1699775|1326041732|CHC13|G0180||11/01/2013|12/31/9999|$62.18|0|0|||MD CERTIFICATION HHA PATIENT|| 58-1699775|1326041732|CHC13|G0181||11/01/2013|12/31/9999|$125.31|0|0|||HOME HEALTH CARE SUPERVISION|| 58-1699775|1326041732|CHC13|G0182||11/01/2013|12/31/9999|$126.84|0|0|||HOSPICE CARE SUPERVISION|| 58-1699775|1326041732|CHC13|G0186||11/01/2013|12/31/9999|$0.00|0|0|||DSTRY EYE LESN|FDR VSSL TECH|| 58-1699775|1326041732|CHC13|G0202||11/01/2013|12/31/9999|$160.13|0|0|||SCREENINGMAMMOGRAPHYDIGITAL|| 58-1699775|1326041732|CHC13|G0202|26|11/01/2013|12/31/9999|$55.52|0|0|||SCREENINGMAMMOGRAPHYDIGITAL|| 58-1699775|1326041732|CHC13|G0202|TC|11/01/2013|12/31/9999|$155.86|0|0|||SCREENINGMAMMOGRAPHYDIGITAL|| 58-1699775|1326041732|CHC13|G0204||11/01/2013|12/31/9999|$193.36|0|0|||DIAGNOSTICMAMMOGRAPHYDIGITAL|| 58-1699775|1326041732|CHC13|G0204|26|11/01/2013|12/31/9999|$69.12|0|0|||DIAGNOSTICMAMMOGRAPHYDIGITAL|| 58-1699775|1326041732|CHC13|G0204|TC|11/01/2013|12/31/9999|$186.12|0|0|||DIAGNOSTICMAMMOGRAPHYDIGITAL|| 58-1699775|1326041732|CHC13|G0206||11/01/2013|12/31/9999|$152.87|0|0|||DIAGNOSTICMAMMOGRAPHYDIGITAL|| 58-1699775|1326041732|CHC13|G0206|26|11/01/2013|12/31/9999|$55.52|0|0|||DIAGNOSTICMAMMOGRAPHYDIGITAL|| 58-1699775|1326041732|CHC13|G0206|TC|11/01/2013|12/31/9999|$146.27|0|0|||DIAGNOSTICMAMMOGRAPHYDIGITAL|| 58-1699775|1326041732|CHC13|G0219||11/01/2013|12/31/9999|$0.00|0|0|||PET IMG WHOLBOD MELANO NONCO|| 58-1699775|1326041732|CHC13|G0219|26|11/01/2013|12/31/9999|$0.00|0|0|||PET IMG WHOLBOD MELANO NONCO|| 58-1699775|1326041732|CHC13|G0219|TC|11/01/2013|12/31/9999|$0.00|0|0|||PET IMG WHOLBOD MELANO NONCO|| 58-1699775|1326041732|CHC13|G0235||11/01/2013|12/31/9999|$0.00|0|0|||PET NOT OTHERWISE SPECIFIED|| 58-1699775|1326041732|CHC13|G0235|26|11/01/2013|12/31/9999|$0.00|0|0|||PET NOT OTHERWISE SPECIFIED|| 58-1699775|1326041732|CHC13|G0235|TC|11/01/2013|12/31/9999|$0.00|0|0|||PET NOT OTHERWISE SPECIFIED|| 58-1699775|1326041732|CHC13|G0237||11/01/2013|12/31/9999|$11.47|0|0|||THERAPEUTIC PROCD STRG ENDUR|| 58-1699775|1326041732|CHC13|G0238||11/01/2013|12/31/9999|$12.24|0|0|||OTH RESP PROC| INDIV|| 58-1699775|1326041732|CHC13|G0239||11/01/2013|12/31/9999|$14.15|0|0|||OTH RESP PROC| GROUP|| 58-1699775|1326041732|CHC13|G0245||11/01/2013|12/31/9999|$51.26|0|0|||INITIAL FOOT EXAM PT LOPS|| 58-1699775|1326041732|CHC13|G0246||11/01/2013|12/31/9999|$25.68|0|0|||FOLLOWUP EVAL OF FOOT PT LOP|| 58-1699775|1326041732|CHC13|G0247||11/01/2013|12/31/9999|$28.97|0|0|||ROUTINE FOOTCARE PT W LOPS|| 58-1699775|1326041732|CHC13|G0248||11/01/2013|12/31/9999|$139.85|0|0|||DEMONSTRATE USE HOME INR MON|| 58-1699775|1326041732|CHC13|G0249||11/01/2013|12/31/9999|$128.77|0|0|||PROVIDE TEST MATERIAL|EQUIPM|| 58-1699775|1326041732|CHC13|G0250||11/01/2013|12/31/9999|$11.11|0|0|||MD REVIEW INTERPRET OF TEST|| 58-1699775|1326041732|CHC13|G0251||11/01/2013|12/31/9999|$0.00|0|0|||LINEAR ACC BASED STERO RADIO|| 58-1699775|1326041732|CHC13|G0252||11/01/2013|12/31/9999|$95.62|0|0|||PET IMAGING INITIAL DX|| 58-1699775|1326041732|CHC13|G0252|26|11/01/2013|12/31/9999|$121.73|0|0|||PET IMAGING INITIAL DX|| 58-1699775|1326041732|CHC13|G0252|TC|11/01/2013|12/31/9999|$0.00|0|0|||PET IMAGING INITIAL DX|| 58-1699775|1326041732|CHC13|G0255||11/01/2013|12/31/9999|$0.00|0|0|||CURRENT PERCEP THRESHOLD TST|| 58-1699775|1326041732|CHC13|G0255|26|11/01/2013|12/31/9999|$0.00|0|0|||CURRENT PERCEP THRESHOLD TST|| 58-1699775|1326041732|CHC13|G0255|TC|11/01/2013|12/31/9999|$0.00|0|0|||CURRENT PERCEP THRESHOLD TST|| 58-1699775|1326041732|CHC13|G0257||11/01/2013|12/31/9999|$0.00|0|0|||UNSCHED DIALYSIS ESRD PT HOS|| 58-1699775|1326041732|CHC13|G0259||11/01/2013|12/31/9999|$0.00|0|0|||INJECT FOR SACROILIAC JOINT|| 58-1699775|1326041732|CHC13|G0260||11/01/2013|12/31/9999|$0.00|0|0|||INJ FOR SACROILIAC JT ANESTH|| 58-1699775|1326041732|CHC13|G0268||11/01/2013|12/31/9999|$38.98|0|0|||REMOVAL OF IMPACTED WAX MD|| 58-1699775|1326041732|CHC13|G0269||11/01/2013|12/31/9999|$0.00|0|0|||OCCLUSIVE DEVICE IN VEIN ART|| 58-1699775|1326041732|CHC13|G0270||11/01/2013|12/31/9999|$32.56|0|0|||MNT SUBS TX FOR CHANGE DX|| 58-1699775|1326041732|CHC13|G0271||11/01/2013|12/31/9999|$17.53|0|0|||GROUP MNT 2 OR MORE 30 MINS|| 58-1699775|1326041732|CHC13|G0275||11/01/2013|12/31/9999|$15.23|0|0|||RENAL ANGIO| CARDIAC CATH|| 58-1699775|1326041732|CHC13|G0278||11/01/2013|12/31/9999|$15.23|0|0|||ILIAC ART ANGIO|CARDIAC CATH|| 58-1699775|1326041732|CHC13|G0279||01/01/2017|12/31/9999|$63.51|0|0|||DIAG DIGITAL BREAST TOMOSYNTHE|| 58-1699775|1326041732|CHC13|G0279|26|01/01/2017|12/31/9999|$36.02|0|0|||DIAG DIGITAL BREAST TOMOSYNTHE|| 58-1699775|1326041732|CHC13|G0279|TC|01/01/2017|12/31/9999|$27.49|0|0|||DIAG DIGITAL BREAST TOMOSYNTHE|| 58-1699775|1326041732|CHC13|G0281||11/01/2013|12/31/9999|$15.69|0|0|||ELEC STIM UNATTEND FOR PRESS|| 58-1699775|1326041732|CHC13|G0282||11/01/2013|12/31/9999|$0.00|0|0|||ELECT STIM WOUND CARE NOT PD|| 58-1699775|1326041732|CHC13|G0283||11/01/2013|12/31/9999|$15.69|0|0|||ELEC STIM OTHER THAN WOUND|| 58-1699775|1326041732|CHC13|G0288||11/01/2013|12/31/9999|$70.31|0|0|||RECON| CTA FOR SURG PLAN|| 58-1699775|1326041732|CHC13|G0289||11/01/2013|12/31/9999|$105.37|0|0|||ARTHRO| LOOSE BODY + CHONDRO|| 58-1699775|1326041732|CHC13|G0290||11/01/2013|12/31/9999|$0.00|0|0|||DRUG-ELUTING STENTS| SINGLE|| 58-1699775|1326041732|CHC13|G0291||11/01/2013|12/31/9999|$0.00|0|0|||DRUG-ELUTING STENTS|EACH ADD|| 58-1699775|1326041732|CHC13|G0293||11/01/2013|12/31/9999|$0.00|0|0|||NON-COV SURG PROC|CLIN TRIAL|| 58-1699775|1326041732|CHC13|G0294||11/01/2013|12/31/9999|$0.00|0|0|||NON-COV PROC| CLINICAL TRIAL|| 58-1699775|1326041732|CHC13|G0295||11/01/2013|12/31/9999|$0.00|0|0|||ELECTROMAGNETIC THERAPY ONC|| 58-1699775|1326041732|CHC13|G0296||05/01/2016|12/31/9999|$34.55|0|0|||PET IMAG RESTAG PREV TX THYROI|| 58-1699775|1326041732|CHC13|G0297||03/01/2016|12/31/9999|$291.09|0|0|||INSERT SINGLE CHAMBER/CD|| 58-1699775|1326041732|CHC13|G0297|26|03/01/2016|12/31/9999|$62.56|0|0|||INSERT SINGLE CHAMBER/CD|| 58-1699775|1326041732|CHC13|G0297|TC|03/01/2016|12/31/9999|$228.54|0|0|||INSERT SINGLE CHAMBER/CD|| 58-1699775|1326041732|CHC13|G0302||11/01/2013|12/31/9999|$0.00|0|0|||PRE-OP SERVICE LVRS COMPLETE|| 58-1699775|1326041732|CHC13|G0303||11/01/2013|12/31/9999|$0.00|0|0|||PRE-OP SERVICE LVRS 10-15DOS|| 58-1699775|1326041732|CHC13|G0304||11/01/2013|12/31/9999|$0.00|0|0|||PRE-OP SERVICE LVRS 1-9 DOS|| 58-1699775|1326041732|CHC13|G0305||11/01/2013|12/31/9999|$0.00|0|0|||POST OP SERVICE LVRS MIN 6|| 58-1699775|1326041732|CHC13|G0306||11/01/2013|12/31/9999|$13.82|0|0|||CBC/DIFFWBC W/O PLATELET|| 58-1699775|1326041732|CHC13|G0307||11/01/2013|12/31/9999|$11.66|0|0|||CBC WITHOUT PLATELET|| 58-1699775|1326041732|CHC13|G0328||11/01/2013|12/31/9999|$28.50|0|0|||FECAL BLOOD SCRN IMMUNOASSAY|| 58-1699775|1326041732|CHC13|G0329||11/01/2013|12/31/9999|$11.35|0|0|||ELECTROMAGNTIC TX FOR ULCERS|| 58-1699775|1326041732|CHC13|G0333||11/01/2013|12/31/9999|$0.00|0|0|||DISPENSE FEE INITIAL 30 DAY|| 58-1699775|1326041732|CHC13|G0337||11/01/2013|12/31/9999|$86.53|0|0|||HOSPICE EVALUATION PREELECTI|| 58-1699775|1326041732|CHC13|G0339||11/01/2013|12/31/9999|$0.00|0|0|||ROBOT LIN-RADSURG COM| FIRST|| 58-1699775|1326041732|CHC13|G0340||11/01/2013|12/31/9999|$0.00|0|0|||ROBT LIN-RADSURG FRACTX 2-5|| 58-1699775|1326041732|CHC13|G0341||11/01/2013|12/31/9999|$393.89|0|0|||PERCUTANEOUS ISLET CELLTRANS|| 58-1699775|1326041732|CHC13|G0342||11/01/2013|12/31/9999|$786.00|0|0|||LAPAROSCOPY ISLET CELL TRANS|| 58-1699775|1326041732|CHC13|G0343||11/01/2013|12/31/9999|$1|358.70|0|0|||LAPAROTOMY ISLET CELL TRANSP|| 58-1699775|1326041732|CHC13|G0364||11/01/2013|12/31/9999|$10.64|0|0|||BONE MARROW ASPIRATE &BIOPSY|| 58-1699775|1326041732|CHC13|G0365||11/01/2013|12/31/9999|$249.86|0|0|||VESSEL MAPPING HEMO ACCESS|| 58-1699775|1326041732|CHC13|G0365|26|11/01/2013|12/31/9999|$19.64|0|0|||VESSEL MAPPING HEMO ACCESS|| 58-1699775|1326041732|CHC13|G0365|TC|11/01/2013|12/31/9999|$310.18|0|0|||VESSEL MAPPING HEMO ACCESS|| 58-1699775|1326041732|CHC13|G0372||11/01/2013|12/31/9999|$10.30|0|0|||MD SERVICE REQUIRED FOR PMD|| 58-1699775|1326041732|CHC13|G0378||11/01/2013|12/31/9999|$0.00|0|0|||HOSPITAL OBSERVATION PER HR|| 58-1699775|1326041732|CHC13|G0379||11/01/2013|12/31/9999|$0.00|0|0|||DIRECT ADMIT HOSPITAL OBSERV|| 58-1699775|1326041732|CHC13|G0389||11/01/2013|12/31/9999|$128.65|0|0|||ULTRASOUND EXAM AAA SCREEN|| 58-1699775|1326041732|CHC13|G0389|26|11/01/2013|12/31/9999|$45.23|0|0|||ULTRASOUND EXAM AAA SCREEN|| 58-1699775|1326041732|CHC13|G0389|TC|11/01/2013|12/31/9999|$124.59|0|0|||ULTRASOUND EXAM AAA SCREEN|| 58-1699775|1326041732|CHC13|G0396||11/01/2013|12/31/9999|$41.46|0|0|||ALCOHOL/SUBS INTERV 15-30MN|| 58-1699775|1326041732|CHC13|G0397||11/01/2013|12/31/9999|$81.78|0|0|||ALCOHOL/SUBS INTERV >30 MIN|| 58-1699775|1326041732|CHC13|G0398||11/01/2013|12/31/9999|$189.05|0|0|||HOME SLEEP TEST/TYPE II PORTA|| 58-1699775|1326041732|CHC13|G0398|26|11/01/2013|12/31/9999|$99.71|0|0|||HOME SLEEP TEST/TYPE II PORTA|| 58-1699775|1326041732|CHC13|G0398|TC|11/01/2013|12/31/9999|$149.84|0|0|||HOME SLEEP TEST/TYPE II PORTA|| 58-1699775|1326041732|CHC13|G0399||11/01/2013|12/31/9999|$189.05|0|0|||HOME SLEEP TEST/TYPE III PORTA|| 58-1699775|1326041732|CHC13|G0399|26|11/01/2013|12/31/9999|$99.71|0|0|||HOME SLEEP TEST/TYPE III PORTA|| 58-1699775|1326041732|CHC13|G0399|TC|11/01/2013|12/31/9999|$149.84|0|0|||HOME SLEEP TEST/TYPE III PORTA|| 58-1699775|1326041732|CHC13|G0400||11/01/2013|12/31/9999|$189.05|0|0|||HOME SLEEP TEST/TYPE IV PORTA|| 58-1699775|1326041732|CHC13|G0400|26|11/01/2013|12/31/9999|$99.71|0|0|||HOME SLEEP TEST/TYPE IV PORTA|| 58-1699775|1326041732|CHC13|G0400|TC|11/01/2013|12/31/9999|$149.84|0|0|||HOME SLEEP TEST/TYPE IV PORTA|| 58-1699775|1326041732|CHC13|G0402||11/01/2013|12/31/9999|$185.69|0|0|||INITIAL PREVENTIVE EXAM|| 58-1699775|1326041732|CHC13|G0403||11/01/2013|12/31/9999|$22.16|0|0|||EKG FOR INITIAL PREVENT EXAM|| 58-1699775|1326041732|CHC13|G0404||11/01/2013|12/31/9999|$11.86|0|0|||EKG TRACING FOR INITIAL PREV|| 58-1699775|1326041732|CHC13|G0405||11/01/2013|12/31/9999|$10.30|0|0|||EKG INTERPRET & REPORT PREVE|| 58-1699775|1326041732|CHC13|G0406||11/01/2013|12/31/9999|$46.15|0|0|||TELHEALTH INPT CONSULT 15MIN|| 58-1699775|1326041732|CHC13|G0407||11/01/2013|12/31/9999|$84.46|0|0|||TELHEATH INPT CONSULT 25MIN|| 58-1699775|1326041732|CHC13|G0408||11/01/2013|12/31/9999|$121.16|0|0|||TELHEALTH INPT CONSULT 35MIN|| 58-1699775|1326041732|CHC13|G0409||11/01/2013|12/31/9999|$11.09|0|0|||CORF RELATED SERV 15 MINS EA|| 58-1699775|1326041732|CHC13|G0410||11/01/2013|12/31/9999|$0.00|0|0|||GRP PSYCH PARTIAL HOSP 45-50|| 58-1699775|1326041732|CHC13|G0411||11/01/2013|12/31/9999|$0.00|0|0|||INTER ACTIVE GRP PSYCH PARTI|| 58-1699775|1326041732|CHC13|G0412||11/01/2013|12/31/9999|$861.39|0|0|||OPEN TX ILIAC SPINE UNI/BIL|| 58-1699775|1326041732|CHC13|G0413||11/01/2013|12/31/9999|$1|262.71|0|0|||PELVIC RING FRACTURE UNI/BIL|| 58-1699775|1326041732|CHC13|G0414||11/01/2013|12/31/9999|$1|197.40|0|0|||PELVIC RING FX TREAT INT FIX|| 58-1699775|1326041732|CHC13|G0415||11/01/2013|12/31/9999|$1|641.69|0|0|||OPEN TX POST PELVIC FXCTURE|| 58-1699775|1326041732|CHC13|G0416||11/01/2013|12/31/9999|$766.63|0|0|||SAT BIOPSY PROSTATE 1-20 SPC|| 58-1699775|1326041732|CHC13|G0416|26|11/01/2013|12/31/9999|$287.71|0|0|||SAT BIOPSY PROSTATE 1-20 SPC|| 58-1699775|1326041732|CHC13|G0416|TC|11/01/2013|12/31/9999|$724.24|0|0|||SAT BIOPSY PROSTATE 1-20 SPC|| 58-1699775|1326041732|CHC13|G0417||11/01/2013|12/31/9999|$1|490.61|0|0|||SAT BIOPSY PROSTATE 21-40|| 58-1699775|1326041732|CHC13|G0417|26|11/01/2013|12/31/9999|$553.44|0|0|||SAT BIOPSY PROSTATE 21-40|| 58-1699775|1326041732|CHC13|G0417|TC|11/01/2013|12/31/9999|$1|414.17|0|0|||SAT BIOPSY PROSTATE 21-40|| 58-1699775|1326041732|CHC13|G0418||11/01/2013|12/31/9999|$2|557.36|0|0|||SAT BIOPSY PROSTATE 41-60|| 58-1699775|1326041732|CHC13|G0418|26|11/01/2013|12/31/9999|$960.94|0|0|||SAT BIOPSY PROSTATE 41-60|| 58-1699775|1326041732|CHC13|G0418|TC|11/01/2013|12/31/9999|$2|414.77|0|0|||SAT BIOPSY PROSTATE 41-60|| 58-1699775|1326041732|CHC13|G0419||11/01/2013|12/31/9999|$3|034.95|0|0|||SAT BIOPSY PROSTATE: >60|| 58-1699775|1326041732|CHC13|G0419|26|11/01/2013|12/31/9999|$1|108.21|0|0|||SAT BIOPSY PROSTATE: >60|| 58-1699775|1326041732|CHC13|G0419|TC|11/01/2013|12/31/9999|$2|897.93|0|0|||SAT BIOPSY PROSTATE: >60|| 58-1699775|1326041732|CHC13|G0420||11/01/2013|12/31/9999|$128.17|0|0|||ED SVC CKD IND PER SESSION|| 58-1699775|1326041732|CHC13|G0421||11/01/2013|12/31/9999|$29.72|0|0|||ED SVC CKD GRP PER SESSION|| 58-1699775|1326041732|CHC13|G0422||11/01/2013|12/31/9999|$83.00|0|0|||INTENS CARDIAC REHAB W/EXERC|| 58-1699775|1326041732|CHC13|G0423||11/01/2013|12/31/9999|$83.00|0|0|||INTENS CARDIAC REHAB NO EXER|| 58-1699775|1326041732|CHC13|G0424||11/01/2013|12/31/9999|$17.30|0|0|||PULMONARY REHAB W EXER|| 58-1699775|1326041732|CHC13|G0425||11/01/2013|12/31/9999|$120.13|0|0|||INPT TELEHEALTH CONSULT 30M|| 58-1699775|1326041732|CHC13|G0426||11/01/2013|12/31/9999|$162.91|0|0|||INPT TELEHEALTH CONSULT 50M|| 58-1699775|1326041732|CHC13|G0427||11/01/2013|12/31/9999|$239.49|0|0|||INPT TELEHEALTH CON 70/>M|| 58-1699775|1326041732|CHC13|G0428||11/01/2013|12/31/9999|$0.00|0|0|||COLLAGEN MENISCUS IMPLANT|| 58-1699775|1326041732|CHC13|G0429||11/01/2013|12/31/9999|$89.53|0|0|||DERMAL FILLER INJECTION(S)|| 58-1699775|1326041732|CHC13|G0431||11/01/2013|12/31/9999|$123.30|0|0|||DRUG SCREEN SINGLE CLASS|| 58-1699775|1326041732|CHC13|G0432||11/01/2013|12/31/9999|$24.62|0|0|||EIA| HIV-1/HIV-2 SCREEN|| 58-1699775|1326041732|CHC13|G0433||11/01/2013|12/31/9999|$24.62|0|0|||ELISA HIV-1/HIV-2 SCREEN|| 58-1699775|1326041732|CHC13|G0434||11/01/2013|12/31/9999|$26.34|0|0|||DRUG SCREEN MULTI DRUG CLASS|| 58-1699775|1326041732|CHC13|G0435||11/01/2013|12/31/9999|$21.59|0|0|||RAPID IMMUNOASSAY HIV-1|2|| 58-1699775|1326041732|CHC13|G0436||11/01/2013|12/31/9999|$16.34|0|0|||TOBACCO-USE COUNSEL 3-10 MIN|| 58-1699775|1326041732|CHC13|G0437||11/01/2013|12/31/9999|$33.92|0|0|||TOBACCO-USE COUNSEL>10MIN|| 58-1699775|1326041732|CHC13|G0438||11/01/2013|12/31/9999|$197.53|0|0|||PPPS| INITIAL VISIT|| 58-1699775|1326041732|CHC13|G0439||11/01/2013|12/31/9999|$131.10|0|0|||PPPS| SUBSEQ VISIT|| 58-1699775|1326041732|CHC13|G0442||11/01/2013|12/31/9999|$20.28|0|0|||ANNUAL ALCOHOL SCREEN 15 MIN|| 58-1699775|1326041732|CHC13|G0443||11/01/2013|12/31/9999|$30.26|0|0|||BRIEF ALCOHOL MISUSE COUNSEL|| 58-1699775|1326041732|CHC13|G0444||11/01/2013|12/31/9999|$20.28|0|0|||DEPRESSION SCREEN ANNUAL|| 58-1699775|1326041732|CHC13|G0445||11/01/2013|12/31/9999|$30.26|0|0|||HIGH INTEN BEH COUNS STD 30M|| 58-1699775|1326041732|CHC13|G0446||11/01/2013|12/31/9999|$30.26|0|0|||INTENS BEHAVE THER CARDIO DX|| 58-1699775|1326041732|CHC13|G0447||11/01/2013|12/31/9999|$30.26|0|0|||BEHAVIOR COUNSEL OBESITY 15M|| 58-1699775|1326041732|CHC13|G0448||11/01/2013|12/31/9999|$0.00|0|0|||PLACE PERM PACING CARDIOVERT|| 58-1699775|1326041732|CHC13|G0451||11/01/2013|12/31/9999|$11.09|0|0|||DEVLOPMENT TEST INTERPT&REP|| 58-1699775|1326041732|CHC13|G0452||11/01/2013|12/31/9999|$65.00|0|0||%|MOLECULAR PATHOLOGY INTERPR|| 58-1699775|1326041732|CHC13|G0452|26|11/01/2013|12/31/9999|$65.00|0|0||%|MOLECULAR PATHOLOGY INTERPR|| 58-1699775|1326041732|CHC13|G0453||11/01/2013|12/31/9999|$31.61|0|0|||CONT INTRAOP NEURO MONITOR|| 58-1699775|1326041732|CHC13|G0453|26|11/01/2013|12/31/9999|$65.00|0|0||%|CONT INTRAOP NEURO MONITOR|| 58-1699775|1326041732|CHC13|G0454||11/01/2013|12/31/9999|$10.72|0|0|||MD DOCUMENT VISIT BY NPP|| 58-1699775|1326041732|CHC13|G0455||11/01/2013|12/31/9999|$130.37|0|0|||FECAL MICROBIOTA PREP INSTIL|| 58-1699775|1326041732|CHC13|G0463||03/01/2016|12/31/9999|$118.61|0|0|||HOSPITAL OUTPT CLINIC VISIT|| 58-1699775|1326041732|CHC13|G0467||01/01/2017|12/31/9999|$103.80|0|0|||FQHC VISIT| ESTAB PT|| 58-1699775|1326041732|CHC13|G0477||01/01/2016|12/31/9999|$18.51|0|0|||DRUG TEST PRESUMP OPTICAL|| 58-1699775|1326041732|CHC13|G0479||11/01/2013|12/31/9999|$12.60|0|0|||DRUG TEST(S) PRESUMPTIVE ANY #|| 58-1699775|1326041732|CHC13|G0479|GW|11/01/2013|12/31/9999|$12.60|0|0|||DRUG TEST(S) PRESUMPTIVE ANY #|| 58-1699775|1326041732|CHC13|G0481||01/01/2017|12/31/9999|$52.91|0|0|||DRUG TEST DEF 8-14 CLASSES|| 58-1699775|1326041732|CHC13|G0506||01/01/2017|12/31/9999|$60.78|0|44.97|||COMP ASSES CARE PLAN CCM SERVI|| 58-1699775|1326041732|CHC13|G0631||11/01/2013|12/31/9999|$32.72|0|0||||| 58-1699775|1326041732|CHC13|G0642||11/01/2013|12/31/9999|$27.50|0|0||||| 58-1699775|1326041732|CHC13|G0643||11/01/2013|12/31/9999|$20.25|0|0||||| 58-1699775|1326041732|CHC13|G0653||11/01/2013|12/31/9999|$28.89|0|0||||| 58-1699775|1326041732|CHC13|G0908||11/01/2013|12/31/9999|$0.00|0|0|||HGB > 12 G/DL|| 58-1699775|1326041732|CHC13|G0909||11/01/2013|12/31/9999|$0.00|0|0|||HBG NOT DOC|| 58-1699775|1326041732|CHC13|G0910||11/01/2013|12/31/9999|$0.00|0|0|||HGB <= 12 G/DL|| 58-1699775|1326041732|CHC13|G0911||11/01/2013|12/31/9999|$0.00|0|0|||ASSESS ACTIVITY SYMPTOMS|| 58-1699775|1326041732|CHC13|G0912||11/01/2013|12/31/9999|$0.00|0|0|||NO ASSESS ACTIVITY SYMPTOMS|| 58-1699775|1326041732|CHC13|G0913||11/01/2013|12/31/9999|$0.00|0|0|||IMPROVE VISUAL FUNCT|| 58-1699775|1326041732|CHC13|G0914||11/01/2013|12/31/9999|$0.00|0|0|||SURVEY NOT COMPLETE|| 58-1699775|1326041732|CHC13|G0915||11/01/2013|12/31/9999|$0.00|0|0|||NO IMPROVE VISUAL FUNCT|| 58-1699775|1326041732|CHC13|G0916||11/01/2013|12/31/9999|$0.00|0|0|||SATISFY WITH CARE|| 58-1699775|1326041732|CHC13|G0917||11/01/2013|12/31/9999|$0.00|0|0|||SATISFY SURVEY NOT COMPLETE|| 58-1699775|1326041732|CHC13|G0918||11/01/2013|12/31/9999|$0.00|0|0|||NO SATISFY WITH CARE|| 58-1699775|1326041732|CHC13|G0919||11/01/2013|12/31/9999|$0.00|0|0|||FLU IMMUNIZE NOT AVAIL|| 58-1699775|1326041732|CHC13|G0920||11/01/2013|12/31/9999|$0.00|0|0|||TYPE LOC ACT DOC|| 58-1699775|1326041732|CHC13|G0921||11/01/2013|12/31/9999|$0.00|0|0|||DOC PT REAS NO ASSESS|| 58-1699775|1326041732|CHC13|G0922||11/01/2013|12/31/9999|$0.00|0|0|||TYPE LOC ACT NOT DOC|| 58-1699775|1326041732|CHC13|G3001||11/01/2013|12/31/9999|$0.00|0|0|||ADMIN + SUPPLY| TOSITUMOMAB|| 58-1699775|1326041732|CHC13|G6002||11/01/2013|12/31/9999|$340.26|0|0|||STEREOSCOPIC X-RAY GUIDANCE|| 58-1699775|1326041732|CHC13|G6012||01/01/2015|12/31/9999|$360.62|0|0|||RADIATION TREATMENT DELIVERY|| 58-1699775|1326041732|CHC13|G6013||11/01/2013|12/31/9999|$380.28|0|0|||RADIATION TREATMENT DELIVERY|| 58-1699775|1326041732|CHC13|G6013|76|11/01/2013|12/31/9999|$380.28|0|0|||RADIATION TREATMENT DELIVERY|| 58-1699775|1326041732|CHC13|G6014||02/01/2016|12/31/9999|$298.95|0|0|||RADIATION TREATMENT DELIVERY|| 58-1699775|1326041732|CHC13|G6015||01/01/2015|12/31/9999|$451.86|0|0|||RADIATION TX DELIVERY IMRT|| 58-1699775|1326041732|CHC13|G6031||11/01/2013|12/31/9999|$32.72|0|0|||ASSAY OF BENZODIAZEPINES|| 58-1699775|1326041732|CHC13|G6042||11/01/2013|12/31/9999|$27.50|0|0|||ASSAY OF AMPHETAMINES|| 58-1699775|1326041732|CHC13|G6043||11/01/2013|12/31/9999|$20.25|0|0|||ASSAY OF BARBITURATES|| 58-1699775|1326041732|CHC13|G6053||11/01/2013|12/31/9999|$28.89|0|0|||ASSAY OF METHADONE|| 58-1699775|1326041732|CHC13|G6058||11/01/2013|12/31/9999|$24.39|0|0||||| 58-1699775|1326041732|CHC13|G8126||11/01/2013|12/31/9999|$0.00|0|0|||PT DCMT TX ANTIDEPRES 12 WK|| 58-1699775|1326041732|CHC13|G8127||11/01/2013|12/31/9999|$0.00|0|0|||PT NOTDCMT TX ANTIDEPRES 12W|| 58-1699775|1326041732|CHC13|G8128||11/01/2013|12/31/9999|$0.00|0|0|||PT NOT ELIG ANTIDEPRES 12 WK|| 58-1699775|1326041732|CHC13|G8395||11/01/2013|12/31/9999|$0.00|0|0|||LVEF>=40% DOC NORMAL OR MILD|| 58-1699775|1326041732|CHC13|G8396||11/01/2013|12/31/9999|$0.00|0|0|||LVEF NOT PERFORMED|| 58-1699775|1326041732|CHC13|G8397||11/01/2013|12/31/9999|$0.00|0|0|||DIL MACULA/FUNDUS EXAM/W DOC|| 58-1699775|1326041732|CHC13|G8398||11/01/2013|12/31/9999|$0.00|0|0|||DIL MACULAR/FUNDUS NOT PERFO|| 58-1699775|1326041732|CHC13|G8399||11/01/2013|12/31/9999|$0.00|0|0|||PT W/DXA DOCUMENT OR ORDER|| 58-1699775|1326041732|CHC13|G8400||11/01/2013|12/31/9999|$0.00|0|0|||PT W/DXA NO DOCUMENT OR ORDE|| 58-1699775|1326041732|CHC13|G8401||11/01/2013|12/31/9999|$0.00|0|0|||PT INELIG OSTEO SCREEN MEASU|| 58-1699775|1326041732|CHC13|G8404||11/01/2013|12/31/9999|$0.00|0|0|||LOW EXTEMITY NEUR EXAM DOCUM|| 58-1699775|1326041732|CHC13|G8405||11/01/2013|12/31/9999|$0.00|0|0|||LOW EXTEMITY NEUR NOT PERFOR|| 58-1699775|1326041732|CHC13|G8406||11/01/2013|12/31/9999|$0.00|0|0|||PT INELIG LOWER EXTREM NEURO|| 58-1699775|1326041732|CHC13|G8410||11/01/2013|12/31/9999|$0.00|0|0|||EVAL ON FOOT DOCUMENTED|| 58-1699775|1326041732|CHC13|G8415||11/01/2013|12/31/9999|$0.00|0|0|||EVAL ON FOOT NOT PERFORMED|| 58-1699775|1326041732|CHC13|G8416||11/01/2013|12/31/9999|$0.00|0|0|||PT INELIG FOOTWEAR EVALUATIO|| 58-1699775|1326041732|CHC13|G8417||11/01/2013|12/31/9999|$0.00|0|0|||BMI >=30 CALCUATE W/FOLLOWUP|| 58-1699775|1326041732|CHC13|G8418||11/01/2013|12/31/9999|$0.00|0|0|||BMI < 22 CALCUATE W/FOLLOWUP|| 58-1699775|1326041732|CHC13|G8419||11/01/2013|12/31/9999|$0.00|0|0|||BMI>=30OR<22 CAL NO FOLLOWUP|| 58-1699775|1326041732|CHC13|G8420||11/01/2013|12/31/9999|$0.00|0|0|||BMI<30 AND >=22 CALC & DOCU|| 58-1699775|1326041732|CHC13|G8421||11/01/2013|12/31/9999|$0.00|0|0|||BMI NOT CALCULATED|| 58-1699775|1326041732|CHC13|G8422||11/01/2013|12/31/9999|$0.00|0|0|||PT INELIG BMI CALCULATION|| 58-1699775|1326041732|CHC13|G8427||11/01/2013|12/31/9999|$0.00|0|0|||DOC MEDS VERIFIED W/PT OR RE|| 58-1699775|1326041732|CHC13|G8428||11/01/2013|12/31/9999|$0.00|0|0|||MEDS DOCUMENT W/O VERIFICA|| 58-1699775|1326041732|CHC13|G8430||11/01/2013|12/31/9999|$0.00|0|0|||PT INELIG MED CHECK|| 58-1699775|1326041732|CHC13|G8431||11/01/2013|12/31/9999|$0.00|0|0|||CLIN DEPRESSION SCREEN DOC|| 58-1699775|1326041732|CHC13|G8432||11/01/2013|12/31/9999|$0.00|0|0|||CLIN DEPRESSION SCREEN NOT D|| 58-1699775|1326041732|CHC13|G8433||11/01/2013|12/31/9999|$0.00|0|0|||PT INELIG FOR DEPRESSION SCR|| 58-1699775|1326041732|CHC13|G8442||11/01/2013|12/31/9999|$0.00|0|0|||PT INELIG PAIN ASSESSMENT|| 58-1699775|1326041732|CHC13|G8447||11/01/2013|12/31/9999|$0.00|0|0|||PT VISIT DOC USING CCHIT CER|| 58-1699775|1326041732|CHC13|G8448||11/01/2013|12/31/9999|$0.00|0|0|||PT VISIT DOCUM W/NON-CCHIT C|| 58-1699775|1326041732|CHC13|G8450||11/01/2013|12/31/9999|$0.00|0|0|||BETA-BLOC RX PT W/ABN LVEF|| 58-1699775|1326041732|CHC13|G8451||11/01/2013|12/31/9999|$0.00|0|0|||PT W/ABN LVEF INELIG B-BLOC|| 58-1699775|1326041732|CHC13|G8452||11/01/2013|12/31/9999|$0.00|0|0|||PT W/ABN LVEF B-BLOC NO RX|| 58-1699775|1326041732|CHC13|G8458||11/01/2013|12/31/9999|$0.00|0|0|||PT INELIG GENO NO ANTVIR TX|| 58-1699775|1326041732|CHC13|G8459||11/01/2013|12/31/9999|$0.00|0|0|||DOC PT REC ANTIVIR TREAT|| 58-1699775|1326041732|CHC13|G8460||11/01/2013|12/31/9999|$0.00|0|0|||PT INELIG RNA NO ANTVIR TX|| 58-1699775|1326041732|CHC13|G8461||11/01/2013|12/31/9999|$0.00|0|0|||PT REC ANTIVIR TREAT HEP C|| 58-1699775|1326041732|CHC13|G8462||11/01/2013|12/31/9999|$0.00|0|0|||PT INELIG COUNS NO ANTVIR TX|| 58-1699775|1326041732|CHC13|G8463||11/01/2013|12/31/9999|$0.00|0|0|||PT REC ANTIVIRAL TREAT DOC|| 58-1699775|1326041732|CHC13|G8464||11/01/2013|12/31/9999|$0.00|0|0|||PT INELIG; LO TO NO DTER RSK|| 58-1699775|1326041732|CHC13|G8465||11/01/2013|12/31/9999|$0.00|0|0|||HIGH RISK RECURRENCE PRO CA|| 58-1699775|1326041732|CHC13|G8468||11/01/2013|12/31/9999|$0.00|0|0|||ACE/ARB RX PT W/ABN LVEF|| 58-1699775|1326041732|CHC13|G8469||11/01/2013|12/31/9999|$0.00|0|0|||PT W/ABN LVEF INELIG ACE/ARB|| 58-1699775|1326041732|CHC13|G8470||11/01/2013|12/31/9999|$0.00|0|0|||PT W/ NORMAL LVEF|| 58-1699775|1326041732|CHC13|G8471||11/01/2013|12/31/9999|$0.00|0|0|||LVEF NOT PERFORMED/DOC|| 58-1699775|1326041732|CHC13|G8472||11/01/2013|12/31/9999|$0.00|0|0|||ACE/ARB NO RX PT W/ABN LVEF|| 58-1699775|1326041732|CHC13|G8473||11/01/2013|12/31/9999|$0.00|0|0|||ACE/ARB THXPY RX'D|| 58-1699775|1326041732|CHC13|G8474||11/01/2013|12/31/9999|$0.00|0|0|||ACE/ARB NOT RX'D; DOC REAS|| 58-1699775|1326041732|CHC13|G8475||11/01/2013|12/31/9999|$0.00|0|0|||ACE/ARB THXPY NOT RX'D|| 58-1699775|1326041732|CHC13|G8476||11/01/2013|12/31/9999|$0.00|0|0|||BP SYS <130 AND DIAS <80|| 58-1699775|1326041732|CHC13|G8477||11/01/2013|12/31/9999|$0.00|0|0|||BP SYS>=130 AND/OR DIAS >=80|| 58-1699775|1326041732|CHC13|G8478||11/01/2013|12/31/9999|$0.00|0|0|||BP NOT PERFORMED/DOC|| 58-1699775|1326041732|CHC13|G8482||11/01/2013|12/31/9999|$0.00|0|0|||FLU IMMUNIZE ORDER/ADMIN|| 58-1699775|1326041732|CHC13|G8483||11/01/2013|12/31/9999|$0.00|0|0|||FLU IMM NO ORD/ADMIN DOC REA|| 58-1699775|1326041732|CHC13|G8484||11/01/2013|12/31/9999|$0.00|0|0|||FLU IMMUNIZE NO ORDER/ADMIN|| 58-1699775|1326041732|CHC13|G8485||11/01/2013|12/31/9999|$0.00|0|0|||REPORT| DIABETES MEASURES|| 58-1699775|1326041732|CHC13|G8486||11/01/2013|12/31/9999|$0.00|0|0|||REPORT| PREV CARE MEASURES|| 58-1699775|1326041732|CHC13|G8487||11/01/2013|12/31/9999|$0.00|0|0|||REPORT CKD MEASURES|| 58-1699775|1326041732|CHC13|G8489||11/01/2013|12/31/9999|$0.00|0|0|||CAD MEASURES GRP|| 58-1699775|1326041732|CHC13|G8490||11/01/2013|12/31/9999|$0.00|0|0|||RA MEASURES GRP|| 58-1699775|1326041732|CHC13|G8491||11/01/2013|12/31/9999|$0.00|0|0|||HIV/AIDS MEASURES GRP|| 58-1699775|1326041732|CHC13|G8492||11/01/2013|12/31/9999|$0.00|0|0|||PREV CARE MEASURES GRP|| 58-1699775|1326041732|CHC13|G8493||11/01/2013|12/31/9999|$0.00|0|0|||BACK PAIN MEASURES GRP|| 58-1699775|1326041732|CHC13|G8494||11/01/2013|12/31/9999|$0.00|0|0|||DM MEAS QUAL ACT PERFORM|| 58-1699775|1326041732|CHC13|G8495||11/01/2013|12/31/9999|$0.00|0|0|||CKD MEAS QUAL ACT PERFORM|| 58-1699775|1326041732|CHC13|G8496||11/01/2013|12/31/9999|$0.00|0|0|||PC MEAS QUAL ACT PERFORM|| 58-1699775|1326041732|CHC13|G8497||11/01/2013|12/31/9999|$0.00|0|0|||CABG MEAS QUAL ACT PERFORM|| 58-1699775|1326041732|CHC13|G8498||11/01/2013|12/31/9999|$0.00|0|0|||CAD MEAS QUAL ACT PERFORM|| 58-1699775|1326041732|CHC13|G8499||11/01/2013|12/31/9999|$0.00|0|0|||RA MEAS QUAL ACT PERFORM|| 58-1699775|1326041732|CHC13|G8500||11/01/2013|12/31/9999|$0.00|0|0|||HIV MEAS QUAL ACT PERFORM|| 58-1699775|1326041732|CHC13|G8501||11/01/2013|12/31/9999|$0.00|0|0|||PERIO MEAS QUAL ACT PERFORM|| 58-1699775|1326041732|CHC13|G8502||11/01/2013|12/31/9999|$0.00|0|0|||BP MEAS QUAL ACT PERFORM|| 58-1699775|1326041732|CHC13|G8506||11/01/2013|12/31/9999|$0.00|0|0|||PT REC ACE/ARB|| 58-1699775|1326041732|CHC13|G8509||11/01/2013|12/31/9999|$0.00|0|0|||PAIN ASSESS NO F/U PLN DOC|| 58-1699775|1326041732|CHC13|G8510||11/01/2013|12/31/9999|$0.00|0|0|||PT INELIG NEG SCRN DEPRES|| 58-1699775|1326041732|CHC13|G8511||11/01/2013|12/31/9999|$0.00|0|0|||CLIN DEPRES SCRN NO F/U DOC|| 58-1699775|1326041732|CHC13|G8524||11/01/2013|12/31/9999|$0.00|0|0|||PATCH CLOSURE CONV CEA|| 58-1699775|1326041732|CHC13|G8525||11/01/2013|12/31/9999|$0.00|0|0|||NO PATCH CLOSURE CEA|| 58-1699775|1326041732|CHC13|G8526||11/01/2013|12/31/9999|$0.00|0|0|||NO PATCH CLOSURE CONV CEA|| 58-1699775|1326041732|CHC13|G8530||11/01/2013|12/31/9999|$0.00|0|0|||AUTO AV FISTULA RECD|| 58-1699775|1326041732|CHC13|G8531||11/01/2013|12/31/9999|$0.00|0|0|||PT INELIG; AUTO AV FISTULA|| 58-1699775|1326041732|CHC13|G8532||11/01/2013|12/31/9999|$0.00|0|0|||NO AUTO AV FISTULA; NO REAS|| 58-1699775|1326041732|CHC13|G8535||11/01/2013|12/31/9999|$0.00|0|0|||PT INELIG NO ELD MAL SCRN|| 58-1699775|1326041732|CHC13|G8536||11/01/2013|12/31/9999|$0.00|0|0|||NO DOC ELDER MAL SCRN|| 58-1699775|1326041732|CHC13|G8539||11/01/2013|12/31/9999|$0.00|0|0|||CUR FUNCT ASSESS & CARE PLN|| 58-1699775|1326041732|CHC13|G8540||11/01/2013|12/31/9999|$0.00|0|0|||PT INELIG FUNCT ASSESS|| 58-1699775|1326041732|CHC13|G8541||11/01/2013|12/31/9999|$0.00|0|0|||NO DOC CUR FUNCT ASSESS|| 58-1699775|1326041732|CHC13|G8542||11/01/2013|12/31/9999|$0.00|0|0|||PT INELIG FUNC ASSES NO PLN|| 58-1699775|1326041732|CHC13|G8543||11/01/2013|12/31/9999|$0.00|0|0|||CUR FUNCT ASSES; NO CARE PLN|| 58-1699775|1326041732|CHC13|G8544||11/01/2013|12/31/9999|$0.00|0|0|||CABG MEASURES GRP|| 58-1699775|1326041732|CHC13|G8545||11/01/2013|12/31/9999|$0.00|0|0|||HEPC MEASURES GRP|| 58-1699775|1326041732|CHC13|G8546||11/01/2013|12/31/9999|$0.00|0|0|||CAP MEASURES GRP|| 58-1699775|1326041732|CHC13|G8547||11/01/2013|12/31/9999|$0.00|0|0|||IVD MEASURES GRP|| 58-1699775|1326041732|CHC13|G8548||11/01/2013|12/31/9999|$0.00|0|0|||HF MEASURES GRP|| 58-1699775|1326041732|CHC13|G8549||11/01/2013|12/31/9999|$0.00|0|0|||HEPC MG QUAL ACT PERFORM|| 58-1699775|1326041732|CHC13|G8550||11/01/2013|12/31/9999|$0.00|0|0|||CAP MG QUAL ACT PERFORM|| 58-1699775|1326041732|CHC13|G8551||11/01/2013|12/31/9999|$0.00|0|0|||HF MG QUAL ACT PERFORM|| 58-1699775|1326041732|CHC13|G8552||11/01/2013|12/31/9999|$0.00|0|0|||IVD MG QUAL ACT PERFORM|| 58-1699775|1326041732|CHC13|G8553||11/01/2013|12/31/9999|$0.00|0|0|||1 RX VIA QUALIFIED ERX SYS|| 58-1699775|1326041732|CHC13|G8556||11/01/2013|12/31/9999|$0.00|0|0|||REF TO DOC OTOLOG EVAL|| 58-1699775|1326041732|CHC13|G8557||11/01/2013|12/31/9999|$0.00|0|0|||PT INELIG REF OTOLOG EVAL|| 58-1699775|1326041732|CHC13|G8558||11/01/2013|12/31/9999|$0.00|0|0|||NO REF TO DOC OTOLOG EVAL|| 58-1699775|1326041732|CHC13|G8559||11/01/2013|12/31/9999|$0.00|0|0|||PT REF DOC OTO EVAL|| 58-1699775|1326041732|CHC13|G8560||11/01/2013|12/31/9999|$0.00|0|0|||PT HX ACT DRAIN PREV 90 DAYS|| 58-1699775|1326041732|CHC13|G8561||11/01/2013|12/31/9999|$0.00|0|0|||PT INELIG FOR REF OTO EVAL|| 58-1699775|1326041732|CHC13|G8562||11/01/2013|12/31/9999|$0.00|0|0|||PT NO HX ACT DRAIN 90 D|| 58-1699775|1326041732|CHC13|G8563||11/01/2013|12/31/9999|$0.00|0|0|||PT NO REF OTO REAS NO SPEC|| 58-1699775|1326041732|CHC13|G8564||11/01/2013|12/31/9999|$0.00|0|0|||PT REF OTO EVAL|| 58-1699775|1326041732|CHC13|G8565||11/01/2013|12/31/9999|$0.00|0|0|||VER DOC HEAR LOSS|| 58-1699775|1326041732|CHC13|G8566||11/01/2013|12/31/9999|$0.00|0|0|||PT INELIG REF OTO EVAL|| 58-1699775|1326041732|CHC13|G8567||11/01/2013|12/31/9999|$0.00|0|0|||PT NO DOC HEAR LOSS|| 58-1699775|1326041732|CHC13|G8568||11/01/2013|12/31/9999|$0.00|0|0|||PT NO REF OTOLO NO SPEC|| 58-1699775|1326041732|CHC13|G8569||11/01/2013|12/31/9999|$0.00|0|0|||PROL INTUBATION REQ|| 58-1699775|1326041732|CHC13|G8570||11/01/2013|12/31/9999|$0.00|0|0|||NO PROL INTUB REQ|| 58-1699775|1326041732|CHC13|G8571||11/01/2013|12/31/9999|$0.00|0|0|||STER WD IFX 30 D POSTOP|| 58-1699775|1326041732|CHC13|G8572||11/01/2013|12/31/9999|$0.00|0|0|||NO STER WD IFX|| 58-1699775|1326041732|CHC13|G8573||11/01/2013|12/31/9999|$0.00|0|0|||STK/CVA CABG|| 58-1699775|1326041732|CHC13|G8574||11/01/2013|12/31/9999|$0.00|0|0|||NO STRK/CVA CABG|| 58-1699775|1326041732|CHC13|G8575||11/01/2013|12/31/9999|$0.00|0|0|||POSTOP REN INSUF|| 58-1699775|1326041732|CHC13|G8576||11/01/2013|12/31/9999|$0.00|0|0|||NO POSTOP REN INSUF|| 58-1699775|1326041732|CHC13|G8577||11/01/2013|12/31/9999|$0.00|0|0|||REOP REQ BLD GRFT OTH|| 58-1699775|1326041732|CHC13|G8578||11/01/2013|12/31/9999|$0.00|0|0|||NO REOP REQ BLD GRFT OTH|| 58-1699775|1326041732|CHC13|G8579||11/01/2013|12/31/9999|$0.00|0|0|||ANTPLT MED DISCH|| 58-1699775|1326041732|CHC13|G8580||11/01/2013|12/31/9999|$0.00|0|0|||ANTPLT MED CONTRAIND|| 58-1699775|1326041732|CHC13|G8581||11/01/2013|12/31/9999|$0.00|0|0|||NO ANTPLT MED DISCH|| 58-1699775|1326041732|CHC13|G8582||11/01/2013|12/31/9999|$0.00|0|0|||BBLOCK DISCH|| 58-1699775|1326041732|CHC13|G8583||11/01/2013|12/31/9999|$0.00|0|0|||BBLOCK CONTRAIND|| 58-1699775|1326041732|CHC13|G8584||11/01/2013|12/31/9999|$0.00|0|0|||NO BBLOCK DISCH|| 58-1699775|1326041732|CHC13|G8585||11/01/2013|12/31/9999|$0.00|0|0|||ANTILIPID TREAT DISCH|| 58-1699775|1326041732|CHC13|G8586||11/01/2013|12/31/9999|$0.00|0|0|||ANTLIP DISCH CONTRA|| 58-1699775|1326041732|CHC13|G8587||11/01/2013|12/31/9999|$0.00|0|0|||NO ANTLIPID TREAT DISCH|| 58-1699775|1326041732|CHC13|G8588||11/01/2013|12/31/9999|$0.00|0|0|||SYS BP <140|| 58-1699775|1326041732|CHC13|G8589||11/01/2013|12/31/9999|$0.00|0|0|||SYS BP >= 140|| 58-1699775|1326041732|CHC13|G8590||11/01/2013|12/31/9999|$0.00|0|0|||DIA BP < 90|| 58-1699775|1326041732|CHC13|G8591||11/01/2013|12/31/9999|$0.00|0|0|||DIA BP >= 90|| 58-1699775|1326041732|CHC13|G8592||11/01/2013|12/31/9999|$0.00|0|0|||NO BP MEASURE|| 58-1699775|1326041732|CHC13|G8593||11/01/2013|12/31/9999|$0.00|0|0|||LIPID PN RESULTS|| 58-1699775|1326041732|CHC13|G8594||11/01/2013|12/31/9999|$0.00|0|0|||NO LIPID PROF PERF|| 58-1699775|1326041732|CHC13|G8595||11/01/2013|12/31/9999|$0.00|0|0|||LDL < 100|| 58-1699775|1326041732|CHC13|G8596||11/01/2013|12/31/9999|$0.00|0|0|||NO LDL PERF|| 58-1699775|1326041732|CHC13|G8597||11/01/2013|12/31/9999|$0.00|0|0|||LDL >= 100|| 58-1699775|1326041732|CHC13|G8598||11/01/2013|12/31/9999|$0.00|0|0|||ASP THERP USED|| 58-1699775|1326041732|CHC13|G8599||11/01/2013|12/31/9999|$0.00|0|0|||NO ASP THERP USED|| 58-1699775|1326041732|CHC13|G8600||11/01/2013|12/31/9999|$0.00|0|0|||TPA INITI W/IN 3 HRS|| 58-1699775|1326041732|CHC13|G8601||11/01/2013|12/31/9999|$0.00|0|0|||NO ELIG TPA INIT W/IN 3 HRS|| 58-1699775|1326041732|CHC13|G8602||11/01/2013|12/31/9999|$0.00|0|0|||NO TPA INIT W/IN 3 HRS|| 58-1699775|1326041732|CHC13|G8603||11/01/2013|12/31/9999|$0.00|0|0|||SPOK LANG COMP SCORE|| 58-1699775|1326041732|CHC13|G8604||11/01/2013|12/31/9999|$0.00|0|0|||NO HIGH SCORE SPOK LANG|| 58-1699775|1326041732|CHC13|G8605||11/01/2013|12/31/9999|$0.00|0|0|||NO SPOK LANG COMP SCORE|| 58-1699775|1326041732|CHC13|G8606||11/01/2013|12/31/9999|$0.00|0|0|||ATTENTION SCORE|| 58-1699775|1326041732|CHC13|G8607||11/01/2013|12/31/9999|$0.00|0|0|||NO HIGH SCORE ATTENTION|| 58-1699775|1326041732|CHC13|G8608||11/01/2013|12/31/9999|$0.00|0|0|||NO ATTENTION SCORE|| 58-1699775|1326041732|CHC13|G8609||11/01/2013|12/31/9999|$0.00|0|0|||MEMORY SCORE|| 58-1699775|1326041732|CHC13|G8610||11/01/2013|12/31/9999|$0.00|0|0|||NO HIGH SCORE MEMORY|| 58-1699775|1326041732|CHC13|G8611||11/01/2013|12/31/9999|$0.00|0|0|||NO MEMORY SCORE|| 58-1699775|1326041732|CHC13|G8612||11/01/2013|12/31/9999|$0.00|0|0|||MOTO SPEECH SCORE|| 58-1699775|1326041732|CHC13|G8613||11/01/2013|12/31/9999|$0.00|0|0|||NO HIGH SCORE MOTO SPEECH|| 58-1699775|1326041732|CHC13|G8614||11/01/2013|12/31/9999|$0.00|0|0|||NO MOTO SPEECH SCORE|| 58-1699775|1326041732|CHC13|G8615||11/01/2013|12/31/9999|$0.00|0|0|||READING SCORE|| 58-1699775|1326041732|CHC13|G8616||11/01/2013|12/31/9999|$0.00|0|0|||NO HIGH SCORE READING|| 58-1699775|1326041732|CHC13|G8617||11/01/2013|12/31/9999|$0.00|0|0|||NO READING SCORE|| 58-1699775|1326041732|CHC13|G8618||11/01/2013|12/31/9999|$0.00|0|0|||SPOK LANG EXP SCORE|| 58-1699775|1326041732|CHC13|G8619||11/01/2013|12/31/9999|$0.00|0|0|||NO HIGH SCORE SPOK LANG EXP|| 58-1699775|1326041732|CHC13|G8620||11/01/2013|12/31/9999|$0.00|0|0|||NO SPOK LANG EXP SCORE|| 58-1699775|1326041732|CHC13|G8621||11/01/2013|12/31/9999|$0.00|0|0|||WRITING SCORE|| 58-1699775|1326041732|CHC13|G8622||11/01/2013|12/31/9999|$0.00|0|0|||NO HIGH SCORE WRITING|| 58-1699775|1326041732|CHC13|G8623||11/01/2013|12/31/9999|$0.00|0|0|||NO WRITING SCORE|| 58-1699775|1326041732|CHC13|G8624||11/01/2013|12/31/9999|$0.00|0|0|||SWALLOWING SCORE|| 58-1699775|1326041732|CHC13|G8625||11/01/2013|12/31/9999|$0.00|0|0|||NO HIGH SCORE SWALLOWING|| 58-1699775|1326041732|CHC13|G8626||11/01/2013|12/31/9999|$0.00|0|0|||NO SWALLOWING SCORE|| 58-1699775|1326041732|CHC13|G8627||11/01/2013|12/31/9999|$0.00|0|0|||SURG PROC W/IN 30 DAYS|| 58-1699775|1326041732|CHC13|G8628||11/01/2013|12/31/9999|$0.00|0|0|||NO SURG PROC W/IN 30 DAYS|| 58-1699775|1326041732|CHC13|G8629||11/01/2013|12/31/9999|$0.00|0|0|||DOC ANTIBIO ORDER B/4 SURG|| 58-1699775|1326041732|CHC13|G8630||11/01/2013|12/31/9999|$0.00|0|0|||DOC ANTIBIO GIVEN B/4 SURG|| 58-1699775|1326041732|CHC13|G8631||11/01/2013|12/31/9999|$0.00|0|0|||PT NO ELG 4 ORDER ANTBI GIVE|| 58-1699775|1326041732|CHC13|G8632||11/01/2013|12/31/9999|$0.00|0|0|||DOC NO ANTIBI ORDER B/4 SURG|| 58-1699775|1326041732|CHC13|G8633||11/01/2013|12/31/9999|$0.00|0|0|||PHARM THER OSTEO RX|| 58-1699775|1326041732|CHC13|G8634||11/01/2013|12/31/9999|$0.00|0|0|||PT NO ELG PHAR THER OSTEO|| 58-1699775|1326041732|CHC13|G8635||11/01/2013|12/31/9999|$0.00|0|0|||NO PHARM THER OSTEO RX|| 58-1699775|1326041732|CHC13|G8642||11/01/2013|12/31/9999|$0.00|0|0|||HRDSHP RURAL W/O INTERNET|| 58-1699775|1326041732|CHC13|G8643||11/01/2013|12/31/9999|$0.00|0|0|||HRDSHP W/O SUFF PHARM W/ERX|| 58-1699775|1326041732|CHC13|G8644||11/01/2013|12/31/9999|$0.00|0|0|||EP NO PRESCRIBE PRIV|| 58-1699775|1326041732|CHC13|G8645||11/01/2013|12/31/9999|$0.00|0|0|||ASTHMA MEASURES GRP|| 58-1699775|1326041732|CHC13|G8646||11/01/2013|12/31/9999|$0.00|0|0|||ASTHMA MG QUAL ACT PERFORM|| 58-1699775|1326041732|CHC13|G8647||11/01/2013|12/31/9999|$0.00|0|0|||FUN STAT SCORE KNEE >= 0|| 58-1699775|1326041732|CHC13|G8648||11/01/2013|12/31/9999|$0.00|0|0|||FUN STAT SCORE KNEE < 0|| 58-1699775|1326041732|CHC13|G8649||11/01/2013|12/31/9999|$0.00|0|0|||FUN STAT SCORE KNEE PT NOELG|| 58-1699775|1326041732|CHC13|G8650||11/01/2013|12/31/9999|$0.00|0|0|||FUN STAT SCORE KNEE NOT DONE|| 58-1699775|1326041732|CHC13|G8651||11/01/2013|12/31/9999|$0.00|0|0|||FUN STAT SCORE HIP >= 0|| 58-1699775|1326041732|CHC13|G8652||11/01/2013|12/31/9999|$0.00|0|0|||FUN STAT SCORE HIP < 0|| 58-1699775|1326041732|CHC13|G8653||11/01/2013|12/31/9999|$0.00|0|0|||FUN STAT SCORE HIP PT NO ELG|| 58-1699775|1326041732|CHC13|G8654||11/01/2013|12/31/9999|$0.00|0|0|||FUN STAT SCORE HIP NOT DONE|| 58-1699775|1326041732|CHC13|G8655||11/01/2013|12/31/9999|$0.00|0|0|||FUN STAT SCORE LE >= 0|| 58-1699775|1326041732|CHC13|G8656||11/01/2013|12/31/9999|$0.00|0|0|||FUN STAT SCORE LE < 0|| 58-1699775|1326041732|CHC13|G8657||11/01/2013|12/31/9999|$0.00|0|0|||FUN STAT SCORE LE PT NO ELG|| 58-1699775|1326041732|CHC13|G8658||11/01/2013|12/31/9999|$0.00|0|0|||FUN STAT SCORE LE NOT DONE|| 58-1699775|1326041732|CHC13|G8659||11/01/2013|12/31/9999|$0.00|0|0|||FUN STAT SCORE LS >= 0|| 58-1699775|1326041732|CHC13|G8660||11/01/2013|12/31/9999|$0.00|0|0|||FUN STAT SCORE LS < 0|| 58-1699775|1326041732|CHC13|G8661||11/01/2013|12/31/9999|$0.00|0|0|||FUN STAT SCORE LS PT NO ELG|| 58-1699775|1326041732|CHC13|G8662||11/01/2013|12/31/9999|$0.00|0|0|||FUN STAT SCORE LS NOT DONE|| 58-1699775|1326041732|CHC13|G8663||11/01/2013|12/31/9999|$0.00|0|0|||FUN STAT SCORE SHDL >=0|| 58-1699775|1326041732|CHC13|G8664||11/01/2013|12/31/9999|$0.00|0|0|||FUN STAT SCORE SHDL < 0|| 58-1699775|1326041732|CHC13|G8665||11/01/2013|12/31/9999|$0.00|0|0|||FUN STAT SCORE SHDL PT NO EL|| 58-1699775|1326041732|CHC13|G8666||11/01/2013|12/31/9999|$0.00|0|0|||FUN STAT SCORE SHDL NOT DONE|| 58-1699775|1326041732|CHC13|G8667||11/01/2013|12/31/9999|$0.00|0|0|||FUN STAT SCORE UE >=0|| 58-1699775|1326041732|CHC13|G8668||11/01/2013|12/31/9999|$0.00|0|0|||FUN STAT SCORE UE < 0|| 58-1699775|1326041732|CHC13|G8669||11/01/2013|12/31/9999|$0.00|0|0|||FUN STAT SCORE UE PT NO ELG|| 58-1699775|1326041732|CHC13|G8670||11/01/2013|12/31/9999|$0.00|0|0|||FUN STAT SCORE UE NOT DONE|| 58-1699775|1326041732|CHC13|G8671||11/01/2013|12/31/9999|$0.00|0|0|||FUN STAT SCORE NECK/TS >=0|| 58-1699775|1326041732|CHC13|G8672||11/01/2013|12/31/9999|$0.00|0|0|||FUN STAT SCORE NECK/TS < 0|| 58-1699775|1326041732|CHC13|G8673||11/01/2013|12/31/9999|$0.00|0|0|||FUN STAT SCOR NEK/TS PT NO E|| 58-1699775|1326041732|CHC13|G8674||11/01/2013|12/31/9999|$0.00|0|0|||FUN STAT SCOR NEK/TS NOT DON|| 58-1699775|1326041732|CHC13|G8682||11/01/2013|12/31/9999|$0.00|0|0|||LVG TEST PERF|| 58-1699775|1326041732|CHC13|G8683||11/01/2013|12/31/9999|$0.00|0|0|||PT NOT ELIG FOR LVF TEST|| 58-1699775|1326041732|CHC13|G8685||11/01/2013|12/31/9999|$0.00|0|0|||LVF TEST NOT PERF|| 58-1699775|1326041732|CHC13|G8694||11/01/2013|12/31/9999|$0.00|0|0|||LVEF <40%|| 58-1699775|1326041732|CHC13|G8695||11/01/2013|12/31/9999|$0.00|0|0|||LVEF >=40%|| 58-1699775|1326041732|CHC13|G8696||11/01/2013|12/31/9999|$0.00|0|0|||ANTITHROMB THX PRESC|| 58-1699775|1326041732|CHC13|G8697||11/01/2013|12/31/9999|$0.00|0|0|||ANTITHROMB NO PRESC DOC REAS|| 58-1699775|1326041732|CHC13|G8698||11/01/2013|12/31/9999|$0.00|0|0|||ANTITHROMB NO PRESC NO REAS|| 58-1699775|1326041732|CHC13|G8699||11/01/2013|12/31/9999|$0.00|0|0|||REHAB ORDERED DISCH|| 58-1699775|1326041732|CHC13|G8700||11/01/2013|12/31/9999|$0.00|0|0|||REHAB NOT INDICATED DISCH|| 58-1699775|1326041732|CHC13|G8701||11/01/2013|12/31/9999|$0.00|0|0|||REHAB NOT ORDERED|| 58-1699775|1326041732|CHC13|G8702||11/01/2013|12/31/9999|$0.00|0|0|||ANTIOBIOTICS 4 HR PRIOR SURG|| 58-1699775|1326041732|CHC13|G8703||11/01/2013|12/31/9999|$0.00|0|0|||ANTIBIOTICS NOT PRIOR SURG|| 58-1699775|1326041732|CHC13|G8704||11/01/2013|12/31/9999|$0.00|0|0|||ECG PERFORMED|| 58-1699775|1326041732|CHC13|G8705||11/01/2013|12/31/9999|$0.00|0|0|||MED REAS NO ECG|| 58-1699775|1326041732|CHC13|G8706||11/01/2013|12/31/9999|$0.00|0|0|||PT REAS NO ECG|| 58-1699775|1326041732|CHC13|G8707||11/01/2013|12/31/9999|$0.00|0|0|||ECG NOT PERFORMED|| 58-1699775|1326041732|CHC13|G8708||11/01/2013|12/31/9999|$0.00|0|0|||ANTIBIOTIC NOT PRES|| 58-1699775|1326041732|CHC13|G8709||11/01/2013|12/31/9999|$0.00|0|0|||MED REAS ANTIBIOTIC PRES|| 58-1699775|1326041732|CHC13|G8710||11/01/2013|12/31/9999|$0.00|0|0|||PT PRES ANTIBIOTIC|| 58-1699775|1326041732|CHC13|G8711||11/01/2013|12/31/9999|$0.00|0|0|||PRES ANTIBIOTIC|| 58-1699775|1326041732|CHC13|G8712||11/01/2013|12/31/9999|$0.00|0|0|||NOT PRES ANTIBIOTIC|| 58-1699775|1326041732|CHC13|G8713||11/01/2013|12/31/9999|$0.00|0|0|||SPKT/V GREAT 1.2 KT/V|| 58-1699775|1326041732|CHC13|G8714||11/01/2013|12/31/9999|$0.00|0|0|||HEMODIALYSIS 3 TIMES WEEK|| 58-1699775|1326041732|CHC13|G8715||11/01/2013|12/31/9999|$0.00|0|0|||HEMODIALYSIS NOT 3 TIMES WK|| 58-1699775|1326041732|CHC13|G8716||11/01/2013|12/31/9999|$0.00|0|0|||PT REAS NOT GREAT 1.2KT/V|| 58-1699775|1326041732|CHC13|G8717||11/01/2013|12/31/9999|$0.00|0|0|||LESS 1.2 KT/V|| 58-1699775|1326041732|CHC13|G8718||11/01/2013|12/31/9999|$0.00|0|0|||GREAT 1.7 KT/V PER WEEK|| 58-1699775|1326041732|CHC13|G8720||11/01/2013|12/31/9999|$0.00|0|0|||LESS 1.7 KT/V PER WEEK|| 58-1699775|1326041732|CHC13|G8721||11/01/2013|12/31/9999|$0.00|0|0|||PT| PN| HIST GRADE DOC|| 58-1699775|1326041732|CHC13|G8722||11/01/2013|12/31/9999|$0.00|0|0|||MED REAS PT| PN| NOT DOC|| 58-1699775|1326041732|CHC13|G8723||11/01/2013|12/31/9999|$0.00|0|0|||SPEC SIT NOT PRIM TUMOR|| 58-1699775|1326041732|CHC13|G8724||11/01/2013|12/31/9999|$0.00|0|0|||PT| PN| HIST GRADE NOT DOC|| 58-1699775|1326041732|CHC13|G8725||11/01/2013|12/31/9999|$0.00|0|0|||LIPID PROFILE PERF DOC|| 58-1699775|1326041732|CHC13|G8726||11/01/2013|12/31/9999|$0.00|0|0|||DOC REAS NO LIPID PROFILE|| 58-1699775|1326041732|CHC13|G8727||11/01/2013|12/31/9999|$0.00|0|0|||HEMO| PERIT| OR KIDNEY TRANS|| 58-1699775|1326041732|CHC13|G8728||11/01/2013|12/31/9999|$0.00|0|0|||LIPID PROFILE NOT PERF|| 58-1699775|1326041732|CHC13|G8730||11/01/2013|12/31/9999|$0.00|0|0|||PAIN DOC POS AND PLAN|| 58-1699775|1326041732|CHC13|G8731||11/01/2013|12/31/9999|$0.00|0|0|||PAIN NEG NO PLAN|| 58-1699775|1326041732|CHC13|G8732||11/01/2013|12/31/9999|$0.00|0|0|||NO DOC OF PAIN|| 58-1699775|1326041732|CHC13|G8733||11/01/2013|12/31/9999|$0.00|0|0|||DOC POS ELDER MAL SCRN PLAN|| 58-1699775|1326041732|CHC13|G8734||11/01/2013|12/31/9999|$0.00|0|0|||DOC NEG ELDER MAL NO PLAN|| 58-1699775|1326041732|CHC13|G8735||11/01/2013|12/31/9999|$0.00|0|0|||ELD MAL SCRN POS NO PLAN|| 58-1699775|1326041732|CHC13|G8736||11/01/2013|12/31/9999|$0.00|0|0|||LDL-C <100MG/DL|| 58-1699775|1326041732|CHC13|G8737||11/01/2013|12/31/9999|$0.00|0|0|||LDL-C >=100MG/DL|| 58-1699775|1326041732|CHC13|G8738||11/01/2013|12/31/9999|$0.00|0|0|||LVEF < 40%|| 58-1699775|1326041732|CHC13|G8739||11/01/2013|12/31/9999|$0.00|0|0|||LVEF >= 40%|| 58-1699775|1326041732|CHC13|G8740||11/01/2013|12/31/9999|$0.00|0|0|||LVEF NOT PERFRMD|| 58-1699775|1326041732|CHC13|G8741||11/01/2013|12/31/9999|$0.00|0|0|||NOT TX SPOKEN LANG|| 58-1699775|1326041732|CHC13|G8742||11/01/2013|12/31/9999|$0.00|0|0|||NOT TX ATTENTION|| 58-1699775|1326041732|CHC13|G8743||11/01/2013|12/31/9999|$0.00|0|0|||NOT TX MEMORY|| 58-1699775|1326041732|CHC13|G8744||11/01/2013|12/31/9999|$0.00|0|0|||NOT TX MOTOR SPEECH|| 58-1699775|1326041732|CHC13|G8745||11/01/2013|12/31/9999|$0.00|0|0|||NOT TX READING|| 58-1699775|1326041732|CHC13|G8746||11/01/2013|12/31/9999|$0.00|0|0|||NOT TX SPOKEN LANG EXPRESS|| 58-1699775|1326041732|CHC13|G8747||11/01/2013|12/31/9999|$0.00|0|0|||NOT TX WRITING|| 58-1699775|1326041732|CHC13|G8748||11/01/2013|12/31/9999|$0.00|0|0|||NOT TX SWALLOWING|| 58-1699775|1326041732|CHC13|G8749||11/01/2013|12/31/9999|$0.00|0|0|||SIGNS OF MELANOMA ABSENT|| 58-1699775|1326041732|CHC13|G8750||11/01/2013|12/31/9999|$0.00|0|0|||SIGNS OF MELANOMA PRESENT|| 58-1699775|1326041732|CHC13|G8751||11/01/2013|12/31/9999|$0.00|0|0|||SMKG STATUS NOT ASSESS|| 58-1699775|1326041732|CHC13|G8752||11/01/2013|12/31/9999|$0.00|0|0|||SYS BP LESS 140|| 58-1699775|1326041732|CHC13|G8753||11/01/2013|12/31/9999|$0.00|0|0|||SYS BP > OR = 140|| 58-1699775|1326041732|CHC13|G8754||11/01/2013|12/31/9999|$0.00|0|0|||DIAS BP LESS 90|| 58-1699775|1326041732|CHC13|G8755||11/01/2013|12/31/9999|$0.00|0|0|||DIAS BP > OR = 90|| 58-1699775|1326041732|CHC13|G8756||11/01/2013|12/31/9999|$0.00|0|0|||NO BP MEASURE DOC|| 58-1699775|1326041732|CHC13|G8757||11/01/2013|12/31/9999|$0.00|0|0|||COPD MG QUAL ACT PERFORM|| 58-1699775|1326041732|CHC13|G8758||11/01/2013|12/31/9999|$0.00|0|0|||IBD MG QUAL ACT PERFORM|| 