Line Type HSMC CDM Code HSMC CDM Description DRG CPT / HCPCS HSMC Revenue Code Gross or Average Charge Self Pay Cash Price Min Negotiated Rate Max Negotiated Rate Aetna Better Health MA Aetna Comm Aetna Medicare Aetna Signature Administrators AmeriHealth MA CBC Comm CBC Medicare Cigna Gateway MA Gateway Medicare Geisinger Comm Geisinger MA Geisinger Medicare Highmark Choice Blue Highmark Comm Highmark Medicare Humana Medicare Medicare Multiplan PA Health & Wellness PAMA UHC Comm UHC MA UHC MA CHIP UPMC Comm UPMC MA UPMC MA CHIP Vibra Medicare 35901035 BX FNA W/O IG EA/ADDL LESN 10004 300 $200.00 73.92 - 369.10 40.85 138.20 - 138.20 35.52 110.50 - 132.00 39.07 36.99 132.38 - - 295.28 369.10 - - - 160.00 - 35.52 134.00 - 81.80 150.00 76.02 89.46 - 80336586 BX FNA W/US 1ST LESN 10005 320 "$3,265.00" " 1,206.74 " 543.97 " 2,612.00 " 892.40 " 2,256.12 " 649.06 " 2,256.12 " 907.92 " 1,803.91 " 636.69 " 1,775.00 " 869.12 808.05 " 2,161.10 " 556.34 618.15 703.12 878.90 633.60 636.69 618.15 " 2,612.00 " 565.61 776.00 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 80536585 BX FNA W/US 1ST LESN 10005 402 "$3,265.00" " 1,206.74 " 543.97 " 2,612.00 " 892.40 " 2,256.12 " 649.06 " 2,256.12 " 907.92 " 1,803.91 " 636.69 " 1,775.00 " 869.12 808.05 " 2,161.10 " 556.34 618.15 703.12 878.90 633.60 636.69 618.15 " 2,612.00 " 565.61 776.00 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 80336594 BX FNA W/US EA ADDL LESN 10006 320 "$1,662.00" 614.28 - " 1,329.60 " 46.82 " 1,148.44 " - " 1,148.44 " 47.63 918.26 - " 1,096.92 " 45.60 42.39 " 1,100.08 " - - 339.44 424.30 - - - " 1,329.60 " - 40.71 " 1,113.54 " - 679.76 " 1,246.50 " 631.73 743.41 - 80536593 BX FNA W/US EA ADDL LESN 10006 402 "$1,662.00" 614.28 - " 1,329.60 " 46.82 " 1,148.44 " - " 1,148.44 " 47.63 918.26 - " 1,096.92 " 45.60 42.39 " 1,100.08 " - - 339.44 424.30 - - - " 1,329.60 " - 40.71 " 1,113.54 " - 679.76 " 1,246.50 " 631.73 743.41 - 80636628 BX FNA W/CT GUIDE 1ST LESN 10009 350 "$3,265.00" " 1,206.74 " 543.97 " 3,182.59 " 892.40 " 2,256.12 " 649.06 " 2,256.12 " 907.92 " 1,803.91 " 636.69 " 1,775.00 " 869.12 808.05 " 2,161.10 " 556.34 618.15 " 2,546.07 " " 3,182.59 " 633.60 636.69 618.15 " 2,612.00 " 565.61 776.00 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 80636636 BX FNA W/CT GUIDE EA ADDL LESN 10010 350 "$1,662.00" 614.28 - " 1,923.55 " 78.19 " 1,148.44 " - " 1,148.44 " 79.55 918.26 - " 1,096.92 " 76.15 70.80 " 1,100.08 " - - " 1,538.84 " " 1,923.55 " - - - " 1,329.60 " - 67.99 " 1,113.54 " - 679.76 " 1,246.50 " 631.73 743.41 - 80436645 BX FNA W/MR GUIDE 1ST LESN 10011 610 "$3,265.00" " 1,206.74 " 134.24 " 2,882.00 " 154.38 " 2,882.00 " 649.06 " 2,882.00 " 157.06 " 1,803.91 " 636.69 " 1,155.00 " 150.35 139.78 " 2,161.10 " 556.34 618.15 700.70 875.88 633.60 636.69 618.15 " 2,612.00 " 565.61 134.24 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 80436653 BX FNA W/MR GUIDE EA ADDL LESN 10012 610 "$1,662.00" 614.28 - " 2,882.00 " 151.01 " 2,882.00 " - " 2,882.00 " 153.63 918.26 - " 1,155.00 " 147.07 136.73 " 1,100.08 " - - 700.70 875.88 - - - " 1,329.60 " - 131.31 " 1,113.54 " - 679.76 " 1,246.50 " 631.73 743.41 - 35900438 BX FNA W/O IG 1ST LESN 10021 300 "$1,816.00" 671.19 302.14 " 1,469.00 " 892.40 " 1,469.00 " 360.51 " 1,469.00 " 776.00 " 1,003.34 " 353.64 845.00 853.60 808.05 " 1,202.01 " 309.01 343.34 707.79 884.74 351.92 353.64 343.34 " 1,452.80 " 314.16 776.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 37090034 BX FNA W/O IG 1ST LESN 10021 450 "$1,816.00" 671.19 302.14 " 1,469.00 " 892.40 " 1,469.00 " 360.51 " 1,469.00 " 907.92 " 1,003.34 " 353.64 845.00 869.12 808.05 " 1,202.01 " 309.01 343.34 707.79 884.74 351.92 353.64 343.34 " 1,452.80 " 314.16 776.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 67741391 GUID FLUID CATH DRAIN 10030 350 "$3,265.00" " 1,206.74 " 125.28 " 2,612.00 " 144.07 " 1,718.00 " 649.06 " 1,718.00 " 146.58 " 1,803.91 " 636.69 845.00 140.31 130.45 " 2,161.10 " 556.34 618.15 " 1,647.30 " " 2,059.12 " 633.60 636.69 618.15 " 2,612.00 " 565.61 125.28 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 80341393 GUID FLUID CATH DRAIN 10030 320 "$3,265.00" " 1,206.74 " 125.28 " 2,612.00 " 144.07 " 1,718.00 " 649.06 " 1,718.00 " 146.58 " 1,803.91 " 636.69 845.00 140.31 130.45 " 2,161.10 " 556.34 618.15 " 1,647.30 " " 2,059.12 " 633.60 636.69 618.15 " 2,612.00 " 565.61 125.28 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 80541392 GUID FLUID CATH DRAIN 10030 402 "$3,265.00" " 1,206.74 " 125.28 " 2,612.00 " 144.07 " 1,718.00 " 649.06 " 1,718.00 " 146.58 " 1,803.91 " 636.69 845.00 140.31 130.45 " 2,161.10 " 556.34 618.15 " 1,647.30 " " 2,059.12 " 633.60 636.69 618.15 " 2,612.00 " 565.61 125.28 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 80641397 GUID FLUID CATH DRAIN 10030 350 "$3,265.00" " 1,206.74 " 125.28 " 2,612.00 " 144.07 " 1,718.00 " 649.06 " 1,718.00 " 146.58 " 1,803.91 " 636.69 845.00 140.31 130.45 " 2,161.10 " 556.34 618.15 " 1,647.30 " " 2,059.12 " 633.60 636.69 618.15 " 2,612.00 " 565.61 125.28 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 80535406 PERC DEV SOFT TISSUE 1ST IMAGE 10035 402 "$3,265.00" " 1,206.74 " 70.26 " 3,583.33 " 80.80 " 2,256.12 " 649.06 " 2,256.12 " 82.20 " 1,803.91 " 636.69 " 2,820.00 " 78.69 73.16 " 2,161.10 " 556.34 618.15 " 2,866.66 " " 3,583.33 " 633.60 636.69 618.15 " 2,612.00 " 565.61 70.26 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 82735402 PERC DEV SOFT TISSUE 1ST IMAGE 10035 320 "$3,265.00" " 1,206.74 " 70.26 " 3,583.33 " 80.80 " 2,256.12 " 649.06 " 2,256.12 " 82.20 " 1,803.91 " 636.69 " 2,820.00 " 78.69 73.16 " 2,161.10 " 556.34 618.15 " 2,866.66 " " 3,583.33 " 633.60 636.69 618.15 " 2,612.00 " 565.61 70.26 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 83035404 PERC DEV SOFT TISSUE 1ST IMAGE 10035 402 "$3,265.00" " 1,206.74 " 70.26 " 3,583.33 " 80.80 " 2,256.12 " 649.06 " 2,256.12 " 82.20 " 1,803.91 " 636.69 " 2,820.00 " 78.69 73.16 " 2,161.10 " 556.34 618.15 " 2,866.66 " " 3,583.33 " 633.60 636.69 618.15 " 2,612.00 " 565.61 70.26 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 80535414 PERC DEV SOFT TISSUE ADD IMAGE 10036 402 $174.00 64.31 - " 3,103.91 " 40.72 120.23 - 120.23 41.43 96.14 - 114.84 39.66 36.87 115.17 - - " 2,483.13 " " 3,103.91 " - - - 139.20 - 35.41 116.58 - 71.17 130.50 66.14 77.83 - 83035412 PERC DEV SOFT TISSUE ADD IMAGE 10036 320 $174.00 64.31 - " 3,103.91 " 40.72 120.23 - 120.23 41.43 96.14 - 114.84 39.66 36.87 115.17 - - " 2,483.13 " " 3,103.91 " - - - 139.20 - 35.41 116.58 - 71.17 130.50 66.14 77.83 - 28162294 I&D SIMPLE ABSCESS 10060 360 $943.00 348.53 156.97 " 1,469.00 " 711.85 " 1,469.00 " 187.30 " 1,469.00 " 724.23 521.01 183.73 845.00 693.28 644.56 624.17 160.54 178.38 393.78 492.23 182.84 183.73 178.38 754.40 163.22 619.00 631.81 156.97 385.69 707.25 358.43 421.80 184.62 37001155 I&D SIMPLE ABSCESS 10060 450 $943.00 348.53 156.97 " 1,469.00 " 711.85 " 1,469.00 " 187.30 " 1,469.00 " 724.23 521.01 183.73 845.00 693.28 644.56 624.17 160.54 178.38 393.78 492.23 182.84 183.73 178.38 754.40 163.22 619.00 631.81 156.97 385.69 707.25 358.43 421.80 184.62 51600002 I&D SIMPLE ABSCESS 10060 510 $943.00 348.53 156.97 " 1,469.00 " 711.85 " 1,469.00 " 187.30 " 1,469.00 " 724.23 521.01 183.73 845.00 693.28 644.56 624.17 160.54 178.38 393.78 492.23 182.84 183.73 178.38 754.40 163.22 619.00 631.81 156.97 385.69 707.25 358.43 421.80 184.62 67726189 I&D SIMPLE ABSCESS 10060 350 $943.00 348.53 156.97 " 1,469.00 " 711.85 " 1,469.00 " 187.30 " 1,469.00 " 724.23 521.01 183.73 845.00 693.28 644.56 624.17 160.54 178.38 393.78 492.23 182.84 183.73 178.38 754.40 163.22 619.00 631.81 156.97 385.69 707.25 358.43 421.80 184.62 80326181 I&D SIMPLE ABSCESS 10060 320 $943.00 348.53 156.97 " 1,469.00 " 711.85 " 1,469.00 " 187.30 " 1,469.00 " 724.23 521.01 183.73 845.00 693.28 644.56 624.17 160.54 178.38 393.78 492.23 182.84 183.73 178.38 754.40 163.22 619.00 631.81 156.97 385.69 707.25 358.43 421.80 184.62 80626185 I&D SIMPLE ABSCESS 10060 350 $943.00 348.53 156.97 " 1,469.00 " 711.85 " 1,469.00 " 187.30 " 1,469.00 " 724.23 521.01 183.73 845.00 693.28 644.56 624.17 160.54 178.38 393.78 492.23 182.84 183.73 178.38 754.40 163.22 619.00 631.81 156.97 385.69 707.25 358.43 421.80 184.62 28162308 I&D ABSCESS COMP/MULTI 10061 360 "$1,816.00" 671.19 302.14 " 1,775.00 " 690.00 " 1,469.00 " 360.51 " 1,469.00 " 702.00 " 1,003.34 " 353.64 " 1,775.00 " 672.00 624.78 " 1,202.01 " 309.01 343.34 " 1,012.58 " " 1,265.72 " 351.92 353.64 343.34 " 1,452.80 " 314.16 600.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 37001163 I&D ABSCESS COMP/MULTI 10061 450 "$1,816.00" 671.19 302.14 " 1,775.00 " 690.00 " 1,469.00 " 360.51 " 1,469.00 " 702.00 " 1,003.34 " 353.64 " 1,775.00 " 672.00 624.78 " 1,202.01 " 309.01 343.34 " 1,012.58 " " 1,265.72 " 351.92 353.64 343.34 " 1,452.80 " 314.16 600.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 37001171 I&D CYST/SIMPLE 10080 450 "$3,265.00" " 1,206.74 " 393.78 " 2,612.00 " 892.40 " 1,469.00 " 649.06 " 1,469.00 " 907.92 " 1,803.91 " 636.69 845.00 869.12 808.05 " 2,161.10 " 556.34 618.15 393.78 492.23 633.60 636.69 618.15 " 2,612.00 " 565.61 776.00 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 37090590 I&D CYST/COMPLICATED 10081 450 "$3,265.00" " 1,206.74 " 543.97 " 2,612.00 " 653.20 " 1,469.00 " 649.06 " 1,469.00 " 664.56 " 1,803.91 " 636.69 845.00 636.16 591.46 " 2,161.10 " 556.34 618.15 " 1,012.58 " " 1,265.72 " 633.60 636.69 618.15 " 2,612.00 " 565.61 568.00 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 28162316 INC/RMV FOREIGN BODY/SIMPLE 10120 360 "$1,816.00" 671.19 302.14 " 1,469.00 " 893.55 " 1,469.00 " 360.51 " 1,469.00 " 909.09 " 1,003.34 " 353.64 845.00 870.24 809.09 " 1,202.01 " 309.01 343.34 393.78 492.23 351.92 353.64 343.34 " 1,452.80 " 314.16 777.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 37001198 INC/RMV FOREIGN BODY/SIMPLE 10120 450 "$1,816.00" 671.19 302.14 " 1,469.00 " 893.55 " 1,469.00 " 360.51 " 1,469.00 " 909.09 " 1,003.34 " 353.64 845.00 870.24 809.09 " 1,202.01 " 309.01 343.34 393.78 492.23 351.92 353.64 343.34 " 1,452.80 " 314.16 777.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 51600011 INC/RMV FOREIGN BODY/SIMPLE 10120 510 "$1,816.00" 671.19 302.14 " 1,469.00 " 893.55 " 1,469.00 " 360.51 " 1,469.00 " 909.09 " 1,003.34 " 353.64 845.00 870.24 809.09 " 1,202.01 " 309.01 343.34 393.78 492.23 351.92 353.64 343.34 " 1,452.80 " 314.16 777.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 80309368 INC/RMV FOREIGN BODY/SIMPLE 10120 320 "$1,816.00" 671.19 302.14 " 1,469.00 " 893.55 " 1,469.00 " 360.51 " 1,469.00 " 909.09 " 1,003.34 " 353.64 845.00 870.24 809.09 " 1,202.01 " 309.01 343.34 393.78 492.23 351.92 353.64 343.34 " 1,452.80 " 314.16 777.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 28162324 INC/RMV FOREIGN BODY/CMP 10121 360 "$7,387.00" " 2,730.24 " 720.00 " 5,909.60 " 828.00 " 1,718.00 " " 1,467.55 " " 1,718.00 " 842.40 " 4,081.32 " " 1,439.60 " " 2,820.00 " 806.40 749.74 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 2,208.66 " " 2,760.83 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 720.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 37003549 INC/RMV FOREIGN BODY/CMP 10121 450 "$7,387.00" " 2,730.24 " 720.00 " 5,909.60 " 828.00 " 1,718.00 " " 1,467.55 " " 1,718.00 " 842.40 " 4,081.32 " " 1,439.60 " " 2,820.00 " 806.40 749.74 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 2,208.66 " " 2,760.83 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 720.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28162332 I&D HEMATOMA 10140 360 "$7,387.00" " 2,730.24 " 618.80 " 5,909.60 " 711.85 " 1,469.00 " " 1,467.55 " " 1,469.00 " 724.23 " 4,081.32 " " 1,439.60 " 845.00 693.28 644.56 " 4,889.46 " " 1,257.90 " " 1,397.67 " 618.80 773.50 " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 619.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 30601921 I&D HEMATOMA 10140 480 "$7,387.00" " 2,730.24 " 618.80 " 5,909.60 " 711.85 " 1,469.00 " " 1,467.55 " " 1,469.00 " 724.23 " 4,081.32 " " 1,439.60 " 845.00 693.28 644.56 " 4,889.46 " " 1,257.90 " " 1,397.67 " 618.80 773.50 " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 619.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 37001210 I&D HEMATOMA 10140 450 "$7,387.00" " 2,730.24 " 618.80 " 5,909.60 " 711.85 " 1,469.00 " " 1,467.55 " " 1,469.00 " 724.23 " 4,081.32 " " 1,439.60 " 845.00 693.28 644.56 " 4,889.46 " " 1,257.90 " " 1,397.67 " 618.80 773.50 " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 619.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 51600029 I&D HEMATOMA 10140 510 "$7,387.00" " 2,730.24 " 618.80 " 5,909.60 " 711.85 " 1,469.00 " " 1,467.55 " " 1,469.00 " 724.23 " 4,081.32 " " 1,439.60 " 845.00 693.28 644.56 " 4,889.46 " " 1,257.90 " " 1,397.67 " 618.80 773.50 " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 619.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 67727444 I&D HEMATOMA 10140 350 "$7,387.00" " 2,730.24 " 618.80 " 5,909.60 " 711.85 " 1,469.00 " " 1,467.55 " " 1,469.00 " 724.23 " 4,081.32 " " 1,439.60 " 845.00 693.28 644.56 " 4,889.46 " " 1,257.90 " " 1,397.67 " 618.80 773.50 " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 619.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 80327447 I&D HEMATOMA 10140 320 "$7,387.00" " 2,730.24 " 618.80 " 5,909.60 " 711.85 " 1,469.00 " " 1,467.55 " " 1,469.00 " 724.23 " 4,081.32 " " 1,439.60 " 845.00 693.28 644.56 " 4,889.46 " " 1,257.90 " " 1,397.67 " 618.80 773.50 " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 619.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 80627441 I&D HEMATOMA 10140 350 "$7,387.00" " 2,730.24 " 618.80 " 5,909.60 " 711.85 " 1,469.00 " " 1,467.55 " " 1,469.00 " 724.23 " 4,081.32 " " 1,439.60 " 845.00 693.28 644.56 " 4,889.46 " " 1,257.90 " " 1,397.67 " 618.80 773.50 " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 619.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 37001228 PUNCTURE ASP ABSC/HEMAT/CYST 10160 450 "$1,816.00" 671.19 302.14 " 1,469.00 " 892.40 " 1,469.00 " 360.51 " 1,469.00 " 907.92 " 1,003.34 " 353.64 845.00 869.12 808.05 " 1,202.01 " 309.01 343.34 393.78 492.23 351.92 353.64 343.34 " 1,452.80 " 314.16 776.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 51600037 PUNCTURE ASP ABSC/HEMAT/CYST 10160 510 "$1,816.00" 671.19 302.14 " 1,469.00 " 892.40 " 1,469.00 " 360.51 " 1,469.00 " 907.92 " 1,003.34 " 353.64 845.00 869.12 808.05 " 1,202.01 " 309.01 343.34 393.78 492.23 351.92 353.64 343.34 " 1,452.80 " 314.16 776.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 67727070 PUNCTURE ASP ABSC/HEMAT/CYST 10160 350 "$1,816.00" 671.19 302.14 " 1,469.00 " 892.40 " 1,469.00 " 360.51 " 1,469.00 " 907.92 " 1,003.34 " 353.64 845.00 869.12 808.05 " 1,202.01 " 309.01 343.34 393.78 492.23 351.92 353.64 343.34 " 1,452.80 " 314.16 776.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 80327072 PUNCTURE ASP ABSC/HEMAT/CYST 10160 320 "$1,816.00" 671.19 302.14 " 1,469.00 " 892.40 " 1,469.00 " 360.51 " 1,469.00 " 907.92 " 1,003.34 " 353.64 845.00 869.12 808.05 " 1,202.01 " 309.01 343.34 393.78 492.23 351.92 353.64 343.34 " 1,452.80 " 314.16 776.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 80527071 PUNCTURE DRAINAGE OF LESION 10160 402 "$1,816.00" 671.19 302.14 " 1,469.00 " 892.40 " 1,469.00 " 360.51 " 1,469.00 " 907.92 " 1,003.34 " 353.64 845.00 869.12 808.05 " 1,202.01 " 309.01 343.34 393.78 492.23 351.92 353.64 343.34 " 1,452.80 " 314.16 776.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 80627076 PUNCTURE ASP ABSC/HEMAT/CYST 10160 350 "$1,816.00" 671.19 302.14 " 1,469.00 " 892.40 " 1,469.00 " 360.51 " 1,469.00 " 907.92 " 1,003.34 " 353.64 845.00 869.12 808.05 " 1,202.01 " 309.01 343.34 393.78 492.23 351.92 353.64 343.34 " 1,452.80 " 314.16 776.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 83027070 PUNCTURE ASP ABSC/HEMAT/CYST 10160 320 "$1,816.00" 671.19 302.14 " 1,469.00 " 892.40 " 1,469.00 " 360.51 " 1,469.00 " 907.92 " 1,003.34 " 353.64 845.00 869.12 808.05 " 1,202.01 " 309.01 343.34 393.78 492.23 351.92 353.64 343.34 " 1,452.80 " 314.16 776.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 28162341 I&D POSTOP WOUND INFECTION/CMP 10180 360 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 1,718.00 " " 2,473.07 " " 1,718.00 " 907.92 " 6,874.76 " " 2,425.96 " " 2,820.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,208.66 " " 2,760.83 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 51600045 I&D POSTOP WOUND INFECTION/CMP 10180 510 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 1,718.00 " " 2,473.07 " " 1,718.00 " 907.92 " 6,874.76 " " 2,425.96 " " 2,820.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,208.66 " " 2,760.83 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28162359 DEBRIDE INFECTED SKIN 11000 360 "$2,752.00" " 1,017.14 " 281.27 " 2,201.60 " 696.90 " 1,469.00 " 546.27 " 1,469.00 " 709.02 " 1,520.48 " 535.87 845.00 678.72 631.03 " 1,821.55 " 468.23 520.26 281.27 351.59 533.27 535.87 520.26 " 2,201.60 " 476.04 606.00 " 1,843.84 " 457.83 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 538.47 28162367 DEBRIDE GENITALIA & PERINEUM 11004 360 "$7,406.00" " 2,737.26 " - " 5,924.80 " - " 5,117.55 " N/A " 5,117.55 " - " 4,091.82 " N/A " 4,887.96 " - N/A " 4,902.03 " - N/A " 3,074.70 " " 3,843.37 " N/A N/A N/A " 5,924.80 " N/A - " 4,962.02 " N/A " 3,029.05 " " 5,554.50 " " 2,815.02 " " 3,312.70 " N/A 28162375 DEBRIDE ABDOM WALL 11005 360 "$2,911.00" " 1,075.91 " - " 5,227.58 " - " 2,011.50 " N/A " 2,011.50 " - " 1,608.33 " N/A " 1,921.26 " - N/A " 1,926.79 " - N/A " 4,182.06 " " 5,227.58 " N/A N/A N/A " 2,328.80 " N/A - " 1,950.37 " N/A " 1,190.60 " " 2,183.25 " " 1,106.47 " " 1,302.09 " N/A 28162383 DEBRIDE SKIN AT FX SITE 11010 360 "$3,265.00" " 1,206.74 " 543.97 " 2,970.02 " 892.40 " 1,718.00 " 649.06 " 1,718.00 " 907.92 " 1,803.91 " 636.69 " 2,820.00 " 869.12 808.05 " 2,161.10 " 556.34 618.15 " 2,376.02 " " 2,970.02 " 633.60 636.69 618.15 " 2,612.00 " 565.61 776.00 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 37090620 DEBRIDE SKIN AT FX SITE 11010 450 "$3,265.00" " 1,206.74 " 543.97 " 2,970.02 " 892.40 " 1,718.00 " 649.06 " 1,718.00 " 907.92 " 1,803.91 " 636.69 " 2,820.00 " 869.12 808.05 " 2,161.10 " 556.34 618.15 " 2,376.02 " " 2,970.02 " 633.60 636.69 618.15 " 2,612.00 " 565.61 776.00 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 28162391 DEBRIDE SKIN MUSC AT FX SITE 11011 360 "$3,265.00" " 1,206.74 " 543.97 " 2,970.02 " 892.40 " 1,718.00 " 649.06 " 1,718.00 " 907.92 " 1,803.91 " 636.69 " 2,820.00 " 869.12 808.05 " 2,161.10 " 556.34 618.15 " 2,376.02 " " 2,970.02 " 633.60 636.69 618.15 " 2,612.00 " 565.61 776.00 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 28162405 DBRDMNT SKIN BONE AT FX SITE 11012 360 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 1,718.00 " " 2,473.07 " " 1,718.00 " 907.92 " 6,874.76 " " 2,425.96 " " 2,820.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,376.02 " " 2,970.02 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 37089788 DBRDMNT SKIN BONE AT FX SITE 11012 450 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 1,718.00 " " 2,473.07 " " 1,718.00 " 907.92 " 6,874.76 " " 2,425.96 " " 2,820.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,376.02 " " 2,970.02 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28162413 DBRDMNT TISS/FS 1ST 20SQCM/< 11042 360 "$1,816.00" 671.19 302.14 " 2,820.00 " 696.90 " 1,718.00 " 360.51 " 1,718.00 " 709.02 " 1,003.34 " 353.64 " 2,820.00 " 678.72 631.03 " 1,202.01 " 309.01 343.34 " 2,208.66 " " 2,760.83 " 351.92 353.64 343.34 " 1,452.80 " 314.16 606.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 37001261 DBRDMNT TISS/FS 1ST 20SQCM/< 11042 450 "$1,816.00" 671.19 302.14 " 2,820.00 " 696.90 " 1,718.00 " 360.51 " 1,718.00 " 709.02 " 1,003.34 " 353.64 " 2,820.00 " 678.72 631.03 " 1,202.01 " 309.01 343.34 " 2,208.66 " " 2,760.83 " 351.92 353.64 343.34 " 1,452.80 " 314.16 606.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 51600053 DBRDMNT TISS/FS 1ST 20SQCM/< 11042 510 "$1,816.00" 671.19 302.14 " 2,820.00 " 696.90 " 1,718.00 " 360.51 " 1,718.00 " 709.02 " 1,003.34 " 353.64 " 2,820.00 " 678.72 631.03 " 1,202.01 " 309.01 343.34 " 2,208.66 " " 2,760.83 " 351.92 353.64 343.34 " 1,452.80 " 314.16 606.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 28162421 DBRDMNT MUC/FS 1ST 20SQCM/< 11043 360 "$2,752.00" " 1,017.14 " 457.83 " 2,820.00 " 696.90 " 1,718.00 " 546.27 " 1,718.00 " 709.02 " 1,520.48 " 535.87 " 2,820.00 " 678.72 631.03 " 1,821.55 " 468.23 520.26 " 2,208.66 " " 2,760.83 " 533.27 535.87 520.26 " 2,201.60 " 476.04 606.00 " 1,843.84 " 457.83 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 538.47 51600061 DBRDMNT MUC/FS 1ST 20SQCM/< 11043 510 "$2,752.00" " 1,017.14 " 457.83 " 2,820.00 " 696.90 " 1,718.00 " 546.27 " 1,718.00 " 709.02 " 1,520.48 " 535.87 " 2,820.00 " 678.72 631.03 " 1,821.55 " 468.23 520.26 " 2,208.66 " " 2,760.83 " 533.27 535.87 520.26 " 2,201.60 " 476.04 606.00 " 1,843.84 " 457.83 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 538.47 28162430 DBRDMNT BONE 1ST 20SQCM/< 11044 360 "$7,387.00" " 2,730.24 " 606.00 " 5,909.60 " 696.90 " 1,718.00 " " 1,467.55 " " 1,718.00 " 709.02 " 4,081.32 " " 1,439.60 " " 2,820.00 " 678.72 631.03 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 2,208.66 " " 2,760.83 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 606.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 37088862 DBRDMNT BONE 1ST 20SQCM/< 11044 450 "$7,387.00" " 2,730.24 " 606.00 " 5,909.60 " 696.90 " 1,718.00 " " 1,467.55 " " 1,718.00 " 709.02 " 4,081.32 " " 1,439.60 " " 2,820.00 " 678.72 631.03 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 2,208.66 " " 2,760.83 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 606.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 51600070 DBRDMNT BONE 1ST 20SQCM/< 11044 510 "$7,387.00" " 2,730.24 " 606.00 " 5,909.60 " 696.90 " 1,718.00 " " 1,467.55 " " 1,718.00 " 709.02 " 4,081.32 " " 1,439.60 " " 2,820.00 " 678.72 631.03 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 2,208.66 " " 2,760.83 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 606.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28162448 DBRDMNT SQ TISS ADD 20SQCM OR< 11045 360 $91.00 33.63 - " 1,469.00 " - " 1,469.00 " - " 1,469.00 " - 50.28 - 60.06 - - 60.23 - - 171.18 213.98 - - - 72.80 - - 60.97 - 37.22 68.25 34.59 40.70 - 37089966 DBRDMNT SQ TISS ADD 20SQCM OR< 11045 450 $91.00 33.63 - " 1,469.00 " - " 1,469.00 " - " 1,469.00 " - 50.28 - 60.06 - - 60.23 - - 171.18 213.98 - - - 72.80 - - 60.97 - 37.22 68.25 34.59 40.70 - 51600088 DBRDMNT SQ TISS ADD 20SQCM OR< 11045 510 $91.00 33.63 - " 1,469.00 " - " 1,469.00 " - " 1,469.00 " - 50.28 - 60.06 - - 60.23 - - 171.18 213.98 - - - 72.80 - - 60.97 - 37.22 68.25 34.59 40.70 - 28162456 DBRDMNT MUC/FC ADDL 20SQCM 11046 360 $91.00 33.63 - " 1,469.00 " - " 1,469.00 " - " 1,469.00 " - 50.28 - 60.06 - - 60.23 - - 298.21 372.76 - - - 72.80 - - 60.97 - 37.22 68.25 34.59 40.70 - 51600096 DBRDMNT MUC/FC ADDL 20SQCM 11046 510 $91.00 33.63 - " 1,469.00 " - " 1,469.00 " - " 1,469.00 " - 50.28 - 60.06 - - 60.23 - - 298.21 372.76 - - - 72.80 - - 60.97 - 37.22 68.25 34.59 40.70 - 28162464 DBRDMNT BONE ADDL 20SQCM 11047 360 $412.00 152.28 - " 1,469.00 " - " 1,469.00 " - " 1,469.00 " - 227.63 - 271.92 - - 272.70 - - 491.72 614.65 - - - 329.60 - - 276.04 - 168.51 309.00 156.60 184.29 - 51600100 DBRDMNT BONE ADDL 20SQCM 11047 510 $412.00 152.28 - " 1,469.00 " - " 1,469.00 " - " 1,469.00 " - 227.63 - 271.92 - - 272.70 - - 491.72 614.65 - - - 329.60 - - 276.04 - 168.51 309.00 156.60 184.29 - 28162472 BX TANGNTL SKIN SINGLE LESN 11102 360 $943.00 348.53 156.97 907.92 892.40 651.61 187.30 651.61 907.92 521.01 183.73 845.00 869.12 808.05 624.17 160.54 178.38 541.67 677.09 182.84 183.73 178.38 754.40 163.22 776.00 631.81 156.97 385.69 707.25 358.43 421.80 184.62 37004481 BX TANGNTL SKIN SINGLE LESN 11102 450 $943.00 348.53 156.97 907.92 892.40 651.61 187.30 651.61 907.92 521.01 183.73 845.00 869.12 808.05 624.17 160.54 178.38 541.67 677.09 182.84 183.73 178.38 754.40 163.22 776.00 631.81 156.97 385.69 707.25 358.43 421.80 184.62 51600851 BX TANGNTL SKIN SINGLE LESN 11102 510 $943.00 348.53 156.97 907.92 892.40 651.61 187.30 651.61 907.92 521.01 183.73 845.00 869.12 808.05 624.17 160.54 178.38 541.67 677.09 182.84 183.73 178.38 754.40 163.22 776.00 631.81 156.97 385.69 707.25 358.43 421.80 184.62 37004499 BX TANGNTL SKIN EA SEP ADDL 11103 450 $322.00 119.01 - 365.58 21.45 222.50 - 222.50 21.82 177.91 - 212.52 20.89 19.42 213.13 - - 292.46 365.58 - - - 257.60 - 18.65 215.74 - 131.70 241.50 122.39 144.03 - 51600860 BX TANGNTL SKIN EA SEP ADDL 11103 510 $322.00 119.01 - 365.58 21.45 222.50 - 222.50 21.82 177.91 - 212.52 20.89 19.42 213.13 - - 292.46 365.58 - - - 257.60 - 18.65 215.74 - 131.70 241.50 122.39 144.03 - 37004502 BX PUNCH SKIN SINGLE LESION 11104 450 "$1,816.00" 671.19 302.14 " 1,452.80 " 892.40 " 1,254.86 " 360.51 " 1,254.86 " 907.92 " 1,003.34 " 353.64 845.00 869.12 808.05 " 1,202.01 " 309.01 343.34 680.90 851.13 351.92 353.64 343.34 " 1,452.80 " 314.16 776.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 51600878 BX PUNCH SKIN SINGLE LESION 11104 510 "$1,816.00" 671.19 302.14 " 1,452.80 " 892.40 " 1,254.86 " 360.51 " 1,254.86 " 907.92 " 1,003.34 " 353.64 845.00 869.12 808.05 " 1,202.01 " 309.01 343.34 680.90 851.13 351.92 353.64 343.34 " 1,452.80 " 314.16 776.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 37004511 BX PUNCH SKIN EA SEP ADDL 11105 450 $322.00 119.01 - 419.17 25.36 222.50 - 222.50 25.80 177.91 - 212.52 24.70 22.96 213.13 - - 335.34 419.17 - - - 257.60 - 22.05 215.74 - 131.70 241.50 122.39 144.03 - 51600886 BX PUNCH SKIN EA SEP ADDL 11105 510 $322.00 119.01 - 419.17 25.36 222.50 - 222.50 25.80 177.91 - 212.52 24.70 22.96 213.13 - - 335.34 419.17 - - - 257.60 - 22.05 215.74 - 131.70 241.50 122.39 144.03 - 28162481 BX INCISIONAL SKIN SINGLE LESN 11106 360 "$2,752.00" " 1,017.14 " 457.83 " 2,201.60 " 892.40 " 1,901.63 " 546.27 " 1,901.63 " 907.92 " 1,520.48 " 535.87 " 1,775.00 " 869.12 808.05 " 1,821.55 " 468.23 520.26 824.24 " 1,030.30 " 533.27 535.87 520.26 " 2,201.60 " 476.04 776.00 " 1,843.84 " 457.83 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 538.47 37004529 BX INCISIONAL SKIN SINGLE LESN 11106 450 "$2,752.00" " 1,017.14 " 457.83 " 2,201.60 " 892.40 " 1,901.63 " 546.27 " 1,901.63 " 907.92 " 1,520.48 " 535.87 " 1,775.00 " 869.12 808.05 " 1,821.55 " 468.23 520.26 824.24 " 1,030.30 " 533.27 535.87 520.26 " 2,201.60 " 476.04 776.00 " 1,843.84 " 457.83 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 538.47 51600894 BX INCISIONAL SKIN SINGLE LESN 11106 510 "$2,752.00" " 1,017.14 " 457.83 " 2,201.60 " 892.40 " 1,901.63 " 546.27 " 1,901.63 " 907.92 " 1,520.48 " 535.87 " 1,775.00 " 869.12 808.05 " 1,821.55 " 468.23 520.26 824.24 " 1,030.30 " 533.27 535.87 520.26 " 2,201.60 " 476.04 776.00 " 1,843.84 " 457.83 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 538.47 37004537 BX INCISIONAL SKIN EA SEP ADDL 11107 450 $322.00 119.01 - 494.34 30.23 222.50 - 222.50 30.76 177.91 - 212.52 29.44 27.38 213.13 - - 395.47 494.34 - - - 257.60 - 26.29 215.74 - 131.70 241.50 122.39 144.03 - 51600908 BX INCISIONAL SKIN EA SEP ADDL 11107 510 $322.00 119.01 - 494.34 30.23 222.50 - 222.50 30.76 177.91 - 212.52 29.44 27.38 213.13 - - 395.47 494.34 - - - 257.60 - 26.29 215.74 - 131.70 241.50 122.39 144.03 - 28162499 REMOVE SKN TAGS 4.0 CM 11406 360 "$7,387.00" " 2,730.24 " 837.00 " 5,909.60 " 962.55 " 1,718.00 " " 1,467.55 " " 1,718.00 " 979.29 " 4,081.32 " " 1,439.60 " " 2,820.00 " 937.44 871.57 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 2,208.66 " " 2,760.83 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 837.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28162570 EXC H-F-NK-SP B9+MARG 0.5/< 11420 360 "$7,387.00" " 2,730.24 " 572.00 " 5,909.60 " 657.80 " 1,718.00 " " 1,467.55 " " 1,718.00 " 669.24 " 4,081.32 " " 1,439.60 " " 1,775.00 " 640.64 595.62 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 572.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28162588 EXC H-F-NK-SP B9+MARG 0.6-1 11421 360 "$3,265.00" " 1,206.74 " 543.97 " 2,612.00 " 779.70 " 1,718.00 " 649.06 " 1,718.00 " 793.26 " 1,803.91 " 636.69 " 1,775.00 " 759.36 706.00 " 2,161.10 " 556.34 618.15 " 1,649.49 " " 2,061.86 " 633.60 636.69 618.15 " 2,612.00 " 565.61 678.00 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 28162596 EXC H-F-NK-SP B9+MARG 1.1-2 11422 360 "$7,387.00" " 2,730.24 " 741.00 " 5,909.60 " 852.15 " 1,469.00 " " 1,467.55 " " 1,469.00 " 866.97 " 4,081.32 " " 1,439.60 " " 1,775.00 " 829.92 771.60 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 741.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28162600 EXC H-F-NK-SP B9+MARG 2.1-3 11423 360 "$7,387.00" " 2,730.24 " 691.00 " 5,909.60 " 794.65 " 1,469.00 " " 1,467.55 " " 1,469.00 " 808.47 " 4,081.32 " " 1,439.60 " " 1,775.00 " 773.92 719.54 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 691.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28162618 EXC H-F-NK-SP B9+MARG >4 CM 11426 360 "$12,443.00" " 4,598.93 " 846.00 " 9,954.40 " 972.90 " 1,718.00 " " 2,473.07 " " 1,718.00 " 989.82 " 6,874.76 " " 2,425.96 " " 2,820.00 " 947.52 880.94 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,208.66 " " 2,760.83 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 846.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28162626 EXC FACE-MM B9+MARG 0.5 CM/< 11440 360 "$3,265.00" " 1,206.74 " 543.97 " 2,612.00 " 892.40 " 1,718.00 " 649.06 " 1,718.00 " 907.92 " 1,803.91 " 636.69 " 1,775.00 " 869.12 808.05 " 2,161.10 " 556.34 618.15 " 1,649.49 " " 2,061.86 " 633.60 636.69 618.15 " 2,612.00 " 565.61 776.00 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 28162634 EXC FACE-MM B9+MARG 0.6-1 CM 11441 360 "$3,265.00" " 1,206.74 " 527.00 " 2,612.00 " 606.05 " 1,718.00 " 649.06 " 1,718.00 " 616.59 " 1,803.91 " 636.69 " 1,775.00 " 590.24 548.77 " 2,161.10 " 556.34 618.15 " 1,649.49 " " 2,061.86 " 633.60 636.69 618.15 " 2,612.00 " 565.61 527.00 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 28162642 EXC FACE-MM B9+MARG 1.1-2 CM 11442 360 "$3,265.00" " 1,206.74 " 543.97 " 2,612.00 " 868.25 " 1,469.00 " 649.06 " 1,469.00 " 883.35 " 1,803.91 " 636.69 " 1,775.00 " 845.60 786.18 " 2,161.10 " 556.34 618.15 " 1,649.49 " " 2,061.86 " 633.60 636.69 618.15 " 2,612.00 " 565.61 755.00 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 28162651 EXC FACE-MM B9+MARG 2.1-3 CM 11443 360 "$7,387.00" " 2,730.24 " 920.00 " 5,909.60 " " 1,058.00 " " 1,469.00 " " 1,467.55 " " 1,469.00 " " 1,076.40 " " 4,081.32 " " 1,439.60 " " 1,775.00 " " 1,030.40 " 958.00 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 920.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28162669 REM SWEAT GLAND AXIL TIS SIMP 11450 360 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 1,718.00 " " 2,473.07 " " 1,718.00 " 907.92 " 6,874.76 " " 2,425.96 " " 2,820.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,208.66 " " 2,760.83 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28162677 REM SWEAT GLAND AXIL TIS COMP 11451 360 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 1,718.00 " " 2,473.07 " " 1,718.00 " 907.92 " 6,874.76 " " 2,425.96 " " 2,820.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,208.66 " " 2,760.83 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28162685 REM SWEAT GLAND INGUIN TIS SIM 11462 360 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 1,718.00 " " 2,473.07 " " 1,718.00 " 907.92 " 6,874.76 " " 2,425.96 " " 2,820.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,208.66 " " 2,760.83 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28162693 REM SWEAT GLAND OTHER TIS SIMP 11470 360 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 1,718.00 " " 2,473.07 " " 1,718.00 " 907.92 " 6,874.76 " " 2,425.96 " " 2,820.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,208.66 " " 2,760.83 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28162707 EXC TR-EXT MAL+MARG 0.6-1 CM 11601 360 "$3,265.00" " 1,206.74 " 543.97 " 2,612.00 " 892.40 " 1,469.00 " 649.06 " 1,469.00 " 907.92 " 1,803.91 " 636.69 " 1,775.00 " 869.12 808.05 " 2,161.10 " 556.34 618.15 " 1,649.49 " " 2,061.86 " 633.60 636.69 618.15 " 2,612.00 " 565.61 776.00 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 28162715 EXC TR-EXT MAL+MARG 1.1-2 CM 11602 360 "$1,816.00" 671.19 302.14 " 2,061.86 " 892.40 " 1,469.00 " 360.51 " 1,469.00 " 907.92 " 1,003.34 " 353.64 " 1,775.00 " 869.12 808.05 " 1,202.01 " 309.01 343.34 " 1,649.49 " " 2,061.86 " 351.92 353.64 343.34 " 1,452.80 " 314.16 776.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 28162723 EXC TR-EXT MAL+MARG 2.1-3 CM 11603 360 "$3,265.00" " 1,206.74 " 543.97 " 2,612.00 " 892.40 " 1,469.00 " 649.06 " 1,469.00 " 907.92 " 1,803.91 " 636.69 " 1,775.00 " 869.12 808.05 " 2,161.10 " 556.34 618.15 " 1,649.49 " " 2,061.86 " 633.60 636.69 618.15 " 2,612.00 " 565.61 776.00 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 28162731 EXC TR-EXT MAL+MARG 3.1-4 CM 11604 360 "$3,265.00" " 1,206.74 " 543.97 " 2,820.00 " 892.40 " 1,718.00 " 649.06 " 1,718.00 " 907.92 " 1,803.91 " 636.69 " 2,820.00 " 869.12 808.05 " 2,161.10 " 556.34 618.15 " 2,208.66 " " 2,760.83 " 633.60 636.69 618.15 " 2,612.00 " 565.61 776.00 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 28162740 EXC TR-EXT MAL+MARG >4 CM 11606 360 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,718.00 " " 1,467.55 " " 1,718.00 " 907.92 " 4,081.32 " " 1,439.60 " " 2,820.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 2,208.66 " " 2,760.83 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28162758 EXC S/N/H/F/G MAL+MRG 0.6-1 11621 360 "$3,265.00" " 1,206.74 " 543.97 " 2,612.00 " 892.40 " 1,469.00 " 649.06 " 1,469.00 " 907.92 " 1,803.91 " 636.69 " 1,775.00 " 869.12 808.05 " 2,161.10 " 556.34 618.15 " 1,649.49 " " 2,061.86 " 633.60 636.69 618.15 " 2,612.00 " 565.61 776.00 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 28162766 EXC S/N/H/F/G MAL+MRG 1.1-2 11622 360 "$3,265.00" " 1,206.74 " 543.97 " 2,760.83 " 892.40 " 1,469.00 " 649.06 " 1,469.00 " 907.92 " 1,803.91 " 636.69 " 1,775.00 " 869.12 808.05 " 2,161.10 " 556.34 618.15 " 2,208.66 " " 2,760.83 " 633.60 636.69 618.15 " 2,612.00 " 565.61 776.00 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 28162774 EXC S/N/H/F/G MAL+MRG 2.1-3 11623 360 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,469.00 " " 1,467.55 " " 1,469.00 " 907.92 " 4,081.32 " " 1,439.60 " 845.00 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 2,208.66 " " 2,760.83 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28162782 EXC S/N/H/F/G MAL+MRG 3.1-4 11624 360 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,718.00 " " 1,467.55 " " 1,718.00 " 907.92 " 4,081.32 " " 1,439.60 " " 2,820.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 2,208.66 " " 2,760.83 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28162791 EXC S/N/H/F/G MAL+MRG >4 CM 11626 360 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 1,718.00 " " 2,473.07 " " 1,718.00 " 907.92 " 6,874.76 " " 2,425.96 " " 2,820.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,208.66 " " 2,760.83 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28162804 EXC F/E/E/N/L MAL+MRG 1.1-2 11642 360 "$3,265.00" " 1,206.74 " 543.97 " 2,760.83 " 892.40 " 1,718.00 " 649.06 " 1,718.00 " 907.92 " 1,803.91 " 636.69 " 1,775.00 " 869.12 808.05 " 2,161.10 " 556.34 618.15 " 2,208.66 " " 2,760.83 " 633.60 636.69 618.15 " 2,612.00 " 565.61 776.00 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 28162812 EXC F/E/E/N/L MAL+MRG 2.1-3 11643 360 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,718.00 " " 1,467.55 " " 1,718.00 " 907.92 " 4,081.32 " " 1,439.60 " " 1,775.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 2,208.66 " " 2,760.83 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28176180 EXC F/E/E/N/L MAL+MRG 3.1-4 11644 360 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,718.00 " " 1,467.55 " " 1,718.00 " 907.92 " 4,081.32 " " 1,439.60 " " 2,820.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 2,208.66 " " 2,760.83 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28162821 EXC F/E/E/N/L MAL+MRG >4 CM 11646 360 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 1,718.00 " " 2,473.07 " " 1,718.00 " 907.92 " 6,874.76 " " 2,425.96 " " 2,820.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,208.66 " " 2,760.83 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 51600126 NAIL DEBRIDEMENT 1-5 11720 510 $292.00 107.92 15.57 " 1,469.00 " 17.91 " 1,469.00 " 58.05 " 1,469.00 " 18.22 161.33 56.95 845.00 17.44 16.21 193.27 49.76 55.29 141.48 176.85 56.67 56.95 55.29 233.60 50.59 15.57 195.64 48.66 119.43 219.00 110.99 130.61 57.23 28174748 DEBRID NAILS 6 OR MORE 11721 360 $292.00 107.92 20.00 " 1,469.00 " 23.00 " 1,469.00 " 58.05 " 1,469.00 " 23.40 161.33 56.95 845.00 22.40 20.83 193.27 49.76 55.29 213.09 266.36 56.67 56.95 55.29 233.60 50.59 20.00 195.64 48.66 119.43 219.00 110.99 130.61 57.23 51600134 NAIL DEBRIDEMENT 6/> 11721 510 $292.00 107.92 20.00 " 1,469.00 " 23.00 " 1,469.00 " 58.05 " 1,469.00 " 23.40 161.33 56.95 845.00 22.40 20.83 193.27 49.76 55.29 213.09 266.36 56.67 56.95 55.29 233.60 50.59 20.00 195.64 48.66 119.43 219.00 110.99 130.61 57.23 28162839 AVULSION OF NAIL PLATE SMPL 11730 360 $943.00 348.53 25.75 " 1,469.00 " 29.61 " 1,469.00 " 187.30 " 1,469.00 " 30.13 521.01 183.73 845.00 28.84 26.81 624.17 160.54 178.38 393.78 492.23 182.84 183.73 178.38 754.40 163.22 25.75 631.81 156.97 385.69 707.25 358.43 421.80 184.62 37003077 AVULSION OF NAIL PLATE SMPL 11730 450 $943.00 348.53 25.75 " 1,469.00 " 29.61 " 1,469.00 " 187.30 " 1,469.00 " 30.13 521.01 183.73 845.00 28.84 26.81 624.17 160.54 178.38 393.78 492.23 182.84 183.73 178.38 754.40 163.22 25.75 631.81 156.97 385.69 707.25 358.43 421.80 184.62 51600142 AVULSION OF NAIL PLATE SMPL 11730 510 $943.00 348.53 25.75 " 1,469.00 " 29.61 " 1,469.00 " 187.30 " 1,469.00 " 30.13 521.01 183.73 845.00 28.84 26.81 624.17 160.54 178.38 393.78 492.23 182.84 183.73 178.38 754.40 163.22 25.75 631.81 156.97 385.69 707.25 358.43 421.80 184.62 28162847 AVULSION OF NAIL PLATE EA ADDL 11732 360 $136.00 50.27 - " 1,469.00 " 29.61 " 1,469.00 " - " 1,469.00 " 30.13 75.14 - 89.76 28.84 26.81 90.02 - - 281.27 351.59 - - - 108.80 - 25.75 91.12 - 55.62 102.00 51.69 60.83 - 51600151 AVULSION OF NAIL PLATE EA ADDL 11732 510 $136.00 50.27 - " 1,469.00 " 29.61 " 1,469.00 " - " 1,469.00 " 30.13 75.14 - 89.76 28.84 26.81 90.02 - - 281.27 351.59 - - - 108.80 - 25.75 91.12 - 55.62 102.00 51.69 60.83 - 37089443 DRAIN BLOOD FROM UNDER NAIL 11740 450 $588.00 217.32 98.57 " 1,469.00 " 892.40 " 1,469.00 " 117.61 " 1,469.00 " 907.92 324.87 115.37 845.00 869.12 808.05 389.20 100.81 112.01 281.27 351.59 114.81 115.37 112.01 470.40 102.49 776.00 393.96 98.57 240.49 441.00 223.50 263.01 115.93 28162855 EXC NAIL/MATRIX PERMANENT 11750 360 "$1,816.00" 671.19 302.14 " 1,775.00 " 892.40 " 1,469.00 " 360.51 " 1,469.00 " 907.92 " 1,003.34 " 353.64 " 1,775.00 " 869.12 808.05 " 1,202.01 " 309.01 343.34 " 1,012.58 " " 1,265.72 " 351.92 353.64 343.34 " 1,452.80 " 314.16 776.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 37003034 EXC NAIL/MATRIX PERMANENT 11750 450 "$1,816.00" 671.19 302.14 " 1,775.00 " 892.40 " 1,469.00 " 360.51 " 1,469.00 " 907.92 " 1,003.34 " 353.64 " 1,775.00 " 869.12 808.05 " 1,202.01 " 309.01 343.34 " 1,012.58 " " 1,265.72 " 351.92 353.64 343.34 " 1,452.80 " 314.16 776.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 51600169 EXC NAIL/MATRIX PERMANENT 11750 510 "$1,816.00" 671.19 302.14 " 1,775.00 " 892.40 " 1,469.00 " 360.51 " 1,469.00 " 907.92 " 1,003.34 " 353.64 " 1,775.00 " 869.12 808.05 " 1,202.01 " 309.01 343.34 " 1,012.58 " " 1,265.72 " 351.92 353.64 343.34 " 1,452.80 " 314.16 776.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 28162863 BIOPSY NAIL UNIT 11755 360 "$3,265.00" " 1,206.74 " 75.26 " 2,612.00 " 86.55 " 1,469.00 " 649.06 " 1,469.00 " 88.05 " 1,803.91 " 636.69 " 1,775.00 " 84.29 78.37 " 2,161.10 " 556.34 618.15 " 1,649.49 " " 2,061.86 " 633.60 636.69 618.15 " 2,612.00 " 565.61 75.26 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 28162871 REPAIR OF NAIL BED 11760 360 "$2,752.00" " 1,017.14 " 457.83 " 2,201.60 " 892.40 " 1,469.00 " 546.27 " 1,469.00 " 907.92 " 1,520.48 " 535.87 845.00 869.12 808.05 " 1,821.55 " 468.23 520.26 " 1,649.49 " " 2,061.86 " 533.27 535.87 520.26 " 2,201.60 " 476.04 776.00 " 1,843.84 " 457.83 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 538.47 37002755 REPAIR OF NAIL BED 11760 450 "$2,752.00" " 1,017.14 " 457.83 " 2,201.60 " 892.40 " 1,469.00 " 546.27 " 1,469.00 " 907.92 " 1,520.48 " 535.87 845.00 869.12 808.05 " 1,821.55 " 468.23 520.26 " 1,649.49 " " 2,061.86 " 533.27 535.87 520.26 " 2,201.60 " 476.04 776.00 " 1,843.84 " 457.83 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 538.47 37090158 EXCISION OF NAIL FOLD TOE 11765 450 "$1,816.00" 671.19 50.00 " 1,469.00 " 57.50 " 1,469.00 " 360.51 " 1,469.00 " 58.50 " 1,003.34 " 353.64 845.00 56.00 52.07 " 1,202.01 " 309.01 343.34 281.27 351.59 351.92 353.64 343.34 " 1,452.80 " 314.16 50.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 28162880 REMOVE PILONIDAL CYST SIMPLE 11770 360 "$12,443.00" " 4,598.93 " 690.00 " 9,954.40 " 793.50 " 2,773.00 " " 2,473.07 " " 2,773.00 " 807.30 " 6,874.76 " " 2,425.96 " " 3,545.00 " 772.80 718.50 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,532.97 " " 3,166.21 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 690.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28162898 REMOVE PILONIDAL CYST EXTEN 11771 360 "$12,443.00" " 4,598.93 " 838.00 " 9,954.40 " 963.70 " 2,773.00 " " 2,473.07 " " 2,773.00 " 980.46 " 6,874.76 " " 2,425.96 " " 3,545.00 " 938.56 872.61 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,532.97 " " 3,166.21 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 838.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28162901 REMOVE PILONIDAL CYST COMPL 11772 360 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 2,773.00 " " 2,473.07 " " 2,773.00 " 907.92 " 6,874.76 " " 2,425.96 " " 3,545.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,532.97 " " 3,166.21 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28162910 INSERT TISSUE EXPANDER(S) 11960 360 "$18,491.00" " 6,834.27 " 776.00 " 14,792.80 " 892.40 " 1,718.00 " " 3,672.72 " " 1,718.00 " 907.92 " 10,216.28 " " 3,602.76 " " 2,820.00 " 869.12 808.05 " 12,239.19 " " 3,148.05 " " 3,497.83 " " 2,208.66 " " 2,760.83 " " 3,585.28 " " 3,602.76 " " 3,497.83 " " 14,792.80 " " 3,200.51 " 776.00 " 12,388.97 " " 3,078.09 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,620.25 " 28162928 REPLACE TISSUE EXPANDER 11970 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28162936 REMOVE TISSUE EXPANDER(S) 11971 360 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 1,469.00 " " 2,473.07 " " 1,469.00 " 907.92 " 6,874.76 " " 2,425.96 " " 1,775.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 1,649.49 " " 2,061.86 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28162944 INSERT DRUG IMPLANT DEVICE 11981 360 $588.00 217.32 98.57 " 1,469.00 " 892.40 " 1,469.00 " 117.61 " 1,469.00 " 907.92 324.87 115.37 845.00 869.12 808.05 389.20 100.81 112.01 668.14 835.17 114.81 115.37 112.01 470.40 102.49 776.00 393.96 98.57 240.49 441.00 223.50 263.01 115.93 28162952 REMOVE DRUG IMPLANT DEVICE 11982 360 "$1,419.00" 524.46 237.25 " 1,469.00 " 892.40 " 1,469.00 " 283.08 " 1,469.00 " 907.92 784.00 277.69 845.00 869.12 808.05 939.24 242.64 269.60 787.56 984.45 276.34 277.69 269.60 " 1,135.20 " 246.68 776.00 950.73 237.25 580.37 " 1,064.25 " 539.36 634.72 279.04 37001562 SMP WND RPR TRUNK 2.5CM/< 12001 450 $943.00 348.53 156.97 " 1,469.00 " 604.90 " 1,469.00 " 187.30 " 1,469.00 " 615.42 521.01 183.73 845.00 589.12 547.72 624.17 160.54 178.38 393.78 492.23 182.84 183.73 178.38 754.40 163.22 526.00 631.81 156.97 385.69 707.25 358.43 421.80 184.62 51600843 SMP WND RPR TRUNK 2.5CM/< 12001 510 $943.00 348.53 156.97 " 1,469.00 " 604.90 " 1,469.00 " 187.30 " 1,469.00 " 615.42 521.01 183.73 845.00 589.12 547.72 624.17 160.54 178.38 393.78 492.23 182.84 183.73 178.38 754.40 163.22 526.00 631.81 156.97 385.69 707.25 358.43 421.80 184.62 28162961 SMP WND RPR TRUNK 2.6-7.5CM 12002 360 $943.00 348.53 156.97 907.92 892.40 651.61 187.30 651.61 907.92 521.01 183.73 845.00 869.12 808.05 624.17 160.54 178.38 393.78 492.23 182.84 183.73 178.38 754.40 163.22 776.00 631.81 156.97 385.69 707.25 358.43 421.80 184.62 37001571 SMP WND RPR TRUNK 2.6-7.5CM 12002 450 $943.00 348.53 156.97 907.92 892.40 651.61 187.30 651.61 907.92 521.01 183.73 845.00 869.12 808.05 624.17 160.54 178.38 393.78 492.23 182.84 183.73 178.38 754.40 163.22 776.00 631.81 156.97 385.69 707.25 358.43 421.80 184.62 51600177 SMP WND RPR TRUNK 2.6-7.5CM 12002 510 $943.00 348.53 156.97 907.92 892.40 651.61 187.30 651.61 907.92 521.01 183.73 845.00 869.12 808.05 624.17 160.54 178.38 393.78 492.23 182.84 183.73 178.38 754.40 163.22 776.00 631.81 156.97 385.69 707.25 358.43 421.80 184.62 37001589 SMP WND RPR TRUNK 7.6-12.5CM 12004 450 $943.00 348.53 156.97 " 1,469.00 " 848.70 " 1,469.00 " 187.30 " 1,469.00 " 863.46 521.01 183.73 845.00 826.56 768.48 624.17 160.54 178.38 618.80 773.50 182.84 183.73 178.38 754.40 163.22 738.00 631.81 156.97 385.69 707.25 358.43 421.80 184.62 37001597 SMP WND RPR TRUNK 12.6-20CM 12005 450 "$1,816.00" 671.19 302.14 " 2,820.00 " 892.40 " 1,718.00 " 360.51 " 1,718.00 " 907.92 " 1,003.34 " 353.64 " 2,820.00 " 869.12 808.05 " 1,202.01 " 309.01 343.34 " 2,208.66 " " 2,760.83 " 351.92 353.64 343.34 " 1,452.80 " 314.16 776.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 37001601 SMP WND RPR TRUNK 20.1-30CM 12006 450 "$1,816.00" 671.19 302.14 " 2,820.00 " 892.40 " 1,718.00 " 360.51 " 1,718.00 " 907.92 " 1,003.34 " 353.64 " 2,820.00 " 869.12 808.05 " 1,202.01 " 309.01 343.34 " 2,208.66 " " 2,760.83 " 351.92 353.64 343.34 " 1,452.80 " 314.16 776.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 37001619 SMP WND RPR TRUNK >30CM 12007 450 $943.00 348.53 156.97 " 2,820.00 " 892.40 " 1,718.00 " 187.30 " 1,718.00 " 907.92 521.01 183.73 " 2,820.00 " 869.12 808.05 624.17 160.54 178.38 " 2,208.66 " " 2,760.83 " 182.84 183.73 178.38 754.40 163.22 776.00 631.81 156.97 385.69 707.25 358.43 421.80 184.62 37001627 SMP WND RPR FACE 2.5CM/< 12011 450 $943.00 348.53 156.97 845.00 566.95 651.61 187.30 651.61 576.81 521.01 183.73 845.00 552.16 513.36 624.17 160.54 178.38 393.78 492.23 182.84 183.73 178.38 754.40 163.22 493.00 631.81 156.97 385.69 707.25 358.43 421.80 184.62 37001635 SMP WND RPR FACE 2.6-5.0CM 12013 450 $943.00 348.53 156.97 907.92 892.40 651.61 187.30 651.61 907.92 521.01 183.73 845.00 869.12 808.05 624.17 160.54 178.38 393.78 492.23 182.84 183.73 178.38 754.40 163.22 776.00 631.81 156.97 385.69 707.25 358.43 421.80 184.62 37001643 SMP WND RPR FACE 5.1-7.5CM 12014 450 $943.00 348.53 156.97 " 1,469.00 " 892.40 " 1,469.00 " 187.30 " 1,469.00 " 907.92 521.01 183.73 845.00 869.12 808.05 624.17 160.54 178.38 618.80 773.50 182.84 183.73 178.38 754.40 163.22 776.00 631.81 156.97 385.69 707.25 358.43 421.80 184.62 37001651 SMP WND RPR FACE 7.6-12.5CM 12015 450 $943.00 348.53 156.97 " 1,469.00 " 631.35 " 1,469.00 " 187.30 " 1,469.00 " 642.33 521.01 183.73 845.00 614.88 571.67 624.17 160.54 178.38 618.80 773.50 182.84 183.73 178.38 754.40 163.22 549.00 631.81 156.97 385.69 707.25 358.43 421.80 184.62 37090166 SMP WND RPR FACE 12.6-20CM 12016 450 "$1,816.00" 671.19 302.14 " 2,820.00 " 892.40 " 1,718.00 " 360.51 " 1,718.00 " 907.92 " 1,003.34 " 353.64 " 2,820.00 " 869.12 808.05 " 1,202.01 " 309.01 343.34 " 2,208.66 " " 2,760.83 " 351.92 353.64 343.34 " 1,452.80 " 314.16 776.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 28176198 TX SUPRFCL WOUND DEH SIMPLE 12020 360 "$2,752.00" " 1,017.14 " 457.83 " 2,201.60 " 892.40 " 1,469.00 " 546.27 " 1,469.00 " 907.92 " 1,520.48 " 535.87 " 1,775.00 " 869.12 808.05 " 1,821.55 " 468.23 520.26 " 1,649.49 " " 2,061.86 " 533.27 535.87 520.26 " 2,201.60 " 476.04 776.00 " 1,843.84 " 457.83 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 538.47 37089800 TX SUPRFCL WOUND DEH SIMPLE 12020 450 "$2,752.00" " 1,017.14 " 457.83 " 2,201.60 " 892.40 " 1,469.00 " 546.27 " 1,469.00 " 907.92 " 1,520.48 " 535.87 " 1,775.00 " 869.12 808.05 " 1,821.55 " 468.23 520.26 " 1,649.49 " " 2,061.86 " 533.27 535.87 520.26 " 2,201.60 " 476.04 776.00 " 1,843.84 " 457.83 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 538.47 51600185 TX SUPRFCL WOUND DEH SIMPLE 12020 510 "$2,752.00" " 1,017.14 " 457.83 " 2,201.60 " 892.40 " 1,469.00 " 546.27 " 1,469.00 " 907.92 " 1,520.48 " 535.87 " 1,775.00 " 869.12 808.05 " 1,821.55 " 468.23 520.26 " 1,649.49 " " 2,061.86 " 533.27 535.87 520.26 " 2,201.60 " 476.04 776.00 " 1,843.84 " 457.83 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 538.47 28162979 CLOSURE OF SPLIT WOUND 12021 360 "$1,816.00" 671.19 302.14 " 2,061.86 " 892.40 " 1,469.00 " 360.51 " 1,469.00 " 907.92 " 1,003.34 " 353.64 " 1,775.00 " 869.12 808.05 " 1,202.01 " 309.01 343.34 " 1,649.49 " " 2,061.86 " 351.92 353.64 343.34 " 1,452.80 " 314.16 776.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 28162987 INT RPR SCP/AX/TRK 2.5CM/< 12031 360 "$1,816.00" 671.19 302.14 " 1,469.00 " 604.90 " 1,469.00 " 360.51 " 1,469.00 " 615.42 " 1,003.34 " 353.64 845.00 589.12 547.72 " 1,202.01 " 309.01 343.34 393.78 492.23 351.92 353.64 343.34 " 1,452.80 " 314.16 526.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 37001694 INT RPR SCP/AX/TRK 2.5CM/< 12031 450 "$1,816.00" 671.19 302.14 " 1,469.00 " 604.90 " 1,469.00 " 360.51 " 1,469.00 " 615.42 " 1,003.34 " 353.64 845.00 589.12 547.72 " 1,202.01 " 309.01 343.34 393.78 492.23 351.92 353.64 343.34 " 1,452.80 " 314.16 526.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 28162995 INT RPR SCP/AX/TRK 2.6-7.5CM 12032 360 "$1,816.00" 671.19 302.14 " 1,469.00 " 892.40 " 1,469.00 " 360.51 " 1,469.00 " 907.92 " 1,003.34 " 353.64 845.00 869.12 808.05 " 1,202.01 " 309.01 343.34 618.80 773.50 351.92 353.64 343.34 " 1,452.80 " 314.16 776.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 37001708 INT RPR SCP/AX/TRK 2.6-7.5CM 12032 450 "$1,816.00" 671.19 302.14 " 1,469.00 " 892.40 " 1,469.00 " 360.51 " 1,469.00 " 907.92 " 1,003.34 " 353.64 845.00 869.12 808.05 " 1,202.01 " 309.01 343.34 618.80 773.50 351.92 353.64 343.34 " 1,452.80 " 314.16 776.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 28163002 INT RPR SCP/AX/TRK 7.6-12.5CM 12034 360 "$1,816.00" 671.19 302.14 " 2,820.00 " 892.40 " 1,718.00 " 360.51 " 1,718.00 " 907.92 " 1,003.34 " 353.64 " 2,820.00 " 869.12 808.05 " 1,202.01 " 309.01 343.34 " 2,208.66 " " 2,760.83 " 351.92 353.64 343.34 " 1,452.80 " 314.16 776.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 37001716 INT RPR SCP/AX/TRK 7.6-12.5CM 12034 450 "$1,816.00" 671.19 302.14 " 2,820.00 " 892.40 " 1,718.00 " 360.51 " 1,718.00 " 907.92 " 1,003.34 " 353.64 " 2,820.00 " 869.12 808.05 " 1,202.01 " 309.01 343.34 " 2,208.66 " " 2,760.83 " 351.92 353.64 343.34 " 1,452.80 " 314.16 776.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 28163011 INT RPR SCP/AX/TRK 12.6-20CM 12035 360 "$1,816.00" 671.19 302.14 " 2,820.00 " 892.40 " 1,718.00 " 360.51 " 1,718.00 " 907.92 " 1,003.34 " 353.64 " 2,820.00 " 869.12 808.05 " 1,202.01 " 309.01 343.34 " 2,208.66 " " 2,760.83 " 351.92 353.64 343.34 " 1,452.80 " 314.16 776.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 37001724 INT RPR SCP/AX/TRK 12.6-20CM 12035 450 "$1,816.00" 671.19 302.14 " 2,820.00 " 892.40 " 1,718.00 " 360.51 " 1,718.00 " 907.92 " 1,003.34 " 353.64 " 2,820.00 " 869.12 808.05 " 1,202.01 " 309.01 343.34 " 2,208.66 " " 2,760.83 " 351.92 353.64 343.34 " 1,452.80 " 314.16 776.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 28174756 INT REP SC TK HD FT 20.1-30 12036 360 "$2,752.00" " 1,017.14 " 457.83 " 2,820.00 " 892.40 " 1,718.00 " 546.27 " 1,718.00 " 907.92 " 1,520.48 " 535.87 " 2,820.00 " 869.12 808.05 " 1,821.55 " 468.23 520.26 " 2,208.66 " " 2,760.83 " 533.27 535.87 520.26 " 2,201.60 " 476.04 776.00 " 1,843.84 " 457.83 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 538.47 37001732 INT RPR SCP/AX/TRK 20.1-30CM 12036 450 "$2,752.00" " 1,017.14 " 457.83 " 2,820.00 " 892.40 " 1,718.00 " 546.27 " 1,718.00 " 907.92 " 1,520.48 " 535.87 " 2,820.00 " 869.12 808.05 " 1,821.55 " 468.23 520.26 " 2,208.66 " " 2,760.83 " 533.27 535.87 520.26 " 2,201.60 " 476.04 776.00 " 1,843.84 " 457.83 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 538.47 37001741 INT RPR SCP/AX/TRK >30CM 12037 450 "$9,006.00" " 3,328.62 " 776.00 " 7,204.80 " 892.40 " 1,718.00 " " 1,786.47 " " 1,718.00 " 907.92 " 4,975.82 " " 1,752.44 " " 2,820.00 " 869.12 808.05 " 5,961.07 " " 1,531.26 " " 1,701.40 " " 2,208.66 " " 2,760.83 " " 1,743.94 " " 1,752.44 " " 1,701.40 " " 7,204.80 " " 1,556.78 " 776.00 " 6,034.02 " " 1,497.23 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,760.95 " 28163029 INT RPR NHFE 2.5CM/< 12041 360 "$1,816.00" 671.19 302.14 " 1,469.00 " 604.90 " 1,469.00 " 360.51 " 1,469.00 " 615.42 " 1,003.34 " 353.64 845.00 589.12 547.72 " 1,202.01 " 309.01 343.34 393.78 492.23 351.92 353.64 343.34 " 1,452.80 " 314.16 526.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 37001759 INT RPR NHFE 2.5CM/< 12041 450 "$1,816.00" 671.19 302.14 " 1,469.00 " 604.90 " 1,469.00 " 360.51 " 1,469.00 " 615.42 " 1,003.34 " 353.64 845.00 589.12 547.72 " 1,202.01 " 309.01 343.34 393.78 492.23 351.92 353.64 343.34 " 1,452.80 " 314.16 526.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 37001767 INT RPR NHFE 2.6-7.5CM 12042 450 "$1,816.00" 671.19 302.14 " 1,469.00 " 892.40 " 1,469.00 " 360.51 " 1,469.00 " 907.92 " 1,003.34 " 353.64 845.00 869.12 808.05 " 1,202.01 " 309.01 343.34 618.80 773.50 351.92 353.64 343.34 " 1,452.80 " 314.16 776.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 37001775 INT RPR NHFE 7.6-12.5CM 12044 450 "$2,752.00" " 1,017.14 " 457.83 " 2,820.00 " 848.70 " 1,718.00 " 546.27 " 1,718.00 " 863.46 " 1,520.48 " 535.87 " 2,820.00 " 826.56 768.48 " 1,821.55 " 468.23 520.26 " 2,208.66 " " 2,760.83 " 533.27 535.87 520.26 " 2,201.60 " 476.04 738.00 " 1,843.84 " 457.83 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 538.47 37001783 INT RPR NHFE 12.6-20CM 12045 450 "$2,752.00" " 1,017.14 " 457.83 " 2,820.00 " 892.40 " 1,718.00 " 546.27 " 1,718.00 " 907.92 " 1,520.48 " 535.87 " 2,820.00 " 869.12 808.05 " 1,821.55 " 468.23 520.26 " 2,208.66 " " 2,760.83 " 533.27 535.87 520.26 " 2,201.60 " 476.04 776.00 " 1,843.84 " 457.83 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 538.47 28163037 INT RPR FEENLM 2.5CM/< 12051 360 "$1,816.00" 671.19 302.14 " 1,469.00 " 566.95 " 1,469.00 " 360.51 " 1,469.00 " 576.81 " 1,003.34 " 353.64 845.00 552.16 513.36 " 1,202.01 " 309.01 343.34 393.78 492.23 351.92 353.64 343.34 " 1,452.80 " 314.16 493.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 37001813 INT RPR FEENLM 2.5CM/< 12051 450 "$1,816.00" 671.19 302.14 " 1,469.00 " 566.95 " 1,469.00 " 360.51 " 1,469.00 " 576.81 " 1,003.34 " 353.64 845.00 552.16 513.36 " 1,202.01 " 309.01 343.34 393.78 492.23 351.92 353.64 343.34 " 1,452.80 " 314.16 493.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 37001821 INT RPR FEENLM 2.6-5.0CM 12052 450 "$1,816.00" 671.19 302.14 " 1,469.00 " 892.40 " 1,469.00 " 360.51 " 1,469.00 " 907.92 " 1,003.34 " 353.64 845.00 869.12 808.05 " 1,202.01 " 309.01 343.34 393.78 492.23 351.92 353.64 343.34 " 1,452.80 " 314.16 776.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 37001830 INT RPR FEENLM 5.1-7.5CM 12053 450 "$1,816.00" 671.19 302.14 " 1,469.00 " 892.40 " 1,469.00 " 360.51 " 1,469.00 " 907.92 " 1,003.34 " 353.64 845.00 869.12 808.05 " 1,202.01 " 309.01 343.34 618.80 773.50 351.92 353.64 343.34 " 1,452.80 " 314.16 776.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 37001848 INT RPR FEENLM 7.6-12.5CM 12054 450 "$1,816.00" 671.19 302.14 " 2,820.00 " 631.35 " 1,718.00 " 360.51 " 1,718.00 " 642.33 " 1,003.34 " 353.64 " 2,820.00 " 614.88 571.67 " 1,202.01 " 309.01 343.34 " 2,208.66 " " 2,760.83 " 351.92 353.64 343.34 " 1,452.80 " 314.16 549.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 28174764 INT RPR FACE EAR 12.6-20C 12055 360 "$1,816.00" 671.19 302.14 " 2,820.00 " 892.40 " 1,718.00 " 360.51 " 1,718.00 " 907.92 " 1,003.34 " 353.64 " 2,820.00 " 869.12 808.05 " 1,202.01 " 309.01 343.34 " 2,208.66 " " 2,760.83 " 351.92 353.64 343.34 " 1,452.80 " 314.16 776.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 37001856 INT RPR FEENLM 12.6-20CM 12055 450 "$1,816.00" 671.19 302.14 " 2,820.00 " 892.40 " 1,718.00 " 360.51 " 1,718.00 " 907.92 " 1,003.34 " 353.64 " 2,820.00 " 869.12 808.05 " 1,202.01 " 309.01 343.34 " 2,208.66 " " 2,760.83 " 351.92 353.64 343.34 " 1,452.80 " 314.16 776.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 28163045 CMPLX RPR TRUNK 1.1-2.5 CM 13100 360 "$2,752.00" " 1,017.14 " 457.83 " 2,820.00 " 892.40 " 1,718.00 " 546.27 " 1,718.00 " 907.92 " 1,520.48 " 535.87 " 2,820.00 " 869.12 808.05 " 1,821.55 " 468.23 520.26 " 2,208.66 " " 2,760.83 " 533.27 535.87 520.26 " 2,201.60 " 476.04 776.00 " 1,843.84 " 457.83 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 538.47 28163053 CPLX RPR TRUNK 2.6-7.5CM 13101 360 "$2,752.00" " 1,017.14 " 457.83 " 3,545.00 " 892.40 " 2,773.00 " 546.27 " 2,773.00 " 907.92 " 1,520.48 " 535.87 " 3,545.00 " 869.12 808.05 " 1,821.55 " 468.23 520.26 " 2,532.97 " " 3,166.21 " 533.27 535.87 520.26 " 2,201.60 " 476.04 776.00 " 1,843.84 " 457.83 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 538.47 37001899 CPLX RPR TRUNK 2.6-7.5CM 13101 450 "$2,752.00" " 1,017.14 " 457.83 " 3,545.00 " 892.40 " 2,773.00 " 546.27 " 2,773.00 " 907.92 " 1,520.48 " 535.87 " 3,545.00 " 869.12 808.05 " 1,821.55 " 468.23 520.26 " 2,532.97 " " 3,166.21 " 533.27 535.87 520.26 " 2,201.60 " 476.04 776.00 " 1,843.84 " 457.83 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 538.47 28163061 CMPLX RPR TRUNK ADDL 5CM/< 13102 360 $327.00 120.86 - " 1,469.00 " - " 1,469.00 " - " 1,469.00 " - 180.67 - 215.82 - - 216.44 - - 515.18 643.97 - - - 261.60 - - 219.09 - 133.74 245.25 124.29 146.27 - 37001911 CPLX RPR S/A/L 1.1-2.5CM 13120 450 "$2,752.00" " 1,017.14 " 457.83 " 2,820.00 " 892.40 " 1,718.00 " 546.27 " 1,718.00 " 907.92 " 1,520.48 " 535.87 " 2,820.00 " 869.12 808.05 " 1,821.55 " 468.23 520.26 " 2,208.66 " " 2,760.83 " 533.27 535.87 520.26 " 2,201.60 " 476.04 776.00 " 1,843.84 " 457.83 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 538.47 28163070 CPLX RPR S/A/L 2.6-7.5CM 13121 360 "$2,752.00" " 1,017.14 " 457.83 " 3,545.00 " 892.40 " 2,773.00 " 546.27 " 2,773.00 " 907.92 " 1,520.48 " 535.87 " 3,545.00 " 869.12 808.05 " 1,821.55 " 468.23 520.26 " 2,532.97 " " 3,166.21 " 533.27 535.87 520.26 " 2,201.60 " 476.04 776.00 " 1,843.84 " 457.83 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 538.47 37001929 CPLX RPR S/A/L 2.6-7.5CM 13121 450 "$2,752.00" " 1,017.14 " 457.83 " 3,545.00 " 892.40 " 2,773.00 " 546.27 " 2,773.00 " 907.92 " 1,520.48 " 535.87 " 3,545.00 " 869.12 808.05 " 1,821.55 " 468.23 520.26 " 2,532.97 " " 3,166.21 " 533.27 535.87 520.26 " 2,201.60 " 476.04 776.00 " 1,843.84 " 457.83 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 538.47 28163088 CPLX RPR S/A/L EA ADD 5CM/< 13122 360 $652.00 240.98 - " 1,469.00 " - " 1,469.00 " - " 1,469.00 " - 360.23 - 430.32 - - 431.56 - - 627.63 784.54 - - - 521.60 - - 436.84 - 266.67 489.00 247.83 291.64 - 37001937 CPLX RPR S/A/L EA ADD 5CM/< 13122 450 $652.00 240.98 - " 1,469.00 " - " 1,469.00 " - " 1,469.00 " - 360.23 - 430.32 - - 431.56 - - 627.63 784.54 - - - 521.60 - - 436.84 - 266.67 489.00 247.83 291.64 - 37001945 CPLX RPR FCCMNAGHF 1.1CM-2.5CM 13131 450 "$1,816.00" 671.19 302.14 " 2,820.00 " 892.40 " 1,718.00 " 360.51 " 1,718.00 " 907.92 " 1,003.34 " 353.64 " 2,820.00 " 869.12 808.05 " 1,202.01 " 309.01 343.34 " 2,208.66 " " 2,760.83 " 351.92 353.64 343.34 " 1,452.80 " 314.16 776.00 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 28163096 CPLX RPR FCCMNAGHF 2.6-7.5CM 13132 360 "$2,752.00" " 1,017.14 " 457.83 " 3,545.00 " 892.40 " 2,773.00 " 546.27 " 2,773.00 " 907.92 " 1,520.48 " 535.87 " 3,545.00 " 869.12 808.05 " 1,821.55 " 468.23 520.26 " 2,532.97 " " 3,166.21 " 533.27 535.87 520.26 " 2,201.60 " 476.04 776.00 " 1,843.84 " 457.83 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 538.47 37001953 CPLX RPR FCCMNAGHF 2.6-7.5CM 13132 450 "$2,752.00" " 1,017.14 " 457.83 " 3,545.00 " 892.40 " 2,773.00 " 546.27 " 2,773.00 " 907.92 " 1,520.48 " 535.87 " 3,545.00 " 869.12 808.05 " 1,821.55 " 468.23 520.26 " 2,532.97 " " 3,166.21 " 533.27 535.87 520.26 " 2,201.60 " 476.04 776.00 " 1,843.84 " 457.83 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 538.47 28163100 CPLX RPR FCMNAGHF EA ADD 5CM/< 13133 360 $627.00 231.74 - " 1,469.00 " - " 1,469.00 " - " 1,469.00 " - 346.42 - 413.82 - - 415.01 - - 821.99 " 1,027.49 " - - - 501.60 - - 420.09 - 256.44 470.25 238.32 280.46 - 37001961 CPLX RPR FCMNAGHF EA ADD 5CM/< 13133 450 $627.00 231.74 - " 1,469.00 " - " 1,469.00 " - " 1,469.00 " - 346.42 - 413.82 - - 415.01 - - 821.99 " 1,027.49 " - - - 501.60 - - 420.09 - 256.44 470.25 238.32 280.46 - 28163118 CPLX RPR ENEL 1.1CM-2.5CM 13151 360 "$2,752.00" " 1,017.14 " 457.83 " 3,545.00 " 892.40 " 2,773.00 " 546.27 " 2,773.00 " 907.92 " 1,520.48 " 535.87 " 3,545.00 " 869.12 808.05 " 1,821.55 " 468.23 520.26 " 2,532.97 " " 3,166.21 " 533.27 535.87 520.26 " 2,201.60 " 476.04 776.00 " 1,843.84 " 457.83 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 538.47 37090051 CPLX RPR ENEL 1.1CM-2.5CM 13151 450 "$2,752.00" " 1,017.14 " 457.83 " 3,545.00 " 892.40 " 2,773.00 " 546.27 " 2,773.00 " 907.92 " 1,520.48 " 535.87 " 3,545.00 " 869.12 808.05 " 1,821.55 " 468.23 520.26 " 2,532.97 " " 3,166.21 " 533.27 535.87 520.26 " 2,201.60 " 476.04 776.00 " 1,843.84 " 457.83 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 538.47 28163126 CPLX RPR ENEL 2.6-7.5CM 13152 360 "$2,752.00" " 1,017.14 " 457.83 " 3,545.00 " 892.40 " 2,773.00 " 546.27 " 2,773.00 " 907.92 " 1,520.48 " 535.87 " 3,545.00 " 869.12 808.05 " 1,821.55 " 468.23 520.26 " 2,532.97 " " 3,166.21 " 533.27 535.87 520.26 " 2,201.60 " 476.04 776.00 " 1,843.84 " 457.83 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 538.47 37001996 CPLX RPR ENEL 2.6-7.5CM 13152 450 "$2,752.00" " 1,017.14 " 457.83 " 3,545.00 " 892.40 " 2,773.00 " 546.27 " 2,773.00 " 907.92 " 1,520.48 " 535.87 " 3,545.00 " 869.12 808.05 " 1,821.55 " 468.23 520.26 " 2,532.97 " " 3,166.21 " 533.27 535.87 520.26 " 2,201.60 " 476.04 776.00 " 1,843.84 " 457.83 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 538.47 37004146 CPLX RPR ENEL EA ADD 5CM/< 13153 450 "$1,057.00" 390.67 - " 2,773.00 " - " 2,773.00 " - " 2,773.00 " - 583.99 - 697.62 - - 699.63 - - 927.24 " 1,159.05 " - - - 845.60 - - 708.19 - 432.31 792.75 401.77 472.80 - 28163134 SCNDRY CLSR SURG WND DEH COMP 13160 360 "$9,006.00" " 3,328.62 " 776.00 " 7,204.80 " 892.40 " 1,718.00 " " 1,786.47 " " 1,718.00 " 907.92 " 4,975.82 " " 1,752.44 " " 2,820.00 " 869.12 808.05 " 5,961.07 " " 1,531.26 " " 1,701.40 " " 2,208.66 " " 2,760.83 " " 1,743.94 " " 1,752.44 " " 1,701.40 " " 7,204.80 " " 1,556.78 " 776.00 " 6,034.02 " " 1,497.23 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,760.95 " 51600193 SCNDRY CLSR SURG WND DEH COMP 13160 510 "$9,006.00" " 3,328.62 " 776.00 " 7,204.80 " 892.40 " 1,718.00 " " 1,786.47 " " 1,718.00 " 907.92 " 4,975.82 " " 1,752.44 " " 2,820.00 " 869.12 808.05 " 5,961.07 " " 1,531.26 " " 1,701.40 " " 2,208.66 " " 2,760.83 " " 1,743.94 " " 1,752.44 " " 1,701.40 " " 7,204.80 " " 1,556.78 " 776.00 " 6,034.02 " " 1,497.23 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,760.95 " 28163142 TIS TRNFR TRUNK 10.1-30SQCM 14001 360 "$9,006.00" " 3,328.62 " 776.00 " 7,204.80 " 892.40 " 2,773.00 " " 1,786.47 " " 2,773.00 " 907.92 " 4,975.82 " " 1,752.44 " " 3,545.00 " 869.12 808.05 " 5,961.07 " " 1,531.26 " " 1,701.40 " " 2,532.97 " " 3,166.21 " " 1,743.94 " " 1,752.44 " " 1,701.40 " " 7,204.80 " " 1,556.78 " 776.00 " 6,034.02 " " 1,497.23 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,760.95 " 28163151 TIS TRNFR S/A/L 10.1-30 SQCM 14021 360 "$9,006.00" " 3,328.62 " 776.00 " 7,204.80 " 892.40 " 2,773.00 " " 1,786.47 " " 2,773.00 " 907.92 " 4,975.82 " " 1,752.44 " " 3,545.00 " 869.12 808.05 " 5,961.07 " " 1,531.26 " " 1,701.40 " " 2,532.97 " " 3,166.21 " " 1,743.94 " " 1,752.44 " " 1,701.40 " " 7,204.80 " " 1,556.78 " 776.00 " 6,034.02 " " 1,497.23 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,760.95 " 28163169 ADJ TIS XFR FCCMNAGHF 10CM/< 14040 360 "$9,006.00" " 3,328.62 " 807.00 " 7,204.80 " 928.05 " 1,718.00 " " 1,786.47 " " 1,718.00 " 944.19 " 4,975.82 " " 1,752.44 " " 2,820.00 " 903.84 840.33 " 5,961.07 " " 1,531.26 " " 1,701.40 " " 2,208.66 " " 2,760.83 " " 1,743.94 " " 1,752.44 " " 1,701.40 " " 7,204.80 " " 1,556.78 " 807.00 " 6,034.02 " " 1,497.23 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,760.95 " 37090069 ADJ TIS XFR FCCMNAGHF 10CM/< 14040 450 "$9,006.00" " 3,328.62 " 807.00 " 7,204.80 " 928.05 " 1,718.00 " " 1,786.47 " " 1,718.00 " 944.19 " 4,975.82 " " 1,752.44 " " 2,820.00 " 903.84 840.33 " 5,961.07 " " 1,531.26 " " 1,701.40 " " 2,208.66 " " 2,760.83 " " 1,743.94 " " 1,752.44 " " 1,701.40 " " 7,204.80 " " 1,556.78 " 807.00 " 6,034.02 " " 1,497.23 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,760.95 " 51600207 ADJ TIS XFR FCCMNAGHF 10CM/< 14040 510 "$9,006.00" " 3,328.62 " 807.00 " 7,204.80 " 928.05 " 1,718.00 " " 1,786.47 " " 1,718.00 " 944.19 " 4,975.82 " " 1,752.44 " " 2,820.00 " 903.84 840.33 " 5,961.07 " " 1,531.26 " " 1,701.40 " " 2,208.66 " " 2,760.83 " " 1,743.94 " " 1,752.44 " " 1,701.40 " " 7,204.80 " " 1,556.78 " 807.00 " 6,034.02 " " 1,497.23 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,760.95 " 28163177 TIS TRNFR E/N/E/L 10 SQ CM/< 14060 360 "$9,006.00" " 3,328.62 " 891.00 " 7,204.80 " " 1,024.65 " " 2,773.00 " " 1,786.47 " " 2,773.00 " " 1,042.47 " " 4,975.82 " " 1,752.44 " " 3,545.00 " 997.92 927.80 " 5,961.07 " " 1,531.26 " " 1,701.40 " " 2,532.97 " " 3,166.21 " " 1,743.94 " " 1,752.44 " " 1,701.40 " " 7,204.80 " " 1,556.78 " 891.00 " 6,034.02 " " 1,497.23 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,760.95 " 28163185 TIS TRNFR ANY 30.1-60 SQ CM 14301 360 "$18,491.00" " 6,834.27 " 776.00 " 14,792.80 " 892.40 " 2,773.00 " " 3,672.72 " " 2,773.00 " 907.92 " 10,216.28 " " 3,602.76 " " 6,576.00 " 869.12 808.05 " 12,239.19 " " 3,148.05 " " 3,497.83 " " 5,573.80 " " 6,967.25 " " 3,585.28 " " 3,602.76 " " 3,497.83 " " 14,792.80 " " 3,200.51 " 776.00 " 12,388.97 " " 3,078.09 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,620.25 " 28163193 TIS TRNFR ADDL 30 SQ CM 14302 360 $727.00 268.70 - " 1,551.43 " - " 1,469.00 " - " 1,469.00 " - 401.67 - 479.82 - - 481.20 - - " 1,241.14 " " 1,551.43 " - - - 581.60 - - 487.09 - 297.34 545.25 276.33 325.19 - 28163207 WND PREP EXC TAL 1ST 100SQCM 15002 360 "$9,006.00" " 3,328.62 " 776.00 " 7,204.80 " 892.40 " 1,718.00 " " 1,786.47 " " 1,718.00 " 907.92 " 4,975.82 " " 1,752.44 " " 2,820.00 " 869.12 808.05 " 5,961.07 " " 1,531.26 " " 1,701.40 " " 2,368.76 " " 2,960.95 " " 1,743.94 " " 1,752.44 " " 1,701.40 " " 7,204.80 " " 1,556.78 " 776.00 " 6,034.02 " " 1,497.23 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,760.95 " 51600215 WND PREP EXC TAL 1ST 100SQCM 15002 510 "$9,006.00" " 3,328.62 " 776.00 " 7,204.80 " 892.40 " 1,718.00 " " 1,786.47 " " 1,718.00 " 907.92 " 4,975.82 " " 1,752.44 " " 2,820.00 " 869.12 808.05 " 5,961.07 " " 1,531.26 " " 1,701.40 " " 2,368.76 " " 2,960.95 " " 1,743.94 " " 1,752.44 " " 1,701.40 " " 7,204.80 " " 1,556.78 " 776.00 " 6,034.02 " " 1,497.23 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,760.95 " 28163215 WND PREP TAL EA ADDL 100 CM 15003 360 $564.00 208.45 - " 2,210.73 " - " 1,469.00 " - " 1,469.00 " - 311.61 - 372.24 - - 373.31 - - " 1,768.58 " " 2,210.73 " - - - 451.20 - - 377.88 - 230.68 423.00 214.38 252.28 - 51600223 WND PREP TAL EA ADDL 100 CM 15003 510 $564.00 208.45 - " 2,210.73 " - " 1,469.00 " - " 1,469.00 " - 311.61 - 372.24 - - 373.31 - - " 1,768.58 " " 2,210.73 " - - - 451.20 - - 377.88 - 230.68 423.00 214.38 252.28 - 28163223 WOUND PREP F/N/HF/G 15004 360 "$2,752.00" " 1,017.14 " 457.83 " 2,960.95 " 892.40 " 1,718.00 " 546.27 " 1,718.00 " 907.92 " 1,520.48 " 535.87 " 2,820.00 " 869.12 808.05 " 1,821.55 " 468.23 520.26 " 2,368.76 " " 2,960.95 " 533.27 535.87 520.26 " 2,201.60 " 476.04 776.00 " 1,843.84 " 457.83 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 538.47 28163231 HARVEST CULTURED SKIN GRAFT 15040 360 "$9,006.00" " 3,328.62 " - " 7,204.80 " - " 1,718.00 " " 1,786.47 " " 1,718.00 " - " 4,975.82 " " 1,752.44 " " 2,820.00 " - - " 5,961.07 " " 1,531.26 " " 1,701.40 " " 2,368.76 " " 2,960.95 " " 1,743.94 " " 1,752.44 " " 1,701.40 " " 7,204.80 " " 1,556.78 " - " 6,034.02 " " 1,497.23 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,760.95 " 28163240 SKIN SPLT GRFT TAL 1ST 100SQCM 15100 360 "$9,006.00" " 3,328.62 " 571.00 " 7,204.80 " 656.65 " 1,718.00 " " 1,786.47 " " 1,718.00 " 668.07 " 4,975.82 " " 1,752.44 " " 2,820.00 " 639.52 594.58 " 5,961.07 " " 1,531.26 " " 1,701.40 " " 2,208.66 " " 2,760.83 " " 1,743.94 " " 1,752.44 " " 1,701.40 " " 7,204.80 " " 1,556.78 " 571.00 " 6,034.02 " " 1,497.23 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,760.95 " 51600231 SKIN SPLT GRFT TAL 1ST 100SQCM 15100 510 "$9,006.00" " 3,328.62 " 571.00 " 7,204.80 " 656.65 " 1,718.00 " " 1,786.47 " " 1,718.00 " 668.07 " 4,975.82 " " 1,752.44 " " 2,820.00 " 639.52 594.58 " 5,961.07 " " 1,531.26 " " 1,701.40 " " 2,208.66 " " 2,760.83 " " 1,743.94 " " 1,752.44 " " 1,701.40 " " 7,204.80 " " 1,556.78 " 571.00 " 6,034.02 " " 1,497.23 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,760.95 " 28163258 SKIN SPLT GRFT TAL ADD-ON 15101 360 "$1,882.00" 695.59 - " 3,166.21 " - " 2,773.00 " - " 2,773.00 " - " 1,039.81 " - " 1,242.12 " - - " 1,245.70 " - - " 2,532.97 " " 3,166.21 " - - - " 1,505.60 " - - " 1,260.94 " - 769.74 " 1,411.50 " 715.35 841.82 - 51600240 SKIN SPLT GRFT TAL ADD-ON 15101 510 "$1,882.00" 695.59 - " 3,166.21 " - " 2,773.00 " - " 2,773.00 " - " 1,039.81 " - " 1,242.12 " - - " 1,245.70 " - - " 2,532.97 " " 3,166.21 " - - - " 1,505.60 " - - " 1,260.94 " - 769.74 " 1,411.50 " 715.35 841.82 - 28163266 EPIDRM A-GRFT FACE/NCK/HF/G 15115 360 "$9,006.00" " 3,328.62 " 776.00 " 7,204.80 " 892.40 " 1,718.00 " " 1,786.47 " " 1,718.00 " 907.92 " 4,975.82 " " 1,752.44 " " 2,820.00 " 869.12 808.05 " 5,961.07 " " 1,531.26 " " 1,701.40 " " 2,368.76 " " 2,960.95 " " 1,743.94 " " 1,752.44 " " 1,701.40 " " 7,204.80 " " 1,556.78 " 776.00 " 6,034.02 " " 1,497.23 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,760.95 " 28163274 SPL-THCK AUTOGRAFT 1ST 100SQCM 15120 360 "$18,491.00" " 6,834.27 " 565.00 " 14,792.80 " 649.75 " 1,718.00 " " 3,672.72 " " 1,718.00 " 661.05 " 10,216.28 " " 3,602.76 " " 2,820.00 " 632.80 588.33 " 12,239.19 " " 3,148.05 " " 3,497.83 " " 2,208.66 " " 2,760.83 " " 3,585.28 " " 3,602.76 " " 3,497.83 " " 14,792.80 " " 3,200.51 " 565.00 " 12,388.97 " " 3,078.09 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,620.25 " 51600258 SPL-THCK AUTOGRAFT 1ST 100SQCM 15120 510 "$18,491.00" " 6,834.27 " 565.00 " 14,792.80 " 649.75 " 1,718.00 " " 3,672.72 " " 1,718.00 " 661.05 " 10,216.28 " " 3,602.76 " " 2,820.00 " 632.80 588.33 " 12,239.19 " " 3,148.05 " " 3,497.83 " " 2,208.66 " " 2,760.83 " " 3,585.28 " " 3,602.76 " " 3,497.83 " " 14,792.80 " " 3,200.51 " 565.00 " 12,388.97 " " 3,078.09 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,620.25 " 28163282 SKN SPLT A-GRFT FNHFG ADDL 15121 360 "$1,112.00" 411.00 - " 3,166.21 " - " 2,773.00 " - " 2,773.00 " - 614.38 - 733.92 - - 736.03 - - " 2,532.97 " " 3,166.21 " - - - 889.60 - - 745.04 - 454.81 834.00 422.67 497.40 - 51600266 SKN SPLT A-GRFT FNHFG ADDL 15121 510 "$1,112.00" 411.00 - " 3,166.21 " - " 2,773.00 " - " 2,773.00 " - 614.38 - 733.92 - - 736.03 - - " 2,532.97 " " 3,166.21 " - - - 889.60 - - 745.04 - 454.81 834.00 422.67 497.40 - 28163291 SKIN FULL GRAFT TRUNK 15200 360 "$9,006.00" " 3,328.62 " 776.00 " 7,204.80 " 892.40 " 2,773.00 " " 1,786.47 " " 2,773.00 " 907.92 " 4,975.82 " " 1,752.44 " " 3,545.00 " 869.12 808.05 " 5,961.07 " " 1,531.26 " " 1,701.40 " " 2,532.97 " " 3,166.21 " " 1,743.94 " " 1,752.44 " " 1,701.40 " " 7,204.80 " " 1,556.78 " 776.00 " 6,034.02 " " 1,497.23 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,760.95 " 28174772 GRAFT FULL SCALP LIMB 20 SQ CM 15220 360 "$9,006.00" " 3,328.62 " 776.00 " 7,204.80 " 892.40 " 1,718.00 " " 1,786.47 " " 1,718.00 " 907.92 " 4,975.82 " " 1,752.44 " " 2,820.00 " 869.12 808.05 " 5,961.07 " " 1,531.26 " " 1,701.40 " " 2,208.66 " " 2,760.83 " " 1,743.94 " " 1,752.44 " " 1,701.40 " " 7,204.80 " " 1,556.78 " 776.00 " 6,034.02 " " 1,497.23 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,760.95 " 28163304 SKIN FULL GRAFT ADD-ON 15221 360 $778.00 287.55 - " 2,760.83 " - " 1,718.00 " - " 1,718.00 " - 429.85 - 513.48 - - 514.96 - - " 2,208.66 " " 2,760.83 " - - - 622.40 - - 521.26 - 318.20 583.50 295.72 348.00 - 28163312 SKIN FULL GRFT FACE/GENIT/HF 15240 360 "$9,006.00" " 3,328.62 " " 1,081.00 " " 7,204.80 " " 1,243.15 " " 2,773.00 " " 1,786.47 " " 2,773.00 " " 1,264.77 " " 4,975.82 " " 1,752.44 " " 3,545.00 " " 1,210.72 " " 1,125.65 " " 5,961.07 " " 1,531.26 " " 1,701.40 " " 2,532.97 " " 3,166.21 " " 1,743.94 " " 1,752.44 " " 1,701.40 " " 7,204.80 " " 1,556.78 " " 1,081.00 " " 6,034.02 " " 1,497.23 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,760.95 " 28163321 SKIN FULL GRAFT EEN & LIPS 15260 360 "$9,006.00" " 3,328.62 " 776.00 " 7,204.80 " 892.40 " 1,718.00 " " 1,786.47 " " 1,718.00 " 907.92 " 4,975.82 " " 1,752.44 " " 2,820.00 " 869.12 808.05 " 5,961.07 " " 1,531.26 " " 1,701.40 " " 2,208.66 " " 2,760.83 " " 1,743.94 " " 1,752.44 " " 1,701.40 " " 7,204.80 " " 1,556.78 " 776.00 " 6,034.02 " " 1,497.23 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,760.95 " 28163339 SKN SUB GRAFT TAL 1ST 25CM/< 15271 360 "$9,006.00" " 3,328.62 " 776.00 " 7,204.80 " 892.40 " 1,718.00 " " 1,786.47 " " 1,718.00 " 907.92 " 4,975.82 " " 1,752.44 " " 1,775.00 " 869.12 808.05 " 5,961.07 " " 1,531.26 " " 1,701.40 " " 1,634.64 " " 2,043.30 " " 1,743.94 " " 1,752.44 " " 1,701.40 " " 7,204.80 " " 1,556.78 " 776.00 " 6,034.02 " " 1,497.23 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,760.95 " 51600274 SKN SUB GRAFT TAL 1ST 25CM/< 15271 510 "$9,006.00" " 3,328.62 " 776.00 " 7,204.80 " 892.40 " 1,718.00 " " 1,786.47 " " 1,718.00 " 907.92 " 4,975.82 " " 1,752.44 " " 1,775.00 " 869.12 808.05 " 5,961.07 " " 1,531.26 " " 1,701.40 " " 1,634.64 " " 2,043.30 " " 1,743.94 " " 1,752.44 " " 1,701.40 " " 7,204.80 " " 1,556.78 " 776.00 " 6,034.02 " " 1,497.23 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,760.95 " 51600282 SKN SUB GRAFT TAL EA ADDL 25CM 15272 510 "$1,871.00" 691.52 - " 1,496.80 " - " 1,469.00 " - " 1,469.00 " - " 1,033.73 " - " 1,234.86 " - - " 1,238.41 " - - 234.18 292.73 - - - " 1,496.80 " - - " 1,253.57 " - 765.24 " 1,403.25 " 711.17 836.90 - 51600291 SKN SUB GRAFT TAL CHILD 15273 510 "$18,491.00" " 6,834.27 " 776.00 " 14,792.80 " 892.40 " 1,718.00 " " 3,672.72 " " 1,718.00 " 907.92 " 10,216.28 " " 3,602.76 " " 1,775.00 " 869.12 808.05 " 12,239.19 " " 3,148.05 " " 3,497.83 " " 2,368.76 " " 2,960.95 " " 3,585.28 " " 3,602.76 " " 3,497.83 " " 14,792.80 " " 3,200.51 " 776.00 " 12,388.97 " " 3,078.09 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,620.25 " 51600304 SKN SUB GRAFT TAL CHILD ADDL 15274 510 "$1,871.00" 691.52 - " 2,210.73 " - " 1,469.00 " - " 1,469.00 " - " 1,033.73 " - " 1,234.86 " - - " 1,238.41 " - - " 1,768.58 " " 2,210.73 " - - - " 1,496.80 " - - " 1,253.57 " - 765.24 " 1,403.25 " 711.17 836.90 - 28163347 SKN SUB GRAFT FNHG 1ST 25CM/< 15275 360 "$9,006.00" " 3,328.62 " 776.00 " 7,204.80 " 892.40 " 1,718.00 " " 1,786.47 " " 1,718.00 " 907.92 " 4,975.82 " " 1,752.44 " " 1,775.00 " 869.12 808.05 " 5,961.07 " " 1,531.26 " " 1,701.40 " " 1,634.64 " " 2,043.30 " " 1,743.94 " " 1,752.44 " " 1,701.40 " " 7,204.80 " " 1,556.78 " 776.00 " 6,034.02 " " 1,497.23 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,760.95 " 51600312 SKN SUB GRAFT FNHG 1ST 25CM/< 15275 510 "$9,006.00" " 3,328.62 " 776.00 " 7,204.80 " 892.40 " 1,718.00 " " 1,786.47 " " 1,718.00 " 907.92 " 4,975.82 " " 1,752.44 " " 1,775.00 " 869.12 808.05 " 5,961.07 " " 1,531.26 " " 1,701.40 " " 1,634.64 " " 2,043.30 " " 1,743.94 " " 1,752.44 " " 1,701.40 " " 7,204.80 " " 1,556.78 " 776.00 " 6,034.02 " " 1,497.23 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,760.95 " 51600321 SKN SUB GRAFT FNHG EA ADDL25CM 15276 510 "$1,871.00" 691.52 - " 1,496.80 " - " 1,469.00 " - " 1,469.00 " - " 1,033.73 " - " 1,234.86 " - - " 1,238.41 " - - 234.18 292.73 - - - " 1,496.80 " - - " 1,253.57 " - 765.24 " 1,403.25 " 711.17 836.90 - 51600339 SKN SUB GRAFT FNHG CHILD 15277 510 "$9,006.00" " 3,328.62 " 776.00 " 7,204.80 " 892.40 " 1,718.00 " " 1,786.47 " " 1,718.00 " 907.92 " 4,975.82 " " 1,752.44 " " 1,775.00 " 869.12 808.05 " 5,961.07 " " 1,531.26 " " 1,701.40 " " 2,368.76 " " 2,960.95 " " 1,743.94 " " 1,752.44 " " 1,701.40 " " 7,204.80 " " 1,556.78 " 776.00 " 6,034.02 " " 1,497.23 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,760.95 " 51600347 SKN SUB GRAFT FNHG CHILD ADDL 15278 510 "$2,610.00" 964.66 - " 2,210.73 " - " 1,469.00 " - " 1,469.00 " - " 1,442.03 " - " 1,722.60 " - - " 1,727.56 " - - " 1,768.58 " " 2,210.73 " - - - " 2,088.00 " - - " 1,748.70 " - " 1,067.49 " " 1,957.50 " 992.06 " 1,167.45 " - 28163355 SKIN PEDICLE FLAP TRUNK 15570 360 "$9,006.00" " 3,328.62 " 776.00 " 7,204.80 " 892.40 " 2,773.00 " " 1,786.47 " " 2,773.00 " 907.92 " 4,975.82 " " 1,752.44 " " 3,545.00 " 869.12 808.05 " 5,961.07 " " 1,531.26 " " 1,701.40 " " 2,532.97 " " 3,166.21 " " 1,743.94 " " 1,752.44 " " 1,701.40 " " 7,204.80 " " 1,556.78 " 776.00 " 6,034.02 " " 1,497.23 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,760.95 " 28163363 PEDICLE E/N/E/L/NTRORAL 15576 360 "$9,006.00" " 3,328.62 " 776.00 " 7,204.80 " 892.40 " 2,773.00 " " 1,786.47 " " 2,773.00 " 907.92 " 4,975.82 " " 1,752.44 " " 3,545.00 " 869.12 808.05 " 5,961.07 " " 1,531.26 " " 1,701.40 " " 2,532.97 " " 3,166.21 " " 1,743.94 " " 1,752.44 " " 1,701.40 " " 7,204.80 " " 1,556.78 " 776.00 " 6,034.02 " " 1,497.23 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,760.95 " 28163371 DELAY FLAP TRUNK 15600 360 "$18,491.00" " 6,834.27 " 776.00 " 14,792.80 " 892.40 " 2,773.00 " " 3,672.72 " " 2,773.00 " 907.92 " 10,216.28 " " 3,602.76 " " 3,545.00 " 869.12 808.05 " 12,239.19 " " 3,148.05 " " 3,497.83 " " 2,532.97 " " 3,166.21 " " 3,585.28 " " 3,602.76 " " 3,497.83 " " 14,792.80 " " 3,200.51 " 776.00 " 12,388.97 " " 3,078.09 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,620.25 " 28163380 MUSC MYOQ/FSCQ FLP H&N PEDCL 15733 360 "$18,491.00" " 6,834.27 " 776.00 " 14,792.80 " 892.40 " 12,777.28 " " 3,672.72 " " 12,777.28 " 907.92 " 10,216.28 " " 3,602.76 " " 6,576.00 " 869.12 808.05 " 12,239.19 " " 3,148.05 " " 3,497.83 " " 2,532.97 " " 3,166.21 " " 3,585.28 " " 3,602.76 " " 3,497.83 " " 14,792.80 " " 3,200.51 " 776.00 " 12,388.97 " " 3,078.09 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,620.25 " 28163398 MUSCLE-SKIN GRAFT TRUNK 15734 360 "$18,491.00" " 6,834.27 " 776.00 " 14,792.80 " 892.40 " 2,773.00 " " 3,672.72 " " 2,773.00 " 907.92 " 10,216.28 " " 3,602.76 " " 3,545.00 " 869.12 808.05 " 12,239.19 " " 3,148.05 " " 3,497.83 " " 2,532.97 " " 3,166.21 " " 3,585.28 " " 3,602.76 " " 3,497.83 " " 14,792.80 " " 3,200.51 " 776.00 " 12,388.97 " " 3,078.09 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,620.25 " 28163401 MUSCLE-SKIN GRAFT ARM 15736 360 "$9,006.00" " 3,328.62 " 776.00 " 7,204.80 " 892.40 " 2,773.00 " " 1,786.47 " " 2,773.00 " 907.92 " 4,975.82 " " 1,752.44 " " 3,545.00 " 869.12 808.05 " 5,961.07 " " 1,531.26 " " 1,701.40 " " 2,532.97 " " 3,166.21 " " 1,743.94 " " 1,752.44 " " 1,701.40 " " 7,204.80 " " 1,556.78 " 776.00 " 6,034.02 " " 1,497.23 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,760.95 " 28163410 MUSCLE-SKIN GRAFT LEG 15738 360 "$18,491.00" " 6,834.27 " 776.00 " 14,792.80 " 892.40 " 2,773.00 " " 3,672.72 " " 2,773.00 " 907.92 " 10,216.28 " " 3,602.76 " " 3,545.00 " 869.12 808.05 " 12,239.19 " " 3,148.05 " " 3,497.83 " " 2,532.97 " " 3,166.21 " " 3,585.28 " " 3,602.76 " " 3,497.83 " " 14,792.80 " " 3,200.51 " 776.00 " 12,388.97 " " 3,078.09 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,620.25 " 28163428 GRFG AUTOL SOFT TISS DIR EXC 15769 360 "$18,491.00" " 6,834.27 " 776.00 " 14,792.80 " 892.40 " 12,777.28 " " 3,672.72 " " 12,777.28 " 907.92 " 10,216.28 " " 3,602.76 " " 6,576.00 " 869.12 808.05 " 12,239.19 " " 3,148.05 " " 3,497.83 " " 2,727.33 " " 3,409.16 " " 3,585.28 " " 3,602.76 " " 3,497.83 " " 14,792.80 " " 3,200.51 " 776.00 " 12,388.97 " " 3,078.09 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,620.25 " 28163436 DERMA-FAT-FASCIA GRAFT 15770 360 "$18,491.00" " 6,834.27 " 776.00 " 14,792.80 " 892.40 " 2,773.00 " " 3,672.72 " " 2,773.00 " 907.92 " 10,216.28 " " 3,602.76 " " 3,545.00 " 869.12 808.05 " 12,239.19 " " 3,148.05 " " 3,497.83 " " 2,532.97 " " 3,166.21 " " 3,585.28 " " 3,602.76 " " 3,497.83 " " 14,792.80 " " 3,200.51 " 776.00 " 12,388.97 " " 3,078.09 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,620.25 " 28163444 GRFG AUTOL FAT LIPO 50 CC/< 15771 360 "$18,491.00" " 6,834.27 " 776.00 " 14,792.80 " 892.40 " 12,777.28 " " 3,672.72 " " 12,777.28 " 907.92 " 10,216.28 " " 3,602.76 " " 6,576.00 " 869.12 808.05 " 12,239.19 " " 3,148.05 " " 3,497.83 " " 3,239.74 " " 4,049.68 " " 3,585.28 " " 3,602.76 " " 3,497.83 " " 14,792.80 " " 3,200.51 " 776.00 " 12,388.97 " " 3,078.09 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,620.25 " 28163452 GRFG AUTOL FAT LIPO EA ADDL 15772 360 "$1,379.00" 509.68 - " 1,283.73 " - 952.89 - 952.89 - 761.90 - 910.14 - - 912.76 - - " 1,026.98 " " 1,283.73 " - - - " 1,103.20 " - - 923.93 - 564.01 " 1,034.25 " 524.16 616.83 - 28163461 ACELLULAR DERM MATRIX IMPLT 15777 360 "$10,972.00" " 4,055.25 " - " 8,777.60 " - " 1,469.00 " - " 1,469.00 " - " 6,062.03 " - " 7,241.52 " - - " 7,262.37 " - - 816.30 " 1,020.38 " - - - " 8,777.60 " - - " 7,351.24 " - " 4,487.55 " " 8,229.00 " " 4,170.46 " " 4,907.78 " - 28163479 CHEMICAL PEEL FACE DERMAL 15789 360 "$2,752.00" " 1,017.14 " - " 3,328.36 " - " 1,901.63 " 546.27 " 1,901.63 " - " 1,520.48 " 535.87 845.00 - - " 1,821.55 " 468.23 520.26 " 2,662.69 " " 3,328.36 " 533.27 535.87 520.26 " 2,201.60 " 476.04 - " 1,843.84 " 457.83 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 538.47 28174781 BLEPHAROPLASTY UPPER LIDS 15822 360 "$9,006.00" " 3,328.62 " 776.00 " 7,204.80 " 892.40 " 2,773.00 " " 1,786.47 " " 2,773.00 " 907.92 " 4,975.82 " " 1,752.44 " " 3,545.00 " 869.12 808.05 " 5,961.07 " " 1,531.26 " " 1,701.40 " " 2,717.03 " " 3,396.29 " " 1,743.94 " " 1,752.44 " " 1,701.40 " " 7,204.80 " " 1,556.78 " 776.00 " 6,034.02 " " 1,497.23 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,760.95 " 28163487 REVISION OF UPPER EYELID 15823 360 "$9,006.00" " 3,328.62 " 776.00 " 7,204.80 " 892.40 " 3,604.00 " " 1,786.47 " " 3,604.00 " 907.92 " 4,975.82 " " 1,752.44 " " 4,445.00 " 869.12 808.05 " 5,961.07 " " 1,531.26 " " 1,701.40 " " 4,937.34 " " 6,171.67 " " 1,743.94 " " 1,752.44 " " 1,701.40 " " 7,204.80 " " 1,556.78 " 776.00 " 6,034.02 " " 1,497.23 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,760.95 " 28163495 REMOVAL OF SKIN WRINKLES 15829 360 "$18,491.00" " 6,834.27 " - " 14,792.80 " - " 3,604.00 " " 3,672.72 " " 3,604.00 " - " 10,216.28 " " 3,602.76 " " 4,445.00 " - - " 12,239.19 " " 3,148.05 " " 3,497.83 " " 3,819.73 " " 4,774.66 " " 3,585.28 " " 3,602.76 " " 3,497.83 " " 14,792.80 " " 3,200.51 " - " 12,388.97 " " 3,078.09 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,620.25 " 28163509 EXC SKIN ABD 15830 360 "$29,053.00" " 10,737.99 " 776.00 " 23,242.40 " 892.40 " 2,773.00 " " 5,772.33 " " 2,773.00 " 907.92 " 16,051.78 " " 5,662.38 " " 3,545.00 " 869.12 808.05 " 19,230.18 " " 4,947.71 " " 5,497.46 " " 2,708.70 " " 3,385.88 " " 5,634.90 " " 5,662.38 " " 5,497.46 " " 23,242.40 " " 5,030.18 " 776.00 " 19,465.51 " " 4,837.76 " " 11,882.68 " " 21,789.75 " " 11,043.05 " " 12,995.41 " " 5,689.87 " 28163517 EXCISE EXCESSIVE SKIN THIGH 15832 360 "$12,443.00" " 4,598.93 " - " 9,954.40 " - " 2,773.00 " " 2,473.07 " " 2,773.00 " - " 6,874.76 " " 2,425.96 " " 3,545.00 " - - " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,717.03 " " 3,396.29 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " - " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28174799 EXC EXCESS SKIN AND TISSUE HIP 15834 360 "$12,443.00" " 4,598.93 " - " 9,954.40 " - " 2,773.00 " " 2,473.07 " " 2,773.00 " - " 6,874.76 " " 2,425.96 " " 3,545.00 " - - " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,717.03 " " 3,396.29 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " - " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28163525 EXCISE EXCESSIVE SKIN BUTTCK 15835 360 "$12,443.00" " 4,598.93 " - " 9,954.40 " - " 2,773.00 " " 2,473.07 " " 2,773.00 " - " 6,874.76 " " 2,425.96 " " 3,545.00 " - - " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,717.03 " " 3,396.29 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " - " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28163533 EXCISE EXCESSIVE SKIN ARM 15836 360 "$12,443.00" " 4,598.93 " - " 9,954.40 " - " 2,773.00 " " 2,473.07 " " 2,773.00 " - " 6,874.76 " " 2,425.96 " " 3,545.00 " - - " 8,236.02 " " 2,119.77 " " 2,355.30 " " 3,539.92 " " 4,424.90 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " - " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28163541 EXCISE EXCESS SKIN & TISSUE 15839 360 "$12,443.00" " 4,598.93 " - " 9,954.40 " - " 2,773.00 " " 2,473.07 " " 2,773.00 " - " 6,874.76 " " 2,425.96 " " 3,545.00 " - - " 8,236.02 " " 2,119.77 " " 2,355.30 " " 3,922.73 " " 4,903.41 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " - " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28163550 EXC SKIN ABD ADD-ON 15847 360 "$8,565.00" " 3,165.62 " - " 6,852.00 " - " 2,773.00 " - " 2,773.00 " - " 4,732.16 " - " 5,652.90 " - - " 5,669.17 " - - " 2,708.70 " " 3,385.88 " - - - " 6,852.00 " - - " 5,738.55 " - " 3,503.09 " " 6,423.75 " " 3,255.56 " " 3,831.12 " - 28163568 REMOVE SUTURES SAME SURGEON 15850 360 "$2,752.00" " 1,017.14 " - " 3,166.21 " - " 1,469.00 " 546.27 " 1,469.00 " - " 1,520.48 " 535.87 " 1,775.00 " - - " 1,821.55 " 468.23 520.26 " 2,532.97 " " 3,166.21 " 533.27 535.87 520.26 " 2,201.60 " 476.04 - " 1,843.84 " 457.83 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 538.47 28163576 DRESSING CHANGE NOT FOR BURN 15852 360 "$2,752.00" " 1,017.14 " 457.83 " 2,201.60 " 892.40 " 1,469.00 " 546.27 " 1,469.00 " 907.92 " 1,520.48 " 535.87 845.00 869.12 808.05 " 1,821.55 " 468.23 520.26 " 1,649.49 " " 2,061.86 " 533.27 535.87 520.26 " 2,201.60 " 476.04 776.00 " 1,843.84 " 457.83 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 538.47 28163584 SUCTION LIPECTOMY HEAD&NECK 15876 360 "$18,491.00" " 6,834.27 " - " 14,792.80 " - " 2,773.00 " " 3,672.72 " " 2,773.00 " - " 10,216.28 " " 3,602.76 " " 3,545.00 " - - " 12,239.19 " " 3,148.05 " " 3,497.83 " " 4,937.34 " " 6,171.67 " " 3,585.28 " " 3,602.76 " " 3,497.83 " " 14,792.80 " " 3,200.51 " - " 12,388.97 " " 3,078.09 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,620.25 " 28163592 SUCTION LIPECTOMY TRUNK 15877 360 "$18,491.00" " 6,834.27 " - " 14,792.80 " - " 2,773.00 " " 3,672.72 " " 2,773.00 " - " 10,216.28 " " 3,602.76 " " 3,545.00 " - - " 12,239.19 " " 3,148.05 " " 3,497.83 " " 4,937.34 " " 6,171.67 " " 3,585.28 " " 3,602.76 " " 3,497.83 " " 14,792.80 " " 3,200.51 " - " 12,388.97 " " 3,078.09 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,620.25 " 28163606 SUCTION LIPECTOMY LWR EXTREM 15879 360 "$18,491.00" " 6,834.27 " - " 14,792.80 " - " 2,773.00 " " 3,672.72 " " 2,773.00 " - " 10,216.28 " " 3,602.76 " " 3,545.00 " - - " 12,239.19 " " 3,148.05 " " 3,497.83 " " 4,937.34 " " 6,171.67 " " 3,585.28 " " 3,602.76 " " 3,497.83 " " 14,792.80 " " 3,200.51 " - " 12,388.97 " " 3,078.09 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,620.25 " 28174802 REMOVAL OF TAIL BONE ULCER 15920 360 "$12,443.00" " 4,598.93 " 258.00 " 9,954.40 " 296.70 " 2,773.00 " " 2,473.07 " " 2,773.00 " 301.86 " 6,874.76 " " 2,425.96 " " 3,545.00 " 288.96 268.66 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,532.97 " " 3,166.21 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 258.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28163614 REMOVE SACRUM PRESSURE SORE 15931 360 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 2,773.00 " " 2,473.07 " " 2,773.00 " 907.92 " 6,874.76 " " 2,425.96 " " 3,545.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,532.97 " " 3,166.21 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28174811 EXC SAC PRES ULC W/O STECTOMY 15937 360 "$9,006.00" " 3,328.62 " 776.00 " 7,204.80 " 892.40 " 3,326.00 " " 1,786.47 " " 3,326.00 " 907.92 " 4,975.82 " " 1,752.44 " " 4,860.00 " 869.12 808.05 " 5,961.07 " " 1,531.26 " " 1,701.40 " " 3,120.10 " " 3,900.12 " " 1,743.94 " " 1,752.44 " " 1,701.40 " " 7,204.80 " " 1,556.78 " 776.00 " 6,034.02 " " 1,497.23 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,760.95 " 28163622 REM HIP PRESS SORE PRIM CLOSUR 15940 360 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 2,773.00 " " 2,473.07 " " 2,773.00 " 907.92 " 6,874.76 " " 2,425.96 " " 3,545.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,532.97 " " 3,166.21 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28174829 EXC ISC PRES ULCER W OSTECTOMY 15945 360 "$9,006.00" " 3,328.62 " 776.00 " 7,204.80 " 892.40 " 3,326.00 " " 1,786.47 " " 3,326.00 " 907.92 " 4,975.82 " " 1,752.44 " " 4,860.00 " 869.12 808.05 " 5,961.07 " " 1,531.26 " " 1,701.40 " " 3,120.10 " " 3,900.12 " " 1,743.94 " " 1,752.44 " " 1,701.40 " " 7,204.80 " " 1,556.78 " 776.00 " 6,034.02 " " 1,497.23 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,760.95 " 28163631 REM HIP PRESS SORE W OSTECTOMY 15946 360 "$9,006.00" " 3,328.62 " 776.00 " 7,204.80 " 892.40 " 3,326.00 " " 1,786.47 " " 3,326.00 " 907.92 " 4,975.82 " " 1,752.44 " " 4,860.00 " 869.12 808.05 " 5,961.07 " " 1,531.26 " " 1,701.40 " " 3,120.10 " " 3,900.12 " " 1,743.94 " " 1,752.44 " " 1,701.40 " " 7,204.80 " " 1,556.78 " 776.00 " 6,034.02 " " 1,497.23 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,760.95 " 37003042 INIT TX 1ST DEGREE BURN LOCAL 16000 450 $943.00 348.53 18.00 845.00 20.70 651.61 187.30 651.61 21.06 521.01 183.73 845.00 20.16 18.74 624.17 160.54 178.38 285.78 357.22 182.84 183.73 178.38 754.40 163.22 18.00 631.81 156.97 385.69 707.25 358.43 421.80 184.62 37001538 DRESS/DEBRID PART-THCK BURN SM 16020 450 $943.00 348.53 20.00 " 1,775.00 " 23.00 " 1,469.00 " 187.30 " 1,469.00 " 23.40 521.01 183.73 " 1,775.00 " 22.40 20.83 624.17 160.54 178.38 281.27 351.59 182.84 183.73 178.38 754.40 163.22 20.00 631.81 156.97 385.69 707.25 358.43 421.80 184.62 51600533 DRESS/DEBRID PART-THCK BURN SM 16020 510 $943.00 348.53 20.00 " 1,775.00 " 23.00 " 1,469.00 " 187.30 " 1,469.00 " 23.40 521.01 183.73 " 1,775.00 " 22.40 20.83 624.17 160.54 178.38 281.27 351.59 182.84 183.73 178.38 754.40 163.22 20.00 631.81 156.97 385.69 707.25 358.43 421.80 184.62 37001546 DRESS/DEBRID PART-THCK BURN MD 16025 450 $943.00 348.53 100.55 " 2,820.00 " 115.63 " 1,718.00 " 187.30 " 1,718.00 " 117.64 521.01 183.73 " 2,820.00 " 112.62 104.70 624.17 160.54 178.38 281.27 351.59 182.84 183.73 178.38 754.40 163.22 100.55 631.81 156.97 385.69 707.25 358.43 421.80 184.62 37001554 DRESS/DEBRID PART-THCK BURN LG 16030 450 "$1,816.00" 671.19 115.08 " 2,820.00 " 132.34 " 1,718.00 " 360.51 " 1,718.00 " 134.64 " 1,003.34 " 353.64 " 2,820.00 " 128.89 119.83 " 1,202.01 " 309.01 343.34 " 1,649.49 " " 2,061.86 " 351.92 353.64 343.34 " 1,452.80 " 314.16 115.08 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 28163649 DESTRUCT B9 LESION 1-14 17110 360 $943.00 348.53 156.97 " 1,469.00 " 741.75 " 1,469.00 " 187.30 " 1,469.00 " 754.65 521.01 183.73 845.00 722.40 671.64 624.17 160.54 178.38 393.78 492.23 182.84 183.73 178.38 754.40 163.22 645.00 631.81 156.97 385.69 707.25 358.43 421.80 184.62 28163657 DESTRUCT LESION 15 OR MORE 17111 360 $943.00 348.53 156.97 " 1,469.00 " 892.40 " 1,469.00 " 187.30 " 1,469.00 " 907.92 521.01 183.73 845.00 869.12 808.05 624.17 160.54 178.38 530.87 663.59 182.84 183.73 178.38 754.40 163.22 776.00 631.81 156.97 385.69 707.25 358.43 421.80 184.62 37090018 CHEM CAUTERY GRANULATED TISS 17250 450 $943.00 348.53 25.82 " 1,469.00 " 29.69 " 1,469.00 " 187.30 " 1,469.00 " 30.21 521.01 183.73 845.00 28.92 26.89 624.17 160.54 178.38 281.27 351.59 182.84 183.73 178.38 754.40 163.22 25.82 631.81 156.97 385.69 707.25 358.43 421.80 184.62 51600355 CHEM CAUTERY GRANULATED TISS 17250 510 $943.00 348.53 25.82 " 1,469.00 " 29.69 " 1,469.00 " 187.30 " 1,469.00 " 30.21 521.01 183.73 845.00 28.92 26.89 624.17 160.54 178.38 281.27 351.59 182.84 183.73 178.38 754.40 163.22 25.82 631.81 156.97 385.69 707.25 358.43 421.80 184.62 80335075 CHEM CAUTERY GRANULATED TISS 17250 320 $943.00 348.53 25.82 " 1,469.00 " 29.69 " 1,469.00 " 187.30 " 1,469.00 " 30.21 521.01 183.73 845.00 28.92 26.89 624.17 160.54 178.38 281.27 351.59 182.84 183.73 178.38 754.40 163.22 25.82 631.81 156.97 385.69 707.25 358.43 421.80 184.62 37004154 UNL PROCEDURE SKIN TISSUE 17999 450 $943.00 348.53 - " 1,469.00 " - " 1,469.00 " 187.30 " 1,469.00 " - 521.01 183.73 622.38 - - 624.17 160.54 178.38 56.26 70.32 182.84 183.73 178.38 754.40 163.22 - 631.81 156.97 385.69 707.25 358.43 421.80 184.62 80010907 UNLISTED SKIN TISSUE PROCEDURE 17999 360 $943.00 348.53 - " 1,469.00 " - " 1,469.00 " 187.30 " 1,469.00 " - 521.01 183.73 622.38 - - 624.17 160.54 178.38 56.26 70.32 182.84 183.73 178.38 754.40 163.22 - 631.81 156.97 385.69 707.25 358.43 421.80 184.62 80508450 P&D BREAST LESION 19000 402 "$3,265.00" " 1,206.74 " 36.50 " 2,612.00 " 41.98 " 1,469.00 " 649.06 " 1,469.00 " 42.71 " 1,803.91 " 636.69 " 1,775.00 " 40.88 38.01 " 2,161.10 " 556.34 618.15 393.78 492.23 633.60 636.69 618.15 " 2,612.00 " 565.61 36.50 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 82708456 P&D BREAST LESION 19000 320 "$3,265.00" " 1,206.74 " 36.50 " 2,612.00 " 41.98 " 1,469.00 " 649.06 " 1,469.00 " 42.71 " 1,803.91 " 636.69 " 1,775.00 " 40.88 38.01 " 2,161.10 " 556.34 618.15 393.78 492.23 633.60 636.69 618.15 " 2,612.00 " 565.61 36.50 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 83008458 P&D BREAST LESION 19000 320 "$3,265.00" " 1,206.74 " 36.50 " 2,612.00 " 41.98 " 1,469.00 " 649.06 " 1,469.00 " 42.71 " 1,803.91 " 636.69 " 1,775.00 " 40.88 38.01 " 2,161.10 " 556.34 618.15 393.78 492.23 633.60 636.69 618.15 " 2,612.00 " 565.61 36.50 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 80501919 P&D BREAST LESION EA ADDL 19001 402 $612.00 226.20 - " 1,469.00 " 23.45 " 1,469.00 " - " 1,469.00 " 23.86 338.13 - 403.92 22.84 21.23 405.08 - - 168.76 210.95 - - - 489.60 - 20.39 410.04 - 250.31 459.00 232.62 273.75 - 81401918 P&D BREAST LESION EA ADDL 19001 320 $612.00 226.20 - " 1,469.00 " 23.45 " 1,469.00 " - " 1,469.00 " 23.86 338.13 - 403.92 22.84 21.23 405.08 - - 168.76 210.95 - - - 489.60 - 20.39 410.04 - 250.31 459.00 232.62 273.75 - 83001917 P&D BREAST LESION EA ADDL 19001 320 $612.00 226.20 - " 1,469.00 " 23.45 " 1,469.00 " - " 1,469.00 " 23.86 338.13 - 403.92 22.84 21.23 405.08 - - 168.76 210.95 - - - 489.60 - 20.39 410.04 - 250.31 459.00 232.62 273.75 - 28163665 I&D OF BREAST LESION 19020 360 "$7,387.00" " 2,730.24 " 821.00 " 5,909.60 " 944.15 " 1,718.00 " " 1,467.55 " " 1,718.00 " 960.57 " 4,081.32 " " 1,439.60 " " 2,820.00 " 919.52 854.91 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 2,208.66 " " 2,760.83 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 821.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 37003611 I&D OF BREAST LESION 19020 450 "$7,387.00" " 2,730.24 " 821.00 " 5,909.60 " 944.15 " 1,718.00 " " 1,467.55 " " 1,718.00 " 960.57 " 4,081.32 " " 1,439.60 " " 2,820.00 " 919.52 854.91 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 2,208.66 " " 2,760.83 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 821.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 83001941 INJ BREAST XR 19030 320 $290.00 107.18 - " 1,469.00 " 72.93 " 1,469.00 " - " 1,469.00 " 74.20 160.23 - 191.40 71.03 66.04 191.95 - - 168.76 210.95 - - - 232.00 - 63.42 194.30 - 118.61 217.50 110.23 129.72 - 82701958 BX BREAST 1ST LESION STEREO 19081 320 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,718.00 " " 1,467.55 " " 1,718.00 " 907.92 " 4,081.32 " " 1,439.60 " " 3,545.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,430.94 " " 1,788.68 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 83001950 BX BREAST 1ST LESION STEREO 19081 320 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,718.00 " " 1,467.55 " " 1,718.00 " 907.92 " 4,081.32 " " 1,439.60 " " 3,545.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,430.94 " " 1,788.68 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 82701966 BX BREAST ADD LESION STEREO 19082 320 $375.00 138.60 - " 1,469.00 " 80.94 " 1,469.00 " - " 1,469.00 " 82.34 207.19 - 247.50 78.83 73.29 248.21 - - " 1,145.74 " " 1,432.17 " - - - 300.00 - 70.38 251.25 - 153.38 281.25 142.54 167.74 - 83001968 BX BREAST ADD LESION STEREO 19082 320 $375.00 138.60 - " 1,469.00 " 80.94 " 1,469.00 " - " 1,469.00 " 82.34 207.19 - 247.50 78.83 73.29 248.21 - - " 1,145.74 " " 1,432.17 " - - - 300.00 - 70.38 251.25 - 153.38 281.25 142.54 167.74 - 80501978 BX BREAST 1ST LESION US IMAGE 19083 401 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,718.00 " " 1,467.55 " " 1,718.00 " 907.92 " 4,081.32 " " 1,439.60 " " 3,545.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,419.35 " " 1,774.19 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 82701974 BX BREAST 1ST LESION US IMAGE 19083 401 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,718.00 " " 1,467.55 " " 1,718.00 " 907.92 " 4,081.32 " " 1,439.60 " " 3,545.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,419.35 " " 1,774.19 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 83001976 BX BREAST 1ST LESION US IMAGE 19083 401 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,718.00 " " 1,467.55 " " 1,718.00 " 907.92 " 4,081.32 " " 1,439.60 " " 3,545.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,419.35 " " 1,774.19 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 80501986 BX BREAST ADD LESION US IMAGE 19084 401 $375.00 138.60 - " 1,469.00 " 76.04 " 1,469.00 " - " 1,469.00 " 77.36 207.19 - 247.50 74.05 68.85 248.21 - - " 1,129.42 " " 1,411.77 " - - - 300.00 - 66.12 251.25 - 153.38 281.25 142.54 167.74 - 82701982 BX BREAST ADD LESION US IMAGE 19084 401 $375.00 138.60 - " 1,469.00 " 76.04 " 1,469.00 " - " 1,469.00 " 77.36 207.19 - 247.50 74.05 68.85 248.21 - - " 1,129.42 " " 1,411.77 " - - - 300.00 - 66.12 251.25 - 153.38 281.25 142.54 167.74 - 83001984 BX BREAST ADD LESION US IMAGE 19084 401 $375.00 138.60 - " 1,469.00 " 76.04 " 1,469.00 " - " 1,469.00 " 77.36 207.19 - 247.50 74.05 68.85 248.21 - - " 1,129.42 " " 1,411.77 " - - - 300.00 - 66.12 251.25 - 153.38 281.25 142.54 167.74 - 80401990 BX BREAST 1ST LESION MRI IMAGE 19085 610 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 2,773.00 " " 1,467.55 " " 2,773.00 " 907.92 " 4,081.32 " " 1,439.60 " " 1,155.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 2,138.90 " " 2,673.63 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 81401993 BX BREAST 1ST LESION MRI IMAGE 19085 320 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 2,773.00 " " 1,467.55 " " 2,773.00 " 907.92 " 4,081.32 " " 1,439.60 " " 3,545.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 2,138.90 " " 2,673.63 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 80402007 BX BREAST ADD LESION MRI IMAGE 19086 610 "$7,266.00" " 2,685.51 " - " 5,812.80 " 82.41 " 1,469.00 " - " 1,469.00 " 83.84 " 4,014.47 " - " 1,155.00 " 80.26 74.62 " 4,809.37 " - - " 1,692.08 " " 2,115.10 " - - - " 5,812.80 " - 71.66 " 4,868.22 " - " 2,971.79 " " 5,449.50 " " 2,761.81 " " 3,250.08 " - 81402001 BX BREAST ADD LESION MRI IMAGE 19086 320 "$7,266.00" " 2,685.51 " - " 5,812.80 " 82.41 " 1,469.00 " - " 1,469.00 " 83.84 " 4,014.47 " - " 4,795.56 " 80.26 74.62 " 4,809.37 " - - " 1,692.08 " " 2,115.10 " - - - " 5,812.80 " - 71.66 " 4,868.22 " - " 2,971.79 " " 5,449.50 " " 2,761.81 " " 3,250.08 " - 28163673 BIOPSY OF BREAST OPEN 19101 360 "$16,578.00" " 6,127.23 " 774.00 " 13,262.40 " 890.10 " 1,718.00 " " 3,293.60 " " 1,718.00 " 905.58 " 9,159.35 " " 3,230.86 " " 2,820.00 " 866.88 805.97 " 10,972.98 " " 2,823.08 " " 3,136.76 " " 2,208.66 " " 2,760.83 " " 3,215.18 " " 3,230.86 " " 3,136.76 " " 13,262.40 " " 2,870.14 " 774.00 " 11,107.26 " " 2,760.35 " " 6,780.40 " " 12,433.50 " " 6,301.30 " " 7,415.34 " " 3,246.55 " 28163681 NIPPLE EXPLORATION 19110 360 "$16,578.00" " 6,127.23 " 776.00 " 13,262.40 " 892.40 " 1,718.00 " " 3,293.60 " " 1,718.00 " 907.92 " 9,159.35 " " 3,230.86 " " 2,820.00 " 869.12 808.05 " 10,972.98 " " 2,823.08 " " 3,136.76 " " 2,208.66 " " 2,760.83 " " 3,215.18 " " 3,230.86 " " 3,136.76 " " 13,262.40 " " 2,870.14 " 776.00 " 11,107.26 " " 2,760.35 " " 6,780.40 " " 12,433.50 " " 6,301.30 " " 7,415.34 " " 3,246.55 " 28163690 REMOVAL OF BREAST LESION 19120 360 "$16,578.00" " 6,127.23 " 833.00 " 13,262.40 " 957.95 " 2,773.00 " " 3,293.60 " " 2,773.00 " 974.61 " 9,159.35 " " 3,230.86 " " 3,545.00 " 932.96 867.40 " 10,972.98 " " 2,823.08 " " 3,136.76 " " 2,532.97 " " 3,166.21 " " 3,215.18 " " 3,230.86 " " 3,136.76 " " 13,262.40 " " 2,870.14 " 833.00 " 11,107.26 " " 2,760.35 " " 6,780.40 " " 12,433.50 " " 6,301.30 " " 7,415.34 " " 3,246.55 " 28163703 EXCISION BREAST LESION 19125 360 "$16,578.00" " 6,127.23 " 776.00 " 13,262.40 " 892.40 " 2,773.00 " " 3,293.60 " " 2,773.00 " 907.92 " 9,159.35 " " 3,230.86 " " 3,545.00 " 869.12 808.05 " 10,972.98 " " 2,823.08 " " 3,136.76 " " 2,532.97 " " 3,166.21 " " 3,215.18 " " 3,230.86 " " 3,136.76 " " 13,262.40 " " 2,870.14 " 776.00 " 11,107.26 " " 2,760.35 " " 6,780.40 " " 12,433.50 " " 6,301.30 " " 7,415.34 " " 3,246.55 " 80102011 PERC DEVICE BREAST 1ST IMAGE 19281 401 "$3,265.00" " 1,206.74 " 82.59 " 2,612.00 " 94.98 " 1,718.00 " 649.06 " 1,718.00 " 96.63 " 1,803.91 " 636.69 " 1,775.00 " 92.50 86.00 " 2,161.10 " 556.34 618.15 519.90 649.88 633.60 636.69 618.15 " 2,612.00 " 565.61 82.59 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 83002018 PERC DEVICE BREAST 1ST IMAGE 19281 401 "$3,265.00" " 1,206.74 " 82.59 " 2,612.00 " 94.98 " 1,718.00 " 649.06 " 1,718.00 " 96.63 " 1,803.91 " 636.69 " 1,775.00 " 92.50 86.00 " 2,161.10 " 556.34 618.15 519.90 649.88 633.60 636.69 618.15 " 2,612.00 " 565.61 82.59 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 80102020 PERC DEVICE BREAST ADD IMAGE 19282 401 $200.00 73.92 - " 1,469.00 " 45.23 " 1,469.00 " - " 1,469.00 " 46.02 110.50 - 132.00 44.05 40.95 132.38 - - 357.22 446.52 - - - 160.00 - 39.33 134.00 - 81.80 150.00 76.02 89.46 - 83002026 PERC DEVICE BREAST ADD IMAGE 19282 401 $200.00 73.92 - " 1,469.00 " 45.23 " 1,469.00 " - " 1,469.00 " 46.02 110.50 - 132.00 44.05 40.95 132.38 - - 357.22 446.52 - - - 160.00 - 39.33 134.00 - 81.80 150.00 76.02 89.46 - 28163711 US PERC DEV BREAST 1ST IMAGE 19285 360 "$3,265.00" " 1,206.74 " 70.71 " 2,612.00 " 81.32 " 1,718.00 " 649.06 " 1,718.00 " 82.73 " 1,803.91 " 636.69 " 1,775.00 " 79.20 73.63 " 2,161.10 " 556.34 618.15 983.16 " 1,228.95 " 633.60 636.69 618.15 " 2,612.00 " 565.61 70.71 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 80502036 US PERC DEV BREAST 1ST IMAGE 19285 402 "$3,265.00" " 1,206.74 " 70.71 " 2,612.00 " 81.32 " 1,718.00 " 649.06 " 1,718.00 " 82.73 " 1,803.91 " 636.69 " 1,775.00 " 79.20 73.63 " 2,161.10 " 556.34 618.15 983.16 " 1,228.95 " 633.60 636.69 618.15 " 2,612.00 " 565.61 70.71 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 83002034 US PERC DEV BREAST 1ST IMAGE 19285 402 "$3,265.00" " 1,206.74 " 70.71 " 2,612.00 " 81.32 " 1,718.00 " 649.06 " 1,718.00 " 82.73 " 1,803.91 " 636.69 " 1,775.00 " 79.20 73.63 " 2,161.10 " 556.34 618.15 983.16 " 1,228.95 " 633.60 636.69 618.15 " 2,612.00 " 565.61 70.71 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 80502044 US PERC DEV BREAST ADD IMAGE 19286 402 $800.00 295.68 - " 1,469.00 " 39.08 " 1,469.00 " - " 1,469.00 " 39.76 442.00 - 528.00 38.06 35.38 529.52 - - 819.51 " 1,024.39 " - - - 640.00 - 33.98 536.00 - 327.20 600.00 304.08 357.84 - 83002042 US PERC DEV BREAST ADD IMAGE 19286 402 $800.00 295.68 - " 1,469.00 " 39.08 " 1,469.00 " - " 1,469.00 " 39.76 442.00 - 528.00 38.06 35.38 529.52 - - 819.51 " 1,024.39 " - - - 640.00 - 33.98 536.00 - 327.20 600.00 304.08 357.84 - 80402058 PERC DEV BREAST 1ST MR GUIDE 19287 610 "$3,265.00" " 1,206.74 " 115.58 " 2,773.00 " 132.92 " 2,773.00 " 649.06 " 2,773.00 " 135.23 " 1,803.91 " 636.69 " 1,155.00 " 129.45 120.35 " 2,161.10 " 556.34 618.15 " 1,820.56 " " 2,275.70 " 633.60 636.69 618.15 " 2,612.00 " 565.61 115.58 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 80402066 PERC DEV BREAST ADD MR GUIDE 19288 610 $253.00 93.51 - " 1,800.35 " 58.44 " 1,469.00 " - " 1,469.00 " 59.46 139.78 - " 1,155.00 " 56.92 52.92 167.46 - - " 1,440.28 " " 1,800.35 " - - - 202.40 - 50.82 169.51 - 103.48 189.75 96.17 113.17 - 28163720 REMOVAL OF BREAST TISSUE 19300 360 "$16,578.00" " 6,127.23 " 776.00 " 13,262.40 " 892.40 " 3,326.00 " " 3,293.60 " " 3,326.00 " 907.92 " 9,159.35 " " 3,230.86 " " 4,860.00 " 869.12 808.05 " 10,972.98 " " 2,823.08 " " 3,136.76 " " 3,346.06 " " 4,182.58 " " 3,215.18 " " 3,230.86 " " 3,136.76 " " 13,262.40 " " 2,870.14 " 776.00 " 11,107.26 " " 2,760.35 " " 6,780.40 " " 12,433.50 " " 6,301.30 " " 7,415.34 " " 3,246.55 " 28163738 PARTIAL MASTECTOMY 19301 360 "$16,578.00" " 6,127.23 " 776.00 " 13,262.40 " 892.40 " 2,773.00 " " 3,293.60 " " 2,773.00 " 907.92 " 9,159.35 " " 3,230.86 " " 3,545.00 " 869.12 808.05 " 10,972.98 " " 2,823.08 " " 3,136.76 " " 2,708.70 " " 3,385.88 " " 3,215.18 " " 3,230.86 " " 3,136.76 " " 13,262.40 " " 2,870.14 " 776.00 " 11,107.26 " " 2,760.35 " " 6,780.40 " " 12,433.50 " " 6,301.30 " " 7,415.34 " " 3,246.55 " 28174837 MASTECTOM PAR W AXIL LYMPHADEN 19302 360 "$29,053.00" " 10,737.99 " 776.00 " 23,242.40 " 892.40 " 4,435.00 " " 5,772.33 " " 4,435.00 " 907.92 " 16,051.78 " " 5,662.38 " " 6,540.00 " 869.12 808.05 " 19,230.18 " " 4,947.71 " " 5,497.46 " " 5,284.54 " " 6,605.67 " " 5,634.90 " " 5,662.38 " " 5,497.46 " " 23,242.40 " " 5,030.18 " 776.00 " 19,465.51 " " 4,837.76 " " 11,882.68 " " 21,789.75 " " 11,043.05 " " 12,995.41 " " 5,689.87 " 28163746 MAST SIMPLE COMPLETE 19303 360 "$29,053.00" " 10,737.99 " 776.00 " 23,242.40 " 892.40 " 3,326.00 " " 5,772.33 " " 3,326.00 " 907.92 " 16,051.78 " " 5,662.38 " " 4,860.00 " 869.12 808.05 " 19,230.18 " " 4,947.71 " " 5,497.46 " " 3,346.06 " " 4,182.58 " " 5,634.90 " " 5,662.38 " " 5,497.46 " " 23,242.40 " " 5,030.18 " 776.00 " 19,465.51 " " 4,837.76 " " 11,882.68 " " 21,789.75 " " 11,043.05 " " 12,995.41 " " 5,689.87 " 28163754 MAST MOD RAD 19307 360 "$29,053.00" " 10,737.99 " 776.00 " 23,242.40 " 892.40 " 3,604.00 " " 5,772.33 " " 3,604.00 " 907.92 " 16,051.78 " " 5,662.38 " " 6,576.00 " 869.12 808.05 " 19,230.18 " " 4,947.71 " " 5,497.46 " " 5,408.30 " " 6,760.37 " " 5,634.90 " " 5,662.38 " " 5,497.46 " " 23,242.40 " " 5,030.18 " 776.00 " 19,465.51 " " 4,837.76 " " 11,882.68 " " 21,789.75 " " 11,043.05 " " 12,995.41 " " 5,689.87 " 28163762 SUSPENSION OF BREAST 19316 360 "$29,053.00" " 10,737.99 " - " 23,242.40 " - " 3,326.00 " " 5,772.33 " " 3,326.00 " - " 16,051.78 " " 5,662.38 " " 4,860.00 " - - " 19,230.18 " " 4,947.71 " " 5,497.46 " " 2,208.66 " " 2,760.83 " " 5,634.90 " " 5,662.38 " " 5,497.46 " " 23,242.40 " " 5,030.18 " - " 19,465.51 " " 4,837.76 " " 11,882.68 " " 21,789.75 " " 11,043.05 " " 12,995.41 " " 5,689.87 " 28163771 REDUCTION OF LARGE BREAST 19318 360 "$29,053.00" " 10,737.99 " 776.00 " 23,242.40 " 892.40 " 3,326.00 " " 5,772.33 " " 3,326.00 " 907.92 " 16,051.78 " " 5,662.38 " " 4,860.00 " 869.12 808.05 " 19,230.18 " " 4,947.71 " " 5,497.46 " " 3,120.10 " " 3,900.12 " " 5,634.90 " " 5,662.38 " " 5,497.46 " " 23,242.40 " " 5,030.18 " 776.00 " 19,465.51 " " 4,837.76 " " 11,882.68 " " 21,789.75 " " 11,043.05 " " 12,995.41 " " 5,689.87 " 28163789 ENLARGE BREAST WITH IMPLANT 19325 360 "$46,830.00" " 17,308.37 " 776.00 " 37,464.00 " 892.40 " 4,656.00 " " 9,300.12 " " 4,656.00 " 907.92 " 25,873.58 " " 9,122.98 " " 6,576.00 " 869.12 808.05 " 30,996.78 " " 7,971.53 " " 8,857.26 " " 2,208.66 " " 2,760.83 " " 9,078.69 " " 9,122.98 " " 8,857.26 " " 37,464.00 " " 8,104.39 " 776.00 " 31,376.10 " " 7,794.39 " " 19,153.47 " " 35,122.50 " " 17,800.08 " " 20,947.06 " " 9,167.26 " 28163797 REMOVAL OF BREAST IMPLANT 19328 360 "$16,578.00" " 6,127.23 " 776.00 " 13,262.40 " 892.40 " 1,469.00 " " 3,293.60 " " 1,469.00 " 907.92 " 9,159.35 " " 3,230.86 " " 1,775.00 " 869.12 808.05 " 10,972.98 " " 2,823.08 " " 3,136.76 " " 1,649.49 " " 2,061.86 " " 3,215.18 " " 3,230.86 " " 3,136.76 " " 13,262.40 " " 2,870.14 " 776.00 " 11,107.26 " " 2,760.35 " " 6,780.40 " " 12,433.50 " " 6,301.30 " " 7,415.34 " " 3,246.55 " 28163801 REMOVAL OF IMPLANT MATERIAL 19330 360 "$16,578.00" " 6,127.23 " 776.00 " 13,262.40 " 892.40 " 1,469.00 " " 3,293.60 " " 1,469.00 " 907.92 " 9,159.35 " " 3,230.86 " " 1,775.00 " 869.12 808.05 " 10,972.98 " " 2,823.08 " " 3,136.76 " " 1,649.49 " " 2,061.86 " " 3,215.18 " " 3,230.86 " " 3,136.76 " " 13,262.40 " " 2,870.14 " 776.00 " 11,107.26 " " 2,760.35 " " 6,780.40 " " 12,433.50 " " 6,301.30 " " 7,415.34 " " 3,246.55 " 28163819 IMMEDIATE BREAST PROSTHESIS 19340 360 "$29,053.00" " 10,737.99 " 776.00 " 23,242.40 " 892.40 " 1,718.00 " " 5,772.33 " " 1,718.00 " 907.92 " 16,051.78 " " 5,662.38 " " 2,820.00 " 869.12 808.05 " 19,230.18 " " 4,947.71 " " 5,497.46 " " 2,208.66 " " 2,760.83 " " 5,634.90 " " 5,662.38 " " 5,497.46 " " 23,242.40 " " 5,030.18 " 776.00 " 19,465.51 " " 4,837.76 " " 11,882.68 " " 21,789.75 " " 11,043.05 " " 12,995.41 " " 5,689.87 " 28163827 DELAYED BREAST PROSTHESIS 19342 360 "$46,830.00" " 17,308.37 " 776.00 " 37,464.00 " 892.40 " 2,773.00 " " 9,300.12 " " 2,773.00 " 907.92 " 25,873.58 " " 9,122.98 " " 3,545.00 " 869.12 808.05 " 30,996.78 " " 7,971.53 " " 8,857.26 " " 2,532.97 " " 3,166.21 " " 9,078.69 " " 9,122.98 " " 8,857.26 " " 37,464.00 " " 8,104.39 " 776.00 " 31,376.10 " " 7,794.39 " " 19,153.47 " " 35,122.50 " " 17,800.08 " " 20,947.06 " " 9,167.26 " 28163835 BREAST RECONSTRUCTION TISS EXP 19357 360 "$78,376.00" " 28,967.77 " 776.00 " 62,700.80 " 892.40 " 3,604.00 " " 15,561.86 " " 3,604.00 " 907.92 " 43,302.74 " " 15,265.44 " " 4,445.00 " 869.12 808.05 " 51,877.07 " " 13,338.74 " " 14,820.82 " " 3,730.57 " " 4,663.21 " " 15,191.34 " " 15,265.44 " " 14,820.82 " " 62,700.80 " " 13,561.05 " 776.00 " 52,511.92 " " 13,042.32 " " 32,055.78 " " 58,782.00 " " 29,790.72 " " 35,057.58 " " 15,339.55 " 28163843 BREAST RECONSTR W/LAT FLAP 19361 360 "$8,766.00" " 3,239.91 " - " 7,012.80 " - " 6,057.31 " N/A " 6,057.31 " - " 4,843.22 " N/A " 5,785.56 " - N/A " 5,802.22 " - N/A " 3,730.57 " " 4,663.21 " N/A N/A N/A " 7,012.80 " N/A - " 5,873.22 " N/A " 3,585.29 " " 6,574.50 " " 3,331.96 " " 3,921.03 " N/A 28163851 BREAST RECONSTRUCTION TRAM FLA 19367 360 "$33,792.00" " 12,489.52 " - " 27,033.60 " - " 23,350.27 " N/A " 23,350.27 " - " 18,670.08 " N/A " 22,302.72 " - N/A " 22,366.92 " - N/A " 3,730.57 " " 4,663.21 " N/A N/A N/A " 27,033.60 " N/A - " 22,640.64 " N/A " 13,820.93 " " 25,344.00 " " 12,844.34 " " 15,115.16 " N/A 28163860 SURGERY OF BREAST CAPSULE 19370 360 "$16,578.00" " 6,127.23 " 776.00 " 13,262.40 " 892.40 " 3,326.00 " " 3,293.60 " " 3,326.00 " 907.92 " 9,159.35 " " 3,230.86 " " 4,860.00 " 869.12 808.05 " 10,972.98 " " 2,823.08 " " 3,136.76 " " 3,120.10 " " 3,900.12 " " 3,215.18 " " 3,230.86 " " 3,136.76 " " 13,262.40 " " 2,870.14 " 776.00 " 11,107.26 " " 2,760.35 " " 6,780.40 " " 12,433.50 " " 6,301.30 " " 7,415.34 " " 3,246.55 " 28163878 REMOVAL OF BREAST CAPSULE 19371 360 "$16,578.00" " 6,127.23 " 776.00 " 13,262.40 " 892.40 " 3,326.00 " " 3,293.60 " " 3,326.00 " 907.92 " 9,159.35 " " 3,230.86 " " 4,860.00 " 869.12 808.05 " 10,972.98 " " 2,823.08 " " 3,136.76 " " 3,120.10 " " 3,900.12 " " 3,215.18 " " 3,230.86 " " 3,136.76 " " 13,262.40 " " 2,870.14 " 776.00 " 11,107.26 " " 2,760.35 " " 6,780.40 " " 12,433.50 " " 6,301.30 " " 7,415.34 " " 3,246.55 " 28163886 REVISE BREAST RECONSTRUCTION 19380 360 "$29,053.00" " 10,737.99 " 776.00 " 23,242.40 " 892.40 " 3,604.00 " " 5,772.33 " " 3,604.00 " 907.92 " 16,051.78 " " 5,662.38 " " 4,445.00 " 869.12 808.05 " 19,230.18 " " 4,947.71 " " 5,497.46 " " 3,730.57 " " 4,663.21 " " 5,634.90 " " 5,662.38 " " 5,497.46 " " 23,242.40 " " 5,030.18 " 776.00 " 19,465.51 " " 4,837.76 " " 11,882.68 " " 21,789.75 " " 11,043.05 " " 12,995.41 " " 5,689.87 " 28163894 UNLISTED BREAST SURGERY PROC 19499 360 "$16,578.00" " 6,127.23 " - " 13,262.40 " - " 1,469.00 " " 3,293.60 " " 1,469.00 " - " 9,159.35 " " 3,230.86 " " 10,941.48 " - - " 10,972.98 " " 2,823.08 " " 3,136.76 " 56.26 70.32 " 3,215.18 " " 3,230.86 " " 3,136.76 " " 13,262.40 " " 2,870.14 " - " 11,107.26 " " 2,760.35 " " 6,780.40 " " 12,433.50 " " 6,301.30 " " 7,415.34 " " 3,246.55 " 80011083 UNLISTED BREAST SURGERY PROC 19499 333 "$16,578.00" " 6,127.23 " - " 13,262.40 " - " 1,469.00 " " 3,293.60 " " 1,469.00 " - " 9,159.35 " " 3,230.86 " " 10,941.48 " - - " 10,972.98 " " 2,823.08 " " 3,136.76 " 56.26 70.32 " 3,215.18 " " 3,230.86 " " 3,136.76 " " 13,262.40 " " 2,870.14 " - " 11,107.26 " " 2,760.35 " " 6,780.40 " " 12,433.50 " " 6,301.30 " " 7,415.34 " " 3,246.55 " 83002158 UNL TOMO GUIDE BREAST BX PROC 19499 320 "$16,578.00" " 6,127.23 " - " 13,262.40 " - " 1,469.00 " " 3,293.60 " " 1,469.00 " - " 9,159.35 " " 3,230.86 " " 10,941.48 " - - " 10,972.98 " " 2,823.08 " " 3,136.76 " 56.26 70.32 " 3,215.18 " " 3,230.86 " " 3,136.76 " " 13,262.40 " " 2,870.14 " - " 11,107.26 " " 2,760.35 " " 6,780.40 " " 12,433.50 " " 6,301.30 " " 7,415.34 " " 3,246.55 " 28163908 EXPLORE WOUND NECK 20100 360 "$2,375.00" 877.80 395.35 " 4,035.90 " 892.40 " 1,641.13 " 471.72 " 1,641.13 " 907.92 " 1,312.19 " 462.74 " 1,775.00 " 869.12 808.05 " 1,572.01 " 404.33 449.26 " 3,228.72 " " 4,035.90 " 460.49 462.74 449.26 " 1,900.00 " 411.07 776.00 " 1,591.25 " 395.35 971.38 " 1,781.25 " 902.74 " 1,062.34 " 464.98 28163916 EXPLORE WOUND CHEST 20101 360 "$9,006.00" " 3,328.62 " 776.00 " 7,204.80 " 892.40 " 6,223.15 " " 1,786.47 " " 6,223.15 " 907.92 " 4,975.82 " " 1,752.44 " " 5,943.96 " 869.12 808.05 " 5,961.07 " " 1,531.26 " " 1,701.40 " " 1,914.73 " " 2,393.41 " " 1,743.94 " " 1,752.44 " " 1,701.40 " " 7,204.80 " " 1,556.78 " 776.00 " 6,034.02 " " 1,497.23 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,760.95 " 28163924 EXPL WOUND ABDOMEN 20102 360 "$9,006.00" " 3,328.62 " 776.00 " 7,204.80 " 892.40 " 6,223.15 " " 1,786.47 " " 6,223.15 " 907.92 " 4,975.82 " " 1,752.44 " " 5,943.96 " 869.12 808.05 " 5,961.07 " " 1,531.26 " " 1,701.40 " " 2,378.83 " " 2,973.54 " " 1,743.94 " " 1,752.44 " " 1,701.40 " " 7,204.80 " " 1,556.78 " 776.00 " 6,034.02 " " 1,497.23 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,760.95 " 37004171 EXPL WOUND ABDOMEN 20102 450 "$9,006.00" " 3,328.62 " 776.00 " 7,204.80 " 892.40 " 6,223.15 " " 1,786.47 " " 6,223.15 " 907.92 " 4,975.82 " " 1,752.44 " " 5,943.96 " 869.12 808.05 " 5,961.07 " " 1,531.26 " " 1,701.40 " " 2,378.83 " " 2,973.54 " " 1,743.94 " " 1,752.44 " " 1,701.40 " " 7,204.80 " " 1,556.78 " 776.00 " 6,034.02 " " 1,497.23 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,760.95 " 28163932 EXPL WOUND EXTREMITY 20103 360 "$3,265.00" " 1,206.74 " 543.97 " 3,656.61 " 892.40 " 1,469.00 " 649.06 " 1,469.00 " 907.92 " 1,803.91 " 636.69 " 1,775.00 " 869.12 808.05 " 2,161.10 " 556.34 618.15 " 2,925.29 " " 3,656.61 " 633.60 636.69 618.15 " 2,612.00 " 565.61 776.00 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 37004383 EXPL WOUND EXTREMITY 20103 450 "$3,265.00" " 1,206.74 " 543.97 " 3,656.61 " 892.40 " 1,469.00 " 649.06 " 1,469.00 " 907.92 " 1,803.91 " 636.69 " 1,775.00 " 869.12 808.05 " 2,161.10 " 556.34 618.15 " 2,925.29 " " 3,656.61 " 633.60 636.69 618.15 " 2,612.00 " 565.61 776.00 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 51600371 EXPL WOUND EXTREMITY 20103 510 "$3,265.00" " 1,206.74 " 543.97 " 3,656.61 " 892.40 " 1,469.00 " 649.06 " 1,469.00 " 907.92 " 1,803.91 " 636.69 " 1,775.00 " 869.12 808.05 " 2,161.10 " 556.34 618.15 " 2,925.29 " " 3,656.61 " 633.60 636.69 618.15 " 2,612.00 " 565.61 776.00 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 28163941 DEEP MUSCLE BIOPSY 20205 360 "$12,443.00" " 4,598.93 " 691.00 " 9,954.40 " 794.65 " 2,773.00 " " 2,473.07 " " 2,773.00 " 808.47 " 6,874.76 " " 2,425.96 " " 3,545.00 " 773.92 719.54 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,532.97 " " 3,166.21 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 691.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 67709543 BX NEEDLE MUSCLE 20206 350 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,469.00 " " 1,467.55 " " 1,469.00 " 907.92 " 4,081.32 " " 1,439.60 " " 1,775.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 80309546 BX NEEDLE MUSCLE 20206 320 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,469.00 " " 1,467.55 " " 1,469.00 " 907.92 " 4,081.32 " " 1,439.60 " " 1,775.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 80509545 BX NEEDLE MUSCLE 20206 402 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,469.00 " " 1,467.55 " " 1,469.00 " 907.92 " 4,081.32 " " 1,439.60 " " 1,775.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 80609540 BX NEEDLE MUSCLE 20206 350 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,469.00 " " 1,467.55 " " 1,469.00 " 907.92 " 4,081.32 " " 1,439.60 " " 1,775.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 67709551 BX BONE TROCAR/NDL SUPERFICIAL 20220 350 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,469.00 " " 1,467.55 " " 1,469.00 " 907.92 " 4,081.32 " " 1,439.60 " " 1,775.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 80309554 BX BONE TROCAR/NDL SUPERFICIAL 20220 320 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,469.00 " " 1,467.55 " " 1,469.00 " 907.92 " 4,081.32 " " 1,439.60 " " 1,775.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 80609558 BX BONE TROCAR/NDL SUPERFICIAL 20220 350 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,469.00 " " 1,467.55 " " 1,469.00 " 907.92 " 4,081.32 " " 1,439.60 " " 1,775.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28163959 BX BONE TROCAR/NDL DEEP 20225 360 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,718.00 " " 1,467.55 " " 1,718.00 " 907.92 " 4,081.32 " " 1,439.60 " " 2,820.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 2,208.66 " " 2,760.83 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 67709560 BX BONE TROCAR/NDL DEEP 20225 350 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,718.00 " " 1,467.55 " " 1,718.00 " 907.92 " 4,081.32 " " 1,439.60 " " 2,820.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 2,208.66 " " 2,760.83 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 80309562 BX BONE TROCAR/NDL DEEP 20225 320 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,718.00 " " 1,467.55 " " 1,718.00 " 907.92 " 4,081.32 " " 1,439.60 " " 2,820.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 2,208.66 " " 2,760.83 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 80609566 BX BONE TROCAR/NDL DEEP 20225 350 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,718.00 " " 1,467.55 " " 1,718.00 " 907.92 " 4,081.32 " " 1,439.60 " " 2,820.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 2,208.66 " " 2,760.83 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28163967 BONE BIOPSY OPEN SUPERFICIAL 20240 360 "$12,443.00" " 4,598.93 " 842.00 " 9,954.40 " 968.30 " 1,718.00 " " 2,473.07 " " 1,718.00 " 985.14 " 6,874.76 " " 2,425.96 " " 2,820.00 " 943.04 876.77 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,208.66 " " 2,760.83 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 842.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28163975 BONE BIOPSY OPEN DEEP 20245 360 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 2,773.00 " " 2,473.07 " " 2,773.00 " 907.92 " 6,874.76 " " 2,425.96 " " 3,545.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,532.97 " " 3,166.21 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 80341148 INJ SINUS TRACT 20500 320 "$7,102.00" " 2,624.90 " 35.00 " 5,681.60 " 40.25 " 1,469.00 " " 1,410.93 " " 1,469.00 " 40.95 " 3,923.86 " " 1,384.05 " 845.00 39.20 36.45 " 4,700.81 " " 1,209.37 " " 1,343.74 " 168.76 210.95 " 1,377.33 " " 1,384.05 " " 1,343.74 " " 5,681.60 " " 1,229.52 " 35.00 " 4,758.34 " " 1,182.49 " " 2,904.72 " " 5,326.50 " " 2,699.47 " " 3,176.72 " " 1,390.77 " 80126492 INJ SINUS TRACT XR 20501 320 $585.00 216.22 - " 1,469.00 " 40.25 " 1,469.00 " - " 1,469.00 " 40.95 323.21 - 386.10 39.20 36.45 387.21 - - 393.78 492.23 - - - 468.00 - 35.00 391.95 - 239.27 438.75 222.36 261.67 - 80326491 INJ SINUS TRACT XR 20501 320 $585.00 216.22 - " 1,469.00 " 40.25 " 1,469.00 " - " 1,469.00 " 40.95 323.21 - 386.10 39.20 36.45 387.21 - - 393.78 492.23 - - - 468.00 - 35.00 391.95 - 239.27 438.75 222.36 261.67 - 28163983 REMOVAL OF FOREIGN BODY 20525 360 "$12,443.00" " 4,598.93 " 804.00 " 9,954.40 " 924.60 " 2,773.00 " " 2,473.07 " " 2,773.00 " 940.68 " 6,874.76 " " 2,425.96 " " 3,545.00 " 900.48 837.21 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,532.97 " " 3,166.21 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 804.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28163991 CARP TUNNEL TX INJ 20526 360 "$1,371.00" 506.72 49.78 " 1,775.00 " 57.25 " 1,469.00 " 272.51 " 1,469.00 " 58.24 757.48 267.32 " 1,775.00 " 55.75 51.84 907.46 233.58 259.53 410.43 513.04 266.02 267.32 259.53 " 1,096.80 " 237.47 49.78 918.57 228.39 560.74 " 1,028.25 " 521.12 613.25 268.61 80537069 CARP TUNNEL TX INJ 20526 402 "$1,371.00" 506.72 49.78 " 1,775.00 " 57.25 " 1,469.00 " 272.51 " 1,469.00 " 58.24 757.48 267.32 " 1,775.00 " 55.75 51.84 907.46 233.58 259.53 410.43 513.04 266.02 267.32 259.53 " 1,096.80 " 237.47 49.78 918.57 228.39 560.74 " 1,028.25 " 521.12 613.25 268.61 37001309 TENDON SHEATH/LIGAMENT INJ 20550 450 "$1,371.00" 506.72 32.00 " 1,775.00 " 36.80 " 1,469.00 " 272.51 " 1,469.00 " 37.44 757.48 267.32 " 1,775.00 " 35.84 33.32 907.46 233.58 259.53 618.80 773.50 266.02 267.32 259.53 " 1,096.80 " 237.47 32.00 918.57 228.39 560.74 " 1,028.25 " 521.12 613.25 268.61 67729277 TENDON SHEATH/LIGAMENT INJ 20550 350 "$1,371.00" 506.72 32.00 " 1,775.00 " 36.80 " 1,469.00 " 272.51 " 1,469.00 " 37.44 757.48 267.32 " 1,775.00 " 35.84 33.32 907.46 233.58 259.53 618.80 773.50 266.02 267.32 259.53 " 1,096.80 " 237.47 32.00 918.57 228.39 560.74 " 1,028.25 " 521.12 613.25 268.61 80329270 TENDON SHEATH/LIGAMENT INJ 20550 320 "$1,371.00" 506.72 32.00 " 1,775.00 " 36.80 " 1,469.00 " 272.51 " 1,469.00 " 37.44 757.48 267.32 " 1,775.00 " 35.84 33.32 907.46 233.58 259.53 618.80 773.50 266.02 267.32 259.53 " 1,096.80 " 237.47 32.00 918.57 228.39 560.74 " 1,028.25 " 521.12 613.25 268.61 80529279 TENDON SHEATH/LIGAMENT INJ 20550 402 "$1,371.00" 506.72 32.00 " 1,775.00 " 36.80 " 1,469.00 " 272.51 " 1,469.00 " 37.44 757.48 267.32 " 1,775.00 " 35.84 33.32 907.46 233.58 259.53 618.80 773.50 266.02 267.32 259.53 " 1,096.80 " 237.47 32.00 918.57 228.39 560.74 " 1,028.25 " 521.12 613.25 268.61 80629273 TENDON SHEATH/LIGAMENT INJ 20550 350 "$1,371.00" 506.72 32.00 " 1,775.00 " 36.80 " 1,469.00 " 272.51 " 1,469.00 " 37.44 757.48 267.32 " 1,775.00 " 35.84 33.32 907.46 233.58 259.53 618.80 773.50 266.02 267.32 259.53 " 1,096.80 " 237.47 32.00 918.57 228.39 560.74 " 1,028.25 " 521.12 613.25 268.61 28164009 TENDON ORIGIN/INSERTION INJ 20551 360 "$1,371.00" 506.72 38.76 " 1,775.00 " 44.57 " 1,469.00 " 272.51 " 1,469.00 " 45.35 757.48 267.32 " 1,775.00 " 43.41 40.36 907.46 233.58 259.53 306.42 383.02 266.02 267.32 259.53 " 1,096.80 " 237.47 38.76 918.57 228.39 560.74 " 1,028.25 " 521.12 613.25 268.61 37003620 TENDON ORIGIN/INSERTION INJ 20551 450 "$1,371.00" 506.72 38.76 " 1,775.00 " 44.57 " 1,469.00 " 272.51 " 1,469.00 " 45.35 757.48 267.32 " 1,775.00 " 43.41 40.36 907.46 233.58 259.53 306.42 383.02 266.02 267.32 259.53 " 1,096.80 " 237.47 38.76 918.57 228.39 560.74 " 1,028.25 " 521.12 613.25 268.61 67729170 TENDON ORIGIN/INSERTION INJ 20551 350 "$1,371.00" 506.72 38.76 " 1,775.00 " 44.57 " 1,469.00 " 272.51 " 1,469.00 " 45.35 757.48 267.32 " 1,775.00 " 43.41 40.36 907.46 233.58 259.53 306.42 383.02 266.02 267.32 259.53 " 1,096.80 " 237.47 38.76 918.57 228.39 560.74 " 1,028.25 " 521.12 613.25 268.61 80629176 TENDON ORIGIN/INSERTION INJ 20551 350 "$1,371.00" 506.72 38.76 " 1,775.00 " 44.57 " 1,469.00 " 272.51 " 1,469.00 " 45.35 757.48 267.32 " 1,775.00 " 43.41 40.36 907.46 233.58 259.53 306.42 383.02 266.02 267.32 259.53 " 1,096.80 " 237.47 38.76 918.57 228.39 560.74 " 1,028.25 " 521.12 613.25 268.61 28176201 TRIGGER POINT 1/2 MUSCL INJ 20552 360 "$1,371.00" 506.72 31.06 " 1,775.00 " 35.72 " 1,469.00 " 272.51 " 1,469.00 " 36.34 757.48 267.32 " 1,775.00 " 34.79 32.34 907.46 233.58 259.53 289.88 362.35 266.02 267.32 259.53 " 1,096.80 " 237.47 31.06 918.57 228.39 560.74 " 1,028.25 " 521.12 613.25 268.61 37090191 TRIGGER POINT 1/2 MUSCL INJ 20552 450 "$1,371.00" 506.72 31.06 " 1,775.00 " 35.72 " 1,469.00 " 272.51 " 1,469.00 " 36.34 757.48 267.32 " 1,775.00 " 34.79 32.34 907.46 233.58 259.53 289.88 362.35 266.02 267.32 259.53 " 1,096.80 " 237.47 31.06 918.57 228.39 560.74 " 1,028.25 " 521.12 613.25 268.61 80336781 TRIGGER POINT 1/2 MUSCL INJ 20552 320 "$1,371.00" 506.72 31.06 " 1,775.00 " 35.72 " 1,469.00 " 272.51 " 1,469.00 " 36.34 757.48 267.32 " 1,775.00 " 34.79 32.34 907.46 233.58 259.53 289.88 362.35 266.02 267.32 259.53 " 1,096.80 " 237.47 31.06 918.57 228.39 560.74 " 1,028.25 " 521.12 613.25 268.61 80536780 TRIGGER POINT 1/2 MUSCL INJ 20552 320 "$1,371.00" 506.72 31.06 " 1,775.00 " 35.72 " 1,469.00 " 272.51 " 1,469.00 " 36.34 757.48 267.32 " 1,775.00 " 34.79 32.34 907.46 233.58 259.53 289.88 362.35 266.02 267.32 259.53 " 1,096.80 " 237.47 31.06 918.57 228.39 560.74 " 1,028.25 " 521.12 613.25 268.61 28164017 INJECT TRIGGER POINTS 3/> 20553 360 "$1,371.00" 506.72 34.47 " 1,775.00 " 39.64 " 1,469.00 " 272.51 " 1,469.00 " 40.33 757.48 267.32 " 1,775.00 " 38.61 35.89 907.46 233.58 259.53 328.64 410.80 266.02 267.32 259.53 " 1,096.80 " 237.47 34.47 918.57 228.39 560.74 " 1,028.25 " 521.12 613.25 268.61 28164025 DRAIN/INJ JT/BURSA W/O US SM 20600 360 "$1,371.00" 506.72 168.76 " 1,775.00 " 892.40 " 1,469.00 " 272.51 " 1,469.00 " 907.92 757.48 267.32 " 1,775.00 " 869.12 808.05 907.46 233.58 259.53 168.76 210.95 266.02 267.32 259.53 " 1,096.80 " 237.47 776.00 918.57 228.39 560.74 " 1,028.25 " 521.12 613.25 268.61 37001279 DRAIN/INJ JT/BURSA W/O US SM 20600 450 "$1,371.00" 506.72 168.76 " 1,775.00 " 892.40 " 1,469.00 " 272.51 " 1,469.00 " 907.92 757.48 267.32 " 1,775.00 " 869.12 808.05 907.46 233.58 259.53 168.76 210.95 266.02 267.32 259.53 " 1,096.80 " 237.47 776.00 918.57 228.39 560.74 " 1,028.25 " 521.12 613.25 268.61 80108982 DRAIN/INJ JOINT/BURSA W/O US 20600 320 "$1,371.00" 506.72 168.76 " 1,775.00 " 892.40 " 1,469.00 " 272.51 " 1,469.00 " 907.92 757.48 267.32 " 1,775.00 " 869.12 808.05 907.46 233.58 259.53 168.76 210.95 266.02 267.32 259.53 " 1,096.80 " 237.47 776.00 918.57 228.39 560.74 " 1,028.25 " 521.12 613.25 268.61 28164033 DRAIN/INJ JT/BURSA W/US SM 20604 360 "$1,371.00" 506.72 144.35 " 1,469.00 " 892.40 " 1,469.00 " 272.51 " 1,469.00 " 907.92 757.48 267.32 845.00 869.12 808.05 907.46 233.58 259.53 144.35 180.44 266.02 267.32 259.53 " 1,096.80 " 237.47 776.00 918.57 228.39 560.74 " 1,028.25 " 521.12 613.25 268.61 37003981 DRAIN/INJ JT/BURSA W/US SM 20604 450 "$1,371.00" 506.72 144.35 " 1,469.00 " 892.40 " 1,469.00 " 272.51 " 1,469.00 " 907.92 757.48 267.32 845.00 869.12 808.05 907.46 233.58 259.53 144.35 180.44 266.02 267.32 259.53 " 1,096.80 " 237.47 776.00 918.57 228.39 560.74 " 1,028.25 " 521.12 613.25 268.61 80508999 DRAIN/INJ JOINT/BURSA W/US 20604 402 "$1,371.00" 506.72 144.35 " 1,469.00 " 892.40 " 1,469.00 " 272.51 " 1,469.00 " 907.92 757.48 267.32 845.00 869.12 808.05 907.46 233.58 259.53 144.35 180.44 266.02 267.32 259.53 " 1,096.80 " 237.47 776.00 918.57 228.39 560.74 " 1,028.25 " 521.12 613.25 268.61 28164041 ARTHRO INT JNT W/O US GUID 20605 360 "$1,371.00" 506.72 56.26 " 1,775.00 " " 1,258.10 " " 1,469.00 " 272.51 " 1,469.00 " " 1,279.98 " 757.48 267.32 " 1,775.00 " " 1,225.28 " " 1,139.18 " 907.46 233.58 259.53 56.26 70.32 266.02 267.32 259.53 " 1,096.80 " 237.47 " 1,094.00 " 918.57 228.39 560.74 " 1,028.25 " 521.12 613.25 268.61 37001287 ARTHRO INT JNT W/O US GUID 20605 450 "$1,371.00" 506.72 56.26 " 1,775.00 " " 1,258.10 " " 1,469.00 " 272.51 " 1,469.00 " " 1,279.98 " 757.48 267.32 " 1,775.00 " " 1,225.28 " " 1,139.18 " 907.46 233.58 259.53 56.26 70.32 266.02 267.32 259.53 " 1,096.80 " 237.47 " 1,094.00 " 918.57 228.39 560.74 " 1,028.25 " 521.12 613.25 268.61 80128690 ARTHRO INT JNT W/O US GUID 20605 320 "$1,371.00" 506.72 56.26 " 1,775.00 " " 1,258.10 " " 1,469.00 " 272.51 " 1,469.00 " " 1,279.98 " 757.48 267.32 " 1,775.00 " " 1,225.28 " " 1,139.18 " 907.46 233.58 259.53 56.26 70.32 266.02 267.32 259.53 " 1,096.80 " 237.47 " 1,094.00 " 918.57 228.39 560.74 " 1,028.25 " 521.12 613.25 268.61 80328699 ARTHRO INT JNT W/O US GUID 20605 320 "$1,371.00" 506.72 56.26 " 1,775.00 " " 1,258.10 " " 1,469.00 " 272.51 " 1,469.00 " " 1,279.98 " 757.48 267.32 " 1,775.00 " " 1,225.28 " " 1,139.18 " 907.46 233.58 259.53 56.26 70.32 266.02 267.32 259.53 " 1,096.80 " 237.47 " 1,094.00 " 918.57 228.39 560.74 " 1,028.25 " 521.12 613.25 268.61 80337001 DRAIN/INJ JT/BURSA W/US INTERM 20606 320 "$3,332.00" " 1,231.51 " 159.93 " 2,665.60 " 892.40 " 1,469.00 " 662.32 " 1,469.00 " 907.92 " 1,840.93 " 649.70 845.00 869.12 808.05 " 2,205.45 " 567.70 630.78 159.93 199.91 646.55 649.70 630.78 " 2,665.60 " 577.16 776.00 " 2,232.44 " 555.09 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 652.86 80537000 DRAIN/INJ JT/BURSA W/US INTERM 20606 402 "$3,332.00" " 1,231.51 " 159.93 " 2,665.60 " 892.40 " 1,469.00 " 662.32 " 1,469.00 " 907.92 " 1,840.93 " 649.70 845.00 869.12 808.05 " 2,205.45 " 567.70 630.78 159.93 199.91 646.55 649.70 630.78 " 2,665.60 " 577.16 776.00 " 2,232.44 " 555.09 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 652.86 28164050 ARTHRO MAJOR JNT W/O US GUID 20610 360 "$1,371.00" 506.72 56.26 " 1,775.00 " 892.40 " 1,469.00 " 272.51 " 1,469.00 " 907.92 757.48 267.32 " 1,775.00 " 869.12 808.05 907.46 233.58 259.53 56.26 70.32 266.02 267.32 259.53 " 1,096.80 " 237.47 776.00 918.57 228.39 560.74 " 1,028.25 " 521.12 613.25 268.61 37001295 ARTHRO MAJOR JNT W/O US GUID 20610 450 "$1,371.00" 506.72 56.26 " 1,775.00 " 892.40 " 1,469.00 " 272.51 " 1,469.00 " 907.92 757.48 267.32 " 1,775.00 " 869.12 808.05 907.46 233.58 259.53 56.26 70.32 266.02 267.32 259.53 " 1,096.80 " 237.47 776.00 918.57 228.39 560.74 " 1,028.25 " 521.12 613.25 268.61 67728068 ARTHRO MAJOR JNT W/O US GUID 20610 350 "$1,371.00" 506.72 56.26 " 1,775.00 " 892.40 " 1,469.00 " 272.51 " 1,469.00 " 907.92 757.48 267.32 " 1,775.00 " 869.12 808.05 907.46 233.58 259.53 56.26 70.32 266.02 267.32 259.53 " 1,096.80 " 237.47 776.00 918.57 228.39 560.74 " 1,028.25 " 521.12 613.25 268.61 80128061 ARTHRO MAJOR JNT W/O US GUID 20610 320 "$1,371.00" 506.72 56.26 " 1,775.00 " 892.40 " 1,469.00 " 272.51 " 1,469.00 " 907.92 757.48 267.32 " 1,775.00 " 869.12 808.05 907.46 233.58 259.53 56.26 70.32 266.02 267.32 259.53 " 1,096.80 " 237.47 776.00 918.57 228.39 560.74 " 1,028.25 " 521.12 613.25 268.61 80328061 ARTHRO MAJOR JNT W/O US GUID 20610 320 "$1,371.00" 506.72 56.26 " 1,775.00 " 892.40 " 1,469.00 " 272.51 " 1,469.00 " 907.92 757.48 267.32 " 1,775.00 " 869.12 808.05 907.46 233.58 259.53 56.26 70.32 266.02 267.32 259.53 " 1,096.80 " 237.47 776.00 918.57 228.39 560.74 " 1,028.25 " 521.12 613.25 268.61 80628064 ARTHRO MAJOR JNT W/O US GUID 20610 350 "$1,371.00" 506.72 56.26 " 1,775.00 " 892.40 " 1,469.00 " 272.51 " 1,469.00 " 907.92 757.48 267.32 " 1,775.00 " 869.12 808.05 907.46 233.58 259.53 56.26 70.32 266.02 267.32 259.53 " 1,096.80 " 237.47 776.00 918.57 228.39 560.74 " 1,028.25 " 521.12 613.25 268.61 80337019 DRAIN/INJ JT/BURSA W/US MAJOR 20611 320 "$1,371.00" 506.72 184.46 " 1,469.00 " 892.40 " 1,469.00 " 272.51 " 1,469.00 " 907.92 757.48 267.32 845.00 869.12 808.05 907.46 233.58 259.53 184.46 230.57 266.02 267.32 259.53 " 1,096.80 " 237.47 776.00 918.57 228.39 560.74 " 1,028.25 " 521.12 613.25 268.61 80537018 DRAIN/INJ JT/BURSA W/US MAJOR 20611 402 "$1,371.00" 506.72 184.46 " 1,469.00 " 892.40 " 1,469.00 " 272.51 " 1,469.00 " 907.92 757.48 267.32 845.00 869.12 808.05 907.46 233.58 259.53 184.46 230.57 266.02 267.32 259.53 " 1,096.80 " 237.47 776.00 918.57 228.39 560.74 " 1,028.25 " 521.12 613.25 268.61 37090204 ASP/INJ GANGLION CYST 20612 450 "$1,371.00" 506.72 228.39 " 1,775.00 " 892.40 " 1,469.00 " 272.51 " 1,469.00 " 907.92 757.48 267.32 " 1,775.00 " 869.12 808.05 907.46 233.58 259.53 303.32 379.15 266.02 267.32 259.53 " 1,096.80 " 237.47 776.00 918.57 228.39 560.74 " 1,028.25 " 521.12 613.25 268.61 67727037 ASP/INJ GANGLION CYST 20612 350 "$1,371.00" 506.72 228.39 " 1,775.00 " 892.40 " 1,469.00 " 272.51 " 1,469.00 " 907.92 757.48 267.32 " 1,775.00 " 869.12 808.05 907.46 233.58 259.53 303.32 379.15 266.02 267.32 259.53 " 1,096.80 " 237.47 776.00 918.57 228.39 560.74 " 1,028.25 " 521.12 613.25 268.61 80527039 ASPIR INJECT OF GANGLION CYST 20612 402 "$1,371.00" 506.72 228.39 " 1,775.00 " 892.40 " 1,469.00 " 272.51 " 1,469.00 " 907.92 757.48 267.32 " 1,775.00 " 869.12 808.05 907.46 233.58 259.53 303.32 379.15 266.02 267.32 259.53 " 1,096.80 " 237.47 776.00 918.57 228.39 560.74 " 1,028.25 " 521.12 613.25 268.61 80627033 ASP/INJ GANGLION CYST 20612 350 "$1,371.00" 506.72 228.39 " 1,775.00 " 892.40 " 1,469.00 " 272.51 " 1,469.00 " 907.92 757.48 267.32 " 1,775.00 " 869.12 808.05 907.46 233.58 259.53 303.32 379.15 266.02 267.32 259.53 " 1,096.80 " 237.47 776.00 918.57 228.39 560.74 " 1,028.25 " 521.12 613.25 268.61 28164068 INSERT AND REMOVE BONE PIN 20650 360 "$14,860.00" " 5,492.26 " 781.00 " 11,888.00 " 898.15 " 2,773.00 " " 2,953.81 " " 2,773.00 " 913.77 " 8,210.15 " " 2,897.54 " " 3,545.00 " 874.72 813.26 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 781.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 37088765 INSERT AND REMOVE BONE PIN 20650 450 "$14,860.00" " 5,492.26 " 781.00 " 11,888.00 " 898.15 " 2,773.00 " " 2,953.81 " " 2,773.00 " 913.77 " 8,210.15 " " 2,897.54 " " 3,545.00 " 874.72 813.26 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 781.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28164076 RMV SUPPORT IMPLANT 20670 360 "$7,387.00" " 2,730.24 " 657.00 " 5,909.60 " 755.55 " 1,469.00 " " 1,467.55 " " 1,469.00 " 768.69 " 4,081.32 " " 1,439.60 " " 1,775.00 " 735.84 684.13 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 657.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 51600380 RMV SUPPORT IMPLANT 20670 510 "$7,387.00" " 2,730.24 " 657.00 " 5,909.60 " 755.55 " 1,469.00 " " 1,467.55 " " 1,469.00 " 768.69 " 4,081.32 " " 1,439.60 " " 1,775.00 " 735.84 684.13 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 657.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28164084 REMOVAL OF SUPPORT IMPLANT 20680 360 "$12,443.00" " 4,598.93 " 720.00 " 9,954.40 " 828.00 " 2,773.00 " " 2,473.07 " " 2,773.00 " 842.40 " 6,874.76 " " 2,425.96 " " 3,545.00 " 806.40 749.74 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,532.97 " " 3,166.21 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 720.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28164092 APPLY BONE FIXATION DEVICE UNI 20690 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 1,718.00 " " 6,533.13 " " 1,718.00 " 907.92 " 18,172.28 " " 6,408.69 " " 2,820.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,208.66 " " 2,760.83 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28164106 APPLY BONE FIXATION DEV MULTI 20692 360 "$64,652.00" " 23,895.38 " 776.00 " 51,721.60 " 892.40 " 2,773.00 " " 12,861.18 " " 2,773.00 " 907.92 " 35,720.23 " " 12,616.20 " " 3,545.00 " 869.12 808.05 " 42,793.16 " " 11,023.87 " " 12,248.74 " " 3,120.10 " " 3,900.12 " " 12,554.96 " " 12,616.20 " " 12,248.74 " " 51,721.60 " " 11,207.60 " 776.00 " 43,316.84 " " 10,778.89 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,677.45 " 28164114 ADJUST BONE FIXATION DEVICE 20693 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,208.66 " " 2,760.83 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28164122 REMOVE BONE FIXATION DEVICE 20694 360 "$7,310.00" " 2,701.78 " 776.00 " 5,848.00 " 892.40 " 1,469.00 " " 1,452.77 " " 1,469.00 " 907.92 " 4,038.78 " " 1,425.10 " " 1,775.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 1,649.49 " " 2,061.86 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28164131 COMP MULTIPLANE EXT FIXATION 20696 360 "$83,308.00" " 30,790.64 " 776.00 " 66,646.40 " 892.40 " 2,773.00 " " 16,864.63 " " 2,773.00 " 907.92 " 46,027.67 " " 16,543.40 " " 6,576.00 " 869.12 808.05 " 55,141.57 " " 14,455.40 " " 16,061.55 " " 5,635.23 " " 7,044.04 " " 16,463.09 " " 16,543.40 " " 16,061.55 " " 66,646.40 " " 14,696.32 " 776.00 " 55,816.36 " " 14,134.16 " " 34,072.97 " " 62,481.00 " " 31,665.37 " " 37,263.67 " " 16,623.70 " 28164149 REMOVAL OF BONE FOR GRAFT 20902 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 3,326.00 " " 6,533.13 " " 3,326.00 " 907.92 " 18,172.28 " " 6,408.69 " " 4,860.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 3,120.10 " " 3,900.12 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28164157 REMOVAL OF TENDON FOR GRAFT 20924 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 3,326.00 " " 6,533.13 " " 3,326.00 " 907.92 " 18,172.28 " " 6,408.69 " " 4,860.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 3,120.10 " " 3,900.12 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28164165 SP BONE ALGRFT MORSEL ADD-ON 20930 360 "$2,606.00" 963.18 - " 2,084.80 " - " 1,469.00 " - " 1,469.00 " - " 1,439.82 " - " 1,719.96 " - - " 1,724.91 " - - 919.20 " 1,149.00 " - - - " 2,084.80 " - - " 1,746.02 " - " 1,065.85 " " 1,954.50 " 990.54 " 1,165.66 " - 28164173 SP BONE ALGRFT STRUCT ADD-ON 20931 360 "$3,287.00" " 1,214.88 " - " 2,629.60 " - " 1,469.00 " - " 1,469.00 " - " 1,816.07 " - " 2,169.42 " - - " 2,175.67 " - - 639.67 799.59 - - - " 2,629.60 " - - " 2,202.29 " - " 1,344.38 " " 2,465.25 " " 1,249.39 " " 1,470.28 " - 28164181 SP BONE AGRFT LOCAL ADD-ON 20936 360 "$2,687.00" 993.12 - " 2,149.60 " - " 1,856.72 " - " 1,856.72 " - " 1,484.57 " - " 1,773.42 " - - " 1,778.53 " - - " 1,147.59 " " 1,434.49 " - - - " 2,149.60 " - - " 1,800.29 " - " 1,098.98 " " 2,015.25 " " 1,021.33 " " 1,201.90 " - 28164190 ABLATE BONE TUMOR(S) RF 20982 360 "$32,891.00" " 12,156.51 " 776.00 " 28,824.54 " 892.40 " 1,469.00 " " 6,533.13 " " 1,469.00 " 907.92 " 18,172.28 " " 6,408.69 " " 21,708.06 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 23,059.63 " " 28,824.54 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 67709853 ABLATE BONE TUMOR(S) RF 20982 350 "$32,891.00" " 12,156.51 " 776.00 " 28,824.54 " 892.40 " 1,469.00 " " 6,533.13 " " 1,469.00 " 907.92 " 18,172.28 " " 6,408.69 " " 21,708.06 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 23,059.63 " " 28,824.54 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 80309856 ABLATE BONE TUMOR(S) RF 20982 320 "$32,891.00" " 12,156.51 " 776.00 " 28,824.54 " 892.40 " 1,469.00 " " 6,533.13 " " 1,469.00 " 907.92 " 18,172.28 " " 6,408.69 " " 21,708.06 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 23,059.63 " " 28,824.54 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 80609850 ABLATE BONE TUMOR(S) RF 20982 350 "$32,891.00" " 12,156.51 " 776.00 " 28,824.54 " 892.40 " 1,469.00 " " 6,533.13 " " 1,469.00 " 907.92 " 18,172.28 " " 6,408.69 " " 21,708.06 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 23,059.63 " " 28,824.54 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 67741269 ABLATE BONE TUMOR(S) PERC 20983 350 "$32,891.00" " 12,156.51 " - " 26,312.80 " - " 1,718.00 " " 6,533.13 " " 1,718.00 " - " 18,172.28 " " 6,408.69 " " 21,708.06 " - - " 21,770.55 " " 5,599.83 " " 6,222.03 " " 13,373.19 " " 16,716.49 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " - " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 80641265 ABLATE BONE TUMOR(S) PERC 20983 350 "$32,891.00" " 12,156.51 " - " 26,312.80 " - " 1,718.00 " " 6,533.13 " " 1,718.00 " - " 18,172.28 " " 6,408.69 " " 21,708.06 " - - " 21,770.55 " " 5,599.83 " " 6,222.03 " " 13,373.19 " " 16,716.49 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " - " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28164203 EXC FACE LES SC <2 CM 21011 360 "$7,387.00" " 2,730.24 " 189.16 " 5,909.60 " 217.53 " 1,469.00 " " 1,467.55 " " 1,469.00 " 221.32 " 4,081.32 " " 1,439.60 " 845.00 211.86 196.97 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,645.55 " " 2,056.94 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 189.16 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28164211 EXC FACE LES SBQ 2 CM/> 21012 360 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,469.00 " " 1,467.55 " " 1,469.00 " 907.92 " 4,081.32 " " 1,439.60 " " 2,820.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,784.67 " " 2,230.84 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28164220 EXC FACE TUM DEEP < 2 CM 21013 360 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,469.00 " " 1,467.55 " " 1,469.00 " 907.92 " 4,081.32 " " 1,439.60 " " 2,820.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 2,567.96 " " 3,209.95 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28164238 EXCISION OF BONE LOWER JAW 21025 360 "$26,702.00" " 9,869.06 " 776.00 " 21,361.60 " 892.40 " 1,718.00 " " 5,304.76 " " 1,718.00 " 907.92 " 14,752.86 " " 5,203.71 " " 2,820.00 " 869.12 808.05 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 2,208.66 " " 2,760.83 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 776.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28164246 REMOVE MANDIBLE CYST COMPLEX 21046 360 "$26,702.00" " 9,869.06 " 776.00 " 21,361.60 " 892.40 " 1,718.00 " " 5,304.76 " " 1,718.00 " 907.92 " 14,752.86 " " 5,203.71 " " 2,820.00 " 869.12 808.05 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 2,376.02 " " 2,970.02 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 776.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28164254 EXCISE LWR JAW CYST W/REPAIR 21047 360 "$26,702.00" " 9,869.06 " 776.00 " 21,361.60 " 892.40 " 1,718.00 " " 5,304.76 " " 1,718.00 " 907.92 " 14,752.86 " " 5,203.71 " " 2,820.00 " 869.12 808.05 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 2,376.02 " " 2,970.02 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 776.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28164262 RECONSTRUCTION OF CHIN 21120 360 "$26,702.00" " 9,869.06 " - " 21,361.60 " - " 4,435.00 " " 5,304.76 " " 4,435.00 " - " 14,752.86 " " 5,203.71 " " 6,540.00 " - - " 17,674.05 " " 4,546.94 " " 5,052.15 " " 3,218.09 " " 4,022.61 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " - " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28164271 LEFORT I-1 PIECE W/O GRAFT 21141 360 "$10,172.00" " 3,759.57 " - " 8,647.92 " - " 3,326.00 " N/A " 3,326.00 " - " 5,620.03 " N/A " 6,713.52 " - N/A " 6,732.85 " - N/A " 6,918.34 " " 8,647.92 " N/A N/A N/A " 8,137.60 " N/A - " 6,815.24 " N/A " 4,160.35 " " 7,629.00 " " 3,866.38 " " 4,549.94 " N/A 28164289 LEFORT I-2 PIECE W/O GRAFT 21142 360 "$10,172.00" " 3,759.57 " - " 8,643.07 " - " 3,326.00 " N/A " 3,326.00 " - " 5,620.03 " N/A " 6,713.52 " - N/A " 6,732.85 " - N/A " 6,914.46 " " 8,643.07 " N/A N/A N/A " 8,137.60 " N/A - " 6,815.24 " N/A " 4,160.35 " " 7,629.00 " " 3,866.38 " " 4,549.94 " N/A 28176546 RECONS MIDFACE LEFORT 21145 360 "$10,172.00" " 3,759.57 " - " 9,302.37 " - " 7,028.85 " N/A " 7,028.85 " - " 5,620.03 " N/A " 6,713.52 " - N/A " 6,732.85 " - N/A " 7,441.90 " " 9,302.37 " N/A N/A N/A " 8,137.60 " N/A - " 6,815.24 " N/A " 4,160.35 " " 7,629.00 " " 3,866.38 " " 4,549.94 " N/A 28174845 "RECONS MIDFACE, LEFORT" 21146 360 "$26,702.00" " 9,869.06 " - " 21,361.60 " - " 3,326.00 " N/A " 3,326.00 " - " 14,752.86 " N/A " 17,623.32 " - N/A " 17,674.05 " - N/A " 7,928.27 " " 9,910.34 " N/A N/A N/A " 21,361.60 " N/A - " 17,890.34 " N/A " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " N/A 28164297 RECONST LWR JAW W/O FIXATION 21195 360 "$26,702.00" " 9,869.06 " - " 21,361.60 " - " 3,604.00 " " 5,304.76 " " 3,604.00 " - " 14,752.86 " " 5,203.71 " " 17,623.32 " - - " 17,674.05 " " 4,546.94 " " 5,052.15 " " 6,841.43 " " 8,551.79 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " - " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28164301 RECONST LWR JAW W/FIXATION 21196 360 "$10,172.00" " 3,759.57 " - " 9,303.70 " - " 7,028.85 " N/A " 7,028.85 " - " 5,620.03 " N/A " 6,713.52 " - N/A " 6,732.85 " - N/A " 7,442.96 " " 9,303.70 " N/A N/A N/A " 8,137.60 " N/A - " 6,815.24 " N/A " 4,160.35 " " 7,629.00 " " 3,866.38 " " 4,549.94 " N/A 28164319 FACE BONE GRAFT 21210 360 "$26,702.00" " 9,869.06 " 776.00 " 21,361.60 " 892.40 " 4,435.00 " " 5,304.76 " " 4,435.00 " 907.92 " 14,752.86 " " 5,203.71 " " 6,540.00 " 869.12 808.05 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 4,937.34 " " 6,171.67 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 776.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28164327 LOWER JAW BONE GRAFT 21215 360 "$26,702.00" " 9,869.06 " 776.00 " 21,361.60 " 892.40 " 4,435.00 " " 5,304.76 " " 4,435.00 " 907.92 " 14,752.86 " " 5,203.71 " " 6,540.00 " 869.12 808.05 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 4,937.34 " " 6,171.67 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 776.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28164335 EAR CARTILAGE GRAFT 21235 360 "$26,702.00" " 9,869.06 " 776.00 " 21,361.60 " 892.40 " 4,435.00 " " 5,304.76 " " 4,435.00 " 907.92 " 14,752.86 " " 5,203.71 " " 6,540.00 " 869.12 808.05 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 4,937.34 " " 6,171.67 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 776.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28174853 ARTHROPLASTY TMJ W/WO AUTOGRAF 21240 360 "$26,702.00" " 9,869.06 " 697.00 " 21,361.60 " 801.55 " 3,326.00 " " 5,304.76 " " 3,326.00 " 815.49 " 14,752.86 " " 5,203.71 " " 4,860.00 " 780.64 725.79 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 3,120.10 " " 3,900.12 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 697.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 37004189 UNL CRANIO/MAXILLOFACIAL SURG 21299 450 "$1,111.00" 410.63 - 888.80 - 767.70 220.67 767.70 - 613.83 216.46 733.26 - - 735.37 189.14 210.16 56.26 70.32 215.41 216.46 210.16 888.80 192.30 - 744.37 184.94 454.40 833.25 422.29 496.95 217.52 37002101 CLOSED TX NOSE FX W/O MAN 21310 450 "$1,082.00" 399.91 - " 2,820.00 " 892.40 " 1,718.00 " N/A " 1,718.00 " 907.92 597.81 N/A " 2,820.00 " 869.12 N/A 716.18 - N/A " 2,208.66 " " 2,760.83 " N/A N/A N/A 865.60 N/A 776.00 724.94 N/A 442.54 811.50 411.27 483.98 N/A 28164343 CLOSED TX NOSE FX W/O STABL 21315 360 "$7,102.00" " 2,624.90 " 587.00 " 5,681.60 " 675.05 " 1,718.00 " " 1,410.93 " " 1,718.00 " 686.79 " 3,923.86 " " 1,384.05 " " 2,820.00 " 657.44 611.24 " 4,700.81 " " 1,209.37 " " 1,343.74 " " 2,208.66 " " 2,760.83 " " 1,377.33 " " 1,384.05 " " 1,343.74 " " 5,681.60 " " 1,229.52 " 587.00 " 4,758.34 " " 1,182.49 " " 2,904.72 " " 5,326.50 " " 2,699.47 " " 3,176.72 " " 1,390.77 " 37002119 CLOSED TX NOSE FX W/O STABL 21315 450 "$7,102.00" " 2,624.90 " 587.00 " 5,681.60 " 675.05 " 1,718.00 " " 1,410.93 " " 1,718.00 " 686.79 " 3,923.86 " " 1,384.05 " " 2,820.00 " 657.44 611.24 " 4,700.81 " " 1,209.37 " " 1,343.74 " " 2,208.66 " " 2,760.83 " " 1,377.33 " " 1,384.05 " " 1,343.74 " " 5,681.60 " " 1,229.52 " 587.00 " 4,758.34 " " 1,182.49 " " 2,904.72 " " 5,326.50 " " 2,699.47 " " 3,176.72 " " 1,390.77 " 28164351 CLOSED TX NOSE FX W/ STABLJ 21320 360 "$14,366.00" " 5,309.67 " 573.00 " 11,492.80 " 658.95 " 1,718.00 " " 2,853.42 " " 1,718.00 " 670.41 " 7,937.22 " " 2,799.07 " " 2,820.00 " 641.76 596.66 " 9,508.86 " " 2,445.79 " " 2,717.54 " " 2,208.66 " " 2,760.83 " " 2,785.48 " " 2,799.07 " " 2,717.54 " " 11,492.80 " " 2,486.55 " 573.00 " 9,625.22 " " 2,391.44 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,812.65 " 28164360 CLOSED TX SEPTAL&NOSE FX 21337 360 "$14,366.00" " 5,309.67 " 776.00 " 11,492.80 " 892.40 " 1,718.00 " " 2,853.42 " " 1,718.00 " 907.92 " 7,937.22 " " 2,799.07 " " 2,820.00 " 869.12 808.05 " 9,508.86 " " 2,445.79 " " 2,717.54 " " 2,208.66 " " 2,760.83 " " 2,785.48 " " 2,799.07 " " 2,717.54 " " 11,492.80 " " 2,486.55 " 776.00 " 9,625.22 " " 2,391.44 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,812.65 " 28164378 OPEN TX DPRSD FRONT SINUS FX 21343 360 "$10,172.00" " 3,759.57 " - " 8,137.60 " - " 3,604.00 " N/A " 3,604.00 " - " 5,620.03 " N/A " 6,713.52 " - N/A " 6,732.85 " - N/A " 3,730.57 " " 4,663.21 " N/A N/A N/A " 8,137.60 " N/A - " 6,815.24 " N/A " 4,160.35 " " 7,629.00 " " 3,866.38 " " 4,549.94 " N/A 28164386 OPN TX DPRSD ZYGOMATIC ARCH 21356 360 "$26,702.00" " 9,869.06 " 776.00 " 21,361.60 " 892.40 " 2,773.00 " " 5,304.76 " " 2,773.00 " 907.92 " 14,752.86 " " 5,203.71 " " 3,545.00 " 869.12 808.05 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 4,937.34 " " 6,171.67 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 776.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28164394 OPN TX COMPLX MALAR FX 21365 360 "$26,702.00" " 9,869.06 " 776.00 " 21,361.60 " 892.40 " 3,604.00 " " 5,304.76 " " 3,604.00 " 907.92 " 14,752.86 " " 5,203.71 " " 6,540.00 " 869.12 808.05 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 3,730.57 " " 4,663.21 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 776.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28164408 OPN TX ORBIT PERIORBTL IMPLT 21390 360 "$26,702.00" " 9,869.06 " 776.00 " 21,361.60 " 892.40 " 4,435.00 " " 5,304.76 " " 4,435.00 " 907.92 " 14,752.86 " " 5,203.71 " " 6,540.00 " 869.12 808.05 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 4,937.34 " " 6,171.67 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 776.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28164416 OPN TX ORBIT FX W/IMPLANT 21407 360 "$26,702.00" " 9,869.06 " 776.00 " 21,361.60 " 892.40 " 3,604.00 " " 5,304.76 " " 3,604.00 " 907.92 " 14,752.86 " " 5,203.71 " " 4,445.00 " 869.12 808.05 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 3,730.57 " " 4,663.21 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 776.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28176708 TREAT LOWER JAW FRACTURE 21451 360 "$7,102.00" " 2,624.90 " 953.00 " 5,681.60 " " 1,095.95 " " 3,326.00 " " 1,410.93 " " 3,326.00 " " 1,115.01 " " 3,923.86 " " 1,384.05 " " 4,860.00 " " 1,067.36 " 992.36 " 4,700.81 " " 1,209.37 " " 1,343.74 " " 3,120.10 " " 3,900.12 " " 1,377.33 " " 1,384.05 " " 1,343.74 " " 5,681.60 " " 1,229.52 " 953.00 " 4,758.34 " " 1,182.49 " " 2,904.72 " " 5,326.50 " " 2,699.47 " " 3,176.72 " " 1,390.77 " 28174861 FRAC MAND OPEN TREAT W EXT FIX 21454 360 "$26,702.00" " 9,869.06 " 776.00 " 21,361.60 " 892.40 " 3,604.00 " " 5,304.76 " " 3,604.00 " 907.92 " 14,752.86 " " 5,203.71 " " 4,445.00 " 869.12 808.05 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 3,730.57 " " 4,663.21 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 776.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28174870 FRAC MAND OPEN W INTER FIXAT 21462 360 "$26,702.00" " 9,869.06 " 776.00 " 21,361.60 " 892.40 " 3,604.00 " " 5,304.76 " " 3,604.00 " 907.92 " 14,752.86 " " 5,203.71 " " 4,445.00 " 869.12 808.05 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 3,730.57 " " 4,663.21 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 776.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28164424 TREAT LOWER JAW FRACTURE 21470 360 "$26,702.00" " 9,869.06 " 776.00 " 21,361.60 " 892.40 " 3,604.00 " " 5,304.76 " " 3,604.00 " 907.92 " 14,752.86 " " 5,203.71 " " 4,445.00 " 869.12 808.05 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 3,730.57 " " 4,663.21 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 776.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 37002127 CLSD TX TEMPOROMANDIBULAR DISL 21480 450 "$1,082.00" 399.91 180.17 " 2,061.86 " 654.35 " 1,469.00 " 214.98 " 1,469.00 " 665.73 597.81 210.88 " 1,775.00 " 637.28 592.50 716.18 184.27 204.74 " 1,649.49 " " 2,061.86 " 209.86 210.88 204.74 865.60 187.34 569.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 28164432 DRAIN NECK/CHEST LESION 21501 360 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 1,718.00 " " 2,473.07 " " 1,718.00 " 907.92 " 6,874.76 " " 2,425.96 " " 2,820.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,208.66 " " 2,760.83 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 80327056 DRAIN NECK/CHEST LESION 21501 320 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 1,718.00 " " 2,473.07 " " 1,718.00 " 907.92 " 6,874.76 " " 2,425.96 " " 2,820.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,208.66 " " 2,760.83 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 80627050 DRAIN NECK/CHEST LESION 21501 350 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 1,718.00 " " 2,473.07 " " 1,718.00 " 907.92 " 6,874.76 " " 2,425.96 " " 2,820.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,208.66 " " 2,760.83 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28164441 BX NECK/CHEST 21550 360 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,469.00 " " 1,467.55 " " 1,469.00 " 907.92 " 4,081.32 " " 1,439.60 " " 1,775.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 67726901 BX NECK/CHEST 21550 350 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,469.00 " " 1,467.55 " " 1,469.00 " 907.92 " 4,081.32 " " 1,439.60 " " 1,775.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 80326904 BX NECK/CHEST 21550 320 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,469.00 " " 1,467.55 " " 1,469.00 " 907.92 " 4,081.32 " " 1,439.60 " " 1,775.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 80526903 BX NECK/CHEST 21550 402 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,469.00 " " 1,467.55 " " 1,469.00 " 907.92 " 4,081.32 " " 1,439.60 " " 1,775.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 80626908 BX NECK/CHEST 21550 350 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,469.00 " " 1,467.55 " " 1,469.00 " 907.92 " 4,081.32 " " 1,439.60 " " 1,775.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28164459 EXC NECK LES SC 3 CM/> 21552 360 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 2,773.00 " " 2,473.07 " " 2,773.00 " 907.92 " 6,874.76 " " 2,425.96 " " 6,576.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,397.90 " " 2,997.38 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28164467 EXC NECK TUM DEEP 5 CM/> 21554 360 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 2,773.00 " " 2,473.07 " " 2,773.00 " 907.92 " 6,874.76 " " 2,425.96 " " 6,576.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 3,940.85 " " 4,926.06 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28164475 EXC NECK LES SC < 3 CM 21555 360 "$7,387.00" " 2,730.24 " 741.00 " 5,909.60 " 852.15 " 1,718.00 " " 1,467.55 " " 1,718.00 " 866.97 " 4,081.32 " " 1,439.60 " " 2,820.00 " 829.92 771.60 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 2,208.66 " " 2,760.83 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 741.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28164483 EXC NECK TUM DEEP < 5 CM 21556 360 "$12,443.00" " 4,598.93 " 804.00 " 9,954.40 " 924.60 " 1,718.00 " " 2,473.07 " " 1,718.00 " 940.68 " 6,874.76 " " 2,425.96 " " 2,820.00 " 900.48 837.21 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,208.66 " " 2,760.83 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 804.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28164491 RESECT NECK THORAX TUMOR<5CM 21557 360 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 1,718.00 " " 2,473.07 " " 1,718.00 " 907.92 " 6,874.76 " " 2,425.96 " " 8,212.38 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,208.66 " " 2,760.83 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28164505 PARTIAL REMOVAL OF RIB 21600 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 1,718.00 " " 6,533.13 " " 1,718.00 " 907.92 " 18,172.28 " " 6,408.69 " " 2,820.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,208.66 " " 2,760.83 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28164513 STERNAL DEBRIDEMENT 21627 360 "$12,530.00" " 4,631.09 " - " 10,024.00 " - " 8,658.23 " N/A " 8,658.23 " - " 6,922.83 " N/A " 8,269.80 " - N/A " 8,293.61 " - N/A " 2,850.07 " " 3,562.59 " N/A N/A N/A " 10,024.00 " N/A - " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 28164521 REPAIR OF STERNUM SEPARATION 21750 360 "$12,530.00" " 4,631.09 " - " 10,024.00 " - " 8,658.23 " N/A " 8,658.23 " - " 6,922.83 " N/A " 8,269.80 " - N/A " 8,293.61 " - N/A " 3,751.33 " " 4,689.16 " N/A N/A N/A " 10,024.00 " N/A - " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 28164530 OPTX OF RIB FX W/FIXJ SCOPE 21811 360 "$32,891.00" " 12,156.51 " - " 26,312.80 " - " 2,773.00 " " 6,533.13 " " 2,773.00 " - " 18,172.28 " " 6,408.69 " " 6,576.00 " - - " 21,770.55 " " 5,599.83 " " 6,222.03 " " 1,254.30 " " 1,567.88 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " - " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28176554 OPEN TREATMNT RIB FX; 4-6 RIBS 21812 360 "$32,891.00" " 12,156.51 " - " 26,312.80 " - " 2,773.00 " " 6,533.13 " " 2,773.00 " - " 18,172.28 " " 6,408.69 " " 6,576.00 " - - " 21,770.55 " " 5,599.83 " " 6,222.03 " " 1,504.30 " " 1,880.37 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " - " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 37002143 CLOSED TX STERNUM FRACTURE 21820 450 "$1,082.00" 399.91 61.00 " 2,061.86 " 70.15 " 1,469.00 " 214.98 " 1,469.00 " 71.37 597.81 210.88 " 1,775.00 " 68.32 63.52 716.18 184.27 204.74 " 1,649.49 " " 2,061.86 " 209.86 210.88 204.74 865.60 187.34 61.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 28164548 EXC BACK LES SC < 3 CM 21930 360 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,718.00 " " 1,467.55 " " 1,718.00 " 907.92 " 4,081.32 " " 1,439.60 " " 2,820.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 2,208.66 " " 2,760.83 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28164556 EXC BACK LES SC 3 CM/> 21931 360 "$7,387.00" " 2,730.24 " 776.00 " 6,576.00 " 892.40 " 2,773.00 " " 1,467.55 " " 2,773.00 " 907.92 " 4,081.32 " " 1,439.60 " " 6,576.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 2,513.45 " " 3,141.81 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28164564 EXC BACK TUM DEEP < 5 CM 21932 360 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 1,718.00 " " 2,473.07 " " 1,718.00 " 907.92 " 6,874.76 " " 2,425.96 " " 6,540.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 3,609.17 " " 4,511.46 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28164572 EXC BACK TUM DEEP 5 CM/> 21933 360 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 2,773.00 " " 2,473.07 " " 2,773.00 " 907.92 " 6,874.76 " " 2,425.96 " " 6,576.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 3,984.73 " " 4,980.91 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28176562 RAD RESEC TUM BACK/FLANK 5CM > 21936 360 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 2,773.00 " " 2,473.07 " " 2,773.00 " 907.92 " 6,874.76 " " 2,425.96 " " 6,576.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 7,728.06 " " 9,660.08 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28164581 I&D P-SPINE C/T/CERV-THOR 22010 360 "$12,530.00" " 4,631.09 " - " 10,024.00 " - " 8,658.23 " N/A " 8,658.23 " - " 6,922.83 " N/A " 8,269.80 " - N/A " 8,293.61 " - N/A " 4,366.41 " " 5,458.01 " N/A N/A N/A " 10,024.00 " N/A - " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 28164599 I&D ABSCESS P-SPINE L/S/LS 22015 360 "$12,530.00" " 4,631.09 " - " 10,024.00 " - " 8,658.23 " N/A " 8,658.23 " - " 6,922.83 " N/A " 8,269.80 " - N/A " 8,293.61 " - N/A " 4,327.99 " " 5,409.99 " N/A N/A N/A " 10,024.00 " N/A - " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 28164602 REMOVE PART THORAX VERTEBRA 22112 360 "$12,530.00" " 4,631.09 " - " 10,024.00 " - " 8,658.23 " N/A " 8,658.23 " - " 6,922.83 " N/A " 8,269.80 " - N/A " 8,293.61 " - N/A " 4,956.24 " " 6,195.30 " N/A N/A N/A " 10,024.00 " N/A - " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 28164611 INCIS SPINE 3 COLUMN LUMBAR 22207 360 "$12,530.00" " 4,631.09 " - " 14,443.32 " - " 8,658.23 " N/A " 8,658.23 " - " 6,922.83 " N/A " 8,269.80 " - N/A " 8,293.61 " - N/A " 11,554.66 " " 14,443.32 " N/A N/A N/A " 10,024.00 " N/A - " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 28164629 INCIS 1 VERTEBRAL SEG LUMBAR 22214 360 "$12,530.00" " 4,631.09 " - " 10,024.00 " - " 8,658.23 " N/A " 8,658.23 " - " 6,922.83 " N/A " 8,269.80 " - N/A " 8,293.61 " - N/A " 7,493.37 " " 9,366.71 " N/A N/A N/A " 10,024.00 " N/A - " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 28164637 INCIS ADDL SPINE SEGMENT 22216 360 "$1,523.00" 562.90 - " 2,645.93 " - " 1,052.39 " N/A " 1,052.39 " - 841.46 N/A " 1,005.18 " - N/A " 1,008.07 " - N/A " 2,116.74 " " 2,645.93 " N/A N/A N/A " 1,218.40 " N/A - " 1,020.41 " N/A 622.91 " 1,142.25 " 578.89 681.24 N/A 28164645 INCIS W/DISCECTOMY CERVICAL 22220 360 "$12,530.00" " 4,631.09 " - " 10,089.79 " - " 8,658.23 " N/A " 8,658.23 " - " 6,922.83 " N/A " 8,269.80 " - N/A " 8,293.61 " - N/A " 8,071.83 " " 10,089.79 " N/A N/A N/A " 10,024.00 " N/A - " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 28164653 INCIS W/DISCECTOMY LUMBAR 22224 360 "$12,530.00" " 4,631.09 " - " 10,065.74 " - " 8,658.23 " N/A " 8,658.23 " - " 6,922.83 " N/A " 8,269.80 " - N/A " 8,293.61 " - N/A " 8,052.59 " " 10,065.74 " N/A N/A N/A " 10,024.00 " N/A - " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 28164661 REVISE EXTRA SPINE SEGMENT 22226 360 "$8,463.00" " 3,127.92 " - " 6,770.40 " - " 5,847.93 " N/A " 5,847.93 " - " 4,675.81 " N/A " 5,585.58 " - N/A " 5,601.66 " - N/A " 2,100.31 " " 2,625.39 " N/A N/A N/A " 6,770.40 " N/A - " 5,670.21 " N/A " 3,461.37 " " 6,347.25 " " 3,216.79 " " 3,785.50 " N/A 37002160 CLOSED TX VERT FX W/O MAN 22310 450 "$1,082.00" 399.91 180.17 " 2,061.86 " 226.55 " 1,469.00 " 214.98 " 1,469.00 " 230.49 597.81 210.88 " 1,775.00 " 220.64 205.14 716.18 184.27 204.74 " 1,649.49 " " 2,061.86 " 209.86 210.88 204.74 865.60 187.34 197.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37002801 CLOSED TX VERT FX W/MAN 22315 450 "$14,860.00" " 5,492.26 " 301.00 " 11,888.00 " 346.15 " 1,718.00 " " 2,953.81 " " 1,718.00 " 352.17 " 8,210.15 " " 2,897.54 " " 2,820.00 " 337.12 313.43 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,208.66 " " 2,760.83 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 301.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 80341270 INJ CERVICOTHORACIC PERC 22510 320 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 4,656.00 " " 2,953.81 " " 4,656.00 " 907.92 " 8,210.15 " " 2,897.54 " " 6,576.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 3,451.60 " " 4,314.50 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 80641273 INJ CERVICOTHORACIC PERC 22510 350 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 4,656.00 " " 2,953.81 " " 4,656.00 " 907.92 " 8,210.15 " " 2,897.54 " " 6,576.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 3,451.60 " " 4,314.50 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 80341288 INJ LUMBOSACRAL PERC 22511 320 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 4,656.00 " " 2,953.81 " " 4,656.00 " 907.92 " 8,210.15 " " 2,897.54 " " 6,576.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 3,417.18 " " 4,271.47 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 80641281 INJ LUMBOSACRAL PERC 22511 350 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 4,656.00 " " 2,953.81 " " 4,656.00 " 907.92 " 8,210.15 " " 2,897.54 " " 6,576.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 3,417.18 " " 4,271.47 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 80341296 INJ VERTEBROPLASTY ADD 22512 320 $550.00 203.28 - " 6,576.00 " - " 1,469.00 " - " 1,469.00 " - 303.88 - " 6,576.00 " - - 364.05 - - " 1,917.10 " " 2,396.37 " - - - 440.00 - - 368.50 - 224.95 412.50 209.06 246.02 - 80641290 INJ VERTEBROPLASTY ADD 22512 350 $550.00 203.28 - " 6,576.00 " - " 1,469.00 " - " 1,469.00 " - 303.88 - " 6,576.00 " - - 364.05 - - " 1,917.10 " " 2,396.37 " - - - 440.00 - - 368.50 - 224.95 412.50 209.06 246.02 - 28164670 PERC VERT AUGMT THORACIC 22513 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 21,708.06 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 14,228.31 " " 17,785.39 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 67741307 PERC VERT AUGMT THORACIC 22513 350 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 21,708.06 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 14,228.31 " " 17,785.39 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 80341300 PERC VERT AUGMT THORACIC 22513 320 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 21,708.06 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 14,228.31 " " 17,785.39 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 80641303 PERC VERT AUGMT THORACIC 22513 350 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 21,708.06 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 14,228.31 " " 17,785.39 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28164688 PERC VERT AUGMT LUMBAR 22514 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 21,708.06 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 14,149.56 " " 17,686.95 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 67741315 PERC VERT AUGMT LUMBAR 22514 350 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 21,708.06 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 14,149.56 " " 17,686.95 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 80341318 PERC VERT AUGMT LUMBAR 22514 320 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 21,708.06 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 14,149.56 " " 17,686.95 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 80641311 PERC VERT AUGMT LUMBAR 22514 350 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 21,708.06 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 14,149.56 " " 17,686.95 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28164696 PERC VERT AUGMT EACH ADD 22515 360 "$5,535.00" " 2,045.74 " - " 10,723.78 " - " 1,469.00 " - " 1,469.00 " - " 3,058.09 " - " 3,653.10 " - - " 3,663.62 " - - " 8,579.02 " " 10,723.78 " - - - " 4,428.00 " - - " 3,708.45 " - " 2,263.82 " " 4,151.25 " " 2,103.85 " " 2,475.81 " - 67741323 PERC VERT AUGMT EACH ADD 22515 350 "$5,535.00" " 2,045.74 " - " 10,723.78 " - " 1,469.00 " - " 1,469.00 " - " 3,058.09 " - " 3,653.10 " - - " 3,663.62 " - - " 8,579.02 " " 10,723.78 " - - - " 4,428.00 " - - " 3,708.45 " - " 2,263.82 " " 4,151.25 " " 2,103.85 " " 2,475.81 " - 80341326 PERC VERT AUGMT EACH ADD 22515 320 "$5,535.00" " 2,045.74 " - " 10,723.78 " - " 1,469.00 " - " 1,469.00 " - " 3,058.09 " - " 3,653.10 " - - " 3,663.62 " - - " 8,579.02 " " 10,723.78 " - - - " 4,428.00 " - - " 3,708.45 " - " 2,263.82 " " 4,151.25 " " 2,103.85 " " 2,475.81 " - 80641320 PERC VERT AUGMT EACH ADD 22515 350 "$5,535.00" " 2,045.74 " - " 10,723.78 " - " 1,469.00 " - " 1,469.00 " - " 3,058.09 " - " 3,653.10 " - - " 3,663.62 " - - " 8,579.02 " " 10,723.78 " - - - " 4,428.00 " - - " 3,708.45 " - " 2,263.82 " " 4,151.25 " " 2,103.85 " " 2,475.81 " - 28174888 "ART, LAT EXTAC TECH LUMBAR" 22533 360 "$31,736.00" " 11,729.63 " - " 25,388.80 " - " 21,929.58 " N/A " 21,929.58 " - " 17,534.14 " N/A " 20,945.76 " - N/A " 21,006.06 " - N/A " 8,079.93 " " 10,099.91 " N/A N/A N/A " 25,388.80 " N/A - " 21,263.12 " N/A " 12,980.02 " " 23,802.00 " " 12,062.85 " " 14,195.51 " N/A 28164700 NECK SPINE FUSE&REMOV BEL C2 22551 360 "$64,652.00" " 23,895.38 " 776.00 " 51,721.60 " 892.40 " 3,686.00 " " 12,861.18 " " 3,686.00 " 907.92 " 35,720.23 " " 12,616.20 " " 42,670.32 " 869.12 808.05 " 42,793.16 " " 11,023.87 " " 12,248.74 " " 9,771.56 " " 12,214.45 " " 12,554.96 " " 12,616.20 " " 12,248.74 " " 51,721.60 " " 11,207.60 " 776.00 " 43,316.84 " " 10,778.89 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,677.45 " 28164718 ADDL NECK SPINE FUSION 22552 360 "$3,123.00" " 1,154.26 " - " 2,854.28 " - " 2,157.99 " - " 2,157.99 " - " 1,725.46 " - " 2,061.18 " - - " 2,067.11 " - - " 2,283.42 " " 2,854.28 " - - - " 2,498.40 " - - " 2,092.41 " - " 1,277.31 " " 2,342.25 " " 1,187.05 " " 1,396.92 " - 28164726 ARTHRODESIS ANTERIOR CERVICAL 22554 360 "$64,652.00" " 23,895.38 " 776.00 " 51,721.60 " 892.40 " 3,686.00 " " 12,861.18 " " 3,686.00 " 907.92 " 35,720.23 " " 12,616.20 " " 42,670.32 " 869.12 808.05 " 42,793.16 " " 11,023.87 " " 12,248.74 " " 7,117.02 " " 8,896.28 " " 12,554.96 " " 12,616.20 " " 12,248.74 " " 51,721.60 " " 11,207.60 " 776.00 " 43,316.84 " " 10,778.89 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,677.45 " 28164734 ARTHRODESIS ANTERIOR THORACIC 22556 360 "$31,736.00" " 11,729.63 " - " 25,388.80 " - " 21,929.58 " N/A " 21,929.58 " - " 17,534.14 " N/A " 20,945.76 " - N/A " 21,006.06 " - N/A " 8,568.78 " " 10,710.98 " N/A N/A N/A " 25,388.80 " N/A - " 21,263.12 " N/A " 12,980.02 " " 23,802.00 " " 12,062.85 " " 14,195.51 " N/A 28164742 ARTHRODESIS ANTERIOR LUMBAR 22558 360 "$31,736.00" " 11,729.63 " - " 25,388.80 " - " 21,929.58 " N/A " 21,929.58 " - " 17,534.14 " N/A " 20,945.76 " - N/A " 21,006.06 " - N/A " 7,842.26 " " 9,802.82 " N/A N/A N/A " 25,388.80 " N/A - " 21,263.12 " N/A " 12,980.02 " " 23,802.00 " " 12,062.85 " " 14,195.51 " N/A 28164751 ADDITIONAL SPINAL FUSION 22585 360 "$1,173.00" 433.54 - " 2,405.51 " - 810.54 - 810.54 - 648.08 - 774.18 - - 776.41 - - " 1,924.41 " " 2,405.51 " - - - 938.40 - - 785.91 - 479.76 879.75 445.86 524.68 - 28164769 SPINE & SKULL SPINAL FUSION 22590 360 "$31,736.00" " 11,729.63 " - " 25,388.80 " - " 21,929.58 " N/A " 21,929.58 " - " 17,534.14 " N/A " 20,945.76 " - N/A " 21,006.06 " - N/A " 7,762.88 " " 9,703.60 " N/A N/A N/A " 25,388.80 " N/A - " 21,263.12 " N/A " 12,980.02 " " 23,802.00 " " 12,062.85 " " 14,195.51 " N/A 28164777 NECK SPINAL FUSION 22595 360 "$31,736.00" " 11,729.63 " - " 25,388.80 " - " 21,929.58 " N/A " 21,929.58 " - " 17,534.14 " N/A " 20,945.76 " - N/A " 21,006.06 " - N/A " 7,366.57 " " 9,208.21 " N/A N/A N/A " 25,388.80 " N/A - " 21,263.12 " N/A " 12,980.02 " " 23,802.00 " " 12,062.85 " " 14,195.51 " N/A 28164785 NECK SPINE FUSION 22600 360 "$31,736.00" " 11,729.63 " - " 25,388.80 " - " 21,929.58 " N/A " 21,929.58 " - " 17,534.14 " N/A " 20,945.76 " - N/A " 21,006.06 " - N/A " 6,245.59 " " 7,806.99 " N/A N/A N/A " 25,388.80 " N/A - " 21,263.12 " N/A " 12,980.02 " " 23,802.00 " " 12,062.85 " " 14,195.51 " N/A 28164793 THORAX SPINE FUSION 22610 360 "$31,736.00" " 11,729.63 " - " 25,388.80 " - " 21,929.58 " N/A " 21,929.58 " - " 17,534.14 " N/A " 20,945.76 " - N/A " 21,006.06 " - N/A " 6,228.60 " " 7,785.75 " N/A N/A N/A " 25,388.80 " N/A - " 21,263.12 " N/A " 12,980.02 " " 23,802.00 " " 12,062.85 " " 14,195.51 " N/A 28164807 LUMBAR SPINE FUSION 22612 360 "$64,652.00" " 23,895.38 " 776.00 " 51,721.60 " 892.40 " 3,686.00 " " 12,861.18 " " 3,686.00 " 907.92 " 35,720.23 " " 12,616.20 " " 42,670.32 " 869.12 808.05 " 42,793.16 " " 11,023.87 " " 12,248.74 " " 7,992.79 " " 9,990.99 " " 12,554.96 " " 12,616.20 " " 12,248.74 " " 51,721.60 " " 11,207.60 " 776.00 " 43,316.84 " " 10,778.89 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,677.45 " 28164815 SPINE FUSION EXTRA SEGMENT 22614 360 "$2,028.00" 749.55 - " 2,823.34 " - " 1,469.00 " - " 1,469.00 " - " 1,120.47 " - " 1,338.48 " - - " 1,342.33 " - - " 2,258.67 " " 2,823.34 " - - - " 1,622.40 " - - " 1,358.76 " - 829.45 " 1,521.00 " 770.84 907.12 - 28164823 LUMBAR SPINE FUSION INTERSPACE 22630 360 "$31,736.00" " 11,729.63 " - " 25,388.80 " - " 21,929.58 " " 16,864.63 " " 21,929.58 " - " 17,534.14 " " 16,543.40 " " 20,945.76 " - - " 21,006.06 " " 14,455.40 " " 16,061.55 " " 7,881.02 " " 9,851.27 " " 16,463.09 " " 16,543.40 " " 16,061.55 " " 25,388.80 " " 14,696.32 " - " 21,263.12 " " 14,134.16 " " 12,980.02 " " 23,802.00 " " 12,062.85 " " 14,195.51 " " 16,623.70 " 28164831 SPINE FUS ADDL SEG INTERSPACE 22632 360 "$1,345.00" 497.11 - " 2,285.26 " - 929.40 N/A 929.40 - 743.11 N/A 887.70 - N/A 890.26 - N/A " 1,828.21 " " 2,285.26 " N/A N/A N/A " 1,076.00 " N/A - 901.15 N/A 550.11 " 1,008.75 " 511.23 601.62 N/A 28164840 LUMBAR SPINE FUSION COMBINED 22633 360 "$64,652.00" " 23,895.38 " - " 51,721.60 " - " 44,674.53 " " 12,861.18 " " 44,674.53 " - " 35,720.23 " " 12,616.20 " " 42,670.32 " - - " 42,793.16 " " 11,023.87 " " 12,248.74 " " 7,082.43 " " 8,853.04 " " 12,554.96 " " 12,616.20 " " 12,248.74 " " 51,721.60 " " 11,207.60 " - " 43,316.84 " " 10,778.89 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,677.45 " 28164858 SPINE FUSION ADD SEG INTERSPAC 22634 360 "$1,009.00" 372.93 - " 2,406.99 " - 697.22 - 697.22 - 557.47 - 665.94 - - 667.86 - - " 1,925.59 " " 2,406.99 " - - - 807.20 - - 676.03 - 412.68 756.75 383.52 451.33 - 28164866 EXPLORATION OF SPINAL FUSION 22830 360 "$24,630.00" " 9,103.25 " - " 19,704.00 " - " 17,019.33 " N/A " 17,019.33 " - " 13,608.08 " N/A " 16,255.80 " - N/A " 16,302.60 " - N/A " 4,248.22 " " 5,310.27 " N/A N/A N/A " 19,704.00 " N/A - " 16,502.10 " N/A " 10,073.67 " " 18,472.50 " " 9,361.86 " " 11,017.00 " N/A 28164874 POST SPINE FIXATION DEVICE 1 22840 360 "$3,042.00" " 1,124.32 " - " 5,502.74 " - " 2,102.02 " - " 2,102.02 " - " 1,680.71 " - " 2,007.72 " - - " 2,013.50 " - - " 4,402.19 " " 5,502.74 " - - - " 2,433.60 " - - " 2,038.14 " - " 1,244.18 " " 2,281.50 " " 1,156.26 " " 1,360.69 " - 28164882 POST SPINE FIXATION DEVICE 3-6 22842 360 "$2,416.00" 892.95 - " 5,502.95 " - " 1,669.46 " - " 1,669.46 " - " 1,334.84 " - " 1,594.56 " - - " 1,599.15 " - - " 4,402.36 " " 5,502.95 " - - - " 1,932.80 " - - " 1,618.72 " - 988.14 " 1,812.00 " 918.32 " 1,080.68 " - 28164891 POST SPINE FIXATION DEVICE7-12 22843 360 $802.00 296.42 - " 5,791.95 " - 554.18 N/A 554.18 - 443.11 N/A 529.32 - N/A 530.84 - N/A " 4,633.56 " " 5,791.95 " N/A N/A N/A 641.60 N/A - 537.34 N/A 328.02 601.50 304.84 358.73 N/A 28164904 ANT SPINE FIXATION DEVICE 2-3 22845 360 "$3,668.00" " 1,355.69 " - " 5,256.41 " - " 2,534.59 " - " 2,534.59 " - " 2,026.57 " - " 2,420.88 " - - " 2,427.85 " - - " 4,205.13 " " 5,256.41 " - - - " 2,934.40 " - - " 2,457.56 " - " 1,500.21 " " 2,751.00 " " 1,394.21 " " 1,640.70 " - 28164912 ANT SPINE FIXATION DEVICE 4-7 22846 360 "$2,620.00" 968.35 - " 5,466.03 " - " 1,810.42 " N/A " 1,810.42 " - " 1,447.55 " N/A " 1,729.20 " - N/A " 1,734.18 " - N/A " 4,372.82 " " 5,466.03 " N/A N/A N/A " 2,096.00 " N/A - " 1,755.40 " N/A " 1,071.58 " " 1,965.00 " 995.86 " 1,171.93 " N/A 28164921 INSERT PELV FIXATION DEVICE 22848 360 $779.00 287.92 - " 2,617.38 " - 538.29 N/A 538.29 - 430.40 N/A 514.14 - N/A 515.62 - N/A " 2,093.90 " " 2,617.38 " N/A N/A N/A 623.20 N/A - 521.93 N/A 318.61 584.25 296.10 348.45 N/A 28174896 REIN OF SPINAL FIXATION DEVICE 22849 360 "$31,736.00" " 11,729.63 " - " 25,388.80 " - " 21,929.58 " N/A " 21,929.58 " - " 17,534.14 " N/A " 20,945.76 " - N/A " 21,006.06 " - N/A " 6,883.34 " " 8,604.18 " N/A N/A N/A " 25,388.80 " N/A - " 21,263.12 " N/A " 12,980.02 " " 23,802.00 " " 12,062.85 " " 14,195.51 " N/A 28164939 REMOVE NONSEG SPINE FIX DEVICE 22850 360 "$24,630.00" " 9,103.25 " - " 19,704.00 " - " 17,019.33 " N/A " 17,019.33 " - " 13,608.08 " N/A " 16,255.80 " - N/A " 16,302.60 " - N/A " 3,736.14 " " 4,670.17 " N/A N/A N/A " 19,704.00 " N/A - " 16,502.10 " N/A " 10,073.67 " " 18,472.50 " " 9,361.86 " " 11,017.00 " N/A 28164947 REMOVE SEGMEN SPINE FIX DEVICE 22852 360 "$24,630.00" " 9,103.25 " - " 19,704.00 " - " 17,019.33 " N/A " 17,019.33 " - " 13,608.08 " N/A " 16,255.80 " - N/A " 16,302.60 " - N/A " 3,562.59 " " 4,453.24 " N/A N/A N/A " 19,704.00 " N/A - " 16,502.10 " N/A " 10,073.67 " " 18,472.50 " " 9,361.86 " " 11,017.00 " N/A 28164955 INSJ INTERBODY BIOMECH DEVICE 22853 360 "$2,838.00" " 1,048.92 " - " 2,270.40 " - " 1,961.06 " - " 1,961.06 " - " 1,568.00 " - " 1,873.08 " - - " 1,878.47 " - - " 1,517.74 " " 1,897.18 " - - - " 2,270.40 " - - " 1,901.46 " - " 1,160.74 " " 2,128.50 " " 1,078.72 " " 1,269.44 " - 28164963 INSJ INTERVERT BIOMECH DEVICE 22854 360 "$2,881.00" " 1,064.82 " - " 2,455.86 " - " 1,990.77 " - " 1,990.77 " - " 1,591.75 " - " 1,901.46 " - - " 1,906.93 " - - " 1,964.69 " " 2,455.86 " - - - " 2,304.80 " - - " 1,930.27 " - " 1,178.33 " " 2,160.75 " " 1,095.07 " " 1,288.67 " - 28164971 CERV ARTIFIC DISKECTOMY 22856 360 "$83,308.00" " 30,790.64 " - " 66,646.40 " - " 3,686.00 " " 16,864.63 " " 3,686.00 " - " 46,027.67 " " 16,543.40 " " 54,983.28 " - - " 55,141.57 " " 14,455.40 " " 16,061.55 " " 8,639.66 " " 10,799.58 " " 16,463.09 " " 16,543.40 " " 16,061.55 " " 66,646.40 " " 14,696.32 " - " 55,816.36 " " 14,134.16 " " 34,072.97 " " 62,481.00 " " 31,665.37 " " 37,263.67 " " 16,623.70 " 28164980 SECOND LEVEL CER DISKECTOMY 22858 360 "$8,042.00" " 2,972.32 " - " 6,433.60 " - " 1,469.00 " - " 1,469.00 " - " 4,443.21 " - " 5,307.72 " - - " 5,323.00 " - - " 1,040.82 " " 1,301.02 " - - - " 6,433.60 " - - " 5,388.14 " - " 3,289.18 " " 6,031.50 " " 3,056.76 " " 3,597.19 " - 28176210 INSJ STABLJ DEV W/DCMPRN 22867 360 "$83,308.00" " 30,790.64 " - " 66,646.40 " - " 57,565.83 " " 16,864.63 " " 57,565.83 " - " 46,027.67 " " 16,543.40 " " 54,983.28 " - - " 55,141.57 " " 14,455.40 " " 16,061.55 " " 5,626.74 " " 7,033.42 " " 16,463.09 " " 16,543.40 " " 16,061.55 " " 66,646.40 " " 14,696.32 " - " 55,816.36 " " 14,134.16 " " 34,072.97 " " 62,481.00 " " 31,665.37 " " 37,263.67 " " 16,623.70 " 80609957 UNL SPINE SURGERY 22899 350 "$1,082.00" 399.91 - " 1,469.00 " - " 1,469.00 " 214.98 " 1,469.00 " - 597.81 210.88 714.12 - - 716.18 184.27 204.74 56.26 70.32 209.86 210.88 204.74 865.60 187.34 - 724.94 180.17 442.54 811.50 411.27 483.98 211.91 28164998 EXC ABDL TUM DEEP < 5 CM 22900 360 "$12,443.00" " 4,598.93 " 837.00 " 9,954.40 " 962.55 " 3,326.00 " " 2,473.07 " " 3,326.00 " 979.29 " 6,874.76 " " 2,425.96 " " 4,860.00 " 937.44 871.57 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 3,120.10 " " 3,900.12 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 837.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28165005 EXC ABDL TUM DEEP 5 CM/> 22901 360 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 2,773.00 " " 2,473.07 " " 2,773.00 " 907.92 " 6,874.76 " " 2,425.96 " " 6,576.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 3,559.05 " " 4,448.81 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28165013 EXC ABD LES SC < 3 CM 22902 360 "$7,387.00" " 2,730.24 " 776.00 " 6,540.00 " 892.40 " 1,718.00 " " 1,467.55 " " 1,718.00 " 907.92 " 4,081.32 " " 1,439.60 " " 6,540.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 2,204.27 " " 2,755.34 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28165021 EXC ABD LES SC 3 CM/> 22903 360 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 2,773.00 " " 2,473.07 " " 2,773.00 " 907.92 " 6,874.76 " " 2,425.96 " " 6,576.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,346.09 " " 2,932.61 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 67741188 UNL BX ABDOMINAL WALL 22999 350 "$1,082.00" 399.91 - " 1,469.00 " - " 1,469.00 " 214.98 " 1,469.00 " - 597.81 210.88 714.12 - - 716.18 184.27 204.74 56.26 70.32 209.86 210.88 204.74 865.60 187.34 - 724.94 180.17 442.54 811.50 411.27 483.98 211.91 80641184 UNL BX ABDOMINAL WALL 22999 350 "$1,082.00" 399.91 - " 1,469.00 " - " 1,469.00 " 214.98 " 1,469.00 " - 597.81 210.88 714.12 - - 716.18 184.27 204.74 56.26 70.32 209.86 210.88 204.74 865.60 187.34 - 724.94 180.17 442.54 811.50 411.27 483.98 211.91 28165030 DRAIN SHOULDER LESION 23030 360 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 1,469.00 " " 2,473.07 " " 1,469.00 " 907.92 " 6,874.76 " " 2,425.96 " " 1,775.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 1,649.49 " " 2,061.86 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28165048 EXC SHOULDER LES SC 3 CM/> 23071 360 "$7,387.00" " 2,730.24 " 776.00 " 6,576.00 " 892.40 " 2,773.00 " " 1,467.55 " " 2,773.00 " 907.92 " 4,081.32 " " 1,439.60 " " 6,576.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 2,228.69 " " 2,785.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28165056 EXC SHOULDER TUM DEEP 5 CM/> 23073 360 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 2,773.00 " " 2,473.07 " " 2,773.00 " 907.92 " 6,874.76 " " 2,425.96 " " 6,576.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 3,697.32 " " 4,621.65 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28165064 EXC SHOULDER LES SC < 3 CM 23075 360 "$7,387.00" " 2,730.24 " 682.00 " 5,909.60 " 784.30 " 1,718.00 " " 1,467.55 " " 1,718.00 " 797.94 " 4,081.32 " " 1,439.60 " " 2,820.00 " 763.84 710.17 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 2,208.66 " " 2,760.83 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 682.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28165072 EXC SHOULDER TUM DEEP < 5 CM 23076 360 "$12,443.00" " 4,598.93 " 837.00 " 9,954.40 " 962.55 " 1,718.00 " " 2,473.07 " " 1,718.00 " 979.29 " 6,874.76 " " 2,425.96 " " 2,820.00 " 937.44 871.57 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,208.66 " " 2,760.83 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 837.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28165081 PARTIAL REMOVAL COLLAR BONE 23120 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 3,604.00 " " 2,953.81 " " 3,604.00 " 907.92 " 8,210.15 " " 2,897.54 " " 4,445.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 3,730.57 " " 4,663.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28165099 RESECT CLAVICLE TUMOR 23200 360 "$12,530.00" " 4,631.09 " - " 10,024.00 " - " 8,658.23 " N/A " 8,658.23 " - " 6,922.83 " N/A " 8,269.80 " - N/A " 8,293.61 " - N/A " 4,579.78 " " 5,724.73 " N/A N/A N/A " 10,024.00 " N/A - " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 28165102 REMOVE SHOULDER FB DEEP 23333 360 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 1,718.00 " " 2,473.07 " " 1,718.00 " 907.92 " 6,874.76 " " 2,425.96 " " 3,545.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 1,649.49 " " 2,061.86 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 80101821 INJ SHOULDER XR 23350 320 $140.00 51.74 - 907.92 892.40 96.74 - 96.74 907.92 77.35 - 92.40 869.12 808.05 92.67 - - 393.78 492.23 - - - 112.00 - 776.00 93.80 - 57.26 105.00 53.21 62.62 - 28165111 INCISION OF TENDON & MUSCLE 23405 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 1,718.00 " " 6,533.13 " " 1,718.00 " 907.92 " 18,172.28 " " 6,408.69 " " 2,820.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,208.66 " " 2,760.83 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28165129 REPAIR ROTATOR CUFF ACUTE 23410 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 3,604.00 " " 6,533.13 " " 3,604.00 " 907.92 " 18,172.28 " " 6,408.69 " " 4,445.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 3,730.57 " " 4,663.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28165137 REPAIR ROTATOR CUFF CHRONIC 23412 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 4,435.00 " " 6,533.13 " " 4,435.00 " 907.92 " 18,172.28 " " 6,408.69 " " 6,540.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 4,937.34 " " 6,171.67 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28165145 REPAIR BICEPS TENDON 23430 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 3,326.00 " " 6,533.13 " " 3,326.00 " 907.92 " 18,172.28 " " 6,408.69 " " 4,860.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 3,120.10 " " 3,900.12 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28165153 REPAIR SHOULDER CAPSULE 23455 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 4,435.00 " " 6,533.13 " " 4,435.00 " 907.92 " 18,172.28 " " 6,408.69 " " 6,540.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 4,937.34 " " 6,171.67 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28165161 RECONSTRUCT SHOULDER JOINT 23472 360 "$24,630.00" " 9,103.25 " - " 19,704.00 " - " 17,019.33 " " 12,861.18 " " 17,019.33 " - " 13,608.08 " " 12,616.20 " " 16,255.80 " - - " 16,302.60 " " 11,023.87 " " 12,248.74 " " 7,922.82 " " 9,903.52 " " 12,554.96 " " 12,616.20 " " 12,248.74 " " 19,704.00 " " 11,207.60 " - " 16,502.10 " " 10,778.89 " " 10,073.67 " " 18,472.50 " " 9,361.86 " " 11,017.00 " " 12,677.45 " 28165170 REVIS RECONST SHOULDER JOINT 23473 360 "$64,652.00" " 23,895.38 " - " 51,721.60 " - " 3,604.00 " " 12,861.18 " " 3,604.00 " - " 35,720.23 " " 12,616.20 " " 42,670.32 " - - " 42,793.16 " " 11,023.87 " " 12,248.74 " " 4,150.11 " " 5,187.64 " " 12,554.96 " " 12,616.20 " " 12,248.74 " " 51,721.60 " " 11,207.60 " - " 43,316.84 " " 10,778.89 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,677.45 " 28175841 REVISION OF COLLAR BONE 23480 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 3,326.00 " " 6,533.13 " " 3,326.00 " 907.92 " 18,172.28 " " 6,408.69 " " 4,860.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 3,120.10 " " 3,900.12 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28165188 REVISION OF COLLAR BONE 23485 360 "$64,652.00" " 23,895.38 " 776.00 " 51,721.60 " 892.40 " 4,435.00 " " 12,861.18 " " 4,435.00 " 907.92 " 35,720.23 " " 12,616.20 " " 6,540.00 " 869.12 808.05 " 42,793.16 " " 11,023.87 " " 12,248.74 " " 4,937.34 " " 6,171.67 " " 12,554.96 " " 12,616.20 " " 12,248.74 " " 51,721.60 " " 11,207.60 " 776.00 " 43,316.84 " " 10,778.89 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,677.45 " 37002241 CLOSED TX CLAVICLE FX W/O MAN 23500 450 "$1,082.00" 399.91 180.17 " 2,061.86 " 892.40 " 1,469.00 " 214.98 " 1,469.00 " 907.92 597.81 210.88 " 1,775.00 " 869.12 808.05 716.18 184.27 204.74 " 1,649.49 " " 2,061.86 " 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37002259 CLOSED TX CLAVICLE FX W/MAN 23505 450 "$7,310.00" " 2,701.78 " 776.00 " 5,848.00 " 892.40 " 1,469.00 " " 1,452.77 " " 1,469.00 " 907.92 " 4,038.78 " " 1,425.10 " " 1,775.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 1,649.49 " " 2,061.86 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28165196 TREAT CLAVICLE FRACTURE 23515 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28165200 TREAT CLAVICLE DISLOCATION 23550 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28165218 TREAT CLAVICLE DISLOC W GRAFT 23552 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 3,326.00 " " 6,533.13 " " 3,326.00 " 907.92 " 18,172.28 " " 6,408.69 " " 4,860.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 3,120.10 " " 3,900.12 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 37089737 CLSD TX SHDR BLADE FX W/O MAN 23570 450 "$1,082.00" 399.91 73.00 " 2,061.86 " 83.95 " 1,469.00 " 214.98 " 1,469.00 " 85.41 597.81 210.88 " 1,775.00 " 81.76 76.01 716.18 184.27 204.74 " 1,649.49 " " 2,061.86 " 209.86 210.88 204.74 865.60 187.34 73.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37004197 CLSD TX SHDR BLADE FX W/MAN 23575 450 "$7,310.00" " 2,701.78 " 776.00 " 5,848.00 " 892.40 " 1,469.00 " " 1,452.77 " " 1,469.00 " 907.92 " 4,038.78 " " 1,425.10 " " 1,775.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 1,649.49 " " 2,061.86 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 37002267 CLSD TX PRXML HMRS FX W/O MAN 23600 450 "$1,082.00" 399.91 180.17 " 2,061.86 " 892.40 " 1,469.00 " 214.98 " 1,469.00 " 907.92 597.81 210.88 " 1,775.00 " 869.12 808.05 716.18 184.27 204.74 " 1,649.49 " " 2,061.86 " 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 28165226 CLSD TX PRXML HMRS FX W/MAN 23605 360 "$7,310.00" " 2,701.78 " 776.00 " 5,848.00 " 892.40 " 1,718.00 " " 1,452.77 " " 1,718.00 " 907.92 " 4,038.78 " " 1,425.10 " " 2,820.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 2,208.66 " " 2,760.83 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 37002275 CLSD TX PRXML HMRS FX W/MAN 23605 450 "$7,310.00" " 2,701.78 " 776.00 " 5,848.00 " 892.40 " 1,718.00 " " 1,452.77 " " 1,718.00 " 907.92 " 4,038.78 " " 1,425.10 " " 2,820.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 2,208.66 " " 2,760.83 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28165234 TREAT HUMERUS NECK FRACTURE 23615 360 "$64,652.00" " 23,895.38 " 776.00 " 51,721.60 " 892.40 " 3,326.00 " " 12,861.18 " " 3,326.00 " 907.92 " 35,720.23 " " 12,616.20 " " 4,860.00 " 869.12 808.05 " 42,793.16 " " 11,023.87 " " 12,248.74 " " 3,120.10 " " 3,900.12 " " 12,554.96 " " 12,616.20 " " 12,248.74 " " 51,721.60 " " 11,207.60 " 776.00 " 43,316.84 " " 10,778.89 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,677.45 " 37002810 CLSD TX GRT HUMERAL FX W/O MAN 23620 450 "$1,082.00" 399.91 180.17 " 2,061.86 " 892.40 " 1,469.00 " 214.98 " 1,469.00 " 907.92 597.81 210.88 " 1,775.00 " 869.12 808.05 716.18 184.27 204.74 " 1,649.49 " " 2,061.86 " 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37002828 CLSD TX GRT HUMERAL FX W/MAN 23625 450 "$7,310.00" " 2,701.78 " 776.00 " 5,848.00 " 892.40 " 1,718.00 " " 1,452.77 " " 1,718.00 " 907.92 " 4,038.78 " " 1,425.10 " " 2,820.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 2,208.66 " " 2,760.83 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28165242 TREAT HUMERUS TUBER FRACTURE 23630 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 3,604.00 " " 6,533.13 " " 3,604.00 " 907.92 " 18,172.28 " " 6,408.69 " " 4,445.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 3,730.57 " " 4,663.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28165251 CLSD TX SHDR W/MAN W/O ANES 23650 360 "$1,082.00" 399.91 180.17 " 2,061.86 " 892.40 " 1,469.00 " 214.98 " 1,469.00 " 907.92 597.81 210.88 " 1,775.00 " 869.12 808.05 716.18 184.27 204.74 " 1,649.49 " " 2,061.86 " 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37002232 CLSD TX SHDR W/MAN W/O ANES 23650 450 "$1,082.00" 399.91 180.17 " 2,061.86 " 892.40 " 1,469.00 " 214.98 " 1,469.00 " 907.92 597.81 210.88 " 1,775.00 " 869.12 808.05 716.18 184.27 204.74 " 1,649.49 " " 2,061.86 " 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 28165269 CLSD TX SHDR W/MAN W/ANES 23655 360 "$7,310.00" " 2,701.78 " 776.00 " 5,848.00 " 892.40 " 1,469.00 " " 1,452.77 " " 1,469.00 " 907.92 " 4,038.78 " " 1,425.10 " " 1,775.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 1,649.49 " " 2,061.86 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 37002178 CLSD TX SHDR W/MAN W/ANES 23655 450 "$7,310.00" " 2,701.78 " 776.00 " 5,848.00 " 892.40 " 1,469.00 " " 1,452.77 " " 1,469.00 " 907.92 " 4,038.78 " " 1,425.10 " " 1,775.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 1,649.49 " " 2,061.86 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 37002186 CLSD TX GRT HUMERAL FX W/MAN 23665 450 "$7,310.00" " 2,701.78 " 776.00 " 5,848.00 " 892.40 " 1,718.00 " " 1,452.77 " " 1,718.00 " 907.92 " 4,038.78 " " 1,425.10 " " 2,820.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 2,208.66 " " 2,760.83 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 37004090 CLSD TX SHDR DSLCTN W/FX W/MAN 23675 450 "$7,310.00" " 2,701.78 " 776.00 " 5,848.00 " 892.40 " 1,718.00 " " 1,452.77 " " 1,718.00 " 907.92 " 4,038.78 " " 1,425.10 " " 2,820.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 2,208.66 " " 2,760.83 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28165277 FIXATION OF SHOULDER 23700 360 "$7,310.00" " 2,701.78 " 567.00 " 5,848.00 " 652.05 " 1,469.00 " " 1,452.77 " " 1,469.00 " 663.39 " 4,038.78 " " 1,425.10 " " 1,775.00 " 635.04 590.42 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 1,649.49 " " 2,061.86 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 567.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28165285 DRAINAGE OF ARM LESION 23930 360 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 1,469.00 " " 2,473.07 " " 1,469.00 " 907.92 " 6,874.76 " " 2,425.96 " " 1,775.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 1,649.49 " " 2,061.86 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28165293 RELEASE ELBOW JOINT 24006 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 3,326.00 " " 2,953.81 " " 3,326.00 " 907.92 " 8,210.15 " " 2,897.54 " " 4,860.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 3,356.30 " " 4,195.38 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28165307 BIOPSY ARM/ELBOW SOFT TISSUE 24065 360 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,469.00 " " 1,467.55 " " 1,469.00 " 907.92 " 4,081.32 " " 1,439.60 " " 1,775.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28165315 EXC ARM/ELBOW LES SC 3 CM/> 24071 360 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 2,773.00 " " 2,473.07 " " 2,773.00 " 907.92 " 6,874.76 " " 2,425.96 " " 6,576.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,160.39 " " 2,700.49 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28165323 EX ARM/ELBOW TUM DEEP 5 CM/> 24073 360 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 2,773.00 " " 2,473.07 " " 2,773.00 " 907.92 " 6,874.76 " " 2,425.96 " " 6,576.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 3,715.43 " " 4,644.29 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28165331 EXC ARM/ELBOW LES SC < 3 CM 24075 360 "$7,387.00" " 2,730.24 " 682.00 " 5,909.60 " 784.30 " 1,718.00 " " 1,467.55 " " 1,718.00 " 797.94 " 4,081.32 " " 1,439.60 " " 2,820.00 " 763.84 710.17 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 2,208.66 " " 2,760.83 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 682.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28165340 EX ARM/ELBOW TUM DEEP < 5 CM 24076 360 "$12,443.00" " 4,598.93 " 837.00 " 9,954.40 " 962.55 " 1,718.00 " " 2,473.07 " " 1,718.00 " 979.29 " 6,874.76 " " 2,425.96 " " 2,820.00 " 937.44 871.57 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,208.66 " " 2,760.83 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 837.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28165358 REMOVAL OF ELBOW BURSA 24105 360 "$14,860.00" " 5,492.26 " 765.00 " 11,888.00 " 879.75 " 2,773.00 " " 2,953.81 " " 2,773.00 " 895.05 " 8,210.15 " " 2,897.54 " " 3,545.00 " 856.80 796.59 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 765.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28165366 REMOVE ELBOW LESION 24120 360 "$14,860.00" " 5,492.26 " 689.00 " 11,888.00 " 792.35 " 2,773.00 " " 2,953.81 " " 2,773.00 " 806.13 " 8,210.15 " " 2,897.54 " " 3,545.00 " 771.68 717.46 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 689.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28174900 IMPLANT REMOVAL RADIAL H 24164 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 2,773.00 " " 2,953.81 " " 2,773.00 " 907.92 " 8,210.15 " " 2,897.54 " " 3,545.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 80128151 INJ ELBOW XR 24220 320 $943.00 348.53 - " 1,469.00 " 40.25 " 1,469.00 " - " 1,469.00 " 40.95 521.01 - 622.38 39.20 36.45 624.17 - - 393.78 492.23 - - - 754.40 - 35.00 631.81 - 385.69 707.25 358.43 421.80 - 28174918 TENODESIS BICEP AT ELBOW 24340 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28165374 REPAIR ARM TENDON/MUSCLE 24341 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,717.03 " " 3,396.29 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28165382 REPAIR OF RUPTURED TENDON 24342 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28165391 RECONSTRUCT ELBOW LAT LIGMNT 24344 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 4,878.00 " " 6,533.13 " " 4,878.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 5,630.39 " " 7,037.99 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28165404 REPAIR ELBOW DEB/ATTCH OPEN 24359 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 2,773.00 " " 2,953.81 " " 2,773.00 " 907.92 " 8,210.15 " " 2,897.54 " " 6,576.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 3,168.70 " " 3,960.87 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28165412 RECONSTRUCT HEAD OF RADIUS 24366 360 "$64,652.00" " 23,895.38 " 776.00 " 51,721.60 " 892.40 " 3,604.00 " " 12,861.18 " " 3,604.00 " 907.92 " 35,720.23 " " 12,616.20 " " 42,670.32 " 869.12 808.05 " 42,793.16 " " 11,023.87 " " 12,248.74 " " 3,730.57 " " 4,663.21 " " 12,554.96 " " 12,616.20 " " 12,248.74 " " 51,721.60 " " 11,207.60 " 776.00 " 43,316.84 " " 10,778.89 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,677.45 " 28165421 REPAIR OF HUMERUS 24430 360 "$64,652.00" " 23,895.38 " 776.00 " 51,721.60 " 892.40 " 2,773.00 " " 12,861.18 " " 2,773.00 " 907.92 " 35,720.23 " " 12,616.20 " " 3,545.00 " 869.12 808.05 " 42,793.16 " " 11,023.87 " " 12,248.74 " " 2,532.97 " " 3,166.21 " " 12,554.96 " " 12,616.20 " " 12,248.74 " " 51,721.60 " " 11,207.60 " 776.00 " 43,316.84 " " 10,778.89 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,677.45 " 28165439 REPAIR HUMERUS WITH GRAFT 24435 360 "$64,652.00" " 23,895.38 " 776.00 " 51,721.60 " 892.40 " 3,326.00 " " 12,861.18 " " 3,326.00 " 907.92 " 35,720.23 " " 12,616.20 " " 4,860.00 " 869.12 808.05 " 42,793.16 " " 11,023.87 " " 12,248.74 " " 3,120.10 " " 3,900.12 " " 12,554.96 " " 12,616.20 " " 12,248.74 " " 51,721.60 " " 11,207.60 " 776.00 " 43,316.84 " " 10,778.89 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,677.45 " 37002283 CLSD TX HMRL SHAFT FX W/O MAN 24500 450 "$1,082.00" 399.91 180.17 " 2,061.86 " 892.40 " 1,469.00 " 214.98 " 1,469.00 " 907.92 597.81 210.88 " 1,775.00 " 869.12 808.05 716.18 184.27 204.74 " 1,649.49 " " 2,061.86 " 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37002291 CLSD TX HMRL SHAFT FX W/MAN 24505 450 "$7,310.00" " 2,701.78 " 740.00 " 5,848.00 " 851.00 " 1,469.00 " " 1,452.77 " " 1,469.00 " 865.80 " 4,038.78 " " 1,425.10 " " 1,775.00 " 828.80 770.56 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 1,649.49 " " 2,061.86 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 740.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28165447 OPEN TREAT HUMERUS SHAFT FX 24515 360 "$64,652.00" " 23,895.38 " 776.00 " 51,721.60 " 892.40 " 3,326.00 " " 12,861.18 " " 3,326.00 " 907.92 " 35,720.23 " " 12,616.20 " " 4,860.00 " 869.12 808.05 " 42,793.16 " " 11,023.87 " " 12,248.74 " " 3,120.10 " " 3,900.12 " " 12,554.96 " " 12,616.20 " " 12,248.74 " " 51,721.60 " " 11,207.60 " 776.00 " 43,316.84 " " 10,778.89 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,677.45 " 37002836 CLSD TX HMRL FX W/O MAN 24530 450 "$1,082.00" 399.91 180.17 " 2,061.86 " 892.40 " 1,469.00 " 214.98 " 1,469.00 " 907.92 597.81 210.88 " 1,775.00 " 869.12 808.05 716.18 184.27 204.74 " 1,649.49 " " 2,061.86 " 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 28165455 PERC CONDYLAR HUMERUS FRACTURE 24538 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 1,718.00 " " 6,533.13 " " 1,718.00 " 907.92 " 18,172.28 " " 6,408.69 " " 2,820.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,208.66 " " 2,760.83 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28165463 OPEN CONDYLA HUMERUS FX WO EXT 24545 360 "$64,652.00" " 23,895.38 " 776.00 " 51,721.60 " 892.40 " 3,326.00 " " 12,861.18 " " 3,326.00 " 907.92 " 35,720.23 " " 12,616.20 " " 4,860.00 " 869.12 808.05 " 42,793.16 " " 11,023.87 " " 12,248.74 " " 3,120.10 " " 3,900.12 " " 12,554.96 " " 12,616.20 " " 12,248.74 " " 51,721.60 " " 11,207.60 " 776.00 " 43,316.84 " " 10,778.89 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,677.45 " 28165471 OPEN CONDYLAR HUMERUS FX W EXT 24546 360 "$83,308.00" " 30,790.64 " 776.00 " 66,646.40 " 892.40 " 3,604.00 " " 16,864.63 " " 3,604.00 " 907.92 " 46,027.67 " " 16,543.40 " " 4,445.00 " 869.12 808.05 " 55,141.57 " " 14,455.40 " " 16,061.55 " " 3,730.57 " " 4,663.21 " " 16,463.09 " " 16,543.40 " " 16,061.55 " " 66,646.40 " " 14,696.32 " 776.00 " 55,816.36 " " 14,134.16 " " 34,072.97 " " 62,481.00 " " 31,665.37 " " 37,263.67 " " 16,623.70 " 28165480 OPEN EPICONDYLAR HUMERUS FX 24575 360 "$64,652.00" " 23,895.38 " 776.00 " 51,721.60 " 892.40 " 2,773.00 " " 12,861.18 " " 2,773.00 " 907.92 " 35,720.23 " " 12,616.20 " " 3,545.00 " 869.12 808.05 " 42,793.16 " " 11,023.87 " " 12,248.74 " " 2,532.97 " " 3,166.21 " " 12,554.96 " " 12,616.20 " " 12,248.74 " " 51,721.60 " " 11,207.60 " 776.00 " 43,316.84 " " 10,778.89 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,677.45 " 28165498 CLSD TX HMRL CDLR FX W/MAN 24577 360 "$7,310.00" " 2,701.78 " 776.00 " 5,848.00 " 892.40 " 1,469.00 " " 1,452.77 " " 1,469.00 " 907.92 " 4,038.78 " " 1,425.10 " " 1,775.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 1,649.49 " " 2,061.86 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 37090077 CLSD TX HMRL CDLR FX W/MAN 24577 450 "$7,310.00" " 2,701.78 " 776.00 " 5,848.00 " 892.40 " 1,469.00 " " 1,452.77 " " 1,469.00 " 907.92 " 4,038.78 " " 1,425.10 " " 1,775.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 1,649.49 " " 2,061.86 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28165501 OPEN HUMERUS CONDYLAR FX MED 24579 360 "$64,652.00" " 23,895.38 " 776.00 " 51,721.60 " 892.40 " 2,773.00 " " 12,861.18 " " 2,773.00 " 907.92 " 35,720.23 " " 12,616.20 " " 3,545.00 " 869.12 808.05 " 42,793.16 " " 11,023.87 " " 12,248.74 " " 2,532.97 " " 3,166.21 " " 12,554.96 " " 12,616.20 " " 12,248.74 " " 51,721.60 " " 11,207.60 " 776.00 " 43,316.84 " " 10,778.89 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,677.45 " 28165510 OPEN HUMERUS CONDYLAR FX W MAN 24582 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 1,718.00 " " 6,533.13 " " 1,718.00 " 907.92 " 18,172.28 " " 6,408.69 " " 2,820.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,208.66 " " 2,760.83 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28174926 OP TX PERIART FX/OSL ELBO 24586 360 "$64,652.00" " 23,895.38 " 776.00 " 51,721.60 " 892.40 " 3,326.00 " " 12,861.18 " " 3,326.00 " 907.92 " 35,720.23 " " 12,616.20 " " 4,860.00 " 869.12 808.05 " 42,793.16 " " 11,023.87 " " 12,248.74 " " 3,120.10 " " 3,900.12 " " 12,554.96 " " 12,616.20 " " 12,248.74 " " 51,721.60 " " 11,207.60 " 776.00 " 43,316.84 " " 10,778.89 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,677.45 " 37002305 CLSD TX ELBOW DSLCTN W/O ANES 24600 450 "$1,082.00" 399.91 102.50 " 2,061.86 " 117.88 " 1,469.00 " 214.98 " 1,469.00 " 119.93 597.81 210.88 " 1,775.00 " 114.80 106.73 716.18 184.27 204.74 " 1,649.49 " " 2,061.86 " 209.86 210.88 204.74 865.60 187.34 102.50 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37002313 CLSD TX ELBOW DSLCTN W/ANES 24605 450 "$7,310.00" " 2,701.78 " 776.00 " 5,848.00 " 892.40 " 1,718.00 " " 1,452.77 " " 1,718.00 " 907.92 " 4,038.78 " " 1,425.10 " " 2,820.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 2,208.66 " " 2,760.83 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28174934 DSL ELBOW SMP/CMP OPEN REDUC 24615 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 37089699 CLSD TX MONTEGGIA FX W/MAN 24620 450 "$7,310.00" " 2,701.78 " 776.00 " 5,848.00 " 892.40 " 1,718.00 " " 1,452.77 " " 1,718.00 " 907.92 " 4,038.78 " " 1,425.10 " " 2,820.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 2,208.66 " " 2,760.83 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28165528 TREAT ELBOW FRACTURE 24635 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 37002194 CLSD TX NURSEMAID ELBOW W/MAN 24640 450 "$1,082.00" 399.91 180.17 " 1,775.00 " 892.40 747.66 214.98 747.66 907.92 597.81 210.88 " 1,775.00 " 869.12 808.05 716.18 184.27 204.74 281.27 351.59 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37002879 CLSD TX HEAD NECK FX W/O MAN 24650 450 "$1,082.00" 399.91 180.17 " 1,469.00 " 892.40 " 1,469.00 " 214.98 " 1,469.00 " 907.92 597.81 210.88 845.00 869.12 808.05 716.18 184.27 204.74 281.27 351.59 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37002887 CLSD TX HEAD NECK FX W/MAN 24655 450 "$7,310.00" " 2,701.78 " 776.00 " 5,848.00 " 892.40 " 1,469.00 " " 1,452.77 " " 1,469.00 " 907.92 " 4,038.78 " " 1,425.10 " " 1,775.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 1,649.49 " " 2,061.86 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28165536 TREAT RADIUS FRACTURE 24665 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 3,326.00 " " 6,533.13 " " 3,326.00 " 907.92 " 18,172.28 " " 6,408.69 " " 4,860.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 3,120.10 " " 3,900.12 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28176228 TREAT RADIUS FRACTURE 24666 360 "$64,652.00" " 23,895.38 " 776.00 " 51,721.60 " 892.40 " 3,326.00 " " 12,861.18 " " 3,326.00 " 907.92 " 35,720.23 " " 12,616.20 " " 4,860.00 " 869.12 808.05 " 42,793.16 " " 11,023.87 " " 12,248.74 " " 3,120.10 " " 3,900.12 " " 12,554.96 " " 12,616.20 " " 12,248.74 " " 51,721.60 " " 11,207.60 " 776.00 " 43,316.84 " " 10,778.89 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,677.45 " 28165544 CLSD TX ULNAR FX PRXML W/O MAN 24670 360 "$1,082.00" 399.91 180.17 " 2,061.86 " 892.40 " 1,469.00 " 214.98 " 1,469.00 " 907.92 597.81 210.88 " 1,775.00 " 869.12 808.05 716.18 184.27 204.74 " 1,649.49 " " 2,061.86 " 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37002895 CLSD TX ULNAR FX PRXML W/O MAN 24670 450 "$1,082.00" 399.91 180.17 " 2,061.86 " 892.40 " 1,469.00 " 214.98 " 1,469.00 " 907.92 597.81 210.88 " 1,775.00 " 869.12 808.05 716.18 184.27 204.74 " 1,649.49 " " 2,061.86 " 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37088919 CLSD TX ULNAR FX PRXML W/MAN 24675 450 "$7,310.00" " 2,701.78 " 776.00 " 5,848.00 " 892.40 " 1,469.00 " " 1,452.77 " " 1,469.00 " 907.92 " 4,038.78 " " 1,425.10 " " 1,775.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 1,649.49 " " 2,061.86 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28165552 TREAT ULNAR FRACTURE 24685 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28165561 UPPER ARM/ELBOW SURGERY 24999 360 "$1,082.00" 399.91 - " 1,469.00 " - " 1,469.00 " 214.98 " 1,469.00 " - 597.81 210.88 714.12 - - 716.18 184.27 204.74 56.26 70.32 209.86 210.88 204.74 865.60 187.34 - 724.94 180.17 442.54 811.50 411.27 483.98 211.91 28165579 INCISION OF TENDON SHEATH 25000 360 "$7,310.00" " 2,701.78 " 550.00 " 5,848.00 " 632.50 " 2,773.00 " " 1,452.77 " " 2,773.00 " 643.50 " 4,038.78 " " 1,425.10 " " 3,545.00 " 616.00 572.72 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 2,532.97 " " 3,166.21 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 550.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28165587 DRAINAGE OF FOREARM LESION 25028 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 1,469.00 " " 2,953.81 " " 1,469.00 " 907.92 " 8,210.15 " " 2,897.54 " " 1,775.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 1,649.49 " " 2,061.86 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28165595 EXC FOREARM LES SC < 3 CM 25075 360 "$7,387.00" " 2,730.24 " 837.00 " 5,909.60 " 962.55 " 1,718.00 " " 1,467.55 " " 1,718.00 " 979.29 " 4,081.32 " " 1,439.60 " " 2,820.00 " 937.44 871.57 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 2,208.66 " " 2,760.83 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 837.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28176236 REMOVE WRIST JOINT CARTILAGE 25107 360 "$14,860.00" " 5,492.26 " 634.00 " 11,888.00 " 729.10 " 2,773.00 " " 2,953.81 " " 2,773.00 " 741.78 " 8,210.15 " " 2,897.54 " " 3,545.00 " 710.08 660.18 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 634.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28165609 REMOVE WRIST TENDON LESION 25111 360 "$7,310.00" " 2,701.78 " 854.00 " 5,848.00 " 982.10 " 2,773.00 " " 1,452.77 " " 2,773.00 " 999.18 " 4,038.78 " " 1,425.10 " " 3,545.00 " 956.48 889.27 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 2,532.97 " " 3,166.21 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 854.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28165617 REREMOVE WRIST TENDON LESION 25112 360 "$7,310.00" " 2,701.78 " 854.00 " 5,848.00 " 982.10 " 3,326.00 " " 1,452.77 " " 3,326.00 " 999.18 " 4,038.78 " " 1,425.10 " " 4,860.00 " 956.48 889.27 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 3,120.10 " " 3,900.12 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 854.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28176244 REMOVAL OF WRIST BONE 25210 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 2,773.00 " " 2,953.81 " " 2,773.00 " 907.92 " 8,210.15 " " 2,897.54 " " 3,545.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28165625 PARTIAL REMOVAL OF RADIUS 25230 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 3,326.00 " " 2,953.81 " " 3,326.00 " 907.92 " 8,210.15 " " 2,897.54 " " 4,860.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 3,120.10 " " 3,900.12 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28176252 PARTIAL REMOVAL OF ULNA 25240 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 3,326.00 " " 2,953.81 " " 3,326.00 " 907.92 " 8,210.15 " " 2,897.54 " " 4,860.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 3,120.10 " " 3,900.12 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 80128142 INJ WRIST XR 25246 320 $943.00 348.53 - " 1,469.00 " 40.25 " 1,469.00 " - " 1,469.00 " 40.95 521.01 - 622.38 39.20 36.45 624.17 - - 393.78 492.23 - - - 754.40 - 35.00 631.81 - 385.69 707.25 358.43 421.80 - 80528141 INJ WRIST XR 25246 320 $943.00 348.53 - " 1,469.00 " 40.25 " 1,469.00 " - " 1,469.00 " 40.95 521.01 - 622.38 39.20 36.45 624.17 - - 393.78 492.23 - - - 754.40 - 35.00 631.81 - 385.69 707.25 358.43 421.80 - 28165633 REMOVE FOREARM FOREIGN BODY 25248 360 "$7,310.00" " 2,701.78 " 776.00 " 5,848.00 " 892.40 " 1,718.00 " " 1,452.77 " " 1,718.00 " 907.92 " 4,038.78 " " 1,425.10 " " 2,820.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 2,208.66 " " 2,760.83 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28165641 MANIPULATE WRIST W/ANESTHES 25259 360 "$7,310.00" " 2,701.78 " 776.00 " 5,848.00 " 892.40 " 1,469.00 " " 1,452.77 " " 1,469.00 " 907.92 " 4,038.78 " " 1,425.10 " " 3,545.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 2,017.45 " " 2,521.81 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28165650 REP FOREARM TEND/MUSCLE FLEXOR 25260 360 "$14,860.00" " 5,492.26 " 849.00 " 11,888.00 " 976.35 " 3,326.00 " " 2,953.81 " " 3,326.00 " 993.33 " 8,210.15 " " 2,897.54 " " 4,860.00 " 950.88 884.06 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 3,120.10 " " 3,900.12 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 849.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28165668 REP FOREARM TEND/MUSCLE EXTEN 25270 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 3,326.00 " " 2,953.81 " " 3,326.00 " 907.92 " 8,210.15 " " 2,897.54 " " 4,860.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 3,120.10 " " 3,900.12 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28165676 REVISE PALSY HAND TENDON(S) 25316 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28174942 REC STABL DRUJ W/W/O ORIF 25337 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 3,604.00 " " 6,533.13 " " 3,604.00 " 907.92 " 18,172.28 " " 6,408.69 " " 4,445.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 3,819.73 " " 4,774.66 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28176261 REVISION OF ULNA 25360 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28165684 SHORTEN RADIUS OR ULNA 25390 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28165692 REPAIR RADIUS OR ULNA 25400 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28165706 REPAIR/GRAFT RADIUS OR ULNA 25405 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 3,326.00 " " 6,533.13 " " 3,326.00 " 907.92 " 18,172.28 " " 6,408.69 " " 4,860.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 3,120.10 " " 3,900.12 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28176279 RECONSTRUCT DISTAL ULNA 25442 360 "$83,308.00" " 30,790.64 " 776.00 " 66,646.40 " 892.40 " 3,604.00 " " 16,864.63 " " 3,604.00 " 907.92 " 46,027.67 " " 16,543.40 " " 54,983.28 " 869.12 808.05 " 55,141.57 " " 14,455.40 " " 16,061.55 " " 3,730.57 " " 4,663.21 " " 16,463.09 " " 16,543.40 " " 16,061.55 " " 66,646.40 " " 14,696.32 " 776.00 " 55,816.36 " " 14,134.16 " " 34,072.97 " " 62,481.00 " " 31,665.37 " " 37,263.67 " " 16,623.70 " 28176287 RECONSTRUCT WRIST JOINT 25445 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 3,604.00 " " 6,533.13 " " 3,604.00 " 907.92 " 18,172.28 " " 6,408.69 " " 4,445.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 3,730.57 " " 4,663.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28165714 REPAIR WRIST JOINTS 25447 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 3,604.00 " " 2,953.81 " " 3,604.00 " 907.92 " 8,210.15 " " 2,897.54 " " 4,445.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 3,730.57 " " 4,663.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28165722 CLSD TX RDL SHAFT FX W/O MAN 25500 360 "$1,082.00" 399.91 168.76 " 1,469.00 " 892.40 " 1,469.00 " 214.98 " 1,469.00 " 907.92 597.81 210.88 845.00 869.12 808.05 716.18 184.27 204.74 168.76 210.95 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37002909 CLSD TX RDL SHAFT FX W/O MAN 25500 450 "$1,082.00" 399.91 168.76 " 1,469.00 " 892.40 " 1,469.00 " 214.98 " 1,469.00 " 907.92 597.81 210.88 845.00 869.12 808.05 716.18 184.27 204.74 168.76 210.95 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37002917 CLSD TX RDL SHAFT FX W/MAN 25505 450 "$7,310.00" " 2,701.78 " 619.00 " 5,848.00 " 711.85 " 1,469.00 " " 1,452.77 " " 1,469.00 " 724.23 " 4,038.78 " " 1,425.10 " " 1,775.00 " 693.28 644.56 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 1,649.49 " " 2,061.86 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 619.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28165731 OPEN TREAT FX RADIUS SHAFT 25515 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28165749 OPEN TX FX RADIUS SHAFT GALEAZ 25525 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 3,326.00 " " 6,533.13 " " 3,326.00 " 907.92 " 18,172.28 " " 6,408.69 " " 4,860.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 3,120.10 " " 3,900.12 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 37088927 CLSD TX ULNAR SHAFT FX W/O MAN 25530 450 "$1,082.00" 399.91 180.17 " 1,469.00 " 892.40 " 1,469.00 " 214.98 " 1,469.00 " 907.92 597.81 210.88 845.00 869.12 808.05 716.18 184.27 204.74 337.30 421.63 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37002925 CLSD TX ULNAR SHAFT FX W/MAN 25535 450 "$1,082.00" 399.91 180.17 " 2,061.86 " 892.40 " 1,469.00 " 214.98 " 1,469.00 " 907.92 597.81 210.88 " 1,775.00 " 869.12 808.05 716.18 184.27 204.74 " 1,649.49 " " 2,061.86 " 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 28165757 TREAT FRACTURE OF ULNA 25545 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28165765 CLSD TX RDL ULNAR FX W/O MAN 25560 360 "$1,082.00" 399.91 180.17 " 1,469.00 " 892.40 " 1,469.00 " 214.98 " 1,469.00 " 907.92 597.81 210.88 845.00 869.12 808.05 716.18 184.27 204.74 701.89 877.36 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37002933 CLSD TX RDL ULNAR FX W/O MAN 25560 450 "$1,082.00" 399.91 180.17 " 1,469.00 " 892.40 " 1,469.00 " 214.98 " 1,469.00 " 907.92 597.81 210.88 845.00 869.12 808.05 716.18 184.27 204.74 701.89 877.36 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 28174951 TX RAD&ULN SHFT FX W/MAN 25565 360 "$7,310.00" " 2,701.78 " 688.00 " 5,848.00 " 791.20 " 1,718.00 " " 1,452.77 " " 1,718.00 " 804.96 " 4,038.78 " " 1,425.10 " " 2,820.00 " 770.56 716.41 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 2,208.66 " " 2,760.83 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 688.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 37002941 CLSD TX RDL ULNAR FX W/MAN 25565 450 "$7,310.00" " 2,701.78 " 688.00 " 5,848.00 " 791.20 " 1,718.00 " " 1,452.77 " " 1,718.00 " 804.96 " 4,038.78 " " 1,425.10 " " 2,820.00 " 770.56 716.41 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 2,208.66 " " 2,760.83 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 688.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28165773 TREAT FRACTURE RADIUS/ULNA 25575 360 "$32,891.00" " 12,156.51 " " 1,202.00 " " 26,312.80 " " 1,382.30 " " 2,773.00 " " 6,533.13 " " 2,773.00 " " 1,406.34 " " 18,172.28 " " 6,408.69 " " 3,545.00 " " 1,346.24 " " 1,251.64 " " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " " 1,202.00 " " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28174969 FX DISTAL RADIUS W/O RED 25600 360 "$1,082.00" 399.91 180.17 " 1,469.00 " 892.40 " 1,469.00 " 214.98 " 1,469.00 " 907.92 597.81 210.88 845.00 869.12 808.05 716.18 184.27 204.74 393.78 492.23 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37002321 CLSD TX DISTAL RDL FX W/O MAN 25600 450 "$1,082.00" 399.91 180.17 " 1,469.00 " 892.40 " 1,469.00 " 214.98 " 1,469.00 " 907.92 597.81 210.88 845.00 869.12 808.05 716.18 184.27 204.74 393.78 492.23 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37002330 CLSD TX DISTAL RDL FX W/MAN 25605 450 "$7,310.00" " 2,701.78 " 994.00 " 5,848.00 " " 1,143.10 " " 2,773.00 " " 1,452.77 " " 2,773.00 " " 1,162.98 " " 4,038.78 " " 1,425.10 " " 3,545.00 " " 1,113.28 " " 1,035.05 " " 4,838.49 " " 1,245.23 " " 1,383.59 " " 2,532.97 " " 3,166.21 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 994.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28165781 TREAT FX DISTAL RADIAL 25606 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 2,773.00 " " 2,953.81 " " 2,773.00 " 907.92 " 8,210.15 " " 2,897.54 " " 3,545.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,708.70 " " 3,385.88 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28165790 TREAT FX RAD EXTRA-ARTICUL 25607 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 3,604.00 " " 6,533.13 " " 3,604.00 " 907.92 " 18,172.28 " " 6,408.69 " " 4,445.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 3,808.03 " " 4,760.04 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28165803 TREAT FX RAD INTRA-ARTICUL 25608 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 3,604.00 " " 6,533.13 " " 3,604.00 " 907.92 " 18,172.28 " " 6,408.69 " " 4,445.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 3,808.03 " " 4,760.04 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28165811 TREAT FX RADIAL 3+ FRAG 25609 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 3,604.00 " " 6,533.13 " " 3,604.00 " 907.92 " 18,172.28 " " 6,408.69 " " 4,445.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 3,808.03 " " 4,760.04 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 37002348 CLSD TX CARPAL FX W/O MAN 25622 450 "$1,082.00" 399.91 180.17 907.92 892.40 747.66 214.98 747.66 907.92 597.81 210.88 845.00 869.12 808.05 716.18 184.27 204.74 393.78 492.23 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37002356 CLSD TX CARPAL FX W/MAN 25624 450 "$7,310.00" " 2,701.78 " 776.00 " 5,848.00 " 892.40 " 1,718.00 " " 1,452.77 " " 1,718.00 " 907.92 " 4,038.78 " " 1,425.10 " " 2,820.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 2,208.66 " " 2,760.83 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28165820 TREAT WRIST BONE FRACTURE 25628 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 37088935 CLSD TX CARPAL FX W/MAN EACH 25635 450 "$7,310.00" " 2,701.78 " 776.00 " 5,848.00 " 892.40 " 1,469.00 " " 1,452.77 " " 1,469.00 " 907.92 " 4,038.78 " " 1,425.10 " " 1,775.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 1,649.49 " " 2,061.86 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 37003638 CLSD TX ULNAR STYLOID FX 25650 450 "$1,082.00" 399.91 180.17 907.92 892.40 747.66 214.98 747.66 907.92 597.81 210.88 845.00 869.12 808.05 716.18 184.27 204.74 393.78 492.23 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 28165838 CLSD TX WRIST DSLCTN W/MAN 25675 360 "$1,082.00" 399.91 180.17 " 2,061.86 " 892.40 " 1,469.00 " 214.98 " 1,469.00 " 907.92 597.81 210.88 " 1,775.00 " 869.12 808.05 716.18 184.27 204.74 " 1,649.49 " " 2,061.86 " 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37089702 CLSD TX WRIST DSLCTN W/MAN 25675 450 "$1,082.00" 399.91 180.17 " 2,061.86 " 892.40 " 1,469.00 " 214.98 " 1,469.00 " 907.92 597.81 210.88 " 1,775.00 " 869.12 808.05 716.18 184.27 204.74 " 1,649.49 " " 2,061.86 " 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37089745 CLSD TX WRIST FX DSLCTN W/MAN 25680 450 "$1,082.00" 399.91 180.17 " 2,820.00 " 892.40 " 1,718.00 " 214.98 " 1,718.00 " 907.92 597.81 210.88 " 2,820.00 " 869.12 808.05 716.18 184.27 204.74 " 2,208.66 " " 2,760.83 " 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 28165846 TREAT WRIST FRACTURE 25685 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 37089621 CLSD TX LUNATE DSLCTN W/MAN 25690 450 "$7,310.00" " 2,701.78 " 776.00 " 5,848.00 " 892.40 " 1,469.00 " " 1,452.77 " " 1,469.00 " 907.92 " 4,038.78 " " 1,425.10 " " 1,775.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 1,649.49 " " 2,061.86 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28165854 FUSION OF WRIST JOINT 25800 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 3,326.00 " " 6,533.13 " " 3,326.00 " 907.92 " 18,172.28 " " 6,408.69 " " 4,860.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 3,120.10 " " 3,900.12 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28165862 FUSION/GRAFT OF WRIST JOINT 25810 360 "$64,652.00" " 23,895.38 " 776.00 " 51,721.60 " 892.40 " 3,604.00 " " 12,861.18 " " 3,604.00 " 907.92 " 35,720.23 " " 12,616.20 " " 4,445.00 " 869.12 808.05 " 42,793.16 " " 11,023.87 " " 12,248.74 " " 3,730.57 " " 4,663.21 " " 12,554.96 " " 12,616.20 " " 12,248.74 " " 51,721.60 " " 11,207.60 " 776.00 " 43,316.84 " " 10,778.89 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,677.45 " 28165871 DRAINAGE FINGER ABSCESS SIMPLE 26010 360 $943.00 348.53 156.97 907.92 892.40 651.61 187.30 651.61 907.92 521.01 183.73 845.00 869.12 808.05 624.17 160.54 178.38 197.22 246.53 182.84 183.73 178.38 754.40 163.22 776.00 631.81 156.97 385.69 707.25 358.43 421.80 184.62 37003603 DRAINAGE FINGER ABSCESS SIMPLE 26010 450 $943.00 348.53 156.97 907.92 892.40 651.61 187.30 651.61 907.92 521.01 183.73 845.00 869.12 808.05 624.17 160.54 178.38 197.22 246.53 182.84 183.73 178.38 754.40 163.22 776.00 631.81 156.97 385.69 707.25 358.43 421.80 184.62 28165889 DRAINAGE OF FINGER ABSCESS 26011 360 "$7,387.00" " 2,730.24 " 700.00 " 5,909.60 " 805.00 " 1,469.00 " " 1,467.55 " " 1,469.00 " 819.00 " 4,081.32 " " 1,439.60 " " 1,775.00 " 784.00 728.91 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 700.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28165897 DRAIN HAND TENDON SHEATH 26020 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 1,718.00 " " 2,953.81 " " 1,718.00 " 907.92 " 8,210.15 " " 2,897.54 " " 2,820.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,208.66 " " 2,760.83 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28165901 TREAT HAND BONE LESION 26034 360 "$7,310.00" " 2,701.78 " 860.00 " 5,848.00 " 989.00 " 1,718.00 " " 1,452.77 " " 1,718.00 " " 1,006.20 " " 4,038.78 " " 1,425.10 " " 2,820.00 " 963.20 895.52 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 2,208.66 " " 2,760.83 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 860.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28176571 DECOMPRESSIVE FASCIOT HAND 26037 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 3,326.00 " " 2,953.81 " " 3,326.00 " 907.92 " 8,210.15 " " 2,897.54 " " 4,860.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 3,120.10 " " 3,900.12 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28165919 INCISE FINGER TENDON SHEATH 26055 360 "$7,310.00" " 2,701.78 " 643.00 " 5,848.00 " 739.45 " 1,718.00 " " 1,452.77 " " 1,718.00 " 752.31 " 4,038.78 " " 1,425.10 " " 2,820.00 " 720.16 669.56 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 2,208.66 " " 2,760.83 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 643.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28165927 EXPLORE/TREAT FINGER JOINT 26075 360 "$14,860.00" " 5,492.26 " 852.00 " 11,888.00 " 979.80 " 3,326.00 " " 2,953.81 " " 3,326.00 " 996.84 " 8,210.15 " " 2,897.54 " " 4,860.00 " 954.24 887.19 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 3,120.10 " " 3,900.12 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 852.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28165935 BIOPSY FINGER JOINT LINING 26110 360 "$7,310.00" " 2,701.78 " 776.00 " 5,848.00 " 892.40 " 1,469.00 " " 1,452.77 " " 1,469.00 " 907.92 " 4,038.78 " " 1,425.10 " " 1,775.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 1,649.49 " " 2,061.86 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28174977 EXC TUMOR OR VASC MALFORMATION 26113 360 "$7,387.00" " 2,730.24 " 776.00 " 6,576.00 " 892.40 " 2,773.00 " " 1,467.55 " " 2,773.00 " 907.92 " 4,081.32 " " 1,439.60 " " 6,576.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 2,873.64 " " 3,592.05 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28165943 EXC HAND LES SC < 1.5 CM 26115 360 "$7,387.00" " 2,730.24 " 741.00 " 5,909.60 " 852.15 " 1,718.00 " " 1,467.55 " " 1,718.00 " 866.97 " 4,081.32 " " 1,439.60 " " 2,820.00 " 829.92 771.60 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 2,208.66 " " 2,760.83 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 741.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28165951 EXC HAND TUM DEEP < 1.5 CM 26116 360 "$7,387.00" " 2,730.24 " 804.00 " 5,909.60 " 924.60 " 1,718.00 " " 1,467.55 " " 1,718.00 " 940.68 " 4,081.32 " " 1,439.60 " " 2,820.00 " 900.48 837.21 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 2,208.66 " " 2,760.83 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 804.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28165960 FASCIECTOMY PALM ONLY 26121 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 3,326.00 " " 2,953.81 " " 3,326.00 " 907.92 " 8,210.15 " " 2,897.54 " " 4,860.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 3,120.10 " " 3,900.12 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28165978 FASCIECTOMY PALM W DIGIT RELEA 26123 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 3,326.00 " " 2,953.81 " " 3,326.00 " 907.92 " 8,210.15 " " 2,897.54 " " 4,860.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 3,120.10 " " 3,900.12 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28165986 REMOVE TENDON SHEATH LESION 26160 360 "$7,310.00" " 2,701.78 " 775.00 " 5,848.00 " 891.25 " 2,773.00 " " 1,452.77 " " 2,773.00 " 906.75 " 4,038.78 " " 1,425.10 " " 3,545.00 " 868.00 807.01 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 2,532.97 " " 3,166.21 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 775.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28165994 REMOVAL OF FINGER TENDON 26180 360 "$7,310.00" " 2,701.78 " 776.00 " 5,848.00 " 892.40 " 2,773.00 " " 1,452.77 " " 2,773.00 " 907.92 " 4,038.78 " " 1,425.10 " " 3,545.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 2,532.97 " " 3,166.21 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28176716 PARTIAL REMOVAL FINGER BONE 26236 360 "$7,310.00" " 2,701.78 " 776.00 " 5,848.00 " 892.40 " 2,773.00 " " 1,452.77 " " 2,773.00 " 907.92 " 4,038.78 " " 1,425.10 " " 3,545.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 2,532.97 " " 3,166.21 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28166001 MANIPULATE FINGER W/ANESTH 26340 360 "$7,310.00" " 2,701.78 " 776.00 " 5,848.00 " 892.40 " 1,469.00 " " 1,452.77 " " 1,469.00 " 907.92 " 4,038.78 " " 1,425.10 " " 1,775.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 1,551.27 " " 1,939.09 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28166010 REPAIR FIN/HND TEND NOT ZONE 2 26350 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 1,469.00 " " 2,953.81 " " 1,469.00 " 907.92 " 8,210.15 " " 2,897.54 " " 1,775.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 1,649.49 " " 2,061.86 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28166028 REPAIR FIN/HND TEND IN ZONE 2 26356 360 "$14,860.00" " 5,492.26 " 849.00 " 11,888.00 " 976.35 " 3,326.00 " " 2,953.81 " " 3,326.00 " 993.33 " 8,210.15 " " 2,897.54 " " 4,860.00 " 950.88 884.06 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 3,120.10 " " 3,900.12 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 849.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28166036 REPAIR FIN/HND PROFUNDUS TEND 26370 360 "$14,860.00" " 5,492.26 " 849.00 " 11,888.00 " 976.35 " 3,326.00 " " 2,953.81 " " 3,326.00 " 993.33 " 8,210.15 " " 2,897.54 " " 4,860.00 " 950.88 884.06 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 3,120.10 " " 3,900.12 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 849.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28166044 REPAIR HAND TENDON 26410 360 "$7,310.00" " 2,701.78 " 808.00 " 5,848.00 " 929.20 " 2,773.00 " " 1,452.77 " " 2,773.00 " 945.36 " 4,038.78 " " 1,425.10 " " 3,545.00 " 904.96 841.37 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 2,532.97 " " 3,166.21 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 808.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28166052 REPAIR FINGER TENDON EACH 26418 360 "$7,310.00" " 2,701.78 " 809.00 " 5,848.00 " 930.35 " 3,326.00 " " 1,452.77 " " 3,326.00 " 946.53 " 4,038.78 " " 1,425.10 " " 4,860.00 " 906.08 842.41 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 3,120.10 " " 3,900.12 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 809.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 37088943 REPAIR FINGER TENDON EACH 26418 450 "$7,310.00" " 2,701.78 " 809.00 " 5,848.00 " 930.35 " 3,326.00 " " 1,452.77 " " 3,326.00 " 946.53 " 4,038.78 " " 1,425.10 " " 4,860.00 " 906.08 842.41 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 3,120.10 " " 3,900.12 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 809.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28166061 REPAIR FINGER TENDON 26433 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 2,773.00 " " 2,953.81 " " 2,773.00 " 907.92 " 8,210.15 " " 2,897.54 " " 3,545.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28166079 RELEASE PALM/FINGER TENDON 26440 360 "$7,310.00" " 2,701.78 " 744.00 " 5,848.00 " 855.60 " 2,773.00 " " 1,452.77 " " 2,773.00 " 870.48 " 4,038.78 " " 1,425.10 " " 3,545.00 " 833.28 774.73 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 2,532.97 " " 3,166.21 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 744.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28166087 RELEASE HAND/FINGER TENDON 26445 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 2,773.00 " " 2,953.81 " " 2,773.00 " 907.92 " 8,210.15 " " 2,897.54 " " 3,545.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28166095 TENDON LENGTHENING 26476 360 "$14,860.00" " 5,492.26 " 808.00 " 11,888.00 " 929.20 " 1,469.00 " " 2,953.81 " " 1,469.00 " 945.36 " 8,210.15 " " 2,897.54 " " 1,775.00 " 904.96 841.37 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 1,649.49 " " 2,061.86 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 808.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28166109 HAND TENDON RECONSTRUCTION 26502 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 3,326.00 " " 2,953.81 " " 3,326.00 " 907.92 " 8,210.15 " " 2,897.54 " " 4,860.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 3,120.10 " " 3,900.12 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28166117 RELEASE KNUCKLE CONTRACTURE 26520 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 2,773.00 " " 2,953.81 " " 2,773.00 " 907.92 " 8,210.15 " " 2,897.54 " " 3,545.