58-1699775|1326041732|CHC13|G8759||11/01/2013|12/31/9999|$0.00|0|0|||OSA MG QUAL ACT PERFORM|| 58-1699775|1326041732|CHC13|G8760||11/01/2013|12/31/9999|$0.00|0|0|||EPILEPSY MG QUAL ACT PERFORM|| 58-1699775|1326041732|CHC13|G8761||11/01/2013|12/31/9999|$0.00|0|0|||DEMENTIA MG QUAL ACT PERFORM|| 58-1699775|1326041732|CHC13|G8762||11/01/2013|12/31/9999|$0.00|0|0|||PD MG QUAL ACT PERFORM|| 58-1699775|1326041732|CHC13|G8763||11/01/2013|12/31/9999|$0.00|0|0|||HYPERTEN MG QUAL ACT PERFORM|| 58-1699775|1326041732|CHC13|G8764||11/01/2013|12/31/9999|$0.00|0|0|||CAR PREV MG QUAL ACT PERFORM|| 58-1699775|1326041732|CHC13|G8765||11/01/2013|12/31/9999|$0.00|0|0|||CATARACT MG QUAL ACT PERFORM|| 58-1699775|1326041732|CHC13|G8767||11/01/2013|12/31/9999|$0.00|0|0|||LIPID PANEL RES DOC REV|| 58-1699775|1326041732|CHC13|G8768||11/01/2013|12/31/9999|$0.00|0|0|||DOC MED REAS NO LIPID PROFLE|| 58-1699775|1326041732|CHC13|G8769||11/01/2013|12/31/9999|$0.00|0|0|||LIPID PROFILE NOT PERFORM|| 58-1699775|1326041732|CHC13|G8770||11/01/2013|12/31/9999|$0.00|0|0|||URINE PROTEIN TEST DOC REV|| 58-1699775|1326041732|CHC13|G8771||11/01/2013|12/31/9999|$0.00|0|0|||DOC DX CKD|| 58-1699775|1326041732|CHC13|G8772||11/01/2013|12/31/9999|$0.00|0|0|||DOC MED REAS NO URINE PROTN|| 58-1699775|1326041732|CHC13|G8773||11/01/2013|12/31/9999|$0.00|0|0|||NO URINE PROTEIN TEST|| 58-1699775|1326041732|CHC13|G8774||11/01/2013|12/31/9999|$0.00|0|0|||SERUM CREATININE DOC REV|| 58-1699775|1326041732|CHC13|G8775||11/01/2013|12/31/9999|$0.00|0|0|||DOC MED REAS NO SERUM CRTN|| 58-1699775|1326041732|CHC13|G8776||11/01/2013|12/31/9999|$0.00|0|0|||NO SERUM CREATININE TEST|| 58-1699775|1326041732|CHC13|G8777||11/01/2013|12/31/9999|$0.00|0|0|||DIABETES SCREEN|| 58-1699775|1326041732|CHC13|G8778||11/01/2013|12/31/9999|$0.00|0|0|||DOC MED REAS NO DIABETE SCRN|| 58-1699775|1326041732|CHC13|G8779||11/01/2013|12/31/9999|$0.00|0|0|||NO DIABETES SCREEN|| 58-1699775|1326041732|CHC13|G8780||11/01/2013|12/31/9999|$0.00|0|0|||COUNSEL DIET PHYS ACTIVITY|| 58-1699775|1326041732|CHC13|G8781||11/01/2013|12/31/9999|$0.00|0|0|||DOC MED REAS NO COUNSEL DIET|| 58-1699775|1326041732|CHC13|G8782||11/01/2013|12/31/9999|$0.00|0|0|||NO COUNSEL DIET PHYS ACT|| 58-1699775|1326041732|CHC13|G8783||11/01/2013|12/31/9999|$0.00|0|0|||BP SCRN PERF REC INTERVAL|| 58-1699775|1326041732|CHC13|G8784||11/01/2013|12/31/9999|$0.00|0|0|||PT NO ELIG FOR BP ASSESS|| 58-1699775|1326041732|CHC13|G8785||11/01/2013|12/31/9999|$0.00|0|0|||BP SCRN NO PERF AT INTERVAL|| 58-1699775|1326041732|CHC13|G8786||11/01/2013|12/31/9999|$0.00|0|0|||SEVERITY OF ANGINA ASSESS|| 58-1699775|1326041732|CHC13|G8787||11/01/2013|12/31/9999|$0.00|0|0|||ANGINA PRESENT|| 58-1699775|1326041732|CHC13|G8788||11/01/2013|12/31/9999|$0.00|0|0|||ANGINA ABSENT|| 58-1699775|1326041732|CHC13|G8789||11/01/2013|12/31/9999|$0.00|0|0|||SEVERITY ANGINA NOT ASSESS|| 58-1699775|1326041732|CHC13|G8790||11/01/2013|12/31/9999|$0.00|0|0|||SYSTOLIC <130MMHG|| 58-1699775|1326041732|CHC13|G8791||11/01/2013|12/31/9999|$0.00|0|0|||SYSTOLIC 130-139MMHG|| 58-1699775|1326041732|CHC13|G8792||11/01/2013|12/31/9999|$0.00|0|0|||SYSTOLIC >=140MMHG|| 58-1699775|1326041732|CHC13|G8793||11/01/2013|12/31/9999|$0.00|0|0|||DIASTOLIC <80MMHG|| 58-1699775|1326041732|CHC13|G8794||11/01/2013|12/31/9999|$0.00|0|0|||DIASTOLIC 80-89MMHG|| 58-1699775|1326041732|CHC13|G8795||11/01/2013|12/31/9999|$0.00|0|0|||DIASTOLIC >=90MMHG|| 58-1699775|1326041732|CHC13|G8796||11/01/2013|12/31/9999|$0.00|0|0|||BP NOT DOC|| 58-1699775|1326041732|CHC13|G8797||11/01/2013|12/31/9999|$0.00|0|0|||SPECIMEN SITE NOT ESOPHAGUS|| 58-1699775|1326041732|CHC13|G8798||11/01/2013|12/31/9999|$0.00|0|0|||SPECIMEN SITE NOT PROSTATE|| 58-1699775|1326041732|CHC13|G8799||11/01/2013|12/31/9999|$0.00|0|0|||ANTICOAG ORDERED|| 58-1699775|1326041732|CHC13|G8800||11/01/2013|12/31/9999|$0.00|0|0|||DOC REAS ANTICOAG NOT ORDER|| 58-1699775|1326041732|CHC13|G8801||11/01/2013|12/31/9999|$0.00|0|0|||ANTICOAG NOT ORDERED|| 58-1699775|1326041732|CHC13|G8802||11/01/2013|12/31/9999|$0.00|0|0|||PREGNANCY TEST ORDER|| 58-1699775|1326041732|CHC13|G8803||11/01/2013|12/31/9999|$0.00|0|0|||DOC REAS NO PREGNANCY TEST|| 58-1699775|1326041732|CHC13|G8805||11/01/2013|12/31/9999|$0.00|0|0|||PREGNANCY TEST NOT ORDER|| 58-1699775|1326041732|CHC13|G8806||11/01/2013|12/31/9999|$0.00|0|0|||TRANSAB OR TRANSVAG US|| 58-1699775|1326041732|CHC13|G8807||11/01/2013|12/31/9999|$0.00|0|0|||DOC REAS NO US|| 58-1699775|1326041732|CHC13|G8808||11/01/2013|12/31/9999|$0.00|0|0|||NO TRANSAB OR TRANSVAG US|| 58-1699775|1326041732|CHC13|G8809||11/01/2013|12/31/9999|$0.00|0|0|||RH-IMMUNOGLOBULIN ORDER|| 58-1699775|1326041732|CHC13|G8810||11/01/2013|12/31/9999|$0.00|0|0|||DOC REAS NO RH-IMMUNO|| 58-1699775|1326041732|CHC13|G8811||11/01/2013|12/31/9999|$0.00|0|0|||NO RH-IMMUNOGLOBULIN ORDER|| 58-1699775|1326041732|CHC13|G8812||11/01/2013|12/31/9999|$0.00|0|0|||PT NOT ELIG CTA| DUPLEX| MRA|| 58-1699775|1326041732|CHC13|G8813||11/01/2013|12/31/9999|$0.00|0|0|||CTA| DUPLEX| MRA PERFORMED|| 58-1699775|1326041732|CHC13|G8814||11/01/2013|12/31/9999|$0.00|0|0|||NO CTA| DUPLEX| MRA|| 58-1699775|1326041732|CHC13|G8815||11/01/2013|12/31/9999|$0.00|0|0|||DOC REAS NO STATIN THERAPY|| 58-1699775|1326041732|CHC13|G8816||11/01/2013|12/31/9999|$0.00|0|0|||STATIN MED PRES AT DISCH|| 58-1699775|1326041732|CHC13|G8817||11/01/2013|12/31/9999|$0.00|0|0|||DOC REAS NO STATIN MED DISCH|| 58-1699775|1326041732|CHC13|G8818||11/01/2013|12/31/9999|$0.00|0|0|||PT DISCH TO HOME BY DAY#7|| 58-1699775|1326041732|CHC13|G8819||11/01/2013|12/31/9999|$0.00|0|0|||ANEURYSM <= 5.5 CM|| 58-1699775|1326041732|CHC13|G8820||11/01/2013|12/31/9999|$0.00|0|0|||ANEURYSM 5.6-6.0 CM|| 58-1699775|1326041732|CHC13|G8821||11/01/2013|12/31/9999|$0.00|0|0|||ANEURYSM NOT INFARENAL|| 58-1699775|1326041732|CHC13|G8822||11/01/2013|12/31/9999|$0.00|0|0|||MALE ANEURYSMS >6CM|| 58-1699775|1326041732|CHC13|G8823||11/01/2013|12/31/9999|$0.00|0|0|||FEMALE ANEURYSM >6CM|| 58-1699775|1326041732|CHC13|G8824||11/01/2013|12/31/9999|$0.00|0|0|||FEMALE ANEURYSM 5.6-6.0 CM|| 58-1699775|1326041732|CHC13|G8825||11/01/2013|12/31/9999|$0.00|0|0|||PT NOT DISCH TO HOME DAY#7|| 58-1699775|1326041732|CHC13|G8826||11/01/2013|12/31/9999|$0.00|0|0|||PT DISCH HOME DAY #2 EVAR|| 58-1699775|1326041732|CHC13|G8827||11/01/2013|12/31/9999|$0.00|0|0|||ANEURYSM <= 5.5CM FOR WOMEN|| 58-1699775|1326041732|CHC13|G8828||11/01/2013|12/31/9999|$0.00|0|0|||ANEURYSM <= 5.5CM FOR MEN|| 58-1699775|1326041732|CHC13|G8829||11/01/2013|12/31/9999|$0.00|0|0|||ANEURYSM 5.6-6.0 CM FOR MEN|| 58-1699775|1326041732|CHC13|G8830||11/01/2013|12/31/9999|$0.00|0|0|||ANEURYSM >6CM FOR MEN|| 58-1699775|1326041732|CHC13|G8831||11/01/2013|12/31/9999|$0.00|0|0|||ANEURYSM >-6CM FOR WOMEN|| 58-1699775|1326041732|CHC13|G8832||11/01/2013|12/31/9999|$0.00|0|0|||ANEURYSM 5.6-6.0 WOMEN|| 58-1699775|1326041732|CHC13|G8833||11/01/2013|12/31/9999|$0.00|0|0|||PT NOT DISCH HOME DAY#2 EVAR|| 58-1699775|1326041732|CHC13|G8834||11/01/2013|12/31/9999|$0.00|0|0|||PT DISCH HOME DAY #2 CEA|| 58-1699775|1326041732|CHC13|G8835||11/01/2013|12/31/9999|$0.00|0|0|||ASYMPTOM NO TRANS|| 58-1699775|1326041732|CHC13|G8836||11/01/2013|12/31/9999|$0.00|0|0|||STROKE OR TIA <120 DAYS CEA|| 58-1699775|1326041732|CHC13|G8837||11/01/2013|12/31/9999|$0.00|0|0|||STROKE OR TIA >120 DAYS CEA|| 58-1699775|1326041732|CHC13|G8838||11/01/2013|12/31/9999|$0.00|0|0|||NOT DISCH HOME BY DAY #2|| 58-1699775|1326041732|CHC13|G8839||11/01/2013|12/31/9999|$0.00|0|0|||SLEEP APNEA ASSESS|| 58-1699775|1326041732|CHC13|G8840||11/01/2013|12/31/9999|$0.00|0|0|||DOC REAS NO SLEEP APNEA|| 58-1699775|1326041732|CHC13|G8841||11/01/2013|12/31/9999|$0.00|0|0|||NO SLEEP APNEA ASSESS|| 58-1699775|1326041732|CHC13|G8842||11/01/2013|12/31/9999|$0.00|0|0|||AHI OR RDI INITIAL DX|| 58-1699775|1326041732|CHC13|G8843||11/01/2013|12/31/9999|$0.00|0|0|||DOC REAS NO AHI OR RDI|| 58-1699775|1326041732|CHC13|G8844||11/01/2013|12/31/9999|$0.00|0|0|||NO AHI OR RDI INITIAL DX|| 58-1699775|1326041732|CHC13|G8845||11/01/2013|12/31/9999|$0.00|0|0|||POS AIRWAY PRESS PRESCRIBED|| 58-1699775|1326041732|CHC13|G8846||11/01/2013|12/31/9999|$0.00|0|0|||MOD OR SEVERE OSA|| 58-1699775|1326041732|CHC13|G8847||11/01/2013|12/31/9999|$0.00|0|0|||POS AIR PRESS NOT PRESCRIBED|| 58-1699775|1326041732|CHC13|G8848||11/01/2013|12/31/9999|$0.00|0|0|||MILD OSA|| 58-1699775|1326041732|CHC13|G8849||11/01/2013|12/31/9999|$0.00|0|0|||DOC REAS NO POS AIR PRESS|| 58-1699775|1326041732|CHC13|G8850||11/01/2013|12/31/9999|$0.00|0|0|||NO PAP PRESCRIBED|| 58-1699775|1326041732|CHC13|G8851||11/01/2013|12/31/9999|$0.00|0|0|||ADHERE POS AIR PRESS THERAPY|| 58-1699775|1326041732|CHC13|G8852||11/01/2013|12/31/9999|$0.00|0|0|||POS AIR PRESS PRESCRIBE|| 58-1699775|1326041732|CHC13|G8853||11/01/2013|12/31/9999|$0.00|0|0|||POS AIR PRESS NOT PRESCRIBE|| 58-1699775|1326041732|CHC13|G8854||11/01/2013|12/31/9999|$0.00|0|0|||REAS NO ADHERE POS AIR PRES|| 58-1699775|1326041732|CHC13|G8855||11/01/2013|12/31/9999|$0.00|0|0|||POS AIR PRESS ADHERE NO PERF|| 58-1699775|1326041732|CHC13|G8856||11/01/2013|12/31/9999|$0.00|0|0|||REF FOR OTO EVAL|| 58-1699775|1326041732|CHC13|G8857||11/01/2013|12/31/9999|$0.00|0|0|||NO ELIG REF FOR OTO EVAL|| 58-1699775|1326041732|CHC13|G8858||11/01/2013|12/31/9999|$0.00|0|0|||NOT REF FOR OTO EVAL|| 58-1699775|1326041732|CHC13|G8859||11/01/2013|12/31/9999|$0.00|0|0|||CORTICOSTEROIDS 10MG 60 DAYS|| 58-1699775|1326041732|CHC13|G8860||11/01/2013|12/31/9999|$0.00|0|0|||CORTICOSTEROID 10 MG 60 DAYS|| 58-1699775|1326041732|CHC13|G8861||11/01/2013|12/31/9999|$0.00|0|0|||DXA ORDERED FOR OSTEO|| 58-1699775|1326041732|CHC13|G8862||11/01/2013|12/31/9999|$0.00|0|0|||NO CORTICOSTRD 10MG 60 DAYS|| 58-1699775|1326041732|CHC13|G8863||11/01/2013|12/31/9999|$0.00|0|0|||NO ASSESS BONE LOSS|| 58-1699775|1326041732|CHC13|G8864||11/01/2013|12/31/9999|$0.00|0|0|||PNEUMOCOCCAL VACCINE ADMIN|| 58-1699775|1326041732|CHC13|G8865||11/01/2013|12/31/9999|$0.00|0|0|||DOC MED REAS NO PNEUMOCOCCAL|| 58-1699775|1326041732|CHC13|G8866||11/01/2013|12/31/9999|$0.00|0|0|||DOC PT REAS NO PNEUMOCOCCAL|| 58-1699775|1326041732|CHC13|G8867||11/01/2013|12/31/9999|$0.00|0|0|||NO PNEUMOCOCCAL ADMIN|| 58-1699775|1326041732|CHC13|G8868||11/01/2013|12/31/9999|$0.00|0|0|||1ST COURSE ANTITNF|| 58-1699775|1326041732|CHC13|G8869||11/01/2013|12/31/9999|$0.00|0|0|||DOC IMMUN HEP B 1ST ANTITNF|| 58-1699775|1326041732|CHC13|G8870||11/01/2013|12/31/9999|$0.00|0|0|||HEPB ADMIN 1ST ANTITNF|| 58-1699775|1326041732|CHC13|G8871||11/01/2013|12/31/9999|$0.00|0|0|||NO 1ST ANTITNF|| 58-1699775|1326041732|CHC13|G8872||11/01/2013|12/31/9999|$0.00|0|0|||INTRAOP IMAGE CONFIRM EXCISE|| 58-1699775|1326041732|CHC13|G8873||11/01/2013|12/31/9999|$0.00|0|0|||SPECIMEN NOT INTRAOP IMAGE|| 58-1699775|1326041732|CHC13|G8874||11/01/2013|12/31/9999|$0.00|0|0|||TISSUE NOT IMAGE INTRAOP|| 58-1699775|1326041732|CHC13|G8875||11/01/2013|12/31/9999|$0.00|0|0|||BREAST CANCER DX MIN INVSIVE|| 58-1699775|1326041732|CHC13|G8876||11/01/2013|12/31/9999|$0.00|0|0|||DOC REAS NO MIN INV DX|| 58-1699775|1326041732|CHC13|G8877||11/01/2013|12/31/9999|$0.00|0|0|||NO BRST CNCR DX MIN INVASIVE|| 58-1699775|1326041732|CHC13|G8878||11/01/2013|12/31/9999|$0.00|0|0|||SENT LYMPH NODE BIOPSY|| 58-1699775|1326041732|CHC13|G8879||11/01/2013|12/31/9999|$0.00|0|0|||NODE NEG INV BRST CNCR|| 58-1699775|1326041732|CHC13|G8880||11/01/2013|12/31/9999|$0.00|0|0|||DOC REAS NO LYMPH NODE BIOP|| 58-1699775|1326041732|CHC13|G8881||11/01/2013|12/31/9999|$0.00|0|0|||BRST CNCR STAGE > T1N0M0|| 58-1699775|1326041732|CHC13|G8882||11/01/2013|12/31/9999|$0.00|0|0|||NO SENT LYMPH NODE BIOPSY|| 58-1699775|1326041732|CHC13|G8883||11/01/2013|12/31/9999|$0.00|0|0|||REV| COMM| TRACK| DOC BIOPSY|| 58-1699775|1326041732|CHC13|G8884||11/01/2013|12/31/9999|$0.00|0|0|||DOC REAS BIOPSY NOT REVIEW|| 58-1699775|1326041732|CHC13|G8885||11/01/2013|12/31/9999|$0.00|0|0|||NO REV| COMM| TRACK BIOPSY|| 58-1699775|1326041732|CHC13|G8886||11/01/2013|12/31/9999|$0.00|0|0|||BP UNDER CONTROL|| 58-1699775|1326041732|CHC13|G8887||11/01/2013|12/31/9999|$0.00|0|0|||DOC MED REAS BP NOT CONTROL|| 58-1699775|1326041732|CHC13|G8888||11/01/2013|12/31/9999|$0.00|0|0|||BP NOT UNDER CONTROL|| 58-1699775|1326041732|CHC13|G8889||11/01/2013|12/31/9999|$0.00|0|0|||NO DOC BP|| 58-1699775|1326041732|CHC13|G8890||11/01/2013|12/31/9999|$0.00|0|0|||LDL-C UNDER CONTROL|| 58-1699775|1326041732|CHC13|G8891||11/01/2013|12/31/9999|$0.00|0|0|||DOC MED REAS NO LDL-C CONTRL|| 58-1699775|1326041732|CHC13|G8892||11/01/2013|12/31/9999|$0.00|0|0|||DOC MED REAS NO LDL-C TEST|| 58-1699775|1326041732|CHC13|G8893||11/01/2013|12/31/9999|$0.00|0|0|||LDL-C NOT UNDER CONTROL|| 58-1699775|1326041732|CHC13|G8894||11/01/2013|12/31/9999|$0.00|0|0|||LDL-C NOT PERFORMED|| 58-1699775|1326041732|CHC13|G8895||11/01/2013|12/31/9999|$0.00|0|0|||ANTICOAG PRESCRIBE|| 58-1699775|1326041732|CHC13|G8896||11/01/2013|12/31/9999|$0.00|0|0|||DOC MED REAS NO ANTICOAG|| 58-1699775|1326041732|CHC13|G8897||11/01/2013|12/31/9999|$0.00|0|0|||ANTICOAG NOT PRESCRIBE|| 58-1699775|1326041732|CHC13|G8898||11/01/2013|12/31/9999|$0.00|0|0|||COPD MEASURES GROUP|| 58-1699775|1326041732|CHC13|G8899||11/01/2013|12/31/9999|$0.00|0|0|||INFLAMMATORY BOWEL DIS MG|| 58-1699775|1326041732|CHC13|G8900||11/01/2013|12/31/9999|$0.00|0|0|||OBSTRUCTIVE SLEEP APNEA MG|| 58-1699775|1326041732|CHC13|G8901||11/01/2013|12/31/9999|$0.00|0|0|||EPILEPSY MEASURES GROUP|| 58-1699775|1326041732|CHC13|G8902||11/01/2013|12/31/9999|$0.00|0|0|||DEMENTIA MEASURES GROUP|| 58-1699775|1326041732|CHC13|G8903||11/01/2013|12/31/9999|$0.00|0|0|||PARKINSON'S DISEASE MG|| 58-1699775|1326041732|CHC13|G8904||11/01/2013|12/31/9999|$0.00|0|0|||HYPERTENSION MG|| 58-1699775|1326041732|CHC13|G8905||11/01/2013|12/31/9999|$0.00|0|0|||CARDIOVASCULAR PREVENTION MG|| 58-1699775|1326041732|CHC13|G8906||11/01/2013|12/31/9999|$0.00|0|0|||CATARACT MEASURES GROUP|| 58-1699775|1326041732|CHC13|G9001||11/01/2013|12/31/9999|$0.00|0|0|||MCCD| INITIAL RATE|| 58-1699775|1326041732|CHC13|G9002||11/01/2013|12/31/9999|$0.00|0|0|||MCCD|MAINTENANCE RATE|| 58-1699775|1326041732|CHC13|G9003||11/01/2013|12/31/9999|$0.00|0|0|||MCCD| RISK ADJ HI| INITIAL|| 58-1699775|1326041732|CHC13|G9004||11/01/2013|12/31/9999|$0.00|0|0|||MCCD| RISK ADJ LO| INITIAL|| 58-1699775|1326041732|CHC13|G9005||11/01/2013|12/31/9999|$0.00|0|0|||MCCD| RISK ADJ| MAINTENANCE|| 58-1699775|1326041732|CHC13|G9006||11/01/2013|12/31/9999|$0.00|0|0|||MCCD| HOME MONITORING|| 58-1699775|1326041732|CHC13|G9007||11/01/2013|12/31/9999|$0.00|0|0|||MCCD| SCH TEAM CONF|| 58-1699775|1326041732|CHC13|G9008||11/01/2013|12/31/9999|$0.00|0|0|||MCCD|PHYS COOR-CARE OVRSGHT|| 58-1699775|1326041732|CHC13|G9009||11/01/2013|12/31/9999|$0.00|0|0|||MCCD| RISK ADJ| LEVEL 3|| 58-1699775|1326041732|CHC13|G9010||11/01/2013|12/31/9999|$0.00|0|0|||MCCD| RISK ADJ| LEVEL 4|| 58-1699775|1326041732|CHC13|G9011||11/01/2013|12/31/9999|$0.00|0|0|||MCCD| RISK ADJ| LEVEL 5|| 58-1699775|1326041732|CHC13|G9012||11/01/2013|12/31/9999|$0.00|0|0|||OTHER SPECIFIED CASE MGMT|| 58-1699775|1326041732|CHC13|G9013||11/01/2013|12/31/9999|$0.00|0|0|||ESRD DEMO BUNDLE LEVEL I|| 58-1699775|1326041732|CHC13|G9014||11/01/2013|12/31/9999|$0.00|0|0|||ESRD DEMO BUNDLE-LEVEL II|| 58-1699775|1326041732|CHC13|G9016||11/01/2013|12/31/9999|$0.00|0|0|||DEMO-SMOKING CESSATION COUN|| 58-1699775|1326041732|CHC13|G9017||11/01/2013|12/31/9999|$1.30|0|0|||AMANTADINE HCL 100MG ORAL|| 58-1699775|1326041732|CHC13|G9018||11/01/2013|12/31/9999|$6.91|0|0|||ZANAMIVIR|INHALATION PWD 10M|| 58-1699775|1326041732|CHC13|G9019||11/01/2013|12/31/9999|$7.34|0|0|||OSELTAMIVIR PHOSPHATE 75MG|| 58-1699775|1326041732|CHC13|G9020||11/01/2013|12/31/9999|$2.16|0|0|||RIMANTADINE HCL 100MG ORAL|| 58-1699775|1326041732|CHC13|G9033||11/01/2013|12/31/9999|$0.00|0|0|||AMANTADINE HCL ORAL BRAND|| 58-1699775|1326041732|CHC13|G9034||11/01/2013|12/31/9999|$0.00|0|0|||ZANAMIVIR| INH PWDR| BRAND|| 58-1699775|1326041732|CHC13|G9035||11/01/2013|12/31/9999|$0.00|0|0|||OSELTAMIVIR PHOSP| BRAND|| 58-1699775|1326041732|CHC13|G9036||11/01/2013|12/31/9999|$0.00|0|0|||RIMANTADINE HCL| BRAND|| 58-1699775|1326041732|CHC13|G9050||11/01/2013|12/31/9999|$0.00|0|0|||ONCOLOGY WORK-UP EVALUATION|| 58-1699775|1326041732|CHC13|G9051||11/01/2013|12/31/9999|$0.00|0|0|||ONCOLOGY TX DECISION-MGMT|| 58-1699775|1326041732|CHC13|G9052||11/01/2013|12/31/9999|$0.00|0|0|||ONC SURVEILLANCE FOR DISEASE|| 58-1699775|1326041732|CHC13|G9053||11/01/2013|12/31/9999|$0.00|0|0|||ONC EXPECTANT MANAGEMENT PT|| 58-1699775|1326041732|CHC13|G9054||11/01/2013|12/31/9999|$0.00|0|0|||ONC SUPERVISION PALLIATIVE|| 58-1699775|1326041732|CHC13|G9055||11/01/2013|12/31/9999|$0.00|0|0|||ONC VISIT UNSPECIFIED NOS|| 58-1699775|1326041732|CHC13|G9056||11/01/2013|12/31/9999|$0.00|0|0|||ONC PRAC MGMT ADHERES GUIDE|| 58-1699775|1326041732|CHC13|G9057||11/01/2013|12/31/9999|$0.00|0|0|||ONC PRACT MGMT DIFFERS GUIDE|| 58-1699775|1326041732|CHC13|G9058||11/01/2013|12/31/9999|$0.00|0|0|||ONC PRAC MGMT DISAGREE W/GUI|| 58-1699775|1326041732|CHC13|G9059||11/01/2013|12/31/9999|$0.00|0|0|||ONC PRAC MGMT PT OPT ALTERNA|| 58-1699775|1326041732|CHC13|G9060||11/01/2013|12/31/9999|$0.00|0|0|||ONC PRAC MGMT DIF PT COMORB|| 58-1699775|1326041732|CHC13|G9061||11/01/2013|12/31/9999|$0.00|0|0|||ONC PRAC COND NOADD BY GUIDE|| 58-1699775|1326041732|CHC13|G9062||11/01/2013|12/31/9999|$0.00|0|0|||ONC PRAC GUIDE DIFFERS NOS|| 58-1699775|1326041732|CHC13|G9063||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX NSCLC STGI NO DX PROG|| 58-1699775|1326041732|CHC13|G9064||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX NSCLC STG2 NO DX PROG|| 58-1699775|1326041732|CHC13|G9065||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX NSCLC STG3A NODX PROG|| 58-1699775|1326041732|CHC13|G9066||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX NSCLC STG3B-4 METASTA|| 58-1699775|1326041732|CHC13|G9067||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX NSCLC DX UNKNOWN NOS|| 58-1699775|1326041732|CHC13|G9068||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX SCLC/NSCLC LIMITED|| 58-1699775|1326041732|CHC13|G9069||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX SCLC/NSCLC EXT AT DX|| 58-1699775|1326041732|CHC13|G9070||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX SCLC/NSCLC EXT UNKNWN|| 58-1699775|1326041732|CHC13|G9071||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX BRST STG1 2B NO DX PR|| 58-1699775|1326041732|CHC13|G9072||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX BRST STG1-2 NOPROGRES|| 58-1699775|1326041732|CHC13|G9073||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX BRST STG3-HR| NO PRO|| 58-1699775|1326041732|CHC13|G9074||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX BRST STG3-NO PROGRESS|| 58-1699775|1326041732|CHC13|G9075||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX BRST METASTIC/ RECUR|| 58-1699775|1326041732|CHC13|G9077||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX PROSTATE T1NO PROGRES|| 58-1699775|1326041732|CHC13|G9078||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX PROSTATE T2NO PROGRES|| 58-1699775|1326041732|CHC13|G9079||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX PROSTATE T3B-T4NOPROG|| 58-1699775|1326041732|CHC13|G9080||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX PROSTATE W/RISE PSA|| 58-1699775|1326041732|CHC13|G9083||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX PROSTATE UNKNOWN NOS|| 58-1699775|1326041732|CHC13|G9084||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX COLON T1-3|N1-2|NO PR|| 58-1699775|1326041732|CHC13|G9085||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX COLON T4| N0 W/O PROG|| 58-1699775|1326041732|CHC13|G9086||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX COLON T1-4 NO DX PROG|| 58-1699775|1326041732|CHC13|G9087||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX COLON METAS EVID DX|| 58-1699775|1326041732|CHC13|G9088||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX COLON M1/METS W/O RAD|| 58-1699775|1326041732|CHC13|G9089||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX COLON EXTENT UNKNOWN|| 58-1699775|1326041732|CHC13|G9090||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX RECTAL T1-2 NO PROGR|| 58-1699775|1326041732|CHC13|G9091||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX RECTAL T3 N0 NO PROG|| 58-1699775|1326041732|CHC13|G9092||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX RECTAL T1-3|N1-2NOPRG|| 58-1699775|1326041732|CHC13|G9093||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX RECTAL T4|N|M0 NO PRG|| 58-1699775|1326041732|CHC13|G9094||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX RECTAL M1 W/METS PROG|| 58-1699775|1326041732|CHC13|G9095||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX RECTAL EXTENT UNKNWN|| 58-1699775|1326041732|CHC13|G9096||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX ESOPHAG T1-T3 NOPROG|| 58-1699775|1326041732|CHC13|G9097||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX ESOPHAGEAL T4 NO PROG|| 58-1699775|1326041732|CHC13|G9098||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX ESOPHAGEAL METS RECUR|| 58-1699775|1326041732|CHC13|G9099||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX ESOPHAGEAL UNKNOWN|| 58-1699775|1326041732|CHC13|G9100||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX GASTRIC NO RECURRENCE|| 58-1699775|1326041732|CHC13|G9101||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX GASTRIC P R1-R2NOPROG|| 58-1699775|1326041732|CHC13|G9102||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX GASTRIC UNRESECTABLE|| 58-1699775|1326041732|CHC13|G9103||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX GASTRIC RECURRENT|| 58-1699775|1326041732|CHC13|G9104||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX GASTRIC UNKNOWN NOS|| 58-1699775|1326041732|CHC13|G9105||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX PANCREATC P R0 RES NO|| 58-1699775|1326041732|CHC13|G9106||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX PANCREATC P R1/R2 NO|| 58-1699775|1326041732|CHC13|G9107||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX PANCREATIC UNRESECTAB|| 58-1699775|1326041732|CHC13|G9108||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX PANCREATIC UNKNWN NOS|| 58-1699775|1326041732|CHC13|G9109||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX HEAD/NECK T1-T2NO PRG|| 58-1699775|1326041732|CHC13|G9110||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX HEAD/NECK T3-4 NOPROG|| 58-1699775|1326041732|CHC13|G9111||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX HEAD/NECK M1 METS REC|| 58-1699775|1326041732|CHC13|G9112||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX HEAD/NECK EXT UNKNOWN|| 58-1699775|1326041732|CHC13|G9113||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX OVARIAN STG1A-B NO PR|| 58-1699775|1326041732|CHC13|G9114||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX OVARIAN STG1A-B OR 2|| 58-1699775|1326041732|CHC13|G9115||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX OVARIAN STG3/4 NOPROG|| 58-1699775|1326041732|CHC13|G9116||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX OVARIAN RECURRENCE|| 58-1699775|1326041732|CHC13|G9117||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX OVARIAN UNKNOWN NOS|| 58-1699775|1326041732|CHC13|G9123||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX CML CHRONIC PHASE|| 58-1699775|1326041732|CHC13|G9124||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX CML ACCELER PHASE|| 58-1699775|1326041732|CHC13|G9125||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX CML BLAST PHASE|| 58-1699775|1326041732|CHC13|G9126||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX CML REMISSION|| 58-1699775|1326041732|CHC13|G9128||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX MULTI MYELOMA STAGE I|| 58-1699775|1326041732|CHC13|G9129||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX MULT MYELOMA STG2 HIG|| 58-1699775|1326041732|CHC13|G9130||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX MULTI MYELOMA UNKNOWN|| 58-1699775|1326041732|CHC13|G9131||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX BRST UNKNOWN NOS|| 58-1699775|1326041732|CHC13|G9132||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX PROSTATE METS NO CAST|| 58-1699775|1326041732|CHC13|G9133||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX PROSTATE CLINICAL MET|| 58-1699775|1326041732|CHC13|G9134||11/01/2013|12/31/9999|$0.00|0|0|||ONC NHLSTG 1-2 NO RELAP NO|| 58-1699775|1326041732|CHC13|G9135||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX NHL STG 3-4 NOT RELAP|| 58-1699775|1326041732|CHC13|G9136||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX NHL TRANS TO LG BCELL|| 58-1699775|1326041732|CHC13|G9137||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX NHL RELAPSE/REFRACTOR|| 58-1699775|1326041732|CHC13|G9138||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX NHL STG UNKNOWN|| 58-1699775|1326041732|CHC13|G9139||11/01/2013|12/31/9999|$0.00|0|0|||ONC DX CML DX STATUS UNKNOWN|| 58-1699775|1326041732|CHC13|G9140||11/01/2013|12/31/9999|$0.00|0|0|||FRONTIER EXTENDED STAY DEMO|| 58-1699775|1326041732|CHC13|G9141||11/01/2013|12/31/9999|$30.54|0|0|||INFLUENZA A H1N1| ADMIN W COUN|| 58-1699775|1326041732|CHC13|G9142||11/01/2013|12/31/9999|$30.54|0|0|||INFLUENZA A H1N1| ANY ADMIN RO|| 58-1699775|1326041732|CHC13|G9143||11/01/2013|12/31/9999|$216.79|0|0|||WARFARIN RESPON GENETIC TEST|| 58-1699775|1326041732|CHC13|G9147||11/01/2013|12/31/9999|$0.00|0|0|||OUTP IV INSULIN TX ANY MEAS|| 58-1699775|1326041732|CHC13|G9156||11/01/2013|12/31/9999|$0.00|0|0|||EVALUATION FOR WHEELCHAIR|| 58-1699775|1326041732|CHC13|G9226||01/01/2017|12/31/9999|$7.50|0|0|||3 COMP FOOT EXAM COMPLETED|| 58-1699775|1326041732|CHC13|H0001||11/01/2013|12/31/9999|$0.00|0|0|||ALCOHOL AND/OR DRUG ASSESS|| 58-1699775|1326041732|CHC13|H0002||11/01/2013|12/31/9999|$0.00|0|0|||ALCOHOL AND/OR DRUG SCREENIN|| 58-1699775|1326041732|CHC13|H0003||11/01/2013|12/31/9999|$0.00|0|0|||ALCOHOL AND/OR DRUG SCREENIN|| 58-1699775|1326041732|CHC13|H0004||11/01/2013|12/31/9999|$0.00|0|0|||ALCOHOL AND/OR DRUG SERVICES|| 58-1699775|1326041732|CHC13|H0005||11/01/2013|12/31/9999|$0.00|0|0|||ALCOHOL AND/OR DRUG SERVICES|| 58-1699775|1326041732|CHC13|H0006||11/01/2013|12/31/9999|$0.00|0|0|||ALCOHOL AND/OR DRUG SERVICES|| 58-1699775|1326041732|CHC13|H0007||11/01/2013|12/31/9999|$0.00|0|0|||ALCOHOL AND/OR DRUG SERVICES|| 58-1699775|1326041732|CHC13|H0008||11/01/2013|12/31/9999|$0.00|0|0|||ALCOHOL AND/OR DRUG SERVICES|| 58-1699775|1326041732|CHC13|H0009||11/01/2013|12/31/9999|$0.00|0|0|||ALCOHOL AND/OR DRUG SERVICES|| 58-1699775|1326041732|CHC13|H0010||11/01/2013|12/31/9999|$0.00|0|0|||ALCOHOL AND/OR DRUG SERVICES|| 58-1699775|1326041732|CHC13|H0011||11/01/2013|12/31/9999|$0.00|0|0|||ALCOHOL AND/OR DRUG SERVICES|| 58-1699775|1326041732|CHC13|H0012||11/01/2013|12/31/9999|$0.00|0|0|||ALCOHOL AND/OR DRUG SERVICES|| 58-1699775|1326041732|CHC13|H0013||11/01/2013|12/31/9999|$0.00|0|0|||ALCOHOL AND/OR DRUG SERVICES|| 58-1699775|1326041732|CHC13|H0014||11/01/2013|12/31/9999|$0.00|0|0|||ALCOHOL AND/OR DRUG SERVICES|| 58-1699775|1326041732|CHC13|H0015||11/01/2013|12/31/9999|$0.00|0|0|||ALCOHOL AND/OR DRUG SERVICES|| 58-1699775|1326041732|CHC13|H0016||11/01/2013|12/31/9999|$0.00|0|0|||ALCOHOL AND/OR DRUG SERVICES|| 58-1699775|1326041732|CHC13|H0017||11/01/2013|12/31/9999|$0.00|0|0|||ALCOHOL AND/OR DRUG SERVICES|| 58-1699775|1326041732|CHC13|H0018||11/01/2013|12/31/9999|$0.00|0|0|||ALCOHOL AND/OR DRUG SERVICES|| 58-1699775|1326041732|CHC13|H0019||11/01/2013|12/31/9999|$0.00|0|0|||ALCOHOL AND/OR DRUG SERVICES|| 58-1699775|1326041732|CHC13|H0020||11/01/2013|12/31/9999|$0.00|0|0|||ALCOHOL AND/OR DRUG SERVICES|| 58-1699775|1326041732|CHC13|H0021||11/01/2013|12/31/9999|$0.00|0|0|||ALCOHOL AND/OR DRUG TRAINING|| 58-1699775|1326041732|CHC13|H0022||11/01/2013|12/31/9999|$0.00|0|0|||ALCOHOL AND/OR DRUG INTERVEN|| 58-1699775|1326041732|CHC13|H0023||11/01/2013|12/31/9999|$0.00|0|0|||ALCOHOL AND/OR DRUG OUTREACH|| 58-1699775|1326041732|CHC13|H0024||11/01/2013|12/31/9999|$0.00|0|0|||ALCOHOL AND/OR DRUG PREVENTI|| 58-1699775|1326041732|CHC13|H0025||11/01/2013|12/31/9999|$0.00|0|0|||ALCOHOL AND/OR DRUG PREVENTI|| 58-1699775|1326041732|CHC13|H0026||11/01/2013|12/31/9999|$0.00|0|0|||ALCOHOL AND/OR DRUG PREVENTI|| 58-1699775|1326041732|CHC13|H0027||11/01/2013|12/31/9999|$0.00|0|0|||ALCOHOL AND/OR DRUG PREVENTI|| 58-1699775|1326041732|CHC13|H0028||11/01/2013|12/31/9999|$0.00|0|0|||ALCOHOL AND/OR DRUG PREVENTI|| 58-1699775|1326041732|CHC13|H0029||11/01/2013|12/31/9999|$0.00|0|0|||ALCOHOL AND/OR DRUG PREVENTI|| 58-1699775|1326041732|CHC13|H0030||11/01/2013|12/31/9999|$0.00|0|0|||ALCOHOL AND/OR DRUG HOTLINE|| 58-1699775|1326041732|CHC13|H0031||11/01/2013|12/31/9999|$0.00|0|0|||MH HEALTH ASSESS BY NON-MD|| 58-1699775|1326041732|CHC13|H0032||11/01/2013|12/31/9999|$0.00|0|0|||MH SVC PLAN DEV BY NON-MD|| 58-1699775|1326041732|CHC13|H0033||11/01/2013|12/31/9999|$0.00|0|0|||ORAL MED ADM DIRECT OBSERVE|| 58-1699775|1326041732|CHC13|H0034||11/01/2013|12/31/9999|$0.00|0|0|||MED TRNG & SUPPORT PER 15MIN|| 58-1699775|1326041732|CHC13|H0035||11/01/2013|12/31/9999|$0.00|0|0|||MH PARTIAL HOSP TX UNDER 24H|| 58-1699775|1326041732|CHC13|H0036||11/01/2013|12/31/9999|$0.00|0|0|||COMM PSY FACE-FACE PER 15MIN|| 58-1699775|1326041732|CHC13|H0037||11/01/2013|12/31/9999|$0.00|0|0|||COMM PSY SUP TX PGM PER DIEM|| 58-1699775|1326041732|CHC13|H0038||11/01/2013|12/31/9999|$0.00|0|0|||SELF-HELP/PEER SVC PER 15MIN|| 58-1699775|1326041732|CHC13|H0039||11/01/2013|12/31/9999|$0.00|0|0|||ASSER COM TX FACE-FACE/15MIN|| 58-1699775|1326041732|CHC13|H0040||11/01/2013|12/31/9999|$0.00|0|0|||ASSERT COMM TX PGM PER DIEM|| 58-1699775|1326041732|CHC13|H0041||11/01/2013|12/31/9999|$0.00|0|0|||FOS C CHLD NON-THER PER DIEM|| 58-1699775|1326041732|CHC13|H0042||11/01/2013|12/31/9999|$0.00|0|0|||FOS C CHLD NON-THER PER MON|| 58-1699775|1326041732|CHC13|H0043||11/01/2013|12/31/9999|$0.00|0|0|||SUPPORTED HOUSING| PER DIEM|| 58-1699775|1326041732|CHC13|H0044||11/01/2013|12/31/9999|$0.00|0|0|||SUPPORTED HOUSING| PER MONTH|| 58-1699775|1326041732|CHC13|H0045||11/01/2013|12/31/9999|$0.00|0|0|||RESPITE NOT-IN-HOME PER DIEM|| 58-1699775|1326041732|CHC13|H0046||11/01/2013|12/31/9999|$0.00|0|0|||MENTAL HEALTH SERVICE| NOS|| 58-1699775|1326041732|CHC13|H0047||11/01/2013|12/31/9999|$0.00|0|0|||ALCOHOL/DRUG ABUSE SVC NOS|| 58-1699775|1326041732|CHC13|H0048||11/01/2013|12/31/9999|$0.00|0|0|||SPEC COLL NON-BLOOD:A/D TEST|| 58-1699775|1326041732|CHC13|H0049||11/01/2013|12/31/9999|$0.00|0|0|||ALCOHOL/DRUG SCREENING|| 58-1699775|1326041732|CHC13|H0050||11/01/2013|12/31/9999|$0.00|0|0|||ALCOHOL/DRUG SERVICE 15 MIN|| 58-1699775|1326041732|CHC13|H1000||11/01/2013|12/31/9999|$0.00|0|0|||PRENATAL CARE ATRISK ASSESSM|| 58-1699775|1326041732|CHC13|H1001||11/01/2013|12/31/9999|$0.00|0|0|||ANTEPARTUM MANAGEMENT|| 58-1699775|1326041732|CHC13|H1002||11/01/2013|12/31/9999|$0.00|0|0|||CARECOORDINATION PRENATAL|| 58-1699775|1326041732|CHC13|H1003||11/01/2013|12/31/9999|$0.00|0|0|||PRENATAL AT RISK EDUCATION|| 58-1699775|1326041732|CHC13|H1004||11/01/2013|12/31/9999|$0.00|0|0|||FOLLOW UP HOME VISIT/PRENTAL|| 58-1699775|1326041732|CHC13|H1005||11/01/2013|12/31/9999|$0.00|0|0|||PRENATALCARE ENHANCED SRV PK|| 58-1699775|1326041732|CHC13|H1010||11/01/2013|12/31/9999|$0.00|0|0|||NONMED FAMILY PLANNING ED|| 58-1699775|1326041732|CHC13|H1011||11/01/2013|12/31/9999|$0.00|0|0|||FAMILY ASSESSMENT|| 58-1699775|1326041732|CHC13|H2000||11/01/2013|12/31/9999|$0.00|0|0|||COMP MULTIDISIPLN EVALUATION|| 58-1699775|1326041732|CHC13|H2001||11/01/2013|12/31/9999|$0.00|0|0|||REHABILITATION PROGRAM 1/2 D|| 58-1699775|1326041732|CHC13|H2010||11/01/2013|12/31/9999|$0.00|0|0|||COMPREHENSIVE MED SVC 15 MIN|| 58-1699775|1326041732|CHC13|H2011||11/01/2013|12/31/9999|$0.00|0|0|||CRISIS INTERVEN SVC| 15 MIN|| 58-1699775|1326041732|CHC13|H2012||11/01/2013|12/31/9999|$0.00|0|0|||BEHAV HLTH DAY TREAT| PER HR|| 58-1699775|1326041732|CHC13|H2013||11/01/2013|12/31/9999|$0.00|0|0|||PSYCH HLTH FAC SVC| PER DIEM|| 58-1699775|1326041732|CHC13|H2014||11/01/2013|12/31/9999|$0.00|0|0|||SKILLS TRAIN AND DEV| 15 MIN|| 58-1699775|1326041732|CHC13|H2015||11/01/2013|12/31/9999|$0.00|0|0|||COMP COMM SUPP SVC| 15 MIN|| 58-1699775|1326041732|CHC13|H2016||11/01/2013|12/31/9999|$0.00|0|0|||COMP COMM SUPP SVC| PER DIEM|| 58-1699775|1326041732|CHC13|H2017||11/01/2013|12/31/9999|$0.00|0|0|||PSYSOC REHAB SVC| PER 15 MIN|| 58-1699775|1326041732|CHC13|H2018||11/01/2013|12/31/9999|$0.00|0|0|||PSYSOC REHAB SVC| PER DIEM|| 58-1699775|1326041732|CHC13|H2019||11/01/2013|12/31/9999|$0.00|0|0|||THER BEHAV SVC| PER 15 MIN|| 58-1699775|1326041732|CHC13|H2020||11/01/2013|12/31/9999|$0.00|0|0|||THER BEHAV SVC| PER DIEM|| 58-1699775|1326041732|CHC13|H2021||11/01/2013|12/31/9999|$0.00|0|0|||COM WRAP-AROUND SV| 15 MIN|| 58-1699775|1326041732|CHC13|H2022||11/01/2013|12/31/9999|$0.00|0|0|||COM WRAP-AROUND SV| PER DIEM|| 58-1699775|1326041732|CHC13|H2023||11/01/2013|12/31/9999|$0.00|0|0|||SUPPORTED EMPLOY| PER 15 MIN|| 58-1699775|1326041732|CHC13|H2024||11/01/2013|12/31/9999|$0.00|0|0|||SUPPORTED EMPLOY| PER DIEM|| 58-1699775|1326041732|CHC13|H2025||11/01/2013|12/31/9999|$0.00|0|0|||SUPP MAINT EMPLOY| 15 MIN|| 58-1699775|1326041732|CHC13|H2026||11/01/2013|12/31/9999|$0.00|0|0|||SUPP MAINT EMPLOY| PER DIEM|| 58-1699775|1326041732|CHC13|H2027||11/01/2013|12/31/9999|$0.00|0|0|||PSYCHOED SVC| PER 15 MIN|| 58-1699775|1326041732|CHC13|H2028||11/01/2013|12/31/9999|$0.00|0|0|||SEX OFFEND TX SVC| 15 MIN|| 58-1699775|1326041732|CHC13|H2029||11/01/2013|12/31/9999|$0.00|0|0|||SEX OFFEND TX SVC| PER DIEM|| 58-1699775|1326041732|CHC13|H2030||11/01/2013|12/31/9999|$0.00|0|0|||MH CLUBHOUSE SVC| PER 15 MIN|| 58-1699775|1326041732|CHC13|H2031||11/01/2013|12/31/9999|$0.00|0|0|||MH CLUBHOUSE SVC| PER DIEM|| 58-1699775|1326041732|CHC13|H2032||11/01/2013|12/31/9999|$0.00|0|0|||ACTIVITY THERAPY| PER 15 MIN|| 58-1699775|1326041732|CHC13|H2033||11/01/2013|12/31/9999|$0.00|0|0|||MULTISYS THER/JUVENILE 15MIN|| 58-1699775|1326041732|CHC13|H2034||11/01/2013|12/31/9999|$0.00|0|0|||A/D HALFWAY HOUSE| PER DIEM|| 58-1699775|1326041732|CHC13|H2035||11/01/2013|12/31/9999|$0.00|0|0|||A/D TX PROGRAM| PER HOUR|| 58-1699775|1326041732|CHC13|H2036||11/01/2013|12/31/9999|$0.00|0|0|||A/D TX PROGRAM| PER DIEM|| 58-1699775|1326041732|CHC13|H2037||11/01/2013|12/31/9999|$0.00|0|0|||DEV DELAY PREV DP CH| 15 MIN|| 58-1699775|1326041732|CHC13|J0120||11/01/2013|12/31/9999|$0.00|0|0|||TETRACYCLIN INJECTION|| 58-1699775|1326041732|CHC13|J0129||10/01/2016|09/30/2017|$52.48|0|0|0||ABATACEPT INJECTION|| 58-1699775|1326041732|CHC13|J0129||10/01/2017|09/30/2018|$59.52|0|0|0||ABATACEPT INJECTION|| 58-1699775|1326041732|CHC13|J0130||10/01/2016|09/30/2017|$1|428.68|0|0|0||ABCIXIMAB INJECTION|| 58-1699775|1326041732|CHC13|J0130||10/01/2017|09/30/2018|$1|544.33|0|0|0||ABCIXIMAB INJECTION|| 58-1699775|1326041732|CHC13|J0132||10/01/2016|09/30/2017|$1.98|0|0|0||ACETYLCYSTEINE INJECTION|| 58-1699775|1326041732|CHC13|J0132||10/01/2017|09/30/2018|$1.58|0|0|0||ACETYLCYSTEINE INJECTION|| 58-1699775|1326041732|CHC13|J0133||10/01/2016|09/30/2017|$0.10|0|0|0||ACYCLOVIR INJECTION|| 58-1699775|1326041732|CHC13|J0133||10/01/2017|09/30/2018|$0.10|0|0|0||ACYCLOVIR INJECTION|| 58-1699775|1326041732|CHC13|J0135||10/01/2016|09/30/2017|$1|061.30|0|0|0||ADALIMUMAB INJECTION|| 58-1699775|1326041732|CHC13|J0150||10/01/2014|12/31/9999|$6.01|0|0|||INJECTION ADENOSINE 6 MG|| 58-1699775|1326041732|CHC13|J0151||10/01/2014|12/31/9999|$2.65|0|0|||INJECTION ADENOSINE 90 MG|| 58-1699775|1326041732|CHC13|J0152||11/01/2013|12/31/9999|$136.43|0|0|||ADENOSINE INJECTION|| 58-1699775|1326041732|CHC13|J0153||10/01/2016|09/30/2017|$0.83|0|0|0||ADENOSINE INJ 1MG|| 58-1699775|1326041732|CHC13|J0153||10/01/2017|09/30/2018|$0.73|0|0|0||ADENOSINE INJ 1MG|| 58-1699775|1326041732|CHC13|J0171||10/01/2016|09/30/2017|$0.18|0|0|0||ADRENALIN EPINEPHRINE INJECT|| 58-1699775|1326041732|CHC13|J0171||10/01/2017|09/30/2018|$0.37|0|0|0||ADRENALIN EPINEPHRINE INJECT|| 58-1699775|1326041732|CHC13|J0178||10/01/2016|09/30/2017|$1|225.63|0|0|0||AFLIBERCEPT INJECTION|| 58-1699775|1326041732|CHC13|J0178||10/01/2017|09/30/2018|$1|222.99|0|0|0||AFLIBERCEPT INJECTION|| 58-1699775|1326041732|CHC13|J0180||10/01/2016|09/30/2017|$205.55|0|0|0||AGALSIDASE BETA INJECTION|| 58-1699775|1326041732|CHC13|J0180||10/01/2017|09/30/2018|$213.74|0|0|0||AGALSIDASE BETA INJECTION|| 58-1699775|1326041732|CHC13|J0202||10/01/2016|09/30/2017|$2|168.20|0|0|0||INJECTION| ALEMTUZUMAB| 1 MG|| 58-1699775|1326041732|CHC13|J0202||10/01/2017|09/30/2018|$2|227.48|0|0|0||INJECTION| ALEMTUZUMAB| 1 MG|| 58-1699775|1326041732|CHC13|J0207||10/01/2016|09/30/2017|$501.78|0|0|0||AMIFOSTINE|| 58-1699775|1326041732|CHC13|J0207||10/01/2017|09/30/2018|$1|292.66|0|0|0||AMIFOSTINE|| 58-1699775|1326041732|CHC13|J0210||10/01/2015|12/31/9999|$53.00|0|0|0||METHYLDOPATE HCL INJECTION|| 58-1699775|1326041732|CHC13|J0215||10/01/2014|12/31/9999|$41.64|0|0|||ALEFACEPT|| 58-1699775|1326041732|CHC13|J0220||10/01/2016|09/30/2017|$258.38|0|0|0||ALGLUCOSIDASE ALFA INJECTION|| 58-1699775|1326041732|CHC13|J0221||10/01/2016|09/30/2017|$199.21|0|0|0||LUMIZYME INJECTION|| 58-1699775|1326041732|CHC13|J0221||10/01/2017|09/30/2018|$199.67|0|0|0||LUMIZYME INJECTION|| 58-1699775|1326041732|CHC13|J0256||10/01/2016|09/30/2017|$5.76|0|0|0||ALPHA 1 PROTEINASE INHIBITOR|| 58-1699775|1326041732|CHC13|J0256||10/01/2017|09/30/2018|$6.18|0|0|0||ALPHA 1 PROTEINASE INHIBITOR|| 58-1699775|1326041732|CHC13|J0257||10/01/2016|09/30/2017|$5.47|0|0|0||GLASSIA INJECTION|| 58-1699775|1326041732|CHC13|J0257||10/01/2017|09/30/2018|$5.79|0|0|0||GLASSIA INJECTION|| 58-1699775|1326041732|CHC13|J0278||10/01/2016|09/30/2017|$1.87|0|0|0||AMIKACIN SULFATE INJECTION|| 58-1699775|1326041732|CHC13|J0278||10/01/2017|09/30/2018|$2.25|0|0|0||AMIKACIN SULFATE INJECTION|| 58-1699775|1326041732|CHC13|J0280||10/01/2016|09/30/2017|$9.66|0|0|0||AMINOPHYLLIN 250 MG INJ|| 58-1699775|1326041732|CHC13|J0280||10/01/2017|09/30/2018|$8.37|0|0|0||AMINOPHYLLIN 250 MG INJ|| 58-1699775|1326041732|CHC13|J0285||10/01/2016|09/30/2017|$31.06|0|0|0||AMPHOTERICIN B|| 58-1699775|1326041732|CHC13|J0285||10/01/2017|09/30/2018|$40.73|0|0|0||AMPHOTERICIN B|| 58-1699775|1326041732|CHC13|J0287||10/01/2016|09/30/2017|$16.42|0|0|0||AMPHOTERICIN B LIPID COMPLEX|| 58-1699775|1326041732|CHC13|J0287||10/01/2017|09/30/2018|$16.35|0|0|0||AMPHOTERICIN B LIPID COMPLEX|| 58-1699775|1326041732|CHC13|J0288||11/01/2013|12/31/9999|$17.50|0|0|||AMPHO B CHOLESTERYL SULFATE|| 58-1699775|1326041732|CHC13|J0289||10/01/2016|09/30/2017|$23.46|0|0|0||AMPHOTERICIN B LIPOSOME INJ|| 58-1699775|1326041732|CHC13|J0289||10/01/2017|09/30/2018|$25.94|0|0|0||AMPHOTERICIN B LIPOSOME INJ|| 58-1699775|1326041732|CHC13|J0290||10/01/2016|09/30/2017|$1.99|0|0|0||AMPICILLIN 500 MG INJ|| 58-1699775|1326041732|CHC13|J0290||10/01/2017|09/30/2018|$1.44|0|0|0||AMPICILLIN 500 MG INJ|| 58-1699775|1326041732|CHC13|J0295||10/01/2016|09/30/2017|$3.36|0|0|0||AMPICILLIN SODIUM PER 1.5 GM|| 58-1699775|1326041732|CHC13|J0295||10/01/2017|09/30/2018|$4.62|0|0|0||AMPICILLIN SODIUM PER 1.5 GM|| 58-1699775|1326041732|CHC13|J0348||10/01/2016|09/30/2017|$0.66|0|0|0||ANADULAFUNGIN INJECTION|| 58-1699775|1326041732|CHC13|J0348||10/01/2017|09/30/2018|$0.66|0|0|0||ANADULAFUNGIN INJECTION|| 58-1699775|1326041732|CHC13|J0360||10/01/2016|09/30/2017|$6.29|0|0|0||HYDRALAZINE HCL INJECTION|| 58-1699775|1326041732|CHC13|J0360||10/01/2017|09/30/2018|$4.12|0|0|0||HYDRALAZINE HCL INJECTION|| 58-1699775|1326041732|CHC13|J0364||11/01/2013|12/31/9999|$41.02|0|0|||APOMORPHINE HYDROCHLORIDE|| 58-1699775|1326041732|CHC13|J0365||11/01/2013|12/31/9999|$3.31|0|0|||APROTONIN| 10|000 KIU|| 58-1699775|1326041732|CHC13|J0400||10/01/2016|09/30/2017|$0.95|0|0|0||INJ TRIMETHAPHAN CAMSYLATE|| 58-1699775|1326041732|CHC13|J0401||10/01/2016|09/30/2017|$5.50|0|0|0||INJ ARIPIPRAZOLE EXT REL 1MG|| 58-1699775|1326041732|CHC13|J0401||10/01/2017|09/30/2018|$5.98|0|0|0||INJ ARIPIPRAZOLE EXT REL 1MG|| 58-1699775|1326041732|CHC13|J0456||10/01/2016|09/30/2017|$5.43|0|0|0||AZITHROMYCIN|| 58-1699775|1326041732|CHC13|J0456||10/01/2017|09/30/2018|$4.50|0|0|0||AZITHROMYCIN|| 58-1699775|1326041732|CHC13|J0461||10/01/2016|09/30/2017|$0.06|0|0|0||ATROPINE SULFATE INJECTION|| 58-1699775|1326041732|CHC13|J0461||10/01/2017|09/30/2018|$0.07|0|0|0||ATROPINE SULFATE INJECTION|| 58-1699775|1326041732|CHC13|J0470||10/01/2016|09/30/2017|$51.91|0|0|0||DIMECAPROL INJECTION|| 58-1699775|1326041732|CHC13|J0470||10/01/2017|09/30/2018|$59.11|0|0|0||DIMECAPROL INJECTION|| 58-1699775|1326041732|CHC13|J0475||10/01/2016|09/30/2017|$222.53|0|0|0||BACLOFEN 10 MG INJECTION|| 58-1699775|1326041732|CHC13|J0475||10/01/2017|09/30/2018|$210.01|0|0|0||BACLOFEN 10 MG INJECTION|| 58-1699775|1326041732|CHC13|J0476||10/01/2016|09/30/2017|$96.28|0|0|0||BACLOFEN INTRATHECAL TRIAL|| 58-1699775|1326041732|CHC13|J0476||10/01/2017|09/30/2018|$91.51|0|0|0||BACLOFEN INTRATHECAL TRIAL|| 58-1699775|1326041732|CHC13|J0480||10/01/2016|09/30/2017|$3|975.27|0|0|0||BASILIXIMAB|| 58-1699775|1326041732|CHC13|J0480||10/01/2017|09/30/2018|$4|279.97|0|0|0||BASILIXIMAB|| 58-1699775|1326041732|CHC13|J0485||10/01/2016|09/30/2017|$4.80|0|0|0||BELATACEPT INJECTION|| 58-1699775|1326041732|CHC13|J0485||10/01/2017|09/30/2018|$4.89|0|0|0||BELATACEPT INJECTION|| 58-1699775|1326041732|CHC13|J0490||10/01/2016|09/30/2017|$52.61|0|0|0||BELIMUMAB INJECTION|| 58-1699775|1326041732|CHC13|J0490||10/01/2017|09/30/2018|$52.48|0|0|0||BELIMUMAB INJECTION|| 58-1699775|1326041732|CHC13|J0500||10/01/2016|09/30/2017|$79.38|0|0|0||DICYCLOMINE INJECTION|| 58-1699775|1326041732|CHC13|J0500||10/01/2017|09/30/2018|$93.48|0|0|0||DICYCLOMINE INJECTION|| 58-1699775|1326041732|CHC13|J0515||10/01/2016|09/30/2017|$30.91|0|0|0||INJ BENZTROPINE MESYLATE|| 58-1699775|1326041732|CHC13|J0515||10/01/2017|09/30/2018|$30.27|0|0|0||INJ BENZTROPINE MESYLATE|| 58-1699775|1326041732|CHC13|J0558||10/01/2016|09/30/2017|$9.29|0|0|0||PENG BENZATHINE/PROCAINE INJ|| 58-1699775|1326041732|CHC13|J0558||10/01/2017|09/30/2018|$11.63|0|0|0||PENG BENZATHINE/PROCAINE INJ|| 58-1699775|1326041732|CHC13|J0561||10/01/2016|09/30/2017|$11.90|0|0|0||PENICILLIN G BENZATHINE INJ|| 58-1699775|1326041732|CHC13|J0561||10/01/2017|09/30/2018|$14.31|0|0|0||PENICILLIN G BENZATHINE INJ|| 58-1699775|1326041732|CHC13|J0570||10/01/2017|09/30/2018|$1|592.55|0|0|0||PENICILLIN G BENZATHINE INJ|| 58-1699775|1326041732|CHC13|J0583||10/01/2016|09/30/2017|$2.37|0|0|0||BIVALIRUDIN|| 58-1699775|1326041732|CHC13|J0583||10/01/2017|09/30/2018|$1.88|0|0|0||BIVALIRUDIN|| 58-1699775|1326041732|CHC13|J0585||10/01/2016|09/30/2017|$7.30|0|0|0||BOTULINUM TOXIN A PER UNIT|| 58-1699775|1326041732|CHC13|J0585||10/01/2017|09/30/2018|$7.49|0|0|0||BOTULINUM TOXIN A PER UNIT|| 58-1699775|1326041732|CHC13|J0586||10/01/2016|09/30/2017|$9.64|0|0|0||ABOBOTULINUMTOXINA|| 58-1699775|1326041732|CHC13|J0586||10/01/2017|09/30/2018|$9.94|0|0|0||ABOBOTULINUMTOXINA|| 58-1699775|1326041732|CHC13|J0587||10/01/2016|09/30/2017|$14.53|0|0|0||BOTULINUM TOXIN TYPE B|| 58-1699775|1326041732|CHC13|J0587||10/01/2017|09/30/2018|$13.36|0|0|0||BOTULINUM TOXIN TYPE B|| 58-1699775|1326041732|CHC13|J0588||10/01/2016|09/30/2017|$6.14|0|0|0||INCOBOTULINUMTOXIN A|| 58-1699775|1326041732|CHC13|J0588||10/01/2017|09/30/2018|$6.35|0|0|0||INCOBOTULINUMTOXIN A|| 58-1699775|1326041732|CHC13|J0592||10/01/2016|09/30/2017|$4.18|0|0|0||BUPRENORPHINE HYDROCHLORIDE|| 58-1699775|1326041732|CHC13|J0592||10/01/2017|09/30/2018|$4.39|0|0|0||BUPRENORPHINE HYDROCHLORIDE|| 58-1699775|1326041732|CHC13|J0594||10/01/2016|09/30/2017|$44.01|0|0|0||BUSULFAN INJECTION|| 58-1699775|1326041732|CHC13|J0594||10/01/2017|09/30/2018|$44.82|0|0|0||BUSULFAN INJECTION|| 58-1699775|1326041732|CHC13|J0595||10/01/2016|09/30/2017|$2.93|0|0|0||BUTORPHANOL TARTRATE 1 MG|| 58-1699775|1326041732|CHC13|J0595||10/01/2017|09/30/2018|$3.38|0|0|0||BUTORPHANOL TARTRATE 1 MG|| 58-1699775|1326041732|CHC13|J0597||10/01/2016|09/30/2017|$58.16|0|0|0||C-1 ESTERASE| BERINERT|| 58-1699775|1326041732|CHC13|J0597||10/01/2017|09/30/2018|$61.13|0|0|0||C-1 ESTERASE| BERINERT|| 58-1699775|1326041732|CHC13|J0598||10/01/2016|09/30/2017|$68.56|0|0|0||C1 ESTERASE INHIBITOR INJ|| 58-1699775|1326041732|CHC13|J0598||10/01/2017|09/30/2018|$70.52|0|0|0||C1 ESTERASE INHIBITOR INJ|| 58-1699775|1326041732|CHC13|J0600||10/01/2016|09/30/2017|$6|993.03|0|0|0||EDETATE CALCIUM DISODIUM INJ|| 58-1699775|1326041732|CHC13|J0600||10/01/2017|09/30/2018|$6|993.03|0|0|0||EDETATE CALCIUM DISODIUM INJ|| 58-1699775|1326041732|CHC13|J0610||10/01/2016|09/30/2017|$3.73|0|0|0||CALCIUM GLUCONATE INJECTION|| 58-1699775|1326041732|CHC13|J0610||10/01/2017|09/30/2018|$3.48|0|0|0||CALCIUM GLUCONATE INJECTION|| 58-1699775|1326041732|CHC13|J0630||10/01/2016|09/30/2017|$2|910.15|0|0|0||CALCITONIN SALMON INJECTION|| 58-1699775|1326041732|CHC13|J0630||10/01/2017|09/30/2018|$2|853.73|0|0|0||CALCITONIN SALMON INJECTION|| 58-1699775|1326041732|CHC13|J0636||10/01/2016|09/30/2017|$0.51|0|0|0||INJ CALCITRIOL PER 0.1 MCG|| 58-1699775|1326041732|CHC13|J0636||10/01/2017|09/30/2018|$0.78|0|0|0||INJ CALCITRIOL PER 0.1 MCG|| 58-1699775|1326041732|CHC13|J0637||10/01/2016|09/30/2017|$14.88|0|0|0||CASPOFUNGIN ACETATE|| 58-1699775|1326041732|CHC13|J0637||10/01/2017|09/30/2018|$14.98|0|0|0||CASPOFUNGIN ACETATE|| 58-1699775|1326041732|CHC13|J0638||10/01/2016|09/30/2017|$115.53|0|0|0||CANAKINUMAB INJECTION|| 58-1699775|1326041732|CHC13|J0638||10/01/2017|09/30/2018|$115.63|0|0|0||CANAKINUMAB INJECTION|| 58-1699775|1326041732|CHC13|J0640||10/01/2016|09/30/2017|$4.33|0|0|0||LEUCOVORIN CALCIUM INJECTION|| 58-1699775|1326041732|CHC13|J0640||10/01/2017|09/30/2018|$3.59|0|0|0||LEUCOVORIN CALCIUM INJECTION|| 58-1699775|1326041732|CHC13|J0641||10/01/2016|09/30/2017|$1.36|0|0|0||LEVOLEUCOVORIN INJECTION|| 58-1699775|1326041732|CHC13|J0641||10/01/2017|09/30/2018|$0.88|0|0|0||LEVOLEUCOVORIN INJECTION|| 58-1699775|1326041732|CHC13|J0670||10/01/2016|09/30/2017|$3.03|0|0|0||INJ MEPIVACAINE HCL/10 ML|| 58-1699775|1326041732|CHC13|J0670||10/01/2017|09/30/2018|$3.08|0|0|0||INJ MEPIVACAINE HCL/10 ML|| 58-1699775|1326041732|CHC13|J0690||10/01/2016|09/30/2017|$1.20|0|0|0||CEFAZOLIN SODIUM INJECTION|| 58-1699775|1326041732|CHC13|J0690||10/01/2017|09/30/2018|$1.10|0|0|0||CEFAZOLIN SODIUM INJECTION|| 58-1699775|1326041732|CHC13|J0692||10/01/2016|09/30/2017|$3.01|0|0|0||CEFEPIME HCL FOR INJECTION|| 58-1699775|1326041732|CHC13|J0692||10/01/2017|09/30/2018|$3.38|0|0|0||CEFEPIME HCL FOR INJECTION|| 58-1699775|1326041732|CHC13|J0694||10/01/2016|09/30/2017|$5.42|0|0|0||CEFOXITIN SODIUM INJECTION|| 58-1699775|1326041732|CHC13|J0694||10/01/2017|09/30/2018|$6.37|0|0|0||CEFOXITIN SODIUM INJECTION|| 58-1699775|1326041732|CHC13|J0696||10/01/2016|09/30/2017|$0.62|0|0|0||CEFTRIAXONE SODIUM INJECTION|| 58-1699775|1326041732|CHC13|J0696||10/01/2017|09/30/2018|$0.72|0|0|0||CEFTRIAXONE SODIUM INJECTION|| 58-1699775|1326041732|CHC13|J0697||10/01/2016|09/30/2017|$4.88|0|0|0||STERILE CEFUROXIME INJECTION|| 58-1699775|1326041732|CHC13|J0697||10/01/2017|09/30/2018|$3.88|0|0|0||STERILE CEFUROXIME INJECTION|| 58-1699775|1326041732|CHC13|J0698||10/01/2016|09/30/2017|$0.67|0|0|0||CEFOTAXIME SODIUM INJECTION|| 58-1699775|1326041732|CHC13|J0702||10/01/2016|09/30/2017|$7.51|0|0|0||BETAMETHASONE ACET&SOD PHOSP|| 58-1699775|1326041732|CHC13|J0702||10/01/2017|09/30/2018|$9.17|0|0|0||BETAMETHASONE ACET&SOD PHOSP|| 58-1699775|1326041732|CHC13|J0706||11/01/2013|12/31/9999|$0.55|0|0|||CAFFEINE CITRATE INJECTION|| 58-1699775|1326041732|CHC13|J0712||10/01/2016|09/30/2017|$3.08|0|0|0||CEFTAROLINE FOSAMIL INJ|| 58-1699775|1326041732|CHC13|J0712||10/01/2017|09/30/2018|$3.27|0|0|0||CEFTAROLINE FOSAMIL INJ|| 58-1699775|1326041732|CHC13|J0713||10/01/2016|09/30/2017|$3.10|0|0|0||INJ CEFTAZIDIME PER 500 MG|| 58-1699775|1326041732|CHC13|J0713||10/01/2017|09/30/2018|$3.12|0|0|0||INJ CEFTAZIDIME PER 500 MG|| 58-1699775|1326041732|CHC13|J0717||10/01/2016|09/30/2017|$8.83|0|0|0||CERTOLIZUMAB PEGOL INJ 1MG|| 58-1699775|1326041732|CHC13|J0717||10/01/2017|09/30/2018|$9.64|0|0|0||CERTOLIZUMAB PEGOL INJ 1MG|| 58-1699775|1326041732|CHC13|J0718||11/01/2013|12/31/9999|$6.27|0|0|||CERTOLIZUMAB PEGOL INJ|| 58-1699775|1326041732|CHC13|J0720||10/01/2016|09/30/2017|$51.57|0|0|0||CHLORAMPHENICOL SODIUM INJEC|| 58-1699775|1326041732|CHC13|J0720||10/01/2017|09/30/2018|$49.84|0|0|0||CHLORAMPHENICOL SODIUM INJEC|| 58-1699775|1326041732|CHC13|J0725||10/01/2016|09/30/2017|$24.17|0|0|0||CHORIONIC GONADOTROPIN/1000U|| 58-1699775|1326041732|CHC13|J0725||10/01/2017|09/30/2018|$26.52|0|0|0||CHORIONIC GONADOTROPIN/1000U|| 58-1699775|1326041732|CHC13|J0735||10/01/2016|09/30/2017|$17.47|0|0|0||CLONIDINE HYDROCHLORIDE|| 58-1699775|1326041732|CHC13|J0735||10/01/2017|09/30/2018|$16.24|0|0|0||CLONIDINE HYDROCHLORIDE|| 58-1699775|1326041732|CHC13|J0740||10/01/2016|09/30/2017|$732.19|0|0|0||CIDOFOVIR INJECTION|| 58-1699775|1326041732|CHC13|J0740||10/01/2017|09/30/2018|$610.50|0|0|0||CIDOFOVIR INJECTION|| 58-1699775|1326041732|CHC13|J0743||10/01/2016|09/30/2017|$8.67|0|0|0||CILASTATIN SODIUM INJECTION|| 58-1699775|1326041732|CHC13|J0743||10/01/2017|09/30/2018|$5.68|0|0|0||CILASTATIN SODIUM INJECTION|| 58-1699775|1326041732|CHC13|J0744||10/01/2016|09/30/2017|$1.86|0|0|0||CIPROFLOXACIN IV|| 58-1699775|1326041732|CHC13|J0744||10/01/2017|09/30/2018|$1.73|0|0|0||CIPROFLOXACIN IV|| 58-1699775|1326041732|CHC13|J0770||10/01/2016|09/30/2017|$13.85|0|0|0||COLISTIMETHATE SODIUM INJ|| 58-1699775|1326041732|CHC13|J0770||10/01/2017|09/30/2018|$16.39|0|0|0||COLISTIMETHATE SODIUM INJ|| 58-1699775|1326041732|CHC13|J0775||10/01/2016|09/30/2017|$50.04|0|0|0||COLLAGENASE| CLOST HIST INJ|| 58-1699775|1326041732|CHC13|J0775||10/01/2017|09/30/2018|$50.82|0|0|0||COLLAGENASE| CLOST HIST INJ|| 58-1699775|1326041732|CHC13|J0780||10/01/2016|09/30/2017|$15.73|0|0|0||PROCHLORPERAZINE INJECTION|| 58-1699775|1326041732|CHC13|J0780||10/01/2017|09/30/2018|$14.97|0|0|0||PROCHLORPERAZINE INJECTION|| 58-1699775|1326041732|CHC13|J0795||10/01/2016|09/30/2017|$10.06|0|0|0||CORTICORELIN OVINE TRIFLUTAL|| 58-1699775|1326041732|CHC13|J0795||10/01/2017|09/30/2018|$10.31|0|0|0||CORTICORELIN OVINE TRIFLUTAL|| 58-1699775|1326041732|CHC13|J0800||10/01/2016|09/30/2017|$4|451.35|0|0|0||CORTICOTROPIN INJECTION|| 58-1699775|1326041732|CHC13|J0800||10/01/2017|09/30/2018|$4|629.22|0|0|0||CORTICOTROPIN INJECTION|| 58-1699775|1326041732|CHC13|J0834||10/01/2016|09/30/2017|$51.84|0|0|0||COSYNTROPIN CORTROSYN INJ|| 58-1699775|1326041732|CHC13|J0834||10/01/2017|09/30/2018|$50.75|0|0|0||COSYNTROPIN CORTROSYN INJ|| 58-1699775|1326041732|CHC13|J0840||10/01/2016|09/30/2017|$3|337.79|0|0|0||CROTALIDAE POLY IMMUNE FAB|| 58-1699775|1326041732|CHC13|J0840||10/01/2017|09/30/2018|$3|588.41|0|0|0||CROTALIDAE POLY IMMUNE FAB|| 58-1699775|1326041732|CHC13|J0850||10/01/2016|09/30/2017|$1|408.70|0|0|0||CYTOMEGALOVIRUS IMM IV /VIAL|| 58-1699775|1326041732|CHC13|J0850||10/01/2017|09/30/2018|$1|410.84|0|0|0||CYTOMEGALOVIRUS IMM IV /VIAL|| 58-1699775|1326041732|CHC13|J0875||10/01/2016|09/30/2017|$18.86|0|0|0||INJECTION| DALBAVANCIN| 5 MG|| 58-1699775|1326041732|CHC13|J0875||10/01/2017|09/30/2018|$18.21|0|0|0||INJECTION| DALBAVANCIN| 5 MG|| 58-1699775|1326041732|CHC13|J0878||10/01/2016|09/30/2017|$1.12|0|0|0||DAPTOMYCIN INJECTION|| 58-1699775|1326041732|CHC13|J0878||10/01/2017|09/30/2018|$0.83|0|0|0||DAPTOMYCIN INJECTION|| 58-1699775|1326041732|CHC13|J0881||10/01/2016|09/30/2017|$5.01|0|0|0||DARBEPOETIN ALFA| NON-ESRD|| 58-1699775|1326041732|CHC13|J0881||10/01/2017|09/30/2018|$4.88|0|0|0||DARBEPOETIN ALFA| NON-ESRD|| 58-1699775|1326041732|CHC13|J0882||10/01/2016|09/30/2017|$5.01|0|0|0||DARBEPOETIN ALFA| ESRD USE|| 58-1699775|1326041732|CHC13|J0882||10/01/2017|09/30/2018|$4.88|0|0|0||DARBEPOETIN ALFA| ESRD USE|| 58-1699775|1326041732|CHC13|J0885||10/01/2016|09/30/2017|$15.65|0|0|0||EPOETIN ALFA| NON-ESRD|| 58-1699775|1326041732|CHC13|J0885||10/01/2017|09/30/2018|$17.20|0|0|0||EPOETIN ALFA| NON-ESRD|| 58-1699775|1326041732|CHC13|J0886||10/01/2015|12/31/9999|$15.18|0|0|0||EPOETIN ALFA| ESRD|| 58-1699775|1326041732|CHC13|J0887||10/01/2016|09/30/2017|$2.11|0|0|0||EPOETIN BETA ESRD USE| 1 MG|| 58-1699775|1326041732|CHC13|J0887||10/01/2017|09/30/2018|$1.74|0|0|0||EPOETIN BETA ESRD USE| 1 MG|| 58-1699775|1326041732|CHC13|J0888||10/01/2016|09/30/2017|$2.38|0|0|0||EPOETIN BETA NON ESRD|| 58-1699775|1326041732|CHC13|J0888||10/01/2017|09/30/2018|$1.74|0|0|0||EPOETIN BETA NON ESRD|| 58-1699775|1326041732|CHC13|J0890||11/01/2013|12/31/9999|$10.25|0|0|||PEGINESATIDE INJECTION|| 58-1699775|1326041732|CHC13|J0894||10/01/2016|09/30/2017|$27.28|0|0|0||DECITABINE INJECTION|| 58-1699775|1326041732|CHC13|J0894||10/01/2017|09/30/2018|$24.19|0|0|0||DECITABINE INJECTION|| 58-1699775|1326041732|CHC13|J0895||10/01/2016|09/30/2017|$11.10|0|0|0||DEFEROXAMINE MESYLATE INJ|| 58-1699775|1326041732|CHC13|J0895||10/01/2017|09/30/2018|$10.63|0|0|0||DEFEROXAMINE MESYLATE INJ|| 58-1699775|1326041732|CHC13|J0897||10/01/2016|09/30/2017|$20.14|0|0|0||DENOSUMAB INJECTION|| 58-1699775|1326041732|CHC13|J0897||10/01/2017|09/30/2018|$21.29|0|0|0||DENOSUMAB INJECTION|| 58-1699775|1326041732|CHC13|J1000||10/01/2016|09/30/2017|$19.61|0|0|0||DEPO-ESTRADIOL CYPIONATE INJ|| 58-1699775|1326041732|CHC13|J1000||10/01/2017|09/30/2018|$24.15|0|0|0||DEPO-ESTRADIOL CYPIONATE INJ|| 58-1699775|1326041732|CHC13|J1020||10/01/2016|09/30/2017|$5.94|0|0|0||METHYLPREDNISOLONE 20 MG INJ|| 58-1699775|1326041732|CHC13|J1020||10/01/2017|09/30/2018|$6.75|0|0|0||METHYLPREDNISOLONE 20 MG INJ|| 58-1699775|1326041732|CHC13|J1030||10/01/2016|09/30/2017|$6.19|0|0|0||METHYLPREDNISOLONE 40 MG INJ|| 58-1699775|1326041732|CHC13|J1030||10/01/2017|09/30/2018|$7.50|0|0|0||METHYLPREDNISOLONE 40 MG INJ|| 58-1699775|1326041732|CHC13|J1040||10/01/2016|09/30/2017|$11.85|0|0|0||METHYLPREDNISOLONE 80 MG INJ|| 58-1699775|1326041732|CHC13|J1040||10/01/2017|09/30/2018|$14.41|0|0|0||METHYLPREDNISOLONE 80 MG INJ|| 58-1699775|1326041732|CHC13|J1050||10/01/2016|09/30/2017|$0.48|0|0|0||INJ MEDRXYPROGSTRNE ACTAT 1MG|| 58-1699775|1326041732|CHC13|J1050||10/01/2017|09/30/2018|$0.60|0|0|0||INJ MEDRXYPROGSTRNE ACTAT 1MG|| 58-1699775|1326041732|CHC13|J1070||10/01/2014|12/31/9999|$5.58|0|0|||TESTOSTERONE CYPIONAT 100 MG|| 58-1699775|1326041732|CHC13|J1071||10/01/2016|09/30/2017|$0.04|0|0|0||INJ TESTOSTERONE CYPIONATE| 1|| 58-1699775|1326041732|CHC13|J1071||10/01/2017|09/30/2018|$0.03|0|0|0||INJ TESTOSTERONE CYPIONATE| 1|| 58-1699775|1326041732|CHC13|J1080||10/01/2014|12/31/9999|$5.76|0|0|||TESTOSTERONE CYPIONAT 200 MG|| 58-1699775|1326041732|CHC13|J1094||05/01/2014|12/31/9999|$4.38|0|0|||INJ DEXAMETHASONE ACETATE|| 58-1699775|1326041732|CHC13|J1100||10/01/2016|09/30/2017|$0.15|0|0|0||DEXAMETHASONE SODIUM PHOS|| 58-1699775|1326041732|CHC13|J1100||10/01/2017|09/30/2018|$0.15|0|0|0||DEXAMETHASONE SODIUM PHOS|| 58-1699775|1326041732|CHC13|J1110||10/01/2016|09/30/2017|$73.27|0|0|0||INJ DIHYDROERGOTAMINE MESYLT|| 58-1699775|1326041732|CHC13|J1110||10/01/2017|09/30/2018|$103.76|0|0|0||INJ DIHYDROERGOTAMINE MESYLT|| 58-1699775|1326041732|CHC13|J1120||10/01/2016|09/30/2017|$25.71|0|0|0||ACETAZOLAMID SODIUM INJECTIO|| 58-1699775|1326041732|CHC13|J1120||10/01/2017|09/30/2018|$27.35|0|0|0||ACETAZOLAMID SODIUM INJECTIO|| 58-1699775|1326041732|CHC13|J1160||10/01/2016|09/30/2017|$6.20|0|0|0||DIGOXIN INJECTION|| 58-1699775|1326041732|CHC13|J1160||10/01/2017|09/30/2018|$7.02|0|0|0||DIGOXIN INJECTION|| 58-1699775|1326041732|CHC13|J1162||10/01/2016|09/30/2017|$3|799.41|0|0|0||DIGOXIN IMMUNE FAB (OVINE)|| 58-1699775|1326041732|CHC13|J1162||10/01/2017|09/30/2018|$4|083.78|0|0|0||DIGOXIN IMMUNE FAB (OVINE)|| 58-1699775|1326041732|CHC13|J1165||10/01/2016|09/30/2017|$0.66|0|0|0||PHENYTOIN SODIUM INJECTION|| 58-1699775|1326041732|CHC13|J1165||10/01/2017|09/30/2018|$0.65|0|0|0||PHENYTOIN SODIUM INJECTION|| 58-1699775|1326041732|CHC13|J1170||10/01/2016|09/30/2017|$2.45|0|0|0||HYDROMORPHONE INJECTION|| 58-1699775|1326041732|CHC13|J1170||10/01/2017|09/30/2018|$2.60|0|0|0||HYDROMORPHONE INJECTION|| 58-1699775|1326041732|CHC13|J1190||10/01/2016|09/30/2017|$226.27|0|0|0||DEXRAZOXANE HCL INJECTION|| 58-1699775|1326041732|CHC13|J1190||10/01/2017|09/30/2018|$230.83|0|0|0||DEXRAZOXANE HCL INJECTION|| 58-1699775|1326041732|CHC13|J1200||10/01/2016|09/30/2017|$0.65|0|0|0||DIPHENHYDRAMINE HCL INJECTIO|| 58-1699775|1326041732|CHC13|J1200||10/01/2017|09/30/2018|$0.75|0|0|0||DIPHENHYDRAMINE HCL INJECTIO|| 58-1699775|1326041732|CHC13|J1205||10/01/2016|09/30/2017|$114.54|0|0|0||CHLOROTHIAZIDE SODIUM INJ|| 58-1699775|1326041732|CHC13|J1205||10/01/2017|09/30/2018|$83.03|0|0|0||CHLOROTHIAZIDE SODIUM INJ|| 58-1699775|1326041732|CHC13|J1212||10/01/2016|09/30/2017|$562.51|0|0|0||DIMETHYL SULFOXIDE 50% 50 ML|| 58-1699775|1326041732|CHC13|J1212||10/01/2017|09/30/2018|$691.77|0|0|0||DIMETHYL SULFOXIDE 50% 50 ML|| 58-1699775|1326041732|CHC13|J1230||10/01/2016|09/30/2017|$15.97|0|0|0||METHADONE INJECTION|| 58-1699775|1326041732|CHC13|J1230||10/01/2017|09/30/2018|$24.07|0|0|0||METHADONE INJECTION|| 58-1699775|1326041732|CHC13|J1240||10/01/2016|09/30/2017|$7.11|0|0|0||DIMENHYDRINATE INJECTION|| 58-1699775|1326041732|CHC13|J1240||10/01/2017|09/30/2018|$9.33|0|0|0||DIMENHYDRINATE INJECTION|| 58-1699775|1326041732|CHC13|J1245||10/01/2016|09/30/2017|$1.03|0|0|0||DIPYRIDAMOLE INJECTION|| 58-1699775|1326041732|CHC13|J1245||10/01/2017|09/30/2018|$0.98|0|0|0||DIPYRIDAMOLE INJECTION|| 58-1699775|1326041732|CHC13|J1250||10/01/2016|09/30/2017|$6.77|0|0|0||INJ DOBUTAMINE HCL/250 MG|| 58-1699775|1326041732|CHC13|J1250||10/01/2017|09/30/2018|$7.61|0|0|0||INJ DOBUTAMINE HCL/250 MG|| 58-1699775|1326041732|CHC13|J1260||10/01/2016|09/30/2017|$7.62|0|0|0||DOLASETRON MESYLATE|| 58-1699775|1326041732|CHC13|J1265||10/01/2016|09/30/2017|$0.75|0|0|0||DOPAMINE INJECTION|| 58-1699775|1326041732|CHC13|J1265||10/01/2017|09/30/2018|$0.81|0|0|0||DOPAMINE INJECTION|| 58-1699775|1326041732|CHC13|J1267||10/01/2016|09/30/2017|$0.97|0|0|0||DORIPENEM INJECTION|| 58-1699775|1326041732|CHC13|J1267||10/01/2017|09/30/2018|$0.81|0|0|0||DORIPENEM INJECTION|| 58-1699775|1326041732|CHC13|J1270||10/01/2016|09/30/2017|$1.19|0|0|0||INJECTION| DOXERCALCIFEROL|| 58-1699775|1326041732|CHC13|J1270||10/01/2017|09/30/2018|$0.53|0|0|0||INJECTION| DOXERCALCIFEROL|| 58-1699775|1326041732|CHC13|J1290||10/01/2016|09/30/2017|$499.70|0|0|0||ECALLANTIDE INJECTION|| 58-1699775|1326041732|CHC13|J1290||10/01/2017|09/30/2018|$540.89|0|0|0||ECALLANTIDE INJECTION|| 58-1699775|1326041732|CHC13|J1300||10/01/2016|09/30/2017|$272.98|0|0|0||ECULIZUMAB INJECTION|| 58-1699775|1326041732|CHC13|J1300||10/01/2017|09/30/2018|$283.29|0|0|0||ECULIZUMAB INJECTION|| 58-1699775|1326041732|CHC13|J1325||10/01/2016|09/30/2017|$19.40|0|0|0||EPOPROSTENOL INJECTION|| 58-1699775|1326041732|CHC13|J1325||10/01/2017|09/30/2018|$19.46|0|0|0||EPOPROSTENOL INJECTION|| 58-1699775|1326041732|CHC13|J1327||11/01/2013|12/31/9999|$32.65|0|0|||EPTIFIBATIDE INJECTION|| 58-1699775|1326041732|CHC13|J1335||10/01/2016|09/30/2017|$56.00|0|0|0||ERTAPENEM INJECTION|| 58-1699775|1326041732|CHC13|J1335||10/01/2017|09/30/2018|$65.42|0|0|0||ERTAPENEM INJECTION|| 58-1699775|1326041732|CHC13|J1364||10/01/2016|09/30/2017|$73.80|0|0|0||ERYTHRO LACTOBIONATE /500 MG|| 58-1699775|1326041732|CHC13|J1364||10/01/2017|09/30/2018|$78.04|0|0|0||ERYTHRO LACTOBIONATE /500 MG|| 58-1699775|1326041732|CHC13|J1380||10/01/2016|09/30/2017|$11.38|0|0|0||ESTRADIOL VALERATE 10 MG INJ|| 58-1699775|1326041732|CHC13|J1380||10/01/2017|09/30/2018|$9.15|0|0|0||ESTRADIOL VALERATE 10 MG INJ|| 58-1699775|1326041732|CHC13|J1410||10/01/2016|09/30/2017|$311.06|0|0|0||INJ ESTROGEN CONJUGATE 25 MG|| 58-1699775|1326041732|CHC13|J1410||10/01/2017|09/30/2018|$378.95|0|0|0||INJ ESTROGEN CONJUGATE 25 MG|| 58-1699775|1326041732|CHC13|J1430||10/01/2016|09/30/2017|$505.12|0|0|0||ETHANOLAMINE OLEATE 100 MG|| 58-1699775|1326041732|CHC13|J1430||10/01/2017|09/30/2018|$555.12|0|0|0||ETHANOLAMINE OLEATE 100 MG|| 58-1699775|1326041732|CHC13|J1438||10/01/2016|09/30/2017|$514.64|0|0|0||ETANERCEPT INJECTION|| 58-1699775|1326041732|CHC13|J1439||10/01/2016|09/30/2017|$1.32|0|0|0||INJ FERRIC CARBOXYMALTOS 1 MG|| 58-1699775|1326041732|CHC13|J1439||10/01/2017|09/30/2018|$1.34|0|0|0||INJ FERRIC CARBOXYMALTOS 1 MG|| 58-1699775|1326041732|CHC13|J1440||11/01/2013|12/31/9999|$356.75|0|0|||FILGRASTIM 300 MCG INJECTION|| 58-1699775|1326041732|CHC13|J1441||11/01/2013|12/31/9999|$565.33|0|0|||FILGRASTIM 480 MCG INJECTION|| 58-1699775|1326041732|CHC13|J1442||10/01/2016|09/30/2017|$1.25|0|0|0||INJ| FILGRASTIM G-CSF 1 MCG|| 58-1699775|1326041732|CHC13|J1442||10/01/2017|09/30/2018|$1.26|0|0|0||INJ| FILGRASTIM G-CSF 1 MCG|| 58-1699775|1326041732|CHC13|J1446||10/01/2015|12/31/9999|$4.92|0|0|0||INJ| TBO-FILGRASTIM| 5 MCG|| 58-1699775|1326041732|CHC13|J1447||10/01/2016|09/30/2017|$0.96|0|0|0||INJ TBO-FILGRASTIM 1 MICROGRAM|| 58-1699775|1326041732|CHC13|J1447||10/01/2017|09/30/2018|$0.81|0|0|0||INJ TBO-FILGRASTIM 1 MICROGRAM|| 58-1699775|1326041732|CHC13|J1450||10/01/2016|09/30/2017|$5.04|0|0|0||FLUCONAZOLE|| 58-1699775|1326041732|CHC13|J1450||10/01/2017|09/30/2018|$5.85|0|0|0||FLUCONAZOLE|| 58-1699775|1326041732|CHC13|J1451||11/01/2013|12/31/9999|$8.07|0|0|||FOMEPIZOLE| 15 MG|| 58-1699775|1326041732|CHC13|J1453||10/01/2016|09/30/2017|$2.25|0|0|0||FOSAPREPITANT INJECTION|| 58-1699775|1326041732|CHC13|J1453||10/01/2017|09/30/2018|$2.39|0|0|0||FOSAPREPITANT INJECTION|| 58-1699775|1326041732|CHC13|J1458||10/01/2016|09/30/2017|$454.65|0|0|0||GALSULFASE INJECTION|| 58-1699775|1326041732|CHC13|J1458||10/01/2017|09/30/2018|$467.26|0|0|0||GALSULFASE INJECTION|| 58-1699775|1326041732|CHC13|J1459||10/01/2016|09/30/2017|$47.79|0|0|0||INJ IVIG PRIVIGEN 500 MG|| 58-1699775|1326041732|CHC13|J1459||10/01/2017|09/30/2018|$48.26|0|0|0||INJ IVIG PRIVIGEN 500 MG|| 58-1699775|1326041732|CHC13|J1460||10/01/2016|09/30/2017|$42.29|0|0|0||GAMMA GLOBULIN 1 CC INJ|| 58-1699775|1326041732|CHC13|J1460||10/01/2017|09/30/2018|$45.46|0|0|0||GAMMA GLOBULIN 1 CC INJ|| 58-1699775|1326041732|CHC13|J1556||10/01/2016|09/30/2017|$46.76|0|0|0||INJ| IMM GLOB BIVIGAM| 500 MG|| 58-1699775|1326041732|CHC13|J1556||10/01/2017|09/30/2018|$47.89|0|0|0||INJ| IMM GLOB BIVIGAM| 500 MG|| 58-1699775|1326041732|CHC13|J1557||10/01/2016|09/30/2017|$46.16|0|0|0||GAMMAPLEX INJECTION|| 58-1699775|1326041732|CHC13|J1557||10/01/2017|09/30/2018|$58.36|0|0|0||GAMMAPLEX INJECTION|| 58-1699775|1326041732|CHC13|J1559||10/01/2016|09/30/2017|$12.29|0|0|0||HIZENTRA INJECTION|| 58-1699775|1326041732|CHC13|J1559||10/01/2017|09/30/2018|$12.29|0|0|0||HIZENTRA INJECTION|| 58-1699775|1326041732|CHC13|J1560||10/01/2016|09/30/2017|$422.93|0|0|0||GAMMA GLOBULIN > 10 CC INJ|| 58-1699775|1326041732|CHC13|J1560||10/01/2017|09/30/2018|$454.57|0|0|0||GAMMA GLOBULIN > 10 CC INJ|| 58-1699775|1326041732|CHC13|J1561||10/01/2016|09/30/2017|$51.13|0|0|0||INJECTION IMMUNE GLOB IV 500 M|| 58-1699775|1326041732|CHC13|J1561||10/01/2017|09/30/2018|$48.01|0|0|0||INJECTION IMMUNE GLOB IV 500 M|| 58-1699775|1326041732|CHC13|J1566||10/01/2016|09/30/2017|$42.54|0|0|0||IMMUNE GLOBULIN| POWDER|| 58-1699775|1326041732|CHC13|J1566||10/01/2017|09/30/2018|$41.18|0|0|0||IMMUNE GLOBULIN| POWDER|| 58-1699775|1326041732|CHC13|J1568||10/01/2016|09/30/2017|$49.72|0|0|0||OCTAGAM INJECTION|| 58-1699775|1326041732|CHC13|J1568||10/01/2017|09/30/2018|$42.66|0|0|0||OCTAGAM INJECTION|| 58-1699775|1326041732|CHC13|J1569||10/01/2016|09/30/2017|$50.00|0|0|0||GAMMAGARD LIQUID INJECTION|| 58-1699775|1326041732|CHC13|J1569||10/01/2017|09/30/2018|$50.24|0|0|0||GAMMAGARD LIQUID INJECTION|| 58-1699775|1326041732|CHC13|J1570||10/01/2016|09/30/2017|$72.65|0|0|0||GANCICLOVIR SODIUM INJECTION|| 58-1699775|1326041732|CHC13|J1570||10/01/2017|09/30/2018|$90.99|0|0|0||GANCICLOVIR SODIUM INJECTION|| 58-1699775|1326041732|CHC13|J1571||10/01/2016|09/30/2017|$68.44|0|0|0||HEPAGAM B IM INJECTION|| 58-1699775|1326041732|CHC13|J1571||10/01/2017|09/30/2018|$75.25|0|0|0||HEPAGAM B IM INJECTION|| 58-1699775|1326041732|CHC13|J1572||10/01/2016|09/30/2017|$47.36|0|0|0||FLEBOGAMMA INJECTION|| 58-1699775|1326041732|CHC13|J1572||10/01/2017|09/30/2018|$34.91|0|0|0||FLEBOGAMMA INJECTION|| 58-1699775|1326041732|CHC13|J1573||11/01/2013|12/31/9999|$64.66|0|0|||HEPAGAM B INTRAVENOUS| INJ|| 58-1699775|1326041732|CHC13|J1575||10/01/2016|09/30/2017|$16.25|0|0|0||INJ HYQVIA 100 MG IMMUNEGLOBUL|| 58-1699775|1326041732|CHC13|J1575||10/01/2017|09/30/2018|$16.30|0|0|0||INJ HYQVIA 100 MG IMMUNEGLOBUL|| 58-1699775|1326041732|CHC13|J1580||10/01/2016|09/30/2017|$1.72|0|0|0||GARAMYCIN GENTAMICIN INJ|| 58-1699775|1326041732|CHC13|J1580||10/01/2017|09/30/2018|$1.92|0|0|0||GARAMYCIN GENTAMICIN INJ|| 58-1699775|1326041732|CHC13|J1600||10/01/2014|12/31/9999|$30.15|0|0|||GOLD SODIUM THIOMALEATE INJ|| 58-1699775|1326041732|CHC13|J1602||10/01/2016|09/30/2017|$30.92|0|0|0||INJ| GOLIMUMAB FOR IV USE 1 MG|| 58-1699775|1326041732|CHC13|J1602||10/01/2017|09/30/2018|$30.91|0|0|0||INJ| GOLIMUMAB FOR IV USE 1 MG|| 58-1699775|1326041732|CHC13|J1610||10/01/2016|09/30/2017|$250.42|0|0|0||GLUCAGON HYDROCHLORIDE/1 MG|| 58-1699775|1326041732|CHC13|J1610||10/01/2017|09/30/2018|$243.04|0|0|0||GLUCAGON HYDROCHLORIDE/1 MG|| 58-1699775|1326041732|CHC13|J1626||10/01/2016|09/30/2017|$0.40|0|0|0||GRANISETRON HCL INJECTION|| 58-1699775|1326041732|CHC13|J1626||10/01/2017|09/30/2018|$0.41|0|0|0||GRANISETRON HCL INJECTION|| 58-1699775|1326041732|CHC13|J1630||10/01/2016|09/30/2017|$1.60|0|0|0||HALOPERIDOL INJECTION|| 58-1699775|1326041732|CHC13|J1630||10/01/2017|09/30/2018|$1.53|0|0|0||HALOPERIDOL INJECTION|| 58-1699775|1326041732|CHC13|J1631||10/01/2016|09/30/2017|$23.55|0|0|0||HALOPERIDOL DECANOATE INJ|| 58-1699775|1326041732|CHC13|J1631||10/01/2017|09/30/2018|$22.55|0|0|0||HALOPERIDOL DECANOATE INJ|| 58-1699775|1326041732|CHC13|J1640||10/01/2016|09/30/2017|$28.34|0|0|0||HEMIN| 1 MG|| 58-1699775|1326041732|CHC13|J1640||10/01/2017|09/30/2018|$29.66|0|0|0||HEMIN| 1 MG|| 58-1699775|1326041732|CHC13|J1642||10/01/2016|09/30/2017|$0.24|0|0|0||INJ HEPARIN SODIUM PER 10 U|| 58-1699775|1326041732|CHC13|J1642||10/01/2017|09/30/2018|$0.22|0|0|0||INJ HEPARIN SODIUM PER 10 U|| 58-1699775|1326041732|CHC13|J1644||10/01/2016|09/30/2017|$0.27|0|0|0||INJ HEPARIN SODIUM PER 1000U|| 58-1699775|1326041732|CHC13|J1644||10/01/2017|09/30/2018|$0.26|0|0|0||INJ HEPARIN SODIUM PER 1000U|| 58-1699775|1326041732|CHC13|J1645||10/01/2016|09/30/2017|$19.97|0|0|0||DALTEPARIN SODIUM|| 58-1699775|1326041732|CHC13|J1645||10/01/2017|09/30/2018|$19.17|0|0|0||DALTEPARIN SODIUM|| 58-1699775|1326041732|CHC13|J1650||10/01/2016|09/30/2017|$1.10|0|0|0||INJ ENOXAPARIN SODIUM|| 58-1699775|1326041732|CHC13|J1650||10/01/2017|09/30/2018|$1.08|0|0|0||INJ ENOXAPARIN SODIUM|| 58-1699775|1326041732|CHC13|J1652||10/01/2016|09/30/2017|$3.05|0|0|0||FONDAPARINUX SODIUM|| 58-1699775|1326041732|CHC13|J1652||10/01/2017|09/30/2018|$2.65|0|0|0||FONDAPARINUX SODIUM|| 58-1699775|1326041732|CHC13|J1670||10/01/2016|09/30/2017|$482.63|0|0|0||TETANUS IMMUNE GLOBULIN INJ|| 58-1699775|1326041732|CHC13|J1670||10/01/2017|09/30/2018|$527.55|0|0|0||TETANUS IMMUNE GLOBULIN INJ|| 58-1699775|1326041732|CHC13|J1720||10/01/2016|09/30/2017|$10.20|0|0|0||HYDROCORTISONE SODIUM SUCC I|| 58-1699775|1326041732|CHC13|J1720||10/01/2017|09/30/2018|$13.57|0|0|0||HYDROCORTISONE SODIUM SUCC I|| 58-1699775|1326041732|CHC13|J1740||10/01/2016|09/30/2017|$141.94|0|0|0||IBANDRONATE SODIUM INJECTION|| 58-1699775|1326041732|CHC13|J1740||10/01/2017|09/30/2018|$104.72|0|0|0||IBANDRONATE SODIUM INJECTION|| 58-1699775|1326041732|CHC13|J1742||10/01/2016|09/30/2017|$330.55|0|0|0||IBUTILIDE FUMARATE INJECTION|| 58-1699775|1326041732|CHC13|J1742||10/01/2017|09/30/2018|$82.18|0|0|0||IBUTILIDE FUMARATE INJECTION|| 58-1699775|1326041732|CHC13|J1743||10/01/2016|09/30/2017|$653.18|0|0|0||IDURSULFASE INJECTION|| 58-1699775|1326041732|CHC13|J1743||10/01/2017|09/30/2018|$666.85|0|0|0||IDURSULFASE INJECTION|| 58-1699775|1326041732|CHC13|J1745||10/01/2016|09/30/2017|$102.85|0|0|0||INFLIXIMAB INJECTION|| 58-1699775|1326041732|CHC13|J1745||10/01/2017|09/30/2018|$107.18|0|0|0||INFLIXIMAB INJECTION|| 58-1699775|1326041732|CHC13|J1750||10/01/2016|09/30/2017|$15.43|0|0|0||INJECTION IRON DEXTRAN 50 MG|| 58-1699775|1326041732|CHC13|J1750||10/01/2017|09/30/2018|$16.28|0|0|0||INJECTION IRON DEXTRAN 50 MG|| 58-1699775|1326041732|CHC13|J1756||10/01/2016|09/30/2017|$0.32|0|0|0||IRON SUCROSE INJECTION|| 58-1699775|1326041732|CHC13|J1756||10/01/2017|09/30/2018|$0.32|0|0|0||IRON SUCROSE INJECTION|| 58-1699775|1326041732|CHC13|J1786||10/01/2016|09/30/2017|$52.42|0|0|0||IMUGLUCERASE INJECTION|| 58-1699775|1326041732|CHC13|J1786||10/01/2017|09/30/2018|$52.18|0|0|0||IMUGLUCERASE INJECTION|| 58-1699775|1326041732|CHC13|J1790||10/01/2015|12/31/9999|$2.68|0|0|0||DROPERIDOL INJECTION|| 58-1699775|1326041732|CHC13|J1800||10/01/2016|09/30/2017|$5.55|0|0|0||PROPRANOLOL INJECTION|| 58-1699775|1326041732|CHC13|J1800||10/01/2017|09/30/2018|$2.07|0|0|0||PROPRANOLOL INJECTION|| 58-1699775|1326041732|CHC13|J1815||10/01/2016|09/30/2017|$0.93|0|0|0||INSULIN INJECTION|| 58-1699775|1326041732|CHC13|J1815||10/01/2017|09/30/2018|$1.04|0|0|0||INSULIN INJECTION|| 58-1699775|1326041732|CHC13|J1817||10/01/2016|09/30/2017|$10.30|0|0|0||INSULIN FOR INSULIN PUMP USE|| 58-1699775|1326041732|CHC13|J1817||10/01/2017|09/30/2018|$11.97|0|0|0||INSULIN FOR INSULIN PUMP USE|| 58-1699775|1326041732|CHC13|J1840||10/01/2015|12/31/9999|$9.61|0|0|0||KANAMYCIN SULFATE 500 MG INJ|| 58-1699775|1326041732|CHC13|J1850||10/01/2015|12/31/9999|$1.44|0|0|0||KANAMYCIN SULFATE 75 MG INJ|| 58-1699775|1326041732|CHC13|J1885||10/01/2016|09/30/2017|$0.82|0|0|0||KETOROLAC TROMETHAMINE INJ|| 58-1699775|1326041732|CHC13|J1885||10/01/2017|09/30/2018|$0.73|0|0|0||KETOROLAC TROMETHAMINE INJ|| 58-1699775|1326041732|CHC13|J1930||10/01/2016|09/30/2017|$61.75|0|0|0||PROPIOMAZINE INJECTION|| 58-1699775|1326041732|CHC13|J1930||10/01/2017|09/30/2018|$67.99|0|0|0||PROPIOMAZINE INJECTION|| 58-1699775|1326041732|CHC13|J1931||10/01/2016|09/30/2017|$38.24|0|0|0||LARONIDASE INJECTION|| 58-1699775|1326041732|CHC13|J1931||10/01/2017|09/30/2018|$38.26|0|0|0||LARONIDASE INJECTION|| 58-1699775|1326041732|CHC13|J1940||10/01/2016|09/30/2017|$3.69|0|0|0||FUROSEMIDE INJECTION|| 58-1699775|1326041732|CHC13|J1940||10/01/2017|09/30/2018|$1.11|0|0|0||FUROSEMIDE INJECTION|| 58-1699775|1326041732|CHC13|J1942||10/01/2017|09/30/2018|$2.95|0|0|0||INJ| ARIPIPRAZOLE LAUROXIL| 1|| 58-1699775|1326041732|CHC13|J1945||11/01/2013|12/31/9999|$713.18|0|0|||LEPIRUDIN|| 58-1699775|1326041732|CHC13|J1950||10/01/2016|09/30/2017|$1|222.36|0|0|0||LEUPROLIDE ACETATE /3.75 MG|| 58-1699775|1326041732|CHC13|J1950||10/01/2017|09/30/2018|$1|270.44|0|0|0||LEUPROLIDE ACETATE /3.75 MG|| 58-1699775|1326041732|CHC13|J1953||10/01/2016|09/30/2017|$0.20|0|0|0||LEVETIRACETAM INJECTION|| 58-1699775|1326041732|CHC13|J1953||10/01/2017|09/30/2018|$0.16|0|0|0||LEVETIRACETAM INJECTION|| 58-1699775|1326041732|CHC13|J1955||10/01/2016|09/30/2017|$23.70|0|0|0||INJ LEVOCARNITINE PER 1 GM|| 58-1699775|1326041732|CHC13|J1955||10/01/2017|09/30/2018|$25.43|0|0|0||INJ LEVOCARNITINE PER 1 GM|| 58-1699775|1326041732|CHC13|J1956||10/01/2016|09/30/2017|$2.42|0|0|0||LEVOFLOXACIN INJECTION|| 58-1699775|1326041732|CHC13|J1956||10/01/2017|09/30/2018|$1.63|0|0|0||LEVOFLOXACIN INJECTION|| 58-1699775|1326041732|CHC13|J1980||10/01/2016|09/30/2017|$33.87|0|0|0||HYOSCYAMINE SULFATE INJ|| 58-1699775|1326041732|CHC13|J1980||10/01/2017|09/30/2018|$34.26|0|0|0||HYOSCYAMINE SULFATE INJ|| 58-1699775|1326041732|CHC13|J2001||10/01/2016|09/30/2017|$0.02|0|0|0||LIDOCAINE INJECTION|| 58-1699775|1326041732|CHC13|J2001||10/01/2017|09/30/2018|$0.02|0|0|0||LIDOCAINE INJECTION|| 58-1699775|1326041732|CHC13|J2010||10/01/2016|09/30/2017|$14.46|0|0|0||LINCOMYCIN INJECTION|| 58-1699775|1326041732|CHC13|J2010||10/01/2017|09/30/2018|$16.06|0|0|0||LINCOMYCIN INJECTION|| 58-1699775|1326041732|CHC13|J2020||10/01/2016|09/30/2017|$19.94|0|0|0||LINEZOLID INJECTION|| 58-1699775|1326041732|CHC13|J2020||10/01/2017|09/30/2018|$19.09|0|0|0||LINEZOLID INJECTION|| 58-1699775|1326041732|CHC13|J2060||10/01/2016|09/30/2017|$1.00|0|0|0||LORAZEPAM INJECTION|| 58-1699775|1326041732|CHC13|J2060||10/01/2017|09/30/2018|$1.14|0|0|0||LORAZEPAM INJECTION|| 58-1699775|1326041732|CHC13|J2150||10/01/2016|09/30/2017|$2.44|0|0|0||MANNITOL INJECTION|| 58-1699775|1326041732|CHC13|J2150||10/01/2017|09/30/2018|$2.36|0|0|0||MANNITOL INJECTION|| 58-1699775|1326041732|CHC13|J2175||10/01/2016|09/30/2017|$6.39|0|0|0||MEPERIDINE HYDROCHL /100 MG|| 58-1699775|1326041732|CHC13|J2175||10/01/2017|09/30/2018|$6.82|0|0|0||MEPERIDINE HYDROCHL /100 MG|| 58-1699775|1326041732|CHC13|J2185||10/01/2016|09/30/2017|$1.92|0|0|0||MEROPENEM|| 58-1699775|1326041732|CHC13|J2185||10/01/2017|09/30/2018|$1.43|0|0|0||MEROPENEM|| 58-1699775|1326041732|CHC13|J2210||10/01/2016|09/30/2017|$9.19|0|0|0||METHYLERGONOVIN MALEATE INJ|| 58-1699775|1326041732|CHC13|J2210||10/01/2017|09/30/2018|$22.04|0|0|0||METHYLERGONOVIN MALEATE INJ|| 58-1699775|1326041732|CHC13|J2248||10/01/2016|09/30/2017|$1.18|0|0|0||MICAFUNGIN SODIUM INJECTION|| 58-1699775|1326041732|CHC13|J2248||10/01/2017|09/30/2018|$1.18|0|0|0||MICAFUNGIN SODIUM INJECTION|| 58-1699775|1326041732|CHC13|J2250||10/01/2016|09/30/2017|$0.16|0|0|0||INJ MIDAZOLAM HYDROCHLORIDE|| 58-1699775|1326041732|CHC13|J2250||10/01/2017|09/30/2018|$0.14|0|0|0||INJ MIDAZOLAM HYDROCHLORIDE|| 58-1699775|1326041732|CHC13|J2260||10/01/2015|12/31/9999|$3.88|0|0|0||INJ MILRINONE LACTATE / 5 MG|| 58-1699775|1326041732|CHC13|J2260||10/01/2017|09/30/2018|$2.19|0|0|0||INJ MILRINONE LACTATE / 5 MG|| 58-1699775|1326041732|CHC13|J2270||10/01/2016|09/30/2017|$1.50|0|0|0||MORPHINE SULFATE INJECTION|| 58-1699775|1326041732|CHC13|J2270||10/01/2017|09/30/2018|$2.06|0|0|0||MORPHINE SULFATE INJECTION|| 58-1699775|1326041732|CHC13|J2271||11/01/2013|12/31/9999|$0.92|0|0|||MORPHINE SO4 INJECTION 100MG|| 58-1699775|1326041732|CHC13|J2274||10/01/2016|09/30/2017|$10.68|0|0|0||IN MORPHINE PRESERVATIV FREE||| 58-1699775|1326041732|CHC13|J2274||10/01/2017|09/30/2018|$12.17|0|0|0||IN MORPHINE PRESERVATIV FREE||| 58-1699775|1326041732|CHC13|J2275||11/01/2013|12/31/9999|$4.09|0|0|||MORPHINE SULFATE INJECTION|| 58-1699775|1326041732|CHC13|J2278||10/01/2016|09/30/2017|$9.11|0|0|0||ZICONOTIDE INJECTION|| 58-1699775|1326041732|CHC13|J2278||10/01/2017|09/30/2018|$9.16|0|0|0||ZICONOTIDE INJECTION|| 58-1699775|1326041732|CHC13|J2280||10/01/2016|09/30/2017|$11.75|0|0|0||INJ| MOXIFLOXACIN 100 MG|| 58-1699775|1326041732|CHC13|J2280||10/01/2017|09/30/2018|$10.60|0|0|0||INJ| MOXIFLOXACIN 100 MG|| 58-1699775|1326041732|CHC13|J2300||10/01/2016|09/30/2017|$2.95|0|0|0||INJ NALBUPHINE HYDROCHLORIDE|| 58-1699775|1326041732|CHC13|J2300||10/01/2017|09/30/2018|$3.20|0|0|0||INJ NALBUPHINE HYDROCHLORIDE|| 58-1699775|1326041732|CHC13|J2310||10/01/2016|09/30/2017|$42.24|0|0|0||INJ NALOXONE HYDROCHLORIDE|| 58-1699775|1326041732|CHC13|J2310||10/01/2017|09/30/2018|$33.41|0|0|0||INJ NALOXONE HYDROCHLORIDE|| 58-1699775|1326041732|CHC13|J2315||10/01/2016|09/30/2017|$4.07|0|0|0||NALTREXONE| DEPOT FORM|| 58-1699775|1326041732|CHC13|J2315||10/01/2017|09/30/2018|$4.06|0|0|0||NALTREXONE| DEPOT FORM|| 58-1699775|1326041732|CHC13|J2323||10/01/2016|09/30/2017|$22.38|0|0|0||NATALIZUMAB INJECTION|| 58-1699775|1326041732|CHC13|J2323||10/01/2017|09/30/2018|$24.28|0|0|0||NATALIZUMAB INJECTION|| 58-1699775|1326041732|CHC13|J2325||11/01/2013|12/31/9999|$74.65|0|0|||NESIRITIDE INJECTION|| 58-1699775|1326041732|CHC13|J2353||10/01/2016|09/30/2017|$208.52|0|0|0||OCTREOTIDE INJECTION| DEPOT|| 58-1699775|1326041732|CHC13|J2353||10/01/2017|09/30/2018|$228.24|0|0|0||OCTREOTIDE INJECTION| DEPOT|| 58-1699775|1326041732|CHC13|J2354||10/01/2016|09/30/2017|$1.30|0|0|0||OCTREOTIDE INJ| NON-DEPOT|| 58-1699775|1326041732|CHC13|J2354||10/01/2017|09/30/2018|$1.41|0|0|0||OCTREOTIDE INJ| NON-DEPOT|| 58-1699775|1326041732|CHC13|J2355||10/01/2016|09/30/2017|$560.59|0|0|0||OPRELVEKIN INJECTION|| 58-1699775|1326041732|CHC13|J2355||10/01/2017|09/30/2018|$584.02|0|0|0||OPRELVEKIN INJECTION|| 58-1699775|1326041732|CHC13|J2357||10/01/2016|09/30/2017|$38.92|0|0|0||OMALIZUMAB INJECTION|| 58-1699775|1326041732|CHC13|J2357||10/01/2017|09/30/2018|$41.99|0|0|0||OMALIZUMAB INJECTION|| 58-1699775|1326041732|CHC13|J2358||10/01/2016|09/30/2017|$3.65|0|0|0||OLANZAPINE LONG-ACTING INJ|| 58-1699775|1326041732|CHC13|J2358||10/01/2017|09/30/2018|$3.65|0|0|0||OLANZAPINE LONG-ACTING INJ|| 58-1699775|1326041732|CHC13|J2360||10/01/2016|09/30/2017|$5.60|0|0|0||ORPHENADRINE INJECTION|| 58-1699775|1326041732|CHC13|J2360||10/01/2017|09/30/2018|$7.55|0|0|0||ORPHENADRINE INJECTION|| 58-1699775|1326041732|CHC13|J2370||10/01/2014|12/31/9999|$2.94|0|0|||PHENYLEPHRINE HCL INJECTION|| 58-1699775|1326041732|CHC13|J2400||10/01/2016|09/30/2017|$29.74|0|0|0||CHLOROPROCAINE HCL INJECTION|| 58-1699775|1326041732|CHC13|J2400||10/01/2017|09/30/2018|$29.98|0|0|0||CHLOROPROCAINE HCL INJECTION|| 58-1699775|1326041732|CHC13|J2405||10/01/2016|09/30/2017|$0.11|0|0|0||ONDANSETRON HCL INJECTION|| 58-1699775|1326041732|CHC13|J2405||10/01/2017|09/30/2018|$0.12|0|0|0||ONDANSETRON HCL INJECTION|| 58-1699775|1326041732|CHC13|J2407||10/01/2016|09/30/2017|$30.87|0|0|0||INJECTION| ORITAVANCIN| 10 MG|| 58-1699775|1326041732|CHC13|J2407||10/01/2017|09/30/2018|$29.21|0|0|0||INJECTION| ORITAVANCIN| 10 MG|| 58-1699775|1326041732|CHC13|J2410||10/01/2016|09/30/2017|$3.59|0|0|0||OXYMORPHONE HCL INJECTION|| 58-1699775|1326041732|CHC13|J2410||10/01/2017|09/30/2018|$3.65|0|0|0||OXYMORPHONE HCL INJECTION|| 58-1699775|1326041732|CHC13|J2425||10/01/2016|09/30/2017|$22.33|0|0|0||PALIFERMIN INJECTION|| 58-1699775|1326041732|CHC13|J2425||10/01/2017|09/30/2018|$23.95|0|0|0||PALIFERMIN INJECTION|| 58-1699775|1326041732|CHC13|J2426||10/01/2016|09/30/2017|$11.32|0|0|0||PALIPERIDONE PALMITATE INJ|| 58-1699775|1326041732|CHC13|J2426||10/01/2017|09/30/2018|$12.45|0|0|0||PALIPERIDONE PALMITATE INJ|| 58-1699775|1326041732|CHC13|J2430||10/01/2016|09/30/2017|$15.94|0|0|0||PAMIDRONATE DISODIUM /30 MG|| 58-1699775|1326041732|CHC13|J2430||10/01/2017|09/30/2018|$11.75|0|0|0||PAMIDRONATE DISODIUM /30 MG|| 58-1699775|1326041732|CHC13|J2469||10/01/2016|09/30/2017|$28.04|0|0|0||PALONOSETRON HCL|| 58-1699775|1326041732|CHC13|J2469||10/01/2017|09/30/2018|$27.56|0|0|0||PALONOSETRON HCL|| 58-1699775|1326041732|CHC13|J2501||10/01/2016|09/30/2017|$3.88|0|0|0||PARICALCITOL|| 58-1699775|1326041732|CHC13|J2501||10/01/2017|09/30/2018|$1.46|0|0|0||PARICALCITOL|| 58-1699775|1326041732|CHC13|J2503||10/01/2016|09/30/2017|$1|318.38|0|0|0||PEGAPTANIB SODIUM INJECTION|| 58-1699775|1326041732|CHC13|J2503||10/01/2017|09/30/2018|$1|318.38|0|0|0||PEGAPTANIB SODIUM INJECTION|| 58-1699775|1326041732|CHC13|J2504||10/01/2016|09/30/2017|$399.58|0|0|0||PEGADEMASE BOVINE| 25 IU|| 58-1699775|1326041732|CHC13|J2504||10/01/2017|09/30/2018|$431.54|0|0|0||PEGADEMASE BOVINE| 25 IU|| 58-1699775|1326041732|CHC13|J2505||10/01/2016|09/30/2017|$4|983.62|0|0|0||INJECTION| PEGFILGRASTIM 6MG|| 58-1699775|1326041732|CHC13|J2505||10/01/2017|09/30/2018|$5|309.06|0|0|0||INJECTION| PEGFILGRASTIM 6MG|| 58-1699775|1326041732|CHC13|J2507||10/01/2016|09/30/2017|$1|888.78|0|0|0||PEGLOTICASE INJECTION|| 58-1699775|1326041732|CHC13|J2507||10/01/2017|09/30/2018|$2|498.56|0|0|0||PEGLOTICASE INJECTION|| 58-1699775|1326041732|CHC13|J2510||10/01/2016|09/30/2017|$31.31|0|0|0||PENICILLIN G PROCAINE INJ|| 58-1699775|1326041732|CHC13|J2510||10/01/2017|09/30/2018|$33.46|0|0|0||PENICILLIN G PROCAINE INJ|| 58-1699775|1326041732|CHC13|J2515||10/01/2016|09/30/2017|$56.63|0|0|0||PENTOBARBITAL SODIUM INJ|| 58-1699775|1326041732|CHC13|J2515||10/01/2017|09/30/2018|$60.27|0|0|0||PENTOBARBITAL SODIUM INJ|| 58-1699775|1326041732|CHC13|J2540||10/01/2016|09/30/2017|$1.22|0|0|0||PENICILLIN G POTASSIUM INJ|| 58-1699775|1326041732|CHC13|J2540||10/01/2017|09/30/2018|$1.33|0|0|0||PENICILLIN G POTASSIUM INJ|| 58-1699775|1326041732|CHC13|J2543||10/01/2016|09/30/2017|$3.38|0|0|0||PIPERACILLIN/TAZOBACTAM|| 58-1699775|1326041732|CHC13|J2543||10/01/2017|09/30/2018|$3.68|0|0|0||PIPERACILLIN/TAZOBACTAM|| 58-1699775|1326041732|CHC13|J2545||10/01/2016|09/30/2017|$131.40|0|0|0||PENTAMIDINE ISETHIONTE/300MG|| 58-1699775|1326041732|CHC13|J2545||10/01/2017|09/30/2018|$147.57|0|0|0||PENTAMIDINE ISETHIONTE/300MG|| 58-1699775|1326041732|CHC13|J2550||10/01/2016|09/30/2017|$2.04|0|0|0||PROMETHAZINE HCL INJECTION|| 58-1699775|1326041732|CHC13|J2550||10/01/2017|09/30/2018|$3.63|0|0|0||PROMETHAZINE HCL INJECTION|| 58-1699775|1326041732|CHC13|J2560||10/01/2016|09/30/2017|$36.93|0|0|0||PHENOBARBITAL SODIUM INJ|| 58-1699775|1326041732|CHC13|J2560||10/01/2017|09/30/2018|$45.16|0|0|0||PHENOBARBITAL SODIUM INJ|| 58-1699775|1326041732|CHC13|J2562||10/01/2016|09/30/2017|$387.82|0|0|0||PLERIXAFOR INJECTION|| 58-1699775|1326041732|CHC13|J2562||10/01/2017|09/30/2018|$392.78|0|0|0||PLERIXAFOR INJECTION|| 58-1699775|1326041732|CHC13|J2590||11/01/2013|12/31/9999|$0.64|0|0|||OXYTOCIN INJECTION|| 58-1699775|1326041732|CHC13|J2597||10/01/2016|09/30/2017|$19.00|0|0|0||INJ DESMOPRESSIN ACETATE|| 58-1699775|1326041732|CHC13|J2597||10/01/2017|09/30/2018|$15.51|0|0|0||INJ DESMOPRESSIN ACETATE|| 58-1699775|1326041732|CHC13|J2675||10/01/2016|09/30/2017|$1.30|0|0|0||INJ PROGESTERONE PER 50 MG|| 58-1699775|1326041732|CHC13|J2675||10/01/2017|09/30/2018|$1.83|0|0|0||INJ PROGESTERONE PER 50 MG|| 58-1699775|1326041732|CHC13|J2680||10/01/2016|09/30/2017|$26.43|0|0|0||FLUPHENAZINE DECANOATE 25 MG|| 58-1699775|1326041732|CHC13|J2680||10/01/2017|09/30/2018|$23.00|0|0|0||FLUPHENAZINE DECANOATE 25 MG|| 58-1699775|1326041732|CHC13|J2690||10/01/2016|09/30/2017|$70.47|0|0|0||PROCAINAMIDE HCL INJECTION|| 58-1699775|1326041732|CHC13|J2690||10/01/2017|09/30/2018|$83.15|0|0|0||PROCAINAMIDE HCL INJECTION|| 58-1699775|1326041732|CHC13|J2700||10/01/2016|09/30/2017|$2.06|0|0|0||OXACILLIN SODIUM INJECITON|| 58-1699775|1326041732|CHC13|J2700||10/01/2017|09/30/2018|$1.89|0|0|0||OXACILLIN SODIUM INJECITON|| 58-1699775|1326041732|CHC13|J2704||10/01/2016|09/30/2017|$0.15|0|0|0||INJ| PROPOFOL| 10 MG|| 58-1699775|1326041732|CHC13|J2704||10/01/2017|09/30/2018|$0.14|0|0|0||INJ| PROPOFOL| 10 MG|| 58-1699775|1326041732|CHC13|J2720||10/01/2016|09/30/2017|$1.43|0|0|0||INJ PROTAMINE SULFATE/10 MG|| 58-1699775|1326041732|CHC13|J2720||10/01/2017|09/30/2018|$1.32|0|0|0||INJ PROTAMINE SULFATE/10 MG|| 58-1699775|1326041732|CHC13|J2724||10/01/2016|09/30/2017|$19.06|0|0|0||PROTEIN C CONCENTRATE|| 58-1699775|1326041732|CHC13|J2724||10/01/2017|09/30/2018|$18.96|0|0|0||PROTEIN C CONCENTRATE|| 58-1699775|1326041732|CHC13|J2730||10/01/2015|12/31/9999|$114.88|0|0|0||PRALIDOXIME CHLORIDE INJ|| 58-1699775|1326041732|CHC13|J2760||10/01/2015|12/31/9999|$198.75|0|0|0||PHENTOLAINE MESYLATE INJ|| 58-1699775|1326041732|CHC13|J2765||10/01/2016|09/30/2017|$0.87|0|0|0||METOCLOPRAMIDE HCL INJECTION|| 58-1699775|1326041732|CHC13|J2765||10/01/2017|09/30/2018|$1.12|0|0|0||METOCLOPRAMIDE HCL INJECTION|| 58-1699775|1326041732|CHC13|J2770||10/01/2016|09/30/2017|$474.82|0|0|0||QUINUPRISTIN/DALFOPRISTIN|| 58-1699775|1326041732|CHC13|J2770||10/01/2017|09/30/2018|$547.87|0|0|0||QUINUPRISTIN/DALFOPRISTIN|| 58-1699775|1326041732|CHC13|J2778||10/01/2016|09/30/2017|$478.25|0|0|0||RANIBIZUMAB INJECTION|| 58-1699775|1326041732|CHC13|J2778||10/01/2017|09/30/2018|$476.11|0|0|0||RANIBIZUMAB INJECTION|| 58-1699775|1326041732|CHC13|J2780||10/01/2016|09/30/2017|$1.32|0|0|0||RANITIDINE HYDROCHLORIDE INJ|| 58-1699775|1326041732|CHC13|J2780||10/01/2017|09/30/2018|$7.71|0|0|0||RANITIDINE HYDROCHLORIDE INJ|| 58-1699775|1326041732|CHC13|J2783||10/01/2016|09/30/2017|$305.63|0|0|0||RASBURICASE|| 58-1699775|1326041732|CHC13|J2783||10/01/2017|09/30/2018|$324.06|0|0|0||RASBURICASE|| 58-1699775|1326041732|CHC13|J2785||10/01/2016|09/30/2017|$67.23|0|0|0||REGADENOSON INJECTION|| 58-1699775|1326041732|CHC13|J2785||10/01/2017|09/30/2018|$69.22|0|0|0||REGADENOSON INJECTION|| 58-1699775|1326041732|CHC13|J2788||10/01/2016|09/30/2017|$32.23|0|0|0||RHO D IMMUNE GLOBULIN 50 MCG|| 58-1699775|1326041732|CHC13|J2788||10/01/2017|09/30/2018|$24.87|0|0|0||RHO D IMMUNE GLOBULIN 50 MCG|| 58-1699775|1326041732|CHC13|J2790||10/01/2016|09/30/2017|$102.17|0|0|0||RHO D IMMUNE GLOBULIN INJ|| 58-1699775|1326041732|CHC13|J2790||10/01/2017|09/30/2018|$98.80|0|0|0||RHO D IMMUNE GLOBULIN INJ|| 58-1699775|1326041732|CHC13|J2791||10/01/2016|09/30/2017|$6.01|0|0|0||RHOPHYLAC INJECTION|| 58-1699775|1326041732|CHC13|J2791||10/01/2017|09/30/2018|$5.98|0|0|0||RHOPHYLAC INJECTION|| 58-1699775|1326041732|CHC13|J2792||10/01/2016|09/30/2017|$26.45|0|0|0||RHO(D) IMMUNE GLOBULIN H| SD|| 58-1699775|1326041732|CHC13|J2792||10/01/2017|09/30/2018|$29.82|0|0|0||RHO(D) IMMUNE GLOBULIN H| SD|| 58-1699775|1326041732|CHC13|J2794||10/01/2016|09/30/2017|$9.70|0|0|0||RISPERIDONE| LONG ACTING|| 58-1699775|1326041732|CHC13|J2794||10/01/2017|09/30/2018|$10.67|0|0|0||RISPERIDONE| LONG ACTING|| 58-1699775|1326041732|CHC13|J2795||10/01/2016|09/30/2017|$0.09|0|0|0||ROPIVACAINE HCL INJECTION|| 58-1699775|1326041732|CHC13|J2795||10/01/2017|09/30/2018|$0.09|0|0|0||ROPIVACAINE HCL INJECTION|| 58-1699775|1326041732|CHC13|J2796||10/01/2016|09/30/2017|$76.91|0|0|0||ROMIPLOSTIM INJECTION|| 58-1699775|1326041732|CHC13|J2796||10/01/2017|09/30/2018|$83.22|0|0|0||ROMIPLOSTIM INJECTION|| 58-1699775|1326041732|CHC13|J2800||10/01/2016|09/30/2017|$49.38|0|0|0||METHOCARBAMOL INJECTION|| 58-1699775|1326041732|CHC13|J2800||10/01/2017|09/30/2018|$45.49|0|0|0||METHOCARBAMOL INJECTION|| 58-1699775|1326041732|CHC13|J2805||10/01/2016|09/30/2017|$118.77|0|0|0||SINCALIDE INJECTION|| 58-1699775|1326041732|CHC13|J2805||10/01/2017|09/30/2018|$128.67|0|0|0||SINCALIDE INJECTION|| 58-1699775|1326041732|CHC13|J2810||10/01/2016|09/30/2017|$0.37|0|0|0||INJ THEOPHYLLINE PER 40 MG|| 58-1699775|1326041732|CHC13|J2810||10/01/2017|09/30/2018|$0.38|0|0|0||INJ THEOPHYLLINE PER 40 MG|| 58-1699775|1326041732|CHC13|J2820||10/01/2016|09/30/2017|$44.12|0|0|0||SARGRAMOSTIM INJECTION|| 58-1699775|1326041732|CHC13|J2820||10/01/2017|09/30/2018|$47.28|0|0|0||SARGRAMOSTIM INJECTION|| 58-1699775|1326041732|CHC13|J2850||10/01/2016|09/30/2017|$43.48|0|0|0||INJ SECRETIN SYNTHETIC HUMAN|| 58-1699775|1326041732|CHC13|J2850||10/01/2017|09/30/2018|$43.48|0|0|0||INJ SECRETIN SYNTHETIC HUMAN|| 58-1699775|1326041732|CHC13|J2916||10/01/2016|09/30/2017|$2.91|0|0|0||NA FERRIC GLUCONATE COMPLEX|| 58-1699775|1326041732|CHC13|J2916||10/01/2017|09/30/2018|$2.88|0|0|0||NA FERRIC GLUCONATE COMPLEX|| 58-1699775|1326041732|CHC13|J2920||10/01/2016|09/30/2017|$4.16|0|0|0||METHYLPREDNISOLONE INJECTION|| 58-1699775|1326041732|CHC13|J2920||10/01/2017|09/30/2018|$5.43|0|0|0||METHYLPREDNISOLONE INJECTION|| 58-1699775|1326041732|CHC13|J2930||10/01/2016|09/30/2017|$6.21|0|0|0||METHYLPREDNISOLONE INJECTION|| 58-1699775|1326041732|CHC13|J2930||10/01/2017|09/30/2018|$7.54|0|0|0||METHYLPREDNISOLONE INJECTION|| 58-1699775|1326041732|CHC13|J2993||10/01/2015|12/31/9999|$2|877.38|0|0|0||RETEPLASE INJECTION|| 58-1699775|1326041732|CHC13|J2997||10/01/2016|09/30/2017|$99.86|0|0|0||ALTEPLASE RECOMBINANT|| 58-1699775|1326041732|CHC13|J2997||10/01/2017|09/30/2018|$104.35|0|0|0||ALTEPLASE RECOMBINANT|| 58-1699775|1326041732|CHC13|J3000||10/01/2016|09/30/2017|$16.66|0|0|0||STREPTOMYCIN INJECTION|| 58-1699775|1326041732|CHC13|J3000||10/01/2017|09/30/2018|$16.11|0|0|0||STREPTOMYCIN INJECTION|| 58-1699775|1326041732|CHC13|J3010||10/01/2016|09/30/2017|$0.54|0|0|0||FENTANYL CITRATE INJECITON|| 58-1699775|1326041732|CHC13|J3010||10/01/2017|09/30/2018|$0.54|0|0|0||FENTANYL CITRATE INJECITON|| 58-1699775|1326041732|CHC13|J3060||10/01/2016|09/30/2017|$50.61|0|0|0||INJ| TALIGLUCERACE ALFA 10 UNI|| 58-1699775|1326041732|CHC13|J3060||10/01/2017|09/30/2018|$50.47|0|0|0||INJ| TALIGLUCERACE ALFA 10 UNI|| 58-1699775|1326041732|CHC13|J3070||10/01/2016|09/30/2017|$180.64|0|0|0||PENTAZOCINE INJECTION|| 58-1699775|1326041732|CHC13|J3070||10/01/2017|09/30/2018|$92.66|0|0|0||PENTAZOCINE INJECTION|| 58-1699775|1326041732|CHC13|J3090||10/01/2016|09/30/2017|$1.59|0|0|0||INJ| TEDIZOLID PHOSPHATE| 1 MG|| 58-1699775|1326041732|CHC13|J3090||10/01/2017|09/30/2018|$1.66|0|0|0||INJ| TEDIZOLID PHOSPHATE| 1 MG|| 58-1699775|1326041732|CHC13|J3095||10/01/2016|09/30/2017|$6.24|0|0|0||TELEVANCIN INJECTION|| 58-1699775|1326041732|CHC13|J3095||10/01/2017|09/30/2018|$6.35|0|0|0||TELEVANCIN INJECTION|| 58-1699775|1326041732|CHC13|J3101||10/01/2016|09/30/2017|$127.26|0|0|0||TENECTEPLASE INJECTION|| 58-1699775|1326041732|CHC13|J3101||10/01/2017|09/30/2018|$137.55|0|0|0||TENECTEPLASE INJECTION|| 58-1699775|1326041732|CHC13|J3105||10/01/2016|09/30/2017|$3.94|0|0|0||TERBUTALINE SULFATE INJ|| 58-1699775|1326041732|CHC13|J3105||10/01/2017|09/30/2018|$3.06|0|0|0||TERBUTALINE SULFATE INJ|| 58-1699775|1326041732|CHC13|J3120||10/01/2014|12/31/9999|$7.20|0|0|||TESTOSTERONE ENANTHATE INJ|| 58-1699775|1326041732|CHC13|J3121||10/01/2016|09/30/2017|$0.06|0|0|0||INJ TESTOSTERO ENANTHATE 1MG|| 58-1699775|1326041732|CHC13|J3121||10/01/2017|09/30/2018|$0.05|0|0|0||INJ TESTOSTERO ENANTHATE 1MG|| 58-1699775|1326041732|CHC13|J3130||10/01/2014|12/31/9999|$9.51|0|0|||TESTOSTERONE ENANTHATE INJ|| 58-1699775|1326041732|CHC13|J3230||10/01/2016|09/30/2017|$28.93|0|0|0||CHLORPROMAZINE HCL INJECTION|| 58-1699775|1326041732|CHC13|J3230||10/01/2017|09/30/2018|$34.64|0|0|0||CHLORPROMAZINE HCL INJECTION|| 58-1699775|1326041732|CHC13|J3240||10/01/2016|09/30/2017|$1|961.93|0|0|0||THYROTROPIN INJECTION|| 58-1699775|1326041732|CHC13|J3240||10/01/2017|09/30/2018|$1|955.32|0|0|0||THYROTROPIN INJECTION|| 58-1699775|1326041732|CHC13|J3243||10/01/2016|09/30/2017|$3.44|0|0|0||TIGECYCLINE INJECTION|| 58-1699775|1326041732|CHC13|J3243||10/01/2017|09/30/2018|$4.09|0|0|0||TIGECYCLINE INJECTION|| 58-1699775|1326041732|CHC13|J3246||11/01/2013|12/31/9999|$10.05|0|0|||TIROFIBAN HCL|| 58-1699775|1326041732|CHC13|J3250||10/01/2016|09/30/2017|$31.61|0|0|0||TRIMETHOBENZAMIDE HCL INJ|| 58-1699775|1326041732|CHC13|J3250||10/01/2017|09/30/2018|$36.84|0|0|0||TRIMETHOBENZAMIDE HCL INJ|| 58-1699775|1326041732|CHC13|J3260||10/01/2016|09/30/2017|$2.62|0|0|0||TOBRAMYCIN SULFATE INJECTION|| 58-1699775|1326041732|CHC13|J3260||10/01/2017|09/30/2018|$2.34|0|0|0||TOBRAMYCIN SULFATE INJECTION|| 58-1699775|1326041732|CHC13|J3262||10/01/2016|09/30/2017|$5.16|0|0|0||TOCILIZUMAB INJECTION|| 58-1699775|1326041732|CHC13|J3262||10/01/2017|09/30/2018|$5.46|0|0|0||TOCILIZUMAB INJECTION|| 58-1699775|1326041732|CHC13|J3285||10/01/2016|09/30/2017|$76.55|0|0|0||TREPROSTINIL INJECTION|| 58-1699775|1326041732|CHC13|J3285||10/01/2017|09/30/2018|$76.55|0|0|0||TREPROSTINIL INJECTION|| 58-1699775|1326041732|CHC13|J3300||10/01/2016|09/30/2017|$4.62|0|0|0||TRIAMCINOLONE A INJ PRS-FREE|| 58-1699775|1326041732|CHC13|J3300||10/01/2017|09/30/2018|$4.87|0|0|0||TRIAMCINOLONE A INJ PRS-FREE|| 58-1699775|1326041732|CHC13|J3301||10/01/2016|09/30/2017|$2.23|0|0|0||TRIAMCINOLONE ACETONIDE INJ|| 58-1699775|1326041732|CHC13|J3301||10/01/2017|09/30/2018|$2.36|0|0|0||TRIAMCINOLONE ACETONIDE INJ|| 58-1699775|1326041732|CHC13|J3302||11/01/2013|12/31/9999|$0.35|0|0|||TRIAMCINOLONE