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28166125 RELEASE FINGER CONTRACTURE 26525 360 "$7,310.00" " 2,701.78 " 776.00 " 5,848.00 " 892.40 " 2,773.00 " " 1,452.77 " " 2,773.00 " 907.92 " 4,038.78 " " 1,425.10 " " 3,545.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 2,532.97 " " 3,166.21 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28166133 REVISE KNUCKLE WITH IMPLANT 26531 360 "$32,891.00" " 12,156.51 " " 1,030.00 " " 26,312.80 " " 1,184.50 " " 4,435.00 " " 6,533.13 " " 4,435.00 " " 1,205.10 " " 18,172.28 " " 6,408.69 " " 6,540.00 " " 1,153.60 " " 1,072.54 " " 21,770.55 " " 5,599.83 " " 6,222.03 " " 4,937.34 " " 6,171.67 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " " 1,030.00 " " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28166141 REVISE FINGER JOINT 26535 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 3,604.00 " " 2,953.81 " " 3,604.00 " 907.92 " 8,210.15 " " 2,897.54 " " 4,445.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 3,730.57 " " 4,663.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28166150 REPAIR HAND JOINT 26540 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 3,326.00 " " 2,953.81 " " 3,326.00 " 907.92 " 8,210.15 " " 2,897.54 " " 4,860.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 3,120.10 " " 3,900.12 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28174985 CL TX METCRP FX SINGLE EA 26600 360 "$1,082.00" 399.91 180.17 907.92 892.40 747.66 214.98 747.66 907.92 597.81 210.88 845.00 869.12 808.05 716.18 184.27 204.74 281.27 351.59 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37002364 CLSD TX MTCPL FX W/O MAN EACH 26600 450 "$1,082.00" 399.91 180.17 907.92 892.40 747.66 214.98 747.66 907.92 597.81 210.88 845.00 869.12 808.05 716.18 184.27 204.74 281.27 351.59 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 28166168 CLSD TX MTCPL FX W/MAN EACH 26605 360 "$1,082.00" 399.91 180.17 " 2,820.00 " 892.40 " 1,718.00 " 214.98 " 1,718.00 " 907.92 597.81 210.88 " 2,820.00 " 869.12 808.05 716.18 184.27 204.74 " 2,208.66 " " 2,760.83 " 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37002372 CLSD TX MTCPL FX W/MAN EACH 26605 450 "$1,082.00" 399.91 180.17 " 2,820.00 " 892.40 " 1,718.00 " 214.98 " 1,718.00 " 907.92 597.81 210.88 " 2,820.00 " 869.12 808.05 716.18 184.27 204.74 " 2,208.66 " " 2,760.83 " 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 28166176 PERC SKEL FIX/METACAR FRA 26608 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 3,326.00 " " 2,953.81 " " 3,326.00 " 907.92 " 8,210.15 " " 2,897.54 " " 4,860.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,208.66 " " 2,760.83 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28166184 FX-METACARPAL SMP/CMP W/WO FIX 26615 360 "$14,860.00" " 5,492.26 " 873.00 " 11,888.00 " " 1,003.95 " " 3,326.00 " " 2,953.81 " " 3,326.00 " " 1,021.41 " " 8,210.15 " " 2,897.54 " " 4,860.00 " 977.76 909.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 3,120.10 " " 3,900.12 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 873.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 37002381 CLSD TX THUMB DSLCTN W/MAN 26641 450 "$1,082.00" 399.91 180.17 " 2,248.77 " 892.40 747.66 214.98 747.66 907.92 597.81 210.88 845.00 869.12 808.05 716.18 184.27 204.74 " 1,799.02 " " 2,248.77 " 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 28174993 BENNETT FRAC MANI RED SKEL FIX 26650 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 1,718.00 " " 2,953.81 " " 1,718.00 " 907.92 " 8,210.15 " " 2,897.54 " " 2,820.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,208.66 " " 2,760.83 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28166192 TREAT THUMB FRACTURE 26665 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 3,326.00 " " 2,953.81 " " 3,326.00 " 907.92 " 8,210.15 " " 2,897.54 " " 4,860.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 3,120.10 " " 3,900.12 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 37089711 CLSD TX HAND W/MAN EA W/O ANES 26670 450 "$1,082.00" 399.91 48.50 865.60 55.78 747.66 214.98 747.66 56.75 597.81 210.88 845.00 54.32 50.50 716.18 184.27 204.74 56.26 70.32 209.86 210.88 204.74 865.60 187.34 48.50 724.94 180.17 442.54 811.50 411.27 483.98 211.91 28166206 PIN HAND DISLOCATION 26676 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 1,718.00 " " 2,953.81 " " 1,718.00 " 907.92 " 8,210.15 " " 2,897.54 " " 2,820.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,208.66 " " 2,760.83 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 37088951 CLSD TX KNUCKLE W/MAN W/O ANES 26700 450 "$1,082.00" 399.91 39.00 865.60 44.85 747.66 214.98 747.66 45.63 597.81 210.88 845.00 43.68 40.61 716.18 184.27 204.74 281.27 351.59 209.86 210.88 204.74 865.60 187.34 39.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37002399 CLSD TX FINGER FX W/O MAN EACH 26720 450 "$1,082.00" 399.91 180.17 " 1,469.00 " 892.40 " 1,469.00 " 214.98 " 1,469.00 " 907.92 597.81 210.88 845.00 869.12 808.05 716.18 184.27 204.74 281.27 351.59 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37002402 CLSD TX FINGER FX W/MAN EACH 26725 450 "$1,082.00" 399.91 180.17 " 1,718.00 " 840.65 " 1,718.00 " 214.98 " 1,718.00 " 855.27 597.81 210.88 845.00 818.72 761.19 716.18 184.27 204.74 393.78 492.23 209.86 210.88 204.74 865.60 187.34 731.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 28166214 FX PRX-MID PHAL W MANIP/TRAC 26727 360 "$14,860.00" " 5,492.26 " 900.00 " 11,888.00 " " 1,035.00 " " 4,435.00 " " 2,953.81 " " 4,435.00 " " 1,053.00 " " 8,210.15 " " 2,897.54 " " 6,540.00 " " 1,008.00 " 937.17 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 4,937.34 " " 6,171.67 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 900.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28166222 FX PHAL PROX OPEN RED W/WO FIX 26735 360 "$14,860.00" " 5,492.26 " 900.00 " 11,888.00 " " 1,035.00 " " 3,326.00 " " 2,953.81 " " 3,326.00 " " 1,053.00 " " 8,210.15 " " 2,897.54 " " 4,860.00 " " 1,008.00 " 937.17 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 3,120.10 " " 3,900.12 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 900.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 37002411 CLSD TX ARTCLR FX W/O MAN EACH 26740 450 "$1,082.00" 399.91 180.17 " 1,469.00 " 892.40 " 1,469.00 " 214.98 " 1,469.00 " 907.92 597.81 210.88 845.00 869.12 808.05 716.18 184.27 204.74 281.27 351.59 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37002429 CLSD TX ARTCLR FX W/MAN EACH 26742 450 "$7,310.00" " 2,701.78 " 776.00 " 5,848.00 " 892.40 " 1,718.00 " " 1,452.77 " " 1,718.00 " 907.92 " 4,038.78 " " 1,425.10 " " 2,820.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 2,208.66 " " 2,760.83 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 37002437 CLSD TX DSTL PHLNGL W/O MAN EA 26750 450 "$1,082.00" 399.91 48.00 865.60 55.20 747.66 214.98 747.66 56.16 597.81 210.88 845.00 53.76 49.98 716.18 184.27 204.74 281.27 351.59 209.86 210.88 204.74 865.60 187.34 48.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37002445 CLSD TX DSTL PHLNGL W/MAN EA 26755 450 "$1,082.00" 399.91 180.17 907.92 892.40 747.66 214.98 747.66 907.92 597.81 210.88 845.00 869.12 808.05 716.18 184.27 204.74 393.78 492.23 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 28166231 PIN FINGER FX EACH 26756 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 1,718.00 " " 2,953.81 " " 1,718.00 " 907.92 " 8,210.15 " " 2,897.54 " " 2,820.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,208.66 " " 2,760.83 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 37088978 PIN FINGER FX EACH 26756 450 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 1,718.00 " " 2,953.81 " " 1,718.00 " 907.92 " 8,210.15 " " 2,897.54 " " 2,820.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,208.66 " " 2,760.83 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28166249 OPEN TX FINGER FX W/FXTN EA 26765 360 "$14,860.00" " 5,492.26 " 832.00 " 11,888.00 " 956.80 " 3,326.00 " " 2,953.81 " " 3,326.00 " 973.44 " 8,210.15 " " 2,897.54 " " 4,860.00 " 931.84 866.36 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 3,120.10 " " 3,900.12 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 832.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 37088986 OPEN TX FINGER FX W/FXTN EA 26765 450 "$14,860.00" " 5,492.26 " 832.00 " 11,888.00 " 956.80 " 3,326.00 " " 2,953.81 " " 3,326.00 " 973.44 " 8,210.15 " " 2,897.54 " " 4,860.00 " 931.84 866.36 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 3,120.10 " " 3,900.12 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 832.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 37002453 CLSD TX FINGER W/MAN W/O ANES 26770 450 "$1,082.00" 399.91 36.50 865.60 41.98 747.66 214.98 747.66 42.71 597.81 210.88 845.00 40.88 38.01 716.18 184.27 204.74 281.27 351.59 209.86 210.88 204.74 865.60 187.34 36.50 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37002208 CLSD TX FINGER W/MAN W/ANES 26775 450 "$1,266.00" 467.91 210.88 " 3,166.21 " 892.40 874.81 251.62 874.81 907.92 699.47 246.83 835.56 869.12 808.05 837.97 215.68 239.64 " 2,532.97 " " 3,166.21 " 245.63 246.83 239.64 " 1,012.80 " 219.27 776.00 848.22 210.88 517.79 949.50 481.21 566.28 248.03 37004006 OPEN TX FINGER DSLCTN W/FXTN 26785 450 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 1,718.00 " " 2,953.81 " " 1,718.00 " 907.92 " 8,210.15 " " 2,897.54 " " 2,820.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,208.66 " " 2,760.83 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28166257 FUSION OF FINGER JOINT 26860 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 2,773.00 " " 2,953.81 " " 2,773.00 " 907.92 " 8,210.15 " " 2,897.54 " " 3,545.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28166265 AMPUTATE METACARPAL BONE 26910 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 2,773.00 " " 2,953.81 " " 2,773.00 " 907.92 " 8,210.15 " " 2,897.54 " " 3,545.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28166273 AMPUTATION FINGER THUMB 26951 360 "$14,860.00" " 5,492.26 " 526.00 " 11,888.00 " 604.90 " 1,718.00 " " 2,953.81 " " 1,718.00 " 615.42 " 8,210.15 " " 2,897.54 " " 2,820.00 " 589.12 547.72 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,208.66 " " 2,760.83 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 526.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 37088994 AMPUTATION FINGER THUMB 26951 450 "$14,860.00" " 5,492.26 " 526.00 " 11,888.00 " 604.90 " 1,718.00 " " 2,953.81 " " 1,718.00 " 615.42 " 8,210.15 " " 2,897.54 " " 2,820.00 " 589.12 547.72 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,208.66 " " 2,760.83 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 526.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28166281 AMPUTATION OF FINGER/THUMB 26952 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 3,326.00 " " 2,953.81 " " 3,326.00 " 907.92 " 8,210.15 " " 2,897.54 " " 4,860.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 3,120.10 " " 3,900.12 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28166290 DRAINAGE OF PELVIS LESION 26990 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 1,469.00 " " 2,953.81 " " 1,469.00 " 907.92 " 8,210.15 " " 2,897.54 " " 1,775.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 1,649.49 " " 2,061.86 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28176589 FASCIOTOMY HIP/THIGH ANY TYPE 27025 360 "$12,530.00" " 4,631.09 " - " 10,024.00 " - " 8,658.23 " N/A " 8,658.23 " - " 6,922.83 " N/A " 8,269.80 " - N/A " 8,293.61 " - N/A " 3,120.10 " " 3,900.12 " N/A N/A N/A " 10,024.00 " N/A - " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 28166303 EXPLORATION OF HIP JOINT 27033 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28166311 BIOPSY OF SOFT TISSUES 27041 360 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,718.00 " " 1,467.55 " " 1,718.00 " 907.92 " 4,081.32 " " 1,439.60 " " 2,820.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 2,208.66 " " 2,760.83 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28166320 EXC HIP PELVIS LES SC 3 CM/> 27043 360 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 2,773.00 " " 2,473.07 " " 2,773.00 " 907.92 " 6,874.76 " " 2,425.96 " " 6,576.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,509.74 " " 3,137.17 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28166338 EXC HIP/PELV TUM DEEP 5 CM/> 27045 360 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 2,773.00 " " 2,473.07 " " 2,773.00 " 907.92 " 6,874.76 " " 2,425.96 " " 6,576.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 3,990.02 " " 4,987.52 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28166346 EXC HIP/PELVIS LES SC < 3 CM 27047 360 "$12,443.00" " 4,598.93 " 682.00 " 9,954.40 " 784.30 " 1,718.00 " " 2,473.07 " " 1,718.00 " 797.94 " 6,874.76 " " 2,425.96 " " 2,820.00 " 763.84 710.17 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,208.66 " " 2,760.83 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 682.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28166354 EXC HIP/PELV TUM DEEP < 5 CM 27048 360 "$12,443.00" " 4,598.93 " 804.00 " 9,954.40 " 924.60 " 2,773.00 " " 2,473.07 " " 2,773.00 " 940.68 " 6,874.76 " " 2,425.96 " " 3,545.00 " 900.48 837.21 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,532.97 " " 3,166.21 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 804.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28175001 EXCISION BURSA TROCHANTERIC 27062 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 3,604.00 " " 2,953.81 " " 3,604.00 " 907.92 " 8,210.15 " " 2,897.54 " " 4,445.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 3,730.57 " " 4,663.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28166362 REMOVE HIP FOREIGN BODY 27086 360 "$12,443.00" " 4,598.93 " 777.00 " 9,954.40 " 893.55 " 1,469.00 " " 2,473.07 " " 1,469.00 " 909.09 " 6,874.76 " " 2,425.96 " " 1,775.00 " 870.24 809.09 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 1,649.49 " " 2,061.86 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 777.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28176597 REM HIP PROSTHESIS INSERT 27091 360 "$4,740.00" " 1,751.90 " - " 10,118.97 " - " 3,275.34 " N/A " 3,275.34 " - " 2,618.85 " N/A " 3,128.40 " - N/A " 3,137.41 " - N/A " 8,095.18 " " 10,118.97 " N/A N/A N/A " 3,792.00 " N/A - " 3,175.80 " N/A " 1,938.66 " " 3,555.00 " " 1,801.67 " " 2,120.20 " N/A 80128088 INJ HIP XR 27093 320 $116.00 42.87 - " 1,469.00 " 55.20 " 1,469.00 " - " 1,469.00 " 56.16 64.09 - 76.56 53.76 49.98 76.78 - - 393.78 492.23 - - - 92.80 - 48.00 77.72 - 47.44 87.00 44.09 51.89 - 80128096 INJ HIP XR W/ANESTHESIA 27095 320 $319.00 117.90 - " 1,469.00 " 892.40 " 1,469.00 " - " 1,469.00 " 907.92 176.25 - 210.54 869.12 808.05 211.15 - - 393.78 492.23 - - - 255.20 - 776.00 213.73 - 130.47 239.25 121.25 142.69 - 80641133 INJ SACROILIAC JOINT 27096 350 $758.00 280.16 - " 1,469.00 " 70.37 " 1,469.00 " N/A " 1,469.00 " 71.59 418.80 N/A 845.00 68.53 N/A 501.72 - N/A " 1,165.14 " " 1,456.43 " N/A N/A N/A 606.40 N/A 61.19 507.86 N/A 310.02 568.50 288.12 339.05 N/A 28176724 RECONSTRUCTION OF HIP SOCKET 27122 360 "$24,630.00" " 9,103.25 " - " 19,704.00 " - " 17,019.33 " N/A " 17,019.33 " - " 13,608.08 " N/A " 16,255.80 " - N/A " 16,302.60 " - N/A " 5,785.14 " " 7,231.43 " N/A N/A N/A " 19,704.00 " N/A - " 16,502.10 " N/A " 10,073.67 " " 18,472.50 " " 9,361.86 " " 11,017.00 " N/A 28166371 PARTIAL HIP REPLACEMENT 27125 360 "$24,630.00" " 9,103.25 " - " 19,704.00 " - " 17,019.33 " N/A " 17,019.33 " - " 13,608.08 " N/A " 16,255.80 " - N/A " 16,302.60 " - N/A " 5,630.95 " " 7,038.69 " N/A N/A N/A " 19,704.00 " N/A - " 16,502.10 " N/A " 10,073.67 " " 18,472.50 " " 9,361.86 " " 11,017.00 " N/A 28166389 TOTAL HIP ARTHROPLASTY 27130 360 "$64,652.00" " 23,895.38 " 776.00 " 51,721.60 " 892.40 " 44,674.53 " " 12,861.18 " " 44,674.53 " 907.92 " 35,720.23 " " 12,616.20 " " 42,670.32 " 869.12 808.05 " 42,793.16 " " 11,023.87 " " 12,248.74 " " 7,473.06 " " 9,341.32 " " 12,554.96 " " 12,616.20 " " 12,248.74 " " 51,721.60 " " 11,207.60 " 776.00 " 43,316.84 " " 10,778.89 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,677.45 " 28166397 REV TOTAL HIP ARTHROPLASTY 27134 360 "$24,630.00" " 9,103.25 " - " 19,704.00 " - " 17,019.33 " N/A " 17,019.33 " - " 13,608.08 " N/A " 16,255.80 " - N/A " 16,302.60 " - N/A " 10,384.28 " " 12,980.35 " N/A N/A N/A " 19,704.00 " N/A - " 16,502.10 " N/A " 10,073.67 " " 18,472.50 " " 9,361.86 " " 11,017.00 " N/A 28166401 REV TOT HIP ARTHRO ACETABULAR 27137 360 "$24,630.00" " 9,103.25 " - " 19,704.00 " - " 17,019.33 " N/A " 17,019.33 " - " 13,608.08 " N/A " 16,255.80 " - N/A " 16,302.60 " - N/A " 7,850.86 " " 9,813.58 " N/A N/A N/A " 19,704.00 " N/A - " 16,502.10 " N/A " 10,073.67 " " 18,472.50 " " 9,361.86 " " 11,017.00 " N/A 28176295 REVISE HIP JOINT REPLACEMENT 27138 360 "$24,630.00" " 9,103.25 " - " 19,704.00 " - " 17,019.33 " N/A " 17,019.33 " - " 13,608.08 " N/A " 16,255.80 " - N/A " 16,302.60 " - N/A " 8,181.36 " " 10,226.70 " N/A N/A N/A " 19,704.00 " N/A - " 16,502.10 " N/A " 10,073.67 " " 18,472.50 " " 9,361.86 " " 11,017.00 " N/A 28166419 REINFORCE HIP BONES 27187 360 "$12,530.00" " 4,631.09 " - " 10,024.00 " - " 8,658.23 " N/A " 8,658.23 " - " 6,922.83 " N/A " 8,269.80 " - N/A " 8,293.61 " - N/A " 5,299.73 " " 6,624.66 " N/A N/A N/A " 10,024.00 " N/A - " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 28166427 TREAT PELVIC FRACTURE(S) 27215 360 "$6,202.00" " 2,292.26 " - " 4,961.60 " - " 4,285.58 " N/A " 4,285.58 " - " 3,426.61 " N/A " 4,093.32 " - N/A " 4,105.10 " - N/A " 3,852.53 " " 4,815.66 " N/A N/A N/A " 4,961.60 " N/A - " 4,155.34 " N/A " 2,536.62 " " 4,651.50 " " 2,357.38 " " 2,774.15 " N/A 28166435 PERC SKEL FX/POS PL R FRC 27216 360 "$4,600.00" " 1,700.16 " - " 6,954.87 " 892.40 " 3,178.60 " N/A " 3,178.60 " 907.92 " 2,541.50 " N/A " 3,036.00 " 869.12 N/A " 3,044.74 " - N/A " 5,563.90 " " 6,954.87 " N/A N/A N/A " 3,680.00 " N/A 776.00 " 3,082.00 " N/A " 1,881.40 " " 3,450.00 " " 1,748.46 " " 2,057.58 " N/A 28166443 OP TRT/ANT RNG F/DIS W/FX 27217 360 "$7,766.00" " 2,870.31 " - " 6,734.78 " - " 5,366.31 " N/A " 5,366.31 " - " 4,290.72 " N/A " 5,125.56 " - N/A " 5,140.32 " - N/A " 5,387.82 " " 6,734.78 " N/A N/A N/A " 6,212.80 " N/A - " 5,203.22 " N/A " 3,176.29 " " 5,824.50 " " 2,951.86 " " 3,473.73 " N/A 28166451 OPN TRT/PST R FRC W/INT F 27218 360 "$11,387.00" " 4,208.64 " - " 9,109.60 " - " 7,868.42 " N/A " 7,868.42 " - " 6,291.32 " N/A " 7,515.42 " - N/A " 7,537.06 " - N/A " 7,108.42 " " 8,885.52 " N/A N/A N/A " 9,109.60 " N/A - " 7,629.29 " N/A " 4,657.28 " " 8,540.25 " " 4,328.20 " " 5,093.41 " N/A 28175019 TX HIP SOCKET FX (CLOSED) 27220 360 "$1,082.00" 399.91 180.17 " 3,263.88 " 892.40 747.66 214.98 747.66 907.92 597.81 210.88 845.00 869.12 808.05 716.18 184.27 204.74 " 2,611.10 " " 3,263.88 " 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37089656 CLSD TX HIP FX W/O MAN 27220 450 "$1,082.00" 399.91 180.17 " 3,263.88 " 892.40 747.66 214.98 747.66 907.92 597.81 210.88 845.00 869.12 808.05 716.18 184.27 204.74 " 2,611.10 " " 3,263.88 " 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 28175027 TX HIP SOCK FX W/MANIP 27222 360 "$1,082.00" 399.91 - " 6,263.86 " - 747.66 N/A 747.66 - 597.81 N/A 714.12 - N/A 716.18 - N/A " 5,011.09 " " 6,263.86 " N/A N/A N/A 865.60 N/A - 724.94 N/A 442.54 811.50 411.27 483.98 N/A 28166460 TREAT HIP WALL FRACTURE 27226 360 "$12,530.00" " 4,631.09 " - " 10,024.00 " - " 8,658.23 " N/A " 8,658.23 " - " 6,922.83 " N/A " 8,269.80 " - N/A " 8,293.61 " - N/A " 5,120.56 " " 6,400.70 " N/A N/A N/A " 10,024.00 " N/A - " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 28166478 OP TX/ACETAB FX ANT/PST 1 COL 27227 360 "$12,530.00" " 4,631.09 " - " 10,852.53 " - " 8,658.23 " N/A " 8,658.23 " - " 6,922.83 " N/A " 8,269.80 " - N/A " 8,293.61 " - N/A " 8,682.02 " " 10,852.53 " N/A N/A N/A " 10,024.00 " N/A - " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 28166486 OP TX/ACETAB FX ANT/PST 2 COL 27228 360 "$12,530.00" " 4,631.09 " - " 12,518.43 " - " 8,658.23 " N/A " 8,658.23 " - " 6,922.83 " N/A " 8,269.80 " - N/A " 8,293.61 " - N/A " 10,014.74 " " 12,518.43 " N/A N/A N/A " 10,024.00 " N/A - " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 28175035 TX FEMORAL FX (CLOSED) 27230 360 "$1,082.00" 399.91 180.17 " 2,061.86 " 301.88 " 1,469.00 " 214.98 " 1,469.00 " 307.13 597.81 210.88 " 1,775.00 " 294.00 273.34 716.18 184.27 204.74 " 1,649.49 " " 2,061.86 " 209.86 210.88 204.74 865.60 187.34 262.50 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37089001 CLSD TX THIGH FX W/O MAN 27230 450 "$1,082.00" 399.91 180.17 " 2,061.86 " 301.88 " 1,469.00 " 214.98 " 1,469.00 " 307.13 597.81 210.88 " 1,775.00 " 294.00 273.34 716.18 184.27 204.74 " 1,649.49 " " 2,061.86 " 209.86 210.88 204.74 865.60 187.34 262.50 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37089796 CLSD TX THIGH FX W/MAN 27232 450 "$7,310.00" " 2,701.78 " - " 5,848.00 " - " 5,051.21 " N/A " 5,051.21 " - " 4,038.78 " N/A " 4,824.60 " - N/A " 4,838.49 " - N/A " 3,961.43 " " 4,951.79 " N/A N/A N/A " 5,848.00 " N/A - " 4,897.70 " N/A " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " N/A 28166494 FX FEMOR NECK CL OP PINN FRAC 27235 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 3,326.00 " " 6,533.13 " " 3,326.00 " 907.92 " 18,172.28 " " 6,408.69 " " 21,708.06 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 4,790.96 " " 5,988.70 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28166508 FX FEMUR NECK SMP/CMP OPEN RED 27236 360 "$12,530.00" " 4,631.09 " - " 10,024.00 " - " 8,658.23 " N/A " 8,658.23 " - " 6,922.83 " N/A " 8,269.80 " - N/A " 8,293.61 " - N/A " 5,936.42 " " 7,420.52 " N/A N/A N/A " 10,024.00 " N/A - " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 28166516 FX-FEMUR INTR/PERT W INT FIX 27244 360 "$12,530.00" " 4,631.09 " - " 10,024.00 " - " 8,658.23 " N/A " 8,658.23 " - " 6,922.83 " N/A " 8,269.80 " - N/A " 8,293.61 " - N/A " 6,068.05 " " 7,585.06 " N/A N/A N/A " 10,024.00 " N/A - " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 28166524 "OP TX/I,P,STROCH FX INTRA IMP" 27245 360 "$12,530.00" " 4,631.09 " - " 10,024.00 " - " 8,658.23 " N/A " 8,658.23 " - " 6,922.83 " N/A " 8,269.80 " - N/A " 8,293.61 " - N/A " 7,602.95 " " 9,503.69 " N/A N/A N/A " 10,024.00 " N/A - " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 37089010 CLSD TX HIP DSLCTN W/O ANES 27250 450 "$1,082.00" 399.91 180.17 " 2,061.86 " 235.35 " 1,469.00 " 214.98 " 1,469.00 " 239.44 597.81 210.88 " 1,775.00 " 229.21 213.10 716.18 184.27 204.74 " 1,649.49 " " 2,061.86 " 209.86 210.88 204.74 865.60 187.34 204.65 724.94 180.17 442.54 811.50 411.27 483.98 211.91 28166532 CLSD TX HIP DSLCTN W/ANES 27252 360 "$7,310.00" " 2,701.78 " 776.00 " 5,848.00 " 892.40 " 1,718.00 " " 1,452.77 " " 1,718.00 " 907.92 " 4,038.78 " " 1,425.10 " " 2,820.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 2,208.66 " " 2,760.83 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 37004201 CLSD TX HIP DSLCTN W/ANES 27252 450 "$7,310.00" " 2,701.78 " 776.00 " 5,848.00 " 892.40 " 1,718.00 " " 1,452.77 " " 1,718.00 " 907.92 " 4,038.78 " " 1,425.10 " " 2,820.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 2,208.66 " " 2,760.83 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28166541 DSL HIP TRAUMA SMP/CMP OPEN RE 27254 360 "$5,661.00" " 2,092.31 " - " 8,455.88 " - " 3,911.75 " N/A " 3,911.75 " - " 3,127.70 " N/A " 3,736.26 " - N/A " 3,747.02 " - N/A " 6,764.70 " " 8,455.88 " N/A N/A N/A " 4,528.80 " N/A - " 3,792.87 " N/A " 2,315.35 " " 4,245.75 " " 2,151.75 " " 2,532.17 " N/A 37003646 TX HIP DSLCTN W/O MAN W/O ANES 27256 450 "$1,082.00" 399.91 180.17 " 2,049.00 " 892.40 " 1,718.00 " 214.98 " 1,718.00 " 907.92 597.81 210.88 845.00 869.12 808.05 716.18 184.27 204.74 " 1,639.20 " " 2,049.00 " 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37003654 TX HIP DSLCTN W/MAN W/ANES 27257 450 "$7,310.00" " 2,701.78 " 776.00 " 5,848.00 " 892.40 " 2,773.00 " " 1,452.77 " " 2,773.00 " 907.92 " 4,038.78 " " 1,425.10 " " 3,545.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 2,717.03 " " 3,396.29 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28166559 DSL HIP CONGENITAL OPEN REDUC 27258 360 "$5,661.00" " 2,092.31 " - " 7,316.31 " - " 3,911.75 " N/A " 3,911.75 " - " 3,127.70 " N/A " 3,736.26 " - N/A " 3,747.02 " - N/A " 5,853.05 " " 7,316.31 " N/A N/A N/A " 4,528.80 " N/A - " 3,792.87 " N/A " 2,315.35 " " 4,245.75 " " 2,151.75 " " 2,532.17 " N/A 37089028 CLSD TX HIP DSLCTN W/O ANES 27265 450 "$1,082.00" 399.91 180.17 " 2,061.86 " 272.55 " 1,469.00 " 214.98 " 1,469.00 " 277.29 597.81 210.88 " 1,775.00 " 265.44 246.79 716.18 184.27 204.74 " 1,649.49 " " 2,061.86 " 209.86 210.88 204.74 865.60 187.34 237.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37089036 CLSD TX HIP DSLCTN W/ANES 27266 450 "$7,310.00" " 2,701.78 " 776.00 " 5,848.00 " 892.40 " 1,718.00 " " 1,452.77 " " 1,718.00 " 907.92 " 4,038.78 " " 1,425.10 " " 2,820.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 2,208.66 " " 2,760.83 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28166567 OPTX THIGH FX 27269 360 "$2,785.00" " 1,029.34 " - " 7,578.73 " - " 1,924.44 " N/A " 1,924.44 " - " 1,538.71 " N/A " 1,838.10 " - N/A " 1,843.39 " - N/A " 6,062.98 " " 7,578.73 " N/A N/A N/A " 2,228.00 " N/A - " 1,865.95 " N/A " 1,139.07 " " 2,088.75 " " 1,058.58 " " 1,245.73 " N/A 28166575 MANIPULATION OF HIP JOINT 27275 360 "$7,310.00" " 2,701.78 " 776.00 " 5,848.00 " 892.40 " 1,718.00 " " 1,452.77 " " 1,718.00 " 907.92 " 4,038.78 " " 1,425.10 " " 2,820.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 2,208.66 " " 2,760.83 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28166583 ARTHRODESIS SACROILIAC JOINT 27279 360 "$83,308.00" " 30,790.64 " - " 66,646.40 " - " 3,604.00 " " 16,864.63 " " 3,604.00 " - " 46,027.67 " " 16,543.40 " " 54,983.28 " - - " 55,141.57 " " 14,455.40 " " 16,061.55 " " 1,142.30 " " 1,427.88 " " 16,463.09 " " 16,543.40 " " 16,061.55 " " 66,646.40 " " 14,696.32 " - " 55,816.36 " " 14,134.16 " " 34,072.97 " " 62,481.00 " " 31,665.37 " " 37,263.67 " " 16,623.70 " 28166591 FUSION OF SACROILIAC JOINT 27280 360 "$31,736.00" " 11,729.63 " - " 25,388.80 " - " 21,929.58 " N/A " 21,929.58 " - " 17,534.14 " N/A " 20,945.76 " - N/A " 21,006.06 " - N/A " 5,262.88 " " 6,578.60 " N/A N/A N/A " 25,388.80 " N/A - " 21,263.12 " N/A " 12,980.02 " " 23,802.00 " " 12,062.85 " " 14,195.51 " N/A 28176601 PELVIS/HIP JOINT SURGERY 27299 360 "$1,082.00" 399.91 - " 1,469.00 " - " 1,469.00 " 214.98 " 1,469.00 " - 597.81 210.88 714.12 - - 716.18 184.27 204.74 56.26 70.32 209.86 210.88 204.74 865.60 187.34 - 724.94 180.17 442.54 811.50 411.27 483.98 211.91 28166605 DRAIN THIGH/KNEE LESION 27301 360 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 2,773.00 " " 2,473.07 " " 2,773.00 " 907.92 " 6,874.76 " " 2,425.96 " " 3,545.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,532.97 " " 3,166.21 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28166613 EXPLORATION OF KNEE JOINT 27310 360 "$14,860.00" " 5,492.26 " 895.00 " 11,888.00 " " 1,029.25 " " 3,326.00 " " 2,953.81 " " 3,326.00 " " 1,047.15 " " 8,210.15 " " 2,897.54 " " 4,860.00 " " 1,002.40 " 931.96 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 3,120.10 " " 3,900.12 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 895.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28175043 BX SOFT TISS KNEE THIGH SUPERF 27323 360 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,469.00 " " 1,467.55 " " 1,469.00 " 907.92 " 4,081.32 " " 1,439.60 " " 1,775.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28166621 EXC THIGH/KNEE LES SC < 3 CM 27327 360 "$7,387.00" " 2,730.24 " 837.00 " 5,909.60 " 962.55 " 1,718.00 " " 1,467.55 " " 1,718.00 " 979.29 " 4,081.32 " " 1,439.60 " " 2,820.00 " 937.44 871.57 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 2,208.66 " " 2,760.83 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 837.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28175051 ARTHRO MENISCECTO KNEE MED/LAT 27332 360 "$14,860.00" " 5,492.26 " " 1,006.00 " " 11,888.00 " " 1,156.90 " " 3,326.00 " " 2,953.81 " " 3,326.00 " " 1,177.02 " " 8,210.15 " " 2,897.54 " " 4,860.00 " " 1,126.72 " " 1,047.55 " " 9,835.83 " " 2,531.84 " " 2,813.15 " " 3,120.10 " " 3,900.12 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " " 1,006.00 " " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28175060 REMOVAL OF KNEE CARTILAGE 27333 360 "$14,860.00" " 5,492.26 " " 1,006.00 " " 11,888.00 " " 1,156.90 " " 3,326.00 " " 2,953.81 " " 3,326.00 " " 1,177.02 " " 8,210.15 " " 2,897.54 " " 4,860.00 " " 1,126.72 " " 1,047.55 " " 9,835.83 " " 2,531.84 " " 2,813.15 " " 3,120.10 " " 3,900.12 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " " 1,006.00 " " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28166630 REMOVE KNEE JOINT LINING 27334 360 "$14,860.00" " 5,492.26 " 963.00 " 11,888.00 " " 1,107.45 " " 3,326.00 " " 2,953.81 " " 3,326.00 " " 1,126.71 " " 8,210.15 " " 2,897.54 " " 4,860.00 " " 1,078.56 " " 1,002.77 " " 9,835.83 " " 2,531.84 " " 2,813.15 " " 3,120.10 " " 3,900.12 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 963.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28166648 EXC THIGH/KNEE LES SC 3 CM/> 27337 360 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 2,773.00 " " 2,473.07 " " 2,773.00 " 907.92 " 6,874.76 " " 2,425.96 " " 6,576.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,232.12 " " 2,790.15 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28166656 EXC THIGH/KNEE TUM DEP 5CM/> 27339 360 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 2,773.00 " " 2,473.07 " " 2,773.00 " 907.92 " 6,874.76 " " 2,425.96 " " 6,576.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 4,029.45 " " 5,036.81 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28166664 REMOVAL OF KNEECAP BURSA 27340 360 "$14,860.00" " 5,492.26 " 793.00 " 11,888.00 " 911.95 " 2,773.00 " " 2,953.81 " " 2,773.00 " 927.81 " 8,210.15 " " 2,897.54 " " 3,545.00 " 888.16 825.75 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 793.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28166672 REMOVAL OF KNEE CYST 27345 360 "$14,860.00" " 5,492.26 " 704.00 " 11,888.00 " 809.60 " 3,326.00 " " 2,953.81 " " 3,326.00 " 823.68 " 8,210.15 " " 2,897.54 " " 4,860.00 " 788.48 733.08 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 3,120.10 " " 3,900.12 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 704.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28166681 REMOVE KNEE CYST 27347 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 3,326.00 " " 2,953.81 " " 3,326.00 " 907.92 " 8,210.15 " " 2,897.54 " " 4,860.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 3,356.30 " " 4,195.38 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28166699 REMOVE FEMUR LESION 27355 360 "$14,860.00" " 5,492.26 " 788.00 " 11,888.00 " 906.20 " 2,773.00 " " 2,953.81 " " 2,773.00 " 921.96 " 8,210.15 " " 2,897.54 " " 3,545.00 " 882.56 820.54 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 788.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 80136561 INJ CONT KNEE ARTHROGRAPHY 27369 320 $787.00 290.88 - 977.70 38.24 543.82 - 543.82 38.90 434.82 - 519.42 37.24 34.62 520.92 - - 782.16 977.70 - - - 629.60 - 33.25 527.29 - 321.88 590.25 299.14 352.03 - 28166702 RMV FOREIGN BODY THIGH KNEE 27372 360 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 4,435.00 " " 2,473.07 " " 4,435.00 " 907.92 " 6,874.76 " " 2,425.96 " " 6,540.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 4,937.34 " " 6,171.67 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 37089052 RMV FOREIGN BODY THIGH KNEE 27372 450 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 4,435.00 " " 2,473.07 " " 4,435.00 " 907.92 " 6,874.76 " " 2,425.96 " " 6,540.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 4,937.34 " " 6,171.67 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28166711 REPAIR OF KNEECAP TENDON 27380 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 1,469.00 " " 6,533.13 " " 1,469.00 " 907.92 " 18,172.28 " " 6,408.69 " " 1,775.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 1,649.49 " " 2,061.86 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28166729 REPAIR OF THIGH MUSCLE 27385 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28166737 REPAIR/GRAFT OF THIGH MUSCLE 27386 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28175078 ARTHROTOMY W OPEN MENISCUS REP 27403 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 3,326.00 " " 6,533.13 " " 3,326.00 " 907.92 " 18,172.28 " " 6,408.69 " " 4,860.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 3,120.10 " " 3,900.12 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28166745 REPAIR OF KNEE LIGAMENT 27405 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 3,326.00 " " 6,533.13 " " 3,326.00 " 907.92 " 18,172.28 " " 6,408.69 " " 4,860.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 3,120.10 " " 3,900.12 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28166753 OSTEOCHONDRAL KNEE ALLOGRAFT 27415 360 "$64,652.00" " 23,895.38 " - " 51,721.60 " - " 2,773.00 " " 12,861.18 " " 2,773.00 " - " 35,720.23 " " 12,616.20 " " 42,670.32 " - - " 42,793.16 " " 11,023.87 " " 12,248.74 " " 7,136.71 " " 8,920.89 " " 12,554.96 " " 12,616.20 " " 12,248.74 " " 51,721.60 " " 11,207.60 " - " 43,316.84 " " 10,778.89 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,677.45 " 28166761 REVISION OF UNSTABLE KNEECAP 27422 360 "$32,891.00" " 12,156.51 " 688.00 " 26,312.80 " 791.20 " 4,435.00 " " 6,533.13 " " 4,435.00 " 804.96 " 18,172.28 " " 6,408.69 " " 6,540.00 " 770.56 716.41 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 4,937.34 " " 6,171.67 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 688.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28166770 "LIG RECONST,KNEE,EX-ARTICULAR" 27427 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28166788 "LIG RECONS,KNEE,INTR-ARTICULAR" 27428 360 "$64,652.00" " 23,895.38 " 776.00 " 51,721.60 " 892.40 " 3,326.00 " " 12,861.18 " " 3,326.00 " 907.92 " 35,720.23 " " 12,616.20 " " 4,860.00 " 869.12 808.05 " 42,793.16 " " 11,023.87 " " 12,248.74 " " 3,120.10 " " 3,900.12 " " 12,554.96 " " 12,616.20 " " 12,248.74 " " 51,721.60 " " 11,207.60 " 776.00 " 43,316.84 " " 10,778.89 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,677.45 " 28166796 REVISION OF THIGH MUSCLES 27430 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 3,326.00 " " 6,533.13 " " 3,326.00 " 907.92 " 18,172.28 " " 6,408.69 " " 4,860.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 3,120.10 " " 3,900.12 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28175850 ARTHROPLASTY PATELLA W/PROSTHE 27438 360 "$64,652.00" " 23,895.38 " 743.79 " 51,721.60 " 855.36 " 3,604.00 " " 12,861.18 " " 3,604.00 " 870.23 " 35,720.23 " " 12,616.20 " " 4,445.00 " 833.04 774.51 " 42,793.16 " " 11,023.87 " " 12,248.74 " " 3,730.57 " " 4,663.21 " " 12,554.96 " " 12,616.20 " " 12,248.74 " " 51,721.60 " " 11,207.60 " 743.79 " 43,316.84 " " 10,778.89 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,677.45 " 28175086 ARTHROPLAS KNEE TIBIAL PLATEAU 27440 360 "$64,652.00" " 23,895.38 " " 1,039.00 " " 51,721.60 " " 1,194.85 " " 3,604.00 " " 12,861.18 " " 3,604.00 " " 1,215.63 " " 35,720.23 " " 12,616.20 " " 4,445.00 " " 1,163.68 " " 1,081.91 " " 42,793.16 " " 11,023.87 " " 12,248.74 " " 3,730.57 " " 4,663.21 " " 12,554.96 " " 12,616.20 " " 12,248.74 " " 51,721.60 " " 11,207.60 " " 1,039.00 " " 43,316.84 " " 10,778.89 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,677.45 " 28166800 REVISION OF KNEE JOINT 27446 360 "$64,652.00" " 23,895.38 " 776.00 " 51,721.60 " 892.40 " 3,604.00 " " 12,861.18 " " 3,604.00 " 907.92 " 35,720.23 " " 12,616.20 " " 42,670.32 " 869.12 808.05 " 42,793.16 " " 11,023.87 " " 12,248.74 " " 6,047.74 " " 7,559.68 " " 12,554.96 " " 12,616.20 " " 12,248.74 " " 51,721.60 " " 11,207.60 " 776.00 " 43,316.84 " " 10,778.89 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,677.45 " 28166818 TOTAL KNEE ARTHROPLASTY 27447 360 "$64,652.00" " 23,895.38 " 776.00 " 51,721.60 " 892.40 " 44,674.53 " " 12,861.18 " " 44,674.53 " 907.92 " 35,720.23 " " 12,616.20 " " 42,670.32 " 869.12 808.05 " 42,793.16 " " 11,023.87 " " 12,248.74 " " 8,066.71 " " 10,083.39 " " 12,554.96 " " 12,616.20 " " 12,248.74 " " 51,721.60 " " 11,207.60 " 776.00 " 43,316.84 " " 10,778.89 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,677.45 " 28166826 REPAIR OF THIGH 27470 360 "$12,530.00" " 4,631.09 " - " 10,024.00 " - " 8,658.23 " N/A " 8,658.23 " - " 6,922.83 " N/A " 8,269.80 " - N/A " 8,293.61 " - N/A " 6,194.90 " " 7,743.63 " N/A N/A N/A " 10,024.00 " N/A - " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 28166834 REPAIR/GRAFT OF THIGH 27472 360 "$12,530.00" " 4,631.09 " - " 10,024.00 " - " 8,658.23 " N/A " 8,658.23 " - " 6,922.83 " N/A " 8,269.80 " - N/A " 8,293.61 " - N/A " 6,766.45 " " 8,458.06 " N/A N/A N/A " 10,024.00 " N/A - " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 28166842 SURGERY TO STOP LEG GROWTH 27485 360 "$32,891.00" " 12,156.51 " - " 26,312.80 " - " 22,727.68 " " 6,533.13 " " 22,727.68 " - " 18,172.28 " " 6,408.69 " " 21,708.06 " - - " 21,770.55 " " 5,599.83 " " 6,222.03 " " 3,588.75 " " 4,485.94 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " - " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28166851 REV TOTAL KNEE ARTHROPLASTY 27486 360 "$24,630.00" " 9,103.25 " - " 19,704.00 " 892.40 " 17,019.33 " N/A " 17,019.33 " 907.92 " 13,608.08 " N/A " 16,255.80 " 869.12 N/A " 16,302.60 " - N/A " 7,306.60 " " 9,133.25 " N/A N/A N/A " 19,704.00 " N/A 776.00 " 16,502.10 " N/A " 10,073.67 " " 18,472.50 " " 9,361.86 " " 11,017.00 " N/A 28166869 REV TOTAL KNEE ARTHO ALL COMP 27487 360 "$24,630.00" " 9,103.25 " - " 19,704.00 " - " 17,019.33 " N/A " 17,019.33 " - " 13,608.08 " N/A " 16,255.80 " - N/A " 16,302.60 " - N/A " 9,354.71 " " 11,693.39 " N/A N/A N/A " 19,704.00 " N/A - " 16,502.10 " N/A " 10,073.67 " " 18,472.50 " " 9,361.86 " " 11,017.00 " N/A 28166877 REMOVAL OF KNEE PROSTHESIS 27488 360 "$12,530.00" " 4,631.09 " - " 10,024.00 " - " 8,658.23 " N/A " 8,658.23 " - " 6,922.83 " N/A " 8,269.80 " - N/A " 8,293.61 " - N/A " 6,100.11 " " 7,625.14 " N/A N/A N/A " 10,024.00 " N/A - " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 28176732 REINFORCE THIGH 27495 360 "$12,530.00" " 4,631.09 " - " 10,024.00 " - " 8,658.23 " N/A " 8,658.23 " - " 6,922.83 " N/A " 8,269.80 " - N/A " 8,293.61 " - N/A " 5,996.10 " " 7,495.13 " N/A N/A N/A " 10,024.00 " N/A - " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 28166885 FX FEMUR SHAFT SMP/CMP OPN RED 27506 360 "$12,530.00" " 4,631.09 " - " 10,024.00 " - " 8,658.23 " N/A " 8,658.23 " - " 6,922.83 " N/A " 8,269.80 " - N/A " 8,293.61 " - N/A " 6,716.38 " " 8,395.48 " N/A N/A N/A " 10,024.00 " N/A - " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 28166893 "TX THIGH FX W/PLT,SCRW W/CERC" 27507 360 "$12,530.00" " 4,631.09 " - " 10,024.00 " - " 3,326.00 " N/A " 3,326.00 " - " 6,922.83 " N/A " 8,269.80 " - N/A " 8,293.61 " - N/A " 3,120.10 " " 3,900.12 " N/A N/A N/A " 10,024.00 " N/A - " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 28166907 CLSD TX THIGH FX DSTL W/O MAN 27508 360 "$1,082.00" 399.91 180.17 " 2,061.86 " 892.40 " 1,469.00 " 214.98 " 1,469.00 " 907.92 597.81 210.88 " 1,775.00 " 869.12 808.05 716.18 184.27 204.74 " 1,649.49 " " 2,061.86 " 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37089079 CLSD TX THIGH FX DSTL W/O MAN 27508 450 "$1,082.00" 399.91 180.17 " 2,061.86 " 892.40 " 1,469.00 " 214.98 " 1,469.00 " 907.92 597.81 210.88 " 1,775.00 " 869.12 808.05 716.18 184.27 204.74 " 1,649.49 " " 2,061.86 " 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 28166915 TX THIGH FR/W/W/O INTERCON EXT 27509 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 37089931 CLSD TX THIGH FX DSTL W/MAN 27510 450 "$7,310.00" " 2,701.78 " 776.00 " 5,848.00 " 892.40 " 1,469.00 " " 1,452.77 " " 1,469.00 " 907.92 " 4,038.78 " " 1,425.10 " " 1,775.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 1,649.49 " " 2,061.86 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28166923 TRT THIGH FR W/W/O INT/EXT FIX 27511 360 "$12,530.00" " 4,631.09 " - " 10,024.00 " - " 3,326.00 " N/A " 3,326.00 " - " 6,922.83 " N/A " 8,269.80 " - N/A " 8,293.61 " - N/A " 3,120.10 " " 3,900.12 " N/A N/A N/A " 10,024.00 " N/A - " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 28166931 OPN TX FEMOR SUPRACON/TRANSCON 27513 360 "$12,530.00" " 4,631.09 " - " 10,024.00 " - " 3,604.00 " N/A " 3,604.00 " - " 6,922.83 " N/A " 8,269.80 " - N/A " 8,293.61 " - N/A " 3,730.57 " " 4,663.21 " N/A N/A N/A " 10,024.00 " N/A - " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 28166940 FX FEMUR DSTL END OP REDUCTION 27514 360 "$12,530.00" " 4,631.09 " - " 10,024.00 " 892.40 " 8,658.23 " N/A " 8,658.23 " 907.92 " 6,922.83 " N/A " 8,269.80 " 869.12 N/A " 8,293.61 " - N/A " 3,730.57 " " 4,663.21 " N/A N/A N/A " 10,024.00 " N/A 776.00 " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 37002461 CLSD TX KNEECAP FX W/O MAN 27520 450 "$1,082.00" 399.91 131.00 " 2,061.86 " 150.65 " 1,469.00 " 214.98 " 1,469.00 " 153.27 597.81 210.88 " 1,775.00 " 146.72 136.41 716.18 184.27 204.74 " 1,649.49 " " 2,061.86 " 209.86 210.88 204.74 865.60 187.34 131.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 28166958 TREAT KNEECAP FRACTURE 27524 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28166966 CLSD TX KNEE FX W/O MAN 27530 360 "$1,082.00" 399.91 180.17 " 2,061.86 " 892.40 " 1,469.00 " 214.98 " 1,469.00 " 907.92 597.81 210.88 " 1,775.00 " 869.12 808.05 716.18 184.27 204.74 " 1,649.49 " " 2,061.86 " 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37002470 CLSD TX KNEE FX W/O MAN 27530 450 "$1,082.00" 399.91 180.17 " 2,061.86 " 892.40 " 1,469.00 " 214.98 " 1,469.00 " 907.92 597.81 210.88 " 1,775.00 " 869.12 808.05 716.18 184.27 204.74 " 1,649.49 " " 2,061.86 " 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37002488 CLSD TX KNEE FX WO/W MAN 27532 450 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 1,469.00 " " 2,953.81 " " 1,469.00 " 907.92 " 8,210.15 " " 2,897.54 " " 1,775.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 1,649.49 " " 2,061.86 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28166974 OPN TRTMNT OF TIBIAL FRAC 27535 360 "$12,530.00" " 4,631.09 " - " 10,024.00 " - " 2,773.00 " N/A " 2,773.00 " - " 6,922.83 " N/A " 8,269.80 " - N/A " 8,293.61 " - N/A " 2,532.97 " " 3,166.21 " N/A N/A N/A " 10,024.00 " N/A - " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 28166982 FX TIBIA PROXML SMP/CMP OP RED 27536 360 "$12,530.00" " 4,631.09 " - " 10,024.00 " - " 8,658.23 " N/A " 8,658.23 " - " 6,922.83 " N/A " 8,269.80 " - N/A " 8,293.61 " - N/A " 3,120.10 " " 3,900.12 " N/A N/A N/A " 10,024.00 " N/A - " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 37089087 CLSD TX KNEE DSLCTN W/O ANES 27550 450 "$1,082.00" 399.91 157.00 " 2,061.86 " 180.55 " 1,469.00 " 214.98 " 1,469.00 " 183.69 597.81 210.88 " 1,775.00 " 175.84 163.48 716.18 184.27 204.74 " 1,649.49 " " 2,061.86 " 209.86 210.88 204.74 865.60 187.34 157.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 28166991 TREAT KNEE DISLOCATION 27558 360 "$12,530.00" " 4,631.09 " - " 10,024.00 " - " 8,658.23 " N/A " 8,658.23 " - " 6,922.83 " N/A " 8,269.80 " - N/A " 8,293.61 " - N/A " 6,841.89 " " 8,552.36 " N/A N/A N/A " 10,024.00 " N/A - " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 37089095 CLSD KNEECAP DSLCTN W/O ANES 27560 450 "$1,082.00" 399.91 102.00 " 2,061.86 " 117.30 " 1,469.00 " 214.98 " 1,469.00 " 119.34 597.81 210.88 " 1,775.00 " 114.24 106.21 716.18 184.27 204.74 " 1,649.49 " " 2,061.86 " 209.86 210.88 204.74 865.60 187.34 102.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 28167008 FIXATION OF KNEE JOINT 27570 360 "$7,310.00" " 2,701.78 " 695.00 " 5,848.00 " 799.25 " 1,469.00 " " 1,452.77 " " 1,469.00 " 813.15 " 4,038.78 " " 1,425.10 " " 1,775.00 " 778.40 723.70 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 1,649.49 " " 2,061.86 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 695.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28167016 AMPUTATE LEG AT THIGH 27590 360 "$31,736.00" " 11,729.63 " - " 25,388.80 " - " 21,929.58 " N/A " 21,929.58 " - " 17,534.14 " N/A " 20,945.76 " - N/A " 21,006.06 " - N/A " 4,158.50 " " 5,198.12 " N/A N/A N/A " 25,388.80 " N/A - " 21,263.12 " N/A " 12,980.02 " " 23,802.00 " " 12,062.85 " " 14,195.51 " N/A 28167024 AMPUTATION THIGH SEC CLOSURE 27594 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 2,773.00 " " 2,953.81 " " 2,773.00 " 907.92 " 8,210.15 " " 2,897.54 " " 3,545.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,717.03 " " 3,396.29 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28167032 REAMPUTATION THIGH 27596 360 "$12,530.00" " 4,631.09 " - " 10,024.00 " - " 8,658.23 " N/A " 8,658.23 " - " 6,922.83 " N/A " 8,269.80 " - N/A " 8,293.61 " - N/A " 3,851.74 " " 4,814.67 " N/A N/A N/A " 10,024.00 " N/A - " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 28167041 FASCIOTOMY LEG ANTERIOR COMPAR 27600 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 2,773.00 " " 2,953.81 " " 2,773.00 " 907.92 " 8,210.15 " " 2,897.54 " " 3,545.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 4,937.34 " " 6,171.67 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28167059 FASCIOTOMY LEG POSTERIOR COMPT 27601 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 2,773.00 " " 2,953.81 " " 2,773.00 " 907.92 " 8,210.15 " " 2,897.54 " " 3,545.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 4,937.34 " " 6,171.67 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28167067 FASCIOTOMY LEG ANT/ POST COMPA 27602 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 2,773.00 " " 2,953.81 " " 2,773.00 " 907.92 " 8,210.15 " " 2,897.54 " " 3,545.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 4,937.34 " " 6,171.67 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28167075 I&D LEG/ANKLE DEEP ABS/HEM 27603 360 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 1,718.00 " " 2,473.07 " " 1,718.00 " 907.92 " 6,874.76 " " 2,425.96 " " 2,820.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,208.66 " " 2,760.83 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 37003662 I&D LEG/ANKLE DEEP ABS/HEM 27603 450 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 1,718.00 " " 2,473.07 " " 1,718.00 " 907.92 " 6,874.76 " " 2,425.96 " " 2,820.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,208.66 " " 2,760.83 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28167083 INCISION OF ACHILLES TENDON 27606 360 "$14,860.00" " 5,492.26 " 878.00 " 11,888.00 " " 1,009.70 " " 1,469.00 " " 2,953.81 " " 1,469.00 " " 1,027.26 " " 8,210.15 " " 2,897.54 " " 1,775.00 " 983.36 914.26 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 1,649.49 " " 2,061.86 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 878.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28175094 XR BX LOWER EXTREM SOFT TISSUE 27613 360 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,469.00 " " 1,467.55 " " 1,469.00 " 907.92 " 4,081.32 " " 1,439.60 " " 1,775.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28167091 BX SOFT TISS LEG/ANKLE DEEP 27614 360 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 1,718.00 " " 2,473.07 " " 1,718.00 " 907.92 " 6,874.76 " " 2,425.96 " " 2,820.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,208.66 " " 2,760.83 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 67708865 BX SOFT TISS LEG/ANKLE DEEP 27614 350 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 1,718.00 " " 2,473.07 " " 1,718.00 " 907.92 " 6,874.76 " " 2,425.96 " " 2,820.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,208.66 " " 2,760.83 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 80608861 BX SOFT TISS LEG/ANKLE DEEP 27614 350 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 1,718.00 " " 2,473.07 " " 1,718.00 " 907.92 " 6,874.76 " " 2,425.96 " " 2,820.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,208.66 " " 2,760.83 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28175108 RADICAL RESECTION OF TUMOR 27615 360 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 2,773.00 " " 2,473.07 " " 2,773.00 " 907.92 " 6,874.76 " " 2,425.96 " " 3,545.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,532.97 " " 3,166.21 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28175116 EXC TUMOR LEG/ANKLE SUBCUTAN 27618 360 "$7,387.00" " 2,730.24 " 682.00 " 5,909.60 " 784.30 " 1,718.00 " " 1,467.55 " " 1,718.00 " 797.94 " 4,081.32 " " 1,439.60 " " 2,820.00 " 763.84 710.17 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 2,208.66 " " 2,760.83 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 682.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28167105 EXC LEG/ANKLE TUM DEEP <5 CM 27619 360 "$12,443.00" " 4,598.93 " 804.00 " 9,954.40 " 924.60 " 2,773.00 " " 2,473.07 " " 2,773.00 " 940.68 " 6,874.76 " " 2,425.96 " " 3,545.00 " 900.48 837.21 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,532.97 " " 3,166.21 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 804.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28167113 REMOVAL OF TENDON LESION 27630 360 "$14,860.00" " 5,492.26 " 817.00 " 11,888.00 " 939.55 " 2,773.00 " " 2,953.81 " " 2,773.00 " 955.89 " 8,210.15 " " 2,897.54 " " 3,545.00 " 915.04 850.74 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 817.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28167121 EXC LEG/ANKLE LES SC 3 CM/> 27632 360 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 2,773.00 " " 2,473.07 " " 2,773.00 " 907.92 " 6,874.76 " " 2,425.96 " " 6,576.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,201.74 " " 2,752.18 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28167130 REMOVE LOWER LEG BONE LESION 27635 360 "$14,860.00" " 5,492.26 " 673.00 " 11,888.00 " 773.95 " 2,773.00 " " 2,953.81 " " 2,773.00 " 787.41 " 8,210.15 " " 2,897.54 " " 3,545.00 " 753.76 700.79 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 673.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28167148 PARTIAL REMOVAL OF FIBULA 27641 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 1,718.00 " " 2,953.81 " " 1,718.00 " 907.92 " 8,210.15 " " 2,897.54 " " 2,820.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,208.66 " " 2,760.83 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 80128380 INJ ANKLE XR 27648 320 $943.00 348.53 - " 1,469.00 " 28.75 " 1,469.00 " - " 1,469.00 " 29.25 521.01 - 622.38 28.00 26.03 624.17 - - 393.78 492.23 - - - 754.40 - 25.00 631.81 - 385.69 707.25 358.43 421.80 - 28167156 REPAIR ACHILLES TENDON 27650 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28167164 REPAIR OF ACHILLES TENDON 27654 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28167172 REP TENDON EXTENSOR LEG SIN PR 27658 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 1,469.00 " " 2,953.81 " " 1,469.00 " 907.92 " 8,210.15 " " 2,897.54 " " 1,775.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 1,649.49 " " 2,061.86 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28167181 REP TENDON FLEXOR LEG SING SEC 27659 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 1,718.00 " " 6,533.13 " " 1,718.00 " 907.92 " 18,172.28 " " 6,408.69 " " 2,820.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,208.66 " " 2,760.83 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28167199 REP TENDON EXTENS PRI W GRF EA 27664 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 1,718.00 " " 6,533.13 " " 1,718.00 " 907.92 " 18,172.28 " " 6,408.69 " " 2,820.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,208.66 " " 2,760.83 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28167202 REP DSL PERON TEN W/O FIB OST 27675 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 1,718.00 " " 2,953.81 " " 1,718.00 " 907.92 " 8,210.15 " " 2,897.54 " " 2,820.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,208.66 " " 2,760.83 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28167211 REP DSL PERONL TEND W/FIB 27676 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28167229 RELEASE OF LOWER LEG TENDON 27680 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 2,773.00 " " 2,953.81 " " 2,773.00 " 907.92 " 8,210.15 " " 2,897.54 " " 3,545.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28167237 REVISION OF LOWER LEG TENDON 27685 360 "$14,860.00" " 5,492.26 " 672.00 " 11,888.00 " 772.80 " 2,773.00 " " 2,953.81 " " 2,773.00 " 786.24 " 8,210.15 " " 2,897.54 " " 3,545.00 " 752.64 699.75 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 672.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28167245 REVISION OF CALF TENDON 27687 360 "$14,860.00" " 5,492.26 " 672.00 " 11,888.00 " 772.80 " 2,773.00 " " 2,953.81 " " 2,773.00 " 786.24 " 8,210.15 " " 2,897.54 " " 3,545.00 " 752.64 699.75 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 672.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28167253 REVISE LOWER LEG TENDON 27691 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 3,326.00 " " 6,533.13 " " 3,326.00 " 907.92 " 18,172.28 " " 6,408.69 " " 4,860.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 3,120.10 " " 3,900.12 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28167261 SUT COLLAT LIG ANKLE PRIMARY 27695 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 1,718.00 " " 6,533.13 " " 1,718.00 " 907.92 " 18,172.28 " " 6,408.69 " " 2,820.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,208.66 " " 2,760.83 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28167270 REPAIR OF ANKLE LIGAMENTS 27696 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 1,718.00 " " 6,533.13 " " 1,718.00 " 907.92 " 18,172.28 " " 6,408.69 " " 2,820.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,208.66 " " 2,760.83 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28167288 SUT COLLAT LIG ANKLE 2NDRY REP 27698 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 1,718.00 " " 6,533.13 " " 1,718.00 " 907.92 " 18,172.28 " " 6,408.69 " " 2,820.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,208.66 " " 2,760.83 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28167296 RECONSTRUCT ANKLE JOINT 27702 360 "$24,630.00" " 9,103.25 " - " 19,704.00 " - " 17,019.33 " " 12,861.18 " " 17,019.33 " - " 13,608.08 " " 12,616.20 " " 16,255.80 " - - " 16,302.60 " " 11,023.87 " " 12,248.74 " " 5,356.49 " " 6,695.61 " " 12,554.96 " " 12,616.20 " " 12,248.74 " " 19,704.00 " " 11,207.60 " - " 16,502.10 " " 10,778.89 " " 10,073.67 " " 18,472.50 " " 9,361.86 " " 11,017.00 " " 12,677.45 " 28167300 REMOVAL OF ANKLE IMPLANT 27704 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 1,718.00 " " 2,953.81 " " 1,718.00 " 907.92 " 8,210.15 " " 2,897.54 " " 2,820.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,208.66 " " 2,760.83 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28167318 INCISION OF TIBIA 27705 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 1,718.00 " " 6,533.13 " " 1,718.00 " 907.92 " 18,172.28 " " 6,408.69 " " 2,820.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,208.66 " " 2,760.83 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28167326 INCISION OF FIBULA 27707 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 1,718.00 " " 2,953.81 " " 1,718.00 " 907.92 " 8,210.15 " " 2,897.54 " " 2,820.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,208.66 " " 2,760.83 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28167334 INCISION OF TIBIA & FIBULA 27709 360 "$64,652.00" " 23,895.38 " 776.00 " 51,721.60 " 892.40 " 1,718.00 " " 12,861.18 " " 1,718.00 " 907.92 " 35,720.23 " " 12,616.20 " " 2,820.00 " 869.12 808.05 " 42,793.16 " " 11,023.87 " " 12,248.74 " " 2,208.66 " " 2,760.83 " " 12,554.96 " " 12,616.20 " " 12,248.74 " " 51,721.60 " " 11,207.60 " 776.00 " 43,316.84 " " 10,778.89 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,677.45 " 28176309 REPAIR OF TIBIA 27720 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 3,604.00 " " 6,533.13 " " 3,604.00 " 907.92 " 18,172.28 " " 6,408.69 " " 6,576.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 4,690.26 " " 5,862.83 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28167342 REPAIR/GRAFT OF TIBIA 27724 360 "$32,891.00" " 12,156.51 " - " 26,312.80 " - " 22,727.68 " N/A " 22,727.68 " - " 18,172.28 " N/A " 21,708.06 " - N/A " 21,770.55 " - N/A " 6,823.49 " " 8,529.36 " N/A N/A N/A " 26,312.80 " N/A - " 22,036.97 " N/A " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " N/A 28167351 CLSD TIBIAL SHAFT FX W/O MAN 27750 360 "$1,082.00" 399.91 142.50 " 2,061.86 " 163.88 " 1,469.00 " 214.98 " 1,469.00 " 166.73 597.81 210.88 " 1,775.00 " 159.60 148.39 716.18 184.27 204.74 " 1,649.49 " " 2,061.86 " 209.86 210.88 204.74 865.60 187.34 142.50 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37002496 CLSD TIBIAL SHAFT FX W/O MAN 27750 450 "$1,082.00" 399.91 142.50 " 2,061.86 " 163.88 " 1,469.00 " 214.98 " 1,469.00 " 166.73 597.81 210.88 " 1,775.00 " 159.60 148.39 716.18 184.27 204.74 " 1,649.49 " " 2,061.86 " 209.86 210.88 204.74 865.60 187.34 142.50 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37002500 CLSD TIBIAL SHAFT FX W/MAN 27752 450 "$7,310.00" " 2,701.78 " 776.00 " 5,848.00 " 892.40 " 1,469.00 " " 1,452.77 " " 1,469.00 " 907.92 " 4,038.78 " " 1,425.10 " " 1,775.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 1,649.49 " " 2,061.86 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28167369 FX TIBIA SHAFT CLOSE/OPEN COMP 27758 360 "$64,652.00" " 23,895.38 " 776.00 " 51,721.60 " 892.40 " 3,326.00 " " 12,861.18 " " 3,326.00 " 907.92 " 35,720.23 " " 12,616.20 " " 4,860.00 " 869.12 808.05 " 42,793.16 " " 11,023.87 " " 12,248.74 " " 3,120.10 " " 3,900.12 " " 12,554.96 " " 12,616.20 " " 12,248.74 " " 51,721.60 " " 11,207.60 " 776.00 " 43,316.84 " " 10,778.89 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,677.45 " 28167377 OP TX TIB SHAFT W IM ROD 27759 360 "$64,652.00" " 23,895.38 " 776.00 " 51,721.60 " 892.40 " 3,326.00 " " 12,861.18 " " 3,326.00 " 907.92 " 35,720.23 " " 12,616.20 " " 4,860.00 " 869.12 808.05 " 42,793.16 " " 11,023.87 " " 12,248.74 " " 3,120.10 " " 3,900.12 " " 12,554.96 " " 12,616.20 " " 12,248.74 " " 51,721.60 " " 11,207.60 " 776.00 " 43,316.84 " " 10,778.89 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,677.45 " 37002518 CLSD TX MDL ANKLE FX W/O MAN 27760 450 "$1,082.00" 399.91 180.17 " 2,061.86 " 892.40 " 1,469.00 " 214.98 " 1,469.00 " 907.92 597.81 210.88 " 1,775.00 " 869.12 808.05 716.18 184.27 204.74 " 1,649.49 " " 2,061.86 " 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37002526 CLSD TX MDL ANKLE FX W/MAN 27762 450 "$7,310.00" " 2,701.78 " 776.00 " 5,848.00 " 892.40 " 1,469.00 " " 1,452.77 " " 1,469.00 " 907.92 " 4,038.78 " " 1,425.10 " " 1,775.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 1,649.49 " " 2,061.86 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28167385 OPTX MEDIAL ANKLE FX 27766 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 37002534 CLSD TX FIBULA FX W/O MAN 27780 450 "$1,082.00" 399.91 180.17 " 2,061.86 " 892.40 " 1,469.00 " 214.98 " 1,469.00 " 907.92 597.81 210.88 " 1,775.00 " 869.12 808.05 716.18 184.27 204.74 " 1,649.49 " " 2,061.86 " 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37002542 CLSD TX FIBULA FX W/MAN 27781 450 "$7,310.00" " 2,701.78 " 776.00 " 5,848.00 " 892.40 " 1,469.00 " " 1,452.77 " " 1,469.00 " 907.92 " 4,038.78 " " 1,425.10 " " 1,775.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 1,649.49 " " 2,061.86 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28167393 TREATMENT OF FIBULA FRACTURE 27784 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 37002551 CLSD TX DSTL ANKLE FX W/O MAN 27786 450 "$1,082.00" 399.91 180.17 " 2,061.86 " 892.40 " 1,469.00 " 214.98 " 1,469.00 " 907.92 597.81 210.88 " 1,775.00 " 869.12 808.05 716.18 184.27 204.74 " 1,649.49 " " 2,061.86 " 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37002569 CLSD TX DSTL ANKLE FX W/MAN 27788 450 "$1,082.00" 399.91 180.17 " 2,061.86 " 892.40 " 1,469.00 " 214.98 " 1,469.00 " 907.92 597.81 210.88 " 1,775.00 " 869.12 808.05 716.18 184.27 204.74 " 1,649.49 " " 2,061.86 " 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 28167407 FX-FIBULA DISTAL CLS/OPN W FX 27792 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 37089109 CLSD TX BMLR ANKLE FX W/O MAN 27808 450 "$1,082.00" 399.91 180.17 " 2,061.86 " 892.40 " 1,469.00 " 214.98 " 1,469.00 " 907.92 597.81 210.88 " 1,775.00 " 869.12 808.05 716.18 184.27 204.74 " 1,649.49 " " 2,061.86 " 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 28175124 TX BIMALL ANKLE FX W/MAN 27810 360 "$7,310.00" " 2,701.78 " 776.00 " 5,848.00 " 892.40 " 1,469.00 " " 1,452.77 " " 1,469.00 " 907.92 " 4,038.78 " " 1,425.10 " " 1,775.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 1,649.49 " " 2,061.86 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 37089117 CLSD TX BMLR ANKLE FX W/MAN 27810 450 "$7,310.00" " 2,701.78 " 776.00 " 5,848.00 " 892.40 " 1,469.00 " " 1,452.77 " " 1,469.00 " 907.92 " 4,038.78 " " 1,425.10 " " 1,775.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 1,649.49 " " 2,061.86 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28167415 FX BI-MALLEOLAR SMP/CMP OPEN R 27814 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 37002577 CLSD TX TRMLR ANKLE FX W/O MAN 27816 450 "$1,082.00" 399.91 180.17 " 2,061.86 " 892.40 " 1,469.00 " 214.98 " 1,469.00 " 907.92 597.81 210.88 " 1,775.00 " 869.12 808.05 716.18 184.27 204.74 " 1,649.49 " " 2,061.86 " 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37002585 CLSD TX TRMLR ANKLE FX W/MAN 27818 450 "$7,310.00" " 2,701.78 " 776.00 " 5,848.00 " 892.40 " 1,469.00 " " 1,452.77 " " 1,469.00 " 907.92 " 4,038.78 " " 1,425.10 " " 1,775.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 1,649.49 " " 2,061.86 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28167423 FX TRI-MALLEOL SMP/CMP OPN RED 27822 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28167431 OPN TRTMNT/TRIMAL ANK FRA 27823 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 37002216 CLSD TX DSTL TIBIA W/O MAN 27824 450 "$1,082.00" 399.91 180.17 " 2,061.86 " 892.40 " 1,469.00 " 214.98 " 1,469.00 " 907.92 597.81 210.88 " 1,775.00 " 869.12 808.05 716.18 184.27 204.74 " 1,649.49 " " 2,061.86 " 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37089125 CLSD TX DSTL TIBIA W/MAN 27825 450 "$7,310.00" " 2,701.78 " 776.00 " 5,848.00 " 892.40 " 1,718.00 " " 1,452.77 " " 1,718.00 " 907.92 " 4,038.78 " " 1,425.10 " " 2,820.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 2,208.66 " " 2,760.83 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28176317 TREAT LOWER LEG FRACTURE 27826 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28167440 TRT LWR LEG FRAC/TIBIA ONLY 27827 360 "$64,652.00" " 23,895.38 " 776.00 " 51,721.60 " 892.40 " 2,773.00 " " 12,861.18 " " 2,773.00 " 907.92 " 35,720.23 " " 12,616.20 " " 3,545.00 " 869.12 808.05 " 42,793.16 " " 11,023.87 " " 12,248.74 " " 2,532.97 " " 3,166.21 " " 12,554.96 " " 12,616.20 " " 12,248.74 " " 51,721.60 " " 11,207.60 " 776.00 " 43,316.84 " " 10,778.89 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,677.45 " 28167458 TRT LWR LEG FRAC/TIB & FIB 27828 360 "$64,652.00" " 23,895.38 " 776.00 " 51,721.60 " 892.40 " 3,326.00 " " 12,861.18 " " 3,326.00 " 907.92 " 35,720.23 " " 12,616.20 " " 4,860.00 " 869.12 808.05 " 42,793.16 " " 11,023.87 " " 12,248.74 " " 3,120.10 " " 3,900.12 " " 12,554.96 " " 12,616.20 " " 12,248.74 " " 51,721.60 " " 11,207.60 " 776.00 " 43,316.84 " " 10,778.89 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,677.45 " 28167466 TREAT LOWER LEG JOINT 27829 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 1,718.00 " " 6,533.13 " " 1,718.00 " 907.92 " 18,172.28 " " 6,408.69 " " 2,820.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,208.66 " " 2,760.83 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 37089133 CLSD TX ANKLE DSLCTN W/O ANES 27840 450 "$1,082.00" 399.91 89.50 " 2,061.86 " 102.93 " 1,469.00 " 214.98 " 1,469.00 " 104.72 597.81 210.88 " 1,775.00 " 100.24 93.20 716.18 184.27 204.74 " 1,649.49 " " 2,061.86 " 209.86 210.88 204.74 865.60 187.34 89.50 724.94 180.17 442.54 811.50 411.27 483.98 211.91 28167474 DSL ANKLE SMP MANIP RED W ANES 27842 360 "$7,310.00" " 2,701.78 " 791.00 " 5,848.00 " 909.65 " 1,469.00 " " 1,452.77 " " 1,469.00 " 925.47 " 4,038.78 " " 1,425.10 " " 1,775.00 " 885.92 823.67 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 1,649.49 " " 2,061.86 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 791.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28167482 DSL ANKLE CLS/OPN OPEN REDUCT 27846 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28167491 ANK DSL OP W/ INTER EXTER FX 27848 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28167504 FUSION OF ANKLE JOINT OPEN 27870 360 "$64,652.00" " 23,895.38 " 776.00 " 51,721.60 " 892.40 " 3,326.00 " " 12,861.18 " " 3,326.00 " 907.92 " 35,720.23 " " 12,616.20 " " 4,860.00 " 869.12 808.05 " 42,793.16 " " 11,023.87 " " 12,248.74 " " 3,120.10 " " 3,900.12 " " 12,554.96 " " 12,616.20 " " 12,248.74 " " 51,721.60 " " 11,207.60 " 776.00 " 43,316.84 " " 10,778.89 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,677.45 " 28167512 AMPUTATE LEG THRU TIB & FIBULA 27880 360 "$31,736.00" " 11,729.63 " - " 25,388.80 " - " 21,929.58 " N/A " 21,929.58 " - " 17,534.14 " N/A " 20,945.76 " - N/A " 21,006.06 " - N/A " 4,211.66 " " 5,264.57 " N/A N/A N/A " 25,388.80 " N/A - " 21,263.12 " N/A " 12,980.02 " " 23,802.00 " " 12,062.85 " " 14,195.51 " N/A 28167521 AMPUTATE TIBIA-FIBULA GUILLOTI 27882 360 "$12,530.00" " 4,631.09 " - " 10,024.00 " - " 8,658.23 " N/A " 8,658.23 " - " 6,922.83 " N/A " 8,269.80 " - N/A " 8,293.61 " - N/A " 3,389.16 " " 4,236.45 " N/A N/A N/A " 10,024.00 " N/A - " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 28167539 REAMPUTATE LEG THRU TIB-FIB 27886 360 "$12,530.00" " 4,631.09 " - " 10,024.00 " - " 8,658.23 " N/A " 8,658.23 " - " 6,922.83 " N/A " 8,269.80 " - N/A " 8,293.61 " - N/A " 3,493.23 " " 4,366.54 " N/A N/A N/A " 10,024.00 " N/A - " 8,395.10 " N/A " 5,124.77 " " 9,397.50 " " 4,762.65 " " 5,604.67 " N/A 28167547 AMPUTATION OF FOOT AT ANKLE 27888 360 "$24,630.00" " 9,103.25 " - " 19,704.00 " - " 17,019.33 " N/A " 17,019.33 " - " 13,608.08 " N/A " 16,255.80 " - N/A " 16,302.60 " - N/A " 3,781.76 " " 4,727.20 " N/A N/A N/A " 19,704.00 " N/A - " 16,502.10 " N/A " 10,073.67 " " 18,472.50 " " 9,361.86 " " 11,017.00 " N/A 28167555 DECOM FASC LEG ANT LAT COMP 27892 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 2,773.00 " " 2,953.81 " " 2,773.00 " 907.92 " 8,210.15 " " 2,897.54 " " 3,545.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,717.03 " " 3,396.29 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28167563 "DECOM FAS LEG ANT,LAT,POSTCOMP" 27894 360 "$14,860.00" " 5,492.26 " 344.00 " 11,888.00 " 395.60 " 2,773.00 " " 2,953.81 " " 2,773.00 " 402.48 " 8,210.15 " " 2,897.54 " " 3,545.00 " 385.28 358.21 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,717.03 " " 3,396.29 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 344.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28167571 DRAINAGE OF BURSA OF FOOT 28001 360 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,718.00 " " 1,467.55 " " 1,718.00 " 907.92 " 4,081.32 " " 1,439.60 " " 4,875.42 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 3,354.90 " " 4,193.62 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28167580 DEEP INF BELOW FASCIA SIN BURS 28002 360 "$7,310.00" " 2,701.78 " 776.00 " 5,848.00 " 892.40 " 2,773.00 " " 1,452.77 " " 2,773.00 " 907.92 " 4,038.78 " " 1,425.10 " " 3,545.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 2,532.97 " " 3,166.21 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28167598 DEEP INF BELOW FASCIA MUL AREA 28003 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 2,773.00 " " 2,953.81 " " 2,773.00 " 907.92 " 8,210.15 " " 2,897.54 " " 3,545.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28167601 INCISION OF FOOT FASCIA 28008 360 "$14,860.00" " 5,492.26 " 888.00 " 11,888.00 " " 1,021.20 " " 2,773.00 " " 2,953.81 " " 2,773.00 " " 1,038.96 " " 8,210.15 " " 2,897.54 " " 3,545.00 " 994.56 924.67 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 888.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28176325 INCISION OF TOE TENDONS 28011 360 "$7,310.00" " 2,701.78 " 776.00 " 5,848.00 " 892.40 " 2,773.00 " " 1,452.77 " " 2,773.00 " 907.92 " 4,038.78 " " 1,425.10 " " 3,545.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 1,012.58 " " 1,265.72 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28167610 DECOMPRESSION OF TIBIA NERVE 28035 360 "$9,211.00" " 3,404.39 " 776.00 " 7,368.80 " 892.40 " 3,326.00 " " 1,831.46 " " 3,326.00 " 907.92 " 5,089.08 " " 1,796.58 " " 4,860.00 " 869.12 808.05 " 6,096.76 " " 1,569.83 " " 1,744.25 " " 3,120.10 " " 3,900.12 " " 1,787.86 " " 1,796.58 " " 1,744.25 " " 7,368.80 " " 1,595.99 " 776.00 " 6,171.37 " " 1,534.94 " " 3,767.30 " " 6,908.25 " " 3,501.10 " " 4,120.08 " " 1,805.30 " 28167628 EXC FOOT/TOE TUM SC 1.5 CM/> 28039 360 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 1,469.00 " " 2,473.07 " " 1,469.00 " 907.92 " 6,874.76 " " 2,425.96 " " 2,820.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,498.09 " " 3,122.61 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28167636 EXC FOOT/TOE TUM DEP 1.5CM/> 28041 360 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 2,773.00 " " 2,473.07 " " 2,773.00 " 907.92 " 6,874.76 " " 2,425.96 " " 2,820.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,385.30 " " 2,981.62 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28167644 EXC FOOT/TOE TUM SC < 1.5 CM 28043 360 "$7,387.00" " 2,730.24 " 741.00 " 5,909.60 " 852.15 " 1,718.00 " " 1,467.55 " " 1,718.00 " 866.97 " 4,081.32 " " 1,439.60 " " 2,820.00 " 829.92 771.60 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 2,208.66 " " 2,760.83 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 741.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28167652 EXC FOOT/TOE TUM DEEP <1.5CM 28045 360 "$12,443.00" " 4,598.93 " 804.00 " 9,954.40 " 924.60 " 2,773.00 " " 2,473.07 " " 2,773.00 " 940.68 " 6,874.76 " " 2,425.96 " " 3,545.00 " 900.48 837.21 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,532.97 " " 3,166.21 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 804.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28167661 PARTIAL REMOVAL FOOT FASCIA 28060 360 "$14,860.00" " 5,492.26 " 628.00 " 11,888.00 " 722.20 " 1,718.00 " " 2,953.81 " " 1,718.00 " 734.76 " 8,210.15 " " 2,897.54 " " 2,820.00 " 703.36 653.94 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,208.66 " " 2,760.83 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 628.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28167679 EXC MORTONS NEUROMA SINGLE 28080 360 "$7,310.00" " 2,701.78 " 779.00 " 5,848.00 " 895.85 " 2,773.00 " " 1,452.77 " " 2,773.00 " 911.43 " 4,038.78 " " 1,425.10 " " 3,545.00 " 872.48 811.17 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 2,532.97 " " 3,166.21 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 779.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28167687 EXC LES TEND/SHEATH/CAPSL FOOT 28090 360 "$7,310.00" " 2,701.78 " 886.00 " 5,848.00 " " 1,018.90 " " 2,773.00 " " 1,452.77 " " 2,773.00 " " 1,036.62 " " 4,038.78 " " 1,425.10 " " 3,545.00 " 992.32 922.59 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 2,532.97 " " 3,166.21 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 886.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28167695 REMOVAL OF ANKLE/HEEL LESION 28100 360 "$14,860.00" " 5,492.26 " " 1,032.00 " " 11,888.00 " " 1,186.80 " " 1,718.00 " " 2,953.81 " " 1,718.00 " " 1,207.44 " " 8,210.15 " " 2,897.54 " " 2,820.00 " " 1,155.84 " " 1,074.62 " " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,208.66 " " 2,760.83 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " " 1,032.00 " " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28167709 REMOVE/GRAFT FOOT LESION 28103 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28175868 REMOVAL OF FOOT LESION 28104 360 "$14,860.00" " 5,492.26 " 912.00 " 11,888.00 " " 1,048.80 " " 1,718.00 " " 2,953.81 " " 1,718.00 " " 1,067.04 " " 8,210.15 " " 2,897.54 " " 2,820.00 " " 1,021.44 " 949.67 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,208.66 " " 2,760.83 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 912.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28167717 REMOVAL OF TOE LESIONS 28108 360 "$7,310.00" " 2,701.78 " 776.00 " 6,171.67 " 892.40 " 1,718.00 " " 1,452.77 " " 1,718.00 " 907.92 " 4,038.78 " " 1,425.10 " " 2,820.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 4,937.34 " " 6,171.67 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28167725 OSTECTOMY BUNIONETTE OPERATION 28110 360 "$14,860.00" " 5,492.26 " 904.00 " 11,888.00 " " 1,039.60 " " 2,773.00 " " 2,953.81 " " 2,773.00 " " 1,057.68 " " 8,210.15 " " 2,897.54 " " 3,545.00 " " 1,012.48 " 941.34 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 904.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28167733 OSTECTOMY COMP 2ND 3RD 4TH MET 28112 360 "$14,860.00" " 5,492.26 " " 1,025.00 " " 11,888.00 " " 1,178.75 " " 2,773.00 " " 2,953.81 " " 2,773.00 " " 1,199.25 " " 8,210.15 " " 2,897.54 " " 3,545.00 " " 1,148.00 " " 1,067.33 " " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " " 1,025.00 " " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28167741 OSTECTOMY COMP 5TH METAT HEAD 28113 360 "$14,860.00" " 5,492.26 " " 1,025.00 " " 11,888.00 " " 1,178.75 " " 2,773.00 " " 2,953.81 " " 2,773.00 " " 1,199.25 " " 8,210.15 " " 2,897.54 " " 3,545.00 " " 1,148.00 " " 1,067.33 " " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " " 1,025.00 " " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28167750 REMOVAL OF METATARSAL HEADS 28114 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 2,773.00 " " 2,953.81 " " 2,773.00 " 907.92 " 8,210.15 " " 2,897.54 " " 3,545.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28167768 REVISION OF FOOT 28116 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 2,773.00 " " 2,953.81 " " 2,773.00 " 907.92 " 8,210.15 " " 2,897.54 " " 3,545.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28167776 REMOVAL OF HEEL BONE 28118 360 "$14,860.00" " 5,492.26 " 832.00 " 11,888.00 " 956.80 " 3,326.00 " " 2,953.81 " " 3,326.00 " 973.44 " 8,210.15 " " 2,897.54 " " 4,860.00 " 931.84 866.36 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 3,120.10 " " 3,900.12 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 832.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28167784 REMOVAL OF HEEL SPUR 28119 360 "$14,860.00" " 5,492.26 " 832.00 " 11,888.00 " 956.80 " 3,326.00 " " 2,953.81 " " 3,326.00 " 973.44 " 8,210.15 " " 2,897.54 " " 4,860.00 " 931.84 866.36 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 3,120.10 " " 3,900.12 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 832.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28167792 PART REMOVAL OF ANKLE/HEEL 28120 360 "$14,860.00" " 5,492.26 " " 1,011.00 " " 11,888.00 " " 1,162.65 " " 4,435.00 " " 2,953.81 " " 4,435.00 " " 1,182.87 " " 8,210.15 " " 2,897.54 " " 6,540.00 " " 1,132.32 " " 1,052.75 " " 9,835.83 " " 2,531.84 " " 2,813.15 " " 4,937.34 " " 6,171.67 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " " 1,011.00 " " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28167806 EXC BONE PARTIAL TARSAL/METAT 28122 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 2,773.00 " " 2,953.81 " " 2,773.00 " 907.92 " 8,210.15 " " 2,897.54 " " 3,545.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28167814 PARTIAL REMOVAL OF TOE 28124 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 1,718.00 " " 2,953.81 " " 1,718.00 " 907.92 " 8,210.15 " " 2,897.54 " " 3,545.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 4,937.34 " " 6,171.67 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 37089141 REMOVAL FOREIGN BODY FOOT 28190 450 "$3,265.00" " 1,206.74 " 393.78 " 2,612.00 " 893.55 " 1,718.00 " 649.06 " 1,718.00 " 909.09 " 1,803.91 " 636.69 " 1,775.00 " 870.24 809.09 " 2,161.10 " 556.34 618.15 393.78 492.23 633.60 636.69 618.15 " 2,612.00 " 565.61 777.00 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 51600398 REMOVAL FOREIGN BODY FOOT 28190 510 "$3,265.00" " 1,206.74 " 393.78 " 2,612.00 " 893.55 " 1,718.00 " 649.06 " 1,718.00 " 909.09 " 1,803.91 " 636.69 " 1,775.00 " 870.24 809.09 " 2,161.10 " 556.34 618.15 393.78 492.23 633.60 636.69 618.15 " 2,612.00 " 565.61 777.00 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 28167822 REM FOREIGN BODY FOOT DEEP 28192 360 "$7,387.00" " 2,730.24 " 720.00 " 5,909.60 " 828.00 " 1,718.00 " " 1,467.55 " " 1,718.00 " 842.40 " 4,081.32 " " 1,439.60 " " 2,820.00 " 806.40 749.74 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 2,208.66 " " 2,760.83 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 720.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28167831 "REMOV FOREIGN BODY, FOOT; COMP" 28193 360 "$7,387.00" " 2,730.24 " 720.00 " 5,909.60 " 828.00 " 3,326.00 " " 1,467.55 " " 3,326.00 " 842.40 " 4,081.32 " " 1,439.60 " " 4,860.00 " 806.40 749.74 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 3,120.10 " " 3,900.12 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 720.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28167849 REP TENDON FLEXOR SINGLE 28200 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 2,773.00 " " 2,953.81 " " 2,773.00 " 907.92 " 8,210.15 " " 2,897.54 " " 3,545.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28167857 REP TENDON EXTENSOR SINGLE 28208 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 2,773.00 " " 2,953.81 " " 2,773.00 " 907.92 " 8,210.15 " " 2,897.54 " " 3,545.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28167865 REVISION OF FOOT TENDON 28238 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28167873 REVISION OF FOOT FASCIA 28250 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 2,773.00 " " 2,953.81 " " 2,773.00 " 907.92 " 8,210.15 " " 2,897.54 " " 3,545.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28167881 RELEASE OF FOOT CONTRACTURE 28270 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 2,773.00 " " 2,953.81 " " 2,773.00 " 907.92 " 8,210.15 " " 2,897.54 " " 3,545.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 1,649.49 " " 2,061.86 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28167890 REPAIR OF HAMMERTOE 28285 360 "$14,860.00" " 5,492.26 " 947.00 " 11,888.00 " " 1,089.05 " " 2,773.00 " " 2,953.81 " " 2,773.00 " " 1,107.99 " " 8,210.15 " " 2,897.54 " " 3,545.00 " " 1,060.64 " 986.11 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 947.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28167903 PARTIAL REMOVAL OF FOOT BONE 28288 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 2,773.00 " " 2,953.81 " " 2,773.00 " 907.92 " 8,210.15 " " 2,897.54 " " 3,545.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28167911 CORRJ HALUX RIGDUS W/O IMPLT 28289 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 2,773.00 " " 2,953.81 " " 2,773.00 " 907.92 " 8,210.15 " " 2,897.54 " " 3,545.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,717.03 " " 3,396.29 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28167920 CORRJ HALUX RIGDUS W/IMPLT 28291 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 22,727.68 " " 6,533.13 " " 22,727.68 " 907.92 " 18,172.28 " " 6,408.69 " " 21,708.06 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 4,102.30 " " 5,127.87 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28167938 HALLUX VALG KELLER MCBRID MAYO 28292 360 "$14,860.00" " 5,492.26 " " 1,236.00 " " 11,888.00 " " 1,421.40 " " 1,718.00 " " 2,953.81 " " 1,718.00 " " 1,446.12 " " 8,210.15 " " 2,897.54 " " 2,820.00 " " 1,384.32 " " 1,287.05 " " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,208.66 " " 2,760.83 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " " 1,236.00 " " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28167946 HAL VAL W/SESMDC W/PROX METAR 28295 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 10,268.26 " " 2,953.81 " " 10,268.26 " 907.92 " 8,210.15 " " 2,897.54 " " 3,545.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 5,231.89 " " 6,539.86 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28167954 HALLUX VALG W METATA OSTEOTOMY 28296 360 "$14,860.00" " 5,492.26 " " 1,085.00 " " 11,888.00 " " 1,247.75 " " 2,773.00 " " 2,953.81 " " 2,773.00 " " 1,269.45 " " 8,210.15 " " 2,897.54 " " 3,545.00 " " 1,215.20 " " 1,129.81 " " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " " 1,085.00 " " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28167962 HAL VALGUS COR LAPIDUS 28297 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28167971 HALLUX VALGUS CORR PHAL OSTEOT 28298 360 "$32,891.00" " 12,156.51 " " 1,372.00 " " 26,312.80 " " 1,577.80 " " 2,773.00 " " 6,533.13 " " 2,773.00 " " 1,605.24 " " 18,172.28 " " 6,408.69 " " 3,545.00 " " 1,536.64 " " 1,428.66 " " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " " 1,372.00 " " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28167989 BUNION BY DOUBLE OSTEOTOMY 28299 360 "$32,891.00" " 12,156.51 " " 1,085.00 " " 26,312.80 " " 1,247.75 " " 3,604.00 " " 6,533.13 " " 3,604.00 " " 1,269.45 " " 18,172.28 " " 6,408.69 " " 4,445.00 " " 1,215.20 " " 1,129.81 " " 21,770.55 " " 5,599.83 " " 6,222.03 " " 3,730.57 " " 4,663.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " " 1,085.00 " " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28167997 INCISION OF HEEL BONE 28300 360 "$32,891.00" " 12,156.51 " " 1,384.00 " " 26,312.80 " " 1,591.60 " " 1,718.00 " " 6,533.13 " " 1,718.00 " " 1,619.28 " " 18,172.28 " " 6,408.69 " " 2,820.00 " " 1,550.08 " " 1,441.16 " " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,208.66 " " 2,760.83 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " " 1,384.00 " " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28168004 INCISION OF MIDFOOT BONES 28304 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 1,718.00 " " 6,533.13 " " 1,718.00 " 907.92 " 18,172.28 " " 6,408.69 " " 2,820.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,208.66 " " 2,760.83 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28168012 OSTEOTOMY FIRST MET-ATARSAL 28306 360 "$32,891.00" " 12,156.51 " " 1,136.00 " " 26,312.80 " " 1,306.40 " " 3,326.00 " " 6,533.13 " " 3,326.00 " " 1,329.12 " " 18,172.28 " " 6,408.69 " " 4,860.00 " " 1,272.32 " " 1,182.92 " " 21,770.55 " " 5,599.83 " " 6,222.03 " " 3,120.10 " " 3,900.12 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " " 1,136.00 " " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28168021 OSTEOTOMY OTHER METATARSALS 28308 360 "$14,860.00" " 5,492.26 " " 1,036.00 " " 11,888.00 " " 1,191.40 " " 1,718.00 " " 2,953.81 " " 1,718.00 " " 1,212.12 " " 8,210.15 " " 2,897.54 " " 2,820.00 " " 1,160.32 " " 1,078.79 " " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,208.66 " " 2,760.83 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " " 1,036.00 " " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28168039 REVISION OF BIG TOE 28310 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28168047 REPAIR DEFORMITY OF TOE 28313 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 1,718.00 " " 2,953.81 " " 1,718.00 " 907.92 " 8,210.15 " " 2,897.54 " " 2,820.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,208.66 " " 2,760.83 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28168055 REMOVAL OF SESAMOID BONE 28315 360 "$14,860.00" " 5,492.26 " 973.00 " 11,888.00 " " 1,118.95 " " 3,326.00 " " 2,953.81 " " 3,326.00 " " 1,138.41 " " 8,210.15 " " 2,897.54 " " 4,860.00 " " 1,089.76 " " 1,013.18 " " 9,835.83 " " 2,531.84 " " 2,813.15 " " 3,120.10 " " 3,900.12 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 973.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28168063 CLSD TX HEEL FX W/O MAN 28400 360 "$1,082.00" 399.91 140.00 " 2,061.86 " 161.00 " 1,469.00 " 214.98 " 1,469.00 " 163.80 597.81 210.88 " 1,775.00 " 156.80 145.78 716.18 184.27 204.74 " 1,649.49 " " 2,061.86 " 209.86 210.88 204.74 865.60 187.34 140.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37002593 CLSD TX HEEL FX W/O MAN 28400 450 "$1,082.00" 399.91 140.00 " 2,061.86 " 161.00 " 1,469.00 " 214.98 " 1,469.00 " 163.80 597.81 210.88 " 1,775.00 " 156.80 145.78 716.18 184.27 204.74 " 1,649.49 " " 2,061.86 " 209.86 210.88 204.74 865.60 187.34 140.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 28168071 CLSD TX HEEL FX W/MAN 28405 360 "$1,082.00" 399.91 180.17 " 2,820.00 " " 1,956.15 " " 1,718.00 " 214.98 " 1,718.00 " " 1,990.17 " 597.81 210.88 " 2,820.00 " " 1,905.12 " " 1,771.25 " 716.18 184.27 204.74 " 2,208.66 " " 2,760.83 " 209.86 210.88 204.74 865.60 187.34 " 1,701.00 " 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37002607 CLSD TX HEEL FX W/MAN 28405 450 "$1,082.00" 399.91 180.17 " 2,820.00 " " 1,956.15 " " 1,718.00 " 214.98 " 1,718.00 " " 1,990.17 " 597.81 210.88 " 2,820.00 " " 1,905.12 " " 1,771.25 " 716.18 184.27 204.74 " 2,208.66 " " 2,760.83 " 209.86 210.88 204.74 865.60 187.34 " 1,701.00 " 724.94 180.17 442.54 811.50 411.27 483.98 211.91 28168080 TREATMENT OF HEEL FRACTURE 28406 360 "$32,891.00" " 12,156.51 " " 1,701.00 " " 26,312.80 " " 1,956.15 " " 1,718.00 " " 6,533.13 " " 1,718.00 " " 1,990.17 " " 18,172.28 " " 6,408.69 " " 2,820.00 " " 1,905.12 " " 1,771.25 " " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,208.66 " " 2,760.83 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " " 1,701.00 " " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28168098 TREAT HEEL FRACTURE 28415 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28168101 CLSD TX ANKLE FX W/MAN 28435 360 "$7,310.00" " 2,701.78 " 776.00 " 5,848.00 " 892.40 " 1,718.00 " " 1,452.77 " " 1,718.00 " 907.92 " 4,038.78 " " 1,425.10 " " 2,820.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 2,208.66 " " 2,760.83 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 37089753 CLSD TX ANKLE FX W/MAN 28435 450 "$7,310.00" " 2,701.78 " 776.00 " 5,848.00 " 892.40 " 1,718.00 " " 1,452.77 " " 1,718.00 " 907.92 " 4,038.78 " " 1,425.10 " " 2,820.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 2,208.66 " " 2,760.83 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28168110 TREATMENT OF ANKLE FRACTURE 28436 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 1,718.00 " " 6,533.13 " " 1,718.00 " 907.92 " 18,172.28 " " 6,408.69 " " 2,820.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,208.66 " " 2,760.83 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28168128 TREAT ANKLE FRACTURE 28445 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 37002224 TX TARSAL FX W/O MAN EACH 28450 450 "$1,082.00" 399.91 180.17 " 1,469.00 " 892.40 " 1,469.00 " 214.98 " 1,469.00 " 907.92 597.81 210.88 845.00 869.12 808.05 716.18 184.27 204.74 393.78 492.23 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 28168136 TREAT MIDFOOT FRACTURE EACH 28465 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28168144 CLSD TX MTRSL FX W/O MAN EACH 28470 360 "$1,082.00" 399.91 180.17 " 1,469.00 " 892.40 " 1,469.00 " 214.98 " 1,469.00 " 907.92 597.81 210.88 845.00 869.12 808.05 716.18 184.27 204.74 393.78 492.23 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37002615 CLSD TX MTRSL FX W/O MAN EACH 28470 450 "$1,082.00" 399.91 180.17 " 1,469.00 " 892.40 " 1,469.00 " 214.98 " 1,469.00 " 907.92 597.81 210.88 845.00 869.12 808.05 716.18 184.27 204.74 393.78 492.23 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37002623 CLSD TX MTRSL FX W/MAN EACH 28475 450 "$1,082.00" 399.91 180.17 " 2,760.83 " 892.40 " 1,469.00 " 214.98 " 1,469.00 " 907.92 597.81 210.88 845.00 869.12 808.05 716.18 184.27 204.74 " 2,208.66 " " 2,760.83 " 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 28168152 TREAT METATARSAL FRACTURE 28485 360 "$32,891.00" " 12,156.51 " 848.00 " 26,312.80 " 975.20 " 3,326.00 " " 6,533.13 " " 3,326.00 " 992.16 " 18,172.28 " " 6,408.69 " " 4,860.00 " 949.76 883.02 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 3,120.10 " " 3,900.12 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 848.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 37002631 CLSD TX GRT TOE FX W/O MAN 28490 450 "$1,082.00" 399.91 55.00 " 1,469.00 " 63.25 " 1,469.00 " 214.98 " 1,469.00 " 64.35 597.81 210.88 845.00 61.60 57.27 716.18 184.27 204.74 281.27 351.59 209.86 210.88 204.74 865.60 187.34 55.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37089761 CLSD TX GRT TOE FX W/MAN 28495 450 "$1,082.00" 399.91 180.17 " 2,760.83 " 892.40 " 1,469.00 " 214.98 " 1,469.00 " 907.92 597.81 210.88 845.00 869.12 808.05 716.18 184.27 204.74 " 2,208.66 " " 2,760.83 " 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37002640 CLSD TX FX PHALANX W/O MAN EA 28510 450 "$1,082.00" 399.91 180.17 " 1,469.00 " 892.40 " 1,469.00 " 214.98 " 1,469.00 " 907.92 597.81 210.88 845.00 869.12 808.05 716.18 184.27 204.74 281.27 351.59 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37002658 CLSD TX FX PHALANX W/MAN EA 28515 450 "$1,082.00" 399.91 180.17 " 1,469.00 " 892.40 " 1,469.00 " 214.98 " 1,469.00 " 907.92 597.81 210.88 845.00 869.12 808.05 716.18 184.27 204.74 281.27 351.59 209.86 210.88 204.74 865.60 187.34 776.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 28168161 TREAT TOE FRACTURE 28525 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 2,773.00 " " 2,953.81 " " 2,773.00 " 907.92 " 8,210.15 " " 2,897.54 " " 3,545.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 37089648 CLSD FOOT JNT DSLCTN W/O ANES 28570 450 "$1,082.00" 399.91 112.00 " 1,469.00 " 128.80 " 1,469.00 " 214.98 " 1,469.00 " 131.04 597.81 210.88 845.00 125.44 116.63 716.18 184.27 204.74 393.78 492.23 209.86 210.88 204.74 865.60 187.34 112.00 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37089613 CLSD TRSMTRSL DSLCTN W/O ANES 28600 450 "$1,082.00" 399.91 54.50 " 1,469.00 " 62.68 " 1,469.00 " 214.98 " 1,469.00 " 63.77 597.81 210.88 845.00 61.04 56.75 716.18 184.27 204.74 393.78 492.23 209.86 210.88 204.74 865.60 187.34 54.50 724.94 180.17 442.54 811.50 411.27 483.98 211.91 28168179 REPAIR FOOT DISLOCATION 28615 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 37002666 CLSD TX TOE JT DSLCTN W/O ANES 28630 450 "$1,082.00" 399.91 54.50 " 1,469.00 " 62.68 " 1,469.00 " 214.98 " 1,469.00 " 63.77 597.81 210.88 845.00 61.04 56.75 716.18 184.27 204.74 393.78 492.23 209.86 210.88 204.74 865.60 187.34 54.50 724.94 180.17 442.54 811.50 411.27 483.98 211.91 28168187 REPAIR TOE DISLOCATION 28645 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 2,773.00 " " 2,953.81 " " 2,773.00 " 907.92 " 8,210.15 " " 2,897.54 " " 3,545.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 37002674 CLSD INTPHLNGL DSLCTN W/O ANES 28660 450 "$1,082.00" 399.91 48.50 " 1,469.00 " 55.78 " 1,469.00 " 214.98 " 1,469.00 " 56.75 597.81 210.88 845.00 54.32 50.50 716.18 184.27 204.74 393.78 492.23 209.86 210.88 204.74 865.60 187.34 48.50 724.94 180.17 442.54 811.50 411.27 483.98 211.91 28168195 ARHTRODESIS TRIPLE 28715 360 "$64,652.00" " 23,895.38 " 776.00 " 51,721.60 " 892.40 " 3,326.00 " " 12,861.18 " " 3,326.00 " 907.92 " 35,720.23 " " 12,616.20 " " 4,860.00 " 869.12 808.05 " 42,793.16 " " 11,023.87 " " 12,248.74 " " 3,120.10 " " 3,900.12 " " 12,554.96 " " 12,616.20 " " 12,248.74 " " 51,721.60 " " 11,207.60 " 776.00 " 43,316.84 " " 10,778.89 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,677.45 " 28168209 ARTHRODESIS SUBTALAR 28725 360 "$64,652.00" " 23,895.38 " 776.00 " 51,721.60 " 892.40 " 3,326.00 " " 12,861.18 " " 3,326.00 " 907.92 " 35,720.23 " " 12,616.20 " " 4,860.00 " 869.12 808.05 " 42,793.16 " " 11,023.87 " " 12,248.74 " " 3,120.10 " " 3,900.12 " " 12,554.96 " " 12,616.20 " " 12,248.74 " " 51,721.60 " " 11,207.60 " 776.00 " 43,316.84 " " 10,778.89 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,677.45 " 28168217 ARTHRODESIS MIDTAR TARSOMET 28730 360 "$64,652.00" " 23,895.38 " 776.00 " 51,721.60 " 892.40 " 3,326.00 " " 12,861.18 " " 3,326.00 " 907.92 " 35,720.23 " " 12,616.20 " " 4,860.00 " 869.12 808.05 " 42,793.16 " " 11,023.87 " " 12,248.74 " " 3,120.10 " " 3,900.12 " " 12,554.96 " " 12,616.20 " " 12,248.74 " " 51,721.60 " " 11,207.60 " 776.00 " 43,316.84 " " 10,778.89 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,677.45 " 28168225 ARTHRODESIS TARSOMETARS SGL JT 28740 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 3,326.00 " " 6,533.13 " " 3,326.00 " 907.92 " 18,172.28 " " 6,408.69 " " 4,860.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 3,120.10 " " 3,900.12 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28168233 FUSION OF BIG TOE JOINT 28750 360 "$32,891.00" " 12,156.51 " " 1,053.00 " " 26,312.80 " " 1,210.95 " " 3,326.00 " " 6,533.13 " " 3,326.00 " " 1,232.01 " " 18,172.28 " " 6,408.69 " " 4,860.00 " " 1,179.36 " " 1,096.49 " " 21,770.55 " " 5,599.83 " " 6,222.03 " " 3,120.10 " " 3,900.12 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " " 1,053.00 " " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28176333 FUSION OF BIG TOE JOINT 28755 360 "$32,891.00" " 12,156.51 " " 1,045.00 " " 26,312.80 " " 1,201.75 " " 3,326.00 " " 6,533.13 " " 3,326.00 " " 1,222.65 " " 18,172.28 " " 6,408.69 " " 4,860.00 " " 1,170.40 " " 1,088.16 " " 21,770.55 " " 5,599.83 " " 6,222.03 " " 3,120.10 " " 3,900.12 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " " 1,045.00 " " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28168241 AMPUTATION OF MIDFOOT 28800 360 "$5,661.00" " 2,092.31 " - " 4,528.80 " - " 3,911.75 " N/A " 3,911.75 " - " 3,127.70 " N/A " 3,736.26 " - N/A " 3,747.02 " - N/A " 3,076.44 " " 3,845.55 " N/A N/A N/A " 4,528.80 " N/A - " 3,792.87 " N/A " 2,315.35 " " 4,245.75 " " 2,151.75 " " 2,532.17 " N/A 28168250 AMPUTATION THRU METATARSAL 28805 360 "$14,860.00" " 5,492.26 " - " 11,888.00 " - " 2,773.00 " " 2,953.81 " " 2,773.00 " - " 8,210.15 " " 2,897.54 " " 9,807.60 " - - " 9,835.83 " " 2,531.84 " " 2,813.15 " " 3,088.98 " " 3,861.23 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " - " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28168268 AMPUTATION TOE & METATARSAL 28810 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 1,718.00 " " 2,953.81 " " 1,718.00 " 907.92 " 8,210.15 " " 2,897.54 " " 2,820.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,208.66 " " 2,760.83 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28168276 AMPUTATION OF TOE 28820 360 "$14,860.00" " 5,492.26 " 730.00 " 11,888.00 " 839.50 " 1,718.00 " " 2,953.81 " " 1,718.00 " 854.10 " 8,210.15 " " 2,897.54 " " 2,820.00 " 817.60 760.15 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,208.66 " " 2,760.83 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 730.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28168284 PARTIAL AMPUTATION OF TOE 28825 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 1,718.00 " " 2,953.81 " " 1,718.00 " 907.92 " 8,210.15 " " 2,897.54 " " 2,820.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,208.66 " " 2,760.83 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28168292 FOOT/TOES SURGERY PROCEDURE 28899 360 "$1,082.00" 399.91 - " 1,469.00 " - " 1,469.00 " 214.98 " 1,469.00 " - 597.81 210.88 714.12 - - 716.18 184.27 204.74 56.26 70.32 209.86 210.88 204.74 865.60 187.34 - 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37089729 APPLY FOREARM CAST 29075 450 "$1,266.00" 467.91 210.88 " 1,012.80 " 892.40 874.81 251.62 874.81 907.92 699.47 246.83 845.00 869.12 808.05 837.97 215.68 239.64 281.27 351.59 245.63 246.83 239.64 " 1,012.80 " 219.27 776.00 848.22 210.88 517.79 949.50 481.21 566.28 248.03 28168306 APPLY HAND/WRIST CAST 29085 360 $741.00 273.87 123.50 907.92 892.40 512.03 147.36 512.03 907.92 409.40 144.55 845.00 869.12 808.05 490.47 126.31 140.34 393.78 492.23 143.85 144.55 140.34 592.80 128.41 776.00 496.47 123.50 303.07 555.75 281.65 331.45 145.25 29121036 APPLY LONG ARM SPLINT 29105 430 $741.00 273.87 123.50 907.92 892.40 512.03 147.36 512.03 907.92 409.40 144.55 845.00 869.12 808.05 490.47 126.31 140.34 393.78 492.23 143.85 144.55 140.34 592.80 128.41 776.00 496.47 123.50 303.07 555.75 281.65 331.45 145.25 37002682 APPLY LONG ARM SPLINT 29105 450 $741.00 273.87 123.50 907.92 892.40 512.03 147.36 512.03 907.92 409.40 144.55 845.00 869.12 808.05 490.47 126.31 140.34 393.78 492.23 143.85 144.55 140.34 592.80 128.41 776.00 496.47 123.50 303.07 555.75 281.65 331.45 145.25 29121028 APPLY FOREARM SPLINT STATIC 29125 430 $588.00 217.32 26.00 845.00 29.90 406.31 117.61 406.31 30.42 324.87 115.37 845.00 29.12 27.07 389.20 100.81 112.01 281.27 351.59 114.81 115.37 112.01 470.40 102.49 26.00 393.96 98.57 240.49 441.00 223.50 263.01 115.93 37002691 APPLY FOREARM SPLINT STATIC 29125 450 $588.00 217.32 26.00 845.00 29.90 406.31 117.61 406.31 30.42 324.87 115.37 845.00 29.12 27.07 389.20 100.81 112.01 281.27 351.59 114.81 115.37 112.01 470.40 102.49 26.00 393.96 98.57 240.49 441.00 223.50 263.01 115.93 29120994 APPLY FOREARM SPLINT DYNAMIC 29126 430 $588.00 217.32 26.00 845.00 29.90 406.31 117.61 406.31 30.42 324.87 115.37 845.00 29.12 27.07 389.20 100.81 112.01 168.76 210.95 114.81 115.37 112.01 470.40 102.49 26.00 393.96 98.57 240.49 441.00 223.50 263.01 115.93 37089150 APPLY FOREARM SPLINT DYNAMIC 29126 450 $588.00 217.32 26.00 845.00 29.90 406.31 117.61 406.31 30.42 324.87 115.37 845.00 29.12 27.07 389.20 100.81 112.01 168.76 210.95 114.81 115.37 112.01 470.40 102.49 26.00 393.96 98.57 240.49 441.00 223.50 263.01 115.93 29121001 APPLY FINGER SPLINT STATIC 29130 430 $588.00 217.32 - 845.00 - 406.31 117.61 406.31 - 324.87 115.37 845.00 - - 389.20 100.81 112.01 168.76 210.95 114.81 115.37 112.01 470.40 102.49 - 393.96 98.57 240.49 441.00 223.50 263.01 115.93 37002704 APPLY FINGER SPLINT STATIC 29130 450 $588.00 217.32 - 845.00 - 406.31 117.61 406.31 - 324.87 115.37 845.00 - - 389.20 100.81 112.01 168.76 210.95 114.81 115.37 112.01 470.40 102.49 - 393.96 98.57 240.49 441.00 223.50 263.01 115.93 29121010 APPLY FINGER SPLINT DYNAMIC 29131 430 $292.00 107.92 27.71 845.00 31.87 201.77 58.05 201.77 32.42 161.33 56.95 845.00 31.04 28.85 193.27 49.76 55.29 281.27 351.59 56.67 56.95 55.29 233.60 50.59 27.71 195.64 48.66 119.43 219.00 110.99 130.61 57.23 29221227 STRAPPING THORAX 29200 420 $741.00 273.87 34.83 845.00 40.05 512.03 147.36 512.03 40.75 409.40 144.55 845.00 39.01 36.27 490.47 126.31 140.34 286.06 357.57 143.85 144.55 140.34 592.80 128.41 34.83 496.47 123.50 303.07 555.75 281.65 331.45 145.25 29585750 STRAPPING THORAX 29200 420 $741.00 273.87 34.83 845.00 40.05 512.03 147.36 512.03 40.75 409.40 144.55 845.00 39.01 36.27 490.47 126.31 140.34 286.06 357.57 143.85 144.55 140.34 592.80 128.41 34.83 496.47 123.50 303.07 555.75 281.65 331.45 145.25 31900000 STRAPPING THORAX 29200 420 $741.00 273.87 34.83 845.00 40.05 512.03 147.36 512.03 40.75 409.40 144.55 845.00 39.01 36.27 490.47 126.31 140.34 286.06 357.57 143.85 144.55 140.34 592.80 128.41 34.83 496.47 123.50 303.07 555.75 281.65 331.45 145.25 64200933 STRAPPING THORAX 29200 420 $741.00 273.87 34.83 845.00 40.05 512.03 147.36 512.03 40.75 409.40 144.55 845.00 39.01 36.27 490.47 126.31 140.34 286.06 357.57 143.85 144.55 140.34 592.80 128.41 34.83 496.47 123.50 303.07 555.75 281.65 331.45 145.25 29121044 STRAPPING SHOULDER 29240 430 $588.00 217.32 19.50 845.00 22.43 406.31 117.61 406.31 22.82 324.87 115.37 845.00 21.84 20.31 389.20 100.81 112.01 281.27 351.59 114.81 115.37 112.01 470.40 102.49 19.50 393.96 98.57 240.49 441.00 223.50 263.01 115.93 29221235 STRAPPING SHOULDER 29240 420 $588.00 217.32 19.50 845.00 22.43 406.31 117.61 406.31 22.82 324.87 115.37 845.00 21.84 20.31 389.20 100.81 112.01 281.27 351.59 114.81 115.37 112.01 470.40 102.49 19.50 393.96 98.57 240.49 441.00 223.50 263.01 115.93 29585768 STRAPPING SHOULDER 29240 420 $588.00 217.32 19.50 845.00 22.43 406.31 117.61 406.31 22.82 324.87 115.37 845.00 21.84 20.31 389.20 100.81 112.01 281.27 351.59 114.81 115.37 112.01 470.40 102.49 19.50 393.96 98.57 240.49 441.00 223.50 263.01 115.93 31900018 STRAPPING SHOULDER 29240 420 $588.00 217.32 19.50 845.00 22.43 406.31 117.61 406.31 22.82 324.87 115.37 845.00 21.84 20.31 389.20 100.81 112.01 281.27 351.59 114.81 115.37 112.01 470.40 102.49 19.50 393.96 98.57 240.49 441.00 223.50 263.01 115.93 37003522 STRAPPING SHOULDER 29240 450 $588.00 217.32 19.50 845.00 22.43 406.31 117.61 406.31 22.82 324.87 115.37 845.00 21.84 20.31 389.20 100.81 112.01 281.27 351.59 114.81 115.37 112.01 470.40 102.49 19.50 393.96 98.57 240.49 441.00 223.50 263.01 115.93 64200941 STRAPPING SHOULDER 29240 420 $588.00 217.32 19.50 845.00 22.43 406.31 117.61 406.31 22.82 324.87 115.37 845.00 21.84 20.31 389.20 100.81 112.01 281.27 351.59 114.81 115.37 112.01 470.40 102.49 19.50 393.96 98.57 240.49 441.00 223.50 263.01 115.93 29121052 STRAPPING ELBOW/WRIST 29260 430 $292.00 107.92 31.38 845.00 36.09 201.77 58.05 201.77 36.71 161.33 56.95 845.00 35.15 32.68 193.27 49.76 55.29 281.27 351.59 56.67 56.95 55.29 233.60 50.59 31.38 195.64 48.66 119.43 219.00 110.99 130.61 57.23 29221243 STRAPPING ELBOW/WRIST 29260 420 $292.00 107.92 31.38 845.00 36.09 201.77 58.05 201.77 36.71 161.33 56.95 845.00 35.15 32.68 193.27 49.76 55.29 281.27 351.59 56.67 56.95 55.29 233.60 50.59 31.38 195.64 48.66 119.43 219.00 110.99 130.61 57.23 29585776 STRAPPING ELBOW/WRIST 29260 420 $292.00 107.92 31.38 845.00 36.09 201.77 58.05 201.77 36.71 161.33 56.95 845.00 35.15 32.68 193.27 49.76 55.29 281.27 351.59 56.67 56.95 55.29 233.60 50.59 31.38 195.64 48.66 119.43 219.00 110.99 130.61 57.23 31900026 STRAPPING ELBOW/WRIST 29260 420 $292.00 107.92 31.38 845.00 36.09 201.77 58.05 201.77 36.71 161.33 56.95 845.00 35.15 32.68 193.27 49.76 55.29 281.27 351.59 56.67 56.95 55.29 233.60 50.59 31.38 195.64 48.66 119.43 219.00 110.99 130.61 57.23 64200950 STRAPPING ELBOW/WRIST 29260 420 $292.00 107.92 31.38 845.00 36.09 201.77 58.05 201.77 36.71 161.33 56.95 845.00 35.15 32.68 193.27 49.76 55.29 281.27 351.59 56.67 56.95 55.29 233.60 50.59 31.38 195.64 48.66 119.43 219.00 110.99 130.61 57.23 28168314 STRAPPING HAND/FINGER 29280 360 $292.00 107.92 - 845.00 - 201.77 58.05 201.77 - 161.33 56.95 845.00 - - 193.27 49.76 55.29 281.27 351.59 56.67 56.95 55.29 233.60 50.59 - 195.64 48.66 119.43 219.00 110.99 130.61 57.23 29121061 STRAPPING HAND/FINGER 29280 430 $292.00 107.92 - 845.00 - 201.77 58.05 201.77 - 161.33 56.95 845.00 - - 193.27 49.76 55.29 281.27 351.59 56.67 56.95 55.29 233.60 50.59 - 195.64 48.66 119.43 219.00 110.99 130.61 57.23 37003671 STRAPPING HAND/FINGER 29280 450 $292.00 107.92 - 845.00 - 201.77 58.05 201.77 - 161.33 56.95 845.00 - - 193.27 49.76 55.29 281.27 351.59 56.67 56.95 55.29 233.60 50.59 - 195.64 48.66 119.43 219.00 110.99 130.61 57.23 28168322 APPLICATION OF LONG LEG CAST 29345 360 "$1,266.00" 467.91 210.88 " 1,469.00 " 892.40 " 1,469.00 " 251.62 " 1,469.00 " 907.92 699.47 246.83 845.00 869.12 808.05 837.97 215.68 239.64 393.78 492.23 245.63 246.83 239.64 " 1,012.80 " 219.27 776.00 848.22 210.88 517.79 949.50 481.21 566.28 248.03 37089770 APPLY LONG LEG CAST BRACE 29358 450 "$1,266.00" 467.91 210.88 " 1,012.80 " 892.40 874.81 251.62 874.81 907.92 699.47 246.83 845.00 869.12 808.05 837.97 215.68 239.64 618.80 773.50 245.63 246.83 239.64 " 1,012.80 " 219.27 776.00 848.22 210.88 517.79 949.50 481.21 566.28 248.03 37090646 APPLICATION OF LONG LEG CAST 29365 450 "$1,266.00" 467.91 210.88 " 1,012.80 " 892.40 874.81 251.62 874.81 907.92 699.47 246.83 845.00 869.12 808.05 837.97 215.68 239.64 393.78 492.23 245.63 246.83 239.64 " 1,012.80 " 219.27 776.00 848.22 210.88 517.79 949.50 481.21 566.28 248.03 37089184 APPLY SHORT LEG CAST 29405 450 "$1,266.00" 467.91 210.88 " 1,012.80 " 892.40 874.81 251.62 874.81 907.92 699.47 246.83 845.00 869.12 808.05 837.97 215.68 239.64 393.78 492.23 245.63 246.83 239.64 " 1,012.80 " 219.27 776.00 848.22 210.88 517.79 949.50 481.21 566.28 248.03 37089630 APPLY SHORT LEG CAST KNEE/TOE 29425 450 "$1,266.00" 467.91 210.88 " 1,012.80 " 892.40 874.81 251.62 874.81 907.92 699.47 246.83 845.00 869.12 808.05 837.97 215.68 239.64 393.78 492.23 245.63 246.83 239.64 " 1,012.80 " 219.27 776.00 848.22 210.88 517.79 949.50 481.21 566.28 248.03 51600401 APPLY RIGID LEG CAST 29445 510 "$1,266.00" 467.91 101.47 " 1,012.80 " 116.69 874.81 251.62 874.81 118.72 699.47 246.83 845.00 113.65 105.66 837.97 215.68 239.64 775.63 969.54 245.63 246.83 239.64 " 1,012.80 " 219.27 101.47 848.22 210.88 517.79 949.50 481.21 566.28 248.03 37002712 APPLY LONG LEG SPLINT 29505 450 $741.00 273.87 37.00 " 1,265.72 " 42.55 512.03 147.36 512.03 43.29 409.40 144.55 845.00 41.44 38.53 490.47 126.31 140.34 " 1,012.58 " " 1,265.72 " 143.85 144.55 140.34 592.80 128.41 37.00 496.47 123.50 303.07 555.75 281.65 331.45 145.25 29121168 APPLY LOWER LEG SPLINT 29515 430 $741.00 273.87 35.00 845.00 40.25 512.03 147.36 512.03 40.95 409.40 144.55 845.00 39.20 36.45 490.47 126.31 140.34 393.78 492.23 143.85 144.55 140.34 592.80 128.41 35.00 496.47 123.50 303.07 555.75 281.65 331.45 145.25 37002721 APPLY LOWER LEG SPLINT 29515 450 $741.00 273.87 35.00 845.00 40.25 512.03 147.36 512.03 40.95 409.40 144.55 845.00 39.20 36.45 490.47 126.31 140.34 393.78 492.23 143.85 144.55 140.34 592.80 128.41 35.00 496.47 123.50 303.07 555.75 281.65 331.45 145.25 29221251 STRAPPING HIP 29520 420 $588.00 217.32 32.99 845.00 37.94 406.31 117.61 406.31 38.60 324.87 115.37 845.00 36.95 34.35 389.20 100.81 112.01 393.78 492.23 114.81 115.37 112.01 470.40 102.49 32.99 393.96 98.57 240.49 441.00 223.50 263.01 115.93 29585784 STRAPPING HIP 29520 420 $588.00 217.32 32.99 845.00 37.94 406.31 117.61 406.31 38.60 324.87 115.37 845.00 36.95 34.35 389.20 100.81 112.01 393.78 492.23 114.81 115.37 112.01 470.40 102.49 32.99 393.96 98.57 240.49 441.00 223.50 263.01 115.93 31900034 STRAPPING HIP 29520 420 $588.00 217.32 32.99 845.00 37.94 406.31 117.61 406.31 38.60 324.87 115.37 845.00 36.95 34.35 389.20 100.81 112.01 393.78 492.23 114.81 115.37 112.01 470.40 102.49 32.99 393.96 98.57 240.49 441.00 223.50 263.01 115.93 64200968 STRAPPING HIP 29520 420 $588.00 217.32 32.99 845.00 37.94 406.31 117.61 406.31 38.60 324.87 115.37 845.00 36.95 34.35 389.20 100.81 112.01 393.78 492.23 114.81 115.37 112.01 470.40 102.49 32.99 393.96 98.57 240.49 441.00 223.50 263.01 115.93 29221260 STRAPPING KNEE 29530 420 $588.00 217.32 25.50 845.00 29.33 406.31 117.61 406.31 29.84 324.87 115.37 845.00 28.56 26.55 389.20 100.81 112.01 393.78 492.23 114.81 115.37 112.01 470.40 102.49 25.50 393.96 98.57 240.49 441.00 223.50 263.01 115.93 29585792 STRAPPING KNEE 29530 420 $588.00 217.32 25.50 845.00 29.33 406.31 117.61 406.31 29.84 324.87 115.37 845.00 28.56 26.55 389.20 100.81 112.01 393.78 492.23 114.81 115.37 112.01 470.40 102.49 25.50 393.96 98.57 240.49 441.00 223.50 263.01 115.93 31900042 STRAPPING KNEE 29530 420 $588.00 217.32 25.50 845.00 29.33 406.31 117.61 406.31 29.84 324.87 115.37 845.00 28.56 26.55 389.20 100.81 112.01 393.78 492.23 114.81 115.37 112.01 470.40 102.49 25.50 393.96 98.57 240.49 441.00 223.50 263.01 115.93 37003689 STRAPPING KNEE 29530 450 $588.00 217.32 25.50 845.00 29.33 406.31 117.61 406.31 29.84 324.87 115.37 845.00 28.56 26.55 389.20 100.81 112.01 393.78 492.23 114.81 115.37 112.01 470.40 102.49 25.50 393.96 98.57 240.49 441.00 223.50 263.01 115.93 64200909 STRAPPING KNEE 29530 420 $588.00 217.32 25.50 845.00 29.33 406.31 117.61 406.31 29.84 324.87 115.37 845.00 28.56 26.55 389.20 100.81 112.01 393.78 492.23 114.81 115.37 112.01 470.40 102.49 25.50 393.96 98.57 240.49 441.00 223.50 263.01 115.93 29221278 STRAPPING ANKLE/FOOT 29540 420 $741.00 273.87 20.00 845.00 23.00 512.03 147.36 512.03 23.40 409.40 144.55 845.00 22.40 20.83 490.47 126.31 140.34 393.78 492.23 143.85 144.55 140.34 592.80 128.41 20.00 496.47 123.50 303.07 555.75 281.65 331.45 145.25 29585806 STRAPPING ANKLE/FOOT 29540 420 $741.00 273.87 20.00 845.00 23.00 512.03 147.36 512.03 23.40 409.40 144.55 845.00 22.40 20.83 490.47 126.31 140.34 393.78 492.23 143.85 144.55 140.34 592.80 128.41 20.00 496.47 123.50 303.07 555.75 281.65 331.45 145.25 31900051 STRAPPING ANKLE/FOOT 29540 420 $741.00 273.87 20.00 845.00 23.00 512.03 147.36 512.03 23.40 409.40 144.55 845.00 22.40 20.83 490.47 126.31 140.34 393.78 492.23 143.85 144.55 140.34 592.80 128.41 20.00 496.47 123.50 303.07 555.75 281.65 331.45 145.25 37003573 STRAPPING ANKLE/FOOT 29540 450 $741.00 273.87 20.00 845.00 23.00 512.03 147.36 512.03 23.40 409.40 144.55 845.00 22.40 20.83 490.47 126.31 140.34 393.78 492.23 143.85 144.55 140.34 592.80 128.41 20.00 496.47 123.50 303.07 555.75 281.65 331.45 145.25 64200917 STRAPPING ANKLE/FOOT 29540 420 $741.00 273.87 20.00 845.00 23.00 512.03 147.36 512.03 23.40 409.40 144.55 845.00 22.40 20.83 490.47 126.31 140.34 393.78 492.23 143.85 144.55 140.34 592.80 128.41 20.00 496.47 123.50 303.07 555.75 281.65 331.45 145.25 29221286 STRAPPING/APPLY UNNA BOOT 29580 420 $741.00 273.87 - 845.00 - 512.03 147.36 512.03 - 409.40 144.55 845.00 - - 490.47 126.31 140.34 393.78 492.23 143.85 144.55 140.34 592.80 128.41 - 496.47 123.50 303.07 555.75 281.65 331.45 145.25 29585814 STRAPPING/APPLY UNNA BOOT 29580 420 $741.00 273.87 - 845.00 - 512.03 147.36 512.03 - 409.40 144.55 845.00 - - 490.47 126.31 140.34 393.78 492.23 143.85 144.55 140.34 592.80 128.41 - 496.47 123.50 303.07 555.75 281.65 331.45 145.25 31900069 STRAPPING/APPLY UNNA BOOT 29580 420 $741.00 273.87 - 845.00 - 512.03 147.36 512.03 - 409.40 144.55 845.00 - - 490.47 126.31 140.34 393.78 492.23 143.85 144.55 140.34 592.80 128.41 - 496.47 123.50 303.07 555.75 281.65 331.45 145.25 51600410 STRAPPING/APPLY UNNA BOOT 29580 510 $741.00 273.87 - 845.00 - 512.03 147.36 512.03 - 409.40 144.55 845.00 - - 490.47 126.31 140.34 393.78 492.23 143.85 144.55 140.34 592.80 128.41 - 496.47 123.50 303.07 555.75 281.65 331.45 145.25 64200976 STRAPPING/APPLY UNNA BOOT 29580 420 $741.00 273.87 - 845.00 - 512.03 147.36 512.03 - 409.40 144.55 845.00 - - 490.47 126.31 140.34 393.78 492.23 143.85 144.55 140.34 592.80 128.41 - 496.47 123.50 303.07 555.75 281.65 331.45 145.25 29221294 APPLY MULTLAY COMPRS LWR LEG 29581 420 $741.00 273.87 25.27 845.00 29.06 512.03 147.36 512.03 29.57 409.40 144.55 845.00 28.30 26.31 490.47 126.31 140.34 460.84 576.05 143.85 144.55 140.34 592.80 128.41 25.27 496.47 123.50 303.07 555.75 281.65 331.45 145.25 29585822 APPLY MULTLAY COMPRS LWR LEG 29581 420 $741.00 273.87 25.27 845.00 29.06 512.03 147.36 512.03 29.57 409.40 144.55 845.00 28.30 26.31 490.47 126.31 140.34 460.84 576.05 143.85 144.55 140.34 592.80 128.41 25.27 496.47 123.50 303.07 555.75 281.65 331.45 145.25 31900077 APPLY MULTLAY COMPRS LWR LEG 29581 420 $741.00 273.87 25.27 845.00 29.06 512.03 147.36 512.03 29.57 409.40 144.55 845.00 28.30 26.31 490.47 126.31 140.34 460.84 576.05 143.85 144.55 140.34 592.80 128.41 25.27 496.47 123.50 303.07 555.75 281.65 331.45 145.25 51600428 APPLY MULTLAY COMPRS LWR LEG 29581 510 $741.00 273.87 25.27 845.00 29.06 512.03 147.36 512.03 29.57 409.40 144.55 845.00 28.30 26.31 490.47 126.31 140.34 460.84 576.05 143.85 144.55 140.34 592.80 128.41 25.27 496.47 123.50 303.07 555.75 281.65 331.45 145.25 64200984 APPLY MULTLAY COMPRS LWR LEG 29581 420 $741.00 273.87 25.27 845.00 29.06 512.03 147.36 512.03 29.57 409.40 144.55 845.00 28.30 26.31 490.47 126.31 140.34 460.84 576.05 143.85 144.55 140.34 592.80 128.41 25.27 496.47 123.50 303.07 555.75 281.65 331.45 145.25 29221308 UNL STRAPPING LOWER BACK 29799 420 $741.00 273.87 - 845.00 - 512.03 147.36 512.03 - 409.40 144.55 845.00 - - 490.47 126.31 140.34 56.26 70.32 143.85 144.55 140.34 592.80 128.41 - 496.47 123.50 303.07 555.75 281.65 331.45 145.25 29585831 UNL STRAPPING LOWER BACK 29799 420 $741.00 273.87 - 845.00 - 512.03 147.36 512.03 - 409.40 144.55 845.00 - - 490.47 126.31 140.34 56.26 70.32 143.85 144.55 140.34 592.80 128.41 - 496.47 123.50 303.07 555.75 281.65 331.45 145.25 31900085 UNL STRAPPING LOWER BACK 29799 420 $741.00 273.87 - 845.00 - 512.03 147.36 512.03 - 409.40 144.55 845.00 - - 490.47 126.31 140.34 56.26 70.32 143.85 144.55 140.34 592.80 128.41 - 496.47 123.50 303.07 555.75 281.65 331.45 145.25 64200992 UNL STRAPPING LOWER BACK 29799 420 $741.00 273.87 - 845.00 - 512.03 147.36 512.03 - 409.40 144.55 845.00 - - 490.47 126.31 140.34 56.26 70.32 143.85 144.55 140.34 592.80 128.41 - 496.47 123.50 303.07 555.75 281.65 331.45 145.25 28168331 SHO ARTHRS DX +- SYNOVIAL BX 29805 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 2,773.00 " " 2,953.81 " " 2,773.00 " 907.92 " 8,210.15 " " 2,897.54 " " 3,545.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,650.99 " " 3,313.74 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28168349 SHO ARTHRS SRG CAPSULORPAPHY 29806 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,650.99 " " 3,313.74 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28168357 SHO ARTHRS SRG RPR SLAP LES 29807 360 "$32,891.00" " 12,156.51 " 788.28 " 26,312.80 " 906.52 " 2,773.00 " " 6,533.13 " " 2,773.00 " 922.29 " 18,172.28 " " 6,408.69 " " 3,545.00 " 882.87 820.84 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,650.99 " " 3,313.74 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 788.28 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28168365 ARTHROSCOPY SHOULDER DEBRI LIM 29822 360 "$14,860.00" " 5,492.26 " 932.00 " 11,888.00 " " 1,071.80 " " 2,773.00 " " 2,953.81 " " 2,773.00 " " 1,090.44 " " 8,210.15 " " 2,897.54 " " 3,545.00 " " 1,043.84 " 970.49 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 932.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28168373 ARTHROSCOPY SHOULDER DEBRI EXT 29823 360 "$14,860.00" " 5,492.26 " 932.00 " 11,888.00 " " 1,071.80 " " 2,773.00 " " 2,953.81 " " 2,773.00 " " 1,090.44 " " 8,210.15 " " 2,897.54 " " 3,545.00 " " 1,043.84 " 970.49 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 932.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28168381 SHO ARTHRS SRG DSTL CLAVICLC 29824 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 3,604.00 " " 2,953.81 " " 3,604.00 " 907.92 " 8,210.15 " " 2,897.54 " " 4,445.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 3,727.42 " " 4,659.27 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28168390 SHO ARTHRS SRG LSS&RESCJ ADS 29825 360 "$14,860.00" " 5,492.26 " 932.00 " 11,888.00 " " 1,071.80 " " 2,773.00 " " 2,953.81 " " 2,773.00 " " 1,090.44 " " 8,210.15 " " 2,897.54 " " 3,545.00 " " 1,043.84 " 970.49 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 932.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28168403 SHO ARTHRS SRG DECOMPRESSION 29826 360 "$9,066.00" " 3,350.79 " - " 7,252.80 " 892.40 " 2,773.00 " - " 2,773.00 " 907.92 " 5,008.97 " - " 3,545.00 " 869.12 808.05 " 6,000.79 " - - " 2,532.97 " " 3,166.21 " - - - " 7,252.80 " - 776.00 " 6,074.22 " - " 3,707.99 " " 6,799.50 " " 3,445.99 " " 4,055.22 " - 28168411 SHO ARTHRS SRG RT8TR CUF RPR 29827 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 3,604.00 " " 6,533.13 " " 3,604.00 " 907.92 " 18,172.28 " " 6,408.69 " " 4,445.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 3,819.73 " " 4,774.66 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28168420 SHO ARTHRS SRG BICP TENODSIS 29828 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 6,576.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 4,491.24 " " 5,614.05 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28168438 WRIST ARTHROSCOPY 29840 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 2,773.00 " " 2,953.81 " " 2,773.00 " 907.92 " 8,210.15 " " 2,897.54 " " 3,545.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28168446 WRIST ARTHROSCOPY/SURGERY 29846 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 2,773.00 " " 2,953.81 " " 2,773.00 " 907.92 " 8,210.15 " " 2,897.54 " " 3,545.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28168454 WRIST ENDOSCOPY/SURGERY 29848 360 "$7,310.00" " 2,701.78 " 776.00 " 6,576.00 " 892.40 " 4,656.00 " " 1,452.77 " " 4,656.00 " 907.92 " 4,038.78 " " 1,425.10 " " 6,576.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 4,937.34 " " 6,171.67 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28168462 KNEE ARTHR/W/INT/EXT FIX 29851 360 "$7,310.00" " 2,701.78 " 776.00 " 5,848.00 " 892.40 " 3,326.00 " " 1,452.77 " " 3,326.00 " 907.92 " 4,038.78 " " 1,425.10 " " 4,860.00 " 869.12 808.05 " 4,838.49 " " 1,245.23 " " 1,383.59 " " 3,120.10 " " 3,900.12 " " 1,418.18 " " 1,425.10 " " 1,383.59 " " 5,848.00 " " 1,265.98 " 776.00 " 4,897.70 " " 1,217.56 " " 2,989.79 " " 5,482.50 " " 2,778.53 " " 3,269.76 " " 1,432.02 " 28175132 ARTHRO HIP W OR W/O BIOPSY 29860 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 3,326.00 " " 6,533.13 " " 3,326.00 " 907.92 " 18,172.28 " " 6,408.69 " " 4,860.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 3,356.30 " " 4,195.38 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28175141 ARTHROSCO OSTEONCHON AUTOGRF 29866 360 "$32,891.00" " 12,156.51 " - " 26,312.80 " - " 2,773.00 " " 6,533.13 " " 2,773.00 " - " 18,172.28 " " 6,408.69 " " 21,708.06 " - - " 21,770.55 " " 5,599.83 " " 6,222.03 " " 5,584.49 " " 6,980.61 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " - " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28175159 ARTHROSCO MENISCAL TSPLNT 29868 360 "$32,891.00" " 12,156.51 " - " 26,312.80 " - " 2,773.00 " " 6,533.13 " " 2,773.00 " - " 18,172.28 " " 6,408.69 " " 21,708.06 " - - " 21,770.55 " " 5,599.83 " " 6,222.03 " " 9,051.95 " " 11,314.94 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " - " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28168471 KNEE ARTHROSCOPY DX 29870 360 "$14,860.00" " 5,492.26 " 970.00 " 11,888.00 " " 1,115.50 " " 2,773.00 " " 2,953.81 " " 2,773.00 " " 1,134.90 " " 8,210.15 " " 2,897.54 " " 3,545.00 " " 1,086.40 " " 1,010.06 " " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 970.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28168489 KNEE ARTHROSCOPY/DRAINAGE 29871 360 "$14,860.00" " 5,492.26 " 932.00 " 11,888.00 " " 1,071.80 " " 2,773.00 " " 2,953.81 " " 2,773.00 " " 1,090.44 " " 8,210.15 " " 2,897.54 " " 3,545.00 " " 1,043.84 " 970.49 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 932.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28168497 ARTHROSCOPY KNEE REM LOOSE BOD 29874 360 "$14,860.00" " 5,492.26 " 932.00 " 11,888.00 " " 1,071.80 " " 2,773.00 " " 2,953.81 " " 2,773.00 " " 1,090.44 " " 8,210.15 " " 2,897.54 " " 3,545.00 " " 1,043.84 " 970.49 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 932.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28168501 ARTHROSCOPY KNEE SYNOVEC LIMIT 29875 360 "$14,860.00" " 5,492.26 " 932.00 " 11,888.00 " " 1,071.80 " " 3,326.00 " " 2,953.81 " " 3,326.00 " " 1,090.44 " " 8,210.15 " " 2,897.54 " " 4,860.00 " " 1,043.84 " 970.49 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 3,120.10 " " 3,900.12 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 932.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28168519 ARTHROSCOPY KNEE DEBRID CHONDR 29877 360 "$14,860.00" " 5,492.26 " 932.00 " 11,888.00 " " 1,071.80 " " 3,326.00 " " 2,953.81 " " 3,326.00 " " 1,090.44 " " 8,210.15 " " 2,897.54 " " 4,860.00 " " 1,043.84 " 970.49 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 3,120.10 " " 3,900.12 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 932.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28168527 ARTHROSCOPY KNEE ABRAS ARTHROP 29879 360 "$14,860.00" " 5,492.26 " 932.00 " 11,888.00 " " 1,071.80 " " 2,773.00 " " 2,953.81 " " 2,773.00 " " 1,090.44 " " 8,210.15 " " 2,897.54 " " 3,545.00 " " 1,043.84 " 970.49 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 932.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28168535 ARTH KNEE MENIS MED & LAT CART 29880 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 3,326.00 " " 2,953.81 " " 3,326.00 " 907.92 " 8,210.15 " " 2,897.54 " " 4,860.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 3,120.10 " " 3,900.12 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28168543 ARTH KNE MENIS MED OR LAT CART 29881 360 "$14,860.00" " 5,492.26 " 932.00 " 11,888.00 " " 1,071.80 " " 3,326.00 " " 2,953.81 " " 3,326.00 " " 1,090.44 " " 8,210.15 " " 2,897.54 " " 4,860.00 " " 1,043.84 " 970.49 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 3,120.10 " " 3,900.12 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 932.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28168551 ARTHRO KNEE MENISCEC MED & LAT 29882 360 "$14,860.00" " 5,492.26 " 932.00 " 11,888.00 " " 1,071.80 " " 2,773.00 " " 2,953.81 " " 2,773.00 " " 1,090.44 " " 8,210.15 " " 2,897.54 " " 3,545.00 " " 1,043.84 " 970.49 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 932.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28168560 ARTHRO KNEE MENISEC MED OR LAT 29883 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 2,773.00 " " 2,953.81 " " 2,773.00 " 907.92 " 8,210.15 " " 2,897.54 " " 3,545.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28175876 KNEE ARTHROSCOPY/SURGERY 29884 360 "$14,860.00" " 5,492.26 " 932.00 " 11,888.00 " " 1,071.80 " " 2,773.00 " " 2,953.81 " " 2,773.00 " " 1,090.44 " " 8,210.15 " " 2,897.54 " " 3,545.00 " " 1,043.84 " 970.49 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 932.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28168578 ARTH/DRIL/OSTEO/DIS W BNE GRFT 29885 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28168586 ARTHROSCOPY KNEE DRILL OST LES 29886 360 "$14,860.00" " 5,492.26 " 932.00 " 11,888.00 " " 1,071.80 " " 2,773.00 " " 2,953.81 " " 2,773.00 " " 1,090.44 " " 8,210.15 " " 2,897.54 " " 3,545.00 " " 1,043.84 " 970.49 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 932.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28168594 ARTHR KNEE DRILL OST LES W FIX 29887 360 "$32,891.00" " 12,156.51 " 932.00 " 26,312.80 " " 1,071.80 " " 2,773.00 " " 6,533.13 " " 2,773.00 " " 1,090.44 " " 18,172.28 " " 6,408.69 " " 3,545.00 " " 1,043.84 " 970.49 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 932.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28168608 ARTHRO ANT CRUC LIG REP RECON 29888 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 2,773.00 " " 6,533.13 " " 2,773.00 " 907.92 " 18,172.28 " " 6,408.69 " " 3,545.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,532.97 " " 3,166.21 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28168616 ARTHRO POST CRUC LIG REP RECON 29889 360 "$64,652.00" " 23,895.38 " 776.00 " 51,721.60 " 892.40 " 2,773.00 " " 12,861.18 " " 2,773.00 " 907.92 " 35,720.23 " " 12,616.20 " " 3,545.00 " 869.12 808.05 " 42,793.16 " " 11,023.87 " " 12,248.74 " " 2,532.97 " " 3,166.21 " " 12,554.96 " " 12,616.20 " " 12,248.74 " " 51,721.60 " " 11,207.60 " 776.00 " 43,316.84 " " 10,778.89 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,677.45 " 28168624 SCOPE PLANTAR FASCIOTOMY 29893 360 "$14,860.00" " 5,492.26 " 776.00 " 11,888.00 " 892.40 " 4,656.00 " " 2,953.81 " " 4,656.00 " 907.92 " 8,210.15 " " 2,897.54 " " 6,576.00 " 869.12 808.05 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 7,133.34 " " 8,916.67 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 776.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28168632 ARTHROSC ANKLE REM LOOSE BODY 29894 360 "$14,860.00" " 5,492.26 " 932.00 " 11,888.00 " " 1,071.80 " " 2,773.00 " " 2,953.81 " " 2,773.00 " " 1,090.44 " " 8,210.15 " " 2,897.54 " " 3,545.00 " " 1,043.84 " 970.49 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 932.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28168641 ARTHROSCOPY ANKLE SYNOV PAR 29895 360 "$14,860.00" " 5,492.26 " 932.00 " 11,888.00 " " 1,071.80 " " 2,773.00 " " 2,953.81 " " 2,773.00 " " 1,090.44 " " 8,210.15 " " 2,897.54 " " 3,545.00 " " 1,043.84 " 970.49 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 932.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28168659 ARTHROSCOPY ANKLE BEBRID EXT 29898 360 "$14,860.00" " 5,492.26 " 932.00 " 11,888.00 " " 1,071.80 " " 2,773.00 " " 2,953.81 " " 2,773.00 " " 1,090.44 " " 8,210.15 " " 2,897.54 " " 3,545.00 " " 1,043.84 " 970.49 " 9,835.83 " " 2,531.84 " " 2,813.15 " " 2,532.97 " " 3,166.21 " " 2,883.48 " " 2,897.54 " " 2,813.15 " " 11,888.00 " " 2,574.03 " 932.00 " 9,956.20 " " 2,475.57 " " 6,077.74 " " 11,145.00 " " 5,648.29 " " 6,646.88 " " 2,911.61 " 28168667 HIP ARTHRO W/FEMOROPLASTY 29914 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 3,326.00 " " 6,533.13 " " 3,326.00 " 907.92 " 18,172.28 " " 6,408.69 " " 6,576.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 5,749.03 " " 7,186.29 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28168675 HIP ARTHRO ACETABULOPLASTY 29915 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 3,326.00 " " 6,533.13 " " 3,326.00 " 907.92 " 18,172.28 " " 6,408.69 " " 6,576.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 5,857.15 " " 7,321.44 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28168683 HIP ARTHRO W/LABRAL REPAIR 29916 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 3,326.00 " " 6,533.13 " " 3,326.00 " 907.92 " 18,172.28 " " 6,408.69 " " 6,576.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 5,857.15 " " 7,321.44 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28168691 ARTHROSCOPY OF JOINT 29999 360 "$1,082.00" 399.91 - " 1,469.00 " - " 1,469.00 " 214.98 " 1,469.00 " - 597.81 210.88 714.12 - - 716.18 184.27 204.74 - - 209.86 210.88 204.74 865.60 187.34 - 724.94 180.17 442.54 811.50 411.27 483.98 211.91 37003824 DRAINAGE NOSE LESION 30000 450 "$1,111.00" 410.63 184.94 " 6,171.67 " 892.40 " 1,469.00 " 220.67 " 1,469.00 " 907.92 613.83 216.46 845.00 869.12 808.05 735.37 189.14 210.16 " 4,937.34 " " 6,171.67 " 215.41 216.46 210.16 888.80 192.30 776.00 744.37 184.94 454.40 833.25 422.29 496.95 217.52 28168705 INTRANASAL BIOPSY 30100 360 "$7,102.00" " 2,624.90 " 776.00 " 5,681.60 " 892.40 " 1,469.00 " " 1,410.93 " " 1,469.00 " 907.92 " 3,923.86 " " 1,384.05 " " 1,775.00 " 869.12 808.05 " 4,700.81 " " 1,209.37 " " 1,343.74 " " 3,730.57 " " 4,663.21 " " 1,377.33 " " 1,384.05 " " 1,343.74 " " 5,681.60 " " 1,229.52 " 776.00 " 4,758.34 " " 1,182.49 " " 2,904.72 " " 5,326.50 " " 2,699.47 " " 3,176.72 " " 1,390.77 " 28168713 REMOVAL OF INTRANASAL LESION 30117 360 "$14,366.00" " 5,309.67 " 615.00 " 11,492.80 " 707.25 " 2,773.00 " " 2,853.42 " " 2,773.00 " 719.55 " 7,937.22 " " 2,799.07 " " 3,545.00 " 688.80 640.40 " 9,508.86 " " 2,445.79 " " 2,717.54 " " 2,532.97 " " 3,166.21 " " 2,785.48 " " 2,799.07 " " 2,717.54 " " 11,492.80 " " 2,486.55 " 615.00 " 9,625.22 " " 2,391.44 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,812.65 " 28168721 REVISION OF NOSE 30120 360 "$14,366.00" " 5,309.67 " 776.00 " 11,492.80 " 892.40 " 1,469.00 " " 2,853.42 " " 1,469.00 " 907.92 " 7,937.22 " " 2,799.07 " " 1,775.00 " 869.12 808.05 " 9,508.86 " " 2,445.79 " " 2,717.54 " " 1,649.49 " " 2,061.86 " " 2,785.48 " " 2,799.07 " " 2,717.54 " " 11,492.80 " " 2,486.55 " 776.00 " 9,625.22 " " 2,391.44 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,812.65 " 28168730 EXCISE INFERIOR TURBINATE 30130 360 "$14,366.00" " 5,309.67 " 704.00 " 11,492.80 " 809.60 " 2,773.00 " " 2,853.42 " " 2,773.00 " 823.68 " 7,937.22 " " 2,799.07 " " 3,545.00 " 788.48 733.08 " 9,508.86 " " 2,445.79 " " 2,717.54 " " 2,532.97 " " 3,166.21 " " 2,785.48 " " 2,799.07 " " 2,717.54 " " 11,492.80 " " 2,486.55 " 704.00 " 9,625.22 " " 2,391.44 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,812.65 " 28168748 RESECT INFERIOR TURBINATE 30140 360 "$14,366.00" " 5,309.67 " 776.00 " 11,492.80 " 892.40 " 1,718.00 " " 2,853.42 " " 1,718.00 " 907.92 " 7,937.22 " " 2,799.07 " " 2,820.00 " 869.12 808.05 " 9,508.86 " " 2,445.79 " " 2,717.54 " " 2,208.66 " " 2,760.83 " " 2,785.48 " " 2,799.07 " " 2,717.54 " " 11,492.80 " " 2,486.55 " 776.00 " 9,625.22 " " 2,391.44 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,812.65 " 28168756 INSERT NASAL SEPTAL BUTTON 30220 360 "$7,102.00" " 2,624.90 " - " 5,681.60 " - " 2,773.00 " " 1,410.93 " " 2,773.00 " - " 3,923.86 " " 1,384.05 " " 3,545.00 " - - " 4,700.81 " " 1,209.37 " " 1,343.74 " 393.78 492.23 " 1,377.33 " " 1,384.05 " " 1,343.74 " " 5,681.60 " " 1,229.52 " - " 4,758.34 " " 1,182.49 " " 2,904.72 " " 5,326.50 " " 2,699.47 " " 3,176.72 " " 1,390.77 " 37089451 FOREIGN BODY REMOVAL NOSE 30300 450 $588.00 217.32 98.57 907.92 892.40 406.31 117.61 406.31 907.92 324.87 115.37 845.00 869.12 808.05 389.20 100.81 112.01 281.27 351.59 114.81 115.37 112.01 470.40 102.49 776.00 393.96 98.57 240.49 441.00 223.50 263.01 115.93 28168764 RHINOPLASTY COMPLETE 30410 360 "$26,702.00" " 9,869.06 " - " 21,361.60 " - " 3,604.00 " " 5,304.76 " " 3,604.00 " - " 14,752.86 " " 5,203.71 " " 4,445.00 " - - " 17,674.05 " " 4,546.94 " " 5,052.15 " " 3,730.57 " " 4,663.21 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " - " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28168772 RHINOPLASTY COMP/ SEPTIAL REP 30420 360 "$26,702.00" " 9,869.06 " - " 21,361.60 " - " 3,604.00 " " 5,304.76 " " 3,604.00 " - " 14,752.86 " " 5,203.71 " " 4,445.00 " - - " 17,674.05 " " 4,546.94 " " 5,052.15 " " 3,730.57 " " 4,663.21 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " - " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28168781 REPAIR NASAL STENOSIS 30465 360 "$26,702.00" " 9,869.06 " 776.00 " 21,361.60 " 892.40 " 4,656.00 " " 5,304.76 " " 4,656.00 " 907.92 " 14,752.86 " " 5,203.71 " " 6,576.00 " 869.12 808.05 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 7,133.34 " " 8,916.67 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 776.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28174730 REPAIR NASAL STENOSIS W/IMPLAN 30468 360 "$26,702.00" " 9,869.06 " 776.00 " 21,361.60 " 892.40 " 18,451.08 " " 5,304.76 " " 18,451.08 " 907.92 " 14,752.86 " " 5,203.71 " " 17,623.32 " 869.12 808.05 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 14,149.39 " " 17,687.40 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 776.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28168799 REPAIR OF NASAL SEPTUM 30520 360 "$14,366.00" " 5,309.67 " 823.00 " 11,492.80 " 946.45 " 3,326.00 " " 2,853.42 " " 3,326.00 " 962.91 " 7,937.22 " " 2,799.07 " " 4,860.00 " 921.76 856.99 " 9,508.86 " " 2,445.79 " " 2,717.54 " " 3,120.10 " " 3,900.12 " " 2,785.48 " " 2,799.07 " " 2,717.54 " " 11,492.80 " " 2,486.55 " 823.00 " 9,625.22 " " 2,391.44 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,812.65 " 28168802 RELEASE OF NASAL ADHESIONS 30560 360 "$2,375.00" 877.80 395.35 " 2,820.00 " " 1,536.40 " " 1,718.00 " 471.72 " 1,718.00 " " 1,563.12 " " 1,312.19 " 462.74 " 2,820.00 " " 1,496.32 " " 1,391.18 " " 1,572.01 " 404.33 449.26 " 2,208.66 " " 2,760.83 " 460.49 462.74 449.26 " 1,900.00 " 411.07 " 1,336.00 " " 1,591.25 " 395.35 971.38 " 1,781.25 " 902.74 " 1,062.34 " 464.98 28176341 REPAIR UPPER JAW FISTULA 30580 360 "$26,702.00" " 9,869.06 " 776.00 " 21,361.60 " 892.40 " 3,326.00 " " 5,304.76 " " 3,326.00 " 907.92 " 14,752.86 " " 5,203.71 " " 4,860.00 " 869.12 808.05 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 3,120.10 " " 3,900.12 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 776.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28168811 ABLATE INF TURBINATE SUPERF 30801 360 "$7,102.00" " 2,624.90 " 776.00 " 5,681.60 " 892.40 " 1,469.00 " " 1,410.93 " " 1,469.00 " 907.92 " 3,923.86 " " 1,384.05 " " 1,775.00 " 869.12 808.05 " 4,700.81 " " 1,209.37 " " 1,343.74 " " 1,649.49 " " 2,061.86 " " 1,377.33 " " 1,384.05 " " 1,343.74 " " 5,681.60 " " 1,229.52 " 776.00 " 4,758.34 " " 1,182.49 " " 2,904.72 " " 5,326.50 " " 2,699.47 " " 3,176.72 " " 1,390.77 " 28168829 ABLATE INF TURBINATE SUBMUC 30802 360 "$7,102.00" " 2,624.90 " 776.00 " 5,681.60 " 892.40 " 1,469.00 " " 1,410.93 " " 1,469.00 " 907.92 " 3,923.86 " " 1,384.05 " " 1,775.00 " 869.12 808.05 " 4,700.81 " " 1,209.37 " " 1,343.74 " " 1,649.49 " " 2,061.86 " " 1,377.33 " " 1,384.05 " " 1,343.74 " " 5,681.60 " " 1,229.52 " 776.00 " 4,758.34 " " 1,182.49 " " 2,904.72 " " 5,326.50 " " 2,699.47 " " 3,176.72 " " 1,390.77 " 28168837 CONTROL NOSEBLEED SIMPLE 30901 360 $588.00 217.32 98.57 " 1,469.00 " 892.40 " 1,469.00 " 117.61 " 1,469.00 " 907.92 324.87 115.37 845.00 869.12 808.05 389.20 100.81 112.01 393.78 492.23 114.81 115.37 112.01 470.40 102.49 776.00 393.96 98.57 240.49 441.00 223.50 263.01 115.93 37001317 CONTROL NOSEBLEED SIMPLE 30901 450 $588.00 217.32 98.57 " 1,469.00 " 892.40 " 1,469.00 " 117.61 " 1,469.00 " 907.92 324.87 115.37 845.00 869.12 808.05 389.20 100.81 112.01 393.78 492.23 114.81 115.37 112.01 470.40 102.49 776.00 393.96 98.57 240.49 441.00 223.50 263.01 115.93 28168845 CONTROL NOSEBLEED COMPLEX 30903 360 $588.00 217.32 98.57 " 2,061.86 " 456.55 " 1,469.00 " 117.61 " 1,469.00 " 464.49 324.87 115.37 " 1,775.00 " 444.64 413.40 389.20 100.81 112.01 " 1,649.49 " " 2,061.86 " 114.81 115.37 112.01 470.40 102.49 397.00 393.96 98.57 240.49 441.00 223.50 263.01 115.93 37001325 CONTROL NOSEBLEED COMPLEX 30903 450 $588.00 217.32 98.57 " 2,061.86 " 456.55 " 1,469.00 " 117.61 " 1,469.00 " 464.49 324.87 115.37 " 1,775.00 " 444.64 413.40 389.20 100.81 112.01 " 1,649.49 " " 2,061.86 " 114.81 115.37 112.01 470.40 102.49 397.00 393.96 98.57 240.49 441.00 223.50 263.01 115.93 37003565 CONTROL NASAL HEMORRHAGE INIT 30905 450 $588.00 217.32 98.57 " 2,061.86 " 892.40 " 1,469.00 " 117.61 " 1,469.00 " 907.92 324.87 115.37 " 1,775.00 " 869.12 808.05 389.20 100.81 112.01 " 1,649.49 " " 2,061.86 " 114.81 115.37 112.01 470.40 102.49 776.00 393.96 98.57 240.49 441.00 223.50 263.01 115.93 28168853 REPEAT CONTROL OF NOSEBLEED 30906 360 "$1,111.00" 410.63 184.94 " 2,061.86 " 892.40 " 1,469.00 " 220.67 " 1,469.00 " 907.92 613.83 216.46 " 1,775.00 " 869.12 808.05 735.37 189.14 210.16 " 1,649.49 " " 2,061.86 " 215.41 216.46 210.16 888.80 192.30 776.00 744.37 184.94 454.40 833.25 422.29 496.95 217.52 28175167 FRAC NASAL TURBINATES THERAP 30930 360 "$14,366.00" " 5,309.67 " 393.78 " 11,492.80 " " 1,254.65 " " 3,326.00 " " 2,853.42 " " 3,326.00 " " 1,276.47 " " 7,937.22 " " 2,799.07 " " 4,860.00 " " 1,221.92 " " 1,136.06 " " 9,508.86 " " 2,445.79 " " 2,717.54 " 393.78 492.23 " 2,785.48 " " 2,799.07 " " 2,717.54 " " 11,492.80 " " 2,486.55 " " 1,091.00 " " 9,625.22 " " 2,391.44 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,812.65 " 28168861 REMOVAL OF UPPER JAW 31230 360 "$2,147.00" 793.53 - " 10,953.36 " - " 1,483.58 " N/A " 1,483.58 " - " 1,186.22 " N/A " 1,417.02 " - N/A " 1,421.10 " - N/A " 8,762.69 " " 10,953.36 " N/A N/A N/A " 1,717.60 " N/A - " 1,438.49 " N/A 878.12 " 1,610.25 " 816.07 960.35 N/A 28168870 NASAL ENDOSCOPY DX 31231 360 $863.00 318.96 143.90 " 2,061.86 " 892.40 " 1,718.00 " 171.70 " 1,718.00 " 907.92 476.81 168.43 845.00 869.12 808.05 571.22 147.17 163.52 " 1,649.49 " " 2,061.86 " 167.61 168.43 163.52 690.40 149.62 776.00 578.21 143.90 352.97 647.25 328.03 386.02 169.24 28168888 "NASAL ENDO, W/ BX OR DEBRIB" 31237 360 "$7,856.00" " 2,903.58 " 776.00 " 6,284.80 " 892.40 " 1,718.00 " " 1,560.50 " " 1,718.00 " 907.92 " 4,340.44 " " 1,530.78 " " 2,820.00 " 869.12 808.05 " 5,199.89 " " 1,337.57 " " 1,486.19 " " 2,208.66 " " 2,760.83 " " 1,523.34 " " 1,530.78 " " 1,486.19 " " 6,284.80 " " 1,359.86 " 776.00 " 5,263.52 " " 1,307.85 " " 3,213.10 " " 5,892.00 " " 2,986.07 " " 3,513.99 " " 1,538.21 " 28168896 "NASAL ENDO, CTL OF EPISTAXIS" 31238 360 "$7,856.00" " 2,903.58 " 776.00 " 6,284.80 " 892.40 " 1,469.00 " " 1,560.50 " " 1,469.00 " 907.92 " 4,340.44 " " 1,530.78 " " 1,775.00 " 869.12 808.05 " 5,199.89 " " 1,337.57 " " 1,486.19 " " 1,649.49 " " 2,061.86 " " 1,523.34 " " 1,530.78 " " 1,486.19 " " 6,284.80 " " 1,359.86 " 776.00 " 5,263.52 " " 1,307.85 " " 3,213.10 " " 5,892.00 " " 2,986.07 " " 3,513.99 " " 1,538.21 " 28168900 NASAL/SINUS ENDO CONCHA BULLOS 31240 360 "$7,856.00" " 2,903.58 " 776.00 " 6,284.80 " 892.40 " 1,718.00 " " 1,560.50 " " 1,718.00 " 907.92 " 4,340.44 " " 1,530.78 " " 2,820.00 " 869.12 808.05 " 5,199.89 " " 1,337.57 " " 1,486.19 " " 2,208.66 " " 2,760.83 " " 1,523.34 " " 1,530.78 " " 1,486.19 " " 6,284.80 " " 1,359.86 " 776.00 " 5,263.52 " " 1,307.85 " " 3,213.10 " " 5,892.00 " " 2,986.07 " " 3,513.99 " " 1,538.21 " 28168918 NSL/SINS NDSC W/ARTERY LIG 31241 360 "$7,856.00" " 2,903.58 " - " 6,284.80 " - " 5,428.50 " " 1,560.50 " " 5,428.50 " - " 4,340.44 " " 1,530.78 " " 5,184.96 " - - " 5,199.89 " " 1,337.57 " " 1,486.19 " " 2,543.43 " " 3,179.29 " " 1,523.34 " " 1,530.78 " " 1,486.19 " " 6,284.80 " " 1,359.86 " - " 5,263.52 " " 1,307.85 " " 3,213.10 " " 5,892.00 " " 2,986.07 " " 3,513.99 " " 1,538.21 " 28175175 NAS END TOT W/FRNT SIN EXP TIS 31253 360 "$30,569.00" " 11,298.30 " 776.00 " 24,455.20 " 892.40 " 21,123.18 " " 6,074.00 " " 21,123.18 " 907.92 " 16,889.37 " " 5,958.30 " " 6,576.00 " 869.12 808.05 " 20,233.62 " " 5,206.28 " " 5,784.76 " " 2,849.74 " " 3,562.17 " " 5,929.38 " " 5,958.30 " " 5,784.76 " " 24,455.20 " " 5,293.06 " 776.00 " 20,481.23 " " 5,090.59 " " 12,502.72 " " 22,926.75 " " 11,619.28 " " 13,673.51 " " 5,987.23 " 28168926 NSL/SINS NDSC W/PRTL ETHMDCT 31254 360 "$30,569.00" " 11,298.30 " 776.00 " 24,455.20 " 892.40 " 2,773.00 " " 6,074.00 " " 2,773.00 " 907.92 " 16,889.37 " " 5,958.30 " " 3,545.00 " 869.12 808.05 " 20,233.62 " " 5,206.28 " " 5,784.76 " " 2,532.97 " " 3,166.21 " " 5,929.38 " " 5,958.30 " " 5,784.76 " " 24,455.20 " " 5,293.06 " 776.00 " 20,481.23 " " 5,090.59 " " 12,502.72 " " 22,926.75 " " 11,619.28 " " 13,673.51 " " 5,987.23 " 28168934 NSL/SINS NDSC W/TOT ETHMDCT 31255 360 "$30,569.00" " 11,298.30 " 776.00 " 24,455.20 " 892.40 " 3,604.00 " " 6,074.00 " " 3,604.00 " 907.92 " 16,889.37 " " 5,958.30 " " 4,445.00 " 869.12 808.05 " 20,233.62 " " 5,206.28 " " 5,784.76 " " 3,730.57 " " 4,663.21 " " 5,929.38 " " 5,958.30 " " 5,784.76 " " 24,455.20 " " 5,293.06 " 776.00 " 20,481.23 " " 5,090.59 " " 12,502.72 " " 22,926.75 " " 11,619.28 " " 13,673.51 " " 5,987.23 " 28168942 EXPLORATION MAXILLARY SINUS 31256 360 "$16,265.00" " 6,011.54 " 776.00 " 13,012.00 " 892.40 " 2,773.00 " " 3,230.87 " " 2,773.00 " 907.92 " 8,986.41 " " 3,169.33 " " 3,545.00 " 869.12 808.05 " 10,765.80 " " 2,769.32 " " 3,077.02 " " 2,532.97 " " 3,166.21 " " 3,153.95 " " 3,169.33 " " 3,077.02 " " 13,012.00 " " 2,815.47 " 776.00 " 10,897.55 " " 2,707.78 " " 6,652.39 " " 12,198.75 " " 6,182.33 " " 7,275.33 " " 3,184.72 " 28168951 NSL/SINS NDSC TOT W/SPHENDT 31257 360 "$30,569.00" " 11,298.30 " 776.00 " 24,455.20 " 892.40 " 21,123.18 " " 6,074.00 " " 21,123.18 " 907.92 " 16,889.37 " " 5,958.30 " " 6,576.00 " 869.12 808.05 " 20,233.62 " " 5,206.28 " " 5,784.76 " " 2,536.18 " " 3,170.22 " " 5,929.38 " " 5,958.30 " " 5,784.76 " " 24,455.20 " " 5,293.06 " 776.00 " 20,481.23 " " 5,090.59 " " 12,502.72 " " 22,926.75 " " 11,619.28 " " 13,673.51 " " 5,987.23 " 28168969 NSL/SINS NDSC SPHN TISS RMVL 31259 360 "$30,569.00" " 11,298.30 " 776.00 " 24,455.20 " 892.40 " 21,123.18 " " 6,074.00 " " 21,123.18 " 907.92 " 16,889.37 " " 5,958.30 " " 6,576.00 " 869.12 808.05 " 20,233.62 " " 5,206.28 " " 5,784.76 " " 2,688.90 " " 3,361.13 " " 5,929.38 " " 5,958.30 " " 5,784.76 " " 24,455.20 " " 5,293.06 " 776.00 " 20,481.23 " " 5,090.59 " " 12,502.72 " " 22,926.75 " " 11,619.28 " " 13,673.51 " " 5,987.23 " 28168977 ENDOSCOPY MAXILLARY SINUS 31267 360 "$30,569.00" " 11,298.30 " 776.00 " 24,455.20 " 892.40 " 2,773.00 " " 6,074.00 " " 2,773.00 " 907.92 " 16,889.37 " " 5,958.30 " " 3,545.00 " 869.12 808.05 " 20,233.62 " " 5,206.28 " " 5,784.76 " " 2,532.97 " " 3,166.21 " " 5,929.38 " " 5,958.30 " " 5,784.76 " " 24,455.20 " " 5,293.06 " 776.00 " 20,481.23 " " 5,090.59 " " 12,502.72 " " 22,926.75 " " 11,619.28 " " 13,673.51 " " 5,987.23 " 28168985 NSL/SINS NDSC FRNT TISS RMVL 31276 360 "$30,569.00" " 11,298.30 " 776.00 " 24,455.20 " 892.40 " 2,773.00 " " 6,074.00 " " 2,773.00 " 907.92 " 16,889.37 " " 5,958.30 " " 3,545.00 " 869.12 808.05 " 20,233.62 " " 5,206.28 " " 5,784.76 " " 2,532.97 " " 3,166.21 " " 5,929.38 " " 5,958.30 " " 5,784.76 " " 24,455.20 " " 5,293.06 " 776.00 " 20,481.23 " " 5,090.59 " " 12,502.72 " " 22,926.75 " " 11,619.28 " " 13,673.51 " " 5,987.23 " 28168993 NASAL/SINUS ENDO SPHENOID 31287 360 "$30,569.00" " 11,298.30 " 776.00 " 24,455.20 " 892.40 " 2,773.00 " " 6,074.00 " " 2,773.00 " 907.92 " 16,889.37 " " 5,958.30 " " 3,545.00 " 869.12 808.05 " 20,233.62 " " 5,206.28 " " 5,784.76 " " 2,532.97 " " 3,166.21 " " 5,929.38 " " 5,958.30 " " 5,784.76 " " 24,455.20 " " 5,293.06 " 776.00 " 20,481.23 " " 5,090.59 " " 12,502.72 " " 22,926.75 " " 11,619.28 " " 13,673.51 " " 5,987.23 " 28169001 NASAL/SINUS ENDO SPHEN TIS REM 31288 360 "$30,569.00" " 11,298.30 " 776.00 " 24,455.20 " 892.40 " 2,773.00 " " 6,074.00 " " 2,773.00 " 907.92 " 16,889.37 " " 5,958.30 " " 3,545.00 " 869.12 808.05 " 20,233.62 " " 5,206.28 " " 5,784.76 " " 2,532.97 " " 3,166.21 " " 5,929.38 " " 5,958.30 " " 5,784.76 " " 24,455.20 " " 5,293.06 " 776.00 " 20,481.23 " " 5,090.59 " " 12,502.72 " " 22,926.75 " " 11,619.28 " " 13,673.51 " " 5,987.23 " 28175183 NASAL/SINUS ENDOSCOPY 31290 360 "$2,792.00" " 1,031.92 " - " 3,166.21 " - " 2,773.00 " N/A " 2,773.00 " - " 1,542.58 " N/A " 1,842.72 " - N/A " 1,848.02 " - N/A " 2,532.97 " " 3,166.21 " N/A N/A N/A " 2,233.60 " N/A - " 1,870.64 " N/A " 1,141.93 " " 2,094.00 " " 1,061.24 " " 1,248.86 " N/A 28169019 NASAL/SINUS ENDO SPHEN CSF REP 31291 360 "$2,708.00" " 1,000.88 " - " 3,166.21 " - " 2,773.00 " N/A " 2,773.00 " - " 1,496.17 " N/A " 1,787.28 " - N/A " 1,792.43 " - N/A " 2,532.97 " " 3,166.21 " N/A N/A N/A " 2,166.40 " N/A - " 1,814.36 " N/A " 1,107.57 " " 2,031.00 " " 1,029.31 " " 1,211.29 " N/A 28169027 SINUS SURGERY PROCEDURE 31299 360 "$1,111.00" 410.63 - 888.80 - 767.70 220.67 767.70 - 613.83 216.46 733.26 - - 735.37 189.14 210.16 56.26 70.32 215.41 216.46 210.16 888.80 192.30 - 744.37 184.94 454.40 833.25 422.29 496.95 217.52 28169035 REMOVAL OF LARYNX 31360 360 "$4,284.00" " 1,583.37 " - " 8,925.75 " - " 2,960.24 " N/A " 2,960.24 " - " 2,366.91 " N/A " 2,827.44 " - N/A " 2,835.58 " - N/A " 7,140.60 " " 8,925.75 " N/A N/A N/A " 3,427.20 " N/A - " 2,870.28 " N/A " 1,752.16 " " 3,213.00 " " 1,628.35 " " 1,916.23 " N/A 24701743 ENDOTRACHEAL INTUBATION 31500 410 "$1,111.00" 410.63 184.94 " 2,061.86 " 892.40 " 1,469.00 " 220.67 " 1,469.00 " 907.92 613.83 216.46 " 1,775.00 " 869.12 808.05 735.37 189.14 210.16 " 1,649.49 " " 2,061.86 " 215.41 216.46 210.16 888.80 192.30 776.00 744.37 184.94 454.40 833.25 422.29 496.95 217.52 27000509 ENDOTRACHEAL INTUBATION 31500 370 "$1,111.00" 410.63 184.94 " 2,061.86 " 892.40 " 1,469.00 " 220.67 " 1,469.00 " 907.92 613.83 216.46 " 1,775.00 " 869.12 808.05 735.37 189.14 210.16 " 1,649.49 " " 2,061.86 " 215.41 216.46 210.16 888.80 192.30 776.00 744.37 184.94 454.40 833.25 422.29 496.95 217.52 28169043 ENDOTRACHEAL INTUBATION 31500 360 "$1,111.00" 410.63 184.94 " 2,061.86 " 892.40 " 1,469.00 " 220.67 " 1,469.00 " 907.92 613.83 216.46 " 1,775.00 " 869.12 808.05 735.37 189.14 210.16 " 1,649.49 " " 2,061.86 " 215.41 216.46 210.16 888.80 192.30 776.00 744.37 184.94 454.40 833.25 422.29 496.95 217.52 37001333 ENDOTRACHEAL INTUBATION 31500 450 "$1,111.00" 410.63 184.94 " 2,061.86 " 892.40 " 1,469.00 " 220.67 " 1,469.00 " 907.92 613.83 216.46 " 1,775.00 " 869.12 808.05 735.37 189.14 210.16 " 1,649.49 " " 2,061.86 " 215.41 216.46 210.16 888.80 192.30 776.00 744.37 184.94 454.40 833.25 422.29 496.95 217.52 24700356 CHANGE OF TRACHEOTOMY TUBE 31502 410 "$1,111.00" 410.63 - " 1,775.00 " - " 1,469.00 " 220.67 " 1,469.00 " - 613.83 216.46 " 1,775.00 " - - 735.37 189.14 210.16 281.27 351.59 215.41 216.46 210.16 888.80 192.30 - 744.37 184.94 454.40 833.25 422.29 496.95 217.52 28169051 CHANGE OF TRACHEOTOMY TUBE 31502 360 "$1,111.00" 410.63 - " 1,775.00 " - " 1,469.00 " 220.67 " 1,469.00 " - 613.83 216.46 " 1,775.00 " - - 735.37 189.14 210.16 281.27 351.59 215.41 216.46 210.16 888.80 192.30 - 744.37 184.94 454.40 833.25 422.29 496.95 217.52 37003069 CHANGE TRACHEOTOMY TUBE 31502 450 "$1,111.00" 410.63 - " 1,775.00 " - " 1,469.00 " 220.67 " 1,469.00 " - 613.83 216.46 " 1,775.00 " - - 735.37 189.14 210.16 281.27 351.59 215.41 216.46 210.16 888.80 192.30 - 744.37 184.94 454.40 833.25 422.29 496.95 217.52 28175191 LARYNGOSC DIR DIAG EXC NB 31525 360 "$7,856.00" " 2,903.58 " 746.00 " 6,284.80 " 857.90 " 1,469.00 " " 1,560.50 " " 1,469.00 " 872.82 " 4,340.44 " " 1,530.78 " " 1,775.00 " 835.52 776.81 " 5,199.89 " " 1,337.57 " " 1,486.19 " " 1,649.49 " " 2,061.86 " " 1,523.34 " " 1,530.78 " " 1,486.19 " " 6,284.80 " " 1,359.86 " 746.00 " 5,263.52 " " 1,307.85 " " 3,213.10 " " 5,892.00 " " 2,986.07 " " 3,513.99 " " 1,538.21 " 37003697 DX LARYNGOSCOPY DIRECT EXCL NB 31525 450 "$7,856.00" " 2,903.58 " 746.00 " 6,284.80 " 857.90 " 1,469.00 " " 1,560.50 " " 1,469.00 " 872.82 " 4,340.44 " " 1,530.78 " " 1,775.00 " 835.52 776.81 " 5,199.89 " " 1,337.57 " " 1,486.19 " " 1,649.49 " " 2,061.86 " " 1,523.34 " " 1,530.78 " " 1,486.19 " " 6,284.80 " " 1,359.86 " 746.00 " 5,263.52 " " 1,307.85 " " 3,213.10 " " 5,892.00 " " 2,986.07 " " 3,513.99 " " 1,538.21 " 28169060 DX LARYNGOSCOPY W/OPER SCOPE 31526 360 "$7,856.00" " 2,903.58 " 746.00 " 6,284.80 " 857.90 " 1,718.00 " " 1,560.50 " " 1,718.00 " 872.82 " 4,340.44 " " 1,530.78 " " 2,820.00 " 835.52 776.81 " 5,199.89 " " 1,337.57 " " 1,486.19 " " 2,208.66 " " 2,760.83 " " 1,523.34 " " 1,530.78 " " 1,486.19 " " 6,284.80 " " 1,359.86 " 746.00 " 5,263.52 " " 1,307.85 " " 3,213.10 " " 5,892.00 " " 2,986.07 " " 3,513.99 " " 1,538.21 " 28169078 LARYNGOSCOPY AND DILATION 31528 360 "$16,265.00" " 6,011.54 " 776.00 " 13,012.00 " 892.40 " 1,718.00 " " 3,230.87 " " 1,718.00 " 907.92 " 8,986.41 " " 3,169.33 " " 2,820.00 " 869.12 808.05 " 10,765.80 " " 2,769.32 " " 3,077.02 " " 2,208.66 " " 2,760.83 " " 3,153.95 " " 3,169.33 " " 3,077.02 " " 13,012.00 " " 2,815.47 " 776.00 " 10,897.55 " " 2,707.78 " " 6,652.39 " " 12,198.75 " " 6,182.33 " " 7,275.33 " " 3,184.72 " 28175205 LARYNGOSCOPY DIR W DILAT SUBS 31529 360 "$16,265.00" " 6,011.54 " 776.00 " 13,012.00 " 892.40 " 1,718.00 " " 3,230.87 " " 1,718.00 " 907.92 " 8,986.41 " " 3,169.33 " " 2,820.00 " 869.12 808.05 " 10,765.80 " " 2,769.32 " " 3,077.02 " " 2,208.66 " " 2,760.83 " " 3,153.95 " " 3,169.33 " " 3,077.02 " " 13,012.00 " " 2,815.47 " 776.00 " 10,897.55 " " 2,707.78 " " 6,652.39 " " 12,198.75 " " 6,182.33 " " 7,275.33 " " 3,184.72 " 28169086 LARYNGOSCOPY W/BIOPSY 31535 360 "$16,265.00" " 6,011.54 " 762.00 " 13,012.00 " 876.30 " 1,718.00 " " 3,230.87 " " 1,718.00 " 891.54 " 8,986.41 " " 3,169.33 " " 2,820.00 " 853.44 793.47 " 10,765.80 " " 2,769.32 " " 3,077.02 " " 2,208.66 " " 2,760.83 " " 3,153.95 " " 3,169.33 " " 3,077.02 " " 13,012.00 " " 2,815.47 " 762.00 " 10,897.55 " " 2,707.78 " " 6,652.39 " " 12,198.75 " " 6,182.33 " " 7,275.33 " " 3,184.72 " 28169094 LARYNGOSCOPY W/BX & OP SCOPE 31536 360 "$16,265.00" " 6,011.54 " 762.00 " 13,012.00 " 876.30 " 2,773.00 " " 3,230.87 " " 2,773.00 " 891.54 " 8,986.41 " " 3,169.33 " " 3,545.00 " 853.44 793.47 " 10,765.80 " " 2,769.32 " " 3,077.02 " " 2,532.97 " " 3,166.21 " " 3,153.95 " " 3,169.33 " " 3,077.02 " " 13,012.00 " " 2,815.47 " 762.00 " 10,897.55 " " 2,707.78 " " 6,652.39 " " 12,198.75 " " 6,182.33 " " 7,275.33 " " 3,184.72 " 28169108 LARYNSCOP W/TUMR EXC + SCOPE 31541 360 "$16,265.00" " 6,011.54 " " 1,036.00 " " 13,012.00 " " 1,191.40 " " 3,326.00 " " 3,230.87 " " 3,326.00 " " 1,212.12 " " 8,986.41 " " 3,169.33 " " 4,860.00 " " 1,160.32 " " 1,078.79 " " 10,765.80 " " 2,769.32 " " 3,077.02 " " 3,120.10 " " 3,900.12 " " 3,153.95 " " 3,169.33 " " 3,077.02 " " 13,012.00 " " 2,815.47 " " 1,036.00 " " 10,897.55 " " 2,707.78 " " 6,652.39 " " 12,198.75 " " 6,182.33 " " 7,275.33 " " 3,184.72 " 28169116 LARYNGOSCOP W/VC INJ + SCOPE 31571 360 "$16,265.00" " 6,011.54 " 776.00 " 13,012.00 " 892.40 " 1,718.00 " " 3,230.87 " " 1,718.00 " 907.92 " 8,986.41 " " 3,169.33 " " 2,820.00 " 869.12 808.05 " 10,765.80 " " 2,769.32 " " 3,077.02 " " 2,208.66 " " 2,760.83 " " 3,153.95 " " 3,169.33 " " 3,077.02 " " 13,012.00 " " 2,815.47 " 776.00 " 10,897.55 " " 2,707.78 " " 6,652.39 " " 12,198.75 " " 6,182.33 " " 7,275.33 " " 3,184.72 " 37003701 DIAGNOSTIC LARYNGOSCOPY 31575 450 $863.00 318.96 143.90 " 1,718.00 " 892.40 " 1,718.00 " 171.70 " 1,718.00 " 907.92 476.81 168.43 845.00 869.12 808.05 571.22 147.17 163.52 618.80 773.50 167.61 168.43 163.52 690.40 149.62 776.00 578.21 143.90 352.97 647.25 328.03 386.02 169.24 80010869 DIAGNOSTIC LARYNGOSCOPY 31575 750 $863.00 318.96 143.90 " 1,718.00 " 892.40 " 1,718.00 " 171.70 " 1,718.00 " 907.92 476.81 168.43 845.00 869.12 808.05 571.22 147.17 163.52 618.80 773.50 167.61 168.43 163.52 690.40 149.62 776.00 578.21 143.90 352.97 647.25 328.03 386.02 169.24 28169124 LARYNGOSCOPY WITH BIOPSY 31576 360 "$7,856.00" " 2,903.58 " 762.00 " 6,284.80 " 876.30 " 1,718.00 " " 1,560.50 " " 1,718.00 " 891.54 " 4,340.44 " " 1,530.78 " " 2,820.00 " 853.44 793.47 " 5,199.89 " " 1,337.57 " " 1,486.19 " " 2,208.66 " " 2,760.83 " " 1,523.34 " " 1,530.78 " " 1,486.19 " " 6,284.80 " " 1,359.86 " 762.00 " 5,263.52 " " 1,307.85 " " 3,213.10 " " 5,892.00 " " 2,986.07 " " 3,513.99 " " 1,538.21 " 28169132 LARYNGOPLASTY MEDIALIZATION 31591 360 "$26,702.00" " 9,869.06 " 776.00 " 21,361.60 " 892.40 " 18,451.08 " " 5,304.76 " " 18,451.08 " 907.92 " 14,752.86 " " 5,203.71 " " 17,623.32 " 869.12 808.05 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 5,834.82 " " 7,293.52 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 776.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 24770877 TRACHEOSTOMY (PLANNED) 31600 360 "$14,366.00" " 5,309.67 " 776.00 " 11,492.80 " 892.40 " 1,718.00 " " 2,853.42 " " 1,718.00 " 907.92 " 7,937.22 " " 2,799.07 " " 2,820.00 " 869.12 808.05 " 9,508.86 " " 2,445.79 " " 2,717.54 " " 2,208.66 " " 2,760.83 " " 2,785.48 " " 2,799.07 " " 2,717.54 " " 11,492.80 " " 2,486.55 " 776.00 " 9,625.22 " " 2,391.44 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,812.65 " 28169141 TRACHEOSTOMY (PLANNED) 31600 360 "$14,366.00" " 5,309.67 " 776.00 " 11,492.80 " 892.40 " 1,718.00 " " 2,853.42 " " 1,718.00 " 907.92 " 7,937.22 " " 2,799.07 " " 2,820.00 " 869.12 808.05 " 9,508.86 " " 2,445.79 " " 2,717.54 " " 2,208.66 " " 2,760.83 " " 2,785.48 " " 2,799.07 " " 2,717.54 " " 11,492.80 " " 2,486.55 " 776.00 " 9,625.22 " " 2,391.44 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,812.65 " 28175213 TRACHEOSTOMY EMERG TRNSTR 31603 360 "$7,102.00" " 2,624.90 " 776.00 " 5,681.60 " 892.40 " 1,469.00 " " 1,410.93 " " 1,469.00 " 907.92 " 3,923.86 " " 1,384.05 " " 1,775.00 " 869.12 808.05 " 4,700.81 " " 1,209.37 " " 1,343.74 " " 2,532.97 " " 3,166.21 " " 1,377.33 " " 1,384.05 " " 1,343.74 " " 5,681.60 " " 1,229.52 " 776.00 " 4,758.34 " " 1,182.49 " " 2,904.72 " " 5,326.50 " " 2,699.47 " " 3,176.72 " " 1,390.77 " 37089541 TRACHEOSTOMY EMERGENCY 31603 450 "$7,102.00" " 2,624.90 " 776.00 " 5,681.60 " 892.40 " 1,469.00 " " 1,410.93 " " 1,469.00 " 907.92 " 3,923.86 " " 1,384.05 " " 1,775.00 " 869.12 808.05 " 4,700.81 " " 1,209.37 " " 1,343.74 " " 2,532.97 " " 3,166.21 " " 1,377.33 " " 1,384.05 " " 1,343.74 " " 5,681.60 " " 1,229.52 " 776.00 " 4,758.34 " " 1,182.49 " " 2,904.72 " " 5,326.50 " " 2,699.47 " " 3,176.72 " " 1,390.77 " 28175221 SURGERY/SPEECH PROSTHESIS 31611 360 "$14,366.00" " 5,309.67 " 776.00 " 11,492.80 " 892.40 " 2,773.00 " " 2,853.42 " " 2,773.00 " 907.92 " 7,937.22 " " 2,799.07 " " 3,545.00 " 869.12 808.05 " 9,508.86 " " 2,445.79 " " 2,717.54 " " 2,532.97 " " 3,166.21 " " 2,785.48 " " 2,799.07 " " 2,717.54 " " 11,492.80 " " 2,486.55 " 776.00 " 9,625.22 " " 2,391.44 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,812.65 " 28169159 REPAIR WINDPIPE OPENING 31613 360 "$14,366.00" " 5,309.67 " 776.00 " 11,492.80 " 892.40 " 1,718.00 " " 2,853.42 " " 1,718.00 " 907.92 " 7,937.22 " " 2,799.07 " " 2,820.00 " 869.12 808.05 " 9,508.86 " " 2,445.79 " " 2,717.54 " " 2,208.66 " " 2,760.83 " " 2,785.48 " " 2,799.07 " " 2,717.54 " " 11,492.80 " " 2,486.55 " 776.00 " 9,625.22 " " 2,391.44 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,812.65 " 28169167 TRACHEOBRONCHOSCOPY VSLZTN 31615 360 "$2,375.00" 877.80 395.35 " 2,061.86 " 857.90 " 1,469.00 " 471.72 " 1,469.00 " 872.82 " 1,312.19 " 462.74 " 1,775.00 " 835.52 776.81 " 1,572.01 " 404.33 449.26 " 1,649.49 " " 2,061.86 " 460.49 462.74 449.26 " 1,900.00 " 411.07 746.00 " 1,591.25 " 395.35 971.38 " 1,781.25 " 902.74 " 1,062.34 " 464.98 34001235 TRACHEOBRONCHOSCOPY VSLZTN 31615 750 "$2,375.00" 877.80 395.35 " 2,061.86 " 857.90 " 1,469.00 " 471.72 " 1,469.00 " 872.82 " 1,312.19 " 462.74 " 1,775.00 " 835.52 776.81 " 1,572.01 " 404.33 449.26 " 1,649.49 " " 2,061.86 " 460.49 462.74 449.26 " 1,900.00 " 411.07 746.00 " 1,591.25 " 395.35 971.38 " 1,781.25 " 902.74 " 1,062.34 " 464.98 37090085 TRACHEOBRONCHOSCOPY VSLZTN 31615 450 "$2,375.00" 877.80 395.35 " 2,061.86 " 857.90 " 1,469.00 " 471.72 " 1,469.00 " 872.82 " 1,312.19 " 462.74 " 1,775.00 " 835.52 776.81 " 1,572.01 " 404.33 449.26 " 1,649.49 " " 2,061.86 " 460.49 462.74 449.26 " 1,900.00 " 411.07 746.00 " 1,591.25 " 395.35 971.38 " 1,781.25 " 902.74 " 1,062.34 " 464.98 28169175 DX BRONCHOSCOPY W/CELL WASHING 31622 360 "$7,856.00" " 2,903.58 " 655.00 " 6,284.80 " 753.25 " 1,469.00 " " 1,560.50 " " 1,469.00 " 766.35 " 4,340.44 " " 1,530.78 " " 1,775.00 " 733.60 682.05 " 5,199.89 " " 1,337.57 " " 1,486.19 " " 1,649.49 " " 2,061.86 " " 1,523.34 " " 1,530.78 " " 1,486.19 " " 6,284.80 " " 1,359.86 " 655.00 " 5,263.52 " " 1,307.85 " " 3,213.10 " " 5,892.00 " " 2,986.07 " " 3,513.99 " " 1,538.21 " 34001243 DX BRONCHOSCOPY W/CELL WASHING 31622 750 "$7,856.00" " 2,903.58 " 655.00 " 6,284.80 " 753.25 " 1,469.00 " " 1,560.50 " " 1,469.00 " 766.35 " 4,340.44 " " 1,530.78 " " 1,775.00 " 733.60 682.05 " 5,199.89 " " 1,337.57 " " 1,486.19 " " 1,649.49 " " 2,061.86 " " 1,523.34 " " 1,530.78 " " 1,486.19 " " 6,284.80 " " 1,359.86 " 655.00 " 5,263.52 " " 1,307.85 " " 3,213.10 " " 5,892.00 " " 2,986.07 " " 3,513.99 " " 1,538.21 " 34001201 DX BRONCHOSCOPE/BRUSH 31623 750 "$7,856.00" " 2,903.58 " 776.00 " 6,284.80 " 892.40 " 1,718.00 " " 1,560.50 " " 1,718.00 " 907.92 " 4,340.44 " " 1,530.78 " " 2,820.00 " 869.12 808.05 " 5,199.89 " " 1,337.57 " " 1,486.19 " " 2,376.02 " " 2,970.02 " " 1,523.34 " " 1,530.78 " " 1,486.19 " " 6,284.80 " " 1,359.86 " 776.00 " 5,263.52 " " 1,307.85 " " 3,213.10 " " 5,892.00 " " 2,986.07 " " 3,513.99 " " 1,538.21 " 34001219 DX BRONCHOSCOPE/LAVAGE 31624 750 "$7,856.00" " 2,903.58 " 776.00 " 6,284.80 " 892.40 " 1,718.00 " " 1,560.50 " " 1,718.00 " 907.92 " 4,340.44 " " 1,530.78 " " 2,820.00 " 869.12 808.05 " 5,199.89 " " 1,337.57 " " 1,486.19 " " 2,376.02 " " 2,970.02 " " 1,523.34 " " 1,530.78 " " 1,486.19 " " 6,284.80 " " 1,359.86 " 776.00 " 5,263.52 " " 1,307.85 " " 3,213.10 " " 5,892.00 " " 2,986.07 " " 3,513.99 " " 1,538.21 " 28175230 BRONCHOSCOPY W/BIOPSY(S) 31625 360 "$7,856.00" " 2,903.58 " 664.00 " 6,284.80 " 763.60 " 1,718.00 " " 1,560.50 " " 1,718.00 " 776.88 " 4,340.44 " " 1,530.78 " " 2,820.00 " 743.68 691.42 " 5,199.89 " " 1,337.57 " " 1,486.19 " " 2,208.66 " " 2,760.83 " " 1,523.34 " " 1,530.78 " " 1,486.19 " " 6,284.80 " " 1,359.86 " 664.00 " 5,263.52 " " 1,307.85 " " 3,213.10 " " 5,892.00 " " 2,986.07 " " 3,513.99 " " 1,538.21 " 34001227 BRONCHOSCOPY W/BIOPSY(S) 31625 750 "$7,856.00" " 2,903.58 " 664.00 " 6,284.80 " 763.60 " 1,718.00 " " 1,560.50 " " 1,718.00 " 776.88 " 4,340.44 " " 1,530.78 " " 2,820.00 " 743.68 691.42 " 5,199.89 " " 1,337.57 " " 1,486.19 " " 2,208.66 " " 2,760.83 " " 1,523.34 " " 1,530.78 " " 1,486.19 " " 6,284.80 " " 1,359.86 " 664.00 " 5,263.52 " " 1,307.85 " " 3,213.10 " " 5,892.00 " " 2,986.07 " " 3,513.99 " " 1,538.21 " 34054762 BRONCH/FLURO+COMP ASST NAV 31627 750 "$3,380.00" " 1,249.25 " - " 7,617.62 " - " 1,469.00 " - " 1,469.00 " - " 1,867.45 " - " 2,230.80 " - - " 2,237.22 " - - " 6,094.10 " " 7,617.62 " - - - " 2,704.00 " - - " 2,264.60 " - " 1,382.42 " " 2,535.00 " " 1,284.74 " " 1,511.87 " - 34054266 BRONCH/FLURO+LUNG BX(S) EA 31628 750 "$16,265.00" " 6,011.54 " 767.00 " 13,012.00 " 882.05 " 1,718.00 " " 3,230.87 " " 1,718.00 " 897.39 " 8,986.41 " " 3,169.33 " " 2,820.00 " 859.04 798.68 " 10,765.80 " " 2,769.32 " " 3,077.02 " " 2,208.66 " " 2,760.83 " " 3,153.95 " " 3,169.33 " " 3,077.02 " " 13,012.00 " " 2,815.47 " 767.00 " 10,897.55 " " 2,707.78 " " 6,652.39 " " 12,198.75 " " 6,182.33 " " 7,275.33 " " 3,184.72 " 34001286 BRONCH/FLURO+NDL BX EA 31629 750 "$16,265.00" " 6,011.54 " 776.00 " 13,012.00 " 892.40 " 1,718.00 " " 3,230.87 " " 1,718.00 " 907.92 " 8,986.41 " " 3,169.33 " " 2,820.00 " 869.12 808.05 " 10,765.80 " " 2,769.32 " " 3,077.02 " " 2,208.66 " " 2,760.83 " " 3,153.95 " " 3,169.33 " " 3,077.02 " " 13,012.00 " " 2,815.47 " 776.00 " 10,897.55 " " 2,707.78 " " 6,652.39 " " 12,198.75 " " 6,182.33 " " 7,275.33 " " 3,184.72 " 34054801 BRONCH/FLURO+DILATE/FX REPR 31630 750 "$16,265.00" " 6,011.54 " 776.00 " 13,012.00 " 892.40 " 1,718.00 " " 3,230.87 " " 1,718.00 " 907.92 " 8,986.41 " " 3,169.33 " " 2,820.00 " 869.12 808.05 " 10,765.80 " " 2,769.32 " " 3,077.02 " " 2,208.66 " " 2,760.83 " " 3,153.95 " " 3,169.33 " " 3,077.02 " " 13,012.00 " " 2,815.47 " 776.00 " 10,897.55 " " 2,707.78 " " 6,652.39 " " 12,198.75 " " 6,182.33 " " 7,275.33 " " 3,184.72 " 34001251 BRONCH/FLURO+DILATE W/STENT 31631 750 "$30,569.00" " 11,298.30 " 213.75 " 24,455.20 " 245.81 " 1,718.00 " " 6,074.00 " " 1,718.00 " 250.09 " 16,889.37 " " 5,958.30 " " 2,820.00 " 239.40 222.58 " 20,233.62 " " 5,206.28 " " 5,784.76 " " 2,208.66 " " 2,760.83 " " 5,929.38 " " 5,958.30 " " 5,784.76 " " 24,455.20 " " 5,293.06 " 213.75 " 20,481.23 " " 5,090.59 " " 12,502.72 " " 22,926.75 " " 11,619.28 " " 13,673.51 " " 5,987.23 " 34001383 BRONCH/FLURO+LUNG BX(S) ADDL 31632 750 "$2,744.00" " 1,014.18 " - " 2,820.00 " 58.06 " 1,718.00 " - " 1,718.00 " 59.07 " 1,516.06 " - " 2,820.00 " 56.55 52.58 " 1,816.25 " - - 410.43 513.04 - - - " 2,195.20 " - 50.49 " 1,838.48 " - " 1,122.30 " " 2,058.00 " " 1,042.99 " " 1,227.39 " - 34001391 BRONCH/FLURO+NDL BX ADDL 31633 750 "$2,744.00" " 1,014.18 " - " 2,820.00 " 71.39 " 1,718.00 " - " 1,718.00 " 72.63 " 1,516.06 " - " 2,820.00 " 69.53 64.64 " 1,816.25 " - - 490.26 612.82 - - - " 2,195.20 " - 62.08 " 1,838.48 " - " 1,122.30 " " 2,058.00 " " 1,042.99 " " 1,227.39 " - 34001278 BRONCH/FLURO+FB REMOVAL 31635 750 "$7,856.00" " 2,903.58 " 776.00 " 6,284.80 " 892.40 " 1,718.00 " " 1,560.50 " " 1,718.00 " 907.92 " 4,340.44 " " 1,530.78 " " 2,820.00 " 869.12 808.05 " 5,199.89 " " 1,337.57 " " 1,486.19 " " 2,208.66 " " 2,760.83 " " 1,523.34 " " 1,530.78 " " 1,486.19 " " 6,284.80 " " 1,359.86 " 776.00 " 5,263.52 " " 1,307.85 " " 3,213.10 " " 5,892.00 " " 2,986.07 " " 3,513.99 " " 1,538.21 " 34054959 BRONCH/FLURO+BRONCH STENT 31636 750 "$30,569.00" " 11,298.30 " 776.00 " 24,455.20 " 892.40 " 1,718.00 " " 6,074.00 " " 1,718.00 " 907.92 " 16,889.37 " " 5,958.30 " " 2,820.00 " 869.12 808.05 " 20,233.62 " " 5,206.28 " " 5,784.76 " " 1,313.71 " " 1,642.14 " " 5,929.38 " " 5,958.30 " " 5,784.76 " " 24,455.20 " " 5,293.06 " 776.00 " 20,481.23 " " 5,090.59 " " 12,502.72 " " 22,926.75 " " 11,619.28 " " 13,673.51 " " 5,987.23 " 34001316 BRONCH/FLURO+TREAT BLOCKAGE 31641 750 "$16,265.00" " 6,011.54 " 776.00 " 13,012.00 " 892.40 " 1,718.00 " " 3,230.87 " " 1,718.00 " 907.92 " 8,986.41 " " 3,169.33 " " 2,820.00 " 869.12 808.05 " 10,765.80 " " 2,769.32 " " 3,077.02 " " 2,208.66 " " 2,760.83 " " 3,153.95 " " 3,169.33 " " 3,077.02 " " 13,012.00 " " 2,815.47 " 776.00 " 10,897.55 " " 2,707.78 " " 6,652.39 " " 12,198.75 " " 6,182.33 " " 7,275.33 " " 3,184.72 " 34001308 BRONCH/FLURO+CATH PLCMNT 31643 750 "$7,856.00" " 2,903.58 " 163.41 " 6,284.80 " 187.92 " 1,718.00 " " 1,560.50 " " 1,718.00 " 191.19 " 4,340.44 " " 1,530.78 " " 2,820.00 " 183.02 170.16 " 5,199.89 " " 1,337.57 " " 1,486.19 " " 2,376.02 " " 2,970.02 " " 1,523.34 " " 1,530.78 " " 1,486.19 " " 6,284.80 " " 1,359.86 " 163.41 " 5,263.52 " " 1,307.85 " " 3,213.10 " " 5,892.00 " " 2,986.07 " " 3,513.99 " " 1,538.21 " 34001294 BRONCH/FLURO+ASPIR INITIAL 31645 750 "$7,856.00" " 2,903.58 " 776.00 " 6,284.80 " 892.40 " 1,469.00 " " 1,560.50 " " 1,469.00 " 907.92 " 4,340.44 " " 1,530.78 " " 1,775.00 " 869.12 808.05 " 5,199.89 " " 1,337.57 " " 1,486.19 " " 1,649.49 " " 2,061.86 " " 1,523.34 " " 1,530.78 " " 1,486.19 " " 6,284.80 " " 1,359.86 " 776.00 " 5,263.52 " " 1,307.85 " " 3,213.10 " " 5,892.00 " " 2,986.07 " " 3,513.99 " " 1,538.21 " 34001260 BRONCH/FLURO+ASPIR SUB 1 STAY 31646 750 "$1,977.00" 730.70 128.44 " 2,061.86 " 147.71 " 1,469.00 " 392.05 " 1,469.00 " 150.27 " 1,092.29 " 384.58 " 1,775.00 " 143.85 133.74 " 1,308.58 " 336.04 373.38 " 1,649.49 " " 2,061.86 " 382.71 384.58 373.38 " 1,581.60 " 341.64 128.44 " 1,324.59 " 328.57 808.59 " 1,482.75 " 751.46 884.31 386.45 28175248 BRONCH EBUS SAMPLNG 1/2 NODE 31652 360 "$16,265.00" " 6,011.54 " 776.00 " 13,012.00 " 892.40 " 11,239.12 " " 3,230.87 " " 11,239.12 " 907.92 " 8,986.41 " " 3,169.33 " " 6,576.00 " 869.12 808.05 " 10,765.80 " " 2,769.32 " " 3,077.02 " " 4,883.10 " " 6,103.88 " " 3,153.95 " " 3,169.33 " " 3,077.02 " " 13,012.00 " " 2,815.47 " 776.00 " 10,897.55 " " 2,707.78 " " 6,652.39 " " 12,198.75 " " 6,182.33 " " 7,275.33 " " 3,184.72 " 34001588 BRONCH EBUS SAMPLNG 1/2 NODE 31652 750 "$16,265.00" " 6,011.54 " 776.00 " 13,012.00 " 892.40 " 11,239.12 " " 3,230.87 " " 11,239.12 " 907.92 " 8,986.41 " " 3,169.33 " " 6,576.00 " 869.12 808.05 " 10,765.80 " " 2,769.32 " " 3,077.02 " " 4,883.10 " " 6,103.88 " " 3,153.95 " " 3,169.33 " " 3,077.02 " " 13,012.00 " " 2,815.47 " 776.00 " 10,897.55 " " 2,707.78 " " 6,652.39 " " 12,198.75 " " 6,182.33 " " 7,275.33 " " 3,184.72 " 34001596 BRONCH EBUS SAMPLNG 3/> NODE 31653 750 "$16,265.00" " 6,011.54 " 776.00 " 13,012.00 " 892.40 " 11,239.12 " " 3,230.87 " " 11,239.12 " 907.92 " 8,986.41 " " 3,169.33 " " 6,576.00 " 869.12 808.05 " 10,765.80 " " 2,769.32 " " 3,077.02 " " 5,193.97 " " 6,492.46 " " 3,153.95 " " 3,169.33 " " 3,077.02 " " 13,012.00 " " 2,815.47 " 776.00 " 10,897.55 " " 2,707.78 " " 6,652.39 " " 12,198.75 " " 6,182.33 " " 7,275.33 " " 3,184.72 " 34001600 BRONCH EBUS IVNTJ PERPH LES 31654 750 "$4,803.00" " 1,775.19 " - " 3,842.40 " 63.19 " 3,318.87 " - " 3,318.87 " 64.29 " 2,653.66 " - " 2,820.00 " 61.54 57.22 " 3,179.11 " - - 788.69 985.86 - - - " 3,842.40 " - 54.95 " 3,218.01 " - " 1,964.43 " " 3,602.25 " " 1,825.62 " " 2,148.38 " - 24701735 TRACHEOBRONCH BEDSIDE INTUBAT 31725 410 $536.00 198.11 - " 2,061.86 " - " 1,469.00 " N/A " 1,469.00 " - 296.14 N/A 353.76 - N/A 354.78 - N/A " 1,649.49 " " 2,061.86 " N/A N/A N/A 428.80 N/A - 359.12 N/A 219.22 402.00 203.73 239.75 N/A 28175256 ROBOT BRNCHPLSTY W/ PLEUR FLAP 31899 360 $863.00 318.96 - 690.40 - 596.33 171.70 596.33 - 476.81 168.43 569.58 - - 571.22 147.17 163.52 56.26 70.32 167.61 168.43 163.52 690.40 149.62 - 578.21 143.90 352.97 647.25 328.03 386.02 169.24 34001545 UNL PROC:TRACHEA/BRONCI 31899 750 $863.00 318.96 - 690.40 - 596.33 171.70 596.33 - 476.81 168.43 569.58 - - 571.22 147.17 163.52 56.26 70.32 167.61 168.43 163.52 690.40 149.62 - 578.21 143.90 352.97 647.25 328.03 386.02 169.24 28176741 OPEN BIOPSY OF LUNG PLEURA 32098 360 "$11,153.00" " 4,122.15 " - " 8,922.40 " - " 7,706.72 " N/A " 7,706.72 " - " 6,162.03 " N/A " 7,360.98 " - N/A " 7,382.17 " - N/A " 2,960.22 " " 3,700.27 " N/A N/A N/A " 8,922.40 " N/A - " 7,472.51 " N/A " 4,561.58 " " 8,364.75 " " 4,239.26 " " 4,988.74 " N/A 28169183 EXPLORATION OF CHEST 32100 360 "$1,603.00" 592.47 - " 6,428.75 " - " 1,107.67 " N/A " 1,107.67 " - 885.66 N/A " 1,057.98 " - N/A " 1,061.03 " - N/A " 5,143.00 " " 6,428.75 " N/A N/A N/A " 1,282.40 " N/A - " 1,074.01 " N/A 655.63 " 1,202.25 " 609.30 717.02 N/A 28169191 EXPLORE/REPAIR CHEST 32110 360 "$2,462.00" 909.96 - " 9,412.77 " - " 1,701.24 " N/A " 1,701.24 " - " 1,360.26 " N/A " 1,624.92 " - N/A " 1,629.60 " - N/A " 7,530.22 " " 9,412.77 " N/A N/A N/A " 1,969.60 " N/A - " 1,649.54 " N/A " 1,006.96 " " 1,846.50 " 935.81 " 1,101.25 " N/A 28169205 RE-EXPLORATION OF CHEST 32120 360 "$15,548.00" " 5,746.54 " - " 12,438.40 " - " 10,743.67 " N/A " 10,743.67 " - " 8,590.27 " N/A " 10,261.68 " - N/A " 10,291.22 " - N/A " 4,113.26 " " 5,141.58 " N/A N/A N/A " 12,438.40 " N/A - " 10,417.16 " N/A " 6,359.13 " " 11,661.00 " " 5,909.79 " " 6,954.62 " N/A 67709594 BX PLEURA PERCUTANEOUS NDL 32400 350 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,469.00 " " 1,467.55 " " 1,469.00 " 907.92 " 4,081.32 " " 1,439.60 " " 1,775.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 80309597 BX PLEURA PERCUTANEOUS NDL 32400 320 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,469.00 " " 1,467.55 " " 1,469.00 " 907.92 " 4,081.32 " " 1,439.60 " " 1,775.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 80609591 BX PLEURA PERCUTANEOUS NDL 32400 350 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,469.00 " " 1,467.55 " " 1,469.00 " 907.92 " 4,081.32 " " 1,439.60 " " 1,775.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 67709608 BX LUNG/MEDIASTINUM PERC 32405 350 "$1,628.00" 601.71 - " 2,061.86 " - " 1,469.00 " N/A " 1,469.00 " - 899.47 N/A " 1,775.00 " - N/A " 1,077.57 " - N/A " 1,649.49 " " 2,061.86 " N/A N/A N/A " 1,302.40 " N/A - " 1,090.76 " N/A 665.85 " 1,221.00 " 618.80 728.20 N/A 80309601 BX LUNG/MEDIASTINUM PERC 32405 320 "$1,628.00" 601.71 - " 2,061.86 " - " 1,469.00 " N/A " 1,469.00 " - 899.47 N/A " 1,775.00 " - N/A " 1,077.57 " - N/A " 1,649.49 " " 2,061.86 " N/A N/A N/A " 1,302.40 " N/A - " 1,090.76 " N/A 665.85 " 1,221.00 " 618.80 728.20 N/A 80609604 BX LUNG/MEDIASTINUM PERC 32405 350 "$1,628.00" 601.71 - " 2,061.86 " - " 1,469.00 " N/A " 1,469.00 " - 899.47 N/A " 1,775.00 " - N/A " 1,077.57 " - N/A " 1,649.49 " " 2,061.86 " N/A N/A N/A " 1,302.40 " N/A - " 1,090.76 " N/A 665.85 " 1,221.00 " 618.80 728.20 N/A 67738381 CORE NDL BX LNG/MED PERQ 32408 350 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 5,104.42 " " 1,467.55 " " 5,104.42 " 907.92 " 4,081.32 " " 1,439.60 " " 4,875.42 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 3,914.37 " " 4,893.15 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 80338384 CORE NDL BX LNG/MED PERQ 32408 320 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 5,104.42 " " 1,467.55 " " 5,104.42 " 907.92 " 4,081.32 " " 1,439.60 " " 4,875.42 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 3,914.37 " " 4,893.15 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 80638388 CORE NDL BX LNG/MED PERQ 32408 350 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 5,104.42 " " 1,467.55 " " 5,104.42 " 907.92 " 4,081.32 " " 1,439.60 " " 4,875.42 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 3,914.37 " " 4,893.15 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 80327293 INSERT PLEURAL CATH W/CUFF 32550 320 "$16,713.00" " 6,177.12 " 776.00 " 13,370.40 " 892.40 " 1,718.00 " " 3,318.47 " " 1,718.00 " 907.92 " 9,233.93 " " 3,255.26 " " 6,576.00 " 869.12 808.05 " 11,062.33 " " 2,844.41 " " 3,160.45 " " 4,291.87 " " 5,364.84 " " 3,239.46 " " 3,255.26 " " 3,160.45 " " 13,370.40 " " 2,891.81 " 776.00 " 11,197.71 " " 2,781.20 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,271.07 " 80627297 INSERT PLEURAL CATH W/CUFF 32550 350 "$16,713.00" " 6,177.12 " 776.00 " 13,370.40 " 892.40 " 1,718.00 " " 3,318.47 " " 1,718.00 " 907.92 " 9,233.93 " " 3,255.26 " " 6,576.00 " 869.12 808.05 " 11,062.33 " " 2,844.41 " " 3,160.45 " " 4,291.87 " " 5,364.84 " " 3,239.46 " " 3,255.26 " " 3,160.45 " " 13,370.40 " " 2,891.81 " 776.00 " 11,197.71 " " 2,781.20 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,271.07 " 28169213 INSERT CHEST TUBE 32551 360 "$7,382.00" " 2,728.39 " 776.00 " 5,905.60 " 892.40 " 1,718.00 " " 1,466.71 " " 1,718.00 " 907.92 " 4,078.56 " " 1,438.78 " " 1,775.00 " 869.12 808.05 " 4,886.15 " " 1,257.18 " " 1,396.87 " 934.95 " 1,168.69 " " 1,431.79 " " 1,438.78 " " 1,396.87 " " 5,905.60 " " 1,278.14 " 776.00 " 4,945.94 " " 1,229.25 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,445.76 " 37001350 INSERT CHEST TUBE 32551 450 "$7,382.00" " 2,728.39 " 776.00 " 5,905.60 " 892.40 " 1,718.00 " " 1,466.71 " " 1,718.00 " 907.92 " 4,078.56 " " 1,438.78 " " 1,775.00 " 869.12 808.05 " 4,886.15 " " 1,257.18 " " 1,396.87 " 934.95 " 1,168.69 " " 1,431.79 " " 1,438.78 " " 1,396.87 " " 5,905.60 " " 1,278.14 " 776.00 " 4,945.94 " " 1,229.25 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,445.76 " 67709667 INSERT CHEST TUBE 32551 350 "$7,382.00" " 2,728.39 " 776.00 " 5,905.60 " 892.40 " 1,718.00 " " 1,466.71 " " 1,718.00 " 907.92 " 4,078.56 " " 1,438.78 " " 1,775.00 " 869.12 808.05 " 4,886.15 " " 1,257.18 " " 1,396.87 " 934.95 " 1,168.69 " " 1,431.79 " " 1,438.78 " " 1,396.87 " " 5,905.60 " " 1,278.14 " 776.00 " 4,945.94 " " 1,229.25 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,445.76 " 80309660 INSERT CHEST TUBE 32551 320 "$7,382.00" " 2,728.39 " 776.00 " 5,905.60 " 892.40 " 1,718.00 " " 1,466.71 " " 1,718.00 " 907.92 " 4,078.56 " " 1,438.78 " " 1,775.00 " 869.12 808.05 " 4,886.15 " " 1,257.18 " " 1,396.87 " 934.95 " 1,168.69 " " 1,431.79 " " 1,438.78 " " 1,396.87 " " 5,905.60 " " 1,278.14 " 776.00 " 4,945.94 " " 1,229.25 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,445.76 " 80609663 INSERT CHEST TUBE 32551 350 "$7,382.00" " 2,728.39 " 776.00 " 5,905.60 " 892.40 " 1,718.00 " " 1,466.71 " " 1,718.00 " 907.92 " 4,078.56 " " 1,438.78 " " 1,775.00 " 869.12 808.05 " 4,886.15 " " 1,257.18 " " 1,396.87 " 934.95 " 1,168.69 " " 1,431.79 " " 1,438.78 " " 1,396.87 " " 5,905.60 " " 1,278.14 " 776.00 " 4,945.94 " " 1,229.25 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,445.76 " 80329016 REMOVE LUNG CATHETER 32552 320 "$2,844.00" " 1,051.14 " 472.51 " 2,275.20 " 892.40 " 1,469.00 " 563.79 " 1,469.00 " 907.92 " 1,571.31 " 553.05 845.00 869.12 808.05 " 1,882.44 " 483.25 536.94 988.95 " 1,236.19 " 550.36 553.05 536.94 " 2,275.20 " 491.30 776.00 " 1,905.48 " 472.51 " 1,163.20 " " 2,133.00 " " 1,081.00 " " 1,272.12 " 555.73 37003484 THORACENTESIS W/O IMAGING 32554 450 "$2,844.00" " 1,051.14 " 472.51 " 2,275.20 " 892.40 " 1,469.00 " 563.79 " 1,469.00 " 907.92 " 1,571.31 " 553.05 " 1,775.00 " 869.12 808.05 " 1,882.44 " 483.25 536.94 896.08 " 1,120.10 " 550.36 553.05 536.94 " 2,275.20 " 491.30 776.00 " 1,905.48 " 472.51 " 1,163.20 " " 2,133.00 " " 1,081.00 " " 1,272.12 " 555.73 80329415 THORACENTESIS W/O IMAGING 32554 320 "$2,844.00" " 1,051.14 " 472.51 " 2,275.20 " 892.40 " 1,469.00 " 563.79 " 1,469.00 " 907.92 " 1,571.31 " 553.05 " 1,775.00 " 869.12 808.05 " 1,882.44 " 483.25 536.94 896.08 " 1,120.10 " 550.36 553.05 536.94 " 2,275.20 " 491.30 776.00 " 1,905.48 " 472.51 " 1,163.20 " " 2,133.00 " " 1,081.00 " " 1,272.12 " 555.73 37003492 THORACENTESIS W/IMAGING 32555 450 "$2,844.00" " 1,051.14 " 472.51 " 2,275.20 " 892.40 " 1,469.00 " 563.79 " 1,469.00 " 907.92 " 1,571.31 " 553.05 " 1,775.00 " 869.12 808.05 " 1,882.44 " 483.25 536.94 " 1,221.79 " " 1,527.24 " 550.36 553.05 536.94 " 2,275.20 " 491.30 776.00 " 1,905.48 " 472.51 " 1,163.20 " " 2,133.00 " " 1,081.00 " " 1,272.12 " 555.73 67729439 THORACENTESIS W/IMAGING 32555 350 "$2,844.00" " 1,051.14 " 472.51 " 2,275.20 " 892.40 " 1,469.00 " 563.79 " 1,469.00 " 907.92 " 1,571.31 " 553.05 " 1,775.00 " 869.12 808.05 " 1,882.44 " 483.25 536.94 " 1,221.79 " " 1,527.24 " 550.36 553.05 536.94 " 2,275.20 " 491.30 776.00 " 1,905.48 " 472.51 " 1,163.20 " " 2,133.00 " " 1,081.00 " " 1,272.12 " 555.73 80329431 THORACENTESIS W/IMAGING 32555 320 "$2,844.00" " 1,051.14 " 472.51 " 2,275.20 " 892.40 " 1,469.00 " 563.79 " 1,469.00 " 907.92 " 1,571.31 " 553.05 " 1,775.00 " 869.12 808.05 " 1,882.44 " 483.25 536.94 " 1,221.79 " " 1,527.24 " 550.36 553.05 536.94 " 2,275.20 " 491.30 776.00 " 1,905.48 " 472.51 " 1,163.20 " " 2,133.00 " " 1,081.00 " " 1,272.12 " 555.73 80529431 THORACENTESIS W/IMAGING 32555 402 "$2,844.00" " 1,051.14 " 472.51 " 2,275.20 " 892.40 " 1,469.00 " 563.79 " 1,469.00 " 907.92 " 1,571.31 " 553.05 " 1,775.00 " 869.12 808.05 " 1,882.44 " 483.25 536.94 " 1,221.79 " " 1,527.24 " 550.36 553.05 536.94 " 2,275.20 " 491.30 776.00 " 1,905.48 " 472.51 " 1,163.20 " " 2,133.00 " " 1,081.00 " " 1,272.12 " 555.73 80629435 THORACENTESIS W/IMAGING 32555 350 "$2,844.00" " 1,051.14 " 472.51 " 2,275.20 " 892.40 " 1,469.00 " 563.79 " 1,469.00 " 907.92 " 1,571.31 " 553.05 " 1,775.00 " 869.12 808.05 " 1,882.44 " 483.25 536.94 " 1,221.79 " " 1,527.24 " 550.36 553.05 536.94 " 2,275.20 " 491.30 776.00 " 1,905.48 " 472.51 " 1,163.20 " " 2,133.00 " " 1,081.00 " " 1,272.12 " 555.73 37003506 INSERT CATH PLEURA W/O IMAGE 32556 450 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 1,718.00 " " 1,694.09 " " 1,718.00 " 907.92 " 4,713.38 " " 1,661.82 " " 1,775.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 1,430.44 " " 1,788.05 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 80329423 INSERT CATH PLEURA W/O IMAGE 32556 320 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 1,718.00 " " 1,694.09 " " 1,718.00 " 907.92 " 4,713.38 " " 1,661.82 " " 1,775.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 1,430.44 " " 1,788.05 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 37003514 INSERT CATH PLEURA W/IMAGE 32557 450 "$7,382.00" " 2,728.39 " 776.00 " 5,905.60 " 892.40 " 1,718.00 " " 1,466.71 " " 1,718.00 " 907.92 " 4,078.56 " " 1,438.78 " " 1,775.00 " 869.12 808.05 " 4,886.15 " " 1,257.18 " " 1,396.87 " " 2,320.22 " " 2,900.27 " " 1,431.79 " " 1,438.78 " " 1,396.87 " " 5,905.60 " " 1,278.14 " 776.00 " 4,945.94 " " 1,229.25 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,445.76 " 67729447 INSERT CATH PLEURA W/IMAGE 32557 350 "$7,382.00" " 2,728.39 " 776.00 " 5,905.60 " 892.40 " 1,718.00 " " 1,466.71 " " 1,718.00 " 907.92 " 4,078.56 " " 1,438.78 " " 1,775.00 " 869.12 808.05 " 4,886.15 " " 1,257.18 " " 1,396.87 " " 2,320.22 " " 2,900.27 " " 1,431.79 " " 1,438.78 " " 1,396.87 " " 5,905.60 " " 1,278.14 " 776.00 " 4,945.94 " " 1,229.25 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,445.76 " 80329440 INSERT CATH PLEURA W/IMAGE 32557 320 "$7,382.00" " 2,728.39 " 776.00 " 5,905.60 " 892.40 " 1,718.00 " " 1,466.71 " " 1,718.00 " 907.92 " 4,078.56 " " 1,438.78 " " 1,775.00 " 869.12 808.05 " 4,886.15 " " 1,257.18 " " 1,396.87 " " 2,320.22 " " 2,900.27 " " 1,431.79 " " 1,438.78 " " 1,396.87 " " 5,905.60 " " 1,278.14 " 776.00 " 4,945.94 " " 1,229.25 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,445.76 " 80529449 INSERT CATH PLEURA W/IMAGE 32557 402 "$7,382.00" " 2,728.39 " 776.00 " 5,905.60 " 892.40 " 1,718.00 " " 1,466.71 " " 1,718.00 " 907.92 " 4,078.56 " " 1,438.78 " " 1,775.00 " 869.12 808.05 " 4,886.15 " " 1,257.18 " " 1,396.87 " " 2,320.22 " " 2,900.27 " " 1,431.79 " " 1,438.78 " " 1,396.87 " " 5,905.60 " " 1,278.14 " 776.00 " 4,945.94 " " 1,229.25 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,445.76 " 80629443 INSERT CATH PLEURA W/IMAGE 32557 350 "$7,382.00" " 2,728.39 " 776.00 " 5,905.60 " 892.40 " 1,718.00 " " 1,466.71 " " 1,718.00 " 907.92 " 4,078.56 " " 1,438.78 " " 1,775.00 " 869.12 808.05 " 4,886.15 " " 1,257.18 " " 1,396.87 " " 2,320.22 " " 2,900.27 " " 1,431.79 " " 1,438.78 " " 1,396.87 " " 5,905.60 " " 1,278.14 " 776.00 " 4,945.94 " " 1,229.25 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,445.76 " 80329288 INSTILL AGENT/PLEURODESIS 32560 320 "$2,844.00" " 1,051.14 " 472.51 " 2,275.20 " 892.40 " 1,718.00 " 563.79 " 1,718.00 " 907.92 " 1,571.31 " 553.05 " 1,775.00 " 869.12 808.05 " 1,882.44 " 483.25 536.94 " 1,587.73 " " 1,984.66 " 550.36 553.05 536.94 " 2,275.20 " 491.30 776.00 " 1,905.48 " 472.51 " 1,163.20 " " 2,133.00 " " 1,081.00 " " 1,272.12 " 555.73 80329296 INSTILL AGENT/FIBRINOLYS/INIT 32561 320 "$2,844.00" " 1,051.14 " - " 2,275.20 " - " 1,469.00 " 563.79 " 1,469.00 " - " 1,571.31 " 553.05 " 1,775.00 " - - " 1,882.44 " 483.25 536.94 514.95 643.69 550.36 553.05 536.94 " 2,275.20 " 491.30 - " 1,905.48 " 472.51 " 1,163.20 " " 2,133.00 " " 1,081.00 " " 1,272.12 " 555.73 80329300 INSTILL AGENT/FIBRINOLYSIS/SUB 32562 320 "$2,844.00" " 1,051.14 " - " 2,275.20 " - " 1,469.00 " 563.79 " 1,469.00 " - " 1,571.31 " 553.05 " 1,775.00 " - - " 1,882.44 " 483.25 536.94 457.80 572.25 550.36 553.05 536.94 " 2,275.20 " 491.30 - " 1,905.48 " 472.51 " 1,163.20 " " 2,133.00 " " 1,081.00 " " 1,272.12 " 555.73 28169221 THORACOSCOPY DIAGNOSTIC 32601 360 "$26,567.00" " 9,819.16 " 776.00 " 21,253.60 " 892.40 " 2,773.00 " " 5,277.62 " " 2,773.00 " 907.92 " 14,678.27 " " 5,177.09 " " 17,534.22 " 869.12 808.05 " 17,584.70 " " 4,523.67 " " 5,026.30 " " 1,754.80 " " 2,193.50 " " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " 776.00 " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 28169230 THORACOSCOPY W/PLEURODESIS 32650 360 "$6,543.00" " 2,418.29 " - " 5,234.40 " - " 4,521.21 " N/A " 4,521.21 " - " 3,615.01 " N/A " 4,318.38 " - N/A " 4,330.81 " - N/A " 3,865.41 " " 4,831.76 " N/A N/A N/A " 5,234.40 " N/A - " 4,383.81 " N/A " 2,676.09 " " 4,907.25 " " 2,486.99 " " 2,926.68 " N/A 80336314 ABLATE PULM TUMORS + EXTENSION 32994 320 "$26,567.00" " 9,819.16 " - " 41,658.35 " - " 18,357.80 " " 5,277.62 " " 18,357.80 " - " 14,678.27 " " 5,177.09 " " 17,534.22 " - - " 17,584.70 " " 4,523.67 " " 5,026.30 " " 33,326.68 " " 41,658.35 " " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " - " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 80636318 ABLATE PULM TUMORS + EXTENSION 32994 350 "$26,567.00" " 9,819.16 " - " 41,658.35 " - " 18,357.80 " " 5,277.62 " " 18,357.80 " - " 14,678.27 " " 5,177.09 " " 17,534.22 " - - " 17,584.70 " " 4,523.67 " " 5,026.30 " " 33,326.68 " " 41,658.35 " " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " - " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 67728289 PERC RF ABLATE TX PULM TUMOR 32998 350 "$26,567.00" " 9,819.16 " 776.00 " 21,253.60 " 892.40 " 3,326.00 " " 5,277.62 " " 3,326.00 " 907.92 " 14,678.27 " " 5,177.09 " " 6,576.00 " 869.12 808.05 " 17,584.70 " " 4,523.67 " " 5,026.30 " " 14,378.85 " " 17,973.56 " " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " 776.00 " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 80628285 PERC RF ABLATE TX PULM TUMOR 32998 350 "$26,567.00" " 9,819.16 " 776.00 " 21,253.60 " 892.40 " 3,326.00 " " 5,277.62 " " 3,326.00 " 907.92 " 14,678.27 " " 5,177.09 " " 6,576.00 " 869.12 808.05 " 17,584.70 " " 4,523.67 " " 5,026.30 " " 14,378.85 " " 17,973.56 " " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " 776.00 " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 80335148 UNL PLEURA DRAIN CATH EXCHANGE 32999 320 "$2,844.00" " 1,051.14 " - " 2,275.20 " - " 1,965.20 " 563.79 " 1,965.20 " - " 1,571.31 " 553.05 " 1,877.04 " - - " 1,882.44 " 483.25 536.94 56.26 70.32 550.36 553.05 536.94 " 2,275.20 " 491.30 - " 1,905.48 " 472.51 " 1,163.20 " " 2,133.00 " " 1,081.00 " " 1,272.12 " 555.73 80641095 UNL BX LUNG LOCALIZATION 32999 350 "$2,844.00" " 1,051.14 " - " 2,275.20 " - " 1,965.20 " 563.79 " 1,965.20 " - " 1,571.31 " 553.05 " 1,877.04 " - - " 1,882.44 " 483.25 536.94 56.26 70.32 550.36 553.05 536.94 " 2,275.20 " 491.30 - " 1,905.48 " 472.51 " 1,163.20 " " 2,133.00 " " 1,081.00 " " 1,272.12 " 555.73 29821241 PERICARDIOCENTESIS W/IMAGING 33016 481 "$7,382.00" " 2,728.39 " 193.93 " 6,540.00 " 223.02 " 5,100.96 " " 1,466.71 " " 5,100.96 " 226.90 " 4,078.56 " " 1,438.78 " " 6,540.00 " 217.20 201.94 " 4,886.15 " " 1,257.18 " " 1,396.87 " " 1,363.66 " " 1,704.58 " " 1,431.79 " " 1,438.78 " " 1,396.87 " " 5,905.60 " " 1,278.14 " 193.93 " 4,945.94 " " 1,229.25 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,445.76 " 30613708 PERICARDIOCENTESIS W/IMAGING 33016 480 "$7,382.00" " 2,728.39 " 193.93 " 6,540.00 " 223.02 " 5,100.96 " " 1,466.71 " " 5,100.96 " 226.90 " 4,078.56 " " 1,438.78 " " 6,540.00 " 217.20 201.94 " 4,886.15 " " 1,257.18 " " 1,396.87 " " 1,363.66 " " 1,704.58 " " 1,431.79 " " 1,438.78 " " 1,396.87 " " 5,905.60 " " 1,278.14 " 193.93 " 4,945.94 " " 1,229.25 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,445.76 " 80338457 PERICARDIOCENTESIS W/IMAGING 33016 320 "$7,382.00" " 2,728.39 " 193.93 " 6,540.00 " 223.02 " 5,100.96 " " 1,466.71 " " 5,100.96 " 226.90 " 4,078.56 " " 1,438.78 " " 6,540.00 " 217.20 201.94 " 4,886.15 " " 1,257.18 " " 1,396.87 " " 1,363.66 " " 1,704.58 " " 1,431.79 " " 1,438.78 " " 1,396.87 " " 5,905.60 " " 1,278.14 " 193.93 " 4,945.94 " " 1,229.25 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,445.76 " 80638451 PERICARDIOCENTESIS W IMAGING 33016 350 "$7,382.00" " 2,728.39 " 193.93 " 6,540.00 " 223.02 " 5,100.96 " " 1,466.71 " " 5,100.96 " 226.90 " 4,078.56 " " 1,438.78 " " 6,540.00 " 217.20 201.94 " 4,886.15 " " 1,257.18 " " 1,396.87 " " 1,363.66 " " 1,704.58 " " 1,431.79 " " 1,438.78 " " 1,396.87 " " 5,905.60 " " 1,278.14 " 193.93 " 4,945.94 " " 1,229.25 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,445.76 " 29821194 PERICARDIAL DRG 6YR+W/O CONGEN 33017 481 "$2,364.00" 873.73 - " 1,891.20 " - " 1,633.52 " N/A " 1,633.52 " - " 1,306.11 " N/A " 1,560.24 " - N/A " 1,564.73 " - N/A " 1,413.90 " " 1,767.37 " N/A N/A N/A " 1,891.20 " N/A - " 1,583.88 " N/A 966.88 " 1,773.00 " 898.56 " 1,057.42 " N/A 30613678 PERICARDIAL DRG 6YR+W/O CONGEN 33017 481 "$2,364.00" 873.73 - " 1,891.20 " - " 1,633.52 " N/A " 1,633.52 " - " 1,306.11 " N/A " 1,560.24 " - N/A " 1,564.73 " - N/A " 1,413.90 " " 1,767.37 " N/A N/A N/A " 1,891.20 " N/A - " 1,583.88 " N/A 966.88 " 1,773.00 " 898.56 " 1,057.42 " N/A 37005002 PERICARDIAL DRG 6YR+WO CONGEN 33017 450 "$2,364.00" 873.73 - " 1,891.20 " - " 1,633.52 " N/A " 1,633.52 " - " 1,306.11 " N/A " 1,560.24 " - N/A " 1,564.73 " - N/A " 1,413.90 " " 1,767.37 " N/A N/A N/A " 1,891.20 " N/A - " 1,583.88 " N/A 966.88 " 1,773.00 " 898.56 " 1,057.42 " N/A 29821208 PERICARDIAL DRG 0-5YR W/CONGEN 33018 481 "$2,693.00" 995.33 - " 2,154.40 " - " 1,860.86 " N/A " 1,860.86 " - " 1,487.88 " N/A " 1,777.38 " - N/A " 1,782.50 " - N/A " 1,612.30 " " 2,015.38 " N/A N/A N/A " 2,154.40 " N/A - " 1,804.31 " N/A " 1,101.44 " " 2,019.75 " " 1,023.61 " " 1,204.58 " N/A 30613686 PERICARDIAL DRG 0-5YR W/CONGEN 33018 481 "$2,693.00" 995.33 - " 2,154.40 " - " 1,860.86 " N/A " 1,860.86 " - " 1,487.88 " N/A " 1,777.38 " - N/A " 1,782.50 " - N/A " 1,612.30 " " 2,015.38 " N/A N/A N/A " 2,154.40 " N/A - " 1,804.31 " N/A " 1,101.44 " " 2,019.75 " " 1,023.61 " " 1,204.58 " N/A 37005011 PERICARDIAL DRG 0-5YR W/CONGEN 33018 450 "$2,693.00" 995.33 - " 2,154.40 " - " 1,860.86 " N/A " 1,860.86 " - " 1,487.88 " N/A " 1,777.38 " - N/A " 1,782.50 " - N/A " 1,612.30 " " 2,015.38 " N/A N/A N/A " 2,154.40 " N/A - " 1,804.31 " N/A " 1,101.44 " " 2,019.75 " " 1,023.61 " " 1,204.58 " N/A 28169248 INCISION OF HEART SAC 33025 360 "$3,063.00" " 1,132.08 " - " 5,136.03 " - " 2,116.53 " N/A " 2,116.53 " - " 1,692.31 " N/A " 2,021.58 " - N/A " 2,027.40 " - N/A " 4,108.82 " " 5,136.03 " N/A N/A N/A " 2,450.40 " N/A - " 2,052.21 " N/A " 1,252.77 " " 2,297.25 " " 1,164.25 " " 1,370.08 " N/A 28176848 PAR RES CHRON CONS PER WO BYPA 33030 360 "$3,860.00" " 1,426.66 " - " 7,888.20 " - " 2,667.26 " N/A " 2,667.26 " - " 2,132.65 " N/A " 2,547.60 " - N/A " 2,554.93 " - N/A " 6,310.56 " " 7,888.20 " N/A N/A N/A " 3,088.00 " N/A - " 2,586.20 " N/A " 1,578.74 " " 2,895.00 " " 1,467.19 " " 1,726.58 " N/A 28169256 REMOVAL OF HEART LESION 33120 360 "$3,652.00" " 1,349.78 " - " 10,127.76 " - " 2,523.53 " N/A " 2,523.53 " - " 2,017.73 " N/A " 2,410.32 " - N/A " 2,417.26 " - N/A " 8,102.21 " " 10,127.76 " N/A N/A N/A " 2,921.60 " N/A - " 2,446.84 " N/A " 1,493.67 " " 2,739.00 " " 1,388.13 " " 1,633.54 " N/A 30600789 INSERT/RPL HEART PM ATRIAL 33206 480 "$54,601.00" " 20,180.53 " 776.00 " 43,680.80 " 892.40 " 4,435.00 " " 10,845.22 " " 4,435.00 " 907.92 " 30,167.05 " " 10,638.64 " " 36,036.66 " 869.12 808.05 " 36,140.40 " " 9,295.90 " " 10,328.78 " " 2,380.18 " " 2,975.22 " " 10,587.00 " " 10,638.64 " " 10,328.78 " " 43,680.80 " " 9,450.83 " 776.00 " 36,582.67 " " 9,089.33 " " 22,331.81 " " 40,950.75 " " 20,753.84 " " 24,423.03 " " 10,690.29 " 30600525 INSERT/RPL HEART PM VENTR 33207 480 "$54,601.00" " 20,180.53 " 776.00 " 43,680.80 " 892.40 " 4,435.00 " " 10,845.22 " " 4,435.00 " 907.92 " 30,167.05 " " 10,638.64 " " 36,036.66 " 869.12 808.05 " 36,140.40 " " 9,295.90 " " 10,328.78 " " 2,726.76 " " 3,408.45 " " 10,587.00 " " 10,638.64 " " 10,328.78 " " 43,680.80 " " 9,450.83 " 776.00 " 36,582.67 " " 9,089.33 " " 22,331.81 " " 40,950.75 " " 20,753.84 " " 24,423.03 " " 10,690.29 " 30600797 INSERT/RPL HRT PM ATRIAL/VENTR 33208 480 "$54,601.00" " 20,180.53 " 776.00 " 43,680.80 " 892.40 " 4,435.00 " " 10,845.22 " " 4,435.00 " 907.92 " 30,167.05 " " 10,638.64 " " 36,036.66 " 869.12 808.05 " 36,140.40 " " 9,295.90 " " 10,328.78 " " 2,764.00 " " 3,455.00 " " 10,587.00 " " 10,638.64 " " 10,328.78 " " 43,680.80 " " 9,450.83 " 776.00 " 36,582.67 " " 9,089.33 " " 22,331.81 " " 40,950.75 " " 20,753.84 " " 24,423.03 " " 10,690.29 " 29802343 INSERT ELECTRD/PM CATH SINGLE 33210 481 "$42,801.00" " 15,819.25 " 776.00 " 34,240.80 " 892.40 " 3,326.00 " " 8,509.62 " " 3,326.00 " 907.92 " 23,647.55 " " 8,347.53 " " 28,248.66 " 869.12 808.05 " 28,329.98 " " 7,293.96 " " 8,104.40 " 980.29 " 1,225.36 " " 8,307.01 " " 8,347.53 " " 8,104.40 " " 34,240.80 " " 7,415.53 " 776.00 " 28,676.67 " " 7,131.87 " " 17,505.61 " " 32,100.75 " " 16,268.66 " " 19,144.89 " " 8,388.05 " 30601254 INSERT/RPL ELECT/PM CATH SGL 33210 481 "$42,801.00" " 15,819.25 " 776.00 " 34,240.80 " 892.40 " 3,326.00 " " 8,509.62 " " 3,326.00 " 907.92 " 23,647.55 " " 8,347.53 " " 28,248.66 " 869.12 808.05 " 28,329.98 " " 7,293.96 " " 8,104.40 " 980.29 " 1,225.36 " " 8,307.01 " " 8,347.53 " " 8,104.40 " " 34,240.80 " " 7,415.53 " 776.00 " 28,676.67 " " 7,131.87 " " 17,505.61 " " 32,100.75 " " 16,268.66 " " 19,144.89 " " 8,388.05 " 30601246 INSERT/RPL ELECT/PM CATH DUAL 33211 480 "$42,801.00" " 15,819.25 " 776.00 " 34,240.80 " 892.40 " 3,326.00 " " 8,509.62 " " 3,326.00 " 907.92 " 23,647.55 " " 8,347.53 " " 28,248.66 " 869.12 808.05 " 28,329.98 " " 7,293.96 " " 8,104.40 " " 1,018.03 " " 1,272.54 " " 8,307.01 " " 8,347.53 " " 8,104.40 " " 34,240.80 " " 7,415.53 " 776.00 " 28,676.67 " " 7,131.87 " " 17,505.61 " " 32,100.75 " " 16,268.66 " " 19,144.89 " " 8,388.05 " 30600801 INSERT PULSE GEN SINGLE LEAD 33212 480 "$42,801.00" " 15,819.25 " 776.00 " 34,240.80 " 892.40 " 2,773.00 " " 8,509.62 " " 2,773.00 " 907.92 " 23,647.55 " " 8,347.53 " " 3,545.00 " 869.12 808.05 " 28,329.98 " " 7,293.96 " " 8,104.40 " " 4,937.34 " " 6,171.67 " " 8,307.01 " " 8,347.53 " " 8,104.40 " " 34,240.80 " " 7,415.53 " 776.00 " 28,676.67 " " 7,131.87 " " 17,505.61 " " 32,100.75 " " 16,268.66 " " 19,144.89 " " 8,388.05 " 30600819 INSERT PULSE GEN DUAL LEADS 33213 480 "$54,601.00" " 20,180.53 " 776.00 " 43,680.80 " 892.40 " 2,773.00 " " 10,845.22 " " 2,773.00 " 907.92 " 30,167.05 " " 10,638.64 " " 3,545.00 " 869.12 808.05 " 36,140.40 " " 9,295.90 " " 10,328.78 " " 4,937.34 " " 6,171.67 " " 10,587.00 " " 10,638.64 " " 10,328.78 " " 43,680.80 " " 9,450.83 " 776.00 " 36,582.67 " " 9,089.33 " " 22,331.81 " " 40,950.75 " " 20,753.84 " " 24,423.03 " " 10,690.29 " 30600827 UPGRADE PM SYSTEM SGL TO DUAL 33214 480 "$54,601.00" " 20,180.53 " 776.00 " 43,680.80 " 892.40 " 4,435.00 " " 10,845.22 " " 4,435.00 " 907.92 " 30,167.05 " " 10,638.64 " " 36,036.66 " 869.12 808.05 " 36,140.40 " " 9,295.90 " " 10,328.78 " " 2,704.66 " " 3,380.82 " " 10,587.00 " " 10,638.64 " " 10,328.78 " " 43,680.80 " " 9,450.83 " 776.00 " 36,582.67 " " 9,089.33 " " 22,331.81 " " 40,950.75 " " 20,753.84 " " 24,423.03 " " 10,690.29 " 30600835 REPOSITION PM/DEFIB LEAD 33215 480 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 2,773.00 " " 2,985.82 " " 2,773.00 " 907.92 " 8,300.76 " " 2,928.95 " " 9,915.84 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 1,697.25 " " 2,121.56 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 30601190 INSERT 1 ELECTRODE PM/DEFIB 33216 480 "$42,801.00" " 15,819.25 " 776.00 " 34,240.80 " 892.40 " 3,326.00 " " 8,509.62 " " 3,326.00 " 907.92 " 23,647.55 " " 8,347.53 " " 28,248.66 " 869.12 808.05 " 28,329.98 " " 7,293.96 " " 8,104.40 " " 2,119.05 " " 2,648.81 " " 8,307.01 " " 8,347.53 " " 8,104.40 " " 34,240.80 " " 7,415.53 " 776.00 " 28,676.67 " " 7,131.87 " " 17,505.61 " " 32,100.75 " " 16,268.66 " " 19,144.89 " " 8,388.05 " 30600843 INSERT 2 ELECTRODE PM/DEFIB 33217 480 "$42,801.00" " 15,819.25 " 776.00 " 34,240.80 " 892.40 " 3,326.00 " " 8,509.62 " " 3,326.00 " 907.92 " 23,647.55 " " 8,347.53 " " 28,248.66 " 869.12 808.05 " 28,329.98 " " 7,293.96 " " 8,104.40 " " 2,120.23 " " 2,650.29 " " 8,307.01 " " 8,347.53 " " 8,104.40 " " 34,240.80 " " 7,415.53 " 776.00 " 28,676.67 " " 7,131.87 " " 17,505.61 " " 32,100.75 " " 16,268.66 " " 19,144.89 " " 8,388.05 " 30600851 REPAIR LEAD PM/DEFIB SINGLE 33218 480 "$18,062.00" " 6,675.72 " 776.00 " 14,449.60 " 892.40 " 3,326.00 " " 3,591.63 " " 3,326.00 " 907.92 " 9,979.26 " " 3,523.22 " " 11,920.92 " 869.12 808.05 " 11,955.24 " " 3,078.54 " " 3,420.60 " " 2,064.37 " " 2,580.46 " " 3,506.12 " " 3,523.22 " " 3,420.60 " " 14,449.60 " " 3,129.85 " 776.00 " 12,101.54 " " 3,010.13 " " 7,387.36 " " 13,546.50 " " 6,865.37 " " 8,079.13 " " 3,540.32 " 30600860 REPAIR LEAD PM/DEFIB DUAL 33220 480 "$18,062.00" " 6,675.72 " 776.00 " 14,449.60 " 892.40 " 3,326.00 " " 3,591.63 " " 3,326.00 " 907.92 " 9,979.26 " " 3,523.22 " " 11,920.92 " 869.12 808.05 " 11,955.24 " " 3,078.54 " " 3,420.60 " " 2,075.56 " " 2,594.45 " " 3,506.12 " " 3,523.22 " " 3,420.60 " " 14,449.60 " " 3,129.85 " 776.00 " 12,101.54 " " 3,010.13 " " 7,387.36 " " 13,546.50 " " 6,865.37 " " 8,079.13 " " 3,540.32 " 30602030 INSERT PULSE GEN MULT LEADS 33221 480 "$97,709.00" " 36,113.25 " 776.00 " 78,167.20 " 892.40 " 2,773.00 " " 19,425.40 " " 2,773.00 " 907.92 " 53,984.22 " " 19,055.39 " " 64,487.94 " 869.12 808.05 " 64,673.59 " " 16,650.34 " " 18,500.38 " " 1,361.92 " " 1,702.40 " " 18,962.89 " " 19,055.39 " " 18,500.38 " " 78,167.20 " " 16,927.85 " 776.00 " 65,465.03 " " 16,280.33 " " 39,962.98 " " 73,281.75 " " 37,139.19 " " 43,705.24 " " 19,147.89 " 30600878 RELOCATE POCKET PACEMAKER 33222 480 "$9,006.00" " 3,328.62 " 776.00 " 7,204.80 " 892.40 " 1,718.00 " " 1,786.47 " " 1,718.00 " 907.92 " 4,975.82 " " 1,752.44 " " 2,820.00 " 869.12 808.05 " 5,961.07 " " 1,531.26 " " 1,701.40 " " 2,376.02 " " 2,970.02 " " 1,743.94 " " 1,752.44 " " 1,701.40 " " 7,204.80 " " 1,556.78 " 776.00 " 6,034.02 " " 1,497.23 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,760.95 " 30600908 RELOCATE POCKET DEFIBRILLATOR 33223 480 "$9,006.00" " 3,328.62 " 776.00 " 7,204.80 " 892.40 " 1,718.00 " " 1,786.47 " " 1,718.00 " 907.92 " 4,975.82 " " 1,752.44 " " 2,820.00 " 869.12 808.05 " 5,961.07 " " 1,531.26 " " 1,701.40 " " 2,376.02 " " 2,970.02 " " 1,743.94 " " 1,752.44 " " 1,701.40 " " 7,204.80 " " 1,556.78 " 776.00 " 6,034.02 " " 1,497.23 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,760.95 " 30601203 INSERT PACING LEAD & CONNECT 33224 480 "$54,601.00" " 20,180.53 " 776.00 " 43,680.80 " 892.40 " 2,773.00 " " 10,845.22 " " 2,773.00 " 907.92 " 30,167.05 " " 10,638.64 " " 36,036.66 " 869.12 808.05 " 36,140.40 " " 9,295.90 " " 10,328.78 " " 2,806.30 " " 3,507.88 " " 10,587.00 " " 10,638.64 " " 10,328.78 " " 43,680.80 " " 9,450.83 " 776.00 " 36,582.67 " " 9,089.33 " " 22,331.81 " " 40,950.75 " " 20,753.84 " " 24,423.03 " " 10,690.29 " 30601017 INSERT PACING LT VENTR ADDL 33225 480 "$2,743.00" " 1,013.81 " - " 3,326.00 " - " 3,326.00 " - " 3,326.00 " - " 1,515.51 " - " 1,810.38 " - - " 1,815.59 " - - " 2,493.02 " " 3,116.28 " - - - " 2,194.40 " - - " 1,837.81 " - " 1,121.89 " " 2,057.25 " " 1,042.61 " " 1,226.94 " - 30601211 REPOSITION LEFT VENTR LEAD 33226 480 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 2,773.00 " " 2,985.82 " " 2,773.00 " 907.92 " 8,300.76 " " 2,928.95 " " 9,915.84 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 2,701.28 " " 3,376.60 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 30602048 REMOVE/RPL PM GEN SGL LEAD 33227 480 "$42,801.00" " 15,819.25 " 776.00 " 34,240.80 " 892.40 " 2,773.00 " " 8,509.62 " " 2,773.00 " 907.92 " 23,647.55 " " 8,347.53 " " 28,248.66 " 869.12 808.05 " 28,329.98 " " 7,293.96 " " 8,104.40 " " 1,299.37 " " 1,624.21 " " 8,307.01 " " 8,347.53 " " 8,104.40 " " 34,240.80 " " 7,415.53 " 776.00 " 28,676.67 " " 7,131.87 " " 17,505.61 " " 32,100.75 " " 16,268.66 " " 19,144.89 " " 8,388.05 " 30602056 REMOVE/RPL PM GEN DUAL LEAD 33228 480 "$54,601.00" " 20,180.53 " 776.00 " 43,680.80 " 892.40 " 2,773.00 " " 10,845.22 " " 2,773.00 " 907.92 " 30,167.05 " " 10,638.64 " " 36,036.66 " 869.12 808.05 " 36,140.40 " " 9,295.90 " " 10,328.78 " " 1,355.62 " " 1,694.52 " " 10,587.00 " " 10,638.64 " " 10,328.78 " " 43,680.80 " " 9,450.83 " 776.00 " 36,582.67 " " 9,089.33 " " 22,331.81 " " 40,950.75 " " 20,753.84 " " 24,423.03 " " 10,690.29 " 30602064 REMOVE/RPL PM GEN MULTI LEADS 33229 480 "$97,709.00" " 36,113.25 " 776.00 " 78,167.20 " 892.40 " 2,773.00 " " 19,425.40 " " 2,773.00 " 907.92 " 53,984.22 " " 19,055.39 " " 64,487.94 " 869.12 808.05 " 64,673.59 " " 16,650.34 " " 18,500.38 " " 1,411.82 " " 1,764.77 " " 18,962.89 " " 19,055.39 " " 18,500.38 " " 78,167.20 " " 16,927.85 " 776.00 " 65,465.03 " " 16,280.33 " " 39,962.98 " " 73,281.75 " " 37,139.19 " " 43,705.24 " " 19,147.89 " 30601122 INSERT PULSE GEN DUAL LEADS 33230 480 "$120,961.00" " 44,707.19 " 776.00 " 96,768.80 " 892.40 " 2,773.00 " " 24,051.83 " " 2,773.00 " 907.92 " 66,830.95 " " 23,593.70 " " 79,834.26 " 869.12 808.05 " 80,064.09 " " 20,615.85 " " 22,906.50 " " 1,467.00 " " 1,833.75 " " 23,479.16 " " 23,593.70 " " 22,906.50 " " 96,768.80 " " 20,959.45 " 776.00 " 81,043.87 " " 20,157.72 " " 49,473.05 " " 90,720.75 " " 45,977.28 " " 54,105.86 " " 23,708.23 " 30602072 INSERT PULSE GEN MULTI LEADS 33231 480 "$172,404.00" " 63,720.52 " 776.00 " 137,923.20 " 892.40 " 2,773.00 " " 34,260.64 " " 2,773.00 " 907.92 " 95,253.21 " " 33,608.06 " " 113,786.64 " 869.12 808.05 " 114,114.21 " " 29,366.26 " " 32,629.18 " " 1,523.26 " " 1,904.07 " " 33,444.91 " " 33,608.06 " " 32,629.18 " " 137,923.20 " " 29,855.70 " 776.00 " 115,510.68 " " 28,713.68 " " 70,513.24 " " 129,303.00 " " 65,530.76 " " 77,116.31 " " 33,771.20 " 30601076 REMOVE PM PULSE GENERATOR 33233 480 "$42,801.00" " 15,819.25 " 776.00 " 34,240.80 " 892.40 " 1,718.00 " " 8,509.62 " " 1,718.00 " 907.92 " 23,647.55 " " 8,347.53 " " 2,820.00 " 869.12 808.05 " 28,329.98 " " 7,293.96 " " 8,104.40 " " 1,379.47 " " 1,724.34 " " 8,307.01 " " 8,347.53 " " 8,104.40 " " 34,240.80 " " 7,415.53 " 776.00 " 28,676.67 " " 7,131.87 " " 17,505.61 " " 32,100.75 " " 16,268.66 " " 19,144.89 " " 8,388.05 " 30600606 REMOVE PM SYSTEM ATRIAL/VENTR 33234 480 "$18,062.00" " 6,675.72 " 776.00 " 14,449.60 " 892.40 " 3,326.00 " " 3,591.63 " " 3,326.00 " 907.92 " 9,979.26 " " 3,523.22 " " 11,920.92 " 869.12 808.05 " 11,955.24 " " 3,078.54 " " 3,420.60 " " 2,723.50 " " 3,404.38 " " 3,506.12 " " 3,523.22 " " 3,420.60 " " 14,449.60 " " 3,129.85 " 776.00 " 12,101.54 " " 3,010.13 " " 7,387.36 " " 13,546.50 " " 6,865.37 " " 8,079.13 " " 3,540.32 " 28169264 REMOVE PM ELECTRODE DUAL LEAD 33235 360 "$18,062.00" " 6,675.72 " 776.00 " 14,449.60 " 892.40 " 3,326.00 " " 3,591.63 " " 3,326.00 " 907.92 " 9,979.26 " " 3,523.22 " " 11,920.92 " 869.12 808.05 " 11,955.24 " " 3,078.54 " " 3,420.60 " " 3,460.60 " " 4,325.75 " " 3,506.12 " " 3,523.22 " " 3,420.60 " " 14,449.60 " " 3,129.85 " 776.00 " 12,101.54 " " 3,010.13 " " 7,387.36 " " 13,546.50 " " 6,865.37 " " 8,079.13 " " 3,540.32 " 30600916 REMOVE PM ELECTRODE DUAL LEAD 33235 480 "$18,062.00" " 6,675.72 " 776.00 " 14,449.60 " 892.40 " 3,326.00 " " 3,591.63 " " 3,326.00 " 907.92 " 9,979.26 " " 3,523.22 " " 11,920.92 " 869.12 808.05 " 11,955.24 " " 3,078.54 " " 3,420.60 " " 3,460.60 " " 4,325.75 " " 3,506.12 " " 3,523.22 " " 3,420.60 " " 14,449.60 " " 3,129.85 " 776.00 " 12,101.54 " " 3,010.13 " " 7,387.36 " " 13,546.50 " " 6,865.37 " " 8,079.13 " " 3,540.32 " 28169272 REMOVE ELECTRODE/THORACOTOMY 33238 360 "$8,607.00" " 3,181.15 " - " 6,885.60 " - " 5,947.44 " N/A " 5,947.44 " - " 4,755.37 " N/A " 5,680.62 " - N/A " 5,696.97 " - N/A " 5,176.86 " " 6,471.08 " N/A N/A N/A " 6,885.60 " N/A - " 5,766.69 " N/A " 3,520.26 " " 6,455.25 " " 3,271.52 " " 3,849.91 " N/A 30600762 INSERT PULSE GEN W/SINGLE LEAD 33240 480 "$120,961.00" " 44,707.19 " 776.00 " 96,768.80 " 892.40 " 4,435.00 " " 24,051.83 " " 4,435.00 " 907.92 " 66,830.95 " " 23,593.70 " " 79,834.26 " 869.12 808.05 " 80,064.09 " " 20,615.85 " " 22,906.50 " " 4,937.34 " " 6,171.67 " " 23,479.16 " " 23,593.70 " " 22,906.50 " " 96,768.80 " " 20,959.45 " 776.00 " 81,043.87 " " 20,157.72 " " 49,473.05 " " 90,720.75 " " 45,977.28 " " 54,105.86 " " 23,708.23 " 30600886 REMOVE PULSE GENERATOR 33241 480 "$18,062.00" " 6,675.72 " 776.00 " 14,449.60 " 892.40 " 3,326.00 " " 3,591.63 " " 3,326.00 " 907.92 " 9,979.26 " " 3,523.22 " " 11,920.92 " 869.12 808.05 " 11,955.24 " " 3,078.54 " " 3,420.60 " " 1,304.88 " " 1,631.10 " " 3,506.12 " " 3,523.22 " " 3,420.60 " " 14,449.60 " " 3,129.85 " 776.00 " 12,101.54 " " 3,010.13 " " 7,387.36 " " 13,546.50 " " 6,865.37 " " 8,079.13 " " 3,540.32 " 30600924 REMOVE ELECT/TRANSVENOUSLY 33244 480 "$18,062.00" " 6,675.72 " 776.00 " 14,449.60 " 892.40 " 3,326.00 " " 3,591.63 " " 3,326.00 " 907.92 " 9,979.26 " " 3,523.22 " " 11,920.92 " 869.12 808.05 " 11,955.24 " " 3,078.54 " " 3,420.60 " " 4,837.14 " " 6,046.43 " " 3,506.12 " " 3,523.22 " " 3,420.60 " " 14,449.60 " " 3,129.85 " 776.00 " 12,101.54 " " 3,010.13 " " 7,387.36 " " 13,546.50 " " 6,865.37 " " 8,079.13 " " 3,540.32 " 29800898 INSERT/RPLCMT DEFIB W/LEAD(S) 33249 480 "$172,404.00" " 63,720.52 " 776.00 " 137,923.20 " 892.40 " 4,435.00 " " 34,260.64 " " 4,435.00 " 907.92 " 95,253.21 " " 33,608.06 " " 113,786.64 " 869.12 808.05 " 114,114.21 " " 29,366.26 " " 32,629.18 " " 4,804.63 " " 6,005.79 " " 33,444.91 " " 33,608.06 " " 32,629.18 " " 137,923.20 " " 29,855.70 " 776.00 " 115,510.68 " " 28,713.68 " " 70,513.24 " " 129,303.00 " " 65,530.76 " " 77,116.31 " " 33,771.20 " 30600894 INSERT/RPL DEFIB W/LEADS SGL 33249 480 "$172,404.00" " 63,720.52 " 776.00 " 137,923.20 " 892.40 " 4,435.00 " " 34,260.64 " " 4,435.00 " 907.92 " 95,253.21 " " 33,608.06 " " 113,786.64 " 869.12 808.05 " 114,114.21 " " 29,366.26 " " 32,629.18 " " 4,804.63 " " 6,005.79 " " 33,444.91 " " 33,608.06 " " 32,629.18 " " 137,923.20 " " 29,855.70 " 776.00 " 115,510.68 " " 28,713.68 " " 70,513.24 " " 129,303.00 " " 65,530.76 " " 77,116.31 " " 33,771.20 " 28169281 ABLATE ATRIA LMTD 33254 360 "$6,847.00" " 2,530.65 " - " 8,754.73 " - " 4,731.28 " N/A " 4,731.28 " - " 3,782.97 " N/A " 4,519.02 " - N/A " 4,532.03 " - N/A " 7,003.78 " " 8,754.73 " N/A N/A N/A " 5,477.60 " N/A - " 4,587.49 " N/A " 2,800.42 " " 5,135.25 " " 2,602.54 " " 3,062.66 " N/A 28169299 ABLATE ATRIA W/BYPASS EXTEN 33256 360 "$18,408.00" " 6,803.60 " - " 14,726.40 " - " 12,719.93 " N/A " 12,719.93 " - " 10,170.42 " N/A " 12,149.28 " - N/A " 12,184.26 " - N/A " 10,080.00 " " 12,600.00 " N/A N/A N/A " 14,726.40 " N/A - " 12,333.36 " N/A " 7,528.87 " " 13,806.00 " " 6,996.88 " " 8,233.90 " N/A 30602081 REMOVE/RPL PULSE GEN SGL LEAD 33262 480 "$120,961.00" " 44,707.19 " 776.00 " 96,768.80 " 892.40 " 2,773.00 " " 24,051.83 " " 2,773.00 " 907.92 " 66,830.95 " " 23,593.70 " " 79,834.26 " 869.12 808.05 " 80,064.09 " " 20,615.85 " " 22,906.50 " " 1,413.28 " " 1,766.60 " " 23,479.16 " " 23,593.70 " " 22,906.50 " " 96,768.80 " " 20,959.45 " 776.00 " 81,043.87 " " 20,157.72 " " 49,473.05 " " 90,720.75 " " 45,977.28 " " 54,105.86 " " 23,708.23 " 30602099 REMOVE/RPL PULSE GEN DUAL LEAD 33263 480 "$120,961.00" " 44,707.19 " 776.00 " 96,768.80 " 892.40 " 2,773.00 " " 24,051.83 " " 2,773.00 " 907.92 " 66,830.95 " " 23,593.70 " " 79,834.26 " 869.12 808.05 " 80,064.09 " " 20,615.85 " " 22,906.50 " " 1,469.48 " " 1,836.85 " " 23,479.16 " " 23,593.70 " " 22,906.50 " " 96,768.80 " " 20,959.45 " 776.00 " 81,043.87 " " 20,157.72 " " 49,473.05 " " 90,720.75 " " 45,977.28 " " 54,105.86 " " 23,708.23 " 30602102 RMVL/RPL PULSE GEN MULTI LEADS 33264 480 "$172,404.00" " 63,720.52 " 776.00 " 137,923.20 " 892.40 " 2,773.00 " " 34,260.64 " " 2,773.00 " 907.92 " 95,253.21 " " 33,608.06 " " 113,786.64 " 869.12 808.05 " 114,114.21 " " 29,366.26 " " 32,629.18 " " 1,525.73 " " 1,907.16 " " 33,444.91 " " 33,608.06 " " 32,629.18 " " 137,923.20 " " 29,855.70 " 776.00 " 115,510.68 " " 28,713.68 " " 70,513.24 " " 129,303.00 " " 65,530.76 " " 77,116.31 " " 33,771.20 " 30602986 INSERT/RPL SUBQ DEFIB SYSTEM 33270 480 "$172,404.00" " 63,720.52 " - " 137,923.20 " - " 2,773.00 " " 34,260.64 " " 2,773.00 " - " 95,253.21 " " 33,608.06 " " 113,786.64 " - - " 114,114.21 " " 29,366.26 " " 32,629.18 " " 1,215.26 " " 1,519.08 " " 33,444.91 " " 33,608.06 " " 32,629.18 " " 137,923.20 " " 29,855.70 " - " 115,510.68 " " 28,713.68 " " 70,513.24 " " 129,303.00 " " 65,530.76 " " 77,116.31 " " 33,771.20 " 30602994 INSERT SUBQ DEFIB ELECTRODE 33271 480 "$42,801.00" " 15,819.25 " - " 34,240.80 " - " 2,773.00 " " 8,509.62 " " 2,773.00 " - " 23,647.55 " " 8,347.53 " " 28,248.66 " - - " 28,329.98 " " 7,293.96 " " 8,104.40 " 998.63 " 1,248.29 " " 8,307.01 " " 8,347.53 " " 8,104.40 " " 34,240.80 " " 7,415.53 " - " 28,676.67 " " 7,131.87 " " 17,505.61 " " 32,100.75 " " 16,268.66 " " 19,144.89 " " 8,388.05 " 30603036 REMOVE SUBQ DEFIB ELECTRODE 33272 480 "$18,062.00" " 6,675.72 " - " 14,449.60 " - " 2,773.00 " " 3,591.63 " " 2,773.00 " - " 9,979.26 " " 3,523.22 " " 11,920.92 " - - " 11,955.24 " " 3,078.54 " " 3,420.60 " " 2,278.58 " " 2,848.23 " " 3,506.12 " " 3,523.22 " " 3,420.60 " " 14,449.60 " " 3,129.85 " - " 12,101.54 " " 3,010.13 " " 7,387.36 " " 13,546.50 " " 6,865.37 " " 8,079.13 " " 3,540.32 " 30603044 REPOSITION SUBQ DEFIB ELECT 33273 480 "$18,062.00" " 6,675.72 " - " 14,449.60 " - " 2,773.00 " " 3,591.63 " " 2,773.00 " - " 9,979.26 " " 3,523.22 " " 6,576.00 " - - " 11,955.24 " " 3,078.54 " " 3,420.60 " 829.64 " 1,037.05 " " 3,506.12 " " 3,523.22 " " 3,420.60 " " 14,449.60 " " 3,129.85 " - " 12,101.54 " " 3,010.13 " " 7,387.36 " " 13,546.50 " " 6,865.37 " " 8,079.13 " " 3,540.32 " 30613449 TRANSCATH INSRT/RPL LDLS PM 33274 480 "$84,336.00" " 31,170.59 " - " 67,468.80 " - " 58,276.18 " " 16,751.22 " " 58,276.18 " - " 46,595.64 " " 16,432.15 " " 55,661.76 " - - " 55,822.00 " " 14,358.19 " " 15,953.54 " " 2,833.31 " " 3,541.64 " " 16,352.38 " " 16,432.15 " " 15,953.54 " " 67,468.80 " " 14,597.49 " - " 56,505.12 " " 14,039.12 " " 34,493.42 " " 63,252.00 " " 32,056.11 " " 37,723.49 " " 16,511.91 " 30613457 TRANSCATH RMVL PERM PM W/IMAGE 33275 480 "$15,024.00" " 5,552.87 " - " 12,019.20 " - " 10,381.58 " " 2,985.82 " " 10,381.58 " - " 8,300.76 " " 2,928.95 " " 6,576.00 " - - " 9,944.39 " " 2,559.28 " " 2,843.64 " " 3,016.75 " " 3,770.94 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " - " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 30613465 INSRT SC CRM W/PROGRAMMING 33285 480 "$42,801.00" " 15,819.25 " 776.00 " 34,681.61 " 892.40 " 29,575.49 " " 8,509.62 " " 29,575.49 " 907.92 " 23,647.55 " " 8,347.53 " " 28,248.66 " 869.12 808.05 " 28,329.98 " " 7,293.96 " " 8,104.40 " " 27,745.29 " " 34,681.61 " " 8,307.01 " " 8,347.53 " " 8,104.40 " " 34,240.80 " " 7,415.53 " 776.00 " 28,676.67 " " 7,131.87 " " 17,505.61 " " 32,100.75 " " 16,268.66 " " 19,144.89 " " 8,388.05 " 30613473 RMVL SC CARD RHYTHM MONITOR 33286 480 "$3,265.00" " 1,206.74 " 543.97 " 2,820.00 " 892.40 " 2,256.12 " 649.06 " 2,256.12 " 907.92 " 1,803.91 " 636.69 " 2,820.00 " 869.12 808.05 " 2,161.10 " 556.34 618.15 747.46 934.32 633.60 636.69 618.15 " 2,612.00 " 565.61 776.00 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 29820627 TCAT IMPL WRLS PULM ART SNSR 33289 481 "$151,281.00" " 55,913.46 " - " 121,024.80 " - " 104,535.17 " " 30,086.67 " " 104,535.17 " - " 83,582.75 " " 29,513.59 " " 99,845.46 " - - " 100,132.89 " " 25,788.57 " " 28,653.97 " " 2,703.06 " " 3,378.82 " " 29,370.32 " " 29,513.59 " " 28,653.97 " " 121,024.80 " " 26,218.38 " - " 101,358.27 " " 25,215.49 " " 61,873.93 " " 113,460.75 " " 57,501.91 " " 67,667.99 " " 29,656.86 " 29811237 PRQ TRANSCATH LAA CLOSURE 33340 481 "$37,233.00" " 13,761.32 " - " 29,786.40 " - " 25,728.00 " N/A " 25,728.00 " - " 20,571.23 " N/A " 24,573.78 " - N/A " 24,644.52 " - N/A " 2,132.32 " " 2,665.40 " N/A N/A N/A " 29,786.40 " N/A - " 24,946.11 " N/A " 15,228.30 " " 27,924.75 " " 14,152.26 " " 16,654.32 " N/A 30611012 PRQ TRANSCATH LAA CLOSURE 33340 481 "$37,233.00" " 13,761.32 " - " 29,786.40 " - " 25,728.00 " N/A " 25,728.00 " - " 20,571.23 " N/A " 24,573.78 " - N/A " 24,644.52 " - N/A " 2,132.32 " " 2,665.40 " N/A N/A N/A " 29,786.40 " N/A - " 24,946.11 " N/A " 15,228.30 " " 27,924.75 " " 14,152.26 " " 16,654.32 " N/A 28169302 RPL AORTIC VALVE PERQ FEM ART 33361 360 "$16,755.00" " 6,192.65 " - " 13,404.00 " - " 11,577.71 " N/A " 11,577.71 " - " 9,257.14 " N/A " 11,058.30 " - N/A " 11,090.13 " - N/A " 3,481.64 " " 4,352.05 " N/A N/A N/A " 13,404.00 " N/A - " 11,225.85 " N/A " 6,852.80 " " 12,566.25 " " 6,368.58 " " 7,494.51 " N/A 29811504 RPL AORTIC VALVE PERQ FEM ART 33361 481 "$16,755.00" " 6,192.65 " - " 13,404.00 " - " 11,577.71 " N/A " 11,577.71 " - " 9,257.14 " N/A " 11,058.30 " - N/A " 11,090.13 " - N/A " 3,481.64 " " 4,352.05 " N/A N/A N/A " 13,404.00 " N/A - " 11,225.85 " N/A " 6,852.80 " " 12,566.25 " " 6,368.58 " " 7,494.51 " N/A 28169311 RPL AORTIC VALVE OPEN FEM ART 33362 360 "$36,462.00" " 13,476.36 " - " 29,169.60 " - " 25,195.24 " N/A " 25,195.24 " - " 20,145.26 " N/A " 24,064.92 " - N/A " 24,134.20 " - N/A " 3,809.43 " " 4,761.79 " N/A N/A N/A " 29,169.60 " N/A - " 24,429.54 " N/A " 14,912.96 " " 27,346.50 " " 13,859.21 " " 16,309.45 " N/A 29811512 RPL AORTIC VALVE OPEN FEM ART 33362 481 "$36,462.00" " 13,476.36 " - " 29,169.60 " - " 25,195.24 " N/A " 25,195.24 " - " 20,145.26 " N/A " 24,064.92 " - N/A " 24,134.20 " - N/A " 3,809.43 " " 4,761.79 " N/A N/A N/A " 29,169.60 " N/A - " 24,429.54 " N/A " 14,912.96 " " 27,346.50 " " 13,859.21 " " 16,309.45 " N/A 28169329 RPL AORTIC VALVE OPEN AUX ART 33363 360 "$20,038.00" " 7,406.04 " - " 16,030.40 " - " 13,846.26 " N/A " 13,846.26 " - " 11,071.00 " N/A " 13,225.08 " - N/A " 13,263.15 " - N/A " 3,944.45 " " 4,930.56 " N/A N/A N/A " 16,030.40 " N/A - " 13,425.46 " N/A " 8,195.54 " " 15,028.50 " " 7,616.44 " " 8,963.00 " N/A 29811521 RPL AORTIC VALVE OPEN AUX ART 33363 481 "$20,038.00" " 7,406.04 " - " 16,030.40 " - " 13,846.26 " N/A " 13,846.26 " - " 11,071.00 " N/A " 13,225.08 " - N/A " 13,263.15 " - N/A " 3,944.45 " " 4,930.56 " N/A N/A N/A " 16,030.40 " N/A - " 13,425.46 " N/A " 8,195.54 " " 15,028.50 " " 7,616.44 " " 8,963.00 " N/A 29811539 RPL AORTIC VLV OPEN ILIAC ART 33364 481 "$31,625.00" " 11,688.60 " - " 25,300.00 " - " 21,852.88 " N/A " 21,852.88 " - " 17,472.81 " N/A " 20,872.50 " - N/A " 20,932.59 " - N/A " 4,193.03 " " 5,241.29 " N/A N/A N/A " 25,300.00 " N/A - " 21,188.75 " N/A " 12,934.63 " " 23,718.75 " " 12,020.66 " " 14,145.86 " N/A 28169337 RPL AORTIC VLV OPEN TRNSAPICAL 33366 360 "$21,340.00" " 7,887.26 " - " 17,072.00 " - " 14,745.94 " N/A " 14,745.94 " - " 11,790.35 " N/A " 14,084.40 " - N/A " 14,124.95 " - N/A " 5,570.14 " " 6,962.68 " N/A N/A N/A " 17,072.00 " N/A - " 14,297.80 " N/A " 8,728.06 " " 16,005.00 " " 8,111.33 " " 9,545.38 " N/A 29812152 RPL AORTIC VLV OPEN TRNSAPICAL 33366 481 "$21,340.00" " 7,887.26 " - " 17,072.00 " - " 14,745.94 " N/A " 14,745.94 " - " 11,790.35 " N/A " 14,084.40 " - N/A " 14,124.95 " - N/A " 5,570.14 " " 6,962.68 " N/A N/A N/A " 17,072.00 " N/A - " 14,297.80 " N/A " 8,728.06 " " 16,005.00 " " 8,111.33 " " 9,545.38 " N/A 28169345 REPLACEMENT AORTIC VALVE OPN 33405 360 "$15,307.00" " 5,657.47 " - " 14,871.62 " - " 10,577.14 " N/A " 10,577.14 " - " 8,457.12 " N/A " 10,102.62 " - N/A " 10,131.70 " - N/A " 11,897.30 " " 14,871.62 " N/A N/A N/A " 12,245.60 " N/A - " 10,255.69 " N/A " 6,260.56 " " 11,480.25 " " 5,818.19 " " 6,846.82 " N/A 28169353 REPAIR OF MITRAL VALVE 33426 360 "$16,861.00" " 6,231.83 " - " 13,986.81 " - " 11,650.95 " N/A " 11,650.95 " - " 9,315.70 " N/A " 11,128.26 " - N/A " 11,160.30 " - N/A " 11,189.45 " " 13,986.81 " N/A N/A N/A " 13,488.80 " N/A - " 11,296.87 " N/A " 6,896.15 " " 12,645.75 " " 6,408.87 " " 7,541.93 " N/A 28169361 VALVULOPLASTY WO RING INSERT 33463 360 "$5,672.00" " 2,096.37 " - " 10,764.98 " - " 3,919.35 " N/A " 3,919.35 " - " 3,133.78 " N/A " 3,743.52 " - N/A " 3,754.30 " - N/A " 8,611.98 " " 10,764.98 " N/A N/A N/A " 4,537.60 " N/A - " 3,800.24 " N/A " 2,319.85 " " 4,254.00 " " 2,155.93 " " 2,537.09 " N/A 28169370 VALVULOPLASTY W RING INSERT 33464 360 "$6,826.00" " 2,522.89 " - " 11,423.30 " - " 4,716.77 " N/A " 4,716.77 " - " 3,771.37 " N/A " 4,505.16 " - N/A " 4,518.13 " - N/A " 9,138.64 " " 11,423.30 " N/A N/A N/A " 5,460.80 " N/A - " 4,573.42 " N/A " 2,791.83 " " 5,119.50 " " 2,594.56 " " 3,053.27 " N/A 28169388 REPLACE TRICUSPID VALVE 33465 360 "$7,175.00" " 2,651.88 " - " 11,722.92 " - " 4,957.93 " N/A " 4,957.93 " - " 3,964.19 " N/A " 4,735.50 " - N/A " 4,749.13 " - N/A " 9,378.34 " " 11,722.92 " N/A N/A N/A " 5,740.00 " N/A - " 4,807.25 " N/A " 2,934.58 " " 5,381.25 " " 2,727.22 " " 3,209.38 " N/A 28169396 ENDOSCOPIC VEIN HARVEST 33508 360 "$4,245.00" " 1,568.95 " - " 3,396.00 " - " 2,933.30 " - " 2,933.30 " - " 2,345.36 " - " 2,801.70 " - - " 2,809.77 " - - 92.48 115.60 - - - " 3,396.00 " - - " 2,844.15 " - " 1,736.21 " " 3,183.75 " " 1,613.52 " " 1,898.79 " - 28169400 CABG VEIN SINGLE 33510 360 "$17,830.00" " 6,589.97 " - " 14,264.00 " - " 12,320.53 " N/A " 12,320.53 " - " 9,851.08 " N/A " 11,767.80 " - N/A " 11,801.68 " - N/A " 10,082.93 " " 12,603.66 " N/A N/A N/A " 14,264.00 " N/A - " 11,946.10 " N/A " 7,292.47 " " 13,372.50 " " 6,777.18 " " 7,975.36 " N/A 28169418 CABG VEIN THREE 33512 360 "$22,297.00" " 8,240.97 " - " 17,837.60 " - " 15,407.23 " N/A " 15,407.23 " - " 12,319.09 " N/A " 14,716.02 " - N/A " 14,758.38 " - N/A " 10,994.47 " " 13,743.09 " N/A N/A N/A " 17,837.60 " N/A - " 14,938.99 " N/A " 9,119.47 " " 16,722.75 " " 8,475.09 " " 9,973.45 " N/A 28169426 CABG ARTERY-VEIN SINGLE 33517 360 "$6,932.00" " 2,562.07 " - " 5,545.60 " - " 4,790.01 " N/A " 4,790.01 " - " 3,829.93 " N/A " 4,575.12 " - N/A " 4,588.29 " - N/A 775.52 969.40 N/A N/A N/A " 5,545.60 " N/A - " 4,644.44 " N/A " 2,835.19 " " 5,199.00 " " 2,634.85 " " 3,100.68 " N/A 28169434 CABG ARTERY-VEIN TWO 33518 360 "$3,052.00" " 1,128.02 " - " 2,441.60 " - " 2,108.93 " N/A " 2,108.93 " - " 1,686.23 " N/A " 2,014.32 " - N/A " 2,020.12 " - N/A " 1,460.65 " " 1,825.81 " N/A N/A N/A " 2,441.60 " N/A - " 2,044.84 " N/A " 1,248.27 " " 2,289.00 " " 1,160.07 " " 1,365.16 " N/A 28169442 CABG ARTERY-VEIN THREE 33519 360 "$3,499.00" " 1,293.23 " - " 2,799.20 " - " 2,417.81 " N/A " 2,417.81 " - " 1,933.20 " N/A " 2,309.34 " - N/A " 2,315.99 " - N/A " 2,145.82 " " 2,682.28 " N/A N/A N/A " 2,799.20 " N/A - " 2,344.33 " N/A " 1,431.09 " " 2,624.25 " " 1,329.97 " " 1,565.10 " N/A 28169451 CABG ARTERY-VEIN FOUR 33521 360 "$6,052.00" " 2,236.82 " - " 4,841.60 " - " 4,181.93 " N/A " 4,181.93 " - " 3,343.73 " N/A " 3,994.32 " - N/A " 4,005.82 " - N/A " 2,833.37 " " 3,541.71 " N/A N/A N/A " 4,841.60 " N/A - " 4,054.84 " N/A " 2,475.27 " " 4,539.00 " " 2,300.37 " " 2,707.06 " N/A 28169469 CABG ARTERY-VEIN FIVE 33522 360 "$25,341.00" " 9,366.03 " - " 20,272.80 " - " 17,510.63 " N/A " 17,510.63 " - " 14,000.90 " N/A " 16,725.06 " - N/A " 16,773.21 " - N/A " 3,518.10 " " 4,397.62 " N/A N/A N/A " 20,272.80 " N/A - " 16,978.47 " N/A " 10,364.47 " " 19,005.75 " " 9,632.11 " " 11,335.03 " N/A 28175264 CABG ART-VEIN SIX OR MORE 33523 360 "$8,434.00" " 3,117.21 " - " 6,747.20 " - " 5,827.89 " N/A " 5,827.89 " - " 4,659.79 " N/A " 5,566.44 " - N/A " 5,582.46 " - N/A " 4,208.34 " " 5,260.42 " N/A N/A N/A " 6,747.20 " N/A - " 5,650.78 " N/A " 3,449.51 " " 6,325.50 " " 3,205.76 " " 3,772.53 " N/A 28169477 CORONARY ARTERY BYPASS/REOP 33530 360 "$7,739.00" " 2,860.33 " - " 6,191.20 " - " 5,347.65 " N/A " 5,347.65 " - " 4,275.80 " N/A " 5,107.74 " - N/A " 5,122.44 " - N/A " 1,766.22 " " 2,207.77 " N/A N/A N/A " 6,191.20 " N/A - " 5,185.13 " N/A " 3,165.25 " " 5,804.25 " " 2,941.59 " " 3,461.65 " N/A 28169485 CABG ARTERIAL SINGLE 33533 360 "$27,667.00" " 10,225.72 " - " 22,133.60 " - " 19,117.90 " N/A " 19,117.90 " - " 15,286.02 " N/A " 18,260.22 " - N/A " 18,312.79 " - N/A " 10,345.52 " " 12,931.90 " N/A N/A N/A " 22,133.60 " N/A - " 18,536.89 " N/A " 11,315.80 " " 20,750.25 " " 10,516.23 " " 12,375.45 " N/A 28169493 CABG ARTERIAL TWO 33534 360 "$3,867.00" " 1,429.24 " - " 13,863.62 " - " 2,672.10 " N/A " 2,672.10 " - " 2,136.52 " N/A " 2,552.22 " - N/A " 2,559.57 " - N/A " 11,090.90 " " 13,863.62 " N/A N/A N/A " 3,093.60 " N/A - " 2,590.89 " N/A " 1,581.60 " " 2,900.25 " " 1,469.85 " " 1,729.71 " N/A 28169507 CABG ARTERIAL THREE 33535 360 "$22,606.00" " 8,355.18 " - " 18,084.80 " - " 15,620.75 " N/A " 15,620.75 " - " 12,489.82 " N/A " 14,919.96 " - N/A " 14,962.91 " - N/A " 11,733.71 " " 14,667.14 " N/A N/A N/A " 18,084.80 " N/A - " 15,146.02 " N/A " 9,245.85 " " 16,954.50 " " 8,592.54 " " 10,111.66 " N/A 28175272 CABG ARTERIAL GRAFTS 4 OR MORE 33536 360 "$30,535.00" " 11,285.74 " - " 24,428.00 " - " 21,099.69 " N/A " 21,099.69 " - " 16,870.59 " N/A " 20,153.10 " - N/A " 20,211.12 " - N/A " 12,459.11 " " 15,573.89 " N/A N/A N/A " 24,428.00 " N/A - " 20,458.45 " N/A " 12,488.82 " " 22,901.25 " " 11,606.35 " " 13,658.31 " N/A 28169515 REPAIR HEART SEPTUM DEFECT 33641 360 "$15,100.00" " 5,580.96 " - " 12,080.00 " - " 10,434.10 " N/A " 10,434.10 " - " 8,342.75 " N/A " 9,966.00 " - N/A " 9,994.69 " - N/A " 6,955.30 " " 8,694.12 " N/A N/A N/A " 12,080.00 " N/A - " 10,117.00 " N/A " 6,175.90 " " 11,325.00 " " 5,739.51 " " 6,754.23 " N/A 28175281 AS-AORT GRF F/DS OTH/THN DSJ 33859 360 "$22,427.00" " 8,289.02 " - " 17,941.60 " - " 15,497.06 " N/A " 15,497.06 " - " 12,390.92 " N/A " 14,801.82 " - N/A " 14,844.43 " - N/A " 14,081.99 " " 17,602.49 " N/A N/A N/A " 17,941.60 " N/A - " 15,026.09 " N/A " 9,172.64 " " 16,820.25 " " 8,524.50 " " 10,031.60 " N/A 28169523 THORACIC AORTIC ANEURYSM 33863 360 "$5,621.00" " 2,077.52 " - " 17,925.25 " - " 3,884.11 " N/A " 3,884.11 " - " 3,105.60 " N/A " 3,709.86 " - N/A " 3,720.54 " - N/A " 14,340.20 " " 17,925.25 " N/A N/A N/A " 4,496.80 " N/A - " 3,766.07 " N/A " 2,298.99 " " 4,215.75 " " 2,136.54 " " 2,514.27 " N/A 28169531 ASC AORT GRF W/BYPASS W/VAL 33864 360 "$29,755.00" " 10,997.45 " - " 23,804.00 " - " 20,560.71 " N/A " 20,560.71 " - " 16,439.64 " N/A " 19,638.30 " - N/A " 19,694.83 " - N/A " 16,611.98 " " 20,764.98 " N/A N/A N/A " 23,804.00 " N/A - " 19,935.85 " N/A " 12,169.80 " " 22,316.25 " " 11,309.88 " " 13,309.41 " N/A 28169540 ENDOVASC TAA REPR INCL SUBCL 33880 360 "$11,088.00" " 4,098.12 " - " 12,630.03 " - " 7,661.81 " N/A " 7,661.81 " - " 6,126.12 " N/A " 7,318.08 " - N/A " 7,339.15 " - N/A " 10,104.02 " " 12,630.03 " N/A N/A N/A " 8,870.40 " N/A - " 7,428.96 " N/A " 4,534.99 " " 8,316.00 " " 4,214.55 " " 4,959.66 " N/A 28169558 ENDOVASC TAA REPR W/O SUBCL 33881 360 "$15,550.00" " 5,747.28 " - " 12,440.00 " - " 10,745.05 " N/A " 10,745.05 " - " 8,591.38 " N/A " 10,263.00 " - N/A " 10,292.55 " - N/A " 8,673.64 " " 10,842.05 " N/A N/A N/A " 12,440.00 " N/A - " 10,418.50 " N/A " 6,359.95 " " 11,662.50 " " 5,910.56 " " 6,955.52 " N/A 28169566 VENTRICULAR ASSIST OR ECMO 33946 360 "$7,907.00" " 2,922.43 " - " 6,325.60 " - " 5,463.74 " N/A " 5,463.74 " - " 4,368.62 " N/A " 5,218.62 " - N/A " 5,233.64 " - N/A 646.82 808.52 N/A N/A N/A " 6,325.60 " N/A - " 5,297.69 " N/A " 3,233.96 " " 5,930.25 " " 3,005.45 " " 3,536.80 " N/A 28169574 ECMO/ECLS INITIATION ARTERY 33947 360 "$9,539.00" " 3,525.61 " - " 7,631.20 " - " 6,591.45 " N/A " 6,591.45 " - " 5,270.30 " N/A " 6,295.74 " - N/A " 6,313.86 " - N/A 714.43 893.04 N/A N/A N/A " 7,631.20 " N/A - " 6,391.13 " N/A " 3,901.45 " " 7,154.25 " " 3,625.77 " " 4,266.79 " N/A 28169582 ECMO/ECLS DAILY MGMT-VENOUS 33948 360 "$6,746.00" " 2,493.32 " - " 5,396.80 " - " 4,661.49 " N/A " 4,661.49 " - " 3,727.17 " N/A " 4,452.36 " - N/A " 4,465.18 " - N/A 510.57 638.21 N/A N/A N/A " 5,396.80 " N/A - " 4,519.82 " N/A " 2,759.11 " " 5,059.50 " " 2,564.15 " " 3,017.49 " N/A 28175299 "ECMO/ECLS DLY MGMT,VENO-ARTERY" 33949 360 "$7,808.00" " 2,885.84 " - " 6,246.40 " - " 5,395.33 " N/A " 5,395.33 " - " 4,313.92 " N/A " 5,153.28 " - N/A " 5,168.12 " - N/A 496.90 621.12 N/A N/A N/A " 6,246.40 " N/A - " 5,231.36 " N/A " 3,193.47 " " 5,856.00 " " 2,967.82 " " 3,492.52 " N/A 28169591 ECMO/ECLS INSJ PRPH CANNULA 33953 360 "$2,186.00" 807.95 - " 1,748.80 " - " 1,510.53 " N/A " 1,510.53 " - " 1,207.77 " N/A " 1,442.76 " - N/A " 1,446.91 " - N/A " 1,034.30 " " 1,292.87 " N/A N/A N/A " 1,748.80 " N/A - " 1,464.62 " N/A 894.07 " 1,639.50 " 830.90 977.80 N/A 29801436 INSERT INTRA AORTIC ASST DEV 33967 481 "$6,978.00" " 2,579.07 " - " 5,582.40 " - " 4,821.80 " N/A " 4,821.80 " - " 3,855.35 " N/A " 4,605.48 " - N/A " 4,618.74 " - N/A " 1,451.30 " " 1,814.13 " N/A N/A N/A " 5,582.40 " N/A - " 4,675.26 " N/A " 2,854.00 " " 5,233.50 " " 2,652.34 " " 3,121.26 " N/A 29804583 REMOVAL INTRA AORTIC ASST DEV 33968 481 "$19,037.00" " 7,036.08 " - " 15,229.60 " - " 1,469.00 " N/A " 1,469.00 " - " 10,517.94 " N/A " 12,564.42 " - N/A " 12,600.59 " - N/A 193.40 241.75 N/A N/A N/A " 15,229.60 " N/A - " 12,754.79 " N/A " 7,786.13 " " 14,277.75 " " 7,235.96 " " 8,515.25 " N/A 29811636 INSERT VAD ARTERY ACCESS 33990 481 "$11,046.00" " 4,082.60 " - " 8,836.80 " - " 7,632.79 " N/A " 7,632.79 " - " 6,102.92 " N/A " 7,290.36 " - N/A " 7,311.35 " - N/A " 1,132.23 " " 1,415.29 " N/A N/A N/A " 8,836.80 " N/A - " 7,400.82 " N/A " 4,517.81 " " 8,284.50 " " 4,198.58 " " 4,940.88 " N/A 29813124 REMOVE VAD DIFFERENT SESSION 33992 481 "$2,185.00" 807.58 - " 1,748.00 " - " 1,509.84 " N/A " 1,509.84 " - " 1,207.21 " N/A " 1,442.10 " - N/A " 1,446.25 " - N/A 539.93 674.91 N/A N/A N/A " 1,748.00 " N/A - " 1,463.95 " N/A 893.67 " 1,638.75 " 830.52 977.35 N/A 29813191 REPOSITION VAD DIFF SESSION 33993 481 "$5,307.00" " 1,961.47 " - " 4,245.60 " - " 3,667.14 " N/A " 3,667.14 " - " 2,932.12 " N/A " 3,502.62 " - N/A " 3,512.70 " - N/A 474.06 592.57 N/A N/A N/A " 4,245.60 " N/A - " 3,555.69 " N/A " 2,170.56 " " 3,980.25 " " 2,017.19 " " 2,373.82 " N/A 28175302 EMBOLECTOMY ART AXL BRAC INNO 34101 360 "$25,044.00" " 9,256.26 " 776.00 " 20,035.20 " 892.40 " 2,773.00 " " 4,973.85 " " 2,773.00 " 907.92 " 13,836.81 " " 4,879.11 " " 3,545.00 " 869.12 808.05 " 16,576.62 " " 4,263.30 " " 4,737.00 " " 2,532.97 " " 3,166.21 " " 4,855.43 " " 4,879.11 " " 4,737.00 " " 20,035.20 " " 4,334.36 " 776.00 " 16,779.48 " " 4,168.56 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,902.80 " 28169604 REMOVAL OF ARM ARTERY CLOT 34111 360 "$25,044.00" " 9,256.26 " 776.00 " 20,035.20 " 892.40 " 17,305.40 " " 4,973.85 " " 17,305.40 " 907.92 " 13,836.81 " " 4,879.11 " " 16,529.04 " 869.12 808.05 " 16,576.62 " " 4,263.30 " " 4,737.00 " " 3,406.49 " " 4,258.11 " " 4,855.43 " " 4,879.11 " " 4,737.00 " " 20,035.20 " " 4,334.36 " 776.00 " 16,779.48 " " 4,168.56 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,902.80 " 28169612 REMOVAL OF ARTERY CLOT 34201 360 "$25,044.00" " 9,256.26 " 776.00 " 20,035.20 " 892.40 " 17,305.40 " " 4,973.85 " " 17,305.40 " 907.92 " 13,836.81 " " 4,879.11 " " 16,529.04 " 869.12 808.05 " 16,576.62 " " 4,263.30 " " 4,737.00 " " 3,434.50 " " 4,293.12 " " 4,855.43 " " 4,879.11 " " 4,737.00 " " 20,035.20 " " 4,334.36 " 776.00 " 16,779.48 " " 4,168.56 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,902.80 " 28169621 REMOVAL OF LEG ARTERY CLOT 34203 360 "$25,044.00" " 9,256.26 " - " 20,035.20 " - " 17,305.40 " " 4,973.85 " " 17,305.40 " - " 13,836.81 " " 4,879.11 " " 16,529.04 " - - " 16,576.62 " " 4,263.30 " " 4,737.00 " " 5,484.30 " " 6,855.37 " " 4,855.43 " " 4,879.11 " " 4,737.00 " " 20,035.20 " " 4,334.36 " - " 16,779.48 " " 4,168.56 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,902.80 " 80327676 REMOVE VEIN CLOT 34421 320 "$15,024.00" " 5,552.87 " - " 12,019.20 " - " 10,381.58 " " 2,985.82 " " 10,381.58 " - " 8,300.76 " " 2,928.95 " " 9,915.84 " - - " 9,944.39 " " 2,559.28 " " 2,843.64 " " 4,046.94 " " 5,058.68 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " - " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 28169639 EVASC RPR A-UNILAC NDGFT 34703 360 "$9,647.00" " 3,565.53 " - " 10,045.49 " - " 6,666.08 " N/A " 6,666.08 " - " 5,329.97 " N/A " 6,367.02 " - N/A " 6,385.35 " - N/A " 8,036.39 " " 10,045.49 " N/A N/A N/A " 7,717.60 " N/A - " 6,463.49 " N/A " 3,945.62 " " 7,235.25 " " 3,666.82 " " 4,315.10 " N/A 28169647 EVAC RPR A-BIILIAC NDGFT 34705 360 "$10,171.00" " 3,759.20 " - " 11,062.57 " - " 7,028.16 " N/A " 7,028.16 " - " 5,619.48 " N/A " 6,712.86 " - N/A " 6,732.18 " - N/A " 8,850.06 " " 11,062.57 " N/A N/A N/A " 8,136.80 " N/A - " 6,814.57 " N/A " 4,159.94 " " 7,628.25 " " 3,866.00 " " 4,549.49 " N/A 28176759 EVASC RPR A-BIILIAC RPT 34706 360 "$13,388.00" " 4,948.20 " - " 16,659.39 " - " 9,251.11 " N/A " 9,251.11 " - " 7,396.87 " N/A " 8,836.08 " - N/A " 8,861.52 " - N/A " 13,327.51 " " 16,659.39 " N/A N/A N/A " 10,710.40 " N/A - " 8,969.96 " N/A " 5,475.69 " " 10,041.00 " " 5,088.78 " " 5,988.45 " N/A 28169655 EVASC RPR ILIO-ILIAC NDGFT 34707 360 "$10,765.00" " 3,978.74 " - " 8,612.00 " - " 7,438.62 " N/A " 7,438.62 " - " 5,947.66 " N/A " 7,104.90 " - N/A " 7,125.35 " - N/A " 6,648.20 " " 8,310.25 " N/A N/A N/A " 8,612.00 " N/A - " 7,212.55 " N/A " 4,402.89 " " 8,073.75 " " 4,091.78 " " 4,815.18 " N/A 28176619 PLMT XTN PROSTH EVASC RPR 34709 360 "$3,724.00" " 1,376.39 " - " 2,979.20 " - " 2,573.28 " N/A " 2,573.28 " - " 2,057.51 " N/A " 2,457.84 " - N/A " 2,464.92 " - N/A " 1,876.37 " " 2,345.46 " N/A N/A N/A " 2,979.20 " N/A - " 2,495.08 " N/A " 1,523.12 " " 2,793.00 " " 1,415.49 " " 1,665.75 " N/A 28169663 DLYD PLMT XTN PROSTH 1ST VSL 34710 360 "$3,386.00" " 1,251.47 " - " 5,791.74 " - " 2,339.73 " N/A " 2,339.73 " - " 1,870.77 " N/A " 2,234.76 " - N/A " 2,241.19 " - N/A " 4,633.39 " " 5,791.74 " N/A N/A N/A " 2,708.80 " N/A - " 2,268.62 " N/A " 1,384.87 " " 2,539.50 " " 1,287.02 " " 1,514.56 " N/A 28176767 PERQ ACCESS & CLSR FEM ART 34713 360 "$1,386.00" 512.27 - " 1,108.80 " - 957.73 - 957.73 - 765.77 - 914.76 - - 917.39 - - 746.27 932.84 - - - " 1,108.80 " - - 928.62 - 566.87 " 1,039.50 " 526.82 619.96 - 28176627 OPEN FEM ART AORTIC ENDO 34812 360 "$5,517.00" " 2,039.08 " - " 4,413.60 " - " 3,812.25 " N/A " 3,812.25 " - " 3,048.14 " N/A " 3,641.22 " - N/A " 3,651.70 " - N/A " 2,069.99 " " 2,587.49 " N/A N/A N/A " 4,413.60 " N/A - " 3,696.39 " N/A " 2,256.45 " " 4,137.75 " " 2,097.01 " " 2,467.75 " N/A 28169671 FEMORAL ENDOVAS GRAFT ADD-ON 34813 360 "$8,540.00" " 3,156.38 " - " 6,832.00 " - " 5,901.14 " N/A " 5,901.14 " - " 4,718.35 " N/A " 5,636.40 " - N/A " 5,652.63 " - N/A " 1,437.75 " " 1,797.19 " N/A N/A N/A " 6,832.00 " N/A - " 5,721.80 " N/A " 3,492.86 " " 6,405.00 " " 3,246.05 " " 3,819.94 " N/A 28169680 REPAIR DEFECT OF ARM ARTERY 35045 360 "$25,044.00" " 9,256.26 " 776.00 " 20,035.20 " 892.40 " 17,305.40 " " 4,973.85 " " 17,305.40 " 907.92 " 13,836.81 " " 4,879.11 " " 16,529.04 " 869.12 808.05 " 16,576.62 " " 4,263.30 " " 4,737.00 " " 5,618.07 " " 7,022.59 " " 4,855.43 " " 4,879.11 " " 4,737.00 " " 20,035.20 " " 4,334.36 " 776.00 " 16,779.48 " " 4,168.56 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,902.80 " 28169698 REP ANEURYSM OCCL ABD AORTA 35081 360 "$2,204.00" 814.60 - " 11,090.91 " - " 1,522.96 " N/A " 1,522.96 " - " 1,217.71 " N/A " 1,454.64 " - N/A " 1,458.83 " - N/A " 8,872.73 " " 11,090.91 " N/A N/A N/A " 1,763.20 " N/A - " 1,476.68 " N/A 901.44 " 1,653.00 " 837.74 985.85 N/A 28169701 REPAIR ARTERY RUPTURE AORTA 35082 360 "$20,258.00" " 7,487.36 " - " 16,206.40 " - " 13,998.28 " N/A " 13,998.28 " - " 11,192.55 " N/A " 13,370.28 " - N/A " 13,408.77 " - N/A " 12,095.03 " " 15,118.79 " N/A N/A N/A " 16,206.40 " N/A - " 13,572.86 " N/A " 8,285.52 " " 15,193.50 " " 7,700.07 " " 9,061.40 " N/A 28169710 REP ANR OCCL ABD AORTA ILIAC 35102 360 "$5,748.00" " 2,124.46 " - " 12,141.46 " - " 3,971.87 " N/A " 3,971.87 " - " 3,175.77 " N/A " 3,793.68 " - N/A " 3,804.60 " - N/A " 9,713.17 " " 12,141.46 " N/A N/A N/A " 4,598.40 " N/A - " 3,851.16 " N/A " 2,350.93 " " 4,311.00 " " 2,184.81 " " 2,571.08 " N/A 28169728 DIR REP ANEUR OCCL FEMORA VES 35141 360 "$20,582.00" " 7,607.11 " - " 16,465.60 " - " 14,222.16 " N/A " 14,222.16 " - " 11,371.56 " N/A " 13,584.12 " - N/A " 13,623.23 " - N/A " 6,481.91 " " 8,102.39 " N/A N/A N/A " 16,465.60 " N/A - " 13,789.94 " N/A " 8,418.04 " " 15,436.50 " " 7,823.22 " " 9,206.33 " N/A 28169736 DIR REP ANEUR OCCL POPLITEAL 35151 360 "$4,678.00" " 1,728.99 " - " 9,144.43 " - " 3,232.50 " N/A " 3,232.50 " - " 2,584.60 " N/A " 3,087.48 " - N/A " 3,096.37 " - N/A " 7,315.54 " " 9,144.43 " N/A N/A N/A " 3,742.40 " N/A - " 3,134.26 " N/A " 1,913.30 " " 3,508.50 " " 1,778.11 " " 2,092.47 " N/A 28169744 REPAIR BLOOD VESSEL LESION 35206 360 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 10,381.58 " " 2,985.82 " " 10,381.58 " 907.92 " 8,300.76 " " 2,928.95 " " 9,915.84 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 2,532.97 " " 3,166.21 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 28169752 THROMBOENDARTEREC CAROT/VERTEB 35301 360 "$5,095.00" " 1,883.11 " - " 7,608.76 " - " 3,520.65 " N/A " 3,520.65 " - " 2,814.99 " N/A " 3,362.70 " - N/A " 3,372.38 " - N/A " 6,087.01 " " 7,608.76 " N/A N/A N/A " 4,076.00 " N/A - " 3,413.65 " N/A " 2,083.86 " " 3,821.25 " " 1,936.61 " " 2,278.99 " N/A 28169761 THROMBOENDARTEREC MESN CEL REN 35341 360 "$12,751.00" " 4,712.77 " - " 10,200.80 " - " 8,810.94 " N/A " 8,810.94 " - " 7,044.93 " N/A " 8,415.66 " - N/A " 8,439.89 " - N/A " 8,102.94 " " 10,128.68 " N/A N/A N/A " 10,200.80 " N/A - " 8,543.17 " N/A " 5,215.16 " " 9,563.25 " " 4,846.66 " " 5,703.52 " N/A 28169779 THROMBOENDARTEREC COM/DEEP FEM 35371 360 "$10,511.00" " 3,884.87 " - " 8,408.80 " - " 7,263.10 " N/A " 7,263.10 " - " 5,807.33 " N/A " 6,937.26 " - N/A " 6,957.23 " - N/A " 4,848.51 " " 6,060.64 " N/A N/A N/A " 8,408.80 " N/A - " 7,042.37 " N/A " 4,299.00 " " 7,883.25 " " 3,995.23 " " 4,701.57 " N/A 28176635 THROMBOENDARTEREC DEEP FEMORAL 35372 360 "$9,541.00" " 3,526.35 " - " 7,632.80 " - " 6,592.83 " N/A " 6,592.83 " - " 5,271.40 " N/A " 6,297.06 " - N/A " 6,315.19 " - N/A " 5,846.13 " " 7,307.66 " N/A N/A N/A " 7,632.80 " N/A - " 6,392.47 " N/A " 3,902.27 " " 7,155.75 " " 3,626.53 " " 4,267.69 " N/A 28175311 BYPASS W/VEIN AXI-FEM-FEM 35533 360 "$25,343.00" " 9,366.77 " - " 20,274.40 " - " 17,512.01 " N/A " 17,512.01 " - " 14,002.01 " N/A " 16,726.38 " - N/A " 16,774.53 " - N/A " 8,885.27 " " 11,106.59 " N/A N/A N/A " 20,274.40 " N/A - " 16,979.81 " N/A " 10,365.29 " " 19,007.25 " " 9,632.87 " " 11,335.92 " N/A 28169787 ART BYP GRFT FEM-POPLITEAL 35556 360 "$2,507.00" 926.59 - " 8,816.40 " - " 1,732.34 " N/A " 1,732.34 " - " 1,385.12 " N/A " 1,654.62 " - N/A " 1,659.38 " - N/A " 7,053.12 " " 8,816.40 " N/A N/A N/A " 2,005.60 " N/A - " 1,679.69 " N/A " 1,025.36 " " 1,880.25 " 952.91 " 1,121.38 " N/A 28169795 BYP GRF VEIN FEMORL -TIBIAL 35566 360 "$3,340.00" " 1,234.46 " - " 10,752.96 " - " 2,307.94 " N/A " 2,307.94 " - " 1,845.35 " N/A " 2,204.40 " - N/A " 2,210.75 " - N/A " 8,602.37 " " 10,752.96 " N/A N/A N/A " 2,672.00 " N/A - " 2,237.80 " N/A " 1,366.06 " " 2,505.00 " " 1,269.53 " " 1,493.98 " N/A 28169809 VEIN BYP GRFT FEM-POPLITEAL 35583 360 "$2,771.00" " 1,024.16 " - " 9,103.30 " - " 1,914.76 " N/A " 1,914.76 " - " 1,530.98 " N/A " 1,828.86 " - N/A " 1,834.12 " - N/A " 7,282.64 " " 9,103.30 " N/A N/A N/A " 2,216.80 " N/A - " 1,856.57 " N/A " 1,133.34 " " 2,078.25 " " 1,053.26 " " 1,239.47 " N/A 28175329 VEIN BYP FEM-TIBIAL PERONEAL 35585 360 "$5,707.00" " 2,109.31 " - " 11,388.14 " - " 3,943.54 " N/A " 3,943.54 " - " 3,153.12 " N/A " 3,766.62 " - N/A " 3,777.46 " - N/A " 9,110.51 " " 11,388.14 " N/A N/A N/A " 4,565.60 " N/A - " 3,823.69 " N/A " 2,334.16 " " 4,280.25 " " 2,169.23 " " 2,552.74 " N/A 28169817 ART BYP AXILLARY-FEMORAL 35621 360 "$8,672.00" " 3,205.17 " - " 8,052.40 " - " 5,992.35 " N/A " 5,992.35 " - " 4,791.28 " N/A " 5,723.52 " - N/A " 5,740.00 " - N/A " 6,441.92 " " 8,052.40 " N/A N/A N/A " 6,937.60 " N/A - " 5,810.24 " N/A " 3,546.85 " " 6,504.00 " " 3,296.23 " " 3,878.99 " N/A 28169825 ART BYP AOR-CELIAC-MSN-RENAL 35631 360 "$31,320.00" " 11,575.87 " - " 25,056.00 " - " 21,642.12 " N/A " 21,642.12 " - " 17,304.30 " N/A " 20,671.20 " - N/A " 20,730.71 " - N/A " 10,773.67 " " 13,467.09 " N/A N/A N/A " 25,056.00 " N/A - " 20,984.40 " N/A " 12,809.88 " " 23,490.00 " " 11,904.73 " " 14,009.44 " N/A 28169833 ART BYP AORTOBIFEMORAL 35646 360 "$6,922.00" " 2,558.37 " - " 12,379.84 " - " 4,783.10 " N/A " 4,783.10 " - " 3,824.41 " N/A " 4,568.52 " - N/A " 4,581.67 " - N/A " 9,903.87 " " 12,379.84 " N/A N/A N/A " 5,537.60 " N/A - " 4,637.74 " N/A " 2,831.10 " " 5,191.50 " " 2,631.05 " " 3,096.21 " N/A 28169841 ART BYP AXILL-FEM-FEMORAL 35654 360 "$6,098.00" " 2,253.82 " - " 9,998.66 " - " 4,213.72 " N/A " 4,213.72 " - " 3,369.15 " N/A " 4,024.68 " - N/A " 4,036.27 " - N/A " 7,998.93 " " 9,998.66 " N/A N/A N/A " 4,878.40 " N/A - " 4,085.66 " N/A " 2,494.08 " " 4,573.50 " " 2,317.85 " " 2,727.64 " N/A 28169850 ART BYP FEMORAL-POPLITEAL 35656 360 "$2,069.00" 764.70 - " 7,882.16 " - " 1,429.68 " N/A " 1,429.68 " - " 1,143.12 " N/A " 1,365.54 " - N/A " 1,369.47 " - N/A " 6,305.73 " " 7,882.16 " N/A N/A N/A " 1,655.20 " N/A - " 1,386.23 " N/A 846.22 " 1,551.75 " 786.43 925.46 N/A 28169868 ART BYP FEMORAL-FEMORAL 35661 360 "$15,850.00" " 5,858.16 " - " 12,680.00 " - " 10,952.35 " N/A " 10,952.35 " - " 8,757.13 " N/A " 10,461.00 " - N/A " 10,491.12 " - N/A " 6,243.22 " " 7,804.03 " N/A N/A N/A " 12,680.00 " N/A - " 10,619.50 " N/A " 6,482.65 " " 11,887.50 " " 6,024.59 " " 7,089.71 " N/A 28169876 ART BYP FEM-ANT-POST TIB/PRL 35666 360 "$24,952.00" " 9,222.26 " - " 19,961.60 " - " 17,241.83 " N/A " 17,241.83 " - " 13,785.98 " N/A " 16,468.32 " - N/A " 16,515.73 " - N/A " 7,336.47 " " 9,170.59 " N/A N/A N/A " 19,961.60 " N/A - " 16,717.84 " N/A " 10,205.37 " " 18,714.00 " " 9,484.26 " " 11,161.03 " N/A 28169884 EXPLORE CHEST VESSELS 35820 360 "$3,938.00" " 1,455.48 " - " 5,584.09 " - " 2,721.16 " N/A " 2,721.16 " - " 2,175.75 " N/A " 2,599.08 " - N/A " 2,606.56 " - N/A " 4,467.27 " " 5,584.09 " N/A N/A N/A " 3,150.40 " N/A - " 2,638.46 " N/A " 1,610.64 " " 2,953.50 " " 1,496.83 " " 1,761.47 " N/A 28169892 EXPLORE LIMB VESSELS 35860 360 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 10,381.58 " " 2,985.82 " " 10,381.58 " 907.92 " 8,300.76 " " 2,928.95 " " 9,915.84 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 2,100.37 " " 2,625.46 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 28169906 THROMBECTOMY REP ART VEN GRAFT 35875 360 "$25,044.00" " 9,256.26 " 776.00 " 20,035.20 " 892.40 " 4,656.00 " " 4,973.85 " " 4,656.00 " 907.92 " 13,836.81 " " 4,879.11 " " 6,576.00 " 869.12 808.05 " 16,576.62 " " 4,263.30 " " 4,737.00 " " 4,937.34 " " 6,171.67 " " 4,855.43 " " 4,879.11 " " 4,737.00 " " 20,035.20 " " 4,334.36 " 776.00 " 16,779.48 " " 4,168.56 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,902.80 " 28169914 THROMBECTOMY W/REV OF GRF 35876 360 "$25,044.00" " 9,256.26 " 776.00 " 20,035.20 " 892.40 " 4,656.00 " " 4,973.85 " " 4,656.00 " 907.92 " 13,836.81 " " 4,879.11 " " 6,576.00 " 869.12 808.05 " 16,576.62 " " 4,263.30 " " 4,737.00 " " 4,937.34 " " 6,171.67 " " 4,855.43 " " 4,879.11 " " 4,737.00 " " 20,035.20 " " 4,334.36 " 776.00 " 16,779.48 " " 4,168.56 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,902.80 " 28169922 EXCISION GRAFT EXTREMITY 35903 360 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 10,381.58 " " 2,985.82 " " 10,381.58 " 907.92 " 8,300.76 " " 2,928.95 " " 9,915.84 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 3,422.35 " " 4,277.94 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 54026307 INJ TX PSEUDOANEURYSM 36002 402 "$2,844.00" " 1,051.14 " 103.33 " 2,275.20 " 118.83 " 1,469.00 " 563.79 " 1,469.00 " 120.90 " 1,571.31 " 553.05 " 1,775.00 " 115.73 107.60 " 