DIACETATE INJ|| 58-1699775|1326041732|CHC13|J3303||10/01/2016|09/30/2017|$2.27|0|0|0||TRIAMCINOLONE HEXACETONL INJ|| 58-1699775|1326041732|CHC13|J3315||10/01/2016|09/30/2017|$490.07|0|0|0||TRIPTORELIN PAMOATE|| 58-1699775|1326041732|CHC13|J3315||10/01/2017|09/30/2018|$349.20|0|0|0||TRIPTORELIN PAMOATE|| 58-1699775|1326041732|CHC13|J3355||11/01/2013|12/31/9999|$80.52|0|0|||UROFOLLITROPIN| 75 IU|| 58-1699775|1326041732|CHC13|J3357||10/01/2016|09/30/2017|$209.66|0|0|0||USTEKINUMAB INJECTION|| 58-1699775|1326041732|CHC13|J3357||10/01/2017|09/30/2018|$229.07|0|0|0||USTEKINUMAB INJECTION|| 58-1699775|1326041732|CHC13|J3360||10/01/2016|09/30/2017|$11.61|0|0|0||DIAZEPAM INJECTION|| 58-1699775|1326041732|CHC13|J3360||10/01/2017|09/30/2018|$12.32|0|0|0||DIAZEPAM INJECTION|| 58-1699775|1326041732|CHC13|J3370||10/01/2016|09/30/2017|$3.55|0|0|0||VANCOMYCIN HCL INJECTION|| 58-1699775|1326041732|CHC13|J3370||10/01/2017|09/30/2018|$3.20|0|0|0||VANCOMYCIN HCL INJECTION|| 58-1699775|1326041732|CHC13|J3380||10/01/2016|09/30/2017|$21.28|0|0|0||INJ ISOXSUPRINE HCL TO 10 MG|| 58-1699775|1326041732|CHC13|J3380||10/01/2017|09/30/2018|$22.58|0|0|0||INJ ISOXSUPRINE HCL TO 10 MG|| 58-1699775|1326041732|CHC13|J3385||10/01/2016|09/30/2017|$428.89|0|0|0||VELAGLUCERASE ALFA|| 58-1699775|1326041732|CHC13|J3385||10/01/2017|09/30/2018|$427.73|0|0|0||VELAGLUCERASE ALFA|| 58-1699775|1326041732|CHC13|J3396||10/01/2016|09/30/2017|$13.65|0|0|0||VERTEPORFIN INJECTION|| 58-1699775|1326041732|CHC13|J3396||10/01/2017|09/30/2018|$13.45|0|0|0||VERTEPORFIN INJECTION|| 58-1699775|1326041732|CHC13|J3410||10/01/2016|09/30/2017|$2.60|0|0|0||HYDROXYZINE HCL INJECTION|| 58-1699775|1326041732|CHC13|J3410||10/01/2017|09/30/2018|$2.65|0|0|0||HYDROXYZINE HCL INJECTION|| 58-1699775|1326041732|CHC13|J3411||10/01/2016|09/30/2017|$4.11|0|0|0||THIAMINE HCL 100 MG|| 58-1699775|1326041732|CHC13|J3411||10/01/2017|09/30/2018|$3.81|0|0|0||THIAMINE HCL 100 MG|| 58-1699775|1326041732|CHC13|J3415||10/01/2016|09/30/2017|$11.64|0|0|0||PYRIDOXINE HCL 100 MG|| 58-1699775|1326041732|CHC13|J3415||10/01/2017|09/30/2018|$12.75|0|0|0||PYRIDOXINE HCL 100 MG|| 58-1699775|1326041732|CHC13|J3420||10/01/2016|09/30/2017|$5.99|0|0|0||VITAMIN B12 INJECTION|| 58-1699775|1326041732|CHC13|J3420||10/01/2017|09/30/2018|$3.14|0|0|0||VITAMIN B12 INJECTION|| 58-1699775|1326041732|CHC13|J3430||10/01/2016|09/30/2017|$4.22|0|0|0||VITAMIN K PHYTONADIONE INJ|| 58-1699775|1326041732|CHC13|J3430||10/01/2017|09/30/2018|$5.11|0|0|0||VITAMIN K PHYTONADIONE INJ|| 58-1699775|1326041732|CHC13|J3465||10/01/2016|09/30/2017|$5.11|0|0|0||INJECTION| VORICONAZOLE|| 58-1699775|1326041732|CHC13|J3465||10/01/2017|09/30/2018|$4.07|0|0|0||INJECTION| VORICONAZOLE|| 58-1699775|1326041732|CHC13|J3470||11/01/2013|12/31/9999|$26.50|0|0|||HYALURONIDASE INJECTION|| 58-1699775|1326041732|CHC13|J3471||10/01/2016|09/30/2017|$0.44|0|0|0||OVINE| UP TO 999 USP UNITS|| 58-1699775|1326041732|CHC13|J3471||10/01/2017|09/30/2018|$0.48|0|0|0||OVINE| UP TO 999 USP UNITS|| 58-1699775|1326041732|CHC13|J3473||10/01/2016|09/30/2017|$0.45|0|0|0||HYALURONIDASE RECOMBINANT|| 58-1699775|1326041732|CHC13|J3473||10/01/2017|09/30/2018|$0.45|0|0|0||HYALURONIDASE RECOMBINANT|| 58-1699775|1326041732|CHC13|J3475||10/01/2016|09/30/2017|$0.29|0|0|0||INJ MAGNESIUM SULFATE|| 58-1699775|1326041732|CHC13|J3475||10/01/2017|09/30/2018|$0.68|0|0|0||INJ MAGNESIUM SULFATE|| 58-1699775|1326041732|CHC13|J3480||10/01/2016|09/30/2017|$0.17|0|0|0||INJ POTASSIUM CHLORIDE|| 58-1699775|1326041732|CHC13|J3480||10/01/2017|09/30/2018|$0.17|0|0|0||INJ POTASSIUM CHLORIDE|| 58-1699775|1326041732|CHC13|J3485||10/01/2016|09/30/2017|$1.88|0|0|0||ZIDOVUDINE|| 58-1699775|1326041732|CHC13|J3485||10/01/2017|09/30/2018|$1.90|0|0|0||ZIDOVUDINE|| 58-1699775|1326041732|CHC13|J3486||10/01/2016|09/30/2017|$22.17|0|0|0||ZIPRASIDONE MESYLATE|| 58-1699775|1326041732|CHC13|J3486||10/01/2017|09/30/2018|$27.10|0|0|0||ZIPRASIDONE MESYLATE|| 58-1699775|1326041732|CHC13|J3489||10/01/2016|09/30/2017|$23.06|0|0|0||INJ| ZOLEDRONIC ACID 1MG|| 58-1699775|1326041732|CHC13|J3489||10/01/2017|09/30/2018|$15.04|0|0|0||INJ| ZOLEDRONIC ACID 1MG|| 58-1699775|1326041732|CHC13|J7030||10/01/2016|09/30/2017|$2.53|0|0|0||NORMAL SALINE SOLUTION INFUS|| 58-1699775|1326041732|CHC13|J7030||10/01/2017|09/30/2018|$2.49|0|0|0||NORMAL SALINE SOLUTION INFUS|| 58-1699775|1326041732|CHC13|J7040||10/01/2016|09/30/2017|$1.26|0|0|0||NORMAL SALINE SOLUTION INFUS|| 58-1699775|1326041732|CHC13|J7040||10/01/2017|09/30/2018|$1.25|0|0|0||NORMAL SALINE SOLUTION INFUS|| 58-1699775|1326041732|CHC13|J7042||10/01/2016|09/30/2017|$0.89|0|0|0||5% DEXTROSE/NORMAL SALINE|| 58-1699775|1326041732|CHC13|J7042||10/01/2017|09/30/2018|$1.10|0|0|0||5% DEXTROSE/NORMAL SALINE|| 58-1699775|1326041732|CHC13|J7050||10/01/2016|09/30/2017|$0.63|0|0|0||NORMAL SALINE SOLUTION INFUS|| 58-1699775|1326041732|CHC13|J7050||10/01/2017|09/30/2018|$0.61|0|0|0||NORMAL SALINE SOLUTION INFUS|| 58-1699775|1326041732|CHC13|J7060||10/01/2016|09/30/2017|$2.24|0|0|0||5% DEXTROSE/WATER|| 58-1699775|1326041732|CHC13|J7060||10/01/2017|09/30/2018|$2.58|0|0|0||5% DEXTROSE/WATER|| 58-1699775|1326041732|CHC13|J7070||10/01/2016|09/30/2017|$4.39|0|0|0||D5W INFUSION|| 58-1699775|1326041732|CHC13|J7070||10/01/2017|09/30/2018|$5.03|0|0|0||D5W INFUSION|| 58-1699775|1326041732|CHC13|J7100||10/01/2014|12/31/9999|$23.65|0|0|||DEXTRAN 40 INFUSION|| 58-1699775|1326041732|CHC13|J7120||10/01/2016|09/30/2017|$2.48|0|0|0||RINGERS LACTATE INFUSION|| 58-1699775|1326041732|CHC13|J7120||10/01/2017|09/30/2018|$3.00|0|0|0||RINGERS LACTATE INFUSION|| 58-1699775|1326041732|CHC13|J7180||10/01/2016|09/30/2017|$10.24|0|0|0||FACTOR XIII ANTI-HEM FACTOR|| 58-1699775|1326041732|CHC13|J7180||10/01/2017|09/30/2018|$10.24|0|0|0||FACTOR XIII ANTI-HEM FACTOR|| 58-1699775|1326041732|CHC13|J7182||10/01/2016|09/30/2017|$1.69|0|0|0||FACTOR VIII RECOMB NOVOEIGHT P|| 58-1699775|1326041732|CHC13|J7182||10/01/2017|09/30/2018|$1.64|0|0|0||FACTOR VIII RECOMB NOVOEIGHT P|| 58-1699775|1326041732|CHC13|J7183||10/01/2016|09/30/2017|$1.00|0|0|0||WILATE INJECTION|| 58-1699775|1326041732|CHC13|J7183||10/01/2017|09/30/2018|$1.29|0|0|0||WILATE INJECTION|| 58-1699775|1326041732|CHC13|J7185||10/01/2016|09/30/2017|$1.55|0|0|0||XYNTHA INJ|| 58-1699775|1326041732|CHC13|J7185||10/01/2017|09/30/2018|$1.58|0|0|0||XYNTHA INJ|| 58-1699775|1326041732|CHC13|J7186||10/01/2016|09/30/2017|$1.21|0|0|0||ANTIHEMOPHILIC VIII/VWF COMP|| 58-1699775|1326041732|CHC13|J7186||10/01/2017|09/30/2018|$1.18|0|0|0||ANTIHEMOPHILIC VIII/VWF COMP|| 58-1699775|1326041732|CHC13|J7187||10/01/2016|09/30/2017|$1.29|0|0|0||INJ VONWILLEBRAND FACTOR IU|| 58-1699775|1326041732|CHC13|J7187||10/01/2017|09/30/2018|$1.36|0|0|0||INJ VONWILLEBRAND FACTOR IU|| 58-1699775|1326041732|CHC13|J7189||10/01/2016|09/30/2017|$2.38|0|0|0||FACTOR VIIA|| 58-1699775|1326041732|CHC13|J7189||10/01/2017|09/30/2018|$2.47|0|0|0||FACTOR VIIA|| 58-1699775|1326041732|CHC13|J7190||10/01/2016|09/30/2017|$1.22|0|0|0||FACTOR VIII|| 58-1699775|1326041732|CHC13|J7190||10/01/2017|09/30/2018|$1.23|0|0|0||FACTOR VIII|| 58-1699775|1326041732|CHC13|J7192||10/01/2016|09/30/2017|$1.50|0|0|0||FACTOR VIII RECOMBINANT|| 58-1699775|1326041732|CHC13|J7192||10/01/2017|09/30/2018|$1.53|0|0|0||FACTOR VIII RECOMBINANT|| 58-1699775|1326041732|CHC13|J7193||10/01/2016|09/30/2017|$1.39|0|0|0||FACTOR IX NON-RECOMBINANT|| 58-1699775|1326041732|CHC13|J7193||10/01/2017|09/30/2018|$1.41|0|0|0||FACTOR IX NON-RECOMBINANT|| 58-1699775|1326041732|CHC13|J7194||10/01/2016|09/30/2017|$1.60|0|0|0||FACTOR IX COMPLEX|| 58-1699775|1326041732|CHC13|J7194||10/01/2017|09/30/2018|$1.74|0|0|0||FACTOR IX COMPLEX|| 58-1699775|1326041732|CHC13|J7195||10/01/2016|09/30/2017|$1.89|0|0|0||FACTOR IX RECOMBINANT|| 58-1699775|1326041732|CHC13|J7195||10/01/2017|09/30/2018|$1.88|0|0|0||FACTOR IX RECOMBINANT|| 58-1699775|1326041732|CHC13|J7197||10/01/2016|09/30/2017|$4.52|0|0|0||ANTITHROMBIN III INJECTION|| 58-1699775|1326041732|CHC13|J7197||10/01/2017|09/30/2018|$4.03|0|0|0||ANTITHROMBIN III INJECTION|| 58-1699775|1326041732|CHC13|J7198||10/01/2016|09/30/2017|$2.41|0|0|0||ANTI-INHIBITOR|| 58-1699775|1326041732|CHC13|J7198||10/01/2017|09/30/2018|$2.42|0|0|0||ANTI-INHIBITOR|| 58-1699775|1326041732|CHC13|J7200||10/01/2016|09/30/2017|$1.56|0|0|0||FACTOR IX RECOMBINAN RIXUBIS P|| 58-1699775|1326041732|CHC13|J7200||10/01/2017|09/30/2018|$1.60|0|0|0||FACTOR IX RECOMBINAN RIXUBIS P|| 58-1699775|1326041732|CHC13|J7201||10/01/2016|09/30/2017|$3.52|0|0|0||FACTOR IX FC FUSION RECOMB| PE|| 58-1699775|1326041732|CHC13|J7201||10/01/2017|09/30/2018|$3.73|0|0|0||FACTOR IX FC FUSION RECOMB| PE|| 58-1699775|1326041732|CHC13|J7205||10/01/2016|09/30/2017|$2.37|0|0|0||FACTOR VIII FC FUSION RECOMB P|| 58-1699775|1326041732|CHC13|J7205||10/01/2017|09/30/2018|$2.53|0|0|0||FACTOR VIII FC FUSION RECOMB P|| 58-1699775|1326041732|CHC13|J7297||01/01/2016|12/31/9999|$65.00|0|0||%|LEVONORGESTREL IU 52 MG 3 YR D|| 58-1699775|1326041732|CHC13|J7298||01/01/2016|12/31/9999|$65.00|0|0||%|LEVONORGESTREL IU 52 MG 5 YR D|| 58-1699775|1326041732|CHC13|J7300||11/01/2013|12/31/9999|$616.00|0|0|||INTRAUT COPPER CONTRACEPTIVE|| 58-1699775|1326041732|CHC13|J7301||01/01/2014|12/31/9999|$65.00|0|0||%|SKYLA 13.5 MG|%| 58-1699775|1326041732|CHC13|J7302||01/01/2014|12/31/9999|$850.00|0|0|||LEVONORGESTREL IU CONTRACEPT|| 58-1699775|1326041732|CHC13|J7307||07/01/2015|12/31/9999|$887.25|0|0|||ETONOGESTREL IMPLANT SYSTEM|| 58-1699775|1326041732|CHC13|J7308||10/01/2016|09/30/2017|$409.27|0|0|0||AMINOLEVULINIC ACID HCL TOP|| 58-1699775|1326041732|CHC13|J7308||10/01/2017|09/30/2018|$459.76|0|0|0||AMINOLEVULINIC ACID HCL TOP|| 58-1699775|1326041732|CHC13|J7309||10/01/2014|12/31/9999|$83.69|0|0|||METHYL AMINOLEVULINATE| TOP|| 58-1699775|1326041732|CHC13|J7310||10/01/2015|12/31/9999|$21|200.00|0|0|0||GANCICLOVIR LONG ACT IMPLANT|| 58-1699775|1326041732|CHC13|J7311||10/01/2016|09/30/2017|$25|173.26|0|0|0||FLUOCINOLONE ACETONIDE IMPLT|| 58-1699775|1326041732|CHC13|J7311||10/01/2017|09/30/2018|$25|179.06|0|0|0||FLUOCINOLONE ACETONIDE IMPLT|| 58-1699775|1326041732|CHC13|J7312||10/01/2016|09/30/2017|$247.26|0|0|0||DEXAMETHASONE INTRA IMPLANT|| 58-1699775|1326041732|CHC13|J7312||10/01/2017|09/30/2018|$250.95|0|0|0||DEXAMETHASONE INTRA IMPLANT|| 58-1699775|1326041732|CHC13|J7313||10/01/2016|09/30/2017|$613.68|0|0|0||FLUOCINOL ACET INTRAVIT IMP 0.|| 58-1699775|1326041732|CHC13|J7313||10/01/2017|09/30/2018|$613.68|0|0|0||FLUOCINOL ACET INTRAVIT IMP 0.|| 58-1699775|1326041732|CHC13|J7316||10/01/2016|09/30/2017|$1|308.44|0|0|0||SODIM HYALURONATE 5 MG ARTICLR|| 58-1699775|1326041732|CHC13|J7316||10/01/2017|09/30/2018|$1|308.44|0|0|0||SODIM HYALURONATE 5 MG ARTICLR|| 58-1699775|1326041732|CHC13|J7320||10/01/2017|09/30/2018|$8.83|0|0|0||HYLAN G-F 20 INJECTION|| 58-1699775|1326041732|CHC13|J7321||10/01/2016|09/30/2017|$108.24|0|0|0||HYALGAN/SUPARTZ INJ PER DOSE|| 58-1699775|1326041732|CHC13|J7321||10/01/2017|09/30/2018|$106.92|0|0|0||HYALGAN/SUPARTZ INJ PER DOSE|| 58-1699775|1326041732|CHC13|J7323||10/01/2016|09/30/2017|$196.98|0|0|0||EUFLEXXA INJ PER DOSE|| 58-1699775|1326041732|CHC13|J7323||10/01/2017|09/30/2018|$190.41|0|0|0||EUFLEXXA INJ PER DOSE|| 58-1699775|1326041732|CHC13|J7324||10/01/2016|09/30/2017|$199.73|0|0|0||ORTHOVISC INJ PER DOSE|| 58-1699775|1326041732|CHC13|J7324||10/01/2017|09/30/2018|$178.40|0|0|0||ORTHOVISC INJ PER DOSE|| 58-1699775|1326041732|CHC13|J7325||10/01/2016|09/30/2017|$15.61|0|0|0||SYNVISC OR SYNVISC-ONE|| 58-1699775|1326041732|CHC13|J7325||10/01/2017|09/30/2018|$15.86|0|0|0||SYNVISC OR SYNVISC-ONE|| 58-1699775|1326041732|CHC13|J7326||10/01/2016|09/30/2017|$762.63|0|0|0||GEL-ONE|| 58-1699775|1326041732|CHC13|J7326||10/01/2017|09/30/2018|$697.66|0|0|0||GEL-ONE|| 58-1699775|1326041732|CHC13|J7327||10/01/2016|09/30/2017|$1|138.42|0|0|0||MONOVISC INJ PER DOSE|| 58-1699775|1326041732|CHC13|J7327||10/01/2017|09/30/2018|$1|084.24|0|0|0||MONOVISC INJ PER DOSE|| 58-1699775|1326041732|CHC13|J7330||11/01/2013|12/31/9999|$37|490.35|0|0|||CULTURED CHONDROCYTES IMPLNT|| 58-1699775|1326041732|CHC13|J7335||10/01/2014|12/31/9999|$26.51|0|0|||CAPSAICIN 8% PATCH|| 58-1699775|1326041732|CHC13|J7336||10/01/2016|09/30/2017|$3.72|0|0|0||CAPSAICIN 8% PATCH| PER SQ CM|| 58-1699775|1326041732|CHC13|J7336||10/01/2017|09/30/2018|$4.00|0|0|0||CAPSAICIN 8% PATCH| PER SQ CM|| 58-1699775|1326041732|CHC13|J7500||10/01/2016|09/30/2017|$0.40|0|0|0||AZATHIOPRINE ORAL 50MG|| 58-1699775|1326041732|CHC13|J7500||10/01/2017|09/30/2018|$0.41|0|0|0||AZATHIOPRINE ORAL 50MG|| 58-1699775|1326041732|CHC13|J7501||10/01/2015|12/31/9999|$271.63|0|0|0||AZATHIOPRINE PARENTERAL|| 58-1699775|1326041732|CHC13|J7502||10/01/2016|09/30/2017|$4.29|0|0|0||CYCLOSPORINE ORAL 100 MG|| 58-1699775|1326041732|CHC13|J7502||10/01/2017|09/30/2018|$3.46|0|0|0||CYCLOSPORINE ORAL 100 MG|| 58-1699775|1326041732|CHC13|J7503||10/01/2016|09/30/2017|$1.35|0|0|0||CYCLOSPORINE PARENTERAL|| 58-1699775|1326041732|CHC13|J7503||10/01/2017|09/30/2018|$1.55|0|0|0||CYCLOSPORINE PARENTERAL|| 58-1699775|1326041732|CHC13|J7504||10/01/2016|09/30/2017|$1|612.20|0|0|0||LYMPHOCYTE IMMUNE GLOBULIN|| 58-1699775|1326041732|CHC13|J7504||10/01/2017|09/30/2018|$2|193.33|0|0|0||LYMPHOCYTE IMMUNE GLOBULIN|| 58-1699775|1326041732|CHC13|J7505||11/01/2013|12/31/9999|$1|445.10|0|0|||MONOCLONAL ANTIBODIES|| 58-1699775|1326041732|CHC13|J7506||10/01/2015|12/31/9999|$0.09|0|0|0||PREDNISONE ORAL|| 58-1699775|1326041732|CHC13|J7507||10/01/2016|09/30/2017|$1.02|0|0|0||TACROLIMUS ORAL PER 1 MG|| 58-1699775|1326041732|CHC13|J7507||10/01/2017|09/30/2018|$0.75|0|0|0||TACROLIMUS ORAL PER 1 MG|| 58-1699775|1326041732|CHC13|J7508||10/01/2016|09/30/2017|$0.49|0|0|0||TACROLIMUS ORAL PER 5 MG|| 58-1699775|1326041732|CHC13|J7508||10/01/2017|09/30/2018|$0.53|0|0|0||TACROLIMUS ORAL PER 5 MG|| 58-1699775|1326041732|CHC13|J7509||10/01/2016|09/30/2017|$0.39|0|0|0||METHYLPREDNISOLONE ORAL|| 58-1699775|1326041732|CHC13|J7509||10/01/2017|09/30/2018|$0.52|0|0|0||METHYLPREDNISOLONE ORAL|| 58-1699775|1326041732|CHC13|J7510||10/01/2016|09/30/2017|$0.15|0|0|0||PREDNISOLONE ORAL PER 5 MG|| 58-1699775|1326041732|CHC13|J7510||10/01/2017|09/30/2018|$0.08|0|0|0||PREDNISOLONE ORAL PER 5 MG|| 58-1699775|1326041732|CHC13|J7511||10/01/2016|09/30/2017|$845.25|0|0|0||ANTITHYMOCYTE GLOBULN RABBIT|| 58-1699775|1326041732|CHC13|J7511||10/01/2017|09/30/2018|$882.66|0|0|0||ANTITHYMOCYTE GLOBULN RABBIT|| 58-1699775|1326041732|CHC13|J7512||10/01/2016|09/30/2017|$0.01|0|0|0||PREDNISONE IR OR DR ORAL 1 MG|| 58-1699775|1326041732|CHC13|J7512||10/01/2017|09/30/2018|$0.01|0|0|0||PREDNISONE IR OR DR ORAL 1 MG|| 58-1699775|1326041732|CHC13|J7513||11/01/2013|12/31/9999|$657.93|0|0|||DACLIZUMAB| PARENTERAL|| 58-1699775|1326041732|CHC13|J7515||10/01/2016|09/30/2017|$1.16|0|0|0||CYCLOSPORINE ORAL 25 MG|| 58-1699775|1326041732|CHC13|J7515||10/01/2017|09/30/2018|$0.98|0|0|0||CYCLOSPORINE ORAL 25 MG|| 58-1699775|1326041732|CHC13|J7516||10/01/2016|09/30/2017|$54.78|0|0|0||CYCLOSPORIN PARENTERAL 250MG|| 58-1699775|1326041732|CHC13|J7516||10/01/2017|09/30/2018|$53.14|0|0|0||CYCLOSPORIN PARENTERAL 250MG|| 58-1699775|1326041732|CHC13|J7517||10/01/2016|09/30/2017|$1.41|0|0|0||MYCOPHENOLATE MOFETIL ORAL|| 58-1699775|1326041732|CHC13|J7517||10/01/2017|09/30/2018|$1.25|0|0|0||MYCOPHENOLATE MOFETIL ORAL|| 58-1699775|1326041732|CHC13|J7518||10/01/2016|09/30/2017|$3.82|0|0|0||MYCOPHENOLIC ACID|| 58-1699775|1326041732|CHC13|J7518||10/01/2017|09/30/2018|$3.39|0|0|0||MYCOPHENOLIC ACID|| 58-1699775|1326041732|CHC13|J7520||10/01/2016|09/30/2017|$9.84|0|0|0||SIROLIMUS| ORAL|| 58-1699775|1326041732|CHC13|J7520||10/01/2017|09/30/2018|$9.68|0|0|0||SIROLIMUS| ORAL|| 58-1699775|1326041732|CHC13|J7525||10/01/2016|09/30/2017|$204.63|0|0|0||TACROLIMUS INJECTION|| 58-1699775|1326041732|CHC13|J7525||10/01/2017|09/30/2018|$231.55|0|0|0||TACROLIMUS INJECTION|| 58-1699775|1326041732|CHC13|J7527||10/01/2016|09/30/2017|$9.62|0|0|0||ORAL EVEROLIMUS|| 58-1699775|1326041732|CHC13|J7527||10/01/2017|09/30/2018|$10.16|0|0|0||ORAL EVEROLIMUS|| 58-1699775|1326041732|CHC13|J7605||10/01/2016|09/30/2017|$10.96|0|0|0||ARFORMOTEROL NON-COMP UNIT|| 58-1699775|1326041732|CHC13|J7605||10/01/2017|09/30/2018|$11.61|0|0|0||ARFORMOTEROL NON-COMP UNIT|| 58-1699775|1326041732|CHC13|J7606||10/01/2016|09/30/2017|$13.05|0|0|0||FORMOTEROL FUMARATE| INH|| 58-1699775|1326041732|CHC13|J7606||10/01/2017|09/30/2018|$12.97|0|0|0||FORMOTEROL FUMARATE| INH|| 58-1699775|1326041732|CHC13|J7608||10/01/2016|09/30/2017|$5.86|0|0|0||ACETYLCYSTEINE INH SOL U D|| 58-1699775|1326041732|CHC13|J7608||10/01/2017|09/30/2018|$5.59|0|0|0||ACETYLCYSTEINE INH SOL U D|| 58-1699775|1326041732|CHC13|J7611||10/01/2016|09/30/2017|$0.14|0|0|0||ALBUTEROL CONCENTRATED FORM|| 58-1699775|1326041732|CHC13|J7611||10/01/2017|09/30/2018|$0.17|0|0|0||ALBUTEROL CONCENTRATED FORM|| 58-1699775|1326041732|CHC13|J7612||10/01/2016|09/30/2017|$0.29|0|0|0||LEVALBUTEROL CONCENTRATED|| 58-1699775|1326041732|CHC13|J7612||10/01/2017|09/30/2018|$0.26|0|0|0||LEVALBUTEROL CONCENTRATED|| 58-1699775|1326041732|CHC13|J7613||10/01/2016|09/30/2017|$0.06|0|0|0||ALBUTEROL UNIT DOSE|| 58-1699775|1326041732|CHC13|J7613||10/01/2017|09/30/2018|$0.06|0|0|0||ALBUTEROL UNIT DOSE|| 58-1699775|1326041732|CHC13|J7614||10/01/2016|09/30/2017|$0.09|0|0|0||LEVALBUTEROL UNIT DOSE|| 58-1699775|1326041732|CHC13|J7614||10/01/2017|09/30/2018|$0.07|0|0|0||LEVALBUTEROL UNIT DOSE|| 58-1699775|1326041732|CHC13|J7620||10/01/2016|09/30/2017|$0.21|0|0|0||ALBUTEROL NON-COMPOUNDED|| 58-1699775|1326041732|CHC13|J7620||10/01/2017|09/30/2018|$0.18|0|0|0||ALBUTEROL NON-COMPOUNDED|| 58-1699775|1326041732|CHC13|J7626||10/01/2016|09/30/2017|$5.36|0|0|0||BUDESONIDE| NON-COMPOUNDED|| 58-1699775|1326041732|CHC13|J7626||10/01/2017|09/30/2018|$4.59|0|0|0||BUDESONIDE| NON-COMPOUNDED|| 58-1699775|1326041732|CHC13|J7631||10/01/2016|09/30/2017|$1.02|0|0|0||CROMOLYN SODIUM INH SOL U D|| 58-1699775|1326041732|CHC13|J7631||10/01/2017|09/30/2018|$1.01|0|0|0||CROMOLYN SODIUM INH SOL U D|| 58-1699775|1326041732|CHC13|J7638||10/01/2014|12/31/9999|$19.37|0|0|||DEXAMETHASONE INHAL SOL U D|| 58-1699775|1326041732|CHC13|J7639||10/01/2016|09/30/2017|$52.87|0|0|0||DORNASE ALPHA INHAL SOL U D|| 58-1699775|1326041732|CHC13|J7639||10/01/2017|09/30/2018|$56.36|0|0|0||DORNASE ALPHA INHAL SOL U D|| 58-1699775|1326041732|CHC13|J7644||10/01/2016|09/30/2017|$0.26|0|0|0||IPRATROPIUM BROM INH SOL U D|| 58-1699775|1326041732|CHC13|J7644||10/01/2017|09/30/2018|$0.28|0|0|0||IPRATROPIUM BROM INH SOL U D|| 58-1699775|1326041732|CHC13|J7645||10/01/2015|12/31/9999|$0.27|0|0|||IPRATROPIUM BROM 0.02% PER ML\|| 58-1699775|1326041732|CHC13|J7665||10/01/2015|12/31/9999|$0.84|0|0|0||ISOPROTERENOL HYDROCHLORIDE| 1|| 58-1699775|1326041732|CHC13|J7669||11/01/2013|12/31/9999|$0.55|0|0|||METAPROTERENOL INH SOL U D|| 58-1699775|1326041732|CHC13|J7674||10/01/2016|09/30/2017|$0.65|0|0|0||METHACHOLINE CHLORIDE| NEB|| 58-1699775|1326041732|CHC13|J7674||10/01/2017|09/30/2018|$0.68|0|0|0||METHACHOLINE CHLORIDE| NEB|| 58-1699775|1326041732|CHC13|J7682||10/01/2016|09/30/2017|$64.22|0|0|0||TOBRAMYCIN INHALATION SOL|| 58-1699775|1326041732|CHC13|J7682||10/01/2017|09/30/2018|$56.69|0|0|0||TOBRAMYCIN INHALATION SOL|| 58-1699775|1326041732|CHC13|J7686||10/01/2016|09/30/2017|$633.04|0|0|0||TREPROSTINIL| NON-COMP UNIT|| 58-1699775|1326041732|CHC13|J7686||10/01/2017|09/30/2018|$664.10|0|0|0||TREPROSTINIL| NON-COMP UNIT|| 58-1699775|1326041732|CHC13|J8501||10/01/2016|09/30/2017|$13.80|0|0|0||ORAL APREPITANT|| 58-1699775|1326041732|CHC13|J8501||10/01/2017|09/30/2018|$11.87|0|0|0||ORAL APREPITANT|| 58-1699775|1326041732|CHC13|J8510||10/01/2016|09/30/2017|$29.31|0|0|0||ORAL BUSULFAN|| 58-1699775|1326041732|CHC13|J8510||10/01/2017|09/30/2018|$31.04|0|0|0||ORAL BUSULFAN|| 58-1699775|1326041732|CHC13|J8520||10/01/2016|09/30/2017|$5.79|0|0|0||CAPECITABINE| ORAL| 150 MG|| 58-1699775|1326041732|CHC13|J8520||10/01/2017|09/30/2018|$3.79|0|0|0||CAPECITABINE| ORAL| 150 MG|| 58-1699775|1326041732|CHC13|J8521||10/01/2016|09/30/2017|$18.45|0|0|0||CAPECITABINE| ORAL| 500 MG|| 58-1699775|1326041732|CHC13|J8521||10/01/2017|09/30/2018|$9.98|0|0|0||CAPECITABINE| ORAL| 500 MG|| 58-1699775|1326041732|CHC13|J8530||10/01/2016|09/30/2017|$4.06|0|0|0||CYCLOPHOSPHAMIDE ORAL 25 MG|| 58-1699775|1326041732|CHC13|J8530||10/01/2017|09/30/2018|$4.38|0|0|0||CYCLOPHOSPHAMIDE ORAL 25 MG|| 58-1699775|1326041732|CHC13|J8540||10/01/2016|09/30/2017|$0.02|0|0|0||ORAL DEXAMETHASONE|| 58-1699775|1326041732|CHC13|J8540||10/01/2017|09/30/2018|$0.11|0|0|0||ORAL DEXAMETHASONE|| 58-1699775|1326041732|CHC13|J8560||10/01/2016|09/30/2017|$83.41|0|0|0||ETOPOSIDE ORAL 50 MG|| 58-1699775|1326041732|CHC13|J8560||10/01/2017|09/30/2018|$92.60|0|0|0||ETOPOSIDE ORAL 50 MG|| 58-1699775|1326041732|CHC13|J8562||11/01/2013|12/31/9999|$102.22|0|0|||ORAL FLUDARABINE PHOSPHATE|| 58-1699775|1326041732|CHC13|J8600||10/01/2016|09/30/2017|$14.05|0|0|0||MELPHALAN ORAL 2 MG|| 58-1699775|1326041732|CHC13|J8600||10/01/2017|09/30/2018|$14.65|0|0|0||MELPHALAN ORAL 2 MG|| 58-1699775|1326041732|CHC13|J8610||10/01/2016|09/30/2017|$1.26|0|0|0||METHOTREXATE ORAL 2.5 MG|| 58-1699775|1326041732|CHC13|J8610||10/01/2017|09/30/2018|$0.67|0|0|0||METHOTREXATE ORAL 2.5 MG|| 58-1699775|1326041732|CHC13|J8655||10/01/2016|09/30/2017|$581.13|0|0|0||NETUPITANT 300/PALONOSETRON 0.|| 58-1699775|1326041732|CHC13|J8655||10/01/2017|09/30/2018|$539.38|0|0|0||NETUPITANT 300/PALONOSETRON 0.|| 58-1699775|1326041732|CHC13|J8700||10/01/2016|09/30/2017|$3.60|0|0|0||TEMOZOLOMIDE|| 58-1699775|1326041732|CHC13|J8700||10/01/2017|09/30/2018|$2.34|0|0|0||TEMOZOLOMIDE|| 58-1699775|1326041732|CHC13|J8705||10/01/2016|09/30/2017|$129.77|0|0|0||TOPOTECAN ORAL|| 58-1699775|1326041732|CHC13|J8705||10/01/2017|09/30/2018|$129.72|0|0|0||TOPOTECAN ORAL|| 58-1699775|1326041732|CHC13|J9000||10/01/2016|09/30/2017|$3.30|0|0|0||DOXORUBIC HCL 10 MG VL CHEMO|| 58-1699775|1326041732|CHC13|J9000||10/01/2017|09/30/2018|$3.34|0|0|0||DOXORUBIC HCL 10 MG VL CHEMO|| 58-1699775|1326041732|CHC13|J9010||11/01/2013|12/31/9999|$779.55|0|0|||ALEMTUZUMAB INJECTION|| 58-1699775|1326041732|CHC13|J9015||10/01/2014|12/31/9999|$1|828.73|0|0|||ALDESLEUKIN/SINGLE USE VIAL|| 58-1699775|1326041732|CHC13|J9017||10/01/2016|09/30/2017|$81.40|0|0|0||ARSENIC TRIOXIDE|| 58-1699775|1326041732|CHC13|J9017||10/01/2017|09/30/2018|$88.67|0|0|0||ARSENIC TRIOXIDE|| 58-1699775|1326041732|CHC13|J9019||10/01/2016|09/30/2017|$498.07|0|0|0||ERWINAZE INJECTION|| 58-1699775|1326041732|CHC13|J9019||10/01/2017|09/30/2018|$503.43|0|0|0||ERWINAZE INJECTION|| 58-1699775|1326041732|CHC13|J9020||10/01/2015|12/31/9999|$80.71|0|0|0||ASPARAGINASE INJECTION|| 58-1699775|1326041732|CHC13|J9025||10/01/2016|09/30/2017|$3.54|0|0|0||AZACITIDINE INJECTION|| 58-1699775|1326041732|CHC13|J9025||10/01/2017|09/30/2018|$2.63|0|0|0||AZACITIDINE INJECTION|| 58-1699775|1326041732|CHC13|J9027||10/01/2016|09/30/2017|$188.30|0|0|0||CLOFARABINE INJECTION|| 58-1699775|1326041732|CHC13|J9027||10/01/2017|09/30/2018|$189.95|0|0|0||CLOFARABINE INJECTION|| 58-1699775|1326041732|CHC13|J9031||10/01/2016|09/30/2017|$154.24|0|0|0||BCG LIVE INTRAVESICAL VAC|| 58-1699775|1326041732|CHC13|J9031||10/01/2017|09/30/2018|$160.85|0|0|0||BCG LIVE INTRAVESICAL VAC|| 58-1699775|1326041732|CHC13|J9032||10/01/2016|09/30/2017|$41.73|0|0|0||INJECTION| BELINOSTAT| 10MG|| 58-1699775|1326041732|CHC13|J9032||10/01/2017|09/30/2018|$44.08|0|0|0||INJECTION| BELINOSTAT| 10MG|| 58-1699775|1326041732|CHC13|J9033||10/01/2016|09/30/2017|$30.93|0|0|0||BENDAMUSTINE INJECTION|| 58-1699775|1326041732|CHC13|J9033||10/01/2017|09/30/2018|$36.14|0|0|0||BENDAMUSTINE INJECTION|| 58-1699775|1326041732|CHC13|J9034||10/01/2017|09/30/2018|$29.43|0|0|0||INJECTION| BENDEKA 1 MG|| 58-1699775|1326041732|CHC13|J9035||10/01/2016|09/30/2017|$90.25|0|0|0||BEVACIZUMAB INJECTION|| 58-1699775|1326041732|CHC13|J9035||10/01/2017|09/30/2018|$93.55|0|0|0||BEVACIZUMAB INJECTION|| 58-1699775|1326041732|CHC13|J9039||10/01/2017|09/30/2018|$127.88|0|0|0||INJECTION| BLINATUMOMAB| 1 MIC|| 58-1699775|1326041732|CHC13|J9040||10/01/2016|09/30/2017|$26.87|0|0|0||BLEOMYCIN SULFATE INJECTION|| 58-1699775|1326041732|CHC13|J9040||10/01/2017|09/30/2018|$58.12|0|0|0||BLEOMYCIN SULFATE INJECTION|| 58-1699775|1326041732|CHC13|J9041||10/01/2016|09/30/2017|$58.20|0|0|0||BORTEZOMIB INJECTION|| 58-1699775|1326041732|CHC13|J9041||10/01/2017|09/30/2018|$58.55|0|0|0||BORTEZOMIB INJECTION|| 58-1699775|1326041732|CHC13|J9042||10/01/2016|09/30/2017|$161.61|0|0|0||BRENTUXIMAB VEDOTIN INJ|| 58-1699775|1326041732|CHC13|J9042||10/01/2017|09/30/2018|$174.69|0|0|0||BRENTUXIMAB VEDOTIN INJ|| 58-1699775|1326041732|CHC13|J9043||10/01/2016|09/30/2017|$187.64|0|0|0||CABAZITAXEL INJECTION|| 58-1699775|1326041732|CHC13|J9043||10/01/2017|09/30/2018|$196.15|0|0|0||CABAZITAXEL INJECTION|| 58-1699775|1326041732|CHC13|J9045||10/01/2016|09/30/2017|$4.53|0|0|0||CARBOPLATIN INJECTION|| 58-1699775|1326041732|CHC13|J9045||10/01/2017|09/30/2018|$4.27|0|0|0||CARBOPLATIN INJECTION|| 58-1699775|1326041732|CHC13|J9047||10/01/2016|09/30/2017|$39.74|0|0|0||INJECTION| CARFILZOMIB| 1 MG|| 58-1699775|1326041732|CHC13|J9047||10/01/2017|09/30/2018|$40.17|0|0|0||INJECTION| CARFILZOMIB| 1 MG|| 58-1699775|1326041732|CHC13|J9050||10/01/2016|09/30/2017|$4|775.94|0|0|0||CARMUS BISCHL NITRO INJ|| 58-1699775|1326041732|CHC13|J9050||10/01/2017|09/30/2018|$4|828.10|0|0|0||CARMUS BISCHL NITRO INJ|| 58-1699775|1326041732|CHC13|J9055||10/01/2016|09/30/2017|$69.96|0|0|0||CETUXIMAB INJECTION|| 58-1699775|1326041732|CHC13|J9055||10/01/2017|09/30/2018|$71.86|0|0|0||CETUXIMAB INJECTION|| 58-1699775|1326041732|CHC13|J9060||10/01/2016|09/30/2017|$2.52|0|0|0||CISPLATIN 10 MG INJECTION|| 58-1699775|1326041732|CHC13|J9060||10/01/2017|09/30/2018|$2.51|0|0|0||CISPLATIN 10 MG INJECTION|| 58-1699775|1326041732|CHC13|J9065||10/01/2016|09/30/2017|$27.42|0|0|0||INJ CLADRIBINE PER 1 MG|| 58-1699775|1326041732|CHC13|J9065||10/01/2017|09/30/2018|$26.52|0|0|0||INJ CLADRIBINE PER 1 MG|| 58-1699775|1326041732|CHC13|J9070||10/01/2016|09/30/2017|$52.73|0|0|0||CYCLOPHOSPHAMIDE 100 MG INJ|| 58-1699775|1326041732|CHC13|J9070||10/01/2017|09/30/2018|$52.70|0|0|0||CYCLOPHOSPHAMIDE 100 MG INJ|| 58-1699775|1326041732|CHC13|J9098||10/01/2016|09/30/2017|$739.14|0|0|0||CYTARABINE LIPOSOME|| 58-1699775|1326041732|CHC13|J9098||10/01/2017|09/30/2018|$764.26|0|0|0||CYTARABINE LIPOSOME|| 58-1699775|1326041732|CHC13|J9100||10/01/2016|09/30/2017|$1.10|0|0|0||CYTARABINE HCL 100 MG INJ|| 58-1699775|1326041732|CHC13|J9100||10/01/2017|09/30/2018|$1.03|0|0|0||CYTARABINE HCL 100 MG INJ|| 58-1699775|1326041732|CHC13|J9120||10/01/2016|09/30/2017|$1|572.54|0|0|0||DACTINOMYCIN ACTINOMYCIN D|| 58-1699775|1326041732|CHC13|J9120||10/01/2017|09/30/2018|$1|712.60|0|0|0||DACTINOMYCIN ACTINOMYCIN D|| 58-1699775|1326041732|CHC13|J9130||10/01/2016|09/30/2017|$4.95|0|0|0||DACARBAZINE 100 MG INJ|| 58-1699775|1326041732|CHC13|J9130||10/01/2017|09/30/2018|$4.89|0|0|0||DACARBAZINE 100 MG INJ|| 58-1699775|1326041732|CHC13|J9145||10/01/2017|09/30/2018|$60.77|0|0|0||INJECTION| DARATUMUMAB| 10 MG|| 58-1699775|1326041732|CHC13|J9150||10/01/2016|09/30/2017|$47.11|0|0|0||DAUNORUBICIN|| 58-1699775|1326041732|CHC13|J9150||10/01/2017|09/30/2018|$51.45|0|0|0||DAUNORUBICIN|| 58-1699775|1326041732|CHC13|J9155||10/01/2016|09/30/2017|$4.65|0|0|0||DEGARELIX INJECTION|| 58-1699775|1326041732|CHC13|J9155||10/01/2017|09/30/2018|$4.56|0|0|0||DEGARELIX INJECTION|| 58-1699775|1326041732|CHC13|J9160||11/01/2013|12/31/9999|$2|057.73|0|0|||DENILEUKIN DIFTITOX| 300 MCG|| 58-1699775|1326041732|CHC13|J9171||10/01/2016|09/30/2017|$3.41|0|0|0||DOCETAXEL INJECTION|| 58-1699775|1326041732|CHC13|J9171||10/01/2017|09/30/2018|$2.25|0|0|0||DOCETAXEL INJECTION|| 58-1699775|1326041732|CHC13|J9175||11/01/2013|12/31/9999|$5.10|0|0|||ELLIOTTS B SOLUTION PER ML|| 58-1699775|1326041732|CHC13|J9176||10/01/2017|09/30/2018|$7.85|0|0|0||INJECTION| ELOTUZUMAB| 1 MG|| 58-1699775|1326041732|CHC13|J9178||10/01/2016|09/30/2017|$1.61|0|0|0||INJ| EPIRUBICIN HCL| 2 MG|| 58-1699775|1326041732|CHC13|J9178||10/01/2017|09/30/2018|$1.51|0|0|0||INJ| EPIRUBICIN HCL| 2 MG|| 58-1699775|1326041732|CHC13|J9179||10/01/2016|09/30/2017|$132.97|0|0|0||ERIBULIN MESYLATE INJECTION|| 58-1699775|1326041732|CHC13|J9179||10/01/2017|09/30/2018|$137.01|0|0|0||ERIBULIN MESYLATE INJECTION|| 58-1699775|1326041732|CHC13|J9181||10/01/2016|09/30/2017|$0.90|0|0|0||ETOPOSIDE 10 MG INJ|| 58-1699775|1326041732|CHC13|J9181||10/01/2017|09/30/2018|$0.73|0|0|0||ETOPOSIDE 10 MG INJ|| 58-1699775|1326041732|CHC13|J9185||10/01/2016|09/30/2017|$80.55|0|0|0||FLUDARABINE PHOSPHATE INJ|| 58-1699775|1326041732|CHC13|J9185||10/01/2017|09/30/2018|$96.00|0|0|0||FLUDARABINE PHOSPHATE INJ|| 58-1699775|1326041732|CHC13|J9190||10/01/2016|09/30/2017|$2.34|0|0|0||FLUOROURACIL INJECTION|| 58-1699775|1326041732|CHC13|J9190||10/01/2017|09/30/2018|$2.06|0|0|0||FLUOROURACIL INJECTION|| 58-1699775|1326041732|CHC13|J9200||10/01/2016|09/30/2017|$20.34|0|0|0||FLOXURIDINE INJECTION|| 58-1699775|1326041732|CHC13|J9200||10/01/2017|09/30/2018|$92.35|0|0|0||FLOXURIDINE INJECTION|| 58-1699775|1326041732|CHC13|J9201||10/01/2016|09/30/2017|$8.81|0|0|0||GEMCITABINE HCL|| 58-1699775|1326041732|CHC13|J9201||10/01/2017|09/30/2018|$7.71|0|0|0||GEMCITABINE HCL|| 58-1699775|1326041732|CHC13|J9202||10/01/2016|09/30/2017|$380.33|0|0|0||GOSERELIN ACETATE IMPLANT|| 58-1699775|1326041732|CHC13|J9202||10/01/2017|09/30/2018|$407.51|0|0|0||GOSERELIN ACETATE IMPLANT|| 58-1699775|1326041732|CHC13|J9205||10/01/2017|09/30/2018|$50.37|0|0|0||INJECTION| IRINOTECAN LIPOSOME|| 58-1699775|1326041732|CHC13|J9206||10/01/2016|09/30/2017|$5.26|0|0|0||IRINOTECAN INJECTION|| 58-1699775|1326041732|CHC13|J9206||10/01/2017|09/30/2018|$4.42|0|0|0||IRINOTECAN INJECTION|| 58-1699775|1326041732|CHC13|J9207||10/01/2016|09/30/2017|$96.13|0|0|0||IXABEPILONE INJECTION|| 58-1699775|1326041732|CHC13|J9207||10/01/2017|09/30/2018|$92.61|0|0|0||IXABEPILONE INJECTION|| 58-1699775|1326041732|CHC13|J9208||10/01/2016|09/30/2017|$36.48|0|0|0||IFOSFOMIDE INJECTION|| 58-1699775|1326041732|CHC13|J9208||10/01/2017|09/30/2018|$34.07|0|0|0||IFOSFOMIDE INJECTION|| 58-1699775|1326041732|CHC13|J9209||10/01/2016|09/30/2017|$4.05|0|0|0||MESNA INJECTION|| 58-1699775|1326041732|CHC13|J9209||10/01/2017|09/30/2018|$2.71|0|0|0||MESNA INJECTION|| 58-1699775|1326041732|CHC13|J9211||10/01/2016|09/30/2017|$32.46|0|0|0||IDARUBICIN HCL INJECTION|| 58-1699775|1326041732|CHC13|J9211||10/01/2017|09/30/2018|$49.10|0|0|0||IDARUBICIN HCL INJECTION|| 58-1699775|1326041732|CHC13|J9214||10/01/2016|09/30/2017|$31.58|0|0|0||INTERFERON ALFA-2B INJ|| 58-1699775|1326041732|CHC13|J9214||10/01/2017|09/30/2018|$35.55|0|0|0||INTERFERON ALFA-2B INJ|| 58-1699775|1326041732|CHC13|J9217||10/01/2016|09/30/2017|$274.85|0|0|0||LEUPROLIDE ACETATE SUSPNSION|| 58-1699775|1326041732|CHC13|J9217||10/01/2017|09/30/2018|$252.65|0|0|0||LEUPROLIDE ACETATE SUSPNSION|| 58-1699775|1326041732|CHC13|J9218||10/01/2016|09/30/2017|$20.94|0|0|0||LEUPROLIDE ACETATE INJECITON|| 58-1699775|1326041732|CHC13|J9218||10/01/2017|09/30/2018|$32.16|0|0|0||LEUPROLIDE ACETATE INJECITON|| 58-1699775|1326041732|CHC13|J9225||10/01/2016|09/30/2017|$3|860.09|0|0|0||HISTRELIN IMPLANT|| 58-1699775|1326041732|CHC13|J9225||10/01/2017|09/30/2018|$4|003.89|0|0|0||HISTRELIN IMPLANT|| 58-1699775|1326041732|CHC13|J9226||10/01/2016|09/30/2017|$32|705.14|0|0|0||SUPPRELIN LA IMPLANT|| 58-1699775|1326041732|CHC13|J9226||10/01/2017|09/30/2018|$34|686.33|0|0|0||SUPPRELIN LA IMPLANT|| 58-1699775|1326041732|CHC13|J9228||10/01/2016|09/30/2017|$175.79|0|0|0||IPILIMUMAB INJECTION|| 58-1699775|1326041732|CHC13|J9228||10/01/2017|09/30/2018|$180.84|0|0|0||IPILIMUMAB INJECTION|| 58-1699775|1326041732|CHC13|J9230||10/01/2016|09/30/2017|$332.93|0|0|0||MECHLORETHAMINE HCL INJ|| 58-1699775|1326041732|CHC13|J9230||10/01/2017|09/30/2018|$366.11|0|0|0||MECHLORETHAMINE HCL INJ|| 58-1699775|1326041732|CHC13|J9245||10/01/2016|09/30/2017|$2|207.46|0|0|0||INJ MELPHALAN HYDROCHL 50 MG|| 58-1699775|1326041732|CHC13|J9245||10/01/2017|09/30/2018|$1|836.06|0|0|0||INJ MELPHALAN HYDROCHL 50 MG|| 58-1699775|1326041732|CHC13|J9250||10/01/2016|09/30/2017|$0.29|0|0|0||METHOTREXATE SODIUM INJ|| 58-1699775|1326041732|CHC13|J9250||10/01/2017|09/30/2018|$0.37|0|0|0||METHOTREXATE SODIUM INJ|| 58-1699775|1326041732|CHC13|J9260||10/01/2016|09/30/2017|$2.88|0|0|0||METHOTREXATE SODIUM INJ|| 58-1699775|1326041732|CHC13|J9260||10/01/2017|09/30/2018|$3.69|0|0|0||METHOTREXATE SODIUM INJ|| 58-1699775|1326041732|CHC13|J9261||10/01/2016|09/30/2017|$190.10|0|0|0||NELARABINE INJECTION|| 58-1699775|1326041732|CHC13|J9261||10/01/2017|09/30/2018|$190.01|0|0|0||NELARABINE INJECTION|| 58-1699775|1326041732|CHC13|J9263||10/01/2016|09/30/2017|$0.38|0|0|0||OXALIPLATIN|| 58-1699775|1326041732|CHC13|J9263||10/01/2017|09/30/2018|$0.22|0|0|0||OXALIPLATIN|| 58-1699775|1326041732|CHC13|J9264||10/01/2016|09/30/2017|$12.57|0|0|0||PACLITAXEL INJECTION|| 58-1699775|1326041732|CHC13|J9264||10/01/2017|09/30/2018|$13.44|0|0|0||PACLITAXEL INJECTION|| 58-1699775|1326041732|CHC13|J9265||10/01/2014|12/31/9999|$4.29|0|0|||PACLITAXEL INJECTION|| 58-1699775|1326041732|CHC13|J9266||10/01/2016|09/30/2017|$17|844.00|0|0|0||PEGASPARGASE/SINGL DOSE VIAL|| 58-1699775|1326041732|CHC13|J9266||10/01/2017|09/30/2018|$17|393.88|0|0|0||PEGASPARGASE/SINGL DOSE VIAL|| 58-1699775|1326041732|CHC13|J9267||10/01/2016|09/30/2017|$0.18|0|0|0||PACLITAXEL INJECTION| 1 MG|| 58-1699775|1326041732|CHC13|J9267||10/01/2017|09/30/2018|$0.18|0|0|0||PACLITAXEL INJECTION| 1 MG|| 58-1699775|1326041732|CHC13|J9268||10/01/2016|09/30/2017|$2|300.40|0|0|0||PENTOSTATIN INJECTION|| 58-1699775|1326041732|CHC13|J9268||10/01/2017|09/30/2018|$2|571.36|0|0|0||PENTOSTATIN INJECTION|| 58-1699775|1326041732|CHC13|J9271||10/01/2016|09/30/2017|$57.21|0|0|0||INJ PEMBROLIZUMAB| 1 MG|| 58-1699775|1326041732|CHC13|J9271||10/01/2017|09/30/2018|$58.97|0|0|0||INJ PEMBROLIZUMAB| 1 MG|| 58-1699775|1326041732|CHC13|J9280||10/01/2016|09/30/2017|$122.76|0|0|0||MITOMYCIN 5 MG INJ|| 58-1699775|1326041732|CHC13|J9280||10/01/2017|09/30/2018|$151.82|0|0|0||MITOMYCIN 5 MG INJ|| 58-1699775|1326041732|CHC13|J9293||10/01/2016|09/30/2017|$45.39|0|0|0||MITOXANTRONE HYDROCHL / 5 MG|| 58-1699775|1326041732|CHC13|J9293||10/01/2017|09/30/2018|$47.34|0|0|0||MITOXANTRONE HYDROCHL / 5 MG|| 58-1699775|1326041732|CHC13|J9295||10/01/2017|09/30/2018|$6.66|0|0|0||POLYESTRADIOL PHOSPHATE 40 MG|| 58-1699775|1326041732|CHC13|J9299||10/01/2016|09/30/2017|$32.12|0|0|0||INJECTION| NIVOLUMAB| 1 MG|| 58-1699775|1326041732|CHC13|J9299||10/01/2017|09/30/2018|$33.03|0|0|0||INJECTION| NIVOLUMAB| 1 MG|| 58-1699775|1326041732|CHC13|J9300||11/01/2013|12/31/9999|$3|428.24|0|0|||GEMTUZUMAB OZOGAMICIN|| 58-1699775|1326041732|CHC13|J9301||10/01/2016|09/30/2017|$70.37|0|0|0||OBINUTUZUMAB INJ| 10 MG|| 58-1699775|1326041732|CHC13|J9301||10/01/2017|09/30/2018|$73.48|0|0|0||OBINUTUZUMAB INJ| 10 MG|| 58-1699775|1326041732|CHC13|J9302||10/01/2016|09/30/2017|$64.95|0|0|0||OFATUMUMAB INJECTION|| 58-1699775|1326041732|CHC13|J9302||10/01/2017|09/30/2018|$68.55|0|0|0||OFATUMUMAB INJECTION|| 58-1699775|1326041732|CHC13|J9303||10/01/2016|09/30/2017|$131.91|0|0|0||PANITUMUMAB INJECTION|| 58-1699775|1326041732|CHC13|J9303||10/01/2017|09/30/2018|$136.75|0|0|0||PANITUMUMAB INJECTION|| 58-1699775|1326041732|CHC13|J9305||10/01/2016|09/30/2017|$78.68|0|0|0||PEMETREXED INJECTION|| 58-1699775|1326041732|CHC13|J9305||10/01/2017|09/30/2018|$80.93|0|0|0||PEMETREXED INJECTION|| 58-1699775|1326041732|CHC13|J9306||10/01/2016|09/30/2017|$13.32|0|0|0||INJECTION| PERTUZUMAB| 1 MG|| 58-1699775|1326041732|CHC13|J9306||10/01/2017|09/30/2018|$13.89|0|0|0||INJECTION| PERTUZUMAB| 1 MG|| 58-1699775|1326041732|CHC13|J9307||10/01/2016|09/30/2017|$287.42|0|0|0||PRALATREXATE INJECTION|| 58-1699775|1326041732|CHC13|J9307||10/01/2017|09/30/2018|$309.50|0|0|0||PRALATREXATE INJECTION|| 58-1699775|1326041732|CHC13|J9308||10/01/2016|09/30/2017|$70.19|0|0|0||INJECTION| RAMUCIRUMAB| 5 MG|| 58-1699775|1326041732|CHC13|J9308||10/01/2017|09/30/2018|$70.70|0|0|0||INJECTION| RAMUCIRUMAB| 5 MG|| 58-1699775|1326041732|CHC13|J9310||10/01/2016|09/30/2017|$989.25|0|0|0||RITUXIMAB CANCER TREATMENT|| 58-1699775|1326041732|CHC13|J9310||10/01/2017|09/30/2018|$1|052.99|0|0|0||RITUXIMAB CANCER TREATMENT|| 58-1699775|1326041732|CHC13|J9315||10/01/2016|09/30/2017|$375.50|0|0|0||ROMIDEPSIN INJECTION|| 58-1699775|1326041732|CHC13|J9315||10/01/2017|09/30/2018|$399.31|0|0|0||ROMIDEPSIN INJECTION|| 58-1699775|1326041732|CHC13|J9320||10/01/2016|09/30/2017|$403.51|0|0|0||STREPTOZOCIN INJECTION|| 58-1699775|1326041732|CHC13|J9320||10/01/2017|09/30/2018|$398.80|0|0|0||STREPTOZOCIN INJECTION|| 58-1699775|1326041732|CHC13|J9325||10/01/2017|09/30/2018|$58.83|0|0|0||INJ TALIMOGENE LAHERPAREPVEC||| 58-1699775|1326041732|CHC13|J9328||10/01/2016|09/30/2017|$9.32|0|0|0||TEMOZOLOMIDE INJECTION|| 58-1699775|1326041732|CHC13|J9328||10/01/2017|09/30/2018|$10.99|0|0|0||TEMOZOLOMIDE INJECTION|| 58-1699775|1326041732|CHC13|J9330||10/01/2016|09/30/2017|$81.98|0|0|0||TEMSIROLIMUS INJECTION|| 58-1699775|1326041732|CHC13|J9330||10/01/2017|09/30/2018|$87.47|0|0|0||TEMSIROLIMUS INJECTION|| 58-1699775|1326041732|CHC13|J9340||11/01/2013|12/31/9999|$331.25|0|0|||THIOTEPA INJECTION|| 58-1699775|1326041732|CHC13|J9351||10/01/2016|09/30/2017|$2.28|0|0|0||TOPOTECAN INJECTION|| 58-1699775|1326041732|CHC13|J9351||10/01/2017|09/30/2018|$1.36|0|0|0||TOPOTECAN INJECTION|| 58-1699775|1326041732|CHC13|J9352||10/01/2017|09/30/2018|$358.03|0|0|0||INJECTION| TRABECTEDIN| 0.1 MG|| 58-1699775|1326041732|CHC13|J9354||10/01/2016|09/30/2017|$36.52|0|0|0||INJ| ADO-TRASTUZUMAB EMT 1 MG|| 58-1699775|1326041732|CHC13|J9354||10/01/2017|09/30/2018|$37.24|0|0|0||INJ| ADO-TRASTUZUMAB EMT 1 MG|| 58-1699775|1326041732|CHC13|J9355||10/01/2016|09/30/2017|$114.66|0|0|0||TRASTUZUMAB|| 58-1699775|1326041732|CHC13|J9355||10/01/2017|09/30/2018|$120.79|0|0|0||TRASTUZUMAB|| 58-1699775|1326041732|CHC13|J9357||10/01/2016|09/30/2017|$1|415.98|0|0|0||VALRUBICIN| 200 MG|| 58-1699775|1326041732|CHC13|J9357||10/01/2017|09/30/2018|$1|452.43|0|0|0||VALRUBICIN| 200 MG|| 58-1699775|1326041732|CHC13|J9360||10/01/2016|09/30/2017|$3.88|0|0|0||VINBLASTINE SULFATE INJ|| 58-1699775|1326041732|CHC13|J9360||10/01/2017|09/30/2018|$4.35|0|0|0||VINBLASTINE SULFATE INJ|| 58-1699775|1326041732|CHC13|J9370||10/01/2016|09/30/2017|$5.33|0|0|0||VINCRISTINE SULFATE 1 MG INJ|| 58-1699775|1326041732|CHC13|J9370||10/01/2017|09/30/2018|$6.14|0|0|0||VINCRISTINE SULFATE 1 MG INJ|| 58-1699775|1326041732|CHC13|J9371||10/01/2016|09/30/2017|$3|116.26|0|0|0||INJ| VINCRISTINE SUL LIP 1 MG|| 58-1699775|1326041732|CHC13|J9371||10/01/2017|09/30/2018|$3|250.45|0|0|0||INJ| VINCRISTINE SUL LIP 1 MG|| 58-1699775|1326041732|CHC13|J9390||10/01/2016|09/30/2017|$13.07|0|0|0||VINORELBINE TARTRATE/10 MG|| 58-1699775|1326041732|CHC13|J9390||10/01/2017|09/30/2018|$11.79|0|0|0||VINORELBINE TARTRATE/10 MG|| 58-1699775|1326041732|CHC13|J9395||10/01/2016|09/30/2017|$117.60|0|0|0||INJECTION| FULVESTRANT|| 58-1699775|1326041732|CHC13|J9395||10/01/2017|09/30/2018|$120.23|0|0|0||INJECTION| FULVESTRANT|| 58-1699775|1326041732|CHC13|J9400||10/01/2016|09/30/2017|$10.09|0|0|0||INJ| ZIV-AFLIBERCEPT| 1 MG|| 58-1699775|1326041732|CHC13|J9400||10/01/2017|09/30/2018|$10.06|0|0|0||INJ| ZIV-AFLIBERCEPT| 1 MG|| 58-1699775|1326041732|CHC13|K0001||11/01/2013|12/31/9999|$63.14|0|0|||STANDARD WHEELCHAIR|| 58-1699775|1326041732|CHC13|K0001|RR|11/01/2013|12/31/9999|$63.14|0|0|||STANDARD WHEELCHAIR|| 58-1699775|1326041732|CHC13|K0002||11/01/2013|12/31/9999|$93.39|0|0|||STND HEMI (LOW SEAT) WHLCHR|| 58-1699775|1326041732|CHC13|K0003||11/01/2013|12/31/9999|$118.77|0|0|||LIGHTWEIGHT WHEELCHAIR|| 58-1699775|1326041732|CHC13|K0003|RR|11/01/2013|12/31/9999|$118.77|0|0|||LIGHTWEIGHT WHEELCHAIR|| 58-1699775|1326041732|CHC13|K0004||11/01/2013|12/31/9999|$152.51|0|0|||HIGH STRENGTH LTWT WHLCHR|| 58-1699775|1326041732|CHC13|K0005|NU|11/01/2013|12/31/2017|$2|482.25|0|0|||ULTRALIGHTWEIGHT WHEELCHAIR|| 58-1699775|1326041732|CHC13|K0005|NU|01/01/2018|12/31/9999|$2|600.98|0|0|||ULTRALIGHTWEIGHT WHEELCHAIR|| 58-1699775|1326041732|CHC13|K0005|RR|11/01/2013|12/31/2017|$248.20|0|0|||ULTRALIGHTWEIGHT WHEELCHAIR|| 58-1699775|1326041732|CHC13|K0005|RR|01/01/2018|12/31/9999|$260.06|0|0|||ULTRALIGHTWEIGHT WHEELCHAIR|| 58-1699775|1326041732|CHC13|K0005|UE|11/01/2013|12/31/9999|$1|861.69|0|0|||ULTRALIGHTWEIGHT WHEELCHAIR|| 58-1699775|1326041732|CHC13|K0006||11/01/2013|12/31/9999|$168.39|0|0|||HEAVY DUTY WHEELCHAIR|| 58-1699775|1326041732|CHC13|K0007|NU|11/01/2013|12/31/9999|$959.75|0|0|||EXTRA HEAVY DUTY WHEELCHAIR|| 58-1699775|1326041732|CHC13|K0007|RR|11/01/2013|12/31/9999|$95.98|0|0|||EXTRA HEAVY DUTY WHEELCHAIR|| 58-1699775|1326041732|CHC13|K0007|UE|11/01/2013|12/31/9999|$639.82|0|0|||EXTRA HEAVY DUTY WHEELCHAIR|| 58-1699775|1326041732|CHC13|K0010||11/01/2013|12/31/9999|$486.16|0|0|||STND WT FRAME POWER WHLCHR|| 58-1699775|1326041732|CHC13|K0011|RR|11/01/2013|12/31/9999|$687.79|0|0|||STND WT PWR WHLCHR W CONTROL|| 58-1699775|1326041732|CHC13|K0012||11/01/2013|12/31/9999|$423.15|0|0|||LTWT PORTBL POWER WHLCHR|| 58-1699775|1326041732|CHC13|K0015|NU|11/01/2013|12/31/9999|$210.28|0|0|||DETACH NON-ADJUS HGHT ARMRST|| 58-1699775|1326041732|CHC13|K0015|RR|11/01/2013|12/31/9999|$21.02|0|0|||DETACH NON-ADJUS HGHT ARMRST|| 58-1699775|1326041732|CHC13|K0015|UE|11/01/2013|12/31/9999|$157.70|0|0|||DETACH NON-ADJUS HGHT ARMRST|| 58-1699775|1326041732|CHC13|K0017|NU|11/01/2013|12/31/9999|$59.14|0|0|||DETACH ADJUST ARMREST BASE|| 58-1699775|1326041732|CHC13|K0017|RR|11/01/2013|12/31/9999|$5.91|0|0|||DETACH ADJUST ARMREST BASE|| 58-1699775|1326041732|CHC13|K0017|UE|11/01/2013|12/31/9999|$44.36|0|0|||DETACH ADJUST ARMREST BASE|| 58-1699775|1326041732|CHC13|K0018|NU|11/01/2013|12/31/9999|$33.04|0|0|||DETACH ADJUST ARMRST UPPER|| 58-1699775|1326041732|CHC13|K0018|RR|11/01/2013|12/31/9999|$3.29|0|0|||DETACH ADJUST ARMRST UPPER|| 58-1699775|1326041732|CHC13|K0018|UE|11/01/2013|12/31/9999|$24.79|0|0|||DETACH ADJUST ARMRST UPPER|| 58-1699775|1326041732|CHC13|K0019|NU|11/01/2013|12/31/9999|$19.66|0|0|||ARM PAD EACH|| 58-1699775|1326041732|CHC13|K0019|RR|11/01/2013|12/31/9999|$1.98|0|0|||ARM PAD EACH|| 58-1699775|1326041732|CHC13|K0019|UE|11/01/2013|12/31/9999|$14.76|0|0|||ARM PAD EACH|| 58-1699775|1326041732|CHC13|K0020|NU|11/01/2013|12/31/9999|$53.78|0|0|||FIXED ADJUST ARMREST PAIR|| 58-1699775|1326041732|CHC13|K0020|RR|11/01/2013|12/31/9999|$5.39|0|0|||FIXED ADJUST ARMREST PAIR|| 58-1699775|1326041732|CHC13|K0020|UE|11/01/2013|12/31/9999|$40.31|0|0|||FIXED ADJUST ARMREST PAIR|| 58-1699775|1326041732|CHC13|K0037|NU|11/01/2013|12/31/9999|$55.73|0|0|||HIGH MOUNT FLIP-UP FOOTREST|| 58-1699775|1326041732|CHC13|K0037|RR|11/01/2013|12/31/9999|$4.98|0|0|||HIGH MOUNT FLIP-UP FOOTREST|| 58-1699775|1326041732|CHC13|K0037|UE|11/01/2013|12/31/9999|$41.81|0|0|||HIGH MOUNT FLIP-UP FOOTREST|| 58-1699775|1326041732|CHC13|K0038|NU|11/01/2013|12/31/9999|$28.09|0|0|||LEG STRAP EACH|| 58-1699775|1326041732|CHC13|K0038|RR|11/01/2013|12/31/9999|$2.81|0|0|||LEG STRAP EACH|| 58-1699775|1326041732|CHC13|K0038|UE|11/01/2013|12/31/9999|$21.05|0|0|||LEG STRAP EACH|| 58-1699775|1326041732|CHC13|K0039|NU|11/01/2013|12/31/9999|$62.35|0|0|||LEG STRAP H STYLE EACH|| 58-1699775|1326041732|CHC13|K0039|RR|11/01/2013|12/31/9999|$6.26|0|0|||LEG STRAP H STYLE EACH|| 58-1699775|1326041732|CHC13|K0039|UE|11/01/2013|12/31/9999|$46.76|0|0|||LEG STRAP H STYLE EACH|| 58-1699775|1326041732|CHC13|K0040|NU|11/01/2013|12/31/9999|$86.41|0|0|||ADJUSTABLE ANGLE FOOTPLATE|| 58-1699775|1326041732|CHC13|K0040|RR|11/01/2013|12/31/9999|$8.61|0|0|||ADJUSTABLE ANGLE FOOTPLATE|| 58-1699775|1326041732|CHC13|K0040|UE|11/01/2013|12/31/9999|$64.79|0|0|||ADJUSTABLE ANGLE FOOTPLATE|| 58-1699775|1326041732|CHC13|K0041|NU|11/01/2013|12/31/9999|$61.24|0|0|||LARGE SIZE FOOTPLATE EACH|| 58-1699775|1326041732|CHC13|K0041|RR|11/01/2013|12/31/9999|$6.16|0|0|||LARGE SIZE FOOTPLATE EACH|| 58-1699775|1326041732|CHC13|K0041|UE|11/01/2013|12/31/9999|$45.93|0|0|||LARGE SIZE FOOTPLATE EACH|| 58-1699775|1326041732|CHC13|K0042|NU|11/01/2013|12/31/9999|$42.16|0|0|||STANDARD SIZE FOOTPLATE EACH|| 58-1699775|1326041732|CHC13|K0042|RR|11/01/2013|12/31/9999|$4.21|0|0|||STANDARD SIZE FOOTPLATE EACH|| 58-1699775|1326041732|CHC13|K0042|UE|11/01/2013|12/31/9999|$31.61|0|0|||STANDARD SIZE FOOTPLATE EACH|| 58-1699775|1326041732|CHC13|K0043|NU|11/01/2013|12/31/9999|$22.59|0|0|||FTRST LOWER EXTENSION TUBE|| 58-1699775|1326041732|CHC13|K0043|RR|11/01/2013|12/31/9999|$2.25|0|0|||FTRST LOWER EXTENSION TUBE|| 58-1699775|1326041732|CHC13|K0043|UE|11/01/2013|12/31/9999|$16.97|0|0|||FTRST LOWER EXTENSION TUBE|| 58-1699775|1326041732|CHC13|K0044|NU|11/01/2013|12/31/9999|$19.25|0|0|||FTRST UPPER HANGER BRACKET|| 58-1699775|1326041732|CHC13|K0044|RR|11/01/2013|12/31/9999|$1.94|0|0|||FTRST UPPER HANGER BRACKET|| 58-1699775|1326041732|CHC13|K0044|UE|11/01/2013|12/31/9999|$14.44|0|0|||FTRST UPPER HANGER BRACKET|| 58-1699775|1326041732|CHC13|K0045|NU|11/01/2013|12/31/9999|$65.52|0|0|||FOOTREST COMPLETE ASSEMBLY|| 58-1699775|1326041732|CHC13|K0045|RR|11/01/2013|12/31/9999|$6.76|0|0|||FOOTREST COMPLETE ASSEMBLY|| 58-1699775|1326041732|CHC13|K0045|UE|11/01/2013|12/31/9999|$49.15|0|0|||FOOTREST COMPLETE ASSEMBLY|| 58-1699775|1326041732|CHC13|K0046|NU|11/01/2013|12/31/9999|$22.59|0|0|||ELEVAT LEGRST LOW EXTENSION|| 58-1699775|1326041732|CHC13|K0046|RR|11/01/2013|12/31/9999|$2.25|0|0|||ELEVAT LEGRST LOW EXTENSION|| 58-1699775|1326041732|CHC13|K0046|UE|11/01/2013|12/31/9999|$16.97|0|0|||ELEVAT LEGRST LOW EXTENSION|| 58-1699775|1326041732|CHC13|K0047|NU|11/01/2013|12/31/9999|$88.50|0|0|||ELEVAT LEGRST UP HANGR BRACK|| 58-1699775|1326041732|CHC13|K0047|RR|11/01/2013|12/31/9999|$8.87|0|0|||ELEVAT LEGRST UP HANGR BRACK|| 58-1699775|1326041732|CHC13|K0047|UE|11/01/2013|12/31/9999|$66.35|0|0|||ELEVAT LEGRST UP HANGR BRACK|| 58-1699775|1326041732|CHC13|K0050|NU|11/01/2013|12/31/9999|$37.61|0|0|||RATCHET ASSEMBLY|| 58-1699775|1326041732|CHC13|K0050|RR|11/01/2013|12/31/9999|$3.75|0|0|||RATCHET ASSEMBLY|| 58-1699775|1326041732|CHC13|K0050|UE|11/01/2013|12/31/9999|$28.22|0|0|||RATCHET ASSEMBLY|| 58-1699775|1326041732|CHC13|K0051|NU|11/01/2013|12/31/9999|$60.88|0|0|||CAM RELESE ASSEM FTRST/LGRST|| 58-1699775|1326041732|CHC13|K0051|RR|11/01/2013|12/31/9999|$6.13|0|0|||CAM RELESE ASSEM FTRST/LGRST|| 58-1699775|1326041732|CHC13|K0051|UE|11/01/2013|12/31/9999|$45.64|0|0|||CAM RELESE ASSEM FTRST/LGRST|| 58-1699775|1326041732|CHC13|K0052|NU|11/01/2013|12/31/9999|$106.99|0|0|||SWINGAWAY DETACH FOOTREST|| 58-1699775|1326041732|CHC13|K0052|RR|11/01/2013|12/31/9999|$10.69|0|0|||SWINGAWAY DETACH FOOTREST|| 58-1699775|1326041732|CHC13|K0052|UE|11/01/2013|12/31/9999|$80.21|0|0|||SWINGAWAY DETACH FOOTREST|| 58-1699775|1326041732|CHC13|K0053|NU|11/01/2013|12/31/9999|$118.05|0|0|||ELEVATE FOOTREST ARTICULATE|| 58-1699775|1326041732|CHC13|K0053|RR|11/01/2013|12/31/9999|$11.79|0|0|||ELEVATE FOOTREST ARTICULATE|| 58-1699775|1326041732|CHC13|K0053|UE|11/01/2013|12/31/9999|$88.54|0|0|||ELEVATE FOOTREST ARTICULATE|| 58-1699775|1326041732|CHC13|K0056|NU|11/01/2013|12/31/9999|$127.69|0|0|||SEAT HT <17 OR >=21 LTWT WC|| 58-1699775|1326041732|CHC13|K0056|RR|11/01/2013|12/31/9999|$12.78|0|0|||SEAT HT <17 OR >=21 LTWT WC|| 58-1699775|1326041732|CHC13|K0056|UE|11/01/2013|12/31/9999|$95.80|0|0|||SEAT HT <17 OR >=21 LTWT WC|| 58-1699775|1326041732|CHC13|K0065|NU|11/01/2013|12/31/9999|$59.69|0|0|||SPOKE PROTECTORS|| 58-1699775|1326041732|CHC13|K0065|RR|11/01/2013|12/31/9999|$5.98|0|0|||SPOKE PROTECTORS|| 58-1699775|1326041732|CHC13|K0065|UE|11/01/2013|12/31/9999|$44.76|0|0|||SPOKE PROTECTORS|| 58-1699775|1326041732|CHC13|K0069|NU|11/01/2013|12/31/9999|$134.17|0|0|||REAR WHL COMPLETE SOLID TIRE|| 58-1699775|1326041732|CHC13|K0069|RR|11/01/2013|12/31/9999|$13.98|0|0|||REAR WHL COMPLETE SOLID TIRE|| 58-1699775|1326041732|CHC13|K0069|UE|11/01/2013|12/31/9999|$100.62|0|0|||REAR WHL COMPLETE SOLID TIRE|| 58-1699775|1326041732|CHC13|K0070|NU|11/01/2013|12/31/9999|$245.93|0|0|||REAR WHL COMPL PNEUM TIRE|| 58-1699775|1326041732|CHC13|K0070|RR|11/01/2013|12/31/9999|$24.61|0|0|||REAR WHL COMPL PNEUM TIRE|| 58-1699775|1326041732|CHC13|K0070|UE|11/01/2013|12/31/9999|$184.45|0|0|||REAR WHL COMPL PNEUM TIRE|| 58-1699775|1326041732|CHC13|K0071|NU|11/01/2013|12/31/9999|$146.69|0|0|||FRONT CASTR COMPL PNEUM TIRE|| 58-1699775|1326041732|CHC13|K0071|RR|11/01/2013|12/31/9999|$14.69|0|0|||FRONT CASTR COMPL PNEUM TIRE|| 58-1699775|1326041732|CHC13|K0071|UE|11/01/2013|12/31/9999|$109.99|0|0|||FRONT CASTR COMPL PNEUM TIRE|| 58-1699775|1326041732|CHC13|K0072|NU|11/01/2013|12/31/9999|$88.30|0|0|||FRNT CSTR CMPL SEM-PNEUM TIR|| 58-1699775|1326041732|CHC13|K0072|RR|11/01/2013|12/31/9999|$8.82|0|0|||FRNT CSTR CMPL SEM-PNEUM TIR|| 58-1699775|1326041732|CHC13|K0072|UE|11/01/2013|12/31/9999|$66.22|0|0|||FRNT CSTR CMPL SEM-PNEUM TIR|| 58-1699775|1326041732|CHC13|K0073|NU|11/01/2013|12/31/9999|$46.73|0|0|||CASTER PIN LOCK EACH|| 58-1699775|1326041732|CHC13|K0073|RR|11/01/2013|12/31/9999|$4.68|0|0|||CASTER PIN LOCK EACH|| 58-1699775|1326041732|CHC13|K0073|UE|11/01/2013|12/31/9999|$35.05|0|0|||CASTER PIN LOCK EACH|| 58-1699775|1326041732|CHC13|K0077|NU|11/01/2013|12/31/9999|$79.01|0|0|||FRONT CASTER ASSEM COMPLETE|| 58-1699775|1326041732|CHC13|K0077|RR|11/01/2013|12/31/9999|$7.89|0|0|||FRONT CASTER ASSEM COMPLETE|| 58-1699775|1326041732|CHC13|K0077|UE|11/01/2013|12/31/9999|$59.25|0|0|||FRONT CASTER ASSEM COMPLETE|| 58-1699775|1326041732|CHC13|K0098|NU|11/01/2013|12/31/9999|$31.50|0|0|||DRIVE BELT POWER WHEELCHAIR|| 58-1699775|1326041732|CHC13|K0098|RR|11/01/2013|12/31/9999|$3.15|0|0|||DRIVE BELT POWER WHEELCHAIR|| 58-1699775|1326041732|CHC13|K0098|UE|11/01/2013|12/31/9999|$23.59|0|0|||DRIVE BELT POWER WHEELCHAIR|| 58-1699775|1326041732|CHC13|K0105|NU|11/01/2013|12/31/9999|$133.50|0|0|||IV HANGER|| 58-1699775|1326041732|CHC13|K0105|RR|11/01/2013|12/31/9999|$13.34|0|0|||IV HANGER|| 58-1699775|1326041732|CHC13|K0105|UE|11/01/2013|12/31/9999|$100.12|0|0|||IV HANGER|| 58-1699775|1326041732|CHC13|K0108|NU|11/01/2013|12/31/9999|$115.00|0|0||%|W/C COMPONENT-ACCESSORY NOS|| 58-1699775|1326041732|CHC13|K0195|RR|11/01/2013|12/31/2017|$24.21|0|0|||ELEVATING WHLCHAIR LEG RESTS|| 58-1699775|1326041732|CHC13|K0195|RR|01/01/2018|12/31/9999|$13.28|0|0|||ELEVATING WHLCHAIR LEG RESTS|| 58-1699775|1326041732|CHC13|K0455||11/01/2013|12/31/9999|$344.98|0|0|||PUMP UNINTERRUPTED INFUSION|| 58-1699775|1326041732|CHC13|K0552||11/01/2013|12/31/9999|$3.56|0|0|||SUPPLY/EXT INF PUMP SYR TYPE|| 58-1699775|1326041732|CHC13|K0553||04/01/2018|12/31/9999|$313.89|0|0|0||COMBINATION ORAL/NASAL MASK|| 58-1699775|1326041732|CHC13|K0554|NU|04/01/2018|12/31/9999|$311.21|0|0|0||REPL ORAL CUSHION COMBO MASK|| 58-1699775|1326041732|CHC13|K0554|RR|04/01/2018|12/31/9999|$31.12|0|0|0||REPL ORAL CUSHION COMBO MASK|| 58-1699775|1326041732|CHC13|K0601||11/01/2013|12/31/9999|$1.49|0|0|||REPL BATT SILVER OXIDE 1.5 V|| 58-1699775|1326041732|CHC13|K0602||11/01/2013|12/31/9999|$8.54|0|0|||REPL BATT SILVER OXIDE 3 V|| 58-1699775|1326041732|CHC13|K0603||11/01/2013|12/31/9999|$0.76|0|0|||REPL BATT ALKALINE 1.5 V|| 58-1699775|1326041732|CHC13|K0604||11/01/2013|12/31/9999|$8.16|0|0|||REPL BATT LITHIUM 3.6 V|| 58-1699775|1326041732|CHC13|K0605||11/01/2013|12/31/9999|$19.60|0|0|||REPL BATT LITHIUM 4.5 V|| 58-1699775|1326041732|CHC13|K0606||11/01/2013|12/31/9999|$3|381.17|0|0|||AED GARMENT W ELEC ANALYSIS|| 58-1699775|1326041732|CHC13|K0607|NU|11/01/2013|12/31/9999|$260.79|0|0|||REPL BATT FOR AED|| 58-1699775|1326041732|CHC13|K0607|RR|11/01/2013|12/31/9999|$26.09|0|0|||REPL BATT FOR AED|| 58-1699775|1326041732|CHC13|K0607|UE|11/01/2013|12/31/9999|$195.59|0|0|||REPL BATT FOR AED|| 58-1699775|1326041732|CHC13|K0608|NU|11/01/2013|12/31/9999|$162.74|0|0|||REPL GARMENT FOR AED|| 58-1699775|1326041732|CHC13|K0608|RR|11/01/2013|12/31/9999|$16.31|0|0|||REPL GARMENT FOR AED|| 58-1699775|1326041732|CHC13|K0608|UE|11/01/2013|12/31/9999|$122.06|0|0|||REPL GARMENT FOR AED|| 58-1699775|1326041732|CHC13|K0609||11/01/2013|12/31/9999|$1|082.29|0|0|||REPL ELECTRODE FOR AED|| 58-1699775|1326041732|CHC13|K0609|KF|11/01/2013|12/31/9999|$1|201.62|0|0|||REPL ELECTRODE FOR AED|| 58-1699775|1326041732|CHC13|K0672||11/01/2013|12/31/9999|$98.71|0|0|||REMOVE SOFT INTERFACE| REPL|| 58-1699775|1326041732|CHC13|K0730|NU|11/01/2013|12/31/9999|$2|314.76|0|0|||CTRL DOSE INH DRUG DELIV SYS|| 58-1699775|1326041732|CHC13|K0730|RR|11/01/2013|12/31/9999|$231.47|0|0|||CTRL DOSE INH DRUG DELIV SYS|| 58-1699775|1326041732|CHC13|K0730|UE|11/01/2013|12/31/9999|$1|736.06|0|0|||CTRL DOSE INH DRUG DELIV SYS|| 58-1699775|1326041732|CHC13|K0733|NU|11/01/2013|12/31/9999|$34.96|0|0|||12-24HR SEALED LEAD ACID|| 58-1699775|1326041732|CHC13|K0733|RR|11/01/2013|12/31/9999|$3.52|0|0|||12-24HR SEALED LEAD ACID|| 58-1699775|1326041732|CHC13|K0733|UE|11/01/2013|12/31/9999|$26.24|0|0|||12-24HR SEALED LEAD ACID|| 58-1699775|1326041732|CHC13|K0738||11/01/2013|12/31/9999|$64.54|0|0|||PORTABLE GAS OXYGEN SYSTEM|| 58-1699775|1326041732|CHC13|K0739|NU|01/01/2017|12/31/9999|$13.60|0|0|||REPAIR/SVC DME NON-OXYGEN EQ|| 58-1699775|1326041732|CHC13|K0800|NU|11/01/2013|12/31/2017|$1|496.05|0|0|||POV GROUP 1 STD UP TO 300 LBS|| 58-1699775|1326041732|CHC13|K0800|NU|01/01/2018|12/31/9999|$1|032.99|0|0|||POV GROUP 1 STD UP TO 300 LBS|| 58-1699775|1326041732|CHC13|K0800|RR|11/01/2013|12/31/2017|$149.61|0|0|||POV GROUP 1 STD UP TO 300 LBS|| 58-1699775|1326041732|CHC13|K0800|RR|01/01/2018|12/31/9999|$103.30|0|0|||POV GROUP 1 STD UP TO 300 LBS|| 58-1699775|1326041732|CHC13|K0800|UE|11/01/2013|12/31/9999|$1|122.04|0|0|||POV GROUP 1 STD UP TO 300 LBS|| 58-1699775|1326041732|CHC13|K0801|NU|11/01/2013|12/31/2017|$2|411.94|0|0|||POV GROUP 1 HD 301-450 LBS|| 58-1699775|1326041732|CHC13|K0801|NU|01/01/2018|12/31/9999|$1|856.60|0|0|||POV GROUP 1 HD 301-450 LBS|| 58-1699775|1326041732|CHC13|K0801|RR|11/01/2013|12/31/2017|$241.16|0|0|||POV GROUP 1 HD 301-450 LBS|| 58-1699775|1326041732|CHC13|K0801|RR|01/01/2018|12/31/9999|$185.66|0|0|||POV GROUP 1 HD 301-450 LBS|| 58-1699775|1326041732|CHC13|K0801|UE|11/01/2013|12/31/9999|$1|808.95|0|0|||POV GROUP 1 HD 301-450 LBS|| 58-1699775|1326041732|CHC13|K0802|NU|11/01/2013|12/31/9999|$2|729.55|0|0|||POV GROUP 1 VHD 451-600 LBS|| 58-1699775|1326041732|CHC13|K0802|RR|11/01/2013|12/31/9999|$272.95|0|0|||POV GROUP 1 VHD 451-600 LBS|| 58-1699775|1326041732|CHC13|K0802|UE|11/01/2013|12/31/9999|$2|047.16|0|0|||POV GROUP 1 VHD 451-600 LBS|| 58-1699775|1326041732|CHC13|K0806|NU|11/01/2013|12/31/9999|$1|809.81|0|0|||POV GROUP 2 STD UP TO 300LBS|| 58-1699775|1326041732|CHC13|K0806|RR|11/01/2013|12/31/9999|$180.97|0|0|||POV GROUP 2 STD UP TO 300LBS|| 58-1699775|1326041732|CHC13|K0806|UE|11/01/2013|12/31/9999|$1|357.36|0|0|||POV GROUP 2 STD UP TO 300LBS|| 58-1699775|1326041732|CHC13|K0807|NU|11/01/2013|12/31/9999|$2|746.19|0|0|||POV GROUP 2 HD 301-450 LBS|| 58-1699775|1326041732|CHC13|K0807|RR|11/01/2013|12/31/9999|$274.62|0|0|||POV GROUP 2 HD 301-450 LBS|| 58-1699775|1326041732|CHC13|K0807|UE|11/01/2013|12/31/9999|$2|059.66|0|0|||POV GROUP 2 HD 301-450 LBS|| 58-1699775|1326041732|CHC13|K0808|NU|11/01/2013|12/31/9999|$4|248.94|0|0|||POV GROUP 2 VHD 451-600 LBS|| 58-1699775|1326041732|CHC13|K0808|RR|11/01/2013|12/31/9999|$424.89|0|0|||POV GROUP 2 VHD 451-600 LBS|| 58-1699775|1326041732|CHC13|K0808|UE|11/01/2013|12/31/9999|$3|186.69|0|0|||POV GROUP 2 VHD 451-600 LBS|| 58-1699775|1326041732|CHC13|K0813||11/01/2013|12/31/9999|$418.75|0|0|||PWC GP 1 STD PORT SEAT/BACK|| 58-1699775|1326041732|CHC13|K0814||11/01/2013|12/31/9999|$536.05|0|0|||PWC GP 1 STD PORT CAP CHAIR|| 58-1699775|1326041732|CHC13|K0815||11/01/2013|12/31/9999|$610.35|0|0|||PWC GP 1 STD SEAT/BACK|| 58-1699775|1326041732|CHC13|K0816||11/01/2013|12/31/9999|$584.55|0|0|||PWC GP 1 STD CAP CHAIR|| 58-1699775|1326041732|CHC13|K0820||11/01/2013|12/31/9999|$447.29|0|0|||PWC GP 2 STD PORT SEAT/BACK|| 58-1699775|1326041732|CHC13|K0821||11/01/2013|12/31/9999|$574.17|0|0|||PWC GP 2 STD PORT CAP CHAIR|| 58-1699775|1326041732|CHC13|K0822|NU|01/01/2016|12/31/9999|$7|463.75|0|0|||PWC GP 2 STD SEAT/BACK|| 58-1699775|1326041732|CHC13|K0822|RR|01/01/2016|12/31/2017|$746.38|0|0|||PWC GP 2 STD SEAT/BACK|| 58-1699775|1326041732|CHC13|K0822|RR|01/01/2018|12/31/9999|$366.00|0|0|||PWC GP 2 STD SEAT/BACK|| 58-1699775|1326041732|CHC13|K0822|UE|01/01/2016|12/31/9999|$5|597.81|0|0|||PWC GP 2 STD SEAT/BACK|| 58-1699775|1326041732|CHC13|K0823|NU|01/01/2016|12/31/9999|$7|463.75|0|0|||PWC GP 2 STD CAP CHAIR|| 58-1699775|1326041732|CHC13|K0823|RR|01/01/2016|12/31/2017|$746.38|0|0|||PWC GP 2 STD CAP CHAIR|| 58-1699775|1326041732|CHC13|K0823|RR|01/01/2018|12/31/9999|$341.95|0|0|||PWC GP 2 STD CAP CHAIR|| 58-1699775|1326041732|CHC13|K0823|UE|01/01/2016|12/31/9999|$5|597.81|0|0|||PWC GP 2 STD CAP CHAIR|| 58-1699775|1326041732|CHC13|K0824|NU|01/01/2016|12/31/9999|$7|562.50|0|0|||PWC GP 2 HD SEAT/BACK|| 58-1699775|1326041732|CHC13|K0824|RR|01/01/2016|12/31/9999|$756.25|0|0|||PWC GP 2 HD SEAT/BACK|| 58-1699775|1326041732|CHC13|K0824|UE|01/01/2016|12/31/9999|$5|671.87|0|0|||PWC GP 2 HD SEAT/BACK|| 58-1699775|1326041732|CHC13|K0825|NU|01/01/2016|12/31/9999|$7|562.50|0|0|||PWC GP 2 HD CAP CHAIR|| 58-1699775|1326041732|CHC13|K0825|RR|01/01/2016|12/31/9999|$756.25|0|0|||PWC GP 2 HD CAP CHAIR|| 58-1699775|1326041732|CHC13|K0825|UE|01/01/2016|12/31/9999|$5|671.87|0|0|||PWC GP 2 HD CAP CHAIR|| 58-1699775|1326041732|CHC13|K0826||11/01/2013|12/31/9999|$1|088.29|0|0|||PWC GP2 VHD SEAT/BACK|| 58-1699775|1326041732|CHC13|K0827||11/01/2013|12/31/9999|$925.36|0|0|||PWC GP VHD CAP CHAIR|| 58-1699775|1326041732|CHC13|K0828||11/01/2013|12/31/9999|$1|199.18|0|0|||PWC GP 2 XTRA HD SEAT/BACK|| 58-1699775|1326041732|CHC13|K0829||11/01/2013|12/31/9999|$1|101.20|0|0|||PWC GP 2 XTRA HD CAP CHAIR|| 58-1699775|1326041732|CHC13|K0835||11/01/2013|12/31/9999|$704.31|0|0|||PWC GP2 STD SING POW OPT S/B|| 58-1699775|1326041732|CHC13|K0836||11/01/2013|12/31/9999|$730.41|0|0|||PWC GP2 STD SING POW OPT CAP|| 58-1699775|1326041732|CHC13|K0837||11/01/2013|12/31/9999|$840.61|0|0|||PWC GP 2 HD SING POW OPT S/B|| 58-1699775|1326041732|CHC13|K0838||11/01/2013|12/31/9999|$752.01|0|0|||PWC GP 2 HD SING POW OPT CAP|| 58-1699775|1326041732|CHC13|K0839||11/01/2013|12/31/9999|$1|088.29|0|0|||PWC GP2 VHD SING POW OPT S/B|| 58-1699775|1326041732|CHC13|K0840||11/01/2013|12/31/9999|$1|648.74|0|0|||PWC GP2 XHD SING POW OPT S/B|| 58-1699775|1326041732|CHC13|K0841||11/01/2013|12/31/9999|$749.66|0|0|||PWC GP2 STD MULT POW OPT S/B|| 58-1699775|1326041732|CHC13|K0842||11/01/2013|12/31/9999|$749.66|0|0|||PWC GP2 STD MULT POW OPT CAP|| 58-1699775|1326041732|CHC13|K0843||11/01/2013|12/31/9999|$902.57|0|0|||PWC GP2 HD MULT POW OPT S/B|| 58-1699775|1326041732|CHC13|K0848|NU|01/01/2016|12/31/9999|$9|493.75|0|0|||PWC GP 3 STD SEAT/BACK|| 58-1699775|1326041732|CHC13|K0848|RR|01/01/2016|12/31/9999|$949.38|0|0|||PWC GP 3 STD SEAT/BACK|| 58-1699775|1326041732|CHC13|K0848|UE|01/01/2016|12/31/9999|$7|120.31|0|0|||PWC GP 3 STD SEAT/BACK|| 58-1699775|1326041732|CHC13|K0849|NU|01/01/2016|12/31/9999|$9|493.75|0|0|||PWC GP 3 STD CAP CHAIR|| 58-1699775|1326041732|CHC13|K0849|RR|01/01/2016|12/31/9999|$949.38|0|0|||PWC GP 3 STD CAP CHAIR|| 58-1699775|1326041732|CHC13|K0849|UE|01/01/2016|12/31/9999|$7|120.31|0|0|||PWC GP 3 STD CAP CHAIR|| 58-1699775|1326041732|CHC13|K0850||11/01/2013|12/31/9999|$1|064.04|0|0|||PWC GP 3 HD SEAT/BACK|| 58-1699775|1326041732|CHC13|K0851||11/01/2013|12/31/9999|$1|023.06|0|0|||PWC GP 3 HD CAP CHAIR|| 58-1699775|1326041732|CHC13|K0852||11/01/2013|12/31/9999|$1|229.42|0|0|||PWC GP 3 VHD SEAT/BACK|| 58-1699775|1326041732|CHC13|K0853||11/01/2013|12/31/9999|$1|262.94|0|0|||PWC GP 3 VHD CAP CHAIR|| 58-1699775|1326041732|CHC13|K0854||11/01/2013|12/31/9999|$1|673.10|0|0|||PWC GP 3 XHD SEAT/BACK|| 58-1699775|1326041732|CHC13|K0855||11/01/2013|12/31/9999|$1|580.49|0|0|||PWC GP 3 XHD CAP CHAIR|| 58-1699775|1326041732|CHC13|K0856|NU|01/01/2016|12/31/9999|$9|493.75|0|0|||PWC GP3 STD SING POW OPT S/B|| 58-1699775|1326041732|CHC13|K0856|RR|01/01/2016|12/31/9999|$949.38|0|0|||PWC GP3 STD SING POW OPT S/B|| 58-1699775|1326041732|CHC13|K0856|UE|01/01/2016|12/31/9999|$7|120.31|0|0|||PWC GP3 STD SING POW OPT S/B|| 58-1699775|1326041732|CHC13|K0857||11/01/2013|12/31/9999|$1|004.35|0|0|||PWC GP3 STD SING POW OPT CAP|| 58-1699775|1326041732|CHC13|K0858||11/01/2013|12/31/9999|$1|221.64|0|0|||PWC GP3 HD SING POW OPT S/B|| 58-1699775|1326041732|CHC13|K0859||11/01/2013|12/31/9999|$1|165.05|0|0|||PWC GP3 HD SING POW OPT CAP|| 58-1699775|1326041732|CHC13|K0860||11/01/2013|12/31/9999|$1|745.25|0|0|||PWC GP3 VHD SING POW OPT S/B|| 58-1699775|1326041732|CHC13|K0861|NU|11/01/2013|12/31/9999|$1|270.36|0|0|||PWC GP3 STD MULT POW OPT S/B|| 58-1699775|1326041732|CHC13|K0861|RR|01/01/2016|12/31/9999|$127.04|0|0|||PWC GP3 STD MULT POW OPT S/B|| 58-1699775|1326041732|CHC13|K0861|UE|01/01/2016|12/31/9999|$952.77|0|0|||PWC GP3 STD MULT POW OPT S/B|| 58-1699775|1326041732|CHC13|K0862||11/01/2013|12/31/9999|$1|221.64|0|0|||PWC GP3 HD MULT POW OPT S/B|| 58-1699775|1326041732|CHC13|K0863||11/01/2013|12/31/9999|$1|745.25|0|0|||PWC GP3 VHD MULT POW OPT S/B|| 58-1699775|1326041732|CHC13|K0864||11/01/2013|12/31/9999|$2|076.86|0|0|||PWC GP3 XHD MULT POW OPT S/B|| 58-1699775|1326041732|CHC13|K0901||01/01/2015|12/31/9999|$1|079.33|0|0|||KNEE ORTHOSIS SNGL THIGH/CALF|| 58-1699775|1326041732|CHC13|L0112||11/01/2013|12/31/9999|$1|629.30|0|0|||CRANIAL CERVICAL ORTHOSIS|| 58-1699775|1326041732|CHC13|L0113||11/01/2013|12/31/9999|$331.99|0|0|||CRANIAL CERVICAL TORTICOLLIS|| 58-1699775|1326041732|CHC13|L0120||11/01/2013|12/31/9999|$32.56|0|0|||CERV FLEXIBLE NON-ADJUSTABLE|| 58-1699775|1326041732|CHC13|L0120|NU|11/01/2013|12/31/9999|$32.56|0|0|||CERV FLEXIBLE NON-ADJUSTABLE|| 58-1699775|1326041732|CHC13|L0130||11/01/2013|12/31/9999|$235.50|0|0|||FLEX THERMOPLASTIC COLLAR MO|| 58-1699775|1326041732|CHC13|L0140||11/01/2013|12/31/9999|$81.26|0|0|||CERVICAL SEMI-RIGID ADJUSTAB|| 58-1699775|1326041732|CHC13|L0150||11/01/2013|12/31/9999|$135.51|0|0|||CERV SEMI-RIG ADJ MOLDED CHN|| 58-1699775|1326041732|CHC13|L0160||11/01/2013|12/31/9999|$192.95|0|0|||CERV SEMI-RIG WIRE OCC/MAND|| 58-1699775|1326041732|CHC13|L0170||11/01/2013|12/31/9999|$816.49|0|0|||CERVICAL COLLAR MOLDED TO PT|| 58-1699775|1326041732|CHC13|L0172||11/01/2013|12/31/9999|$165.55|0|0|||CERV COL THERMPLAS FOAM 2 PI|| 58-1699775|1326041732|CHC13|L0172|NU|11/01/2013|12/31/9999|$165.55|0|0|||CERV COL THERMPLAS FOAM 2 PI|| 58-1699775|1326041732|CHC13|L0174||11/01/2013|12/31/9999|$297.40|0|0|||CERV COL FOAM 2 PIECE W THOR|| 58-1699775|1326041732|CHC13|L0180||11/01/2013|12/31/9999|$404.46|0|0|||CER POST COL OCC/MAN SUP ADJ|| 58-1699775|1326041732|CHC13|L0180|NU|11/01/2013|12/31/9999|$404.46|0|0|||CER POST COL OCC/MAN SUP ADJ|| 58-1699775|1326041732|CHC13|L0190||11/01/2013|12/31/9999|$608.85|0|0|||CERV COLLAR SUPP ADJ CERV BA|| 58-1699775|1326041732|CHC13|L0200||11/01/2013|12/31/9999|$559.06|0|0|||CERV COL SUPP ADJ BAR & THOR|| 58-1699775|1326041732|CHC13|L0220||11/01/2013|12/31/9999|$132.59|0|0|||THOR RIB BELT CUSTOM FABRICA|| 58-1699775|1326041732|CHC13|L0430||11/01/2013|12/31/9999|$1|619.24|0|0|||DEWALL POSTURE PROTECTOR|| 58-1699775|1326041732|CHC13|L0450||11/01/2013|12/31/9999|$218.89|0|0|||TLSO FLEX PREFAB THORACIC|| 58-1699775|1326041732|CHC13|L0452||11/01/2013|12/31/9999|$0.00|0|0|||TLSO FLEX CUSTOM FAB THORACI|| 58-1699775|1326041732|CHC13|L0454||11/01/2013|12/31/9999|$403.74|0|0|||TLSO FLEX PREFAB SACROCOC-T9|| 58-1699775|1326041732|CHC13|L0456||11/01/2013|12/31/9999|$1|157.80|0|0|||TLSO FLEX PREFAB|| 58-1699775|1326041732|CHC13|L0458||11/01/2013|12/31/9999|$1|038.20|0|0|||TLSO 2MOD SYMPHIS-XIPHO PRE|| 58-1699775|1326041732|CHC13|L0460||11/01/2013|12/31/9999|$1|168.57|0|0|||TLSO2MOD SYMPHYSIS-STERN PRE|| 58-1699775|1326041732|CHC13|L0462||11/01/2013|12/31/9999|$1|453.50|0|0|||TLSO 3MOD SACRO-SCAP PRE|| 58-1699775|1326041732|CHC13|L0464||11/01/2013|12/31/9999|$1|730.38|0|0|||TLSO 4MOD SACRO-SCAP PRE|| 58-1699775|1326041732|CHC13|L0466||11/01/2013|12/31/9999|$444.94|0|0|||TLSO RIGID FRAME PRE SOFT AP|| 58-1699775|1326041732|CHC13|L0468||11/01/2013|12/31/9999|$557.84|0|0|||TLSO RIGID FRAME PREFAB PELV|| 58-1699775|1326041732|CHC13|L0470||11/01/2013|12/31/9999|$794.24|0|0|||TLSO RIGID FRAME PRE SUBCLAV|| 58-1699775|1326041732|CHC13|L0472||11/01/2013|12/31/9999|$498.54|0|0|||TLSO RIGID FRAME HYPEREX PRE|| 58-1699775|1326041732|CHC13|L0480||11/01/2013|12/31/9999|$1|541.58|0|0|||TLSO RIGID PLASTIC CUSTOM FA|| 58-1699775|1326041732|CHC13|L0482||11/01/2013|12/31/9999|$1|767.21|0|0|||TLSO RIGID LINED CUSTOM FAB|| 58-1699775|1326041732|CHC13|L0484||11/01/2013|12/31/9999|$2|060.53|0|0|||TLSO RIGID PLASTIC CUST FAB|| 58-1699775|1326041732|CHC13|L0486||11/01/2013|12/31/9999|$2|041.20|0|0|||TLSO RIGIDLINED CUST FAB TWO|| 58-1699775|1326041732|CHC13|L0488||11/01/2013|12/31/9999|$1|168.57|0|0|||TLSO RIGID LINED PRE ONE PIE|| 58-1699775|1326041732|CHC13|L0490||11/01/2013|12/31/9999|$329.29|0|0|||TLSO RIGID PLASTIC PRE ONE|| 58-1699775|1326041732|CHC13|L0491||11/01/2013|12/31/9999|$894.01|0|0|||TLSO 2 PIECE RIGID SHELL|| 58-1699775|1326041732|CHC13|L0492||11/01/2013|12/31/9999|$579.41|0|0|||TLSO 3 PIECE RIGID SHELL|| 58-1699775|1326041732|CHC13|L0621||11/01/2013|12/31/9999|$103.80|0|0|||SIO FLEX PELVISACRAL PREFAB|| 58-1699775|1326041732|CHC13|L0622||11/01/2013|12/31/9999|$281.46|0|0|||SIO FLEX PELVISACRAL CUSTOM|| 58-1699775|1326041732|CHC13|L0623||11/01/2013|12/31/9999|$0.00|0|0|||SIO PANEL PREFAB|| 58-1699775|1326041732|CHC13|L0624||11/01/2013|12/31/9999|$0.00|0|0|||SIO PANEL CUSTOM|| 58-1699775|1326041732|CHC13|L0625||11/01/2013|12/31/9999|$64.15|0|0|||LO FLEXIBL L1-BELOW L5 PRE|| 58-1699775|1326041732|CHC13|L0625|NU|11/01/2013|12/31/9999|$64.15|0|0|||LO FLEXIBL L1-BELOW L5 PRE|| 58-1699775|1326041732|CHC13|L0626||11/01/2013|12/31/9999|$90.75|0|0|||LO SAG STAYS/PANELS PRE-FAB|| 58-1699775|1326041732|CHC13|L0626|NU|11/01/2013|12/31/9999|$90.75|0|0|||LO SAG STAYS/PANELS PRE-FAB|| 58-1699775|1326041732|CHC13|L0627||11/01/2013|12/31/9999|$478.53|0|0|||LO SAGITT RIGID PANEL PREFAB|| 58-1699775|1326041732|CHC13|L0627|NU|11/01/2013|12/31/9999|$478.53|0|0|||LO SAGITT RIGID PANEL PREFAB|| 58-1699775|1326041732|CHC13|L0628||11/01/2013|12/31/9999|$97.64|0|0|||LO FLEX W/O RIGID STAYS PRE|| 58-1699775|1326041732|CHC13|L0629||11/01/2013|12/31/9999|$0.00|0|0|||LSO FLEX W/RIGID STAYS CUST|| 58-1699775|1326041732|CHC13|L0630||11/01/2013|12/31/9999|$188.50|0|0|||LSO POST RIGID PANEL PRE|| 58-1699775|1326041732|CHC13|L0631||11/01/2013|12/31/9999|$1|195.04|0|0|||LSO SAG-CORO RIGID FRAME PRE|| 58-1699775|1326041732|CHC13|L0632||11/01/2013|12/31/9999|$0.00|0|0|||LSO SAG RIGID FRAME CUST|| 58-1699775|1326041732|CHC13|L0633||11/01/2013|12/31/9999|$333.81|0|0|||LSO FLEXION CONTROL PREFAB|| 58-1699775|1326041732|CHC13|L0634||11/01/2013|12/31/9999|$0.00|0|0|||LSO FLEXION CONTROL CUSTOM|| 58-1699775|1326041732|CHC13|L0635||11/01/2013|12/31/9999|$1|237.87|0|0|||LSO SAGIT RIGID PANEL PREFAB|| 58-1699775|1326041732|CHC13|L0636||11/01/2013|12/31/9999|$1|826.55|0|0|||LSO SAGITTAL RIGID PANEL CUS|| 58-1699775|1326041732|CHC13|L0637||11/01/2013|12/31/9999|$1|584.77|0|0|||LSO SAG-CORONAL PANEL PREFAB|| 58-1699775|1326041732|CHC13|L0637|NU|11/01/2013|12/31/9999|$1|584.77|0|0|||LSO SAG-CORONAL PANEL PREFAB|| 58-1699775|1326041732|CHC13|L0638||11/01/2013|12/31/9999|$1|535.35|0|0|||LSO SAG-CORONAL PANEL CUSTOM|| 58-1699775|1326041732|CHC13|L0639||11/01/2013|12/31/9999|$1|584.77|0|0|||LSO S/C SHELL/PANEL PREFAB|| 58-1699775|1326041732|CHC13|L0640||11/01/2013|12/31/9999|$1|218.12|0|0|||LSO S/C SHELL/PANEL CUSTOM|| 58-1699775|1326041732|CHC13|L0642||01/01/2017|12/31/9999|$352.61|0|0|||LO SAG RI AN/POS PNL PRE OTS|| 58-1699775|1326041732|CHC13|L0650||01/01/2018|12/31/9999|$1|660.55|0|0|||LSO SC R ANT/POS PNL PRE OTS|| 58-1699775|1326041732|CHC13|L0700||11/01/2013|12/31/9999|$2|506.35|0|0|||CTLSO A-P-L CONTROL MOLDED|| 58-1699775|1326041732|CHC13|L0710||11/01/2013|12/31/9999|$2|735.85|0|0|||CTLSO A-P-L CONTROL W/ INTER|| 58-1699775|1326041732|CHC13|L0810||11/01/2013|12/31/9999|$2|906.42|0|0|||HALO CERVICAL INTO JCKT VEST|| 58-1699775|1326041732|CHC13|L0820||11/01/2013|12/31/9999|$2|351.17|0|0|||HALO CERVICAL INTO BODY JACK|| 58-1699775|1326041732|CHC13|L0830||11/01/2013|12/31/9999|$3|394.85|0|0|||HALO CERV INTO MILWAUKEE TYP|| 58-1699775|1326041732|CHC13|L0859||11/01/2013|12/31/9999|$1|318.87|0|0|||MRI COMPATIBLE SYSTEM|| 58-1699775|1326041732|CHC13|L0861||11/01/2013|12/31/9999|$250.90|0|0|||HALO REPL LINER/INTERFACE|| 58-1699775|1326041732|CHC13|L0970||11/01/2013|12/31/9999|$123.74|0|0|||TLSO CORSET FRONT|| 58-1699775|1326041732|CHC13|L0972||11/01/2013|12/31/9999|$126.48|0|0|||LSO CORSET FRONT|| 58-1699775|1326041732|CHC13|L0974||11/01/2013|12/31/9999|$258.44|0|0|||TLSO FULL CORSET|| 58-1699775|1326041732|CHC13|L0976||11/01/2013|12/31/9999|$230.81|0|0|||LSO FULL CORSET|| 58-1699775|1326041732|CHC13|L0978||11/01/2013|12/31/9999|$208.40|0|0|||AXILLARY CRUTCH EXTENSION|| 58-1699775|1326041732|CHC13|L0980||11/01/2013|12/31/9999|$18.90|0|0|||PERONEAL STRAPS PAIR|| 58-1699775|1326041732|CHC13|L0982||11/01/2013|12/31/9999|$20.60|0|0|||STOCKING SUPP GRIPS SET OF F|| 58-1699775|1326041732|CHC13|L0984||11/01/2013|12/31/9999|$65.74|0|0|||PROTECTIVE BODY SOCK EACH|| 58-1699775|1326041732|CHC13|L1000||11/01/2013|12/31/9999|$2|197.96|0|0|||CTLSO MILWAUKE INITIAL MODEL|| 58-1699775|1326041732|CHC13|L1001||11/01/2013|12/31/9999|$0.00|0|0|||CTLSO INFANT IMMOBILIZER|| 58-1699775|1326041732|CHC13|L1005||11/01/2013|12/31/9999|$3|725.90|0|0|||TENSION BASED SCOLIOSIS ORTH|| 58-1699775|1326041732|CHC13|L1010||11/01/2013|12/31/9999|$88.51|0|0|||CTLSO AXILLA SLING|| 58-1699775|1326041732|CHC13|L1020||11/01/2013|12/31/9999|$120.94|0|0|||KYPHOSIS PAD|| 58-1699775|1326041732|CHC13|L1025||11/01/2013|12/31/9999|$137.45|0|0|||KYPHOSIS PAD FLOATING|| 58-1699775|1326041732|CHC13|L1030||11/01/2013|12/31/9999|$91.82|0|0|||LUMBAR BOLSTER PAD|| 58-1699775|1326041732|CHC13|L1040||11/01/2013|12/31/9999|$110.52|0|0|||LUMBAR OR LUMBAR RIB PAD|| 58-1699775|1326041732|CHC13|L1050||11/01/2013|12/31/9999|$95.70|0|0|||STERNAL PAD|| 58-1699775|1326041732|CHC13|L1060||11/01/2013|12/31/9999|$107.95|0|0|||THORACIC PAD|| 58-1699775|1326041732|CHC13|L1070||11/01/2013|12/31/9999|$110.35|0|0|||TRAPEZIUS SLING|| 58-1699775|1326041732|CHC13|L1080||11/01/2013|12/31/9999|$76.48|0|0|||OUTRIGGER|| 58-1699775|1326041732|CHC13|L1085||11/01/2013|12/31/9999|$212.44|0|0|||OUTRIGGER BIL W/ VERT EXTENS|| 58-1699775|1326041732|CHC13|L1090||11/01/2013|12/31/9999|$99.24|0|0|||LUMBAR SLING|| 58-1699775|1326041732|CHC13|L1100||11/01/2013|12/31/9999|$175.17|0|0|||RING FLANGE PLASTIC/LEATHER|| 58-1699775|1326041732|CHC13|L1110||11/01/2013|12/31/9999|$296.71|0|0|||RING FLANGE PLAS/LEATHER MOL|| 58-1699775|1326041732|CHC13|L1120||11/01/2013|12/31/9999|$47.27|0|0|||COVERS FOR UPRIGHT EACH|| 58-1699775|1326041732|CHC13|L1200||11/01/2013|12/31/9999|$1|881.45|0|0|||FURNSH INITIAL ORTHOSIS ONLY|| 58-1699775|1326041732|CHC13|L1210||11/01/2013|12/31/9999|$283.27|0|0|||LATERAL THORACIC EXTENSION|| 58-1699775|1326041732|CHC13|L1220||11/01/2013|12/31/9999|$239.85|0|0|||ANTERIOR THORACIC EXTENSION|| 58-1699775|1326041732|CHC13|L1230||11/01/2013|12/31/9999|$615.41|0|0|||MILWAUKEE TYPE SUPERSTRUCTUR|| 58-1699775|1326041732|CHC13|L1240||11/01/2013|12/31/9999|$105.91|0|0|||LUMBAR DEROTATION PAD|| 58-1699775|1326041732|CHC13|L1250||11/01/2013|12/31/9999|$104.29|0|0|||ANTERIOR ASIS PAD|| 58-1699775|1326041732|CHC13|L1260||11/01/2013|12/31/9999|$107.16|0|0|||ANTERIOR THORACIC DEROTATION|| 58-1699775|1326041732|CHC13|L1270||11/01/2013|12/31/9999|$107.04|0|0|||ABDOMINAL PAD|| 58-1699775|1326041732|CHC13|L1280||11/01/2013|12/31/9999|$95.41|0|0|||RIB GUSSET (ELASTIC) EACH|| 58-1699775|1326041732|CHC13|L1290||11/01/2013|12/31/9999|$108.19|0|0|||LATERAL TROCHANTERIC PAD|| 58-1699775|1326041732|CHC13|L1300||11/01/2013|12/31/9999|$1|808.44|0|0|||BODY JACKET MOLD TO PATIENT|| 58-1699775|1326041732|CHC13|L1310||11/01/2013|12/31/9999|$1|860.87|0|0|||POST-OPERATIVE BODY JACKET|| 58-1699775|1326041732|CHC13|L1600||11/01/2013|12/31/9999|$139.51|0|0|||ABDUCT HIP FLEX FREJKA W CVR|| 58-1699775|1326041732|CHC13|L1610||11/01/2013|12/31/9999|$47.53|0|0|||ABDUCT HIP FLEX FREJKA COVR|| 58-1699775|1326041732|CHC13|L1620||11/01/2013|12/31/9999|$156.51|0|0|||ABDUCT HIP FLEX PAVLIK HARNE|| 58-1699775|1326041732|CHC13|L1630||11/01/2013|12/31/9999|$186.76|0|0|||ABDUCT CONTROL HIP SEMI-FLEX|| 58-1699775|1326041732|CHC13|L1640||11/01/2013|12/31/9999|$499.55|0|0|||PELV BAND/SPREAD BAR THIGH C|| 58-1699775|1326041732|CHC13|L1650||11/01/2013|12/31/9999|$264.91|0|0|||HO ABDUCTION HIP ADJUSTABLE|| 58-1699775|1326041732|CHC13|L1652||11/01/2013|12/31/9999|$414.98|0|0|||HO BI THIGHCUFFS W SPRDR BAR|| 58-1699775|1326041732|CHC13|L1660||11/01/2013|12/31/9999|$185.28|0|0|||HO ABDUCTION STATIC PLASTIC|| 58-1699775|1326041732|CHC13|L1680||11/01/2013|12/31/9999|$1|523.22|0|0|||PELVIC & HIP CONTROL THIGH C|| 58-1699775|1326041732|CHC13|L1685||11/01/2013|12/31/9999|$1|607.25|0|0|||POST-OP HIP ABDUCT CUSTOM FA|| 58-1699775|1326041732|CHC13|L1686||11/01/2013|12/31/9999|$1|078.26|0|0|||HO POST-OP HIP ABDUCTION|| 58-1699775|1326041732|CHC13|L1690||11/01/2013|12/31/9999|$2|251.10|0|0|||COMBINATION BILATERAL HO|| 58-1699775|1326041732|CHC13|L1700||11/01/2013|12/31/9999|$1|872.76|0|0|||LEG PERTHES ORTH TORONTO TYP|| 58-1699775|1326041732|CHC13|L1710||11/01/2013|12/31/9999|$2|201.33|0|0|||LEGG PERTHES ORTH NEWINGTON|| 58-1699775|1326041732|CHC13|L1720||11/01/2013|12/31/9999|$1|626.13|0|0|||LEGG PERTHES ORTHOSIS TRILAT|| 58-1699775|1326041732|CHC13|L1730||11/01/2013|12/31/9999|$1|226.88|0|0|||LEGG PERTHES ORTH SCOTTISH R|| 58-1699775|1326041732|CHC13|L1755||11/01/2013|12/31/9999|$1|785.72|0|0|||LEGG PERTHES PATTEN BOTTOM T|| 58-1699775|1326041732|CHC13|L1810||11/01/2013|12/31/9999|$140.94|0|0|||KO ELASTIC WITH JOINTS|| 58-1699775|1326041732|CHC13|L1810|NU|11/01/2013|12/31/9999|$140.94|0|0|||KO ELASTIC WITH JOINTS|| 58-1699775|1326041732|CHC13|L1812||11/01/2013|12/31/9999|$140.94|0|0|||KO ELASTIC W/JOINTS PRE OTS|| 58-1699775|1326041732|CHC13|L1812|KX|11/01/2013|12/31/9999|$140.94|0|0|||KO ELASTIC W/JOINTS PRE OTS|| 58-1699775|1326041732|CHC13|L1812|NU|11/01/2013|12/31/9999|$140.94|0|0|||KO ELASTIC W/JOINTS PRE OTS|| 58-1699775|1326041732|CHC13|L1820||11/01/2013|12/31/9999|$140.38|0|0|||KO ELAS W/ CONDYLE PADS & JO|| 58-1699775|1326041732|CHC13|L1830||11/01/2013|12/31/9999|$117.43|0|0|||KO IMMOBILIZER CANVAS LONGIT|| 58-1699775|1326041732|CHC13|L1831||11/01/2013|12/31/9999|$342.60|0|0|||KNEE ORTH POS LOCKING JOINT|| 58-1699775|1326041732|CHC13|L1832||11/01/2013|12/31/9999|$877.60|0|0|||KO ADJ JNT POS RIGID SUPPORT|| 58-1699775|1326041732|CHC13|L1832|NU|11/01/2013|12/31/9999|$877.60|0|0|||KO ADJ JNT POS RIGID SUPPORT|| 58-1699775|1326041732|CHC13|L1833||11/01/2013|12/31/9999|$714.77|0|0|||KO ADJ JNT POS R SUP PRE OTS|| 58-1699775|1326041732|CHC13|L1833|NU|11/01/2013|12/31/9999|$714.77|0|0|||KO ADJ JNT POS R SUP PRE OTS|| 58-1699775|1326041732|CHC13|L1834||11/01/2013|12/31/9999|$1|032.46|0|0|||KO W/0 JOINT RIGID MOLDED TO|| 58-1699775|1326041732|CHC13|L1836||11/01/2013|12/31/9999|$155.31|0|0|||RIGID KO WO JOINTS|| 58-1699775|1326041732|CHC13|L1840||11/01/2013|12/31/9999|$1|085.30|0|0|||KO DEROT ANT CRUCIATE CUSTOM|| 58-1699775|1326041732|CHC13|L1843||11/01/2013|12/31/9999|$1|044.50|0|0|||KO SINGLE UPRIGHT CUSTOM FIT|| 58-1699775|1326041732|CHC13|L1844||11/01/2013|12/31/9999|$1|809.89|0|0|||KO W/ADJ JT ROT CNTRL MOLDED|| 58-1699775|1326041732|CHC13|L1845||11/01/2013|12/31/9999|$1|090.37|0|0|||KO W/ ADJ FLEX/EXT ROTAT CUS|| 58-1699775|1326041732|CHC13|L1846||11/01/2013|12/31/9999|$1|383.49|0|0|||KO W ADJ FLEX/EXT ROTAT MOLD|| 58-1699775|1326041732|CHC13|L1847||11/01/2013|12/31/9999|$669.56|0|0|||KO ADJUSTABLE W AIR CHAMBERS|| 58-1699775|1326041732|CHC13|L1850||11/01/2013|12/31/9999|$311.63|0|0|||KO SWEDISH TYPE|| 58-1699775|1326041732|CHC13|L1860||11/01/2013|12/31/9999|$1|208.65|0|0|||KO SUPRACONDYLAR SOCKET MOLD|| 58-1699775|1326041732|CHC13|L1900||11/01/2013|12/31/9999|$327.43|0|0|||AFO SPRNG WIR DRSFLX CALF BD|| 58-1699775|1326041732|CHC13|L1902||11/01/2013|12/31/9999|$88.92|0|0|||AFO ANKLE GAUNTLET|| 58-1699775|1326041732|CHC13|L1902|NU|11/01/2013|12/31/9999|$88.92|0|0|||AFO ANKLE GAUNTLET|| 58-1699775|1326041732|CHC13|L1904||11/01/2013|12/31/9999|$509.10|0|0|||AFO MOLDED ANKLE GAUNTLET|| 58-1699775|1326041732|CHC13|L1906||11/01/2013|12/31/9999|$148.76|0|0|||AFO MULTILIGAMENTUS ANKLE SU|| 58-1699775|1326041732|CHC13|L1907||11/01/2013|12/31/9999|$655.04|0|0|||AFO SUPRAMALLEOLAR CUSTOM|| 58-1699775|1326041732|CHC13|L1910||11/01/2013|12/31/9999|$289.51|0|0|||AFO SING BAR CLASP ATTACH SH|| 58-1699775|1326041732|CHC13|L1920||11/01/2013|12/31/9999|$378.47|0|0|||AFO SING UPRIGHT W/ ADJUST S|| 58-1699775|1326041732|CHC13|L1930||11/01/2013|12/31/9999|$256.11|0|0|||AFO PLASTIC|| 58-1699775|1326041732|CHC13|L1932||11/01/2013|12/31/9999|$1|038.79|0|0|||AFO RIG ANT TIB PREFAB TCF/=|| 58-1699775|1326041732|CHC13|L1940||11/01/2013|12/31/9999|$578.76|0|0|||AFO MOLDED TO PATIENT PLASTI|| 58-1699775|1326041732|CHC13|L1945||11/01/2013|12/31/9999|$1|062.86|0|0|||AFO MOLDED PLAS RIG ANT TIB|| 58-1699775|1326041732|CHC13|L1950||11/01/2013|12/31/9999|$806.37|0|0|||AFO SPIRAL MOLDED TO PT PLAS|| 58-1699775|1326041732|CHC13|L1951||11/01/2013|12/31/9999|$977.65|0|0|||AFO SPIRAL PREFABRICATED|| 58-1699775|1326041732|CHC13|L1960||11/01/2013|12/31/9999|$600.07|0|0|||AFO POS SOLID ANK PLASTIC MO|| 58-1699775|1326041732|CHC13|L1970||11/01/2013|12/31/9999|$887.55|0|0|||AFO PLASTIC MOLDED W/ANKLE J|| 58-1699775|1326041732|CHC13|L1971||11/01/2013|12/31/9999|$545.64|0|0|||AFO W/ANKLE JOINT| PREFAB|| 58-1699775|1326041732|CHC13|L1980||11/01/2013|12/31/9999|$397.32|0|0|||AFO SING SOLID STIRRUP CALF|| 58-1699775|1326041732|CHC13|L1990||11/01/2013|12/31/9999|$510.50|0|0|||AFO DOUB SOLID STIRRUP CALF|| 58-1699775|1326041732|CHC13|L2000||11/01/2013|12/31/9999|$1|098.09|0|0|||KAFO SING FRE STIRR THI/CALF|| 58-1699775|1326041732|CHC13|L2005||11/01/2013|12/31/9999|$4|770.19|0|0|||KAFO SNG/DBL MECHANICAL ACT|| 58-1699775|1326041732|CHC13|L2010||11/01/2013|12/31/9999|$1|001.00|0|0|||KAFO SNG SOLID STIRRUP W/O J|| 58-1699775|1326041732|CHC13|L2020||11/01/2013|12/31/9999|$1|264.11|0|0|||KAFO DBL SOLID STIRRUP BAND/|| 58-1699775|1326041732|CHC13|L2030||11/01/2013|12/31/9999|$1|096.74|0|0|||KAFO DBL SOLID STIRRUP W/O J|| 58-1699775|1326041732|CHC13|L2034||11/01/2013|12/31/9999|$2|390.26|0|0|||KAFO PLA SIN UP W/WO K/A CUS|| 58-1699775|1326041732|CHC13|L2035||11/01/2013|12/31/9999|$201.66|0|0|||KAFO PLASTIC PEDIATRIC SIZE|| 58-1699775|1326041732|CHC13|L2036||11/01/2013|12/31/9999|$2|008.60|0|0|||KAFO PLAS DOUB FREE KNEE MOL|| 58-1699775|1326041732|CHC13|L2037||11/01/2013|12/31/9999|$1|851.04|0|0|||KAFO PLAS SING FREE KNEE MOL|| 58-1699775|1326041732|CHC13|L2038||11/01/2013|12/31/9999|$1|547.85|0|0|||KAFO W/O JOINT MULTI-AXIS AN|| 58-1699775|1326041732|CHC13|L2040||11/01/2013|12/31/9999|$197.71|0|0|||HKAFO TORSION BIL ROT STRAPS|| 58-1699775|1326041732|CHC13|L2050||11/01/2013|12/31/9999|$526.54|0|0|||HKAFO TORSION CABLE HIP PELV|| 58-1699775|1326041732|CHC13|L2060||11/01/2013|12/31/9999|$675.77|0|0|||HKAFO TORSION BALL BEARING J|| 58-1699775|1326041732|CHC13|L2070||11/01/2013|12/31/9999|$194.13|0|0|||HKAFO TORSION UNILAT ROT STR|| 58-1699775|1326041732|CHC13|L2080||11/01/2013|12/31/9999|$413.99|0|0|||HKAFO UNILAT TORSION CABLE|| 58-1699775|1326041732|CHC13|L2090||11/01/2013|12/31/9999|$510.29|0|0|||HKAFO UNILAT TORSION BALL BR|| 58-1699775|1326041732|CHC13|L2106||11/01/2013|12/31/9999|$736.09|0|0|||AFO TIB FX CAST PLASTER MOLD|| 58-1699775|1326041732|CHC13|L2108||11/01/2013|12/31/9999|$1|156.73|0|0|||AFO TIB FX CAST MOLDED TO PT|| 58-1699775|1326041732|CHC13|L2112||11/01/2013|12/31/9999|$549.23|0|0|||AFO TIBIAL FRACTURE SOFT|| 58-1699775|1326041732|CHC13|L2114||11/01/2013|12/31/9999|$628.39|0|0|||AFO TIB FX SEMI-RIGID|| 58-1699775|1326041732|CHC13|L2116||11/01/2013|12/31/9999|$827.91|0|0|||AFO TIBIAL FRACTURE RIGID|| 58-1699775|1326041732|CHC13|L2126||11/01/2013|12/31/9999|$1|473.06|0|0|||KAFO FEM FX CAST THERMOPLAS|| 58-1699775|1326041732|CHC13|L2128||11/01/2013|12/31/9999|$1|856.39|0|0|||KAFO FEM FX CAST MOLDED TO P|| 58-1699775|1326041732|CHC13|L2132||11/01/2013|12/31/9999|$873.32|0|0|||KAFO FEMORAL FX CAST SOFT|| 58-1699775|1326041732|CHC13|L2134||11/01/2013|12/31/9999|$1|047.07|0|0|||KAFO FEM FX CAST SEMI-RIGID|| 58-1699775|1326041732|CHC13|L2136||11/01/2013|12/31/9999|$1|280.30|0|0|||KAFO FEMORAL FX CAST RIGID|| 58-1699775|1326041732|CHC13|L2180||11/01/2013|12/31/9999|$126.79|0|0|||PLAS SHOE INSERT W ANK JOINT|| 58-1699775|1326041732|CHC13|L2182||11/01/2013|12/31/9999|$99.22|0|0|||DROP LOCK KNEE|| 58-1699775|1326041732|CHC13|L2184||11/01/2013|12/31/9999|$178.81|0|0|||LIMITED MOTION KNEE JOINT|| 58-1699775|1326041732|CHC13|L2186||11/01/2013|12/31/9999|$198.15|0|0|||ADJ MOTION KNEE JNT LERMAN T|| 58-1699775|1326041732|CHC13|L2188||11/01/2013|12/31/9999|$432.31|0|0|||QUADRILATERAL BRIM|| 58-1699775|1326041732|CHC13|L2190||11/01/2013|12/31/9999|$112.29|0|0|||WAIST BELT|| 58-1699775|1326041732|CHC13|L2192||11/01/2013|12/31/9999|$386.01|0|0|||PELVIC BAND & BELT THIGH FLA|| 58-1699775|1326041732|CHC13|L2200||11/01/2013|12/31/9999|$51.48|0|0|||LIMITED ANKLE MOTION EA JNT|| 58-1699775|1326041732|CHC13|L2210||11/01/2013|12/31/9999|$83.54|0|0|||DORSIFLEXION ASSIST EACH JOI|| 58-1699775|1326041732|CHC13|L2220||11/01/2013|12/31/9999|$95.91|0|0|||DORSI & PLANTAR FLEX ASS/RES|| 58-1699775|1326041732|CHC13|L2230||11/01/2013|12/31/9999|$83.07|0|0|||SPLIT FLAT CALIPER STIRR & P|| 58-1699775|1326041732|CHC13|L2232||11/01/2013|12/31/9999|$112.46|0|0|||ROCKER BOTTOM| CONTACT AFO|| 58-1699775|1326041732|CHC13|L2240||11/01/2013|12/31/9999|$90.54|0|0|||ROUND CALIPER AND PLATE ATTA|| 58-1699775|1326041732|CHC13|L2250||11/01/2013|12/31/9999|$384.69|0|0|||FOOT PLATE MOLDED STIRRUP AT|| 58-1699775|1326041732|CHC13|L2260||11/01/2013|12/31/9999|$217.02|0|0|||REINFORCED SOLID STIRRUP|| 58-1699775|1326041732|CHC13|L2265||11/01/2013|12/31/9999|$127.50|0|0|||LONG TONGUE STIRRUP|| 58-1699775|1326041732|CHC13|L2270||11/01/2013|12/31/9999|$58.14|0|0|||VARUS/VALGUS STRAP PADDED/LI|| 58-1699775|1326041732|CHC13|L2275||11/01/2013|12/31/9999|$141.46|0|0|||PLASTIC MOD LOW EXT PAD/LINE|| 58-1699775|1326041732|CHC13|L2280||11/01/2013|12/31/9999|$525.55|0|0|||MOLDED INNER BOOT|| 58-1699775|1326041732|CHC13|L2300||11/01/2013|12/31/9999|$296.66|0|0|||ABDUCTION BAR JOINTED ADJUST|| 58-1699775|1326041732|CHC13|L2310||11/01/2013|12/31/9999|$133.19|0|0|||ABDUCTION BAR-STRAIGHT|| 58-1699775|1326041732|CHC13|L2320||11/01/2013|12/31/9999|$222.75|0|0|||NON-MOLDED LACER|| 58-1699775|1326041732|CHC13|L2330||11/01/2013|12/31/9999|$425.10|0|0|||LACER MOLDED TO PATIENT MODE|| 58-1699775|1326041732|CHC13|L2335||11/01/2013|12/31/9999|$250.07|0|0|||ANTERIOR SWING BAND|| 58-1699775|1326041732|CHC13|L2340||11/01/2013|12/31/9999|$590.11|0|0|||PRE-TIBIAL SHELL MOLDED TO P|| 58-1699775|1326041732|CHC13|L2350||11/01/2013|12/31/9999|$964.66|0|0|||PROSTHETIC TYPE SOCKET MOLDE|| 58-1699775|1326041732|CHC13|L2360||11/01/2013|12/31/9999|$56.01|0|0|||EXTENDED STEEL SHANK|| 58-1699775|1326041732|CHC13|L2370||11/01/2013|12/31/9999|$277.91|0|0|||PATTEN BOTTOM|| 58-1699775|1326041732|CHC13|L2375||11/01/2013|12/31/9999|$122.33|0|0|||TORSION ANK & HALF SOLID STI|| 58-1699775|1326041732|CHC13|L2380||11/01/2013|12/31/9999|$133.28|0|0|||TORSION STRAIGHT KNEE JOINT|| 58-1699775|1326041732|CHC13|L2385||11/01/2013|12/31/9999|$145.01|0|0|||STRAIGHT KNEE JOINT HEAVY DU|| 58-1699775|1326041732|CHC13|L2387||11/01/2013|12/31/9999|$196.80|0|0|||ADD LE POLY KNEE CUSTOM KAFO|| 58-1699775|1326041732|CHC13|L2390||11/01/2013|12/31/9999|$118.51|0|0|||OFFSET KNEE JOINT EACH|| 58-1699775|1326041732|CHC13|L2395||11/01/2013|12/31/9999|$180.94|0|0|||OFFSET KNEE JOINT HEAVY DUTY|| 58-1699775|1326041732|CHC13|L2397||11/01/2013|12/31/9999|$126.89|0|0|||SUSPENSION SLEEVE LOWER EXT|| 58-1699775|1326041732|CHC13|L2405||11/01/2013|12/31/9999|$101.50|0|0|||KNEE JOINT DROP LOCK EA JNT|| 58-1699775|1326041732|CHC13|L2415||11/01/2013|12/31/9999|$141.41|0|0|||KNEE JOINT CAM LOCK EACH JOI|| 58-1699775|1326041732|CHC13|L2425||11/01/2013|12/31/9999|$166.85|0|0|||KNEE DISC/DIAL LOCK/ADJ FLEX|| 58-1699775|1326041732|CHC13|L2430||11/01/2013|12/31/9999|$166.85|0|0|||KNEE JNT RATCHET LOCK EA JNT|| 58-1699775|1326041732|CHC13|L2492||11/01/2013|12/31/9999|$110.40|0|0|||KNEE LIFT LOOP DROP LOCK RIN|| 58-1699775|1326041732|CHC13|L2500||11/01/2013|12/31/9999|$341.54|0|0|||THI/GLUT/ISCHIA WGT BEARING|| 58-1699775|1326041732|CHC13|L2510||11/01/2013|12/31/9999|$914.44|0|0|||TH/WGHT BEAR QUAD-LAT BRIM M|| 58-1699775|1326041732|CHC13|L2520||11/01/2013|12/31/9999|$498.74|0|0|||TH/WGHT BEAR QUAD-LAT BRIM C|| 58-1699775|1326041732|CHC13|L2525||11/01/2013|12/31/9999|$1|711.06|0|0|||TH/WGHT BEAR NAR M-L BRIM MO|| 58-1699775|1326041732|CHC13|L2526||11/01/2013|12/31/9999|$922.28|0|0|||TH/WGHT BEAR NAR M-L BRIM CU|| 58-1699775|1326041732|CHC13|L2530||11/01/2013|12/31/9999|$254.38|0|0|||THIGH/WGHT BEAR LACER NON-MO|| 58-1699775|1326041732|CHC13|L2540||11/01/2013|12/31/9999|$457.71|0|0|||THIGH/WGHT BEAR LACER MOLDED|| 58-1699775|1326041732|CHC13|L2550||11/01/2013|12/31/9999|$310.93|0|0|||THIGH/WGHT BEAR HIGH ROLL CU|| 58-1699775|1326041732|CHC13|L2570||11/01/2013|12/31/9999|$687.55|0|0|||HIP CLEVIS TYPE 2 POSIT JNT|| 58-1699775|1326041732|CHC13|L2580||11/01/2013|12/31/9999|$651.75|0|0|||PELVIC CONTROL PELVIC SLING|| 58-1699775|1326041732|CHC13|L2600||11/01/2013|12/31/9999|$222.34|0|0|||HIP CLEVIS/THRUST BEARING FR|| 58-1699775|1326041732|CHC13|L2610||11/01/2013|12/31/9999|$262.91|0|0|||HIP CLEVIS/THRUST BEARING LO|| 58-1699775|1326041732|CHC13|L2620||11/01/2013|12/31/9999|$289.46|0|0|||PELVIC CONTROL HIP HEAVY DUT|| 58-1699775|1326041732|CHC13|L2622||11/01/2013|12/31/9999|$332.00|0|0|||HIP JOINT ADJUSTABLE FLEXION|| 58-1699775|1326041732|CHC13|L2624||11/01/2013|12/31/9999|$451.34|0|0|||HIP ADJ FLEX EXT ABDUCT CONT|| 58-1699775|1326041732|CHC13|L2627||11/01/2013|12/31/9999|$1|859.49|0|0|||PLASTIC MOLD RECIPRO HIP & C|| 58-1699775|1326041732|CHC13|L2628||11/01/2013|12/31/9999|$2|184.30|0|0|||METAL FRAME RECIPRO HIP & CA|| 58-1699775|1326041732|CHC13|L2630||11/01/2013|12/31/9999|$268.08|0|0|||PELVIC CONTROL BAND & BELT U|| 58-1699775|1326041732|CHC13|L2640||11/01/2013|12/31/9999|$363.81|0|0|||PELVIC CONTROL BAND & BELT B|| 58-1699775|1326041732|CHC13|L2650||11/01/2013|12/31/9999|$129.91|0|0|||PELV & THOR CONTROL GLUTEAL|| 58-1699775|1326041732|CHC13|L2660||11/01/2013|12/31/9999|$201.77|0|0|||THORACIC CONTROL THORACIC BA|| 58-1699775|1326041732|CHC13|L2670||11/01/2013|12/31/9999|$184.68|0|0|||THORAC CONT PARASPINAL UPRIG|| 58-1699775|1326041732|CHC13|L2680||11/01/2013|12/31/9999|$169.41|0|0|||THORAC CONT LAT SUPPORT UPRI|| 58-1699775|1326041732|CHC13|L2750||11/01/2013|12/31/9999|$90.49|0|0|||PLATING CHROME/NICKEL PR BAR|| 58-1699775|1326041732|CHC13|L2755||11/01/2013|12/31/9999|$152.14|0|0|||CARBON GRAPHITE LAMINATION|| 58-1699775|1326041732|CHC13|L2760||11/01/2013|12/31/9999|$65.77|0|0|||EXTENSION PER EXTENSION PER|| 58-1699775|1326041732|CHC13|L2768||11/01/2013|12/31/9999|$151.70|0|0|||ORTHO SIDEBAR DISCONNECT|| 58-1699775|1326041732|CHC13|L2780||11/01/2013|12/31/9999|$77.81|0|0|||NON-CORROSIVE FINISH|| 58-1699775|1326041732|CHC13|L2785||11/01/2013|12/31/9999|$45.75|0|0|||DROP LOCK RETAINER EACH|| 58-1699775|1326041732|CHC13|L2795||11/01/2013|12/31/9999|$91.99|0|0|||KNEE CONTROL FULL KNEECAP|| 58-1699775|1326041732|CHC13|L2800||11/01/2013|12/31/9999|$115.47|0|0|||KNEE CAP MEDIAL OR LATERAL P|| 58-1699775|1326041732|CHC13|L2810||11/01/2013|12/31/9999|$84.56|0|0|||KNEE CONTROL CONDYLAR PAD|| 58-1699775|1326041732|CHC13|L2820||11/01/2013|12/31/9999|$94.01|0|0|||SOFT INTERFACE BELOW KNEE SE|| 58-1699775|1326041732|CHC13|L2830||11/01/2013|12/31/9999|$105.73|0|0|||SOFT INTERFACE ABOVE KNEE SE|| 58-1699775|1326041732|CHC13|L2840||11/01/2013|12/31/9999|$59.00|0|0|||TIBIAL LENGTH SOCK FX OR EQU|| 58-1699775|1326041732|CHC13|L2850||11/01/2013|12/31/9999|$67.04|0|0|||FEMORAL LGTH SOCK FX OR EQUA|| 58-1699775|1326041732|CHC13|L3000||11/01/2013|12/31/9999|$365.69|0|0|||FT INSERT UCB BERKELEY SHELL|| 58-1699775|1326041732|CHC13|L3001||11/01/2013|12/31/9999|$153.95|0|0|||FOOT INSERT REMOV MOLDED SPE|| 58-1699775|1326041732|CHC13|L3002||11/01/2013|12/31/9999|$188.01|0|0|||FOOT INSERT PLASTAZOTE OR EQ|| 58-1699775|1326041732|CHC13|L3003||11/01/2013|12/31/9999|$202.81|0|0|||FOOT INSERT SILICONE GEL EAC|| 58-1699775|1326041732|CHC13|L3010||11/01/2013|12/31/9999|$202.81|0|0|||FOOT LONGITUDINAL ARCH SUPPO|| 58-1699775|1326041732|CHC13|L3020||11/01/2013|12/31/9999|$230.96|0|0|||FOOT LONGITUD/METATARSAL SUP|| 58-1699775|1326041732|CHC13|L3030||11/01/2013|12/31/9999|$88.84|0|0|||FOOT ARCH SUPPORT REMOV PREM|| 58-1699775|1326041732|CHC13|L3031||11/01/2013|12/31/9999|$0.00|0|0|||FOOT LAMIN/PREPREG COMPOSITE|| 58-1699775|1326041732|CHC13|L3040||11/01/2013|12/31/9999|$54.79|0|0|||FT ARCH SUPRT PREMOLD LONGIT|| 58-1699775|1326041732|CHC13|L3050||11/01/2013|12/31/9999|$54.79|0|0|||FOOT ARCH SUPP PREMOLD METAT|| 58-1699775|1326041732|CHC13|L3060||11/01/2013|12/31/9999|$85.86|0|0|||FOOT ARCH SUPP LONGITUD/META|| 58-1699775|1326041732|CHC13|L3070||11/01/2013|12/31/9999|$37.01|0|0|||ARCH SUPRT ATT TO SHO LONGIT|| 58-1699775|1326041732|CHC13|L3080||11/01/2013|12/31/9999|$37.01|0|0|||ARCH SUPP ATT TO SHOE METATA|| 58-1699775|1326041732|CHC13|L3090||11/01/2013|12/31/9999|$47.40|0|0|||ARCH SUPP ATT TO SHOE LONG/M|| 58-1699775|1326041732|CHC13|L3100||11/01/2013|12/31/9999|$50.31|0|0|||HALLUS-VALGUS NGHT DYNAMIC S|| 58-1699775|1326041732|CHC13|L3140||11/01/2013|12/31/9999|$103.64|0|0|||ABDUCTION ROTATION BAR SHOE|| 58-1699775|1326041732|CHC13|L3150||11/01/2013|12/31/9999|$94.76|0|0|||ABDUCT ROTATION BAR W/O SHOE|| 58-1699775|1326041732|CHC13|L3170||11/01/2013|12/31/9999|$59.24|0|0|||FOOT PLASTIC HEEL STABILIZER|| 58-1699775|1326041732|CHC13|L3203||11/01/2013|12/31/9999|$31.63|0|0|||OXFORD W/ SUPINATOR/PRONATOR|| 58-1699775|1326041732|CHC13|L3224||11/01/2013|12/31/9999|$63.66|0|0|||WOMAN'S SHOE OXFORD BRACE|| 58-1699775|1326041732|CHC13|L3225||11/01/2013|12/31/9999|$73.24|0|0|||MAN'S SHOE OXFORD BRACE|| 58-1699775|1326041732|CHC13|L3260||11/01/2013|12/31/9999|$15.97|0|0|||AMBULATORY SURGICAL BOOT EAC|| 58-1699775|1326041732|CHC13|L3300||11/01/2013|12/31/9999|$60.69|0|0|||SHO LIFT TAPER TO METATARSAL|| 58-1699775|1326041732|CHC13|L3310||11/01/2013|12/31/9999|$94.76|0|0|||SHOE LIFT ELEV HEEL/SOLE NEO|| 58-1699775|1326041732|CHC13|L3330||11/01/2013|12/31/9999|$658.80|0|0|||LIFTS ELEVATION METAL EXTENS|| 58-1699775|1326041732|CHC13|L3332||11/01/2013|12/31/9999|$85.86|0|0|||SHOE LIFTS TAPERED TO ONE-HA|| 58-1699775|1326041732|CHC13|L3334||11/01/2013|12/31/9999|$44.41|0|0|||SHOE LIFTS ELEVATION HEEL /I|| 58-1699775|1326041732|CHC13|L3334|NU|11/01/2013|12/31/9999|$44.41|0|0|||SHOE LIFTS ELEVATION HEEL /I|| 58-1699775|1326041732|CHC13|L3340||11/01/2013|12/31/9999|$99.22|0|0|||SHOE WEDGE SACH|| 58-1699775|1326041732|CHC13|L3350||11/01/2013|12/31/9999|$26.62|0|0|||SHOE HEEL WEDGE|| 58-1699775|1326041732|CHC13|L3360||11/01/2013|12/31/9999|$41.45|0|0|||SHOE SOLE WEDGE OUTSIDE SOLE|| 58-1699775|1326041732|CHC13|L3370||11/01/2013|12/31/9999|$57.74|0|0|||SHOE SOLE WEDGE BETWEEN SOLE|| 58-1699775|1326041732|CHC13|L3380||11/01/2013|12/31/9999|$57.74|0|0|||SHOE CLUBFOOT WEDGE|| 58-1699775|1326041732|CHC13|L3390||11/01/2013|12/31/9999|$57.74|0|0|||SHOE OUTFLARE WEDGE|| 58-1699775|1326041732|CHC13|L3400||11/01/2013|12/31/9999|$47.40|0|0|||SHOE METATARSAL BAR WEDGE RO|| 58-1699775|1326041732|CHC13|L3410||11/01/2013|12/31/9999|$108.11|0|0|||SHOE METATARSAL BAR BETWEEN|| 58-1699775|1326041732|CHC13|L3420||11/01/2013|12/31/9999|$63.64|0|0|||FULL SOLE/HEEL WEDGE BTWEEN|| 58-1699775|1326041732|CHC13|L3430||11/01/2013|12/31/9999|$186.55|0|0|||SHO HEEL COUNT PLAST REINFOR|| 58-1699775|1326041732|CHC13|L3440||11/01/2013|12/31/9999|$88.84|0|0|||HEEL LEATHER REINFORCED|| 58-1699775|1326041732|CHC13|L3450||11/01/2013|12/31/9999|$122.85|0|0|||SHOE HEEL SACH CUSHION TYPE|| 58-1699775|1326041732|CHC13|L3455||11/01/2013|12/31/9999|$47.40|0|0|||SHOE HEEL NEW LEATHER STANDA|| 58-1699775|1326041732|CHC13|L3460||11/01/2013|12/31/9999|$39.95|0|0|||SHOE HEEL NEW RUBBER STANDAR|| 58-1699775|1326041732|CHC13|L3465||11/01/2013|12/31/9999|$68.10|0|0|||SHOE HEEL THOMAS WITH WEDGE|| 58-1699775|1326041732|CHC13|L3470||11/01/2013|12/31/9999|$72.53|0|0|||SHOE HEEL THOMAS EXTEND TO B|| 58-1699775|1326041732|CHC13|L3480||11/01/2013|12/31/9999|$72.53|0|0|||SHOE HEEL PAD & DEPRESS FOR|| 58-1699775|1326041732|CHC13|L3500||11/01/2013|12/31/9999|$34.08|0|0|||ORTHO SHOE ADD LEATHER INSOL|| 58-1699775|1326041732|CHC13|L3510||11/01/2013|12/31/9999|$34.08|0|0|||ORTHOPEDIC SHOE ADD RUB INSL|| 58-1699775|1326041732|CHC13|L3520||11/01/2013|12/31/9999|$37.01|0|0|||O SHOE ADD FELT W LEATH INSL|| 58-1699775|1326041732|CHC13|L3530||11/01/2013|12/31/9999|$37.01|0|0|||ORTHO SHOE ADD HALF SOLE|| 58-1699775|1326041732|CHC13|L3540||11/01/2013|12/31/9999|$59.24|0|0|||ORTHO SHOE ADD FULL SOLE|| 58-1699775|1326041732|CHC13|L3550||11/01/2013|12/31/9999|$10.38|0|0|||O SHOE ADD STANDARD TOE TAP|| 58-1699775|1326041732|CHC13|L3560||11/01/2013|12/31/9999|$26.62|0|0|||O SHOE ADD HORSESHOE TOE TAP|| 58-1699775|1326041732|CHC13|L3570||11/01/2013|12/31/9999|$99.22|0|0|||O SHOE ADD INSTEP EXTENSION|| 58-1699775|1326041732|CHC13|L3580||11/01/2013|12/31/9999|$75.50|0|0|||O SHOE ADD INSTEP VELCRO CLO|| 58-1699775|1326041732|CHC13|L3590||11/01/2013|12/31/9999|$62.19|0|0|||O SHOE CONVERT TO SOF COUNTE|| 58-1699775|1326041732|CHC13|L3595||11/01/2013|12/31/9999|$48.85|0|0|||ORTHO SHOE ADD MARCH BAR|| 58-1699775|1326041732|CHC13|L3600||11/01/2013|12/31/9999|$88.84|0|0|||TRANS SHOE CALIP PLATE EXIST|| 58-1699775|1326041732|CHC13|L3610||11/01/2013|12/31/9999|$116.96|0|0|||TRANS SHOE CALIPER PLATE NEW|| 58-1699775|1326041732|CHC13|L3620||11/01/2013|12/31/9999|$88.84|0|0|||TRANS SHOE SOLID STIRRUP EXI|| 58-1699775|1326041732|CHC13|L3630||11/01/2013|12/31/9999|$116.96|0|0|||TRANS SHOE SOLID STIRRUP NEW|| 58-1699775|1326041732|CHC13|L3640||11/01/2013|12/31/9999|$50.31|0|0|||SHOE DENNIS BROWNE SPLINT BO|| 58-1699775|1326041732|CHC13|L3650||11/01/2013|12/31/9999|$63.41|0|0|||SHLDER FIG 8 ABDUCT RESTRAIN|| 58-1699775|1326041732|CHC13|L3650|NU|11/01/2013|12/31/9999|$50.31|0|0|||SHLDER FIG 8 ABDUCT RESTRAIN|| 58-1699775|1326041732|CHC13|L3660||11/01/2013|12/31/9999|$108.89|0|0|||ABDUCT RESTRAINER CANVAS&WEB|| 58-1699775|1326041732|CHC13|L3670||11/01/2013|12/31/9999|$151.77|0|0|||ACROMIO/CLAVICULAR CANVAS&WE|| 58-1699775|1326041732|CHC13|L3670|NU|11/01/2013|12/31/9999|$151.77|0|0|||ACROMIO/CLAVICULAR CANVAS&WE|| 58-1699775|1326041732|CHC13|L3671||11/01/2013|12/31/9999|$954.60|0|0|||SO CAP DESIGN W/O JNTS CF|| 58-1699775|1326041732|CHC13|L3674||11/01/2013|12/31/9999|$1|252.30|0|0|||SO AIRPLANE W/WO JOINT CF|| 58-1699775|1326041732|CHC13|L3675||11/01/2013|12/31/9999|$185.93|0|0|||CANVAS VEST SO|| 58-1699775|1326041732|CHC13|L3702||11/01/2013|12/31/9999|$305.91|0|0|||EO W/O JOINTS CF|| 58-1699775|1326041732|CHC13|L3702|NU|11/01/2013|12/31/9999|$305.91|0|0|||EO W/O JOINTS CF|| 58-1699775|1326041732|CHC13|L3710||11/01/2013|12/31/9999|$153.60|0|0|||ELBOW ELASTIC WITH METAL JOI|| 58-1699775|1326041732|CHC13|L3720||11/01/2013|12/31/9999|$766.34|0|0|||FOREARM/ARM CUFFS FREE MOTIO|| 58-1699775|1326041732|CHC13|L3730||11/01/2013|12/31/9999|$1|008.79|0|0|||FOREARM/ARM CUFFS EXT/FLEX A|| 58-1699775|1326041732|CHC13|L3740||11/01/2013|12/31/9999|$1|133.71|0|0|||CUFFS ADJ LOCK W/ ACTIVE CON|| 58-1699775|1326041732|CHC13|L3760||11/01/2013|12/31/9999|$529.81|0|0|||EO WITHJOINT| PREFABRICATED|| 58-1699775|1326041732|CHC13|L3761||04/01/2018|12/31/9999|$555.14|0|0|0||EO| ADJ LOCK JOINT PREFAB OFF|| 58-1699775|1326041732|CHC13|L3762||11/01/2013|12/31/9999|$113.92|0|0|||RIGID EO WO JOINTS|| 58-1699775|1326041732|CHC13|L3762|NU|11/01/2013|12/31/9999|$113.92|0|0|||RIGID EO WO JOINTS|| 58-1699775|1326041732|CHC13|L3763||11/01/2013|12/31/9999|$841.14|0|0|||EWHO RIGID W/O JNTS CF|| 58-1699775|1326041732|CHC13|L3764||11/01/2013|12/31/9999|$838.86|0|0|||EWHO W/JOINT(S) CF|| 58-1699775|1326041732|CHC13|L3765||11/01/2013|12/31/9999|$1|358.46|0|0|||EWHFO RIGID W/O JNTS CF|| 58-1699775|1326041732|CHC13|L3766||11/01/2013|12/31/9999|$1|438.52|0|0|||EWHFO W/JOINT(S) CF|| 58-1699775|1326041732|CHC13|L3806||11/01/2013|12/31/9999|$481.24|0|0|||WHFO W/JOINT(S) CUSTOM FAB|| 58-1699775|1326041732|CHC13|L3807||11/01/2013|12/31/9999|$264.91|0|0|||WHFO|NO JOINT| PREFABRICATED|| 58-1699775|1326041732|CHC13|L3807|NU|11/01/2013|12/31/9999|$264.91|0|0|||WHFO|NO JOINT| PREFABRICATED|| 58-1699775|1326041732|CHC13|L3808||11/01/2013|12/31/9999|$353.88|0|0|||WHFO| RIGID W/O JOINTS|| 58-1699775|1326041732|CHC13|L3809||11/01/2013|12/31/9999|$219.01|0|0|||WHFO W/O JOINTS PRE OTS|| 58-1699775|1326041732|CHC13|L3900||11/01/2013|12/31/9999|$1|655.03|0|0|||HINGE EXTENSION/FLEX WRIST/F|| 58-1699775|1326041732|CHC13|L3901||11/01/2013|12/31/9999|$1|855.72|0|0|||HINGE EXT/FLEX WRIST FINGER|| 58-1699775|1326041732|CHC13|L3904||11/01/2013|12/31/9999|$3|777.74|0|0|||WHFO ELECTRIC CUSTOM FITTED|| 58-1699775|1326041732|CHC13|L3905||11/01/2013|12/31/9999|$1|050.64|0|0|||WHO W/NONTORSION JNT(S) CF|| 58-1699775|1326041732|CHC13|L3906||11/01/2013|12/31/9999|$446.93|0|0|||WHO W/O JOINTS CF|| 58-1699775|1326041732|CHC13|L3908||01/01/2016|12/31/9999|$63.50|0|0|||WRIST COCK-UP NON-MOLDED|| 58-1699775|1326041732|CHC13|L3908|NU|01/01/2016|12/31/9999|$63.50|0|0|||WRIST COCK-UP NON-MOLDED|| 58-1699775|1326041732|CHC13|L3912||11/01/2013|12/31/9999|$101.82|0|0|||FLEX GLOVE W/ELASTIC FINGER|| 58-1699775|1326041732|CHC13|L3913||11/01/2013|12/31/9999|$286.95|0|0|||HFO W/O JOINTS CF|| 58-1699775|1326041732|CHC13|L3915||11/01/2013|12/31/9999|$563.18|0|0|||WHO W NONTOR JNT(S) PREFAB|| 58-1699775|1326041732|CHC13|L3917||11/01/2013|12/31/9999|$111.91|0|0|||PREFAB METACARPL FX ORTHOSIS|| 58-1699775|1326041732|CHC13|L3919||11/01/2013|12/31/9999|$286.95|0|0|||HO W/O JOINTS CF|| 58-1699775|1326041732|CHC13|L3921||11/01/2013|12/31/9999|$340.28|0|0|||HFO W/JOINT(S) CF|| 58-1699775|1326041732|CHC13|L3923||11/01/2013|12/31/9999|$92.15|0|0|||HFO W/O JOINTS PF|| 58-1699775|1326041732|CHC13|L3923|NU|11/01/2013|12/31/9999|$92.15|0|0|||HFO W/O JOINTS PF|| 58-1699775|1326041732|CHC13|L3924|NU|11/01/2013|12/31/9999|$76.18|0|0|||OPPENHEIMER|| 58-1699775|1326041732|CHC13|L3925||11/01/2013|12/31/9999|$55.97|0|0|||FO PIP/DIP WITH JOINT/SPRING|| 58-1699775|1326041732|CHC13|L3927||11/01/2013|12/31/9999|$37.07|0|0|||FO PIP/DIP W/O JOINT/SPRING|| 58-1699775|1326041732|CHC13|L3929||11/01/2013|12/31/9999|$89.19|0|0|||HFO NONTORSION JOINT| PREFAB|| 58-1699775|1326041732|CHC13|L3931||11/01/2013|12/31/9999|$215.75|0|0|||WHFO NONTORSION JOINT PREFAB|| 58-1699775|1326041732|CHC13|L3933||11/01/2013|12/31/9999|$226.06|0|0|||FO W/O JOINTS CF|| 58-1699775|1326041732|CHC13|L3935||11/01/2013|12/31/9999|$234.07|0|0|||FO NONTORSION JOINT CF|| 58-1699775|1326041732|CHC13|L3956||11/01/2013|12/31/9999|$0.00|0|0|||ADD JOINT UPPER EXT ORTHOSIS|| 58-1699775|1326041732|CHC13|L3960||11/01/2013|12/31/9999|$873.27|0|0|||SEWHO AIRPLAN DESIG ABDU POS|| 58-1699775|1326041732|CHC13|L3961||11/01/2013|12/31/9999|$1|779.99|0|0|||SEWHO CAP DESIGN W/O JNTS CF|| 58-1699775|1326041732|CHC13|L3962||11/01/2013|12/31/9999|$909.27|0|0|||SEWHO ERBS PALSEY DESIGN ABD|| 58-1699775|1326041732|CHC13|L3967||11/01/2013|12/31/9999|$2|101.55|0|0|||SEWHO AIRPLANE W/O JNTS CF|| 58-1699775|1326041732|CHC13|L3971||11/01/2013|12/31/9999|$1|994.82|0|0|||SEWHO CAP DESIGN W/JNT(S) CF|| 58-1699775|1326041732|CHC13|L3973||11/01/2013|12/31/9999|$2|101.55|0|0|||SEWHO AIRPLANE W/JNT(S) CF|| 58-1699775|1326041732|CHC13|L3975||11/01/2013|12/31/9999|$1|779.99|0|0|||SEWHFO CAP DESIGN W/O JNT CF|| 58-1699775|1326041732|CHC13|L3976||11/01/2013|12/31/9999|$1|779.99|0|0|||SEWHFO AIRPLANE W/O JNTS CF|| 58-1699775|1326041732|CHC13|L3977||11/01/2013|12/31/9999|$1|994.82|0|0|||SEWHFO CAP DESGN W/JNT(S) CF|| 58-1699775|1326041732|CHC13|L3978||11/01/2013|12/31/9999|$2|101.55|0|0|||SEWHFO AIRPLANE W/JNT(S) CF|| 58-1699775|1326041732|CHC13|L3980||11/01/2013|12/31/9999|$327.50|0|0|||UPP EXT FX ORTHOSIS HUMERAL|| 58-1699775|1326041732|CHC13|L3980|NU|11/01/2013|12/31/9999|$327.50|0|0|||UPP EXT FX ORTHOSIS HUMERAL|| 58-1699775|1326041732|CHC13|L3982||11/01/2013|12/31/9999|$404.64|0|0|||UPPER EXT FX ORTHOSIS RAD/UL|| 58-1699775|1326041732|CHC13|L3984||11/01/2013|12/31/9999|$431.91|0|0|||UPPER EXT FX ORTHOSIS WRIST|| 58-1699775|1326041732|CHC13|L3995||11/01/2013|12/31/9999|$36.25|0|0|||SOCK FRACTURE OR EQUAL EACH|| 58-1699775|1326041732|CHC13|L3995|NU|11/01/2013|12/31/9999|$36.25|0|0|||SOCK FRACTURE OR EQUAL EACH|| 58-1699775|1326041732|CHC13|L4000||11/01/2013|12/31/9999|$1|412.31|0|0|||REPL GIRDLE MILWAUKEE ORTH|| 58-1699775|1326041732|CHC13|L4002||11/01/2013|12/31/9999|$0.00|0|0|||REPLACE STRAP| ANY ORTHOSIS|| 58-1699775|1326041732|CHC13|L4010||11/01/2013|12/31/9999|$794.76|0|0|||REPLACE TRILATERAL SOCKET BR|| 58-1699775|1326041732|CHC13|L4020||11/01/2013|12/31/9999|$992.72|0|0|||REPLACE QUADLAT SOCKET BRIM|| 58-1699775|1326041732|CHC13|L4030||11/01/2013|12/31/9999|$546.60|0|0|||REPLACE SOCKET BRIM CUST FIT|| 58-1699775|1326041732|CHC13|L4040||11/01/2013|12/31/9999|$441.91|0|0|||REPLACE MOLDED THIGH LACER|| 58-1699775|1326041732|CHC13|L4045||11/01/2013|12/31/9999|$355.13|0|0|||REPLACE NON-MOLDED THIGH LAC|| 58-1699775|1326041732|CHC13|L4050||11/01/2013|12/31/9999|$446.95|0|0|||REPLACE MOLDED CALF LACER|| 58-1699775|1326041732|CHC13|L4055||11/01/2013|12/31/9999|$289.41|0|0|||REPLACE NON-MOLDED CALF LACE|| 58-1699775|1326041732|CHC13|L4060||11/01/2013|12/31/9999|$344.05|0|0|||REPLACE HIGH ROLL CUFF|| 58-1699775|1326041732|CHC13|L4070||11/01/2013|12/31/9999|$328.25|0|0|||REPLACE PROX & DIST UPRIGHT|| 58-1699775|1326041732|CHC13|L4080||11/01/2013|12/31/9999|$115.73|0|0|||REPL MET BAND KAFO-AFO PROX|| 58-1699775|1326041732|CHC13|L4090||11/01/2013|12/31/9999|$102.43|0|0|||REPL MET BAND KAFO-AFO CALF/|| 58-1699775|1326041732|CHC13|L4100||11/01/2013|12/31/9999|$115.52|0|0|||REPL LEATH CUFF KAFO PROX TH|| 58-1699775|1326041732|CHC13|L4110||11/01/2013|12/31/9999|$91.80|0|0|||REPL LEATH CUFF KAFO-AFO CAL|| 58-1699775|1326041732|CHC13|L4130||11/01/2013|12/31/9999|$631.88|0|0|||REPLACE PRETIBIAL SHELL|| 58-1699775|1326041732|CHC13|L4350||11/01/2013|12/31/9999|$113.84|0|0|||ANKLE CONTROL ORTHOSI PREFAB|| 58-1699775|1326041732|CHC13|L4350|NU|11/01/2013|12/31/9999|$113.84|0|0|||ANKLE CONTROL ORTHOSI PREFAB|| 58-1699775|1326041732|CHC13|L4360||11/01/2013|12/31/9999|$318.49|0|0|||PNEUMATI WALKING BOOT PREFAB|| 58-1699775|1326041732|CHC13|L4360|NU|11/01/2013|12/31/9999|$318.49|0|0|||PNEUMATI WALKING BOOT PREFAB|| 58-1699775|1326041732|CHC13|L4361||11/01/2013|12/31/9999|$318.49|0|0|||PNEUMA/VAC WALK BOOT PRE OTS|| 58-1699775|1326041732|CHC13|L4361|NU|11/01/2013|12/31/9999|$318.49|0|0|||PNEUMA/VAC WALK BOOT PRE OTS|| 58-1699775|1326041732|CHC13|L4370||11/01/2013|12/31/9999|$204.39|0|0|||PNEUMATIC FULL LEG SPLINT|| 58-1699775|1326041732|CHC13|L4386||11/01/2013|12/31/9999|$184.58|0|0|||NON-PNEUM WALK BOOT PREFAB|| 58-1699775|1326041732|CHC13|L4386|NU|11/01/2013|12/31/9999|$184.58|0|0|||NON-PNEUM WALK BOOT PREFAB|| 58-1699775|1326041732|CHC13|L4387||11/01/2013|12/31/9999|$151.97|0|0|||NON-PNEUM WALK BOOT PRE OTS|| 58-1699775|1326041732|CHC13|L4392||11/01/2013|12/31/9999|$27.41|0|0|||REPLACE AFO SOFT INTERFACE|| 58-1699775|1326041732|CHC13|L4394||11/01/2013|12/31/9999|$20.01|0|0|||REPLACE FOOT DROP SPINT|| 58-1699775|1326041732|CHC13|L4396||11/01/2013|12/31/9999|$195.39|0|0|||STATIC AFO|| 58-1699775|1326041732|CHC13|L4396|NU|11/01/2013|12/31/9999|$195.39|0|0|||STATIC AFO|| 58-1699775|1326041732|CHC13|L4397||11/01/2013|12/31/9999|$161.53|0|0|||STATIC OR DYNAMI AFO PRE OTS|| 58-1699775|1326041732|CHC13|L4397|NU|11/01/2013|12/31/9999|$161.53|0|0|||STATIC OR DYNAMI AFO PRE OTS|| 58-1699775|1326041732|CHC13|L4398||11/01/2013|12/31/9999|$89.91|0|0|||FOOT DROP SPLINT RECUMBENT|| 58-1699775|1326041732|CHC13|L4631||11/01/2013|12/31/9999|$1|737.21|0|0|||AFO| WALK BOOT TYPE| CUS FAB|| 58-1699775|1326041732|CHC13|L5000||11/01/2013|12/31/9999|$610.39|0|0|||SHO INSERT W ARCH TOE FILLER|| 58-1699775|1326041732|CHC13|L5010||11/01/2013|12/31/9999|$1|474.24|0|0|||MOLD SOCKET ANK HGT W/ TOE F|| 58-1699775|1326041732|CHC13|L5020||11/01/2013|12/31/9999|$2|503.61|0|0|||TIBIAL TUBERCLE HGT W/ TOE F|| 58-1699775|1326041732|CHC13|L5050||11/01/2013|12/31/9999|$2|769.46|0|0|||ANK SYMES MOLD SCKT SACH FT|| 58-1699775|1326041732|CHC13|L5060||11/01/2013|12/31/9999|$3|185.68|0|0|||SYMES MET FR LEATH SOCKET AR|| 58-1699775|1326041732|CHC13|L5100||11/01/2013|12/31/9999|$2|775.57|0|0|||MOLDED SOCKET SHIN SACH FOOT|| 58-1699775|1326041732|CHC13|L5105||11/01/2013|12/31/9999|$4|006.82|0|0|||PLAST SOCKET JTS/THGH LACER|| 58-1699775|1326041732|CHC13|L5150||11/01/2013|12/31/9999|$4|050.35|0|0|||MOLD SCKT EXT KNEE SHIN SACH|| 58-1699775|1326041732|CHC13|L5160||11/01/2013|12/31/9999|$4|405.49|0|0|||MOLD SOCKET BENT KNEE SHIN S|| 58-1699775|1326041732|CHC13|L5200||11/01/2013|12/31/9999|$4|218.88|0|0|||KNE SING AXIS FRIC SHIN SACH|| 58-1699775|1326041732|CHC13|L5210||11/01/2013|12/31/9999|$2|798.80|0|0|||NO KNEE/ANKLE JOINTS W/ FT B|| 58-1699775|1326041732|CHC13|L5220||11/01/2013|12/31/9999|$3|181.35|0|0|||NO KNEE JOINT WITH ARTIC ALI|| 58-1699775|1326041732|CHC13|L5230||11/01/2013|12/31/9999|$4|387.70|0|0|||FEM FOCAL DEFIC CONSTANT FRI|| 58-1699775|1326041732|CHC13|L5250||11/01/2013|12/31/9999|$5|984.43|0|0|||HIP CANAD SING AXI CONS FRIC|| 58-1699775|1326041732|CHC13|L5270||11/01/2013|12/31/9999|$5|957.87|0|0|||TILT TABLE LOCKING HIP SING|| 58-1699775|1326041732|CHC13|L5280||11/01/2013|12/31/9999|$5|912.25|0|0|||HEMIPELVECT CANAD SING AXIS|| 58-1699775|1326041732|CHC13|L5301||11/01/2013|12/31/9999|$3|172.65|0|0|||BK MOLD SOCKET SACH FT ENDO|| 58-1699775|1326041732|CHC13|L5312||11/01/2013|12/31/9999|$4|541.42|0|0|||KNEE DISART| SACH FT| ENDO|| 58-1699775|1326041732|CHC13|L5321||11/01/2013|12/31/9999|$4|598.84|0|0|||AK OPEN END SACH|| 58-1699775|1326041732|CHC13|L5331||11/01/2013|12/31/9999|$5|859.85|0|0|||HIP DISART CANADIAN SACH FT|| 58-1699775|1326041732|CHC13|L5341||11/01/2013|12/31/9999|$6|100.13|0|0|||HEMIPELVECTOMY CANADIAN SACH|| 58-1699775|1326041732|CHC13|L5400||11/01/2013|12/31/9999|$1|570.72|0|0|||POSTOP DRESS & 1 CAST CHG BK|| 58-1699775|1326041732|CHC13|L5410||11/01/2013|12/31/9999|$481.90|0|0|||POSTOP DSG BK EA ADD CAST CH|| 58-1699775|1326041732|CHC13|L5420||11/01/2013|12/31/9999|$1|924.88|0|0|||POSTOP DSG & 1 CAST CHG AK/D|| 58-1699775|1326041732|CHC13|L5430||11/01/2013|12/31/9999|$580.40|0|0|||POSTOP DSG AK EA ADD CAST CH|| 58-1699775|1326041732|CHC13|L5450||11/01/2013|12/31/9999|$472.17|0|0|||POSTOP APP NON-WGT BEAR DSG|| 58-1699775|1326041732|CHC13|L5460||11/01/2013|12/31/9999|$629.09|0|0|||POSTOP APP NON-WGT BEAR DSG|| 58-1699775|1326041732|CHC13|L5500||11/01/2013|12/31/9999|$1|481.34|0|0|||INIT BK PTB PLASTER DIRECT|| 58-1699775|1326041732|CHC13|L5505||11/01/2013|12/31/9999|$2|048.72|0|0|||INIT AK ISCHAL PLSTR DIRECT|| 58-1699775|1326041732|CHC13|L5510||11/01/2013|12/31/9999|$1|679.19|0|0|||PREP BK PTB PLASTER MOLDED|| 58-1699775|1326041732|CHC13|L5520||11/01/2013|12/31/9999|$1|658.64|0|0|||PERP BK PTB THERMOPLS DIRECT|| 58-1699775|1326041732|CHC13|L5530||11/01/2013|12/31/9999|$1|992.19|0|0|||PREP BK PTB THERMOPLS MOLDED|| 58-1699775|1326041732|CHC13|L5535||11/01/2013|12/31/9999|$1|955.92|0|0|||PREP BK PTB OPEN END SOCKET|| 58-1699775|1326041732|CHC13|L5540||11/01/2013|12/31/9999|$2|087.60|0|0|||PREP BK PTB LAMINATED SOCKET|| 58-1699775|1326041732|CHC13|L5560||11/01/2013|12/31/9999|$2|241.71|0|0|||PREP AK ISCHIAL PLAST MOLDED|| 58-1699775|1326041732|CHC13|L5570||11/01/2013|12/31/9999|$2|330.59|0|0|||PREP AK ISCHIAL DIRECT FORM|| 58-1699775|1326041732|CHC13|L5580||11/01/2013|12/31/9999|$2|720.80|0|0|||PREP AK ISCHIAL THERMO MOLD|| 58-1699775|1326041732|CHC13|L5585||11/01/2013|12/31/9999|$3|348.37|0|0|||PREP AK ISCHIAL OPEN END|| 58-1699775|1326041732|CHC13|L5590||11/01/2013|12/31/9999|$2|772.67|0|0|||PREP AK ISCHIAL LAMINATED|| 58-1699775|1326041732|CHC13|L5595||11/01/2013|12/31/9999|$4|898.31|0|0|||HIP DISARTIC SACH THERMOPLS|| 58-1699775|1326041732|CHC13|L5600||11/01/2013|12/31/9999|$5|265.45|0|0|||HIP DISART SACH LAMINAT MOLD|| 58-1699775|1326041732|CHC13|L5610||11/01/2013|12/31/9999|$2|387.96|0|0|||ABOVE KNEE HYDRACADENCE|| 58-1699775|1326041732|CHC13|L5611||11/01/2013|12/31/9999|$1|858.31|0|0|||AK 4 BAR LINK W/FRIC SWING|| 58-1699775|1326041732|CHC13|L5613||11/01/2013|12/31/9999|$2|905.41|0|0|||AK 4 BAR LING W/HYDRAUL SWIG|| 58-1699775|1326041732|CHC13|L5614||11/01/2013|12/31/9999|$1|968.21|0|0|||4-BAR LINK ABOVE KNEE W/SWNG|| 58-1699775|1326041732|CHC13|L5616||11/01/2013|12/31/9999|$1|570.06|0|0|||AK UNIV MULTIPLEX SYS FRICT|| 58-1699775|1326041732|CHC13|L5617||11/01/2013|12/31/9999|$652.60|0|0|||AK/BK SELF-ALIGNING UNIT EA|| 58-1699775|1326041732|CHC13|L5618||11/01/2013|12/31/9999|$345.24|0|0|||TEST SOCKET SYMES|| 58-1699775|1326041732|CHC13|L5620||11/01/2013|12/31/9999|$320.66|0|0|||TEST SOCKET BELOW KNEE|| 58-1699775|1326041732|CHC13|L5622||11/01/2013|12/31/9999|$418.14|0|0|||TEST SOCKET KNEE DISARTICULA|| 58-1699775|1326041732|CHC13|L5624||11/01/2013|12/31/9999|$419.32|0|0|||TEST SOCKET ABOVE KNEE|| 58-1699775|1326041732|CHC13|L5626||11/01/2013|12/31/9999|$549.91|0|0|||TEST SOCKET HIP DISARTICULAT|| 58-1699775|1326041732|CHC13|L5628||11/01/2013|12/31/9999|$588.01|0|0|||TEST SOCKET HEMIPELVECTOMY|| 58-1699775|1326041732|CHC13|L5629||11/01/2013|12/31/9999|$366.54|0|0|||BELOW KNEE ACRYLIC SOCKET|| 58-1699775|1326041732|CHC13|L5630||11/01/2013|12/31/9999|$517.64|0|0|||SYME TYP EXPANDABL WALL SCKT|| 58-1699775|1326041732|CHC13|L5631||11/01/2013|12/31/9999|$506.78|0|0|||AK/KNEE DISARTIC ACRYLIC SOC|| 58-1699775|1326041732|CHC13|L5632||11/01/2013|12/31/9999|$282.84|0|0|||SYMES TYPE PTB BRIM DESIGN S|| 58-1699775|1326041732|CHC13|L5634||11/01/2013|12/31/9999|$350.85|0|0|||SYMES TYPE POSTER OPENING SO|| 58-1699775|1326041732|CHC13|L5636||11/01/2013|12/31/9999|$293.89|0|0|||SYMES TYPE MEDIAL OPENING SO|| 58-1699775|1326041732|CHC13|L5637||11/01/2013|12/31/9999|$333.20|0|0|||BELOW KNEE TOTAL CONTACT|| 58-1699775|1326041732|CHC13|L5638||11/01/2013|12/31/9999|$580.44|0|0|||BELOW KNEE LEATHER SOCKET|| 58-1699775|1326041732|CHC13|L5639||11/01/2013|12/31/9999|$1|293.16|0|0|||BELOW KNEE WOOD SOCKET|| 58-1699775|1326041732|CHC13|L5640||11/01/2013|12/31/9999|$737.51|0|0|||KNEE DISARTICULAT LEATHER SO|| 58-1699775|1326041732|CHC13|L5642||11/01/2013|12/31/9999|$714.60|0|0|||ABOVE KNEE LEATHER SOCKET|| 58-1699775|1326041732|CHC13|L5643||11/01/2013|12/31/9999|$1|795.19|0|0|||HIP FLEX INNER SOCKET EXT FR|| 58-1699775|1326041732|CHC13|L5644||11/01/2013|12/31/9999|$681.24|0|0|||ABOVE KNEE WOOD SOCKET|| 58-1699775|1326041732|CHC13|L5645||11/01/2013|12/31/9999|$920.29|0|0|||BK FLEX INNER SOCKET EXT FRA|| 58-1699775|1326041732|CHC13|L5646||11/01/2013|12/31/9999|$631.95|0|0|||BELOW KNEE CUSHION SOCKET|| 58-1699775|1326041732|CHC13|L5647||11/01/2013|12/31/9999|$917.47|0|0|||BELOW KNEE SUCTION SOCKET|| 58-1699775|1326041732|CHC13|L5648||11/01/2013|12/31/9999|$759.36|0|0|||ABOVE KNEE CUSHION SOCKET|| 58-1699775|1326041732|CHC13|L5649||11/01/2013|12/31/9999|$2|751.60|0|0|||ISCH CONTAINMT/NARROW M-L SO|| 58-1699775|1326041732|CHC13|L5650||11/01/2013|12/31/9999|$563.06|0|0|||TOT CONTACT AK/KNEE DISART S|| 58-1699775|1326041732|CHC13|L5651||11/01/2013|12/31/9999|$1|385.12|0|0|||AK FLEX INNER SOCKET EXT FRA|| 58-1699775|1326041732|CHC13|L5652||11/01/2013|12/31/9999|$502.85|0|0|||SUCTION SUSP AK/KNEE DISART|| 58-1699775|1326041732|CHC13|L5653||11/01/2013|12/31/9999|$671.26|0|0|||KNEE DISART EXPAND WALL SOCK|| 58-1699775|1326041732|CHC13|L5654||11/01/2013|12/31/9999|$382.51|0|0|||SOCKET INSERT SYMES|| 58-1699775|1326041732|CHC13|L5655||11/01/2013|12/31/9999|$324.16|0|0|||SOCKET INSERT BELOW KNEE|| 58-1699775|1326041732|CHC13|L5656||11/01/2013|12/31/9999|$434.85|0|0|||SOCKET INSERT KNEE ARTICULAT|| 58-1699775|1326041732|CHC13|L5658||11/01/2013|12/31/9999|$419.38|0|0|||SOCKET INSERT ABOVE KNEE|| 58-1699775|1326041732|CHC13|L5661||11/01/2013|12/31/9999|$701.89|0|0|||MULTI-DUROMETER SYMES|| 58-1699775|1326041732|CHC13|L5665||11/01/2013|12/31/9999|$590.56|0|0|||MULTI-DUROMETER BELOW KNEE|| 58-1699775|1326041732|CHC13|L5666||11/01/2013|12/31/9999|$80.74|0|0|||BELOW KNEE CUFF SUSPENSION|| 58-1699775|1326041732|CHC13|L5668||11/01/2013|12/31/9999|$130.23|0|0|||SOCKET INSERT W/O LOCK LOWER|| 58-1699775|1326041732|CHC13|L5670||11/01/2013|12/31/9999|$312.98|0|0|||BK MOLDED SUPRACONDYLAR SUSP|| 58-1699775|1326041732|CHC13|L5671||11/01/2013|12/31/9999|$663.23|0|0|||BK/AK LOCKING MECHANISM|| 58-1699775|1326041732|CHC13|L5672||11/01/2013|12/31/9999|$343.93|0|0|||BK REMOVABLE MEDIAL BRIM SUS|| 58-1699775|1326041732|CHC13|L5673||11/01/2013|12/31/9999|$820.12|0|0|||SOCKET INSERT W LOCK MECH|| 58-1699775|1326041732|CHC13|L5676||11/01/2013|12/31/9999|$417.96|0|0|||BK KNEE JOINTS SINGLE AXIS P|| 58-1699775|1326041732|CHC13|L5677||11/01/2013|12/31/9999|$568.69|0|0|||BK KNEE JOINTS POLYCENTRIC P|| 58-1699775|1326041732|CHC13|L5678||11/01/2013|12/31/9999|$45.80|0|0|||BK JOINT COVERS PAIR|| 58-1699775|1326041732|CHC13|L5679||11/01/2013|12/31/9999|$683.41|0|0|||SOCKET INSERT W/O LOCK MECH|| 58-1699775|1326041732|CHC13|L5680||11/01/2013|12/31/9999|$382.29|0|0|||BK THIGH LACER NON-MOLDED|| 58-1699775|1326041732|CHC13|L5681||11/01/2013|12/31/9999|$1|534.26|0|0|||INTL CUSTM CONG/LATYP INSERT|| 58-1699775|1326041732|CHC13|L5682||11/01/2013|12/31/9999|$721.31|0|0|||BK THIGH LACER GLUT/ISCHIA M|| 58-1699775|1326041732|CHC13|L5683||11/01/2013|12/31/9999|$1|534.26|0|0|||INITIAL CUSTOM SOCKET INSERT|| 58-1699775|1326041732|CHC13|L5684||11/01/2013|12/31/9999|$55.51|0|0|||BK FORK STRAP|| 58-1699775|1326041732|CHC13|L5685||11/01/2013|12/31/9999|$149.39|0|0|||BELOW KNEE SUS/SEAL SLEEVE|| 58-1699775|1326041732|CHC13|L5686||11/01/2013|12/31/9999|$58.92|0|0|||BK BACK CHECK|| 58-1699775|1326041732|CHC13|L5688||11/01/2013|12/31/9999|$70.45|0|0|||BK WAIST BELT WEBBING|| 58-1699775|1326041732|CHC13|L5690||11/01/2013|12/31/9999|$112.86|0|0|||BK WAIST BELT PADDED AND LIN|| 58-1699775|1326041732|CHC13|L5692||11/01/2013|12/31/9999|$153.26|0|0|||AK PELVIC CONTROL BELT LIGHT|| 58-1699775|1326041732|CHC13|L5694||11/01/2013|12/31/9999|$209.24|0|0|||AK PELVIC CONTROL BELT PAD/L|| 58-1699775|1326041732|CHC13|L5695||11/01/2013|12/31/9999|$193.16|0|0|||AK SLEEVE SUSP NEOPRENE/EQUA|| 58-1699775|1326041732|CHC13|L5696||11/01/2013|12/31/9999|$213.40|0|0|||AK/KNEE DISARTIC PELVIC JOIN|| 58-1699775|1326041732|CHC13|L5697||11/01/2013|12/31/9999|$92.59|0|0|||AK/KNEE DISARTIC PELVIC BAND|| 58-1699775|1326041732|CHC13|L5698||11/01/2013|12/31/9999|$151.41|0|0|||AK/KNEE DISARTIC SILESIAN BA|| 58-1699775|1326041732|CHC13|L5699||11/01/2013|12/31/9999|$272.75|0|0|||SHOULDER HARNESS|| 58-1699775|1326041732|CHC13|L5700||11/01/2013|12/31/9999|$3|304.69|0|0|||REPLACE SOCKET BELOW KNEE|| 58-1699775|1326041732|CHC13|L5701||11/01/2013|12/31/9999|$3|968.67|0|0|||REPLACE SOCKET ABOVE KNEE|| 58-1699775|1326041732|CHC13|L5702||11/01/2013|12/31/9999|$5|020.96|0|0|||REPLACE SOCKET HIP|| 58-1699775|1326041732|CHC13|L5703||11/01/2013|12/31/9999|$2|598.40|0|0|||SYMES ANKLE W/O (SACH) FOOT|| 58-1699775|1326041732|CHC13|L5704||11/01/2013|12/31/9999|$618.22|0|0|||CUSTOM SHAPE COVER BK|| 58-1699775|1326041732|CHC13|L5705||11/01/2013|12/31/9999|$1|104.66|0|0|||CUSTOM SHAPE COVER AK|| 58-1699775|1326041732|CHC13|L5706||11/01/2013|12/31/9999|$1|082.86|0|0|||CUSTOM SHAPE CVR KNEE DISART|| 58-1699775|1326041732|CHC13|L5707||11/01/2013|12/31/9999|$1|427.59|0|0|||CUSTOM SHAPE CVR HIP DISART|| 58-1699775|1326041732|CHC13|L5710||11/01/2013|12/31/9999|$431.35|0|0|||KNE-SHIN EXO SNG AXI MNL LOC|| 58-1699775|1326041732|CHC13|L5711||11/01/2013|12/31/9999|$602.85|0|0|||KNEE-SHIN EXO MNL LOCK ULTRA|| 58-1699775|1326041732|CHC13|L5712||11/01/2013|12/31/9999|$505.14|0|0|||KNEE-SHIN EXO FRICT SWG & ST|| 58-1699775|1326041732|CHC13|L5714||11/01/2013|12/31/9999|$518.86|0|0|||KNEE-SHIN EXO VARIABLE FRICT|| 58-1699775|1326041732|CHC13|L5716||11/01/2013|12/31/9999|$840.64|0|0|||KNEE-SHIN EXO MECH STANCE PH|| 58-1699775|1326041732|CHC13|L5718||11/01/2013|12/31/9999|$1|050.71|0|0|||KNEE-SHIN EXO FRCT SWG & STA|| 58-1699775|1326041732|CHC13|L5722||11/01/2013|12/31/9999|$1|110.04|0|0|||KNEE-SHIN PNEUM SWG FRCT EXO|| 58-1699775|1326041732|CHC13|L5724||11/01/2013|12/31/9999|$1|740.94|0|0|||KNEE-SHIN EXO FLUID SWING PH|| 58-1699775|1326041732|CHC13|L5726||11/01/2013|12/31/9999|$2|006.40|0|0|||KNEE-SHIN EXT JNTS FLD SWG E|| 58-1699775|1326041732|CHC13|L5728||11/01/2013|12/31/9999|$2|744.49|0|0|||KNEE-SHIN FLUID SWG & STANCE|| 58-1699775|1326041732|CHC13|L5780||11/01/2013|12/31/9999|$1|320.53|0|0|||KNEE-SHIN PNEUM/HYDRA PNEUM|| 58-1699775|1326041732|CHC13|L5781||11/01/2013|12/31/9999|$4|666.88|0|0|||LOWER LIMB PROS VACUUM PUMP|| 58-1699775|1326041732|CHC13|L5782||11/01/2013|12/31/9999|$4|919.96|0|0|||HD LOW LIMB PROS VACUUM PUMP|| 58-1699775|1326041732|CHC13|L5785||11/01/2013|12/31/9999|$742.29|0|0|||EXOSKELETAL BK ULTRALT MATER|| 58-1699775|1326041732|CHC13|L5790||11/01/2013|12/31/9999|$829.31|0|0|||EXOSKELETAL AK ULTRA-LIGHT M|| 58-1699775|1326041732|CHC13|L5795||11/01/2013|12/31/9999|$1|651.19|0|0|||EXOSKEL HIP ULTRA-LIGHT MATE|| 58-1699775|1326041732|CHC13|L5810||11/01/2013|12/31/9999|$561.55|0|0|||ENDOSKEL KNEE-SHIN MNL LOCK|| 58-1699775|1326041732|CHC13|L5811||11/01/2013|12/31/9999|$841.19|0|0|||ENDO KNEE-SHIN MNL LCK ULTRA|| 58-1699775|1326041732|CHC13|L5812||11/01/2013|12/31/9999|$652.01|0|0|||ENDO KNEE-SHIN FRCT SWG & ST|| 58-1699775|1326041732|CHC13|L5814||11/01/2013|12/31/9999|$4|331.77|0|0|||ENDO KNEE-SHIN HYDRAL SWG PH|| 58-1699775|1326041732|CHC13|L5816||11/01/2013|12/31/9999|$986.79|0|0|||ENDO KNEE-SHIN POLYC MCH STA|| 58-1699775|1326041732|CHC13|L5818||11/01/2013|12/31/9999|$1|107.62|0|0|||ENDO KNEE-SHIN FRCT SWG & ST|| 58-1699775|1326041732|CHC13|L5822||11/01/2013|12/31/9999|$1|964.11|0|0|||ENDO KNEE-SHIN PNEUM SWG FRC|| 58-1699775|1326041732|CHC13|L5824||11/01/2013|12/31/9999|$1|768.80|0|0|||ENDO KNEE-SHIN FLUID SWING P|| 58-1699775|1326041732|CHC13|L5826||11/01/2013|12/31/9999|$3|642.46|0|0|||MINIATURE KNEE JOINT|| 58-1699775|1326041732|CHC13|L5828||11/01/2013|12/31/9999|$3|257.10|0|0|||ENDO KNEE-SHIN FLUID SWG/STA|| 58-1699775|1326041732|CHC13|L5830||11/01/2013|12/31/9999|$2|188.60|0|0|||ENDO KNEE-SHIN PNEUM/SWG PHA|| 58-1699775|1326041732|CHC13|L5840||11/01/2013|12/31/9999|$4|046.74|0|0|||MULTI-AXIAL KNEE/SHIN SYSTEM|| 58-1699775|1326041732|CHC13|L5845||11/01/2013|12/31/9999|$2|090.60|0|0|||KNEE-SHIN SYS STANCE FLEXION|| 58-1699775|1326041732|CHC13|L5848||11/01/2013|12/31/9999|$1|254.21|0|0|||KNEE-SHIN SYS HYDRAUL STANCE|| 58-1699775|1326041732|CHC13|L5850||11/01/2013|12/31/9999|$147.55|0|0|||ENDO AK/HIP KNEE EXTENS ASSI|| 58-1699775|1326041732|CHC13|L5855||11/01/2013|12/31/9999|$396.46|0|0|||MECH HIP EXTENSION ASSIST|| 58-1699775|1326041732|CHC13|L5856||11/01/2013|12/31/9999|$27|999.90|0|0|||ELEC KNEE-SHIN SWING/STANCE|| 58-1699775|1326041732|CHC13|L5857||11/01/2013|12/31/9999|$9|935.37|0|0|||ELEC KNEE-SHIN SWING ONLY|| 58-1699775|1326041732|CHC13|L5858||11/01/2013|12/31/9999|$21|677.36|0|0|||STANCE PHASE ONLY|| 58-1699775|1326041732|CHC13|L5910||11/01/2013|12/31/9999|$417.74|0|0|||ENDO BELOW KNEE ALIGNABLE SY|| 58-1699775|1326041732|CHC13|L5920||11/01/2013|12/31/9999|$611.97|0|0|||ENDO AK/HIP ALIGNABLE SYSTEM|| 58-1699775|1326041732|CHC13|L5925||11/01/2013|12/31/9999|$516.73|0|0|||ABOVE KNEE MANUAL LOCK|| 58-1699775|1326041732|CHC13|L5930||11/01/2013|12/31/9999|$3|925.89|0|0|||HIGH ACTIVITY KNEE FRAME|| 58-1699775|1326041732|CHC13|L5940||11/01/2013|12/31/9999|$578.55|0|0|||ENDO BK ULTRA-LIGHT MATERIAL|| 58-1699775|1326041732|CHC13|L5950||11/01/2013|12/31/9999|$904.61|0|0|||ENDO AK ULTRA-LIGHT MATERIAL|| 58-1699775|1326041732|CHC13|L5960||11/01/2013|12/31/9999|$1|111.91|0|0|||ENDO HIP ULTRA-LIGHT MATERIA|| 58-1699775|1326041732|CHC13|L5961||11/01/2013|12/31/9999|$5|302.06|0|0|||ENDO POLY HIP| PNEU/HYD/ROT|| 58-1699775|1326041732|CHC13|L5962||11/01/2013|12/31/9999|$731.76|0|0|||BELOW KNEE FLEX COVER SYSTEM|| 58-1699775|1326041732|CHC13|L5964||11/01/2013|12/31/9999|$1|080.18|0|0|||ABOVE KNEE FLEX COVER SYSTEM|| 58-1699775|1326041732|CHC13|L5966||11/01/2013|12/31/9999|$1|376.41|0|0|||HIP FLEXIBLE COVER SYSTEM|| 58-1699775|1326041732|CHC13|L5968||11/01/2013|12/31/9999|$4|238.54|0|0|||MULTIAXIAL ANKLE W DORSIFLEX|| 58-1699775|1326041732|CHC13|L5970||11/01/2013|12/31/9999|$234.25|0|0|||FOOT EXTERNAL KEEL SACH FOOT|| 58-1699775|1326041732|CHC13|L5971||11/01/2013|12/31/9999|$234.25|0|0|||SACH FOOT| REPLACEMENT|| 58-1699775|1326041732|CHC13|L5972||11/01/2013|12/31/9999|$437.54|0|0|||FLEXIBLE KEEL FOOT|| 58-1699775|1326041732|CHC13|L5973||11/01/2013|12/31/9999|$20|067.16|0|0|||ANK-FOOT SYS DORS-PLANT FLEX|| 58-1699775|1326041732|CHC13|L5974||11/01/2013|12/31/9999|$268.78|0|0|||FOOT SINGLE AXIS ANKLE/FOOT|| 58-1699775|1326041732|CHC13|L5975||11/01/2013|12/31/9999|$540.75|0|0|||COMBO ANKLE/FOOT PROSTHESIS|| 58-1699775|1326041732|CHC13|L5976||11/01/2013|12/31/9999|$645.92|0|0|||ENERGY STORING FOOT|| 58-1699775|1326041732|CHC13|L5978||11/01/2013|12/31/9999|$336.60|0|0|||FT PROSTH MULTIAXIAL ANKL/FT|| 58-1699775|1326041732|CHC13|L5979||11/01/2013|12/31/9999|$2|631.76|0|0|||MULTI-AXIAL ANKLE/FT PROSTH|| 58-1699775|1326041732|CHC13|L5980||11/01/2013|12/31/9999|$4|276.44|0|0|||FLEX FOOT SYSTEM|| 58-1699775|1326041732|CHC13|L5981||11/01/2013|12/31/9999|$3|454.78|0|0|||FLEX-WALK SYS LOW EXT PROSTH|| 58-1699775|1326041732|CHC13|L5982||11/01/2013|12/31/9999|$666.79|0|0|||EXOSKELETAL AXIAL ROTATION U|| 58-1699775|1326041732|CHC13|L5984||11/01/2013|12/31/9999|$657.06|0|0|||ENDOSKELETAL AXIAL ROTATION|| 58-1699775|1326041732|CHC13|L5985||11/01/2013|12/31/9999|$329.36|0|0|||LWR EXT DYNAMIC PROSTH PYLON|| 58-1699775|1326041732|CHC13|L5986||11/01/2013|12/31/9999|$730.89|0|0|||MULTI-AXIAL ROTATION UNIT|| 58-1699775|1326041732|CHC13|L5987||11/01/2013|12/31/9999|$8|390.62|0|0|||SHANK FT W VERT LOAD PYLON|| 58-1699775|1326041732|CHC13|L5988||11/01/2013|12/31/9999|$2|330.06|0|0|||VERTICAL SHOCK REDUCING PYLO|| 58-1699775|1326041732|CHC13|L5990||11/01/2013|12/31/9999|$2|116.06|0|0|||USER ADJUSTABLE HEEL HEIGHT|| 58-1699775|1326041732|CHC13|L6000||11/01/2013|12/31/9999|$1|532.50|0|0|||PAR HAND ROBIN-AIDS THUM REM|| 58-1699775|1326041732|CHC13|L6010||11/01/2013|12/31/9999|$1|705.42|0|0|||HAND ROBIN-AIDS LITTLE/RING|| 58-1699775|1326041732|CHC13|L6020||11/01/2013|12/31/9999|$1|590.04|0|0|||PART HAND ROBIN-AIDS NO FING|| 58-1699775|1326041732|CHC13|L6025||11/01/2013|12/31/9999|$9|333.79|0|0|||PART HAND DISART MYOELECTRIC|| 58-1699775|1326041732|CHC13|L6050||11/01/2013|12/31/9999|$2|191.00|0|0|||WRST MLD SCK FLX HNG TRI PAD|| 58-1699775|1326041732|CHC13|L6055||11/01/2013|12/31/9999|$3|053.70|0|0|||WRST MOLD SOCK W/EXP INTERFA|| 58-1699775|1326041732|CHC13|L6100||11/01/2013|12/31/9999|$2|219.82|0|0|||ELB MOLD SOCK FLEX HINGE PAD|| 58-1699775|1326041732|CHC13|L6110||11/01/2013|12/31/9999|$2|354.50|0|0|||ELBOW MOLD SOCK SUSPENSION T|| 58-1699775|1326041732|CHC13|L6120||11/01/2013|12/31/9999|$2|743.84|0|0|||ELBOW MOLD DOUB SPLT SOC STE|| 58-1699775|1326041732|CHC13|L6130||11/01/2013|12/31/9999|$2|985.80|0|0|||ELBOW STUMP ACTIVATED LOCK H|| 58-1699775|1326041732|CHC13|L6200||11/01/2013|12/31/9999|$3|146.55|0|0|||ELBOW MOLD OUTSID LOCK HINGE|| 58-1699775|1326041732|CHC13|L6205||11/01/2013|12/31/9999|$4|200.15|0|0|||ELBOW MOLDED W/ EXPAND INTER|| 58-1699775|1326041732|CHC13|L6250||11/01/2013|12/31/9999|$3|296.85|0|0|||ELBOW INTER LOC ELBOW FORARM|| 58-1699775|1326041732|CHC13|L6300||11/01/2013|12/31/9999|$4|297.10|0|0|||SHLDER DISART INT LOCK ELBOW|| 58-1699775|1326041732|CHC13|L6310||11/01/2013|12/31/9999|$3|710.35|0|0|||SHOULDER PASSIVE RESTOR COMP|| 58-1699775|1326041732|CHC13|L6320||11/01/2013|12/31/9999|$2|026.89|0|0|||SHOULDER PASSIVE RESTOR CAP|| 58-1699775|1326041732|CHC13|L6350||11/01/2013|12/31/9999|$4|517.75|0|0|||THORACIC INTERN LOCK ELBOW|| 58-1699775|1326041732|CHC13|L6360||11/01/2013|12/31/9999|$4|063.01|0|0|||THORACIC PASSIVE RESTOR COMP|| 58-1699775|1326041732|CHC13|L6370||11/01/2013|12/31/9999|$2|431.17|0|0|||THORACIC PASSIVE RESTOR CAP|| 58-1699775|1326041732|CHC13|L6380||11/01/2013|12/31/9999|$1|408.81|0|0|||POSTOP DSG CAST CHG WRST/ELB|| 58-1699775|1326041732|CHC13|L6382||11/01/2013|12/31/9999|$2|119.50|0|0|||POSTOP DSG CAST CHG ELB DIS/|| 58-1699775|1326041732|CHC13|L6384||11/01/2013|12/31/9999|$2|932.09|0|0|||POSTOP DSG CAST CHG SHLDER/T|| 58-1699775|1326041732|CHC13|L6386||11/01/2013|12/31/9999|$463.19|0|0|||POSTOP EA CAST CHG & REALIGN|| 58-1699775|1326041732|CHC13|L6388||11/01/2013|12/31/9999|$507.05|0|0|||POSTOP APPLICAT RIGID DSG ON|| 58-1699775|1326041732|CHC13|L6400||11/01/2013|12/31/9999|$2|676.33|0|0|||BELOW ELBOW PROSTH TISS SHAP|| 58-1699775|1326041732|CHC13|L6450||11/01/2013|12/31/9999|$3|575.50|0|0|||ELB DISART PROSTH TISS SHAP|| 58-1699775|1326041732|CHC13|L6500||11/01/2013|12/31/9999|$3|740.71|0|0|||ABOVE ELBOW PROSTH TISS SHAP|| 58-1699775|1326041732|CHC13|L6550||11/01/2013|12/31/9999|$4|496.40|0|0|||SHLDR DISAR PROSTH TISS SHAP|| 58-1699775|1326041732|CHC13|L6570||11/01/2013|12/31/9999|$5|048.25|0|0|||SCAP THORAC PROSTH TISS SHAP|| 58-1699775|1326041732|CHC13|L6580||11/01/2013|12/31/9999|$1|927.31|0|0|||WRIST/ELBOW BOWDEN CABLE MOL|| 58-1699775|1326041732|CHC13|L6582||11/01/2013|12/31/9999|$1|745.62|0|0|||WRIST/ELBOW BOWDEN CBL DIR F|| 58-1699775|1326041732|CHC13|L6584||11/01/2013|12/31/9999|$2|737.59|0|0|||ELBOW FAIR LEAD CABLE MOLDED|| 58-1699775|1326041732|CHC13|L6586||11/01/2013|12/31/9999|$2|561.95|0|0|||ELBOW FAIR LEAD CABLE DIR FO|| 58-1699775|1326041732|CHC13|L6588||11/01/2013|12/31/9999|$3|366.35|0|0|||SHDR FAIR LEAD CABLE MOLDED|| 58-1699775|1326041732|CHC13|L6590||11/01/2013|12/31/9999|$3|197.51|0|0|||SHDR FAIR LEAD CABLE DIRECT|| 58-1699775|1326041732|CHC13|L6600||11/01/2013|12/31/9999|$216.35|0|0|||POLYCENTRIC HINGE PAIR|| 58-1699775|1326041732|CHC13|L6605||11/01/2013|12/31/9999|$213.62|0|0|||SINGLE PIVOT HINGE PAIR|| 58-1699775|1326041732|CHC13|L6610||11/01/2013|12/31/9999|$205.15|0|0|||FLEXIBLE METAL HINGE PAIR|| 58-1699775|1326041732|CHC13|L6611||11/01/2013|12/31/9999|$480.20|0|0|||ADDITIONAL SWITCH| EXT POWER|| 58-1699775|1326041732|CHC13|L6615||11/01/2013|12/31/9999|$221.05|0|0|||DISCONNECT LOCKING WRIST UNI|| 58-1699775|1326041732|CHC13|L6616||11/01/2013|12/31/9999|$81.91|0|0|||DISCONNECT INSERT LOCKING WR|| 58-1699775|1326041732|CHC13|L6620||11/01/2013|12/31/9999|$353.65|0|0|||FLEXION/EXTENSION WRIST UNIT|| 58-1699775|1326041732|CHC13|L6621||11/01/2013|12/31/9999|$2|667.83|0|0|||FLEX/EXT WRIST W/WO FRICTION|| 58-1699775|1326041732|CHC13|L6623||11/01/2013|12/31/9999|$986.47|0|0|||SPRING-ASS ROT WRST W/ LATCH|| 58-1699775|1326041732|CHC13|L6624||11/01/2013|12/31/9999|$4|392.66|0|0|||FLEX/EXT/ROTATION WRIST UNIT|| 58-1699775|1326041732|CHC13|L6625||11/01/2013|12/31/9999|$700.91|0|0|||ROTATION WRST W/ CABLE LOCK|| 58-1699775|1326041732|CHC13|L6628||11/01/2013|12/31/9999|$552.52|0|0|||QUICK DISCONN HOOK ADAPTER O|| 58-1699775|1326041732|CHC13|L6629||11/01/2013|12/31/9999|$168.75|0|0|||LAMINATION COLLAR W/ COUPLIN|| 58-1699775|1326041732|CHC13|L6630||11/01/2013|12/31/9999|$248.58|0|0|||STAINLESS STEEL ANY WRIST|| 58-1699775|1326041732|CHC13|L6632||11/01/2013|12/31/9999|$86.34|0|0|||LATEX SUSPENSION SLEEVE EACH|| 58-1699775|1326041732|CHC13|L6635||11/01/2013|12/31/9999|$203.15|0|0|||LIFT ASSIST FOR ELBOW|| 58-1699775|1326041732|CHC13|L6637||11/01/2013|12/31/9999|$433.31|0|0|||NUDGE CONTROL ELBOW LOCK|| 58-1699775|1326041732|CHC13|L6638||11/01/2013|12/31/9999|$2|916.80|0|0|||ELEC LOCK ON MANUAL PW ELBOW|| 58-1699775|1326041732|CHC13|L6640||11/01/2013|12/31/9999|$384.95|0|0|||SHOULDER ABDUCTION JOINT PAI|| 58-1699775|1326041732|CHC13|L6641||11/01/2013|12/31/9999|$185.04|0|0|||EXCURSION AMPLIFIER PULLEY T|| 58-1699775|1326041732|CHC13|L6642||11/01/2013|12/31/9999|$250.80|0|0|||EXCURSION AMPLIFIER LEVER TY|| 58-1699775|1326041732|CHC13|L6645||11/01/2013|12/31/9999|$462.94|0|0|||SHOULDER FLEXION-ABDUCTION J|| 58-1699775|1326041732|CHC13|L6646||11/01/2013|12/31/9999|$3|678.75|0|0|||MULTIPO LOCKING SHOULDER JNT|| 58-1699775|1326041732|CHC13|L6647||11/01/2013|12/31/9999|$605.62|0|0|||SHOULDER LOCK ACTUATOR|| 58-1699775|1326041732|CHC13|L6648||11/01/2013|12/31/9999|$3|794.09|0|0|||EXT PWRD SHLDER LOCK/UNLOCK|| 58-1699775|1326041732|CHC13|L6650||11/01/2013|12/31/9999|$480.64|0|0|||SHOULDER UNIVERSAL JOINT|| 58-1699775|1326041732|CHC13|L6655||11/01/2013|12/31/9999|$94.48|0|0|||STANDARD CONTROL CABLE EXTRA|| 58-1699775|1326041732|CHC13|L6660||11/01/2013|12/31/9999|$105.87|0|0|||HEAVY DUTY CONTROL CABLE|| 58-1699775|1326041732|CHC13|L6665||11/01/2013|12/31/9999|$53.12|0|0|||TEFLON OR EQUAL CABLE LINING|| 58-1699775|1326041732|CHC13|L6670||11/01/2013|12/31/9999|$58.72|0|0|||HOOK TO HAND CABLE ADAPTER|| 58-1699775|1326041732|CHC13|L6672||11/01/2013|12/31/9999|$233.08|0|0|||HARNESS CHEST/SHLDER SADDLE|| 58-1699775|1326041732|CHC13|L6675||11/01/2013|12/31/9999|$138.51|0|0|||HARNESS FIGURE OF 8 SING CON|| 58-1699775|1326041732|CHC13|L6676||11/01/2013|12/31/9999|$160.11|0|0|||HARNESS FIGURE OF 8 DUAL CON|| 58-1699775|1326041732|CHC13|L6677||11/01/2013|12/31/9999|$346.05|0|0|||UE TRIPLE CONTROL HARNESS|| 58-1699775|1326041732|CHC13|L6680||11/01/2013|12/31/9999|$267.60|0|0|||TEST SOCK WRIST DISART/BEL E|| 58-1699775|1326041732|CHC13|L6682||11/01/2013|12/31/9999|$295.86|0|0|||TEST SOCK ELBW DISART/ABOVE|| 58-1699775|1326041732|CHC13|L6684||11/01/2013|12/31/9999|$402.04|0|0|||TEST SOCKET SHLDR DISART/THO|| 58-1699775|1326041732|CHC13|L6686||11/01/2013|12/31/9999|$907.90|0|0|||SUCTION SOCKET|| 58-1699775|1326041732|CHC13|L6687||11/01/2013|12/31/9999|$665.29|0|0|||FRAME TYP SOCKET BEL ELBOW/W|| 58-1699775|1326041732|CHC13|L6688||11/01/2013|12/31/9999|$661.29|0|0|||FRAME TYP SOCK ABOVE ELB/DIS|| 58-1699775|1326041732|CHC13|L6689||11/01/2013|12/31/9999|$792.29|0|0|||FRAME TYP SOCKET SHOULDER DI|| 58-1699775|1326041732|CHC13|L6690||11/01/2013|12/31/9999|$863.36|0|0|||FRAME TYP SOCK INTERSCAP-THO|| 58-1699775|1326041732|CHC13|L6691||11/01/2013|12/31/9999|$399.61|0|0|||REMOVABLE INSERT EACH|| 58-1699775|1326041732|CHC13|L6692||11/01/2013|12/31/9999|$645.01|0|0|||SILICONE GEL INSERT OR EQUAL|| 58-1699775|1326041732|CHC13|L6693||11/01/2013|12/31/9999|$3|311.33|0|0|||LOCKINGELBOW FOREARM CNTRBAL|| 58-1699775|1326041732|CHC13|L6694||11/01/2013|12/31/9999|$820.12|0|0|||ELBOW SOCKET INS USE W/LOCK|| 58-1699775|1326041732|CHC13|L6695||11/01/2013|12/31/9999|$683.41|0|0|||ELBOW SOCKET INS USE W/O LCK|| 58-1699775|1326041732|CHC13|L6696||11/01/2013|12/31/9999|$1|534.26|0|0|||CUS ELBO SKT IN FOR CON/ATYP|| 58-1699775|1326041732|CHC13|L6697||11/01/2013|12/31/9999|$1|534.26|0|0|||CUS ELBO SKT IN NOT CON/ATYP|| 58-1699775|1326041732|CHC13|L6698||11/01/2013|12/31/9999|$663.23|0|0|||BELOW/ABOVE ELBOW LOCK MECH|| 58-1699775|1326041732|CHC13|L6703||11/01/2013|12/31/9999|$419.31|0|0|||TERM DEV| PASSIVE HAND MITT|| 58-1699775|1326041732|CHC13|L6704||11/01/2013|12/31/9999|$675.46|0|0|||TERM DEV| SPORT/REC/WORK ATT|| 58-1699775|1326041732|CHC13|L6706||11/01/2013|12/31/9999|$402.45|0|0|||TERM DEV MECH HOOK VOL OPEN|| 58-1699775|1326041732|CHC13|L6707||11/01/2013|12/31/9999|$1|483.34|0|0|||TERM DEV MECH HOOK VOL CLOSE|| 58-1699775|1326041732|CHC13|L6708||11/01/2013|12/31/9999|$969.70|0|0|||TERM DEV MECH HAND VOL OPEN|| 58-1699775|1326041732|CHC13|L6709||11/01/2013|12/31/9999|$1|397.38|0|0|||TERM DEV MECH HAND VOL CLOSE|| 58-1699775|1326041732|CHC13|L6711||11/01/2013|12/31/9999|$784.16|0|0|||PED TERM DEV| HOOK| VOL OPEN|| 58-1699775|1326041732|CHC13|L6712||11/01/2013|12/31/9999|$1|443.83|0|0|||PED TERM DEV| HOOK| VOL CLOS|| 58-1699775|1326041732|CHC13|L6713||11/01/2013|12/31/9999|$1|822.23|0|0|||PED TERM DEV| HAND| VOL OPEN|| 58-1699775|1326041732|CHC13|L6714||11/01/2013|12/31/9999|$1|543.42|0|0|||PED TERM DEV| HAND| VOL CLOS|| 58-1699775|1326041732|CHC13|L6715||11/01/2013|12/31/9999|$3|711.89|0|0|||TERMINAL DEVICE MODEL #5XA|| 58-1699775|1326041732|CHC13|L6721||11/01/2013|12/31/9999|$2|743.30|0|0|||HOOK/HAND| HVY DTY| VOL OPEN|| 58-1699775|1326041732|CHC13|L6722||11/01/2013|12/31/9999|$2|364.90|0|0|||HOOK/HAND| HVY DTY| VOL CLOS|| 58-1699775|1326041732|CHC13|L6805||11/01/2013|12/31/9999|$392.43|0|0|||MODIFIER WRIST FLEXION UNIT|| 58-1699775|1326041732|CHC13|L6810||11/01/2013|12/31/9999|$222.44|0|0|||PINCHER TOOL OTTO BOCK OR EQ|| 58-1699775|1326041732|CHC13|L6880||11/01/2013|12/31/9999|$28|090.62|0|0|||HAND BOCK VO|| 58-1699775|1326041732|CHC13|L6881||11/01/2013|12/31/9999|$4|768.41|0|0|||AUTOGRASP FEATURE UL TERM DV|| 58-1699775|1326041732|CHC13|L6882||11/01/2013|12/31/9999|$3|617.10|0|0|||MICROPROCESSOR CONTROL UPLMB|| 58-1699775|1326041732|CHC13|L6883||11/01/2013|12/31/9999|$1|830.30|0|0|||REPLC SOCKT BELOW E/W DISA|| 58-1699775|1326041732|CHC13|L6884||11/01/2013|12/31/9999|$2|716.52|0|0|||REPLC SOCKT ABOVE ELBOW DISA|| 58-1699775|1326041732|CHC13|L6885||11/01/2013|12/31/9999|$4|063.01|0|0|||REPLC SOCKT SHLDR DIS/INTERC|| 58-1699775|1326041732|CHC13|L6890||11/01/2013|12/31/9999|$196.18|0|0|||PREFAB GLOVE FOR TERM DEVICE|| 58-1699775|1326041732|CHC13|L6895||11/01/2013|12/31/9999|$721.69|0|0|||CUSTOM GLOVE FOR TERM DEVICE|| 58-1699775|1326041732|CHC13|L6900||11/01/2013|12/31/9999|$2|059.51|0|0|||HAND RESTORAT THUMB/1 FINGER|| 58-1699775|1326041732|CHC13|L6905||11/01/2013|12/31/9999|$2|047.80|0|0|||HAND RESTORATION MULTIPLE FI|| 58-1699775|1326041732|CHC13|L6910||11/01/2013|12/31/9999|$1|751.07|0|0|||HAND RESTORATION NO FINGERS|| 58-1699775|1326041732|CHC13|L6915||11/01/2013|12/31/9999|$882.86|0|0|||HAND RESTORATION REPLACMNT G|| 58-1699775|1326041732|CHC13|L6920||11/01/2013|12/31/9999|$7|697.42|0|0|||WRIST DISARTICUL SWITCH CTRL|| 58-1699775|1326041732|CHC13|L6925||11/01/2013|12/31/9999|$10|362.06|0|0|||WRIST DISART MYOELECTRONIC C|| 58-1699775|1326041732|CHC13|L6930||11/01/2013|12/31/9999|$7|745.15|0|0|||BELOW ELBOW SWITCH CONTROL|| 58-1699775|1326041732|CHC13|L6935||11/01/2013|12/31/9999|$10|522.86|0|0|||BELOW ELBOW MYOELECTRONIC CT|| 58-1699775|1326041732|CHC13|L6940||11/01/2013|12/31/9999|$10|119.55|0|0|||ELBOW DISARTICULATION SWITCH|| 58-1699775|1326041732|CHC13|L6945||11/01/2013|12/31/9999|$12|364.88|0|0|||ELBOW DISART MYOELECTRONIC C|| 58-1699775|1326041732|CHC13|L6950||11/01/2013|12/31/9999|$11|502.29|0|0|||ABOVE ELBOW SWITCH CONTROL|| 58-1699775|1326041732|CHC13|L6955||11/01/2013|12/31/9999|$13|775.56|0|0|||ABOVE ELBOW MYOELECTRONIC CT|| 58-1699775|1326041732|CHC13|L6960||11/01/2013|12/31/9999|$15|604.27|0|0|||SHLDR DISARTIC SWITCH CONTRO|| 58-1699775|1326041732|CHC13|L6965||11/01/2013|12/31/9999|$16|642.52|0|0|||SHLDR DISARTIC MYOELECTRONIC|| 58-1699775|1326041732|CHC13|L6970||11/01/2013|12/31/9999|$17|341.79|0|0|||INTERSCAPULAR-THOR SWITCH CT|| 58-1699775|1326041732|CHC13|L6975||11/01/2013|12/31/9999|$18|966.34|0|0|||INTERSCAP-THOR MYOELECTRONIC|| 58-1699775|1326041732|CHC13|L7007||11/01/2013|12/31/9999|$3|968.90|0|0|||ADULT ELECTRIC HAND|| 58-1699775|1326041732|CHC13|L7008||11/01/2013|12/31/9999|$6|246.62|0|0|||PEDIATRIC ELECTRIC HAND|| 58-1699775|1326041732|CHC13|L7009||11/01/2013|12/31/9999|$4|049.53|0|0|||ADULT ELECTRIC HOOK|| 58-1699775|1326041732|CHC13|L7040||11/01/2013|12/31/9999|$3|251.61|0|0|||PREHENSILE ACTUATOR HOSMER S|| 58-1699775|1326041732|CHC13|L7045||11/01/2013|12/31/9999|$1|864.26|0|0|||ELECTRON HOOK CHILD MICHIGAN|| 58-1699775|1326041732|CHC13|L7170||11/01/2013|12/31/9999|$8|583.76|0|0|||ELECTRONIC ELBOW HOSMER SWIT|| 58-1699775|1326041732|CHC13|L7180||11/01/2013|12/31/9999|$37|677.96|0|0|||ELECTRONIC ELBOW SEQUENTIAL|| 58-1699775|1326041732|CHC13|L7181||11/01/2013|12/31/9999|$46|734.45|0|0|||ELECTRONIC ELBO SIMULTANEOUS|| 58-1699775|1326041732|CHC13|L7185||11/01/2013|12/31/9999|$8|476.57|0|0|||ELECTRON ELBOW ADOLESCENT SW|| 58-1699775|1326041732|CHC13|L7186||11/01/2013|12/31/9999|$10|202.39|0|0|||ELECTRON ELBOW CHILD SWITCH|| 58-1699775|1326041732|CHC13|L7190||11/01/2013|12/31/9999|$8|903.30|0|0|||ELBOW ADOLESCENT MYOELECTRON|| 58-1699775|1326041732|CHC13|L7191||11/01/2013|12/31/9999|$10|660.89|0|0|||ELBOW CHILD MYOELECTRONIC CT|| 58-1699775|1326041732|CHC13|L7260||11/01/2013|12/31/9999|$2|269.90|0|0|||ELECTRON