1,882.44 " 483.25 536.94 " 1,005.54 " " 1,256.93 " 550.36 553.05 536.94 " 2,275.20 " 491.30 103.33 " 1,905.48 " 472.51 " 1,163.20 " " 2,133.00 " " 1,081.00 " " 1,272.12 " 555.73 80326301 INJ TX PSEUDOANEURYSM 36002 320 "$2,844.00" " 1,051.14 " 103.33 " 2,275.20 " 118.83 " 1,469.00 " 563.79 " 1,469.00 " 120.90 " 1,571.31 " 553.05 " 1,775.00 " 115.73 107.60 " 1,882.44 " 483.25 536.94 " 1,005.54 " " 1,256.93 " 550.36 553.05 536.94 " 2,275.20 " 491.30 103.33 " 1,905.48 " 472.51 " 1,163.20 " " 2,133.00 " " 1,081.00 " " 1,272.12 " 555.73 80526300 INJ TX PSEUDOANEURYSM 36002 402 "$2,844.00" " 1,051.14 " 103.33 " 2,275.20 " 118.83 " 1,469.00 " 563.79 " 1,469.00 " 120.90 " 1,571.31 " 553.05 " 1,775.00 " 115.73 107.60 " 1,882.44 " 483.25 536.94 " 1,005.54 " " 1,256.93 " 550.36 553.05 536.94 " 2,275.20 " 491.30 103.33 " 1,905.48 " 472.51 " 1,163.20 " " 2,133.00 " " 1,081.00 " " 1,272.12 " 555.73 28169931 INJ EXTREMITY VENOGRAPHY 36005 360 $196.00 72.44 - " 1,469.00 " 50.20 " 1,469.00 " - " 1,469.00 " 51.07 108.29 - 129.36 48.89 45.45 129.73 - - 281.27 351.59 - - - 156.80 - 43.65 131.32 - 80.16 147.00 74.50 87.67 - 29820384 INJ EXTREMITY VENOGRAPHY 36005 480 $196.00 72.44 - " 1,469.00 " 50.20 " 1,469.00 " - " 1,469.00 " 51.07 108.29 - 129.36 48.89 45.45 129.73 - - 281.27 351.59 - - - 156.80 - 43.65 131.32 - 80.16 147.00 74.50 87.67 - 30601742 INJ EXTREMITY VENOGRAPHY 36005 480 $196.00 72.44 - " 1,469.00 " 50.20 " 1,469.00 " - " 1,469.00 " 51.07 108.29 - 129.36 48.89 45.45 129.73 - - 281.27 351.59 - - - 156.80 - 43.65 131.32 - 80.16 147.00 74.50 87.67 - 80301855 INJ EXTREMITY VENOGRAPHY 36005 320 $196.00 72.44 - " 1,469.00 " 50.20 " 1,469.00 " - " 1,469.00 " 51.07 108.29 - 129.36 48.89 45.45 129.73 - - 281.27 351.59 - - - 156.80 - 43.65 131.32 - 80.16 147.00 74.50 87.67 - 29803722 PLACE CATH SVC OR IVC 36010 481 $561.00 207.35 - " 6,171.67 " 892.40 " 1,469.00 " - " 1,469.00 " 907.92 309.95 - 370.26 869.12 808.05 371.33 - - " 4,937.34 " " 6,171.67 " - - - 448.80 - 776.00 375.87 - 229.45 420.75 213.24 250.94 - 80327013 PLACE CATH SVC OR IVC 36010 320 $561.00 207.35 - " 6,171.67 " 892.40 " 1,469.00 " - " 1,469.00 " 907.92 309.95 - 370.26 869.12 808.05 371.33 - - " 4,937.34 " " 6,171.67 " - - - 448.80 - 776.00 375.87 - 229.45 420.75 213.24 250.94 - 28176350 PLACE CATH 1ST ORDER VEIN 36011 360 $314.00 116.05 - " 6,171.67 " 892.40 " 1,469.00 " - " 1,469.00 " 907.92 173.49 - 207.24 869.12 808.05 207.84 - - " 4,937.34 " " 6,171.67 " - - - 251.20 - 776.00 210.38 - 128.43 235.50 119.35 140.45 - 80326912 PLACE CATH 1ST ORDER VEIN 36011 320 $314.00 116.05 - " 6,171.67 " 892.40 " 1,469.00 " - " 1,469.00 " 907.92 173.49 - 207.24 869.12 808.05 207.84 - - " 4,937.34 " " 6,171.67 " - - - 251.20 - 776.00 210.38 - 128.43 235.50 119.35 140.45 - 29812659 PLACE CATH 2ND ORDER VEIN 36012 481 $296.00 109.40 - " 6,171.67 " 131.68 " 1,469.00 " - " 1,469.00 " 133.97 163.54 - 195.36 128.24 119.23 195.92 - - " 4,937.34 " " 6,171.67 " - - - 236.80 - 114.50 198.32 - 121.06 222.00 112.51 132.40 - 80327463 PLACE CATH 2ND ORDER VEIN 36012 320 $296.00 109.40 - " 6,171.67 " 131.68 " 1,469.00 " - " 1,469.00 " 133.97 163.54 - 195.36 128.24 119.23 195.92 - - " 4,937.34 " " 6,171.67 " - - - 236.80 - 114.50 198.32 - 121.06 222.00 112.51 132.40 - 29804320 PLACE CATH RT OR LT PULM ART 36014 481 "$1,361.00" 503.03 - " 2,061.86 " 131.68 " 1,469.00 " - " 1,469.00 " 133.97 751.95 - 898.26 128.24 119.23 900.85 - - " 1,649.49 " " 2,061.86 " - - - " 1,088.80 " - 114.50 911.87 - 556.65 " 1,020.75 " 517.32 608.78 - 80327471 PLACE CATH RT OR LT PULM ART 36014 320 "$1,361.00" 503.03 - " 2,061.86 " 131.68 " 1,469.00 " - " 1,469.00 " 133.97 751.95 - 898.26 128.24 119.23 900.85 - - " 1,649.49 " " 2,061.86 " - - - " 1,088.80 " - 114.50 911.87 - 556.65 " 1,020.75 " 517.32 608.78 - 80328001 PLACE CATHETER PULM ARTERY 36015 320 "$1,123.00" 415.06 - " 2,061.86 " 131.68 " 1,469.00 " - " 1,469.00 " 133.97 620.46 - 741.18 128.24 119.23 743.31 - - " 1,649.49 " " 2,061.86 " - - - 898.40 - 114.50 752.41 - 459.31 842.25 426.85 502.32 - 80326921 PLACE CATHETER CAROTID/ARTERY 36100 320 "$1,146.00" 423.56 - " 2,061.86 " 892.40 " 1,469.00 " - " 1,469.00 " 907.92 633.17 - 756.36 869.12 808.05 758.54 - - " 1,649.49 " " 2,061.86 " - - - 916.80 - 776.00 767.82 - 468.71 859.50 435.59 512.61 - 29802769 PLACE CATH/NDL EXTREMITY ART 36140 481 "$2,206.00" 815.34 - " 3,166.21 " 892.40 " 1,469.00 " - " 1,469.00 " 907.92 " 1,218.82 " - " 1,455.96 " 869.12 808.05 " 1,460.15 " - - " 2,532.97 " " 3,166.21 " - - - " 1,764.80 " - 776.00 " 1,478.02 " - 902.25 " 1,654.50 " 838.50 986.74 - 80326998 PLACE CATH/NDL EXTREMITY ART 36140 320 "$2,206.00" 815.34 - " 3,166.21 " 892.40 " 1,469.00 " - " 1,469.00 " 907.92 " 1,218.82 " - " 1,455.96 " 869.12 808.05 " 1,460.15 " - - " 2,532.97 " " 3,166.21 " - - - " 1,764.80 " - 776.00 " 1,478.02 " - 902.25 " 1,654.50 " 838.50 986.74 - 80628111 NDL PLCMT AORTIC OR TRANSLUMB 36160 350 $753.00 278.31 - " 4,015.72 " 892.40 " 1,718.00 " - " 1,718.00 " 907.92 416.03 - 496.98 869.12 808.05 498.41 - - " 3,212.58 " " 4,015.72 " - - - 602.40 - 776.00 504.51 - 307.98 564.75 286.22 336.82 - 28169949 PLACE CATH AORTA 36200 360 $823.00 304.18 - " 3,166.21 " 892.40 " 1,718.00 " - " 1,718.00 " 907.92 454.71 - 543.18 869.12 808.05 544.74 - - " 2,532.97 " " 3,166.21 " - - - 658.40 - 776.00 551.41 - 336.61 617.25 312.82 368.13 - 29803943 PLACE CATH AORTA 36200 481 $823.00 304.18 - " 3,166.21 " 892.40 " 1,718.00 " - " 1,718.00 " 907.92 454.71 - 543.18 869.12 808.05 544.74 - - " 2,532.97 " " 3,166.21 " - - - 658.40 - 776.00 551.41 - 336.61 617.25 312.82 368.13 - 80326319 PLACE CATH AORTA 36200 320 $823.00 304.18 - " 3,166.21 " 892.40 " 1,718.00 " - " 1,718.00 " 907.92 454.71 - 543.18 869.12 808.05 544.74 - - " 2,532.97 " " 3,166.21 " - - - 658.40 - 776.00 551.41 - 336.61 617.25 312.82 368.13 - 80626312 PLACE CATH AORTA 36200 350 $823.00 304.18 - " 3,166.21 " 892.40 " 1,718.00 " - " 1,718.00 " 907.92 454.71 - 543.18 869.12 808.05 544.74 - - " 2,532.97 " " 3,166.21 " - - - 658.40 - 776.00 551.41 - 336.61 617.25 312.82 368.13 - 28169957 PLACE CATH 1ST ORDER THORACIC 36215 360 $823.00 304.18 - " 5,102.27 " 892.40 " 1,718.00 " - " 1,718.00 " 907.92 454.71 - 543.18 869.12 808.05 544.74 - - " 4,081.82 " " 5,102.27 " - - - 658.40 - 776.00 551.41 - 336.61 617.25 312.82 368.13 - 29803307 PLACE CATH 1ST ORDER THORACIC 36215 481 $823.00 304.18 - " 5,102.27 " 892.40 " 1,718.00 " - " 1,718.00 " 907.92 454.71 - 543.18 869.12 808.05 544.74 - - " 4,081.82 " " 5,102.27 " - - - 658.40 - 776.00 551.41 - 336.61 617.25 312.82 368.13 - 80326327 PLCMT CATH ART SYS 1ST ORDER 36215 320 $823.00 304.18 - " 5,102.27 " 892.40 " 1,718.00 " - " 1,718.00 " 907.92 454.71 - 543.18 869.12 808.05 544.74 - - " 4,081.82 " " 5,102.27 " - - - 658.40 - 776.00 551.41 - 336.61 617.25 312.82 368.13 - 80326335 PLCMT CATH ART SYS 2ND ORDER 36216 320 "$1,308.00" 483.44 - " 6,171.67 " 892.40 " 1,718.00 " - " 1,718.00 " 907.92 722.67 - 863.28 869.12 808.05 865.77 - - " 4,937.34 " " 6,171.67 " - - - " 1,046.40 " - 776.00 876.36 - 534.97 981.00 497.17 585.07 - 80326343 PLCMT CATH ART SYS 3RD ORDER 36217 320 "$1,497.00" 553.29 - " 6,171.67 " 892.40 " 1,718.00 " - " 1,718.00 " 907.92 827.09 - 988.02 869.12 808.05 990.86 - - " 4,937.34 " " 6,171.67 " - - - " 1,197.60 " - 776.00 " 1,002.99 " - 612.27 " 1,122.75 " 569.01 669.61 - 80326351 PLCMT CATH ART SYS ADD ORDER 36218 320 "$1,497.00" 553.29 - " 1,718.00 " 55.48 " 1,718.00 " - " 1,718.00 " 56.44 827.09 - 988.02 54.03 50.23 990.86 - - 618.80 773.50 - - - " 1,197.60 " - 48.24 " 1,002.99 " - 612.27 " 1,122.75 " 569.01 669.61 - 80329458 PLCMT CATH W/ANGIO THOR AORTA 36221 320 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 1,718.00 " " 2,985.82 " " 1,718.00 " 907.92 " 8,300.76 " " 2,928.95 " " 9,915.84 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 2,794.16 " " 3,492.70 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 28169965 PLCMT CATH CAROTID CERV ARCH 36222 360 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 1,718.00 " " 2,985.82 " " 1,718.00 " 907.92 " 8,300.76 " " 2,928.95 " " 9,915.84 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 3,462.18 " " 4,327.72 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 29811598 PLCMT CATH CAROTID CERV ARCH 36222 481 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 1,718.00 " " 2,985.82 " " 1,718.00 " 907.92 " 8,300.76 " " 2,928.95 " " 9,915.84 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 3,462.18 " " 4,327.72 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80329466 PLCMT CATH CAROT/INOM ART EXTR 36222 320 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 1,718.00 " " 2,985.82 " " 1,718.00 " 907.92 " 8,300.76 " " 2,928.95 " " 9,915.84 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 3,462.18 " " 4,327.72 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 29818886 PLCMT CATH CAROTID EXTCRN ARCH 36223 481 "$25,044.00" " 9,256.26 " 776.00 " 20,035.20 " 892.40 " 1,718.00 " " 4,973.85 " " 1,718.00 " 907.92 " 13,836.81 " " 4,879.11 " " 16,529.04 " 869.12 808.05 " 16,576.62 " " 4,263.30 " " 4,737.00 " " 3,787.10 " " 4,733.88 " " 4,855.43 " " 4,879.11 " " 4,737.00 " " 20,035.20 " " 4,334.36 " 776.00 " 16,779.48 " " 4,168.56 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,902.80 " 80329474 PLCMT CATH CAROTID/INOM ARTERY 36223 320 "$25,044.00" " 9,256.26 " 776.00 " 20,035.20 " 892.40 " 1,718.00 " " 4,973.85 " " 1,718.00 " 907.92 " 13,836.81 " " 4,879.11 " " 16,529.04 " 869.12 808.05 " 16,576.62 " " 4,263.30 " " 4,737.00 " " 3,787.10 " " 4,733.88 " " 4,855.43 " " 4,879.11 " " 4,737.00 " " 20,035.20 " " 4,334.36 " 776.00 " 16,779.48 " " 4,168.56 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,902.80 " 80329482 PLCMT CATH CAROTID ARTERY 36224 320 "$25,044.00" " 9,256.26 " 776.00 " 20,035.20 " 892.40 " 2,773.00 " " 4,973.85 " " 2,773.00 " 907.92 " 13,836.81 " " 4,879.11 " " 16,529.04 " 869.12 808.05 " 16,576.62 " " 4,263.30 " " 4,737.00 " " 4,112.26 " " 5,140.32 " " 4,855.43 " " 4,879.11 " " 4,737.00 " " 20,035.20 " " 4,334.36 " 776.00 " 16,779.48 " " 4,168.56 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,902.80 " 28169973 PLACE CATH SUBCLAVIAN ARTERY 36225 360 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 1,718.00 " " 2,985.82 " " 1,718.00 " 907.92 " 8,300.76 " " 2,928.95 " " 9,915.84 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 3,759.65 " " 4,699.56 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 29811440 PLACE CATH SUBCLAVIAN ARTERY 36225 481 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 1,718.00 " " 2,985.82 " " 1,718.00 " 907.92 " 8,300.76 " " 2,928.95 " " 9,915.84 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 3,759.65 " " 4,699.56 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80329491 PLCMT CATH SUBCLAVIAN ARTERY 36225 320 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 1,718.00 " " 2,985.82 " " 1,718.00 " 907.92 " 8,300.76 " " 2,928.95 " " 9,915.84 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 3,759.65 " " 4,699.56 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 29811458 PLACE CATH VERTEBRAL ARTERY 36226 481 "$25,044.00" " 9,256.26 " 776.00 " 20,035.20 " 892.40 " 2,773.00 " " 4,973.85 " " 2,773.00 " 907.92 " 13,836.81 " " 4,879.11 " " 16,529.04 " 869.12 808.05 " 16,576.62 " " 4,263.30 " " 4,737.00 " " 4,190.84 " " 5,238.55 " " 4,855.43 " " 4,879.11 " " 4,737.00 " " 20,035.20 " " 4,334.36 " 776.00 " 16,779.48 " " 4,168.56 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,902.80 " 80329504 PLCMT CATH VERTEBRAL ARTERY 36226 320 "$25,044.00" " 9,256.26 " 776.00 " 20,035.20 " 892.40 " 2,773.00 " " 4,973.85 " " 2,773.00 " 907.92 " 13,836.81 " " 4,879.11 " " 16,529.04 " 869.12 808.05 " 16,576.62 " " 4,263.30 " " 4,737.00 " " 4,190.84 " " 5,238.55 " " 4,855.43 " " 4,879.11 " " 4,737.00 " " 20,035.20 " " 4,334.36 " 776.00 " 16,779.48 " " 4,168.56 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,902.80 " 80329512 PLCMT CATH EXTERNAL CAROTID 36227 320 $244.00 90.18 - " 1,469.00 " 99.89 " 1,469.00 " - " 1,469.00 " 101.63 134.81 - 161.04 97.28 90.45 161.50 - - 615.20 769.00 - - - 195.20 - 86.86 163.48 - 99.80 183.00 92.74 109.14 - 80329521 PLCMT CATH INTRACRANIAL ARTERY 36228 320 $499.00 184.43 - " 3,591.98 " 203.45 " 1,469.00 " - " 1,469.00 " 206.98 275.70 - 329.34 198.14 184.22 330.29 - - " 2,873.58 " " 3,591.98 " - - - 399.20 - 176.91 334.33 - 204.09 374.25 189.67 223.20 - 29802742 PLACE CATH 1ST ORDER ABD 36245 481 $777.00 287.18 - " 3,166.21 " 892.40 " 1,718.00 " - " 1,718.00 " 907.92 429.29 - 512.82 869.12 808.05 514.30 - - " 2,532.97 " " 3,166.21 " - - - 621.60 - 776.00 520.59 - 317.79 582.75 295.34 347.55 - 80326360 PLCMT CATH ABD/L-EXTR ART 1ST 36245 320 $777.00 287.18 - " 3,166.21 " 892.40 " 1,718.00 " - " 1,718.00 " 907.92 429.29 - 512.82 869.12 808.05 514.30 - - " 2,532.97 " " 3,166.21 " - - - 621.60 - 776.00 520.59 - 317.79 582.75 295.34 347.55 - 28175884 PLACE CATH 2ND ORDER ABD 36246 360 $802.00 296.42 - " 4,193.62 " 892.40 " 1,718.00 " - " 1,718.00 " 907.92 443.11 - 529.32 869.12 808.05 530.84 - - " 3,354.90 " " 4,193.62 " - - - 641.60 - 776.00 537.34 - 328.02 601.50 304.84 358.73 - 29803340 PLACE CATH 2ND ORDER ABD 36246 481 $802.00 296.42 - " 4,193.62 " 892.40 " 1,718.00 " - " 1,718.00 " 907.92 443.11 - 529.32 869.12 808.05 530.84 - - " 3,354.90 " " 4,193.62 " - - - 641.60 - 776.00 537.34 - 328.02 601.50 304.84 358.73 - 80326378 PLCMT CATH ABD/L-EXTR ART 2ND 36246 320 $802.00 296.42 - " 4,193.62 " 892.40 " 1,718.00 " - " 1,718.00 " 907.92 443.11 - 529.32 869.12 808.05 530.84 - - " 3,354.90 " " 4,193.62 " - - - 641.60 - 776.00 537.34 - 328.02 601.50 304.84 358.73 - 28169981 PLACE CATH 3RD ORDER ABD 36247 360 $823.00 304.18 - " 4,663.21 " 892.40 " 1,718.00 " - " 1,718.00 " 907.92 454.71 - 543.18 869.12 808.05 544.74 - - " 3,730.57 " " 4,663.21 " - - - 658.40 - 776.00 551.41 - 336.61 617.25 312.82 368.13 - 29803358 PLACE CATH 3RD ORDER ABD 36247 481 $823.00 304.18 - " 4,663.21 " 892.40 " 1,718.00 " - " 1,718.00 " 907.92 454.71 - 543.18 869.12 808.05 544.74 - - " 3,730.57 " " 4,663.21 " - - - 658.40 - 776.00 551.41 - 336.61 617.25 312.82 368.13 - 80326386 PLCMT CATH ABD/L-EXTR ART 3RD 36247 320 $823.00 304.18 - " 4,663.21 " 892.40 " 1,718.00 " - " 1,718.00 " 907.92 454.71 - 543.18 869.12 808.05 544.74 - - " 3,730.57 " " 4,663.21 " - - - 658.40 - 776.00 551.41 - 336.61 617.25 312.82 368.13 - 29803366 PLACE CATH 2ND 3RD ORDER ADDL 36248 481 $765.00 282.74 - " 1,718.00 " 55.87 " 1,718.00 " - " 1,718.00 " 56.84 422.66 - 504.90 54.41 50.59 506.35 - - 618.80 773.50 - - - 612.00 - 48.58 512.55 - 312.89 573.75 290.78 342.18 - 80326394 PLCMT CATH ABD/L-EXTR ART ADD 36248 320 $765.00 282.74 - " 1,718.00 " 55.87 " 1,718.00 " - " 1,718.00 " 56.84 422.66 - 504.90 54.41 50.59 506.35 - - 618.80 773.50 - - - 612.00 - 48.58 512.55 - 312.89 573.75 290.78 342.18 - 29811156 PLACE CATH 1ST ORD REN ART UNI 36251 481 "$15,024.00" " 5,552.87 " 224.74 " 12,019.20 " 258.45 " 1,718.00 " " 2,985.82 " " 1,718.00 " 262.95 " 8,300.76 " " 2,928.95 " " 9,915.84 " 251.71 234.02 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 5,263.44 " " 6,579.30 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 224.74 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80329199 PLCMT CATH REN ART 1ST UNI 36251 320 "$15,024.00" " 5,552.87 " 224.74 " 12,019.20 " 258.45 " 1,718.00 " " 2,985.82 " " 1,718.00 " 262.95 " 8,300.76 " " 2,928.95 " " 9,915.84 " 251.71 234.02 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 5,263.44 " " 6,579.30 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 224.74 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 29811164 PLACE CATH 1ST ORD REN ART BIL 36252 481 "$15,024.00" " 5,552.87 " 292.74 " 12,019.20 " 336.65 " 1,718.00 " " 2,985.82 " " 1,718.00 " 342.51 " 8,300.76 " " 2,928.95 " " 9,915.84 " 327.87 304.83 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 5,795.94 " " 7,244.93 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 292.74 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80329202 PLCMT CATH REN ART 1ST BILAT 36252 320 "$15,024.00" " 5,552.87 " 292.74 " 12,019.20 " 336.65 " 1,718.00 " " 2,985.82 " " 1,718.00 " 342.51 " 8,300.76 " " 2,928.95 " " 9,915.84 " 327.87 304.83 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 5,795.94 " " 7,244.93 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 292.74 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80329211 PLCMT CATH REN ART 2ND+ UNI 36253 320 "$25,044.00" " 9,256.26 " 313.10 " 20,035.20 " 360.07 " 1,718.00 " " 4,973.85 " " 1,718.00 " 366.33 " 13,836.81 " " 4,879.11 " " 16,529.04 " 350.67 326.03 " 16,576.62 " " 4,263.30 " " 4,737.00 " " 8,041.79 " " 10,052.24 " " 4,855.43 " " 4,879.11 " " 4,737.00 " " 20,035.20 " " 4,334.36 " 313.10 " 16,779.48 " " 4,168.56 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,902.80 " 80329229 PLCMT CATH REN ART 2ND+ BILAT 36254 320 "$15,024.00" " 5,552.87 " 337.77 " 12,019.20 " 388.44 " 1,718.00 " " 2,985.82 " " 1,718.00 " 395.19 " 8,300.76 " " 2,928.95 " " 9,915.84 " 378.30 351.72 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 8,371.50 " " 10,464.37 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 337.77 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80328672 UNL INJ JUGULAR VENOGRAM 36299 320 "$5,041.00" " 1,863.15 " - " 4,032.80 " - " 3,483.33 " - " 3,483.33 " - " 2,785.15 " - " 3,327.06 " - - " 3,336.64 " - - 56.26 70.32 - - - " 4,032.80 " - - " 3,377.47 " - " 2,061.77 " " 3,780.75 " " 1,916.08 " " 2,254.84 " - 37089231 VENIPUNCTURE UNDER 3 YEARS 36400 450 $197.00 72.81 - 773.50 - 136.13 - 136.13 - 108.84 - 130.02 - - 130.39 - - 618.80 773.50 - - - 157.60 - - 131.99 - 80.57 147.75 74.88 88.12 - 37089249 VENIPUNCTURE 3 YEARS OR OLDER 36410 450 $222.00 82.05 - 177.60 - 153.40 - 153.40 - 122.66 - 19.72 - - 146.94 - - 56.26 70.32 - - - 177.60 - - 148.74 - 90.80 166.50 84.38 99.30 - 80301863 NON-ROUTINE BLD DRAW 3+ YRS 36410 320 $222.00 82.05 - 177.60 - 153.40 - 153.40 - 122.66 - 19.72 - - 146.94 - - 56.26 70.32 - - - 177.60 - - 148.74 - 90.80 166.50 84.38 99.30 - 10588146 VENIPUNCTURE 36415 300 $16.00 5.91 - 12.80 - 11.06 3.15 11.06 - 8.84 3.09 6.12 - - 10.59 2.70 3.00 0.05 0.06 3.08 3.09 3.00 12.80 2.75 - 7.86 2.64 6.54 12.00 6.08 7.16 3.11 10688132 VENIPUNCTURE 36415 300 $16.00 5.91 - 12.80 - 11.06 3.15 11.06 - 8.84 3.09 6.12 - - 10.59 2.70 3.00 0.05 0.06 3.08 3.09 3.00 12.80 2.75 - 7.86 2.64 6.54 12.00 6.08 7.16 3.11 11288146 VENIPUNCTURE 36415 300 $16.00 5.91 - 12.80 - 11.06 3.15 11.06 - 8.84 3.09 6.12 - - 10.59 2.70 3.00 0.05 0.06 3.08 3.09 3.00 12.80 2.75 - 7.86 2.64 6.54 12.00 6.08 7.16 3.11 15288159 VENIPUNCTURE 36415 300 $16.00 5.91 - 12.80 - 11.06 3.15 11.06 - 8.84 3.09 6.12 - - 10.59 2.70 3.00 0.05 0.06 3.08 3.09 3.00 12.80 2.75 - 7.86 2.64 6.54 12.00 6.08 7.16 3.11 17100009 VENIPUNCTURE 36415 300 $16.00 5.91 - 12.80 - 11.06 3.15 11.06 - 8.84 3.09 6.12 - - 10.59 2.70 3.00 0.05 0.06 3.08 3.09 3.00 12.80 2.75 - 7.86 2.64 6.54 12.00 6.08 7.16 3.11 17288041 VENIPUNCTURE 36415 300 $16.00 5.91 - 12.80 - 11.06 3.15 11.06 - 8.84 3.09 6.12 - - 10.59 2.70 3.00 0.05 0.06 3.08 3.09 3.00 12.80 2.75 - 7.86 2.64 6.54 12.00 6.08 7.16 3.11 17380052 VENIPUNCTURE 36415 300 $16.00 5.91 - 12.80 - 11.06 3.15 11.06 - 8.84 3.09 6.12 - - 10.59 2.70 3.00 0.05 0.06 3.08 3.09 3.00 12.80 2.75 - 7.86 2.64 6.54 12.00 6.08 7.16 3.11 18200031 VENIPUNCTURE 36415 300 $16.00 5.91 - 12.80 - 11.06 3.15 11.06 - 8.84 3.09 6.12 - - 10.59 2.70 3.00 0.05 0.06 3.08 3.09 3.00 12.80 2.75 - 7.86 2.64 6.54 12.00 6.08 7.16 3.11 19000095 VENIPUNCTURE 36415 300 $16.00 5.91 - 12.80 - 11.06 3.15 11.06 - 8.84 3.09 6.12 - - 10.59 2.70 3.00 0.05 0.06 3.08 3.09 3.00 12.80 2.75 - 7.86 2.64 6.54 12.00 6.08 7.16 3.11 19388140 VENIPUNCTURE 36415 300 $16.00 5.91 - 12.80 - 11.06 3.15 11.06 - 8.84 3.09 6.12 - - 10.59 2.70 3.00 0.05 0.06 3.08 3.09 3.00 12.80 2.75 - 7.86 2.64 6.54 12.00 6.08 7.16 3.11 19488144 VENIPUNCTURE 36415 300 $16.00 5.91 - 12.80 - 11.06 3.15 11.06 - 8.84 3.09 6.12 - - 10.59 2.70 3.00 0.05 0.06 3.08 3.09 3.00 12.80 2.75 - 7.86 2.64 6.54 12.00 6.08 7.16 3.11 27100007 VENIPUNCTURE 36415 300 $16.00 5.91 - 12.80 - 11.06 3.15 11.06 - 8.84 3.09 6.12 - - 10.59 2.70 3.00 0.05 0.06 3.08 3.09 3.00 12.80 2.75 - 7.86 2.64 6.54 12.00 6.08 7.16 3.11 29812683 VENIPUNCTURE 36415 300 $16.00 5.91 - 12.80 - 11.06 3.15 11.06 - 8.84 3.09 6.12 - - 10.59 2.70 3.00 0.05 0.06 3.08 3.09 3.00 12.80 2.75 - 7.86 2.64 6.54 12.00 6.08 7.16 3.11 35300015 VENIPUNCTURE NHS 36415 300 $16.00 5.91 - 12.80 - 11.06 3.15 11.06 - 8.84 3.09 6.12 - - 10.59 2.70 3.00 0.05 0.06 3.08 3.09 3.00 12.80 2.75 - 7.86 2.64 6.54 12.00 6.08 7.16 3.11 35300023 VENIPUNCTURE NHM 36415 300 $16.00 5.91 - 12.80 - 11.06 3.15 11.06 - 8.84 3.09 6.12 - - 10.59 2.70 3.00 0.05 0.06 3.08 3.09 3.00 12.80 2.75 - 7.86 2.64 6.54 12.00 6.08 7.16 3.11 35300031 HOME PHLEBOTOMY CONTRACT 36415 300 $16.00 5.91 - 12.80 - 11.06 3.15 11.06 - 8.84 3.09 6.12 - - 10.59 2.70 3.00 0.05 0.06 3.08 3.09 3.00 12.80 2.75 - 7.86 2.64 6.54 12.00 6.08 7.16 3.11 35300121 VENIPUNCTURE-COURTESY DRAW 36415 300 $16.00 5.91 - 12.80 - 11.06 3.15 11.06 - 8.84 3.09 6.12 - - 10.59 2.70 3.00 0.05 0.06 3.08 3.09 3.00 12.80 2.75 - 7.86 2.64 6.54 12.00 6.08 7.16 3.11 35300139 VENIPUNCTURE WELLNESS SCN 36415 300 $16.00 5.91 - 12.80 - 11.06 3.15 11.06 - 8.84 3.09 6.12 - - 10.59 2.70 3.00 0.05 0.06 3.08 3.09 3.00 12.80 2.75 - 7.86 2.64 6.54 12.00 6.08 7.16 3.11 36000147 PATIENT SVC CNTR-VENIPUNCTURE 36415 300 $16.00 5.91 - 12.80 - 11.06 3.15 11.06 - 8.84 3.09 6.12 - - 10.59 2.70 3.00 0.05 0.06 3.08 3.09 3.00 12.80 2.75 - 7.86 2.64 6.54 12.00 6.08 7.16 3.11 36200006 VENIPUNCTURE 36415 300 $16.00 5.91 - 12.80 - 11.06 3.15 11.06 - 8.84 3.09 6.12 - - 10.59 2.70 3.00 0.05 0.06 3.08 3.09 3.00 12.80 2.75 - 7.86 2.64 6.54 12.00 6.08 7.16 3.11 36200146 VENIPUNCTURE OUTPATIENT 36415 300 $16.00 5.91 - 12.80 - 11.06 3.15 11.06 - 8.84 3.09 6.12 - - 10.59 2.70 3.00 0.05 0.06 3.08 3.09 3.00 12.80 2.75 - 7.86 2.64 6.54 12.00 6.08 7.16 3.11 36934395 VENIPUNCTURE OUTSIDE AGENCY 36415 300 $25.00 9.24 - 20.00 - 17.28 3.15 17.28 - 13.81 3.09 6.12 - - 16.55 2.70 3.00 0.05 0.06 3.08 3.09 3.00 20.00 2.75 - 7.86 2.64 10.23 18.75 9.50 11.18 3.11 37001139 VENIPUNCTURE 36415 300 $16.00 5.91 - 12.80 - 11.06 3.15 11.06 - 8.84 3.09 6.12 - - 10.59 2.70 3.00 0.05 0.06 3.08 3.09 3.00 12.80 2.75 - 7.86 2.64 6.54 12.00 6.08 7.16 3.11 41900008 VENIPUNCTURE 36415 300 $16.00 5.91 - 12.80 - 11.06 3.15 11.06 - 8.84 3.09 6.12 - - 10.59 2.70 3.00 0.05 0.06 3.08 3.09 3.00 12.80 2.75 - 7.86 2.64 6.54 12.00 6.08 7.16 3.11 36000155 PATIENT SVC CNTR-SKIN PUNCTURE 36416 300 $37.00 13.68 - 29.60 - 25.57 - 25.57 - 20.44 - 5.84 - - 24.49 - - 0.05 0.06 - - - 29.60 - - 24.79 - 15.13 27.75 14.06 16.55 - 36200138 SKIN PUNCTURE OUTPATIENT 36416 300 $37.00 13.68 - 29.60 - 25.57 - 25.57 - 20.44 - 5.84 - - 24.49 - - 0.05 0.06 - - - 29.60 - - 24.79 - 15.13 27.75 14.06 16.55 - 36200154 BLOOD SKIN COLLECTION 36416 300 $37.00 13.68 - 29.60 - 25.57 - 25.57 - 20.44 - 5.84 - - 24.49 - - 0.05 0.06 - - - 29.60 - - 24.79 - 15.13 27.75 14.06 16.55 - 36934468 SKIN PUNCT OUTSIDE AGENCY 36416 300 $37.00 13.68 - 29.60 - 25.57 - 25.57 - 20.44 - 5.84 - - 24.49 - - 0.05 0.06 - - - 29.60 - - 24.79 - 15.13 27.75 14.06 16.55 - 10588154 BLOOD TRANSFUSION 36430 391 "$2,085.00" 770.62 219.34 " 1,775.00 " 892.40 " 1,469.00 " 413.99 " 1,469.00 " 907.92 " 1,151.96 " 406.11 " 1,775.00 " 869.12 808.05 " 1,380.06 " 354.85 394.28 219.34 274.18 404.14 406.11 394.28 " 1,668.00 " 360.77 776.00 " 1,396.95 " 346.97 852.77 " 1,563.75 " 792.51 932.62 408.08 10688141 BLOOD TRANSFUSION 36430 391 "$2,085.00" 770.62 219.34 " 1,775.00 " 892.40 " 1,469.00 " 413.99 " 1,469.00 " 907.92 " 1,151.96 " 406.11 " 1,775.00 " 869.12 808.05 " 1,380.06 " 354.85 394.28 219.34 274.18 404.14 406.11 394.28 " 1,668.00 " 360.77 776.00 " 1,396.95 " 346.97 852.77 " 1,563.75 " 792.51 932.62 408.08 11288154 BLOOD TRANSFUSION 36430 391 "$2,085.00" 770.62 219.34 " 1,775.00 " 892.40 " 1,469.00 " 413.99 " 1,469.00 " 907.92 " 1,151.96 " 406.11 " 1,775.00 " 869.12 808.05 " 1,380.06 " 354.85 394.28 219.34 274.18 404.14 406.11 394.28 " 1,668.00 " 360.77 776.00 " 1,396.95 " 346.97 852.77 " 1,563.75 " 792.51 932.62 408.08 15288167 BLOOD TRANSFUSION 36430 391 "$2,085.00" 770.62 219.34 " 1,775.00 " 892.40 " 1,469.00 " 413.99 " 1,469.00 " 907.92 " 1,151.96 " 406.11 " 1,775.00 " 869.12 808.05 " 1,380.06 " 354.85 394.28 219.34 274.18 404.14 406.11 394.28 " 1,668.00 " 360.77 776.00 " 1,396.95 " 346.97 852.77 " 1,563.75 " 792.51 932.62 408.08 17100017 BLOOD TRANSFUSION 36430 391 "$2,085.00" 770.62 219.34 " 1,775.00 " 892.40 " 1,469.00 " 413.99 " 1,469.00 " 907.92 " 1,151.96 " 406.11 " 1,775.00 " 869.12 808.05 " 1,380.06 " 354.85 394.28 219.34 274.18 404.14 406.11 394.28 " 1,668.00 " 360.77 776.00 " 1,396.95 " 346.97 852.77 " 1,563.75 " 792.51 932.62 408.08 17288059 BLOOD TRANSFUSION 36430 391 "$2,085.00" 770.62 219.34 " 1,775.00 " 892.40 " 1,469.00 " 413.99 " 1,469.00 " 907.92 " 1,151.96 " 406.11 " 1,775.00 " 869.12 808.05 " 1,380.06 " 354.85 394.28 219.34 274.18 404.14 406.11 394.28 " 1,668.00 " 360.77 776.00 " 1,396.95 " 346.97 852.77 " 1,563.75 " 792.51 932.62 408.08 17380061 BLOOD TRANSFUSION 36430 391 "$2,085.00" 770.62 219.34 " 1,775.00 " 892.40 " 1,469.00 " 413.99 " 1,469.00 " 907.92 " 1,151.96 " 406.11 " 1,775.00 " 869.12 808.05 " 1,380.06 " 354.85 394.28 219.34 274.18 404.14 406.11 394.28 " 1,668.00 " 360.77 776.00 " 1,396.95 " 346.97 852.77 " 1,563.75 " 792.51 932.62 408.08 18200040 BLOOD TRANSFUSION 36430 391 "$2,085.00" 770.62 219.34 " 1,775.00 " 892.40 " 1,469.00 " 413.99 " 1,469.00 " 907.92 " 1,151.96 " 406.11 " 1,775.00 " 869.12 808.05 " 1,380.06 " 354.85 394.28 219.34 274.18 404.14 406.11 394.28 " 1,668.00 " 360.77 776.00 " 1,396.95 " 346.97 852.77 " 1,563.75 " 792.51 932.62 408.08 19000109 BLOOD TRANSFUSION 36430 391 "$2,085.00" 770.62 219.34 " 1,775.00 " 892.40 " 1,469.00 " 413.99 " 1,469.00 " 907.92 " 1,151.96 " 406.11 " 1,775.00 " 869.12 808.05 " 1,380.06 " 354.85 394.28 219.34 274.18 404.14 406.11 394.28 " 1,668.00 " 360.77 776.00 " 1,396.95 " 346.97 852.77 " 1,563.75 " 792.51 932.62 408.08 19388158 BLOOD TRANSFUSION 36430 391 "$2,085.00" 770.62 219.34 " 1,775.00 " 892.40 " 1,469.00 " 413.99 " 1,469.00 " 907.92 " 1,151.96 " 406.11 " 1,775.00 " 869.12 808.05 " 1,380.06 " 354.85 394.28 219.34 274.18 404.14 406.11 394.28 " 1,668.00 " 360.77 776.00 " 1,396.95 " 346.97 852.77 " 1,563.75 " 792.51 932.62 408.08 19488152 BLOOD TRANSFUSION 36430 391 "$2,085.00" 770.62 219.34 " 1,775.00 " 892.40 " 1,469.00 " 413.99 " 1,469.00 " 907.92 " 1,151.96 " 406.11 " 1,775.00 " 869.12 808.05 " 1,380.06 " 354.85 394.28 219.34 274.18 404.14 406.11 394.28 " 1,668.00 " 360.77 776.00 " 1,396.95 " 346.97 852.77 " 1,563.75 " 792.51 932.62 408.08 27700586 BLOOD TRANSFUSION 36430 391 "$2,085.00" 770.62 219.34 " 1,775.00 " 892.40 " 1,469.00 " 413.99 " 1,469.00 " 907.92 " 1,151.96 " 406.11 " 1,775.00 " 869.12 808.05 " 1,380.06 " 354.85 394.28 219.34 274.18 404.14 406.11 394.28 " 1,668.00 " 360.77 776.00 " 1,396.95 " 346.97 852.77 " 1,563.75 " 792.51 932.62 408.08 29817693 BLOOD TRANSFUSION 36430 391 "$2,085.00" 770.62 219.34 " 1,775.00 " 892.40 " 1,469.00 " 413.99 " 1,469.00 " 907.92 " 1,151.96 " 406.11 " 1,775.00 " 869.12 808.05 " 1,380.06 " 354.85 394.28 219.34 274.18 404.14 406.11 394.28 " 1,668.00 " 360.77 776.00 " 1,396.95 " 346.97 852.77 " 1,563.75 " 792.51 932.62 408.08 37089460 BLOOD TRANSFUSION 36430 391 "$2,085.00" 770.62 219.34 " 1,775.00 " 892.40 " 1,469.00 " 413.99 " 1,469.00 " 907.92 " 1,151.96 " 406.11 " 1,775.00 " 869.12 808.05 " 1,380.06 " 354.85 394.28 219.34 274.18 404.14 406.11 394.28 " 1,668.00 " 360.77 776.00 " 1,396.95 " 346.97 852.77 " 1,563.75 " 792.51 932.62 408.08 39100541 BLOOD TRANSFUSION 36430 391 "$2,085.00" 770.62 219.34 " 1,775.00 " 892.40 " 1,469.00 " 413.99 " 1,469.00 " 907.92 " 1,151.96 " 406.11 " 1,775.00 " 869.12 808.05 " 1,380.06 " 354.85 394.28 219.34 274.18 404.14 406.11 394.28 " 1,668.00 " 360.77 776.00 " 1,396.95 " 346.97 852.77 " 1,563.75 " 792.51 932.62 408.08 41900016 BLOOD TRANSFUSION 36430 391 "$2,085.00" 770.62 219.34 " 1,775.00 " 892.40 " 1,469.00 " 413.99 " 1,469.00 " 907.92 " 1,151.96 " 406.11 " 1,775.00 " 869.12 808.05 " 1,380.06 " 354.85 394.28 219.34 274.18 404.14 406.11 394.28 " 1,668.00 " 360.77 776.00 " 1,396.95 " 346.97 852.77 " 1,563.75 " 792.51 932.62 408.08 80000014 BLOOD TRANSFUSION 36430 391 "$2,085.00" 770.62 219.34 " 1,775.00 " 892.40 " 1,469.00 " 413.99 " 1,469.00 " 907.92 " 1,151.96 " 406.11 " 1,775.00 " 869.12 808.05 " 1,380.06 " 354.85 394.28 219.34 274.18 404.14 406.11 394.28 " 1,668.00 " 360.77 776.00 " 1,396.95 " 346.97 852.77 " 1,563.75 " 792.51 932.62 408.08 80328320 INJ TX SINGLE VEIN 36470 320 "$1,816.00" 671.19 9.35 " 1,469.00 " 10.75 " 1,469.00 " 360.51 " 1,469.00 " 10.94 " 1,003.34 " 353.64 845.00 10.47 9.74 " 1,202.01 " 309.01 343.34 776.37 970.46 351.92 353.64 343.34 " 1,452.80 " 314.16 9.35 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 80328311 INJ TX MULTIPLE VEINS 36471 320 "$1,816.00" 671.19 91.12 " 1,469.00 " 104.79 " 1,469.00 " 360.51 " 1,469.00 " 106.61 " 1,003.34 " 353.64 845.00 102.05 94.88 " 1,202.01 " 309.01 343.34 618.80 773.50 351.92 353.64 343.34 " 1,452.80 " 314.16 91.12 " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 28169990 ENDOV ABLATION RF 1ST VEIN 36475 360 "$15,024.00" " 5,552.87 " 776.00 " 14,414.70 " 892.40 " 4,656.00 " " 2,985.82 " " 4,656.00 " 907.92 " 8,300.76 " " 2,928.95 " " 6,576.00 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 11,531.76 " " 14,414.70 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80328605 ENDOV ABLATION RF 1ST VEIN 36475 320 "$15,024.00" " 5,552.87 " 776.00 " 14,414.70 " 892.40 " 4,656.00 " " 2,985.82 " " 4,656.00 " 907.92 " 8,300.76 " " 2,928.95 " " 6,576.00 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 11,531.76 " " 14,414.70 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 28170009 ENDOV ABLATION RF VEIN ADD-ON 36476 360 "$2,194.00" 810.90 - " 4,656.00 " - " 4,656.00 " - " 4,656.00 " - " 1,212.19 " - " 1,448.04 " - - " 1,452.21 " - - " 2,290.34 " " 2,862.93 " - - - " 1,755.20 " - - " 1,469.98 " - 897.35 " 1,645.50 " 833.94 981.38 - 80328613 ENDOV ABLATION RF VEIN ADD-ON 36476 320 "$2,194.00" 810.90 - " 4,656.00 " - " 4,656.00 " - " 4,656.00 " - " 1,212.19 " - " 1,448.04 " - - " 1,452.21 " - - " 2,290.34 " " 2,862.93 " - - - " 1,755.20 " - - " 1,469.98 " - 897.35 " 1,645.50 " 833.94 981.38 - 80327307 ENDOV ABLATION 1ST VEIN 36478 320 "$15,024.00" " 5,552.87 " 776.00 " 13,286.94 " 892.40 " 4,656.00 " " 2,985.82 " " 4,656.00 " 907.92 " 8,300.76 " " 2,928.95 " " 6,576.00 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 10,629.55 " " 13,286.94 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80327315 ENDOV ABLATION VEIN ADD-ON 36479 320 "$3,305.00" " 1,221.53 " - " 4,656.00 " - " 4,656.00 " - " 4,656.00 " - " 1,826.01 " - " 2,181.30 " - - " 2,187.58 " - - " 2,311.83 " " 2,889.79 " - - - " 2,644.00 " - - " 2,214.35 " - " 1,351.75 " " 2,478.75 " " 1,256.23 " " 1,478.33 " - 80327919 PLCMT CATH PORTAL VEIN 36481 320 "$19,211.00" " 7,100.39 " - " 15,368.80 " 892.40 " 1,469.00 " - " 1,469.00 " 907.92 " 10,614.08 " - " 12,679.26 " 869.12 808.05 " 12,715.76 " - - " 2,699.82 " " 3,374.77 " - - - " 15,368.80 " - 776.00 " 12,871.37 " - " 7,857.30 " " 14,408.25 " " 7,302.10 " " 8,593.08 " - 80328966 PLCMT CATH ORGAN BLOOD SAMPLE 36500 320 "$1,871.00" 691.52 - " 2,760.83 " " 1,102.85 " " 1,469.00 " - " 1,469.00 " " 1,122.03 " " 1,033.73 " - " 1,234.86 " " 1,074.08 " 998.61 " 1,238.41 " - - " 2,208.66 " " 2,760.83 " - - - " 1,496.80 " - 959.00 " 1,253.57 " - 765.24 " 1,403.25 " 711.17 836.90 - 22500066 THERAPEUTIC PLASMA APHERESIS 36514 940 "$7,157.00" " 2,645.23 " 75.00 " 5,725.60 " 86.25 " 1,718.00 " " 1,422.66 " " 1,718.00 " 87.75 " 3,954.24 " " 1,395.56 " " 4,723.62 " 84.00 78.10 " 4,737.22 " " 1,219.42 " " 1,354.91 " " 3,698.62 " " 4,623.27 " " 1,388.78 " " 1,395.56 " " 1,354.91 " " 5,725.60 " " 1,239.74 " 75.00 " 4,795.19 " " 1,192.32 " " 2,927.21 " " 5,367.75 " " 2,720.38 " " 3,201.33 " " 1,402.33 " 27001939 INSERT CVP CATH < AGE 5 36555 370 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 1,469.00 " " 2,985.82 " " 1,469.00 " 907.92 " 8,300.76 " " 2,928.95 " " 1,775.00 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 1,768.58 " " 2,210.73 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 37001376 INSERT CVP CATH < AGE 5 36555 450 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 1,469.00 " " 2,985.82 " " 1,469.00 " 907.92 " 8,300.76 " " 2,928.95 " " 1,775.00 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 1,768.58 " " 2,210.73 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 27000681 INSERT CVP CATH => AGE 5 36556 370 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 1,469.00 " " 2,985.82 " " 1,469.00 " 907.92 " 8,300.76 " " 2,928.95 " " 1,775.00 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 1,768.58 " " 2,210.73 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 29802599 INSERT CVP CATH => AGE 5 36556 481 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 1,469.00 " " 2,985.82 " " 1,469.00 " 907.92 " 8,300.76 " " 2,928.95 " " 1,775.00 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 1,768.58 " " 2,210.73 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 37001384 INSERT CVP CATH => AGE 5 36556 450 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 1,469.00 " " 2,985.82 " " 1,469.00 " 907.92 " 8,300.76 " " 2,928.95 " " 1,775.00 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 1,768.58 " " 2,210.73 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80126603 INSERT CATH CV => 5 YR 36556 320 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 1,469.00 " " 2,985.82 " " 1,469.00 " 907.92 " 8,300.76 " " 2,928.95 " " 1,775.00 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 1,768.58 " " 2,210.73 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80326602 INSERT CATH CV => 5 YR 36556 320 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 1,469.00 " " 2,985.82 " " 1,469.00 " 907.92 " 8,300.76 " " 2,928.95 " " 1,775.00 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 1,768.58 " " 2,210.73 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 28170017 INSERT CATH CV NO PORT => 5 YR 36558 360 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 1,718.00 " " 2,985.82 " " 1,718.00 " 907.92 " 8,300.76 " " 2,928.95 " " 2,820.00 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 2,368.76 " " 2,960.95 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80326629 INSERT CATH CV NO PORT => 5 YR 36558 320 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 1,718.00 " " 2,985.82 " " 1,718.00 " 907.92 " 8,300.76 " " 2,928.95 " " 2,820.00 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 2,368.76 " " 2,960.95 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 28170025 INSERT CATH CV PORT => 5 YR 36561 360 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 2,773.00 " " 2,985.82 " " 2,773.00 " 907.92 " 8,300.76 " " 2,928.95 " " 3,545.00 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 2,708.70 " " 3,385.88 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80326645 INSERT CATH CV PORT => 5 YR 36561 320 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 2,773.00 " " 2,985.82 " " 2,773.00 " 907.92 " 8,300.76 " " 2,928.95 " " 3,545.00 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 2,708.70 " " 3,385.88 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80326661 INSERT CATH CV 2 SITES NO PORT 36565 320 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 2,773.00 " " 2,985.82 " " 2,773.00 " 907.92 " 8,300.76 " " 2,928.95 " " 3,545.00 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 2,708.70 " " 3,385.88 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 29812691 INS PICC NO IG/PORT =>AGE 5 36569 481 "$7,382.00" " 2,728.39 " 776.00 " 5,905.60 " 892.40 " 1,469.00 " " 1,466.71 " " 1,469.00 " 907.92 " 4,078.56 " " 1,438.78 " " 1,775.00 " 869.12 808.05 " 4,886.15 " " 1,257.18 " " 1,396.87 " " 1,768.58 " " 2,210.73 " " 1,431.79 " " 1,438.78 " " 1,396.87 " " 5,905.60 " " 1,278.14 " 776.00 " 4,945.94 " " 1,229.25 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,445.76 " 34300437 INS PICC NO IG/PORT =>AGE 5 36569 360 "$7,382.00" " 2,728.39 " 776.00 " 5,905.60 " 892.40 " 1,469.00 " " 1,466.71 " " 1,469.00 " 907.92 " 4,078.56 " " 1,438.78 " " 1,775.00 " 869.12 808.05 " 4,886.15 " " 1,257.18 " " 1,396.87 " " 1,768.58 " " 2,210.73 " " 1,431.79 " " 1,438.78 " " 1,396.87 " " 5,905.60 " " 1,278.14 " 776.00 " 4,945.94 " " 1,229.25 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,445.76 " 80126697 INS PICC NO IG/PORT =>AGE 5 36569 320 "$7,382.00" " 2,728.39 " 776.00 " 5,905.60 " 892.40 " 1,469.00 " " 1,466.71 " " 1,469.00 " 907.92 " 4,078.56 " " 1,438.78 " " 1,775.00 " 869.12 808.05 " 4,886.15 " " 1,257.18 " " 1,396.87 " " 1,768.58 " " 2,210.73 " " 1,431.79 " " 1,438.78 " " 1,396.87 " " 5,905.60 " " 1,278.14 " 776.00 " 4,945.94 " " 1,229.25 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,445.76 " 80326696 INS PICC NO IG/PORT =>AGE 5 36569 320 "$7,382.00" " 2,728.39 " 776.00 " 5,905.60 " 892.40 " 1,469.00 " " 1,466.71 " " 1,469.00 " 907.92 " 4,078.56 " " 1,438.78 " " 1,775.00 " 869.12 808.05 " 4,886.15 " " 1,257.18 " " 1,396.87 " " 1,768.58 " " 2,210.73 " " 1,431.79 " " 1,438.78 " " 1,396.87 " " 5,905.60 " " 1,278.14 " 776.00 " 4,945.94 " " 1,229.25 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,445.76 " 80626690 INS PICC NO IG/PORT =>AGE 5 36569 350 "$7,382.00" " 2,728.39 " 776.00 " 5,905.60 " 892.40 " 1,469.00 " " 1,466.71 " " 1,469.00 " 907.92 " 4,078.56 " " 1,438.78 " " 1,775.00 " 869.12 808.05 " 4,886.15 " " 1,257.18 " " 1,396.87 " " 1,768.58 " " 2,210.73 " " 1,431.79 " " 1,438.78 " " 1,396.87 " " 5,905.60 " " 1,278.14 " 776.00 " 4,945.94 " " 1,229.25 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,445.76 " 80326718 INSERT CATH PICVAD => 5 YR 36571 320 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 2,773.00 " " 2,985.82 " " 2,773.00 " 907.92 " 8,300.76 " " 2,928.95 " " 3,545.00 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 2,708.70 " " 3,385.88 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80336667 INS PICC W/IG NO PORT AGE 5 36573 450 "$7,382.00" " 2,728.39 " 776.00 " 5,905.60 " 892.40 " 5,100.96 " " 1,466.71 " " 5,100.96 " 907.92 " 4,078.56 " " 1,438.78 " " 4,645.00 " 869.12 808.05 " 4,886.15 " " 1,257.18 " " 1,396.87 " " 2,150.94 " " 2,688.68 " " 1,431.79 " " 1,438.78 " " 1,396.87 " " 5,905.60 " " 1,278.14 " 776.00 " 4,945.94 " " 1,229.25 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,445.76 " 80336675 INS PICC W/IG NO PORT =>AGE 5 36573 320 "$7,382.00" " 2,728.39 " 776.00 " 5,905.60 " 892.40 " 5,100.96 " " 1,466.71 " " 5,100.96 " 907.92 " 4,078.56 " " 1,438.78 " " 4,645.00 " 869.12 808.05 " 4,886.15 " " 1,257.18 " " 1,396.87 " " 2,150.94 " " 2,688.68 " " 1,431.79 " " 1,438.78 " " 1,396.87 " " 5,905.60 " " 1,278.14 " 776.00 " 4,945.94 " " 1,229.25 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,445.76 " 80326726 RPR TUNNELED CV CATH W/O PORT 36575 320 "$2,844.00" " 1,051.14 " 472.51 " 2,960.95 " 892.40 " 1,718.00 " 563.79 " 1,718.00 " 907.92 " 1,571.31 " 553.05 " 2,820.00 " 869.12 808.05 " 1,882.44 " 483.25 536.94 " 2,368.76 " " 2,960.95 " 550.36 553.05 536.94 " 2,275.20 " 491.30 776.00 " 1,905.48 " 472.51 " 1,163.20 " " 2,133.00 " " 1,081.00 " " 1,272.12 " 555.73 80326734 RPR TUNNELED CV CATH W/PORT 36576 320 "$7,382.00" " 2,728.39 " 776.00 " 5,905.60 " 892.40 " 1,718.00 " " 1,466.71 " " 1,718.00 " 907.92 " 4,078.56 " " 1,438.78 " " 2,820.00 " 869.12 808.05 " 4,886.15 " " 1,257.18 " " 1,396.87 " " 2,368.76 " " 2,960.95 " " 1,431.79 " " 1,438.78 " " 1,396.87 " " 5,905.60 " " 1,278.14 " 776.00 " 4,945.94 " " 1,229.25 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,445.76 " 80326742 RPL TUNNELED CV CATH W/PORT 36578 320 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 1,718.00 " " 2,985.82 " " 1,718.00 " 907.92 " 8,300.76 " " 2,928.95 " " 2,820.00 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 2,368.76 " " 2,960.95 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80326751 RPL CVAD CATH W/O PORT 36580 320 "$7,382.00" " 2,728.39 " 776.00 " 5,905.60 " 892.40 " 1,469.00 " " 1,466.71 " " 1,469.00 " 907.92 " 4,078.56 " " 1,438.78 " " 1,775.00 " 869.12 808.05 " 4,886.15 " " 1,257.18 " " 1,396.87 " " 1,768.58 " " 2,210.73 " " 1,431.79 " " 1,438.78 " " 1,396.87 " " 5,905.60 " " 1,278.14 " 776.00 " 4,945.94 " " 1,229.25 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,445.76 " 28170033 RPL TUNNELED CV CATH W/O PORT 36581 360 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 1,718.00 " " 2,985.82 " " 1,718.00 " 907.92 " 8,300.76 " " 2,928.95 " " 2,820.00 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 2,368.76 " " 2,960.95 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80326769 RPL TUNNELED CV CATH W/O PORT 36581 320 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 1,718.00 " " 2,985.82 " " 1,718.00 " 907.92 " 8,300.76 " " 2,928.95 " " 2,820.00 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 2,368.76 " " 2,960.95 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80326777 RPL TNNL CV CATH W/PORT CPL 36582 320 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 2,773.00 " " 2,985.82 " " 2,773.00 " 907.92 " 8,300.76 " " 2,928.95 " " 3,545.00 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 2,708.70 " " 3,385.88 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80326793 RPL PICC W/IMG NO PORT 36584 320 "$7,382.00" " 2,728.39 " 776.00 " 5,905.60 " 892.40 " 1,469.00 " " 1,466.71 " " 1,469.00 " 907.92 " 4,078.56 " " 1,438.78 " " 1,775.00 " 869.12 808.05 " 4,886.15 " " 1,257.18 " " 1,396.87 " " 1,768.58 " " 2,210.73 " " 1,431.79 " " 1,438.78 " " 1,396.87 " " 5,905.60 " " 1,278.14 " 776.00 " 4,945.94 " " 1,229.25 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,445.76 " 80326807 RPL PICVAD CATH W/PORT 36585 320 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 2,773.00 " " 2,985.82 " " 2,773.00 " 907.92 " 8,300.76 " " 2,928.95 " " 3,545.00 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 2,708.70 " " 3,385.88 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 29812705 RMV TUN CV CATH W/O PORT 36589 481 "$2,844.00" " 1,051.14 " 472.51 " 2,275.20 " 892.40 " 1,469.00 " 563.79 " 1,469.00 " 907.92 " 1,571.31 " 553.05 " 1,775.00 " 869.12 808.05 " 1,882.44 " 483.25 536.94 " 1,768.58 " " 2,210.73 " 550.36 553.05 536.94 " 2,275.20 " 491.30 776.00 " 1,905.48 " 472.51 " 1,163.20 " " 2,133.00 " " 1,081.00 " " 1,272.12 " 555.73 80326815 RMV TUN CV CATH W/O PORT 36589 320 "$2,844.00" " 1,051.14 " 472.51 " 2,275.20 " 892.40 " 1,469.00 " 563.79 " 1,469.00 " 907.92 " 1,571.31 " 553.05 " 1,775.00 " 869.12 808.05 " 1,882.44 " 483.25 536.94 " 1,768.58 " " 2,210.73 " 550.36 553.05 536.94 " 2,275.20 " 491.30 776.00 " 1,905.48 " 472.51 " 1,163.20 " " 2,133.00 " " 1,081.00 " " 1,272.12 " 555.73 28170041 RMV TUN CV CATH W/PORT 36590 360 "$7,382.00" " 2,728.39 " 776.00 " 5,905.60 " 892.40 " 1,469.00 " " 1,466.71 " " 1,469.00 " 907.92 " 4,078.56 " " 1,438.78 " " 1,775.00 " 869.12 808.05 " 4,886.15 " " 1,257.18 " " 1,396.87 " " 1,768.58 " " 2,210.73 " " 1,431.79 " " 1,438.78 " " 1,396.87 " " 5,905.60 " " 1,278.14 " 776.00 " 4,945.94 " " 1,229.25 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,445.76 " 80326823 RMV TUN CV CATH W/PORT 36590 320 "$7,382.00" " 2,728.39 " 776.00 " 5,905.60 " 892.40 " 1,469.00 " " 1,466.71 " " 1,469.00 " 907.92 " 4,078.56 " " 1,438.78 " " 1,775.00 " 869.12 808.05 " 4,886.15 " " 1,257.18 " " 1,396.87 " " 1,768.58 " " 2,210.73 " " 1,431.79 " " 1,438.78 " " 1,396.87 " " 5,905.60 " " 1,278.14 " 776.00 " 4,945.94 " " 1,229.25 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,445.76 " 27700632 BLOOD DRAW FROM IAD 36591 360 $588.00 217.32 - 845.00 - 406.31 117.61 406.31 - 324.87 115.37 845.00 - - 389.20 100.81 112.01 107.78 134.73 114.81 115.37 112.01 470.40 102.49 - 393.96 98.57 240.49 441.00 223.50 263.01 115.93 34300119 BLOOD DRAW FROM IAD 36591 300 $588.00 217.32 - 845.00 - 406.31 117.61 406.31 - 324.87 115.37 845.00 - - 389.20 100.81 112.01 107.78 134.73 114.81 115.37 112.01 470.40 102.49 - 393.96 98.57 240.49 441.00 223.50 263.01 115.93 37089257 BLOOD DRAW FROM IAD 36591 450 $588.00 217.32 - 845.00 - 406.31 117.61 406.31 - 324.87 115.37 845.00 - - 389.20 100.81 112.01 107.78 134.73 114.81 115.37 112.01 470.40 102.49 - 393.96 98.57 240.49 441.00 223.50 263.01 115.93 41900024 BLOOD DRAW FROM IAD 36591 360 $588.00 217.32 - 845.00 - 406.31 117.61 406.31 - 324.87 115.37 845.00 - - 389.20 100.81 112.01 107.78 134.73 114.81 115.37 112.01 470.40 102.49 - 393.96 98.57 240.49 441.00 223.50 263.01 115.93 80010362 BLOOD DRAW FRM IMPLANTABLE VAD 36591 300 $588.00 217.32 - 845.00 - 406.31 117.61 406.31 - 324.87 115.37 845.00 - - 389.20 100.81 112.01 107.78 134.73 114.81 115.37 112.01 470.40 102.49 - 393.96 98.57 240.49 441.00 223.50 263.01 115.93 10588162 CVC & PERIPHERAL BLOOD DRAW 36592 300 $588.00 217.32 - 845.00 - 406.31 117.61 406.31 - 324.87 115.37 845.00 - - 389.20 100.81 112.01 133.21 166.51 114.81 115.37 112.01 470.40 102.49 - 393.96 98.57 240.49 441.00 223.50 263.01 115.93 10688159 CVC & PERIPHERAL BLOOD DRAW 36592 300 $588.00 217.32 - 845.00 - 406.31 117.61 406.31 - 324.87 115.37 845.00 - - 389.20 100.81 112.01 133.21 166.51 114.81 115.37 112.01 470.40 102.49 - 393.96 98.57 240.49 441.00 223.50 263.01 115.93 11288162 CVC & PERIPHERAL BLOOD DRAW 36592 300 $588.00 217.32 - 845.00 - 406.31 117.61 406.31 - 324.87 115.37 845.00 - - 389.20 100.81 112.01 133.21 166.51 114.81 115.37 112.01 470.40 102.49 - 393.96 98.57 240.49 441.00 223.50 263.01 115.93 15288175 CVC & PERIPHERAL BLOOD DRAW 36592 300 $588.00 217.32 - 845.00 - 406.31 117.61 406.31 - 324.87 115.37 845.00 - - 389.20 100.81 112.01 133.21 166.51 114.81 115.37 112.01 470.40 102.49 - 393.96 98.57 240.49 441.00 223.50 263.01 115.93 17100025 CVC & PERIPHERAL BLOOD DRAW 36592 300 $588.00 217.32 - 845.00 - 406.31 117.61 406.31 - 324.87 115.37 845.00 - - 389.20 100.81 112.01 133.21 166.51 114.81 115.37 112.01 470.40 102.49 - 393.96 98.57 240.49 441.00 223.50 263.01 115.93 17288067 CVC & PERIPHERAL BLOOD DRAW 36592 300 $588.00 217.32 - 845.00 - 406.31 117.61 406.31 - 324.87 115.37 845.00 - - 389.20 100.81 112.01 133.21 166.51 114.81 115.37 112.01 470.40 102.49 - 393.96 98.57 240.49 441.00 223.50 263.01 115.93 17380079 CVC & PERIPHERAL BLOOD DRAW 36592 300 $588.00 217.32 - 845.00 - 406.31 117.61 406.31 - 324.87 115.37 845.00 - - 389.20 100.81 112.01 133.21 166.51 114.81 115.37 112.01 470.40 102.49 - 393.96 98.57 240.49 441.00 223.50 263.01 115.93 18200058 CVC & PERIPHERAL BLOOD DRAW 36592 300 $588.00 217.32 - 845.00 - 406.31 117.61 406.31 - 324.87 115.37 845.00 - - 389.20 100.81 112.01 133.21 166.51 114.81 115.37 112.01 470.40 102.49 - 393.96 98.57 240.49 441.00 223.50 263.01 115.93 19000117 CVC & PERIPHERAL BLOOD DRAW 36592 300 $588.00 217.32 - 845.00 - 406.31 117.61 406.31 - 324.87 115.37 845.00 - - 389.20 100.81 112.01 133.21 166.51 114.81 115.37 112.01 470.40 102.49 - 393.96 98.57 240.49 441.00 223.50 263.01 115.93 19388166 CVC & PERIPHERAL BLOOD DRAW 36592 300 $588.00 217.32 - 845.00 - 406.31 117.61 406.31 - 324.87 115.37 845.00 - - 389.20 100.81 112.01 133.21 166.51 114.81 115.37 112.01 470.40 102.49 - 393.96 98.57 240.49 441.00 223.50 263.01 115.93 19488161 CVC & PERIPHERAL BLOOD DRAW 36592 300 $588.00 217.32 - 845.00 - 406.31 117.61 406.31 - 324.87 115.37 845.00 - - 389.20 100.81 112.01 133.21 166.51 114.81 115.37 112.01 470.40 102.49 - 393.96 98.57 240.49 441.00 223.50 263.01 115.93 29812713 CVC & PERIPHERAL BLOOD DRAW 36592 481 $588.00 217.32 - 845.00 - 406.31 117.61 406.31 - 324.87 115.37 845.00 - - 389.20 100.81 112.01 133.21 166.51 114.81 115.37 112.01 470.40 102.49 - 393.96 98.57 240.49 441.00 223.50 263.01 115.93 34300275 CVC & PERIPHERAL BLOOD DRAW 36592 300 $588.00 217.32 - 845.00 - 406.31 117.61 406.31 - 324.87 115.37 845.00 - - 389.20 100.81 112.01 133.21 166.51 114.81 115.37 112.01 470.40 102.49 - 393.96 98.57 240.49 441.00 223.50 263.01 115.93 41900032 CVC & PERIPHERAL BLOOD DRAW 36592 360 $588.00 217.32 - 845.00 - 406.31 117.61 406.31 - 324.87 115.37 845.00 - - 389.20 100.81 112.01 133.21 166.51 114.81 115.37 112.01 470.40 102.49 - 393.96 98.57 240.49 441.00 223.50 263.01 115.93 10588171 DECLOT THROMBOLYTIC IMPLTD VAD 36593 360 "$1,631.00" 602.82 25.06 " 1,469.00 " 28.82 " 1,469.00 " 332.57 " 1,469.00 " 29.32 901.13 326.23 845.00 28.07 26.09 " 1,079.56 " 285.06 316.73 191.88 239.85 324.65 326.23 316.73 " 1,304.80 " 289.81 25.06 " 1,092.77 " 278.72 667.08 " 1,223.25 " 619.94 729.55 327.82 10688167 DECLOT THROMBOLYTIC IMPLTD VAD 36593 360 "$1,631.00" 602.82 25.06 " 1,469.00 " 28.82 " 1,469.00 " 332.57 " 1,469.00 " 29.32 901.13 326.23 845.00 28.07 26.09 " 1,079.56 " 285.06 316.73 191.88 239.85 324.65 326.23 316.73 " 1,304.80 " 289.81 25.06 " 1,092.77 " 278.72 667.08 " 1,223.25 " 619.94 729.55 327.82 11288171 DECLOT THROMBOLYTIC IMPLTD VAD 36593 360 "$1,631.00" 602.82 25.06 " 1,469.00 " 28.82 " 1,469.00 " 332.57 " 1,469.00 " 29.32 901.13 326.23 845.00 28.07 26.09 " 1,079.56 " 285.06 316.73 191.88 239.85 324.65 326.23 316.73 " 1,304.80 " 289.81 25.06 " 1,092.77 " 278.72 667.08 " 1,223.25 " 619.94 729.55 327.82 15288183 DECLOT THROMBOLYTIC IMPLTD VAD 36593 360 "$1,631.00" 602.82 25.06 " 1,469.00 " 28.82 " 1,469.00 " 332.57 " 1,469.00 " 29.32 901.13 326.23 845.00 28.07 26.09 " 1,079.56 " 285.06 316.73 191.88 239.85 324.65 326.23 316.73 " 1,304.80 " 289.81 25.06 " 1,092.77 " 278.72 667.08 " 1,223.25 " 619.94 729.55 327.82 17100033 DECLOT THROMBOLYTIC IMPLTD VAD 36593 360 "$1,631.00" 602.82 25.06 " 1,469.00 " 28.82 " 1,469.00 " 332.57 " 1,469.00 " 29.32 901.13 326.23 845.00 28.07 26.09 " 1,079.56 " 285.06 316.73 191.88 239.85 324.65 326.23 316.73 " 1,304.80 " 289.81 25.06 " 1,092.77 " 278.72 667.08 " 1,223.25 " 619.94 729.55 327.82 17288075 DECLOT THROMBOLYTIC IMPLTD VAD 36593 360 "$1,631.00" 602.82 25.06 " 1,469.00 " 28.82 " 1,469.00 " 332.57 " 1,469.00 " 29.32 901.13 326.23 845.00 28.07 26.09 " 1,079.56 " 285.06 316.73 191.88 239.85 324.65 326.23 316.73 " 1,304.80 " 289.81 25.06 " 1,092.77 " 278.72 667.08 " 1,223.25 " 619.94 729.55 327.82 17380087 DECLOT THROMBOLYTIC IMPLTD VAD 36593 360 "$1,631.00" 602.82 25.06 " 1,469.00 " 28.82 " 1,469.00 " 332.57 " 1,469.00 " 29.32 901.13 326.23 845.00 28.07 26.09 " 1,079.56 " 285.06 316.73 191.88 239.85 324.65 326.23 316.73 " 1,304.80 " 289.81 25.06 " 1,092.77 " 278.72 667.08 " 1,223.25 " 619.94 729.55 327.82 18200066 DECLOT THROMBOLYTIC IMPLTD VAD 36593 360 "$1,631.00" 602.82 25.06 " 1,469.00 " 28.82 " 1,469.00 " 332.57 " 1,469.00 " 29.32 901.13 326.23 845.00 28.07 26.09 " 1,079.56 " 285.06 316.73 191.88 239.85 324.65 326.23 316.73 " 1,304.80 " 289.81 25.06 " 1,092.77 " 278.72 667.08 " 1,223.25 " 619.94 729.55 327.82 19000125 DECLOT THROMBOLYTIC IMPLTD VAD 36593 360 "$1,631.00" 602.82 25.06 " 1,469.00 " 28.82 " 1,469.00 " 332.57 " 1,469.00 " 29.32 901.13 326.23 845.00 28.07 26.09 " 1,079.56 " 285.06 316.73 191.88 239.85 324.65 326.23 316.73 " 1,304.80 " 289.81 25.06 " 1,092.77 " 278.72 667.08 " 1,223.25 " 619.94 729.55 327.82 19388174 DECLOT THROMBOLYTIC IMPLTD VAD 36593 360 "$1,631.00" 602.82 25.06 " 1,469.00 " 28.82 " 1,469.00 " 332.57 " 1,469.00 " 29.32 901.13 326.23 845.00 28.07 26.09 " 1,079.56 " 285.06 316.73 191.88 239.85 324.65 326.23 316.73 " 1,304.80 " 289.81 25.06 " 1,092.77 " 278.72 667.08 " 1,223.25 " 619.94 729.55 327.82 19488179 DECLOT THROMBOLYTIC IMPLTD VAD 36593 360 "$1,631.00" 602.82 25.06 " 1,469.00 " 28.82 " 1,469.00 " 332.57 " 1,469.00 " 29.32 901.13 326.23 845.00 28.07 26.09 " 1,079.56 " 285.06 316.73 191.88 239.85 324.65 326.23 316.73 " 1,304.80 " 289.81 25.06 " 1,092.77 " 278.72 667.08 " 1,223.25 " 619.94 729.55 327.82 27700578 DECLOT THROMBOLYTIC IMPLTD VAD 36593 360 "$1,631.00" 602.82 25.06 " 1,469.00 " 28.82 " 1,469.00 " 332.57 " 1,469.00 " 29.32 901.13 326.23 845.00 28.07 26.09 " 1,079.56 " 285.06 316.73 191.88 239.85 324.65 326.23 316.73 " 1,304.80 " 289.81 25.06 " 1,092.77 " 278.72 667.08 " 1,223.25 " 619.94 729.55 327.82 29812721 DECLOT THROMBOLYTIC IMPLTD VAD 36593 481 "$1,631.00" 602.82 25.06 " 1,469.00 " 28.82 " 1,469.00 " 332.57 " 1,469.00 " 29.32 901.13 326.23 845.00 28.07 26.09 " 1,079.56 " 285.06 316.73 191.88 239.85 324.65 326.23 316.73 " 1,304.80 " 289.81 25.06 " 1,092.77 " 278.72 667.08 " 1,223.25 " 619.94 729.55 327.82 34300186 DECLOT THROMBOLYTIC IMPLTD VAD 36593 260 "$1,631.00" 602.82 25.06 " 1,469.00 " 28.82 " 1,469.00 " 332.57 " 1,469.00 " 29.32 901.13 326.23 845.00 28.07 26.09 " 1,079.56 " 285.06 316.73 191.88 239.85 324.65 326.23 316.73 " 1,304.80 " 289.81 25.06 " 1,092.77 " 278.72 667.08 " 1,223.25 " 619.94 729.55 327.82 37089265 DECLOT THROMBOLYTIC IMPLTD VAD 36593 450 "$1,631.00" 602.82 25.06 " 1,469.00 " 28.82 " 1,469.00 " 332.57 " 1,469.00 " 29.32 901.13 326.23 845.00 28.07 26.09 " 1,079.56 " 285.06 316.73 191.88 239.85 324.65 326.23 316.73 " 1,304.80 " 289.81 25.06 " 1,092.77 " 278.72 667.08 " 1,223.25 " 619.94 729.55 327.82 41900041 DECLOT THROMBOLYTIC IMPLTD VAD 36593 360 "$1,631.00" 602.82 25.06 " 1,469.00 " 28.82 " 1,469.00 " 332.57 " 1,469.00 " 29.32 901.13 326.23 845.00 28.07 26.09 " 1,079.56 " 285.06 316.73 191.88 239.85 324.65 326.23 316.73 " 1,304.80 " 289.81 25.06 " 1,092.77 " 278.72 667.08 " 1,223.25 " 619.94 729.55 327.82 80326556 DECLOT THROMBOLYTIC IMPLTD VAD 36593 320 "$1,631.00" 602.82 25.06 " 1,469.00 " 28.82 " 1,469.00 " 332.57 " 1,469.00 " 29.32 901.13 326.23 845.00 28.07 26.09 " 1,079.56 " 285.06 316.73 191.88 239.85 324.65 326.23 316.73 " 1,304.80 " 289.81 25.06 " 1,092.77 " 278.72 667.08 " 1,223.25 " 619.94 729.55 327.82 80326432 MECH RMV PERICATH OBS MATL 36595 320 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 10,381.58 " " 2,985.82 " " 10,381.58 " 907.92 " 8,300.76 " " 2,928.95 " " 1,775.00 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 4,175.20 " " 5,219.00 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80326441 MECH REMOVE TUNNELED CV CATH 36596 320 "$7,382.00" " 2,728.39 " 776.00 " 5,905.60 " 892.40 " 5,100.96 " " 1,466.71 " " 5,100.96 " 907.92 " 4,078.56 " " 1,438.78 " " 1,775.00 " 869.12 808.05 " 4,886.15 " " 1,257.18 " " 1,396.87 " 889.10 " 1,111.38 " " 1,431.79 " " 1,438.78 " " 1,396.87 " " 5,905.60 " " 1,278.14 " 776.00 " 4,945.94 " " 1,229.25 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,445.76 " 80326068 REPOSITION VENOUS CATHETER 36597 320 "$7,382.00" " 2,728.39 " 740.37 " 5,905.60 " 892.40 " 1,469.00 " " 1,466.71 " " 1,469.00 " 907.92 " 4,078.56 " " 1,438.78 " " 1,775.00 " 869.12 808.05 " 4,886.15 " " 1,257.18 " " 1,396.87 " 740.37 925.46 " 1,431.79 " " 1,438.78 " " 1,396.87 " " 5,905.60 " " 1,278.14 " 776.00 " 4,945.94 " " 1,229.25 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,445.76 " 80127618 INJ W/FLUORO EVAL CV DEVICE 36598 320 "$1,068.00" 394.73 - " 1,775.00 " - " 1,718.00 " 213.37 " 1,718.00 " - 590.07 209.31 " 1,775.00 " - - 706.91 182.89 203.21 628.63 785.79 208.29 209.31 203.21 854.40 185.94 - 715.56 178.82 436.81 801.00 405.95 477.72 210.32 80327617 INJ W/FLUORO EVAL CV DEVICE 36598 320 "$1,068.00" 394.73 - " 1,775.00 " - " 1,718.00 " 213.37 " 1,718.00 " - 590.07 209.31 " 1,775.00 " - - 706.91 182.89 203.21 628.63 785.79 208.29 209.31 203.21 854.40 185.94 - 715.56 178.82 436.81 801.00 405.95 477.72 210.32 24701182 ARTERIAL PUNCTURE 36600 410 $588.00 217.32 13.00 " 1,469.00 " 14.95 " 1,469.00 " 117.61 " 1,469.00 " 15.21 324.87 115.37 845.00 14.56 13.54 389.20 100.81 112.01 44.10 55.12 114.81 115.37 112.01 470.40 102.49 13.00 393.96 98.57 240.49 441.00 223.50 263.01 115.93 24970876 ARTERIAL PUNCTURE 36600 460 $588.00 217.32 13.00 " 1,469.00 " 14.95 " 1,469.00 " 117.61 " 1,469.00 " 15.21 324.87 115.37 845.00 14.56 13.54 389.20 100.81 112.01 44.10 55.12 114.81 115.37 112.01 470.40 102.49 13.00 393.96 98.57 240.49 441.00 223.50 263.01 115.93 37001392 ARTERIAL PUNCTURE BLOOD DX 36600 450 $588.00 217.32 13.00 " 1,469.00 " 14.95 " 1,469.00 " 117.61 " 1,469.00 " 15.21 324.87 115.37 845.00 14.56 13.54 389.20 100.81 112.01 44.10 55.12 114.81 115.37 112.01 470.40 102.49 13.00 393.96 98.57 240.49 441.00 223.50 263.01 115.93 27000576 INSERT CATHETER ARTERY 36620 370 $360.00 133.06 - " 1,469.00 " 892.40 " 1,469.00 " - " 1,469.00 " 907.92 198.90 - 237.60 869.12 808.05 238.28 - - 281.27 351.59 - - - 288.00 - 776.00 241.20 - 147.24 270.00 136.84 161.03 - 28170050 INSERT CATHETER ARTERY 36620 360 $360.00 133.06 - " 1,469.00 " 892.40 " 1,469.00 " - " 1,469.00 " 907.92 198.90 - 237.60 869.12 808.05 238.28 - - 281.27 351.59 - - - 288.00 - 776.00 241.20 - 147.24 270.00 136.84 161.03 - 30612256 INSERT CATHETER ARTERY 36620 481 $360.00 133.06 - " 1,469.00 " 892.40 " 1,469.00 " - " 1,469.00 " 907.92 198.90 - 237.60 869.12 808.05 238.28 - - 281.27 351.59 - - - 288.00 - 776.00 241.20 - 147.24 270.00 136.84 161.03 - 37001406 INSERT CATHETER ARTERY 36620 450 $360.00 133.06 - " 1,469.00 " 892.40 " 1,469.00 " - " 1,469.00 " 907.92 198.90 - 237.60 869.12 808.05 238.28 - - 281.27 351.59 - - - 288.00 - 776.00 241.20 - 147.24 270.00 136.84 161.03 - 37088790 PLACE INTRAOSSEOUS NEEDLE 36680 450 "$1,419.00" 524.46 49.50 " 1,469.00 " 56.93 " 1,469.00 " 283.08 " 1,469.00 " 57.92 784.00 277.69 845.00 55.44 51.54 939.24 242.64 269.60 370.43 463.04 276.34 277.69 269.60 " 1,135.20 " 246.68 49.50 950.73 237.25 580.37 " 1,064.25 " 539.36 634.72 279.04 80326548 INSERTION CANNULA 36810 320 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 2,773.00 " " 2,985.82 " " 2,773.00 " 907.92 " 8,300.76 " " 2,928.95 " " 3,545.00 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 2,532.97 " " 3,166.21 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80336969 AV ANASTOMOSIS UPPER ARM 36818 320 "$25,044.00" " 9,256.26 " 776.00 " 20,035.20 " 892.40 " 2,773.00 " " 4,973.85 " " 2,773.00 " 907.92 " 13,836.81 " " 4,879.11 " " 3,545.00 " 869.12 808.05 " 16,576.62 " " 4,263.30 " " 4,737.00 " " 3,956.54 " " 4,945.68 " " 4,855.43 " " 4,879.11 " " 4,737.00 " " 20,035.20 " " 4,334.36 " 776.00 " 16,779.48 " " 4,168.56 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,902.80 " 80336951 AV ANASTOMOSIS FOREARM 36820 320 "$25,044.00" " 9,256.26 " 776.00 " 20,035.20 " 892.40 " 2,773.00 " " 4,973.85 " " 2,773.00 " 907.92 " 13,836.81 " " 4,879.11 " " 3,545.00 " 869.12 808.05 " 16,576.62 " " 4,263.30 " " 4,737.00 " " 2,650.99 " " 3,313.74 " " 4,855.43 " " 4,879.11 " " 4,737.00 " " 20,035.20 " " 4,334.36 " 776.00 " 16,779.48 " " 4,168.56 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,902.80 " 28170068 AV FUSION DIRECT ANY SITE 36821 360 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 2,773.00 " " 2,985.82 " " 2,773.00 " 907.92 " 8,300.76 " " 2,928.95 " " 3,545.00 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 2,532.97 " " 3,166.21 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 28176368 INSERTION OF CANNULA(S) 36823 360 "$12,902.00" " 4,768.58 " - " 10,321.60 " - " 8,915.28 " N/A " 8,915.28 " - " 7,128.36 " N/A " 8,515.32 " - N/A " 8,539.83 " - N/A " 6,784.95 " " 8,481.19 " N/A N/A N/A " 10,321.60 " N/A - " 8,644.34 " N/A " 5,276.92 " " 9,676.50 " " 4,904.05 " " 5,771.06 " N/A 28170076 AV ANASTOMOSIS FISTULA 36825 360 "$25,044.00" " 9,256.26 " 776.00 " 20,035.20 " 892.40 " 3,326.00 " " 4,973.85 " " 3,326.00 " 907.92 " 13,836.81 " " 4,879.11 " " 4,860.00 " 869.12 808.05 " 16,576.62 " " 4,263.30 " " 4,737.00 " " 3,120.10 " " 3,900.12 " " 4,855.43 " " 4,879.11 " " 4,737.00 " " 20,035.20 " " 4,334.36 " 776.00 " 16,779.48 " " 4,168.56 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,902.80 " 80336977 AV ANASTOMOSIS FISTULA 36825 320 "$25,044.00" " 9,256.26 " 776.00 " 20,035.20 " 892.40 " 3,326.00 " " 4,973.85 " " 3,326.00 " 907.92 " 13,836.81 " " 4,879.11 " " 4,860.00 " 869.12 808.05 " 16,576.62 " " 4,263.30 " " 4,737.00 " " 3,120.10 " " 3,900.12 " " 4,855.43 " " 4,879.11 " " 4,737.00 " " 20,035.20 " " 4,334.36 " 776.00 " 16,779.48 " " 4,168.56 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,902.80 " 28170084 ARTERY-VEIN NONAUTOGRAFT 36830 360 "$25,044.00" " 9,256.26 " 776.00 " 20,035.20 " 892.40 " 3,326.00 " " 4,973.85 " " 3,326.00 " 907.92 " 13,836.81 " " 4,879.11 " " 4,860.00 " 869.12 808.05 " 16,576.62 " " 4,263.30 " " 4,737.00 " " 3,120.10 " " 3,900.12 " " 4,855.43 " " 4,879.11 " " 4,737.00 " " 20,035.20 " " 4,334.36 " 776.00 " 16,779.48 " " 4,168.56 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,902.80 " 28170092 AV FISTULA REVISION OPEN 36832 360 "$25,044.00" " 9,256.26 " 776.00 " 20,035.20 " 892.40 " 3,326.00 " " 4,973.85 " " 3,326.00 " 907.92 " 13,836.81 " " 4,879.11 " " 4,860.00 " 869.12 808.05 " 16,576.62 " " 4,263.30 " " 4,737.00 " " 3,120.10 " " 3,900.12 " " 4,855.43 " " 4,879.11 " " 4,737.00 " " 20,035.20 " " 4,334.36 " 776.00 " 16,779.48 " " 4,168.56 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,902.80 " 28170106 AV FISTULA REVISION 36833 360 "$25,044.00" " 9,256.26 " 776.00 " 20,035.20 " 892.40 " 3,326.00 " " 4,973.85 " " 3,326.00 " 907.92 " 13,836.81 " " 4,879.11 " " 4,860.00 " 869.12 808.05 " 16,576.62 " " 4,263.30 " " 4,737.00 " " 3,356.30 " " 4,195.38 " " 4,855.43 " " 4,879.11 " " 4,737.00 " " 20,035.20 " " 4,334.36 " 776.00 " 16,779.48 " " 4,168.56 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,902.80 " 28176376 INTRO CATH DIALYSIS CIRCUIT 36901 360 "$7,382.00" " 2,728.39 " 776.00 " 5,905.60 " 892.40 " 5,100.96 " " 1,466.71 " " 5,100.96 " 907.92 " 4,078.56 " " 1,438.78 " 845.00 869.12 808.05 " 4,886.15 " " 1,257.18 " " 1,396.87 " " 3,093.15 " " 3,866.44 " " 1,431.79 " " 1,438.78 " " 1,396.87 " " 5,905.60 " " 1,278.14 " 776.00 " 4,945.94 " " 1,229.25 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,445.76 " 29812977 INTRO CATH DIALYSIS CIRCUIT 36901 481 "$7,382.00" " 2,728.39 " 776.00 " 5,905.60 " 892.40 " 5,100.96 " " 1,466.71 " " 5,100.96 " 907.92 " 4,078.56 " " 1,438.78 " 845.00 869.12 808.05 " 4,886.15 " " 1,257.18 " " 1,396.87 " " 3,093.15 " " 3,866.44 " " 1,431.79 " " 1,438.78 " " 1,396.87 " " 5,905.60 " " 1,278.14 " 776.00 " 4,945.94 " " 1,229.25 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,445.76 " 80335733 INTRO CATH DIALYSIS CIRCUIT 36901 320 "$7,382.00" " 2,728.39 " 776.00 " 5,905.60 " 892.40 " 5,100.96 " " 1,466.71 " " 5,100.96 " 907.92 " 4,078.56 " " 1,438.78 " 845.00 869.12 808.05 " 4,886.15 " " 1,257.18 " " 1,396.87 " " 3,093.15 " " 3,866.44 " " 1,431.79 " " 1,438.78 " " 1,396.87 " " 5,905.60 " " 1,278.14 " 776.00 " 4,945.94 " " 1,229.25 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,445.76 " 28175892 INTRO CATH DIAL CIRC W/BALLOON 36902 360 "$26,023.00" " 9,618.10 " 776.00 " 20,818.40 " 892.40 " 17,981.89 " " 5,169.57 " " 17,981.89 " 907.92 " 14,377.71 " " 5,071.10 " " 17,175.18 " 869.12 808.05 " 17,224.62 " " 4,431.06 " " 4,923.40 " " 6,549.82 " " 8,187.27 " " 5,046.49 " " 5,071.10 " " 4,923.40 " " 20,818.40 " " 4,504.91 " 776.00 " 17,435.41 " " 4,332.59 " " 10,643.41 " " 19,517.25 " " 9,891.34 " " 11,640.09 " " 5,095.72 " 29812985 INTRO CATH DIAL CIRC W/BALLOON 36902 481 "$26,023.00" " 9,618.10 " 776.00 " 20,818.40 " 892.40 " 17,981.89 " " 5,169.57 " " 17,981.89 " 907.92 " 14,377.71 " " 5,071.10 " " 17,175.18 " 869.12 808.05 " 17,224.62 " " 4,431.06 " " 4,923.40 " " 6,549.82 " " 8,187.27 " " 5,046.49 " " 5,071.10 " " 4,923.40 " " 20,818.40 " " 4,504.91 " 776.00 " 17,435.41 " " 4,332.59 " " 10,643.41 " " 19,517.25 " " 9,891.34 " " 11,640.09 " " 5,095.72 " 80335741 INTRO CATH DIAL CIRC W/BALLOON 36902 320 "$26,023.00" " 9,618.10 " 776.00 " 20,818.40 " 892.40 " 17,981.89 " " 5,169.57 " " 17,981.89 " 907.92 " 14,377.71 " " 5,071.10 " " 17,175.18 " 869.12 808.05 " 17,224.62 " " 4,431.06 " " 4,923.40 " " 6,549.82 " " 8,187.27 " " 5,046.49 " " 5,071.10 " " 4,923.40 " " 20,818.40 " " 4,504.91 " 776.00 " 17,435.41 " " 4,332.59 " " 10,643.41 " " 19,517.25 " " 9,891.34 " " 11,640.09 " " 5,095.72 " 28170114 INTRO CATH DIAL CIRC W/STENT 36903 360 "$52,725.00" " 19,487.16 " 776.00 " 52,813.32 " 892.40 " 36,432.98 " " 10,476.71 " " 36,432.98 " 907.92 " 29,130.56 " " 10,277.15 " " 34,798.50 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 42,250.66 " " 52,813.32 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 29812993 INTRO CATH DIAL CIRC W/STENT 36903 481 "$52,725.00" " 19,487.16 " 776.00 " 52,813.32 " 892.40 " 36,432.98 " " 10,476.71 " " 36,432.98 " 907.92 " 29,130.56 " " 10,277.15 " " 34,798.50 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 42,250.66 " " 52,813.32 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 80335750 INTRO CATH DIALYSIS CIRCUIT 36903 320 "$52,725.00" " 19,487.16 " 776.00 " 52,813.32 " 892.40 " 36,432.98 " " 10,476.71 " " 36,432.98 " 907.92 " 29,130.56 " " 10,277.15 " " 34,798.50 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 42,250.66 " " 52,813.32 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 29813001 THRMBC/NFS DIAL CIRCUIT 36904 481 "$26,023.00" " 9,618.10 " 776.00 " 20,818.40 " 892.40 " 17,981.89 " " 5,169.57 " " 17,981.89 " 907.92 " 14,377.71 " " 5,071.10 " " 17,175.18 " 869.12 808.05 " 17,224.62 " " 4,431.06 " " 4,923.40 " " 9,558.46 " " 11,948.08 " " 5,046.49 " " 5,071.10 " " 4,923.40 " " 20,818.40 " " 4,504.91 " 776.00 " 17,435.41 " " 4,332.59 " " 10,643.41 " " 19,517.25 " " 9,891.34 " " 11,640.09 " " 5,095.72 " 80335768 THRMBC/NFS DIALYSIS CIRCUIT 36904 320 "$26,023.00" " 9,618.10 " 776.00 " 20,818.40 " 892.40 " 17,981.89 " " 5,169.57 " " 17,981.89 " 907.92 " 14,377.71 " " 5,071.10 " " 17,175.18 " 869.12 808.05 " 17,224.62 " " 4,431.06 " " 4,923.40 " " 9,558.46 " " 11,948.08 " " 5,046.49 " " 5,071.10 " " 4,923.40 " " 20,818.40 " " 4,504.91 " 776.00 " 17,435.41 " " 4,332.59 " " 10,643.41 " " 19,517.25 " " 9,891.34 " " 11,640.09 " " 5,095.72 " 29813019 THRMBC/NFS DIAL CIRC W/BALLOON 36905 481 "$52,725.00" " 19,487.16 " 776.00 " 42,180.00 " 892.40 " 36,432.98 " " 10,476.71 " " 36,432.98 " 907.92 " 29,130.56 " " 10,277.15 " " 34,798.50 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 12,229.09 " " 15,286.36 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 80335776 THRMBC/NFS DIALYSIS CIRCUIT 36905 320 "$52,725.00" " 19,487.16 " 776.00 " 42,180.00 " 892.40 " 36,432.98 " " 10,476.71 " " 36,432.98 " 907.92 " 29,130.56 " " 10,277.15 " " 34,798.50 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 12,229.09 " " 15,286.36 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 29813027 THRMBC/NFS DIAL CIRC W/STENT 36906 481 "$84,336.00" " 31,170.59 " 776.00 " 67,468.80 " 892.40 " 58,276.18 " " 16,751.22 " " 58,276.18 " 907.92 " 46,595.64 " " 16,432.15 " " 55,661.76 " 869.12 808.05 " 55,822.00 " " 14,358.19 " " 15,953.54 " " 51,297.47 " " 64,121.84 " " 16,352.38 " " 16,432.15 " " 15,953.54 " " 67,468.80 " " 14,597.49 " 776.00 " 56,505.12 " " 14,039.12 " " 34,493.42 " " 63,252.00 " " 32,056.11 " " 37,723.49 " " 16,511.91 " 80335784 THRMBC/NFS DIALYSIS CIRCUIT 36906 320 "$84,336.00" " 31,170.59 " 776.00 " 67,468.80 " 892.40 " 58,276.18 " " 16,751.22 " " 58,276.18 " 907.92 " 46,595.64 " " 16,432.15 " " 55,661.76 " 869.12 808.05 " 55,822.00 " " 14,358.19 " " 15,953.54 " " 51,297.47 " " 64,121.84 " " 16,352.38 " " 16,432.15 " " 15,953.54 " " 67,468.80 " " 14,597.49 " 776.00 " 56,505.12 " " 14,039.12 " " 34,493.42 " " 63,252.00 " " 32,056.11 " " 37,723.49 " " 16,511.91 " 28175906 BLLN ANGIO CTR DIALYSIS SEG 36907 360 "$6,532.00" " 2,414.23 " - " 5,225.60 " 117.74 " 4,513.61 " - " 4,513.61 " 119.78 " 3,608.93 " - " 4,311.12 " 114.67 106.61 " 4,323.53 " - - " 3,918.34 " " 4,897.93 " - - - " 5,225.60 " - 102.38 " 4,376.44 " - " 2,671.59 " " 4,899.00 " " 2,482.81 " " 2,921.76 " - 29813035 BLLN ANGIO CTR DIALYSIS SEG 36907 481 "$6,532.00" " 2,414.23 " - " 5,225.60 " 117.74 " 4,513.61 " - " 4,513.61 " 119.78 " 3,608.93 " - " 4,311.12 " 114.67 106.61 " 4,323.53 " - - " 3,918.34 " " 4,897.93 " - - - " 5,225.60 " - 102.38 " 4,376.44 " - " 2,671.59 " " 4,899.00 " " 2,482.81 " " 2,921.76 " - 80335792 BLLN ANGIO CTR DIALYSIS SEG 36907 320 "$6,532.00" " 2,414.23 " - " 5,225.60 " 117.74 " 4,513.61 " - " 4,513.61 " 119.78 " 3,608.93 " - " 4,311.12 " 114.67 106.61 " 4,323.53 " - - " 3,918.34 " " 4,897.93 " - - - " 5,225.60 " - 102.38 " 4,376.44 " - " 2,671.59 " " 4,899.00 " " 2,482.81 " " 2,921.76 " - 29813043 PLCMT STENT CTR DIALYSIS SEG 36908 481 "$13,093.00" " 4,839.17 " - " 25,408.89 " 176.48 " 9,047.26 " - " 9,047.26 " 179.55 " 7,233.88 " - " 8,641.38 " 171.88 159.80 " 8,666.26 " - - " 20,327.11 " " 25,408.89 " - - - " 10,474.40 " - 153.46 " 8,772.31 " - " 5,355.04 " " 9,819.75 " " 4,976.65 " " 5,856.50 " - 80335806 PLCMT STENT CTR DIALYSIS SEG 36908 320 "$13,093.00" " 4,839.17 " - " 25,408.89 " 176.48 " 9,047.26 " - " 9,047.26 " 179.55 " 7,233.88 " - " 8,641.38 " 171.88 159.80 " 8,666.26 " - - " 20,327.11 " " 25,408.89 " - - - " 10,474.40 " - 153.46 " 8,772.31 " - " 5,355.04 " " 9,819.75 " " 4,976.65 " " 5,856.50 " - 29813051 DIALYSIS CIRCUIT EMBOLIZATION 36909 481 "$17,457.00" " 6,452.11 " - " 13,965.60 " 167.51 " 12,062.79 " - " 12,062.79 " 170.42 " 9,644.99 " - " 11,521.62 " 163.14 151.68 " 11,554.79 " - - " 10,476.31 " " 13,095.39 " - - - " 13,965.60 " - 145.66 " 11,696.19 " - " 7,139.91 " " 13,092.75 " " 6,635.41 " " 7,808.52 " - 80335814 DIALYSIS CIRCUIT EMBOLIZATION 36909 320 "$17,457.00" " 6,452.11 " - " 13,965.60 " 167.51 " 12,062.79 " - " 12,062.79 " 170.42 " 9,644.99 " - " 11,521.62 " 163.14 151.68 " 11,554.79 " - - " 10,476.31 " " 13,095.39 " - - - " 13,965.60 " - 145.66 " 11,696.19 " - " 7,139.91 " " 13,092.75 " " 6,635.41 " " 7,808.52 " - 80326459 INSERT HEPATIC SHUNT (TIPS) 37182 320 "$52,725.00" " 19,487.16 " - " 42,180.00 " - " 36,432.98 " N/A " 36,432.98 " - " 29,130.56 " N/A " 34,798.50 " - N/A " 34,898.68 " - N/A " 7,046.64 " " 8,808.30 " N/A N/A N/A " 42,180.00 " N/A - " 35,325.75 " N/A " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " N/A 80326467 REMOVE HEPATIC SHUNT (TIPS) 37183 320 "$26,023.00" " 9,618.10 " 776.00 " 20,818.40 " 892.40 " 4,656.00 " " 5,169.57 " " 4,656.00 " 907.92 " 14,377.71 " " 5,071.10 " " 17,175.18 " 869.12 808.05 " 17,224.62 " " 4,431.06 " " 4,923.40 " " 3,363.38 " " 4,204.23 " " 5,046.49 " " 5,071.10 " " 4,923.40 " " 20,818.40 " " 4,504.91 " 776.00 " 17,435.41 " " 4,332.59 " " 10,643.41 " " 19,517.25 " " 9,891.34 " " 11,640.09 " " 5,095.72 " 28170122 PRIM ART MECH THRMBC 1ST VSL 37184 360 "$52,725.00" " 19,487.16 " 776.00 " 42,180.00 " 892.40 " 4,656.00 " " 10,476.71 " " 4,656.00 " 907.92 " 29,130.56 " " 10,277.15 " " 6,576.00 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 15,766.93 " " 19,708.66 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 29803102 PRIM ART MECH THRMBC 1ST VSL 37184 481 "$52,725.00" " 19,487.16 " 776.00 " 42,180.00 " 892.40 " 4,656.00 " " 10,476.71 " " 4,656.00 " 907.92 " 29,130.56 " " 10,277.15 " " 6,576.00 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 15,766.93 " " 19,708.66 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 80327625 PRIM ART M-THRMBC 1ST VSL 37184 320 "$52,725.00" " 19,487.16 " 776.00 " 42,180.00 " 892.40 " 4,656.00 " " 10,476.71 " " 4,656.00 " 907.92 " 29,130.56 " " 10,277.15 " " 6,576.00 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 15,766.93 " " 19,708.66 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 29803072 PRIM ART MECH THRMBC SBSQ VSL 37185 481 "$9,461.00" " 3,496.79 " - " 7,568.80 " - " 1,718.00 " - " 1,718.00 " - " 5,227.20 " - " 6,244.26 " - - " 6,262.24 " - - " 5,148.57 " " 6,435.71 " - - - " 7,568.80 " - - " 6,338.87 " - " 3,869.55 " " 7,095.75 " " 3,596.13 " " 4,231.91 " - 80327757 PRIM ART M-THRMBC SBSQ VSL 37185 320 "$9,461.00" " 3,496.79 " - " 7,568.80 " - " 1,718.00 " - " 1,718.00 " - " 5,227.20 " - " 6,244.26 " - - " 6,262.24 " - - " 5,148.57 " " 6,435.71 " - - - " 7,568.80 " - - " 6,338.87 " - " 3,869.55 " " 7,095.75 " " 3,596.13 " " 4,231.91 " - 29803081 SEC ART MECH THRMBC ADDL 37186 481 "$10,231.00" " 3,781.38 " - " 13,285.46 " - " 1,469.00 " - " 1,469.00 " - " 5,652.63 " - " 6,752.46 " - - " 6,771.90 " - - " 10,628.37 " " 13,285.46 " - - - " 8,184.80 " - - " 6,854.77 " - " 4,184.48 " " 7,673.25 " " 3,888.80 " " 4,576.33 " - 80327765 2ND ART THROMBECTOMY ADD-ON 37186 320 "$10,231.00" " 3,781.38 " - " 13,285.46 " - " 1,469.00 " - " 1,469.00 " - " 5,652.63 " - " 6,752.46 " - - " 6,771.90 " - - " 10,628.37 " " 13,285.46 " - - - " 8,184.80 " - - " 6,854.77 " - " 4,184.48 " " 7,673.25 " " 3,888.80 " " 4,576.33 " - 80327773 VENOUS M-THROMBECTOMY 37187 320 "$52,725.00" " 19,487.16 " 776.00 " 42,180.00 " 892.40 " 4,656.00 " " 10,476.71 " " 4,656.00 " 907.92 " 29,130.56 " " 10,277.15 " " 6,576.00 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 15,333.43 " " 19,166.79 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 29812748 VENOUS M-THROMBECTOMY ADD-ON 37188 481 "$15,024.00" " 5,552.87 " 776.00 " 16,540.20 " 892.40 " 4,656.00 " " 2,985.82 " " 4,656.00 " 907.92 " 8,300.76 " " 2,928.95 " " 6,576.00 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 13,232.16 " " 16,540.20 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80327781 VENOUS M-THROMBECTOMY ADD-ON 37188 320 "$15,024.00" " 5,552.87 " 776.00 " 16,540.20 " 892.40 " 4,656.00 " " 2,985.82 " " 4,656.00 " 907.92 " 8,300.76 " " 2,928.95 " " 6,576.00 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 13,232.16 " " 16,540.20 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 28170131 INSERT ENDO VENA CAVA FILTER 37191 360 "$25,044.00" " 9,256.26 " 776.00 " 20,035.20 " 892.40 " 2,773.00 " " 4,973.85 " " 2,773.00 " 907.92 " 13,836.81 " " 4,879.11 " " 16,529.04 " 869.12 808.05 " 16,576.62 " " 4,263.30 " " 4,737.00 " " 9,479.66 " " 11,849.57 " " 4,855.43 " " 4,879.11 " " 4,737.00 " " 20,035.20 " " 4,334.36 " 776.00 " 16,779.48 " " 4,168.56 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,902.80 " 29811199 INSERT ENDO VENA CAVA FILTER 37191 481 "$25,044.00" " 9,256.26 " 776.00 " 20,035.20 " 892.40 " 2,773.00 " " 4,973.85 " " 2,773.00 " 907.92 " 13,836.81 " " 4,879.11 " " 16,529.04 " 869.12 808.05 " 16,576.62 " " 4,263.30 " " 4,737.00 " " 9,479.66 " " 11,849.57 " " 4,855.43 " " 4,879.11 " " 4,737.00 " " 20,035.20 " " 4,334.36 " 776.00 " 16,779.48 " " 4,168.56 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,902.80 " 80329237 INSERT ENDOV VENA CAVA FILTR 37191 320 "$25,044.00" " 9,256.26 " 776.00 " 20,035.20 " 892.40 " 2,773.00 " " 4,973.85 " " 2,773.00 " 907.92 " 13,836.81 " " 4,879.11 " " 16,529.04 " 869.12 808.05 " 16,576.62 " " 4,263.30 " " 4,737.00 " " 9,479.66 " " 11,849.57 " " 4,855.43 " " 4,879.11 " " 4,737.00 " " 20,035.20 " " 4,334.36 " 776.00 " 16,779.48 " " 4,168.56 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,902.80 " 80329245 REPOS ENDOV VENA CAVA FILTER 37192 320 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 2,773.00 " " 2,985.82 " " 2,773.00 " 907.92 " 8,300.76 " " 2,928.95 " " 9,915.84 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 6,422.90 " " 8,028.63 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 28170149 REMOVAL ENDO VENA CAVA FILTER 37193 360 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 2,773.00 " " 2,985.82 " " 2,773.00 " 907.92 " 8,300.76 " " 2,928.95 " " 9,915.84 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 6,135.38 " " 7,669.23 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 29811211 REMOVAL ENDO VENA CAVA FILTER 37193 481 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 2,773.00 " " 2,985.82 " " 2,773.00 " 907.92 " 8,300.76 " " 2,928.95 " " 9,915.84 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 6,135.38 " " 7,669.23 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80329253 RMV ENDOV VENA CAVA FILTER 37193 320 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 2,773.00 " " 2,985.82 " " 2,773.00 " 907.92 " 8,300.76 " " 2,928.95 " " 9,915.84 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 6,135.38 " " 7,669.23 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80329539 REMOVE INTRVAS FOREIGN BODY 37197 320 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 2,773.00 " " 2,985.82 " " 2,773.00 " 907.92 " 8,300.76 " " 2,928.95 " " 6,576.00 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 7,087.61 " " 8,859.51 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80328362 BX TRANSCATHETER 37200 320 "$25,044.00" " 9,256.26 " 776.00 " 20,035.20 " 892.40 " 3,326.00 " " 4,973.85 " " 3,326.00 " 907.92 " 13,836.81 " " 4,879.11 " " 1,775.00 " 869.12 808.05 " 16,576.62 " " 4,263.30 " " 4,737.00 " " 1,309.32 " " 1,636.65 " " 4,855.43 " " 4,879.11 " " 4,737.00 " " 20,035.20 " " 4,334.36 " 776.00 " 16,779.48 " " 4,168.56 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,902.80 " 29812756 THROMBOLYTIC ART THERAPY 37211 481 "$25,044.00" " 9,256.26 " 776.00 " 20,035.20 " 892.40 " 1,469.00 " " 4,973.85 " " 1,469.00 " 907.92 " 13,836.81 " " 4,879.11 " " 4,860.00 " 869.12 808.05 " 16,576.62 " " 4,263.30 " " 4,737.00 " " 1,044.58 " " 1,305.73 " " 4,855.43 " " 4,879.11 " " 4,737.00 " " 20,035.20 " " 4,334.36 " 776.00 " 16,779.48 " " 4,168.56 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,902.80 " 80329547 THROMBOLYTIC ART THERAPY 37211 320 "$25,044.00" " 9,256.26 " 776.00 " 20,035.20 " 892.40 " 1,469.00 " " 4,973.85 " " 1,469.00 " 907.92 " 13,836.81 " " 4,879.11 " " 4,860.00 " 869.12 808.05 " 16,576.62 " " 4,263.30 " " 4,737.00 " " 1,044.58 " " 1,305.73 " " 4,855.43 " " 4,879.11 " " 4,737.00 " " 20,035.20 " " 4,334.36 " 776.00 " 16,779.48 " " 4,168.56 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,902.80 " 29811750 THROMBOLYTIC VENOUS THERAPY 37212 481 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 1,469.00 " " 2,985.82 " " 1,469.00 " 907.92 " 8,300.76 " " 2,928.95 " " 4,860.00 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " 922.23 " 1,152.79 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80329555 THROMBOLYTIC VENOUS THERAPY 37212 320 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 1,469.00 " " 2,985.82 " " 1,469.00 " 907.92 " 8,300.76 " " 2,928.95 " " 4,860.00 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " 922.23 " 1,152.79 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 28170157 THROMBLYTIC ART/VEN THERAPY 37213 360 "$15,024.00" " 5,552.87 " - " 12,019.20 " - " 2,773.00 " " 2,985.82 " " 2,773.00 " - " 8,300.76 " " 2,928.95 " " 6,576.00 " - - " 9,944.39 " " 2,559.28 " " 2,843.64 " 645.02 806.27 " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " - " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 29811768 THROMBLYTIC ART/VEN THERAPY 37213 481 "$15,024.00" " 5,552.87 " - " 12,019.20 " - " 2,773.00 " " 2,985.82 " " 2,773.00 " - " 8,300.76 " " 2,928.95 " " 6,576.00 " - - " 9,944.39 " " 2,559.28 " " 2,843.64 " 645.02 806.27 " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " - " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80329563 THROMBLYTIC ART/VEN THERAPY 37213 320 "$15,024.00" " 5,552.87 " - " 12,019.20 " - " 2,773.00 " " 2,985.82 " " 2,773.00 " - " 8,300.76 " " 2,928.95 " " 6,576.00 " - - " 9,944.39 " " 2,559.28 " " 2,843.64 " 645.02 806.27 " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " - " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 28170165 REMOVE CESSATION TX CATH 37214 360 "$15,024.00" " 5,552.87 " - " 12,019.20 " - " 2,773.00 " " 2,985.82 " " 2,773.00 " - " 8,300.76 " " 2,928.95 " " 6,576.00 " - - " 9,944.39 " " 2,559.28 " " 2,843.64 " 376.85 471.06 " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " - " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 29811776 REMOVE CESSATION TX CATH 37214 481 "$15,024.00" " 5,552.87 " - " 12,019.20 " - " 2,773.00 " " 2,985.82 " " 2,773.00 " - " 8,300.76 " " 2,928.95 " " 6,576.00 " - - " 9,944.39 " " 2,559.28 " " 2,843.64 " 376.85 471.06 " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " - " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80329571 REMOVE CESSATION TX CATH 37214 320 "$15,024.00" " 5,552.87 " - " 12,019.20 " - " 2,773.00 " " 2,985.82 " " 2,773.00 " - " 8,300.76 " " 2,928.95 " " 6,576.00 " - - " 9,944.39 " " 2,559.28 " " 2,843.64 " 376.85 471.06 " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " - " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 28170173 OPEN/PRQ PLCMT STENT CCA W/EPS 37215 360 "$27,343.00" " 10,105.97 " - " 21,874.40 " - " 2,773.00 " N/A " 2,773.00 " - " 15,107.01 " N/A " 18,046.38 " - N/A " 18,098.33 " - N/A " 8,432.64 " " 10,540.80 " N/A N/A N/A " 21,874.40 " N/A - " 18,319.81 " N/A " 11,183.29 " " 20,507.25 " " 10,393.07 " " 12,230.52 " N/A 29802831 OPEN/PRQ PLCMT STENT CCA W/EPS 37215 481 "$27,343.00" " 10,105.97 " - " 21,874.40 " - " 2,773.00 " N/A " 2,773.00 " - " 15,107.01 " N/A " 18,046.38 " - N/A " 18,098.33 " - N/A " 8,432.64 " " 10,540.80 " N/A N/A N/A " 21,874.40 " N/A - " 18,319.81 " N/A " 11,183.29 " " 20,507.25 " " 10,393.07 " " 12,230.52 " N/A 28170181 STENT PLACEMT RETRO CAROTID 37217 360 "$15,125.00" " 5,590.20 " - " 12,100.00 " - " 2,773.00 " N/A " 2,773.00 " - " 8,356.56 " N/A " 9,982.50 " - N/A " 10,011.24 " - N/A " 2,566.83 " " 3,208.54 " N/A N/A N/A " 12,100.00 " N/A - " 10,133.75 " N/A " 6,186.13 " " 11,343.75 " " 5,749.01 " " 6,765.41 " N/A 29812390 PLACE STENT ANTE CAROTID 37218 481 "$11,210.00" " 4,143.22 " - " 8,968.00 " - " 2,773.00 " N/A " 2,773.00 " - " 6,193.53 " N/A " 7,398.60 " - N/A " 7,419.90 " - N/A " 1,725.94 " " 2,157.43 " N/A N/A N/A " 8,968.00 " N/A - " 7,510.70 " N/A " 4,584.89 " " 8,407.50 " " 4,260.92 " " 5,014.23 " N/A 28175337 REVAS ILIAC ARTER ANGI 1ST VSL 37220 360 "$26,023.00" " 9,618.10 " 776.00 " 21,504.86 " 892.40 " 3,326.00 " " 5,169.57 " " 3,326.00 " 907.92 " 14,377.71 " " 5,071.10 " " 17,175.18 " 869.12 808.05 " 17,224.62 " " 4,431.06 " " 4,923.40 " " 17,203.89 " " 21,504.86 " " 5,046.49 " " 5,071.10 " " 4,923.40 " " 20,818.40 " " 4,504.91 " 776.00 " 17,435.41 " " 4,332.59 " " 10,643.41 " " 19,517.25 " " 9,891.34 " " 11,640.09 " " 5,095.72 " 29810893 OPEN/PRQ ILIAC REVASC INIT 37220 481 "$26,023.00" " 9,618.10 " 776.00 " 21,504.86 " 892.40 " 3,326.00 " " 5,169.57 " " 3,326.00 " 907.92 " 14,377.71 " " 5,071.10 " " 17,175.18 " 869.12 808.05 " 17,224.62 " " 4,431.06 " " 4,923.40 " " 17,203.89 " " 21,504.86 " " 5,046.49 " " 5,071.10 " " 4,923.40 " " 20,818.40 " " 4,504.91 " 776.00 " 17,435.41 " " 4,332.59 " " 10,643.41 " " 19,517.25 " " 9,891.34 " " 11,640.09 " " 5,095.72 " 80329385 ILIAC REVASC 37220 320 "$26,023.00" " 9,618.10 " 776.00 " 21,504.86 " 892.40 " 3,326.00 " " 5,169.57 " " 3,326.00 " 907.92 " 14,377.71 " " 5,071.10 " " 17,175.18 " 869.12 808.05 " 17,224.62 " " 4,431.06 " " 4,923.40 " " 17,203.89 " " 21,504.86 " " 5,046.49 " " 5,071.10 " " 4,923.40 " " 20,818.40 " " 4,504.91 " 776.00 " 17,435.41 " " 4,332.59 " " 10,643.41 " " 19,517.25 " " 9,891.34 " " 11,640.09 " " 5,095.72 " 28170190 OPEN/PRQ ILIAC REVASC W/STENT 37221 360 "$52,725.00" " 19,487.16 " 776.00 " 42,180.00 " 892.40 " 3,326.00 " " 10,476.71 " " 3,326.00 " 907.92 " 29,130.56 " " 10,277.15 " " 34,798.50 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 25,387.55 " " 31,734.44 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 29810907 OPEN/PRQ ILIAC REVASC W/STENT 37221 481 "$52,725.00" " 19,487.16 " 776.00 " 42,180.00 " 892.40 " 3,326.00 " " 10,476.71 " " 3,326.00 " 907.92 " 29,130.56 " " 10,277.15 " " 34,798.50 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 25,387.55 " " 31,734.44 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 80329393 ILIAC REVASC W/STENT 37221 320 "$52,725.00" " 19,487.16 " 776.00 " 42,180.00 " 892.40 " 3,326.00 " " 10,476.71 " " 3,326.00 " 907.92 " 29,130.56 " " 10,277.15 " " 34,798.50 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 25,387.55 " " 31,734.44 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 29810915 OPEN/PRQ ILIAC REVASC ADDL 37222 481 "$3,183.00" " 1,176.44 " - " 6,224.83 " 182.87 " 1,469.00 " - " 1,469.00 " 186.05 " 1,758.61 " - " 2,100.78 " 178.10 165.59 " 2,106.83 " - - " 4,979.86 " " 6,224.83 " - - - " 2,546.40 " - 159.02 " 2,132.61 " - " 1,301.85 " " 2,387.25 " " 1,209.86 " " 1,423.76 " - 80329610 ILIAC REVASC ADD-ON 37222 320 "$3,183.00" " 1,176.44 " - " 6,224.83 " 182.87 " 1,469.00 " - " 1,469.00 " 186.05 " 1,758.61 " - " 2,100.78 " 178.10 165.59 " 2,106.83 " - - " 4,979.86 " " 6,224.83 " - - - " 2,546.40 " - 159.02 " 2,132.61 " - " 1,301.85 " " 2,387.25 " " 1,209.86 " " 1,423.76 " - 28170203 OPEN/PRQ ILIAC REVASC STNT ADD 37223 360 "$5,420.00" " 2,003.23 " - " 17,457.15 " 207.58 " 1,469.00 " - " 1,469.00 " 211.19 " 2,994.55 " - " 3,577.20 " 202.16 187.95 " 3,587.50 " - - " 13,965.72 " " 17,457.15 " - - - " 4,336.00 " - 180.50 " 3,631.40 " - " 2,216.78 " " 4,065.00 " " 2,060.14 " " 2,424.37 " - 29810923 OPEN/PRQ ILIAC REVASC STNT ADD 37223 481 "$5,420.00" " 2,003.23 " - " 17,457.15 " 207.58 " 1,469.00 " - " 1,469.00 " 211.19 " 2,994.55 " - " 3,577.20 " 202.16 187.95 " 3,587.50 " - - " 13,965.72 " " 17,457.15 " - - - " 4,336.00 " - 180.50 " 3,631.40 " - " 2,216.78 " " 4,065.00 " " 2,060.14 " " 2,424.37 " - 80329407 ILIAC REVASC W/STENT ADD-ON 37223 320 "$5,420.00" " 2,003.23 " - " 17,457.15 " 207.58 " 1,469.00 " - " 1,469.00 " 211.19 " 2,994.55 " - " 3,577.20 " 202.16 187.95 " 3,587.50 " - - " 13,965.72 " " 17,457.15 " - - - " 4,336.00 " - 180.50 " 3,631.40 " - " 2,216.78 " " 4,065.00 " " 2,060.14 " " 2,424.37 " - 28170211 OPEN/PRQ FEM/POPL REVASC W/TLA 37224 360 "$26,023.00" " 9,618.10 " 776.00 " 25,821.12 " 892.40 " 3,326.00 " " 5,169.57 " " 3,326.00 " 907.92 " 14,377.71 " " 5,071.10 " " 17,175.18 " 869.12 808.05 " 17,224.62 " " 4,431.06 " " 4,923.40 " " 20,656.90 " " 25,821.12 " " 5,046.49 " " 5,071.10 " " 4,923.40 " " 20,818.40 " " 4,504.91 " 776.00 " 17,435.41 " " 4,332.59 " " 10,643.41 " " 19,517.25 " " 9,891.34 " " 11,640.09 " " 5,095.72 " 29810931 OPEN/PRQ FEM/POPL REVASC W/TLA 37224 481 "$26,023.00" " 9,618.10 " 776.00 " 25,821.12 " 892.40 " 3,326.00 " " 5,169.57 " " 3,326.00 " 907.92 " 14,377.71 " " 5,071.10 " " 17,175.18 " 869.12 808.05 " 17,224.62 " " 4,431.06 " " 4,923.40 " " 20,656.90 " " 25,821.12 " " 5,046.49 " " 5,071.10 " " 4,923.40 " " 20,818.40 " " 4,504.91 " 776.00 " 17,435.41 " " 4,332.59 " " 10,643.41 " " 19,517.25 " " 9,891.34 " " 11,640.09 " " 5,095.72 " 80329628 FEMORAL/POPL REVASC W/TLA UNI 37224 320 "$26,023.00" " 9,618.10 " 776.00 " 25,821.12 " 892.40 " 3,326.00 " " 5,169.57 " " 3,326.00 " 907.92 " 14,377.71 " " 5,071.10 " " 17,175.18 " 869.12 808.05 " 17,224.62 " " 4,431.06 " " 4,923.40 " " 20,656.90 " " 25,821.12 " " 5,046.49 " " 5,071.10 " " 4,923.40 " " 20,818.40 " " 4,504.91 " 776.00 " 17,435.41 " " 4,332.59 " " 10,643.41 " " 19,517.25 " " 9,891.34 " " 11,640.09 " " 5,095.72 " 28175345 FEM/POPL REVAS W/ATHER 37225 360 "$52,725.00" " 19,487.16 " 776.00 " 72,672.46 " 892.40 " 3,326.00 " " 10,476.71 " " 3,326.00 " 907.92 " 29,130.56 " " 10,277.15 " " 34,798.50 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 58,137.97 " " 72,672.46 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 29810940 OPEN/PRQ FEM/POPL REVAS ATHER 37225 481 "$52,725.00" " 19,487.16 " 776.00 " 72,672.46 " 892.40 " 3,326.00 " " 10,476.71 " " 3,326.00 " 907.92 " 29,130.56 " " 10,277.15 " " 34,798.50 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 58,137.97 " " 72,672.46 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 80336497 OPEN/PRQ FEM/POPL REVAS ATHER 37225 320 "$52,725.00" " 19,487.16 " 776.00 " 72,672.46 " 892.40 " 3,326.00 " " 10,476.71 " " 3,326.00 " 907.92 " 29,130.56 " " 10,277.15 " " 34,798.50 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 58,137.97 " " 72,672.46 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 28170220 OPEN/PRQ FEM/POPL REVASC STNT 37226 360 "$52,725.00" " 19,487.16 " 776.00 " 60,805.03 " 892.40 " 3,326.00 " " 10,476.71 " " 3,326.00 " 907.92 " 29,130.56 " " 10,277.15 " " 34,798.50 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 48,644.02 " " 60,805.03 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 29810958 OPEN/PRQ FEM/POPL REVASC STNT 37226 481 "$52,725.00" " 19,487.16 " 776.00 " 60,805.03 " 892.40 " 3,326.00 " " 10,476.71 " " 3,326.00 " 907.92 " 29,130.56 " " 10,277.15 " " 34,798.50 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 48,644.02 " " 60,805.03 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 80329644 FEMORAL/POPL REVASC W/STENT 37226 320 "$52,725.00" " 19,487.16 " 776.00 " 60,805.03 " 892.40 " 3,326.00 " " 10,476.71 " " 3,326.00 " 907.92 " 29,130.56 " " 10,277.15 " " 34,798.50 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 48,644.02 " " 60,805.03 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 28170238 OPEN/PRQ FEM/POPL W/STNT ATHER 37227 360 "$84,336.00" " 31,170.59 " 776.00 " 98,217.58 " 892.40 " 3,326.00 " " 16,751.22 " " 3,326.00 " 907.92 " 46,595.64 " " 16,432.15 " " 55,661.76 " 869.12 808.05 " 55,822.00 " " 14,358.19 " " 15,953.54 " " 78,574.06 " " 98,217.58 " " 16,352.38 " " 16,432.15 " " 15,953.54 " " 67,468.80 " " 14,597.49 " 776.00 " 56,505.12 " " 14,039.12 " " 34,493.42 " " 63,252.00 " " 32,056.11 " " 37,723.49 " " 16,511.91 " 29810966 OPEN/PRQ FEM/POPL W/STNT ATHER 37227 481 "$84,336.00" " 31,170.59 " 776.00 " 98,217.58 " 892.40 " 3,326.00 " " 16,751.22 " " 3,326.00 " 907.92 " 46,595.64 " " 16,432.15 " " 55,661.76 " 869.12 808.05 " 55,822.00 " " 14,358.19 " " 15,953.54 " " 78,574.06 " " 98,217.58 " " 16,352.38 " " 16,432.15 " " 15,953.54 " " 67,468.80 " " 14,597.49 " 776.00 " 56,505.12 " " 14,039.12 " " 34,493.42 " " 63,252.00 " " 32,056.11 " " 37,723.49 " " 16,511.91 " 28170246 OPEN/PRQ TIBIAL REVASC W/TLA 37228 360 "$52,725.00" " 19,487.16 " 776.00 " 42,180.00 " 892.40 " 3,326.00 " " 10,476.71 " " 3,326.00 " 907.92 " 29,130.56 " " 10,277.15 " " 34,798.50 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 29,380.89 " " 36,726.11 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 29810974 OPEN/PRQ TIBIAL REVASC W/TLA 37228 481 "$52,725.00" " 19,487.16 " 776.00 " 42,180.00 " 892.40 " 3,326.00 " " 10,476.71 " " 3,326.00 " 907.92 " 29,130.56 " " 10,277.15 " " 34,798.50 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 29,380.89 " " 36,726.11 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 80329636 TIB/PERC REVASC W/TLA 37228 320 "$52,725.00" " 19,487.16 " 776.00 " 42,180.00 " 892.40 " 3,326.00 " " 10,476.71 " " 3,326.00 " 907.92 " 29,130.56 " " 10,277.15 " " 34,798.50 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 29,380.89 " " 36,726.11 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 29810982 OPEN/PRQ TIBIAL REVASC W/ATHER 37229 481 "$84,336.00" " 31,170.59 " 776.00 " 72,090.79 " 892.40 " 3,326.00 " " 16,751.22 " " 3,326.00 " 907.92 " 46,595.64 " " 16,432.15 " " 55,661.76 " 869.12 808.05 " 55,822.00 " " 14,358.19 " " 15,953.54 " " 57,672.63 " " 72,090.79 " " 16,352.38 " " 16,432.15 " " 15,953.54 " " 67,468.80 " " 14,597.49 " 776.00 " 56,505.12 " " 14,039.12 " " 34,493.42 " " 63,252.00 " " 32,056.11 " " 37,723.49 " " 16,511.91 " 29810991 OPEN/PRQ TIBIAL REVASC W/STENT 37230 481 "$84,336.00" " 31,170.59 " 776.00 " 67,468.80 " 892.40 " 3,326.00 " " 16,751.22 " " 3,326.00 " 907.92 " 46,595.64 " " 16,432.15 " " 55,661.76 " 869.12 808.05 " 55,822.00 " " 14,358.19 " " 15,953.54 " " 45,341.22 " " 56,676.52 " " 16,352.38 " " 16,432.15 " " 15,953.54 " " 67,468.80 " " 14,597.49 " 776.00 " 56,505.12 " " 14,039.12 " " 34,493.42 " " 63,252.00 " " 32,056.11 " " 37,723.49 " " 16,511.91 " 29811008 OPEN/PRQ TIBIAL W/STENT ATHER 37231 481 "$84,336.00" " 31,170.59 " 776.00 " 90,820.27 " 892.40 " 3,326.00 " " 16,751.22 " " 3,326.00 " 907.92 " 46,595.64 " " 16,432.15 " " 55,661.76 " 869.12 808.05 " 55,822.00 " " 14,358.19 " " 15,953.54 " " 72,656.22 " " 90,820.27 " " 16,352.38 " " 16,432.15 " " 15,953.54 " " 67,468.80 " " 14,597.49 " 776.00 " 56,505.12 " " 14,039.12 " " 34,493.42 " " 63,252.00 " " 32,056.11 " " 37,723.49 " " 16,511.91 " 29811016 OPEN/PRQ TIBIAL REVASC ADDL 37232 481 "$3,183.00" " 1,176.44 " - " 8,275.80 " 196.08 " 1,469.00 " - " 1,469.00 " 199.49 " 1,758.61 " - " 2,100.78 " 190.96 177.54 " 2,106.83 " - - " 6,620.64 " " 8,275.80 " - - - " 2,546.40 " - 170.50 " 2,132.61 " - " 1,301.85 " " 2,387.25 " " 1,209.86 " " 1,423.76 " - 80329873 TIB/PERC REVASC ADD-ON 37232 320 "$3,183.00" " 1,176.44 " - " 8,275.80 " 196.08 " 1,469.00 " - " 1,469.00 " 199.49 " 1,758.61 " - " 2,100.78 " 190.96 177.54 " 2,106.83 " - - " 6,620.64 " " 8,275.80 " - - - " 2,546.40 " - 170.50 " 2,132.61 " - " 1,301.85 " " 2,387.25 " " 1,209.86 " " 1,423.76 " - 29811024 OPEN/PRQ TIBIAL W/ATHER ADDL 37233 481 "$24,261.00" " 8,966.87 " - " 19,408.80 " 322.20 " 1,469.00 " - " 1,469.00 " 327.80 " 13,404.20 " - " 16,012.26 " 313.79 291.74 " 16,058.36 " - - " 8,115.09 " " 10,143.86 " - - - " 19,408.80 " - 280.17 " 16,254.87 " - " 9,922.75 " " 18,195.75 " " 9,221.61 " " 10,851.95 " - 29811032 OPEN/PRQ TIB REVASC W/STNT ADD 37234 481 "$19,447.00" " 7,187.61 " - " 26,223.76 " 268.43 " 1,469.00 " - " 1,469.00 " 273.10 " 10,744.47 " - " 12,835.02 " 261.43 243.06 " 12,871.97 " - - " 20,979.01 " " 26,223.76 " - - - " 15,557.60 " - 233.42 " 13,029.49 " - " 7,953.82 " " 14,585.25 " " 7,391.80 " " 8,698.64 " - 28170254 OPEN/PRQ PLCMT STENT INIT ART 37236 360 "$52,725.00" " 19,487.16 " 776.00 " 42,180.00 " 892.40 " 2,773.00 " " 10,476.71 " " 2,773.00 " 907.92 " 29,130.56 " " 10,277.15 " " 34,798.50 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 5,959.59 " " 7,449.49 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 29812161 OPEN/PRQ PLCMT STENT INIT ART 37236 481 "$52,725.00" " 19,487.16 " 776.00 " 42,180.00 " 892.40 " 2,773.00 " " 10,476.71 " " 2,773.00 " 907.92 " 29,130.56 " " 10,277.15 " " 34,798.50 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 5,959.59 " " 7,449.49 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 80329750 PLCMT STENT OPEN/PERC 1ST 37236 320 "$52,725.00" " 19,487.16 " 776.00 " 42,180.00 " 892.40 " 2,773.00 " " 10,476.71 " " 2,773.00 " 907.92 " 29,130.56 " " 10,277.15 " " 34,798.50 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 5,959.59 " " 7,449.49 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 28170262 OPEN/PRQ PLCMT STENT ART ADDL 37237 360 "$9,961.00" " 3,681.59 " - " 7,968.80 " 205.52 " 1,469.00 " - " 1,469.00 " 209.09 " 5,503.45 " - " 6,574.26 " 200.16 186.09 " 6,593.19 " - - " 2,591.81 " " 3,239.76 " - - - " 7,968.80 " - 178.71 " 6,673.87 " - " 4,074.05 " " 7,470.75 " " 3,786.18 " " 4,455.56 " - 29812179 OPEN/PRQ PLCMT STENT ART ADDL 37237 481 "$9,961.00" " 3,681.59 " - " 7,968.80 " 205.52 " 1,469.00 " - " 1,469.00 " 209.09 " 5,503.45 " - " 6,574.26 " 200.16 186.09 " 6,593.19 " - - " 2,591.81 " " 3,239.76 " - - - " 7,968.80 " - 178.71 " 6,673.87 " - " 4,074.05 " " 7,470.75 " " 3,786.18 " " 4,455.56 " - 80329768 PLCMT STENT OPEN/PERC EACH ADD 37237 320 "$9,961.00" " 3,681.59 " - " 7,968.80 " 205.52 " 1,469.00 " - " 1,469.00 " 209.09 " 5,503.45 " - " 6,574.26 " 200.16 186.09 " 6,593.19 " - - " 2,591.81 " " 3,239.76 " - - - " 7,968.80 " - 178.71 " 6,673.87 " - " 4,074.05 " " 7,470.75 " " 3,786.18 " " 4,455.56 " - 28170271 OPEN/PRQ PLCMT STENT INIT VEIN 37238 360 "$52,725.00" " 19,487.16 " 776.00 " 42,180.00 " 892.40 " 2,773.00 " " 10,476.71 " " 2,773.00 " 907.92 " 29,130.56 " " 10,277.15 " " 34,798.50 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 8,657.89 " " 10,822.36 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 29812187 OPEN/PRQ PLCMT STENT INIT VEIN 37238 481 "$52,725.00" " 19,487.16 " 776.00 " 42,180.00 " 892.40 " 2,773.00 " " 10,476.71 " " 2,773.00 " 907.92 " 29,130.56 " " 10,277.15 " " 34,798.50 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 8,657.89 " " 10,822.36 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 80329776 PLCMT STENT OPEN/PERC SAME 37238 320 "$52,725.00" " 19,487.16 " 776.00 " 42,180.00 " 892.40 " 2,773.00 " " 10,476.71 " " 2,773.00 " 907.92 " 29,130.56 " " 10,277.15 " " 34,798.50 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 8,657.89 " " 10,822.36 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 28176384 OPEN/PRQ PLCMT STENT VEIN ADDL 37239 360 "$3,490.00" " 1,289.90 " - " 5,377.99 " 143.45 " 1,469.00 " - " 1,469.00 " 145.95 " 1,928.23 " - " 2,303.40 " 139.71 129.89 " 2,310.03 " - - " 4,302.39 " " 5,377.99 " - - - " 2,792.00 " - 124.74 " 2,338.30 " - " 1,427.41 " " 2,617.50 " " 1,326.55 " " 1,561.08 " - 29812195 OPEN/PRQ PLCMT STENT VEIN ADDL 37239 481 "$3,490.00" " 1,289.90 " - " 5,377.99 " 143.45 " 1,469.00 " - " 1,469.00 " 145.95 " 1,928.23 " - " 2,303.40 " 139.71 129.89 " 2,310.03 " - - " 4,302.39 " " 5,377.99 " - - - " 2,792.00 " - 124.74 " 2,338.30 " - " 1,427.41 " " 2,617.50 " " 1,326.55 " " 1,561.08 " - 80329784 PLCMT STENT OPEN/PERC EACH ADD 37239 320 "$3,490.00" " 1,289.90 " - " 5,377.99 " 143.45 " 1,469.00 " - " 1,469.00 " 145.95 " 1,928.23 " - " 2,303.40 " 139.71 129.89 " 2,310.03 " - - " 4,302.39 " " 5,377.99 " - - - " 2,792.00 " - 124.74 " 2,338.30 " - " 1,427.41 " " 2,617.50 " " 1,326.55 " " 1,561.08 " - 29812209 VASC EMBOL/OCCLUSION VENOUS 37241 481 "$52,725.00" " 19,487.16 " 776.00 " 42,180.00 " 892.40 " 2,773.00 " " 10,476.71 " " 2,773.00 " 907.92 " 29,130.56 " " 10,277.15 " " 34,798.50 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 9,595.54 " " 11,994.42 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 67729790 VASC EMBOLIZE/OCCLUDE VENOUS 37241 350 "$52,725.00" " 19,487.16 " 776.00 " 42,180.00 " 892.40 " 2,773.00 " " 10,476.71 " " 2,773.00 " 907.92 " 29,130.56 " " 10,277.15 " " 34,798.50 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 9,595.54 " " 11,994.42 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 80329792 VASC EMBOLIZE/OCCLUDE VENOUS 37241 320 "$52,725.00" " 19,487.16 " 776.00 " 42,180.00 " 892.40 " 2,773.00 " " 10,476.71 " " 2,773.00 " 907.92 " 29,130.56 " " 10,277.15 " " 34,798.50 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 9,595.54 " " 11,994.42 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 80629796 VASC EMBOLIZE/OCCLUDE VENOUS 37241 350 "$52,725.00" " 19,487.16 " 776.00 " 42,180.00 " 892.40 " 2,773.00 " " 10,476.71 " " 2,773.00 " 907.92 " 29,130.56 " " 10,277.15 " " 34,798.50 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 9,595.54 " " 11,994.42 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 28170289 VASC EMBOL/OCCLUSION ARTERY 37242 360 "$52,725.00" " 19,487.16 " 776.00 " 42,180.00 " 892.40 " 2,773.00 " " 10,476.71 " " 2,773.00 " 907.92 " 29,130.56 " " 10,277.15 " " 34,798.50 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 16,123.81 " " 20,154.76 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 29812217 VASC EMBOL/OCCLUSION ARTERY 37242 481 "$52,725.00" " 19,487.16 " 776.00 " 42,180.00 " 892.40 " 2,773.00 " " 10,476.71 " " 2,773.00 " 907.92 " 29,130.56 " " 10,277.15 " " 34,798.50 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 16,123.81 " " 20,154.76 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 67729803 VASC EMBOLIZE/OCCLUDE ARTERY 37242 350 "$52,725.00" " 19,487.16 " 776.00 " 42,180.00 " 892.40 " 2,773.00 " " 10,476.71 " " 2,773.00 " 907.92 " 29,130.56 " " 10,277.15 " " 34,798.50 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 16,123.81 " " 20,154.76 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 80329806 VASC EMBOLIZE/OCCLUDE ARTERY 37242 320 "$52,725.00" " 19,487.16 " 776.00 " 42,180.00 " 892.40 " 2,773.00 " " 10,476.71 " " 2,773.00 " 907.92 " 29,130.56 " " 10,277.15 " " 34,798.50 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 16,123.81 " " 20,154.76 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 80629800 VASC EMBOLIZE/OCCLUDE ARTERY 37242 350 "$52,725.00" " 19,487.16 " 776.00 " 42,180.00 " 892.40 " 2,773.00 " " 10,476.71 " " 2,773.00 " 907.92 " 29,130.56 " " 10,277.15 " " 34,798.50 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 16,123.81 " " 20,154.76 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 67729811 VASC EMBOLIZE/OCCLUDE ORGAN 37243 350 "$52,725.00" " 19,487.16 " 776.00 " 42,180.00 " 892.40 " 2,773.00 " " 10,476.71 " " 2,773.00 " 907.92 " 29,130.56 " " 10,277.15 " " 34,798.50 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 11,004.21 " " 13,755.26 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 80329814 VASC EMBOLIZE/OCCLUDE ORGAN 37243 320 "$52,725.00" " 19,487.16 " 776.00 " 42,180.00 " 892.40 " 2,773.00 " " 10,476.71 " " 2,773.00 " 907.92 " 29,130.56 " " 10,277.15 " " 34,798.50 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 11,004.21 " " 13,755.26 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 80629818 VASC EMBOLIZE/OCCLUDE ORGAN 37243 350 "$52,725.00" " 19,487.16 " 776.00 " 42,180.00 " 892.40 " 2,773.00 " " 10,476.71 " " 2,773.00 " 907.92 " 29,130.56 " " 10,277.15 " " 34,798.50 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 11,004.21 " " 13,755.26 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 67729820 VASC EMBOLIZE/OCCLUDE BLEED 37244 350 "$52,725.00" " 19,487.16 " 776.00 " 42,180.00 " 892.40 " 2,773.00 " " 10,476.71 " " 2,773.00 " 907.92 " 29,130.56 " " 10,277.15 " " 34,798.50 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 14,290.36 " " 17,862.95 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 80329822 VASC EMBOLIZE/OCCLUDE BLEED 37244 320 "$52,725.00" " 19,487.16 " 776.00 " 42,180.00 " 892.40 " 2,773.00 " " 10,476.71 " " 2,773.00 " 907.92 " 29,130.56 " " 10,277.15 " " 34,798.50 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 14,290.36 " " 17,862.95 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 80629826 VASC EMBOLIZE/OCCLUDE BLEED 37244 350 "$52,725.00" " 19,487.16 " 776.00 " 42,180.00 " 892.40 " 2,773.00 " " 10,476.71 " " 2,773.00 " 907.92 " 29,130.56 " " 10,277.15 " " 34,798.50 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 14,290.36 " " 17,862.95 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 28170297 TRLUML BLLN ANGIO 1ST ART 37246 360 "$26,023.00" " 9,618.10 " 776.00 " 20,818.40 " 892.40 " 17,981.89 " " 5,169.57 " " 17,981.89 " 907.92 " 14,377.71 " " 5,071.10 " " 17,175.18 " 869.12 808.05 " 17,224.62 " " 4,431.06 " " 4,923.40 " " 11,528.16 " " 14,410.20 " " 5,046.49 " " 5,071.10 " " 4,923.40 " " 20,818.40 " " 4,504.91 " 776.00 " 17,435.41 " " 4,332.59 " " 10,643.41 " " 19,517.25 " " 9,891.34 " " 11,640.09 " " 5,095.72 " 29813060 TRLUML BLLN ANGIO 1ST ART 37246 481 "$26,023.00" " 9,618.10 " 776.00 " 20,818.40 " 892.40 " 17,981.89 " " 5,169.57 " " 17,981.89 " 907.92 " 14,377.71 " " 5,071.10 " " 17,175.18 " 869.12 808.05 " 17,224.62 " " 4,431.06 " " 4,923.40 " " 11,528.16 " " 14,410.20 " " 5,046.49 " " 5,071.10 " " 4,923.40 " " 20,818.40 " " 4,504.91 " 776.00 " 17,435.41 " " 4,332.59 " " 10,643.41 " " 19,517.25 " " 9,891.34 " " 11,640.09 " " 5,095.72 " 80335822 TRLUML BLLN ANGIO 1ST ART 37246 320 "$26,023.00" " 9,618.10 " 776.00 " 20,818.40 " 892.40 " 17,981.89 " " 5,169.57 " " 17,981.89 " 907.92 " 14,377.71 " " 5,071.10 " " 17,175.18 " 869.12 808.05 " 17,224.62 " " 4,431.06 " " 4,923.40 " " 11,528.16 " " 14,410.20 " " 5,046.49 " " 5,071.10 " " 4,923.40 " " 20,818.40 " " 4,504.91 " 776.00 " 17,435.41 " " 4,332.59 " " 10,643.41 " " 19,517.25 " " 9,891.34 " " 11,640.09 " " 5,095.72 " 29813078 TRLUML BLLN ANGIO ADD ART 37247 481 "$2,882.00" " 1,065.19 " - " 5,844.20 " 166.37 " 1,991.46 " - " 1,991.46 " 169.26 " 1,592.31 " - " 1,902.12 " 162.03 150.64 " 1,907.60 " - - " 4,675.36 " " 5,844.20 " - - - " 2,305.60 " - 144.67 " 1,930.94 " - " 1,178.74 " " 2,161.50 " " 1,095.45 " " 1,289.12 " - 80335831 TRLUML BLLN ANGIO ADD ART 37247 320 "$2,882.00" " 1,065.19 " - " 5,844.20 " 166.37 " 1,991.46 " - " 1,991.46 " 169.26 " 1,592.31 " - " 1,902.12 " 162.03 150.64 " 1,907.60 " - - " 4,675.36 " " 5,844.20 " - - - " 2,305.60 " - 144.67 " 1,930.94 " - " 1,178.74 " " 2,161.50 " " 1,095.45 " " 1,289.12 " - 29813086 TRLUML BLLN ANGIO 1ST VEIN 37248 481 "$26,023.00" " 9,618.10 " 776.00 " 20,818.40 " 892.40 " 17,981.89 " " 5,169.57 " " 17,981.89 " 907.92 " 14,377.71 " " 5,071.10 " " 17,175.18 " 869.12 808.05 " 17,224.62 " " 4,431.06 " " 4,923.40 " " 8,004.66 " " 10,005.83 " " 5,046.49 " " 5,071.10 " " 4,923.40 " " 20,818.40 " " 4,504.91 " 776.00 " 17,435.41 " " 4,332.59 " " 10,643.41 " " 19,517.25 " " 9,891.34 " " 11,640.09 " " 5,095.72 " 30612302 TRLUML BLLN ANGIO 1ST VEIN 37248 480 "$26,023.00" " 9,618.10 " 776.00 " 20,818.40 " 892.40 " 17,981.89 " " 5,169.57 " " 17,981.89 " 907.92 " 14,377.71 " " 5,071.10 " " 17,175.18 " 869.12 808.05 " 17,224.62 " " 4,431.06 " " 4,923.40 " " 8,004.66 " " 10,005.83 " " 5,046.49 " " 5,071.10 " " 4,923.40 " " 20,818.40 " " 4,504.91 " 776.00 " 17,435.41 " " 4,332.59 " " 10,643.41 " " 19,517.25 " " 9,891.34 " " 11,640.09 " " 5,095.72 " 80335849 TRLUML BLLN ANGIO 1ST VEIN 37248 320 "$26,023.00" " 9,618.10 " 776.00 " 20,818.40 " 892.40 " 17,981.89 " " 5,169.57 " " 17,981.89 " 907.92 " 14,377.71 " " 5,071.10 " " 17,175.18 " 869.12 808.05 " 17,224.62 " " 4,431.06 " " 4,923.40 " " 8,004.66 " " 10,005.83 " " 5,046.49 " " 5,071.10 " " 4,923.40 " " 20,818.40 " " 4,504.91 " 776.00 " 17,435.41 " " 4,332.59 " " 10,643.41 " " 19,517.25 " " 9,891.34 " " 11,640.09 " " 5,095.72 " 29813094 TRLUML BLLN ANGIO ADDL VEIN 37249 481 "$4,365.00" " 1,613.30 " - " 4,295.94 " 141.57 " 3,016.22 " - " 3,016.22 " 144.03 " 2,411.66 " - " 2,880.90 " 137.87 128.18 " 2,889.19 " - - " 3,436.75 " " 4,295.94 " - - - " 3,492.00 " - 123.10 " 2,924.55 " - " 1,785.29 " " 3,273.75 " " 1,659.14 " " 1,952.46 " - 80335857 TRLUML BLLN ANGIO ADD VEIN 37249 320 "$4,365.00" " 1,613.30 " - " 4,295.94 " 141.57 " 3,016.22 " - " 3,016.22 " 144.03 " 2,411.66 " - " 2,880.90 " 137.87 128.18 " 2,889.19 " - - " 3,436.75 " " 4,295.94 " - - - " 3,492.00 " - 123.10 " 2,924.55 " - " 1,785.29 " " 3,273.75 " " 1,659.14 " " 1,952.46 " - 28176392 IVUS OR NONCORONARY INIT VSL 37252 360 "$1,299.00" 480.11 - " 9,351.66 " - 897.61 - 897.61 - 717.70 - 857.34 - - 859.81 - - " 7,481.33 " " 9,351.66 " - - - " 1,039.20 " - - 870.33 - 531.29 974.25 493.75 581.04 - 29804478 IVUS OR NONCORONARY INIT VSL 37252 481 "$1,299.00" 480.11 - " 9,351.66 " - 897.61 - 897.61 - 717.70 - 857.34 - - 859.81 - - " 7,481.33 " " 9,351.66 " - - - " 1,039.20 " - - 870.33 - 531.29 974.25 493.75 581.04 - 29804486 IVUS OR NONCORONARY ADDL VSL 37253 481 "$1,299.00" 480.11 - " 1,478.37 " - 897.61 - 897.61 - 717.70 - 857.34 - - 859.81 - - " 1,182.70 " " 1,478.37 " - - - " 1,039.20 " - - 870.33 - 531.29 974.25 493.75 581.04 - 28170301 LIGATION OF A-V FISTULA 37607 360 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 2,773.00 " " 2,985.82 " " 2,773.00 " 907.92 " 8,300.76 " " 2,928.95 " " 3,545.00 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 4,937.34 " " 6,171.67 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80328516 LIGATION A-V FISTULA 37607 320 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 2,773.00 " " 2,985.82 " " 2,773.00 " 907.92 " 8,300.76 " " 2,928.95 " " 3,545.00 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 4,937.34 " " 6,171.67 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 28170319 TEMPORAL ARTERY PROCEDURE 37609 360 "$7,387.00" " 2,730.24 " 408.00 " 5,909.60 " 469.20 " 1,718.00 " " 1,467.55 " " 1,718.00 " 477.36 " 4,081.32 " " 1,439.60 " " 2,820.00 " 456.96 424.85 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 2,208.66 " " 2,760.83 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 408.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28170327 REVISION OF MAJOR VEIN 37660 360 "$19,256.00" " 7,117.02 " - " 15,404.80 " - " 13,305.90 " N/A " 13,305.90 " - " 10,638.94 " N/A " 12,708.96 " - N/A " 12,745.55 " - N/A " 6,660.58 " " 8,325.72 " N/A N/A N/A " 15,404.80 " N/A - " 12,901.52 " N/A " 7,875.70 " " 14,442.00 " " 7,319.21 " " 8,613.21 " N/A 28170335 REVISE LEG VEIN 37700 360 "$15,024.00" " 5,552.87 " 968.00 " 12,019.20 " " 1,113.20 " " 1,718.00 " " 2,985.82 " " 1,718.00 " " 1,132.56 " " 8,300.76 " " 2,928.95 " " 2,820.00 " " 1,084.16 " " 1,007.98 " " 9,944.39 " " 2,559.28 " " 2,843.64 " " 2,208.66 " " 2,760.83 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 968.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 28170343 LIGATE/STRIP LONG LEG VEIN 37722 360 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 2,773.00 " " 2,985.82 " " 2,773.00 " 907.92 " 8,300.76 " " 2,928.95 " " 3,545.00 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 2,708.70 " " 3,385.88 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 28170351 LIGATE LEG VEINS OPEN 37761 360 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 10,381.58 " " 2,985.82 " " 10,381.58 " 907.92 " 8,300.76 " " 2,928.95 " " 2,820.00 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 3,155.87 " " 3,944.84 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 28170360 STAB PHLEB VEINS XTR 10-20 37765 360 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 2,773.00 " " 2,985.82 " " 2,773.00 " 907.92 " 8,300.76 " " 2,928.95 " " 3,545.00 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 2,549.50 " " 3,186.88 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 28170378 LIGATE/DIVIDE/EXCISE VEIN 37785 360 "$15,024.00" " 5,552.87 " 868.00 " 12,019.20 " 998.20 " 2,773.00 " " 2,985.82 " " 2,773.00 " " 1,015.56 " " 8,300.76 " " 2,928.95 " " 3,545.00 " 972.16 903.85 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 2,532.97 " " 3,166.21 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 868.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 28175914 UNL PROCEDURE VASCULAR SURGERY 37799 360 "$2,844.00" " 1,051.14 " - " 2,275.20 " - " 1,718.00 " 563.79 " 1,718.00 " - " 1,571.31 " 553.05 " 1,877.04 " - - " 1,882.44 " 483.25 536.94 56.26 70.32 550.36 553.05 536.94 " 2,275.20 " 491.30 - " 1,905.48 " 472.51 " 1,163.20 " " 2,133.00 " " 1,081.00 " " 1,272.12 " 555.73 80338007 UNL PROCEDURE VASCULAR SURGERY 37799 320 "$2,844.00" " 1,051.14 " - " 2,275.20 " - " 1,718.00 " 563.79 " 1,718.00 " - " 1,571.31 " 553.05 " 1,877.04 " - - " 1,882.44 " 483.25 536.94 56.26 70.32 550.36 553.05 536.94 " 2,275.20 " 491.30 - " 1,905.48 " 472.51 " 1,163.20 " " 2,133.00 " " 1,081.00 " " 1,272.12 " 555.73 82935169 UNL SCLEROTHERAPY DIRECT 37799 320 "$2,844.00" " 1,051.14 " - " 2,275.20 " - " 1,718.00 " 563.79 " 1,718.00 " - " 1,571.31 " 553.05 " 1,877.04 " - - " 1,882.44 " 483.25 536.94 56.26 70.32 550.36 553.05 536.94 " 2,275.20 " 491.30 - " 1,905.48 " 472.51 " 1,163.20 " " 2,133.00 " " 1,081.00 " " 1,272.12 " 555.73 28170386 REMOVAL OF SPLEEN TOTAL 38100 360 "$11,192.00" " 4,136.56 " - " 8,953.60 " - " 7,733.67 " N/A " 7,733.67 " - " 6,183.58 " N/A " 7,386.72 " - N/A " 7,407.98 " - N/A " 4,614.94 " " 5,768.68 " N/A N/A N/A " 8,953.60 " N/A - " 7,498.64 " N/A " 4,577.53 " " 8,394.00 " " 4,254.08 " " 5,006.18 " N/A 28175353 SPLENECTOMY 38102 360 "$2,678.00" 989.79 - " 2,142.40 " - " 1,850.50 " N/A " 1,850.50 " - " 1,479.60 " N/A " 1,767.48 " - N/A " 1,772.57 " - N/A " 1,447.99 " " 1,809.99 " N/A N/A N/A " 2,142.40 " N/A - " 1,794.26 " N/A " 1,095.30 " " 2,008.50 " " 1,017.91 " " 1,197.87 " N/A 28175361 SPLENORRHAPHY 38115 360 "$21,190.00" " 7,831.82 " - " 16,952.00 " - " 14,642.29 " N/A " 14,642.29 " - " 11,707.48 " N/A " 13,985.40 " - N/A " 14,025.66 " - N/A " 5,008.72 " " 6,260.90 " N/A N/A N/A " 16,952.00 " N/A - " 14,197.30 " N/A " 8,666.71 " " 15,892.50 " " 8,054.32 " " 9,478.29 " N/A 80335881 INJ SPLEEN XR 38200 320 $458.00 169.28 - " 1,469.00 " 84.53 " 1,469.00 " - " 1,469.00 " 86.00 253.05 - 302.28 82.32 76.54 303.15 - - 765.85 957.31 - - - 366.40 - 73.50 306.86 - 187.32 343.50 174.09 204.86 - 67729706 ASP BONE MARROW 38220 350 "$7,387.00" " 2,730.24 " 54.68 " 5,909.60 " 62.88 " 1,469.00 " " 1,467.55 " " 1,469.00 " 63.98 " 4,081.32 " " 1,439.60 " " 1,775.00 " 61.24 56.94 " 4,889.46 " " 1,257.90 " " 1,397.67 " 967.02 " 1,208.77 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 54.68 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 80329709 ASP BONE MARROW 38220 320 "$7,387.00" " 2,730.24 " 54.68 " 5,909.60 " 62.88 " 1,469.00 " " 1,467.55 " " 1,469.00 " 63.98 " 4,081.32 " " 1,439.60 " " 1,775.00 " 61.24 56.94 " 4,889.46 " " 1,257.90 " " 1,397.67 " 967.02 " 1,208.77 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 54.68 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 80629702 ASP BONE MARROW 38220 350 "$7,387.00" " 2,730.24 " 54.68 " 5,909.60 " 62.88 " 1,469.00 " " 1,467.55 " " 1,469.00 " 63.98 " 4,081.32 " " 1,439.60 " " 1,775.00 " 61.24 56.94 " 4,889.46 " " 1,257.90 " " 1,397.67 " 967.02 " 1,208.77 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 54.68 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 67728688 BX BONE MARROW 38221 350 "$7,387.00" " 2,730.24 " 69.82 " 5,909.60 " 80.29 " 1,469.00 " " 1,467.55 " " 1,469.00 " 81.69 " 4,081.32 " " 1,439.60 " " 1,775.00 " 78.20 72.70 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,071.54 " " 1,339.42 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 69.82 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 80328681 BX BONE MARROW 38221 320 "$7,387.00" " 2,730.24 " 69.82 " 5,909.60 " 80.29 " 1,469.00 " " 1,467.55 " " 1,469.00 " 81.69 " 4,081.32 " " 1,439.60 " " 1,775.00 " 78.20 72.70 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,071.54 " " 1,339.42 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 69.82 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 80628684 BX BONE MARROW 38221 350 "$7,387.00" " 2,730.24 " 69.82 " 5,909.60 " 80.29 " 1,469.00 " " 1,467.55 " " 1,469.00 " 81.69 " 4,081.32 " " 1,439.60 " " 1,775.00 " 78.20 72.70 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,071.54 " " 1,339.42 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 69.82 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 80336322 BONE MARROW ASPIRATION BX 38222 320 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 8,598.11 " " 2,473.07 " " 8,598.11 " 907.92 " 6,874.76 " " 2,425.96 " " 1,775.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " 935.18 " 1,168.97 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 80636326 BONE MARROW ASPIRATION BX 38222 350 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 8,598.11 " " 2,473.07 " " 8,598.11 " 907.92 " 6,874.76 " " 2,425.96 " " 1,775.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " 935.18 " 1,168.97 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28175370 DRAIN LYMPH NODE ABSCESS EXT 38305 360 "$12,443.00" " 4,598.93 " 776.00 " 9,954.40 " 892.40 " 1,718.00 " " 2,473.07 " " 1,718.00 " 907.92 " 6,874.76 " " 2,425.96 " " 2,820.00 " 869.12 808.05 " 8,236.02 " " 2,119.77 " " 2,355.30 " " 2,208.66 " " 2,760.83 " " 2,414.18 " " 2,425.96 " " 2,355.30 " " 9,954.40 " " 2,155.10 " 776.00 " 8,336.81 " " 2,072.66 " " 5,089.19 " " 9,332.25 " " 4,729.58 " " 5,565.75 " " 2,437.74 " 28170394 BIOPSY LYMPH NODE SUPERFICIAL 38500 360 "$16,578.00" " 6,127.23 " 656.00 " 13,262.40 " 754.40 " 1,718.00 " " 3,293.60 " " 1,718.00 " 767.52 " 9,159.35 " " 3,230.86 " " 2,820.00 " 734.72 683.09 " 10,972.98 " " 2,823.08 " " 3,136.76 " " 2,208.66 " " 2,760.83 " " 3,215.18 " " 3,230.86 " " 3,136.76 " " 13,262.40 " " 2,870.14 " 656.00 " 11,107.26 " " 2,760.35 " " 6,780.40 " " 12,433.50 " " 6,301.30 " " 7,415.34 " " 3,246.55 " 67727509 BX NEEDLE LYMPH NODES 38505 350 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,469.00 " " 1,467.55 " " 1,469.00 " 907.92 " 4,081.32 " " 1,439.60 " " 1,775.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 80327501 BX NEEDLE LYMPH NODES 38505 320 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,469.00 " " 1,467.55 " " 1,469.00 " 907.92 " 4,081.32 " " 1,439.60 " " 1,775.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 80527501 BX NEEDLE LYMPH NODES 38505 402 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,469.00 " " 1,467.55 " " 1,469.00 " 907.92 " 4,081.32 " " 1,439.60 " " 1,775.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 80627505 BX NEEDLE LYMPH NODES 38505 350 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,469.00 " " 1,467.55 " " 1,469.00 " 907.92 " 4,081.32 " " 1,439.60 " " 1,775.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 83027509 BX NEEDLE LYMPH NODES 38505 402 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,469.00 " " 1,467.55 " " 1,469.00 " 907.92 " 4,081.32 " " 1,439.60 " " 1,775.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28170408 BIOPSY DEEP CERVICAL NODE 38510 360 "$16,578.00" " 6,127.23 " 743.00 " 13,262.40 " 854.45 " 1,718.00 " " 3,293.60 " " 1,718.00 " 869.31 " 9,159.35 " " 3,230.86 " " 2,820.00 " 832.16 773.69 " 10,972.98 " " 2,823.08 " " 3,136.76 " " 2,208.66 " " 2,760.83 " " 3,215.18 " " 3,230.86 " " 3,136.76 " " 13,262.40 " " 2,870.14 " 743.00 " 11,107.26 " " 2,760.35 " " 6,780.40 " " 12,433.50 " " 6,301.30 " " 7,415.34 " " 3,246.55 " 28170416 BIOPSY DEEP AXILLARY NODE(S) 38525 360 "$16,578.00" " 6,127.23 " 776.00 " 13,262.40 " 892.40 " 1,718.00 " " 3,293.60 " " 1,718.00 " 907.92 " 9,159.35 " " 3,230.86 " " 2,820.00 " 869.12 808.05 " 10,972.98 " " 2,823.08 " " 3,136.76 " " 2,208.66 " " 2,760.83 " " 3,215.18 " " 3,230.86 " " 3,136.76 " " 13,262.40 " " 2,870.14 " 776.00 " 11,107.26 " " 2,760.35 " " 6,780.40 " " 12,433.50 " " 6,301.30 " " 7,415.34 " " 3,246.55 " 28170424 OPEN BX/EXC INGUINOFEM NODES 38531 360 "$16,578.00" " 6,127.23 " 776.00 " 13,262.40 " 892.40 " 11,455.40 " " 3,293.60 " " 11,455.40 " 907.92 " 9,159.35 " " 3,230.86 " " 10,941.48 " 869.12 808.05 " 10,972.98 " " 2,823.08 " " 3,136.76 " " 2,503.21 " " 3,129.01 " " 3,215.18 " " 3,230.86 " " 3,136.76 " " 13,262.40 " " 2,870.14 " 776.00 " 11,107.26 " " 2,760.35 " " 6,780.40 " " 12,433.50 " " 6,301.30 " " 7,415.34 " " 3,246.55 " 28170432 LAPAROSCOPY LYMPHADENECTOMY 38571 360 "$46,765.00" " 17,284.34 " 776.00 " 37,412.00 " 892.40 " 4,656.00 " " 9,289.96 " " 4,656.00 " 907.92 " 25,837.66 " " 9,113.01 " " 6,576.00 " 869.12 808.05 " 30,953.75 " " 7,962.82 " " 8,847.58 " " 7,133.34 " " 8,916.67 " " 9,068.77 " " 9,113.01 " " 8,847.58 " " 37,412.00 " " 8,095.54 " 776.00 " 31,332.55 " " 7,785.87 " " 19,126.89 " " 35,073.75 " " 17,775.38 " " 20,917.98 " " 9,157.25 " 28170441 REMOVAL OF LYMPH NODES NECK 38724 360 "$9,062.00" " 3,349.32 " - " 7,249.60 " - " 3,326.00 " N/A " 3,326.00 " - " 5,006.76 " N/A " 5,980.92 " - N/A " 5,998.14 " - N/A " 5,240.26 " " 6,550.33 " N/A N/A N/A " 7,249.60 " N/A - " 6,071.54 " N/A " 3,706.36 " " 6,796.50 " " 3,444.47 " " 4,053.43 " N/A 28170459 REMOVE GROIN LYMPH NODES 38760 360 "$29,053.00" " 10,737.99 " 855.00 " 23,242.40 " 983.25 " 1,718.00 " " 5,772.33 " " 1,718.00 " " 1,000.35 " " 16,051.78 " " 5,662.38 " " 2,820.00 " 957.60 890.31 " 19,230.18 " " 4,947.71 " " 5,497.46 " " 2,208.66 " " 2,760.83 " " 5,634.90 " " 5,662.38 " " 5,497.46 " " 23,242.40 " " 5,030.18 " 855.00 " 19,465.51 " " 4,837.76 " " 11,882.68 " " 21,789.75 " " 11,043.05 " " 12,995.41 " " 5,689.87 " 28170467 REMOVE PELVIS LYMPH NODES 38770 360 "$14,931.00" " 5,518.50 " - " 11,944.80 " - " 10,317.32 " N/A " 10,317.32 " - " 8,249.38 " N/A " 9,854.46 " - N/A " 9,882.83 " - N/A " 4,179.42 " " 5,224.28 " N/A N/A N/A " 11,944.80 " N/A - " 10,003.77 " N/A " 6,106.78 " " 11,198.25 " " 5,675.27 " " 6,678.64 " N/A 28175922 INJ RA TRACER ID SENTINL NODE 38792 360 "$1,980.00" 731.81 - " 1,775.00 " - " 1,368.18 " 393.18 " 1,368.18 " - " 1,093.95 " 385.69 " 1,775.00 " - - " 1,310.56 " 337.01 374.46 207.07 258.84 383.82 385.69 374.46 " 1,584.00 " 342.63 - " 1,326.60 " 329.52 809.82 " 1,485.00 " 752.60 885.65 387.57 80225695 INJ RA TRACER ID SENTINL NODE 38792 340 "$1,980.00" 731.81 - " 1,775.00 " - " 1,368.18 " 393.18 " 1,368.18 " - " 1,093.95 " 385.69 " 1,775.00 " - - " 1,310.56 " 337.01 374.46 207.07 258.84 383.82 385.69 374.46 " 1,584.00 " 342.63 - " 1,326.60 " 329.52 809.82 " 1,485.00 " 752.60 885.65 387.57 80329326 CANNULATION THORACIC DUCT 38794 320 "$4,557.00" " 1,684.27 " - " 3,645.60 " - " 3,148.89 " - " 3,148.89 " - " 2,517.74 " - " 3,007.62 " - - " 3,016.28 " - - " 1,673.57 " " 2,091.96 " - - - " 3,645.60 " - - " 3,053.19 " - " 1,863.81 " " 3,417.75 " " 1,732.12 " " 2,038.35 " - 28170475 IO MAP OF SENT LYMPH NODE 38900 360 "$3,485.00" " 1,288.06 " - " 2,788.00 " - " 1,469.00 " - " 1,469.00 " - " 1,925.46 " - " 2,300.10 " - - " 2,306.72 " - - 774.29 967.86 - - - " 2,788.00 " - - " 2,334.95 " - " 1,425.37 " " 2,613.75 " " 1,324.65 " " 1,558.84 " - 80309970 UNL HEMIC OR LYMPHATIC 38999 320 "$2,085.00" 770.62 - " 1,668.00 " - " 1,469.00 " 413.99 " 1,469.00 " - " 1,151.96 " 406.11 " 1,376.10 " - - " 1,380.06 " 354.85 394.28 56.26 70.32 404.14 406.11 394.28 " 1,668.00 " 360.77 - " 1,396.95 " 346.97 852.77 " 1,563.75 " 792.51 932.62 408.08 80609973 UNL HEMIC OR LYMPHATIC 38999 350 "$2,085.00" 770.62 - " 1,668.00 " - " 1,469.00 " 413.99 " 1,469.00 " - " 1,151.96 " 406.11 " 1,376.10 " - - " 1,380.06 " 354.85 394.28 56.26 70.32 404.14 406.11 394.28 " 1,668.00 " 360.77 - " 1,396.95 " 346.97 852.77 " 1,563.75 " 792.51 932.62 408.08 28170483 RESECT MEDIASTINAL TUMOR 39220 360 "$4,383.00" " 1,619.96 " - " 7,430.22 " - " 3,028.65 " N/A " 3,028.65 " - " 2,421.61 " N/A " 2,892.78 " - N/A " 2,901.11 " - N/A " 5,944.18 " " 7,430.22 " N/A N/A N/A " 3,506.40 " N/A - " 2,936.61 " N/A " 1,792.65 " " 3,287.25 " " 1,665.98 " " 1,960.52 " N/A 28170491 REPAIR DIAPHRAGM LACERATION 39501 360 "$2,348.00" 867.82 - " 5,455.69 " - " 1,622.47 " N/A " 1,622.47 " - " 1,297.27 " N/A " 1,549.68 " - N/A " 1,554.14 " - N/A " 4,364.55 " " 5,455.69 " N/A N/A N/A " 1,878.40 " N/A - " 1,573.16 " N/A 960.33 " 1,761.00 " 892.47 " 1,050.26 " N/A 28170505 VERMILIONECTOMY LIP PEEL 40500 360 "$14,366.00" " 5,309.67 " 776.00 " 11,492.80 " 892.40 " 1,718.00 " " 2,853.42 " " 1,718.00 " 907.92 " 7,937.22 " " 2,799.07 " " 2,820.00 " 869.12 808.05 " 9,508.86 " " 2,445.79 " " 2,717.54 " " 2,208.66 " " 2,760.83 " " 2,785.48 " " 2,799.07 " " 2,717.54 " " 11,492.80 " " 2,486.55 " 776.00 " 9,625.22 " " 2,391.44 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,812.65 " 28170513 V-EXC LESION LIP PRIMARY CLOSR 40520 360 "$14,366.00" " 5,309.67 " 776.00 " 11,492.80 " 892.40 " 1,718.00 " " 2,853.42 " " 1,718.00 " 907.92 " 7,937.22 " " 2,799.07 " " 2,820.00 " 869.12 808.05 " 9,508.86 " " 2,445.79 " " 2,717.54 " " 2,208.66 " " 2,760.83 " " 2,785.48 " " 2,799.07 " " 2,717.54 " " 11,492.80 " " 2,486.55 " 776.00 " 9,625.22 " " 2,391.44 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,812.65 " 28170521 RECONSTRUCT LIP WITH FLAP 40525 360 "$14,366.00" " 5,309.67 " 776.00 " 11,492.80 " 892.40 " 1,718.00 " " 2,853.42 " " 1,718.00 " 907.92 " 7,937.22 " " 2,799.07 " " 2,820.00 " 869.12 808.05 " 9,508.86 " " 2,445.79 " " 2,717.54 " " 2,208.66 " " 2,760.83 " " 2,785.48 " " 2,799.07 " " 2,717.54 " " 11,492.80 " " 2,486.55 " 776.00 " 9,625.22 " " 2,391.44 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,812.65 " 37003719 RPR LIP FULL-THCK VERMILION 40650 450 "$2,375.00" 877.80 395.35 " 3,545.00 " 892.40 " 2,773.00 " 471.72 " 2,773.00 " 907.92 " 1,312.19 " 462.74 " 3,545.00 " 869.12 808.05 " 1,572.01 " 404.33 449.26 " 2,532.97 " " 3,166.21 " 460.49 462.74 449.26 " 1,900.00 " 411.07 776.00 " 1,591.25 " 395.35 971.38 " 1,781.25 " 902.74 " 1,062.34 " 464.98 37089281 DRAINAGE MOUTH LESION SMPL 40800 450 "$3,265.00" " 1,206.74 " 393.78 " 2,612.00 " 892.40 " 2,256.12 " 649.06 " 2,256.12 " 907.92 " 1,803.91 " 636.69 845.00 869.12 808.05 " 2,161.10 " 556.34 618.15 393.78 492.23 633.60 636.69 618.15 " 2,612.00 " 565.61 776.00 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 28170530 EXCISION OF MOUTH LESION 40810 360 "$14,366.00" " 5,309.67 " 618.80 " 11,492.80 " 892.40 " 1,469.00 " " 2,853.42 " " 1,469.00 " 907.92 " 7,937.22 " " 2,799.07 " " 9,481.56 " 869.12 808.05 " 9,508.86 " " 2,445.79 " " 2,717.54 " 618.80 773.50 " 2,785.48 " " 2,799.07 " " 2,717.54 " " 11,492.80 " " 2,486.55 " 776.00 " 9,625.22 " " 2,391.44 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,812.65 " 28176406 EXCISE LIP OR CHEEK FOLD 40819 360 "$7,102.00" " 2,624.90 " - " 5,681.60 " - " 1,469.00 " " 1,410.93 " " 1,469.00 " - " 3,923.86 " " 1,384.05 " " 1,775.00 " - - " 4,700.81 " " 1,209.37 " " 1,343.74 " " 1,649.49 " " 2,061.86 " " 1,377.33 " " 1,384.05 " " 1,343.74 " " 5,681.60 " " 1,229.52 " - " 4,758.34 " " 1,182.49 " " 2,904.72 " " 5,326.50 " " 2,699.47 " " 3,176.72 " " 1,390.77 " 37003310 RPR MOUTH LACERATION <=2.5 CM 40830 450 "$1,111.00" 410.63 184.94 888.80 566.95 767.70 220.67 767.70 576.81 613.83 216.46 845.00 552.16 513.36 735.37 189.14 210.16 393.78 492.23 215.41 216.46 210.16 888.80 192.30 493.00 744.37 184.94 454.40 833.25 422.29 496.95 217.52 37004014 RPR MOUTH LACERATION >2.5 CM 40831 450 "$2,375.00" 877.80 395.35 " 2,061.86 " 892.40 " 1,469.00 " 471.72 " 1,469.00 " 907.92 " 1,312.19 " 462.74 " 1,775.00 " 869.12 808.05 " 1,572.01 " 404.33 449.26 " 1,649.49 " " 2,061.86 " 460.49 462.74 449.26 " 1,900.00 " 411.07 776.00 " 1,591.25 " 395.35 971.38 " 1,781.25 " 902.74 " 1,062.34 " 464.98 28170548 EXCISION OF TONGUE FOLD 41115 360 "$7,102.00" " 2,624.90 " 776.00 " 5,681.60 " 892.40 " 1,469.00 " " 1,410.93 " " 1,469.00 " 907.92 " 3,923.86 " " 1,384.05 " " 1,775.00 " 869.12 808.05 " 4,700.81 " " 1,209.37 " " 1,343.74 " " 1,649.49 " " 2,061.86 " " 1,377.33 " " 1,384.05 " " 1,343.74 " " 5,681.60 " " 1,229.52 " 776.00 " 4,758.34 " " 1,182.49 " " 2,904.72 " " 5,326.50 " " 2,699.47 " " 3,176.72 " " 1,390.77 " 28170556 GLOSSECTOMY PARTIAL 41120 360 "$26,702.00" " 9,869.06 " 776.00 " 21,361.60 " 892.40 " 3,604.00 " " 5,304.76 " " 3,604.00 " 907.92 " 14,752.86 " " 5,203.71 " " 4,445.00 " 869.12 808.05 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 3,730.57 " " 4,663.21 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 776.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28170564 GLOSSECTOMY HEMIGLOSSECTOMY 41130 360 "$3,434.00" " 1,269.21 " - " 7,126.38 " - " 2,372.89 " N/A " 2,372.89 " - " 1,897.29 " N/A " 2,266.44 " - N/A " 2,272.96 " - N/A " 5,701.10 " " 7,126.38 " N/A N/A N/A " 2,747.20 " N/A - " 2,300.78 " N/A " 1,404.51 " " 2,575.50 " " 1,305.26 " " 1,536.03 " N/A 37090271 RPR TONGUE LACERATION <=2.5 CM 41250 450 "$1,419.00" 524.46 237.25 " 2,820.00 " 566.95 " 1,718.00 " 283.08 " 1,718.00 " 576.81 784.00 277.69 " 2,820.00 " 552.16 513.36 939.24 242.64 269.60 " 2,208.66 " " 2,760.83 " 276.34 277.69 269.60 " 1,135.20 " 246.68 493.00 950.73 237.25 580.37 " 1,064.25 " 539.36 634.72 279.04 37090280 DRAINAGE GUM LESION 41800 450 $588.00 217.32 98.57 " 2,061.86 " 711.85 " 1,469.00 " 117.61 " 1,469.00 " 724.23 324.87 115.37 " 1,775.00 " 693.28 644.56 389.20 100.81 112.01 " 1,649.49 " " 2,061.86 " 114.81 115.37 112.01 470.40 102.49 619.00 393.96 98.57 240.49 441.00 223.50 263.01 115.93 28170572 DENTAL SURGERY PROCEDURE 41899 360 "$1,111.00" 410.63 - " 1,469.00 " - " 1,469.00 " 220.67 " 1,469.00 " - 613.83 216.46 733.26 - - 735.37 189.14 210.16 56.26 70.32 215.41 216.46 210.16 888.80 192.30 - 744.37 184.94 454.40 833.25 422.29 496.95 217.52 28176414 REPAIR PALATE PHARYNX/UVULA 42145 360 "$26,702.00" " 9,869.06 " 776.00 " 21,361.60 " 892.40 " 3,604.00 " " 5,304.76 " " 3,604.00 " 907.92 " 14,752.86 " " 5,203.71 " " 4,445.00 " 869.12 808.05 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 3,730.57 " " 4,663.21 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 776.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28170581 REMOVAL OF SALIVARY STONE 42330 360 "$14,366.00" " 5,309.67 " 776.00 " 11,492.80 " 892.40 " 1,469.00 " " 2,853.42 " " 1,469.00 " 907.92 " 7,937.22 " " 2,799.07 " " 9,481.56 " 869.12 808.05 " 9,508.86 " " 2,445.79 " " 2,717.54 " " 2,532.97 " " 3,166.21 " " 2,785.48 " " 2,799.07 " " 2,717.54 " " 11,492.80 " " 2,486.55 " 776.00 " 9,625.22 " " 2,391.44 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,812.65 " 80328346 BX SALIVARY GLAND NEEDLE 42400 320 "$3,265.00" " 1,206.74 " 393.78 " 2,612.00 " 892.40 " 1,469.00 " 649.06 " 1,469.00 " 907.92 " 1,803.91 " 636.69 " 1,775.00 " 869.12 808.05 " 2,161.10 " 556.34 618.15 393.78 492.23 633.60 636.69 618.15 " 2,612.00 " 565.61 776.00 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 80528345 BX SALIVARY GLAND NEEDLE 42400 402 "$3,265.00" " 1,206.74 " 393.78 " 2,612.00 " 892.40 " 1,469.00 " 649.06 " 1,469.00 " 907.92 " 1,803.91 " 636.69 " 1,775.00 " 869.12 808.05 " 2,161.10 " 556.34 618.15 393.78 492.23 633.60 636.69 618.15 " 2,612.00 " 565.61 776.00 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 80628340 BX SALIVARY GLAND NEEDLE 42400 350 "$3,265.00" " 1,206.74 " 393.78 " 2,612.00 " 892.40 " 1,469.00 " 649.06 " 1,469.00 " 907.92 " 1,803.91 " 636.69 " 1,775.00 " 869.12 808.05 " 2,161.10 " 556.34 618.15 393.78 492.23 633.60 636.69 618.15 " 2,612.00 " 565.61 776.00 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 28175388 BIOPSY SALIVARY GLAND INCISION 42405 360 "$7,102.00" " 2,624.90 " 572.00 " 5,681.60 " 657.80 " 1,718.00 " " 1,410.93 " " 1,718.00 " 669.24 " 3,923.86 " " 1,384.05 " " 2,820.00 " 640.64 595.62 " 4,700.81 " " 1,209.37 " " 1,343.74 " " 2,208.66 " " 2,760.83 " " 1,377.33 " " 1,384.05 " " 1,343.74 " " 5,681.60 " " 1,229.52 " 572.00 " 4,758.34 " " 1,182.49 " " 2,904.72 " " 5,326.50 " " 2,699.47 " " 3,176.72 " " 1,390.77 " 28170599 EXCISION OF SALIVARY CYST 42408 360 "$14,366.00" " 5,309.67 " 776.00 " 11,492.80 " 892.40 " 2,773.00 " " 2,853.42 " " 2,773.00 " 907.92 " 7,937.22 " " 2,799.07 " " 3,545.00 " 869.12 808.05 " 9,508.86 " " 2,445.79 " " 2,717.54 " " 2,532.97 " " 3,166.21 " " 2,785.48 " " 2,799.07 " " 2,717.54 " " 11,492.80 " " 2,486.55 " 776.00 " 9,625.22 " " 2,391.44 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,812.65 " 28170602 EXC PAROTID TUMOR W NRV DISSEC 42415 360 "$26,702.00" " 9,869.06 " 776.00 " 21,361.60 " 892.40 " 4,435.00 " " 5,304.76 " " 4,435.00 " 907.92 " 14,752.86 " " 5,203.71 " " 6,540.00 " 869.12 808.05 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 4,937.34 " " 6,171.67 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 776.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28170611 EXC PAROT GLAND PRESERVE FCL N 42420 360 "$26,702.00" " 9,869.06 " 776.00 " 21,361.60 " 892.40 " 4,435.00 " " 5,304.76 " " 4,435.00 " 907.92 " 14,752.86 " " 5,203.71 " " 6,540.00 " 869.12 808.05 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 4,937.34 " " 6,171.67 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 776.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28170629 EXC PAROT GLAND W UNI NK DISS 42426 360 "$28,904.00" " 10,682.92 " - " 23,123.20 " - " 19,972.66 " N/A " 19,972.66 " - " 15,969.46 " N/A " 19,076.64 " - N/A " 19,131.56 " - N/A " 4,937.34 " " 6,171.67 " N/A N/A N/A " 23,123.20 " N/A - " 19,365.68 " N/A " 11,821.74 " " 21,678.00 " " 10,986.41 " " 12,928.76 " N/A 28170637 EXCISE SUBMAXILLARY GLAND 42440 360 "$26,702.00" " 9,869.06 " 695.00 " 21,361.60 " 799.25 " 2,773.00 " " 5,304.76 " " 2,773.00 " 813.15 " 14,752.86 " " 5,203.71 " " 3,545.00 " 778.40 723.70 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 2,532.97 " " 3,166.21 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 695.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28170645 EXCISE SUBLINGUAL GLAND 42450 360 "$26,702.00" " 9,869.06 " 776.00 " 21,361.60 " 892.40 " 1,718.00 " " 5,304.76 " " 1,718.00 " 907.92 " 14,752.86 " " 5,203.71 " " 2,820.00 " 869.12 808.05 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 2,208.66 " " 2,760.83 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 776.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28175396 REP SALIVARY DUCT SECOND COMPL 42505 360 "$26,702.00" " 9,869.06 " 776.00 " 21,361.60 " 892.40 " 3,326.00 " " 5,304.76 " " 3,326.00 " 907.92 " 14,752.86 " " 5,203.71 " " 4,860.00 " 869.12 808.05 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 3,120.10 " " 3,900.12 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 776.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 80101805 INJ SALIVARY XR 42550 320 "$1,514.00" 559.57 - " 1,469.00 " 892.40 " 1,469.00 " - " 1,469.00 " 907.92 836.49 - 999.24 869.12 808.05 " 1,002.12 " - - 281.27 351.59 - - - " 1,211.20 " - 776.00 " 1,014.38 " - 619.23 " 1,135.50 " 575.47 677.21 - 80128185 DILATION SALIVARY DUCT 42660 320 "$2,375.00" 877.80 35.00 " 1,900.00 " 40.25 " 1,469.00 " 471.72 " 1,469.00 " 40.95 " 1,312.19 " 462.74 845.00 39.20 36.45 " 1,572.01 " 404.33 449.26 393.78 492.23 460.49 462.74 449.26 " 1,900.00 " 411.07 35.00 " 1,591.25 " 395.35 971.38 " 1,781.25 " 902.74 " 1,062.34 " 464.98 37089567 I&D TONSIL ABSCESS 42700 450 "$1,111.00" 410.63 184.94 " 2,061.86 " 892.40 " 1,469.00 " 220.67 " 1,469.00 " 907.92 613.83 216.46 " 1,775.00 " 869.12 808.05 735.37 189.14 210.16 " 1,649.49 " " 2,061.86 " 215.41 216.46 210.16 888.80 192.30 776.00 744.37 184.94 454.40 833.25 422.29 496.95 217.52 28170653 BIOPSY OF THROAT 42800 360 "$7,102.00" " 2,624.90 " 393.78 " 5,681.60 " 892.40 " 1,469.00 " " 1,410.93 " " 1,469.00 " 907.92 " 3,923.86 " " 1,384.05 " " 4,687.32 " 869.12 808.05 " 4,700.81 " " 1,209.37 " " 1,343.74 " 393.78 492.23 " 1,377.33 " " 1,384.05 " " 1,343.74 " " 5,681.60 " " 1,229.52 " 776.00 " 4,758.34 " " 1,182.49 " " 2,904.72 " " 5,326.50 " " 2,699.47 " " 3,176.72 " " 1,390.77 " 28170661 BIOPSY OF UPPER NOSE/THROAT 42804 360 "$14,366.00" " 5,309.67 " 776.00 " 11,492.80 " 892.40 " 1,469.00 " " 2,853.42 " " 1,469.00 " 907.92 " 7,937.22 " " 2,799.07 " " 1,775.00 " 869.12 808.05 " 9,508.86 " " 2,445.79 " " 2,717.54 " " 1,649.49 " " 2,061.86 " " 2,785.48 " " 2,799.07 " " 2,717.54 " " 11,492.80 " " 2,486.55 " 776.00 " 9,625.22 " " 2,391.44 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,812.65 " 28170670 EXCISION OF NECK CYST 42815 360 "$26,702.00" " 9,869.06 " 776.00 " 21,361.60 " 892.40 " 3,604.00 " " 5,304.76 " " 3,604.00 " 907.92 " 14,752.86 " " 5,203.71 " " 4,445.00 " 869.12 808.05 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 3,730.57 " " 4,663.21 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 776.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28170688 TONSILLECTOMY ADENOID CHILD 42820 360 "$26,702.00" " 9,869.06 " 694.00 " 21,361.60 " 798.10 " 2,773.00 " " 5,304.76 " " 2,773.00 " 811.98 " 14,752.86 " " 5,203.71 " " 3,545.00 " 777.28 722.66 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 4,937.34 " " 6,171.67 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 694.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28170696 TONSILLECTOMY ADENOID ADULT 42821 360 "$14,366.00" " 5,309.67 " 700.00 " 11,492.80 " 805.00 " 3,604.00 " " 2,853.42 " " 3,604.00 " 819.00 " 7,937.22 " " 2,799.07 " " 4,445.00 " 784.00 728.91 " 9,508.86 " " 2,445.79 " " 2,717.54 " " 3,730.57 " " 4,663.21 " " 2,785.48 " " 2,799.07 " " 2,717.54 " " 11,492.80 " " 2,486.55 " 700.00 " 9,625.22 " " 2,391.44 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,812.65 " 28175400 TONSILLECTOMY PRI/SEC UND 12 42825 360 "$26,702.00" " 9,869.06 " 694.00 " 21,361.60 " 798.10 " 3,326.00 " " 5,304.76 " " 3,326.00 " 811.98 " 14,752.86 " " 5,203.71 " " 4,860.00 " 777.28 722.66 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 4,937.34 " " 6,171.67 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 694.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28170700 REMOVAL OF TONSILS 42826 360 "$14,366.00" " 5,309.67 " 700.00 " 11,492.80 " 805.00 " 3,326.00 " " 2,853.42 " " 3,326.00 " 819.00 " 7,937.22 " " 2,799.07 " " 4,860.00 " 784.00 728.91 " 9,508.86 " " 2,445.79 " " 2,717.54 " " 3,120.10 " " 3,900.12 " " 2,785.48 " " 2,799.07 " " 2,717.54 " " 11,492.80 " " 2,486.55 " 700.00 " 9,625.22 " " 2,391.44 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,812.65 " 28170718 ADENOIDECTOMY PRIMAR UNDER 12 42830 360 "$14,366.00" " 5,309.67 " 620.00 " 11,492.80 " 713.00 " 3,326.00 " " 2,853.42 " " 3,326.00 " 725.40 " 7,937.22 " " 2,799.07 " " 4,860.00 " 694.40 645.61 " 9,508.86 " " 2,445.79 " " 2,717.54 " " 3,730.57 " " 4,663.21 " " 2,785.48 " " 2,799.07 " " 2,717.54 " " 11,492.80 " " 2,486.55 " 620.00 " 9,625.22 " " 2,391.44 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,812.65 " 28170726 ADENOIDECTOMY PRIMAR OVER 12 42831 360 "$14,366.00" " 5,309.67 " 620.00 " 11,492.80 " 713.00 " 3,326.00 " " 2,853.42 " " 3,326.00 " 725.40 " 7,937.22 " " 2,799.07 " " 4,860.00 " 694.40 645.61 " 9,508.86 " " 2,445.79 " " 2,717.54 " " 3,120.10 " " 3,900.12 " " 2,785.48 " " 2,799.07 " " 2,717.54 " " 11,492.80 " " 2,486.55 " 620.00 " 9,625.22 " " 2,391.44 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,812.65 " 28170734 PARTIAL REMOVAL OF PHARYNX 42890 360 "$26,702.00" " 9,869.06 " 776.00 " 21,361.60 " 892.40 " 4,435.00 " " 5,304.76 " " 4,435.00 " 907.92 " 14,752.86 " " 5,203.71 " " 6,540.00 " 869.12 808.05 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 5,300.74 " " 6,625.92 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 776.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28170742 CONTROL OROPHARYNGEAL HEMORRH 42960 360 "$2,375.00" 877.80 395.35 " 2,061.86 " 892.40 " 1,469.00 " 471.72 " 1,469.00 " 907.92 " 1,312.19 " 462.74 " 1,775.00 " 869.12 808.05 " 1,572.01 " 404.33 449.26 " 1,649.49 " " 2,061.86 " 460.49 462.74 449.26 " 1,900.00 " 411.07 776.00 " 1,591.25 " 395.35 971.38 " 1,781.25 " 902.74 " 1,062.34 " 464.98 37089575 CONTROL OROPHARYNGEAL HEMORRH 42960 450 "$2,375.00" 877.80 395.35 " 2,061.86 " 892.40 " 1,469.00 " 471.72 " 1,469.00 " 907.92 " 1,312.19 " 462.74 " 1,775.00 " 869.12 808.05 " 1,572.01 " 404.33 449.26 " 1,649.49 " " 2,061.86 " 460.49 462.74 449.26 " 1,900.00 " 411.07 776.00 " 1,591.25 " 395.35 971.38 " 1,781.25 " 902.74 " 1,062.34 " 464.98 28170751 CONTROL THROAT BLEEDING 42962 360 "$14,366.00" " 5,309.67 " 776.00 " 11,492.80 " 892.40 " 1,718.00 " " 2,853.42 " " 1,718.00 " 907.92 " 7,937.22 " " 2,799.07 " " 2,820.00 " 869.12 808.05 " 9,508.86 " " 2,445.79 " " 2,717.54 " " 2,208.66 " " 2,760.83 " " 2,785.48 " " 2,799.07 " " 2,717.54 " " 11,492.80 " " 2,486.55 " 776.00 " 9,625.22 " " 2,391.44 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,812.65 " 28170769 ESOPHAGOSCOPY RIGID TRNSO 43180 360 "$26,702.00" " 9,869.06 " 776.00 " 21,361.60 " 892.40 " 1,718.00 " " 5,304.76 " " 1,718.00 " 907.92 " 14,752.86 " " 5,203.71 " " 6,576.00 " 869.12 808.05 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 1,152.94 " " 1,441.17 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 776.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28175418 ESOPHAGOSCO RIGID TRANSORAL DX 43191 360 "$8,531.00" " 3,153.06 " 282.96 " 6,824.80 " 892.40 " 1,469.00 " " 1,694.09 " " 1,469.00 " 907.92 " 4,713.38 " " 1,661.82 " " 3,545.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " 282.96 353.70 " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 28170777 ESOPHAGOSCP RIG TRNSO REM FB 43194 360 "$8,531.00" " 3,153.06 " 367.79 " 6,824.80 " 892.40 " 1,469.00 " " 1,694.09 " " 1,469.00 " 907.92 " 4,713.38 " " 1,661.82 " " 4,445.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " 367.79 459.74 " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 28170785 ESOPHAGOSCOPY DIAGNOSTIC 43200 360 "$4,250.00" " 1,570.80 " 707.33 " 3,400.00 " " 1,017.75 " " 1,469.00 " 843.97 " 1,469.00 " " 1,035.45 " " 2,348.13 " 827.89 " 1,775.00 " 991.20 921.55 " 2,813.08 " 723.40 803.78 " 1,649.49 " " 2,061.86 " 823.87 827.89 803.78 " 3,400.00 " 735.46 885.00 " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 34032009 ESOPHAGOSCOPY DIAGNOSTIC 43200 750 "$4,250.00" " 1,570.80 " 707.33 " 3,400.00 " " 1,017.75 " " 1,469.00 " 843.97 " 1,469.00 " " 1,035.45 " " 2,348.13 " 827.89 " 1,775.00 " 991.20 921.55 " 2,813.08 " 723.40 803.78 " 1,649.49 " " 2,061.86 " 823.87 827.89 803.78 " 3,400.00 " 735.46 885.00 " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 34132003 ESOPHAGOSCOPY DIAGNOSTIC 43200 750 "$4,250.00" " 1,570.80 " 707.33 " 3,400.00 " " 1,017.75 " " 1,469.00 " 843.97 " 1,469.00 " " 1,035.45 " " 2,348.13 " 827.89 " 1,775.00 " 991.20 921.55 " 2,813.08 " 723.40 803.78 " 1,649.49 " " 2,061.86 " 823.87 827.89 803.78 " 3,400.00 " 735.46 885.00 " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 34000905 ESOPH SCOPE W/SUBMUCOUS INJ 43201 750 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 1,469.00 " " 1,694.09 " " 1,469.00 " 907.92 " 4,713.38 " " 1,661.82 " " 1,775.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 1,774.04 " " 2,217.55 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34032025 ESOPH SCOPE FLEX BIOPSY 43202 750 "$8,531.00" " 3,153.06 " 406.00 " 6,824.80 " 466.90 " 1,469.00 " " 1,694.09 " " 1,469.00 " 475.02 " 4,713.38 " " 1,661.82 " " 1,775.00 " 454.72 422.77 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 1,649.49 " " 2,061.86 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 406.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34132020 ESOPH SCOPE FLEX BIOPSY 43202 750 "$8,531.00" " 3,153.06 " 406.00 " 6,824.80 " 466.90 " 1,469.00 " " 1,694.09 " " 1,469.00 " 475.02 " 4,713.38 " " 1,661.82 " " 1,775.00 " 454.72 422.77 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 1,649.49 " " 2,061.86 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 406.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34032041 ESOPH SCOPE W/SCLEROSIS INJ 43204 750 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 1,469.00 " " 1,694.09 " " 1,469.00 " 907.92 " 4,713.38 " " 1,661.82 " " 1,775.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 1,649.49 " " 2,061.86 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34053944 ESOPH SCOPE ENDOSCOPY/LIGATION 43205 750 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 1,469.00 " " 1,694.09 " " 1,469.00 " 907.92 " 4,713.38 " " 1,661.82 " " 1,775.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 1,649.49 " " 2,061.86 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34054908 ESOPH SCOPE OPTCL ENDOMCROSCPY 43206 750 "$8,531.00" " 3,153.06 " - " 6,824.80 " - " 1,469.00 " " 1,694.09 " " 1,469.00 " - " 4,713.38 " " 1,661.82 " " 4,445.00 " - - " 5,646.67 " " 1,452.08 " " 1,613.42 " 673.48 841.85 " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " - " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34154554 ESOPH SCOPE OPTCL ENDOMCROSCPY 43206 750 "$8,531.00" " 3,153.06 " - " 6,824.80 " - " 1,469.00 " " 1,694.09 " " 1,469.00 " - " 4,713.38 " " 1,661.82 " " 4,445.00 " - - " 5,646.67 " " 1,452.08 " " 1,613.42 " 673.48 841.85 " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " - " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34055017 ESOPH SCOPE MUCOSAL RESECT 43211 750 "$8,531.00" " 3,153.06 " 552.70 " 6,824.80 " 892.40 " 1,718.00 " " 1,694.09 " " 1,718.00 " 907.92 " 4,713.38 " " 1,661.82 " " 3,545.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " 552.70 690.87 " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34055025 ESOPH SCOPE STENT PLACEMENT 43212 750 "$26,400.00" " 9,757.44 " 776.00 " 21,120.00 " 892.40 " 1,718.00 " " 5,250.21 " " 1,718.00 " 907.92 " 14,586.00 " " 5,150.21 " " 6,576.00 " 869.12 808.05 " 17,474.16 " " 4,500.18 " " 5,000.20 " " 2,337.27 " " 2,921.59 " " 5,125.21 " " 5,150.21 " " 5,000.20 " " 21,120.00 " " 4,575.18 " 776.00 " 17,688.00 " " 4,400.18 " " 10,797.60 " " 19,800.00 " " 10,034.64 " " 11,808.72 " " 5,175.21 " 34055033 ESOPH SCOPE RETRO BALLOON 43213 750 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 1,718.00 " " 1,694.09 " " 1,718.00 " 907.92 " 4,713.38 " " 1,661.82 " " 4,445.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 2,208.66 " " 2,760.83 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34154589 ESOPH SCOPE RETRO BALLOON 43213 750 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 1,718.00 " " 1,694.09 " " 1,718.00 " 907.92 " 4,713.38 " " 1,661.82 " " 4,445.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 2,208.66 " " 2,760.83 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34055041 ESOPH SCOPE DILATE BALLOON 30< 43214 750 "$8,531.00" " 3,153.06 " 444.86 " 6,824.80 " 892.40 " 1,718.00 " " 1,694.09 " " 1,718.00 " 907.92 " 4,713.38 " " 1,661.82 " " 4,445.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " 444.86 556.07 " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34154597 ESOPH SCOPE DILATE BALLOON 30< 43214 750 "$8,531.00" " 3,153.06 " 444.86 " 6,824.80 " 892.40 " 1,718.00 " " 1,694.09 " " 1,718.00 " 907.92 " 4,713.38 " " 1,661.82 " " 4,445.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " 444.86 556.07 " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34032157 ESOPH SCOPE FLEX REMOVE FB 43215 750 "$8,531.00" " 3,153.06 " 451.00 " 6,824.80 " 518.65 " 1,469.00 " " 1,694.09 " " 1,469.00 " 527.67 " 4,713.38 " " 1,661.82 " " 1,775.00 " 505.12 469.63 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 1,649.49 " " 2,061.86 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 451.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34132151 ESOPH SCOPE FLEX REMOVE FB 43215 750 "$8,531.00" " 3,153.06 " 451.00 " 6,824.80 " 518.65 " 1,469.00 " " 1,694.09 " " 1,469.00 " 527.67 " 4,713.38 " " 1,661.82 " " 1,775.00 " 505.12 469.63 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 1,649.49 " " 2,061.86 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 451.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 28175426 ESOPHAGOSCOPY LESION REMOVAL 43216 360 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 1,469.00 " " 1,694.09 " " 1,469.00 " 907.92 " 4,713.38 " " 1,661.82 " " 1,775.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 1,649.49 " " 2,061.86 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34032173 ESOPH SCOPE SNARE LESN RMV 43217 750 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 1,469.00 " " 1,694.09 " " 1,469.00 " 907.92 " 4,713.38 " " 1,661.82 " " 1,775.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 1,649.49 " " 2,061.86 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34132178 ESOPH SCOPE SNARE LESN RMV 43217 750 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 1,469.00 " " 1,694.09 " " 1,469.00 " 907.92 " 4,713.38 " " 1,661.82 " " 1,775.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 1,649.49 " " 2,061.86 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34032203 ESOPH SCOPE BALLOON <30MM 43220 750 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 1,469.00 " " 1,694.09 " " 1,469.00 " 907.92 " 4,713.38 " " 1,661.82 " " 1,775.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 1,649.49 " " 2,061.86 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34132208 ESOPH SCOPE BALLOON <30MM 43220 750 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 1,469.00 " " 1,694.09 " " 1,469.00 " 907.92 " 4,713.38 " " 1,661.82 " " 1,775.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 1,649.49 " " 2,061.86 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34032262 ESOPH SCOPE ENDOSCOPY DILATION 43226 750 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 1,469.00 " " 1,694.09 " " 1,469.00 " 907.92 " 4,713.38 " " 1,661.82 " " 1,775.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 2,717.03 " " 3,396.29 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34132267 ESOPH SCOPE ENDOSCOPY DILATION 43226 750 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 1,469.00 " " 1,694.09 " " 1,469.00 " 907.92 " 4,713.38 " " 1,661.82 " " 1,775.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 2,717.03 " " 3,396.29 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34032271 ESOPH SCOPE CONTROL BLEED 43227 750 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 1,718.00 " " 1,694.09 " " 1,718.00 " 907.92 " 4,713.38 " " 1,661.82 " " 2,820.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 2,208.66 " " 2,760.83 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34055050 ESOPH SCOPE LESION ABLATE 43229 750 "$16,174.00" " 5,977.91 " 776.00 " 12,939.20 " 892.40 " 1,718.00 " " 3,202.61 " " 1,718.00 " 907.92 " 8,936.14 " " 3,141.60 " " 6,576.00 " 869.12 808.05 " 10,705.57 " " 2,745.09 " " 3,050.10 " " 2,208.66 " " 2,760.83 " " 3,126.35 " " 3,141.60 " " 3,050.10 " " 12,939.20 " " 2,790.84 " 776.00 " 10,836.58 " " 2,684.09 " " 6,615.17 " " 12,130.50 " " 6,147.74 " " 7,234.63 " " 3,156.85 " 34154601 ESOPH SCOPE LESION ABLATE 43229 750 "$16,174.00" " 5,977.91 " 776.00 " 12,939.20 " 892.40 " 1,718.00 " " 3,202.61 " " 1,718.00 " 907.92 " 8,936.14 " " 3,141.60 " " 6,576.00 " 869.12 808.05 " 10,705.57 " " 2,745.09 " " 3,050.10 " " 2,208.66 " " 2,760.83 " " 3,126.35 " " 3,141.60 " " 3,050.10 " " 12,939.20 " " 2,790.84 " 776.00 " 10,836.58 " " 2,684.09 " " 6,615.17 " " 12,130.50 " " 6,147.74 " " 7,234.63 " " 3,156.85 " 34000646 EGD ULTRASOUND EXAM 43231 750 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 1,718.00 " " 1,694.09 " " 1,718.00 " 907.92 " 4,713.38 " " 1,661.82 " " 2,820.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 2,376.02 " " 2,970.02 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34055068 UGI ENDO FLX ORAL W/DILA ESOPH 43233 750 "$8,531.00" " 3,153.06 " 528.12 " 6,824.80 " 892.40 " 1,718.00 " " 1,694.09 " " 1,718.00 " 907.92 " 4,713.38 " " 1,661.82 " " 4,445.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " 528.12 660.15 " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34154619 UGI ENDO FLX ORAL W/DILA ESOPH 43233 750 "$8,531.00" " 3,153.06 " 528.12 " 6,824.80 " 892.40 " 1,718.00 " " 1,694.09 " " 1,718.00 " 907.92 " 4,713.38 " " 1,661.82 " " 4,445.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " 528.12 660.15 " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 28170793 UGI ENDO DIAGNOSTIC COMPLEX 43235 360 "$4,250.00" " 1,570.80 " 286.00 " 3,400.00 " 328.90 " 1,469.00 " 843.97 " 1,469.00 " 334.62 " 2,348.13 " 827.89 " 1,775.00 " 320.32 297.81 " 2,813.08 " 723.40 803.78 " 1,649.49 " " 2,061.86 " 823.87 827.89 803.78 " 3,400.00 " 735.46 286.00 " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 34032351 UGI ENDO DIAGNOSTIC COMPLEX 43235 750 "$4,250.00" " 1,570.80 " 286.00 " 3,400.00 " 328.90 " 1,469.00 " 843.97 " 1,469.00 " 334.62 " 2,348.13 " 827.89 " 1,775.00 " 320.32 297.81 " 2,813.08 " 723.40 803.78 " 1,649.49 " " 2,061.86 " 823.87 827.89 803.78 " 3,400.00 " 735.46 286.00 " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 34132356 UGI ENDO DIAGNOSTIC COMPLEX 43235 750 "$4,250.00" " 1,570.80 " 286.00 " 3,400.00 " 328.90 " 1,469.00 " 843.97 " 1,469.00 " 334.62 " 2,348.13 " 827.89 " 1,775.00 " 320.32 297.81 " 2,813.08 " 723.40 803.78 " 1,649.49 " " 2,061.86 " 823.87 827.89 803.78 " 3,400.00 " 735.46 286.00 " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 34000913 UGI ENDO SCOPE W/SUBMUCOSL INJ 43236 750 "$4,250.00" " 1,570.80 " 707.33 " 3,400.00 " 892.40 " 1,718.00 " 843.97 " 1,718.00 " 907.92 " 2,348.13 " 827.89 " 2,820.00 " 869.12 808.05 " 2,813.08 " 723.40 803.78 " 2,376.02 " " 2,970.02 " 823.87 827.89 803.78 " 3,400.00 " 735.46 776.00 " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 34100918 UGI ENDO SCOPE W/SUBMUCOSL INJ 43236 750 "$4,250.00" " 1,570.80 " 707.33 " 3,400.00 " 892.40 " 1,718.00 " 843.97 " 1,718.00 " 907.92 " 2,348.13 " 827.89 " 2,820.00 " 869.12 808.05 " 2,813.08 " 723.40 803.78 " 2,376.02 " " 2,970.02 " 823.87 827.89 803.78 " 3,400.00 " 735.46 776.00 " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 34001031 UGI ENDO US EXAM ESOPHAGUS 43237 750 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 1,718.00 " " 1,694.09 " " 1,718.00 " 907.92 " 4,713.38 " " 1,661.82 " " 2,820.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 1,234.62 " " 1,543.27 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34001049 UGI ENDO TRNSND US FNA/BX ESOP 43238 750 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 1,718.00 " " 1,694.09 " " 1,718.00 " 907.92 " 4,713.38 " " 1,661.82 " " 2,820.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 1,528.60 " " 1,910.75 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34032394 UGI ENDO BIOPSY SGL/MULTI 43239 750 "$4,250.00" " 1,570.80 " 281.00 " 3,400.00 " 323.15 " 1,718.00 " 843.97 " 1,718.00 " 328.77 " 2,348.13 " 827.89 " 2,820.00 " 314.72 292.61 " 2,813.08 " 723.40 803.78 " 2,208.66 " " 2,760.83 " 823.87 827.89 803.78 " 3,400.00 " 735.46 281.00 " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 34132399 UGI ENDO BIOPSY SGL/MULTI 43239 750 "$4,250.00" " 1,570.80 " 281.00 " 3,400.00 " 323.15 " 1,718.00 " 843.97 " 1,718.00 " 328.77 " 2,348.13 " 827.89 " 2,820.00 " 314.72 292.61 " 2,813.08 " 723.40 803.78 " 2,208.66 " " 2,760.83 " 823.87 827.89 803.78 " 3,400.00 " 735.46 281.00 " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 34055009 UGI W/DRAIN OF CYST 43240 750 "$16,174.00" " 5,977.91 " 776.00 " 12,939.20 " 892.40 " 1,718.00 " " 5,250.21 " " 1,718.00 " 907.92 " 8,936.14 " " 5,150.21 " " 2,820.00 " 869.12 808.05 " 10,705.57 " " 4,500.18 " " 5,000.20 " " 2,376.02 " " 2,970.02 " " 5,125.21 " " 5,150.21 " " 5,000.20 " " 12,939.20 " " 4,575.18 " 776.00 " 10,836.58 " " 4,400.18 " " 6,615.17 " " 12,130.50 " " 6,147.74 " " 7,234.63 " " 5,175.21 " 34032416 UGI ENDO TUBE/CATH INSERTION 43241 750 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 1,718.00 " " 1,694.09 " " 1,718.00 " 907.92 " 4,713.38 " " 1,661.82 " " 2,820.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 2,208.66 " " 2,760.83 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34001014 UGI ENDO TRNSCND USG FNA/BX 43242 750 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 1,718.00 " " 1,694.09 " " 1,718.00 " 907.92 " 4,713.38 " " 1,661.82 " " 2,820.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 2,376.02 " " 2,970.02 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34032432 UGI ENDO INJ SCLEROSIS 43243 750 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 1,718.00 " " 1,694.09 " " 1,718.00 " 907.92 " 4,713.38 " " 1,661.82 " " 2,820.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 2,208.66 " " 2,760.83 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34053936 UGI ENDO BAND LIGATION VARICES 43244 750 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 1,718.00 " " 1,694.09 " " 1,718.00 " 907.92 " 4,713.38 " " 1,661.82 " " 2,820.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 2,208.66 " " 2,760.83 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34032459 UGI ENDO DILAT GASTRIC OUTLET 43245 750 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 1,718.00 " " 1,694.09 " " 1,718.00 " 907.92 " 4,713.38 " " 1,661.82 " " 2,820.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 2,208.66 " " 2,760.83 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34132453 UGI ENDO DILAT GASTRIC OUTLET 43245 750 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 1,718.00 " " 1,694.09 " " 1,718.00 " 907.92 " 4,713.38 " " 1,661.82 " " 2,820.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 2,208.66 " " 2,760.83 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 28170807 GASTROSTOMY TUBE PLACEMENT 43246 360 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 1,718.00 " " 1,694.09 " " 1,718.00 " 907.92 " 4,713.38 " " 1,661.82 " " 2,820.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 2,208.66 " " 2,760.83 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34032467 GASTROSTOMY TUBE PLACEMENT 43246 750 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 1,718.00 " " 1,694.09 " " 1,718.00 " 907.92 " 4,713.38 " " 1,661.82 " " 2,820.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 2,208.66 " " 2,760.83 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 28170815 UGI ENDO DILAT GASTRIC OUTLET 43247 360 "$4,250.00" " 1,570.80 " 451.00 " 3,400.00 " 518.65 " 1,718.00 " 843.97 " 1,718.00 " 527.67 " 2,348.13 " 827.89 " 2,820.00 " 505.12 469.63 " 2,813.08 " 723.40 803.78 " 2,208.66 " " 2,760.83 " 823.87 827.89 803.78 " 3,400.00 " 735.46 451.00 " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 34032475 UGI ENDO DILAT GASTRIC OUTLET 43247 750 "$4,250.00" " 1,570.80 " 451.00 " 3,400.00 " 518.65 " 1,718.00 " 843.97 " 1,718.00 " 527.67 " 2,348.13 " 827.89 " 2,820.00 " 505.12 469.63 " 2,813.08 " 723.40 803.78 " 2,208.66 " " 2,760.83 " 823.87 827.89 803.78 " 3,400.00 " 735.46 451.00 " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 34132470 UGI ENDO DILAT GASTRIC OUTLET 43247 750 "$4,250.00" " 1,570.80 " 451.00 " 3,400.00 " 518.65 " 1,718.00 " 843.97 " 1,718.00 " 527.67 " 2,348.13 " 827.89 " 2,820.00 " 505.12 469.63 " 2,813.08 " 723.40 803.78 " 2,208.66 " " 2,760.83 " 823.87 827.89 803.78 " 3,400.00 " 735.46 451.00 " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 34054312 UGI EGD W/BALLOON DILATE GW 43248 750 "$4,250.00" " 1,570.80 " 707.33 " 3,400.00 " 892.40 " 1,718.00 " 843.97 " 1,718.00 " 907.92 " 2,348.13 " 827.89 " 2,820.00 " 869.12 808.05 " 2,813.08 " 723.40 803.78 " 2,208.66 " " 2,760.83 " 823.87 827.89 803.78 " 3,400.00 " 735.46 776.00 " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 34053952 UGI ENDO BAL DIL ESOPH <30MM 43249 750 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 1,718.00 " " 1,694.09 " " 1,718.00 " 907.92 " 4,713.38 " " 1,661.82 " " 2,820.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 2,208.66 " " 2,760.83 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34153957 UGI ENDO BAL DIL ESOPH <30MM 43249 750 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 1,718.00 " " 1,694.09 " " 1,718.00 " 907.92 " 4,713.38 " " 1,661.82 " " 2,820.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 2,208.66 " " 2,760.83 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34053961 EGD W/REM BY HOT BX FORCEPS 43250 750 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 1,718.00 " " 1,694.09 " " 1,718.00 " 907.92 " 4,713.38 " " 1,661.82 " " 2,820.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 2,208.66 " " 2,760.83 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34032513 UGI END SNARE RMV TMR/PLYP/LSN 43251 750 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 1,718.00 " " 1,694.09 " " 1,718.00 " 907.92 " 4,713.38 " " 1,661.82 " " 2,820.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 2,208.66 " " 2,760.83 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34132518 UGI END SNARE RMV TMR/PLYP/LSN 43251 750 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 1,718.00 " " 1,694.09 " " 1,718.00 " 907.92 " 4,713.38 " " 1,661.82 " " 2,820.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 2,208.66 " " 2,760.83 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34054894 UGI ENDO W/OPTICAL SCOPE 43252 750 "$16,174.00" " 5,977.91 " - " 12,939.20 " - " 1,718.00 " " 3,202.61 " " 1,718.00 " - " 8,936.14 " " 3,141.60 " " 4,445.00 " - - " 10,705.57 " " 2,745.09 " " 3,050.10 " " 1,028.33 " " 1,285.41 " " 3,126.35 " " 3,141.60 " " 3,050.10 " " 12,939.20 " " 2,790.84 " - " 10,836.58 " " 2,684.09 " " 6,615.17 " " 12,130.50 " " 6,147.74 " " 7,234.63 " " 3,156.85 " 34154546 UGI ENDO W/OPTICAL SCOPE 43252 750 "$16,174.00" " 5,977.91 " - " 12,939.20 " - " 1,718.00 " " 3,202.61 " " 1,718.00 " - " 8,936.14 " " 3,141.60 " " 4,445.00 " - - " 10,705.57 " " 2,745.09 " " 3,050.10 " " 1,028.33 " " 1,285.41 " " 3,126.35 " " 3,141.60 " " 3,050.10 " " 12,939.20 " " 2,790.84 " - " 10,836.58 " " 2,684.09 " " 6,615.17 " " 12,130.50 " " 6,147.74 " " 7,234.63 " " 3,156.85 " 34055076 UGI ENDO FLX ORAL W/US INJ 43253 750 "$8,531.00" " 3,153.06 " 612.61 " 6,824.80 " 892.40 " 2,773.00 " " 1,694.09 " " 2,773.00 " 907.92 " 4,713.38 " " 1,661.82 " " 4,445.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " 612.61 765.76 " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34055084 UGI ENDO FLX ORAL W/MUC RES 43254 750 "$8,531.00" " 3,153.06 " 636.46 " 6,824.80 " 892.40 " 2,773.00 " " 1,694.09 " " 2,773.00 " 907.92 " 4,713.38 " " 1,661.82 " " 3,545.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " 636.46 795.58 " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34032556 UGI ENDO CONTROL BLEED 43255 750 "$8,531.00" " 3,153.06 " 356.00 " 6,824.80 " 409.40 " 1,718.00 " " 1,694.09 " " 1,718.00 " 416.52 " 4,713.38 " " 1,661.82 " " 2,820.00 " 398.72 370.70 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 2,208.66 " " 2,760.83 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 356.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34000875 UGI ENDO THERM ENERGY TX GERD 43257 750 "$16,174.00" " 5,977.91 " - " 12,939.20 " - " 2,773.00 " " 3,202.61 " " 2,773.00 " - " 8,936.14 " " 3,141.60 " " 3,545.00 " - - " 10,705.57 " " 2,745.09 " " 3,050.10 " " 1,664.01 " " 2,080.01 " " 3,126.35 " " 3,141.60 " " 3,050.10 " " 12,939.20 " " 2,790.84 " - " 10,836.58 " " 2,684.09 " " 6,615.17 " " 12,130.50 " " 6,147.74 " " 7,234.63 " " 3,156.85 " 28170823 UGI ENDO US DUODENUM/JEJUNUM 43259 360 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 2,773.00 " " 1,694.09 " " 2,773.00 " 907.92 " 4,713.38 " " 1,661.82 " " 3,545.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 2,532.97 " " 3,166.21 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34000603 UGI ENDO US DUODENUM/JEJUNUM 43259 750 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 2,773.00 " " 1,694.09 " " 2,773.00 " 907.92 " 4,713.38 " " 1,661.82 " " 3,545.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 2,532.97 " " 3,166.21 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 28170831 ERCP DX WO/W BIOPSY 43260 360 "$16,174.00" " 5,977.91 " 410.00 " 12,939.20 " 471.50 " 1,718.00 " " 3,202.61 " " 1,718.00 " 479.70 " 8,936.14 " " 3,141.60 " " 2,820.00 " 459.20 426.93 " 10,705.57 " " 2,745.09 " " 3,050.10 " " 2,208.66 " " 2,760.83 " " 3,126.35 " " 3,141.60 " " 3,050.10 " " 12,939.20 " " 2,790.84 " 410.00 " 10,836.58 " " 2,684.09 " " 6,615.17 " " 12,130.50 " " 6,147.74 " " 7,234.63 " " 3,156.85 " 34032602 ERCP DX WO/W BIOPSY 43260 750 "$16,174.00" " 5,977.91 " 410.00 " 12,939.20 " 471.50 " 1,718.00 " " 3,202.61 " " 1,718.00 " 479.70 " 8,936.14 " " 3,141.60 " " 2,820.00 " 459.20 426.93 " 10,705.57 " " 2,745.09 " " 3,050.10 " " 2,208.66 " " 2,760.83 " " 3,126.35 " " 3,141.60 " " 3,050.10 " " 12,939.20 " " 2,790.84 " 410.00 " 10,836.58 " " 2,684.09 " " 6,615.17 " " 12,130.50 " " 6,147.74 " " 7,234.63 " " 3,156.85 " 34054045 ERCP W/BIOPSY 43261 750 "$16,174.00" " 5,977.91 " 776.00 " 12,939.20 " 892.40 " 1,718.00 " " 3,202.61 " " 1,718.00 " 907.92 " 8,936.14 " " 3,141.60 " " 2,820.00 " 869.12 808.05 " 10,705.57 " " 2,745.09 " " 3,050.10 " " 2,208.66 " " 2,760.83 " " 3,126.35 " " 3,141.60 " " 3,050.10 " " 12,939.20 " " 2,790.84 " 776.00 " 10,836.58 " " 2,684.09 " " 6,615.17 " " 12,130.50 " " 6,147.74 " " 7,234.63 " " 3,156.85 " 34032629 ERCP SPHINCT/PAPILLOTOMY 43262 750 "$16,174.00" " 5,977.91 " 144.00 " 12,939.20 " 165.60 " 1,718.00 " " 3,202.61 " " 1,718.00 " 168.48 " 8,936.14 " " 3,141.60 " " 2,820.00 " 161.28 149.95 " 10,705.57 " " 2,745.09 " " 3,050.10 " " 2,208.66 " " 2,760.83 " " 3,126.35 " " 3,141.60 " " 3,050.10 " " 12,939.20 " " 2,790.84 " 144.00 " 10,836.58 " " 2,684.09 " " 6,615.17 " " 12,130.50 " " 6,147.74 " " 7,234.63 " " 3,156.85 " 28170840 ERCP RMV STONE BIL/PAN DUCT 43264 360 "$16,174.00" " 5,977.91 " 776.00 " 12,939.20 " 892.40 " 1,718.00 " " 3,202.61 " " 1,718.00 " 907.92 " 8,936.14 " " 3,141.60 " " 2,820.00 " 869.12 808.05 " 10,705.57 " " 2,745.09 " " 3,050.10 " " 2,208.66 " " 2,760.83 " " 3,126.35 " " 3,141.60 " " 3,050.10 " " 12,939.20 " " 2,790.84 " 776.00 " 10,836.58 " " 2,684.09 " " 6,615.17 " " 12,130.50 " " 6,147.74 " " 7,234.63 " " 3,156.85 " 34032645 ERCP RMV STONE BIL/PAN DUCT 43264 750 "$16,174.00" " 5,977.91 " 776.00 " 12,939.20 " 892.40 " 1,718.00 " " 3,202.61 " " 1,718.00 " 907.92 " 8,936.14 " " 3,141.60 " " 2,820.00 " 869.12 808.05 " 10,705.57 " " 2,745.09 " " 3,050.10 " " 2,208.66 " " 2,760.83 " " 3,126.35 " " 3,141.60 " " 3,050.10 " " 12,939.20 " " 2,790.84 " 776.00 " 10,836.58 " " 2,684.09 " " 6,615.17 " " 12,130.50 " " 6,147.74 " " 7,234.63 " " 3,156.85 " 34032653 ERCP DESTR LITHOTRIPSY STONE 43265 750 "$26,400.00" " 9,757.44 " 776.00 " 21,120.00 " 892.40 " 1,718.00 " " 5,250.21 " " 1,718.00 " 907.92 " 14,586.00 " " 5,150.21 " " 2,820.00 " 869.12 808.05 " 17,474.16 " " 4,500.18 " " 5,000.20 " " 2,208.66 " " 2,760.83 " " 5,125.21 " " 5,150.21 " " 5,000.20 " " 21,120.00 " " 4,575.18 " 776.00 " 17,688.00 " " 4,400.18 " " 10,797.60 " " 19,800.00 " " 10,034.64 " " 11,808.72 " " 5,175.21 " 34055092 UGI ENDO FLX ORAL W/STENT 43266 750 "$26,400.00" " 9,757.44 " 746.65 " 21,120.00 " 892.40 " 2,773.00 " " 5,250.21 " " 2,773.00 " 907.92 " 14,586.00 " " 5,150.21 " " 6,576.00 " 869.12 808.05 " 17,474.16 " " 4,500.18 " " 5,000.20 " 746.65 933.31 " 5,125.21 " " 5,150.21 " " 5,000.20 " " 21,120.00 " " 4,575.18 " 776.00 " 17,688.00 " " 4,400.18 " " 10,797.60 " " 19,800.00 " " 10,034.64 " " 11,808.72 " " 5,175.21 " 34055106 UGI ENDO FLX ORAL W/ABLATION 43270 750 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 2,773.00 " " 1,694.09 " " 2,773.00 " 907.92 " 4,713.38 " " 1,661.82 " " 4,445.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 2,532.97 " " 3,166.21 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34154651 UGI ENDO FLX ORAL W/ABLATION 43270 750 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 2,773.00 " " 1,694.09 " " 2,773.00 " 907.92 " 4,713.38 " " 1,661.82 " " 4,445.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 2,532.97 " " 3,166.21 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34054436 ENDO CAN PAP W/DRT VIS BLE DCT 43273 750 "$3,462.00" " 1,279.56 " - " 6,576.00 " - " 1,718.00 " - " 1,718.00 " - " 1,912.76 " - " 6,576.00 " - - " 2,291.50 " - - 692.26 865.33 - - - " 2,769.60 " - - " 2,319.54 " - " 1,415.96 " " 2,596.50 " " 1,315.91 " " 1,548.55 " - 28170858 ERCP W/STENT PLACEMENT 43274 360 "$26,400.00" " 9,757.44 " 776.00 " 21,120.00 " 892.40 " 2,773.00 " " 5,250.21 " " 2,773.00 " 907.92 " 14,586.00 " " 5,150.21 " " 6,576.00 " 869.12 808.05 " 17,474.16 " " 4,500.18 " " 5,000.20 " " 1,545.74 " " 1,932.18 " " 5,125.21 " " 5,150.21 " " 5,000.20 " " 21,120.00 " " 4,575.18 " 776.00 " 17,688.00 " " 4,400.18 " " 10,797.60 " " 19,800.00 " " 10,034.64 " " 11,808.72 " " 5,175.21 " 34055114 ERCP W/STENT PLACEMENT 43274 750 "$26,400.00" " 9,757.44 " 776.00 " 21,120.00 " 892.40 " 2,773.00 " " 5,250.21 " " 2,773.00 " 907.92 " 14,586.00 " " 5,150.21 " " 6,576.00 " 869.12 808.05 " 17,474.16 " " 4,500.18 " " 5,000.20 " " 1,545.74 " " 1,932.18 " " 5,125.21 " " 5,150.21 " " 5,000.20 " " 21,120.00 " " 4,575.18 " 776.00 " 17,688.00 " " 4,400.18 " " 10,797.60 " " 19,800.00 " " 10,034.64 " " 11,808.72 " " 5,175.21 " 34055122 ERCP W/FB REMOVAL 43275 750 "$16,174.00" " 5,977.91 " 776.00 " 12,939.20 " 892.40 " 2,773.00 " " 3,202.61 " " 2,773.00 " 907.92 " 8,936.14 " " 3,141.60 " " 6,576.00 " 869.12 808.05 " 10,705.57 " " 2,745.09 " " 3,050.10 " " 1,274.33 " " 1,592.91 " " 3,126.35 " " 3,141.60 " " 3,050.10 " " 12,939.20 " " 2,790.84 " 776.00 " 10,836.58 " " 2,684.09 " " 6,615.17 " " 12,130.50 " " 6,147.74 " " 7,234.63 " " 3,156.85 " 34055131 ERCP W/REMOV AND EXC STENT 43276 750 "$26,400.00" " 9,757.44 " 776.00 " 21,120.00 " 892.40 " 2,773.00 " " 5,250.21 " " 2,773.00 " 907.92 " 14,586.00 " " 5,150.21 " " 6,576.00 " 869.12 808.05 " 17,474.16 " " 4,500.18 " " 5,000.20 " " 1,608.08 " " 2,010.10 " " 5,125.21 " " 5,150.21 " " 5,000.20 " " 21,120.00 " " 4,575.18 " 776.00 " 17,688.00 " " 4,400.18 " " 10,797.60 " " 19,800.00 " " 10,034.64 " " 11,808.72 " " 5,175.21 " 34055149 ERCP W/BALLOON DILATION 43277 750 "$16,174.00" " 5,977.91 " 776.00 " 12,939.20 " 892.40 " 2,773.00 " " 3,202.61 " " 2,773.00 " 907.92 " 8,936.14 " " 3,141.60 " " 6,576.00 " 869.12 808.05 " 10,705.57 " " 2,745.09 " " 3,050.10 " 904.74 " 1,130.92 " " 3,126.35 " " 3,141.60 " " 3,050.10 " " 12,939.20 " " 2,790.84 " 776.00 " 10,836.58 " " 2,684.09 " " 6,615.17 " " 12,130.50 " " 6,147.74 " " 7,234.63 " " 3,156.85 " 34055203 ERCP LESION ABLATE W/DILATE 43278 750 "$16,174.00" " 5,977.91 " 776.00 " 12,939.20 " 892.40 " 2,773.00 " " 3,202.61 " " 2,773.00 " 907.92 " 8,936.14 " " 3,141.60 " " 6,576.00 " 869.12 808.05 " 10,705.57 " " 2,745.09 " " 3,050.10 " " 2,208.66 " " 2,760.83 " " 3,126.35 " " 3,141.60 " " 3,050.10 " " 12,939.20 " " 2,790.84 " 776.00 " 10,836.58 " " 2,684.09 " " 6,615.17 " " 12,130.50 " " 6,147.74 " " 7,234.63 " " 3,156.85 " 28170866 LAPAROSCOPY FUNDOPLASTY 43280 360 "$46,765.00" " 17,284.34 " 776.00 " 37,412.00 " 892.40 " 3,604.00 " " 9,289.96 " " 3,604.00 " 907.92 " 25,837.66 " " 9,113.01 " " 4,445.00 " 869.12 808.05 " 30,953.75 " " 7,962.82 " " 8,847.58 " " 5,477.43 " " 6,846.79 " " 9,068.77 " " 9,113.01 " " 8,847.58 " " 37,412.00 " " 8,095.54 " 776.00 " 31,332.55 " " 7,785.87 " " 19,126.89 " " 35,073.75 " " 17,775.38 " " 20,917.98 " " 9,157.25 " 28170874 LAP PARAESOPHAG HERN REPAIR 43281 360 "$46,765.00" " 17,284.34 " 776.00 " 37,412.00 " 892.40 " 32,314.62 " " 9,289.96 " " 32,314.62 " 907.92 " 25,837.66 " " 9,113.01 " " 30,864.90 " 869.12 808.05 " 30,953.75 " " 7,962.82 " " 8,847.58 " " 8,507.13 " " 10,633.91 " " 9,068.77 " " 9,113.01 " " 8,847.58 " " 37,412.00 " " 8,095.54 " 776.00 " 31,332.55 " " 7,785.87 " " 19,126.89 " " 35,073.75 " " 17,775.38 " " 20,917.98 " " 9,157.25 " 34053863 ENDO LIGATION ESOPH VARICES 43400 750 "$2,643.00" 976.85 - " 8,353.71 " - " 1,826.31 " N/A " 1,826.31 " - " 1,460.26 " N/A " 1,744.38 " - N/A " 1,749.40 " - N/A " 6,682.97 " " 8,353.71 " N/A N/A N/A " 2,114.40 " N/A - " 1,770.81 " N/A " 1,080.99 " " 1,982.25 " " 1,004.60 " " 1,182.21 " N/A 34054118 ESOPH DILATION-SOUND/BOUGIE 43450 750 "$4,250.00" " 1,570.80 " 325.00 " 3,400.00 " 373.75 " 1,469.00 " 843.97 " 1,469.00 " 380.25 " 2,348.13 " 827.89 " 1,775.00 " 364.00 338.42 " 2,813.08 " 723.40 803.78 " 1,649.49 " " 2,061.86 " 823.87 827.89 803.78 " 3,400.00 " 735.46 325.00 " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 34154350 ESOPH DILATION-SOUND/BOUGIE 43450 750 "$4,250.00" " 1,570.80 " 325.00 " 3,400.00 " 373.75 " 1,469.00 " 843.97 " 1,469.00 " 380.25 " 2,348.13 " 827.89 " 1,775.00 " 364.00 338.42 " 2,813.08 " 723.40 803.78 " 1,649.49 " " 2,061.86 " 823.87 827.89 803.78 " 3,400.00 " 735.46 325.00 " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 34053979 ESOPH DILATION W/GUIDEWIRE 43453 750 "$8,531.00" " 3,153.06 " 325.00 " 6,824.80 " 373.75 " 1,469.00 " " 1,694.09 " " 1,469.00 " 380.25 " 4,713.38 " " 1,661.82 " " 1,775.00 " 364.00 338.42 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 1,649.49 " " 2,061.86 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 325.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34001561 UNL PROC:ESOPHAGUS 43499 750 "$4,250.00" " 1,570.80 " - " 3,400.00 " - " 1,469.00 " 843.97 " 1,469.00 " - " 2,348.13 " 827.89 " 2,805.00 " - - " 2,813.08 " 723.40 803.78 56.26 70.32 823.87 827.89 803.78 " 3,400.00 " 735.46 - " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 28170882 REMOVAL OF STOMACH PARTIAL 43633 360 "$2,384.00" 881.13 - " 9,071.58 " - " 1,647.34 " N/A " 1,647.34 " - " 1,317.16 " N/A " 1,573.44 " - N/A " 1,577.97 " - N/A " 7,257.26 " " 9,071.58 " N/A N/A N/A " 1,907.20 " N/A - " 1,597.28 " N/A 975.06 " 1,788.00 " 906.16 " 1,066.36 " N/A 28170891 LAP GASTRIC BYPASS/ROUX-EN-Y 43644 360 "$10,250.00" " 3,788.40 " - " 10,825.03 " - " 7,082.75 " N/A " 7,082.75 " - " 5,663.13 " N/A " 6,765.00 " - N/A " 6,784.48 " - N/A " 8,660.02 " " 10,825.03 " N/A N/A N/A " 8,200.00 " N/A - " 6,867.50 " N/A " 4,192.25 " " 7,687.50 " " 3,896.03 " " 4,584.83 " N/A 28170904 LAPAROSCOPE PROC STOM 43659 360 "$26,567.00" " 9,819.16 " - " 21,253.60 " - " 2,773.00 " " 5,277.62 " " 2,773.00 " - " 14,678.27 " " 5,177.09 " " 17,534.22 " - - " 17,584.70 " " 4,523.67 " " 5,026.30 " " 4,937.34 " " 6,171.67 " " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " - " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 28170912 NASO/OROGAST W/TUBE PLACEMENT 43752 360 "$1,419.00" 524.46 - " 1,718.00 " - " 1,718.00 " 283.08 " 1,718.00 " - 784.00 277.69 845.00 - - 939.24 242.64 269.60 230.81 288.51 276.34 277.69 269.60 " 1,135.20 " 246.68 - 950.73 237.25 580.37 " 1,064.25 " 539.36 634.72 279.04 34054860 NASO/OROGAST W/TUBE PLACEMENT 43752 750 "$1,419.00" 524.46 - " 1,718.00 " - " 1,718.00 " 283.08 " 1,718.00 " - 784.00 277.69 845.00 - - 939.24 242.64 269.60 230.81 288.51 276.34 277.69 269.60 " 1,135.20 " 246.68 - 950.73 237.25 580.37 " 1,064.25 " 539.36 634.72 279.04 80326572 PLCMT NASAL/OROGASTRIC W/TUBE 43752 320 "$1,419.00" 524.46 - " 1,718.00 " - " 1,718.00 " 283.08 " 1,718.00 " - 784.00 277.69 845.00 - - 939.24 242.64 269.60 230.81 288.51 276.34 277.69 269.60 " 1,135.20 " 246.68 - 950.73 237.25 580.37 " 1,064.25 " 539.36 634.72 279.04 34054631 GASTRIC INTUBATN AND ASPIRATN 43753 750 "$1,388.00" 513.00 164.52 " 1,775.00 " 892.40 " 1,469.00 " 276.03 " 1,469.00 " 907.92 766.87 270.78 " 1,775.00 " 869.12 808.05 918.72 236.60 262.89 164.52 205.65 269.46 270.78 262.89 " 1,110.40 " 240.54 776.00 929.96 231.34 567.69 " 1,041.00 " 527.58 620.85 272.09 37089958 GASTRIC INTUBATN AND ASPIRATN 43753 450 "$1,388.00" 513.00 164.52 " 1,775.00 " 892.40 " 1,469.00 " 276.03 " 1,469.00 " 907.92 766.87 270.78 " 1,775.00 " 869.12 808.05 918.72 236.60 262.89 164.52 205.65 269.46 270.78 262.89 " 1,110.40 " 240.54 776.00 929.96 231.34 567.69 " 1,041.00 " 527.58 620.85 272.09 34054649 GASTRIC INTUB ASPDIAG/SGL 43754 750 "$1,388.00" 513.00 231.34 " 1,775.00 " 892.40 " 1,469.00 " 276.03 " 1,469.00 " 907.92 766.87 270.78 " 1,775.00 " 869.12 808.05 918.72 236.60 262.89 608.59 760.74 269.46 270.78 262.89 " 1,110.40 " 240.54 776.00 929.96 231.34 567.69 " 1,041.00 " 527.58 620.85 272.09 34054657 GASTRIC INTUB ASPDIAG/MULTI 43755 750 $733.00 270.92 122.05 " 1,775.00 " 892.40 " 1,469.00 " 145.62 " 1,469.00 " 907.92 404.98 142.85 " 1,775.00 " 869.12 808.05 485.17 124.82 138.69 932.22 " 1,165.27 " 142.16 142.85 138.69 586.40 126.90 776.00 491.11 122.05 299.80 549.75 278.61 327.87 143.54 34054665 DUOD INT ASPDIAGIMAG/SGL 43756 750 "$4,250.00" " 1,570.80 " 707.33 " 3,400.00 " 892.40 " 1,469.00 " 843.97 " 1,469.00 " 907.92 " 2,348.13 " 827.89 " 1,775.00 " 869.12 808.05 " 2,813.08 " 723.40 803.78 " 1,676.39 " " 2,095.49 " 823.87 827.89 803.78 " 3,400.00 " 735.46 776.00 " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 34054673 DUOD INT ASPDIAGIMAG/MULTI 43757 750 "$4,250.00" " 1,570.80 " 707.33 " 3,400.00 " 892.40 " 1,469.00 " 843.97 " 1,469.00 " 907.92 " 2,348.13 " 827.89 " 1,775.00 " 869.12 808.05 " 2,813.08 " 723.40 803.78 " 2,160.47 " " 2,700.59 " 823.87 827.89 803.78 " 3,400.00 " 735.46 776.00 " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 34054886 GASTROSTOMY TUBE REPOSITION 43761 750 "$1,397.00" 516.33 94.43 " 2,760.83 " 108.59 " 1,469.00 " 277.55 " 1,469.00 " 110.48 771.84 272.26 " 1,775.00 " 105.76 98.33 924.67 237.90 264.33 " 2,208.66 " " 2,760.83 " 270.94 272.26 264.33 " 1,117.60 " 241.86 94.43 935.99 232.61 571.37 " 1,047.75 " 531.00 624.88 273.58 80301642 REPOSITION GASTROSTOMY TUBE 43761 320 "$1,397.00" 516.33 94.43 " 2,760.83 " 108.59 " 1,469.00 " 277.55 " 1,469.00 " 110.48 771.84 272.26 " 1,775.00 " 105.76 98.33 924.67 237.90 264.33 " 2,208.66 " " 2,760.83 " 270.94 272.26 264.33 " 1,117.60 " 241.86 94.43 935.99 232.61 571.37 " 1,047.75 " 531.00 624.88 273.58 37004545 RPLC GTUBE NO REVISION G TRACT 43762 450 "$1,397.00" 516.33 31.10 " 1,775.00 " 35.77 965.33 277.55 965.33 36.39 771.84 272.26 " 1,775.00 " 34.83 32.38 924.67 237.90 264.33 " 1,209.30 " " 1,511.63 " 270.94 272.26 264.33 " 1,117.60 " 241.86 31.10 935.99 232.61 571.37 " 1,047.75 " 531.00 624.88 273.58 80336683 RPLC GTUBE NO REVISION G TRACT 43762 320 "$1,397.00" 516.33 31.10 " 1,775.00 " 35.77 965.33 277.55 965.33 36.39 771.84 272.26 " 1,775.00 " 34.83 32.38 924.67 237.90 264.33 " 1,209.30 " " 1,511.63 " 270.94 272.26 264.33 " 1,117.60 " 241.86 31.10 935.99 232.61 571.37 " 1,047.75 " 531.00 624.88 273.58 37004553 RPLC GTUBE W/REVISION G TRACT 43763 450 "$1,397.00" 516.33 232.61 " 2,250.39 " 892.40 965.33 277.55 965.33 907.92 771.84 272.26 " 1,775.00 " 869.12 808.05 924.67 237.90 264.33 " 1,800.31 " " 2,250.39 " 270.94 272.26 264.33 " 1,117.60 " 241.86 776.00 935.99 232.61 571.37 " 1,047.75 " 531.00 624.88 273.58 80336691 RPLC GTUBE W/REVISION G TRACT 43763 320 "$1,397.00" 516.33 232.61 " 2,250.39 " 892.40 965.33 277.55 965.33 907.92 771.84 272.26 " 1,775.00 " 869.12 808.05 924.67 237.90 264.33 " 1,800.31 " " 2,250.39 " 270.94 272.26 264.33 " 1,117.60 " 241.86 776.00 935.99 232.61 571.37 " 1,047.75 " 531.00 624.88 273.58 28170921 LAP RMVL GASTR ADJ ALL PARTS 43774 360 "$16,174.00" " 5,977.91 " - " 12,939.20 " - " 2,773.00 " " 3,202.61 " " 2,773.00 " - " 8,936.14 " " 3,141.60 " " 10,674.84 " - - " 10,705.57 " " 2,745.09 " " 3,050.10 " " 4,779.32 " " 5,974.15 " " 3,126.35 " " 3,141.60 " " 3,050.10 " " 12,939.20 " " 2,790.84 " - " 10,836.58 " " 2,684.09 " " 6,615.17 " " 12,130.50 " " 6,147.74 " " 7,234.63 " " 3,156.85 " 28170939 LAP SLEEVE GASTRECTOMY 43775 360 "$7,018.00" " 2,593.85 " - " 8,908.73 " - " 4,849.44 " N/A " 4,849.44 " - " 3,877.45 " N/A " 4,631.88 " - N/A " 4,645.21 " - N/A " 7,126.98 " " 8,908.73 " N/A N/A N/A " 5,614.40 " N/A - " 4,702.06 " N/A " 2,870.36 " " 5,263.50 " " 2,667.54 " " 3,139.15 " N/A 28170947 PLACE GASTROSTOMY TUBE 43830 360 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 5,894.92 " " 1,694.09 " " 5,894.92 " 907.92 " 4,713.38 " " 1,661.82 " " 5,630.46 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 4,081.82 " " 5,102.27 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34001553 UNL PROC:STOMACH 43999 750 "$4,250.00" " 1,570.80 " - " 3,400.00 " - " 1,469.00 " 843.97 " 1,469.00 " - " 2,348.13 " 827.89 " 2,805.00 " - - " 2,813.08 " 723.40 803.78 56.26 70.32 823.87 827.89 803.78 " 3,400.00 " 735.46 - " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 28170955 INCISION OF LARGE BOWEL 44025 360 "$3,308.00" " 1,222.64 " - " 5,654.06 " - " 3,686.00 " N/A " 3,686.00 " - " 1,827.67 " N/A " 2,183.28 " - N/A " 2,189.57 " - N/A " 4,523.25 " " 5,654.06 " N/A N/A N/A " 2,646.40 " N/A - " 2,216.36 " N/A " 1,352.97 " " 2,481.00 " " 1,257.37 " " 1,479.67 " N/A 28170963 REMOVAL OF SMALL INTESTINE 44120 360 "$10,091.00" " 3,729.63 " - " 8,072.80 " - " 6,972.88 " N/A " 6,972.88 " - " 5,575.28 " N/A " 6,660.06 " - N/A " 6,679.23 " - N/A " 5,374.77 " " 6,718.46 " N/A N/A N/A " 8,072.80 " N/A - " 6,760.97 " N/A " 4,127.22 " " 7,568.25 " " 3,835.59 " " 4,513.70 " N/A 28176775 MOBILIZATION OF COLON 44139 360 "$3,383.00" " 1,250.36 " - " 2,706.40 " - " 2,337.65 " N/A " 2,337.65 " - " 1,869.11 " N/A " 2,232.78 " - N/A " 2,239.21 " - N/A 671.96 839.95 N/A N/A N/A " 2,706.40 " N/A - " 2,266.61 " N/A " 1,383.65 " " 2,537.25 " " 1,285.88 " " 1,513.22 " N/A 28170971 COLECTOMY PART W ANASTOMOSIS 44140 360 "$10,112.00" " 3,737.40 " - " 8,270.80 " - " 6,987.39 " N/A " 6,987.39 " - " 5,586.88 " N/A " 6,673.92 " - N/A " 6,693.13 " - N/A " 6,616.64 " " 8,270.80 " N/A N/A N/A " 8,089.60 " N/A - " 6,775.04 " N/A " 4,135.81 " " 7,584.00 " " 3,843.57 " " 4,523.10 " N/A 28170980 COLECTOMY PARTIAL W COLOSTOMY 44141 360 "$13,478.00" " 4,981.47 " - " 10,782.40 " - " 9,313.30 " N/A " 9,313.30 " - " 7,446.60 " N/A " 8,895.48 " - N/A " 8,921.09 " - N/A " 6,541.43 " " 8,176.79 " N/A N/A N/A " 10,782.40 " N/A - " 9,030.26 " N/A " 5,512.50 " " 10,108.50 " " 5,122.99 " " 6,028.71 " N/A 28170998 COLECTOMY W HARTMANN CLOSURE 44143 360 "$10,235.00" " 3,782.86 " - " 9,359.19 " - " 7,072.39 " N/A " 7,072.39 " - " 5,654.84 " N/A " 6,755.10 " - N/A " 6,774.55 " - N/A " 7,487.35 " " 9,359.19 " N/A N/A N/A " 8,188.00 " N/A - " 6,857.45 " N/A " 4,186.12 " " 7,676.25 " " 3,890.32 " " 4,578.12 " N/A 28171005 COLECTOMY W LOW PELV ANASTOMOS 44145 360 "$2,076.00" 767.29 - " 10,362.20 " - " 1,434.52 " N/A " 1,434.52 " - " 1,146.99 " N/A " 1,370.16 " - N/A " 1,374.10 " - N/A " 8,289.76 " " 10,362.20 " N/A N/A N/A " 1,660.80 " N/A - " 1,390.92 " N/A 849.08 " 1,557.00 " 789.09 928.59 N/A 28171013 COLECTOMY ABD & TRANS APP EEA 44147 360 "$21,798.00" " 8,056.54 " - " 17,438.40 " - " 15,062.42 " N/A " 15,062.42 " - " 12,043.40 " N/A " 14,386.68 " - N/A " 14,428.10 " - N/A " 6,535.13 " " 8,168.91 " N/A N/A N/A " 17,438.40 " N/A - " 14,604.66 " N/A " 8,915.38 " " 16,348.50 " " 8,285.42 " " 9,750.25 " N/A 28171021 COLECTOMY TOTAL W ILEOSTOMY 44150 360 "$8,096.00" " 2,992.28 " - " 9,950.21 " - " 5,594.34 " N/A " 5,594.34 " - " 4,473.04 " N/A " 5,343.36 " - N/A " 5,358.74 " - N/A " 7,960.17 " " 9,950.21 " N/A N/A N/A " 6,476.80 " N/A - " 5,424.32 " N/A " 3,311.26 " " 6,072.00 " " 3,077.29 " " 3,621.34 " N/A 28171030 COLECTOMY RIGHT W ILEOCLOSTOMY 44160 360 "$9,050.00" " 3,344.88 " - " 7,343.80 " - " 6,253.55 " N/A " 6,253.55 " - " 5,000.13 " N/A " 5,973.00 " - N/A " 5,990.20 " - N/A " 5,875.04 " " 7,343.80 " N/A N/A N/A " 7,240.00 " N/A - " 6,063.50 " N/A " 3,701.45 " " 6,787.50 " " 3,439.91 " " 4,048.07 " N/A 28175434 "LAPAROSCOPY, SURG, ENTERO" 44180 360 "$26,567.00" " 9,819.16 " 776.00 " 21,253.60 " 892.40 " 2,773.00 " " 5,277.62 " " 2,773.00 " 907.92 " 14,678.27 " " 5,177.09 " " 4,445.00 " 869.12 808.05 " 17,584.70 " " 4,523.67 " " 5,026.30 " " 4,593.96 " " 5,742.45 " " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " 776.00 " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 28171048 LAP JEJUNOSTOMY 44186 360 "$26,567.00" " 9,819.16 " 776.00 " 21,253.60 " 892.40 " 3,604.00 " " 5,277.62 " " 3,604.00 " 907.92 " 14,678.27 " " 5,177.09 " " 4,445.00 " 869.12 808.05 " 17,584.70 " " 4,523.67 " " 5,026.30 " " 3,224.11 " " 4,030.14 " " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " 776.00 " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 28171056 LAP COLOSTOMY 44188 360 "$8,585.00" " 3,173.02 " - " 7,303.93 " - " 2,773.00 " N/A " 2,773.00 " - " 4,743.21 " N/A " 5,666.10 " - N/A " 5,682.41 " - N/A " 5,843.14 " " 7,303.93 " N/A N/A N/A " 6,868.00 " N/A - " 5,751.95 " N/A " 3,511.27 " " 6,438.75 " " 3,263.16 " " 3,840.07 " N/A 28175442 LAPARO RESECT INTESTINE 44202 360 "$8,208.00" " 3,033.68 " - " 8,646.37 " - " 3,604.00 " N/A " 3,604.00 " - " 4,534.92 " N/A " 5,417.28 " - N/A " 5,432.88 " - N/A " 6,917.10 " " 8,646.37 " N/A N/A N/A " 6,566.40 " N/A - " 5,499.36 " N/A " 3,357.07 " " 6,156.00 " " 3,119.86 " " 3,671.44 " N/A 28171064 LAPARO PARTIAL COLECTOMY 44204 360 "$5,369.00" " 1,984.38 " - " 9,761.05 " - " 3,709.98 " N/A " 3,709.98 " - " 2,966.37 " N/A " 3,543.54 " - N/A " 3,553.74 " - N/A " 7,808.84 " " 9,761.05 " N/A N/A N/A " 4,295.20 " N/A - " 3,597.23 " N/A " 2,195.92 " " 4,026.75 " " 2,040.76 " " 2,401.55 " N/A 28171072 LAP COLECTOMY PART W/ILEUM 44205 360 "$9,368.00" " 3,462.41 " - " 8,656.01 " - " 6,473.29 " N/A " 6,473.29 " - " 5,175.82 " N/A " 6,182.88 " - N/A " 6,200.68 " - N/A " 6,924.81 " " 8,656.01 " N/A N/A N/A " 7,494.40 " N/A - " 6,276.56 " N/A " 3,831.51 " " 7,026.00 " " 3,560.78 " " 4,190.31 " N/A 28175451 "LAP COLEC,PARTIAL & CLOSURE" 44206 360 "$11,925.00" " 4,407.48 " - " 10,663.09 " - " 8,240.18 " N/A " 8,240.18 " - " 6,588.56 " N/A " 7,870.50 " - N/A " 7,893.16 " - N/A " 8,530.47 " " 10,663.09 " N/A N/A N/A " 9,540.00 " N/A - " 7,989.75 " N/A " 4,877.33 " " 8,943.75 " " 4,532.69 " " 5,334.05 " N/A 28171081 "LAP SURG, COLECTOMY W/ANASTOM" 44207 360 "$8,475.00" " 3,132.36 " - " 11,565.97 " - " 5,856.23 " N/A " 5,856.23 " - " 4,682.44 " N/A " 5,593.50 " - N/A " 5,609.60 " - N/A " 9,252.78 " " 11,565.97 " N/A N/A N/A " 6,780.00 " N/A - " 5,678.25 " N/A " 3,466.28 " " 6,356.25 " " 3,221.35 " " 3,790.87 " N/A 28171099 "COLECTOMY,PART,W/ANASTOM" 44208 360 "$12,908.00" " 4,770.80 " - " 12,544.17 " - " 8,919.43 " N/A " 8,919.43 " - " 7,131.67 " N/A " 8,519.28 " - N/A " 8,543.81 " - N/A " 10,035.34 " " 12,544.17 " N/A N/A N/A " 10,326.40 " N/A - " 8,648.36 " N/A " 5,279.37 " " 9,681.00 " " 4,906.33 " " 5,773.75 " N/A 28171102 LAPARO TOTAL PROCTOCOLECTOMY 44212 360 "$8,567.00" " 3,166.36 " - " 12,772.98 " - " 5,919.80 " N/A " 5,919.80 " - " 4,733.27 " N/A " 5,654.22 " - N/A " 5,670.50 " - N/A " 10,218.38 " " 12,772.98 " N/A N/A N/A " 6,853.60 " N/A - " 5,739.89 " N/A " 3,503.90 " " 6,425.25 " " 3,256.32 " " 3,832.02 " N/A 28171111 LAP CLOSE ENTEROSTOMY 44227 360 "$2,220.00" 820.51 - " 10,345.75 " - " 2,773.00 " N/A " 2,773.00 " - " 1,226.55 " N/A " 1,465.20 " - N/A " 1,469.42 " - N/A " 8,276.60 " " 10,345.75 " N/A N/A N/A " 1,776.00 " N/A - " 1,487.40 " N/A 907.98 " 1,665.00 " 843.82 993.01 N/A 28171129 COLOSTOMY 44320 360 "$6,428.00" " 2,375.79 " - " 7,039.18 " - " 4,441.75 " N/A " 4,441.75 " - " 3,551.47 " N/A " 4,242.48 " - N/A " 4,254.69 " - N/A " 5,631.34 " " 7,039.18 " N/A N/A N/A " 5,142.40 " N/A - " 4,306.76 " N/A " 2,629.05 " " 4,821.00 " " 2,443.28 " " 2,875.24 " N/A 28171137 REVISION OF COLOSTOMY 44340 360 "$18,491.00" " 6,834.27 " 469.00 " 14,792.80 " 539.35 " 2,773.00 " " 3,672.72 " " 2,773.00 " 548.73 " 10,216.28 " " 3,602.76 " " 3,545.00 " 525.28 488.37 " 12,239.19 " " 3,148.05 " " 3,497.83 " " 2,532.97 " " 3,166.21 " " 3,585.28 " " 3,602.76 " " 3,497.83 " " 14,792.80 " " 3,200.51 " 469.00 " 12,388.97 " " 3,078.09 " " 7,562.82 " " 13,868.25 " " 7,028.43 " " 8,271.02 " " 3,620.25 " 34054088 ENTEROSCPY SM BWL DIAG 44360 750 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 1,718.00 " " 1,694.09 " " 1,718.00 " 907.92 " 4,713.38 " " 1,661.82 " " 2,820.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 2,208.66 " " 2,760.83 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34054070 ENTEROSCPY SM BWL W/BIOPSY 44361 750 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 1,718.00 " " 1,694.09 " " 1,718.00 " 907.92 " 4,713.38 " " 1,661.82 " " 2,820.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 2,208.66 " " 2,760.83 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34054061 ENTEROSCPY SM BWL W/FBR 44363 750 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 1,718.00 " " 1,694.09 " " 1,718.00 " 907.92 " 4,713.38 " " 1,661.82 " " 2,820.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 2,208.66 " " 2,760.83 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34054291 ENTEROSCPY SM BWL W/SNRE RMV 44364 750 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 1,718.00 " " 1,694.09 " " 1,718.00 " 907.92 " 4,713.38 " " 1,661.82 " " 2,820.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 2,208.66 " " 2,760.83 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34054304 ENTEROSCPY SM BWL W/RMV HOT BX 44365 750 "$8,531.00" " 3,153.06 " 170.51 " 6,824.80 " 196.09 " 1,718.00 " " 1,694.09 " " 1,718.00 " 199.50 " 4,713.38 " " 1,661.82 " " 2,820.00 " 190.97 177.55 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 2,208.66 " " 2,760.83 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 170.51 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34054053 ENTEROSCPY SM BWL W/BLEED CTRL 44366 750 "$8,531.00" " 3,153.06 " 207.50 " 6,824.80 " 238.63 " 1,718.00 " " 1,694.09 " " 1,718.00 " 242.78 " 4,713.38 " " 1,661.82 " " 2,820.00 " 232.40 216.07 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 2,208.66 " " 2,760.83 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 207.50 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34054622 ENTEROSCPY SM BWL W/ABL LESNS 44369 750 "$8,531.00" " 3,153.06 " 207.50 " 6,824.80 " 238.63 " 1,718.00 " " 1,694.09 " " 1,718.00 " 242.78 " 4,713.38 " " 1,661.82 " " 2,820.00 " 232.40 216.07 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 2,208.66 " " 2,760.83 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 207.50 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34000654 ENTEROSCPY SM BWL W/STENT PLC 44370 750 "$26,400.00" " 9,757.44 " 776.00 " 21,120.00 " 892.40 " 4,656.00 " " 5,250.21 " " 4,656.00 " 907.92 " 14,586.00 " " 5,150.21 " " 6,576.00 " 869.12 808.05 " 17,474.16 " " 4,500.18 " " 5,000.20 " " 10,107.68 " " 12,634.60 " " 5,125.21 " " 5,150.21 " " 5,000.20 " " 21,120.00 " " 4,575.18 " 776.00 " 17,688.00 " " 4,400.18 " " 10,797.60 " " 19,800.00 " " 10,034.64 " " 11,808.72 " " 5,175.21 " 34054835 ENTEROSCPY SM INT W/PLC JTUBE 44372 750 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 1,718.00 " " 1,694.09 " " 1,718.00 " 907.92 " 4,713.38 " " 1,661.82 " " 2,820.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 2,208.66 " " 2,760.83 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 28171145 ENTEROSCPY SM INT PEG CNVRSN 44373 360 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 1,718.00 " " 1,694.09 " " 1,718.00 " 907.92 " 4,713.38 " " 1,661.82 " " 2,820.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 2,208.66 " " 2,760.83 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34054720 ENTEROSCPY SM INT PEG CNVRSN 44373 750 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 1,718.00 " " 1,694.09 " " 1,718.00 " 907.92 " 4,713.38 " " 1,661.82 " " 2,820.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 2,208.66 " " 2,760.83 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34054509 ENTEROSCPY SM INT ILEUM ALONE 44376 750 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 1,718.00 " " 1,694.09 " " 1,718.00 " 907.92 " 4,713.38 " " 1,661.82 " " 2,820.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 1,653.43 " " 2,066.79 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34054517 ENTRS0CPY SM BWL ILEUM BIOPSY 44377 750 "$8,531.00" " 3,153.06 " 279.13 " 6,824.80 " 321.00 " 1,718.00 " " 1,694.09 " " 1,718.00 " 326.58 " 4,713.38 " " 1,661.82 " " 2,820.00 " 312.63 290.66 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 1,653.43 " " 2,066.79 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 279.13 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34054339 ENTRSOCPY SM INT>2ND W/BL CTRL 44378 750 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 1,718.00 " " 1,694.09 " " 1,718.00 " 907.92 " 4,713.38 " " 1,661.82 " " 2,820.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 1,649.49 " " 2,061.86 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34054525 ENTRSOCPY W/ILEUM STNT PLCMNT 44379 750 "$26,400.00" " 9,757.44 " 776.00 " 21,120.00 " 892.40 " 4,656.00 " " 5,250.21 " " 4,656.00 " 907.92 " 14,586.00 " " 5,150.21 " " 6,576.00 " 869.12 808.05 " 17,474.16 " " 4,500.18 " " 5,000.20 " " 10,107.68 " " 12,634.60 " " 5,125.21 " " 5,150.21 " " 5,000.20 " " 21,120.00 " " 4,575.18 " 776.00 " 17,688.00 " " 4,400.18 " " 10,797.60 " " 19,800.00 " " 10,034.64 " " 11,808.72 " " 5,175.21 " 34054185 ILLESCOPY THRU STOMA DX 44380 750 "$4,250.00" " 1,570.80 " 343.00 " 3,400.00 " 394.45 " 1,469.00 " 843.97 " 1,469.00 " 401.31 " 2,348.13 " 827.89 " 1,775.00 " 384.16 357.17 " 2,813.08 " 723.40 803.78 " 1,649.49 " " 2,061.86 " 823.87 827.89 803.78 " 3,400.00 " 735.46 343.00 " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 34055262 ILLESCOPY THRU STOMA W/DILAT 44381 750 "$8,531.00" " 3,153.06 " 327.06 " 6,824.80 " 892.40 " 1,469.00 " " 1,694.09 " " 1,469.00 " 907.92 " 4,713.38 " " 1,661.82 " " 4,860.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " 327.06 408.83 " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 34054274 ILLESCOPY W/BIOPSY SGL/MULTI 44382 750 "$4,250.00" " 1,570.80 " 344.00 " 3,400.00 " 395.60 " 1,469.00 " 843.97 " 1,469.00 " 402.48 " 2,348.13 " 827.89 " 1,775.00 " 385.28 358.21 " 2,813.08 " 723.40 803.78 " 1,649.49 " " 2,061.86 " 823.87 827.89 803.78 " 3,400.00 " 735.46 344.00 " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 34054347 ILLESCOPY THR STOMA W/STNT PLC 44384 750 "$16,174.00" " 5,977.91 " 463.44 " 12,939.20 " 892.40 " 1,718.00 " " 3,202.61 " " 1,718.00 " 907.92 " 8,936.14 " " 3,141.60 " " 4,860.00 " 869.12 808.05 " 10,705.57 " " 2,745.09 " " 3,050.10 " 463.44 579.30 " 3,126.35 " " 3,141.60 " " 3,050.10 " " 12,939.20 " " 2,790.84 " 776.00 " 10,836.58 " " 2,684.09 " " 6,615.17 " " 12,130.50 " " 6,147.74 " " 7,234.63 " " 3,156.85 " 34000042 ENDO EVAL SMALL INT 44385 750 "$4,167.00" " 1,540.12 " 93.72 " 3,333.60 " 107.78 " 1,469.00 " 827.73 " 1,469.00 " 109.65 " 2,302.27 " 811.96 " 1,775.00 " 104.97 97.59 " 2,758.14 " 709.48 788.31 " 1,649.49 " " 2,061.86 " 808.02 811.96 788.31 " 3,333.60 " 721.30 93.72 " 2,791.89 " 693.71 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 815.90 34000051 ENDO EVAL SMALL INT W/BIOPSY 44386 750 "$4,167.00" " 1,540.12 " 110.26 " 3,333.60 " 126.80 " 1,469.00 " 827.73 " 1,469.00 " 129.00 " 2,302.27 " 811.96 " 1,775.00 " 123.49 114.81 " 2,758.14 " 709.48 788.31 " 1,649.49 " " 2,061.86 " 808.02 811.96 788.31 " 3,333.60 " 721.30 110.26 " 2,791.89 " 693.71 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 815.90 34053987 COLONOSCOPY THRU STOMA DX 44388 750 "$4,167.00" " 1,540.12 " 693.71 " 3,333.60 " 892.40 " 1,469.00 " 827.73 " 1,469.00 " 907.92 " 2,302.27 " 811.96 " 1,775.00 " 869.12 808.05 " 2,758.14 " 709.48 788.31 " 1,649.49 " " 2,061.86 " 808.02 811.96 788.31 " 3,333.60 " 721.30 776.00 " 2,791.89 " 693.71 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 815.90 34154392 COLONOSCOPY THRU STOMA DX 44388 750 "$4,167.00" " 1,540.12 " 693.71 " 3,333.60 " 892.40 " 1,469.00 " 827.73 " 1,469.00 " 907.92 " 2,302.27 " 811.96 " 1,775.00 " 869.12 808.05 " 2,758.14 " 709.48 788.31 " 1,649.49 " " 2,061.86 " 808.02 811.96 788.31 " 3,333.60 " 721.30 776.00 " 2,791.89 " 693.71 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 815.90 34053995 COLONOSCOPY THRU STOMA W/BX 44389 750 "$5,444.00" " 2,012.10 " 344.00 " 4,355.20 " 395.60 " 1,469.00 " " 1,081.58 " " 1,469.00 " 402.48 " 3,007.81 " " 1,060.98 " " 1,775.00 " 385.28 358.21 " 3,603.38 " 927.07 " 1,030.08 " " 1,649.49 " " 2,061.86 " " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 344.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 34154376 COLONOSCOPY THRU STOMA W/BX 44389 750 "$5,444.00" " 2,012.10 " 344.00 " 4,355.20 " 395.60 " 1,469.00 " " 1,081.58 " " 1,469.00 " 402.48 " 3,007.81 " " 1,060.98 " " 1,775.00 " 385.28 358.21 " 3,603.38 " 927.07 " 1,030.08 " " 1,649.49 " " 2,061.86 " " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 344.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 34054029 COLONOSCOPY W/BLEED CTRL 44391 750 "$5,444.00" " 2,012.10 " 344.00 " 4,355.20 " 395.60 " 1,469.00 " " 1,081.58 " " 1,469.00 " 402.48 " 3,007.81 " " 1,060.98 " " 1,775.00 " 385.28 358.21 " 3,603.38 " 927.07 " 1,030.08 " " 1,649.49 " " 2,061.86 " " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 344.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 34054282 COLONOSCOPY W/RMV HOT BIOPSY 44392 750 "$5,444.00" " 2,012.10 " 332.00 " 4,355.20 " 381.80 " 1,469.00 " " 1,081.58 " " 1,469.00 " 388.44 " 3,007.81 " " 1,060.98 " " 1,775.00 " 371.84 345.71 " 3,603.38 " 927.07 " 1,030.08 " " 1,649.49 " " 2,061.86 " " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 332.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 34054002 COLONOSCOPY W/RMV BY SNARE 44394 750 "$5,444.00" " 2,012.10 " 776.00 " 4,355.20 " 892.40 " 1,469.00 " " 1,081.58 " " 1,469.00 " 907.92 " 3,007.81 " " 1,060.98 " " 1,775.00 " 869.12 808.05 " 3,603.38 " 927.07 " 1,030.08 " " 1,649.49 " " 2,061.86 " " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 776.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 34154384 COLONOSCOPY W/RMV BY SNARE 44394 750 "$5,444.00" " 2,012.10 " 776.00 " 4,355.20 " 892.40 " 1,469.00 " " 1,081.58 " " 1,469.00 " 907.92 " 3,007.81 " " 1,060.98 " " 1,775.00 " 869.12 808.05 " 3,603.38 " 927.07 " 1,030.08 " " 1,649.49 " " 2,061.86 " " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 776.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 34054355 COLONOSCOPY W/ABLATION 44401 750 "$5,444.00" " 2,012.10 " 776.00 " 4,860.00 " 892.40 " 1,469.00 " " 1,081.58 " " 1,469.00 " 907.92 " 3,007.81 " " 1,060.98 " " 4,860.00 " 869.12 808.05 " 3,603.38 " 927.07 " 1,030.08 " 981.70 " 1,227.12 " " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 776.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 34055271 COLONOSCOPY THRU STOMA W/ABL 44402 750 "$26,400.00" " 9,757.44 " 755.66 " 21,120.00 " 892.40 " 1,469.00 " " 5,250.21 " " 1,469.00 " 907.92 " 14,586.00 " " 5,150.21 " " 4,860.00 " 869.12 808.05 " 17,474.16 " " 4,500.18 " " 5,000.20 " 755.66 944.57 " 5,125.21 " " 5,150.21 " " 5,000.20 " " 21,120.00 " " 4,575.18 " 776.00 " 17,688.00 " " 4,400.18 " " 10,797.60 " " 19,800.00 " " 10,034.64 " " 11,808.72 " " 5,175.21 " 34055289 COLONOSCOPY THRU STOMA W/STENT 44403 750 "$5,444.00" " 2,012.10 " 533.29 " 4,860.00 " 892.40 " 1,469.00 " " 1,081.58 " " 1,469.00 " 907.92 " 3,007.81 " " 1,060.98 " " 4,860.00 " 869.12 808.05 " 3,603.38 " 927.07 " 1,030.08 " 533.29 666.61 " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 776.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 34055297 COLONOSCOPY THRU STOMA W/INJ 44404 750 "$5,444.00" " 2,012.10 " 533.29 " 4,860.00 " 892.40 " 1,469.00 " " 1,081.58 " " 1,469.00 " 907.92 " 3,007.81 " " 1,060.98 " " 4,860.00 " 869.12 808.05 " 3,603.38 " 927.07 " 1,030.08 " 533.29 666.61 " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 776.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 34055301 COLONOSCOPY THRU STOMA W/DILAT 44405 750 "$5,444.00" " 2,012.10 " 533.29 " 4,860.00 " 892.40 " 1,469.00 " " 1,081.58 " " 1,469.00 " 907.92 " 3,007.81 " " 1,060.98 " " 4,860.00 " 869.12 808.05 " 3,603.38 " 927.07 " 1,030.08 " 533.29 666.61 " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 776.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 34055319 COLONOSCOPY THRU STOMA W/EUS 44406 750 "$5,444.00" " 2,012.10 " 776.00 " 4,860.00 " 892.40 " 1,469.00 " " 1,081.58 " " 1,469.00 " 907.92 " 3,007.81 " " 1,060.98 " " 4,860.00 " 869.12 808.05 " 3,603.38 " 927.07 " 1,030.08 " 981.70 " 1,227.12 " " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 776.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 34055327 COLONOSCOPY STOMA W/ASP/BX 44407 750 "$5,444.00" " 2,012.10 " 776.00 " 4,860.00 " 892.40 " 1,469.00 " " 1,081.58 " " 1,469.00 " 907.92 " 3,007.81 " " 1,060.98 " " 4,860.00 " 869.12 808.05 " 3,603.38 " 927.07 " 1,030.08 " 981.70 " 1,227.12 " " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 776.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 34055335 COLONOSCOPY THRU STOMA W/DECMP 44408 750 "$4,167.00" " 1,540.12 " 533.29 " 4,860.00 " 892.40 " 1,469.00 " 827.73 " 1,469.00 " 907.92 " 2,302.27 " 811.96 " 4,860.00 " 869.12 808.05 " 2,758.14 " 709.48 788.31 533.29 666.61 808.02 811.96 788.31 " 3,333.60 " 721.30 776.00 " 2,791.89 " 693.71 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 815.90 80327021 INTRO GASTROINTESTINAL TUBE 44500 320 "$4,250.00" " 1,570.80 " 19.67 " 3,400.00 " 22.62 " 2,936.75 " 843.97 " 2,936.75 " 23.01 " 2,348.13 " 827.89 " 1,775.00 " 22.03 20.48 " 2,813.08 " 723.40 803.78 168.76 210.95 823.87 827.89 803.78 " 3,400.00 " 735.46 19.67 " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 28176783 SUTURE SMALL INTESTINE 44603 360 "$25,984.00" " 9,603.69 " - " 20,787.20 " - " 17,954.94 " N/A " 17,954.94 " - " 14,356.16 " N/A " 17,149.44 " - N/A " 17,198.81 " - N/A " 5,800.39 " " 7,250.49 " N/A N/A N/A " 20,787.20 " N/A - " 17,409.28 " N/A " 10,627.46 " " 19,488.00 " " 9,876.52 " " 11,622.64 " N/A 28176791 SUTURE LARGE INTESTINE 44604 360 "$7,958.00" " 2,941.28 " - " 6,366.40 " - " 5,498.98 " N/A " 5,498.98 " - " 4,396.80 " N/A " 5,252.28 " - N/A " 5,267.40 " - N/A " 5,023.30 " " 6,279.12 " N/A N/A N/A " 6,366.40 " N/A - " 5,331.86 " N/A " 3,254.82 " " 5,968.50 " " 3,024.84 " " 3,559.61 " N/A 28176805 REPAIR OF BOWEL LESION 44605 360 "$12,032.00" " 4,447.03 " - " 9,625.60 " - " 8,314.11 " N/A " 8,314.11 " - " 6,647.68 " N/A " 7,941.12 " - N/A " 7,963.98 " - N/A " 6,221.79 " " 7,777.24 " N/A N/A N/A " 9,625.60 " N/A - " 8,061.44 " N/A " 4,921.09 " " 9,024.00 " " 4,573.36 " " 5,381.91 " N/A 28171153 CLOSE ENTEROSTOMY LG/SM INTEST 44620 360 "$6,569.00" " 2,427.90 " - " 5,255.20 " - " 4,539.18 " N/A " 4,539.18 " - " 3,629.37 " N/A " 4,335.54 " - N/A " 4,348.02 " - N/A " 3,895.00 " " 4,868.75 " N/A N/A N/A " 5,255.20 " N/A - " 4,401.23 " N/A " 2,686.72 " " 4,926.75 " " 2,496.88 " " 2,938.31 " N/A 28171161 CLS ENTROS SM/LG INTEST W ANAS 44625 360 "$3,577.00" " 1,322.06 " - " 5,936.25 " - " 2,471.71 " N/A " 2,471.71 " - " 1,976.29 " N/A " 2,360.82 " - N/A " 2,367.62 " - N/A " 4,749.00 " " 5,936.25 " N/A N/A N/A " 2,861.60 " N/A - " 2,396.59 " N/A " 1,462.99 " " 2,682.75 " " 1,359.62 " " 1,599.99 " N/A 34002339 PREP OF FECAL MICROB/INSTILL 44705 750 "$2,360.00" 872.26 - " 1,888.00 " 70.92 " 1,469.00 " N/A " 1,469.00 " 72.15 " 1,303.90 " N/A " 1,557.60 " 69.07 N/A " 1,562.08 " - N/A 639.27 799.09 N/A N/A N/A " 1,888.00 " N/A 61.67 " 1,581.20 " N/A 965.24 " 1,770.00 " 897.04 " 1,055.63 " N/A 34102333 PREP OF FECAL MICROB/INSTILL 44705 750 "$2,360.00" 872.26 - " 1,888.00 " 70.92 " 1,469.00 " N/A " 1,469.00 " 72.15 " 1,303.90 " N/A " 1,557.60 " 69.07 N/A " 1,562.08 " - N/A 639.27 799.09 N/A N/A N/A " 1,888.00 " N/A 61.67 " 1,581.20 " N/A 965.24 " 1,770.00 " 897.04 " 1,055.63 " N/A 34055238 UNL PROC:INTESTINE ENDOSCOPY 44799 750 "$4,250.00" " 1,570.80 " - " 3,400.00 " - " 1,469.00 " 843.97 " 1,469.00 " - " 2,348.13 " 827.89 " 2,805.00 " - - " 2,813.08 " 723.40 803.78 56.26 70.32 823.87 827.89 803.78 " 3,400.00 " 735.46 - " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 80629699 UNL SMALL INTESTINE 44799 350 "$4,250.00" " 1,570.80 " - " 3,400.00 " - " 1,469.00 " 843.97 " 1,469.00 " - " 2,348.13 " 827.89 " 2,805.00 " - - " 2,813.08 " 723.40 803.78 56.26 70.32 823.87 827.89 803.78 " 3,400.00 " 735.46 - " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 28171170 APPENDECTOMY 44950 360 "$16,713.00" " 6,177.12 " 776.00 " 13,370.40 " 892.40 " 3,326.00 " " 3,318.47 " " 3,326.00 " 907.92 " 9,233.93 " " 3,255.26 " " 11,030.58 " 869.12 808.05 " 11,062.33 " " 2,844.41 " " 3,160.45 " " 4,937.34 " " 6,171.67 " " 3,239.46 " " 3,255.26 " " 3,160.45 " " 13,370.40 " " 2,891.81 " 776.00 " 11,197.71 " " 2,781.20 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,271.07 " 28171188 LAPAROSCOPY APPENDECTOMY 44970 360 "$26,567.00" " 9,819.16 " 776.00 " 21,253.60 " 892.40 " 2,773.00 " " 5,277.62 " " 2,773.00 " 907.92 " 14,678.27 " " 5,177.09 " " 4,860.00 " 869.12 808.05 " 17,584.70 " " 4,523.67 " " 5,026.30 " " 4,937.34 " " 6,171.67 " " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " 776.00 " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 34054916 BX ANAL WALL ANAL APPROACH 45100 750 "$12,828.00" " 4,741.23 " 579.00 " 10,262.40 " 665.85 " 1,469.00 " " 2,548.12 " " 1,469.00 " 677.43 " 7,087.47 " " 2,499.58 " " 1,775.00 " 648.48 602.91 " 8,490.85 " " 2,184.10 " " 2,426.78 " " 1,649.49 " " 2,061.86 " " 2,487.45 " " 2,499.58 " " 2,426.78 " " 10,262.40 " " 2,220.50 " 579.00 " 8,594.76 " " 2,135.57 " " 5,246.65 " " 9,621.00 " " 4,875.92 " " 5,737.96 " " 2,511.72 " 28171196 EXC RECT TUM TRANSANAL PART 45171 360 "$12,828.00" " 4,741.23 " 776.00 " 10,262.40 " 892.40 " 1,469.00 " " 2,548.12 " " 1,469.00 " 907.92 " 7,087.47 " " 2,499.58 " " 4,445.00 " 869.12 808.05 " 8,490.85 " " 2,184.10 " " 2,426.78 " " 3,166.95 " " 3,958.69 " " 2,487.45 " " 2,499.58 " " 2,426.78 " " 10,262.40 " " 2,220.50 " 776.00 " 8,594.76 " " 2,135.57 " " 5,246.65 " " 9,621.00 " " 4,875.92 " " 5,737.96 " " 2,511.72 " 28171200 PROCTOSIGMOIDOSCOPY RIGID DX 45300 360 "$4,167.00" " 1,540.12 " 693.71 " 3,333.60 " 892.40 " 1,469.00 " 827.73 " 1,469.00 " 907.92 " 2,302.27 " 811.96 " 1,775.00 " 869.12 808.05 " 2,758.14 " 709.48 788.31 " 1,012.58 " " 1,265.72 " 808.02 811.96 788.31 " 3,333.60 " 721.30 776.00 " 2,791.89 " 693.71 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 815.90 34153027 PROCTOSIGMOIDOSCOPY RIGID DX 45300 750 "$4,167.00" " 1,540.12 " 693.71 " 3,333.60 " 892.40 " 1,469.00 " 827.73 " 1,469.00 " 907.92 " 2,302.27 " 811.96 " 1,775.00 " 869.12 808.05 " 2,758.14 " 709.48 788.31 " 1,012.58 " " 1,265.72 " 808.02 811.96 788.31 " 3,333.60 " 721.30 776.00 " 2,791.89 " 693.71 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 815.90 34055254 PROCTOSIG W/BX SGL OR MULTI 45305 750 "$5,444.00" " 2,012.10 " 776.00 " 4,355.20 " 892.40 " 1,469.00 " " 1,081.58 " " 1,469.00 " 907.92 " 3,007.81 " " 1,060.98 " " 1,775.00 " 869.12 808.05 " 3,603.38 " 927.07 " 1,030.08 " " 1,649.49 " " 2,061.86 " " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 776.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 34153051 PROCTOSIG W/BX SGL OR MULTI 45305 750 "$5,444.00" " 2,012.10 " 776.00 " 4,355.20 " 892.40 " 1,469.00 " " 1,081.58 " " 1,469.00 " 907.92 " 3,007.81 " " 1,060.98 " " 1,775.00 " 869.12 808.05 " 3,603.38 " 927.07 " 1,030.08 " " 1,649.49 " " 2,061.86 " " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 776.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 28171218 SIGMOIDOSCOPY FLEX DIAGNOSTIC 45330 360 "$4,167.00" " 1,540.12 " 337.00 " 3,333.60 " 387.55 " 1,469.00 " 827.73 " 1,469.00 " 394.29 " 2,302.27 " 811.96 " 1,775.00 " 377.44 350.92 " 2,758.14 " 709.48 788.31 " 1,012.58 " " 1,265.72 " 808.02 811.96 788.31 " 3,333.60 " 721.30 337.00 " 2,791.89 " 693.71 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 815.90 34053308 SIGMOIDOSCOPY FLEX DIAGNOSTIC 45330 750 "$4,167.00" " 1,540.12 " 337.00 " 3,333.60 " 387.55 " 1,469.00 " 827.73 " 1,469.00 " 394.29 " 2,302.27 " 811.96 " 1,775.00 " 377.44 350.92 " 2,758.14 " 709.48 788.31 " 1,012.58 " " 1,265.72 " 808.02 811.96 788.31 " 3,333.60 " 721.30 337.00 " 2,791.89 " 693.71 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 815.90 34153302 SIGMOIDOSCOPY FLEX DIAGNOSTIC 45330 750 "$4,167.00" " 1,540.12 " 337.00 " 3,333.60 " 387.55 " 1,469.00 " 827.73 " 1,469.00 " 394.29 " 2,302.27 " 811.96 " 1,775.00 " 377.44 350.92 " 2,758.14 " 709.48 788.31 " 1,012.58 " " 1,265.72 " 808.02 811.96 788.31 " 3,333.60 " 721.30 337.00 " 2,791.89 " 693.71 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 815.90 34053316 SIGMOIDOSCOPY W/BX SGL/MULTI 45331 750 "$4,167.00" " 1,540.12 " 227.00 " 3,333.60 " 261.05 " 1,469.00 " 827.73 " 1,469.00 " 265.59 " 2,302.27 " 811.96 " 1,775.00 " 254.24 236.38 " 2,758.14 " 709.48 788.31 " 1,649.49 " " 2,061.86 " 808.02 811.96 788.31 " 3,333.60 " 721.30 227.00 " 2,791.89 " 693.71 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 815.90 34153311 SIGMOIDOSCOPY W/BX SGL/MULTI 45331 750 "$4,167.00" " 1,540.12 " 227.00 " 3,333.60 " 261.05 " 1,469.00 " 827.73 " 1,469.00 " 265.59 " 2,302.27 " 811.96 " 1,775.00 " 254.24 236.38 " 2,758.14 " 709.48 788.31 " 1,649.49 " " 2,061.86 " 808.02 811.96 788.31 " 3,333.60 " 721.30 227.00 " 2,791.89 " 693.71 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 815.90 34053324 SIGMOIDOSCOPY W/FBR(S) 45332 750 "$5,444.00" " 2,012.10 " 776.00 " 4,355.20 " 892.40 " 1,469.00 " " 1,081.58 " " 1,469.00 " 907.92 " 3,007.81 " " 1,060.98 " " 1,775.00 " 869.12 808.05 " 3,603.38 " 927.07 " 1,030.08 " " 1,649.49 " " 2,061.86 " " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 776.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 34053332 SIGMOIDOSCOPY W/RMV T/P/L 45333 750 "$4,167.00" " 1,540.12 " 693.71 " 3,333.60 " 892.40 " 1,469.00 " 827.73 " 1,469.00 " 907.92 " 2,302.27 " 811.96 " 1,775.00 " 869.12 808.05 " 2,758.14 " 709.48 788.31 " 1,649.49 " " 2,061.86 " 808.02 811.96 788.31 " 3,333.60 " 721.30 776.00 " 2,791.89 " 693.71 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 815.90 34153337 SIGMOIDOSCOPY W/RMV T/P/L 45333 750 "$4,167.00" " 1,540.12 " 693.71 " 3,333.60 " 892.40 " 1,469.00 " 827.73 " 1,469.00 " 907.92 " 2,302.27 " 811.96 " 1,775.00 " 869.12 808.05 " 2,758.14 " 709.48 788.31 " 1,649.49 " " 2,061.86 " 808.02 811.96 788.31 " 3,333.60 " 721.30 776.00 " 2,791.89 " 693.71 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 815.90 34053341 SIGMOIDOSCOPY W/CTRL BLDNG 45334 750 "$5,444.00" " 2,012.10 " 776.00 " 4,355.20 " 892.40 " 1,469.00 " " 1,081.58 " " 1,469.00 " 907.92 " 3,007.81 " " 1,060.98 " " 1,775.00 " 869.12 808.05 " 3,603.38 " 927.07 " 1,030.08 " " 1,649.49 " " 2,061.86 " " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 776.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 34153345 SIGMOIDOSCOPY W/CTRL BLDNG 45334 750 "$5,444.00" " 2,012.10 " 776.00 " 4,355.20 " 892.40 " 1,469.00 " " 1,081.58 " " 1,469.00 " 907.92 " 3,007.81 " " 1,060.98 " " 1,775.00 " 869.12 808.05 " 3,603.38 " 927.07 " 1,030.08 " " 1,649.49 " " 2,061.86 " " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 776.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 34000921 SIGMOIDOSCOPY W/SUBMUC INJ 45335 750 "$4,167.00" " 1,540.12 " 693.71 " 3,333.60 " 892.40 " 1,469.00 " 827.73 " 1,469.00 " 907.92 " 2,302.27 " 811.96 " 1,775.00 " 869.12 808.05 " 2,758.14 " 709.48 788.31 " 1,774.04 " " 2,217.55 " 808.02 811.96 788.31 " 3,333.60 " 721.30 776.00 " 2,791.89 " 693.71 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 815.90 34100926 SIGMOIDOSCOPY W/SUBMUC INJ 45335 750 "$4,167.00" " 1,540.12 " 693.71 " 3,333.60 " 892.40 " 1,469.00 " 827.73 " 1,469.00 " 907.92 " 2,302.27 " 811.96 " 1,775.00 " 869.12 808.05 " 2,758.14 " 709.48 788.31 " 1,774.04 " " 2,217.55 " 808.02 811.96 788.31 " 3,333.60 " 721.30 776.00 " 2,791.89 " 693.71 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 815.90 34053375 SIGMOIDOSCOPY W/DECOMPRESSN 45337 750 "$4,167.00" " 1,540.12 " 693.71 " 3,333.60 " 892.40 " 1,469.00 " 827.73 " 1,469.00 " 907.92 " 2,302.27 " 811.96 " 1,775.00 " 869.12 808.05 " 2,758.14 " 709.48 788.31 " 1,649.49 " " 2,061.86 " 808.02 811.96 788.31 " 3,333.60 " 721.30 776.00 " 2,791.89 " 693.71 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 815.90 34054037 SIGMOIDOSCOPY W/SNR RMV T/P/L 45338 750 "$5,444.00" " 2,012.10 " 776.00 " 4,355.20 " 892.40 " 1,469.00 " " 1,081.58 " " 1,469.00 " 907.92 " 3,007.81 " " 1,060.98 " " 1,775.00 " 869.12 808.05 " 3,603.38 " 927.07 " 1,030.08 " " 1,649.49 " " 2,061.86 " " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 776.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 34000930 SIGMOIDOSCOPY W/BALLOON DIL 45340 750 "$5,444.00" " 2,012.10 " 776.00 " 4,355.20 " 892.40 " 1,469.00 " " 1,081.58 " " 1,469.00 " 907.92 " 3,007.81 " " 1,060.98 " " 1,775.00 " 869.12 808.05 " 3,603.38 " 927.07 " 1,030.08 " " 1,768.58 " " 2,210.73 " " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 776.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 34100934 SIGMOIDOSCOPY W/BALLOON DIL 45340 750 "$5,444.00" " 2,012.10 " 776.00 " 4,355.20 " 892.40 " 1,469.00 " " 1,081.58 " " 1,469.00 " 907.92 " 3,007.81 " " 1,060.98 " " 1,775.00 " 869.12 808.05 " 3,603.38 " 927.07 " 1,030.08 " " 1,768.58 " " 2,210.73 " " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 776.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 34001154 SIGMOIDOSCOPY W/US ENDO EXAM 45341 750 "$4,167.00" " 1,540.12 " 134.47 " 3,333.60 " 154.64 " 1,469.00 " 827.73 " 1,469.00 " 157.33 " 2,302.27 " 811.96 " 1,775.00 " 150.61 140.02 " 2,758.14 " 709.48 788.31 797.63 997.04 808.02 811.96 788.31 " 3,333.60 " 721.30 134.47 " 2,791.89 " 693.71 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 815.90 34101159 SIGMOIDOSCOPY W/US ENDO EXAM 45341 750 "$4,167.00" " 1,540.12 " 134.47 " 3,333.60 " 154.64 " 1,469.00 " 827.73 " 1,469.00 " 157.33 " 2,302.27 " 811.96 " 1,775.00 " 150.61 140.02 " 2,758.14 " 709.48 788.31 797.63 997.04 808.02 811.96 788.31 " 3,333.60 " 721.30 134.47 " 2,791.89 " 693.71 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 815.90 34054380 SIGMOIDOSCOPY W/TRAN US FNA/BX 45342 750 "$5,444.00" " 2,012.10 " 199.76 " 4,355.20 " 229.72 " 1,469.00 " " 1,081.58 " " 1,469.00 " 233.72 " 3,007.81 " " 1,060.98 " " 1,775.00 " 223.73 208.01 " 3,603.38 " 927.07 " 1,030.08 " " 1,215.71 " " 1,519.64 " " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 199.76 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 34053367 SIGMOIDOSCOPY W/ABLATION T/P/L 45346 750 "$5,444.00" " 2,012.10 " 661.50 " 4,860.00 " 892.40 " 1,469.00 " " 1,081.58 " " 1,469.00 " 907.92 " 3,007.81 " " 1,060.98 " " 4,860.00 " 869.12 808.05 " 3,603.38 " 927.07 " 1,030.08 " 661.50 826.87 " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 776.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 34153361 SIGMOIDOSCOPY W/ABLATION T/P/L 45346 750 "$5,444.00" " 2,012.10 " 661.50 " 4,860.00 " 892.40 " 1,469.00 " " 1,081.58 " " 1,469.00 " 907.92 " 3,007.81 " " 1,060.98 " " 4,860.00 " 869.12 808.05 " 3,603.38 " 927.07 " 1,030.08 " 661.50 826.87 " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 776.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 34000662 SIGMOIDOSCOPY W/STENT PLCMNT 45347 750 "$26,400.00" " 9,757.44 " 479.70 " 21,120.00 " 892.40 " 1,469.00 " " 5,250.21 " " 1,469.00 " 907.92 " 14,586.00 " " 5,150.21 " " 4,860.00 " 869.12 808.05 " 17,474.16 " " 4,500.18 " " 5,000.20 " 479.70 599.62 " 5,125.21 " " 5,150.21 " " 5,000.20 " " 21,120.00 " " 4,575.18 " 776.00 " 17,688.00 " " 4,400.18 " " 10,797.60 " " 19,800.00 " " 10,034.64 " " 11,808.72 " " 5,175.21 " 34055343 SIGMOIDOSCOPY W/ENDO MUC RES 45349 750 "$12,828.00" " 4,741.23 " 338.54 " 10,262.40 " 892.40 " 1,469.00 " " 2,548.12 " " 1,469.00 " 907.92 " 7,087.47 " " 2,499.58 " " 4,860.00 " 869.12 808.05 " 8,490.85 " " 2,184.10 " " 2,426.78 " 338.54 423.17 " 2,487.45 " " 2,499.58 " " 2,426.78 " " 10,262.40 " " 2,220.50 " 776.00 " 8,594.76 " " 2,135.57 " " 5,246.65 " " 9,621.00 " " 4,875.92 " " 5,737.96 " " 2,511.72 " 34055351 SIGMOIDOSCOPY W/BAND LIGATION 45350 750 "$5,444.00" " 2,012.10 " 338.54 " 4,860.00 " 892.40 " 1,469.00 " " 1,081.58 " " 1,469.00 " 907.92 " 3,007.81 " " 1,060.98 " " 4,860.00 " 869.12 808.05 " 3,603.38 " 927.07 " 1,030.08 " 338.54 423.17 " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 776.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 28171226 COLONOSCOPY FLEX DIAGNOSTIC 45378 360 "$4,167.00" " 1,540.12 " 443.00 " 3,333.60 " 509.45 " 1,718.00 " 827.73 " 1,718.00 " 518.31 " 2,302.27 " 811.96 " 2,820.00 " 496.16 461.30 " 2,758.14 " 709.48 788.31 " 2,208.66 " " 2,760.83 " 808.02 811.96 788.31 " 3,333.60 " 721.30 443.00 " 2,791.89 " 693.71 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 815.90 34053782 COLONOSCOPY FLEX DIAGNOSTIC 45378 750 "$4,167.00" " 1,540.12 " 443.00 " 3,333.60 " 509.45 " 1,718.00 " 827.73 " 1,718.00 " 518.31 " 2,302.27 " 811.96 " 2,820.00 " 496.16 461.30 " 2,758.14 " 709.48 788.31 " 2,208.66 " " 2,760.83 " 808.02 811.96 788.31 " 3,333.60 " 721.30 443.00 " 2,791.89 " 693.71 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 815.90 34153787 COLONOSCOPY FLEX DIAGNOSTIC 45378 750 "$4,167.00" " 1,540.12 " 443.00 " 3,333.60 " 509.45 " 1,718.00 " 827.73 " 1,718.00 " 518.31 " 2,302.27 " 811.96 " 2,820.00 " 496.16 461.30 " 2,758.14 " 709.48 788.31 " 2,208.66 " " 2,760.83 " 808.02 811.96 788.31 " 3,333.60 " 721.30 443.00 " 2,791.89 " 693.71 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 815.90 28171234 COLONOSCOPY W/FBR(S) 45379 360 "$5,444.00" " 2,012.10 " 475.00 " 4,355.20 " 546.25 " 1,718.00 " " 1,081.58 " " 1,718.00 " 555.75 " 3,007.81 " " 1,060.98 " " 2,820.00 " 532.00 494.62 " 3,603.38 " 927.07 " 1,030.08 " " 2,208.66 " " 2,760.83 " " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 475.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 34053791 COLONOSCOPY W/FBR(S) 45379 750 "$5,444.00" " 2,012.10 " 475.00 " 4,355.20 " 546.25 " 1,718.00 " " 1,081.58 " " 1,718.00 " 555.75 " 3,007.81 " " 1,060.98 " " 2,820.00 " 532.00 494.62 " 3,603.38 " 927.07 " 1,030.08 " " 2,208.66 " " 2,760.83 " " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 475.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 34153795 COLONOSCOPY W/FBR(S) 45379 750 "$5,444.00" " 2,012.10 " 475.00 " 4,355.20 " 546.25 " 1,718.00 " " 1,081.58 " " 1,718.00 " 555.75 " 3,007.81 " " 1,060.98 " " 2,820.00 " 532.00 494.62 " 3,603.38 " 927.07 " 1,030.08 " " 2,208.66 " " 2,760.83 " " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 475.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 34053804 COLONOSCOPY W/BX SGL/MULTI 45380 750 "$5,444.00" " 2,012.10 " 320.00 " 4,355.20 " 368.00 " 1,718.00 " " 1,081.58 " " 1,718.00 " 374.40 " 3,007.81 " " 1,060.98 " " 2,820.00 " 358.40 333.22 " 3,603.38 " 927.07 " 1,030.08 " " 2,208.66 " " 2,760.83 " " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 320.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 34153809 COLONOSCOPY W/BX SGL/MULTI 45380 750 "$5,444.00" " 2,012.10 " 320.00 " 4,355.20 " 368.00 " 1,718.00 " " 1,081.58 " " 1,718.00 " 374.40 " 3,007.81 " " 1,060.98 " " 2,820.00 " 358.40 333.22 " 3,603.38 " 927.07 " 1,030.08 " " 2,208.66 " " 2,760.83 " " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 320.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 34000948 COLONOSCOPY W/SUBMUC INJ 45381 750 "$5,444.00" " 2,012.10 " 776.00 " 4,355.20 " 892.40 " 1,718.00 " " 1,081.58 " " 1,718.00 " 907.92 " 3,007.81 " " 1,060.98 " " 2,820.00 " 869.12 808.05 " 3,603.38 " 927.07 " 1,030.08 " " 2,376.02 " " 2,970.02 " " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 776.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 34100942 COLONOSCOPY W/SUBMUC INJ 45381 750 "$5,444.00" " 2,012.10 " 776.00 " 4,355.20 " 892.40 " 1,718.00 " " 1,081.58 " " 1,718.00 " 907.92 " 3,007.81 " " 1,060.98 " " 2,820.00 " 869.12 808.05 " 3,603.38 " 927.07 " 1,030.08 " " 2,376.02 " " 2,970.02 " " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 776.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 34053821 COLONOSCOPY W/BLEED CTRL 45382 750 "$5,444.00" " 2,012.10 " 475.00 " 4,355.20 " 546.25 " 1,718.00 " " 1,081.58 " " 1,718.00 " 555.75 " 3,007.81 " " 1,060.98 " " 2,820.00 " 532.00 494.62 " 3,603.38 " 927.07 " 1,030.08 " " 2,208.66 " " 2,760.83 " " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 475.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 34153825 COLONOSCOPY W/BLEED CTRL 45382 750 "$5,444.00" " 2,012.10 " 475.00 " 4,355.20 " 546.25 " 1,718.00 " " 1,081.58 " " 1,718.00 " 555.75 " 3,007.81 " " 1,060.98 " " 2,820.00 " 532.00 494.62 " 3,603.38 " 927.07 " 1,030.08 " " 2,208.66 " " 2,760.83 " " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 475.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 34054134 COLONOSCOPY W/REMOVAL T/P/L 45384 750 "$5,444.00" " 2,012.10 " 776.00 " 4,355.20 " 892.40 " 1,718.00 " " 1,081.58 " " 1,718.00 " 907.92 " 3,007.81 " " 1,060.98 " " 2,820.00 " 869.12 808.05 " 3,603.38 " 927.07 " 1,030.08 " " 2,208.66 " " 2,760.83 " " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 776.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 34154139 COLONOSCOPY W/REMOVAL T/P/L 45384 750 "$5,444.00" " 2,012.10 " 776.00 " 4,355.20 " 892.40 " 1,718.00 " " 1,081.58 " " 1,718.00 " 907.92 " 3,007.81 " " 1,060.98 " " 2,820.00 " 869.12 808.05 " 3,603.38 " 927.07 " 1,030.08 " " 2,208.66 " " 2,760.83 " " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 776.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 34053855 COLONOSCOPY W/SN RMV T/P/L 45385 750 "$5,444.00" " 2,012.10 " 380.00 " 4,355.20 " 437.00 " 1,718.00 " " 1,081.58 " " 1,718.00 " 444.60 " 3,007.81 " " 1,060.98 " " 2,820.00 " 425.60 395.69 " 3,603.38 " 927.07 " 1,030.08 " " 2,208.66 " " 2,760.83 " " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 380.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 34153850 COLONOSCOPY W/SN RMV T/P/L 45385 750 "$5,444.00" " 2,012.10 " 380.00 " 4,355.20 " 437.00 " 1,718.00 " " 1,081.58 " " 1,718.00 " 444.60 " 3,007.81 " " 1,060.98 " " 2,820.00 " 425.60 395.69 " 3,603.38 " 927.07 " 1,030.08 " " 2,208.66 " " 2,760.83 " " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 380.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 34000956 COLONOSCOPY W/TRAN BALOON DIL 45386 750 "$5,444.00" " 2,012.10 " 776.00 " 4,355.20 " 892.40 " 1,718.00 " " 1,081.58 " " 1,718.00 " 907.92 " 3,007.81 " " 1,060.98 " " 2,820.00 " 869.12 808.05 " 3,603.38 " 927.07 " 1,030.08 " " 2,376.02 " " 2,970.02 " " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 776.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 34100951 COLONOSCOPY W/TRAN BALOON DIL 45386 750 "$5,444.00" " 2,012.10 " 776.00 " 4,355.20 " 892.40 " 1,718.00 " " 1,081.58 " " 1,718.00 " 907.92 " 3,007.81 " " 1,060.98 " " 2,820.00 " 869.12 808.05 " 3,603.38 " 927.07 " 1,030.08 " " 2,376.02 " " 2,970.02 " " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 776.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 34053839 COLONOSCOPY W/ABLATION T/P/L 45388 750 "$5,444.00" " 2,012.10 " 776.00 " 4,860.00 " 892.40 " 1,718.00 " " 1,081.58 " " 1,718.00 " 907.92 " 3,007.81 " " 1,060.98 " " 4,860.00 " 869.12 808.05 " 3,603.38 " 927.07 " 1,030.08 " " 1,089.37 " " 1,361.71 " " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 776.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 34153833 COLONOSCOPY W/ABLATION T/P/L 45388 750 "$5,444.00" " 2,012.10 " 776.00 " 4,860.00 " 892.40 " 1,718.00 " " 1,081.58 " " 1,718.00 " 907.92 " 3,007.81 " " 1,060.98 " " 4,860.00 " 869.12 808.05 " 3,603.38 " 927.07 " 1,030.08 " " 1,089.37 " " 1,361.71 " " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 776.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 34000671 COLONOSCOPY W/ENDO STENT PLC 45389 750 "$26,400.00" " 9,757.44 " 776.00 " 21,120.00 " 892.40 " 1,718.00 " " 5,250.21 " " 1,718.00 " 907.92 " 14,586.00 " " 5,150.21 " " 4,860.00 " 869.12 808.05 " 17,474.16 " " 4,500.18 " " 5,000.20 " 951.02 " 1,188.78 " " 5,125.21 " " 5,150.21 " " 5,000.20 " " 21,120.00 " " 4,575.18 " 776.00 " 17,688.00 " " 4,400.18 " " 10,797.60 " " 19,800.00 " " 10,034.64 " " 11,808.72 " " 5,175.21 " 34055360 COLONOSCOPY W/ENDO MUC RES 45390 750 "$12,828.00" " 4,741.23 " 671.17 " 10,262.40 " 892.40 " 1,718.00 " " 2,548.12 " " 1,718.00 " 907.92 " 7,087.47 " " 2,499.58 " " 4,860.00 " 869.12 808.05 " 8,490.85 " " 2,184.10 " " 2,426.78 " 671.17 838.96 " 2,487.45 " " 2,499.58 " " 2,426.78 " " 10,262.40 " " 2,220.50 " 776.00 " 8,594.76 " " 2,135.57 " " 5,246.65 " " 9,621.00 " " 4,875.92 " " 5,737.96 " " 2,511.72 " 28171242 COLONOSCOPY W/ENDO US EXAM 45391 360 "$5,444.00" " 2,012.10 " 776.00 " 4,355.20 " 892.40 " 1,718.00 " " 1,081.58 " " 1,718.00 " 907.92 " 3,007.81 " " 1,060.98 " " 2,820.00 " 869.12 808.05 " 3,603.38 " 927.07 " 1,030.08 " " 1,541.99 " " 1,927.49 " " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 776.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 34054606 COLONOSCOPY W/ENDO US EXAM 45391 750 "$5,444.00" " 2,012.10 " 776.00 " 4,355.20 " 892.40 " 1,718.00 " " 1,081.58 " " 1,718.00 " 907.92 " 3,007.81 " " 1,060.98 " " 2,820.00 " 869.12 808.05 " 3,603.38 " 927.07 " 1,030.08 " " 1,541.99 " " 1,927.49 " " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 776.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 34054819 UGI COLONOSCOPY W/TRAN FNA/BX 45392 750 "$5,444.00" " 2,012.10 " 776.00 " 4,355.20 " 892.40 " 1,718.00 " " 1,081.58 " " 1,718.00 " 907.92 " 3,007.81 " " 1,060.98 " " 2,820.00 " 869.12 808.05 " 3,603.38 " 927.07 " 1,030.08 " " 1,950.74 " " 2,438.42 " " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 776.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 34055378 COLONOSCOPY W/DECOMPRESSION 45393 750 "$5,444.00" " 2,012.10 " 671.17 " 4,860.00 " 892.40 " 1,718.00 " " 1,081.58 " " 1,718.00 " 907.92 " 3,007.81 " " 1,060.98 " " 4,860.00 " 869.12 808.05 " 3,603.38 " 927.07 " 1,030.08 " 671.17 838.96 " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 776.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 34055386 COLONOSCOPY W/BAND LIGATION 45398 750 "$5,444.00" " 2,012.10 " 671.17 " 4,860.00 " 892.40 " 1,718.00 " " 1,081.58 " " 1,718.00 " 907.92 " 3,007.81 " " 1,060.98 " " 4,860.00 " 869.12 808.05 " 3,603.38 " 927.07 " 1,030.08 " 671.17 838.96 " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 776.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 34055394 UNL PROC:COLON ENDOSCOPY 45399 750 "$4,167.00" " 1,540.12 " - " 4,445.00 " - " 1,469.00 " 827.73 " 1,469.00 " - " 2,302.27 " 811.96 " 4,445.00 " - - " 2,758.14 " 709.48 788.31 - - 808.02 811.96 788.31 " 3,333.60 " 721.30 - " 2,791.89 " 693.71 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 815.90 34154708 UNL PROC:COLON ENDOSCOPY 45399 750 "$4,167.00" " 1,540.12 " - " 4,445.00 " - " 1,469.00 " 827.73 " 1,469.00 " - " 2,302.27 " 811.96 " 4,445.00 " - - " 2,758.14 " 709.48 788.31 - - 808.02 811.96 788.31 " 3,333.60 " 721.30 - " 2,791.89 " 693.71 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 815.90 28171251 LAP PROCTOPEXY W/SIG RESECT 45402 360 "$4,648.00" " 1,717.90 " - " 9,682.51 " - " 2,773.00 " N/A " 2,773.00 " - " 2,568.02 " N/A " 3,067.68 " - N/A " 3,076.51 " - N/A " 7,746.01 " " 9,682.51 " N/A N/A N/A " 3,718.40 " N/A - " 3,114.16 " N/A " 1,901.03 " " 3,486.00 " " 1,766.70 " " 2,079.05 " N/A 34000077 SCLEROTHERAPY 45520 750 "$4,167.00" " 1,540.12 " 33.09 " 3,333.60 " 38.05 " 1,469.00 " 827.73 " 1,469.00 " 38.72 " 2,302.27 " 811.96 845.00 37.06 34.46 " 2,758.14 " 709.48 788.31 393.78 492.23 808.02 811.96 788.31 " 3,333.60 " 721.30 33.09 " 2,791.89 " 693.71 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 815.90 28171269 CORRECT RECTAL PROLAPSE 45541 360 "$12,828.00" " 4,741.23 " 776.00 " 10,262.40 " 892.40 " 1,718.00 " " 2,548.12 " " 1,718.00 " 907.92 " 7,087.47 " " 2,499.58 " " 8,466.48 " 869.12 808.05 " 8,490.85 " " 2,184.10 " " 2,426.78 " " 4,278.82 " " 5,348.53 " " 2,487.45 " " 2,499.58 " " 2,426.78 " " 10,262.40 " " 2,220.50 " 776.00 " 8,594.76 " " 2,135.57 " " 5,246.65 " " 9,621.00 " " 4,875.92 " " 5,737.96 " " 2,511.72 " 28171277 REPAIR RECTUM/REMOVE SIGMOID 45550 360 "$15,240.00" " 5,632.70 " - " 12,192.00 " - " 10,530.84 " N/A " 10,530.84 " - " 8,420.10 " N/A " 10,058.40 " - N/A " 10,087.36 " - N/A " 7,138.86 " " 8,923.57 " N/A N/A N/A " 12,192.00 " N/A - " 10,210.80 " N/A " 6,233.16 " " 11,430.00 " " 5,792.72 " " 6,816.85 " N/A 28176422 REPAIR OF RECTOCELE 45560 360 "$12,828.00" " 4,741.23 " 776.00 " 10,262.40 " 892.40 " 1,718.00 " " 2,548.12 " " 1,718.00 " 907.92 " 7,087.47 " " 2,499.58 " " 2,820.00 " 869.12 808.05 " 8,490.85 " " 2,184.10 " " 2,426.78 " " 2,208.66 " " 2,760.83 " " 2,487.45 " " 2,499.58 " " 2,426.78 " " 10,262.40 " " 2,220.50 " 776.00 " 8,594.76 " " 2,135.57 " " 5,246.65 " " 9,621.00 " " 4,875.92 " " 5,737.96 " " 2,511.72 " 34000018 ENDO RMV RECTAL OBSTRUCTION 45915 750 "$5,444.00" " 2,012.10 " 776.00 " 4,355.20 " 892.40 " 1,469.00 " " 1,081.58 " " 1,469.00 " 907.92 " 3,007.81 " " 1,060.98 " " 1,775.00 " 869.12 808.05 " 3,603.38 " 927.07 " 1,030.08 " " 1,649.49 " " 2,061.86 " " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 776.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 34100012 ENDO RMV RECTAL OBSTRUCTION 45915 750 "$5,444.00" " 2,012.10 " 776.00 " 4,355.20 " 892.40 " 1,469.00 " " 1,081.58 " " 1,469.00 " 907.92 " 3,007.81 " " 1,060.98 " " 1,775.00 " 869.12 808.05 " 3,603.38 " 927.07 " 1,030.08 " " 1,649.49 " " 2,061.86 " " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 776.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 28171285 SURG DX EXAM ANORECTAL 45990 360 "$12,828.00" " 4,741.23 " 776.00 " 10,262.40 " 892.40 " 1,718.00 " " 2,548.12 " " 1,718.00 " 907.92 " 7,087.47 " " 2,499.58 " " 2,820.00 " 869.12 808.05 " 8,490.85 " " 2,184.10 " " 2,426.78 " " 2,368.76 " " 2,960.95 " " 2,487.45 " " 2,499.58 " " 2,426.78 " " 10,262.40 " " 2,220.50 " 776.00 " 8,594.76 " " 2,135.57 " " 5,246.65 " " 9,621.00 " " 4,875.92 " " 5,737.96 " " 2,511.72 " 34001570 UNL PROC:RECTUM 45999 750 "$4,167.00" " 1,540.12 " - " 3,333.60 " - " 2,879.40 " 827.73 " 2,879.40 " - " 2,302.27 " 811.96 " 2,750.22 " - - " 2,758.14 " 709.48 788.31 56.26 70.32 808.02 811.96 788.31 " 3,333.60 " 721.30 - " 2,791.89 " 693.71 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 815.90 28171293 PLACEMENT OF SETON 46020 360 "$12,828.00" " 4,741.23 " 776.00 " 10,262.40 " 892.40 " 2,773.00 " " 2,548.12 " " 2,773.00 " 907.92 " 7,087.47 " " 2,499.58 " " 3,545.00 " 869.12 808.05 " 8,490.85 " " 2,184.10 " " 2,426.78 " " 2,650.99 " " 3,313.74 " " 2,487.45 " " 2,499.58 " " 2,426.78 " " 10,262.40 " " 2,220.50 " 776.00 " 8,594.76 " " 2,135.57 " " 5,246.65 " " 9,621.00 " " 4,875.92 " " 5,737.96 " " 2,511.72 " 28171307 I&D RECTAL ABSCESS 46040 360 "$5,444.00" " 2,012.10 " 776.00 " 4,355.20 " 892.40 " 2,773.00 " " 1,081.58 " " 2,773.00 " 907.92 " 3,007.81 " " 1,060.98 " " 3,545.00 " 869.12 808.05 " 3,603.38 " 927.07 " 1,030.08 " " 2,532.97 " " 3,166.21 " " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 776.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 37089915 I&D RECTAL ABSCESS 46040 450 "$5,444.00" " 2,012.10 " 776.00 " 4,355.20 " 892.40 " 2,773.00 " " 1,081.58 " " 2,773.00 " 907.92 " 3,007.81 " " 1,060.98 " " 3,545.00 " 869.12 808.05 " 3,603.38 " 927.07 " 1,030.08 " " 2,532.97 " " 3,166.21 " " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 776.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 28171315 I&D ANAL ABSCESS SPFL 46050 360 "$4,167.00" " 1,540.12 " 693.71 " 3,333.60 " 837.20 " 1,469.00 " 827.73 " 1,469.00 " 851.76 " 2,302.27 " 811.96 " 1,775.00 " 815.36 758.07 " 2,758.14 " 709.48 788.31 " 1,649.49 " " 2,061.86 " 808.02 811.96 788.31 " 3,333.60 " 721.30 728.00 " 2,791.89 " 693.71 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 815.90 37003808 I&D ANAL ABSCESS SPFL 46050 450 "$4,167.00" " 1,540.12 " 693.71 " 3,333.60 " 837.20 " 1,469.00 " 827.73 " 1,469.00 " 851.76 " 2,302.27 " 811.96 " 1,775.00 " 815.36 758.07 " 2,758.14 " 709.48 788.31 " 1,649.49 " " 2,061.86 " 808.02 811.96 788.31 " 3,333.60 " 721.30 728.00 " 2,791.89 " 693.71 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 815.90 28171323 INCISION OF RECTAL ABSCESS 46060 360 "$12,828.00" " 4,741.23 " 489.00 " 10,262.40 " 562.35 " 1,718.00 " " 2,548.12 " " 1,718.00 " 572.13 " 7,087.47 " " 2,499.58 " " 2,820.00 " 547.68 509.20 " 8,490.85 " " 2,184.10 " " 2,426.78 " " 2,208.66 " " 2,760.83 " " 2,487.45 " " 2,499.58 " " 2,426.78 " " 10,262.40 " " 2,220.50 " 489.00 " 8,594.76 " " 2,135.57 " " 5,246.65 " " 9,621.00 " " 4,875.92 " " 5,737.96 " " 2,511.72 " 28171331 SPHINCTERECTOMY 46080 360 "$12,828.00" " 4,741.23 " 469.00 " 10,262.40 " 539.35 " 2,773.00 " " 2,548.12 " " 2,773.00 " 548.73 " 7,087.47 " " 2,499.58 " " 3,545.00 " 525.28 488.37 " 8,490.85 " " 2,184.10 " " 2,426.78 " " 2,532.97 " " 3,166.21 " " 2,487.45 " " 2,499.58 " " 2,426.78 " " 10,262.40 " " 2,220.50 " 469.00 " 8,594.76 " " 2,135.57 " " 5,246.65 " " 9,621.00 " " 4,875.92 " " 5,737.96 " " 2,511.72 " 34000166 SPHINCTERECTOMY 46080 750 "$12,828.00" " 4,741.23 " 469.00 " 10,262.40 " 539.35 " 2,773.00 " " 2,548.12 " " 2,773.00 " 548.73 " 7,087.47 " " 2,499.58 " " 3,545.00 " 525.28 488.37 " 8,490.85 " " 2,184.10 " " 2,426.78 " " 2,532.97 " " 3,166.21 " " 2,487.45 " " 2,499.58 " " 2,426.78 " " 10,262.40 " " 2,220.50 " 469.00 " 8,594.76 " " 2,135.57 " " 5,246.65 " " 9,621.00 " " 4,875.92 " " 5,737.96 " " 2,511.72 " 37090344 INCISION EXTERNAL HEMORRHOID 46083 450 "$1,397.00" 516.33 232.61 " 1,775.00 " 892.40 965.33 277.55 965.33 907.92 771.84 272.26 " 1,775.00 " 869.12 808.05 924.67 237.90 264.33 393.78 492.23 270.94 272.26 264.33 " 1,117.60 " 241.86 776.00 935.99 232.61 571.37 " 1,047.75 " 531.00 624.88 273.58 28171340 EXCISE ANAL EXT TAG/PAPILLA 46220 360 "$5,444.00" " 2,012.10 " 776.00 " 4,355.20 " 892.40 " 1,469.00 " " 1,081.58 " " 1,469.00 " 907.92 " 3,007.81 " " 1,060.98 " " 1,775.00 " 869.12 808.05 " 3,603.38 " 927.07 " 1,030.08 " " 1,649.49 " " 2,061.86 " " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 776.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 28171358 REMOVAL ANAL TAGS 46230 360 "$12,828.00" " 4,741.23 " 776.00 " 10,262.40 " 892.40 " 1,469.00 " " 2,548.12 " " 1,469.00 " 907.92 " 7,087.47 " " 2,499.58 " " 1,775.00 " 869.12 808.05 " 8,490.85 " " 2,184.10 " " 2,426.78 " " 1,649.49 " " 2,061.86 " " 2,487.45 " " 2,499.58 " " 2,426.78 " " 10,262.40 " " 2,220.50 " 776.00 " 8,594.76 " " 2,135.57 " " 5,246.65 " " 9,621.00 " " 4,875.92 " " 5,737.96 " " 2,511.72 " 37003727 REMOVAL ANAL TAGS 46230 450 "$12,828.00" " 4,741.23 " 776.00 " 10,262.40 " 892.40 " 1,469.00 " " 2,548.12 " " 1,469.00 " 907.92 " 7,087.47 " " 2,499.58 " " 1,775.00 " 869.12 808.05 " 8,490.85 " " 2,184.10 " " 2,426.78 " " 1,649.49 " " 2,061.86 " " 2,487.45 " " 2,499.58 " " 2,426.78 " " 10,262.40 " " 2,220.50 " 776.00 " 8,594.76 " " 2,135.57 " " 5,246.65 " " 9,621.00 " " 4,875.92 " " 5,737.96 " " 2,511.72 " 28171366 REMOVE INT/EXT HEM 1 GROUP 46255 360 "$12,828.00" " 4,741.23 " 883.00 " 10,262.40 " " 1,015.45 " " 2,773.00 " " 2,548.12 " " 2,773.00 " " 1,033.11 " " 7,087.47 " " 2,499.58 " " 3,545.00 " 988.96 919.47 " 8,490.85 " " 2,184.10 " " 2,426.78 " " 2,532.97 " " 3,166.21 " " 2,487.45 " " 2,499.58 " " 2,426.78 " " 10,262.40 " " 2,220.50 " 883.00 " 8,594.76 " " 2,135.57 " " 5,246.65 " " 9,621.00 " " 4,875.92 " " 5,737.96 " " 2,511.72 " 28171374 REMOVE IN/EX HEM GROUPS 2+ 46260 360 "$12,828.00" " 4,741.23 " 776.00 " 10,262.40 " 892.40 " 2,773.00 " " 2,548.12 " " 2,773.00 " 907.92 " 7,087.47 " " 2,499.58 " " 3,545.00 " 869.12 808.05 " 8,490.85 " " 2,184.10 " " 2,426.78 " " 2,532.97 " " 3,166.21 " " 2,487.45 " " 2,499.58 " " 2,426.78 " " 10,262.40 " " 2,220.50 " 776.00 " 8,594.76 " " 2,135.57 " " 5,246.65 " " 9,621.00 " " 4,875.92 " " 5,737.96 " " 2,511.72 " 28171382 REMOVE ANAL FIST SUBQ 46270 360 "$12,828.00" " 4,741.23 " 725.00 " 10,262.40 " 833.75 " 2,773.00 " " 2,548.12 " " 2,773.00 " 848.25 " 7,087.47 " " 2,499.58 " " 3,545.00 " 812.00 754.94 " 8,490.85 " " 2,184.10 " " 2,426.78 " " 2,532.97 " " 3,166.21 " " 2,487.45 " " 2,499.58 " " 2,426.78 " " 10,262.40 " " 2,220.50 " 725.00 " 8,594.76 " " 2,135.57 " " 5,246.65 " " 9,621.00 " " 4,875.92 " " 5,737.96 " " 2,511.72 " 28171391 REMOVE ANAL FIST INTER 46275 360 "$12,828.00" " 4,741.23 " 776.00 " 10,262.40 " 892.40 " 2,773.00 " " 2,548.12 " " 2,773.00 " 907.92 " 7,087.47 " " 2,499.58 " " 3,545.00 " 869.12 808.05 " 8,490.85 " " 2,184.10 " " 2,426.78 " " 2,532.97 " " 3,166.21 " " 2,487.45 " " 2,499.58 " " 2,426.78 " " 10,262.40 " " 2,220.50 " 776.00 " 8,594.76 " " 2,135.57 " " 5,246.65 " " 9,621.00 " " 4,875.92 " " 5,737.96 " " 2,511.72 " 28171404 REMOVE ANAL FIST COMPLEX 46280 360 "$12,828.00" " 4,741.23 " 776.00 " 10,262.40 " 892.40 " 3,326.00 " " 2,548.12 " " 3,326.00 " 907.92 " 7,087.47 " " 2,499.58 " " 4,860.00 " 869.12 808.05 " 8,490.85 " " 2,184.10 " " 2,426.78 " " 3,120.10 " " 3,900.12 " " 2,487.45 " " 2,499.58 " " 2,426.78 " " 10,262.40 " " 2,220.50 " 776.00 " 8,594.76 " " 2,135.57 " " 5,246.65 " " 9,621.00 " " 4,875.92 " " 5,737.96 " " 2,511.72 " 37090352 REMOVAL HEMORRHOID CLOT 46320 450 "$5,444.00" " 2,012.10 " 776.00 " 4,355.20 " 892.40 " 1,469.00 " " 1,081.58 " " 1,469.00 " 907.92 " 3,007.81 " " 1,060.98 " " 1,775.00 " 869.12 808.05 " 3,603.38 " 927.07 " 1,030.08 " " 1,649.49 " " 2,061.86 " " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 776.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 28171412 CHEMODENERVATION ANAL MUSC 46505 360 "$5,444.00" " 2,012.10 " 776.00 " 4,355.20 " 892.40 " 1,469.00 " " 1,081.58 " " 1,469.00 " 907.92 " 3,007.81 " " 1,060.98 " " 1,775.00 " 869.12 808.05 " 3,603.38 " 927.07 " 1,030.08 " " 1,220.27 " " 1,525.34 " " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 776.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 37001414 DX ANOSCOPY 46600 450 $588.00 217.32 20.00 " 1,469.00 " 23.00 " 1,469.00 " 117.61 " 1,469.00 " 23.40 324.87 115.37 845.00 22.40 20.83 389.20 100.81 112.01 281.27 351.59 114.81 115.37 112.01 470.40 102.49 20.00 393.96 98.57 240.49 441.00 223.50 263.01 115.93 28175469 ANOSCOPY FOR BIOPSY 46606 360 "$5,444.00" " 2,012.10 " 776.00 " 5,102.27 " 892.40 " 1,469.00 " " 1,081.58 " " 1,469.00 " 907.92 " 3,007.81 " " 1,060.98 " " 3,593.04 " 869.12 808.05 " 3,603.38 " 927.07 " 1,030.08 " " 4,081.82 " " 5,102.27 " " 1,055.83 " " 1,060.98 " " 1,030.08 " " 4,355.20 " 942.52 776.00 " 3,647.48 " 906.47 " 2,226.60 " " 4,083.00 " " 2,069.26 " " 2,435.10 " " 1,066.13 " 28176431 REPAIR OF ANAL SPHINCTER 46750 360 "$12,828.00" " 4,741.23 " 776.00 " 10,262.40 " 892.40 " 2,773.00 " " 2,548.12 " " 2,773.00 " 907.92 " 7,087.47 " " 2,499.58 " " 3,545.00 " 869.12 808.05 " 8,490.85 " " 2,184.10 " " 2,426.78 " " 2,532.97 " " 3,166.21 " " 2,487.45 " " 2,499.58 " " 2,426.78 " " 10,262.40 " " 2,220.50 " 776.00 " 8,594.76 " " 2,135.57 " " 5,246.65 " " 9,621.00 " " 4,875.92 " " 5,737.96 " " 2,511.72 " 28171421 EXCISION OF ANAL LESION(S) 46922 360 "$12,828.00" " 4,741.23 " 776.00 " 10,262.40 " 892.40 " 1,469.00 " " 2,548.12 " " 1,469.00 " 907.92 " 7,087.47 " " 2,499.58 " " 1,775.00 " 869.12 808.05 " 8,490.85 " " 2,184.10 " " 2,426.78 " " 1,649.49 " " 2,061.86 " " 2,487.45 " " 2,499.58 " " 2,426.78 " " 10,262.40 " " 2,220.50 " 776.00 " 8,594.76 " " 2,135.57 " " 5,246.65 " " 9,621.00 " " 4,875.92 " " 5,737.96 " " 2,511.72 " 34000000 HEMORRHOIDECTOMY SNG LIG WO IG 46945 750 "$12,828.00" " 4,741.23 " 618.80 " 10,262.40 " 892.40 " 1,469.00 " " 2,548.12 " " 1,469.00 " 907.92 " 7,087.47 " " 2,499.58 " " 8,466.48 " 869.12 808.05 " 8,490.85 " " 2,184.10 " " 2,426.78 " 618.80 773.50 " 2,487.45 " " 2,499.58 " " 2,426.78 " " 10,262.40 " " 2,220.50 " 776.00 " 8,594.76 " " 2,135.57 " " 5,246.65 " " 9,621.00 " " 4,875.92 " " 5,737.96 " " 2,511.72 " 28171439 INT HRHC TRANAL DARTLZJ 2+ 46948 360 "$12,828.00" " 4,741.23 " 776.00 " 10,262.40 " 892.40 " 8,864.15 " " 2,548.12 " " 8,864.15 " 907.92 " 7,087.47 " " 2,499.58 " " 6,540.00 " 869.12 808.05 " 8,490.85 " " 2,184.10 " " 2,426.78 " " 2,494.15 " " 3,117.69 " " 2,487.45 " " 2,499.58 " " 2,426.78 " " 10,262.40 " " 2,220.50 " 776.00 " 8,594.76 " " 2,135.57 " " 5,246.65 " " 9,621.00 " " 4,875.92 " " 5,737.96 " " 2,511.72 " 34054541 BX LIVER/NDL; PERCUTANEOUS 47000 750 "$7,387.00" " 2,730.24 " 278.00 " 5,909.60 " 319.70 " 1,469.00 " " 1,467.55 " " 1,469.00 " 325.26 " 4,081.32 " " 1,439.60 " " 1,775.00 " 311.36 289.48 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 278.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 67709772 BX NEEDLE LIVER 47000 350 "$7,387.00" " 2,730.24 " 278.00 " 5,909.60 " 319.70 " 1,469.00 " " 1,467.55 " " 1,469.00 " 325.26 " 4,081.32 " " 1,439.60 " " 1,775.00 " 311.36 289.48 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 278.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 80309775 BX NEEDLE LIVER 47000 320 "$7,387.00" " 2,730.24 " 278.00 " 5,909.60 " 319.70 " 1,469.00 " " 1,467.55 " " 1,469.00 " 325.26 " 4,081.32 " " 1,439.60 " " 1,775.00 " 311.36 289.48 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 278.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 80509774 BX NEEDLE LIVER 47000 402 "$7,387.00" " 2,730.24 " 278.00 " 5,909.60 " 319.70 " 1,469.00 " " 1,467.55 " " 1,469.00 " 325.26 " 4,081.32 " " 1,439.60 " " 1,775.00 " 311.36 289.48 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 278.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 80609779 BX NEEDLE LIVER 47000 350 "$7,387.00" " 2,730.24 " 278.00 " 5,909.60 " 319.70 " 1,469.00 " " 1,467.55 " " 1,469.00 " 325.26 " 4,081.32 " " 1,439.60 " " 1,775.00 " 311.36 289.48 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 278.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28171447 LAPAROSCOPE PROCEDURE LIVER 47379 360 "$26,567.00" " 9,819.16 " - " 21,253.60 " - " 3,604.00 " " 5,277.62 " " 3,604.00 " - " 14,678.27 " " 5,177.09 " " 17,534.22 " - - " 17,584.70 " " 4,523.67 " " 5,026.30 " - - " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " - " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 67708555 ABLATE PERC LIVER RF 47382 350 "$26,567.00" " 9,819.16 " 776.00 " 21,253.60 " 892.40 " 3,326.00 " " 5,277.62 " " 3,326.00 " 907.92 " 14,678.27 " " 5,177.09 " " 17,534.22 " 869.12 808.05 " 17,584.70 " " 4,523.67 " " 5,026.30 " " 4,586.14 " " 5,732.67 " " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " 776.00 " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 80308558 ABLATE LIVER TUMORS PERC +1 47382 320 "$26,567.00" " 9,819.16 " 776.00 " 21,253.60 " 892.40 " 3,326.00 " " 5,277.62 " " 3,326.00 " 907.92 " 14,678.27 " " 5,177.09 " " 17,534.22 " 869.12 808.05 " 17,584.70 " " 4,523.67 " " 5,026.30 " " 4,586.14 " " 5,732.67 " " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " 776.00 " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 80508557 ABLATE PERC LIVER RF 47382 402 "$26,567.00" " 9,819.16 " 776.00 " 21,253.60 " 892.40 " 3,326.00 " " 5,277.62 " " 3,326.00 " 907.92 " 14,678.27 " " 5,177.09 " " 17,534.22 " 869.12 808.05 " 17,584.70 " " 4,523.67 " " 5,026.30 " " 4,586.14 " " 5,732.67 " " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " 776.00 " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 80608551 ABLATE LIVER TUMORS PERC 1+ 47382 350 "$26,567.00" " 9,819.16 " 776.00 " 21,253.60 " 892.40 " 3,326.00 " " 5,277.62 " " 3,326.00 " 907.92 " 14,678.27 " " 5,177.09 " " 17,534.22 " 869.12 808.05 " 17,584.70 " " 4,523.67 " " 5,026.30 " " 4,586.14 " " 5,732.67 " " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " 776.00 " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 67709918 PERC CRYOBLATION LIVER 47383 350 "$26,567.00" " 9,819.16 " 776.00 " 21,253.60 " 892.40 " 4,656.00 " " 5,277.62 " " 4,656.00 " 907.92 " 14,678.27 " " 5,177.09 " " 6,576.00 " 869.12 808.05 " 17,584.70 " " 4,523.67 " " 5,026.30 " " 14,694.66 " " 18,368.33 " " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " 776.00 " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 80609914 PERC CRYOBLATION LIVER 47383 350 "$26,567.00" " 9,819.16 " 776.00 " 21,253.60 " 892.40 " 4,656.00 " " 5,277.62 " " 4,656.00 " 907.92 " 14,678.27 " " 5,177.09 " " 6,576.00 " 869.12 808.05 " 17,584.70 " " 4,523.67 " " 5,026.30 " " 14,694.66 " " 18,368.33 " " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " 776.00 " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 67709900 INCISION GALLBLADDER 47490 350 "$16,713.00" " 6,177.12 " - " 13,370.40 " - " 11,548.68 " " 3,318.47 " " 11,548.68 " - " 9,233.93 " " 3,255.26 " " 11,030.58 " - - " 11,062.33 " " 2,844.41 " " 3,160.45 " " 2,700.61 " " 3,375.76 " " 3,239.46 " " 3,255.26 " " 3,160.45 " " 13,370.40 " " 2,891.81 " - " 11,197.71 " " 2,781.20 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,271.07 " 80309902 INCISION GALLBLADDER 47490 320 "$16,713.00" " 6,177.12 " - " 13,370.40 " - " 11,548.68 " " 3,318.47 " " 11,548.68 " - " 9,233.93 " " 3,255.26 " " 11,030.58 " - - " 11,062.33 " " 2,844.41 " " 3,160.45 " " 2,700.61 " " 3,375.76 " " 3,239.46 " " 3,255.26 " " 3,160.45 " " 13,370.40 " " 2,891.81 " - " 11,197.71 " " 2,781.20 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,271.07 " 80609906 INCISION GALLBLADDER 47490 350 "$16,713.00" " 6,177.12 " - " 13,370.40 " - " 11,548.68 " " 3,318.47 " " 11,548.68 " - " 9,233.93 " " 3,255.26 " " 11,030.58 " - - " 11,062.33 " " 2,844.41 " " 3,160.45 " " 2,700.61 " " 3,375.76 " " 3,239.46 " " 3,255.26 " " 3,160.45 " " 13,370.40 " " 2,891.81 " - " 11,197.71 " " 2,781.20 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,271.07 " 80135238 INJ CHOLANGIOGRAM EXIST 47531 320 "$16,713.00" " 6,177.12 " 776.00 " 13,370.40 " 892.40 " 11,548.68 " " 3,318.47 " " 11,548.68 " 907.92 " 9,233.93 " " 3,255.26 " " 1,775.00 " 869.12 808.05 " 11,062.33 " " 2,844.41 " " 3,160.45 " " 2,009.30 " " 2,511.62 " " 3,239.46 " " 3,255.26 " " 3,160.45 " " 13,370.40 " " 2,891.81 " 776.00 " 11,197.71 " " 2,781.20 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,271.07 " 80335237 INJ CHOLANGIOGRAM EXIST 47531 320 "$16,713.00" " 6,177.12 " 776.00 " 13,370.40 " 892.40 " 11,548.68 " " 3,318.47 " " 11,548.68 " 907.92 " 9,233.93 " " 3,255.26 " " 1,775.00 " 869.12 808.05 " 11,062.33 " " 2,844.41 " " 3,160.45 " " 2,009.30 " " 2,511.62 " " 3,239.46 " " 3,255.26 " " 3,160.45 " " 13,370.40 " " 2,891.81 " 776.00 " 11,197.71 " " 2,781.20 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,271.07 " 80335245 INJ CHOLANGIOGRAM NEW 47532 320 "$16,713.00" " 6,177.12 " 776.00 " 13,370.40 " 892.40 " 11,548.68 " " 3,318.47 " " 11,548.68 " 907.92 " 9,233.93 " " 3,255.26 " " 6,576.00 " 869.12 808.05 " 11,062.33 " " 2,844.41 " " 3,160.45 " " 4,427.56 " " 5,534.45 " " 3,239.46 " " 3,255.26 " " 3,160.45 " " 13,370.40 " " 2,891.81 " 776.00 " 11,197.71 " " 2,781.20 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,271.07 " 80335261 PLCMT BILIARY DRAIN CATH EXT 47533 320 "$16,713.00" " 6,177.12 " 776.00 " 13,370.40 " 892.40 " 11,548.68 " " 3,318.47 " " 11,548.68 " 907.92 " 9,233.93 " " 3,255.26 " " 6,576.00 " 869.12 808.05 " 11,062.33 " " 2,844.41 " " 3,160.45 " " 7,210.07 " " 9,012.59 " " 3,239.46 " " 3,255.26 " " 3,160.45 " " 13,370.40 " " 2,891.81 " 776.00 " 11,197.71 " " 2,781.20 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,271.07 " 80335270 PLCMT BILIARY DRAINAGE CATH 47534 320 "$16,713.00" " 6,177.12 " 776.00 " 13,370.40 " 892.40 " 11,548.68 " " 3,318.47 " " 11,548.68 " 907.92 " 9,233.93 " " 3,255.26 " " 6,576.00 " 869.12 808.05 " 11,062.33 " " 2,844.41 " " 3,160.45 " " 8,895.85 " " 11,119.81 " " 3,239.46 " " 3,255.26 " " 3,160.45 " " 13,370.40 " " 2,891.81 " 776.00 " 11,197.71 " " 2,781.20 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,271.07 " 80335423 CONVERSION EXT BIL DRG CATH 47535 320 "$16,713.00" " 6,177.12 " 776.00 " 13,370.40 " 892.40 " 11,548.68 " " 3,318.47 " " 11,548.68 " 907.92 " 9,233.93 " " 3,255.26 " " 6,576.00 " 869.12 808.05 " 11,062.33 " " 2,844.41 " " 3,160.45 " " 5,954.02 " " 7,442.53 " " 3,239.46 " " 3,255.26 " " 3,160.45 " " 13,370.40 " " 2,891.81 " 776.00 " 11,197.71 " " 2,781.20 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,271.07 " 67735439 EXCHANGE BILIARY DRG CATH 47536 320 "$16,713.00" " 6,177.12 " 776.00 " 13,370.40 " 892.40 " 11,548.68 " " 3,318.47 " " 11,548.68 " 907.92 " 9,233.93 " " 3,255.26 " " 6,576.00 " 869.12 808.05 " 11,062.33 " " 2,844.41 " " 3,160.45 " " 4,385.26 " " 5,481.57 " " 3,239.46 " " 3,255.26 " " 3,160.45 " " 13,370.40 " " 2,891.81 " 776.00 " 11,197.71 " " 2,781.20 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,271.07 " 80335431 EXCHANGE BILIARY DRG CATH 47536 320 "$16,713.00" " 6,177.12 " 776.00 " 13,370.40 " 892.40 " 11,548.68 " " 3,318.47 " " 11,548.68 " 907.92 " 9,233.93 " " 3,255.26 " " 6,576.00 " 869.12 808.05 " 11,062.33 " " 2,844.41 " " 3,160.45 " " 4,385.26 " " 5,481.57 " " 3,239.46 " " 3,255.26 " " 3,160.45 " " 13,370.40 " " 2,891.81 " 776.00 " 11,197.71 " " 2,781.20 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,271.07 " 80635435 EXCHANGE BILIARY DRG CATH 47536 350 "$16,713.00" " 6,177.12 " 776.00 " 13,370.40 " 892.40 " 11,548.68 " " 3,318.47 " " 11,548.68 " 907.92 " 9,233.93 " " 3,255.26 " " 6,576.00 " 869.12 808.05 " 11,062.33 " " 2,844.41 " " 3,160.45 " " 4,385.26 " " 5,481.57 " " 3,239.46 " " 3,255.26 " " 3,160.45 " " 13,370.40 " " 2,891.81 " 776.00 " 11,197.71 " " 2,781.20 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,271.07 " 80335440 REMOVE BILIARY DRG CATH 47537 320 "$4,250.00" " 1,570.80 " 707.33 " 3,400.00 " 892.40 " 2,936.75 " 843.97 " 2,936.75 " 907.92 " 2,348.13 " 827.89 " 1,775.00 " 869.12 808.05 " 2,813.08 " 723.40 803.78 " 2,175.19 " " 2,718.99 " 823.87 827.89 803.78 " 3,400.00 " 735.46 776.00 " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 80335458 PLCMT STENT BILE DUCT PERC 47538 320 "$26,567.00" " 9,819.16 " 776.00 " 42,610.59 " 892.40 " 18,357.80 " " 5,277.62 " " 18,357.80 " 907.92 " 14,678.27 " " 5,177.09 " " 6,576.00 " 869.12 808.05 " 17,584.70 " " 4,523.67 " " 5,026.30 " " 34,088.47 " " 42,610.59 " " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " 776.00 " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 80335466 PLCMT STENT BILE DUCT WO/CATH 47539 320 "$26,567.00" " 9,819.16 " 776.00 " 46,612.95 " 892.40 " 18,357.80 " " 5,277.62 " " 18,357.80 " 907.92 " 14,678.27 " " 5,177.09 " " 6,576.00 " 869.12 808.05 " 17,584.70 " " 4,523.67 " " 5,026.30 " " 37,290.36 " " 46,612.95 " " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " 776.00 " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 80335474 PLCMT STENT BILE DUCT W/CATH 47540 320 "$26,567.00" " 9,819.16 " 776.00 " 48,499.79 " 892.40 " 18,357.80 " " 5,277.62 " " 18,357.80 " 907.92 " 14,678.27 " " 5,177.09 " " 6,576.00 " 869.12 808.05 " 17,584.70 " " 4,523.67 " " 5,026.30 " " 38,799.83 " " 48,499.79 " " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " 776.00 " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 80335482 PLCMT ACCESS BIL TREE SM BWL 47541 320 "$16,713.00" " 6,177.12 " 776.00 " 13,370.40 " 892.40 " 11,548.68 " " 3,318.47 " " 11,548.68 " 907.92 " 9,233.93 " " 3,255.26 " " 6,576.00 " 869.12 808.05 " 11,062.33 " " 2,844.41 " " 3,160.45 " " 6,370.30 " " 7,962.88 " " 3,239.46 " " 3,255.26 " " 3,160.45 " " 13,370.40 " " 2,891.81 " 776.00 " 11,197.71 " " 2,781.20 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,271.07 " 80335491 DILATE BILIARY DUCT/AMPULLA 47542 320 "$4,928.00" " 1,821.39 " - " 3,942.40 " 125.71 " 3,405.25 " - " 3,405.25 " 127.89 " 2,722.72 " - " 3,252.48 " 122.43 113.82 " 3,261.84 " - - " 2,793.20 " " 3,491.50 " - - - " 3,942.40 " - 109.31 " 3,301.76 " - " 2,015.55 " " 3,696.00 " " 1,873.13 " " 2,204.29 " - 80335555 BX ENDOLUMINAL BILIARY TREE 47543 320 "$2,763.00" " 1,021.20 " - " 8,883.27 " 157.91 " 1,909.23 " - " 1,909.23 " 160.65 " 1,526.56 " - " 1,823.58 " 153.79 142.98 " 1,828.83 " - - " 7,106.62 " " 8,883.27 " - - - " 2,210.40 " - 137.31 " 1,851.21 " - " 1,130.07 " " 2,072.25 " " 1,050.22 " " 1,235.89 " - 80635559 BX ENDOLUMINAL BILIARY TREE 47543 350 "$2,763.00" " 1,021.20 " - " 8,883.27 " 157.91 " 1,909.23 " - " 1,909.23 " 160.65 " 1,526.56 " - " 1,823.58 " 153.79 142.98 " 1,828.83 " - - " 7,106.62 " " 8,883.27 " - - - " 2,210.40 " - 137.31 " 1,851.21 " - " 1,130.07 " " 2,072.25 " " 1,050.22 " " 1,235.89 " - 80335253 REMOVE DUCT GLBLDR CALCULI 47544 320 $591.00 218.43 - " 5,513.35 " 202.34 408.38 - 408.38 205.86 326.53 - 390.06 197.06 183.22 391.18 - - " 4,410.68 " " 5,513.35 " - - - 472.80 - 175.95 395.97 - 241.72 443.25 224.64 264.35 - 80308523 BILIARY ENDOSCOPY W/O STENT 47555 320 "$16,713.00" " 6,177.12 " - " 13,370.40 " - " 2,773.00 " " 3,318.47 " " 2,773.00 " - " 9,233.93 " " 3,255.26 " " 3,545.00 " - - " 11,062.33 " " 2,844.41 " " 3,160.45 " " 2,532.97 " " 3,166.21 " " 3,239.46 " " 3,255.26 " " 3,160.45 " " 13,370.40 " " 2,891.81 " - " 11,197.71 " " 2,781.20 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,271.07 " 80306962 BILIARY ENDOSCOPY W/STENT 47556 320 "$26,567.00" " 9,819.16 " 225.00 " 21,253.60 " 258.75 " 4,656.00 " " 5,277.62 " " 4,656.00 " 263.25 " 14,678.27 " " 5,177.09 " " 6,576.00 " 252.00 234.29 " 17,584.70 " " 4,523.67 " " 5,026.30 " " 10,107.68 " " 12,634.60 " " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " 225.00 " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 28171455 LAPAROSCOPIC CHOLECYSTECTOMY 47562 360 "$26,567.00" " 9,819.16 " 776.00 " 21,253.60 " 892.40 " 3,604.00 " " 5,277.62 " " 3,604.00 " 907.92 " 14,678.27 " " 5,177.09 " " 7,248.00 " 869.12 808.05 " 17,584.70 " " 4,523.67 " " 5,026.30 " " 4,937.34 " " 6,171.67 " " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " 776.00 " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 28171463 LAPARO CHOLECYSTECTOMY/GRAPH 47563 360 "$26,567.00" " 9,819.16 " 776.00 " 21,253.60 " 892.40 " 3,604.00 " " 5,277.62 " " 3,604.00 " 907.92 " 14,678.27 " " 5,177.09 " " 7,248.00 " 869.12 808.05 " 17,584.70 " " 4,523.67 " " 5,026.30 " " 4,937.34 " " 6,171.67 " " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " 776.00 " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 28176449 LAPARO CHOLECYSTECTOMY/EXPLR 47564 360 "$26,567.00" " 9,819.16 " 776.00 " 21,253.60 " 892.40 " 4,435.00 " " 5,277.62 " " 4,435.00 " 907.92 " 14,678.27 " " 5,177.09 " " 7,248.00 " 869.12 808.05 " 17,584.70 " " 4,523.67 " " 5,026.30 " " 4,509.02 " " 5,636.27 " " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " 776.00 " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 28175477 CHOLECYSTECTOMY W CHOLANGRAPHY 47605 360 "$4,426.00" " 1,635.85 " - " 5,906.01 " - " 3,604.00 " N/A " 3,604.00 " - " 2,445.37 " N/A " 2,921.16 " - N/A " 2,929.57 " - N/A " 4,724.81 " " 5,906.01 " N/A N/A N/A " 3,540.80 " N/A - " 2,965.42 " N/A " 1,810.23 " " 3,319.50 " " 1,682.32 " " 1,979.75 " N/A 34001537 UNL PROC:BILIARY TRACT 47999 750 "$4,250.00" " 1,570.80 " - " 3,400.00 " - " 2,936.75 " 843.97 " 2,936.75 " - " 2,348.13 " 827.89 " 2,805.00 " - - " 2,813.08 " 723.40 803.78 56.26 70.32 823.87 827.89 803.78 " 3,400.00 " 735.46 - " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 80328591 UNL BILIARY TRACT 47999 320 "$4,250.00" " 1,570.80 " - " 3,400.00 " - " 2,936.75 " 843.97 " 2,936.75 " - " 2,348.13 " 827.89 " 2,805.00 " - - " 2,813.08 " 723.40 803.78 56.26 70.32 823.87 827.89 803.78 " 3,400.00 " 735.46 - " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 80628595 UNL BILIARY TRACT 47999 350 "$4,250.00" " 1,570.80 " - " 3,400.00 " - " 2,936.75 " 843.97 " 2,936.75 " - " 2,348.13 " 827.89 " 2,805.00 " - - " 2,813.08 " 723.40 803.78 56.26 70.32 823.87 827.89 803.78 " 3,400.00 " 735.46 - " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 67709616 BX NEEDLE PANCREAS 48102 350 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,469.00 " " 1,467.55 " " 1,469.00 " 907.92 " 4,081.32 " " 1,439.60 " " 1,775.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 80309619 BX NEEDLE PANCREAS 48102 320 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,469.00 " " 1,467.55 " " 1,469.00 " 907.92 " 4,081.32 " " 1,439.60 " " 1,775.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 80509618 BX NEEDLE PANCREAS 48102 402 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,469.00 " " 1,467.55 " " 1,469.00 " 907.92 " 4,081.32 " " 1,439.60 " " 1,775.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 80609612 BX NEEDLE PANCREAS 48102 350 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,469.00 " " 1,467.55 " " 1,469.00 " 907.92 " 4,081.32 " " 1,439.60 " " 1,775.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 34055246 UNL PROC: PANCREAS 48999 750 "$3,265.00" " 1,206.74 " - " 2,612.00 " - " 2,256.12 " 649.06 " 2,256.12 " - " 1,803.91 " 636.69 " 2,154.90 " - - " 2,161.10 " 556.34 618.15 56.26 70.32 633.60 636.69 618.15 " 2,612.00 " 565.61 - " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 28171471 EXPLORATION OF ABDOMEN 49000 360 "$2,649.00" 979.07 - " 3,900.12 " - " 3,326.00 " N/A " 3,326.00 " - " 1,463.57 " N/A " 1,748.34 " - N/A " 1,753.37 " - N/A " 3,120.10 " " 3,900.12 " N/A N/A N/A " 2,119.20 " N/A - " 1,774.83 " N/A " 1,083.44 " " 1,986.75 " " 1,006.88 " " 1,184.90 " N/A 37003301 ABD PARACENTESIS W/O IMAGING 49082 450 "$4,250.00" " 1,570.80 " 707.33 " 3,400.00 " 892.40 " 1,718.00 " 843.97 " 1,718.00 " 907.92 " 2,348.13 " 827.89 " 1,775.00 " 869.12 808.05 " 2,813.08 " 723.40 803.78 " 2,208.66 " " 2,760.83 " 823.87 827.89 803.78 " 3,400.00 " 735.46 776.00 " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 80329342 ABD PARACENTESIS 49082 320 "$4,250.00" " 1,570.80 " 707.33 " 3,400.00 " 892.40 " 1,718.00 " 843.97 " 1,718.00 " 907.92 " 2,348.13 " 827.89 " 1,775.00 " 869.12 808.05 " 2,813.08 " 723.40 803.78 " 2,208.66 " " 2,760.83 " 823.87 827.89 803.78 " 3,400.00 " 735.46 776.00 " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 37090310 ABD PARACENTESIS W/IMAGING 49083 450 "$4,250.00" " 1,570.80 " 707.33 " 3,400.00 " 892.40 " 1,718.00 " 843.97 " 1,718.00 " 907.92 " 2,348.13 " 827.89 " 1,775.00 " 869.12 808.05 " 2,813.08 " 723.40 803.78 " 2,534.38 " " 3,167.97 " 823.87 827.89 803.78 " 3,400.00 " 735.46 776.00 " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 67729188 ABD PARACENTESIS W/IMAGING 49083 350 "$4,250.00" " 1,570.80 " 707.33 " 3,400.00 " 892.40 " 1,718.00 " 843.97 " 1,718.00 " 907.92 " 2,348.13 " 827.89 " 1,775.00 " 869.12 808.05 " 2,813.08 " 723.40 803.78 " 2,534.38 " " 3,167.97 " 823.87 827.89 803.78 " 3,400.00 " 735.46 776.00 " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 80329181 ABD PARACENTESIS W/IMAGING 49083 320 "$4,250.00" " 1,570.80 " 707.33 " 3,400.00 " 892.40 " 1,718.00 " 843.97 " 1,718.00 " 907.92 " 2,348.13 " 827.89 " 1,775.00 " 869.12 808.05 " 2,813.08 " 723.40 803.78 " 2,534.38 " " 3,167.97 " 823.87 827.89 803.78 " 3,400.00 " 735.46 776.00 " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 80529180 ABD PARACENTESIS W/IMAGING 49083 402 "$4,250.00" " 1,570.80 " 707.33 " 3,400.00 " 892.40 " 1,718.00 " 843.97 " 1,718.00 " 907.92 " 2,348.13 " 827.89 " 1,775.00 " 869.12 808.05 " 2,813.08 " 723.40 803.78 " 2,534.38 " " 3,167.97 " 823.87 827.89 803.78 " 3,400.00 " 735.46 776.00 " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 80629184 ABD PARACENTESIS W/IMAGING 49083 350 "$4,250.00" " 1,570.80 " 707.33 " 3,400.00 " 892.40 " 1,718.00 " 843.97 " 1,718.00 " 907.92 " 2,348.13 " 827.89 " 1,775.00 " 869.12 808.05 " 2,813.08 " 723.40 803.78 " 2,534.38 " " 3,167.97 " 823.87 827.89 803.78 " 3,400.00 " 735.46 776.00 " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 67709624 BX ABDOMINAL MASS 49180 350 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,469.00 " " 1,467.55 " " 1,469.00 " 907.92 " 4,081.32 " " 1,439.60 " " 1,775.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 80309627 BX ABDOMINAL MASS 49180 320 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,469.00 " " 1,467.55 " " 1,469.00 " 907.92 " 4,081.32 " " 1,439.60 " " 1,775.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 80509626 BX ABDOMINAL MASS 49180 402 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,469.00 " " 1,467.55 " " 1,469.00 " 907.92 " 4,081.32 " " 1,439.60 " " 1,775.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 80609621 BX ABDOMINAL MASS 49180 350 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,469.00 " " 1,467.55 " " 1,469.00 " 907.92 " 4,081.32 " " 1,439.60 " " 1,775.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 80335636 SCLEROTX FLUID COLLECTION 49185 320 "$3,265.00" " 1,206.74 " - " 6,657.64 " - " 2,256.12 " 649.06 " 2,256.12 " - " 1,803.91 " 636.69 " 6,540.00 " - - " 2,161.10 " 556.34 618.15 " 5,326.11 " " 6,657.64 " 633.60 636.69 618.15 " 2,612.00 " 565.61 - " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 80535635 SCLEROTX FLUID COLLECTION 49185 402 "$3,265.00" " 1,206.74 " - " 6,657.64 " - " 2,256.12 " 649.06 " 2,256.12 " - " 1,803.91 " 636.69 " 6,540.00 " - - " 2,161.10 " 556.34 618.15 " 5,326.11 " " 6,657.64 " 633.60 636.69 618.15 " 2,612.00 " 565.61 - " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 28171480 EXC ABD TUM OVER 5 CM 49204 360 "$3,026.00" " 1,118.41 " - " 9,140.85 " - " 2,090.97 " N/A " 2,090.97 " - " 1,671.87 " N/A " 1,997.16 " - N/A " 2,002.91 " - N/A " 7,312.68 " " 9,140.85 " N/A N/A N/A " 2,420.80 " N/A - " 2,027.42 " N/A " 1,237.63 " " 2,269.50 " " 1,150.18 " " 1,353.53 " N/A 28171498 EXC ABD TUM OVER 10 CM 49205 360 "$10,511.00" " 3,884.87 " - " 10,463.46 " - " 7,263.10 " N/A " 7,263.10 " - " 5,807.33 " N/A " 6,937.26 " - N/A " 6,957.23 " - N/A " 8,370.77 " " 10,463.46 " N/A N/A N/A " 8,408.80 " N/A - " 7,042.37 " N/A " 4,299.00 " " 7,883.25 " " 3,995.23 " " 4,701.57 " N/A 28175485 UMBILEC OMPHAL EXC UMBILICUS 49250 360 "$16,713.00" " 6,177.12 " 776.00 " 13,370.40 " 892.40 " 3,326.00 " " 3,318.47 " " 3,326.00 " 907.92 " 9,233.93 " " 3,255.26 " " 4,860.00 " 869.12 808.05 " 11,062.33 " " 2,844.41 " " 3,160.45 " " 3,120.10 " " 3,900.12 " " 3,239.46 " " 3,255.26 " " 3,160.45 " " 13,370.40 " " 2,891.81 " 776.00 " 11,197.71 " " 2,781.20 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,271.07 " 28171501 DIAG LAPARO SEPARATE PROC 49320 360 "$26,567.00" " 9,819.16 " 776.00 " 21,253.60 " 892.40 " 2,773.00 " " 5,277.62 " " 2,773.00 " 907.92 " 14,678.27 " " 5,177.09 " " 3,545.00 " 869.12 808.05 " 17,584.70 " " 4,523.67 " " 5,026.30 " " 2,532.97 " " 3,166.21 " " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " 776.00 " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 28171510 LAP INSERT TUNNEL IP CATH 49324 360 "$26,567.00" " 9,819.16 " 776.00 " 21,253.60 " 892.40 " 3,326.00 " " 5,277.62 " " 3,326.00 " 907.92 " 14,678.27 " " 5,177.09 " " 6,576.00 " 869.12 808.05 " 17,584.70 " " 4,523.67 " " 5,026.30 " " 1,865.46 " " 2,331.82 " " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " 776.00 " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 28171528 LAP REVISION PERM IP CATH 49325 360 "$26,567.00" " 9,819.16 " 776.00 " 21,253.60 " 892.40 " 3,326.00 " " 5,277.62 " " 3,326.00 " 907.92 " 14,678.27 " " 5,177.09 " " 6,576.00 " 869.12 808.05 " 17,584.70 " " 4,523.67 " " 5,026.30 " " 2,008.39 " " 2,510.49 " " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " 776.00 " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 28175493 LAP/THOR IVOR LEWIS 49329 360 "$26,567.00" " 9,819.16 " - " 21,253.60 " - " 1,469.00 " " 5,277.62 " " 1,469.00 " - " 14,678.27 " " 5,177.09 " " 17,534.22 " - - " 17,584.70 " " 4,523.67 " " 5,026.30 " " 4,937.34 " " 6,171.67 " " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " - " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 80326114 INJ AIR/CONTRAST INTO ABDOMEN 49400 320 "$2,486.00" 918.83 - " 2,061.86 " 892.40 " 1,469.00 " - " 1,469.00 " 907.92 " 1,373.52 " - " 1,640.76 " 869.12 808.05 " 1,645.48 " - - " 1,649.49 " " 2,061.86 " - - - " 1,988.80 " - 776.00 " 1,665.62 " - " 1,016.77 " " 1,864.50 " 944.93 " 1,111.99 " - 67741366 GUID FLUID CATH DRAIN VISC 49405 350 "$7,387.00" " 2,730.24 " 776.00 " 6,576.00 " 892.40 " 1,718.00 " " 1,467.55 " " 1,718.00 " 907.92 " 4,081.32 " " 1,439.60 " " 6,576.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,852.90 " " 2,316.13 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 80341369 GUID FLUID CATH DRAIN VISC 49405 320 "$7,387.00" " 2,730.24 " 776.00 " 6,576.00 " 892.40 " 1,718.00 " " 1,467.55 " " 1,718.00 " 907.92 " 4,081.32 " " 1,439.60 " " 6,576.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,852.90 " " 2,316.13 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 80641362 GUID FLUID CATH DRAIN VISC 49405 350 "$7,387.00" " 2,730.24 " 776.00 " 6,576.00 " 892.40 " 1,718.00 " " 1,467.55 " " 1,718.00 " 907.92 " 4,081.32 " " 1,439.60 " " 6,576.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,852.90 " " 2,316.13 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 67741374 GUID FLUID CATH DRAIN PERI/RET 49406 350 "$7,387.00" " 2,730.24 " 776.00 " 6,576.00 " 892.40 " 1,718.00 " " 1,467.55 " " 1,718.00 " 907.92 " 4,081.32 " " 1,439.60 " " 6,576.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,852.18 " " 2,315.22 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 80341377 GUID FLUID CATH DRAIN PERI/RET 49406 320 "$7,387.00" " 2,730.24 " 776.00 " 6,576.00 " 892.40 " 1,718.00 " " 1,467.55 " " 1,718.00 " 907.92 " 4,081.32 " " 1,439.60 " " 6,576.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,852.18 " " 2,315.22 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 80541376 GUID FLUID CATH DRAIN PERI/RET 49406 402 "$7,387.00" " 2,730.24 " 776.00 " 6,576.00 " 892.40 " 1,718.00 " " 1,467.55 " " 1,718.00 " 907.92 " 4,081.32 " " 1,439.60 " " 6,576.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,852.18 " " 2,315.22 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 80641371 GUID FLUID CATH DRAIN PERI/RET 49406 350 "$7,387.00" " 2,730.24 " 776.00 " 6,576.00 " 892.40 " 1,718.00 " " 1,467.55 " " 1,718.00 " 907.92 " 4,081.32 " " 1,439.60 " " 6,576.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,852.18 " " 2,315.22 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 80011385 PLC INT DEV RAD TX SGL/MULTI 49411 333 "$6,626.00" " 2,448.97 " 776.00 " 5,300.80 " 892.40 " 1,469.00 " " 1,317.10 " " 1,469.00 " 907.92 " 3,660.87 " " 1,292.01 " " 2,820.00 " 869.12 808.05 " 4,385.75 " " 1,128.94 " " 1,254.38 " " 2,685.64 " " 3,357.05 " " 1,285.74 " " 1,292.01 " " 1,254.38 " " 5,300.80 " " 1,147.76 " 776.00 " 4,439.42 " " 1,103.85 " " 2,710.03 " " 4,969.50 " " 2,518.54 " " 2,963.81 " " 1,298.28 " 80341113 PLC INT DEV RAD TX SGL/MULTI 49411 320 "$6,626.00" " 2,448.97 " 776.00 " 5,300.80 " 892.40 " 1,469.00 " " 1,317.10 " " 1,469.00 " 907.92 " 3,660.87 " " 1,292.01 " " 2,820.00 " 869.12 808.05 " 4,385.75 " " 1,128.94 " " 1,254.38 " " 2,685.64 " " 3,357.05 " " 1,285.74 " " 1,292.01 " " 1,254.38 " " 5,300.80 " " 1,147.76 " 776.00 " 4,439.42 " " 1,103.85 " " 2,710.03 " " 4,969.50 " " 2,518.54 " " 2,963.81 " " 1,298.28 " 80641117 PLC INT DEV RAD TX SGL/MULTI 49411 350 "$6,626.00" " 2,448.97 " 776.00 " 5,300.80 " 892.40 " 1,469.00 " " 1,317.10 " " 1,469.00 " 907.92 " 3,660.87 " " 1,292.01 " " 2,820.00 " 869.12 808.05 " 4,385.75 " " 1,128.94 " " 1,254.38 " " 2,685.64 " " 3,357.05 " " 1,285.74 " " 1,292.01 " " 1,254.38 " " 5,300.80 " " 1,147.76 " 776.00 " 4,439.42 " " 1,103.85 " " 2,710.03 " " 4,969.50 " " 2,518.54 " " 2,963.81 " " 1,298.28 " 80329261 INSERT TUNNELED IP CATH PERC 49418 320 "$16,713.00" " 6,177.12 " 776.00 " 13,370.40 " 892.40 " 1,718.00 " " 3,318.47 " " 1,718.00 " 907.92 " 9,233.93 " " 3,255.26 " " 6,576.00 " 869.12 808.05 " 11,062.33 " " 2,844.41 " " 3,160.45 " " 8,237.62 " " 10,297.02 " " 3,239.46 " " 3,255.26 " " 3,160.45 " " 13,370.40 " " 2,891.81 " 776.00 " 11,197.71 " " 2,781.20 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,271.07 " 80629265 INSERT TUNNELED IP CATH PERC 49418 350 "$16,713.00" " 6,177.12 " 776.00 " 13,370.40 " 892.40 " 1,718.00 " " 3,318.47 " " 1,718.00 " 907.92 " 9,233.93 " " 3,255.26 " " 6,576.00 " 869.12 808.05 " 11,062.33 " " 2,844.41 " " 3,160.45 " " 8,237.62 " " 10,297.02 " " 3,239.46 " " 3,255.26 " " 3,160.45 " " 13,370.40 " " 2,891.81 " 776.00 " 11,197.71 " " 2,781.20 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,271.07 " 80329687 INSERT TUNNELED IP CATH W/PORT 49419 320 "$25,044.00" " 9,256.26 " 776.00 " 20,035.20 " 892.40 " 1,718.00 " " 4,973.85 " " 1,718.00 " 907.92 " 13,836.81 " " 4,879.11 " " 1,775.00 " 869.12 808.05 " 16,576.62 " " 4,263.30 " " 4,737.00 " " 2,248.26 " " 2,810.33 " " 4,855.43 " " 4,879.11 " " 4,737.00 " " 20,035.20 " " 4,334.36 " 776.00 " 16,779.48 " " 4,168.56 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,902.80 " 28171536 INS TUN IP CATH FOR DIAL OPN 49421 360 "$16,713.00" " 6,177.12 " 776.00 " 13,370.40 " 892.40 " 1,718.00 " " 3,318.47 " " 1,718.00 " 907.92 " 9,233.93 " " 3,255.26 " " 1,775.00 " 869.12 808.05 " 11,062.33 " " 2,844.41 " " 3,160.45 " " 1,649.49 " " 2,061.86 " " 3,239.46 " " 3,255.26 " " 3,160.45 " " 13,370.40 " " 2,891.81 " 776.00 " 11,197.71 " " 2,781.20 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,271.07 " 28171544 REMOVE TUNNELED IP CATH 49422 360 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 1,469.00 " " 2,985.82 " " 1,469.00 " 907.92 " 8,300.76 " " 2,928.95 " " 1,775.00 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 1,774.04 " " 2,217.55 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80329113 REMOVE TUNNELED IP CATH 49422 320 "$15,024.00" " 5,552.87 " 776.00 " 12,019.20 " 892.40 " 1,469.00 " " 2,985.82 " " 1,469.00 " 907.92 " 8,300.76 " " 2,928.95 " " 1,775.00 " 869.12 808.05 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 1,774.04 " " 2,217.55 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 776.00 " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 67706978 EXCHANGE DRAIN CATH W/GUID 49423 350 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 1,469.00 " " 1,694.09 " " 1,469.00 " 907.92 " 4,713.38 " " 1,661.82 " " 5,630.46 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 3,074.36 " " 3,842.95 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 80306971 EXCHANGE DRAIN CATH W/GUID 49423 320 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 1,469.00 " " 1,694.09 " " 1,469.00 " 907.92 " 4,713.38 " " 1,661.82 " " 5,630.46 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 3,074.36 " " 3,842.95 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 80506970 EXCHANGE DRAIN CATH W/GUID 49423 402 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 1,469.00 " " 1,694.09 " " 1,469.00 " 907.92 " 4,713.38 " " 1,661.82 " " 5,630.46 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 3,074.36 " " 3,842.95 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 80606974 EXCHANGE DRAIN CATH W/RAD GUID 49423 350 "$8,531.00" " 3,153.06 " 776.00 " 6,824.80 " 892.40 " 1,469.00 " " 1,694.09 " " 1,469.00 " 907.92 " 4,713.38 " " 1,661.82 " " 5,630.46 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 3,074.36 " " 3,842.95 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 80326505 INJ CONTRAST ASSESS CYST 49424 320 $334.00 123.45 - " 1,469.00 " 892.40 " 1,469.00 " - " 1,469.00 " 907.92 184.54 - 220.44 869.12 808.05 221.07 - - 895.12 " 1,118.90 " - - - 267.20 - 776.00 223.78 - 136.61 250.50 126.95 149.40 - 28171552 REVISE ABDOMEN-VENOUS SHUNT 49426 360 "$16,713.00" " 6,177.12 " 776.00 " 13,370.40 " 892.40 " 1,718.00 " " 3,318.47 " " 1,718.00 " 907.92 " 9,233.93 " " 3,255.26 " " 2,820.00 " 869.12 808.05 " 11,062.33 " " 2,844.41 " " 3,160.45 " " 2,208.66 " " 2,760.83 " " 3,239.46 " " 3,255.26 " " 3,160.45 " " 13,370.40 " " 2,891.81 " 776.00 " 11,197.71 " " 2,781.20 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,271.07 " 80329334 INJ PREV ABDOMINAL SHUNT 49427 320 $718.00 265.37 - " 1,469.00 " - " 1,469.00 " - " 1,469.00 " - 396.70 - 473.88 - - 475.24 - - 260.34 325.43 - - - 574.40 - - 481.06 - 293.66 538.50 272.91 321.16 - 28171561 PLCMT GASTROSTOMY TUBE PERC 49440 360 "$8,531.00" " 3,153.06 " 776.00 " 7,243.04 " 892.40 " 1,718.00 " " 1,694.09 " " 1,718.00 " 907.92 " 4,713.38 " " 1,661.82 " " 1,775.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 5,794.43 " " 7,243.04 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 80328401 PLCMT GASTROSTOMY TUBE PERC 49440 320 "$8,531.00" " 3,153.06 " 776.00 " 7,243.04 " 892.40 " 1,718.00 " " 1,694.09 " " 1,718.00 " 907.92 " 4,713.38 " " 1,661.82 " " 1,775.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 5,794.43 " " 7,243.04 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 80628404 PLCMT GASTROSTOMY TUBE PERC 49440 320 "$8,531.00" " 3,153.06 " 776.00 " 7,243.04 " 892.40 " 1,718.00 " " 1,694.09 " " 1,718.00 " 907.92 " 4,713.38 " " 1,661.82 " " 1,775.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 5,794.43 " " 7,243.04 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 80328435 CONVERT G TUBE TO G-J TUBE 49446 320 "$8,531.00" " 3,153.06 " 776.00 " 7,135.17 " 892.40 " 1,469.00 " " 1,694.09 " " 1,469.00 " 907.92 " 4,713.38 " " 1,661.82 " " 1,775.00 " 869.12 808.05 " 5,646.67 " " 1,452.08 " " 1,613.42 " " 5,708.14 " " 7,135.17 " " 1,653.76 " " 1,661.82 " " 1,613.42 " " 6,824.80 " " 1,476.28 " 776.00 " 5,715.77 " " 1,419.81 " " 3,489.18 " " 6,398.25 " " 3,242.63 " " 3,815.92 " " 1,669.89 " 37003743 RPL G/C TUBE PERC 49450 450 "$4,250.00" " 1,570.80 " 707.33 " 4,985.12 " 892.40 " 1,469.00 " 843.97 " 1,469.00 " 907.92 " 2,348.13 " 827.89 " 1,775.00 " 869.12 808.05 " 2,813.08 " 723.40 803.78 " 3,988.10 " " 4,985.12 " 823.87 827.89 803.78 " 3,400.00 " 735.46 776.00 " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 80328397 RPL G/C TUBE PERC 49450 320 "$4,250.00" " 1,570.80 " 707.33 " 4,985.12 " 892.40 " 1,469.00 " 843.97 " 1,469.00 " 907.92 " 2,348.13 " 827.89 " 1,775.00 " 869.12 808.05 " 2,813.08 " 723.40 803.78 " 3,988.10 " " 4,985.12 " 823.87 827.89 803.78 " 3,400.00 " 735.46 776.00 " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 80328443 RPL DUOD/JEJ TUBE PERC 49451 320 "$4,250.00" " 1,570.80 " 707.33 " 5,286.30 " 892.40 " 1,469.00 " 843.97 " 1,469.00 " 907.92 " 2,348.13 " 827.89 " 1,775.00 " 869.12 808.05 " 2,813.08 " 723.40 803.78 " 4,229.04 " " 5,286.30 " 823.87 827.89 803.78 " 3,400.00 " 735.46 776.00 " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 80328451 RPL G-J TUBE PERC W/GUID 49452 320 "$4,250.00" " 1,570.80 " 707.33 " 6,475.09 " 892.40 " 1,469.00 " 843.97 " 1,469.00 " 907.92 " 2,348.13 " 827.89 " 1,775.00 " 869.12 808.05 " 2,813.08 " 723.40 803.78 " 5,180.07 " " 6,475.09 " 823.87 827.89 803.78 " 3,400.00 " 735.46 776.00 " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 80328460 RMV OBST G/COLON TUBE W/DEVICE 49460 320 "$4,250.00" " 1,570.80 " 707.33 " 5,280.39 " 892.40 " 1,469.00 " 843.97 " 1,469.00 " 907.92 " 2,348.13 " 827.89 " 1,775.00 " 869.12 808.05 " 2,813.08 " 723.40 803.78 " 4,224.31 " " 5,280.39 " 823.87 827.89 803.78 " 3,400.00 " 735.46 776.00 " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 80128479 INJ CONTRAST EXAM G/COLON TUBE 49465 320 "$1,208.00" 446.48 23.74 " 1,469.00 " 27.30 " 1,469.00 " 240.00 " 1,469.00 " 27.78 667.42 235.43 845.00 26.59 24.72 799.58 205.71 228.57 885.67 " 1,107.09 " 234.28 235.43 228.57 966.40 209.14 23.74 809.36 201.14 494.07 906.00 459.16 540.34 236.57 80328478 INJ CONTRAST EXAM G/COLON TUBE 49465 320 "$1,208.00" 446.48 23.74 " 1,469.00 " 27.30 " 1,469.00 " 240.00 " 1,469.00 " 27.78 667.42 235.43 845.00 26.59 24.72 799.58 205.71 228.57 885.67 " 1,107.09 " 234.28 235.43 228.57 966.40 209.14 23.74 809.36 201.14 494.07 906.00 459.16 540.34 236.57 28171579 PRP I/HERN INIT REDUC >5 YR 49505 360 "$16,713.00" " 6,177.12 " 806.00 " 13,370.40 " 926.90 " 3,326.00 " " 3,318.47 " " 3,326.00 " 943.02 " 9,233.93 " " 3,255.26 " " 4,860.00 " 902.72 839.29 " 11,062.33 " " 2,844.41 " " 3,160.45 " " 3,120.10 " " 3,900.12 " " 3,239.46 " " 3,255.26 " " 3,160.45 " " 13,370.40 " " 2,891.81 " 806.00 " 11,197.71 " " 2,781.20 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,271.07 " 28171587 PRP I/HERN INIT BLOCK >5 YR 49507 360 "$16,713.00" " 6,177.12 " 776.00 " 13,370.40 " 892.40 " 4,656.00 " " 3,318.47 " " 4,656.00 " 907.92 " 9,233.93 " " 3,255.26 " " 6,576.00 " 869.12 808.05 " 11,062.33 " " 2,844.41 " " 3,160.45 " " 4,937.34 " " 6,171.67 " " 3,239.46 " " 3,255.26 " " 3,160.45 " " 13,370.40 " " 2,891.81 " 776.00 " 11,197.71 " " 2,781.20 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,271.07 " 28176457 REREPAIR ING HERNIA REDUCE 49520 360 "$16,713.00" " 6,177.12 " 921.00 " 13,370.40 " " 1,059.15 " " 4,435.00 " " 3,318.47 " " 4,435.00 " " 1,077.57 " " 9,233.93 " " 3,255.26 " " 6,540.00 " " 1,031.52 " 959.04 " 11,062.33 " " 2,844.41 " " 3,160.45 " " 4,937.34 " " 6,171.67 " " 3,239.46 " " 3,255.26 " " 3,160.45 " " 13,370.40 " " 2,891.81 " 921.00 " 11,197.71 " " 2,781.20 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,271.07 " 28171595 REREPAIR ING HERNIA BLOCKED 49521 360 "$16,713.00" " 6,177.12 " 776.00 " 13,370.40 " 892.40 " 4,656.00 " " 3,318.47 " " 4,656.00 " 907.92 " 9,233.93 " " 3,255.26 " " 6,576.00 " 869.12 808.05 " 11,062.33 " " 2,844.41 " " 3,160.45 " " 4,937.34 " " 6,171.67 " " 3,239.46 " " 3,255.26 " " 3,160.45 " " 13,370.40 " " 2,891.81 " 776.00 " 11,197.71 " " 2,781.20 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,271.07 " 28171609 RPR REM HERNIA INIT REDUCE 49550 360 "$16,713.00" " 6,177.12 " 935.00 " 13,370.40 " " 1,075.25 " " 3,604.00 " " 3,318.47 " " 3,604.00 " " 1,093.95 " " 9,233.93 " " 3,255.26 " " 4,445.00 " " 1,047.20 " 973.62 " 11,062.33 " " 2,844.41 " " 3,160.45 " " 3,730.57 " " 4,663.21 " " 3,239.46 " " 3,255.26 " " 3,160.45 " " 13,370.40 " " 2,891.81 " 935.00 " 11,197.71 " " 2,781.20 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,271.07 " 28171617 RPR FEM HERNIA INIT BLOCKED 49553 360 "$16,713.00" " 6,177.12 " 776.00 " 13,370.40 " 892.40 " 4,656.00 " " 3,318.47 " " 4,656.00 " 907.92 " 9,233.93 " " 3,255.26 " " 6,576.00 " 869.12 808.05 " 11,062.33 " " 2,844.41 " " 3,160.45 " " 4,937.34 " " 6,171.67 " " 3,239.46 " " 3,255.26 " " 3,160.45 " " 13,370.40 " " 2,891.81 " 776.00 " 11,197.71 " " 2,781.20 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,271.07 " 28171625 RPR VENTRAL HERN INIT REDUC 49560 360 "$16,713.00" " 6,177.12 " 790.00 " 13,370.40 " 908.50 " 3,326.00 " " 3,318.47 " " 3,326.00 " 924.30 " 9,233.93 " " 3,255.26 " " 4,860.00 " 884.80 822.63 " 11,062.33 " " 2,844.41 " " 3,160.45 " " 3,120.10 " " 3,900.12 " " 3,239.46 " " 3,255.26 " " 3,160.45 " " 13,370.40 " " 2,891.81 " 790.00 " 11,197.71 " " 2,781.20 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,271.07 " 28171633 REREPAIR VENTRL HERN REDUCE 49565 360 "$26,567.00" " 9,819.16 " 776.00 " 21,253.60 " 892.40 " 3,326.00 " " 5,277.62 " " 3,326.00 " 907.92 " 14,678.27 " " 5,177.09 " " 4,860.00 " 869.12 808.05 " 17,584.70 " " 4,523.67 " " 5,026.30 " " 3,120.10 " " 3,900.12 " " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " 776.00 " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 28171641 HERNIA REPAIR W/MESH 49568 360 "$2,012.00" 743.64 - " 6,625.92 " - " 4,435.00 " - " 4,435.00 " - " 1,111.63 " - " 1,327.92 " - - " 1,331.74 " - - " 5,300.74 " " 6,625.92 " - - - " 1,609.60 " - - " 1,348.04 " - 822.91 " 1,509.00 " 764.76 899.97 - 28171650 RPR EPIGASTRIC HERN REDUCE 49570 360 "$16,713.00" " 6,177.12 " 776.00 " 13,370.40 " 892.40 " 3,326.00 " " 3,318.47 " " 3,326.00 " 907.92 " 9,233.93 " " 3,255.26 " " 4,860.00 " 869.12 808.05 " 11,062.33 " " 2,844.41 " " 3,160.45 " " 3,120.10 " " 3,900.12 " " 3,239.46 " " 3,255.26 " " 3,160.45 " " 13,370.40 " " 2,891.81 " 776.00 " 11,197.71 " " 2,781.20 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,271.07 " 28171668 RPR UMBIL HERN REDUC < 5 YR 49580 360 "$16,713.00" " 6,177.12 " 789.00 " 13,370.40 " 907.35 " 3,326.00 " " 3,318.47 " " 3,326.00 " 923.13 " 9,233.93 " " 3,255.26 " " 4,860.00 " 883.68 821.59 " 11,062.33 " " 2,844.41 " " 3,160.45 " " 4,937.34 " " 6,171.67 " " 3,239.46 " " 3,255.26 " " 3,160.45 " " 13,370.40 " " 2,891.81 " 789.00 " 11,197.71 " " 2,781.20 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,271.07 " 28171676 RPR UMBIL HERN REDUC > 5 YR 49585 360 "$16,713.00" " 6,177.12 " 776.00 " 13,370.40 " 892.40 " 3,326.00 " " 3,318.47 " " 3,326.00 " 907.92 " 9,233.93 " " 3,255.26 " " 4,860.00 " 869.12 808.05 " 11,062.33 " " 2,844.41 " " 3,160.45 " " 3,120.10 " " 3,900.12 " " 3,239.46 " " 3,255.26 " " 3,160.45 " " 13,370.40 " " 2,891.81 " 776.00 " 11,197.71 " " 2,781.20 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,271.07 " 28171684 RPR UMBIL HERN BLOCK > 5 YR 49587 360 "$16,713.00" " 6,177.12 " 776.00 " 13,370.40 " 892.40 " 4,656.00 " " 3,318.47 " " 4,656.00 " 907.92 " 9,233.93 " " 3,255.26 " " 6,576.00 " 869.12 808.05 " 11,062.33 " " 2,844.41 " " 3,160.45 " " 4,937.34 " " 6,171.67 " " 3,239.46 " " 3,255.26 " " 3,160.45 " " 13,370.40 " " 2,891.81 " 776.00 " 11,197.71 " " 2,781.20 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,271.07 " 28171692 LAP ING HERNIA REPAIR INIT 49650 360 "$26,567.00" " 9,819.16 " 776.99 " 21,253.60 " 893.54 " 3,326.00 " " 5,277.62 " " 3,326.00 " 909.08 " 14,678.27 " " 5,177.09 " " 4,860.00 " 870.23 809.08 " 17,584.70 " " 4,523.67 " " 5,026.30 " " 3,120.10 " " 3,900.12 " " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " 776.99 " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 28171706 LAP VENT/ABD HERNIA REPAIR 49652 360 "$26,567.00" " 9,819.16 " 776.00 " 21,253.60 " 892.40 " 3,326.00 " " 5,277.62 " " 3,326.00 " 907.92 " 14,678.27 " " 5,177.09 " " 6,576.00 " 869.12 808.05 " 17,584.70 " " 4,523.67 " " 5,026.30 " " 3,975.78 " " 4,969.72 " " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " 776.00 " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 28171714 LAP VENT/ABD HERN PROC COMP 49653 360 "$26,567.00" " 9,819.16 " 776.00 " 21,253.60 " 892.40 " 3,326.00 " " 5,277.62 " " 3,326.00 " 907.92 " 14,678.27 " " 5,177.09 " " 6,576.00 " 869.12 808.05 " 17,584.70 " " 4,523.67 " " 5,026.30 " " 4,962.26 " " 6,202.82 " " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " 776.00 " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 28171722 LAP INC HERNIA REPAIR 49654 360 "$46,765.00" " 17,284.34 " 776.00 " 37,412.00 " 892.40 " 3,326.00 " " 9,289.96 " " 3,326.00 " 907.92 " 25,837.66 " " 9,113.01 " " 6,576.00 " 869.12 808.05 " 30,953.75 " " 7,962.82 " " 8,847.58 " " 4,564.37 " " 5,705.46 " " 9,068.77 " " 9,113.01 " " 8,847.58 " " 37,412.00 " " 8,095.54 " 776.00 " 31,332.55 " " 7,785.87 " " 19,126.89 " " 35,073.75 " " 17,775.38 " " 20,917.98 " " 9,157.25 " 28171731 LAP INC HERN REPAIR COMP 49655 360 "$46,765.00" " 17,284.34 " 776.00 " 37,412.00 " 892.40 " 3,326.00 " " 9,289.96 " " 3,326.00 " 907.92 " 25,837.66 " " 9,113.01 " " 6,576.00 " 869.12 808.05 " 30,953.75 " " 7,962.82 " " 8,847.58 " " 5,495.83 " " 6,869.79 " " 9,068.77 " " 9,113.01 " " 8,847.58 " " 37,412.00 " " 8,095.54 " 776.00 " 31,332.55 " " 7,785.87 " " 19,126.89 " " 35,073.75 " " 17,775.38 " " 20,917.98 " " 9,157.25 " 28171749 LAP INC HERN RECUR COMP 49657 360 "$46,765.00" " 17,284.34 " 776.00 " 37,412.00 " 892.40 " 3,326.00 " " 9,289.96 " " 3,326.00 " 907.92 " 25,837.66 " " 9,113.01 " " 6,576.00 " 869.12 808.05 " 30,953.75 " " 7,962.82 " " 8,847.58 " " 6,623.78 " " 8,279.73 " " 9,068.77 " " 9,113.01 " " 8,847.58 " " 37,412.00 " " 8,095.54 " 776.00 " 31,332.55 " " 7,785.87 " " 19,126.89 " " 35,073.75 " " 17,775.38 " " 20,917.98 " " 9,157.25 " 28171757 OMENTAL FLAP INTRA-ABDOM 49905 360 "$3,230.00" " 1,193.81 " - " 2,584.00 " - " 2,231.93 " N/A " 2,231.93 " - " 1,784.58 " N/A " 2,131.80 " - N/A " 2,137.94 " - N/A " 1,973.74 " " 2,467.18 " N/A N/A N/A " 2,584.00 " N/A - " 2,164.10 " N/A " 1,321.07 " " 2,422.50 " " 1,227.72 " " 1,444.78 " N/A 67728564 UNL ABD PERITONEIUM OMENTUM 49999 350 "$4,250.00" " 1,570.80 " - " 3,400.00 " - " 1,469.00 " 843.97 " 1,469.00 " - " 2,348.13 " 827.89 " 2,805.00 " - - " 2,813.08 " 723.40 803.78 56.26 70.32 823.87 827.89 803.78 " 3,400.00 " 735.46 - " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 80329890 UNL REPOS PERITONL DIALYS CATH 49999 320 "$4,250.00" " 1,570.80 " - " 3,400.00 " - " 1,469.00 " 843.97 " 1,469.00 " - " 2,348.13 " 827.89 " 2,805.00 " - - " 2,813.08 " 723.40 803.78 56.26 70.32 823.87 827.89 803.78 " 3,400.00 " 735.46 - " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 80628561 UNL ABD PERITONEIUM OMENTUM 49999 350 "$4,250.00" " 1,570.80 " - " 3,400.00 " - " 1,469.00 " 843.97 " 1,469.00 " - " 2,348.13 " 827.89 " 2,805.00 " - - " 2,813.08 " 723.40 803.78 56.26 70.32 823.87 827.89 803.78 " 3,400.00 " 735.46 - " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 80629958 UNL CT GUID PLCMT GASTRO CATH 49999 350 "$4,250.00" " 1,570.80 " - " 3,400.00 " - " 1,469.00 " 843.97 " 1,469.00 " - " 2,348.13 " 827.89 " 2,805.00 " - - " 2,813.08 " 723.40 803.78 56.26 70.32 823.87 827.89 803.78 " 3,400.00 " 735.46 - " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 80641249 UNL CT GUID ASP ABD ANEURYSM 49999 350 "$4,250.00" " 1,570.80 " - " 3,400.00 " - " 1,469.00 " 843.97 " 1,469.00 " - " 2,348.13 " 827.89 " 2,805.00 " - - " 2,813.08 " 723.40 803.78 56.26 70.32 823.87 827.89 803.78 " 3,400.00 " 735.46 - " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 28171765 REMOVE KIDNEY STONE 50080 360 "$43,355.00" " 16,024.01 " 776.00 " 34,684.00 " 892.40 " 3,326.00 " " 8,608.12 " " 3,326.00 " 907.92 " 23,953.64 " " 8,444.16 " " 28,614.30 " 869.12 808.05 " 28,696.67 " " 7,378.39 " " 8,198.21 " " 4,534.90 " " 5,668.62 " " 8,403.17 " " 8,444.16 " " 8,198.21 " " 34,684.00 " " 7,501.36 " 776.00 " 29,047.85 " " 7,214.42 " " 17,732.20 " " 32,516.25 " " 16,479.24 " " 19,392.69 " " 8,485.15 " 80326203 REMOVE KIDNEY STONE 50080 320 "$43,355.00" " 16,024.01 " 776.00 " 34,684.00 " 892.40 " 3,326.00 " " 8,608.12 " " 3,326.00 " 907.92 " 23,953.64 " " 8,444.16 " " 28,614.30 " 869.12 808.05 " 28,696.67 " " 7,378.39 " " 8,198.21 " " 4,534.90 " " 5,668.62 " " 8,403.17 " " 8,444.16 " " 8,198.21 " " 34,684.00 " " 7,501.36 " 776.00 " 29,047.85 " " 7,214.42 " " 17,732.20 " " 32,516.25 " " 16,479.24 " " 19,392.69 " " 8,485.15 " 28171773 REMOVAL OF KIDNEY STONE 50081 360 "$43,355.00" " 16,024.01 " 776.00 " 34,684.00 " 892.40 " 3,604.00 " " 8,608.12 " " 3,604.00 " 907.92 " 23,953.64 " " 8,444.16 " " 28,614.30 " 869.12 808.05 " 28,696.67 " " 7,378.39 " " 8,198.21 " " 6,614.50 " " 8,268.13 " " 8,403.17 " " 8,444.16 " " 8,198.21 " " 34,684.00 " " 7,501.36 " 776.00 " 29,047.85 " " 7,214.42 " " 17,732.20 " " 32,516.25 " " 16,479.24 " " 19,392.69 " " 8,485.15 " 67709632 BX RENAL TROCAR OR NEEDLE 50200 350 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,469.00 " " 1,467.55 " " 1,469.00 " 907.92 " 4,081.32 " " 1,439.60 " " 1,775.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 80309635 BX RENAL TROCAR OR NEEDLE 50200 320 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,469.00 " " 1,467.55 " " 1,469.00 " 907.92 " 4,081.32 " " 1,439.60 " " 1,775.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 80509634 BX RENAL TROCAR OR NEEDLE 50200 320 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,469.00 " " 1,467.55 " " 1,469.00 " 907.92 " 4,081.32 " " 1,439.60 " " 1,775.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 80609639 BX RENAL TROCAR OR NEEDLE 50200 350 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,469.00 " " 1,467.55 " " 1,469.00 " 907.92 " 4,081.32 " " 1,439.60 " " 1,775.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28171781 REMOVE KIDNEY OPEN 50220 360 "$9,027.00" " 3,336.38 " - " 7,221.60 " - " 6,237.66 " N/A " 6,237.66 " - " 4,987.42 " N/A " 5,957.82 " - N/A " 5,974.97 " - N/A " 5,298.82 " " 6,623.53 " N/A N/A N/A " 7,221.60 " N/A - " 6,048.09 " N/A " 3,692.04 " " 6,770.25 " " 3,431.16 " " 4,037.78 " N/A 28171790 REMOVAL OF KIDNEY & URETER 50234 360 "$8,334.00" " 3,080.25 " - " 8,460.10 " - " 5,758.79 " N/A " 5,758.79 " - " 4,604.54 " N/A " 5,500.44 " - N/A " 5,516.27 " - N/A " 6,768.08 " " 8,460.10 " N/A N/A N/A " 6,667.20 " N/A - " 5,583.78 " N/A " 3,408.61 " " 6,250.50 " " 3,167.75 " " 3,727.80 " N/A 80327811 CHANGE URETER STENT PERC 50382 320 "$9,413.00" " 3,479.04 " 776.00 " 10,244.98 " 892.40 " 1,469.00 " " 1,867.55 " " 1,469.00 " 907.92 " 5,200.68 " " 1,831.98 " " 2,820.00 " 869.12 808.05 " 6,230.46 " " 1,600.76 " " 1,778.62 " " 8,195.98 " " 10,244.98 " " 1,823.09 " " 1,831.98 " " 1,778.62 " " 7,530.40 " " 1,627.44 " 776.00 " 6,306.71 " " 1,565.19 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,840.87 " 80327820 REMOVE URETER STENT PERC 50384 320 "$9,413.00" " 3,479.04 " 776.00 " 9,888.96 " 892.40 " 1,469.00 " " 1,867.55 " " 1,469.00 " 907.92 " 5,200.68 " " 1,831.98 " " 1,775.00 " 869.12 808.05 " 6,230.46 " " 1,600.76 " " 1,778.62 " " 7,911.17 " " 9,888.96 " " 1,823.09 " " 1,831.98 " " 1,778.62 " " 7,530.40 " " 1,627.44 " 776.00 " 6,306.71 " " 1,565.19 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,840.87 " 80327838 CHANGE NEPHROURETERAL CATH 50387 320 "$9,413.00" " 3,479.04 " 776.00 " 7,530.40 " 892.40 " 1,469.00 " " 1,867.55 " " 1,469.00 " 907.92 " 5,200.68 " " 1,831.98 " " 2,820.00 " 869.12 808.05 " 6,230.46 " " 1,600.76 " " 1,778.62 " " 3,958.34 " " 4,947.93 " " 1,823.09 " " 1,831.98 " " 1,778.62 " " 7,530.40 " " 1,627.44 " 776.00 " 6,306.71 " " 1,565.19 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,840.87 " 80327846 REMOVE RENAL TUBE W/FLUORO 50389 320 "$3,018.00" " 1,115.45 " 502.90 " 3,380.12 " 892.40 " 1,469.00 " 600.05 " 1,469.00 " 907.92 " 1,667.45 " 588.62 " 1,775.00 " 869.12 808.05 " 1,997.61 " 514.33 571.48 " 2,704.10 " " 3,380.12 " 585.77 588.62 571.48 " 2,414.40 " 522.90 776.00 " 2,022.06 " 502.90 " 1,234.36 " " 2,263.50 " " 1,147.14 " " 1,349.95 " 591.48 67709641 DRAINAGE KIDNEY LESION 50390 350 "$3,265.00" " 1,206.74 " 543.97 " 2,612.00 " 892.40 " 1,469.00 " 649.06 " 1,469.00 " 907.92 " 1,803.91 " 636.69 " 1,775.00 " 869.12 808.05 " 2,161.10 " 556.34 618.15 " 1,649.49 " " 2,061.86 " 633.60 636.69 618.15 " 2,612.00 " 565.61 776.00 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 80309643 DRAINAGE KIDNEY LESION 50390 320 "$3,265.00" " 1,206.74 " 543.97 " 2,612.00 " 892.40 " 1,469.00 " 649.06 " 1,469.00 " 907.92 " 1,803.91 " 636.69 " 1,775.00 " 869.12 808.05 " 2,161.10 " 556.34 618.15 " 1,649.49 " " 2,061.86 " 633.60 636.69 618.15 " 2,612.00 " 565.61 776.00 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 80609647 DRAINAGE KIDNEY LESION 50390 350 "$3,265.00" " 1,206.74 " 543.97 " 2,612.00 " 892.40 " 1,469.00 " 649.06 " 1,469.00 " 907.92 " 1,803.91 " 636.69 " 1,775.00 " 869.12 808.05 " 2,161.10 " 556.34 618.15 " 1,649.49 " " 2,061.86 " 633.60 636.69 618.15 " 2,612.00 " 565.61 776.00 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 80335521 NEPHRO/URETERO NEW ACCESS 50430 320 "$3,018.00" " 1,115.45 " 502.90 " 3,545.00 " 892.40 " 2,085.44 " 600.05 " 2,085.44 " 907.92 " 1,667.45 " 588.62 " 3,545.00 " 869.12 808.05 " 1,997.61 " 514.33 571.48 " 2,821.33 " " 3,526.66 " 585.77 588.62 571.48 " 2,414.40 " 522.90 776.00 " 2,022.06 " 502.90 " 1,234.36 " " 2,263.50 " " 1,147.14 " " 1,349.95 " 591.48 80135530 NEPHRO/URETERO EXIST ACCESS 50431 320 "$3,018.00" " 1,115.45 " 502.90 " 3,545.00 " 892.40 " 2,085.44 " 600.05 " 2,085.44 " 907.92 " 1,667.45 " 588.62 " 3,545.00 " 869.12 808.05 " 1,997.61 " 514.33 571.48 879.48 " 1,099.35 " 585.77 588.62 571.48 " 2,414.40 " 522.90 776.00 " 2,022.06 " 502.90 " 1,234.36 " " 2,263.50 " " 1,147.14 " " 1,349.95 " 591.48 80335539 NEPHRO/URETERO EXIST ACCESS 50431 320 "$3,018.00" " 1,115.45 " 502.90 " 3,545.00 " 892.40 " 2,085.44 " 600.05 " 2,085.44 " 907.92 " 1,667.45 " 588.62 " 3,545.00 " 869.12 808.05 " 1,997.61 " 514.33 571.48 879.48 " 1,099.35 " 585.77 588.62 571.48 " 2,414.40 " 522.90 776.00 " 2,022.06 " 502.90 " 1,234.36 " " 2,263.50 " " 1,147.14 " " 1,349.95 " 591.48 67735307 PLCMT NEPHRO CATH PERC EXIST 50432 350 "$9,413.00" " 3,479.04 " 776.00 " 7,530.40 " 892.40 " 6,504.38 " " 1,867.55 " " 6,504.38 " 907.92 " 5,200.68 " " 1,831.98 " " 6,540.00 " 869.12 808.05 " 6,230.46 " " 1,600.76 " " 1,778.62 " " 4,561.45 " " 5,701.81 " " 1,823.09 " " 1,831.98 " " 1,778.62 " " 7,530.40 " " 1,627.44 " 776.00 " 6,306.71 " " 1,565.19 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,840.87 " 80335300 PLCMT NEPHRO CATH PERC EXIST 50432 320 "$9,413.00" " 3,479.04 " 776.00 " 7,530.40 " 892.40 " 6,504.38 " " 1,867.55 " " 6,504.38 " 907.92 " 5,200.68 " " 1,831.98 " " 6,540.00 " 869.12 808.05 " 6,230.46 " " 1,600.76 " " 1,778.62 " " 4,561.45 " " 5,701.81 " " 1,823.09 " " 1,831.98 " " 1,778.62 " " 7,530.40 " " 1,627.44 " 776.00 " 6,306.71 " " 1,565.19 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,840.87 " 80635303 PLCMT NEPHRO CATH PERC EXIST 50432 350 "$9,413.00" " 3,479.04 " 776.00 " 7,530.40 " 892.40 " 6,504.38 " " 1,867.55 " " 6,504.38 " 907.92 " 5,200.68 " " 1,831.98 " " 6,540.00 " 869.12 808.05 " 6,230.46 " " 1,600.76 " " 1,778.62 " " 4,561.45 " " 5,701.81 " " 1,823.09 " " 1,831.98 " " 1,778.62 " " 7,530.40 " " 1,627.44 " 776.00 " 6,306.71 " " 1,565.19 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,840.87 " 80335318 PLCMT NEPHRO CATH PERC NEW 50433 320 "$16,151.00" " 5,969.41 " 776.00 " 12,920.80 " 892.40 " 11,160.34 " " 3,206.84 " " 11,160.34 " 907.92 " 8,923.43 " " 3,145.75 " " 6,540.00 " 869.12 808.05 " 10,690.35 " " 2,748.72 " " 3,054.13 " " 6,132.58 " " 7,665.72 " " 3,130.48 " " 3,145.75 " " 3,054.13 " " 12,920.80 " " 2,794.53 " 776.00 " 10,821.17 " " 2,687.63 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,161.02 " 80335326 CONVERT NEPHROSTOMY CATHETER 50434 320 "$9,413.00" " 3,479.04 " 776.00 " 7,530.40 " 892.40 " 6,504.38 " " 1,867.55 " " 6,504.38 " 907.92 " 5,200.68 " " 1,831.98 " " 3,545.00 " 869.12 808.05 " 6,230.46 " " 1,600.76 " " 1,778.62 " " 4,849.69 " " 6,062.11 " " 1,823.09 " " 1,831.98 " " 1,778.62 " " 7,530.40 " " 1,627.44 " 776.00 " 6,306.71 " " 1,565.19 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,840.87 " 80335334 EXCHANGE NEPHROSTOMY CATHETER 50435 320 "$9,413.00" " 3,479.04 " 776.00 " 7,530.40 " 892.40 " 6,504.38 " " 1,867.55 " " 6,504.38 " 907.92 " 5,200.68 " " 1,831.98 " " 3,545.00 " 869.12 808.05 " 6,230.46 " " 1,600.76 " " 1,778.62 " " 2,540.84 " " 3,176.05 " " 1,823.09 " " 1,831.98 " " 1,778.62 " " 7,530.40 " " 1,627.44 " 776.00 " 6,306.71 " " 1,565.19 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,840.87 " 80336705 DILAT XST TRC NDURLGC PX W/IMG 50436 320 "$16,151.00" " 5,969.41 " 776.00 " 12,920.80 " 892.40 " 11,160.34 " " 3,206.84 " " 11,160.34 " 907.92 " 8,923.43 " " 3,145.75 " " 6,576.00 " 869.12 808.05 " 10,690.35 " " 2,748.72 " " 3,054.13 " 870.65 " 1,088.31 " " 3,130.48 " " 3,145.75 " " 3,054.13 " " 12,920.80 " " 2,794.53 " 776.00 " 10,821.17 " " 2,687.63 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,161.02 " 80336713 DILAT XST TRC NEW ACCESS RCS 50437 320 "$16,151.00" " 5,969.41 " 776.00 " 12,920.80 " 892.40 " 11,160.34 " " 3,206.84 " " 11,160.34 " 907.92 " 8,923.43 " " 3,145.75 " " 10,659.66 " 869.12 808.05 " 10,690.35 " " 2,748.72 " " 3,054.13 " " 1,455.14 " " 1,818.92 " " 3,130.48 " " 3,145.75 " " 3,054.13 " " 12,920.80 " " 2,794.53 " 776.00 " 10,821.17 " " 2,687.63 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,161.02 " 28171803 LITHOTRIPSY UNILATERAL 50590 360 "$16,151.00" " 5,969.41 " 776.00 " 12,920.80 " 892.40 " 4,656.00 " " 3,206.84 " " 4,656.00 " 907.92 " 8,923.43 " " 3,145.75 " " 6,576.00 " 869.12 808.05 " 10,690.35 " " 2,748.72 " " 3,054.13 " " 4,937.34 " " 6,171.67 " " 3,130.48 " " 3,145.75 " " 3,054.13 " " 12,920.80 " " 2,794.53 " 776.00 " 10,821.17 " " 2,687.63 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,161.02 " 34000701 LITHOTRIPSY UNILATERAL 50590 750 "$16,151.00" " 5,969.41 " 776.00 " 12,920.80 " 892.40 " 4,656.00 " " 3,206.84 " " 4,656.00 " 907.92 " 8,923.43 " " 3,145.75 " " 6,576.00 " 869.12 808.05 " 10,690.35 " " 2,748.72 " " 3,054.13 " " 4,937.34 " " 6,171.67 " " 3,130.48 " " 3,145.75 " " 3,054.13 " " 12,920.80 " " 2,794.53 " 776.00 " 10,821.17 " " 2,687.63 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,161.02 " 67727851 ABLATE RENAL TUMOR RF PERC 50592 350 "$26,567.00" " 9,819.16 " 776.00 " 37,814.70 " 892.40 " 3,326.00 " " 5,277.62 " " 3,326.00 " 907.92 " 14,678.27 " " 5,177.09 " " 1,775.00 " 869.12 808.05 " 17,584.70 " " 4,523.67 " " 5,026.30 " " 30,251.76 " " 37,814.70 " " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " 776.00 " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 80627858 ABLATE RENAL TUMOR RF PERC 50592 350 "$26,567.00" " 9,819.16 " 776.00 " 37,814.70 " 892.40 " 3,326.00 " " 5,277.62 " " 3,326.00 " 907.92 " 14,678.27 " " 5,177.09 " " 1,775.00 " 869.12 808.05 " 17,584.70 " " 4,523.67 " " 5,026.30 " " 30,251.76 " " 37,814.70 " " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " 776.00 " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 67727941 ABLATE RENAL TUMOR CRYO PERC 50593 350 "$46,765.00" " 17,284.34 " - " 37,412.00 " - " 4,656.00 " " 9,289.96 " " 4,656.00 " - " 25,837.66 " " 9,113.01 " " 6,576.00 " - - " 30,953.75 " " 7,962.82 " " 8,847.58 " " 24,276.64 " " 30,345.80 " " 9,068.77 " " 9,113.01 " " 8,847.58 " " 37,412.00 " " 8,095.54 " - " 31,332.55 " " 7,785.87 " " 19,126.89 " " 35,073.75 " " 17,775.38 " " 20,917.98 " " 9,157.25 " 80327943 ABLATE RENAL TUMOR CRYO PERC 50593 350 "$46,765.00" " 17,284.34 " - " 37,412.00 " - " 4,656.00 " " 9,289.96 " " 4,656.00 " - " 25,837.66 " " 9,113.01 " " 6,576.00 " - - " 30,953.75 " " 7,962.82 " " 8,847.58 " " 24,276.64 " " 30,345.80 " " 9,068.77 " " 9,113.01 " " 8,847.58 " " 37,412.00 " " 8,095.54 " - " 31,332.55 " " 7,785.87 " " 19,126.89 " " 35,073.75 " " 17,775.38 " " 20,917.98 " " 9,157.25 " 80627947 ABLATE RENAL TUMOR CRYO PERC 50593 350 "$46,765.00" " 17,284.34 " - " 37,412.00 " - " 4,656.00 " " 9,289.96 " " 4,656.00 " - " 25,837.66 " " 9,113.01 " " 6,576.00 " - - " 30,953.75 " " 7,962.82 " " 8,847.58 " " 24,276.64 " " 30,345.80 " " 9,068.77 " " 9,113.01 " " 8,847.58 " " 37,412.00 " " 8,095.54 " - " 31,332.55 " " 7,785.87 " " 19,126.89 " " 35,073.75 " " 17,775.38 " " 20,917.98 " " 9,157.25 " 28171811 ENDOLUMINAL BX URTR RNL PLVS 50606 360 $468.00 172.97 - " 3,574.69 " 147.60 323.39 - 323.39 150.17 258.57 - 308.88 143.75 133.65 309.77 - - " 2,859.75 " " 3,574.69 " - - - 374.40 - 128.35 313.56 - 191.41 351.00 177.89 209.34 - 80128070 INJ URETER XR 50684 320 $193.00 71.33 - " 2,061.86 " 51.46 " 1,469.00 " - " 1,469.00 " 52.36 106.63 - 127.38 50.12 46.60 127.75 - - " 1,649.49 " " 2,061.86 " - - - 154.40 - 44.75 129.31 - 78.94 144.75 73.36 86.33 - 80329091 CHANGE URETER TUBE/STENT 50688 320 "$9,413.00" " 3,479.04 " - " 7,530.40 " - " 1,469.00 " " 1,867.55 " " 1,469.00 " - " 5,200.68 " " 1,831.98 " " 1,775.00 " - - " 6,230.46 " " 1,600.76 " " 1,778.62 " " 1,649.49 " " 2,061.86 " " 1,823.09 " " 1,831.98 " " 1,778.62 " " 7,530.40 " " 1,627.44 " - " 6,306.71 " " 1,565.19 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,840.87 " 80326891 INJ VISUALIZATION URETER XR 50690 320 "$1,584.00" 585.45 - " 2,061.86 " 49.45 " 1,469.00 " - " 1,469.00 " 50.31 875.16 - " 1,045.44 " 48.16 44.78 " 1,048.45 " - - " 1,649.49 " " 2,061.86 " - - - " 1,267.20 " - 43.00 " 1,061.28 " - 647.86 " 1,188.00 " 602.08 708.52 - 80335351 PLCMT URETERAL STENT EXIST 50693 320 "$16,151.00" " 5,969.41 " 776.00 " 12,920.80 " 892.40 " 11,160.34 " " 3,206.84 " " 11,160.34 " 907.92 " 8,923.43 " " 3,145.75 " " 6,576.00 " 869.12 808.05 " 10,690.35 " " 2,748.72 " " 3,054.13 " " 8,071.95 " " 10,089.94 " " 3,130.48 " " 3,145.75 " " 3,054.13 " " 12,920.80 " " 2,794.53 " 776.00 " 10,821.17 " " 2,687.63 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,161.02 " 80335369 PLCMT URETERAL STENT NEW 50694 320 "$16,151.00" " 5,969.41 " 776.00 " 12,920.80 " 892.40 " 11,160.34 " " 3,206.84 " " 11,160.34 " 907.92 " 8,923.43 " " 3,145.75 " " 6,576.00 " 869.12 808.05 " 10,690.35 " " 2,748.72 " " 3,054.13 " " 8,908.75 " " 11,135.94 " " 3,130.48 " " 3,145.75 " " 3,054.13 " " 12,920.80 " " 2,794.53 " 776.00 " 10,821.17 " " 2,687.63 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,161.02 " 80335377 PLCMT URETERAL STENT W/NEW 50695 320 "$16,151.00" " 5,969.41 " 776.00 " 13,587.34 " 892.40 " 11,160.34 " " 3,206.84 " " 11,160.34 " 907.92 " 8,923.43 " " 3,145.75 " " 6,576.00 " 869.12 808.05 " 10,690.35 " " 2,748.72 " " 3,054.13 " " 10,869.87 " " 13,587.34 " " 3,130.48 " " 3,145.75 " " 3,054.13 " " 12,920.80 " " 2,794.53 " 776.00 " 10,821.17 " " 2,687.63 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,161.02 " 80335393 BALLOON DILATE URTRL STRICTURE 50706 320 "$4,413.00" " 1,631.04 " - " 5,158.04 " 175.74 " 3,049.38 " - " 3,049.38 " 178.80 " 2,438.18 " - " 2,912.58 " 171.16 159.13 " 2,920.96 " - - " 4,126.43 " " 5,158.04 " - - - " 3,530.40 " - 152.82 " 2,956.71 " - " 1,804.92 " " 3,309.75 " " 1,677.38 " " 1,973.93 " - 28171820 FUSION OF URETERS 50760 360 "$8,199.00" " 3,030.35 " - " 7,112.31 " - " 5,665.51 " N/A " 5,665.51 " - " 4,529.95 " N/A " 5,411.34 " - N/A " 5,426.92 " - N/A " 5,689.85 " " 7,112.31 " N/A N/A N/A " 6,559.20 " N/A - " 5,493.33 " N/A " 3,353.39 " " 6,149.25 " " 3,116.44 " " 3,667.41 " N/A 28171838 LAPARO NEW URETER/BLADDER 50947 360 "$26,567.00" " 9,819.16 " 776.00 " 21,253.60 " 892.40 " 4,656.00 " " 5,277.62 " " 4,656.00 " 907.92 " 14,678.27 " " 5,177.09 " " 6,576.00 " 869.12 808.05 " 17,584.70 " " 4,523.67 " " 5,026.30 " " 7,133.34 " " 8,916.67 " " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " 776.00 " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 28171846 INCISE & TREAT BLADDER 51020 360 "$16,151.00" " 5,969.41 " 400.22 " 12,920.80 " 460.25 " 3,326.00 " " 3,206.84 " " 3,326.00 " 468.26 " 8,923.43 " " 3,145.75 " " 4,860.00 " 448.25 416.75 " 10,690.35 " " 2,748.72 " " 3,054.13 " " 3,120.10 " " 3,900.12 " " 3,130.48 " " 3,145.75 " " 3,054.13 " " 12,920.80 " " 2,794.53 " 400.22 " 10,821.17 " " 2,687.63 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,161.02 " 28171854 INCISE & DRAIN BLADDER 51040 360 "$9,413.00" " 3,479.04 " 776.00 " 7,530.40 " 892.40 " 3,326.00 " " 1,867.55 " " 3,326.00 " 907.92 " 5,200.68 " " 1,831.98 " " 4,860.00 " 869.12 808.05 " 6,230.46 " " 1,600.76 " " 1,778.62 " " 3,120.10 " " 3,900.12 " " 1,823.09 " " 1,831.98 " " 1,778.62 " " 7,530.40 " " 1,627.44 " 776.00 " 6,306.71 " " 1,565.19 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,840.87 " 28171862 REMOVE URETER CALCULUS 51065 360 "$16,151.00" " 5,969.41 " 776.00 " 12,920.80 " 892.40 " 3,326.00 " " 3,206.84 " " 3,326.00 " 907.92 " 8,923.43 " " 3,145.75 " " 4,860.00 " 869.12 808.05 " 10,690.35 " " 2,748.72 " " 3,054.13 " " 3,356.30 " " 4,195.38 " " 3,130.48 " " 3,145.75 " " 3,054.13 " " 12,920.80 " " 2,794.53 " 776.00 " 10,821.17 " " 2,687.63 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,161.02 " 80329580 DRAIN BLADDER BY TROCAR/CATH 51101 320 "$4,829.00" " 1,784.80 " 39.75 " 3,863.20 " 45.71 " 1,469.00 " 959.60 " 1,469.00 " 46.51 " 2,668.02 " 941.32 845.00 44.52 41.39 " 3,196.32 " 822.51 913.90 684.90 856.12 936.75 941.32 913.90 " 3,863.20 " 836.22 39.75 " 3,235.43 " 804.23 " 1,975.06 " " 3,621.75 " " 1,835.50 " " 2,160.01 " 945.89 28171871 DRAIN BLADDER W/CATH INSERTION 51102 360 "$9,413.00" " 3,479.04 " 776.00 " 7,530.40 " 892.40 " 1,469.00 " " 1,867.55 " " 1,469.00 " 907.92 " 5,200.68 " " 1,831.98 " " 2,820.00 " 869.12 808.05 " 6,230.46 " " 1,600.76 " " 1,778.62 " " 1,792.10 " " 2,240.12 " " 1,823.09 " " 1,831.98 " " 1,778.62 " " 7,530.40 " " 1,627.44 " 776.00 " 6,306.71 " " 1,565.19 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,840.87 " 67726171 DRAIN BLADDER W/CATH INSERTION 51102 350 "$9,413.00" " 3,479.04 " 776.00 " 7,530.40 " 892.40 " 1,469.00 " " 1,867.55 " " 1,469.00 " 907.92 " 5,200.68 " " 1,831.98 " " 2,820.00 " 869.12 808.05 " 6,230.46 " " 1,600.76 " " 1,778.62 " " 1,792.10 " " 2,240.12 " " 1,823.09 " " 1,831.98 " " 1,778.62 " " 7,530.40 " " 1,627.44 " 776.00 " 6,306.71 " " 1,565.19 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,840.87 " 80326173 DRAIN BLADDER W/CATH INSERTION 51102 320 "$9,413.00" " 3,479.04 " 776.00 " 7,530.40 " 892.40 " 1,469.00 " " 1,867.55 " " 1,469.00 " 907.92 " 5,200.68 " " 1,831.98 " " 2,820.00 " 869.12 808.05 " 6,230.46 " " 1,600.76 " " 1,778.62 " " 1,792.10 " " 2,240.12 " " 1,823.09 " " 1,831.98 " " 1,778.62 " " 7,530.40 " " 1,627.44 " 776.00 " 6,306.71 " " 1,565.19 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,840.87 " 80626177 DRAIN BLADDER W/CATH INSERTION 51102 350 "$9,413.00" " 3,479.04 " 776.00 " 7,530.40 " 892.40 " 1,469.00 " " 1,867.55 " " 1,469.00 " 907.92 " 5,200.68 " " 1,831.98 " " 2,820.00 " 869.12 808.05 " 6,230.46 " " 1,600.76 " " 1,778.62 " " 1,792.10 " " 2,240.12 " " 1,823.09 " " 1,831.98 " " 1,778.62 " " 7,530.40 " " 1,627.44 " 776.00 " 6,306.71 " " 1,565.19 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,840.87 " 28171889 INJ BLADDER XR 51600 360 $264.00 97.57 - " 2,061.86 " 36.80 182.42 - 182.42 37.44 145.86 - 174.24 35.84 33.32 174.74 - - " 1,649.49 " " 2,061.86 " - - - 211.20 - 32.00 176.88 - 107.98 198.00 100.35 118.09 - 80101830 INJ BLADDER XR 51600 320 $264.00 97.57 - " 2,061.86 " 36.80 182.42 - 182.42 37.44 145.86 - 174.24 35.84 33.32 174.74 - - " 1,649.49 " " 2,061.86 " - - - 211.20 - 32.00 176.88 - 107.98 198.00 100.35 118.09 - 80301839 INJ BLADDER XR 51600 320 $264.00 97.57 - " 2,061.86 " 36.80 182.42 - 182.42 37.44 145.86 - 174.24 35.84 33.32 174.74 - - " 1,649.49 " " 2,061.86 " - - - 211.20 - 32.00 176.88 - 107.98 198.00 100.35 118.09 - 80601832 INJ BLADDER XR 51600 320 $264.00 97.57 - " 2,061.86 " 36.80 182.42 - 182.42 37.44 145.86 - 174.24 35.84 33.32 174.74 - - " 1,649.49 " " 2,061.86 " - - - 211.20 - 32.00 176.88 - 107.98 198.00 100.35 118.09 - 67701844 INJ RETROGRADE URETHROGRAM 51610 350 "$1,514.00" 559.57 - " 2,061.86 " 39.68 " 1,046.17 " - " 1,046.17 " 40.37 836.49 - 999.24 38.64 35.92 " 1,002.12 " - - " 1,649.49 " " 2,061.86 " - - - " 1,211.20 " - 34.50 " 1,014.38 " - 619.23 " 1,135.50 " 575.47 677.21 - 80101848 INJ RETROGRADE URETHROGRAM 51610 320 "$1,514.00" 559.57 - " 2,061.86 " 39.68 " 1,046.17 " - " 1,046.17 " 40.37 836.49 - 999.24 38.64 35.92 " 1,002.12 " - - " 1,649.49 " " 2,061.86 " - - - " 1,211.20 " - 34.50 " 1,014.38 " - 619.23 " 1,135.50 " 575.47 677.21 - 80601841 INJ RETROGRADE URETHROGRAM 51610 350 "$1,514.00" 559.57 - " 2,061.86 " 39.68 " 1,046.17 " - " 1,046.17 " 40.37 836.49 - 999.24 38.64 35.92 " 1,002.12 " - - " 1,649.49 " " 2,061.86 " - - - " 1,211.20 " - 34.50 " 1,014.38 " - 619.23 " 1,135.50 " 575.47 677.21 - 10588189 BLADDER IRRIGATION 51700 360 "$1,397.00" 516.33 28.70 " 1,469.00 " 33.01 " 1,469.00 " 277.55 " 1,469.00 " 33.58 771.84 272.26 845.00 32.14 29.89 924.67 237.90 264.33 618.80 773.50 270.94 272.26 264.33 " 1,117.60 " 241.86 28.70 935.99 232.61 571.37 " 1,047.75 " 531.00 624.88 273.58 10688175 BLADDER IRRIGATION 51700 360 "$1,397.00" 516.33 28.70 " 1,469.00 " 33.01 " 1,469.00 " 277.55 " 1,469.00 " 33.58 771.84 272.26 845.00 32.14 29.89 924.67 237.90 264.33 618.80 773.50 270.94 272.26 264.33 " 1,117.60 " 241.86 28.70 935.99 232.61 571.37 " 1,047.75 " 531.00 624.88 273.58 11288189 BLADDER IRRIGATION 51700 360 "$1,397.00" 516.33 28.70 " 1,469.00 " 33.01 " 1,469.00 " 277.55 " 1,469.00 " 33.58 771.84 272.26 845.00 32.14 29.89 924.67 237.90 264.33 618.80 773.50 270.94 272.26 264.33 " 1,117.60 " 241.86 28.70 935.99 232.61 571.37 " 1,047.75 " 531.00 624.88 273.58 15288191 BLADDER IRRIGATION 51700 360 "$1,397.00" 516.33 28.70 " 1,469.00 " 33.01 " 1,469.00 " 277.55 " 1,469.00 " 33.58 771.84 272.26 845.00 32.14 29.89 924.67 237.90 264.33 618.80 773.50 270.94 272.26 264.33 " 1,117.60 " 241.86 28.70 935.99 232.61 571.37 " 1,047.75 " 531.00 624.88 273.58 17100041 BLADDER IRRIGATION 51700 360 "$1,397.00" 516.33 28.70 " 1,469.00 " 33.01 " 1,469.00 " 277.55 " 1,469.00 " 33.58 771.84 272.26 845.00 32.14 29.89 924.67 237.90 264.33 618.80 773.50 270.94 272.26 264.33 " 1,117.60 " 241.86 28.70 935.99 232.61 571.37 " 1,047.75 " 531.00 624.88 273.58 17288083 BLADDER IRRIGATION 51700 360 "$1,397.00" 516.33 28.70 " 1,469.00 " 33.01 " 1,469.00 " 277.55 " 1,469.00 " 33.58 771.84 272.26 845.00 32.14 29.89 924.67 237.90 264.33 618.80 773.50 270.94 272.26 264.33 " 1,117.60 " 241.86 28.70 935.99 232.61 571.37 " 1,047.75 " 531.00 624.88 273.58 17380095 BLADDER IRRIGATION 51700 360 "$1,397.00" 516.33 28.70 " 1,469.00 " 33.01 " 1,469.00 " 277.55 " 1,469.00 " 33.58 771.84 272.26 845.00 32.14 29.89 924.67 237.90 264.33 618.80 773.50 270.94 272.26 264.33 " 1,117.60 " 241.86 28.70 935.99 232.61 571.37 " 1,047.75 " 531.00 624.88 273.58 18200074 BLADDER IRRIGATION 51700 360 "$1,397.00" 516.33 28.70 " 1,469.00 " 33.01 " 1,469.00 " 277.55 " 1,469.00 " 33.58 771.84 272.26 845.00 32.14 29.89 924.67 237.90 264.33 618.80 773.50 270.94 272.26 264.33 " 1,117.60 " 241.86 28.70 935.99 232.61 571.37 " 1,047.75 " 531.00 624.88 273.58 19000133 BLADDER IRRIGATION 51700 360 "$1,397.00" 516.33 28.70 " 1,469.00 " 33.01 " 1,469.00 " 277.55 " 1,469.00 " 33.58 771.84 272.26 845.00 32.14 29.89 924.67 237.90 264.33 618.80 773.50 270.94 272.26 264.33 " 1,117.60 " 241.86 28.70 935.99 232.61 571.37 " 1,047.75 " 531.00 624.88 273.58 19388182 BLADDER IRRIGATION 51700 360 "$1,397.00" 516.33 28.70 " 1,469.00 " 33.01 " 1,469.00 " 277.55 " 1,469.00 " 33.58 771.84 272.26 845.00 32.14 29.89 924.67 237.90 264.33 618.80 773.50 270.94 272.26 264.33 " 1,117.60 " 241.86 28.70 935.99 232.61 571.37 " 1,047.75 " 531.00 624.88 273.58 19488187 BLADDER IRRIGATION 51700 360 "$1,397.00" 516.33 28.70 " 1,469.00 " 33.01 " 1,469.00 " 277.55 " 1,469.00 " 33.58 771.84 272.26 845.00 32.14 29.89 924.67 237.90 264.33 618.80 773.50 270.94 272.26 264.33 " 1,117.60 " 241.86 28.70 935.99 232.61 571.37 " 1,047.75 " 531.00 624.88 273.58 28171897 BLADDER IRRIGATION 51700 360 "$1,397.00" 516.33 28.70 " 1,469.00 " 33.01 " 1,469.00 " 277.55 " 1,469.00 " 33.58 771.84 272.26 845.00 32.14 29.89 924.67 237.90 264.33 618.80 773.50 270.94 272.26 264.33 " 1,117.60 " 241.86 28.70 935.99 232.61 571.37 " 1,047.75 " 531.00 624.88 273.58 29817707 BLADDER IRRIGATION 51700 360 "$1,397.00" 516.33 28.70 " 1,469.00 " 33.01 " 1,469.00 " 277.55 " 1,469.00 " 33.58 771.84 272.26 845.00 32.14 29.89 924.67 237.90 264.33 618.80 773.50 270.94 272.26 264.33 " 1,117.60 " 241.86 28.70 935.99 232.61 571.37 " 1,047.75 " 531.00 624.88 273.58 37089290 BLADDER IRRIGATION 51700 450 "$1,397.00" 516.33 28.70 " 1,469.00 " 33.01 " 1,469.00 " 277.55 " 1,469.00 " 33.58 771.84 272.26 845.00 32.14 29.89 924.67 237.90 264.33 618.80 773.50 270.94 272.26 264.33 " 1,117.60 " 241.86 28.70 935.99 232.61 571.37 " 1,047.75 " 531.00 624.88 273.58 10588197 INSRT NON-INDWELL BLADDER CATH 51701 360 $588.00 217.32 25.45 " 1,469.00 " 29.27 " 1,469.00 " 117.61 " 1,469.00 " 29.78 324.87 115.37 845.00 28.50 26.50 389.20 100.81 112.01 422.02 527.53 114.81 115.37 112.01 470.40 102.49 25.45 393.96 98.57 240.49 441.00 223.50 263.01 115.93 10688183 INSRT NON-INDWELL BLADDER CATH 51701 360 $588.00 217.32 25.45 " 1,469.00 " 29.27 " 1,469.00 " 117.61 " 1,469.00 " 29.78 324.87 115.37 845.00 28.50 26.50 389.20 100.81 112.01 422.02 527.53 114.81 115.37 112.01 470.40 102.49 25.45 393.96 98.57 240.49 441.00 223.50 263.01 115.93 11288197 INSRT NON-INDWELL BLADDER CATH 51701 360 $588.00 217.32 25.45 " 1,469.00 " 29.27 " 1,469.00 " 117.61 " 1,469.00 " 29.78 324.87 115.37 845.00 28.50 26.50 389.20 100.81 112.01 422.02 527.53 114.81 115.37 112.01 470.40 102.49 25.45 393.96 98.57 240.49 441.00 223.50 263.01 115.93 15288205 INSRT NON-INDWELL BLADDER CATH 51701 360 $588.00 217.32 25.45 " 1,469.00 " 29.27 " 1,469.00 " 117.61 " 1,469.00 " 29.78 324.87 115.37 845.00 28.50 26.50 389.20 100.81 112.01 422.02 527.53 114.81 115.37 112.01 470.40 102.49 25.45 393.96 98.57 240.49 441.00 223.50 263.01 115.93 17100050 INSRT NON-INDWELL BLADDER CATH 51701 360 $588.00 217.32 25.45 " 1,469.00 " 29.27 " 1,469.00 " 117.61 " 1,469.00 " 29.78 324.87 115.37 845.00 28.50 26.50 389.20 100.81 112.01 422.02 527.53 114.81 115.37 112.01 470.40 102.49 25.45 393.96 98.57 240.49 441.00 223.50 263.01 115.93 17288091 INSRT NON-INDWELL BLADDER CATH 51701 360 $588.00 217.32 25.45 " 1,469.00 " 29.27 " 1,469.00 " 117.61 " 1,469.00 " 29.78 324.87 115.37 845.00 28.50 26.50 389.20 100.81 112.01 422.02 527.53 114.81 115.37 112.01 470.40 102.49 25.45 393.96 98.57 240.49 441.00 223.50 263.01 115.93 17380109 INSRT NON-INDWELL BLADDER CATH 51701 360 $588.00 217.32 25.45 " 1,469.00 " 29.27 " 1,469.00 " 117.61 " 1,469.00 " 29.78 324.87 115.37 845.00 28.50 26.50 389.20 100.81 112.01 422.02 527.53 114.81 115.37 112.01 470.40 102.49 25.45 393.96 98.57 240.49 441.00 223.50 263.01 115.93 18200082 INSRT NON-INDWELL BLADDER CATH 51701 360 $588.00 217.32 25.45 " 1,469.00 " 29.27 " 1,469.00 " 117.61 " 1,469.00 " 29.78 324.87 115.37 845.00 28.50 26.50 389.20 100.81 112.01 422.02 527.53 114.81 115.37 112.01 470.40 102.49 25.45 393.96 98.57 240.49 441.00 223.50 263.01 115.93 19000141 INSRT NON-INDWELL BLADDER CATH 51701 360 $588.00 217.32 25.45 " 1,469.00 " 29.27 " 1,469.00 " 117.61 " 1,469.00 " 29.78 324.87 115.37 845.00 28.50 26.50 389.20 100.81 112.01 422.02 527.53 114.81 115.37 112.01 470.40 102.49 25.45 393.96 98.57 240.49 441.00 223.50 263.01 115.93 19388191 INSRT NON-INDWELL BLADDER CATH 51701 360 $588.00 217.32 25.45 " 1,469.00 " 29.27 " 1,469.00 " 117.61 " 1,469.00 " 29.78 324.87 115.37 845.00 28.50 26.50 389.20 100.81 112.01 422.02 527.53 114.81 115.37 112.01 470.40 102.49 25.45 393.96 98.57 240.49 441.00 223.50 263.01 115.93 19488195 INSRT NON-INDWELL BLADDER CATH 51701 360 $588.00 217.32 25.45 " 1,469.00 " 29.27 " 1,469.00 " 117.61 " 1,469.00 " 29.78 324.87 115.37 845.00 28.50 26.50 389.20 100.81 112.01 422.02 527.53 114.81 115.37 112.01 470.40 102.49 25.45 393.96 98.57 240.49 441.00 223.50 263.01 115.93 27700641 INSRT NON-INDWELL BLADDER CATH 51701 361 $588.00 217.32 25.45 " 1,469.00 " 29.27 " 1,469.00 " 117.61 " 1,469.00 " 29.78 324.87 115.37 845.00 28.50 26.50 389.20 100.81 112.01 422.02 527.53 114.81 115.37 112.01 470.40 102.49 25.45 393.96 98.57 240.49 441.00 223.50 263.01 115.93 29817715 INSRT NON-INDWELL BLADDER CATH 51701 360 $588.00 217.32 25.45 " 1,469.00 " 29.27 " 1,469.00 " 117.61 " 1,469.00 " 29.78 324.87 115.37 845.00 28.50 26.50 389.20 100.81 112.01 422.02 527.53 114.81 115.37 112.01 470.40 102.49 25.45 393.96 98.57 240.49 441.00 223.50 263.01 115.93 37001431 INSRT NON-INDWELL BLADDER CATH 51701 450 $588.00 217.32 25.45 " 1,469.00 " 29.27 " 1,469.00 " 117.61 " 1,469.00 " 29.78 324.87 115.37 845.00 28.50 26.50 389.20 100.81 112.01 422.02 527.53 114.81 115.37 112.01 470.40 102.49 25.45 393.96 98.57 240.49 441.00 223.50 263.01 115.93 10588201 INSRT TEMP BLADDER CATH/FOLEY 51702 360 $588.00 217.32 27.51 " 1,469.00 " 31.64 " 1,469.00 " 117.61 " 1,469.00 " 32.19 324.87 115.37 845.00 30.81 28.65 389.20 100.81 112.01 519.68 649.60 114.81 115.37 112.01 470.40 102.49 27.51 393.96 98.57 240.49 441.00 223.50 263.01 115.93 10688191 INSRT TEMP BLADDER CATH/FOLEY 51702 360 $588.00 217.32 27.51 " 1,469.00 " 31.64 " 1,469.00 " 117.61 " 1,469.00 " 32.19 324.87 115.37 845.00 30.81 28.65 389.20 100.81 112.01 519.68 649.60 114.81 115.37 112.01 470.40 102.49 27.51 393.96 98.57 240.49 441.00 223.50 263.01 115.93 11288201 INSRT TEMP BLADDER CATH/FOLEY 51702 360 $588.00 217.32 27.51 " 1,469.00 " 31.64 " 1,469.00 " 117.61 " 1,469.00 " 32.19 324.87 115.37 845.00 30.81 28.65 389.20 100.81 112.01 519.68 649.60 114.81 115.37 112.01 470.40 102.49 27.51 393.96 98.57 240.49 441.00 223.50 263.01 115.93 15288213 INSRT TEMP BLADDER CATH/FOLEY 51702 360 $588.00 217.32 27.51 " 1,469.00 " 31.64 " 1,469.00 " 117.61 " 1,469.00 " 32.19 324.87 115.37 845.00 30.81 28.65 389.20 100.81 112.01 519.68 649.60 114.81 115.37 112.01 470.40 102.49 27.51 393.96 98.57 240.49 441.00 223.50 263.01 115.93 17100068 INSRT TEMP BLADDER CATH/FOLEY 51702 360 $588.00 217.32 27.51 " 1,469.00 " 31.64 " 1,469.00 " 117.61 " 1,469.00 " 32.19 324.87 115.37 845.00 30.81 28.65 389.20 100.81 112.01 519.68 649.60 114.81 115.37 112.01 470.40 102.49 27.51 393.96 98.57 240.49 441.00 223.50 263.01 115.93 17288105 INSRT TEMP BLADDER CATH/FOLEY 51702 360 $588.00 217.32 27.51 " 1,469.00 " 31.64 " 1,469.00 " 117.61 " 1,469.00 " 32.19 324.87 115.37 845.00 30.81 28.65 389.20 100.81 112.01 519.68 649.60 114.81 115.37 112.01 470.40 102.49 27.51 393.96 98.57 240.49 441.00 223.50 263.01 115.93 17380117 INSRT TEMP BLADDER CATH/FOLEY 51702 360 $588.00 217.32 27.51 " 1,469.00 " 31.64 " 1,469.00 " 117.61 " 1,469.00 " 32.19 324.87 115.37 845.00 30.81 28.65 389.20 100.81 112.01 519.68 649.60 114.81 115.37 112.01 470.40 102.49 27.51 393.96 98.57 240.49 441.00 223.50 263.01 115.93 18200091 INSRT TEMP BLADDER CATH/FOLEY 51702 360 $588.00 217.32 27.51 " 1,469.00 " 31.64 " 1,469.00 " 117.61 " 1,469.00 " 32.19 324.87 115.37 845.00 30.81 28.65 389.20 100.81 112.01 519.68 649.60 114.81 115.37 112.01 470.40 102.49 27.51 393.96 98.57 240.49 441.00 223.50 263.01 115.93 19000150 INSRT TEMP BLADDER CATH/FOLEY 51702 360 $588.00 217.32 27.51 " 1,469.00 " 31.64 " 1,469.00 " 117.61 " 1,469.00 " 32.19 324.87 115.37 845.00 30.81 28.65 389.20 100.81 112.01 519.68 649.60 114.81 115.37 112.01 470.40 102.49 27.51 393.96 98.57 240.49 441.00 223.50 263.01 115.93 19388204 INSRT TEMP BLADDER CATH/FOLEY 51702 360 $588.00 217.32 27.51 " 1,469.00 " 31.64 " 1,469.00 " 117.61 " 1,469.00 " 32.19 324.87 115.37 845.00 30.81 28.65 389.20 100.81 112.01 519.68 649.60 114.81 115.37 112.01 470.40 102.49 27.51 393.96 98.57 240.49 441.00 223.50 263.01 115.93 19488209 INSRT TEMP BLADDER CATH/FOLEY 51702 360 $588.00 217.32 27.51 " 1,469.00 " 31.64 " 1,469.00 " 117.61 " 1,469.00 " 32.19 324.87 115.37 845.00 30.81 28.65 389.20 100.81 112.01 519.68 649.60 114.81 115.37 112.01 470.40 102.49 27.51 393.96 98.57 240.49 441.00 223.50 263.01 115.93 27700659 INSRT TEMP BLADDER CATH/FOLEY 51702 361 $588.00 217.32 27.51 " 1,469.00 " 31.64 " 1,469.00 " 117.61 " 1,469.00 " 32.19 324.87 115.37 845.00 30.81 28.65 389.20 100.81 112.01 519.68 649.60 114.81 115.37 112.01 470.40 102.49 27.51 393.96 98.57 240.49 441.00 223.50 263.01 115.93 28171901 INSRT TEMP BLADDER CATH/FOLEY 51702 360 $588.00 217.32 27.51 " 1,469.00 " 31.64 " 1,469.00 " 117.61 " 1,469.00 " 32.19 324.87 115.37 845.00 30.81 28.65 389.20 100.81 112.01 519.68 649.60 114.81 115.37 112.01 470.40 102.49 27.51 393.96 98.57 240.49 441.00 223.50 263.01 115.93 29817723 INSRT TEMP BLADDER CATH/FOLEY 51702 360 $588.00 217.32 27.51 " 1,469.00 " 31.64 " 1,469.00 " 117.61 " 1,469.00 " 32.19 324.87 115.37 845.00 30.81 28.65 389.20 100.81 112.01 519.68 649.60 114.81 115.37 112.01 470.40 102.49 27.51 393.96 98.57 240.49 441.00 223.50 263.01 115.93 37003107 INSRT TEMP BLADDER CATH/FOLEY 51702 450 $588.00 217.32 27.51 " 1,469.00 " 31.64 " 1,469.00 " 117.61 " 1,469.00 " 32.19 324.87 115.37 845.00 30.81 28.65 389.20 100.81 112.01 519.68 649.60 114.81 115.37 112.01 470.40 102.49 27.51 393.96 98.57 240.49 441.00 223.50 263.01 115.93 80010648 INSRT TEMP BLADDER CATH SIMPLE 51702 360 $588.00 217.32 27.51 " 1,469.00 " 31.64 " 1,469.00 " 117.61 " 1,469.00 " 32.19 324.87 115.37 845.00 30.81 28.65 389.20 100.81 112.01 519.68 649.60 114.81 115.37 112.01 470.40 102.49 27.51 393.96 98.57 240.49 441.00 223.50 263.01 115.93 37089559 INSERT BLADDER CATH COMPLEX 51703 450 $733.00 270.92 122.05 " 1,775.00 " 892.40 " 1,469.00 " 145.62 " 1,469.00 " 907.92 404.98 142.85 " 1,775.00 " 869.12 808.05 485.17 124.82 138.69 865.42 " 1,081.77 " 142.16 142.85 138.69 586.40 126.90 776.00 491.11 122.05 299.80 549.75 278.61 327.87 143.54 28171919 CHANGE BLADDER TUBE SIMPLE 51705 360 "$1,397.00" 516.33 28.00 " 1,775.00 " 32.20 " 1,469.00 " 277.55 " 1,469.00 " 32.76 771.84 272.26 " 1,775.00 " 31.36 29.16 924.67 237.90 264.33 168.76 210.95 270.94 272.26 264.33 " 1,117.60 " 241.86 28.00 935.99 232.61 571.37 " 1,047.75 " 531.00 624.88 273.58 37090000 CHANGE BLADDER TUBE SIMPLE 51705 450 "$1,397.00" 516.33 28.00 " 1,775.00 " 32.20 " 1,469.00 " 277.55 " 1,469.00 " 32.76 771.84 272.26 " 1,775.00 " 31.36 29.16 924.67 237.90 264.33 168.76 210.95 270.94 272.26 264.33 " 1,117.60 " 241.86 28.00 935.99 232.61 571.37 " 1,047.75 " 531.00 624.88 273.58 80329369 CHANGE CYSTOSTOMY TUBE SIMPLE 51705 320 "$1,397.00" 516.33 28.00 " 1,775.00 " 32.20 " 1,469.00 " 277.55 " 1,469.00 " 32.76 771.84 272.26 " 1,775.00 " 31.36 29.16 924.67 237.90 264.33 168.76 210.95 270.94 272.26 264.33 " 1,117.60 " 241.86 28.00 935.99 232.61 571.37 " 1,047.75 " 531.00 624.88 273.58 80336730 CYSTOSTOMY TUBE CHNG COMPLCATD 51710 320 "$3,018.00" " 1,115.45 " 502.90 " 2,414.40 " 892.40 " 1,469.00 " 600.05 " 1,469.00 " 907.92 " 1,667.45 " 588.62 " 1,775.00 " 869.12 808.05 " 1,997.61 " 514.33 571.48 " 1,649.49 " " 2,061.86 " 585.77 588.62 571.48 " 2,414.40 " 522.90 776.00 " 2,022.06 " 502.90 " 1,234.36 " " 2,263.50 " " 1,147.14 " " 1,349.95 " 591.48 28171927 ENDOSCOPIC INJECTION/IMPLANT 51715 360 "$16,151.00" " 5,969.41 " 776.00 " 12,920.80 " 892.40 " 2,773.00 " " 3,206.84 " " 2,773.00 " 907.92 " 8,923.43 " " 3,145.75 " " 3,545.00 " 869.12 808.05 " 10,690.35 " " 2,748.72 " " 3,054.13 " " 4,937.34 " " 6,171.67 " " 3,130.48 " " 3,145.75 " " 3,054.13 " " 12,920.80 " " 2,794.53 " 776.00 " 10,821.17 " " 2,687.63 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,161.02 " 27700608 TX BLADDER LESN/INSTILLATION 51720 361 "$1,397.00" 516.33 232.61 " 1,775.00 " 892.40 " 1,469.00 " 277.55 " 1,469.00 " 907.92 771.84 272.26 " 1,775.00 " 869.12 808.05 924.67 237.90 264.33 " 1,012.58 " " 1,265.72 " 270.94 272.26 264.33 " 1,117.60 " 241.86 776.00 935.99 232.61 571.37 " 1,047.75 " 531.00 624.88 273.58 28171935 TX BLADDER LESN/INSTILLATION 51720 360 "$1,397.00" 516.33 232.61 " 1,775.00 " 892.40 " 1,469.00 " 277.55 " 1,469.00 " 907.92 771.84 272.26 " 1,775.00 " 869.12 808.05 924.67 237.90 264.33 " 1,012.58 " " 1,265.72 " 270.94 272.26 264.33 " 1,117.60 " 241.86 776.00 935.99 232.61 571.37 " 1,047.75 " 531.00 624.88 273.58 31200415 EMG NDL ANAL URETHERAL 51785 922 "$1,397.00" 516.33 - " 2,061.86 " - " 1,469.00 " 277.55 " 1,469.00 " - 771.84 272.26 " 1,775.00 " - - 924.67 237.90 264.33 " 1,649.49 " " 2,061.86 " 270.94 272.26 264.33 " 1,117.60 " 241.86 - 935.99 232.61 571.37 " 1,047.75 " 531.00 624.88 273.58 37003905 MEASURE POST VOIDING RESIDUAL 51798 450 $292.00 107.92 14.07 845.00 16.18 201.77 58.05 201.77 16.46 161.33 56.95 845.00 15.76 14.65 193.27 49.76 55.29 49.74 62.17 56.67 56.95 55.29 233.60 50.59 14.07 195.64 48.66 119.43 219.00 110.99 130.61 57.23 28171943 REPAIR OF BLADDER WOUND 51860 360 "$23,173.00" " 8,564.74 " 416.00 " 18,538.40 " 478.40 " 1,718.00 " " 4,601.74 " " 1,718.00 " 486.72 " 12,803.08 " " 4,514.09 " " 15,294.18 " 465.92 433.18 " 15,338.21 " " 3,944.35 " " 4,382.61 " " 3,880.49 " " 4,850.61 " " 4,492.18 " " 4,514.09 " " 4,382.61 " " 18,538.40 " " 4,010.09 " 416.00 " 15,525.91 " " 3,856.70 " " 9,477.76 " " 17,379.75 " " 8,808.06 " " 10,365.28 " " 4,536.00 " 28175507 CYSTORRHAPHY COMPLICATED 51865 360 "$2,626.00" 970.57 - " 3,900.12 " - " 3,326.00 " N/A " 3,326.00 " - " 1,450.87 " N/A " 1,733.16 " - N/A " 1,738.15 " - N/A " 3,120.10 " " 3,900.12 " N/A N/A N/A " 2,100.80 " N/A - " 1,759.42 " N/A " 1,074.03 " " 1,969.50 " 998.14 " 1,174.61 " N/A 28171951 CYSTOSCOPY 52000 360 "$3,018.00" " 1,115.45 " 502.90 " 2,414.40 " 669.30 " 1,469.00 " 600.05 " 1,469.00 " 680.94 " 1,667.45 " 588.62 " 1,775.00 " 651.84 606.04 " 1,997.61 " 514.33 571.48 " 1,649.49 " " 2,061.86 " 585.77 588.62 571.48 " 2,414.40 " 522.90 582.00 " 2,022.06 " 502.90 " 1,234.36 " " 2,263.50 " " 1,147.14 " " 1,349.95 " 591.48 28171960 CYSTOSCOPY REMOVAL OF CLOTS 52001 360 "$16,151.00" " 5,969.41 " 776.00 " 12,920.80 " 892.40 " 1,718.00 " " 3,206.84 " " 1,718.00 " 907.92 " 8,923.43 " " 3,145.75 " " 2,820.00 " 869.12 808.05 " 10,690.35 " " 2,748.72 " " 3,054.13 " " 2,318.92 " " 2,898.65 " " 3,130.48 " " 3,145.75 " " 3,054.13 " " 12,920.80 " " 2,794.53 " 776.00 " 10,821.17 " " 2,687.63 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,161.02 " 28171978 CYSTOSCOPY & URETER CATHETER 52005 360 "$9,413.00" " 3,479.04 " 688.00 " 7,530.40 " 791.20 " 1,718.00 " " 1,867.55 " " 1,718.00 " 804.96 " 5,200.68 " " 1,831.98 " " 2,820.00 " 770.56 716.41 " 6,230.46 " " 1,600.76 " " 1,778.62 " " 2,208.66 " " 2,760.83 " " 1,823.09 " " 1,831.98 " " 1,778.62 " " 7,530.40 " " 1,627.44 " 688.00 " 6,306.71 " " 1,565.19 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,840.87 " 28171986 CYSTOSCOPY W/BIOPSY(S) 52204 360 "$9,413.00" " 3,479.04 " 698.00 " 7,530.40 " 802.70 " 1,718.00 " " 1,867.55 " " 1,718.00 " 816.66 " 5,200.68 " " 1,831.98 " " 2,820.00 " 781.76 726.83 " 6,230.46 " " 1,600.76 " " 1,778.62 " " 2,208.66 " " 2,760.83 " " 1,823.09 " " 1,831.98 " " 1,778.62 " " 7,530.40 " " 1,627.44 " 698.00 " 6,306.71 " " 1,565.19 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,840.87 " 28171994 CYS W FULG TRIG-BLAD PROS URET 52214 360 "$16,151.00" " 5,969.41 " 609.00 " 12,920.80 " 700.35 " 1,718.00 " " 3,206.84 " " 1,718.00 " 712.53 " 8,923.43 " " 3,145.75 " " 2,820.00 " 682.08 634.15 " 10,690.35 " " 2,748.72 " " 3,054.13 " " 2,208.66 " " 2,760.83 " " 3,130.48 " " 3,145.75 " " 3,054.13 " " 12,920.80 " " 2,794.53 " 609.00 " 10,821.17 " " 2,687.63 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,161.02 " 28172001 CYS W FULG RX MINOR W/WO BIOPS 52224 360 "$16,151.00" " 5,969.41 " 545.00 " 12,920.80 " 626.75 " 1,718.00 " " 3,206.84 " " 1,718.00 " 637.65 " 8,923.43 " " 3,145.75 " " 2,820.00 " 610.40 567.51 " 10,690.35 " " 2,748.72 " " 3,054.13 " " 2,208.66 " " 2,760.83 " " 3,130.48 " " 3,145.75 " " 3,054.13 " " 12,920.80 " " 2,794.53 " 545.00 " 10,821.17 " " 2,687.63 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,161.02 " 28172010 CYS W FULG OR RESEC SM BLA TUM 52234 360 "$16,151.00" " 5,969.41 " 701.00 " 12,920.80 " 806.15 " 1,718.00 " " 3,206.84 " " 1,718.00 " 820.17 " 8,923.43 " " 3,145.75 " " 2,820.00 " 785.12 729.95 " 10,690.35 " " 2,748.72 " " 3,054.13 " " 2,208.66 " " 2,760.83 " " 3,130.48 " " 3,145.75 " " 3,054.13 " " 12,920.80 " " 2,794.53 " 701.00 " 10,821.17 " " 2,687.63 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,161.02 " 28175515 CYS W/RESEC MED BLADDER TUMOR 52235 360 "$16,151.00" " 5,969.41 " 597.00 " 12,920.80 " 686.55 " 2,773.00 " " 3,206.84 " " 2,773.00 " 698.49 " 8,923.43 " " 3,145.75 " " 3,545.00 " 668.64 621.66 " 10,690.35 " " 2,748.72 " " 3,054.13 " " 2,532.97 " " 3,166.21 " " 3,130.48 " " 3,145.75 " " 3,054.13 " " 12,920.80 " " 2,794.53 " 597.00 " 10,821.17 " " 2,687.63 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,161.02 " 28172028 CYS W/RESEC LG BLADDER TUMOR 52240 360 "$23,173.00" " 8,564.74 " 776.00 " 18,538.40 " 892.40 " 2,773.00 " " 4,601.74 " " 2,773.00 " 907.92 " 12,803.08 " " 4,514.09 " " 3,545.00 " 869.12 808.05 " 15,338.21 " " 3,944.35 " " 4,382.61 " " 2,532.97 " " 3,166.21 " " 4,492.18 " " 4,514.09 " " 4,382.61 " " 18,538.40 " " 4,010.09 " 776.00 " 15,525.91 " " 3,856.70 " " 9,477.76 " " 17,379.75 " " 8,808.06 " " 10,365.28 " " 4,536.00 " 28172036 CYSTO DILATION BLADDER GEN ANE 52260 360 "$9,413.00" " 3,479.04 " 566.00 " 7,530.40 " 650.90 " 1,718.00 " " 1,867.55 " " 1,718.00 " 662.22 " 5,200.68 " " 1,831.98 " " 2,820.00 " 633.92 589.38 " 6,230.46 " " 1,600.76 " " 1,778.62 " " 2,208.66 " " 2,760.83 " " 1,823.09 " " 1,831.98 " " 1,778.62 " " 7,530.40 " " 1,627.44 " 566.00 " 6,306.71 " " 1,565.19 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,840.87 " 28172044 CYSTO VISION INT URETHROTOMY 52276 360 "$9,413.00" " 3,479.04 " 776.00 " 7,530.40 " 892.40 " 2,773.00 " " 1,867.55 " " 2,773.00 " 907.92 " 5,200.68 " " 1,831.98 " " 3,545.00 " 869.12 808.05 " 6,230.46 " " 1,600.76 " " 1,778.62 " " 2,532.97 " " 3,166.21 " " 1,823.09 " " 1,831.98 " " 1,778.62 " " 7,530.40 " " 1,627.44 " 776.00 " 6,306.71 " " 1,565.19 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,840.87 " 28172052 CYSTOSCOPY W/CAL &/OR DIL URET 52281 360 "$9,413.00" " 3,479.04 " 530.00 " 7,530.40 " 609.50 " 1,718.00 " " 1,867.55 " " 1,718.00 " 620.10 " 5,200.68 " " 1,831.98 " " 2,820.00 " 593.60 551.89 " 6,230.46 " " 1,600.76 " " 1,778.62 " " 2,208.66 " " 2,760.83 " " 1,823.09 " " 1,831.98 " " 1,778.62 " " 7,530.40 " " 1,627.44 " 530.00 " 6,306.71 " " 1,565.19 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,840.87 " 34000221 CYSTOSCOPY W/CAL &/OR DIL URET 52281 750 "$9,413.00" " 3,479.04 " 530.00 " 7,530.40 " 609.50 " 1,718.00 " " 1,867.55 " " 1,718.00 " 620.10 " 5,200.68 " " 1,831.98 " " 2,820.00 " 593.60 551.89 " 6,230.46 " " 1,600.76 " " 1,778.62 " " 2,208.66 " " 2,760.83 " " 1,823.09 " " 1,831.98 " " 1,778.62 " " 7,530.40 " " 1,627.44 " 530.00 " 6,306.71 " " 1,565.19 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,840.87 " 28175523 CYSTO INSER URETH STENT 52282 360 "$16,151.00" " 5,969.41 " - " 12,920.80 " - " 4,656.00 " " 3,206.84 " " 4,656.00 " - " 8,923.43 " " 3,145.75 " " 6,576.00 " - - " 10,690.35 " " 2,748.72 " " 3,054.13 " " 7,133.34 " " 8,916.67 " " 3,130.48 " " 3,145.75 " " 3,054.13 " " 12,920.80 " " 2,794.53 " - " 10,821.17 " " 2,687.63 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,161.02 " 28172061 CYSTO W STEROID INJ IN STRICT 52283 360 "$9,413.00" " 3,479.04 " 776.00 " 7,530.40 " 892.40 " 1,718.00 " " 1,867.55 " " 1,718.00 " 907.92 " 5,200.68 " " 1,831.98 " " 2,820.00 " 869.12 808.05 " 6,230.46 " " 1,600.76 " " 1,778.62 " " 2,208.66 " " 2,760.83 " " 1,823.09 " " 1,831.98 " " 1,778.62 " " 7,530.40 " " 1,627.44 " 776.00 " 6,306.71 " " 1,565.19 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,840.87 " 28172079 CYSTOSCOPY CHEMODENERVATION 52287 360 "$9,413.00" " 3,479.04 " 759.15 " 7,530.40 " 892.40 " 1,718.00 " " 1,867.55 " " 1,718.00 " 907.92 " 5,200.68 " " 1,831.98 " " 4,445.00 " 869.12 808.05 " 6,230.46 " " 1,600.76 " " 1,778.62 " 759.15 948.94 " 1,823.09 " " 1,831.98 " " 1,778.62 " " 7,530.40 " " 1,627.44 " 776.00 " 6,306.71 " " 1,565.19 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,840.87 " 28172087 CYSTO W RES URETEROCEL UNI/BIL 52300 360 "$16,151.00" " 5,969.41 " 776.00 " 12,920.80 " 892.40 " 1,718.00 " " 3,206.84 " " 1,718.00 " 907.92 " 8,923.43 " " 3,145.75 " " 2,820.00 " 869.12 808.05 " 10,690.35 " " 2,748.72 " " 3,054.13 " " 2,208.66 " " 2,760.83 " " 3,130.48 " " 3,145.75 " " 3,054.13 " " 12,920.80 " " 2,794.53 " 776.00 " 10,821.17 " " 2,687.63 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,161.02 " 28172095 CYSTO REM FB STENT OR CALCULUS 52310 360 "$9,413.00" " 3,479.04 " 649.00 " 7,530.40 " 746.35 " 1,718.00 " " 1,867.55 " " 1,718.00 " 759.33 " 5,200.68 " " 1,831.98 " " 2,820.00 " 726.88 675.80 " 6,230.46 " " 1,600.76 " " 1,778.62 " " 2,208.66 " " 2,760.83 " " 1,823.09 " " 1,831.98 " " 1,778.62 " " 7,530.40 " " 1,627.44 " 649.00 " 6,306.71 " " 1,565.19 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,840.87 " 28172109 CYSTO REM FB STEN OR CALC COMP 52315 360 "$9,413.00" " 3,479.04 " 776.00 " 7,530.40 " 892.40 " 1,718.00 " " 1,867.55 " " 1,718.00 " 907.92 " 5,200.68 " " 1,831.98 " " 2,820.00 " 869.12 808.05 " 6,230.46 " " 1,600.76 " " 1,778.62 " " 2,208.66 " " 2,760.83 " " 1,823.09 " " 1,831.98 " " 1,778.62 " " 7,530.40 " " 1,627.44 " 776.00 " 6,306.71 " " 1,565.19 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,840.87 " 28172117 REMOVE BLADDER STONE 52317 360 "$16,151.00" " 5,969.41 " 776.00 " 12,920.80 " 892.40 " 1,469.00 " " 3,206.84 " " 1,469.00 " 907.92 " 8,923.43 " " 3,145.75 " " 1,775.00 " 869.12 808.05 " 10,690.35 " " 2,748.72 " " 3,054.13 " " 1,649.49 " " 2,061.86 " " 3,130.48 " " 3,145.75 " " 3,054.13 " " 12,920.80 " " 2,794.53 " 776.00 " 10,821.17 " " 2,687.63 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,161.02 " 28176643 CYSTO REM URETERAL CALCULUS 52320 360 "$16,151.00" " 5,969.41 " 512.00 " 12,920.80 " 588.80 " 3,604.00 " " 3,206.84 " " 3,604.00 " 599.04 " 8,923.43 " " 3,145.75 " " 4,445.00 " 573.44 533.15 " 10,690.35 " " 2,748.72 " " 3,054.13 " " 3,730.57 " " 4,663.21 " " 3,130.48 " " 3,145.75 " " 3,054.13 " " 12,920.80 " " 2,794.53 " 512.00 " 10,821.17 " " 2,687.63 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,161.02 " 28172125 CYSTO W INSTERT URETERAL STENT 52332 360 "$16,151.00" " 5,969.41 " 776.00 " 12,920.80 " 892.40 " 1,718.00 " " 3,206.84 " " 1,718.00 " 907.92 " 8,923.43 " " 3,145.75 " " 2,820.00 " 869.12 808.05 " 10,690.35 " " 2,748.72 " " 3,054.13 " " 2,208.66 " " 2,760.83 " " 3,130.48 " " 3,145.75 " " 3,054.13 " " 12,920.80 " " 2,794.53 " 776.00 " 10,821.17 " " 2,687.63 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,161.02 " 37090662 CYSTO W INSTERT URETERAL STENT 52332 450 "$16,151.00" " 5,969.41 " 776.00 " 12,920.80 " 892.40 " 1,718.00 " " 3,206.84 " " 1,718.00 " 907.92 " 8,923.43 " " 3,145.75 " " 2,820.00 " 869.12 808.05 " 10,690.35 " " 2,748.72 " " 3,054.13 " " 2,208.66 " " 2,760.83 " " 3,130.48 " " 3,145.75 " " 3,054.13 " " 12,920.80 " " 2,794.53 " 776.00 " 10,821.17 " " 2,687.63 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,161.02 " 28172133 CYSTO/URETERO STRICTURE TX 52344 360 "$16,151.00" " 5,969.41 " 776.00 " 12,920.80 " 892.40 " 2,773.00 " " 3,206.84 " " 2,773.00 " 907.92 " 8,923.43 " " 3,145.75 " " 3,545.00 " 869.12 808.05 " 10,690.35 " " 2,748.72 " " 3,054.13 " " 2,717.03 " " 3,396.29 " " 3,130.48 " " 3,145.75 " " 3,054.13 " " 12,920.80 " " 2,794.53 " 776.00 " 10,821.17 " " 2,687.63 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,161.02 " 28172141 CYSTOURETERO & OR PYELOSCOPE 52351 360 "$16,151.00" " 5,969.41 " 776.00 " 12,920.80 " 892.40 " 2,773.00 " " 3,206.84 " " 2,773.00 " 907.92 " 8,923.43 " " 3,145.75 " " 3,545.00 " 869.12 808.05 " 10,690.35 " " 2,748.72 " " 3,054.13 " " 2,717.03 " " 3,396.29 " " 3,130.48 " " 3,145.75 " " 3,054.13 " " 12,920.80 " " 2,794.53 " 776.00 " 10,821.17 " " 2,687.63 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,161.02 " 28172150 CYSTOURETERO W/STONE REMOVE 52352 360 "$16,151.00" " 5,969.41 " 776.00 " 12,920.80 " 892.40 " 3,326.00 " " 3,206.84 " " 3,326.00 " 907.92 " 8,923.43 " " 3,145.75 " " 4,860.00 " 869.12 808.05 " 10,690.35 " " 2,748.72 " " 3,054.13 " " 3,356.30 " " 4,195.38 " " 3,130.48 " " 3,145.75 " " 3,054.13 " " 12,920.80 " " 2,794.53 " 776.00 " 10,821.17 " " 2,687.63 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,161.02 " 28172168 CYSTOURETERO W/LITHOTRIPSY 52353 360 "$23,173.00" " 8,564.74 " 776.00 " 18,538.40 " 892.40 " 3,326.00 " " 4,601.74 " " 3,326.00 " 907.92 " 12,803.08 " " 4,514.09 " " 4,860.00 " 869.12 808.05 " 15,338.21 " " 3,944.35 " " 4,382.61 " " 3,356.30 " " 4,195.38 " " 4,492.18 " " 4,514.09 " " 4,382.61 " " 18,538.40 " " 4,010.09 " 776.00 " 15,525.91 " " 3,856.70 " " 9,477.76 " " 17,379.75 " " 8,808.06 " " 10,365.28 " " 4,536.00 " 28172176 CYSTOURETERO W/BIOPSY 52354 360 "$23,173.00" " 8,564.74 " 776.00 " 18,538.40 " 892.40 " 3,326.00 " " 4,601.74 " " 3,326.00 " 907.92 " 12,803.08 " " 4,514.09 " " 4,860.00 " 869.12 808.05 " 15,338.21 " " 3,944.35 " " 4,382.61 " " 3,356.30 " " 4,195.38 " " 4,492.18 " " 4,514.09 " " 4,382.61 " " 18,538.40 " " 4,010.09 " 776.00 " 15,525.91 " " 3,856.70 " " 9,477.76 " " 17,379.75 " " 8,808.06 " " 10,365.28 " " 4,536.00 " 28172184 CYSTO/URETERO W/LITHOTRIPSY 52356 360 "$23,173.00" " 8,564.74 " 776.00 " 18,538.40 " 892.40 " 3,326.00 " " 4,601.74 " " 3,326.00 " 907.92 " 12,803.08 " " 4,514.09 " " 6,576.00 " 869.12 808.05 " 15,338.21 " " 3,944.35 " " 4,382.61 " 929.78 " 1,162.22 " " 4,492.18 " " 4,514.09 " " 4,382.61 " " 18,538.40 " " 4,010.09 " 776.00 " 15,525.91 " " 3,856.70 " " 9,477.76 " " 17,379.75 " " 8,808.06 " " 10,365.28 " " 4,536.00 " 28172192 REVISION OF BLADDER NECK 52500 360 "$16,151.00" " 5,969.41 " 776.00 " 12,920.80 " 892.40 " 2,773.00 " " 3,206.84 " " 2,773.00 " 907.92 " 8,923.43 " " 3,145.75 " " 3,545.00 " 869.12 808.05 " 10,690.35 " " 2,748.72 " " 3,054.13 " " 2,532.97 " " 3,166.21 " " 3,130.48 " " 3,145.75 " " 3,054.13 " " 12,920.80 " " 2,794.53 " 776.00 " 10,821.17 " " 2,687.63 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,161.02 " 28172206 PROSTATECTOMY (TURP) 52601 360 "$23,173.00" " 8,564.74 " 776.00 " 18,538.40 " 892.40 " 3,326.00 " " 4,601.74 " " 3,326.00 " 907.92 " 12,803.08 " " 4,514.09 " " 4,860.00 " 869.12 808.05 " 15,338.21 " " 3,944.35 " " 4,382.61 " " 3,120.10 " " 3,900.12 " " 4,492.18 " " 4,514.09 " " 4,382.61 " " 18,538.40 " " 4,010.09 " 776.00 " 15,525.91 " " 3,856.70 " " 9,477.76 " " 17,379.75 " " 8,808.06 " " 10,365.28 " " 4,536.00 " 28172214 RELIEVE BLADDER CONTRACTURE 52640 360 "$16,151.00" " 5,969.41 " 776.00 " 12,920.80 " 892.40 " 1,718.00 " " 3,206.84 " " 1,718.00 " 907.92 " 8,923.43 " " 3,145.75 " " 2,820.00 " 869.12 808.05 " 10,690.35 " " 2,748.72 " " 3,054.13 " " 2,208.66 " " 2,760.83 " " 3,130.48 " " 3,145.75 " " 3,054.13 " " 12,920.80 " " 2,794.53 " 776.00 " 10,821.17 " " 2,687.63 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,161.02 " 28172222 LASER SURGERY OF PROSTATE 52648 360 "$23,173.00" " 8,564.74 " 776.00 " 18,538.40 " 892.40 " 4,656.00 " " 4,601.74 " " 4,656.00 " 907.92 " 12,803.08 " " 4,514.09 " " 6,576.00 " 869.12 808.05 " 15,338.21 " " 3,944.35 " " 4,382.61 " " 7,133.34 " " 8,916.67 " " 4,492.18 " " 4,514.09 " " 4,382.61 " " 18,538.40 " " 4,010.09 " 776.00 " 15,525.91 " " 3,856.70 " " 9,477.76 " " 17,379.75 " " 8,808.06 " " 10,365.28 " " 4,536.00 " 28172231 INCISION OF URETHRA 53020 360 "$9,413.00" " 3,479.04 " 584.00 " 7,530.40 " 671.60 " 1,469.00 " " 1,867.55 " " 1,469.00 " 683.28 " 5,200.68 " " 1,831.98 " " 1,775.00 " 654.08 608.12 " 6,230.46 " " 1,600.76 " " 1,778.62 " " 1,649.49 " " 2,061.86 " " 1,823.09 " " 1,831.98 " " 1,778.62 " " 7,530.40 " " 1,627.44 " 584.00 " 6,306.71 " " 1,565.19 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,840.87 " 28172249 DILATION URETHRAL STRICT PASS 53600 360 "$1,397.00" 516.33 232.61 " 1,775.00 " 892.40 " 1,469.00 " 277.55 " 1,469.00 " 907.92 771.84 272.26 " 1,775.00 " 869.12 808.05 924.67 237.90 264.33 496.05 620.06 270.94 272.26 264.33 " 1,117.60 " 241.86 776.00 935.99 232.61 571.37 " 1,047.75 " 531.00 624.88 273.58 28172257 DILATION MALE URETHRAL STRICT 53605 360 "$16,151.00" " 5,969.41 " 776.00 " 12,920.80 " 892.40 " 1,718.00 " " 3,206.84 " " 1,718.00 " 907.92 " 8,923.43 " " 3,145.75 " " 2,820.00 " 869.12 808.05 " 10,690.35 " " 2,748.72 " " 3,054.13 " " 2,208.66 " " 2,760.83 " " 3,130.48 " " 3,145.75 " " 3,054.13 " " 12,920.80 " " 2,794.53 " 776.00 " 10,821.17 " " 2,687.63 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,161.02 " 28175531 DILATION OF FEMALE URETHRA 53660 360 $733.00 270.92 122.05 " 1,469.00 " 483.00 " 1,469.00 " 145.62 " 1,469.00 " 491.40 404.98 142.85 845.00 470.40 437.35 485.17 124.82 138.69 415.78 519.72 142.16 142.85 138.69 586.40 126.90 420.00 491.11 122.05 299.80 549.75 278.61 327.87 143.54 67709934 UNL BX URINARY BLADDER 53899 350 "$1,397.00" 516.33 - " 1,469.00 " - " 1,469.00 " 277.55 " 1,469.00 " - 771.84 272.26 922.02 - - 924.67 237.90 264.33 56.26 70.32 270.94 272.26 264.33 " 1,117.60 " 241.86 - 935.99 232.61 571.37 " 1,047.75 " 531.00 624.88 273.58 80609931 UNL BX URINARY BLADDER 53899 350 "$1,397.00" 516.33 - " 1,469.00 " - " 1,469.00 " 277.55 " 1,469.00 " - 771.84 272.26 922.02 - - 924.67 237.90 264.33 56.26 70.32 270.94 272.26 264.33 " 1,117.60 " 241.86 - 935.99 232.61 571.37 " 1,047.75 " 531.00 624.88 273.58 80635541 UNL BX URETERAL 53899 350 "$1,397.00" 516.33 - " 1,469.00 " - " 1,469.00 " 277.55 " 1,469.00 " - 771.84 272.26 922.02 - - 924.67 237.90 264.33 56.26 70.32 270.94 272.26 264.33 " 1,117.60 " 241.86 - 935.99 232.61 571.37 " 1,047.75 " 531.00 624.88 273.58 28175540 BIOPSY PENIS CUTANEOUS IND PRO 54100 360 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,469.00 " " 1,467.55 " " 1,469.00 " 907.92 " 4,081.32 " " 1,439.60 " " 1,775.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28172265 CIRCUMCISION W/REGIONL BLOCK 54150 360 "$9,413.00" " 3,479.04 " 357.00 " 7,530.40 " 410.55 " 1,469.00 " " 1,867.55 " " 1,469.00 " 417.69 " 5,200.68 " " 1,831.98 " " 1,775.00 " 399.84 371.74 " 6,230.46 " " 1,600.76 " " 1,778.62 " 393.78 492.23 " 1,823.09 " " 1,831.98 " " 1,778.62 " " 7,530.40 " " 1,627.44 " 357.00 " 6,306.71 " " 1,565.19 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,840.87 " 28172273 CIRCUM 28 DAYS OR OLDER 54161 360 "$9,413.00" " 3,479.04 " 615.00 " 7,530.40 " 707.25 " 1,718.00 " " 1,867.55 " " 1,718.00 " 719.55 " 5,200.68 " " 1,831.98 " " 2,820.00 " 688.80 640.40 " 6,230.46 " " 1,600.76 " " 1,778.62 " " 2,208.66 " " 2,760.83 " " 1,823.09 " " 1,831.98 " " 1,778.62 " " 7,530.40 " " 1,627.44 " 615.00 " 6,306.71 " " 1,565.19 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,840.87 " 37004103 PENIS IRR CORP CAV PRIAPISM 54220 450 "$1,397.00" 516.33 232.61 " 2,061.86 " 892.40 " 1,469.00 " 277.55 " 1,469.00 " 907.92 771.84 272.26 " 1,775.00 " 869.12 808.05 924.67 237.90 264.33 " 1,649.49 " " 2,061.86 " 270.94 272.26 264.33 " 1,117.60 " 241.86 776.00 935.99 232.61 571.37 " 1,047.75 " 531.00 624.88 273.58 28172281 INSERT MULTI-COMP PENIS PROS 54405 360 "$95,856.00" " 35,428.38 " - " 76,684.80 " - " 2,773.00 " " 19,049.81 " " 2,773.00 " - " 52,960.44 " " 18,686.96 " " 3,545.00 " - - " 63,447.09 " " 16,328.41 " " 18,142.68 " " 2,717.03 " " 3,396.29 " " 18,596.25 " " 18,686.96 " " 18,142.68 " " 76,684.80 " " 16,600.55 " - " 64,223.52 " " 15,965.56 " " 39,205.10 " " 71,892.00 " " 36,434.87 " " 42,876.39 " " 18,777.67 " 37090654 PREPUTIAL STRETCHING 54450 450 "$1,397.00" 516.33 - " 2,061.86 " - " 1,469.00 " 277.55 " 1,469.00 " - 771.84 272.26 " 1,775.00 " - - 924.67 237.90 264.33 " 1,649.49 " " 2,061.86 " 270.94 272.26 264.33 " 1,117.60 " 241.86 - 935.99 232.61 571.37 " 1,047.75 " 531.00 624.88 273.58 28172290 ORCHIECTOMY SIMPLE 54520 360 "$16,151.00" " 5,969.41 " 763.00 " 12,920.80 " 877.45 " 2,773.00 " " 3,206.84 " " 2,773.00 " 892.71 " 8,923.43 " " 3,145.75 " " 3,545.00 " 854.56 794.51 " 10,690.35 " " 2,748.72 " " 3,054.13 " " 2,532.97 " " 3,166.21 " " 3,130.48 " " 3,145.75 " " 3,054.13 " " 12,920.80 " " 2,794.53 " 763.00 " 10,821.17 " " 2,687.63 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,161.02 " 28172303 ORCHIECTOMY RADICAL TUMOR INGU 54530 360 "$16,713.00" " 6,177.12 " 776.00 " 13,370.40 " 892.40 " 3,326.00 " " 3,318.47 " " 3,326.00 " 907.92 " 9,233.93 " " 3,255.26 " " 4,860.00 " 869.12 808.05 " 11,062.33 " " 2,844.41 " " 3,160.45 " " 3,120.10 " " 3,900.12 " " 3,239.46 " " 3,255.26 " " 3,160.45 " " 13,370.40 " " 2,891.81 " 776.00 " 11,197.71 " " 2,781.20 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,271.07 " 28172311 REDUCE TESTIS TORSION 54600 360 "$16,151.00" " 5,969.41 " 776.00 " 12,920.80 " 892.40 " 3,326.00 " " 3,206.84 " " 3,326.00 " 907.92 " 8,923.43 " " 3,145.75 " " 4,860.00 " 869.12 808.05 " 10,690.35 " " 2,748.72 " " 3,054.13 " " 3,120.10 " " 3,900.12 " " 3,130.48 " " 3,145.75 " " 3,054.13 " " 12,920.80 " " 2,794.53 " 776.00 " 10,821.17 " " 2,687.63 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,161.02 " 28176465 ORCHIOPEXY INGUN/SCROT APPR 54640 360 "$16,713.00" " 6,177.12 " 701.00 " 13,370.40 " 806.15 " 3,326.00 " " 3,318.47 " " 3,326.00 " 820.17 " 9,233.93 " " 3,255.26 " " 4,860.00 " 785.12 729.95 " 11,062.33 " " 2,844.41 " " 3,160.45 " " 3,120.10 " " 3,900.12 " " 3,239.46 " " 3,255.26 " " 3,160.45 " " 13,370.40 " " 2,891.81 " 701.00 " 11,197.71 " " 2,781.20 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,271.07 " 28172320 I&D SCROTUM 54700 360 "$9,413.00" " 3,479.04 " 776.00 " 7,530.40 " 892.40 " 1,718.00 " " 1,867.55 " " 1,718.00 " 907.92 " 5,200.68 " " 1,831.98 " " 2,820.00 " 869.12 808.05 " 6,230.46 " " 1,600.76 " " 1,778.62 " " 2,208.66 " " 2,760.83 " " 1,823.09 " " 1,831.98 " " 1,778.62 " " 7,530.40 " " 1,627.44 " 776.00 " 6,306.71 " " 1,565.19 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,840.87 " 37004022 I&D SCROTUM 54700 450 "$9,413.00" " 3,479.04 " 776.00 " 7,530.40 " 892.40 " 1,718.00 " " 1,867.55 " " 1,718.00 " 907.92 " 5,200.68 " " 1,831.98 " " 2,820.00 " 869.12 808.05 " 6,230.46 " " 1,600.76 " " 1,778.62 " " 2,208.66 " " 2,760.83 " " 1,823.09 " " 1,831.98 " " 1,778.62 " " 7,530.40 " " 1,627.44 " 776.00 " 6,306.71 " " 1,565.19 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,840.87 " 28172338 EXC OF LOCAL LESION EPIDIDYMIS 54830 360 "$16,151.00" " 5,969.41 " 776.00 " 12,920.80 " 892.40 " 2,773.00 " " 3,206.84 " " 2,773.00 " 907.92 " 8,923.43 " " 3,145.75 " " 3,545.00 " 869.12 808.05 " 10,690.35 " " 2,748.72 " " 3,054.13 " " 2,532.97 " " 3,166.21 " " 3,130.48 " " 3,145.75 " " 3,054.13 " " 12,920.80 " " 2,794.53 " 776.00 " 10,821.17 " " 2,687.63 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,161.02 " 28172346 EXC OF SPERMATOCELE EPIDIDYMEC 54840 360 "$9,413.00" " 3,479.04 " 705.00 " 7,530.40 " 810.75 " 3,326.00 " " 1,867.55 " " 3,326.00 " 824.85 " 5,200.68 " " 1,831.98 " " 4,860.00 " 789.60 734.12 " 6,230.46 " " 1,600.76 " " 1,778.62 " " 3,120.10 " " 3,900.12 " " 1,823.09 " " 1,831.98 " " 1,778.62 " " 7,530.40 " " 1,627.44 " 705.00 " 6,306.71 " " 1,565.19 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,840.87 " 28172354 REMOVAL OF HYDROCELE 55040 360 "$16,713.00" " 6,177.12 " 833.00 " 13,370.40 " 957.95 " 2,773.00 " " 3,318.47 " " 2,773.00 " 974.61 " 9,233.93 " " 3,255.26 " " 3,545.00 " 932.96 867.40 " 11,062.33 " " 2,844.41 " " 3,160.45 " " 2,532.97 " " 3,166.21 " " 3,239.46 " " 3,255.26 " " 3,160.45 " " 13,370.40 " " 2,891.81 " 833.00 " 11,197.71 " " 2,781.20 " " 6,835.62 " " 12,534.75 " " 6,352.61 " " 7,475.72 " " 3,271.07 " 28172362 REPAIR OF HYDROCELE 55060 360 "$16,151.00" " 5,969.41 " 757.00 " 12,920.80 " 870.55 " 3,326.00 " " 3,206.84 " " 3,326.00 " 885.69 " 8,923.43 " " 3,145.75 " " 4,860.00 " 847.84 788.26 " 10,690.35 " " 2,748.72 " " 3,054.13 " " 3,120.10 " " 3,900.12 " " 3,130.48 " " 3,145.75 " " 3,054.13 " " 12,920.80 " " 2,794.53 " 757.00 " 10,821.17 " " 2,687.63 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,161.02 " 28172371 DRAIN SCROTAL WALL ABCESS 55100 360 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,469.00 " " 1,467.55 " " 1,469.00 " 907.92 " 4,081.32 " " 1,439.60 " " 1,775.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 37090301 DRAIN SCROTAL WALL ABCESS 55100 450 "$7,387.00" " 2,730.24 " 776.00 " 5,909.60 " 892.40 " 1,469.00 " " 1,467.55 " " 1,469.00 " 907.92 " 4,081.32 " " 1,439.60 " " 1,775.00 " 869.12 808.05 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 776.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 28172389 EXPLORE SCROTUM 55110 360 "$16,151.00" " 5,969.41 " 776.00 " 12,920.80 " 892.40 " 1,718.00 " " 3,206.84 " " 1,718.00 " 907.92 " 8,923.43 " " 3,145.75 " " 2,820.00 " 869.12 808.05 " 10,690.35 " " 2,748.72 " " 3,054.13 " " 2,208.66 " " 2,760.83 " " 3,130.48 " " 3,145.75 " " 3,054.13 " " 12,920.80 " " 2,794.53 " 776.00 " 10,821.17 " " 2,687.63 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,161.02 " 28172397 REVISE SPERMATIC CORD VEINS 55530 360 "$16,151.00" " 5,969.41 " 943.00 " 12,920.80 " " 1,084.45 " " 3,326.00 " " 3,206.84 " " 3,326.00 " " 1,103.31 " " 8,923.43 " " 3,145.75 " " 4,860.00 " " 1,056.16 " 981.95 " 10,690.35 " " 2,748.72 " " 3,054.13 " " 3,120.10 " " 3,900.12 " " 3,130.48 " " 3,145.75 " " 3,054.13 " " 12,920.80 " " 2,794.53 " 943.00 " 10,821.17 " " 2,687.63 " " 6,605.76 " " 12,113.25 " " 6,139.00 " " 7,224.34 " " 3,161.02 " 28172401 BX PROSTATE NEEDLE PUNCH 55700 360 "$9,413.00" " 3,479.04 " 776.00 " 7,530.40 " 892.40 " 1,718.00 " " 1,867.55 " " 1,718.00 " 907.92 " 5,200.68 " " 1,831.98 " " 2,820.00 " 869.12 808.05 " 6,230.46 " " 1,600.76 " " 1,778.62 " " 2,208.66 " " 2,760.83 " " 1,823.09 " " 1,831.98 " " 1,778.62 " " 7,530.40 " " 1,627.44 " 776.00 " 6,306.71 " " 1,565.19 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,840.87 " 80501650 BX PROSTATE NEEDLE PUNCH 55700 402 "$9,413.00" " 3,479.04 " 776.00 " 7,530.40 " 892.40 " 1,718.00 " " 1,867.55 " " 1,718.00 " 907.92 " 5,200.68 " " 1,831.98 " " 2,820.00 " 869.12 808.05 " 6,230.46 " " 1,600.76 " " 1,778.62 " " 2,208.66 " " 2,760.83 " " 1,823.09 " " 1,831.98 " " 1,778.62 " " 7,530.40 " " 1,627.44 " 776.00 " 6,306.71 " " 1,565.19 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,840.87 " 28172419 GENITAL SURGERY PROCEDURE 55899 360 "$1,397.00" 516.33 - " 1,718.00 " - " 1,718.00 " 277.55 " 1,718.00 " - 771.84 272.26 922.02 - - 924.67 237.90 264.33 56.26 70.32 270.94 272.26 264.33 " 1,117.60 " 241.86 - 935.99 232.61 571.37 " 1,047.75 " 531.00 624.88 273.58 28172427 I&D VULVA PERINEUM 56405 360 "$1,478.00" 546.27 246.54 " 2,820.00 " 892.40 " 1,718.00 " 294.17 " 1,718.00 " 907.92 816.60 288.56 " 2,820.00 " 869.12 808.05 978.29 252.14 280.16 " 2,208.66 " " 2,760.83 " 287.16 288.56 280.16 " 1,182.40 " 256.35 776.00 990.26 246.54 604.50 " 1,108.50 " 561.79 661.11 289.97 37090638 I&D VULVA PERINEUM 56405 450 "$1,478.00" 546.27 246.54 " 2,820.00 " 892.40 " 1,718.00 " 294.17 " 1,718.00 " 907.92 816.60 288.56 " 2,820.00 " 869.12 808.05 978.29 252.14 280.16 " 2,208.66 " " 2,760.83 " 287.16 288.56 280.16 " 1,182.40 " 256.35 776.00 990.26 246.54 604.50 " 1,108.50 " 561.79 661.11 289.97 28172435 I&D BARTHOLINS GLAND ABSCESS 56420 360 $894.00 330.42 148.92 " 2,061.86 " 776.25 " 1,469.00 " 177.69 " 1,469.00 " 789.75 493.94 174.31 " 1,775.00 " 756.00 702.88 591.74 152.31 169.23 " 1,649.49 " " 2,061.86 " 173.46 174.31 169.23 715.20 154.85 675.00 598.98 148.92 365.65 670.50 339.81 399.89 175.15 37003751 I&D BARTHOLINS GLAND ABSCESS 56420 450 $894.00 330.42 148.92 " 2,061.86 " 776.25 " 1,469.00 " 177.69 " 1,469.00 " 789.75 493.94 174.31 " 1,775.00 " 756.00 702.88 591.74 152.31 169.23 " 1,649.49 " " 2,061.86 " 173.46 174.31 169.23 715.20 154.85 675.00 598.98 148.92 365.65 670.50 339.81 399.89 175.15 28172443 SURGERY FOR VULVA LESION 56440 360 "$13,772.00" " 5,090.13 " 748.00 " 11,017.60 " 860.20 " 1,718.00 " " 2,736.56 " " 1,718.00 " 875.16 " 7,609.03 " " 2,684.44 " " 2,820.00 " 837.76 778.89 " 9,115.69 " " 2,345.63 " " 2,606.25 " " 2,208.66 " " 2,760.83 " " 2,671.41 " " 2,684.44 " " 2,606.25 " " 11,017.60 " " 2,384.72 " 748.00 " 9,227.24 " " 2,293.50 " " 5,632.75 " " 10,329.00 " " 5,234.74 " " 6,160.22 " " 2,697.47 " 28172451 DESTROY VULVA LESIONS SIM 56501 360 "$9,006.00" " 3,328.62 " 552.00 " 7,204.80 " 634.80 " 1,469.00 " " 1,786.47 " " 1,469.00 " 645.84 " 4,975.82 " " 1,752.44 " " 5,943.96 " 618.24 574.80 " 5,961.07 " " 1,531.26 " " 1,701.40 " " 3,120.10 " " 3,900.12 " " 1,743.94 " " 1,752.44 " " 1,701.40 " " 7,204.80 " " 1,556.78 " 552.00 " 6,034.02 " " 1,497.23 " " 3,683.45 " " 6,754.50 " " 3,423.18 " " 4,028.38 " " 1,760.95 " 28172460 PARTIAL REMOVAL OF VULVA 56620 360 "$13,772.00" " 5,090.13 " 776.00 " 11,017.60 " 892.40 " 3,604.00 " " 2,736.56 " " 3,604.00 " 907.92 " 7,609.03 " " 2,684.44 " " 4,445.00 " 869.12 808.05 " 9,115.69 " " 2,345.63 " " 2,606.25 " " 3,730.57 " " 4,663.21 " " 2,671.41 " " 2,684.44 " " 2,606.25 " " 11,017.60 " " 2,384.72 " 776.00 " 9,227.24 " " 2,293.50 " " 5,632.75 " " 10,329.00 " " 5,234.74 " " 6,160.22 " " 2,697.47 " 28172478 PARTIAL REMOVAL OF HYMEN 56700 360 "$13,772.00" " 5,090.13 " 684.00 " 11,017.60 " 786.60 " 1,469.00 " " 2,736.56 " " 1,469.00 " 800.28 " 7,609.03 " " 2,684.44 " " 1,775.00 " 766.08 712.25 " 9,115.69 " " 2,345.63 " " 2,606.25 " " 1,649.49 " " 2,061.86 " " 2,671.41 " " 2,684.44 " " 2,606.25 " " 11,017.60 " " 2,384.72 " 684.00 " 9,227.24 " " 2,293.50 " " 5,632.75 " " 10,329.00 " " 5,234.74 " " 6,160.22 " " 2,697.47 " 28172486 REPAIR OF PERINEUM 56810 360 "$13,772.00" " 5,090.13 " 776.00 " 11,017.60 " 892.40 " 3,604.00 " " 2,736.56 " " 3,604.00 " 907.92 " 7,609.03 " " 2,684.44 " " 4,445.00 " 869.12 808.05 " 9,115.69 " " 2,345.63 " " 2,606.25 " " 3,730.57 " " 4,663.21 " " 2,671.41 " " 2,684.44 " " 2,606.25 " " 11,017.60 " " 2,384.72 " 776.00 " 9,227.24 " " 2,293.50 " " 5,632.75 " " 10,329.00 " " 5,234.74 " " 6,160.22 " " 2,697.47 " 28172494 DESTROY VAG LESIONS SIMPLE 57061 360 "$13,772.00" " 5,090.13 " 607.00 " 11,017.60 " 698.05 " 1,469.00 " " 2,736.56 " " 1,469.00 " 710.19 " 7,609.03 " " 2,684.44 " " 9,089.52 " 679.84 632.07 " 9,115.69 " " 2,345.63 " " 2,606.25 " " 3,730.57 " " 4,663.21 " " 2,671.41 " " 2,684.44 " " 2,606.25 " " 11,017.60 " " 2,384.72 " 607.00 " 9,227.24 " " 2,293.50 " " 5,632.75 " " 10,329.00 " " 5,234.74 " " 6,160.22 " " 2,697.47 " 28172508 CLOSURE OF VAGINA 57120 360 "$23,150.00" " 8,556.24 " 776.00 " 18,520.00 " 892.40 " 15,996.65 " " 4,599.28 " " 15,996.65 " 907.92 " 12,790.38 " " 4,511.68 " " 15,279.00 " 869.12 808.05 " 15,322.99 " " 3,942.24 " " 4,380.27 " " 2,625.39 " " 3,281.74 " " 4,489.78 " " 4,511.68 " " 4,380.27 " " 18,520.00 " " 4,007.95 " 776.00 " 15,510.50 " " 3,854.64 " " 9,468.35 " " 17,362.50 " " 8,799.32 " " 10,355.00 " " 4,533.58 " 28172516 REMOVE VAGINA LESION 57135 360 "$13,772.00" " 5,090.13 " 776.00 " 11,017.60 " 892.40 " 1,718.00 " " 2,736.56 " " 1,718.00 " 907.92 " 7,609.03 " " 2,684.44 " " 2,820.00 " 869.12 808.05 " 9,115.69 " " 2,345.63 " " 2,606.25 " " 2,208.66 " " 2,760.83 " " 2,671.41 " " 2,684.44 " " 2,606.25 " " 11,017.60 " " 2,384.72 " 776.00 " 9,227.24 " " 2,293.50 " " 5,632.75 " " 10,329.00 " " 5,234.74 " " 6,160.22 " " 2,697.47 " 80010702 INSRT UTERI TANDEMS/VAG OVOIDS 57155 280 "$23,150.00" " 8,556.24 " 776.00 " 18,520.00 " 892.40 " 1,718.00 " " 4,599.28 " " 1,718.00 " 907.92 " 12,790.38 " " 4,511.68 " " 2,820.00 " 869.12 808.05 " 15,322.99 " " 3,942.24 " " 4,380.27 " " 2,298.95 " " 2,873.69 " " 4,489.78 " " 4,511.68 " " 4,380.27 " " 18,520.00 " " 4,007.95 " 776.00 " 15,510.50 " " 3,854.64 " " 9,468.35 " " 17,362.50 " " 8,799.32 " " 10,355.00 " " 4,533.58 " 80010711 INSERT VAGINAL BRACHYTX DEVICE 57156 280 "$1,478.00" 546.27 246.54 " 1,775.00 " 892.40 " 1,718.00 " 294.17 " 1,718.00 " 907.92 816.60 288.56 " 1,775.00 " 869.12 808.05 978.29 252.14 280.16 826.88 " 1,033.60 " 287.16 288.56 280.16 " 1,182.40 " 256.35 776.00 990.26 246.54 604.50 " 1,108.50 " 561.79 661.11 289.97 28172524 ANTERIOR COLPORRHAPHY 57240 360 "$23,150.00" " 8,556.24 " 776.00 " 18,520.00 " 892.40 " 3,604.00 " " 4,599.28 " " 3,604.00 " 907.92 " 12,790.38 " " 4,511.68 " " 4,445.00 " 869.12 808.05 " 15,322.99 " " 3,942.24 " " 4,380.27 " " 3,730.57 " " 4,663.21 " " 4,489.78 " " 4,511.68 " " 4,380.27 " " 18,520.00 " " 4,007.95 " 776.00 " 15,510.50 " " 3,854.64 " " 9,468.35 " " 17,362.50 " " 8,799.32 " " 10,355.00 " " 4,533.58 " 28172532 REPAIR RECTUM & VAGINA 57250 360 "$23,150.00" " 8,556.24 " 776.00 " 18,520.00 " 892.40 " 3,604.00 " " 4,599.28 " " 3,604.00 " 907.92 " 12,790.38 " " 4,511.68 " " 4,445.00 " 869.12 808.05 " 15,322.99 " " 3,942.24 " " 4,380.27 " " 3,730.57 " " 4,663.21 " " 4,489.78 " " 4,511.68 " " 4,380.27 " " 18,520.00 " " 4,007.95 " 776.00 " 15,510.50 " " 3,854.64 " " 9,468.35 " " 17,362.50 " " 8,799.32 " " 10,355.00 " " 4,533.58 " 28172541 CMBN ANT PST COLPRHY 57260 360 "$23,150.00" " 8,556.24 " 776.00 " 18,520.00 " 892.40 " 3,604.00 " " 4,599.28 " " 3,604.00 " 907.92 " 12,790.38 " " 4,511.68 " " 4,445.00 " 869.12 808.05 " 15,322.99 " " 3,942.24 " " 4,380.27 " " 3,730.57 " " 4,663.21 " " 4,489.78 " " 4,511.68 " " 4,380.27 " " 18,520.00 " " 4,007.95 " 776.00 " 15,510.50 " " 3,854.64 " " 9,468.35 " " 17,362.50 " " 8,799.32 " " 10,355.00 " " 4,533.58 " 28172559 REPAIR OF BOWEL BULGE 57268 360 "$23,150.00" " 8,556.24 " 776.00 " 18,520.00 " 892.40 " 2,773.00 " " 4,599.28 " " 2,773.00 " 907.92 " 12,790.38 " " 4,511.68 " " 3,545.00 " 869.12 808.05 " 15,322.99 " " 3,942.24 " " 4,380.27 " " 2,532.97 " " 3,166.21 " " 4,489.78 " " 4,511.68 " " 4,380.27 " " 18,520.00 " " 4,007.95 " 776.00 " 15,510.50 " " 3,854.64 " " 9,468.35 " " 17,362.50 " " 8,799.32 " " 10,355.00 " " 4,533.58 " 28172567 COLPOPEXY EXTRAPERITONEAL 57282 360 "$35,670.00" " 13,183.63 " 776.00 " 28,536.00 " 892.40 " 3,604.00 " " 7,080.71 " " 3,604.00 " 907.92 " 19,707.68 " " 6,945.84 " " 23,542.20 " 869.12 808.05 " 23,609.97 " " 6,069.18 " " 6,743.53 " " 2,516.54 " " 3,145.68 " " 6,912.12 " " 6,945.84 " " 6,743.53 " " 28,536.00 " " 6,170.33 " 776.00 " 23,898.90 " " 5,934.31 " " 14,589.03 " " 26,752.50 " " 13,558.17 " " 15,955.19 " " 6,979.55 " 28172575 COLPOPEXY INTRAPERITONEAL 57283 360 "$35,670.00" " 13,183.63 " 776.00 " 28,536.00 " 892.40 " 3,604.00 " " 7,080.71 " " 3,604.00 " 907.92 " 19,707.68 " " 6,945.84 " " 23,542.20 " 869.12 808.05 " 23,609.97 " " 6,069.18 " " 6,743.53 " " 3,640.39 " " 4,550.49 " " 6,912.12 " " 6,945.84 " " 6,743.53 " " 28,536.00 " " 6,170.33 " 776.00 " 23,898.90 " " 5,934.31 " " 14,589.03 " " 26,752.50 " " 13,558.17 " " 15,955.19 " " 6,979.55 " 28172583 REVISE/REMOVE SLING REPAIR 57287 360 "$13,772.00" " 5,090.13 " 776.00 " 11,017.60 " 892.40 " 3,604.00 " " 2,736.56 " " 3,604.00 " 907.92 " 7,609.03 " " 2,684.44 " " 9,089.52 " 869.12 808.05 " 9,115.69 " " 2,345.63 " " 2,606.25 " " 3,503.58 " " 4,379.48 " " 2,671.41 " " 2,684.44 " " 2,606.25 " " 11,017.60 " " 2,384.72 " 776.00 " 9,227.24 " " 2,293.50 " " 5,632.75 " " 10,329.00 " " 5,234.74 " " 6,160.22 " " 2,697.47 " 28172591 REPAIR BLADDER DEFECT 57288 360 "$23,150.00" " 8,556.24 " 776.00 " 18,520.00 " 892.40 " 3,604.00 " " 4,599.28 " " 3,604.00 " 907.92 " 12,790.38 " " 4,511.68 " " 4,445.00 " 869.12 808.05 " 15,322.99 " " 3,942.24 " " 4,380.27 " " 4,116.08 " " 5,145.10 " " 4,489.78 " " 4,511.68 " " 4,380.27 " " 18,520.00 " " 4,007.95 " 776.00 " 15,510.50 " " 3,854.64 " " 9,468.35 " " 17,362.50 " " 8,799.32 " " 10,355.00 " " 4,533.58 " 28172605 REVISE VAG GRAFT VIA VAGINA 57295 360 "$13,772.00" " 5,090.13 " 776.00 " 11,017.60 " 892.40 " 2,773.00 " " 2,736.56 " " 2,773.00 " 907.92 " 7,609.03 " " 2,684.44 " " 3,545.00 " 869.12 808.05 " 9,115.69 " " 2,345.63 " " 2,606.25 " " 2,598.45 " " 3,248.06 " " 2,671.41 " " 2,684.44 " " 2,606.25 " " 11,017.60 " " 2,384.72 " 776.00 " 9,227.24 " " 2,293.50 " " 5,632.75 " " 10,329.00 " " 5,234.74 " " 6,160.22 " " 2,697.47 " 28172613 PELVIC EXAMINATION 57410 360 "$13,772.00" " 5,090.13 " 100.00 " 11,017.60 " 115.00 " 1,718.00 " " 2,736.56 " " 1,718.00 " 117.00 " 7,609.03 " " 2,684.44 " " 2,820.00 " 112.00 104.13 " 9,115.69 " " 2,345.63 " " 2,606.25 " " 2,208.66 " " 2,760.83 " " 2,671.41 " " 2,684.44 " " 2,606.25 " " 11,017.60 " " 2,384.72 " 100.00 " 9,227.24 " " 2,293.50 " " 5,632.75 " " 10,329.00 " " 5,234.74 " " 6,160.22 " " 2,697.47 " 28172621 REMOVE VAGINAL FOREIGN BODY 57415 360 "$13,772.00" " 5,090.13 " 168.76 " 11,017.60 " 892.40 " 1,718.00 " " 2,736.56 " " 1,718.00 " 907.92 " 7,609.03 " " 2,684.44 " " 2,820.00 " 869.12 808.05 " 9,115.69 " " 2,345.63 " " 2,606.25 " 168.76 210.95 " 2,671.41 " " 2,684.44 " " 2,606.25 " " 11,017.60 " " 2,384.72 " 776.00 " 9,227.24 " " 2,293.50 " " 5,632.75 " " 10,329.00 " " 5,234.74 " " 6,160.22 " " 2,697.47 " 28172630 EXAM OF VAGINA W/SCOPE 57420 360 "$1,478.00" 546.27 246.54 " 1,775.00 " 892.40 " 1,469.00 " 294.17 " 1,469.00 " 907.92 816.60 288.56 " 1,775.00 " 869.12 808.05 978.29 252.14 280.16 635.67 794.59 287.16 288.56 280.16 " 1,182.40 " 256.35 776.00 990.26 246.54 604.50 " 1,108.50 " 561.79 661.11 289.97 28172648 LAPAROSCOPY SURG COLPOPEXY 57425 360 "$46,765.00" " 17,284.34 " 776.00 " 37,412.00 " 892.40 " 3,604.00 " " 9,289.96 " " 3,604.00 " 907.92 " 25,837.66 " " 9,113.01 " " 30,864.90 " 869.12 808.05 " 30,953.75 " " 7,962.82 " " 8,847.58 " " 4,947.18 " " 6,183.98 " " 9,068.77 " " 9,113.01 " " 8,847.58 " " 37,412.00 " " 8,095.54 " 776.00 " 31,332.55 " " 7,785.87 " " 19,126.89 " " 35,073.75 " " 17,775.38 " " 20,917.98 " " 9,157.25 " 28172656 EXAM OF CERVIX W/SCOPE 57452 360 $894.00 330.42 148.92 " 1,775.00 " 671.60 " 1,718.00 " 177.69 " 1,718.00 " 683.28 493.94 174.31 " 1,775.00 " 654.08 608.12 591.74 152.31 169.23 393.78 492.23 173.46 174.31 169.23 715.20 154.85 584.00 598.98 148.92 365.65 670.50 339.81 399.89 175.15 28172664 BX/CURETT OF CERVIX W/SCOPE 57454 360 "$1,478.00" 546.27 246.54 " 1,775.00 " 892.40 " 1,718.00 " 294.17 " 1,718.00 " 907.92 816.60 288.56 " 1,775.00 " 869.12 808.05 978.29 252.14 280.16 393.78 492.23 287.16 288.56 280.16 " 1,182.40 " 256.35 776.00 990.26 246.54 604.50 " 1,108.50 " 561.79 661.11 289.97 28172672 ENDOCERV CURETTAGE W/SCOPE 57456 360 "$1,478.00" 546.27 246.54 " 1,775.00 " 892.40 " 1,469.00 " 294.17 " 1,469.00 " 907.92 816.60 288.56 " 1,775.00 " 869.12 808.05 978.29 252.14 280.16 754.42 943.03 287.16 288.56 280.16 " 1,182.40 " 256.35 776.00 990.26 246.54 604.50 " 1,108.50 " 561.79 661.11 289.97 28172681 BX OF CERVIX W/SCOPE LEEP 57460 360 "$13,772.00" " 5,090.13 " 776.00 " 11,017.60 " 892.40 " 1,718.00 " " 2,736.56 " " 1,718.00 " 907.92 " 7,609.03 " " 2,684.44 " " 9,089.52 " 869.12 808.05 " 9,115.69 " " 2,345.63 " " 2,606.25 " " 4,937.34 " " 6,171.67 " " 2,671.41 " " 2,684.44 " " 2,606.25 " " 11,017.60 " " 2,384.72 " 776.00 " 9,227.24 " " 2,293.50 " " 5,632.75 " " 10,329.00 " " 5,234.74 " " 6,160.22 " " 2,697.47 " 28172699 BIOPSY OF CERVIX 57500 360 "$3,325.00" " 1,228.92 " 554.19 " 5,102.27 " 895.85 " 1,469.00 " 661.25 " 1,469.00 " 911.43 " 1,837.06 " 648.65 " 1,775.00 " 872.48 811.17 " 2,200.82 " 566.78 629.76 " 4,081.82 " " 5,102.27 " 645.50 648.65 629.76 " 2,660.00 " 576.23 779.00 " 2,227.75 " 554.19 " 1,359.93 " " 2,493.75 " " 1,263.83 " " 1,487.27 " 651.80 28172702 ENDOCERVICAL CURETTAGE 57505 360 "$3,325.00" " 1,228.92 " 550.50 " 2,660.00 " 892.40 " 1,469.00 " 661.25 " 1,469.00 " 907.92 " 1,837.06 " 648.65 " 1,775.00 " 869.12 808.05 " 2,200.82 " 566.78 629.76 550.50 688.13 645.50 648.65 629.76 " 2,660.00 " 576.23 776.00 " 2,227.75 " 554.19 " 1,359.93 " " 2,493.75 " " 1,263.83 " " 1,487.27 " 651.80 28172711 CAUTERIZATION OF CERVIX 57510 360 "$13,772.00" " 5,090.13 " 738.00 " 11,017.60 " 848.70 " 1,718.00 " " 2,736.56 " " 1,718.00 " 863.46 " 7,609.03 " " 2,684.44 " " 9,089.52 " 826.56 768.48 " 9,115.69 " " 2,345.63 " " 2,606.25 " " 4,937.34 " " 6,171.67 " " 2,671.41 " " 2,684.44 " " 2,606.25 " " 11,017.60 " " 2,384.72 " 738.00 " 9,227.24 " " 2,293.50 " " 5,632.75 " " 10,329.00 " " 5,234.74 " " 6,160.22 " " 2,697.47 " 28172729 CONIZATION OF CERVIX 57520 360 "$13,772.00" " 5,090.13 " 796.00 " 11,017.60 " 915.40 " 1,718.00 " " 2,736.56 " " 1,718.00 " 931.32 " 7,609.03 " " 2,684.44 " " 2,820.00 " 891.52 828.87 " 9,115.69 " " 2,345.63 " " 2,606.25 " " 2,208.66 " " 2,760.83 " " 2,671.41 " " 2,684.44 " " 2,606.25 " " 11,017.60 " " 2,384.72 " 796.00 " 9,227.24 " " 2,293.50 " " 5,632.75 " " 10,329.00 " " 5,234.74 " " 6,160.22 " " 2,697.47 " 28172737 CONIZ. CERV LEEP PROCEDUR 57522 360 "$13,772.00" " 5,090.13 " 776.00 " 11,017.60 " 892.40 " 1,718.00 " " 2,736.56 " " 1,718.00 " 907.92 " 7,609.03 " " 2,684.44 " " 2,820.00 " 869.12 808.05 " 9,115.69 " " 2,345.63 " " 2,606.25 " " 4,937.34 " " 6,171.67 " " 2,671.41 " " 2,684.44 " " 2,606.25 " " 11,017.60 " " 2,384.72 " 776.00 " 9,227.24 " " 2,293.50 " " 5,632.75 " " 10,329.00 " " 5,234.74 " " 6,160.22 " " 2,697.47 " 28172745 DILATION OF CERVICAL CANAL 57800 360 "$13,772.00" " 5,090.13 " 817.00 " 11,017.60 " 939.55 " 1,469.00 " " 2,736.56 " " 1,469.00 " 955.89 " 7,609.03 " " 2,684.44 " " 1,775.00 " 915.04 850.74 " 9,115.69 " " 2,345.63 " " 2,606.25 " " 1,649.49 " " 2,061.86 " " 2,671.41 " " 2,684.44 " " 2,606.25 " " 11,017.60 " " 2,384.72 " 817.00 " 9,227.24 " " 2,293.50 " " 5,632.75 " " 10,329.00 " " 5,234.74 " " 6,160.22 " " 2,697.47 " 28172753 BX DONE W/COLPOSCOPY ADD-ON 58110 360 $95.00 35.11 - " 1,469.00 " 36.86 " 1,469.00 " - " 1,469.00 " 37.50 52.49 - 62.70 35.90 33.37 62.88 - - 285.38 356.72 - - - 76.00 - 32.05 63.65 - 38.86 71.25 36.11 42.49 - 28172761 DILATION AND CURETTAGE 58120 360 "$13,772.00" " 5,090.13 " 726.00 " 11,017.60 " 834.90 " 1,718.00 " " 2,736.56 " " 1,718.00 " 849.42 " 7,609.03 " " 2,684.44 " " 2,820.00 " 813.12 755.98 " 9,115.69 " " 2,345.63 " " 2,606.25 " " 2,208.66 " " 2,760.83 " " 2,671.41 " " 2,684.44 " " 2,606.25 " " 11,017.60 " " 2,384.72 " 726.00 " 9,227.24 " " 2,293.50 " " 5,632.75 " " 10,329.00 " " 5,234.74 " " 6,160.22 " " 2,697.47 " 28172770 MYOMECTOMY ABDOM METHOD 58140 360 "$9,424.00" " 3,483.11 " - " 7,539.20 " - " 4,435.00 " N/A " 4,435.00 " - " 5,206.76 " N/A " 6,219.84 " - N/A " 6,237.75 " - N/A " 4,800.70 " " 6,000.87 " N/A N/A N/A " 7,539.20 " N/A - " 6,314.08 " N/A " 3,854.42 " " 7,068.00 " " 3,582.06 " " 4,215.36 " N/A 28172788 MYOMECTOMY VAG METHOD 58145 360 "$13,772.00" " 5,090.13 " " 1,004.00 " " 11,017.60 " " 1,154.60 " " 3,604.00 " " 2,736.56 " " 3,604.00 " " 1,174.68 " " 7,609.03 " " 2,684.44 " " 4,445.00 " " 1,124.48 " " 1,045.47 " " 9,115.69 " " 2,345.63 " " 2,606.25 " " 3,730.57 " " 4,663.21 " " 2,671.41 " " 2,684.44 " " 2,606.25 " " 11,017.60 " " 2,384.72 " " 1,004.00 " " 9,227.24 " " 2,293.50 " " 5,632.75 " " 10,329.00 " " 5,234.74 " " 6,160.22 " " 2,697.47 " 28172796 TOTAL HYSTERECTOMY 58150 360 "$4,084.00" " 1,509.45 " - " 6,270.61 " - " 4,435.00 " N/A " 4,435.00 " - " 2,256.41 " N/A " 2,695.44 " - N/A " 2,703.20 " - N/A " 5,016.49 " " 6,270.61 " N/A N/A N/A " 3,267.20 " N/A - " 2,736.28 " N/A " 1,670.36 " " 3,063.00 " " 1,552.33 " " 1,826.77 " N/A 28172800 PARTIAL HYSTERECTOMY 58180 360 "$3,437.00" " 1,270.32 " - " 6,240.09 " - " 4,435.00 " N/A " 4,435.00 " - " 1,898.94 " N/A " 2,268.42 " - N/A " 2,274.95 " - N/A " 4,992.07 " " 6,240.09 " N/A N/A N/A " 2,749.60 " N/A - " 2,302.79 " N/A " 1,405.73 " " 2,577.75 " " 1,306.40 " " 1,537.37 " N/A 28172818 VAG HYST INCLUDING T/O 58262 360 "$23,150.00" " 8,556.24 " 776.00 " 18,520.00 " 892.40 " 3,604.00 " " 4,599.28 " " 3,604.00 " 907.92 " 12,790.38 " " 4,511.68 " " 6,576.00 " 869.12 808.05 " 15,322.99 " " 3,942.24 " " 4,380.27 " " 4,889.86 " " 6,112.32 " " 4,489.78 " " 4,511.68 " " 4,380.27 " " 18,520.00 " " 4,007.95 " 776.00 " 15,510.50 " " 3,854.64 " " 9,468.35 " " 17,362.50 " " 8,799.32 " " 10,355.00 " " 4,533.58 " 28172826 INSERT INTRAUTERINE DEVICE 58300 360 "$3,496.00" " 1,292.12 " - " 2,796.80 " 19.84 " 1,469.00 " N/A " 1,469.00 " 20.18 " 1,931.54 " N/A 845.00 19.32 N/A " 2,314.00 " - N/A 281.27 351.59 N/A N/A N/A " 2,796.80 " N/A 17.25 " 2,342.32 " N/A " 1,429.86 " " 2,622.00 " " 1,328.83 " " 1,563.76 " N/A 28172834 REMOVE INTRAUTERINE DEVICE 58301 360 "$1,478.00" 546.27 246.54 " 1,775.00 " 892.40 " 1,469.00 " 294.17 " 1,469.00 " 907.92 816.60 288.56 " 1,775.00 " 869.12 808.05 978.29 252.14 280.16 554.27 692.84 287.16 288.56 280.16 " 1,182.40 " 256.35 776.00 990.26 246.54 604.50 " 1,108.50 " 561.79 661.11 289.97 37090409 REMOVE INTRAUTERINE DEVICE 58301 450 "$1,478.00" 546.27 246.54 " 1,775.00 " 892.40 " 1,469.00 " 294.17 " 1,469.00 " 907.92 816.60 288.56 " 1,775.00 " 869.12 808.05 978.29 252.14 280.16 554.27 692.84 287.16 288.56 280.16 " 1,182.40 " 256.35 776.00 990.26 246.54 604.50 " 1,108.50 " 561.79 661.11 289.97 28172842 CATHETER HYSTEROGRAPHY 58340 360 $264.00 97.57 - " 1,469.00 " 892.40 " 1,469.00 " - " 1,469.00 " 907.92 145.86 - 174.24 869.12 808.05 174.74 - - 393.78 492.23 - - - 211.20 - 776.00 176.88 - 107.98 198.00 100.35 118.09 - 80108796 CATHETER HYSTEROGRAPHY 58340 320 $264.00 97.57 - " 1,469.00 " 892.40 " 1,469.00 " - " 1,469.00 " 907.92 145.86 - 174.24 869.12 808.05 174.74 - - 393.78 492.23 - - - 211.20 - 776.00 176.88 - 107.98 198.00 100.35 118.09 - 80508794 CATHETER HYSTEROGRAPHY 58340 402 $264.00 97.57 - " 1,469.00 " 892.40 " 1,469.00 " - " 1,469.00 " 907.92 145.86 - 174.24 869.12 808.05 174.74 - - 393.78 492.23 - - - 211.20 - 776.00 176.88 - 107.98 198.00 100.35 118.09 - 83008792 CATHETER HYSTEROGRAPHY 58340 320 $264.00 97.57 - " 1,469.00 " 892.40 " 1,469.00 " - " 1,469.00 " 907.92 145.86 - 174.24 869.12 808.05 174.74 - - 393.78 492.23 - - - 211.20 - 776.00 176.88 - 107.98 198.00 100.35 118.09 - 28172851 TRANSCERV FALLOPIAN TUBE CATH 58345 360 "$13,772.00" " 5,090.13 " - " 11,017.60 " - " 1,469.00 " " 2,736.56 " " 1,469.00 " - " 7,609.03 " " 2,684.44 " " 9,089.52 " - - " 9,115.69 " " 2,345.63 " " 2,606.25 " " 2,208.66 " " 2,760.83 " " 2,671.41 " " 2,684.44 " " 2,606.25 " " 11,017.60 " " 2,384.72 " - " 9,227.24 " " 2,293.50 " " 5,632.75 " " 10,329.00 " " 5,234.74 " " 6,160.22 " " 2,697.47 " 28172869 HYDROTUBATION OF OVIDUCT 58350 360 "$23,150.00" " 8,556.24 " - " 18,520.00 " - " 2,773.00 " " 4,599.28 " " 2,773.00 " - " 12,790.38 " " 4,511.68 " " 3,545.00 " - - " 15,322.99 " " 3,942.24 " " 4,380.27 " " 2,717.03 " " 3,396.29 " " 4,489.78 " " 4,511.68 " " 4,380.27 " " 18,520.00 " " 4,007.95 " - " 15,510.50 " " 3,854.64 " " 9,468.35 " " 17,362.50 " " 8,799.32 " " 10,355.00 " " 4,533.58 " 28172877 ENDOMETR ABLATE THERMAL 58353 360 "$23,150.00" " 8,556.24 " 776.00 " 18,520.00 " 892.40 " 4,435.00 " " 4,599.28 " " 4,435.00 " 907.92 " 12,790.38 " " 4,511.68 " " 6,540.00 " 869.12 808.05 " 15,322.99 " " 3,942.24 " " 4,380.27 " " 3,356.30 " " 4,195.38 " " 4,489.78 " " 4,511.68 " " 4,380.27 " " 18,520.00 " " 4,007.95 " 776.00 " 15,510.50 " " 3,854.64 " " 9,468.35 " " 17,362.50 " " 8,799.32 " " 10,355.00 " " 4,533.58 " 28172885 LAPAROSCOPIC MYOMECTOMY 58545 360 "$26,567.00" " 9,819.16 " 776.00 " 21,253.60 " 892.40 " 4,656.00 " " 5,277.62 " " 4,656.00 " 907.92 " 14,678.27 " " 5,177.09 " " 6,576.00 " 869.12 808.05 " 17,584.70 " " 4,523.67 " " 5,026.30 " " 7,133.34 " " 8,916.67 " " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " 776.00 " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 28176473 LAPARO-MYOMECTOMY COMPLEX 58546 360 "$46,765.00" " 17,284.34 " 776.00 " 37,412.00 " 892.40 " 4,656.00 " " 9,289.96 " " 4,656.00 " 907.92 " 25,837.66 " " 9,113.01 " " 6,576.00 " 869.12 808.05 " 30,953.75 " " 7,962.82 " " 8,847.58 " " 7,133.34 " " 8,916.67 " " 9,068.77 " " 9,113.01 " " 8,847.58 " " 37,412.00 " " 8,095.54 " 776.00 " 31,332.55 " " 7,785.87 " " 19,126.89 " " 35,073.75 " " 17,775.38 " " 20,917.98 " " 9,157.25 " 28172893 LAPARO-ASST VAG HYSTERECTOMY 58550 360 "$26,567.00" " 9,819.16 " 776.00 " 21,253.60 " 892.40 " 4,656.00 " " 5,277.62 " " 4,656.00 " 907.92 " 14,678.27 " " 5,177.09 " " 6,958.00 " 869.12 808.05 " 17,584.70 " " 4,523.67 " " 5,026.30 " " 7,133.34 " " 8,916.67 " " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " 776.00 " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 28172907 LAPARO-VAG HYST INCL T/O 58552 360 "$46,765.00" " 17,284.34 " 776.00 " 37,412.00 " 892.40 " 4,435.00 " " 9,289.96 " " 4,435.00 " 907.92 " 25,837.66 " " 9,113.01 " " 6,958.00 " 869.12 808.05 " 30,953.75 " " 7,962.82 " " 8,847.58 " " 5,263.10 " " 6,578.88 " " 9,068.77 " " 9,113.01 " " 8,847.58 " " 37,412.00 " " 8,095.54 " 776.00 " 31,332.55 " " 7,785.87 " " 19,126.89 " " 35,073.75 " " 17,775.38 " " 20,917.98 " " 9,157.25 " 28172915 HYSTEROSCOPY DX SEP PROC 58555 360 "$13,772.00" " 5,090.13 " 776.00 " 11,017.60 " 892.40 " 1,469.00 " " 2,736.56 " " 1,469.00 " 907.92 " 7,609.03 " " 2,684.44 " " 1,775.00 " 869.12 808.05 " 9,115.69 " " 2,345.63 " " 2,606.25 " " 1,649.49 " " 2,061.86 " " 2,671.41 " " 2,684.44 " " 2,606.25 " " 11,017.60 " " 2,384.72 " 776.00 " 9,227.24 " " 2,293.50 " " 5,632.75 " " 10,329.00 " " 5,234.74 " " 6,160.22 " " 2,697.47 " 28172923 HYSTEROSCOPY BIOPSY 58558 360 "$13,772.00" " 5,090.13 " 776.00 " 11,017.60 " 892.40 " 2,773.00 " " 2,736.56 " " 2,773.00 " 907.92 " 7,609.03 " " 2,684.44 " " 3,545.00 " 869.12 808.05 " 9,115.69 " " 2,345.63 " " 2,606.25 " " 2,717.03 " " 3,396.29 " " 2,671.41 " " 2,684.44 " " 2,606.25 " " 11,017.60 " " 2,384.72 " 776.00 " 9,227.24 " " 2,293.50 " " 5,632.75 " " 10,329.00 " " 5,234.74 " " 6,160.22 " " 2,697.47 " 28172931 HYSTEROSCOPY RESECT SEPTUM 58560 360 "$23,150.00" " 8,556.24 " 337.82 " 18,520.00 " 388.49 " 2,773.00 " " 4,599.28 " " 2,773.00 " 395.25 " 12,790.38 " " 4,511.68 " " 3,545.00 " 378.36 351.77 " 15,322.99 " " 3,942.24 " " 4,380.27 " " 2,717.03 " " 3,396.29 " " 4,489.78 " " 4,511.68 " " 4,380.27 " " 18,520.00 " " 4,007.95 " 337.82 " 15,510.50 " " 3,854.64 " " 9,468.35 " " 17,362.50 " " 8,799.32 " " 10,355.00 " " 4,533.58 " 28172940 HYSTEROSCOPY REMOVE MYOMA 58561 360 "$23,150.00" " 8,556.24 " 776.00 " 18,520.00 " 892.40 " 2,773.00 " " 4,599.28 " " 2,773.00 " 907.92 " 12,790.38 " " 4,511.68 " " 3,545.00 " 869.12 808.05 " 15,322.99 " " 3,942.24 " " 4,380.27 " " 2,532.97 " " 3,166.21 " " 4,489.78 " " 4,511.68 " " 4,380.27 " " 18,520.00 " " 4,007.95 " 776.00 " 15,510.50 " " 3,854.64 " " 9,468.35 " " 17,362.50 " " 8,799.32 " " 10,355.00 " " 4,533.58 " 28172958 HYSTEROSCOPY REMOVE FB 58562 360 "$13,772.00" " 5,090.13 " 776.00 " 11,017.60 " 892.40 " 2,773.00 " " 2,736.56 " " 2,773.00 " 907.92 " 7,609.03 " " 2,684.44 " " 3,545.00 " 869.12 808.05 " 9,115.69 " " 2,345.63 " " 2,606.25 " " 2,717.03 " " 3,396.29 " " 2,671.41 " " 2,684.44 " " 2,606.25 " " 11,017.60 " " 2,384.72 " 776.00 " 9,227.24 " " 2,293.50 " " 5,632.75 " " 10,329.00 " " 5,234.74 " " 6,160.22 " " 2,697.47 " 28172966 HYSTEROSCOPY ABLATION 58563 360 "$23,150.00" " 8,556.24 " 776.00 " 18,520.00 " 892.40 " 4,656.00 " " 4,599.28 " " 4,656.00 " 907.92 " 12,790.38 " " 4,511.68 " " 6,576.00 " 869.12 808.05 " 15,322.99 " " 3,942.24 " " 4,380.27 " " 2,532.97 " " 3,166.21 " " 4,489.78 " " 4,511.68 " " 4,380.27 " " 18,520.00 " " 4,007.95 " 776.00 " 15,510.50 " " 3,854.64 " " 9,468.35 " " 17,362.50 " " 8,799.32 " " 10,355.00 " " 4,533.58 " 28172974 TLH W/T/O 250 G OR LESS 58571 360 "$46,765.00" " 17,284.34 " 776.00 " 37,412.00 " 892.40 " 3,686.00 " " 9,289.96 " " 3,686.00 " 907.92 " 25,837.66 " " 9,113.01 " " 6,958.00 " 869.12 808.05 " 30,953.75 " " 7,962.82 " " 8,847.58 " " 5,037.18 " " 6,296.48 " " 9,068.77 " " 9,113.01 " " 8,847.58 " " 37,412.00 " " 8,095.54 " 776.00 " 31,332.55 " " 7,785.87 " " 19,126.89 " " 35,073.75 " " 17,775.38 " " 20,917.98 " " 9,157.25 " 28172982 TLH W/T/O UTERUS OVER 250 G 58573 360 "$46,765.00" " 17,284.34 " 776.00 " 37,412.00 " 892.40 " 3,686.00 " " 9,289.96 " " 3,686.00 " 907.92 " 25,837.66 " " 9,113.01 " " 6,958.00 " 869.12 808.05 " 30,953.75 " " 7,962.82 " " 8,847.58 " " 6,443.66 " " 8,054.58 " " 9,068.77 " " 9,113.01 " " 8,847.58 " " 37,412.00 " " 8,095.54 " 776.00 " 31,332.55 " " 7,785.87 " " 19,126.89 " " 35,073.75 " " 17,775.38 " " 20,917.98 " " 9,157.25 " 28175833 UNLISTED LAPARO PROC UTERUS 58578 360 "$26,567.00" " 9,819.16 " - " 21,253.60 " - " 2,773.00 " " 5,277.62 " " 2,773.00 " - " 14,678.27 " " 5,177.09 " " 17,534.22 " - - " 17,584.70 " " 4,523.67 " " 5,026.30 " " 4,937.34 " " 6,171.67 " " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " - " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 28172991 LAPAROSCOPY REMOVE ADNEXA 58661 360 "$26,567.00" " 9,819.16 " 776.00 " 21,253.60 " 892.40 " 3,604.00 " " 5,277.62 " " 3,604.00 " 907.92 " 14,678.27 " " 5,177.09 " " 4,445.00 " 869.12 808.05 " 17,584.70 " " 4,523.67 " " 5,026.30 " " 3,730.57 " " 4,663.21 " " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " 776.00 " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 28173008 LAPAROSCOPY EXCISE LESIONS 58662 360 "$26,567.00" " 9,819.16 " 776.00 " 21,253.60 " 892.40 " 3,604.00 " " 5,277.62 " " 3,604.00 " 907.92 " 14,678.27 " " 5,177.09 " " 4,445.00 " 869.12 808.05 " 17,584.70 " " 4,523.67 " " 5,026.30 " " 3,730.57 " " 4,663.21 " " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " 776.00 " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 28173016 REMOVAL OF OVARY/TUBE(S) 58720 360 "$2,786.00" " 1,029.71 " - " 4,724.74 " - " 3,604.00 " N/A " 3,604.00 " - " 1,539.27 " N/A " 1,838.76 " - N/A " 1,844.05 " - N/A " 3,779.79 " " 4,724.74 " N/A N/A N/A " 2,228.80 " N/A - " 1,866.62 " N/A " 1,139.47 " " 2,089.50 " " 1,058.96 " " 1,246.18 " N/A 28173024 ADHESIOLYSIS TUBE OVARY 58740 360 "$9,440.00" " 3,489.02 " - " 7,552.00 " - " 3,604.00 " N/A " 3,604.00 " - " 5,215.60 " N/A " 6,230.40 " - N/A " 6,248.34 " - N/A " 4,659.72 " " 5,824.65 " N/A N/A N/A " 7,552.00 " N/A - " 6,324.80 " N/A " 3,860.96 " " 7,080.00 " " 3,588.14 " " 4,222.51 " N/A 28173032 REMOVAL OF OVARIAN CYST(S) 58925 360 "$23,150.00" " 8,556.24 " 986.00 " 18,520.00 " " 1,133.90 " " 3,604.00 " " 4,599.28 " " 3,604.00 " " 1,153.62 " " 12,790.38 " " 4,511.68 " " 15,279.00 " " 1,104.32 " " 1,026.72 " " 15,322.99 " " 3,942.24 " " 4,380.27 " " 4,937.34 " " 6,171.67 " " 4,489.78 " " 4,511.68 " " 4,380.27 " " 18,520.00 " " 4,007.95 " 986.00 " 15,510.50 " " 3,854.64 " " 9,468.35 " " 17,362.50 " " 8,799.32 " " 10,355.00 " " 4,533.58 " 28173041 REMOVAL OF OVARY(S) 58940 360 "$6,164.00" " 2,278.21 " - " 4,931.20 " - " 3,604.00 " N/A " 3,604.00 " - " 3,405.61 " N/A " 4,068.24 " - N/A " 4,079.95 " - N/A " 2,505.62 " " 3,132.03 " N/A N/A N/A " 4,931.20 " N/A - " 4,129.88 " N/A " 2,521.08 " " 4,623.00 " " 2,342.94 " " 2,757.16 " N/A 28173059 UNLISTED PROC F GENITAL NONOBS 58999 360 $894.00 330.42 - " 1,469.00 " - " 1,469.00 " 177.69 " 1,469.00 " - 493.94 174.31 590.04 - - 591.74 152.31 169.23 56.26 70.32 173.46 174.31 169.23 715.20 154.85 - 598.98 148.92 365.65 670.50 339.81 399.89 175.15 80011091 UNLISTED PROC F GENITAL NONOBS 58999 333 $894.00 330.42 - " 1,469.00 " - " 1,469.00 " 177.69 " 1,469.00 " - 493.94 174.31 590.04 - - 591.74 152.31 169.23 56.26 70.32 173.46 174.31 169.23 715.20 154.85 - 598.98 148.92 365.65 670.50 339.81 399.89 175.15 80508441 DX AMNIOCENTESIS 59000 402 "$3,325.00" " 1,228.92 " 50.00 " 2,660.00 " 57.50 " 1,469.00 " 661.25 " 1,469.00 " 58.50 " 1,837.06 " 648.65 " 2,194.50 " 56.00 52.07 " 2,200.82 " 566.78 629.76 " 1,012.58 " " 1,265.72 " 645.50 648.65 629.76 " 2,660.00 " 576.23 50.00 " 2,227.75 " 554.19 " 1,359.93 " " 2,493.75 " " 1,263.83 " " 1,487.27 " 651.80 39100223 FETAL NON-STRESS TEST 59025 920 $894.00 330.42 17.50 715.20 20.13 617.75 177.69 617.75 20.48 493.94 174.31 590.04 19.60 18.22 591.74 152.31 169.23 557.98 697.47 173.46 174.31 169.23 715.20 154.85 17.50 598.98 148.92 365.65 670.50 339.81 399.89 175.15 28173067 LAP TREAT OF ECTOPIC PREGNANCY 59150 360 "$26,567.00" " 9,819.16 " 776.00 " 21,253.60 " 892.40 " 3,326.00 " " 5,277.62 " " 3,326.00 " 907.92 " 14,678.27 " " 5,177.09 " " 17,534.22 " 869.12 808.05 " 17,584.70 " " 4,523.67 " " 5,026.30 " " 4,937.34 " " 6,171.67 " " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " 776.00 " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 28173075 LAP ECTOPIC PREG W/SALPIN 59151 360 "$26,567.00" " 9,819.16 " 776.00 " 21,253.60 " 892.40 " 3,326.00 " " 5,277.62 " " 3,326.00 " 907.92 " 14,678.27 " " 5,177.09 " " 17,534.22 " 869.12 808.05 " 17,584.70 " " 4,523.67 " " 5,026.30 " " 4,937.34 " " 6,171.67 " " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " 776.00 " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 28173083 D & C AFTER DELIVERY 59160 360 "$13,772.00" " 5,090.13 " 665.00 " 11,017.60 " 764.75 " 2,773.00 " " 2,736.56 " " 2,773.00 " 778.05 " 7,609.03 " " 2,684.44 " " 3,545.00 " 744.80 692.46 " 9,115.69 " " 2,345.63 " " 2,606.25 " " 4,081.82 " " 5,102.27 " " 2,671.41 " " 2,684.44 " " 2,606.25 " " 11,017.60 " " 2,384.72 " 665.00 " 9,227.24 " " 2,293.50 " " 5,632.75 " " 10,329.00 " " 5,234.74 " " 6,160.22 " " 2,697.47 " 28173091 INSERT CERVICAL DILATOR 59200 360 "$1,478.00" 546.27 - " 1,775.00 " - " 1,469.00 " 294.17 " 1,469.00 " - 816.60 288.56 " 1,775.00 " - - 978.29 252.14 280.16 618.80 773.50 287.16 288.56 280.16 " 1,182.40 " 256.35 - 990.26 246.54 604.50 " 1,108.50 " 561.79 661.11 289.97 28173105 REVISION OF CERVIX 59320 360 "$13,772.00" " 5,090.13 " 776.00 " 11,017.60 " 892.40 " 1,469.00 " " 2,736.56 " " 1,469.00 " 907.92 " 7,609.03 " " 2,684.44 " " 1,775.00 " 869.12 808.05 " 9,115.69 " " 2,345.63 " " 2,606.25 " " 4,937.34 " " 6,171.67 " " 2,671.41 " " 2,684.44 " " 2,606.25 " " 11,017.60 " " 2,384.72 " 776.00 " 9,227.24 " " 2,293.50 " " 5,632.75 " " 10,329.00 " " 5,234.74 " " 6,160.22 " " 2,697.47 " 28173113 DELIVER PLACENTA 59414 360 "$13,772.00" " 5,090.13 " 533.52 " 11,017.60 " 892.40 " 9,516.45 " " 2,736.56 " " 9,516.45 " 907.92 " 7,609.03 " " 2,684.44 " " 9,089.52 " 869.12 808.05 " 9,115.69 " " 2,345.63 " " 2,606.25 " 533.52 666.90 " 2,671.41 " " 2,684.44 " " 2,606.25 " " 11,017.60 " " 2,384.72 " 776.00 " 9,227.24 " " 2,293.50 " " 5,632.75 " " 10,329.00 " " 5,234.74 " " 6,160.22 " " 2,697.47 " 28173121 CESAREAN DELIVERY 59515 360 "$10,000.00" " 3,696.00 " - " 8,000.00 " " 2,357.50 " " 3,604.00 " N/A " 3,604.00 " " 2,398.50 " " 5,525.00 " N/A " 6,600.00 " " 2,296.00 " N/A " 6,619.00 " - N/A " 5,928.54 " " 7,410.67 " N/A N/A N/A " 8,000.00 " N/A " 2,050.00 " " 6,700.00 " N/A " 4,090.00 " " 7,500.00 " " 3,801.00 " " 4,473.00 " N/A 28173130 TREATMENT OF MISCARRIAGE 59812 360 "$13,772.00" " 5,090.13 " 776.00 " 11,017.60 " 892.40 " 3,604.00 " " 2,736.56 " " 3,604.00 " 907.92 " 7,609.03 " " 2,684.44 " " 4,445.00 " 869.12 808.05 " 9,115.69 " " 2,345.63 " " 2,606.25 " " 4,081.82 " " 5,102.27 " " 2,671.41 " " 2,684.44 " " 2,606.25 " " 11,017.60 " " 2,384.72 " 776.00 " 9,227.24 " " 2,293.50 " " 5,632.75 " " 10,329.00 " " 5,234.74 " " 6,160.22 " " 2,697.47 " 28173148 CARE OF MISCARRIAGE 59820 360 "$13,772.00" " 5,090.13 " 585.00 " 11,017.60 " 672.75 " 3,604.00 " " 2,736.56 " " 3,604.00 " 684.45 " 7,609.03 " " 2,684.44 " " 4,445.00 " 655.20 609.16 " 9,115.69 " " 2,345.63 " " 2,606.25 " " 4,081.82 " " 5,102.27 " " 2,671.41 " " 2,684.44 " " 2,606.25 " " 11,017.60 " " 2,384.72 " 585.00 " 9,227.24 " " 2,293.50 " " 5,632.75 " " 10,329.00 " " 5,234.74 " " 6,160.22 " " 2,697.47 " 28175558 MISS ABORT 2ND TRIM COMP SURG 59821 360 "$13,772.00" " 5,090.13 " 776.00 " 11,017.60 " 892.40 " 3,604.00 " " 2,736.56 " " 3,604.00 " 907.92 " 7,609.03 " " 2,684.44 " " 4,445.00 " 869.12 808.05 " 9,115.69 " " 2,345.63 " " 2,606.25 " " 4,081.82 " " 5,102.27 " " 2,671.41 " " 2,684.44 " " 2,606.25 " " 11,017.60 " " 2,384.72 " 776.00 " 9,227.24 " " 2,293.50 " " 5,632.75 " " 10,329.00 " " 5,234.74 " " 6,160.22 " " 2,697.47 " 28176481 EVACUATE MOLE OF UTERUS 59870 360 "$13,772.00" " 5,090.13 " 776.00 " 11,017.60 " 892.40 " 3,604.00 " " 2,736.56 " " 3,604.00 " 907.92 " 7,609.03 " " 2,684.44 " " 4,445.00 " 869.12 808.05 " 9,115.69 " " 2,345.63 " " 2,606.25 " " 4,081.82 " " 5,102.27 " " 2,671.41 " " 2,684.44 " " 2,606.25 " " 11,017.60 " " 2,384.72 " 776.00 " 9,227.24 " " 2,293.50 " " 5,632.75 " " 10,329.00 " " 5,234.74 " " 6,160.22 " " 2,697.47 " 28173156 REMOVE CERCLAGE SUTURE 59871 360 "$13,772.00" " 5,090.13 " - " 11,017.60 " - " 3,604.00 " " 2,736.56 " " 3,604.00 " - " 7,609.03 " " 2,684.44 " " 4,445.00 " - - " 9,115.69 " " 2,345.63 " " 2,606.25 " " 3,819.73 " " 4,774.66 " " 2,671.41 " " 2,684.44 " " 2,606.25 " " 11,017.60 " " 2,384.72 " - " 9,227.24 " " 2,293.50 " " 5,632.75 " " 10,329.00 " " 5,234.74 " " 6,160.22 " " 2,697.47 " 80308515 BX THYROID PERC CORE NEEDLE 60100 320 "$3,265.00" " 1,206.74 " 543.97 " 2,612.00 " 841.80 " 1,469.00 " 649.06 " 1,469.00 " 856.44 " 1,803.91 " 636.69 " 1,775.00 " 819.84 762.23 " 2,161.10 " 556.34 618.15 618.80 773.50 633.60 636.69 618.15 " 2,612.00 " 565.61 732.00 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 80508514 BX THYROID PERC CORE NEEDLE 60100 402 "$3,265.00" " 1,206.74 " 543.97 " 2,612.00 " 841.80 " 1,469.00 " 649.06 " 1,469.00 " 856.44 " 1,803.91 " 636.69 " 1,775.00 " 819.84 762.23 " 2,161.10 " 556.34 618.15 618.80 773.50 633.60 636.69 618.15 " 2,612.00 " 565.61 732.00 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 80608519 BX THYROID PERC CORE NDL 60100 350 "$3,265.00" " 1,206.74 " 543.97 " 2,612.00 " 841.80 " 1,469.00 " 649.06 " 1,469.00 " 856.44 " 1,803.91 " 636.69 " 1,775.00 " 819.84 762.23 " 2,161.10 " 556.34 618.15 618.80 773.50 633.60 636.69 618.15 " 2,612.00 " 565.61 732.00 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 28173164 PARTIAL THYROID EXCISION 60210 360 "$26,567.00" " 9,819.16 " 776.00 " 21,253.60 " 892.40 " 3,326.00 " " 5,277.62 " " 3,326.00 " 907.92 " 14,678.27 " " 5,177.09 " " 17,534.22 " 869.12 808.05 " 17,584.70 " " 4,523.67 " " 5,026.30 " " 4,937.34 " " 6,171.67 " " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " 776.00 " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 28173172 THYROID LOBECTOMY UNIL 60220 360 "$26,567.00" " 9,819.16 " 776.00 " 21,253.60 " 892.40 " 1,718.00 " " 5,277.62 " " 1,718.00 " 907.92 " 14,678.27 " " 5,177.09 " " 2,820.00 " 869.12 808.05 " 17,584.70 " " 4,523.67 " " 5,026.30 " " 2,208.66 " " 2,760.83 " " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " 776.00 " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 28173181 THYROID LOBEC W CONT SUB LOBEC 60225 360 "$26,567.00" " 9,819.16 " 776.00 " 21,253.60 " 892.40 " 2,773.00 " " 5,277.62 " " 2,773.00 " 907.92 " 14,678.27 " " 5,177.09 " " 3,545.00 " 869.12 808.05 " 17,584.70 " " 4,523.67 " " 5,026.30 " " 2,532.97 " " 3,166.21 " " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " 776.00 " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 28173199 REMOVAL OF THYROID 60240 360 "$26,567.00" " 9,819.16 " 776.00 " 21,253.60 " 892.40 " 4,435.00 " " 5,277.62 " " 4,435.00 " 907.92 " 14,678.27 " " 5,177.09 " " 17,534.22 " 869.12 808.05 " 17,584.70 " " 4,523.67 " " 5,026.30 " " 5,217.71 " " 6,522.14 " " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " 776.00 " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 28176490 REMOVAL OF THYROID 60252 360 "$26,702.00" " 9,869.06 " 776.00 " 21,361.60 " 892.40 " 4,435.00 " " 5,304.76 " " 4,435.00 " 907.92 " 14,752.86 " " 5,203.71 " " 17,623.32 " 869.12 808.05 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 6,746.26 " " 8,432.82 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 776.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28175566 THYROIDEC MALIG RAD NECK DISEC 60254 360 "$4,706.00" " 1,739.34 " - " 11,198.35 " - " 4,435.00 " N/A " 4,435.00 " - " 2,600.07 " N/A " 3,105.96 " - N/A " 3,114.90 " - N/A " 8,958.68 " " 11,198.35 " N/A N/A N/A " 3,764.80 " N/A - " 3,153.02 " N/A " 1,924.75 " " 3,529.50 " " 1,788.75 " " 2,104.99 " N/A 28176503 REPEAT THYROID SURGERY 60260 360 "$26,702.00" " 9,869.06 " 776.00 " 21,361.60 " 892.40 " 3,604.00 " " 5,304.76 " " 3,604.00 " 907.92 " 14,752.86 " " 5,203.71 " " 17,623.32 " 869.12 808.05 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 5,738.62 " " 7,173.28 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 776.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28173202 REMOVE THYROID DUCT LESION 60280 360 "$26,567.00" " 9,819.16 " 776.00 " 21,253.60 " 892.40 " 3,326.00 " " 5,277.62 " " 3,326.00 " 907.92 " 14,678.27 " " 5,177.09 " " 4,860.00 " 869.12 808.05 " 17,584.70 " " 4,523.67 " " 5,026.30 " " 3,120.10 " " 3,900.12 " " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " 776.00 " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 80309651 ASP/INJ THYROID CYST 60300 320 "$3,265.00" " 1,206.74 " 36.81 " 2,612.00 " 42.33 " 1,469.00 " 649.06 " 1,469.00 " 43.07 " 1,803.91 " 636.69 845.00 41.23 38.33 " 2,161.10 " 556.34 618.15 523.22 654.03 633.60 636.69 618.15 " 2,612.00 " 565.61 36.81 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 28173211 EXPLORE PARATHYROID GLANDS 60500 360 "$26,702.00" " 9,869.06 " 776.00 " 21,361.60 " 892.40 " 4,435.00 " " 5,304.76 " " 4,435.00 " 907.92 " 14,752.86 " " 5,203.71 " " 17,623.32 " 869.12 808.05 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 5,244.54 " " 6,555.68 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 776.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28173229 LAPAROSCOPY ADRENALECTOMY 60650 360 "$9,286.00" " 3,432.11 " - " 7,757.27 " - " 3,326.00 " N/A " 3,326.00 " - " 5,130.52 " N/A " 6,128.76 " - N/A " 6,146.40 " - N/A " 6,205.82 " " 7,757.27 " N/A N/A N/A " 7,428.80 " N/A - " 6,221.62 " N/A " 3,797.97 " " 6,964.50 " " 3,529.61 " " 4,153.63 " N/A 67709926 UNL BX ADRENAL GLAND 60699 350 "$26,567.00" " 9,819.16 " - " 21,253.60 " - " 1,469.00 " " 5,277.62 " " 1,469.00 " - " 14,678.27 " " 5,177.09 " " 17,534.22 " - - " 17,584.70 " " 4,523.67 " " 5,026.30 " 56.26 70.32 " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " - " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 67728351 UNL ABLATE 1+ ADRENAL TUMOR 60699 350 "$26,567.00" " 9,819.16 " - " 21,253.60 " - " 1,469.00 " " 5,277.62 " " 1,469.00 " - " 14,678.27 " " 5,177.09 " " 17,534.22 " - - " 17,584.70 " " 4,523.67 " " 5,026.30 " 56.26 70.32 " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " - " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 80609922 UNL BX ADRENAL GLAND 60699 350 "$26,567.00" " 9,819.16 " - " 21,253.60 " - " 1,469.00 " " 5,277.62 " " 1,469.00 " - " 14,678.27 " " 5,177.09 " " 17,534.22 " - - " 17,584.70 " " 4,523.67 " " 5,026.30 " 56.26 70.32 " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " - " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 80628358 UNL ABLATE 1+ ADRENAL TUMOR 60699 350 "$26,567.00" " 9,819.16 " - " 21,253.60 " - " 1,469.00 " " 5,277.62 " " 1,469.00 " - " 14,678.27 " " 5,177.09 " " 17,534.22 " - - " 17,584.70 " " 4,523.67 " " 5,026.30 " 56.26 70.32 " 5,151.96 " " 5,177.09 " " 5,026.30 " " 21,253.60 " " 4,599.06 " - " 17,799.89 " " 4,423.14 " " 10,865.90 " " 19,925.25 " " 10,098.12 " " 11,883.42 " " 5,202.22 " 80244011 BRAIN CANAL SHUNT PROCEDURE 61070 340 "$3,332.00" " 1,231.51 " 555.09 " 2,665.60 " 892.40 " 1,469.00 " 662.32 " 1,469.00 " 907.92 " 1,840.93 " 649.70 " 1,775.00 " 869.12 808.05 " 2,205.45 " 567.70 630.78 " 1,649.49 " " 2,061.86 " 646.55 649.70 630.78 " 2,665.60 " 577.16 776.00 " 2,232.44 " 555.09 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 652.86 28173237 PIERCE SKULL FOR BIOPSY 61140 360 "$1,248.00" 461.26 - " 7,509.19 " - 862.37 N/A 862.37 - 689.52 N/A 823.68 - N/A 826.05 - N/A " 6,007.35 " " 7,509.19 " N/A N/A N/A 998.40 N/A - 836.16 N/A 510.43 936.00 474.36 558.23 N/A 28173245 PIERCE SKULL & REMOVE CLOT 61154 360 "$2,882.00" " 1,065.19 " - " 7,177.64 " - " 1,991.46 " N/A " 1,991.46 " - " 1,592.31 " N/A " 1,902.12 " - N/A " 1,907.60 " - N/A " 5,742.11 " " 7,177.64 " N/A N/A N/A " 2,305.60 " N/A - " 1,930.94 " N/A " 1,178.74 " " 2,161.50 " " 1,095.45 " " 1,289.12 " N/A 28173253 PIERCE SKULL IMPLANT DEVICE 61210 360 "$4,898.00" " 1,810.30 " - " 3,918.40 " - " 3,384.52 " N/A " 3,384.52 " - " 2,706.15 " N/A " 3,232.68 " - N/A " 3,241.99 " - N/A " 2,060.32 " " 2,575.40 " N/A N/A N/A " 3,918.40 " N/A - " 3,281.66 " N/A " 2,003.28 " " 3,673.50 " " 1,861.73 " " 2,190.88 " N/A 28173261 OPEN SKULL FOR EXPLORATION 61304 360 "$7,026.00" " 2,596.81 " - " 10,090.63 " - " 4,854.97 " N/A " 4,854.97 " - " 3,881.87 " N/A " 4,637.16 " - N/A " 4,650.51 " - N/A " 8,072.50 " " 10,090.63 " N/A N/A N/A " 5,620.80 " N/A - " 4,707.42 " N/A " 2,873.63 " " 5,269.50 " " 2,670.58 " " 3,142.73 " N/A 28173270 CRANI EVAC HEMAT SUPRA EPI/SUB 61312 360 "$3,530.00" " 1,304.69 " - " 11,527.02 " - " 2,439.23 " N/A " 2,439.23 " - " 1,950.33 " N/A " 2,329.80 " - N/A " 2,336.51 " - N/A " 9,221.62 " " 11,527.02 " N/A N/A N/A " 2,824.00 " N/A - " 2,365.10 " N/A " 1,443.77 " " 2,647.50 " " 1,341.75 " " 1,578.97 " N/A 28173288 CRANI EVAC IPT/SUBD HEM INFRAT 61314 360 "$7,906.00" " 2,922.06 " - " 10,941.48 " - " 5,463.05 " N/A " 5,463.05 " - " 4,368.07 " N/A " 5,217.96 " - N/A " 5,232.98 " - N/A " 8,753.18 " " 10,941.48 " N/A N/A N/A " 6,324.80 " N/A - " 5,297.02 " N/A " 3,233.55 " " 5,929.50 " " 3,005.07 " " 3,536.35 " N/A 28173296 CRANI EVAC INTRACEREBELLAR HE 61315 360 "$2,507.00" 926.59 - " 12,758.01 " - " 1,732.34 " N/A " 1,732.34 " - " 1,385.12 " N/A " 1,654.62 " - N/A " 1,659.38 " - N/A " 10,206.41 " " 12,758.01 " N/A N/A N/A " 2,005.60 " N/A - " 1,679.69 " N/A " 1,025.36 " " 1,880.25 " 952.91 " 1,121.38 " N/A 28173300 INCISE SKULL (PRESS RELIEF) 61343 360 "$11,684.00" " 4,318.41 " - " 13,613.07 " - " 8,073.64 " N/A " 8,073.64 " - " 6,455.41 " N/A " 7,711.44 " - N/A " 7,733.64 " - N/A " 10,890.46 " " 13,613.07 " N/A N/A N/A " 9,347.20 " N/A - " 7,828.28 " N/A " 4,778.76 " " 8,763.00 " " 4,441.09 " " 5,226.25 " N/A 28173318 REMOVAL OF SKULL LESION 61500 360 "$2,538.00" 938.04 - " 6,171.67 " - " 4,878.00 " N/A " 4,878.00 " - " 1,402.25 " N/A " 1,675.08 " - N/A " 1,679.90 " - N/A " 4,937.34 " " 6,171.67 " N/A N/A N/A " 2,030.40 " N/A - " 1,700.46 " N/A " 1,038.04 " " 1,903.50 " 964.69 " 1,135.25 " N/A 28173326 CRANI EXC BR TUM SUPRA NOT MNG 61510 360 "$1,833.00" 677.48 - " 13,167.82 " - " 1,266.60 " N/A " 1,266.60 " - " 1,012.73 " N/A " 1,209.78 " - N/A " 1,213.26 " - N/A " 10,534.26 " " 13,167.82 " N/A N/A N/A " 1,466.40 " N/A - " 1,228.11 " N/A 749.70 " 1,374.75 " 696.72 819.90 N/A 28173334 CRANIECT EXC MENIGOMA SUPRAT 61512 360 "$2,045.00" 755.83 - " 16,020.76 " - " 1,413.10 " N/A " 1,413.10 " - " 1,129.86 " N/A " 1,349.70 " - N/A " 1,353.59 " - N/A " 12,816.61 " " 16,020.76 " N/A N/A N/A " 1,636.00 " N/A - " 1,370.15 " N/A 836.41 " 1,533.75 " 777.30 914.73 N/A 28173342 CRANIECT EXC MENINGOMA INFRAT 61519 360 "$10,304.00" " 3,808.36 " - " 18,709.79 " - " 7,120.06 " N/A " 7,120.06 " - " 5,692.96 " N/A " 6,800.64 " - N/A " 6,820.22 " - N/A " 14,967.83 " " 18,709.79 " N/A N/A N/A " 8,243.20 " N/A - " 6,903.68 " N/A " 4,214.34 " " 7,728.00 " " 3,916.55 " " 4,608.98 " N/A 28173351 CRANI EXC CP-ANGLE TUM (ACOUST 61520 360 "$4,892.00" " 1,808.08 " - " 24,296.63 " - " 3,380.37 " N/A " 3,380.37 " - " 2,702.83 " N/A " 3,228.72 " - N/A " 3,238.01 " - N/A " 19,437.30 " " 24,296.63 " N/A N/A N/A " 3,913.60 " N/A - " 3,277.64 " N/A " 2,000.83 " " 3,669.00 " " 1,859.45 " " 2,188.19 " N/A 28173369 INCISE SKULL/SUTURES 61556 360 "$16,341.00" " 6,039.63 " - " 13,072.80 " - " 11,291.63 " N/A " 11,291.63 " - " 9,028.40 " N/A " 10,785.06 " - N/A " 10,816.11 " - N/A " 7,748.03 " " 9,685.04 " N/A N/A N/A " 13,072.80 " N/A - " 10,948.47 " N/A " 6,683.47 " " 12,255.75 " " 6,211.21 " " 7,309.33 " N/A 28175574 INCISION OF BRAIN TISSUE 61567 360 "$25,012.00" " 9,244.44 " - " 20,009.60 " - " 17,283.29 " N/A " 17,283.29 " - " 13,819.13 " N/A " 16,507.92 " - N/A " 16,555.44 " - N/A " 12,709.27 " " 15,886.59 " N/A N/A N/A " 20,009.60 " N/A - " 16,758.04 " N/A " 10,229.91 " " 18,759.00 " " 9,507.06 " " 11,187.87 " N/A 28175582 SKULL BASE DURA REPAIR 61619 360 "$20,846.00" " 7,704.68 " - " 16,676.80 " - " 14,404.59 " N/A " 14,404.59 " - " 11,517.42 " N/A " 13,758.36 " - N/A " 13,797.97 " - N/A " 7,467.43 " " 9,334.29 " N/A N/A N/A " 16,676.80 " N/A - " 13,966.82 " N/A " 8,526.01 " " 15,634.50 " " 7,923.56 " " 9,324.42 " N/A 80330065 TRANSCATH OCCLUSION NON-CNS 61626 320 "$52,725.00" " 19,487.16 " 776.00 " 42,180.00 " 892.40 " 3,686.00 " " 10,476.71 " " 3,686.00 " 907.92 " 29,130.56 " " 10,277.15 " " 34,798.50 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 4,828.03 " " 6,035.04 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 28173377 INCISE SKULL/BRAIN BIOPSY 61750 360 "$3,219.00" " 1,189.74 " - " 8,398.57 " - " 2,224.33 " N/A " 2,224.33 " - " 1,778.50 " N/A " 2,124.54 " - N/A " 2,130.66 " - N/A " 6,718.86 " " 8,398.57 " N/A N/A N/A " 2,575.20 " N/A - " 2,156.73 " N/A " 1,316.57 " " 2,414.25 " " 1,223.54 " " 1,439.86 " N/A 28175591 STER BX/ASP/EXC CRANL LES W CT 61751 360 "$6,819.00" " 2,520.30 " - " 8,271.65 " - " 4,711.93 " N/A " 4,711.93 " - " 3,767.50 " N/A " 4,500.54 " - N/A " 4,513.50 " - N/A " 6,617.32 " " 8,271.65 " N/A N/A N/A " 5,455.20 " N/A - " 4,568.73 " N/A " 2,788.97 " " 5,114.25 " " 2,591.90 " " 3,050.14 " N/A 28173385 SCAN PROC CRANIAL INTRA 61781 360 "$4,495.00" " 1,661.35 " - " 3,596.00 " - " 1,469.00 " - " 1,469.00 " - " 2,483.49 " - " 2,966.70 " - - " 2,975.24 " - - " 1,369.79 " " 1,712.24 " - - - " 3,596.00 " - - " 3,011.65 " - " 1,838.46 " " 3,371.25 " " 1,708.55 " " 2,010.61 " - 28173393 SCAN PROC CRANIAL EXTRA 61782 360 "$3,768.00" " 1,392.65 " - " 3,014.40 " - " 1,469.00 " - " 1,469.00 " - " 2,081.82 " - " 2,486.88 " - - " 2,494.04 " - - " 1,120.47 " " 1,400.59 " - - - " 3,014.40 " - - " 2,524.56 " - " 1,541.11 " " 2,826.00 " " 1,432.22 " " 1,685.43 " - 28173407 SCAN PROC SPINAL 61783 360 "$2,356.00" 870.78 - " 1,884.80 " - " 1,469.00 " - " 1,469.00 " - " 1,301.69 " - " 1,554.96 " - - " 1,559.44 " - - " 1,369.79 " " 1,712.24 " - - - " 1,884.80 " - - " 1,578.52 " - 963.60 " 1,767.00 " 895.52 " 1,053.84 " - 28173415 REPAIR BRAIN FLUID LEAKAGE 62100 360 "$6,923.00" " 2,558.74 " - " 9,994.02 " - " 4,783.79 " N/A " 4,783.79 " - " 3,824.96 " N/A " 4,569.18 " - N/A " 4,582.33 " - N/A " 7,995.22 " " 9,994.02 " N/A N/A N/A " 5,538.40 " N/A - " 4,638.41 " N/A " 2,831.51 " " 5,192.25 " " 2,631.43 " " 3,096.66 " N/A 28173423 REPAIR SKULL CAVITY LESION 62120 360 "$16,251.00" " 6,006.37 " - " 13,000.80 " - " 11,229.44 " N/A " 11,229.44 " - " 8,978.68 " N/A " 10,725.66 " - N/A " 10,756.54 " - N/A " 9,086.89 " " 11,358.61 " N/A N/A N/A " 13,000.80 " N/A - " 10,888.17 " N/A " 6,646.66 " " 12,188.25 " " 6,177.01 " " 7,269.07 " N/A 28175604 CRANIOT/REPAIR ENCEPHALOCELE 62121 360 "$4,734.00" " 1,749.69 " - " 10,390.54 " - " 3,271.19 " N/A " 3,271.19 " - " 2,615.54 " N/A " 3,124.44 " - N/A " 3,133.43 " - N/A " 8,312.43 " " 10,390.54 " N/A N/A N/A " 3,787.20 " N/A - " 3,171.78 " N/A " 1,936.21 " " 3,550.50 " " 1,799.39 " " 2,117.52 " N/A 28173431 CRANIOPL SKULL DEFECT <5CM 62140 360 "$7,932.00" " 2,931.67 " - " 6,345.60 " - " 5,481.01 " N/A " 5,481.01 " - " 4,382.43 " N/A " 5,235.12 " - N/A " 5,250.19 " - N/A " 5,053.95 " " 6,317.44 " N/A N/A N/A " 6,345.60 " N/A - " 5,314.44 " N/A " 3,244.19 " " 5,949.00 " " 3,014.95 " " 3,547.98 " N/A 28173440 CRANIOPLASTY SK DEF >5CM DIAM 62141 360 "$4,666.00" " 1,724.55 " - " 6,924.28 " - " 3,224.21 " N/A " 3,224.21 " - " 2,577.97 " N/A " 3,079.56 " - N/A " 3,088.43 " - N/A " 5,539.42 " " 6,924.28 " N/A N/A N/A " 3,732.80 " N/A - " 3,126.22 " N/A " 1,908.39 " " 3,499.50 " " 1,773.55 " " 2,087.10 " N/A 28173458 REMOVE SKULL PLATE/FLAP 62142 360 "$6,451.00" " 2,384.29 " - " 5,160.80 " - " 4,457.64 " N/A " 4,457.64 " - " 3,564.18 " N/A " 4,257.66 " - N/A " 4,269.92 " - N/A " 4,099.26 " " 5,124.07 " N/A N/A N/A " 5,160.80 " N/A - " 4,322.17 " N/A " 2,638.46 " " 4,838.25 " " 2,452.03 " " 2,885.53 " N/A 28175612 CRANIOPLASTY SKULL REP BRAIN 62145 360 "$19,811.00" " 7,322.15 " - " 15,848.80 " - " 13,689.40 " N/A " 13,689.40 " - " 10,945.58 " N/A " 13,075.26 " - N/A " 13,112.90 " - N/A " 6,871.36 " " 8,589.20 " N/A N/A N/A " 15,848.80 " N/A - " 13,273.37 " N/A " 8,102.70 " " 14,858.25 " " 7,530.16 " " 8,861.46 " N/A 28175621 CRANIOPLASTY W/AUTOGRAFT >5CM 62147 360 "$20,005.00" " 7,393.85 " - " 16,004.00 " - " 13,823.46 " N/A " 13,823.46 " - " 11,052.76 " N/A " 13,203.30 " - N/A " 13,241.31 " - N/A " 7,045.08 " " 8,806.35 " N/A N/A N/A " 16,004.00 " N/A - " 13,403.35 " N/A " 8,182.05 " " 15,003.75 " " 7,603.90 " " 8,948.24 " N/A 28173466 RETR BONE FLAP TO FIX SKULL 62148 360 "$1,769.00" 653.82 - " 1,415.20 " - " 1,222.38 " N/A " 1,222.38 " - 977.37 N/A " 1,167.54 " - N/A " 1,170.90 " - N/A 675.11 843.89 N/A N/A N/A " 1,415.20 " N/A - " 1,185.23 " N/A 723.52 " 1,326.75 " 672.40 791.27 N/A 28173474 NEUROENDOSCOPY ADD-ON 62160 360 "$2,861.00" " 1,057.43 " - " 2,288.80 " - " 1,469.00 " - " 1,469.00 " - " 1,580.70 " - " 1,888.26 " - - " 1,893.70 " - - " 1,067.20 " " 1,334.00 " - - - " 2,288.80 " - - " 1,916.87 " - " 1,170.15 " " 2,145.75 " " 1,087.47 " " 1,279.73 " - 28173482 REMOVE BRAIN TUMOR W/SCOPE 62164 360 "$29,433.00" " 10,878.44 " - " 23,546.40 " - " 20,338.20 " N/A " 20,338.20 " - " 16,261.73 " N/A " 19,425.78 " - N/A " 19,481.70 " - N/A " 9,686.10 " " 12,107.63 " N/A N/A N/A " 23,546.40 " N/A - " 19,720.11 " N/A " 12,038.10 " " 22,074.75 " " 11,187.48 " " 13,165.38 " N/A 28173491 REMOVE PITUIT TUMOR W/SCOPE 62165 360 "$14,996.00" " 5,542.52 " - " 11,996.80 " - " 10,362.24 " N/A " 10,362.24 " - " 8,285.29 " N/A " 9,897.36 " - N/A " 9,925.85 " - N/A " 7,803.55 " " 9,754.44 " N/A N/A N/A " 11,996.80 " N/A - " 10,047.32 " N/A " 6,133.36 " " 11,247.00 " " 5,699.98 " " 6,707.71 " N/A 28173504 ESTABLISH BRAIN CAVITY SHUNT 62223 360 "$4,175.00" " 1,543.08 " - " 6,084.41 " - " 2,884.93 " N/A " 2,884.93 " - " 2,306.69 " N/A " 2,755.50 " - N/A " 2,763.43 " - N/A " 4,867.53 " " 6,084.41 " N/A N/A N/A " 3,340.00 " N/A - " 2,797.25 " N/A " 1,707.58 " " 3,131.25 " " 1,586.92 " " 1,867.48 " N/A 28173512 REPLACE/REVISE BRAIN SHUNT 62230 360 "$29,927.00" " 11,061.02 " 776.00 " 23,941.60 " 892.40 " 1,718.00 " " 5,947.84 " " 1,718.00 " 907.92 " 16,534.67 " " 5,834.55 " " 2,820.00 " 869.12 808.05 " 19,808.68 " " 5,098.15 " " 5,664.61 " " 2,208.66 " " 2,760.83 " " 5,806.23 " " 5,834.55 " " 5,664.61 " " 23,941.60 " " 5,183.12 " 776.00 " 20,051.09 " " 4,984.86 " " 12,240.14 " " 22,445.25 " " 11,375.25 " " 13,386.35 " " 5,862.87 " 28173521 CSF SHUNT REPROGRAM 62252 360 "$1,430.00" 528.53 - " 1,775.00 " - 988.13 284.79 988.13 - 790.08 279.37 " 1,775.00 " - - 946.52 244.11 271.23 218.26 272.83 278.01 279.37 271.23 " 1,144.00 " 248.18 - 958.10 238.68 584.87 " 1,072.50 " 543.54 639.64 280.72 67703464 ASP INTERDISCAL PERC DX 62267 350 "$3,265.00" " 1,206.74 " 543.97 " 2,612.00 " 892.40 " 1,469.00 " 649.06 " 1,469.00 " 907.92 " 1,803.91 " 636.69 " 1,775.00 " 869.12 808.05 " 2,161.10 " 556.34 618.15 " 1,293.46 " " 1,616.82 " 633.60 636.69 618.15 " 2,612.00 " 565.61 776.00 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 80303467 ASP INTERDISCAL PERC DX 62267 320 "$3,265.00" " 1,206.74 " 543.97 " 2,612.00 " 892.40 " 1,469.00 " 649.06 " 1,469.00 " 907.92 " 1,803.91 " 636.69 " 1,775.00 " 869.12 808.05 " 2,161.10 " 556.34 618.15 " 1,293.46 " " 1,616.82 " 633.60 636.69 618.15 " 2,612.00 " 565.61 776.00 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 80603461 PERC ASP NP/INRVBL/PRVBL TS DX 62267 350 "$3,265.00" " 1,206.74 " 543.97 " 2,612.00 " 892.40 " 1,469.00 " 649.06 " 1,469.00 " 907.92 " 1,803.91 " 636.69 " 1,775.00 " 869.12 808.05 " 2,161.10 " 556.34 618.15 " 1,293.46 " " 1,616.82 " 633.60 636.69 618.15 " 2,612.00 " 565.61 776.00 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 80628552 DRAIN SPINAL CORD CYST 62268 350 "$4,318.00" " 1,595.93 " - " 3,454.40 " - " 1,469.00 " 858.62 " 1,469.00 " - " 2,385.70 " 842.26 " 1,775.00 " - - " 2,858.08 " 735.96 817.73 " 1,649.49 " " 2,061.86 " 838.17 842.26 817.73 " 3,454.40 " 748.22 - " 2,893.06 " 719.60 " 1,766.06 " " 3,238.50 " " 1,641.27 " " 1,931.44 " 846.35 27001670 DX SPINAL PUNCT LUMBAR 62270 370 "$3,332.00" " 1,231.51 " 358.00 " 2,665.60 " 411.70 " 1,469.00 " 662.32 " 1,469.00 " 418.86 " 1,840.93 " 649.70 " 1,775.00 " 400.96 372.79 " 2,205.45 " 567.70 630.78 " 1,649.49 " " 2,061.86 " 646.55 649.70 630.78 " 2,665.60 " 577.16 358.00 " 2,232.44 " 555.09 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 652.86 28175639 SPINAL PUNCTURE LUMBAR DIAG 62270 360 "$3,332.00" " 1,231.51 " 358.00 " 2,665.60 " 411.70 " 1,469.00 " 662.32 " 1,469.00 " 418.86 " 1,840.93 " 649.70 " 1,775.00 " 400.96 372.79 " 2,205.45 " 567.70 630.78 " 1,649.49 " " 2,061.86 " 646.55 649.70 630.78 " 2,665.60 " 577.16 358.00 " 2,232.44 " 555.09 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 652.86 37001457 DX SPINAL PUNCT LUMBAR 62270 450 "$3,332.00" " 1,231.51 " 358.00 " 2,665.60 " 411.70 " 1,469.00 " 662.32 " 1,469.00 " 418.86 " 1,840.93 " 649.70 " 1,775.00 " 400.96 372.79 " 2,205.45 " 567.70 630.78 " 1,649.49 " " 2,061.86 " 646.55 649.70 630.78 " 2,665.60 " 577.16 358.00 " 2,232.44 " 555.09 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 652.86 67701674 SPINAL PUNCTURE LUMBAR DX 62270 350 "$3,332.00" " 1,231.51 " 358.00 " 2,665.60 " 411.70 " 1,469.00 " 662.32 " 1,469.00 " 418.86 " 1,840.93 " 649.70 " 1,775.00 " 400.96 372.79 " 2,205.45 " 567.70 630.78 " 1,649.49 " " 2,061.86 " 646.55 649.70 630.78 " 2,665.60 " 577.16 358.00 " 2,232.44 " 555.09 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 652.86 80101678 SPINAL PUNCTURE LUMBAR DX 62270 320 "$3,332.00" " 1,231.51 " 358.00 " 2,665.60 " 411.70 " 1,469.00 " 662.32 " 1,469.00 " 418.86 " 1,840.93 " 649.70 " 1,775.00 " 400.96 372.79 " 2,205.45 " 567.70 630.78 " 1,649.49 " " 2,061.86 " 646.55 649.70 630.78 " 2,665.60 " 577.16 358.00 " 2,232.44 " 555.09 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 652.86 80301677 SPINAL PUNCTURE LUMBAR DX 62270 320 "$3,332.00" " 1,231.51 " 358.00 " 2,665.60 " 411.70 " 1,469.00 " 662.32 " 1,469.00 " 418.86 " 1,840.93 " 649.70 " 1,775.00 " 400.96 372.79 " 2,205.45 " 567.70 630.78 " 1,649.49 " " 2,061.86 " 646.55 649.70 630.78 " 2,665.60 " 577.16 358.00 " 2,232.44 " 555.09 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 652.86 80601671 SPINAL PUNCT LUMBAR/DIAGNST 62270 350 "$3,332.00" " 1,231.51 " 358.00 " 2,665.60 " 411.70 " 1,469.00 " 662.32 " 1,469.00 " 418.86 " 1,840.93 " 649.70 " 1,775.00 " 400.96 372.79 " 2,205.45 " 567.70 630.78 " 1,649.49 " " 2,061.86 " 646.55 649.70 630.78 " 2,665.60 " 577.16 358.00 " 2,232.44 " 555.09 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 652.86 28173539 DRAIN CEREBRO SPINAL FLUID 62272 360 "$3,332.00" " 1,231.51 " 555.09 " 2,665.60 " 892.40 " 1,469.00 " 662.32 " 1,469.00 " 907.92 " 1,840.93 " 649.70 " 1,775.00 " 869.12 808.05 " 2,205.45 " 567.70 630.78 " 1,649.49 " " 2,061.86 " 646.55 649.70 630.78 " 2,665.60 " 577.16 776.00 " 2,232.44 " 555.09 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 652.86 37003760 DRAIN CEREBRO SPINAL FLUID 62272 450 "$3,332.00" " 1,231.51 " 555.09 " 2,665.60 " 892.40 " 1,469.00 " 662.32 " 1,469.00 " 907.92 " 1,840.93 " 649.70 " 1,775.00 " 869.12 808.05 " 2,205.45 " 567.70 630.78 " 1,649.49 " " 2,061.86 " 646.55 649.70 630.78 " 2,665.60 " 577.16 776.00 " 2,232.44 " 555.09 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 652.86 80128916 DRAIN CEREBRO SPINAL FLUID 62272 320 "$3,332.00" " 1,231.51 " 555.09 " 2,665.60 " 892.40 " 1,469.00 " 662.32 " 1,469.00 " 907.92 " 1,840.93 " 649.70 " 1,775.00 " 869.12 808.05 " 2,205.45 " 567.70 630.78 " 1,649.49 " " 2,061.86 " 646.55 649.70 630.78 " 2,665.60 " 577.16 776.00 " 2,232.44 " 555.09 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 652.86 27000461 EPIDURAL INJ LUMBAR PATCH 62273 370 "$3,332.00" " 1,231.51 " 555.09 " 2,665.60 " 892.40 " 1,469.00 " 662.32 " 1,469.00 " 907.92 " 1,840.93 " 649.70 " 1,775.00 " 869.12 808.05 " 2,205.45 " 567.70 630.78 " 1,649.49 " " 2,061.86 " 646.55 649.70 630.78 " 2,665.60 " 577.16 776.00 " 2,232.44 " 555.09 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 652.86 28173547 EPIDURAL INJ LUMBAR PATCH 62273 360 "$3,332.00" " 1,231.51 " 555.09 " 2,665.60 " 892.40 " 1,469.00 " 662.32 " 1,469.00 " 907.92 " 1,840.93 " 649.70 " 1,775.00 " 869.12 808.05 " 2,205.45 " 567.70 630.78 " 1,649.49 " " 2,061.86 " 646.55 649.70 630.78 " 2,665.60 " 577.16 776.00 " 2,232.44 " 555.09 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 652.86 37003531 EPIDURAL INJ LUMBAR PATCH 62273 450 "$3,332.00" " 1,231.51 " 555.09 " 2,665.60 " 892.40 " 1,469.00 " 662.32 " 1,469.00 " 907.92 " 1,840.93 " 649.70 " 1,775.00 " 869.12 808.05 " 2,205.45 " 567.70 630.78 " 1,649.49 " " 2,061.86 " 646.55 649.70 630.78 " 2,665.60 " 577.16 776.00 " 2,232.44 " 555.09 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 652.86 80101813 LUMB INJ FOR MYELOGRAM 62284 320 $971.00 358.88 - " 1,469.00 " 685.40 " 1,469.00 " - " 1,469.00 " 697.32 536.48 - 640.86 667.52 620.61 642.70 - - " 1,012.58 " " 1,265.72 " - - - 776.80 - 596.00 650.57 - 397.14 728.25 369.08 434.33 - 80301812 LUMB INJ FOR MYELOGRAM 62284 320 $971.00 358.88 - " 1,469.00 " 685.40 " 1,469.00 " - " 1,469.00 " 697.32 536.48 - 640.86 667.52 620.61 642.70 - - " 1,012.58 " " 1,265.72 " - - - 776.80 - 596.00 650.57 - 397.14 728.25 369.08 434.33 - 80135017 INJ MYELOGRAPHY CERVICAL 62302 320 "$3,755.00" " 1,387.85 " 451.33 " 4,860.00 " 892.40 " 1,469.00 " 746.21 " 1,469.00 " 907.92 " 2,074.64 " 732.00 " 4,860.00 " 869.12 808.05 " 2,485.43 " 639.61 710.68 451.33 564.16 728.45 732.00 710.68 " 3,004.00 " 650.27 776.00 " 2,515.85 " 625.40 " 1,535.80 " " 2,816.25 " " 1,427.28 " " 1,679.61 " 735.55 80335016 INJ MYELOGRAPHY CERVICAL 62302 320 "$3,755.00" " 1,387.85 " 451.33 " 4,860.00 " 892.40 " 1,469.00 " 746.21 " 1,469.00 " 907.92 " 2,074.64 " 732.00 " 4,860.00 " 869.12 808.05 " 2,485.43 " 639.61 710.68 451.33 564.16 728.45 732.00 710.68 " 3,004.00 " 650.27 776.00 " 2,515.85 " 625.40 " 1,535.80 " " 2,816.25 " " 1,427.28 " " 1,679.61 " 735.55 80135025 INJ MYELOGRAPHY THORACIC 62303 320 "$3,755.00" " 1,387.85 " 468.34 " 4,860.00 " 892.40 " 1,469.00 " 746.21 " 1,469.00 " 907.92 " 2,074.64 " 732.00 " 4,860.00 " 869.12 808.05 " 2,485.43 " 639.61 710.68 468.34 585.42 728.45 732.00 710.68 " 3,004.00 " 650.27 776.00 " 2,515.85 " 625.40 " 1,535.80 " " 2,816.25 " " 1,427.28 " " 1,679.61 " 735.55 80335024 INJ MYELOGRAPHY THORACIC 62303 320 "$3,755.00" " 1,387.85 " 468.34 " 4,860.00 " 892.40 " 1,469.00 " 746.21 " 1,469.00 " 907.92 " 2,074.64 " 732.00 " 4,860.00 " 869.12 808.05 " 2,485.43 " 639.61 710.68 468.34 585.42 728.45 732.00 710.68 " 3,004.00 " 650.27 776.00 " 2,515.85 " 625.40 " 1,535.80 " " 2,816.25 " " 1,427.28 " " 1,679.61 " 735.55 80135033 INJ MYELOGRAPHY LUMBAR 62304 320 "$3,755.00" " 1,387.85 " 445.42 " 4,860.00 " 892.40 " 1,469.00 " 746.21 " 1,469.00 " 907.92 " 2,074.64 " 732.00 " 4,860.00 " 869.12 808.05 " 2,485.43 " 639.61 710.68 445.42 556.77 728.45 732.00 710.68 " 3,004.00 " 650.27 776.00 " 2,515.85 " 625.40 " 1,535.80 " " 2,816.25 " " 1,427.28 " " 1,679.61 " 735.55 80335032 INJ MYELOGRAPHY LUMBAR 62304 320 "$3,755.00" " 1,387.85 " 445.42 " 4,860.00 " 892.40 " 1,469.00 " 746.21 " 1,469.00 " 907.92 " 2,074.64 " 732.00 " 4,860.00 " 869.12 808.05 " 2,485.43 " 639.61 710.68 445.42 556.77 728.45 732.00 710.68 " 3,004.00 " 650.27 776.00 " 2,515.85 " 625.40 " 1,535.80 " " 2,816.25 " " 1,427.28 " " 1,679.61 " 735.55 80135041 INJ MYELOGRAPHY LUMBAR 2+ REG 62305 320 "$3,755.00" " 1,387.85 " 485.75 " 4,860.00 " 892.40 " 1,718.00 " 746.21 " 1,718.00 " 907.92 " 2,074.64 " 732.00 " 4,860.00 " 869.12 808.05 " 2,485.43 " 639.61 710.68 485.75 607.19 728.45 732.00 710.68 " 3,004.00 " 650.27 776.00 " 2,515.85 " 625.40 " 1,535.80 " " 2,816.25 " " 1,427.28 " " 1,679.61 " 735.55 80335041 INJ MYELOGRAPHY LUMBAR 2+ REG 62305 320 "$3,755.00" " 1,387.85 " 485.75 " 4,860.00 " 892.40 " 1,718.00 " 746.21 " 1,718.00 " 907.92 " 2,074.64 " 732.00 " 4,860.00 " 869.12 808.05 " 2,485.43 " 639.61 710.68 485.75 607.19 728.45 732.00 710.68 " 3,004.00 " 650.27 776.00 " 2,515.85 " 625.40 " 1,535.80 " " 2,816.25 " " 1,427.28 " " 1,679.61 " 735.55 27001891 INTRLM C/T INJ W/O IG 62320 370 "$3,332.00" " 1,231.51 " 555.09 " 2,665.60 " 892.40 " 2,302.41 " 662.32 " 2,302.41 " 907.92 " 1,840.93 " 649.70 " 1,775.00 " 869.12 808.05 " 2,205.45 " 567.70 630.78 922.51 " 1,153.14 " 646.55 649.70 630.78 " 2,665.60 " 577.16 776.00 " 2,232.44 " 555.09 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 652.86 27001904 INTRLM C/T INJ W/IG 62321 370 "$3,332.00" " 1,231.51 " 555.09 " 2,665.60 " 892.40 " 2,302.41 " 662.32 " 2,302.41 " 907.92 " 1,840.93 " 649.70 " 1,775.00 " 869.12 808.05 " 2,205.45 " 567.70 630.78 " 1,359.95 " " 1,699.94 " 646.55 649.70 630.78 " 2,665.60 " 577.16 776.00 " 2,232.44 " 555.09 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 652.86 27001912 INTRLM L/S INJ W/O IG 62322 370 "$3,332.00" " 1,231.51 " 555.09 " 2,665.60 " 892.40 " 2,302.41 " 662.32 " 2,302.41 " 907.92 " 1,840.93 " 649.70 " 1,775.00 " 869.12 808.05 " 2,205.45 " 567.70 630.78 858.22 " 1,072.77 " 646.55 649.70 630.78 " 2,665.60 " 577.16 776.00 " 2,232.44 " 555.09 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 652.86 27001921 INTRLM L/S INJ W/IG 62323 370 "$3,332.00" " 1,231.51 " 555.09 " 2,665.60 " 892.40 " 2,302.41 " 662.32 " 2,302.41 " 907.92 " 1,840.93 " 649.70 " 1,775.00 " 869.12 808.05 " 2,205.45 " 567.70 630.78 " 1,332.83 " " 1,666.04 " 646.55 649.70 630.78 " 2,665.60 " 577.16 776.00 " 2,232.44 " 555.09 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 652.86 80235879 NJX INTERLAMINAR LMBR/SAC 62323 320 "$3,332.00" " 1,231.51 " 555.09 " 2,665.60 " 892.40 " 2,302.41 " 662.32 " 2,302.41 " 907.92 " 1,840.93 " 649.70 " 1,775.00 " 869.12 808.05 " 2,205.45 " 567.70 630.78 " 1,332.83 " " 1,666.04 " 646.55 649.70 630.78 " 2,665.60 " 577.16 776.00 " 2,232.44 " 555.09 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 652.86 27001858 INTRLM CATH C/T INJ W/O IG 62324 370 "$4,318.00" " 1,595.93 " 719.60 " 3,454.40 " 892.40 " 2,983.74 " 858.62 " 2,983.74 " 907.92 " 2,385.70 " 842.26 " 2,820.00 " 869.12 808.05 " 2,858.08 " 735.96 817.73 811.02 " 1,013.77 " 838.17 842.26 817.73 " 3,454.40 " 748.22 776.00 " 2,893.06 " 719.60 " 1,766.06 " " 3,238.50 " " 1,641.27 " " 1,931.44 " 846.35 27001866 INTRLM CATH C/T INJ W/IG 62325 370 "$4,318.00" " 1,595.93 " 719.60 " 3,454.40 " 892.40 " 2,983.74 " 858.62 " 2,983.74 " 907.92 " 2,385.70 " 842.26 " 2,820.00 " 869.12 808.05 " 2,858.08 " 735.96 817.73 " 1,213.24 " " 1,516.55 " 838.17 842.26 817.73 " 3,454.40 " 748.22 776.00 " 2,893.06 " 719.60 " 1,766.06 " " 3,238.50 " " 1,641.27 " " 1,931.44 " 846.35 27001874 INTRLM CATH L/S INJ W/O IG 62326 370 "$4,318.00" " 1,595.93 " 719.60 " 3,454.40 " 892.40 " 2,983.74 " 858.62 " 2,983.74 " 907.92 " 2,385.70 " 842.26 " 2,820.00 " 869.12 808.05 " 2,858.08 " 735.96 817.73 848.60 " 1,060.75 " 838.17 842.26 817.73 " 3,454.40 " 748.22 776.00 " 2,893.06 " 719.60 " 1,766.06 " " 3,238.50 " " 1,641.27 " " 1,931.44 " 846.35 27001882 INTRLM CATH L/S INJ W/IG 62327 370 "$4,318.00" " 1,595.93 " 719.60 " 3,454.40 " 892.40 " 2,983.74 " 858.62 " 2,983.74 " 907.92 " 2,385.70 " 842.26 " 2,820.00 " 869.12 808.05 " 2,858.08 " 735.96 817.73 " 1,231.02 " " 1,538.77 " 838.17 842.26 817.73 " 3,454.40 " 748.22 776.00 " 2,893.06 " 719.60 " 1,766.06 " " 3,238.50 " " 1,641.27 " " 1,931.44 " 846.35 80136871 DX SPINAL PUNCTURE LUMBAR W/IG 62328 320 "$3,332.00" " 1,231.51 " 555.09 " 2,665.60 " 892.40 " 2,302.41 " 662.32 " 2,302.41 " 907.92 " 1,840.93 " 649.70 " 1,775.00 " 869.12 808.05 " 2,205.45 " 567.70 630.78 " 1,430.94 " " 1,788.68 " 646.55 649.70 630.78 " 2,665.60 " 577.16 776.00 " 2,232.44 " 555.09 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 652.86 80336870 DX SPINAL PUNCTURE LUMBAR W/IG 62328 320 "$3,332.00" " 1,231.51 " 555.09 " 2,665.60 " 892.40 " 2,302.41 " 662.32 " 2,302.41 " 907.92 " 1,840.93 " 649.70 " 1,775.00 " 869.12 808.05 " 2,205.45 " 567.70 630.78 " 1,430.94 " " 1,788.68 " 646.55 649.70 630.78 " 2,665.60 " 577.16 776.00 " 2,232.44 " 555.09 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 652.86 80636873 DX SPINAL PUNCTURE LUMBAR W/IG 62328 350 "$3,332.00" " 1,231.51 " 555.09 " 2,665.60 " 892.40 " 2,302.41 " 662.32 " 2,302.41 " 907.92 " 1,840.93 " 649.70 " 1,775.00 " 869.12 808.05 " 2,205.45 " 567.70 630.78 " 1,430.94 " " 1,788.68 " 646.55 649.70 630.78 " 2,665.60 " 577.16 776.00 " 2,232.44 " 555.09 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 652.86 80136889 THER SPINAL PUNCTURE DRAIN IG 62329 320 "$3,332.00" " 1,231.51 " 555.09 " 2,665.60 " 892.40 " 2,302.41 " 662.32 " 2,302.41 " 907.92 " 1,840.93 " 649.70 " 1,775.00 " 869.12 808.05 " 2,205.45 " 567.70 630.78 " 1,776.18 " " 2,220.22 " 646.55 649.70 630.78 " 2,665.60 " 577.16 776.00 " 2,232.44 " 555.09 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 652.86 80336888 THER SPINAL PUNCTURE DRAIN IG 62329 320 "$3,332.00" " 1,231.51 " 555.09 " 2,665.60 " 892.40 " 2,302.41 " 662.32 " 2,302.41 " 907.92 " 1,840.93 " 649.70 " 1,775.00 " 869.12 808.05 " 2,205.45 " 567.70 630.78 " 1,776.18 " " 2,220.22 " 646.55 649.70 630.78 " 2,665.60 " 577.16 776.00 " 2,232.44 " 555.09 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 652.86 80636881 THER SPINAL PUNCTURE DRAIN IG 62329 350 "$3,332.00" " 1,231.51 " 555.09 " 2,665.60 " 892.40 " 2,302.41 " 662.32 " 2,302.41 " 907.92 " 1,840.93 " 649.70 " 1,775.00 " 869.12 808.05 " 2,205.45 " 567.70 630.78 " 1,776.18 " " 2,220.22 " 646.55 649.70 630.78 " 2,665.60 " 577.16 776.00 " 2,232.44 " 555.09 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 652.86 28173555 REMOVE SPINAL CANAL CATHETER 62355 360 "$9,211.00" " 3,404.39 " 776.00 " 7,368.80 " 892.40 " 1,718.00 " " 1,831.46 " " 1,718.00 " 907.92 " 5,089.08 " " 1,796.58 " " 2,820.00 " 869.12 808.05 " 6,096.76 " " 1,569.83 " " 1,744.25 " " 2,376.02 " " 2,970.02 " " 1,787.86 " " 1,796.58 " " 1,744.25 " " 7,368.80 " " 1,595.99 " 776.00 " 6,171.37 " " 1,534.94 " " 3,767.30 " " 6,908.25 " " 3,501.10 " " 4,120.08 " " 1,805.30 " 28173563 REMOVE SPINE LAMINA 1/2 CRVL 63001 360 "$32,891.00" " 12,156.51 " - " 26,312.80 " - " 3,686.00 " " 6,533.13 " " 3,686.00 " - " 18,172.28 " " 6,408.69 " " 6,755.00 " - - " 21,770.55 " " 5,599.83 " " 6,222.03 " " 4,937.34 " " 6,171.67 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " - " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28173571 REMOVE SPINE LAMINA 1/2 LMBR 63005 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 3,604.00 " " 6,533.13 " " 3,604.00 " 907.92 " 18,172.28 " " 6,408.69 " " 6,755.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 5,685.41 " " 7,106.76 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28175647 LAMI REM ABNOR FCTS SPOND LUMB 63012 360 "$32,891.00" " 12,156.51 " - " 26,312.80 " - " 3,604.00 " " 6,533.13 " " 3,604.00 " - " 18,172.28 " " 6,408.69 " " 6,755.00 " - - " 21,770.55 " " 5,599.83 " " 6,222.03 " " 5,841.06 " " 7,301.33 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " - " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28173580 REMOVE SPINE LAMINA >2 CRVCL 63015 360 "$32,891.00" " 12,156.51 " - " 26,312.80 " - " 3,686.00 " " 6,533.13 " " 3,686.00 " - " 18,172.28 " " 6,408.69 " " 6,755.00 " - - " 21,770.55 " " 5,599.83 " " 6,222.03 " " 7,234.14 " " 9,042.68 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " - " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28173598 REMOVE SPINE LAMINA >2 THRC 63016 360 "$32,891.00" " 12,156.51 " - " 26,312.80 " - " 3,686.00 " " 6,533.13 " " 3,686.00 " - " 18,172.28 " " 6,408.69 " " 6,755.00 " - - " 21,770.55 " " 5,599.83 " " 6,222.03 " " 7,151.90 " " 8,939.88 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " - " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28173601 REMOVE SPINE LAMINA >2 LMBR 63017 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 3,326.00 " " 6,533.13 " " 3,326.00 " 907.92 " 18,172.28 " " 6,408.69 " " 6,755.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 6,034.69 " " 7,543.36 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28173610 LOW BACK DISK SURGERY 63030 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 3,604.00 " " 6,533.13 " " 3,604.00 " 907.92 " 18,172.28 " " 6,408.69 " " 6,755.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 4,937.34 " " 6,171.67 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28173628 SPINAL DISK SURGERY ADD-ON 63035 360 "$10,000.00" " 3,696.00 " - " 8,000.00 " - " 3,604.00 " - " 3,604.00 " - " 5,525.00 " - " 6,755.00 " - - " 6,619.00 " - - " 1,114.34 " " 1,392.93 " - - - " 8,000.00 " - - " 6,700.00 " - " 4,090.00 " " 7,500.00 " " 3,801.00 " " 4,473.00 " - 28173636 LAMINOTOMY SINGLE CERVICAL 63040 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 3,604.00 " " 6,533.13 " " 3,604.00 " 907.92 " 18,172.28 " " 6,408.69 " " 6,755.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 7,021.00 " " 8,776.25 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28173644 REMOVE SPINE LAMINA 1 CRVL 63045 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 3,604.00 " " 6,533.13 " " 3,604.00 " 907.92 " 18,172.28 " " 6,408.69 " " 6,755.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 6,202.94 " " 7,753.68 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28173652 REMOVE SPINE LAMINA 1 THRC 63046 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 3,604.00 " " 6,533.13 " " 3,604.00 " 907.92 " 18,172.28 " " 6,408.69 " " 6,755.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 5,948.34 " " 7,435.43 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28173661 REMOVE SPINE LAMINA 1 LMBR 63047 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 3,604.00 " " 6,533.13 " " 3,604.00 " 907.92 " 18,172.28 " " 6,408.69 " " 6,755.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 5,583.08 " " 6,978.85 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28173679 REMOVE SPINAL LAMINA ADD-ON 63048 360 "$2,587.00" 956.16 - " 6,755.00 " - " 3,604.00 " - " 3,604.00 " - " 1,429.32 " - " 6,755.00 " - - " 1,712.34 " - - " 1,141.18 " " 1,426.47 " - - - " 2,069.60 " - - " 1,733.29 " - " 1,058.08 " " 1,940.25 " 983.32 " 1,157.17 " - 28175655 DISKECTOMY ANT 1 LVL CERV 63075 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 3,604.00 " " 6,533.13 " " 3,604.00 " 907.92 " 18,172.28 " " 6,408.69 " " 21,708.06 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 4,937.34 " " 6,171.67 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28173687 REMOVE VERT BODY DCMPRN CRVL 63081 360 "$1,738.00" 642.36 - " 10,959.90 " - " 1,200.96 " N/A " 1,200.96 " - 960.25 N/A " 1,147.08 " - N/A " 1,150.38 " - N/A " 8,767.92 " " 10,959.90 " N/A N/A N/A " 1,390.40 " N/A - " 1,164.46 " N/A 710.84 " 1,303.50 " 660.61 777.41 N/A 28175663 VERT CORP EA ADD LVL CERV 63082 360 "$1,679.00" 620.56 - " 1,918.56 " - " 1,160.19 " N/A " 1,160.19 " - 927.65 N/A " 1,108.14 " - N/A " 1,111.33 " - N/A " 1,534.85 " " 1,918.56 " N/A N/A N/A " 1,343.20 " N/A - " 1,124.93 " N/A 686.71 " 1,259.25 " 638.19 751.02 N/A 28173695 REMOVE VERT BODY DCMPRN THRC 63085 360 "$33,373.00" " 12,334.66 " - " 26,698.40 " - " 23,060.74 " N/A " 23,060.74 " - " 18,438.58 " N/A " 22,026.18 " - N/A " 22,089.59 " - N/A " 9,469.81 " " 11,837.26 " N/A N/A N/A " 26,698.40 " N/A - " 22,359.91 " N/A " 13,649.56 " " 25,029.75 " " 12,685.08 " " 14,927.74 " N/A 28175671 INCISE SPINE&CORD 2 TRX THRC 63197 360 "$17,319.00" " 6,401.10 " - " 13,855.20 " - " 11,967.43 " N/A " 11,967.43 " - " 9,568.75 " N/A " 6,755.00 " - N/A " 11,463.45 " - N/A " 7,792.36 " " 9,740.45 " N/A N/A N/A " 13,855.20 " N/A - " 11,603.73 " N/A " 7,083.47 " " 12,989.25 " " 6,582.95 " " 7,746.79 " N/A 28173709 EXCISE INTRASPINL LESION CRV 63265 360 "$32,891.00" " 12,156.51 " - " 26,312.80 " - " 3,604.00 " " 6,533.13 " " 3,604.00 " - " 18,172.28 " " 6,408.69 " " 6,755.00 " - - " 21,770.55 " " 5,599.83 " " 6,222.03 " " 7,989.02 " " 9,986.28 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " - " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28173717 EXCISE INTRSPINL LESION LMBR 63267 360 "$32,891.00" " 12,156.51 " 776.00 " 26,312.80 " 892.40 " 22,727.68 " " 6,533.13 " " 22,727.68 " 907.92 " 18,172.28 " " 6,408.69 " " 6,755.00 " 869.12 808.05 " 21,770.55 " " 5,599.83 " " 6,222.03 " " 6,714.13 " " 8,392.66 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " 776.00 " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 28173725 EXCISE INTRSPINL LESION THRC 63271 360 "$13,340.00" " 4,930.46 " - " 12,351.08 " - " 9,217.94 " N/A " 9,217.94 " - " 7,370.35 " N/A " 6,755.00 " - N/A " 8,829.75 " - N/A " 9,880.86 " " 12,351.08 " N/A N/A N/A " 10,672.00 " N/A - " 8,937.80 " N/A " 5,456.06 " " 10,005.00 " " 5,070.53 " " 5,966.98 " N/A 28173733 BX/EXC XDRL SPINE LESN THRC 63276 360 "$18,417.00" " 6,806.92 " - " 14,733.60 " - " 12,726.15 " N/A " 12,726.15 " - " 10,175.39 " N/A " 6,755.00 " - N/A " 12,190.21 " - N/A " 8,622.56 " " 10,778.20 " N/A N/A N/A " 14,733.60 " N/A - " 12,339.39 " N/A " 7,532.55 " " 13,812.75 " " 7,000.30 " " 8,237.92 " N/A 28173741 BX/EXC IDRL SPINE LESN THRC 63281 360 "$10,545.00" " 3,897.43 " - " 12,891.05 " - " 7,286.60 " N/A " 7,286.60 " - " 5,826.11 " N/A " 6,755.00 " - N/A " 6,979.74 " - N/A " 10,312.84 " " 12,891.05 " N/A N/A N/A " 8,436.00 " N/A - " 7,065.15 " N/A " 4,312.91 " " 7,908.75 " " 4,008.15 " " 4,716.78 " N/A 28173750 REMOVE VERT XDRL BODY CRVCL 63300 360 "$1,445.00" 534.07 - " 11,182.11 " - 998.50 N/A 998.50 - 798.36 N/A 953.70 - N/A 956.45 - N/A " 8,945.69 " " 11,182.11 " N/A N/A N/A " 1,156.00 " N/A - 968.15 N/A 591.01 " 1,083.75 " 549.24 646.35 N/A 28173768 LAMINEC IMPL NEUR ELE EPIDURAL 63655 360 "$107,519.00" " 39,739.02 " 776.00 " 86,015.20 " 892.40 " 3,686.00 " " 21,357.40 " " 3,686.00 " 907.92 " 59,404.25 " " 20,950.59 " " 6,755.00 " 869.12 808.05 " 71,166.83 " " 18,306.34 " " 20,340.38 " " 3,935.34 " " 4,919.17 " " 20,848.89 " " 20,950.59 " " 20,340.38 " " 86,015.20 " " 18,611.45 " 776.00 " 72,037.73 " " 17,899.53 " " 43,975.27 " " 80,639.25 " " 40,867.97 " " 48,093.25 " " 21,052.29 " 28173776 REMOVE SPINE ELTRD PLATE 63662 360 "$17,195.00" " 6,355.27 " 776.00 " 13,756.00 " 892.40 " 1,469.00 " " 3,416.90 " " 1,469.00 " 907.92 " 9,500.24 " " 3,351.82 " " 6,540.00 " 869.12 808.05 " 11,381.37 " " 2,928.77 " " 3,254.19 " " 3,759.59 " " 4,699.49 " " 3,335.54 " " 3,351.82 " " 3,254.19 " " 13,756.00 " " 2,977.58 " 776.00 " 11,520.65 " " 2,863.69 " " 7,032.76 " " 12,896.25 " " 6,535.82 " " 7,691.32 " " 3,368.09 " 28173784 REVISE SPINE ELTRD PERQ ARAY 63663 360 "$32,344.00" " 11,954.34 " 776.00 " 25,875.20 " 892.40 " 1,469.00 " " 6,429.37 " " 1,469.00 " 907.92 " 17,870.06 " " 6,306.91 " " 6,540.00 " 869.12 808.05 " 21,408.49 " " 5,510.89 " " 6,123.21 " " 4,252.83 " " 5,316.04 " " 6,276.29 " " 6,306.91 " " 6,123.21 " " 25,875.20 " " 5,602.74 " 776.00 " 21,670.48 " " 5,388.42 " " 13,228.70 " " 24,258.00 " " 12,293.95 " " 14,467.47 " " 6,337.52 " 28173792 INSRT/REDO SPINE N GENERATOR 63685 360 "$154,584.00" " 57,134.25 " 776.00 " 123,667.20 " 892.40 " 1,718.00 " " 30,702.99 " " 1,718.00 " 907.92 " 85,407.66 " " 30,118.17 " " 2,820.00 " 869.12 808.05 " 102,319.15 " " 26,316.85 " " 29,240.94 " " 2,208.66 " " 2,760.83 " " 29,971.96 " " 30,118.17 " " 29,240.94 " " 123,667.20 " " 26,755.46 " 776.00 " 103,571.28 " " 25,732.03 " " 63,224.86 " " 115,938.00 " " 58,757.38 " " 69,145.42 " " 30,264.37 " 28173806 REVISE/REMOVE NEURORECEIVER 63688 360 "$17,195.00" " 6,355.27 " 776.00 " 13,756.00 " 892.40 " 1,469.00 " " 3,416.90 " " 1,469.00 " 907.92 " 9,500.24 " " 3,351.82 " " 1,775.00 " 869.12 808.05 " 11,381.37 " " 2,928.77 " " 3,254.19 " " 1,649.49 " " 2,061.86 " " 3,335.54 " " 3,351.82 " " 3,254.19 " " 13,756.00 " " 2,977.58 " 776.00 " 11,520.65 " " 2,863.69 " " 7,032.76 " " 12,896.25 " " 6,535.82 " " 7,691.32 " " 3,368.09 " 28173814 RPR DUR/CSF LEAK NO LMNX 63707 360 "$7,865.00" " 2,906.90 " - " 6,292.00 " - " 5,434.72 " N/A " 5,434.72 " - " 4,345.41 " N/A " 5,190.90 " - N/A " 5,205.84 " - N/A " 4,314.04 " " 5,392.55 " N/A N/A N/A " 6,292.00 " N/A - " 5,269.55 " N/A " 3,216.79 " " 5,898.75 " " 2,989.49 " " 3,518.01 " N/A 28173822 REP DUR/CSF LK/PSEUDOMENING/LM 63709 360 "$4,941.00" " 1,826.19 " - " 6,751.58 " - " 3,414.23 " N/A " 3,414.23 " - " 2,729.90 " N/A " 3,261.06 " - N/A " 3,270.45 " - N/A " 5,401.26 " " 6,751.58 " N/A N/A N/A " 3,952.80 " N/A - " 3,310.47 " N/A " 2,020.87 " " 3,705.75 " " 1,878.07 " " 2,210.11 " N/A 28176651 DURAL GRAFT SPINAL 63710 360 "$1,838.00" 679.32 - " 6,171.67 " - " 1,270.06 " N/A " 1,270.06 " - " 1,015.50 " N/A " 1,213.08 " - N/A " 1,216.57 " - N/A " 4,937.34 " " 6,171.67 " N/A N/A N/A " 1,470.40 " N/A - " 1,231.46 " N/A 751.74 " 1,378.50 " 698.62 822.14 N/A 28173831 INSTALL SPINAL SHUNT 63741 360 "$29,927.00" " 11,061.02 " - " 23,941.60 " - " 1,718.00 " " 5,947.84 " " 1,718.00 " - " 16,534.67 " " 5,834.55 " " 19,751.82 " - - " 19,808.68 " " 5,098.15 " " 5,664.61 " " 2,957.46 " " 3,696.83 " " 5,806.23 " " 5,834.55 " " 5,664.61 " " 23,941.60 " " 5,183.12 " - " 20,051.09 " " 4,984.86 " " 12,240.14 " " 22,445.25 " " 11,375.25 " " 13,386.35 " " 5,862.87 " 28173849 REVISION OF SPINAL SHUNT 63744 360 "$29,927.00" " 11,061.02 " 776.00 " 23,941.60 " 892.40 " 2,773.00 " " 5,947.84 " " 2,773.00 " 907.92 " 16,534.67 " " 5,834.55 " " 3,545.00 " 869.12 808.05 " 19,808.68 " " 5,098.15 " " 5,664.61 " " 2,532.97 " " 3,166.21 " " 5,806.23 " " 5,834.55 " " 5,664.61 " " 23,941.60 " " 5,183.12 " 776.00 " 20,051.09 " " 4,984.86 " " 12,240.14 " " 22,445.25 " " 11,375.25 " " 13,386.35 " " 5,862.87 " 28173857 REMOVAL OF SPINAL SHUNT 63746 360 "$9,211.00" " 3,404.39 " 776.00 " 7,368.80 " 892.40 " 1,718.00 " " 1,831.46 " " 1,718.00 " 907.92 " 5,089.08 " " 1,796.58 " " 2,820.00 " 869.12 808.05 " 6,096.76 " " 1,569.83 " " 1,744.25 " " 2,208.66 " " 2,760.83 " " 1,787.86 " " 1,796.58 " " 1,744.25 " " 7,368.80 " " 1,595.99 " 776.00 " 6,171.37 " " 1,534.94 " " 3,767.30 " " 6,908.25 " " 3,501.10 " " 4,120.08 " " 1,805.30 " 37090425 N BLOCK INJ TRIGEMINAL 64400 450 "$1,371.00" 506.72 228.39 " 1,775.00 " 892.40 " 1,469.00 " 272.51 " 1,469.00 " 907.92 757.48 267.32 " 1,775.00 " 869.12 808.05 907.46 233.58 259.53 " 1,012.58 " " 1,265.72 " 266.02 267.32 259.53 " 1,096.80 " 237.47 776.00 918.57 228.39 560.74 " 1,028.25 " 521.12 613.25 268.61 27001726 N BLOCK INJ BRACHIAL PLEX/SGL 64415 370 "$4,318.00" " 1,595.93 " 719.60 " 3,454.40 " 892.40 " 1,469.00 " 858.62 " 1,469.00 " 907.92 " 2,385.70 " 842.26 " 1,775.00 " 869.12 808.05 " 2,858.08 " 735.96 817.73 " 1,649.49 " " 2,061.86 " 838.17 842.26 817.73 " 3,454.40 " 748.22 776.00 " 2,893.06 " 719.60 " 1,766.06 " " 3,238.50 " " 1,641.27 " " 1,931.44 " 846.35 27001742 N BLOCK INJ AXILLARY 64417 370 "$4,318.00" " 1,595.93 " 21.00 " 3,454.40 " 24.15 " 1,469.00 " 858.62 " 1,469.00 " 24.57 " 2,385.70 " 842.26 " 1,775.00 " 23.52 21.87 " 2,858.08 " 735.96 817.73 " 1,649.49 " " 2,061.86 " 838.17 842.26 817.73 " 3,454.40 " 748.22 21.00 " 2,893.06 " 719.60 " 1,766.06 " " 3,238.50 " " 1,641.27 " " 1,931.44 " 846.35 37090433 N BLOCK INJ INTERCOST/SGL 64420 450 "$3,332.00" " 1,231.51 " 555.09 " 2,665.60 " 892.40 " 1,469.00 " 662.32 " 1,469.00 " 907.92 " 1,840.93 " 649.70 " 1,775.00 " 869.12 808.05 " 2,205.45 " 567.70 630.78 " 1,649.49 " " 2,061.86 " 646.55 649.70 630.78 " 2,665.60 " 577.16 776.00 " 2,232.44 " 555.09 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 652.86 27001769 N BLOCK INJ SCIATIC SGL 64445 370 "$3,332.00" " 1,231.51 " 23.50 " 2,665.60 " 27.03 " 1,469.00 " 662.32 " 1,469.00 " 27.50 " 1,840.93 " 649.70 " 1,775.00 " 26.32 24.47 " 2,205.45 " 567.70 630.78 " 1,649.49 " " 2,061.86 " 646.55 649.70 630.78 " 2,665.60 " 577.16 23.50 " 2,232.44 " 555.09 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 652.86 27001785 N BLOCK INJ FEM/SGL 64447 370 "$3,332.00" " 1,231.51 " 420.95 " 2,665.60 " 892.40 " 2,302.41 " 662.32 " 2,302.41 " 907.92 " 1,840.93 " 649.70 " 1,775.00 " 869.12 808.05 " 2,205.45 " 567.70 630.78 420.95 526.19 646.55 649.70 630.78 " 2,665.60 " 577.16 776.00 " 2,232.44 " 555.09 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 652.86 80537077 N BLOCK INJ FEM/SGL 64447 320 "$3,332.00" " 1,231.51 " 420.95 " 2,665.60 " 892.40 " 2,302.41 " 662.32 " 2,302.41 " 907.92 " 1,840.93 " 649.70 " 1,775.00 " 869.12 808.05 " 2,205.45 " 567.70 630.78 420.95 526.19 646.55 649.70 630.78 " 2,665.60 " 577.16 776.00 " 2,232.44 " 555.09 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 652.86 27001815 OTHER PERIPHERAL NERVE INJ 64450 370 "$3,332.00" " 1,231.51 " 21.00 " 2,665.60 " 24.15 " 1,469.00 " 662.32 " 1,469.00 " 24.57 " 1,840.93 " 649.70 " 1,775.00 " 23.52 21.87 " 2,205.45 " 567.70 630.78 618.80 773.50 646.55 649.70 630.78 " 2,665.60 " 577.16 21.00 " 2,232.44 " 555.09 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 652.86 28173865 OTHER PERIPHERAL NERVE INJ 64450 360 "$3,332.00" " 1,231.51 " 21.00 " 2,665.60 " 24.15 " 1,469.00 " 662.32 " 1,469.00 " 24.57 " 1,840.93 " 649.70 " 1,775.00 " 23.52 21.87 " 2,205.45 " 567.70 630.78 618.80 773.50 646.55 649.70 630.78 " 2,665.60 " 577.16 21.00 " 2,232.44 " 555.09 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 652.86 37001473 OTHER PERIPHERAL NERVE INJ 64450 450 "$3,332.00" " 1,231.51 " 21.00 " 2,665.60 " 24.15 " 1,469.00 " 662.32 " 1,469.00 " 24.57 " 1,840.93 " 649.70 " 1,775.00 " 23.52 21.87 " 2,205.45 " 567.70 630.78 618.80 773.50 646.55 649.70 630.78 " 2,665.60 " 577.16 21.00 " 2,232.44 " 555.09 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 652.86 80336799 OTHER PERIPHERAL NERVE INJ 64450 320 "$3,332.00" " 1,231.51 " 21.00 " 2,665.60 " 24.15 " 1,469.00 " 662.32 " 1,469.00 " 24.57 " 1,840.93 " 649.70 " 1,775.00 " 23.52 21.87 " 2,205.45 " 567.70 630.78 618.80 773.50 646.55 649.70 630.78 " 2,665.60 " 577.16 21.00 " 2,232.44 " 555.09 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 652.86 80536798 OTHER PERIPHERAL NERVE INJ 64450 402 "$3,332.00" " 1,231.51 " 21.00 " 2,665.60 " 24.15 " 1,469.00 " 662.32 " 1,469.00 " 24.57 " 1,840.93 " 649.70 " 1,775.00 " 23.52 21.87 " 2,205.45 " 567.70 630.78 618.80 773.50 646.55 649.70 630.78 " 2,665.60 " 577.16 21.00 " 2,232.44 " 555.09 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 652.86 80336896 INJ ANES/STEROID SAC JT W/IG 64451 320 "$3,332.00" " 1,231.51 " - " 2,665.60 " - " 2,302.41 " 662.32 " 2,302.41 " - " 1,840.93 " 649.70 " 1,775.00 " - - " 2,205.45 " 567.70 630.78 " 1,159.63 " " 1,449.54 " 646.55 649.70 630.78 " 2,665.60 " 577.16 - " 2,232.44 " 555.09 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 652.86 80636890 INJ ANES/STEROID SAC JT W/IG 64451 350 "$3,332.00" " 1,231.51 " - " 2,665.60 " - " 2,302.41 " 662.32 " 2,302.41 " - " 1,840.93 " 649.70 " 1,775.00 " - - " 2,205.45 " 567.70 630.78 " 1,159.63 " " 1,449.54 " 646.55 649.70 630.78 " 2,665.60 " 577.16 - " 2,232.44 " 555.09 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 652.86 80336900 INJ ANES/STEROID NERVE BR W/IG 64454 320 "$3,332.00" " 1,231.51 " - " 2,665.60 " - " 2,302.41 " 662.32 " 2,302.41 " - " 1,840.93 " 649.70 " 1,775.00 " - - " 2,205.45 " 567.70 630.78 " 1,171.05 " " 1,463.81 " 646.55 649.70 630.78 " 2,665.60 " 577.16 - " 2,232.44 " 555.09 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 652.86 80636903 INJ ANES/STEROID NERVE BR W/IG 64454 350 "$3,332.00" " 1,231.51 " - " 2,665.60 " - " 2,302.41 " 662.32 " 2,302.41 " - " 1,840.93 " 649.70 " 1,775.00 " - - " 2,205.45 " 567.70 630.78 " 1,171.05 " " 1,463.81 " 646.55 649.70 630.78 " 2,665.60 " 577.16 - " 2,232.44 " 555.09 " 1,362.79 " " 2,499.00 " " 1,266.49 " " 1,490.40 " 652.86 80335695 INJ SPHENOPALATINE GANGLION 64505 320 "$1,371.00" 506.72 217.00 " 1,775.00 " 249.55 " 1,469.00 " 272.51 " 1,469.00 " 253.89 757.48 267.32 " 1,775.00 " 243.04 225.96 907.46 233.58 259.53 549.26 686.58 266.02 267.32 259.53 " 1,096.80 " 237.47 217.00 918.57 228.39 560.74 " 1,028.25 " 521.12 613.25 268.61 80641346 INJ LUMBAR OR THORACIC 64520 350 "$4,318.00" " 1,595.93 " 719.60 " 3,454.40 " 892.40 " 1,469.00 " 858.62 " 1,469.00 " 907.92 " 2,385.70 " 842.26 " 1,775.00 " 869.12 808.05 " 2,858.08 " 735.96 817.73 " 1,649.49 " " 2,061.86 " 838.17 842.26 817.73 " 3,454.40 " 748.22 776.00 " 2,893.06 " 719.60 " 1,766.06 " " 3,238.50 " " 1,641.27 " " 1,931.44 " 846.35 80641419 N BLOCK CELIAC PELUS INJ 64530 350 "$4,318.00" " 1,595.93 " 719.60 " 3,454.40 " 892.40 " 1,469.00 " 858.62 " 1,469.00 " 907.92 " 2,385.70 " 842.26 " 1,775.00 " 869.12 808.05 " 2,858.08 " 735.96 817.73 " 1,649.49 " " 2,061.86 " 838.17 842.26 817.73 " 3,454.40 " 748.22 776.00 " 2,893.06 " 719.60 " 1,766.06 " " 3,238.50 " " 1,641.27 " " 1,931.44 " 846.35 28173873 INC FOR VAGUS N ELECT IMPL 64568 360 "$154,584.00" " 57,134.25 " 776.00 " 123,667.20 " 892.40 " 1,718.00 " " 30,702.99 " " 1,718.00 " 907.92 " 85,407.66 " " 30,118.17 " " 102,025.44 " 869.12 808.05 " 102,319.15 " " 26,316.85 " " 29,240.94 " " 3,565.23 " " 4,456.54 " " 29,971.96 " " 30,118.17 " " 29,240.94 " " 123,667.20 " " 26,755.46 " 776.00 " 103,571.28 " " 25,732.03 " " 63,224.86 " " 115,938.00 " " 58,757.38 " " 69,145.42 " " 30,264.37 " 28173881 IMPL NEUROELECTRODE-SACRAL NER 64581 360 "$32,344.00" " 11,954.34 " 776.00 " 25,875.20 " 892.40 " 2,773.00 " " 6,429.37 " " 2,773.00 " 907.92 " 17,870.06 " " 6,306.91 " " 3,545.00 " 869.12 808.05 " 21,408.49 " " 5,510.89 " " 6,123.21 " " 4,102.91 " " 5,128.64 " " 6,276.29 " " 6,306.91 " " 6,123.21 " " 25,875.20 " " 5,602.74 " 776.00 " 21,670.48 " " 5,388.42 " " 13,228.70 " " 24,258.00 " " 12,293.95 " " 14,467.47 " " 6,337.52 " 28173890 INSRT/REDO PN/GASTR STIMUL 64590 360 "$107,519.00" " 39,739.02 " 776.00 " 86,015.20 " 892.40 " 1,718.00 " " 21,357.40 " " 1,718.00 " 907.92 " 59,404.25 " " 20,950.59 " " 2,820.00 " 869.12 808.05 " 71,166.83 " " 18,306.34 " " 20,340.38 " " 2,208.66 " " 2,760.83 " " 20,848.89 " " 20,950.59 " " 20,340.38 " " 86,015.20 " " 18,611.45 " 776.00 " 72,037.73 " " 17,899.53 " " 43,975.27 " " 80,639.25 " " 40,867.97 " " 48,093.25 " " 21,052.29 " 28173903 REVISE/RMV PN/GASTR STIMUL 64595 360 "$17,195.00" " 6,355.27 " 776.00 " 13,756.00 " 892.40 " 1,469.00 " " 3,416.90 " " 1,469.00 " 907.92 " 9,500.24 " " 3,351.82 " " 1,775.00 " 869.12 808.05 " 11,381.37 " " 2,928.77 " " 3,254.19 " " 1,649.49 " " 2,061.86 " " 3,335.54 " " 3,351.82 " " 3,254.19 " " 13,756.00 " " 2,977.58 " 776.00 " 11,520.65 " " 2,863.69 " " 7,032.76 " " 12,896.25 " " 6,535.82 " " 7,691.32 " " 3,368.09 " 80336918 DESTR NEURO AGNT NERVE BR W/IG 64624 320 "$9,211.00" " 3,404.39 " - " 7,368.80 " - " 6,364.80 " " 1,831.46 " " 6,364.80 " - " 5,089.08 " " 1,796.58 " " 1,775.00 " - - " 6,096.76 " " 1,569.83 " " 1,744.25 " " 2,234.03 " " 2,792.54 " " 1,787.86 " " 1,796.58 " " 1,744.25 " " 7,368.80 " " 1,595.99 " - " 6,171.37 " " 1,534.94 " " 3,767.30 " " 6,908.25 " " 3,501.10 " " 4,120.08 " " 1,805.30 " 80636911 DESTR NEURO AGNT NERVE BR W/IG 64624 350 "$9,211.00" " 3,404.39 " - " 7,368.80 " - " 6,364.80 " " 1,831.46 " " 6,364.80 " - " 5,089.08 " " 1,796.58 " " 1,775.00 " - - " 6,096.76 " " 1,569.83 " " 1,744.25 " " 2,234.03 " " 2,792.54 " " 1,787.86 " " 1,796.58 " " 1,744.25 " " 7,368.80 " " 1,595.99 " - " 6,171.37 " " 1,534.94 " " 3,767.30 " " 6,908.25 " " 3,501.10 " " 4,120.08 " " 1,805.30 " 80336926 RF ABLAT NERVE SAC JT W/IG 64625 320 "$9,211.00" " 3,404.39 " - " 7,368.80 " - " 6,364.80 " " 1,831.46 " " 6,364.80 " - " 5,089.08 " " 1,796.58 " " 6,540.00 " - - " 6,096.76 " " 1,569.83 " " 1,744.25 " " 2,734.70 " " 3,418.37 " " 1,787.86 " " 1,796.58 " " 1,744.25 " " 7,368.80 " " 1,595.99 " - " 6,171.37 " " 1,534.94 " " 3,767.30 " " 6,908.25 " " 3,501.10 " " 4,120.08 " " 1,805.30 " 80636920 RF ABLAT NERVE SAC JT W/IG 64625 350 "$9,211.00" " 3,404.39 " - " 7,368.80 " - " 6,364.80 " " 1,831.46 " " 6,364.80 " - " 5,089.08 " " 1,796.58 " " 6,540.00 " - - " 6,096.76 " " 1,569.83 " " 1,744.25 " " 2,734.70 " " 3,418.37 " " 1,787.86 " " 1,796.58 " " 1,744.25 " " 7,368.80 " " 1,595.99 " - " 6,171.37 " " 1,534.94 " " 3,767.30 " " 6,908.25 " " 3,501.10 " " 4,120.08 " " 1,805.30 " 41900342 DESTR BY NEURO AGNT/OTHER NRV 64640 510 "$4,318.00" " 1,595.93 " 618.80 " 3,454.40 " 892.40 " 1,469.00 " 858.62 " 1,469.00 " 907.92 " 2,385.70 " 842.26 " 1,775.00 " 869.12 808.05 " 2,858.08 " 735.96 817.73 618.80 773.50 838.17 842.26 817.73 " 3,454.40 " 748.22 776.00 " 2,893.06 " 719.60 " 1,766.06 " " 3,238.50 " " 1,641.27 " " 1,931.44 " 846.35 80341083 INJ DESTRUCTION CELIAC PLEXUS 64680 320 "$4,318.00" " 1,595.93 " 719.60 " 3,454.40 " 892.40 " 1,718.00 " 858.62 " 1,718.00 " 907.92 " 2,385.70 " 842.26 " 2,820.00 " 869.12 808.05 " 2,858.08 " 735.96 817.73 " 2,208.66 " " 2,760.83 " 838.17 842.26 817.73 " 3,454.40 " 748.22 776.00 " 2,893.06 " 719.60 " 1,766.06 " " 3,238.50 " " 1,641.27 " " 1,931.44 " 846.35 80641087 INJ DESTRUCTION CELIAC PLEXUS 64680 320 "$4,318.00" " 1,595.93 " 719.60 " 3,454.40 " 892.40 " 1,718.00 " 858.62 " 1,718.00 " 907.92 " 2,385.70 " 842.26 " 2,820.00 " 869.12 808.05 " 2,858.08 " 735.96 817.73 " 2,208.66 " " 2,760.83 " 838.17 842.26 817.73 " 3,454.40 " 748.22 776.00 " 2,893.06 " 719.60 " 1,766.06 " " 3,238.50 " " 1,641.27 " " 1,931.44 " 846.35 28173911 REVISE HAND/FOOT NERVE 64704 360 "$9,211.00" " 3,404.39 " 776.00 " 7,368.80 " 892.40 " 1,469.00 " " 1,831.46 " " 1,469.00 " 907.92 " 5,089.08 " " 1,796.58 " " 1,775.00 " 869.12 808.05 " 6,096.76 " " 1,569.83 " " 1,744.25 " " 1,649.49 " " 2,061.86 " " 1,787.86 " " 1,796.58 " " 1,744.25 " " 7,368.80 " " 1,595.99 " 776.00 " 6,171.37 " " 1,534.94 " " 3,767.30 " " 6,908.25 " " 3,501.10 " " 4,120.08 " " 1,805.30 " 28173920 REVISE ARM/LEG NERVE 64708 360 "$9,211.00" " 3,404.39 " 776.00 " 7,368.80 " 892.40 " 1,718.00 " " 1,831.46 " " 1,718.00 " 907.92 " 5,089.08 " " 1,796.58 " " 2,820.00 " 869.12 808.05 " 6,096.76 " " 1,569.83 " " 1,744.25 " " 2,208.66 " " 2,760.83 " " 1,787.86 " " 1,796.58 " " 1,744.25 " " 7,368.80 " " 1,595.99 " 776.00 " 6,171.37 " " 1,534.94 " " 3,767.30 " " 6,908.25 " " 3,501.10 " " 4,120.08 " " 1,805.30 " 28173938 REVISION OF SCIATIC NERVE 64712 360 "$9,211.00" " 3,404.39 " 776.00 " 7,368.80 " 892.40 " 1,718.00 " " 1,831.46 " " 1,718.00 " 907.92 " 5,089.08 " " 1,796.58 " " 2,820.00 " 869.12 808.05 " 6,096.76 " " 1,569.83 " " 1,744.25 " " 2,208.66 " " 2,760.83 " " 1,787.86 " " 1,796.58 " " 1,744.25 " " 7,368.80 " " 1,595.99 " 776.00 " 6,171.37 " " 1,534.94 " " 3,767.30 " " 6,908.25 " " 3,501.10 " " 4,120.08 " " 1,805.30 " 28173946 REVISION OF CRANIAL NERVE 64716 360 "$9,211.00" " 3,404.39 " 776.00 " 7,368.80 " 892.40 " 2,773.00 " " 1,831.46 " " 2,773.00 " 907.92 " 5,089.08 " " 1,796.58 " " 3,545.00 " 869.12 808.05 " 6,096.76 " " 1,569.83 " " 1,744.25 " " 2,532.97 " " 3,166.21 " " 1,787.86 " " 1,796.58 " " 1,744.25 " " 7,368.80 " " 1,595.99 " 776.00 " 6,171.37 " " 1,534.94 " " 3,767.30 " " 6,908.25 " " 3,501.10 " " 4,120.08 " " 1,805.30 " 28173954 REVISE ULNAR NERVE AT ELBOW 64718 360 "$9,211.00" " 3,404.39 " 776.00 " 7,368.80 " 892.40 " 1,718.00 " " 1,831.46 " " 1,718.00 " 907.92 " 5,089.08 " " 1,796.58 " " 2,820.00 " 869.12 808.05 " 6,096.76 " " 1,569.83 " " 1,744.25 " " 2,208.66 " " 2,760.83 " " 1,787.86 " " 1,796.58 " " 1,744.25 " " 7,368.80 " " 1,595.99 " 776.00 " 6,171.37 " " 1,534.94 " " 3,767.30 " " 6,908.25 " " 3,501.10 " " 4,120.08 " " 1,805.30 " 28173962 REVISE ULNAR NERVE AT WRIST 64719 360 "$9,211.00" " 3,404.39 " 664.00 " 7,368.80 " 763.60 " 1,718.00 " " 1,831.46 " " 1,718.00 " 776.88 " 5,089.08 " " 1,796.58 " " 2,820.00 " 743.68 691.42 " 6,096.76 " " 1,569.83 " " 1,744.25 " " 2,208.66 " " 2,760.83 " " 1,787.86 " " 1,796.58 " " 1,744.25 " " 7,368.80 " " 1,595.99 " 664.00 " 6,171.37 " " 1,534.94 " " 3,767.30 " " 6,908.25 " " 3,501.10 " " 4,120.08 " " 1,805.30 " 28173971 CARPAL TUNNEL SURGERY 64721 360 "$9,211.00" " 3,404.39 " 664.00 " 7,368.80 " 763.60 " 1,718.00 " " 1,831.46 " " 1,718.00 " 776.88 " 5,089.08 " " 1,796.58 " " 2,820.00 " 743.68 691.42 " 6,096.76 " " 1,569.83 " " 1,744.25 " " 2,208.66 " " 2,760.83 " " 1,787.86 " " 1,796.58 " " 1,744.25 " " 7,368.80 " " 1,595.99 " 664.00 " 6,171.37 " " 1,534.94 " " 3,767.30 " " 6,908.25 " " 3,501.10 " " 4,120.08 " " 1,805.30 " 28173989 INTERNAL NERVE REVISION 64727 360 "$5,180.00" " 1,914.53 " - " 4,144.00 " - " 1,469.00 " - " 1,469.00 " - " 2,861.95 " - " 3,418.80 " - - " 3,428.64 " - - " 1,649.49 " " 2,061.86 " - - - " 4,144.00 " - - " 3,470.60 " - " 2,118.62 " " 3,885.00 " " 1,968.92 " " 2,317.01 " - 28173997 REMOVE DIGIT NERVE LESION 64776 360 "$9,211.00" " 3,404.39 " 964.00 " 7,368.80 " " 1,108.60 " " 2,773.00 " " 1,831.46 " " 2,773.00 " " 1,127.88 " " 5,089.08 " " 1,796.58 " " 3,545.00 " " 1,079.68 " " 1,003.81 " " 6,096.76 " " 1,569.83 " " 1,744.25 " " 2,532.97 " " 3,166.21 " " 1,787.86 " " 1,796.58 " " 1,744.25 " " 7,368.80 " " 1,595.99 " 964.00 " 6,171.37 " " 1,534.94 " " 3,767.30 " " 6,908.25 " " 3,501.10 " " 4,120.08 " " 1,805.30 " 28174004 IMPLANT NERVE END 64787 360 "$3,491.00" " 1,290.27 " - " 2,792.80 " - " 1,718.00 " - " 1,718.00 " - " 1,928.78 " - " 2,304.06 " - - " 2,310.69 " - - " 2,208.66 " " 2,760.83 " - - - " 2,792.80 " - - " 2,338.97 " - " 1,427.82 " " 2,618.25 " " 1,326.93 " " 1,561.52 " - 28174012 REPAIR OF DIGIT NERVE 64831 360 "$9,211.00" " 3,404.39 " 756.00 " 7,368.80 " 869.40 " 3,326.00 " " 1,831.46 " " 3,326.00 " 884.52 " 5,089.08 " " 1,796.58 " " 4,860.00 " 846.72 787.22 " 6,096.76 " " 1,569.83 " " 1,744.25 " " 3,120.10 " " 3,900.12 " " 1,787.86 " " 1,796.58 " " 1,744.25 " " 7,368.80 " " 1,595.99 " 756.00 " 6,171.37 " " 1,534.94 " " 3,767.30 " " 6,908.25 " " 3,501.10 " " 4,120.08 " " 1,805.30 " 28174021 REPAIR OF HAND OR FOOT NERVE 64836 360 "$29,927.00" " 11,061.02 " - " 23,941.60 " - " 2,773.00 " " 5,947.84 " " 2,773.00 " - " 16,534.67 " " 5,834.55 " " 3,545.00 " - - " 19,808.68 " " 5,098.15 " " 5,664.61 " " 2,532.97 " " 3,166.21 " " 5,806.23 " " 5,834.55 " " 5,664.61 " " 23,941.60 " " 5,183.12 " - " 20,051.09 " " 4,984.86 " " 12,240.14 " " 22,445.25 " " 11,375.25 " " 13,386.35 " " 5,862.87 " 28174039 REPAIR/TRANSPOSE NERVE 64856 360 "$29,927.00" " 11,061.02 " 776.00 " 23,941.60 " 892.40 " 1,718.00 " " 5,947.84 " " 1,718.00 " 907.92 " 16,534.67 " " 5,834.55 " " 2,820.00 " 869.12 808.05 " 19,808.68 " " 5,098.15 " " 5,664.61 " " 2,208.66 " " 2,760.83 " " 5,806.23 " " 5,834.55 " " 5,664.61 " " 23,941.60 " " 5,183.12 " 776.00 " 20,051.09 " " 4,984.86 " " 12,240.14 " " 22,445.25 " " 11,375.25 " " 13,386.35 " " 5,862.87 " 28174047 REPAIR OF FACIAL NERVE 64865 360 "$29,927.00" " 11,061.02 " 776.00 " 23,941.60 " 892.40 " 3,326.00 " " 5,947.84 " " 3,326.00 " 907.92 " 16,534.67 " " 5,834.55 " " 4,860.00 " 869.12 808.05 " 19,808.68 " " 5,098.15 " " 5,664.61 " " 3,120.10 " " 3,900.12 " " 5,806.23 " " 5,834.55 " " 5,664.61 " " 23,941.60 " " 5,183.12 " 776.00 " 20,051.09 " " 4,984.86 " " 12,240.14 " " 22,445.25 " " 11,375.25 " " 13,386.35 " " 5,862.87 " 28174055 NERVE GRAFT ADD-ON 64901 360 "$8,419.00" " 3,111.66 " - " 6,735.20 " - " 1,718.00 " - " 1,718.00 " - " 4,651.50 " - " 5,556.54 " - - " 5,572.54 " - - " 2,208.66 " " 2,760.83 " - - - " 6,735.20 " - - " 5,640.73 " - " 3,443.37 " " 6,314.25 " " 3,200.06 " " 3,765.82 " - 28176660 NERVE REPRW/SYNTHETIC CO 64910 360 "$29,927.00" " 11,061.02 " 776.00 " 23,941.60 " 892.40 " 1,718.00 " " 5,947.84 " " 1,718.00 " 907.92 " 16,534.67 " " 5,834.55 " " 4,445.00 " 869.12 808.05 " 19,808.68 " " 5,098.15 " " 5,664.61 " " 3,447.22 " " 4,309.02 " " 5,806.23 " " 5,834.55 " " 5,664.61 " " 23,941.60 " " 5,183.12 " 776.00 " 20,051.09 " " 4,984.86 " " 12,240.14 " " 22,445.25 " " 11,375.25 " " 13,386.35 " " 5,862.87 " 28176511 NRV RPR W/NRV ALGRFT 1ST 64912 360 "$29,927.00" " 11,061.02 " - " 23,941.60 " - " 20,679.56 " " 5,947.84 " " 20,679.56 " - " 16,534.67 " " 5,834.55 " " 19,751.82 " - - " 19,808.68 " " 5,098.15 " " 5,664.61 " " 4,409.90 " " 5,512.37 " " 5,806.23 " " 5,834.55 " " 5,664.61 " " 23,941.60 " " 5,183.12 " - " 20,051.09 " " 4,984.86 " " 12,240.14 " " 22,445.25 " " 11,375.25 " " 13,386.35 " " 5,862.87 " 37005029 UNL PROC:N BLOCK INJ FACIAL 64999 450 "$1,371.00" 506.72 - " 1,469.00 " - " 1,469.00 " 272.51 " 1,469.00 " - 757.48 267.32 904.86 - - 907.46 233.58 259.53 56.26 70.32 266.02 267.32 259.53 " 1,096.80 " 237.47 - 918.57 228.39 560.74 " 1,028.25 " 521.12 613.25 268.61 80336811 UNL CT SHENOGANGLION BLOCK 64999 320 "$1,371.00" 506.72 - " 1,469.00 " - " 1,469.00 " 272.51 " 1,469.00 " - 757.48 267.32 904.86 - - 907.46 233.58 259.53 56.26 70.32 266.02 267.32 259.53 " 1,096.80 " 237.47 - 918.57 228.39 560.74 " 1,028.25 " 521.12 613.25 268.61 80341121 UNL BX INTERVERTEBRAL DISK 64999 320 "$1,371.00" 506.72 - " 1,469.00 " - " 1,469.00 " 272.51 " 1,469.00 " - 757.48 267.32 904.86 - - 907.46 233.58 259.53 56.26 70.32 266.02 267.32 259.53 " 1,096.80 " 237.47 - 918.57 228.39 560.74 " 1,028.25 " 521.12 613.25 268.61 80641125 UNL BX INTERVERTEBRAL DISK 64999 350 "$1,371.00" 506.72 - " 1,469.00 " - " 1,469.00 " 272.51 " 1,469.00 " - 757.48 267.32 904.86 - - 907.46 233.58 259.53 56.26 70.32 266.02 267.32 259.53 " 1,096.80 " 237.47 - 918.57 228.39 560.74 " 1,028.25 " 521.12 613.25 268.61 37001481 REMOVE FOREIGN BODY EYE 65205 450 $588.00 217.32 98.57 907.92 892.40 406.31 117.61 406.31 907.92 324.87 115.37 845.00 869.12 808.05 389.20 100.81 112.01 168.76 210.95 114.81 115.37 112.01 470.40 102.49 776.00 393.96 98.57 240.49 441.00 223.50 263.01 115.93 37001490 REMOVE FOREIGN BODY EYE EXT 65210 450 "$1,419.00" 524.46 237.25 " 1,135.20 " 892.40 980.53 283.08 980.53 907.92 784.00 277.69 845.00 869.12 808.05 939.24 242.64 269.60 393.78 492.23 276.34 277.69 269.60 " 1,135.20 " 246.68 776.00 950.73 237.25 580.37 " 1,064.25 " 539.36 634.72 279.04 37001503 REMOVE FB CORNEA EXT W/O LAMP 65220 450 "$1,419.00" 524.46 237.25 " 1,135.20 " 887.80 980.53 283.08 980.53 903.24 784.00 277.69 845.00 864.64 803.88 939.24 242.64 269.60 281.27 351.59 276.34 277.69 269.60 " 1,135.20 " 246.68 772.00 950.73 237.25 580.37 " 1,064.25 " 539.36 634.72 279.04 37001511 REMOVE FB CORNEA EXT W/LAMP 65222 450 $588.00 217.32 98.57 845.00 727.95 406.31 117.61 406.31 740.61 324.87 115.37 845.00 708.96 659.14 389.20 100.81 112.01 393.78 492.23 114.81 115.37 112.01 470.40 102.49 633.00 393.96 98.57 240.49 441.00 223.50 263.01 115.93 28174063 REMOVE FOREIGN BODY FROM EYE 65235 360 "$10,916.00" " 4,034.55 " 776.00 " 8,732.80 " 892.40 " 1,718.00 " " 2,165.97 " " 1,718.00 " 907.92 " 6,031.09 " " 2,124.71 " " 2,820.00 " 869.12 808.05 " 7,225.30 " " 1,856.55 " " 2,062.83 " " 2,208.66 " " 2,760.83 " " 2,114.40 " " 2,124.71 " " 2,062.83 " " 8,732.80 " " 1,887.49 " 776.00 " 7,313.72 " " 1,815.29 " " 4,464.64 " " 8,187.00 " " 4,149.17 " " 4,882.73 " " 2,135.03 " 28176520 REPAIR OF EYE WOUND 65285 360 "$20,568.00" " 7,601.93 " 776.00 " 16,454.40 " 892.40 " 3,326.00 " " 4,084.67 " " 3,326.00 " 907.92 " 11,363.82 " " 4,006.86 " " 4,860.00 " 869.12 808.05 " 13,613.96 " " 3,501.14 " " 3,890.16 " " 3,120.10 " " 3,900.12 " " 3,987.41 " " 4,006.86 " " 3,890.16 " " 16,454.40 " " 3,559.50 " 776.00 " 13,780.56 " " 3,423.34 " " 8,412.31 " " 15,426.00 " " 7,817.90 " " 9,200.07 " " 4,026.32 " 28174071 DRAINAGE OF EYE 65800 360 "$10,916.00" " 4,034.55 " 776.00 " 8,732.80 " 892.40 " 1,469.00 " " 2,165.97 " " 1,469.00 " 907.92 " 6,031.09 " " 2,124.71 " " 1,775.00 " 869.12 808.05 " 7,225.30 " " 1,856.55 " " 2,062.83 " " 1,649.49 " " 2,061.86 " " 2,114.40 " " 2,124.71 " " 2,062.83 " " 8,732.80 " " 1,887.49 " 776.00 " 7,313.72 " " 1,815.29 " " 4,464.64 " " 8,187.00 " " 4,149.17 " " 4,882.73 " " 2,135.03 " 28174080 INJ ANTER CHAMB AIR/LIQUID 66020 360 "$10,916.00" " 4,034.55 " 776.00 " 8,732.80 " 892.40 " 1,469.00 " " 2,165.97 " " 1,469.00 " 907.92 " 6,031.09 " " 2,124.71 " " 1,775.00 " 869.12 808.05 " 7,225.30 " " 1,856.55 " " 2,062.83 " " 1,649.49 " " 2,061.86 " " 2,114.40 " " 2,124.71 " " 2,062.83 " " 8,732.80 " " 1,887.49 " 776.00 " 7,313.72 " " 1,815.29 " " 4,464.64 " " 8,187.00 " " 4,149.17 " " 4,882.73 " " 2,135.03 " 28174098 INJ ANTER CHAMB MEDICATION 66030 360 "$10,916.00" " 4,034.55 " 776.00 " 8,732.80 " 892.40 " 1,469.00 " " 2,165.97 " " 1,469.00 " 907.92 " 6,031.09 " " 2,124.71 " " 1,775.00 " 869.12 808.05 " 7,225.30 " " 1,856.55 " " 2,062.83 " " 1,649.49 " " 2,061.86 " " 2,114.40 " " 2,124.71 " " 2,062.83 " " 8,732.80 " " 1,887.49 " 776.00 " 7,313.72 " " 1,815.29 " " 4,464.64 " " 8,187.00 " " 4,149.17 " " 4,882.73 " " 2,135.03 " 28175680 REMOVAL SECONDARY CATARACT 66830 360 "$10,916.00" " 4,034.55 " " 1,529.00 " " 8,732.80 " " 1,758.35 " " 3,326.00 " " 2,165.97 " " 3,326.00 " " 1,788.93 " " 6,031.09 " " 2,124.71 " " 4,860.00 " " 1,712.48 " " 1,592.15 " " 7,225.30 " " 1,856.55 " " 2,062.83 " " 3,120.10 " " 3,900.12 " " 2,114.40 " " 2,124.71 " " 2,062.83 " " 8,732.80 " " 1,887.49 " " 1,529.00 " " 7,313.72 " " 1,815.29 " " 4,464.64 " " 8,187.00 " " 4,149.17 " " 4,882.73 " " 2,135.03 " 28174101 ASPIRATION PHACOE- MULSIFICAT 66850 360 "$10,916.00" " 4,034.55 " " 1,496.00 " " 8,732.80 " " 1,720.40 " " 4,435.00 " " 2,165.97 " " 4,435.00 " " 1,750.32 " " 6,031.09 " " 2,124.71 " " 6,540.00 " " 1,675.52 " " 1,557.78 " " 7,225.30 " " 1,856.55 " " 2,062.83 " " 4,937.34 " " 6,171.67 " " 2,114.40 " " 2,124.71 " " 2,062.83 " " 8,732.80 " " 1,887.49 " " 1,496.00 " " 7,313.72 " " 1,815.29 " " 4,464.64 " " 8,187.00 " " 4,149.17 " " 4,882.73 " " 2,135.03 " 28174110 REM LENS MATERIAL W/WO VITRECT 66852 360 "$20,568.00" " 7,601.93 " 776.00 " 16,454.40 " 892.40 " 3,326.00 " " 4,084.67 " " 3,326.00 " 907.92 " 11,363.82 " " 4,006.86 " " 4,860.00 " 869.12 808.05 " 13,613.96 " " 3,501.14 " " 3,890.16 " " 3,120.10 " " 3,900.12 " " 3,987.41 " " 4,006.86 " " 3,890.16 " " 16,454.40 " " 3,559.50 " 776.00 " 13,780.56 " " 3,423.34 " " 8,412.31 " " 15,426.00 " " 7,817.90 " " 9,200.07 " " 4,026.32 " 28174128 XCAPSL CTRC RMVL CPLX WO ECP 66982 360 "$10,916.00" " 4,034.55 " " 1,654.00 " " 8,732.80 " " 1,902.10 " " 4,878.00 " " 2,165.97 " " 4,878.00 " " 1,935.18 " " 6,031.09 " " 2,124.71 " " 5,865.00 " " 1,852.48 " " 1,722.31 " " 7,225.30 " " 1,856.55 " " 2,062.83 " " 4,371.02 " " 5,463.78 " " 2,114.40 " " 2,124.71 " " 2,062.83 " " 8,732.80 " " 1,887.49 " " 1,654.00 " " 7,313.72 " " 1,815.29 " " 4,464.64 " " 8,187.00 " " 4,149.17 " " 4,882.73 " " 2,135.03 " 28174136 INSERT LENS PROSTHESIS 66985 360 "$10,916.00" " 4,034.55 " " 1,373.00 " " 8,732.80 " " 1,578.95 " " 3,686.00 " " 2,165.97 " " 3,686.00 " " 1,606.41 " " 6,031.09 " " 2,124.71 " " 4,645.00 " " 1,537.76 " " 1,429.70 " " 7,225.30 " " 1,856.55 " " 2,062.83 " " 3,590.33 " " 4,487.91 " " 2,114.40 " " 2,124.71 " " 2,062.83 " " 8,732.80 " " 1,887.49 " " 1,373.00 " " 7,313.72 " " 1,815.29 " " 4,464.64 " " 8,187.00 " " 4,149.17 " " 4,882.73 " " 2,135.03 " 28174144 EXCHANGE LENS PROSTHESIS 66986 360 "$10,916.00" " 4,034.55 " 776.00 " 8,732.80 " 892.40 " 3,686.00 " " 2,165.97 " " 3,686.00 " 907.92 " 6,031.09 " " 2,124.71 " " 4,645.00 " 869.12 808.05 " 7,225.30 " " 1,856.55 " " 2,062.83 " " 3,590.33 " " 4,487.91 " " 2,114.40 " " 2,124.71 " " 2,062.83 " " 8,732.80 " " 1,887.49 " 776.00 " 7,313.72 " " 1,815.29 " " 4,464.64 " " 8,187.00 " " 4,149.17 " " 4,882.73 " " 2,135.03 " 28175698 ASPIRATION OR RELEASE VITREOUS 67015 360 "$10,916.00" " 4,034.55 " 776.00 " 8,732.80 " 892.40 " 1,469.00 " " 2,165.97 " " 1,469.00 " 907.92 " 6,031.09 " " 2,124.71 " " 1,775.00 " 869.12 808.05 " 7,225.30 " " 1,856.55 " " 2,062.83 " " 1,649.49 " " 2,061.86 " " 2,114.40 " " 2,124.71 " " 2,062.83 " " 8,732.80 " " 1,887.49 " 776.00 " 7,313.72 " " 1,815.29 " " 4,464.64 " " 8,187.00 " " 4,149.17 " " 4,882.73 " " 2,135.03 " 28174152 INJECTION EYE DRUG 67028 360 "$1,631.00" 602.82 105.88 " 1,775.00 " 121.76 " 1,469.00 " 332.57 " 1,469.00 " 123.88 901.13 326.23 " 1,775.00 " 118.59 110.25 " 1,079.56 " 285.06 316.73 " 1,085.14 " " 1,356.43 " 324.65 326.23 316.73 " 1,304.80 " 289.81 105.88 " 1,092.77 " 278.72 667.08 " 1,223.25 " 619.94 729.55 327.82 28174161 REMOVAL OF INNER EYE FLUID 67036 360 "$20,568.00" " 7,601.93 " 776.00 " 16,454.40 " 892.40 " 3,326.00 " " 4,084.67 " " 3,326.00 " 907.92 " 11,363.82 " " 4,006.86 " " 4,860.00 " 869.12 808.05 " 13,613.96 " " 3,501.14 " " 3,890.16 " " 3,120.10 " " 3,900.12 " " 3,987.41 " " 4,006.86 " " 3,890.16 " " 16,454.40 " " 3,559.50 " 776.00 " 13,780.56 " " 3,423.34 " " 8,412.31 " " 15,426.00 " " 7,817.90 " " 9,200.07 " " 4,026.32 " 28174179 VITRECT W/FOC ENDOLAS PHOTOCOA 67039 360 "$20,568.00" " 7,601.93 " 776.00 " 16,454.40 " 892.40 " 4,435.00 " " 4,084.67 " " 4,435.00 " 907.92 " 11,363.82 " " 4,006.86 " " 6,540.00 " 869.12 808.05 " 13,613.96 " " 3,501.14 " " 3,890.16 " " 4,937.34 " " 6,171.67 " " 3,987.41 " " 4,006.86 " " 3,890.16 " " 16,454.40 " " 3,559.50 " 776.00 " 13,780.56 " " 3,423.34 " " 8,412.31 " " 15,426.00 " " 7,817.90 " " 9,200.07 " " 4,026.32 " 28174187 VITRECT ENDOLAS PANRET PHOTOCO 67040 360 "$20,568.00" " 7,601.93 " 776.00 " 16,454.40 " 892.40 " 4,435.00 " " 4,084.67 " " 4,435.00 " 907.92 " 11,363.82 " " 4,006.86 " " 6,540.00 " 869.12 808.05 " 13,613.96 " " 3,501.14 " " 3,890.16 " " 4,937.34 " " 6,171.67 " " 3,987.41 " " 4,006.86 " " 3,890.16 " " 16,454.40 " " 3,559.50 " 776.00 " 13,780.56 " " 3,423.34 " " 8,412.31 " " 15,426.00 " " 7,817.90 " " 9,200.07 " " 4,026.32 " 28174195 VIT FOR MACULAR PUCKER 67041 360 "$20,568.00" " 7,601.93 " 776.00 " 16,454.40 " 892.40 " 3,604.00 " " 4,084.67 " " 3,604.00 " 907.92 " 11,363.82 " " 4,006.86 " " 6,576.00 " 869.12 808.05 " 13,613.96 " " 3,501.14 " " 3,890.16 " " 5,788.07 " " 7,235.09 " " 3,987.41 " " 4,006.86 " " 3,890.16 " " 16,454.40 " " 3,559.50 " 776.00 " 13,780.56 " " 3,423.34 " " 8,412.31 " " 15,426.00 " " 7,817.90 " " 9,200.07 " " 4,026.32 " 28174209 VIT FOR MACULAR HOLE 67042 360 "$20,568.00" " 7,601.93 " 776.00 " 16,454.40 " 892.40 " 3,604.00 " " 4,084.67 " " 3,604.00 " 907.92 " 11,363.82 " " 4,006.86 " " 6,576.00 " 869.12 808.05 " 13,613.96 " " 3,501.14 " " 3,890.16 " " 6,626.94 " " 8,283.67 " " 3,987.41 " " 4,006.86 " " 3,890.16 " " 16,454.40 " " 3,559.50 " 776.00 " 13,780.56 " " 3,423.34 " " 8,412.31 " " 15,426.00 " " 7,817.90 " " 9,200.07 " " 4,026.32 " 28175701 PHOTOCOAGULATION (XENON) 67105 360 "$2,645.00" 977.59 439.93 " 4,663.21 " 733.70 " 3,604.00 " 524.92 " 3,604.00 " 746.46 " 1,461.36 " 514.92 " 1,775.00 " 714.56 664.35 " 1,750.73 " 449.93 499.92 " 3,730.57 " " 4,663.21 " 512.42 514.92 499.92 " 2,116.00 " 457.43 638.00 " 1,772.15 " 439.93 " 1,081.81 " " 1,983.75 " " 1,005.36 " " 1,183.11 " 517.42 28174217 RETINOPEX W SCLERAL BUCKLING 67107 360 "$20,568.00" " 7,601.93 " 951.54 " 16,454.40 " " 1,094.27 " " 3,604.00 " " 4,084.67 " " 3,604.00 " " 1,113.30 " " 11,363.82 " " 4,006.86 " " 4,445.00 " " 1,065.72 " 990.84 " 13,613.96 " " 3,501.14 " " 3,890.16 " " 3,730.57 " " 4,663.21 " " 3,987.41 " " 4,006.86 " " 3,890.16 " " 16,454.40 " " 3,559.50 " 951.54 " 13,780.56 " " 3,423.34 " " 8,412.31 " " 15,426.00 " " 7,817.90 " " 9,200.07 " " 4,026.32 " 28174225 REP RET DETACH W VITRECTOMY 67108 360 "$20,568.00" " 7,601.93 " " 1,000.00 " " 16,454.40 " " 1,150.00 " " 4,435.00 " " 4,084.67 " " 4,435.00 " " 1,170.00 " " 11,363.82 " " 4,006.86 " " 6,540.00 " " 1,120.00 " " 1,041.30 " " 13,613.96 " " 3,501.14 " " 3,890.16 " " 4,937.34 " " 6,171.67 " " 3,987.41 " " 4,006.86 " " 3,890.16 " " 16,454.40 " " 3,559.50 " " 1,000.00 " " 13,780.56 " " 3,423.34 " " 8,412.31 " " 15,426.00 " " 7,817.90 " " 9,200.07 " " 4,026.32 " 28174233 REPAIR RETINAL DETACH CPLX 67113 360 "$20,568.00" " 7,601.93 " 776.00 " 16,454.40 " 892.40 " 3,604.00 " " 4,084.67 " " 3,604.00 " 907.92 " 11,363.82 " " 4,006.86 " " 6,576.00 " 869.12 808.05 " 13,613.96 " " 3,501.14 " " 3,890.16 " " 7,637.66 " " 9,547.07 " " 3,987.41 " " 4,006.86 " " 3,890.16 " " 16,454.40 " " 3,559.50 " 776.00 " 13,780.56 " " 3,423.34 " " 8,412.31 " " 15,426.00 " " 7,817.90 " " 9,200.07 " " 4,026.32 " 28174241 REMOVE EYE IMPLANT MATERIAL 67121 360 "$10,916.00" " 4,034.55 " 776.00 " 8,732.80 " 892.40 " 1,718.00 " " 2,165.97 " " 1,718.00 " 907.92 " 6,031.09 " " 2,124.71 " " 2,820.00 " 869.12 808.05 " 7,225.30 " " 1,856.55 " " 2,062.83 " " 2,208.66 " " 2,760.83 " " 2,114.40 " " 2,124.71 " " 2,062.83 " " 8,732.80 " " 1,887.49 " 776.00 " 7,313.72 " " 1,815.29 " " 4,464.64 " " 8,187.00 " " 4,149.17 " " 4,882.73 " " 2,135.03 " 28174250 TREATMENT OF RETINA 67145 360 "$2,645.00" 977.59 439.93 " 2,116.00 " 892.40 " 1,469.00 " 524.92 " 1,469.00 " 907.92 " 1,461.36 " 514.92 " 1,775.00 " 869.12 808.05 " 1,750.73 " 449.93 499.92 618.80 773.50 512.42 514.92 499.92 " 2,116.00 " 457.43 776.00 " 1,772.15 " 439.93 " 1,081.81 " " 1,983.75 " " 1,005.36 " " 1,183.11 " 517.42 28174268 TREATMENT X10SV RETINOPATHY 67228 360 "$2,645.00" 977.59 439.93 " 2,116.00 " 564.08 " 1,469.00 " 524.92 " 1,469.00 " 573.89 " 1,461.36 " 514.92 " 1,775.00 " 549.36 510.76 " 1,750.73 " 449.93 499.92 " 1,012.58 " " 1,265.72 " 512.42 514.92 499.92 " 2,116.00 " 457.43 490.50 " 1,772.15 " 439.93 " 1,081.81 " " 1,983.75 " " 1,005.36 " " 1,183.11 " 517.42 37003778 DRAINAGE EYELID ABSCESS 67700 450 "$1,372.00" 507.09 228.67 " 4,663.21 " 957.95 " 1,469.00 " 272.84 " 1,469.00 " 974.61 758.03 267.65 " 1,775.00 " 932.96 867.40 908.13 233.87 259.85 " 3,730.57 " " 4,663.21 " 266.35 267.65 259.85 " 1,097.60 " 237.76 833.00 919.24 228.67 561.15 " 1,029.00 " 521.50 613.70 268.94 28174276 REPAIR BROW DEFECT 67900 360 "$10,512.00" " 3,885.24 " - " 8,409.60 " - " 3,326.00 " " 2,087.17 " " 3,326.00 " - " 5,807.88 " " 2,047.41 " " 4,860.00 " - - " 6,957.89 " " 1,789.00 " " 1,987.78 " " 4,937.34 " " 6,171.67 " " 2,037.47 " " 2,047.41 " " 1,987.78 " " 8,409.60 " " 1,818.82 " - " 7,043.04 " " 1,749.25 " " 4,299.41 " " 7,884.00 " " 3,995.61 " " 4,702.02 " " 2,057.35 " 37089320 DRAIN EXT EAR LESION SIMPLE 69000 450 "$3,265.00" " 1,206.74 " 543.97 " 2,612.00 " 892.40 " 1,469.00 " 649.06 " 1,469.00 " 907.92 " 1,803.91 " 636.69 845.00 869.12 808.05 " 2,161.10 " 556.34 618.15 618.80 773.50 633.60 636.69 618.15 " 2,612.00 " 565.61 776.00 " 2,187.55 " 543.97 " 1,335.39 " " 2,448.75 " " 1,241.03 " " 1,460.43 " 639.79 28174284 DRAIN EXT EAR LESION COMP 69005 360 "$7,387.00" " 2,730.24 " 507.00 " 5,909.60 " 583.05 " 1,469.00 " " 1,467.55 " " 1,469.00 " 593.19 " 4,081.32 " " 1,439.60 " " 4,875.42 " 567.84 527.94 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,012.58 " " 1,265.72 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 507.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 37000051 DRAIN EXT EAR LESION COMP 69005 450 "$7,387.00" " 2,730.24 " 507.00 " 5,909.60 " 583.05 " 1,469.00 " " 1,467.55 " " 1,469.00 " 593.19 " 4,081.32 " " 1,439.60 " " 4,875.42 " 567.84 527.94 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,012.58 " " 1,265.72 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 507.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 37003051 FBR EXT EAR CANAL W/O ANES 69200 450 $588.00 217.32 98.57 845.00 558.90 406.31 117.61 406.31 568.62 324.87 115.37 845.00 544.32 506.07 389.20 100.81 112.01 281.27 351.59 114.81 115.37 112.01 470.40 102.49 486.00 393.96 98.57 240.49 441.00 223.50 263.01 115.93 28174292 CLEAR OUTER EAR CANAL 69205 360 "$7,387.00" " 2,730.24 " 520.00 " 5,909.60 " 598.00 " 1,469.00 " " 1,467.55 " " 1,469.00 " 608.40 " 4,081.32 " " 1,439.60 " " 1,775.00 " 582.40 541.48 " 4,889.46 " " 1,257.90 " " 1,397.67 " " 1,649.49 " " 2,061.86 " " 1,432.61 " " 1,439.60 " " 1,397.67 " " 5,909.60 " " 1,278.87 " 520.00 " 4,949.29 " " 1,229.95 " " 3,021.28 " " 5,540.25 " " 2,807.80 " " 3,304.21 " " 1,446.59 " 37003816 RMV IMPACTED EAR WAX W/LAV UNI 69209 450 $292.00 107.92 48.66 907.92 892.40 201.77 58.05 201.77 907.92 161.33 56.95 845.00 869.12 808.05 193.27 49.76 55.29 95.66 119.57 56.67 56.95 55.29 233.60 50.59 776.00 195.64 48.66 119.43 219.00 110.99 130.61 57.23 28174306 RMV IMPACTED EAR WAX INSTR UNI 69210 360 $292.00 107.92 48.66 " 1,469.00 " 892.40 " 1,469.00 " 58.05 " 1,469.00 " 907.92 161.33 56.95 845.00 869.12 808.05 193.27 49.76 55.29 56.26 70.32 56.67 56.95 55.29 233.60 50.59 776.00 195.64 48.66 119.43 219.00 110.99 130.61 57.23 37003018 RMV IMPACTED EAR WAX INSTR UNI 69210 450 $292.00 107.92 48.66 " 1,469.00 " 892.40 " 1,469.00 " 58.05 " 1,469.00 " 907.92 161.33 56.95 845.00 869.12 808.05 193.27 49.76 55.29 56.26 70.32 56.67 56.95 55.29 233.60 50.59 776.00 195.64 48.66 119.43 219.00 110.99 130.61 57.23 28174314 DEBRIDE MASTOID CAVITY SIM 69220 360 $943.00 348.53 49.25 845.00 56.64 651.61 187.30 651.61 57.62 521.01 183.73 845.00 55.16 51.28 624.17 160.54 178.38 281.27 351.59 182.84 183.73 178.38 754.40 163.22 49.25 631.81 156.97 385.69 707.25 358.43 421.80 184.62 28174322 DEBRID MASTOID CAVITY COMP 69222 360 "$2,375.00" 877.80 395.35 " 1,900.00 " 598.00 " 1,718.00 " 471.72 " 1,718.00 " 608.40 " 1,312.19 " 462.74 " 1,567.50 " 582.40 541.48 " 1,572.01 " 404.33 449.26 " 1,070.91 " " 1,338.64 " 460.49 462.74 449.26 " 1,900.00 " 411.07 520.00 " 1,591.25 " 395.35 971.38 " 1,781.25 " 902.74 " 1,062.34 " 464.98 28176813 REVISE EXTERNAL EAR 69300 360 "$14,366.00" " 5,309.67 " - " 11,492.80 " - " 2,773.00 " " 2,853.42 " " 2,773.00 " - " 7,937.22 " " 2,799.07 " " 3,545.00 " - - " 9,508.86 " " 2,445.79 " " 2,717.54 " " 4,937.34 " " 6,171.67 " " 2,785.48 " " 2,799.07 " " 2,717.54 " " 11,492.80 " " 2,486.55 " - " 9,625.22 " " 2,391.44 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,812.65 " 28174331 REC EXT AUD CANAL MEATOPLASTY 69310 360 "$26,702.00" " 9,869.06 " 776.00 " 21,361.60 " 892.40 " 2,773.00 " " 5,304.76 " " 2,773.00 " 907.92 " 14,752.86 " " 5,203.71 " " 3,545.00 " 869.12 808.05 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 2,532.97 " " 3,166.21 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 776.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28174349 RECONSTRUCT EXT AUDITORY CANAL 69320 360 "$26,702.00" " 9,869.06 " 776.00 " 21,361.60 " 892.40 " 4,435.00 " " 5,304.76 " " 4,435.00 " 907.92 " 14,752.86 " " 5,203.71 " " 6,540.00 " 869.12 808.05 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 4,937.34 " " 6,171.67 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 776.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28174357 INCISION OF EARDRUM 69421 360 "$14,366.00" " 5,309.67 " 776.00 " 11,492.80 " 892.40 " 2,773.00 " " 2,853.42 " " 2,773.00 " 907.92 " 7,937.22 " " 2,799.07 " " 3,545.00 " 869.12 808.05 " 9,508.86 " " 2,445.79 " " 2,717.54 " " 2,532.97 " " 3,166.21 " " 2,785.48 " " 2,799.07 " " 2,717.54 " " 11,492.80 " " 2,486.55 " 776.00 " 9,625.22 " " 2,391.44 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,812.65 " 28174365 REMOVE VENTILATING TUBE 69424 360 "$14,366.00" " 5,309.67 " 544.00 " 11,492.80 " 625.60 " 1,469.00 " " 2,853.42 " " 1,469.00 " 636.48 " 7,937.22 " " 2,799.07 " " 1,775.00 " 609.28 566.47 " 9,508.86 " " 2,445.79 " " 2,717.54 " " 1,649.49 " " 2,061.86 " " 2,785.48 " " 2,799.07 " " 2,717.54 " " 11,492.80 " " 2,486.55 " 544.00 " 9,625.22 " " 2,391.44 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,812.65 " 28174373 CREATE EARDRUM OPENING 69436 360 "$7,102.00" " 2,624.90 " 514.00 " 5,681.60 " 591.10 " 2,773.00 " " 1,410.93 " " 2,773.00 " 601.38 " 3,923.86 " " 1,384.05 " " 3,545.00 " 575.68 535.23 " 4,700.81 " " 1,209.37 " " 1,343.74 " " 2,532.97 " " 3,166.21 " " 1,377.33 " " 1,384.05 " " 1,343.74 " " 5,681.60 " " 1,229.52 " 514.00 " 4,758.34 " " 1,182.49 " " 2,904.72 " " 5,326.50 " " 2,699.47 " " 3,176.72 " " 1,390.77 " 37005045 EARDRUM REVISION 69450 450 "$14,366.00" " 5,309.67 " 776.00 " 11,492.80 " 892.40 " 1,469.00 " " 2,853.42 " " 1,469.00 " 907.92 " 7,937.22 " " 2,799.07 " " 1,775.00 " 869.12 808.05 " 9,508.86 " " 2,445.79 " " 2,717.54 " " 1,649.49 " " 2,061.86 " " 2,785.48 " " 2,799.07 " " 2,717.54 " " 11,492.80 " " 2,486.55 " 776.00 " 9,625.22 " " 2,391.44 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,812.65 " 28174381 MASTOIDECTOMY 69502 360 "$26,702.00" " 9,869.06 " 776.00 " 21,361.60 " 892.40 " 4,435.00 " " 5,304.76 " " 4,435.00 " 907.92 " 14,752.86 " " 5,203.71 " " 6,540.00 " 869.12 808.05 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 4,937.34 " " 6,171.67 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 776.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28174390 REMOVE EAR LESION 69552 360 "$26,702.00" " 9,869.06 " 776.00 " 21,361.60 " 892.40 " 4,435.00 " " 5,304.76 " " 4,435.00 " 907.92 " 14,752.86 " " 5,203.71 " " 6,540.00 " 869.12 808.05 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 4,937.34 " " 6,171.67 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 776.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28174403 MASTOID SURGERY REVISION 69602 360 "$26,702.00" " 9,869.06 " 776.00 " 21,361.60 " 892.40 " 4,435.00 " " 5,304.76 " " 4,435.00 " 907.92 " 14,752.86 " " 5,203.71 " " 6,540.00 " 869.12 808.05 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 4,937.34 " " 6,171.67 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 776.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28174411 TYMPANIC MEM PATCH W/WO PATCH 69610 360 "$7,102.00" " 2,624.90 " 776.00 " 6,171.67 " 892.40 " 2,773.00 " " 1,410.93 " " 2,773.00 " 907.92 " 3,923.86 " " 1,384.05 " " 4,687.32 " 869.12 808.05 " 4,700.81 " " 1,209.37 " " 1,343.74 " " 4,937.34 " " 6,171.67 " " 1,377.33 " " 1,384.05 " " 1,343.74 " " 5,681.60 " " 1,229.52 " 776.00 " 4,758.34 " " 1,182.49 " " 2,904.72 " " 5,326.50 " " 2,699.47 " " 3,176.72 " " 1,390.77 " 28174420 MYRINGOPLASTY 69620 360 "$14,366.00" " 5,309.67 " 626.00 " 11,492.80 " 719.90 " 1,718.00 " " 2,853.42 " " 1,718.00 " 732.42 " 7,937.22 " " 2,799.07 " " 2,820.00 " 701.12 651.85 " 9,508.86 " " 2,445.79 " " 2,717.54 " " 2,208.66 " " 2,760.83 " " 2,785.48 " " 2,799.07 " " 2,717.54 " " 11,492.80 " " 2,486.55 " 626.00 " 9,625.22 " " 2,391.44 " " 5,875.69 " " 10,774.50 " " 5,460.52 " " 6,425.91 " " 2,812.65 " 28174438 REPAIR EARDRUM STRUCTURES 69631 360 "$26,702.00" " 9,869.06 " 924.00 " 21,361.60 " " 1,062.60 " " 3,604.00 " " 5,304.76 " " 3,604.00 " " 1,081.08 " " 14,752.86 " " 5,203.71 " " 4,445.00 " " 1,034.88 " 962.16 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 3,730.57 " " 4,663.21 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 924.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28174446 TYMPANOPLASTY W OSS CHAIN RECO 69632 360 "$26,702.00" " 9,869.06 " 776.00 " 21,361.60 " 892.40 " 3,604.00 " " 5,304.76 " " 3,604.00 " 907.92 " 14,752.86 " " 5,203.71 " " 4,445.00 " 869.12 808.05 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 3,730.57 " " 4,663.21 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 776.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28174454 TYMPANOPLASTY W OSS CH REC PRO 69633 360 "$26,702.00" " 9,869.06 " " 1,051.00 " " 21,361.60 " " 1,208.65 " " 3,604.00 " " 5,304.76 " " 3,604.00 " " 1,229.67 " " 14,752.86 " " 5,203.71 " " 4,445.00 " " 1,177.12 " " 1,094.41 " " 17,674.05 " " 4,546.94 " " 5,052.15 " " 3,730.57 " " 4,663.21 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " " 1,051.00 " " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28174462 TYMPANOPLASTY W OSSIC CH RECON 69636 360 "$26,702.00" " 9,869.06 " 776.00 " 21,361.60 " 892.40 " 4,435.00 " " 5,304.76 " " 4,435.00 " 907.92 " 14,752.86 " " 5,203.71 " " 6,540.00 " 869.12 808.05 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 4,937.34 " " 6,171.67 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 776.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28174471 TYMPANOPLASTY W MASTOIDECTOMY 69641 360 "$26,702.00" " 9,869.06 " 776.00 " 21,361.60 " 892.40 " 4,435.00 " " 5,304.76 " " 4,435.00 " 907.92 " 14,752.86 " " 5,203.71 " " 6,540.00 " 869.12 808.05 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 4,937.34 " " 6,171.67 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 776.