WRIST ROTATOR OTTO|| 58-1699775|1326041732|CHC13|L7261||11/01/2013|12/31/9999|$4|132.10|0|0|||ELECTRON WRIST ROTATOR UTAH|| 58-1699775|1326041732|CHC13|L7360||11/01/2013|12/31/9999|$275.21|0|0|||SIX VOLT BAT OTTO BOCK/EQ EA|| 58-1699775|1326041732|CHC13|L7362||11/01/2013|12/31/9999|$288.97|0|0|||BATTERY CHRGR SIX VOLT OTTO|| 58-1699775|1326041732|CHC13|L7364||11/01/2013|12/31/9999|$459.60|0|0|||TWELVE VOLT BATTERY UTAH/EQU|| 58-1699775|1326041732|CHC13|L7366||11/01/2013|12/31/9999|$619.10|0|0|||BATTERY CHRGR 12 VOLT UTAH/E|| 58-1699775|1326041732|CHC13|L7367||11/01/2013|12/31/9999|$454.08|0|0|||REPLACEMNT LITHIUM IONBATTER|| 58-1699775|1326041732|CHC13|L7368||11/01/2013|12/31/9999|$588.66|0|0|||LITHIUM ION BATTERY CHARGER|| 58-1699775|1326041732|CHC13|L7400||11/01/2013|12/31/9999|$357.49|0|0|||ADD UE PROST BE/WD| ULTLITE|| 58-1699775|1326041732|CHC13|L7401||11/01/2013|12/31/9999|$400.20|0|0|||ADD UE PROST A/E ULTLITE MAT|| 58-1699775|1326041732|CHC13|L7402||11/01/2013|12/31/9999|$432.15|0|0|||ADD UE PROST S/D ULTLITE MAT|| 58-1699775|1326041732|CHC13|L7403||11/01/2013|12/31/9999|$429.55|0|0|||ADD UE PROST B/E ACRYLIC|| 58-1699775|1326041732|CHC13|L7404||11/01/2013|12/31/9999|$648.25|0|0|||ADD UE PROST A/E ACRYLIC|| 58-1699775|1326041732|CHC13|L7405||11/01/2013|12/31/9999|$847.84|0|0|||ADD UE PROST S/D ACRYLIC|| 58-1699775|1326041732|CHC13|L7700||04/01/2018|12/31/9999|$136.40|0|0|0||PROS SOCKET INSERT GASKET/SEAL|| 58-1699775|1326041732|CHC13|L7900||11/01/2013|12/31/9999|$631.26|0|0|||MALE VACUUM ERECTION SYSTEM|| 58-1699775|1326041732|CHC13|L8000||11/01/2013|12/31/9999|$50.74|0|0|||MASTECTOMY BRA|| 58-1699775|1326041732|CHC13|L8001||11/01/2013|12/31/9999|$146.29|0|0|||BREAST PROSTHESIS BRA & FORM|| 58-1699775|1326041732|CHC13|L8002||11/01/2013|12/31/9999|$192.45|0|0|||BRST PRSTH BRA & BILAT FORM|| 58-1699775|1326041732|CHC13|L8010||04/01/2016|12/31/9999|$63.00|0|0|||MASTECTOMY SLEEVE|| 58-1699775|1326041732|CHC13|L8015||11/01/2013|12/31/9999|$69.91|0|0|||EXT BREASTPROSTHESIS GARMENT|| 58-1699775|1326041732|CHC13|L8020||11/01/2013|12/31/9999|$262.95|0|0|||MASTECTOMY FORM|| 58-1699775|1326041732|CHC13|L8030||11/01/2013|12/31/9999|$380.35|0|0|||BREAST PROSTHESIS SILICONE/E|| 58-1699775|1326041732|CHC13|L8031||11/01/2013|12/31/9999|$380.35|0|0|||BREAST PROSTHESIS W ADHESIVE|| 58-1699775|1326041732|CHC13|L8032||11/01/2013|12/31/9999|$45.69|0|0|||REUSABLE NIPPLE PROSTHESIS|| 58-1699775|1326041732|CHC13|L8035||11/01/2013|12/31/9999|$4|273.16|0|0|||CUSTOM BREAST PROSTHESIS|| 58-1699775|1326041732|CHC13|L8040||11/01/2013|12/31/9999|$2|819.34|0|0|||NASAL PROSTHESIS|| 58-1699775|1326041732|CHC13|L8040|KM|11/01/2013|12/31/9999|$2|678.37|0|0|||NASAL PROSTHESIS|| 58-1699775|1326041732|CHC13|L8040|KN|11/01/2013|12/31/9999|$1|127.75|0|0|||NASAL PROSTHESIS|| 58-1699775|1326041732|CHC13|L8041||11/01/2013|12/31/9999|$3|398.18|0|0|||MIDFACIAL PROSTHESIS|| 58-1699775|1326041732|CHC13|L8041|KM|11/01/2013|12/31/9999|$3|228.25|0|0|||MIDFACIAL PROSTHESIS|| 58-1699775|1326041732|CHC13|L8041|KN|11/01/2013|12/31/9999|$1|359.28|0|0|||MIDFACIAL PROSTHESIS|| 58-1699775|1326041732|CHC13|L8042||11/01/2013|12/31/9999|$3|818.15|0|0|||ORBITAL PROSTHESIS|| 58-1699775|1326041732|CHC13|L8042|KM|11/01/2013|12/31/9999|$3|627.25|0|0|||ORBITAL PROSTHESIS|| 58-1699775|1326041732|CHC13|L8042|KN|11/01/2013|12/31/9999|$1|527.25|0|0|||ORBITAL PROSTHESIS|| 58-1699775|1326041732|CHC13|L8043||11/01/2013|12/31/9999|$4|276.35|0|0|||UPPER FACIAL PROSTHESIS|| 58-1699775|1326041732|CHC13|L8043|KM|11/01/2013|12/31/9999|$4|062.50|0|0|||UPPER FACIAL PROSTHESIS|| 58-1699775|1326041732|CHC13|L8043|KN|11/01/2013|12/31/9999|$1|710.53|0|0|||UPPER FACIAL PROSTHESIS|| 58-1699775|1326041732|CHC13|L8044||11/01/2013|12/31/9999|$4|734.51|0|0|||HEMI-FACIAL PROSTHESIS|| 58-1699775|1326041732|CHC13|L8044|KM|11/01/2013|12/31/9999|$4|497.80|0|0|||HEMI-FACIAL PROSTHESIS|| 58-1699775|1326041732|CHC13|L8044|KN|11/01/2013|12/31/9999|$1|893.83|0|0|||HEMI-FACIAL PROSTHESIS|| 58-1699775|1326041732|CHC13|L8045||11/01/2013|12/31/9999|$2|964.87|0|0|||AURICULAR PROSTHESIS|| 58-1699775|1326041732|CHC13|L8045|KM|11/01/2013|12/31/9999|$2|816.63|0|0|||AURICULAR PROSTHESIS|| 58-1699775|1326041732|CHC13|L8045|KN|11/01/2013|12/31/9999|$1|185.95|0|0|||AURICULAR PROSTHESIS|| 58-1699775|1326041732|CHC13|L8046||11/01/2013|12/31/9999|$3|054.53|0|0|||PARTIAL FACIAL PROSTHESIS|| 58-1699775|1326041732|CHC13|L8046|KM|11/01/2013|12/31/9999|$2|901.80|0|0|||PARTIAL FACIAL PROSTHESIS|| 58-1699775|1326041732|CHC13|L8046|KN|11/01/2013|12/31/9999|$1|221.79|0|0|||PARTIAL FACIAL PROSTHESIS|| 58-1699775|1326041732|CHC13|L8047||11/01/2013|12/31/9999|$1|565.44|0|0|||NASAL SEPTAL PROSTHESIS|| 58-1699775|1326041732|CHC13|L8047|KM|11/01/2013|12/31/9999|$1|487.16|0|0|||NASAL SEPTAL PROSTHESIS|| 58-1699775|1326041732|CHC13|L8047|KN|11/01/2013|12/31/9999|$626.18|0|0|||NASAL SEPTAL PROSTHESIS|| 58-1699775|1326041732|CHC13|L8300||11/01/2013|12/31/9999|$112.33|0|0|||TRUSS SINGLE W/ STANDARD PAD|| 58-1699775|1326041732|CHC13|L8310||11/01/2013|12/31/9999|$172.71|0|0|||TRUSS DOUBLE W/ STANDARD PAD|| 58-1699775|1326041732|CHC13|L8320||11/01/2013|12/31/9999|$75.45|0|0|||TRUSS ADDITION TO STD PAD WA|| 58-1699775|1326041732|CHC13|L8330||11/01/2013|12/31/9999|$74.79|0|0|||TRUSS ADD TO STD PAD SCROTAL|| 58-1699775|1326041732|CHC13|L8400||11/01/2013|12/31/9999|$21.85|0|0|||SHEATH BELOW KNEE|| 58-1699775|1326041732|CHC13|L8410||11/01/2013|12/31/9999|$24.87|0|0|||SHEATH ABOVE KNEE|| 58-1699775|1326041732|CHC13|L8415||11/01/2013|12/31/9999|$24.73|0|0|||SHEATH UPPER LIMB|| 58-1699775|1326041732|CHC13|L8417||11/01/2013|12/31/9999|$87.70|0|0|||PROS SHEATH/SOCK W GEL CUSHN|| 58-1699775|1326041732|CHC13|L8420||11/01/2013|12/31/9999|$28.91|0|0|||PROSTHETIC SOCK MULTI PLY BK|| 58-1699775|1326041732|CHC13|L8430||11/01/2013|12/31/9999|$31.79|0|0|||PROSTHETIC SOCK MULTI PLY AK|| 58-1699775|1326041732|CHC13|L8435||11/01/2013|12/31/9999|$28.52|0|0|||PROS SOCK MULTI PLY UPPER LM|| 58-1699775|1326041732|CHC13|L8440||11/01/2013|12/31/9999|$60.46|0|0|||SHRINKER BELOW KNEE|| 58-1699775|1326041732|CHC13|L8460||11/01/2013|12/31/9999|$84.15|0|0|||SHRINKER ABOVE KNEE|| 58-1699775|1326041732|CHC13|L8465||11/01/2013|12/31/9999|$75.01|0|0|||SHRINKER UPPER LIMB|| 58-1699775|1326041732|CHC13|L8470||11/01/2013|12/31/9999|$7.70|0|0|||PROS SOCK SINGLE PLY BK|| 58-1699775|1326041732|CHC13|L8480||11/01/2013|12/31/9999|$10.61|0|0|||PROS SOCK SINGLE PLY AK|| 58-1699775|1326041732|CHC13|L8485||11/01/2013|12/31/9999|$12.83|0|0|||PROS SOCK SINGLE PLY UPPER L|| 58-1699775|1326041732|CHC13|L8500||11/01/2013|12/31/9999|$761.19|0|0|||ARTIFICIAL LARYNX|| 58-1699775|1326041732|CHC13|L8501||11/01/2013|12/31/9999|$169.06|0|0|||TRACHEOSTOMY SPEAKING VALVE|| 58-1699775|1326041732|CHC13|L8507||11/01/2013|12/31/9999|$48.86|0|0|||TRACH-ESOPH VOICE PROS PT IN|| 58-1699775|1326041732|CHC13|L8509||11/01/2013|12/31/9999|$127.39|0|0|||TRACH-ESOPH VOICE PROS MD IN|| 58-1699775|1326041732|CHC13|L8510||11/01/2013|12/31/9999|$294.75|0|0|||VOICE AMPLIFIER|| 58-1699775|1326041732|CHC13|L8511||11/01/2013|12/31/9999|$84.84|0|0|||INDWELLING TRACH INSERT|| 58-1699775|1326041732|CHC13|L8512||11/01/2013|12/31/9999|$2.56|0|0|||GEL CAP FOR TRACH VOICE PROS|| 58-1699775|1326041732|CHC13|L8513||11/01/2013|12/31/9999|$6.08|0|0|||TRACH PROS CLEANING DEVICE|| 58-1699775|1326041732|CHC13|L8514||11/01/2013|12/31/9999|$110.00|0|0|||REPL TRACH PUNCTURE DILATOR|| 58-1699775|1326041732|CHC13|L8515||11/01/2013|12/31/9999|$73.61|0|0|||GEL CAP APP DEVICE FOR TRACH|| 58-1699775|1326041732|CHC13|L8600||11/01/2013|12/31/9999|$720.22|0|0|||IMPLANT BREAST SILICONE/EQ|| 58-1699775|1326041732|CHC13|L8603||11/01/2013|12/31/9999|$505.81|0|0|||COLLAGEN IMP URINARY 2.5 ML|| 58-1699775|1326041732|CHC13|L8606||11/01/2013|12/31/9999|$265.52|0|0|||SYNTHETIC IMPLNT URINARY 1ML|| 58-1699775|1326041732|CHC13|L8609||11/01/2013|12/31/9999|$7|599.48|0|0|||ARTIFICIAL CORNEA|| 58-1699775|1326041732|CHC13|L8610||11/01/2013|12/31/9999|$738.78|0|0|||OCULAR IMPLANT|| 58-1699775|1326041732|CHC13|L8612||11/01/2013|12/31/9999|$779.20|0|0|||AQUEOUS SHUNT PROSTHESIS|| 58-1699775|1326041732|CHC13|L8613||11/01/2013|12/31/9999|$348.86|0|0|||OSSICULAR IMPLANT|| 58-1699775|1326041732|CHC13|L8614||11/01/2013|12/31/9999|$22|081.37|0|0|||COCHLEAR DEVICE/SYSTEM|| 58-1699775|1326041732|CHC13|L8615||11/01/2013|12/31/9999|$526.05|0|0|||COCH IMPLANT HEADSET REPLACE|| 58-1699775|1326041732|CHC13|L8616||11/01/2013|12/31/9999|$122.52|0|0|||COCH IMPLANT MICROPHONE REPL|| 58-1699775|1326041732|CHC13|L8617||11/01/2013|12/31/9999|$107.04|0|0|||COCH IMPLANT TRANS COIL REPL|| 58-1699775|1326041732|CHC13|L8618||11/01/2013|12/31/9999|$30.56|0|0|||COCH IMPLANT TRAN CABLE REPL|| 58-1699775|1326041732|CHC13|L8619||11/01/2013|12/31/9999|$9|472.09|0|0|||REPLACE COCHLEAR PROCESSOR|| 58-1699775|1326041732|CHC13|L8621||11/01/2013|12/31/9999|$0.71|0|0|||REPL ZINC AIR BATTERY|| 58-1699775|1326041732|CHC13|L8622||11/01/2013|12/31/9999|$0.39|0|0|||REPL ALKALINE BATTERY|| 58-1699775|1326041732|CHC13|L8623||11/01/2013|12/31/9999|$75.45|0|0|||LITH ION BATT CID|NON-EARLVL|| 58-1699775|1326041732|CHC13|L8624||11/01/2013|12/31/9999|$188.05|0|0|||LITH ION BATT CID| EAR LEVEL|| 58-1699775|1326041732|CHC13|L8625||04/01/2018|12/31/9999|$230.82|0|0|0||TRAPEZIUM IMPLANT|| 58-1699775|1326041732|CHC13|L8627||11/01/2013|12/31/9999|$8|029.17|0|0|||LUNATE IMPLANT|| 58-1699775|1326041732|CHC13|L8628||11/01/2013|12/31/9999|$1|442.91|0|0|||CARPUS IMPLANT|| 58-1699775|1326041732|CHC13|L8629||11/01/2013|12/31/9999|$208.85|0|0|||SCAPHOID IMPLANT|| 58-1699775|1326041732|CHC13|L8630||11/01/2013|12/31/9999|$388.57|0|0|||METACARPOPHALANGEAL IMPLANT|| 58-1699775|1326041732|CHC13|L8631||11/01/2013|12/31/9999|$2|607.81|0|0|||MCP JOINT REPL 2 PC OR MORE|| 58-1699775|1326041732|CHC13|L8641||11/01/2013|12/31/9999|$421.75|0|0|||METATARSAL JOINT IMPLANT|| 58-1699775|1326041732|CHC13|L8642||11/01/2013|12/31/9999|$346.19|0|0|||HALLUX IMPLANT|| 58-1699775|1326041732|CHC13|L8658||11/01/2013|12/31/9999|$361.80|0|0|||INTERPHALANGEAL JOINT SPACER|| 58-1699775|1326041732|CHC13|L8659||11/01/2013|12/31/9999|$2|250.72|0|0|||INTERPHALANGEAL JOINT REPL|| 58-1699775|1326041732|CHC13|L8670||11/01/2013|12/31/9999|$642.04|0|0|||VASCULAR GRAFT| SYNTHETIC|| 58-1699775|1326041732|CHC13|L8680||11/01/2013|12/31/9999|$535.76|0|0|||IMPLT NEUROSTIM ELCTR EACH|| 58-1699775|1326041732|CHC13|L8681||11/01/2013|12/31/9999|$1|317.40|0|0|||PT PRGRM FOR IMPLT NEUROSTIM|| 58-1699775|1326041732|CHC13|L8682||11/01/2013|12/31/9999|$6|953.56|0|0|||IMPLT NEUROSTIM RADIOFQ REC|| 58-1699775|1326041732|CHC13|L8683||11/01/2013|12/31/9999|$6|120.69|0|0|||RADIOFQ TRSMTR FOR IMPLT NEU|| 58-1699775|1326041732|CHC13|L8684||11/01/2013|12/31/9999|$803.78|0|0|||RADIOF TRSMTR IMPLT SCRL NEU|| 58-1699775|1326041732|CHC13|L8685||11/01/2013|12/31/9999|$15|252.46|0|0|||IMPLT NROSTM PLS GEN SNG REC|| 58-1699775|1326041732|CHC13|L8686||11/01/2013|12/31/9999|$9|732.32|0|0|||IMPLT NROSTM PLS GEN SNG NON|| 58-1699775|1326041732|CHC13|L8687||11/01/2013|12/31/9999|$19|849.56|0|0|||IMPLT NROSTM PLS GEN DUA REC|| 58-1699775|1326041732|CHC13|L8688||11/01/2013|12/31/9999|$12|665.64|0|0|||IMPLT NROSTM PLS GEN DUA NON|| 58-1699775|1326041732|CHC13|L8689||11/01/2013|12/31/9999|$2|011.91|0|0|||EXTERNAL RECHARGING SYSTEM|| 58-1699775|1326041732|CHC13|L8690||11/01/2013|12/31/9999|$5|548.65|0|0|||AUD OSSEO DEV|INT/EXT COMP|| 58-1699775|1326041732|CHC13|L8691||11/01/2013|12/31/9999|$3|110.20|0|0|||AUD OSSEO DEV EXT SND PROCES|| 58-1699775|1326041732|CHC13|L8693||11/01/2013|12/31/9999|$1|768.61|0|0|||AUD OSSEO DEV| ABUTMENT|| 58-1699775|1326041732|CHC13|L8694||04/01/2018|12/31/9999|$1|154.20|0|0|0||AOI TRANSDUCER/CCTUATOR REPL E|| 58-1699775|1326041732|CHC13|L8695||11/01/2013|12/31/9999|$19.42|0|0|||EXTERNAL RECHARG SYS EXTERN|| 58-1699775|1326041732|CHC13|P2038||11/01/2013|12/31/9999|$8.90|0|0|||BLOOD MUCOPROTEIN|| 58-1699775|1326041732|CHC13|P3000||11/01/2013|12/31/9999|$18.71|0|0|||SCREEN PAP BY TECH W MD SUPV|| 58-1699775|1326041732|CHC13|P3001||11/01/2013|12/31/9999|$34.72|0|0|||SCREENING PAP SMEAR BY PHYS|| 58-1699775|1326041732|CHC13|P7001||10/01/2014|12/31/9999|$8.50|0|0|||CULTURE BACTERIAL URINE|| 58-1699775|1326041732|CHC13|P9041||10/01/2016|09/30/2017|$14.15|0|0|0||ALBUMIN (HUMAN)|5%| 50ML|| 58-1699775|1326041732|CHC13|P9041||10/01/2017|09/30/2018|$14.75|0|0|0||ALBUMIN (HUMAN)|5%| 50ML|| 58-1699775|1326041732|CHC13|P9043||11/01/2013|12/31/9999|$10.42|0|0|||PLASMA PROTEIN FRACT|5%|50ML|| 58-1699775|1326041732|CHC13|P9045||10/01/2016|09/30/2017|$68.40|0|0|0||ALBUMIN (HUMAN)| 5%| 250 ML|| 58-1699775|1326041732|CHC13|P9045||10/01/2017|09/30/2018|$68.40|0|0|0||ALBUMIN (HUMAN)| 5%| 250 ML|| 58-1699775|1326041732|CHC13|P9046||10/01/2016|09/30/2017|$28.11|0|0|0||ALBUMIN (HUMAN)| 25%| 20 ML|| 58-1699775|1326041732|CHC13|P9046||10/01/2017|09/30/2018|$28.11|0|0|0||ALBUMIN (HUMAN)| 25%| 20 ML|| 58-1699775|1326041732|CHC13|P9047||10/01/2016|09/30/2017|$66.80|0|0|0||ALBUMIN (HUMAN)| 25%| 50ML|| 58-1699775|1326041732|CHC13|P9047||10/01/2017|09/30/2018|$66.80|0|0|0||ALBUMIN (HUMAN)| 25%| 50ML|| 58-1699775|1326041732|CHC13|P9048||11/01/2013|12/31/9999|$52.08|0|0|||PLASMAPROTEIN FRACT|5%|250ML|| 58-1699775|1326041732|CHC13|P9612||11/01/2013|12/31/9999|$3.75|0|0|||CATHETERIZE FOR URINE SPEC|| 58-1699775|1326041732|CHC13|P9615||11/01/2013|12/31/9999|$3.75|0|0|||URINE SPECIMEN COLLECT MULT|| 58-1699775|1326041732|CHC13|Q0035||11/01/2013|12/31/9999|$21.40|0|0|||CARDIOKYMOGRAPHY|| 58-1699775|1326041732|CHC13|Q0035|26|11/01/2013|12/31/9999|$13.09|0|0|||CARDIOKYMOGRAPHY|| 58-1699775|1326041732|CHC13|Q0035|TC|11/01/2013|12/31/9999|$15.15|0|0|||CARDIOKYMOGRAPHY|| 58-1699775|1326041732|CHC13|Q0091||11/01/2013|12/31/9999|$51.70|0|0|||OBTAINING SCREEN PAP SMEAR|| 58-1699775|1326041732|CHC13|Q0111||11/01/2013|12/31/9999|$7.56|0|0|||WET MOUNTS/ W PREPARATIONS|| 58-1699775|1326041732|CHC13|Q0112||11/01/2013|12/31/9999|$7.56|0|0|||POTASSIUM HYDROXIDE PREPS|| 58-1699775|1326041732|CHC13|Q0113||11/01/2013|12/31/9999|$9.59|0|0|||PINWORM EXAMINATIONS|| 58-1699775|1326041732|CHC13|Q0114||11/01/2013|12/31/9999|$12.66|0|0|||FERN TEST|| 58-1699775|1326041732|CHC13|Q0115||11/01/2013|12/31/9999|$17.53|0|0|||POST-COITAL MUCOUS EXAM|| 58-1699775|1326041732|CHC13|Q0138||10/01/2016|09/30/2017|$1.08|0|0|0||INJ|FERUMOXYTOL 1MG (NON-ESRD)|| 58-1699775|1326041732|CHC13|Q0138||10/01/2017|09/30/2018|$1.11|0|0|0||INJ|FERUMOXYTOL 1MG (NON-ESRD)|| 58-1699775|1326041732|CHC13|Q0139||10/01/2016|09/30/2017|$1.08|0|0|0||INJ|FERUMOXYTOL 1MG-ESRD/DIALY|| 58-1699775|1326041732|CHC13|Q0139||10/01/2017|09/30/2018|$1.11|0|0|0||INJ|FERUMOXYTOL 1MG-ESRD/DIALY|| 58-1699775|1326041732|CHC13|Q0162||10/01/2016|09/30/2017|$0.04|0|0|0||ONDANSETRON ORAL|| 58-1699775|1326041732|CHC13|Q0162||10/01/2017|09/30/2018|$0.04|0|0|0||ONDANSETRON ORAL|| 58-1699775|1326041732|CHC13|Q0163||10/01/2016|09/30/2017|$0.33|0|0|0||DIPHENHYDRAMINE HCL 50MG|| 58-1699775|1326041732|CHC13|Q0163||10/01/2017|09/30/2018|$0.34|0|0|0||DIPHENHYDRAMINE HCL 50MG|| 58-1699775|1326041732|CHC13|Q0164||10/01/2016|09/30/2017|$0.08|0|0|0||PROCHLORPERAZINE MALEATE 5MG|| 58-1699775|1326041732|CHC13|Q0164||10/01/2017|09/30/2018|$0.05|0|0|0||PROCHLORPERAZINE MALEATE 5MG|| 58-1699775|1326041732|CHC13|Q0165||11/01/2013|12/31/9999|$0.07|0|0|||PROCHLORPERAZINE MALEATE10MG|| 58-1699775|1326041732|CHC13|Q0166||10/01/2016|09/30/2017|$1.18|0|0|0||GRANISETRON HCL 1 MG ORAL|| 58-1699775|1326041732|CHC13|Q0166||10/01/2017|09/30/2018|$2.95|0|0|0||GRANISETRON HCL 1 MG ORAL|| 58-1699775|1326041732|CHC13|Q0167||10/01/2016|09/30/2017|$11.34|0|0|0||DRONABINOL 2.5MG ORAL|| 58-1699775|1326041732|CHC13|Q0167||10/01/2017|09/30/2018|$5.20|0|0|0||DRONABINOL 2.5MG ORAL|| 58-1699775|1326041732|CHC13|Q0168||11/01/2013|12/31/9999|$8.92|0|0|||DRONABINOL 5MG ORAL|| 58-1699775|1326041732|CHC13|Q0169||10/01/2016|09/30/2017|$0.04|0|0|0||PROMETHAZINE HCL 12.5MG ORAL|| 58-1699775|1326041732|CHC13|Q0169||10/01/2017|09/30/2018|$0.05|0|0|0||PROMETHAZINE HCL 12.5MG ORAL|| 58-1699775|1326041732|CHC13|Q0170||11/01/2013|12/31/9999|$0.04|0|0|||PROMETHAZINE HCL 25 MG ORAL|| 58-1699775|1326041732|CHC13|Q0180||10/01/2016|09/30/2017|$119.03|0|0|0||DOLASETRON MESYLATE ORAL|| 58-1699775|1326041732|CHC13|Q0478||11/01/2013|12/31/9999|$214.34|0|0|||POWER ADAPTER| COMBO VAD|| 58-1699775|1326041732|CHC13|Q0479||11/01/2013|12/31/9999|$14|087.18|0|0|||POWER MODULE COMBO VAD| REP|| 58-1699775|1326041732|CHC13|Q0480||11/01/2013|12/31/9999|$105|049.24|0|0|||DRIVER PNEUMATIC VAD| REP|| 58-1699775|1326041732|CHC13|Q0481||11/01/2013|12/31/9999|$16|948.49|0|0|||MICROPRCSR CU ELEC VAD| REP|| 58-1699775|1326041732|CHC13|Q0482||11/01/2013|12/31/9999|$5|308.59|0|0|||MICROPRCSR CU COMBO VAD| REP|| 58-1699775|1326041732|CHC13|Q0483||11/01/2013|12/31/9999|$21|868.96|0|0|||MONITOR ELEC VAD| REP|| 58-1699775|1326041732|CHC13|Q0484||11/01/2013|12/31/9999|$4|246.89|0|0|||MONITOR ELEC OR COMB VAD REP|| 58-1699775|1326041732|CHC13|Q0485||11/01/2013|12/31/9999|$410.04|0|0|||MONITOR CABLE ELEC VAD| REP|| 58-1699775|1326041732|CHC13|Q0486||11/01/2013|12/31/9999|$341.26|0|0|||MON CABLE ELEC/PNEUM VAD REP|| 58-1699775|1326041732|CHC13|Q0487||11/01/2013|12/31/9999|$398.16|0|0|||LEADS ANY TYPE VAD| REP ONLY|| 58-1699775|1326041732|CHC13|Q0489||11/01/2013|12/31/9999|$18|959.19|0|0|||PWR PCK BASE COMBO VAD| REP|| 58-1699775|1326041732|CHC13|Q0490||11/01/2013|12/31/9999|$820.09|0|0|||EMR PWR SOURCE ELEC VAD| REP|| 58-1699775|1326041732|CHC13|Q0491||11/01/2013|12/31/9999|$1|289.23|0|0|||EMR PWR SOURCE COMBO VAD REP|| 58-1699775|1326041732|CHC13|Q0492||11/01/2013|12/31/9999|$103.90|0|0|||EMR PWR CBL ELEC VAD| REP|| 58-1699775|1326041732|CHC13|Q0493||11/01/2013|12/31/9999|$295.73|0|0|||EMR PWR CBL COMBO VAD| REP|| 58-1699775|1326041732|CHC13|Q0494||11/01/2013|12/31/9999|$250.25|0|0|||EMR HD PMP ELEC/COMBO| REP|| 58-1699775|1326041732|CHC13|Q0495||11/01/2013|12/31/9999|$4|872.07|0|0|||CHARGER ELEC/COMBO VAD| REP|| 58-1699775|1326041732|CHC13|Q0496||11/01/2013|12/31/9999|$1|748.67|0|0|||BATTERY ELEC/COMBO VAD| REP|| 58-1699775|1326041732|CHC13|Q0497||11/01/2013|12/31/9999|$546.03|0|0|||BAT CLPS ELEC/COMB VAD| REP|| 58-1699775|1326041732|CHC13|Q0498||11/01/2013|12/31/9999|$599.11|0|0|||HOLSTER ELEC/COMBO VAD| REP|| 58-1699775|1326041732|CHC13|Q0499||11/01/2013|12/31/9999|$194.65|0|0|||BELT/VEST ELEC/COMBO VAD REP|| 58-1699775|1326041732|CHC13|Q0500||11/01/2013|12/31/9999|$35.61|0|0|||FILTERS ELEC/COMBO VAD| REP|| 58-1699775|1326041732|CHC13|Q0501||11/01/2013|12/31/9999|$595.66|0|0|||SHWR COV ELEC/COMBO VAD| REP|| 58-1699775|1326041732|CHC13|Q0502||11/01/2013|12/31/9999|$758.35|0|0|||MOBILITY CART PNEUM VAD| REP|| 58-1699775|1326041732|CHC13|Q0503||11/01/2013|12/31/9999|$1|516.73|0|0|||BATTERY PNEUM VAD REPLACEMNT|| 58-1699775|1326041732|CHC13|Q0504||11/01/2013|12/31/9999|$800.33|0|0|||PWR ADPT PNEUM VAD| REP VEH|| 58-1699775|1326041732|CHC13|Q0506||11/01/2013|12/31/9999|$996.22|0|0|||LITH-ION BATT ELEC/PNEUM VAD|| 58-1699775|1326041732|CHC13|Q0515||11/01/2013|12/31/9999|$2.25|0|0|||SERMORELIN ACETATE INJECTION|| 58-1699775|1326041732|CHC13|Q2009||11/01/2013|12/31/9999|$1.37|0|0|||FOSPHENYTOIN| 50 MG|| 58-1699775|1326041732|CHC13|Q2017||11/01/2013|12/31/9999|$401.31|0|0|||TENIPOSIDE| 50 MG|| 58-1699775|1326041732|CHC13|Q2035||10/01/2016|09/30/2017|$16.28|0|0|0||AFLURIA VACC| 3 YRS & >| IM|| 58-1699775|1326041732|CHC13|Q2035||10/01/2017|09/30/2018|$20.36|0|0|0||AFLURIA VACC| 3 YRS & >| IM|| 58-1699775|1326041732|CHC13|Q2036||10/01/2015|12/31/9999|$10.72|0|0|0||FLULAVAL VACC| 3 YRS & >| IM|| 58-1699775|1326041732|CHC13|Q2037||10/01/2016|09/30/2017|$19.79|0|0|0||FLUVIRIN VACC| 3 YRS & >| IM|| 58-1699775|1326041732|CHC13|Q2037||10/01/2017|09/30/2018|$20.36|0|0|0||FLUVIRIN VACC| 3 YRS & >| IM|| 58-1699775|1326041732|CHC13|Q2038||10/01/2016|09/30/2017|$15.06|0|0|0||FLUZONE VACC| 3 YRS & >| IM|| 58-1699775|1326041732|CHC13|Q2043||10/01/2016|09/30/2017|$47|544.01|0|0|0||SIPULEUCEL-T AUTO CD54+|| 58-1699775|1326041732|CHC13|Q2043||10/01/2017|09/30/2018|$49|446.10|0|0|0||SIPULEUCEL-T AUTO CD54+|| 58-1699775|1326041732|CHC13|Q2046||11/01/2013|12/31/9999|$1|225.62|0|0|||AFLIBERCEPT INJECTION|| 58-1699775|1326041732|CHC13|Q2047||11/01/2013|12/31/9999|$14.32|0|0|||PEGINESATIDE INJECTION|| 58-1699775|1326041732|CHC13|Q2048||11/01/2013|12/31/9999|$671.51|0|0|||DOXIL INJECTION|| 58-1699775|1326041732|CHC13|Q2049||10/01/2015|12/31/9999|$635.54|0|0|0||IMPORTED LIPODOX INJ|| 58-1699775|1326041732|CHC13|Q2050||10/01/2016|09/30/2017|$532.81|0|0|0||DOXORUBICIN INJ 10MG|| 58-1699775|1326041732|CHC13|Q2050||10/01/2017|09/30/2018|$479.78|0|0|0||DOXORUBICIN INJ 10MG|| 58-1699775|1326041732|CHC13|Q2051||11/01/2013|12/31/9999|$245.53|0|0|||ZOLDEDRONIC ACID 1MG|| 58-1699775|1326041732|CHC13|Q3025||11/01/2013|12/31/9999|$389.14|0|0|||IM INJ INTERFERON BETA 1-A|| 58-1699775|1326041732|CHC13|Q3027||10/01/2016|09/30/2017|$56.00|0|0|0||INJ BETA INTERFERON IM 1 MCG|| 58-1699775|1326041732|CHC13|Q3027||10/01/2017|09/30/2018|$62.83|0|0|0||INJ BETA INTERFERON IM 1 MCG|| 58-1699775|1326041732|CHC13|Q4006||11/01/2013|12/31/9999|$35.69|0|0|||CAST SUP LONG ARM ADULT FBRG|| 58-1699775|1326041732|CHC13|Q4008||11/01/2013|12/31/9999|$54.75|0|0|||CAST SUP LONG ARM PED FBRGLS|| 58-1699775|1326041732|CHC13|Q4010||11/01/2013|12/31/9999|$58.74|0|0|||CAST SUP SHT ARM ADULT FBRGL|| 58-1699775|1326041732|CHC13|Q4011||11/01/2013|12/31/9999|$126.75|0|0|||CAST SUP SHT ARM PED PLASTER|| 58-1699775|1326041732|CHC13|Q4012||10/01/2014|12/31/9999|$12.09|0|0|||CAST SUP SHT ARM PED FBRGLAS|| 58-1699775|1326041732|CHC13|Q4014||11/01/2013|12/31/9999|$33.75|0|0|||CAST SUP GAUNTLET FIBERGLASS|| 58-1699775|1326041732|CHC13|Q4017||03/01/2016|12/31/9999|$11.30|0|0|||CAST SUP LNG ARM SPLINT PLST|| 58-1699775|1326041732|CHC13|Q4018||11/01/2013|12/31/9999|$35.69|0|0|||CAST SUP LNG ARM SPLINT FBRG|| 58-1699775|1326041732|CHC13|Q4019||10/01/2015|12/31/9999|$65.00|0|0||%|CAST SUP LNG ARM SPLNT PED P|| 58-1699775|1326041732|CHC13|Q4020||10/01/2015|12/31/9999|$65.00|0|0||%|CAST SUP LNG ARM SPLNT PED F|| 58-1699775|1326041732|CHC13|Q4021||11/01/2013|12/31/9999|$112.50|0|0|||CAST SUP SHT ARM SPLINT PLST|| 58-1699775|1326041732|CHC13|Q4022||11/01/2013|12/31/9999|$112.50|0|0|||CAST SUP SHT ARM SPLINT FBRG|| 58-1699775|1326041732|CHC13|Q4023||01/01/2017|12/31/9999|$4.21|0|0|||CAST SUP SHT ARM SPLNT PED P|| 58-1699775|1326041732|CHC13|Q4024||05/01/2016|12/31/9999|$7.55|0|0|||CAST SUP SHT ARM SPLNT PED F|| 58-1699775|1326041732|CHC13|Q4030||11/01/2013|12/31/9999|$104.94|0|0|||CAST SUP LONG LEG FIBERGLASS|| 58-1699775|1326041732|CHC13|Q4032||11/01/2013|12/31/9999|$52.69|0|0|||CAST SUP LNG LEG PED FBRGLS|| 58-1699775|1326041732|CHC13|Q4037||11/01/2013|12/31/9999|$48.74|0|0|||CAST SUP SHRT LEG PLASTER|| 58-1699775|1326041732|CHC13|Q4038||11/01/2013|12/31/9999|$120.49|0|0|||CAST SUP SHRT LEG FIBERGLASS|| 58-1699775|1326041732|CHC13|Q4039||01/01/2017|12/31/9999|$10.66|0|0|||CAST SUP SHRT LEG PED PLSTER|| 58-1699775|1326041732|CHC13|Q4040||10/01/2014|12/31/9999|$66.00|0|0|||CAST SUP SHRT LEG PED FBRGLS|| 58-1699775|1326041732|CHC13|Q4041||01/01/2017|12/31/9999|$24.88|0|24.88|||CAST SUP LNG LEG SPLNT PLSTR|| 58-1699775|1326041732|CHC13|Q4045||11/01/2013|12/31/9999|$39.20|0|0|||CAST SUP SHT LEG SPLNT PLSTR|| 58-1699775|1326041732|CHC13|Q4046||10/01/2014|12/31/9999|$18.25|0|0|||CAST SUP SHT LEG SPLNT FBRGL|| 58-1699775|1326041732|CHC13|Q4047||01/01/2017|12/31/9999|$7.20|0|0|||CAST SUP SHT LEG SPLNT PED P|| 58-1699775|1326041732|CHC13|Q4049||10/01/2014|12/31/9999|$2.59|0|0|||FINGER SPLINT| STATIC|| 58-1699775|1326041732|CHC13|Q4074||10/01/2016|09/30/2017|$151.59|0|0|0||ILOPROST NON-COMP UNIT DOSE|| 58-1699775|1326041732|CHC13|Q4074||10/01/2017|09/30/2018|$158.25|0|0|0||ILOPROST NON-COMP UNIT DOSE|| 58-1699775|1326041732|CHC13|Q4081||10/01/2016|09/30/2017|$1.56|0|0|0||EPOETIN ALFA| 100 UNITS ESRD|| 58-1699775|1326041732|CHC13|Q4081||10/01/2017|09/30/2018|$1.72|0|0|0||EPOETIN ALFA| 100 UNITS ESRD|| 58-1699775|1326041732|CHC13|Q4101||10/01/2016|09/30/2017|$38.78|0|0|0||APLIGRAF SKIN SUB|| 58-1699775|1326041732|CHC13|Q4101||10/01/2017|09/30/2018|$38.59|0|0|0||APLIGRAF SKIN SUB|| 58-1699775|1326041732|CHC13|Q4102||10/01/2016|09/30/2017|$13.57|0|0|0||OASIS WOUND MATRIX SKIN SUB|| 58-1699775|1326041732|CHC13|Q4102||10/01/2017|09/30/2018|$13.74|0|0|0||OASIS WOUND MATRIX SKIN SUB|| 58-1699775|1326041732|CHC13|Q4103||11/01/2013|12/31/9999|$10.21|0|0|||OASIS BURN MATRIX SKIN SUB|| 58-1699775|1326041732|CHC13|Q4104||10/01/2016|09/30/2017|$48.48|0|0|0||INTEGRA BMWD SKIN SUB|| 58-1699775|1326041732|CHC13|Q4105||10/01/2016|09/30/2017|$37.28|0|0|0||INTEGRA DRT SKIN SUB|| 58-1699775|1326041732|CHC13|Q4106||10/01/2016|09/30/2017|$41.11|0|0|0||DERMAGRAFT SKIN SUB|| 58-1699775|1326041732|CHC13|Q4106||10/01/2017|09/30/2018|$41.34|0|0|0||DERMAGRAFT SKIN SUB|| 58-1699775|1326041732|CHC13|Q4107||10/01/2016|09/30/2017|$110.25|0|0|0||GRAFTJACKET SKIN SUB|| 58-1699775|1326041732|CHC13|Q4107||10/01/2017|09/30/2018|$116.66|0|0|0||GRAFTJACKET SKIN SUB|| 58-1699775|1326041732|CHC13|Q4108||10/01/2016|09/30/2017|$45.67|0|0|0||INTEGRA MATRIX SKIN SUB|| 58-1699775|1326041732|CHC13|Q4110||10/01/2016|09/30/2017|$60.14|0|0|0||PRIMATRIX SKIN SUB|| 58-1699775|1326041732|CHC13|Q4111||10/01/2016|09/30/2017|$8.76|0|0|0||GAMMAGRAFT SKIN SUB|| 58-1699775|1326041732|CHC13|Q4111||10/01/2017|09/30/2018|$9.21|0|0|0||GAMMAGRAFT SKIN SUB|| 58-1699775|1326041732|CHC13|Q4112||10/01/2016|09/30/2017|$309.18|0|0|0||CYMETRA ALLOGRAFT|| 58-1699775|1326041732|CHC13|Q4112||10/01/2017|09/30/2018|$250.06|0|0|0||CYMETRA ALLOGRAFT|| 58-1699775|1326041732|CHC13|Q4113||10/01/2016|09/30/2017|$309.18|0|0|0||GRAFTJACKET EXPRESS ALLOGRAF|| 58-1699775|1326041732|CHC13|Q4113||10/01/2017|09/30/2018|$250.06|0|0|0||GRAFTJACKET EXPRESS ALLOGRAF|| 58-1699775|1326041732|CHC13|Q4114||10/01/2015|12/31/9999|$1|890.22|0|0|0||INTEGRA FLOWABLE WOUND MATRI|| 58-1699775|1326041732|CHC13|Q4115||10/01/2016|09/30/2017|$13.48|0|0|0||ALLOSKIN SKIN SUB|| 58-1699775|1326041732|CHC13|Q4115||10/01/2017|09/30/2018|$9.43|0|0|0||ALLOSKIN SKIN SUB|| 58-1699775|1326041732|CHC13|Q4116||10/01/2016|09/30/2017|$40.38|0|0|0||ALLODERM SKIN SUB|| 58-1699775|1326041732|CHC13|Q4116||10/01/2017|09/30/2018|$39.29|0|0|0||ALLODERM SKIN SUB|| 58-1699775|1326041732|CHC13|Q4121||10/01/2016|09/30/2017|$50.19|0|0|0||THERASKIN|| 58-1699775|1326041732|CHC13|Q4121||10/01/2017|09/30/2018|$52.33|0|0|0||THERASKIN|| 58-1699775|1326041732|CHC13|Q4123||10/01/2016|09/30/2017|$31.17|0|0|0||ALLOSKIN|| 58-1699775|1326041732|CHC13|Q4123||10/01/2017|09/30/2018|$40.55|0|0|0||ALLOSKIN|| 58-1699775|1326041732|CHC13|Q4131||10/01/2016|09/30/2017|$222.88|0|0|0||EPIFIX|| 58-1699775|1326041732|CHC13|Q4131||10/01/2017|09/30/2018|$202.52|0|0|0||EPIFIX|| 58-1699775|1326041732|CHC13|Q4132||10/01/2017|09/30/2018|$171.08|0|0|0||GRAFIX CORE|| 58-1699775|1326041732|CHC13|Q4133||10/01/2017|09/30/2018|$173.01|0|0|0||GRAFIX PRIME|| 58-1699775|1326041732|CHC13|Q5001||01/01/2014|12/31/9999|$125.00|0|0|||HOSPICE IN PATIENT HOME|| 58-1699775|1326041732|CHC13|Q5006||01/01/2014|12/31/9999|$65.00|0|0||%|HOSPICE IN HOSPICE FACILITY|%| 58-1699775|1326041732|CHC13|Q5101||10/01/2016|09/30/2017|$1.09|0|0|0||INJ FILGRASTIM G-CSF BIOSIM| 1|| 58-1699775|1326041732|CHC13|Q5101||10/01/2017|09/30/2018|$0.91|0|0|0||INJ FILGRASTIM G-CSF BIOSIM| 1|| 58-1699775|1326041732|CHC13|Q5102||10/01/2017|09/30/2018|$100.24|0|0|0||INJ| INFLIXIMAB BIOSIMILAR| 10|| 58-1699775|1326041732|CHC13|Q9950||10/01/2016|09/30/2017|$28.66|0|0|0||LOCM 350-399MG/ML IODINE|1ML|| 58-1699775|1326041732|CHC13|Q9950||10/01/2017|09/30/2018|$26.36|0|0|0||LOCM 350-399MG/ML IODINE|1ML|| 58-1699775|1326041732|CHC13|Q9953||11/01/2013|12/31/9999|$0.00|0|0|||INJ FE-BASED MR CONTRAST|1ML|| 58-1699775|1326041732|CHC13|Q9954||11/01/2013|12/31/9999|$11.03|0|0|||ORAL MR CONTRAST| 100 ML|| 58-1699775|1326041732|CHC13|Q9956||10/01/2016|09/30/2017|$43.47|0|0|0||INJ OCTAFLUOROPROPANE MIC|ML|| 58-1699775|1326041732|CHC13|Q9956||10/01/2017|09/30/2018|$42.68|0|0|0||INJ OCTAFLUOROPROPANE MIC|ML|| 58-1699775|1326041732|CHC13|Q9957||10/01/2016|09/30/2017|$65.21|0|0|0||INJ PERFLUTREN LIP MICROS|ML|| 58-1699775|1326041732|CHC13|Q9957||10/01/2017|09/30/2018|$64.02|0|0|0||INJ PERFLUTREN LIP MICROS|ML|| 58-1699775|1326041732|CHC13|Q9958||10/01/2016|09/30/2017|$0.11|0|0|0||HOCM <=149 MG/ML IODINE| 1ML|| 58-1699775|1326041732|CHC13|Q9958||10/01/2017|09/30/2018|$0.11|0|0|0||HOCM <=149 MG/ML IODINE| 1ML|| 58-1699775|1326041732|CHC13|Q9960||10/01/2016|09/30/2017|$0.23|0|0|0||HOCM 200-249MG/ML IODINE|1ML|| 58-1699775|1326041732|CHC13|Q9960||10/01/2017|09/30/2018|$0.35|0|0|0||HOCM 200-249MG/ML IODINE|1ML|| 58-1699775|1326041732|CHC13|Q9961||10/01/2016|09/30/2017|$0.26|0|0|0||HOCM 250-299MG/ML IODINE|1ML|| 58-1699775|1326041732|CHC13|Q9961||10/01/2017|09/30/2018|$0.32|0|0|0||HOCM 250-299MG/ML IODINE|1ML|| 58-1699775|1326041732|CHC13|Q9963||10/01/2016|09/30/2017|$0.24|0|0|0||HOCM 350-399MG/ML IODINE|1ML|| 58-1699775|1326041732|CHC13|Q9963||10/01/2017|09/30/2018|$0.24|0|0|0||HOCM 350-399MG/ML IODINE|1ML|| 58-1699775|1326041732|CHC13|Q9965||10/01/2016|09/30/2017|$1.01|0|0|0||LOCM 100-199MG/ML IODINE|1ML|| 58-1699775|1326041732|CHC13|Q9965||10/01/2017|09/30/2018|$0.96|0|0|0||LOCM 100-199MG/ML IODINE|1ML|| 58-1699775|1326041732|CHC13|Q9966||10/01/2016|09/30/2017|$0.22|0|0|0||LOCM 200-299MG/ML IODINE|1ML|| 58-1699775|1326041732|CHC13|Q9966||10/01/2017|09/30/2018|$0.41|0|0|0||LOCM 200-299MG/ML IODINE|1ML|| 58-1699775|1326041732|CHC13|Q9967||10/01/2016|09/30/2017|$0.16|0|0|0||LOCM 300-399MG/ML IODINE|1ML|| 58-1699775|1326041732|CHC13|Q9967||10/01/2017|09/30/2018|$0.16|0|0|0||LOCM 300-399MG/ML IODINE|1ML|| 58-1699775|1326041732|CHC13|Q9970||11/01/2013|12/31/9999|$0.28|0|0|||INJ FERRIC CARBOXYMALTOS 1MG|| 58-1699775|1326041732|CHC13|Q9975||10/01/2015|12/31/9999|$2.37|0|0|0|||| 58-1699775|1326041732|CHC13|Q9989||10/01/2017|09/30/2018|$16.10|0|0|0||USTEKINUMAB| IV INJ| 1 MG|| 58-1699775|1326041732|CHC13|S0012||11/01/2013|12/31/9999|$73.85|0|0|||BUTORPHANOL TARTRATE| NASAL|| 58-1699775|1326041732|CHC13|S0014||11/01/2013|12/31/9999|$2.59|0|0|||TACRINE HYDROCHLORIDE| 10 MG|| 58-1699775|1326041732|CHC13|S0017||11/01/2013|12/31/9999|$6.05|0|0|||INJECTION| AMINOCAPROIC ACID|| 58-1699775|1326041732|CHC13|S0020||11/01/2013|12/31/9999|$9.66|0|0|||INJECTION| BUPIVICAINE HYDRO|| 58-1699775|1326041732|CHC13|S0021||11/01/2013|12/31/9999|$0.00|0|0|||INJECTION| CEFOPERAZONE SOD|| 58-1699775|1326041732|CHC13|S0023||11/01/2013|12/31/9999|$2.59|0|0|||INJECTION| CIMETIDINE HYDROC|| 58-1699775|1326041732|CHC13|S0028||11/01/2013|12/31/9999|$2.16|0|0|||INJECTION| FAMOTIDINE| 20 MG|| 58-1699775|1326041732|CHC13|S0030||11/01/2013|12/31/9999|$9.93|0|0|||INJECTION| METRONIDAZOLE|| 58-1699775|1326041732|CHC13|S0032||11/01/2013|12/31/9999|$21.16|0|0|||INJECTION| NAFCILLIN SODIUM|| 58-1699775|1326041732|CHC13|S0034||11/01/2013|12/31/9999|$0.00|0|0|||INJECTION| OFLOXACIN| 400 MG|| 58-1699775|1326041732|CHC13|S0039||11/01/2013|12/31/9999|$0.00|0|0|||INJECTION| SULFAMETHOXAZOLE|| 58-1699775|1326041732|CHC13|S0040||11/01/2013|12/31/9999|$13.82|0|0|||INJECTION| TICARCILLIN DISOD|| 58-1699775|1326041732|CHC13|S0073||11/01/2013|12/31/9999|$17.27|0|0|||INJECTION| AZTREONAM| 500 MG|| 58-1699775|1326041732|CHC13|S0074||11/01/2013|12/31/9999|$0.00|0|0|||INJECTION| CEFOTETAN DISODIU|| 58-1699775|1326041732|CHC13|S0077||11/01/2013|12/31/9999|$3.45|0|0|||INJECTION| CLINDAMYCIN PHOSP|| 58-1699775|1326041732|CHC13|S0078||11/01/2013|12/31/9999|$169.72|0|0|||INJECTION| FOSPHENYTOIN SODI|| 58-1699775|1326041732|CHC13|S0080||11/01/2013|12/31/9999|$66.07|0|0|||INJECTION| PENTAMIDINE ISETH|| 58-1699775|1326041732|CHC13|S0081||11/01/2013|12/31/9999|$1.73|0|0|||INJECTION| PIPERACILLIN SODI|| 58-1699775|1326041732|CHC13|S0088||11/01/2013|12/31/9999|$0.00|0|0|||IMATINIB 100 MG|| 58-1699775|1326041732|CHC13|S0090||11/01/2013|12/31/9999|$16.41|0|0|||SILDENAFIL CITRATE| 25 MG|| 58-1699775|1326041732|CHC13|S0091||11/01/2013|12/31/9999|$78.60|0|0|||GRANISETRON 1MG|| 58-1699775|1326041732|CHC13|S0092||11/01/2013|12/31/9999|$99.76|0|0|||HYDROMORPHONE 250 MG|| 58-1699775|1326041732|CHC13|S0093||11/01/2013|12/31/9999|$229.31|0|0|||MORPHINE 500 MG|| 58-1699775|1326041732|CHC13|S0104||11/01/2013|12/31/9999|$1.73|0|0|||ZIDOVUDINE| ORAL| 100 MG|| 58-1699775|1326041732|CHC13|S0106||11/01/2013|12/31/9999|$105.37|0|0|||BUPROPION HCL SR 60 TABLETS|| 58-1699775|1326041732|CHC13|S0108||11/01/2013|12/31/9999|$3.45|0|0|||MERCAPTOPURINE 50 MG|| 58-1699775|1326041732|CHC13|S0109||11/01/2013|12/31/9999|$0.43|0|0|||METHADONE ORAL 5MG|| 58-1699775|1326041732|CHC13|S0117||11/01/2013|12/31/9999|$0.00|0|0|||TRETINOIN TOPICAL 5 G|| 58-1699775|1326041732|CHC13|S0119||11/01/2013|12/31/9999|$19.00|0|0|||ONDANSETRON 4 MG|| 58-1699775|1326041732|CHC13|S0122||11/01/2013|12/31/9999|$67.80|0|0|||INJ MENOTROPINS 75 IU|| 58-1699775|1326041732|CHC13|S0126||11/01/2013|12/31/9999|$77.30|0|0|||INJ FOLLITROPIN ALFA 75 IU|| 58-1699775|1326041732|CHC13|S0128||11/01/2013|12/31/9999|$73.41|0|0|||INJ FOLLITROPIN BETA 75 IU|| 58-1699775|1326041732|CHC13|S0132||11/01/2013|12/31/9999|$101.92|0|0|||INJ GANIRELIX ACETAT 250 MCG|| 58-1699775|1326041732|CHC13|S0136||11/01/2013|12/31/9999|$1.30|0|0|||CLOZAPINE| 25 MG|| 58-1699775|1326041732|CHC13|S0137||11/01/2013|12/31/9999|$0.00|0|0|||DIDANOSINE| 25 MG|| 58-1699775|1326041732|CHC13|S0138||11/01/2013|12/31/9999|$2.59|0|0|||FINASTERIDE| 5 MG|| 58-1699775|1326041732|CHC13|S0139||11/01/2013|12/31/9999|$0.86|0|0|||MINOXIDIL| 10 MG|| 58-1699775|1326041732|CHC13|S0140||11/01/2013|12/31/9999|$1.73|0|0|||SAQUINAVIR| 200 MG|| 58-1699775|1326041732|CHC13|S0142||11/01/2013|12/31/9999|$0.00|0|0|||COLISTIMETHATE INH SOL MG|| 58-1699775|1326041732|CHC13|S0145||11/01/2013|12/31/9999|$962.35|0|0|||PEG INTERFERON ALFA-2A/180|| 58-1699775|1326041732|CHC13|S0148||11/01/2013|12/31/9999|$0.00|0|0|||PEG INTERFERON ALFA-2B/10|| 58-1699775|1326041732|CHC13|S0155||11/01/2013|12/31/9999|$16.86|0|0|||EPOPROSTENOL DILUTANT|| 58-1699775|1326041732|CHC13|S0156||11/01/2013|12/31/9999|$8.21|0|0|||EXEMESTANE| 25 MG|| 58-1699775|1326041732|CHC13|S0157||11/01/2013|12/31/9999|$16.84|0|0|||BECAPLERMIN GEL 1%| 0.5 GM|| 58-1699775|1326041732|CHC13|S0160||11/01/2013|12/31/9999|$0.43|0|0|||DEXTROAMPHETAMINE|| 58-1699775|1326041732|CHC13|S0164||11/01/2013|12/31/9999|$12.52|0|0|||INJECTION PANTROPRAZOLE|| 58-1699775|1326041732|CHC13|S0166||11/01/2013|12/31/9999|$5.61|0|0|||INJ OLANZAPINE 2.5MG|| 58-1699775|1326041732|CHC13|S0169||11/01/2013|12/31/9999|$1.30|0|0|||CALCITROL|| 58-1699775|1326041732|CHC13|S0170||11/01/2013|12/31/9999|$7.77|0|0|||ANASTROZOLE 1 MG|| 58-1699775|1326041732|CHC13|S0171||11/01/2013|12/31/9999|$1.30|0|0|||BUMETANIDE 0.5 MG|| 58-1699775|1326041732|CHC13|S0172||11/01/2013|12/31/9999|$2.16|0|0|||CHLORAMBUCIL 2 MG|| 58-1699775|1326041732|CHC13|S0174||11/01/2013|12/31/9999|$50.09|0|0|||DOLASETRON 50 MG|| 58-1699775|1326041732|CHC13|S0175||11/01/2013|12/31/9999|$2.16|0|0|||FLUTAMIDE 125 MG|| 58-1699775|1326041732|CHC13|S0176||11/01/2013|12/31/9999|$1.30|0|0|||HYDROXYUREA 500 MG|| 58-1699775|1326041732|CHC13|S0177||11/01/2013|12/31/9999|$4.75|0|0|||LEVAMISOLE 50 MG|| 58-1699775|1326041732|CHC13|S0178||11/01/2013|12/31/9999|$24.62|0|0|||LOMUSTINE 10 MG|| 58-1699775|1326041732|CHC13|S0179||11/01/2013|12/31/9999|$0.43|0|0|||MEGESTROL 20 MG|| 58-1699775|1326041732|CHC13|S0182||11/01/2013|12/31/9999|$49.66|0|0|||PROCARBAZINE 5 MG|| 58-1699775|1326041732|CHC13|S0183||11/01/2013|12/31/9999|$0.43|0|0|||PROCHLORPERAZINE 5 MG|| 58-1699775|1326041732|CHC13|S0187||11/01/2013|12/31/9999|$2.16|0|0|||TAMOXIFEN 10 MG|| 58-1699775|1326041732|CHC13|S0189||11/01/2013|12/31/9999|$120.31|0|0|||TESTOSTERONE PELLET 75 MG|| 58-1699775|1326041732|CHC13|S0190||11/01/2013|12/31/9999|$78.17|0|0|||MIFEPRISTONE| ORAL| 200 MG|| 58-1699775|1326041732|CHC13|S0191||11/01/2013|12/31/9999|$2.16|0|0|||MISOPROSTOL| ORAL| 200 MCG|| 58-1699775|1326041732|CHC13|S0194||11/01/2013|12/31/9999|$0.00|0|0|||VITAMIN SUPPL 100 CAPS|| 58-1699775|1326041732|CHC13|S0195||11/01/2013|12/31/9999|$95.91|0|0|||PNEUMO VACCINE 5-9 YRS|| 58-1699775|1326041732|CHC13|S0197||11/01/2013|12/31/9999|$0.00|0|0|||PRENATAL VITAMINS 30 DAY|| 58-1699775|1326041732|CHC13|S0199||11/01/2013|12/31/9999|$0.00|0|0|||MED ABORTION INC ALL EX DRUG|| 58-1699775|1326041732|CHC13|S0201||11/01/2013|12/31/9999|$0.00|0|0|||PARTIAL HOSPITALIZATION SERV|| 58-1699775|1326041732|CHC13|S0207||11/01/2013|12/31/9999|$0.00|0|0|||PARAMEDICINTERCEP NONHOSPALS|| 58-1699775|1326041732|CHC13|S0208||11/01/2013|12/31/9999|$0.00|0|0|||PARAMED INTRCEPT NONVOL|| 58-1699775|1326041732|CHC13|S0209||11/01/2013|12/31/9999|$0.00|0|0|||WC VAN MILEAGE PER MI|| 58-1699775|1326041732|CHC13|S0215||11/01/2013|12/31/9999|$0.00|0|0|||NONEMERG TRANSP MILEAGE|| 58-1699775|1326041732|CHC13|S0220||11/01/2013|12/31/9999|$0.00|0|0|||MEDICAL CONFERENCE BY PHYSIC|| 58-1699775|1326041732|CHC13|S0221||11/01/2013|12/31/9999|$0.00|0|0|||MEDICAL CONFERENCE| 60 MIN|| 58-1699775|1326041732|CHC13|S0250||11/01/2013|12/31/9999|$0.00|0|0|||COMP GERIATR ASSMT TEAM|| 58-1699775|1326041732|CHC13|S0255||11/01/2013|12/31/9999|$0.00|0|0|||HOSPICE REFER VISIT NONMD|| 58-1699775|1326041732|CHC13|S0257||11/01/2013|12/31/9999|$0.00|0|0|||END OF LIFE COUNSELING|| 58-1699775|1326041732|CHC13|S0260||11/01/2013|12/31/9999|$0.00|0|0|||H&P FOR SURGERY|| 58-1699775|1326041732|CHC13|S0265||11/01/2013|12/31/9999|$0.00|0|0|||GENETIC COUNSEL 15 MINS|| 58-1699775|1326041732|CHC13|S0270||11/01/2013|12/31/9999|$0.00|0|0|||HOME STD CASE RATE 30 DAYS|| 58-1699775|1326041732|CHC13|S0271||11/01/2013|12/31/9999|$0.00|0|0|||HOME HOSPICE CASE 30 DAYS|| 58-1699775|1326041732|CHC13|S0272||11/01/2013|12/31/9999|$0.00|0|0|||HOME EPISODIC CASE 30 DAYS|| 58-1699775|1326041732|CHC13|S0273||11/01/2013|12/31/9999|$0.00|0|0|||MD HOME VISIT OUTSIDE CAP|| 58-1699775|1326041732|CHC13|S0274||11/01/2013|12/31/9999|$0.00|0|0|||NURSE PRACTR VISIT OUTS CAP|| 58-1699775|1326041732|CHC13|S0280||11/01/2013|12/31/9999|$0.00|0|0|||MEDICAL HOME| INITIAL PLAN|| 58-1699775|1326041732|CHC13|S0281||11/01/2013|12/31/9999|$0.00|0|0|||MEDICAL HOME| MAINTENANCE|| 58-1699775|1326041732|CHC13|S0285||01/01/2017|12/31/9999|$123.00|0|0|||CONSULT BEFORE SCREEN COLONOSC|| 58-1699775|1326041732|CHC13|S0302||11/01/2013|12/31/9999|$0.00|0|0|||COMPLETED EPSDT|| 58-1699775|1326041732|CHC13|S0310||11/01/2013|12/31/9999|$0.00|0|0|||HOSPITALIST VISIT|| 58-1699775|1326041732|CHC13|S0315||11/01/2013|12/31/9999|$0.00|0|0|||DISEASE MANAGEMENT PROGRAM|| 58-1699775|1326041732|CHC13|S0316||11/01/2013|12/31/9999|$0.00|0|0|||FOLLOW-UP/REASSESSMENT|| 58-1699775|1326041732|CHC13|S0317||11/01/2013|12/31/9999|$0.00|0|0|||DISEASE MGMT PER DIEM|| 58-1699775|1326041732|CHC13|S0320||11/01/2013|12/31/9999|$0.00|0|0|||RN TELEPHONE CALLS TO DMP|| 58-1699775|1326041732|CHC13|S0340||11/01/2013|12/31/9999|$0.00|0|0|||LIFESTYLE MOD 1ST STAGE|| 58-1699775|1326041732|CHC13|S0341||11/01/2013|12/31/9999|$0.00|0|0|||LIFESTYLE MOD 2 OR 3 STAGE|| 58-1699775|1326041732|CHC13|S0342||11/01/2013|12/31/9999|$0.00|0|0|||LIFESTYLE MOD 4TH STAGE|| 58-1699775|1326041732|CHC13|S0390||11/01/2013|12/31/9999|$0.00|0|0|||ROUT FOOT CARE PER VISIT|| 58-1699775|1326041732|CHC13|S0395||11/01/2013|12/31/9999|$0.00|0|0|||IMPRESSION CASTING FT|| 58-1699775|1326041732|CHC13|S0400||11/01/2013|12/31/9999|$0.00|0|0|||GLOBAL ESWL KIDNEY|| 58-1699775|1326041732|CHC13|S0500||11/01/2013|12/31/9999|$0.00|0|0|||DISPOS CONT LENS|| 58-1699775|1326041732|CHC13|S0504||11/01/2013|12/31/9999|$0.00|0|0|||SINGL PRSCRP LENS|| 58-1699775|1326041732|CHC13|S0506||11/01/2013|12/31/9999|$0.00|0|0|||BIFOC PRSCP LENS|| 58-1699775|1326041732|CHC13|S0508||11/01/2013|12/31/9999|$0.00|0|0|||TRIFOC PRSCRP LENS|| 58-1699775|1326041732|CHC13|S0510||11/01/2013|12/31/9999|$0.00|0|0|||NON-PRSCRP LENS|| 58-1699775|1326041732|CHC13|S0512||11/01/2013|12/31/9999|$0.00|0|0|||DAILY CONT LENS|| 58-1699775|1326041732|CHC13|S0514||11/01/2013|12/31/9999|$0.00|0|0|||COLOR CONT LENS|| 58-1699775|1326041732|CHC13|S0515||11/01/2013|12/31/9999|$0.00|0|0|||SCLERAL LENS LIQUID BANDAGE|| 58-1699775|1326041732|CHC13|S0516||11/01/2013|12/31/9999|$0.00|0|0|||SAFETY FRAMES|| 58-1699775|1326041732|CHC13|S0518||11/01/2013|12/31/9999|$0.00|0|0|||SUNGLASS FRAMES|| 58-1699775|1326041732|CHC13|S0580||11/01/2013|12/31/9999|$0.00|0|0|||POLYCARB LENS|| 58-1699775|1326041732|CHC13|S0581||11/01/2013|12/31/9999|$0.00|0|0|||NONSTND LENS|| 58-1699775|1326041732|CHC13|S0590||11/01/2013|12/31/9999|$0.00|0|0|||MISC INTEGRAL LENS SERV|| 58-1699775|1326041732|CHC13|S0592||11/01/2013|12/31/9999|$0.00|0|0|||COMP CONT LENS EVAL|| 58-1699775|1326041732|CHC13|S0595||11/01/2013|12/31/9999|$0.00|0|0|||NEW LENSES IN PTS OLD FRAME|| 58-1699775|1326041732|CHC13|S0601||11/01/2013|12/31/9999|$0.00|0|0|||SCREENING PROCTOSCOPY|| 58-1699775|1326041732|CHC13|S0610||11/01/2013|12/31/9999|$0.00|0|0|||ANNUAL GYNECOLOGICAL EXAMINA|| 58-1699775|1326041732|CHC13|S0612||11/01/2013|12/31/9999|$0.00|0|0|||ANNUAL GYNECOLOGICAL EXAMINA|| 58-1699775|1326041732|CHC13|S0613||11/01/2013|12/31/9999|$0.00|0|0|||ANN BREAST EXAM|| 58-1699775|1326041732|CHC13|S0618||11/01/2013|12/31/9999|$0.00|0|0|||AUDIOMETRY FOR HEARING AID|| 58-1699775|1326041732|CHC13|S0620||11/01/2013|12/31/9999|$0.00|0|0|||ROUTINE OPHTHALMOLOGICAL EXA|| 58-1699775|1326041732|CHC13|S0621||11/01/2013|12/31/9999|$0.00|0|0|||ROUTINE OPHTHALMOLOGICAL EXA|| 58-1699775|1326041732|CHC13|S0622||11/01/2013|12/31/9999|$0.00|0|0|||PHYS EXAM FOR COLLEGE|| 58-1699775|1326041732|CHC13|S0625||11/01/2013|12/31/9999|$0.00|0|0|||DIGITAL SCREENING RETINA|| 58-1699775|1326041732|CHC13|S0630||11/01/2013|12/31/9999|$0.00|0|0|||REMOVAL OF SUTURES|| 58-1699775|1326041732|CHC13|S0800||11/01/2013|12/31/9999|$0.00|0|0|||LASER IN SITU KERATOMILEUSIS|| 58-1699775|1326041732|CHC13|S0810||11/01/2013|12/31/9999|$0.00|0|0|||PHOTOREFRACTIVE KERATECTOMY|| 58-1699775|1326041732|CHC13|S0812||11/01/2013|12/31/9999|$0.00|0|0|||PHOTOTHERAP KERATECT|| 58-1699775|1326041732|CHC13|S1001||11/01/2013|12/31/9999|$0.00|0|0|||DELUXE ITEM|| 58-1699775|1326041732|CHC13|S1002||11/01/2013|12/31/9999|$0.00|0|0|||CUSTOM ITEM|| 58-1699775|1326041732|CHC13|S1015||11/01/2013|12/31/9999|$0.00|0|0|||IV TUBING EXTENSION SET|| 58-1699775|1326041732|CHC13|S1016||11/01/2013|12/31/9999|$0.00|0|0|||NON-PVC INTRAVENOUS ADMINIST|| 58-1699775|1326041732|CHC13|S1030||11/01/2013|12/31/9999|$0.00|0|0|||GLUC MONITOR PURCHASE|| 58-1699775|1326041732|CHC13|S1031||11/01/2013|12/31/9999|$0.00|0|0|||GLUC MONITOR RENTAL|| 58-1699775|1326041732|CHC13|S1040||11/01/2013|12/31/9999|$0.00|0|0|||CRANIAL REMOLDING ORTHOSIS|| 58-1699775|1326041732|CHC13|S2053||11/01/2013|12/31/9999|$0.00|0|0|||TRANSPLANTATION OF SMALL INT|| 58-1699775|1326041732|CHC13|S2054||11/01/2013|12/31/9999|$0.00|0|0|||TRANSPLANTATION OF MULTIVISC|| 58-1699775|1326041732|CHC13|S2055||11/01/2013|12/31/9999|$0.00|0|0|||HARVESTING OF DONOR MULTIVIS|| 58-1699775|1326041732|CHC13|S2060||11/01/2013|12/31/9999|$0.00|0|0|||LOBAR LUNG TRANSPLANTATION|| 58-1699775|1326041732|CHC13|S2061||11/01/2013|12/31/9999|$0.00|0|0|||DONOR LOBECTOMY (LUNG)|| 58-1699775|1326041732|CHC13|S2065||11/01/2013|12/31/9999|$0.00|0|0|||SIMULT PANC KIDN TRANS|| 58-1699775|1326041732|CHC13|S2066||11/01/2013|12/31/9999|$0.00|0|0|||BREAST GAP FLAP RECONST|| 58-1699775|1326041732|CHC13|S2067||11/01/2013|12/31/9999|$0.00|0|0|||BREAST 'STACKED' DIEP/GAP|| 58-1699775|1326041732|CHC13|S2068||11/01/2013|12/31/9999|$0.00|0|0|||BREAST DIEP FLAP RECONSTRUCT|| 58-1699775|1326041732|CHC13|S2070||11/01/2013|12/31/9999|$0.00|0|0|||CYSTO LASER TX URETERAL CALC|| 58-1699775|1326041732|CHC13|S2079||11/01/2013|12/31/9999|$0.00|0|0|||LAP ESOPHAGOMYOTOMY|| 58-1699775|1326041732|CHC13|S2080||11/01/2013|12/31/9999|$0.00|0|0|||LAUP|| 58-1699775|1326041732|CHC13|S2083||11/01/2013|12/31/9999|$0.00|0|0|||ADJUSTMENT GASTRIC BAND|| 58-1699775|1326041732|CHC13|S2095||11/01/2013|12/31/9999|$0.00|0|0|||TRANSCATH EMBOLIZ MICROSPHER|| 58-1699775|1326041732|CHC13|S2102||11/01/2013|12/31/9999|$0.00|0|0|||ISLET CELL TISSUE TRANSPLANT|| 58-1699775|1326041732|CHC13|S2103||11/01/2013|12/31/9999|$0.00|0|0|||ADRENAL TISSUE TRANSPLANT|| 58-1699775|1326041732|CHC13|S2107||11/01/2013|12/31/9999|$0.00|0|0|||ADOPTIVE IMMUNOTHERAPY|| 58-1699775|1326041732|CHC13|S2112||11/01/2013|12/31/9999|$0.00|0|0|||KNEE ARTHROSCP HARV|| 58-1699775|1326041732|CHC13|S2115||11/01/2013|12/31/9999|$0.00|0|0|||PERIACETABULAR OSTEOTOMY|| 58-1699775|1326041732|CHC13|S2117||11/01/2013|12/31/9999|$0.00|0|0|||ARTHROEREISIS| SUBTALAR|| 58-1699775|1326041732|CHC13|S2118||11/01/2013|12/31/9999|$0.00|0|0|||TOTAL HIP RESURFACING|| 58-1699775|1326041732|CHC13|S2120||11/01/2013|12/31/9999|$0.00|0|0|||LOW DENSITY LIPOPROTEIN(LDL)|| 58-1699775|1326041732|CHC13|S2140||11/01/2013|12/31/9999|$0.00|0|0|||CORD BLOOD HARVESTING|| 58-1699775|1326041732|CHC13|S2142||11/01/2013|12/31/9999|$0.00|0|0|||CORD BLOOD-DERIVED STEM-CELL|| 58-1699775|1326041732|CHC13|S2150||11/01/2013|12/31/9999|$0.00|0|0|||BMT HARV/TRANSPL 28D PKG|| 58-1699775|1326041732|CHC13|S2152||11/01/2013|12/31/9999|$0.00|0|0|||SOLID ORGAN TRANSPL PKG|| 58-1699775|1326041732|CHC13|S2202||11/01/2013|12/31/9999|$0.00|0|0|||ECHOSCLEROTHERAPY|| 58-1699775|1326041732|CHC13|S2205||11/01/2013|12/31/9999|$0.00|0|0|||MINIMALLY INVASIVE DIRECT CO|| 58-1699775|1326041732|CHC13|S2206||11/01/2013|12/31/9999|$0.00|0|0|||MINIMALLY INVASIVE DIRECT CO|| 58-1699775|1326041732|CHC13|S2207||11/01/2013|12/31/9999|$0.00|0|0|||MINIMALLY INVASIVE DIRECT CO|| 58-1699775|1326041732|CHC13|S2208||11/01/2013|12/31/9999|$0.00|0|0|||MINIMALLY