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28174489 TYMPANOPLASTY W OSS CH RECON 69642 360 "$26,702.00" " 9,869.06 " 776.00 " 21,361.60 " 892.40 " 4,435.00 " " 5,304.76 " " 4,435.00 " 907.92 " 14,752.86 " " 5,203.71 " " 6,540.00 " 869.12 808.05 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 4,937.34 " " 6,171.67 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 776.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28174497 TYM W MAST REC WA WO CH RE 69643 360 "$26,702.00" " 9,869.06 " 776.00 " 21,361.60 " 892.40 " 4,435.00 " " 5,304.76 " " 4,435.00 " 907.92 " 14,752.86 " " 5,203.71 " " 6,540.00 " 869.12 808.05 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 4,937.34 " " 6,171.67 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 776.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28174501 TYM W MAST REC WA WO OSS CH RE 69644 360 "$26,702.00" " 9,869.06 " 776.00 " 21,361.60 " 892.40 " 4,435.00 " " 5,304.76 " " 4,435.00 " 907.92 " 14,752.86 " " 5,203.71 " " 6,540.00 " 869.12 808.05 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 4,937.34 " " 6,171.67 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 776.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28174519 TYM MAST RAD COM WO OSS CH REC 69645 360 "$26,702.00" " 9,869.06 " 776.00 " 21,361.60 " 892.40 " 4,435.00 " " 5,304.76 " " 4,435.00 " 907.92 " 14,752.86 " " 5,203.71 " " 6,540.00 " 869.12 808.05 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 4,937.34 " " 6,171.67 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 776.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28174527 STAP W INSER PROS STAP W FENES 69660 360 "$26,702.00" " 9,869.06 " 776.00 " 21,361.60 " 892.40 " 3,604.00 " " 5,304.76 " " 3,604.00 " 907.92 " 14,752.86 " " 5,203.71 " " 4,445.00 " 869.12 808.05 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 3,730.57 " " 4,663.21 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 776.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28174535 STAPEDECTOMY W FOODPLATE DRILL 69661 360 "$26,702.00" " 9,869.06 " 776.00 " 21,361.60 " 892.40 " 3,604.00 " " 5,304.76 " " 3,604.00 " 907.92 " 14,752.86 " " 5,203.71 " " 4,445.00 " 869.12 808.05 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 3,730.57 " " 4,663.21 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 776.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28175710 IMPLANT/REPLACE HEARING AID 69710 360 "$2,500.00" 924.00 - " 3,545.00 " 892.40 " 2,773.00 " N/A " 2,773.00 " 907.92 " 1,381.25 " N/A " 3,545.00 " 869.12 N/A " 1,654.75 " - N/A " 2,532.97 " " 3,166.21 " N/A N/A N/A " 2,000.00 " N/A 776.00 " 1,675.00 " N/A " 1,022.50 " " 1,875.00 " 950.25 " 1,118.25 " N/A 28174543 IMPLANT TEMPLE BONE W/STIMUL 69714 360 "$64,652.00" " 23,895.38 " 776.00 " 51,721.60 " 892.40 " 4,656.00 " " 12,861.18 " " 4,656.00 " 907.92 " 35,720.23 " " 12,616.20 " " 42,670.32 " 869.12 808.05 " 42,793.16 " " 11,023.87 " " 12,248.74 " " 7,133.34 " " 8,916.67 " " 12,554.96 " " 12,616.20 " " 12,248.74 " " 51,721.60 " " 11,207.60 " 776.00 " 43,316.84 " " 10,778.89 " " 26,442.67 " " 48,489.00 " " 24,574.23 " " 28,918.84 " " 12,677.45 " 28176678 DEC FAC NRV INTRT LAT GEN GANG 69720 360 "$26,702.00" " 9,869.06 " 776.00 " 21,361.60 " 892.40 " 3,604.00 " " 5,304.76 " " 3,604.00 " 907.92 " 14,752.86 " " 5,203.71 " " 4,445.00 " 869.12 808.05 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 3,730.57 " " 4,663.21 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 776.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28174551 MIDDLE EAR SURGERY PROCEDURE 69799 360 "$1,111.00" 410.63 - " 1,469.00 " - " 1,469.00 " 220.67 " 1,469.00 " - 613.83 216.46 733.26 - - 735.37 189.14 210.16 56.26 70.32 215.41 216.46 210.16 888.80 192.30 - 744.37 184.94 454.40 833.25 422.29 496.95 217.52 28174560 EXPLORE INNER EAR 69805 360 "$26,702.00" " 9,869.06 " 776.00 " 21,361.60 " 892.40 " 4,435.00 " " 5,304.76 " " 4,435.00 " 907.92 " 14,752.86 " " 5,203.71 " " 6,540.00 " 869.12 808.05 " 17,674.05 " " 4,546.94 " " 5,052.15 " " 4,937.34 " " 6,171.67 " " 5,178.45 " " 5,203.71 " " 5,052.15 " " 21,361.60 " " 4,622.72 " 776.00 " 17,890.34 " " 4,445.89 " " 10,921.12 " " 20,026.50 " " 10,149.43 " " 11,943.80 " " 5,228.98 " 28174578 IMPLANT COCHLEAR DEVICE 69930 360 "$180,745.00" " 66,803.35 " 776.00 " 144,596.00 " 892.40 " 4,435.00 " " 35,951.44 " " 4,435.00 " 907.92 " 99,861.61 " " 35,266.65 " " 6,540.00 " 869.12 808.05 " 119,635.12 " " 30,815.52 " " 34,239.47 " " 4,937.34 " " 6,171.67 " " 35,095.46 " " 35,266.65 " " 34,239.47 " " 144,596.00 " " 31,329.12 " 776.00 " 121,099.15 " " 30,130.73 " " 73,924.71 " " 135,558.75 " " 68,701.17 " " 80,847.24 " " 35,437.85 " 28175825 MICROSURGERY ADD-ON 69990 360 "$2,153.00" 795.75 - " 1,722.40 " - " 1,469.00 " - " 1,469.00 " - " 1,189.53 " - " 1,420.98 " - - " 1,425.07 " - - " 1,229.83 " " 1,537.29 " - - - " 1,722.40 " - - " 1,442.51 " - 880.58 " 1,614.75 " 818.36 963.04 - 80128908 XR CONTRAST BRAIN 70015 320 "$3,755.00" " 1,387.85 " 104.56 " 3,004.00 " 120.24 " 2,594.71 " 746.21 " 2,594.71 " 122.34 " 2,074.64 " 732.00 " 2,478.30 " 117.11 104.56 " 2,485.43 " 639.61 710.68 371.39 464.24 728.45 732.00 710.68 " 3,004.00 " 650.27 104.56 " 1,873.77 " 625.40 " 1,535.80 " " 2,816.25 " " 1,427.28 " " 1,679.61 " 735.55 67900014 XR EYE/DETECT FOREIGN BODY 70030 320 $425.00 157.08 23.01 340.00 26.46 293.68 84.37 293.68 26.92 234.81 82.76 280.50 25.77 23.01 281.31 72.32 80.35 80.98 101.23 82.36 82.76 80.35 340.00 73.52 23.01 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80100019 XR EYE/DETECT FOREIGN BODY 70030 320 $425.00 157.08 23.01 340.00 26.46 293.68 84.37 293.68 26.92 234.81 82.76 280.50 25.77 23.01 281.31 72.32 80.35 80.98 101.23 82.36 82.76 80.35 340.00 73.52 23.01 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81400016 XR EYE/DETECT FOREIGN BODY 70030 320 $425.00 157.08 23.01 340.00 26.46 293.68 84.37 293.68 26.92 234.81 82.76 280.50 25.77 23.01 281.31 72.32 80.35 80.98 101.23 82.36 82.76 80.35 340.00 73.52 23.01 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81600015 XR EYE/DETECT FOREIGN BODY 70030 320 $425.00 157.08 23.01 340.00 26.46 293.68 84.37 293.68 26.92 234.81 82.76 280.50 25.77 23.01 281.31 72.32 80.35 80.98 101.23 82.36 82.76 80.35 340.00 73.52 23.01 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81700010 XR EYE/DETECT FOREIGN BODY 70030 320 $425.00 157.08 23.01 340.00 26.46 293.68 84.37 293.68 26.92 234.81 82.76 280.50 25.77 23.01 281.31 72.32 80.35 80.98 101.23 82.36 82.76 80.35 340.00 73.52 23.01 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82600019 XR EYE/DETECT FOREIGN BODY 70030 320 $425.00 157.08 23.01 340.00 26.46 293.68 84.37 293.68 26.92 234.81 82.76 280.50 25.77 23.01 281.31 72.32 80.35 80.98 101.23 82.36 82.76 80.35 340.00 73.52 23.01 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82900012 XR EYE/DETECT FOREIGN BODY 70030 320 $425.00 157.08 23.01 340.00 26.46 293.68 84.37 293.68 26.92 234.81 82.76 280.50 25.77 23.01 281.31 72.32 80.35 80.98 101.23 82.36 82.76 80.35 340.00 73.52 23.01 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83000015 XR EYE/DETECT FOREIGN BODY 70030 320 $425.00 157.08 23.01 340.00 26.46 293.68 84.37 293.68 26.92 234.81 82.76 280.50 25.77 23.01 281.31 72.32 80.35 80.98 101.23 82.36 82.76 80.35 340.00 73.52 23.01 211.96 70.71 173.83 318.75 161.54 190.10 83.16 67900022 XR MANDIBLE <4VWS 70100 320 $425.00 157.08 24.92 340.00 28.66 293.68 84.37 293.68 29.16 234.81 82.76 280.50 27.91 24.92 281.31 72.32 80.35 96.42 120.52 82.36 82.76 80.35 340.00 73.52 24.92 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80100027 XR MANDIBLE <4VWS 70100 320 $425.00 157.08 24.92 340.00 28.66 293.68 84.37 293.68 29.16 234.81 82.76 280.50 27.91 24.92 281.31 72.32 80.35 96.42 120.52 82.36 82.76 80.35 340.00 73.52 24.92 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81400024 XR MANDIBLE <4VWS 70100 320 $425.00 157.08 24.92 340.00 28.66 293.68 84.37 293.68 29.16 234.81 82.76 280.50 27.91 24.92 281.31 72.32 80.35 96.42 120.52 82.36 82.76 80.35 340.00 73.52 24.92 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81600023 XR MANDIBLE <4VWS 70100 320 $425.00 157.08 24.92 340.00 28.66 293.68 84.37 293.68 29.16 234.81 82.76 280.50 27.91 24.92 281.31 72.32 80.35 96.42 120.52 82.36 82.76 80.35 340.00 73.52 24.92 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81700028 XR MANDIBLE <4VWS 70100 320 $425.00 157.08 24.92 340.00 28.66 293.68 84.37 293.68 29.16 234.81 82.76 280.50 27.91 24.92 281.31 72.32 80.35 96.42 120.52 82.36 82.76 80.35 340.00 73.52 24.92 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82600027 XR MANDIBLE <4VWS 70100 320 $425.00 157.08 24.92 340.00 28.66 293.68 84.37 293.68 29.16 234.81 82.76 280.50 27.91 24.92 281.31 72.32 80.35 96.42 120.52 82.36 82.76 80.35 340.00 73.52 24.92 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82900021 XR MANDIBLE <4VWS 70100 320 $425.00 157.08 24.92 340.00 28.66 293.68 84.37 293.68 29.16 234.81 82.76 280.50 27.91 24.92 281.31 72.32 80.35 96.42 120.52 82.36 82.76 80.35 340.00 73.52 24.92 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83000023 XR MANDIBLE <4VWS 70100 320 $425.00 157.08 24.92 340.00 28.66 293.68 84.37 293.68 29.16 234.81 82.76 280.50 27.91 24.92 281.31 72.32 80.35 96.42 120.52 82.36 82.76 80.35 340.00 73.52 24.92 211.96 70.71 173.83 318.75 161.54 190.10 83.16 67900031 XR MANDIBLE COMPLETE 70110 320 $572.00 211.41 27.50 457.60 31.63 395.25 113.56 395.25 32.18 316.03 111.39 377.52 30.80 27.50 378.61 97.34 108.15 119.80 149.75 110.85 111.39 108.15 457.60 98.96 27.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80100035 XR MANDIBLE COMPLETE 70110 320 $572.00 211.41 27.50 457.60 31.63 395.25 113.56 395.25 32.18 316.03 111.39 377.52 30.80 27.50 378.61 97.34 108.15 119.80 149.75 110.85 111.39 108.15 457.60 98.96 27.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81400032 XR MANDIBLE COMPLETE 70110 320 $572.00 211.41 27.50 457.60 31.63 395.25 113.56 395.25 32.18 316.03 111.39 377.52 30.80 27.50 378.61 97.34 108.15 119.80 149.75 110.85 111.39 108.15 457.60 98.96 27.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81600031 XR MANDIBLE COMPLETE 70110 320 $572.00 211.41 27.50 457.60 31.63 395.25 113.56 395.25 32.18 316.03 111.39 377.52 30.80 27.50 378.61 97.34 108.15 119.80 149.75 110.85 111.39 108.15 457.60 98.96 27.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81700036 XR MANDIBLE COMPLETE 70110 320 $572.00 211.41 27.50 457.60 31.63 395.25 113.56 395.25 32.18 316.03 111.39 377.52 30.80 27.50 378.61 97.34 108.15 119.80 149.75 110.85 111.39 108.15 457.60 98.96 27.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82600035 XR MANDIBLE COMPLETE 70110 320 $572.00 211.41 27.50 457.60 31.63 395.25 113.56 395.25 32.18 316.03 111.39 377.52 30.80 27.50 378.61 97.34 108.15 119.80 149.75 110.85 111.39 108.15 457.60 98.96 27.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82900039 XR MANDIBLE COMPLETE 70110 320 $572.00 211.41 27.50 457.60 31.63 395.25 113.56 395.25 32.18 316.03 111.39 377.52 30.80 27.50 378.61 97.34 108.15 119.80 149.75 110.85 111.39 108.15 457.60 98.96 27.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83000031 XR MANDIBLE COMPLETE 70110 320 $572.00 211.41 27.50 457.60 31.63 395.25 113.56 395.25 32.18 316.03 111.39 377.52 30.80 27.50 378.61 97.34 108.15 119.80 149.75 110.85 111.39 108.15 457.60 98.96 27.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80100043 XR MASTOID <3VWS 70120 320 $572.00 211.41 24.92 457.60 28.66 395.25 113.56 395.25 29.16 316.03 111.39 377.52 27.91 24.92 378.61 97.34 108.15 106.78 133.47 110.85 111.39 108.15 457.60 98.96 24.92 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81400041 XR MASTOID <3VWS 70120 320 $572.00 211.41 24.92 457.60 28.66 395.25 113.56 395.25 29.16 316.03 111.39 377.52 27.91 24.92 378.61 97.34 108.15 106.78 133.47 110.85 111.39 108.15 457.60 98.96 24.92 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81600040 XR MASTOID <3VWS 70120 320 $572.00 211.41 24.92 457.60 28.66 395.25 113.56 395.25 29.16 316.03 111.39 377.52 27.91 24.92 378.61 97.34 108.15 106.78 133.47 110.85 111.39 108.15 457.60 98.96 24.92 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81700044 XR MASTOID <3VWS 70120 320 $572.00 211.41 24.92 457.60 28.66 395.25 113.56 395.25 29.16 316.03 111.39 377.52 27.91 24.92 378.61 97.34 108.15 106.78 133.47 110.85 111.39 108.15 457.60 98.96 24.92 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82600043 XR MASTOID <3VWS 70120 320 $572.00 211.41 24.92 457.60 28.66 395.25 113.56 395.25 29.16 316.03 111.39 377.52 27.91 24.92 378.61 97.34 108.15 106.78 133.47 110.85 111.39 108.15 457.60 98.96 24.92 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82900047 XR MASTOID <3VWS 70120 320 $572.00 211.41 24.92 457.60 28.66 395.25 113.56 395.25 29.16 316.03 111.39 377.52 27.91 24.92 378.61 97.34 108.15 106.78 133.47 110.85 111.39 108.15 457.60 98.96 24.92 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67900057 XR MASTOID COMPLETE 70130 320 $572.00 211.41 43.47 457.60 49.99 395.25 113.56 395.25 50.86 316.03 111.39 377.52 48.69 43.47 378.61 97.34 108.15 154.70 193.37 110.85 111.39 108.15 457.60 98.96 43.47 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80100051 XR MASTOID COMPLETE 70130 320 $572.00 211.41 43.47 457.60 49.99 395.25 113.56 395.25 50.86 316.03 111.39 377.52 48.69 43.47 378.61 97.34 108.15 154.70 193.37 110.85 111.39 108.15 457.60 98.96 43.47 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81400059 XR MASTOID COMPLETE 70130 320 $572.00 211.41 43.47 457.60 49.99 395.25 113.56 395.25 50.86 316.03 111.39 377.52 48.69 43.47 378.61 97.34 108.15 154.70 193.37 110.85 111.39 108.15 457.60 98.96 43.47 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81600058 XR MASTOID COMPLETE 70130 320 $572.00 211.41 43.47 457.60 49.99 395.25 113.56 395.25 50.86 316.03 111.39 377.52 48.69 43.47 378.61 97.34 108.15 154.70 193.37 110.85 111.39 108.15 457.60 98.96 43.47 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81700052 XR MASTOID COMPLETE 70130 320 $572.00 211.41 43.47 457.60 49.99 395.25 113.56 395.25 50.86 316.03 111.39 377.52 48.69 43.47 378.61 97.34 108.15 154.70 193.37 110.85 111.39 108.15 457.60 98.96 43.47 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82600051 XR MASTOID COMPLETE 70130 320 $572.00 211.41 43.47 457.60 49.99 395.25 113.56 395.25 50.86 316.03 111.39 377.52 48.69 43.47 378.61 97.34 108.15 154.70 193.37 110.85 111.39 108.15 457.60 98.96 43.47 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82900055 XR MASTOID COMPLETE 70130 320 $572.00 211.41 43.47 457.60 49.99 395.25 113.56 395.25 50.86 316.03 111.39 377.52 48.69 43.47 378.61 97.34 108.15 154.70 193.37 110.85 111.39 108.15 457.60 98.96 43.47 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83000058 XR MASTOID COMPLETE 70130 320 $572.00 211.41 43.47 457.60 49.99 395.25 113.56 395.25 50.86 316.03 111.39 377.52 48.69 43.47 378.61 97.34 108.15 154.70 193.37 110.85 111.39 108.15 457.60 98.96 43.47 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67900065 XR INT AUDITORY MEATI COMPLETE 70134 320 "$2,535.00" 936.94 38.47 " 2,028.00 " 44.24 " 1,751.69 " 503.98 " 1,751.69 " 45.01 " 1,400.59 " 494.38 " 1,673.10 " 43.09 38.47 " 1,677.92 " 431.98 479.98 148.94 186.18 491.98 494.38 479.98 " 2,028.00 " 439.18 38.47 " 1,265.17 " 422.38 " 1,036.82 " " 1,901.25 " 963.55 " 1,133.91 " 496.78 80100060 XR INT AUDITORY MEATI COMPLETE 70134 320 "$2,535.00" 936.94 38.47 " 2,028.00 " 44.24 " 1,751.69 " 503.98 " 1,751.69 " 45.01 " 1,400.59 " 494.38 " 1,673.10 " 43.09 38.47 " 1,677.92 " 431.98 479.98 148.94 186.18 491.98 494.38 479.98 " 2,028.00 " 439.18 38.47 " 1,265.17 " 422.38 " 1,036.82 " " 1,901.25 " 963.55 " 1,133.91 " 496.78 81400067 XR INT AUDITORY MEATI COMPLETE 70134 320 "$2,535.00" 936.94 38.47 " 2,028.00 " 44.24 " 1,751.69 " 503.98 " 1,751.69 " 45.01 " 1,400.59 " 494.38 " 1,673.10 " 43.09 38.47 " 1,677.92 " 431.98 479.98 148.94 186.18 491.98 494.38 479.98 " 2,028.00 " 439.18 38.47 " 1,265.17 " 422.38 " 1,036.82 " " 1,901.25 " 963.55 " 1,133.91 " 496.78 81600066 XR INT AUDITORY MEATI COMPLETE 70134 320 "$2,535.00" 936.94 38.47 " 2,028.00 " 44.24 " 1,751.69 " 503.98 " 1,751.69 " 45.01 " 1,400.59 " 494.38 " 1,673.10 " 43.09 38.47 " 1,677.92 " 431.98 479.98 148.94 186.18 491.98 494.38 479.98 " 2,028.00 " 439.18 38.47 " 1,265.17 " 422.38 " 1,036.82 " " 1,901.25 " 963.55 " 1,133.91 " 496.78 81700061 XR INT AUDITORY MEATI COMPLETE 70134 320 "$2,535.00" 936.94 38.47 " 2,028.00 " 44.24 " 1,751.69 " 503.98 " 1,751.69 " 45.01 " 1,400.59 " 494.38 " 1,673.10 " 43.09 38.47 " 1,677.92 " 431.98 479.98 148.94 186.18 491.98 494.38 479.98 " 2,028.00 " 439.18 38.47 " 1,265.17 " 422.38 " 1,036.82 " " 1,901.25 " 963.55 " 1,133.91 " 496.78 67928172 XR FACIAL BONES <3VWS 70140 320 $425.00 157.08 27.44 340.00 31.56 293.68 84.37 293.68 32.10 234.81 82.76 280.50 30.73 27.44 281.31 72.32 80.35 128.28 160.35 82.36 82.76 80.35 340.00 73.52 27.44 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80128177 XR FACIAL BONES <3VWS 70140 320 $425.00 157.08 27.44 340.00 31.56 293.68 84.37 293.68 32.10 234.81 82.76 280.50 30.73 27.44 281.31 72.32 80.35 128.28 160.35 82.36 82.76 80.35 340.00 73.52 27.44 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81428174 XR FACIAL BONES <3VWS 70140 320 $425.00 157.08 27.44 340.00 31.56 293.68 84.37 293.68 32.10 234.81 82.76 280.50 30.73 27.44 281.31 72.32 80.35 128.28 160.35 82.36 82.76 80.35 340.00 73.52 27.44 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81628173 XR FACIAL BONES <3VWS 70140 320 $425.00 157.08 27.44 340.00 31.56 293.68 84.37 293.68 32.10 234.81 82.76 280.50 30.73 27.44 281.31 72.32 80.35 128.28 160.35 82.36 82.76 80.35 340.00 73.52 27.44 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81728178 XR FACIAL BONES <3VWS 70140 320 $425.00 157.08 27.44 340.00 31.56 293.68 84.37 293.68 32.10 234.81 82.76 280.50 30.73 27.44 281.31 72.32 80.35 128.28 160.35 82.36 82.76 80.35 340.00 73.52 27.44 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82628177 XR FACIAL BONES <3VWS 70140 320 $425.00 157.08 27.44 340.00 31.56 293.68 84.37 293.68 32.10 234.81 82.76 280.50 30.73 27.44 281.31 72.32 80.35 128.28 160.35 82.36 82.76 80.35 340.00 73.52 27.44 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82928171 XR FACIAL BONES <3VWS 70140 320 $425.00 157.08 27.44 340.00 31.56 293.68 84.37 293.68 32.10 234.81 82.76 280.50 30.73 27.44 281.31 72.32 80.35 128.28 160.35 82.36 82.76 80.35 340.00 73.52 27.44 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83028173 XR FACIAL BONES <3VWS 70140 320 $425.00 157.08 27.44 340.00 31.56 293.68 84.37 293.68 32.10 234.81 82.76 280.50 30.73 27.44 281.31 72.32 80.35 128.28 160.35 82.36 82.76 80.35 340.00 73.52 27.44 211.96 70.71 173.83 318.75 161.54 190.10 83.16 67900073 XR FACIAL BONES COMPLETE 70150 320 $572.00 211.41 34.26 457.60 39.40 395.25 113.56 395.25 40.08 316.03 111.39 377.52 38.37 34.26 378.61 97.34 108.15 141.98 177.48 110.85 111.39 108.15 457.60 98.96 34.26 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80100078 XR FACIAL BONES COMPLETE 70150 320 $572.00 211.41 34.26 457.60 39.40 395.25 113.56 395.25 40.08 316.03 111.39 377.52 38.37 34.26 378.61 97.34 108.15 141.98 177.48 110.85 111.39 108.15 457.60 98.96 34.26 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81400075 XR FACIAL BONES COMPLETE 70150 320 $572.00 211.41 34.26 457.60 39.40 395.25 113.56 395.25 40.08 316.03 111.39 377.52 38.37 34.26 378.61 97.34 108.15 141.98 177.48 110.85 111.39 108.15 457.60 98.96 34.26 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81600074 XR FACIAL BONES COMPLETE 70150 320 $572.00 211.41 34.26 457.60 39.40 395.25 113.56 395.25 40.08 316.03 111.39 377.52 38.37 34.26 378.61 97.34 108.15 141.98 177.48 110.85 111.39 108.15 457.60 98.96 34.26 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81700079 XR FACIAL BONES COMPLETE 70150 320 $572.00 211.41 34.26 457.60 39.40 395.25 113.56 395.25 40.08 316.03 111.39 377.52 38.37 34.26 378.61 97.34 108.15 141.98 177.48 110.85 111.39 108.15 457.60 98.96 34.26 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82600078 XR FACIAL BONES COMPLETE 70150 320 $572.00 211.41 34.26 457.60 39.40 395.25 113.56 395.25 40.08 316.03 111.39 377.52 38.37 34.26 378.61 97.34 108.15 141.98 177.48 110.85 111.39 108.15 457.60 98.96 34.26 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82900071 XR FACIAL BONES COMPLETE 70150 320 $572.00 211.41 34.26 457.60 39.40 395.25 113.56 395.25 40.08 316.03 111.39 377.52 38.37 34.26 378.61 97.34 108.15 141.98 177.48 110.85 111.39 108.15 457.60 98.96 34.26 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83000074 XR FACIAL BONES COMPLETE 70150 320 $572.00 211.41 34.26 457.60 39.40 395.25 113.56 395.25 40.08 316.03 111.39 377.52 38.37 34.26 378.61 97.34 108.15 141.98 177.48 110.85 111.39 108.15 457.60 98.96 34.26 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67900081 XR NASAL BONES 70160 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 98.30 122.88 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80100086 XR NASAL BONES 70160 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 98.30 122.88 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81400083 XR NASAL BONES 70160 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 98.30 122.88 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81600082 XR NASAL BONES 70160 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 98.30 122.88 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81700087 XR NASAL BONES 70160 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 98.30 122.88 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82600086 XR NASAL BONES 70160 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 98.30 122.88 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82900080 XR NASAL BONES 70160 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 98.30 122.88 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83000082 XR NASAL BONES 70160 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 98.30 122.88 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 67900090 XR OPTIC FORAMINA 70190 320 $425.00 157.08 30.65 340.00 35.25 293.68 84.37 293.68 35.86 234.81 82.76 280.50 34.33 30.65 281.31 72.32 80.35 111.38 139.23 82.36 82.76 80.35 340.00 73.52 30.65 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80100094 XR OPTIC FORAMINA 70190 320 $425.00 157.08 30.65 340.00 35.25 293.68 84.37 293.68 35.86 234.81 82.76 280.50 34.33 30.65 281.31 72.32 80.35 111.38 139.23 82.36 82.76 80.35 340.00 73.52 30.65 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81400091 XR OPTIC FORAMINA 70190 320 $425.00 157.08 30.65 340.00 35.25 293.68 84.37 293.68 35.86 234.81 82.76 280.50 34.33 30.65 281.31 72.32 80.35 111.38 139.23 82.36 82.76 80.35 340.00 73.52 30.65 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81600091 XR OPTIC FORAMINA 70190 320 $425.00 157.08 30.65 340.00 35.25 293.68 84.37 293.68 35.86 234.81 82.76 280.50 34.33 30.65 281.31 72.32 80.35 111.38 139.23 82.36 82.76 80.35 340.00 73.52 30.65 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81700095 XR OPTIC FORAMINA 70190 320 $425.00 157.08 30.65 340.00 35.25 293.68 84.37 293.68 35.86 234.81 82.76 280.50 34.33 30.65 281.31 72.32 80.35 111.38 139.23 82.36 82.76 80.35 340.00 73.52 30.65 211.96 70.71 173.83 318.75 161.54 190.10 83.16 67900103 XR ORBITS MIN 4VWS 70200 320 $572.00 211.41 33.86 457.60 38.94 395.25 113.56 395.25 39.62 316.03 111.39 377.52 37.92 33.86 378.61 97.34 108.15 148.06 185.07 110.85 111.39 108.15 457.60 98.96 33.86 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80100108 XR ORBITS MIN 4VWS 70200 320 $572.00 211.41 33.86 457.60 38.94 395.25 113.56 395.25 39.62 316.03 111.39 377.52 37.92 33.86 378.61 97.34 108.15 148.06 185.07 110.85 111.39 108.15 457.60 98.96 33.86 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81400105 XR ORBITS MIN 4VWS 70200 320 $572.00 211.41 33.86 457.60 38.94 395.25 113.56 395.25 39.62 316.03 111.39 377.52 37.92 33.86 378.61 97.34 108.15 148.06 185.07 110.85 111.39 108.15 457.60 98.96 33.86 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81600104 XR ORBITS MIN 4VWS 70200 320 $572.00 211.41 33.86 457.60 38.94 395.25 113.56 395.25 39.62 316.03 111.39 377.52 37.92 33.86 378.61 97.34 108.15 148.06 185.07 110.85 111.39 108.15 457.60 98.96 33.86 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81700109 XR ORBITS MIN 4VWS 70200 320 $572.00 211.41 33.86 457.60 38.94 395.25 113.56 395.25 39.62 316.03 111.39 377.52 37.92 33.86 378.61 97.34 108.15 148.06 185.07 110.85 111.39 108.15 457.60 98.96 33.86 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82600108 XR ORBITS MIN 4VWS 70200 320 $572.00 211.41 33.86 457.60 38.94 395.25 113.56 395.25 39.62 316.03 111.39 377.52 37.92 33.86 378.61 97.34 108.15 148.06 185.07 110.85 111.39 108.15 457.60 98.96 33.86 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82900101 XR ORBITS MIN 4VWS 70200 320 $572.00 211.41 33.86 457.60 38.94 395.25 113.56 395.25 39.62 316.03 111.39 377.52 37.92 33.86 378.61 97.34 108.15 148.06 185.07 110.85 111.39 108.15 457.60 98.96 33.86 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83000104 XR ORBITS MIN 4VWS 70200 320 $572.00 211.41 33.86 457.60 38.94 395.25 113.56 395.25 39.62 316.03 111.39 377.52 37.92 33.86 378.61 97.34 108.15 148.06 185.07 110.85 111.39 108.15 457.60 98.96 33.86 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67900111 XR SINUS PARA <3VWS 70210 320 $425.00 157.08 24.31 340.00 27.96 293.68 84.37 293.68 28.44 234.81 82.76 280.50 27.23 24.31 281.31 72.32 80.35 104.47 130.59 82.36 82.76 80.35 340.00 73.52 24.31 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80100116 XR SINUS PARA <3VWS 70210 320 $425.00 157.08 24.31 340.00 27.96 293.68 84.37 293.68 28.44 234.81 82.76 280.50 27.23 24.31 281.31 72.32 80.35 104.47 130.59 82.36 82.76 80.35 340.00 73.52 24.31 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81400113 XR SINUS PARA <3VWS 70210 320 $425.00 157.08 24.31 340.00 27.96 293.68 84.37 293.68 28.44 234.81 82.76 280.50 27.23 24.31 281.31 72.32 80.35 104.47 130.59 82.36 82.76 80.35 340.00 73.52 24.31 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81600112 XR SINUS PARA <3VWS 70210 320 $425.00 157.08 24.31 340.00 27.96 293.68 84.37 293.68 28.44 234.81 82.76 280.50 27.23 24.31 281.31 72.32 80.35 104.47 130.59 82.36 82.76 80.35 340.00 73.52 24.31 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81700117 XR SINUS PARA <3VWS 70210 320 $425.00 157.08 24.31 340.00 27.96 293.68 84.37 293.68 28.44 234.81 82.76 280.50 27.23 24.31 281.31 72.32 80.35 104.47 130.59 82.36 82.76 80.35 340.00 73.52 24.31 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82600116 XR SINUS PARA <3VWS 70210 320 $425.00 157.08 24.31 340.00 27.96 293.68 84.37 293.68 28.44 234.81 82.76 280.50 27.23 24.31 281.31 72.32 80.35 104.47 130.59 82.36 82.76 80.35 340.00 73.52 24.31 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82900110 XR SINUS PARA <3VWS 70210 320 $425.00 157.08 24.31 340.00 27.96 293.68 84.37 293.68 28.44 234.81 82.76 280.50 27.23 24.31 281.31 72.32 80.35 104.47 130.59 82.36 82.76 80.35 340.00 73.52 24.31 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83000112 XR SINUS PARA <3VWS 70210 320 $425.00 157.08 24.31 340.00 27.96 293.68 84.37 293.68 28.44 234.81 82.76 280.50 27.23 24.31 281.31 72.32 80.35 104.47 130.59 82.36 82.76 80.35 340.00 73.52 24.31 211.96 70.71 173.83 318.75 161.54 190.10 83.16 67900120 XR SINUS PARA COMPLETE 70220 320 $425.00 157.08 33.88 340.00 38.96 293.68 84.37 293.68 39.64 234.81 82.76 280.50 37.95 33.88 281.31 72.32 80.35 139.79 174.74 82.36 82.76 80.35 340.00 73.52 33.88 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80100124 XR SINUS PARA COMPLETE 70220 320 $425.00 157.08 33.88 340.00 38.96 293.68 84.37 293.68 39.64 234.81 82.76 280.50 37.95 33.88 281.31 72.32 80.35 139.79 174.74 82.36 82.76 80.35 340.00 73.52 33.88 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81400121 XR SINUS PARA COMPLETE 70220 320 $425.00 157.08 33.88 340.00 38.96 293.68 84.37 293.68 39.64 234.81 82.76 280.50 37.95 33.88 281.31 72.32 80.35 139.79 174.74 82.36 82.76 80.35 340.00 73.52 33.88 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81600121 XR SINUS PARA COMPLETE 70220 320 $425.00 157.08 33.88 340.00 38.96 293.68 84.37 293.68 39.64 234.81 82.76 280.50 37.95 33.88 281.31 72.32 80.35 139.79 174.74 82.36 82.76 80.35 340.00 73.52 33.88 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81700125 XR SINUS PARA COMPLETE 70220 320 $425.00 157.08 33.88 340.00 38.96 293.68 84.37 293.68 39.64 234.81 82.76 280.50 37.95 33.88 281.31 72.32 80.35 139.79 174.74 82.36 82.76 80.35 340.00 73.52 33.88 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82600124 XR SINUS PARA COMPLETE 70220 320 $425.00 157.08 33.88 340.00 38.96 293.68 84.37 293.68 39.64 234.81 82.76 280.50 37.95 33.88 281.31 72.32 80.35 139.79 174.74 82.36 82.76 80.35 340.00 73.52 33.88 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82900128 XR SINUS PARA COMPLETE 70220 320 $425.00 157.08 33.88 340.00 38.96 293.68 84.37 293.68 39.64 234.81 82.76 280.50 37.95 33.88 281.31 72.32 80.35 139.79 174.74 82.36 82.76 80.35 340.00 73.52 33.88 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83000121 XR SINUS PARA COMPLETE 70220 320 $425.00 157.08 33.88 340.00 38.96 293.68 84.37 293.68 39.64 234.81 82.76 280.50 37.95 33.88 281.31 72.32 80.35 139.79 174.74 82.36 82.76 80.35 340.00 73.52 33.88 211.96 70.71 173.83 318.75 161.54 190.10 83.16 67900138 XR SELLA TURCICA 70240 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 84.44 105.55 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80100132 XR SELLA TURCICA 70240 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 84.44 105.55 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81400130 XR SELLA TURCICA 70240 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 84.44 105.55 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81700133 XR SELLA TURCICA 70240 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 84.44 105.55 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82600132 XR SELLA TURCICA 70240 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 84.44 105.55 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 67900146 XR SKULL <4VWS 70250 320 $572.00 211.41 31.79 457.60 36.56 395.25 113.56 395.25 37.19 316.03 111.39 377.52 35.60 31.79 378.61 97.34 108.15 130.48 163.10 110.85 111.39 108.15 457.60 98.96 31.79 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80100141 XR SKULL <4VWS 70250 320 $572.00 211.41 31.79 457.60 36.56 395.25 113.56 395.25 37.19 316.03 111.39 377.52 35.60 31.79 378.61 97.34 108.15 130.48 163.10 110.85 111.39 108.15 457.60 98.96 31.79 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81400148 XR SKULL <4VWS 70250 320 $572.00 211.41 31.79 457.60 36.56 395.25 113.56 395.25 37.19 316.03 111.39 377.52 35.60 31.79 378.61 97.34 108.15 130.48 163.10 110.85 111.39 108.15 457.60 98.96 31.79 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81600147 XR SKULL <4VWS 70250 320 $572.00 211.41 31.79 457.60 36.56 395.25 113.56 395.25 37.19 316.03 111.39 377.52 35.60 31.79 378.61 97.34 108.15 130.48 163.10 110.85 111.39 108.15 457.60 98.96 31.79 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81700141 XR SKULL <4VWS 70250 320 $572.00 211.41 31.79 457.60 36.56 395.25 113.56 395.25 37.19 316.03 111.39 377.52 35.60 31.79 378.61 97.34 108.15 130.48 163.10 110.85 111.39 108.15 457.60 98.96 31.79 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82600141 XR SKULL <4VWS 70250 320 $572.00 211.41 31.79 457.60 36.56 395.25 113.56 395.25 37.19 316.03 111.39 377.52 35.60 31.79 378.61 97.34 108.15 130.48 163.10 110.85 111.39 108.15 457.60 98.96 31.79 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82900144 XR SKULL <4VWS 70250 320 $572.00 211.41 31.79 457.60 36.56 395.25 113.56 395.25 37.19 316.03 111.39 377.52 35.60 31.79 378.61 97.34 108.15 130.48 163.10 110.85 111.39 108.15 457.60 98.96 31.79 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83000147 XR SKULL <4VWS 70250 320 $572.00 211.41 31.79 457.60 36.56 395.25 113.56 395.25 37.19 316.03 111.39 377.52 35.60 31.79 378.61 97.34 108.15 130.48 163.10 110.85 111.39 108.15 457.60 98.96 31.79 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67900154 XR SKULL COMPLETE 70260 320 $572.00 211.41 43.47 457.60 49.99 395.25 113.56 395.25 50.86 316.03 111.39 377.52 48.69 43.47 378.61 97.34 108.15 167.78 209.72 110.85 111.39 108.15 457.60 98.96 43.47 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80100159 XR SKULL COMPLETE 70260 320 $572.00 211.41 43.47 457.60 49.99 395.25 113.56 395.25 50.86 316.03 111.39 377.52 48.69 43.47 378.61 97.34 108.15 167.78 209.72 110.85 111.39 108.15 457.60 98.96 43.47 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81400156 XR SKULL COMPLETE 70260 320 $572.00 211.41 43.47 457.60 49.99 395.25 113.56 395.25 50.86 316.03 111.39 377.52 48.69 43.47 378.61 97.34 108.15 167.78 209.72 110.85 111.39 108.15 457.60 98.96 43.47 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81600155 XR SKULL COMPLETE 70260 320 $572.00 211.41 43.47 457.60 49.99 395.25 113.56 395.25 50.86 316.03 111.39 377.52 48.69 43.47 378.61 97.34 108.15 167.78 209.72 110.85 111.39 108.15 457.60 98.96 43.47 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81700150 XR SKULL COMPLETE 70260 320 $572.00 211.41 43.47 457.60 49.99 395.25 113.56 395.25 50.86 316.03 111.39 377.52 48.69 43.47 378.61 97.34 108.15 167.78 209.72 110.85 111.39 108.15 457.60 98.96 43.47 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82600159 XR SKULL COMPLETE 70260 320 $572.00 211.41 43.47 457.60 49.99 395.25 113.56 395.25 50.86 316.03 111.39 377.52 48.69 43.47 378.61 97.34 108.15 167.78 209.72 110.85 111.39 108.15 457.60 98.96 43.47 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82900152 XR SKULL COMPLETE 70260 320 $572.00 211.41 43.47 457.60 49.99 395.25 113.56 395.25 50.86 316.03 111.39 377.52 48.69 43.47 378.61 97.34 108.15 167.78 209.72 110.85 111.39 108.15 457.60 98.96 43.47 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83000155 XR SKULL COMPLETE 70260 320 $572.00 211.41 43.47 457.60 49.99 395.25 113.56 395.25 50.86 316.03 111.39 377.52 48.69 43.47 378.61 97.34 108.15 167.78 209.72 110.85 111.39 108.15 457.60 98.96 43.47 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67929071 XR TMJ OPEN CLOSED MOUTH UNI 70328 320 $425.00 157.08 24.92 340.00 28.66 293.68 84.37 293.68 29.16 234.81 82.76 280.50 27.91 24.92 281.31 72.32 80.35 91.40 114.25 82.36 82.76 80.35 340.00 73.52 24.92 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80129076 XR TMJ OPEN CLOSED MOUTH UNI 70328 320 $425.00 157.08 24.92 340.00 28.66 293.68 84.37 293.68 29.16 234.81 82.76 280.50 27.91 24.92 281.31 72.32 80.35 91.40 114.25 82.36 82.76 80.35 340.00 73.52 24.92 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81429073 XR TMJ OPEN CLOSED MOUTH UNI 70328 320 $425.00 157.08 24.92 340.00 28.66 293.68 84.37 293.68 29.16 234.81 82.76 280.50 27.91 24.92 281.31 72.32 80.35 91.40 114.25 82.36 82.76 80.35 340.00 73.52 24.92 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81629072 XR TMJ OPEN CLOSED MOUTH UNI 70328 320 $425.00 157.08 24.92 340.00 28.66 293.68 84.37 293.68 29.16 234.81 82.76 280.50 27.91 24.92 281.31 72.32 80.35 91.40 114.25 82.36 82.76 80.35 340.00 73.52 24.92 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81729077 XR TMJ OPEN CLOSED MOUTH UNI 70328 320 $425.00 157.08 24.92 340.00 28.66 293.68 84.37 293.68 29.16 234.81 82.76 280.50 27.91 24.92 281.31 72.32 80.35 91.40 114.25 82.36 82.76 80.35 340.00 73.52 24.92 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82629076 XR TMJ OPEN CLOSED MOUTH UNI 70328 320 $425.00 157.08 24.92 340.00 28.66 293.68 84.37 293.68 29.16 234.81 82.76 280.50 27.91 24.92 281.31 72.32 80.35 91.40 114.25 82.36 82.76 80.35 340.00 73.52 24.92 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82929070 XR TMJ OPEN CLOSED MOUTH UNI 70328 320 $425.00 157.08 24.92 340.00 28.66 293.68 84.37 293.68 29.16 234.81 82.76 280.50 27.91 24.92 281.31 72.32 80.35 91.40 114.25 82.36 82.76 80.35 340.00 73.52 24.92 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83029072 XR TMJ OPEN CLOSED MOUTH UNI 70328 320 $425.00 157.08 24.92 340.00 28.66 293.68 84.37 293.68 29.16 234.81 82.76 280.50 27.91 24.92 281.31 72.32 80.35 91.40 114.25 82.36 82.76 80.35 340.00 73.52 24.92 211.96 70.71 173.83 318.75 161.54 190.10 83.16 67900162 XR TMJ BILATERAL 70330 320 $425.00 157.08 27.50 340.00 31.63 293.68 84.37 293.68 32.18 234.81 82.76 280.50 30.80 27.50 281.31 72.32 80.35 143.24 179.05 82.36 82.76 80.35 340.00 73.52 27.50 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80100167 XR TMJ BILATERAL 70330 320 $425.00 157.08 27.50 340.00 31.63 293.68 84.37 293.68 32.18 234.81 82.76 280.50 30.80 27.50 281.31 72.32 80.35 143.24 179.05 82.36 82.76 80.35 340.00 73.52 27.50 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81400164 XR TMJ BILATERAL 70330 320 $425.00 157.08 27.50 340.00 31.63 293.68 84.37 293.68 32.18 234.81 82.76 280.50 30.80 27.50 281.31 72.32 80.35 143.24 179.05 82.36 82.76 80.35 340.00 73.52 27.50 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81600163 XR TMJ BILATERAL 70330 320 $425.00 157.08 27.50 340.00 31.63 293.68 84.37 293.68 32.18 234.81 82.76 280.50 30.80 27.50 281.31 72.32 80.35 143.24 179.05 82.36 82.76 80.35 340.00 73.52 27.50 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81700168 XR TMJ BILATERAL 70330 320 $425.00 157.08 27.50 340.00 31.63 293.68 84.37 293.68 32.18 234.81 82.76 280.50 30.80 27.50 281.31 72.32 80.35 143.24 179.05 82.36 82.76 80.35 340.00 73.52 27.50 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82600167 XR TMJ BILATERAL 70330 320 $425.00 157.08 27.50 340.00 31.63 293.68 84.37 293.68 32.18 234.81 82.76 280.50 30.80 27.50 281.31 72.32 80.35 143.24 179.05 82.36 82.76 80.35 340.00 73.52 27.50 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82900161 XR TMJ BILATERAL 70330 320 $425.00 157.08 27.50 340.00 31.63 293.68 84.37 293.68 32.18 234.81 82.76 280.50 30.80 27.50 281.31 72.32 80.35 143.24 179.05 82.36 82.76 80.35 340.00 73.52 27.50 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83000163 XR TMJ BILATERAL 70330 320 $425.00 157.08 27.50 340.00 31.63 293.68 84.37 293.68 32.18 234.81 82.76 280.50 30.80 27.50 281.31 72.32 80.35 143.24 179.05 82.36 82.76 80.35 340.00 73.52 27.50 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80407025 MRI TMJ 70336 614 "$1,208.00" 446.48 201.14 " 2,882.00 " 383.13 " 2,882.00 " 240.00 " 2,882.00 " 389.80 667.42 235.43 " 1,155.00 " 373.14 333.16 799.58 205.71 228.57 " 1,503.14 " " 1,878.93 " 234.28 235.43 228.57 966.40 209.14 333.16 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81407029 MRI TMJ 70336 614 "$1,208.00" 446.48 201.14 " 2,882.00 " 383.13 " 2,882.00 " 240.00 " 2,882.00 " 389.80 667.42 235.43 " 1,155.00 " 373.14 333.16 799.58 205.71 228.57 " 1,503.14 " " 1,878.93 " 234.28 235.43 228.57 966.40 209.14 333.16 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81607028 MRI TMJ 70336 614 "$1,208.00" 446.48 201.14 " 2,882.00 " 383.13 " 2,882.00 " 240.00 " 2,882.00 " 389.80 667.42 235.43 " 1,155.00 " 373.14 333.16 799.58 205.71 228.57 " 1,503.14 " " 1,878.93 " 234.28 235.43 228.57 966.40 209.14 333.16 602.94 201.14 494.07 906.00 459.16 540.34 236.57 67900189 XR NECK SOFT TISSUE 70360 320 $425.00 157.08 17.50 340.00 20.13 293.68 84.37 293.68 20.48 234.81 82.76 280.50 19.60 17.50 281.31 72.32 80.35 80.98 101.23 82.36 82.76 80.35 340.00 73.52 17.50 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80100183 XR NECK SOFT TISSUE 70360 320 $425.00 157.08 17.50 340.00 20.13 293.68 84.37 293.68 20.48 234.81 82.76 280.50 19.60 17.50 281.31 72.32 80.35 80.98 101.23 82.36 82.76 80.35 340.00 73.52 17.50 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81400181 XR NECK SOFT TISSUE 70360 320 $425.00 157.08 17.50 340.00 20.13 293.68 84.37 293.68 20.48 234.81 82.76 280.50 19.60 17.50 281.31 72.32 80.35 80.98 101.23 82.36 82.76 80.35 340.00 73.52 17.50 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81600180 XR NECK SOFT TISSUE 70360 320 $425.00 157.08 17.50 340.00 20.13 293.68 84.37 293.68 20.48 234.81 82.76 280.50 19.60 17.50 281.31 72.32 80.35 80.98 101.23 82.36 82.76 80.35 340.00 73.52 17.50 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81700184 XR NECK SOFT TISSUE 70360 320 $425.00 157.08 17.50 340.00 20.13 293.68 84.37 293.68 20.48 234.81 82.76 280.50 19.60 17.50 281.31 72.32 80.35 80.98 101.23 82.36 82.76 80.35 340.00 73.52 17.50 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82600183 XR NECK SOFT TISSUE 70360 320 $425.00 157.08 17.50 340.00 20.13 293.68 84.37 293.68 20.48 234.81 82.76 280.50 19.60 17.50 281.31 72.32 80.35 80.98 101.23 82.36 82.76 80.35 340.00 73.52 17.50 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82900187 XR NECK SOFT TISSUE 70360 320 $425.00 157.08 17.50 340.00 20.13 293.68 84.37 293.68 20.48 234.81 82.76 280.50 19.60 17.50 281.31 72.32 80.35 80.98 101.23 82.36 82.76 80.35 340.00 73.52 17.50 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83000180 XR NECK SOFT TISSUE 70360 320 $425.00 157.08 17.50 340.00 20.13 293.68 84.37 293.68 20.48 234.81 82.76 280.50 19.60 17.50 281.31 72.32 80.35 80.98 101.23 82.36 82.76 80.35 340.00 73.52 17.50 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80100191 XR SALIVARY GLAND 70380 320 $425.00 157.08 29.04 340.00 33.40 293.68 84.37 293.68 33.98 234.81 82.76 280.50 32.52 29.04 281.31 72.32 80.35 110.23 137.79 82.36 82.76 80.35 340.00 73.52 29.04 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81400199 XR SALIVARY GLAND 70380 320 $425.00 157.08 29.04 340.00 33.40 293.68 84.37 293.68 33.98 234.81 82.76 280.50 32.52 29.04 281.31 72.32 80.35 110.23 137.79 82.36 82.76 80.35 340.00 73.52 29.04 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80100205 XR SALIVARY DUCT 70390 320 "$1,208.00" 446.48 35.00 966.40 40.25 834.73 240.00 834.73 40.95 667.42 235.43 797.28 39.20 35.00 799.58 205.71 228.57 280.83 351.04 234.28 235.43 228.57 966.40 209.14 35.00 602.94 201.14 494.07 906.00 459.16 540.34 236.57 67709004 CT HEAD/BRAIN W/O CONTRAST 70450 351 $572.00 211.41 95.17 " 1,774.00 " 134.26 " 1,774.00 " 113.56 " 1,774.00 " 136.60 316.03 111.39 725.00 130.76 116.75 378.61 97.34 108.15 724.74 905.92 110.85 111.39 108.15 457.60 98.96 116.75 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67909003 CT HEAD/BRAIN W/O CONTRAST 70450 351 $572.00 211.41 95.17 " 1,774.00 " 134.26 " 1,774.00 " 113.56 " 1,774.00 " 136.60 316.03 111.39 725.00 130.76 116.75 378.61 97.34 108.15 724.74 905.92 110.85 111.39 108.15 457.60 98.96 116.75 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80609001 CT HEAD/BRAIN W/O CONT 70450 351 $572.00 211.41 95.17 " 1,774.00 " 134.26 " 1,774.00 " 113.56 " 1,774.00 " 136.60 316.03 111.39 725.00 130.76 116.75 378.61 97.34 108.15 724.74 905.92 110.85 111.39 108.15 457.60 98.96 116.75 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81409005 CT HEAD/BRAIN W/O CONTRAST 70450 351 $572.00 211.41 95.17 " 1,774.00 " 134.26 " 1,774.00 " 113.56 " 1,774.00 " 136.60 316.03 111.39 725.00 130.76 116.75 378.61 97.34 108.15 724.74 905.92 110.85 111.39 108.15 457.60 98.96 116.75 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81609004 CT HEAD/BRAIN W/O CONTRAST 70450 351 $572.00 211.41 95.17 " 1,774.00 " 134.26 " 1,774.00 " 113.56 " 1,774.00 " 136.60 316.03 111.39 725.00 130.76 116.75 378.61 97.34 108.15 724.74 905.92 110.85 111.39 108.15 457.60 98.96 116.75 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83009004 CT HEAD/BRAIN W/O CONTRAST 70450 351 $572.00 211.41 95.17 " 1,774.00 " 134.26 " 1,774.00 " 113.56 " 1,774.00 " 136.60 316.03 111.39 725.00 130.76 116.75 378.61 97.34 108.15 724.74 905.92 110.85 111.39 108.15 457.60 98.96 116.75 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67709012 CT HEAD/BRAIN W/CONTRAST 70460 351 $937.00 346.32 134.00 " 1,774.00 " 154.10 " 1,774.00 " 186.31 " 1,774.00 " 156.78 517.69 182.76 725.00 150.08 134.00 620.20 159.70 177.44 875.30 " 1,094.12 " 181.88 182.76 177.44 749.60 162.36 134.00 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67909011 CT HEAD/BRAIN W/CONTRAST 70460 351 $937.00 346.32 134.00 " 1,774.00 " 154.10 " 1,774.00 " 186.31 " 1,774.00 " 156.78 517.69 182.76 725.00 150.08 134.00 620.20 159.70 177.44 875.30 " 1,094.12 " 181.88 182.76 177.44 749.60 162.36 134.00 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80609019 CT HEAD/BRAIN W/CONT 70460 351 $937.00 346.32 134.00 " 1,774.00 " 154.10 " 1,774.00 " 186.31 " 1,774.00 " 156.78 517.69 182.76 725.00 150.08 134.00 620.20 159.70 177.44 875.30 " 1,094.12 " 181.88 182.76 177.44 749.60 162.36 134.00 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81409013 CT HEAD/BRAIN W/CONTRAST 70460 351 $937.00 346.32 134.00 " 1,774.00 " 154.10 " 1,774.00 " 186.31 " 1,774.00 " 156.78 517.69 182.76 725.00 150.08 134.00 620.20 159.70 177.44 875.30 " 1,094.12 " 181.88 182.76 177.44 749.60 162.36 134.00 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81609012 CT HEAD/BRAIN W/CONTRAST 70460 351 $937.00 346.32 134.00 " 1,774.00 " 154.10 " 1,774.00 " 186.31 " 1,774.00 " 156.78 517.69 182.76 725.00 150.08 134.00 620.20 159.70 177.44 875.30 " 1,094.12 " 181.88 182.76 177.44 749.60 162.36 134.00 467.80 156.15 383.23 702.75 356.15 419.12 183.65 83009012 CT HEAD/BRAIN W/CONTRAST 70460 351 $937.00 346.32 134.00 " 1,774.00 " 154.10 " 1,774.00 " 186.31 " 1,774.00 " 156.78 517.69 182.76 725.00 150.08 134.00 620.20 159.70 177.44 875.30 " 1,094.12 " 181.88 182.76 177.44 749.60 162.36 134.00 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67709021 CT HEAD/BRAIN WO/W CONTRAST 70470 351 $937.00 346.32 156.15 " 1,774.00 " 182.91 " 1,774.00 " 186.31 " 1,774.00 " 186.09 517.69 182.76 725.00 178.14 159.05 620.20 159.70 177.44 " 1,067.87 " " 1,334.84 " 181.88 182.76 177.44 749.60 162.36 159.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67909020 CT HEAD/BRAIN WO/W CONTRAST 70470 351 $937.00 346.32 156.15 " 1,774.00 " 182.91 " 1,774.00 " 186.31 " 1,774.00 " 186.09 517.69 182.76 725.00 178.14 159.05 620.20 159.70 177.44 " 1,067.87 " " 1,334.84 " 181.88 182.76 177.44 749.60 162.36 159.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80609027 CT HEAD/BRAIN WO/W CONT 70470 351 $937.00 346.32 156.15 " 1,774.00 " 182.91 " 1,774.00 " 186.31 " 1,774.00 " 186.09 517.69 182.76 725.00 178.14 159.05 620.20 159.70 177.44 " 1,067.87 " " 1,334.84 " 181.88 182.76 177.44 749.60 162.36 159.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81409021 CT HEAD/BRAIN WO/W CONTRAST 70470 351 $937.00 346.32 156.15 " 1,774.00 " 182.91 " 1,774.00 " 186.31 " 1,774.00 " 186.09 517.69 182.76 725.00 178.14 159.05 620.20 159.70 177.44 " 1,067.87 " " 1,334.84 " 181.88 182.76 177.44 749.60 162.36 159.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81609021 CT HEAD/BRAIN WO/W CONTRAST 70470 351 $937.00 346.32 156.15 " 1,774.00 " 182.91 " 1,774.00 " 186.31 " 1,774.00 " 186.09 517.69 182.76 725.00 178.14 159.05 620.20 159.70 177.44 " 1,067.87 " " 1,334.84 " 181.88 182.76 177.44 749.60 162.36 159.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 83009021 CT HEAD/BRAIN WO/W CONTRAST 70470 351 $937.00 346.32 156.15 " 1,774.00 " 182.91 " 1,774.00 " 186.31 " 1,774.00 " 186.09 517.69 182.76 725.00 178.14 159.05 620.20 159.70 177.44 " 1,067.87 " " 1,334.84 " 181.88 182.76 177.44 749.60 162.36 159.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67709039 CT ORBIT SELLA W/O CONTRAST 70480 351 $572.00 211.41 95.17 " 1,774.00 " 199.44 " 1,774.00 " 113.56 " 1,774.00 " 202.91 316.03 111.39 725.00 194.24 173.43 378.61 97.34 108.15 790.18 987.73 110.85 111.39 108.15 457.60 98.96 173.43 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67909038 CT ORBIT SELLA W/O CONTRAST 70480 351 $572.00 211.41 95.17 " 1,774.00 " 199.44 " 1,774.00 " 113.56 " 1,774.00 " 202.91 316.03 111.39 725.00 194.24 173.43 378.61 97.34 108.15 790.18 987.73 110.85 111.39 108.15 457.60 98.96 173.43 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80609035 CT ORBIT SELLA W/O CONT 70480 351 $572.00 211.41 95.17 " 1,774.00 " 199.44 " 1,774.00 " 113.56 " 1,774.00 " 202.91 316.03 111.39 725.00 194.24 173.43 378.61 97.34 108.15 790.18 987.73 110.85 111.39 108.15 457.60 98.96 173.43 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81409030 CT ORBIT SELLA W/O CONTRAST 70480 351 $572.00 211.41 95.17 " 1,774.00 " 199.44 " 1,774.00 " 113.56 " 1,774.00 " 202.91 316.03 111.39 725.00 194.24 173.43 378.61 97.34 108.15 790.18 987.73 110.85 111.39 108.15 457.60 98.96 173.43 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81609039 CT ORBIT SELLA W/O CONTRAST 70480 351 $572.00 211.41 95.17 " 1,774.00 " 199.44 " 1,774.00 " 113.56 " 1,774.00 " 202.91 316.03 111.39 725.00 194.24 173.43 378.61 97.34 108.15 790.18 987.73 110.85 111.39 108.15 457.60 98.96 173.43 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83009039 CT ORBIT SELLA W/O CONTRAST 70480 351 $572.00 211.41 95.17 " 1,774.00 " 199.44 " 1,774.00 " 113.56 " 1,774.00 " 202.91 316.03 111.39 725.00 194.24 173.43 378.61 97.34 108.15 790.18 987.73 110.85 111.39 108.15 457.60 98.96 173.43 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67709047 CT ORBIT SELLA W/CONTRAST 70481 351 $937.00 346.32 156.15 " 1,774.00 " 221.80 " 1,774.00 " 186.31 " 1,774.00 " 225.66 517.69 182.76 725.00 216.01 192.87 620.20 159.70 177.44 918.14 " 1,147.68 " 181.88 182.76 177.44 749.60 162.36 192.87 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67909046 CT ORBIT SELLA W/CONTRAST 70481 351 $937.00 346.32 156.15 " 1,774.00 " 221.80 " 1,774.00 " 186.31 " 1,774.00 " 225.66 517.69 182.76 725.00 216.01 192.87 620.20 159.70 177.44 918.14 " 1,147.68 " 181.88 182.76 177.44 749.60 162.36 192.87 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80609043 CT ORBIT SELLA W/CONT 70481 351 $937.00 346.32 156.15 " 1,774.00 " 221.80 " 1,774.00 " 186.31 " 1,774.00 " 225.66 517.69 182.76 725.00 216.01 192.87 620.20 159.70 177.44 918.14 " 1,147.68 " 181.88 182.76 177.44 749.60 162.36 192.87 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81409048 CT ORBIT SELLA W/CONTRAST 70481 351 $937.00 346.32 156.15 " 1,774.00 " 221.80 " 1,774.00 " 186.31 " 1,774.00 " 225.66 517.69 182.76 725.00 216.01 192.87 620.20 159.70 177.44 918.14 " 1,147.68 " 181.88 182.76 177.44 749.60 162.36 192.87 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81609047 CT ORBIT SELLA W/CONTRAST 70481 351 $937.00 346.32 156.15 " 1,774.00 " 221.80 " 1,774.00 " 186.31 " 1,774.00 " 225.66 517.69 182.76 725.00 216.01 192.87 620.20 159.70 177.44 918.14 " 1,147.68 " 181.88 182.76 177.44 749.60 162.36 192.87 467.80 156.15 383.23 702.75 356.15 419.12 183.65 83009047 CT ORBIT SELLA W/CONTRAST 70481 351 $937.00 346.32 156.15 " 1,774.00 " 221.80 " 1,774.00 " 186.31 " 1,774.00 " 225.66 517.69 182.76 725.00 216.01 192.87 620.20 159.70 177.44 918.14 " 1,147.68 " 181.88 182.76 177.44 749.60 162.36 192.87 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67709055 CT ORBIT SELLA WO/W CONTRAST 70482 351 $937.00 346.32 156.15 " 1,774.00 " 251.65 " 1,774.00 " 186.31 " 1,774.00 " 256.03 517.69 182.76 725.00 245.09 218.83 620.20 159.70 177.44 " 1,099.32 " " 1,374.15 " 181.88 182.76 177.44 749.60 162.36 218.83 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67909054 CT ORBIT SELLA WO/W CONTRAST 70482 351 $937.00 346.32 156.15 " 1,774.00 " 251.65 " 1,774.00 " 186.31 " 1,774.00 " 256.03 517.69 182.76 725.00 245.09 218.83 620.20 159.70 177.44 " 1,099.32 " " 1,374.15 " 181.88 182.76 177.44 749.60 162.36 218.83 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80609051 CT ORBIT SELLA WO/W CONT 70482 351 $937.00 346.32 156.15 " 1,774.00 " 251.65 " 1,774.00 " 186.31 " 1,774.00 " 256.03 517.69 182.76 725.00 245.09 218.83 620.20 159.70 177.44 " 1,099.32 " " 1,374.15 " 181.88 182.76 177.44 749.60 162.36 218.83 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81409056 CT ORBIT SELLA WO/W CONTRAST 70482 351 $937.00 346.32 156.15 " 1,774.00 " 251.65 " 1,774.00 " 186.31 " 1,774.00 " 256.03 517.69 182.76 725.00 245.09 218.83 620.20 159.70 177.44 " 1,099.32 " " 1,374.15 " 181.88 182.76 177.44 749.60 162.36 218.83 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81609055 CT ORBIT SELLA WO/W CONTRAST 70482 351 $937.00 346.32 156.15 " 1,774.00 " 251.65 " 1,774.00 " 186.31 " 1,774.00 " 256.03 517.69 182.76 725.00 245.09 218.83 620.20 159.70 177.44 " 1,099.32 " " 1,374.15 " 181.88 182.76 177.44 749.60 162.36 218.83 467.80 156.15 383.23 702.75 356.15 419.12 183.65 83009055 CT ORBIT SELLA WO/W CONTRAST 70482 351 $937.00 346.32 156.15 " 1,774.00 " 251.65 " 1,774.00 " 186.31 " 1,774.00 " 256.03 517.69 182.76 725.00 245.09 218.83 620.20 159.70 177.44 " 1,099.32 " " 1,374.15 " 181.88 182.76 177.44 749.60 162.36 218.83 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67709063 CT MAXILLOFACIAL W/O CONTRAST 70486 351 $572.00 211.41 95.17 " 1,774.00 " 149.50 " 1,774.00 " 113.56 " 1,774.00 " 152.10 316.03 111.39 725.00 145.60 130.00 378.61 97.34 108.15 764.54 955.68 110.85 111.39 108.15 457.60 98.96 130.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67909062 CT MAXILLOFACIAL W/O CONTRAST 70486 351 $572.00 211.41 95.17 " 1,774.00 " 149.50 " 1,774.00 " 113.56 " 1,774.00 " 152.10 316.03 111.39 725.00 145.60 130.00 378.61 97.34 108.15 764.54 955.68 110.85 111.39 108.15 457.60 98.96 130.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80609060 CT MAXILLOFACIAL W/O CONT 70486 351 $572.00 211.41 95.17 " 1,774.00 " 149.50 " 1,774.00 " 113.56 " 1,774.00 " 152.10 316.03 111.39 725.00 145.60 130.00 378.61 97.34 108.15 764.54 955.68 110.85 111.39 108.15 457.60 98.96 130.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81409064 CT MAXILLOFACIAL W/O CONTRAST 70486 351 $572.00 211.41 95.17 " 1,774.00 " 149.50 " 1,774.00 " 113.56 " 1,774.00 " 152.10 316.03 111.39 725.00 145.60 130.00 378.61 97.34 108.15 764.54 955.68 110.85 111.39 108.15 457.60 98.96 130.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81609063 CT MAXILLOFACIAL W/O CONTRAST 70486 351 $572.00 211.41 95.17 " 1,774.00 " 149.50 " 1,774.00 " 113.56 " 1,774.00 " 152.10 316.03 111.39 725.00 145.60 130.00 378.61 97.34 108.15 764.54 955.68 110.85 111.39 108.15 457.60 98.96 130.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83009063 CT MAXILLOFACIAL W/O CONTRAST 70486 351 $572.00 211.41 95.17 " 1,774.00 " 149.50 " 1,774.00 " 113.56 " 1,774.00 " 152.10 316.03 111.39 725.00 145.60 130.00 378.61 97.34 108.15 764.54 955.68 110.85 111.39 108.15 457.60 98.96 130.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67709071 CT MAXILLOFACIAL W/CONTRAST 70487 351 $937.00 346.32 134.00 " 1,774.00 " 154.10 " 1,774.00 " 186.31 " 1,774.00 " 156.78 517.69 182.76 725.00 150.08 134.00 620.20 159.70 177.44 904.38 " 1,130.48 " 181.88 182.76 177.44 749.60 162.36 134.00 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67909071 CT MAXILLOFACIAL W/CONTRAST 70487 351 $937.00 346.32 134.00 " 1,774.00 " 154.10 " 1,774.00 " 186.31 " 1,774.00 " 156.78 517.69 182.76 725.00 150.08 134.00 620.20 159.70 177.44 904.38 " 1,130.48 " 181.88 182.76 177.44 749.60 162.36 134.00 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80609078 CT MAXILLOFACIAL W/CONT 70487 351 $937.00 346.32 134.00 " 1,774.00 " 154.10 " 1,774.00 " 186.31 " 1,774.00 " 156.78 517.69 182.76 725.00 150.08 134.00 620.20 159.70 177.44 904.38 " 1,130.48 " 181.88 182.76 177.44 749.60 162.36 134.00 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81409072 CT MAXILLOFACIAL W/CONTRAST 70487 351 $937.00 346.32 134.00 " 1,774.00 " 154.10 " 1,774.00 " 186.31 " 1,774.00 " 156.78 517.69 182.76 725.00 150.08 134.00 620.20 159.70 177.44 904.38 " 1,130.48 " 181.88 182.76 177.44 749.60 162.36 134.00 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81609071 CT MAXILLOFACIAL W/CONTRAST 70487 351 $937.00 346.32 134.00 " 1,774.00 " 154.10 " 1,774.00 " 186.31 " 1,774.00 " 156.78 517.69 182.76 725.00 150.08 134.00 620.20 159.70 177.44 904.38 " 1,130.48 " 181.88 182.76 177.44 749.60 162.36 134.00 467.80 156.15 383.23 702.75 356.15 419.12 183.65 83009071 CT MAXILLOFACIAL W/CONTRAST 70487 351 $937.00 346.32 134.00 " 1,774.00 " 154.10 " 1,774.00 " 186.31 " 1,774.00 " 156.78 517.69 182.76 725.00 150.08 134.00 620.20 159.70 177.44 904.38 " 1,130.48 " 181.88 182.76 177.44 749.60 162.36 134.00 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67709080 CT MAXILLOFACIAL WO/W CONTRAST 70488 351 $937.00 346.32 156.15 " 1,774.00 " 190.59 " 1,774.00 " 186.31 " 1,774.00 " 193.90 517.69 182.76 725.00 185.62 165.73 620.20 159.70 177.44 " 1,094.71 " " 1,368.39 " 181.88 182.76 177.44 749.60 162.36 165.73 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67909089 CT MAXILLOFACIAL WO/W CONTRAST 70488 351 $937.00 346.32 156.15 " 1,774.00 " 190.59 " 1,774.00 " 186.31 " 1,774.00 " 193.90 517.69 182.76 725.00 185.62 165.73 620.20 159.70 177.44 " 1,094.71 " " 1,368.39 " 181.88 182.76 177.44 749.60 162.36 165.73 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80609086 CT MAXILLOFACIAL WO/W CONT 70488 351 $937.00 346.32 156.15 " 1,774.00 " 190.59 " 1,774.00 " 186.31 " 1,774.00 " 193.90 517.69 182.76 725.00 185.62 165.73 620.20 159.70 177.44 " 1,094.71 " " 1,368.39 " 181.88 182.76 177.44 749.60 162.36 165.73 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81409081 CT MAXILLOFACIAL WO/W CONTRAST 70488 351 $937.00 346.32 156.15 " 1,774.00 " 190.59 " 1,774.00 " 186.31 " 1,774.00 " 193.90 517.69 182.76 725.00 185.62 165.73 620.20 159.70 177.44 " 1,094.71 " " 1,368.39 " 181.88 182.76 177.44 749.60 162.36 165.73 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81609080 CT MAXILLOFACIAL WO/W CONTRAST 70488 351 $937.00 346.32 156.15 " 1,774.00 " 190.59 " 1,774.00 " 186.31 " 1,774.00 " 193.90 517.69 182.76 725.00 185.62 165.73 620.20 159.70 177.44 " 1,094.71 " " 1,368.39 " 181.88 182.76 177.44 749.60 162.36 165.73 467.80 156.15 383.23 702.75 356.15 419.12 183.65 83009080 CT MAXILLOFACIAL WO/W CONTRAST 70488 351 $937.00 346.32 156.15 " 1,774.00 " 190.59 " 1,774.00 " 186.31 " 1,774.00 " 193.90 517.69 182.76 725.00 185.62 165.73 620.20 159.70 177.44 " 1,094.71 " " 1,368.39 " 181.88 182.76 177.44 749.60 162.36 165.73 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67709098 CT NECK W/O CONTRAST 70490 351 $572.00 211.41 95.17 " 1,774.00 " 151.23 " 1,774.00 " 113.56 " 1,774.00 " 153.86 316.03 111.39 725.00 147.28 131.50 378.61 97.34 108.15 790.18 987.73 110.85 111.39 108.15 457.60 98.96 131.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67909097 CT NECK W/O CONTRAST 70490 351 $572.00 211.41 95.17 " 1,774.00 " 151.23 " 1,774.00 " 113.56 " 1,774.00 " 153.86 316.03 111.39 725.00 147.28 131.50 378.61 97.34 108.15 790.18 987.73 110.85 111.39 108.15 457.60 98.96 131.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80609094 CT NECK W/O CONTRAST 70490 351 $572.00 211.41 95.17 " 1,774.00 " 151.23 " 1,774.00 " 113.56 " 1,774.00 " 153.86 316.03 111.39 725.00 147.28 131.50 378.61 97.34 108.15 790.18 987.73 110.85 111.39 108.15 457.60 98.96 131.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81409099 CT NECK W/O CONTRAST 70490 351 $572.00 211.41 95.17 " 1,774.00 " 151.23 " 1,774.00 " 113.56 " 1,774.00 " 153.86 316.03 111.39 725.00 147.28 131.50 378.61 97.34 108.15 790.18 987.73 110.85 111.39 108.15 457.60 98.96 131.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81609098 CT NECK W/O CONTRAST 70490 351 $572.00 211.41 95.17 " 1,774.00 " 151.23 " 1,774.00 " 113.56 " 1,774.00 " 153.86 316.03 111.39 725.00 147.28 131.50 378.61 97.34 108.15 790.18 987.73 110.85 111.39 108.15 457.60 98.96 131.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83009098 CT NECK W/O CONTRAST 70490 351 $572.00 211.41 95.17 " 1,774.00 " 151.23 " 1,774.00 " 113.56 " 1,774.00 " 153.86 316.03 111.39 725.00 147.28 131.50 378.61 97.34 108.15 790.18 987.73 110.85 111.39 108.15 457.60 98.96 131.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67709101 CT NECK W/CONTRAST 70491 351 $937.00 346.32 137.50 " 1,774.00 " 158.13 " 1,774.00 " 186.31 " 1,774.00 " 160.88 517.69 182.76 725.00 154.00 137.50 620.20 159.70 177.44 918.14 " 1,147.68 " 181.88 182.76 177.44 749.60 162.36 137.50 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67909101 CT NECK W/CONTRAST 70491 351 $937.00 346.32 137.50 " 1,774.00 " 158.13 " 1,774.00 " 186.31 " 1,774.00 " 160.88 517.69 182.76 725.00 154.00 137.50 620.20 159.70 177.44 918.14 " 1,147.68 " 181.88 182.76 177.44 749.60 162.36 137.50 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80609108 CT NECK W/CONTRAST 70491 351 $937.00 346.32 137.50 " 1,774.00 " 158.13 " 1,774.00 " 186.31 " 1,774.00 " 160.88 517.69 182.76 725.00 154.00 137.50 620.20 159.70 177.44 918.14 " 1,147.68 " 181.88 182.76 177.44 749.60 162.36 137.50 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81409102 CT NECK W/CONTRAST 70491 351 $937.00 346.32 137.50 " 1,774.00 " 158.13 " 1,774.00 " 186.31 " 1,774.00 " 160.88 517.69 182.76 725.00 154.00 137.50 620.20 159.70 177.44 918.14 " 1,147.68 " 181.88 182.76 177.44 749.60 162.36 137.50 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81609101 CT NECK W/CONTRAST 70491 351 $937.00 346.32 137.50 " 1,774.00 " 158.13 " 1,774.00 " 186.31 " 1,774.00 " 160.88 517.69 182.76 725.00 154.00 137.50 620.20 159.70 177.44 918.14 " 1,147.68 " 181.88 182.76 177.44 749.60 162.36 137.50 467.80 156.15 383.23 702.75 356.15 419.12 183.65 83009101 CT NECK W/CONTRAST 70491 351 $937.00 346.32 137.50 " 1,774.00 " 158.13 " 1,774.00 " 186.31 " 1,774.00 " 160.88 517.69 182.76 725.00 154.00 137.50 620.20 159.70 177.44 918.14 " 1,147.68 " 181.88 182.76 177.44 749.60 162.36 137.50 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67709110 CT NECK WO/W CONTRAST 70492 351 $937.00 346.32 154.00 " 1,774.00 " 177.10 " 1,774.00 " 186.31 " 1,774.00 " 180.18 517.69 182.76 725.00 172.48 154.00 620.20 159.70 177.44 " 1,099.32 " " 1,374.15 " 181.88 182.76 177.44 749.60 162.36 154.00 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67909119 CT NECK WO/W CONTRAST 70492 351 $937.00 346.32 154.00 " 1,774.00 " 177.10 " 1,774.00 " 186.31 " 1,774.00 " 180.18 517.69 182.76 725.00 172.48 154.00 620.20 159.70 177.44 " 1,099.32 " " 1,374.15 " 181.88 182.76 177.44 749.60 162.36 154.00 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80609116 CT NECK WO/W CONTRAST 70492 351 $937.00 346.32 154.00 " 1,774.00 " 177.10 " 1,774.00 " 186.31 " 1,774.00 " 180.18 517.69 182.76 725.00 172.48 154.00 620.20 159.70 177.44 " 1,099.32 " " 1,374.15 " 181.88 182.76 177.44 749.60 162.36 154.00 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81409111 CT NECK WO/W CONTRAST 70492 351 $937.00 346.32 154.00 " 1,774.00 " 177.10 " 1,774.00 " 186.31 " 1,774.00 " 180.18 517.69 182.76 725.00 172.48 154.00 620.20 159.70 177.44 " 1,099.32 " " 1,374.15 " 181.88 182.76 177.44 749.60 162.36 154.00 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81609110 CT NECK WO/W CONTRAST 70492 351 $937.00 346.32 154.00 " 1,774.00 " 177.10 " 1,774.00 " 186.31 " 1,774.00 " 180.18 517.69 182.76 725.00 172.48 154.00 620.20 159.70 177.44 " 1,099.32 " " 1,374.15 " 181.88 182.76 177.44 749.60 162.36 154.00 467.80 156.15 383.23 702.75 356.15 419.12 183.65 83009110 CT NECK WO/W CONTRAST 70492 351 $937.00 346.32 154.00 " 1,774.00 " 177.10 " 1,774.00 " 186.31 " 1,774.00 " 180.18 517.69 182.76 725.00 172.48 154.00 620.20 159.70 177.44 " 1,099.32 " " 1,374.15 " 181.88 182.76 177.44 749.60 162.36 154.00 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67709683 CTA HEAD WO/W CONTRAST 70496 351 $937.00 346.32 156.15 " 1,774.00 " 323.48 " 1,774.00 " 186.31 " 1,774.00 " 329.11 517.69 182.76 725.00 315.04 281.29 620.20 159.70 177.44 " 1,214.83 " " 1,518.54 " 181.88 182.76 177.44 749.60 162.36 281.29 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67909682 CTA HEAD WO/W CONTRAST 70496 351 $937.00 346.32 156.15 " 1,774.00 " 323.48 " 1,774.00 " 186.31 " 1,774.00 " 329.11 517.69 182.76 725.00 315.04 281.29 620.20 159.70 177.44 " 1,214.83 " " 1,518.54 " 181.88 182.76 177.44 749.60 162.36 281.29 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80609680 CTA HEAD WO/W CONTRAST 70496 351 $937.00 346.32 156.15 " 1,774.00 " 323.48 " 1,774.00 " 186.31 " 1,774.00 " 329.11 517.69 182.76 725.00 315.04 281.29 620.20 159.70 177.44 " 1,214.83 " " 1,518.54 " 181.88 182.76 177.44 749.60 162.36 281.29 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81409684 CTA HEAD WO/W CONTRAST 70496 351 $937.00 346.32 156.15 " 1,774.00 " 323.48 " 1,774.00 " 186.31 " 1,774.00 " 329.11 517.69 182.76 725.00 315.04 281.29 620.20 159.70 177.44 " 1,214.83 " " 1,518.54 " 181.88 182.76 177.44 749.60 162.36 281.29 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81609683 CTA HEAD WO/W CONTRAST 70496 351 $937.00 346.32 156.15 " 1,774.00 " 323.48 " 1,774.00 " 186.31 " 1,774.00 " 329.11 517.69 182.76 725.00 315.04 281.29 620.20 159.70 177.44 " 1,214.83 " " 1,518.54 " 181.88 182.76 177.44 749.60 162.36 281.29 467.80 156.15 383.23 702.75 356.15 419.12 183.65 83009683 CTA HEAD WO/W CONTRAST 70496 351 $937.00 346.32 156.15 " 1,774.00 " 323.48 " 1,774.00 " 186.31 " 1,774.00 " 329.11 517.69 182.76 725.00 315.04 281.29 620.20 159.70 177.44 " 1,214.83 " " 1,518.54 " 181.88 182.76 177.44 749.60 162.36 281.29 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67709691 CTA NECK WO/W CONTRAST 70498 351 $937.00 346.32 156.15 " 1,774.00 " 323.48 " 1,774.00 " 186.31 " 1,774.00 " 329.11 517.69 182.76 725.00 315.04 281.29 620.20 159.70 177.44 " 1,214.83 " " 1,518.54 " 181.88 182.76 177.44 749.60 162.36 281.29 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67909691 CTA NECK WO/W CONTRAST 70498 351 $937.00 346.32 156.15 " 1,774.00 " 323.48 " 1,774.00 " 186.31 " 1,774.00 " 329.11 517.69 182.76 725.00 315.04 281.29 620.20 159.70 177.44 " 1,214.83 " " 1,518.54 " 181.88 182.76 177.44 749.60 162.36 281.29 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80609698 CTA NECK WO/W CONTRAST 70498 351 $937.00 346.32 156.15 " 1,774.00 " 323.48 " 1,774.00 " 186.31 " 1,774.00 " 329.11 517.69 182.76 725.00 315.04 281.29 620.20 159.70 177.44 " 1,214.83 " " 1,518.54 " 181.88 182.76 177.44 749.60 162.36 281.29 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81409692 CTA NECK WO/W CONTRAST 70498 351 $937.00 346.32 156.15 " 1,774.00 " 323.48 " 1,774.00 " 186.31 " 1,774.00 " 329.11 517.69 182.76 725.00 315.04 281.29 620.20 159.70 177.44 " 1,214.83 " " 1,518.54 " 181.88 182.76 177.44 749.60 162.36 281.29 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81609691 CTA NECK WO/W CONTRAST 70498 351 $937.00 346.32 156.15 " 1,774.00 " 323.48 " 1,774.00 " 186.31 " 1,774.00 " 329.11 517.69 182.76 725.00 315.04 281.29 620.20 159.70 177.44 " 1,214.83 " " 1,518.54 " 181.88 182.76 177.44 749.60 162.36 281.29 467.80 156.15 383.23 702.75 356.15 419.12 183.65 83009691 CTA NECK WO/W CONTRAST 70498 351 $937.00 346.32 156.15 " 1,774.00 " 323.48 " 1,774.00 " 186.31 " 1,774.00 " 329.11 517.69 182.76 725.00 315.04 281.29 620.20 159.70 177.44 " 1,214.83 " " 1,518.54 " 181.88 182.76 177.44 749.60 162.36 281.29 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80407050 MRI ORBIT FACE NECK W/O CONT 70540 614 "$1,208.00" 446.48 201.14 " 2,882.00 " 381.10 " 2,882.00 " 240.00 " 2,882.00 " 387.73 667.42 235.43 " 1,155.00 " 371.16 331.39 799.58 205.71 228.57 " 1,596.58 " " 1,995.72 " 234.28 235.43 228.57 966.40 209.14 331.39 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81407053 MRI ORBIT FACE NECK W/O CONT 70540 614 "$1,208.00" 446.48 201.14 " 2,882.00 " 381.10 " 2,882.00 " 240.00 " 2,882.00 " 387.73 667.42 235.43 " 1,155.00 " 371.16 331.39 799.58 205.71 228.57 " 1,596.58 " " 1,995.72 " 234.28 235.43 228.57 966.40 209.14 331.39 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81607052 MRI ORBIT FACE NECK W/O CONT 70540 614 "$1,208.00" 446.48 201.14 " 2,882.00 " 381.10 " 2,882.00 " 240.00 " 2,882.00 " 387.73 667.42 235.43 " 1,155.00 " 371.16 331.39 799.58 205.71 228.57 " 1,596.58 " " 1,995.72 " 234.28 235.43 228.57 966.40 209.14 331.39 602.94 201.14 494.07 906.00 459.16 540.34 236.57 80407041 MRI ORBIT FACE NECK W/CONTRAST 70542 614 "$1,933.00" 714.44 321.90 " 2,882.00 " 440.06 " 2,882.00 " 384.09 " 2,882.00 " 447.71 " 1,067.98 " 376.77 " 1,155.00 " 428.58 382.66 " 1,279.45 " 329.22 365.80 " 1,519.15 " " 1,898.94 " 374.95 376.77 365.80 " 1,546.40 " 334.71 382.66 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81407045 MRI ORBIT FACE NECK W/CONTRAST 70542 614 "$1,933.00" 714.44 321.90 " 2,882.00 " 440.06 " 2,882.00 " 384.09 " 2,882.00 " 447.71 " 1,067.98 " 376.77 " 1,155.00 " 428.58 382.66 " 1,279.45 " 329.22 365.80 " 1,519.15 " " 1,898.94 " 374.95 376.77 365.80 " 1,546.40 " 334.71 382.66 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81607044 MRI ORBIT FACE NECK W/CONTRAST 70542 614 "$1,933.00" 714.44 321.90 " 2,882.00 " 440.06 " 2,882.00 " 384.09 " 2,882.00 " 447.71 " 1,067.98 " 376.77 " 1,155.00 " 428.58 382.66 " 1,279.45 " 329.22 365.80 " 1,519.15 " " 1,898.94 " 374.95 376.77 365.80 " 1,546.40 " 334.71 382.66 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 80407033 MRI ORBIT FACE NECK WO/W CONT 70543 614 "$1,933.00" 714.44 321.90 " 3,514.26 " 658.44 " 2,882.00 " 384.09 " 2,882.00 " 669.90 " 1,067.98 " 376.77 " 1,155.00 " 641.27 572.56 " 1,279.45 " 329.22 365.80 " 2,811.41 " " 3,514.26 " 374.95 376.77 365.80 " 1,546.40 " 334.71 572.56 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81407037 MRI ORBIT FACE NECK WO/W CONT 70543 614 "$1,933.00" 714.44 321.90 " 3,514.26 " 658.44 " 2,882.00 " 384.09 " 2,882.00 " 669.90 " 1,067.98 " 376.77 " 1,155.00 " 641.27 572.56 " 1,279.45 " 329.22 365.80 " 2,811.41 " " 3,514.26 " 374.95 376.77 365.80 " 1,546.40 " 334.71 572.56 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81607036 MRI ORBIT FACE NECK WO/W CONT 70543 614 "$1,933.00" 714.44 321.90 " 3,514.26 " 658.44 " 2,882.00 " 384.09 " 2,882.00 " 669.90 " 1,067.98 " 376.77 " 1,155.00 " 641.27 572.56 " 1,279.45 " 329.22 365.80 " 2,811.41 " " 3,514.26 " 374.95 376.77 365.80 " 1,546.40 " 334.71 572.56 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 80407068 MRA HEAD W/O CONTRAST 70544 615 "$1,208.00" 446.48 201.14 " 2,882.00 " 371.68 " 2,882.00 " 240.00 " 2,882.00 " 378.14 667.42 235.43 " 1,155.00 " 361.98 323.20 799.58 205.71 228.57 " 1,282.26 " " 1,602.83 " 234.28 235.43 228.57 966.40 209.14 323.20 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81407061 MRA HEAD W/O CONTRAST 70544 615 "$1,208.00" 446.48 201.14 " 2,882.00 " 371.68 " 2,882.00 " 240.00 " 2,882.00 " 378.14 667.42 235.43 " 1,155.00 " 361.98 323.20 799.58 205.71 228.57 " 1,282.26 " " 1,602.83 " 234.28 235.43 228.57 966.40 209.14 323.20 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81607061 MRA HEAD W/O CONTRAST 70544 615 "$1,208.00" 446.48 201.14 " 2,882.00 " 371.68 " 2,882.00 " 240.00 " 2,882.00 " 378.14 667.42 235.43 " 1,155.00 " 361.98 323.20 799.58 205.71 228.57 " 1,282.26 " " 1,602.83 " 234.28 235.43 228.57 966.40 209.14 323.20 602.94 201.14 494.07 906.00 459.16 540.34 236.57 80407696 MRA HEAD W/CONTRAST 70545 615 "$1,933.00" 714.44 321.90 " 2,882.00 " 371.29 " 2,882.00 " 384.09 " 2,882.00 " 377.75 " 1,067.98 " 376.77 " 1,155.00 " 361.60 322.86 " 1,279.45 " 329.22 365.80 " 1,282.26 " " 1,602.83 " 374.95 376.77 365.80 " 1,546.40 " 334.71 322.86 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81407690 MRA HEAD W/CONTRAST 70545 615 "$1,933.00" 714.44 321.90 " 2,882.00 " 371.29 " 2,882.00 " 384.09 " 2,882.00 " 377.75 " 1,067.98 " 376.77 " 1,155.00 " 361.60 322.86 " 1,279.45 " 329.22 365.80 " 1,282.26 " " 1,602.83 " 374.95 376.77 365.80 " 1,546.40 " 334.71 322.86 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81607699 MRA HEAD W/CONTRAST 70545 615 "$1,933.00" 714.44 321.90 " 2,882.00 " 371.29 " 2,882.00 " 384.09 " 2,882.00 " 377.75 " 1,067.98 " 376.77 " 1,155.00 " 361.60 322.86 " 1,279.45 " 329.22 365.80 " 1,282.26 " " 1,602.83 " 374.95 376.77 365.80 " 1,546.40 " 334.71 322.86 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 80407700 MRA HEAD WO/W CONTRAST 70546 615 "$1,933.00" 714.44 321.90 " 3,147.79 " 640.15 " 2,882.00 " 384.09 " 2,882.00 " 651.28 " 1,067.98 " 376.77 " 1,155.00 " 623.45 556.65 " 1,279.45 " 329.22 365.80 " 2,518.23 " " 3,147.79 " 374.95 376.77 365.80 " 1,546.40 " 334.71 556.65 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81407703 MRA HEAD WO/W CONTRAST 70546 615 "$1,933.00" 714.44 321.90 " 3,147.79 " 640.15 " 2,882.00 " 384.09 " 2,882.00 " 651.28 " 1,067.98 " 376.77 " 1,155.00 " 623.45 556.65 " 1,279.45 " 329.22 365.80 " 2,518.23 " " 3,147.79 " 374.95 376.77 365.80 " 1,546.40 " 334.71 556.65 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81607702 MRA HEAD WO/W CONTRAST 70546 615 "$1,933.00" 714.44 321.90 " 3,147.79 " 640.15 " 2,882.00 " 384.09 " 2,882.00 " 651.28 " 1,067.98 " 376.77 " 1,155.00 " 623.45 556.65 " 1,279.45 " 329.22 365.80 " 2,518.23 " " 3,147.79 " 374.95 376.77 365.80 " 1,546.40 " 334.71 556.65 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 80407556 MRA NECK W/O CONTRAST 70547 615 "$1,208.00" 446.48 201.14 " 2,882.00 " 371.29 " 2,882.00 " 240.00 " 2,882.00 " 377.75 667.42 235.43 " 1,155.00 " 361.60 322.86 799.58 205.71 228.57 " 1,282.26 " " 1,602.83 " 234.28 235.43 228.57 966.40 209.14 322.86 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81407550 MRA NECK W/O CONTRAST 70547 615 "$1,208.00" 446.48 201.14 " 2,882.00 " 371.29 " 2,882.00 " 240.00 " 2,882.00 " 377.75 667.42 235.43 " 1,155.00 " 361.60 322.86 799.58 205.71 228.57 " 1,282.26 " " 1,602.83 " 234.28 235.43 228.57 966.40 209.14 322.86 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81607559 MRA NECK W/O CONTRAST 70547 615 "$1,208.00" 446.48 201.14 " 2,882.00 " 371.29 " 2,882.00 " 240.00 " 2,882.00 " 377.75 667.42 235.43 " 1,155.00 " 361.60 322.86 799.58 205.71 228.57 " 1,282.26 " " 1,602.83 " 234.28 235.43 228.57 966.40 209.14 322.86 602.94 201.14 494.07 906.00 459.16 540.34 236.57 80407718 MRA NECK W/CONTRAST 70548 615 "$1,933.00" 714.44 321.90 " 2,882.00 " 371.29 " 2,882.00 " 384.09 " 2,882.00 " 377.75 " 1,067.98 " 376.77 " 1,155.00 " 361.60 322.86 " 1,279.45 " 329.22 365.80 " 1,282.26 " " 1,602.83 " 374.95 376.77 365.80 " 1,546.40 " 334.71 322.86 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81407711 MRA NECK W/CONTRAST 70548 615 "$1,933.00" 714.44 321.90 " 2,882.00 " 371.29 " 2,882.00 " 384.09 " 2,882.00 " 377.75 " 1,067.98 " 376.77 " 1,155.00 " 361.60 322.86 " 1,279.45 " 329.22 365.80 " 1,282.26 " " 1,602.83 " 374.95 376.77 365.80 " 1,546.40 " 334.71 322.86 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81607711 MRA NECK W/CONTRAST 70548 615 "$1,933.00" 714.44 321.90 " 2,882.00 " 371.29 " 2,882.00 " 384.09 " 2,882.00 " 377.75 " 1,067.98 " 376.77 " 1,155.00 " 361.60 322.86 " 1,279.45 " 329.22 365.80 " 1,282.26 " " 1,602.83 " 374.95 376.77 365.80 " 1,546.40 " 334.71 322.86 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 80407726 MRA NECK WO/W CONTRAST 70549 615 "$1,933.00" 714.44 321.90 " 3,147.79 " 641.67 " 2,882.00 " 384.09 " 2,882.00 " 652.82 " 1,067.98 " 376.77 " 1,155.00 " 624.93 557.97 " 1,279.45 " 329.22 365.80 " 2,518.23 " " 3,147.79 " 374.95 376.77 365.80 " 1,546.40 " 334.71 557.97 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81407720 MRA NECK WO/W CONTRAST 70549 615 "$1,933.00" 714.44 321.90 " 3,147.79 " 641.67 " 2,882.00 " 384.09 " 2,882.00 " 652.82 " 1,067.98 " 376.77 " 1,155.00 " 624.93 557.97 " 1,279.45 " 329.22 365.80 " 2,518.23 " " 3,147.79 " 374.95 376.77 365.80 " 1,546.40 " 334.71 557.97 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81607729 MRA NECK WO/W CONTRAST 70549 615 "$1,933.00" 714.44 321.90 " 3,147.79 " 641.67 " 2,882.00 " 384.09 " 2,882.00 " 652.82 " 1,067.98 " 376.77 " 1,155.00 " 624.93 557.97 " 1,279.45 " 329.22 365.80 " 2,518.23 " " 3,147.79 " 374.95 376.77 365.80 " 1,546.40 " 334.71 557.97 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 80407076 MRI BRAIN W/O CONTRAST 70551 611 "$1,208.00" 446.48 201.14 " 2,882.00 " 388.25 " 2,882.00 " 240.00 " 2,882.00 " 395.00 667.42 235.43 " 1,155.00 " 378.12 337.61 799.58 205.71 228.57 " 1,596.58 " " 1,995.72 " 234.28 235.43 228.57 966.40 209.14 337.61 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81407070 MRI BRAIN W/O CONTRAST 70551 611 "$1,208.00" 446.48 201.14 " 2,882.00 " 388.25 " 2,882.00 " 240.00 " 2,882.00 " 395.00 667.42 235.43 " 1,155.00 " 378.12 337.61 799.58 205.71 228.57 " 1,596.58 " " 1,995.72 " 234.28 235.43 228.57 966.40 209.14 337.61 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81607079 MRI BRAIN W/O CONTRAST 70551 611 "$1,208.00" 446.48 201.14 " 2,882.00 " 388.25 " 2,882.00 " 240.00 " 2,882.00 " 395.00 667.42 235.43 " 1,155.00 " 378.12 337.61 799.58 205.71 228.57 " 1,596.58 " " 1,995.72 " 234.28 235.43 228.57 966.40 209.14 337.61 602.94 201.14 494.07 906.00 459.16 540.34 236.57 80407084 MRI BRAIN W/CONTRAST 70552 611 "$1,933.00" 714.44 321.90 " 2,882.00 " 389.85 " 2,882.00 " 384.09 " 2,882.00 " 396.63 " 1,067.98 " 376.77 " 1,155.00 " 379.68 339.00 " 1,279.45 " 329.22 365.80 " 1,917.54 " " 2,396.92 " 374.95 376.77 365.80 " 1,546.40 " 334.71 339.00 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81407088 MRI BRAIN W/CONTRAST 70552 611 "$1,933.00" 714.44 321.90 " 2,882.00 " 389.85 " 2,882.00 " 384.09 " 2,882.00 " 396.63 " 1,067.98 " 376.77 " 1,155.00 " 379.68 339.00 " 1,279.45 " 329.22 365.80 " 1,917.54 " " 2,396.92 " 374.95 376.77 365.80 " 1,546.40 " 334.71 339.00 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81607087 MRI BRAIN W/CONTRAST 70552 611 "$1,933.00" 714.44 321.90 " 2,882.00 " 389.85 " 2,882.00 " 384.09 " 2,882.00 " 396.63 " 1,067.98 " 376.77 " 1,155.00 " 379.68 339.00 " 1,279.45 " 329.22 365.80 " 1,917.54 " " 2,396.92 " 374.95 376.77 365.80 " 1,546.40 " 334.71 339.00 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 80407092 MRI BRAIN WO/W CONTRAST 70553 611 "$1,933.00" 714.44 321.90 " 4,231.06 " 389.85 " 2,882.00 " 384.09 " 2,882.00 " 396.63 " 1,067.98 " 376.77 " 1,155.00 " 379.68 339.00 " 1,279.45 " 329.22 365.80 " 3,384.85 " " 4,231.06 " 374.95 376.77 365.80 " 1,546.40 " 334.71 339.00 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81407096 MRI BRAIN WO/W CONTRAST 70553 611 "$1,933.00" 714.44 321.90 " 4,231.06 " 389.85 " 2,882.00 " 384.09 " 2,882.00 " 396.63 " 1,067.98 " 376.77 " 1,155.00 " 379.68 339.00 " 1,279.45 " 329.22 365.80 " 3,384.85 " " 4,231.06 " 374.95 376.77 365.80 " 1,546.40 " 334.71 339.00 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81607095 MRI BRAIN WO/W CONTRAST 70553 611 "$1,933.00" 714.44 321.90 " 4,231.06 " 389.85 " 2,882.00 " 384.09 " 2,882.00 " 396.63 " 1,067.98 " 376.77 " 1,155.00 " 379.68 339.00 " 1,279.45 " 329.22 365.80 " 3,384.85 " " 4,231.06 " 374.95 376.77 365.80 " 1,546.40 " 334.71 339.00 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 67936221 XR CHEST 1VW 71045 320 $425.00 157.08 15.48 340.00 17.80 293.68 84.37 293.68 18.11 234.81 82.76 280.50 17.34 15.48 281.31 72.32 80.35 53.05 66.31 82.36 82.76 80.35 340.00 73.52 15.48 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80136226 XR CHEST 1VW 71045 320 $425.00 157.08 15.48 340.00 17.80 293.68 84.37 293.68 18.11 234.81 82.76 280.50 17.34 15.48 281.31 72.32 80.35 53.05 66.31 82.36 82.76 80.35 340.00 73.52 15.48 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81436223 XR CHEST 1VW 71045 320 $425.00 157.08 15.48 340.00 17.80 293.68 84.37 293.68 18.11 234.81 82.76 280.50 17.34 15.48 281.31 72.32 80.35 53.05 66.31 82.36 82.76 80.35 340.00 73.52 15.48 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81636222 XR CHEST 1VW 71045 320 $425.00 157.08 15.48 340.00 17.80 293.68 84.37 293.68 18.11 234.81 82.76 280.50 17.34 15.48 281.31 72.32 80.35 53.05 66.31 82.36 82.76 80.35 340.00 73.52 15.48 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81736227 XR CHEST 1VW 71045 320 $425.00 157.08 15.48 340.00 17.80 293.68 84.37 293.68 18.11 234.81 82.76 280.50 17.34 15.48 281.31 72.32 80.35 53.05 66.31 82.36 82.76 80.35 340.00 73.52 15.48 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82636226 XR CHEST 1VW 71045 320 $425.00 157.08 15.48 340.00 17.80 293.68 84.37 293.68 18.11 234.81 82.76 280.50 17.34 15.48 281.31 72.32 80.35 53.05 66.31 82.36 82.76 80.35 340.00 73.52 15.48 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82936220 XR CHEST 1VW 71045 320 $425.00 157.08 15.48 340.00 17.80 293.68 84.37 293.68 18.11 234.81 82.76 280.50 17.34 15.48 281.31 72.32 80.35 53.05 66.31 82.36 82.76 80.35 340.00 73.52 15.48 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83036222 XR CHEST 1VW 71045 320 $425.00 157.08 15.48 340.00 17.80 293.68 84.37 293.68 18.11 234.81 82.76 280.50 17.34 15.48 281.31 72.32 80.35 53.05 66.31 82.36 82.76 80.35 340.00 73.52 15.48 211.96 70.71 173.83 318.75 161.54 190.10 83.16 67936230 XR CHEST 2VWS 71046 320 $425.00 157.08 23.64 340.00 27.19 293.68 84.37 293.68 27.66 234.81 82.76 280.50 26.48 23.64 281.31 72.32 80.35 97.15 121.44 82.36 82.76 80.35 340.00 73.52 23.64 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80136234 XR CHEST 2VWS 71046 320 $425.00 157.08 23.64 340.00 27.19 293.68 84.37 293.68 27.66 234.81 82.76 280.50 26.48 23.64 281.31 72.32 80.35 97.15 121.44 82.36 82.76 80.35 340.00 73.52 23.64 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81436231 XR CHEST 2VWS 71046 320 $425.00 157.08 23.64 340.00 27.19 293.68 84.37 293.68 27.66 234.81 82.76 280.50 26.48 23.64 281.31 72.32 80.35 97.15 121.44 82.36 82.76 80.35 340.00 73.52 23.64 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81636231 XR CHEST 2VWS 71046 320 $425.00 157.08 23.64 340.00 27.19 293.68 84.37 293.68 27.66 234.81 82.76 280.50 26.48 23.64 281.31 72.32 80.35 97.15 121.44 82.36 82.76 80.35 340.00 73.52 23.64 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81736235 XR CHEST 2VWS 71046 320 $425.00 157.08 23.64 340.00 27.19 293.68 84.37 293.68 27.66 234.81 82.76 280.50 26.48 23.64 281.31 72.32 80.35 97.15 121.44 82.36 82.76 80.35 340.00 73.52 23.64 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82636234 XR CHEST 2VWS 71046 320 $425.00 157.08 23.64 340.00 27.19 293.68 84.37 293.68 27.66 234.81 82.76 280.50 26.48 23.64 281.31 72.32 80.35 97.15 121.44 82.36 82.76 80.35 340.00 73.52 23.64 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82936238 XR CHEST 2VWS 71046 320 $425.00 157.08 23.64 340.00 27.19 293.68 84.37 293.68 27.66 234.81 82.76 280.50 26.48 23.64 281.31 72.32 80.35 97.15 121.44 82.36 82.76 80.35 340.00 73.52 23.64 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83036231 XR CHEST 2VWS 71046 320 $425.00 157.08 23.64 340.00 27.19 293.68 84.37 293.68 27.66 234.81 82.76 280.50 26.48 23.64 281.31 72.32 80.35 97.15 121.44 82.36 82.76 80.35 340.00 73.52 23.64 211.96 70.71 173.83 318.75 161.54 190.10 83.16 67936248 XR CHEST 3VWS 71047 320 $425.00 157.08 30.21 340.00 34.74 293.68 84.37 293.68 35.35 234.81 82.76 280.50 33.84 30.21 281.31 72.32 80.35 123.57 154.46 82.36 82.76 80.35 340.00 73.52 30.21 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80136242 XR CHEST 3VWS 71047 320 $425.00 157.08 30.21 340.00 34.74 293.68 84.37 293.68 35.35 234.81 82.76 280.50 33.84 30.21 281.31 72.32 80.35 123.57 154.46 82.36 82.76 80.35 340.00 73.52 30.21 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81436240 XR CHEST 3VWS 71047 320 $425.00 157.08 30.21 340.00 34.74 293.68 84.37 293.68 35.35 234.81 82.76 280.50 33.84 30.21 281.31 72.32 80.35 123.57 154.46 82.36 82.76 80.35 340.00 73.52 30.21 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81636249 XR CHEST 3VWS 71047 320 $425.00 157.08 30.21 340.00 34.74 293.68 84.37 293.68 35.35 234.81 82.76 280.50 33.84 30.21 281.31 72.32 80.35 123.57 154.46 82.36 82.76 80.35 340.00 73.52 30.21 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81736243 XR CHEST 3VWS 71047 320 $425.00 157.08 30.21 340.00 34.74 293.68 84.37 293.68 35.35 234.81 82.76 280.50 33.84 30.21 281.31 72.32 80.35 123.57 154.46 82.36 82.76 80.35 340.00 73.52 30.21 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82636242 XR CHEST 3VWS 71047 320 $425.00 157.08 30.21 340.00 34.74 293.68 84.37 293.68 35.35 234.81 82.76 280.50 33.84 30.21 281.31 72.32 80.35 123.57 154.46 82.36 82.76 80.35 340.00 73.52 30.21 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82936246 XR CHEST 3VWS 71047 320 $425.00 157.08 30.21 340.00 34.74 293.68 84.37 293.68 35.35 234.81 82.76 280.50 33.84 30.21 281.31 72.32 80.35 123.57 154.46 82.36 82.76 80.35 340.00 73.52 30.21 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83036249 XR CHEST 3VWS 71047 320 $425.00 157.08 30.21 340.00 34.74 293.68 84.37 293.68 35.35 234.81 82.76 280.50 33.84 30.21 281.31 72.32 80.35 123.57 154.46 82.36 82.76 80.35 340.00 73.52 30.21 211.96 70.71 173.83 318.75 161.54 190.10 83.16 67936256 XR CHEST MIN 4VWS 71048 320 $572.00 211.41 32.43 457.60 37.29 395.25 113.56 395.25 37.94 316.03 111.39 377.52 36.32 32.43 378.61 97.34 108.15 127.13 158.91 110.85 111.39 108.15 457.60 98.96 32.43 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80136251 XR CHEST MIN 4VWS 71048 320 $572.00 211.41 32.43 457.60 37.29 395.25 113.56 395.25 37.94 316.03 111.39 377.52 36.32 32.43 378.61 97.34 108.15 127.13 158.91 110.85 111.39 108.15 457.60 98.96 32.43 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81436258 XR CHEST MIN 4VWS 71048 320 $572.00 211.41 32.43 457.60 37.29 395.25 113.56 395.25 37.94 316.03 111.39 377.52 36.32 32.43 378.61 97.34 108.15 127.13 158.91 110.85 111.39 108.15 457.60 98.96 32.43 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81636257 XR CHEST MIN 4VWS 71048 320 $572.00 211.41 32.43 457.60 37.29 395.25 113.56 395.25 37.94 316.03 111.39 377.52 36.32 32.43 378.61 97.34 108.15 127.13 158.91 110.85 111.39 108.15 457.60 98.96 32.43 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81736251 XR CHEST MIN 4VWS 71048 320 $572.00 211.41 32.43 457.60 37.29 395.25 113.56 395.25 37.94 316.03 111.39 377.52 36.32 32.43 378.61 97.34 108.15 127.13 158.91 110.85 111.39 108.15 457.60 98.96 32.43 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82636251 XR CHEST MIN 4VWS 71048 320 $572.00 211.41 32.43 457.60 37.29 395.25 113.56 395.25 37.94 316.03 111.39 377.52 36.32 32.43 378.61 97.34 108.15 127.13 158.91 110.85 111.39 108.15 457.60 98.96 32.43 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82936254 XR CHEST MIN 4VWS 71048 320 $572.00 211.41 32.43 457.60 37.29 395.25 113.56 395.25 37.94 316.03 111.39 377.52 36.32 32.43 378.61 97.34 108.15 127.13 158.91 110.85 111.39 108.15 457.60 98.96 32.43 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83036257 XR CHEST MIN 4VWS 71048 320 $572.00 211.41 32.43 457.60 37.29 395.25 113.56 395.25 37.94 316.03 111.39 377.52 36.32 32.43 378.61 97.34 108.15 127.13 158.91 110.85 111.39 108.15 457.60 98.96 32.43 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67926510 XR RIBS UNILATERAL 2VWS 71100 320 $425.00 157.08 26.50 340.00 30.48 293.68 84.37 293.68 31.01 234.81 82.76 280.50 29.68 26.50 281.31 72.32 80.35 108.30 135.37 82.36 82.76 80.35 340.00 73.52 26.50 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80126514 XR RIBS UNILATERAL 2VWS 71100 320 $425.00 157.08 26.50 340.00 30.48 293.68 84.37 293.68 31.01 234.81 82.76 280.50 29.68 26.50 281.31 72.32 80.35 108.30 135.37 82.36 82.76 80.35 340.00 73.52 26.50 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81426511 XR RIBS UNILATERAL 2VWS 71100 320 $425.00 157.08 26.50 340.00 30.48 293.68 84.37 293.68 31.01 234.81 82.76 280.50 29.68 26.50 281.31 72.32 80.35 108.30 135.37 82.36 82.76 80.35 340.00 73.52 26.50 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81626511 XR RIBS UNILATERAL 2VWS 71100 320 $425.00 157.08 26.50 340.00 30.48 293.68 84.37 293.68 31.01 234.81 82.76 280.50 29.68 26.50 281.31 72.32 80.35 108.30 135.37 82.36 82.76 80.35 340.00 73.52 26.50 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81726515 XR RIBS UNILATERAL 2VWS 71100 320 $425.00 157.08 26.50 340.00 30.48 293.68 84.37 293.68 31.01 234.81 82.76 280.50 29.68 26.50 281.31 72.32 80.35 108.30 135.37 82.36 82.76 80.35 340.00 73.52 26.50 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82626514 XR RIBS UNILATERAL 2VWS 71100 320 $425.00 157.08 26.50 340.00 30.48 293.68 84.37 293.68 31.01 234.81 82.76 280.50 29.68 26.50 281.31 72.32 80.35 108.30 135.37 82.36 82.76 80.35 340.00 73.52 26.50 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82926518 XR RIBS UNILATERAL 2VWS 71100 320 $425.00 157.08 26.50 340.00 30.48 293.68 84.37 293.68 31.01 234.81 82.76 280.50 29.68 26.50 281.31 72.32 80.35 108.30 135.37 82.36 82.76 80.35 340.00 73.52 26.50 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83026511 XR RIBS UNILATERAL 2VWS 71100 320 $425.00 157.08 26.50 340.00 30.48 293.68 84.37 293.68 31.01 234.81 82.76 280.50 29.68 26.50 281.31 72.32 80.35 108.30 135.37 82.36 82.76 80.35 340.00 73.52 26.50 211.96 70.71 173.83 318.75 161.54 190.10 83.16 67900260 XR RIB CAGE 3VWS 71101 320 $572.00 211.41 26.50 457.60 30.48 395.25 113.56 395.25 31.01 316.03 111.39 377.52 29.68 26.50 378.61 97.34 108.15 135.97 169.96 110.85 111.39 108.15 457.60 98.96 26.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80100264 XR RIB CAGE 3VWS 71101 320 $572.00 211.41 26.50 457.60 30.48 395.25 113.56 395.25 31.01 316.03 111.39 377.52 29.68 26.50 378.61 97.34 108.15 135.97 169.96 110.85 111.39 108.15 457.60 98.96 26.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81400261 XR RIB CAGE 3VWS 71101 320 $572.00 211.41 26.50 457.60 30.48 395.25 113.56 395.25 31.01 316.03 111.39 377.52 29.68 26.50 378.61 97.34 108.15 135.97 169.96 110.85 111.39 108.15 457.60 98.96 26.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81600261 XR RIB CAGE 3VWS 71101 320 $572.00 211.41 26.50 457.60 30.48 395.25 113.56 395.25 31.01 316.03 111.39 377.52 29.68 26.50 378.61 97.34 108.15 135.97 169.96 110.85 111.39 108.15 457.60 98.96 26.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81700265 XR RIB CAGE 3VWS 71101 320 $572.00 211.41 26.50 457.60 30.48 395.25 113.56 395.25 31.01 316.03 111.39 377.52 29.68 26.50 378.61 97.34 108.15 135.97 169.96 110.85 111.39 108.15 457.60 98.96 26.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82600264 XR RIB CAGE 3VWS 71101 320 $572.00 211.41 26.50 457.60 30.48 395.25 113.56 395.25 31.01 316.03 111.39 377.52 29.68 26.50 378.61 97.34 108.15 135.97 169.96 110.85 111.39 108.15 457.60 98.96 26.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82900268 XR RIB CAGE 3VWS 71101 320 $572.00 211.41 26.50 457.60 30.48 395.25 113.56 395.25 31.01 316.03 111.39 377.52 29.68 26.50 378.61 97.34 108.15 135.97 169.96 110.85 111.39 108.15 457.60 98.96 26.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83000261 XR RIB CAGE 3VWS 71101 320 $572.00 211.41 26.50 457.60 30.48 395.25 113.56 395.25 31.01 316.03 111.39 377.52 29.68 26.50 378.61 97.34 108.15 135.97 169.96 110.85 111.39 108.15 457.60 98.96 26.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67928661 XR RIBS BILATERAL 3VWS 71110 320 $572.00 211.41 27.50 457.60 31.63 395.25 113.56 395.25 32.18 316.03 111.39 377.52 30.80 27.50 378.61 97.34 108.15 143.24 179.05 110.85 111.39 108.15 457.60 98.96 27.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80128665 XR RIBS BILATERAL 3VWS 71110 320 $572.00 211.41 27.50 457.60 31.63 395.25 113.56 395.25 32.18 316.03 111.39 377.52 30.80 27.50 378.61 97.34 108.15 143.24 179.05 110.85 111.39 108.15 457.60 98.96 27.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81428662 XR RIBS BILATERAL 3VWS 71110 320 $572.00 211.41 27.50 457.60 31.63 395.25 113.56 395.25 32.18 316.03 111.39 377.52 30.80 27.50 378.61 97.34 108.15 143.24 179.05 110.85 111.39 108.15 457.60 98.96 27.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81628661 XR RIBS BILATERAL 3VWS 71110 320 $572.00 211.41 27.50 457.60 31.63 395.25 113.56 395.25 32.18 316.03 111.39 377.52 30.80 27.50 378.61 97.34 108.15 143.24 179.05 110.85 111.39 108.15 457.60 98.96 27.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81728666 XR RIBS BILATERAL 3VWS 71110 320 $572.00 211.41 27.50 457.60 31.63 395.25 113.56 395.25 32.18 316.03 111.39 377.52 30.80 27.50 378.61 97.34 108.15 143.24 179.05 110.85 111.39 108.15 457.60 98.96 27.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82628665 XR RIBS BILATERAL 3VWS 71110 320 $572.00 211.41 27.50 457.60 31.63 395.25 113.56 395.25 32.18 316.03 111.39 377.52 30.80 27.50 378.61 97.34 108.15 143.24 179.05 110.85 111.39 108.15 457.60 98.96 27.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82928669 XR RIBS BILATERAL 3VWS 71110 320 $572.00 211.41 27.50 457.60 31.63 395.25 113.56 395.25 32.18 316.03 111.39 377.52 30.80 27.50 378.61 97.34 108.15 143.24 179.05 110.85 111.39 108.15 457.60 98.96 27.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83028661 XR RIBS BILATERAL 3VWS 71110 320 $572.00 211.41 27.50 457.60 31.63 395.25 113.56 395.25 32.18 316.03 111.39 377.52 30.80 27.50 378.61 97.34 108.15 143.24 179.05 110.85 111.39 108.15 457.60 98.96 27.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67900278 XR RIBS BILATERAL MIN 4VWS 71111 320 $572.00 211.41 27.50 457.60 31.63 395.25 113.56 395.25 32.18 316.03 111.39 377.52 30.80 27.50 378.61 97.34 108.15 164.38 205.47 110.85 111.39 108.15 457.60 98.96 27.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80100272 XR RIBS BILATERAL MIN 4VWS 71111 320 $572.00 211.41 27.50 457.60 31.63 395.25 113.56 395.25 32.18 316.03 111.39 377.52 30.80 27.50 378.61 97.34 108.15 164.38 205.47 110.85 111.39 108.15 457.60 98.96 27.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81400270 XR RIBS BILATERAL MIN 4VWS 71111 320 $572.00 211.41 27.50 457.60 31.63 395.25 113.56 395.25 32.18 316.03 111.39 377.52 30.80 27.50 378.61 97.34 108.15 164.38 205.47 110.85 111.39 108.15 457.60 98.96 27.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81600279 XR RIBS BILATERAL MIN 4VWS 71111 320 $572.00 211.41 27.50 457.60 31.63 395.25 113.56 395.25 32.18 316.03 111.39 377.52 30.80 27.50 378.61 97.34 108.15 164.38 205.47 110.85 111.39 108.15 457.60 98.96 27.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81700273 XR RIBS BILATERAL MIN 4VWS 71111 320 $572.00 211.41 27.50 457.60 31.63 395.25 113.56 395.25 32.18 316.03 111.39 377.52 30.80 27.50 378.61 97.34 108.15 164.38 205.47 110.85 111.39 108.15 457.60 98.96 27.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82600272 XR RIBS BILATERAL MIN 4VWS 71111 320 $572.00 211.41 27.50 457.60 31.63 395.25 113.56 395.25 32.18 316.03 111.39 377.52 30.80 27.50 378.61 97.34 108.15 164.38 205.47 110.85 111.39 108.15 457.60 98.96 27.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82900276 XR RIBS BILATERAL MIN 4VWS 71111 320 $572.00 211.41 27.50 457.60 31.63 395.25 113.56 395.25 32.18 316.03 111.39 377.52 30.80 27.50 378.61 97.34 108.15 164.38 205.47 110.85 111.39 108.15 457.60 98.96 27.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83000279 XR RIBS BILATERAL MIN 4VWS 71111 320 $572.00 211.41 27.50 457.60 31.63 395.25 113.56 395.25 32.18 316.03 111.39 377.52 30.80 27.50 378.61 97.34 108.15 164.38 205.47 110.85 111.39 108.15 457.60 98.96 27.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67900286 XR STERNUM MIN 2VWS 71120 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 112.48 140.60 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80100281 XR STERNUM MIN 2VWS 71120 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 112.48 140.60 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81400288 XR STERNUM MIN 2VWS 71120 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 112.48 140.60 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81600287 XR STERNUM MIN 2VWS 71120 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 112.48 140.60 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81700281 XR STERNUM MIN 2VWS 71120 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 112.48 140.60 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82600281 XR STERNUM MIN 2VWS 71120 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 112.48 140.60 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82900284 XR STERNUM MIN 2VWS 71120 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 112.48 140.60 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83000287 XR STERNUM MIN 2VWS 71120 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 112.48 140.60 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 67901789 XR STERNOCLAV JT/S MIN 3VWS 71130 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 121.69 152.11 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80101783 XR STERNOCLAV JT/S MIN 3VWS 71130 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 121.69 152.11 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81401781 XR STERNOCLAV JT/S MIN 3VWS 71130 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 121.69 152.11 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81601780 XR STERNOCLAV JT/S MIN 3VWS 71130 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 121.69 152.11 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81701784 XR STERNOCLAV JT/S MIN 3VWS 71130 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 121.69 152.11 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82601783 XR STERNOCLAV JT/S MIN 3VWS 71130 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 121.69 152.11 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82901787 XR STERNOCLAV JT/S MIN 3VWS 71130 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 121.69 152.11 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83001780 XR STERNOCLAV JT/S MIN 3VWS 71130 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 121.69 152.11 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 67709128 CT THORAX DX W/O CONTRAST 71250 352 $572.00 211.41 95.17 " 1,774.00 " 153.63 " 1,774.00 " 113.56 " 1,774.00 " 156.30 316.03 111.39 725.00 149.62 133.59 378.61 97.34 108.15 909.10 " 1,136.37 " 110.85 111.39 108.15 457.60 98.96 133.59 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67909127 CT THORAX DX W/O CONTRAST 71250 352 $572.00 211.41 95.17 " 1,774.00 " 153.63 " 1,774.00 " 113.56 " 1,774.00 " 156.30 316.03 111.39 725.00 149.62 133.59 378.61 97.34 108.15 909.10 " 1,136.37 " 110.85 111.39 108.15 457.60 98.96 133.59 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80609124 CT THORAX DX W/O CONTRAST 71250 352 $572.00 211.41 95.17 " 1,774.00 " 153.63 " 1,774.00 " 113.56 " 1,774.00 " 156.30 316.03 111.39 725.00 149.62 133.59 378.61 97.34 108.15 909.10 " 1,136.37 " 110.85 111.39 108.15 457.60 98.96 133.59 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81409129 CT THORAX DX W/O CONTRAST 71250 352 $572.00 211.41 95.17 " 1,774.00 " 153.63 " 1,774.00 " 113.56 " 1,774.00 " 156.30 316.03 111.39 725.00 149.62 133.59 378.61 97.34 108.15 909.10 " 1,136.37 " 110.85 111.39 108.15 457.60 98.96 133.59 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81609128 CT THORAX DX W/O CONTRAST 71250 352 $572.00 211.41 95.17 " 1,774.00 " 153.63 " 1,774.00 " 113.56 " 1,774.00 " 156.30 316.03 111.39 725.00 149.62 133.59 378.61 97.34 108.15 909.10 " 1,136.37 " 110.85 111.39 108.15 457.60 98.96 133.59 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83009128 CT THORAX DX W/O CONTRAST 71250 352 $572.00 211.41 95.17 " 1,774.00 " 153.63 " 1,774.00 " 113.56 " 1,774.00 " 156.30 316.03 111.39 725.00 149.62 133.59 378.61 97.34 108.15 909.10 " 1,136.37 " 110.85 111.39 108.15 457.60 98.96 133.59 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67709136 CT THORAX DX W CONTRAST 71260 352 $937.00 346.32 145.15 " 1,774.00 " 166.92 " 1,774.00 " 186.31 " 1,774.00 " 169.83 517.69 182.76 725.00 162.57 145.15 620.20 159.70 177.44 " 1,061.75 " " 1,327.19 " 181.88 182.76 177.44 749.60 162.36 145.15 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67909135 CT THORAX DX W CONTRAST 71260 352 $937.00 346.32 145.15 " 1,774.00 " 166.92 " 1,774.00 " 186.31 " 1,774.00 " 169.83 517.69 182.76 725.00 162.57 145.15 620.20 159.70 177.44 " 1,061.75 " " 1,327.19 " 181.88 182.76 177.44 749.60 162.36 145.15 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80609132 CT THORAX DX W CONTRAST 71260 352 $937.00 346.32 145.15 " 1,774.00 " 166.92 " 1,774.00 " 186.31 " 1,774.00 " 169.83 517.69 182.76 725.00 162.57 145.15 620.20 159.70 177.44 " 1,061.75 " " 1,327.19 " 181.88 182.76 177.44 749.60 162.36 145.15 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81409137 CT THORAX DX W CONTRAST 71260 352 $937.00 346.32 145.15 " 1,774.00 " 166.92 " 1,774.00 " 186.31 " 1,774.00 " 169.83 517.69 182.76 725.00 162.57 145.15 620.20 159.70 177.44 " 1,061.75 " " 1,327.19 " 181.88 182.76 177.44 749.60 162.36 145.15 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81609136 CT THORAX DX W CONTRAST 71260 352 $937.00 346.32 145.15 " 1,774.00 " 166.92 " 1,774.00 " 186.31 " 1,774.00 " 169.83 517.69 182.76 725.00 162.57 145.15 620.20 159.70 177.44 " 1,061.75 " " 1,327.19 " 181.88 182.76 177.44 749.60 162.36 145.15 467.80 156.15 383.23 702.75 356.15 419.12 183.65 83009136 CT THORAX DX W CONTRAST 71260 352 $937.00 346.32 145.15 " 1,774.00 " 166.92 " 1,774.00 " 186.31 " 1,774.00 " 169.83 517.69 182.76 725.00 162.57 145.15 620.20 159.70 177.44 " 1,061.75 " " 1,327.19 " 181.88 182.76 177.44 749.60 162.36 145.15 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67709144 CT THORAX DX WO/W CONTRAST 71270 352 $937.00 346.32 156.15 " 1,774.00 " 192.48 " 1,774.00 " 186.31 " 1,774.00 " 195.82 517.69 182.76 725.00 187.45 167.37 620.20 159.70 177.44 " 1,295.08 " " 1,618.85 " 181.88 182.76 177.44 749.60 162.36 167.37 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67909143 CT THORAX DX WO/W CONTRAST 71270 352 $937.00 346.32 156.15 " 1,774.00 " 192.48 " 1,774.00 " 186.31 " 1,774.00 " 195.82 517.69 182.76 725.00 187.45 167.37 620.20 159.70 177.44 " 1,295.08 " " 1,618.85 " 181.88 182.76 177.44 749.60 162.36 167.37 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80609141 CT THORAX DX WO/W CONTRAST 71270 352 $937.00 346.32 156.15 " 1,774.00 " 192.48 " 1,774.00 " 186.31 " 1,774.00 " 195.82 517.69 182.76 725.00 187.45 167.37 620.20 159.70 177.44 " 1,295.08 " " 1,618.85 " 181.88 182.76 177.44 749.60 162.36 167.37 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81409145 CT THORAX DX WO/W CONTRAST 71270 352 $937.00 346.32 156.15 " 1,774.00 " 192.48 " 1,774.00 " 186.31 " 1,774.00 " 195.82 517.69 182.76 725.00 187.45 167.37 620.20 159.70 177.44 " 1,295.08 " " 1,618.85 " 181.88 182.76 177.44 749.60 162.36 167.37 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81609144 CT THORAX DX WO/W CONTRAST 71270 352 $937.00 346.32 156.15 " 1,774.00 " 192.48 " 1,774.00 " 186.31 " 1,774.00 " 195.82 517.69 182.76 725.00 187.45 167.37 620.20 159.70 177.44 " 1,295.08 " " 1,618.85 " 181.88 182.76 177.44 749.60 162.36 167.37 467.80 156.15 383.23 702.75 356.15 419.12 183.65 83009144 CT THORAX DX WO/W CONTRAST 71270 352 $937.00 346.32 156.15 " 1,774.00 " 192.48 " 1,774.00 " 186.31 " 1,774.00 " 195.82 517.69 182.76 725.00 187.45 167.37 620.20 159.70 177.44 " 1,295.08 " " 1,618.85 " 181.88 182.76 177.44 749.60 162.36 167.37 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67942035 CT THORAX LUNG CANCER SCR C- 71271 352 $425.00 157.08 95.17 " 1,774.00 " 132.24 " 1,774.00 " 113.56 " 1,774.00 " 134.54 234.81 111.39 725.00 128.79 114.99 281.31 97.34 108.15 225.21 281.52 110.85 111.39 108.15 340.00 98.96 114.99 211.96 95.17 173.83 318.75 161.54 190.10 111.94 80642032 CT THORAX LUNG CANCER SCR C- 71271 352 $425.00 157.08 95.17 " 1,774.00 " 132.24 " 1,774.00 " 113.56 " 1,774.00 " 134.54 234.81 111.39 725.00 128.79 114.99 281.31 97.34 108.15 225.21 281.52 110.85 111.39 108.15 340.00 98.96 114.99 211.96 95.17 173.83 318.75 161.54 190.10 111.94 81442037 CT THORAX LUNG CANCER SCR C- 71271 352 $425.00 157.08 95.17 " 1,774.00 " 132.24 " 1,774.00 " 113.56 " 1,774.00 " 134.54 234.81 111.39 725.00 128.79 114.99 281.31 97.34 108.15 225.21 281.52 110.85 111.39 108.15 340.00 98.96 114.99 211.96 95.17 173.83 318.75 161.54 190.10 111.94 81642036 CT THORAX LUNG CANCER SCR C- 71271 352 $425.00 157.08 95.17 " 1,774.00 " 132.24 " 1,774.00 " 113.56 " 1,774.00 " 134.54 234.81 111.39 725.00 128.79 114.99 281.31 97.34 108.15 225.21 281.52 110.85 111.39 108.15 340.00 98.96 114.99 211.96 95.17 173.83 318.75 161.54 190.10 111.94 83042036 CT THORAX LUNG CANCER SCR C- 71271 352 $425.00 157.08 95.17 " 1,774.00 " 132.24 " 1,774.00 " 113.56 " 1,774.00 " 134.54 234.81 111.39 725.00 128.79 114.99 281.31 97.34 108.15 225.21 281.52 110.85 111.39 108.15 340.00 98.96 114.99 211.96 95.17 173.83 318.75 161.54 190.10 111.94 53909701 CTA CHEST WO/W CONTRAST 71275 350 $937.00 346.32 156.15 " 1,774.00 " 351.87 " 1,774.00 " 186.31 " 1,774.00 " 357.98 517.69 182.76 725.00 342.69 305.97 620.20 159.70 177.44 " 1,396.26 " " 1,745.33 " 181.88 182.76 177.44 749.60 162.36 305.97 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67709705 CTA CHEST WO/W CONTRAST 71275 352 $937.00 346.32 156.15 " 1,774.00 " 351.87 " 1,774.00 " 186.31 " 1,774.00 " 357.98 517.69 182.76 725.00 342.69 305.97 620.20 159.70 177.44 " 1,396.26 " " 1,745.33 " 181.88 182.76 177.44 749.60 162.36 305.97 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67909704 CTA CHEST WO/W CONTRAST 71275 352 $937.00 346.32 156.15 " 1,774.00 " 351.87 " 1,774.00 " 186.31 " 1,774.00 " 357.98 517.69 182.76 725.00 342.69 305.97 620.20 159.70 177.44 " 1,396.26 " " 1,745.33 " 181.88 182.76 177.44 749.60 162.36 305.97 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80609701 CTA CHEST WO/W CONTRAST 71275 352 $937.00 346.32 156.15 " 1,774.00 " 351.87 " 1,774.00 " 186.31 " 1,774.00 " 357.98 517.69 182.76 725.00 342.69 305.97 620.20 159.70 177.44 " 1,396.26 " " 1,745.33 " 181.88 182.76 177.44 749.60 162.36 305.97 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81409706 CTA CHEST WO/W CONTRAST 71275 352 $937.00 346.32 156.15 " 1,774.00 " 351.87 " 1,774.00 " 186.31 " 1,774.00 " 357.98 517.69 182.76 725.00 342.69 305.97 620.20 159.70 177.44 " 1,396.26 " " 1,745.33 " 181.88 182.76 177.44 749.60 162.36 305.97 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81609705 CTA CHEST WO/W CONTRAST 71275 352 $937.00 346.32 156.15 " 1,774.00 " 351.87 " 1,774.00 " 186.31 " 1,774.00 " 357.98 517.69 182.76 725.00 342.69 305.97 620.20 159.70 177.44 " 1,396.26 " " 1,745.33 " 181.88 182.76 177.44 749.60 162.36 305.97 467.80 156.15 383.23 702.75 356.15 419.12 183.65 83009705 CTA CHEST WO/W CONTRAST 71275 352 $937.00 346.32 156.15 " 1,774.00 " 351.87 " 1,774.00 " 186.31 " 1,774.00 " 357.98 517.69 182.76 725.00 342.69 305.97 620.20 159.70 177.44 " 1,396.26 " " 1,745.33 " 181.88 182.76 177.44 749.60 162.36 305.97 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80407106 MRI CHEST W/O CONTRAST 71550 614 "$1,208.00" 446.48 201.14 " 2,882.00 " 386.64 " 2,882.00 " 240.00 " 2,882.00 " 393.37 667.42 235.43 " 1,155.00 " 376.56 336.21 799.58 205.71 228.57 " 1,618.82 " " 2,023.52 " 234.28 235.43 228.57 966.40 209.14 336.21 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81407100 MRI CHEST W/O CONTRAST 71550 614 "$1,208.00" 446.48 201.14 " 2,882.00 " 386.64 " 2,882.00 " 240.00 " 2,882.00 " 393.37 667.42 235.43 " 1,155.00 " 376.56 336.21 799.58 205.71 228.57 " 1,618.82 " " 2,023.52 " 234.28 235.43 228.57 966.40 209.14 336.21 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81607109 MRI CHEST W/O CONTRAST 71550 614 "$1,208.00" 446.48 201.14 " 2,882.00 " 386.64 " 2,882.00 " 240.00 " 2,882.00 " 393.37 667.42 235.43 " 1,155.00 " 376.56 336.21 799.58 205.71 228.57 " 1,618.82 " " 2,023.52 " 234.28 235.43 228.57 966.40 209.14 336.21 602.94 201.14 494.07 906.00 459.16 540.34 236.57 80407114 MRI CHEST W/CONTRAST 71551 614 "$3,755.00" " 1,387.85 " 392.47 " 3,004.00 " 451.34 " 2,882.00 " 746.21 " 2,882.00 " 459.19 " 2,074.64 " 732.00 " 1,155.00 " 439.57 392.47 " 2,485.43 " 639.61 710.68 " 1,522.82 " " 1,903.52 " 728.45 732.00 710.68 " 3,004.00 " 650.27 392.47 " 1,873.77 " 625.40 " 1,535.80 " " 2,816.25 " " 1,427.28 " " 1,679.61 " 735.55 81407118 MRI CHEST W/CONTRAST 71551 614 "$3,755.00" " 1,387.85 " 392.47 " 3,004.00 " 451.34 " 2,882.00 " 746.21 " 2,882.00 " 459.19 " 2,074.64 " 732.00 " 1,155.00 " 439.57 392.47 " 2,485.43 " 639.61 710.68 " 1,522.82 " " 1,903.52 " 728.45 732.00 710.68 " 3,004.00 " 650.27 392.47 " 1,873.77 " 625.40 " 1,535.80 " " 2,816.25 " " 1,427.28 " " 1,679.61 " 735.55 81607117 MRI CHEST W/CONTRAST 71551 614 "$3,755.00" " 1,387.85 " 392.47 " 3,004.00 " 451.34 " 2,882.00 " 746.21 " 2,882.00 " 459.19 " 2,074.64 " 732.00 " 1,155.00 " 439.57 392.47 " 2,485.43 " 639.61 710.68 " 1,522.82 " " 1,903.52 " 728.45 732.00 710.68 " 3,004.00 " 650.27 392.47 " 1,873.77 " 625.40 " 1,535.80 " " 2,816.25 " " 1,427.28 " " 1,679.61 " 735.55 80407122 MRI CHEST WO/W CONTRAST 71552 614 "$1,933.00" 714.44 321.90 " 3,498.11 " 664.13 " 2,882.00 " 384.09 " 2,882.00 " 675.68 " 1,067.98 " 376.77 " 1,155.00 " 646.80 577.50 " 1,279.45 " 329.22 365.80 " 2,798.49 " " 3,498.11 " 374.95 376.77 365.80 " 1,546.40 " 334.71 577.50 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81407126 MRI CHEST WO/W CONTRAST 71552 614 "$1,933.00" 714.44 321.90 " 3,498.11 " 664.13 " 2,882.00 " 384.09 " 2,882.00 " 675.68 " 1,067.98 " 376.77 " 1,155.00 " 646.80 577.50 " 1,279.45 " 329.22 365.80 " 2,798.49 " " 3,498.11 " 374.95 376.77 365.80 " 1,546.40 " 334.71 577.50 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81607125 MRI CHEST WO/W CONTRAST 71552 614 "$1,933.00" 714.44 321.90 " 3,498.11 " 664.13 " 2,882.00 " 384.09 " 2,882.00 " 675.68 " 1,067.98 " 376.77 " 1,155.00 " 646.80 577.50 " 1,279.45 " 329.22 365.80 " 2,798.49 " " 3,498.11 " 374.95 376.77 365.80 " 1,546.40 " 334.71 577.50 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 67900294 XR SPINE 1VW 72020 320 $425.00 157.08 21.40 340.00 24.61 293.68 84.37 293.68 25.04 234.81 82.76 280.50 23.97 21.40 281.31 72.32 80.35 77.58 96.98 82.36 82.76 80.35 340.00 73.52 21.40 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80100299 XR SPINE 1VW 72020 320 $425.00 157.08 21.40 340.00 24.61 293.68 84.37 293.68 25.04 234.81 82.76 280.50 23.97 21.40 281.31 72.32 80.35 77.58 96.98 82.36 82.76 80.35 340.00 73.52 21.40 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81400296 XR SPINE 1VW 72020 320 $425.00 157.08 21.40 340.00 24.61 293.68 84.37 293.68 25.04 234.81 82.76 280.50 23.97 21.40 281.31 72.32 80.35 77.58 96.98 82.36 82.76 80.35 340.00 73.52 21.40 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81600295 XR SPINE 1VW 72020 320 $425.00 157.08 21.40 340.00 24.61 293.68 84.37 293.68 25.04 234.81 82.76 280.50 23.97 21.40 281.31 72.32 80.35 77.58 96.98 82.36 82.76 80.35 340.00 73.52 21.40 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81700290 XR SPINE 1VW 72020 320 $425.00 157.08 21.40 340.00 24.61 293.68 84.37 293.68 25.04 234.81 82.76 280.50 23.97 21.40 281.31 72.32 80.35 77.58 96.98 82.36 82.76 80.35 340.00 73.52 21.40 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82600299 XR SPINE 1VW 72020 320 $425.00 157.08 21.40 340.00 24.61 293.68 84.37 293.68 25.04 234.81 82.76 280.50 23.97 21.40 281.31 72.32 80.35 77.58 96.98 82.36 82.76 80.35 340.00 73.52 21.40 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82900292 XR SPINE 1VW 72020 320 $425.00 157.08 21.40 340.00 24.61 293.68 84.37 293.68 25.04 234.81 82.76 280.50 23.97 21.40 281.31 72.32 80.35 77.58 96.98 82.36 82.76 80.35 340.00 73.52 21.40 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83000295 XR SPINE 1VW 72020 320 $425.00 157.08 21.40 340.00 24.61 293.68 84.37 293.68 25.04 234.81 82.76 280.50 23.97 21.40 281.31 72.32 80.35 77.58 96.98 82.36 82.76 80.35 340.00 73.52 21.40 211.96 70.71 173.83 318.75 161.54 190.10 83.16 67900308 XR CERVICAL SPINE 2-3VWS 72040 320 $425.00 157.08 26.50 340.00 30.48 293.68 84.37 293.68 31.01 234.81 82.76 280.50 29.68 26.50 281.31 72.32 80.35 112.06 140.08 82.36 82.76 80.35 340.00 73.52 26.50 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80100302 XR CERVICAL SPINE 2-3VWS 72040 320 $425.00 157.08 26.50 340.00 30.48 293.68 84.37 293.68 31.01 234.81 82.76 280.50 29.68 26.50 281.31 72.32 80.35 112.06 140.08 82.36 82.76 80.35 340.00 73.52 26.50 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81400300 XR CERVICAL SPINE 2-3VWS 72040 320 $425.00 157.08 26.50 340.00 30.48 293.68 84.37 293.68 31.01 234.81 82.76 280.50 29.68 26.50 281.31 72.32 80.35 112.06 140.08 82.36 82.76 80.35 340.00 73.52 26.50 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81600309 XR CERVICAL SPINE 2-3VWS 72040 320 $425.00 157.08 26.50 340.00 30.48 293.68 84.37 293.68 31.01 234.81 82.76 280.50 29.68 26.50 281.31 72.32 80.35 112.06 140.08 82.36 82.76 80.35 340.00 73.52 26.50 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81700303 XR CERVICAL SPINE 2-3VWS 72040 320 $425.00 157.08 26.50 340.00 30.48 293.68 84.37 293.68 31.01 234.81 82.76 280.50 29.68 26.50 281.31 72.32 80.35 112.06 140.08 82.36 82.76 80.35 340.00 73.52 26.50 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82600302 XR CERVICAL SPINE 2-3VWS 72040 320 $425.00 157.08 26.50 340.00 30.48 293.68 84.37 293.68 31.01 234.81 82.76 280.50 29.68 26.50 281.31 72.32 80.35 112.06 140.08 82.36 82.76 80.35 340.00 73.52 26.50 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82900306 XR CERVICAL SPINE 2-3VWS 72040 320 $425.00 157.08 26.50 340.00 30.48 293.68 84.37 293.68 31.01 234.81 82.76 280.50 29.68 26.50 281.31 72.32 80.35 112.06 140.08 82.36 82.76 80.35 340.00 73.52 26.50 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83000309 XR CERVICAL SPINE 2-3VWS 72040 320 $425.00 157.08 26.50 340.00 30.48 293.68 84.37 293.68 31.01 234.81 82.76 280.50 29.68 26.50 281.31 72.32 80.35 112.06 140.08 82.36 82.76 80.35 340.00 73.52 26.50 211.96 70.71 173.83 318.75 161.54 190.10 83.16 67901401 XR CERVICAL SPINE MIN 4VWS 72050 320 $572.00 211.41 40.62 457.60 46.71 395.25 113.56 395.25 47.53 316.03 111.39 377.52 45.49 40.62 378.61 97.34 108.15 162.07 202.59 110.85 111.39 108.15 457.60 98.96 40.62 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80101406 XR CERVICAL SPINE MIN 4VWS 72050 320 $572.00 211.41 40.62 457.60 46.71 395.25 113.56 395.25 47.53 316.03 111.39 377.52 45.49 40.62 378.61 97.34 108.15 162.07 202.59 110.85 111.39 108.15 457.60 98.96 40.62 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81401403 XR CERVICAL SPINE MIN 4VWS 72050 320 $572.00 211.41 40.62 457.60 46.71 395.25 113.56 395.25 47.53 316.03 111.39 377.52 45.49 40.62 378.61 97.34 108.15 162.07 202.59 110.85 111.39 108.15 457.60 98.96 40.62 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81601402 XR CERVICAL SPINE MIN 4VWS 72050 320 $572.00 211.41 40.62 457.60 46.71 395.25 113.56 395.25 47.53 316.03 111.39 377.52 45.49 40.62 378.61 97.34 108.15 162.07 202.59 110.85 111.39 108.15 457.60 98.96 40.62 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81701407 XR CERVICAL SPINE MIN 4VWS 72050 320 $572.00 211.41 40.62 457.60 46.71 395.25 113.56 395.25 47.53 316.03 111.39 377.52 45.49 40.62 378.61 97.34 108.15 162.07 202.59 110.85 111.39 108.15 457.60 98.96 40.62 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82601406 XR CERVICAL SPINE MIN 4VWS 72050 320 $572.00 211.41 40.62 457.60 46.71 395.25 113.56 395.25 47.53 316.03 111.39 377.52 45.49 40.62 378.61 97.34 108.15 162.07 202.59 110.85 111.39 108.15 457.60 98.96 40.62 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82901400 XR CERVICAL SPINE MIN 4VWS 72050 320 $572.00 211.41 40.62 457.60 46.71 395.25 113.56 395.25 47.53 316.03 111.39 377.52 45.49 40.62 378.61 97.34 108.15 162.07 202.59 110.85 111.39 108.15 457.60 98.96 40.62 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83001402 XR CERVICAL SPINE MIN 4VWS 72050 320 $572.00 211.41 40.62 457.60 46.71 395.25 113.56 395.25 47.53 316.03 111.39 377.52 45.49 40.62 378.61 97.34 108.15 162.07 202.59 110.85 111.39 108.15 457.60 98.96 40.62 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67900316 XR C SPINE W/FLEX 72052 320 $572.00 211.41 49.34 457.60 56.74 395.25 113.56 395.25 57.73 316.03 111.39 377.52 55.26 49.34 378.61 97.34 108.15 199.27 249.09 110.85 111.39 108.15 457.60 98.96 49.34 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80100311 XR C SPINE W/FLEX 72052 320 $572.00 211.41 49.34 457.60 56.74 395.25 113.56 395.25 57.73 316.03 111.39 377.52 55.26 49.34 378.61 97.34 108.15 199.27 249.09 110.85 111.39 108.15 457.60 98.96 49.34 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81400318 XR C SPINE W/FLEX 72052 320 $572.00 211.41 49.34 457.60 56.74 395.25 113.56 395.25 57.73 316.03 111.39 377.52 55.26 49.34 378.61 97.34 108.15 199.27 249.09 110.85 111.39 108.15 457.60 98.96 49.34 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81600317 XR C SPINE W/FLEX 72052 320 $572.00 211.41 49.34 457.60 56.74 395.25 113.56 395.25 57.73 316.03 111.39 377.52 55.26 49.34 378.61 97.34 108.15 199.27 249.09 110.85 111.39 108.15 457.60 98.96 49.34 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81700311 XR C SPINE W/FLEX 72052 320 $572.00 211.41 49.34 457.60 56.74 395.25 113.56 395.25 57.73 316.03 111.39 377.52 55.26 49.34 378.61 97.34 108.15 199.27 249.09 110.85 111.39 108.15 457.60 98.96 49.34 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82600311 XR C SPINE W/FLEX 72052 320 $572.00 211.41 49.34 457.60 56.74 395.25 113.56 395.25 57.73 316.03 111.39 377.52 55.26 49.34 378.61 97.34 108.15 199.27 249.09 110.85 111.39 108.15 457.60 98.96 49.34 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82900314 XR C SPINE W/FLEX 72052 320 $572.00 211.41 49.34 457.60 56.74 395.25 113.56 395.25 57.73 316.03 111.39 377.52 55.26 49.34 378.61 97.34 108.15 199.27 249.09 110.85 111.39 108.15 457.60 98.96 49.34 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83000317 XR C SPINE W/FLEX 72052 320 $572.00 211.41 49.34 457.60 56.74 395.25 113.56 395.25 57.73 316.03 111.39 377.52 55.26 49.34 378.61 97.34 108.15 199.27 249.09 110.85 111.39 108.15 457.60 98.96 49.34 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67900332 XR THORACIC SPINE 2VWS 72070 320 $572.00 211.41 30.94 457.60 35.58 395.25 113.56 395.25 36.20 316.03 111.39 377.52 34.65 30.94 378.61 97.34 108.15 117.34 146.68 110.85 111.39 108.15 457.60 98.96 30.94 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80100337 XR THORACIC SPINE 2VWS 72070 320 $572.00 211.41 30.94 457.60 35.58 395.25 113.56 395.25 36.20 316.03 111.39 377.52 34.65 30.94 378.61 97.34 108.15 117.34 146.68 110.85 111.39 108.15 457.60 98.96 30.94 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81400334 XR THORACIC SPINE 2VWS 72070 320 $572.00 211.41 30.94 457.60 35.58 395.25 113.56 395.25 36.20 316.03 111.39 377.52 34.65 30.94 378.61 97.34 108.15 117.34 146.68 110.85 111.39 108.15 457.60 98.96 30.94 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81600333 XR THORACIC SPINE 2VWS 72070 320 $572.00 211.41 30.94 457.60 35.58 395.25 113.56 395.25 36.20 316.03 111.39 377.52 34.65 30.94 378.61 97.34 108.15 117.34 146.68 110.85 111.39 108.15 457.60 98.96 30.94 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81700338 XR THORACIC SPINE 2VWS 72070 320 $572.00 211.41 30.94 457.60 35.58 395.25 113.56 395.25 36.20 316.03 111.39 377.52 34.65 30.94 378.61 97.34 108.15 117.34 146.68 110.85 111.39 108.15 457.60 98.96 30.94 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82600337 XR THORACIC SPINE 2VWS 72070 320 $572.00 211.41 30.94 457.60 35.58 395.25 113.56 395.25 36.20 316.03 111.39 377.52 34.65 30.94 378.61 97.34 108.15 117.34 146.68 110.85 111.39 108.15 457.60 98.96 30.94 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82900331 XR THORACIC SPINE 2VWS 72070 320 $572.00 211.41 30.94 457.60 35.58 395.25 113.56 395.25 36.20 316.03 111.39 377.52 34.65 30.94 378.61 97.34 108.15 117.34 146.68 110.85 111.39 108.15 457.60 98.96 30.94 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83000333 XR THORACIC SPINE 2VWS 72070 320 $572.00 211.41 30.94 457.60 35.58 395.25 113.56 395.25 36.20 316.03 111.39 377.52 34.65 30.94 378.61 97.34 108.15 117.34 146.68 110.85 111.39 108.15 457.60 98.96 30.94 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67901703 XR THORACIC SPINE 3VWS 72072 320 $572.00 211.41 31.53 457.60 36.26 395.25 113.56 395.25 36.89 316.03 111.39 377.52 35.31 31.53 378.61 97.34 108.15 126.71 158.39 110.85 111.39 108.15 457.60 98.96 31.53 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80101708 XR THORACIC SPINE 3VWS 72072 320 $572.00 211.41 31.53 457.60 36.26 395.25 113.56 395.25 36.89 316.03 111.39 377.52 35.31 31.53 378.61 97.34 108.15 126.71 158.39 110.85 111.39 108.15 457.60 98.96 31.53 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81401705 XR THORACIC SPINE 3VWS 72072 320 $572.00 211.41 31.53 457.60 36.26 395.25 113.56 395.25 36.89 316.03 111.39 377.52 35.31 31.53 378.61 97.34 108.15 126.71 158.39 110.85 111.39 108.15 457.60 98.96 31.53 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81601704 XR THORACIC SPINE 3VWS 72072 320 $572.00 211.41 31.53 457.60 36.26 395.25 113.56 395.25 36.89 316.03 111.39 377.52 35.31 31.53 378.61 97.34 108.15 126.71 158.39 110.85 111.39 108.15 457.60 98.96 31.53 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81701709 XR THORACIC SPINE 3VWS 72072 320 $572.00 211.41 31.53 457.60 36.26 395.25 113.56 395.25 36.89 316.03 111.39 377.52 35.31 31.53 378.61 97.34 108.15 126.71 158.39 110.85 111.39 108.15 457.60 98.96 31.53 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82601708 XR THORACIC SPINE 3VWS 72072 320 $572.00 211.41 31.53 457.60 36.26 395.25 113.56 395.25 36.89 316.03 111.39 377.52 35.31 31.53 378.61 97.34 108.15 126.71 158.39 110.85 111.39 108.15 457.60 98.96 31.53 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82901701 XR THORACIC SPINE 3VWS 72072 320 $572.00 211.41 31.53 457.60 36.26 395.25 113.56 395.25 36.89 316.03 111.39 377.52 35.31 31.53 378.61 97.34 108.15 126.71 158.39 110.85 111.39 108.15 457.60 98.96 31.53 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83001704 XR THORACIC SPINE 3VWS 72072 320 $572.00 211.41 31.53 457.60 36.26 395.25 113.56 395.25 36.89 316.03 111.39 377.52 35.31 31.53 378.61 97.34 108.15 126.71 158.39 110.85 111.39 108.15 457.60 98.96 31.53 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67901711 XR T SPINE MIN 4VWS 72074 320 $572.00 211.41 31.53 457.60 36.26 395.25 113.56 395.25 36.89 316.03 111.39 377.52 35.31 31.53 378.61 97.34 108.15 147.90 184.87 110.85 111.39 108.15 457.60 98.96 31.53 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80101716 XR T SPINE MIN 4VWS 72074 320 $572.00 211.41 31.53 457.60 36.26 395.25 113.56 395.25 36.89 316.03 111.39 377.52 35.31 31.53 378.61 97.34 108.15 147.90 184.87 110.85 111.39 108.15 457.60 98.96 31.53 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81401713 XR T SPINE MIN 4VWS 72074 320 $572.00 211.41 31.53 457.60 36.26 395.25 113.56 395.25 36.89 316.03 111.39 377.52 35.31 31.53 378.61 97.34 108.15 147.90 184.87 110.85 111.39 108.15 457.60 98.96 31.53 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81601712 XR T SPINE MIN 4VWS 72074 320 $572.00 211.41 31.53 457.60 36.26 395.25 113.56 395.25 36.89 316.03 111.39 377.52 35.31 31.53 378.61 97.34 108.15 147.90 184.87 110.85 111.39 108.15 457.60 98.96 31.53 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81701717 XR T SPINE MIN 4VWS 72074 320 $572.00 211.41 31.53 457.60 36.26 395.25 113.56 395.25 36.89 316.03 111.39 377.52 35.31 31.53 378.61 97.34 108.15 147.90 184.87 110.85 111.39 108.15 457.60 98.96 31.53 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82601716 XR T SPINE MIN 4VWS 72074 320 $572.00 211.41 31.53 457.60 36.26 395.25 113.56 395.25 36.89 316.03 111.39 377.52 35.31 31.53 378.61 97.34 108.15 147.90 184.87 110.85 111.39 108.15 457.60 98.96 31.53 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82901710 XR T SPINE MIN 4VWS 72074 320 $572.00 211.41 31.53 457.60 36.26 395.25 113.56 395.25 36.89 316.03 111.39 377.52 35.31 31.53 378.61 97.34 108.15 147.90 184.87 110.85 111.39 108.15 457.60 98.96 31.53 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83001712 XR T SPINE MIN 4VWS 72074 320 $572.00 211.41 31.53 457.60 36.26 395.25 113.56 395.25 36.89 316.03 111.39 377.52 35.31 31.53 378.61 97.34 108.15 147.90 184.87 110.85 111.39 108.15 457.60 98.96 31.53 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67900341 XR THORACOLUMBAR SPINE MIN 2VW 72080 320 $425.00 157.08 26.50 340.00 30.48 293.68 84.37 293.68 31.01 234.81 82.76 280.50 29.68 26.50 281.31 72.32 80.35 118.29 147.86 82.36 82.76 80.35 340.00 73.52 26.50 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80100345 XR THORACOLUMBAR SPINE MIN 2VW 72080 320 $425.00 157.08 26.50 340.00 30.48 293.68 84.37 293.68 31.01 234.81 82.76 280.50 29.68 26.50 281.31 72.32 80.35 118.29 147.86 82.36 82.76 80.35 340.00 73.52 26.50 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81400342 XR THORACOLUMBAR SPINE MIN 2VW 72080 320 $425.00 157.08 26.50 340.00 30.48 293.68 84.37 293.68 31.01 234.81 82.76 280.50 29.68 26.50 281.31 72.32 80.35 118.29 147.86 82.36 82.76 80.35 340.00 73.52 26.50 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81600341 XR THORACOLUMBAR SPINE MIN 2VW 72080 320 $425.00 157.08 26.50 340.00 30.48 293.68 84.37 293.68 31.01 234.81 82.76 280.50 29.68 26.50 281.31 72.32 80.35 118.29 147.86 82.36 82.76 80.35 340.00 73.52 26.50 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81700346 XR THORACOLUMBAR SPINE MIN 2VW 72080 320 $425.00 157.08 26.50 340.00 30.48 293.68 84.37 293.68 31.01 234.81 82.76 280.50 29.68 26.50 281.31 72.32 80.35 118.29 147.86 82.36 82.76 80.35 340.00 73.52 26.50 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82600345 XR THORACOLUMBAR SPINE MIN 2VW 72080 320 $425.00 157.08 26.50 340.00 30.48 293.68 84.37 293.68 31.01 234.81 82.76 280.50 29.68 26.50 281.31 72.32 80.35 118.29 147.86 82.36 82.76 80.35 340.00 73.52 26.50 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82900349 XR THORACOLUMBAR SPINE MIN 2VW 72080 320 $425.00 157.08 26.50 340.00 30.48 293.68 84.37 293.68 31.01 234.81 82.76 280.50 29.68 26.50 281.31 72.32 80.35 118.29 147.86 82.36 82.76 80.35 340.00 73.52 26.50 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83000341 XR THORACOLUMBAR SPINE MIN 2VW 72080 320 $425.00 157.08 26.50 340.00 30.48 293.68 84.37 293.68 31.01 234.81 82.76 280.50 29.68 26.50 281.31 72.32 80.35 118.29 147.86 82.36 82.76 80.35 340.00 73.52 26.50 211.96 70.71 173.83 318.75 161.54 190.10 83.16 67935560 XR SPINE ENTIRE T&L 1VW 72081 320 $425.00 157.08 29.58 340.00 34.02 293.68 84.37 293.68 34.61 234.81 82.76 280.50 33.13 29.58 281.31 72.32 80.35 123.67 154.59 82.36 82.76 80.35 340.00 73.52 29.58 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80135564 XR SPINE ENTIRE T&L 1VW 72081 320 $425.00 157.08 29.58 340.00 34.02 293.68 84.37 293.68 34.61 234.81 82.76 280.50 33.13 29.58 281.31 72.32 80.35 123.67 154.59 82.36 82.76 80.35 340.00 73.52 29.58 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81435561 XR SPINE ENTIRE T&L 1VW 72081 320 $425.00 157.08 29.58 340.00 34.02 293.68 84.37 293.68 34.61 234.81 82.76 280.50 33.13 29.58 281.31 72.32 80.35 123.67 154.59 82.36 82.76 80.35 340.00 73.52 29.58 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81635561 XR SPINE ENTIRE T&L 1VW 72081 320 $425.00 157.08 29.58 340.00 34.02 293.68 84.37 293.68 34.61 234.81 82.76 280.50 33.13 29.58 281.31 72.32 80.35 123.67 154.59 82.36 82.76 80.35 340.00 73.52 29.58 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81735565 XR SPINE ENTIRE T&L 1VW 72081 320 $425.00 157.08 29.58 340.00 34.02 293.68 84.37 293.68 34.61 234.81 82.76 280.50 33.13 29.58 281.31 72.32 80.35 123.67 154.59 82.36 82.76 80.35 340.00 73.52 29.58 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82635564 XR SPINE ENTIRE T&L 1VW 72081 320 $425.00 157.08 29.58 340.00 34.02 293.68 84.37 293.68 34.61 234.81 82.76 280.50 33.13 29.58 281.31 72.32 80.35 123.67 154.59 82.36 82.76 80.35 340.00 73.52 29.58 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82935568 XR SPINE ENTIRE T&L 1VW 72081 320 $425.00 157.08 29.58 340.00 34.02 293.68 84.37 293.68 34.61 234.81 82.76 280.50 33.13 29.58 281.31 72.32 80.35 123.67 154.59 82.36 82.76 80.35 340.00 73.52 29.58 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83035561 XR SPINE ENTIRE T&L 1VW 72081 320 $425.00 157.08 29.58 340.00 34.02 293.68 84.37 293.68 34.61 234.81 82.76 280.50 33.13 29.58 281.31 72.32 80.35 123.67 154.59 82.36 82.76 80.35 340.00 73.52 29.58 211.96 70.71 173.83 318.75 161.54 190.10 83.16 67935578 XR SPINE ENTIRE T&L 2-3VWS 72082 320 $572.00 211.41 47.24 457.60 54.33 395.25 113.56 395.25 55.27 316.03 111.39 377.52 52.91 47.24 378.61 97.34 108.15 224.59 280.74 110.85 111.39 108.15 457.60 98.96 47.24 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80135572 XR SPINE ENTIRE T&L 2-3VWS 72082 320 $572.00 211.41 47.24 457.60 54.33 395.25 113.56 395.25 55.27 316.03 111.39 377.52 52.91 47.24 378.61 97.34 108.15 224.59 280.74 110.85 111.39 108.15 457.60 98.96 47.24 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81435570 XR SPINE ENTIRE T&L 2-3VWS 72082 320 $572.00 211.41 47.24 457.60 54.33 395.25 113.56 395.25 55.27 316.03 111.39 377.52 52.91 47.24 378.61 97.34 108.15 224.59 280.74 110.85 111.39 108.15 457.60 98.96 47.24 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81635579 XR SPINE ENTIRE T&L 2-3VWS 72082 320 $572.00 211.41 47.24 457.60 54.33 395.25 113.56 395.25 55.27 316.03 111.39 377.52 52.91 47.24 378.61 97.34 108.15 224.59 280.74 110.85 111.39 108.15 457.60 98.96 47.24 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81735573 XR SPINE ENTIRE T&L 2-3VWS 72082 320 $572.00 211.41 47.24 457.60 54.33 395.25 113.56 395.25 55.27 316.03 111.39 377.52 52.91 47.24 378.61 97.34 108.15 224.59 280.74 110.85 111.39 108.15 457.60 98.96 47.24 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82635572 XR SPINE ENTIRE T&L 2-3VWS 72082 320 $572.00 211.41 47.24 457.60 54.33 395.25 113.56 395.25 55.27 316.03 111.39 377.52 52.91 47.24 378.61 97.34 108.15 224.59 280.74 110.85 111.39 108.15 457.60 98.96 47.24 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82935576 XR SPINE ENTIRE T&L 2-3VWS 72082 320 $572.00 211.41 47.24 457.60 54.33 395.25 113.56 395.25 55.27 316.03 111.39 377.52 52.91 47.24 378.61 97.34 108.15 224.59 280.74 110.85 111.39 108.15 457.60 98.96 47.24 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83035579 XR SPINE ENTIRE T&L 2-3VWS 72082 320 $572.00 211.41 47.24 457.60 54.33 395.25 113.56 395.25 55.27 316.03 111.39 377.52 52.91 47.24 378.61 97.34 108.15 224.59 280.74 110.85 111.39 108.15 457.60 98.96 47.24 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67935179 XR SPINE ENTIRE T&L 4-5VWS 72083 320 $572.00 211.41 51.32 457.60 59.02 395.25 113.56 395.25 60.04 316.03 111.39 377.52 57.48 51.32 378.61 97.34 108.15 243.74 304.68 110.85 111.39 108.15 457.60 98.96 51.32 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80135173 XR SPINE ENTIRE T&L 4-5VWS 72083 320 $572.00 211.41 51.32 457.60 59.02 395.25 113.56 395.25 60.04 316.03 111.39 377.52 57.48 51.32 378.61 97.34 108.15 243.74 304.68 110.85 111.39 108.15 457.60 98.96 51.32 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81435171 XR SPINE ENTIRE T&L 4-5VWS 72083 320 $572.00 211.41 51.32 457.60 59.02 395.25 113.56 395.25 60.04 316.03 111.39 377.52 57.48 51.32 378.61 97.34 108.15 243.74 304.68 110.85 111.39 108.15 457.60 98.96 51.32 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81635170 XR SPINE ENTIRE T&L 4-5VWS 72083 320 $572.00 211.41 51.32 457.60 59.02 395.25 113.56 395.25 60.04 316.03 111.39 377.52 57.48 51.32 378.61 97.34 108.15 243.74 304.68 110.85 111.39 108.15 457.60 98.96 51.32 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81735174 XR SPINE ENTIRE T&L 4-5VWS 72083 320 $572.00 211.41 51.32 457.60 59.02 395.25 113.56 395.25 60.04 316.03 111.39 377.52 57.48 51.32 378.61 97.34 108.15 243.74 304.68 110.85 111.39 108.15 457.60 98.96 51.32 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82635173 XR SPINE ENTIRE T&L 4-5VWS 72083 320 $572.00 211.41 51.32 457.60 59.02 395.25 113.56 395.25 60.04 316.03 111.39 377.52 57.48 51.32 378.61 97.34 108.15 243.74 304.68 110.85 111.39 108.15 457.60 98.96 51.32 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67935586 XR SPINE ENTIRE T&L MIN 6VWS 72084 320 $572.00 211.41 61.28 457.60 70.47 395.25 113.56 395.25 71.70 316.03 111.39 377.52 68.63 61.28 378.61 97.34 108.15 294.18 367.72 110.85 111.39 108.15 457.60 98.96 61.28 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80135581 XR SPINE ENTIRE T&L MIN 6VWS 72084 320 $572.00 211.41 61.28 457.60 70.47 395.25 113.56 395.25 71.70 316.03 111.39 377.52 68.63 61.28 378.61 97.34 108.15 294.18 367.72 110.85 111.39 108.15 457.60 98.96 61.28 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81435588 XR SPINE ENTIRE T&L MIN 6VWS 72084 320 $572.00 211.41 61.28 457.60 70.47 395.25 113.56 395.25 71.70 316.03 111.39 377.52 68.63 61.28 378.61 97.34 108.15 294.18 367.72 110.85 111.39 108.15 457.60 98.96 61.28 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81635587 XR SPINE ENTIRE T&L MIN 6VWS 72084 320 $572.00 211.41 61.28 457.60 70.47 395.25 113.56 395.25 71.70 316.03 111.39 377.52 68.63 61.28 378.61 97.34 108.15 294.18 367.72 110.85 111.39 108.15 457.60 98.96 61.28 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81735581 XR SPINE ENTIRE T&L MIN 6VWS 72084 320 $572.00 211.41 61.28 457.60 70.47 395.25 113.56 395.25 71.70 316.03 111.39 377.52 68.63 61.28 378.61 97.34 108.15 294.18 367.72 110.85 111.39 108.15 457.60 98.96 61.28 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82635581 XR SPINE ENTIRE T&L MIN 6VWS 72084 320 $572.00 211.41 61.28 457.60 70.47 395.25 113.56 395.25 71.70 316.03 111.39 377.52 68.63 61.28 378.61 97.34 108.15 294.18 367.72 110.85 111.39 108.15 457.60 98.96 61.28 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82935584 XR SPINE ENTIRE T&L MIN 6VWS 72084 320 $572.00 211.41 61.28 457.60 70.47 395.25 113.56 395.25 71.70 316.03 111.39 377.52 68.63 61.28 378.61 97.34 108.15 294.18 367.72 110.85 111.39 108.15 457.60 98.96 61.28 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83035587 XR SPINE ENTIRE T&L MIN 6VWS 72084 320 $572.00 211.41 61.28 457.60 70.47 395.25 113.56 395.25 71.70 316.03 111.39 377.52 68.63 61.28 378.61 97.34 108.15 294.18 367.72 110.85 111.39 108.15 457.60 98.96 61.28 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67900367 XR LS SPINE 2-3VWS 72100 320 $572.00 211.41 32.53 457.60 37.41 395.25 113.56 395.25 38.06 316.03 111.39 377.52 36.43 32.53 378.61 97.34 108.15 120.17 150.21 110.85 111.39 108.15 457.60 98.96 32.53 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80100361 XR LS SPINE 2-3VWS 72100 320 $572.00 211.41 32.53 457.60 37.41 395.25 113.56 395.25 38.06 316.03 111.39 377.52 36.43 32.53 378.61 97.34 108.15 120.17 150.21 110.85 111.39 108.15 457.60 98.96 32.53 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81400369 XR LS SPINE 2-3VWS 72100 320 $572.00 211.41 32.53 457.60 37.41 395.25 113.56 395.25 38.06 316.03 111.39 377.52 36.43 32.53 378.61 97.34 108.15 120.17 150.21 110.85 111.39 108.15 457.60 98.96 32.53 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81600368 XR LS SPINE 2-3VWS 72100 320 $572.00 211.41 32.53 457.60 37.41 395.25 113.56 395.25 38.06 316.03 111.39 377.52 36.43 32.53 378.61 97.34 108.15 120.17 150.21 110.85 111.39 108.15 457.60 98.96 32.53 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81700362 XR LS SPINE 2-3VWS 72100 320 $572.00 211.41 32.53 457.60 37.41 395.25 113.56 395.25 38.06 316.03 111.39 377.52 36.43 32.53 378.61 97.34 108.15 120.17 150.21 110.85 111.39 108.15 457.60 98.96 32.53 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82600361 XR LS SPINE 2-3VWS 72100 320 $572.00 211.41 32.53 457.60 37.41 395.25 113.56 395.25 38.06 316.03 111.39 377.52 36.43 32.53 378.61 97.34 108.15 120.17 150.21 110.85 111.39 108.15 457.60 98.96 32.53 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82900365 XR LS SPINE 2-3VWS 72100 320 $572.00 211.41 32.53 457.60 37.41 395.25 113.56 395.25 38.06 316.03 111.39 377.52 36.43 32.53 378.61 97.34 108.15 120.17 150.21 110.85 111.39 108.15 457.60 98.96 32.53 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83000368 XR LS SPINE 2-3VWS 72100 320 $572.00 211.41 32.53 457.60 37.41 395.25 113.56 395.25 38.06 316.03 111.39 377.52 36.43 32.53 378.61 97.34 108.15 120.17 150.21 110.85 111.39 108.15 457.60 98.96 32.53 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67900375 XR LS SPINE MIN 4VWS 72110 320 $572.00 211.41 36.62 457.60 42.11 395.25 113.56 395.25 42.85 316.03 111.39 377.52 41.01 36.62 378.61 97.34 108.15 164.38 205.47 110.85 111.39 108.15 457.60 98.96 36.62 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80100370 XR LS SPINE MIN 4VWS 72110 320 $572.00 211.41 36.62 457.60 42.11 395.25 113.56 395.25 42.85 316.03 111.39 377.52 41.01 36.62 378.61 97.34 108.15 164.38 205.47 110.85 111.39 108.15 457.60 98.96 36.62 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81400377 XR LS SPINE MIN 4VWS 72110 320 $572.00 211.41 36.62 457.60 42.11 395.25 113.56 395.25 42.85 316.03 111.39 377.52 41.01 36.62 378.61 97.34 108.15 164.38 205.47 110.85 111.39 108.15 457.60 98.96 36.62 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81600376 XR LS SPINE MIN 4VWS 72110 320 $572.00 211.41 36.62 457.60 42.11 395.25 113.56 395.25 42.85 316.03 111.39 377.52 41.01 36.62 378.61 97.34 108.15 164.38 205.47 110.85 111.39 108.15 457.60 98.96 36.62 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81700371 XR LS SPINE MIN 4VWS 72110 320 $572.00 211.41 36.62 457.60 42.11 395.25 113.56 395.25 42.85 316.03 111.39 377.52 41.01 36.62 378.61 97.34 108.15 164.38 205.47 110.85 111.39 108.15 457.60 98.96 36.62 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82600370 XR LS SPINE MIN 4VWS 72110 320 $572.00 211.41 36.62 457.60 42.11 395.25 113.56 395.25 42.85 316.03 111.39 377.52 41.01 36.62 378.61 97.34 108.15 164.38 205.47 110.85 111.39 108.15 457.60 98.96 36.62 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82900373 XR LS SPINE MIN 4VWS 72110 320 $572.00 211.41 36.62 457.60 42.11 395.25 113.56 395.25 42.85 316.03 111.39 377.52 41.01 36.62 378.61 97.34 108.15 164.38 205.47 110.85 111.39 108.15 457.60 98.96 36.62 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83000376 XR LS SPINE MIN 4VWS 72110 320 $572.00 211.41 36.62 457.60 42.11 395.25 113.56 395.25 42.85 316.03 111.39 377.52 41.01 36.62 378.61 97.34 108.15 164.38 205.47 110.85 111.39 108.15 457.60 98.96 36.62 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67901517 XR L-SPINE COMPLETE MIN 6VWS 72114 320 $572.00 211.41 35.00 457.60 40.25 395.25 113.56 395.25 40.95 316.03 111.39 377.52 39.20 35.00 378.61 97.34 108.15 205.08 256.35 110.85 111.39 108.15 457.60 98.96 35.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80101511 XR L-SPINE COMPLETE MIN 6VWS 72114 320 $572.00 211.41 35.00 457.60 40.25 395.25 113.56 395.25 40.95 316.03 111.39 377.52 39.20 35.00 378.61 97.34 108.15 205.08 256.35 110.85 111.39 108.15 457.60 98.96 35.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81401519 XR L-SPINE COMPLETE MIN 6VWS 72114 320 $572.00 211.41 35.00 457.60 40.25 395.25 113.56 395.25 40.95 316.03 111.39 377.52 39.20 35.00 378.61 97.34 108.15 205.08 256.35 110.85 111.39 108.15 457.60 98.96 35.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81601518 XR L-SPINE COMPLETE MIN 6VWS 72114 320 $572.00 211.41 35.00 457.60 40.25 395.25 113.56 395.25 40.95 316.03 111.39 377.52 39.20 35.00 378.61 97.34 108.15 205.08 256.35 110.85 111.39 108.15 457.60 98.96 35.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81701512 XR L-SPINE COMPLETE MIN 6VWS 72114 320 $572.00 211.41 35.00 457.60 40.25 395.25 113.56 395.25 40.95 316.03 111.39 377.52 39.20 35.00 378.61 97.34 108.15 205.08 256.35 110.85 111.39 108.15 457.60 98.96 35.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82601511 XR L-SPINE COMPLETE MIN 6VWS 72114 320 $572.00 211.41 35.00 457.60 40.25 395.25 113.56 395.25 40.95 316.03 111.39 377.52 39.20 35.00 378.61 97.34 108.15 205.08 256.35 110.85 111.39 108.15 457.60 98.96 35.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82901515 XR L-SPINE COMPLETE MIN 6VWS 72114 320 $572.00 211.41 35.00 457.60 40.25 395.25 113.56 395.25 40.95 316.03 111.39 377.52 39.20 35.00 378.61 97.34 108.15 205.08 256.35 110.85 111.39 108.15 457.60 98.96 35.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83001518 XR L-SPINE COMPLETE MIN 6VWS 72114 320 $572.00 211.41 35.00 457.60 40.25 395.25 113.56 395.25 40.95 316.03 111.39 377.52 39.20 35.00 378.61 97.34 108.15 205.08 256.35 110.85 111.39 108.15 457.60 98.96 35.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67901525 XR L-SPINE BEND 2-3VWS 72120 320 $572.00 211.41 31.03 457.60 35.68 395.25 113.56 395.25 36.31 316.03 111.39 377.52 34.75 31.03 378.61 97.34 108.15 145.59 181.99 110.85 111.39 108.15 457.60 98.96 31.03 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80101520 XR L-SPINE BEND 2-3VWS 72120 320 $572.00 211.41 31.03 457.60 35.68 395.25 113.56 395.25 36.31 316.03 111.39 377.52 34.75 31.03 378.61 97.34 108.15 145.59 181.99 110.85 111.39 108.15 457.60 98.96 31.03 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81401527 XR L-SPINE BEND 2-3VWS 72120 320 $572.00 211.41 31.03 457.60 35.68 395.25 113.56 395.25 36.31 316.03 111.39 377.52 34.75 31.03 378.61 97.34 108.15 145.59 181.99 110.85 111.39 108.15 457.60 98.96 31.03 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81601526 XR L-SPINE BEND 2-3VWS 72120 320 $572.00 211.41 31.03 457.60 35.68 395.25 113.56 395.25 36.31 316.03 111.39 377.52 34.75 31.03 378.61 97.34 108.15 145.59 181.99 110.85 111.39 108.15 457.60 98.96 31.03 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81701521 XR L-SPINE BEND 2-3VWS 72120 320 $572.00 211.41 31.03 457.60 35.68 395.25 113.56 395.25 36.31 316.03 111.39 377.52 34.75 31.03 378.61 97.34 108.15 145.59 181.99 110.85 111.39 108.15 457.60 98.96 31.03 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82601520 XR L-SPINE BEND 2-3VWS 72120 320 $572.00 211.41 31.03 457.60 35.68 395.25 113.56 395.25 36.31 316.03 111.39 377.52 34.75 31.03 378.61 97.34 108.15 145.59 181.99 110.85 111.39 108.15 457.60 98.96 31.03 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82901523 XR L-SPINE BEND 2-3VWS 72120 320 $572.00 211.41 31.03 457.60 35.68 395.25 113.56 395.25 36.31 316.03 111.39 377.52 34.75 31.03 378.61 97.34 108.15 145.59 181.99 110.85 111.39 108.15 457.60 98.96 31.03 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83001526 XR L-SPINE BEND 2-3VWS 72120 320 $572.00 211.41 31.03 457.60 35.68 395.25 113.56 395.25 36.31 316.03 111.39 377.52 34.75 31.03 378.61 97.34 108.15 145.59 181.99 110.85 111.39 108.15 457.60 98.96 31.03 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67709152 CT C-SPINE W/O CONTRAST 72125 352 $572.00 211.41 95.17 " 1,774.00 " 153.63 " 1,774.00 " 113.56 " 1,774.00 " 156.30 316.03 111.39 725.00 149.62 133.59 378.61 97.34 108.15 909.10 " 1,136.37 " 110.85 111.39 108.15 457.60 98.96 133.59 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67909151 CT C-SPINE W/O CONTRAST 72125 352 $572.00 211.41 95.17 " 1,774.00 " 153.63 " 1,774.00 " 113.56 " 1,774.00 " 156.30 316.03 111.39 725.00 149.62 133.59 378.61 97.34 108.15 909.10 " 1,136.37 " 110.85 111.39 108.15 457.60 98.96 133.59 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80609159 CT C-SPINE W/O CONTRAST 72125 352 $572.00 211.41 95.17 " 1,774.00 " 153.63 " 1,774.00 " 113.56 " 1,774.00 " 156.30 316.03 111.39 725.00 149.62 133.59 378.61 97.34 108.15 909.10 " 1,136.37 " 110.85 111.39 108.15 457.60 98.96 133.59 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81409153 CT C-SPINE W/O CONTRAST 72125 352 $572.00 211.41 95.17 " 1,774.00 " 153.63 " 1,774.00 " 113.56 " 1,774.00 " 156.30 316.03 111.39 725.00 149.62 133.59 378.61 97.34 108.15 909.10 " 1,136.37 " 110.85 111.39 108.15 457.60 98.96 133.59 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81609152 CT C-SPINE W/O CONTRAST 72125 352 $572.00 211.41 95.17 " 1,774.00 " 153.63 " 1,774.00 " 113.56 " 1,774.00 " 156.30 316.03 111.39 725.00 149.62 133.59 378.61 97.34 108.15 909.10 " 1,136.37 " 110.85 111.39 108.15 457.60 98.96 133.59 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83009152 CT C-SPINE W/O CONTRAST 72125 352 $572.00 211.41 95.17 " 1,774.00 " 153.63 " 1,774.00 " 113.56 " 1,774.00 " 156.30 316.03 111.39 725.00 149.62 133.59 378.61 97.34 108.15 909.10 " 1,136.37 " 110.85 111.39 108.15 457.60 98.96 133.59 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67709161 CT C-SPINE W/CONTRAST 72126 352 "$1,933.00" 714.44 150.55 " 1,774.00 " 173.13 " 1,774.00 " 384.09 " 1,774.00 " 176.14 " 1,067.98 " 376.77 725.00 168.62 150.55 " 1,279.45 " 329.22 365.80 " 1,057.15 " " 1,321.44 " 374.95 376.77 365.80 " 1,546.40 " 334.71 150.55 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 67909160 CT C-SPINE W/CONTRAST 72126 352 "$1,933.00" 714.44 150.55 " 1,774.00 " 173.13 " 1,774.00 " 384.09 " 1,774.00 " 176.14 " 1,067.98 " 376.77 725.00 168.62 150.55 " 1,279.45 " 329.22 365.80 " 1,057.15 " " 1,321.44 " 374.95 376.77 365.80 " 1,546.40 " 334.71 150.55 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 80609167 CT C-SPINE W/CONTRAST 72126 352 "$1,933.00" 714.44 150.55 " 1,774.00 " 173.13 " 1,774.00 " 384.09 " 1,774.00 " 176.14 " 1,067.98 " 376.77 725.00 168.62 150.55 " 1,279.45 " 329.22 365.80 " 1,057.15 " " 1,321.44 " 374.95 376.77 365.80 " 1,546.40 " 334.71 150.55 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81409161 CT C-SPINE W/CONTRAST 72126 352 "$1,933.00" 714.44 150.55 " 1,774.00 " 173.13 " 1,774.00 " 384.09 " 1,774.00 " 176.14 " 1,067.98 " 376.77 725.00 168.62 150.55 " 1,279.45 " 329.22 365.80 " 1,057.15 " " 1,321.44 " 374.95 376.77 365.80 " 1,546.40 " 334.71 150.55 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81609161 CT C-SPINE W/CONTRAST 72126 352 "$1,933.00" 714.44 150.55 " 1,774.00 " 173.13 " 1,774.00 " 384.09 " 1,774.00 " 176.14 " 1,067.98 " 376.77 725.00 168.62 150.55 " 1,279.45 " 329.22 365.80 " 1,057.15 " " 1,321.44 " 374.95 376.77 365.80 " 1,546.40 " 334.71 150.55 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 83009161 CT C-SPINE W/CONTRAST 72126 352 "$1,933.00" 714.44 150.55 " 1,774.00 " 173.13 " 1,774.00 " 384.09 " 1,774.00 " 176.14 " 1,067.98 " 376.77 725.00 168.62 150.55 " 1,279.45 " 329.22 365.80 " 1,057.15 " " 1,321.44 " 374.95 376.77 365.80 " 1,546.40 " 334.71 150.55 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 67709799 CT C-SPINE WO/W CONTRAST 72127 352 $937.00 346.32 156.15 " 1,774.00 " 224.31 " 1,774.00 " 186.31 " 1,774.00 " 228.21 517.69 182.76 725.00 218.46 195.05 620.20 159.70 177.44 " 1,276.72 " " 1,595.90 " 181.88 182.76 177.44 749.60 162.36 195.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67909798 CT C-SPINE WO/W CONTRAST 72127 352 $937.00 346.32 156.15 " 1,774.00 " 224.31 " 1,774.00 " 186.31 " 1,774.00 " 228.21 517.69 182.76 725.00 218.46 195.05 620.20 159.70 177.44 " 1,276.72 " " 1,595.90 " 181.88 182.76 177.44 749.60 162.36 195.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80609795 CT C-SPINE WO/W CONTRAST 72127 352 $937.00 346.32 156.15 " 1,774.00 " 224.31 " 1,774.00 " 186.31 " 1,774.00 " 228.21 517.69 182.76 725.00 218.46 195.05 620.20 159.70 177.44 " 1,276.72 " " 1,595.90 " 181.88 182.76 177.44 749.60 162.36 195.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81409790 CT C-SPINE WO/W CONTRAST 72127 352 $937.00 346.32 156.15 " 1,774.00 " 224.31 " 1,774.00 " 186.31 " 1,774.00 " 228.21 517.69 182.76 725.00 218.46 195.05 620.20 159.70 177.44 " 1,276.72 " " 1,595.90 " 181.88 182.76 177.44 749.60 162.36 195.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81609799 CT C-SPINE WO/W CONTRAST 72127 352 $937.00 346.32 156.15 " 1,774.00 " 224.31 " 1,774.00 " 186.31 " 1,774.00 " 228.21 517.69 182.76 725.00 218.46 195.05 620.20 159.70 177.44 " 1,276.72 " " 1,595.90 " 181.88 182.76 177.44 749.60 162.36 195.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 83009799 CT C-SPINE WO/W CONTRAST 72127 352 $937.00 346.32 156.15 " 1,774.00 " 224.31 " 1,774.00 " 186.31 " 1,774.00 " 228.21 517.69 182.76 725.00 218.46 195.05 620.20 159.70 177.44 " 1,276.72 " " 1,595.90 " 181.88 182.76 177.44 749.60 162.36 195.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67709179 CT T-SPINE W/O CONTRAST 72128 352 $572.00 211.41 95.17 " 1,774.00 " 162.25 " 1,774.00 " 113.56 " 1,774.00 " 165.08 316.03 111.39 725.00 158.02 141.09 378.61 97.34 108.15 909.10 " 1,136.37 " 110.85 111.39 108.15 457.60 98.96 141.09 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67909178 CT T-SPINE W/O CONTRAST 72128 352 $572.00 211.41 95.17 " 1,774.00 " 162.25 " 1,774.00 " 113.56 " 1,774.00 " 165.08 316.03 111.39 725.00 158.02 141.09 378.61 97.34 108.15 909.10 " 1,136.37 " 110.85 111.39 108.15 457.60 98.96 141.09 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80609175 CT T-SPINE W/O CONTRAST 72128 352 $572.00 211.41 95.17 " 1,774.00 " 162.25 " 1,774.00 " 113.56 " 1,774.00 " 165.08 316.03 111.39 725.00 158.02 141.09 378.61 97.34 108.15 909.10 " 1,136.37 " 110.85 111.39 108.15 457.60 98.96 141.09 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81409170 CT T-SPINE W/O CONTRAST 72128 352 $572.00 211.41 95.17 " 1,774.00 " 162.25 " 1,774.00 " 113.56 " 1,774.00 " 165.08 316.03 111.39 725.00 158.02 141.09 378.61 97.34 108.15 909.10 " 1,136.37 " 110.85 111.39 108.15 457.60 98.96 141.09 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81609179 CT T-SPINE W/O CONTRAST 72128 352 $572.00 211.41 95.17 " 1,774.00 " 162.25 " 1,774.00 " 113.56 " 1,774.00 " 165.08 316.03 111.39 725.00 158.02 141.09 378.61 97.34 108.15 909.10 " 1,136.37 " 110.85 111.39 108.15 457.60 98.96 141.09 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83009179 CT T-SPINE W/O CONTRAST 72128 352 $572.00 211.41 95.17 " 1,774.00 " 162.25 " 1,774.00 " 113.56 " 1,774.00 " 165.08 316.03 111.39 725.00 158.02 141.09 378.61 97.34 108.15 909.10 " 1,136.37 " 110.85 111.39 108.15 457.60 98.96 141.09 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67709187 CT T-SPINE W/CONTRAST 72129 352 $937.00 346.32 144.05 " 1,774.00 " 165.66 " 1,774.00 " 186.31 " 1,774.00 " 168.54 517.69 182.76 725.00 161.34 144.05 620.20 159.70 177.44 " 1,057.15 " " 1,321.44 " 181.88 182.76 177.44 749.60 162.36 144.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67909186 CT T-SPINE W/CONTRAST 72129 352 $937.00 346.32 144.05 " 1,774.00 " 165.66 " 1,774.00 " 186.31 " 1,774.00 " 168.54 517.69 182.76 725.00 161.34 144.05 620.20 159.70 177.44 " 1,057.15 " " 1,321.44 " 181.88 182.76 177.44 749.60 162.36 144.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80609183 CT T-SPINE W/CONTRAST 72129 352 $937.00 346.32 144.05 " 1,774.00 " 165.66 " 1,774.00 " 186.31 " 1,774.00 " 168.54 517.69 182.76 725.00 161.34 144.05 620.20 159.70 177.44 " 1,057.15 " " 1,321.44 " 181.88 182.76 177.44 749.60 162.36 144.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81409188 CT T-SPINE W/CONTRAST 72129 352 $937.00 346.32 144.05 " 1,774.00 " 165.66 " 1,774.00 " 186.31 " 1,774.00 " 168.54 517.69 182.76 725.00 161.34 144.05 620.20 159.70 177.44 " 1,057.15 " " 1,321.44 " 181.88 182.76 177.44 749.60 162.36 144.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81609187 CT T-SPINE W/CONTRAST 72129 352 $937.00 346.32 144.05 " 1,774.00 " 165.66 " 1,774.00 " 186.31 " 1,774.00 " 168.54 517.69 182.76 725.00 161.34 144.05 620.20 159.70 177.44 " 1,057.15 " " 1,321.44 " 181.88 182.76 177.44 749.60 162.36 144.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 83009187 CT T-SPINE W/CONTRAST 72129 352 $937.00 346.32 144.05 " 1,774.00 " 165.66 " 1,774.00 " 186.31 " 1,774.00 " 168.54 517.69 182.76 725.00 161.34 144.05 620.20 159.70 177.44 " 1,057.15 " " 1,321.44 " 181.88 182.76 177.44 749.60 162.36 144.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67709802 CT T-SPINE WO/W CONTRAST 72130 352 $937.00 346.32 156.15 " 1,774.00 " 224.31 " 1,774.00 " 186.31 " 1,774.00 " 228.21 517.69 182.76 725.00 218.46 195.05 620.20 159.70 177.44 " 1,276.72 " " 1,595.90 " 181.88 182.76 177.44 749.60 162.36 195.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67909801 CT T-SPINE WO/W CONTRAST 72130 352 $937.00 346.32 156.15 " 1,774.00 " 224.31 " 1,774.00 " 186.31 " 1,774.00 " 228.21 517.69 182.76 725.00 218.46 195.05 620.20 159.70 177.44 " 1,276.72 " " 1,595.90 " 181.88 182.76 177.44 749.60 162.36 195.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80609809 CT T-SPINE WO/W CONTRAST 72130 352 $937.00 346.32 156.15 " 1,774.00 " 224.31 " 1,774.00 " 186.31 " 1,774.00 " 228.21 517.69 182.76 725.00 218.46 195.05 620.20 159.70 177.44 " 1,276.72 " " 1,595.90 " 181.88 182.76 177.44 749.60 162.36 195.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81409803 CT T-SPINE WO/W CONTRAST 72130 352 $937.00 346.32 156.15 " 1,774.00 " 224.31 " 1,774.00 " 186.31 " 1,774.00 " 228.21 517.69 182.76 725.00 218.46 195.05 620.20 159.70 177.44 " 1,276.72 " " 1,595.90 " 181.88 182.76 177.44 749.60 162.36 195.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81609802 CT T-SPINE WO/W CONTRAST 72130 352 $937.00 346.32 156.15 " 1,774.00 " 224.31 " 1,774.00 " 186.31 " 1,774.00 " 228.21 517.69 182.76 725.00 218.46 195.05 620.20 159.70 177.44 " 1,276.72 " " 1,595.90 " 181.88 182.76 177.44 749.60 162.36 195.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 83009802 CT T-SPINE WO/W CONTRAST 72130 352 $937.00 346.32 156.15 " 1,774.00 " 224.31 " 1,774.00 " 186.31 " 1,774.00 " 228.21 517.69 182.76 725.00 218.46 195.05 620.20 159.70 177.44 " 1,276.72 " " 1,595.90 " 181.88 182.76 177.44 749.60 162.36 195.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67709195 CT L-SPINE W/O CONTRAST 72131 352 $572.00 211.41 95.17 " 1,774.00 " 159.38 " 1,774.00 " 113.56 " 1,774.00 " 162.15 316.03 111.39 725.00 155.22 138.59 378.61 97.34 108.15 909.10 " 1,136.37 " 110.85 111.39 108.15 457.60 98.96 138.59 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67909194 CT L-SPINE W/O CONTRAST 72131 352 $572.00 211.41 95.17 " 1,774.00 " 159.38 " 1,774.00 " 113.56 " 1,774.00 " 162.15 316.03 111.39 725.00 155.22 138.59 378.61 97.34 108.15 909.10 " 1,136.37 " 110.85 111.39 108.15 457.60 98.96 138.59 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80609191 CT L-SPINE W/O CONTRAST 72131 352 $572.00 211.41 95.17 " 1,774.00 " 159.38 " 1,774.00 " 113.56 " 1,774.00 " 162.15 316.03 111.39 725.00 155.22 138.59 378.61 97.34 108.15 909.10 " 1,136.37 " 110.85 111.39 108.15 457.60 98.96 138.59 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81409196 CT L-SPINE W/O CONTRAST 72131 352 $572.00 211.41 95.17 " 1,774.00 " 159.38 " 1,774.00 " 113.56 " 1,774.00 " 162.15 316.03 111.39 725.00 155.22 138.59 378.61 97.34 108.15 909.10 " 1,136.37 " 110.85 111.39 108.15 457.60 98.96 138.59 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81609195 CT L-SPINE W/O CONTRAST 72131 352 $572.00 211.41 95.17 " 1,774.00 " 159.38 " 1,774.00 " 113.56 " 1,774.00 " 162.15 316.03 111.39 725.00 155.22 138.59 378.61 97.34 108.15 909.10 " 1,136.37 " 110.85 111.39 108.15 457.60 98.96 138.59 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83009195 CT L-SPINE W/O CONTRAST 72131 352 $572.00 211.41 95.17 " 1,774.00 " 159.38 " 1,774.00 " 113.56 " 1,774.00 " 162.15 316.03 111.39 725.00 155.22 138.59 378.61 97.34 108.15 909.10 " 1,136.37 " 110.85 111.39 108.15 457.60 98.96 138.59 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67709209 CT L-SPINE W/CONTRAST 72132 352 "$1,933.00" 714.44 150.55 " 1,774.00 " 173.13 " 1,774.00 " 384.09 " 1,774.00 " 176.14 " 1,067.98 " 376.77 725.00 168.62 150.55 " 1,279.45 " 329.22 365.80 " 1,057.15 " " 1,321.44 " 374.95 376.77 365.80 " 1,546.40 " 334.71 150.55 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 67909208 CT L-SPINE W/CONTRAST 72132 352 "$1,933.00" 714.44 150.55 " 1,774.00 " 173.13 " 1,774.00 " 384.09 " 1,774.00 " 176.14 " 1,067.98 " 376.77 725.00 168.62 150.55 " 1,279.45 " 329.22 365.80 " 1,057.15 " " 1,321.44 " 374.95 376.77 365.80 " 1,546.40 " 334.71 150.55 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 80609205 CT L-SPINE W/CONTRAST 72132 352 "$1,933.00" 714.44 150.55 " 1,774.00 " 173.13 " 1,774.00 " 384.09 " 1,774.00 " 176.14 " 1,067.98 " 376.77 725.00 168.62 150.55 " 1,279.45 " 329.22 365.80 " 1,057.15 " " 1,321.44 " 374.95 376.77 365.80 " 1,546.40 " 334.71 150.55 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81409200 CT L-SPINE W/CONTRAST 72132 352 "$1,933.00" 714.44 150.55 " 1,774.00 " 173.13 " 1,774.00 " 384.09 " 1,774.00 " 176.14 " 1,067.98 " 376.77 725.00 168.62 150.55 " 1,279.45 " 329.22 365.80 " 1,057.15 " " 1,321.44 " 374.95 376.77 365.80 " 1,546.40 " 334.71 150.55 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81609209 CT L-SPINE W/CONTRAST 72132 352 "$1,933.00" 714.44 150.55 " 1,774.00 " 173.13 " 1,774.00 " 384.09 " 1,774.00 " 176.14 " 1,067.98 " 376.77 725.00 168.62 150.55 " 1,279.45 " 329.22 365.80 " 1,057.15 " " 1,321.44 " 374.95 376.77 365.80 " 1,546.40 " 334.71 150.55 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 83009209 CT L-SPINE W/CONTRAST 72132 352 "$1,933.00" 714.44 150.55 " 1,774.00 " 173.13 " 1,774.00 " 384.09 " 1,774.00 " 176.14 " 1,067.98 " 376.77 725.00 168.62 150.55 " 1,279.45 " 329.22 365.80 " 1,057.15 " " 1,321.44 " 374.95 376.77 365.80 " 1,546.40 " 334.71 150.55 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 67709217 CT L-SPINE WO/W CONTRAST 72133 352 $937.00 346.32 156.15 " 1,774.00 " 224.31 " 1,774.00 " 186.31 " 1,774.00 " 228.21 517.69 182.76 725.00 218.46 195.05 620.20 159.70 177.44 " 1,276.72 " " 1,595.90 " 181.88 182.76 177.44 749.60 162.36 195.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67909216 CT L-SPINE WO/W CONTRAST 72133 352 $937.00 346.32 156.15 " 1,774.00 " 224.31 " 1,774.00 " 186.31 " 1,774.00 " 228.21 517.69 182.76 725.00 218.46 195.05 620.20 159.70 177.44 " 1,276.72 " " 1,595.90 " 181.88 182.76 177.44 749.60 162.36 195.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80609213 CT L-SPINE WO/W CONTRAST 72133 352 $937.00 346.32 156.15 " 1,774.00 " 224.31 " 1,774.00 " 186.31 " 1,774.00 " 228.21 517.69 182.76 725.00 218.46 195.05 620.20 159.70 177.44 " 1,276.72 " " 1,595.90 " 181.88 182.76 177.44 749.60 162.36 195.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81409218 CT L-SPINE WO/W CONTRAST 72133 352 $937.00 346.32 156.15 " 1,774.00 " 224.31 " 1,774.00 " 186.31 " 1,774.00 " 228.21 517.69 182.76 725.00 218.46 195.05 620.20 159.70 177.44 " 1,276.72 " " 1,595.90 " 181.88 182.76 177.44 749.60 162.36 195.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81609217 CT L-SPINE WO/W CONTRAST 72133 352 $937.00 346.32 156.15 " 1,774.00 " 224.31 " 1,774.00 " 186.31 " 1,774.00 " 228.21 517.69 182.76 725.00 218.46 195.05 620.20 159.70 177.44 " 1,276.72 " " 1,595.90 " 181.88 182.76 177.44 749.60 162.36 195.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 83009217 CT L-SPINE WO/W CONTRAST 72133 352 $937.00 346.32 156.15 " 1,774.00 " 224.31 " 1,774.00 " 186.31 " 1,774.00 " 228.21 517.69 182.76 725.00 218.46 195.05 620.20 159.70 177.44 " 1,276.72 " " 1,595.90 " 181.88 182.76 177.44 749.60 162.36 195.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80407149 MRI C-SPINE W/O CONTRAST 72141 612 "$1,208.00" 446.48 201.14 " 2,882.00 " 389.85 " 2,882.00 " 240.00 " 2,882.00 " 396.63 667.42 235.43 " 1,155.00 " 379.68 339.00 799.58 205.71 228.57 " 1,618.82 " " 2,023.52 " 234.28 235.43 228.57 966.40 209.14 339.00 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81407142 MRI C-SPINE W/O CONTRAST 72141 612 "$1,208.00" 446.48 201.14 " 2,882.00 " 389.85 " 2,882.00 " 240.00 " 2,882.00 " 396.63 667.42 235.43 " 1,155.00 " 379.68 339.00 799.58 205.71 228.57 " 1,618.82 " " 2,023.52 " 234.28 235.43 228.57 966.40 209.14 339.00 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81607141 MRI C-SPINE W/O CONTRAST 72141 612 "$1,208.00" 446.48 201.14 " 2,882.00 " 389.85 " 2,882.00 " 240.00 " 2,882.00 " 396.63 667.42 235.43 " 1,155.00 " 379.68 339.00 799.58 205.71 228.57 " 1,618.82 " " 2,023.52 " 234.28 235.43 228.57 966.40 209.14 339.00 602.94 201.14 494.07 906.00 459.16 540.34 236.57 80407157 MRI C-SPINE W/CONTRAST 72142 612 "$1,933.00" 714.44 321.90 " 2,882.00 " 389.85 " 2,882.00 " 384.09 " 2,882.00 " 396.63 " 1,067.98 " 376.77 " 1,155.00 " 379.68 339.00 " 1,279.45 " 329.22 365.80 " 1,942.02 " " 2,427.53 " 374.95 376.77 365.80 " 1,546.40 " 334.71 339.00 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81407151 MRI C-SPINE W/CONTRAST 72142 612 "$1,933.00" 714.44 321.90 " 2,882.00 " 389.85 " 2,882.00 " 384.09 " 2,882.00 " 396.63 " 1,067.98 " 376.77 " 1,155.00 " 379.68 339.00 " 1,279.45 " 329.22 365.80 " 1,942.02 " " 2,427.53 " 374.95 376.77 365.80 " 1,546.40 " 334.71 339.00 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81607150 MRI C-SPINE W/CONTRAST 72142 612 "$1,933.00" 714.44 321.90 " 2,882.00 " 389.85 " 2,882.00 " 384.09 " 2,882.00 " 396.63 " 1,067.98 " 376.77 " 1,155.00 " 379.68 339.00 " 1,279.45 " 329.22 365.80 " 1,942.02 " " 2,427.53 " 374.95 376.77 365.80 " 1,546.40 " 334.71 339.00 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 80407165 MRI T-SPINE W/O CONTRAST 72146 612 "$1,208.00" 446.48 201.14 " 2,882.00 " 300.55 " 2,882.00 " 240.00 " 2,882.00 " 305.78 667.42 235.43 " 1,155.00 " 292.71 261.35 799.58 205.71 228.57 " 1,765.72 " " 2,207.15 " 234.28 235.43 228.57 966.40 209.14 261.35 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81407169 MRI T-SPINE W/O CONTRAST 72146 612 "$1,208.00" 446.48 201.14 " 2,882.00 " 300.55 " 2,882.00 " 240.00 " 2,882.00 " 305.78 667.42 235.43 " 1,155.00 " 292.71 261.35 799.58 205.71 228.57 " 1,765.72 " " 2,207.15 " 234.28 235.43 228.57 966.40 209.14 261.35 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81607168 MRI T-SPINE W/O CONTRAST 72146 612 "$1,208.00" 446.48 201.14 " 2,882.00 " 300.55 " 2,882.00 " 240.00 " 2,882.00 " 305.78 667.42 235.43 " 1,155.00 " 292.71 261.35 799.58 205.71 228.57 " 1,765.72 " " 2,207.15 " 234.28 235.43 228.57 966.40 209.14 261.35 602.94 201.14 494.07 906.00 459.16 540.34 236.57 80407173 MRI T-SPINE W/CONTRAST 72147 612 "$1,933.00" 714.44 321.90 " 2,882.00 " 389.85 " 2,882.00 " 384.09 " 2,882.00 " 396.63 " 1,067.98 " 376.77 " 1,155.00 " 379.68 339.00 " 1,279.45 " 329.22 365.80 " 1,942.02 " " 2,427.53 " 374.95 376.77 365.80 " 1,546.40 " 334.71 339.00 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81407177 MRI T-SPINE W/CONTRAST 72147 612 "$1,933.00" 714.44 321.90 " 2,882.00 " 389.85 " 2,882.00 " 384.09 " 2,882.00 " 396.63 " 1,067.98 " 376.77 " 1,155.00 " 379.68 339.00 " 1,279.45 " 329.22 365.80 " 1,942.02 " " 2,427.53 " 374.95 376.77 365.80 " 1,546.40 " 334.71 339.00 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81607176 MRI T-SPINE W/CONTRAST 72147 612 "$1,933.00" 714.44 321.90 " 2,882.00 " 389.85 " 2,882.00 " 384.09 " 2,882.00 " 396.63 " 1,067.98 " 376.77 " 1,155.00 " 379.68 339.00 " 1,279.45 " 329.22 365.80 " 1,942.02 " " 2,427.53 " 374.95 376.77 365.80 " 1,546.40 " 334.71 339.00 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 80407181 MRI L-SPINE W/O CONTRAST 72148 612 "$1,208.00" 446.48 201.14 " 2,882.00 " 294.57 " 2,882.00 " 240.00 " 2,882.00 " 299.70 667.42 235.43 " 1,155.00 " 286.89 256.15 799.58 205.71 228.57 " 1,743.54 " " 2,179.42 " 234.28 235.43 228.57 966.40 209.14 256.15 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81407185 MRI L-SPINE W/O CONTRAST 72148 612 "$1,208.00" 446.48 201.14 " 2,882.00 " 294.57 " 2,882.00 " 240.00 " 2,882.00 " 299.70 667.42 235.43 " 1,155.00 " 286.89 256.15 799.58 205.71 228.57 " 1,743.54 " " 2,179.42 " 234.28 235.43 228.57 966.40 209.14 256.15 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81607184 MRI L-SPINE W/O CONTRAST 72148 612 "$1,208.00" 446.48 201.14 " 2,882.00 " 294.57 " 2,882.00 " 240.00 " 2,882.00 " 299.70 667.42 235.43 " 1,155.00 " 286.89 256.15 799.58 205.71 228.57 " 1,743.54 " " 2,179.42 " 234.28 235.43 228.57 966.40 209.14 256.15 602.94 201.14 494.07 906.00 459.16 540.34 236.57 80407190 MRI L-SPINE W/CONTRAST 72149 612 "$1,933.00" 714.44 321.90 " 2,882.00 " 389.85 " 2,882.00 " 384.09 " 2,882.00 " 396.63 " 1,067.98 " 376.77 " 1,155.00 " 379.68 339.00 " 1,279.45 " 329.22 365.80 " 1,917.54 " " 2,396.92 " 374.95 376.77 365.80 " 1,546.40 " 334.71 339.00 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81407193 MRI L-SPINE W/CONTRAST 72149 612 "$1,933.00" 714.44 321.90 " 2,882.00 " 389.85 " 2,882.00 " 384.09 " 2,882.00 " 396.63 " 1,067.98 " 376.77 " 1,155.00 " 379.68 339.00 " 1,279.45 " 329.22 365.80 " 1,917.54 " " 2,396.92 " 374.95 376.77 365.80 " 1,546.40 " 334.71 339.00 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81607192 MRI L-SPINE W/CONTRAST 72149 612 "$1,933.00" 714.44 321.90 " 2,882.00 " 389.85 " 2,882.00 " 384.09 " 2,882.00 " 396.63 " 1,067.98 " 376.77 " 1,155.00 " 379.68 339.00 " 1,279.45 " 329.22 365.80 " 1,917.54 " " 2,396.92 " 374.95 376.77 365.80 " 1,546.40 " 334.71 339.00 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 80407203 MRI C-SPINE WO/W CONTRAST 72156 612 "$1,933.00" 714.44 321.90 " 4,274.61 " 389.85 " 2,882.00 " 384.09 " 2,882.00 " 396.63 " 1,067.98 " 376.77 " 1,155.00 " 379.68 339.00 " 1,279.45 " 329.22 365.80 " 3,419.69 " " 4,274.61 " 374.95 376.77 365.80 " 1,546.40 " 334.71 339.00 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81407207 MRI C-SPINE WO/W CONTRAST 72156 612 "$1,933.00" 714.44 321.90 " 4,274.61 " 389.85 " 2,882.00 " 384.09 " 2,882.00 " 396.63 " 1,067.98 " 376.77 " 1,155.00 " 379.68 339.00 " 1,279.45 " 329.22 365.80 " 3,419.69 " " 4,274.61 " 374.95 376.77 365.80 " 1,546.40 " 334.71 339.00 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81607206 MRI C-SPINE WO/W CONTRAST 72156 612 "$1,933.00" 714.44 321.90 " 4,274.61 " 389.85 " 2,882.00 " 384.09 " 2,882.00 " 396.63 " 1,067.98 " 376.77 " 1,155.00 " 379.68 339.00 " 1,279.45 " 329.22 365.80 " 3,419.69 " " 4,274.61 " 374.95 376.77 365.80 " 1,546.40 " 334.71 339.00 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 80407211 MRI T-SPINE WO/W CONTRAST 72157 612 "$1,933.00" 714.44 321.90 " 4,274.61 " 389.85 " 2,882.00 " 384.09 " 2,882.00 " 396.63 " 1,067.98 " 376.77 " 1,155.00 " 379.68 339.00 " 1,279.45 " 329.22 365.80 " 3,419.69 " " 4,274.61 " 374.95 376.77 365.80 " 1,546.40 " 334.71 339.00 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81407215 MRI T-SPINE WO/W CONTRAST 72157 612 "$1,933.00" 714.44 321.90 " 4,274.61 " 389.85 " 2,882.00 " 384.09 " 2,882.00 " 396.63 " 1,067.98 " 376.77 " 1,155.00 " 379.68 339.00 " 1,279.45 " 329.22 365.80 " 3,419.69 " " 4,274.61 " 374.95 376.77 365.80 " 1,546.40 " 334.71 339.00 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81607214 MRI T-SPINE WO/W CONTRAST 72157 612 "$1,933.00" 714.44 321.90 " 4,274.61 " 389.85 " 2,882.00 " 384.09 " 2,882.00 " 396.63 " 1,067.98 " 376.77 " 1,155.00 " 379.68 339.00 " 1,279.45 " 329.22 365.80 " 3,419.69 " " 4,274.61 " 374.95 376.77 365.80 " 1,546.40 " 334.71 339.00 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 80407220 MRI L-SPINE WO/W CONTRAST 72158 612 "$1,933.00" 714.44 321.90 " 4,231.06 " 389.85 " 2,882.00 " 384.09 " 2,882.00 " 396.63 " 1,067.98 " 376.77 " 1,155.00 " 379.68 339.00 " 1,279.45 " 329.22 365.80 " 3,384.85 " " 4,231.06 " 374.95 376.77 365.80 " 1,546.40 " 334.71 339.00 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81407223 MRI L-SPINE WO/W CONTRAST 72158 612 "$1,933.00" 714.44 321.90 " 4,231.06 " 389.85 " 2,882.00 " 384.09 " 2,882.00 " 396.63 " 1,067.98 " 376.77 " 1,155.00 " 379.68 339.00 " 1,279.45 " 329.22 365.80 " 3,384.85 " " 4,231.06 " 374.95 376.77 365.80 " 1,546.40 " 334.71 339.00 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81607222 MRI L-SPINE WO/W CONTRAST 72158 612 "$1,933.00" 714.44 321.90 " 4,231.06 " 389.85 " 2,882.00 " 384.09 " 2,882.00 " 396.63 " 1,067.98 " 376.77 " 1,155.00 " 379.68 339.00 " 1,279.45 " 329.22 365.80 " 3,384.85 " " 4,231.06 " 374.95 376.77 365.80 " 1,546.40 " 334.71 339.00 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81607923 MRA SPINAL CONTENTS W/O CONT 72159 618 "$4,862.00" " 1,797.00 " - " 3,889.60 " 524.58 " 2,882.00 " N/A " 2,882.00 " 533.71 " 2,686.26 " N/A " 1,155.00 " 510.90 N/A " 3,218.16 " - N/A " 1,780.16 " " 2,225.20 " N/A N/A N/A " 3,889.60 " N/A 456.16 807.25 N/A " 1,988.56 " " 3,646.50 " " 1,848.05 " " 2,174.77 " N/A 81607931 MRA SPINAL CONTENTS W/CONTRAST 72159 618 "$4,862.00" " 1,797.00 " - " 3,889.60 " 524.58 " 2,882.00 " N/A " 2,882.00 " 533.71 " 2,686.26 " N/A " 1,155.00 " 510.90 N/A " 3,218.16 " - N/A " 1,780.16 " " 2,225.20 " N/A N/A N/A " 3,889.60 " N/A 456.16 807.25 N/A " 1,988.56 " " 3,646.50 " " 1,848.05 " " 2,174.77 " N/A 81607940 MRA SPINAL CONTENTS WO/W CONT 72159 618 "$4,862.00" " 1,797.00 " - " 3,889.60 " 524.58 " 2,882.00 " N/A " 2,882.00 " 533.71 " 2,686.26 " N/A " 1,155.00 " 510.90 N/A " 3,218.16 " - N/A " 1,780.16 " " 2,225.20 " N/A N/A N/A " 3,889.60 " N/A 456.16 807.25 N/A " 1,988.56 " " 3,646.50 " " 1,848.05 " " 2,174.77 " N/A 67900383 XR PELVIS 1-2VWS 72170 320 $572.00 211.41 17.50 457.60 20.13 395.25 113.56 395.25 20.48 316.03 111.39 377.52 19.60 17.50 378.61 97.34 108.15 91.40 114.25 110.85 111.39 108.15 457.60 98.96 17.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80100388 XR PELVIS 1-2VWS 72170 320 $572.00 211.41 17.50 457.60 20.13 395.25 113.56 395.25 20.48 316.03 111.39 377.52 19.60 17.50 378.61 97.34 108.15 91.40 114.25 110.85 111.39 108.15 457.60 98.96 17.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81400385 XR PELVIS 1-2VWS 72170 320 $572.00 211.41 17.50 457.60 20.13 395.25 113.56 395.25 20.48 316.03 111.39 377.52 19.60 17.50 378.61 97.34 108.15 91.40 114.25 110.85 111.39 108.15 457.60 98.96 17.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81600384 XR PELVIS 1-2VWS 72170 320 $572.00 211.41 17.50 457.60 20.13 395.25 113.56 395.25 20.48 316.03 111.39 377.52 19.60 17.50 378.61 97.34 108.15 91.40 114.25 110.85 111.39 108.15 457.60 98.96 17.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81700389 XR PELVIS 1-2VWS 72170 320 $572.00 211.41 17.50 457.60 20.13 395.25 113.56 395.25 20.48 316.03 111.39 377.52 19.60 17.50 378.61 97.34 108.15 91.40 114.25 110.85 111.39 108.15 457.60 98.96 17.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82600388 XR PELVIS 1-2VWS 72170 320 $572.00 211.41 17.50 457.60 20.13 395.25 113.56 395.25 20.48 316.03 111.39 377.52 19.60 17.50 378.61 97.34 108.15 91.40 114.25 110.85 111.39 108.15 457.60 98.96 17.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82900381 XR PELVIS 1-2VWS 72170 320 $572.00 211.41 17.50 457.60 20.13 395.25 113.56 395.25 20.48 316.03 111.39 377.52 19.60 17.50 378.61 97.34 108.15 91.40 114.25 110.85 111.39 108.15 457.60 98.96 17.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83000384 XR PELVIS 1-2VWS 72170 320 $572.00 211.41 17.50 457.60 20.13 395.25 113.56 395.25 20.48 316.03 111.39 377.52 19.60 17.50 378.61 97.34 108.15 91.40 114.25 110.85 111.39 108.15 457.60 98.96 17.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67900391 XR PELVIS COMPLETE 72190 320 $572.00 211.41 30.65 457.60 35.25 395.25 113.56 395.25 35.86 316.03 111.39 377.52 34.33 30.65 378.61 97.34 108.15 117.08 146.35 110.85 111.39 108.15 457.60 98.96 30.65 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80100396 XR PELVIS COMPLETE 72190 320 $572.00 211.41 30.65 457.60 35.25 395.25 113.56 395.25 35.86 316.03 111.39 377.52 34.33 30.65 378.61 97.34 108.15 117.08 146.35 110.85 111.39 108.15 457.60 98.96 30.65 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81400393 XR PELVIS COMPLETE 72190 320 $572.00 211.41 30.65 457.60 35.25 395.25 113.56 395.25 35.86 316.03 111.39 377.52 34.33 30.65 378.61 97.34 108.15 117.08 146.35 110.85 111.39 108.15 457.60 98.96 30.65 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81600392 XR PELVIS COMPLETE 72190 320 $572.00 211.41 30.65 457.60 35.25 395.25 113.56 395.25 35.86 316.03 111.39 377.52 34.33 30.65 378.61 97.34 108.15 117.08 146.35 110.85 111.39 108.15 457.60 98.96 30.65 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81700397 XR PELVIS COMPLETE 72190 320 $572.00 211.41 30.65 457.60 35.25 395.25 113.56 395.25 35.86 316.03 111.39 377.52 34.33 30.65 378.61 97.34 108.15 117.08 146.35 110.85 111.39 108.15 457.60 98.96 30.65 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82600396 XR PELVIS COMPLETE 72190 320 $572.00 211.41 30.65 457.60 35.25 395.25 113.56 395.25 35.86 316.03 111.39 377.52 34.33 30.65 378.61 97.34 108.15 117.08 146.35 110.85 111.39 108.15 457.60 98.96 30.65 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82900390 XR PELVIS COMPLETE 72190 320 $572.00 211.41 30.65 457.60 35.25 395.25 113.56 395.25 35.86 316.03 111.39 377.52 34.33 30.65 378.61 97.34 108.15 117.08 146.35 110.85 111.39 108.15 457.60 98.96 30.65 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83000392 XR PELVIS COMPLETE 72190 320 $572.00 211.41 30.65 457.60 35.25 395.25 113.56 395.25 35.86 316.03 111.39 377.52 34.33 30.65 378.61 97.34 108.15 117.08 146.35 110.85 111.39 108.15 457.60 98.96 30.65 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67709713 CTA PELVIS WO/W CONTRAST 72191 352 $937.00 346.32 156.15 " 1,774.00 " 337.93 " 1,774.00 " 186.31 " 1,774.00 " 343.80 517.69 182.76 725.00 329.11 293.85 620.20 159.70 177.44 " 1,356.40 " " 1,695.50 " 181.88 182.76 177.44 749.60 162.36 293.85 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67909712 CTA PELVIS WO/W CONTRAST 72191 352 $937.00 346.32 156.15 " 1,774.00 " 337.93 " 1,774.00 " 186.31 " 1,774.00 " 343.80 517.69 182.76 725.00 329.11 293.85 620.20 159.70 177.44 " 1,356.40 " " 1,695.50 " 181.88 182.76 177.44 749.60 162.36 293.85 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80609710 CTA PELVIS WO/W CONTRAST 72191 352 $937.00 346.32 156.15 " 1,774.00 " 337.93 " 1,774.00 " 186.31 " 1,774.00 " 343.80 517.69 182.76 725.00 329.11 293.85 620.20 159.70 177.44 " 1,356.40 " " 1,695.50 " 181.88 182.76 177.44 749.60 162.36 293.85 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81409714 CTA PELVIS WO/W CONTRAST 72191 352 $937.00 346.32 156.15 " 1,774.00 " 337.93 " 1,774.00 " 186.31 " 1,774.00 " 343.80 517.69 182.76 725.00 329.11 293.85 620.20 159.70 177.44 " 1,356.40 " " 1,695.50 " 181.88 182.76 177.44 749.60 162.36 293.85 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81609713 CTA PELVIS WO/W CONTRAST 72191 352 $937.00 346.32 156.15 " 1,774.00 " 337.93 " 1,774.00 " 186.31 " 1,774.00 " 343.80 517.69 182.76 725.00 329.11 293.85 620.20 159.70 177.44 " 1,356.40 " " 1,695.50 " 181.88 182.76 177.44 749.60 162.36 293.85 467.80 156.15 383.23 702.75 356.15 419.12 183.65 83009713 CTA PELVIS WO/W CONTRAST 72191 352 $937.00 346.32 156.15 " 1,774.00 " 337.93 " 1,774.00 " 186.31 " 1,774.00 " 343.80 517.69 182.76 725.00 329.11 293.85 620.20 159.70 177.44 " 1,356.40 " " 1,695.50 " 181.88 182.76 177.44 749.60 162.36 293.85 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67709233 CT PELVIS W/O CONTRAST 72192 352 $572.00 211.41 95.17 " 1,774.00 " 129.38 " 1,774.00 " 113.56 " 1,774.00 " 131.63 316.03 111.39 725.00 126.00 112.50 378.61 97.34 108.15 896.07 " 1,120.09 " 110.85 111.39 108.15 457.60 98.96 112.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67909232 CT PELVIS W/O CONTRAST 72192 352 $572.00 211.41 95.17 " 1,774.00 " 129.38 " 1,774.00 " 113.56 " 1,774.00 " 131.63 316.03 111.39 725.00 126.00 112.50 378.61 97.34 108.15 896.07 " 1,120.09 " 110.85 111.39 108.15 457.60 98.96 112.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80609230 CT PELVIS W/O CONTRAST 72192 352 $572.00 211.41 95.17 " 1,774.00 " 129.38 " 1,774.00 " 113.56 " 1,774.00 " 131.63 316.03 111.39 725.00 126.00 112.50 378.61 97.34 108.15 896.07 " 1,120.09 " 110.85 111.39 108.15 457.60 98.96 112.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81409234 CT PELVIS W/O CONTRAST 72192 352 $572.00 211.41 95.17 " 1,774.00 " 129.38 " 1,774.00 " 113.56 " 1,774.00 " 131.63 316.03 111.39 725.00 126.00 112.50 378.61 97.34 108.15 896.07 " 1,120.09 " 110.85 111.39 108.15 457.60 98.96 112.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81609233 CT PELVIS W/O CONTRAST 72192 352 $572.00 211.41 95.17 " 1,774.00 " 129.38 " 1,774.00 " 113.56 " 1,774.00 " 131.63 316.03 111.39 725.00 126.00 112.50 378.61 97.34 108.15 896.07 " 1,120.09 " 110.85 111.39 108.15 457.60 98.96 112.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83009233 CT PELVIS W/O CONTRAST 72192 352 $572.00 211.41 95.17 " 1,774.00 " 129.38 " 1,774.00 " 113.56 " 1,774.00 " 131.63 316.03 111.39 725.00 126.00 112.50 378.61 97.34 108.15 896.07 " 1,120.09 " 110.85 111.39 108.15 457.60 98.96 112.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67709241 CT PELVIS W/CONTRAST 72193 352 $937.00 346.32 140.09 " 1,774.00 " 161.10 " 1,774.00 " 186.31 " 1,774.00 " 163.91 517.69 182.76 725.00 156.90 140.09 620.20 159.70 177.44 " 1,019.48 " " 1,274.35 " 181.88 182.76 177.44 749.60 162.36 140.09 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67909241 CT PELVIS W/CONTRAST 72193 352 $937.00 346.32 140.09 " 1,774.00 " 161.10 " 1,774.00 " 186.31 " 1,774.00 " 163.91 517.69 182.76 725.00 156.90 140.09 620.20 159.70 177.44 " 1,019.48 " " 1,274.35 " 181.88 182.76 177.44 749.60 162.36 140.09 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80609248 CT PELVIS W/CONTRAST 72193 352 $937.00 346.32 140.09 " 1,774.00 " 161.10 " 1,774.00 " 186.31 " 1,774.00 " 163.91 517.69 182.76 725.00 156.90 140.09 620.20 159.70 177.44 " 1,019.48 " " 1,274.35 " 181.88 182.76 177.44 749.60 162.36 140.09 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81409242 CT PELVIS W/CONTRAST 72193 352 $937.00 346.32 140.09 " 1,774.00 " 161.10 " 1,774.00 " 186.31 " 1,774.00 " 163.91 517.69 182.76 725.00 156.90 140.09 620.20 159.70 177.44 " 1,019.48 " " 1,274.35 " 181.88 182.76 177.44 749.60 162.36 140.09 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81609241 CT PELVIS W/CONTRAST 72193 352 $937.00 346.32 140.09 " 1,774.00 " 161.10 " 1,774.00 " 186.31 " 1,774.00 " 163.91 517.69 182.76 725.00 156.90 140.09 620.20 159.70 177.44 " 1,019.48 " " 1,274.35 " 181.88 182.76 177.44 749.60 162.36 140.09 467.80 156.15 383.23 702.75 356.15 419.12 183.65 83009241 CT PELVIS W/CONTRAST 72193 352 $937.00 346.32 140.09 " 1,774.00 " 161.10 " 1,774.00 " 186.31 " 1,774.00 " 163.91 517.69 182.76 725.00 156.90 140.09 620.20 159.70 177.44 " 1,019.48 " " 1,274.35 " 181.88 182.76 177.44 749.60 162.36 140.09 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67709250 CT PELVIS WO/W CONTRAST 72194 352 $937.00 346.32 156.15 " 1,774.00 " 182.91 " 1,774.00 " 186.31 " 1,774.00 " 186.09 517.69 182.76 725.00 178.14 159.05 620.20 159.70 177.44 " 1,223.67 " " 1,529.59 " 181.88 182.76 177.44 749.60 162.36 159.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67909259 CT PELVIS WO/W CONTRAST 72194 352 $937.00 346.32 156.15 " 1,774.00 " 182.91 " 1,774.00 " 186.31 " 1,774.00 " 186.09 517.69 182.76 725.00 178.14 159.05 620.20 159.70 177.44 " 1,223.67 " " 1,529.59 " 181.88 182.76 177.44 749.60 162.36 159.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80609256 CT PELVIS WO/W CONTRAST 72194 352 $937.00 346.32 156.15 " 1,774.00 " 182.91 " 1,774.00 " 186.31 " 1,774.00 " 186.09 517.69 182.76 725.00 178.14 159.05 620.20 159.70 177.44 " 1,223.67 " " 1,529.59 " 181.88 182.76 177.44 749.60 162.36 159.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81409251 CT PELVIS WO/W CONTRAST 72194 352 $937.00 346.32 156.15 " 1,774.00 " 182.91 " 1,774.00 " 186.31 " 1,774.00 " 186.09 517.69 182.76 725.00 178.14 159.05 620.20 159.70 177.44 " 1,223.67 " " 1,529.59 " 181.88 182.76 177.44 749.60 162.36 159.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81609250 CT PELVIS WO/W CONTRAST 72194 352 $937.00 346.32 156.15 " 1,774.00 " 182.91 " 1,774.00 " 186.31 " 1,774.00 " 186.09 517.69 182.76 725.00 178.14 159.05 620.20 159.70 177.44 " 1,223.67 " " 1,529.59 " 181.88 182.76 177.44 749.60 162.36 159.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 83009250 CT PELVIS WO/W CONTRAST 72194 352 $937.00 346.32 156.15 " 1,774.00 " 182.91 " 1,774.00 " 186.31 " 1,774.00 " 186.09 517.69 182.76 725.00 178.14 159.05 620.20 159.70 177.44 " 1,223.67 " " 1,529.59 " 181.88 182.76 177.44 749.60 162.36 159.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80407238 MRI PELVIS W/O CONTRAST 72195 614 "$1,208.00" 446.48 201.14 " 2,882.00 " 377.97 " 2,882.00 " 240.00 " 2,882.00 " 384.54 667.42 235.43 " 1,155.00 " 368.11 328.67 799.58 205.71 228.57 " 1,271.18 " " 1,588.97 " 234.28 235.43 228.57 966.40 209.14 328.67 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81407231 MRI PELVIS W/O CONTRAST 72195 614 "$1,208.00" 446.48 201.14 " 2,882.00 " 377.97 " 2,882.00 " 240.00 " 2,882.00 " 384.54 667.42 235.43 " 1,155.00 " 368.11 328.67 799.58 205.71 228.57 " 1,271.18 " " 1,588.97 " 234.28 235.43 228.57 966.40 209.14 328.67 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81607231 MRI PELVIS W/O CONTRAST 72195 614 "$1,208.00" 446.48 201.14 " 2,882.00 " 377.97 " 2,882.00 " 240.00 " 2,882.00 " 384.54 667.42 235.43 " 1,155.00 " 368.11 328.67 799.58 205.71 228.57 " 1,271.18 " " 1,588.97 " 234.28 235.43 228.57 966.40 209.14 328.67 602.94 201.14 494.07 906.00 459.16 540.34 236.57 80407254 MRI PELVIS W/CONTRAST 72196 614 "$1,933.00" 714.44 283.77 " 2,882.00 " 326.34 " 2,882.00 " 384.09 " 2,882.00 " 332.01 " 1,067.98 " 376.77 " 1,155.00 " 317.82 283.77 " 1,279.45 " 329.22 365.80 " 1,618.82 " " 2,023.52 " 374.95 376.77 365.80 " 1,546.40 " 334.71 283.77 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81407258 MRI PELVIS W/CONTRAST 72196 614 "$1,933.00" 714.44 283.77 " 2,882.00 " 326.34 " 2,882.00 " 384.09 " 2,882.00 " 332.01 " 1,067.98 " 376.77 " 1,155.00 " 317.82 283.77 " 1,279.45 " 329.22 365.80 " 1,618.82 " " 2,023.52 " 374.95 376.77 365.80 " 1,546.40 " 334.71 283.77 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81607257 MRI PELVIS W/CONTRAST 72196 614 "$1,933.00" 714.44 283.77 " 2,882.00 " 326.34 " 2,882.00 " 384.09 " 2,882.00 " 332.01 " 1,067.98 " 376.77 " 1,155.00 " 317.82 283.77 " 1,279.45 " 329.22 365.80 " 1,618.82 " " 2,023.52 " 374.95 376.77 365.80 " 1,546.40 " 334.71 283.77 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 80407262 MRI PELVIS WO/W CONTRAST 72197 614 "$1,933.00" 714.44 321.90 " 3,521.19 " 663.40 " 2,882.00 " 384.09 " 2,882.00 " 674.94 " 1,067.98 " 376.77 " 1,155.00 " 646.09 576.87 " 1,279.45 " 329.22 365.80 " 2,816.95 " " 3,521.19 " 374.95 376.77 365.80 " 1,546.40 " 334.71 576.87 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81407266 MRI PELVIS WO/W CONTRAST 72197 614 "$1,933.00" 714.44 321.90 " 3,521.19 " 663.40 " 2,882.00 " 384.09 " 2,882.00 " 674.94 " 1,067.98 " 376.77 " 1,155.00 " 646.09 576.87 " 1,279.45 " 329.22 365.80 " 2,816.95 " " 3,521.19 " 374.95 376.77 365.80 " 1,546.40 " 334.71 576.87 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81607265 MRI PELVIS WO/W CONTRAST 72197 614 "$1,933.00" 714.44 321.90 " 3,521.19 " 663.40 " 2,882.00 " 384.09 " 2,882.00 " 674.94 " 1,067.98 " 376.77 " 1,155.00 " 646.09 576.87 " 1,279.45 " 329.22 365.80 " 2,816.95 " " 3,521.19 " 374.95 376.77 365.80 " 1,546.40 " 334.71 576.87 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 80129084 XR S-I JOINTS <3VWS 72200 320 $572.00 211.41 24.54 457.60 28.22 395.25 113.56 395.25 28.71 316.03 111.39 377.52 27.48 24.54 378.61 97.34 108.15 92.54 115.68 110.85 111.39 108.15 457.60 98.96 24.54 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81429081 XR S-I JOINTS <3VWS 72200 320 $572.00 211.41 24.54 457.60 28.22 395.25 113.56 395.25 28.71 316.03 111.39 377.52 27.48 24.54 378.61 97.34 108.15 92.54 115.68 110.85 111.39 108.15 457.60 98.96 24.54 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81629081 XR S-I JOINTS <3VWS 72200 320 $572.00 211.41 24.54 457.60 28.22 395.25 113.56 395.25 28.71 316.03 111.39 377.52 27.48 24.54 378.61 97.34 108.15 92.54 115.68 110.85 111.39 108.15 457.60 98.96 24.54 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67900405 XR SI JOINTS 3 > VWS 72202 320 $572.00 211.41 25.30 457.60 29.10 395.25 113.56 395.25 29.60 316.03 111.39 377.52 28.34 25.30 378.61 97.34 108.15 107.87 134.84 110.85 111.39 108.15 457.60 98.96 25.30 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80100400 XR SI JOINTS 3 > VWS 72202 320 $572.00 211.41 25.30 457.60 29.10 395.25 113.56 395.25 29.60 316.03 111.39 377.52 28.34 25.30 378.61 97.34 108.15 107.87 134.84 110.85 111.39 108.15 457.60 98.96 25.30 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81400407 XR SI JOINTS 3 > VWS 72202 320 $572.00 211.41 25.30 457.60 29.10 395.25 113.56 395.25 29.60 316.03 111.39 377.52 28.34 25.30 378.61 97.34 108.15 107.87 134.84 110.85 111.39 108.15 457.60 98.96 25.30 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81600406 XR SI JOINTS 3 > VWS 72202 320 $572.00 211.41 25.30 457.60 29.10 395.25 113.56 395.25 29.60 316.03 111.39 377.52 28.34 25.30 378.61 97.34 108.15 107.87 134.84 110.85 111.39 108.15 457.60 98.96 25.30 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81700401 XR SI JOINTS 3 > VWS 72202 320 $572.00 211.41 25.30 457.60 29.10 395.25 113.56 395.25 29.60 316.03 111.39 377.52 28.34 25.30 378.61 97.34 108.15 107.87 134.84 110.85 111.39 108.15 457.60 98.96 25.30 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82600400 XR SI JOINTS 3 > VWS 72202 320 $572.00 211.41 25.30 457.60 29.10 395.25 113.56 395.25 29.60 316.03 111.39 377.52 28.34 25.30 378.61 97.34 108.15 107.87 134.84 110.85 111.39 108.15 457.60 98.96 25.30 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82900403 XR SI JOINTS 3 > VWS 72202 320 $572.00 211.41 25.30 457.60 29.10 395.25 113.56 395.25 29.60 316.03 111.39 377.52 28.34 25.30 378.61 97.34 108.15 107.87 134.84 110.85 111.39 108.15 457.60 98.96 25.30 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83000406 XR SI JOINTS 3 > VWS 72202 320 $572.00 211.41 25.30 457.60 29.10 395.25 113.56 395.25 29.60 316.03 111.39 377.52 28.34 25.30 378.61 97.34 108.15 107.87 134.84 110.85 111.39 108.15 457.60 98.96 25.30 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67900413 XR SACRUM/COCCYX <3VWS 72220 320 $425.00 157.08 24.54 340.00 28.22 293.68 84.37 293.68 28.71 234.81 82.76 280.50 27.48 24.54 281.31 72.32 80.35 101.60 127.00 82.36 82.76 80.35 340.00 73.52 24.54 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80100418 XR SACRUM/COCCYX <3VWS 72220 320 $425.00 157.08 24.54 340.00 28.22 293.68 84.37 293.68 28.71 234.81 82.76 280.50 27.48 24.54 281.31 72.32 80.35 101.60 127.00 82.36 82.76 80.35 340.00 73.52 24.54 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81400415 XR SACRUM/COCCYX <3VWS 72220 320 $425.00 157.08 24.54 340.00 28.22 293.68 84.37 293.68 28.71 234.81 82.76 280.50 27.48 24.54 281.31 72.32 80.35 101.60 127.00 82.36 82.76 80.35 340.00 73.52 24.54 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81600414 XR SACRUM/COCCYX <3VWS 72220 320 $425.00 157.08 24.54 340.00 28.22 293.68 84.37 293.68 28.71 234.81 82.76 280.50 27.48 24.54 281.31 72.32 80.35 101.60 127.00 82.36 82.76 80.35 340.00 73.52 24.54 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81700419 XR SACRUM/COCCYX <3VWS 72220 320 $425.00 157.08 24.54 340.00 28.22 293.68 84.37 293.68 28.71 234.81 82.76 280.50 27.48 24.54 281.31 72.32 80.35 101.60 127.00 82.36 82.76 80.35 340.00 73.52 24.54 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82600418 XR SACRUM/COCCYX <3VWS 72220 320 $425.00 157.08 24.54 340.00 28.22 293.68 84.37 293.68 28.71 234.81 82.76 280.50 27.48 24.54 281.31 72.32 80.35 101.60 127.00 82.36 82.76 80.35 340.00 73.52 24.54 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82900411 XR SACRUM/COCCYX <3VWS 72220 320 $425.00 157.08 24.54 340.00 28.22 293.68 84.37 293.68 28.71 234.81 82.76 280.50 27.48 24.54 281.31 72.32 80.35 101.60 127.00 82.36 82.76 80.35 340.00 73.52 24.54 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83000414 XR SACRUM/COCCYX <3VWS 72220 320 $425.00 157.08 24.54 340.00 28.22 293.68 84.37 293.68 28.71 234.81 82.76 280.50 27.48 24.54 281.31 72.32 80.35 101.60 127.00 82.36 82.76 80.35 340.00 73.52 24.54 211.96 70.71 173.83 318.75 161.54 190.10 83.16 28175728 XR MYELOGRAM CERVICAL SPINE 72240 360 "$3,755.00" " 1,387.85 " 52.50 " 3,004.00 " 60.38 " 2,594.71 " 746.21 " 2,594.71 " 61.43 " 2,074.64 " 732.00 " 2,478.30 " 58.80 52.50 " 2,485.43 " 639.61 710.68 726.98 908.73 728.45 732.00 710.68 " 3,004.00 " 650.27 52.50 " 1,873.77 " 625.40 " 1,535.80 " " 2,816.25 " " 1,427.28 " " 1,679.61 " 735.55 67900464 XR CLAVICLE COMPLETE 73000 320 $425.00 157.08 18.82 340.00 21.64 293.68 84.37 293.68 22.02 234.81 82.76 280.50 21.08 18.82 281.31 72.32 80.35 91.45 114.31 82.36 82.76 80.35 340.00 73.52 18.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80100469 XR CLAVICLE COMPLETE 73000 320 $425.00 157.08 18.82 340.00 21.64 293.68 84.37 293.68 22.02 234.81 82.76 280.50 21.08 18.82 281.31 72.32 80.35 91.45 114.31 82.36 82.76 80.35 340.00 73.52 18.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81400466 XR CLAVICLE COMPLETE 73000 320 $425.00 157.08 18.82 340.00 21.64 293.68 84.37 293.68 22.02 234.81 82.76 280.50 21.08 18.82 281.31 72.32 80.35 91.45 114.31 82.36 82.76 80.35 340.00 73.52 18.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81600465 XR CLAVICLE COMPLETE 73000 320 $425.00 157.08 18.82 340.00 21.64 293.68 84.37 293.68 22.02 234.81 82.76 280.50 21.08 18.82 281.31 72.32 80.35 91.45 114.31 82.36 82.76 80.35 340.00 73.52 18.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81700460 XR CLAVICLE COMPLETE 73000 320 $425.00 157.08 18.82 340.00 21.64 293.68 84.37 293.68 22.02 234.81 82.76 280.50 21.08 18.82 281.31 72.32 80.35 91.45 114.31 82.36 82.76 80.35 340.00 73.52 18.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82600469 XR CLAVICLE COMPLETE 73000 320 $425.00 157.08 18.82 340.00 21.64 293.68 84.37 293.68 22.02 234.81 82.76 280.50 21.08 18.82 281.31 72.32 80.35 91.45 114.31 82.36 82.76 80.35 340.00 73.52 18.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82900462 XR CLAVICLE COMPLETE 73000 320 $425.00 157.08 18.82 340.00 21.64 293.68 84.37 293.68 22.02 234.81 82.76 280.50 21.08 18.82 281.31 72.32 80.35 91.45 114.31 82.36 82.76 80.35 340.00 73.52 18.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83000465 XR CLAVICLE COMPLETE 73000 320 $425.00 157.08 18.82 340.00 21.64 293.68 84.37 293.68 22.02 234.81 82.76 280.50 21.08 18.82 281.31 72.32 80.35 91.45 114.31 82.36 82.76 80.35 340.00 73.52 18.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 67900472 XR SCAPULA COMPLETE 73010 320 $572.00 211.41 24.00 457.60 27.60 395.25 113.56 395.25 28.08 316.03 111.39 377.52 26.88 24.00 378.61 97.34 108.15 95.32 119.15 110.85 111.39 108.15 457.60 98.96 24.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80100477 XR SCAPULA COMPLETE 73010 320 $572.00 211.41 24.00 457.60 27.60 395.25 113.56 395.25 28.08 316.03 111.39 377.52 26.88 24.00 378.61 97.34 108.15 95.32 119.15 110.85 111.39 108.15 457.60 98.96 24.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81400474 XR SCAPULA COMPLETE 73010 320 $572.00 211.41 24.00 457.60 27.60 395.25 113.56 395.25 28.08 316.03 111.39 377.52 26.88 24.00 378.61 97.34 108.15 95.32 119.15 110.85 111.39 108.15 457.60 98.96 24.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81600473 XR SCAPULA COMPLETE 73010 320 $572.00 211.41 24.00 457.60 27.60 395.25 113.56 395.25 28.08 316.03 111.39 377.52 26.88 24.00 378.61 97.34 108.15 95.32 119.15 110.85 111.39 108.15 457.60 98.96 24.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81700478 XR SCAPULA COMPLETE 73010 320 $572.00 211.41 24.00 457.60 27.60 395.25 113.56 395.25 28.08 316.03 111.39 377.52 26.88 24.00 378.61 97.34 108.15 95.32 119.15 110.85 111.39 108.15 457.60 98.96 24.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82600477 XR SCAPULA COMPLETE 73010 320 $572.00 211.41 24.00 457.60 27.60 395.25 113.56 395.25 28.08 316.03 111.39 377.52 26.88 24.00 378.61 97.34 108.15 95.32 119.15 110.85 111.39 108.15 457.60 98.96 24.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82900471 XR SCAPULA COMPLETE 73010 320 $572.00 211.41 24.00 457.60 27.60 395.25 113.56 395.25 28.08 316.03 111.39 377.52 26.88 24.00 378.61 97.34 108.15 95.32 119.15 110.85 111.39 108.15 457.60 98.96 24.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83000473 XR SCAPULA COMPLETE 73010 320 $572.00 211.41 24.00 457.60 27.60 395.25 113.56 395.25 28.08 316.03 111.39 377.52 26.88 24.00 378.61 97.34 108.15 95.32 119.15 110.85 111.39 108.15 457.60 98.96 24.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67900481 XR SHOULDER 1VW 73020 320 $425.00 157.08 21.93 340.00 25.22 293.68 84.37 293.68 25.66 234.81 82.76 280.50 24.56 21.93 281.31 72.32 80.35 83.34 104.17 82.36 82.76 80.35 340.00 73.52 21.93 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80100485 XR SHOULDER 1VW 73020 320 $425.00 157.08 21.93 340.00 25.22 293.68 84.37 293.68 25.66 234.81 82.76 280.50 24.56 21.93 281.31 72.32 80.35 83.34 104.17 82.36 82.76 80.35 340.00 73.52 21.93 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81400482 XR SHOULDER 1VW 73020 320 $425.00 157.08 21.93 340.00 25.22 293.68 84.37 293.68 25.66 234.81 82.76 280.50 24.56 21.93 281.31 72.32 80.35 83.34 104.17 82.36 82.76 80.35 340.00 73.52 21.93 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81600481 XR SHOULDER 1VW 73020 320 $425.00 157.08 21.93 340.00 25.22 293.68 84.37 293.68 25.66 234.81 82.76 280.50 24.56 21.93 281.31 72.32 80.35 83.34 104.17 82.36 82.76 80.35 340.00 73.52 21.93 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81700486 XR SHOULDER 1VW 73020 320 $425.00 157.08 21.93 340.00 25.22 293.68 84.37 293.68 25.66 234.81 82.76 280.50 24.56 21.93 281.31 72.32 80.35 83.34 104.17 82.36 82.76 80.35 340.00 73.52 21.93 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82600485 XR SHOULDER 1VW 73020 320 $425.00 157.08 21.93 340.00 25.22 293.68 84.37 293.68 25.66 234.81 82.76 280.50 24.56 21.93 281.31 72.32 80.35 83.34 104.17 82.36 82.76 80.35 340.00 73.52 21.93 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82900489 XR SHOULDER 1VW 73020 320 $425.00 157.08 21.93 340.00 25.22 293.68 84.37 293.68 25.66 234.81 82.76 280.50 24.56 21.93 281.31 72.32 80.35 83.34 104.17 82.36 82.76 80.35 340.00 73.52 21.93 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83000481 XR SHOULDER 1VW 73020 320 $425.00 157.08 21.93 340.00 25.22 293.68 84.37 293.68 25.66 234.81 82.76 280.50 24.56 21.93 281.31 72.32 80.35 83.34 104.17 82.36 82.76 80.35 340.00 73.52 21.93 211.96 70.71 173.83 318.75 161.54 190.10 83.16 67900499 XR SHOULDER COMPLETE 73030 320 $425.00 157.08 24.92 340.00 28.66 293.68 84.37 293.68 29.16 234.81 82.76 280.50 27.91 24.92 281.31 72.32 80.35 99.82 124.77 82.36 82.76 80.35 340.00 73.52 24.92 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80100493 XR SHOULDER COMPLETE 73030 320 $425.00 157.08 24.92 340.00 28.66 293.68 84.37 293.68 29.16 234.81 82.76 280.50 27.91 24.92 281.31 72.32 80.35 99.82 124.77 82.36 82.76 80.35 340.00 73.52 24.92 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81400491 XR SHOULDER COMPLETE 73030 320 $425.00 157.08 24.92 340.00 28.66 293.68 84.37 293.68 29.16 234.81 82.76 280.50 27.91 24.92 281.31 72.32 80.35 99.82 124.77 82.36 82.76 80.35 340.00 73.52 24.92 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81600490 XR SHOULDER COMPLETE 73030 320 $425.00 157.08 24.92 340.00 28.66 293.68 84.37 293.68 29.16 234.81 82.76 280.50 27.91 24.92 281.31 72.32 80.35 99.82 124.77 82.36 82.76 80.35 340.00 73.52 24.92 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81700494 XR SHOULDER COMPLETE 73030 320 $425.00 157.08 24.92 340.00 28.66 293.68 84.37 293.68 29.16 234.81 82.76 280.50 27.91 24.92 281.31 72.32 80.35 99.82 124.77 82.36 82.76 80.35 340.00 73.52 24.92 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82600493 XR SHOULDER COMPLETE 73030 320 $425.00 157.08 24.92 340.00 28.66 293.68 84.37 293.68 29.16 234.81 82.76 280.50 27.91 24.92 281.31 72.32 80.35 99.82 124.77 82.36 82.76 80.35 340.00 73.52 24.92 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82900497 XR SHOULDER COMPLETE 73030 320 $425.00 157.08 24.92 340.00 28.66 293.68 84.37 293.68 29.16 234.81 82.76 280.50 27.91 24.92 281.31 72.32 80.35 99.82 124.77 82.36 82.76 80.35 340.00 73.52 24.92 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83000490 XR SHOULDER COMPLETE 73030 320 $425.00 157.08 24.92 340.00 28.66 293.68 84.37 293.68 29.16 234.81 82.76 280.50 27.91 24.92 281.31 72.32 80.35 99.82 124.77 82.36 82.76 80.35 340.00 73.52 24.92 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80100507 XR CONTRAST SHOULDER 73040 320 "$1,933.00" 714.44 27.50 " 1,546.40 " 31.63 " 1,335.70 " 384.09 " 1,335.70 " 32.18 " 1,067.98 " 376.77 " 1,275.78 " 30.80 27.50 " 1,279.45 " 329.22 365.80 347.64 434.55 374.95 376.77 365.80 " 1,546.40 " 334.71 27.50 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 67900511 XR AC JTS BILAT SHOULDERS 73050 320 $425.00 157.08 28.52 340.00 32.80 293.68 84.37 293.68 33.37 234.81 82.76 280.50 31.94 28.52 281.31 72.32 80.35 114.83 143.54 82.36 82.76 80.35 340.00 73.52 28.52 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80100515 XR AC JTS BILAT SHOULDERS 73050 320 $425.00 157.08 28.52 340.00 32.80 293.68 84.37 293.68 33.37 234.81 82.76 280.50 31.94 28.52 281.31 72.32 80.35 114.83 143.54 82.36 82.76 80.35 340.00 73.52 28.52 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81400512 XR AC JTS BILAT SHOULDERS 73050 320 $425.00 157.08 28.52 340.00 32.80 293.68 84.37 293.68 33.37 234.81 82.76 280.50 31.94 28.52 281.31 72.32 80.35 114.83 143.54 82.36 82.76 80.35 340.00 73.52 28.52 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81600511 XR AC JTS BILAT SHOULDERS 73050 320 $425.00 157.08 28.52 340.00 32.80 293.68 84.37 293.68 33.37 234.81 82.76 280.50 31.94 28.52 281.31 72.32 80.35 114.83 143.54 82.36 82.76 80.35 340.00 73.52 28.52 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81700516 XR AC JTS BILAT SHOULDERS 73050 320 $425.00 157.08 28.52 340.00 32.80 293.68 84.37 293.68 33.37 234.81 82.76 280.50 31.94 28.52 281.31 72.32 80.35 114.83 143.54 82.36 82.76 80.35 340.00 73.52 28.52 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82600515 XR AC JTS BILAT SHOULDERS 73050 320 $425.00 157.08 28.52 340.00 32.80 293.68 84.37 293.68 33.37 234.81 82.76 280.50 31.94 28.52 281.31 72.32 80.35 114.83 143.54 82.36 82.76 80.35 340.00 73.52 28.52 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82900519 XR AC JTS BILAT SHOULDERS 73050 320 $425.00 157.08 28.52 340.00 32.80 293.68 84.37 293.68 33.37 234.81 82.76 280.50 31.94 28.52 281.31 72.32 80.35 114.83 143.54 82.36 82.76 80.35 340.00 73.52 28.52 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83000511 XR AC JTS BILAT SHOULDERS 73050 320 $425.00 157.08 28.52 340.00 32.80 293.68 84.37 293.68 33.37 234.81 82.76 280.50 31.94 28.52 281.31 72.32 80.35 114.83 143.54 82.36 82.76 80.35 340.00 73.52 28.52 211.96 70.71 173.83 318.75 161.54 190.10 83.16 67900529 XR HUMERUS MIN 2VWS 73060 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 99.87 124.84 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80100523 XR HUMERUS MIN 2VWS 73060 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 99.87 124.84 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81400521 XR HUMERUS MIN 2VWS 73060 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 99.87 124.84 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81600520 XR HUMERUS MIN 2VWS 73060 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 99.87 124.84 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81700524 XR HUMERUS MIN 2VWS 73060 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 99.87 124.84 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82600523 XR HUMERUS MIN 2VWS 73060 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 99.87 124.84 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82900527 XR HUMERUS MIN 2VWS 73060 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 99.87 124.84 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83000520 XR HUMERUS MIN 2VWS 73060 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 99.87 124.84 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 67900537 XR ELBOW 2VWS 73070 320 $425.00 157.08 18.44 340.00 21.21 293.68 84.37 293.68 21.57 234.81 82.76 280.50 20.65 18.44 281.31 72.32 80.35 91.45 114.31 82.36 82.76 80.35 340.00 73.52 18.44 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80100531 XR ELBOW 2VWS 73070 320 $425.00 157.08 18.44 340.00 21.21 293.68 84.37 293.68 21.57 234.81 82.76 280.50 20.65 18.44 281.31 72.32 80.35 91.45 114.31 82.36 82.76 80.35 340.00 73.52 18.44 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81400539 XR ELBOW 2VWS 73070 320 $425.00 157.08 18.44 340.00 21.21 293.68 84.37 293.68 21.57 234.81 82.76 280.50 20.65 18.44 281.31 72.32 80.35 91.45 114.31 82.36 82.76 80.35 340.00 73.52 18.44 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81600538 XR ELBOW 2VWS 73070 320 $425.00 157.08 18.44 340.00 21.21 293.68 84.37 293.68 21.57 234.81 82.76 280.50 20.65 18.44 281.31 72.32 80.35 91.45 114.31 82.36 82.76 80.35 340.00 73.52 18.44 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81700532 XR ELBOW 2VWS 73070 320 $425.00 157.08 18.44 340.00 21.21 293.68 84.37 293.68 21.57 234.81 82.76 280.50 20.65 18.44 281.31 72.32 80.35 91.45 114.31 82.36 82.76 80.35 340.00 73.52 18.44 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82600531 XR ELBOW 2VWS 73070 320 $425.00 157.08 18.44 340.00 21.21 293.68 84.37 293.68 21.57 234.81 82.76 280.50 20.65 18.44 281.31 72.32 80.35 91.45 114.31 82.36 82.76 80.35 340.00 73.52 18.44 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82900535 XR ELBOW 2VWS 73070 320 $425.00 157.08 18.44 340.00 21.21 293.68 84.37 293.68 21.57 234.81 82.76 280.50 20.65 18.44 281.31 72.32 80.35 91.45 114.31 82.36 82.76 80.35 340.00 73.52 18.44 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83000538 XR ELBOW 2VWS 73070 320 $425.00 157.08 18.44 340.00 21.21 293.68 84.37 293.68 21.57 234.81 82.76 280.50 20.65 18.44 281.31 72.32 80.35 91.45 114.31 82.36 82.76 80.35 340.00 73.52 18.44 211.96 70.71 173.83 318.75 161.54 190.10 83.16 67900545 XR ELBOW MIN 3VWS 73080 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 98.72 123.40 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80100540 XR ELBOW MIN 3VWS 73080 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 98.72 123.40 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81400547 XR ELBOW MIN 3VWS 73080 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 98.72 123.40 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81600546 XR ELBOW MIN 3VWS 73080 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 98.72 123.40 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81700541 XR ELBOW MIN 3VWS 73080 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 98.72 123.40 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82600540 XR ELBOW MIN 3VWS 73080 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 98.72 123.40 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82900543 XR ELBOW MIN 3VWS 73080 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 98.72 123.40 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83000546 XR ELBOW MIN 3VWS 73080 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 98.72 123.40 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80100558 XR CONTRAST ELBOW 73085 320 "$1,933.00" 714.44 46.50 " 1,546.40 " 53.48 " 1,335.70 " 384.09 " 1,335.70 " 54.41 " 1,067.98 " 376.77 " 1,275.78 " 52.08 46.50 " 1,279.45 " 329.22 365.80 347.64 434.55 374.95 376.77 365.80 " 1,546.40 " 334.71 46.50 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 67900561 XR FOREARM 2VWS 73090 320 $425.00 157.08 18.82 340.00 21.64 293.68 84.37 293.68 22.02 234.81 82.76 280.50 21.08 18.82 281.31 72.32 80.35 93.54 116.93 82.36 82.76 80.35 340.00 73.52 18.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80100566 XR FOREARM 2VWS 73090 320 $425.00 157.08 18.82 340.00 21.64 293.68 84.37 293.68 22.02 234.81 82.76 280.50 21.08 18.82 281.31 72.32 80.35 93.54 116.93 82.36 82.76 80.35 340.00 73.52 18.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81400563 XR FOREARM 2VWS 73090 320 $425.00 157.08 18.82 340.00 21.64 293.68 84.37 293.68 22.02 234.81 82.76 280.50 21.08 18.82 281.31 72.32 80.35 93.54 116.93 82.36 82.76 80.35 340.00 73.52 18.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81600562 XR FOREARM 2VWS 73090 320 $425.00 157.08 18.82 340.00 21.64 293.68 84.37 293.68 22.02 234.81 82.76 280.50 21.08 18.82 281.31 72.32 80.35 93.54 116.93 82.36 82.76 80.35 340.00 73.52 18.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81700567 XR FOREARM 2VWS 73090 320 $425.00 157.08 18.82 340.00 21.64 293.68 84.37 293.68 22.02 234.81 82.76 280.50 21.08 18.82 281.31 72.32 80.35 93.54 116.93 82.36 82.76 80.35 340.00 73.52 18.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82600566 XR FOREARM 2VWS 73090 320 $425.00 157.08 18.82 340.00 21.64 293.68 84.37 293.68 22.02 234.81 82.76 280.50 21.08 18.82 281.31 72.32 80.35 93.54 116.93 82.36 82.76 80.35 340.00 73.52 18.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82900560 XR FOREARM 2VWS 73090 320 $425.00 157.08 18.82 340.00 21.64 293.68 84.37 293.68 22.02 234.81 82.76 280.50 21.08 18.82 281.31 72.32 80.35 93.54 116.93 82.36 82.76 80.35 340.00 73.52 18.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83000562 XR FOREARM 2VWS 73090 320 $425.00 157.08 18.82 340.00 21.64 293.68 84.37 293.68 22.02 234.81 82.76 280.50 21.08 18.82 281.31 72.32 80.35 93.54 116.93 82.36 82.76 80.35 340.00 73.52 18.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 67900570 XR UPR EXTR INFANT MIN 2VWS 73092 320 $572.00 211.41 18.32 457.60 21.07 395.25 113.56 395.25 21.43 316.03 111.39 377.52 20.52 18.32 378.61 97.34 108.15 86.79 108.49 110.85 111.39 108.15 457.60 98.96 18.32 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80100574 XR UPR EXTR INFANT MIN 2VWS 73092 320 $572.00 211.41 18.32 457.60 21.07 395.25 113.56 395.25 21.43 316.03 111.39 377.52 20.52 18.32 378.61 97.34 108.15 86.79 108.49 110.85 111.39 108.15 457.60 98.96 18.32 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81400571 XR UPR EXTR INFANT MIN 2VWS 73092 320 $572.00 211.41 18.32 457.60 21.07 395.25 113.56 395.25 21.43 316.03 111.39 377.52 20.52 18.32 378.61 97.34 108.15 86.79 108.49 110.85 111.39 108.15 457.60 98.96 18.32 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81600571 XR UPR EXTR INFANT MIN 2VWS 73092 320 $572.00 211.41 18.32 457.60 21.07 395.25 113.56 395.25 21.43 316.03 111.39 377.52 20.52 18.32 378.61 97.34 108.15 86.79 108.49 110.85 111.39 108.15 457.60 98.96 18.32 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81700575 XR UPR EXTR INFANT MIN 2VWS 73092 320 $572.00 211.41 18.32 457.60 21.07 395.25 113.56 395.25 21.43 316.03 111.39 377.52 20.52 18.32 378.61 97.34 108.15 86.79 108.49 110.85 111.39 108.15 457.60 98.96 18.32 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82600574 XR UPR EXTR INFANT MIN 2VWS 73092 320 $572.00 211.41 18.32 457.60 21.07 395.25 113.56 395.25 21.43 316.03 111.39 377.52 20.52 18.32 378.61 97.34 108.15 86.79 108.49 110.85 111.39 108.15 457.60 98.96 18.32 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82900578 XR UPR EXTR INFANT MIN 2VWS 73092 320 $572.00 211.41 18.32 457.60 21.07 395.25 113.56 395.25 21.43 316.03 111.39 377.52 20.52 18.32 378.61 97.34 108.15 86.79 108.49 110.85 111.39 108.15 457.60 98.96 18.32 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83000571 XR UPR EXTR INFANT MIN 2VWS 73092 320 $572.00 211.41 18.32 457.60 21.07 395.25 113.56 395.25 21.43 316.03 111.39 377.52 20.52 18.32 378.61 97.34 108.15 86.79 108.49 110.85 111.39 108.15 457.60 98.96 18.32 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67900588 XR WRIST 2VWS 73100 320 $425.00 157.08 18.82 340.00 21.64 293.68 84.37 293.68 22.02 234.81 82.76 280.50 21.08 18.82 281.31 72.32 80.35 88.15 110.19 82.36 82.76 80.35 340.00 73.52 18.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80100582 XR WRIST 2VWS 73100 320 $425.00 157.08 18.82 340.00 21.64 293.68 84.37 293.68 22.02 234.81 82.76 280.50 21.08 18.82 281.31 72.32 80.35 88.15 110.19 82.36 82.76 80.35 340.00 73.52 18.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81400580 XR WRIST 2VWS 73100 320 $425.00 157.08 18.82 340.00 21.64 293.68 84.37 293.68 22.02 234.81 82.76 280.50 21.08 18.82 281.31 72.32 80.35 88.15 110.19 82.36 82.76 80.35 340.00 73.52 18.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81600589 XR WRIST 2VWS 73100 320 $425.00 157.08 18.82 340.00 21.64 293.68 84.37 293.68 22.02 234.81 82.76 280.50 21.08 18.82 281.31 72.32 80.35 88.15 110.19 82.36 82.76 80.35 340.00 73.52 18.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81700583 XR WRIST 2VWS 73100 320 $425.00 157.08 18.82 340.00 21.64 293.68 84.37 293.68 22.02 234.81 82.76 280.50 21.08 18.82 281.31 72.32 80.35 88.15 110.19 82.36 82.76 80.35 340.00 73.52 18.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82600582 XR WRIST 2VWS 73100 320 $425.00 157.08 18.82 340.00 21.64 293.68 84.37 293.68 22.02 234.81 82.76 280.50 21.08 18.82 281.31 72.32 80.35 88.15 110.19 82.36 82.76 80.35 340.00 73.52 18.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82900586 XR WRIST 2VWS 73100 320 $425.00 157.08 18.82 340.00 21.64 293.68 84.37 293.68 22.02 234.81 82.76 280.50 21.08 18.82 281.31 72.32 80.35 88.15 110.19 82.36 82.76 80.35 340.00 73.52 18.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83000589 XR WRIST 2VWS 73100 320 $425.00 157.08 18.82 340.00 21.64 293.68 84.37 293.68 22.02 234.81 82.76 280.50 21.08 18.82 281.31 72.32 80.35 88.15 110.19 82.36 82.76 80.35 340.00 73.52 18.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 67900596 XR WRIST MIN 3VWS 73110 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 93.70 117.12 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80100591 XR WRIST MIN 3VWS 73110 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 93.70 117.12 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81400598 XR WRIST MIN 3VWS 73110 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 93.70 117.12 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81600597 XR WRIST MIN 3VWS 73110 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 93.70 117.12 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81700591 XR WRIST MIN 3VWS 73110 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 93.70 117.12 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82600591 XR WRIST MIN 3VWS 73110 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 93.70 117.12 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82900594 XR WRIST MIN 3VWS 73110 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 93.70 117.12 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83000597 XR WRIST MIN 3VWS 73110 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 93.70 117.12 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80100604 XR CONTRAST WRIST 73115 320 "$1,933.00" 714.44 46.50 " 1,546.40 " 53.48 " 1,335.70 " 384.09 " 1,335.70 " 54.41 " 1,067.98 " 376.77 " 1,275.78 " 52.08 46.50 " 1,279.45 " 329.22 365.80 285.33 356.66 374.95 376.77 365.80 " 1,546.40 " 334.71 46.50 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 67900618 XR HAND 2VWS 73120 320 $572.00 211.41 17.32 457.60 19.92 395.25 113.56 395.25 20.26 316.03 111.39 377.52 19.40 17.32 378.61 97.34 108.15 88.15 110.19 110.85 111.39 108.15 457.60 98.96 17.32 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80100612 XR HAND 2VWS 73120 320 $572.00 211.41 17.32 457.60 19.92 395.25 113.56 395.25 20.26 316.03 111.39 377.52 19.40 17.32 378.61 97.34 108.15 88.15 110.19 110.85 111.39 108.15 457.60 98.96 17.32 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81400610 XR HAND 2VWS 73120 320 $572.00 211.41 17.32 457.60 19.92 395.25 113.56 395.25 20.26 316.03 111.39 377.52 19.40 17.32 378.61 97.34 108.15 88.15 110.19 110.85 111.39 108.15 457.60 98.96 17.32 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81600619 XR HAND 2VWS 73120 320 $572.00 211.41 17.32 457.60 19.92 395.25 113.56 395.25 20.26 316.03 111.39 377.52 19.40 17.32 378.61 97.34 108.15 88.15 110.19 110.85 111.39 108.15 457.60 98.96 17.32 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81700613 XR HAND 2VWS 73120 320 $572.00 211.41 17.32 457.60 19.92 395.25 113.56 395.25 20.26 316.03 111.39 377.52 19.40 17.32 378.61 97.34 108.15 88.15 110.19 110.85 111.39 108.15 457.60 98.96 17.32 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82600612 XR HAND 2VWS 73120 320 $572.00 211.41 17.32 457.60 19.92 395.25 113.56 395.25 20.26 316.03 111.39 377.52 19.40 17.32 378.61 97.34 108.15 88.15 110.19 110.85 111.39 108.15 457.60 98.96 17.32 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82900616 XR HAND 2VWS 73120 320 $572.00 211.41 17.32 457.60 19.92 395.25 113.56 395.25 20.26 316.03 111.39 377.52 19.40 17.32 378.61 97.34 108.15 88.15 110.19 110.85 111.39 108.15 457.60 98.96 17.32 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83000619 XR HAND 2VWS 73120 320 $572.00 211.41 17.32 457.60 19.92 395.25 113.56 395.25 20.26 316.03 111.39 377.52 19.40 17.32 378.61 97.34 108.15 88.15 110.19 110.85 111.39 108.15 457.60 98.96 17.32 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67900626 XR HAND MIN 3VWS 73130 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 93.70 117.12 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80100621 XR HAND MIN 3VWS 73130 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 93.70 117.12 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81400628 XR HAND MIN 3VWS 73130 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 93.70 117.12 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81600627 XR HAND MIN 3VWS 73130 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 93.70 117.12 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81700621 XR HAND MIN 3VWS 73130 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 93.70 117.12 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82600621 XR HAND MIN 3VWS 73130 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 93.70 117.12 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82900624 XR HAND MIN 3VWS 73130 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 93.70 117.12 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83000627 XR HAND MIN 3VWS 73130 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 93.70 117.12 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 67900634 XR FINGER(S) MIN 2VWS 73140 320 $425.00 157.08 14.00 340.00 16.10 293.68 84.37 293.68 16.38 234.81 82.76 280.50 15.68 14.00 281.31 72.32 80.35 74.13 92.66 82.36 82.76 80.35 340.00 73.52 14.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80100639 XR FINGER(S) MIN 2VWS 73140 320 $425.00 157.08 14.00 340.00 16.10 293.68 84.37 293.68 16.38 234.81 82.76 280.50 15.68 14.00 281.31 72.32 80.35 74.13 92.66 82.36 82.76 80.35 340.00 73.52 14.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81400636 XR FINGER(S) MIN 2VWS 73140 320 $425.00 157.08 14.00 340.00 16.10 293.68 84.37 293.68 16.38 234.81 82.76 280.50 15.68 14.00 281.31 72.32 80.35 74.13 92.66 82.36 82.76 80.35 340.00 73.52 14.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81600635 XR FINGER(S) MIN 2VWS 73140 320 $425.00 157.08 14.00 340.00 16.10 293.68 84.37 293.68 16.38 234.81 82.76 280.50 15.68 14.00 281.31 72.32 80.35 74.13 92.66 82.36 82.76 80.35 340.00 73.52 14.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81700630 XR FINGER(S) MIN 2VWS 73140 320 $425.00 157.08 14.00 340.00 16.10 293.68 84.37 293.68 16.38 234.81 82.76 280.50 15.68 14.00 281.31 72.32 80.35 74.13 92.66 82.36 82.76 80.35 340.00 73.52 14.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82600639 XR FINGER(S) MIN 2VWS 73140 320 $425.00 157.08 14.00 340.00 16.10 293.68 84.37 293.68 16.38 234.81 82.76 280.50 15.68 14.00 281.31 72.32 80.35 74.13 92.66 82.36 82.76 80.35 340.00 73.52 14.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82900632 XR FINGER(S) MIN 2VWS 73140 320 $425.00 157.08 14.00 340.00 16.10 293.68 84.37 293.68 16.38 234.81 82.76 280.50 15.68 14.00 281.31 72.32 80.35 74.13 92.66 82.36 82.76 80.35 340.00 73.52 14.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83000635 XR FINGER(S) MIN 2VWS 73140 320 $425.00 157.08 14.00 340.00 16.10 293.68 84.37 293.68 16.38 234.81 82.76 280.50 15.68 14.00 281.31 72.32 80.35 74.13 92.66 82.36 82.76 80.35 340.00 73.52 14.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 67709268 CT UPPER EXTR W/O CONTRAST 73200 352 $572.00 211.41 95.17 " 1,774.00 " 149.07 " 1,774.00 " 113.56 " 1,774.00 " 151.67 316.03 111.39 725.00 145.19 129.63 378.61 97.34 108.15 783.02 978.77 110.85 111.39 108.15 457.60 98.96 129.63 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67909267 CT UPPER EXTR W/O CONTRAST 73200 352 $572.00 211.41 95.17 " 1,774.00 " 149.07 " 1,774.00 " 113.56 " 1,774.00 " 151.67 316.03 111.39 725.00 145.19 129.63 378.61 97.34 108.15 783.02 978.77 110.85 111.39 108.15 457.60 98.96 129.63 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80609264 CT UPPER EXTR W/O CONTRAST 73200 352 $572.00 211.41 95.17 " 1,774.00 " 149.07 " 1,774.00 " 113.56 " 1,774.00 " 151.67 316.03 111.39 725.00 145.19 129.63 378.61 97.34 108.15 783.02 978.77 110.85 111.39 108.15 457.60 98.96 129.63 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81409269 CT UPPER EXTR W/O CONTRAST 73200 352 $572.00 211.41 95.17 " 1,774.00 " 149.07 " 1,774.00 " 113.56 " 1,774.00 " 151.67 316.03 111.39 725.00 145.19 129.63 378.61 97.34 108.15 783.02 978.77 110.85 111.39 108.15 457.60 98.96 129.63 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81609268 CT UPPER EXTR W/O CONTRAST 73200 352 $572.00 211.41 95.17 " 1,774.00 " 149.07 " 1,774.00 " 113.56 " 1,774.00 " 151.67 316.03 111.39 725.00 145.19 129.63 378.61 97.34 108.15 783.02 978.77 110.85 111.39 108.15 457.60 98.96 129.63 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83009268 CT UPPER EXTR W/O CONTRAST 73200 352 $572.00 211.41 95.17 " 1,774.00 " 149.07 " 1,774.00 " 113.56 " 1,774.00 " 151.67 316.03 111.39 725.00 145.19 129.63 378.61 97.34 108.15 783.02 978.77 110.85 111.39 108.15 457.60 98.96 129.63 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67709276 CT UPPER EXTR W/CONTRAST 73201 352 "$1,933.00" 714.44 136.09 " 1,774.00 " 156.50 " 1,774.00 " 384.09 " 1,774.00 " 159.23 " 1,067.98 " 376.77 725.00 152.42 136.09 " 1,279.45 " 329.22 365.80 909.10 " 1,136.37 " 374.95 376.77 365.80 " 1,546.40 " 334.71 136.09 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 67909275 CT UPPER EXTR W/CONTRAST 73201 352 "$1,933.00" 714.44 136.09 " 1,774.00 " 156.50 " 1,774.00 " 384.09 " 1,774.00 " 159.23 " 1,067.98 " 376.77 725.00 152.42 136.09 " 1,279.45 " 329.22 365.80 909.10 " 1,136.37 " 374.95 376.77 365.80 " 1,546.40 " 334.71 136.09 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 80609272 CT UPPER EXTR W/CONTRAST 73201 352 "$1,933.00" 714.44 136.09 " 1,774.00 " 156.50 " 1,774.00 " 384.09 " 1,774.00 " 159.23 " 1,067.98 " 376.77 725.00 152.42 136.09 " 1,279.45 " 329.22 365.80 909.10 " 1,136.37 " 374.95 376.77 365.80 " 1,546.40 " 334.71 136.09 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81409277 CT UPPER EXTR W/CONTRAST 73201 352 "$1,933.00" 714.44 136.09 " 1,774.00 " 156.50 " 1,774.00 " 384.09 " 1,774.00 " 159.23 " 1,067.98 " 376.77 725.00 152.42 136.09 " 1,279.45 " 329.22 365.80 909.10 " 1,136.37 " 374.95 376.77 365.80 " 1,546.40 " 334.71 136.09 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81609276 CT UPPER EXTR W/CONTRAST 73201 352 "$1,933.00" 714.44 136.09 " 1,774.00 " 156.50 " 1,774.00 " 384.09 " 1,774.00 " 159.23 " 1,067.98 " 376.77 725.00 152.42 136.09 " 1,279.45 " 329.22 365.80 909.10 " 1,136.37 " 374.95 376.77 365.80 " 1,546.40 " 334.71 136.09 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 83009276 CT UPPER EXTR W/CONTRAST 73201 352 "$1,933.00" 714.44 136.09 " 1,774.00 " 156.50 " 1,774.00 " 384.09 " 1,774.00 " 159.23 " 1,067.98 " 376.77 725.00 152.42 136.09 " 1,279.45 " 329.22 365.80 909.10 " 1,136.37 " 374.95 376.77 365.80 " 1,546.40 " 334.71 136.09 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 67709284 CT UPPER EXTR WO/W CONTRAST 73202 352 $937.00 346.32 149.05 " 1,774.00 " 171.41 " 1,774.00 " 186.31 " 1,774.00 " 174.39 517.69 182.76 725.00 166.94 149.05 620.20 159.70 177.44 " 1,099.47 " " 1,374.34 " 181.88 182.76 177.44 749.60 162.36 149.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67909283 CT UPPER EXTR WO/W CONTRAST 73202 352 $937.00 346.32 149.05 " 1,774.00 " 171.41 " 1,774.00 " 186.31 " 1,774.00 " 174.39 517.69 182.76 725.00 166.94 149.05 620.20 159.70 177.44 " 1,099.47 " " 1,374.34 " 181.88 182.76 177.44 749.60 162.36 149.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80609281 CT UPPER EXTR WO/W CONTRAST 73202 352 $937.00 346.32 149.05 " 1,774.00 " 171.41 " 1,774.00 " 186.31 " 1,774.00 " 174.39 517.69 182.76 725.00 166.94 149.05 620.20 159.70 177.44 " 1,099.47 " " 1,374.34 " 181.88 182.76 177.44 749.60 162.36 149.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81409285 CT UPPER EXTR WO/W CONTRAST 73202 352 $937.00 346.32 149.05 " 1,774.00 " 171.41 " 1,774.00 " 186.31 " 1,774.00 " 174.39 517.69 182.76 725.00 166.94 149.05 620.20 159.70 177.44 " 1,099.47 " " 1,374.34 " 181.88 182.76 177.44 749.60 162.36 149.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81609284 CT UPPER EXTR WO/W CONTRAST 73202 352 $937.00 346.32 149.05 " 1,774.00 " 171.41 " 1,774.00 " 186.31 " 1,774.00 " 174.39 517.69 182.76 725.00 166.94 149.05 620.20 159.70 177.44 " 1,099.47 " " 1,374.34 " 181.88 182.76 177.44 749.60 162.36 149.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 83009284 CT UPPER EXTR WO/W CONTRAST 73202 352 $937.00 346.32 149.05 " 1,774.00 " 171.41 " 1,774.00 " 186.31 " 1,774.00 " 174.39 517.69 182.76 725.00 166.94 149.05 620.20 159.70 177.44 " 1,099.47 " " 1,374.34 " 181.88 182.76 177.44 749.60 162.36 149.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67709721 CTA UPPER EXTR WO/W CONTRAST 73206 352 $937.00 346.32 156.15 " 1,774.00 " 313.51 " 1,774.00 " 186.31 " 1,774.00 " 318.97 517.69 182.76 725.00 305.33 272.62 620.20 159.70 177.44 " 1,239.99 " " 1,549.99 " 181.88 182.76 177.44 749.60 162.36 272.62 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67909721 CTA UPPER EXTR WO/W CONTRAST 73206 352 $937.00 346.32 156.15 " 1,774.00 " 313.51 " 1,774.00 " 186.31 " 1,774.00 " 318.97 517.69 182.76 725.00 305.33 272.62 620.20 159.70 177.44 " 1,239.99 " " 1,549.99 " 181.88 182.76 177.44 749.60 162.36 272.62 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80609728 CTA UPPER EXTR WO/W CONTRAST 73206 352 $937.00 346.32 156.15 " 1,774.00 " 313.51 " 1,774.00 " 186.31 " 1,774.00 " 318.97 517.69 182.76 725.00 305.33 272.62 620.20 159.70 177.44 " 1,239.99 " " 1,549.99 " 181.88 182.76 177.44 749.60 162.36 272.62 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81409722 CTA UPPER EXTR WO/W CONTRAST 73206 352 $937.00 346.32 156.15 " 1,774.00 " 313.51 " 1,774.00 " 186.31 " 1,774.00 " 318.97 517.69 182.76 725.00 305.33 272.62 620.20 159.70 177.44 " 1,239.99 " " 1,549.99 " 181.88 182.76 177.44 749.60 162.36 272.62 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81609721 CTA UPPER EXTR WO/W CONTRAST 73206 352 $937.00 346.32 156.15 " 1,774.00 " 313.51 " 1,774.00 " 186.31 " 1,774.00 " 318.97 517.69 182.76 725.00 305.33 272.62 620.20 159.70 177.44 " 1,239.99 " " 1,549.99 " 181.88 182.76 177.44 749.60 162.36 272.62 467.80 156.15 383.23 702.75 356.15 419.12 183.65 83009721 CTA UPPER EXTR WO/W CONTRAST 73206 352 $937.00 346.32 156.15 " 1,774.00 " 313.51 " 1,774.00 " 186.31 " 1,774.00 " 318.97 517.69 182.76 725.00 305.33 272.62 620.20 159.70 177.44 " 1,239.99 " " 1,549.99 " 181.88 182.76 177.44 749.60 162.36 272.62 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80407289 MRI UP EXTR NO JT W/O CONTRAST 73218 614 "$1,208.00" 446.48 201.14 " 2,882.00 " 367.14 " 2,882.00 " 240.00 " 2,882.00 " 373.52 667.42 235.43 " 1,155.00 " 357.56 319.25 799.58 205.71 228.57 " 1,266.57 " " 1,583.21 " 234.28 235.43 228.57 966.40 209.14 319.25 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81407282 MRI UP EXTR NO JT W/O CONTRAST 73218 614 "$1,208.00" 446.48 201.14 " 2,882.00 " 367.14 " 2,882.00 " 240.00 " 2,882.00 " 373.52 667.42 235.43 " 1,155.00 " 357.56 319.25 799.58 205.71 228.57 " 1,266.57 " " 1,583.21 " 234.28 235.43 228.57 966.40 209.14 319.25 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81607281 MRI UP EXTR NO JT W/O CONTRAST 73218 614 "$1,208.00" 446.48 201.14 " 2,882.00 " 367.14 " 2,882.00 " 240.00 " 2,882.00 " 373.52 667.42 235.43 " 1,155.00 " 357.56 319.25 799.58 205.71 228.57 " 1,266.57 " " 1,583.21 " 234.28 235.43 228.57 966.40 209.14 319.25 602.94 201.14 494.07 906.00 459.16 540.34 236.57 80407301 MRI UP EXTR NO JT W/CONTRAST 73219 614 "$1,933.00" 714.44 321.90 " 2,882.00 " 440.45 " 2,882.00 " 384.09 " 2,882.00 " 448.11 " 1,067.98 " 376.77 " 1,155.00 " 428.96 383.00 " 1,279.45 " 329.22 365.80 " 1,519.15 " " 1,898.94 " 374.95 376.77 365.80 " 1,546.40 " 334.71 383.00 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81407304 MRI UP EXTR NO JT W/CONTRAST 73219 614 "$1,933.00" 714.44 321.90 " 2,882.00 " 440.45 " 2,882.00 " 384.09 " 2,882.00 " 448.11 " 1,067.98 " 376.77 " 1,155.00 " 428.96 383.00 " 1,279.45 " 329.22 365.80 " 1,519.15 " " 1,898.94 " 374.95 376.77 365.80 " 1,546.40 " 334.71 383.00 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81607303 MRI UP EXTR NO JT W/CONTRAST 73219 614 "$1,933.00" 714.44 321.90 " 2,882.00 " 440.45 " 2,882.00 " 384.09 " 2,882.00 " 448.11 " 1,067.98 " 376.77 " 1,155.00 " 428.96 383.00 " 1,279.45 " 329.22 365.80 " 1,519.15 " " 1,898.94 " 374.95 376.77 365.80 " 1,546.40 " 334.71 383.00 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 80407319 MRI UP EXTR NO JT WO/W CONT 73220 614 "$1,933.00" 714.44 321.90 " 2,882.00 " 389.85 " 2,882.00 " 384.09 " 2,882.00 " 396.63 " 1,067.98 " 376.77 " 1,155.00 " 379.68 339.00 " 1,279.45 " 329.22 365.80 " 1,596.58 " " 1,995.72 " 374.95 376.77 365.80 " 1,546.40 " 334.71 339.00 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81407312 MRI UP EXTR NO JT WO/W CONT 73220 614 "$1,933.00" 714.44 321.90 " 2,882.00 " 389.85 " 2,882.00 " 384.09 " 2,882.00 " 396.63 " 1,067.98 " 376.77 " 1,155.00 " 379.68 339.00 " 1,279.45 " 329.22 365.80 " 1,596.58 " " 1,995.72 " 374.95 376.77 365.80 " 1,546.40 " 334.71 339.00 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81607311 MRI UP EXTR NO JT WO/W CONT 73220 614 "$1,933.00" 714.44 321.90 " 2,882.00 " 389.85 " 2,882.00 " 384.09 " 2,882.00 " 396.63 " 1,067.98 " 376.77 " 1,155.00 " 379.68 339.00 " 1,279.45 " 329.22 365.80 " 1,596.58 " " 1,995.72 " 374.95 376.77 365.80 " 1,546.40 " 334.71 339.00 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 80407297 MRI UP EXTR JT W/O CONTRAST 73221 614 "$1,208.00" 446.48 201.14 " 2,882.00 " 381.10 " 2,882.00 " 240.00 " 2,882.00 " 387.73 667.42 235.43 " 1,155.00 " 371.16 331.39 799.58 205.71 228.57 " 1,503.14 " " 1,878.93 " 234.28 235.43 228.57 966.40 209.14 331.39 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81407291 MRI UP EXTR JT W/O CONTRAST 73221 614 "$1,208.00" 446.48 201.14 " 2,882.00 " 381.10 " 2,882.00 " 240.00 " 2,882.00 " 387.73 667.42 235.43 " 1,155.00 " 371.16 331.39 799.58 205.71 228.57 " 1,503.14 " " 1,878.93 " 234.28 235.43 228.57 966.40 209.14 331.39 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81607290 MRI UP EXTR JT W/O CONTRAST 73221 614 "$1,208.00" 446.48 201.14 " 2,882.00 " 381.10 " 2,882.00 " 240.00 " 2,882.00 " 387.73 667.42 235.43 " 1,155.00 " 371.16 331.39 799.58 205.71 228.57 " 1,503.14 " " 1,878.93 " 234.28 235.43 228.57 966.40 209.14 331.39 602.94 201.14 494.07 906.00 459.16 540.34 236.57 80407335 MRI UP EXTR JT W/CONTRAST 73222 614 "$3,755.00" " 1,387.85 " 383.00 " 3,004.00 " 440.45 " 2,882.00 " 746.21 " 2,882.00 " 448.11 " 2,074.64 " 732.00 " 1,155.00 " 428.96 383.00 " 2,485.43 " 639.61 710.68 " 1,519.15 " " 1,898.94 " 728.45 732.00 710.68 " 3,004.00 " 650.27 383.00 " 1,873.77 " 625.40 " 1,535.80 " " 2,816.25 " " 1,427.28 " " 1,679.61 " 735.55 81407339 MRI UP EXTR JT W/CONTRAST 73222 614 "$3,755.00" " 1,387.85 " 383.00 " 3,004.00 " 440.45 " 2,882.00 " 746.21 " 2,882.00 " 448.11 " 2,074.64 " 732.00 " 1,155.00 " 428.96 383.00 " 2,485.43 " 639.61 710.68 " 1,519.15 " " 1,898.94 " 728.45 732.00 710.68 " 3,004.00 " 650.27 383.00 " 1,873.77 " 625.40 " 1,535.80 " " 2,816.25 " " 1,427.28 " " 1,679.61 " 735.55 81607338 MRI UP EXTR JT W/CONTRAST 73222 614 "$3,755.00" " 1,387.85 " 383.00 " 3,004.00 " 440.45 " 2,882.00 " 746.21 " 2,882.00 " 448.11 " 2,074.64 " 732.00 " 1,155.00 " 428.96 383.00 " 2,485.43 " 639.61 710.68 " 1,519.15 " " 1,898.94 " 728.45 732.00 710.68 " 3,004.00 " 650.27 383.00 " 1,873.77 " 625.40 " 1,535.80 " " 2,816.25 " " 1,427.28 " " 1,679.61 " 735.55 80407327 MRI UP EXTR JT WO/W CONTRAST 73223 614 "$1,933.00" 714.44 321.90 " 3,514.26 " 658.84 " 2,882.00 " 384.09 " 2,882.00 " 670.29 " 1,067.98 " 376.77 " 1,155.00 " 641.65 572.90 " 1,279.45 " 329.22 365.80 " 2,811.41 " " 3,514.26 " 374.95 376.77 365.80 " 1,546.40 " 334.71 572.90 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81407321 MRI UP EXTR JT WO/W CONTRAST 73223 614 "$1,933.00" 714.44 321.90 " 3,514.26 " 658.84 " 2,882.00 " 384.09 " 2,882.00 " 670.29 " 1,067.98 " 376.77 " 1,155.00 " 641.65 572.90 " 1,279.45 " 329.22 365.80 " 2,811.41 " " 3,514.26 " 374.95 376.77 365.80 " 1,546.40 " 334.71 572.90 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81607320 MRI UP EXTR JT WO/W CONTRAST 73223 614 "$1,933.00" 714.44 321.90 " 3,514.26 " 658.84 " 2,882.00 " 384.09 " 2,882.00 " 670.29 " 1,067.98 " 376.77 " 1,155.00 " 641.65 572.90 " 1,279.45 " 329.22 365.80 " 2,811.41 " " 3,514.26 " 374.95 376.77 365.80 " 1,546.40 " 334.71 572.90 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 67935594 XR HIP UNILATERAL 1VW 73501 320 $425.00 157.08 22.49 340.00 25.86 293.68 84.37 293.68 26.31 234.81 82.76 280.50 25.19 22.49 281.31 72.32 80.35 97.57 121.96 82.36 82.76 80.35 340.00 73.52 22.49 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80135599 XR HIP UNILATERAL 1VW 73501 320 $425.00 157.08 22.49 340.00 25.86 293.68 84.37 293.68 26.31 234.81 82.76 280.50 25.19 22.49 281.31 72.32 80.35 97.57 121.96 82.36 82.76 80.35 340.00 73.52 22.49 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81435596 XR HIP UNILATERAL 1VW 73501 320 $425.00 157.08 22.49 340.00 25.86 293.68 84.37 293.68 26.31 234.81 82.76 280.50 25.19 22.49 281.31 72.32 80.35 97.57 121.96 82.36 82.76 80.35 340.00 73.52 22.49 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81635595 XR HIP UNILATERAL 1VW 73501 320 $425.00 157.08 22.49 340.00 25.86 293.68 84.37 293.68 26.31 234.81 82.76 280.50 25.19 22.49 281.31 72.32 80.35 97.57 121.96 82.36 82.76 80.35 340.00 73.52 22.49 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81735590 XR HIP UNILATERAL 1VW 73501 320 $425.00 157.08 22.49 340.00 25.86 293.68 84.37 293.68 26.31 234.81 82.76 280.50 25.19 22.49 281.31 72.32 80.35 97.57 121.96 82.36 82.76 80.35 340.00 73.52 22.49 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82635599 XR HIP UNILATERAL 1VW 73501 320 $425.00 157.08 22.49 340.00 25.86 293.68 84.37 293.68 26.31 234.81 82.76 280.50 25.19 22.49 281.31 72.32 80.35 97.57 121.96 82.36 82.76 80.35 340.00 73.52 22.49 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82935592 XR HIP UNILATERAL 1VW 73501 320 $425.00 157.08 22.49 340.00 25.86 293.68 84.37 293.68 26.31 234.81 82.76 280.50 25.19 22.49 281.31 72.32 80.35 97.57 121.96 82.36 82.76 80.35 340.00 73.52 22.49 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83035595 XR HIP UNILATERAL 1VW 73501 320 $425.00 157.08 22.49 340.00 25.86 293.68 84.37 293.68 26.31 234.81 82.76 280.50 25.19 22.49 281.31 72.32 80.35 97.57 121.96 82.36 82.76 80.35 340.00 73.52 22.49 211.96 70.71 173.83 318.75 161.54 190.10 83.16 67935608 XR HIP UNILATERAL 2-3VWS 73502 320 $425.00 157.08 31.34 340.00 36.04 293.68 84.37 293.68 36.67 234.81 82.76 280.50 35.10 31.34 281.31 72.32 80.35 146.27 182.84 82.36 82.76 80.35 340.00 73.52 31.34 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80135602 XR HIP UNILATERAL 2-3VWS 73502 320 $425.00 157.08 31.34 340.00 36.04 293.68 84.37 293.68 36.67 234.81 82.76 280.50 35.10 31.34 281.31 72.32 80.35 146.27 182.84 82.36 82.76 80.35 340.00 73.52 31.34 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81435600 XR HIP UNILATERAL 2-3VWS 73502 320 $425.00 157.08 31.34 340.00 36.04 293.68 84.37 293.68 36.67 234.81 82.76 280.50 35.10 31.34 281.31 72.32 80.35 146.27 182.84 82.36 82.76 80.35 340.00 73.52 31.34 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81635609 XR HIP UNILATERAL 2-3VWS 73502 320 $425.00 157.08 31.34 340.00 36.04 293.68 84.37 293.68 36.67 234.81 82.76 280.50 35.10 31.34 281.31 72.32 80.35 146.27 182.84 82.36 82.76 80.35 340.00 73.52 31.34 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81735603 XR HIP UNILATERAL 2-3VWS 73502 320 $425.00 157.08 31.34 340.00 36.04 293.68 84.37 293.68 36.67 234.81 82.76 280.50 35.10 31.34 281.31 72.32 80.35 146.27 182.84 82.36 82.76 80.35 340.00 73.52 31.34 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82635602 XR HIP UNILATERAL 2-3VWS 73502 320 $425.00 157.08 31.34 340.00 36.04 293.68 84.37 293.68 36.67 234.81 82.76 280.50 35.10 31.34 281.31 72.32 80.35 146.27 182.84 82.36 82.76 80.35 340.00 73.52 31.34 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82935606 XR HIP UNILATERAL 2-3VWS 73502 320 $425.00 157.08 31.34 340.00 36.04 293.68 84.37 293.68 36.67 234.81 82.76 280.50 35.10 31.34 281.31 72.32 80.35 146.27 182.84 82.36 82.76 80.35 340.00 73.52 31.34 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83035609 XR HIP UNILATERAL 2-3VWS 73502 320 $425.00 157.08 31.34 340.00 36.04 293.68 84.37 293.68 36.67 234.81 82.76 280.50 35.10 31.34 281.31 72.32 80.35 146.27 182.84 82.36 82.76 80.35 340.00 73.52 31.34 211.96 70.71 173.83 318.75 161.54 190.10 83.16 67935152 XR HIP UNILATERAL MIN 4VWS 73503 320 $572.00 211.41 39.18 457.60 45.06 395.25 113.56 395.25 45.84 316.03 111.39 377.52 43.88 39.18 378.61 97.34 108.15 181.06 226.33 110.85 111.39 108.15 457.60 98.96 39.18 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80135157 XR HIP UNILATERAL MIN 4VWS 73503 320 $572.00 211.41 39.18 457.60 45.06 395.25 113.56 395.25 45.84 316.03 111.39 377.52 43.88 39.18 378.61 97.34 108.15 181.06 226.33 110.85 111.39 108.15 457.60 98.96 39.18 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81435154 XR HIP UNILATERAL MIN 4VWS 73503 320 $572.00 211.41 39.18 457.60 45.06 395.25 113.56 395.25 45.84 316.03 111.39 377.52 43.88 39.18 378.61 97.34 108.15 181.06 226.33 110.85 111.39 108.15 457.60 98.96 39.18 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81635153 XR HIP UNILATERAL MIN 4VWS 73503 320 $572.00 211.41 39.18 457.60 45.06 395.25 113.56 395.25 45.84 316.03 111.39 377.52 43.88 39.18 378.61 97.34 108.15 181.06 226.33 110.85 111.39 108.15 457.60 98.96 39.18 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81735158 XR HIP UNILATERAL MIN 4VWS 73503 320 $572.00 211.41 39.18 457.60 45.06 395.25 113.56 395.25 45.84 316.03 111.39 377.52 43.88 39.18 378.61 97.34 108.15 181.06 226.33 110.85 111.39 108.15 457.60 98.96 39.18 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82635157 XR HIP UNILATERAL MIN 4VWS 73503 320 $572.00 211.41 39.18 457.60 45.06 395.25 113.56 395.25 45.84 316.03 111.39 377.52 43.88 39.18 378.61 97.34 108.15 181.06 226.33 110.85 111.39 108.15 457.60 98.96 39.18 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82935151 XR HIP UNILATERAL MIN 4VWS 73503 320 $572.00 211.41 39.18 457.60 45.06 395.25 113.56 395.25 45.84 316.03 111.39 377.52 43.88 39.18 378.61 97.34 108.15 181.06 226.33 110.85 111.39 108.15 457.60 98.96 39.18 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83035153 XR HIP UNILATERAL MIN 4VWS 73503 320 $572.00 211.41 39.18 457.60 45.06 395.25 113.56 395.25 45.84 316.03 111.39 377.52 43.88 39.18 378.61 97.34 108.15 181.06 226.33 110.85 111.39 108.15 457.60 98.96 39.18 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67935501 XR HIP BILAT 2VWS 73521 320 $572.00 211.41 30.02 457.60 34.52 395.25 113.56 395.25 35.12 316.03 111.39 377.52 33.62 30.02 378.61 97.34 108.15 135.86 169.83 110.85 111.39 108.15 457.60 98.96 30.02 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80135505 XR HIP BILAT 2VWS 73521 320 $572.00 211.41 30.02 457.60 34.52 395.25 113.56 395.25 35.12 316.03 111.39 377.52 33.62 30.02 378.61 97.34 108.15 135.86 169.83 110.85 111.39 108.15 457.60 98.96 30.02 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81435502 XR HIP BILAT 2VWS 73521 320 $572.00 211.41 30.02 457.60 34.52 395.25 113.56 395.25 35.12 316.03 111.39 377.52 33.62 30.02 378.61 97.34 108.15 135.86 169.83 110.85 111.39 108.15 457.60 98.96 30.02 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81635501 XR HIP BILAT 2VWS 73521 320 $572.00 211.41 30.02 457.60 34.52 395.25 113.56 395.25 35.12 316.03 111.39 377.52 33.62 30.02 378.61 97.34 108.15 135.86 169.83 110.85 111.39 108.15 457.60 98.96 30.02 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81735506 XR HIP BILAT 2VWS 73521 320 $572.00 211.41 30.02 457.60 34.52 395.25 113.56 395.25 35.12 316.03 111.39 377.52 33.62 30.02 378.61 97.34 108.15 135.86 169.83 110.85 111.39 108.15 457.60 98.96 30.02 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82635505 XR HIP BILAT 2VWS 73521 320 $572.00 211.41 30.02 457.60 34.52 395.25 113.56 395.25 35.12 316.03 111.39 377.52 33.62 30.02 378.61 97.34 108.15 135.86 169.83 110.85 111.39 108.15 457.60 98.96 30.02 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82935509 XR HIP BILAT 2VWS 73521 320 $572.00 211.41 30.02 457.60 34.52 395.25 113.56 395.25 35.12 316.03 111.39 377.52 33.62 30.02 378.61 97.34 108.15 135.86 169.83 110.85 111.39 108.15 457.60 98.96 30.02 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83035501 XR HIP BILAT 2VWS 73521 320 $572.00 211.41 30.02 457.60 34.52 395.25 113.56 395.25 35.12 316.03 111.39 377.52 33.62 30.02 378.61 97.34 108.15 135.86 169.83 110.85 111.39 108.15 457.60 98.96 30.02 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67935616 XR HIP BILAT 3-4VWS 73522 320 $572.00 211.41 37.09 457.60 42.65 395.25 113.56 395.25 43.40 316.03 111.39 377.52 41.54 37.09 378.61 97.34 108.15 163.70 204.62 110.85 111.39 108.15 457.60 98.96 37.09 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80135611 XR HIP BILAT 3-4VWS 73522 320 $572.00 211.41 37.09 457.60 42.65 395.25 113.56 395.25 43.40 316.03 111.39 377.52 41.54 37.09 378.61 97.34 108.15 163.70 204.62 110.85 111.39 108.15 457.60 98.96 37.09 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81435618 XR HIP BILAT 3-4VWS 73522 320 $572.00 211.41 37.09 457.60 42.65 395.25 113.56 395.25 43.40 316.03 111.39 377.52 41.54 37.09 378.61 97.34 108.15 163.70 204.62 110.85 111.39 108.15 457.60 98.96 37.09 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81635617 XR HIP BILAT 3-4VWS 73522 320 $572.00 211.41 37.09 457.60 42.65 395.25 113.56 395.25 43.40 316.03 111.39 377.52 41.54 37.09 378.61 97.34 108.15 163.70 204.62 110.85 111.39 108.15 457.60 98.96 37.09 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81735611 XR HIP BILAT 3-4VWS 73522 320 $572.00 211.41 37.09 457.60 42.65 395.25 113.56 395.25 43.40 316.03 111.39 377.52 41.54 37.09 378.61 97.34 108.15 163.70 204.62 110.85 111.39 108.15 457.60 98.96 37.09 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82635611 XR HIP BILAT 3-4VWS 73522 320 $572.00 211.41 37.09 457.60 42.65 395.25 113.56 395.25 43.40 316.03 111.39 377.52 41.54 37.09 378.61 97.34 108.15 163.70 204.62 110.85 111.39 108.15 457.60 98.96 37.09 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82935614 XR HIP BILAT 3-4VWS 73522 320 $572.00 211.41 37.09 457.60 42.65 395.25 113.56 395.25 43.40 316.03 111.39 377.52 41.54 37.09 378.61 97.34 108.15 163.70 204.62 110.85 111.39 108.15 457.60 98.96 37.09 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83035617 XR HIP BILAT 3-4VWS 73522 320 $572.00 211.41 37.09 457.60 42.65 395.25 113.56 395.25 43.40 316.03 111.39 377.52 41.54 37.09 378.61 97.34 108.15 163.70 204.62 110.85 111.39 108.15 457.60 98.96 37.09 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67935187 XR HIP BILAT MIN 5VWS 73523 320 $572.00 211.41 42.99 457.60 49.44 395.25 113.56 395.25 50.30 316.03 111.39 377.52 48.15 42.99 378.61 97.34 108.15 196.76 245.95 110.85 111.39 108.15 457.60 98.96 42.99 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80135181 XR HIP BILAT MIN 5VWS 73523 320 $572.00 211.41 42.99 457.60 49.44 395.25 113.56 395.25 50.30 316.03 111.39 377.52 48.15 42.99 378.61 97.34 108.15 196.76 245.95 110.85 111.39 108.15 457.60 98.96 42.99 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81435189 XR HIP BILAT MIN 5VWS 73523 320 $572.00 211.41 42.99 457.60 49.44 395.25 113.56 395.25 50.30 316.03 111.39 377.52 48.15 42.99 378.61 97.34 108.15 196.76 245.95 110.85 111.39 108.15 457.60 98.96 42.99 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81635188 XR HIP BILAT MIN 5VWS 73523 320 $572.00 211.41 42.99 457.60 49.44 395.25 113.56 395.25 50.30 316.03 111.39 377.52 48.15 42.99 378.61 97.34 108.15 196.76 245.95 110.85 111.39 108.15 457.60 98.96 42.99 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81735182 XR HIP BILAT MIN 5VWS 73523 320 $572.00 211.41 42.99 457.60 49.44 395.25 113.56 395.25 50.30 316.03 111.39 377.52 48.15 42.99 378.61 97.34 108.15 196.76 245.95 110.85 111.39 108.15 457.60 98.96 42.99 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82635181 XR HIP BILAT MIN 5VWS 73523 320 $572.00 211.41 42.99 457.60 49.44 395.25 113.56 395.25 50.30 316.03 111.39 377.52 48.15 42.99 378.61 97.34 108.15 196.76 245.95 110.85 111.39 108.15 457.60 98.96 42.99 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82935185 XR HIP BILAT MIN 5VWS 73523 320 $572.00 211.41 42.99 457.60 49.44 395.25 113.56 395.25 50.30 316.03 111.39 377.52 48.15 42.99 378.61 97.34 108.15 196.76 245.95 110.85 111.39 108.15 457.60 98.96 42.99 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83035188 XR HIP BILAT MIN 5VWS 73523 320 $572.00 211.41 42.99 457.60 49.44 395.25 113.56 395.25 50.30 316.03 111.39 377.52 48.15 42.99 378.61 97.34 108.15 196.76 245.95 110.85 111.39 108.15 457.60 98.96 42.99 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80100671 XR CONTRAST HIP 73525 320 "$1,933.00" 714.44 73.12 " 1,546.40 " 84.09 " 1,335.70 " 384.09 " 1,335.70 " 85.55 " 1,067.98 " 376.77 " 1,275.78 " 81.89 73.12 " 1,279.45 " 329.22 365.80 347.64 434.55 374.95 376.77 365.80 " 1,546.40 " 334.71 73.12 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 67935195 XR FEMUR 1VW 73551 320 $425.00 157.08 21.11 340.00 24.28 293.68 84.37 293.68 24.70 234.81 82.76 280.50 23.64 21.11 281.31 72.32 80.35 94.06 117.58 82.36 82.76 80.35 340.00 73.52 21.11 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80135190 XR FEMUR 1VW 73551 320 $425.00 157.08 21.11 340.00 24.28 293.68 84.37 293.68 24.70 234.81 82.76 280.50 23.64 21.11 281.31 72.32 80.35 94.06 117.58 82.36 82.76 80.35 340.00 73.52 21.11 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81435197 XR FEMUR 1VW 73551 320 $425.00 157.08 21.11 340.00 24.28 293.68 84.37 293.68 24.70 234.81 82.76 280.50 23.64 21.11 281.31 72.32 80.35 94.06 117.58 82.36 82.76 80.35 340.00 73.52 21.11 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81635196 XR FEMUR 1VW 73551 320 $425.00 157.08 21.11 340.00 24.28 293.68 84.37 293.68 24.70 234.81 82.76 280.50 23.64 21.11 281.31 72.32 80.35 94.06 117.58 82.36 82.76 80.35 340.00 73.52 21.11 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81735191 XR FEMUR 1VW 73551 320 $425.00 157.08 21.11 340.00 24.28 293.68 84.37 293.68 24.70 234.81 82.76 280.50 23.64 21.11 281.31 72.32 80.35 94.06 117.58 82.36 82.76 80.35 340.00 73.52 21.11 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82635190 XR FEMUR 1VW 73551 320 $425.00 157.08 21.11 340.00 24.28 293.68 84.37 293.68 24.70 234.81 82.76 280.50 23.64 21.11 281.31 72.32 80.35 94.06 117.58 82.36 82.76 80.35 340.00 73.52 21.11 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82935193 XR FEMUR 1VW 73551 320 $425.00 157.08 21.11 340.00 24.28 293.68 84.37 293.68 24.70 234.81 82.76 280.50 23.64 21.11 281.31 72.32 80.35 94.06 117.58 82.36 82.76 80.35 340.00 73.52 21.11 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83035196 XR FEMUR 1VW 73551 320 $425.00 157.08 21.11 340.00 24.28 293.68 84.37 293.68 24.70 234.81 82.76 280.50 23.64 21.11 281.31 72.32 80.35 94.06 117.58 82.36 82.76 80.35 340.00 73.52 21.11 211.96 70.71 173.83 318.75 161.54 190.10 83.16 67935624 XR FEMUR MIN 2VWS 73552 320 $425.00 157.08 24.62 340.00 28.31 293.68 84.37 293.68 28.81 234.81 82.76 280.50 27.57 24.62 281.31 72.32 80.35 111.49 139.36 82.36 82.76 80.35 340.00 73.52 24.62 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80135629 XR FEMUR MIN 2VWS 73552 320 $425.00 157.08 24.62 340.00 28.31 293.68 84.37 293.68 28.81 234.81 82.76 280.50 27.57 24.62 281.31 72.32 80.35 111.49 139.36 82.36 82.76 80.35 340.00 73.52 24.62 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81435626 XR FEMUR MIN 2VWS 73552 320 $425.00 157.08 24.62 340.00 28.31 293.68 84.37 293.68 28.81 234.81 82.76 280.50 27.57 24.62 281.31 72.32 80.35 111.49 139.36 82.36 82.76 80.35 340.00 73.52 24.62 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81635625 XR FEMUR MIN 2VWS 73552 320 $425.00 157.08 24.62 340.00 28.31 293.68 84.37 293.68 28.81 234.81 82.76 280.50 27.57 24.62 281.31 72.32 80.35 111.49 139.36 82.36 82.76 80.35 340.00 73.52 24.62 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81735620 XR FEMUR MIN 2VWS 73552 320 $425.00 157.08 24.62 340.00 28.31 293.68 84.37 293.68 28.81 234.81 82.76 280.50 27.57 24.62 281.31 72.32 80.35 111.49 139.36 82.36 82.76 80.35 340.00 73.52 24.62 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82635629 XR FEMUR MIN 2VWS 73552 320 $425.00 157.08 24.62 340.00 28.31 293.68 84.37 293.68 28.81 234.81 82.76 280.50 27.57 24.62 281.31 72.32 80.35 111.49 139.36 82.36 82.76 80.35 340.00 73.52 24.62 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82935622 XR FEMUR MIN 2VWS 73552 320 $425.00 157.08 24.62 340.00 28.31 293.68 84.37 293.68 28.81 234.81 82.76 280.50 27.57 24.62 281.31 72.32 80.35 111.49 139.36 82.36 82.76 80.35 340.00 73.52 24.62 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83035625 XR FEMUR MIN 2VWS 73552 320 $425.00 157.08 24.62 340.00 28.31 293.68 84.37 293.68 28.81 234.81 82.76 280.50 27.57 24.62 281.31 72.32 80.35 111.49 139.36 82.36 82.76 80.35 340.00 73.52 24.62 211.96 70.71 173.83 318.75 161.54 190.10 83.16 67900715 XR KNEE 1-2VWS 73560 320 $425.00 157.08 24.54 340.00 28.22 293.68 84.37 293.68 28.71 234.81 82.76 280.50 27.48 24.54 281.31 72.32 80.35 91.40 114.25 82.36 82.76 80.35 340.00 73.52 24.54 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80100710 XR KNEE 1-2VWS 73560 320 $425.00 157.08 24.54 340.00 28.22 293.68 84.37 293.68 28.71 234.81 82.76 280.50 27.48 24.54 281.31 72.32 80.35 91.40 114.25 82.36 82.76 80.35 340.00 73.52 24.54 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81400717 XR KNEE 1-2VWS 73560 320 $425.00 157.08 24.54 340.00 28.22 293.68 84.37 293.68 28.71 234.81 82.76 280.50 27.48 24.54 281.31 72.32 80.35 91.40 114.25 82.36 82.76 80.35 340.00 73.52 24.54 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81600716 XR KNEE 1-2VWS 73560 320 $425.00 157.08 24.54 340.00 28.22 293.68 84.37 293.68 28.71 234.81 82.76 280.50 27.48 24.54 281.31 72.32 80.35 91.40 114.25 82.36 82.76 80.35 340.00 73.52 24.54 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81700711 XR KNEE 1-2VWS 73560 320 $425.00 157.08 24.54 340.00 28.22 293.68 84.37 293.68 28.71 234.81 82.76 280.50 27.48 24.54 281.31 72.32 80.35 91.40 114.25 82.36 82.76 80.35 340.00 73.52 24.54 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82600710 XR KNEE 1-2VWS 73560 320 $425.00 157.08 24.54 340.00 28.22 293.68 84.37 293.68 28.71 234.81 82.76 280.50 27.48 24.54 281.31 72.32 80.35 91.40 114.25 82.36 82.76 80.35 340.00 73.52 24.54 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82900713 XR KNEE 1-2VWS 73560 320 $425.00 157.08 24.54 340.00 28.22 293.68 84.37 293.68 28.71 234.81 82.76 280.50 27.48 24.54 281.31 72.32 80.35 91.40 114.25 82.36 82.76 80.35 340.00 73.52 24.54 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83000716 XR KNEE 1-2VWS 73560 320 $425.00 157.08 24.54 340.00 28.22 293.68 84.37 293.68 28.71 234.81 82.76 280.50 27.48 24.54 281.31 72.32 80.35 91.40 114.25 82.36 82.76 80.35 340.00 73.52 24.54 211.96 70.71 173.83 318.75 161.54 190.10 83.16 67900723 XR KNEE 3VWS 73562 320 $425.00 157.08 24.92 340.00 28.66 293.68 84.37 293.68 29.16 234.81 82.76 280.50 27.91 24.92 281.31 72.32 80.35 100.97 126.21 82.36 82.76 80.35 340.00 73.52 24.92 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80100728 XR KNEE 3VWS 73562 320 $425.00 157.08 24.92 340.00 28.66 293.68 84.37 293.68 29.16 234.81 82.76 280.50 27.91 24.92 281.31 72.32 80.35 100.97 126.21 82.36 82.76 80.35 340.00 73.52 24.92 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81400725 XR KNEE 3VWS 73562 320 $425.00 157.08 24.92 340.00 28.66 293.68 84.37 293.68 29.16 234.81 82.76 280.50 27.91 24.92 281.31 72.32 80.35 100.97 126.21 82.36 82.76 80.35 340.00 73.52 24.92 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81600724 XR KNEE 3VWS 73562 320 $425.00 157.08 24.92 340.00 28.66 293.68 84.37 293.68 29.16 234.81 82.76 280.50 27.91 24.92 281.31 72.32 80.35 100.97 126.21 82.36 82.76 80.35 340.00 73.52 24.92 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81700729 XR KNEE 3VWS 73562 320 $425.00 157.08 24.92 340.00 28.66 293.68 84.37 293.68 29.16 234.81 82.76 280.50 27.91 24.92 281.31 72.32 80.35 100.97 126.21 82.36 82.76 80.35 340.00 73.52 24.92 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82600728 XR KNEE 3VWS 73562 320 $425.00 157.08 24.92 340.00 28.66 293.68 84.37 293.68 29.16 234.81 82.76 280.50 27.91 24.92 281.31 72.32 80.35 100.97 126.21 82.36 82.76 80.35 340.00 73.52 24.92 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82900721 XR KNEE 3VWS 73562 320 $425.00 157.08 24.92 340.00 28.66 293.68 84.37 293.68 29.16 234.81 82.76 280.50 27.91 24.92 281.31 72.32 80.35 100.97 126.21 82.36 82.76 80.35 340.00 73.52 24.92 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83000724 XR KNEE 3VWS 73562 320 $425.00 157.08 24.92 340.00 28.66 293.68 84.37 293.68 29.16 234.81 82.76 280.50 27.91 24.92 281.31 72.32 80.35 100.97 126.21 82.36 82.76 80.35 340.00 73.52 24.92 211.96 70.71 173.83 318.75 161.54 190.10 83.16 67901550 XR KNEE COMPLETE 4 > VWS 73564 320 $572.00 211.41 32.45 457.60 37.32 395.25 113.56 395.25 37.97 316.03 111.39 377.52 36.34 32.45 378.61 97.34 108.15 114.05 142.56 110.85 111.39 108.15 457.60 98.96 32.45 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80101554 XR KNEE COMPLETE 4 > VWS 73564 320 $572.00 211.41 32.45 457.60 37.32 395.25 113.56 395.25 37.97 316.03 111.39 377.52 36.34 32.45 378.61 97.34 108.15 114.05 142.56 110.85 111.39 108.15 457.60 98.96 32.45 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81401551 XR KNEE COMPLETE 4 > VWS 73564 320 $572.00 211.41 32.45 457.60 37.32 395.25 113.56 395.25 37.97 316.03 111.39 377.52 36.34 32.45 378.61 97.34 108.15 114.05 142.56 110.85 111.39 108.15 457.60 98.96 32.45 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81601551 XR KNEE COMPLETE 4 > VWS 73564 320 $572.00 211.41 32.45 457.60 37.32 395.25 113.56 395.25 37.97 316.03 111.39 377.52 36.34 32.45 378.61 97.34 108.15 114.05 142.56 110.85 111.39 108.15 457.60 98.96 32.45 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81701555 XR KNEE COMPLETE 4 > VWS 73564 320 $572.00 211.41 32.45 457.60 37.32 395.25 113.56 395.25 37.97 316.03 111.39 377.52 36.34 32.45 378.61 97.34 108.15 114.05 142.56 110.85 111.39 108.15 457.60 98.96 32.45 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82601554 XR KNEE COMPLETE 4 > VWS 73564 320 $572.00 211.41 32.45 457.60 37.32 395.25 113.56 395.25 37.97 316.03 111.39 377.52 36.34 32.45 378.61 97.34 108.15 114.05 142.56 110.85 111.39 108.15 457.60 98.96 32.45 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82901558 XR KNEE COMPLETE 4 > VWS 73564 320 $572.00 211.41 32.45 457.60 37.32 395.25 113.56 395.25 37.97 316.03 111.39 377.52 36.34 32.45 378.61 97.34 108.15 114.05 142.56 110.85 111.39 108.15 457.60 98.96 32.45 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83001551 XR KNEE COMPLETE 4 > VWS 73564 320 $572.00 211.41 32.45 457.60 37.32 395.25 113.56 395.25 37.97 316.03 111.39 377.52 36.34 32.45 378.61 97.34 108.15 114.05 142.56 110.85 111.39 108.15 457.60 98.96 32.45 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67900731 XR KNEES STANDING 73565 320 $425.00 157.08 25.40 340.00 29.21 293.68 84.37 293.68 29.72 234.81 82.76 280.50 28.45 25.40 281.31 72.32 80.35 88.36 110.45 82.36 82.76 80.35 340.00 73.52 25.40 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80100736 XR KNEES STANDING 73565 320 $425.00 157.08 25.40 340.00 29.21 293.68 84.37 293.68 29.72 234.81 82.76 280.50 28.45 25.40 281.31 72.32 80.35 88.36 110.45 82.36 82.76 80.35 340.00 73.52 25.40 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81400733 XR KNEES STANDING 73565 320 $425.00 157.08 25.40 340.00 29.21 293.68 84.37 293.68 29.72 234.81 82.76 280.50 28.45 25.40 281.31 72.32 80.35 88.36 110.45 82.36 82.76 80.35 340.00 73.52 25.40 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81600732 XR KNEES STANDING 73565 320 $425.00 157.08 25.40 340.00 29.21 293.68 84.37 293.68 29.72 234.81 82.76 280.50 28.45 25.40 281.31 72.32 80.35 88.36 110.45 82.36 82.76 80.35 340.00 73.52 25.40 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81700737 XR KNEES STANDING 73565 320 $425.00 157.08 25.40 340.00 29.21 293.68 84.37 293.68 29.72 234.81 82.76 280.50 28.45 25.40 281.31 72.32 80.35 88.36 110.45 82.36 82.76 80.35 340.00 73.52 25.40 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82600736 XR KNEES STANDING 73565 320 $425.00 157.08 25.40 340.00 29.21 293.68 84.37 293.68 29.72 234.81 82.76 280.50 28.45 25.40 281.31 72.32 80.35 88.36 110.45 82.36 82.76 80.35 340.00 73.52 25.40 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82900730 XR KNEES STANDING 73565 320 $425.00 157.08 25.40 340.00 29.21 293.68 84.37 293.68 29.72 234.81 82.76 280.50 28.45 25.40 281.31 72.32 80.35 88.36 110.45 82.36 82.76 80.35 340.00 73.52 25.40 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83000732 XR KNEES STANDING 73565 320 $425.00 157.08 25.40 340.00 29.21 293.68 84.37 293.68 29.72 234.81 82.76 280.50 28.45 25.40 281.31 72.32 80.35 88.36 110.45 82.36 82.76 80.35 340.00 73.52 25.40 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80100744 XR CONTRAST KNEE JOINT 73580 320 "$1,933.00" 714.44 27.50 " 1,546.40 " 31.63 " 1,335.70 " 384.09 " 1,335.70 " 32.18 " 1,067.98 " 376.77 " 1,275.78 " 30.80 27.50 " 1,279.45 " 329.22 365.80 411.52 514.40 374.95 376.77 365.80 " 1,546.40 " 334.71 27.50 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 67900758 XR TIBIA FIBULA 2VWS 73590 320 $425.00 157.08 24.54 340.00 28.22 293.68 84.37 293.68 28.71 234.81 82.76 280.50 27.48 24.54 281.31 72.32 80.35 93.02 116.27 82.36 82.76 80.35 340.00 73.52 24.54 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80100752 XR TIBIA FIBULA 2VWS 73590 320 $425.00 157.08 24.54 340.00 28.22 293.68 84.37 293.68 28.71 234.81 82.76 280.50 27.48 24.54 281.31 72.32 80.35 93.02 116.27 82.36 82.76 80.35 340.00 73.52 24.54 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81400750 XR TIBIA FIBULA 2VWS 73590 320 $425.00 157.08 24.54 340.00 28.22 293.68 84.37 293.68 28.71 234.81 82.76 280.50 27.48 24.54 281.31 72.32 80.35 93.02 116.27 82.36 82.76 80.35 340.00 73.52 24.54 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81600759 XR TIBIA FIBULA 2VWS 73590 320 $425.00 157.08 24.54 340.00 28.22 293.68 84.37 293.68 28.71 234.81 82.76 280.50 27.48 24.54 281.31 72.32 80.35 93.02 116.27 82.36 82.76 80.35 340.00 73.52 24.54 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81700753 XR TIBIA FIBULA 2VWS 73590 320 $425.00 157.08 24.54 340.00 28.22 293.68 84.37 293.68 28.71 234.81 82.76 280.50 27.48 24.54 281.31 72.32 80.35 93.02 116.27 82.36 82.76 80.35 340.00 73.52 24.54 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82600752 XR TIBIA FIBULA 2VWS 73590 320 $425.00 157.08 24.54 340.00 28.22 293.68 84.37 293.68 28.71 234.81 82.76 280.50 27.48 24.54 281.31 72.32 80.35 93.02 116.27 82.36 82.76 80.35 340.00 73.52 24.54 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82900756 XR TIBIA FIBULA 2VWS 73590 320 $425.00 157.08 24.54 340.00 28.22 293.68 84.37 293.68 28.71 234.81 82.76 280.50 27.48 24.54 281.31 72.32 80.35 93.02 116.27 82.36 82.76 80.35 340.00 73.52 24.54 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83000759 XR TIBIA FIBULA 2VWS 73590 320 $425.00 157.08 24.54 340.00 28.22 293.68 84.37 293.68 28.71 234.81 82.76 280.50 27.48 24.54 281.31 72.32 80.35 93.02 116.27 82.36 82.76 80.35 340.00 73.52 24.54 211.96 70.71 173.83 318.75 161.54 190.10 83.16 67900766 XR LWR EXTR INFANT 73592 320 $425.00 157.08 23.82 340.00 27.39 293.68 84.37 293.68 27.87 234.81 82.76 280.50 26.68 23.82 281.31 72.32 80.35 86.79 108.49 82.36 82.76 80.35 340.00 73.52 23.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80100761 XR LWR EXTR INFANT 73592 320 $425.00 157.08 23.82 340.00 27.39 293.68 84.37 293.68 27.87 234.81 82.76 280.50 26.68 23.82 281.31 72.32 80.35 86.79 108.49 82.36 82.76 80.35 340.00 73.52 23.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81400768 XR LWR EXTR INFANT 73592 320 $425.00 157.08 23.82 340.00 27.39 293.68 84.37 293.68 27.87 234.81 82.76 280.50 26.68 23.82 281.31 72.32 80.35 86.79 108.49 82.36 82.76 80.35 340.00 73.52 23.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81600767 XR LWR EXTR INFANT 73592 320 $425.00 157.08 23.82 340.00 27.39 293.68 84.37 293.68 27.87 234.81 82.76 280.50 26.68 23.82 281.31 72.32 80.35 86.79 108.49 82.36 82.76 80.35 340.00 73.52 23.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81700761 XR LWR EXTR INFANT 73592 320 $425.00 157.08 23.82 340.00 27.39 293.68 84.37 293.68 27.87 234.81 82.76 280.50 26.68 23.82 281.31 72.32 80.35 86.79 108.49 82.36 82.76 80.35 340.00 73.52 23.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82600761 XR LWR EXTR INFANT 73592 320 $425.00 157.08 23.82 340.00 27.39 293.68 84.37 293.68 27.87 234.81 82.76 280.50 26.68 23.82 281.31 72.32 80.35 86.79 108.49 82.36 82.76 80.35 340.00 73.52 23.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82900764 XR LWR EXTR INFANT 73592 320 $425.00 157.08 23.82 340.00 27.39 293.68 84.37 293.68 27.87 234.81 82.76 280.50 26.68 23.82 281.31 72.32 80.35 86.79 108.49 82.36 82.76 80.35 340.00 73.52 23.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83000767 XR LWR EXTR INFANT 73592 320 $425.00 157.08 23.82 340.00 27.39 293.68 84.37 293.68 27.87 234.81 82.76 280.50 26.68 23.82 281.31 72.32 80.35 86.79 108.49 82.36 82.76 80.35 340.00 73.52 23.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 67900774 XR ANKLE 2VWS 73600 320 $425.00 157.08 18.82 340.00 21.64 293.68 84.37 293.68 22.02 234.81 82.76 280.50 21.08 18.82 281.31 72.32 80.35 87.89 109.86 82.36 82.76 80.35 340.00 73.52 18.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80100779 XR ANKLE 2VWS 73600 320 $425.00 157.08 18.82 340.00 21.64 293.68 84.37 293.68 22.02 234.81 82.76 280.50 21.08 18.82 281.31 72.32 80.35 87.89 109.86 82.36 82.76 80.35 340.00 73.52 18.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81400776 XR ANKLE 2VWS 73600 320 $425.00 157.08 18.82 340.00 21.64 293.68 84.37 293.68 22.02 234.81 82.76 280.50 21.08 18.82 281.31 72.32 80.35 87.89 109.86 82.36 82.76 80.35 340.00 73.52 18.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81600775 XR ANKLE 2VWS 73600 320 $425.00 157.08 18.82 340.00 21.64 293.68 84.37 293.68 22.02 234.81 82.76 280.50 21.08 18.82 281.31 72.32 80.35 87.89 109.86 82.36 82.76 80.35 340.00 73.52 18.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81700770 XR ANKLE 2VWS 73600 320 $425.00 157.08 18.82 340.00 21.64 293.68 84.37 293.68 22.02 234.81 82.76 280.50 21.08 18.82 281.31 72.32 80.35 87.89 109.86 82.36 82.76 80.35 340.00 73.52 18.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82600779 XR ANKLE 2VWS 73600 320 $425.00 157.08 18.82 340.00 21.64 293.68 84.37 293.68 22.02 234.81 82.76 280.50 21.08 18.82 281.31 72.32 80.35 87.89 109.86 82.36 82.76 80.35 340.00 73.52 18.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82900772 XR ANKLE 2VWS 73600 320 $425.00 157.08 18.82 340.00 21.64 293.68 84.37 293.68 22.02 234.81 82.76 280.50 21.08 18.82 281.31 72.32 80.35 87.89 109.86 82.36 82.76 80.35 340.00 73.52 18.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83000775 XR ANKLE 2VWS 73600 320 $425.00 157.08 18.82 340.00 21.64 293.68 84.37 293.68 22.02 234.81 82.76 280.50 21.08 18.82 281.31 72.32 80.35 87.89 109.86 82.36 82.76 80.35 340.00 73.52 18.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 67900782 XR ANKLE >2VWS 73610 320 $425.00 157.08 26.77 340.00 30.79 293.68 84.37 293.68 31.32 234.81 82.76 280.50 29.98 26.77 281.31 72.32 80.35 93.70 117.12 82.36 82.76 80.35 340.00 73.52 26.77 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80100787 XR ANKLE >2VWS 73610 320 $425.00 157.08 26.77 340.00 30.79 293.68 84.37 293.68 31.32 234.81 82.76 280.50 29.98 26.77 281.31 72.32 80.35 93.70 117.12 82.36 82.76 80.35 340.00 73.52 26.77 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81400784 XR ANKLE >2VWS 73610 320 $425.00 157.08 26.77 340.00 30.79 293.68 84.37 293.68 31.32 234.81 82.76 280.50 29.98 26.77 281.31 72.32 80.35 93.70 117.12 82.36 82.76 80.35 340.00 73.52 26.77 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81600783 XR ANKLE >2VWS 73610 320 $425.00 157.08 26.77 340.00 30.79 293.68 84.37 293.68 31.32 234.81 82.76 280.50 29.98 26.77 281.31 72.32 80.35 93.70 117.12 82.36 82.76 80.35 340.00 73.52 26.77 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81700788 XR ANKLE >2VWS 73610 320 $425.00 157.08 26.77 340.00 30.79 293.68 84.37 293.68 31.32 234.81 82.76 280.50 29.98 26.77 281.31 72.32 80.35 93.70 117.12 82.36 82.76 80.35 340.00 73.52 26.77 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82600787 XR ANKLE >2VWS 73610 320 $425.00 157.08 26.77 340.00 30.79 293.68 84.37 293.68 31.32 234.81 82.76 280.50 29.98 26.77 281.31 72.32 80.35 93.70 117.12 82.36 82.76 80.35 340.00 73.52 26.77 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82900781 XR ANKLE >2VWS 73610 320 $425.00 157.08 26.77 340.00 30.79 293.68 84.37 293.68 31.32 234.81 82.76 280.50 29.98 26.77 281.31 72.32 80.35 93.70 117.12 82.36 82.76 80.35 340.00 73.52 26.77 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83000783 XR ANKLE >2VWS 73610 320 $425.00 157.08 26.77 340.00 30.79 293.68 84.37 293.68 31.32 234.81 82.76 280.50 29.98 26.77 281.31 72.32 80.35 93.70 117.12 82.36 82.76 80.35 340.00 73.52 26.77 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80100795 XR CONTRAST ANKLE 73615 320 "$1,933.00" 714.44 46.50 " 1,546.40 " 53.48 " 1,335.70 " 384.09 " 1,335.70 " 54.41 " 1,067.98 " 376.77 " 1,275.78 " 52.08 46.50 " 1,279.45 " 329.22 365.80 347.64 434.55 374.95 376.77 365.80 " 1,546.40 " 334.71 46.50 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 67900804 XR FOOT 2VWS 73620 320 $425.00 157.08 17.32 340.00 19.92 293.68 84.37 293.68 20.26 234.81 82.76 280.50 19.40 17.32 281.31 72.32 80.35 86.79 108.49 82.36 82.76 80.35 340.00 73.52 17.32 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80100809 XR FOOT 2VWS 73620 320 $425.00 157.08 17.32 340.00 19.92 293.68 84.37 293.68 20.26 234.81 82.76 280.50 19.40 17.32 281.31 72.32 80.35 86.79 108.49 82.36 82.76 80.35 340.00 73.52 17.32 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81400806 XR FOOT 2VWS 73620 320 $425.00 157.08 17.32 340.00 19.92 293.68 84.37 293.68 20.26 234.81 82.76 280.50 19.40 17.32 281.31 72.32 80.35 86.79 108.49 82.36 82.76 80.35 340.00 73.52 17.32 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81600805 XR FOOT 2VWS 73620 320 $425.00 157.08 17.32 340.00 19.92 293.68 84.37 293.68 20.26 234.81 82.76 280.50 19.40 17.32 281.31 72.32 80.35 86.79 108.49 82.36 82.76 80.35 340.00 73.52 17.32 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81700800 XR FOOT 2VWS 73620 320 $425.00 157.08 17.32 340.00 19.92 293.68 84.37 293.68 20.26 234.81 82.76 280.50 19.40 17.32 281.31 72.32 80.35 86.79 108.49 82.36 82.76 80.35 340.00 73.52 17.32 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82600809 XR FOOT 2VWS 73620 320 $425.00 157.08 17.32 340.00 19.92 293.68 84.37 293.68 20.26 234.81 82.76 280.50 19.40 17.32 281.31 72.32 80.35 86.79 108.49 82.36 82.76 80.35 340.00 73.52 17.32 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82900802 XR FOOT 2VWS 73620 320 $425.00 157.08 17.32 340.00 19.92 293.68 84.37 293.68 20.26 234.81 82.76 280.50 19.40 17.32 281.31 72.32 80.35 86.79 108.49 82.36 82.76 80.35 340.00 73.52 17.32 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83000805 XR FOOT 2VWS 73620 320 $425.00 157.08 17.32 340.00 19.92 293.68 84.37 293.68 20.26 234.81 82.76 280.50 19.40 17.32 281.31 72.32 80.35 86.79 108.49 82.36 82.76 80.35 340.00 73.52 17.32 211.96 70.71 173.83 318.75 161.54 190.10 83.16 67900812 XR FOOT >2VWS 73630 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 93.70 117.12 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80100817 XR FOOT >2VWS 73630 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 93.70 117.12 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81400814 XR FOOT >2VWS 73630 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 93.70 117.12 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81600813 XR FOOT >2VWS 73630 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 93.70 117.12 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81700818 XR FOOT >2VWS 73630 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 93.70 117.12 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82600817 XR FOOT >2VWS 73630 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 93.70 117.12 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82900811 XR FOOT >2VWS 73630 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 93.70 117.12 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83000813 XR FOOT >2VWS 73630 320 $425.00 157.08 19.00 340.00 21.85 293.68 84.37 293.68 22.23 234.81 82.76 280.50 21.28 19.00 281.31 72.32 80.35 93.70 117.12 82.36 82.76 80.35 340.00 73.52 19.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 67900821 XR HEEL MIN 2VWS 73650 320 $425.00 157.08 18.82 340.00 21.64 293.68 84.37 293.68 22.02 234.81 82.76 280.50 21.08 18.82 281.31 72.32 80.35 85.80 107.25 82.36 82.76 80.35 340.00 73.52 18.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80100825 XR HEEL MIN 2VWS 73650 320 $425.00 157.08 18.82 340.00 21.64 293.68 84.37 293.68 22.02 234.81 82.76 280.50 21.08 18.82 281.31 72.32 80.35 85.80 107.25 82.36 82.76 80.35 340.00 73.52 18.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81400822 XR HEEL MIN 2VWS 73650 320 $425.00 157.08 18.82 340.00 21.64 293.68 84.37 293.68 22.02 234.81 82.76 280.50 21.08 18.82 281.31 72.32 80.35 85.80 107.25 82.36 82.76 80.35 340.00 73.52 18.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81600821 XR HEEL MIN 2VWS 73650 320 $425.00 157.08 18.82 340.00 21.64 293.68 84.37 293.68 22.02 234.81 82.76 280.50 21.08 18.82 281.31 72.32 80.35 85.80 107.25 82.36 82.76 80.35 340.00 73.52 18.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81700826 XR HEEL MIN 2VWS 73650 320 $425.00 157.08 18.82 340.00 21.64 293.68 84.37 293.68 22.02 234.81 82.76 280.50 21.08 18.82 281.31 72.32 80.35 85.80 107.25 82.36 82.76 80.35 340.00 73.52 18.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82600825 XR HEEL MIN 2VWS 73650 320 $425.00 157.08 18.82 340.00 21.64 293.68 84.37 293.68 22.02 234.81 82.76 280.50 21.08 18.82 281.31 72.32 80.35 85.80 107.25 82.36 82.76 80.35 340.00 73.52 18.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82900829 XR HEEL MIN 2VWS 73650 320 $425.00 157.08 18.82 340.00 21.64 293.68 84.37 293.68 22.02 234.81 82.76 280.50 21.08 18.82 281.31 72.32 80.35 85.80 107.25 82.36 82.76 80.35 340.00 73.52 18.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83000821 XR HEEL MIN 2VWS 73650 320 $425.00 157.08 18.82 340.00 21.64 293.68 84.37 293.68 22.02 234.81 82.76 280.50 21.08 18.82 281.31 72.32 80.35 85.80 107.25 82.36 82.76 80.35 340.00 73.52 18.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 67900839 XR TOES MIN 2VWS 73660 320 $425.00 157.08 14.00 340.00 16.10 293.68 84.37 293.68 16.38 234.81 82.76 280.50 15.68 14.00 281.31 72.32 80.35 74.92 93.65 82.36 82.76 80.35 340.00 73.52 14.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80100833 XR TOES MIN 2VWS 73660 320 $425.00 157.08 14.00 340.00 16.10 293.68 84.37 293.68 16.38 234.81 82.76 280.50 15.68 14.00 281.31 72.32 80.35 74.92 93.65 82.36 82.76 80.35 340.00 73.52 14.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81400831 XR TOES MIN 2VWS 73660 320 $425.00 157.08 14.00 340.00 16.10 293.68 84.37 293.68 16.38 234.81 82.76 280.50 15.68 14.00 281.31 72.32 80.35 74.92 93.65 82.36 82.76 80.35 340.00 73.52 14.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81600830 XR TOES MIN 2VWS 73660 320 $425.00 157.08 14.00 340.00 16.10 293.68 84.37 293.68 16.38 234.81 82.76 280.50 15.68 14.00 281.31 72.32 80.35 74.92 93.65 82.36 82.76 80.35 340.00 73.52 14.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81700834 XR TOES MIN 2VWS 73660 320 $425.00 157.08 14.00 340.00 16.10 293.68 84.37 293.68 16.38 234.81 82.76 280.50 15.68 14.00 281.31 72.32 80.35 74.92 93.65 82.36 82.76 80.35 340.00 73.52 14.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82600833 XR TOES MIN 2VWS 73660 320 $425.00 157.08 14.00 340.00 16.10 293.68 84.37 293.68 16.38 234.81 82.76 280.50 15.68 14.00 281.31 72.32 80.35 74.92 93.65 82.36 82.76 80.35 340.00 73.52 14.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82900837 XR TOES MIN 2VWS 73660 320 $425.00 157.08 14.00 340.00 16.10 293.68 84.37 293.68 16.38 234.81 82.76 280.50 15.68 14.00 281.31 72.32 80.35 74.92 93.65 82.36 82.76 80.35 340.00 73.52 14.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83000830 XR TOES MIN 2VWS 73660 320 $425.00 157.08 14.00 340.00 16.10 293.68 84.37 293.68 16.38 234.81 82.76 280.50 15.68 14.00 281.31 72.32 80.35 74.92 93.65 82.36 82.76 80.35 340.00 73.52 14.00 211.96 70.71 173.83 318.75 161.54 190.10 83.16 67709292 CT LOWER EXTR W/O CONTRAST 73700 352 $572.00 211.41 95.17 " 1,774.00 " 149.07 " 1,774.00 " 113.56 " 1,774.00 " 151.67 316.03 111.39 725.00 145.19 129.63 378.61 97.34 108.15 783.02 978.77 110.85 111.39 108.15 457.60 98.96 129.63 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67909291 CT LOWER EXTR W/O CONTRAST 73700 352 $572.00 211.41 95.17 " 1,774.00 " 149.07 " 1,774.00 " 113.56 " 1,774.00 " 151.67 316.03 111.39 725.00 145.19 129.63 378.61 97.34 108.15 783.02 978.77 110.85 111.39 108.15 457.60 98.96 129.63 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80609299 CT LOWER EXTR W/O CONTRAST 73700 352 $572.00 211.41 95.17 " 1,774.00 " 149.07 " 1,774.00 " 113.56 " 1,774.00 " 151.67 316.03 111.39 725.00 145.19 129.63 378.61 97.34 108.15 783.02 978.77 110.85 111.39 108.15 457.60 98.96 129.63 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81409293 CT LOWER EXTR W/O CONTRAST 73700 352 $572.00 211.41 95.17 " 1,774.00 " 149.07 " 1,774.00 " 113.56 " 1,774.00 " 151.67 316.03 111.39 725.00 145.19 129.63 378.61 97.34 108.15 783.02 978.77 110.85 111.39 108.15 457.60 98.96 129.63 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81609292 CT LOWER EXTR W/O CONTRAST 73700 352 $572.00 211.41 95.17 " 1,774.00 " 149.07 " 1,774.00 " 113.56 " 1,774.00 " 151.67 316.03 111.39 725.00 145.19 129.63 378.61 97.34 108.15 783.02 978.77 110.85 111.39 108.15 457.60 98.96 129.63 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83009292 CT LOWER EXTR W/O CONTRAST 73700 352 $572.00 211.41 95.17 " 1,774.00 " 149.07 " 1,774.00 " 113.56 " 1,774.00 " 151.67 316.03 111.39 725.00 145.19 129.63 378.61 97.34 108.15 783.02 978.77 110.85 111.39 108.15 457.60 98.96 129.63 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67709306 CT LOWER EXTR W/CONTRAST 73701 352 $937.00 346.32 136.09 " 1,774.00 " 156.50 " 1,774.00 " 186.31 " 1,774.00 " 159.23 517.69 182.76 725.00 152.42 136.09 620.20 159.70 177.44 909.10 " 1,136.37 " 181.88 182.76 177.44 749.60 162.36 136.09 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67909305 CT LOWER EXTR W/CONTRAST 73701 352 $937.00 346.32 136.09 " 1,774.00 " 156.50 " 1,774.00 " 186.31 " 1,774.00 " 159.23 517.69 182.76 725.00 152.42 136.09 620.20 159.70 177.44 909.10 " 1,136.37 " 181.88 182.76 177.44 749.60 162.36 136.09 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80609302 CT LOWER EXTR W/CONTRAST 73701 352 $937.00 346.32 136.09 " 1,774.00 " 156.50 " 1,774.00 " 186.31 " 1,774.00 " 159.23 517.69 182.76 725.00 152.42 136.09 620.20 159.70 177.44 909.10 " 1,136.37 " 181.88 182.76 177.44 749.60 162.36 136.09 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81409307 CT LOWER EXTR W/CONTRAST 73701 352 $937.00 346.32 136.09 " 1,774.00 " 156.50 " 1,774.00 " 186.31 " 1,774.00 " 159.23 517.69 182.76 725.00 152.42 136.09 620.20 159.70 177.44 909.10 " 1,136.37 " 181.88 182.76 177.44 749.60 162.36 136.09 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81609306 CT LOWER EXTR W/CONTRAST 73701 352 $937.00 346.32 136.09 " 1,774.00 " 156.50 " 1,774.00 " 186.31 " 1,774.00 " 159.23 517.69 182.76 725.00 152.42 136.09 620.20 159.70 177.44 909.10 " 1,136.37 " 181.88 182.76 177.44 749.60 162.36 136.09 467.80 156.15 383.23 702.75 356.15 419.12 183.65 83009306 CT LOWER EXTR W/CONTRAST 73701 352 $937.00 346.32 136.09 " 1,774.00 " 156.50 " 1,774.00 " 186.31 " 1,774.00 " 159.23 517.69 182.76 725.00 152.42 136.09 620.20 159.70 177.44 909.10 " 1,136.37 " 181.88 182.76 177.44 749.60 162.36 136.09 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67709314 CT LOWER EXTR WO/W CONTRAST 73702 352 $937.00 346.32 149.05 " 1,774.00 " 171.41 " 1,774.00 " 186.31 " 1,774.00 " 174.39 517.69 182.76 725.00 166.94 149.05 620.20 159.70 177.44 " 1,099.47 " " 1,374.34 " 181.88 182.76 177.44 749.60 162.36 149.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67909313 CT LOWER EXTR WO/W CONTRAST 73702 352 $937.00 346.32 149.05 " 1,774.00 " 171.41 " 1,774.00 " 186.31 " 1,774.00 " 174.39 517.69 182.76 725.00 166.94 149.05 620.20 159.70 177.44 " 1,099.47 " " 1,374.34 " 181.88 182.76 177.44 749.60 162.36 149.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80609311 CT LOWER EXTR WO/W CONTRAST 73702 352 $937.00 346.32 149.05 " 1,774.00 " 171.41 " 1,774.00 " 186.31 " 1,774.00 " 174.39 517.69 182.76 725.00 166.94 149.05 620.20 159.70 177.44 " 1,099.47 " " 1,374.34 " 181.88 182.76 177.44 749.60 162.36 149.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81409315 CT LOWER EXTR WO/W CONTRAST 73702 352 $937.00 346.32 149.05 " 1,774.00 " 171.41 " 1,774.00 " 186.31 " 1,774.00 " 174.39 517.69 182.76 725.00 166.94 149.05 620.20 159.70 177.44 " 1,099.47 " " 1,374.34 " 181.88 182.76 177.44 749.60 162.36 149.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81609314 CT LOWER EXTR WO/W CONTRAST 73702 352 $937.00 346.32 149.05 " 1,774.00 " 171.41 " 1,774.00 " 186.31 " 1,774.00 " 174.39 517.69 182.76 725.00 166.94 149.05 620.20 159.70 177.44 " 1,099.47 " " 1,374.34 " 181.88 182.76 177.44 749.60 162.36 149.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 83009314 CT LOWER EXTR WO/W CONTRAST 73702 352 $937.00 346.32 149.05 " 1,774.00 " 171.41 " 1,774.00 " 186.31 " 1,774.00 " 174.39 517.69 182.76 725.00 166.94 149.05 620.20 159.70 177.44 " 1,099.47 " " 1,374.34 " 181.88 182.76 177.44 749.60 162.36 149.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67709730 CTA LOWER EXTR WO/W CONTRAST 73706 352 $937.00 346.32 156.15 " 1,774.00 " 318.57 " 1,774.00 " 186.31 " 1,774.00 " 324.11 517.69 182.76 725.00 310.26 277.02 620.20 159.70 177.44 " 1,239.99 " " 1,549.99 " 181.88 182.76 177.44 749.60 162.36 277.02 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67909739 CTA LOWER EXTR WO/W CONTRAST 73706 352 $937.00 346.32 156.15 " 1,774.00 " 318.57 " 1,774.00 " 186.31 " 1,774.00 " 324.11 517.69 182.76 725.00 310.26 277.02 620.20 159.70 177.44 " 1,239.99 " " 1,549.99 " 181.88 182.76 177.44 749.60 162.36 277.02 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80609736 CTA LOWER EXTR WO/W CONTRAST 73706 352 $937.00 346.32 156.15 " 1,774.00 " 318.57 " 1,774.00 " 186.31 " 1,774.00 " 324.11 517.69 182.76 725.00 310.26 277.02 620.20 159.70 177.44 " 1,239.99 " " 1,549.99 " 181.88 182.76 177.44 749.60 162.36 277.02 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81409731 CTA LOWER EXTR WO/W CONTRAST 73706 352 $937.00 346.32 156.15 " 1,774.00 " 318.57 " 1,774.00 " 186.31 " 1,774.00 " 324.11 517.69 182.76 725.00 310.26 277.02 620.20 159.70 177.44 " 1,239.99 " " 1,549.99 " 181.88 182.76 177.44 749.60 162.36 277.02 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81609730 CTA LOWER EXTR WO/W CONTRAST 73706 352 $937.00 346.32 156.15 " 1,774.00 " 318.57 " 1,774.00 " 186.31 " 1,774.00 " 324.11 517.69 182.76 725.00 310.26 277.02 620.20 159.70 177.44 " 1,239.99 " " 1,549.99 " 181.88 182.76 177.44 749.60 162.36 277.02 467.80 156.15 383.23 702.75 356.15 419.12 183.65 83009730 CTA LOWER EXTR WO/W CONTRAST 73706 352 $937.00 346.32 156.15 " 1,774.00 " 318.57 " 1,774.00 " 186.31 " 1,774.00 " 324.11 517.69 182.76 725.00 310.26 277.02 620.20 159.70 177.44 " 1,239.99 " " 1,549.99 " 181.88 182.76 177.44 749.60 162.36 277.02 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80407351 MRI LWR EXTR NO JT W/O CONT 73718 614 "$1,208.00" 446.48 201.14 " 2,882.00 " 367.14 " 2,882.00 " 240.00 " 2,882.00 " 373.52 667.42 235.43 " 1,155.00 " 357.56 319.25 799.58 205.71 228.57 " 1,266.57 " " 1,583.21 " 234.28 235.43 228.57 966.40 209.14 319.25 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81407355 MRI LWR EXTR NO JT W/O CONT 73718 614 "$1,208.00" 446.48 201.14 " 2,882.00 " 367.14 " 2,882.00 " 240.00 " 2,882.00 " 373.52 667.42 235.43 " 1,155.00 " 357.56 319.25 799.58 205.71 228.57 " 1,266.57 " " 1,583.21 " 234.28 235.43 228.57 966.40 209.14 319.25 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81607354 MRI LWR EXTR NO JT W/O CONT 73718 614 "$1,208.00" 446.48 201.14 " 2,882.00 " 367.14 " 2,882.00 " 240.00 " 2,882.00 " 373.52 667.42 235.43 " 1,155.00 " 357.56 319.25 799.58 205.71 228.57 " 1,266.57 " " 1,583.21 " 234.28 235.43 228.57 966.40 209.14 319.25 602.94 201.14 494.07 906.00 459.16 540.34 236.57 80407394 MRI LWR EXTR NO JT W/CONTRAST 73719 614 "$1,933.00" 714.44 321.90 " 2,882.00 " 440.06 " 2,882.00 " 384.09 " 2,882.00 " 447.71 " 1,067.98 " 376.77 " 1,155.00 " 428.58 382.66 " 1,279.45 " 329.22 365.80 " 1,519.15 " " 1,898.94 " 374.95 376.77 365.80 " 1,546.40 " 334.71 382.66 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81407398 MRI LWR EXTR NO JT W/CONTRAST 73719 614 "$1,933.00" 714.44 321.90 " 2,882.00 " 440.06 " 2,882.00 " 384.09 " 2,882.00 " 447.71 " 1,067.98 " 376.77 " 1,155.00 " 428.58 382.66 " 1,279.45 " 329.22 365.80 " 1,519.15 " " 1,898.94 " 374.95 376.77 365.80 " 1,546.40 " 334.71 382.66 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81607397 MRI LWR EXTR NO JT W/CONTRAST 73719 614 "$1,933.00" 714.44 321.90 " 2,882.00 " 440.06 " 2,882.00 " 384.09 " 2,882.00 " 447.71 " 1,067.98 " 376.77 " 1,155.00 " 428.58 382.66 " 1,279.45 " 329.22 365.80 " 1,519.15 " " 1,898.94 " 374.95 376.77 365.80 " 1,546.40 " 334.71 382.66 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 80407378 MRI LWR EXTR NO JT WO/W CONT 73720 614 "$1,933.00" 714.44 321.90 " 2,882.00 " 389.85 " 2,882.00 " 384.09 " 2,882.00 " 396.63 " 1,067.98 " 376.77 " 1,155.00 " 379.68 339.00 " 1,279.45 " 329.22 365.80 " 1,596.58 " " 1,995.72 " 374.95 376.77 365.80 " 1,546.40 " 334.71 339.00 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81407371 MRI LWR EXTR NO JT WO/W CONT 73720 614 "$1,933.00" 714.44 321.90 " 2,882.00 " 389.85 " 2,882.00 " 384.09 " 2,882.00 " 396.63 " 1,067.98 " 376.77 " 1,155.00 " 379.68 339.00 " 1,279.45 " 329.22 365.80 " 1,596.58 " " 1,995.72 " 374.95 376.77 365.80 " 1,546.40 " 334.71 339.00 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81607371 MRI LWR EXTR NO JT WO/W CONT 73720 614 "$1,933.00" 714.44 321.90 " 2,882.00 " 389.85 " 2,882.00 " 384.09 " 2,882.00 " 396.63 " 1,067.98 " 376.77 " 1,155.00 " 379.68 339.00 " 1,279.45 " 329.22 365.80 " 1,596.58 " " 1,995.72 " 374.95 376.77 365.80 " 1,546.40 " 334.71 339.00 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 80407360 MRI LWR EXTR JT W/O CONTRAST 73721 614 "$1,208.00" 446.48 201.14 " 2,882.00 " 381.10 " 2,882.00 " 240.00 " 2,882.00 " 387.73 667.42 235.43 " 1,155.00 " 371.16 331.39 799.58 205.71 228.57 " 1,503.14 " " 1,878.93 " 234.28 235.43 228.57 966.40 209.14 331.39 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81407363 MRI LWR EXTR JT W/O CONTRAST 73721 614 "$1,208.00" 446.48 201.14 " 2,882.00 " 381.10 " 2,882.00 " 240.00 " 2,882.00 " 387.73 667.42 235.43 " 1,155.00 " 371.16 331.39 799.58 205.71 228.57 " 1,503.14 " " 1,878.93 " 234.28 235.43 228.57 966.40 209.14 331.39 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81607362 MRI LWR EXTR JT W/O CONTRAST 73721 614 "$1,208.00" 446.48 201.14 " 2,882.00 " 381.10 " 2,882.00 " 240.00 " 2,882.00 " 387.73 667.42 235.43 " 1,155.00 " 371.16 331.39 799.58 205.71 228.57 " 1,503.14 " " 1,878.93 " 234.28 235.43 228.57 966.40 209.14 331.39 602.94 201.14 494.07 906.00 459.16 540.34 236.57 80407386 MRI LWR EXTR JT W/CONTRAST 73722 614 "$3,755.00" " 1,387.85 " 383.00 " 3,004.00 " 440.45 " 2,882.00 " 746.21 " 2,882.00 " 448.11 " 2,074.64 " 732.00 " 1,155.00 " 428.96 383.00 " 2,485.43 " 639.61 710.68 " 1,519.15 " " 1,898.94 " 728.45 732.00 710.68 " 3,004.00 " 650.27 383.00 " 1,873.77 " 625.40 " 1,535.80 " " 2,816.25 " " 1,427.28 " " 1,679.61 " 735.55 81407380 MRI LWR EXTR JT W/CONTRAST 73722 614 "$3,755.00" " 1,387.85 " 383.00 " 3,004.00 " 440.45 " 2,882.00 " 746.21 " 2,882.00 " 448.11 " 2,074.64 " 732.00 " 1,155.00 " 428.96 383.00 " 2,485.43 " 639.61 710.68 " 1,519.15 " " 1,898.94 " 728.45 732.00 710.68 " 3,004.00 " 650.27 383.00 " 1,873.77 " 625.40 " 1,535.80 " " 2,816.25 " " 1,427.28 " " 1,679.61 " 735.55 81607389 MRI LWR EXTR JT W/CONTRAST 73722 614 "$3,755.00" " 1,387.85 " 383.00 " 3,004.00 " 440.45 " 2,882.00 " 746.21 " 2,882.00 " 448.11 " 2,074.64 " 732.00 " 1,155.00 " 428.96 383.00 " 2,485.43 " 639.61 710.68 " 1,519.15 " " 1,898.94 " 728.45 732.00 710.68 " 3,004.00 " 650.27 383.00 " 1,873.77 " 625.40 " 1,535.80 " " 2,816.25 " " 1,427.28 " " 1,679.61 " 735.55 80407564 MRI LWR EXTR JT WO/W CONTRAST 73723 614 "$1,933.00" 714.44 321.90 " 3,514.26 " 658.05 " 2,882.00 " 384.09 " 2,882.00 " 669.50 " 1,067.98 " 376.77 " 1,155.00 " 640.89 572.22 " 1,279.45 " 329.22 365.80 " 2,811.41 " " 3,514.26 " 374.95 376.77 365.80 " 1,546.40 " 334.71 572.22 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81407568 MRI LWR EXTR JT WO/W CONTRAST 73723 614 "$1,933.00" 714.44 321.90 " 3,514.26 " 658.05 " 2,882.00 " 384.09 " 2,882.00 " 669.50 " 1,067.98 " 376.77 " 1,155.00 " 640.89 572.22 " 1,279.45 " 329.22 365.80 " 2,811.41 " " 3,514.26 " 374.95 376.77 365.80 " 1,546.40 " 334.71 572.22 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81607567 MRI LWR EXTR JT WO/W CONTRAST 73723 614 "$1,933.00" 714.44 321.90 " 3,514.26 " 658.05 " 2,882.00 " 384.09 " 2,882.00 " 669.50 " 1,067.98 " 376.77 " 1,155.00 " 640.89 572.22 " 1,279.45 " 329.22 365.80 " 2,811.41 " " 3,514.26 " 374.95 376.77 365.80 " 1,546.40 " 334.71 572.22 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81607664 MRA LWR EXTR WO/W CONTRAST 73725 616 "$5,901.00" " 2,181.01 " - " 4,720.80 " 482.39 " 2,882.00 " N/A " 2,882.00 " 490.78 " 3,260.30 " N/A " 1,155.00 " 469.81 N/A " 3,905.87 " - N/A " 1,635.50 " " 2,044.38 " N/A N/A N/A " 4,720.80 " N/A 419.47 777.98 N/A " 2,413.51 " " 4,425.75 " " 2,242.97 " " 2,639.52 " N/A 67936264 XR ABDOMEN 1VW 74018 320 $425.00 157.08 21.14 340.00 24.31 293.68 84.37 293.68 24.73 234.81 82.76 280.50 23.68 21.14 281.31 72.32 80.35 90.09 112.61 82.36 82.76 80.35 340.00 73.52 21.14 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80136269 XR ABDOMEN 1VW 74018 320 $425.00 157.08 21.14 340.00 24.31 293.68 84.37 293.68 24.73 234.81 82.76 280.50 23.68 21.14 281.31 72.32 80.35 90.09 112.61 82.36 82.76 80.35 340.00 73.52 21.14 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81436266 XR ABDOMEN 1VW 74018 320 $425.00 157.08 21.14 340.00 24.31 293.68 84.37 293.68 24.73 234.81 82.76 280.50 23.68 21.14 281.31 72.32 80.35 90.09 112.61 82.36 82.76 80.35 340.00 73.52 21.14 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81636265 XR ABDOMEN 1VW 74018 320 $425.00 157.08 21.14 340.00 24.31 293.68 84.37 293.68 24.73 234.81 82.76 280.50 23.68 21.14 281.31 72.32 80.35 90.09 112.61 82.36 82.76 80.35 340.00 73.52 21.14 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81736260 XR ABDOMEN 1VW 74018 320 $425.00 157.08 21.14 340.00 24.31 293.68 84.37 293.68 24.73 234.81 82.76 280.50 23.68 21.14 281.31 72.32 80.35 90.09 112.61 82.36 82.76 80.35 340.00 73.52 21.14 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82636269 XR ABDOMEN 1VW 74018 320 $425.00 157.08 21.14 340.00 24.31 293.68 84.37 293.68 24.73 234.81 82.76 280.50 23.68 21.14 281.31 72.32 80.35 90.09 112.61 82.36 82.76 80.35 340.00 73.52 21.14 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82936262 XR ABDOMEN 1VW 74018 320 $425.00 157.08 21.14 340.00 24.31 293.68 84.37 293.68 24.73 234.81 82.76 280.50 23.68 21.14 281.31 72.32 80.35 90.09 112.61 82.36 82.76 80.35 340.00 73.52 21.14 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83036265 XR ABDOMEN 1VW 74018 320 $425.00 157.08 21.14 340.00 24.31 293.68 84.37 293.68 24.73 234.81 82.76 280.50 23.68 21.14 281.31 72.32 80.35 90.09 112.61 82.36 82.76 80.35 340.00 73.52 21.14 211.96 70.71 173.83 318.75 161.54 190.10 83.16 67936272 XR ABDOMEN 2VW 74019 320 $572.00 211.41 25.82 457.60 29.69 395.25 113.56 395.25 30.21 316.03 111.39 377.52 28.92 25.82 378.61 97.34 108.15 107.72 134.65 110.85 111.39 108.15 457.60 98.96 25.82 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80136277 XR ABDOMEN 2VW 74019 320 $572.00 211.41 25.82 457.60 29.69 395.25 113.56 395.25 30.21 316.03 111.39 377.52 28.92 25.82 378.61 97.34 108.15 107.72 134.65 110.85 111.39 108.15 457.60 98.96 25.82 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81436274 XR ABDOMEN 2VW 74019 320 $572.00 211.41 25.82 457.60 29.69 395.25 113.56 395.25 30.21 316.03 111.39 377.52 28.92 25.82 378.61 97.34 108.15 107.72 134.65 110.85 111.39 108.15 457.60 98.96 25.82 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81636273 XR ABDOMEN 2VW 74019 320 $572.00 211.41 25.82 457.60 29.69 395.25 113.56 395.25 30.21 316.03 111.39 377.52 28.92 25.82 378.61 97.34 108.15 107.72 134.65 110.85 111.39 108.15 457.60 98.96 25.82 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81736278 XR ABDOMEN 2VW 74019 320 $572.00 211.41 25.82 457.60 29.69 395.25 113.56 395.25 30.21 316.03 111.39 377.52 28.92 25.82 378.61 97.34 108.15 107.72 134.65 110.85 111.39 108.15 457.60 98.96 25.82 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82636277 XR ABDOMEN 2VW 74019 320 $572.00 211.41 25.82 457.60 29.69 395.25 113.56 395.25 30.21 316.03 111.39 377.52 28.92 25.82 378.61 97.34 108.15 107.72 134.65 110.85 111.39 108.15 457.60 98.96 25.82 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82936271 XR ABDOMEN 2VW 74019 320 $572.00 211.41 25.82 457.60 29.69 395.25 113.56 395.25 30.21 316.03 111.39 377.52 28.92 25.82 378.61 97.34 108.15 107.72 134.65 110.85 111.39 108.15 457.60 98.96 25.82 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83036273 XR ABDOMEN 2VW 74019 320 $572.00 211.41 25.82 457.60 29.69 395.25 113.56 395.25 30.21 316.03 111.39 377.52 28.92 25.82 378.61 97.34 108.15 107.72 134.65 110.85 111.39 108.15 457.60 98.96 25.82 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67936281 XR ABDOMEN 3VW 74021 320 $572.00 211.41 30.23 457.60 34.76 395.25 113.56 395.25 35.37 316.03 111.39 377.52 33.86 30.23 378.61 97.34 108.15 125.35 156.69 110.85 111.39 108.15 457.60 98.96 30.23 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80136285 XR ABDOMEN 3VW 74021 320 $572.00 211.41 30.23 457.60 34.76 395.25 113.56 395.25 35.37 316.03 111.39 377.52 33.86 30.23 378.61 97.34 108.15 125.35 156.69 110.85 111.39 108.15 457.60 98.96 30.23 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81436282 XR ABDOMEN 3VW 74021 320 $572.00 211.41 30.23 457.60 34.76 395.25 113.56 395.25 35.37 316.03 111.39 377.52 33.86 30.23 378.61 97.34 108.15 125.35 156.69 110.85 111.39 108.15 457.60 98.96 30.23 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81636281 XR ABDOMEN 3VW 74021 320 $572.00 211.41 30.23 457.60 34.76 395.25 113.56 395.25 35.37 316.03 111.39 377.52 33.86 30.23 378.61 97.34 108.15 125.35 156.69 110.85 111.39 108.15 457.60 98.96 30.23 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81736286 XR ABDOMEN 3VW 74021 320 $572.00 211.41 30.23 457.60 34.76 395.25 113.56 395.25 35.37 316.03 111.39 377.52 33.86 30.23 378.61 97.34 108.15 125.35 156.69 110.85 111.39 108.15 457.60 98.96 30.23 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82636285 XR ABDOMEN 3VW 74021 320 $572.00 211.41 30.23 457.60 34.76 395.25 113.56 395.25 35.37 316.03 111.39 377.52 33.86 30.23 378.61 97.34 108.15 125.35 156.69 110.85 111.39 108.15 457.60 98.96 30.23 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82936289 XR ABDOMEN 3VW 74021 320 $572.00 211.41 30.23 457.60 34.76 395.25 113.56 395.25 35.37 316.03 111.39 377.52 33.86 30.23 378.61 97.34 108.15 125.35 156.69 110.85 111.39 108.15 457.60 98.96 30.23 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83036281 XR ABDOMEN 3VW 74021 320 $572.00 211.41 30.23 457.60 34.76 395.25 113.56 395.25 35.37 316.03 111.39 377.52 33.86 30.23 378.61 97.34 108.15 125.35 156.69 110.85 111.39 108.15 457.60 98.96 30.23 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67901479 XR CPL ABD SRS 2VW CHEST 1VW 74022 320 $572.00 211.41 38.72 457.60 44.53 395.25 113.56 395.25 45.30 316.03 111.39 377.52 43.37 38.72 378.61 97.34 108.15 145.49 181.86 110.85 111.39 108.15 457.60 98.96 38.72 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80101473 XR CPL ABD SRS 2VW CHEST 1VW 74022 320 $572.00 211.41 38.72 457.60 44.53 395.25 113.56 395.25 45.30 316.03 111.39 377.52 43.37 38.72 378.61 97.34 108.15 145.49 181.86 110.85 111.39 108.15 457.60 98.96 38.72 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81401471 XR CPL ABD SRS 2VW CHEST 1VW 74022 320 $572.00 211.41 38.72 457.60 44.53 395.25 113.56 395.25 45.30 316.03 111.39 377.52 43.37 38.72 378.61 97.34 108.15 145.49 181.86 110.85 111.39 108.15 457.60 98.96 38.72 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81601470 XR CPL ABD SRS 2VW CHEST 1VW 74022 320 $572.00 211.41 38.72 457.60 44.53 395.25 113.56 395.25 45.30 316.03 111.39 377.52 43.37 38.72 378.61 97.34 108.15 145.49 181.86 110.85 111.39 108.15 457.60 98.96 38.72 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81701474 XR CPL ABD SRS 2VW CHEST 1VW 74022 320 $572.00 211.41 38.72 457.60 44.53 395.25 113.56 395.25 45.30 316.03 111.39 377.52 43.37 38.72 378.61 97.34 108.15 145.49 181.86 110.85 111.39 108.15 457.60 98.96 38.72 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82601473 XR CPL ABD SRS 2VW CHEST 1VW 74022 320 $572.00 211.41 38.72 457.60 44.53 395.25 113.56 395.25 45.30 316.03 111.39 377.52 43.37 38.72 378.61 97.34 108.15 145.49 181.86 110.85 111.39 108.15 457.60 98.96 38.72 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82901477 XR CPL ABD SRS 2VW CHEST 1VW 74022 320 $572.00 211.41 38.72 457.60 44.53 395.25 113.56 395.25 45.30 316.03 111.39 377.52 43.37 38.72 378.61 97.34 108.15 145.49 181.86 110.85 111.39 108.15 457.60 98.96 38.72 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83001470 XR CPL ABD SRS 2VW CHEST 1VW 74022 320 $572.00 211.41 38.72 457.60 44.53 395.25 113.56 395.25 45.30 316.03 111.39 377.52 43.37 38.72 378.61 97.34 108.15 145.49 181.86 110.85 111.39 108.15 457.60 98.96 38.72 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67709322 CT ABDOMEN W/O CONTRAST 74150 352 $572.00 211.41 95.17 " 1,774.00 " 148.35 " 1,774.00 " 113.56 " 1,774.00 " 150.93 316.03 111.39 725.00 144.48 129.00 378.61 97.34 108.15 884.46 " 1,105.57 " 110.85 111.39 108.15 457.60 98.96 129.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67909321 CT ABDOMEN W/O CONTRAST 74150 352 $572.00 211.41 95.17 " 1,774.00 " 148.35 " 1,774.00 " 113.56 " 1,774.00 " 150.93 316.03 111.39 725.00 144.48 129.00 378.61 97.34 108.15 884.46 " 1,105.57 " 110.85 111.39 108.15 457.60 98.96 129.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80609329 CT ABDOMEN W/O CONTRAST 74150 352 $572.00 211.41 95.17 " 1,774.00 " 148.35 " 1,774.00 " 113.56 " 1,774.00 " 150.93 316.03 111.39 725.00 144.48 129.00 378.61 97.34 108.15 884.46 " 1,105.57 " 110.85 111.39 108.15 457.60 98.96 129.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81409323 CT ABDOMEN W/O CONTRAST 74150 352 $572.00 211.41 95.17 " 1,774.00 " 148.35 " 1,774.00 " 113.56 " 1,774.00 " 150.93 316.03 111.39 725.00 144.48 129.00 378.61 97.34 108.15 884.46 " 1,105.57 " 110.85 111.39 108.15 457.60 98.96 129.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81609322 CT ABDOMEN W/O CONTRAST 74150 352 $572.00 211.41 95.17 " 1,774.00 " 148.35 " 1,774.00 " 113.56 " 1,774.00 " 150.93 316.03 111.39 725.00 144.48 129.00 378.61 97.34 108.15 884.46 " 1,105.57 " 110.85 111.39 108.15 457.60 98.96 129.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83009322 CT ABDOMEN W/O CONTRAST 74150 352 $572.00 211.41 95.17 " 1,774.00 " 148.35 " 1,774.00 " 113.56 " 1,774.00 " 150.93 316.03 111.39 725.00 144.48 129.00 378.61 97.34 108.15 884.46 " 1,105.57 " 110.85 111.39 108.15 457.60 98.96 129.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67709331 CT ABDOMEN W/CONTRAST 74160 352 $937.00 346.32 149.05 " 1,774.00 " 171.41 " 1,774.00 " 186.31 " 1,774.00 " 174.39 517.69 182.76 725.00 166.94 149.05 620.20 159.70 177.44 " 1,039.42 " " 1,299.27 " 181.88 182.76 177.44 749.60 162.36 149.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67909330 CT ABDOMEN W/CONTRAST 74160 352 $937.00 346.32 149.05 " 1,774.00 " 171.41 " 1,774.00 " 186.31 " 1,774.00 " 174.39 517.69 182.76 725.00 166.94 149.05 620.20 159.70 177.44 " 1,039.42 " " 1,299.27 " 181.88 182.76 177.44 749.60 162.36 149.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80609337 CT ABDOMEN W/CONTRAST 74160 352 $937.00 346.32 149.05 " 1,774.00 " 171.41 " 1,774.00 " 186.31 " 1,774.00 " 174.39 517.69 182.76 725.00 166.94 149.05 620.20 159.70 177.44 " 1,039.42 " " 1,299.27 " 181.88 182.76 177.44 749.60 162.36 149.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81409331 CT ABDOMEN W/CONTRAST 74160 352 $937.00 346.32 149.05 " 1,774.00 " 171.41 " 1,774.00 " 186.31 " 1,774.00 " 174.39 517.69 182.76 725.00 166.94 149.05 620.20 159.70 177.44 " 1,039.42 " " 1,299.27 " 181.88 182.76 177.44 749.60 162.36 149.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81609331 CT ABDOMEN W/CONTRAST 74160 352 $937.00 346.32 149.05 " 1,774.00 " 171.41 " 1,774.00 " 186.31 " 1,774.00 " 174.39 517.69 182.76 725.00 166.94 149.05 620.20 159.70 177.44 " 1,039.42 " " 1,299.27 " 181.88 182.76 177.44 749.60 162.36 149.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 83009331 CT ABDOMEN W/CONTRAST 74160 352 $937.00 346.32 149.05 " 1,774.00 " 171.41 " 1,774.00 " 186.31 " 1,774.00 " 174.39 517.69 182.76 725.00 166.94 149.05 620.20 159.70 177.44 " 1,039.42 " " 1,299.27 " 181.88 182.76 177.44 749.60 162.36 149.05 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67709349 CT ABDOMEN WO/W CONTRAST 74170 352 $937.00 346.32 156.15 " 1,774.00 " 202.94 " 1,774.00 " 186.31 " 1,774.00 " 206.47 517.69 182.76 725.00 197.65 176.47 620.20 159.70 177.44 " 1,257.78 " " 1,572.23 " 181.88 182.76 177.44 749.60 162.36 176.47 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67909348 CT ABDOMEN WO/W CONTRAST 74170 352 $937.00 346.32 156.15 " 1,774.00 " 202.94 " 1,774.00 " 186.31 " 1,774.00 " 206.47 517.69 182.76 725.00 197.65 176.47 620.20 159.70 177.44 " 1,257.78 " " 1,572.23 " 181.88 182.76 177.44 749.60 162.36 176.47 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80609345 CT ABDOMEN WO/W CONTRAST 74170 352 $937.00 346.32 156.15 " 1,774.00 " 202.94 " 1,774.00 " 186.31 " 1,774.00 " 206.47 517.69 182.76 725.00 197.65 176.47 620.20 159.70 177.44 " 1,257.78 " " 1,572.23 " 181.88 182.76 177.44 749.60 162.36 176.47 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81409340 CT ABDOMEN WO/W CONTRAST 74170 352 $937.00 346.32 156.15 " 1,774.00 " 202.94 " 1,774.00 " 186.31 " 1,774.00 " 206.47 517.69 182.76 725.00 197.65 176.47 620.20 159.70 177.44 " 1,257.78 " " 1,572.23 " 181.88 182.76 177.44 749.60 162.36 176.47 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81609349 CT ABDOMEN WO/W CONTRAST 74170 352 $937.00 346.32 156.15 " 1,774.00 " 202.94 " 1,774.00 " 186.31 " 1,774.00 " 206.47 517.69 182.76 725.00 197.65 176.47 620.20 159.70 177.44 " 1,257.78 " " 1,572.23 " 181.88 182.76 177.44 749.60 162.36 176.47 467.80 156.15 383.23 702.75 356.15 419.12 183.65 83009349 CT ABDOMEN WO/W CONTRAST 74170 352 $937.00 346.32 156.15 " 1,774.00 " 202.94 " 1,774.00 " 186.31 " 1,774.00 " 206.47 517.69 182.76 725.00 197.65 176.47 620.20 159.70 177.44 " 1,257.78 " " 1,572.23 " 181.88 182.76 177.44 749.60 162.36 176.47 467.80 156.15 383.23 702.75 356.15 419.12 183.65 53941061 CTA ABDOMEN & PELVIS 74174 350 "$1,933.00" 714.44 321.90 " 2,543.28 " 479.30 " 1,774.00 " 384.09 " 1,774.00 " 487.63 " 1,067.98 " 376.77 725.00 466.79 416.78 " 1,279.45 " 329.22 365.80 " 2,034.62 " " 2,543.28 " 374.95 376.77 365.80 " 1,546.40 " 334.71 416.78 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 67741064 CTA ABDOMEN & PELVIS 74174 352 "$1,933.00" 714.44 321.90 " 2,543.28 " 479.30 " 1,774.00 " 384.09 " 1,774.00 " 487.63 " 1,067.98 " 376.77 725.00 466.79 416.78 " 1,279.45 " 329.22 365.80 " 2,034.62 " " 2,543.28 " 374.95 376.77 365.80 " 1,546.40 " 334.71 416.78 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 67941063 CTA ABDOMEN & PELVIS 74174 352 "$1,933.00" 714.44 321.90 " 2,543.28 " 479.30 " 1,774.00 " 384.09 " 1,774.00 " 487.63 " 1,067.98 " 376.77 725.00 466.79 416.78 " 1,279.45 " 329.22 365.80 " 2,034.62 " " 2,543.28 " 374.95 376.77 365.80 " 1,546.40 " 334.71 416.78 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 80641061 CTA ABDOMEN & PELVIS 74174 352 "$1,933.00" 714.44 321.90 " 2,543.28 " 479.30 " 1,774.00 " 384.09 " 1,774.00 " 487.63 " 1,067.98 " 376.77 725.00 466.79 416.78 " 1,279.45 " 329.22 365.80 " 2,034.62 " " 2,543.28 " 374.95 376.77 365.80 " 1,546.40 " 334.71 416.78 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81441065 CTA ABDOMEN & PELVIS 74174 352 "$1,933.00" 714.44 321.90 " 2,543.28 " 479.30 " 1,774.00 " 384.09 " 1,774.00 " 487.63 " 1,067.98 " 376.77 725.00 466.79 416.78 " 1,279.45 " 329.22 365.80 " 2,034.62 " " 2,543.28 " 374.95 376.77 365.80 " 1,546.40 " 334.71 416.78 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81641064 CTA ABDOMEN & PELVIS 74174 352 "$1,933.00" 714.44 321.90 " 2,543.28 " 479.30 " 1,774.00 " 384.09 " 1,774.00 " 487.63 " 1,067.98 " 376.77 725.00 466.79 416.78 " 1,279.45 " 329.22 365.80 " 2,034.62 " " 2,543.28 " 374.95 376.77 365.80 " 1,546.40 " 334.71 416.78 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 83041064 CTA ABDOMEN & PELVIS 74174 352 "$1,933.00" 714.44 321.90 " 2,543.28 " 479.30 " 1,774.00 " 384.09 " 1,774.00 " 487.63 " 1,067.98 " 376.77 725.00 466.79 416.78 " 1,279.45 " 329.22 365.80 " 2,034.62 " " 2,543.28 " 374.95 376.77 365.80 " 1,546.40 " 334.71 416.78 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 67709748 CTA ABDOMEN WO/W CONTRAST 74175 352 $937.00 346.32 156.15 " 1,774.00 " 342.60 " 1,774.00 " 186.31 " 1,774.00 " 348.55 517.69 182.76 725.00 333.66 297.91 620.20 159.70 177.44 " 1,356.40 " " 1,695.50 " 181.88 182.76 177.44 749.60 162.36 297.91 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67909747 CTA ABDOMEN WO/W CONTRAST 74175 352 $937.00 346.32 156.15 " 1,774.00 " 342.60 " 1,774.00 " 186.31 " 1,774.00 " 348.55 517.69 182.76 725.00 333.66 297.91 620.20 159.70 177.44 " 1,356.40 " " 1,695.50 " 181.88 182.76 177.44 749.60 162.36 297.91 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80609744 CTA ABDOMEN WO/W CONTRAST 74175 352 $937.00 346.32 156.15 " 1,774.00 " 342.60 " 1,774.00 " 186.31 " 1,774.00 " 348.55 517.69 182.76 725.00 333.66 297.91 620.20 159.70 177.44 " 1,356.40 " " 1,695.50 " 181.88 182.76 177.44 749.60 162.36 297.91 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81409749 CTA ABDOMEN WO/W CONTRAST 74175 352 $937.00 346.32 156.15 " 1,774.00 " 342.60 " 1,774.00 " 186.31 " 1,774.00 " 348.55 517.69 182.76 725.00 333.66 297.91 620.20 159.70 177.44 " 1,356.40 " " 1,695.50 " 181.88 182.76 177.44 749.60 162.36 297.91 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81609748 CTA ABDOMEN WO/W CONTRAST 74175 352 $937.00 346.32 156.15 " 1,774.00 " 342.60 " 1,774.00 " 186.31 " 1,774.00 " 348.55 517.69 182.76 725.00 333.66 297.91 620.20 159.70 177.44 " 1,356.40 " " 1,695.50 " 181.88 182.76 177.44 749.60 162.36 297.91 467.80 156.15 383.23 702.75 356.15 419.12 183.65 83009748 CTA ABDOMEN WO/W CONTRAST 74175 352 $937.00 346.32 156.15 " 1,774.00 " 342.60 " 1,774.00 " 186.31 " 1,774.00 " 348.55 517.69 182.76 725.00 333.66 297.91 620.20 159.70 177.44 " 1,356.40 " " 1,695.50 " 181.88 182.76 177.44 749.60 162.36 297.91 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67741013 CT ABDOMEN & PELVIS W/O CONT 74176 352 "$1,208.00" 446.48 168.29 " 1,774.00 " 193.53 " 1,774.00 " 240.00 " 1,774.00 " 196.90 667.42 235.43 725.00 188.48 168.29 799.58 205.71 228.57 " 1,335.42 " " 1,669.27 " 234.28 235.43 228.57 966.40 209.14 168.29 602.94 201.14 494.07 906.00 459.16 540.34 236.57 67941012 CT ABDOMEN & PELVIS W/O CONT 74176 352 "$1,208.00" 446.48 168.29 " 1,774.00 " 193.53 " 1,774.00 " 240.00 " 1,774.00 " 196.90 667.42 235.43 725.00 188.48 168.29 799.58 205.71 228.57 " 1,335.42 " " 1,669.27 " 234.28 235.43 228.57 966.40 209.14 168.29 602.94 201.14 494.07 906.00 459.16 540.34 236.57 80641010 CT ABDOMEN & PELVIS W/O CONT 74176 352 "$1,208.00" 446.48 168.29 " 1,774.00 " 193.53 " 1,774.00 " 240.00 " 1,774.00 " 196.90 667.42 235.43 725.00 188.48 168.29 799.58 205.71 228.57 " 1,335.42 " " 1,669.27 " 234.28 235.43 228.57 966.40 209.14 168.29 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81441014 CT ABDOMEN & PELVIS W/O CONT 74176 352 "$1,208.00" 446.48 168.29 " 1,774.00 " 193.53 " 1,774.00 " 240.00 " 1,774.00 " 196.90 667.42 235.43 725.00 188.48 168.29 799.58 205.71 228.57 " 1,335.42 " " 1,669.27 " 234.28 235.43 228.57 966.40 209.14 168.29 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81641013 CT ABDOMEN & PELVIS W/O CONT 74176 352 "$1,208.00" 446.48 168.29 " 1,774.00 " 193.53 " 1,774.00 " 240.00 " 1,774.00 " 196.90 667.42 235.43 725.00 188.48 168.29 799.58 205.71 228.57 " 1,335.42 " " 1,669.27 " 234.28 235.43 228.57 966.40 209.14 168.29 602.94 201.14 494.07 906.00 459.16 540.34 236.57 83041013 CT ABDOMEN & PELVIS W/O CONT 74176 352 "$1,208.00" 446.48 168.29 " 1,774.00 " 193.53 " 1,774.00 " 240.00 " 1,774.00 " 196.90 667.42 235.43 725.00 188.48 168.29 799.58 205.71 228.57 " 1,335.42 " " 1,669.27 " 234.28 235.43 228.57 966.40 209.14 168.29 602.94 201.14 494.07 906.00 459.16 540.34 236.57 67741021 CT ABDOMEN & PELVIS W/CONTRAST 74177 352 "$1,933.00" 714.44 263.16 " 1,930.20 " 302.63 " 1,774.00 " 384.09 " 1,774.00 " 307.90 " 1,067.98 " 376.77 725.00 294.74 263.16 " 1,279.45 " 329.22 365.80 " 1,544.16 " " 1,930.20 " 374.95 376.77 365.80 " 1,546.40 " 334.71 263.16 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 67941021 CT ABDOMEN & PELVIS W/CONTRAST 74177 352 "$1,933.00" 714.44 263.16 " 1,930.20 " 302.63 " 1,774.00 " 384.09 " 1,774.00 " 307.90 " 1,067.98 " 376.77 725.00 294.74 263.16 " 1,279.45 " 329.22 365.80 " 1,544.16 " " 1,930.20 " 374.95 376.77 365.80 " 1,546.40 " 334.71 263.16 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 80641028 CT ABDOMEN & PELVIS W/CONTRAST 74177 352 "$1,933.00" 714.44 263.16 " 1,930.20 " 302.63 " 1,774.00 " 384.09 " 1,774.00 " 307.90 " 1,067.98 " 376.77 725.00 294.74 263.16 " 1,279.45 " 329.22 365.80 " 1,544.16 " " 1,930.20 " 374.95 376.77 365.80 " 1,546.40 " 334.71 263.16 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81441022 CT ABDOMEN & PELVIS W/CONTRAST 74177 352 "$1,933.00" 714.44 263.16 " 1,930.20 " 302.63 " 1,774.00 " 384.09 " 1,774.00 " 307.90 " 1,067.98 " 376.77 725.00 294.74 263.16 " 1,279.45 " 329.22 365.80 " 1,544.16 " " 1,930.20 " 374.95 376.77 365.80 " 1,546.40 " 334.71 263.16 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81641021 CT ABDOMEN & PELVIS W/CONTRAST 74177 352 "$1,933.00" 714.44 263.16 " 1,930.20 " 302.63 " 1,774.00 " 384.09 " 1,774.00 " 307.90 " 1,067.98 " 376.77 725.00 294.74 263.16 " 1,279.45 " 329.22 365.80 " 1,544.16 " " 1,930.20 " 374.95 376.77 365.80 " 1,546.40 " 334.71 263.16 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 83041021 CT ABDOMEN & PELVIS W/CONTRAST 74177 352 "$1,933.00" 714.44 263.16 " 1,930.20 " 302.63 " 1,774.00 " 384.09 " 1,774.00 " 307.90 " 1,067.98 " 376.77 725.00 294.74 263.16 " 1,279.45 " 329.22 365.80 " 1,544.16 " " 1,930.20 " 374.95 376.77 365.80 " 1,546.40 " 334.71 263.16 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 67741030 CT ABDOMEN & PELVIS WO/W CONT 74178 352 "$1,933.00" 714.44 321.90 " 2,326.36 " 382.63 " 1,774.00 " 384.09 " 1,774.00 " 389.28 " 1,067.98 " 376.77 725.00 372.65 332.72 " 1,279.45 " 329.22 365.80 " 1,861.09 " " 2,326.36 " 374.95 376.77 365.80 " 1,546.40 " 334.71 332.72 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 67941039 CT ABDOMEN & PELVIS WO/W CONT 74178 352 "$1,933.00" 714.44 321.90 " 2,326.36 " 382.63 " 1,774.00 " 384.09 " 1,774.00 " 389.28 " 1,067.98 " 376.77 725.00 372.65 332.72 " 1,279.45 " 329.22 365.80 " 1,861.09 " " 2,326.36 " 374.95 376.77 365.80 " 1,546.40 " 334.71 332.72 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 80641036 CT ABDOMEN & PELVIS WO/W CONT 74178 352 "$1,933.00" 714.44 321.90 " 2,326.36 " 382.63 " 1,774.00 " 384.09 " 1,774.00 " 389.28 " 1,067.98 " 376.77 725.00 372.65 332.72 " 1,279.45 " 329.22 365.80 " 1,861.09 " " 2,326.36 " 374.95 376.77 365.80 " 1,546.40 " 334.71 332.72 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81441031 CT ABDOMEN & PELVIS WO/W CONT 74178 352 "$1,933.00" 714.44 321.90 " 2,326.36 " 382.63 " 1,774.00 " 384.09 " 1,774.00 " 389.28 " 1,067.98 " 376.77 725.00 372.65 332.72 " 1,279.45 " 329.22 365.80 " 1,861.09 " " 2,326.36 " 374.95 376.77 365.80 " 1,546.40 " 334.71 332.72 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81641030 CT ABDOMEN & PELVIS WO/W CONT 74178 352 "$1,933.00" 714.44 321.90 " 2,326.36 " 382.63 " 1,774.00 " 384.09 " 1,774.00 " 389.28 " 1,067.98 " 376.77 725.00 372.65 332.72 " 1,279.45 " 329.22 365.80 " 1,861.09 " " 2,326.36 " 374.95 376.77 365.80 " 1,546.40 " 334.71 332.72 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 83041030 CT ABDOMEN & PELVIS WO/W CONT 74178 352 "$1,933.00" 714.44 321.90 " 2,326.36 " 382.63 " 1,774.00 " 384.09 " 1,774.00 " 389.28 " 1,067.98 " 376.77 725.00 372.65 332.72 " 1,279.45 " 329.22 365.80 " 1,861.09 " " 2,326.36 " 374.95 376.77 365.80 " 1,546.40 " 334.71 332.72 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 80407424 MRI ABDOMEN W/O CONTRAST 74181 614 "$1,208.00" 446.48 201.14 " 2,882.00 " 386.64 " 2,882.00 " 240.00 " 2,882.00 " 393.37 667.42 235.43 " 1,155.00 " 376.56 336.21 799.58 205.71 228.57 " 1,618.82 " " 2,023.52 " 234.28 235.43 228.57 966.40 209.14 336.21 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81407428 MRI ABDOMEN W/O CONTRAST 74181 614 "$1,208.00" 446.48 201.14 " 2,882.00 " 386.64 " 2,882.00 " 240.00 " 2,882.00 " 393.37 667.42 235.43 " 1,155.00 " 376.56 336.21 799.58 205.71 228.57 " 1,618.82 " " 2,023.52 " 234.28 235.43 228.57 966.40 209.14 336.21 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81607427 MRI ABDOMEN W/O CONTRAST 74181 614 "$1,208.00" 446.48 201.14 " 2,882.00 " 386.64 " 2,882.00 " 240.00 " 2,882.00 " 393.37 667.42 235.43 " 1,155.00 " 376.56 336.21 799.58 205.71 228.57 " 1,618.82 " " 2,023.52 " 234.28 235.43 228.57 966.40 209.14 336.21 602.94 201.14 494.07 906.00 459.16 540.34 236.57 80407432 MRI ABDOMEN W/CONTRAST 74182 614 "$1,933.00" 714.44 321.90 " 2,882.00 " 451.46 " 2,882.00 " 384.09 " 2,882.00 " 459.31 " 1,067.98 " 376.77 " 1,155.00 " 439.68 392.57 " 1,279.45 " 329.22 365.80 " 1,522.82 " " 1,903.52 " 374.95 376.77 365.80 " 1,546.40 " 334.71 392.57 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81407436 MRI ABDOMEN W/CONTRAST 74182 614 "$1,933.00" 714.44 321.90 " 2,882.00 " 451.46 " 2,882.00 " 384.09 " 2,882.00 " 459.31 " 1,067.98 " 376.77 " 1,155.00 " 439.68 392.57 " 1,279.45 " 329.22 365.80 " 1,522.82 " " 1,903.52 " 374.95 376.77 365.80 " 1,546.40 " 334.71 392.57 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81607435 MRI ABDOMEN W/CONTRAST 74182 614 "$1,933.00" 714.44 321.90 " 2,882.00 " 451.46 " 2,882.00 " 384.09 " 2,882.00 " 459.31 " 1,067.98 " 376.77 " 1,155.00 " 439.68 392.57 " 1,279.45 " 329.22 365.80 " 1,522.82 " " 1,903.52 " 374.95 376.77 365.80 " 1,546.40 " 334.71 392.57 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 80407416 MRI ABDOMEN WO/W CONTRAST 74183 614 "$1,933.00" 714.44 321.90 " 3,521.19 " 663.40 " 2,882.00 " 384.09 " 2,882.00 " 674.94 " 1,067.98 " 376.77 " 1,155.00 " 646.09 576.87 " 1,279.45 " 329.22 365.80 " 2,816.95 " " 3,521.19 " 374.95 376.77 365.80 " 1,546.40 " 334.71 576.87 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81407410 MRI ABDOMEN WO/W CONTRAST 74183 614 "$1,933.00" 714.44 321.90 " 3,521.19 " 663.40 " 2,882.00 " 384.09 " 2,882.00 " 674.94 " 1,067.98 " 376.77 " 1,155.00 " 646.09 576.87 " 1,279.45 " 329.22 365.80 " 2,816.95 " " 3,521.19 " 374.95 376.77 365.80 " 1,546.40 " 334.71 576.87 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81607419 MRI ABDOMEN WO/W CONTRAST 74183 614 "$1,933.00" 714.44 321.90 " 3,521.19 " 663.40 " 2,882.00 " 384.09 " 2,882.00 " 674.94 " 1,067.98 " 376.77 " 1,155.00 " 646.09 576.87 " 1,279.45 " 329.22 365.80 " 2,816.95 " " 3,521.19 " 374.95 376.77 365.80 " 1,546.40 " 334.71 576.87 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 80326122 XR PERITONEOGRAM 74190 320 "$2,535.00" 936.94 53.69 " 2,028.00 " 61.74 " 1,751.69 " 503.98 " 1,751.69 " 62.82 " 1,400.59 " 494.38 " 1,673.10 " 60.13 53.69 " 1,677.92 " 431.98 479.98 228.46 285.58 491.98 494.38 479.98 " 2,028.00 " 439.18 53.69 " 1,265.17 " 422.38 " 1,036.82 " " 1,901.25 " 963.55 " 1,133.91 " 496.78 80100868 XR ESOPHAGUS SINGLE CONTRAST 74220 320 $937.00 346.32 37.50 749.60 43.13 647.47 186.31 647.47 43.88 517.69 182.76 618.42 42.00 37.50 620.20 159.70 177.44 222.66 278.32 181.88 182.76 177.44 749.60 162.36 37.50 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80136862 XR ESOPHAGUS DOUBLE CONTRAST 74221 320 $937.00 346.32 84.08 749.60 96.69 647.47 186.31 647.47 98.37 517.69 182.76 618.42 94.17 84.08 620.20 159.70 177.44 366.26 457.83 181.88 182.76 177.44 749.60 162.36 84.08 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80100876 XR CINE/VID THROAT/ESOPHAGUS 74230 320 $937.00 346.32 46.00 749.60 52.90 647.47 186.31 647.47 53.82 517.69 182.76 618.42 51.52 46.00 620.20 159.70 177.44 251.12 313.90 181.88 182.76 177.44 749.60 162.36 46.00 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80100884 XR UPPER GI DELAY SGL CONTRAST 74240 320 $937.00 346.32 65.00 749.60 74.75 647.47 186.31 647.47 76.05 517.69 182.76 618.42 72.80 65.00 620.20 159.70 177.44 297.89 372.36 181.88 182.76 177.44 749.60 162.36 65.00 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80100906 XR UPPER GI DELAY DBL CONTRAST 74246 320 $937.00 346.32 66.50 749.60 76.48 647.47 186.31 647.47 77.81 517.69 182.76 618.42 74.48 66.50 620.20 159.70 177.44 320.22 400.28 181.88 182.76 177.44 749.60 162.36 66.50 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80136854 XR SMALL INTESTINE FOLLOWTHRU 74248 320 $328.00 121.23 - 294.15 73.67 226.65 - 226.65 74.95 181.22 - 216.48 71.75 64.06 217.10 - - 235.32 294.15 - - - 262.40 - 64.06 137.13 - 134.15 246.00 124.67 146.71 - 80100922 XR SMALL BOWEL SINGLE CONTRAST 74250 320 $937.00 346.32 37.50 749.60 43.13 647.47 186.31 647.47 43.88 517.69 182.76 618.42 42.00 37.50 620.20 159.70 177.44 238.09 297.61 181.88 182.76 177.44 749.60 162.36 37.50 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80609833 CT COLONOGRAPHY DX W/O CONT 74261 350 $572.00 211.41 - " 1,774.00 " - " 1,774.00 " 113.56 " 1,774.00 " - 316.03 111.39 725.00 - - 378.61 97.34 108.15 944.98 " 1,181.23 " 110.85 111.39 108.15 457.60 98.96 - 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81409838 CT COLONOGRAPHY DX W/O CONT 74261 350 $572.00 211.41 - " 1,774.00 " - " 1,774.00 " 113.56 " 1,774.00 " - 316.03 111.39 725.00 - - 378.61 97.34 108.15 944.98 " 1,181.23 " 110.85 111.39 108.15 457.60 98.96 - 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81609837 CT COLONOGRAPHY DX W/O CONT 74261 350 $572.00 211.41 - " 1,774.00 " - " 1,774.00 " 113.56 " 1,774.00 " - 316.03 111.39 725.00 - - 378.61 97.34 108.15 944.98 " 1,181.23 " 110.85 111.39 108.15 457.60 98.96 - 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80641052 CT COLONOGRAPHY DX W/CONT 74262 350 $937.00 346.32 - " 1,796.79 " - " 1,774.00 " 186.31 " 1,774.00 " - 517.69 182.76 725.00 - - 620.20 159.70 177.44 " 1,437.43 " " 1,796.79 " 181.88 182.76 177.44 749.60 162.36 - 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81441057 CT COLONOGRAPHY DX W/CONT 74262 350 $937.00 346.32 - " 1,796.79 " - " 1,774.00 " 186.31 " 1,774.00 " - 517.69 182.76 725.00 - - 620.20 159.70 177.44 " 1,437.43 " " 1,796.79 " 181.88 182.76 177.44 749.60 162.36 - 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81641056 CT COLONOGRAPHY DX W/CONT 74262 350 $937.00 346.32 - " 1,796.79 " - " 1,774.00 " 186.31 " 1,774.00 " - 517.69 182.76 725.00 - - 620.20 159.70 177.44 " 1,437.43 " " 1,796.79 " 181.88 182.76 177.44 749.60 162.36 - 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80609825 CT COLONOGRAPHY SCREENING 74263 350 "$2,444.00" 903.30 - " 3,569.19 " - " 1,774.00 " N/A " 1,774.00 " - " 1,350.31 " N/A 725.00 - N/A " 1,617.68 " - N/A " 2,855.35 " " 3,569.19 " N/A N/A N/A " 1,955.20 " N/A - " 1,731.51 " N/A 999.60 " 1,833.00 " 928.96 " 1,093.20 " N/A 81409820 CT COLONOGRAPHY SCREENING 74263 350 "$2,444.00" 903.30 - " 3,569.19 " - " 1,774.00 " N/A " 1,774.00 " - " 1,350.31 " N/A 725.00 - N/A " 1,617.68 " - N/A " 2,855.35 " " 3,569.19 " N/A N/A N/A " 1,955.20 " N/A - " 1,731.51 " N/A 999.60 " 1,833.00 " 928.96 " 1,093.20 " N/A 81609829 CT COLONOGRAPHY SCREENING 74263 350 "$2,444.00" 903.30 - " 3,569.19 " - " 1,774.00 " N/A " 1,774.00 " - " 1,350.31 " N/A 725.00 - N/A " 1,617.68 " - N/A " 2,855.35 " " 3,569.19 " N/A N/A N/A " 1,955.20 " N/A - " 1,731.51 " N/A 999.60 " 1,833.00 " 928.96 " 1,093.20 " N/A 80100949 XR COLON ENEMA SGL CONTRAST 74270 320 $937.00 346.32 37.50 749.60 43.13 647.47 186.31 647.47 43.88 517.69 182.76 618.42 42.00 37.50 620.20 159.70 177.44 327.55 409.44 181.88 182.76 177.44 749.60 162.36 37.50 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80100957 XR COLON HD BARIUM DBL CONT 74280 320 $937.00 346.32 65.00 749.60 74.75 647.47 186.31 647.47 76.05 517.69 182.76 618.42 72.80 65.00 620.20 159.70 177.44 443.43 554.29 181.88 182.76 177.44 749.60 162.36 65.00 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80100981 XR BILE DUCTS/PANCREAS 74300 320 "$2,815.00" " 1,040.42 " - " 2,252.00 " - " 1,945.17 " - " 1,945.17 " - " 1,555.29 " - " 1,857.90 " - - " 1,863.25 " - - 157.31 196.64 - - - " 2,252.00 " - - " 1,886.05 " - " 1,151.34 " " 2,111.25 " " 1,069.98 " " 1,259.15 " - 80100990 XR SURGERY ADD-ON 74301 320 $40.00 14.78 - 163.49 - 27.64 - 27.64 - 22.10 - 26.40 - - 26.48 - - 130.79 163.49 - - - 32.00 - - 26.80 - 16.36 30.00 15.20 17.89 - 80129149 XR BILE ENDOSCOPY 74328 320 "$1,426.00" 527.05 - " 1,140.80 " - 985.37 - 985.37 - 787.87 - 941.16 - - 943.87 - - 500.25 625.31 - - - " 1,140.80 " - - 955.42 - 583.23 " 1,069.50 " 542.02 637.85 - 80129157 XR PANCREAS ENDOSCOPY 74329 320 "$2,151.00" 795.01 - " 1,720.80 " - " 1,486.34 " - " 1,486.34 " - " 1,188.43 " - " 1,419.66 " - - " 1,423.75 " - - 500.25 625.31 - - - " 1,720.80 " - - " 1,441.17 " - 879.76 " 1,613.25 " 817.60 962.14 - 80101015 XR BILE/PANCREAS ENDOSCOPY 74330 320 $175.00 64.68 - 625.31 - 120.93 - 120.93 - 96.69 - 115.50 - - 115.83 - - 500.25 625.31 - - - 140.00 - - 117.25 - 71.58 131.25 66.52 78.28 - 80301022 XR GUID GI TUBE 74340 320 $380.00 140.45 - 514.40 - 262.58 - 262.58 - 209.95 - 250.80 - - 251.52 - - 411.52 514.40 - - - 304.00 - - 254.60 - 155.42 285.00 144.44 169.97 - 80101031 XR GUID GI DILATION 74360 320 "$1,053.00" 389.19 - 842.40 124.65 727.62 - 727.62 126.82 581.78 - 694.98 121.40 108.39 696.98 - - 472.26 590.32 - - - 842.40 - 108.39 705.51 - 430.68 789.75 400.25 471.01 - 80301031 XR GUID GI DILATION 74360 320 "$1,053.00" 389.19 - 842.40 124.65 727.62 - 727.62 126.82 581.78 - 694.98 121.40 108.39 696.98 - - 472.26 590.32 - - - 842.40 - 108.39 705.51 - 430.68 789.75 400.25 471.01 - 80306008 XR BILE DUCT DILATION 74363 320 "$1,054.00" 389.56 - " 1,104.46 " 154.62 728.31 - 728.31 157.31 582.34 - 695.64 150.58 134.45 697.64 - - 883.57 " 1,104.46 " - - - 843.20 - 134.45 706.18 - 431.09 790.50 400.63 471.45 - 80101040 XR CONT UROGRAPHY IV WO/W KUB 74400 320 $937.00 346.32 46.50 749.60 53.48 647.47 186.31 647.47 54.41 517.69 182.76 618.42 52.08 46.50 620.20 159.70 177.44 287.69 359.61 181.88 182.76 177.44 749.60 162.36 46.50 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80101074 XR CONTRAST RETRO WO/W KUB 74420 320 "$1,933.00" 714.44 37.50 " 1,546.40 " 43.13 " 1,335.70 " 384.09 " 1,335.70 " 43.88 " 1,067.98 " 376.77 " 1,275.78 " 42.00 37.50 " 1,279.45 " 329.22 365.80 377.41 471.76 374.95 376.77 365.80 " 1,546.40 " 334.71 37.50 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 28174586 XR UROGRAPHY ANTEGRADE 74425 360 "$1,933.00" 714.44 37.50 " 1,546.40 " 43.13 " 1,335.70 " 384.09 " 1,335.70 " 43.88 " 1,067.98 " 376.77 " 1,275.78 " 42.00 37.50 " 1,279.45 " 329.22 365.80 218.16 272.70 374.95 376.77 365.80 " 1,546.40 " 334.71 37.50 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 80101082 XR UROGRAPHY ANTEGRADE 74425 320 "$1,933.00" 714.44 37.50 " 1,546.40 " 43.13 " 1,335.70 " 384.09 " 1,335.70 " 43.88 " 1,067.98 " 376.77 " 1,275.78 " 42.00 37.50 " 1,279.45 " 329.22 365.80 218.16 272.70 374.95 376.77 365.80 " 1,546.40 " 334.71 37.50 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 80301081 XR UROGRAPHY ANTEGRADE 74425 320 "$1,933.00" 714.44 37.50 " 1,546.40 " 43.13 " 1,335.70 " 384.09 " 1,335.70 " 43.88 " 1,067.98 " 376.77 " 1,275.78 " 42.00 37.50 " 1,279.45 " 329.22 365.80 218.16 272.70 374.95 376.77 365.80 " 1,546.40 " 334.71 37.50 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 80101091 XR CONTRAST BLADDER 74430 320 "$1,933.00" 714.44 36.50 " 1,546.40 " 41.98 " 1,335.70 " 384.09 " 1,335.70 " 42.71 " 1,067.98 " 376.77 " 1,275.78 " 40.88 36.50 " 1,279.45 " 329.22 365.80 183.21 229.01 374.95 376.77 365.80 " 1,546.40 " 334.71 36.50 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 80301090 XR CONTRAST BLADDER 74430 320 "$1,933.00" 714.44 36.50 " 1,546.40 " 41.98 " 1,335.70 " 384.09 " 1,335.70 " 42.71 " 1,067.98 " 376.77 " 1,275.78 " 40.88 36.50 " 1,279.45 " 329.22 365.80 183.21 229.01 374.95 376.77 365.80 " 1,546.40 " 334.71 36.50 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 80101104 XR URETHROCYSTOGRAPHY RETRO 74450 320 "$1,208.00" 446.48 37.50 966.40 43.13 834.73 240.00 834.73 43.88 667.42 235.43 797.28 42.00 37.50 799.58 205.71 228.57 232.38 290.48 234.28 235.43 228.57 966.40 209.14 37.50 602.94 201.14 494.07 906.00 459.16 540.34 236.57 80101112 XR URETHROCYSTOGRAPHY VOIDING 74455 320 "$1,208.00" 446.48 42.50 966.40 48.88 834.73 240.00 834.73 49.73 667.42 235.43 797.28 47.60 42.50 799.58 205.71 228.57 246.67 308.34 234.28 235.43 228.57 966.40 209.14 42.50 602.94 201.14 494.07 906.00 459.16 540.34 236.57 80306016 XR KIDNEY LESION 74470 320 "$2,535.00" 936.94 44.00 " 2,028.00 " 50.60 " 1,751.69 " 503.98 " 1,751.69 " 51.48 " 1,400.59 " 494.38 " 1,673.10 " 49.28 44.00 " 1,677.92 " 431.98 479.98 246.51 308.14 491.98 494.38 479.98 " 2,028.00 " 439.18 44.00 " 1,265.17 " 422.38 " 1,036.82 " " 1,901.25 " 963.55 " 1,133.91 " 496.78 80306041 XR GUID GU DILATION 74485 320 "$9,413.00" " 3,479.04 " 104.73 " 7,530.40 " 120.44 " 6,504.38 " " 1,867.55 " " 6,504.38 " 122.53 " 5,200.68 " " 1,831.98 " " 6,212.58 " 117.30 104.73 " 6,230.46 " " 1,600.76 " " 1,778.62 " 472.26 590.32 " 1,823.09 " " 1,831.98 " " 1,778.62 " " 7,530.40 " " 1,627.44 " 104.73 " 4,697.63 " " 1,565.19 " " 3,849.92 " " 7,059.75 " " 3,577.88 " " 4,210.43 " " 1,840.87 " 80435282 MRI FETAL SNGL/1ST GESTATION 74712 320 "$1,208.00" 446.48 - " 1,657.76 " - 834.73 240.00 834.73 - 667.42 235.43 797.28 - - 799.58 205.71 228.57 " 1,326.21 " " 1,657.76 " 234.28 235.43 228.57 966.40 209.14 - 602.94 201.14 494.07 906.00 459.16 540.34 236.57 80435291 MRI FETAL EACH ADD GESTATION 74713 320 $345.00 127.51 - 863.67 - 238.40 - 238.40 - 190.61 - 227.70 - - 228.36 - - 690.94 863.67 - - - 276.00 - - 356.53 - 141.11 258.75 131.13 154.32 - 80101121 XR FEMALE GENITAL TRACT 74740 320 "$1,208.00" 446.48 26.50 966.40 30.48 834.73 240.00 834.73 31.01 667.42 235.43 797.28 29.68 26.50 799.58 205.71 228.57 223.18 278.98 234.28 235.43 228.57 966.40 209.14 26.50 602.94 201.14 494.07 906.00 459.16 540.34 236.57 28176538 X-RAY FALLOPIAN TUBE 74742 360 "$1,080.00" 399.17 - 864.00 - 746.28 - 746.28 - 596.70 - 712.80 - - 714.85 - - 480.26 600.33 - - - 864.00 - - 723.60 - 441.72 810.00 410.51 483.08 - 80101139 XR PERINEUM 74775 320 "$1,208.00" 446.48 63.00 966.40 72.45 834.73 240.00 834.73 73.71 667.42 235.43 797.28 70.56 63.00 799.58 205.71 228.57 284.91 356.14 234.28 235.43 228.57 966.40 209.14 63.00 602.94 201.14 494.07 906.00 459.16 540.34 236.57 80407831 MRI CARDIAC MORPHO W/O CONT 75557 614 "$1,208.00" 446.48 201.14 " 2,882.00 " 395.39 " 2,882.00 " 240.00 " 2,882.00 " 402.27 667.42 235.43 " 1,155.00 " 385.08 343.82 799.58 205.71 228.57 " 1,646.07 " " 2,057.59 " 234.28 235.43 228.57 966.40 209.14 343.82 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81407835 MRI CARDIAC MORPHO W/O CONT 75557 614 "$1,208.00" 446.48 201.14 " 2,882.00 " 395.39 " 2,882.00 " 240.00 " 2,882.00 " 402.27 667.42 235.43 " 1,155.00 " 385.08 343.82 799.58 205.71 228.57 " 1,646.07 " " 2,057.59 " 234.28 235.43 228.57 966.40 209.14 343.82 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81607834 MRI CARDIAC MORPHO W/O CONT 75557 614 "$1,208.00" 446.48 201.14 " 2,882.00 " 395.39 " 2,882.00 " 240.00 " 2,882.00 " 402.27 667.42 235.43 " 1,155.00 " 385.08 343.82 799.58 205.71 228.57 " 1,646.07 " " 2,057.59 " 234.28 235.43 228.57 966.40 209.14 343.82 602.94 201.14 494.07 906.00 459.16 540.34 236.57 80407840 MRI CARDIAC W/STRESS IMAGING 75559 614 "$2,535.00" 936.94 368.99 " 2,882.00 " 424.34 " 2,882.00 " 503.98 " 2,882.00 " 431.72 " 1,400.59 " 494.38 " 1,155.00 " 413.27 368.99 " 1,677.92 " 431.98 479.98 " 1,644.97 " " 2,056.21 " 491.98 494.38 479.98 " 2,028.00 " 439.18 368.99 " 1,265.17 " 422.38 " 1,036.82 " " 1,901.25 " 963.55 " 1,133.91 " 496.78 81407843 MRI CARDIAC W/STRESS IMAGING 75559 614 "$2,535.00" 936.94 368.99 " 2,882.00 " 424.34 " 2,882.00 " 503.98 " 2,882.00 " 431.72 " 1,400.59 " 494.38 " 1,155.00 " 413.27 368.99 " 1,677.92 " 431.98 479.98 " 1,644.97 " " 2,056.21 " 491.98 494.38 479.98 " 2,028.00 " 439.18 368.99 " 1,265.17 " 422.38 " 1,036.82 " " 1,901.25 " 963.55 " 1,133.91 " 496.78 81607842 MRI CARDIAC W/STRESS IMAGING 75559 614 "$2,535.00" 936.94 368.99 " 2,882.00 " 424.34 " 2,882.00 " 503.98 " 2,882.00 " 431.72 " 1,400.59 " 494.38 " 1,155.00 " 413.27 368.99 " 1,677.92 " 431.98 479.98 " 1,644.97 " " 2,056.21 " 491.98 494.38 479.98 " 2,028.00 " 439.18 368.99 " 1,265.17 " 422.38 " 1,036.82 " " 1,901.25 " 963.55 " 1,133.91 " 496.78 80407858 MRI CARDIAC MORPHO W/CONTRAST 75561 614 "$1,933.00" 714.44 321.90 " 3,144.26 " 559.51 " 2,882.00 " 384.09 " 2,882.00 " 569.24 " 1,067.98 " 376.77 " 1,155.00 " 544.91 486.53 " 1,279.45 " 329.22 365.80 " 2,515.41 " " 3,144.26 " 374.95 376.77 365.80 " 1,546.40 " 334.71 486.53 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81407851 MRI CARDIAC MORPHO W/CONTRAST 75561 614 "$1,933.00" 714.44 321.90 " 3,144.26 " 559.51 " 2,882.00 " 384.09 " 2,882.00 " 569.24 " 1,067.98 " 376.77 " 1,155.00 " 544.91 486.53 " 1,279.45 " 329.22 365.80 " 2,515.41 " " 3,144.26 " 374.95 376.77 365.80 " 1,546.40 " 334.71 486.53 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81607851 MRI CARDIAC MORPHO W/CONTRAST 75561 614 "$1,933.00" 714.44 321.90 " 3,144.26 " 559.51 " 2,882.00 " 384.09 " 2,882.00 " 569.24 " 1,067.98 " 376.77 " 1,155.00 " 544.91 486.53 " 1,279.45 " 329.22 365.80 " 2,515.41 " " 3,144.26 " 374.95 376.77 365.80 " 1,546.40 " 334.71 486.53 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 80407866 MRI CARDIAC W/STRESS WO/W CONT 75563 614 "$3,755.00" " 1,387.85 " 506.84 " 3,145.63 " 582.87 " 2,882.00 " 746.21 " 2,882.00 " 593.00 " 2,074.64 " 732.00 " 1,155.00 " 567.66 506.84 " 2,485.43 " 639.61 710.68 " 2,516.50 " " 3,145.63 " 728.45 732.00 710.68 " 3,004.00 " 650.27 506.84 " 1,873.77 " 625.40 " 1,535.80 " " 2,816.25 " " 1,427.28 " " 1,679.61 " 735.55 81407860 MRI CARDIAC W/STRESS WO/W CONT 75563 614 "$3,755.00" " 1,387.85 " 506.84 " 3,145.63 " 582.87 " 2,882.00 " 746.21 " 2,882.00 " 593.00 " 2,074.64 " 732.00 " 1,155.00 " 567.66 506.84 " 2,485.43 " 639.61 710.68 " 2,516.50 " " 3,145.63 " 728.45 732.00 710.68 " 3,004.00 " 650.27 506.84 " 1,873.77 " 625.40 " 1,535.80 " " 2,816.25 " " 1,427.28 " " 1,679.61 " 735.55 81607869 MRI CARDIAC W/STRESS WO/W CONT 75563 614 "$3,755.00" " 1,387.85 " 506.84 " 3,145.63 " 582.87 " 2,882.00 " 746.21 " 2,882.00 " 593.00 " 2,074.64 " 732.00 " 1,155.00 " 567.66 506.84 " 2,485.43 " 639.61 710.68 " 2,516.50 " " 3,145.63 " 728.45 732.00 710.68 " 3,004.00 " 650.27 506.84 " 1,873.77 " 625.40 " 1,535.80 " " 2,816.25 " " 1,427.28 " " 1,679.61 " 735.55 80407882 MRI CARDIAC VELOC FLOW MAPPING 75565 614 "$2,043.00" 755.09 - " 2,882.00 " - " 2,882.00 " - " 2,882.00 " - " 1,128.76 " - " 1,155.00 " - - " 1,352.26 " - - 382.69 478.36 - - - " 1,634.40 " - - 107.87 - 835.59 " 1,532.25 " 776.54 913.83 - 81407886 MRI CARDIAC VELOC FLOW MAPPING 75565 614 "$2,043.00" 755.09 - " 2,882.00 " - " 2,882.00 " - " 2,882.00 " - " 1,128.76 " - " 1,155.00 " - - " 1,352.26 " - - 382.69 478.36 - - - " 1,634.40 " - - 107.87 - 835.59 " 1,532.25 " 776.54 913.83 - 81607885 MRI CARDIAC VELOC FLOW MAPPING 75565 614 "$2,043.00" 755.09 - " 2,882.00 " - " 2,882.00 " - " 2,882.00 " - " 1,128.76 " - " 1,155.00 " - - " 1,352.26 " - - 382.69 478.36 - - - " 1,634.40 " - - 107.87 - 835.59 " 1,532.25 " 776.54 913.83 - 53927530 CT HEART W/O CONT W/CA TEST 75571 352 $425.00 157.08 56.84 " 1,774.00 " 65.37 " 1,774.00 " 84.37 " 1,774.00 " 66.50 234.81 82.76 725.00 63.66 56.84 281.31 72.32 80.35 218.58 273.22 82.36 82.76 80.35 340.00 73.52 56.84 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80627530 CT HEART W/O CONT W/CA TEST 75571 352 $425.00 157.08 56.84 " 1,774.00 " 65.37 " 1,774.00 " 84.37 " 1,774.00 " 66.50 234.81 82.76 725.00 63.66 56.84 281.31 72.32 80.35 218.58 273.22 82.36 82.76 80.35 340.00 73.52 56.84 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81427534 CT HEART W/O CONT W/CA TEST 75571 352 $425.00 157.08 56.84 " 1,774.00 " 65.37 " 1,774.00 " 84.37 " 1,774.00 " 66.50 234.81 82.76 725.00 63.66 56.84 281.31 72.32 80.35 218.58 273.22 82.36 82.76 80.35 340.00 73.52 56.84 211.96 70.71 173.83 318.75 161.54 190.10 83.16 53927548 CT HEART W/CONTRAST W/3D IMAGE 75572 352 $937.00 346.32 156.15 " 1,774.00 " 271.81 " 1,774.00 " 186.31 " 1,774.00 " 276.54 517.69 182.76 725.00 264.72 236.36 620.20 159.70 177.44 861.18 " 1,076.47 " 181.88 182.76 177.44 749.60 162.36 236.36 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80627548 CT HEART W/CONTRAST W/3D IMAGE 75572 352 $937.00 346.32 156.15 " 1,774.00 " 271.81 " 1,774.00 " 186.31 " 1,774.00 " 276.54 517.69 182.76 725.00 264.72 236.36 620.20 159.70 177.44 861.18 " 1,076.47 " 181.88 182.76 177.44 749.60 162.36 236.36 467.80 156.15 383.23 702.75 356.15 419.12 183.65 53927599 CT HRT W/3D IMAGE CONGENITAL 75573 352 $937.00 346.32 156.15 " 1,774.00 " 349.89 " 1,774.00 " 186.31 " 1,774.00 " 355.97 517.69 182.76 725.00 340.76 304.25 620.20 159.70 177.44 " 1,219.18 " " 1,523.97 " 181.88 182.76 177.44 749.60 162.36 304.25 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80627599 CT HRT W/3D IMAGE CONGENITAL 75573 352 $937.00 346.32 156.15 " 1,774.00 " 349.89 " 1,774.00 " 186.31 " 1,774.00 " 355.97 517.69 182.76 725.00 340.76 304.25 620.20 159.70 177.44 " 1,219.18 " " 1,523.97 " 181.88 182.76 177.44 749.60 162.36 304.25 467.80 156.15 383.23 702.75 356.15 419.12 183.65 53909990 CTA HRT W/3D IMAGE & CONTRAST 75574 352 $937.00 346.32 156.15 " 1,774.00 " 344.24 " 1,774.00 " 186.31 " 1,774.00 " 350.23 517.69 182.76 725.00 335.26 299.34 620.20 159.70 177.44 " 1,302.98 " " 1,628.73 " 181.88 182.76 177.44 749.60 162.36 299.34 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80609990 CTA HRT W/3D IMAGE & CONTRAST 75574 352 $937.00 346.32 156.15 " 1,774.00 " 344.24 " 1,774.00 " 186.31 " 1,774.00 " 350.23 517.69 182.76 725.00 335.26 299.34 620.20 159.70 177.44 " 1,302.98 " " 1,628.73 " 181.88 182.76 177.44 749.60 162.36 299.34 467.80 156.15 383.23 702.75 356.15 419.12 183.65 29812764 CONTRAST EXAM THORACIC AORTA 75605 481 "$25,044.00" " 9,256.26 " 39.00 " 20,035.20 " 44.85 " 17,305.40 " " 4,973.85 " " 17,305.40 " 45.63 " 13,836.81 " " 4,879.11 " " 16,529.04 " 43.68 39.00 " 16,576.62 " " 4,263.30 " " 4,737.00 " " 1,701.89 " " 2,127.36 " " 4,855.43 " " 4,879.11 " " 4,737.00 " " 20,035.20 " " 4,334.36 " 39.00 " 12,498.37 " " 4,168.56 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,902.80 " 80306083 CONTRAST EXAM THORACIC AORTA 75605 320 "$25,044.00" " 9,256.26 " 39.00 " 20,035.20 " 44.85 " 17,305.40 " " 4,973.85 " " 17,305.40 " 45.63 " 13,836.81 " " 4,879.11 " " 16,529.04 " 43.68 39.00 " 16,576.62 " " 4,263.30 " " 4,737.00 " " 1,701.89 " " 2,127.36 " " 4,855.43 " " 4,879.11 " " 4,737.00 " " 20,035.20 " " 4,334.36 " 39.00 " 12,498.37 " " 4,168.56 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,902.80 " 28174594 AORTOGRAPHY ABDOMINAL 75625 360 "$15,024.00" " 5,552.87 " 39.00 " 12,019.20 " 44.85 " 10,381.58 " " 2,985.82 " " 10,381.58 " 45.63 " 8,300.76 " " 2,928.95 " " 9,915.84 " 43.68 39.00 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 1,701.89 " " 2,127.36 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 39.00 " 7,497.55 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 29802751 AORTOGRAPHY ABDOMINAL 75625 481 "$15,024.00" " 5,552.87 " 39.00 " 12,019.20 " 44.85 " 10,381.58 " " 2,985.82 " " 10,381.58 " 45.63 " 8,300.76 " " 2,928.95 " " 9,915.84 " 43.68 39.00 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 1,701.89 " " 2,127.36 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 39.00 " 7,497.55 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80306091 CONTRAST EXAM ABDOMINAL AORTA 75625 320 "$15,024.00" " 5,552.87 " 39.00 " 12,019.20 " 44.85 " 10,381.58 " " 2,985.82 " " 10,381.58 " 45.63 " 8,300.76 " " 2,928.95 " " 9,915.84 " 43.68 39.00 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 1,701.89 " " 2,127.36 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 39.00 " 7,497.55 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 29802734 AORTOGRAPHY ABD BIL CATH EXTR 75630 320 "$15,024.00" " 5,552.87 " 244.28 " 12,019.20 " 280.92 " 10,381.58 " " 2,985.82 " " 10,381.58 " 285.81 " 8,300.76 " " 2,928.95 " " 9,915.84 " 273.59 244.28 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 1,796.01 " " 2,245.01 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 244.28 " 7,497.55 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80306105 XR AORTA LEG ARTERIES 75630 320 "$15,024.00" " 5,552.87 " 244.28 " 12,019.20 " 280.92 " 10,381.58 " " 2,985.82 " " 10,381.58 " 285.81 " 8,300.76 " " 2,928.95 " " 9,915.84 " 273.59 244.28 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 1,796.01 " " 2,245.01 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 244.28 " 7,497.55 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 53909752 CTA ABDOMINAL ARTERIES 75635 352 $937.00 346.32 156.15 " 2,231.67 " 391.29 " 1,774.00 " 186.31 " 1,774.00 " 398.09 517.69 182.76 725.00 381.08 340.25 620.20 159.70 177.44 " 1,785.34 " " 2,231.67 " 181.88 182.76 177.44 749.60 162.36 340.25 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67709756 CTA ABDOMINAL ARTERIES 75635 352 $937.00 346.32 156.15 " 2,231.67 " 391.29 " 1,774.00 " 186.31 " 1,774.00 " 398.09 517.69 182.76 725.00 381.08 340.25 620.20 159.70 177.44 " 1,785.34 " " 2,231.67 " 181.88 182.76 177.44 749.60 162.36 340.25 467.80 156.15 383.23 702.75 356.15 419.12 183.65 67909755 CTA ABDOMINAL ARTERIES 75635 352 $937.00 346.32 156.15 " 2,231.67 " 391.29 " 1,774.00 " 186.31 " 1,774.00 " 398.09 517.69 182.76 725.00 381.08 340.25 620.20 159.70 177.44 " 1,785.34 " " 2,231.67 " 181.88 182.76 177.44 749.60 162.36 340.25 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80609752 CTA ABDOMINAL ARTERIES 75635 352 $937.00 346.32 156.15 " 2,231.67 " 391.29 " 1,774.00 " 186.31 " 1,774.00 " 398.09 517.69 182.76 725.00 381.08 340.25 620.20 159.70 177.44 " 1,785.34 " " 2,231.67 " 181.88 182.76 177.44 749.60 162.36 340.25 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81409757 CTA ABDOMINAL ARTERIES 75635 352 $937.00 346.32 156.15 " 2,231.67 " 391.29 " 1,774.00 " 186.31 " 1,774.00 " 398.09 517.69 182.76 725.00 381.08 340.25 620.20 159.70 177.44 " 1,785.34 " " 2,231.67 " 181.88 182.76 177.44 749.60 162.36 340.25 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81609756 CTA ABDOMINAL ARTERIES 75635 352 $937.00 346.32 156.15 " 2,231.67 " 391.29 " 1,774.00 " 186.31 " 1,774.00 " 398.09 517.69 182.76 725.00 381.08 340.25 620.20 159.70 177.44 " 1,785.34 " " 2,231.67 " 181.88 182.76 177.44 749.60 162.36 340.25 467.80 156.15 383.23 702.75 356.15 419.12 183.65 83009756 CTA ABDOMINAL ARTERIES 75635 352 $937.00 346.32 156.15 " 2,231.67 " 391.29 " 1,774.00 " 186.31 " 1,774.00 " 398.09 517.69 182.76 725.00 381.08 340.25 620.20 159.70 177.44 " 1,785.34 " " 2,231.67 " 181.88 182.76 177.44 749.60 162.36 340.25 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80306202 ANGIO SPINE ARTERY XR 75705 320 "$25,044.00" " 9,256.26 " 37.50 " 20,035.20 " 43.13 " 17,305.40 " " 4,973.85 " " 17,305.40 " 43.88 " 13,836.81 " " 4,879.11 " " 16,529.04 " 42.00 37.50 " 16,576.62 " " 4,263.30 " " 4,737.00 " " 1,887.19 " " 2,358.99 " " 4,855.43 " " 4,879.11 " " 4,737.00 " " 20,035.20 " " 4,334.36 " 37.50 " 12,498.37 " " 4,168.56 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,902.80 " 28174608 ANGIO EXTREMITY UNILATERAL 75710 360 "$15,024.00" " 5,552.87 " 37.50 " 12,019.20 " 43.13 " 10,381.58 " " 2,985.82 " " 10,381.58 " 43.88 " 8,300.76 " " 2,928.95 " " 9,915.84 " 42.00 37.50 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 1,701.89 " " 2,127.36 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 37.50 " 7,497.55 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 29803838 ANGIO EXTREMITY UNILATERAL 75710 320 "$15,024.00" " 5,552.87 " 37.50 " 12,019.20 " 43.13 " 10,381.58 " " 2,985.82 " " 10,381.58 " 43.88 " 8,300.76 " " 2,928.95 " " 9,915.84 " 42.00 37.50 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 1,701.89 " " 2,127.36 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 37.50 " 7,497.55 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80306211 ANGIO ARM LEG UNILATERAL XR 75710 320 "$15,024.00" " 5,552.87 " 37.50 " 12,019.20 " 43.13 " 10,381.58 " " 2,985.82 " " 10,381.58 " 43.88 " 8,300.76 " " 2,928.95 " " 9,915.84 " 42.00 37.50 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 1,701.89 " " 2,127.36 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 37.50 " 7,497.55 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 28174616 ANGIO EXTREMITY BILATERAL 75716 360 "$15,024.00" " 5,552.87 " 37.50 " 12,019.20 " 43.13 " 10,381.58 " " 2,985.82 " " 10,381.58 " 43.88 " 8,300.76 " " 2,928.95 " " 9,915.84 " 42.00 37.50 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 1,732.13 " " 2,165.16 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 37.50 " 7,497.55 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 29803820 ANGIO EXTREMITY BILATERAL 75716 481 "$15,024.00" " 5,552.87 " 37.50 " 12,019.20 " 43.13 " 10,381.58 " " 2,985.82 " " 10,381.58 " 43.88 " 8,300.76 " " 2,928.95 " " 9,915.84 " 42.00 37.50 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 1,732.13 " " 2,165.16 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 37.50 " 7,497.55 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80306229 ANGIO ARM LEG BILATERAL XR 75716 320 "$15,024.00" " 5,552.87 " 37.50 " 12,019.20 " 43.13 " 10,381.58 " " 2,985.82 " " 10,381.58 " 43.88 " 8,300.76 " " 2,928.95 " " 9,915.84 " 42.00 37.50 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 1,732.13 " " 2,165.16 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 37.50 " 7,497.55 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 29803790 ANGIO VISCERAL FLUSH AORTOGRAM 75726 481 "$25,044.00" " 9,256.26 " 37.50 " 20,035.20 " 43.13 " 17,305.40 " " 4,973.85 " " 17,305.40 " 43.88 " 13,836.81 " " 4,879.11 " " 16,529.04 " 42.00 37.50 " 16,576.62 " " 4,263.30 " " 4,737.00 " " 1,701.89 " " 2,127.36 " " 4,855.43 " " 4,879.11 " " 4,737.00 " " 20,035.20 " " 4,334.36 " 37.50 " 12,498.37 " " 4,168.56 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,902.80 " 80306253 ANGIO ABDOMEN ARTERY XR 75726 320 "$25,044.00" " 9,256.26 " 37.50 " 20,035.20 " 43.13 " 17,305.40 " " 4,973.85 " " 17,305.40 " 43.88 " 13,836.81 " " 4,879.11 " " 16,529.04 " 42.00 37.50 " 16,576.62 " " 4,263.30 " " 4,737.00 " " 1,701.89 " " 2,127.36 " " 4,855.43 " " 4,879.11 " " 4,737.00 " " 20,035.20 " " 4,334.36 " 37.50 " 12,498.37 " " 4,168.56 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,902.80 " 80306261 ANGIO ADRENAL ARTERY UNI XR 75731 320 "$15,024.00" " 5,552.87 " 37.50 " 12,019.20 " 43.13 " 10,381.58 " " 2,985.82 " " 10,381.58 " 43.88 " 8,300.76 " " 2,928.95 " " 9,915.84 " 42.00 37.50 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 1,701.89 " " 2,127.36 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 37.50 " 7,497.55 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80306270 ANGIO ADRENAL BILATERAL XR 75733 320 "$15,024.00" " 5,552.87 " 37.50 " 12,019.20 " 43.13 " 10,381.58 " " 2,985.82 " " 10,381.58 " 43.88 " 8,300.76 " " 2,928.95 " " 9,915.84 " 42.00 37.50 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 1,732.13 " " 2,165.16 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 37.50 " 7,497.55 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 29812772 ANGIO PELVIS XR 75736 481 "$25,044.00" " 9,256.26 " 37.50 " 20,035.20 " 43.13 " 17,305.40 " " 4,973.85 " " 17,305.40 " 43.88 " 13,836.81 " " 4,879.11 " " 16,529.04 " 42.00 37.50 " 16,576.62 " " 4,263.30 " " 4,737.00 " " 1,701.89 " " 2,127.36 " " 4,855.43 " " 4,879.11 " " 4,737.00 " " 20,035.20 " " 4,334.36 " 37.50 " 12,498.37 " " 4,168.56 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,902.80 " 80306288 ANGIO PELVIS XR 75736 320 "$25,044.00" " 9,256.26 " 37.50 " 20,035.20 " 43.13 " 17,305.40 " " 4,973.85 " " 17,305.40 " 43.88 " 13,836.81 " " 4,879.11 " " 16,529.04 " 42.00 37.50 " 16,576.62 " " 4,263.30 " " 4,737.00 " " 1,701.89 " " 2,127.36 " " 4,855.43 " " 4,879.11 " " 4,737.00 " " 20,035.20 " " 4,334.36 " 37.50 " 12,498.37 " " 4,168.56 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,902.80 " 29803781 ANGIO PULM SELECT UNILATERAL 75741 481 "$15,024.00" " 5,552.87 " 37.50 " 12,019.20 " 43.13 " 10,381.58 " " 2,985.82 " " 10,381.58 " 43.88 " 8,300.76 " " 2,928.95 " " 9,915.84 " 42.00 37.50 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 1,732.13 " " 2,165.16 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 37.50 " 7,497.55 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80306296 ANGIO LUNG UNITALERAL XR 75741 320 "$15,024.00" " 5,552.87 " 37.50 " 12,019.20 " 43.13 " 10,381.58 " " 2,985.82 " " 10,381.58 " 43.88 " 8,300.76 " " 2,928.95 " " 9,915.84 " 42.00 37.50 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 1,732.13 " " 2,165.16 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 37.50 " 7,497.55 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 29812934 ANGIO PULM SELECT BILATERAL 75743 481 "$15,024.00" " 5,552.87 " 37.50 " 12,019.20 " 43.13 " 10,381.58 " " 2,985.82 " " 10,381.58 " 43.88 " 8,300.76 " " 2,928.95 " " 9,915.84 " 42.00 37.50 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 1,793.76 " " 2,242.20 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 37.50 " 7,497.55 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80306300 ANGIO LUNG BILATERAL XR 75743 320 "$15,024.00" " 5,552.87 " 37.50 " 12,019.20 " 43.13 " 10,381.58 " " 2,985.82 " " 10,381.58 " 43.88 " 8,300.76 " " 2,928.95 " " 9,915.84 " 42.00 37.50 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 1,793.76 " " 2,242.20 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 37.50 " 7,497.55 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80306318 ANGIO LUNG NONSELECTIVE XR 75746 320 "$15,024.00" " 5,552.87 " 25.00 " 12,019.20 " 28.75 " 10,381.58 " " 2,985.82 " " 10,381.58 " 29.25 " 8,300.76 " " 2,928.95 " " 9,915.84 " 28.00 25.00 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 1,701.89 " " 2,127.36 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 25.00 " 7,497.55 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80327374 ANGIO CHEST INT MAMMARY XR 75756 320 "$15,024.00" " 5,552.87 " 37.50 " 12,019.20 " 43.13 " 10,381.58 " " 2,985.82 " " 10,381.58 " 43.88 " 8,300.76 " " 2,928.95 " " 9,915.84 " 42.00 37.50 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 1,701.89 " " 2,127.36 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 37.50 " 7,497.55 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 28174624 ANGIO SELECTIVE ADDL VESSEL 75774 360 $908.00 335.60 - " 1,955.05 " 43.13 627.43 - 627.43 43.88 501.67 - 599.28 42.00 37.50 601.01 - - " 1,564.04 " " 1,955.05 " - - - 726.40 - 37.50 152.67 - 371.37 681.00 345.13 406.15 - 29803773 ANGIO SELECTIVE ADDL VESSEL 75774 481 $908.00 335.60 - " 1,955.05 " 43.13 627.43 - 627.43 43.88 501.67 - 599.28 42.00 37.50 601.01 - - " 1,564.04 " " 1,955.05 " - - - 726.40 - 37.50 152.67 - 371.37 681.00 345.13 406.15 - 80306326 ANGIO SELECT EA ADD VESSEL XR 75774 320 $908.00 335.60 - " 1,955.05 " 43.13 627.43 - 627.43 43.88 501.67 - 599.28 42.00 37.50 601.01 - - " 1,564.04 " " 1,955.05 " - - - 726.40 - 37.50 152.67 - 371.37 681.00 345.13 406.15 - 80306385 SHUNTOGRAM NON VASC PREV XR 75809 320 $572.00 211.41 49.74 457.60 57.20 395.25 113.56 395.25 58.20 316.03 111.39 377.52 55.71 49.74 378.61 97.34 108.15 174.63 218.29 110.85 111.39 108.15 457.60 98.96 49.74 285.50 95.17 233.95 429.00 217.42 255.86 111.94 29805113 VENOGRAPHY EXTR UNILATERAL 75820 481 "$7,382.00" " 2,728.39 " 37.50 " 5,905.60 " 43.13 " 5,100.96 " " 1,466.71 " " 5,100.96 " 43.88 " 4,078.56 " " 1,438.78 " " 4,872.12 " 42.00 37.50 " 4,886.15 " " 1,257.18 " " 1,396.87 " 237.88 297.35 " 1,431.79 " " 1,438.78 " " 1,396.87 " " 5,905.60 " " 1,278.14 " 37.50 " 3,684.09 " " 1,229.25 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,445.76 " 30601734 XR VEIN EXTREMITY UNILATERAL 75820 320 "$7,382.00" " 2,728.39 " 37.50 " 5,905.60 " 43.13 " 5,100.96 " " 1,466.71 " " 5,100.96 " 43.88 " 4,078.56 " " 1,438.78 " " 4,872.12 " 42.00 37.50 " 4,886.15 " " 1,257.18 " " 1,396.87 " 237.88 297.35 " 1,431.79 " " 1,438.78 " " 1,396.87 " " 5,905.60 " " 1,278.14 " 37.50 " 3,684.09 " " 1,229.25 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,445.76 " 80101147 XR VEIN EXTREMITY UNILATERAL 75820 320 "$7,382.00" " 2,728.39 " 37.50 " 5,905.60 " 43.13 " 5,100.96 " " 1,466.71 " " 5,100.96 " 43.88 " 4,078.56 " " 1,438.78 " " 4,872.12 " 42.00 37.50 " 4,886.15 " " 1,257.18 " " 1,396.87 " 237.88 297.35 " 1,431.79 " " 1,438.78 " " 1,396.87 " " 5,905.60 " " 1,278.14 " 37.50 " 3,684.09 " " 1,229.25 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,445.76 " 80301146 XR VEIN EXTREMITY UNILATERAL 75820 320 "$7,382.00" " 2,728.39 " 37.50 " 5,905.60 " 43.13 " 5,100.96 " " 1,466.71 " " 5,100.96 " 43.88 " 4,078.56 " " 1,438.78 " " 4,872.12 " 42.00 37.50 " 4,886.15 " " 1,257.18 " " 1,396.87 " 237.88 297.35 " 1,431.79 " " 1,438.78 " " 1,396.87 " " 5,905.60 " " 1,278.14 " 37.50 " 3,684.09 " " 1,229.25 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,445.76 " 30603265 XR VEIN EXTREMITY BILATERAL 75822 320 "$7,382.00" " 2,728.39 " 37.50 " 5,905.60 " 43.13 " 5,100.96 " " 1,466.71 " " 5,100.96 " 43.88 " 4,078.56 " " 1,438.78 " " 4,872.12 " 42.00 37.50 " 4,886.15 " " 1,257.18 " " 1,396.87 " 363.02 453.78 " 1,431.79 " " 1,438.78 " " 1,396.87 " " 5,905.60 " " 1,278.14 " 37.50 " 3,684.09 " " 1,229.25 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,445.76 " 80301154 XR VEIN EXTREMITY BILATERAL 75822 320 "$7,382.00" " 2,728.39 " 37.50 " 5,905.60 " 43.13 " 5,100.96 " " 1,466.71 " " 5,100.96 " 43.88 " 4,078.56 " " 1,438.78 " " 4,872.12 " 42.00 37.50 " 4,886.15 " " 1,257.18 " " 1,396.87 " 363.02 453.78 " 1,431.79 " " 1,438.78 " " 1,396.87 " " 5,905.60 " " 1,278.14 " 37.50 " 3,684.09 " " 1,229.25 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,445.76 " 29803765 VENOGRAPHY CAVAL INFERIOR 75825 481 "$15,024.00" " 5,552.87 " 37.50 " 12,019.20 " 43.13 " 10,381.58 " " 2,985.82 " " 10,381.58 " 43.88 " 8,300.76 " " 2,928.95 " " 9,915.84 " 42.00 37.50 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 1,701.89 " " 2,127.36 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 37.50 " 7,497.55 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80306407 XR VEIN TRUNK 75825 320 "$15,024.00" " 5,552.87 " 37.50 " 12,019.20 " 43.13 " 10,381.58 " " 2,985.82 " " 10,381.58 " 43.88 " 8,300.76 " " 2,928.95 " " 9,915.84 " 42.00 37.50 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 1,701.89 " " 2,127.36 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 37.50 " 7,497.55 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 29803757 VENOGRAPHY CAVAL SUPERIOR 75827 481 "$7,382.00" " 2,728.39 " 37.50 " 5,905.60 " 43.13 " 5,100.96 " " 1,466.71 " " 5,100.96 " 43.88 " 4,078.56 " " 1,438.78 " " 4,872.12 " 42.00 37.50 " 4,886.15 " " 1,257.18 " " 1,396.87 " " 1,701.89 " " 2,127.36 " " 1,431.79 " " 1,438.78 " " 1,396.87 " " 5,905.60 " " 1,278.14 " 37.50 " 3,684.09 " " 1,229.25 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,445.76 " 80306415 XR VEIN CHEST 75827 320 "$7,382.00" " 2,728.39 " 37.50 " 5,905.60 " 43.13 " 5,100.96 " " 1,466.71 " " 5,100.96 " 43.88 " 4,078.56 " " 1,438.78 " " 4,872.12 " 42.00 37.50 " 4,886.15 " " 1,257.18 " " 1,396.87 " " 1,701.89 " " 2,127.36 " " 1,431.79 " " 1,438.78 " " 1,396.87 " " 5,905.60 " " 1,278.14 " 37.50 " 3,684.09 " " 1,229.25 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,445.76 " 80306423 XR VEIN KIDNEY UNILATERAL 75831 320 "$15,024.00" " 5,552.87 " 37.50 " 12,019.20 " 43.13 " 10,381.58 " " 2,985.82 " " 10,381.58 " 43.88 " 8,300.76 " " 2,928.95 " " 9,915.84 " 42.00 37.50 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 1,701.89 " " 2,127.36 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 37.50 " 7,497.55 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80306431 XR VEIN KIDNEY BILATERAL 75833 320 "$15,024.00" " 5,552.87 " 37.50 " 12,019.20 " 43.13 " 10,381.58 " " 2,985.82 " " 10,381.58 " 43.88 " 8,300.76 " " 2,928.95 " " 9,915.84 " 42.00 37.50 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 1,763.52 " " 2,204.40 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 37.50 " 7,497.55 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80306440 XR VEIN ADRENAL UNILATERAL 75840 320 "$15,024.00" " 5,552.87 " 37.50 " 12,019.20 " 43.13 " 10,381.58 " " 2,985.82 " " 10,381.58 " 43.88 " 8,300.76 " " 2,928.95 " " 9,915.84 " 42.00 37.50 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 1,701.89 " " 2,127.36 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 37.50 " 7,497.55 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80306458 XR VEIN ADRENAL BILATERAL 75842 320 "$25,044.00" " 9,256.26 " 37.50 " 20,035.20 " 43.13 " 17,305.40 " " 4,973.85 " " 17,305.40 " 43.88 " 13,836.81 " " 4,879.11 " " 16,529.04 " 42.00 37.50 " 16,576.62 " " 4,263.30 " " 4,737.00 " " 1,763.52 " " 2,204.40 " " 4,855.43 " " 4,879.11 " " 4,737.00 " " 20,035.20 " " 4,334.36 " 37.50 " 12,498.37 " " 4,168.56 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,902.80 " 80306466 XR VEIN NECK 75860 320 "$15,024.00" " 5,552.87 " 25.00 " 12,019.20 " 28.75 " 10,381.58 " " 2,985.82 " " 10,381.58 " 29.25 " 8,300.76 " " 2,928.95 " " 9,915.84 " 28.00 25.00 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 1,701.89 " " 2,127.36 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 25.00 " 7,497.55 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80327048 XR VEIN EYE SOCKET 75880 320 "$2,844.00" " 1,051.14 " 37.50 " 2,275.20 " 43.13 " 1,965.20 " 563.79 " 1,965.20 " 43.88 " 1,571.31 " 553.05 " 1,877.04 " 42.00 37.50 " 1,882.44 " 483.25 536.94 237.88 297.35 550.36 553.05 536.94 " 2,275.20 " 491.30 37.50 " 1,419.04 " 472.51 " 1,163.20 " " 2,133.00 " " 1,081.00 " " 1,272.12 " 555.73 80306482 XR VEIN LIVER W/HEMODYNAMIC 75885 320 "$15,024.00" " 5,552.87 " 193.33 " 12,019.20 " 222.33 " 10,381.58 " " 2,985.82 " " 10,381.58 " 226.20 " 8,300.76 " " 2,928.95 " " 9,915.84 " 216.53 193.33 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 1,755.46 " " 2,194.33 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 193.33 " 7,497.55 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80306491 XR VEIN LIVER WO/HEMODYNAMIC 75887 320 "$15,024.00" " 5,552.87 " 174.67 " 12,019.20 " 200.87 " 10,381.58 " " 2,985.82 " " 10,381.58 " 204.36 " 8,300.76 " " 2,928.95 " " 9,915.84 " 195.63 174.67 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 1,755.46 " " 2,194.33 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 174.67 " 7,497.55 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80306504 XR VEIN HEPATIC W/HEMODYNAMIC 75889 320 "$15,024.00" " 5,552.87 " 184.37 " 12,019.20 " 212.03 " 10,381.58 " " 2,985.82 " " 10,381.58 " 215.71 " 8,300.76 " " 2,928.95 " " 9,915.84 " 206.49 184.37 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 1,701.89 " " 2,127.36 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 184.37 " 7,497.55 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80306512 XR VEIN HEPATIC WO/HEMODYNAMIC 75891 320 "$15,024.00" " 5,552.87 " 174.37 " 12,019.20 " 200.53 " 10,381.58 " " 2,985.82 " " 10,381.58 " 204.01 " 8,300.76 " " 2,928.95 " " 9,915.84 " 195.29 174.37 " 9,944.39 " " 2,559.28 " " 2,843.64 " " 1,701.89 " " 2,127.36 " " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " 174.37 " 7,497.55 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80306521 VENOUS SAMPLING BY CATHETER 75893 320 "$25,044.00" " 9,256.26 " - " 20,035.20 " - " 17,305.40 " " 4,973.85 " " 17,305.40 " - " 13,836.81 " " 4,879.11 " " 16,529.04 " - - " 16,576.62 " " 4,263.30 " " 4,737.00 " " 1,598.15 " " 1,997.69 " " 4,855.43 " " 4,879.11 " " 4,737.00 " " 20,035.20 " " 4,334.36 " - " 12,498.37 " " 4,168.56 " " 10,243.00 " " 18,783.00 " " 9,519.22 " " 11,202.18 " " 4,902.80 " 80306539 XR TRANSCATH THERAPY 75894 320 "$3,396.00" " 1,255.16 " - " 3,883.09 " 178.88 " 2,346.64 " - " 2,346.64 " 181.99 " 1,876.29 " - " 2,241.36 " 174.22 155.55 " 2,247.81 " - - " 3,106.47 " " 3,883.09 " - - - " 2,716.80 " - 155.55 " 2,275.32 " - " 1,388.96 " " 2,547.00 " " 1,290.82 " " 1,519.03 " - 28174632 ANGIO FOLLOW-UP EXIST CATH 75898 360 "$15,024.00" " 5,552.87 " - " 12,019.20 " - " 10,381.58 " " 2,985.82 " " 10,381.58 " - " 8,300.76 " " 2,928.95 " " 9,915.84 " - - " 9,944.39 " " 2,559.28 " " 2,843.64 " 430.30 537.87 " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " - " 7,497.55 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80306555 ANGIO FOLLOW-UP EXIST CATH 75898 320 "$15,024.00" " 5,552.87 " - " 12,019.20 " - " 10,381.58 " " 2,985.82 " " 10,381.58 " - " 8,300.76 " " 2,928.95 " " 9,915.84 " - - " 9,944.39 " " 2,559.28 " " 2,843.64 " 430.30 537.87 " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " - " 7,497.55 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80326408 REMOVE CVA DEVICE OBSTRUCTION 75901 320 "$1,871.00" 691.52 - " 1,496.80 " - " 1,292.86 " - " 1,292.86 " - " 1,033.73 " - " 1,234.86 " - - " 1,238.41 " - - 277.33 346.66 - - - " 1,496.80 " - - 575.04 - 765.24 " 1,403.25 " 711.17 836.90 - 80326416 REMOVE CVA LUMEN OBSTRUCTION 75902 320 "$1,734.00" 640.89 - " 1,387.20 " - " 1,198.19 " - " 1,198.19 " - 958.04 - " 1,144.44 " - - " 1,147.73 " - - 229.72 287.15 - - - " 1,387.20 " - - 196.55 - 709.21 " 1,300.50 " 659.09 775.62 - 28174641 XRAY ENDOVASC THOR AO REPR 75957 360 "$1,531.00" 565.86 - " 1,224.80 " - " 1,057.92 " N/A " 1,057.92 " - 845.88 N/A " 1,010.46 " - N/A " 1,013.37 " - N/A - - N/A N/A N/A " 1,224.80 " N/A - " 1,025.77 " N/A 626.18 " 1,148.25 " 581.93 684.82 N/A 80306741 BX TRANSCATHETER 75970 320 "$1,497.00" 553.29 - " 1,904.56 " 20.13 " 1,034.43 " - " 1,034.43 " 20.48 827.09 - 988.02 19.60 17.50 990.86 - - " 1,523.65 " " 1,904.56 " - - - " 1,197.60 " - 17.50 " 1,002.99 " - 612.27 " 1,122.75 " 569.01 669.61 - 67706650 XR CHANGE CATH/TUBE W/CONTRAST 75984 320 $757.00 279.79 - 605.60 20.13 523.09 - 523.09 20.48 418.24 - 499.62 19.60 17.50 501.06 - - 361.34 451.68 - - - 605.60 - 17.50 177.35 - 309.61 567.75 287.74 338.61 - 80106653 XR CHANGE CATH/TUBE W/CONTRAST 75984 320 $757.00 279.79 - 605.60 20.13 523.09 - 523.09 20.48 418.24 - 499.62 19.60 17.50 501.06 - - 361.34 451.68 - - - 605.60 - 17.50 177.35 - 309.61 567.75 287.74 338.61 - 80306652 XR CHANGE CATH/TUBE W/CONTRAST 75984 320 $757.00 279.79 - 605.60 20.13 523.09 - 523.09 20.48 418.24 - 499.62 19.60 17.50 501.06 - - 361.34 451.68 - - - 605.60 - 17.50 177.35 - 309.61 567.75 287.74 338.61 - 80606656 XR CHANGE CATH/TUBE W/CONTRAST 75984 320 $757.00 279.79 - 605.60 20.13 523.09 - 523.09 20.48 418.24 - 499.62 19.60 17.50 501.06 - - 361.34 451.68 - - - 605.60 - 17.50 177.35 - 309.61 567.75 287.74 338.61 - 80306661 GUID PERC DRNG W/CATH S&I 75989 320 $246.00 90.92 - 730.07 20.13 169.99 - 169.99 20.48 135.92 - 162.36 19.60 17.50 162.83 - - 584.06 730.07 - - - 196.80 - 17.50 169.12 - 100.61 184.50 93.50 110.04 - 80506660 GUID PERC DRNG W/CATH S&I 75989 402 $246.00 90.92 - 730.07 20.13 169.99 - 169.99 20.48 135.92 - 162.36 19.60 17.50 162.83 - - 584.06 730.07 - - - 196.80 - 17.50 169.12 - 100.61 184.50 93.50 110.04 - 80606664 GUIDE PERC DRNG W/CATH S&I 75989 350 $246.00 90.92 - " 1,774.00 " 20.13 " 1,774.00 " - " 1,774.00 " 20.48 135.92 - 725.00 19.60 17.50 162.83 - - 584.06 730.07 - - - 196.80 - 17.50 169.12 - 100.61 184.50 93.50 110.04 - 30603273 XR FLUORO TO 1HR C ARM 76000 320 "$1,208.00" 446.48 19.00 966.40 21.85 834.73 240.00 834.73 22.23 667.42 235.43 797.28 21.28 19.00 799.58 205.71 228.57 184.46 230.58 234.28 235.43 228.57 966.40 209.14 19.00 602.94 201.14 494.07 906.00 459.16 540.34 236.57 80101171 XR FLUORO TO 1HR FLUORO SUITE 76000 320 "$1,208.00" 446.48 19.00 966.40 21.85 834.73 240.00 834.73 22.23 667.42 235.43 797.28 21.28 19.00 799.58 205.71 228.57 184.46 230.58 234.28 235.43 228.57 966.40 209.14 19.00 602.94 201.14 494.07 906.00 459.16 540.34 236.57 80101341 XR FLUORO TO 1HR C ARM 76000 320 "$1,208.00" 446.48 19.00 966.40 21.85 834.73 240.00 834.73 22.23 667.42 235.43 797.28 21.28 19.00 799.58 205.71 228.57 184.46 230.58 234.28 235.43 228.57 966.40 209.14 19.00 602.94 201.14 494.07 906.00 459.16 540.34 236.57 80306776 XR FLUORO TO 1HR ANGIO SUITE 76000 320 "$1,208.00" 446.48 19.00 966.40 21.85 834.73 240.00 834.73 22.23 667.42 235.43 797.28 21.28 19.00 799.58 205.71 228.57 184.46 230.58 234.28 235.43 228.57 966.40 209.14 19.00 602.94 201.14 494.07 906.00 459.16 540.34 236.57 67901452 XR FOREIGN BODY NOSE-RECTUM 1V 76010 320 $425.00 157.08 14.50 340.00 16.68 293.68 84.37 293.68 16.97 234.81 82.76 280.50 16.24 14.50 281.31 72.32 80.35 93.70 117.12 82.36 82.76 80.35 340.00 73.52 14.50 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80101457 XR FOREIGN BODY NOSE-RECTUM 1V 76010 320 $425.00 157.08 14.50 340.00 16.68 293.68 84.37 293.68 16.97 234.81 82.76 280.50 16.24 14.50 281.31 72.32 80.35 93.70 117.12 82.36 82.76 80.35 340.00 73.52 14.50 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81401454 XR FOREIGN BODY NOSE-RECTUM 1V 76010 320 $425.00 157.08 14.50 340.00 16.68 293.68 84.37 293.68 16.97 234.81 82.76 280.50 16.24 14.50 281.31 72.32 80.35 93.70 117.12 82.36 82.76 80.35 340.00 73.52 14.50 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81701458 XR FOREIGN BODY NOSE-RECTUM 1V 76010 320 $425.00 157.08 14.50 340.00 16.68 293.68 84.37 293.68 16.97 234.81 82.76 280.50 16.24 14.50 281.31 72.32 80.35 93.70 117.12 82.36 82.76 80.35 340.00 73.52 14.50 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82601457 XR FOREIGN BODY NOSE-RECTUM 1V 76010 320 $425.00 157.08 14.50 340.00 16.68 293.68 84.37 293.68 16.97 234.81 82.76 280.50 16.24 14.50 281.31 72.32 80.35 93.70 117.12 82.36 82.76 80.35 340.00 73.52 14.50 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80101244 XR FISTULA/SINUS ABSCESS 76080 320 "$2,535.00" 936.94 27.50 " 2,028.00 " 31.63 " 1,751.69 " 503.98 " 1,751.69 " 32.18 " 1,400.59 " 494.38 " 1,673.10 " 30.80 27.50 " 1,677.92 " 431.98 479.98 223.02 278.78 491.98 494.38 479.98 " 2,028.00 " 439.18 27.50 " 1,265.17 " 422.38 " 1,036.82 " " 1,901.25 " 963.55 " 1,133.91 " 496.78 80301243 XR FISTULA/SINUS ABSCESS 76080 320 "$2,535.00" 936.94 27.50 " 2,028.00 " 31.63 " 1,751.69 " 503.98 " 1,751.69 " 32.18 " 1,400.59 " 494.38 " 1,673.10 " 30.80 27.50 " 1,677.92 " 431.98 479.98 223.02 278.78 491.98 494.38 479.98 " 2,028.00 " 439.18 27.50 " 1,265.17 " 422.38 " 1,036.82 " " 1,901.25 " 963.55 " 1,133.91 " 496.78 80101309 XR BREAST SPECIMEN 76098 320 "$2,535.00" 936.94 18.71 " 2,028.00 " 21.52 " 1,751.69 " 503.98 " 1,751.69 " 21.89 " 1,400.59 " 494.38 " 1,673.10 " 20.96 18.71 " 1,677.92 " 431.98 479.98 78.68 98.35 491.98 494.38 479.98 " 2,028.00 " 439.18 18.71 " 1,265.17 " 422.38 " 1,036.82 " " 1,901.25 " 963.55 " 1,133.91 " 496.78 80501307 XR BREAST SPECIMEN 76098 320 "$2,535.00" 936.94 18.71 " 2,028.00 " 21.52 " 1,751.69 " 503.98 " 1,751.69 " 21.89 " 1,400.59 " 494.38 " 1,673.10 " 20.96 18.71 " 1,677.92 " 431.98 479.98 78.68 98.35 491.98 494.38 479.98 " 2,028.00 " 439.18 18.71 " 1,265.17 " 422.38 " 1,036.82 " " 1,901.25 " 963.55 " 1,133.91 " 496.78 82701303 XR BREAST SPECIMEN 76098 320 "$2,535.00" 936.94 18.71 " 2,028.00 " 21.52 " 1,751.69 " 503.98 " 1,751.69 " 21.89 " 1,400.59 " 494.38 " 1,673.10 " 20.96 18.71 " 1,677.92 " 431.98 479.98 78.68 98.35 491.98 494.38 479.98 " 2,028.00 " 439.18 18.71 " 1,265.17 " 422.38 " 1,036.82 " " 1,901.25 " 963.55 " 1,133.91 " 496.78 67727665 3D RENDER W/INTN POSTPROCESS 76377 350 $134.00 49.53 - " 1,774.00 " - " 1,774.00 " - " 1,774.00 " - 74.04 - 725.00 - - 88.69 - - 662.95 828.69 - - - 107.20 - - 87.77 - 54.81 100.50 50.93 59.94 - 67927664 3D RENDER W/INTN POSTPROCESS 76377 350 $134.00 49.53 - " 1,774.00 " - " 1,774.00 " - " 1,774.00 " - 74.04 - 725.00 - - 88.69 - - 662.95 828.69 - - - 107.20 - - 87.77 - 54.81 100.50 50.93 59.94 - 80427662 3D RENDER W/INTN POSTPROCESS 76377 610 $134.00 49.53 - " 2,882.00 " - " 2,882.00 " - " 2,882.00 " - 74.04 - " 1,155.00 " - - 88.69 - - 662.95 828.69 - - - 107.20 - - 87.77 - 54.81 100.50 50.93 59.94 - 80627661 3D RENDER W/INTN POSTPROCESS 76377 350 $134.00 49.53 - " 1,774.00 " - " 1,774.00 " - " 1,774.00 " - 74.04 - 725.00 - - 88.69 - - 662.95 828.69 - - - 107.20 - - 87.77 - 54.81 100.50 50.93 59.94 - 81427666 3D RENDER W/INTN POSTPROCESS 76377 350 $134.00 49.53 - " 1,774.00 " - " 1,774.00 " - " 1,774.00 " - 74.04 - 725.00 - - 88.69 - - 662.95 828.69 - - - 107.20 - - 87.77 - 54.81 100.50 50.93 59.94 - 81627665 3D RENDER W/INTN POSTPROCESS 76377 350 $134.00 49.53 - " 1,774.00 " - " 1,774.00 " - " 1,774.00 " - 74.04 - 725.00 - - 88.69 - - 662.95 828.69 - - - 107.20 - - 87.77 - 54.81 100.50 50.93 59.94 - 83027665 3D RENDER W/INTN POSTPROCESS 76377 350 $134.00 49.53 - " 1,774.00 " - " 1,774.00 " - " 1,774.00 " - 74.04 - 725.00 - - 88.69 - - 662.95 828.69 - - - 107.20 - - 87.77 - 54.81 100.50 50.93 59.94 - 80609515 CT FOLLOW-UP STDY OR LOCAL LTD 76380 350 $425.00 157.08 - " 1,774.00 " - " 1,774.00 " 84.37 " 1,774.00 " - 234.81 82.76 725.00 - - 281.31 72.32 80.35 591.54 739.42 82.36 82.76 80.35 340.00 73.52 - 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80407611 MR SPECTROSCOPY 76390 610 $425.00 157.08 - " 2,882.00 " - " 2,882.00 " 84.37 " 2,882.00 " - 234.81 82.76 " 1,155.00 " - - 281.31 72.32 80.35 " 1,466.47 " " 1,833.09 " 82.36 82.76 80.35 340.00 73.52 - 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81407614 MR SPECTROSCOPY 76390 610 $425.00 157.08 - " 2,882.00 " - " 2,882.00 " 84.37 " 2,882.00 " - 234.81 82.76 " 1,155.00 " - - 281.31 72.32 80.35 " 1,466.47 " " 1,833.09 " 82.36 82.76 80.35 340.00 73.52 - 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80330821 UNL FLUORO PROCEDURE 76496 320 $425.00 157.08 - 340.00 - 293.68 84.37 293.68 - 234.81 82.76 280.50 - - 281.31 72.32 80.35 225.21 281.52 82.36 82.76 80.35 340.00 73.52 - 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80420153 HC UNL MRI BRAIN PERFUSION 76498 610 $425.00 157.08 - " 2,882.00 " - " 2,882.00 " 84.37 " 2,882.00 " - 234.81 82.76 " 1,155.00 " - - 281.31 72.32 80.35 225.21 281.52 82.36 82.76 80.35 340.00 73.52 - 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81420157 HC UNL MRI BRAIN PERFUSION 76498 610 $425.00 157.08 - " 2,882.00 " - " 2,882.00 " 84.37 " 2,882.00 " - 234.81 82.76 " 1,155.00 " - - 281.31 72.32 80.35 225.21 281.52 82.36 82.76 80.35 340.00 73.52 - 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81620156 HC UNL MRI BRAIN PERFUSION 76498 610 $425.00 157.08 - " 2,882.00 " - " 2,882.00 " 84.37 " 2,882.00 " - 234.81 82.76 " 1,155.00 " - - 281.31 72.32 80.35 225.21 281.52 82.36 82.76 80.35 340.00 73.52 - 211.96 70.71 173.83 318.75 161.54 190.10 83.16 67908007 US HEAD 76506 402 $572.00 211.41 78.25 457.60 89.99 395.25 113.56 395.25 91.55 316.03 111.39 377.52 87.64 78.25 378.61 97.34 108.15 281.41 351.76 110.85 111.39 108.15 457.60 98.96 78.25 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80508000 US HEAD 76506 402 $572.00 211.41 78.25 457.60 89.99 395.25 113.56 395.25 91.55 316.03 111.39 377.52 87.64 78.25 378.61 97.34 108.15 281.41 351.76 110.85 111.39 108.15 457.60 98.96 78.25 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81408009 US HEAD 76506 402 $572.00 211.41 78.25 457.60 89.99 395.25 113.56 395.25 91.55 316.03 111.39 377.52 87.64 78.25 378.61 97.34 108.15 281.41 351.76 110.85 111.39 108.15 457.60 98.96 78.25 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81608008 US HEAD 76506 402 $572.00 211.41 78.25 457.60 89.99 395.25 113.56 395.25 91.55 316.03 111.39 377.52 87.64 78.25 378.61 97.34 108.15 281.41 351.76 110.85 111.39 108.15 457.60 98.96 78.25 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81708002 US HEAD 76506 402 $572.00 211.41 78.25 457.60 89.99 395.25 113.56 395.25 91.55 316.03 111.39 377.52 87.64 78.25 378.61 97.34 108.15 281.41 351.76 110.85 111.39 108.15 457.60 98.96 78.25 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82608001 US HEAD 76506 402 $572.00 211.41 78.25 457.60 89.99 395.25 113.56 395.25 91.55 316.03 111.39 377.52 87.64 78.25 378.61 97.34 108.15 281.41 351.76 110.85 111.39 108.15 457.60 98.96 78.25 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82908005 US HEAD 76506 402 $572.00 211.41 78.25 457.60 89.99 395.25 113.56 395.25 91.55 316.03 111.39 377.52 87.64 78.25 378.61 97.34 108.15 281.41 351.76 110.85 111.39 108.15 457.60 98.96 78.25 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83008008 US HEAD 76506 402 $572.00 211.41 78.25 457.60 89.99 395.25 113.56 395.25 91.55 316.03 111.39 377.52 87.64 78.25 378.61 97.34 108.15 281.41 351.76 110.85 111.39 108.15 457.60 98.96 78.25 285.50 95.17 233.95 429.00 217.42 255.86 111.94 37003883 OPHTHALMIC B-SCAN US 76512 402 $572.00 211.41 77.10 457.60 88.67 395.25 113.56 395.25 90.21 316.03 111.39 377.52 86.35 77.10 378.61 97.34 108.15 300.61 375.76 110.85 111.39 108.15 457.60 98.96 77.10 285.50 95.17 233.95 429.00 217.42 255.86 111.94 37003891 ECHO EXAM OF EYE 76529 402 $425.00 157.08 64.82 340.00 74.54 293.68 84.37 293.68 75.84 234.81 82.76 280.50 72.60 64.82 281.31 72.32 80.35 265.30 331.62 82.36 82.76 80.35 340.00 73.52 64.82 211.96 70.71 173.83 318.75 161.54 190.10 83.16 67908015 US SOFT TISSUE HEAD/NECK 76536 402 $572.00 211.41 76.35 457.60 87.80 395.25 113.56 395.25 89.33 316.03 111.39 377.52 85.51 76.35 378.61 97.34 108.15 269.95 337.44 110.85 111.39 108.15 457.60 98.96 76.35 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80308019 US SOFT TISSUE HEAD/NECK 76536 402 $572.00 211.41 76.35 457.60 87.80 395.25 113.56 395.25 89.33 316.03 111.39 377.52 85.51 76.35 378.61 97.34 108.15 269.95 337.44 110.85 111.39 108.15 457.60 98.96 76.35 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80508018 US SOFT TISSUE HEAD/NECK 76536 402 $572.00 211.41 76.35 457.60 87.80 395.25 113.56 395.25 89.33 316.03 111.39 377.52 85.51 76.35 378.61 97.34 108.15 269.95 337.44 110.85 111.39 108.15 457.60 98.96 76.35 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81408017 US SOFT TISSUE HEAD/NECK 76536 402 $572.00 211.41 76.35 457.60 87.80 395.25 113.56 395.25 89.33 316.03 111.39 377.52 85.51 76.35 378.61 97.34 108.15 269.95 337.44 110.85 111.39 108.15 457.60 98.96 76.35 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81608016 US SOFT TISSUE HEAD/NECK 76536 402 $572.00 211.41 76.35 457.60 87.80 395.25 113.56 395.25 89.33 316.03 111.39 377.52 85.51 76.35 378.61 97.34 108.15 269.95 337.44 110.85 111.39 108.15 457.60 98.96 76.35 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81708011 US SOFT TISSUE HEAD/NECK 76536 402 $572.00 211.41 76.35 457.60 87.80 395.25 113.56 395.25 89.33 316.03 111.39 377.52 85.51 76.35 378.61 97.34 108.15 269.95 337.44 110.85 111.39 108.15 457.60 98.96 76.35 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82608010 US SOFT TISSUE HEAD/NECK 76536 402 $572.00 211.41 76.35 457.60 87.80 395.25 113.56 395.25 89.33 316.03 111.39 377.52 85.51 76.35 378.61 97.34 108.15 269.95 337.44 110.85 111.39 108.15 457.60 98.96 76.35 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82908013 US SOFT TISSUE HEAD/NECK 76536 402 $572.00 211.41 76.35 457.60 87.80 395.25 113.56 395.25 89.33 316.03 111.39 377.52 85.51 76.35 378.61 97.34 108.15 269.95 337.44 110.85 111.39 108.15 457.60 98.96 76.35 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83008016 US SOFT TISSUE HEAD/NECK 76536 402 $572.00 211.41 76.35 457.60 87.80 395.25 113.56 395.25 89.33 316.03 111.39 377.52 85.51 76.35 378.61 97.34 108.15 269.95 337.44 110.85 111.39 108.15 457.60 98.96 76.35 285.50 95.17 233.95 429.00 217.42 255.86 111.94 37003930 US CHEST 76604 402 $572.00 211.41 74.03 457.60 85.13 395.25 113.56 395.25 86.62 316.03 111.39 377.52 82.91 74.03 378.61 97.34 108.15 254.57 318.21 110.85 111.39 108.15 457.60 98.96 74.03 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67908023 US CHEST 76604 402 $572.00 211.41 74.03 457.60 85.13 395.25 113.56 395.25 86.62 316.03 111.39 377.52 82.91 74.03 378.61 97.34 108.15 254.57 318.21 110.85 111.39 108.15 457.60 98.96 74.03 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80308027 US CHEST 76604 402 $572.00 211.41 74.03 457.60 85.13 395.25 113.56 395.25 86.62 316.03 111.39 377.52 82.91 74.03 378.61 97.34 108.15 254.57 318.21 110.85 111.39 108.15 457.60 98.96 74.03 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80508026 US CHEST 76604 402 $572.00 211.41 74.03 457.60 85.13 395.25 113.56 395.25 86.62 316.03 111.39 377.52 82.91 74.03 378.61 97.34 108.15 254.57 318.21 110.85 111.39 108.15 457.60 98.96 74.03 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81408025 US CHEST 76604 402 $572.00 211.41 74.03 457.60 85.13 395.25 113.56 395.25 86.62 316.03 111.39 377.52 82.91 74.03 378.61 97.34 108.15 254.57 318.21 110.85 111.39 108.15 457.60 98.96 74.03 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81608024 US CHEST 76604 402 $572.00 211.41 74.03 457.60 85.13 395.25 113.56 395.25 86.62 316.03 111.39 377.52 82.91 74.03 378.61 97.34 108.15 254.57 318.21 110.85 111.39 108.15 457.60 98.96 74.03 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81708029 US CHEST 76604 402 $572.00 211.41 74.03 457.60 85.13 395.25 113.56 395.25 86.62 316.03 111.39 377.52 82.91 74.03 378.61 97.34 108.15 254.57 318.21 110.85 111.39 108.15 457.60 98.96 74.03 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82608028 US CHEST 76604 402 $572.00 211.41 74.03 457.60 85.13 395.25 113.56 395.25 86.62 316.03 111.39 377.52 82.91 74.03 378.61 97.34 108.15 254.57 318.21 110.85 111.39 108.15 457.60 98.96 74.03 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82708022 US CHEST 76604 402 $572.00 211.41 74.03 457.60 85.13 395.25 113.56 395.25 86.62 316.03 111.39 377.52 82.91 74.03 378.61 97.34 108.15 254.57 318.21 110.85 111.39 108.15 457.60 98.96 74.03 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82908021 US CHEST 76604 402 $572.00 211.41 74.03 457.60 85.13 395.25 113.56 395.25 86.62 316.03 111.39 377.52 82.91 74.03 378.61 97.34 108.15 254.57 318.21 110.85 111.39 108.15 457.60 98.96 74.03 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83008024 US CHEST 76604 402 $572.00 211.41 74.03 457.60 85.13 395.25 113.56 395.25 86.62 316.03 111.39 377.52 82.91 74.03 378.61 97.34 108.15 254.57 318.21 110.85 111.39 108.15 457.60 98.96 74.03 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67937023 US BREAST COMPLETE 76641 402 $572.00 211.41 82.89 457.60 95.32 395.25 113.56 395.25 96.98 316.03 111.39 377.52 92.84 82.89 378.61 97.34 108.15 127.07 158.84 110.85 111.39 108.15 457.60 98.96 82.89 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80537026 US BREAST COMPLETE 76641 402 $572.00 211.41 82.89 457.60 95.32 395.25 113.56 395.25 96.98 316.03 111.39 377.52 92.84 82.89 378.61 97.34 108.15 127.07 158.84 110.85 111.39 108.15 457.60 98.96 82.89 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81437025 US BREAST COMPLETE 76641 402 $572.00 211.41 82.89 457.60 95.32 395.25 113.56 395.25 96.98 316.03 111.39 377.52 92.84 82.89 378.61 97.34 108.15 127.07 158.84 110.85 111.39 108.15 457.60 98.96 82.89 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81637024 US BREAST COMPLETE 76641 402 $572.00 211.41 82.89 457.60 95.32 395.25 113.56 395.25 96.98 316.03 111.39 377.52 92.84 82.89 378.61 97.34 108.15 127.07 158.84 110.85 111.39 108.15 457.60 98.96 82.89 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81737029 US BREAST COMPLETE 76641 402 $572.00 211.41 82.89 457.60 95.32 395.25 113.56 395.25 96.98 316.03 111.39 377.52 92.84 82.89 378.61 97.34 108.15 127.07 158.84 110.85 111.39 108.15 457.60 98.96 82.89 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82637028 US BREAST COMPLETE 76641 402 $572.00 211.41 82.89 457.60 95.32 395.25 113.56 395.25 96.98 316.03 111.39 377.52 92.84 82.89 378.61 97.34 108.15 127.07 158.84 110.85 111.39 108.15 457.60 98.96 82.89 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82737022 US BREAST COMPLETE 76641 402 $572.00 211.41 82.89 457.60 95.32 395.25 113.56 395.25 96.98 316.03 111.39 377.52 92.84 82.89 378.61 97.34 108.15 127.07 158.84 110.85 111.39 108.15 457.60 98.96 82.89 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83037024 US BREAST COMPLETE 76641 402 $572.00 211.41 82.89 457.60 95.32 395.25 113.56 395.25 96.98 316.03 111.39 377.52 92.84 82.89 378.61 97.34 108.15 127.07 158.84 110.85 111.39 108.15 457.60 98.96 82.89 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67937031 US BREAST LIMITED 76642 402 $425.00 157.08 68.44 340.00 78.71 293.68 84.37 293.68 80.07 234.81 82.76 280.50 76.65 68.44 281.31 72.32 80.35 97.36 121.70 82.36 82.76 80.35 340.00 73.52 68.44 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80537034 US BREAST LIMITED 76642 402 $425.00 157.08 68.44 340.00 78.71 293.68 84.37 293.68 80.07 234.81 82.76 280.50 76.65 68.44 281.31 72.32 80.35 97.36 121.70 82.36 82.76 80.35 340.00 73.52 68.44 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81437033 US BREAST LIMITED 76642 402 $425.00 157.08 68.44 340.00 78.71 293.68 84.37 293.68 80.07 234.81 82.76 280.50 76.65 68.44 281.31 72.32 80.35 97.36 121.70 82.36 82.76 80.35 340.00 73.52 68.44 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81637032 US BREAST LIMITED 76642 402 $425.00 157.08 68.44 340.00 78.71 293.68 84.37 293.68 80.07 234.81 82.76 280.50 76.65 68.44 281.31 72.32 80.35 97.36 121.70 82.36 82.76 80.35 340.00 73.52 68.44 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81737037 US BREAST LIMITED 76642 402 $425.00 157.08 68.44 340.00 78.71 293.68 84.37 293.68 80.07 234.81 82.76 280.50 76.65 68.44 281.31 72.32 80.35 97.36 121.70 82.36 82.76 80.35 340.00 73.52 68.44 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82637036 US BREAST LIMITED 76642 402 $425.00 157.08 68.44 340.00 78.71 293.68 84.37 293.68 80.07 234.81 82.76 280.50 76.65 68.44 281.31 72.32 80.35 97.36 121.70 82.36 82.76 80.35 340.00 73.52 68.44 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82737031 US BREAST LIMITED 76642 402 $425.00 157.08 68.44 340.00 78.71 293.68 84.37 293.68 80.07 234.81 82.76 280.50 76.65 68.44 281.31 72.32 80.35 97.36 121.70 82.36 82.76 80.35 340.00 73.52 68.44 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83037032 US BREAST LIMITED 76642 402 $425.00 157.08 68.44 340.00 78.71 293.68 84.37 293.68 80.07 234.81 82.76 280.50 76.65 68.44 281.31 72.32 80.35 97.36 121.70 82.36 82.76 80.35 340.00 73.52 68.44 211.96 70.71 173.83 318.75 161.54 190.10 83.16 67908040 US ABDOMEN COMPLETE 76700 402 $572.00 211.41 95.17 473.20 109.56 395.25 113.56 395.25 111.47 316.03 111.39 377.52 106.70 95.27 378.61 97.34 108.15 378.56 473.20 110.85 111.39 108.15 457.60 98.96 95.27 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80508042 US ABDOMEN COMPLETE 76700 402 $572.00 211.41 95.17 473.20 109.56 395.25 113.56 395.25 111.47 316.03 111.39 377.52 106.70 95.27 378.61 97.34 108.15 378.56 473.20 110.85 111.39 108.15 457.60 98.96 95.27 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81408041 US ABDOMEN COMPLETE 76700 402 $572.00 211.41 95.17 473.20 109.56 395.25 113.56 395.25 111.47 316.03 111.39 377.52 106.70 95.27 378.61 97.34 108.15 378.56 473.20 110.85 111.39 108.15 457.60 98.96 95.27 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81608041 US ABDOMEN COMPLETE 76700 402 $572.00 211.41 95.17 473.20 109.56 395.25 113.56 395.25 111.47 316.03 111.39 377.52 106.70 95.27 378.61 97.34 108.15 378.56 473.20 110.85 111.39 108.15 457.60 98.96 95.27 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81708045 US ABDOMEN COMPLETE 76700 402 $572.00 211.41 95.17 473.20 109.56 395.25 113.56 395.25 111.47 316.03 111.39 377.52 106.70 95.27 378.61 97.34 108.15 378.56 473.20 110.85 111.39 108.15 457.60 98.96 95.27 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82608044 US ABDOMEN COMPLETE 76700 402 $572.00 211.41 95.17 473.20 109.56 395.25 113.56 395.25 111.47 316.03 111.39 377.52 106.70 95.27 378.61 97.34 108.15 378.56 473.20 110.85 111.39 108.15 457.60 98.96 95.27 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82908048 US ABDOMEN COMPLETE 76700 402 $572.00 211.41 95.17 473.20 109.56 395.25 113.56 395.25 111.47 316.03 111.39 377.52 106.70 95.27 378.61 97.34 108.15 378.56 473.20 110.85 111.39 108.15 457.60 98.96 95.27 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83008041 US ABDOMEN COMPLETE 76700 402 $572.00 211.41 95.17 473.20 109.56 395.25 113.56 395.25 111.47 316.03 111.39 377.52 106.70 95.27 378.61 97.34 108.15 378.56 473.20 110.85 111.39 108.15 457.60 98.96 95.27 285.50 95.17 233.95 429.00 217.42 255.86 111.94 37003841 US ABDOMEN LIMITED 76705 402 $572.00 211.41 62.50 457.60 71.88 395.25 113.56 395.25 73.13 316.03 111.39 377.52 70.00 62.50 378.61 97.34 108.15 274.50 343.13 110.85 111.39 108.15 457.60 98.96 62.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67908058 US ABDOMEN LIMITED 76705 402 $572.00 211.41 62.50 457.60 71.88 395.25 113.56 395.25 73.13 316.03 111.39 377.52 70.00 62.50 378.61 97.34 108.15 274.50 343.13 110.85 111.39 108.15 457.60 98.96 62.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80308051 US ABDOMEN LIMITED 76705 402 $572.00 211.41 62.50 457.60 71.88 395.25 113.56 395.25 73.13 316.03 111.39 377.52 70.00 62.50 378.61 97.34 108.15 274.50 343.13 110.85 111.39 108.15 457.60 98.96 62.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80508051 US ABDOMEN LIMITED 76705 402 $572.00 211.41 62.50 457.60 71.88 395.25 113.56 395.25 73.13 316.03 111.39 377.52 70.00 62.50 378.61 97.34 108.15 274.50 343.13 110.85 111.39 108.15 457.60 98.96 62.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81408050 US ABDOMEN LIMITED 76705 402 $572.00 211.41 62.50 457.60 71.88 395.25 113.56 395.25 73.13 316.03 111.39 377.52 70.00 62.50 378.61 97.34 108.15 274.50 343.13 110.85 111.39 108.15 457.60 98.96 62.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81608059 US ABDOMEN LIMITED 76705 402 $572.00 211.41 62.50 457.60 71.88 395.25 113.56 395.25 73.13 316.03 111.39 377.52 70.00 62.50 378.61 97.34 108.15 274.50 343.13 110.85 111.39 108.15 457.60 98.96 62.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81708053 US ABDOMEN LIMITED 76705 402 $572.00 211.41 62.50 457.60 71.88 395.25 113.56 395.25 73.13 316.03 111.39 377.52 70.00 62.50 378.61 97.34 108.15 274.50 343.13 110.85 111.39 108.15 457.60 98.96 62.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82608052 US ABDOMEN LIMITED 76705 402 $572.00 211.41 62.50 457.60 71.88 395.25 113.56 395.25 73.13 316.03 111.39 377.52 70.00 62.50 378.61 97.34 108.15 274.50 343.13 110.85 111.39 108.15 457.60 98.96 62.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82908056 US ABDOMEN LIMITED 76705 402 $572.00 211.41 62.50 457.60 71.88 395.25 113.56 395.25 73.13 316.03 111.39 377.52 70.00 62.50 378.61 97.34 108.15 274.50 343.13 110.85 111.39 108.15 457.60 98.96 62.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83008059 US ABDOMEN LIMITED 76705 402 $572.00 211.41 62.50 457.60 71.88 395.25 113.56 395.25 73.13 316.03 111.39 377.52 70.00 62.50 378.61 97.34 108.15 274.50 343.13 110.85 111.39 108.15 457.60 98.96 62.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 54008813 US B-SCAN AAA SCREENING 76706 402 $572.00 211.41 72.40 457.60 83.26 395.25 113.56 395.25 84.71 316.03 111.39 377.52 81.09 72.40 378.61 97.34 108.15 327.70 409.63 110.85 111.39 108.15 457.60 98.96 72.40 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67908813 US B-SCAN AAA SCREENING 76706 402 $572.00 211.41 72.40 457.60 83.26 395.25 113.56 395.25 84.71 316.03 111.39 377.52 81.09 72.40 378.61 97.34 108.15 327.70 409.63 110.85 111.39 108.15 457.60 98.96 72.40 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80508816 US B-SCAN AAA SCREENING 76706 402 $572.00 211.41 72.40 457.60 83.26 395.25 113.56 395.25 84.71 316.03 111.39 377.52 81.09 72.40 378.61 97.34 108.15 327.70 409.63 110.85 111.39 108.15 457.60 98.96 72.40 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81408815 US B-SCAN AAA SCREENING 76706 402 $572.00 211.41 72.40 457.60 83.26 395.25 113.56 395.25 84.71 316.03 111.39 377.52 81.09 72.40 378.61 97.34 108.15 327.70 409.63 110.85 111.39 108.15 457.60 98.96 72.40 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81608814 US B-SCAN AAA SCREENING 76706 402 $572.00 211.41 72.40 457.60 83.26 395.25 113.56 395.25 84.71 316.03 111.39 377.52 81.09 72.40 378.61 97.34 108.15 327.70 409.63 110.85 111.39 108.15 457.60 98.96 72.40 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81708819 US B-SCAN AAA SCREENING 76706 402 $572.00 211.41 72.40 457.60 83.26 395.25 113.56 395.25 84.71 316.03 111.39 377.52 81.09 72.40 378.61 97.34 108.15 327.70 409.63 110.85 111.39 108.15 457.60 98.96 72.40 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82608818 US B-SCAN AAA SCREENING 76706 402 $572.00 211.41 72.40 457.60 83.26 395.25 113.56 395.25 84.71 316.03 111.39 377.52 81.09 72.40 378.61 97.34 108.15 327.70 409.63 110.85 111.39 108.15 457.60 98.96 72.40 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82908811 US B-SCAN AAA SCREENING 76706 402 $572.00 211.41 72.40 457.60 83.26 395.25 113.56 395.25 84.71 316.03 111.39 377.52 81.09 72.40 378.61 97.34 108.15 327.70 409.63 110.85 111.39 108.15 457.60 98.96 72.40 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83008814 US B-SCAN AAA SCREENING 76706 402 $572.00 211.41 72.40 457.60 83.26 395.25 113.56 395.25 84.71 316.03 111.39 377.52 81.09 72.40 378.61 97.34 108.15 327.70 409.63 110.85 111.39 108.15 457.60 98.96 72.40 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67908066 US RETROPERITONEAL COMPLETE 76770 402 $572.00 211.41 81.50 458.88 93.73 395.25 113.56 395.25 95.36 316.03 111.39 377.52 91.28 81.50 378.61 97.34 108.15 367.10 458.88 110.85 111.39 108.15 457.60 98.96 81.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80508069 US RETROPERITONEAL COMPLETE 76770 402 $572.00 211.41 81.50 458.88 93.73 395.25 113.56 395.25 95.36 316.03 111.39 377.52 91.28 81.50 378.61 97.34 108.15 367.10 458.88 110.85 111.39 108.15 457.60 98.96 81.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81408068 US RETROPERITONEAL COMPLETE 76770 402 $572.00 211.41 81.50 458.88 93.73 395.25 113.56 395.25 95.36 316.03 111.39 377.52 91.28 81.50 378.61 97.34 108.15 367.10 458.88 110.85 111.39 108.15 457.60 98.96 81.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81608067 US RETROPERITONEAL COMPLETE 76770 402 $572.00 211.41 81.50 458.88 93.73 395.25 113.56 395.25 95.36 316.03 111.39 377.52 91.28 81.50 378.61 97.34 108.15 367.10 458.88 110.85 111.39 108.15 457.60 98.96 81.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81708061 US RETROPERITONEAL COMPLETE 76770 402 $572.00 211.41 81.50 458.88 93.73 395.25 113.56 395.25 95.36 316.03 111.39 377.52 91.28 81.50 378.61 97.34 108.15 367.10 458.88 110.85 111.39 108.15 457.60 98.96 81.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82608061 US RETROPERITONEAL COMPLETE 76770 402 $572.00 211.41 81.50 458.88 93.73 395.25 113.56 395.25 95.36 316.03 111.39 377.52 91.28 81.50 378.61 97.34 108.15 367.10 458.88 110.85 111.39 108.15 457.60 98.96 81.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82708065 US RETROPERITONEAL COMPLETE 76770 402 $572.00 211.41 81.50 458.88 93.73 395.25 113.56 395.25 95.36 316.03 111.39 377.52 91.28 81.50 378.61 97.34 108.15 367.10 458.88 110.85 111.39 108.15 457.60 98.96 81.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82908064 US RETROPERITONEAL COMPLETE 76770 402 $572.00 211.41 81.50 458.88 93.73 395.25 113.56 395.25 95.36 316.03 111.39 377.52 91.28 81.50 378.61 97.34 108.15 367.10 458.88 110.85 111.39 108.15 457.60 98.96 81.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83008067 US RETROPERITONEAL COMPLETE 76770 402 $572.00 211.41 81.50 458.88 93.73 395.25 113.56 395.25 95.36 316.03 111.39 377.52 91.28 81.50 378.61 97.34 108.15 367.10 458.88 110.85 111.39 108.15 457.60 98.96 81.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 37003948 US NATIVE KIDNEY LTD 76775 402 $572.00 211.41 76.12 457.60 87.54 395.25 113.56 395.25 89.06 316.03 111.39 377.52 85.25 76.12 378.61 97.34 108.15 273.35 341.69 110.85 111.39 108.15 457.60 98.96 76.12 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67908074 US RETROPERITONEAL LIMITED 76775 402 $572.00 211.41 76.12 457.60 87.54 395.25 113.56 395.25 89.06 316.03 111.39 377.52 85.25 76.12 378.61 97.34 108.15 273.35 341.69 110.85 111.39 108.15 457.60 98.96 76.12 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80508077 US RETROPERITONEAL LIMITED 76775 402 $572.00 211.41 76.12 457.60 87.54 395.25 113.56 395.25 89.06 316.03 111.39 377.52 85.25 76.12 378.61 97.34 108.15 273.35 341.69 110.85 111.39 108.15 457.60 98.96 76.12 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81408076 US RETROPERITONEAL LIMITED 76775 402 $572.00 211.41 76.12 457.60 87.54 395.25 113.56 395.25 89.06 316.03 111.39 377.52 85.25 76.12 378.61 97.34 108.15 273.35 341.69 110.85 111.39 108.15 457.60 98.96 76.12 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81608075 US RETROPERITONEAL LIMITED 76775 402 $572.00 211.41 76.12 457.60 87.54 395.25 113.56 395.25 89.06 316.03 111.39 377.52 85.25 76.12 378.61 97.34 108.15 273.35 341.69 110.85 111.39 108.15 457.60 98.96 76.12 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81708070 US RETROPERITONEAL LIMITED 76775 402 $572.00 211.41 76.12 457.60 87.54 395.25 113.56 395.25 89.06 316.03 111.39 377.52 85.25 76.12 378.61 97.34 108.15 273.35 341.69 110.85 111.39 108.15 457.60 98.96 76.12 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82608079 US RETROPERITONEAL LIMITED 76775 402 $572.00 211.41 76.12 457.60 87.54 395.25 113.56 395.25 89.06 316.03 111.39 377.52 85.25 76.12 378.61 97.34 108.15 273.35 341.69 110.85 111.39 108.15 457.60 98.96 76.12 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82908072 US RETROPERITONEAL LIMITED 76775 402 $572.00 211.41 76.12 457.60 87.54 395.25 113.56 395.25 89.06 316.03 111.39 377.52 85.25 76.12 378.61 97.34 108.15 273.35 341.69 110.85 111.39 108.15 457.60 98.96 76.12 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83008075 US RETROPERITONEAL LIMITED 76775 402 $572.00 211.41 76.12 457.60 87.54 395.25 113.56 395.25 89.06 316.03 111.39 377.52 85.25 76.12 378.61 97.34 108.15 273.35 341.69 110.85 111.39 108.15 457.60 98.96 76.12 285.50 95.17 233.95 429.00 217.42 255.86 111.94 54008082 US TRANS KIDNEY W/IMG 76776 402 $572.00 211.41 91.13 518.97 104.80 395.25 113.56 395.25 106.62 316.03 111.39 377.52 102.07 91.13 378.61 97.34 108.15 415.18 518.97 110.85 111.39 108.15 457.60 98.96 91.13 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67908082 US RENAL TRANSPLANT W/DOPPLER 76776 402 $572.00 211.41 91.13 518.97 104.80 395.25 113.56 395.25 106.62 316.03 111.39 377.52 102.07 91.13 378.61 97.34 108.15 415.18 518.97 110.85 111.39 108.15 457.60 98.96 91.13 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80508085 US RENAL TRANSPLANT W/DOPPLER 76776 402 $572.00 211.41 91.13 518.97 104.80 395.25 113.56 395.25 106.62 316.03 111.39 377.52 102.07 91.13 378.61 97.34 108.15 415.18 518.97 110.85 111.39 108.15 457.60 98.96 91.13 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81408084 US RENAL TRANSPLANT W/DOPPLER 76776 402 $572.00 211.41 91.13 518.97 104.80 395.25 113.56 395.25 106.62 316.03 111.39 377.52 102.07 91.13 378.61 97.34 108.15 415.18 518.97 110.85 111.39 108.15 457.60 98.96 91.13 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81608083 US RENAL TRANSPLANT W/DOPPLER 76776 402 $572.00 211.41 91.13 518.97 104.80 395.25 113.56 395.25 106.62 316.03 111.39 377.52 102.07 91.13 378.61 97.34 108.15 415.18 518.97 110.85 111.39 108.15 457.60 98.96 91.13 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81708088 US RENAL TRANSPLANT W/DOPPLER 76776 402 $572.00 211.41 91.13 518.97 104.80 395.25 113.56 395.25 106.62 316.03 111.39 377.52 102.07 91.13 378.61 97.34 108.15 415.18 518.97 110.85 111.39 108.15 457.60 98.96 91.13 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82608087 US RENAL TRANSPLANT W/DOPPLER 76776 402 $572.00 211.41 91.13 518.97 104.80 395.25 113.56 395.25 106.62 316.03 111.39 377.52 102.07 91.13 378.61 97.34 108.15 415.18 518.97 110.85 111.39 108.15 457.60 98.96 91.13 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82908081 US RENAL TRANSPLANT W/DOPPLER 76776 402 $572.00 211.41 91.13 518.97 104.80 395.25 113.56 395.25 106.62 316.03 111.39 377.52 102.07 91.13 378.61 97.34 108.15 415.18 518.97 110.85 111.39 108.15 457.60 98.96 91.13 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83008083 US RENAL TRANSPLANT W/DOPPLER 76776 402 $572.00 211.41 91.13 518.97 104.80 395.25 113.56 395.25 106.62 316.03 111.39 377.52 102.07 91.13 378.61 97.34 108.15 415.18 518.97 110.85 111.39 108.15 457.60 98.96 91.13 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67908091 US SPINAL CANAL & CONTENTS 76800 402 $572.00 211.41 95.17 481.44 116.89 395.25 113.56 395.25 118.92 316.03 111.39 377.52 113.84 101.64 378.61 97.34 108.15 385.15 481.44 110.85 111.39 108.15 457.60 98.96 101.64 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80508093 US SPINAL CANAL & CONTENTS 76800 402 $572.00 211.41 95.17 481.44 116.89 395.25 113.56 395.25 118.92 316.03 111.39 377.52 113.84 101.64 378.61 97.34 108.15 385.15 481.44 110.85 111.39 108.15 457.60 98.96 101.64 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81408092 US SPINAL CANAL & CONTENTS 76800 402 $572.00 211.41 95.17 481.44 116.89 395.25 113.56 395.25 118.92 316.03 111.39 377.52 113.84 101.64 378.61 97.34 108.15 385.15 481.44 110.85 111.39 108.15 457.60 98.96 101.64 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81608091 US SPINAL CANAL & CONTENTS 76800 402 $572.00 211.41 95.17 481.44 116.89 395.25 113.56 395.25 118.92 316.03 111.39 377.52 113.84 101.64 378.61 97.34 108.15 385.15 481.44 110.85 111.39 108.15 457.60 98.96 101.64 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81708096 US SPINAL CANAL & CONTENTS 76800 402 $572.00 211.41 95.17 481.44 116.89 395.25 113.56 395.25 118.92 316.03 111.39 377.52 113.84 101.64 378.61 97.34 108.15 385.15 481.44 110.85 111.39 108.15 457.60 98.96 101.64 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82608095 US SPINAL CANAL & CONTENTS 76800 402 $572.00 211.41 95.17 481.44 116.89 395.25 113.56 395.25 118.92 316.03 111.39 377.52 113.84 101.64 378.61 97.34 108.15 385.15 481.44 110.85 111.39 108.15 457.60 98.96 101.64 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82908099 US SPINAL CANAL & CONTENTS 76800 402 $572.00 211.41 95.17 481.44 116.89 395.25 113.56 395.25 118.92 316.03 111.39 377.52 113.84 101.64 378.61 97.34 108.15 385.15 481.44 110.85 111.39 108.15 457.60 98.96 101.64 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83008091 US SPINAL CANAL & CONTENTS 76800 402 $572.00 211.41 95.17 481.44 116.89 395.25 113.56 395.25 118.92 316.03 111.39 377.52 113.84 101.64 378.61 97.34 108.15 385.15 481.44 110.85 111.39 108.15 457.60 98.96 101.64 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67908724 US PREG UTERUS <14 WEEKS SNG 76801 402 $572.00 211.41 84.09 498.70 96.70 395.25 113.56 395.25 98.39 316.03 111.39 377.52 94.18 84.09 378.61 97.34 108.15 398.96 498.70 110.85 111.39 108.15 457.60 98.96 84.09 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80508727 US PREG UTERUS <14 WEEKS SNG 76801 402 $572.00 211.41 84.09 498.70 96.70 395.25 113.56 395.25 98.39 316.03 111.39 377.52 94.18 84.09 378.61 97.34 108.15 398.96 498.70 110.85 111.39 108.15 457.60 98.96 84.09 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81408726 US PREG UTERUS <14 WEEKS SNG 76801 402 $572.00 211.41 84.09 498.70 96.70 395.25 113.56 395.25 98.39 316.03 111.39 377.52 94.18 84.09 378.61 97.34 108.15 398.96 498.70 110.85 111.39 108.15 457.60 98.96 84.09 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81608725 US PREG UTERUS <14 WEEKS SNG 76801 402 $572.00 211.41 84.09 498.70 96.70 395.25 113.56 395.25 98.39 316.03 111.39 377.52 94.18 84.09 378.61 97.34 108.15 398.96 498.70 110.85 111.39 108.15 457.60 98.96 84.09 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81708720 US PREG UTERUS <14 WEEKS SNG 76801 402 $572.00 211.41 84.09 498.70 96.70 395.25 113.56 395.25 98.39 316.03 111.39 377.52 94.18 84.09 378.61 97.34 108.15 398.96 498.70 110.85 111.39 108.15 457.60 98.96 84.09 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82608729 US PREG UTERUS <14 WEEKS SNG 76801 402 $572.00 211.41 84.09 498.70 96.70 395.25 113.56 395.25 98.39 316.03 111.39 377.52 94.18 84.09 378.61 97.34 108.15 398.96 498.70 110.85 111.39 108.15 457.60 98.96 84.09 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82908722 US PREG UTERUS <14 WEEKS SNG 76801 402 $572.00 211.41 84.09 498.70 96.70 395.25 113.56 395.25 98.39 316.03 111.39 377.52 94.18 84.09 378.61 97.34 108.15 398.96 498.70 110.85 111.39 108.15 457.60 98.96 84.09 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83008725 US PREG UTERUS <14 WEEKS SNG 76801 402 $572.00 211.41 84.09 498.70 96.70 395.25 113.56 395.25 98.39 316.03 111.39 377.52 94.18 84.09 378.61 97.34 108.15 398.96 498.70 110.85 111.39 108.15 457.60 98.96 84.09 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67908732 US PREG UTERUS <14 WK ADD GEST 76802 402 $141.00 52.11 - 150.02 63.20 97.43 - 97.43 64.30 77.90 - 93.06 61.56 54.96 93.33 - - 120.02 150.02 - - - 112.80 - 54.96 59.42 - 57.67 105.75 53.59 63.07 - 80508735 US PREG UTERUS <14 WK ADD GEST 76802 402 $141.00 52.11 - 150.02 63.20 97.43 - 97.43 64.30 77.90 - 93.06 61.56 54.96 93.33 - - 120.02 150.02 - - - 112.80 - 54.96 59.42 - 57.67 105.75 53.59 63.07 - 81408734 US PREG UTERUS <14 WK ADD GEST 76802 402 $141.00 52.11 - 150.02 63.20 97.43 - 97.43 64.30 77.90 - 93.06 61.56 54.96 93.33 - - 120.02 150.02 - - - 112.80 - 54.96 59.42 - 57.67 105.75 53.59 63.07 - 81608733 US PREG UTERUS <14 WK ADD GEST 76802 402 $141.00 52.11 - 150.02 63.20 97.43 - 97.43 64.30 77.90 - 93.06 61.56 54.96 93.33 - - 120.02 150.02 - - - 112.80 - 54.96 59.42 - 57.67 105.75 53.59 63.07 - 81708738 US PREG UTERUS <14 WK ADD GEST 76802 402 $141.00 52.11 - 150.02 63.20 97.43 - 97.43 64.30 77.90 - 93.06 61.56 54.96 93.33 - - 120.02 150.02 - - - 112.80 - 54.96 59.42 - 57.67 105.75 53.59 63.07 - 82608737 US PREG UTERUS <14 WK ADD GEST 76802 402 $141.00 52.11 - 150.02 63.20 97.43 - 97.43 64.30 77.90 - 93.06 61.56 54.96 93.33 - - 120.02 150.02 - - - 112.80 - 54.96 59.42 - 57.67 105.75 53.59 63.07 - 82908731 US PREG UTERUS <14 WK ADD GEST 76802 402 $141.00 52.11 - 150.02 63.20 97.43 - 97.43 64.30 77.90 - 93.06 61.56 54.96 93.33 - - 120.02 150.02 - - - 112.80 - 54.96 59.42 - 57.67 105.75 53.59 63.07 - 83008733 US PREG UTERUS <14 WK ADD GEST 76802 402 $141.00 52.11 - 150.02 63.20 97.43 - 97.43 64.30 77.90 - 93.06 61.56 54.96 93.33 - - 120.02 150.02 - - - 112.80 - 54.96 59.42 - 57.67 105.75 53.59 63.07 - 67908104 US PREG UTERUS >14 WEEKS SNG 76805 402 $572.00 211.41 77.50 533.62 89.13 395.25 113.56 395.25 90.68 316.03 111.39 377.52 86.80 77.50 378.61 97.34 108.15 426.90 533.62 110.85 111.39 108.15 457.60 98.96 77.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80508107 US PREG UTERUS >14 WEEKS SNG 76805 402 $572.00 211.41 77.50 533.62 89.13 395.25 113.56 395.25 90.68 316.03 111.39 377.52 86.80 77.50 378.61 97.34 108.15 426.90 533.62 110.85 111.39 108.15 457.60 98.96 77.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81408106 US PREG UTERUS >14 WEEKS SNG 76805 402 $572.00 211.41 77.50 533.62 89.13 395.25 113.56 395.25 90.68 316.03 111.39 377.52 86.80 77.50 378.61 97.34 108.15 426.90 533.62 110.85 111.39 108.15 457.60 98.96 77.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81608105 US PREG UTERUS >14 WEEKS SNG 76805 402 $572.00 211.41 77.50 533.62 89.13 395.25 113.56 395.25 90.68 316.03 111.39 377.52 86.80 77.50 378.61 97.34 108.15 426.90 533.62 110.85 111.39 108.15 457.60 98.96 77.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81708100 US PREG UTERUS >14 WEEKS SNG 76805 402 $572.00 211.41 77.50 533.62 89.13 395.25 113.56 395.25 90.68 316.03 111.39 377.52 86.80 77.50 378.61 97.34 108.15 426.90 533.62 110.85 111.39 108.15 457.60 98.96 77.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82608109 US PREG UTERUS >14 WEEKS SNG 76805 402 $572.00 211.41 77.50 533.62 89.13 395.25 113.56 395.25 90.68 316.03 111.39 377.52 86.80 77.50 378.61 97.34 108.15 426.90 533.62 110.85 111.39 108.15 457.60 98.96 77.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82908102 US PREG UTERUS >14 WEEKS SNG 76805 402 $572.00 211.41 77.50 533.62 89.13 395.25 113.56 395.25 90.68 316.03 111.39 377.52 86.80 77.50 378.61 97.34 108.15 426.90 533.62 110.85 111.39 108.15 457.60 98.96 77.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83008105 US PREG UTERUS >14 WEEKS SNG 76805 402 $572.00 211.41 77.50 533.62 89.13 395.25 113.56 395.25 90.68 316.03 111.39 377.52 86.80 77.50 378.61 97.34 108.15 426.90 533.62 110.85 111.39 108.15 457.60 98.96 77.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67908112 US PREG UTERUS >14WK ADD GEST 76810 402 "$1,305.00" 482.33 - " 1,059.07 " 85.23 901.76 - 901.76 86.71 721.01 - 861.30 83.00 74.11 863.78 - - 847.26 " 1,059.07 " - - - " 1,044.00 " - 74.11 117.01 - 533.75 978.75 496.03 583.73 - 80508115 US PREG UTERUS >14WK ADD GEST 76810 402 "$1,305.00" 482.33 - " 1,059.07 " 85.23 901.76 - 901.76 86.71 721.01 - 861.30 83.00 74.11 863.78 - - 847.26 " 1,059.07 " - - - " 1,044.00 " - 74.11 117.01 - 533.75 978.75 496.03 583.73 - 81408114 US PREG UTERUS >14WK ADD GEST 76810 402 "$1,305.00" 482.33 - " 1,059.07 " 85.23 901.76 - 901.76 86.71 721.01 - 861.30 83.00 74.11 863.78 - - 847.26 " 1,059.07 " - - - " 1,044.00 " - 74.11 117.01 - 533.75 978.75 496.03 583.73 - 81608113 US PREG UTERUS >14WK ADD GEST 76810 402 "$1,305.00" 482.33 - " 1,059.07 " 85.23 901.76 - 901.76 86.71 721.01 - 861.30 83.00 74.11 863.78 - - 847.26 " 1,059.07 " - - - " 1,044.00 " - 74.11 117.01 - 533.75 978.75 496.03 583.73 - 81708118 US PREG UTERUS >14WK ADD GEST 76810 402 "$1,305.00" 482.33 - " 1,059.07 " 85.23 901.76 - 901.76 86.71 721.01 - 861.30 83.00 74.11 863.78 - - 847.26 " 1,059.07 " - - - " 1,044.00 " - 74.11 117.01 - 533.75 978.75 496.03 583.73 - 82608117 US PREG UTERUS >14WK ADD GEST 76810 402 "$1,305.00" 482.33 - " 1,059.07 " 85.23 901.76 - 901.76 86.71 721.01 - 861.30 83.00 74.11 863.78 - - 847.26 " 1,059.07 " - - - " 1,044.00 " - 74.11 117.01 - 533.75 978.75 496.03 583.73 - 82908111 US PREG UTERUS >14WK ADD GEST 76810 402 "$1,305.00" 482.33 - " 1,059.07 " 85.23 901.76 - 901.76 86.71 721.01 - 861.30 83.00 74.11 863.78 - - 847.26 " 1,059.07 " - - - " 1,044.00 " - 74.11 117.01 - 533.75 978.75 496.03 583.73 - 83008113 US PREG UTERUS >14WK ADD GEST 76810 402 "$1,305.00" 482.33 - " 1,059.07 " 85.23 901.76 - 901.76 86.71 721.01 - 861.30 83.00 74.11 863.78 - - 847.26 " 1,059.07 " - - - " 1,044.00 " - 74.11 117.01 - 533.75 978.75 496.03 583.73 - 67908741 US PREG UTERUS DETAIL SINGLE 76811 402 "$1,208.00" 446.48 184.11 " 1,183.91 " 211.73 834.73 240.00 834.73 215.41 667.42 235.43 797.28 206.20 184.11 799.58 205.71 228.57 947.13 " 1,183.91 " 234.28 235.43 228.57 966.40 209.14 184.11 602.94 201.14 494.07 906.00 459.16 540.34 236.57 80508743 US PREG UTERUS DETAIL SINGLE 76811 402 "$1,208.00" 446.48 184.11 " 1,183.91 " 211.73 834.73 240.00 834.73 215.41 667.42 235.43 797.28 206.20 184.11 799.58 205.71 228.57 947.13 " 1,183.91 " 234.28 235.43 228.57 966.40 209.14 184.11 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81408742 US PREG UTERUS DETAIL SINGLE 76811 402 "$1,208.00" 446.48 184.11 " 1,183.91 " 211.73 834.73 240.00 834.73 215.41 667.42 235.43 797.28 206.20 184.11 799.58 205.71 228.57 947.13 " 1,183.91 " 234.28 235.43 228.57 966.40 209.14 184.11 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81608741 US PREG UTERUS DETAIL SINGLE 76811 402 "$1,208.00" 446.48 184.11 " 1,183.91 " 211.73 834.73 240.00 834.73 215.41 667.42 235.43 797.28 206.20 184.11 799.58 205.71 228.57 947.13 " 1,183.91 " 234.28 235.43 228.57 966.40 209.14 184.11 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81708746 US PREG UTERUS DETAIL SINGLE 76811 402 "$1,208.00" 446.48 184.11 " 1,183.91 " 211.73 834.73 240.00 834.73 215.41 667.42 235.43 797.28 206.20 184.11 799.58 205.71 228.57 947.13 " 1,183.91 " 234.28 235.43 228.57 966.40 209.14 184.11 602.94 201.14 494.07 906.00 459.16 540.34 236.57 82608745 US PREG UTERUS DETAIL SINGLE 76811 402 "$1,208.00" 446.48 184.11 " 1,183.91 " 211.73 834.73 240.00 834.73 215.41 667.42 235.43 797.28 206.20 184.11 799.58 205.71 228.57 947.13 " 1,183.91 " 234.28 235.43 228.57 966.40 209.14 184.11 602.94 201.14 494.07 906.00 459.16 540.34 236.57 82908749 US PREG UTERUS DETAIL SINGLE 76811 402 "$1,208.00" 446.48 184.11 " 1,183.91 " 211.73 834.73 240.00 834.73 215.41 667.42 235.43 797.28 206.20 184.11 799.58 205.71 228.57 947.13 " 1,183.91 " 234.28 235.43 228.57 966.40 209.14 184.11 602.94 201.14 494.07 906.00 459.16 540.34 236.57 83008741 US PREG UTERUS DETAIL SINGLE 76811 402 "$1,208.00" 446.48 184.11 " 1,183.91 " 211.73 834.73 240.00 834.73 215.41 667.42 235.43 797.28 206.20 184.11 799.58 205.71 228.57 947.13 " 1,183.91 " 234.28 235.43 228.57 966.40 209.14 184.11 602.94 201.14 494.07 906.00 459.16 540.34 236.57 67908759 US PREG UTERUS DETAIL ADD GEST 76812 402 "$1,957.00" 723.31 - " 1,565.60 " 124.76 " 1,352.29 " - " 1,352.29 " 126.93 " 1,081.24 " - " 1,291.62 " 121.51 108.49 " 1,295.34 " - - 285.44 356.80 - - - " 1,565.60 " - 108.49 302.61 - 800.41 " 1,467.75 " 743.86 875.37 - 80508751 US PREG UTERUS DETAIL ADD GEST 76812 402 "$1,957.00" 723.31 - " 1,565.60 " 124.76 " 1,352.29 " - " 1,352.29 " 126.93 " 1,081.24 " - " 1,291.62 " 121.51 108.49 " 1,295.34 " - - 285.44 356.80 - - - " 1,565.60 " - 108.49 302.61 - 800.41 " 1,467.75 " 743.86 875.37 - 81408751 US PREG UTERUS DETAIL ADD GEST 76812 402 "$1,957.00" 723.31 - " 1,565.60 " 124.76 " 1,352.29 " - " 1,352.29 " 126.93 " 1,081.24 " - " 1,291.62 " 121.51 108.49 " 1,295.34 " - - 285.44 356.80 - - - " 1,565.60 " - 108.49 302.61 - 800.41 " 1,467.75 " 743.86 875.37 - 81608750 US PREG UTERUS DETAIL ADD GEST 76812 402 "$1,957.00" 723.31 - " 1,565.60 " 124.76 " 1,352.29 " - " 1,352.29 " 126.93 " 1,081.24 " - " 1,291.62 " 121.51 108.49 " 1,295.34 " - - 285.44 356.80 - - - " 1,565.60 " - 108.49 302.61 - 800.41 " 1,467.75 " 743.86 875.37 - 81708754 US PREG UTERUS DETAIL ADD GEST 76812 402 "$1,957.00" 723.31 - " 1,565.60 " 124.76 " 1,352.29 " - " 1,352.29 " 126.93 " 1,081.24 " - " 1,291.62 " 121.51 108.49 " 1,295.34 " - - 285.44 356.80 - - - " 1,565.60 " - 108.49 302.61 - 800.41 " 1,467.75 " 743.86 875.37 - 82608753 US PREG UTERUS DETAIL ADD GEST 76812 402 "$1,957.00" 723.31 - " 1,565.60 " 124.76 " 1,352.29 " - " 1,352.29 " 126.93 " 1,081.24 " - " 1,291.62 " 121.51 108.49 " 1,295.34 " - - 285.44 356.80 - - - " 1,565.60 " - 108.49 302.61 - 800.41 " 1,467.75 " 743.86 875.37 - 82908757 US PREG UTERUS DETAIL ADD GEST 76812 402 "$1,957.00" 723.31 - " 1,565.60 " 124.76 " 1,352.29 " - " 1,352.29 " 126.93 " 1,081.24 " - " 1,291.62 " 121.51 108.49 " 1,295.34 " - - 285.44 356.80 - - - " 1,565.60 " - 108.49 302.61 - 800.41 " 1,467.75 " 743.86 875.37 - 83008750 US PREG UTERUS DETAIL ADD GEST 76812 402 "$1,957.00" 723.31 - " 1,565.60 " 124.76 " 1,352.29 " - " 1,352.29 " 126.93 " 1,081.24 " - " 1,291.62 " 121.51 108.49 " 1,295.34 " - - 285.44 356.80 - - - " 1,565.60 " - 108.49 302.61 - 800.41 " 1,467.75 " 743.86 875.37 - 37003913 US PREG LTD 1 OR MORE 76815 402 $572.00 211.41 64.00 457.60 73.60 395.25 113.56 395.25 74.88 316.03 111.39 377.52 71.68 64.00 378.61 97.34 108.15 284.86 356.08 110.85 111.39 108.15 457.60 98.96 64.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67908121 US PREG UTERUS >14WK ADD GEST 76815 402 $572.00 211.41 64.00 457.60 73.60 395.25 113.56 395.25 74.88 316.03 111.39 377.52 71.68 64.00 378.61 97.34 108.15 284.86 356.08 110.85 111.39 108.15 457.60 98.96 64.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80508123 US PREG UTERUS >14WK ADD GEST 76815 402 $572.00 211.41 64.00 457.60 73.60 395.25 113.56 395.25 74.88 316.03 111.39 377.52 71.68 64.00 378.61 97.34 108.15 284.86 356.08 110.85 111.39 108.15 457.60 98.96 64.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81408122 US PREG UTERUS >14WK ADD GEST 76815 402 $572.00 211.41 64.00 457.60 73.60 395.25 113.56 395.25 74.88 316.03 111.39 377.52 71.68 64.00 378.61 97.34 108.15 284.86 356.08 110.85 111.39 108.15 457.60 98.96 64.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81608121 US PREG UTERUS >14WK ADD GEST 76815 402 $572.00 211.41 64.00 457.60 73.60 395.25 113.56 395.25 74.88 316.03 111.39 377.52 71.68 64.00 378.61 97.34 108.15 284.86 356.08 110.85 111.39 108.15 457.60 98.96 64.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81708126 US PREG UTERUS >14WK ADD GEST 76815 402 $572.00 211.41 64.00 457.60 73.60 395.25 113.56 395.25 74.88 316.03 111.39 377.52 71.68 64.00 378.61 97.34 108.15 284.86 356.08 110.85 111.39 108.15 457.60 98.96 64.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82608125 US PREG UTERUS >14WK ADD GEST 76815 402 $572.00 211.41 64.00 457.60 73.60 395.25 113.56 395.25 74.88 316.03 111.39 377.52 71.68 64.00 378.61 97.34 108.15 284.86 356.08 110.85 111.39 108.15 457.60 98.96 64.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82908129 US PREG UTERUS >14WK ADD GEST 76815 402 $572.00 211.41 64.00 457.60 73.60 395.25 113.56 395.25 74.88 316.03 111.39 377.52 71.68 64.00 378.61 97.34 108.15 284.86 356.08 110.85 111.39 108.15 457.60 98.96 64.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83008121 US PREG UTERUS >14WK ADD GEST 76815 402 $572.00 211.41 64.00 457.60 73.60 395.25 113.56 395.25 74.88 316.03 111.39 377.52 71.68 64.00 378.61 97.34 108.15 284.86 356.08 110.85 111.39 108.15 457.60 98.96 64.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67908767 US PREG UTERUS F/UP PER FETUS 76816 402 $572.00 211.41 72.28 457.60 83.12 395.25 113.56 395.25 84.57 316.03 111.39 377.52 80.95 72.28 378.61 97.34 108.15 236.83 296.04 110.85 111.39 108.15 457.60 98.96 72.28 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80508760 US PREG UTERUS F/UP PER FETUS 76816 402 $572.00 211.41 72.28 457.60 83.12 395.25 113.56 395.25 84.57 316.03 111.39 377.52 80.95 72.28 378.61 97.34 108.15 236.83 296.04 110.85 111.39 108.15 457.60 98.96 72.28 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81408769 US PREG UTERUS F/UP PER FETUS 76816 402 $572.00 211.41 72.28 457.60 83.12 395.25 113.56 395.25 84.57 316.03 111.39 377.52 80.95 72.28 378.61 97.34 108.15 236.83 296.04 110.85 111.39 108.15 457.60 98.96 72.28 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81608768 US PREG UTERUS F/UP PER FETUS 76816 402 $572.00 211.41 72.28 457.60 83.12 395.25 113.56 395.25 84.57 316.03 111.39 377.52 80.95 72.28 378.61 97.34 108.15 236.83 296.04 110.85 111.39 108.15 457.60 98.96 72.28 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81708762 US PREG UTERUS F/UP PER FETUS 76816 402 $572.00 211.41 72.28 457.60 83.12 395.25 113.56 395.25 84.57 316.03 111.39 377.52 80.95 72.28 378.61 97.34 108.15 236.83 296.04 110.85 111.39 108.15 457.60 98.96 72.28 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82608761 US PREG UTERUS F/UP PER FETUS 76816 402 $572.00 211.41 72.28 457.60 83.12 395.25 113.56 395.25 84.57 316.03 111.39 377.52 80.95 72.28 378.61 97.34 108.15 236.83 296.04 110.85 111.39 108.15 457.60 98.96 72.28 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82908765 US PREG UTERUS F/UP PER FETUS 76816 402 $572.00 211.41 72.28 457.60 83.12 395.25 113.56 395.25 84.57 316.03 111.39 377.52 80.95 72.28 378.61 97.34 108.15 236.83 296.04 110.85 111.39 108.15 457.60 98.96 72.28 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83008768 US PREG UTERUS F/UP PER FETUS 76816 402 $572.00 211.41 72.28 457.60 83.12 395.25 113.56 395.25 84.57 316.03 111.39 377.52 80.95 72.28 378.61 97.34 108.15 236.83 296.04 110.85 111.39 108.15 457.60 98.96 72.28 285.50 95.17 233.95 429.00 217.42 255.86 111.94 37003921 US PREG TRANSVAG OBSTETRIC 76817 402 $572.00 211.41 87.59 486.54 100.73 395.25 113.56 395.25 102.48 316.03 111.39 377.52 98.10 87.59 378.61 97.34 108.15 389.23 486.54 110.85 111.39 108.15 457.60 98.96 87.59 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67908775 US PREG UTERUS TRANSVAGINAL 76817 402 $572.00 211.41 87.59 486.54 100.73 395.25 113.56 395.25 102.48 316.03 111.39 377.52 98.10 87.59 378.61 97.34 108.15 389.23 486.54 110.85 111.39 108.15 457.60 98.96 87.59 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80508778 US PREG UTERUS TRANSVAGINAL 76817 402 $572.00 211.41 87.59 486.54 100.73 395.25 113.56 395.25 102.48 316.03 111.39 377.52 98.10 87.59 378.61 97.34 108.15 389.23 486.54 110.85 111.39 108.15 457.60 98.96 87.59 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81408777 US PREG UTERUS TRANSVAGINAL 76817 402 $572.00 211.41 87.59 486.54 100.73 395.25 113.56 395.25 102.48 316.03 111.39 377.52 98.10 87.59 378.61 97.34 108.15 389.23 486.54 110.85 111.39 108.15 457.60 98.96 87.59 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81608776 US PREG UTERUS TRANSVAGINAL 76817 402 $572.00 211.41 87.59 486.54 100.73 395.25 113.56 395.25 102.48 316.03 111.39 377.52 98.10 87.59 378.61 97.34 108.15 389.23 486.54 110.85 111.39 108.15 457.60 98.96 87.59 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81708771 US PREG UTERUS TRANSVAGINAL 76817 402 $572.00 211.41 87.59 486.54 100.73 395.25 113.56 395.25 102.48 316.03 111.39 377.52 98.10 87.59 378.61 97.34 108.15 389.23 486.54 110.85 111.39 108.15 457.60 98.96 87.59 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82608770 US PREG UTERUS TRANSVAGINAL 76817 402 $572.00 211.41 87.59 486.54 100.73 395.25 113.56 395.25 102.48 316.03 111.39 377.52 98.10 87.59 378.61 97.34 108.15 389.23 486.54 110.85 111.39 108.15 457.60 98.96 87.59 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82908773 US PREG UTERUS TRANSVAGINAL 76817 402 $572.00 211.41 87.59 486.54 100.73 395.25 113.56 395.25 102.48 316.03 111.39 377.52 98.10 87.59 378.61 97.34 108.15 389.23 486.54 110.85 111.39 108.15 457.60 98.96 87.59 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83008776 US PREG UTERUS TRANSVAGINAL 76817 402 $572.00 211.41 87.59 486.54 100.73 395.25 113.56 395.25 102.48 316.03 111.39 377.52 98.10 87.59 378.61 97.34 108.15 389.23 486.54 110.85 111.39 108.15 457.60 98.96 87.59 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67908937 US FETAL BIO PROFILE W/O NST 76819 402 $572.00 211.41 85.52 457.60 98.35 395.25 113.56 395.25 100.06 316.03 111.39 377.52 95.78 85.52 378.61 97.34 108.15 185.88 232.35 110.85 111.39 108.15 457.60 98.96 85.52 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80508930 US FETAL BIO PROFILE W/O NST 76819 402 $572.00 211.41 85.52 457.60 98.35 395.25 113.56 395.25 100.06 316.03 111.39 377.52 95.78 85.52 378.61 97.34 108.15 185.88 232.35 110.85 111.39 108.15 457.60 98.96 85.52 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81408939 US FETAL BIO PROFILE W/O NST 76819 402 $572.00 211.41 85.52 457.60 98.35 395.25 113.56 395.25 100.06 316.03 111.39 377.52 95.78 85.52 378.61 97.34 108.15 185.88 232.35 110.85 111.39 108.15 457.60 98.96 85.52 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81608938 US FETAL BIO PROFILE W/O NST 76819 402 $572.00 211.41 85.52 457.60 98.35 395.25 113.56 395.25 100.06 316.03 111.39 377.52 95.78 85.52 378.61 97.34 108.15 185.88 232.35 110.85 111.39 108.15 457.60 98.96 85.52 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81708932 US FETAL BIO PROFILE W/O NST 76819 402 $572.00 211.41 85.52 457.60 98.35 395.25 113.56 395.25 100.06 316.03 111.39 377.52 95.78 85.52 378.61 97.34 108.15 185.88 232.35 110.85 111.39 108.15 457.60 98.96 85.52 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82608931 US FETAL BIO PROFILE W/O NST 76819 402 $572.00 211.41 85.52 457.60 98.35 395.25 113.56 395.25 100.06 316.03 111.39 377.52 95.78 85.52 378.61 97.34 108.15 185.88 232.35 110.85 111.39 108.15 457.60 98.96 85.52 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82908935 US FETAL BIO PROFILE W/O NST 76819 402 $572.00 211.41 85.52 457.60 98.35 395.25 113.56 395.25 100.06 316.03 111.39 377.52 95.78 85.52 378.61 97.34 108.15 185.88 232.35 110.85 111.39 108.15 457.60 98.96 85.52 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83008938 US FETAL BIO PROFILE W/O NST 76819 402 $572.00 211.41 85.52 457.60 98.35 395.25 113.56 395.25 100.06 316.03 111.39 377.52 95.78 85.52 378.61 97.34 108.15 185.88 232.35 110.85 111.39 108.15 457.60 98.96 85.52 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67908902 DOPPLER UMBILICAL ARTERY FETAL 76820 402 $572.00 211.41 45.73 457.60 52.59 395.25 113.56 395.25 53.50 316.03 111.39 377.52 51.22 45.73 378.61 97.34 108.15 193.20 241.50 110.85 111.39 108.15 457.60 98.96 45.73 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80508905 DOPPLER UMBILICAL ARTERY FETAL 76820 402 $572.00 211.41 45.73 457.60 52.59 395.25 113.56 395.25 53.50 316.03 111.39 377.52 51.22 45.73 378.61 97.34 108.15 193.20 241.50 110.85 111.39 108.15 457.60 98.96 45.73 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81408904 DOPPLER UMBILICAL ARTERY FETAL 76820 402 $572.00 211.41 45.73 457.60 52.59 395.25 113.56 395.25 53.50 316.03 111.39 377.52 51.22 45.73 378.61 97.34 108.15 193.20 241.50 110.85 111.39 108.15 457.60 98.96 45.73 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81608903 DOPPLER UMBILICAL ARTERY FETAL 76820 402 $572.00 211.41 45.73 457.60 52.59 395.25 113.56 395.25 53.50 316.03 111.39 377.52 51.22 45.73 378.61 97.34 108.15 193.20 241.50 110.85 111.39 108.15 457.60 98.96 45.73 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81708908 DOPPLER UMBILICAL ARTERY FETAL 76820 402 $572.00 211.41 45.73 457.60 52.59 395.25 113.56 395.25 53.50 316.03 111.39 377.52 51.22 45.73 378.61 97.34 108.15 193.20 241.50 110.85 111.39 108.15 457.60 98.96 45.73 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82608907 DOPPLER UMBILICAL ARTERY FETAL 76820 402 $572.00 211.41 45.73 457.60 52.59 395.25 113.56 395.25 53.50 316.03 111.39 377.52 51.22 45.73 378.61 97.34 108.15 193.20 241.50 110.85 111.39 108.15 457.60 98.96 45.73 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82908901 DOPPLER UMBILICAL ARTERY FETAL 76820 402 $572.00 211.41 45.73 457.60 52.59 395.25 113.56 395.25 53.50 316.03 111.39 377.52 51.22 45.73 378.61 97.34 108.15 193.20 241.50 110.85 111.39 108.15 457.60 98.96 45.73 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83008903 DOPPLER UMBILICAL ARTERY FETAL 76820 402 $572.00 211.41 45.73 457.60 52.59 395.25 113.56 395.25 53.50 316.03 111.39 377.52 51.22 45.73 378.61 97.34 108.15 193.20 241.50 110.85 111.39 108.15 457.60 98.96 45.73 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67908911 DOPPLER MIDDLE ARTERY FETAL 76821 402 $572.00 211.41 77.10 457.60 88.67 395.25 113.56 395.25 90.21 316.03 111.39 377.52 86.35 77.10 378.61 97.34 108.15 193.20 241.50 110.85 111.39 108.15 457.60 98.96 77.10 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80508913 DOPPLER MIDDLE ARTERY FETAL 76821 402 $572.00 211.41 77.10 457.60 88.67 395.25 113.56 395.25 90.21 316.03 111.39 377.52 86.35 77.10 378.61 97.34 108.15 193.20 241.50 110.85 111.39 108.15 457.60 98.96 77.10 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81408912 DOPPLER MIDDLE ARTERY FETAL 76821 402 $572.00 211.41 77.10 457.60 88.67 395.25 113.56 395.25 90.21 316.03 111.39 377.52 86.35 77.10 378.61 97.34 108.15 193.20 241.50 110.85 111.39 108.15 457.60 98.96 77.10 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81608911 DOPPLER MIDDLE ARTERY FETAL 76821 402 $572.00 211.41 77.10 457.60 88.67 395.25 113.56 395.25 90.21 316.03 111.39 377.52 86.35 77.10 378.61 97.34 108.15 193.20 241.50 110.85 111.39 108.15 457.60 98.96 77.10 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81708916 DOPPLER MIDDLE ARTERY FETAL 76821 402 $572.00 211.41 77.10 457.60 88.67 395.25 113.56 395.25 90.21 316.03 111.39 377.52 86.35 77.10 378.61 97.34 108.15 193.20 241.50 110.85 111.39 108.15 457.60 98.96 77.10 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82608915 DOPPLER MIDDLE ARTERY FETAL 76821 402 $572.00 211.41 77.10 457.60 88.67 395.25 113.56 395.25 90.21 316.03 111.39 377.52 86.35 77.10 378.61 97.34 108.15 193.20 241.50 110.85 111.39 108.15 457.60 98.96 77.10 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82908919 DOPPLER MIDDLE ARTERY FETAL 76821 402 $572.00 211.41 77.10 457.60 88.67 395.25 113.56 395.25 90.21 316.03 111.39 377.52 86.35 77.10 378.61 97.34 108.15 193.20 241.50 110.85 111.39 108.15 457.60 98.96 77.10 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83008911 DOPPLER MIDDLE ARTERY FETAL 76821 402 $572.00 211.41 77.10 457.60 88.67 395.25 113.56 395.25 90.21 316.03 111.39 377.52 86.35 77.10 378.61 97.34 108.15 193.20 241.50 110.85 111.39 108.15 457.60 98.96 77.10 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67908147 US TRANSVAGINAL NON OB 76830 402 $572.00 211.41 76.50 457.60 87.98 395.25 113.56 395.25 89.51 316.03 111.39 377.52 85.68 76.50 378.61 97.34 108.15 306.36 382.95 110.85 111.39 108.15 457.60 98.96 76.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80508140 US TRANSVAGINAL NON OB 76830 402 $572.00 211.41 76.50 457.60 87.98 395.25 113.56 395.25 89.51 316.03 111.39 377.52 85.68 76.50 378.61 97.34 108.15 306.36 382.95 110.85 111.39 108.15 457.60 98.96 76.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81408149 US TRANSVAGINAL NON OB 76830 402 $572.00 211.41 76.50 457.60 87.98 395.25 113.56 395.25 89.51 316.03 111.39 377.52 85.68 76.50 378.61 97.34 108.15 306.36 382.95 110.85 111.39 108.15 457.60 98.96 76.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81608148 US TRANSVAGINAL NON OB 76830 402 $572.00 211.41 76.50 457.60 87.98 395.25 113.56 395.25 89.51 316.03 111.39 377.52 85.68 76.50 378.61 97.34 108.15 306.36 382.95 110.85 111.39 108.15 457.60 98.96 76.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81708142 US TRANSVAGINAL NON OB 76830 402 $572.00 211.41 76.50 457.60 87.98 395.25 113.56 395.25 89.51 316.03 111.39 377.52 85.68 76.50 378.61 97.34 108.15 306.36 382.95 110.85 111.39 108.15 457.60 98.96 76.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82608141 US TRANSVAGINAL NON OB 76830 402 $572.00 211.41 76.50 457.60 87.98 395.25 113.56 395.25 89.51 316.03 111.39 377.52 85.68 76.50 378.61 97.34 108.15 306.36 382.95 110.85 111.39 108.15 457.60 98.96 76.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82908145 US TRANSVAGINAL NON OB 76830 402 $572.00 211.41 76.50 457.60 87.98 395.25 113.56 395.25 89.51 316.03 111.39 377.52 85.68 76.50 378.61 97.34 108.15 306.36 382.95 110.85 111.39 108.15 457.60 98.96 76.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83008148 US TRANSVAGINAL NON OB 76830 402 $572.00 211.41 76.50 457.60 87.98 395.25 113.56 395.25 89.51 316.03 111.39 377.52 85.68 76.50 378.61 97.34 108.15 306.36 382.95 110.85 111.39 108.15 457.60 98.96 76.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67908783 US ECHO UTERUS SIS 76831 402 "$1,208.00" 446.48 - 966.40 - 834.73 240.00 834.73 - 667.42 235.43 797.28 - - 799.58 205.71 228.57 285.49 356.86 234.28 235.43 228.57 966.40 209.14 - 602.94 201.14 494.07 906.00 459.16 540.34 236.57 80508786 US ECHO UTERUS SIS 76831 402 "$1,208.00" 446.48 - 966.40 - 834.73 240.00 834.73 - 667.42 235.43 797.28 - - 799.58 205.71 228.57 285.49 356.86 234.28 235.43 228.57 966.40 209.14 - 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81408785 US ECHO UTERUS SIS 76831 402 "$1,208.00" 446.48 - 966.40 - 834.73 240.00 834.73 - 667.42 235.43 797.28 - - 799.58 205.71 228.57 285.49 356.86 234.28 235.43 228.57 966.40 209.14 - 602.94 201.14 494.07 906.00 459.16 540.34 236.57 83008784 US ECHO UTERUS SIS 76831 402 "$1,208.00" 446.48 - 966.40 - 834.73 240.00 834.73 - 667.42 235.43 797.28 - - 799.58 205.71 228.57 285.49 356.86 234.28 235.43 228.57 966.40 209.14 - 602.94 201.14 494.07 906.00 459.16 540.34 236.57 67908155 US PELVIC NON-OB COMPLETE 76856 402 $572.00 211.41 76.50 457.60 87.98 395.25 113.56 395.25 89.51 316.03 111.39 377.52 85.68 76.50 378.61 97.34 108.15 306.36 382.95 110.85 111.39 108.15 457.60 98.96 76.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80508158 US PELVIC NON-OB COMPLETE 76856 402 $572.00 211.41 76.50 457.60 87.98 395.25 113.56 395.25 89.51 316.03 111.39 377.52 85.68 76.50 378.61 97.34 108.15 306.36 382.95 110.85 111.39 108.15 457.60 98.96 76.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81408157 US PELVIC NON-OB COMPLETE 76856 402 $572.00 211.41 76.50 457.60 87.98 395.25 113.56 395.25 89.51 316.03 111.39 377.52 85.68 76.50 378.61 97.34 108.15 306.36 382.95 110.85 111.39 108.15 457.60 98.96 76.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81608156 US PELVIC NON-OB COMPLETE 76856 402 $572.00 211.41 76.50 457.60 87.98 395.25 113.56 395.25 89.51 316.03 111.39 377.52 85.68 76.50 378.61 97.34 108.15 306.36 382.95 110.85 111.39 108.15 457.60 98.96 76.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81708151 US PELVIC NON-OB COMPLETE 76856 402 $572.00 211.41 76.50 457.60 87.98 395.25 113.56 395.25 89.51 316.03 111.39 377.52 85.68 76.50 378.61 97.34 108.15 306.36 382.95 110.85 111.39 108.15 457.60 98.96 76.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82608150 US PELVIC NON-OB COMPLETE 76856 402 $572.00 211.41 76.50 457.60 87.98 395.25 113.56 395.25 89.51 316.03 111.39 377.52 85.68 76.50 378.61 97.34 108.15 306.36 382.95 110.85 111.39 108.15 457.60 98.96 76.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82908153 US PELVIC NON-OB COMPLETE 76856 402 $572.00 211.41 76.50 457.60 87.98 395.25 113.56 395.25 89.51 316.03 111.39 377.52 85.68 76.50 378.61 97.34 108.15 306.36 382.95 110.85 111.39 108.15 457.60 98.96 76.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83008156 US PELVIC NON-OB COMPLETE 76856 402 $572.00 211.41 76.50 457.60 87.98 395.25 113.56 395.25 89.51 316.03 111.39 377.52 85.68 76.50 378.61 97.34 108.15 306.36 382.95 110.85 111.39 108.15 457.60 98.96 76.50 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67908163 US PELVIC NON-OB LIMITED 76857 402 $572.00 211.41 32.00 457.60 36.80 395.25 113.56 395.25 37.44 316.03 111.39 377.52 35.84 32.00 378.61 97.34 108.15 193.94 242.42 110.85 111.39 108.15 457.60 98.96 32.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80508166 US PELVIC NON-OB LIMITED 76857 402 $572.00 211.41 32.00 457.60 36.80 395.25 113.56 395.25 37.44 316.03 111.39 377.52 35.84 32.00 378.61 97.34 108.15 193.94 242.42 110.85 111.39 108.15 457.60 98.96 32.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81408165 US PELVIC NON-OB LIMITED 76857 402 $572.00 211.41 32.00 457.60 36.80 395.25 113.56 395.25 37.44 316.03 111.39 377.52 35.84 32.00 378.61 97.34 108.15 193.94 242.42 110.85 111.39 108.15 457.60 98.96 32.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81608164 US PELVIC NON-OB LIMITED 76857 402 $572.00 211.41 32.00 457.60 36.80 395.25 113.56 395.25 37.44 316.03 111.39 377.52 35.84 32.00 378.61 97.34 108.15 193.94 242.42 110.85 111.39 108.15 457.60 98.96 32.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81708169 US PELVIC NON-OB LIMITED 76857 402 $572.00 211.41 32.00 457.60 36.80 395.25 113.56 395.25 37.44 316.03 111.39 377.52 35.84 32.00 378.61 97.34 108.15 193.94 242.42 110.85 111.39 108.15 457.60 98.96 32.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82608168 US PELVIC NON-OB LIMITED 76857 402 $572.00 211.41 32.00 457.60 36.80 395.25 113.56 395.25 37.44 316.03 111.39 377.52 35.84 32.00 378.61 97.34 108.15 193.94 242.42 110.85 111.39 108.15 457.60 98.96 32.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82908161 US PELVIC NON-OB LIMITED 76857 402 $572.00 211.41 32.00 457.60 36.80 395.25 113.56 395.25 37.44 316.03 111.39 377.52 35.84 32.00 378.61 97.34 108.15 193.94 242.42 110.85 111.39 108.15 457.60 98.96 32.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83008164 US PELVIC NON-OB LIMITED 76857 402 $572.00 211.41 32.00 457.60 36.80 395.25 113.56 395.25 37.44 316.03 111.39 377.52 35.84 32.00 378.61 97.34 108.15 193.94 242.42 110.85 111.39 108.15 457.60 98.96 32.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67908171 US SCROTUM & CONTENTS 76870 402 $572.00 211.41 74.00 457.60 85.10 395.25 113.56 395.25 86.58 316.03 111.39 377.52 82.88 74.00 378.61 97.34 108.15 295.64 369.55 110.85 111.39 108.15 457.60 98.96 74.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80508174 US SCROTUM & CONTENTS 76870 402 $572.00 211.41 74.00 457.60 85.10 395.25 113.56 395.25 86.58 316.03 111.39 377.52 82.88 74.00 378.61 97.34 108.15 295.64 369.55 110.85 111.39 108.15 457.60 98.96 74.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81408173 US SCROTUM & CONTENTS 76870 402 $572.00 211.41 74.00 457.60 85.10 395.25 113.56 395.25 86.58 316.03 111.39 377.52 82.88 74.00 378.61 97.34 108.15 295.64 369.55 110.85 111.39 108.15 457.60 98.96 74.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81608172 US SCROTUM & CONTENTS 76870 402 $572.00 211.41 74.00 457.60 85.10 395.25 113.56 395.25 86.58 316.03 111.39 377.52 82.88 74.00 378.61 97.34 108.15 295.64 369.55 110.85 111.39 108.15 457.60 98.96 74.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81708177 US SCROTUM & CONTENTS 76870 402 $572.00 211.41 74.00 457.60 85.10 395.25 113.56 395.25 86.58 316.03 111.39 377.52 82.88 74.00 378.61 97.34 108.15 295.64 369.55 110.85 111.39 108.15 457.60 98.96 74.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82608176 US SCROTUM & CONTENTS 76870 402 $572.00 211.41 74.00 457.60 85.10 395.25 113.56 395.25 86.58 316.03 111.39 377.52 82.88 74.00 378.61 97.34 108.15 295.64 369.55 110.85 111.39 108.15 457.60 98.96 74.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82708171 US SCROTUM & CONTENTS 76870 402 $572.00 211.41 74.00 457.60 85.10 395.25 113.56 395.25 86.58 316.03 111.39 377.52 82.88 74.00 378.61 97.34 108.15 295.64 369.55 110.85 111.39 108.15 457.60 98.96 74.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82908170 US SCROTUM & CONTENTS 76870 402 $572.00 211.41 74.00 457.60 85.10 395.25 113.56 395.25 86.58 316.03 111.39 377.52 82.88 74.00 378.61 97.34 108.15 295.64 369.55 110.85 111.39 108.15 457.60 98.96 74.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83008172 US SCROTUM & CONTENTS 76870 402 $572.00 211.41 74.00 457.60 85.10 395.25 113.56 395.25 86.58 316.03 111.39 377.52 82.88 74.00 378.61 97.34 108.15 295.64 369.55 110.85 111.39 108.15 457.60 98.96 74.00 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67901355 US TRANSRECTAL 76872 402 $572.00 211.41 86.73 457.60 99.74 395.25 113.56 395.25 101.47 316.03 111.39 377.52 97.14 86.73 378.61 97.34 108.15 306.36 382.95 110.85 111.39 108.15 457.60 98.96 86.73 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80501358 US TRANSRECTAL 76872 402 $572.00 211.41 86.73 457.60 99.74 395.25 113.56 395.25 101.47 316.03 111.39 377.52 97.14 86.73 378.61 97.34 108.15 306.36 382.95 110.85 111.39 108.15 457.60 98.96 86.73 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81401357 US TRANSRECTAL 76872 402 $572.00 211.41 86.73 457.60 99.74 395.25 113.56 395.25 101.47 316.03 111.39 377.52 97.14 86.73 378.61 97.34 108.15 306.36 382.95 110.85 111.39 108.15 457.60 98.96 86.73 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83001356 US TRANSRECTAL 76872 402 $572.00 211.41 86.73 457.60 99.74 395.25 113.56 395.25 101.47 316.03 111.39 377.52 97.14 86.73 378.61 97.34 108.15 306.36 382.95 110.85 111.39 108.15 457.60 98.96 86.73 285.50 95.17 233.95 429.00 217.42 255.86 111.94 54008881 US XTR NON-VASC COMPLETE 76881 402 $572.00 211.41 89.14 540.95 102.51 395.25 113.56 395.25 104.29 316.03 111.39 377.52 99.84 89.14 378.61 97.34 108.15 432.76 540.95 110.85 111.39 108.15 457.60 98.96 89.14 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67908881 US EXTR NON-VASC COMPLETE 76881 402 $572.00 211.41 89.14 540.95 102.51 395.25 113.56 395.25 104.29 316.03 111.39 377.52 99.84 89.14 378.61 97.34 108.15 432.76 540.95 110.85 111.39 108.15 457.60 98.96 89.14 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80508883 US EXTR NON-VASC COMPLETE 76881 402 $572.00 211.41 89.14 540.95 102.51 395.25 113.56 395.25 104.29 316.03 111.39 377.52 99.84 89.14 378.61 97.34 108.15 432.76 540.95 110.85 111.39 108.15 457.60 98.96 89.14 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81408882 US EXTR NON-VASC COMPLETE 76881 402 $572.00 211.41 89.14 540.95 102.51 395.25 113.56 395.25 104.29 316.03 111.39 377.52 99.84 89.14 378.61 97.34 108.15 432.76 540.95 110.85 111.39 108.15 457.60 98.96 89.14 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81608881 US EXTR NON-VASC COMPLETE 76881 402 $572.00 211.41 89.14 540.95 102.51 395.25 113.56 395.25 104.29 316.03 111.39 377.52 99.84 89.14 378.61 97.34 108.15 432.76 540.95 110.85 111.39 108.15 457.60 98.96 89.14 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81708886 US EXTR NON-VASC COMPLETE 76881 402 $572.00 211.41 89.14 540.95 102.51 395.25 113.56 395.25 104.29 316.03 111.39 377.52 99.84 89.14 378.61 97.34 108.15 432.76 540.95 110.85 111.39 108.15 457.60 98.96 89.14 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82608885 US EXTR NON-VASC COMPLETE 76881 402 $572.00 211.41 89.14 540.95 102.51 395.25 113.56 395.25 104.29 316.03 111.39 377.52 99.84 89.14 378.61 97.34 108.15 432.76 540.95 110.85 111.39 108.15 457.60 98.96 89.14 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82908889 US EXTR NON-VASC COMPLETE 76881 402 $572.00 211.41 89.14 540.95 102.51 395.25 113.56 395.25 104.29 316.03 111.39 377.52 99.84 89.14 378.61 97.34 108.15 432.76 540.95 110.85 111.39 108.15 457.60 98.96 89.14 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83008881 US EXTR NON-VASC COMPLETE 76881 402 $572.00 211.41 89.14 540.95 102.51 395.25 113.56 395.25 104.29 316.03 111.39 377.52 99.84 89.14 378.61 97.34 108.15 432.76 540.95 110.85 111.39 108.15 457.60 98.96 89.14 285.50 95.17 233.95 429.00 217.42 255.86 111.94 37003875 US XTR NON-VASC LTD 76882 402 $572.00 211.41 23.79 457.60 27.36 395.25 113.56 395.25 27.83 316.03 111.39 377.52 26.64 23.79 378.61 97.34 108.15 51.32 64.15 110.85 111.39 108.15 457.60 98.96 23.79 285.50 95.17 233.95 429.00 217.42 255.86 111.94 54008899 US XTR NON-VASC LTD 76882 402 $572.00 211.41 23.79 457.60 27.36 395.25 113.56 395.25 27.83 316.03 111.39 377.52 26.64 23.79 378.61 97.34 108.15 51.32 64.15 110.85 111.39 108.15 457.60 98.96 23.79 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67908899 US EXTR NON-VASC LIMITED 76882 402 $572.00 211.41 23.79 457.60 27.36 395.25 113.56 395.25 27.83 316.03 111.39 377.52 26.64 23.79 378.61 97.34 108.15 51.32 64.15 110.85 111.39 108.15 457.60 98.96 23.79 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80508891 US EXTR NON-VASC LIMITED 76882 402 $572.00 211.41 23.79 457.60 27.36 395.25 113.56 395.25 27.83 316.03 111.39 377.52 26.64 23.79 378.61 97.34 108.15 51.32 64.15 110.85 111.39 108.15 457.60 98.96 23.79 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81408891 US EXTR NON-VASC LIMITED 76882 402 $572.00 211.41 23.79 457.60 27.36 395.25 113.56 395.25 27.83 316.03 111.39 377.52 26.64 23.79 378.61 97.34 108.15 51.32 64.15 110.85 111.39 108.15 457.60 98.96 23.79 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81608890 US EXTR NON-VASC LIMITED 76882 402 $572.00 211.41 23.79 457.60 27.36 395.25 113.56 395.25 27.83 316.03 111.39 377.52 26.64 23.79 378.61 97.34 108.15 51.32 64.15 110.85 111.39 108.15 457.60 98.96 23.79 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81708894 US EXTR NON-VASC LIMITED 76882 402 $572.00 211.41 23.79 457.60 27.36 395.25 113.56 395.25 27.83 316.03 111.39 377.52 26.64 23.79 378.61 97.34 108.15 51.32 64.15 110.85 111.39 108.15 457.60 98.96 23.79 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82608893 US EXTR NON-VASC LIMITED 76882 402 $572.00 211.41 23.79 457.60 27.36 395.25 113.56 395.25 27.83 316.03 111.39 377.52 26.64 23.79 378.61 97.34 108.15 51.32 64.15 110.85 111.39 108.15 457.60 98.96 23.79 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82708898 US EXTR NON-VASC LIMITED 76882 402 $572.00 211.41 23.79 457.60 27.36 395.25 113.56 395.25 27.83 316.03 111.39 377.52 26.64 23.79 378.61 97.34 108.15 51.32 64.15 110.85 111.39 108.15 457.60 98.96 23.79 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82908897 US EXTR NON-VASC LIMITED 76882 402 $572.00 211.41 23.79 457.60 27.36 395.25 113.56 395.25 27.83 316.03 111.39 377.52 26.64 23.79 378.61 97.34 108.15 51.32 64.15 110.85 111.39 108.15 457.60 98.96 23.79 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83008890 US EXTR NON-VASC LIMITED 76882 402 $572.00 211.41 23.79 457.60 27.36 395.25 113.56 395.25 27.83 316.03 111.39 377.52 26.64 23.79 378.61 97.34 108.15 51.32 64.15 110.85 111.39 108.15 457.60 98.96 23.79 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67908431 US INFANT HIPS DYNAMIC 76885 402 $425.00 157.08 70.71 359.61 129.86 293.68 84.37 293.68 132.12 234.81 82.76 280.50 126.47 112.92 281.31 72.32 80.35 287.69 359.61 82.36 82.76 80.35 340.00 73.52 112.92 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80508433 US INFANT HIPS DYNAMIC 76885 402 $425.00 157.08 70.71 359.61 129.86 293.68 84.37 293.68 132.12 234.81 82.76 280.50 126.47 112.92 281.31 72.32 80.35 287.69 359.61 82.36 82.76 80.35 340.00 73.52 112.92 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81408432 US INFANT HIPS DYNAMIC 76885 402 $425.00 157.08 70.71 359.61 129.86 293.68 84.37 293.68 132.12 234.81 82.76 280.50 126.47 112.92 281.31 72.32 80.35 287.69 359.61 82.36 82.76 80.35 340.00 73.52 112.92 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81608431 US INFANT HIPS DYNAMIC 76885 402 $425.00 157.08 70.71 359.61 129.86 293.68 84.37 293.68 132.12 234.81 82.76 280.50 126.47 112.92 281.31 72.32 80.35 287.69 359.61 82.36 82.76 80.35 340.00 73.52 112.92 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81708436 US INFANT HIPS DYNAMIC 76885 402 $425.00 157.08 70.71 359.61 129.86 293.68 84.37 293.68 132.12 234.81 82.76 280.50 126.47 112.92 281.31 72.32 80.35 287.69 359.61 82.36 82.76 80.35 340.00 73.52 112.92 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82608435 US INFANT HIPS DYNAMIC 76885 402 $425.00 157.08 70.71 359.61 129.86 293.68 84.37 293.68 132.12 234.81 82.76 280.50 126.47 112.92 281.31 72.32 80.35 287.69 359.61 82.36 82.76 80.35 340.00 73.52 112.92 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82908439 US INFANT HIPS DYNAMIC 76885 402 $425.00 157.08 70.71 359.61 129.86 293.68 84.37 293.68 132.12 234.81 82.76 280.50 126.47 112.92 281.31 72.32 80.35 287.69 359.61 82.36 82.76 80.35 340.00 73.52 112.92 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83008431 US INFANT HIPS DYNAMIC 76885 402 $425.00 157.08 70.71 359.61 129.86 293.68 84.37 293.68 132.12 234.81 82.76 280.50 126.47 112.92 281.31 72.32 80.35 287.69 359.61 82.36 82.76 80.35 340.00 73.52 112.92 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81408840 US INFANT HIPS STATIC 76886 402 $425.00 157.08 - 340.00 - 293.68 84.37 293.68 - 234.81 82.76 280.50 - - 281.31 72.32 80.35 256.50 320.63 82.36 82.76 80.35 340.00 73.52 - 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81608849 US INFANT HIPS STATIC 76886 402 $425.00 157.08 - 340.00 - 293.68 84.37 293.68 - 234.81 82.76 280.50 - - 281.31 72.32 80.35 256.50 320.63 82.36 82.76 80.35 340.00 73.52 - 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81708843 US INFANT HIPS STATIC 76886 402 $425.00 157.08 - 340.00 - 293.68 84.37 293.68 - 234.81 82.76 280.50 - - 281.31 72.32 80.35 256.50 320.63 82.36 82.76 80.35 340.00 73.52 - 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82608842 US INFANT HIPS STATIC 76886 402 $425.00 157.08 - 340.00 - 293.68 84.37 293.68 - 234.81 82.76 280.50 - - 281.31 72.32 80.35 256.50 320.63 82.36 82.76 80.35 340.00 73.52 - 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82908846 US INFANT HIPS STATIC 76886 402 $425.00 157.08 - 340.00 - 293.68 84.37 293.68 - 234.81 82.76 280.50 - - 281.31 72.32 80.35 256.50 320.63 82.36 82.76 80.35 340.00 73.52 - 211.96 70.71 173.83 318.75 161.54 190.10 83.16 30100727 ECHO GUIDE FOR ARTERY REPAIR 76936 402 "$1,388.00" 513.00 189.44 " 1,256.37 " 217.86 959.11 276.03 959.11 221.64 766.87 270.78 916.08 212.17 189.44 918.72 236.60 262.89 " 1,005.10 " " 1,256.37 " 269.46 270.78 262.89 " 1,110.40 " 240.54 189.44 692.86 231.34 567.69 " 1,041.00 " 527.58 620.85 272.09 54090404 ECHO GUIDE FOR ARTERY REPAIR 76936 402 "$1,388.00" 513.00 189.44 " 1,256.37 " 217.86 959.11 276.03 959.11 221.64 766.87 270.78 916.08 212.17 189.44 918.72 236.60 262.89 " 1,005.10 " " 1,256.37 " 269.46 270.78 262.89 " 1,110.40 " 240.54 189.44 692.86 231.34 567.69 " 1,041.00 " 527.58 620.85 272.09 80590407 US GUID ARTERY REPAIR 76936 402 "$1,388.00" 513.00 189.44 " 1,256.37 " 217.86 959.11 276.03 959.11 221.64 766.87 270.78 916.08 212.17 189.44 918.72 236.60 262.89 " 1,005.10 " " 1,256.37 " 269.46 270.78 262.89 " 1,110.40 " 240.54 189.44 692.86 231.34 567.69 " 1,041.00 " 527.58 620.85 272.09 29812799 US GUIDE VASCULAR ACCESS 76937 402 $171.00 63.20 - 136.80 29.36 118.16 - 118.16 29.87 94.48 - 112.86 28.59 25.53 113.18 - - 100.55 125.69 - - - 136.80 - 25.53 65.81 - 69.94 128.25 65.00 76.49 - 37003964 US GUID VASCULAR ACCESS 76937 402 $171.00 63.20 - 136.80 29.36 118.16 - 118.16 29.87 94.48 - 112.86 28.59 25.53 113.18 - - 100.55 125.69 - - - 136.80 - 25.53 65.81 - 69.94 128.25 65.00 76.49 - 54008805 US GUIDE VASCULAR ACCESS 76937 402 $171.00 63.20 - 136.80 29.36 118.16 - 118.16 29.87 94.48 - 112.86 28.59 25.53 113.18 - - 100.55 125.69 - - - 136.80 - 25.53 65.81 - 69.94 128.25 65.00 76.49 - 80308809 US GUID VASCULAR ACCESS 76937 402 $171.00 63.20 - 136.80 29.36 118.16 - 118.16 29.87 94.48 - 112.86 28.59 25.53 113.18 - - 100.55 125.69 - - - 136.80 - 25.53 65.81 - 69.94 128.25 65.00 76.49 - 80508671 US GUID TISSUE ABLATION 76940 402 "$1,464.00" 541.09 - " 1,171.20 " - " 1,011.62 " - " 1,011.62 " - 808.86 - 966.24 - - 969.02 - - 541.68 677.10 - - - " 1,171.20 " - - 980.88 - 598.78 " 1,098.00 " 556.47 654.85 - 34001456 US GUIDE NDL PLACEMENT IMG S&I 76942 402 "$3,238.00" " 1,196.76 " - " 2,590.40 " 82.80 " 2,237.46 " - " 2,237.46 " 84.24 " 1,789.00 " - " 2,137.08 " 80.64 72.00 " 2,143.23 " - - 302.91 378.64 - - - " 2,590.40 " - 72.00 72.23 - " 1,324.34 " " 2,428.50 " " 1,230.76 " " 1,448.36 " - 37003956 US GUIDE NDL PLACEMENT IMG S&I 76942 402 "$3,238.00" " 1,196.76 " - " 2,590.40 " 82.80 " 2,237.46 " - " 2,237.46 " 84.24 " 1,789.00 " - " 2,137.08 " 80.64 72.00 " 2,143.23 " - - 302.91 378.64 - - - " 2,590.40 " - 72.00 72.23 - " 1,324.34 " " 2,428.50 " " 1,230.76 " " 1,448.36 " - 54008201 US GUIDE NDL PLACEMENT IMG S&I 76942 402 "$3,238.00" " 1,196.76 " - " 2,590.40 " 82.80 " 2,237.46 " - " 2,237.46 " 84.24 " 1,789.00 " - " 2,137.08 " 80.64 72.00 " 2,143.23 " - - 302.91 378.64 - - - " 2,590.40 " - 72.00 72.23 - " 1,324.34 " " 2,428.50 " " 1,230.76 " " 1,448.36 " - 80308205 US GUIDE NDL PLACEMENT IMG S&I 76942 402 "$3,238.00" " 1,196.76 " - " 2,590.40 " 82.80 " 2,237.46 " - " 2,237.46 " 84.24 " 1,789.00 " - " 2,137.08 " 80.64 72.00 " 2,143.23 " - - 302.91 378.64 - - - " 2,590.40 " - 72.00 72.23 - " 1,324.34 " " 2,428.50 " " 1,230.76 " " 1,448.36 " - 80508204 US GUIDE NDL PLACEMENT IMG S&I 76942 402 "$3,238.00" " 1,196.76 " - " 2,590.40 " 82.80 " 2,237.46 " - " 2,237.46 " 84.24 " 1,789.00 " - " 2,137.08 " 80.64 72.00 " 2,143.23 " - - 302.91 378.64 - - - " 2,590.40 " - 72.00 72.23 - " 1,324.34 " " 2,428.50 " " 1,230.76 " " 1,448.36 " - 80608209 US GUIDE NDL PLACEMENT IMG S&I 76942 402 "$3,238.00" " 1,196.76 " - " 2,590.40 " 82.80 " 2,237.46 " - " 2,237.46 " 84.24 " 1,789.00 " - " 2,137.08 " 80.64 72.00 " 2,143.23 " - - 302.91 378.64 - - - " 2,590.40 " - 72.00 72.23 - " 1,324.34 " " 2,428.50 " " 1,230.76 " " 1,448.36 " - 81408203 US GUIDE NDL PLACEMENT IMG S&I 76942 402 "$3,238.00" " 1,196.76 " - " 2,590.40 " 82.80 " 2,237.46 " - " 2,237.46 " 84.24 " 1,789.00 " - " 2,137.08 " 80.64 72.00 " 2,143.23 " - - 302.91 378.64 - - - " 2,590.40 " - 72.00 72.23 - " 1,324.34 " " 2,428.50 " " 1,230.76 " " 1,448.36 " - 81608202 US GUIDE NDL PLACEMENT IMG S&I 76942 402 "$3,238.00" " 1,196.76 " - " 2,590.40 " 82.80 " 2,237.46 " - " 2,237.46 " 84.24 " 1,789.00 " - " 2,137.08 " 80.64 72.00 " 2,143.23 " - - 302.91 378.64 - - - " 2,590.40 " - 72.00 72.23 - " 1,324.34 " " 2,428.50 " " 1,230.76 " " 1,448.36 " - 82708201 US GUID NDL PLACEMENT IMAGING 76942 402 "$3,238.00" " 1,196.76 " - " 2,590.40 " 82.80 " 2,237.46 " - " 2,237.46 " 84.24 " 1,789.00 " - " 2,137.08 " 80.64 72.00 " 2,143.23 " - - 302.91 378.64 - - - " 2,590.40 " - 72.00 72.23 - " 1,324.34 " " 2,428.50 " " 1,230.76 " " 1,448.36 " - 83008202 US GUIDE NDL PLACEMENT IMG S&I 76942 402 "$3,238.00" " 1,196.76 " - " 2,590.40 " 82.80 " 2,237.46 " - " 2,237.46 " 84.24 " 1,789.00 " - " 2,137.08 " 80.64 72.00 " 2,143.23 " - - 302.91 378.64 - - - " 2,590.40 " - 72.00 72.23 - " 1,324.34 " " 2,428.50 " " 1,230.76 " " 1,448.36 " - 80508221 US GUID AMNIOCENTESIS 76946 402 "$1,642.00" 606.88 - " 1,313.60 " 42.65 " 1,134.62 " - " 1,134.62 " 43.40 907.21 - " 1,083.72 " 41.54 37.09 " 1,086.84 " - - 250.49 313.11 - - - " 1,313.60 " - 37.09 37.49 - 671.58 " 1,231.50 " 624.12 734.47 - 83008229 US GUID AMNIOCENTESIS 76946 402 "$1,642.00" 606.88 - " 1,313.60 " 42.65 " 1,134.62 " - " 1,134.62 " 43.40 907.21 - " 1,083.72 " 41.54 37.09 " 1,086.84 " - - 250.49 313.11 - - - " 1,313.60 " - 37.09 37.49 - 671.58 " 1,231.50 " 624.12 734.47 - 80008171 ECHO GUIDANCE RADIOTHERAPY 76965 402 "$1,923.00" 710.74 - " 2,192.63 " - " 1,328.79 " - " 1,328.79 " - " 1,062.46 " - " 1,269.18 " - - " 1,272.83 " - - " 1,754.10 " " 2,192.63 " - - - " 1,538.40 " - - 69.48 - 786.51 " 1,442.25 " 730.93 860.16 - 28174659 US GUID INTRAOPERATIVE 76998 360 $157.00 58.03 - 614.71 - 108.49 - 108.49 - 86.74 - 103.62 - - 103.92 - - 491.77 614.71 - - - 125.60 - - 105.19 - 64.21 117.75 59.68 70.23 - 80508239 US GUID INTRAOPERATIVE 76998 402 $157.00 58.03 - 614.71 - 108.49 - 108.49 - 86.74 - 103.62 - - 103.92 - - 491.77 614.71 - - - 125.60 - - 105.19 - 64.21 117.75 59.68 70.23 - 67937040 UNL US TRANSLABIAL 76999 402 $425.00 157.08 - 340.00 - 293.68 84.37 293.68 - 234.81 82.76 280.50 - - 281.31 72.32 80.35 52.32 65.40 82.36 82.76 80.35 340.00 73.52 - 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80508832 UNL ULTRASOUND PROCEDURE 76999 402 $425.00 157.08 - 340.00 - 293.68 84.37 293.68 - 234.81 82.76 280.50 - - 281.31 72.32 80.35 52.32 65.40 82.36 82.76 80.35 340.00 73.52 - 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80537042 UNL US TRANSLABIAL 76999 402 $425.00 157.08 - 340.00 - 293.68 84.37 293.68 - 234.81 82.76 280.50 - - 281.31 72.32 80.35 52.32 65.40 82.36 82.76 80.35 340.00 73.52 - 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81437041 UNL US TRANSLABIAL 76999 402 $425.00 157.08 - 340.00 - 293.68 84.37 293.68 - 234.81 82.76 280.50 - - 281.31 72.32 80.35 52.32 65.40 82.36 82.76 80.35 340.00 73.52 - 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81637041 UNL US TRANSLABIAL 76999 402 $425.00 157.08 - 340.00 - 293.68 84.37 293.68 - 234.81 82.76 280.50 - - 281.31 72.32 80.35 52.32 65.40 82.36 82.76 80.35 340.00 73.52 - 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81737045 UNL US TRANSLABIAL 76999 402 $425.00 157.08 - 340.00 - 293.68 84.37 293.68 - 234.81 82.76 280.50 - - 281.31 72.32 80.35 52.32 65.40 82.36 82.76 80.35 340.00 73.52 - 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82637044 UNL US TRANSLABIAL 76999 402 $425.00 157.08 - 340.00 - 293.68 84.37 293.68 - 234.81 82.76 280.50 - - 281.31 72.32 80.35 52.32 65.40 82.36 82.76 80.35 340.00 73.52 - 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82937048 UNL US TRANSLABIAL 76999 402 $425.00 157.08 - 340.00 - 293.68 84.37 293.68 - 234.81 82.76 280.50 - - 281.31 72.32 80.35 52.32 65.40 82.36 82.76 80.35 340.00 73.52 - 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83037041 UNL US TRANSLABIAL 76999 402 $425.00 157.08 - 340.00 - 293.68 84.37 293.68 - 234.81 82.76 280.50 - - 281.31 72.32 80.35 52.32 65.40 82.36 82.76 80.35 340.00 73.52 - 211.96 70.71 173.83 318.75 161.54 190.10 83.16 80126581 FLUORO GUID PLCMT VEIN DEVICE 77001 320 "$1,505.00" 556.25 - " 1,204.00 " 69.43 " 1,039.96 " - " 1,039.96 " 70.63 831.51 - 993.30 67.61 60.37 996.16 - - 302.49 378.11 - - - " 1,204.00 " - 60.37 225.82 - 615.55 " 1,128.75 " 572.05 673.19 - 80326581 FLUORO GUID PLCMT VEIN DEVICE 77001 320 "$1,505.00" 556.25 - " 1,204.00 " 69.43 " 1,039.96 " - " 1,039.96 " 70.63 831.51 - 993.30 67.61 60.37 996.16 - - 302.49 378.11 - - - " 1,204.00 " - 60.37 225.82 - 615.55 " 1,128.75 " 572.05 673.19 - 29810460 FLUORO GUIDE NDL LOCALIZATION 77002 481 $294.00 108.66 - 291.60 63.70 203.15 - 203.15 64.81 162.44 - 194.04 62.04 55.39 194.60 - - 233.28 291.60 - - - 235.20 - 55.39 238.60 - 120.25 220.50 111.75 131.51 - 80101180 FLUORO GUID NEEDLE PLACEMENT 77002 320 $294.00 108.66 - 291.60 63.70 203.15 - 203.15 64.81 162.44 - 194.04 62.04 55.39 194.60 - - 233.28 291.60 - - - 235.20 - 55.39 238.60 - 120.25 220.50 111.75 131.51 - 80301189 FLUORO GUID NEEDLE PLACEMENT 77002 320 $294.00 108.66 - 291.60 63.70 203.15 - 203.15 64.81 162.44 - 194.04 62.04 55.39 194.60 - - 233.28 291.60 - - - 235.20 - 55.39 238.60 - 120.25 220.50 111.75 131.51 - 80101589 FLUORO GUID SPINE INJ 77003 320 $246.00 90.92 - 266.94 57.83 169.99 - 169.99 58.84 135.92 - 162.36 56.32 50.29 162.83 - - 213.55 266.94 - - - 196.80 - 50.29 202.95 - 100.61 184.50 93.50 110.04 - 80301588 FLUORO GUID SPINE INJ 77003 320 $246.00 90.92 - 266.94 57.83 169.99 - 169.99 58.84 135.92 - 162.36 56.32 50.29 162.83 - - 213.55 266.94 - - - 196.80 - 50.29 202.95 - 100.61 184.50 93.50 110.04 - 80011105 CT SCAN FOR LOCALIZATION 77011 333 $451.00 166.69 - " 1,476.29 " 259.37 311.64 - 311.64 263.88 249.18 - 297.66 252.60 225.54 298.52 - - " 1,181.03 " " 1,476.29 " - - - 360.80 - 225.54 465.34 - 184.46 338.25 171.43 201.73 - 80609353 CT GUID STEREO LOCALIZATION 77011 350 $451.00 166.69 - " 1,774.00 " 259.37 " 1,774.00 " - " 1,774.00 " 263.88 249.18 - 725.00 252.60 225.54 298.52 - - " 1,181.03 " " 1,476.29 " - - - 360.80 - 225.54 465.34 - 184.46 338.25 171.43 201.73 - 67709365 CT GUID NEEDLE PLACEMENT 77012 350 $552.00 204.02 - " 1,774.00 " 182.60 " 1,774.00 " - " 1,774.00 " 185.77 304.98 - 725.00 177.83 158.78 365.37 - - " 1,177.94 " " 1,472.43 " - - - 441.60 - 158.78 205.70 - 225.77 414.00 209.82 246.91 - 80336829 CT GUID NEEDLE PLACEMENT 77012 350 $552.00 204.02 - " 1,774.00 " 182.60 " 1,774.00 " - " 1,774.00 " 185.77 304.98 - 725.00 177.83 158.78 365.37 - - " 1,177.94 " " 1,472.43 " - - - 441.60 - 158.78 205.70 - 225.77 414.00 209.82 246.91 - 80609361 CT GUID NEEDLE PLACEMENT 77012 350 $552.00 204.02 - " 1,774.00 " 182.60 " 1,774.00 " - " 1,774.00 " 185.77 304.98 - 725.00 177.83 158.78 365.37 - - " 1,177.94 " " 1,472.43 " - - - 441.60 - 158.78 205.70 - 225.77 414.00 209.82 246.91 - 67709764 CT GUID TISSUE ABLATION 77013 350 "$3,154.00" " 1,165.72 " - " 2,523.20 " - " 1,774.00 " - " 1,774.00 " - " 1,742.59 " - 725.00 - - " 2,087.63 " - - " 1,603.49 " " 2,004.36 " - - - " 2,523.20 " - - " 2,113.18 " - " 1,289.99 " " 2,365.50 " " 1,198.84 " " 1,410.78 " - 80609761 CT GUID TISSUE ABLATION 77013 350 "$3,154.00" " 1,165.72 " - " 2,523.20 " - " 1,774.00 " - " 1,774.00 " - " 1,742.59 " - 725.00 - - " 2,087.63 " - - " 1,603.49 " " 2,004.36 " - - - " 2,523.20 " - - " 2,113.18 " - " 1,289.99 " " 2,365.50 " " 1,198.84 " " 1,410.78 " - 80003005 CT SCAN FOR THERAPY GUIDE 77014 352 $223.00 82.42 - " 1,774.00 " 114.48 " 1,774.00 " - " 1,774.00 " 116.47 123.21 - 725.00 111.50 99.55 147.60 - - 443.85 554.81 - - - 178.40 - 99.55 212.09 - 91.21 167.25 84.76 99.75 - 80407823 MR GUID NEEDLE PLACEMENT 77021 610 "$3,611.00" " 1,334.63 " - " 2,888.80 " 296.22 " 2,882.00 " - " 2,882.00 " 301.37 " 1,995.08 " - " 1,155.00 " 288.49 257.58 " 2,390.12 " - - " 1,314.81 " " 1,643.51 " - - - " 2,888.80 " - 257.58 " 1,047.66 " - " 1,476.90 " " 2,708.25 " " 1,372.54 " " 1,615.20 " - 80420021 MRI BREAST UNI W/O CONTRAST 77046 614 "$1,208.00" 446.48 192.37 " 2,882.00 " 221.23 " 2,882.00 " 240.00 " 2,882.00 " 225.07 667.42 235.43 " 1,155.00 " 215.45 192.37 799.58 205.71 228.57 875.51 " 1,094.39 " 234.28 235.43 228.57 966.40 209.14 192.37 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81420025 MRI BREAST UNI W/O CONTRAST 77046 614 "$1,208.00" 446.48 192.37 " 2,882.00 " 221.23 " 2,882.00 " 240.00 " 2,882.00 " 225.07 667.42 235.43 " 1,155.00 " 215.45 192.37 799.58 205.71 228.57 875.51 " 1,094.39 " 234.28 235.43 228.57 966.40 209.14 192.37 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81620024 MRI BREAST UNI W/O CONTRAST 77046 614 "$1,208.00" 446.48 192.37 " 2,882.00 " 221.23 " 2,882.00 " 240.00 " 2,882.00 " 225.07 667.42 235.43 " 1,155.00 " 215.45 192.37 799.58 205.71 228.57 875.51 " 1,094.39 " 234.28 235.43 228.57 966.40 209.14 192.37 602.94 201.14 494.07 906.00 459.16 540.34 236.57 80420048 MRI BREAST BILAT W/O CONTRAST 77047 614 "$1,208.00" 446.48 197.80 " 2,882.00 " 227.47 " 2,882.00 " 240.00 " 2,882.00 " 231.43 667.42 235.43 " 1,155.00 " 221.54 197.80 799.58 205.71 228.57 870.22 " 1,087.78 " 234.28 235.43 228.57 966.40 209.14 197.80 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81420041 MRI BREAST BILAT W/O CONTRAST 77047 614 "$1,208.00" 446.48 197.80 " 2,882.00 " 227.47 " 2,882.00 " 240.00 " 2,882.00 " 231.43 667.42 235.43 " 1,155.00 " 221.54 197.80 799.58 205.71 228.57 870.22 " 1,087.78 " 234.28 235.43 228.57 966.40 209.14 197.80 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81620041 MRI BREAST BILAT W/O CONTRAST 77047 614 "$1,208.00" 446.48 197.80 " 2,882.00 " 227.47 " 2,882.00 " 240.00 " 2,882.00 " 231.43 667.42 235.43 " 1,155.00 " 221.54 197.80 799.58 205.71 228.57 870.22 " 1,087.78 " 234.28 235.43 228.57 966.40 209.14 197.80 602.94 201.14 494.07 906.00 459.16 540.34 236.57 80420030 MRI BREAST CAD UNI WO/W CONT 77048 614 "$5,127.00" " 1,894.94 " - " 4,101.60 " 350.93 " 2,882.00 " N/A " 2,882.00 " 357.04 " 2,832.67 " N/A " 1,155.00 " 341.78 N/A " 3,393.56 " - N/A " 1,442.19 " " 1,802.74 " N/A N/A N/A " 4,101.60 " N/A 305.16 744.16 N/A " 2,096.94 " " 3,845.25 " " 1,948.77 " " 2,293.31 " N/A 81420033 MRI BREAST CAD UNI WO/W CONT 77048 614 "$5,127.00" " 1,894.94 " - " 4,101.60 " 350.93 " 2,882.00 " N/A " 2,882.00 " 357.04 " 2,832.67 " N/A " 1,155.00 " 341.78 N/A " 3,393.56 " - N/A " 1,442.19 " " 1,802.74 " N/A N/A N/A " 4,101.60 " N/A 305.16 744.16 N/A " 2,096.94 " " 3,845.25 " " 1,948.77 " " 2,293.31 " N/A 81620032 MRI BREAST CAD UNI WO/W CONT 77048 614 "$5,127.00" " 1,894.94 " - " 4,101.60 " 350.93 " 2,882.00 " N/A " 2,882.00 " 357.04 " 2,832.67 " N/A " 1,155.00 " 341.78 N/A " 3,393.56 " - N/A " 1,442.19 " " 1,802.74 " N/A N/A N/A " 4,101.60 " N/A 305.16 744.16 N/A " 2,096.94 " " 3,845.25 " " 1,948.77 " " 2,293.31 " N/A 80420056 MRI BREAST CAD BILAT WO/W CONT 77049 614 "$5,127.00" " 1,894.94 " - " 4,101.60 " 358.83 " 2,882.00 " N/A " 2,882.00 " 365.08 " 2,832.67 " N/A " 1,155.00 " 349.47 N/A " 3,393.56 " - N/A " 1,435.14 " " 1,793.92 " N/A N/A N/A " 4,101.60 " N/A 312.03 740.49 N/A " 2,096.94 " " 3,845.25 " " 1,948.77 " " 2,293.31 " N/A 81420050 MRI BREAST CAD BILAT WO/W CONT 77049 614 "$5,127.00" " 1,894.94 " - " 4,101.60 " 358.83 " 2,882.00 " N/A " 2,882.00 " 365.08 " 2,832.67 " N/A " 1,155.00 " 349.47 N/A " 3,393.56 " - N/A " 1,435.14 " " 1,793.92 " N/A N/A N/A " 4,101.60 " N/A 312.03 740.49 N/A " 2,096.94 " " 3,845.25 " " 1,948.77 " " 2,293.31 " N/A 81620059 MRI BREAST CAD BILAT WO/W CONT 77049 614 "$5,127.00" " 1,894.94 " - " 4,101.60 " 358.83 " 2,882.00 " N/A " 2,882.00 " 365.08 " 2,832.67 " N/A " 1,155.00 " 349.47 N/A " 3,393.56 " - N/A " 1,435.14 " " 1,793.92 " N/A N/A N/A " 4,101.60 " N/A 312.03 740.49 N/A " 2,096.94 " " 3,845.25 " " 1,948.77 " " 2,293.31 " N/A 83001534 XR MAMMARY DUCT SINGLE 77053 320 "$1,208.00" 446.48 56.47 966.40 64.94 834.73 240.00 834.73 66.07 667.42 235.43 797.28 63.25 56.47 799.58 205.71 228.57 396.61 495.76 234.28 235.43 228.57 966.40 209.14 56.47 602.94 201.14 494.07 906.00 459.16 540.34 236.57 83002115 XR MAMMARY DUCT MULTIPLE 77054 320 "$1,208.00" 446.48 76.07 966.40 87.48 834.73 240.00 834.73 89.00 667.42 235.43 797.28 85.20 76.07 799.58 205.71 228.57 489.36 611.70 234.28 235.43 228.57 966.40 209.14 76.07 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81402094 BREAST TOMO SCREEN BILATERAL 77063 403 $126.00 46.57 44.03 100.80 50.63 87.07 54.48 87.07 51.52 69.62 53.45 83.16 49.31 44.03 83.40 46.70 51.89 45.57 56.96 53.19 53.45 51.89 100.80 47.48 44.03 66.73 45.66 51.53 94.50 47.89 56.36 53.71 82702091 BREAST TOMO SCREEN BILATERAL 77063 403 $126.00 46.57 44.03 100.80 50.63 87.07 54.48 87.07 51.52 69.62 53.45 83.16 49.31 44.03 83.40 46.70 51.89 45.57 56.96 53.19 53.45 51.89 100.80 47.48 44.03 66.73 45.66 51.53 94.50 47.89 56.36 53.71 83002093 BREAST TOMO SCREEN BILATERAL 77063 403 $126.00 46.57 44.03 100.80 50.63 87.07 54.48 87.07 51.52 69.62 53.45 83.16 49.31 44.03 83.40 46.70 51.89 45.57 56.96 53.19 53.45 51.89 100.80 47.48 44.03 66.73 45.66 51.53 94.50 47.89 56.36 53.71 67902149 DX MAMMO UNI ALL VIEWS CAD 77065 401 $451.00 166.69 102.41 582.02 117.77 311.64 129.99 311.64 119.82 249.18 127.51 297.66 114.70 102.41 298.52 111.42 123.80 465.62 582.02 126.90 127.51 123.80 360.80 113.28 102.41 239.52 108.94 184.46 338.25 171.43 201.73 128.13 80102143 DX MAMMO UNI ALL VIEWS CAD 77065 401 $451.00 166.69 102.41 582.02 117.77 311.64 129.99 311.64 119.82 249.18 127.51 297.66 114.70 102.41 298.52 111.42 123.80 465.62 582.02 126.90 127.51 123.80 360.80 113.28 102.41 239.52 108.94 184.46 338.25 171.43 201.73 128.13 81402141 DX MAMMO UNI ALL VIEWS CAD 77065 401 $451.00 166.69 102.41 582.02 117.77 311.64 129.99 311.64 119.82 249.18 127.51 297.66 114.70 102.41 298.52 111.42 123.80 465.62 582.02 126.90 127.51 123.80 360.80 113.28 102.41 239.52 108.94 184.46 338.25 171.43 201.73 128.13 81602140 DX MAMMO UNI ALL VIEWS CAD 77065 401 $451.00 166.69 102.41 582.02 117.77 311.64 129.99 311.64 119.82 249.18 127.51 297.66 114.70 102.41 298.52 111.42 123.80 465.62 582.02 126.90 127.51 123.80 360.80 113.28 102.41 239.52 108.94 184.46 338.25 171.43 201.73 128.13 81702144 DX MAMMO UNI ALL VIEWS CAD 77065 401 $451.00 166.69 102.41 582.02 117.77 311.64 129.99 311.64 119.82 249.18 127.51 297.66 114.70 102.41 298.52 111.42 123.80 465.62 582.02 126.90 127.51 123.80 360.80 113.28 102.41 239.52 108.94 184.46 338.25 171.43 201.73 128.13 82602143 DX MAMMO UNI ALL VIEWS CAD 77065 401 $451.00 166.69 102.41 582.02 117.77 311.64 129.99 311.64 119.82 249.18 127.51 297.66 114.70 102.41 298.52 111.42 123.80 465.62 582.02 126.90 127.51 123.80 360.80 113.28 102.41 239.52 108.94 184.46 338.25 171.43 201.73 128.13 82702148 DX MAMMO UNI ALL VIEWS CAD 77065 401 $451.00 166.69 102.41 582.02 117.77 311.64 129.99 311.64 119.82 249.18 127.51 297.66 114.70 102.41 298.52 111.42 123.80 465.62 582.02 126.90 127.51 123.80 360.80 113.28 102.41 239.52 108.94 184.46 338.25 171.43 201.73 128.13 82902147 DX MAMMO UNI ALL VIEWS CAD 77065 401 $451.00 166.69 102.41 582.02 117.77 311.64 129.99 311.64 119.82 249.18 127.51 297.66 114.70 102.41 298.52 111.42 123.80 465.62 582.02 126.90 127.51 123.80 360.80 113.28 102.41 239.52 108.94 184.46 338.25 171.43 201.73 128.13 83002140 DX MAMMO UNI ALL VIEWS CAD 77065 401 $451.00 166.69 102.41 582.02 117.77 311.64 129.99 311.64 119.82 249.18 127.51 297.66 114.70 102.41 298.52 111.42 123.80 465.62 582.02 126.90 127.51 123.80 360.80 113.28 102.41 239.52 108.94 184.46 338.25 171.43 201.73 128.13 67902131 DX MAMMO BILAT 77066 401 $576.00 212.89 129.85 742.23 149.33 398.02 164.18 398.02 151.92 318.24 161.05 380.16 145.43 129.85 381.25 140.72 156.36 593.78 742.23 160.27 161.05 156.36 460.80 143.07 129.85 306.25 137.60 235.58 432.00 218.94 257.64 161.83 80102135 DX MAMMO BILAT 77066 401 $576.00 212.89 129.85 742.23 149.33 398.02 164.18 398.02 151.92 318.24 161.05 380.16 145.43 129.85 381.25 140.72 156.36 593.78 742.23 160.27 161.05 156.36 460.80 143.07 129.85 306.25 137.60 235.58 432.00 218.94 257.64 161.83 81402132 DX MAMMO BILAT 77066 401 $576.00 212.89 129.85 742.23 149.33 398.02 164.18 398.02 151.92 318.24 161.05 380.16 145.43 129.85 381.25 140.72 156.36 593.78 742.23 160.27 161.05 156.36 460.80 143.07 129.85 306.25 137.60 235.58 432.00 218.94 257.64 161.83 81602131 DX MAMMO BILAT 77066 401 $576.00 212.89 129.85 742.23 149.33 398.02 164.18 398.02 151.92 318.24 161.05 380.16 145.43 129.85 381.25 140.72 156.36 593.78 742.23 160.27 161.05 156.36 460.80 143.07 129.85 306.25 137.60 235.58 432.00 218.94 257.64 161.83 81702136 DX MAMMO BILAT 77066 401 $576.00 212.89 129.85 742.23 149.33 398.02 164.18 398.02 151.92 318.24 161.05 380.16 145.43 129.85 381.25 140.72 156.36 593.78 742.23 160.27 161.05 156.36 460.80 143.07 129.85 306.25 137.60 235.58 432.00 218.94 257.64 161.83 82602135 DX MAMMO BILAT 77066 401 $576.00 212.89 129.85 742.23 149.33 398.02 164.18 398.02 151.92 318.24 161.05 380.16 145.43 129.85 381.25 140.72 156.36 593.78 742.23 160.27 161.05 156.36 460.80 143.07 129.85 306.25 137.60 235.58 432.00 218.94 257.64 161.83 82702130 DX MAMMO BILAT 77066 401 $576.00 212.89 129.85 742.23 149.33 398.02 164.18 398.02 151.92 318.24 161.05 380.16 145.43 129.85 381.25 140.72 156.36 593.78 742.23 160.27 161.05 156.36 460.80 143.07 129.85 306.25 137.60 235.58 432.00 218.94 257.64 161.83 82902139 DX MAMMO BILAT 77066 401 $576.00 212.89 129.85 742.23 149.33 398.02 164.18 398.02 151.92 318.24 161.05 380.16 145.43 129.85 381.25 140.72 156.36 593.78 742.23 160.27 161.05 156.36 460.80 143.07 129.85 306.25 137.60 235.58 432.00 218.94 257.64 161.83 83002131 DX MAMMO BILAT 77066 401 $576.00 212.89 129.85 742.23 149.33 398.02 164.18 398.02 151.92 318.24 161.05 380.16 145.43 129.85 381.25 140.72 156.36 593.78 742.23 160.27 161.05 156.36 460.80 143.07 129.85 306.25 137.60 235.58 432.00 218.94 257.64 161.83 67902122 SCREENING MAMMO BILAT CAD 77067 403 $476.00 175.93 104.70 614.71 120.41 328.92 132.27 328.92 122.50 262.99 129.75 314.16 117.26 104.70 315.06 113.37 125.97 491.77 614.71 129.12 129.75 125.97 380.80 115.26 104.70 253.22 110.85 194.68 357.00 180.93 212.91 130.38 80102127 SCREENING MAMMO BILAT CAD 77067 403 $476.00 175.93 104.70 614.71 120.41 328.92 132.27 328.92 122.50 262.99 129.75 314.16 117.26 104.70 315.06 113.37 125.97 491.77 614.71 129.12 129.75 125.97 380.80 115.26 104.70 253.22 110.85 194.68 357.00 180.93 212.91 130.38 81402124 SCREENING MAMMO BILAT CAD 77067 403 $476.00 175.93 104.70 614.71 120.41 328.92 132.27 328.92 122.50 262.99 129.75 314.16 117.26 104.70 315.06 113.37 125.97 491.77 614.71 129.12 129.75 125.97 380.80 115.26 104.70 253.22 110.85 194.68 357.00 180.93 212.91 130.38 81602123 SCREENING MAMMO BILAT CAD 77067 403 $476.00 175.93 104.70 614.71 120.41 328.92 132.27 328.92 122.50 262.99 129.75 314.16 117.26 104.70 315.06 113.37 125.97 491.77 614.71 129.12 129.75 125.97 380.80 115.26 104.70 253.22 110.85 194.68 357.00 180.93 212.91 130.38 81702128 SCREENING MAMMO BILAT CAD 77067 403 $476.00 175.93 104.70 614.71 120.41 328.92 132.27 328.92 122.50 262.99 129.75 314.16 117.26 104.70 315.06 113.37 125.97 491.77 614.71 129.12 129.75 125.97 380.80 115.26 104.70 253.22 110.85 194.68 357.00 180.93 212.91 130.38 82602127 SCREENING MAMMO BILAT CAD 77067 403 $476.00 175.93 104.70 614.71 120.41 328.92 132.27 328.92 122.50 262.99 129.75 314.16 117.26 104.70 315.06 113.37 125.97 491.77 614.71 129.12 129.75 125.97 380.80 115.26 104.70 253.22 110.85 194.68 357.00 180.93 212.91 130.38 82702121 SCREENING MAMMO BILAT CAD 77067 403 $476.00 175.93 104.70 614.71 120.41 328.92 132.27 328.92 122.50 262.99 129.75 314.16 117.26 104.70 315.06 113.37 125.97 491.77 614.71 129.12 129.75 125.97 380.80 115.26 104.70 253.22 110.85 194.68 357.00 180.93 212.91 130.38 82902121 SCREENING MAMMO BILAT CAD 77067 403 $476.00 175.93 104.70 614.71 120.41 328.92 132.27 328.92 122.50 262.99 129.75 314.16 117.26 104.70 315.06 113.37 125.97 491.77 614.71 129.12 129.75 125.97 380.80 115.26 104.70 253.22 110.85 194.68 357.00 180.93 212.91 130.38 83002123 SCREENING MAMMO BILAT CAD 77067 403 $476.00 175.93 104.70 614.71 120.41 328.92 132.27 328.92 122.50 262.99 129.75 314.16 117.26 104.70 315.06 113.37 125.97 491.77 614.71 129.12 129.75 125.97 380.80 115.26 104.70 253.22 110.85 194.68 357.00 180.93 212.91 130.38 67901193 XR BONE AGE STUDY 77072 320 $572.00 211.41 16.57 457.60 19.06 395.25 113.56 395.25 19.39 316.03 111.39 377.52 18.56 16.57 378.61 97.34 108.15 64.09 80.11 110.85 111.39 108.15 457.60 98.96 16.57 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80101198 XR BONE AGE STUDY 77072 320 $572.00 211.41 16.57 457.60 19.06 395.25 113.56 395.25 19.39 316.03 111.39 377.52 18.56 16.57 378.61 97.34 108.15 64.09 80.11 110.85 111.39 108.15 457.60 98.96 16.57 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81401195 XR BONE AGE STUDY 77072 320 $572.00 211.41 16.57 457.60 19.06 395.25 113.56 395.25 19.39 316.03 111.39 377.52 18.56 16.57 378.61 97.34 108.15 64.09 80.11 110.85 111.39 108.15 457.60 98.96 16.57 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81601194 XR BONE AGE STUDY 77072 320 $572.00 211.41 16.57 457.60 19.06 395.25 113.56 395.25 19.39 316.03 111.39 377.52 18.56 16.57 378.61 97.34 108.15 64.09 80.11 110.85 111.39 108.15 457.60 98.96 16.57 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81701199 XR BONE AGE STUDY 77072 320 $572.00 211.41 16.57 457.60 19.06 395.25 113.56 395.25 19.39 316.03 111.39 377.52 18.56 16.57 378.61 97.34 108.15 64.09 80.11 110.85 111.39 108.15 457.60 98.96 16.57 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82601198 XR BONE AGE STUDY 77072 320 $572.00 211.41 16.57 457.60 19.06 395.25 113.56 395.25 19.39 316.03 111.39 377.52 18.56 16.57 378.61 97.34 108.15 64.09 80.11 110.85 111.39 108.15 457.60 98.96 16.57 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82901191 XR BONE AGE STUDY 77072 320 $572.00 211.41 16.57 457.60 19.06 395.25 113.56 395.25 19.39 316.03 111.39 377.52 18.56 16.57 378.61 97.34 108.15 64.09 80.11 110.85 111.39 108.15 457.60 98.96 16.57 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83001194 XR BONE AGE STUDY 77072 320 $572.00 211.41 16.57 457.60 19.06 395.25 113.56 395.25 19.39 316.03 111.39 377.52 18.56 16.57 378.61 97.34 108.15 64.09 80.11 110.85 111.39 108.15 457.60 98.96 16.57 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67901207 XR BONE LENGTH STUDY 77073 320 $572.00 211.41 30.92 457.60 35.56 395.25 113.56 395.25 36.18 316.03 111.39 377.52 34.63 30.92 378.61 97.34 108.15 136.91 171.14 110.85 111.39 108.15 457.60 98.96 30.92 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80101201 XR BONE LENGTH STUDY 77073 320 $572.00 211.41 30.92 457.60 35.56 395.25 113.56 395.25 36.18 316.03 111.39 377.52 34.63 30.92 378.61 97.34 108.15 136.91 171.14 110.85 111.39 108.15 457.60 98.96 30.92 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81401209 XR BONE LENGTH STUDY 77073 320 $572.00 211.41 30.92 457.60 35.56 395.25 113.56 395.25 36.18 316.03 111.39 377.52 34.63 30.92 378.61 97.34 108.15 136.91 171.14 110.85 111.39 108.15 457.60 98.96 30.92 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81601208 XR BONE LENGTH STUDY 77073 320 $572.00 211.41 30.92 457.60 35.56 395.25 113.56 395.25 36.18 316.03 111.39 377.52 34.63 30.92 378.61 97.34 108.15 136.91 171.14 110.85 111.39 108.15 457.60 98.96 30.92 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81701202 XR BONE LENGTH STUDY 77073 320 $572.00 211.41 30.92 457.60 35.56 395.25 113.56 395.25 36.18 316.03 111.39 377.52 34.63 30.92 378.61 97.34 108.15 136.91 171.14 110.85 111.39 108.15 457.60 98.96 30.92 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82601201 XR BONE LENGTH STUDY 77073 320 $572.00 211.41 30.92 457.60 35.56 395.25 113.56 395.25 36.18 316.03 111.39 377.52 34.63 30.92 378.61 97.34 108.15 136.91 171.14 110.85 111.39 108.15 457.60 98.96 30.92 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82901205 XR BONE LENGTH STUDY 77073 320 $572.00 211.41 30.92 457.60 35.56 395.25 113.56 395.25 36.18 316.03 111.39 377.52 34.63 30.92 378.61 97.34 108.15 136.91 171.14 110.85 111.39 108.15 457.60 98.96 30.92 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83001208 XR BONE LENGTH STUDY 77073 320 $572.00 211.41 30.92 457.60 35.56 395.25 113.56 395.25 36.18 316.03 111.39 377.52 34.63 30.92 378.61 97.34 108.15 136.91 171.14 110.85 111.39 108.15 457.60 98.96 30.92 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67901215 XR BONE SURVEY LIMITED 77074 320 $572.00 211.41 46.94 457.60 53.98 395.25 113.56 395.25 54.92 316.03 111.39 377.52 52.57 46.94 378.61 97.34 108.15 197.65 247.06 110.85 111.39 108.15 457.60 98.96 46.94 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80101210 XR BONE SURVEY LIMITED 77074 320 $572.00 211.41 46.94 457.60 53.98 395.25 113.56 395.25 54.92 316.03 111.39 377.52 52.57 46.94 378.61 97.34 108.15 197.65 247.06 110.85 111.39 108.15 457.60 98.96 46.94 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81401217 XR BONE SURVEY LIMITED 77074 320 $572.00 211.41 46.94 457.60 53.98 395.25 113.56 395.25 54.92 316.03 111.39 377.52 52.57 46.94 378.61 97.34 108.15 197.65 247.06 110.85 