INVASIVE DIRECT CO|| 58-1699775|1326041732|CHC13|S2209||11/01/2013|12/31/9999|$0.00|0|0|||MINIMALLY INVASIVE DIRECT CO|| 58-1699775|1326041732|CHC13|S2225||11/01/2013|12/31/9999|$0.00|0|0|||MYRINGOTOMY LASER-ASSIST|| 58-1699775|1326041732|CHC13|S2230||11/01/2013|12/31/9999|$0.00|0|0|||IMPLANT SEMI-IMP HEAR|| 58-1699775|1326041732|CHC13|S2235||11/01/2013|12/31/9999|$0.00|0|0|||IMPLANT AUDITORY BRAIN IMP|| 58-1699775|1326041732|CHC13|S2260||11/01/2013|12/31/9999|$0.00|0|0|||INDUCED ABORTION 17-24 WEEKS|| 58-1699775|1326041732|CHC13|S2265||11/01/2013|12/31/9999|$0.00|0|0|||ABORTION 25-28WKS FETAL INDI|| 58-1699775|1326041732|CHC13|S2266||11/01/2013|12/31/9999|$0.00|0|0|||ABORTION 29-31WKS FETAL INDI|| 58-1699775|1326041732|CHC13|S2267||11/01/2013|12/31/9999|$0.00|0|0|||ABORTION >=32WKS FETAL INDIC|| 58-1699775|1326041732|CHC13|S2300||11/01/2013|12/31/9999|$0.00|0|0|||ARTHROSCOPY| SHOULDER| SURGI|| 58-1699775|1326041732|CHC13|S2325||11/01/2013|12/31/9999|$0.00|0|0|||HIP CORE DECOMPRESSION|| 58-1699775|1326041732|CHC13|S2340||11/01/2013|12/31/9999|$0.00|0|0|||CHEMODENERVATION OF ABDUCTOR|| 58-1699775|1326041732|CHC13|S2341||11/01/2013|12/31/9999|$0.00|0|0|||CHEMODENERV ADDUCT VOCAL|| 58-1699775|1326041732|CHC13|S2342||11/01/2013|12/31/9999|$0.00|0|0|||NASAL ENDOSCOP PO DEBRID|| 58-1699775|1326041732|CHC13|S2348||11/01/2013|12/31/9999|$0.00|0|0|||DECOMPRESS DISC RF LUMBAR|| 58-1699775|1326041732|CHC13|S2350||11/01/2013|12/31/9999|$0.00|0|0|||DISKECTOMY| ANTERIOR| WITH D|| 58-1699775|1326041732|CHC13|S2351||11/01/2013|12/31/9999|$0.00|0|0|||DISKECTOMY| ANTERIOR| WITH D|| 58-1699775|1326041732|CHC13|S2360||11/01/2013|12/31/9999|$0.00|0|0|||VERTEBROPLAST CERV 1ST|| 58-1699775|1326041732|CHC13|S2361||11/01/2013|12/31/9999|$0.00|0|0|||VERTEBROPLAST CERV ADDL|| 58-1699775|1326041732|CHC13|S2400||11/01/2013|12/31/9999|$0.00|0|0|||FETAL SURG CONGEN HERNIA|| 58-1699775|1326041732|CHC13|S2401||11/01/2013|12/31/9999|$0.00|0|0|||FETAL SURG URIN TRAC OBSTR|| 58-1699775|1326041732|CHC13|S2402||11/01/2013|12/31/9999|$0.00|0|0|||FETAL SURG CONG CYST MALF|| 58-1699775|1326041732|CHC13|S2403||11/01/2013|12/31/9999|$0.00|0|0|||FETAL SURG PULMON SEQUEST|| 58-1699775|1326041732|CHC13|S2404||11/01/2013|12/31/9999|$0.00|0|0|||FETAL SURG MYELOMENINGO|| 58-1699775|1326041732|CHC13|S2405||11/01/2013|12/31/9999|$0.00|0|0|||FETAL SURG SACROCOC TERATOMA|| 58-1699775|1326041732|CHC13|S2409||11/01/2013|12/31/9999|$0.00|0|0|||FETAL SURG NOC|| 58-1699775|1326041732|CHC13|S2411||11/01/2013|12/31/9999|$0.00|0|0|||FETOSCOP LASER THER TTTS|| 58-1699775|1326041732|CHC13|S2900||11/01/2013|12/31/9999|$0.00|0|0|||ROBOTIC SURGICAL SYSTEM|| 58-1699775|1326041732|CHC13|S3000||11/01/2013|12/31/9999|$0.00|0|0|||BILAT DIL RETINAL EXAM|| 58-1699775|1326041732|CHC13|S3005||11/01/2013|12/31/9999|$0.00|0|0|||EVAL SELF-ASSESS DEPRESSION|| 58-1699775|1326041732|CHC13|S3600||11/01/2013|12/31/9999|$0.00|0|0|||STAT LAB|| 58-1699775|1326041732|CHC13|S3601||11/01/2013|12/31/9999|$0.00|0|0|||STAT LAB HOME/NF|| 58-1699775|1326041732|CHC13|S3620||11/01/2013|12/31/9999|$0.00|0|0|||NEWBORN METABOLIC SCREENING|| 58-1699775|1326041732|CHC13|S3625||11/01/2013|12/31/9999|$0.00|0|0|||MATERNAL TRIPLE SCREEN TEST|| 58-1699775|1326041732|CHC13|S3626||11/01/2013|12/31/9999|$0.00|0|0|||MATERNAL SERUM QUAD SCREEN|| 58-1699775|1326041732|CHC13|S3630||11/01/2013|12/31/9999|$0.00|0|0|||EOSINOPHIL BLOOD COUNT|| 58-1699775|1326041732|CHC13|S3645||11/01/2013|12/31/9999|$0.00|0|0|||HIV-1 ANTIBODY TESTING OF OR|| 58-1699775|1326041732|CHC13|S3650||11/01/2013|12/31/9999|$0.00|0|0|||SALIVA TEST| HORMONE LEVEL;|| 58-1699775|1326041732|CHC13|S3652||11/01/2013|12/31/9999|$0.00|0|0|||SALIVA TEST| HORMONE LEVEL;|| 58-1699775|1326041732|CHC13|S3655||11/01/2013|12/31/9999|$0.00|0|0|||ANTISPERM ANTIBODIES TEST|| 58-1699775|1326041732|CHC13|S3708||11/01/2013|12/31/9999|$0.00|0|0|||GASTROINTESTINAL FAT ABSORPT|| 58-1699775|1326041732|CHC13|S3711||11/01/2013|12/31/9999|$0.00|0|0|||CIRCULATING TUMOR CELL TEST|| 58-1699775|1326041732|CHC13|S3713||11/01/2013|12/31/9999|$0.00|0|0|||KRAS MUTATION ANALYSIS TESTING|| 58-1699775|1326041732|CHC13|S3722||11/01/2013|12/31/9999|$0.00|0|0|||DOSE OPTIMIZATION AUC - 5FU|| 58-1699775|1326041732|CHC13|S3800||11/01/2013|12/31/9999|$0.00|0|0|||GENETIC TESTING ALS|| 58-1699775|1326041732|CHC13|S3818||11/01/2013|12/31/9999|$0.00|0|0|||BRCA1 GENE ANAL|| 58-1699775|1326041732|CHC13|S3819||11/01/2013|12/31/9999|$0.00|0|0|||BRCA2 GENE ANAL|| 58-1699775|1326041732|CHC13|S3820||11/01/2013|12/31/9999|$0.00|0|0|||COMP BRCA1/BRCA2|| 58-1699775|1326041732|CHC13|S3822||11/01/2013|12/31/9999|$0.00|0|0|||SING MUTATION BRST/OVAR|| 58-1699775|1326041732|CHC13|S3823||11/01/2013|12/31/9999|$0.00|0|0|||3 MUTATION BRST/OVAR|| 58-1699775|1326041732|CHC13|S3828||11/01/2013|12/31/9999|$0.00|0|0|||COMP MLH1 GENE|| 58-1699775|1326041732|CHC13|S3829||11/01/2013|12/31/9999|$0.00|0|0|||COMP MLH2 GENE|| 58-1699775|1326041732|CHC13|S3830||11/01/2013|12/31/9999|$0.00|0|0|||GENE TEST HNPCC COMP|| 58-1699775|1326041732|CHC13|S3831||11/01/2013|12/31/9999|$0.00|0|0|||GENE TEST HNPCC SINGLE|| 58-1699775|1326041732|CHC13|S3833||11/01/2013|12/31/9999|$0.00|0|0|||COMP APC SEQUENCE|| 58-1699775|1326041732|CHC13|S3834||11/01/2013|12/31/9999|$0.00|0|0|||SING MUTATION APC|| 58-1699775|1326041732|CHC13|S3835||11/01/2013|12/31/9999|$0.00|0|0|||GENE TEST CYSTIC FIBROSIS|| 58-1699775|1326041732|CHC13|S3837||11/01/2013|12/31/9999|$0.00|0|0|||GENE TEST HEMOCHROMATO|| 58-1699775|1326041732|CHC13|S3840||11/01/2013|12/31/9999|$0.00|0|0|||DNA ANALYSIS RET-ONCOGENE|| 58-1699775|1326041732|CHC13|S3841||11/01/2013|12/31/9999|$0.00|0|0|||GENE TEST RETINOBLASTOMA|| 58-1699775|1326041732|CHC13|S3842||11/01/2013|12/31/9999|$0.00|0|0|||GENE TEST HIPPEL-LINDAU|| 58-1699775|1326041732|CHC13|S3843||11/01/2013|12/31/9999|$0.00|0|0|||DNA ANALYSIS FACTOR V|| 58-1699775|1326041732|CHC13|S3844||11/01/2013|12/31/9999|$0.00|0|0|||DNA ANALYSIS DEAFNESS|| 58-1699775|1326041732|CHC13|S3845||11/01/2013|12/31/9999|$0.00|0|0|||GENE TEST ALPHA-THALASSEMIA|| 58-1699775|1326041732|CHC13|S3846||11/01/2013|12/31/9999|$0.00|0|0|||GENE TEST BETA-THALASSEMIA|| 58-1699775|1326041732|CHC13|S3847||11/01/2013|12/31/9999|$0.00|0|0|||GENE TEST TAY-SACHS|| 58-1699775|1326041732|CHC13|S3848||11/01/2013|12/31/9999|$0.00|0|0|||GENE TEST GAUCHER|| 58-1699775|1326041732|CHC13|S3849||11/01/2013|12/31/9999|$0.00|0|0|||GENE TEST NIEMANN-PICK|| 58-1699775|1326041732|CHC13|S3850||11/01/2013|12/31/9999|$0.00|0|0|||GENE TEST SICKLE CELL|| 58-1699775|1326041732|CHC13|S3851||11/01/2013|12/31/9999|$0.00|0|0|||GENE TEST CANAVAN|| 58-1699775|1326041732|CHC13|S3852||11/01/2013|12/31/9999|$0.00|0|0|||DNA ANALYSIS APOE ALZHEIMER|| 58-1699775|1326041732|CHC13|S3853||11/01/2013|12/31/9999|$0.00|0|0|||GENE TEST MYO MUSCLR DYST|| 58-1699775|1326041732|CHC13|S3854||11/01/2013|12/31/9999|$0.00|0|0|||GENE PROFILE PANEL BREAST|| 58-1699775|1326041732|CHC13|S3855||11/01/2013|12/31/9999|$0.00|0|0|||GENE TEST PRESENILIN-1 GENE|| 58-1699775|1326041732|CHC13|S3860||11/01/2013|12/31/9999|$0.00|0|0|||GENET TEST CARDIAC ION-COMP|| 58-1699775|1326041732|CHC13|S3861||11/01/2013|12/31/9999|$0.00|0|0|||GENETIC TEST BRUGADA|| 58-1699775|1326041732|CHC13|S3862||11/01/2013|12/31/9999|$0.00|0|0|||GENET TEST CARDIAC ION-SPEC|| 58-1699775|1326041732|CHC13|S3865||11/01/2013|12/31/9999|$0.00|0|0|||COMP GENET TEST HYP CARDIOMY|| 58-1699775|1326041732|CHC13|S3866||11/01/2013|12/31/9999|$0.00|0|0|||SPEC GENE TEST HYP CARDIOMY|| 58-1699775|1326041732|CHC13|S3870||11/01/2013|12/31/9999|$0.00|0|0|||CGH TEST DEVELOPMENTAL DELAY|| 58-1699775|1326041732|CHC13|S3890||11/01/2013|12/31/9999|$0.00|0|0|||FECAL DNA ANALYSIS|| 58-1699775|1326041732|CHC13|S3900||11/01/2013|12/31/9999|$0.00|0|0|||SURFACE EMG|| 58-1699775|1326041732|CHC13|S3902||11/01/2013|12/31/9999|$0.00|0|0|||BALLISTOCARDIOGRAM|| 58-1699775|1326041732|CHC13|S3904||11/01/2013|12/31/9999|$0.00|0|0|||MASTERS TWO STEP|| 58-1699775|1326041732|CHC13|S4005||11/01/2013|12/31/9999|$0.00|0|0|||INTERIM LABOR FACILITY GLOBA|| 58-1699775|1326041732|CHC13|S4011||11/01/2013|12/31/9999|$0.00|0|0|||IVF PACKAGE|| 58-1699775|1326041732|CHC13|S4013||11/01/2013|12/31/9999|$0.00|0|0|||COMPL GIFT CASE RATE|| 58-1699775|1326041732|CHC13|S4014||11/01/2013|12/31/9999|$0.00|0|0|||COMPL ZIFT CASE RATE|| 58-1699775|1326041732|CHC13|S4015||11/01/2013|12/31/9999|$0.00|0|0|||COMPLETE IVF NOS CASE RATE|| 58-1699775|1326041732|CHC13|S4016||11/01/2013|12/31/9999|$0.00|0|0|||FROZEN IVF CASE RATE|| 58-1699775|1326041732|CHC13|S4017||11/01/2013|12/31/9999|$0.00|0|0|||IVF CANC A STIM CASE RATE|| 58-1699775|1326041732|CHC13|S4018||11/01/2013|12/31/9999|$0.00|0|0|||F EMB TRNS CANC CASE RATE|| 58-1699775|1326041732|CHC13|S4020||11/01/2013|12/31/9999|$0.00|0|0|||IVF CANC A ASPIR CASE RATE|| 58-1699775|1326041732|CHC13|S4021||11/01/2013|12/31/9999|$0.00|0|0|||IVF CANC P ASPIR CASE RATE|| 58-1699775|1326041732|CHC13|S4022||11/01/2013|12/31/9999|$0.00|0|0|||ASST OOCYTE FERT CASE RATE|| 58-1699775|1326041732|CHC13|S4023||11/01/2013|12/31/9999|$0.00|0|0|||INCOMPL DONOR EGG CASE RATE|| 58-1699775|1326041732|CHC13|S4025||11/01/2013|12/31/9999|$0.00|0|0|||DONOR SERV IVF CASE RATE|| 58-1699775|1326041732|CHC13|S4026||11/01/2013|12/31/9999|$0.00|0|0|||PROCURE DONOR SPERM|| 58-1699775|1326041732|CHC13|S4027||11/01/2013|12/31/9999|$0.00|0|0|||STORE PREV FROZ EMBRYOS|| 58-1699775|1326041732|CHC13|S4028||11/01/2013|12/31/9999|$0.00|0|0|||MICROSURG EPI SPERM ASP|| 58-1699775|1326041732|CHC13|S4030||11/01/2013|12/31/9999|$0.00|0|0|||SPERM PROCURE INIT VISIT|| 58-1699775|1326041732|CHC13|S4031||11/01/2013|12/31/9999|$0.00|0|0|||SPERM PROCURE SUBS VISIT|| 58-1699775|1326041732|CHC13|S4035||11/01/2013|12/31/9999|$0.00|0|0|||STIMULATED IUI CASE RATE|| 58-1699775|1326041732|CHC13|S4037||11/01/2013|12/31/9999|$0.00|0|0|||CRYO EMBRYO TRANSF CASE RATE|| 58-1699775|1326041732|CHC13|S4040||11/01/2013|12/31/9999|$0.00|0|0|||MONIT STORE CRYO EMBRYO 30 D|| 58-1699775|1326041732|CHC13|S4042||11/01/2013|12/31/9999|$0.00|0|0|||OVULATION MGMT PER CYCLE|| 58-1699775|1326041732|CHC13|S4981||11/01/2013|12/31/9999|$0.00|0|0|||INSERT LEVONORGESTREL IUS|| 58-1699775|1326041732|CHC13|S4989||11/01/2013|12/31/9999|$0.00|0|0|||CONTRACEPT IUD|| 58-1699775|1326041732|CHC13|S4990||11/01/2013|12/31/9999|$0.00|0|0|||NICOTINE PATCH LEGEND|| 58-1699775|1326041732|CHC13|S4991||11/01/2013|12/31/9999|$0.00|0|0|||NICOTINE PATCH NONLEGEND|| 58-1699775|1326041732|CHC13|S4993||11/01/2013|12/31/9999|$0.00|0|0|||CONTRACEPTIVE PILLS FOR BC|| 58-1699775|1326041732|CHC13|S4995||11/01/2013|12/31/9999|$0.00|0|0|||SMOKING CESSATION GUM|| 58-1699775|1326041732|CHC13|S5000||11/01/2013|12/31/9999|$0.00|0|0|||PRESCRIPTION DRUG| GENERIC|| 58-1699775|1326041732|CHC13|S5001||11/01/2013|12/31/9999|$0.00|0|0|||PRESCRIPTION DRUG|BRAND NAME|| 58-1699775|1326041732|CHC13|S5010||11/01/2013|12/31/9999|$0.00|0|0|||5% DEXTROSE AND 0.45% SALINE|| 58-1699775|1326041732|CHC13|S5011||11/01/2013|12/31/9999|$0.00|0|0|||5% DEXTROSE IN LACTATED RING|| 58-1699775|1326041732|CHC13|S5012||11/01/2013|12/31/9999|$0.00|0|0|||5% DEXTROSE WITH POTASSIUM|| 58-1699775|1326041732|CHC13|S5013||11/01/2013|12/31/9999|$0.00|0|0|||5%DEXTROSE/0.45%SALINE1000ML|| 58-1699775|1326041732|CHC13|S5014||11/01/2013|12/31/9999|$0.00|0|0|||D5W/0.45NS W KCL AND MGS04|| 58-1699775|1326041732|CHC13|S5035||11/01/2013|12/31/9999|$0.00|0|0|||HIT ROUTINE DEVICE MAINT|| 58-1699775|1326041732|CHC13|S5036||11/01/2013|12/31/9999|$0.00|0|0|||HIT DEVICE REPAIR|| 58-1699775|1326041732|CHC13|S5100||11/01/2013|12/31/9999|$0.00|0|0|||ADULT DAYCARE SERVICES 15MIN|| 58-1699775|1326041732|CHC13|S5101||11/01/2013|12/31/9999|$0.00|0|0|||ADULT DAY CARE PER HALF DAY|| 58-1699775|1326041732|CHC13|S5102||11/01/2013|12/31/9999|$0.00|0|0|||ADULT DAY CARE PER DIEM|| 58-1699775|1326041732|CHC13|S5105||11/01/2013|12/31/9999|$0.00|0|0|||CENTERBASED DAY CARE PERDIEM|| 58-1699775|1326041732|CHC13|S5108||11/01/2013|12/31/9999|$0.00|0|0|||HOMECARE TRAIN PT 15 MIN|| 58-1699775|1326041732|CHC13|S5109||11/01/2013|12/31/9999|$0.00|0|0|||HOMECARE TRAIN PT SESSION|| 58-1699775|1326041732|CHC13|S5110||11/01/2013|12/31/9999|$0.00|0|0|||FAMILY HOMECARE TRAINING 15M|| 58-1699775|1326041732|CHC13|S5111||11/01/2013|12/31/9999|$0.00|0|0|||FAMILY HOMECARE TRAIN/SESSIO|| 58-1699775|1326041732|CHC13|S5115||11/01/2013|12/31/9999|$0.00|0|0|||NONFAMILY HOMECARE TRAIN/15M|| 58-1699775|1326041732|CHC13|S5116||11/01/2013|12/31/9999|$0.00|0|0|||NONFAMILY HC TRAIN/SESSION|| 58-1699775|1326041732|CHC13|S5120||11/01/2013|12/31/9999|$0.00|0|0|||CHORE SERVICES PER 15 MIN|| 58-1699775|1326041732|CHC13|S5121||11/01/2013|12/31/9999|$0.00|0|0|||CHORE SERVICES PER DIEM|| 58-1699775|1326041732|CHC13|S5125||11/01/2013|12/31/9999|$0.00|0|0|||ATTENDANT CARE SERVICE /15M|| 58-1699775|1326041732|CHC13|S5126||11/01/2013|12/31/9999|$0.00|0|0|||ATTENDANT CARE SERVICE /DIEM|| 58-1699775|1326041732|CHC13|S5130||11/01/2013|12/31/9999|$0.00|0|0|||HOMAKER SERVICE NOS PER 15M|| 58-1699775|1326041732|CHC13|S5131||11/01/2013|12/31/9999|$0.00|0|0|||HOMEMAKER SERVICE NOS /DIEM|| 58-1699775|1326041732|CHC13|S5135||11/01/2013|12/31/9999|$0.00|0|0|||ADULT COMPANIONCARE PER 15M|| 58-1699775|1326041732|CHC13|S5136||11/01/2013|12/31/9999|$0.00|0|0|||ADULT COMPANIONCARE PER DIEM|| 58-1699775|1326041732|CHC13|S5140||11/01/2013|12/31/9999|$0.00|0|0|||ADULT FOSTER CARE PER DIEM|| 58-1699775|1326041732|CHC13|S5141||11/01/2013|12/31/9999|$0.00|0|0|||ADULT FOSTER CARE PER MONTH|| 58-1699775|1326041732|CHC13|S5145||11/01/2013|12/31/9999|$0.00|0|0|||CHILD FOSTERCARE TH PER DIEM|| 58-1699775|1326041732|CHC13|S5146||11/01/2013|12/31/9999|$0.00|0|0|||THER FOSTERCARE CHILD /MONTH|| 58-1699775|1326041732|CHC13|S5150||11/01/2013|12/31/9999|$0.00|0|0|||UNSKILLED RESPITE CARE /15M|| 58-1699775|1326041732|CHC13|S5151||11/01/2013|12/31/9999|$0.00|0|0|||UNSKILLED RESPITECARE /DIEM|| 58-1699775|1326041732|CHC13|S5160||11/01/2013|12/31/9999|$0.00|0|0|||EMER RESPONSE SYS INSTAL&TST|| 58-1699775|1326041732|CHC13|S5161||11/01/2013|12/31/9999|$0.00|0|0|||EMER RSPNS SYS SERV PERMONTH|| 58-1699775|1326041732|CHC13|S5162||11/01/2013|12/31/9999|$0.00|0|0|||EMER RSPNS SYSTEM PURCHASE|| 58-1699775|1326041732|CHC13|S5165||11/01/2013|12/31/9999|$0.00|0|0|||HOME MODIFICATIONS PER SERV|| 58-1699775|1326041732|CHC13|S5170||11/01/2013|12/31/9999|$0.00|0|0|||HOMEDELIVERED PREPARED MEAL|| 58-1699775|1326041732|CHC13|S5175||11/01/2013|12/31/9999|$0.00|0|0|||LAUNDRY SERV|EXT|PROF|/ORDER|| 58-1699775|1326041732|CHC13|S5180||11/01/2013|12/31/9999|$0.00|0|0|||HH RESPIRATORY THRPY IN EVAL|| 58-1699775|1326041732|CHC13|S5181||11/01/2013|12/31/9999|$0.00|0|0|||HH RESPIRATORY THRPY NOS/DAY|| 58-1699775|1326041732|CHC13|S5185||11/01/2013|12/31/9999|$0.00|0|0|||MED REMINDER SERV PER MONTH|| 58-1699775|1326041732|CHC13|S5190||11/01/2013|12/31/9999|$0.00|0|0|||WELLNESS ASSESSMENT BY NONPH|| 58-1699775|1326041732|CHC13|S5199||11/01/2013|12/31/9999|$0.00|0|0|||PERSONAL CARE ITEM NOS EACH|| 58-1699775|1326041732|CHC13|S5497||11/01/2013|12/31/9999|$0.00|0|0|||HIT CATH CARE NOC|| 58-1699775|1326041732|CHC13|S5498||11/01/2013|12/31/9999|$0.00|0|0|||HIT SIMPLE CATH CARE|| 58-1699775|1326041732|CHC13|S5501||11/01/2013|12/31/9999|$0.00|0|0|||HIT COMPLEX CATH CARE|| 58-1699775|1326041732|CHC13|S5502||11/01/2013|12/31/9999|$0.00|0|0|||HIT INTERIM CATH CARE|| 58-1699775|1326041732|CHC13|S5517||11/01/2013|12/31/9999|$0.00|0|0|||HIT DECLOTTING KIT|| 58-1699775|1326041732|CHC13|S5518||11/01/2013|12/31/9999|$0.00|0|0|||HIT CATH REPAIR KIT|| 58-1699775|1326041732|CHC13|S5520||11/01/2013|12/31/9999|$0.00|0|0|||HIT PICC INSERT KIT|| 58-1699775|1326041732|CHC13|S5521||11/01/2013|12/31/9999|$0.00|0|0|||HIT MIDLINE CATH INSERT KIT|| 58-1699775|1326041732|CHC13|S5522||11/01/2013|12/31/9999|$0.00|0|0|||HIT PICC INSERT NO SUPP|| 58-1699775|1326041732|CHC13|S5523||11/01/2013|12/31/9999|$0.00|0|0|||HIP MIDLINE CATH INSERT KIT|| 58-1699775|1326041732|CHC13|S5550||11/01/2013|12/31/9999|$0.54|0|0|||INSULIN RAPID 5 U|| 58-1699775|1326041732|CHC13|S5551||11/01/2013|12/31/9999|$1.04|0|0|||INSULIN MOST RAPID 5 U|| 58-1699775|1326041732|CHC13|S5552||11/01/2013|12/31/9999|$0.55|0|0|||INSULIN INTERMED 5 U|| 58-1699775|1326041732|CHC13|S5553||11/01/2013|12/31/9999|$1.05|0|0|||INSULIN LONG ACTING 5 U|| 58-1699775|1326041732|CHC13|S5560||11/01/2013|12/31/9999|$0.00|0|0|||INSULIN REUSE PEN 1.5 ML|| 58-1699775|1326041732|CHC13|S5561||11/01/2013|12/31/9999|$75.16|0|0|||INSULIN REUSE PEN 3 ML|| 58-1699775|1326041732|CHC13|S5565||11/01/2013|12/31/9999|$0.00|0|0|||INSULIN CARTRIDGE 150 U|| 58-1699775|1326041732|CHC13|S5566||11/01/2013|12/31/9999|$0.00|0|0|||INSULIN CARTRIDGE 300 U|| 58-1699775|1326041732|CHC13|S5570||11/01/2013|12/31/9999|$0.00|0|0|||INSULIN DISPOS PEN 1.5 ML|| 58-1699775|1326041732|CHC13|S5571||11/01/2013|12/31/9999|$66.95|0|0|||INSULIN DISPOS PEN 3 ML|| 58-1699775|1326041732|CHC13|S8030||11/01/2013|12/31/9999|$0.00|0|0|||TANTALUM RING APPLICATION|| 58-1699775|1326041732|CHC13|S8032||11/01/2013|12/31/9999|$65.00|0|0||%|LOW DOSE CT LUNG SCREENING|| 58-1699775|1326041732|CHC13|S8035||11/01/2013|12/31/9999|$0.00|0|0|||MAGNETIC SOURCE IMAGING|| 58-1699775|1326041732|CHC13|S8037||11/01/2013|12/31/9999|$0.00|0|0|||MRCP|| 58-1699775|1326041732|CHC13|S8040||11/01/2013|12/31/9999|$0.00|0|0|||TOPOGRAPHIC BRAIN MAPPING|| 58-1699775|1326041732|CHC13|S8042||11/01/2013|12/31/9999|$0.00|0|0|||MRI LOW FIELD|| 58-1699775|1326041732|CHC13|S8049||11/01/2013|12/31/9999|$0.00|0|0|||INTRAOPERATIVE RADIATION THE|| 58-1699775|1326041732|CHC13|S8055||11/01/2013|12/31/9999|$0.00|0|0|||US GUIDANCE FETAL REDUCT|| 58-1699775|1326041732|CHC13|S8080||11/01/2013|12/31/9999|$0.00|0|0|||SCINTIMAMMOGRAPHY|| 58-1699775|1326041732|CHC13|S8085||11/01/2013|12/31/9999|$0.00|0|0|||FLUORINE-18 FLUORODEOXYGLUCO|| 58-1699775|1326041732|CHC13|S8092||11/01/2013|12/31/9999|$0.00|0|0|||ELECTRON BEAM COMPUTED TOMOG|| 58-1699775|1326041732|CHC13|S8096||11/01/2013|12/31/9999|$0.00|0|0|||PORTABLE PEAK FLOW METER|| 58-1699775|1326041732|CHC13|S8097||11/01/2013|12/31/9999|$0.00|0|0|||ASTHMA KIT|| 58-1699775|1326041732|CHC13|S8100||11/01/2013|12/31/9999|$0.00|0|0|||SPACER WITHOUT MASK|| 58-1699775|1326041732|CHC13|S8101||11/01/2013|12/31/9999|$0.00|0|0|||SPACER WITH MASK|| 58-1699775|1326041732|CHC13|S8110||11/01/2013|12/31/9999|$0.00|0|0|||PEAK EXPIRATORY FLOW RATE (P|| 58-1699775|1326041732|CHC13|S8120||11/01/2013|12/31/9999|$0.00|0|0|||O2 CONTENTS GAS CUBIC FT|| 58-1699775|1326041732|CHC13|S8121||11/01/2013|12/31/9999|$0.00|0|0|||O2 CONTENTS LIQUID LB|| 58-1699775|1326041732|CHC13|S8130||11/01/2013|12/31/9999|$0.00|0|0|||INTERFERENTIAL STIM 2 CHAN|| 58-1699775|1326041732|CHC13|S8131||11/01/2013|12/31/9999|$0.00|0|0|||INTERFERENTIAL STIM 4 CHAN|| 58-1699775|1326041732|CHC13|S8185||11/01/2013|12/31/9999|$0.00|0|0|||FLUTTER DEVICE|| 58-1699775|1326041732|CHC13|S8186||11/01/2013|12/31/9999|$0.00|0|0|||SWIVEL ADAPTOR|| 58-1699775|1326041732|CHC13|S8189||11/01/2013|12/31/9999|$0.00|0|0|||TRACH SUPPLY NOC|| 58-1699775|1326041732|CHC13|S8210||11/01/2013|12/31/9999|$0.00|0|0|||MUCUS TRAP|| 58-1699775|1326041732|CHC13|S8262||11/01/2013|12/31/9999|$0.00|0|0|||MANDIB ORTHO REPOS DEVICE|| 58-1699775|1326041732|CHC13|S8265||11/01/2013|12/31/9999|$0.00|0|0|||HABERMAN FEEDER|| 58-1699775|1326041732|CHC13|S8270||11/01/2013|12/31/9999|$0.00|0|0|||ENURESIS ALARM|| 58-1699775|1326041732|CHC13|S8301||11/01/2013|12/31/9999|$0.00|0|0|||INFECT CONTROL SUPPLIES NOS|| 58-1699775|1326041732|CHC13|S8415||11/01/2013|12/31/9999|$0.00|0|0|||SUPPLIES FOR HOME DELIVERY|| 58-1699775|1326041732|CHC13|S8420||11/01/2013|12/31/9999|$0.00|0|0|||CUSTOM GRADIENT SLEEV/GLOV|| 58-1699775|1326041732|CHC13|S8421||11/01/2013|12/31/9999|$0.00|0|0|||READY GRADIENT SLEEV/GLOV|| 58-1699775|1326041732|CHC13|S8422||11/01/2013|12/31/9999|$0.00|0|0|||CUSTOM GRAD SLEEVE MED|| 58-1699775|1326041732|CHC13|S8423||11/01/2013|12/31/9999|$0.00|0|0|||CUSTOM GRAD SLEEVE HEAVY|| 58-1699775|1326041732|CHC13|S8424||11/01/2013|12/31/9999|$0.00|0|0|||READY GRADIENT SLEEVE|| 58-1699775|1326041732|CHC13|S8425||11/01/2013|12/31/9999|$0.00|0|0|||CUSTOM GRAD GLOVE MED|| 58-1699775|1326041732|CHC13|S8426||11/01/2013|12/31/9999|$0.00|0|0|||CUSTOM GRAD GLOVE HEAVY|| 58-1699775|1326041732|CHC13|S8427||11/01/2013|12/31/9999|$0.00|0|0|||READY GRADIENT GLOVE|| 58-1699775|1326041732|CHC13|S8428||11/01/2013|12/31/9999|$0.00|0|0|||READY GRADIENT GAUNTLET|| 58-1699775|1326041732|CHC13|S8429||11/01/2013|12/31/9999|$0.00|0|0|||GRADIENT PRESSURE WRAP|| 58-1699775|1326041732|CHC13|S8430||11/01/2013|12/31/9999|$0.00|0|0|||PADDING FOR COMPRSSN BDG|| 58-1699775|1326041732|CHC13|S8431||11/01/2013|12/31/9999|$0.00|0|0|||COMPRESSION BANDAGE|| 58-1699775|1326041732|CHC13|S8450||11/01/2013|12/31/9999|$0.00|0|0|||SPLINT DIGIT|| 58-1699775|1326041732|CHC13|S8451||11/01/2013|12/31/9999|$0.00|0|0|||SPLINT WRIST OR ANKLE|| 58-1699775|1326041732|CHC13|S8452||11/01/2013|12/31/9999|$0.00|0|0|||SPLINT ELBOW|| 58-1699775|1326041732|CHC13|S8460||11/01/2013|12/31/9999|$0.00|0|0|||CAMISOLE POST-MAST|| 58-1699775|1326041732|CHC13|S8490||11/01/2013|12/31/9999|$0.00|0|0|||100 INSULIN SYRINGES|| 58-1699775|1326041732|CHC13|S8940||11/01/2013|12/31/9999|$0.00|0|0|||HIPPOTHERAPY PER SESSION|| 58-1699775|1326041732|CHC13|S8948||11/01/2013|12/31/9999|$0.00|0|0|||LOW-LEVEL LASER TRMT 15 MIN|| 58-1699775|1326041732|CHC13|S8950||11/01/2013|12/31/9999|$0.00|0|0|||COMPLEX LYMPHEDEMA THERAPY||| 58-1699775|1326041732|CHC13|S8990||11/01/2013|12/31/9999|$0.00|0|0|||PT OR MANIP FOR MAINT|| 58-1699775|1326041732|CHC13|S8999||11/01/2013|12/31/9999|$0.00|0|0|||RESUSCITATION BAG|| 58-1699775|1326041732|CHC13|S9001||11/01/2013|12/31/9999|$0.00|0|0|||HOME UTERINE MONITOR WITH OR|| 58-1699775|1326041732|CHC13|S9007||11/01/2013|12/31/9999|$0.00|0|0|||ULTRAFILTRATION MONITOR|| 58-1699775|1326041732|CHC13|S9015||11/01/2013|12/31/9999|$0.00|0|0|||AUTOMATED EEG MONITORING|| 58-1699775|1326041732|CHC13|S9024||11/01/2013|12/31/9999|$0.00|0|0|||PARANASAL SINUS ULTRASOUND|| 58-1699775|1326041732|CHC13|S9025||11/01/2013|12/31/9999|$0.00|0|0|||OMNICARDIOGRAM/CARDIOINTEGRA|| 58-1699775|1326041732|CHC13|S9034||11/01/2013|12/31/9999|$0.00|0|0|||ESWL FOR GALLSTONES|| 58-1699775|1326041732|CHC13|S9055||11/01/2013|12/31/9999|$0.00|0|0|||PROCUREN OR OTHER GROWTH FAC|| 58-1699775|1326041732|CHC13|S9056||11/01/2013|12/31/9999|$0.00|0|0|||COMA STIMULATION PER DIEM|| 58-1699775|1326041732|CHC13|S9061||11/01/2013|12/31/9999|$0.00|0|0|||MEDICAL SUPPLIES AND EQUIPME|| 58-1699775|1326041732|CHC13|S9083||11/01/2013|12/31/9999|$0.00|0|0|||URGENT CARE CENTER GLOBAL|| 58-1699775|1326041732|CHC13|S9088||11/01/2013|12/31/9999|$0.00|0|0|||SERVICES PROVIDED IN URGENT|| 58-1699775|1326041732|CHC13|S9090||11/01/2013|12/31/9999|$0.00|0|0|||VERTEBRAL AXIAL DECOMPRESSIO|| 58-1699775|1326041732|CHC13|S9097||11/01/2013|12/31/9999|$0.00|0|0|||HOME VISIT WOUND CARE|| 58-1699775|1326041732|CHC13|S9098||11/01/2013|12/31/9999|$0.00|0|0|||HOME PHOTOTHERAPY VISIT|| 58-1699775|1326041732|CHC13|S9109||11/01/2013|12/31/9999|$0.00|0|0|||CHF TELEMONITORING MONTH|| 58-1699775|1326041732|CHC13|S9117||11/01/2013|12/31/9999|$0.00|0|0|||BACK SCHOOL VISIT|| 58-1699775|1326041732|CHC13|S9122||11/01/2013|12/31/9999|$0.00|0|0|||HOME HEALTH AIDE OR CERTIFIE|| 58-1699775|1326041732|CHC13|S9123||11/01/2013|12/31/9999|$0.00|0|0|||NURSING CARE IN HOME RN|| 58-1699775|1326041732|CHC13|S9124||11/01/2013|12/31/9999|$0.00|0|0|||NURSING CARE| IN THE HOME; B|| 58-1699775|1326041732|CHC13|S9125||11/01/2013|12/31/9999|$0.00|0|0|||RESPITE CARE| IN THE HOME| P|| 58-1699775|1326041732|CHC13|S9126||11/01/2013|12/31/9999|$0.00|0|0|||HOSPICE CARE| IN THE HOME| P|| 58-1699775|1326041732|CHC13|S9127||11/01/2013|12/31/9999|$0.00|0|0|||SOCIAL WORK VISIT| IN THE HO|| 58-1699775|1326041732|CHC13|S9128||11/01/2013|12/31/9999|$0.00|0|0|||SPEECH THERAPY| IN THE HOME||| 58-1699775|1326041732|CHC13|S9129||11/01/2013|12/31/9999|$0.00|0|0|||OCCUPATIONAL THERAPY| IN THE|| 58-1699775|1326041732|CHC13|S9131||11/01/2013|12/31/9999|$0.00|0|0|||PT IN THE HOME PER DIEM|| 58-1699775|1326041732|CHC13|S9140||11/01/2013|12/31/9999|$0.00|0|0|||DIABETIC MANAGEMENT PROGRAM||| 58-1699775|1326041732|CHC13|S9141||11/01/2013|12/31/9999|$0.00|0|0|||DIABETIC MANAGEMENT PROGRAM||| 58-1699775|1326041732|CHC13|S9145||11/01/2013|12/31/9999|$0.00|0|0|||INSULIN PUMP INITIATION|| 58-1699775|1326041732|CHC13|S9150||11/01/2013|12/31/9999|$0.00|0|0|||EVALUATION BY OCULARIST|| 58-1699775|1326041732|CHC13|S9152||11/01/2013|12/31/9999|$0.00|0|0|||SPEECH THERAPY| RE-EVAL|| 58-1699775|1326041732|CHC13|S9208||11/01/2013|12/31/9999|$0.00|0|0|||HOME MGMT PRETERM LABOR|| 58-1699775|1326041732|CHC13|S9209||11/01/2013|12/31/9999|$0.00|0|0|||HOME MGMT PPROM|| 58-1699775|1326041732|CHC13|S9211||11/01/2013|12/31/9999|$0.00|0|0|||HOME MGMT GEST HYPERTENSION|| 58-1699775|1326041732|CHC13|S9212||11/01/2013|12/31/9999|$0.00|0|0|||HM POSTPAR HYPER PER DIEM|| 58-1699775|1326041732|CHC13|S9213||11/01/2013|12/31/9999|$0.00|0|0|||HM PREECLAMP PER DIEM|| 58-1699775|1326041732|CHC13|S9214||11/01/2013|12/31/9999|$0.00|0|0|||HM GEST DM PER DIEM|| 58-1699775|1326041732|CHC13|S9325||11/01/2013|12/31/9999|$0.00|0|0|||HIT PAIN MGMT PER DIEM|| 58-1699775|1326041732|CHC13|S9326||11/01/2013|12/31/9999|$0.00|0|0|||HIT CONT PAIN PER DIEM|| 58-1699775|1326041732|CHC13|S9327||11/01/2013|12/31/9999|$0.00|0|0|||HIT INT PAIN PER DIEM|| 58-1699775|1326041732|CHC13|S9328||11/01/2013|12/31/9999|$0.00|0|0|||HIT PAIN IMP PUMP DIEM|| 58-1699775|1326041732|CHC13|S9329||11/01/2013|12/31/9999|$0.00|0|0|||HIT CHEMO PER DIEM|| 58-1699775|1326041732|CHC13|S9330||11/01/2013|12/31/9999|$0.00|0|0|||HIT CONT CHEM DIEM|| 58-1699775|1326041732|CHC13|S9331||11/01/2013|12/31/9999|$0.00|0|0|||HIT INTERMIT CHEMO DIEM|| 58-1699775|1326041732|CHC13|S9335||11/01/2013|12/31/9999|$0.00|0|0|||HT HEMODIALYSIS DIEM|| 58-1699775|1326041732|CHC13|S9336||11/01/2013|12/31/9999|$0.00|0|0|||HIT CONT ANTICOAG DIEM|| 58-1699775|1326041732|CHC13|S9338||11/01/2013|12/31/9999|$0.00|0|0|||HIT IMMUNOTHERAPY DIEM|| 58-1699775|1326041732|CHC13|S9339||11/01/2013|12/31/9999|$0.00|0|0|||HIT PERITON DIALYSIS DIEM|| 58-1699775|1326041732|CHC13|S9340||11/01/2013|12/31/9999|$0.00|0|0|||HIT ENTERAL PER DIEM|| 58-1699775|1326041732|CHC13|S9341||11/01/2013|12/31/9999|$0.00|0|0|||HIT ENTERAL GRAV DIEM|| 58-1699775|1326041732|CHC13|S9342||11/01/2013|12/31/9999|$0.00|0|0|||HIT ENTERAL PUMP DIEM|| 58-1699775|1326041732|CHC13|S9343||11/01/2013|12/31/9999|$0.00|0|0|||HIT ENTERAL BOLUS NURS|| 58-1699775|1326041732|CHC13|S9345||11/01/2013|12/31/9999|$0.00|0|0|||HIT ANTI-HEMOPHIL DIEM|| 58-1699775|1326041732|CHC13|S9346||11/01/2013|12/31/9999|$0.00|0|0|||HIT ALPHA-1-PROTEINAS DIEM|| 58-1699775|1326041732|CHC13|S9347||11/01/2013|12/31/9999|$0.00|0|0|||HIT LONGTERM INFUSION DIEM|| 58-1699775|1326041732|CHC13|S9348||11/01/2013|12/31/9999|$0.00|0|0|||HIT SYMPATHOMIM DIEM|| 58-1699775|1326041732|CHC13|S9349||11/01/2013|12/31/9999|$0.00|0|0|||HIT TOCOLYSIS DIEM|| 58-1699775|1326041732|CHC13|S9351||11/01/2013|12/31/9999|$0.00|0|0|||HIT CONT ANTIEMETIC DIEM|| 58-1699775|1326041732|CHC13|S9353||11/01/2013|12/31/9999|$0.00|0|0|||HIT CONT INSULIN DIEM|| 58-1699775|1326041732|CHC13|S9355||11/01/2013|12/31/9999|$0.00|0|0|||HIT CHELATION DIEM|| 58-1699775|1326041732|CHC13|S9357||11/01/2013|12/31/9999|$0.00|0|0|||HIT ENZYME REPLACE DIEM|| 58-1699775|1326041732|CHC13|S9359||11/01/2013|12/31/9999|$0.00|0|0|||HIT ANTI-TNF PER DIEM|| 58-1699775|1326041732|CHC13|S9361||11/01/2013|12/31/9999|$0.00|0|0|||HIT DIURETIC INFUS DIEM|| 58-1699775|1326041732|CHC13|S9363||11/01/2013|12/31/9999|$0.00|0|0|||HIT ANTI-SPASMOTIC DIEM|| 58-1699775|1326041732|CHC13|S9364||11/01/2013|12/31/9999|$0.00|0|0|||HIT TPN TOTAL DIEM|| 58-1699775|1326041732|CHC13|S9365||11/01/2013|12/31/9999|$0.00|0|0|||HIT TPN 1 LITER DIEM|| 58-1699775|1326041732|CHC13|S9366||11/01/2013|12/31/9999|$0.00|0|0|||HIT TPN 2 LITER DIEM|| 58-1699775|1326041732|CHC13|S9367||11/01/2013|12/31/9999|$0.00|0|0|||HIT TPN 3 LITER DIEM|| 58-1699775|1326041732|CHC13|S9368||11/01/2013|12/31/9999|$0.00|0|0|||HIT TPN OVER 3L DIEM|| 58-1699775|1326041732|CHC13|S9370||11/01/2013|12/31/9999|$0.00|0|0|||HT INJ ANTIEMETIC DIEM|| 58-1699775|1326041732|CHC13|S9372||11/01/2013|12/31/9999|$0.00|0|0|||HT INJ ANTICOAG DIEM|| 58-1699775|1326041732|CHC13|S9373||11/01/2013|12/31/9999|$0.00|0|0|||HIT HYDRA TOTAL DIEM|| 58-1699775|1326041732|CHC13|S9374||11/01/2013|12/31/9999|$0.00|0|0|||HIT HYDRA 1 LITER DIEM|| 58-1699775|1326041732|CHC13|S9375||11/01/2013|12/31/9999|$0.00|0|0|||HIT HYDRA 2 LITER DIEM|| 58-1699775|1326041732|CHC13|S9376||11/01/2013|12/31/9999|$0.00|0|0|||HIT HYDRA 3 LITER DIEM|| 58-1699775|1326041732|CHC13|S9377||11/01/2013|12/31/9999|$0.00|0|0|||HIT HYDRA OVER 3L DIEM|| 58-1699775|1326041732|CHC13|S9379||11/01/2013|12/31/9999|$0.00|0|0|||HIT NOC PER DIEM|| 58-1699775|1326041732|CHC13|S9381||11/01/2013|12/31/9999|$0.00|0|0|||HIT HIGH RISK/ESCORT|| 58-1699775|1326041732|CHC13|S9401||11/01/2013|12/31/9999|$0.00|0|0|||ANTICOAG CLINIC PER SESSION|| 58-1699775|1326041732|CHC13|S9430||11/01/2013|12/31/9999|$0.00|0|0|||PHARMACY COMP/DISP SERV|| 58-1699775|1326041732|CHC13|S9433||11/01/2013|12/31/9999|$0.00|0|0|||MEDICAL FOOD ORAL 100% NUTR|| 58-1699775|1326041732|CHC13|S9434||11/01/2013|12/31/9999|$0.00|0|0|||MOD SOLID FOOD SUPPL|| 58-1699775|1326041732|CHC13|S9435||11/01/2013|12/31/9999|$0.00|0|0|||MEDICAL FOODS FOR INBORN ERR|| 58-1699775|1326041732|CHC13|S9436||11/01/2013|12/31/9999|$0.00|0|0|||LAMAZE CLASS|| 58-1699775|1326041732|CHC13|S9437||11/01/2013|12/31/9999|$0.00|0|0|||CHILDBIRTH REFRESHER CLASS|| 58-1699775|1326041732|CHC13|S9438||11/01/2013|12/31/9999|$0.00|0|0|||CESAREAN BIRTH CLASS|| 58-1699775|1326041732|CHC13|S9439||11/01/2013|12/31/9999|$0.00|0|0|||VBAC CLASS|| 58-1699775|1326041732|CHC13|S9441||11/01/2013|12/31/9999|$0.00|0|0|||ASTHMA EDUCATION|| 58-1699775|1326041732|CHC13|S9442||11/01/2013|12/31/9999|$0.00|0|0|||BIRTHING CLASS|| 58-1699775|1326041732|CHC13|S9443||11/01/2013|12/31/9999|$0.00|0|0|||LACTATION CLASS|| 58-1699775|1326041732|CHC13|S9444||11/01/2013|12/31/9999|$0.00|0|0|||PARENTING CLASS|| 58-1699775|1326041732|CHC13|S9445||11/01/2013|12/31/9999|$0.00|0|0|||PT EDUCATION NOC INDIVID|| 58-1699775|1326041732|CHC13|S9446||11/01/2013|12/31/9999|$0.00|0|0|||PT EDUCATION NOC GROUP|| 58-1699775|1326041732|CHC13|S9447||11/01/2013|12/31/9999|$0.00|0|0|||INFANT SAFETY CLASS|| 58-1699775|1326041732|CHC13|S9449||11/01/2013|12/31/9999|$0.00|0|0|||WEIGHT MGMT CLASS|| 58-1699775|1326041732|CHC13|S9451||11/01/2013|12/31/9999|$0.00|0|0|||EXERCISE CLASS|| 58-1699775|1326041732|CHC13|S9452||11/01/2013|12/31/9999|$0.00|0|0|||NUTRITION CLASS|| 58-1699775|1326041732|CHC13|S9453||11/01/2013|12/31/9999|$0.00|0|0|||SMOKING CESSATION CLASS|| 58-1699775|1326041732|CHC13|S9454||11/01/2013|12/31/9999|$0.00|0|0|||STRESS MGMT CLASS|| 58-1699775|1326041732|CHC13|S9455||11/01/2013|12/31/9999|$0.00|0|0|||DIABETIC MANAGEMENT PROGRAM||| 58-1699775|1326041732|CHC13|S9460||11/01/2013|12/31/9999|$0.00|0|0|||DIABETIC MANAGEMENT PROGRAM||| 58-1699775|1326041732|CHC13|S9465||11/01/2013|12/31/9999|$0.00|0|0|||DIABETIC MANAGEMENT PROGRAM||| 58-1699775|1326041732|CHC13|S9470||11/01/2013|12/31/9999|$0.00|0|0|||NUTRITIONAL COUNSELING| DIET|| 58-1699775|1326041732|CHC13|S9472||11/01/2013|12/31/9999|$0.00|0|0|||CARDIAC REHABILITATION PROGR|| 58-1699775|1326041732|CHC13|S9473||11/01/2013|12/31/9999|$0.00|0|0|||PULMONARY REHABILITATION PRO|| 58-1699775|1326041732|CHC13|S9474||11/01/2013|12/31/9999|$0.00|0|0|||ENTEROSTOMAL THERAPY BY A RE|| 58-1699775|1326041732|CHC13|S9475||11/01/2013|12/31/9999|$0.00|0|0|||AMBULATORY SETTING SUBSTANCE|| 58-1699775|1326041732|CHC13|S9476||11/01/2013|12/31/9999|$0.00|0|0|||VESTIBULAR REHAB PER DIEM|| 58-1699775|1326041732|CHC13|S9480||11/01/2013|12/31/9999|$0.00|0|0|||INTENSIVE OUTPATIENT PSYCHIA|| 58-1699775|1326041732|CHC13|S9482||11/01/2013|12/31/9999|$0.00|0|0|||FAMILY STABILIZATION 15 MIN|| 58-1699775|1326041732|CHC13|S9484||11/01/2013|12/31/9999|$0.00|0|0|||CRISIS INTERVENTION PER HOUR|| 58-1699775|1326041732|CHC13|S9485||11/01/2013|12/31/9999|$0.00|0|0|||CRISIS INTERVENTION MENTAL H|| 58-1699775|1326041732|CHC13|S9490||11/01/2013|12/31/9999|$0.00|0|0|||HIT CORTICOSTEROID/DIEM|| 58-1699775|1326041732|CHC13|S9494||11/01/2013|12/31/9999|$0.00|0|0|||HIT ANTIBIOTIC TOTAL DIEM|| 58-1699775|1326041732|CHC13|S9497||11/01/2013|12/31/9999|$0.00|0|0|||HIT ANTIBIOTIC Q3H DIEM|| 58-1699775|1326041732|CHC13|S9500||11/01/2013|12/31/9999|$143.65|0|0|||HIT ANTIBIOTIC Q24H DIEM|| 58-1699775|1326041732|CHC13|S9501||11/01/2013|12/31/9999|$0.00|0|0|||HIT ANTIBIOTIC Q12H DIEM|| 58-1699775|1326041732|CHC13|S9502||11/01/2013|12/31/9999|$0.00|0|0|||HIT ANTIBIOTIC Q8H DIEM|| 58-1699775|1326041732|CHC13|S9503||11/01/2013|12/31/9999|$0.00|0|0|||HIT ANTIBIOTIC Q6H DIEM|| 58-1699775|1326041732|CHC13|S9504||11/01/2013|12/31/9999|$0.00|0|0|||HIT ANTIBIOTIC Q4H DIEM|| 58-1699775|1326041732|CHC13|S9529||11/01/2013|12/31/9999|$0.00|0|0|||VENIPUNCTURE HOME/SNF|| 58-1699775|1326041732|CHC13|S9537||11/01/2013|12/31/9999|$0.00|0|0|||HT HEM HORM INJ DIEM|| 58-1699775|1326041732|CHC13|S9538||11/01/2013|12/31/9999|$0.00|0|0|||HIT BLOOD PRODUCTS DIEM|| 58-1699775|1326041732|CHC13|S9542||11/01/2013|12/31/9999|$0.00|0|0|||HT INJ NOC PER DIEM|| 58-1699775|1326041732|CHC13|S9558||11/01/2013|12/31/9999|$0.00|0|0|||HT INJ GROWTH HORM DIEM|| 58-1699775|1326041732|CHC13|S9559||11/01/2013|12/31/9999|$0.00|0|0|||HIT INJ INTERFERON DIEM|| 58-1699775|1326041732|CHC13|S9560||11/01/2013|12/31/9999|$0.00|0|0|||HT INJ HORMONE DIEM|| 58-1699775|1326041732|CHC13|S9562||11/01/2013|12/31/9999|$0.00|0|0|||HT INJ PALIVIZUMAB DIEM|| 58-1699775|1326041732|CHC13|S9590||11/01/2013|12/31/9999|$0.00|0|0|||HT IRRIGATION DIEM|| 58-1699775|1326041732|CHC13|S9810||11/01/2013|12/31/9999|$0.00|0|0|||HT PHARM PER HOUR|| 58-1699775|1326041732|CHC13|S9900||11/01/2013|12/31/9999|$0.00|0|0|||CHRISTIAN SCI PRACT VISIT|| 58-1699775|1326041732|CHC13|S9970||11/01/2013|12/31/9999|$0.00|0|0|||HEALTH CLUB MEMBERSHIP YR|| 58-1699775|1326041732|CHC13|S9975||11/01/2013|12/31/9999|$0.00|0|0|||TRANSPLANT RELATED PER DIEM|| 58-1699775|1326041732|CHC13|S9976||11/01/2013|12/31/9999|$0.00|0|0|||LODGING PER DIEM|| 58-1699775|1326041732|CHC13|S9977||11/01/2013|12/31/9999|$0.00|0|0|||MEALS PER DIEM|| 58-1699775|1326041732|CHC13|S9981||11/01/2013|12/31/9999|$0.00|0|0|||MED RECORD COPY ADMIN|| 58-1699775|1326041732|CHC13|S9982||11/01/2013|12/31/9999|$0.00|0|0|||MED RECORD COPY PER PAGE|| 58-1699775|1326041732|CHC13|S9986||11/01/2013|12/31/9999|$0.00|0|0|||NOT MEDICALLY NECESSARY SVC|| 58-1699775|1326041732|CHC13|S9988||11/01/2013|12/31/9999|$0.00|0|0|||SERV PART OF PHASE I TRIAL|| 58-1699775|1326041732|CHC13|S9989||11/01/2013|12/31/9999|$0.00|0|0|||SERVICES OUTSIDE US|| 58-1699775|1326041732|CHC13|S9990||11/01/2013|12/31/9999|$0.00|0|0|||SERVICES PROVIDED AS PART OF|| 58-1699775|1326041732|CHC13|S9991||11/01/2013|12/31/9999|$0.00|0|0|||SERVICES PROVIDED AS PART OF|| 58-1699775|1326041732|CHC13|S9992||11/01/2013|12/31/9999|$0.00|0|0|||TRANSPORTATION COSTS TO AND|| 58-1699775|1326041732|CHC13|S9994||11/01/2013|12/31/9999|$0.00|0|0|||LODGING COSTS (E.G. HOTEL CH|| 58-1699775|1326041732|CHC13|S9996||11/01/2013|12/31/9999|$0.00|0|0|||MEALS FOR CLINICAL TRIAL PAR|| 58-1699775|1326041732|CHC13|S9999||11/01/2013|12/31/9999|$0.00|0|0|||SALES TAX|| 58-1699775|1326041732|CHC13|V2020||11/01/2013|12/31/9999|$92.96|0|0|||VISION SVCS FRAMES PURCHASES|| 58-1699775|1326041732|CHC13|V2025||11/01/2013|12/31/9999|$0.00|0|0|||EYEGLASSES DELUX FRAMES|| 58-1699775|1326041732|CHC13|V2100||11/01/2013|12/31/9999|$45.17|0|0|||LENS SPHER SINGLE PLANO 4.00|| 58-1699775|1326041732|CHC13|V2101||11/01/2013|12/31/9999|$47.60|0|0|||SINGLE VISN SPHERE 4.12-7.00|| 58-1699775|1326041732|CHC13|V2102||11/01/2013|12/31/9999|$67.53|0|0|||SINGL VISN SPHERE 7.12-20.00|| 58-1699775|1326041732|CHC13|V2103||11/01/2013|12/31/9999|$39.22|0|0|||SPHEROCYLINDR 4.00D/12-2.00D|| 58-1699775|1326041732|CHC13|V2104||11/01/2013|12/31/9999|$43.44|0|0|||SPHEROCYLINDR 4.00D/2.12-4D|| 58-1699775|1326041732|CHC13|V2105||11/01/2013|12/31/9999|$53.19|0|0|||SPHEROCYLINDER 4.00D/4.25-6D|| 58-1699775|1326041732|CHC13|V2106||11/01/2013|12/31/9999|$53.98|0|0|||SPHEROCYLINDER 4.00D/>6.00D|| 58-1699775|1326041732|CHC13|V2107||11/01/2013|12/31/9999|$56.74|0|0|||SPHEROCYLINDER 4.25D/12-2D|| 58-1699775|1326041732|CHC13|V2108||11/01/2013|12/31/9999|$55.04|0|0|||SPHEROCYLINDER 4.25D/2.12-4D|| 58-1699775|1326041732|CHC13|V2109||11/01/2013|12/31/9999|$63.26|0|0|||SPHEROCYLINDER 4.25D/4.25-6D|| 58-1699775|1326041732|CHC13|V2110||11/01/2013|12/31/9999|$73.83|0|0|||SPHEROCYLINDER 4.25D/OVER 6D|| 58-1699775|1326041732|CHC13|V2111||11/01/2013|12/31/9999|$65.08|0|0|||SPHEROCYLINDR 7.25D/.25-2.25|| 58-1699775|1326041732|CHC13|V2112||11/01/2013|12/31/9999|$64.21|0|0|||SPHEROCYLINDR 7.25D/2.25-4D|| 58-1699775|1326041732|CHC13|V2113||11/01/2013|12/31/9999|$88.71|0|0|||SPHEROCYLINDR 7.25D/4.25-6D|| 58-1699775|1326041732|CHC13|V2114||11/01/2013|12/31/9999|$78.47|0|0|||SPHEROCYLINDER OVER 12.00D|| 58-1699775|1326041732|CHC13|V2115||11/01/2013|12/31/9999|$85.33|0|0|||LENS LENTICULAR| SINGLE VISION|| 58-1699775|1326041732|CHC13|V2118||11/01/2013|12/31/9999|$84.59|0|0|||LENS ANISEIKONIC SINGLE|| 58-1699775|1326041732|CHC13|V2121||11/01/2013|12/31/9999|$87.33|0|0|||LENTICULAR LENS| SINGLE|| 58-1699775|1326041732|CHC13|V2200||11/01/2013|12/31/9999|$59.14|0|0|||LENS SPHER BIFOC PLANO 4.00D|| 58-1699775|1326041732|CHC13|V2201||11/01/2013|12/31/9999|$64.45|0|0|||LENS SPHERE BIFOCAL 4.12-7.0|| 58-1699775|1326041732|CHC13|V2202||11/01/2013|12/31/9999|$75.84|0|0|||LENS SPHERE BIFOCAL 7.12-20.|| 58-1699775|1326041732|CHC13|V2203||11/01/2013|12/31/9999|$59.65|0|0|||LENS SPHCYL BIFOCAL 4.00D/.1|| 58-1699775|1326041732|CHC13|V2204||11/01/2013|12/31/9999|$64.69|0|0|||LENS SPHCY BIFOCAL 4.00D/2.1|| 58-1699775|1326041732|CHC13|V2205||11/01/2013|12/31/9999|$70.96|0|0|||LENS SPHCY BIFOCAL 4.00D/4.2|| 58-1699775|1326041732|CHC13|V2206||11/01/2013|12/31/9999|$86.40|0|0|||LENS SPHCY BIFOCAL 4.00D/OVE|| 58-1699775|1326041732|CHC13|V2207||11/01/2013|12/31/9999|$72.13|0|0|||LENS SPHCY BIFOCAL 4.25-7D/.|| 58-1699775|1326041732|CHC13|V2208||11/01/2013|12/31/9999|$73.00|0|0|||LENS SPHCY BIFOCAL 4.25-7/2.|| 58-1699775|1326041732|CHC13|V2209||11/01/2013|12/31/9999|$80.31|0|0|||LENS SPHCY BIFOCAL 4.25-7/4.|| 58-1699775|1326041732|CHC13|V2210||11/01/2013|12/31/9999|$103.33|0|0|||LENS SPHCY BIFOCAL 4.25-7/OV|| 58-1699775|1326041732|CHC13|V2211||11/01/2013|12/31/9999|$88.10|0|0|||LENS SPHCY BIFO 7.25-12/.25-|| 58-1699775|1326041732|CHC13|V2212||11/01/2013|12/31/9999|$95.89|0|0|||LENS SPHCYL BIFO 7.25-12/2.2|| 58-1699775|1326041732|CHC13|V2213||11/01/2013|12/31/9999|$98.31|0|0|||LENS SPHCYL BIFO 7.25-12/4.2|| 58-1699775|1326041732|CHC13|V2214||11/01/2013|12/31/9999|$105.39|0|0|||LENS SPHCYL BIFOCAL OVER 12.|| 58-1699775|1326041732|CHC13|V2215||11/01/2013|12/31/9999|$114.04|0|0|||LENS LENTICULAR BIFOCAL|| 58-1699775|1326041732|CHC13|V2218||11/01/2013|12/31/9999|$116.66|0|0|||LENS ANISEIKONIC BIFOCAL|| 58-1699775|1326041732|CHC13|V2219||11/01/2013|12/31/9999|$51.36|0|0|||LENS BIFOCAL SEG WIDTH OVER|| 58-1699775|1326041732|CHC13|V2220||11/01/2013|12/31/9999|$41.65|0|0|||LENS BIFOCAL ADD OVER 3.25D|| 58-1699775|1326041732|CHC13|V2221||11/01/2013|12/31/9999|$111.27|0|0|||LENTICULAR LENS| BIFOCAL|| 58-1699775|1326041732|CHC13|V2300||11/01/2013|12/31/9999|$76.79|0|0|||LENS SPHERE TRIFOCAL 4.00D|| 58-1699775|1326041732|CHC13|V2301||11/01/2013|12/31/9999|$89.05|0|0|||LENS SPHERE TRIFOCAL 4.12-7.|| 58-1699775|1326041732|CHC13|V2302||11/01/2013|12/31/9999|$97.56|0|0|||LENS SPHERE TRIFOCAL 7.12-20|| 58-1699775|1326041732|CHC13|V2303||11/01/2013|12/31/9999|$80.83|0|0|||LENS SPHCY TRIFOCAL 4.0/.12-|| 58-1699775|1326041732|CHC13|V2304||11/01/2013|12/31/9999|$84.59|0|0|||LENS SPHCY TRIFOCAL 4.0/2.25|| 58-1699775|1326041732|CHC13|V2305||11/01/2013|12/31/9999|$103.71|0|0|||LENS SPHCY TRIFOCAL 4.0/4.25|| 58-1699775|1326041732|CHC13|V2306||11/01/2013|12/31/9999|$96.71|0|0|||LENS SPHCYL TRIFOCAL 4.00/>6|| 58-1699775|1326041732|CHC13|V2307||11/01/2013|12/31/9999|$95.91|0|0|||LENS SPHCY TRIFOCAL 4.25-7/.|| 58-1699775|1326041732|CHC13|V2308||11/01/2013|12/31/9999|$102.34|0|0|||LENS SPHC TRIFOCAL 4.25-7/2.|| 58-1699775|1326041732|CHC13|V2309||11/01/2013|12/31/9999|$119.71|0|0|||LENS SPHC TRIFOCAL 4.25-7/4.|| 58-1699775|1326041732|CHC13|V2310||11/01/2013|12/31/9999|$131.67|0|0|||LENS SPHC TRIFOCAL 4.25-7/>6|| 58-1699775|1326041732|CHC13|V2311||11/01/2013|12/31/9999|$125.41|0|0|||LENS SPHC TRIFO 7.25-12/.25-|| 58-1699775|1326041732|CHC13|V2312||11/01/2013|12/31/9999|$110.55|0|0|||LENS SPHC TRIFO 7.25-12/2.25|| 58-1699775|1326041732|CHC13|V2313||11/01/2013|12/31/9999|$150.89|0|0|||LENS SPHC TRIFO 7.25-12/4.25|| 58-1699775|1326041732|CHC13|V2314||11/01/2013|12/31/9999|$165.29|0|0|||LENS SPHCYL TRIFOCAL OVER 12|| 58-1699775|1326041732|CHC13|V2315||11/01/2013|12/31/9999|$183.50|0|0|||LENS LENTICULAR TRIFOCAL|| 58-1699775|1326041732|CHC13|V2318||11/01/2013|12/31/9999|$169.19|0|0|||LENS ANISEIKONIC TRIFOCAL|| 58-1699775|1326041732|CHC13|V2319||11/01/2013|12/31/9999|$57.27|0|0|||LENS TRIFOCAL SEG WIDTH > 28|| 58-1699775|1326041732|CHC13|V2320||11/01/2013|12/31/9999|$60.43|0|0|||LENS TRIFOCAL ADD OVER 3.25D|| 58-1699775|1326041732|CHC13|V2321||11/01/2013|12/31/9999|$180.87|0|0|||LENTICULAR LENS| TRIFOCAL|| 58-1699775|1326041732|CHC13|V2410||11/01/2013|12/31/9999|$103.42|0|0|||LENS VARIAB ASPHERICITY SING|| 58-1699775|1326041732|CHC13|V2430||11/01/2013|12/31/9999|$134.64|0|0|||LENS VARIABLE ASPHERICITY BI|| 58-1699775|1326041732|CHC13|V2500||11/01/2013|12/31/9999|$93.75|0|0|||CONTACT LENS PMMA SPHERICAL|| 58-1699775|1326041732|CHC13|V2501||11/01/2013|12/31/9999|$142.80|0|0|||CNTCT LENS PMMA-TORIC/PRISM|| 58-1699775|1326041732|CHC13|V2502||11/01/2013|12/31/9999|$175.91|0|0|||CONTACT LENS PMMA BIFOCAL|| 58-1699775|1326041732|CHC13|V2503||11/01/2013|12/31/9999|$168.31|0|0|||CNTCT LENS PMMA COLOR VISION|| 58-1699775|1326041732|CHC13|V2510||11/01/2013|12/31/9999|$127.97|0|0|||CNTCT GAS PERMEABLE SPHERICL|| 58-1699775|1326041732|CHC13|V2511||11/01/2013|12/31/9999|$183.88|0|0|||CNTCT TORIC PRISM BALLAST|| 58-1699775|1326041732|CHC13|V2512||11/01/2013|12/31/9999|$217.28|0|0|||CNTCT LENS GAS PERMBL BIFOCL|| 58-1699775|1326041732|CHC13|V2513||11/01/2013|12/31/9999|$182.41|0|0|||CONTACT LENS EXTENDED WEAR|| 58-1699775|1326041732|CHC13|V2520||11/01/2013|12/31/9999|$120.29|0|0|||CONTACT LENS HYDROPHILIC|| 58-1699775|1326041732|CHC13|V2521||11/01/2013|12/31/9999|$209.42|0|0|||CNTCT LENS HYDROPHILIC TORIC|| 58-1699775|1326041732|CHC13|V2522||11/01/2013|12/31/9999|$203.80|0|0|||CNTCT LENS HYDROPHIL BIFOCL|| 58-1699775|1326041732|CHC13|V2523||11/01/2013|12/31/9999|$173.68|0|0|||CNTCT LENS HYDROPHIL EXTEND|| 58-1699775|1326041732|CHC13|V2530||11/01/2013|12/31/9999|$257.25|0|0|||CONTACT LENS GAS IMPERMEABLE|| 58-1699775|1326041732|CHC13|V2531||11/01/2013|12/31/9999|$631.54|0|0|||CONTACT LENS GAS PERMEABLE|| 58-1699775|1326041732|CHC13|V2623||11/01/2013|12/31/9999|$1|035.33|0|0|||PLASTIC EYE PROSTH CUSTOM|| 58-1699775|1326041732|CHC13|V2624||11/01/2013|12/31/9999|$70.21|0|0|||POLISHING ARTIFICAL EYE|| 58-1699775|1326041732|CHC13|V2625||11/01/2013|12/31/9999|$454.80|0|0|||ENLARGEMNT OF EYE PROSTHESIS|| 58-1699775|1326041732|CHC13|V2626||11/01/2013|12/31/9999|$288.54|0|0|||REDUCTION OF EYE PROSTHESIS|| 58-1699775|1326041732|CHC13|V2627||11/01/2013|12/31/9999|$1|651.96|0|0|||SCLERAL COVER SHELL|| 58-1699775|1326041732|CHC13|V2628||11/01/2013|12/31/9999|$377.70|0|0|||FABRICATION & FITTING|| 58-1699775|1326041732|CHC13|V2700||11/01/2013|12/31/9999|$50.52|0|0|||BALANCE LENS|| 58-1699775|1326041732|CHC13|V2702||11/01/2013|12/31/9999|$0.00|0|0|||DELUXE LENS FEATURE|| 58-1699775|1326041732|CHC13|V2710||11/01/2013|12/31/9999|$73.95|0|0|||GLASS/PLASTIC SLAB OFF PRISM|| 58-1699775|1326041732|CHC13|V2715||11/01/2013|12/31/9999|$13.41|0|0|||PRISM LENS/ES|| 58-1699775|1326041732|CHC13|V2718||11/01/2013|12/31/9999|$32.93|0|0|||FRESNELL PRISM PRESS-ON LENS|| 58-1699775|1326041732|CHC13|V2730||11/01/2013|12/31/9999|$24.32|0|0|||SPECIAL BASE CURVE|| 58-1699775|1326041732|CHC13|V2744||11/01/2013|12/31/9999|$25.24|0|0|||TINT PHOTOCHROMATIC LENS/ES|| 58-1699775|1326041732|CHC13|V2745||11/01/2013|12/31/9999|$14.31|0|0|||TINT| ANY COLOR/SOLID/GRAD|| 58-1699775|1326041732|CHC13|V2750||11/01/2013|12/31/9999|$29.35|0|0|||ANTI-REFLECTIVE COATING|| 58-1699775|1326041732|CHC13|V2755||11/01/2013|12/31/9999|$21.21|0|0|||UV LENS/ES|| 58-1699775|1326041732|CHC13|V2760||11/01/2013|12/31/9999|$18.47|0|0|||SCRATCH RESISTANT COATING|| 58-1699775|1326041732|CHC13|V2762||11/01/2013|12/31/9999|$69.54|0|0|||POLARIZATION| ANY LENS|| 58-1699775|1326041732|CHC13|V2770||11/01/2013|12/31/9999|$23.86|0|0|||OCCLUDER LENS/ES|| 58-1699775|1326041732|CHC13|V2780||11/01/2013|12/31/9999|$19.28|0|0|||OVERSIZE LENS/ES|| 58-1699775|1326041732|CHC13|V2781||11/01/2013|12/31/9999|$0.00|0|0|||PROGRESSIVE LENS PER LENS|| 58-1699775|1326041732|CHC13|V2782||11/01/2013|12/31/9999|$75.08|0|0|||LENS| 1.54-1.65 P/1.60-1.79G|| 58-1699775|1326041732|CHC13|V2783||11/01/2013|12/31/9999|$84.67|0|0|||LENS| >= 1.66 P/>=1.80 G|| 58-1699775|1326041732|CHC13|V2784||11/01/2013|12/31/9999|$55.06|0|0|||LENS POLYCARB OR EQUAL|| 58-1699775|1326041732|CHC13|V2786||11/01/2013|12/31/9999|$0.00|0|0|||OCCUPATIONAL MULTIFOCAL LENS|| 58-1699775|1326041732|CHC13|V5257||11/01/2013|12/31/9999|$937.50|0|0|||HEARING AID| DIGIT| MON| BTE||