111.39 108.15 457.60 98.96 46.94 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81601216 XR BONE SURVEY LIMITED 77074 320 $572.00 211.41 46.94 457.60 53.98 395.25 113.56 395.25 54.92 316.03 111.39 377.52 52.57 46.94 378.61 97.34 108.15 197.65 247.06 110.85 111.39 108.15 457.60 98.96 46.94 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82601210 XR BONE SURVEY LIMITED 77074 320 $572.00 211.41 46.94 457.60 53.98 395.25 113.56 395.25 54.92 316.03 111.39 377.52 52.57 46.94 378.61 97.34 108.15 197.65 247.06 110.85 111.39 108.15 457.60 98.96 46.94 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82901213 XR BONE SURVEY LIMITED 77074 320 $572.00 211.41 46.94 457.60 53.98 395.25 113.56 395.25 54.92 316.03 111.39 377.52 52.57 46.94 378.61 97.34 108.15 197.65 247.06 110.85 111.39 108.15 457.60 98.96 46.94 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83001216 XR BONE SURVEY LIMITED 77074 320 $572.00 211.41 46.94 457.60 53.98 395.25 113.56 395.25 54.92 316.03 111.39 377.52 52.57 46.94 378.61 97.34 108.15 197.65 247.06 110.85 111.39 108.15 457.60 98.96 46.94 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67901223 XR BONE SURVEY COMPLETE 77075 320 $572.00 211.41 65.49 457.60 75.31 395.25 113.56 395.25 76.62 316.03 111.39 377.52 73.35 65.49 378.61 97.34 108.15 295.74 369.68 110.85 111.39 108.15 457.60 98.96 65.49 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80101228 XR BONE SURVEY COMPLETE 77075 320 $572.00 211.41 65.49 457.60 75.31 395.25 113.56 395.25 76.62 316.03 111.39 377.52 73.35 65.49 378.61 97.34 108.15 295.74 369.68 110.85 111.39 108.15 457.60 98.96 65.49 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81401225 XR BONE SURVEY COMPLETE 77075 320 $572.00 211.41 65.49 457.60 75.31 395.25 113.56 395.25 76.62 316.03 111.39 377.52 73.35 65.49 378.61 97.34 108.15 295.74 369.68 110.85 111.39 108.15 457.60 98.96 65.49 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81601224 XR BONE SURVEY COMPLETE 77075 320 $572.00 211.41 65.49 457.60 75.31 395.25 113.56 395.25 76.62 316.03 111.39 377.52 73.35 65.49 378.61 97.34 108.15 295.74 369.68 110.85 111.39 108.15 457.60 98.96 65.49 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81701229 XR BONE SURVEY COMPLETE 77075 320 $572.00 211.41 65.49 457.60 75.31 395.25 113.56 395.25 76.62 316.03 111.39 377.52 73.35 65.49 378.61 97.34 108.15 295.74 369.68 110.85 111.39 108.15 457.60 98.96 65.49 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82601228 XR BONE SURVEY COMPLETE 77075 320 $572.00 211.41 65.49 457.60 75.31 395.25 113.56 395.25 76.62 316.03 111.39 377.52 73.35 65.49 378.61 97.34 108.15 295.74 369.68 110.85 111.39 108.15 457.60 98.96 65.49 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82901221 XR BONE SURVEY COMPLETE 77075 320 $572.00 211.41 65.49 457.60 75.31 395.25 113.56 395.25 76.62 316.03 111.39 377.52 73.35 65.49 378.61 97.34 108.15 295.74 369.68 110.85 111.39 108.15 457.60 98.96 65.49 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83001224 XR BONE SURVEY COMPLETE 77075 320 $572.00 211.41 65.49 457.60 75.31 395.25 113.56 395.25 76.62 316.03 111.39 377.52 73.35 65.49 378.61 97.34 108.15 295.74 369.68 110.85 111.39 108.15 457.60 98.96 65.49 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67901231 XR BONE SURVEY INFANT 77076 320 $572.00 211.41 53.91 457.60 62.00 395.25 113.56 395.25 63.07 316.03 111.39 377.52 60.38 53.91 378.61 97.34 108.15 183.53 229.41 110.85 111.39 108.15 457.60 98.96 53.91 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80101236 XR BONE SURVEY INFANT 77076 320 $572.00 211.41 53.91 457.60 62.00 395.25 113.56 395.25 63.07 316.03 111.39 377.52 60.38 53.91 378.61 97.34 108.15 183.53 229.41 110.85 111.39 108.15 457.60 98.96 53.91 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81401233 XR BONE SURVEY INFANT 77076 320 $572.00 211.41 53.91 457.60 62.00 395.25 113.56 395.25 63.07 316.03 111.39 377.52 60.38 53.91 378.61 97.34 108.15 183.53 229.41 110.85 111.39 108.15 457.60 98.96 53.91 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81601232 XR BONE SURVEY INFANT 77076 320 $572.00 211.41 53.91 457.60 62.00 395.25 113.56 395.25 63.07 316.03 111.39 377.52 60.38 53.91 378.61 97.34 108.15 183.53 229.41 110.85 111.39 108.15 457.60 98.96 53.91 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81701237 XR BONE SURVEY INFANT 77076 320 $572.00 211.41 53.91 457.60 62.00 395.25 113.56 395.25 63.07 316.03 111.39 377.52 60.38 53.91 378.61 97.34 108.15 183.53 229.41 110.85 111.39 108.15 457.60 98.96 53.91 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82601236 XR BONE SURVEY INFANT 77076 320 $572.00 211.41 53.91 457.60 62.00 395.25 113.56 395.25 63.07 316.03 111.39 377.52 60.38 53.91 378.61 97.34 108.15 183.53 229.41 110.85 111.39 108.15 457.60 98.96 53.91 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82901230 XR BONE SURVEY INFANT 77076 320 $572.00 211.41 53.91 457.60 62.00 395.25 113.56 395.25 63.07 316.03 111.39 377.52 60.38 53.91 378.61 97.34 108.15 183.53 229.41 110.85 111.39 108.15 457.60 98.96 53.91 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83001232 XR BONE SURVEY INFANT 77076 320 $572.00 211.41 53.91 457.60 62.00 395.25 113.56 395.25 63.07 316.03 111.39 377.52 60.38 53.91 378.61 97.34 108.15 183.53 229.41 110.85 111.39 108.15 457.60 98.96 53.91 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67929675 JOINT SURVEY SINGLE VIEW 77077 320 $572.00 211.41 36.74 457.60 42.25 395.25 113.56 395.25 42.99 316.03 111.39 377.52 41.15 36.74 378.61 97.34 108.15 183.26 229.08 110.85 111.39 108.15 457.60 98.96 36.74 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80129670 JOINT SURVEY SINGLE VIEW 77077 320 $572.00 211.41 36.74 457.60 42.25 395.25 113.56 395.25 42.99 316.03 111.39 377.52 41.15 36.74 378.61 97.34 108.15 183.26 229.08 110.85 111.39 108.15 457.60 98.96 36.74 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67905865 DXA BONE DENSITY AXIAL 77080 320 $572.00 211.41 60.11 457.60 69.13 395.25 113.56 395.25 70.33 316.03 111.39 377.52 67.32 60.11 378.61 97.34 108.15 339.69 424.61 110.85 111.39 108.15 457.60 98.96 60.11 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81405867 DXA BONE DENSITY AXIAL 77080 320 $572.00 211.41 60.11 457.60 69.13 395.25 113.56 395.25 70.33 316.03 111.39 377.52 67.32 60.11 378.61 97.34 108.15 339.69 424.61 110.85 111.39 108.15 457.60 98.96 60.11 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81605866 DXA BONE DENSITY AXIAL 77080 320 $572.00 211.41 60.11 457.60 69.13 395.25 113.56 395.25 70.33 316.03 111.39 377.52 67.32 60.11 378.61 97.34 108.15 339.69 424.61 110.85 111.39 108.15 457.60 98.96 60.11 285.50 95.17 233.95 429.00 217.42 255.86 111.94 82905863 DXA BONE DENSITY AXIAL 77080 320 $572.00 211.41 60.11 457.60 69.13 395.25 113.56 395.25 70.33 316.03 111.39 377.52 67.32 60.11 378.61 97.34 108.15 339.69 424.61 110.85 111.39 108.15 457.60 98.96 60.11 285.50 95.17 233.95 429.00 217.42 255.86 111.94 83005866 DXA BONE DENSITY AXIAL 77080 320 $572.00 211.41 60.11 457.60 69.13 395.25 113.56 395.25 70.33 316.03 111.39 377.52 67.32 60.11 378.61 97.34 108.15 339.69 424.61 110.85 111.39 108.15 457.60 98.96 60.11 285.50 95.17 233.95 429.00 217.42 255.86 111.94 67925866 DXA BONE DENSITY/PERIPHERAL 77081 320 $425.00 157.08 27.48 340.00 31.60 293.68 84.37 293.68 32.15 234.81 82.76 280.50 30.78 27.48 281.31 72.32 80.35 136.91 171.14 82.36 82.76 80.35 340.00 73.52 27.48 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81425868 DXA BONE DENSITY/PERIPHERAL 77081 320 $425.00 157.08 27.48 340.00 31.60 293.68 84.37 293.68 32.15 234.81 82.76 280.50 30.78 27.48 281.31 72.32 80.35 136.91 171.14 82.36 82.76 80.35 340.00 73.52 27.48 211.96 70.71 173.83 318.75 161.54 190.10 83.16 81625867 DXA BONE DENSITY/PERIPHERAL 77081 320 $425.00 157.08 27.48 340.00 31.60 293.68 84.37 293.68 32.15 234.81 82.76 280.50 30.78 27.48 281.31 72.32 80.35 136.91 171.14 82.36 82.76 80.35 340.00 73.52 27.48 211.96 70.71 173.83 318.75 161.54 190.10 83.16 82925864 DXA BONE DENSITY/PERIPHERAL 77081 320 $425.00 157.08 27.48 340.00 31.60 293.68 84.37 293.68 32.15 234.81 82.76 280.50 30.78 27.48 281.31 72.32 80.35 136.91 171.14 82.36 82.76 80.35 340.00 73.52 27.48 211.96 70.71 173.83 318.75 161.54 190.10 83.16 83025867 DXA BONE DENSITY/PERIPHERAL 77081 320 $425.00 157.08 27.48 340.00 31.60 293.68 84.37 293.68 32.15 234.81 82.76 280.50 30.78 27.48 281.31 72.32 80.35 136.91 171.14 82.36 82.76 80.35 340.00 73.52 27.48 211.96 70.71 173.83 318.75 161.54 190.10 83.16 67925998 DXA BONE DENSITY STUDY 77085 320 $572.00 211.41 - 457.60 - 395.25 113.56 395.25 - 316.03 111.39 377.52 - - 378.61 97.34 108.15 72.72 90.90 110.85 111.39 108.15 457.60 98.96 - 285.50 95.17 233.95 429.00 217.42 255.86 111.94 81425990 DXA BONE DENSITY STUDY 77085 320 $572.00 211.41 - 457.60 - 395.25 113.56 395.25 - 316.03 111.39 377.52 - - 378.61 97.34 108.15 72.72 90.90 110.85 111.39 108.15 457.60 98.96 - 285.50 95.17 233.95 429.00 217.42 255.86 111.94 80003013 SET RADIATION TX FIELD SIMPLE 77280 333 $666.00 246.15 60.00 673.83 69.00 460.21 132.34 460.21 70.20 367.97 129.82 439.56 67.20 60.00 440.83 113.44 126.04 539.06 673.83 129.19 129.82 126.04 532.80 115.33 60.00 446.22 110.92 272.39 499.50 253.15 297.90 130.45 80003021 SET RAD TX FIELD INTERMEDIATE 77285 333 "$1,778.00" 657.15 85.00 " 1,422.40 " 97.75 " 1,228.60 " 353.21 " 1,228.60 " 99.45 982.35 346.48 " 1,173.48 " 95.20 85.00 " 1,176.86 " 302.75 336.39 849.19 " 1,061.49 " 344.80 346.48 336.39 " 1,422.40 " 307.80 85.00 " 1,191.26 " 296.02 727.20 " 1,333.50 " 675.82 795.30 348.16 80003072 SET RADIATION TX FIELD COMPLEX 77290 333 "$1,778.00" 657.15 121.50 " 1,422.40 " 139.73 " 1,228.60 " 353.21 " 1,228.60 " 142.16 982.35 346.48 " 1,173.48 " 136.08 121.50 " 1,176.86 " 302.75 336.39 " 1,051.86 " " 1,314.83 " 344.80 346.48 336.39 " 1,422.40 " 307.80 121.50 " 1,191.26 " 296.02 727.20 " 1,333.50 " 675.82 795.30 348.16 80010877 RESPIRATOR MOTION MGMT SIMULTR 77293 333 "$1,198.00" 442.78 - 958.40 372.06 827.82 - 827.82 378.53 661.90 - 790.68 362.35 323.53 792.96 - - 628.21 785.26 - - - 958.40 - 323.53 802.66 - 489.98 898.50 455.36 535.87 - 80008279 3D RADIOTHERAPY PLAN 77295 333 "$6,626.00" " 2,448.97 " 548.84 " 5,300.80 " 631.17 " 4,578.57 " " 1,317.10 " " 4,578.57 " 642.14 " 3,660.87 " " 1,292.01 " " 4,373.16 " 614.70 548.84 " 4,385.75 " " 1,128.94 " " 1,254.38 " " 4,129.98 " " 5,162.48 " " 1,285.74 " " 1,292.01 " " 1,254.38 " " 5,300.80 " " 1,147.76 " 548.84 " 4,439.42 " " 1,103.85 " " 2,710.03 " " 4,969.50 " " 2,518.54 " " 2,963.81 " " 1,298.28 " 80003102 RADIATION THERAPY DOSE PLAN 77300 333 $666.00 246.15 36.50 532.80 41.98 460.21 132.34 460.21 42.71 367.97 129.82 439.56 40.88 36.50 440.83 113.44 126.04 269.48 336.85 129.19 129.82 126.04 532.80 115.33 36.50 446.22 110.92 272.39 499.50 253.15 297.90 130.45 80010478 IMRT RADIOTHERAPY DOSE PLAN 77301 333 "$6,626.00" " 2,448.97 " " 1,080.41 " " 5,300.80 " " 1,242.47 " " 4,578.57 " " 1,317.10 " " 4,578.57 " " 1,264.08 " " 3,660.87 " " 1,292.01 " " 4,373.16 " " 1,210.06 " " 1,080.41 " " 4,385.75 " " 1,128.94 " " 1,254.38 " " 3,196.19 " " 3,995.24 " " 1,285.74 " " 1,292.01 " " 1,254.38 " " 5,300.80 " " 1,147.76 " " 1,080.41 " " 4,439.42 " " 1,103.85 " " 2,710.03 " " 4,969.50 " " 2,518.54 " " 2,963.81 " " 1,298.28 " 80010974 TELETHERAPY ISODOSE PLN SIMPLE 77306 333 "$1,778.00" 657.15 111.11 " 1,422.40 " 127.78 " 1,228.60 " 353.21 " 1,228.60 " 130.00 982.35 346.48 " 1,173.48 " 124.44 111.11 " 1,176.86 " 302.75 336.39 129.58 161.98 344.80 346.48 336.39 " 1,422.40 " 307.80 111.11 " 1,191.26 " 296.02 727.20 " 1,333.50 " 675.82 795.30 348.16 80010982 TELETHERAPY ISODOSE PLN CPLX 77307 333 "$1,778.00" 657.15 217.95 " 1,422.40 " 250.64 " 1,228.60 " 353.21 " 1,228.60 " 255.00 982.35 346.48 " 1,173.48 " 244.10 217.95 " 1,176.86 " 302.75 336.39 237.72 297.15 344.80 346.48 336.39 " 1,422.40 " 307.80 217.95 " 1,191.26 " 296.02 727.20 " 1,333.50 " 675.82 795.30 348.16 80010991 BRACHYTX ISODOSE PLAN SIMPLE 77316 333 "$1,778.00" 657.15 141.70 " 1,422.40 " 162.96 " 1,228.60 " 353.21 " 1,228.60 " 165.79 982.35 346.48 " 1,173.48 " 158.70 141.70 " 1,176.86 " 302.75 336.39 202.30 252.88 344.80 346.48 336.39 " 1,422.40 " 307.80 141.70 " 1,191.26 " 296.02 727.20 " 1,333.50 " 675.82 795.30 348.16 80011008 BRACHYTX ISODOSE PLAN INTERMED 77317 333 "$1,778.00" 657.15 185.42 " 1,422.40 " 213.23 " 1,228.60 " 353.21 " 1,228.60 " 216.94 982.35 346.48 " 1,173.48 " 207.67 185.42 " 1,176.86 " 302.75 336.39 263.67 329.59 344.80 346.48 336.39 " 1,422.40 " 307.80 185.42 " 1,191.26 " 296.02 727.20 " 1,333.50 " 675.82 795.30 348.16 80011016 BRACHYTX ISODOSE PLAN COMPLEX 77318 333 "$1,778.00" 657.15 268.48 " 1,422.40 " 308.75 " 1,228.60 " 353.21 " 1,228.60 " 314.12 982.35 346.48 " 1,173.48 " 300.70 268.48 " 1,176.86 " 302.75 336.39 357.84 447.30 344.80 346.48 336.39 " 1,422.40 " 307.80 268.48 " 1,191.26 " 296.02 727.20 " 1,333.50 " 675.82 795.30 348.16 80003145 SPECIAL TELETHERAPY PORT PLAN 77321 333 "$1,778.00" 657.15 51.80 " 1,422.40 " 59.57 " 1,228.60 " 353.21 " 1,228.60 " 60.61 982.35 346.48 " 1,173.48 " 58.02 51.80 " 1,176.86 " 302.75 336.39 648.87 811.09 344.80 346.48 336.39 " 1,422.40 " 307.80 51.80 " 1,191.26 " 296.02 727.20 " 1,333.50 " 675.82 795.30 348.16 80003188 SPECIAL RAD DOSIMETRY RX BY MD 77331 333 $666.00 246.15 57.81 532.80 66.48 460.21 132.34 460.21 67.64 367.97 129.82 439.56 64.75 57.81 440.83 113.44 126.04 219.42 274.27 129.19 129.82 126.04 532.80 115.33 57.81 446.22 110.92 272.39 499.50 253.15 297.90 130.45 80003196 TREATMENT DEVICE SIMPLE 77332 333 $666.00 246.15 55.00 532.80 63.25 460.21 132.34 460.21 64.35 367.97 129.82 439.56 61.60 55.00 440.83 113.44 126.04 256.87 321.09 129.19 129.82 126.04 532.80 115.33 55.00 446.22 110.92 272.39 499.50 253.15 297.90 130.45 80003200 TREATMENT DEVICE INTERMEDIATE 77333 333 $666.00 246.15 58.72 532.80 67.53 460.21 132.34 460.21 68.70 367.97 129.82 439.56 65.77 58.72 440.83 113.44 126.04 376.67 470.84 129.19 129.82 126.04 532.80 115.33 58.72 446.22 110.92 272.39 499.50 253.15 297.90 130.45 80003218 TREATMENT DEVICE COMPLEX 77334 333 "$1,778.00" 657.15 91.50 " 1,422.40 " 105.23 " 1,228.60 " 353.21 " 1,228.60 " 107.06 982.35 346.48 " 1,173.48 " 102.48 91.50 " 1,176.86 " 302.75 336.39 603.62 754.53 344.80 346.48 336.39 " 1,422.40 " 307.80 91.50 " 1,191.26 " 296.02 727.20 " 1,333.50 " 675.82 795.30 348.16 80003226 RADIATION PHYSICS CONSULT 77336 333 $666.00 246.15 49.00 532.80 56.35 460.21 132.34 460.21 57.33 367.97 129.82 439.56 54.88 49.00 440.83 113.44 126.04 358.31 447.89 129.19 129.82 126.04 532.80 115.33 49.00 446.22 110.92 272.39 499.50 253.15 297.90 130.45 80010842 IMRT MULTI LEAF COLLIMATOR DEV 77338 333 "$1,778.00" 657.15 - " 1,526.12 " - " 1,228.60 " 353.21 " 1,228.60 " - 982.35 346.48 " 1,173.48 " - - " 1,176.86 " 302.75 336.39 " 1,220.90 " " 1,526.12 " 344.80 346.48 336.39 " 1,422.40 " 307.80 - " 1,191.26 " 296.02 727.20 " 1,333.50 " 675.82 795.30 348.16 80003234 SPCL RADIATION PHYSICS CONSULT 77370 333 $666.00 246.15 96.50 532.80 110.98 460.21 132.34 460.21 112.91 367.97 129.82 439.56 108.08 96.50 440.83 113.44 126.04 420.10 525.12 129.19 129.82 126.04 532.80 115.33 96.50 446.22 110.92 272.39 499.50 253.15 297.90 130.45 80011113 SRS MULTISOURCE 77371 333 "$40,807.00" " 15,082.27 " 832.20 " 32,645.60 " 957.03 " 28,197.64 " " 8,111.94 " " 28,197.64 " 973.67 " 22,545.87 " " 7,957.43 " " 26,932.62 " 932.06 832.20 " 27,010.15 " " 6,953.09 " " 7,725.66 " " 18,430.93 " " 23,038.66 " " 7,918.80 " " 7,957.43 " " 7,725.66 " " 32,645.60 " " 7,068.98 " 832.20 " 27,340.69 " " 6,798.58 " " 16,690.06 " " 30,605.25 " " 15,510.74 " " 18,252.97 " " 7,996.06 " 80010893 STEREOTATIC BODY RADIATION TX 77373 333 "$9,102.00" " 3,364.10 " " 1,000.00 " " 9,630.07 " " 1,150.00 " " 6,289.48 " " 1,808.96 " " 6,289.48 " " 1,170.00 " " 5,028.86 " " 1,774.50 " " 6,007.32 " " 1,120.00 " " 1,000.00 " " 6,024.61 " " 1,550.54 " " 1,722.82 " " 7,704.06 " " 9,630.07 " " 1,765.89 " " 1,774.50 " " 1,722.82 " " 7,281.60 " " 1,576.38 " " 1,000.00 " " 6,098.34 " " 1,516.08 " " 3,722.72 " " 6,826.50 " " 3,459.67 " " 4,071.32 " " 1,783.12 " 80010958 IMRT DELIVERY SIMPLE 77385 333 "$2,848.00" " 1,052.62 " 268.80 " 2,278.40 " 309.12 " 1,967.97 " 565.91 " 1,967.97 " 314.50 " 1,573.52 " 555.13 " 1,879.68 " 301.06 268.80 " 1,885.09 " 485.06 538.96 831.35 " 1,039.19 " 552.43 555.13 538.96 " 2,278.40 " 493.15 268.80 " 1,908.16 " 474.28 " 1,164.83 " " 2,136.00 " " 1,082.52 " " 1,273.91 " 557.82 80010966 IMRT DELIVERY COMPLEX 77386 333 "$2,848.00" " 1,052.62 " 284.49 " 2,278.40 " 327.16 " 1,967.97 " 565.91 " 1,967.97 " 332.85 " 1,573.52 " 555.13 " 1,879.68 " 318.63 284.49 " 1,885.09 " 485.06 538.96 791.38 989.23 552.43 555.13 538.96 " 2,278.40 " 493.15 284.49 " 1,908.16 " 474.28 " 1,164.83 " " 2,136.00 " " 1,082.52 " " 1,273.91 " 557.82 80010575 GUIDE FOR DEL RADIATION TRMNT 77387 333 $141.00 52.11 - 112.80 91.47 97.43 - 97.43 93.06 77.90 - 93.06 89.08 79.54 93.33 - - 44.73 55.91 - - - 112.80 - 79.54 94.47 - 57.67 105.75 53.59 63.07 - 80010834 GUIDE FOR DEL RADIATION TRMNT 77387 333 $141.00 52.11 - 112.80 91.47 97.43 - 97.43 93.06 77.90 - 93.06 89.08 79.54 93.33 - - 44.73 55.91 - - - 112.80 - 79.54 94.47 - 57.67 105.75 53.59 63.07 - 80003277 RAD TMNT DEL >/=1 MEV SIMPLE 77402 333 $633.00 233.96 21.50 506.40 24.73 437.40 124.94 437.40 25.16 349.73 122.56 417.78 24.08 21.50 418.98 107.09 118.99 213.34 266.68 121.96 122.56 118.99 506.40 108.88 21.50 424.11 104.71 258.90 474.75 240.60 283.14 123.15 80003293 RAD TMNT DEL >/=1 MEV SIMPLE 77402 333 $633.00 233.96 21.50 506.40 24.73 437.40 124.94 437.40 25.16 349.73 122.56 417.78 24.08 21.50 418.98 107.09 118.99 213.34 266.68 121.96 122.56 118.99 506.40 108.88 21.50 424.11 104.71 258.90 474.75 240.60 283.14 123.15 80003323 RAD TMNT DEL >/=1 MEV INTM 77407 333 "$1,269.00" 469.02 32.50 " 1,015.20 " 37.38 876.88 252.13 876.88 38.03 701.12 247.32 837.54 36.40 32.50 839.95 216.11 240.12 251.64 314.55 246.12 247.32 240.12 " 1,015.20 " 219.71 32.50 850.23 211.31 519.02 951.75 482.35 567.62 248.52 80003340 RAD TMNT DEL >/=1 MEV INTM 77407 333 "$1,269.00" 469.02 32.50 " 1,015.20 " 37.38 876.88 252.13 876.88 38.03 701.12 247.32 837.54 36.40 32.50 839.95 216.11 240.12 251.64 314.55 246.12 247.32 240.12 " 1,015.20 " 219.71 32.50 850.23 211.31 519.02 951.75 482.35 567.62 248.52 80003374 RAD TMNT DEL >/=1 MEV COMPLEX 77412 333 "$1,269.00" 469.02 44.00 " 1,015.20 " 50.60 876.88 252.13 876.88 51.48 701.12 247.32 837.54 49.28 44.00 839.95 216.11 240.12 280.78 350.97 246.12 247.32 240.12 " 1,015.20 " 219.71 44.00 850.23 211.31 519.02 951.75 482.35 567.62 248.52 80003391 RAD TMNT DEL >/=1 MEV COMPLEX 77412 333 "$1,269.00" 469.02 44.00 " 1,015.20 " 50.60 876.88 252.13 876.88 51.48 701.12 247.32 837.54 49.28 44.00 839.95 216.11 240.12 280.78 350.97 246.12 247.32 240.12 " 1,015.20 " 219.71 44.00 850.23 211.31 519.02 951.75 482.35 567.62 248.52 80010257 RAD TMNT DEL >/=1 MEV COMPLEX 77412 333 "$1,269.00" 469.02 44.00 " 1,015.20 " 50.60 876.88 252.13 876.88 51.48 701.12 247.32 837.54 49.28 44.00 839.95 216.11 240.12 280.78 350.97 246.12 247.32 240.12 " 1,015.20 " 219.71 44.00 850.23 211.31 519.02 951.75 482.35 567.62 248.52 80003404 RADIOLOGY PORT IMAGES 77417 333 $84.00 31.05 - 89.59 14.86 58.04 - 58.04 15.12 46.41 - 55.44 14.47 12.92 55.60 - - 71.67 89.59 - - - 67.20 - 12.92 56.28 - 34.36 63.00 31.93 37.57 - 80006764 SPECIAL RADIATION TREATMENT 77470 333 "$2,848.00" " 1,052.62 " 36.50 " 2,278.40 " 41.98 " 1,967.97 " 565.91 " 1,967.97 " 42.71 " 1,573.52 " 555.13 " 1,879.68 " 40.88 36.50 " 1,885.09 " 485.06 538.96 " 1,695.35 " " 2,119.19 " 552.43 555.13 538.96 " 2,278.40 " 493.15 36.50 " 1,908.16 " 474.28 " 1,164.83 " " 2,136.00 " " 1,082.52 " " 1,273.91 " 557.82 80003439 INFUSION RADIOELEMENT SOLUTION 77750 333 "$1,269.00" 469.02 96.60 " 1,259.31 " 111.09 876.88 252.13 876.88 113.02 701.12 247.32 837.54 108.19 96.60 839.95 216.11 240.12 " 1,007.45 " " 1,259.31 " 246.12 247.32 240.12 " 1,015.20 " 219.71 96.60 850.23 211.31 519.02 951.75 482.35 567.62 248.52 80003447 INTRACVTRY RAD SRC APPL SIMPLE 77761 333 "$2,848.00" " 1,052.62 " 211.08 " 2,278.40 " 242.74 " 1,967.97 " 565.91 " 1,967.97 " 246.96 " 1,573.52 " 555.13 " 1,879.68 " 236.41 211.08 " 1,885.09 " 485.06 538.96 945.19 " 1,181.49 " 552.43 555.13 538.96 " 2,278.40 " 493.15 211.08 " 1,908.16 " 474.28 " 1,164.83 " " 2,136.00 " " 1,082.52 " " 1,273.91 " 557.82 80003455 INTRACVTRY RAD SRC APPL INTM 77762 333 "$2,848.00" " 1,052.62 " 250.55 " 2,278.40 " 288.13 " 1,967.97 " 565.91 " 1,967.97 " 293.14 " 1,573.52 " 555.13 " 1,879.68 " 280.62 250.55 " 1,885.09 " 485.06 538.96 " 1,401.91 " " 1,752.39 " 552.43 555.13 538.96 " 2,278.40 " 493.15 250.55 " 1,908.16 " 474.28 " 1,164.83 " " 2,136.00 " " 1,082.52 " " 1,273.91 " 557.82 80003463 INTRACVTRY RAD SRC APPL CPLX 77763 333 "$3,719.00" " 1,374.54 " 281.85 " 2,975.20 " 324.13 " 2,569.83 " 739.91 " 2,569.83 " 329.76 " 2,054.75 " 725.82 " 2,454.54 " 315.67 281.85 " 2,461.61 " 634.21 704.68 " 1,992.87 " " 2,491.09 " 722.30 725.82 704.68 " 2,975.20 " 644.78 281.85 " 2,491.73 " 620.12 " 1,521.07 " " 2,789.25 " " 1,413.59 " " 1,663.51 " 729.34 80011130 HDR RDNCL SK SRF BRCHYTX 1 CHL 77767 333 "$1,269.00" 469.02 - " 1,046.65 " - 876.88 252.13 876.88 - 701.12 247.32 837.54 - - 839.95 216.11 240.12 837.32 " 1,046.65 " 246.12 247.32 240.12 " 1,015.20 " 219.71 - 850.23 211.31 519.02 951.75 482.35 567.62 248.52 80011148 HDR RDNCL SK SRF BRCHYTX 2 CHL 77768 333 "$1,269.00" 469.02 - " 1,721.26 " - 876.88 252.13 876.88 - 701.12 247.32 837.54 - - 839.95 216.11 240.12 " 1,377.01 " " 1,721.26 " 246.12 247.32 240.12 " 1,015.20 " 219.71 - 850.23 211.31 519.02 951.75 482.35 567.62 248.52 80011041 HDR RDNCL BRACHYTX 1 CHANNEL 77770 333 "$3,719.00" " 1,374.54 " 245.25 " 2,975.20 " 282.04 " 2,569.83 " 739.91 " 2,569.83 " 286.94 " 2,054.75 " 725.82 " 2,454.54 " 274.68 245.25 " 2,461.61 " 634.21 704.68 " 1,081.06 " " 1,351.32 " 722.30 725.82 704.68 " 2,975.20 " 644.78 245.25 " 2,491.73 " 620.12 " 1,521.07 " " 2,789.25 " " 1,413.59 " " 1,663.51 " 729.34 80011059 HDR RDNCL BRACHYTX 2-12 CHNLS 77771 333 "$3,719.00" " 1,374.54 " 456.75 " 2,975.20 " 525.26 " 2,569.83 " 739.91 " 2,569.83 " 534.40 " 2,054.75 " 725.82 " 2,454.54 " 511.56 456.75 " 2,461.61 " 634.21 704.68 " 1,968.86 " " 2,461.08 " 722.30 725.82 704.68 " 2,975.20 " 644.78 456.75 " 2,491.73 " 620.12 " 1,521.07 " " 2,789.25 " " 1,413.59 " " 1,663.51 " 729.34 80011067 HDR RDNCL BRACHYTX >12 CHNLS 77772 333 "$3,719.00" " 1,374.54 " 620.12 " 3,890.87 " 801.58 " 2,569.83 " 739.91 " 2,569.83 " 815.53 " 2,054.75 " 725.82 " 2,454.54 " 780.67 697.03 " 2,461.61 " 634.21 704.68 " 3,112.70 " " 3,890.87 " 722.30 725.82 704.68 " 2,975.20 " 644.78 697.03 " 2,491.73 " 620.12 " 1,521.07 " " 2,789.25 " " 1,413.59 " " 1,663.51 " 729.34 80011032 INTERSTITIAL RAD SRC APPL CPLX 77778 333 "$3,719.00" " 1,374.54 " 328.95 " 3,176.76 " 378.29 " 2,569.83 " 739.91 " 2,569.83 " 384.87 " 2,054.75 " 725.82 " 2,454.54 " 368.42 328.95 " 2,461.61 " 634.21 704.68 " 2,541.41 " " 3,176.76 " 722.30 725.82 704.68 " 2,975.20 " 644.78 328.95 " 2,491.73 " 620.12 " 1,521.07 " " 2,789.25 " " 1,413.59 " " 1,663.51 " 729.34 80003544 SUPERVISION RADIATION HANDLING 77790 333 $784.00 289.77 - 627.20 62.33 541.74 - 541.74 63.41 433.16 - 517.44 60.70 54.20 518.93 - - 251.17 313.96 - - - 627.20 - 54.20 525.28 - 320.66 588.00 298.00 350.68 - 80225946 NM THYROID UPTAKE MEASUREMENT 78012 341 "$1,980.00" 731.81 61.20 " 1,584.00 " 70.38 " 1,368.18 " 393.18 " 1,368.18 " 71.60 " 1,093.95 " 385.69 " 1,306.80 " 68.54 61.20 " 1,310.56 " 337.01 374.46 172.54 215.67 383.82 385.69 374.46 " 1,584.00 " 342.63 61.20 988.05 329.52 809.82 " 1,485.00 " 752.60 885.65 387.57 80225954 NM THYROID IMAGING W/VASC FLOW 78013 341 "$1,980.00" 731.81 154.43 " 1,584.00 " 177.59 " 1,368.18 " 393.18 " 1,368.18 " 180.68 " 1,093.95 " 385.69 " 1,306.80 " 172.96 154.43 " 1,310.56 " 337.01 374.46 380.81 476.01 383.82 385.69 374.46 " 1,584.00 " 342.63 154.43 988.05 329.52 809.82 " 1,485.00 " 752.60 885.65 387.57 80225962 NM THYROID UPTAKE QUANTITATIVE 78014 341 "$1,980.00" 731.81 178.71 " 1,584.00 " 205.52 " 1,368.18 " 393.18 " 1,368.18 " 209.09 " 1,093.95 " 385.69 " 1,306.80 " 200.16 178.71 " 1,310.56 " 337.01 374.46 285.44 356.80 383.82 385.69 374.46 " 1,584.00 " 342.63 178.71 988.05 329.52 809.82 " 1,485.00 " 752.60 885.65 387.57 80205082 NM PARATHYROID PLANAR IMAGING 78070 341 "$1,980.00" 731.81 89.26 " 1,584.00 " 102.65 " 1,368.18 " 393.18 " 1,368.18 " 104.43 " 1,093.95 " 385.69 " 1,306.80 " 99.97 89.26 " 1,310.56 " 337.01 374.46 307.67 384.59 383.82 385.69 374.46 " 1,584.00 " 342.63 89.26 988.05 329.52 809.82 " 1,485.00 " 752.60 885.65 387.57 80225971 NM PARATHYROID PLANAR W/SPECT 78071 341 "$1,980.00" 731.81 267.51 " 1,584.00 " 307.64 " 1,368.18 " 393.18 " 1,368.18 " 312.99 " 1,093.95 " 385.69 " 1,306.80 " 299.61 267.51 " 1,310.56 " 337.01 374.46 669.18 836.47 383.82 385.69 374.46 " 1,584.00 " 342.63 267.51 988.05 329.52 809.82 " 1,485.00 " 752.60 885.65 387.57 80225989 NM PARATHYRD PLANAR W/SPECT&CT 78072 341 "$2,569.00" 949.50 319.38 " 2,055.20 " 367.29 " 1,775.18 " 510.42 " 1,775.18 " 373.67 " 1,419.37 " 500.69 " 1,695.54 " 357.71 319.38 " 1,700.42 " 437.50 486.11 811.16 " 1,013.95 " 498.26 500.69 486.11 " 2,055.20 " 444.79 319.38 " 1,282.23 " 427.78 " 1,050.72 " " 1,926.75 " 976.48 " 1,149.11 " 503.12 80205091 NM BONE MARROW IMAGING LTD 78102 341 "$1,980.00" 731.81 64.34 " 1,584.00 " 73.99 " 1,368.18 " 393.18 " 1,368.18 " 75.28 " 1,093.95 " 385.69 " 1,306.80 " 72.06 64.34 " 1,310.56 " 337.01 374.46 384.68 480.85 383.82 385.69 374.46 " 1,584.00 " 342.63 64.34 988.05 329.52 809.82 " 1,485.00 " 752.60 885.65 387.57 28175736 LYMPHATICS LYMPH NODES IMAGING 78195 360 "$2,569.00" 949.50 180.00 " 2,055.20 " 207.00 " 1,775.18 " 510.42 " 1,775.18 " 210.60 " 1,419.37 " 500.69 " 1,695.54 " 201.60 180.00 " 1,700.42 " 437.50 486.11 605.77 757.21 498.26 500.69 486.11 " 2,055.20 " 444.79 180.00 " 1,282.23 " 427.78 " 1,050.72 " " 1,926.75 " 976.48 " 1,149.11 " 503.12 80205139 NM LYMPH SYSTEM IMAGING 78195 341 "$2,569.00" 949.50 180.00 " 2,055.20 " 207.00 " 1,775.18 " 510.42 " 1,775.18 " 210.60 " 1,419.37 " 500.69 " 1,695.54 " 201.60 180.00 " 1,700.42 " 437.50 486.11 605.77 757.21 498.26 500.69 486.11 " 2,055.20 " 444.79 180.00 " 1,282.23 " 427.78 " 1,050.72 " " 1,926.75 " 976.48 " 1,149.11 " 503.12 80205155 NM LIVER & SPLEEN IMAGING 78215 341 "$1,980.00" 731.81 69.26 " 1,584.00 " 79.65 " 1,368.18 " 393.18 " 1,368.18 " 81.03 " 1,093.95 " 385.69 " 1,306.80 " 77.57 69.26 " 1,310.56 " 337.01 374.46 435.38 544.22 383.82 385.69 374.46 " 1,584.00 " 342.63 69.26 988.05 329.52 809.82 " 1,485.00 " 752.60 885.65 387.57 80205163 NM LIVER & SPLEEN IMAGE/FLOW 78216 341 "$1,980.00" 731.81 87.60 " 1,584.00 " 100.74 " 1,368.18 " 393.18 " 1,368.18 " 102.49 " 1,093.95 " 385.69 " 1,306.80 " 98.11 87.60 " 1,310.56 " 337.01 374.46 516.88 646.10 383.82 385.69 374.46 " 1,584.00 " 342.63 87.60 988.05 329.52 809.82 " 1,485.00 " 752.60 885.65 387.57 80205171 NM HEPATOBIL SYSTEM IMAGING 78226 341 "$1,980.00" 731.81 242.06 " 1,584.00 " 278.37 " 1,368.18 " 393.18 " 1,368.18 " 283.21 " 1,093.95 " 385.69 " 1,306.80 " 271.11 242.06 " 1,310.56 " 337.01 374.46 585.89 732.36 383.82 385.69 374.46 " 1,584.00 " 342.63 242.06 988.05 329.52 809.82 " 1,485.00 " 752.60 885.65 387.57 80225903 NM HEPATOBIL SYS IMAGE W/DRUG 78227 341 "$2,569.00" 949.50 331.01 " 2,055.20 " 380.66 " 1,775.18 " 510.42 " 1,775.18 " 387.28 " 1,419.37 " 500.69 " 1,695.54 " 370.73 331.01 " 1,700.42 " 437.50 486.11 585.89 732.36 498.26 500.69 486.11 " 2,055.20 " 444.79 331.01 " 1,282.23 " 427.78 " 1,050.72 " " 1,926.75 " 976.48 " 1,149.11 " 503.12 80205180 NM SALIVARY GLAND IMAGING 78230 340 "$1,980.00" 731.81 59.56 " 1,584.00 " 68.49 " 1,368.18 " 393.18 " 1,368.18 " 69.69 " 1,093.95 " 385.69 " 1,306.80 " 66.71 59.56 " 1,310.56 " 337.01 374.46 383.37 479.21 383.82 385.69 374.46 " 1,584.00 " 342.63 59.56 988.05 329.52 809.82 " 1,485.00 " 752.60 885.65 387.57 80205210 NM GASTRIC EMPTYING IMAG STUDY 78264 341 "$1,980.00" 731.81 134.99 " 1,584.00 " 155.24 " 1,368.18 " 393.18 " 1,368.18 " 157.94 " 1,093.95 " 385.69 " 1,306.80 " 151.19 134.99 " 1,310.56 " 337.01 374.46 653.48 816.85 383.82 385.69 374.46 " 1,584.00 " 342.63 134.99 988.05 329.52 809.82 " 1,485.00 " 752.60 885.65 387.57 80205244 NM ACUTE GI BLOOD LOSS IMAGING 78278 341 "$1,980.00" 731.81 64.00 " 1,584.00 " 73.60 " 1,368.18 " 393.18 " 1,368.18 " 74.88 " 1,093.95 " 385.69 " 1,306.80 " 71.68 64.00 " 1,310.56 " 337.01 374.46 727.09 908.86 383.82 385.69 374.46 " 1,584.00 " 342.63 64.00 988.05 329.52 809.82 " 1,485.00 " 752.60 885.65 387.57 80205252 NM INTESTINE IMAGING 78290 341 "$1,980.00" 731.81 75.00 " 1,584.00 " 86.25 " 1,368.18 " 393.18 " 1,368.18 " 87.75 " 1,093.95 " 385.69 " 1,306.80 " 84.00 75.00 " 1,310.56 " 337.01 374.46 483.71 604.64 383.82 385.69 374.46 " 1,584.00 " 342.63 75.00 988.05 329.52 809.82 " 1,485.00 " 752.60 885.65 387.57 80205279 NM BONE IMAGING LIMITED AREA 78300 341 "$1,980.00" 731.81 69.00 " 1,584.00 " 79.35 " 1,368.18 " 393.18 " 1,368.18 " 80.73 " 1,093.95 " 385.69 " 1,306.80 " 77.28 69.00 " 1,310.56 " 337.01 374.46 408.74 510.93 383.82 385.69 374.46 " 1,584.00 " 342.63 69.00 988.05 329.52 809.82 " 1,485.00 " 752.60 885.65 387.57 80205287 NM BONE IMAGING MULTIPLE AREAS 78305 341 "$1,980.00" 731.81 82.50 " 1,584.00 " 94.88 " 1,368.18 " 393.18 " 1,368.18 " 96.53 " 1,093.95 " 385.69 " 1,306.80 " 92.40 82.50 " 1,310.56 " 337.01 374.46 584.74 730.92 383.82 385.69 374.46 " 1,584.00 " 342.63 82.50 988.05 329.52 809.82 " 1,485.00 " 752.60 885.65 387.57 80205295 NM BONE IMAGING WHOLE BODY 78306 341 "$1,980.00" 731.81 101.48 " 1,584.00 " 116.70 " 1,368.18 " 393.18 " 1,368.18 " 118.73 " 1,093.95 " 385.69 " 1,306.80 " 113.66 101.48 " 1,310.56 " 337.01 374.46 662.42 828.03 383.82 385.69 374.46 " 1,584.00 " 342.63 101.48 988.05 329.52 809.82 " 1,485.00 " 752.60 885.65 387.57 80205309 NM BONE IMAGING 3 PHASE STUDY 78315 341 "$1,980.00" 731.81 166.37 " 1,584.00 " 191.33 " 1,368.18 " 393.18 " 1,368.18 " 194.65 " 1,093.95 " 385.69 " 1,306.80 " 186.33 166.37 " 1,310.56 " 337.01 374.46 792.27 990.34 383.82 385.69 374.46 " 1,584.00 " 342.63 166.37 988.05 329.52 809.82 " 1,485.00 " 752.60 885.65 387.57 80205325 NM NON-CARD VASC FLOW IMAGING 78445 341 "$1,980.00" 731.81 53.00 " 1,584.00 " 60.95 " 1,368.18 " 393.18 " 1,368.18 " 62.01 " 1,093.95 " 385.69 " 1,306.80 " 59.36 53.00 " 1,310.56 " 337.01 374.46 324.62 405.78 383.82 385.69 374.46 " 1,584.00 " 342.63 53.00 988.05 329.52 809.82 " 1,485.00 " 752.60 885.65 387.57 53925821 NM MYOC PERF SPECT SCAN SINGLE 78451 340 "$6,856.00" " 2,533.98 " 242.94 " 5,484.80 " 279.38 " 4,737.50 " " 1,363.01 " " 4,737.50 " 284.24 " 3,787.94 " " 1,337.04 " " 4,524.96 " 272.09 242.94 " 4,537.99 " " 1,168.29 " " 1,298.10 " 752.93 941.16 " 1,330.55 " " 1,337.04 " " 1,298.10 " " 5,484.80 " " 1,187.76 " 242.94 " 3,421.56 " " 1,142.33 " " 2,804.10 " " 5,142.00 " " 2,605.97 " " 3,066.69 " " 1,343.53 " 53925839 NM MYOC PERF SPECT SCAN MULT 78452 340 "$6,856.00" " 2,533.98 " 340.80 " 5,484.80 " 391.92 " 4,737.50 " " 1,363.01 " " 4,737.50 " 398.74 " 3,787.94 " " 1,337.04 " " 4,524.96 " 381.70 340.80 " 4,537.99 " " 1,168.29 " " 1,298.10 " " 1,454.90 " " 1,818.63 " " 1,330.55 " " 1,337.04 " " 1,298.10 " " 5,484.80 " " 1,187.76 " 340.80 " 3,421.56 " " 1,142.33 " " 2,804.10 " " 5,142.00 " " 2,605.97 " " 3,066.69 " " 1,343.53 " 67725484 NM HEART MUSCLE IMAGING (PET) 78459 404 "$6,856.00" " 2,533.98 " " 1,142.33 " " 5,484.80 " " 1,666.99 " " 4,737.50 " " 1,363.01 " " 4,737.50 " " 1,695.99 " " 3,787.94 " " 1,337.04 " " 4,524.96 " " 1,623.51 " " 1,449.56 " " 4,537.99 " " 1,168.29 " " 1,298.10 " " 4,257.22 " " 5,321.52 " " 1,330.55 " " 1,337.04 " " 1,298.10 " " 5,484.80 " " 1,187.76 " " 1,449.56 " " 3,421.56 " " 1,142.33 " " 2,804.10 " " 5,142.00 " " 2,605.97 " " 3,066.69 " " 1,343.53 " 53905412 NM MYCO BLD POOL SINGLE 78472 340 "$1,980.00" 731.81 102.00 " 1,584.00 " 117.30 " 1,368.18 " 393.18 " 1,368.18 " 119.34 " 1,093.95 " 385.69 " 1,306.80 " 114.24 102.00 " 1,310.56 " 337.01 374.46 831.98 " 1,039.98 " 383.82 385.69 374.46 " 1,584.00 " 342.63 102.00 988.05 329.52 809.82 " 1,485.00 " 752.60 885.65 387.57 80205414 NM GATED HEART PLANAR SINGLE 78472 341 "$1,980.00" 731.81 102.00 " 1,584.00 " 117.30 " 1,368.18 " 393.18 " 1,368.18 " 119.34 " 1,093.95 " 385.69 " 1,306.80 " 114.24 102.00 " 1,310.56 " 337.01 374.46 831.98 " 1,039.98 " 383.82 385.69 374.46 " 1,584.00 " 342.63 102.00 988.05 329.52 809.82 " 1,485.00 " 752.60 885.65 387.57 80225253 NM HEART IMAGE SPECT 78494 341 "$1,980.00" 731.81 228.22 " 1,584.00 " 262.45 " 1,368.18 " 393.18 " 1,368.18 " 267.02 " 1,093.95 " 385.69 " 1,306.80 " 255.61 228.22 " 1,310.56 " 337.01 374.46 792.17 990.21 383.82 385.69 374.46 " 1,584.00 " 342.63 228.22 988.05 329.52 809.82 " 1,485.00 " 752.60 885.65 387.57 80205465 NM LUNG VENTILATION IMAGING 78579 341 "$1,980.00" 731.81 128.98 " 1,584.00 " 148.33 " 1,368.18 " 393.18 " 1,368.18 " 150.91 " 1,093.95 " 385.69 " 1,306.80 " 144.46 128.98 " 1,310.56 " 337.01 374.46 496.22 620.27 383.82 385.69 374.46 " 1,584.00 " 342.63 128.98 988.05 329.52 809.82 " 1,485.00 " 752.60 885.65 387.57 80205457 NM LUNG PERFUSION IMAGING 78580 341 "$1,980.00" 731.81 79.00 " 1,584.00 " 90.85 " 1,368.18 " 393.18 " 1,368.18 " 92.43 " 1,093.95 " 385.69 " 1,306.80 " 88.48 79.00 " 1,310.56 " 337.01 374.46 541.31 676.64 383.82 385.69 374.46 " 1,584.00 " 342.63 79.00 988.05 329.52 809.82 " 1,485.00 " 752.60 885.65 387.57 80205881 NM LUNG PERF/VENT IMAGING 78582 341 "$2,569.00" 949.50 238.18 " 2,055.20 " 273.91 " 1,775.18 " 510.42 " 1,775.18 " 278.67 " 1,419.37 " 500.69 " 1,695.54 " 266.76 238.18 " 1,700.42 " 437.50 486.11 890.84 " 1,113.55 " 498.26 500.69 486.11 " 2,055.20 " 444.79 238.18 " 1,282.23 " 427.78 " 1,050.72 " " 1,926.75 " 976.48 " 1,149.11 " 503.12 80225911 NM LUNG PERFUSION DIFFERENTIAL 78597 341 "$1,980.00" 731.81 145.70 " 1,584.00 " 167.56 " 1,368.18 " 393.18 " 1,368.18 " 170.47 " 1,093.95 " 385.69 " 1,306.80 " 163.18 145.70 " 1,310.56 " 337.01 374.46 531.90 664.87 383.82 385.69 374.46 " 1,584.00 " 342.63 145.70 988.05 329.52 809.82 " 1,485.00 " 752.60 885.65 387.57 80225733 NM LUNG PERF/VENT DIFERENTIAL 78598 341 "$2,569.00" 949.50 223.12 " 2,055.20 " 256.59 " 1,775.18 " 510.42 " 1,775.18 " 261.05 " 1,419.37 " 500.69 " 1,695.54 " 249.89 223.12 " 1,700.42 " 437.50 486.11 861.90 " 1,077.38 " 498.26 500.69 486.11 " 2,055.20 " 444.79 223.12 " 1,282.23 " 427.78 " 1,050.72 " " 1,926.75 " 976.48 " 1,149.11 " 503.12 80205481 NM BRAIN IMAGE W/FLOW <4 VWS 78601 341 "$1,980.00" 731.81 93.52 " 1,584.00 " 107.55 " 1,368.18 " 393.18 " 1,368.18 " 109.42 " 1,093.95 " 385.69 " 1,306.80 " 104.74 93.52 " 1,310.56 " 337.01 374.46 531.38 664.22 383.82 385.69 374.46 " 1,584.00 " 342.63 93.52 988.05 329.52 809.82 " 1,485.00 " 752.60 885.65 387.57 80205503 NM BRAIN IMAGE W/FLOW 4+ VWS 78606 341 "$2,569.00" 949.50 88.71 " 2,055.20 " 102.02 " 1,775.18 " 510.42 " 1,775.18 " 103.79 " 1,419.37 " 500.69 " 1,695.54 " 99.36 88.71 " 1,700.42 " 437.50 486.11 574.11 717.64 498.26 500.69 486.11 " 2,055.20 " 444.79 88.71 " 1,282.23 " 427.78 " 1,050.72 " " 1,926.75 " 976.48 " 1,149.11 " 503.12 67725468 NM PET CT BRAIN IMAGING 78608 341 "$7,772.00" " 2,872.53 " 683.09 " 8,548.89 " 785.55 " 5,370.45 " " 1,543.71 " " 5,370.45 " 799.22 " 4,294.03 " " 1,514.31 " " 5,129.52 " 765.06 683.09 " 5,144.29 " " 1,323.18 " " 1,470.20 " " 6,839.11 " " 8,548.89 " " 1,506.96 " " 1,514.31 " " 1,470.20 " " 6,217.60 " " 1,345.23 " 683.09 " 3,878.49 " " 1,293.78 " " 3,178.75 " " 5,829.00 " " 2,954.14 " " 3,476.42 " " 1,521.66 " 80205538 NM CEREBROSPINAL FLUID SCAN 78630 341 "$2,569.00" 949.50 113.06 " 2,055.20 " 130.02 " 1,775.18 " 510.42 " 1,775.18 " 132.28 " 1,419.37 " 500.69 " 1,695.54 " 126.63 113.06 " 1,700.42 " 437.50 486.11 722.95 903.69 498.26 500.69 486.11 " 2,055.20 " 444.79 113.06 " 1,282.23 " 427.78 " 1,050.72 " " 1,926.75 " 976.48 " 1,149.11 " 503.12 80205546 NM CSF SHUNT EVALUATION 78645 341 "$2,569.00" 949.50 136.10 " 2,055.20 " 156.52 " 1,775.18 " 510.42 " 1,775.18 " 159.24 " 1,419.37 " 500.69 " 1,695.54 " 152.43 136.10 " 1,700.42 " 437.50 486.11 538.90 673.63 498.26 500.69 486.11 " 2,055.20 " 444.79 136.10 " 1,282.23 " 427.78 " 1,050.72 " " 1,926.75 " 976.48 " 1,149.11 " 503.12 80205554 NM CSF LEAKAGE IMAGING 78650 341 "$6,856.00" " 2,533.98 " 82.60 " 5,484.80 " 94.99 " 4,737.50 " " 1,363.01 " " 4,737.50 " 96.64 " 3,787.94 " " 1,337.04 " " 4,524.96 " 92.51 82.60 " 4,537.99 " " 1,168.29 " " 1,298.10 " 741.90 927.37 " 1,330.55 " " 1,337.04 " " 1,298.10 " " 5,484.80 " " 1,187.76 " 82.60 " 3,421.56 " " 1,142.33 " " 2,804.10 " " 5,142.00 " " 2,605.97 " " 3,066.69 " " 1,343.53 " 80205597 NM K FLOW/FUNCT IMAGE W/O DRUG 78707 341 "$2,569.00" 949.50 113.41 " 2,055.20 " 130.42 " 1,775.18 " 510.42 " 1,775.18 " 132.69 " 1,419.37 " 500.69 " 1,695.54 " 127.02 113.41 " 1,700.42 " 437.50 486.11 675.56 844.45 498.26 500.69 486.11 " 2,055.20 " 444.79 113.41 " 1,282.23 " 427.78 " 1,050.72 " " 1,926.75 " 976.48 " 1,149.11 " 503.12 80225679 NM K FLOW/FUNCT IMAGE W/DRUG 78708 341 "$2,569.00" 949.50 114.00 " 2,055.20 " 131.10 " 1,775.18 " 510.42 " 1,775.18 " 133.38 " 1,419.37 " 500.69 " 1,695.54 " 127.68 114.00 " 1,700.42 " 437.50 486.11 674.51 843.14 498.26 500.69 486.11 " 2,055.20 " 444.79 114.00 " 1,282.23 " 427.78 " 1,050.72 " " 1,926.75 " 976.48 " 1,149.11 " 503.12 80205627 NM K FLOW/FUNCT IMAGE MULTIPLE 78709 341 "$2,569.00" 949.50 238.50 " 2,055.20 " 274.28 " 1,775.18 " 510.42 " 1,775.18 " 279.05 " 1,419.37 " 500.69 " 1,695.54 " 267.12 238.50 " 1,700.42 " 437.50 486.11 696.12 870.15 498.26 500.69 486.11 " 2,055.20 " 444.79 238.50 " 1,282.23 " 427.78 " 1,050.72 " " 1,926.75 " 976.48 " 1,149.11 " 503.12 80205643 NM URETERAL REFLUX STUDY 78740 341 "$1,980.00" 731.81 76.40 " 1,584.00 " 87.86 " 1,368.18 " 393.18 " 1,368.18 " 89.39 " 1,093.95 " 385.69 " 1,306.80 " 85.57 76.40 " 1,310.56 " 337.01 374.46 417.33 521.66 383.82 385.69 374.46 " 1,584.00 " 342.63 76.40 988.05 329.52 809.82 " 1,485.00 " 752.60 885.65 387.57 80205651 NM TESTICULAR IMAGING W/FLOW 78761 341 "$1,980.00" 731.81 128.04 " 1,584.00 " 147.25 " 1,368.18 " 393.18 " 1,368.18 " 149.81 " 1,093.95 " 385.69 " 1,306.80 " 143.40 128.04 " 1,310.56 " 337.01 374.46 560.14 700.18 383.82 385.69 374.46 " 1,584.00 " 342.63 128.04 988.05 329.52 809.82 " 1,485.00 " 752.60 885.65 387.57 80205660 NM TUMOR IMAGING SINGLE AREA 78800 342 "$1,980.00" 731.81 85.76 " 1,584.00 " 98.62 " 1,368.18 " 393.18 " 1,368.18 " 100.34 " 1,093.95 " 385.69 " 1,306.80 " 96.05 85.76 " 1,310.56 " 337.01 374.46 537.91 672.39 383.82 385.69 374.46 " 1,584.00 " 342.63 85.76 988.05 329.52 809.82 " 1,485.00 " 752.60 885.65 387.57 80205678 NM TUMOR IMAGING MULTI AREAS 78801 342 "$1,980.00" 731.81 96.32 " 1,584.00 " 110.77 " 1,368.18 " 393.18 " 1,368.18 " 112.69 " 1,093.95 " 385.69 " 1,306.80 " 107.88 96.32 " 1,310.56 " 337.01 374.46 722.85 903.56 383.82 385.69 374.46 " 1,584.00 " 342.63 96.32 988.05 329.52 809.82 " 1,485.00 " 752.60 885.65 387.57 80205686 NM TUMOR IMAGING WHOLE BODY 78802 342 "$6,856.00" " 2,533.98 " 109.98 " 5,484.80 " 126.48 " 4,737.50 " " 1,363.01 " " 4,737.50 " 128.68 " 3,787.94 " " 1,337.04 " " 4,524.96 " 123.18 109.98 " 4,537.99 " " 1,168.29 " " 1,298.10 " 865.94 " 1,082.42 " " 1,330.55 " " 1,337.04 " " 1,298.10 " " 5,484.80 " " 1,187.76 " 109.98 " 3,421.56 " " 1,142.33 " " 2,804.10 " " 5,142.00 " " 2,605.97 " " 3,066.69 " " 1,343.53 " 53905706 RP LOCAL TUMOR 1 AREA 1 DAY 78803 349 "$6,856.00" " 2,533.98 " 273.17 " 5,484.80 " 314.15 " 4,737.50 " " 1,363.01 " " 4,737.50 " 319.61 " 3,787.94 " " 1,337.04 " " 4,524.96 " 305.95 273.17 " 4,537.99 " " 1,168.29 " " 1,298.10 " 972.24 " 1,215.30 " " 1,330.55 " " 1,337.04 " " 1,298.10 " " 5,484.80 " " 1,187.76 " 273.17 " 3,421.56 " " 1,142.33 " " 2,804.10 " " 5,142.00 " " 2,605.97 " " 3,066.69 " " 1,343.53 " 80205708 NM TUMOR IMAGING SPECT 78803 342 "$6,856.00" " 2,533.98 " 273.17 " 5,484.80 " 314.15 " 4,737.50 " " 1,363.01 " " 4,737.50 " 319.61 " 3,787.94 " " 1,337.04 " " 4,524.96 " 305.95 273.17 " 4,537.99 " " 1,168.29 " " 1,298.10 " 972.24 " 1,215.30 " " 1,330.55 " " 1,337.04 " " 1,298.10 " " 5,484.80 " " 1,187.76 " 273.17 " 3,421.56 " " 1,142.33 " " 2,804.10 " " 5,142.00 " " 2,605.97 " " 3,066.69 " " 1,343.53 " 80225164 NM TUMOR IMG WHOLE BODY 2 DAYS 78804 342 "$6,856.00" " 2,533.98 " 358.26 " 5,484.80 " 412.00 " 4,737.50 " " 1,363.01 " " 4,737.50 " 419.16 " 3,787.94 " " 1,337.04 " " 4,524.96 " 401.25 358.26 " 4,537.99 " " 1,168.29 " " 1,298.10 " 655.21 819.01 " 1,330.55 " " 1,337.04 " " 1,298.10 " " 5,484.80 " " 1,187.76 " 358.26 " 3,421.56 " " 1,142.33 " " 2,804.10 " " 5,142.00 " " 2,605.97 " " 3,066.69 " " 1,343.53 " 80244002 NM INJ IV RA DRUG DX STUDY 78808 342 "$1,980.00" 731.81 - " 1,584.00 " - " 1,368.18 " 393.18 " 1,368.18 " - " 1,093.95 " 385.69 " 1,306.80 " - - " 1,310.56 " 337.01 374.46 218.42 273.02 383.82 385.69 374.46 " 1,584.00 " 342.63 - 988.05 329.52 809.82 " 1,485.00 " 752.60 885.65 387.57 67725565 NM PET IMAGE SKULL-THIGH 78812 404 "$7,772.00" " 2,872.53 " " 1,286.78 " " 10,600.53 " " 1,479.80 " " 5,370.45 " " 1,543.71 " " 5,370.45 " " 1,505.53 " " 4,294.03 " " 1,514.31 " " 5,129.52 " " 1,441.19 " " 1,286.78 " " 5,144.29 " " 1,323.18 " " 1,470.20 " " 8,480.42 " " 10,600.53 " " 1,506.96 " " 1,514.31 " " 1,470.20 " " 6,217.60 " " 1,345.23 " " 1,286.78 " " 3,878.49 " " 1,293.78 " " 3,178.75 " " 5,829.00 " " 2,954.14 " " 3,476.42 " " 1,521.66 " 67725590 NM PET IMAGE FULL BODY 78813 404 "$7,772.00" " 2,872.53 " " 1,289.74 " " 13,275.19 " " 1,483.20 " " 5,370.45 " " 1,543.71 " " 5,370.45 " " 1,509.00 " " 4,294.03 " " 1,514.31 " " 5,129.52 " " 1,444.51 " " 1,289.74 " " 5,144.29 " " 1,323.18 " " 1,470.20 " " 10,620.15 " " 13,275.19 " " 1,506.96 " " 1,514.31 " " 1,470.20 " " 6,217.60 " " 1,345.23 " " 1,289.74 " " 3,878.49 " " 1,293.78 " " 3,178.75 " " 5,829.00 " " 2,954.14 " " 3,476.42 " " 1,521.66 " 67725603 NM PET IMAGE W/CT LMTD 78814 404 "$7,772.00" " 2,872.53 " " 1,293.78 " " 9,102.98 " " 1,492.41 " " 5,370.45 " " 1,543.71 " " 5,370.45 " " 1,518.37 " " 4,294.03 " " 1,514.31 " " 5,129.52 " " 1,453.48 " " 1,297.75 " " 5,144.29 " " 1,323.18 " " 1,470.20 " " 7,282.38 " " 9,102.98 " " 1,506.96 " " 1,514.31 " " 1,470.20 " " 6,217.60 " " 1,345.23 " " 1,297.75 " " 3,878.49 " " 1,293.78 " " 3,178.75 " " 5,829.00 " " 2,954.14 " " 3,476.42 " " 1,521.66 " 67725611 NM PET IMAGE W/CT SKULL-THIGH 78815 404 "$7,772.00" " 2,872.53 " " 1,293.78 " " 11,784.18 " " 1,503.33 " " 5,370.45 " " 1,543.71 " " 5,370.45 " " 1,529.47 " " 4,294.03 " " 1,514.31 " " 5,129.52 " " 1,464.11 " " 1,307.24 " " 5,144.29 " " 1,323.18 " " 1,470.20 " " 9,427.34 " " 11,784.18 " " 1,506.96 " " 1,514.31 " " 1,470.20 " " 6,217.60 " " 1,345.23 " " 1,307.24 " " 3,878.49 " " 1,293.78 " " 3,178.75 " " 5,829.00 " " 2,954.14 " " 3,476.42 " " 1,521.66 " 67725638 NM PET IMAGE W/CT FULL BODY 78816 404 "$7,772.00" " 2,872.53 " " 1,293.78 " " 14,458.83 " " 1,506.06 " " 5,370.45 " " 1,543.71 " " 5,370.45 " " 1,532.26 " " 4,294.03 " " 1,514.31 " " 5,129.52 " " 1,466.77 " " 1,309.62 " " 5,144.29 " " 1,323.18 " " 1,470.20 " " 11,567.06 " " 14,458.83 " " 1,506.96 " " 1,514.31 " " 1,470.20 " " 6,217.60 " " 1,345.23 " " 1,309.62 " " 3,878.49 " " 1,293.78 " " 3,178.75 " " 5,829.00 " " 2,954.14 " " 3,476.42 " " 1,521.66 " 53944043 NM RADPHARM TUMOR LOCAL 1 AREA 78830 340 "$6,856.00" " 2,533.98 " 383.42 " 5,484.80 " 440.93 " 4,737.50 " " 1,363.01 " " 4,737.50 " 448.60 " 3,787.94 " " 1,337.04 " " 4,524.96 " 429.43 383.42 " 4,537.99 " " 1,168.29 " " 1,298.10 " " 2,128.48 " " 2,660.60 " " 1,330.55 " " 1,337.04 " " 1,298.10 " " 5,484.80 " " 1,187.76 " 383.42 " 3,421.56 " " 1,142.33 " " 2,804.10 " " 5,142.00 " " 2,605.97 " " 3,066.69 " " 1,343.53 " 80244045 NM RADPHARM TUMOR LOCAL 1 AREA 78830 340 "$6,856.00" " 2,533.98 " 383.42 " 5,484.80 " 440.93 " 4,737.50 " " 1,363.01 " " 4,737.50 " 448.60 " 3,787.94 " " 1,337.04 " " 4,524.96 " 429.43 383.42 " 4,537.99 " " 1,168.29 " " 1,298.10 " " 2,128.48 " " 2,660.60 " " 1,330.55 " " 1,337.04 " " 1,298.10 " " 5,484.80 " " 1,187.76 " 383.42 " 3,421.56 " " 1,142.33 " " 2,804.10 " " 5,142.00 " " 2,605.97 " " 3,066.69 " " 1,343.53 " 80244053 NM RADPHARM TUMOR LOCAL 2 AREA 78831 340 "$6,856.00" " 2,533.98 " 553.94 " 5,484.80 " 637.03 " 4,737.50 " " 1,363.01 " " 4,737.50 " 648.11 " 3,787.94 " " 1,337.04 " " 4,524.96 " 620.41 553.94 " 4,537.99 " " 1,168.29 " " 1,298.10 " " 3,160.04 " " 3,950.05 " " 1,330.55 " " 1,337.04 " " 1,298.10 " " 5,484.80 " " 1,187.76 " 553.94 " 3,421.56 " " 1,142.33 " " 2,804.10 " " 5,142.00 " " 2,605.97 " " 3,066.69 " " 1,343.53 " 80244061 NM RADPHARM TUMOR LOCAL W/CT 78832 340 "$7,772.00" " 2,872.53 " 720.34 " 6,217.60 " 828.39 " 5,370.45 " " 1,543.71 " " 5,370.45 " 842.80 " 4,294.03 " " 1,514.31 " " 5,129.52 " 806.78 720.34 " 5,144.29 " " 1,323.18 " " 1,470.20 " " 4,171.94 " " 5,214.92 " " 1,506.96 " " 1,514.31 " " 1,470.20 " " 6,217.60 " " 1,345.23 " 720.34 " 3,878.49 " " 1,293.78 " " 3,178.75 " " 5,829.00 " " 2,954.14 " " 3,476.42 " " 1,521.66 " 80244070 NM RADPHARM QUAN MEAS SGL AREA 78835 340 $568.00 209.93 - 510.87 92.78 392.49 - 392.49 94.40 313.82 - 374.88 90.36 80.68 375.96 - - 408.70 510.87 - - - 454.40 - 80.68 216.67 - 232.31 426.00 215.90 254.07 - 80205783 NM THYROID RX ORAL ADMIN 79005 340 "$1,311.00" 484.55 108.73 " 1,048.80 " 125.04 905.90 263.92 905.90 127.21 724.33 258.89 865.26 121.78 108.73 867.75 226.22 251.35 308.87 386.09 257.63 258.89 251.35 " 1,048.80 " 229.99 108.73 654.00 221.19 536.20 983.25 498.31 586.41 260.15 80205872 NM RX TX IV ADMIN 79101 340 "$1,311.00" 484.55 114.93 " 1,048.80 " 132.17 905.90 263.92 905.90 134.47 724.33 258.89 865.26 128.72 114.93 867.75 226.22 251.35 308.87 386.09 257.63 258.89 251.35 " 1,048.80 " 229.99 114.93 654.00 221.19 536.20 983.25 498.31 586.41 260.15 35200789 BASIC METAB PNL (IONIZED CA) 80047 300 $72.00 26.61 11.91 168.16 13.70 49.75 14.42 49.75 11.91 39.78 14.14 23.52 13.10 11.91 47.66 12.36 13.73 134.53 168.16 14.07 14.14 13.73 57.60 12.56 11.91 35.97 12.08 29.45 54.00 27.37 32.21 14.21 35790420 BASIC METABOLIC PANEL 80048 300 $44.00 16.26 7.44 66.63 10.76 30.40 8.88 30.40 9.36 24.31 8.71 23.52 10.30 9.36 29.12 7.61 8.46 53.30 66.63 8.67 8.71 8.46 35.20 7.74 9.36 22.17 7.44 18.00 33.00 16.72 19.68 8.76 35790144 ELECTROLYTES 80051 300 $37.00 13.68 6.17 53.41 8.05 25.57 7.36 25.57 7.00 20.44 7.22 19.50 7.70 7.00 24.49 6.31 7.01 42.73 53.41 7.19 7.22 7.01 29.60 6.41 7.00 18.37 6.17 15.13 27.75 14.06 16.55 7.26 35790438 COMPREHENSIVE METABOLIC PANEL 80053 300 $55.00 20.33 9.29 83.22 13.44 38.01 11.09 38.01 11.69 30.39 10.88 29.36 12.86 11.69 36.40 9.50 10.56 66.58 83.22 10.82 10.88 10.56 44.00 9.66 11.69 27.67 9.29 22.50 41.25 20.91 24.60 10.93 35790543 EXPOSURE COMPR METABOLIC PANEL 80053 300 $55.00 20.33 9.29 83.22 13.44 38.01 11.09 38.01 11.69 30.39 10.88 29.36 12.86 11.69 36.40 9.50 10.56 66.58 83.22 10.82 10.88 10.56 44.00 9.66 11.69 27.67 9.29 22.50 41.25 20.91 24.60 10.93 35790314 LIPOPROTEINS (LIPID PANEL)(X3) 80061 300 $70.00 25.87 11.78 80.74 16.10 48.37 14.06 48.37 14.00 38.68 13.79 36.17 15.40 14.00 46.33 12.05 13.39 64.59 80.74 13.72 13.79 13.39 56.00 12.25 14.00 35.08 11.78 28.63 52.50 26.61 31.31 13.86 35790527 LIPID PANEL W/REFLEX DIRCT LDL 80061 300 $70.00 25.87 11.78 80.74 16.10 48.37 14.06 48.37 14.00 38.68 13.79 36.17 15.40 14.00 46.33 12.05 13.39 64.59 80.74 13.72 13.79 13.39 56.00 12.25 14.00 35.08 11.78 28.63 52.50 26.61 31.31 13.86 36937726 LIPID PANEL 80061 300 $405.00 149.69 11.78 324.00 16.10 279.86 14.06 279.86 14.00 223.76 13.79 36.17 15.40 14.00 268.07 12.05 13.39 64.59 80.74 13.72 13.79 13.39 324.00 12.25 14.00 35.08 11.78 165.65 303.75 153.94 181.16 13.86 36939133 LIPID PANEL 80061 300 $405.00 149.69 11.78 324.00 16.10 279.86 14.06 279.86 14.00 223.76 13.79 36.17 15.40 14.00 268.07 12.05 13.39 64.59 80.74 13.72 13.79 13.39 324.00 12.25 14.00 35.08 11.78 165.65 303.75 153.94 181.16 13.86 35790454 RENAL FUNCTION PANEL 80069 300 $46.00 17.00 7.64 68.34 11.04 31.79 9.11 31.79 9.60 25.42 8.94 24.15 10.56 9.60 30.45 7.81 8.68 54.67 68.34 8.90 8.94 8.68 36.80 7.94 9.60 22.74 7.64 18.81 34.50 17.48 20.58 8.98 36190019 ACUTE HEPATITIS PANEL 80074 300 $250.00 92.40 41.91 374.84 60.56 172.75 50.01 172.75 52.66 138.13 49.06 129.81 57.93 52.66 165.48 42.87 47.63 299.87 374.84 48.82 49.06 47.63 200.00 43.58 52.66 124.79 41.91 102.25 187.50 95.03 111.83 49.30 35790446 HEPATIC FUNCTION PANEL 80076 300 $43.00 15.89 7.19 64.32 10.38 29.71 8.58 29.71 9.03 23.76 8.42 22.70 9.93 9.03 28.46 7.35 8.17 51.46 64.32 8.37 8.42 8.17 34.40 7.48 9.03 21.41 7.19 17.59 32.25 16.34 19.23 8.46 35700030 ACETAMINOPHEN 80143 300 $98.00 36.22 - 78.40 - 67.72 19.57 67.72 - 54.15 19.20 64.68 - - 64.87 16.78 18.64 51.93 64.92 19.11 19.20 18.64 78.40 17.06 - 48.84 16.40 40.08 73.50 37.25 43.84 19.29 36944609 ADALIMUMAB REF1 80145 300 $798.00 294.94 - 638.40 - 551.42 40.50 551.42 - 440.90 39.73 526.68 - - 528.20 34.71 38.57 170.06 212.58 39.53 39.73 38.57 638.40 35.29 - 101.05 33.94 326.38 598.50 303.32 356.95 39.92 36910780 AMIKACIN RANDOM 80150 300 $265.00 97.94 11.00 212.00 12.65 183.12 15.83 183.12 11.00 146.41 15.53 41.92 12.10 11.00 175.40 13.57 15.08 97.18 121.47 15.46 15.53 15.08 212.00 13.80 11.00 39.51 13.27 108.39 198.75 100.73 118.53 15.61 36910798 AMIKACIN PEAK 80150 300 $194.00 71.70 11.00 155.20 12.65 134.05 15.83 134.05 11.00 107.19 15.53 41.92 12.10 11.00 128.41 13.57 15.08 97.18 121.47 15.46 15.53 15.08 155.20 13.80 11.00 39.51 13.27 79.35 145.50 73.74 86.78 15.61 36910801 AMIKACIN TROUGH 80150 300 $194.00 71.70 11.00 155.20 12.65 134.05 15.83 134.05 11.00 107.19 15.53 41.92 12.10 11.00 128.41 13.57 15.08 97.18 121.47 15.46 15.53 15.08 155.20 13.80 11.00 39.51 13.27 79.35 145.50 73.74 86.78 15.61 36922141 AMIODARONE 80151 300 $144.00 53.22 - 115.20 - 99.50 19.57 99.50 - 79.56 19.20 95.04 - - 95.31 16.78 18.64 76.31 95.39 19.11 19.20 18.64 115.20 17.06 - 48.84 16.40 58.90 108.00 54.73 64.41 19.29 35702792 CAFFEINE 80155 300 $202.00 74.66 15.44 161.60 17.76 139.58 40.50 139.58 15.44 111.61 39.73 39.34 16.98 15.44 133.70 34.71 38.57 33.78 42.22 39.53 39.73 38.57 161.60 35.29 15.44 101.05 33.94 82.62 151.50 76.78 90.35 39.92 35701681 CARBAMAZEPINE 80156 300 $76.00 28.09 12.82 83.44 21.28 52.52 15.30 52.52 18.50 41.99 15.01 40.51 20.35 18.50 50.30 13.11 14.57 66.75 83.44 14.93 15.01 14.57 60.80 13.33 18.50 38.17 12.82 31.08 57.00 28.89 33.99 15.08 36913011 CARBAMAZEPINE TOTAL 80156 300 $404.00 149.32 12.82 323.20 21.28 279.16 15.30 279.16 18.50 223.21 15.01 40.51 20.35 18.50 267.41 13.11 14.57 66.75 83.44 14.93 15.01 14.57 323.20 13.33 18.50 38.17 12.82 165.24 303.00 153.56 180.71 15.08 36914971 CARBAMAZEPINE FREE 80157 300 $386.00 142.67 10.99 308.80 12.64 266.73 13.91 266.73 10.99 213.27 13.65 36.86 12.09 10.99 255.49 11.93 13.25 62.61 78.26 13.58 13.65 13.25 308.80 12.12 10.99 34.72 11.66 157.87 289.50 146.72 172.66 13.71 35703055 CYCLOSPORINE 80158 300 $95.00 35.11 15.88 103.45 19.65 65.65 18.95 65.65 17.09 52.49 18.59 50.18 18.80 17.09 62.88 16.25 18.05 82.76 103.45 18.50 18.59 18.05 76.00 16.52 17.09 47.29 15.88 38.86 71.25 36.11 42.49 18.68 36941600 CYCLOSPORIN LC MS/MS 80158 300 $110.00 40.66 15.88 103.45 19.65 76.01 18.95 76.01 17.09 60.78 18.59 50.18 18.80 17.09 72.81 16.25 18.05 82.76 103.45 18.50 18.59 18.05 88.00 16.52 17.09 47.29 15.88 44.99 82.50 41.81 49.20 18.68 36936193 CLOZAPINE (CLOZARIL) CHROM QNT 80159 300 $106.00 39.18 17.73 84.80 23.21 73.25 21.16 73.25 20.18 58.57 20.75 51.40 22.20 20.18 70.16 18.14 20.15 44.14 55.17 20.65 20.75 20.15 84.80 18.44 20.18 52.79 17.73 43.35 79.50 40.29 47.41 20.86 36982586 CARBAMAZEPINE 10 11-EPOXIDE 80161 300 $98.00 36.22 - 78.40 - 67.72 19.57 67.72 - 54.15 19.20 64.68 - - 64.87 16.78 18.64 51.93 64.92 19.11 19.20 18.64 78.40 17.06 - 48.84 16.40 40.08 73.50 37.25 43.84 19.29 36982594 CARBAMAZEPINE 10 11-EPOX FREE 80161 300 $98.00 36.22 - 78.40 - 67.72 19.57 67.72 - 54.15 19.20 64.68 - - 64.87 16.78 18.64 51.93 64.92 19.11 19.20 18.64 78.40 17.06 - 48.84 16.40 40.08 73.50 37.25 43.84 19.29 35702512 DIGOXIN 80162 300 $70.00 25.87 11.00 76.11 12.65 48.37 13.94 48.37 11.00 38.68 13.68 36.93 12.10 11.00 46.33 11.95 13.28 60.89 76.11 13.61 13.68 13.28 56.00 12.15 11.00 34.79 11.69 28.63 52.50 26.61 31.31 13.74 35701818 VALPROIC ACID 80164 300 $71.00 26.24 11.92 76.94 21.53 49.06 14.22 49.06 18.72 39.23 13.95 37.68 20.59 18.72 46.99 12.19 13.54 61.55 76.94 13.88 13.95 13.54 56.80 12.39 18.72 35.47 11.92 29.04 53.25 26.99 31.76 14.01 36934565 VALPROIC ACID FREE 80165 300 $254.00 93.88 11.92 203.20 16.96 175.51 14.22 175.51 14.75 140.34 13.95 37.68 16.23 14.75 168.12 12.19 13.54 29.58 36.98 13.88 13.95 13.54 203.20 12.39 14.75 35.47 11.92 103.89 190.50 96.55 113.61 14.01 36909081 FELBAMATE 80167 300 $337.00 124.56 - 269.60 - 232.87 19.57 232.87 - 186.19 19.20 222.42 - - 223.06 16.78 18.64 178.58 223.23 19.11 19.20 18.64 269.60 17.06 - 48.84 16.40 137.83 252.75 128.09 150.74 19.29 36921960 ETHOSUXIMIDE QUANT 80168 300 $108.00 39.92 13.00 93.64 14.95 74.63 17.16 74.63 13.00 59.67 16.83 45.44 14.30 13.00 71.49 14.71 16.34 74.91 93.64 16.75 16.83 16.34 86.40 14.95 13.00 42.81 14.38 44.17 81.00 41.05 48.31 16.91 36941618 EVEROLIMUS 80169 300 $538.00 198.84 12.08 430.40 17.23 371.76 14.42 371.76 14.98 297.25 14.14 38.18 16.48 14.98 356.10 12.36 13.73 32.76 40.95 14.07 14.14 13.73 430.40 12.56 14.98 35.97 12.08 220.04 403.50 204.49 240.65 14.21 35702016 GENTAMICIN RANDOM 80170 300 $86.00 31.79 12.00 93.92 13.80 59.43 17.20 59.43 12.00 47.52 16.87 45.56 13.20 12.00 56.92 14.74 16.38 75.14 93.92 16.79 16.87 16.38 68.80 14.99 12.00 42.92 14.41 35.17 64.50 32.69 38.47 16.95 35709207 GENTAMICIN TROUGH 80170 300 $86.00 31.79 12.00 93.92 13.80 59.43 17.20 59.43 12.00 47.52 16.87 45.56 13.20 12.00 56.92 14.74 16.38 75.14 93.92 16.79 16.87 16.38 68.80 14.99 12.00 42.92 14.41 35.17 64.50 32.69 38.47 16.95 35709215 GENTAMICIN PEAK 80170 300 $86.00 31.79 12.00 93.92 13.80 59.43 17.20 59.43 12.00 47.52 16.87 45.56 13.20 12.00 56.92 14.74 16.38 75.14 93.92 16.79 16.87 16.38 68.80 14.99 12.00 42.92 14.41 35.17 64.50 32.69 38.47 16.95 36909561 NEURONTIN GABAPENTIN 80171 300 $141.00 52.11 14.47 112.80 16.64 97.43 22.75 97.43 14.47 77.90 22.32 36.86 15.92 14.47 93.33 19.50 21.67 31.66 39.57 22.21 22.32 21.67 112.80 19.83 14.47 56.78 19.07 57.67 105.75 53.59 63.07 22.43 36901705 HALOPERIDOL (HALDOL) 80173 300 $181.00 66.90 13.89 144.80 18.52 125.07 16.57 125.07 16.10 100.00 16.25 40.51 17.71 16.10 119.80 14.20 15.78 91.66 114.58 16.17 16.25 15.78 144.80 14.44 16.10 41.34 13.89 74.03 135.75 68.80 80.96 16.33 35709606 LAMOTRIGINE 80175 300 $70.00 25.87 11.66 56.00 16.64 48.37 13.91 48.37 14.47 38.68 13.65 36.86 15.92 14.47 46.33 11.93 13.25 31.66 39.57 13.58 13.65 13.25 56.00 12.12 14.47 34.72 11.66 28.63 52.50 26.61 31.31 13.71 35701036 LIDOCAINE 80176 300 $77.00 28.46 12.93 112.32 14.95 53.21 15.42 53.21 13.00 42.54 15.13 40.85 14.30 13.00 50.97 13.22 14.69 89.86 112.32 15.06 15.13 14.69 61.60 13.44 13.00 38.49 12.93 31.49 57.75 29.27 34.44 15.20 36937335 LIDOCAINE 80176 300 $77.00 28.46 12.93 112.32 14.95 53.21 15.42 53.21 13.00 42.54 15.13 40.85 14.30 13.00 50.97 13.22 14.69 89.86 112.32 15.06 15.13 14.69 61.60 13.44 13.00 38.49 12.93 31.49 57.75 29.27 34.44 15.20 35709614 LEVETIRACETAM 80177 300 $70.00 25.87 11.66 56.00 16.64 48.37 13.91 48.37 14.47 38.68 13.65 36.86 15.92 14.47 46.33 11.93 13.25 31.66 39.57 13.58 13.65 13.25 56.00 12.12 14.47 34.72 11.66 28.63 52.50 26.61 31.31 13.71 35701061 LITHIUM 80178 300 $35.00 12.94 5.82 37.86 9.20 24.19 6.94 24.19 8.00 19.34 6.81 18.40 8.80 8.00 23.17 5.95 6.61 30.29 37.86 6.78 6.81 6.61 28.00 6.05 8.00 17.32 5.82 14.32 26.25 13.30 15.66 6.84 35701591 SALICYLATES 80179 300 $98.00 36.22 - 78.40 - 67.72 19.57 67.72 - 54.15 19.20 64.68 - - 64.87 16.78 18.64 51.93 64.92 19.11 19.20 18.64 78.40 17.06 - 48.84 16.40 40.08 73.50 37.25 43.84 19.29 36934255 MYCOPHENOLIC ACID MS QUANT 80180 300 $506.00 187.02 15.88 404.80 22.66 349.65 18.95 349.65 19.70 279.57 18.59 50.18 21.67 19.70 334.92 16.25 18.05 43.08 53.85 18.50 18.59 18.05 404.80 16.52 19.70 47.29 15.88 206.95 379.50 192.33 226.33 18.68 36903341 FLECAINIDE 80181 300 $209.00 77.25 - 167.20 - 144.42 19.57 144.42 - 115.47 19.20 137.94 - - 138.34 16.78 18.64 110.75 138.44 19.11 19.20 18.64 167.20 17.06 - 48.84 16.40 85.48 156.75 79.44 93.49 19.29 36916206 10 HYDROXYCARBAZEPINE MET 80183 300 $271.00 100.16 11.66 216.80 16.64 187.26 13.91 187.26 14.47 149.73 13.65 36.86 15.92 14.47 179.37 11.93 13.25 31.66 39.57 13.58 13.65 13.25 216.80 12.12 14.47 34.72 11.66 110.84 203.25 103.01 121.22 13.71 35701362 PHENOBARBITAL 80184 300 $80.00 29.57 13.46 65.53 18.41 55.28 16.07 55.28 16.01 44.20 15.76 31.84 17.61 16.01 52.95 13.77 15.30 52.42 65.53 15.68 15.76 15.30 64.00 14.00 16.01 40.09 13.46 32.72 60.00 30.41 35.78 15.84 36940191 PHENOBARBITAL 80184 300 $80.00 29.57 13.46 65.53 18.41 55.28 16.07 55.28 16.01 44.20 15.76 31.84 17.61 16.01 52.95 13.77 15.30 52.42 65.53 15.68 15.76 15.30 64.00 14.00 16.01 40.09 13.46 32.72 60.00 30.41 35.78 15.84 35700641 PHENYTOIN 80185 300 $70.00 25.87 11.66 76.00 14.95 48.37 13.91 48.37 13.00 38.68 13.65 36.86 14.30 13.00 46.33 11.93 13.25 60.80 76.00 13.58 13.65 13.25 56.00 12.12 13.00 34.72 11.66 28.63 52.50 26.61 31.31 13.71 35704825 PHENYTOIN UNBOUND 80186 300 $72.00 26.61 12.11 80.36 14.95 49.75 14.45 49.75 13.00 39.78 14.17 38.28 14.30 13.00 47.66 12.38 13.76 64.29 80.36 14.10 14.17 13.76 57.60 12.59 13.00 36.05 12.11 29.45 54.00 27.37 32.21 14.24 36934557 PHENYTOIN FREE 80186 300 $108.00 39.92 12.11 86.40 14.95 74.63 14.45 74.63 13.00 59.67 14.17 38.28 14.30 13.00 71.49 12.38 13.76 64.29 80.36 14.10 14.17 13.76 86.40 12.59 13.00 36.05 12.11 44.17 81.00 41.05 48.31 14.24 35701303 PRIMIDONE 80188 300 $87.00 32.16 14.60 95.13 19.55 60.12 17.42 60.12 17.00 48.07 17.09 46.16 18.70 17.00 57.59 14.93 16.59 76.10 95.13 17.00 17.09 16.59 69.60 15.18 17.00 43.47 14.60 35.58 65.25 33.07 38.92 17.17 36937327 PRIMIDONE 80188 300 $87.00 32.16 14.60 95.13 19.55 60.12 17.42 60.12 17.00 48.07 17.09 46.16 18.70 17.00 57.59 14.93 16.59 76.10 95.13 17.00 17.09 16.59 69.60 15.18 17.00 43.47 14.60 35.58 65.25 33.07 38.92 17.17 36940247 PRIMIDONE 80188 300 $87.00 32.16 14.60 95.13 19.55 60.12 17.42 60.12 17.00 48.07 17.09 46.16 18.70 17.00 57.59 14.93 16.59 76.10 95.13 17.00 17.09 16.59 69.60 15.18 17.00 43.47 14.60 35.58 65.25 33.07 38.92 17.17 36910542 ITRACONAZOLE 80189 300 $558.00 206.24 21.69 446.40 24.94 385.58 28.47 385.58 21.69 308.30 27.92 368.28 23.86 21.69 369.34 24.40 27.11 295.68 369.62 27.79 27.92 27.11 446.40 24.81 21.69 71.03 23.86 228.22 418.50 212.10 249.59 28.06 35701508 PROCAINAMIDE/NAPA 80192 300 $88.00 32.52 14.74 95.68 22.43 60.81 17.59 60.81 19.50 48.62 17.25 46.57 21.45 19.50 58.25 15.08 16.75 76.54 95.68 17.17 17.25 16.75 70.40 15.33 19.50 43.89 14.74 35.99 66.00 33.45 39.36 17.34 36937319 PROCAINAMIDE/NAPA 80192 300 $88.00 32.52 14.74 95.68 22.43 60.81 17.59 60.81 19.50 48.62 17.25 46.57 21.45 19.50 58.25 15.08 16.75 76.54 95.68 17.17 17.25 16.75 70.40 15.33 19.50 43.89 14.74 35.99 66.00 33.45 39.36 17.34 36981628 LEFLUNOMIDE 80193 300 $887.00 327.84 - 709.60 - 612.92 40.50 612.92 - 490.07 39.73 585.42 - - 587.11 34.71 38.57 470.02 587.55 39.53 39.73 38.57 709.60 35.29 - 101.05 33.94 362.78 665.25 337.15 396.76 39.92 35701567 QUINIDINE 80194 300 $77.00 28.46 12.85 83.66 19.55 53.21 15.33 53.21 17.00 42.54 15.04 40.60 18.70 17.00 50.97 13.14 14.60 66.93 83.66 14.97 15.04 14.60 61.60 13.36 17.00 38.25 12.85 31.49 57.75 29.27 34.44 15.11 36937301 QUINIDINE 80194 300 $108.00 39.92 12.85 86.40 19.55 74.63 15.33 74.63 17.00 59.67 15.04 40.60 18.70 17.00 71.49 13.14 14.60 66.93 83.66 14.97 15.04 14.60 86.40 13.36 17.00 38.25 12.85 44.17 81.00 41.05 48.31 15.11 36917202 SIROLIMUS 80195 300 $330.00 121.97 12.08 264.00 17.64 228.03 14.42 228.03 15.34 182.33 14.14 38.18 16.87 15.34 218.43 12.36 13.73 84.53 105.66 14.07 14.14 13.73 264.00 12.56 15.34 35.97 12.08 134.97 247.50 125.43 147.61 14.21 35708693 FK506 TACROLIMUS QUANT 80197 300 $72.00 26.61 12.08 108.03 17.89 49.75 14.42 49.75 15.56 39.78 14.14 38.18 17.12 15.56 47.66 12.36 13.73 86.42 108.03 14.07 14.14 13.73 57.60 12.56 15.56 35.97 12.08 29.45 54.00 27.37 32.21 14.21 35701711 THEOPHYLLINE 80198 300 $74.00 27.35 11.00 81.13 12.65 51.13 14.85 51.13 11.00 40.89 14.56 39.34 12.10 11.00 48.98 12.73 14.14 64.90 81.13 14.49 14.56 14.14 59.20 12.94 11.00 37.05 12.44 30.27 55.50 28.13 33.10 14.63 35701966 TOBRAMYCIN RANDOM 80200 300 $85.00 31.42 14.19 129.91 20.13 58.74 16.94 58.74 17.50 46.96 16.61 44.81 19.25 17.50 56.26 14.52 16.13 103.93 129.91 16.53 16.61 16.13 68.00 14.76 17.50 42.26 14.19 34.77 63.75 32.31 38.02 16.69 35709185 TOBRAMYCIN TROUGH 80200 300 $85.00 31.42 14.19 129.91 20.13 58.74 16.94 58.74 17.50 46.96 16.61 44.81 19.25 17.50 56.26 14.52 16.13 103.93 129.91 16.53 16.61 16.13 68.00 14.76 17.50 42.26 14.19 34.77 63.75 32.31 38.02 16.69 35709193 TOBRAMYCIN PEAK 80200 300 $85.00 31.42 14.19 129.91 20.13 58.74 16.94 58.74 17.50 46.96 16.61 44.81 19.25 17.50 56.26 14.52 16.13 103.93 129.91 16.53 16.61 16.13 68.00 14.76 17.50 42.26 14.19 34.77 63.75 32.31 38.02 16.69 36910933 TOPIRAMATE 80201 300 $144.00 53.22 10.49 115.20 15.54 99.50 12.52 99.50 13.51 79.56 12.28 33.16 14.86 13.51 95.31 10.73 11.92 75.09 93.86 12.22 12.28 11.92 115.20 10.91 13.51 31.23 10.49 58.90 108.00 54.73 64.41 12.34 35702539 VANCOMYCIN RANDOM 80202 300 $71.00 26.24 11.92 76.94 21.53 49.06 14.22 49.06 18.72 39.23 13.95 37.68 20.59 18.72 46.99 12.19 13.54 61.55 76.94 13.88 13.95 13.54 56.80 12.39 18.72 35.47 11.92 29.04 53.25 26.99 31.76 14.01 35709169 VANCOMYCIN TROUGH 80202 300 $71.00 26.24 11.92 76.94 21.53 49.06 14.22 49.06 18.72 39.23 13.95 37.68 20.59 18.72 46.99 12.19 13.54 61.55 76.94 13.88 13.95 13.54 56.80 12.39 18.72 35.47 11.92 29.04 53.25 26.99 31.76 14.01 35709177 VANCOMYCIN PEAK 80202 300 $71.00 26.24 11.92 76.94 21.53 49.06 14.22 49.06 18.72 39.23 13.95 37.68 20.59 18.72 46.99 12.19 13.54 61.55 76.94 13.88 13.95 13.54 56.80 12.39 18.72 35.47 11.92 29.04 53.25 26.99 31.76 14.01 36924829 ZONISAMIDE QUANTITATION 80203 300 $611.00 225.83 11.66 488.80 16.64 422.20 13.91 422.20 14.47 337.58 13.65 36.86 15.92 14.47 404.42 11.93 13.25 31.66 39.57 13.58 13.65 13.25 488.80 12.12 14.47 34.72 11.66 249.90 458.25 232.24 273.30 13.71 35702547 METHOTREXATE 80204 300 $202.00 74.66 - 161.60 - 139.58 40.50 139.58 - 111.61 39.73 133.32 - - 133.70 34.71 38.57 107.04 133.80 39.53 39.73 38.57 161.60 35.29 - 101.05 33.94 82.62 151.50 76.78 90.35 39.92 36944471 RUFINAMIDE 80210 300 $227.00 83.90 - 181.60 - 156.86 28.47 156.86 - 125.42 27.92 149.82 - - 150.25 24.40 27.11 120.29 150.36 27.79 27.92 27.11 181.60 24.81 - 71.03 23.86 92.84 170.25 86.28 101.54 28.06 36937246 INFLIXIMAB REF1 80230 300 "$1,007.00" 372.19 - 805.60 - 695.84 40.50 695.84 - 556.37 39.73 664.62 - - 666.53 34.71 38.57 170.06 212.58 39.53 39.73 38.57 805.60 35.29 - 101.05 33.94 411.86 755.25 382.76 450.43 39.92 36944561 INFLIXIMAB REF2 80230 300 $798.00 294.94 - 638.40 - 551.42 40.50 551.42 - 440.90 39.73 526.68 - - 528.20 34.71 38.57 170.06 212.58 39.53 39.73 38.57 638.40 35.29 - 101.05 33.94 326.38 598.50 303.32 356.95 39.92 36940344 LACOSAMIDE REF1 80235 300 $441.00 162.99 - 352.80 - 304.73 28.47 304.73 - 243.65 27.92 291.06 - - 291.90 24.40 27.11 119.54 149.42 27.79 27.92 27.11 352.80 24.81 - 71.03 23.86 180.37 330.75 167.62 197.26 28.06 36944579 VEDOLIZUMAB REF1 80280 300 "$1,123.00" 415.06 - 898.40 - 775.99 40.50 775.99 - 620.46 39.73 741.18 - - 743.31 34.71 38.57 170.06 212.58 39.53 39.73 38.57 898.40 35.29 - 101.05 33.94 459.31 842.25 426.85 502.32 39.92 36938013 VORICONAZOLE REF1 80285 300 $863.00 318.96 21.69 690.40 24.94 596.33 28.47 596.33 21.69 476.81 27.92 569.58 23.86 21.69 571.22 24.40 27.11 119.54 149.42 27.79 27.92 27.11 690.40 24.81 21.69 71.03 23.86 352.97 647.25 328.03 386.02 28.06 36902086 DISOPYRAMIDE 80299 300 $773.00 285.70 15.30 618.40 17.60 534.14 19.57 534.14 15.30 427.08 19.20 38.09 16.83 15.30 511.65 16.78 18.64 62.74 78.43 19.11 19.20 18.64 618.40 17.06 15.30 48.84 16.40 316.16 579.75 293.82 345.76 19.29 36902809 5-FLUOROCYTOSINE 80299 300 $773.00 285.70 15.30 618.40 17.60 534.14 19.57 534.14 15.30 427.08 19.20 38.09 16.83 15.30 511.65 16.78 18.64 62.74 78.43 19.11 19.20 18.64 618.40 17.06 15.30 48.84 16.40 316.16 579.75 293.82 345.76 19.29 36935693 FONDAPARINUX SODIUM QUANT 80299 300 $773.00 285.70 15.30 618.40 17.60 534.14 19.57 534.14 15.30 427.08 19.20 38.09 16.83 15.30 511.65 16.78 18.64 62.74 78.43 19.11 19.20 18.64 618.40 17.06 15.30 48.84 16.40 316.16 579.75 293.82 345.76 19.29 36940905 RIVAROXABAN 80299 300 $773.00 285.70 15.30 618.40 17.60 534.14 19.57 534.14 15.30 427.08 19.20 38.09 16.83 15.30 511.65 16.78 18.64 62.74 78.43 19.11 19.20 18.64 618.40 17.06 15.30 48.84 16.40 316.16 579.75 293.82 345.76 19.29 36944463 QNT THERAPEUTIC DRUG NES 80299 300 $773.00 285.70 15.30 618.40 17.60 534.14 19.57 534.14 15.30 427.08 19.20 38.09 16.83 15.30 511.65 16.78 18.64 62.74 78.43 19.11 19.20 18.64 618.40 17.06 15.30 48.84 16.40 316.16 579.75 293.82 345.76 19.29 35710060 TOX URINE DRUG SCREEN 80305 300 $66.00 24.39 11.09 81.90 13.77 45.61 13.23 45.61 11.97 36.47 12.98 43.56 13.17 11.97 43.69 11.34 12.60 65.52 81.90 12.92 12.98 12.60 52.80 11.53 11.97 33.01 11.09 26.99 49.50 25.09 29.52 13.04 35703250 AMPHETAMINES (SCREEN) 80307 300 $326.00 120.49 54.68 439.87 73.43 225.27 65.25 225.27 63.85 180.12 64.00 215.16 70.24 63.85 215.78 55.93 62.14 351.90 439.87 63.69 64.00 62.14 260.80 56.86 63.85 162.81 54.68 133.33 244.50 123.91 145.82 64.31 35703268 BARBITURATES (SCREEN) 80307 300 $326.00 120.49 54.68 439.87 73.43 225.27 65.25 225.27 63.85 180.12 64.00 215.16 70.24 63.85 215.78 55.93 62.14 351.90 439.87 63.69 64.00 62.14 260.80 56.86 63.85 162.81 54.68 133.33 244.50 123.91 145.82 64.31 35703276 BENZODIAZEPINES (SCREEN) 80307 300 $326.00 120.49 54.68 439.87 73.43 225.27 65.25 225.27 63.85 180.12 64.00 215.16 70.24 63.85 215.78 55.93 62.14 351.90 439.87 63.69 64.00 62.14 260.80 56.86 63.85 162.81 54.68 133.33 244.50 123.91 145.82 64.31 35703284 CANNABINOIDS (SCREEN) 80307 300 $326.00 120.49 54.68 439.87 73.43 225.27 65.25 225.27 63.85 180.12 64.00 215.16 70.24 63.85 215.78 55.93 62.14 351.90 439.87 63.69 64.00 62.14 260.80 56.86 63.85 162.81 54.68 133.33 244.50 123.91 145.82 64.31 35703292 COCAINE METABOLITES (SCREEN) 80307 300 $326.00 120.49 54.68 439.87 73.43 225.27 65.25 225.27 63.85 180.12 64.00 215.16 70.24 63.85 215.78 55.93 62.14 351.90 439.87 63.69 64.00 62.14 260.80 56.86 63.85 162.81 54.68 133.33 244.50 123.91 145.82 64.31 35703306 OPIATES (SCREEN) 80307 300 $326.00 120.49 54.68 439.87 73.43 225.27 65.25 225.27 63.85 180.12 64.00 215.16 70.24 63.85 215.78 55.93 62.14 351.90 439.87 63.69 64.00 62.14 260.80 56.86 63.85 162.81 54.68 133.33 244.50 123.91 145.82 64.31 35703314 PCP (SCREEN) 80307 300 $326.00 120.49 54.68 439.87 73.43 225.27 65.25 225.27 63.85 180.12 64.00 215.16 70.24 63.85 215.78 55.93 62.14 351.90 439.87 63.69 64.00 62.14 260.80 56.86 63.85 162.81 54.68 133.33 244.50 123.91 145.82 64.31 35703365 ETHANOL URINE 80307 300 $326.00 120.49 54.68 439.87 73.43 225.27 65.25 225.27 63.85 180.12 64.00 215.16 70.24 63.85 215.78 55.93 62.14 351.90 439.87 63.69 64.00 62.14 260.80 56.86 63.85 162.81 54.68 133.33 244.50 123.91 145.82 64.31 35704868 PROPOXYPHENE SCREEN FORENSIC 80307 300 $326.00 120.49 54.68 439.87 73.43 225.27 65.25 225.27 63.85 180.12 64.00 215.16 70.24 63.85 215.78 55.93 62.14 351.90 439.87 63.69 64.00 62.14 260.80 56.86 63.85 162.81 54.68 133.33 244.50 123.91 145.82 64.31 35706089 BARBITURATES SCREEN FORENSIC 80307 300 $326.00 120.49 54.68 439.87 73.43 225.27 65.25 225.27 63.85 180.12 64.00 215.16 70.24 63.85 215.78 55.93 62.14 351.90 439.87 63.69 64.00 62.14 260.80 56.86 63.85 162.81 54.68 133.33 244.50 123.91 145.82 64.31 35706097 BENZODIAZEPINES SCR FORENSIC 80307 300 $326.00 120.49 54.68 439.87 73.43 225.27 65.25 225.27 63.85 180.12 64.00 215.16 70.24 63.85 215.78 55.93 62.14 351.90 439.87 63.69 64.00 62.14 260.80 56.86 63.85 162.81 54.68 133.33 244.50 123.91 145.82 64.31 35706101 CANNABINOIDS SCREEN FORENSIC 80307 300 $326.00 120.49 54.68 439.87 73.43 225.27 65.25 225.27 63.85 180.12 64.00 215.16 70.24 63.85 215.78 55.93 62.14 351.90 439.87 63.69 64.00 62.14 260.80 56.86 63.85 162.81 54.68 133.33 244.50 123.91 145.82 64.31 35706119 COCAINE METAB SCREEN FORENSIC 80307 300 $326.00 120.49 54.68 439.87 73.43 225.27 65.25 225.27 63.85 180.12 64.00 215.16 70.24 63.85 215.78 55.93 62.14 351.90 439.87 63.69 64.00 62.14 260.80 56.86 63.85 162.81 54.68 133.33 244.50 123.91 145.82 64.31 35706127 OPIATES SCREEN FORENSIC 80307 300 $326.00 120.49 54.68 439.87 73.43 225.27 65.25 225.27 63.85 180.12 64.00 215.16 70.24 63.85 215.78 55.93 62.14 351.90 439.87 63.69 64.00 62.14 260.80 56.86 63.85 162.81 54.68 133.33 244.50 123.91 145.82 64.31 35706135 PCP SCREEN FORENSIC 80307 300 $326.00 120.49 54.68 439.87 73.43 225.27 65.25 225.27 63.85 180.12 64.00 215.16 70.24 63.85 215.78 55.93 62.14 351.90 439.87 63.69 64.00 62.14 260.80 56.86 63.85 162.81 54.68 133.33 244.50 123.91 145.82 64.31 35706909 AMPHETAMINES SCREEN FORENSIC 80307 300 $326.00 120.49 54.68 439.87 73.43 225.27 65.25 225.27 63.85 180.12 64.00 215.16 70.24 63.85 215.78 55.93 62.14 351.90 439.87 63.69 64.00 62.14 260.80 56.86 63.85 162.81 54.68 133.33 244.50 123.91 145.82 64.31 35708456 METHADONE (SCREEN) 80307 300 $326.00 120.49 54.68 439.87 73.43 225.27 65.25 225.27 63.85 180.12 64.00 215.16 70.24 63.85 215.78 55.93 62.14 351.90 439.87 63.69 64.00 62.14 260.80 56.86 63.85 162.81 54.68 133.33 244.50 123.91 145.82 64.31 35709088 OXYCODONE (SCREEN) 80307 300 $326.00 120.49 54.68 439.87 73.43 225.27 65.25 225.27 63.85 180.12 64.00 215.16 70.24 63.85 215.78 55.93 62.14 351.90 439.87 63.69 64.00 62.14 260.80 56.86 63.85 162.81 54.68 133.33 244.50 123.91 145.82 64.31 35709355 OXYCODONE SCREEN FORENSIC 80307 300 $326.00 120.49 54.68 439.87 73.43 225.27 65.25 225.27 63.85 180.12 64.00 215.16 70.24 63.85 215.78 55.93 62.14 351.90 439.87 63.69 64.00 62.14 260.80 56.86 63.85 162.81 54.68 133.33 244.50 123.91 145.82 64.31 35709380 BUPRENORPHINE SCREEN MED 80307 300 $326.00 120.49 54.68 439.87 73.43 225.27 65.25 225.27 63.85 180.12 64.00 215.16 70.24 63.85 215.78 55.93 62.14 351.90 439.87 63.69 64.00 62.14 260.80 56.86 63.85 162.81 54.68 133.33 244.50 123.91 145.82 64.31 35709398 BUPRENORPHINE SCREEN FORENSIC 80307 300 $326.00 120.49 54.68 439.87 73.43 225.27 65.25 225.27 63.85 180.12 64.00 215.16 70.24 63.85 215.78 55.93 62.14 351.90 439.87 63.69 64.00 62.14 260.80 56.86 63.85 162.81 54.68 133.33 244.50 123.91 145.82 64.31 35709452 COTININE SCREEN 80307 300 $326.00 120.49 54.68 439.87 73.43 225.27 65.25 225.27 63.85 180.12 64.00 215.16 70.24 63.85 215.78 55.93 62.14 351.90 439.87 63.69 64.00 62.14 260.80 56.86 63.85 162.81 54.68 133.33 244.50 123.91 145.82 64.31 35709584 HEROIN SCREEN CONFIRM URINE 80307 300 $326.00 120.49 54.68 439.87 73.43 225.27 65.25 225.27 63.85 180.12 64.00 215.16 70.24 63.85 215.78 55.93 62.14 351.90 439.87 63.69 64.00 62.14 260.80 56.86 63.85 162.81 54.68 133.33 244.50 123.91 145.82 64.31 35709631 METHADONE METABOLITE (EDDP)FOR 80307 300 $326.00 120.49 54.68 439.87 73.43 225.27 65.25 225.27 63.85 180.12 64.00 215.16 70.24 63.85 215.78 55.93 62.14 351.90 439.87 63.69 64.00 62.14 260.80 56.86 63.85 162.81 54.68 133.33 244.50 123.91 145.82 64.31 35709649 METHADONE METABOLITE (EDDP) 80307 300 $326.00 120.49 54.68 439.87 73.43 225.27 65.25 225.27 63.85 180.12 64.00 215.16 70.24 63.85 215.78 55.93 62.14 351.90 439.87 63.69 64.00 62.14 260.80 56.86 63.85 162.81 54.68 133.33 244.50 123.91 145.82 64.31 35709908 FENTANYL SCREEN 80307 300 $326.00 120.49 54.68 439.87 73.43 225.27 65.25 225.27 63.85 180.12 64.00 215.16 70.24 63.85 215.78 55.93 62.14 351.90 439.87 63.69 64.00 62.14 260.80 56.86 63.85 162.81 54.68 133.33 244.50 123.91 145.82 64.31 35709916 FENTANYL SCREEN W/REFLEX CONF 80307 300 $326.00 120.49 54.68 439.87 73.43 225.27 65.25 225.27 63.85 180.12 64.00 215.16 70.24 63.85 215.78 55.93 62.14 351.90 439.87 63.69 64.00 62.14 260.80 56.86 63.85 162.81 54.68 133.33 244.50 123.91 145.82 64.31 35709959 DAU FORENSIC DRUGS X5 80307 300 $326.00 120.49 54.68 439.87 73.43 225.27 65.25 225.27 63.85 180.12 64.00 215.16 70.24 63.85 215.78 55.93 62.14 351.90 439.87 63.69 64.00 62.14 260.80 56.86 63.85 162.81 54.68 133.33 244.50 123.91 145.82 64.31 35709967 DAU FORENSIC (X7) 80307 300 $326.00 120.49 54.68 439.87 73.43 225.27 65.25 225.27 63.85 180.12 64.00 215.16 70.24 63.85 215.78 55.93 62.14 351.90 439.87 63.69 64.00 62.14 260.80 56.86 63.85 162.81 54.68 133.33 244.50 123.91 145.82 64.31 35709975 DAU 9 SCREEN FORENSIC 80307 300 $326.00 120.49 54.68 439.87 73.43 225.27 65.25 225.27 63.85 180.12 64.00 215.16 70.24 63.85 215.78 55.93 62.14 351.90 439.87 63.69 64.00 62.14 260.80 56.86 63.85 162.81 54.68 133.33 244.50 123.91 145.82 64.31 35709983 FORENSIC DRUG SCREEN UR(5) PNL 80307 300 $326.00 120.49 54.68 439.87 73.43 225.27 65.25 225.27 63.85 180.12 64.00 215.16 70.24 63.85 215.78 55.93 62.14 351.90 439.87 63.69 64.00 62.14 260.80 56.86 63.85 162.81 54.68 133.33 244.50 123.91 145.82 64.31 35709991 FORENSIC DRUG SCREEN UR(8) PNL 80307 300 $326.00 120.49 54.68 439.87 73.43 225.27 65.25 225.27 63.85 180.12 64.00 215.16 70.24 63.85 215.78 55.93 62.14 351.90 439.87 63.69 64.00 62.14 260.80 56.86 63.85 162.81 54.68 133.33 244.50 123.91 145.82 64.31 35710001 TOXICOLOGY SCREEN URINE 80307 300 $326.00 120.49 54.68 439.87 73.43 225.27 65.25 225.27 63.85 180.12 64.00 215.16 70.24 63.85 215.78 55.93 62.14 351.90 439.87 63.69 64.00 62.14 260.80 56.86 63.85 162.81 54.68 133.33 244.50 123.91 145.82 64.31 35710019 DRUG SCREEN SINGLE DRUG CLASS 80307 300 $326.00 120.49 54.68 439.87 73.43 225.27 65.25 225.27 63.85 180.12 64.00 215.16 70.24 63.85 215.78 55.93 62.14 351.90 439.87 63.69 64.00 62.14 260.80 56.86 63.85 162.81 54.68 133.33 244.50 123.91 145.82 64.31 35791566 HYDROCODONE SCREEN 80307 300 $326.00 120.49 54.68 439.87 73.43 225.27 65.25 225.27 63.85 180.12 64.00 215.16 70.24 63.85 215.78 55.93 62.14 351.90 439.87 63.69 64.00 62.14 260.80 56.86 63.85 162.81 54.68 133.33 244.50 123.91 145.82 64.31 35791574 BARBITURATE SCREEN 80307 300 $326.00 120.49 54.68 439.87 73.43 225.27 65.25 225.27 63.85 180.12 64.00 215.16 70.24 63.85 215.78 55.93 62.14 351.90 439.87 63.69 64.00 62.14 260.80 56.86 63.85 162.81 54.68 133.33 244.50 123.91 145.82 64.31 35791582 BARBITURATE SCREEN W CONFIRM 80307 300 $326.00 120.49 54.68 439.87 73.43 225.27 65.25 225.27 63.85 180.12 64.00 215.16 70.24 63.85 215.78 55.93 62.14 351.90 439.87 63.69 64.00 62.14 260.80 56.86 63.85 162.81 54.68 133.33 244.50 123.91 145.82 64.31 35791591 "BARBITURATE SCREEN, FOR" 80307 300 $326.00 120.49 54.68 439.87 73.43 225.27 65.25 225.27 63.85 180.12 64.00 215.16 70.24 63.85 215.78 55.93 62.14 351.90 439.87 63.69 64.00 62.14 260.80 56.86 63.85 162.81 54.68 133.33 244.50 123.91 145.82 64.31 36909749 LSD RIA 80307 300 $326.00 120.49 54.68 439.87 73.43 225.27 65.25 225.27 63.85 180.12 64.00 215.16 70.24 63.85 215.78 55.93 62.14 351.90 439.87 63.69 64.00 62.14 260.80 56.86 63.85 162.81 54.68 133.33 244.50 123.91 145.82 64.31 36910551 EMETINE & CEPHAELINE 80307 300 $976.00 360.73 54.68 780.80 73.43 674.42 65.25 674.42 63.85 539.24 64.00 644.16 70.24 63.85 646.01 55.93 62.14 351.90 439.87 63.69 64.00 62.14 780.80 56.86 63.85 162.81 54.68 399.18 732.00 370.98 436.56 64.31 36910585 KETAMINE 80307 300 $326.00 120.49 54.68 439.87 73.43 225.27 65.25 225.27 63.85 180.12 64.00 215.16 70.24 63.85 215.78 55.93 62.14 351.90 439.87 63.69 64.00 62.14 260.80 56.86 63.85 162.81 54.68 133.33 244.50 123.91 145.82 64.31 36933160 CHLORAL HYDRATE 80307 300 $326.00 120.49 54.68 439.87 73.43 225.27 65.25 225.27 63.85 180.12 64.00 215.16 70.24 63.85 215.78 55.93 62.14 351.90 439.87 63.69 64.00 62.14 260.80 56.86 63.85 162.81 54.68 133.33 244.50 123.91 145.82 64.31 36939028 DRUG ABUSE SCREEN 80307 300 $337.00 124.56 54.68 439.87 73.43 232.87 65.25 232.87 63.85 186.19 64.00 222.42 70.24 63.85 223.06 55.93 62.14 351.90 439.87 63.69 64.00 62.14 269.60 56.86 63.85 162.81 54.68 137.83 252.75 128.09 150.74 64.31 36939036 DRUG SCREEN MECONIUM ELISA 80307 300 $326.00 120.49 54.68 439.87 73.43 225.27 65.25 225.27 63.85 180.12 64.00 215.16 70.24 63.85 215.78 55.93 62.14 351.90 439.87 63.69 64.00 62.14 260.80 56.86 63.85 162.81 54.68 133.33 244.50 123.91 145.82 64.31 36939044 INFANT DRUG SCREN #2 MECONIUM 80307 300 $487.00 180.00 54.68 439.87 73.43 336.52 65.25 336.52 63.85 269.07 64.00 321.42 70.24 63.85 322.35 55.93 62.14 351.90 439.87 63.69 64.00 62.14 389.60 56.86 63.85 162.81 54.68 199.18 365.25 185.11 217.84 64.31 36940913 DRUG SCREEN MECONIUM 80307 300 $791.00 292.35 54.68 632.80 73.43 546.58 65.25 546.58 63.85 437.03 64.00 522.06 70.24 63.85 523.56 55.93 62.14 351.90 439.87 63.69 64.00 62.14 632.80 56.86 63.85 162.81 54.68 323.52 593.25 300.66 353.81 64.31 36942819 DRUG SCR UMBIL CORD 80307 300 $823.00 304.18 54.68 658.40 73.43 568.69 65.25 568.69 63.85 454.71 64.00 543.18 70.24 63.85 544.74 55.93 62.14 351.90 439.87 63.69 64.00 62.14 658.40 56.86 63.85 162.81 54.68 336.61 617.25 312.82 368.13 64.31 35710035 ETHANOL (GC) 80320 300 $208.00 76.88 - 166.40 13.52 143.73 N/A 143.73 11.76 114.92 N/A 137.28 12.94 N/A 137.68 - N/A 45.37 56.71 N/A N/A N/A 166.40 N/A 11.76 139.36 N/A 85.07 156.00 79.06 93.04 N/A 36938021 ACETYL FENTANYL CONFIRM URINE 80354 300 $255.00 94.25 - 204.00 39.93 176.21 N/A 176.21 34.72 140.89 N/A 168.30 38.19 N/A 168.78 - N/A 81.74 102.18 N/A N/A N/A 204.00 N/A 34.72 170.85 N/A 104.30 191.25 96.93 114.06 N/A 36938030 ACETYL FENTANYL CONFIRM BLOOD 80354 300 $255.00 94.25 - 204.00 39.93 176.21 N/A 176.21 34.72 140.89 N/A 168.30 38.19 N/A 168.78 - N/A 81.74 102.18 N/A N/A N/A 204.00 N/A 34.72 170.85 N/A 104.30 191.25 96.93 114.06 N/A 35200061 URINANALYSIS W/MICROSCOPIC 81000 300 $21.00 7.76 3.54 18.08 4.97 14.51 4.22 14.51 4.32 11.60 4.14 8.82 4.75 4.32 13.90 3.62 4.02 14.46 18.08 4.12 4.14 4.02 16.80 3.68 4.32 10.53 3.54 8.59 15.75 7.98 9.39 4.16 35701583 MANUAL DIP W/MICRO 81000 300 $21.00 7.76 3.54 18.08 4.97 14.51 4.22 14.51 4.32 11.60 4.14 8.82 4.75 4.32 13.90 3.62 4.02 14.46 18.08 4.12 4.14 4.02 16.80 3.68 4.32 10.53 3.54 8.59 15.75 7.98 9.39 4.16 35200592 URINE AUTO WITH MICROSCOPIC 81001 300 $17.00 6.28 2.79 24.91 3.45 11.75 3.33 11.75 3.00 9.39 3.27 8.82 3.30 3.00 11.25 2.85 3.17 19.93 24.91 3.25 3.27 3.17 13.60 2.90 3.00 8.31 2.79 6.95 12.75 6.46 7.60 3.28 35707671 AUTO DIP W/MICRO 81001 300 $17.00 6.28 2.79 24.91 3.45 11.75 3.33 11.75 3.00 9.39 3.27 8.82 3.30 3.00 11.25 2.85 3.17 19.93 24.91 3.25 3.27 3.17 13.60 2.90 3.00 8.31 2.79 6.95 12.75 6.46 7.60 3.28 35709029 AUTO DIP W/MICRO-AD/IR 81001 300 $17.00 6.28 2.79 24.91 3.45 11.75 3.33 11.75 3.00 9.39 3.27 8.82 3.30 3.00 11.25 2.85 3.17 19.93 24.91 3.25 3.27 3.17 13.60 2.90 3.00 8.31 2.79 6.95 12.75 6.46 7.60 3.28 35200070 URINALYSIS DIPSTICK ONLY 81002 300 $18.00 6.65 3.06 20.61 4.11 12.44 3.65 12.44 3.57 9.95 3.58 7.10 3.93 3.57 11.91 3.13 3.48 16.49 20.61 3.57 3.58 3.48 14.40 3.18 3.57 9.12 3.06 7.36 13.50 6.84 8.05 3.60 35703926 MANUAL DIP W/O MICRO 81002 300 $18.00 6.65 3.06 20.61 4.11 12.44 3.65 12.44 3.57 9.95 3.58 7.10 3.93 3.57 11.91 3.13 3.48 16.49 20.61 3.57 3.58 3.48 14.40 3.18 3.57 9.12 3.06 7.36 13.50 6.84 8.05 3.60 35200495 URINALYSIS AUTODIP ONLY 81003 300 $12.00 4.44 1.98 18.13 3.57 8.29 2.36 8.29 3.10 6.63 2.32 6.25 3.41 3.10 7.94 2.03 2.25 14.50 18.13 2.31 2.32 2.25 9.60 2.06 3.10 5.90 1.98 4.91 9.00 4.56 5.37 2.33 35200681 POC URINE AUTOMATED NO MICRO 81003 300 $12.00 4.44 1.98 18.13 3.57 8.29 2.36 8.29 3.10 6.63 2.32 6.25 3.41 3.10 7.94 2.03 2.25 14.50 18.13 2.31 2.32 2.25 9.60 2.06 3.10 5.90 1.98 4.91 9.00 4.56 5.37 2.33 35707662 AUTO DIP W/O MICRO 81003 300 $12.00 4.44 1.98 18.13 3.57 8.29 2.36 8.29 3.10 6.63 2.32 6.25 3.41 3.10 7.94 2.03 2.25 14.50 18.13 2.31 2.32 2.25 9.60 2.06 3.10 5.90 1.98 4.91 9.00 4.56 5.37 2.33 35708529 URINE PH 81003 300 $12.00 4.44 1.98 18.13 3.57 8.29 2.36 8.29 3.10 6.63 2.32 6.25 3.41 3.10 7.94 2.03 2.25 14.50 18.13 2.31 2.32 2.25 9.60 2.06 3.10 5.90 1.98 4.91 9.00 4.56 5.37 2.33 35708537 URINE KETONE AUTO 81003 300 $12.00 4.44 1.98 18.13 3.57 8.29 2.36 8.29 3.10 6.63 2.32 6.25 3.41 3.10 7.94 2.03 2.25 14.50 18.13 2.31 2.32 2.25 9.60 2.06 3.10 5.90 1.98 4.91 9.00 4.56 5.37 2.33 35709037 AUTO DIP W/O MICRO-A/I 81003 300 $12.00 4.44 1.98 18.13 3.57 8.29 2.36 8.29 3.10 6.63 2.32 6.25 3.41 3.10 7.94 2.03 2.25 14.50 18.13 2.31 2.32 2.25 9.60 2.06 3.10 5.90 1.98 4.91 9.00 4.56 5.37 2.33 35701575 REDUCING SUBSTANCES 81005 300 $11.00 4.07 1.91 17.42 3.44 7.60 2.28 7.60 2.99 6.08 2.24 6.03 3.29 2.99 7.28 1.95 2.17 13.94 17.42 2.22 2.24 2.17 8.80 1.99 2.99 5.69 1.91 4.50 8.25 4.18 4.92 2.25 36940352 MELANIN 81005 300 $86.00 31.79 1.91 68.80 3.44 59.43 2.28 59.43 2.99 47.52 2.24 6.03 3.29 2.99 56.92 1.95 2.17 13.94 17.42 2.22 2.24 2.17 68.80 1.99 2.99 5.69 1.91 35.17 64.50 32.69 38.47 2.25 35200088 URINALYSIS MICROSCOPIC 81015 300 $16.00 5.91 2.68 24.47 3.12 11.06 3.20 11.06 2.71 8.84 3.14 8.48 2.98 2.71 10.59 2.75 3.05 19.58 24.47 3.13 3.14 3.05 12.80 2.79 2.71 7.99 2.68 6.54 12.00 6.08 7.16 3.16 35701222 MICRO ONLY-ALL LOC 81015 300 $16.00 5.91 2.68 24.47 3.12 11.06 3.20 11.06 2.71 8.84 3.14 8.48 2.98 2.71 10.59 2.75 3.05 19.58 24.47 3.13 3.14 3.05 12.80 2.79 2.71 7.99 2.68 6.54 12.00 6.08 7.16 3.16 35709011 MICRO ONLY-ADVI/IRIS 81015 300 $16.00 5.91 2.68 24.47 3.12 11.06 3.20 11.06 2.71 8.84 3.14 8.48 2.98 2.71 10.59 2.75 3.05 19.58 24.47 3.13 3.14 3.05 12.80 2.79 2.71 7.99 2.68 6.54 12.00 6.08 7.16 3.16 35200207 PREGNANCY TEST 81025 300 $45.00 16.63 4.00 50.98 4.60 31.10 9.04 31.10 4.00 24.86 8.87 17.58 4.40 4.00 29.79 7.75 8.61 40.78 50.98 8.83 8.87 8.61 36.00 7.88 4.00 22.56 7.58 18.41 33.75 17.10 20.13 8.91 35702342 PREGNANCY TEST URINE 81025 300 $45.00 16.63 4.00 50.98 4.60 31.10 9.04 31.10 4.00 24.86 8.87 17.58 4.40 4.00 29.79 7.75 8.61 40.78 50.98 8.83 8.87 8.61 36.00 7.88 4.00 22.56 7.58 18.41 33.75 17.10 20.13 8.91 35709819 EXPOSURE PREGNANCY URINE 81025 300 $45.00 16.63 4.00 50.98 4.60 31.10 9.04 31.10 4.00 24.86 8.87 17.58 4.40 4.00 29.79 7.75 8.61 40.78 50.98 8.83 8.87 8.61 36.00 7.88 4.00 22.56 7.58 18.41 33.75 17.10 20.13 8.91 35706941 VOLUME TOTAL 81050 300 $19.00 7.02 - 24.14 - 13.13 3.82 13.13 - 10.50 3.75 8.35 - - 12.58 3.28 3.64 19.31 24.14 3.73 3.75 3.64 15.20 3.33 - 9.54 3.20 7.77 14.25 7.22 8.50 3.77 36936665 PLATELET GLYCOPROTEIN 81105 300 "$1,513.00" 559.20 107.55 " 1,210.40 " 138.82 " 1,045.48 " 128.33 " 1,045.48 " 120.71 835.93 125.89 998.58 132.78 120.71 " 1,001.45 " 110.00 122.22 665.30 831.63 125.28 125.89 122.22 " 1,210.40 " 111.83 120.71 320.22 107.55 618.82 " 1,134.75 " 575.09 676.76 126.50 36934654 BRCA1 & 2 GENE ANALYSIS 81162 300 "$12,541.00" " 4,635.15 " " 1,605.89 " " 13,700.82 " " 1,865.43 " " 8,665.83 " " 1,916.12 " " 8,665.83 " " 1,622.11 " " 6,928.90 " " 1,879.63 " " 5,073.64 " " 1,784.32 " " 1,622.11 " " 8,300.89 " " 1,642.39 " " 1,824.88 " " 10,960.66 " " 13,700.82 " " 1,870.50 " " 1,879.63 " " 1,824.88 " " 10,032.80 " " 1,669.77 " " 1,622.11 " " 4,781.19 " " 1,605.89 " " 5,129.27 " " 9,405.75 " " 4,766.83 " " 5,609.59 " " 1,888.75 " 36934671 BRCA1 & 2 GENE ANALYSIS 81162 300 "$9,581.00" " 3,541.14 " " 1,605.89 " " 13,700.82 " " 1,865.43 " " 6,620.47 " " 1,916.12 " " 6,620.47 " " 1,622.11 " " 5,293.50 " " 1,879.63 " " 5,073.64 " " 1,784.32 " " 1,622.11 " " 6,341.66 " " 1,642.39 " " 1,824.88 " " 10,960.66 " " 13,700.82 " " 1,870.50 " " 1,879.63 " " 1,824.88 " " 7,664.80 " " 1,669.77 " " 1,622.11 " " 4,781.19 " " 1,605.89 " " 3,918.63 " " 7,185.75 " " 3,641.74 " " 4,285.58 " " 1,888.75 " 36942053 INVITAE PNL BRCA1 & 2 GENE AN 81162 300 "$9,581.00" " 3,541.14 " " 1,605.89 " " 13,700.82 " " 1,865.43 " " 6,620.47 " " 1,916.12 " " 6,620.47 " " 1,622.11 " " 5,293.50 " " 1,879.63 " " 5,073.64 " " 1,784.32 " " 1,622.11 " " 6,341.66 " " 1,642.39 " " 1,824.88 " " 10,960.66 " " 13,700.82 " " 1,870.50 " " 1,879.63 " " 1,824.88 " " 7,664.80 " " 1,669.77 " " 1,622.11 " " 4,781.19 " " 1,605.89 " " 3,918.63 " " 7,185.75 " " 3,641.74 " " 4,285.58 " " 1,888.75 " 36942118 INVITAE BREAST PNL BRCA1&BRCA2 81162 300 "$9,581.00" " 3,541.14 " " 1,605.89 " " 13,700.82 " " 1,865.43 " " 6,620.47 " " 1,916.12 " " 6,620.47 " " 1,622.11 " " 5,293.50 " " 1,879.63 " " 5,073.64 " " 1,784.32 " " 1,622.11 " " 6,341.66 " " 1,642.39 " " 1,824.88 " " 10,960.66 " " 13,700.82 " " 1,870.50 " " 1,879.63 " " 1,824.88 " " 7,664.80 " " 1,669.77 " " 1,622.11 " " 4,781.19 " " 1,605.89 " " 3,918.63 " " 7,185.75 " " 3,641.74 " " 4,285.58 " " 1,888.75 " 36930748 BRCA1 GENE ANALYSIS 81165 300 "$1,485.00" 548.86 226.30 " 1,559.09 " 260.25 " 1,026.14 " 297.02 " 1,026.14 " 226.30 820.46 291.37 980.10 248.93 226.30 982.92 254.59 282.88 " 1,247.27 " " 1,559.09 " 289.95 291.37 282.88 " 1,188.00 " 258.84 226.30 741.15 248.93 607.37 " 1,113.75 " 564.45 664.24 292.78 36944269 COMP STR FULL GENE SEQUENCE 81189 300 "$1,443.00" 533.33 - " 1,514.73 " - 997.11 288.57 997.11 - 797.26 283.07 952.38 - - 955.12 247.35 274.83 " 1,211.78 " " 1,514.73 " 281.70 283.07 274.83 " 1,154.40 " 251.47 - 720.05 241.85 590.19 " 1,082.25 " 548.48 645.45 284.45 36944307 COMP STR FULL GENE SEQUENCE 81189 300 "$1,443.00" 533.33 - " 1,514.73 " - 997.11 288.57 997.11 - 797.26 283.07 952.38 - - 955.12 247.35 274.83 " 1,211.78 " " 1,514.73 " 281.70 283.07 274.83 " 1,154.40 " 251.47 - 720.05 241.85 590.19 " 1,082.25 " 548.48 645.45 284.45 36934581 CANAVAN DISEASE MUT ASPA 81200 300 $952.00 351.86 41.58 807.21 144.35 657.83 49.61 657.83 125.52 525.98 48.67 124.63 138.07 125.52 630.13 42.53 47.25 645.77 807.21 48.43 48.67 47.25 761.60 43.23 125.52 123.80 41.58 389.37 714.00 361.86 425.83 48.90 36930705 APC FULL GENE SEQUENCE 81201 300 "$4,095.00" " 1,513.51 " 686.40 " 3,276.00 " " 1,051.89 " " 2,829.65 " 819.00 " 2,829.65 " 914.69 " 2,262.49 " 803.40 788.43 " 1,006.16 " 914.69 " 2,710.48 " 702.00 780.00 " 1,534.75 " " 1,918.44 " 799.50 803.40 780.00 " 3,276.00 " 713.70 914.69 " 2,043.60 " 686.40 " 1,674.86 " " 3,071.25 " " 1,556.51 " " 1,831.69 " 807.30 36937157 APC GENE 81201 300 "$4,891.00" " 1,807.71 " 686.40 " 3,912.80 " " 1,051.89 " " 3,379.68 " 819.00 " 3,379.68 " 914.69 " 2,702.28 " 803.40 788.43 " 1,006.16 " 914.69 " 3,237.35 " 702.00 780.00 " 1,534.75 " " 1,918.44 " 799.50 803.40 780.00 " 3,912.80 " 713.70 914.69 " 2,043.60 " 686.40 " 2,000.42 " " 3,668.25 " " 1,859.07 " " 2,187.74 " 807.30 36937866 APC GENE ANALYSIS 81201 300 "$5,350.00" " 1,977.36 " 686.40 " 4,280.00 " " 1,051.89 " " 3,696.85 " 819.00 " 3,696.85 " 914.69 " 2,955.88 " 803.40 788.43 " 1,006.16 " 914.69 " 3,541.17 " 702.00 780.00 " 1,534.75 " " 1,918.44 " 799.50 803.40 780.00 " 4,280.00 " 713.70 914.69 " 2,043.60 " 686.40 " 2,188.15 " " 4,012.50 " " 2,033.54 " " 2,393.06 " 807.30 36936771 FAM ADENO POLY SINGLE SITE PNL 81202 300 "$1,470.00" 543.31 88.67 " 1,176.00 " 190.00 " 1,015.77 " 294.00 " 1,015.77 " 165.22 812.18 288.40 269.48 181.74 165.22 972.99 252.00 280.00 88.67 110.84 287.00 288.40 280.00 " 1,176.00 " 256.20 165.22 733.60 246.40 601.23 " 1,102.50 " 558.75 657.53 289.80 36937165 APC DUPLICATION/DELETION 81203 300 "$4,891.00" " 1,807.71 " 176.00 " 3,912.80 " 520.57 " 3,379.68 " 210.00 " 3,379.68 " 452.67 " 2,702.28 " 206.00 808.98 497.94 452.67 " 3,237.35 " 180.00 200.00 831.22 " 1,039.03 " 205.00 206.00 200.00 " 3,912.80 " 183.00 452.67 524.00 176.00 " 2,000.42 " " 3,668.25 " " 1,859.07 " " 2,187.74 " 207.00 36937874 APC DUP/DELETION VARIANTS 81203 300 "$5,350.00" " 1,977.36 " 176.00 " 4,280.00 " 520.57 " 3,696.85 " 210.00 " 3,696.85 " 452.67 " 2,955.88 " 206.00 808.98 497.94 452.67 " 3,541.17 " 180.00 200.00 831.22 " 1,039.03 " 205.00 206.00 200.00 " 4,280.00 " 183.00 452.67 524.00 176.00 " 2,188.15 " " 4,012.50 " " 2,033.54 " " 2,393.06 " 207.00 35101748 BCR ABL 1 MAJOR BREAKPOINT 81206 300 $861.00 318.23 - 688.80 - 594.95 172.16 594.95 - 475.70 168.88 455.87 - - 569.90 147.56 163.96 380.12 475.15 168.06 168.88 163.96 688.80 150.02 - 429.58 144.28 352.15 645.75 327.27 385.13 169.70 35101870 BCR ABL P210 MONITOR MAJOR BP 81206 300 $861.00 318.23 - 688.80 - 594.95 172.16 594.95 - 475.70 168.88 455.87 - - 569.90 147.56 163.96 380.12 475.15 168.06 168.88 163.96 688.80 150.02 - 429.58 144.28 352.15 645.75 327.27 385.13 169.70 36934603 BCR ABL PCR QUANT T922 81206 300 "$3,027.00" " 1,118.78 " - " 2,421.60 " - " 2,091.66 " 172.16 " 2,091.66 " - " 1,672.42 " 168.88 455.87 - - " 2,003.57 " 147.56 163.96 380.12 475.15 168.06 168.88 163.96 " 2,421.60 " 150.02 - 429.58 144.28 " 1,238.04 " " 2,270.25 " " 1,150.56 " " 1,353.98 " 169.70 36936339 P210 BCR ABL REFLEX 81206 300 $861.00 318.23 - 688.80 - 594.95 172.16 594.95 - 475.70 168.88 455.87 - - 569.90 147.56 163.96 380.12 475.15 168.06 168.88 163.96 688.80 150.02 - 429.58 144.28 352.15 645.75 327.27 385.13 169.70 36936347 BCR/ABL1 P210 TRNS ANAL MJR BP 81206 300 $861.00 318.23 - 688.80 - 594.95 172.16 594.95 - 475.70 168.88 455.87 - - 569.90 147.56 163.96 380.12 475.15 168.06 168.88 163.96 688.80 150.02 - 429.58 144.28 352.15 645.75 327.27 385.13 169.70 35101756 BCR ABL 1 MINOR BREAKPOINT 81207 300 $760.00 280.90 - 608.00 - 525.16 152.08 525.16 - 419.90 149.19 402.71 - - 503.04 130.36 144.84 380.12 475.15 148.46 149.19 144.84 608.00 132.53 - 379.48 127.46 310.84 570.00 288.88 339.95 149.91 35101861 BCR ABL P190 MONITOR MINOR BP 81207 300 $760.00 280.90 - 608.00 - 525.16 152.08 525.16 - 419.90 149.19 402.71 - - 503.04 130.36 144.84 380.12 475.15 148.46 149.19 144.84 608.00 132.53 - 379.48 127.46 310.84 570.00 288.88 339.95 149.91 36936321 BCR/ABL1 P190 TRNC ANAL MNR BP 81207 300 $760.00 280.90 - 608.00 - 525.16 152.08 525.16 - 419.90 149.19 402.71 - - 503.04 130.36 144.84 380.12 475.15 148.46 149.19 144.84 608.00 132.53 - 379.48 127.46 310.84 570.00 288.88 339.95 149.91 35101691 BRAF GENE ANALYSIS 81210 300 $921.00 340.40 143.18 944.12 164.66 636.41 184.17 636.41 143.18 508.85 180.66 365.31 157.50 143.18 609.61 157.86 175.40 755.30 944.12 179.79 180.66 175.40 736.80 160.49 143.18 459.55 154.35 376.69 690.75 350.07 411.96 181.54 36934646 BRAF MUTATION ANALYSIS 81210 300 "$2,040.00" 753.98 143.18 " 1,632.00 " 164.66 " 1,409.64 " 184.17 " 1,409.64 " 143.18 " 1,127.10 " 180.66 365.31 157.50 143.18 " 1,350.28 " 157.86 175.40 755.30 944.12 179.79 180.66 175.40 " 1,632.00 " 160.49 143.18 459.55 154.35 834.36 " 1,530.00 " 775.40 912.49 181.54 36942436 BRAF GENE MUTATION 81210 300 $921.00 340.40 143.18 944.12 164.66 636.41 184.17 636.41 143.18 508.85 180.66 365.31 157.50 143.18 609.61 157.86 175.40 755.30 944.12 179.79 180.66 175.40 736.80 160.49 143.18 459.55 154.35 376.69 690.75 350.07 411.96 181.54 36936746 MULTISITE 3 BRAC ANALYSIS PANL 81212 300 "$2,968.00" " 1,096.97 " 141.36 " 2,374.40 " 162.56 " 2,050.89 " 462.00 " 2,050.89 " 141.36 " 1,639.82 " 453.20 360.13 155.50 141.36 " 1,964.52 " 396.00 440.00 397.98 497.47 451.00 453.20 440.00 " 2,374.40 " 402.60 141.36 " 1,152.80 " 387.20 " 1,213.91 " " 2,226.00 " " 1,128.14 " " 1,327.59 " 455.40 36934697 SINGLE SITE BRCA1 ANALYSIS 81215 300 "$2,458.00" 908.48 74.59 " 1,966.40 " 85.78 " 1,698.48 " 394.01 " 1,698.48 " 74.59 " 1,358.05 " 386.51 190.03 82.05 74.59 " 1,626.95 " 337.73 375.25 129.63 162.04 384.63 386.51 375.25 " 1,966.40 " 343.35 74.59 983.16 330.22 " 1,005.32 " " 1,843.50 " 934.29 " 1,099.46 " 388.38 36930756 BRCA2 GENE ANALYSIS 81216 300 $972.00 359.25 148.10 " 7,103.72 " 170.32 671.65 194.38 671.65 148.10 537.03 190.67 " 1,199.48 " 162.91 148.10 643.37 166.61 185.12 " 5,682.98 " " 7,103.72 " 189.75 190.67 185.12 777.60 169.38 148.10 485.01 162.91 397.55 729.00 369.46 434.78 191.60 36934719 SINGLE SITE BRCA2 ANALYSIS 81217 300 "$2,458.00" 908.48 74.59 " 1,966.40 " 85.78 " 1,698.48 " 394.01 " 1,698.48 " 74.59 " 1,358.05 " 386.51 190.03 82.05 74.59 " 1,626.95 " 337.73 375.25 161.60 202.00 384.63 386.51 375.25 " 1,966.40 " 343.35 74.59 983.16 330.22 " 1,005.32 " " 1,843.50 " 934.29 " 1,099.46 " 388.38 36941341 CALR DNA REFLEX 81219 300 "$1,340.00" 495.26 - " 1,072.00 " - 925.94 127.71 925.94 - 740.35 125.28 338.15 - - 886.95 109.47 121.63 730.52 913.15 124.67 125.28 121.63 " 1,072.00 " 111.29 - 318.67 107.03 548.06 " 1,005.00 " 509.33 599.38 125.89 35101527 CFTR GENE COM VARIANTS 81220 300 "$2,922.00" " 1,079.97 " 445.28 " 2,337.60 " 512.07 " 2,019.10 " 584.43 " 2,019.10 " 445.28 " 1,614.41 " 573.30 613.00 489.81 445.28 " 1,934.07 " 500.94 556.60 " 1,819.59 " " 2,274.49 " 570.52 573.30 556.60 " 2,337.60 " 509.29 445.28 " 1,458.29 " 489.81 " 1,195.10 " " 2,191.50 " " 1,110.65 " " 1,307.01 " 576.08 36940981 CYSTIC FIBROSIS SCRN 81220 300 "$2,922.00" " 1,079.97 " 445.28 " 2,337.60 " 512.07 " 2,019.10 " 584.43 " 2,019.10 " 445.28 " 1,614.41 " 573.30 613.00 489.81 445.28 " 1,934.07 " 500.94 556.60 " 1,819.59 " " 2,274.49 " 570.52 573.30 556.60 " 2,337.60 " 509.29 445.28 " 1,458.29 " 489.81 " 1,195.10 " " 2,191.50 " " 1,110.65 " " 1,307.01 " 576.08 36941146 CFTR GENE FULL SEQUENCE 81223 300 "$2,620.00" 968.35 399.20 " 6,234.88 " 459.08 " 1,810.42 " 523.95 " 1,810.42 " 399.20 " 1,447.55 " 513.97 934.11 439.12 399.20 " 1,734.18 " 449.10 499.00 " 4,987.90 " " 6,234.88 " 511.48 513.97 499.00 " 2,096.00 " 456.59 399.20 " 1,307.38 " 439.12 " 1,071.58 " " 1,965.00 " 995.86 " 1,171.93 " 516.47 35101772 CYP2C19 81225 300 "$1,530.00" 565.49 - " 1,224.00 " - " 1,057.23 " 305.93 " 1,057.23 " - 845.33 300.10 594.65 - - " 1,012.71 " 262.22 291.36 643.87 804.84 298.64 300.10 291.36 " 1,224.00 " 266.59 - 763.36 256.40 625.77 " 1,147.50 " 581.55 684.37 301.56 36937220 SIGNATURECHIP MICROARRAY 81228 300 "$4,853.00" " 1,793.67 " - " 3,882.40 " - " 3,353.42 " 945.00 " 3,353.42 " - " 2,681.28 " 927.00 " 1,262.00 " - - " 3,212.20 " 810.00 900.00 " 2,416.99 " " 3,021.24 " 922.50 927.00 900.00 " 3,882.40 " 823.50 - " 2,358.00 " 792.00 " 1,984.88 " " 3,639.75 " " 1,844.63 " " 2,170.75 " 931.50 36937351 ADMI GNDX MICROARRAY 81228 300 "$5,139.00" " 1,899.37 " - " 4,111.20 " - " 3,551.05 " 945.00 " 3,551.05 " - " 2,839.30 " 927.00 " 1,262.00 " - - " 3,401.50 " 810.00 900.00 " 2,416.99 " " 3,021.24 " 922.50 927.00 900.00 " 4,111.20 " 823.50 - " 2,358.00 " 792.00 " 2,101.85 " " 3,854.25 " " 1,953.33 " " 2,298.67 " 931.50 36938838 CYTOGENOMIC CONST MICROARRAY 81228 300 "$6,333.00" " 2,340.68 " - " 5,066.40 " - " 4,376.10 " 945.00 " 4,376.10 " - " 3,498.98 " 927.00 " 1,262.00 " - - " 4,191.81 " 810.00 900.00 " 2,416.99 " " 3,021.24 " 922.50 927.00 900.00 " 5,066.40 " 823.50 - " 2,358.00 " 792.00 " 2,590.20 " " 4,749.75 " " 2,407.17 " " 2,832.75 " 931.50 36937238 SIGNATURECHIP MICROARRAY +SNP 81229 300 "$6,090.00" " 2,250.86 " - " 9,382.12 " - " 4,208.19 " " 1,218.00 " " 4,208.19 " - " 3,364.73 " " 1,194.80 " " 1,522.47 " - - " 4,030.97 " " 1,044.00 " " 1,160.00 " " 7,505.70 " " 9,382.12 " " 1,189.00 " " 1,194.80 " " 1,160.00 " " 4,872.00 " " 1,061.40 " - " 3,039.20 " " 1,020.80 " " 2,490.81 " " 4,567.50 " " 2,314.81 " " 2,724.06 " " 1,200.60 " 36938781 WHOLE GENOME MICROARRAY ANAL 81229 300 "$6,090.00" " 2,250.86 " - " 9,382.12 " - " 4,208.19 " " 1,218.00 " " 4,208.19 " - " 3,364.73 " " 1,194.80 " " 1,522.47 " - - " 4,030.97 " " 1,044.00 " " 1,160.00 " " 7,505.70 " " 9,382.12 " " 1,189.00 " " 1,194.80 " " 1,160.00 " " 4,872.00 " " 1,061.40 " - " 3,039.20 " " 1,020.80 " " 2,490.81 " " 4,567.50 " " 2,314.81 " " 2,724.06 " " 1,200.60 " 36940549 RAPID MICROARRAY 81229 300 "$6,090.00" " 2,250.86 " - " 9,382.12 " - " 4,208.19 " " 1,218.00 " " 4,208.19 " - " 3,364.73 " " 1,194.80 " " 1,522.47 " - - " 4,030.97 " " 1,044.00 " " 1,160.00 " " 7,505.70 " " 9,382.12 " " 1,189.00 " " 1,194.80 " " 1,160.00 " " 4,872.00 " " 1,061.40 " - " 3,039.20 " " 1,020.80 " " 2,490.81 " " 4,567.50 " " 2,314.81 " " 2,724.06 " " 1,200.60 " 36936991 DMPK MYOTONIC DYSTROPHY TYPE 1 81234 300 "$2,554.00" 943.96 - " 2,043.20 " - " 1,764.81 " 143.85 " 1,764.81 " - " 1,411.09 " 141.11 " 1,685.64 " - - " 1,690.49 " 123.30 137.00 604.06 755.08 140.43 141.11 137.00 " 2,043.20 " 125.36 - 358.94 120.56 " 1,044.59 " " 1,915.50 " 970.78 " 1,142.40 " 141.80 35101713 EGFR GENE ANALYSIS 81235 300 "$1,704.00" 629.80 263.34 " 1,363.20 " 302.84 " 1,177.46 " 340.81 " 1,177.46 " 263.34 941.46 334.32 672.53 289.67 263.34 " 1,127.88 " 292.12 324.58 292.24 365.30 332.69 334.32 324.58 " 1,363.20 " 296.99 263.34 850.40 285.63 696.94 " 1,278.00 " 647.69 762.20 335.94 35101535 F2 GENE 81240 300 $345.00 127.51 53.70 276.00 61.76 238.40 68.97 238.40 53.70 190.61 67.66 136.81 59.07 53.70 228.36 59.12 65.69 150.49 188.11 67.33 67.66 65.69 276.00 60.11 53.70 172.11 57.81 141.11 258.75 131.13 154.32 67.99 36982691 PROTHROMBIN (FACTOR II) MUTAT 81240 300 $345.00 127.51 53.70 276.00 61.76 238.40 68.97 238.40 53.70 190.61 67.66 136.81 59.07 53.70 228.36 59.12 65.69 150.49 188.11 67.33 67.66 65.69 276.00 60.11 53.70 172.11 57.81 141.11 258.75 131.13 154.32 67.99 35101543 F5 GENE 81241 300 $385.00 142.30 64.57 807.21 76.71 266.04 77.04 266.04 66.70 212.71 75.57 169.91 73.37 66.70 254.83 66.03 73.37 645.77 807.21 75.20 75.57 73.37 308.00 67.13 66.70 192.23 64.57 157.47 288.75 146.34 172.21 75.94 36982900 FACTOR V (LEIDEN) 81241 300 $385.00 142.30 64.57 807.21 76.71 266.04 77.04 266.04 66.70 212.71 75.57 169.91 73.37 66.70 254.83 66.03 73.37 645.77 807.21 75.20 75.57 73.37 308.00 67.13 66.70 192.23 64.57 157.47 288.75 146.34 172.21 75.94 36934859 FRAGILE X DNA ANAL FMR1 GENE 81243 300 $977.00 361.10 50.20 781.60 107.11 675.11 59.89 675.11 93.14 539.79 58.75 229.92 102.45 93.14 646.68 51.34 57.04 363.76 454.70 58.47 58.75 57.04 781.60 52.19 93.14 149.44 50.20 399.59 732.75 371.36 437.01 59.04 36936550 FMR1 GENE 81243 300 $871.00 321.92 50.20 696.80 107.11 601.86 59.89 601.86 93.14 481.23 58.75 229.92 102.45 93.14 576.51 51.34 57.04 363.76 454.70 58.47 58.75 57.04 696.80 52.19 93.14 149.44 50.20 356.24 653.25 331.07 389.60 59.04 36941308 FMR1 GENE DETECT ABN ALLELES 81243 300 $299.00 110.51 50.20 454.70 107.11 206.61 59.89 206.61 93.14 165.20 58.75 229.92 102.45 93.14 197.91 51.34 57.04 363.76 454.70 58.47 58.75 57.04 239.20 52.19 93.14 149.44 50.20 122.29 224.25 113.65 133.74 59.04 36934867 FRAGLX SOUTH-FMR1 GENE CHAR 81244 300 $568.00 209.93 39.50 " 1,132.94 " 95.39 392.49 47.13 392.49 82.95 313.82 46.24 120.02 91.25 82.95 375.96 40.40 44.89 906.35 " 1,132.94 " 46.01 46.24 44.89 454.40 41.07 82.95 117.61 39.50 232.31 426.00 215.90 254.07 46.46 36941316 FMR1 CHARACTERIZE ABN ALLELES 81244 300 $236.00 87.23 39.50 " 1,132.94 " 95.39 163.08 47.13 163.08 82.95 130.39 46.24 120.02 91.25 82.95 156.21 40.40 44.89 906.35 " 1,132.94 " 46.01 46.24 44.89 188.80 41.07 82.95 117.61 39.50 96.52 177.00 89.70 105.56 46.46 36934891 GAUCHER DIS DNA MUT GBA GENE 81251 300 $804.00 297.16 - 807.21 - 555.56 49.61 555.56 - 444.21 48.67 148.57 - - 532.17 42.53 47.25 645.77 807.21 48.43 48.67 47.25 643.20 43.23 - 123.80 41.58 328.84 603.00 305.60 359.63 48.90 35101764 HFE DNA 81256 300 $343.00 126.77 57.52 " 1,076.34 " 82.04 237.01 68.63 237.01 71.34 189.51 67.32 181.74 78.47 71.34 227.03 58.82 65.36 861.07 " 1,076.34 " 66.99 67.32 65.36 274.40 59.80 71.34 171.24 57.52 140.29 257.25 130.37 153.42 67.65 36934913 HERE HEMOCHROMATOSIS (HFE) 81256 300 "$1,381.00" 510.42 57.52 " 1,104.80 " 82.04 954.27 68.63 954.27 71.34 763.00 67.32 181.74 78.47 71.34 914.08 58.82 65.36 861.07 " 1,076.34 " 66.99 67.32 65.36 " 1,104.80 " 59.80 71.34 171.24 57.52 564.83 " 1,035.75 " 524.92 617.72 67.65 36934930 CHR LYMPH LEUK IGVH (IKBKAP) 81260 300 "$1,870.00" 691.15 34.59 " 1,496.00 " 137.24 " 1,292.17 " 41.28 " 1,292.17 " 119.34 " 1,033.18 " 40.49 97.71 131.27 119.34 " 1,237.75 " 35.38 39.31 299.61 374.51 40.29 40.49 39.31 " 1,496.00 " 35.97 119.34 102.99 34.59 764.83 " 1,402.50 " 710.79 836.45 40.69 36934948 B CELL GENE REARR QN PCR (IGH) 81261 300 "$1,039.00" 384.01 174.23 831.20 247.87 717.95 207.89 717.95 215.54 574.05 203.93 550.47 237.09 215.54 687.71 178.19 197.99 528.70 660.88 202.94 203.93 197.99 831.20 181.16 215.54 518.73 174.23 424.95 779.25 394.92 464.74 204.92 36937360 CLL IGVH MUTATION ANALYSIS 81263 300 "$1,870.00" 691.15 259.18 " 1,496.00 " 368.72 " 1,292.17 " 309.25 " 1,292.17 " 320.63 " 1,033.18 " 303.36 818.82 352.69 320.63 " 1,237.75 " 265.07 294.52 755.30 944.12 301.88 303.36 294.52 " 1,496.00 " 269.49 320.63 771.64 259.18 764.83 " 1,402.50 " 710.79 836.45 304.83 36938846 COMPARATIVE ANALYSIS (STR) 81265 300 "$4,272.00" " 1,578.93 " - " 3,417.60 " - " 2,951.95 " 244.72 " 2,951.95 " - " 2,360.28 " 240.06 597.89 - - " 2,827.64 " 209.76 233.07 911.03 " 1,138.79 " 238.90 240.06 233.07 " 3,417.60 " 213.26 - 610.64 205.10 " 1,747.25 " " 3,204.00 " " 1,623.79 " " 1,910.87 " 241.23 36942673 RECIP PRE ENGRAF MON COMP STR 81265 300 "$3,229.00" " 1,193.44 " - " 2,583.20 " - " 2,231.24 " 244.72 " 2,231.24 " - " 1,784.02 " 240.06 597.89 - - " 2,137.28 " 209.76 233.07 911.03 " 1,138.79 " 238.90 240.06 233.07 " 2,583.20 " 213.26 - 610.64 205.10 " 1,320.66 " " 2,421.75 " " 1,227.34 " " 1,444.33 " 241.23 36935006 BONE MRW ENGRAPHMNT STUDY 81267 300 "$2,020.00" 746.59 - " 1,616.00 " - " 1,395.82 " 217.83 " 1,395.82 " - " 1,116.05 " 213.68 576.79 - - " 1,337.04 " 186.71 207.46 670.94 838.68 212.65 213.68 207.46 " 1,616.00 " 189.83 - 543.55 182.56 826.18 " 1,515.00 " 767.80 903.55 214.72 36942681 NON-ENRICH EM POST TRANSPLANT 81267 300 "$2,044.00" 755.46 - " 1,635.20 " - " 1,412.40 " 217.83 " 1,412.40 " - " 1,129.31 " 213.68 576.79 - - " 1,352.92 " 186.71 207.46 670.94 838.68 212.65 213.68 207.46 " 1,635.20 " 189.83 - 543.55 182.56 836.00 " 1,533.00 " 776.92 914.28 214.72 36942690 T-CELL ENRICHED EM 81268 300 "$2,712.00" " 1,002.36 " - " 2,169.60 " - " 1,873.99 " 273.83 " 1,873.99 " - " 1,498.38 " 268.61 725.06 - - " 1,795.07 " 234.71 260.79 " 1,224.08 " " 1,530.10 " 267.31 268.61 260.79 " 2,169.60 " 238.62 - 683.27 229.50 " 1,109.21 " " 2,034.00 " " 1,030.83 " " 1,213.08 " 269.92 36942703 NK CELL ENRICHED EM 81268 300 "$2,712.00" " 1,002.36 " - " 2,169.60 " - " 1,873.99 " 273.83 " 1,873.99 " - " 1,498.38 " 268.61 725.06 - - " 1,795.07 " 234.71 260.79 " 1,224.08 " " 1,530.10 " 267.31 268.61 260.79 " 2,169.60 " 238.62 - 683.27 229.50 " 1,109.21 " " 2,034.00 " " 1,030.83 " " 1,213.08 " 269.92 36942711 MYELOID ENRICHED EM 81268 300 "$2,712.00" " 1,002.36 " - " 2,169.60 " - " 1,873.99 " 273.83 " 1,873.99 " - " 1,498.38 " 268.61 725.06 - - " 1,795.07 " 234.71 260.79 " 1,224.08 " " 1,530.10 " 267.31 268.61 260.79 " 2,169.60 " 238.62 - 683.27 229.50 " 1,109.21 " " 2,034.00 " " 1,030.83 " " 1,213.08 " 269.92 36942720 B-CELL ENRICHED EM 81268 300 "$2,712.00" " 1,002.36 " - " 2,169.60 " - " 1,873.99 " 273.83 " 1,873.99 " - " 1,498.38 " 268.61 725.06 - - " 1,795.07 " 234.71 260.79 " 1,224.08 " " 1,530.10 " 267.31 268.61 260.79 " 2,169.60 " 238.62 - 683.27 229.50 " 1,109.21 " " 2,034.00 " " 1,030.83 " " 1,213.08 " 269.92 36942738 MONOCYTE ENRICHED EM 81268 300 "$2,712.00" " 1,002.36 " - " 2,169.60 " - " 1,873.99 " 273.83 " 1,873.99 " - " 1,498.38 " 268.61 725.06 - - " 1,795.07 " 234.71 260.79 " 1,224.08 " " 1,530.10 " 267.31 268.61 260.79 " 2,169.60 " 238.62 - 683.27 229.50 " 1,109.21 " " 2,034.00 " " 1,030.83 " " 1,213.08 " 269.92 36936398 ALPHA GLOBIN GENE DEL/DUP 81269 300 "$1,987.00" 734.40 - " 1,589.60 " - " 1,373.02 " 212.52 " 1,373.02 " - " 1,097.82 " 208.47 " 1,311.42 " - - " 1,315.20 " 182.16 202.40 892.42 " 1,115.53 " 207.46 208.47 202.40 " 1,589.60 " 185.20 - 530.29 178.11 812.68 " 1,490.25 " 755.26 888.79 209.48 35101551 JAK2 GENE 81270 300 $481.00 177.78 80.66 384.80 115.06 332.37 96.24 332.37 100.05 265.75 94.41 254.87 110.06 100.05 318.37 82.49 91.66 145.06 181.33 93.95 94.41 91.66 384.80 83.87 100.05 240.15 80.66 196.73 360.75 182.83 215.15 94.87 36937262 JAK2 V17F QL W/RFL EXONS 12;13 81270 300 "$1,459.00" 539.25 80.66 " 1,167.20 " 115.06 " 1,008.17 " 96.24 " 1,008.17 " 100.05 806.10 94.41 254.87 110.06 100.05 965.71 82.49 91.66 145.06 181.33 93.95 94.41 91.66 " 1,167.20 " 83.87 100.05 240.15 80.66 596.73 " 1,094.25 " 554.57 652.61 94.87 36935511 HUNTINGTON DIS GENE ANALYSIS 81271 300 "$1,487.00" 549.60 - " 1,189.60 " - " 1,027.52 " 143.85 " 1,027.52 " - 821.57 141.11 981.42 - - 984.25 123.30 137.00 604.06 755.08 140.43 141.11 137.00 " 1,189.60 " 125.36 - 358.94 120.56 608.18 " 1,115.25 " 565.21 665.14 141.80 35101799 C-KIT MUTATION 81272 300 "$1,730.00" 639.41 263.61 " 1,816.09 " 303.15 " 1,195.43 " 345.99 " 1,195.43 " 263.61 955.83 339.40 672.53 289.97 263.61 " 1,145.09 " 296.56 329.51 " 1,452.87 " " 1,816.09 " 337.75 339.40 329.51 " 1,384.00 " 301.50 263.61 863.32 289.97 707.57 " 1,297.50 " 657.57 773.83 341.04 35101560 KRAS GENE VARIANTS EXON 2 81275 300 "$1,015.00" 375.14 157.98 925.27 181.68 701.37 202.91 701.37 157.98 560.79 199.05 402.45 173.78 157.98 671.83 173.93 193.25 740.22 925.27 198.08 199.05 193.25 812.00 176.82 157.98 506.32 170.06 415.14 761.25 385.80 454.01 200.01 36942444 KRAS GENE MUTATION 81275 300 "$1,015.00" 375.14 157.98 925.27 181.68 701.37 202.91 701.37 157.98 560.79 199.05 402.45 173.78 157.98 671.83 173.93 193.25 740.22 925.27 198.08 199.05 193.25 812.00 176.82 157.98 506.32 170.06 415.14 761.25 385.80 454.01 200.01 35101853 KRAS GENE ADDL VARIANTS 81276 300 "$1,015.00" 375.14 157.75 " 1,086.81 " 181.41 701.37 202.91 701.37 157.75 560.79 199.05 402.45 173.53 157.75 671.83 173.93 193.25 869.45 " 1,086.81 " 198.08 199.05 193.25 812.00 176.82 157.75 506.32 170.06 415.14 761.25 385.80 454.01 200.01 36938307 CYTO NEO MICROARRAY REF1 81277 300 "$6,090.00" " 2,250.86 " - " 6,393.34 " - " 4,208.19 " " 1,218.00 " " 4,208.19 " - " 3,364.73 " " 1,194.80 " " 4,019.40 " - - " 4,030.97 " " 1,044.00 " " 1,160.00 " " 5,114.67 " " 6,393.34 " " 1,189.00 " " 1,194.80 " " 1,160.00 " " 4,872.00 " " 1,061.40 " - " 3,039.20 " " 1,020.80 " " 2,490.81 " " 4,567.50 " " 2,314.81 " " 2,724.06 " " 1,200.60 " 36944188 JAK2 EXON 12 SEQUENCE ANALYSIS 81279 300 $972.00 359.25 148.16 777.60 170.38 671.65 194.46 671.65 148.16 537.03 190.76 641.52 162.98 148.16 643.37 166.68 185.20 515.06 643.85 189.83 190.76 185.20 777.60 169.46 148.16 485.22 162.98 397.55 729.00 369.46 434.78 191.68 36936657 FRIEDREICH ATAXIA GENE ANLYSIS 81284 300 "$3,524.00" " 1,302.47 " - " 2,819.20 " - " 2,435.08 " 143.85 " 2,435.08 " - " 1,947.01 " 141.11 " 2,325.84 " - - " 2,332.54 " 123.30 137.00 604.06 755.08 140.43 141.11 137.00 " 2,819.20 " 125.36 - 358.94 120.56 " 1,441.32 " " 2,643.00 " " 1,339.47 " " 1,576.29 " 141.80 35101578 MTHFR GENE 81291 300 $624.00 230.63 - 499.20 - 431.18 68.61 431.18 - 344.76 67.30 121.36 - - 413.03 58.81 65.34 193.87 242.34 66.97 67.30 65.34 499.20 59.79 - 171.19 57.50 255.22 468.00 237.18 279.12 67.63 35101608 A1286C BILL ONLY 81291 300 $624.00 230.63 - 499.20 - 431.18 68.61 431.18 - 344.76 67.30 121.36 - - 413.03 58.81 65.34 193.87 242.34 66.97 67.30 65.34 499.20 59.79 - 171.19 57.50 255.22 468.00 237.18 279.12 67.63 35101730 MTHFR C677T AND A1298C 81291 300 $624.00 230.63 - 499.20 - 431.18 68.61 431.18 - 344.76 67.30 121.36 - - 413.03 58.81 65.34 193.87 242.34 66.97 67.30 65.34 499.20 59.79 - 171.19 57.50 255.22 468.00 237.18 279.12 67.63 36942134 MTHFR C677T AND A1298C 81291 300 $624.00 230.63 - 499.20 - 431.18 68.61 431.18 - 344.76 67.30 121.36 - - 413.03 58.81 65.34 193.87 242.34 66.97 67.30 65.34 499.20 59.79 - 171.19 57.50 255.22 468.00 237.18 279.12 67.63 36935090 MLH1 GENE FULL SEQ 81292 300 "$3,546.00" " 1,310.60 " 516.99 " 3,614.11 " 594.54 " 2,450.29 " 709.17 " 2,450.29 " 516.99 " 1,959.17 " 695.66 " 1,316.98 " 568.69 516.99 " 2,347.10 " 607.86 675.40 " 2,891.29 " " 3,614.11 " 692.29 695.66 675.40 " 2,836.80 " 617.99 516.99 " 1,769.55 " 594.35 " 1,450.31 " " 2,659.50 " " 1,347.83 " " 1,586.13 " 699.04 36936428 MLH1 GENE FULL SEQ 81292 300 "$3,546.00" " 1,310.60 " 516.99 " 3,614.11 " 594.54 " 2,450.29 " 709.17 " 2,450.29 " 516.99 " 1,959.17 " 695.66 " 1,316.98 " 568.69 516.99 " 2,347.10 " 607.86 675.40 " 2,891.29 " " 3,614.11 " 692.29 695.66 675.40 " 2,836.80 " 617.99 516.99 " 1,769.55 " 594.35 " 1,450.31 " " 2,659.50 " " 1,347.83 " " 1,586.13 " 699.04 36943343 MLH1 GENE ANALYSIS 81292 300 "$3,546.00" " 1,310.60 " 516.99 " 3,614.11 " 594.54 " 2,450.29 " 709.17 " 2,450.29 " 516.99 " 1,959.17 " 695.66 " 1,316.98 " 568.69 516.99 " 2,347.10 " 607.86 675.40 " 2,891.29 " " 3,614.11 " 692.29 695.66 675.40 " 2,836.80 " 617.99 516.99 " 1,769.55 " 594.35 " 1,450.31 " " 2,659.50 " " 1,347.83 " " 1,586.13 " 699.04 36935111 MLH1 GENE DUP/DELETE VARIANT 81294 300 "$3,149.00" " 1,163.87 " 152.54 " 2,519.20 " 175.42 " 2,175.96 " 212.52 " 2,175.96 " 152.54 " 1,739.82 " 208.47 388.58 167.79 152.54 " 2,084.32 " 182.16 202.40 " 1,547.46 " " 1,934.32 " 207.46 208.47 202.40 " 2,519.20 " 185.20 152.54 530.29 178.11 " 1,287.94 " " 2,361.75 " " 1,196.93 " " 1,408.55 " 209.48 36936436 MLH1 GENE DUP/DELETE VARIANT 81294 300 "$1,773.00" 655.30 152.54 " 1,934.32 " 175.42 " 1,225.14 " 212.52 " 1,225.14 " 152.54 979.58 208.47 388.58 167.79 152.54 " 1,173.55 " 182.16 202.40 " 1,547.46 " " 1,934.32 " 207.46 208.47 202.40 " 1,418.40 " 185.20 152.54 530.29 178.11 725.16 " 1,329.75 " 673.92 793.06 209.48 36935120 MSH2 GENE FULL SEQ 81295 300 "$2,699.00" 997.55 121.37 " 3,147.12 " 139.58 " 1,865.01 " 400.79 " 1,865.01 " 121.37 " 1,491.20 " 393.15 309.16 133.51 121.37 " 1,786.47 " 343.53 381.70 " 2,517.70 " " 3,147.12 " 391.24 393.15 381.70 " 2,159.20 " 349.26 121.37 " 1,000.05 " 335.90 " 1,103.89 " " 2,024.25 " " 1,025.89 " " 1,207.26 " 395.06 36936444 MSH2 GENE FULL SEQ 81295 300 "$2,004.00" 740.68 121.37 " 3,147.12 " 139.58 " 1,384.76 " 400.79 " 1,384.76 " 121.37 " 1,107.21 " 393.15 309.16 133.51 121.37 " 1,326.45 " 343.53 381.70 " 2,517.70 " " 3,147.12 " 391.24 393.15 381.70 " 1,603.20 " 349.26 121.37 " 1,000.05 " 335.90 819.64 " 1,503.00 " 761.72 896.39 395.06 36943351 MSH2 GENE ANALYSIS 81295 300 "$2,004.00" 740.68 121.37 " 3,147.12 " 139.58 " 1,384.76 " 400.79 " 1,384.76 " 121.37 " 1,107.21 " 393.15 309.16 133.51 121.37 " 1,326.45 " 343.53 381.70 " 2,517.70 " " 3,147.12 " 391.24 393.15 381.70 " 1,603.20 " 349.26 121.37 " 1,000.05 " 335.90 819.64 " 1,503.00 " 761.72 896.39 395.06 36935146 MSH2 GENE DUP/DELETE VARIANT 81297 300 "$2,700.00" 997.92 121.37 " 2,160.00 " 139.58 " 1,865.70 " 223.97 " 1,865.70 " 121.37 " 1,491.75 " 219.70 309.16 133.51 121.37 " 1,787.13 " 191.97 213.30 " 1,240.00 " " 1,550.00 " 218.63 219.70 213.30 " 2,160.00 " 195.17 121.37 558.85 187.70 " 1,104.30 " " 2,025.00 " " 1,026.27 " " 1,207.71 " 220.77 36936452 MSH2 GENE DUP/DELETE VARIANT 81297 300 "$1,773.00" 655.30 121.37 " 1,550.00 " 139.58 " 1,225.14 " 223.97 " 1,225.14 " 121.37 979.58 219.70 309.16 133.51 121.37 " 1,173.55 " 191.97 213.30 " 1,240.00 " " 1,550.00 " 218.63 219.70 213.30 " 1,418.40 " 195.17 121.37 558.85 187.70 725.16 " 1,329.75 " 673.92 793.06 220.77 36935154 MSH6 GENE FULL SEQ 81298 300 "$3,370.00" " 1,245.55 " 230.26 " 3,399.22 " 264.80 " 2,328.67 " 673.94 " 2,328.67 " 230.26 " 1,861.93 " 661.11 586.58 253.29 230.26 " 2,230.60 " 577.67 641.85 " 2,719.38 " " 3,399.22 " 657.90 661.11 641.85 " 2,696.00 " 587.29 230.26 " 1,681.65 " 564.83 " 1,378.33 " " 2,527.50 " " 1,280.94 " " 1,507.40 " 664.31 36936461 MSH6 GENE FULL SEQ 81298 300 "$3,370.00" " 1,245.55 " 230.26 " 3,399.22 " 264.80 " 2,328.67 " 673.94 " 2,328.67 " 230.26 " 1,861.93 " 661.11 586.58 253.29 230.26 " 2,230.60 " 577.67 641.85 " 2,719.38 " " 3,399.22 " 657.90 661.11 641.85 " 2,696.00 " 587.29 230.26 " 1,681.65 " 564.83 " 1,378.33 " " 2,527.50 " " 1,280.94 " " 1,507.40 " 664.31 36943360 MSH6 GENE ANALYSIS 81298 300 "$3,370.00" " 1,245.55 " 230.26 " 3,399.22 " 264.80 " 2,328.67 " 673.94 " 2,328.67 " 230.26 " 1,861.93 " 661.11 586.58 253.29 230.26 " 2,230.60 " 577.67 641.85 " 2,719.38 " " 3,399.22 " 657.90 661.11 641.85 " 2,696.00 " 587.29 230.26 " 1,681.65 " 564.83 " 1,378.33 " " 2,527.50 " " 1,280.94 " " 1,507.40 " 664.31 36935162 SINGLE SITE MSH6 81299 300 "$2,458.00" 908.48 128.99 " 1,966.40 " 148.34 " 1,698.48 " 323.40 " 1,698.48 " 128.99 " 1,358.05 " 317.24 328.60 141.89 128.99 " 1,626.95 " 277.20 308.00 189.42 236.77 315.70 317.24 308.00 " 1,966.40 " 281.82 128.99 806.96 271.04 " 1,005.32 " " 1,843.50 " 934.29 " 1,099.46 " 318.78 36935171 MSH6 GENE DUP/DELETE VARIANT 81300 300 "$3,056.00" " 1,129.50 " 129.34 " 2,444.80 " 148.74 " 2,111.70 " 249.90 " 2,111.70 " 129.34 " 1,688.44 " 245.14 329.51 142.27 129.34 " 2,022.77 " 214.20 238.00 " 1,522.85 " " 1,903.56 " 243.95 245.14 238.00 " 2,444.80 " 217.77 129.34 623.56 209.44 " 1,249.90 " " 2,292.00 " " 1,161.59 " " 1,366.95 " 246.33 36936479 MSH6 GENE DUP/DELETE VARIANT 81300 300 "$1,773.00" 655.30 129.34 " 1,903.56 " 148.74 " 1,225.14 " 249.90 " 1,225.14 " 129.34 979.58 245.14 329.51 142.27 129.34 " 1,173.55 " 214.20 238.00 " 1,522.85 " " 1,903.56 " 243.95 245.14 238.00 " 1,418.40 " 217.77 129.34 623.56 209.44 725.16 " 1,329.75 " 673.92 793.06 246.33 36982055 MECP2 GENE FULL SEQUENCE 81302 300 "$2,771.00" " 1,024.16 " 464.53 " 2,216.80 " 537.77 " 1,914.76 " 554.26 " 1,914.76 " 467.63 " 1,530.98 " 543.71 686.50 514.39 467.63 " 1,834.12 " 475.08 527.87 " 1,239.74 " " 1,549.67 " 541.07 543.71 527.87 " 2,216.80 " 483.00 467.63 " 1,383.02 " 464.53 " 1,133.34 " " 2,078.25 " " 1,053.26 " " 1,239.47 " 546.35 35101802 NRAS MUTATION 81311 300 "$1,553.00" 573.99 236.63 " 1,630.25 " 272.12 " 1,073.12 " 310.58 " 1,073.12 " 236.63 858.03 304.66 603.70 260.29 236.63 " 1,027.93 " 266.21 295.79 " 1,304.20 " " 1,630.25 " 303.18 304.66 295.79 " 1,242.40 " 270.65 236.63 774.97 260.30 635.18 " 1,164.75 " 590.30 694.66 306.14 36942495 NRAS MUTATION 81311 300 "$1,553.00" 573.99 236.63 " 1,630.25 " 272.12 " 1,073.12 " 310.58 " 1,073.12 " 236.63 858.03 304.66 603.70 260.29 236.63 " 1,027.93 " 266.21 295.79 " 1,304.20 " " 1,630.25 " 303.18 304.66 295.79 " 1,242.40 " 270.65 236.63 774.97 260.30 635.18 " 1,164.75 " 590.30 694.66 306.14 36936487 PMS2 GENE FULL SEQ ANALYSIS 81317 300 "$3,552.00" " 1,312.82 " 595.32 " 4,394.37 " 718.78 " 2,454.43 " 710.33 " 2,454.43 " 625.03 " 1,962.48 " 696.80 " 1,592.23 " 687.53 625.03 " 2,351.07 " 608.85 676.50 " 3,515.50 " " 4,394.37 " 693.41 696.80 676.50 " 2,841.60 " 619.00 625.03 " 1,772.43 " 595.32 " 1,452.77 " " 2,664.00 " " 1,350.12 " " 1,588.81 " 700.18 36943475 PMS2 GENE ANALYSIS 81317 300 "$3,552.00" " 1,312.82 " 595.32 " 4,394.37 " 718.78 " 2,454.43 " 710.33 " 2,454.43 " 625.03 " 1,962.48 " 696.80 " 1,592.23 " 687.53 625.03 " 2,351.07 " 608.85 676.50 " 3,515.50 " " 4,394.37 " 693.41 696.80 676.50 " 2,841.60 " 619.00 625.03 " 1,772.43 " 595.32 " 1,452.77 " " 2,664.00 " " 1,350.12 " " 1,588.81 " 700.18 36936495 PMS2 GENE DUP/DELET VARIANTS 81319 300 "$1,773.00" 655.30 177.33 " 1,418.40 " 203.93 " 1,225.14 " 213.68 " 1,225.14 " 177.33 979.58 209.61 451.72 195.06 177.33 " 1,173.55 " 183.15 203.50 " 1,031.31 " " 1,289.14 " 208.59 209.61 203.50 " 1,418.40 " 186.20 177.33 533.17 179.08 725.16 " 1,329.75 " 673.92 793.06 210.62 36943491 PTEN GENE ANALYSIS 81321 300 "$3,150.00" " 1,164.24 " - " 2,520.00 " - " 2,176.65 " 630.00 " 2,176.65 " - " 1,740.38 " 618.00 " 1,224.19 " - - " 2,084.99 " 540.00 600.00 635.46 794.32 615.00 618.00 600.00 " 2,520.00 " 549.00 - " 1,572.00 " 528.00 " 1,288.35 " " 2,362.50 " " 1,197.32 " " 1,409.00 " 621.00 36982063 PTEN GENE FULL SEQUENCE 81321 300 "$3,150.00" " 1,164.24 " - " 2,520.00 " - " 2,176.65 " 630.00 " 2,176.65 " - " 1,740.38 " 618.00 " 1,224.19 " - - " 2,084.99 " 540.00 600.00 635.46 794.32 615.00 618.00 600.00 " 2,520.00 " 549.00 - " 1,572.00 " 528.00 " 1,288.35 " " 2,362.50 " " 1,197.32 " " 1,409.00 " 621.00 36982128 PTEN GENE FULL SEQUENCE 81321 300 "$5,487.00" " 2,028.00 " - " 4,389.60 " - " 3,791.52 " 630.00 " 3,791.52 " - " 3,031.57 " 618.00 " 1,224.19 " - - " 3,631.85 " 540.00 600.00 635.46 794.32 615.00 618.00 600.00 " 4,389.60 " 549.00 - " 1,572.00 " 528.00 " 2,244.18 " " 4,115.25 " " 2,085.61 " " 2,454.34 " 621.00 36942452 PTEN GENE KNOWN FAM VARIANT 81322 300 $256.00 94.62 - 204.80 - 176.90 48.93 176.90 - 141.44 48.00 119.01 - - 169.45 41.94 46.60 88.67 110.84 47.77 48.00 46.60 204.80 42.64 - 122.09 41.01 104.70 192.00 97.31 114.51 48.23 36944234 PTEN GENE DUP DELETE VARIANT 81323 300 "$1,939.00" 716.65 - " 1,551.20 " - " 1,339.85 " 315.00 " 1,339.85 " - " 1,071.30 " 309.00 178.54 - - " 1,283.42 " 270.00 300.00 121.30 151.62 307.50 309.00 300.00 " 1,551.20 " 274.50 - 786.00 264.00 793.05 " 1,454.25 " 737.01 867.31 310.50 36936789 PMP22 DNA DUPLICATION/DELETION 81324 300 "$3,981.00" " 1,471.38 " 633.23 " 3,184.80 " 728.21 " 2,750.87 " 796.28 " 2,750.87 " 633.23 " 2,199.50 " 781.11 827.33 696.55 633.23 " 2,635.02 " 682.52 758.36 " 1,287.93 " " 1,609.91 " 777.32 781.11 758.36 " 3,184.80 " 693.90 633.23 " 1,986.90 " 667.36 " 1,628.23 " " 2,985.75 " " 1,513.18 " " 1,780.70 " 784.90 36938862 SMA CARRIER SCREEN 81329 300 $787.00 290.88 109.60 755.08 126.04 543.82 143.85 543.82 109.60 434.82 141.11 519.42 120.56 109.60 520.92 123.30 137.00 604.06 755.08 140.43 141.11 137.00 629.60 125.36 109.60 358.94 120.56 321.88 590.25 299.14 352.03 141.80 36940140 SMA GENE ANALYSIS 81329 300 "$4,272.00" " 1,578.93 " 109.60 " 3,417.60 " 126.04 " 2,951.95 " 143.85 " 2,951.95 " 109.60 " 2,360.28 " 141.11 " 2,819.52 " 120.56 109.60 " 2,827.64 " 123.30 137.00 604.06 755.08 140.43 141.11 137.00 " 3,417.60 " 125.36 109.60 358.94 120.56 " 1,747.25 " " 3,204.00 " " 1,623.79 " " 1,910.87 " 141.80 36944676 SMA DIAGNOSTIC SMN1 SMN2 81329 300 "$1,392.00" 514.48 109.60 " 1,113.60 " 126.04 961.87 143.85 961.87 109.60 769.08 141.11 918.72 120.56 109.60 921.36 123.30 137.00 604.06 755.08 140.43 141.11 137.00 " 1,113.60 " 125.36 109.60 358.94 120.56 569.33 " 1,044.00 " 529.10 622.64 141.80 36941154 SMPD1 GENE COMMON VARIANTS 81330 300 "$2,551.00" 942.85 41.36 " 2,040.80 " 139.41 " 1,762.74 " 49.35 " 1,762.74 " 121.23 " 1,409.43 " 48.41 102.49 133.35 121.23 " 1,688.51 " 42.30 47.00 645.77 807.21 48.18 48.41 47.00 " 2,040.80 " 43.01 121.23 123.14 41.36 " 1,043.36 " " 1,913.25 " 969.64 " 1,141.06 " 48.65 36935294 PRAD WILLI ANGEL (SNRPN/UBE3A) 81331 300 "$1,321.00" 488.24 44.94 " 1,056.80 " 77.90 912.81 53.62 912.81 67.74 729.85 52.60 180.30 74.51 67.74 874.37 45.96 51.07 465.78 582.23 52.35 52.60 51.07 " 1,056.80 " 46.73 67.74 133.80 44.94 540.29 990.75 502.11 590.88 52.86 36935308 A 1 ANTITRYPSIN MUT (SERPINA1) 81332 300 "$1,720.00" 635.71 38.41 " 1,376.00 " 54.71 " 1,188.52 " 45.83 " 1,188.52 " 47.57 950.30 44.96 121.36 52.33 47.57 " 1,138.47 " 39.29 43.65 187.92 234.90 44.74 44.96 43.65 " 1,376.00 " 39.94 47.57 114.36 38.41 703.48 " 1,290.00 " 653.77 769.36 45.18 36941162 SERPINA1 GENE 81332 300 "$2,555.00" 944.33 38.41 " 2,044.00 " 54.71 " 1,765.51 " 45.83 " 1,765.51 " 47.57 " 1,411.64 " 44.96 121.36 52.33 47.57 " 1,691.15 " 39.29 43.65 187.92 234.90 44.74 44.96 43.65 " 2,044.00 " 39.94 47.57 114.36 38.41 " 1,045.00 " " 1,916.25 " 971.16 " 1,142.85 " 45.18 36935529 MPL GENE COM VAR W515 S505 81338 300 "$2,652.00" 980.18 - " 2,121.60 " - " 1,832.53 " 157.85 " 1,832.53 " - " 1,465.23 " 154.84 " 1,750.32 " - - " 1,755.36 " 135.30 150.33 " 1,405.29 " " 1,756.68 " 154.09 154.84 150.33 " 2,121.60 " 137.55 - 393.86 132.29 " 1,084.67 " " 1,989.00 " " 1,008.03 " " 1,186.24 " 155.59 36941359 MPL GENE COMMON VARIANTS 81338 300 $789.00 291.61 - 631.20 - 545.20 157.85 545.20 - 435.92 154.84 520.74 - - 522.24 135.30 150.33 418.09 522.63 154.09 154.84 150.33 631.20 137.55 - 393.86 132.29 322.70 591.75 299.90 352.92 155.59 36938277 TCELL GENE REARRANGEMENT 81342 300 "$1,959.00" 724.05 - " 1,567.20 " - " 1,353.67 " 211.58 " 1,353.67 " - " 1,082.35 " 207.55 560.21 - - " 1,296.66 " 181.35 201.50 604.24 755.30 206.54 207.55 201.50 " 1,567.20 " 184.37 - 527.93 177.32 801.23 " 1,469.25 " 744.62 876.26 208.55 36943670 TP53 FULL GENE SEQUENCE 81351 300 "$3,370.00" " 1,245.55 " - " 2,696.00 " - " 2,328.67 " 673.94 " 2,328.67 " - " 1,861.93 " 661.11 " 2,224.20 " - - " 2,230.60 " 577.67 641.85 " 1,785.76 " " 2,232.29 " 657.90 661.11 641.85 " 2,696.00 " 587.29 - " 1,681.65 " 564.83 " 1,378.33 " " 2,527.50 " " 1,280.94 " " 1,507.40 " 664.31 36770619 HLA ABC AND DR LOCUS 81370 300 "$2,111.00" 780.23 353.87 " 1,688.80 " 504.71 " 1,458.70 " 422.23 " 1,458.70 " 438.88 " 1,166.33 " 414.18 " 1,118.03 " 482.77 438.88 " 1,397.27 " 361.91 402.12 " 1,208.52 " " 1,510.65 " 412.17 414.18 402.12 " 1,688.80 " 367.94 438.88 " 1,053.55 " 353.87 863.40 " 1,583.25 " 802.39 944.25 416.19 36770716 HLA I AND II TYPING LOW RES 81370 300 "$2,111.00" 780.23 353.87 " 1,688.80 " 504.71 " 1,458.70 " 422.23 " 1,458.70 " 438.88 " 1,166.33 " 414.18 " 1,118.03 " 482.77 438.88 " 1,397.27 " 361.91 402.12 " 1,208.52 " " 1,510.65 " 412.17 414.18 402.12 " 1,688.80 " 367.94 438.88 " 1,053.55 " 353.87 863.40 " 1,583.25 " 802.39 944.25 416.19 36942649 HLA CLASS I II TYPING LO RES 81370 300 "$3,478.00" " 1,285.47 " 353.87 " 2,782.40 " 504.71 " 2,403.30 " 422.23 " 2,403.30 " 438.88 " 1,921.60 " 414.18 " 1,118.03 " 482.77 438.88 " 2,302.09 " 361.91 402.12 " 1,208.52 " " 1,510.65 " 412.17 414.18 402.12 " 2,782.40 " 367.94 438.88 " 1,053.55 " 353.87 " 1,422.50 " " 2,608.50 " " 1,321.99 " " 1,555.71 " 416.19 36900300 HLA-A B C CLS I DNA TYPING 81372 300 "$2,119.00" 783.18 241.09 " 1,695.20 " 277.25 " 1,464.23 " 423.77 " 1,464.23 " 241.09 " 1,170.75 " 415.70 614.15 265.20 241.09 " 1,402.57 " 363.23 403.59 906.35 " 1,132.94 " 413.68 415.70 403.59 " 1,695.20 " 369.28 241.09 " 1,057.41 " 355.16 866.67 " 1,589.25 " 805.43 947.83 417.72 36770864 HLA CLASS I II DNA TYPING 81373 300 $669.00 247.26 112.14 755.30 139.77 462.28 133.80 462.28 121.54 369.62 131.25 309.64 133.69 121.54 442.81 114.69 127.43 604.24 755.30 130.62 131.25 127.43 535.20 116.60 121.54 333.87 112.14 273.62 501.75 254.29 299.24 131.89 36937530 HLA ABC LOW RES CLS 1 81373 300 "$1,386.00" 512.27 112.14 " 1,108.80 " 139.77 957.73 133.80 957.73 121.54 765.77 131.25 309.64 133.69 121.54 917.39 114.69 127.43 604.24 755.30 130.62 131.25 127.43 " 1,108.80 " 116.60 121.54 333.87 112.14 566.87 " 1,039.50 " 526.82 619.96 131.89 36937548 HLA ABC LOW RES CLS 1 81373 300 "$1,386.00" 512.27 112.14 " 1,108.80 " 139.77 957.73 133.80 957.73 121.54 765.77 131.25 309.64 133.69 121.54 917.39 114.69 127.43 604.24 755.30 130.62 131.25 127.43 " 1,108.80 " 116.60 121.54 333.87 112.14 566.87 " 1,039.50 " 526.82 619.96 131.89 36937556 HLA ABC LOW RES CLS 1 81373 300 "$1,386.00" 512.27 112.14 " 1,108.80 " 139.77 957.73 133.80 957.73 121.54 765.77 131.25 309.64 133.69 121.54 917.39 114.69 127.43 604.24 755.30 130.62 131.25 127.43 " 1,108.80 " 116.60 121.54 333.87 112.14 566.87 " 1,039.50 " 526.82 619.96 131.89 36770627 HLA CLASS 1 SINGLE ANTIGEN 81374 300 $504.00 186.28 65.41 566.47 91.31 348.26 78.05 348.26 79.40 278.46 76.56 202.28 87.34 79.40 333.60 66.90 74.33 453.18 566.47 76.19 76.56 74.33 403.20 68.01 79.40 194.74 65.41 206.14 378.00 191.57 225.44 76.93 36937009 HLA-A29 DNA TYPING 81374 300 $504.00 186.28 65.41 566.47 91.31 348.26 78.05 348.26 79.40 278.46 76.56 202.28 87.34 79.40 333.60 66.90 74.33 453.18 566.47 76.19 76.56 74.33 403.20 68.01 79.40 194.74 65.41 206.14 378.00 191.57 225.44 76.93 36900296 HLA-DR DQ CLS II DNA TYPING 81375 300 "$1,159.00" 428.37 194.25 " 1,132.94 " 277.06 800.87 231.78 800.87 240.92 640.35 227.36 613.74 265.01 240.92 767.14 198.67 220.74 906.35 " 1,132.94 " 226.26 227.36 220.74 927.20 201.98 240.92 578.34 194.25 474.03 869.25 440.54 518.42 228.47 36770724 HLA II TYPING 1 LOCUS LOW RES 81376 300 $642.00 237.28 107.55 755.30 153.40 443.62 128.33 443.62 133.39 354.71 125.89 339.81 146.73 133.39 424.94 110.00 122.22 604.24 755.30 125.28 125.89 122.22 513.60 111.83 133.39 320.22 107.55 262.58 481.50 244.02 287.17 126.50 36770821 LOW RES DPA1 TYPING 81376 300 $642.00 237.28 107.55 755.30 153.40 443.62 128.33 443.62 133.39 354.71 125.89 339.81 146.73 133.39 424.94 110.00 122.22 604.24 755.30 125.28 125.89 122.22 513.60 111.83 133.39 320.22 107.55 262.58 481.50 244.02 287.17 126.50 36770856 HLA II TYPING 1 LOCUS LOW RES 81376 300 $642.00 237.28 107.55 755.30 153.40 443.62 128.33 443.62 133.39 354.71 125.89 339.81 146.73 133.39 424.94 110.00 122.22 604.24 755.30 125.28 125.89 122.22 513.60 111.83 133.39 320.22 107.55 262.58 481.50 244.02 287.17 126.50 36936908 HLA DRB/DQB LOW RES CLS II 81376 300 "$2,769.00" " 1,023.42 " 107.55 " 2,215.20 " 153.40 " 1,913.38 " 128.33 " 1,913.38 " 133.39 " 1,529.87 " 125.89 339.81 146.73 133.39 " 1,832.80 " 110.00 122.22 604.24 755.30 125.28 125.89 122.22 " 2,215.20 " 111.83 133.39 320.22 107.55 " 1,132.52 " " 2,076.75 " " 1,052.50 " " 1,238.57 " 126.50 36936916 HLA DRB/DQB LOW RES CLS II 81376 300 "$2,769.00" " 1,023.42 " 107.55 " 2,215.20 " 153.40 " 1,913.38 " 128.33 " 1,913.38 " 133.39 " 1,529.87 " 125.89 339.81 146.73 133.39 " 1,832.80 " 110.00 122.22 604.24 755.30 125.28 125.89 122.22 " 2,215.20 " 111.83 133.39 320.22 107.55 " 1,132.52 " " 2,076.75 " " 1,052.50 " " 1,238.57 " 126.50 36940662 HLA CLS II TYP LOW RES 1 LOCUS 81376 300 $642.00 237.28 107.55 755.30 153.40 443.62 128.33 443.62 133.39 354.71 125.89 339.81 146.73 133.39 424.94 110.00 122.22 604.24 755.30 125.28 125.89 122.22 513.60 111.83 133.39 320.22 107.55 262.58 481.50 244.02 287.17 126.50 36942657 HLA CLS II TYP LOW RES 1 LOCUS 81376 300 "$1,067.00" 394.36 107.55 853.60 153.40 737.30 128.33 737.30 133.39 589.52 125.89 339.81 146.73 133.39 706.25 110.00 122.22 604.24 755.30 125.28 125.89 122.22 853.60 111.83 133.39 320.22 107.55 436.40 800.25 405.57 477.27 126.50 36942665 HLA CLS II TYP LOW RES 1 LOCUS 81376 300 "$1,067.00" 394.36 107.55 853.60 153.40 737.30 128.33 737.30 133.39 589.52 125.89 339.81 146.73 133.39 706.25 110.00 122.22 604.24 755.30 125.28 125.89 122.22 853.60 111.83 133.39 320.22 107.55 436.40 800.25 405.57 477.27 126.50 36982501 HLA CLASS II TYP LOW RES LOC1 81376 300 $642.00 237.28 107.55 755.30 153.40 443.62 128.33 443.62 133.39 354.71 125.89 339.81 146.73 133.39 424.94 110.00 122.22 604.24 755.30 125.28 125.89 122.22 513.60 111.83 133.39 320.22 107.55 262.58 481.50 244.02 287.17 126.50 36770635 HLA CLASS 2 SINGLE ANTIGEN 81377 300 $497.00 183.69 83.37 566.47 115.23 343.43 99.48 343.43 100.20 274.59 97.58 255.25 110.22 100.20 328.96 85.27 94.74 453.18 566.47 97.11 97.58 94.74 397.60 86.69 100.20 248.22 83.37 203.27 372.75 188.91 222.31 98.06 36937017 HLA CLS II LO RES AG EA 81377 300 $497.00 183.69 83.37 566.47 115.23 343.43 99.48 343.43 100.20 274.59 97.58 255.25 110.22 100.20 328.96 85.27 94.74 453.18 566.47 97.11 97.58 94.74 397.60 86.69 100.20 248.22 83.37 203.27 372.75 188.91 222.31 98.06 36937041 HLA CLS II LO RES AG EA 81377 300 $497.00 183.69 83.37 566.47 115.23 343.43 99.48 343.43 100.20 274.59 97.58 255.25 110.22 100.20 328.96 85.27 94.74 453.18 566.47 97.11 97.58 94.74 397.60 86.69 100.20 248.22 83.37 203.27 372.75 188.91 222.31 98.06 36937050 HLA CLS II LO RES AG EA 81377 300 $497.00 183.69 83.37 566.47 115.23 343.43 99.48 343.43 100.20 274.59 97.58 255.25 110.22 100.20 328.96 85.27 94.74 453.18 566.47 97.11 97.58 94.74 397.60 86.69 100.20 248.22 83.37 203.27 372.75 188.91 222.31 98.06 36942363 HLA CLASS I II TYPING HIGH RES 81378 300 "$4,491.00" " 1,659.87 " 304.10 " 3,592.80 " 433.72 " 3,103.28 " 362.85 " 3,103.28 " 377.15 " 2,481.28 " 355.94 960.75 414.87 377.15 " 2,972.59 " 311.01 345.57 " 1,510.64 " " 1,888.30 " 354.21 355.94 345.57 " 3,592.80 " 316.20 377.15 905.39 304.10 " 1,836.82 " " 3,368.25 " " 1,707.03 " " 2,008.82 " 357.66 36943246 HLA CLASS I TYPING HIGH RES 81379 300 "$3,562.00" " 1,316.52 " 295.13 " 2,849.60 " 420.93 " 2,461.34 " 352.15 " 2,461.34 " 366.03 " 1,968.01 " 345.44 932.45 402.63 366.03 " 2,357.69 " 301.84 335.38 906.35 " 1,132.94 " 343.76 345.44 335.38 " 2,849.60 " 306.87 366.03 878.70 295.13 " 1,456.86 " " 2,671.50 " " 1,353.92 " " 1,593.28 " 347.12 36935464 HLA I TYPING 1 LOCUS HR 81380 300 "$2,410.00" 890.74 155.98 " 1,928.00 " 222.47 " 1,665.31 " 186.11 " 1,665.31 " 193.45 " 1,331.53 " 182.57 492.79 212.80 193.45 " 1,595.18 " 159.53 177.25 604.24 755.30 181.68 182.57 177.25 " 1,928.00 " 162.18 193.45 464.40 155.98 985.69 " 1,807.50 " 916.04 " 1,077.99 " 183.45 36936835 HLA B HIGH RES 81380 300 "$2,410.00" 890.74 155.98 " 1,928.00 " 222.47 " 1,665.31 " 186.11 " 1,665.31 " 193.45 " 1,331.53 " 182.57 492.79 212.80 193.45 " 1,595.18 " 159.53 177.25 604.24 755.30 181.68 182.57 177.25 " 1,928.00 " 162.18 193.45 464.40 155.98 985.69 " 1,807.50 " 916.04 " 1,077.99 " 183.45 36935472 HLA-B*5701 TYPING 1 81381 300 $892.00 329.68 103.22 713.60 118.70 616.37 178.40 616.37 103.22 492.83 175.00 262.98 113.54 103.22 590.41 152.91 169.90 453.18 566.47 174.15 175.00 169.90 713.60 155.46 103.22 445.14 149.51 364.83 669.00 339.05 398.99 175.85 36981873 HLA-B*5801 GENOTYPE 81381 300 "$1,299.00" 480.11 103.22 " 1,039.20 " 118.70 897.61 178.40 897.61 103.22 717.70 175.00 262.98 113.54 103.22 859.81 152.91 169.90 453.18 566.47 174.15 175.00 169.90 " 1,039.20 " 155.46 103.22 445.14 149.51 531.29 974.25 493.75 581.04 175.85 36770791 HLA DPB1 CLS II TYPE HIGH RES 81382 300 "$2,415.00" 892.58 108.84 " 1,932.00 " 155.23 " 1,668.77 " 129.86 " 1,668.77 " 134.98 " 1,334.29 " 127.39 343.86 148.48 134.98 " 1,598.49 " 111.31 123.68 " 1,057.42 " " 1,321.77 " 126.77 127.39 123.68 " 1,932.00 " 113.17 134.98 324.04 108.84 987.74 " 1,811.25 " 917.94 " 1,080.23 " 128.01 36770830 HIGH RES DPB1 TYPING 81382 300 "$2,415.00" 892.58 108.84 " 1,932.00 " 155.23 " 1,668.77 " 129.86 " 1,668.77 " 134.98 " 1,334.29 " 127.39 343.86 148.48 134.98 " 1,598.49 " 111.31 123.68 " 1,057.42 " " 1,321.77 " 126.77 127.39 123.68 " 1,932.00 " 113.17 134.98 324.04 108.84 987.74 " 1,811.25 " 917.94 " 1,080.23 " 128.01 36770848 HLA II TYPING 1 LOCUS HIGH RES 81382 300 "$2,415.00" 892.58 108.84 " 1,932.00 " 155.23 " 1,668.77 " 129.86 " 1,668.77 " 134.98 " 1,334.29 " 127.39 343.86 148.48 134.98 " 1,598.49 " 111.31 123.68 " 1,057.42 " " 1,321.77 " 126.77 127.39 123.68 " 1,932.00 " 113.17 134.98 324.04 108.84 987.74 " 1,811.25 " 917.94 " 1,080.23 " 128.01 36935481 HLA II TYPING 1 LOC HR 81382 300 "$2,419.00" 894.06 108.84 " 1,935.20 " 155.23 " 1,671.53 " 129.86 " 1,671.53 " 134.98 " 1,336.50 " 127.39 343.86 148.48 134.98 " 1,601.14 " 111.31 123.68 " 1,057.42 " " 1,321.77 " 126.77 127.39 123.68 " 1,935.20 " 113.17 134.98 324.04 108.84 989.37 " 1,814.25 " 919.46 " 1,082.02 " 128.01 36936681 HLA-DRB 1 HI RESOLUT SBT TYP 81382 300 "$2,415.00" 892.58 108.84 " 1,932.00 " 155.23 " 1,668.77 " 129.86 " 1,668.77 " 134.98 " 1,334.29 " 127.39 343.86 148.48 134.98 " 1,598.49 " 111.31 123.68 " 1,057.42 " " 1,321.77 " 126.77 127.39 123.68 " 1,932.00 " 113.17 134.98 324.04 108.84 987.74 " 1,811.25 " 917.94 " 1,080.23 " 128.01 36938986 HLA CLASS II TYPING HIGH RES 81382 300 "$2,415.00" 892.58 108.84 " 1,932.00 " 155.23 " 1,668.77 " 129.86 " 1,668.77 " 134.98 " 1,334.29 " 127.39 343.86 148.48 134.98 " 1,598.49 " 111.31 123.68 " 1,057.42 " " 1,321.77 " 126.77 127.39 123.68 " 1,932.00 " 113.17 134.98 324.04 108.84 987.74 " 1,811.25 " 917.94 " 1,080.23 " 128.01 36938994 HLA CLASS II TYPING HIGH RES 81382 300 "$2,415.00" 892.58 108.84 " 1,932.00 " 155.23 " 1,668.77 " 129.86 " 1,668.77 " 134.98 " 1,334.29 " 127.39 343.86 148.48 134.98 " 1,598.49 " 111.31 123.68 " 1,057.42 " " 1,321.77 " 126.77 127.39 123.68 " 1,932.00 " 113.17 134.98 324.04 108.84 987.74 " 1,811.25 " 917.94 " 1,080.23 " 128.01 36940654 HLA CLS II TYP HIGH RES 1LOCUS 81382 300 "$2,415.00" 892.58 108.84 " 1,932.00 " 155.23 " 1,668.77 " 129.86 " 1,668.77 " 134.98 " 1,334.29 " 127.39 343.86 148.48 134.98 " 1,598.49 " 111.31 123.68 " 1,057.42 " " 1,321.77 " 126.77 127.39 123.68 " 1,932.00 " 113.17 134.98 324.04 108.84 987.74 " 1,811.25 " 917.94 " 1,080.23 " 128.01 36942371 HLA CLASS II TYPING HIGH RES 81382 300 "$2,415.00" 892.58 108.84 " 1,932.00 " 155.23 " 1,668.77 " 129.86 " 1,668.77 " 134.98 " 1,334.29 " 127.39 343.86 148.48 134.98 " 1,598.49 " 111.31 123.68 " 1,057.42 " " 1,321.77 " 126.77 127.39 123.68 " 1,932.00 " 113.17 134.98 324.04 108.84 987.74 " 1,811.25 " 917.94 " 1,080.23 " 128.01 36942380 HLA CLASS II TYPING HIGH RES 81382 300 "$2,415.00" 892.58 108.84 " 1,932.00 " 155.23 " 1,668.77 " 129.86 " 1,668.77 " 134.98 " 1,334.29 " 127.39 343.86 148.48 134.98 " 1,598.49 " 111.31 123.68 " 1,057.42 " " 1,321.77 " 126.77 127.39 123.68 " 1,932.00 " 113.17 134.98 324.04 108.84 987.74 " 1,811.25 " 917.94 " 1,080.23 " 128.01 36943238 HLA CLASS II TYPING HIGH RES 81382 300 "$2,415.00" 892.58 108.84 " 1,932.00 " 155.23 " 1,668.77 " 129.86 " 1,668.77 " 134.98 " 1,334.29 " 127.39 343.86 148.48 134.98 " 1,598.49 " 111.31 123.68 " 1,057.42 " " 1,321.77 " 126.77 127.39 123.68 " 1,932.00 " 113.17 134.98 324.04 108.84 987.74 " 1,811.25 " 917.94 " 1,080.23 " 128.01 36982497 HLA CLASS II TYP HIGH RES LOC1 81382 300 "$2,415.00" 892.58 108.84 " 1,932.00 " 155.23 " 1,668.77 " 129.86 " 1,668.77 " 134.98 " 1,334.29 " 127.39 343.86 148.48 134.98 " 1,598.49 " 111.31 123.68 " 1,057.42 " " 1,321.77 " 126.77 127.39 123.68 " 1,932.00 " 113.17 134.98 324.04 108.84 987.74 " 1,811.25 " 917.94 " 1,080.23 " 128.01 36937025 HLA CLS II HI RES EA ALLELE 81383 300 "$1,291.00" 477.15 96.03 " 1,032.80 " 136.97 892.08 114.59 892.08 119.10 713.28 112.40 303.42 131.01 119.10 854.51 98.22 109.13 604.24 755.30 111.86 112.40 109.13 " 1,032.80 " 99.85 119.10 285.92 96.03 528.02 968.25 490.71 577.46 112.95 36937033 HLA CLS II HI RES EA ALLELE 81383 300 "$1,291.00" 477.15 96.03 " 1,032.80 " 136.97 892.08 114.59 892.08 119.10 713.28 112.40 303.42 131.01 119.10 854.51 98.22 109.13 604.24 755.30 111.86 112.40 109.13 " 1,032.80 " 99.85 119.10 285.92 96.03 528.02 968.25 490.71 577.46 112.95 36937068 HLA CLS II HI RES EA ALLELE 81383 300 "$1,291.00" 477.15 96.03 " 1,032.80 " 136.97 892.08 114.59 892.08 119.10 713.28 112.40 303.42 131.01 119.10 854.51 98.22 109.13 604.24 755.30 111.86 112.40 109.13 " 1,032.80 " 99.85 119.10 285.92 96.03 528.02 968.25 490.71 577.46 112.95 36937076 HLA CLS II HI RES EA ALLELE 81383 300 "$1,291.00" 477.15 96.03 " 1,032.80 " 136.97 892.08 114.59 892.08 119.10 713.28 112.40 303.42 131.01 119.10 854.51 98.22 109.13 604.24 755.30 111.86 112.40 109.13 " 1,032.80 " 99.85 119.10 285.92 96.03 528.02 968.25 490.71 577.46 112.95 36940158 HLA CLASS II TYP ONE ALLELE 81383 300 "$1,291.00" 477.15 96.03 " 1,032.80 " 136.97 892.08 114.59 892.08 119.10 713.28 112.40 303.42 131.01 119.10 854.51 98.22 109.13 604.24 755.30 111.86 112.40 109.13 " 1,032.80 " 99.85 119.10 285.92 96.03 528.02 968.25 490.71 577.46 112.95 36936967 MOLECULAR PATH LEVEL 2 81401 300 "$8,363.00" " 3,090.96 " - " 6,690.40 " - " 5,778.83 " 143.85 " 5,778.83 " - " 4,620.56 " 141.11 286.39 - - " 5,535.47 " 123.30 137.00 574.03 717.54 140.43 141.11 137.00 " 6,690.40 " 125.36 - 358.94 120.56 " 3,420.47 " " 6,272.25 " " 3,178.78 " " 3,740.77 " 141.80 36937271 MELAS MTDNA EVAL (MP LVL2) 81401 300 "$6,010.00" " 2,221.30 " - " 4,808.00 " - " 4,152.91 " 143.85 " 4,152.91 " - " 3,320.53 " 141.11 286.39 - - " 3,978.02 " 123.30 137.00 574.03 717.54 140.43 141.11 137.00 " 4,808.00 " 125.36 - 358.94 120.56 " 2,458.09 " " 4,507.50 " " 2,284.40 " " 2,688.27 " 141.80 36942461 PAX8/PPARG TRANSLOCATION 81401 300 $719.00 265.74 - 717.54 - 496.83 143.85 496.83 - 397.25 141.11 286.39 - - 475.91 123.30 137.00 574.03 717.54 140.43 141.11 137.00 575.20 125.36 - 358.94 120.56 294.07 539.25 273.29 321.61 141.80 36982241 MOLECULAR PATH LEVEL 2 81401 300 $719.00 265.74 - 717.54 - 496.83 143.85 496.83 - 397.25 141.11 286.39 - - 475.91 123.30 137.00 574.03 717.54 140.43 141.11 137.00 575.20 125.36 - 358.94 120.56 294.07 539.25 273.29 321.61 141.80 36982250 MOLECULAR PATH LEVEL 2 81401 300 $719.00 265.74 - 717.54 - 496.83 143.85 496.83 - 397.25 141.11 286.39 - - 475.91 123.30 137.00 574.03 717.54 140.43 141.11 137.00 575.20 125.36 - 358.94 120.56 294.07 539.25 273.29 321.61 141.80 36982268 MOLECULAR PATH LEVEL 2 81401 300 $719.00 265.74 - 717.54 - 496.83 143.85 496.83 - 397.25 141.11 286.39 - - 475.91 123.30 137.00 574.03 717.54 140.43 141.11 137.00 575.20 125.36 - 358.94 120.56 294.07 539.25 273.29 321.61 141.80 36982276 MOLECULAR PATH LEVEL 2 81401 300 $719.00 265.74 - 717.54 - 496.83 143.85 496.83 - 397.25 141.11 286.39 - - 475.91 123.30 137.00 574.03 717.54 140.43 141.11 137.00 575.20 125.36 - 358.94 120.56 294.07 539.25 273.29 321.61 141.80 36982284 MOLECULAR PATH LEVEL 2 81401 300 $719.00 265.74 - 717.54 - 496.83 143.85 496.83 - 397.25 141.11 286.39 - - 475.91 123.30 137.00 574.03 717.54 140.43 141.11 137.00 575.20 125.36 - 358.94 120.56 294.07 539.25 273.29 321.61 141.80 36982292 MOLECULAR PATH LEVEL 2 81401 300 $719.00 265.74 - 717.54 - 496.83 143.85 496.83 - 397.25 141.11 286.39 - - 475.91 123.30 137.00 574.03 717.54 140.43 141.11 137.00 575.20 125.36 - 358.94 120.56 294.07 539.25 273.29 321.61 141.80 36936355 T CELL RCPTR GENE QL(MP LVL3) 81402 300 "$1,019.00" 376.62 - 925.27 - 704.13 157.85 704.13 - 563.00 154.84 335.58 - - 674.48 135.30 150.33 740.22 925.27 154.09 154.84 150.33 815.20 137.55 - 393.86 132.29 416.77 764.25 387.32 455.80 155.59 36935537 JAK2 EXNS 12&13 MUT (MP LVL 4) 81403 300 "$1,614.00" 596.53 - " 1,359.58 " - " 1,115.27 " 194.46 " 1,115.27 " - 891.74 190.76 373.11 - - " 1,068.31 " 166.68 185.20 " 1,087.66 " " 1,359.58 " 189.83 190.76 185.20 " 1,291.20 " 169.46 - 485.22 162.98 660.13 " 1,210.50 " 613.48 721.94 191.68 36936363 Y CHROM MICRODLTN (MP LVL 4) 81403 300 "$1,543.00" 570.29 - " 1,359.58 " - " 1,066.21 " 194.46 " 1,066.21 " - 852.51 190.76 373.11 - - " 1,021.31 " 166.68 185.20 " 1,087.66 " " 1,359.58 " 189.83 190.76 185.20 " 1,234.40 " 169.46 - 485.22 162.98 631.09 " 1,157.25 " 586.49 690.18 191.68 36936797 CONNEXIN32 DNA SEQUENCING TEST 81403 300 "$3,638.00" " 1,344.60 " - " 2,910.40 " - " 2,513.86 " 194.46 " 2,513.86 " - " 2,010.00 " 190.76 373.11 - - " 2,407.99 " 166.68 185.20 " 1,087.66 " " 1,359.58 " 189.83 190.76 185.20 " 2,910.40 " 169.46 - 485.22 162.98 " 1,487.94 " " 2,728.50 " " 1,382.80 " " 1,627.28 " 191.68 36942479 HRAS MUTATION 81403 300 $972.00 359.25 - " 1,359.58 " - 671.65 194.46 671.65 - 537.03 190.76 373.11 - - 643.37 166.68 185.20 " 1,087.66 " " 1,359.58 " 189.83 190.76 185.20 777.60 169.46 - 485.22 162.98 397.55 729.00 369.46 434.78 191.68 36942487 CTNNB1 MUTATION 81403 300 $972.00 359.25 - " 1,359.58 " - 671.65 194.46 671.65 - 537.03 190.76 373.11 - - 643.37 166.68 185.20 " 1,087.66 " " 1,359.58 " 189.83 190.76 185.20 777.60 169.46 - 485.22 162.98 397.55 729.00 369.46 434.78 191.68 36944315 MOPATH PROCEDURE LVL 4 81403 300 $972.00 359.25 - " 1,359.58 " - 671.65 194.46 671.65 - 537.03 190.76 373.11 - - 643.37 166.68 185.20 " 1,087.66 " " 1,359.58 " 189.83 190.76 185.20 777.60 169.46 - 485.22 162.98 397.55 729.00 369.46 434.78 191.68 36982306 MOLECULAR PATH LEVEL 4 81403 300 $972.00 359.25 - " 1,359.58 " - 671.65 194.46 671.65 - 537.03 190.76 373.11 - - 643.37 166.68 185.20 " 1,087.66 " " 1,359.58 " 189.83 190.76 185.20 777.60 169.46 - 485.22 162.98 397.55 729.00 369.46 434.78 191.68 36935545 TTR AMYLOID-MOL PATH LVL 5 81404 300 "$4,938.00" " 1,825.08 " - " 3,950.40 " - " 3,412.16 " 288.57 " 3,412.16 " - " 2,728.25 " 283.07 617.48 - - " 3,268.46 " 247.35 274.83 " 1,123.90 " " 1,404.88 " 281.70 283.07 274.83 " 3,950.40 " 251.47 - 720.05 241.85 " 2,019.64 " " 3,703.50 " " 1,876.93 " " 2,208.77 " 284.45 36936673 FACIOSCALPULOHUMERAL MUS DYS 81404 300 "$4,627.00" " 1,710.14 " - " 3,701.60 " - " 3,197.26 " 288.57 " 3,197.26 " - " 2,556.42 " 283.07 617.48 - - " 3,062.61 " 247.35 274.83 " 1,123.90 " " 1,404.88 " 281.70 283.07 274.83 " 3,701.60 " 251.47 - 720.05 241.85 " 1,892.44 " " 3,470.25 " " 1,758.72 " " 2,069.66 " 284.45 36936762 CAVEOLIN 3 DNA SEQ PANEL 81404 300 "$3,537.00" " 1,307.28 " - " 2,829.60 " - " 2,444.07 " 288.57 " 2,444.07 " - " 1,954.19 " 283.07 617.48 - - " 2,341.14 " 247.35 274.83 " 1,123.90 " " 1,404.88 " 281.70 283.07 274.83 " 2,829.60 " 251.47 - 720.05 241.85 " 1,446.63 " " 2,652.75 " " 1,344.41 " " 1,582.10 " 284.45 36936983 MOLECULAR PATH LEVEL 5 81404 300 "$8,363.00" " 3,090.96 " - " 6,690.40 " - " 5,778.83 " 288.57 " 5,778.83 " - " 4,620.56 " 283.07 617.48 - - " 5,535.47 " 247.35 274.83 " 1,123.90 " " 1,404.88 " 281.70 283.07 274.83 " 6,690.40 " 251.47 - 720.05 241.85 " 3,420.47 " " 6,272.25 " " 3,178.78 " " 3,740.77 " 284.45 36937564 MOLEC PATH LVL 5 81404 300 "$1,443.00" 533.33 - " 1,404.88 " - 997.11 288.57 997.11 - 797.26 283.07 617.48 - - 955.12 247.35 274.83 " 1,123.90 " " 1,404.88 " 281.70 283.07 274.83 " 1,154.40 " 251.47 - 720.05 241.85 590.19 " 1,082.25 " 548.48 645.45 284.45 36941171 MOPATH PROCEDURE LEVEL 5 81404 300 "$2,551.00" 942.85 - " 2,040.80 " - " 1,762.74 " 288.57 " 1,762.74 " - " 1,409.43 " 283.07 617.48 - - " 1,688.51 " 247.35 274.83 " 1,123.90 " " 1,404.88 " 281.70 283.07 274.83 " 2,040.80 " 251.47 - 720.05 241.85 " 1,043.36 " " 1,913.25 " 969.64 " 1,141.06 " 284.45 36942509 PIK3CA MUTATION 81404 300 "$1,443.00" 533.33 - " 1,404.88 " - 997.11 288.57 997.11 - 797.26 283.07 617.48 - - 955.12 247.35 274.83 " 1,123.90 " " 1,404.88 " 281.70 283.07 274.83 " 1,154.40 " 251.47 - 720.05 241.85 590.19 " 1,082.25 " 548.48 645.45 284.45 36942517 TP53 MUTATION 81404 300 "$1,443.00" 533.33 - " 1,404.88 " - 997.11 288.57 997.11 - 797.26 283.07 617.48 - - 955.12 247.35 274.83 " 1,123.90 " " 1,404.88 " 281.70 283.07 274.83 " 1,154.40 " 251.47 - 720.05 241.85 590.19 " 1,082.25 " 548.48 645.45 284.45 36943581 SDHD FULL GENE SEQUENCE 81404 300 "$1,443.00" 533.33 - " 1,404.88 " - 997.11 288.57 997.11 - 797.26 283.07 617.48 - - 955.12 247.35 274.83 " 1,123.90 " " 1,404.88 " 281.70 283.07 274.83 " 1,154.40 " 251.47 - 720.05 241.85 590.19 " 1,082.25 " 548.48 645.45 284.45 36943718 VHL FULL GENE SEQUENCE 81404 300 "$1,443.00" 533.33 - " 1,404.88 " - 997.11 288.57 997.11 - 797.26 283.07 617.48 - - 955.12 247.35 274.83 " 1,123.90 " " 1,404.88 " 281.70 283.07 274.83 " 1,154.40 " 251.47 - 720.05 241.85 590.19 " 1,082.25 " 548.48 645.45 284.45 36944323 MOPATH PROCEDURE LVL 5 81404 300 "$1,443.00" 533.33 - " 1,404.88 " - 997.11 288.57 997.11 - 797.26 283.07 617.48 - - 955.12 247.35 274.83 " 1,123.90 " " 1,404.88 " 281.70 283.07 274.83 " 1,154.40 " 251.47 - 720.05 241.85 590.19 " 1,082.25 " 548.48 645.45 284.45 36944331 MOPATH PROCEDURE LVL 5 81404 300 "$1,443.00" 533.33 - " 1,404.88 " - 997.11 288.57 997.11 - 797.26 283.07 617.48 - - 955.12 247.35 274.83 " 1,123.90 " " 1,404.88 " 281.70 283.07 274.83 " 1,154.40 " 251.47 - 720.05 241.85 590.19 " 1,082.25 " 548.48 645.45 284.45 36944340 MOPATH PROCEDURE LVL 5 81404 300 "$1,443.00" 533.33 - " 1,404.88 " - 997.11 288.57 997.11 - 797.26 283.07 617.48 - - 955.12 247.35 274.83 " 1,123.90 " " 1,404.88 " 281.70 283.07 274.83 " 1,154.40 " 251.47 - 720.05 241.85 590.19 " 1,082.25 " 548.48 645.45 284.45 36944358 MOPATH PROCEDURE LVL 5 81404 300 "$1,443.00" 533.33 - " 1,404.88 " - 997.11 288.57 997.11 - 797.26 283.07 617.48 - - 955.12 247.35 274.83 " 1,123.90 " " 1,404.88 " 281.70 283.07 274.83 " 1,154.40 " 251.47 - 720.05 241.85 590.19 " 1,082.25 " 548.48 645.45 284.45 36982012 MOPATH PROCEDURE LVL 5 81404 300 "$1,443.00" 533.33 - " 1,404.88 " - 997.11 288.57 997.11 - 797.26 283.07 617.48 - - 955.12 247.35 274.83 " 1,123.90 " " 1,404.88 " 281.70 283.07 274.83 " 1,154.40 " 251.47 - 720.05 241.85 590.19 " 1,082.25 " 548.48 645.45 284.45 36982071 MOPATH PROCEDURE LVL 5 81404 300 "$1,503.00" 555.51 - " 1,404.88 " - " 1,038.57 " 288.57 " 1,038.57 " - 830.41 283.07 617.48 - - 994.84 247.35 274.83 " 1,123.90 " " 1,404.88 " 281.70 283.07 274.83 " 1,202.40 " 251.47 - 720.05 241.85 614.73 " 1,127.25 " 571.29 672.29 284.45 36982136 MOPATH PROCEDURE LVL 5 81404 300 "$4,204.00" " 1,553.80 " - " 3,363.20 " - " 2,904.96 " 288.57 " 2,904.96 " - " 2,322.71 " 283.07 617.48 - - " 2,782.63 " 247.35 274.83 " 1,123.90 " " 1,404.88 " 281.70 283.07 274.83 " 3,363.20 " 251.47 - 720.05 241.85 " 1,719.44 " " 3,153.00 " " 1,597.94 " " 1,880.45 " 284.45 36982314 MOLECULAR PATH LEVEL 5 TTPA 81404 300 "$1,443.00" 533.33 - " 1,404.88 " - 997.11 288.57 997.11 - 797.26 283.07 617.48 - - 955.12 247.35 274.83 " 1,123.90 " " 1,404.88 " 281.70 283.07 274.83 " 1,154.40 " 251.47 - 720.05 241.85 590.19 " 1,082.25 " 548.48 645.45 284.45 36982322 MOLECULAR PATH LEVEL 5 81404 300 "$1,443.00" 533.33 - " 1,404.88 " - 997.11 288.57 997.11 - 797.26 283.07 617.48 - - 955.12 247.35 274.83 " 1,123.90 " " 1,404.88 " 281.70 283.07 274.83 " 1,154.40 " 251.47 - 720.05 241.85 590.19 " 1,082.25 " 548.48 645.45 284.45 36930683 ACTA2 FULL GENE SEQUENCE 81405 300 "$1,582.00" 584.71 - " 2,643.59 " - " 1,093.16 " 316.42 " 1,093.16 " - 874.06 310.39 665.44 - - " 1,047.13 " 271.22 301.35 " 2,114.87 " " 2,643.59 " 308.88 310.39 301.35 " 1,265.60 " 275.74 - 789.54 265.19 647.04 " 1,186.50 " 601.32 707.63 311.90 36930691 ACTC1 FULL GENE SEQUENCE 81405 300 "$1,582.00" 584.71 - " 2,643.59 " - " 1,093.16 " 316.42 " 1,093.16 " - 874.06 310.39 665.44 - - " 1,047.13 " 271.22 301.35 " 2,114.87 " " 2,643.59 " 308.88 310.39 301.35 " 1,265.60 " 275.74 - 789.54 265.19 647.04 " 1,186.50 " 601.32 707.63 311.90 36930829 GLA FULL GENE SEQUENCE 81405 300 "$1,582.00" 584.71 - " 2,643.59 " - " 1,093.16 " 316.42 " 1,093.16 " - 874.06 310.39 665.44 - - " 1,047.13 " 271.22 301.35 " 2,114.87 " " 2,643.59 " 308.88 310.39 301.35 " 1,265.60 " 275.74 - 789.54 265.19 647.04 " 1,186.50 " 601.32 707.63 311.90 36935553 MOLEC PATH LVL 6 81405 300 "$1,582.00" 584.71 - " 2,643.59 " - " 1,093.16 " 316.42 " 1,093.16 " - 874.06 310.39 665.44 - - " 1,047.13 " 271.22 301.35 " 2,114.87 " " 2,643.59 " 308.88 310.39 301.35 " 1,265.60 " 275.74 - 789.54 265.19 647.04 " 1,186.50 " 601.32 707.63 311.90 36936371 CAH 21 RARE MUTAT (MP LVL 6) 81405 300 "$2,134.00" 788.73 - " 2,643.59 " - " 1,474.59 " 316.42 " 1,474.59 " - " 1,179.04 " 310.39 665.44 - - " 1,412.49 " 271.22 301.35 " 2,114.87 " " 2,643.59 " 308.88 310.39 301.35 " 1,707.20 " 275.74 - 789.54 265.19 872.81 " 1,600.50 " 811.13 954.54 311.90 36936959 MOLECULAR PATH LEVEL 6 81405 300 "$8,363.00" " 3,090.96 " - " 6,690.40 " - " 5,778.83 " 316.42 " 5,778.83 " - " 4,620.56 " 310.39 665.44 - - " 5,535.47 " 271.22 301.35 " 2,114.87 " " 2,643.59 " 308.88 310.39 301.35 " 6,690.40 " 275.74 - 789.54 265.19 " 3,420.47 " " 6,272.25 " " 3,178.78 " " 3,740.77 " 311.90 36940581 INHER FSGS MOLEC PATH LVL6 81405 300 "$6,214.00" " 2,296.69 " - " 4,971.20 " - " 4,293.87 " 316.42 " 4,293.87 " - " 3,433.24 " 310.39 665.44 - - " 4,113.05 " 271.22 301.35 " 2,114.87 " " 2,643.59 " 308.88 310.39 301.35 " 4,971.20 " 275.74 - 789.54 265.19 " 2,541.53 " " 4,660.50 " " 2,361.94 " " 2,779.52 " 311.90 36940816 MOLECULAR PATH PROC LVL6 81405 300 "$4,081.00" " 1,508.34 " - " 3,264.80 " - " 2,819.97 " 316.42 " 2,819.97 " - " 2,254.75 " 310.39 665.44 - - " 2,701.21 " 271.22 301.35 " 2,114.87 " " 2,643.59 " 308.88 310.39 301.35 " 3,264.80 " 275.74 - 789.54 265.19 " 1,669.13 " " 3,060.75 " " 1,551.19 " " 1,825.43 " 311.90 36941189 MOPATH PROCEDURE LEVEL 6 81405 300 "$2,551.00" 942.85 - " 2,643.59 " - " 1,762.74 " 316.42 " 1,762.74 " - " 1,409.43 " 310.39 665.44 - - " 1,688.51 " 271.22 301.35 " 2,114.87 " " 2,643.59 " 308.88 310.39 301.35 " 2,040.80 " 275.74 - 789.54 265.19 " 1,043.36 " " 1,913.25 " 969.64 " 1,141.06 " 311.90 36942525 RET MUTATION 81405 300 "$1,582.00" 584.71 - " 2,643.59 " - " 1,093.16 " 316.42 " 1,093.16 " - 874.06 310.39 665.44 - - " 1,047.13 " 271.22 301.35 " 2,114.87 " " 2,643.59 " 308.88 310.39 301.35 " 1,265.60 " 275.74 - 789.54 265.19 647.04 " 1,186.50 " 601.32 707.63 311.90 36943335 MEN1 FULL GENE SEQUENCE 81405 300 "$1,582.00" 584.71 - " 2,643.59 " - " 1,093.16 " 316.42 " 1,093.16 " - 874.06 310.39 665.44 - - " 1,047.13 " 271.22 301.35 " 2,114.87 " " 2,643.59 " 308.88 310.39 301.35 " 1,265.60 " 275.74 - 789.54 265.19 647.04 " 1,186.50 " 601.32 707.63 311.90 36943416 MYL2 FULL GENE SEQUENCE 81405 300 "$1,582.00" 584.71 - " 2,643.59 " - " 1,093.16 " 316.42 " 1,093.16 " - 874.06 310.39 665.44 - - " 1,047.13 " 271.22 301.35 " 2,114.87 " " 2,643.59 " 308.88 310.39 301.35 " 1,265.60 " 275.74 - 789.54 265.19 647.04 " 1,186.50 " 601.32 707.63 311.90 36943424 MYL3 FULL GENE SEQUENCE 81405 300 "$1,582.00" 584.71 - " 2,643.59 " - " 1,093.16 " 316.42 " 1,093.16 " - 874.06 310.39 665.44 - - " 1,047.13 " 271.22 301.35 " 2,114.87 " " 2,643.59 " 308.88 310.39 301.35 " 1,265.60 " 275.74 - 789.54 265.19 647.04 " 1,186.50 " 601.32 707.63 311.90 36943441 OTC FULL GENE SEQUENCE 81405 300 "$1,582.00" 584.71 - " 2,643.59 " - " 1,093.16 " 316.42 " 1,093.16 " - 874.06 310.39 665.44 - - " 1,047.13 " 271.22 301.35 " 2,114.87 " " 2,643.59 " 308.88 310.39 301.35 " 1,265.60 " 275.74 - 789.54 265.19 647.04 " 1,186.50 " 601.32 707.63 311.90 36943564 SDHB FULL GENE SEQUENCE 81405 300 "$1,582.00" 584.71 - " 2,643.59 " - " 1,093.16 " 316.42 " 1,093.16 " - 874.06 310.39 665.44 - - " 1,047.13 " 271.22 301.35 " 2,114.87 " " 2,643.59 " 308.88 310.39 301.35 " 1,265.60 " 275.74 - 789.54 265.19 647.04 " 1,186.50 " 601.32 707.63 311.90 36943572 SDHC FULL GENE SEQUENCE 81405 300 "$1,582.00" 584.71 - " 2,643.59 " - " 1,093.16 " 316.42 " 1,093.16 " - 874.06 310.39 665.44 - - " 1,047.13 " 271.22 301.35 " 2,114.87 " " 2,643.59 " 308.88 310.39 301.35 " 1,265.60 " 275.74 - 789.54 265.19 647.04 " 1,186.50 " 601.32 707.63 311.90 36943611 STK11 FULL GENE SEQUENCE 81405 300 "$1,582.00" 584.71 - " 2,643.59 " - " 1,093.16 " 316.42 " 1,093.16 " - 874.06 310.39 665.44 - - " 1,047.13 " 271.22 301.35 " 2,114.87 " " 2,643.59 " 308.88 310.39 301.35 " 1,265.60 " 275.74 - 789.54 265.19 647.04 " 1,186.50 " 601.32 707.63 311.90 36943629 TGFBR1 FULL GENE SEQUENCE 81405 300 "$1,582.00" 584.71 - " 2,643.59 " - " 1,093.16 " 316.42 " 1,093.16 " - 874.06 310.39 665.44 - - " 1,047.13 " 271.22 301.35 " 2,114.87 " " 2,643.59 " 308.88 310.39 301.35 " 1,265.60 " 275.74 - 789.54 265.19 647.04 " 1,186.50 " 601.32 707.63 311.90 36943637 TGFBR2 FULL GENE SEQUENCE 81405 300 "$1,582.00" 584.71 - " 2,643.59 " - " 1,093.16 " 316.42 " 1,093.16 " - 874.06 310.39 665.44 - - " 1,047.13 " 271.22 301.35 " 2,114.87 " " 2,643.59 " 308.88 310.39 301.35 " 1,265.60 " 275.74 - 789.54 265.19 647.04 " 1,186.50 " 601.32 707.63 311.90 36943653 TNNI3 FULL GENE SEQUENCE 81405 300 "$1,582.00" 584.71 - " 2,643.59 " - " 1,093.16 " 316.42 " 1,093.16 " - 874.06 310.39 665.44 - - " 1,047.13 " 271.22 301.35 " 2,114.87 " " 2,643.59 " 308.88 310.39 301.35 " 1,265.60 " 275.74 - 789.54 265.19 647.04 " 1,186.50 " 601.32 707.63 311.90 36943688 TPM1 FULL GENE SEQUENCE 81405 300 "$1,582.00" 584.71 - " 2,643.59 " - " 1,093.16 " 316.42 " 1,093.16 " - 874.06 310.39 665.44 - - " 1,047.13 " 271.22 301.35 " 2,114.87 " " 2,643.59 " 308.88 310.39 301.35 " 1,265.60 " 275.74 - 789.54 265.19 647.04 " 1,186.50 " 601.32 707.63 311.90 36943726 WT1 FULL GENE SEQUENCE 81405 300 "$1,582.00" 584.71 - " 2,643.59 " - " 1,093.16 " 316.42 " 1,093.16 " - 874.06 310.39 665.44 - - " 1,047.13 " 271.22 301.35 " 2,114.87 " " 2,643.59 " 308.88 310.39 301.35 " 1,265.60 " 275.74 - 789.54 265.19 647.04 " 1,186.50 " 601.32 707.63 311.90 36944226 MOPATH PROCEDURE LVL 6 81405 300 "$1,582.00" 584.71 - " 2,643.59 " - " 1,093.16 " 316.42 " 1,093.16 " - 874.06 310.39 665.44 - - " 1,047.13 " 271.22 301.35 " 2,114.87 " " 2,643.59 " 308.88 310.39 301.35 " 1,265.60 " 275.74 - 789.54 265.19 647.04 " 1,186.50 " 601.32 707.63 311.90 36944277 MOPATH PROCEDURE LVL 6 81405 300 "$1,582.00" 584.71 - " 2,643.59 " - " 1,093.16 " 316.42 " 1,093.16 " - 874.06 310.39 665.44 - - " 1,047.13 " 271.22 301.35 " 2,114.87 " " 2,643.59 " 308.88 310.39 301.35 " 1,265.60 " 275.74 - 789.54 265.19 647.04 " 1,186.50 " 601.32 707.63 311.90 36944366 MOPATH PROCEDURE LVL 6 81405 300 "$1,582.00" 584.71 - " 2,643.59 " - " 1,093.16 " 316.42 " 1,093.16 " - 874.06 310.39 665.44 - - " 1,047.13 " 271.22 301.35 " 2,114.87 " " 2,643.59 " 308.88 310.39 301.35 " 1,265.60 " 275.74 - 789.54 265.19 647.04 " 1,186.50 " 601.32 707.63 311.90 36981954 MOPATH PROCEDURE LVL 6 81405 300 "$1,768.00" 653.45 - " 2,643.59 " - " 1,221.69 " 316.42 " 1,221.69 " - 976.82 310.39 665.44 - - " 1,170.24 " 271.22 301.35 " 2,114.87 " " 2,643.59 " 308.88 310.39 301.35 " 1,414.40 " 275.74 - 789.54 265.19 723.11 " 1,326.00 " 672.02 790.83 311.90 36981989 MOPATH PROCEDURE LVL 6 81405 300 "$1,768.00" 653.45 - " 2,643.59 " - " 1,221.69 " 316.42 " 1,221.69 " - 976.82 310.39 665.44 - - " 1,170.24 " 271.22 301.35 " 2,114.87 " " 2,643.59 " 308.88 310.39 301.35 " 1,414.40 " 275.74 - 789.54 265.19 723.11 " 1,326.00 " 672.02 790.83 311.90 36982021 MOPATH PROCEDURE LVL 6 81405 300 "$1,582.00" 584.71 - " 2,643.59 " - " 1,093.16 " 316.42 " 1,093.16 " - 874.06 310.39 665.44 - - " 1,047.13 " 271.22 301.35 " 2,114.87 " " 2,643.59 " 308.88 310.39 301.35 " 1,265.60 " 275.74 - 789.54 265.19 647.04 " 1,186.50 " 601.32 707.63 311.90 36982080 MOPATH PROCEDURE LVL 6 81405 300 "$1,582.00" 584.71 - " 2,643.59 " - " 1,093.16 " 316.42 " 1,093.16 " - 874.06 310.39 665.44 - - " 1,047.13 " 271.22 301.35 " 2,114.87 " " 2,643.59 " 308.88 310.39 301.35 " 1,265.60 " 275.74 - 789.54 265.19 647.04 " 1,186.50 " 601.32 707.63 311.90 36982152 MOPATH PROCEDURE LVL 6 81405 300 "$1,582.00" 584.71 - " 2,643.59 " - " 1,093.16 " 316.42 " 1,093.16 " - 874.06 310.39 665.44 - - " 1,047.13 " 271.22 301.35 " 2,114.87 " " 2,643.59 " 308.88 310.39 301.35 " 1,265.60 " 275.74 - 789.54 265.19 647.04 " 1,186.50 " 601.32 707.63 311.90 36982411 MOLECULAR PATH LEVEL 6 81405 300 "$1,582.00" 584.71 - " 2,643.59 " - " 1,093.16 " 316.42 " 1,093.16 " - 874.06 310.39 665.44 - - " 1,047.13 " 271.22 301.35 " 2,114.87 " " 2,643.59 " 308.88 310.39 301.35 " 1,265.60 " 275.74 - 789.54 265.19 647.04 " 1,186.50 " 601.32 707.63 311.90 36982420 MOLECULAR PATH LEVEL 6 81405 300 "$1,582.00" 584.71 - " 2,643.59 " - " 1,093.16 " 316.42 " 1,093.16 " - 874.06 310.39 665.44 - - " 1,047.13 " 271.22 301.35 " 2,114.87 " " 2,643.59 " 308.88 310.39 301.35 " 1,265.60 " 275.74 - 789.54 265.19 647.04 " 1,186.50 " 601.32 707.63 311.90 36601281 MOPATH PROCEDURE LVL7 USCF 81406 300 "$1,485.00" 548.86 - " 3,172.31 " - " 1,026.14 " 297.02 " 1,026.14 " - 820.46 291.37 761.22 - - 982.92 254.59 282.88 " 2,537.85 " " 3,172.31 " 289.95 291.37 282.88 " 1,188.00 " 258.84 - 741.15 248.93 607.37 " 1,113.75 " 564.45 664.24 292.78 36930721 ATP7B FULL GENE SEQUENCE 81406 300 "$1,485.00" 548.86 - " 3,172.31 " - " 1,026.14 " 297.02 " 1,026.14 " - 820.46 291.37 761.22 - - 982.92 254.59 282.88 " 2,537.85 " " 3,172.31 " 289.95 291.37 282.88 " 1,188.00 " 258.84 - 741.15 248.93 607.37 " 1,113.75 " 564.45 664.24 292.78 36930781 DSC2 FULL GENE SEQUENCE 81406 300 "$1,485.00" 548.86 - " 3,172.31 " - " 1,026.14 " 297.02 " 1,026.14 " - 820.46 291.37 761.22 - - 982.92 254.59 282.88 " 2,537.85 " " 3,172.31 " 289.95 291.37 282.88 " 1,188.00 " 258.84 - 741.15 248.93 607.37 " 1,113.75 " 564.45 664.24 292.78 36930799 DSG2 FULL GENE SEQUENCE 81406 300 "$1,485.00" 548.86 - " 3,172.31 " - " 1,026.14 " 297.02 " 1,026.14 " - 820.46 291.37 761.22 - - 982.92 254.59 282.88 " 2,537.85 " " 3,172.31 " 289.95 291.37 282.88 " 1,188.00 " 258.84 - 741.15 248.93 607.37 " 1,113.75 " 564.45 664.24 292.78 36930802 DSP FULL GENE SEQUENCE 81406 300 "$1,485.00" 548.86 - " 3,172.31 " - " 1,026.14 " 297.02 " 1,026.14 " - 820.46 291.37 761.22 - - 982.92 254.59 282.88 " 2,537.85 " " 3,172.31 " 289.95 291.37 282.88 " 1,188.00 " 258.84 - 741.15 248.93 607.37 " 1,113.75 " 564.45 664.24 292.78 36930837 KCNH2 FULL GENE SEQUENCE 81406 300 "$1,485.00" 548.86 - " 3,172.31 " - " 1,026.14 " 297.02 " 1,026.14 " - 820.46 291.37 761.22 - - 982.92 254.59 282.88 " 2,537.85 " " 3,172.31 " 289.95 291.37 282.88 " 1,188.00 " 258.84 - 741.15 248.93 607.37 " 1,113.75 " 564.45 664.24 292.78 36930845 KCNQ1 FULL GENE SEQUENCE 81406 300 "$1,485.00" 548.86 - " 3,172.31 " - " 1,026.14 " 297.02 " 1,026.14 " - 820.46 291.37 761.22 - - 982.92 254.59 282.88 " 2,537.85 " " 3,172.31 " 289.95 291.37 282.88 " 1,188.00 " 258.84 - 741.15 248.93 607.37 " 1,113.75 " 564.45 664.24 292.78 36930853 LDLR FULL GENE SEQUENCE 81406 300 "$1,485.00" 548.86 - " 3,172.31 " - " 1,026.14 " 297.02 " 1,026.14 " - 820.46 291.37 761.22 - - 982.92 254.59 282.88 " 2,537.85 " " 3,172.31 " 289.95 291.37 282.88 " 1,188.00 " 258.84 - 741.15 248.93 607.37 " 1,113.75 " 564.45 664.24 292.78 36935561 CADASIL EVAL-MOL PATH LVL 7 81406 300 "$7,334.00" " 2,710.65 " - " 5,867.20 " - " 5,067.79 " 297.02 " 5,067.79 " - " 4,052.04 " 291.37 761.22 - - " 4,854.37 " 254.59 282.88 " 2,537.85 " " 3,172.31 " 289.95 291.37 282.88 " 5,867.20 " 258.84 - 741.15 248.93 " 2,999.61 " " 5,500.50 " " 2,787.65 " " 3,280.50 " 292.78 36936975 MOLECULAR PATH LEVEL 7 81406 300 "$8,363.00" " 3,090.96 " - " 6,690.40 " - " 5,778.83 " 297.02 " 5,778.83 " - " 4,620.56 " 291.37 761.22 - - " 5,535.47 " 254.59 282.88 " 2,537.85 " " 3,172.31 " 289.95 291.37 282.88 " 6,690.40 " 258.84 - 741.15 248.93 " 3,420.47 " " 6,272.25 " " 3,178.78 " " 3,740.77 " 292.78 36937149 MYH SEQUENCE ANAL LVL 7 81406 300 "$5,689.00" " 2,102.65 " - " 4,551.20 " - " 3,931.10 " 297.02 " 3,931.10 " - " 3,143.17 " 291.37 761.22 - - " 3,765.55 " 254.59 282.88 " 2,537.85 " " 3,172.31 " 289.95 291.37 282.88 " 4,551.20 " 258.84 - 741.15 248.93 " 2,326.80 " " 4,266.75 " " 2,162.39 " " 2,544.69 " 292.78 36937882 MOLECULAR PATH LVL 7 81406 300 "$5,350.00" " 1,977.36 " - " 4,280.00 " - " 3,696.85 " 297.02 " 3,696.85 " - " 2,955.88 " 291.37 761.22 - - " 3,541.17 " 254.59 282.88 " 2,537.85 " " 3,172.31 " 289.95 291.37 282.88 " 4,280.00 " 258.84 - 741.15 248.93 " 2,188.15 " " 4,012.50 " " 2,033.54 " " 2,393.06 " 292.78 36938811 PKU GENE ANALYSIS - LVL 7 81406 300 "$14,158.00" " 5,232.80 " - " 11,326.40 " - " 9,783.18 " 297.02 " 9,783.18 " - " 7,822.30 " 291.37 761.22 - - " 9,371.18 " 254.59 282.88 " 2,537.85 " " 3,172.31 " 289.95 291.37 282.88 " 11,326.40 " 258.84 - 741.15 248.93 " 5,790.62 " " 10,618.50 " " 5,381.46 " " 6,332.87 " 292.78 36940590 INHER FSGS MOLEC PATH LVL7 81406 300 "$6,214.00" " 2,296.69 " - " 4,971.20 " - " 4,293.87 " 297.02 " 4,293.87 " - " 3,433.24 " 291.37 761.22 - - " 4,113.05 " 254.59 282.88 " 2,537.85 " " 3,172.31 " 289.95 291.37 282.88 " 4,971.20 " 258.84 - 741.15 248.93 " 2,541.53 " " 4,660.50 " " 2,361.94 " " 2,779.52 " 292.78 36940603 INHER FSGS MOLEC PATH LVL7 81406 300 "$6,214.00" " 2,296.69 " - " 4,971.20 " - " 4,293.87 " 297.02 " 4,293.87 " - " 3,433.24 " 291.37 761.22 - - " 4,113.05 " 254.59 282.88 " 2,537.85 " " 3,172.31 " 289.95 291.37 282.88 " 4,971.20 " 258.84 - 741.15 248.93 " 2,541.53 " " 4,660.50 " " 2,361.94 " " 2,779.52 " 292.78 36940611 INHER FSGS MOLEC PATH LVL7 81406 300 "$6,214.00" " 2,296.69 " - " 4,971.20 " - " 4,293.87 " 297.02 " 4,293.87 " - " 3,433.24 " 291.37 761.22 - - " 4,113.05 " 254.59 282.88 " 2,537.85 " " 3,172.31 " 289.95 291.37 282.88 " 4,971.20 " 258.84 - 741.15 248.93 " 2,541.53 " " 4,660.50 " " 2,361.94 " " 2,779.52 " 292.78 36940824 MOLECULAR PATH PROC LVL7 81406 300 "$4,081.00" " 1,508.34 " - " 3,264.80 " - " 2,819.97 " 297.02 " 2,819.97 " - " 2,254.75 " 291.37 761.22 - - " 2,701.21 " 254.59 282.88 " 2,537.85 " " 3,172.31 " 289.95 291.37 282.88 " 3,264.80 " 258.84 - 741.15 248.93 " 1,669.13 " " 3,060.75 " " 1,551.19 " " 1,825.43 " 292.78 36941197 MOPATH PROCEDURE LEVEL 7 81406 300 "$2,551.00" 942.85 - " 3,172.31 " - " 1,762.74 " 297.02 " 1,762.74 " - " 1,409.43 " 291.37 761.22 - - " 1,688.51 " 254.59 282.88 " 2,537.85 " " 3,172.31 " 289.95 291.37 282.88 " 2,040.80 " 258.84 - 741.15 248.93 " 1,043.36 " " 1,913.25 " 969.64 " 1,141.06 " 292.78 36943327 LMNA FULL GENE SEQUENCE 81406 300 "$1,485.00" 548.86 - " 3,172.31 " - " 1,026.14 " 297.02 " 1,026.14 " - 820.46 291.37 761.22 - - 982.92 254.59 282.88 " 2,537.85 " " 3,172.31 " 289.95 291.37 282.88 " 1,188.00 " 258.84 - 741.15 248.93 607.37 " 1,113.75 " 564.45 664.24 292.78 36943378 MUTYH FULL GENE SEQUENCE 81406 300 "$1,485.00" 548.86 - " 3,172.31 " - " 1,026.14 " 297.02 " 1,026.14 " - 820.46 291.37 761.22 - - 982.92 254.59 282.88 " 2,537.85 " " 3,172.31 " 289.95 291.37 282.88 " 1,188.00 " 258.84 - 741.15 248.93 607.37 " 1,113.75 " 564.45 664.24 292.78 36943432 NF2 FULL GENE SEQUENCE 81406 300 "$1,485.00" 548.86 - " 3,172.31 " - " 1,026.14 " 297.02 " 1,026.14 " - 820.46 291.37 761.22 - - 982.92 254.59 282.88 " 2,537.85 " " 3,172.31 " 289.95 291.37 282.88 " 1,188.00 " 258.84 - 741.15 248.93 607.37 " 1,113.75 " 564.45 664.24 292.78 36943459 PCSK9 FULL GENE SEQUENCE 81406 300 "$1,485.00" 548.86 - " 3,172.31 " - " 1,026.14 " 297.02 " 1,026.14 " - 820.46 291.37 761.22 - - 982.92 254.59 282.88 " 2,537.85 " " 3,172.31 " 289.95 291.37 282.88 " 1,188.00 " 258.84 - 741.15 248.93 607.37 " 1,113.75 " 564.45 664.24 292.78 36943467 PKP2 FULL GENE SEQUENCE 81406 300 "$1,485.00" 548.86 - " 3,172.31 " - " 1,026.14 " 297.02 " 1,026.14 " - 820.46 291.37 761.22 - - 982.92 254.59 282.88 " 2,537.85 " " 3,172.31 " 289.95 291.37 282.88 " 1,188.00 " 258.84 - 741.15 248.93 607.37 " 1,113.75 " 564.45 664.24 292.78 36943483 PRKAG2 FULL GENE SEQUENCE 81406 300 "$1,485.00" 548.86 - " 3,172.31 " - " 1,026.14 " 297.02 " 1,026.14 " - 820.46 291.37 761.22 - - 982.92 254.59 282.88 " 2,537.85 " " 3,172.31 " 289.95 291.37 282.88 " 1,188.00 " 258.84 - 741.15 248.93 607.37 " 1,113.75 " 564.45 664.24 292.78 36943513 RET FULL GENE SEQUENCE 81406 300 "$1,485.00" 548.86 - " 3,172.31 " - " 1,026.14 " 297.02 " 1,026.14 " - 820.46 291.37 761.22 - - 982.92 254.59 282.88 " 2,537.85 " " 3,172.31 " 289.95 291.37 282.88 " 1,188.00 " 258.84 - 741.15 248.93 607.37 " 1,113.75 " 564.45 664.24 292.78 36943602 SMAD4 FULL GENE SEQUENCE 81406 300 "$1,485.00" 548.86 - " 3,172.31 " - " 1,026.14 " 297.02 " 1,026.14 " - 820.46 291.37 761.22 - - 982.92 254.59 282.88 " 2,537.85 " " 3,172.31 " 289.95 291.37 282.88 " 1,188.00 " 258.84 - 741.15 248.93 607.37 " 1,113.75 " 564.45 664.24 292.78 36943645 TMEM43 FULL GENE SEQUENCE 81406 300 "$1,485.00" 548.86 - " 3,172.31 " - " 1,026.14 " 297.02 " 1,026.14 " - 820.46 291.37 761.22 - - 982.92 254.59 282.88 " 2,537.85 " " 3,172.31 " 289.95 291.37 282.88 " 1,188.00 " 258.84 - 741.15 248.93 607.37 " 1,113.75 " 564.45 664.24 292.78 36943661 TNNT2 FULL GENE SEQUENCE 81406 300 "$1,485.00" 548.86 - " 3,172.31 " - " 1,026.14 " 297.02 " 1,026.14 " - 820.46 291.37 761.22 - - 982.92 254.59 282.88 " 2,537.85 " " 3,172.31 " 289.95 291.37 282.88 " 1,188.00 " 258.84 - 741.15 248.93 607.37 " 1,113.75 " 564.45 664.24 292.78 36943696 TSC1 FULL GENE SEQUENCE 81406 300 "$1,485.00" 548.86 - " 3,172.31 " - " 1,026.14 " 297.02 " 1,026.14 " - 820.46 291.37 761.22 - - 982.92 254.59 282.88 " 2,537.85 " " 3,172.31 " 289.95 291.37 282.88 " 1,188.00 " 258.84 - 741.15 248.93 607.37 " 1,113.75 " 564.45 664.24 292.78 36944170 CADASIL EVAL 81406 300 "$7,334.00" " 2,710.65 " - " 5,867.20 " - " 5,067.79 " 297.02 " 5,067.79 " - " 4,052.04 " 291.37 761.22 - - " 4,854.37 " 254.59 282.88 " 2,537.85 " " 3,172.31 " 289.95 291.37 282.88 " 5,867.20 " 258.84 - 741.15 248.93 " 2,999.61 " " 5,500.50 " " 2,787.65 " " 3,280.50 " 292.78 36944285 MOPATH PROCEDURE LVL 7 81406 300 "$1,485.00" 548.86 - " 3,172.31 " - " 1,026.14 " 297.02 " 1,026.14 " - 820.46 291.37 761.22 - - 982.92 254.59 282.88 " 2,537.85 " " 3,172.31 " 289.95 291.37 282.88 " 1,188.00 " 258.84 - 741.15 248.93 607.37 " 1,113.75 " 564.45 664.24 292.78 36944374 MOPATH PROCEDURE LVL 7 81406 300 "$1,485.00" 548.86 - " 3,172.31 " - " 1,026.14 " 297.02 " 1,026.14 " - 820.46 291.37 761.22 - - 982.92 254.59 282.88 " 2,537.85 " " 3,172.31 " 289.95 291.37 282.88 " 1,188.00 " 258.84 - 741.15 248.93 607.37 " 1,113.75 " 564.45 664.24 292.78 36981962 MOPATH PROCEDURE LVL 7 81406 300 "$1,682.00" 621.67 - " 3,172.31 " - " 1,162.26 " 297.02 " 1,162.26 " - 929.31 291.37 761.22 - - " 1,113.32 " 254.59 282.88 " 2,537.85 " " 3,172.31 " 289.95 291.37 282.88 " 1,345.60 " 258.84 - 741.15 248.93 687.94 " 1,261.50 " 639.33 752.36 292.78 36981997 MOPATH PROCEDURE LVL 7 81406 300 "$1,682.00" 621.67 - " 3,172.31 " - " 1,162.26 " 297.02 " 1,162.26 " - 929.31 291.37 761.22 - - " 1,113.32 " 254.59 282.88 " 2,537.85 " " 3,172.31 " 289.95 291.37 282.88 " 1,345.60 " 258.84 - 741.15 248.93 687.94 " 1,261.50 " 639.33 752.36 292.78 36982039 MOPATH PROCEDURE LVL 7 81406 300 "$1,485.00" 548.86 - " 3,172.31 " - " 1,026.14 " 297.02 " 1,026.14 " - 820.46 291.37 761.22 - - 982.92 254.59 282.88 " 2,537.85 " " 3,172.31 " 289.95 291.37 282.88 " 1,188.00 " 258.84 - 741.15 248.93 607.37 " 1,113.75 " 564.45 664.24 292.78 36982098 MOPATH PROCEDURE LVL 7 81406 300 "$1,503.00" 555.51 - " 3,172.31 " - " 1,038.57 " 297.02 " 1,038.57 " - 830.41 291.37 761.22 - - 994.84 254.59 282.88 " 2,537.85 " " 3,172.31 " 289.95 291.37 282.88 " 1,202.40 " 258.84 - 741.15 248.93 614.73 " 1,127.25 " 571.29 672.29 292.78 36982161 MOPATH PROCEDURE LVL 7 81406 300 "$1,485.00" 548.86 - " 3,172.31 " - " 1,026.14 " 297.02 " 1,026.14 " - 820.46 291.37 761.22 - - 982.92 254.59 282.88 " 2,537.85 " " 3,172.31 " 289.95 291.37 282.88 " 1,188.00 " 258.84 - 741.15 248.93 607.37 " 1,113.75 " 564.45 664.24 292.78 36982331 MOLECULAR PATH LEVEL 7 81406 300 "$1,485.00" 548.86 - " 3,172.31 " - " 1,026.14 " 297.02 " 1,026.14 " - 820.46 291.37 761.22 - - 982.92 254.59 282.88 " 2,537.85 " " 3,172.31 " 289.95 291.37 282.88 " 1,188.00 " 258.84 - 741.15 248.93 607.37 " 1,113.75 " 564.45 664.24 292.78 36982349 MOLECULAR PATH LEVEL 7 81406 300 "$1,485.00" 548.86 - " 3,172.31 " - " 1,026.14 " 297.02 " 1,026.14 " - 820.46 291.37 761.22 - - 982.92 254.59 282.88 " 2,537.85 " " 3,172.31 " 289.95 291.37 282.88 " 1,188.00 " 258.84 - 741.15 248.93 607.37 " 1,113.75 " 564.45 664.24 292.78 36982357 MOLECULAR PATH LEVEL 7 81406 300 "$1,485.00" 548.86 - " 3,172.31 " - " 1,026.14 " 297.02 " 1,026.14 " - 820.46 291.37 761.22 - - 982.92 254.59 282.88 " 2,537.85 " " 3,172.31 " 289.95 291.37 282.88 " 1,188.00 " 258.84 - 741.15 248.93 607.37 " 1,113.75 " 564.45 664.24 292.78 36982365 MOLECULAR PATH LEVEL 7 81406 300 "$1,485.00" 548.86 - " 3,172.31 " - " 1,026.14 " 297.02 " 1,026.14 " - 820.46 291.37 761.22 - - 982.92 254.59 282.88 " 2,537.85 " " 3,172.31 " 289.95 291.37 282.88 " 1,188.00 " 258.84 - 741.15 248.93 607.37 " 1,113.75 " 564.45 664.24 292.78 36982373 MOLECULAR PATH LEVEL 7 81406 300 "$1,485.00" 548.86 - " 3,172.31 " - " 1,026.14 " 297.02 " 1,026.14 " - 820.46 291.37 761.22 - - 982.92 254.59 282.88 " 2,537.85 " " 3,172.31 " 289.95 291.37 282.88 " 1,188.00 " 258.84 - 741.15 248.93 607.37 " 1,113.75 " 564.45 664.24 292.78 36940832 MOLECULAR PATH PROC LVL8 81407 300 "$4,443.00" " 1,642.13 " - " 5,627.08 " - " 3,070.11 " 888.58 " 3,070.11 " - " 2,454.76 " 871.66 " 1,287.50 " - - " 2,940.82 " 761.64 846.27 " 4,501.66 " " 5,627.08 " 867.43 871.66 846.27 " 3,554.40 " 774.34 - " 2,217.23 " 744.72 " 1,817.19 " " 3,332.25 " " 1,688.78 " " 1,987.35 " 875.89 36940841 MOLECULAR PATH PROC LVL8 81407 300 "$4,443.00" " 1,642.13 " - " 5,627.08 " - " 3,070.11 " 888.58 " 3,070.11 " - " 2,454.76 " 871.66 " 1,287.50 " - - " 2,940.82 " 761.64 846.27 " 4,501.66 " " 5,627.08 " 867.43 871.66 846.27 " 3,554.40 " 774.34 - " 2,217.23 " 744.72 " 1,817.19 " " 3,332.25 " " 1,688.78 " " 1,987.35 " 875.89 36943386 MYBPC3 FULL GENE SEQUENCE 81407 300 "$4,443.00" " 1,642.13 " - " 5,627.08 " - " 3,070.11 " 888.58 " 3,070.11 " - " 2,454.76 " 871.66 " 1,287.50 " - - " 2,940.82 " 761.64 846.27 " 4,501.66 " " 5,627.08 " 867.43 871.66 846.27 " 3,554.40 " 774.34 - " 2,217.23 " 744.72 " 1,817.19 " " 3,332.25 " " 1,688.78 " " 1,987.35 " 875.89 36943408 MYH7 FULL GENE SEQUENCE 81407 300 "$4,443.00" " 1,642.13 " - " 5,627.08 " - " 3,070.11 " 888.58 " 3,070.11 " - " 2,454.76 " 871.66 " 1,287.50 " - - " 2,940.82 " 761.64 846.27 " 4,501.66 " " 5,627.08 " 867.43 871.66 846.27 " 3,554.40 " 774.34 - " 2,217.23 " 744.72 " 1,817.19 " " 3,332.25 " " 1,688.78 " " 1,987.35 " 875.89 36943548 SCN5A FULL GENE SEQUENCE 81407 300 "$4,443.00" " 1,642.13 " - " 5,627.08 " - " 3,070.11 " 888.58 " 3,070.11 " - " 2,454.76 " 871.66 " 1,287.50 " - - " 2,940.82 " 761.64 846.27 " 4,501.66 " " 5,627.08 " 867.43 871.66 846.27 " 3,554.40 " 774.34 - " 2,217.23 " 744.72 " 1,817.19 " " 3,332.25 " " 1,688.78 " " 1,987.35 " 875.89 36943700 TSC2 FULL GENE SEQUENCE 81407 300 "$4,443.00" " 1,642.13 " - " 5,627.08 " - " 3,070.11 " 888.58 " 3,070.11 " - " 2,454.76 " 871.66 " 1,287.50 " - - " 2,940.82 " 761.64 846.27 " 4,501.66 " " 5,627.08 " 867.43 871.66 846.27 " 3,554.40 " 774.34 - " 2,217.23 " 744.72 " 1,817.19 " " 3,332.25 " " 1,688.78 " " 1,987.35 " 875.89 36944293 MOPATH PROCEDURE LVL 8 81407 300 "$4,443.00" " 1,642.13 " - " 5,627.08 " - " 3,070.11 " 888.58 " 3,070.11 " - " 2,454.76 " 871.66 " 1,287.50 " - - " 2,940.82 " 761.64 846.27 " 4,501.66 " " 5,627.08 " 867.43 871.66 846.27 " 3,554.40 " 774.34 - " 2,217.23 " 744.72 " 1,817.19 " " 3,332.25 " " 1,688.78 " " 1,987.35 " 875.89 36981971 MOPATH PROCEDURE LVL 8 81407 300 "$4,960.00" " 1,833.22 " - " 5,627.08 " - " 3,427.36 " 888.58 " 3,427.36 " - " 2,740.40 " 871.66 " 1,287.50 " - - " 3,283.02 " 761.64 846.27 " 4,501.66 " " 5,627.08 " 867.43 871.66 846.27 " 3,968.00 " 774.34 - " 2,217.23 " 744.72 " 2,028.64 " " 3,720.00 " " 1,885.30 " " 2,218.61 " 875.89 36982004 MOPATH PROCEDURE LVL 8 81407 300 "$4,960.00" " 1,833.22 " - " 5,627.08 " - " 3,427.36 " 888.58 " 3,427.36 " - " 2,740.40 " 871.66 " 1,287.50 " - - " 3,283.02 " 761.64 846.27 " 4,501.66 " " 5,627.08 " 867.43 871.66 846.27 " 3,968.00 " 774.34 - " 2,217.23 " 744.72 " 2,028.64 " " 3,720.00 " " 1,885.30 " " 2,218.61 " 875.89 36982047 MOPATH PROCEDURE LVL 8 81407 300 "$4,443.00" " 1,642.13 " - " 5,627.08 " - " 3,070.11 " 888.58 " 3,070.11 " - " 2,454.76 " 871.66 " 1,287.50 " - - " 2,940.82 " 761.64 846.27 " 4,501.66 " " 5,627.08 " 867.43 871.66 846.27 " 3,554.40 " 774.34 - " 2,217.23 " 744.72 " 1,817.19 " " 3,332.25 " " 1,688.78 " " 1,987.35 " 875.89 36982101 MOPATH PROCEDURE LVL 8 81407 300 "$4,503.00" " 1,664.31 " - " 5,627.08 " - " 3,111.57 " 888.58 " 3,111.57 " - " 2,487.91 " 871.66 " 1,287.50 " - - " 2,980.54 " 761.64 846.27 " 4,501.66 " " 5,627.08 " 867.43 871.66 846.27 " 3,602.40 " 774.34 - " 2,217.23 " 744.72 " 1,841.73 " " 3,377.25 " " 1,711.59 " " 2,014.19 " 875.89 36982438 MOLECULAR PATH LEVEL 8 81407 300 "$4,443.00" " 1,642.13 " - " 5,627.08 " - " 3,070.11 " 888.58 " 3,070.11 " - " 2,454.76 " 871.66 " 1,287.50 " - - " 2,940.82 " 761.64 846.27 " 4,501.66 " " 5,627.08 " 867.43 871.66 846.27 " 3,554.40 " 774.34 - " 2,217.23 " 744.72 " 1,817.19 " " 3,332.25 " " 1,688.78 " " 1,987.35 " 875.89 36930811 FBN1 FULL GENE SEQUENCE 81408 300 "$10,500.00" " 3,880.80 " - " 8,400.00 " - " 7,255.50 " " 2,100.00 " " 7,255.50 " - " 5,801.25 " " 2,060.00 " " 1,474.80 " - - " 6,949.95 " " 1,800.00 " " 2,000.00 " " 6,042.50 " " 7,553.12 " " 2,050.00 " " 2,060.00 " " 2,000.00 " " 8,400.00 " " 1,830.00 " - " 5,240.00 " " 1,760.00 " " 4,294.50 " " 7,875.00 " " 3,991.05 " " 4,696.65 " " 2,070.00 " 36943394 MYH11 FULL GENE SEQUENCE 81408 300 "$10,500.00" " 3,880.80 " - " 8,400.00 " - " 7,255.50 " " 2,100.00 " " 7,255.50 " - " 5,801.25 " " 2,060.00 " " 1,474.80 " - - " 6,949.95 " " 1,800.00 " " 2,000.00 " " 6,042.50 " " 7,553.12 " " 2,050.00 " " 2,060.00 " " 2,000.00 " " 8,400.00 " " 1,830.00 " - " 5,240.00 " " 1,760.00 " " 4,294.50 " " 7,875.00 " " 3,991.05 " " 4,696.65 " " 2,070.00 " 36943521 RYR1 FULL GENE SEQUENCE 81408 300 "$10,500.00" " 3,880.80 " - " 8,400.00 " - " 7,255.50 " " 2,100.00 " " 7,255.50 " - " 5,801.25 " " 2,060.00 " " 1,474.80 " - - " 6,949.95 " " 1,800.00 " " 2,000.00 " " 6,042.50 " " 7,553.12 " " 2,050.00 " " 2,060.00 " " 2,000.00 " " 8,400.00 " " 1,830.00 " - " 5,240.00 " " 1,760.00 " " 4,294.50 " " 7,875.00 " " 3,991.05 " " 4,696.65 " " 2,070.00 " 36943530 RYR2 FULL GENE SEQUENCE 81408 300 "$10,500.00" " 3,880.80 " - " 8,400.00 " - " 7,255.50 " " 2,100.00 " " 7,255.50 " - " 5,801.25 " " 2,060.00 " " 1,474.80 " - - " 6,949.95 " " 1,800.00 " " 2,000.00 " " 6,042.50 " " 7,553.12 " " 2,050.00 " " 2,060.00 " " 2,000.00 " " 8,400.00 " " 1,830.00 " - " 5,240.00 " " 1,760.00 " " 4,294.50 " " 7,875.00 " " 3,991.05 " " 4,696.65 " " 2,070.00 " 36982110 MOPATH PROCEDURE LVL 9 81408 300 "$10,500.00" " 3,880.80 " - " 8,400.00 " - " 7,255.50 " " 2,100.00 " " 7,255.50 " - " 5,801.25 " " 2,060.00 " " 1,474.80 " - - " 6,949.95 " " 1,800.00 " " 2,000.00 " " 6,042.50 " " 7,553.12 " " 2,050.00 " " 2,060.00 " " 2,000.00 " " 8,400.00 " " 1,830.00 " - " 5,240.00 " " 1,760.00 " " 4,294.50 " " 7,875.00 " " 3,991.05 " " 4,696.65 " " 2,070.00 " 36982179 MOPATH PROCEDURE LVL 9 81408 300 "$10,500.00" " 3,880.80 " - " 8,400.00 " - " 7,255.50 " " 2,100.00 " " 7,255.50 " - " 5,801.25 " " 2,060.00 " " 1,474.80 " - - " 6,949.95 " " 1,800.00 " " 2,000.00 " " 6,042.50 " " 7,553.12 " " 2,050.00 " " 2,060.00 " " 2,000.00 " " 8,400.00 " " 1,830.00 " - " 5,240.00 " " 1,760.00 " " 4,294.50 " " 7,875.00 " " 3,991.05 " " 4,696.65 " " 2,070.00 " 36982381 MOLECULAR PATH LEVEL 9 81408 300 "$10,500.00" " 3,880.80 " - " 8,400.00 " - " 7,255.50 " " 2,100.00 " " 7,255.50 " - " 5,801.25 " " 2,060.00 " " 1,474.80 " - - " 6,949.95 " " 1,800.00 " " 2,000.00 " " 6,042.50 " " 7,553.12 " " 2,050.00 " " 2,060.00 " " 2,000.00 " " 8,400.00 " " 1,830.00 " - " 5,240.00 " " 1,760.00 " " 4,294.50 " " 7,875.00 " " 3,991.05 " " 4,696.65 " " 2,070.00 " 36982390 MOLECULAR PATH LEVEL 9 81408 300 "$10,500.00" " 3,880.80 " - " 8,400.00 " - " 7,255.50 " " 2,100.00 " " 7,255.50 " - " 5,801.25 " " 2,060.00 " " 1,474.80 " - - " 6,949.95 " " 1,800.00 " " 2,000.00 " " 6,042.50 " " 7,553.12 " " 2,050.00 " " 2,060.00 " " 2,000.00 " " 8,400.00 " " 1,830.00 " - " 5,240.00 " " 1,760.00 " " 4,294.50 " " 7,875.00 " " 3,991.05 " " 4,696.65 " " 2,070.00 " 36943190 EXOME SEQUENCE ANALYSIS 81415 300 "$25,095.00" " 9,275.11 " - " 26,344.97 " - " 17,340.65 " " 5,019.00 " " 17,340.65 " - " 13,864.99 " " 4,923.40 " " 16,562.70 " - - " 16,610.38 " " 4,302.00 " " 4,780.00 " " 21,075.98 " " 26,344.97 " " 4,899.50 " " 4,923.40 " " 4,780.00 " " 20,076.00 " " 4,373.70 " - " 12,523.60 " " 4,206.40 " " 10,263.86 " " 18,821.25 " " 9,538.61 " " 11,224.99 " " 4,947.30 " 36943220 WHOLE EXOME PROBAND 81415 300 "$25,095.00" " 9,275.11 " - " 26,344.97 " - " 17,340.65 " " 5,019.00 " " 17,340.65 " - " 13,864.99 " " 4,923.40 " " 16,562.70 " - - " 16,610.38 " " 4,302.00 " " 4,780.00 " " 21,075.98 " " 26,344.97 " " 4,899.50 " " 4,923.40 " " 4,780.00 " " 20,076.00 " " 4,373.70 " - " 12,523.60 " " 4,206.40 " " 10,263.86 " " 18,821.25 " " 9,538.61 " " 11,224.99 " " 4,947.30 " 36981920 EXOME SEQUENCE ANALYSIS 81415 300 "$25,095.00" " 9,275.11 " - " 26,344.97 " - " 17,340.65 " " 5,019.00 " " 17,340.65 " - " 13,864.99 " " 4,923.40 " " 16,562.70 " - - " 16,610.38 " " 4,302.00 " " 4,780.00 " " 21,075.98 " " 26,344.97 " " 4,899.50 " " 4,923.40 " " 4,780.00 " " 20,076.00 " " 4,373.70 " - " 12,523.60 " " 4,206.40 " " 10,263.86 " " 18,821.25 " " 9,538.61 " " 11,224.99 " " 4,947.30 " 36943203 SEQ ANAL EA COMPARATOR EXOME 81416 300 "$63,000.00" " 23,284.80 " - " 66,138.00 " - " 43,533.00 " " 12,600.00 " " 43,533.00 " - " 34,807.50 " " 12,360.00 " " 41,580.00 " - - " 41,699.70 " " 10,800.00 " " 12,000.00 " " 52,910.40 " " 66,138.00 " " 12,300.00 " " 12,360.00 " " 12,000.00 " " 50,400.00 " " 10,980.00 " - " 31,440.00 " " 10,560.00 " " 25,767.00 " " 47,250.00 " " 23,946.30 " " 28,179.90 " " 12,420.00 " 36943211 SEQ ANAL EA COMPARATOR EXOME 81416 300 "$63,000.00" " 23,284.80 " - " 66,138.00 " - " 43,533.00 " " 12,600.00 " " 43,533.00 " - " 34,807.50 " " 12,360.00 " " 41,580.00 " - - " 41,699.70 " " 10,800.00 " " 12,000.00 " " 52,910.40 " " 66,138.00 " " 12,300.00 " " 12,360.00 " " 12,000.00 " " 50,400.00 " " 10,980.00 " - " 31,440.00 " " 10,560.00 " " 25,767.00 " " 47,250.00 " " 23,946.30 " " 28,179.90 " " 12,420.00 " 36981938 EXOME SEQUENCE ANALYSIS 81416 300 "$63,000.00" " 23,284.80 " - " 66,138.00 " - " 43,533.00 " " 12,600.00 " " 43,533.00 " - " 34,807.50 " " 12,360.00 " " 41,580.00 " - - " 41,699.70 " " 10,800.00 " " 12,000.00 " " 52,910.40 " " 66,138.00 " " 12,300.00 " " 12,360.00 " " 12,000.00 " " 50,400.00 " " 10,980.00 " - " 31,440.00 " " 10,560.00 " " 25,767.00 " " 47,250.00 " " 23,946.30 " " 28,179.90 " " 12,420.00 " 36981946 EXOME SEQUENCE ANALYSIS 81416 300 "$63,000.00" " 23,284.80 " - " 66,138.00 " - " 43,533.00 " " 12,600.00 " " 43,533.00 " - " 34,807.50 " " 12,360.00 " " 41,580.00 " - - " 41,699.70 " " 10,800.00 " " 12,000.00 " " 52,910.40 " " 66,138.00 " " 12,300.00 " " 12,360.00 " " 12,000.00 " " 50,400.00 " " 10,980.00 " - " 31,440.00 " " 10,560.00 " " 25,767.00 " " 47,250.00 " " 23,946.30 " " 28,179.90 " " 12,420.00 " 36944544 QNATAL FETAL CHROM ANEUPLOIDY 81420 300 "$3,985.00" " 1,472.86 " 607.24 " 3,188.00 " 698.33 " 2,753.64 " 797.00 " 2,753.64 " 607.24 " 2,201.71 " 781.82 " 2,630.10 " 667.96 607.24 " 2,637.67 " 683.15 759.05 " 1,274.66 " " 1,593.32 " 778.03 781.82 759.05 " 3,188.00 " 694.53 607.24 " 1,988.71 " 667.96 " 1,629.87 " " 2,988.75 " " 1,514.70 " " 1,782.49 " 785.62 36982195 ATAXIA COMPREHENSIVE EVAL 81443 300 "$20,000.00" " 7,392.00 " - " 16,000.00 " - " 13,820.00 " " 2,570.99 " " 13,820.00 " - " 11,050.00 " " 2,522.02 " " 13,200.00 " - - " 13,238.00 " " 2,203.70 " " 2,448.56 " " 10,796.19 " " 13,495.24 " " 2,509.77 " " 2,522.02 " " 2,448.56 " " 16,000.00 " " 2,240.43 " - " 6,415.23 " " 2,154.73 " " 8,180.00 " " 15,000.00 " " 7,602.00 " " 8,946.00 " " 2,534.26 " 08500011 MPD5 TARGETD GENOMIC SEQ ANLYS 81450 300 "$3,988.00" " 1,473.96 " - " 3,573.66 " - " 2,755.71 " 797.51 " 2,755.71 " - " 2,203.37 " 782.32 " 1,323.38 " - - " 2,639.66 " 683.58 759.53 " 2,858.93 " " 3,573.66 " 778.52 782.32 759.53 " 3,190.40 " 694.97 - " 1,989.97 " 668.39 " 1,631.09 " " 2,991.00 " " 1,515.84 " " 1,783.83 " 786.11 08500002 NGS HEMATOLOGY 75 GENE PANEL 81455 300 "$15,328.00" " 5,665.23 " - " 16,091.38 " - " 10,591.65 " " 3,065.58 " " 10,591.65 " - " 8,468.72 " " 3,007.19 " " 10,116.48 " - - " 10,145.60 " " 2,627.64 " " 2,919.60 " " 12,873.10 " " 16,091.38 " " 2,992.59 " " 3,007.19 " " 2,919.60 " " 12,262.40 " " 2,671.43 " - " 7,649.35 " " 2,569.25 " " 6,269.15 " " 11,496.00 " " 5,826.17 " " 6,856.21 " " 3,021.79 " 36944242 X LINKED INTELLECT DISABILITY 81470 300 "$11,133.00" " 4,114.76 " - " 8,906.40 " - " 7,692.90 " 959.70 " 7,692.90 " - " 6,150.98 " 941.42 " 7,347.78 " - - " 7,368.93 " 822.60 914.00 " 4,030.01 " " 5,037.51 " 936.85 941.42 914.00 " 8,906.40 " 836.31 - " 2,394.68 " 804.32 " 4,553.40 " " 8,349.75 " " 4,231.65 " " 4,979.79 " 945.99 36944251 X LINKED INTELLECT DUP/DEL 81471 300 "$11,133.00" " 4,114.76 " - " 8,906.40 " - " 7,692.90 " 959.70 " 7,692.90 " - " 6,150.98 " 941.42 " 7,347.78 " - - " 7,368.93 " 822.60 914.00 " 4,030.01 " " 5,037.51 " 936.85 941.42 914.00 " 8,906.40 " 836.31 - " 2,394.68 " 804.32 " 4,553.40 " " 8,349.75 " " 4,231.65 " " 4,979.79 " 945.99 35101659 WGS MUT CONF UNLISTED MOL 81479 300 "$2,238.00" 827.16 - " 1,790.40 " - " 1,546.46 " N/A " 1,546.46 " - " 1,236.50 " N/A 342.98 - N/A " 1,481.33 " - N/A 180.21 225.26 N/A N/A N/A " 1,790.40 " N/A - " 1,499.46 " N/A 915.34 " 1,678.50 " 850.66 " 1,001.06 " N/A 35101705 WGS DNA EXTRACTION 81479 300 "$2,238.00" 827.16 - " 1,790.40 " - " 1,546.46 " N/A " 1,546.46 " - " 1,236.50 " N/A 342.98 - N/A " 1,481.33 " - N/A 180.21 225.26 N/A N/A N/A " 1,790.40 " N/A - " 1,499.46 " N/A 915.34 " 1,678.50 " 850.66 " 1,001.06 " N/A 36930713 APOB GENE 81479 300 $47.00 17.37 - 342.98 - 32.48 N/A 32.48 - 25.97 N/A 342.98 - N/A 31.11 - N/A 180.21 225.26 N/A N/A N/A 37.60 N/A - 31.49 N/A 19.22 35.25 17.86 21.02 N/A 36930730 BMPR1A GENE 81479 300 $47.00 17.37 - 342.98 - 32.48 N/A 32.48 - 25.97 N/A 342.98 - N/A 31.11 - N/A 180.21 225.26 N/A N/A N/A 37.60 N/A - 31.49 N/A 19.22 35.25 17.86 21.02 N/A 36930764 CACNA1S GENE 81479 300 $47.00 17.37 - 342.98 - 32.48 N/A 32.48 - 25.97 N/A 342.98 - N/A 31.11 - N/A 180.21 225.26 N/A N/A N/A 37.60 N/A - 31.49 N/A 19.22 35.25 17.86 21.02 N/A 36930772 COL3A1 GENE 81479 300 $47.00 17.37 - 342.98 - 32.48 N/A 32.48 - 25.97 N/A 342.98 - N/A 31.11 - N/A 180.21 225.26 N/A N/A N/A 37.60 N/A - 31.49 N/A 19.22 35.25 17.86 21.02 N/A 36936401 KIF6 GENOTYPE -UNLISTED MOL 81479 300 $378.00 139.71 - 342.98 - 261.20 N/A 261.20 - 208.85 N/A 342.98 - N/A 250.20 - N/A 180.21 225.26 N/A N/A N/A 302.40 N/A - 253.26 N/A 154.60 283.50 143.68 169.08 N/A 36936410 HNPCC LYNCH SYN SS UNLIST MOL 81479 300 "$2,410.00" 890.74 - " 1,928.00 " - " 1,665.31 " N/A " 1,665.31 " - " 1,331.53 " N/A 342.98 - N/A " 1,595.18 " - N/A 180.21 225.26 N/A N/A N/A " 1,928.00 " N/A - " 1,614.70 " N/A 985.69 " 1,807.50 " 916.04 " 1,077.99 " N/A 36936509 SS COLARIS AP-UNLIST MOL PATH 81479 300 "$2,458.00" 908.48 - " 1,966.40 " - " 1,698.48 " N/A " 1,698.48 " - " 1,358.05 " N/A 342.98 - N/A " 1,626.95 " - N/A 180.21 225.26 N/A N/A N/A " 1,966.40 " N/A - " 1,646.86 " N/A " 1,005.32 " " 1,843.50 " 934.29 " 1,099.46 " N/A 36936517 SS COLARIS-UNLIST MOL PATH 81479 300 "$2,458.00" 908.48 - " 1,966.40 " - " 1,698.48 " N/A " 1,698.48 " - " 1,358.05 " N/A 342.98 - N/A " 1,626.95 " - N/A 180.21 225.26 N/A N/A N/A " 1,966.40 " N/A - " 1,646.86 " N/A " 1,005.32 " " 1,843.50 " 934.29 " 1,099.46 " N/A 36936525 SS MYH-UNLIST MOL PATH 81479 300 "$2,458.00" 908.48 - " 1,966.40 " - " 1,698.48 " N/A " 1,698.48 " - " 1,358.05 " N/A 342.98 - N/A " 1,626.95 " - N/A 180.21 225.26 N/A N/A N/A " 1,966.40 " N/A - " 1,646.86 " N/A " 1,005.32 " " 1,843.50 " 934.29 " 1,099.46 " N/A 36936533 MYH MUT-UNLIST MOL PATH 81479 300 "$2,070.00" 765.07 - " 1,656.00 " - " 1,430.37 " N/A " 1,430.37 " - " 1,143.68 " N/A 342.98 - N/A " 1,370.13 " - N/A 180.21 225.26 N/A N/A N/A " 1,656.00 " N/A - " 1,386.90 " N/A 846.63 " 1,552.50 " 786.81 925.91 N/A 36936541 T-CELL RECEP EXCS CIRCLS(TREC) 81479 300 "$3,191.00" " 1,179.39 " - " 2,552.80 " - " 2,204.98 " N/A " 2,204.98 " - " 1,763.03 " N/A 342.98 - N/A " 2,112.12 " - N/A 180.21 225.26 N/A N/A N/A " 2,552.80 " N/A - " 2,137.97 " N/A " 1,305.12 " " 2,393.25 " " 1,212.90 " " 1,427.33 " N/A 36936568 FRIEDREICHS ATAXIA 81479 300 "$3,524.00" " 1,302.47 " - " 2,819.20 " - " 2,435.08 " N/A " 2,435.08 " - " 1,947.01 " N/A 342.98 - N/A " 2,332.54 " - N/A 180.21 225.26 N/A N/A N/A " 2,819.20 " N/A - " 2,361.08 " N/A " 1,441.32 " " 2,643.00 " " 1,339.47 " " 1,576.29 " N/A 36936576 PLATELET GLYCOPROTEIN 81479 300 "$1,513.00" 559.20 - " 1,210.40 " - " 1,045.48 " N/A " 1,045.48 " - 835.93 N/A 342.98 - N/A " 1,001.45 " - N/A 180.21 225.26 N/A N/A N/A " 1,210.40 " N/A - " 1,013.71 " N/A 618.82 " 1,134.75 " 575.09 676.76 N/A 36936584 HLA-DRB 1 HI RESOLUT SBT TYP 81479 300 "$2,415.00" 892.58 - " 1,932.00 " - " 1,668.77 " N/A " 1,668.77 " - " 1,334.29 " N/A 342.98 - N/A " 1,598.49 " - N/A 180.21 225.26 N/A N/A N/A " 1,932.00 " N/A - " 1,618.05 " N/A 987.74 " 1,811.25 " 917.94 " 1,080.23 " N/A 36936592 MEN 2&FMTC MUT EX 10;11;13-16 81479 300 "$1,200.00" 443.52 - 960.00 - 829.20 N/A 829.20 - 663.00 N/A 342.98 - N/A 794.28 - N/A 180.21 225.26 N/A N/A N/A 960.00 N/A - 804.00 N/A 490.80 900.00 456.12 536.76 N/A 36936606 CLL PROGNOSTIC PANEL 81479 300 "$4,901.00" " 1,811.41 " - " 3,920.80 " - " 3,386.59 " N/A " 3,386.59 " - " 2,707.80 " N/A 342.98 - N/A " 3,243.97 " - N/A 180.21 225.26 N/A N/A N/A " 3,920.80 " N/A - " 3,283.67 " N/A " 2,004.51 " " 3,675.75 " " 1,862.87 " " 2,192.22 " N/A 36936614 CAVEOLIN 3 DNA SEQ PANEL 81479 300 "$3,537.00" " 1,307.28 " - " 2,829.60 " - " 2,444.07 " N/A " 2,444.07 " - " 1,954.19 " N/A 342.98 - N/A " 2,341.14 " - N/A 180.21 225.26 N/A N/A N/A " 2,829.60 " N/A - " 2,369.79 " N/A " 1,446.63 " " 2,652.75 " " 1,344.41 " " 1,582.10 " N/A 36936622 PMP22 DNA DUPLICATION/DELETION 81479 300 "$3,645.00" " 1,347.19 " - " 2,916.00 " - " 2,518.70 " N/A " 2,518.70 " - " 2,013.86 " N/A 342.98 - N/A " 2,412.63 " - N/A 180.21 225.26 N/A N/A N/A " 2,916.00 " N/A - " 2,442.15 " N/A " 1,490.81 " " 2,733.75 " " 1,385.46 " " 1,630.41 " N/A 36936631 CONNEXIN32 DNA SEQUENCING TEST 81479 300 "$3,638.00" " 1,344.60 " - " 2,910.40 " - " 2,513.86 " N/A " 2,513.86 " - " 2,010.00 " N/A 342.98 - N/A " 2,407.99 " - N/A 180.21 225.26 N/A N/A N/A " 2,910.40 " N/A - " 2,437.46 " N/A " 1,487.94 " " 2,728.50 " " 1,382.80 " " 1,627.28 " N/A 36936649 FAM ADENO POLY SINGLE SITE PNL 81479 300 $971.00 358.88 - 776.80 - 670.96 N/A 670.96 - 536.48 N/A 342.98 - N/A 642.70 - N/A 180.21 225.26 N/A N/A N/A 776.80 N/A - 650.57 N/A 397.14 728.25 369.08 434.33 N/A 36936690 SUB BCR/ABL RFLX 81479 300 "$1,200.00" 443.52 - 960.00 - 829.20 N/A 829.20 - 663.00 N/A 342.98 - N/A 794.28 - N/A 180.21 225.26 N/A N/A N/A 960.00 N/A - 804.00 N/A 490.80 900.00 456.12 536.76 N/A 36936703 CLL PROGNOSTIC PANEL 81479 300 "$4,901.00" " 1,811.41 " - " 3,920.80 " - " 3,386.59 " N/A " 3,386.59 " - " 2,707.80 " N/A 342.98 - N/A " 3,243.97 " - N/A 180.21 225.26 N/A N/A N/A " 3,920.80 " N/A - " 3,283.67 " N/A " 2,004.51 " " 3,675.75 " " 1,862.87 " " 2,192.22 " N/A 36936711 SINGLE SITE COLARIS AP 81479 300 "$2,458.00" 908.48 - " 1,966.40 " - " 1,698.48 " N/A " 1,698.48 " - " 1,358.05 " N/A 342.98 - N/A " 1,626.95 " - N/A 180.21 225.26 N/A N/A N/A " 1,966.40 " N/A - " 1,646.86 " N/A " 1,005.32 " " 1,843.50 " 934.29 " 1,099.46 " N/A 36936720 SINGLE SITE COLARIS 81479 300 "$2,458.00" 908.48 - " 1,966.40 " - " 1,698.48 " N/A " 1,698.48 " - " 1,358.05 " N/A 342.98 - N/A " 1,626.95 " - N/A 180.21 225.26 N/A N/A N/A " 1,966.40 " N/A - " 1,646.86 " N/A " 1,005.32 " " 1,843.50 " 934.29 " 1,099.46 " N/A 36936738 SINGLE SITE MYH 81479 300 "$2,458.00" 908.48 - " 1,966.40 " - " 1,698.48 " N/A " 1,698.48 " - " 1,358.05 " N/A 342.98 - N/A " 1,626.95 " - N/A 180.21 225.26 N/A N/A N/A " 1,966.40 " N/A - " 1,646.86 " N/A " 1,005.32 " " 1,843.50 " 934.29 " 1,099.46 " N/A 36936754 MYH MUTATION PANEL 81479 300 "$2,070.00" 765.07 - " 1,656.00 " - " 1,430.37 " N/A " 1,430.37 " - " 1,143.68 " N/A 342.98 - N/A " 1,370.13 " - N/A 180.21 225.26 N/A N/A N/A " 1,656.00 " N/A - " 1,386.90 " N/A 846.63 " 1,552.50 " 786.81 925.91 N/A 36936801 UNLISTED MOL PROCEDURE 81479 300 "$4,134.00" " 1,527.93 " - " 3,307.20 " - " 2,856.59 " N/A " 2,856.59 " - " 2,284.04 " N/A 342.98 - N/A " 2,736.29 " - N/A 180.21 225.26 N/A N/A N/A " 3,307.20 " N/A - " 2,769.78 " N/A " 1,690.81 " " 3,100.50 " " 1,571.33 " " 1,849.14 " N/A 36936819 HNPCC LYNCH SYNDROME 81479 300 "$16,353.00" " 6,044.07 " - " 13,082.40 " - " 11,299.92 " N/A " 11,299.92 " - " 9,035.03 " N/A 342.98 - N/A " 10,824.05 " - N/A 180.21 225.26 N/A N/A N/A " 13,082.40 " N/A - " 10,956.51 " N/A " 6,688.38 " " 12,264.75 " " 6,215.78 " " 7,314.70 " N/A 36936827 FAMILIAL ADENO POLY 81479 300 "$9,493.00" " 3,508.61 " - " 7,594.40 " - " 6,559.66 " N/A " 6,559.66 " - " 5,244.88 " N/A 342.98 - N/A " 6,283.42 " - N/A 180.21 225.26 N/A N/A N/A " 7,594.40 " N/A - " 6,360.31 " N/A " 3,882.64 " " 7,119.75 " " 3,608.29 " " 4,246.22 " N/A 36936941 UNLISTED MOLECULAR PATH 81479 300 "$8,363.00" " 3,090.96 " - " 6,690.40 " - " 5,778.83 " N/A " 5,778.83 " - " 4,620.56 " N/A 342.98 - N/A " 5,535.47 " - N/A 180.21 225.26 N/A N/A N/A " 6,690.40 " N/A - " 5,603.21 " N/A " 3,420.47 " " 6,272.25 " " 3,178.78 " " 3,740.77 " N/A 36937084 FRAGILE X CAP ELECTRO 81479 300 $342.00 126.40 - 342.98 - 236.32 N/A 236.32 - 188.96 N/A 342.98 - N/A 226.37 - N/A 180.21 225.26 N/A N/A N/A 273.60 N/A - 229.14 N/A 139.88 256.50 129.99 152.98 N/A 36937921 G6PD DNA POINT MUTATION 81479 300 $26.00 9.61 - 342.98 - 17.97 N/A 17.97 - 14.37 N/A 342.98 - N/A 17.21 - N/A 180.21 225.26 N/A N/A N/A 20.80 N/A - 17.42 N/A 10.63 19.50 9.88 11.63 N/A 36938544 SCID 81479 300 $30.00 11.09 - 342.98 - 20.73 N/A 20.73 - 16.58 N/A 342.98 - N/A 19.86 - N/A 180.21 225.26 N/A N/A N/A 24.00 N/A - 20.10 N/A 12.27 22.50 11.40 13.42 N/A 36938595 MLH1H HYPERMETHYLATION 81479 300 "$2,537.00" 937.68 - " 2,029.60 " - " 1,753.07 " N/A " 1,753.07 " - " 1,401.69 " N/A 342.98 - N/A " 1,679.24 " - N/A 180.21 225.26 N/A N/A N/A " 2,029.60 " N/A - " 1,699.79 " N/A " 1,037.63 " " 1,902.75 " 964.31 " 1,134.80 " N/A 36942061 INVITAE PANEL W/O BRCA 81479 300 "$4,543.00" " 1,679.09 " - " 3,634.40 " - " 3,139.21 " N/A " 3,139.21 " - " 2,510.01 " N/A 342.98 - N/A " 3,007.01 " - N/A 180.21 225.26 N/A N/A N/A " 3,634.40 " N/A - " 3,043.81 " N/A " 1,858.09 " " 3,407.25 " " 1,726.79 " " 2,032.08 " N/A 36942096 INVITAE COLON PANEL 81479 300 "$4,543.00" " 1,679.09 " - " 3,634.40 " - " 3,139.21 " N/A " 3,139.21 " - " 2,510.01 " N/A 342.98 - N/A " 3,007.01 " - N/A 180.21 225.26 N/A N/A N/A " 3,634.40 " N/A - " 3,043.81 " N/A " 1,858.09 " " 3,407.25 " " 1,726.79 " " 2,032.08 " N/A 36942100 INVITAE PANCREATIC PANEL 81479 300 "$4,543.00" " 1,679.09 " - " 3,634.40 " - " 3,139.21 " N/A " 3,139.21 " - " 2,510.01 " N/A 342.98 - N/A " 3,007.01 " - N/A 180.21 225.26 N/A N/A N/A " 3,634.40 " N/A - " 3,043.81 " N/A " 1,858.09 " " 3,407.25 " " 1,726.79 " " 2,032.08 " N/A 36942126 INVITAE GYNO PANEL 81479 300 "$4,543.00" " 1,679.09 " - " 3,634.40 " - " 3,139.21 " N/A " 3,139.21 " - " 2,510.01 " N/A 342.98 - N/A " 3,007.01 " - N/A 180.21 225.26 N/A N/A N/A " 3,634.40 " N/A - " 3,043.81 " N/A " 1,858.09 " " 3,407.25 " " 1,726.79 " " 2,032.08 " N/A 36942533 TSHR MUTATION 81479 300 $256.00 94.62 - 342.98 - 176.90 N/A 176.90 - 141.44 N/A 342.98 - N/A 169.45 - N/A 180.21 225.26 N/A N/A N/A 204.80 N/A - 171.52 N/A 104.70 192.00 97.31 114.51 N/A 36942541 AKT1 MUTATION 81479 300 $256.00 94.62 - 342.98 - 176.90 N/A 176.90 - 141.44 N/A 342.98 - N/A 169.45 - N/A 180.21 225.26 N/A N/A N/A 204.80 N/A - 171.52 N/A 104.70 192.00 97.31 114.51 N/A 36942550 GNAS MUTATION 81479 300 $256.00 94.62 - 342.98 - 176.90 N/A 176.90 - 141.44 N/A 342.98 - N/A 169.45 - N/A 180.21 225.26 N/A N/A N/A 204.80 N/A - 171.52 N/A 104.70 192.00 97.31 114.51 N/A 36942568 RET/PTC1 GENE FUSIOR TRANS 81479 300 $256.00 94.62 - 342.98 - 176.90 N/A 176.90 - 141.44 N/A 342.98 - N/A 169.45 - N/A 180.21 225.26 N/A N/A N/A 204.80 N/A - 171.52 N/A 104.70 192.00 97.31 114.51 N/A 36942576 RET/PTC3 GENE FUSIOR TRANS 81479 300 $256.00 94.62 - 342.98 - 176.90 N/A 176.90 - 141.44 N/A 342.98 - N/A 169.45 - N/A 180.21 225.26 N/A N/A N/A 204.80 N/A - 171.52 N/A 104.70 192.00 97.31 114.51 N/A 36943505 RB1 GENE 81479 300 $46.00 17.00 - 342.98 - 31.79 N/A 31.79 - 25.42 N/A 342.98 - N/A 30.45 - N/A 180.21 225.26 N/A N/A N/A 36.80 N/A - 30.82 N/A 18.81 34.50 17.48 20.58 N/A 36943556 SDHAF2 GENE 81479 300 $49.00 18.11 - 342.98 - 33.86 N/A 33.86 - 27.07 N/A 342.98 - N/A 32.43 - N/A 180.21 225.26 N/A N/A N/A 39.20 N/A - 32.83 N/A 20.04 36.75 18.62 21.92 N/A 36943599 SMAD3 GENE 81479 300 $49.00 18.11 - 342.98 - 33.86 N/A 33.86 - 27.07 N/A 342.98 - N/A 32.43 - N/A 180.21 225.26 N/A N/A N/A 39.20 N/A - 32.83 N/A 20.04 36.75 18.62 21.92 N/A 36982144 UNLISTED MOPATH PROCEDURE 81479 300 "$4,204.00" " 1,553.80 " - " 3,363.20 " - " 2,904.96 " N/A " 2,904.96 " - " 2,322.71 " N/A 342.98 - N/A " 2,782.63 " - N/A 180.21 225.26 N/A N/A N/A " 3,363.20 " N/A - " 2,816.68 " N/A " 1,719.44 " " 3,153.00 " " 1,597.94 " " 1,880.45 " N/A 36982187 CSF3R REFLEX 81479 300 "$1,754.00" 648.28 - " 1,403.20 " - " 1,212.01 " N/A " 1,212.01 " - 969.09 N/A 342.98 - N/A " 1,160.97 " - N/A 180.21 225.26 N/A N/A N/A " 1,403.20 " N/A - " 1,175.18 " N/A 717.39 " 1,315.50 " 666.70 784.56 N/A 36982403 UNLISTED MO PATH PROCEDURE 81479 300 $562.00 207.72 - 449.60 - 388.34 N/A 388.34 - 310.51 N/A 342.98 - N/A 371.99 - N/A 180.21 225.26 N/A N/A N/A 449.60 N/A - 376.54 N/A 229.86 421.50 213.62 251.38 N/A 36925116 ONCOTYPE BREAST CANCER ASSAY 81519 300 "$20,333.00" " 7,515.08 " " 2,865.00 " " 16,266.40 " " 3,294.75 " " 14,050.10 " " 4,066.65 " " 14,050.10 " " 2,865.00 " " 11,233.98 " " 3,989.19 " " 6,979.03 " " 3,151.50 " " 2,865.00 " " 13,458.41 " " 3,485.70 " " 3,873.00 " " 3,206.68 " " 4,008.35 " " 3,969.83 " " 3,989.19 " " 3,873.00 " " 16,266.40 " " 3,543.80 " " 2,865.00 " " 10,147.26 " " 3,408.24 " " 8,316.20 " " 15,249.75 " " 7,728.57 " " 9,094.95 " " 4,008.56 " 35101811 PROSIGNA PAM50 81520 300 "$13,179.00" " 4,870.96 " - " 17,080.25 " - " 9,106.69 " " 2,635.72 " " 9,106.69 " - " 7,281.40 " " 2,585.52 " " 8,698.14 " - - " 8,723.18 " " 2,259.19 " " 2,510.21 " " 13,664.20 " " 17,080.25 " " 2,572.97 " " 2,585.52 " " 2,510.21 " " 10,543.20 " " 2,296.84 " - " 6,576.75 " " 2,208.98 " " 5,390.21 " " 9,884.25 " " 5,009.34 " " 5,894.97 " " 2,598.07 " 36942070 MAMMAPRINT 81521 300 "$20,333.00" " 7,515.08 " - " 21,346.04 " - " 14,050.10 " " 4,066.65 " " 14,050.10 " - " 11,233.98 " " 3,989.19 " " 13,419.78 " - - " 13,458.41 " " 3,485.70 " " 3,873.00 " " 17,076.83 " " 21,346.04 " " 3,969.83 " " 3,989.19 " " 3,873.00 " " 16,266.40 " " 3,543.80 " - " 10,147.26 " " 3,408.24 " " 8,316.20 " " 15,249.75 " " 7,728.57 " " 9,094.95 " " 4,008.56 " 36934441 ONCOTYPE DX COLON CANCER- QNT 81525 300 "$16,359.00" " 6,046.29 " - " 17,227.46 " - " 11,304.07 " " 3,271.80 " " 11,304.07 " - " 9,038.35 " " 3,209.48 " " 10,796.94 " - - " 10,828.02 " " 2,804.40 " " 3,116.00 " " 13,781.97 " " 17,227.46 " " 3,193.90 " " 3,209.48 " " 3,116.00 " " 13,087.20 " " 2,851.14 " - " 8,163.92 " " 2,742.08 " " 6,690.83 " " 12,269.25 " " 6,218.06 " " 7,317.38 " " 3,225.06 " 36941448 COLOGUARD ONC COLORECTAL SCRN 81528 300 "$2,672.00" 987.57 407.10 " 2,765.51 " 468.17 " 1,846.35 " 534.31 " 1,846.35 " 407.10 " 1,476.28 " 524.14 " 1,006.65 " 447.81 407.10 " 1,768.60 " 457.98 508.87 " 2,212.41 " " 2,765.51 " 521.59 524.14 508.87 " 2,137.60 " 465.62 407.10 " 1,333.24 " 447.81 " 1,092.85 " " 2,004.00 " " 1,015.63 " " 1,195.19 " 526.68 36944871 HEPATITIS C VIRUS FIBROSURE 81596 300 $498.00 184.06 57.75 398.40 66.41 344.12 75.80 344.12 57.75 275.15 74.36 328.68 63.53 57.75 329.63 64.97 72.19 318.30 397.88 73.99 74.36 72.19 398.40 66.05 57.75 189.14 63.53 203.68 373.50 189.29 222.76 74.72 36940298 HCV FIBROSURE ASSAY 81599 300 "$1,959.00" 724.05 - " 1,567.20 " - " 1,353.67 " N/A " 1,353.67 " - " 1,082.35 " N/A 732.76 - N/A " 1,296.66 " - N/A " 1,038.07 " " 1,297.64 " N/A N/A N/A " 1,567.20 " N/A - " 1,312.53 " N/A 801.23 " 1,469.25 " 744.62 876.26 N/A 36940557 PROSIGNA BREAST CANCER 81599 300 "$16,164.00" " 5,974.21 " - " 12,931.20 " - " 11,169.32 " N/A " 11,169.32 " - " 8,930.61 " N/A 732.76 - N/A " 10,698.95 " - N/A " 8,565.30 " " 10,707.03 " N/A N/A N/A " 12,931.20 " N/A - " 10,829.88 " N/A " 6,611.08 " " 12,123.00 " " 6,143.94 " " 7,230.16 " N/A 35751165 B HYDROXYBUTYRATE QUANT 82010 300 $487.00 180.00 5.00 389.60 5.75 336.52 8.58 336.52 5.00 269.07 8.42 22.70 5.50 5.00 322.35 7.35 8.17 30.46 38.08 8.37 8.42 8.17 389.60 7.48 5.00 21.41 7.19 199.18 365.25 185.11 217.84 8.46 36910747 B HYDROXBUTYRIC QUANT 82010 300 $487.00 180.00 5.00 389.60 5.75 336.52 8.58 336.52 5.00 269.07 8.42 22.70 5.50 5.00 322.35 7.35 8.17 30.46 38.08 8.37 8.42 8.17 389.60 7.48 5.00 21.41 7.19 199.18 365.25 185.11 217.84 8.46 36923385 ACYLCARNITINES QUALITATIVE 82016 300 $109.00 40.29 - 109.13 - 75.32 17.31 75.32 - 60.22 16.98 38.56 - - 72.15 14.84 16.49 87.30 109.13 16.90 16.98 16.49 87.20 15.09 - 43.20 14.51 44.58 81.75 41.43 48.76 17.07 36938765 ACYLCARNITINE QUANT 82017 300 "$1,925.00" 711.48 - " 1,540.00 " - " 1,330.18 " 17.71 " 1,330.18 " - " 1,063.56 " 17.38 46.88 - - " 1,274.16 " 15.18 16.87 106.22 132.77 17.29 17.38 16.87 " 1,540.00 " 15.44 - 44.20 14.85 787.33 " 1,443.75 " 731.69 861.05 17.46 35705236 ACTH 82024 300 $203.00 75.03 33.99 221.34 46.00 140.27 40.55 140.27 40.00 112.16 39.78 107.39 44.00 40.00 134.37 34.76 38.62 177.07 221.34 39.59 39.78 38.62 162.40 35.34 40.00 101.18 33.99 83.03 152.25 77.16 90.80 39.97 35700064 ALBUMIN SERUM 82040 300 $26.00 9.61 3.65 28.38 4.20 17.97 5.20 17.97 3.65 14.37 5.10 13.75 4.02 3.65 17.21 4.46 4.95 22.70 28.38 5.07 5.10 4.95 20.80 4.53 3.65 12.97 4.36 10.63 19.50 9.88 11.63 5.12 36917474 ALBUMIN SERUM 82040 300 $87.00 32.16 3.65 69.60 4.20 60.12 5.20 60.12 3.65 48.07 5.10 13.75 4.02 3.65 57.59 4.46 4.95 22.70 28.38 5.07 5.10 4.95 69.60 4.53 3.65 12.97 4.36 35.58 65.25 33.07 38.92 5.12 36917890 ALBUMIN SERUM 82040 300 $87.00 32.16 3.65 69.60 4.20 60.12 5.20 60.12 3.65 48.07 5.10 13.75 4.02 3.65 57.59 4.46 4.95 22.70 28.38 5.07 5.10 4.95 69.60 4.53 3.65 12.97 4.36 35.58 65.25 33.07 38.92 5.12 35707808 ALBUMIN FLUID 82042 300 $41.00 15.15 - 32.80 - 28.33 8.17 28.33 - 22.65 8.01 14.38 - - 27.14 7.00 7.78 10.54 13.17 7.97 8.01 7.78 32.80 7.12 - 20.38 6.85 16.77 30.75 15.58 18.34 8.05 36917466 ALBUMIN CSF 82042 300 $79.00 29.20 - 63.20 - 54.59 8.17 54.59 - 43.65 8.01 14.38 - - 52.29 7.00 7.78 10.54 13.17 7.97 8.01 7.78 63.20 7.12 - 20.38 6.85 32.31 59.25 30.03 35.34 8.05 36917881 ALBUMIN CSF 82042 300 $79.00 29.20 - 63.20 - 54.59 8.17 54.59 - 43.65 8.01 14.38 - - 52.29 7.00 7.78 10.54 13.17 7.97 8.01 7.78 63.20 7.12 - 20.38 6.85 32.31 59.25 30.03 35.34 8.05 35702962 MICROALBUMIN RANDOM URINE 82043 300 $30.00 11.09 5.09 33.18 9.20 20.73 6.07 20.73 8.00 16.58 5.95 16.08 8.80 8.00 19.86 5.20 5.78 26.54 33.18 5.92 5.95 5.78 24.00 5.29 8.00 15.14 5.09 12.27 22.50 11.40 13.42 5.98 35706976 MICROALBUMIN 24 HR URINE QNT 82043 300 $30.00 11.09 5.09 33.18 9.20 20.73 6.07 20.73 8.00 16.58 5.95 16.08 8.80 8.00 19.86 5.20 5.78 26.54 33.18 5.92 5.95 5.78 24.00 5.29 8.00 15.14 5.09 12.27 22.50 11.40 13.42 5.98 35702563 ALCOHOL ETHANOL IA 82077 300 $91.00 33.63 - 72.80 - 62.88 18.13 62.88 - 50.28 17.79 60.06 - - 60.23 15.54 17.27 48.22 60.28 17.70 17.79 17.27 72.80 15.80 - 45.25 15.20 37.22 68.25 34.59 40.70 17.87 35700081 ALDOLASE 82085 300 $51.00 18.85 8.54 55.67 10.35 35.24 10.20 35.24 9.00 28.18 10.00 26.97 9.90 9.00 33.76 8.74 9.71 44.54 55.67 9.95 10.00 9.71 40.80 8.88 9.00 25.44 8.54 20.86 38.25 19.39 22.81 10.05 36998725 ALDOLASE 82085 300 $51.00 18.85 8.54 55.67 10.35 35.24 10.20 35.24 9.00 28.18 10.00 26.97 9.90 9.00 33.76 8.74 9.71 44.54 55.67 9.95 10.00 9.71 40.80 8.88 9.00 25.44 8.54 20.86 38.25 19.39 22.81 10.05 36900008 ALDOSTERONE 24HR URINE 82088 300 $392.00 144.88 26.00 313.60 29.90 270.87 42.79 270.87 26.00 216.58 41.97 113.29 28.60 26.00 259.46 36.68 40.75 186.86 233.58 41.77 41.97 40.75 313.60 37.29 26.00 106.77 35.86 160.33 294.00 149.00 175.34 42.18 36910119 ALDOSTERONE 82088 300 $214.00 79.09 26.00 233.58 29.90 147.87 42.79 147.87 26.00 118.24 41.97 113.29 28.60 26.00 141.65 36.68 40.75 186.86 233.58 41.77 41.97 40.75 171.20 37.29 26.00 106.77 35.86 87.53 160.50 81.34 95.72 42.18 36923547 ALDOSTERONE 82088 300 $214.00 79.09 26.00 233.58 29.90 147.87 42.79 147.87 26.00 118.24 41.97 113.29 28.60 26.00 141.65 36.68 40.75 186.86 233.58 41.77 41.97 40.75 171.20 37.29 26.00 106.77 35.86 87.53 160.50 81.34 95.72 42.18 36938927 ALDOSTERONE 82088 300 $214.00 79.09 26.00 233.58 29.90 147.87 42.79 147.87 26.00 118.24 41.97 113.29 28.60 26.00 141.65 36.68 40.75 186.86 233.58 41.77 41.97 40.75 171.20 37.29 26.00 106.77 35.86 87.53 160.50 81.34 95.72 42.18 36938935 ALDOSTERONE 82088 300 $214.00 79.09 26.00 233.58 29.90 147.87 42.79 147.87 26.00 118.24 41.97 113.29 28.60 26.00 141.65 36.68 40.75 186.86 233.58 41.77 41.97 40.75 171.20 37.29 26.00 106.77 35.86 87.53 160.50 81.34 95.72 42.18 36938943 ALDOSTERONE 82088 300 $214.00 79.09 26.00 233.58 29.90 147.87 42.79 147.87 26.00 118.24 41.97 113.29 28.60 26.00 141.65 36.68 40.75 186.86 233.58 41.77 41.97 40.75 171.20 37.29 26.00 106.77 35.86 87.53 160.50 81.34 95.72 42.18 36913797 ALPHA 1 ANTITRYPSIN STOOL 82103 300 $910.00 336.34 11.83 728.00 19.55 628.81 14.11 628.81 17.00 502.78 13.84 37.37 18.70 17.00 602.33 12.10 13.44 61.55 76.94 13.78 13.84 13.44 728.00 12.30 17.00 35.21 11.83 372.19 682.50 345.89 407.04 13.91 36941201 ALPHA-1-ANTITRYPSIN TOTAL 82103 300 $71.00 26.24 11.83 76.94 19.55 49.06 14.11 49.06 17.00 39.23 13.84 37.37 18.70 17.00 46.99 12.10 13.44 61.55 76.94 13.78 13.84 13.44 56.80 12.30 17.00 35.21 11.83 29.04 53.25 26.99 31.76 13.91 36982225 ALPHA1 ANTITRYPSIN TOTAL 82103 300 $71.00 26.24 11.83 76.94 19.55 49.06 14.11 49.06 17.00 39.23 13.84 37.37 18.70 17.00 46.99 12.10 13.44 61.55 76.94 13.78 13.84 13.44 56.80 12.30 17.00 35.21 11.83 29.04 53.25 26.99 31.76 13.91 36982233 ALPHA1 ANTITRYP PHENOTYPE 82104 300 $76.00 28.09 12.72 82.84 19.55 52.52 15.18 52.52 17.00 41.99 14.89 40.22 18.70 17.00 50.30 13.01 14.46 66.27 82.84 14.82 14.89 14.46 60.80 13.23 17.00 37.89 12.72 31.08 57.00 28.89 33.99 14.97 35705244 AFP SERUM 82105 300 $88.00 32.52 14.76 96.12 23.00 60.81 17.61 60.81 20.00 48.62 17.27 46.63 22.00 20.00 58.25 15.09 16.77 76.90 96.12 17.19 17.27 16.77 70.40 15.34 20.00 43.94 14.76 35.99 66.00 33.45 39.36 17.36 35708979 MATERNAL SERUM SCREEN 1 (AFP) 82105 300 $88.00 32.52 14.76 96.12 23.00 60.81 17.61 60.81 20.00 48.62 17.27 46.63 22.00 20.00 58.25 15.09 16.77 76.90 96.12 17.19 17.27 16.77 70.40 15.34 20.00 43.94 14.76 35.99 66.00 33.45 39.36 17.36 36942584 AFP SERUM 82105 300 $88.00 32.52 14.76 96.12 23.00 60.81 17.61 60.81 20.00 48.62 17.27 46.63 22.00 20.00 58.25 15.09 16.77 76.90 96.12 17.19 17.27 16.77 70.40 15.34 20.00 43.94 14.76 35.99 66.00 33.45 39.36 17.36 36982446 MATERNAL SERUM AFP 82105 300 $88.00 32.52 14.76 96.12 23.00 60.81 17.61 60.81 20.00 48.62 17.27 46.63 22.00 20.00 58.25 15.09 16.77 76.90 96.12 17.19 17.27 16.77 70.40 15.34 20.00 43.94 14.76 35.99 66.00 33.45 39.36 17.36 36905492 ALPHA FETOPROTEIN AMNIOTIC FL 82106 300 $119.00 43.98 14.96 96.12 23.00 82.23 17.85 82.23 20.00 65.75 17.51 46.63 22.00 20.00 78.77 15.30 17.00 76.90 96.12 17.43 17.51 17.00 95.20 15.56 20.00 44.54 14.96 48.67 89.25 45.23 53.23 17.60 36927810 ALPH FETOPROTEIN AMNIOTIC FL 82106 300 $101.00 37.33 14.96 96.12 23.00 69.79 17.85 69.79 20.00 55.80 17.51 46.63 22.00 20.00 66.85 15.30 17.00 76.90 96.12 17.43 17.51 17.00 80.80 15.56 20.00 44.54 14.96 41.31 75.75 38.39 45.18 17.60 36940701 AFP AMNIOTIC FLUID 82106 300 $119.00 43.98 14.96 96.12 23.00 82.23 17.85 82.23 20.00 65.75 17.51 46.63 22.00 20.00 78.77 15.30 17.00 76.90 96.12 17.43 17.51 17.00 95.20 15.56 20.00 44.54 14.96 48.67 89.25 45.23 53.23 17.60 36941456 AFP AND AFP-L3 82107 300 $338.00 124.92 56.68 495.98 81.44 233.56 67.63 233.56 70.82 186.75 66.34 179.07 77.90 70.82 223.72 57.97 64.41 396.78 495.98 66.02 66.34 64.41 270.40 58.94 70.82 168.75 56.68 138.24 253.50 128.47 151.19 66.66 36901934 ALUMINUM 82108 300 $134.00 49.53 22.42 146.00 40.50 92.59 26.75 92.59 35.22 74.04 26.24 70.84 38.74 35.22 88.69 22.93 25.48 116.80 146.00 26.12 26.24 25.48 107.20 23.31 35.22 66.76 22.42 54.81 100.50 50.93 59.94 26.37 36900954 CYSTINE URINE 82131 300 $387.00 143.04 20.22 309.60 26.67 267.42 24.13 267.42 23.19 213.82 23.67 46.91 25.51 23.19 256.16 20.68 22.98 76.90 96.12 23.55 23.67 22.98 309.60 21.03 23.19 60.21 20.22 158.28 290.25 147.10 173.11 23.78 36909145 CYSTINE 24HR URINE 82131 300 $410.00 151.54 20.22 328.00 26.67 283.31 24.13 283.31 23.19 226.53 23.67 46.91 25.51 23.19 271.38 20.68 22.98 76.90 96.12 23.55 23.67 22.98 328.00 21.03 23.19 60.21 20.22 167.69 307.50 155.84 183.39 23.78 36914351 AMINO ACID SINGLE QUANT 82131 300 $441.00 162.99 20.22 352.80 26.67 304.73 24.13 304.73 23.19 243.65 23.67 46.91 25.51 23.19 291.90 20.68 22.98 76.90 96.12 23.55 23.67 22.98 352.80 21.03 23.19 60.21 20.22 180.37 330.75 167.62 197.26 23.78 36900792 DELTA ALA 24HR URINE 82135 300 $86.00 31.79 12.00 94.30 13.80 59.43 17.27 59.43 12.00 47.52 16.94 45.75 13.20 12.00 56.92 14.81 16.45 75.44 94.30 16.86 16.94 16.45 68.80 15.05 12.00 43.10 14.48 35.17 64.50 32.69 38.47 17.03 36900032 AMINO ACID QUANT 82139 300 "$2,172.00" 802.77 14.85 " 1,737.60 " 26.80 " 1,500.85 " 17.71 " 1,500.85 " 23.30 " 1,200.03 " 17.38 46.88 25.63 23.30 " 1,437.65 " 15.18 16.87 106.22 132.77 17.29 17.38 16.87 " 1,737.60 " 15.44 23.30 44.20 14.85 888.35 " 1,629.00 " 825.58 971.54 17.46 35700145 AMMONIA 82140 300 $76.00 28.09 5.00 83.55 5.75 52.52 15.30 52.52 5.00 41.99 15.01 40.51 5.50 5.00 50.30 13.11 14.57 66.84 83.55 14.93 15.01 14.57 60.80 13.33 5.00 38.17 12.82 31.08 57.00 28.89 33.99 15.08 36914815 AMMONIA URINE 82140 300 $268.00 99.05 5.00 214.40 5.75 185.19 15.30 185.19 5.00 148.07 15.01 40.51 5.50 5.00 177.39 13.11 14.57 66.84 83.55 14.93 15.01 14.57 214.40 13.33 5.00 38.17 12.82 109.61 201.00 101.87 119.88 15.08 36923211 AMNIOTIC FLUID BILIRUBIN 82143 300 $59.00 21.81 5.00 47.20 5.75 40.77 9.82 40.77 5.00 32.60 9.63 19.09 5.50 5.00 39.05 8.42 9.35 34.30 42.88 9.58 9.63 9.35 47.20 8.56 5.00 24.50 8.23 24.13 44.25 22.43 26.39 9.68 35700188 AMYLASE 82150 300 $34.00 12.57 5.00 37.20 5.75 23.49 6.80 23.49 5.00 18.79 6.67 18.02 5.50 5.00 22.50 5.83 6.48 29.76 37.20 6.64 6.67 6.48 27.20 5.93 5.00 16.98 5.70 13.91 25.50 12.92 15.21 6.71 35705317 AMYLASE FLUID 82150 300 $34.00 12.57 5.00 37.20 5.75 23.49 6.80 23.49 5.00 18.79 6.67 18.02 5.50 5.00 22.50 5.83 6.48 29.76 37.20 6.64 6.67 6.48 27.20 5.93 5.00 16.98 5.70 13.91 25.50 12.92 15.21 6.71 35705325 AMYLASE RANDOM URINE 82150 300 $34.00 12.57 5.00 37.20 5.75 23.49 6.80 23.49 5.00 18.79 6.67 18.02 5.50 5.00 22.50 5.83 6.48 29.76 37.20 6.64 6.67 6.48 27.20 5.93 5.00 16.98 5.70 13.91 25.50 12.92 15.21 6.71 35709134 AMYLASE 12-HOUR URINE 82150 300 $34.00 12.57 5.00 37.20 5.75 23.49 6.80 23.49 5.00 18.79 6.67 18.02 5.50 5.00 22.50 5.83 6.48 29.76 37.20 6.64 6.67 6.48 27.20 5.93 5.00 16.98 5.70 13.91 25.50 12.92 15.21 6.71 36911212 PANCREATIC FRACTION (AMYLASE) 82150 300 $119.00 43.98 5.00 95.20 5.75 82.23 6.80 82.23 5.00 65.75 6.67 18.02 5.50 5.00 78.77 5.83 6.48 29.76 37.20 6.64 6.67 6.48 95.20 5.93 5.00 16.98 5.70 48.67 89.25 45.23 53.23 6.71 36911221 SALIVARY FRACTION (AMYLASE) 82150 300 $119.00 43.98 5.00 95.20 5.75 82.23 6.80 82.23 5.00 65.75 6.67 18.02 5.50 5.00 78.77 5.83 6.48 29.76 37.20 6.64 6.67 6.48 95.20 5.93 5.00 16.98 5.70 48.67 89.25 45.23 53.23 6.71 36934158 AMYLASE 82150 300 $119.00 43.98 5.00 95.20 5.75 82.23 6.80 82.23 5.00 65.75 6.67 18.02 5.50 5.00 78.77 5.83 6.48 29.76 37.20 6.64 6.67 6.48 95.20 5.93 5.00 16.98 5.70 48.67 89.25 45.23 53.23 6.71 36913444 ANDROSTENEDIONE 82157 300 $154.00 56.92 25.00 167.71 28.75 106.41 30.74 106.41 25.00 85.09 30.16 81.39 27.50 25.00 101.93 26.35 29.28 134.17 167.71 30.01 30.16 29.28 123.20 26.79 25.00 76.71 25.77 62.99 115.50 58.54 68.88 30.30 36918110 ANDROSTENEDIONE 82157 300 $154.00 56.92 25.00 167.71 28.75 106.41 30.74 106.41 25.00 85.09 30.16 81.39 27.50 25.00 101.93 26.35 29.28 134.17 167.71 30.01 30.16 29.28 123.20 26.79 25.00 76.71 25.77 62.99 115.50 58.54 68.88 30.30 36923229 ANDROSTENEDIONE 82157 300 $154.00 56.92 25.00 167.71 28.75 106.41 30.74 106.41 25.00 85.09 30.16 81.39 27.50 25.00 101.93 26.35 29.28 134.17 167.71 30.01 30.16 29.28 123.20 26.79 25.00 76.71 25.77 62.99 115.50 58.54 68.88 30.30 36934271 ANDROSTENEDIONE 82157 300 $501.00 185.17 25.00 400.80 28.75 346.19 30.74 346.19 25.00 276.80 30.16 81.39 27.50 25.00 331.61 26.35 29.28 134.17 167.71 30.01 30.16 29.28 400.80 26.79 25.00 76.71 25.77 204.91 375.75 190.43 224.10 30.30 36909030 ANGIOTENSIN 1 ENZYME CSF 82164 300 $211.00 77.99 12.85 168.80 23.20 145.80 15.33 145.80 20.17 116.58 15.04 40.60 22.19 20.17 139.66 13.14 14.60 66.93 83.66 14.97 15.04 14.60 168.80 13.36 20.17 38.25 12.85 86.30 158.25 80.20 94.38 15.11 36912596 ANGIOTENSIN 1 ENZYME BLD 82164 300 $211.00 77.99 12.85 168.80 23.20 145.80 15.33 145.80 20.17 116.58 15.04 40.60 22.19 20.17 139.66 13.14 14.60 66.93 83.66 14.97 15.04 14.60 168.80 13.36 20.17 38.25 12.85 86.30 158.25 80.20 94.38 15.11 36912944 APOLIPOPROTEIN B-100 82172 300 $111.00 41.03 18.56 88.80 21.85 76.70 22.14 76.70 19.00 61.33 21.72 43.08 20.90 19.00 73.47 18.98 21.09 70.99 88.74 21.62 21.72 21.09 88.80 19.30 19.00 55.26 18.56 45.40 83.25 42.19 49.65 21.83 36912952 APOLIPOPROTEIN A-1 82172 300 $111.00 41.03 18.56 88.80 21.85 76.70 22.14 76.70 19.00 61.33 21.72 43.08 20.90 19.00 73.47 18.98 21.09 70.99 88.74 21.62 21.72 21.09 88.80 19.30 19.00 55.26 18.56 45.40 83.25 42.19 49.65 21.83 36939141 APOLIPOPROTEIN 82172 300 $111.00 41.03 18.56 88.80 21.85 76.70 22.14 76.70 19.00 61.33 21.72 43.08 20.90 19.00 73.47 18.98 21.09 70.99 88.74 21.62 21.72 21.09 88.80 19.30 19.00 55.26 18.56 45.40 83.25 42.19 49.65 21.83 36941383 APOLIPOPROTEIN EACH 82172 300 $111.00 41.03 18.56 88.80 21.85 76.70 22.14 76.70 19.00 61.33 21.72 43.08 20.90 19.00 73.47 18.98 21.09 70.99 88.74 21.62 21.72 21.09 88.80 19.30 19.00 55.26 18.56 45.40 83.25 42.19 49.65 21.83 36944633 ASSAY OF APOLIPOPROTEIN B EACH 82172 300 $111.00 41.03 18.56 88.80 21.85 76.70 22.14 76.70 19.00 61.33 21.72 43.08 20.90 19.00 73.47 18.98 21.09 70.99 88.74 21.62 21.72 21.09 88.80 19.30 19.00 55.26 18.56 45.40 83.25 42.19 49.65 21.83 36909731 ARSENIC 24 HR URINE 82175 300 $103.00 38.07 - 108.74 - 71.17 19.92 71.17 - 56.91 19.54 52.75 - - 68.18 17.07 18.97 86.99 108.74 19.44 19.54 18.97 82.40 17.36 - 49.70 16.69 42.13 77.25 39.15 46.07 19.63 36910704 ARSENIC BLOOD 82175 300 $103.00 38.07 - 108.74 - 71.17 19.92 71.17 - 56.91 19.54 52.75 - - 68.18 17.07 18.97 86.99 108.74 19.44 19.54 18.97 82.40 17.36 - 49.70 16.69 42.13 77.25 39.15 46.07 19.63 36911697 ARSENIC 82175 300 $103.00 38.07 - 108.74 - 71.17 19.92 71.17 - 56.91 19.54 52.75 - - 68.18 17.07 18.97 86.99 108.74 19.44 19.54 18.97 82.40 17.36 - 49.70 16.69 42.13 77.25 39.15 46.07 19.63 36937742 ARSENIC 82175 300 $103.00 38.07 - 108.74 - 71.17 19.92 71.17 - 56.91 19.54 52.75 - - 68.18 17.07 18.97 86.99 108.74 19.44 19.54 18.97 82.40 17.36 - 49.70 16.69 42.13 77.25 39.15 46.07 19.63 36945460 ARSENIC BLOOD 82175 300 $100.00 36.96 - 108.74 - 69.10 19.92 69.10 - 55.25 19.54 52.75 - - 66.19 17.07 18.97 86.99 108.74 19.44 19.54 18.97 80.00 17.36 - 49.70 16.69 40.90 75.00 38.01 44.73 19.63 36901977 VITAMIN C 82180 300 $106.00 39.18 7.00 84.80 8.05 73.25 10.38 73.25 7.00 58.57 10.19 27.48 7.70 7.00 70.16 8.90 9.89 63.71 79.64 10.14 10.19 9.89 84.80 9.05 7.00 25.91 8.70 43.35 79.50 40.29 47.41 10.24 35705171 BETA-2-MICROGLOBULIN 82232 300 $85.00 31.42 14.24 92.70 21.85 58.74 16.99 58.74 19.00 46.96 16.67 45.00 20.90 19.00 56.26 14.56 16.18 74.16 92.70 16.58 16.67 16.18 68.00 14.80 19.00 42.39 14.24 34.77 63.75 32.31 38.02 16.75 36909072 BETA-2 MICROGLOBULIN URINE 82232 300 $487.00 180.00 14.24 389.60 21.85 336.52 16.99 336.52 19.00 269.07 16.67 45.00 20.90 19.00 322.35 14.56 16.18 74.16 92.70 16.58 16.67 16.18 389.60 14.80 19.00 42.39 14.24 199.18 365.25 185.11 217.84 16.75 36940689 BETA 2 MICROGLOBULIN 82232 300 $85.00 31.42 14.24 92.70 21.85 58.74 16.99 58.74 19.00 46.96 16.67 45.00 20.90 19.00 56.26 14.56 16.18 74.16 92.70 16.58 16.67 16.18 68.00 14.80 19.00 42.39 14.24 34.77 63.75 32.31 38.02 16.75 36924853 BILE ACIDS TOTAL 82239 300 $896.00 331.16 15.00 716.80 17.25 619.14 17.98 619.14 15.00 495.04 17.63 47.60 16.50 15.00 593.06 15.41 17.12 111.55 139.44 17.55 17.63 17.12 716.80 15.66 15.00 44.85 15.07 366.46 672.00 340.57 400.78 17.72 35700307 BILIRUBIN TOTAL 82247 300 $26.00 9.61 4.42 39.52 7.97 17.97 5.27 17.97 6.93 14.37 5.17 13.94 7.62 6.93 17.21 4.52 5.02 31.62 39.52 5.15 5.17 5.02 20.80 4.59 6.93 13.15 4.42 10.63 19.50 9.88 11.63 5.20 35705350 BILIRUBIN FLUID 82247 300 $26.00 9.61 4.42 39.52 7.97 17.97 5.27 17.97 6.93 14.37 5.17 13.94 7.62 6.93 17.21 4.52 5.02 31.62 39.52 5.15 5.17 5.02 20.80 4.59 6.93 13.15 4.42 10.63 19.50 9.88 11.63 5.20 36941391 BILIRUBIN TOTAL 82247 300 $113.00 41.76 4.42 90.40 7.97 78.08 5.27 78.08 6.93 62.43 5.17 13.94 7.62 6.93 74.79 4.52 5.02 31.62 39.52 5.15 5.17 5.02 90.40 4.59 6.93 13.15 4.42 46.22 84.75 42.95 50.54 5.20 35700285 BILIRUBIN DIRECT 82248 300 $26.00 9.61 4.42 39.52 7.97 17.97 5.27 17.97 6.93 14.37 5.17 13.94 7.62 6.93 17.21 4.52 5.02 31.62 39.52 5.15 5.17 5.02 20.80 4.59 6.93 13.15 4.42 10.63 19.50 9.88 11.63 5.20 36937289 BIOTINIDASE 82261 300 $514.00 189.97 - 411.20 - 355.17 17.71 355.17 - 283.99 17.38 46.88 - - 340.22 15.18 16.87 106.22 132.77 17.29 17.38 16.87 411.20 15.44 - 44.20 14.85 210.23 385.50 195.37 229.91 17.46 36937904 BIOTINIDASE 82261 300 $89.00 32.89 - 132.77 - 61.50 17.71 61.50 - 49.17 17.38 46.88 - - 58.91 15.18 16.87 106.22 132.77 17.29 17.38 16.87 71.20 15.44 - 44.20 14.85 36.40 66.75 33.83 39.81 17.46 35200053 OCCULT BLOOD SCRN POC 82270 300 $23.00 8.50 3.47 18.40 3.99 15.89 4.60 15.89 3.47 12.71 4.51 9.04 3.82 3.47 15.22 3.94 4.38 11.51 14.39 4.49 4.51 4.38 18.40 4.01 3.47 11.48 3.85 9.41 17.25 8.74 10.29 4.53 35700358 OCCULT BLOOD SCREEN 82270 300 $23.00 8.50 3.47 18.40 3.99 15.89 4.60 15.89 3.47 12.71 4.51 9.04 3.82 3.47 15.22 3.94 4.38 11.51 14.39 4.49 4.51 4.38 18.40 4.01 3.47 11.48 3.85 9.41 17.25 8.74 10.29 4.53 35200401 OCCULT BLOOD GASTRIC 82271 300 $28.00 10.35 3.63 25.02 4.17 19.35 5.59 19.35 3.63 15.47 5.48 9.04 3.99 3.63 18.53 4.79 5.32 20.02 25.02 5.45 5.48 5.32 22.40 4.87 3.63 13.94 4.68 11.45 21.00 10.64 12.52 5.51 35708677 GASTRIC OCCULT BLOOD 82271 300 $28.00 10.35 3.63 25.02 4.17 19.35 5.59 19.35 3.63 15.47 5.48 9.04 3.99 3.63 18.53 4.79 5.32 20.02 25.02 5.45 5.48 5.32 22.40 4.87 3.63 13.94 4.68 11.45 21.00 10.64 12.52 5.51 35200690 OCCULT BLOOD DIAGNOSTIC 82272 300 $22.00 8.13 3.63 25.02 4.17 15.20 4.44 15.20 3.63 12.16 4.36 9.04 3.99 3.63 14.56 3.81 4.23 20.02 25.02 4.34 4.36 4.23 17.60 3.87 3.63 11.08 3.72 9.00 16.50 8.36 9.84 4.38 35709495 OCCULT BLOOD DIAGNOSTIC EIA 82274 300 $84.00 31.05 2.80 67.20 3.22 58.04 16.72 58.04 2.80 46.41 16.40 44.24 3.08 2.80 55.60 14.33 15.92 13.85 17.31 16.32 16.40 15.92 67.20 14.57 2.80 41.71 14.01 34.36 63.00 31.93 37.57 16.48 36902337 CADMIUM BLOOD 82300 300 $162.00 59.88 19.00 129.60 21.85 111.94 24.82 111.94 19.00 89.51 24.35 64.34 20.90 19.00 107.23 21.28 23.64 86.38 107.97 24.23 24.35 23.64 129.60 21.63 19.00 61.94 20.80 66.26 121.50 61.58 72.46 24.47 35708421 25OH VITAMIN D-3 82306 300 $155.00 57.29 26.05 169.64 47.05 107.11 31.08 107.11 40.91 85.64 30.49 82.30 45.00 40.91 102.59 26.64 29.60 135.71 169.64 30.34 30.49 29.60 124.00 27.08 40.91 77.55 26.05 63.40 116.25 58.92 69.33 30.64 36901373 VITAMIN D 25-HYDROXY 82306 300 $158.00 58.40 26.05 169.64 47.05 109.18 31.08 109.18 40.91 87.30 30.49 82.30 45.00 40.91 104.58 26.64 29.60 135.71 169.64 30.34 30.49 29.60 126.40 27.08 40.91 77.55 26.05 64.62 118.50 60.06 70.67 30.64 36923148 VITAMIN D 25OH HYDR 82306 300 $158.00 58.40 26.05 169.64 47.05 109.18 31.08 109.18 40.91 87.30 30.49 82.30 45.00 40.91 104.58 26.64 29.60 135.71 169.64 30.34 30.49 29.60 126.40 27.08 40.91 77.55 26.05 64.62 118.50 60.06 70.67 30.64 35708511 CALCITONIN 82308 300 $141.00 52.11 20.93 153.44 24.07 97.43 28.13 97.43 20.93 77.90 27.59 74.48 23.02 20.93 93.33 24.11 26.79 122.75 153.44 27.46 27.59 26.79 112.80 24.51 20.93 70.19 23.58 57.67 105.75 53.59 63.07 27.73 36940697 CALCITONIN 82308 300 $141.00 52.11 20.93 153.44 24.07 97.43 28.13 97.43 20.93 77.90 27.59 74.48 23.02 20.93 93.33 24.11 26.79 122.75 153.44 27.46 27.59 26.79 112.80 24.51 20.93 70.19 23.58 57.67 105.75 53.59 63.07 27.73 35700421 CALCIUM 82310 300 $27.00 9.98 4.54 29.49 8.18 18.66 5.42 18.66 7.11 14.92 5.31 14.35 7.82 7.11 17.87 4.64 5.16 23.59 29.49 5.29 5.31 5.16 21.60 4.72 7.11 13.52 4.54 11.04 20.25 10.26 12.08 5.34 35705376 CALCIUM FLUID 82310 300 $27.00 9.98 4.54 29.49 8.18 18.66 5.42 18.66 7.11 14.92 5.31 14.35 7.82 7.11 17.87 4.64 5.16 23.59 29.49 5.29 5.31 5.16 21.60 4.72 7.11 13.52 4.54 11.04 20.25 10.26 12.08 5.34 35705384 CALCIUM RANDOM URINE 82310 300 $27.00 9.98 4.54 29.49 8.18 18.66 5.42 18.66 7.11 14.92 5.31 14.35 7.82 7.11 17.87 4.64 5.16 23.59 29.49 5.29 5.31 5.16 21.60 4.72 7.11 13.52 4.54 11.04 20.25 10.26 12.08 5.34 35200339 CALCIUM IONIZED I-STAT (EXP) 82330 300 $72.00 26.61 8.85 78.32 10.18 49.75 14.36 49.75 8.85 39.78 14.09 38.03 9.74 8.85 47.66 12.31 13.68 62.66 78.32 14.02 14.09 13.68 57.60 12.52 8.85 35.84 12.04 29.45 54.00 27.37 32.21 14.16 35200673 CALCIUM I-STAT 82330 300 $72.00 26.61 8.85 78.32 10.18 49.75 14.36 49.75 8.85 39.78 14.09 38.03 9.74 8.85 47.66 12.31 13.68 62.66 78.32 14.02 14.09 13.68 57.60 12.52 8.85 35.84 12.04 29.45 54.00 27.37 32.21 14.16 35200843 CALCIUM IONIZED EPOC 82330 300 $72.00 26.61 8.85 78.32 10.18 49.75 14.36 49.75 8.85 39.78 14.09 38.03 9.74 8.85 47.66 12.31 13.68 62.66 78.32 14.02 14.09 13.68 57.60 12.52 8.85 35.84 12.04 29.45 54.00 27.37 32.21 14.16 35702466 CALCIUM-IONIZED 82330 300 $72.00 26.61 8.85 78.32 10.18 49.75 14.36 49.75 8.85 39.78 14.09 38.03 9.74 8.85 47.66 12.31 13.68 62.66 78.32 14.02 14.09 13.68 57.60 12.52 8.85 35.84 12.04 29.45 54.00 27.37 32.21 14.16 35705961 CALCIUM IONIZED-WB 82330 300 $72.00 26.61 8.85 78.32 10.18 49.75 14.36 49.75 8.85 39.78 14.09 38.03 9.74 8.85 47.66 12.31 13.68 62.66 78.32 14.02 14.09 13.68 57.60 12.52 8.85 35.84 12.04 29.45 54.00 27.37 32.21 14.16 35709002 CALCIUM IONIZED CIT 82330 300 $72.00 26.61 8.85 78.32 10.18 49.75 14.36 49.75 8.85 39.78 14.09 38.03 9.74 8.85 47.66 12.31 13.68 62.66 78.32 14.02 14.09 13.68 57.60 12.52 8.85 35.84 12.04 29.45 54.00 27.37 32.21 14.16 35703748 CALCIUM 24 HOUR URINE 82340 300 $32.00 11.83 5.31 34.56 9.20 22.11 6.33 22.11 8.00 17.68 6.21 16.77 8.80 8.00 21.18 5.43 6.03 27.65 34.56 6.18 6.21 6.03 25.60 5.52 8.00 15.80 5.31 13.09 24.00 12.16 14.31 6.24 36914254 CALCIUM TIMED URINE QUANT 82340 300 $111.00 41.03 5.31 88.80 9.20 76.70 6.33 76.70 8.00 61.33 6.21 16.77 8.80 8.00 73.47 5.43 6.03 27.65 34.56 6.18 6.21 6.03 88.80 5.52 8.00 15.80 5.31 45.40 83.25 42.19 49.65 6.24 36914696 CALCIUM URINE QUAN & TIMED 82340 300 $111.00 41.03 5.31 88.80 9.20 76.70 6.33 76.70 8.00 61.33 6.21 16.77 8.80 8.00 73.47 5.43 6.03 27.65 34.56 6.18 6.21 6.03 88.80 5.52 8.00 15.80 5.31 45.40 83.25 42.19 49.65 6.24 36931931 STONE ANALYSIS SPECTRO 82365 300 $465.00 171.86 10.00 372.00 11.50 321.32 13.55 321.32 10.00 256.91 13.29 35.83 11.00 10.00 307.78 11.61 12.90 59.13 73.91 13.22 13.29 12.90 372.00 11.80 10.00 33.80 11.35 190.19 348.75 176.75 207.99 13.35 35200771 TOTAL CO2 I-STAT 82374 300 $26.00 9.61 4.29 27.17 7.73 17.97 5.12 17.97 6.72 14.37 5.03 13.60 7.39 6.72 17.21 4.39 4.88 21.74 27.17 5.00 5.03 4.88 20.80 4.47 6.72 12.79 4.29 10.63 19.50 9.88 11.63 5.05 35700536 CO2 TOTAL 82374 300 $26.00 9.61 4.29 27.17 7.73 17.97 5.12 17.97 6.72 14.37 5.03 13.60 7.39 6.72 17.21 4.39 4.88 21.74 27.17 5.00 5.03 4.88 20.80 4.47 6.72 12.79 4.29 10.63 19.50 9.88 11.63 5.05 35705406 CO2 FLUID 82374 300 $26.00 9.61 4.29 27.17 7.73 17.97 5.12 17.97 6.72 14.37 5.03 13.60 7.39 6.72 17.21 4.39 4.88 21.74 27.17 5.00 5.03 4.88 20.80 4.47 6.72 12.79 4.29 10.63 19.50 9.88 11.63 5.05 35702253 CARBOXYHEMOGLOBIN QNT 82375 300 $65.00 24.02 5.60 52.00 6.44 44.92 12.94 44.92 5.60 35.91 12.69 34.26 6.16 5.60 43.02 11.09 12.32 22.09 27.61 12.63 12.69 12.32 52.00 11.27 5.60 32.28 10.84 26.59 48.75 24.71 29.07 12.75 35704914 CEA 82378 300 $100.00 36.96 16.68 108.52 19.55 69.10 19.91 69.10 17.00 55.25 19.53 52.75 18.70 17.00 66.19 17.06 18.96 86.82 108.52 19.43 19.53 18.96 80.00 17.35 17.00 49.68 16.68 40.90 75.00 38.01 44.73 19.62 36909404 CARNITINE URINE 82379 300 "$1,148.00" 424.30 - 918.40 - 793.27 17.71 793.27 - 634.27 17.38 46.88 - - 759.86 15.18 16.87 106.22 132.77 17.29 17.38 16.87 918.40 15.44 - 44.20 14.85 469.53 861.00 436.35 513.50 17.46 36918101 CARNITINE PLASMA-TOTAL & FREE 82379 300 "$1,148.00" 424.30 - 918.40 - 793.27 17.71 793.27 - 634.27 17.38 46.88 - - 759.86 15.18 16.87 106.22 132.77 17.29 17.38 16.87 918.40 15.44 - 44.20 14.85 469.53 861.00 436.35 513.50 17.46 36938749 URINE CARNITINE (TOTAL & FREE) 82379 300 "$1,757.00" 649.39 - " 1,405.60 " - " 1,214.09 " 17.71 " 1,214.09 " - 970.74 17.38 46.88 - - " 1,162.96 " 15.18 16.87 106.22 132.77 17.29 17.38 16.87 " 1,405.60 " 15.44 - 44.20 14.85 718.61 " 1,317.75 " 667.84 785.91 17.46 36938757 PLASMA CARNITINE(TOTAL & FREE) 82379 300 "$1,757.00" 649.39 - " 1,405.60 " - " 1,214.09 " 17.71 " 1,214.09 " - 970.74 17.38 46.88 - - " 1,162.96 " 15.18 16.87 106.22 132.77 17.29 17.38 16.87 " 1,405.60 " 15.44 - 44.20 14.85 718.61 " 1,317.75 " 667.84 785.91 17.46 36922150 BETA CAROTENE HPLC 82380 300 $383.00 141.56 8.11 306.40 12.65 264.65 9.68 264.65 11.00 211.61 9.50 25.65 12.10 11.00 253.51 8.30 9.22 42.33 52.91 9.45 9.50 9.22 306.40 8.44 11.00 24.16 8.11 156.65 287.25 145.58 171.32 9.54 36900156 CATECHOLAMINES FRACT PLASMA 82384 300 $348.00 128.62 22.00 278.40 25.30 240.47 26.51 240.47 22.00 192.27 26.01 70.21 24.20 22.00 230.34 22.73 25.25 115.78 144.73 25.88 26.01 25.25 278.40 23.10 22.00 66.16 22.22 142.33 261.00 132.27 155.66 26.13 36940743 CATECHOLAMINE FRACT 82384 300 $348.00 128.62 22.00 278.40 25.30 240.47 26.51 240.47 22.00 192.27 26.01 70.21 24.20 22.00 230.34 22.73 25.25 115.78 144.73 25.88 26.01 25.25 278.40 23.10 22.00 66.16 22.22 142.33 261.00 132.27 155.66 26.13 36940786 CATECHOLAMINES FRACT 82384 300 $348.00 128.62 22.00 278.40 25.30 240.47 26.51 240.47 22.00 192.27 26.01 70.21 24.20 22.00 230.34 22.73 25.25 115.78 144.73 25.88 26.01 25.25 278.40 23.10 22.00 66.16 22.22 142.33 261.00 132.27 155.66 26.13 35707921 CERULOPLASMIN 82390 300 $56.00 20.70 9.45 61.56 11.50 38.70 11.28 38.70 10.00 30.94 11.06 29.86 11.00 10.00 37.07 9.67 10.74 49.25 61.56 11.01 11.06 10.74 44.80 9.83 10.00 28.14 9.45 22.90 42.00 21.29 25.05 11.12 36941626 CERULOPLASMIN 82390 300 $56.00 20.70 9.45 61.56 11.50 38.70 11.28 38.70 10.00 30.94 11.06 29.86 11.00 10.00 37.07 9.67 10.74 49.25 61.56 11.01 11.06 10.74 44.80 9.83 10.00 28.14 9.45 22.90 42.00 21.29 25.05 11.12 36906693 ALPHA SUBUNIT/PITUITARY GLYCOP 82397 300 $338.00 124.92 - 270.40 - 233.56 14.83 233.56 - 186.75 14.54 39.28 - - 223.72 12.71 14.12 91.14 113.92 14.47 14.54 14.12 270.40 12.92 - 36.99 12.43 138.24 253.50 128.47 151.19 14.61 36936843 LEPTIN CHEMILUMINESCENT ASSAY 82397 300 $321.00 118.64 - 256.80 - 221.81 14.83 221.81 - 177.35 14.54 39.28 - - 212.47 12.71 14.12 91.14 113.92 14.47 14.54 14.12 256.80 12.92 - 36.99 12.43 131.29 240.75 122.01 143.58 14.61 36937254 ANTI-INFLIXIMAB AB 82397 300 "$1,007.00" 372.19 - 805.60 - 695.84 14.83 695.84 - 556.37 14.54 39.28 - - 666.53 12.71 14.12 91.14 113.92 14.47 14.54 14.12 805.60 12.92 - 36.99 12.43 411.86 755.25 382.76 450.43 14.61 36944587 CHEMILUMINESCENT ASSAY VEDO 82397 300 $945.00 349.27 - 756.00 - 653.00 14.83 653.00 - 522.11 14.54 39.28 - - 625.50 12.71 14.12 91.14 113.92 14.47 14.54 14.12 756.00 12.92 - 36.99 12.43 386.51 708.75 359.19 422.70 14.61 36944625 CHEMILUMINESCENT ASSAY AMH 82397 300 $321.00 118.64 - 256.80 - 221.81 14.83 221.81 - 177.35 14.54 39.28 - - 212.47 12.71 14.12 91.14 113.92 14.47 14.54 14.12 256.80 12.92 - 36.99 12.43 131.29 240.75 122.01 143.58 14.61 36906316 CHLORAMPHENICOL 82415 300 $134.00 49.53 11.15 107.20 13.80 92.59 13.30 92.59 12.00 74.04 13.05 35.23 13.20 12.00 88.69 11.40 12.67 81.70 102.13 12.99 13.05 12.67 107.20 11.59 12.00 33.20 11.15 54.81 100.50 50.93 59.94 13.11 35200258 CHLORIDE I-STAT 82435 300 $24.00 8.87 4.05 26.57 7.29 16.58 4.83 16.58 6.34 13.26 4.74 12.78 6.97 6.34 15.89 4.14 4.60 21.26 26.57 4.72 4.74 4.60 19.20 4.21 6.34 12.05 4.05 9.82 18.00 9.12 10.74 4.76 35200886 CHLORIDE EPOC 82435 300 $24.00 8.87 4.05 26.57 7.29 16.58 4.83 16.58 6.34 13.26 4.74 12.78 6.97 6.34 15.89 4.14 4.60 21.26 26.57 4.72 4.74 4.60 19.20 4.21 6.34 12.05 4.05 9.82 18.00 9.12 10.74 4.76 35700471 CHLORIDE BLOOD 82435 300 $24.00 8.87 4.05 26.57 7.29 16.58 4.83 16.58 6.34 13.26 4.74 12.78 6.97 6.34 15.89 4.14 4.60 21.26 26.57 4.72 4.74 4.60 19.20 4.21 6.34 12.05 4.05 9.82 18.00 9.12 10.74 4.76 35708723 CHLORIDE WHOLE BLOOD 82435 300 $24.00 8.87 4.05 26.57 7.29 16.58 4.83 16.58 6.34 13.26 4.74 12.78 6.97 6.34 15.89 4.14 4.60 21.26 26.57 4.72 4.74 4.60 19.20 4.21 6.34 12.05 4.05 9.82 18.00 9.12 10.74 4.76 35703705 CHLORIDE RANDOM URINE 82436 300 $30.00 11.09 5.06 28.83 7.99 20.73 6.04 20.73 6.95 16.58 5.92 13.97 7.65 6.95 19.86 5.18 5.75 23.06 28.83 5.89 5.92 5.75 24.00 5.26 6.95 15.07 5.06 12.27 22.50 11.40 13.42 5.95 35706020 CHLORIDE 24 HOUR URINE 82436 300 $30.00 11.09 5.06 28.83 7.99 20.73 6.04 20.73 6.95 16.58 5.92 13.97 7.65 6.95 19.86 5.18 5.75 23.06 28.83 5.89 5.92 5.75 24.00 5.26 6.95 15.07 5.06 12.27 22.50 11.40 13.42 5.95 35703781 CHLORIDE FLUID 82438 300 $26.00 9.61 3.00 39.41 3.45 17.97 5.25 17.97 3.00 14.37 5.15 13.60 3.30 3.00 17.21 4.50 5.00 31.53 39.41 5.13 5.15 5.00 20.80 4.58 3.00 13.10 4.40 10.63 19.50 9.88 11.63 5.18 35708251 SWEAT CHLORIDE ANALYSIS SITE 1 82438 300 $26.00 9.61 3.00 39.41 3.45 17.97 5.25 17.97 3.00 14.37 5.15 13.60 3.30 3.00 17.21 4.50 5.00 31.53 39.41 5.13 5.15 5.00 20.80 4.58 3.00 13.10 4.40 10.63 19.50 9.88 11.63 5.18 35708260 SWEAT CHLORIDE ANALYSIS SITE 2 82438 300 $26.00 9.61 3.00 39.41 3.45 17.97 5.25 17.97 3.00 14.37 5.15 13.60 3.30 3.00 17.21 4.50 5.00 31.53 39.41 5.13 5.15 5.00 20.80 4.58 3.00 13.10 4.40 10.63 19.50 9.88 11.63 5.18 36944480 CHLORIDE OTHER SOURCE 82438 300 $60.00 22.18 3.00 48.00 3.45 41.46 5.25 41.46 3.00 33.15 5.15 13.60 3.30 3.00 39.71 4.50 5.00 31.53 39.41 5.13 5.15 5.00 48.00 4.58 3.00 13.10 4.40 24.54 45.00 22.81 26.84 5.18 36925639 PCB PANEL CHROM QUANT 82441 300 $412.00 152.28 5.29 329.60 9.55 284.69 6.31 284.69 8.30 227.63 6.19 16.70 9.13 8.30 272.70 5.41 6.01 38.71 48.39 6.16 6.19 6.01 329.60 5.50 8.30 15.75 5.29 168.51 309.00 156.60 184.29 6.22 35700480 CHOLESTEROL 82465 300 $23.00 8.50 3.83 24.91 6.91 15.89 4.57 15.89 6.01 12.71 4.48 12.09 6.61 6.01 15.22 3.92 4.35 19.93 24.91 4.46 4.48 4.35 18.40 3.98 6.01 11.40 3.83 9.41 17.25 8.74 10.29 4.50 35705392 CHOLESTEROL FLUID 82465 300 $23.00 8.50 3.83 24.91 6.91 15.89 4.57 15.89 6.01 12.71 4.48 12.09 6.61 6.01 15.22 3.92 4.35 19.93 24.91 4.46 4.48 4.35 18.40 3.98 6.01 11.40 3.83 9.41 17.25 8.74 10.29 4.50 36912910 CHOLESTEROL TOTAL 82465 300 $94.00 34.74 3.83 75.20 6.91 64.95 4.57 64.95 6.01 51.94 4.48 12.09 6.61 6.01 62.22 3.92 4.35 19.93 24.91 4.46 4.48 4.35 75.20 3.98 6.01 11.40 3.83 38.45 70.50 35.73 42.05 4.50 36901993 CHOLINESTERASE SERUM 82480 300 $147.00 54.33 6.00 117.60 6.90 101.58 8.26 101.58 6.00 81.22 8.11 21.89 6.60 6.00 97.30 7.08 7.87 50.79 63.49 8.07 8.11 7.87 117.60 7.20 6.00 20.62 6.93 60.12 110.25 55.87 65.75 8.15 36906324 CHOLINESTERASE 82480 300 $90.00 33.26 6.00 72.00 6.90 62.19 8.26 62.19 6.00 49.73 8.11 21.89 6.60 6.00 59.57 7.08 7.87 50.79 63.49 8.07 8.11 7.87 72.00 7.20 6.00 20.62 6.93 36.81 67.50 34.21 40.26 8.15 36904097 RBC CHOLINESTERASE 82482 300 $184.00 68.01 8.63 147.20 10.35 127.14 10.30 127.14 9.00 101.66 10.10 21.35 9.90 9.00 121.79 8.83 9.81 49.51 61.89 10.06 10.10 9.81 147.20 8.98 9.00 25.70 8.63 75.26 138.00 69.94 82.30 10.15 36900903 CHROMIUM SERUM 82495 300 $164.00 60.61 6.00 131.20 6.90 113.32 21.29 113.32 6.00 90.61 20.89 56.39 6.60 6.00 108.55 18.25 20.28 41.71 52.14 20.79 20.89 20.28 131.20 18.56 6.00 53.13 17.85 67.08 123.00 62.34 73.36 20.99 36902451 CITRATE 24 HR URINE 82507 300 $429.00 158.56 - 343.20 - 296.44 29.19 296.44 - 237.02 28.63 77.31 - - 283.96 25.02 27.80 127.42 159.28 28.50 28.63 27.80 343.20 25.44 - 72.84 24.46 175.46 321.75 163.06 191.89 28.77 36914289 CITRATE URINE 82507 300 $429.00 158.56 - 343.20 - 296.44 29.19 296.44 - 237.02 28.63 77.31 - - 283.96 25.02 27.80 127.42 159.28 28.50 28.63 27.80 343.20 25.44 - 72.84 24.46 175.46 321.75 163.06 191.89 28.77 36914726 CITRATE URINE 82507 300 $429.00 158.56 - 343.20 - 296.44 29.19 296.44 - 237.02 28.63 77.31 - - 283.96 25.02 27.80 127.42 159.28 28.50 28.63 27.80 343.20 25.44 - 72.84 24.46 175.46 321.75 163.06 191.89 28.77 36913738 COLLAGEN CROSS LINKS 82523 300 $98.00 36.22 - 85.43 - 67.72 19.61 67.72 - 54.15 19.24 51.97 - - 64.87 16.81 18.68 68.34 85.43 19.15 19.24 18.68 78.40 17.09 - 48.94 16.44 40.08 73.50 37.25 43.84 19.33 36932376 COLL X LINKED N -TELOPEPTIDE 82523 300 $98.00 36.22 - 85.43 - 67.72 19.61 67.72 - 54.15 19.24 51.97 - - 64.87 16.81 18.68 68.34 85.43 19.15 19.24 18.68 78.40 17.09 - 48.94 16.44 40.08 73.50 37.25 43.84 19.33 36900164 COPPER SERUM 82525 300 $102.00 37.70 10.92 81.60 13.80 70.48 13.03 70.48 12.00 56.36 12.78 34.51 13.20 12.00 67.51 11.17 12.41 57.06 71.32 12.72 12.78 12.41 81.60 11.36 12.00 32.51 10.92 41.72 76.50 38.77 45.62 12.84 36910739 COPPER 24 HOUR URINE 82525 300 $102.00 37.70 10.92 81.60 13.80 70.48 13.03 70.48 12.00 56.36 12.78 34.51 13.20 12.00 67.51 11.17 12.41 57.06 71.32 12.72 12.78 12.41 81.60 11.36 12.00 32.51 10.92 41.72 76.50 38.77 45.62 12.84 36923709 CORTISOL FREE 24 HR URINE 82530 300 $194.00 71.70 14.70 155.20 26.85 134.05 17.55 134.05 23.35 107.19 17.21 46.44 25.69 23.35 128.41 15.04 16.71 77.74 97.17 17.13 17.21 16.71 155.20 15.29 23.35 43.78 14.70 79.35 145.50 73.74 86.78 17.29 36941219 CORTISOL SALIVA 82530 300 $194.00 71.70 14.70 155.20 26.85 134.05 17.55 134.05 23.35 107.19 17.21 46.44 25.69 23.35 128.41 15.04 16.71 77.74 97.17 17.13 17.21 16.71 155.20 15.29 23.35 43.78 14.70 79.35 145.50 73.74 86.78 17.29 35704922 CORTISOL 82533 300 $86.00 31.79 12.00 93.48 13.80 59.43 17.12 59.43 12.00 47.52 16.79 45.34 13.20 12.00 56.92 14.67 16.30 74.78 93.48 16.71 16.79 16.30 68.80 14.91 12.00 42.71 14.34 35.17 64.50 32.69 38.47 16.87 35710159 CORTISOL POST 1MG DEX 82533 300 $86.00 31.79 12.00 93.48 13.80 59.43 17.12 59.43 12.00 47.52 16.79 45.34 13.20 12.00 56.92 14.67 16.30 74.78 93.48 16.71 16.79 16.30 68.80 14.91 12.00 42.71 14.34 35.17 64.50 32.69 38.47 16.87 36913452 TOTAL CORTISOL 82533 300 $268.00 99.05 12.00 214.40 13.80 185.19 17.12 185.19 12.00 148.07 16.79 45.34 13.20 12.00 177.39 14.67 16.30 74.78 93.48 16.71 16.79 16.30 214.40 14.91 12.00 42.71 14.34 109.61 201.00 101.87 119.88 16.87 36917156 CORTISOL TOTAL 82533 300 $268.00 99.05 12.00 214.40 13.80 185.19 17.12 185.19 12.00 148.07 16.79 45.34 13.20 12.00 177.39 14.67 16.30 74.78 93.48 16.71 16.79 16.30 214.40 14.91 12.00 42.71 14.34 109.61 201.00 101.87 119.88 16.87 36918136 CORTISOL TOTAL 82533 300 $268.00 99.05 12.00 214.40 13.80 185.19 17.12 185.19 12.00 148.07 16.79 45.34 13.20 12.00 177.39 14.67 16.30 74.78 93.48 16.71 16.79 16.30 214.40 14.91 12.00 42.71 14.34 109.61 201.00 101.87 119.88 16.87 36934298 CORTISOL TOTAL 82533 300 $268.00 99.05 12.00 214.40 13.80 185.19 17.12 185.19 12.00 148.07 16.79 45.34 13.20 12.00 177.39 14.67 16.30 74.78 93.48 16.71 16.79 16.30 214.40 14.91 12.00 42.71 14.34 109.61 201.00 101.87 119.88 16.87 36938951 TOTAL CORTISOL 82533 300 $86.00 31.79 12.00 93.48 13.80 59.43 17.12 59.43 12.00 47.52 16.79 45.34 13.20 12.00 56.92 14.67 16.30 74.78 93.48 16.71 16.79 16.30 68.80 14.91 12.00 42.71 14.34 35.17 64.50 32.69 38.47 16.87 36938960 TOTAL CORTISOL 82533 300 $86.00 31.79 12.00 93.48 13.80 59.43 17.12 59.43 12.00 47.52 16.79 45.34 13.20 12.00 56.92 14.67 16.30 74.78 93.48 16.71 16.79 16.30 68.80 14.91 12.00 42.71 14.34 35.17 64.50 32.69 38.47 16.87 36938978 TOTAL CORTISOL 82533 300 $86.00 31.79 12.00 93.48 13.80 59.43 17.12 59.43 12.00 47.52 16.79 45.34 13.20 12.00 56.92 14.67 16.30 74.78 93.48 16.71 16.79 16.30 68.80 14.91 12.00 42.71 14.34 35.17 64.50 32.69 38.47 16.87 36907878 MARIJUANA CONF GCMS MECONIUM 82542 300 $599.00 221.39 19.27 479.20 22.16 413.91 25.29 413.91 19.27 330.95 24.81 50.21 21.20 19.27 396.48 21.68 24.09 113.71 142.14 24.69 24.81 24.09 479.20 22.04 19.27 63.12 21.20 244.99 449.25 227.68 267.93 24.93 36910577 IODIDE CHROMATOGRAPHY QNT 82542 300 $696.00 257.24 19.27 556.80 22.16 480.94 25.29 480.94 19.27 384.54 24.81 50.21 21.20 19.27 460.68 21.68 24.09 113.71 142.14 24.69 24.81 24.09 556.80 22.04 19.27 63.12 21.20 284.66 522.00 264.55 311.32 24.93 36917075 INSULN LIKE GROWTH FACT II RIA 82542 300 $599.00 221.39 19.27 479.20 22.16 413.91 25.29 413.91 19.27 330.95 24.81 50.21 21.20 19.27 396.48 21.68 24.09 113.71 142.14 24.69 24.81 24.09 479.20 22.04 19.27 63.12 21.20 244.99 449.25 227.68 267.93 24.93 36918683 GALACTITOL HPLC QUANT 82542 300 $599.00 221.39 19.27 479.20 22.16 413.91 25.29 413.91 19.27 330.95 24.81 50.21 21.20 19.27 396.48 21.68 24.09 113.71 142.14 24.69 24.81 24.09 479.20 22.04 19.27 63.12 21.20 244.99 449.25 227.68 267.93 24.93 36921994 CHROMATOGRAPHY QUANT HPLC 82542 300 $687.00 253.92 19.27 549.60 22.16 474.72 25.29 474.72 19.27 379.57 24.81 50.21 21.20 19.27 454.73 21.68 24.09 113.71 142.14 24.69 24.81 24.09 549.60 22.04 19.27 63.12 21.20 280.98 515.25 261.13 307.30 24.93 36930187 COENZYME Q10 CHROM QUANT 82542 300 $599.00 221.39 19.27 479.20 22.16 413.91 25.29 413.91 19.27 330.95 24.81 50.21 21.20 19.27 396.48 21.68 24.09 113.71 142.14 24.69 24.81 24.09 479.20 22.04 19.27 63.12 21.20 244.99 449.25 227.68 267.93 24.93 36937203 PG- THIN LAYER CHROM 82542 300 $599.00 221.39 19.27 479.20 22.16 413.91 25.29 413.91 19.27 330.95 24.81 50.21 21.20 19.27 396.48 21.68 24.09 113.71 142.14 24.69 24.81 24.09 479.20 22.04 19.27 63.12 21.20 244.99 449.25 227.68 267.93 24.93 35700544 CK-TOTAL 82550 300 $34.00 12.57 5.73 37.59 8.27 23.49 6.84 23.49 7.19 18.79 6.71 18.12 7.91 7.19 22.50 5.86 6.51 30.07 37.59 6.67 6.71 6.51 27.20 5.96 7.19 17.06 5.73 13.91 25.50 12.92 15.21 6.74 36933119 TOTAL CK (CREATININE KINASE) 82550 300 $119.00 43.98 5.73 95.20 8.27 82.23 6.84 82.23 7.19 65.75 6.71 18.12 7.91 7.19 78.77 5.86 6.51 30.07 37.59 6.67 6.71 6.51 95.20 5.96 7.19 17.06 5.73 48.67 89.25 45.23 53.23 6.74 36906294 CK ISOENZYME ELECTROPHORESIS 82552 300 $304.00 112.36 11.78 243.20 21.28 210.06 14.06 210.06 18.50 167.96 13.79 37.24 20.35 18.50 201.22 12.05 13.39 61.38 76.72 13.72 13.79 13.39 243.20 12.25 18.50 35.08 11.78 124.34 228.00 115.55 135.98 13.86 35702814 CK-MB 82553 300 $61.00 22.55 10.08 57.43 11.59 42.15 12.13 42.15 10.08 33.70 11.90 32.09 11.09 10.08 40.38 10.40 11.55 45.94 57.43 11.84 11.90 11.55 48.80 10.57 10.08 30.26 10.16 24.95 45.75 23.19 27.29 11.95 35200657 CREATININE I-STAT 82565 300 $27.00 9.98 4.51 29.32 7.37 18.66 5.38 18.66 6.41 14.92 5.27 14.26 7.05 6.41 17.87 4.61 5.12 23.46 29.32 5.25 5.27 5.12 21.60 4.68 6.41 13.41 4.51 11.04 20.25 10.26 12.08 5.30 35200894 CREATININE EPOC 82565 300 $27.00 9.98 4.51 29.32 7.37 18.66 5.38 18.66 6.41 14.92 5.27 14.26 7.05 6.41 17.87 4.61 5.12 23.46 29.32 5.25 5.27 5.12 21.60 4.68 6.41 13.41 4.51 11.04 20.25 10.26 12.08 5.30 35700595 CREATININE 82565 300 $27.00 9.98 4.51 29.32 7.37 18.66 5.38 18.66 6.41 14.92 5.27 14.26 7.05 6.41 17.87 4.61 5.12 23.46 29.32 5.25 5.27 5.12 21.60 4.68 6.41 13.41 4.51 11.04 20.25 10.26 12.08 5.30 35703721 CREATININE RANDOM URINE 82570 300 $27.00 9.98 4.56 29.65 8.22 18.66 5.44 18.66 7.15 14.92 5.34 14.38 7.87 7.15 17.87 4.66 5.18 23.72 29.65 5.31 5.34 5.18 21.60 4.74 7.15 13.57 4.56 11.04 20.25 10.26 12.08 5.36 35706054 CREATININE 24 HOUR URINE 82570 300 $27.00 9.98 4.56 29.65 8.22 18.66 5.44 18.66 7.15 14.92 5.34 14.38 7.87 7.15 17.87 4.66 5.18 23.72 29.65 5.31 5.34 5.18 21.60 4.74 7.15 13.57 4.56 11.04 20.25 10.26 12.08 5.36 35706062 CREATININE FLUID 82570 300 $27.00 9.98 4.56 29.65 8.22 18.66 5.44 18.66 7.15 14.92 5.34 14.38 7.87 7.15 17.87 4.66 5.18 23.72 29.65 5.31 5.34 5.18 21.60 4.74 7.15 13.57 4.56 11.04 20.25 10.26 12.08 5.36 36900202 CREATININE URINE 82570 300 $97.00 35.85 4.56 77.60 8.22 67.03 5.44 67.03 7.15 53.59 5.34 14.38 7.87 7.15 64.20 4.66 5.18 23.72 29.65 5.31 5.34 5.18 77.60 4.74 7.15 13.57 4.56 39.67 72.75 36.87 43.39 5.36 36913746 CREATININE URINE 82570 300 $97.00 35.85 4.56 77.60 8.22 67.03 5.44 67.03 7.15 53.59 5.34 14.38 7.87 7.15 64.20 4.66 5.18 23.72 29.65 5.31 5.34 5.18 77.60 4.74 7.15 13.57 4.56 39.67 72.75 36.87 43.39 5.36 36914335 CREATININE URINE 82570 300 $97.00 35.85 4.56 77.60 8.22 67.03 5.44 67.03 7.15 53.59 5.34 14.38 7.87 7.15 64.20 4.66 5.18 23.72 29.65 5.31 5.34 5.18 77.60 4.74 7.15 13.57 4.56 39.67 72.75 36.87 43.39 5.36 36914378 CREATININE URINE 82570 300 $97.00 35.85 4.56 77.60 8.22 67.03 5.44 67.03 7.15 53.59 5.34 14.38 7.87 7.15 64.20 4.66 5.18 23.72 29.65 5.31 5.34 5.18 77.60 4.74 7.15 13.57 4.56 39.67 72.75 36.87 43.39 5.36 36914793 CREATININE URINE 82570 300 $97.00 35.85 4.56 77.60 8.22 67.03 5.44 67.03 7.15 53.59 5.34 14.38 7.87 7.15 64.20 4.66 5.18 23.72 29.65 5.31 5.34 5.18 77.60 4.74 7.15 13.57 4.56 39.67 72.75 36.87 43.39 5.36 36922630 CREATININE URINE 82570 300 $97.00 35.85 4.56 77.60 8.22 67.03 5.44 67.03 7.15 53.59 5.34 14.38 7.87 7.15 64.20 4.66 5.18 23.72 29.65 5.31 5.34 5.18 77.60 4.74 7.15 13.57 4.56 39.67 72.75 36.87 43.39 5.36 36928905 CREATININE URINE 82570 300 $97.00 35.85 4.56 77.60 8.22 67.03 5.44 67.03 7.15 53.59 5.34 14.38 7.87 7.15 64.20 4.66 5.18 23.72 29.65 5.31 5.34 5.18 77.60 4.74 7.15 13.57 4.56 39.67 72.75 36.87 43.39 5.36 36932384 CREATININE URINE 82570 300 $97.00 35.85 4.56 77.60 8.22 67.03 5.44 67.03 7.15 53.59 5.34 14.38 7.87 7.15 64.20 4.66 5.18 23.72 29.65 5.31 5.34 5.18 77.60 4.74 7.15 13.57 4.56 39.67 72.75 36.87 43.39 5.36 36937777 CREATININE URINE 82570 300 $97.00 35.85 4.56 77.60 8.22 67.03 5.44 67.03 7.15 53.59 5.34 14.38 7.87 7.15 64.20 4.66 5.18 23.72 29.65 5.31 5.34 5.18 77.60 4.74 7.15 13.57 4.56 39.67 72.75 36.87 43.39 5.36 36940182 CREATININE URINE 82570 300 $27.00 9.98 4.56 29.65 8.22 18.66 5.44 18.66 7.15 14.92 5.34 14.38 7.87 7.15 17.87 4.66 5.18 23.72 29.65 5.31 5.34 5.18 21.60 4.74 7.15 13.57 4.56 11.04 20.25 10.26 12.08 5.36 36940476 CREATININE URINE 82570 300 $46.00 17.00 4.56 36.80 8.22 31.79 5.44 31.79 7.15 25.42 5.34 14.38 7.87 7.15 30.45 4.66 5.18 23.72 29.65 5.31 5.34 5.18 36.80 4.74 7.15 13.57 4.56 18.81 34.50 17.48 20.58 5.36 36940751 CREATININE URINE 82570 300 $27.00 9.98 4.56 29.65 8.22 18.66 5.44 18.66 7.15 14.92 5.34 14.38 7.87 7.15 17.87 4.66 5.18 23.72 29.65 5.31 5.34 5.18 21.60 4.74 7.15 13.57 4.56 11.04 20.25 10.26 12.08 5.36 36940778 CREATININE URINE 82570 300 $27.00 9.98 4.56 29.65 8.22 18.66 5.44 18.66 7.15 14.92 5.34 14.38 7.87 7.15 17.87 4.66 5.18 23.72 29.65 5.31 5.34 5.18 21.60 4.74 7.15 13.57 4.56 11.04 20.25 10.26 12.08 5.36 36940859 CREATININE URINE 82570 300 $29.00 10.72 4.56 29.65 8.22 20.04 5.44 20.04 7.15 16.02 5.34 14.38 7.87 7.15 19.20 4.66 5.18 23.72 29.65 5.31 5.34 5.18 23.20 4.74 7.15 13.57 4.56 11.86 21.75 11.02 12.97 5.36 36941227 CREATININE URINE 82570 300 $27.00 9.98 4.56 29.65 8.22 18.66 5.44 18.66 7.15 14.92 5.34 14.38 7.87 7.15 17.87 4.66 5.18 23.72 29.65 5.31 5.34 5.18 21.60 4.74 7.15 13.57 4.56 11.04 20.25 10.26 12.08 5.36 36941243 CREATININE URINE 82570 300 $27.00 9.98 4.56 29.65 8.22 18.66 5.44 18.66 7.15 14.92 5.34 14.38 7.87 7.15 17.87 4.66 5.18 23.72 29.65 5.31 5.34 5.18 21.60 4.74 7.15 13.57 4.56 11.04 20.25 10.26 12.08 5.36 36941260 CREATININE URINE 82570 300 $27.00 9.98 4.56 29.65 8.22 18.66 5.44 18.66 7.15 14.92 5.34 14.38 7.87 7.15 17.87 4.66 5.18 23.72 29.65 5.31 5.34 5.18 21.60 4.74 7.15 13.57 4.56 11.04 20.25 10.26 12.08 5.36 36941286 CREATININE URINE 82570 300 $27.00 9.98 4.56 29.65 8.22 18.66 5.44 18.66 7.15 14.92 5.34 14.38 7.87 7.15 17.87 4.66 5.18 23.72 29.65 5.31 5.34 5.18 21.60 4.74 7.15 13.57 4.56 11.04 20.25 10.26 12.08 5.36 35700587 CREATININE CLEARANCE 82575 300 $50.00 18.48 8.32 54.07 11.50 34.55 9.93 34.55 10.00 27.63 9.74 26.28 11.00 10.00 33.10 8.51 9.46 43.26 54.07 9.70 9.74 9.46 40.00 8.66 10.00 24.79 8.32 20.45 37.50 19.01 22.37 9.79 36100206 CRYOGLOBULIN SCREEN 82595 300 $34.00 12.57 5.69 37.09 8.05 23.49 6.79 23.49 7.00 18.79 6.66 17.99 7.70 7.00 22.50 5.82 6.47 29.67 37.09 6.63 6.66 6.47 27.20 5.92 7.00 16.95 5.69 13.91 25.50 12.92 15.21 6.70 36902205 CYANIDE BLOOD 82600 300 $223.00 82.42 17.00 178.40 19.55 154.09 20.37 154.09 17.00 123.21 19.98 53.95 18.70 17.00 147.60 17.46 19.40 125.14 156.42 19.89 19.98 19.40 178.40 17.75 17.00 50.83 17.07 91.21 167.25 84.76 99.75 20.08 35705074 VITAMIN B-12 82607 300 $79.00 29.20 13.00 86.37 14.95 54.59 15.83 54.59 13.00 43.65 15.53 41.92 14.30 13.00 52.29 13.57 15.08 69.10 86.37 15.46 15.53 15.08 63.20 13.80 13.00 39.51 13.27 32.31 59.25 30.03 35.34 15.61 36900181 DEHYDROEPIANDROSTERONE 82626 300 $172.00 63.57 21.00 144.84 24.15 118.85 26.53 118.85 21.00 95.03 26.03 70.24 23.10 21.00 113.85 22.74 25.27 115.87 144.84 25.90 26.03 25.27 137.60 23.12 21.00 66.21 22.24 70.35 129.00 65.38 76.94 26.15 36913461 DEHYDROEPIANDROSTERONE 82626 300 $172.00 63.57 21.00 144.84 24.15 118.85 26.53 118.85 21.00 95.03 26.03 70.24 23.10 21.00 113.85 22.74 25.27 115.87 144.84 25.90 26.03 25.27 137.60 23.12 21.00 66.21 22.24 70.35 129.00 65.38 76.94 26.15 36917164 DEHYDROEPIANDROSTERONE (DHEA) 82626 300 $456.00 168.54 21.00 364.80 24.15 315.10 26.53 315.10 21.00 251.94 26.03 70.24 23.10 21.00 301.83 22.74 25.27 115.87 144.84 25.90 26.03 25.27 364.80 23.12 21.00 66.21 22.24 186.50 342.00 173.33 203.97 26.15 36918128 DEHYDROEPIANDROSTERONE 82626 300 $400.00 147.84 21.00 320.00 24.15 276.40 26.53 276.40 21.00 221.00 26.03 70.24 23.10 21.00 264.76 22.74 25.27 115.87 144.84 25.90 26.03 25.27 320.00 23.12 21.00 66.21 22.24 163.60 300.00 152.04 178.92 26.15 36934301 DEHYDROEPIANDROSTERONE (DHEA) 82626 300 $430.00 158.93 21.00 344.00 24.15 297.13 26.53 297.13 21.00 237.58 26.03 70.24 23.10 21.00 284.62 22.74 25.27 115.87 144.84 25.90 26.03 25.27 344.00 23.12 21.00 66.21 22.24 175.87 322.50 163.44 192.34 26.15 36923202 DHEAS-SULFATE 82627 300 $187.00 69.12 19.56 149.60 24.15 129.22 23.34 129.22 21.00 103.32 22.90 61.83 23.10 21.00 123.78 20.01 22.23 101.90 127.37 22.79 22.90 22.23 149.60 20.34 21.00 58.24 19.56 76.48 140.25 71.08 83.65 23.01 36910658 DEOXYCORTICOSTERONE 82633 300 $912.00 337.08 27.26 729.60 49.23 630.19 32.53 630.19 42.81 503.88 31.91 86.13 47.09 42.81 603.65 27.88 30.98 199.74 249.67 31.75 31.91 30.98 729.60 28.35 42.81 81.17 27.26 373.01 684.00 346.65 407.94 32.06 36913517 11-DESOXYCORTICOSTERONE 82633 300 $321.00 118.64 27.26 256.80 49.23 221.81 32.53 221.81 42.81 177.35 31.91 86.13 47.09 42.81 212.47 27.88 30.98 199.74 249.67 31.75 31.91 30.98 256.80 28.35 42.81 81.17 27.26 131.29 240.75 122.01 143.58 32.06 36934310 DESOXYCORTICOSTERONE 82633 300 $529.00 195.52 27.26 423.20 49.23 365.54 32.53 365.54 42.81 292.27 31.91 86.13 47.09 42.81 350.15 27.88 30.98 199.74 249.67 31.75 31.91 30.98 423.20 28.35 42.81 81.17 27.26 216.36 396.75 201.07 236.62 32.06 36902035 11-DEOXYCORTISOL (COMPOUND S) 82634 300 $253.00 93.51 17.50 202.40 20.13 174.82 30.74 174.82 17.50 139.78 30.16 81.39 19.25 17.50 167.46 26.35 29.28 110.98 138.72 30.01 30.16 29.28 202.40 26.79 17.50 76.71 25.77 103.48 189.75 96.17 113.17 30.30 36913525 11-DEOXYCORTISOL 82634 300 $193.00 71.33 17.50 154.40 20.13 133.36 30.74 133.36 17.50 106.63 30.16 81.39 19.25 17.50 127.75 26.35 29.28 110.98 138.72 30.01 30.16 29.28 154.40 26.79 17.50 76.71 25.77 78.94 144.75 73.36 86.33 30.30 36918152 11-DEOXYCORTISOL (COMPOUND S) 82634 300 $299.00 110.51 17.50 239.20 20.13 206.61 30.74 206.61 17.50 165.20 30.16 81.39 19.25 17.50 197.91 26.35 29.28 110.98 138.72 30.01 30.16 29.28 239.20 26.79 17.50 76.71 25.77 122.29 224.25 113.65 133.74 30.30 36934280 11-DEOXYCORTISOL 82634 300 $312.00 115.32 17.50 249.60 20.13 215.59 30.74 215.59 17.50 172.38 30.16 81.39 19.25 17.50 206.51 26.35 29.28 110.98 138.72 30.01 30.16 29.28 249.60 26.79 17.50 76.71 25.77 127.61 234.00 118.59 139.56 30.30 36919141 DIBUCAINE NUMBER 82638 300 $77.00 28.46 7.00 86.75 8.05 53.21 12.86 53.21 7.00 42.54 12.62 34.04 7.70 7.00 50.97 11.03 12.25 69.40 86.75 12.56 12.62 12.25 61.60 11.21 7.00 32.10 10.78 31.49 57.75 29.27 34.44 12.68 36912561 DIHYDROTESTOSTERONE 82642 300 $611.00 225.83 - 488.80 - 422.20 30.74 422.20 - 337.58 30.16 403.26 - - 404.42 26.35 29.28 143.43 179.29 30.01 30.16 29.28 488.80 26.79 - 76.71 25.77 249.90 458.25 232.24 273.30 30.30 36937971 VITAMIN D 125-DIHYDROXY 82652 300 $202.00 74.66 33.88 220.57 61.85 139.58 40.43 139.58 53.78 111.61 39.66 107.04 59.16 53.78 133.70 34.65 38.50 176.46 220.57 39.46 39.66 38.50 161.60 35.23 53.78 100.87 33.88 82.62 151.50 76.78 90.35 39.85 36921978 PANCREATIC ELASTASE1 STOOL 82656 300 "$1,619.00" 598.38 10.15 " 1,295.20 " 14.16 " 1,118.73 " 12.11 " 1,118.73 " 12.31 894.50 11.88 32.06 13.54 12.31 " 1,071.62 " 10.38 11.53 70.10 87.63 11.82 11.88 11.53 " 1,295.20 " 10.55 12.31 30.21 10.15 662.17 " 1,214.25 " 615.38 724.18 11.93 36918691 LYSOSOMAL ENZYME 82657 300 "$1,314.00" 485.65 - " 1,051.20 " - 907.97 23.28 907.97 - 725.99 22.84 50.21 - - 869.74 19.95 22.17 113.71 142.14 22.72 22.84 22.17 " 1,051.20 " 20.29 - 58.09 19.51 537.43 985.50 499.45 587.75 22.95 36919418 ADENOSINE DEAMINASE BLOOD 82657 300 $785.00 290.14 - 628.00 - 542.44 23.28 542.44 - 433.71 22.84 50.21 - - 519.59 19.95 22.17 113.71 142.14 22.72 22.84 22.17 628.00 20.29 - 58.09 19.51 321.07 588.75 298.38 351.13 22.95 36922001 ENZYME ACTIVITY 82657 300 $687.00 253.92 - 549.60 - 474.72 23.28 474.72 - 379.57 22.84 50.21 - - 454.73 19.95 22.17 113.71 142.14 22.72 22.84 22.17 549.60 20.29 - 58.09 19.51 280.98 515.25 261.13 307.30 22.95 36933895 ENZYME ACT NONRAD SUBSTR 82657 300 $253.00 93.51 - 202.40 - 174.82 23.28 174.82 - 139.78 22.84 50.21 - - 167.46 19.95 22.17 113.71 142.14 22.72 22.84 22.17 202.40 20.29 - 58.09 19.51 103.48 189.75 96.17 113.17 22.95 36933909 ENZYME ACT NONRAD SUBSTR 82657 300 $253.00 93.51 - 202.40 - 174.82 23.28 174.82 - 139.78 22.84 50.21 - - 167.46 19.95 22.17 113.71 142.14 22.72 22.84 22.17 202.40 20.29 - 58.09 19.51 103.48 189.75 96.17 113.17 22.95 36933917 ENZYME ACT NONRAD SUBSTR 82657 300 $253.00 93.51 - 202.40 - 174.82 23.28 174.82 - 139.78 22.84 50.21 - - 167.46 19.95 22.17 113.71 142.14 22.72 22.84 22.17 202.40 20.29 - 58.09 19.51 103.48 189.75 96.17 113.17 22.95 36933925 ENZYME ACT NONRAD SUBSTR 82657 300 $253.00 93.51 - 202.40 - 174.82 23.28 174.82 - 139.78 22.84 50.21 - - 167.46 19.95 22.17 113.71 142.14 22.72 22.84 22.17 202.40 20.29 - 58.09 19.51 103.48 189.75 96.17 113.17 22.95 36940891 ALPHA GALACTOSIDASE CELL ACT 82657 300 "$1,981.00" 732.18 - " 1,584.80 " - " 1,368.87 " 23.28 " 1,368.87 " - " 1,094.50 " 22.84 50.21 - - " 1,311.22 " 19.95 22.17 113.71 142.14 22.72 22.84 22.17 " 1,584.80 " 20.29 - 58.09 19.51 810.23 " 1,485.75 " 752.98 886.10 22.95 36945427 ENZYME ACTIVITY TPMT 82657 300 $379.00 140.08 - 303.20 - 261.89 23.28 261.89 - 209.40 22.84 50.21 - - 250.86 19.95 22.17 113.71 142.14 22.72 22.84 22.17 303.20 20.29 - 58.09 19.51 155.01 284.25 144.06 169.53 22.95 36912936 SEPARATION AND QUANTITATION 82664 300 $323.00 119.38 - 276.90 - 223.19 64.58 223.19 - 178.46 63.35 95.52 - - 213.79 55.35 61.50 221.52 276.90 63.04 63.35 61.50 258.40 56.27 - 161.13 54.12 132.11 242.25 122.77 144.48 63.65 36924918 ACETYLCHOLINESTERASE AF ELECT 82664 300 $526.00 194.41 - 420.80 - 363.47 64.58 363.47 - 290.62 63.35 95.52 - - 348.16 55.35 61.50 221.52 276.90 63.04 63.35 61.50 420.80 56.27 - 161.13 54.12 215.13 394.50 199.93 235.28 63.65 36944196 ACETYLCHOLINE AMNIO 82664 300 $323.00 119.38 - 276.90 - 223.19 64.58 223.19 - 178.46 63.35 95.52 - - 213.79 55.35 61.50 221.52 276.90 63.04 63.35 61.50 258.40 56.27 - 161.13 54.12 132.11 242.25 122.77 144.48 63.65 35707956 ERYTHROPOIETIN 82668 300 $117.00 43.24 15.00 93.60 17.25 80.85 19.73 80.85 15.00 64.64 19.35 52.25 16.50 15.00 77.44 16.91 18.79 73.81 92.26 19.26 19.35 18.79 93.60 17.19 15.00 49.23 16.54 47.85 87.75 44.47 52.33 19.45 36938820 ERYTHROPOIETIN 82668 300 $117.00 43.24 15.00 93.60 17.25 80.85 19.73 80.85 15.00 64.64 19.35 52.25 16.50 15.00 77.44 16.91 18.79 73.81 92.26 19.26 19.35 18.79 93.60 17.19 15.00 49.23 16.54 47.85 87.75 44.47 52.33 19.45 35705112 ESTRADIOL TOTAL 82670 300 $147.00 54.33 21.50 160.16 24.73 101.58 29.34 101.58 21.50 81.22 28.78 77.68 23.65 21.50 97.30 25.15 27.94 128.13 160.16 28.64 28.78 27.94 117.60 25.57 21.50 73.20 24.59 60.12 110.25 55.87 65.75 28.92 36941367 ESTRADIOL TOTAL REF 82670 300 $194.00 71.70 21.50 160.16 24.73 134.05 29.34 134.05 21.50 107.19 28.78 77.68 23.65 21.50 128.41 25.15 27.94 128.13 160.16 28.64 28.78 27.94 155.20 25.57 21.50 73.20 24.59 79.35 145.50 73.74 86.78 28.92 36905336 ESTROGEN TOTAL 82672 300 $114.00 42.13 13.92 173.45 16.01 78.77 22.79 78.77 13.92 62.99 22.35 60.32 15.31 13.92 75.46 19.53 21.70 138.76 173.45 22.24 22.35 21.70 91.20 19.86 13.92 56.85 19.10 46.63 85.50 43.33 50.99 22.46 35705261 ESTRIOL 82677 300 $127.00 46.94 17.50 139.17 20.13 87.76 25.39 87.76 17.50 70.17 24.91 67.23 19.25 17.50 84.06 21.76 24.18 111.34 139.17 24.78 24.91 24.18 101.60 22.12 17.50 63.35 21.28 51.94 95.25 48.27 56.81 25.03 36942592 ESTRIOL 82677 300 $127.00 46.94 17.50 139.17 20.13 87.76 25.39 87.76 17.50 70.17 24.91 67.23 19.25 17.50 84.06 21.76 24.18 111.34 139.17 24.78 24.91 24.18 101.60 22.12 17.50 63.35 21.28 51.94 95.25 48.27 56.81 25.03 36905174 ESTRONE 82679 300 $147.00 54.33 13.00 143.02 14.95 101.58 26.20 101.58 13.00 81.22 25.70 69.39 14.30 13.00 97.30 22.46 24.95 114.42 143.02 25.57 25.70 24.95 117.60 22.83 13.00 65.37 21.96 60.12 110.25 55.87 65.75 25.82 36941375 ESTRADIOL FREE EQUIL DIALYSIS 82681 300 $194.00 71.70 - 155.20 - 134.05 29.34 134.05 - 107.19 28.78 128.04 - - 128.41 25.15 27.94 102.80 128.51 28.64 28.78 27.94 155.20 25.57 - 73.20 24.59 79.35 145.50 73.74 86.78 28.92 35710124 ETHYLENE GLYCOL 82693 300 $78.00 28.83 - 91.22 - 53.90 15.65 53.90 - 43.10 15.35 41.42 - - 51.63 13.41 14.90 72.98 91.22 15.27 15.35 14.90 62.40 13.63 - 39.04 13.11 31.90 58.50 29.65 34.89 15.42 36904461 ETHYLENE GLYCOL 82693 300 $215.00 79.46 - 172.00 - 148.57 15.65 148.57 - 118.79 15.35 41.42 - - 142.31 13.41 14.90 72.98 91.22 15.27 15.35 14.90 172.00 13.63 - 39.04 13.11 87.94 161.25 81.72 96.17 15.42 36911051 ETHYLENE GLYCOL URINE 82693 300 $215.00 79.46 - 172.00 - 148.57 15.65 148.57 - 118.79 15.35 41.42 - - 142.31 13.41 14.90 72.98 91.22 15.27 15.35 14.90 172.00 13.63 - 39.04 13.11 87.94 161.25 81.72 96.17 15.42 35700731 SUDAN STAIN 82705 300 $136.00 50.27 4.49 108.80 8.10 93.98 5.36 93.98 7.04 75.14 5.25 14.13 7.74 7.04 90.02 4.59 5.10 23.37 29.21 5.23 5.25 5.10 108.80 4.67 7.04 13.36 4.49 55.62 102.00 51.69 60.83 5.28 35705414 SUDAN STAIN FLUID 82705 300 $136.00 50.27 4.49 108.80 8.10 93.98 5.36 93.98 7.04 75.14 5.25 14.13 7.74 7.04 90.02 4.59 5.10 23.37 29.21 5.23 5.25 5.10 108.80 4.67 7.04 13.36 4.49 55.62 102.00 51.69 60.83 5.28 36939010 FECAL FAT QUALITATIVE 82705 300 $136.00 50.27 4.49 108.80 8.10 93.98 5.36 93.98 7.04 75.14 5.25 14.13 7.74 7.04 90.02 4.59 5.10 23.37 29.21 5.23 5.25 5.10 108.80 4.67 7.04 13.36 4.49 55.62 102.00 51.69 60.83 5.28 36909251 FECAL LIPIDS TOTAL 82710 300 $644.00 238.02 4.02 515.20 4.62 445.00 17.64 445.00 4.02 355.81 17.30 46.72 4.42 4.02 426.26 15.12 16.80 77.03 96.29 17.22 17.30 16.80 515.20 15.37 4.02 44.02 14.78 263.40 483.00 244.78 288.06 17.39 36901667 FREE FATTY ACIDS 82725 300 $122.00 45.09 13.18 97.60 15.16 84.30 19.71 84.30 13.18 67.41 19.33 36.99 14.50 13.18 80.75 16.89 18.77 69.40 86.75 19.24 19.33 18.77 97.60 17.17 13.18 49.18 16.52 49.90 91.50 46.37 54.57 19.43 36909854 VERY LONG CHAIN FATTY ACIDS 82726 300 "$1,099.00" 406.19 17.38 879.20 22.97 759.41 20.74 759.41 19.97 607.20 20.34 50.21 21.97 19.97 727.43 17.78 19.75 113.71 142.14 20.24 20.34 19.75 879.20 18.07 19.97 51.75 17.38 449.49 824.25 417.73 491.58 20.44 35704931 FERRITIN 82728 300 $72.00 26.61 11.99 78.04 13.80 49.75 14.31 49.75 12.00 39.78 14.04 37.90 13.20 12.00 47.66 12.27 13.63 62.43 78.04 13.97 14.04 13.63 57.60 12.47 12.00 35.71 11.99 29.45 54.00 27.37 32.21 14.11 35708669 FETAL FIBRONECTIN 82731 300 $338.00 124.92 20.00 270.40 23.00 233.56 67.63 233.56 20.00 186.75 66.34 179.07 22.00 20.00 223.72 57.97 64.41 91.40 114.25 66.02 66.34 64.41 270.40 58.94 20.00 168.75 56.68 138.24 253.50 128.47 151.19 66.66 35704949 FOLIC ACID SERUM 82746 300 $77.00 28.46 12.00 84.27 13.80 53.21 15.44 53.21 12.00 42.54 15.14 40.88 13.20 12.00 50.97 13.23 14.70 67.42 84.27 15.07 15.14 14.70 61.60 13.45 12.00 38.51 12.94 31.49 57.75 29.27 34.44 15.21 35707760 FOLIC ACID RBC 82747 300 $93.00 34.37 15.53 91.33 25.93 64.26 18.53 64.26 22.55 51.38 18.18 48.14 24.81 22.55 61.56 15.89 17.65 73.06 91.33 18.09 18.18 17.65 74.40 16.15 22.55 46.24 15.53 38.04 69.75 35.35 41.60 18.27 36937343 RED BLOOD CELL FOLATE 82747 300 $93.00 34.37 15.53 91.33 25.93 64.26 18.53 64.26 22.55 51.38 18.18 48.14 24.81 22.55 61.56 15.89 17.65 73.06 91.33 18.09 18.18 17.65 74.40 16.15 22.55 46.24 15.53 38.04 69.75 35.35 41.60 18.27 36918675 GALACTOSE-1-PHOS URIDYL QUANT 82775 300 "$1,390.00" 513.74 2.00 " 1,112.00 " 2.30 960.49 22.12 960.49 2.00 767.98 21.70 58.59 2.20 2.00 920.04 18.96 21.07 16.14 20.17 21.60 21.70 21.07 " 1,112.00 " 19.28 2.00 55.20 18.54 568.51 " 1,042.50 " 528.34 621.75 21.81 35707841 IGG 82784 300 $49.00 18.11 8.18 53.30 14.78 33.86 9.77 33.86 12.85 27.07 9.58 25.87 14.14 12.85 32.43 8.37 9.30 42.64 53.30 9.53 9.58 9.30 39.20 8.51 12.85 24.37 8.18 20.04 36.75 18.62 21.92 9.63 35707859 IGA 82784 300 $49.00 18.11 8.18 53.30 14.78 33.86 9.77 33.86 12.85 27.07 9.58 25.87 14.14 12.85 32.43 8.37 9.30 42.64 53.30 9.53 9.58 9.30 39.20 8.51 12.85 24.37 8.18 20.04 36.75 18.62 21.92 9.63 35707867 IGM 82784 300 $49.00 18.11 8.18 53.30 14.78 33.86 9.77 33.86 12.85 27.07 9.58 25.87 14.14 12.85 32.43 8.37 9.30 42.64 53.30 9.53 9.58 9.30 39.20 8.51 12.85 24.37 8.18 20.04 36.75 18.62 21.92 9.63 36917482 IGG CSF 82784 300 $153.00 56.55 8.18 122.40 14.78 105.72 9.77 105.72 12.85 84.53 9.58 25.87 14.14 12.85 101.27 8.37 9.30 42.64 53.30 9.53 9.58 9.30 122.40 8.51 12.85 24.37 8.18 62.58 114.75 58.16 68.44 9.63 36917491 IGG SERUM 82784 300 $153.00 56.55 8.18 122.40 14.78 105.72 9.77 105.72 12.85 84.53 9.58 25.87 14.14 12.85 101.27 8.37 9.30 42.64 53.30 9.53 9.58 9.30 122.40 8.51 12.85 24.37 8.18 62.58 114.75 58.16 68.44 9.63 36917865 IGG CSF 82784 300 $64.00 23.65 8.18 53.30 14.78 44.22 9.77 44.22 12.85 35.36 9.58 25.87 14.14 12.85 42.36 8.37 9.30 42.64 53.30 9.53 9.58 9.30 51.20 8.51 12.85 24.37 8.18 26.18 48.00 24.33 28.63 9.63 36917873 IGG SERUM 82784 300 $64.00 23.65 8.18 53.30 14.78 44.22 9.77 44.22 12.85 35.36 9.58 25.87 14.14 12.85 42.36 8.37 9.30 42.64 53.30 9.53 9.58 9.30 51.20 8.51 12.85 24.37 8.18 26.18 48.00 24.33 28.63 9.63 36922834 GAMMAGLOBULIN IGD 82784 300 $189.00 69.85 8.18 151.20 14.78 130.60 9.77 130.60 12.85 104.42 9.58 25.87 14.14 12.85 125.10 8.37 9.30 42.64 53.30 9.53 9.58 9.30 151.20 8.51 12.85 24.37 8.18 77.30 141.75 71.84 84.54 9.63 36935987 GAMMAGLOBULIN EACH 82784 300 $426.00 157.45 8.18 340.80 14.78 294.37 9.77 294.37 12.85 235.37 9.58 25.87 14.14 12.85 281.97 8.37 9.30 42.64 53.30 9.53 9.58 9.30 340.80 8.51 12.85 24.37 8.18 174.23 319.50 161.92 190.55 9.63 36935995 GAMMAGLOBULIN EACH 82784 300 $426.00 157.45 8.18 340.80 14.78 294.37 9.77 294.37 12.85 235.37 9.58 25.87 14.14 12.85 281.97 8.37 9.30 42.64 53.30 9.53 9.58 9.30 340.80 8.51 12.85 24.37 8.18 174.23 319.50 161.92 190.55 9.63 36940441 GAMMAGLOBULIN IGA 82784 300 $209.00 77.25 8.18 167.20 14.78 144.42 9.77 144.42 12.85 115.47 9.58 25.87 14.14 12.85 138.34 8.37 9.30 42.64 53.30 9.53 9.58 9.30 167.20 8.51 12.85 24.37 8.18 85.48 156.75 79.44 93.49 9.63 36945192 GAMMAGLOBULIN IGG 82784 300 $49.00 18.11 8.18 53.30 14.78 33.86 9.77 33.86 12.85 27.07 9.58 25.87 14.14 12.85 32.43 8.37 9.30 42.64 53.30 9.53 9.58 9.30 39.20 8.51 12.85 24.37 8.18 20.04 36.75 18.62 21.92 9.63 35704981 IGE 82785 300 $86.00 31.79 14.48 94.36 20.13 59.43 17.28 59.43 17.50 47.52 16.95 45.78 19.25 17.50 56.92 14.81 16.46 75.49 94.36 16.87 16.95 16.46 68.80 15.06 17.50 43.13 14.48 35.17 64.50 32.69 38.47 17.04 36915757 IMMUNOGLOBULIN SUBCLASS IGG1 82787 300 $42.00 15.52 7.06 190.86 12.88 29.02 8.42 29.02 11.20 23.21 8.26 22.29 12.32 11.20 27.80 7.22 8.02 152.69 190.86 8.22 8.26 8.02 33.60 7.34 11.20 21.01 7.06 17.18 31.50 15.96 18.79 8.30 36915765 IMMUNOGLOBULIN SUBCLASS IGG2 82787 300 $42.00 15.52 7.06 190.86 12.88 29.02 8.42 29.02 11.20 23.21 8.26 22.29 12.32 11.20 27.80 7.22 8.02 152.69 190.86 8.22 8.26 8.02 33.60 7.34 11.20 21.01 7.06 17.18 31.50 15.96 18.79 8.30 36915773 IMMUNOGLOBULIN SUBCLASS IGG3 82787 300 $42.00 15.52 7.06 190.86 12.88 29.02 8.42 29.02 11.20 23.21 8.26 22.29 12.32 11.20 27.80 7.22 8.02 152.69 190.86 8.22 8.26 8.02 33.60 7.34 11.20 21.01 7.06 17.18 31.50 15.96 18.79 8.30 36915781 IMMUNOGLOBULIN SUBCLASS IGG4 82787 300 $42.00 15.52 7.06 190.86 12.88 29.02 8.42 29.02 11.20 23.21 8.26 22.29 12.32 11.20 27.80 7.22 8.02 152.69 190.86 8.22 8.26 8.02 33.60 7.34 11.20 21.01 7.06 17.18 31.50 15.96 18.79 8.30 36940450 IGA SUBCLASS 1 82787 300 $64.00 23.65 7.06 190.86 12.88 44.22 8.42 44.22 11.20 35.36 8.26 22.29 12.32 11.20 42.36 7.22 8.02 152.69 190.86 8.22 8.26 8.02 51.20 7.34 11.20 21.01 7.06 26.18 48.00 24.33 28.63 8.30 36940468 IGA SUBCLASS 2 82787 300 $64.00 23.65 7.06 190.86 12.88 44.22 8.42 44.22 11.20 35.36 8.26 22.29 12.32 11.20 42.36 7.22 8.02 152.69 190.86 8.22 8.26 8.02 51.20 7.34 11.20 21.01 7.06 26.18 48.00 24.33 28.63 8.30 35703233 PH UMBILICAL 82800 300 $58.00 21.44 9.68 68.23 13.46 40.08 11.55 40.08 11.70 32.05 11.33 23.52 12.87 11.70 38.39 9.90 11.00 54.58 68.23 11.28 11.33 11.00 46.40 10.07 11.70 28.82 9.68 23.72 43.50 22.05 25.94 11.39 35707522 PH VENOUS 82800 300 $58.00 21.44 9.68 68.23 13.46 40.08 11.55 40.08 11.70 32.05 11.33 23.52 12.87 11.70 38.39 9.90 11.00 54.58 68.23 11.28 11.33 11.00 46.40 10.07 11.70 28.82 9.68 23.72 43.50 22.05 25.94 11.39 35200321 BLOOD GAS I-STAT 82803 300 $137.00 50.64 22.94 155.92 30.75 94.67 27.37 94.67 26.74 75.69 26.85 53.79 29.41 26.74 90.68 23.46 26.07 124.74 155.92 26.72 26.85 26.07 109.60 23.85 26.74 68.30 22.94 56.03 102.75 52.07 61.28 26.98 35200908 BLOOD GASES EPOC 82803 300 $137.00 50.64 22.94 155.92 30.75 94.67 27.37 94.67 26.74 75.69 26.85 53.79 29.41 26.74 90.68 23.46 26.07 124.74 155.92 26.72 26.85 26.07 109.60 23.85 26.74 68.30 22.94 56.03 102.75 52.07 61.28 26.98 35709428 BLOOD GAS CORD 82803 300 $137.00 50.64 22.94 155.92 30.75 94.67 27.37 94.67 26.74 75.69 26.85 53.79 29.41 26.74 90.68 23.46 26.07 124.74 155.92 26.72 26.85 26.07 109.60 23.85 26.74 68.30 22.94 56.03 102.75 52.07 61.28 26.98 35702113 BLOOD GAS 82805 300 $414.00 153.01 38.86 331.20 44.69 286.07 82.71 286.07 38.86 228.74 81.13 78.88 42.75 38.86 274.03 70.89 78.77 181.30 226.63 80.74 81.13 78.77 331.20 72.07 38.86 206.38 69.32 169.33 310.50 157.36 185.18 81.53 35705945 BLOOD GAS 82805 300 $414.00 153.01 38.86 331.20 44.69 286.07 82.71 286.07 38.86 228.74 81.13 78.88 42.75 38.86 274.03 70.89 78.77 181.30 226.63 80.74 81.13 78.77 331.20 72.07 38.86 206.38 69.32 169.33 310.50 157.36 185.18 81.53 35705953 BLOOD GAS 82805 300 $414.00 153.01 38.86 331.20 44.69 286.07 82.71 286.07 38.86 228.74 81.13 78.88 42.75 38.86 274.03 70.89 78.77 181.30 226.63 80.74 81.13 78.77 331.20 72.07 38.86 206.38 69.32 169.33 310.50 157.36 185.18 81.53 35290079 AVOXIMETER WHOLE BLD-OXIMETER 82810 300 $51.00 18.85 8.60 70.33 13.87 35.24 10.26 35.24 12.06 28.18 10.06 24.27 13.27 12.06 33.76 8.79 9.77 56.26 70.33 10.01 10.06 9.77 40.80 8.94 12.06 25.60 8.60 20.86 38.25 19.39 22.81 10.11 35702920 O2SAT ARTERIAL 82810 300 $51.00 18.85 8.60 70.33 13.87 35.24 10.26 35.24 12.06 28.18 10.06 24.27 13.27 12.06 33.76 8.79 9.77 56.26 70.33 10.01 10.06 9.77 40.80 8.94 12.06 25.60 8.60 20.86 38.25 19.39 22.81 10.11 35706925 O2SAT VENOUS 82810 300 $51.00 18.85 8.60 70.33 13.87 35.24 10.26 35.24 12.06 28.18 10.06 24.27 13.27 12.06 33.76 8.79 9.77 56.26 70.33 10.01 10.06 9.77 40.80 8.94 12.06 25.60 8.60 20.86 38.25 19.39 22.81 10.11 35706933 O2SAT CAPILLARY 82810 300 $51.00 18.85 8.60 70.33 13.87 35.24 10.26 35.24 12.06 28.18 10.06 24.27 13.27 12.06 33.76 8.79 9.77 56.26 70.33 10.01 10.06 9.77 40.80 8.94 12.06 25.60 8.60 20.86 38.25 19.39 22.81 10.11 35704965 GASTRIN 82941 300 $93.00 34.37 14.00 101.08 16.10 64.26 18.51 64.26 14.00 51.38 18.16 49.02 15.40 14.00 61.56 15.87 17.63 80.86 101.08 18.07 18.16 17.63 74.40 16.13 14.00 46.19 15.51 38.04 69.75 35.35 41.60 18.25 36940671 GASTRIN 82941 300 $93.00 34.37 14.00 101.08 16.10 64.26 18.51 64.26 14.00 51.38 18.16 49.02 15.40 14.00 61.56 15.87 17.63 80.86 101.08 18.07 18.16 17.63 74.40 16.13 14.00 46.19 15.51 38.04 69.75 35.35 41.60 18.25 36911603 GLUCAGON PLASMA 82943 300 $500.00 184.80 12.58 400.00 22.71 345.50 15.00 345.50 19.75 276.25 14.72 39.72 21.73 19.75 330.95 12.86 14.29 92.11 115.14 14.65 14.72 14.29 400.00 13.08 19.75 37.44 12.58 204.50 375.00 190.05 223.65 14.79 35700790 GLUCOSE CSF 82945 300 $21.00 7.76 3.46 30.86 4.99 14.51 4.13 14.51 4.34 11.60 4.05 10.93 4.77 4.34 13.90 3.54 3.93 24.69 30.86 4.03 4.05 3.93 16.80 3.60 4.34 10.30 3.46 8.59 15.75 7.98 9.39 4.07 35705431 GLUCOSE 24 HOUR URINE 82945 300 $21.00 7.76 3.46 30.86 4.99 14.51 4.13 14.51 4.34 11.60 4.05 10.93 4.77 4.34 13.90 3.54 3.93 24.69 30.86 4.03 4.05 3.93 16.80 3.60 4.34 10.30 3.46 8.59 15.75 7.98 9.39 4.07 35705449 GLUCOSE RANDOM URINE 82945 300 $21.00 7.76 3.46 30.86 4.99 14.51 4.13 14.51 4.34 11.60 4.05 10.93 4.77 4.34 13.90 3.54 3.93 24.69 30.86 4.03 4.05 3.93 16.80 3.60 4.34 10.30 3.46 8.59 15.75 7.98 9.39 4.07 35705457 GLUCOSE FLUID 82945 300 $21.00 7.76 3.46 30.86 4.99 14.51 4.13 14.51 4.34 11.60 4.05 10.93 4.77 4.34 13.90 3.54 3.93 24.69 30.86 4.03 4.05 3.93 16.80 3.60 4.34 10.30 3.46 8.59 15.75 7.98 9.39 4.07 35200096 GLUCOSE (HEMOCUE) 82947 300 $21.00 7.76 3.46 22.54 4.60 14.51 4.13 14.51 4.00 11.60 4.05 10.93 4.40 4.00 13.90 3.54 3.93 18.03 22.54 4.03 4.05 3.93 16.80 3.60 4.00 10.30 3.46 8.59 15.75 7.98 9.39 4.07 35200274 GLUCOSE I-STAT 82947 300 $21.00 7.76 3.46 22.54 4.60 14.51 4.13 14.51 4.00 11.60 4.05 10.93 4.40 4.00 13.90 3.54 3.93 18.03 22.54 4.03 4.05 3.93 16.80 3.60 4.00 10.30 3.46 8.59 15.75 7.98 9.39 4.07 35200410 GLUCOSE HEMOCUE (NEONATAL) 82947 300 $21.00 7.76 3.46 22.54 4.60 14.51 4.13 14.51 4.00 11.60 4.05 10.93 4.40 4.00 13.90 3.54 3.93 18.03 22.54 4.03 4.05 3.93 16.80 3.60 4.00 10.30 3.46 8.59 15.75 7.98 9.39 4.07 35200703 GLUCOSE QUANT HEMOCUE (201) 82947 300 $21.00 7.76 3.46 22.54 4.60 14.51 4.13 14.51 4.00 11.60 4.05 10.93 4.40 4.00 13.90 3.54 3.93 18.03 22.54 4.03 4.05 3.93 16.80 3.60 4.00 10.30 3.46 8.59 15.75 7.98 9.39 4.07 35200711 GLUCOSE QNT HEMOCU NEONAT(201) 82947 300 $21.00 7.76 3.46 22.54 4.60 14.51 4.13 14.51 4.00 11.60 4.05 10.93 4.40 4.00 13.90 3.54 3.93 18.03 22.54 4.03 4.05 3.93 16.80 3.60 4.00 10.30 3.46 8.59 15.75 7.98 9.39 4.07 35200851 GLUCOSE EPOC 82947 300 $21.00 7.76 3.46 22.54 4.60 14.51 4.13 14.51 4.00 11.60 4.05 10.93 4.40 4.00 13.90 3.54 3.93 18.03 22.54 4.03 4.05 3.93 16.80 3.60 4.00 10.30 3.46 8.59 15.75 7.98 9.39 4.07 35700781 GLUCOSE SERUM/FLUID/URINE-RDM 82947 300 $21.00 7.76 3.46 22.54 4.60 14.51 4.13 14.51 4.00 11.60 4.05 10.93 4.40 4.00 13.90 3.54 3.93 18.03 22.54 4.03 4.05 3.93 16.80 3.60 4.00 10.30 3.46 8.59 15.75 7.98 9.39 4.07 35703063 GLUCOSE WHOLE BLOOD 82947 300 $21.00 7.76 3.46 22.54 4.60 14.51 4.13 14.51 4.00 11.60 4.05 10.93 4.40 4.00 13.90 3.54 3.93 18.03 22.54 4.03 4.05 3.93 16.80 3.60 4.00 10.30 3.46 8.59 15.75 7.98 9.39 4.07 35705422 GLUCOSE 2 HOUR POSTPRANDIAL 82947 300 $21.00 7.76 3.46 22.54 4.60 14.51 4.13 14.51 4.00 11.60 4.05 10.93 4.40 4.00 13.90 3.54 3.93 18.03 22.54 4.03 4.05 3.93 16.80 3.60 4.00 10.30 3.46 8.59 15.75 7.98 9.39 4.07 35707735 GLUCOSE FASTING PLASMA 82947 300 $21.00 7.76 3.46 22.54 4.60 14.51 4.13 14.51 4.00 11.60 4.05 10.93 4.40 4.00 13.90 3.54 3.93 18.03 22.54 4.03 4.05 3.93 16.80 3.60 4.00 10.30 3.46 8.59 15.75 7.98 9.39 4.07 35702903 GLUCOSE GESTATIONAL 82950 300 $25.00 9.24 4.18 27.17 7.51 17.28 4.99 17.28 6.53 13.81 4.89 13.22 7.18 6.53 16.55 4.28 4.75 21.74 27.17 4.87 4.89 4.75 20.00 4.35 6.53 12.45 4.18 10.23 18.75 9.50 11.18 4.92 35707816 2 HOUR POST CHALLENGE GLUCOSE 82950 300 $25.00 9.24 4.18 27.17 7.51 17.28 4.99 17.28 6.53 13.81 4.89 13.22 7.18 6.53 16.55 4.28 4.75 21.74 27.17 4.87 4.89 4.75 20.00 4.35 6.53 12.45 4.18 10.23 18.75 9.50 11.18 4.92 35703497 GLUCOSE PLASMA FASTING UP TO 3 82951 300 $68.00 25.13 11.33 73.80 14.38 46.99 13.51 46.99 12.50 37.57 13.26 35.76 13.75 12.50 45.01 11.58 12.87 59.04 73.80 13.19 13.26 12.87 54.40 11.78 12.50 33.72 11.33 27.81 51.00 25.85 30.42 13.32 35707743 GLUCOSE FAST (LACT TOL)UP TO 3 82951 300 $68.00 25.13 11.33 73.80 14.38 46.99 13.51 46.99 12.50 37.57 13.26 35.76 13.75 12.50 45.01 11.58 12.87 59.04 73.80 13.19 13.26 12.87 54.40 11.78 12.50 33.72 11.33 27.81 51.00 25.85 30.42 13.32 35708367 GLUCOSE TOL TEST- UP TO 3 SPEC 82951 300 $68.00 25.13 11.33 73.80 14.38 46.99 13.51 46.99 12.50 37.57 13.26 35.76 13.75 12.50 45.01 11.58 12.87 59.04 73.80 13.19 13.26 12.87 54.40 11.78 12.50 33.72 11.33 27.81 51.00 25.85 30.42 13.32 35703501 GLUCOSE TOLERANCE 0.5 HOUR 82952 300 $21.00 7.76 3.27 16.80 3.76 14.51 4.12 14.51 3.27 11.60 4.04 10.90 3.60 3.27 13.90 3.53 3.92 12.22 15.27 4.02 4.04 3.92 16.80 3.59 3.27 10.27 3.45 8.59 15.75 7.98 9.39 4.06 35703667 GLUCOSE TOLERANCE 1.5 HOURS 82952 300 $21.00 7.76 3.27 16.80 3.76 14.51 4.12 14.51 3.27 11.60 4.04 10.90 3.60 3.27 13.90 3.53 3.92 12.22 15.27 4.02 4.04 3.92 16.80 3.59 3.27 10.27 3.45 8.59 15.75 7.98 9.39 4.06 35703675 GLUCOSE TOLERANCE 3.0 HOURS 82952 300 $21.00 7.76 3.27 16.80 3.76 14.51 4.12 14.51 3.27 11.60 4.04 10.90 3.60 3.27 13.90 3.53 3.92 12.22 15.27 4.02 4.04 3.92 16.80 3.59 3.27 10.27 3.45 8.59 15.75 7.98 9.39 4.06 35703691 GLUCOSE TOLERANCE 5.0 HOURS 82952 300 $21.00 7.76 3.27 16.80 3.76 14.51 4.12 14.51 3.27 11.60 4.04 10.90 3.60 3.27 13.90 3.53 3.92 12.22 15.27 4.02 4.04 3.92 16.80 3.59 3.27 10.27 3.45 8.59 15.75 7.98 9.39 4.06 35703713 GLUCOSE TOLERANCE 4.0 HOURS 82952 300 $21.00 7.76 3.27 16.80 3.76 14.51 4.12 14.51 3.27 11.60 4.04 10.90 3.60 3.27 13.90 3.53 3.92 12.22 15.27 4.02 4.04 3.92 16.80 3.59 3.27 10.27 3.45 8.59 15.75 7.98 9.39 4.06 35707751 GLUCOSE (LACT TOL) 1.5 HOURS 82952 300 $21.00 7.76 3.27 16.80 3.76 14.51 4.12 14.51 3.27 11.60 4.04 10.90 3.60 3.27 13.90 3.53 3.92 12.22 15.27 4.02 4.04 3.92 16.80 3.59 3.27 10.27 3.45 8.59 15.75 7.98 9.39 4.06 35708375 GLUCOSE TOLERANCE 100G 3.0 HR 82952 300 $21.00 7.76 3.27 16.80 3.76 14.51 4.12 14.51 3.27 11.60 4.04 10.90 3.60 3.27 13.90 3.53 3.92 12.22 15.27 4.02 4.04 3.92 16.80 3.59 3.27 10.27 3.45 8.59 15.75 7.98 9.39 4.06 36906570 G-6-PD QUANT 82955 300 $211.00 77.99 8.00 168.80 9.20 145.80 10.19 145.80 8.00 116.58 9.99 26.97 8.80 8.00 139.66 8.73 9.70 44.45 55.56 9.94 9.99 9.70 168.80 8.88 8.00 25.41 8.54 86.30 158.25 80.20 94.38 10.04 35290044 GLUCOSE METER 82962 300 $17.00 6.28 2.00 20.94 2.30 11.75 3.44 11.75 2.00 9.39 3.38 6.50 2.20 2.00 11.25 2.95 3.28 16.75 20.94 3.36 3.38 3.28 13.60 3.00 2.00 8.59 2.89 6.95 12.75 6.46 7.60 3.39 35290052 GLUCOSE METER PRO 82962 300 $17.00 6.28 2.00 20.94 2.30 11.75 3.44 11.75 2.00 9.39 3.38 6.50 2.20 2.00 11.25 2.95 3.28 16.75 20.94 3.36 3.38 3.28 13.60 3.00 2.00 8.59 2.89 6.95 12.75 6.46 7.60 3.39 35290061 GLUCOSE METER FLEX 82962 300 $17.00 6.28 2.00 20.94 2.30 11.75 3.44 11.75 2.00 9.39 3.38 6.50 2.20 2.00 11.25 2.95 3.28 16.75 20.94 3.36 3.38 3.28 13.60 3.00 2.00 8.59 2.89 6.95 12.75 6.46 7.60 3.39 35700765 GGTP 82977 300 $38.00 14.04 6.34 41.45 10.76 26.26 7.56 26.26 9.36 21.00 7.42 20.03 10.30 9.36 25.15 6.48 7.20 33.16 41.45 7.38 7.42 7.20 30.40 6.59 9.36 18.86 6.34 15.54 28.50 14.44 17.00 7.45 36941405 GAMMA GLUTAMYL TRANSFERASE 82977 300 $99.00 36.59 6.34 79.20 10.76 68.41 7.56 68.41 9.36 54.70 7.42 20.03 10.30 9.36 65.53 6.48 7.20 33.16 41.45 7.38 7.42 7.20 79.20 6.59 9.36 18.86 6.34 40.49 74.25 37.63 44.28 7.45 36903988 FRUCTOSAMINE 82985 300 $108.00 39.92 14.75 86.40 18.91 74.63 17.60 74.63 16.44 59.67 17.26 41.92 18.08 16.44 71.49 15.08 16.76 61.55 76.94 17.18 17.26 16.76 86.40 15.34 16.44 43.91 14.75 44.17 81.00 41.05 48.31 17.35 35704957 FSH 83001 300 $98.00 36.22 16.35 106.48 20.13 67.72 19.51 67.72 17.50 54.15 19.14 51.65 19.25 17.50 64.87 16.72 18.58 85.18 106.48 19.04 19.14 18.58 78.40 17.00 17.50 48.68 16.35 40.08 73.50 37.25 43.84 19.23 35704990 LH 83002 300 $97.00 35.85 16.30 106.10 19.55 67.03 19.45 67.03 17.00 53.59 19.08 51.46 18.70 17.00 64.20 16.67 18.52 84.88 106.10 18.98 19.08 18.52 77.60 16.95 17.00 48.52 16.30 39.67 72.75 36.87 43.39 19.17 35704973 GROWTH HORMONE 83003 300 $88.00 32.52 8.00 95.51 9.20 60.81 17.50 60.81 8.00 48.62 17.17 46.38 8.80 8.00 58.25 15.00 16.67 76.41 95.51 17.09 17.17 16.67 70.40 15.25 8.00 43.68 14.67 35.99 66.00 33.45 39.36 17.25 35707948 HAPTOGLOBIN QUANT 83010 300 $66.00 24.39 11.07 72.09 13.80 45.61 13.21 45.61 12.00 36.47 12.96 34.95 13.20 12.00 43.69 11.32 12.58 57.67 72.09 12.89 12.96 12.58 52.80 11.51 12.00 32.96 11.07 26.99 49.50 25.09 29.52 13.02 36941413 HAPTOGLOBIN QUANTITATIVE 83010 300 $235.00 86.86 11.07 188.00 13.80 162.39 13.21 162.39 12.00 129.84 12.96 34.95 13.20 12.00 155.55 11.32 12.58 57.67 72.09 12.89 12.96 12.58 188.00 11.51 12.00 32.96 11.07 96.12 176.25 89.32 105.12 13.02 36903147 THALLIUM 83018 300 $384.00 141.93 19.32 307.20 34.90 265.34 23.06 265.34 30.35 212.16 22.62 61.07 33.39 30.35 254.17 19.76 21.96 141.58 176.97 22.51 22.62 21.96 307.20 20.09 30.35 57.54 19.32 157.06 288.00 145.96 171.76 22.73 36905981 BROMINE BLOOD 83018 300 $384.00 141.93 19.32 307.20 34.90 265.34 23.06 265.34 30.35 212.16 22.62 61.07 33.39 30.35 254.17 19.76 21.96 141.58 176.97 22.51 22.62 21.96 307.20 20.09 30.35 57.54 19.32 157.06 288.00 145.96 171.76 22.73 36940875 COBALT SERUM/PLASMA 83018 300 $384.00 141.93 19.32 307.20 34.90 265.34 23.06 265.34 30.35 212.16 22.62 61.07 33.39 30.35 254.17 19.76 21.96 141.58 176.97 22.51 22.62 21.96 307.20 20.09 30.35 57.54 19.32 157.06 288.00 145.96 171.76 22.73 36913401 HEMOGLOBIN A2 83021 300 $189.00 69.85 15.89 151.20 22.97 130.60 18.96 130.60 19.97 104.42 18.60 50.21 21.97 19.97 125.10 16.25 18.06 113.71 142.14 18.51 18.60 18.06 151.20 16.52 19.97 47.32 15.89 77.30 141.75 71.84 84.54 18.69 36913410 HEMOGLOBIN F CHROMATOGRAPHY 83021 300 $95.00 35.11 15.89 142.14 22.97 65.65 18.96 65.65 19.97 52.49 18.60 50.21 21.97 19.97 62.88 16.25 18.06 113.71 142.14 18.51 18.60 18.06 76.00 16.52 19.97 47.32 15.89 38.86 71.25 36.11 42.49 18.69 36919248 HGB FRAC & QNT CHROMATOGRAPHY 83021 300 $380.00 140.45 15.89 304.00 22.97 262.58 18.96 262.58 19.97 209.95 18.60 50.21 21.97 19.97 251.52 16.25 18.06 113.71 142.14 18.51 18.60 18.06 304.00 16.52 19.97 47.32 15.89 155.42 285.00 144.44 169.97 18.69 36943254 HEMOGLOBIN FRACT & QNT; CHROM 83021 300 $95.00 35.11 15.89 142.14 22.97 65.65 18.96 65.65 19.97 52.49 18.60 50.21 21.97 19.97 62.88 16.25 18.06 113.71 142.14 18.51 18.60 18.06 76.00 16.52 19.97 47.32 15.89 38.86 71.25 36.11 42.49 18.69 36944145 HEMOGLOBIN CHROMATOGRAPHY 83021 300 $236.00 87.23 15.89 188.80 22.97 163.08 18.96 163.08 19.97 130.39 18.60 50.21 21.97 19.97 156.21 16.25 18.06 113.71 142.14 18.51 18.60 18.06 188.80 16.52 19.97 47.32 15.89 96.52 177.00 89.70 105.56 18.69 36944153 HEMOGLOBIN CHROMATOGRAPHY 83021 300 $236.00 87.23 15.89 188.80 22.97 163.08 18.96 163.08 19.97 130.39 18.60 50.21 21.97 19.97 156.21 16.25 18.06 113.71 142.14 18.51 18.60 18.06 188.80 16.52 19.97 47.32 15.89 96.52 177.00 89.70 105.56 18.69 35708278 APT TEST 83033 300 $42.00 15.52 6.53 42.99 7.51 29.02 8.40 29.02 6.53 23.21 8.24 16.58 7.18 6.53 27.80 7.20 8.00 34.39 42.99 8.20 8.24 8.00 33.60 7.32 6.53 20.96 7.04 17.18 31.50 15.96 18.79 8.28 36924942 FETAL HEMOGLOBIN BY RID QUAL 83033 300 $77.00 28.46 6.53 61.60 7.51 53.21 8.40 53.21 6.53 42.54 8.24 16.58 7.18 6.53 50.97 7.20 8.00 34.39 42.99 8.20 8.24 8.00 61.60 7.32 6.53 20.96 7.04 31.49 57.75 29.27 34.44 8.28 36944200 FETAL HGB AMNIO FLD 83033 300 $184.00 68.01 6.53 147.20 7.51 127.14 8.40 127.14 6.53 101.66 8.24 16.58 7.18 6.53 121.79 7.20 8.00 34.39 42.99 8.20 8.24 8.00 147.20 7.32 6.53 20.96 7.04 75.26 138.00 69.94 82.30 8.28 35200916 POC HEMOGLOBIN A1C 83036 300 $51.00 18.85 7.00 61.07 8.05 35.24 10.20 35.24 7.00 28.18 10.00 26.97 7.70 7.00 33.76 8.74 9.71 48.86 61.07 9.95 10.00 9.71 40.80 8.88 7.00 25.44 8.54 20.86 38.25 19.39 22.81 10.05 35702997 HEMOGLOBIN A1C 83036 300 $51.00 18.85 7.00 61.07 8.05 35.24 10.20 35.24 7.00 28.18 10.00 26.97 7.70 7.00 33.76 8.74 9.71 48.86 61.07 9.95 10.00 9.71 40.80 8.88 7.00 25.44 8.54 20.86 38.25 19.39 22.81 10.05 36935928 HEMOGLOBIN A1C 83036 300 $51.00 18.85 7.00 61.07 8.05 35.24 10.20 35.24 7.00 28.18 10.00 26.97 7.70 7.00 33.76 8.74 9.71 48.86 61.07 9.95 10.00 9.71 40.80 8.88 7.00 25.44 8.54 20.86 38.25 19.39 22.81 10.05 35701206 METHEMOGLOBIN QUANT 83050 300 $43.00 15.89 3.00 35.16 3.45 29.71 8.61 29.71 3.00 23.76 8.45 20.38 3.30 3.00 28.46 7.38 8.20 28.13 35.16 8.41 8.45 8.20 34.40 7.50 3.00 21.48 7.22 17.59 32.25 16.34 19.23 8.49 36906600 HEMOGLOBIN PLASMA 83051 300 $150.00 55.44 3.50 120.00 4.03 103.65 7.68 103.65 3.50 82.88 7.53 20.32 3.85 3.50 99.29 6.58 7.31 27.74 34.67 7.49 7.53 7.31 120.00 6.69 3.50 19.15 6.43 61.35 112.50 57.02 67.10 7.57 36909455 URINE HEMOGLOBIN 83069 300 $147.00 54.33 - 117.60 - 101.58 4.15 101.58 - 81.22 4.07 10.99 - - 97.30 3.56 3.95 18.08 22.60 4.05 4.07 3.95 117.60 3.61 - 10.35 3.48 60.12 110.25 55.87 65.75 4.09 36930942 HISTAMINE 83088 300 $360.00 133.06 13.00 288.00 14.95 248.76 31.01 248.76 13.00 198.90 30.42 82.11 14.30 13.00 238.28 26.58 29.53 190.39 237.99 30.27 30.42 29.53 288.00 27.02 13.00 77.37 25.99 147.24 270.00 136.84 161.03 30.56 36939176 HISTAMINE PLASMA 83088 300 $360.00 133.06 13.00 288.00 14.95 248.76 31.01 248.76 13.00 198.90 30.42 82.11 14.30 13.00 238.28 26.58 29.53 190.39 237.99 30.27 30.42 29.53 288.00 27.02 13.00 77.37 25.99 147.24 270.00 136.84 161.03 30.56 35707689 HOMOCYSTEINE 83090 300 $94.00 34.74 15.77 132.77 21.45 64.95 18.82 64.95 18.65 51.94 18.46 46.91 20.52 18.65 62.22 16.13 17.92 106.22 132.77 18.37 18.46 17.92 75.20 16.40 18.65 46.95 15.77 38.45 70.50 35.73 42.05 18.55 36928891 HOMOCYSTEINE URINE 83090 300 $174.00 64.31 15.77 139.20 21.45 120.23 18.82 120.23 18.65 96.14 18.46 46.91 20.52 18.65 115.17 16.13 17.92 106.22 132.77 18.37 18.46 17.92 139.20 16.40 18.65 46.95 15.77 71.17 130.50 66.14 77.83 18.55 36982772 HOMOCYSTEINE (CARDIOVASCULAR) 83090 300 $94.00 34.74 15.77 132.77 21.45 64.95 18.82 64.95 18.65 51.94 18.46 46.91 20.52 18.65 62.22 16.13 17.92 106.22 132.77 18.37 18.46 17.92 75.20 16.40 18.65 46.95 15.77 38.45 70.50 35.73 42.05 18.55 35707107 HOMOVANILLIC ACID RANDOM URINE 83150 300 $118.00 43.61 7.50 94.40 8.63 81.54 23.53 81.54 7.50 65.20 23.08 53.79 8.25 7.50 78.10 20.17 22.41 69.40 86.75 22.97 23.08 22.41 94.40 20.51 7.50 58.71 19.72 48.26 88.50 44.85 52.78 23.19 35707719 HOMOVANILLIC ACID 24 HR URINE 83150 300 $118.00 43.61 7.50 94.40 8.63 81.54 23.53 81.54 7.50 65.20 23.08 53.79 8.25 7.50 78.10 20.17 22.41 69.40 86.75 22.97 23.08 22.41 94.40 20.51 7.50 58.71 19.72 48.26 88.50 44.85 52.78 23.19 36941235 HOMOVANILLIC ACID 83150 300 $118.00 43.61 7.50 94.40 8.63 81.54 23.53 81.54 7.50 65.20 23.08 53.79 8.25 7.50 78.10 20.17 22.41 69.40 86.75 22.97 23.08 22.41 94.40 20.51 7.50 58.71 19.72 48.26 88.50 44.85 52.78 23.19 36941251 HOMOVANILLIC ACID URINE 83150 300 $118.00 43.61 7.50 94.40 8.63 81.54 23.53 81.54 7.50 65.20 23.08 53.79 8.25 7.50 78.10 20.17 22.41 69.40 86.75 22.97 23.08 22.41 94.40 20.51 7.50 58.71 19.72 48.26 88.50 44.85 52.78 23.19 36906499 HYDROXYCORTICOSTEROID 83491 300 $347.00 128.25 7.00 277.60 8.05 239.78 18.80 239.78 7.00 191.72 18.44 48.73 7.70 7.00 229.68 16.11 17.90 80.29 100.36 18.35 18.44 17.90 277.60 16.38 7.00 46.90 15.75 141.92 260.25 131.89 155.21 18.53 36906723 5HIAA 24 HOUR URINE 83497 300 $348.00 128.62 11.35 278.40 15.18 240.47 13.55 240.47 13.20 192.27 13.29 35.83 14.52 13.20 230.34 11.61 12.90 54.06 67.57 13.22 13.29 12.90 278.40 11.80 13.20 33.80 11.35 142.33 261.00 132.27 155.66 13.35 36909137 5HIAA RANDOM URINE 83497 300 $348.00 128.62 11.35 278.40 15.18 240.47 13.55 240.47 13.20 192.27 13.29 35.83 14.52 13.20 230.34 11.61 12.90 54.06 67.57 13.22 13.29 12.90 278.40 11.80 13.20 33.80 11.35 142.33 261.00 132.27 155.66 13.35 35705139 PROGESTERONE 17 OH 83498 300 $143.00 52.85 20.50 155.64 23.58 98.81 28.53 98.81 20.50 79.01 27.99 75.55 22.55 20.50 94.65 24.45 27.17 124.51 155.64 27.85 27.99 27.17 114.40 24.86 20.50 71.19 23.91 58.49 107.25 54.35 63.96 28.12 36913479 HYDROXYPROGESTERONE 17-D 83498 300 $143.00 52.85 20.50 155.64 23.58 98.81 28.53 98.81 20.50 79.01 27.99 75.55 22.55 20.50 94.65 24.45 27.17 124.51 155.64 27.85 27.99 27.17 114.40 24.86 20.50 71.19 23.91 58.49 107.25 54.35 63.96 28.12 36917172 17 HYDROXYPROGESTERONE 83498 300 $143.00 52.85 20.50 155.64 23.58 98.81 28.53 98.81 20.50 79.01 27.99 75.55 22.55 20.50 94.65 24.45 27.17 124.51 155.64 27.85 27.99 27.17 114.40 24.86 20.50 71.19 23.91 58.49 107.25 54.35 63.96 28.12 36918144 PROGESTERONE 17 OH 83498 300 $430.00 158.93 20.50 344.00 23.58 297.13 28.53 297.13 20.50 237.58 27.99 75.55 22.55 20.50 284.62 24.45 27.17 124.51 155.64 27.85 27.99 27.17 344.00 24.86 20.50 71.19 23.91 175.87 322.50 163.44 192.34 28.12 36934026 17OH PROGESTERONE 83498 300 $143.00 52.85 20.50 155.64 23.58 98.81 28.53 98.81 20.50 79.01 27.99 75.55 22.55 20.50 94.65 24.45 27.17 124.51 155.64 27.85 27.99 27.17 114.40 24.86 20.50 71.19 23.91 58.49 107.25 54.35 63.96 28.12 36934344 HYDROXYPROGESTERONE 17-D 83498 300 $466.00 172.23 20.50 372.80 23.58 322.01 28.53 322.01 20.50 257.47 27.99 75.55 22.55 20.50 308.45 24.45 27.17 124.51 155.64 27.85 27.99 27.17 372.80 24.86 20.50 71.19 23.91 190.59 349.50 177.13 208.44 28.12 36110546 ACTIN AB IMM SEMI QNT MULT 83516 300 $61.00 22.55 - 85.43 - 42.15 12.11 42.15 - 33.70 11.88 32.06 - - 40.38 10.38 11.53 68.34 85.43 11.82 11.88 11.53 48.80 10.55 - 30.21 10.15 24.95 45.75 23.19 27.29 11.93 36110554 PBC IMMUNO SEMI QNT MULT 83516 300 $61.00 22.55 - 85.43 - 42.15 12.11 42.15 - 33.70 11.88 32.06 - - 40.38 10.38 11.53 68.34 85.43 11.82 11.88 11.53 48.80 10.55 - 30.21 10.15 24.95 45.75 23.19 27.29 11.93 36905000 RIBOSOMAL P PROTEIN AB QUAL 83516 300 $770.00 284.59 - 616.00 - 532.07 12.11 532.07 - 425.43 11.88 32.06 - - 509.66 10.38 11.53 68.34 85.43 11.82 11.88 11.53 616.00 10.55 - 30.21 10.15 314.93 577.50 292.68 344.42 11.93 36906065 HISTONE ANTIBODY EIA 83516 300 $229.00 84.64 - 183.20 - 158.24 12.11 158.24 - 126.52 11.88 32.06 - - 151.58 10.38 11.53 68.34 85.43 11.82 11.88 11.53 183.20 10.55 - 30.21 10.15 93.66 171.75 87.04 102.43 11.93 36922541 IGA FIBRONECTIN AGGREGAT ELISA 83516 300 $427.00 157.82 - 341.60 - 295.06 12.11 295.06 - 235.92 11.88 32.06 - - 282.63 10.38 11.53 68.34 85.43 11.82 11.88 11.53 341.60 10.55 - 30.21 10.15 174.64 320.25 162.30 191.00 11.93 36931191 ATOPIC DERMATITIS IMMUN NON AB 83516 300 "$1,252.00" 462.74 - " 1,001.60 " - 865.13 12.11 865.13 - 691.73 11.88 32.06 - - 828.70 10.38 11.53 68.34 85.43 11.82 11.88 11.53 " 1,001.60 " 10.55 - 30.21 10.15 512.07 939.00 475.89 560.02 11.93 36933399 GAD IMMUNOASSAY QUAL 83516 300 $835.00 308.62 - 668.00 - 576.99 12.11 576.99 - 461.34 11.88 32.06 - - 552.69 10.38 11.53 68.34 85.43 11.82 11.88 11.53 668.00 10.55 - 30.21 10.15 341.52 626.25 317.38 373.50 11.93 36933411 IMMUNOASSAY NON ANTIBODY 83516 300 "$1,665.00" 615.38 - " 1,332.00 " - " 1,150.52 " 12.11 " 1,150.52 " - 919.91 11.88 32.06 - - " 1,102.06 " 10.38 11.53 68.34 85.43 11.82 11.88 11.53 " 1,332.00 " 10.55 - 30.21 10.15 680.99 " 1,248.75 " 632.87 744.75 11.93 36933488 IMMUNOASSAY NON ANTIBODY 83516 300 $847.00 313.05 - 677.60 - 585.28 12.11 585.28 - 467.97 11.88 32.06 - - 560.63 10.38 11.53 68.34 85.43 11.82 11.88 11.53 677.60 10.55 - 30.21 10.15 346.42 635.25 321.94 378.86 11.93 36936223 IMMNOASSAY NON ANTIBODY 83516 300 $194.00 71.70 - 155.20 - 134.05 12.11 134.05 - 107.19 11.88 32.06 - - 128.41 10.38 11.53 68.34 85.43 11.82 11.88 11.53 155.20 10.55 - 30.21 10.15 79.35 145.50 73.74 86.78 11.93 36936231 IMMNOASSAY NON ANTIBODY 83516 300 $194.00 71.70 - 155.20 - 134.05 12.11 134.05 - 107.19 11.88 32.06 - - 128.41 10.38 11.53 68.34 85.43 11.82 11.88 11.53 155.20 10.55 - 30.21 10.15 79.35 145.50 73.74 86.78 11.93 36936240 IMMNOASSAY NON ANTIBODY 83516 300 $194.00 71.70 - 155.20 - 134.05 12.11 134.05 - 107.19 11.88 32.06 - - 128.41 10.38 11.53 68.34 85.43 11.82 11.88 11.53 155.20 10.55 - 30.21 10.15 79.35 145.50 73.74 86.78 11.93 36936258 IMMNOASSAY NON ANTIBODY 83516 300 $194.00 71.70 - 155.20 - 134.05 12.11 134.05 - 107.19 11.88 32.06 - - 128.41 10.38 11.53 68.34 85.43 11.82 11.88 11.53 155.20 10.55 - 30.21 10.15 79.35 145.50 73.74 86.78 11.93 36936266 IMMNOASSAY NON ANTIBODY 83516 300 $194.00 71.70 - 155.20 - 134.05 12.11 134.05 - 107.19 11.88 32.06 - - 128.41 10.38 11.53 68.34 85.43 11.82 11.88 11.53 155.20 10.55 - 30.21 10.15 79.35 145.50 73.74 86.78 11.93 36937386 IMMUNOASSY NON AB QL/ SEMIQNT 83516 300 "$1,085.00" 401.02 - 868.00 - 749.74 12.11 749.74 - 599.46 11.88 32.06 - - 718.16 10.38 11.53 68.34 85.43 11.82 11.88 11.53 868.00 10.55 - 30.21 10.15 443.77 813.75 412.41 485.32 11.93 36937394 IMMUNOASSY NON AB QL/ SEMIQNT 83516 300 "$1,085.00" 401.02 - 868.00 - 749.74 12.11 749.74 - 599.46 11.88 32.06 - - 718.16 10.38 11.53 68.34 85.43 11.82 11.88 11.53 868.00 10.55 - 30.21 10.15 443.77 813.75 412.41 485.32 11.93 36937602 IMMUNOASSAY NON ANTIBODY 83516 300 "$1,665.00" 615.38 - " 1,332.00 " - " 1,150.52 " 12.11 " 1,150.52 " - 919.91 11.88 32.06 - - " 1,102.06 " 10.38 11.53 68.34 85.43 11.82 11.88 11.53 " 1,332.00 " 10.55 - 30.21 10.15 680.99 " 1,248.75 " 632.87 744.75 11.93 36937912 CYSTIC FIBRO (IRT) IMMUNOASSAY 83516 300 $61.00 22.55 - 85.43 - 42.15 12.11 42.15 - 33.70 11.88 32.06 - - 40.38 10.38 11.53 68.34 85.43 11.82 11.88 11.53 48.80 10.55 - 30.21 10.15 24.95 45.75 23.19 27.29 11.93 36938048 IMMUNOASSAY NON AB 83516 300 $986.00 364.43 - 788.80 - 681.33 12.11 681.33 - 544.77 11.88 32.06 - - 652.63 10.38 11.53 68.34 85.43 11.82 11.88 11.53 788.80 10.55 - 30.21 10.15 403.27 739.50 374.78 441.04 11.93 36938609 NMOAB-IGG AB 83516 300 "$2,263.00" 836.40 - " 1,810.40 " - " 1,563.73 " 12.11 " 1,563.73 " - " 1,250.31 " 11.88 32.06 - - " 1,497.88 " 10.38 11.53 68.34 85.43 11.82 11.88 11.53 " 1,810.40 " 10.55 - 30.21 10.15 925.57 " 1,697.25 " 860.17 " 1,012.24 " 11.93 36940379 TISSUE TRANSGLUT IGG IA 83516 300 $172.00 63.57 - 137.60 - 118.85 12.11 118.85 - 95.03 11.88 32.06 - - 113.85 10.38 11.53 68.34 85.43 11.82 11.88 11.53 137.60 10.55 - 30.21 10.15 70.35 129.00 65.38 76.94 11.93 36940492 TISSUE TRANSGLUT IGG IA 83516 300 $163.00 60.24 - 130.40 - 112.63 12.11 112.63 - 90.06 11.88 32.06 - - 107.89 10.38 11.53 68.34 85.43 11.82 11.88 11.53 130.40 10.55 - 30.21 10.15 66.67 122.25 61.96 72.91 11.93 36940506 TISSUE TRANSGLUT IGA IA 83516 300 $163.00 60.24 - 130.40 - 112.63 12.11 112.63 - 90.06 11.88 32.06 - - 107.89 10.38 11.53 68.34 85.43 11.82 11.88 11.53 130.40 10.55 - 30.21 10.15 66.67 122.25 61.96 72.91 11.93 36981024 PARIETAL CELL AB-IMMUNOASSAY 83516 300 $146.00 53.96 - 116.80 - 100.89 12.11 100.89 - 80.67 11.88 32.06 - - 96.64 10.38 11.53 68.34 85.43 11.82 11.88 11.53 116.80 10.55 - 30.21 10.15 59.71 109.50 55.49 65.31 11.93 36982489 IMMUNOASSAY NON INF QUAL 83516 300 $61.00 22.55 - 85.43 - 42.15 12.11 42.15 - 33.70 11.88 32.06 - - 40.38 10.38 11.53 68.34 85.43 11.82 11.88 11.53 48.80 10.55 - 30.21 10.15 24.95 45.75 23.19 27.29 11.93 36900059 PROCOLL PEP TYPE 3 QUANT RIA 83519 300 "$1,371.00" 506.72 - " 1,096.80 " - 947.36 19.32 947.36 - 757.48 18.95 37.55 - - 907.46 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,096.80 " 16.84 - 48.21 16.19 560.74 " 1,028.25 " 521.12 613.25 19.04 36900547 TSH RECEPTOR ANTIBODY ASSAY 83519 300 "$1,371.00" 506.72 - " 1,096.80 " - 947.36 19.32 947.36 - 757.48 18.95 37.55 - - 907.46 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,096.80 " 16.84 - 48.21 16.19 560.74 " 1,028.25 " 521.12 613.25 19.04 36905921 TRYPSINOGEN 83519 300 "$1,371.00" 506.72 - " 1,096.80 " - 947.36 19.32 947.36 - 757.48 18.95 37.55 - - 907.46 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,096.80 " 16.84 - 48.21 16.19 560.74 " 1,028.25 " 521.12 613.25 19.04 36905930 IGF BINDING PROTEIN 83519 300 $602.00 222.50 - 481.60 - 415.98 19.32 415.98 - 332.61 18.95 37.55 - - 398.46 16.56 18.40 87.13 108.91 18.86 18.95 18.40 481.60 16.84 - 48.21 16.19 246.22 451.50 228.82 269.27 19.04 36910691 TSH RECEPTOR AB 83519 300 "$1,550.00" 572.88 - " 1,240.00 " - " 1,071.05 " 19.32 " 1,071.05 " - 856.38 18.95 37.55 - - " 1,025.95 " 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,240.00 " 16.84 - 48.21 16.19 633.95 " 1,162.50 " 589.16 693.32 19.04 36917067 PTH RELATED PEPTIDE 83519 300 "$1,371.00" 506.72 - " 1,096.80 " - 947.36 19.32 947.36 - 757.48 18.95 37.55 - - 907.46 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,096.80 " 16.84 - 48.21 16.19 560.74 " 1,028.25 " 521.12 613.25 19.04 36917113 LEMS AUTOANTIBODY 83519 300 "$1,660.00" 613.54 - " 1,328.00 " - " 1,147.06 " 19.32 " 1,147.06 " - 917.15 18.95 37.55 - - " 1,098.75 " 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,328.00 " 16.84 - 48.21 16.19 678.94 " 1,245.00 " 630.97 742.52 19.04 36918179 LEMS IMMUNO QUANT RIA 83519 300 "$1,371.00" 506.72 - " 1,096.80 " - 947.36 19.32 947.36 - 757.48 18.95 37.55 - - 907.46 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,096.80 " 16.84 - 48.21 16.19 560.74 " 1,028.25 " 521.12 613.25 19.04 36924497 MUSK ANTIBODY TEST QUANT RIA 83519 300 "$3,987.00" " 1,473.60 " - " 3,189.60 " - " 2,755.02 " 19.32 " 2,755.02 " - " 2,202.82 " 18.95 37.55 - - " 2,639.00 " 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 3,189.60 " 16.84 - 48.21 16.19 " 1,630.68 " " 2,990.25 " " 1,515.46 " " 1,783.39 " 19.04 36924926 IMMUNOASSAY RIA QUANT 83519 300 "$1,371.00" 506.72 - " 1,096.80 " - 947.36 19.32 947.36 - 757.48 18.95 37.55 - - 907.46 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,096.80 " 16.84 - 48.21 16.19 560.74 " 1,028.25 " 521.12 613.25 19.04 36926121 VOLT GRATED K QUANT RIA 83519 300 "$1,371.00" 506.72 - " 1,096.80 " - 947.36 19.32 947.36 - 757.48 18.95 37.55 - - 907.46 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,096.80 " 16.84 - 48.21 16.19 560.74 " 1,028.25 " 521.12 613.25 19.04 36930268 IMMUNOASSAY QUANT RIA 83519 300 "$1,371.00" 506.72 - " 1,096.80 " - 947.36 19.32 947.36 - 757.48 18.95 37.55 - - 907.46 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,096.80 " 16.84 - 48.21 16.19 560.74 " 1,028.25 " 521.12 613.25 19.04 36933429 IMMUNOASSAY RIA QUANT 83519 300 "$2,035.00" 752.14 - " 1,628.00 " - " 1,406.19 " 19.32 " 1,406.19 " - " 1,124.34 " 18.95 37.55 - - " 1,346.97 " 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,628.00 " 16.84 - 48.21 16.19 832.32 " 1,526.25 " 773.50 910.26 19.04 36933569 GANG NACHR IMMUNO RIA QNT 83519 300 "$2,434.00" 899.61 - " 1,947.20 " - " 1,681.89 " 19.32 " 1,681.89 " - " 1,344.79 " 18.95 37.55 - - " 1,611.06 " 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,947.20 " 16.84 - 48.21 16.19 995.51 " 1,825.50 " 925.16 " 1,088.73 " 19.04 36933658 VGKC AB IMMUNO QUANT RIA 83519 300 "$2,287.00" 845.28 - " 1,829.60 " - " 1,580.32 " 19.32 " 1,580.32 " - " 1,263.57 " 18.95 37.55 - - " 1,513.77 " 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,829.60 " 16.84 - 48.21 16.19 935.38 " 1,715.25 " 869.29 " 1,022.98 " 19.04 36934204 IMMUNOASSAY RIA QUANT 83519 300 "$1,371.00" 506.72 - " 1,096.80 " - 947.36 19.32 947.36 - 757.48 18.95 37.55 - - 907.46 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,096.80 " 16.84 - 48.21 16.19 560.74 " 1,028.25 " 521.12 613.25 19.04 36934212 IMMUNOASSAY RIA QUANT 83519 300 "$1,371.00" 506.72 - " 1,096.80 " - 947.36 19.32 947.36 - 757.48 18.95 37.55 - - 907.46 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,096.80 " 16.84 - 48.21 16.19 560.74 " 1,028.25 " 521.12 613.25 19.04 36936312 GHRELIN TOTAL RIA NON AB QNT 83519 300 "$1,901.00" 702.61 - " 1,520.80 " - " 1,313.59 " 19.32 " 1,313.59 " - " 1,050.30 " 18.95 37.55 - - " 1,258.27 " 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,520.80 " 16.84 - 48.21 16.19 777.51 " 1,425.75 " 722.57 850.32 19.04 36937408 IMMUNOASSAY NON AB QNT 83519 300 "$1,371.00" 506.72 - " 1,096.80 " - 947.36 19.32 947.36 - 757.48 18.95 37.55 - - 907.46 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,096.80 " 16.84 - 48.21 16.19 560.74 " 1,028.25 " 521.12 613.25 19.04 36937416 IMMUNOASSAY NON AB QNT 83519 300 "$1,371.00" 506.72 - " 1,096.80 " - 947.36 19.32 947.36 - 757.48 18.95 37.55 - - 907.46 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,096.80 " 16.84 - 48.21 16.19 560.74 " 1,028.25 " 521.12 613.25 19.04 36937424 IMMUNOASSAY NON AB QNT 83519 300 "$1,371.00" 506.72 - " 1,096.80 " - 947.36 19.32 947.36 - 757.48 18.95 37.55 - - 907.46 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,096.80 " 16.84 - 48.21 16.19 560.74 " 1,028.25 " 521.12 613.25 19.04 36938064 IMMUNO QUANT BY RIA 83519 300 "$1,371.00" 506.72 - " 1,096.80 " - 947.36 19.32 947.36 - 757.48 18.95 37.55 - - 907.46 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,096.80 " 16.84 - 48.21 16.19 560.74 " 1,028.25 " 521.12 613.25 19.04 36938072 IMMUNO QUANT BY RIA 83519 300 "$1,371.00" 506.72 - " 1,096.80 " - 947.36 19.32 947.36 - 757.48 18.95 37.55 - - 907.46 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,096.80 " 16.84 - 48.21 16.19 560.74 " 1,028.25 " 521.12 613.25 19.04 36938081 IMMUNO QUANT BY RIA 83519 300 "$1,371.00" 506.72 - " 1,096.80 " - 947.36 19.32 947.36 - 757.48 18.95 37.55 - - 907.46 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,096.80 " 16.84 - 48.21 16.19 560.74 " 1,028.25 " 521.12 613.25 19.04 36938099 IMMUNO QUANT BY RIA 83519 300 "$1,371.00" 506.72 - " 1,096.80 " - 947.36 19.32 947.36 - 757.48 18.95 37.55 - - 907.46 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,096.80 " 16.84 - 48.21 16.19 560.74 " 1,028.25 " 521.12 613.25 19.04 36938102 IMMUNO QUANT BY RIA 83519 300 "$1,371.00" 506.72 - " 1,096.80 " - 947.36 19.32 947.36 - 757.48 18.95 37.55 - - 907.46 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,096.80 " 16.84 - 48.21 16.19 560.74 " 1,028.25 " 521.12 613.25 19.04 36938480 CORTICOTROPIN RF QUANT BY RIA 83519 300 "$1,446.00" 534.44 - " 1,156.80 " - 999.19 19.32 999.19 - 798.92 18.95 37.55 - - 957.11 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,156.80 " 16.84 - 48.21 16.19 591.41 " 1,084.50 " 549.62 646.80 19.04 36939184 ACETYLCHOLINE RCPT BLOCKAB RIA 83519 300 "$1,371.00" 506.72 - " 1,096.80 " - 947.36 19.32 947.36 - 757.48 18.95 37.55 - - 907.46 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,096.80 " 16.84 - 48.21 16.19 560.74 " 1,028.25 " 521.12 613.25 19.04 36939303 QUANATATIVE BY RIA 83519 300 "$1,371.00" 506.72 - " 1,096.80 " - 947.36 19.32 947.36 - 757.48 18.95 37.55 - - 907.46 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,096.80 " 16.84 - 48.21 16.19 560.74 " 1,028.25 " 521.12 613.25 19.04 36939311 QUANATATIVE BY RIA 83519 300 "$1,371.00" 506.72 - " 1,096.80 " - 947.36 19.32 947.36 - 757.48 18.95 37.55 - - 907.46 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,096.80 " 16.84 - 48.21 16.19 560.74 " 1,028.25 " 521.12 613.25 19.04 36939320 QUANATATIVE BY RIA 83519 300 "$1,371.00" 506.72 - " 1,096.80 " - 947.36 19.32 947.36 - 757.48 18.95 37.55 - - 907.46 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,096.80 " 16.84 - 48.21 16.19 560.74 " 1,028.25 " 521.12 613.25 19.04 36939338 QUANATATIVE BY RIA 83519 300 "$1,371.00" 506.72 - " 1,096.80 " - 947.36 19.32 947.36 - 757.48 18.95 37.55 - - 907.46 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,096.80 " 16.84 - 48.21 16.19 560.74 " 1,028.25 " 521.12 613.25 19.04 36939346 QUANATATIVE BY RIA 83519 300 "$1,371.00" 506.72 - " 1,096.80 " - 947.36 19.32 947.36 - 757.48 18.95 37.55 - - 907.46 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,096.80 " 16.84 - 48.21 16.19 560.74 " 1,028.25 " 521.12 613.25 19.04 36939559 QUANATATIVE BY RIA 83519 300 "$1,371.00" 506.72 - " 1,096.80 " - 947.36 19.32 947.36 - 757.48 18.95 37.55 - - 907.46 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,096.80 " 16.84 - 48.21 16.19 560.74 " 1,028.25 " 521.12 613.25 19.04 36939567 QUANATATIVE BY RIA 83519 300 "$1,371.00" 506.72 - " 1,096.80 " - 947.36 19.32 947.36 - 757.48 18.95 37.55 - - 907.46 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,096.80 " 16.84 - 48.21 16.19 560.74 " 1,028.25 " 521.12 613.25 19.04 36939575 QUANATATIVE BY RIA 83519 300 "$1,371.00" 506.72 - " 1,096.80 " - 947.36 19.32 947.36 - 757.48 18.95 37.55 - - 907.46 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,096.80 " 16.84 - 48.21 16.19 560.74 " 1,028.25 " 521.12 613.25 19.04 36939583 QUANATATIVE BY RIA 83519 300 "$1,371.00" 506.72 - " 1,096.80 " - 947.36 19.32 947.36 - 757.48 18.95 37.55 - - 907.46 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,096.80 " 16.84 - 48.21 16.19 560.74 " 1,028.25 " 521.12 613.25 19.04 36939591 QUANATATIVE BY RIA 83519 300 "$1,371.00" 506.72 - " 1,096.80 " - 947.36 19.32 947.36 - 757.48 18.95 37.55 - - 907.46 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,096.80 " 16.84 - 48.21 16.19 560.74 " 1,028.25 " 521.12 613.25 19.04 36939753 QUANATATIVE BY RIA 83519 300 "$1,371.00" 506.72 - " 1,096.80 " - 947.36 19.32 947.36 - 757.48 18.95 37.55 - - 907.46 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,096.80 " 16.84 - 48.21 16.19 560.74 " 1,028.25 " 521.12 613.25 19.04 36939761 QUANATATIVE BY RIA 83519 300 "$1,371.00" 506.72 - " 1,096.80 " - 947.36 19.32 947.36 - 757.48 18.95 37.55 - - 907.46 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,096.80 " 16.84 - 48.21 16.19 560.74 " 1,028.25 " 521.12 613.25 19.04 36939770 QUANATATIVE BY RIA 83519 300 "$1,371.00" 506.72 - " 1,096.80 " - 947.36 19.32 947.36 - 757.48 18.95 37.55 - - 907.46 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,096.80 " 16.84 - 48.21 16.19 560.74 " 1,028.25 " 521.12 613.25 19.04 36939788 QUANATATIVE BY RIA 83519 300 "$1,371.00" 506.72 - " 1,096.80 " - 947.36 19.32 947.36 - 757.48 18.95 37.55 - - 907.46 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,096.80 " 16.84 - 48.21 16.19 560.74 " 1,028.25 " 521.12 613.25 19.04 36939796 QUANATATIVE BY RIA 83519 300 "$1,371.00" 506.72 - " 1,096.80 " - 947.36 19.32 947.36 - 757.48 18.95 37.55 - - 907.46 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,096.80 " 16.84 - 48.21 16.19 560.74 " 1,028.25 " 521.12 613.25 19.04 36940166 QUANT BY RIA 83519 300 "$2,912.00" " 1,076.28 " - " 2,329.60 " - " 2,012.19 " 19.32 " 2,012.19 " - " 1,608.88 " 18.95 37.55 - - " 1,927.45 " 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 2,329.60 " 16.84 - 48.21 16.19 " 1,191.01 " " 2,184.00 " " 1,106.85 " " 1,302.54 " 19.04 36940301 ACHR MODULATING AB RIA 83519 300 "$1,371.00" 506.72 - " 1,096.80 " - 947.36 19.32 947.36 - 757.48 18.95 37.55 - - 907.46 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,096.80 " 16.84 - 48.21 16.19 560.74 " 1,028.25 " 521.12 613.25 19.04 36941758 RIA NONANTIBODY QUANT 83519 300 "$1,371.00" 506.72 - " 1,096.80 " - 947.36 19.32 947.36 - 757.48 18.95 37.55 - - 907.46 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,096.80 " 16.84 - 48.21 16.19 560.74 " 1,028.25 " 521.12 613.25 19.04 36941766 RIA NONANTIBODY QUANT 83519 300 "$1,371.00" 506.72 - " 1,096.80 " - 947.36 19.32 947.36 - 757.48 18.95 37.55 - - 907.46 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,096.80 " 16.84 - 48.21 16.19 560.74 " 1,028.25 " 521.12 613.25 19.04 36941774 RIA NONANTIBODY QUANT 83519 300 "$1,371.00" 506.72 - " 1,096.80 " - 947.36 19.32 947.36 - 757.48 18.95 37.55 - - 907.46 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,096.80 " 16.84 - 48.21 16.19 560.74 " 1,028.25 " 521.12 613.25 19.04 36941782 RIA NONANTIBODY QUANT 83519 300 "$1,371.00" 506.72 - " 1,096.80 " - 947.36 19.32 947.36 - 757.48 18.95 37.55 - - 907.46 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,096.80 " 16.84 - 48.21 16.19 560.74 " 1,028.25 " 521.12 613.25 19.04 36941791 RIA NONANTIBODY QUANT 83519 300 "$1,371.00" 506.72 - " 1,096.80 " - 947.36 19.32 947.36 - 757.48 18.95 37.55 - - 907.46 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,096.80 " 16.84 - 48.21 16.19 560.74 " 1,028.25 " 521.12 613.25 19.04 36944617 IMMUNOASSAY NON AB RIA 83519 300 "$1,371.00" 506.72 - " 1,096.80 " - 947.36 19.32 947.36 - 757.48 18.95 37.55 - - 907.46 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,096.80 " 16.84 - 48.21 16.19 560.74 " 1,028.25 " 521.12 613.25 19.04 36945290 RIA NON INF AGT AB/AG QNT 83519 300 $109.00 40.29 - 108.91 - 75.32 19.32 75.32 - 60.22 18.95 37.55 - - 72.15 16.56 18.40 87.13 108.91 18.86 18.95 18.40 87.20 16.84 - 48.21 16.19 44.58 81.75 41.43 48.76 19.04 36945303 RIA NON INF AGT AB/AG QNT 83519 300 "$1,371.00" 506.72 - " 1,096.80 " - 947.36 19.32 947.36 - 757.48 18.95 37.55 - - 907.46 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,096.80 " 16.84 - 48.21 16.19 560.74 " 1,028.25 " 521.12 613.25 19.04 36945311 RIA NON INF AGT AB/AG QNT 83519 300 "$1,371.00" 506.72 - " 1,096.80 " - 947.36 19.32 947.36 - 757.48 18.95 37.55 - - 907.46 16.56 18.40 87.13 108.91 18.86 18.95 18.40 " 1,096.80 " 16.84 - 48.21 16.19 560.74 " 1,028.25 " 521.12 613.25 19.04 36150238 ANIT-PROTEINASE 3A 83520 300 $91.00 33.63 - 74.18 - 62.88 18.13 62.88 - 50.28 17.79 35.98 - - 60.23 15.54 17.27 59.34 74.18 17.70 17.79 17.27 72.80 15.80 - 45.25 15.20 37.22 68.25 34.59 40.70 17.87 36150246 ANTI-MYELOPEROXIDASE 83520 300 $91.00 33.63 - 74.18 - 62.88 18.13 62.88 - 50.28 17.79 35.98 - - 60.23 15.54 17.27 59.34 74.18 17.70 17.79 17.27 72.80 15.80 - 45.25 15.20 37.22 68.25 34.59 40.70 17.87 36150289 GLIADIN IGG ANTIBODY 83520 300 $91.00 33.63 - 74.18 - 62.88 18.13 62.88 - 50.28 17.79 35.98 - - 60.23 15.54 17.27 59.34 74.18 17.70 17.79 17.27 72.80 15.80 - 45.25 15.20 37.22 68.25 34.59 40.70 17.87 36150297 GLIADIN IGA ANTIBODY 83520 300 $91.00 33.63 - 74.18 - 62.88 18.13 62.88 - 50.28 17.79 35.98 - - 60.23 15.54 17.27 59.34 74.18 17.70 17.79 17.27 72.80 15.80 - 45.25 15.20 37.22 68.25 34.59 40.70 17.87 36150301 TIS TRNSGLU (ENDOMYSIAL A AB) 83520 300 $91.00 33.63 - 74.18 - 62.88 18.13 62.88 - 50.28 17.79 35.98 - - 60.23 15.54 17.27 59.34 74.18 17.70 17.79 17.27 72.80 15.80 - 45.25 15.20 37.22 68.25 34.59 40.70 17.87 36900571 GLOMER BASE MEMB IGG AB IMMUNO 83520 300 $208.00 76.88 - 166.40 - 143.73 18.13 143.73 - 114.92 17.79 35.98 - - 137.68 15.54 17.27 59.34 74.18 17.70 17.79 17.27 166.40 15.80 - 45.25 15.20 85.07 156.00 79.06 93.04 17.87 36905298 MYELIN ASSOC GLYCOPROTEIN 83520 300 "$2,277.00" 841.58 - " 1,821.60 " - " 1,573.41 " 18.13 " 1,573.41 " - " 1,258.04 " 17.79 35.98 - - " 1,507.15 " 15.54 17.27 59.34 74.18 17.70 17.79 17.27 " 1,821.60 " 15.80 - 45.25 15.20 931.29 " 1,707.75 " 865.49 " 1,018.50 " 17.87 36911581 INTERLEUKIN 6 EIA 83520 300 "$1,388.00" 513.00 - " 1,110.40 " - 959.11 18.13 959.11 - 766.87 17.79 35.98 - - 918.72 15.54 17.27 59.34 74.18 17.70 17.79 17.27 " 1,110.40 " 15.80 - 45.25 15.20 567.69 " 1,041.00 " 527.58 620.85 17.87 36913223 SGPG SINGLE ANTIGEN TEST 83520 300 "$2,277.00" 841.58 - " 1,821.60 " - " 1,573.41 " 18.13 " 1,573.41 " - " 1,258.04 " 17.79 35.98 - - " 1,507.15 " 15.54 17.27 59.34 74.18 17.70 17.79 17.27 " 1,821.60 " 15.80 - 45.25 15.20 931.29 " 1,707.75 " 865.49 " 1,018.50 " 17.87 36913274 SULFATIDE AB IGG 83520 300 $782.00 289.03 - 625.60 - 540.36 18.13 540.36 - 432.06 17.79 35.98 - - 517.61 15.54 17.27 59.34 74.18 17.70 17.79 17.27 625.60 15.80 - 45.25 15.20 319.84 586.50 297.24 349.79 17.87 36913282 SULFATIDE AB IGM 83520 300 $782.00 289.03 - 625.60 - 540.36 18.13 540.36 - 432.06 17.79 35.98 - - 517.61 15.54 17.27 59.34 74.18 17.70 17.79 17.27 625.60 15.80 - 45.25 15.20 319.84 586.50 297.24 349.79 17.87 36913291 IMMUNOASSAY CO-GM1 83520 300 $782.00 289.03 - 625.60 - 540.36 18.13 540.36 - 432.06 17.79 35.98 - - 517.61 15.54 17.27 59.34 74.18 17.70 17.79 17.27 625.60 15.80 - 45.25 15.20 319.84 586.50 297.24 349.79 17.87 36913304 MYELIN ASSOC GLYCOPROTEIN 83520 300 $782.00 289.03 - 625.60 - 540.36 18.13 540.36 - 432.06 17.79 35.98 - - 517.61 15.54 17.27 59.34 74.18 17.70 17.79 17.27 625.60 15.80 - 45.25 15.20 319.84 586.50 297.24 349.79 17.87 36913312 SGPG SINGLE ANTIGEN TEST 83520 300 $782.00 289.03 - 625.60 - 540.36 18.13 540.36 - 432.06 17.79 35.98 - - 517.61 15.54 17.27 59.34 74.18 17.70 17.79 17.27 625.60 15.80 - 45.25 15.20 319.84 586.50 297.24 349.79 17.87 36913347 IMMUNOASSAY CO-ASIALO-GM1 TITR 83520 300 $782.00 289.03 - 625.60 - 540.36 18.13 540.36 - 432.06 17.79 35.98 - - 517.61 15.54 17.27 59.34 74.18 17.70 17.79 17.27 625.60 15.80 - 45.25 15.20 319.84 586.50 297.24 349.79 17.87 36913355 IMMUNOASSAY CO-GD1B TITER 83520 300 $782.00 289.03 - 625.60 - 540.36 18.13 540.36 - 432.06 17.79 35.98 - - 517.61 15.54 17.27 59.34 74.18 17.70 17.79 17.27 625.60 15.80 - 45.25 15.20 319.84 586.50 297.24 349.79 17.87 36913371 IMMUNOASSAY GALOP ANTIBODY 83520 300 $782.00 289.03 - 625.60 - 540.36 18.13 540.36 - 432.06 17.79 35.98 - - 517.61 15.54 17.27 59.34 74.18 17.70 17.79 17.27 625.60 15.80 - 45.25 15.20 319.84 586.50 297.24 349.79 17.87 36913380 IMMUNOASSAY GALOP ANTIBODY 83520 300 $782.00 289.03 - 625.60 - 540.36 18.13 540.36 - 432.06 17.79 35.98 - - 517.61 15.54 17.27 59.34 74.18 17.70 17.79 17.27 625.60 15.80 - 45.25 15.20 319.84 586.50 297.24 349.79 17.87 36917369 SOLUBLE TRANSFERRIN RECEPTOR 83520 300 $714.00 263.89 - 571.20 - 493.37 18.13 493.37 - 394.49 17.79 35.98 - - 472.60 15.54 17.27 59.34 74.18 17.70 17.79 17.27 571.20 15.80 - 45.25 15.20 292.03 535.50 271.39 319.37 17.87 36917920 ANTI GM1 ANTIBODY 83520 300 $521.00 192.56 - 416.80 - 360.01 18.13 360.01 - 287.85 17.79 35.98 - - 344.85 15.54 17.27 59.34 74.18 17.70 17.79 17.27 416.80 15.80 - 45.25 15.20 213.09 390.75 198.03 233.04 17.87 36917946 ANTI SULFATIDE ANTIBODY 83520 300 $521.00 192.56 - 416.80 - 360.01 18.13 360.01 - 287.85 17.79 35.98 - - 344.85 15.54 17.27 59.34 74.18 17.70 17.79 17.27 416.80 15.80 - 45.25 15.20 213.09 390.75 198.03 233.04 17.87 36917954 ANTI-SGPG ANTIBODY/WB CONFIRM 83520 300 $521.00 192.56 - 416.80 - 360.01 18.13 360.01 - 287.85 17.79 35.98 - - 344.85 15.54 17.27 59.34 74.18 17.70 17.79 17.27 416.80 15.80 - 45.25 15.20 213.09 390.75 198.03 233.04 17.87 36917962 ANTI MAG ANTIBODY 83520 300 $521.00 192.56 - 416.80 - 360.01 18.13 360.01 - 287.85 17.79 35.98 - - 344.85 15.54 17.27 59.34 74.18 17.70 17.79 17.27 416.80 15.80 - 45.25 15.20 213.09 390.75 198.03 233.04 17.87 36917971 ANTI-HU ANTIBODY 83520 300 $521.00 192.56 - 416.80 - 360.01 18.13 360.01 - 287.85 17.79 35.98 - - 344.85 15.54 17.27 59.34 74.18 17.70 17.79 17.27 416.80 15.80 - 45.25 15.20 213.09 390.75 198.03 233.04 17.87 36918187 HU ATO AB QUANT NS 83520 300 "$1,014.00" 374.77 - 811.20 - 700.67 18.13 700.67 - 560.24 17.79 35.98 - - 671.17 15.54 17.27 59.34 74.18 17.70 17.79 17.27 811.20 15.80 - 45.25 15.20 414.73 760.50 385.42 453.56 17.87 36918926 SULFATIDE IGM QUANT ELISA 83520 300 $974.00 359.99 - 779.20 - 673.03 18.13 673.03 - 538.14 17.79 35.98 - - 644.69 15.54 17.27 59.34 74.18 17.70 17.79 17.27 779.20 15.80 - 45.25 15.20 398.37 730.50 370.22 435.67 17.87 36918934 SULFATIDE IGG QUANT ELISA 83520 300 $974.00 359.99 - 779.20 - 673.03 18.13 673.03 - 538.14 17.79 35.98 - - 644.69 15.54 17.27 59.34 74.18 17.70 17.79 17.27 779.20 15.80 - 45.25 15.20 398.37 730.50 370.22 435.67 17.87 36920831 GM1-ELISA 83520 300 "$1,141.00" 421.71 - 912.80 - 788.43 18.13 788.43 - 630.40 17.79 35.98 - - 755.23 15.54 17.27 59.34 74.18 17.70 17.79 17.27 912.80 15.80 - 45.25 15.20 466.67 855.75 433.69 510.37 17.87 36920840 ASIALO GM1 ELISA 83520 300 "$1,164.00" 430.21 - 931.20 - 804.32 18.13 804.32 - 643.11 17.79 35.98 - - 770.45 15.54 17.27 59.34 74.18 17.70 17.79 17.27 931.20 15.80 - 45.25 15.20 476.08 873.00 442.44 520.66 17.87 36920858 GD1B ELISA 83520 300 "$1,164.00" 430.21 - 931.20 - 804.32 18.13 804.32 - 643.11 17.79 35.98 - - 770.45 15.54 17.27 59.34 74.18 17.70 17.79 17.27 931.20 15.80 - 45.25 15.20 476.08 873.00 442.44 520.66 17.87 36920866 SGPG ELISA 83520 300 "$1,164.00" 430.21 - 931.20 - 804.32 18.13 804.32 - 643.11 17.79 35.98 - - 770.45 15.54 17.27 59.34 74.18 17.70 17.79 17.27 931.20 15.80 - 45.25 15.20 476.08 873.00 442.44 520.66 17.87 36920874 MAG ELISA 83520 300 "$1,160.00" 428.74 - 928.00 - 801.56 18.13 801.56 - 640.90 17.79 35.98 - - 767.80 15.54 17.27 59.34 74.18 17.70 17.79 17.27 928.00 15.80 - 45.25 15.20 474.44 870.00 440.92 518.87 17.87 36922079 IMMUNOASSAY QUANT 83520 300 $973.00 359.62 - 778.40 - 672.34 18.13 672.34 - 537.58 17.79 35.98 - - 644.03 15.54 17.27 59.34 74.18 17.70 17.79 17.27 778.40 15.80 - 45.25 15.20 397.96 729.75 369.84 435.22 17.87 36922303 TRYPTASE EIA QUANT 83520 300 $344.00 127.14 - 275.20 - 237.70 18.13 237.70 - 190.06 17.79 35.98 - - 227.69 15.54 17.27 59.34 74.18 17.70 17.79 17.27 275.20 15.80 - 45.25 15.20 140.70 258.00 130.75 153.87 17.87 36922320 INHIBIN B ELISA QUANT 83520 300 $871.00 321.92 - 696.80 - 601.86 18.13 601.86 - 481.23 17.79 35.98 - - 576.51 15.54 17.27 59.34 74.18 17.70 17.79 17.27 696.80 15.80 - 45.25 15.20 356.24 653.25 331.07 389.60 17.87 36923016 ANTI ASIALO GM1 ANTIBODY 83520 300 $521.00 192.56 - 416.80 - 360.01 18.13 360.01 - 287.85 17.79 35.98 - - 344.85 15.54 17.27 59.34 74.18 17.70 17.79 17.27 416.80 15.80 - 45.25 15.20 213.09 390.75 198.03 233.04 17.87 36923024 ANTI GD1B ANTIBODY 83520 300 $521.00 192.56 - 416.80 - 360.01 18.13 360.01 - 287.85 17.79 35.98 - - 344.85 15.54 17.27 59.34 74.18 17.70 17.79 17.27 416.80 15.80 - 45.25 15.20 213.09 390.75 198.03 233.04 17.87 36923032 ANTI CQ1B ANTIBODY 83520 300 $521.00 192.56 - 416.80 - 360.01 18.13 360.01 - 287.85 17.79 35.98 - - 344.85 15.54 17.27 59.34 74.18 17.70 17.79 17.27 416.80 15.80 - 45.25 15.20 213.09 390.75 198.03 233.04 17.87 36924748 ADIPONECTIN IMMUNOASSAY QUANT 83520 300 $857.00 316.75 - 685.60 - 592.19 18.13 592.19 - 473.49 17.79 35.98 - - 567.25 15.54 17.27 59.34 74.18 17.70 17.79 17.27 685.60 15.80 - 45.25 15.20 350.51 642.75 325.75 383.34 17.87 36926058 ANTI GD1A 83520 300 $782.00 289.03 - 625.60 - 540.36 18.13 540.36 - 432.06 17.79 35.98 - - 517.61 15.54 17.27 59.34 74.18 17.70 17.79 17.27 625.60 15.80 - 45.25 15.20 319.84 586.50 297.24 349.79 17.87 36926066 ANTI HU ANTIBODY RECOMB 83520 300 $782.00 289.03 - 625.60 - 540.36 18.13 540.36 - 432.06 17.79 35.98 - - 517.61 15.54 17.27 59.34 74.18 17.70 17.79 17.27 625.60 15.80 - 45.25 15.20 319.84 586.50 297.24 349.79 17.87 36930861 ADAMTS 13 AB QNT IMMUNOASSAY 83520 300 $890.00 328.94 - 712.00 - 614.99 18.13 614.99 - 491.73 17.79 35.98 - - 589.09 15.54 17.27 59.34 74.18 17.70 17.79 17.27 712.00 15.80 - 45.25 15.20 364.01 667.50 338.29 398.10 17.87 36932953 GD1A ELISA 83520 300 "$1,160.00" 428.74 - 928.00 - 801.56 18.13 801.56 - 640.90 17.79 35.98 - - 767.80 15.54 17.27 59.34 74.18 17.70 17.79 17.27 928.00 15.80 - 45.25 15.20 474.44 870.00 440.92 518.87 17.87 36933321 MAG SGPG AB IGM EIA QNT 83520 300 $182.00 67.27 - 145.60 - 125.76 18.13 125.76 - 100.56 17.79 35.98 - - 120.47 15.54 17.27 59.34 74.18 17.70 17.79 17.27 145.60 15.80 - 45.25 15.20 74.44 136.50 69.18 81.41 17.87 36933330 MYELIN ASSC GLY AB IGM EIA QNT 83520 300 $509.00 188.13 - 407.20 - 351.72 18.13 351.72 - 281.22 17.79 35.98 - - 336.91 15.54 17.27 59.34 74.18 17.70 17.79 17.27 407.20 15.80 - 45.25 15.20 208.18 381.75 193.47 227.68 17.87 36933364 MAG SGPG AB QUANT NS 83520 300 $621.00 229.52 - 496.80 - 429.11 18.13 429.11 - 343.10 17.79 35.98 - - 411.04 15.54 17.27 59.34 74.18 17.70 17.79 17.27 496.80 15.80 - 45.25 15.20 253.99 465.75 236.04 277.77 17.87 36933372 MAG AB QUANT NS 83520 300 $621.00 229.52 - 496.80 - 429.11 18.13 429.11 - 343.10 17.79 35.98 - - 411.04 15.54 17.27 59.34 74.18 17.70 17.79 17.27 496.80 15.80 - 45.25 15.20 253.99 465.75 236.04 277.77 17.87 36933593 MATA COMB AUTO AB WB PROBE 83520 300 "$2,404.00" 888.52 - " 1,923.20 " - " 1,661.16 " 18.13 " 1,661.16 " - " 1,328.21 " 17.79 35.98 - - " 1,591.21 " 15.54 17.27 59.34 74.18 17.70 17.79 17.27 " 1,923.20 " 15.80 - 45.25 15.20 983.24 " 1,803.00 " 913.76 " 1,075.31 " 17.87 36933607 GQIB AB IMMUNO QNT NOT SPEC 83520 300 "$1,527.00" 564.38 - " 1,221.60 " - " 1,055.16 " 18.13 " 1,055.16 " - 843.67 17.79 35.98 - - " 1,010.72 " 15.54 17.27 59.34 74.18 17.70 17.79 17.27 " 1,221.60 " 15.80 - 45.25 15.20 624.54 " 1,145.25 " 580.41 683.03 17.87 36933615 CV2 AUTO AB WB IMM PROBE 83520 300 "$1,760.00" 650.50 - " 1,408.00 " - " 1,216.16 " 18.13 " 1,216.16 " - 972.40 17.79 35.98 - - " 1,164.94 " 15.54 17.27 59.34 74.18 17.70 17.79 17.27 " 1,408.00 " 15.80 - 45.25 15.20 719.84 " 1,320.00 " 668.98 787.25 17.87 36933623 ZIC4 AB WB IMM PROBE 83520 300 "$1,760.00" 650.50 - " 1,408.00 " - " 1,216.16 " 18.13 " 1,216.16 " - 972.40 17.79 35.98 - - " 1,164.94 " 15.54 17.27 59.34 74.18 17.70 17.79 17.27 " 1,408.00 " 15.80 - 45.25 15.20 719.84 " 1,320.00 " 668.98 787.25 17.87 36933631 AMPHIPHYSIN AB WESTERN BLOT 83520 300 "$1,879.00" 694.48 - " 1,503.20 " - " 1,298.39 " 18.13 " 1,298.39 " - " 1,038.15 " 17.79 35.98 - - " 1,243.71 " 15.54 17.27 59.34 74.18 17.70 17.79 17.27 " 1,503.20 " 15.80 - 45.25 15.20 768.51 " 1,409.25 " 714.21 840.48 17.87 36933640 GD1A AB IMMUNO QNT NOT SPEC 83520 300 "$2,169.00" 801.66 - " 1,735.20 " - " 1,498.78 " 18.13 " 1,498.78 " - " 1,198.37 " 17.79 35.98 - - " 1,435.66 " 15.54 17.27 59.34 74.18 17.70 17.79 17.27 " 1,735.20 " 15.80 - 45.25 15.20 887.12 " 1,626.75 " 824.44 970.19 17.87 36933666 IMMUNOASSAY QUANT NOT SPEC 83520 300 "$1,503.00" 555.51 - " 1,202.40 " - " 1,038.57 " 18.13 " 1,038.57 " - 830.41 17.79 35.98 - - 994.84 15.54 17.27 59.34 74.18 17.70 17.79 17.27 " 1,202.40 " 15.80 - 45.25 15.20 614.73 " 1,127.25 " 571.29 672.29 17.87 36933674 IMMUNOASSAY QUANT NOT SPEC 83520 300 "$1,503.00" 555.51 - " 1,202.40 " - " 1,038.57 " 18.13 " 1,038.57 " - 830.41 17.79 35.98 - - 994.84 15.54 17.27 59.34 74.18 17.70 17.79 17.27 " 1,202.40 " 15.80 - 45.25 15.20 614.73 " 1,127.25 " 571.29 672.29 17.87 36933682 IMMUNOASSAY QUANT NOT SPEC 83520 300 "$1,503.00" 555.51 - " 1,202.40 " - " 1,038.57 " 18.13 " 1,038.57 " - 830.41 17.79 35.98 - - 994.84 15.54 17.27 59.34 74.18 17.70 17.79 17.27 " 1,202.40 " 15.80 - 45.25 15.20 614.73 " 1,127.25 " 571.29 672.29 17.87 36934379 IMMUNOASSAY QUANT NS 83520 300 "$1,427.00" 527.42 - " 1,141.60 " - 986.06 18.13 986.06 - 788.42 17.79 35.98 - - 944.53 15.54 17.27 59.34 74.18 17.70 17.79 17.27 " 1,141.60 " 15.80 - 45.25 15.20 583.64 " 1,070.25 " 542.40 638.30 17.87 36934387 IMMUNOASSAY QUANT NS 83520 300 "$1,427.00" 527.42 - " 1,141.60 " - 986.06 18.13 986.06 - 788.42 17.79 35.98 - - 944.53 15.54 17.27 59.34 74.18 17.70 17.79 17.27 " 1,141.60 " 15.80 - 45.25 15.20 583.64 " 1,070.25 " 542.40 638.30 17.87 36934417 VASC ENDO GROWTH FAC IMM QNT 83520 300 $783.00 289.40 - 626.40 - 541.05 18.13 541.05 - 432.61 17.79 35.98 - - 518.27 15.54 17.27 59.34 74.18 17.70 17.79 17.27 626.40 15.80 - 45.25 15.20 320.25 587.25 297.62 350.24 17.87 36934531 ANTI-MULLERIAN HORMONE QNT NS 83520 300 $583.00 215.48 - 466.40 - 402.85 18.13 402.85 - 322.11 17.79 35.98 - - 385.89 15.54 17.27 59.34 74.18 17.70 17.79 17.27 466.40 15.80 - 45.25 15.20 238.45 437.25 221.60 260.78 17.87 36936142 IMMUNOASSAY QNT NOT SPEC 83520 300 $534.00 197.37 - 427.20 - 368.99 18.13 368.99 - 295.04 17.79 35.98 - - 353.45 15.54 17.27 59.34 74.18 17.70 17.79 17.27 427.20 15.80 - 45.25 15.20 218.41 400.50 202.97 238.86 17.87 36936151 IMMUNOASSAY QNT NOT SPEC 83520 300 $534.00 197.37 - 427.20 - 368.99 18.13 368.99 - 295.04 17.79 35.98 - - 353.45 15.54 17.27 59.34 74.18 17.70 17.79 17.27 427.20 15.80 - 45.25 15.20 218.41 400.50 202.97 238.86 17.87 36937106 IMMUNO QUANT NS 83520 300 $588.00 217.32 - 470.40 - 406.31 18.13 406.31 - 324.87 17.79 35.98 - - 389.20 15.54 17.27 59.34 74.18 17.70 17.79 17.27 470.40 15.80 - 45.25 15.20 240.49 441.00 223.50 263.01 17.87 36938056 CAR RECOVERIN AB WEST BLOT 83520 300 "$1,588.00" 586.92 - " 1,270.40 " - " 1,097.31 " 18.13 " 1,097.31 " - 877.37 17.79 35.98 - - " 1,051.10 " 15.54 17.27 59.34 74.18 17.70 17.79 17.27 " 1,270.40 " 15.80 - 45.25 15.20 649.49 " 1,191.00 " 603.60 710.31 17.87 36938111 IMMUNO QUANT NOS 83520 300 $443.00 163.73 - 354.40 - 306.11 18.13 306.11 - 244.76 17.79 35.98 - - 293.22 15.54 17.27 59.34 74.18 17.70 17.79 17.27 354.40 15.80 - 45.25 15.20 181.19 332.25 168.38 198.15 17.87 36938561 RNA POLYMERASE III AB 83520 300 $293.00 108.29 - 234.40 - 202.46 18.13 202.46 - 161.88 17.79 35.98 - - 193.94 15.54 17.27 59.34 74.18 17.70 17.79 17.27 234.40 15.80 - 45.25 15.20 119.84 219.75 111.37 131.06 17.87 36939478 RECOMBX HU AB IMMUNOASSAY 83520 300 "$2,748.00" " 1,015.66 " - " 2,198.40 " - " 1,898.87 " 18.13 " 1,898.87 " - " 1,518.27 " 17.79 35.98 - - " 1,818.90 " 15.54 17.27 59.34 74.18 17.70 17.79 17.27 " 2,198.40 " 15.80 - 45.25 15.20 " 1,123.93 " " 2,061.00 " " 1,044.51 " " 1,229.18 " 17.87 36941090 TRYPSIN QUANT NOS 83520 300 $364.00 134.53 - 291.20 - 251.52 18.13 251.52 - 201.11 17.79 35.98 - - 240.93 15.54 17.27 59.34 74.18 17.70 17.79 17.27 291.20 15.80 - 45.25 15.20 148.88 273.00 138.36 162.82 17.87 36941103 HMGCR ANTIBODIES 83520 300 "$1,030.00" 380.69 - 824.00 - 711.73 18.13 711.73 - 569.08 17.79 35.98 - - 681.76 15.54 17.27 59.34 74.18 17.70 17.79 17.27 824.00 15.80 - 45.25 15.20 421.27 772.50 391.50 460.72 17.87 36943998 MAG SGPG AB IA QUANT NOS 83520 300 $139.00 51.37 - 111.20 - 96.05 18.13 96.05 - 76.80 17.79 35.98 - - 92.00 15.54 17.27 59.34 74.18 17.70 17.79 17.27 111.20 15.80 - 45.25 15.20 56.85 104.25 52.83 62.17 17.87 36944005 MAG AB IA QUANT NOS 83520 300 $360.00 133.06 - 288.00 - 248.76 18.13 248.76 - 198.90 17.79 35.98 - - 238.28 15.54 17.27 59.34 74.18 17.70 17.79 17.27 288.00 15.80 - 45.25 15.20 147.24 270.00 136.84 161.03 17.87 36944111 IMMUNOASSAY QUANT NOS NONAB 83520 300 "$2,030.00" 750.29 - " 1,624.00 " - " 1,402.73 " 18.13 " 1,402.73 " - " 1,121.58 " 17.79 35.98 - - " 1,343.66 " 15.54 17.27 59.34 74.18 17.70 17.79 17.27 " 1,624.00 " 15.80 - 45.25 15.20 830.27 " 1,522.50 " 771.60 908.02 17.87 36944552 IA ANALYTE QNT NOS NONAB INFLX 83520 300 $739.00 273.13 - 591.20 - 510.65 18.13 510.65 - 408.30 17.79 35.98 - - 489.14 15.54 17.27 59.34 74.18 17.70 17.79 17.27 591.20 15.80 - 45.25 15.20 302.25 554.25 280.89 330.55 17.87 36944595 IA ANALYTE QNT NOS ADALIM 83520 300 $739.00 273.13 - 591.20 - 510.65 18.13 510.65 - 408.30 17.79 35.98 - - 489.14 15.54 17.27 59.34 74.18 17.70 17.79 17.27 591.20 15.80 - 45.25 15.20 302.25 554.25 280.89 330.55 17.87 36944951 IA ANALYTE QT NOS ANTI IGE IGG 83520 300 $129.00 47.68 - 103.20 - 89.14 18.13 89.14 - 71.27 17.79 35.98 - - 85.39 15.54 17.27 59.34 74.18 17.70 17.79 17.27 103.20 15.80 - 45.25 15.20 52.76 96.75 49.03 57.70 17.87 36945320 CHEMILUMIN ASSAY HMG COA AB 83520 300 $856.00 316.38 - 684.80 - 591.50 18.13 591.50 - 472.94 17.79 35.98 - - 566.59 15.54 17.27 59.34 74.18 17.70 17.79 17.27 684.80 15.80 - 45.25 15.20 350.10 642.00 325.37 382.89 17.87 36945508 IA NONINF AB/AG QUANT NOS 83520 300 $91.00 33.63 - 74.18 - 62.88 18.13 62.88 - 50.28 17.79 35.98 - - 60.23 15.54 17.27 59.34 74.18 17.70 17.79 17.27 72.80 15.80 - 45.25 15.20 37.22 68.25 34.59 40.70 17.87 36982535 TSH RECEPTOR BINDING AB IA QNT 83520 300 $91.00 33.63 - 74.18 - 62.88 18.13 62.88 - 50.28 17.79 35.98 - - 60.23 15.54 17.27 59.34 74.18 17.70 17.79 17.27 72.80 15.80 - 45.25 15.20 37.22 68.25 34.59 40.70 17.87 35708227 INSULIN TOTAL 83525 300 $60.00 22.18 10.06 65.53 12.65 41.46 12.00 41.46 11.00 33.15 11.77 31.78 12.10 11.00 39.71 10.29 11.43 52.42 65.53 11.72 11.77 11.43 48.00 10.46 11.00 29.95 10.06 24.54 45.00 22.81 26.84 11.83 36905701 INSULIN FREE 83527 300 $289.00 106.81 11.40 231.20 20.59 199.70 13.60 199.70 17.90 159.67 13.34 36.02 19.69 17.90 191.29 11.66 12.95 84.22 105.27 13.27 13.34 12.95 231.20 11.85 17.90 33.93 11.40 118.20 216.75 109.85 129.27 13.40 35700951 IRON TOTAL 83540 300 $34.00 12.57 5.69 37.15 9.72 23.49 6.79 23.49 8.45 18.79 6.66 17.99 9.30 8.45 22.50 5.82 6.47 29.72 37.15 6.63 6.66 6.47 27.20 5.92 8.45 16.95 5.69 13.91 25.50 12.92 15.21 6.70 36904399 IRON LIVER TISSUE 83540 300 $228.00 84.27 5.69 182.40 9.72 157.55 6.79 157.55 8.45 125.97 6.66 17.99 9.30 8.45 150.91 5.82 6.47 29.72 37.15 6.63 6.66 6.47 182.40 5.92 8.45 16.95 5.69 93.25 171.00 86.66 101.98 6.70 36911085 IRON 24 HR URINE 83540 300 $441.00 162.99 5.69 352.80 9.72 304.73 6.79 304.73 8.45 243.65 6.66 17.99 9.30 8.45 291.90 5.82 6.47 29.72 37.15 6.63 6.66 6.47 352.80 5.92 8.45 16.95 5.69 180.37 330.75 167.62 197.26 6.70 35700943 IRON BINDING CAPACITY 83550 300 $46.00 17.00 5.00 50.49 5.75 31.79 9.18 31.79 5.00 25.42 9.00 24.30 5.50 5.00 30.45 7.87 8.74 40.39 50.49 8.96 9.00 8.74 36.80 8.00 5.00 22.90 7.69 18.81 34.50 17.48 20.58 9.05 36902876 17-KETOSTEROIDS 24 HR URINE 83586 300 $184.00 68.01 11.26 147.20 20.34 127.14 13.44 127.14 17.69 101.66 13.18 35.61 19.46 17.69 121.79 11.52 12.80 58.69 73.36 13.12 13.18 12.80 147.20 11.71 17.69 33.54 11.26 75.26 138.00 69.94 82.30 13.25 36940484 KETOSTEROIDS 17 TOTAL 83586 300 $102.00 37.70 11.26 81.60 20.34 70.48 13.44 70.48 17.69 56.36 13.18 35.61 19.46 17.69 67.51 11.52 12.80 58.69 73.36 13.12 13.18 12.80 81.60 11.71 17.69 33.54 11.26 41.72 76.50 38.77 45.62 13.25 35200762 LACTATE (LACTIC ACID) I-STAT 83605 300 $61.00 22.55 8.00 86.03 9.20 42.15 12.15 42.15 8.00 33.70 11.92 29.70 8.80 8.00 40.38 10.41 11.57 68.82 86.03 11.86 11.92 11.57 48.80 10.59 8.00 30.31 10.18 24.95 45.75 23.19 27.29 11.97 35200860 LACTATE EPOC 83605 300 $61.00 22.55 8.00 86.03 9.20 42.15 12.15 42.15 8.00 33.70 11.92 29.70 8.80 8.00 40.38 10.41 11.57 68.82 86.03 11.86 11.92 11.57 48.80 10.59 8.00 30.31 10.18 24.95 45.75 23.19 27.29 11.97 35700978 LACTIC ACID 83605 300 $61.00 22.55 8.00 86.03 9.20 42.15 12.15 42.15 8.00 33.70 11.92 29.70 8.80 8.00 40.38 10.41 11.57 68.82 86.03 11.86 11.92 11.57 48.80 10.59 8.00 30.31 10.18 24.95 45.75 23.19 27.29 11.97 35703225 LACTATE WHOLE BLOOD 83605 300 $61.00 22.55 8.00 86.03 9.20 42.15 12.15 42.15 8.00 33.70 11.92 29.70 8.80 8.00 40.38 10.41 11.57 68.82 86.03 11.86 11.92 11.57 48.80 10.59 8.00 30.31 10.18 24.95 45.75 23.19 27.29 11.97 35705481 LACTIC ACID FLUID 83605 300 $61.00 22.55 8.00 86.03 9.20 42.15 12.15 42.15 8.00 33.70 11.92 29.70 8.80 8.00 40.38 10.41 11.57 68.82 86.03 11.86 11.92 11.57 48.80 10.59 8.00 30.31 10.18 24.95 45.75 23.19 27.29 11.97 35700986 LD 83615 300 $32.00 11.83 5.32 34.50 8.27 22.11 6.34 22.11 7.19 17.68 6.22 16.77 7.91 7.19 21.18 5.44 6.04 27.60 34.50 6.19 6.22 6.04 25.60 5.53 7.19 15.82 5.32 13.09 24.00 12.16 14.31 6.25 35705490 LD FLUID 83615 300 $32.00 11.83 5.32 34.50 8.27 22.11 6.34 22.11 7.19 17.68 6.22 16.77 7.91 7.19 21.18 5.44 6.04 27.60 34.50 6.19 6.22 6.04 25.60 5.53 7.19 15.82 5.32 13.09 24.00 12.16 14.31 6.25 36912880 LACTATE DEHYDROGENASE 83615 300 $108.00 39.92 5.32 86.40 8.27 74.63 6.34 74.63 7.19 59.67 6.22 16.77 7.91 7.19 71.49 5.44 6.04 27.60 34.50 6.19 6.22 6.04 86.40 5.53 7.19 15.82 5.32 44.17 81.00 41.05 48.31 6.25 36912898 SEPAR & QUANT ISOENZYMES 83625 300 $229.00 84.64 11.00 183.20 12.65 158.24 13.43 158.24 11.00 126.52 13.17 35.58 12.10 11.00 151.58 11.51 12.79 58.55 73.19 13.11 13.17 12.79 183.20 11.70 11.00 33.51 11.26 93.66 171.75 87.04 102.43 13.24 36303794 FECAL LEUKOCYTE EIA 83630 300 $103.00 38.07 12.31 87.63 14.16 71.17 20.69 71.17 12.31 56.91 20.29 54.57 13.54 12.31 68.18 17.73 19.70 70.10 87.63 20.19 20.29 19.70 82.40 18.03 12.31 51.61 17.34 42.13 77.25 39.15 46.07 20.39 35702580 LEAD 83655 300 $64.00 23.65 10.00 69.33 11.50 44.22 12.72 44.22 10.00 35.36 12.47 33.66 11.00 10.00 42.36 10.90 12.11 55.46 69.33 12.41 12.47 12.11 51.20 11.08 10.00 31.73 10.66 26.18 48.00 24.33 28.63 12.53 35705970 LEAD MICRO 83655 300 $64.00 23.65 10.00 69.33 11.50 44.22 12.72 44.22 10.00 35.36 12.47 33.66 11.00 10.00 42.36 10.90 12.11 55.46 69.33 12.41 12.47 12.11 51.20 11.08 10.00 31.73 10.66 26.18 48.00 24.33 28.63 12.53 36900261 LEAD 24 HOUR URINE 83655 300 $103.00 38.07 10.00 82.40 11.50 71.17 12.72 71.17 10.00 56.91 12.47 33.66 11.00 10.00 68.18 10.90 12.11 55.46 69.33 12.41 12.47 12.11 82.40 11.08 10.00 31.73 10.66 42.13 77.25 39.15 46.07 12.53 36911701 LEAD 83655 300 $103.00 38.07 10.00 82.40 11.50 71.17 12.72 71.17 10.00 56.91 12.47 33.66 11.00 10.00 68.18 10.90 12.11 55.46 69.33 12.41 12.47 12.11 82.40 11.08 10.00 31.73 10.66 42.13 77.25 39.15 46.07 12.53 36934263 LEAD (SEND OUT) 83655 300 $103.00 38.07 10.00 82.40 11.50 71.17 12.72 71.17 10.00 56.91 12.47 33.66 11.00 10.00 68.18 10.90 12.11 55.46 69.33 12.41 12.47 12.11 82.40 11.08 10.00 31.73 10.66 42.13 77.25 39.15 46.07 12.53 36937769 LEAD 83655 300 $103.00 38.07 10.00 82.40 11.50 71.17 12.72 71.17 10.00 56.91 12.47 33.66 11.00 10.00 68.18 10.90 12.11 55.46 69.33 12.41 12.47 12.11 82.40 11.08 10.00 31.73 10.66 42.13 77.25 39.15 46.07 12.53 36937955 LEAD URINE 83655 300 $103.00 38.07 10.00 82.40 11.50 71.17 12.72 71.17 10.00 56.91 12.47 33.66 11.00 10.00 68.18 10.90 12.11 55.46 69.33 12.41 12.47 12.11 82.40 11.08 10.00 31.73 10.66 42.13 77.25 39.15 46.07 12.53 36945478 LEAD BLOOD 83655 300 $64.00 23.65 10.00 69.33 11.50 44.22 12.72 44.22 10.00 35.36 12.47 33.66 11.00 10.00 42.36 10.90 12.11 55.46 69.33 12.41 12.47 12.11 51.20 11.08 10.00 31.73 10.66 26.18 48.00 24.33 28.63 12.53 35703471 L/S RATIO-EXP 83661 300 $115.00 42.50 19.35 177.14 25.30 79.47 23.09 79.47 22.00 63.54 22.65 61.14 24.20 22.00 76.12 19.79 21.99 141.71 177.14 22.54 22.65 21.99 92.00 20.12 22.00 57.61 19.35 47.04 86.25 43.71 51.44 22.76 36937211 L/S RATIO-FETAL LUNG 83661 300 $153.00 56.55 19.35 177.14 25.30 105.72 23.09 105.72 22.00 84.53 22.65 61.14 24.20 22.00 101.27 19.79 21.99 141.71 177.14 22.54 22.65 21.99 122.40 20.12 22.00 57.61 19.35 62.58 114.75 58.16 68.44 22.76 35709479 FET LUNG:LAMELLAR BODY DENSITY 83664 300 $101.00 37.33 5.22 80.80 6.00 69.79 20.29 69.79 5.22 55.80 19.90 52.56 5.74 5.22 66.85 17.39 19.32 29.76 37.20 19.80 19.90 19.32 80.80 17.68 5.22 50.62 17.00 41.31 75.75 38.39 45.18 20.00 35701044 LIPASE 83690 300 $36.00 13.31 5.00 39.41 5.75 24.88 7.23 24.88 5.00 19.89 7.10 19.15 5.50 5.00 23.83 6.20 6.89 31.53 39.41 7.06 7.10 6.89 28.80 6.30 5.00 18.05 6.06 14.72 27.00 13.68 16.10 7.13 35705503 LIPASE FLUID 83690 300 $36.00 13.31 5.00 39.41 5.75 24.88 7.23 24.88 5.00 19.89 7.10 19.15 5.50 5.00 23.83 6.20 6.89 31.53 39.41 7.06 7.10 6.89 28.80 6.30 5.00 18.05 6.06 14.72 27.00 13.68 16.10 7.13 36934166 LIPASE 83690 300 $78.00 28.83 5.00 62.40 5.75 53.90 7.23 53.90 5.00 43.10 7.10 19.15 5.50 5.00 51.63 6.20 6.89 31.53 39.41 7.06 7.10 6.89 62.40 6.30 5.00 18.05 6.06 31.90 58.50 29.65 34.89 7.13 36910712 LIPOPROTEIN A 83695 300 $299.00 110.51 12.60 239.20 16.64 206.61 15.04 206.61 14.47 165.20 14.75 35.98 15.92 14.47 197.91 12.89 14.32 79.76 99.70 14.68 14.75 14.32 239.20 13.10 14.47 37.52 12.60 122.29 224.25 113.65 133.74 14.82 36939150 LIPOPROTEIN (A) 83695 300 $126.00 46.57 12.60 100.80 16.64 87.07 15.04 87.07 14.47 69.62 14.75 35.98 15.92 14.47 83.40 12.89 14.32 79.76 99.70 14.68 14.75 14.32 100.80 13.10 14.47 37.52 12.60 51.53 94.50 47.89 56.36 14.82 36939915 LP-PLA2 LIPOPROT PHOSPHOLIPID 83698 300 $311.00 114.95 37.94 261.41 43.63 214.90 48.63 214.90 37.94 171.83 47.70 94.39 41.73 37.94 205.85 41.68 46.31 209.13 261.41 47.47 47.70 46.31 248.80 42.37 37.94 121.33 40.75 127.20 233.25 118.21 139.11 47.93 36937734 LIPOPROTEIN PARTICLES QNT(NMR) 83704 300 $409.00 151.17 - 327.20 - 282.62 35.90 282.62 - 225.97 35.22 87.73 - - 270.72 30.77 34.19 194.36 242.95 35.04 35.22 34.19 327.20 31.28 - 89.58 30.09 167.28 306.75 155.46 182.95 35.39 36939168 QUANT LIPO PARTICLES 83704 300 $179.00 66.16 - 242.95 - 123.69 35.90 123.69 - 98.90 35.22 87.73 - - 118.48 30.77 34.19 194.36 242.95 35.04 35.22 34.19 143.20 31.28 - 89.58 30.09 73.21 134.25 68.04 80.07 35.39 35700846 CHOLESTEROL-HDL 83718 300 $43.00 15.89 7.00 46.90 8.05 29.71 8.60 29.71 7.00 23.76 8.44 22.77 7.70 7.00 28.46 7.37 8.19 37.52 46.90 8.39 8.44 8.19 34.40 7.49 7.00 21.46 7.21 17.59 32.25 16.34 19.23 8.48 35704906 LDL DIRECT MEASURE 83721 300 $55.00 20.33 9.24 44.00 13.80 38.01 11.03 38.01 12.00 30.39 10.82 26.53 13.20 12.00 36.40 9.45 10.50 21.78 27.23 10.76 10.82 10.50 44.00 9.61 12.00 27.51 9.24 22.50 41.25 20.91 24.60 10.87 36910941 GONADOTROPIN RELEASING HORMO 83727 300 "$1,565.00" 578.42 15.13 " 1,252.00 " 27.32 " 1,081.42 " 18.05 " 1,081.42 " 23.76 864.66 17.71 47.79 26.14 23.76 " 1,035.87 " 15.47 17.19 110.89 138.61 17.62 17.71 17.19 " 1,252.00 " 15.73 23.76 45.04 15.13 640.09 " 1,173.75 " 594.86 700.02 17.79 35701087 MAGNESIUM 83735 300 $35.00 12.94 5.90 38.14 8.34 24.19 7.04 24.19 7.25 19.34 6.90 18.62 7.98 7.25 23.17 6.03 6.70 30.51 38.14 6.87 6.90 6.70 28.00 6.13 7.25 17.55 5.90 14.32 26.25 13.30 15.66 6.93 36911514 MAGNESIUM 24 HOUR URINE 83735 300 $189.00 69.85 5.90 151.20 8.34 130.60 7.04 130.60 7.25 104.42 6.90 18.62 7.98 7.25 125.10 6.03 6.70 30.51 38.14 6.87 6.90 6.70 151.20 6.13 7.25 17.55 5.90 77.30 141.75 71.84 84.54 6.93 36912090 MAGNESIUM STOOL 83735 300 $523.00 193.30 5.90 418.40 8.34 361.39 7.04 361.39 7.25 288.96 6.90 18.62 7.98 7.25 346.17 6.03 6.70 30.51 38.14 6.87 6.90 6.70 418.40 6.13 7.25 17.55 5.90 213.91 392.25 198.79 233.94 6.93 36914327 MAGNESIUM URINE 83735 300 $79.00 29.20 5.90 63.20 8.34 54.59 7.04 54.59 7.25 43.65 6.90 18.62 7.98 7.25 52.29 6.03 6.70 30.51 38.14 6.87 6.90 6.70 63.20 6.13 7.25 17.55 5.90 32.31 59.25 30.03 35.34 6.93 36914785 MAGNESIUM URINE 83735 300 $79.00 29.20 5.90 63.20 8.34 54.59 7.04 54.59 7.25 43.65 6.90 18.62 7.98 7.25 52.29 6.03 6.70 30.51 38.14 6.87 6.90 6.70 63.20 6.13 7.25 17.55 5.90 32.31 59.25 30.03 35.34 6.93 36940867 MAGNESIUM 83735 300 $35.00 12.94 5.90 38.14 8.34 24.19 7.04 24.19 7.25 19.34 6.90 18.62 7.98 7.25 23.17 6.03 6.70 30.51 38.14 6.87 6.90 6.70 28.00 6.13 7.25 17.55 5.90 14.32 26.25 13.30 15.66 6.93 36941642 MAGNESIUM RBC 83735 300 $172.00 63.57 5.90 137.60 8.34 118.85 7.04 118.85 7.25 95.03 6.90 18.62 7.98 7.25 113.85 6.03 6.70 30.51 38.14 6.87 6.90 6.70 137.60 6.13 7.25 17.55 5.90 70.35 129.00 65.38 76.94 6.93 36912855 MANGANESE 83785 300 $340.00 125.66 - 272.00 - 234.94 27.98 234.94 - 187.85 27.45 68.39 - - 225.05 23.99 26.65 39.86 49.82 27.32 27.45 26.65 272.00 24.38 - 69.82 23.45 139.06 255.00 129.23 152.08 27.58 36910828 CLOZAPINE (CLOZARIL) 83789 300 $254.00 93.88 - 203.20 - 175.51 25.32 175.51 - 140.34 24.83 50.21 - - 168.12 21.70 24.11 113.71 142.14 24.71 24.83 24.11 203.20 22.06 - 63.17 21.22 103.89 190.50 96.55 113.61 24.95 36937891 MASS SPEC AND TANDEM MS(MS/MS) 83789 300 $127.00 46.94 - 142.14 - 87.76 25.32 87.76 - 70.17 24.83 50.21 - - 84.06 21.70 24.11 113.71 142.14 24.71 24.83 24.11 101.60 22.06 - 63.17 21.22 51.94 95.25 48.27 56.81 24.95 36900270 MERC QUANT METHYL/PHENYL 83825 300 $103.00 38.07 12.00 92.70 13.80 71.17 17.07 71.17 12.00 56.91 16.75 45.18 13.20 12.00 68.18 14.63 16.26 74.16 92.70 16.67 16.75 16.26 82.40 14.88 12.00 42.60 14.31 42.13 77.25 39.15 46.07 16.83 36909676 MERCURY 24HR URINE 83825 300 $103.00 38.07 12.00 92.70 13.80 71.17 17.07 71.17 12.00 56.91 16.75 45.18 13.20 12.00 68.18 14.63 16.26 74.16 92.70 16.67 16.75 16.26 82.40 14.88 12.00 42.60 14.31 42.13 77.25 39.15 46.07 16.83 36909722 MERCURY QUANT 83825 300 $103.00 38.07 12.00 92.70 13.80 71.17 17.07 71.17 12.00 56.91 16.75 45.18 13.20 12.00 68.18 14.63 16.26 74.16 92.70 16.67 16.75 16.26 82.40 14.88 12.00 42.60 14.31 42.13 77.25 39.15 46.07 16.83 36911719 MERCURY 83825 300 $103.00 38.07 12.00 92.70 13.80 71.17 17.07 71.17 12.00 56.91 16.75 45.18 13.20 12.00 68.18 14.63 16.26 74.16 92.70 16.67 16.75 16.26 82.40 14.88 12.00 42.60 14.31 42.13 77.25 39.15 46.07 16.83 36937751 MERCURY 83825 300 $103.00 38.07 12.00 92.70 13.80 71.17 17.07 71.17 12.00 56.91 16.75 45.18 13.20 12.00 68.18 14.63 16.26 74.16 92.70 16.67 16.75 16.26 82.40 14.88 12.00 42.60 14.31 42.13 77.25 39.15 46.07 16.83 36945486 MERCURY QUANT BLOOD 83825 300 $103.00 38.07 12.00 92.70 13.80 71.17 17.07 71.17 12.00 56.91 16.75 45.18 13.20 12.00 68.18 14.63 16.26 74.16 92.70 16.67 16.75 16.26 82.40 14.88 12.00 42.60 14.31 42.13 77.25 39.15 46.07 16.83 35707085 METANEPHRINES 83835 300 $621.00 229.52 13.00 496.80 14.95 429.11 17.79 429.11 13.00 343.10 17.45 47.10 14.30 13.00 411.04 15.25 16.94 77.69 97.11 17.36 17.45 16.94 496.80 15.50 13.00 44.38 14.91 253.99 465.75 236.04 277.77 17.53 35707140 METANEPHRINES RANDOM URINE 83835 300 $621.00 229.52 13.00 496.80 14.95 429.11 17.79 429.11 13.00 343.10 17.45 47.10 14.30 13.00 411.04 15.25 16.94 77.69 97.11 17.36 17.45 16.94 496.80 15.50 13.00 44.38 14.91 253.99 465.75 236.04 277.77 17.53 36932635 METANEPHRINES FRACT PLASMA 83835 300 $621.00 229.52 13.00 496.80 14.95 429.11 17.79 429.11 13.00 343.10 17.45 47.10 14.30 13.00 411.04 15.25 16.94 77.69 97.11 17.36 17.45 16.94 496.80 15.50 13.00 44.38 14.91 253.99 465.75 236.04 277.77 17.53 36940719 METANEPHRINES FRACT 83835 300 $621.00 229.52 13.00 496.80 14.95 429.11 17.79 429.11 13.00 343.10 17.45 47.10 14.30 13.00 411.04 15.25 16.94 77.69 97.11 17.36 17.45 16.94 496.80 15.50 13.00 44.38 14.91 253.99 465.75 236.04 277.77 17.53 36940760 METANEPRINES 83835 300 $89.00 32.89 13.00 97.11 14.95 61.50 17.79 61.50 13.00 49.17 17.45 47.10 14.30 13.00 58.91 15.25 16.94 77.69 97.11 17.36 17.45 16.94 71.20 15.50 13.00 44.38 14.91 36.40 66.75 33.83 39.81 17.53 36906154 OLIGOSACCHARIDES QUANT 83864 300 $150.00 55.44 18.00 160.44 20.70 103.65 29.93 103.65 18.00 82.88 29.36 55.36 19.80 18.00 99.29 25.65 28.50 128.35 160.44 29.21 29.36 28.50 120.00 26.08 18.00 74.67 25.08 61.35 112.50 57.02 67.10 29.50 36917393 MYELIN BASIC PROTEIN CSF 83873 300 $274.00 101.27 15.00 219.20 17.25 189.33 18.06 189.33 15.00 151.39 17.72 47.85 16.50 15.00 181.36 15.48 17.20 103.79 129.74 17.63 17.72 17.20 219.20 15.74 15.00 45.06 15.14 112.07 205.50 104.15 122.56 17.80 36917831 MYELIN BASIC PROTEIN 83873 300 $274.00 101.27 15.00 219.20 17.25 189.33 18.06 189.33 15.00 151.39 17.72 47.85 16.50 15.00 181.36 15.48 17.20 103.79 129.74 17.63 17.72 17.20 219.20 15.74 15.00 45.06 15.14 112.07 205.50 104.15 122.56 17.80 35707964 MYOGLOBIN BLOOD 83874 300 $136.00 50.27 11.37 108.80 17.25 93.98 13.57 93.98 15.00 75.14 13.31 35.89 16.50 15.00 90.02 11.63 12.92 59.17 73.96 13.24 13.31 12.92 108.80 11.82 15.00 33.85 11.37 55.62 102.00 51.69 60.83 13.37 36912324 MYOGLOBIN URINE 83874 300 $136.00 50.27 11.37 108.80 17.25 93.98 13.57 93.98 15.00 75.14 13.31 35.89 16.50 15.00 90.02 11.63 12.92 59.17 73.96 13.24 13.31 12.92 108.80 11.82 15.00 33.85 11.37 55.62 102.00 51.69 60.83 13.37 35708391 BRAIN NATRIURETIC PEPTIDE 83880 300 $206.00 76.14 34.55 270.12 43.63 142.35 41.22 142.35 37.94 113.82 40.44 94.39 41.73 37.94 136.35 35.33 39.26 216.10 270.12 40.24 40.44 39.26 164.80 35.92 37.94 102.86 34.55 84.25 154.50 78.30 92.14 40.63 35708642 BRAIN NATRIURETIC PEPTIDE-PRO 83880 300 $206.00 76.14 34.55 270.12 43.63 142.35 41.22 142.35 37.94 113.82 40.44 94.39 41.73 37.94 136.35 35.33 39.26 216.10 270.12 40.24 40.44 39.26 164.80 35.92 37.94 102.86 34.55 84.25 154.50 78.30 92.14 40.63 36935910 NATRIURETIC PEPTIDE 83880 300 $288.00 106.44 34.55 270.12 43.63 199.01 41.22 199.01 37.94 159.12 40.44 94.39 41.73 37.94 190.63 35.33 39.26 216.10 270.12 40.24 40.44 39.26 230.40 35.92 37.94 102.86 34.55 117.79 216.00 109.47 128.82 40.63 35709304 FREE KAPPA LT CHNS SER NEPHEL 83883 300 $71.00 26.24 - 77.99 - 49.06 14.28 49.06 - 39.23 14.01 37.81 - - 46.99 12.24 13.60 62.39 77.99 13.94 14.01 13.60 56.80 12.44 - 35.63 11.97 29.04 53.25 26.99 31.76 14.08 35709312 FREE LAMBDA LT CHNS SER NEPHEL 83883 300 $71.00 26.24 - 77.99 - 49.06 14.28 49.06 - 39.23 14.01 37.81 - - 46.99 12.24 13.60 62.39 77.99 13.94 14.01 13.60 56.80 12.44 - 35.63 11.97 29.04 53.25 26.99 31.76 14.08 36917423 LAMBDA 24 HOUR URINE 83883 300 $138.00 51.00 - 110.40 - 95.36 14.28 95.36 - 76.25 14.01 37.81 - - 91.34 12.24 13.60 62.39 77.99 13.94 14.01 13.60 110.40 12.44 - 35.63 11.97 56.44 103.50 52.45 61.73 14.08 36917431 KAPPA 24 HOUR URINE 83883 300 $138.00 51.00 - 110.40 - 95.36 14.28 95.36 - 76.25 14.01 37.81 - - 91.34 12.24 13.60 62.39 77.99 13.94 14.01 13.60 110.40 12.44 - 35.63 11.97 56.44 103.50 52.45 61.73 14.08 36917440 LAMBDA RANDOM URINE 83883 300 $138.00 51.00 - 110.40 - 95.36 14.28 95.36 - 76.25 14.01 37.81 - - 91.34 12.24 13.60 62.39 77.99 13.94 14.01 13.60 110.40 12.44 - 35.63 11.97 56.44 103.50 52.45 61.73 14.08 36917458 KAPPA RANDOM URINE 83883 300 $138.00 51.00 - 110.40 - 95.36 14.28 95.36 - 76.25 14.01 37.81 - - 91.34 12.24 13.60 62.39 77.99 13.94 14.01 13.60 110.40 12.44 - 35.63 11.97 56.44 103.50 52.45 61.73 14.08 36936134 NEPHELOMETRY EACH ANALYTE 83883 300 $537.00 198.48 - 429.60 - 371.07 14.28 371.07 - 296.69 14.01 37.81 - - 355.44 12.24 13.60 62.39 77.99 13.94 14.01 13.60 429.60 12.44 - 35.63 11.97 219.63 402.75 204.11 240.20 14.08 36941421 NEPHELOMETRY EA ANALYTE NOS 83883 300 $412.00 152.28 - 329.60 - 284.69 14.28 284.69 - 227.63 14.01 37.81 - - 272.70 12.24 13.60 62.39 77.99 13.94 14.01 13.60 329.60 12.44 - 35.63 11.97 168.51 309.00 156.60 184.29 14.08 36919370 NUCLEOTIDASE 5 83915 300 $721.00 266.48 9.81 576.80 17.72 498.21 11.71 498.21 15.41 398.35 11.48 30.99 16.95 15.41 477.23 10.04 11.15 51.14 63.93 11.43 11.48 11.15 576.80 10.20 15.41 29.21 9.81 294.89 540.75 274.05 322.50 11.54 36917555 OLIGOCLONAL PROTEINS CSF 83916 300 $272.00 100.53 15.00 217.60 17.25 187.95 28.76 187.95 15.00 150.28 28.21 55.89 16.50 15.00 180.04 24.65 27.39 129.63 162.04 28.07 28.21 27.39 217.60 25.06 15.00 71.76 24.10 111.25 204.00 103.39 121.67 28.35 36917849 OLIGOCLONAL BANDS 83916 300 $272.00 100.53 15.00 217.60 17.25 187.95 28.76 187.95 15.00 150.28 28.21 55.89 16.50 15.00 180.04 24.65 27.39 129.63 162.04 28.07 28.21 27.39 217.60 25.06 15.00 71.76 24.10 111.25 204.00 103.39 121.67 28.35 36902167 ORGANIC ACIDS QUANT URINE-CHOP 83918 300 "$1,841.00" 680.43 20.77 " 1,472.80 " 26.16 " 1,272.13 " 24.78 " 1,272.13 " 22.75 " 1,017.15 " 24.31 45.75 25.03 22.75 " 1,218.56 " 21.24 23.60 106.13 132.66 24.19 24.31 23.60 " 1,472.80 " 21.59 22.75 61.83 20.77 752.97 " 1,380.75 " 699.76 823.48 24.43 36904348 OROTIC ACID URINE QUANT 83921 300 "$1,009.00" 372.93 18.20 807.20 20.93 697.22 22.27 697.22 18.20 557.47 21.85 45.75 20.02 18.20 667.86 19.09 21.21 103.66 129.58 21.74 21.85 21.21 807.20 19.41 18.20 55.57 18.66 412.68 756.75 383.52 451.33 21.95 36904691 METHYLMALONIC ACID QUANT 83921 300 $228.00 84.27 18.20 182.40 20.93 157.55 22.27 157.55 18.20 125.97 21.85 45.75 20.02 18.20 150.91 19.09 21.21 103.66 129.58 21.74 21.85 21.21 182.40 19.41 18.20 55.57 18.66 93.25 171.00 86.66 101.98 21.95 36909633 METHYLMALONIC ACID QN SERUM 83921 300 $228.00 84.27 18.20 182.40 20.93 157.55 22.27 157.55 18.20 125.97 21.85 45.75 20.02 18.20 150.91 19.09 21.21 103.66 129.58 21.74 21.85 21.21 182.40 19.41 18.20 55.57 18.66 93.25 171.00 86.66 101.98 21.95 35701320 OSMOLALITY 83930 300 $35.00 12.94 3.00 37.86 3.45 24.19 6.94 24.19 3.00 19.34 6.81 18.40 3.30 3.00 23.17 5.95 6.61 30.29 37.86 6.78 6.81 6.61 28.00 6.05 3.00 17.32 5.82 14.32 26.25 13.30 15.66 6.84 35703870 OSMOLALITY URINE 83935 300 $36.00 13.31 3.00 39.08 3.45 24.88 7.16 24.88 3.00 19.89 7.02 18.97 3.30 3.00 23.83 6.14 6.82 31.26 39.08 6.99 7.02 6.82 28.80 6.24 3.00 17.87 6.00 14.72 27.00 13.68 16.10 7.06 36909846 OSTEOCALCIN 83937 300 $437.00 161.52 26.27 349.60 47.44 301.97 31.34 301.97 41.25 241.44 30.75 82.99 45.38 41.25 289.25 26.87 29.85 192.46 240.58 30.60 30.75 29.85 349.60 27.31 41.25 78.21 26.27 178.73 327.75 166.10 195.47 30.89 36914262 OXALATE URINE 83945 300 $219.00 80.94 12.72 175.20 14.95 151.33 15.17 151.33 13.00 121.00 14.88 35.76 14.30 13.00 144.96 13.01 14.45 59.04 73.80 14.81 14.88 14.45 175.20 13.22 13.00 37.86 12.72 89.57 164.25 83.24 97.96 14.96 36914700 OXALATE URINE 83945 300 $219.00 80.94 12.72 175.20 14.95 151.33 15.17 151.33 13.00 121.00 14.88 35.76 14.30 13.00 144.96 13.01 14.45 59.04 73.80 14.81 14.88 14.45 175.20 13.22 13.00 37.86 12.72 89.57 164.25 83.24 97.96 14.96 36919388 OXALATE URINE 24HR 83945 300 $219.00 80.94 12.72 175.20 14.95 151.33 15.17 151.33 13.00 121.00 14.88 35.76 14.30 13.00 144.96 13.01 14.45 59.04 73.80 14.81 14.88 14.45 175.20 13.22 13.00 37.86 12.72 89.57 164.25 83.24 97.96 14.96 35707794 PARATHYROID HORMONE 83970 300 $217.00 80.20 36.33 236.55 48.88 149.95 43.34 149.95 42.50 119.89 42.52 114.77 46.75 42.50 143.63 37.15 41.28 189.24 236.55 42.31 42.52 41.28 173.60 37.77 42.50 108.15 36.33 88.75 162.75 82.48 97.06 42.72 35708570 PTH RAPID 83970 300 $217.00 80.20 36.33 236.55 48.88 149.95 43.34 149.95 42.50 119.89 42.52 114.77 46.75 42.50 143.63 37.15 41.28 189.24 236.55 42.31 42.52 41.28 173.60 37.77 42.50 108.15 36.33 88.75 162.75 82.48 97.06 42.72 35710094 PARATHYROID HORMONE 83970 300 $217.00 80.20 36.33 236.55 48.88 149.95 43.34 149.95 42.50 119.89 42.52 114.77 46.75 42.50 143.63 37.15 41.28 189.24 236.55 42.31 42.52 41.28 173.60 37.77 42.50 108.15 36.33 88.75 162.75 82.48 97.06 42.72 35710141 INTRAOP PTH 83970 300 $217.00 80.20 36.33 236.55 48.88 149.95 43.34 149.95 42.50 119.89 42.52 114.77 46.75 42.50 143.63 37.15 41.28 189.24 236.55 42.31 42.52 41.28 173.60 37.77 42.50 108.15 36.33 88.75 162.75 82.48 97.06 42.72 35200126 FLUID PH 83986 300 $19.00 7.02 2.00 20.78 2.30 13.13 3.76 13.13 2.00 10.50 3.69 9.95 2.20 2.00 12.58 3.22 3.58 16.62 20.78 3.67 3.69 3.58 15.20 3.28 2.00 9.38 3.15 7.77 14.25 7.22 8.50 3.71 35200428 PH GASTRIC 83986 300 $19.00 7.02 2.00 20.78 2.30 13.13 3.76 13.13 2.00 10.50 3.69 9.95 2.20 2.00 12.58 3.22 3.58 16.62 20.78 3.67 3.69 3.58 15.20 3.28 2.00 9.38 3.15 7.77 14.25 7.22 8.50 3.71 35701354 PH FLUID 83986 300 $19.00 7.02 2.00 20.78 2.30 13.13 3.76 13.13 2.00 10.50 3.69 9.95 2.20 2.00 12.58 3.22 3.58 16.62 20.78 3.67 3.69 3.58 15.20 3.28 2.00 9.38 3.15 7.77 14.25 7.22 8.50 3.71 35708685 BLOOD OCCULT GASTRIC PH 83986 300 $19.00 7.02 2.00 20.78 2.30 13.13 3.76 13.13 2.00 10.50 3.69 9.95 2.20 2.00 12.58 3.22 3.58 16.62 20.78 3.67 3.69 3.58 15.20 3.28 2.00 9.38 3.15 7.77 14.25 7.22 8.50 3.71 36914297 PH URINE 83986 300 $66.00 24.39 2.00 52.80 2.30 45.61 3.76 45.61 2.00 36.47 3.69 9.95 2.20 2.00 43.69 3.22 3.58 16.62 20.78 3.67 3.69 3.58 52.80 3.28 2.00 9.38 3.15 26.99 49.50 25.09 29.52 3.71 36914734 PH URINE 83986 300 $66.00 24.39 2.00 52.80 2.30 45.61 3.76 45.61 2.00 36.47 3.69 9.95 2.20 2.00 43.69 3.22 3.58 16.62 20.78 3.67 3.69 3.58 52.80 3.28 2.00 9.38 3.15 26.99 49.50 25.09 29.52 3.71 36934191 PH DUODENAL FLUID 83986 300 $66.00 24.39 2.00 52.80 2.30 45.61 3.76 45.61 2.00 36.47 3.69 9.95 2.20 2.00 43.69 3.22 3.58 16.62 20.78 3.67 3.69 3.58 52.80 3.28 2.00 9.38 3.15 26.99 49.50 25.09 29.52 3.71 36925078 PCP CONF GCMS MECONIUM 83992 300 $128.00 47.31 - 118.44 18.40 88.45 N/A 88.45 16.00 70.72 N/A 40.85 17.60 N/A 84.72 - N/A 94.75 118.44 N/A N/A N/A 102.40 N/A 16.00 85.76 N/A 52.35 96.00 48.65 57.25 N/A 36935707 PCP CONFIRMATION URINE 83992 300 $176.00 65.05 - 140.80 18.40 121.62 N/A 121.62 16.00 97.24 N/A 40.85 17.60 N/A 116.49 - N/A 94.75 118.44 N/A N/A N/A 140.80 N/A 16.00 117.92 N/A 71.98 132.00 66.90 78.72 N/A 36940972 PHENCYCLIDINE MECONIUM 83992 300 $995.00 367.75 - 796.00 18.40 687.55 N/A 687.55 16.00 549.74 N/A 40.85 17.60 N/A 658.59 - N/A 94.75 118.44 N/A N/A N/A 796.00 N/A 16.00 666.65 N/A 406.96 746.25 378.20 445.06 N/A 36941596 PHENCYCLIDINE PCP 83992 300 $59.00 21.81 - 118.44 18.40 40.77 N/A 40.77 16.00 32.60 N/A 40.85 17.60 N/A 39.05 - N/A 94.75 118.44 N/A N/A N/A 47.20 N/A 16.00 39.53 N/A 24.13 44.25 22.43 26.39 N/A 36938552 CALPROTECTIN STOOL 83993 300 $673.00 248.74 17.27 538.40 25.23 465.04 20.61 465.04 21.94 371.83 20.22 54.57 24.13 21.94 445.46 17.67 19.63 120.90 151.13 20.12 20.22 19.63 538.40 17.96 21.94 51.43 17.27 275.26 504.75 255.81 301.03 20.32 36916664 PHENYLALANINE PKU BLOOD 84030 300 $380.00 140.45 4.84 304.00 8.12 262.58 5.78 262.58 7.06 209.95 5.67 15.29 7.77 7.06 251.52 4.95 5.50 35.50 44.37 5.64 5.67 5.50 304.00 5.03 7.06 14.41 4.84 155.42 285.00 144.44 169.97 5.69 36909579 PROSTATIC ACID PHOS (PAP) 84066 300 $131.00 48.42 8.50 104.80 11.50 90.52 10.14 90.52 10.00 72.38 9.95 26.85 11.00 10.00 86.71 8.69 9.66 44.36 55.45 9.90 9.95 9.66 104.80 8.84 10.00 25.31 8.50 53.58 98.25 49.79 58.60 10.00 35701397 ALKALINE PHOSPHATASE 84075 300 $27.00 9.98 4.56 29.65 7.33 18.66 5.44 18.66 6.37 14.92 5.34 14.38 7.01 6.37 17.87 4.66 5.18 23.72 29.65 5.31 5.34 5.18 21.60 4.74 6.37 13.57 4.56 11.04 20.25 10.26 12.08 5.36 36900148 ALKALINE PHOSPHATASE 84075 300 $119.00 43.98 4.56 95.20 7.33 82.23 5.44 82.23 6.37 65.75 5.34 14.38 7.01 6.37 78.77 4.66 5.18 23.72 29.65 5.31 5.34 5.18 95.20 4.74 6.37 13.57 4.56 48.67 89.25 45.23 53.23 5.36 36911999 ALKALINE PHOSPHATASE 84075 300 $119.00 43.98 4.56 95.20 7.33 82.23 5.44 82.23 6.37 65.75 5.34 14.38 7.01 6.37 78.77 4.66 5.18 23.72 29.65 5.31 5.34 5.18 95.20 4.74 6.37 13.57 4.56 48.67 89.25 45.23 53.23 5.36 36937122 ALKALINE PHOSPHATASE BONE SPEC 84075 300 $487.00 180.00 4.56 389.60 7.33 336.52 5.44 336.52 6.37 269.07 5.34 14.38 7.01 6.37 322.35 4.66 5.18 23.72 29.65 5.31 5.34 5.18 389.60 4.74 6.37 13.57 4.56 199.18 365.25 185.11 217.84 5.36 36900172 ALKALINE PHOS HEAT STABLE 84078 300 $126.00 46.57 - 100.80 - 87.07 8.67 87.07 - 69.62 8.51 20.32 - - 83.40 7.43 8.26 47.05 58.81 8.47 8.51 8.26 100.80 7.56 - 21.64 7.27 51.53 94.50 47.89 56.36 8.55 36906928 ALKALINE PHOS/ISOENZYMES 84080 300 $119.00 43.98 - 95.20 - 82.23 15.52 82.23 - 65.75 15.22 41.10 - - 78.77 13.30 14.78 67.82 84.77 15.15 15.22 14.78 95.20 13.52 - 38.72 13.01 48.67 89.25 45.23 53.23 15.30 36912006 ALKALINE PHOS/ISOENZYMES 84080 300 $119.00 43.98 - 95.20 - 82.23 15.52 82.23 - 65.75 15.22 41.10 - - 78.77 13.30 14.78 67.82 84.77 15.15 15.22 14.78 95.20 13.52 - 38.72 13.01 48.67 89.25 45.23 53.23 15.30 36913681 ALK PHOSPHATASE BONE SPEC ISO 84080 300 $119.00 43.98 - 95.20 - 82.23 15.52 82.23 - 65.75 15.22 41.10 - - 78.77 13.30 14.78 67.82 84.77 15.15 15.22 14.78 95.20 13.52 - 38.72 13.01 48.67 89.25 45.23 53.23 15.30 35701401 PHOSPHORUS 84100 300 $25.00 9.24 4.17 27.12 7.53 17.28 4.98 17.28 6.55 13.81 4.88 13.19 7.21 6.55 16.55 4.27 4.74 21.70 27.12 4.86 4.88 4.74 20.00 4.34 6.55 12.42 4.17 10.23 18.75 9.50 11.18 4.91 35705899 PHOSPHORUS FLUID 84100 300 $25.00 9.24 4.17 27.12 7.53 17.28 4.98 17.28 6.55 13.81 4.88 13.19 7.21 6.55 16.55 4.27 4.74 21.70 27.12 4.86 4.88 4.74 20.00 4.34 6.55 12.42 4.17 10.23 18.75 9.50 11.18 4.91 36912103 PHOSPHORUS STOOL 84100 300 $368.00 136.01 4.17 294.40 7.53 254.29 4.98 254.29 6.55 203.32 4.88 13.19 7.21 6.55 243.58 4.27 4.74 21.70 27.12 4.86 4.88 4.74 294.40 4.34 6.55 12.42 4.17 150.51 276.00 139.88 164.61 4.91 35703730 PHOSPHORUS 24 HOUR URINE 84105 300 $30.00 11.09 5.09 29.65 8.22 20.73 6.07 20.73 7.15 16.58 5.95 14.38 7.87 7.15 19.86 5.20 5.78 23.72 29.65 5.92 5.95 5.78 24.00 5.29 7.15 15.14 5.09 12.27 22.50 11.40 13.42 5.98 35709533 PHOSPHORUS RANDOM URINE 84105 300 $30.00 11.09 5.09 29.65 8.22 20.73 6.07 20.73 7.15 16.58 5.95 14.38 7.87 7.15 19.86 5.20 5.78 23.72 29.65 5.92 5.95 5.78 24.00 5.29 7.15 15.14 5.09 12.27 22.50 11.40 13.42 5.98 36914319 PHOSPHATE URINE 84105 300 $70.00 25.87 5.09 56.00 8.22 48.37 6.07 48.37 7.15 38.68 5.95 14.38 7.87 7.15 46.33 5.20 5.78 23.72 29.65 5.92 5.95 5.78 56.00 5.29 7.15 15.14 5.09 28.63 52.50 26.61 31.31 5.98 36914777 PHOSPHATE URINE 84105 300 $70.00 25.87 5.09 56.00 8.22 48.37 6.07 48.37 7.15 38.68 5.95 14.38 7.87 7.15 46.33 5.20 5.78 23.72 29.65 5.92 5.95 5.78 56.00 5.29 7.15 15.14 5.09 28.63 52.50 26.61 31.31 5.98 36901225 PORPHOBILINOGEN URINE QUANT 84110 300 $206.00 76.14 2.00 164.80 2.30 142.35 8.86 142.35 2.00 113.82 8.69 23.49 2.20 2.00 136.35 7.60 8.44 38.76 48.45 8.65 8.69 8.44 164.80 7.72 2.00 22.11 7.43 84.25 154.50 78.30 92.14 8.74 36909374 PORPHOBILINOGEN 24 HR UR QNT 84110 300 $206.00 76.14 2.00 164.80 2.30 142.35 8.86 142.35 2.00 113.82 8.69 23.49 2.20 2.00 136.35 7.60 8.44 38.76 48.45 8.65 8.69 8.44 164.80 7.72 2.00 22.11 7.43 84.25 154.50 78.30 92.14 8.74 35200819 POCT PROM 84112 300 $515.00 190.34 - 499.56 - 355.87 103.02 355.87 - 284.54 101.05 179.07 - - 340.88 88.30 98.11 399.65 499.56 100.56 101.05 98.11 412.00 89.77 - 257.05 86.34 210.64 386.25 195.75 230.36 101.54 35709274 PLACENTAL PROTEIN IMMUNOCHROM 84112 300 $515.00 190.34 - 499.56 - 355.87 103.02 355.87 - 284.54 101.05 179.07 - - 340.88 88.30 98.11 399.65 499.56 100.56 101.05 98.11 412.00 89.77 - 257.05 86.34 210.64 386.25 195.75 230.36 101.54 36901233 PORPHYRINS FRAC RANDOM URINE 84120 300 $293.00 108.29 7.50 234.40 8.63 202.46 15.45 202.46 7.50 161.88 15.15 40.91 8.25 7.50 193.94 13.24 14.71 53.30 66.63 15.08 15.15 14.71 234.40 13.46 7.50 38.54 12.94 119.84 219.75 111.37 131.06 15.22 36909480 PORPHYRINS FRAC 24 HOUR URINE 84120 300 $293.00 108.29 7.50 234.40 8.63 202.46 15.45 202.46 7.50 161.88 15.15 40.91 8.25 7.50 193.94 13.24 14.71 53.30 66.63 15.08 15.15 14.71 234.40 13.46 7.50 38.54 12.94 119.84 219.75 111.37 131.06 15.22 35200240 POTASSIUM I-STAT 84132 300 $25.00 9.24 4.19 26.57 7.29 17.28 5.00 17.28 6.34 13.81 4.90 12.78 6.97 6.34 16.55 4.28 4.76 21.26 26.57 4.88 4.90 4.76 20.00 4.36 6.34 12.47 4.19 10.23 18.75 9.50 11.18 4.93 35200665 POTASSIUM I-STAT 84132 300 $25.00 9.24 4.19 26.57 7.29 17.28 5.00 17.28 6.34 13.81 4.90 12.78 6.97 6.34 16.55 4.28 4.76 21.26 26.57 4.88 4.90 4.76 20.00 4.36 6.34 12.47 4.19 10.23 18.75 9.50 11.18 4.93 35200835 POTASSIUM EPOC 84132 300 $25.00 9.24 4.19 26.57 7.29 17.28 5.00 17.28 6.34 13.81 4.90 12.78 6.97 6.34 16.55 4.28 4.76 21.26 26.57 4.88 4.90 4.76 20.00 4.36 6.34 12.47 4.19 10.23 18.75 9.50 11.18 4.93 35701460 POTASSIUM 84132 300 $25.00 9.24 4.19 26.57 7.29 17.28 5.00 17.28 6.34 13.81 4.90 12.78 6.97 6.34 16.55 4.28 4.76 21.26 26.57 4.88 4.90 4.76 20.00 4.36 6.34 12.47 4.19 10.23 18.75 9.50 11.18 4.93 35702164 POTASSIUM WHOLE BLOOD 84132 300 $25.00 9.24 4.19 26.57 7.29 17.28 5.00 17.28 6.34 13.81 4.90 12.78 6.97 6.34 16.55 4.28 4.76 21.26 26.57 4.88 4.90 4.76 20.00 4.36 6.34 12.47 4.19 10.23 18.75 9.50 11.18 4.93 35703764 POTASSIUM FLUID 84132 300 $25.00 9.24 4.19 26.57 7.29 17.28 5.00 17.28 6.34 13.81 4.90 12.78 6.97 6.34 16.55 4.28 4.76 21.26 26.57 4.88 4.90 4.76 20.00 4.36 6.34 12.47 4.19 10.23 18.75 9.50 11.18 4.93 35703641 POTASSIUM RANDOM URINE 84133 300 $25.00 9.24 4.16 24.64 6.83 17.28 4.97 17.28 5.94 13.81 4.87 11.96 6.53 5.94 16.55 4.26 4.73 19.71 24.64 4.85 4.87 4.73 20.00 4.33 5.94 12.39 4.16 10.23 18.75 9.50 11.18 4.90 35706011 POTASSIUM 24 HOUR URINE 84133 300 $25.00 9.24 4.16 24.64 6.83 17.28 4.97 17.28 5.94 13.81 4.87 11.96 6.53 5.94 16.55 4.26 4.73 19.71 24.64 4.85 4.87 4.73 20.00 4.33 5.94 12.39 4.16 10.23 18.75 9.50 11.18 4.90 36914343 POTASSIUM URINE 84133 300 $80.00 29.57 4.16 64.00 6.83 55.28 4.97 55.28 5.94 44.20 4.87 11.96 6.53 5.94 52.95 4.26 4.73 19.71 24.64 4.85 4.87 4.73 64.00 4.33 5.94 12.39 4.16 32.72 60.00 30.41 35.78 4.90 36914807 POTASSIUM URINE 84133 300 $80.00 29.57 4.16 64.00 6.83 55.28 4.97 55.28 5.94 44.20 4.87 11.96 6.53 5.94 52.95 4.26 4.73 19.71 24.64 4.85 4.87 4.73 64.00 4.33 5.94 12.39 4.16 32.72 60.00 30.41 35.78 4.90 35707891 PRE-ALBUMIN 84134 300 $77.00 28.46 12.84 83.83 23.18 53.21 15.32 53.21 20.16 42.54 15.03 40.57 22.18 20.16 50.97 13.13 14.59 67.06 83.83 14.95 15.03 14.59 61.60 13.35 20.16 38.23 12.84 31.49 57.75 29.27 34.44 15.10 36911620 PREGNENOLONE 84140 300 $764.00 282.37 18.19 611.20 32.87 527.92 21.70 527.92 28.58 422.11 21.29 57.46 31.44 28.58 505.69 18.60 20.67 133.34 166.67 21.19 21.29 20.67 611.20 18.91 28.58 54.16 18.19 312.48 573.00 290.40 341.74 21.39 36911590 17 OH PREGNENOLONE 84143 300 $878.00 324.51 20.07 702.40 36.27 606.70 23.95 606.70 31.54 485.10 23.49 63.43 34.69 31.54 581.15 20.53 22.81 147.18 183.97 23.38 23.49 22.81 702.40 20.87 31.54 59.76 20.07 359.10 658.50 333.73 392.73 23.61 36913487 17-HYDROXYPREGNENOLONE 84143 300 $878.00 324.51 20.07 702.40 36.27 606.70 23.95 606.70 31.54 485.10 23.49 63.43 34.69 31.54 581.15 20.53 22.81 147.18 183.97 23.38 23.49 22.81 702.40 20.87 31.54 59.76 20.07 359.10 658.50 333.73 392.73 23.61 36934328 17-HYDROXYPREGNENOLONE 84143 300 $878.00 324.51 20.07 702.40 36.27 606.70 23.95 606.70 31.54 485.10 23.49 63.43 34.69 31.54 581.15 20.53 22.81 147.18 183.97 23.38 23.49 22.81 702.40 20.87 31.54 59.76 20.07 359.10 658.50 333.73 392.73 23.61 35705201 PROGESTERONE 84144 300 $110.00 40.66 17.00 119.54 19.55 76.01 21.90 76.01 17.00 60.78 21.49 58.00 18.70 17.00 72.81 18.77 20.86 95.63 119.54 21.38 21.49 20.86 88.00 19.09 17.00 54.65 18.36 44.99 82.50 41.81 49.20 21.59 36913495 PROGESTERONE 84144 300 $208.00 76.88 17.00 166.40 19.55 143.73 21.90 143.73 17.00 114.92 21.49 58.00 18.70 17.00 137.68 18.77 20.86 95.63 119.54 21.38 21.49 20.86 166.40 19.09 17.00 54.65 18.36 85.07 156.00 79.06 93.04 21.59 36934336 PROGESTERONE 84144 300 $208.00 76.88 17.00 166.40 19.55 143.73 21.90 143.73 17.00 114.92 21.49 58.00 18.70 17.00 137.68 18.77 20.86 95.63 119.54 21.38 21.49 20.86 166.40 19.09 17.00 54.65 18.36 85.07 156.00 79.06 93.04 21.59 35709576 PROCALCITONIN (PCT) 84145 300 $143.00 52.85 22.21 153.00 25.54 98.81 28.58 98.81 22.21 79.01 28.04 74.48 24.43 22.21 94.65 24.50 27.22 122.40 153.00 27.90 28.04 27.22 114.40 24.91 22.21 71.32 23.95 58.49 107.25 54.35 63.96 28.17 35751157 PROCALCITONIN 84145 300 $143.00 52.85 22.21 153.00 25.54 98.81 28.58 98.81 22.21 79.01 28.04 74.48 24.43 22.21 94.65 24.50 27.22 122.40 153.00 27.90 28.04 27.22 114.40 24.91 22.21 71.32 23.95 58.49 107.25 54.35 63.96 28.17 35705007 PROLACTIN 84146 300 $102.00 37.70 17.05 111.00 27.60 70.48 20.35 70.48 24.00 56.36 19.96 53.88 26.40 24.00 67.51 17.44 19.38 88.80 111.00 19.86 19.96 19.38 81.60 17.73 24.00 50.78 17.05 41.72 76.50 38.77 45.62 20.06 35705198 PROSTATE SPECIFIC ANTIGEN 84153 300 $97.00 35.85 16.18 105.43 28.01 67.03 19.31 67.03 24.36 53.59 18.94 51.15 26.80 24.36 64.20 16.55 18.39 84.34 105.43 18.85 18.94 18.39 77.60 16.83 24.36 48.18 16.18 39.67 72.75 36.87 43.39 19.03 35710078 PROSTATE SPECIFIC ANTIGEN 84153 300 $97.00 35.85 16.18 105.43 28.01 67.03 19.31 67.03 24.36 53.59 18.94 51.15 26.80 24.36 64.20 16.55 18.39 84.34 105.43 18.85 18.94 18.39 77.60 16.83 24.36 48.18 16.18 39.67 72.75 36.87 43.39 19.03 36944218 PROSTATE HEALTH INDEX W REFLEX 84153 300 $551.00 203.65 16.18 440.80 28.01 380.74 19.31 380.74 24.36 304.43 18.94 51.15 26.80 24.36 364.71 16.55 18.39 84.34 105.43 18.85 18.94 18.39 440.80 16.83 24.36 48.18 16.18 225.36 413.25 209.44 246.46 19.03 35708286 PROSTATE SPECIFIC ANTIGEN FREE 84154 300 $97.00 35.85 16.18 144.79 23.39 67.03 19.31 67.03 20.34 53.59 18.94 51.15 22.37 20.34 64.20 16.55 18.39 115.83 144.79 18.85 18.94 18.39 77.60 16.83 20.34 48.18 16.18 39.67 72.75 36.87 43.39 19.03 36944382 FREE PSA 84154 300 $430.00 158.93 16.18 344.00 23.39 297.13 19.31 297.13 20.34 237.58 18.94 51.15 22.37 20.34 284.62 16.55 18.39 115.83 144.79 18.85 18.94 18.39 344.00 16.83 20.34 48.18 16.18 175.87 322.50 163.44 192.34 19.03 35701559 PROTEIN 84155 300 $19.00 7.02 3.23 20.94 5.37 13.13 3.85 13.13 4.67 10.50 3.78 10.21 5.14 4.67 12.58 3.30 3.67 16.75 20.94 3.76 3.78 3.67 15.20 3.36 4.67 9.62 3.23 7.77 14.25 7.22 8.50 3.80 35705902 PROTEIN RANDOM URINE 84156 300 $19.00 7.02 3.23 29.16 4.72 13.13 3.85 13.13 4.10 10.50 3.78 10.21 4.51 4.10 12.58 3.30 3.67 23.33 29.16 3.76 3.78 3.67 15.20 3.36 4.10 9.62 3.23 7.77 14.25 7.22 8.50 3.80 35705911 PROTEIN 24 HOUR URINE 84156 300 $19.00 7.02 3.23 29.16 4.72 13.13 3.85 13.13 4.10 10.50 3.78 10.21 4.51 4.10 12.58 3.30 3.67 23.33 29.16 3.76 3.78 3.67 15.20 3.36 4.10 9.62 3.23 7.77 14.25 7.22 8.50 3.80 35701532 PROTEIN CSF 84157 300 $21.00 7.76 3.52 29.16 4.72 14.51 4.20 14.51 4.10 11.60 4.12 10.21 4.51 4.10 13.90 3.60 4.00 23.33 29.16 4.10 4.12 4.00 16.80 3.66 4.10 10.48 3.52 8.59 15.75 7.98 9.39 4.14 35705929 PROTEIN FLUID 84157 300 $21.00 7.76 3.52 29.16 4.72 14.51 4.20 14.51 4.10 11.60 4.12 10.21 4.51 4.10 13.90 3.60 4.00 23.33 29.16 4.10 4.12 4.00 16.80 3.66 4.10 10.48 3.52 8.59 15.75 7.98 9.39 4.14 36933054 PROTEIN TOTAL CSF 84157 300 $46.00 17.00 3.52 36.80 4.72 31.79 4.20 31.79 4.10 25.42 4.12 10.21 4.51 4.10 30.45 3.60 4.00 23.33 29.16 4.10 4.12 4.00 36.80 3.66 4.10 10.48 3.52 18.81 34.50 17.48 20.58 4.14 36934182 PROTEIN TOTAL 84157 300 $161.00 59.51 3.52 128.80 4.72 111.25 4.20 111.25 4.10 88.95 4.12 10.21 4.51 4.10 106.57 3.60 4.00 23.33 29.16 4.10 4.12 4.00 128.80 3.66 4.10 10.48 3.52 65.85 120.75 61.20 72.02 4.14 35709525 PREG ASSOC PLAS PROT A(PAPP-A) 84163 300 $247.00 91.29 13.24 197.60 18.65 170.68 15.80 170.68 16.22 136.47 15.50 41.86 17.84 16.22 163.49 13.55 15.05 92.38 115.47 15.43 15.50 15.05 197.60 13.77 16.22 39.43 13.24 101.02 185.25 93.88 110.48 15.58 36900024 PREG-ASSOC PLAS PROT A(PAPP-A) 84163 300 $271.00 100.16 13.24 216.80 18.65 187.26 15.80 187.26 16.22 149.73 15.50 41.86 17.84 16.22 179.37 13.55 15.05 92.38 115.47 15.43 15.50 15.05 216.80 13.77 16.22 39.43 13.24 110.84 203.25 103.01 121.22 15.58 36944404 PAPPA SERUM 84163 300 $247.00 91.29 13.24 197.60 18.65 170.68 15.80 170.68 16.22 136.47 15.50 41.86 17.84 16.22 163.49 13.55 15.05 92.38 115.47 15.43 15.50 15.05 197.60 13.77 16.22 39.43 13.24 101.02 185.25 93.88 110.48 15.58 36110449 ELECTROPHORETIC FRAC SERUM 84165 300 $56.00 20.70 9.45 61.62 16.85 38.70 11.28 38.70 14.65 30.94 11.06 29.86 16.12 14.65 37.07 9.67 10.74 49.30 61.62 11.01 11.06 10.74 44.80 9.83 14.65 28.14 9.45 22.90 42.00 21.29 25.05 11.12 36110465 EPG URINE PROTEIN 84166 300 $94.00 34.74 15.69 141.92 22.93 64.95 18.72 64.95 19.94 51.94 18.36 49.58 21.93 19.94 62.22 16.05 17.83 113.54 141.92 18.28 18.36 17.83 75.20 16.31 19.94 46.71 15.69 38.45 70.50 35.73 42.05 18.45 36922915 CSF PROTEIN ELECTROPHORESIS 84166 300 $251.00 92.77 15.69 200.80 22.93 173.44 18.72 173.44 19.94 138.68 18.36 49.58 21.93 19.94 166.14 16.05 17.83 113.54 141.92 18.28 18.36 17.83 200.80 16.31 19.94 46.71 15.69 102.66 188.25 95.41 112.27 18.45 36922354 ANTI-68KD (HSP70) WESTERN BLOT 84181 300 "$1,372.00" 507.09 14.99 " 1,097.60 " 26.73 948.05 17.88 948.05 23.24 758.03 17.54 47.35 25.56 23.24 908.13 15.33 17.03 109.79 137.24 17.46 17.54 17.03 " 1,097.60 " 15.58 23.24 44.62 14.99 561.15 " 1,029.00 " 521.50 613.70 17.63 36930250 WESTERN BLOT 84181 300 "$1,372.00" 507.09 14.99 " 1,097.60 " 26.73 948.05 17.88 948.05 23.24 758.03 17.54 47.35 25.56 23.24 908.13 15.33 17.03 109.79 137.24 17.46 17.54 17.03 " 1,097.60 " 15.58 23.24 44.62 14.99 561.15 " 1,029.00 " 521.50 613.70 17.63 36933348 NEURONAL AB WESTERN BLOT 84181 300 "$1,372.00" 507.09 14.99 " 1,097.60 " 26.73 948.05 17.88 948.05 23.24 758.03 17.54 47.35 25.56 23.24 908.13 15.33 17.03 109.79 137.24 17.46 17.54 17.03 " 1,097.60 " 15.58 23.24 44.62 14.99 561.15 " 1,029.00 " 521.50 613.70 17.63 36933445 WESTERN BLOT WITH INTERP 84181 300 "$2,589.00" 956.89 14.99 " 2,071.20 " 26.73 " 1,789.00 " 17.88 " 1,789.00 " 23.24 " 1,430.42 " 17.54 47.35 25.56 23.24 " 1,713.66 " 15.33 17.03 109.79 137.24 17.46 17.54 17.03 " 2,071.20 " 15.58 23.24 44.62 14.99 " 1,058.90 " " 1,941.75 " 984.08 " 1,158.06 " 17.63 36933500 WESTERN BLOT WITH INTERP 84181 300 "$1,372.00" 507.09 14.99 " 1,097.60 " 26.73 948.05 17.88 948.05 23.24 758.03 17.54 47.35 25.56 23.24 908.13 15.33 17.03 109.79 137.24 17.46 17.54 17.03 " 1,097.60 " 15.58 23.24 44.62 14.99 561.15 " 1,029.00 " 521.50 613.70 17.63 36934549 MAG AB WITH REFLEX WEST BLOT 84181 300 "$1,372.00" 507.09 14.99 " 1,097.60 " 26.73 948.05 17.88 948.05 23.24 758.03 17.54 47.35 25.56 23.24 908.13 15.33 17.03 109.79 137.24 17.46 17.54 17.03 " 1,097.60 " 15.58 23.24 44.62 14.99 561.15 " 1,029.00 " 521.50 613.70 17.63 36936118 NEURONAL NUCLEAR (RI) AB- WB 84181 300 "$1,372.00" 507.09 14.99 " 1,097.60 " 26.73 948.05 17.88 948.05 23.24 758.03 17.54 47.35 25.56 23.24 908.13 15.33 17.03 109.79 137.24 17.46 17.54 17.03 " 1,097.60 " 15.58 23.24 44.62 14.99 561.15 " 1,029.00 " 521.50 613.70 17.63 36936215 HU CSF WESTERN BLOT 84181 300 "$1,372.00" 507.09 14.99 " 1,097.60 " 26.73 948.05 17.88 948.05 23.24 758.03 17.54 47.35 25.56 23.24 908.13 15.33 17.03 109.79 137.24 17.46 17.54 17.03 " 1,097.60 " 15.58 23.24 44.62 14.99 561.15 " 1,029.00 " 521.50 613.70 17.63 36937432 WESTERN BLOT 84181 300 "$1,736.00" 641.63 14.99 " 1,388.80 " 26.73 " 1,199.58 " 17.88 " 1,199.58 " 23.24 959.14 17.54 47.35 25.56 23.24 " 1,149.06 " 15.33 17.03 109.79 137.24 17.46 17.54 17.03 " 1,388.80 " 15.58 23.24 44.62 14.99 710.02 " 1,302.00 " 659.85 776.51 17.63 36918195 YO AUTOAB WESTERN BLOT 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36918209 RI AUTOAB WESTERN BLOT 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36918217 CAR AUTOAB WESTERN BLOT 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36918225 CV2 AUTOAN WESTERN BLOT 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36918233 MA AUTOAB WESTERN BLOT 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36922133 ZIC4 AUTOAB WESTERN BLOT 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36933453 WESTERN BLOT IMMUNO PROBE EA 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36933461 WESTERN BLOT IMMUNO PROBE EA 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36933518 WESTERN BLOT IMMUNO PROBE EA 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36933526 WESTERN BLOT IMMUNO PROBE EA 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36933534 WESTERN BLOT IMMUNO PROBE EA 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36933542 WESTERN BLOT IMMUNO PROBE EA 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36933551 WESTERN BLOT IMMUNO PROBE EA 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36937441 PROTEIN WEST BLOT 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36937459 PROTEIN WEST BLOT 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36937467 PROTEIN WEST BLOT 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36937475 PROTEIN WEST BLOT 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36937483 PROTEIN WEST BLOT 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36937491 PROTEIN WEST BLOT 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36938218 CRMP 5 IGG WEST BLOT 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36938234 PARANEOPLASTIC WEST BLOT 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36938242 AMPHIPHYSIN WEST BLOT 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36940034 RI AUTOAB WESTERN BLOT 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36940107 YO AUTOAB WESTERN BLOT 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36940522 WESTERN BLOT W INTERPR & RPT 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36941804 PROTEIN WESTERN BLOT 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36941812 PROTEIN WESTERN BLOT 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36941821 PROTEIN WESTERN BLOT 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36941839 PROTEIN WESTERN BLOT 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36941847 PROTEIN WESTERN BLOT 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36941855 PROTEIN WESTERN BLOT 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36941936 PROTEIN WESTERN BLOT 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36941944 PROTEIN WESTERN BLOT 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36941952 PROTEIN WESTERN BLOT 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36941961 PROTEIN WESTERN BLOT 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36941979 PROTEIN WESTERN BLOT 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36941987 PROTEIN WESTERN BLOT 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36941995 PROTEIN WESTERN BLOT 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36942002 PROTEIN WESTERN BLOT 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36942011 PROTEIN WESTERN BLOT 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36942029 PROTEIN WESTERN BLOT 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36942037 PROTEIN WESTERN BLOT 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36942045 PROTEIN WESTERN BLOT 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36943866 PROTEIN WESTERN BLOT TEST 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36943874 PROTEIN WESTERN BLOT TEST 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36943882 PROTEIN WESTERN BLOT TEST 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36943891 PROTEIN WESTERN BLOT TEST 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36943904 PROTEIN WESTERN BLOT TEST 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36943912 PROTEIN WESTERN BLOT TEST 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36943921 PROTEIN WESTERN BLOT TEST 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36943939 PROTEIN WESTERN BLOT TEST 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36943947 PROTEIN WESTERN BLOT TEST 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36943980 MAG AB WB EN 84182 300 "$2,713.00" " 1,002.72 " 24.55 " 2,170.40 " 28.23 " 1,874.68 " 30.67 " 1,874.68 " 24.55 " 1,498.93 " 30.09 50.05 27.01 24.55 " 1,795.73 " 26.29 29.21 116.05 145.06 29.94 30.09 29.21 " 2,170.40 " 26.73 24.55 76.53 25.70 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 30.23 36901250 ZINC PROTOPORPHYRIN QUANT 84202 300 $144.00 53.22 12.63 115.69 22.82 99.50 15.07 99.50 19.84 79.56 14.78 39.88 21.82 19.84 95.31 12.92 14.35 92.55 115.69 14.71 14.78 14.35 115.20 13.13 19.84 37.60 12.63 58.90 108.00 54.73 64.41 14.85 36923288 ZINC PROTOPORPHYRIN RBC QUANT 84202 300 $144.00 53.22 12.63 115.69 22.82 99.50 15.07 99.50 19.84 79.56 14.78 39.88 21.82 19.84 95.31 12.92 14.35 92.55 115.69 14.71 14.78 14.35 115.20 13.13 19.84 37.60 12.63 58.90 108.00 54.73 64.41 14.85 36939206 ERYTHROCYTE PROTOPORPHYRIN 84202 300 $144.00 53.22 12.63 115.69 22.82 99.50 15.07 99.50 19.84 79.56 14.78 39.88 21.82 19.84 95.31 12.92 14.35 92.55 115.69 14.71 14.78 14.35 115.20 13.13 19.84 37.60 12.63 58.90 108.00 54.73 64.41 14.85 36922338 PROINSULIN 84206 300 $573.00 211.78 8.00 458.40 9.20 395.94 28.02 395.94 8.00 316.58 27.49 49.52 8.80 8.00 379.27 24.02 26.69 114.90 143.63 27.36 27.49 26.69 458.40 24.42 8.00 69.93 23.49 234.36 429.75 217.80 256.30 27.62 36901624 VITAMIN B-6 84207 300 $148.00 54.70 24.73 226.41 44.64 102.27 29.51 102.27 38.82 81.77 28.94 78.12 42.70 38.82 97.96 25.29 28.10 181.13 226.41 28.80 28.94 28.10 118.40 25.71 38.82 73.62 24.73 60.53 111.00 56.25 66.20 29.08 36901543 PYRUVIC ACID 84210 300 $146.00 53.96 8.00 116.80 9.20 100.89 15.20 100.89 8.00 80.67 14.91 30.18 8.80 8.00 96.64 13.03 14.48 69.40 86.75 14.84 14.91 14.48 116.80 13.25 8.00 37.94 12.74 59.71 109.50 55.49 65.31 14.99 36901471 PYRUVATE KINASE 84220 300 $516.00 190.71 8.00 412.80 9.20 356.56 9.91 356.56 8.00 285.09 9.72 26.25 8.80 8.00 341.54 8.50 9.44 60.85 76.06 9.68 9.72 9.44 412.80 8.64 8.00 24.73 8.31 211.04 387.00 196.13 230.81 9.77 36935880 SOLUBLE TRANSFERRIN RECEPTOR 84238 300 $265.00 97.94 22.00 212.00 25.30 183.12 38.40 183.12 22.00 146.41 37.67 101.67 24.20 22.00 175.40 32.91 36.57 167.59 209.49 37.48 37.67 36.57 212.00 33.46 22.00 95.81 32.18 108.39 198.75 100.73 118.53 37.85 36923521 PLASMA RENIN ACTIVITY 84244 300 $115.00 42.50 12.00 126.05 13.80 79.47 23.09 79.47 12.00 63.54 22.65 61.14 13.20 12.00 76.12 19.79 21.99 100.84 126.05 22.54 22.65 21.99 92.00 20.12 12.00 57.61 19.35 47.04 86.25 43.71 51.44 22.76 36923555 RENIN 84244 300 $115.00 42.50 12.00 126.05 13.80 79.47 23.09 79.47 12.00 63.54 22.65 61.14 13.20 12.00 76.12 19.79 21.99 100.84 126.05 22.54 22.65 21.99 92.00 20.12 12.00 57.61 19.35 47.04 86.25 43.71 51.44 22.76 36924756 PLASMA RENIN ACTIVITY 1 84244 300 $115.00 42.50 12.00 126.05 13.80 79.47 23.09 79.47 12.00 63.54 22.65 61.14 13.20 12.00 76.12 19.79 21.99 100.84 126.05 22.54 22.65 21.99 92.00 20.12 12.00 57.61 19.35 47.04 86.25 43.71 51.44 22.76 36924764 PLASMA RENIN ACTIVITY 2 84244 300 $115.00 42.50 12.00 126.05 13.80 79.47 23.09 79.47 12.00 63.54 22.65 61.14 13.20 12.00 76.12 19.79 21.99 100.84 126.05 22.54 22.65 21.99 92.00 20.12 12.00 57.61 19.35 47.04 86.25 43.71 51.44 22.76 36924772 PLASMA RENIN ACTIVITY 3 84244 300 $115.00 42.50 12.00 126.05 13.80 79.47 23.09 79.47 12.00 63.54 22.65 61.14 13.20 12.00 76.12 19.79 21.99 100.84 126.05 22.54 22.65 21.99 92.00 20.12 12.00 57.61 19.35 47.04 86.25 43.71 51.44 22.76 36924781 PLASMA RENIN ACTIVITY 4 84244 300 $115.00 42.50 12.00 126.05 13.80 79.47 23.09 79.47 12.00 63.54 22.65 61.14 13.20 12.00 76.12 19.79 21.99 100.84 126.05 22.54 22.65 21.99 92.00 20.12 12.00 57.61 19.35 47.04 86.25 43.71 51.44 22.76 36924799 PLASMA RENIN ACTIVITY 5 84244 300 $115.00 42.50 12.00 126.05 13.80 79.47 23.09 79.47 12.00 63.54 22.65 61.14 13.20 12.00 76.12 19.79 21.99 100.84 126.05 22.54 22.65 21.99 92.00 20.12 12.00 57.61 19.35 47.04 86.25 43.71 51.44 22.76 36924802 PLASMA RENIN ACTIVITY 6 84244 300 $115.00 42.50 12.00 126.05 13.80 79.47 23.09 79.47 12.00 63.54 22.65 61.14 13.20 12.00 76.12 19.79 21.99 100.84 126.05 22.54 22.65 21.99 92.00 20.12 12.00 57.61 19.35 47.04 86.25 43.71 51.44 22.76 36940387 VITAMIN B2 RIBOFLAVIN 84252 300 $181.00 66.90 8.00 163.09 9.20 125.07 21.25 125.07 8.00 100.00 20.85 56.27 8.80 8.00 119.80 18.22 20.24 130.47 163.09 20.75 20.85 20.24 144.80 18.52 8.00 53.03 17.81 74.03 135.75 68.80 80.96 20.95 36903066 SELENIUM 84255 300 $324.00 119.75 - 259.20 - 223.88 26.81 223.88 - 179.01 26.30 71.00 - - 214.46 22.98 25.53 164.64 205.80 26.17 26.30 25.53 259.20 23.36 - 66.89 22.47 132.52 243.00 123.15 144.93 26.42 36900407 SEROTONIN BLOOD 84260 300 $524.00 193.67 27.26 419.20 35.65 362.08 32.53 362.08 31.00 289.51 31.91 86.13 34.10 31.00 346.84 27.88 30.98 142.02 177.53 31.75 31.91 30.98 419.20 28.35 31.00 81.17 27.26 214.32 393.00 199.17 234.39 32.06 35709401 SEX HORMONE BINDING GLOBULIN 84270 300 $114.00 42.13 19.12 104.55 29.69 78.77 22.82 78.77 25.82 62.99 22.38 60.45 28.40 25.82 75.46 19.56 21.73 83.64 104.55 22.27 22.38 21.73 91.20 19.88 25.82 56.93 19.12 46.63 85.50 43.33 50.99 22.49 36905590 SEX HORMONE BINDING GLOBULIN 84270 300 $114.00 42.13 19.12 104.55 29.69 78.77 22.82 78.77 25.82 62.99 22.38 60.45 28.40 25.82 75.46 19.56 21.73 83.64 104.55 22.27 22.38 21.73 91.20 19.88 25.82 56.93 19.12 46.63 85.50 43.33 50.99 22.49 35200231 SODIUM I-STAT 84295 300 $25.00 9.24 4.23 27.45 7.48 17.28 5.05 17.28 6.50 13.81 4.95 13.38 7.15 6.50 16.55 4.33 4.81 21.96 27.45 4.93 4.95 4.81 20.00 4.40 6.50 12.60 4.23 10.23 18.75 9.50 11.18 4.98 35200827 SODIUM EPOC 84295 300 $25.00 9.24 4.23 27.45 7.48 17.28 5.05 17.28 6.50 13.81 4.95 13.38 7.15 6.50 16.55 4.33 4.81 21.96 27.45 4.93 4.95 4.81 20.00 4.40 6.50 12.60 4.23 10.23 18.75 9.50 11.18 4.98 35701664 SODIUM 84295 300 $25.00 9.24 4.23 27.45 7.48 17.28 5.05 17.28 6.50 13.81 4.95 13.38 7.15 6.50 16.55 4.33 4.81 21.96 27.45 4.93 4.95 4.81 20.00 4.40 6.50 12.60 4.23 10.23 18.75 9.50 11.18 4.98 35702156 SODIUM WHOLE BLOOD 84295 300 $25.00 9.24 4.23 27.45 7.48 17.28 5.05 17.28 6.50 13.81 4.95 13.38 7.15 6.50 16.55 4.33 4.81 21.96 27.45 4.93 4.95 4.81 20.00 4.40 6.50 12.60 4.23 10.23 18.75 9.50 11.18 4.98 35703632 SODIUM RANDOM URINE 84300 300 $27.00 9.98 4.45 27.89 7.73 18.66 5.31 18.66 6.72 14.92 5.21 13.53 7.39 6.72 17.87 4.55 5.06 22.31 27.89 5.19 5.21 5.06 21.60 4.63 6.72 13.26 4.45 11.04 20.25 10.26 12.08 5.24 35706003 SODIUM 24 HOUR URINE 84300 300 $27.00 9.98 4.45 27.89 7.73 18.66 5.31 18.66 6.72 14.92 5.21 13.53 7.39 6.72 17.87 4.55 5.06 22.31 27.89 5.19 5.21 5.06 21.60 4.63 6.72 13.26 4.45 11.04 20.25 10.26 12.08 5.24 36914301 SODIUM URINE 84300 300 $79.00 29.20 4.45 63.20 7.73 54.59 5.31 54.59 6.72 43.65 5.21 13.53 7.39 6.72 52.29 4.55 5.06 22.31 27.89 5.19 5.21 5.06 63.20 4.63 6.72 13.26 4.45 32.31 59.25 30.03 35.34 5.24 36914751 SODIUM URINE 84300 300 $79.00 29.20 4.45 63.20 7.73 54.59 5.31 54.59 6.72 43.65 5.21 13.53 7.39 6.72 52.29 4.55 5.06 22.31 27.89 5.19 5.21 5.06 63.20 4.63 6.72 13.26 4.45 32.31 59.25 30.03 35.34 5.24 35703772 SODIUM FLUID 84302 300 $26.00 9.61 4.28 38.69 6.24 17.97 5.10 17.97 5.43 14.37 5.01 13.53 5.97 5.43 17.21 4.37 4.86 30.95 38.69 4.98 5.01 4.86 20.80 4.45 5.43 12.73 4.28 10.63 19.50 9.88 11.63 5.03 36944498 SODIUM OTHER SOURCE 84302 300 $60.00 22.18 4.28 48.00 6.24 41.46 5.10 41.46 5.43 33.15 5.01 13.53 5.97 5.43 39.71 4.37 4.86 30.95 38.69 4.98 5.01 4.86 48.00 4.45 5.43 12.73 4.28 24.54 45.00 22.81 26.84 5.03 35705228 IGF 1 84305 300 $112.00 41.40 18.71 104.11 29.57 77.39 22.32 77.39 25.71 61.88 21.90 59.09 28.28 25.71 74.13 19.13 21.26 83.29 104.11 21.79 21.90 21.26 89.60 19.45 25.71 55.70 18.71 45.81 84.00 42.57 50.10 22.00 36937297 ASSAY OF SOMATOMEDIN 84305 300 $141.00 52.11 18.71 112.80 29.57 97.43 22.32 97.43 25.71 77.90 21.90 59.09 28.28 25.71 93.33 19.13 21.26 83.29 104.11 21.79 21.90 21.26 112.80 19.45 25.71 55.70 18.71 57.67 105.75 53.59 63.07 22.00 36940735 INSULIN-LIKE GROWTH FACT 1 84305 300 $112.00 41.40 18.71 104.11 29.57 77.39 22.32 77.39 25.71 61.88 21.90 59.09 28.28 25.71 74.13 19.13 21.26 83.29 104.11 21.79 21.90 21.26 89.60 19.45 25.71 55.70 18.71 45.81 84.00 42.57 50.10 22.00 35705937 VALIDATION SCREEN-SPECTROPHOTO 84311 300 $43.00 15.89 - 40.07 - 29.71 8.51 29.71 - 23.76 8.34 19.44 - - 28.46 7.29 8.10 32.06 40.07 8.30 8.34 8.10 34.40 7.41 - 21.22 7.13 17.59 32.25 16.34 19.23 8.38 36924934 ADENOSINE DEAMINASE BLOOD SPEC 84311 300 $175.00 64.68 - 140.00 - 120.93 8.51 120.93 - 96.69 8.34 19.44 - - 115.83 7.29 8.10 32.06 40.07 8.30 8.34 8.10 140.00 7.41 - 21.22 7.13 71.58 131.25 66.52 78.28 8.38 36930217 PANCREATIC ENZYME ANALYSIS 84311 300 $606.00 223.98 - 484.80 - 418.75 8.51 418.75 - 334.82 8.34 19.44 - - 401.11 7.29 8.10 32.06 40.07 8.30 8.34 8.10 484.80 7.41 - 21.22 7.13 247.85 454.50 230.34 271.06 8.38 36934174 CHYMOTRYPSIN SPECT 84311 300 $125.00 46.20 - 100.00 - 86.38 8.51 86.38 - 69.06 8.34 19.44 - - 82.74 7.29 8.10 32.06 40.07 8.30 8.34 8.10 100.00 7.41 - 21.22 7.13 51.13 93.75 47.51 55.91 8.38 36944501 SPECTROPHOTO ANALYTE NES 84311 300 $88.00 32.52 - 70.40 - 60.81 8.51 60.81 - 48.62 8.34 19.44 - - 58.25 7.29 8.10 32.06 40.07 8.30 8.34 8.10 70.40 7.41 - 21.22 7.13 35.99 66.00 33.45 39.36 8.38 36981903 SPECTROPHOTOMETRY ANAL NOS 84311 300 $491.00 181.47 - 392.80 - 339.28 8.51 339.28 - 271.28 8.34 19.44 - - 324.99 7.29 8.10 32.06 40.07 8.30 8.34 8.10 392.80 7.41 - 21.22 7.13 200.82 368.25 186.63 219.62 8.38 36982471 SPECTROPHOTOMETRY NES 84311 300 $43.00 15.89 - 40.07 - 29.71 8.51 29.71 - 23.76 8.34 19.44 - - 28.46 7.29 8.10 32.06 40.07 8.30 8.34 8.10 34.40 7.41 - 21.22 7.13 17.59 32.25 16.34 19.23 8.38 35706950 SPECIFIC GRAVITY FLUID 84315 300 $17.00 6.28 - 20.23 - 11.75 3.44 11.75 - 9.39 3.38 6.97 - - 11.25 2.95 3.28 16.18 20.23 3.36 3.38 3.28 13.60 3.00 - 8.59 2.89 6.95 12.75 6.46 7.60 3.39 35709541 SUGARS-SINGLE QUAL (RED SUB) 84376 300 $49.00 18.11 4.84 43.32 7.00 33.86 5.78 33.86 6.09 27.07 5.67 15.29 6.70 6.09 32.43 4.95 5.50 34.66 43.32 5.64 5.67 5.50 39.20 5.03 6.09 14.41 4.84 20.04 36.75 18.62 21.92 5.69 36938366 REDUCE SUBS FECES SUGARS QUAL 84376 300 $49.00 18.11 4.84 43.32 7.00 33.86 5.78 33.86 6.09 27.07 5.67 15.29 6.70 6.09 32.43 4.95 5.50 34.66 43.32 5.64 5.67 5.50 39.20 5.03 6.09 14.41 4.84 20.04 36.75 18.62 21.92 5.69 36916389 GALACTOSE 1 PHOSPHATE QUAN 84378 300 "$1,586.00" 586.19 10.15 " 1,268.80 " 14.65 " 1,095.93 " 12.11 " 1,095.93 " 12.74 876.27 11.88 32.06 14.01 12.74 " 1,049.77 " 10.38 11.53 72.53 90.66 11.82 11.88 11.53 " 1,268.80 " 10.55 12.74 30.21 10.15 648.67 " 1,189.50 " 602.84 709.42 11.93 36914769 SULFATE URINE 84392 300 $40.00 14.78 - 38.25 - 27.64 5.76 27.64 - 22.10 5.65 13.22 - - 26.48 4.94 5.49 30.60 38.25 5.63 5.65 5.49 32.00 5.02 - 14.38 4.83 16.36 30.00 15.20 17.89 5.68 35705155 TESTOSTERONE FREE 84402 300 $134.00 49.53 22.41 149.03 31.05 92.59 26.74 92.59 27.00 74.04 26.23 70.81 29.70 27.00 88.69 22.92 25.47 119.22 149.03 26.11 26.23 25.47 107.20 23.31 27.00 66.73 22.41 54.81 100.50 50.93 59.94 26.36 36930209 FREE TESTOSTERNE BY EQUIL DIAL 84402 300 $134.00 49.53 22.41 149.03 31.05 92.59 26.74 92.59 27.00 74.04 26.23 70.81 29.70 27.00 88.69 22.92 25.47 119.22 149.03 26.11 26.23 25.47 107.20 23.31 27.00 66.73 22.41 54.81 100.50 50.93 59.94 26.36 35705031 TESTOSTERONE TOTAL 84403 300 $136.00 50.27 22.71 147.93 31.05 93.98 27.10 93.98 27.00 75.14 26.58 71.78 29.70 27.00 90.02 23.23 25.81 118.34 147.93 26.46 26.58 25.81 108.80 23.62 27.00 67.62 22.71 55.62 102.00 51.69 60.83 26.71 36913509 TOTAL TESTOSTERONE 84403 300 $242.00 89.44 22.71 193.60 31.05 167.22 27.10 167.22 27.00 133.71 26.58 71.78 29.70 27.00 160.18 23.23 25.81 118.34 147.93 26.46 26.58 25.81 193.60 23.62 27.00 67.62 22.71 98.98 181.50 91.98 108.25 26.71 36917148 TESTOSTERONE TOTAL 84403 300 $242.00 89.44 22.71 193.60 31.05 167.22 27.10 167.22 27.00 133.71 26.58 71.78 29.70 27.00 160.18 23.23 25.81 118.34 147.93 26.46 26.58 25.81 193.60 23.62 27.00 67.62 22.71 98.98 181.50 91.98 108.25 26.71 36918161 TESTOSTERONE TOTAL 84403 300 $242.00 89.44 22.71 193.60 31.05 167.22 27.10 167.22 27.00 133.71 26.58 71.78 29.70 27.00 160.18 23.23 25.81 118.34 147.93 26.46 26.58 25.81 193.60 23.62 27.00 67.62 22.71 98.98 181.50 91.98 108.25 26.71 36930195 TOTAL TESTOSTRNE BY EQUIL DIAL 84403 300 $136.00 50.27 22.71 147.93 31.05 93.98 27.10 93.98 27.00 75.14 26.58 71.78 29.70 27.00 90.02 23.23 25.81 118.34 147.93 26.46 26.58 25.81 108.80 23.62 27.00 67.62 22.71 55.62 102.00 51.69 60.83 26.71 36934352 TESTOSTERONE TOTAL 84403 300 $242.00 89.44 22.71 193.60 31.05 167.22 27.10 167.22 27.00 133.71 26.58 71.78 29.70 27.00 160.18 23.23 25.81 118.34 147.93 26.46 26.58 25.81 193.60 23.62 27.00 67.62 22.71 98.98 181.50 91.98 108.25 26.71 36936185 PEDIATRIC/FEMALE TESTOSTERONE 84403 300 $136.00 50.27 22.71 147.93 31.05 93.98 27.10 93.98 27.00 75.14 26.58 71.78 29.70 27.00 90.02 23.23 25.81 118.34 147.93 26.46 26.58 25.81 108.80 23.62 27.00 67.62 22.71 55.62 102.00 51.69 60.83 26.71 36901616 VITAMIN B1 84425 300 $383.00 141.56 7.00 306.40 8.05 264.65 22.29 264.65 7.00 211.61 21.87 59.03 7.70 7.00 253.51 19.11 21.23 136.95 171.19 21.76 21.87 21.23 306.40 19.43 7.00 55.62 18.68 156.65 287.25 145.58 171.32 21.97 36941634 VITAMIN B1 WHOLE BLOOD 84425 300 $383.00 141.56 7.00 306.40 8.05 264.65 22.29 264.65 7.00 211.61 21.87 59.03 7.70 7.00 253.51 19.11 21.23 136.95 171.19 21.76 21.87 21.23 306.40 19.43 7.00 55.62 18.68 156.65 287.25 145.58 171.32 21.97 36923512 THIOCYANATE 84430 300 $205.00 75.77 4.80 164.00 5.52 141.66 12.21 141.66 4.80 113.26 11.98 32.34 5.28 4.80 135.69 10.47 11.63 27.74 34.67 11.92 11.98 11.63 164.00 10.64 4.80 30.47 10.23 83.85 153.75 77.92 91.70 12.04 35705210 THYROGLOBULIN 84432 300 $84.00 31.05 14.13 93.86 25.02 58.04 16.86 58.04 21.76 46.41 16.54 44.65 23.94 21.76 55.60 14.45 16.06 75.09 93.86 16.46 16.54 16.06 67.20 14.69 21.76 42.08 14.13 34.36 63.00 31.93 37.57 16.62 35710167 THYROGLOBULIN 84432 300 $84.00 31.05 14.13 93.86 25.02 58.04 16.86 58.04 21.76 46.41 16.54 44.65 23.94 21.76 55.60 14.45 16.06 75.09 93.86 16.46 16.54 16.06 67.20 14.69 21.76 42.08 14.13 34.36 63.00 31.93 37.57 16.62 36945516 QN THYROGLOBULIN W/O TGAB 84432 300 $84.00 31.05 14.13 93.86 25.02 58.04 16.86 58.04 21.76 46.41 16.54 44.65 23.94 21.76 55.60 14.45 16.06 75.09 93.86 16.46 16.54 16.06 67.20 14.69 21.76 42.08 14.13 34.36 63.00 31.93 37.57 16.62 36982934 THYROGLOBULIN 84432 300 $84.00 31.05 14.13 93.86 25.02 58.04 16.86 58.04 21.76 46.41 16.54 44.65 23.94 21.76 55.60 14.45 16.06 75.09 93.86 16.46 16.54 16.06 67.20 14.69 21.76 42.08 14.13 34.36 63.00 31.93 37.57 16.62 36982942 THYROGLOBULIN LC/MS/MS 84432 300 $160.00 59.14 14.13 128.00 25.02 110.56 16.86 110.56 21.76 88.40 16.54 44.65 23.94 21.76 105.90 14.45 16.06 75.09 93.86 16.46 16.54 16.06 128.00 14.69 21.76 42.08 14.13 65.44 120.00 60.82 71.57 16.62 35705066 T4 TOTAL 84436 300 $36.00 13.31 6.05 39.41 10.93 24.88 7.21 24.88 9.50 19.89 7.08 19.09 10.45 9.50 23.83 6.18 6.87 31.53 39.41 7.04 7.08 6.87 28.80 6.29 9.50 18.00 6.05 14.72 27.00 13.68 16.10 7.11 35705279 T4 FREE EIA 84439 300 $47.00 17.37 7.94 51.70 9.20 32.48 9.47 32.48 8.00 25.97 9.29 25.06 8.80 8.00 31.11 8.12 9.02 41.36 51.70 9.25 9.29 9.02 37.60 8.25 8.00 23.63 7.94 19.22 35.25 17.86 21.02 9.34 36911450 FREE THYROXINE 84439 300 $168.00 62.09 7.94 134.40 9.20 116.09 9.47 116.09 8.00 92.82 9.29 25.06 8.80 8.00 111.20 8.12 9.02 41.36 51.70 9.25 9.29 9.02 134.40 8.25 8.00 23.63 7.94 68.71 126.00 63.86 75.15 9.34 36903163 THYROXINE BINDING GLOBULIN 84442 300 $164.00 60.61 10.00 131.20 11.50 113.32 15.52 113.32 10.00 90.61 15.22 41.10 11.00 10.00 108.55 13.30 14.78 67.82 84.77 15.15 15.22 14.78 131.20 13.52 10.00 38.72 13.01 67.08 123.00 62.34 73.36 15.30 35705058 TSH 84443 300 $88.00 32.52 14.78 96.29 26.69 60.81 17.64 60.81 23.21 48.62 17.30 46.72 25.53 23.21 58.25 15.12 16.80 77.03 96.29 17.22 17.30 16.80 70.40 15.37 23.21 44.02 14.78 35.99 66.00 33.45 39.36 17.39 35709592 TSH REFLEX TO FREE T4 84443 300 $88.00 32.52 14.78 96.29 26.69 60.81 17.64 60.81 23.21 48.62 17.30 46.72 25.53 23.21 58.25 15.12 16.80 77.03 96.29 17.22 17.30 16.80 70.40 15.37 23.21 44.02 14.78 35.99 66.00 33.45 39.36 17.39 36930977 THYROID STIMULATING HORMONE 84443 300 $333.00 123.08 14.78 266.40 26.69 230.10 17.64 230.10 23.21 183.98 17.30 46.72 25.53 23.21 220.41 15.12 16.80 77.03 96.29 17.22 17.30 16.80 266.40 15.37 23.21 44.02 14.78 136.20 249.75 126.57 148.95 17.39 36944960 THYROID STIMULATING HORMONE 84443 300 $126.00 46.57 14.78 100.80 26.69 87.07 17.64 87.07 23.21 69.62 17.30 46.72 25.53 23.21 83.40 15.12 16.80 77.03 96.29 17.22 17.30 16.80 100.80 15.37 23.21 44.02 14.78 51.53 94.50 47.89 56.36 17.39 36903325 THYROID STIMUL IMMUNOGLOBULIN 84445 300 $373.00 137.86 20.00 298.40 23.00 257.74 53.40 257.74 20.00 206.08 52.39 141.39 22.00 20.00 246.89 45.77 50.86 216.89 271.11 52.13 52.39 50.86 298.40 46.54 20.00 133.25 44.76 152.56 279.75 141.78 166.84 52.64 35702806 VITAMIN E 84446 300 $74.00 27.35 10.00 88.90 11.50 51.13 14.89 51.13 10.00 40.89 14.61 39.41 11.00 10.00 48.98 12.76 14.18 71.12 88.90 14.53 14.61 14.18 59.20 12.97 10.00 37.15 12.48 30.27 55.50 28.13 33.10 14.68 36982209 VITAMIN E 84446 300 $74.00 27.35 10.00 88.90 11.50 51.13 14.89 51.13 10.00 40.89 14.61 39.41 11.00 10.00 48.98 12.76 14.18 71.12 88.90 14.53 14.61 14.18 59.20 12.97 10.00 37.15 12.48 30.27 55.50 28.13 33.10 14.68 35701630 AST 84450 300 $27.00 9.98 4.56 29.65 8.20 18.66 5.44 18.66 7.13 14.92 5.34 14.38 7.84 7.13 17.87 4.66 5.18 23.72 29.65 5.31 5.34 5.18 21.60 4.74 7.13 13.57 4.56 11.04 20.25 10.26 12.08 5.36 35701648 ALT 84460 300 $28.00 10.35 4.66 29.98 8.28 19.35 5.57 19.35 7.20 15.47 5.46 14.73 7.92 7.20 18.53 4.77 5.30 23.98 29.98 5.43 5.46 5.30 22.40 4.85 7.20 13.89 4.66 11.45 21.00 10.64 12.52 5.49 35709797 EXPOSURE ALT 84460 300 $28.00 10.35 4.66 29.98 8.28 19.35 5.57 19.35 7.20 15.47 5.46 14.73 7.92 7.20 18.53 4.77 5.30 23.98 29.98 5.43 5.46 5.30 22.40 4.85 7.20 13.89 4.66 11.45 21.00 10.64 12.52 5.49 36941430 ALANINE AMINO ALT 84460 300 $74.00 27.35 4.66 59.20 8.28 51.13 5.57 51.13 7.20 40.89 5.46 14.73 7.92 7.20 48.98 4.77 5.30 23.98 29.98 5.43 5.46 5.30 59.20 4.85 7.20 13.89 4.66 30.27 55.50 28.13 33.10 5.49 35707883 TRANSFERRIN 84466 300 $67.00 24.76 11.23 75.34 19.55 46.30 13.40 46.30 17.00 37.02 13.14 35.48 18.70 17.00 44.35 11.48 12.76 60.27 75.34 13.08 13.14 12.76 53.60 11.68 17.00 33.43 11.23 27.40 50.25 25.47 29.97 13.21 35701761 TRIGLYCERIDES 84478 300 $30.00 11.09 5.05 32.79 8.27 20.73 6.03 20.73 7.19 16.58 5.91 15.98 7.91 7.19 19.86 5.17 5.74 26.23 32.79 5.88 5.91 5.74 24.00 5.25 7.19 15.04 5.05 12.27 22.50 11.40 13.42 5.94 35708405 TRIGLYCERIDE FLUID 84478 300 $30.00 11.09 5.05 32.79 8.27 20.73 6.03 20.73 7.19 16.58 5.91 15.98 7.91 7.19 19.86 5.17 5.74 26.23 32.79 5.88 5.91 5.74 24.00 5.25 7.19 15.04 5.05 12.27 22.50 11.40 13.42 5.94 36912928 TRIGLYCERIDES 84478 300 $106.00 39.18 5.05 84.80 8.27 73.25 6.03 73.25 7.19 58.57 5.91 15.98 7.91 7.19 70.16 5.17 5.74 26.23 32.79 5.88 5.91 5.74 84.80 5.25 7.19 15.04 5.05 43.35 79.50 40.29 47.41 5.94 36920742 T3 UPTAKE 84479 300 $119.00 43.98 5.69 95.20 10.29 82.23 6.79 82.23 8.95 65.75 6.66 17.99 9.85 8.95 78.77 5.82 6.47 29.67 37.09 6.63 6.66 6.47 95.20 5.92 8.95 16.95 5.69 48.67 89.25 45.23 53.23 6.70 35708707 T3 TOTAL (TRIIODOTHYRONINE) 84480 300 $74.00 27.35 8.00 81.24 9.20 51.13 14.89 51.13 8.00 40.89 14.61 39.41 8.80 8.00 48.98 12.76 14.18 64.99 81.24 14.53 14.61 14.18 59.20 12.97 8.00 37.15 12.48 30.27 55.50 28.13 33.10 14.68 36918098 T3 TOTAL 84480 300 $200.00 73.92 8.00 160.00 9.20 138.20 14.89 138.20 8.00 110.50 14.61 39.41 8.80 8.00 132.38 12.76 14.18 64.99 81.24 14.53 14.61 14.18 160.00 12.97 8.00 37.15 12.48 81.80 150.00 76.02 89.46 14.68 35705121 T3 FREE 84481 300 $89.00 32.89 14.91 97.11 26.92 61.50 17.79 61.50 23.41 49.17 17.45 47.10 25.75 23.41 58.91 15.25 16.94 77.69 97.11 17.36 17.45 16.94 71.20 15.50 23.41 44.38 14.91 36.40 66.75 33.83 39.81 17.53 36918080 T3 FREE 84481 300 $223.00 82.42 14.91 178.40 26.92 154.09 17.79 154.09 23.41 123.21 17.45 47.10 25.75 23.41 147.60 15.25 16.94 77.69 97.11 17.36 17.45 16.94 178.40 15.50 23.41 44.38 14.91 91.21 167.25 84.76 99.75 17.53 36909684 T3 REVERSE 84482 300 $83.00 30.68 13.87 133.82 25.05 57.35 16.55 57.35 21.78 45.86 16.23 43.83 23.96 21.78 54.94 14.18 15.76 107.06 133.82 16.15 16.23 15.76 66.40 14.42 21.78 41.29 13.87 33.95 62.25 31.55 37.13 16.31 35200797 TRPONIN I (I-STAT) 84484 300 $65.00 24.02 9.87 68.56 11.35 44.92 13.09 44.92 9.87 35.91 12.84 27.35 10.86 9.87 43.02 11.22 12.47 54.85 68.56 12.78 12.84 12.47 52.00 11.41 9.87 32.67 10.97 26.59 48.75 24.71 29.07 12.91 35707123 TROPONIN T 84484 300 $65.00 24.02 9.87 68.56 11.35 44.92 13.09 44.92 9.87 35.91 12.84 27.35 10.86 9.87 43.02 11.22 12.47 54.85 68.56 12.78 12.84 12.47 52.00 11.41 9.87 32.67 10.97 26.59 48.75 24.71 29.07 12.91 35710043 TROPONIN I 84484 300 $65.00 24.02 9.87 68.56 11.35 44.92 13.09 44.92 9.87 35.91 12.84 27.35 10.86 9.87 43.02 11.22 12.47 54.85 68.56 12.78 12.84 12.47 52.00 11.41 9.87 32.67 10.97 26.59 48.75 24.71 29.07 12.91 35710116 HIGH SENSITIVITY TROPONIN T 84484 300 $65.00 24.02 9.87 68.56 11.35 44.92 13.09 44.92 9.87 35.91 12.84 27.35 10.86 9.87 43.02 11.22 12.47 54.85 68.56 12.78 12.84 12.47 52.00 11.41 9.87 32.67 10.97 26.59 48.75 24.71 29.07 12.91 36934140 TRYPSIN DUODENAL FLUID 84485 300 $129.00 47.68 6.34 103.20 11.16 89.14 7.56 89.14 9.70 71.27 7.42 20.88 10.67 9.70 85.39 6.48 7.20 48.37 60.46 7.38 7.42 7.20 103.20 6.59 9.70 18.86 6.34 52.76 96.75 49.03 57.70 7.45 35200266 BUN I-STAT QUANT 84520 300 $21.00 7.76 3.48 22.60 6.26 14.51 4.15 14.51 5.44 11.60 4.07 10.99 5.98 5.44 13.90 3.56 3.95 18.08 22.60 4.05 4.07 3.95 16.80 3.61 5.44 10.35 3.48 8.59 15.75 7.98 9.39 4.09 35700382 BUN QUANT 84520 300 $21.00 7.76 3.48 22.60 6.26 14.51 4.15 14.51 5.44 11.60 4.07 10.99 5.98 5.44 13.90 3.56 3.95 18.08 22.60 4.05 4.07 3.95 16.80 3.61 5.44 10.35 3.48 8.59 15.75 7.98 9.39 4.09 35705368 UREA NITROGEN FLUID 84520 300 $21.00 7.76 3.48 22.60 6.26 14.51 4.15 14.51 5.44 11.60 4.07 10.99 5.98 5.44 13.90 3.56 3.95 18.08 22.60 4.05 4.07 3.95 16.80 3.61 5.44 10.35 3.48 8.59 15.75 7.98 9.39 4.09 35707549 PREDIALYSIS BUN 84520 300 $21.00 7.76 3.48 22.60 6.26 14.51 4.15 14.51 5.44 11.60 4.07 10.99 5.98 5.44 13.90 3.56 3.95 18.08 22.60 4.05 4.07 3.95 16.80 3.61 5.44 10.35 3.48 8.59 15.75 7.98 9.39 4.09 35707557 POSTDIALYSIS BUN 84520 300 $21.00 7.76 3.48 22.60 6.26 14.51 4.15 14.51 5.44 11.60 4.07 10.99 5.98 5.44 13.90 3.56 3.95 18.08 22.60 4.05 4.07 3.95 16.80 3.61 5.44 10.35 3.48 8.59 15.75 7.98 9.39 4.09 35701788 UREA NITROGEN 24 HOUR URINE 84540 300 $29.00 10.72 - 37.48 - 20.04 5.84 20.04 - 16.02 5.73 13.22 - - 19.20 5.00 5.56 29.98 37.48 5.70 5.73 5.56 23.20 5.09 - 14.57 4.89 11.86 21.75 11.02 12.97 5.75 35708995 UREA NITROGEN RANDOM URINE 84540 300 $29.00 10.72 - 37.48 - 20.04 5.84 20.04 - 16.02 5.73 13.22 - - 19.20 5.00 5.56 29.98 37.48 5.70 5.73 5.56 23.20 5.09 - 14.57 4.89 11.86 21.75 11.02 12.97 5.75 35701796 URIC ACID 84550 300 $24.00 8.87 3.98 25.90 7.18 16.58 4.75 16.58 6.24 13.26 4.66 12.56 6.86 6.24 15.89 4.07 4.52 20.72 25.90 4.63 4.66 4.52 19.20 4.14 6.24 11.84 3.98 9.82 18.00 9.12 10.74 4.68 35703551 URIC ACID RANDOM URINE 84560 300 $27.00 9.98 4.47 21.60 5.18 18.66 5.33 18.66 4.50 14.92 5.23 13.22 4.95 4.50 17.87 4.57 5.08 14.64 18.30 5.21 5.23 5.08 21.60 4.65 4.50 13.31 4.47 11.04 20.25 10.26 12.08 5.26 35705988 URIC ACID 24 HOUR URINE 84560 300 $27.00 9.98 4.47 21.60 5.18 18.66 5.33 18.66 4.50 14.92 5.23 13.22 4.95 4.50 17.87 4.57 5.08 14.64 18.30 5.21 5.23 5.08 21.60 4.65 4.50 13.31 4.47 11.04 20.25 10.26 12.08 5.26 35705996 URIC ACID FLUID 84560 300 $27.00 9.98 4.47 21.60 5.18 18.66 5.33 18.66 4.50 14.92 5.23 13.22 4.95 4.50 17.87 4.57 5.08 14.64 18.30 5.21 5.23 5.08 21.60 4.65 4.50 13.31 4.47 11.04 20.25 10.26 12.08 5.26 36914271 URIC ACID URINE 84560 300 $94.00 34.74 4.47 75.20 5.18 64.95 5.33 64.95 4.50 51.94 5.23 13.22 4.95 4.50 62.22 4.57 5.08 14.64 18.30 5.21 5.23 5.08 75.20 4.65 4.50 13.31 4.47 38.45 70.50 35.73 42.05 5.26 36914718 URIC ACID URINE 84560 300 $94.00 34.74 4.47 75.20 5.18 64.95 5.33 64.95 4.50 51.94 5.23 13.22 4.95 4.50 62.22 4.57 5.08 14.64 18.30 5.21 5.23 5.08 75.20 4.65 4.50 13.31 4.47 38.45 70.50 35.73 42.05 5.26 35707115 VANILLYLMANDELIC ACID RD URINE 84585 300 $81.00 29.94 12.00 88.85 13.80 55.97 16.28 55.97 12.00 44.75 15.97 43.08 13.20 12.00 53.61 13.95 15.50 71.08 88.85 15.89 15.97 15.50 64.80 14.18 12.00 40.61 13.64 33.13 60.75 30.79 36.23 16.04 35707727 VANILLYLMANDELIC ACID 24HR UR 84585 300 $81.00 29.94 12.00 88.85 13.80 55.97 16.28 55.97 12.00 44.75 15.97 43.08 13.20 12.00 53.61 13.95 15.50 71.08 88.85 15.89 15.97 15.50 64.80 14.18 12.00 40.61 13.64 33.13 60.75 30.79 36.23 16.04 36941278 VANILLYLMANDELIC ACID URINE 84585 300 $81.00 29.94 12.00 88.85 13.80 55.97 16.28 55.97 12.00 44.75 15.97 43.08 13.20 12.00 53.61 13.95 15.50 71.08 88.85 15.89 15.97 15.50 64.80 14.18 12.00 40.61 13.64 33.13 60.75 30.79 36.23 16.04 36941294 VANILLYLMANDELIC ACID URINE 84585 300 $81.00 29.94 12.00 88.85 13.80 55.97 16.28 55.97 12.00 44.75 15.97 43.08 13.20 12.00 53.61 13.95 15.50 71.08 88.85 15.89 15.97 15.50 64.80 14.18 12.00 40.61 13.64 33.13 60.75 30.79 36.23 16.04 36909668 VASOACTIVE INTEST POLYPEPTIDE 84586 300 $185.00 68.38 31.09 284.78 56.15 127.84 37.10 127.84 48.83 102.21 36.39 98.22 53.71 48.83 122.45 31.80 35.33 227.82 284.78 36.21 36.39 35.33 148.00 32.33 48.83 92.56 31.09 75.67 138.75 70.32 82.75 36.57 36913860 ANTIDIURETIC HORMONE-VASOPRESN 84588 300 $239.00 88.33 29.87 273.54 41.40 165.15 35.64 165.15 36.00 132.05 34.96 94.39 39.60 36.00 158.19 30.55 33.94 218.83 273.54 34.79 34.96 33.94 191.20 31.06 36.00 88.92 29.87 97.75 179.25 90.84 106.90 35.13 35702989 VITAMIN A 84590 300 $61.00 22.55 10.22 66.47 14.95 42.15 12.19 42.15 13.00 33.70 11.96 32.28 14.30 13.00 40.38 10.45 11.61 53.18 66.47 11.90 11.96 11.61 48.80 10.62 13.00 30.42 10.22 24.95 45.75 23.19 27.29 12.02 36982217 VITAMIN A 84590 300 $61.00 22.55 10.22 66.47 14.95 42.15 12.19 42.15 13.00 33.70 11.96 32.28 14.30 13.00 40.38 10.45 11.61 53.18 66.47 11.90 11.96 11.61 48.80 10.62 13.00 30.42 10.22 24.95 45.75 23.19 27.29 12.02 36914190 VITAMIN K 84597 300 "$1,189.00" 439.45 - 951.20 - 821.60 14.41 821.60 - 656.92 14.13 38.15 - - 787.00 12.35 13.72 88.41 110.51 14.06 14.13 13.72 951.20 12.55 - 35.95 12.07 486.30 891.75 451.94 531.84 14.20 35700072 VOLATILES 84600 300 $90.00 33.26 - 129.52 - 62.19 17.97 62.19 - 49.73 17.62 44.71 - - 59.57 15.40 17.11 103.62 129.52 17.54 17.62 17.11 72.00 15.66 - 44.83 15.06 36.81 67.50 34.21 40.26 17.71 36910437 HYDROCARBON & OXYGENATED PANEL 84600 300 $448.00 165.58 - 358.40 - 309.57 17.97 309.57 - 247.52 17.62 44.71 - - 296.53 15.40 17.11 103.62 129.52 17.54 17.62 17.11 358.40 15.66 - 44.83 15.06 183.23 336.00 170.28 200.39 17.71 36916419 TOLUENE 84600 300 $343.00 126.77 - 274.40 - 237.01 17.97 237.01 - 189.51 17.62 44.71 - - 227.03 15.40 17.11 103.62 129.52 17.54 17.62 17.11 274.40 15.66 - 44.83 15.06 140.29 257.25 130.37 153.42 17.71 36937572 VOLATILES 84600 300 $105.00 38.81 - 129.52 - 72.56 17.97 72.56 - 58.01 17.62 44.71 - - 69.50 15.40 17.11 103.62 129.52 17.54 17.62 17.11 84.00 15.66 - 44.83 15.06 42.95 78.75 39.91 46.97 17.71 36901659 D-XYLOSE 2 HR 84620 300 $194.00 71.70 3.00 155.20 3.45 134.05 13.56 134.05 3.00 107.19 13.30 32.94 3.30 3.00 128.41 11.62 12.91 76.37 95.46 13.23 13.30 12.91 155.20 11.81 3.00 33.82 11.36 79.35 145.50 73.74 86.78 13.36 36906545 D-XYLOSE 5HR URINE 84620 300 $194.00 71.70 3.00 155.20 3.45 134.05 13.56 134.05 3.00 107.19 13.30 32.94 3.30 3.00 128.41 11.62 12.91 76.37 95.46 13.23 13.30 12.91 155.20 11.81 3.00 33.82 11.36 79.35 145.50 73.74 86.78 13.36 36900458 ZINC SERUM OR URINE 84630 300 $219.00 80.94 10.02 175.20 15.24 151.33 11.96 151.33 13.25 121.00 11.73 31.65 14.58 13.25 144.96 10.25 11.39 52.25 65.31 11.67 11.73 11.39 175.20 10.42 13.25 29.84 10.02 89.57 164.25 83.24 97.96 11.79 36911611 ZINC 24 HR URINE 84630 300 $219.00 80.94 10.02 175.20 15.24 151.33 11.96 151.33 13.25 121.00 11.73 31.65 14.58 13.25 144.96 10.25 11.39 52.25 65.31 11.67 11.73 11.39 175.20 10.42 13.25 29.84 10.02 89.57 164.25 83.24 97.96 11.79 36924811 ZINC PLASMA 84630 300 $82.00 30.31 10.02 65.60 15.24 56.66 11.96 56.66 13.25 45.31 11.73 31.65 14.58 13.25 54.28 10.25 11.39 52.25 65.31 11.67 11.73 11.39 65.60 10.42 13.25 29.84 10.02 33.54 61.50 31.17 36.68 11.79 35708715 C PEPTIDE 84681 300 $109.00 40.29 18.31 119.21 33.06 75.32 21.85 75.32 28.75 60.22 21.43 57.87 31.63 28.75 72.15 18.73 20.81 95.37 119.21 21.33 21.43 20.81 87.20 19.04 28.75 54.52 18.31 44.58 81.75 41.43 48.76 21.54 35705252 GONADOTROPIN CHORIONIC(HCG)QNT 84702 300 $79.00 29.20 13.24 76.89 18.88 54.59 15.80 54.59 16.42 43.65 15.50 41.86 18.06 16.42 52.29 13.55 15.05 61.51 76.89 15.43 15.50 15.05 63.20 13.77 16.42 39.43 13.24 32.31 59.25 30.03 35.34 15.58 35708359 HCG-BETA QUANTITATIVE 84702 300 $79.00 29.20 13.24 76.89 18.88 54.59 15.80 54.59 16.42 43.65 15.50 41.86 18.06 16.42 52.29 13.55 15.05 61.51 76.89 15.43 15.50 15.05 63.20 13.77 16.42 39.43 13.24 32.31 59.25 30.03 35.34 15.58 36900016 GONADOTROPIN CHORION (HCG) QNT 84702 300 $242.00 89.44 13.24 193.60 18.88 167.22 15.80 167.22 16.42 133.71 15.50 41.86 18.06 16.42 160.18 13.55 15.05 61.51 76.89 15.43 15.50 15.05 193.60 13.77 16.42 39.43 13.24 98.98 181.50 91.98 108.25 15.58 36942606 GONADOTROPIN CHORIONIC QUANT 84702 300 $79.00 29.20 13.24 76.89 18.88 54.59 15.80 54.59 16.42 43.65 15.50 41.86 18.06 16.42 52.29 13.55 15.05 61.51 76.89 15.43 15.50 15.05 63.20 13.77 16.42 39.43 13.24 32.31 59.25 30.03 35.34 15.58 36944412 CHORIONIC GONADOTROPIN QUANT 84702 300 $247.00 91.29 13.24 197.60 18.88 170.68 15.80 170.68 16.42 136.47 15.50 41.86 18.06 16.42 163.49 13.55 15.05 61.51 76.89 15.43 15.50 15.05 197.60 13.77 16.42 39.43 13.24 101.02 185.25 93.88 110.48 15.58 35706984 PREGNANCY SERUM QUAL 84703 300 $39.00 14.41 6.62 43.04 11.80 26.95 7.90 26.95 10.26 21.55 7.75 20.91 11.29 10.26 25.81 6.77 7.52 34.43 43.04 7.71 7.75 7.52 31.20 6.88 10.26 19.70 6.62 15.95 29.25 14.82 17.44 7.78 35705881 OSMOLALITY FLUID 84999 300 $122.00 45.09 - 97.60 - 84.30 N/A 84.30 - 67.41 N/A 39.88 - N/A 80.75 - N/A 6.26 7.83 N/A N/A N/A 97.60 N/A - 81.74 N/A 49.90 91.50 46.37 54.57 N/A 35708618 DIFFERENTIAL MANUAL 85007 300 $20.00 7.39 3.34 19.73 5.18 13.82 3.99 13.82 4.50 11.05 3.91 9.55 4.95 4.50 13.24 3.42 3.80 15.78 19.73 3.90 3.91 3.80 16.00 3.48 4.50 9.96 3.34 8.18 15.00 7.60 8.95 3.93 35709762 EXPOSURE MANUAL DIFF 85007 300 $20.00 7.39 3.34 19.73 5.18 13.82 3.99 13.82 4.50 11.05 3.91 9.55 4.95 4.50 13.24 3.42 3.80 15.78 19.73 3.90 3.91 3.80 16.00 3.48 4.50 9.96 3.34 8.18 15.00 7.60 8.95 3.93 35708626 DIFFERENTIAL AUTO WITH SCAN 85008 300 $18.00 6.65 3.02 19.73 4.14 12.44 3.60 12.44 3.60 9.95 3.53 9.55 3.96 3.60 11.91 3.09 3.43 15.78 19.73 3.52 3.53 3.43 14.40 3.14 3.60 8.99 3.02 7.36 13.50 6.84 8.05 3.55 35709746 EXPOSURE SMEAR REVIEW 85008 300 $18.00 6.65 3.02 19.73 4.14 12.44 3.60 12.44 3.60 9.95 3.53 9.55 3.96 3.60 11.91 3.09 3.43 15.78 19.73 3.52 3.53 3.43 14.40 3.14 3.60 8.99 3.02 7.36 13.50 6.84 8.05 3.55 35708634 DIFFERENTIAL MANUAL BUFFY COAT 85009 300 $27.00 9.98 4.46 29.98 5.18 18.66 5.32 18.66 4.50 14.92 5.22 10.36 4.95 4.50 17.87 4.56 5.07 23.98 29.98 5.20 5.22 5.07 21.60 4.64 4.50 13.28 4.46 11.04 20.25 10.26 12.08 5.25 35709789 EXPOSURE BUFFY COAT DIFF 85009 300 $27.00 9.98 4.46 29.98 5.18 18.66 5.32 18.66 4.50 14.92 5.22 10.36 4.95 4.50 17.87 4.56 5.07 23.98 29.98 5.20 5.22 5.07 21.60 4.64 4.50 13.28 4.46 11.04 20.25 10.26 12.08 5.25 35707069 HCT MANUAL 85013 300 $37.00 13.68 3.27 29.60 3.76 25.57 7.35 25.57 3.27 20.44 7.21 6.59 3.60 3.27 24.49 6.30 7.00 10.80 13.50 7.18 7.21 7.00 29.60 6.41 3.27 18.34 6.16 15.13 27.75 14.06 16.55 7.25 35200223 HEMATOCRIT I-STAT 85014 300 $12.00 4.44 2.09 13.50 3.71 8.29 2.49 8.29 3.23 6.63 2.44 6.59 3.55 3.23 7.94 2.13 2.37 10.80 13.50 2.43 2.44 2.37 9.60 2.17 3.23 6.21 2.09 4.91 9.00 4.56 5.37 2.45 35200878 HEMATOCRIT EPOC 85014 300 $12.00 4.44 2.09 13.50 3.71 8.29 2.49 8.29 3.23 6.63 2.44 6.59 3.55 3.23 7.94 2.13 2.37 10.80 13.50 2.43 2.44 2.37 9.60 2.17 3.23 6.21 2.09 4.91 9.00 4.56 5.37 2.45 35706275 HEMATOCRIT 85014 300 $12.00 4.44 2.09 13.50 3.71 8.29 2.49 8.29 3.23 6.63 2.44 6.59 3.55 3.23 7.94 2.13 2.37 10.80 13.50 2.43 2.44 2.37 9.60 2.17 3.23 6.21 2.09 4.91 9.00 4.56 5.37 2.45 35710108 FETAL HCT INTRAUTERINE TRANSF 85014 300 $12.00 4.44 2.09 13.50 3.71 8.29 2.49 8.29 3.23 6.63 2.44 6.59 3.55 3.23 7.94 2.13 2.37 10.80 13.50 2.43 2.44 2.37 9.60 2.17 3.23 6.21 2.09 4.91 9.00 4.56 5.37 2.45 36943262 HEMATOCRIT 85014 300 $12.00 4.44 2.09 13.50 3.71 8.29 2.49 8.29 3.23 6.63 2.44 6.59 3.55 3.23 7.94 2.13 2.37 10.80 13.50 2.43 2.44 2.37 9.60 2.17 3.23 6.21 2.09 4.91 9.00 4.56 5.37 2.45 35200436 HEMOGLOBIN (HEMOCUE) 85018 300 $12.00 4.44 2.09 13.50 3.71 8.29 2.49 8.29 3.23 6.63 2.44 6.59 3.55 3.23 7.94 2.13 2.37 10.80 13.50 2.43 2.44 2.37 9.60 2.17 3.23 6.21 2.09 4.91 9.00 4.56 5.37 2.45 35200720 HEMOGLOBIN HEMOCUE (201) 85018 300 $12.00 4.44 2.09 13.50 3.71 8.29 2.49 8.29 3.23 6.63 2.44 6.59 3.55 3.23 7.94 2.13 2.37 10.80 13.50 2.43 2.44 2.37 9.60 2.17 3.23 6.21 2.09 4.91 9.00 4.56 5.37 2.45 35703039 HEMOGLOBIN MEASURED 85018 300 $12.00 4.44 2.09 13.50 3.71 8.29 2.49 8.29 3.23 6.63 2.44 6.59 3.55 3.23 7.94 2.13 2.37 10.80 13.50 2.43 2.44 2.37 9.60 2.17 3.23 6.21 2.09 4.91 9.00 4.56 5.37 2.45 35706283 HEMOGLOBIN 85018 300 $12.00 4.44 2.09 13.50 3.71 8.29 2.49 8.29 3.23 6.63 2.44 6.59 3.55 3.23 7.94 2.13 2.37 10.80 13.50 2.43 2.44 2.37 9.60 2.17 3.23 6.21 2.09 4.91 9.00 4.56 5.37 2.45 36943271 HEMOGLOBIN 85018 300 $12.00 4.44 2.09 13.50 3.71 8.29 2.49 8.29 3.23 6.63 2.44 6.59 3.55 3.23 7.94 2.13 2.37 10.80 13.50 2.43 2.44 2.37 9.60 2.17 3.23 6.21 2.09 4.91 9.00 4.56 5.37 2.45 35706640 CBC/AUTO DIFFERENTIAL 85025 300 $41.00 15.15 6.00 44.53 6.90 28.33 8.16 28.33 6.00 22.65 8.00 21.60 6.60 6.00 27.14 6.99 7.77 35.62 44.53 7.96 8.00 7.77 32.80 7.11 6.00 20.36 6.84 16.77 30.75 15.58 18.34 8.04 35709720 EXPOSURE CBC AUTO DIFF 85025 300 $41.00 15.15 6.00 44.53 6.90 28.33 8.16 28.33 6.00 22.65 8.00 21.60 6.60 6.00 27.14 6.99 7.77 35.62 44.53 7.96 8.00 7.77 32.80 7.11 6.00 20.36 6.84 16.77 30.75 15.58 18.34 8.04 35706631 CBC 85027 300 $34.00 12.57 5.69 37.09 8.65 23.49 6.79 23.49 7.52 18.79 6.66 17.99 8.27 7.52 22.50 5.82 6.47 29.67 37.09 6.63 6.66 6.47 27.20 5.92 7.52 16.95 5.69 13.91 25.50 12.92 15.21 6.70 35708600 CBC (WITH DIFFERENTIALS) 85027 300 $34.00 12.57 5.69 37.09 8.65 23.49 6.79 23.49 7.52 18.79 6.66 17.99 8.27 7.52 22.50 5.82 6.47 29.67 37.09 6.63 6.66 6.47 27.20 5.92 7.52 16.95 5.69 13.91 25.50 12.92 15.21 6.70 35709738 EXPOSURE CBC 85027 300 $34.00 12.57 5.69 37.09 8.65 23.49 6.79 23.49 7.52 18.79 6.66 17.99 8.27 7.52 22.50 5.82 6.47 29.67 37.09 6.63 6.66 6.47 27.20 5.92 7.52 16.95 5.69 13.91 25.50 12.92 15.21 6.70 35709754 EXPOSURE CBC 85027 300 $34.00 12.57 5.69 37.09 8.65 23.49 6.79 23.49 7.52 18.79 6.66 17.99 8.27 7.52 22.50 5.82 6.47 29.67 37.09 6.63 6.66 6.47 27.20 5.92 7.52 16.95 5.69 13.91 25.50 12.92 15.21 6.70 35709771 EXPOSURE CBC 85027 300 $34.00 12.57 5.69 37.09 8.65 23.49 6.79 23.49 7.52 18.79 6.66 17.99 8.27 7.52 22.50 5.82 6.47 29.67 37.09 6.63 6.66 6.47 27.20 5.92 7.52 16.95 5.69 13.91 25.50 12.92 15.21 6.70 35706402 RBC AUTO 85041 300 $16.00 5.91 2.66 17.25 4.62 11.06 3.17 11.06 4.02 8.84 3.11 8.38 4.42 4.02 10.59 2.72 3.02 13.80 17.25 3.10 3.11 3.02 12.80 2.76 4.02 7.91 2.66 6.54 12.00 6.08 7.16 3.13 36943289 RBC AUTO 85041 300 $16.00 5.91 2.66 17.25 4.62 11.06 3.17 11.06 4.02 8.84 3.11 8.38 4.42 4.02 10.59 2.72 3.02 13.80 17.25 3.10 3.11 3.02 12.80 2.76 4.02 7.91 2.66 6.54 12.00 6.08 7.16 3.13 35706437 RETIC COUNT MANUAL 85044 300 $23.00 8.50 3.79 24.64 4.60 15.89 4.53 15.89 4.00 12.71 4.44 11.96 4.40 4.00 15.22 3.88 4.31 19.71 24.64 4.42 4.44 4.31 18.40 3.94 4.00 11.29 3.79 9.41 17.25 8.74 10.29 4.46 36916362 BLOOD PITTED RETIC MANUAL 85044 300 $206.00 76.14 3.79 164.80 4.60 142.35 4.53 142.35 4.00 113.82 4.44 11.96 4.40 4.00 136.35 3.88 4.31 19.71 24.64 4.42 4.44 4.31 164.80 3.94 4.00 11.29 3.79 84.25 154.50 78.30 92.14 4.46 35706615 RETIC AUTO 85045 300 $21.00 7.76 3.51 32.24 5.18 14.51 4.19 14.51 4.50 11.60 4.11 11.12 4.95 4.50 13.90 3.59 3.99 25.79 32.24 4.09 4.11 3.99 16.80 3.65 4.50 10.45 3.51 8.59 15.75 7.98 9.39 4.13 35709509 RETICULOCYTE AUTO WITH IRF 85046 300 $29.00 10.72 4.90 43.98 7.11 20.04 5.85 20.04 6.18 16.02 5.74 15.48 6.80 6.18 19.20 5.01 5.57 35.18 43.98 5.71 5.74 5.57 23.20 5.10 6.18 14.59 4.90 11.86 21.75 11.02 12.97 5.76 35200746 WBC HEMOCUE 85048 300 $13.00 4.80 2.24 14.66 4.05 8.98 2.67 8.98 3.52 7.18 2.62 7.07 3.87 3.52 8.60 2.29 2.54 11.73 14.66 2.60 2.62 2.54 10.40 2.32 3.52 6.65 2.24 5.32 9.75 4.94 5.81 2.63 35706496 WBC AUTO 85048 300 $13.00 4.80 2.24 14.66 4.05 8.98 2.67 8.98 3.52 7.18 2.62 7.07 3.87 3.52 8.60 2.29 2.54 11.73 14.66 2.60 2.62 2.54 10.40 2.32 3.52 6.65 2.24 5.32 9.75 4.94 5.81 2.63 35706879 EOSINOPHIL COUNT AUTO 85048 300 $13.00 4.80 2.24 14.66 4.05 8.98 2.67 8.98 3.52 7.18 2.62 7.07 3.87 3.52 8.60 2.29 2.54 11.73 14.66 2.60 2.62 2.54 10.40 2.32 3.52 6.65 2.24 5.32 9.75 4.94 5.81 2.63 35706364 PLATELET COUNT 85049 300 $24.00 8.87 3.00 35.60 3.45 16.58 4.70 16.58 3.00 13.26 4.61 12.47 3.30 3.00 15.89 4.03 4.48 28.48 35.60 4.59 4.61 4.48 19.20 4.10 3.00 11.74 3.94 9.82 18.00 9.12 10.74 4.64 35709517 IPF-RETICULATED PLATELET ASSAY 85055 300 $188.00 69.48 29.93 213.07 34.42 129.91 37.53 129.91 29.93 103.87 36.81 74.45 32.92 29.93 124.44 32.17 35.74 170.46 213.07 36.63 36.81 35.74 150.40 32.70 29.93 93.64 31.45 76.89 141.00 71.46 84.09 36.99 35706810 FACTOR II ASSAY 85210 300 $68.00 25.13 4.00 54.40 4.60 46.99 13.63 46.99 4.00 37.57 13.37 36.11 4.40 4.00 45.01 11.68 12.98 34.39 42.99 13.30 13.37 12.98 54.40 11.88 4.00 34.01 11.42 27.81 51.00 25.85 30.42 13.43 35706151 FACTOR V ASSAY 85220 300 $93.00 34.37 5.00 114.64 5.75 64.26 18.53 64.26 5.00 51.38 18.18 49.08 5.50 5.00 61.56 15.89 17.65 91.71 114.64 18.09 18.18 17.65 74.40 16.15 5.00 46.24 15.53 38.04 69.75 35.35 41.60 18.27 35706500 FACTOR VII ASSAY 85230 300 $94.00 34.74 5.00 114.64 5.75 64.95 18.80 64.95 5.00 51.94 18.44 49.77 5.50 5.00 62.22 16.11 17.90 91.71 114.64 18.35 18.44 17.90 75.20 16.38 5.00 46.90 15.75 38.45 70.50 35.73 42.05 18.53 35706160 FACTOR VIII ASSAY 1 STAGE 85240 300 $94.00 34.74 13.00 102.57 14.95 64.95 18.80 64.95 13.00 51.94 18.44 49.77 14.30 13.00 62.22 16.11 17.90 82.06 102.57 18.35 18.44 17.90 75.20 16.38 13.00 46.90 15.75 38.45 70.50 35.73 42.05 18.53 36924501 FACTOR VIII ACTIVITY (AHG) 85240 300 $589.00 217.69 13.00 471.20 14.95 407.00 18.80 407.00 13.00 325.42 18.44 49.77 14.30 13.00 389.86 16.11 17.90 82.06 102.57 18.35 18.44 17.90 471.20 16.38 13.00 46.90 15.75 240.90 441.75 223.88 263.46 18.53 36982748 FACTOR VIII ACTIVITY CLOTTING 85240 300 $94.00 34.74 13.00 102.57 14.95 64.95 18.80 64.95 13.00 51.94 18.44 49.77 14.30 13.00 62.22 16.11 17.90 82.06 102.57 18.35 18.44 17.90 75.20 16.38 13.00 46.90 15.75 38.45 70.50 35.73 42.05 18.53 35706551 RISTOCETIN COFACTOR ASSAY 85245 300 $120.00 44.35 20.19 184.91 36.47 82.92 24.09 82.92 31.71 66.30 23.63 63.77 34.88 31.71 79.43 20.65 22.94 147.93 184.91 23.51 23.63 22.94 96.00 20.99 31.71 60.10 20.19 49.08 90.00 45.61 53.68 23.74 36924527 FACT VIII VW RISTOCETIN COFACT 85245 300 $625.00 231.00 20.19 500.00 36.47 431.88 24.09 431.88 31.71 345.31 23.63 63.77 34.88 31.71 413.69 20.65 22.94 147.93 184.91 23.51 23.63 22.94 500.00 20.99 31.71 60.10 20.19 255.63 468.75 237.56 279.56 23.74 35706526 FACTOR 8 VON WILLEBRANDS AG 85246 300 $120.00 44.35 20.19 131.45 36.47 82.92 24.09 82.92 31.71 66.30 23.63 63.77 34.88 31.71 79.43 20.65 22.94 105.16 131.45 23.51 23.63 22.94 96.00 20.99 31.71 60.10 20.19 49.08 90.00 45.61 53.68 23.74 36922087 FACTOR VIII VW FACTOR ANTIGEN 85246 300 $168.00 62.09 20.19 134.40 36.47 116.09 24.09 116.09 31.71 92.82 23.63 63.77 34.88 31.71 111.20 20.65 22.94 105.16 131.45 23.51 23.63 22.94 134.40 20.99 31.71 60.10 20.19 68.71 126.00 63.86 75.15 23.74 36924519 VON WILLIBRAND FACTOR VIII AG 85246 300 $625.00 231.00 20.19 500.00 36.47 431.88 24.09 431.88 31.71 345.31 23.63 63.77 34.88 31.71 413.69 20.65 22.94 105.16 131.45 23.51 23.63 22.94 500.00 20.99 31.71 60.10 20.19 255.63 468.75 237.56 279.56 23.74 36910593 VON WILLEBRAND MULTIMERS 85247 300 $589.00 217.69 20.19 471.20 36.47 407.00 24.09 407.00 31.71 325.42 23.63 63.77 34.88 31.71 389.86 20.65 22.94 147.93 184.91 23.51 23.63 22.94 471.20 20.99 31.71 60.10 20.19 240.90 441.75 223.88 263.46 23.74 36924535 FACT VIII VW MULTIMERIC ANALYS 85247 300 $589.00 217.69 20.19 471.20 36.47 407.00 24.09 407.00 31.71 325.42 23.63 63.77 34.88 31.71 389.86 20.65 22.94 147.93 184.91 23.51 23.63 22.94 471.20 20.99 31.71 60.10 20.19 240.90 441.75 223.88 263.46 23.74 35706887 FACTOR IX ASSAY 85250 300 $100.00 36.96 5.00 114.64 5.75 69.10 19.99 69.10 5.00 55.25 19.61 52.94 5.50 5.00 66.19 17.14 19.04 91.71 114.64 19.52 19.61 19.04 80.00 17.42 5.00 49.88 16.76 40.90 75.00 38.01 44.73 19.71 35706186 FACTOR X ASSAY 85260 300 $94.00 34.74 12.00 114.64 13.80 64.95 18.80 64.95 12.00 51.94 18.44 49.77 13.20 12.00 62.22 16.11 17.90 91.71 114.64 18.35 18.44 17.90 75.20 16.38 12.00 46.90 15.75 38.45 70.50 35.73 42.05 18.53 35706194 FACTOR XI ASSAY 85270 300 $94.00 34.74 12.00 114.64 13.80 64.95 18.80 64.95 12.00 51.94 18.44 49.77 13.20 12.00 62.22 16.11 17.90 91.71 114.64 18.35 18.44 17.90 75.20 16.38 12.00 46.90 15.75 38.45 70.50 35.73 42.05 18.53 35706208 FACTOR XII ASSAY 85280 300 $102.00 37.70 13.00 114.64 14.95 70.48 20.32 70.48 13.00 56.36 19.93 53.79 14.30 13.00 67.51 17.42 19.35 91.71 114.64 19.83 19.93 19.35 81.60 17.71 13.00 50.70 17.03 41.72 76.50 38.77 45.62 20.03 35706216 FACTOR XIII SCREEN 85291 300 $48.00 17.74 8.00 60.35 9.20 33.17 9.57 33.17 8.00 26.52 9.38 24.74 8.80 8.00 31.77 8.20 9.11 48.28 60.35 9.34 9.38 9.11 38.40 8.34 8.00 23.87 8.02 19.63 36.00 18.24 21.47 9.43 35706780 ANTI-THROMBIN III ACTIVITY 85300 300 $62.00 22.92 9.40 49.60 10.81 42.84 12.44 42.84 9.40 34.26 12.21 32.97 10.34 9.40 41.04 10.67 11.85 37.08 46.35 12.15 12.21 11.85 49.60 10.84 9.40 31.05 10.43 25.36 46.50 23.57 27.73 12.26 36982730 ANTITHROMBIN III ACTIVITY 85300 300 $62.00 22.92 9.40 49.60 10.81 42.84 12.44 42.84 9.40 34.26 12.21 32.97 10.34 9.40 41.04 10.67 11.85 37.08 46.35 12.15 12.21 11.85 49.60 10.84 9.40 31.05 10.43 25.36 46.50 23.57 27.73 12.26 36916192 PROTEIN C ANTIGEN 85302 300 $172.00 63.57 10.57 137.60 19.10 118.85 12.61 118.85 16.61 95.03 12.37 33.41 18.27 16.61 113.85 10.81 12.01 55.11 68.89 12.31 12.37 12.01 137.60 10.99 16.61 31.47 10.57 70.35 129.00 65.38 76.94 12.43 35706585 PROTEIN C ASSAY ACTIVITY 85303 300 $73.00 26.98 12.18 111.55 21.98 50.44 14.53 50.44 19.11 40.33 14.26 38.47 21.02 19.11 48.32 12.46 13.84 89.24 111.55 14.19 14.26 13.84 58.40 12.66 19.11 36.26 12.18 29.86 54.75 27.75 32.65 14.32 36982705 PROTEIN C ACTIVITY 85303 300 $73.00 26.98 12.18 111.55 21.98 50.44 14.53 50.44 19.11 40.33 14.26 38.47 21.02 19.11 48.32 12.46 13.84 89.24 111.55 14.19 14.26 13.84 58.40 12.66 19.11 36.26 12.18 29.86 54.75 27.75 32.65 14.32 35709321 PROTEIN S TOTAL 85305 300 $61.00 22.55 10.22 66.47 18.42 42.15 12.19 42.15 16.02 33.70 11.96 32.28 17.62 16.02 40.38 10.45 11.61 53.18 66.47 11.90 11.96 11.61 48.80 10.62 16.02 30.42 10.22 24.95 45.75 23.19 27.29 12.02 36982721 PROTEIN S TOTAL ANTIGEN 85305 300 $61.00 22.55 10.22 66.47 18.42 42.15 12.19 42.15 16.02 33.70 11.96 32.28 17.62 16.02 40.38 10.45 11.61 53.18 66.47 11.90 11.96 11.61 48.80 10.62 16.02 30.42 10.22 24.95 45.75 23.19 27.29 12.02 35707042 PROTEIN S FREE FUNCTIONAL 85306 300 $80.00 29.57 13.48 123.51 24.36 55.28 16.09 55.28 21.18 44.20 15.78 42.61 23.30 21.18 52.95 13.79 15.32 98.81 123.51 15.70 15.78 15.32 64.00 14.02 21.18 40.14 13.48 32.72 60.00 30.41 35.78 15.86 35709339 PROTEIN S FREE 85306 300 $80.00 29.57 13.48 123.51 24.36 55.28 16.09 55.28 21.18 44.20 15.78 42.61 23.30 21.18 52.95 13.79 15.32 98.81 123.51 15.70 15.78 15.32 64.00 14.02 21.18 40.14 13.48 32.72 60.00 30.41 35.78 15.86 36982713 PROTEIN S FREE 85306 300 $80.00 29.57 13.48 123.51 24.36 55.28 16.09 55.28 21.18 44.20 15.78 42.61 23.30 21.18 52.95 13.79 15.32 98.81 123.51 15.70 15.78 15.32 64.00 14.02 21.18 40.14 13.48 32.72 60.00 30.41 35.78 15.86 35707034 ACTIVATED PROTEIN C RESISTANCE 85307 300 $80.00 29.57 13.48 120.65 19.48 55.28 16.09 55.28 16.94 44.20 15.78 42.61 18.63 16.94 52.95 13.79 15.32 96.52 120.65 15.70 15.78 15.32 64.00 14.02 16.94 40.14 13.48 32.72 60.00 30.41 35.78 15.86 36982683 ACTIVATED PROTEIN C RESISTANCE 85307 300 $80.00 29.57 13.48 120.65 19.48 55.28 16.09 55.28 16.94 44.20 15.78 42.61 18.63 16.94 52.95 13.79 15.32 96.52 120.65 15.70 15.78 15.32 64.00 14.02 16.94 40.14 13.48 32.72 60.00 30.41 35.78 15.86 35706178 FACTOR VIII INHIBITOR 85335 300 $68.00 25.13 7.55 54.40 8.68 46.99 13.51 46.99 7.55 37.57 13.26 35.76 8.31 7.55 45.01 11.58 12.87 34.39 42.99 13.19 13.26 12.87 54.40 11.78 7.55 33.72 11.33 27.81 51.00 25.85 30.42 13.32 36940280 ADAMTS 13 INHIBITOR 85335 300 "$1,035.00" 382.54 7.55 828.00 8.68 715.19 13.51 715.19 7.55 571.84 13.26 35.76 8.31 7.55 685.07 11.58 12.87 34.39 42.99 13.19 13.26 12.87 828.00 11.78 7.55 33.72 11.33 423.32 776.25 393.40 462.96 13.32 36981644 ADAMTS-13 INHIBITOR 85335 300 $765.00 282.74 7.55 612.00 8.68 528.62 13.51 528.62 7.55 422.66 13.26 35.76 8.31 7.55 506.35 11.58 12.87 34.39 42.99 13.19 13.26 12.87 612.00 11.78 7.55 33.72 11.33 312.89 573.75 290.78 342.18 13.32 35200533 ACT HEPARINASE TEST HIGH RANGE 85347 300 $22.00 8.13 3.77 34.28 6.06 15.20 4.49 15.20 5.27 12.16 4.41 11.84 5.80 5.27 14.56 3.85 4.28 27.42 34.28 4.39 4.41 4.28 17.60 3.92 5.27 11.21 3.77 9.00 16.50 8.36 9.84 4.43 35200606 TEG R-ACTIVATED CLOTTING TIME 85347 300 $22.00 8.13 3.77 34.28 6.06 15.20 4.49 15.20 5.27 12.16 4.41 11.84 5.80 5.27 14.56 3.85 4.28 27.42 34.28 4.39 4.41 4.28 17.60 3.92 5.27 11.21 3.77 9.00 16.50 8.36 9.84 4.43 35200738 ACTIVATED CLOTTING TIME 85347 300 $22.00 8.13 3.77 34.28 6.06 15.20 4.49 15.20 5.27 12.16 4.41 11.84 5.80 5.27 14.56 3.85 4.28 27.42 34.28 4.39 4.41 4.28 17.60 3.92 5.27 11.21 3.77 9.00 16.50 8.36 9.84 4.43 35708545 TEG R-ACTIVATED CLOTTING TIME 85347 300 $22.00 8.13 3.77 34.28 6.06 15.20 4.49 15.20 5.27 12.16 4.41 11.84 5.80 5.27 14.56 3.85 4.28 27.42 34.28 4.39 4.41 4.28 17.60 3.92 5.27 11.21 3.77 9.00 16.50 8.36 9.84 4.43 35706453 FSP SEMIQUANT 85362 300 $41.00 15.15 6.06 39.41 10.95 28.33 7.23 28.33 9.52 22.65 7.10 19.15 10.47 9.52 27.14 6.20 6.89 31.53 39.41 7.06 7.10 6.89 32.80 6.30 9.52 18.05 6.06 16.77 30.75 15.58 18.34 7.13 36944641 FIBRINOGEN DEGRADATION PROD 85362 300 $41.00 15.15 6.06 39.41 10.95 28.33 7.23 28.33 9.52 22.65 7.10 19.15 10.47 9.52 27.14 6.20 6.89 31.53 39.41 7.06 7.10 6.89 32.80 6.30 9.52 18.05 6.06 16.77 30.75 15.58 18.34 7.13 35706607 SOL FIBRIN MONOMER PARACO 85366 300 $422.00 155.97 11.79 337.60 13.56 291.60 84.48 291.60 11.79 233.16 82.87 23.96 12.97 11.79 279.32 72.41 80.46 55.51 69.39 82.47 82.87 80.46 337.60 73.62 11.79 210.81 70.80 172.60 316.50 160.40 188.76 83.28 35707972 D-DIMER QUANTITATED 85379 300 $53.00 19.59 8.96 60.35 12.19 36.62 10.69 36.62 10.60 29.28 10.49 28.32 11.66 10.60 35.08 9.16 10.18 48.28 60.35 10.43 10.49 10.18 42.40 9.31 10.60 26.67 8.96 21.68 39.75 20.15 23.71 10.54 35200622 TEG ANGLE (FIBRINGN) 85384 300 $51.00 18.85 8.55 48.39 11.40 35.24 10.21 35.24 9.91 28.18 10.01 23.61 10.90 9.91 33.76 8.75 9.72 38.71 48.39 9.96 10.01 9.72 40.80 8.89 9.91 25.47 8.55 20.86 38.25 19.39 22.81 10.06 35706232 FIBRINOGEN ASSAY ACTIVITY 85384 300 $51.00 18.85 8.55 48.39 11.40 35.24 10.21 35.24 9.91 28.18 10.01 23.61 10.90 9.91 33.76 8.75 9.72 38.71 48.39 9.96 10.01 9.72 40.80 8.89 9.91 25.47 8.55 20.86 38.25 19.39 22.81 10.06 35708561 TEG ANGLE (FIBRINOGEN) 85384 300 $51.00 18.85 8.55 48.39 11.40 35.24 10.21 35.24 9.91 28.18 10.01 23.61 10.90 9.91 33.76 8.75 9.72 38.71 48.39 9.96 10.01 9.72 40.80 8.89 9.91 25.47 8.55 20.86 38.25 19.39 22.81 10.06 36916214 FIBRINOGEN ANTIGEN 85385 300 $77.00 28.46 9.91 68.07 11.40 53.21 15.18 53.21 9.91 42.54 14.89 23.61 10.90 9.91 50.97 13.01 14.46 54.46 68.07 14.82 14.89 14.46 61.60 13.23 9.91 37.89 12.72 31.49 57.75 29.27 34.44 14.97 36928166 ADAMTS-13 ACTIVITY 85397 300 "$1,035.00" 382.54 26.30 828.00 30.25 715.19 32.40 715.19 26.30 571.84 31.79 63.77 28.93 26.30 685.07 27.77 30.86 147.75 184.69 31.63 31.79 30.86 828.00 28.24 26.30 80.85 27.16 423.32 776.25 393.40 462.96 31.94 36940271 ADAMTS 13 ACTIVITY 85397 300 "$1,035.00" 382.54 26.30 828.00 30.25 715.19 32.40 715.19 26.30 571.84 31.79 63.77 28.93 26.30 685.07 27.77 30.86 147.75 184.69 31.63 31.79 30.86 828.00 28.24 26.30 80.85 27.16 423.32 776.25 393.40 462.96 31.94 36916371 ALPHA 2 ANTIPLASMIN ASSAY 85410 300 $617.00 228.04 6.78 493.60 12.26 426.35 8.10 426.35 10.66 340.89 7.94 21.45 11.73 10.66 408.39 6.94 7.71 49.69 62.11 7.90 7.94 7.71 493.60 7.05 10.66 20.20 6.78 252.35 462.75 234.52 275.98 7.98 36916184 TISSUE PLASMINOGEN ACTIVATR AG 85415 300 "$1,476.00" 545.53 15.13 " 1,180.80 " 17.94 " 1,019.92 " 18.05 " 1,019.92 " 15.60 815.49 17.71 47.79 17.16 15.60 976.96 15.47 17.19 86.64 108.30 17.62 17.71 17.19 " 1,180.80 " 15.73 15.60 45.04 15.13 603.68 " 1,107.00 " 561.03 660.21 17.79 36917377 TISSUE PLASMINOGEN ACTIVATOR 85415 300 "$1,491.00" 551.07 15.13 " 1,192.80 " 17.94 " 1,030.28 " 18.05 " 1,030.28 " 15.60 823.78 17.71 47.79 17.16 15.60 986.89 15.47 17.19 86.64 108.30 17.62 17.71 17.19 " 1,192.80 " 15.73 15.60 45.04 15.13 609.82 " 1,118.25 " 566.73 666.92 17.79 36935979 PLASMINOGEN ACT INHIB ANTIGEN 85415 300 "$1,476.00" 545.53 15.13 " 1,180.80 " 17.94 " 1,019.92 " 18.05 " 1,019.92 " 15.60 815.49 17.71 47.79 17.16 15.60 976.96 15.47 17.19 86.64 108.30 17.62 17.71 17.19 " 1,180.80 " 15.73 15.60 45.04 15.13 603.68 " 1,107.00 " 561.03 660.21 17.79 36903937 PLASMINOGEN ACTIVITY 85420 300 $503.00 185.91 5.00 402.40 5.75 347.57 6.86 347.57 5.00 277.91 6.73 18.18 5.50 5.00 332.94 5.88 6.53 42.20 52.75 6.69 6.73 6.53 402.40 5.97 5.00 17.11 5.75 205.73 377.25 191.19 224.99 6.76 35706801 HEINZ BODIES 85441 300 $22.00 8.13 3.00 33.84 3.45 15.20 4.41 15.20 3.00 12.16 4.33 11.68 3.30 3.00 14.56 3.78 4.20 27.07 33.84 4.31 4.33 4.20 17.60 3.84 3.00 11.00 3.70 9.00 16.50 8.36 9.84 4.35 35706224 FETAL RBC STAIN 85460 300 $41.00 15.15 6.80 62.39 12.29 28.33 8.12 28.33 10.69 22.65 7.96 21.51 11.76 10.69 27.14 6.96 7.73 49.91 62.39 7.92 7.96 7.73 32.80 7.07 10.69 20.25 6.80 16.77 30.75 15.58 18.34 8.00 36920670 FETAL HEMOGLOBIN BY RID 85460 300 $77.00 28.46 6.80 62.39 12.29 53.21 8.12 53.21 10.69 42.54 7.96 21.51 11.76 10.69 50.97 6.96 7.73 49.91 62.39 7.92 7.96 7.73 61.60 7.07 10.69 20.25 6.80 31.49 57.75 29.27 34.44 8.00 35600451 FETAL SCREEN 85461 300 $49.00 18.11 8.24 62.39 10.55 33.86 9.83 33.86 9.17 27.07 9.64 18.46 10.09 9.17 32.43 8.42 9.36 49.91 62.39 9.59 9.64 9.36 39.20 8.56 9.17 24.52 8.24 20.04 36.75 18.62 21.92 9.69 35706259 HAM TEST 85475 300 $47.00 17.37 7.81 70.71 12.55 32.48 9.31 32.48 10.91 25.97 9.14 24.68 12.00 10.91 31.11 7.98 8.87 56.57 70.71 9.09 9.14 8.87 37.60 8.12 10.91 23.24 7.81 19.22 35.25 17.86 21.02 9.18 35707573 HEPARIN UNFRACT OR LMW ASSAY 85520 300 $69.00 25.50 6.53 55.20 7.51 47.68 13.74 47.68 6.53 38.12 13.48 36.39 7.18 6.53 45.67 11.78 13.09 34.39 42.99 13.42 13.48 13.09 55.20 11.98 6.53 34.30 11.52 28.22 51.75 26.23 30.86 13.55 35707026 HEPARIN NEUTRALIZATION 85525 300 $62.00 22.92 10.42 95.68 18.84 42.84 12.43 42.84 16.38 34.26 12.20 32.91 18.02 16.38 41.04 10.66 11.84 76.54 95.68 12.14 12.20 11.84 49.60 10.83 16.38 31.02 10.42 25.36 46.50 23.57 27.73 12.25 36600705 IRON STAIN PERIPHERAL BLOOD 85536 300 $36.00 13.31 6.05 50.98 8.23 24.88 7.22 24.88 7.16 19.89 7.09 17.99 7.88 7.16 23.83 6.19 6.88 40.78 50.98 7.05 7.09 6.88 28.80 6.30 7.16 18.03 6.05 14.72 27.00 13.68 16.10 7.12 35706313 LEUKOCYTE ALKALINE PHOSPHATASE 85540 300 $45.00 16.63 7.57 69.33 9.20 31.10 9.03 31.10 8.00 24.86 8.86 23.93 8.80 8.00 29.79 7.74 8.60 55.46 69.33 8.82 8.86 8.60 36.00 7.87 8.00 22.53 7.57 18.41 33.75 17.10 20.13 8.90 36911638 MURAMIDASE URINE 85549 300 $194.00 71.70 16.44 155.20 18.91 134.05 19.69 134.05 16.44 107.19 19.31 52.12 18.08 16.44 128.41 16.88 18.75 86.55 108.19 19.22 19.31 18.75 155.20 17.16 16.44 49.13 16.50 79.35 145.50 73.74 86.78 19.41 36911646 MURAMIDASE 85549 300 $194.00 71.70 16.44 155.20 18.91 134.05 19.69 134.05 16.44 107.19 19.31 52.12 18.08 16.44 128.41 16.88 18.75 86.55 108.19 19.22 19.31 18.75 155.20 17.16 16.44 49.13 16.50 79.35 145.50 73.74 86.78 19.41 36923270 RBC OSMOTIC FRAG-INCUBATED 85557 300 $70.00 25.87 11.76 107.64 13.80 48.37 14.03 48.37 12.00 38.68 13.76 37.15 13.20 12.00 46.33 12.02 13.36 86.11 107.64 13.69 13.76 13.36 56.00 12.22 12.00 35.00 11.76 28.63 52.50 26.61 31.31 13.83 35200614 TEG MA (PLT AGGREGATION) 85576 300 $131.00 48.42 21.92 173.17 33.71 90.52 26.16 90.52 29.31 72.38 25.66 59.75 32.24 29.31 86.71 22.42 24.91 138.54 173.17 25.53 25.66 24.91 104.80 22.79 29.31 65.26 21.92 53.58 98.25 49.79 58.60 25.78 35706658 PLATELET AGGREGATION-ADP 85576 300 $131.00 48.42 21.92 173.17 33.71 90.52 26.16 90.52 29.31 72.38 25.66 59.75 32.24 29.31 86.71 22.42 24.91 138.54 173.17 25.53 25.66 24.91 104.80 22.79 29.31 65.26 21.92 53.58 98.25 49.79 58.60 25.78 35706691 PLATELET AGGREGATION-COLLAGEN 85576 300 $131.00 48.42 21.92 173.17 33.71 90.52 26.16 90.52 29.31 72.38 25.66 59.75 32.24 29.31 86.71 22.42 24.91 138.54 173.17 25.53 25.66 24.91 104.80 22.79 29.31 65.26 21.92 53.58 98.25 49.79 58.60 25.78 35706704 PLATELET AGGREGATION-EPINEPHNE 85576 300 $131.00 48.42 21.92 173.17 33.71 90.52 26.16 90.52 29.31 72.38 25.66 59.75 32.24 29.31 86.71 22.42 24.91 138.54 173.17 25.53 25.66 24.91 104.80 22.79 29.31 65.26 21.92 53.58 98.25 49.79 58.60 25.78 35706712 PLATELET AGGREGATION-RISTOCETN 85576 300 $131.00 48.42 21.92 173.17 33.71 90.52 26.16 90.52 29.31 72.38 25.66 59.75 32.24 29.31 86.71 22.42 24.91 138.54 173.17 25.53 25.66 24.91 104.80 22.79 29.31 65.26 21.92 53.58 98.25 49.79 58.60 25.78 35708294 PLATELET FUNCTION SCREEN 85576 300 $131.00 48.42 21.92 173.17 33.71 90.52 26.16 90.52 29.31 72.38 25.66 59.75 32.24 29.31 86.71 22.42 24.91 138.54 173.17 25.53 25.66 24.91 104.80 22.79 29.31 65.26 21.92 53.58 98.25 49.79 58.60 25.78 35708308 PLATELET FUNCTION CONFIRMATION 85576 300 $131.00 48.42 21.92 173.17 33.71 90.52 26.16 90.52 29.31 72.38 25.66 59.75 32.24 29.31 86.71 22.42 24.91 138.54 173.17 25.53 25.66 24.91 104.80 22.79 29.31 65.26 21.92 53.58 98.25 49.79 58.60 25.78 35708553 TEG MA (PLT AGGREGATION) 85576 300 $131.00 48.42 21.92 173.17 33.71 90.52 26.16 90.52 29.31 72.38 25.66 59.75 32.24 29.31 86.71 22.42 24.91 138.54 173.17 25.53 25.66 24.91 104.80 22.79 29.31 65.26 21.92 53.58 98.25 49.79 58.60 25.78 35709371 PLATELET MAP FEE 85576 300 $131.00 48.42 21.92 173.17 33.71 90.52 26.16 90.52 29.31 72.38 25.66 59.75 32.24 29.31 86.71 22.42 24.91 138.54 173.17 25.53 25.66 24.91 104.80 22.79 29.31 65.26 21.92 53.58 98.25 49.79 58.60 25.78 35709886 ASPIRIN PLATELET AGGREGATION 85576 300 $131.00 48.42 21.92 173.17 33.71 90.52 26.16 90.52 29.31 72.38 25.66 59.75 32.24 29.31 86.71 22.42 24.91 138.54 173.17 25.53 25.66 24.91 104.80 22.79 29.31 65.26 21.92 53.58 98.25 49.79 58.60 25.78 35709894 PLAVIX PLATELET AGGREGATION 85576 300 $131.00 48.42 21.92 173.17 33.71 90.52 26.16 90.52 29.31 72.38 25.66 59.75 32.24 29.31 86.71 22.42 24.91 138.54 173.17 25.53 25.66 24.91 104.80 22.79 29.31 65.26 21.92 53.58 98.25 49.79 58.60 25.78 35708910 PLATELET NEUTRALIZATION PROC 85597 300 $270.00 99.79 15.82 216.00 28.57 186.57 18.88 186.57 24.84 149.18 18.52 49.99 27.32 24.84 178.71 16.18 17.98 113.89 142.36 18.43 18.52 17.98 216.00 16.45 24.84 47.11 15.82 110.43 202.50 102.63 120.77 18.61 36922818 DRVVT CONFIRMATION 85597 300 $270.00 99.79 15.82 216.00 28.57 186.57 18.88 186.57 24.84 149.18 18.52 49.99 27.32 24.84 178.71 16.18 17.98 113.89 142.36 18.43 18.52 17.98 216.00 16.45 24.84 47.11 15.82 110.43 202.50 102.63 120.77 18.61 36982861 DRVVT CONFIRMATION 85597 300 $270.00 99.79 15.82 216.00 28.57 186.57 18.88 186.57 24.84 149.18 18.52 49.99 27.32 24.84 178.71 16.18 17.98 113.89 142.36 18.43 18.52 17.98 216.00 16.45 24.84 47.11 15.82 110.43 202.50 102.63 120.77 18.61 36982888 HEXAGONAL PHASE CONFIRM 85598 300 $94.00 34.74 15.82 139.44 23.28 64.95 18.88 64.95 20.24 51.94 18.52 49.99 22.26 20.24 62.22 16.18 17.98 111.55 139.44 18.43 18.52 17.98 75.20 16.45 20.24 47.11 15.82 38.45 70.50 35.73 42.05 18.61 35200487 PRO-TIME FINGER STICK 85610 300 $23.00 8.50 3.78 22.60 4.60 15.89 4.50 15.89 4.00 12.71 4.42 10.93 4.40 4.00 15.22 3.86 4.29 18.08 22.60 4.40 4.42 4.29 18.40 3.93 4.00 11.24 3.78 9.41 17.25 8.74 10.29 4.44 35701516 PROTIME HEPASORBED 85610 300 $23.00 8.50 3.78 22.60 4.60 15.89 4.50 15.89 4.00 12.71 4.42 10.93 4.40 4.00 15.22 3.86 4.29 18.08 22.60 4.40 4.42 4.29 18.40 3.93 4.00 11.24 3.78 9.41 17.25 8.74 10.29 4.44 35706992 PT/INR 85610 300 $23.00 8.50 3.78 22.60 4.60 15.89 4.50 15.89 4.00 12.71 4.42 10.93 4.40 4.00 15.22 3.86 4.29 18.08 22.60 4.40 4.42 4.29 18.40 3.93 4.00 11.24 3.78 9.41 17.25 8.74 10.29 4.44 35706593 ANTICOAGULANT SCREEN 50/54 85611 300 $21.00 7.76 3.47 31.75 6.24 14.51 4.14 14.51 5.43 11.60 4.06 10.96 5.97 5.43 13.90 3.55 3.94 25.40 31.75 4.04 4.06 3.94 16.80 3.61 5.43 10.32 3.47 8.59 15.75 7.98 9.39 4.08 35706739 DRVV 85613 300 $50.00 18.48 8.43 77.11 13.43 34.55 10.06 34.55 11.68 27.63 9.87 26.63 12.85 11.68 33.10 8.62 9.58 61.69 77.11 9.82 9.87 9.58 40.00 8.77 11.68 25.10 8.43 20.45 37.50 19.01 22.37 9.92 36982608 RUSSELL VIPER VENOM TIME 85613 300 $50.00 18.48 8.43 77.11 13.43 34.55 10.06 34.55 11.68 27.63 9.87 26.63 12.85 11.68 33.10 8.62 9.58 61.69 77.11 9.82 9.87 9.58 40.00 8.77 11.68 25.10 8.43 20.45 37.50 19.01 22.37 9.92 36982756 RUSSELL VIPER VENOM TIME 85613 300 $50.00 18.48 8.43 77.11 13.43 34.55 10.06 34.55 11.68 27.63 9.87 26.63 12.85 11.68 33.10 8.62 9.58 61.69 77.11 9.82 9.87 9.58 40.00 8.77 11.68 25.10 8.43 20.45 37.50 19.01 22.37 9.92 36982870 DRVVT 1:1 MIX 85613 300 $50.00 18.48 8.43 77.11 13.43 34.55 10.06 34.55 11.68 27.63 9.87 26.63 12.85 11.68 33.10 8.62 9.58 61.69 77.11 9.82 9.87 9.58 40.00 8.77 11.68 25.10 8.43 20.45 37.50 19.01 22.37 9.92 36982918 DRVVT SCR W RFL DRVVT CF & MIX 85613 300 $50.00 18.48 8.43 77.11 13.43 34.55 10.06 34.55 11.68 27.63 9.87 26.63 12.85 11.68 33.10 8.62 9.58 61.69 77.11 9.82 9.87 9.58 40.00 8.77 11.68 25.10 8.43 20.45 37.50 19.01 22.37 9.92 35706518 REPTILASE 85635 300 $52.00 19.22 6.00 52.14 6.90 35.93 10.34 35.93 6.00 28.73 10.15 27.38 6.60 6.00 34.42 8.87 9.85 41.71 52.14 10.10 10.15 9.85 41.60 9.01 6.00 25.81 8.67 21.27 39.00 19.77 23.26 10.19 35200754 SEDIMENTATION RATE POC NONAUTO 85651 300 $22.00 8.13 3.00 20.34 3.45 15.20 4.48 15.20 3.00 12.16 4.40 9.86 3.30 3.00 14.56 3.84 4.27 16.27 20.34 4.38 4.40 4.27 17.60 3.91 3.00 11.19 3.76 9.00 16.50 8.36 9.84 4.42 35706445 SEDIMENTATION RATE NON AUTO 85651 300 $22.00 8.13 3.00 20.34 3.45 15.20 4.48 15.20 3.00 12.16 4.40 9.86 3.30 3.00 14.56 3.84 4.27 16.27 20.34 4.38 4.40 4.27 17.60 3.91 3.00 11.19 3.76 9.00 16.50 8.36 9.84 4.42 35709282 ESR MANUAL BILL 85651 300 $22.00 8.13 3.00 20.34 3.45 15.20 4.48 15.20 3.00 12.16 4.40 9.86 3.30 3.00 14.56 3.84 4.27 16.27 20.34 4.38 4.40 4.27 17.60 3.91 3.00 11.19 3.76 9.00 16.50 8.36 9.84 4.42 35709291 ESR AUTO BILL 85652 300 $14.00 5.17 2.38 49.27 3.45 9.67 2.84 9.67 3.00 7.74 2.78 7.50 3.30 3.00 9.27 2.43 2.70 39.42 49.27 2.77 2.78 2.70 11.20 2.47 3.00 7.07 2.38 5.73 10.50 5.32 6.26 2.79 35600418 SICKLE CELL SCREEN (ARC) 85660 300 $29.00 10.72 3.00 27.17 3.45 20.04 5.79 20.04 3.00 16.02 5.68 15.32 3.30 3.00 19.20 4.96 5.51 21.74 27.17 5.65 5.68 5.51 23.20 5.04 3.00 14.44 4.85 11.86 21.75 11.02 12.97 5.70 35706968 SICKLE CELL SCREEN 85660 300 $29.00 10.72 3.00 27.17 3.45 20.04 5.79 20.04 3.00 16.02 5.68 15.32 3.30 3.00 19.20 4.96 5.51 21.74 27.17 5.65 5.68 5.51 23.20 5.04 3.00 14.44 4.85 11.86 21.75 11.02 12.97 5.70 35706470 THROMBIN TIME PLASMA 85670 300 $30.00 11.09 5.08 46.57 9.19 20.73 6.06 20.73 7.99 16.58 5.94 16.05 8.79 7.99 19.86 5.19 5.77 37.26 46.57 5.91 5.94 5.77 24.00 5.28 7.99 15.12 5.08 12.27 22.50 11.40 13.42 5.97 35708588 BOVINE THROMBIN TIME 85670 300 $30.00 11.09 5.08 46.57 9.19 20.73 6.06 20.73 7.99 16.58 5.94 16.05 8.79 7.99 19.86 5.19 5.77 37.26 46.57 5.91 5.94 5.77 24.00 5.28 7.99 15.12 5.08 12.27 22.50 11.40 13.42 5.97 35708596 HUMAN THROMBIN TIME 85670 300 $30.00 11.09 5.08 46.57 9.19 20.73 6.06 20.73 7.99 16.58 5.94 16.05 8.79 7.99 19.86 5.19 5.77 37.26 46.57 5.91 5.94 5.77 24.00 5.28 7.99 15.12 5.08 12.27 22.50 11.40 13.42 5.97 36982896 THROMBIN CLOTTING TIME 85670 300 $38.00 14.04 5.08 46.57 9.19 26.26 6.06 26.26 7.99 21.00 5.94 16.05 8.79 7.99 25.15 5.19 5.77 37.26 46.57 5.91 5.94 5.77 30.40 5.28 7.99 15.12 5.08 15.54 28.50 14.44 17.00 5.97 35701524 APTT HEPARIN NEUTRALIZED 85730 300 $32.00 11.83 5.29 34.39 8.63 22.11 6.31 22.11 7.50 17.68 6.19 16.70 8.25 7.50 21.18 5.41 6.01 27.51 34.39 6.16 6.19 6.01 25.60 5.50 7.50 15.75 5.29 13.09 24.00 12.16 14.31 6.22 35706399 APTT PLASMA/WHOLE BLOOD 85730 300 $32.00 11.83 5.29 34.39 8.63 22.11 6.31 22.11 7.50 17.68 6.19 16.70 8.25 7.50 21.18 5.41 6.01 27.51 34.39 6.16 6.19 6.01 25.60 5.50 7.50 15.75 5.29 13.09 24.00 12.16 14.31 6.22 35708928 APTT LUPUS SENSITIVE 85730 300 $32.00 11.83 5.29 34.39 8.63 22.11 6.31 22.11 7.50 17.68 6.19 16.70 8.25 7.50 21.18 5.41 6.01 27.51 34.39 6.16 6.19 6.01 25.60 5.50 7.50 15.75 5.29 13.09 24.00 12.16 14.31 6.22 35709231 PTTLA BASELINE 85730 300 $32.00 11.83 5.29 34.39 8.63 22.11 6.31 22.11 7.50 17.68 6.19 16.70 8.25 7.50 21.18 5.41 6.01 27.51 34.39 6.16 6.19 6.01 25.60 5.50 7.50 15.75 5.29 13.09 24.00 12.16 14.31 6.22 36982616 "THROMBOPLASTIN TIME, PARTIAL" 85730 300 $32.00 11.83 5.29 34.39 8.63 22.11 6.31 22.11 7.50 17.68 6.19 16.70 8.25 7.50 21.18 5.41 6.01 27.51 34.39 6.16 6.19 6.01 25.60 5.50 7.50 15.75 5.29 13.09 24.00 12.16 14.31 6.22 36982764 "THROMBOPLASTIN TIME, PARTIAL" 85730 300 $32.00 11.83 5.29 34.39 8.63 22.11 6.31 22.11 7.50 17.68 6.19 16.70 8.25 7.50 21.18 5.41 6.01 27.51 34.39 6.16 6.19 6.01 25.60 5.50 7.50 15.75 5.29 13.09 24.00 12.16 14.31 6.22 35709240 PTTLA IMMEDIATE 85732 300 $34.00 12.57 5.69 47.84 8.36 23.49 6.79 23.49 7.27 18.79 6.66 17.99 8.00 7.27 22.50 5.82 6.47 38.27 47.84 6.63 6.66 6.47 27.20 5.92 7.27 16.95 5.69 13.91 25.50 12.92 15.21 6.70 35709258 PTTLA 60 MINUTE 85732 300 $34.00 12.57 5.69 47.84 8.36 23.49 6.79 23.49 7.27 18.79 6.66 17.99 8.00 7.27 22.50 5.82 6.47 38.27 47.84 6.63 6.66 6.47 27.20 5.92 7.27 16.95 5.69 13.91 25.50 12.92 15.21 6.70 35701826 VISCOSITY 85810 300 $61.00 22.55 4.00 94.14 4.60 42.15 12.25 42.15 4.00 33.70 12.02 32.47 4.40 4.00 40.38 10.50 11.67 75.31 94.14 11.96 12.02 11.67 48.80 10.68 4.00 30.58 10.27 24.95 45.75 23.19 27.29 12.08 36998709 PROTEIN S ACTIVITY 85999 300 $238.04 87.98 - 190.43 - 164.49 N/A 164.49 - 131.52 N/A 39.88 - N/A 157.56 - N/A 27.51 34.39 N/A N/A N/A 190.43 N/A - 159.49 N/A 97.36 178.53 90.48 106.48 N/A 36931639 EGG WHITE IGG RAST 86001 300 $102.00 37.70 5.78 81.60 6.65 70.48 8.21 70.48 5.78 56.36 8.05 14.51 6.36 5.78 67.51 7.04 7.82 32.90 41.12 8.02 8.05 7.82 81.60 7.16 5.78 20.49 6.88 41.72 76.50 38.77 45.62 8.09 36931809 SOYBEAN IGG RAST 86001 300 $102.00 37.70 5.78 81.60 6.65 70.48 8.21 70.48 5.78 56.36 8.05 14.51 6.36 5.78 67.51 7.04 7.82 32.90 41.12 8.02 8.05 7.82 81.60 7.16 5.78 20.49 6.88 41.72 76.50 38.77 45.62 8.09 36931876 WHEAT IGG RAST 86001 300 $102.00 37.70 5.78 81.60 6.65 70.48 8.21 70.48 5.78 56.36 8.05 14.51 6.36 5.78 67.51 7.04 7.82 32.90 41.12 8.02 8.05 7.82 81.60 7.16 5.78 20.49 6.88 41.72 76.50 38.77 45.62 8.09 36945109 WHEATG F4 IGG 86001 300 $88.00 32.52 5.78 70.40 6.65 60.81 8.21 60.81 5.78 48.62 8.05 14.51 6.36 5.78 58.25 7.04 7.82 32.90 41.12 8.02 8.05 7.82 70.40 7.16 5.78 20.49 6.88 35.99 66.00 33.45 39.36 8.09 36945222 EGG WHITE F1 IGG 86001 300 $41.00 15.15 5.78 41.12 6.65 28.33 8.21 28.33 5.78 22.65 8.05 14.51 6.36 5.78 27.14 7.04 7.82 32.90 41.12 8.02 8.05 7.82 32.80 7.16 5.78 20.49 6.88 16.77 30.75 15.58 18.34 8.09 35705511 ORCHARD GRASS 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35705520 TIMOTHY (RAST) 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35705538 COMMON RAGWEED (RAST) 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35705546 GIANT RAGWEED 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35705554 BIRCH TREE (RAST) 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35705562 OAK TREE (RAST) 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35705571 CAT EPITHELIUM (RAST) 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35705589 DOG EPITHELIUM (RAST) 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35705597 DOG DANDER (RAST) 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35705601 ASPERGILLUS (RAST) 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35705619 CLADOSPORIUM (RAST) 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35705627 HOUSE DUST (RAST) 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35705635 ALTERNARIA (RAST) 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35705643 MITE FARINAE (RAST) 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35705651 MITE PTERONYSSINUS (RAST) 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35705660 CORN (RAST) 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35705678 EGG YOLK (RAST) 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35705686 EGG WHITE (RAST) 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35705694 WHEAT (RAST) 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35705708 MILK 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35705716 LAMBS QUARTERS (RAST) 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35705724 PIGWEED (RAST) 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35705732 ELM TREE (RAST) 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35705741 JUNE GRASS (RAST) 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35705759 PENICILLIUM NOTATUM (RAST) 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35705767 MAPLE (BOX ELDER) RAST 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35705775 COD FISH 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35705783 CRAB 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35705791 SHRIMP 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35705805 MOLLUSK (RAST) 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35705813 TUNA 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35705821 LOBSTER 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35705830 PEANUT 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35705848 SOY BEAN (RAST) 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35705856 ALMOND 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35705864 TOMATO (RAST) 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35705872 HORSE DANDER 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35707077 RAST LATEX ANTIGEN 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35707166 OAT 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35707174 MEADOW FESCUE 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35707182 PLAINTAIN (ENGLISH RIBORT)RAST 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35707191 HAMSTER EPITHELIUM 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35707204 GUINEA PIG EPITHELIUM 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35707212 HELMINTHOSPORIUM HALODES(RAST) 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35707221 MUCOR RACEMOSUS (RAST) 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35707239 STRAWBERRY 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35707247 COCKROACH 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35707255 DANDELION 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35707263 GOLDENROD 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35707271 COTTONWOOD (RAST) 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35707280 PECAN HICKORY (RAST) 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35707298 SYCAMORE 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35707301 WALNUT TREE 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35707310 WHITE ASH (RAST) 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35707328 GOOSE FEATHERS 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35707336 YELLOW HORNET VENOM 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35707344 HONEYBEE VENOM 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35707352 WHITE FACED HORNET VENOM 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35707361 YELLOW JACKET VENOM (WASP) 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35707379 PAPER WASP VENOM 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35707387 RYE GRASS 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35707395 CHICKEN MEAT 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35707409 WESTERN RAGWEED 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35707476 CHICKEN FEATHERS 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35707484 DUCK FEATHERS 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35707492 RABBIT EPITHELIUM 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35707506 HOUSE DUST (GREER LABS INC) 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35707514 CANDIDA ALBICANS 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35708014 CARROT 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35708022 CASHEW NUT 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35708031 WALNUT NUT 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35708049 MELON 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35708057 APPLE 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35708065 BRAZIL NUT 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35708073 ORANGE 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35708081 BEEF 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35708090 BANANA 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35708103 COW DANDER 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35708111 PECAN NUT 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35708120 HAZEL NUT 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35708138 OYSTER 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35708146 BERMUDA GRASS (RAST) 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35708154 MUGWORT (RAST) 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35708162 PULLULARIA 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35708171 CASEIN 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35708189 CULTIVATED WHEAT 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35708197 CULTIVATED RYE 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35708740 BAKERS YEAST (RAST) 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35708758 JOHNSON GRASS (RAST) 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35708766 POTATO WHITE (RAST) 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35708774 SHEEP SORREL (YELLOW DOCK)RAST 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35709045 COCONUT (RAST) 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35709053 SALMON (RAST) 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35709061 CLAM (RAST) 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35709436 ALLERGEN SPECIFIC IGE EACH 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35709550 SESAME SEED IGE 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35709568 SUNFLOWER IGE 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35709801 BEECH IGE 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35709827 WILLOW IGE 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35709835 COCKLEBUR IGE 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35709843 CACAO IGE 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35709851 COFFEE IGE 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35709860 ONION IGE 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 35709878 GARLIC IGE 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 36908246 AUSTRALIAN PINE (RAST) 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36908254 BAHIA GRASS (RAST) 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36908262 BARLEY (RAST) 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36908271 BEECH AMERICAN (RAST) 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36908297 BENT GRASS (RAST) 86003 300 $99.00 36.59 4.59 79.20 8.29 68.41 5.48 68.41 7.21 54.70 5.38 14.51 7.93 7.21 65.53 4.70 5.22 33.78 42.22 5.35 5.38 5.22 79.20 4.78 7.21 13.68 4.59 40.49 74.25 37.63 44.28 5.40 36908351 CELERY (RAST) 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36908394 COCKLEBUR (RAST) 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36908513 FIRE ANT IMPORT (RAST) 86003 300 $152.00 56.18 4.59 121.60 8.29 105.03 5.48 105.03 7.21 83.98 5.38 14.51 7.93 7.21 100.61 4.70 5.22 33.78 42.22 5.35 5.38 5.22 121.60 4.78 7.21 13.68 4.59 62.17 114.00 57.78 67.99 5.40 36908564 HAZEL TREE (RAST) 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36908602 CYPRESS ITALIAN IGE 86003 300 $66.00 24.39 4.59 52.80 8.29 45.61 5.48 45.61 7.21 36.47 5.38 14.51 7.93 7.21 43.69 4.70 5.22 33.78 42.22 5.35 5.38 5.22 52.80 4.78 7.21 13.68 4.59 26.99 49.50 25.09 29.52 5.40 36908611 JAPANESE CEDAR (RAST) 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36908637 KOCHIA-FIREBUSH (RAST) 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36908645 ALLERGEN SPECIFIC IGE EACH 86003 300 $161.00 59.51 4.59 128.80 8.29 111.25 5.48 111.25 7.21 88.95 5.38 14.51 7.93 7.21 106.57 4.70 5.22 33.78 42.22 5.35 5.38 5.22 128.80 4.78 7.21 13.68 4.59 65.85 120.75 61.20 72.02 5.40 36908661 MARSHELDER ROUGH (RAST) 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36908688 MELALEUCA CAVEP (RAST) 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36908718 MULBERRY TREE (RAST) 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36908734 NETTLE (RAST) 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36908793 PRIVET (RAST) 86003 300 $152.00 56.18 4.59 121.60 8.29 105.03 5.48 105.03 7.21 83.98 5.38 14.51 7.93 7.21 100.61 4.70 5.22 33.78 42.22 5.35 5.38 5.22 121.60 4.78 7.21 13.68 4.59 62.17 114.00 57.78 67.99 5.40 36908807 QUEEN PALM (RAST) 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36908831 RAGWEED FALSE (RAST) 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36908858 RUSSIAN THISTLE (RAST) 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36908866 RYE GRAIN (RAST) 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36908874 SWEET GUM TREE (RAST) 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36908882 STEMPHYLIUM BOT (RAST) 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36908921 TEA (RAST) 86003 300 $243.00 89.81 4.59 194.40 8.29 167.91 5.48 167.91 7.21 134.26 5.38 14.51 7.93 7.21 160.84 4.70 5.22 33.78 42.22 5.35 5.38 5.22 194.40 4.78 7.21 13.68 4.59 99.39 182.25 92.36 108.69 5.40 36908939 TRICH RUBRUM (RAST) 86003 300 $152.00 56.18 4.59 121.60 8.29 105.03 5.48 105.03 7.21 83.98 5.38 14.51 7.93 7.21 100.61 4.70 5.22 33.78 42.22 5.35 5.38 5.22 121.60 4.78 7.21 13.68 4.59 62.17 114.00 57.78 67.99 5.40 36908955 WHITE PINE (RAST) 86003 300 $66.00 24.39 4.59 52.80 8.29 45.61 5.48 45.61 7.21 36.47 5.38 14.51 7.93 7.21 43.69 4.70 5.22 33.78 42.22 5.35 5.38 5.22 52.80 4.78 7.21 13.68 4.59 26.99 49.50 25.09 29.52 5.40 36908963 WILLOW (RAST) 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36909935 BROME GRASS 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36909951 CEPHAL ACREMONIUM 86003 300 $243.00 89.81 4.59 194.40 8.29 167.91 5.48 167.91 7.21 134.26 5.38 14.51 7.93 7.21 160.84 4.70 5.22 33.78 42.22 5.35 5.38 5.22 194.40 4.78 7.21 13.68 4.59 99.39 182.25 92.36 108.69 5.40 36909960 CHEDDAR CHEESE 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36909978 CLAM 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36909986 EUCALYPTUS GUM TREE 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36910020 VELVET GRASS 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36910038 LETTUCE 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36910046 TURKEY MEAT 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36910054 SESAME SEED 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36910071 RICE 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36910089 RHIZOPUS NIGRICANS 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36910097 POTATO SWEET 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36910127 GREEN BEAN 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36910135 GREY ALDER TREE 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36910143 F MONILFORMES 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36910151 GARLIC 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36910178 ONION 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36910186 OLIVE TREE 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36910194 PEACH 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36910208 PENICILLOYL G 86003 300 $161.00 59.51 4.59 128.80 8.29 111.25 5.48 111.25 7.21 88.95 5.38 14.51 7.93 7.21 106.57 4.70 5.22 33.78 42.22 5.35 5.38 5.22 128.80 4.78 7.21 13.68 4.59 65.85 120.75 61.20 72.02 5.40 36910216 PENICILLOYL V 86003 300 $161.00 59.51 4.59 128.80 8.29 111.25 5.48 111.25 7.21 88.95 5.38 14.51 7.93 7.21 106.57 4.70 5.22 33.78 42.22 5.35 5.38 5.22 128.80 4.78 7.21 13.68 4.59 65.85 120.75 61.20 72.02 5.40 36910232 LACTOGLOBULIN-B 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36910241 LACTALBUMIN-A 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36910259 PINEAPPLE 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36911522 HADDOCK 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36911531 WATERMELON 86003 300 $235.00 86.86 4.59 188.00 8.29 162.39 5.48 162.39 7.21 129.84 5.38 14.51 7.93 7.21 155.55 4.70 5.22 33.78 42.22 5.35 5.38 5.22 188.00 4.78 7.21 13.68 4.59 96.12 176.25 89.32 105.12 5.40 36911549 FLOUNDER 86003 300 $161.00 59.51 4.59 128.80 8.29 111.25 5.48 111.25 7.21 88.95 5.38 14.51 7.93 7.21 106.57 4.70 5.22 33.78 42.22 5.35 5.38 5.22 128.80 4.78 7.21 13.68 4.59 65.85 120.75 61.20 72.02 5.40 36913029 PEAS-RAST 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36913037 PLUM/PRUNE-RAST 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36913045 TROUT-RAST 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36914408 APRICOT (RAST) 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36914921 PERCH (RAST) 86003 300 $99.00 36.59 4.59 79.20 8.29 68.41 5.48 68.41 7.21 54.70 5.38 14.51 7.93 7.21 65.53 4.70 5.22 33.78 42.22 5.35 5.38 5.22 79.20 4.78 7.21 13.68 4.59 40.49 74.25 37.63 44.28 5.40 36915641 PEAR 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36916575 CABBAGE-RAST 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36916583 BUCKWHEAT-RAST 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36916591 BLACK PEPPER-RAST 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36916605 AVOCADO-RAST 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36916613 CRANBERRY-RAST 86003 300 $161.00 59.51 4.59 128.80 8.29 111.25 5.48 111.25 7.21 88.95 5.38 14.51 7.93 7.21 106.57 4.70 5.22 33.78 42.22 5.35 5.38 5.22 128.80 4.78 7.21 13.68 4.59 65.85 120.75 61.20 72.02 5.40 36916621 CHERRY BING-RAST 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36916630 SUNFLOWER SEED-RAST 86003 300 $152.00 56.18 4.59 121.60 8.29 105.03 5.48 105.03 7.21 83.98 5.38 14.51 7.93 7.21 100.61 4.70 5.22 33.78 42.22 5.35 5.38 5.22 121.60 4.78 7.21 13.68 4.59 62.17 114.00 57.78 67.99 5.40 36916648 PISTACHIO-RAST 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36916931 COFFEE (RAST) 86003 300 $243.00 89.81 4.59 194.40 8.29 167.91 5.48 167.91 7.21 134.26 5.38 14.51 7.93 7.21 160.84 4.70 5.22 33.78 42.22 5.35 5.38 5.22 194.40 4.78 7.21 13.68 4.59 99.39 182.25 92.36 108.69 5.40 36916940 LEMONS (RAST) 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36916958 SPINACH (RAST) 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36916966 GRAPE (RAST) 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36917032 BLUEBERRY (RAST) 86003 300 $243.00 89.81 4.59 194.40 8.29 167.91 5.48 167.91 7.21 134.26 5.38 14.51 7.93 7.21 160.84 4.70 5.22 33.78 42.22 5.35 5.38 5.22 194.40 4.78 7.21 13.68 4.59 99.39 182.25 92.36 108.69 5.40 36917041 RASPBERRY (RAST) 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36917121 CAULIFLOWER (RAST) 86003 300 $243.00 89.81 4.59 194.40 8.29 167.91 5.48 167.91 7.21 134.26 5.38 14.51 7.93 7.21 160.84 4.70 5.22 33.78 42.22 5.35 5.38 5.22 194.40 4.78 7.21 13.68 4.59 99.39 182.25 92.36 108.69 5.40 36917130 SALMON (RAST) 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36917237 LENTIL (RAST) 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36917644 CLOVE (RAST) 86003 300 $152.00 56.18 4.59 121.60 8.29 105.03 5.48 105.03 7.21 83.98 5.38 14.51 7.93 7.21 100.61 4.70 5.22 33.78 42.22 5.35 5.38 5.22 121.60 4.78 7.21 13.68 4.59 62.17 114.00 57.78 67.99 5.40 36917652 BROCCOLI (RAST) 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36917661 CINNAMON (RAST) 86003 300 $243.00 89.81 4.59 194.40 8.29 167.91 5.48 167.91 7.21 134.26 5.38 14.51 7.93 7.21 160.84 4.70 5.22 33.78 42.22 5.35 5.38 5.22 194.40 4.78 7.21 13.68 4.59 99.39 182.25 92.36 108.69 5.40 36919396 SWEET VERNAL GRAIN (RAST) 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36924586 PORK ALLERGEN IGE 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36925132 MUSTARD IGE 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36925141 ASPARAGUS IGE 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36925159 CHILI PEPPER IGE 86003 300 $243.00 89.81 4.59 194.40 8.29 167.91 5.48 167.91 7.21 134.26 5.38 14.51 7.93 7.21 160.84 4.70 5.22 33.78 42.22 5.35 5.38 5.22 194.40 4.78 7.21 13.68 4.59 99.39 182.25 92.36 108.69 5.40 36925167 CUCUMBER IGE 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36925175 GINGER IGE 86003 300 $243.00 89.81 4.59 194.40 8.29 167.91 5.48 167.91 7.21 134.26 5.38 14.51 7.93 7.21 160.84 4.70 5.22 33.78 42.22 5.35 5.38 5.22 194.40 4.78 7.21 13.68 4.59 99.39 182.25 92.36 108.69 5.40 36925183 GLUTEN IGE 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36925191 GRAPEFRUIT IGE 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36925205 HALIBUT IGE 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36925213 HONEY IGE 86003 300 $243.00 89.81 4.59 194.40 8.29 167.91 5.48 167.91 7.21 134.26 5.38 14.51 7.93 7.21 160.84 4.70 5.22 33.78 42.22 5.35 5.38 5.22 194.40 4.78 7.21 13.68 4.59 99.39 182.25 92.36 108.69 5.40 36925221 MUSHROOM IGE 86003 300 $243.00 89.81 4.59 194.40 8.29 167.91 5.48 167.91 7.21 134.26 5.38 14.51 7.93 7.21 160.84 4.70 5.22 33.78 42.22 5.35 5.38 5.22 194.40 4.78 7.21 13.68 4.59 99.39 182.25 92.36 108.69 5.40 36925230 GREEN PEPPER IGE 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36925248 VANILLA IGE 86003 300 $243.00 89.81 4.59 194.40 8.29 167.91 5.48 167.91 7.21 134.26 5.38 14.51 7.93 7.21 160.84 4.70 5.22 33.78 42.22 5.35 5.38 5.22 194.40 4.78 7.21 13.68 4.59 99.39 182.25 92.36 108.69 5.40 36925256 WHEY IGE 86003 300 $161.00 59.51 4.59 128.80 8.29 111.25 5.48 111.25 7.21 88.95 5.38 14.51 7.93 7.21 106.57 4.70 5.22 33.78 42.22 5.35 5.38 5.22 128.80 4.78 7.21 13.68 4.59 65.85 120.75 61.20 72.02 5.40 36925264 BLACK OLIVE IGE 86003 300 $161.00 59.51 4.59 128.80 8.29 111.25 5.48 111.25 7.21 88.95 5.38 14.51 7.93 7.21 106.57 4.70 5.22 33.78 42.22 5.35 5.38 5.22 128.80 4.78 7.21 13.68 4.59 65.85 120.75 61.20 72.02 5.40 36925272 CHEESE AMERICAN IGE 86003 300 $99.00 36.59 4.59 79.20 8.29 68.41 5.48 68.41 7.21 54.70 5.38 14.51 7.93 7.21 65.53 4.70 5.22 33.78 42.22 5.35 5.38 5.22 79.20 4.78 7.21 13.68 4.59 40.49 74.25 37.63 44.28 5.40 36925281 SUGAR CANE IGE 86003 300 $99.00 36.59 4.59 79.20 8.29 68.41 5.48 68.41 7.21 54.70 5.38 14.51 7.93 7.21 65.53 4.70 5.22 33.78 42.22 5.35 5.38 5.22 79.20 4.78 7.21 13.68 4.59 40.49 74.25 37.63 44.28 5.40 36925299 RED BEETS IGE 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36925302 LIMA BEANS IGE 86003 300 $161.00 59.51 4.59 128.80 8.29 111.25 5.48 111.25 7.21 88.95 5.38 14.51 7.93 7.21 106.57 4.70 5.22 33.78 42.22 5.35 5.38 5.22 128.80 4.78 7.21 13.68 4.59 65.85 120.75 61.20 72.02 5.40 36925311 YOGURT IGE 86003 300 $99.00 36.59 4.59 79.20 8.29 68.41 5.48 68.41 7.21 54.70 5.38 14.51 7.93 7.21 65.53 4.70 5.22 33.78 42.22 5.35 5.38 5.22 79.20 4.78 7.21 13.68 4.59 40.49 74.25 37.63 44.28 5.40 36925329 CHEESE PARMESAN IGE 86003 300 $99.00 36.59 4.59 79.20 8.29 68.41 5.48 68.41 7.21 54.70 5.38 14.51 7.93 7.21 65.53 4.70 5.22 33.78 42.22 5.35 5.38 5.22 79.20 4.78 7.21 13.68 4.59 40.49 74.25 37.63 44.28 5.40 36925655 AMARANTH (RED 2) IGE 86003 300 $152.00 56.18 4.59 121.60 8.29 105.03 5.48 105.03 7.21 83.98 5.38 14.51 7.93 7.21 100.61 4.70 5.22 33.78 42.22 5.35 5.38 5.22 121.60 4.78 7.21 13.68 4.59 62.17 114.00 57.78 67.99 5.40 36925663 ASCORBIC ACID IGE 86003 300 $254.00 93.88 4.59 203.20 8.29 175.51 5.48 175.51 7.21 140.34 5.38 14.51 7.93 7.21 168.12 4.70 5.22 33.78 42.22 5.35 5.38 5.22 203.20 4.78 7.21 13.68 4.59 103.89 190.50 96.55 113.61 5.40 36925671 BENZOIC ACID IGE 86003 300 $254.00 93.88 4.59 203.20 8.29 175.51 5.48 175.51 7.21 140.34 5.38 14.51 7.93 7.21 168.12 4.70 5.22 33.78 42.22 5.35 5.38 5.22 203.20 4.78 7.21 13.68 4.59 103.89 190.50 96.55 113.61 5.40 36925680 CYCLAMIC ACID IGE 86003 300 $254.00 93.88 4.59 203.20 8.29 175.51 5.48 175.51 7.21 140.34 5.38 14.51 7.93 7.21 168.12 4.70 5.22 33.78 42.22 5.35 5.38 5.22 203.20 4.78 7.21 13.68 4.59 103.89 190.50 96.55 113.61 5.40 36925698 GLUTAMIC ACID IGE 86003 300 $254.00 93.88 4.59 203.20 8.29 175.51 5.48 175.51 7.21 140.34 5.38 14.51 7.93 7.21 168.12 4.70 5.22 33.78 42.22 5.35 5.38 5.22 203.20 4.78 7.21 13.68 4.59 103.89 190.50 96.55 113.61 5.40 36925701 MAPLE SYRUP IGE 86003 300 $187.00 69.12 4.59 149.60 8.29 129.22 5.48 129.22 7.21 103.32 5.38 14.51 7.93 7.21 123.78 4.70 5.22 33.78 42.22 5.35 5.38 5.22 149.60 4.78 7.21 13.68 4.59 76.48 140.25 71.08 83.65 5.40 36925710 METHYLPARABEN IGE 86003 300 $254.00 93.88 4.59 203.20 8.29 175.51 5.48 175.51 7.21 140.34 5.38 14.51 7.93 7.21 168.12 4.70 5.22 33.78 42.22 5.35 5.38 5.22 203.20 4.78 7.21 13.68 4.59 103.89 190.50 96.55 113.61 5.40 36925728 SACCHARIN IGE 86003 300 $254.00 93.88 4.59 203.20 8.29 175.51 5.48 175.51 7.21 140.34 5.38 14.51 7.93 7.21 168.12 4.70 5.22 33.78 42.22 5.35 5.38 5.22 203.20 4.78 7.21 13.68 4.59 103.89 190.50 96.55 113.61 5.40 36925736 SODIUM NITRITE IGE 86003 300 $254.00 93.88 4.59 203.20 8.29 175.51 5.48 175.51 7.21 140.34 5.38 14.51 7.93 7.21 168.12 4.70 5.22 33.78 42.22 5.35 5.38 5.22 203.20 4.78 7.21 13.68 4.59 103.89 190.50 96.55 113.61 5.40 36925744 SODIUM SULFITE IGE 86003 300 $254.00 93.88 4.59 203.20 8.29 175.51 5.48 175.51 7.21 140.34 5.38 14.51 7.93 7.21 168.12 4.70 5.22 33.78 42.22 5.35 5.38 5.22 203.20 4.78 7.21 13.68 4.59 103.89 190.50 96.55 113.61 5.40 36925752 SORBIC ACID IGE 86003 300 $254.00 93.88 4.59 203.20 8.29 175.51 5.48 175.51 7.21 140.34 5.38 14.51 7.93 7.21 168.12 4.70 5.22 33.78 42.22 5.35 5.38 5.22 203.20 4.78 7.21 13.68 4.59 103.89 190.50 96.55 113.61 5.40 36925761 TARTRAZINE YELLOW 5 IGE 86003 300 $254.00 93.88 4.59 203.20 8.29 175.51 5.48 175.51 7.21 140.34 5.38 14.51 7.93 7.21 168.12 4.70 5.22 33.78 42.22 5.35 5.38 5.22 203.20 4.78 7.21 13.68 4.59 103.89 190.50 96.55 113.61 5.40 36925779 WINE VINEGAR IGE 86003 300 $152.00 56.18 4.59 121.60 8.29 105.03 5.48 105.03 7.21 83.98 5.38 14.51 7.93 7.21 100.61 4.70 5.22 33.78 42.22 5.35 5.38 5.22 121.60 4.78 7.21 13.68 4.59 62.17 114.00 57.78 67.99 5.40 36925787 GELATIN BOVINE IGE 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36925795 GELATIN PORCINE IGE 86003 300 $99.00 36.59 4.59 79.20 8.29 68.41 5.48 68.41 7.21 54.70 5.38 14.51 7.93 7.21 65.53 4.70 5.22 33.78 42.22 5.35 5.38 5.22 79.20 4.78 7.21 13.68 4.59 40.49 74.25 37.63 44.28 5.40 36925809 BRAN WHEAT IGE 86003 300 $99.00 36.59 4.59 79.20 8.29 68.41 5.48 68.41 7.21 54.70 5.38 14.51 7.93 7.21 65.53 4.70 5.22 33.78 42.22 5.35 5.38 5.22 79.20 4.78 7.21 13.68 4.59 40.49 74.25 37.63 44.28 5.40 36925817 MOZZARELLA CHEESE IGE 86003 300 $99.00 36.59 4.59 79.20 8.29 68.41 5.48 68.41 7.21 54.70 5.38 14.51 7.93 7.21 65.53 4.70 5.22 33.78 42.22 5.35 5.38 5.22 79.20 4.78 7.21 13.68 4.59 40.49 74.25 37.63 44.28 5.40 36925825 VENISON IGE 86003 300 $99.00 36.59 4.59 79.20 8.29 68.41 5.48 68.41 7.21 54.70 5.38 14.51 7.93 7.21 65.53 4.70 5.22 33.78 42.22 5.35 5.38 5.22 79.20 4.78 7.21 13.68 4.59 40.49 74.25 37.63 44.28 5.40 36925833 GUM XANTHAN IGE 86003 300 $152.00 56.18 4.59 121.60 8.29 105.03 5.48 105.03 7.21 83.98 5.38 14.51 7.93 7.21 100.61 4.70 5.22 33.78 42.22 5.35 5.38 5.22 121.60 4.78 7.21 13.68 4.59 62.17 114.00 57.78 67.99 5.40 36929979 ALLERGEN SPECIFIC IGE EACH 86003 300 $99.00 36.59 4.59 79.20 8.29 68.41 5.48 68.41 7.21 54.70 5.38 14.51 7.93 7.21 65.53 4.70 5.22 33.78 42.22 5.35 5.38 5.22 79.20 4.78 7.21 13.68 4.59 40.49 74.25 37.63 44.28 5.40 36929987 SWISS CHEESE IGE 86003 300 $99.00 36.59 4.59 79.20 8.29 68.41 5.48 68.41 7.21 54.70 5.38 14.51 7.93 7.21 65.53 4.70 5.22 33.78 42.22 5.35 5.38 5.22 79.20 4.78 7.21 13.68 4.59 40.49 74.25 37.63 44.28 5.40 36930110 MINT (PEPPERMINT) IGE 86003 300 $161.00 59.51 4.59 128.80 8.29 111.25 5.48 111.25 7.21 88.95 5.38 14.51 7.93 7.21 106.57 4.70 5.22 33.78 42.22 5.35 5.38 5.22 128.80 4.78 7.21 13.68 4.59 65.85 120.75 61.20 72.02 5.40 36930179 MANGO IGE 86003 300 $83.00 30.68 4.59 66.40 8.29 57.35 5.48 57.35 7.21 45.86 5.38 14.51 7.93 7.21 54.94 4.70 5.22 33.78 42.22 5.35 5.38 5.22 66.40 4.78 7.21 13.68 4.59 33.95 62.25 31.55 37.13 5.40 36931531 AMOXICILLIN IGE RAST 86003 300 $125.00 46.20 4.59 100.00 8.29 86.38 5.48 86.38 7.21 69.06 5.38 14.51 7.93 7.21 82.74 4.70 5.22 33.78 42.22 5.35 5.38 5.22 100.00 4.78 7.21 13.68 4.59 51.13 93.75 47.51 55.91 5.40 36931540 AMPICILLIN IGE RAST 86003 300 $125.00 46.20 4.59 100.00 8.29 86.38 5.48 86.38 7.21 69.06 5.38 14.51 7.93 7.21 82.74 4.70 5.22 33.78 42.22 5.35 5.38 5.22 100.00 4.78 7.21 13.68 4.59 51.13 93.75 47.51 55.91 5.40 36931558 BASIL IGE RAST 86003 300 $189.00 69.85 4.59 151.20 8.29 130.60 5.48 130.60 7.21 104.42 5.38 14.51 7.93 7.21 125.10 4.70 5.22 33.78 42.22 5.35 5.38 5.22 151.20 4.78 7.21 13.68 4.59 77.30 141.75 71.84 84.54 5.40 36931566 BLACKBERRY IGE RAST 86003 300 $125.00 46.20 4.59 100.00 8.29 86.38 5.48 86.38 7.21 69.06 5.38 14.51 7.93 7.21 82.74 4.70 5.22 33.78 42.22 5.35 5.38 5.22 100.00 4.78 7.21 13.68 4.59 51.13 93.75 47.51 55.91 5.40 36931591 CEDAR RED IGE RAST 86003 300 $125.00 46.20 4.59 100.00 8.29 86.38 5.48 86.38 7.21 69.06 5.38 14.51 7.93 7.21 82.74 4.70 5.22 33.78 42.22 5.35 5.38 5.22 100.00 4.78 7.21 13.68 4.59 51.13 93.75 47.51 55.91 5.40 36931604 CURRY IGE RAST 86003 300 $189.00 69.85 4.59 151.20 8.29 130.60 5.48 130.60 7.21 104.42 5.38 14.51 7.93 7.21 125.10 4.70 5.22 33.78 42.22 5.35 5.38 5.22 151.20 4.78 7.21 13.68 4.59 77.30 141.75 71.84 84.54 5.40 36931612 DILL IGE RAST 86003 300 $189.00 69.85 4.59 151.20 8.29 130.60 5.48 130.60 7.21 104.42 5.38 14.51 7.93 7.21 125.10 4.70 5.22 33.78 42.22 5.35 5.38 5.22 151.20 4.78 7.21 13.68 4.59 77.30 141.75 71.84 84.54 5.40 36931621 ECHINOCOCC IGE RAST 86003 300 $125.00 46.20 4.59 100.00 8.29 86.38 5.48 86.38 7.21 69.06 5.38 14.51 7.93 7.21 82.74 4.70 5.22 33.78 42.22 5.35 5.38 5.22 100.00 4.78 7.21 13.68 4.59 51.13 93.75 47.51 55.91 5.40 36931647 EGG WHITE IGE RAST 86003 300 $64.00 23.65 4.59 51.20 8.29 44.22 5.48 44.22 7.21 35.36 5.38 14.51 7.93 7.21 42.36 4.70 5.22 33.78 42.22 5.35 5.38 5.22 51.20 4.78 7.21 13.68 4.59 26.18 48.00 24.33 28.63 5.40 36931655 EGGPLANT IGE RAST 86003 300 $189.00 69.85 4.59 151.20 8.29 130.60 5.48 130.60 7.21 104.42 5.38 14.51 7.93 7.21 125.10 4.70 5.22 33.78 42.22 5.35 5.38 5.22 151.20 4.78 7.21 13.68 4.59 77.30 141.75 71.84 84.54 5.40 36931680 LIME IGE RAST 86003 300 $189.00 69.85 4.59 151.20 8.29 130.60 5.48 130.60 7.21 104.42 5.38 14.51 7.93 7.21 125.10 4.70 5.22 33.78 42.22 5.35 5.38 5.22 151.20 4.78 7.21 13.68 4.59 77.30 141.75 71.84 84.54 5.40 36931698 MACADAMIA NUT IGE RAST 86003 300 $64.00 23.65 4.59 51.20 8.29 44.22 5.48 44.22 7.21 35.36 5.38 14.51 7.93 7.21 42.36 4.70 5.22 33.78 42.22 5.35 5.38 5.22 51.20 4.78 7.21 13.68 4.59 26.18 48.00 24.33 28.63 5.40 36931728 ALLERGEN SPECIFIC IGE EACH 86003 300 $125.00 46.20 4.59 100.00 8.29 86.38 5.48 86.38 7.21 69.06 5.38 14.51 7.93 7.21 82.74 4.70 5.22 33.78 42.22 5.35 5.38 5.22 100.00 4.78 7.21 13.68 4.59 51.13 93.75 47.51 55.91 5.40 36931736 OREGANO IGE RAST 86003 300 $189.00 69.85 4.59 151.20 8.29 130.60 5.48 130.60 7.21 104.42 5.38 14.51 7.93 7.21 125.10 4.70 5.22 33.78 42.22 5.35 5.38 5.22 151.20 4.78 7.21 13.68 4.59 77.30 141.75 71.84 84.54 5.40 36931752 PAPRIKA IGE RAST 86003 300 $64.00 23.65 4.59 51.20 8.29 44.22 5.48 44.22 7.21 35.36 5.38 14.51 7.93 7.21 42.36 4.70 5.22 33.78 42.22 5.35 5.38 5.22 51.20 4.78 7.21 13.68 4.59 26.18 48.00 24.33 28.63 5.40 36931779 PINE NUT IGE RAST 86003 300 $125.00 46.20 4.59 100.00 8.29 86.38 5.48 86.38 7.21 69.06 5.38 14.51 7.93 7.21 82.74 4.70 5.22 33.78 42.22 5.35 5.38 5.22 100.00 4.78 7.21 13.68 4.59 51.13 93.75 47.51 55.91 5.40 36931787 SCALLOP IGE RAST 86003 300 $64.00 23.65 4.59 51.20 8.29 44.22 5.48 44.22 7.21 35.36 5.38 14.51 7.93 7.21 42.36 4.70 5.22 33.78 42.22 5.35 5.38 5.22 51.20 4.78 7.21 13.68 4.59 26.18 48.00 24.33 28.63 5.40 36931795 SMUT BARLEY IGE RAST 86003 300 $189.00 69.85 4.59 151.20 8.29 130.60 5.48 130.60 7.21 104.42 5.38 14.51 7.93 7.21 125.10 4.70 5.22 33.78 42.22 5.35 5.38 5.22 151.20 4.78 7.21 13.68 4.59 77.30 141.75 71.84 84.54 5.40 36931825 SUMMER SQUASH IGE RAST 86003 300 $78.00 28.83 4.59 62.40 8.29 53.90 5.48 53.90 7.21 43.10 5.38 14.51 7.93 7.21 51.63 4.70 5.22 33.78 42.22 5.35 5.38 5.22 62.40 4.78 7.21 13.68 4.59 31.90 58.50 29.65 34.89 5.40 36931833 SWORDFISH IGE RAST 86003 300 $189.00 69.85 4.59 151.20 8.29 130.60 5.48 130.60 7.21 104.42 5.38 14.51 7.93 7.21 125.10 4.70 5.22 33.78 42.22 5.35 5.38 5.22 151.20 4.78 7.21 13.68 4.59 77.30 141.75 71.84 84.54 5.40 36931841 TOBACCO LEAF IGE RAST 86003 300 $189.00 69.85 4.59 151.20 8.29 130.60 5.48 130.60 7.21 104.42 5.38 14.51 7.93 7.21 125.10 4.70 5.22 33.78 42.22 5.35 5.38 5.22 151.20 4.78 7.21 13.68 4.59 77.30 141.75 71.84 84.54 5.40 36931850 WATERMELON IGE RAST 86003 300 $64.00 23.65 4.59 51.20 8.29 44.22 5.48 44.22 7.21 35.36 5.38 14.51 7.93 7.21 42.36 4.70 5.22 33.78 42.22 5.35 5.38 5.22 51.20 4.78 7.21 13.68 4.59 26.18 48.00 24.33 28.63 5.40 36931884 ALLERGEN SPECIFIC IGE EACH 86003 300 $64.00 23.65 4.59 51.20 8.29 44.22 5.48 44.22 7.21 35.36 5.38 14.51 7.93 7.21 42.36 4.70 5.22 33.78 42.22 5.35 5.38 5.22 51.20 4.78 7.21 13.68 4.59 26.18 48.00 24.33 28.63 5.40 36931892 WHITE MULBERRY IGE RAST 86003 300 $64.00 23.65 4.59 51.20 8.29 44.22 5.48 44.22 7.21 35.36 5.38 14.51 7.93 7.21 42.36 4.70 5.22 33.78 42.22 5.35 5.38 5.22 51.20 4.78 7.21 13.68 4.59 26.18 48.00 24.33 28.63 5.40 36931906 WOOL SHEEP IGE RAST 86003 300 $119.00 43.98 4.59 95.20 8.29 82.23 5.48 82.23 7.21 65.75 5.38 14.51 7.93 7.21 78.77 4.70 5.22 33.78 42.22 5.35 5.38 5.22 95.20 4.78 7.21 13.68 4.59 48.67 89.25 45.23 53.23 5.40 36931914 ZUCCHINI IGE RAST 86003 300 $78.00 28.83 4.59 62.40 8.29 53.90 5.48 53.90 7.21 43.10 5.38 14.51 7.93 7.21 51.63 4.70 5.22 33.78 42.22 5.35 5.38 5.22 62.40 4.78 7.21 13.68 4.59 31.90 58.50 29.65 34.89 5.40 36932597 BROMELIN IGE 86003 300 $205.00 75.77 4.59 164.00 8.29 141.66 5.48 141.66 7.21 113.26 5.38 14.51 7.93 7.21 135.69 4.70 5.22 33.78 42.22 5.35 5.38 5.22 164.00 4.78 7.21 13.68 4.59 83.85 153.75 77.92 91.70 5.40 36932601 CHOCOLATE (COCOA) IGE 86003 300 $35.00 12.94 4.59 42.22 8.29 24.19 5.48 24.19 7.21 19.34 5.38 14.51 7.93 7.21 23.17 4.70 5.22 33.78 42.22 5.35 5.38 5.22 28.00 4.78 7.21 13.68 4.59 14.32 26.25 13.30 15.66 5.40 36932619 CANTALOUPE IGE 86003 300 $35.00 12.94 4.59 42.22 8.29 24.19 5.48 24.19 7.21 19.34 5.38 14.51 7.93 7.21 23.17 4.70 5.22 33.78 42.22 5.35 5.38 5.22 28.00 4.78 7.21 13.68 4.59 14.32 26.25 13.30 15.66 5.40 36936053 PAPAIN IGE 86003 300 $186.00 68.75 4.59 148.80 8.29 128.53 5.48 128.53 7.21 102.77 5.38 14.51 7.93 7.21 123.11 4.70 5.22 33.78 42.22 5.35 5.38 5.22 148.80 4.78 7.21 13.68 4.59 76.07 139.50 70.70 83.20 5.40 36936169 NECTARINE IGE 86003 300 $109.00 40.29 4.59 87.20 8.29 75.32 5.48 75.32 7.21 60.22 5.38 14.51 7.93 7.21 72.15 4.70 5.22 33.78 42.22 5.35 5.38 5.22 87.20 4.78 7.21 13.68 4.59 44.58 81.75 41.43 48.76 5.40 36937114 ALLERGEN SPECIFIC IGE 86003 300 $592.00 218.80 4.59 473.60 8.29 409.07 5.48 409.07 7.21 327.08 5.38 14.51 7.93 7.21 391.84 4.70 5.22 33.78 42.22 5.35 5.38 5.22 473.60 4.78 7.21 13.68 4.59 242.13 444.00 225.02 264.80 5.40 36940361 ASPERGILLUS NIGER IGE 86003 300 $28.00 10.35 4.59 42.22 8.29 19.35 5.48 19.35 7.21 15.47 5.38 14.51 7.93 7.21 18.53 4.70 5.22 33.78 42.22 5.35 5.38 5.22 22.40 4.78 7.21 13.68 4.59 11.45 21.00 10.64 12.52 5.40 36942398 RED TOP GRASS IGE 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 36942401 RAT EPITHELIA 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 36942410 TRICHOPHYTON RUBRUM 86003 300 $33.00 12.20 4.59 42.22 8.29 22.80 5.48 22.80 7.21 18.23 5.38 14.51 7.93 7.21 21.84 4.70 5.22 33.78 42.22 5.35 5.38 5.22 26.40 4.78 7.21 13.68 4.59 13.50 24.75 12.54 14.76 5.40 36942428 FIREBUSH IGE 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 36944668 RED KIDNEY BEAN IGE 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 36944897 ALLERGEN SPEC IGE EA PINE NUT 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 36944901 ALLERGEN SPEC IGE EA OREGANO 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 36944919 ALLERGEN SPECIFIC IGE EA DILL 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 36944927 ALLERGEN SPECIFIC IGE EA BASIL 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 36944935 ALLERGEN SPEC IGE EA MOSQUITO 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 36944943 ALLERGEN SPECIFIC IGE EA CURRY 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 36945001 ALLERGEN SPEC IGE CARM RED DYE 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 36945010 ALLERGEN SPEC IGE EA PAPAIN 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 36945028 ALLERGEN SPEC IGE EA RED CEDAR 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 36945036 ALLERG SPEC IGE EA MACADAM NUT 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 36945044 NECTARINE IGE 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 36945052 ZUCCHINI IGE 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 36945061 POPPY SEED IGE 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 36945079 PUMPKIN SEED IGE 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 36945087 CANOLA RAPE SEED IGE 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 36945095 QUINOA IGE 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 36945117 THYME IGE 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 36945125 PARSLEY IGE 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 36945133 TARRAGON IGE 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 36945141 CORIANDER CILANTRO IGE 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 36945150 TURMERIC IGE 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 36945168 FLAXSEED LINSEED IGE 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 36945176 BLACKBERRY IGE 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 36945184 BAY LEAF IGE 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 36945206 EGGPLANT RF262 IGE 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 36945214 SQUASH SUMMER IGE 86003 300 $129.00 47.68 4.59 103.20 8.29 89.14 5.48 89.14 7.21 71.27 5.38 14.51 7.93 7.21 85.39 4.70 5.22 33.78 42.22 5.35 5.38 5.22 103.20 4.78 7.21 13.68 4.59 52.76 96.75 49.03 57.70 5.40 36945231 LIME RF306 IGE 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 36945249 SWORDFISH IGE 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 36945257 AMOXICILLIN IGE 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 36945265 FENNEL SEED IGE 86003 300 $212.00 78.36 4.59 169.60 8.29 146.49 5.48 146.49 7.21 117.13 5.38 14.51 7.93 7.21 140.32 4.70 5.22 33.78 42.22 5.35 5.38 5.22 169.60 4.78 7.21 13.68 4.59 86.71 159.00 80.58 94.83 5.40 36998733 KU213 86003 300 $27.00 9.98 4.59 42.22 8.29 18.66 5.48 18.66 7.21 14.92 5.38 14.51 7.93 7.21 17.87 4.70 5.22 33.78 42.22 5.35 5.38 5.22 21.60 4.78 7.21 13.68 4.59 11.04 20.25 10.26 12.08 5.40 36998741 POPLAR WHITE 86003 300 $48.00 17.74 4.59 42.22 8.29 33.17 5.48 33.17 7.21 26.52 5.38 14.51 7.93 7.21 31.77 4.70 5.22 33.78 42.22 5.35 5.38 5.22 38.40 4.78 7.21 13.68 4.59 19.63 36.00 18.24 21.47 5.40 36937670 ALLERGEN SPEC IGE PURIF COMP 86008 300 $94.00 34.74 15.78 122.02 20.37 64.95 18.83 64.95 17.71 51.94 18.47 62.04 19.48 17.71 62.22 16.14 17.93 97.62 122.02 18.38 18.47 17.93 75.20 16.41 17.71 46.98 15.78 38.45 70.50 35.73 42.05 18.56 36937688 ALLERGEN SPEC IGE PURIF COMP 86008 300 $94.00 34.74 15.78 122.02 20.37 64.95 18.83 64.95 17.71 51.94 18.47 62.04 19.48 17.71 62.22 16.14 17.93 97.62 122.02 18.38 18.47 17.93 75.20 16.41 17.71 46.98 15.78 38.45 70.50 35.73 42.05 18.56 36937696 ALLERGEN SPEC IGE PURIF COMP 86008 300 $94.00 34.74 15.78 122.02 20.37 64.95 18.83 64.95 17.71 51.94 18.47 62.04 19.48 17.71 62.22 16.14 17.93 97.62 122.02 18.38 18.47 17.93 75.20 16.41 17.71 46.98 15.78 38.45 70.50 35.73 42.05 18.56 36937700 ALLERGEN SPEC IGE PURIF COMP 86008 300 $94.00 34.74 15.78 122.02 20.37 64.95 18.83 64.95 17.71 51.94 18.47 62.04 19.48 17.71 62.22 16.14 17.93 97.62 122.02 18.38 18.47 17.93 75.20 16.41 17.71 46.98 15.78 38.45 70.50 35.73 42.05 18.56 36937718 ALLERGEN SPEC IGE PURIF COMP 86008 300 $94.00 34.74 15.78 122.02 20.37 64.95 18.83 64.95 17.71 51.94 18.47 62.04 19.48 17.71 62.22 16.14 17.93 97.62 122.02 18.38 18.47 17.93 75.20 16.41 17.71 46.98 15.78 38.45 70.50 35.73 42.05 18.56 36770465 HLA CLASS I ANTIBODY ID 86021 300 $79.00 29.20 5.00 63.20 5.75 54.59 15.80 54.59 5.00 43.65 15.50 41.86 5.50 5.00 52.29 13.55 15.05 37.08 46.35 15.43 15.50 15.05 63.20 13.77 5.00 39.43 13.24 32.31 59.25 30.03 35.34 15.58 36770473 HLA CLASS 2 ANTIBODY ID 86021 300 $79.00 29.20 5.00 63.20 5.75 54.59 15.80 54.59 5.00 43.65 15.50 41.86 5.50 5.00 52.29 13.55 15.05 37.08 46.35 15.43 15.50 15.05 63.20 13.77 5.00 39.43 13.24 32.31 59.25 30.03 35.34 15.58 36770562 LEUKOCYTE AB ID- BILL ONLY 86021 300 $79.00 29.20 5.00 63.20 5.75 54.59 15.80 54.59 5.00 43.65 15.50 41.86 5.50 5.00 52.29 13.55 15.05 37.08 46.35 15.43 15.50 15.05 63.20 13.77 5.00 39.43 13.24 32.31 59.25 30.03 35.34 15.58 36902833 GRANULOCYTE ANTIBODIES 86021 300 "$1,153.00" 426.15 5.00 922.40 5.75 796.72 15.80 796.72 5.00 637.03 15.50 41.86 5.50 5.00 763.17 13.55 15.05 37.08 46.35 15.43 15.50 15.05 922.40 13.77 5.00 39.43 13.24 471.58 864.75 438.26 515.74 15.58 36930951 WBC ANTIBODY ID 86021 300 $178.00 65.79 5.00 142.40 5.75 123.00 15.80 123.00 5.00 98.35 15.50 41.86 5.50 5.00 117.82 13.55 15.05 37.08 46.35 15.43 15.50 15.05 142.40 13.77 5.00 39.43 13.24 72.80 133.50 67.66 79.62 15.58 36933151 NEUTROPHIL AB FLOW CYTOMETRY 86021 300 $673.00 248.74 5.00 538.40 5.75 465.04 15.80 465.04 5.00 371.83 15.50 41.86 5.50 5.00 445.46 13.55 15.05 37.08 46.35 15.43 15.50 15.05 538.40 13.77 5.00 39.43 13.24 275.26 504.75 255.81 301.03 15.58 36110406 HEPARIN INDUCED PLATELET AB 86022 300 $96.00 35.48 5.00 76.80 5.75 66.34 19.29 66.34 5.00 53.04 18.92 51.06 5.50 5.00 63.54 16.53 18.37 37.08 46.35 18.83 18.92 18.37 76.80 16.81 5.00 48.13 16.17 39.26 72.00 36.49 42.94 19.01 36915897 POST TRANSFUSION PURPURA 86022 300 "$4,048.00" " 1,496.14 " 5.00 " 3,238.40 " 5.75 " 2,797.17 " 19.29 " 2,797.17 " 5.00 " 2,236.52 " 18.92 51.06 5.50 5.00 " 2,679.37 " 16.53 18.37 37.08 46.35 18.83 18.92 18.37 " 3,238.40 " 16.81 5.00 48.13 16.17 " 1,655.63 " " 3,036.00 " " 1,538.64 " " 1,810.67 " 19.01 36915927 DRUG INDUCED PLATELET AB SCRN 86022 300 "$1,333.00" 492.68 5.00 " 1,066.40 " 5.75 921.10 19.29 921.10 5.00 736.48 18.92 51.06 5.50 5.00 882.31 16.53 18.37 37.08 46.35 18.83 18.92 18.37 " 1,066.40 " 16.81 5.00 48.13 16.17 545.20 999.75 506.67 596.25 19.01 36923636 PLATELET ANTIBODIES ID 86022 300 $220.00 81.31 5.00 176.00 5.75 152.02 19.29 152.02 5.00 121.55 18.92 51.06 5.50 5.00 145.62 16.53 18.37 37.08 46.35 18.83 18.92 18.37 176.00 16.81 5.00 48.13 16.17 89.98 165.00 83.62 98.41 19.01 36932929 PLATELET ANTIBODIES ID 86022 300 $220.00 81.31 5.00 176.00 5.75 152.02 19.29 152.02 5.00 121.55 18.92 51.06 5.50 5.00 145.62 16.53 18.37 37.08 46.35 18.83 18.92 18.37 176.00 16.81 5.00 48.13 16.17 89.98 165.00 83.62 98.41 19.01 36932937 PLATELET ANTIBODIES ID 86022 300 $220.00 81.31 5.00 176.00 5.75 152.02 19.29 152.02 5.00 121.55 18.92 51.06 5.50 5.00 145.62 16.53 18.37 37.08 46.35 18.83 18.92 18.37 176.00 16.81 5.00 48.13 16.17 89.98 165.00 83.62 98.41 19.01 36932945 PLATELET ANTIBODIES ID 86022 300 $220.00 81.31 5.00 176.00 5.75 152.02 19.29 152.02 5.00 121.55 18.92 51.06 5.50 5.00 145.62 16.53 18.37 37.08 46.35 18.83 18.92 18.37 176.00 16.81 5.00 48.13 16.17 89.98 165.00 83.62 98.41 19.01 36934051 SEROTONIN RELEASE-PLATELET AB 86022 300 "$1,975.00" 729.96 5.00 " 1,580.00 " 5.75 " 1,364.73 " 19.29 " 1,364.73 " 5.00 " 1,091.19 " 18.92 51.06 5.50 5.00 " 1,307.25 " 16.53 18.37 37.08 46.35 18.83 18.92 18.37 " 1,580.00 " 16.81 5.00 48.13 16.17 807.78 " 1,481.25 " 750.70 883.42 19.01 36935944 PLATELET CROSSMATCH 86022 300 "$3,246.00" " 1,199.72 " 5.00 " 2,596.80 " 5.75 " 2,242.99 " 19.29 " 2,242.99 " 5.00 " 1,793.42 " 18.92 51.06 5.50 5.00 " 2,148.53 " 16.53 18.37 37.08 46.35 18.83 18.92 18.37 " 2,596.80 " 16.81 5.00 48.13 16.17 " 1,327.61 " " 2,434.50 " " 1,233.80 " " 1,451.94 " 19.01 36942746 PLATELET ANTIBODIES ID 86022 300 $161.00 59.51 5.00 128.80 5.75 111.25 19.29 111.25 5.00 88.95 18.92 51.06 5.50 5.00 106.57 16.53 18.37 37.08 46.35 18.83 18.92 18.37 128.80 16.81 5.00 48.13 16.17 65.85 120.75 61.20 72.02 19.01 36942754 PLATELET ANTIBODIES ID 86022 300 $161.00 59.51 5.00 128.80 5.75 111.25 19.29 111.25 5.00 88.95 18.92 51.06 5.50 5.00 106.57 16.53 18.37 37.08 46.35 18.83 18.92 18.37 128.80 16.81 5.00 48.13 16.17 65.85 120.75 61.20 72.02 19.01 36942762 PLATELET ANTIBODIES ID 86022 300 $161.00 59.51 5.00 128.80 5.75 111.25 19.29 111.25 5.00 88.95 18.92 51.06 5.50 5.00 106.57 16.53 18.37 37.08 46.35 18.83 18.92 18.37 128.80 16.81 5.00 48.13 16.17 65.85 120.75 61.20 72.02 19.01 36942771 PLATELET ANTIBODIES ID 86022 300 $159.00 58.77 5.00 127.20 5.75 109.87 19.29 109.87 5.00 87.85 18.92 51.06 5.50 5.00 105.24 16.53 18.37 37.08 46.35 18.83 18.92 18.37 127.20 16.81 5.00 48.13 16.17 65.03 119.25 60.44 71.12 19.01 36942789 PLATELET ANTIBODIES ID 86022 300 $159.00 58.77 5.00 127.20 5.75 109.87 19.29 109.87 5.00 87.85 18.92 51.06 5.50 5.00 105.24 16.53 18.37 37.08 46.35 18.83 18.92 18.37 127.20 16.81 5.00 48.13 16.17 65.03 119.25 60.44 71.12 19.01 36998661 HEPARIN INDUCED PLT AB 86022 300 $96.00 35.48 5.00 76.80 5.75 66.34 19.29 66.34 5.00 53.04 18.92 51.06 5.50 5.00 63.54 16.53 18.37 37.08 46.35 18.83 18.92 18.37 76.80 16.81 5.00 48.13 16.17 39.26 72.00 36.49 42.94 19.01 36917083 PLATELET ANTIBODY DIRECT 86023 300 $595.00 219.91 10.96 476.00 17.48 411.15 13.08 411.15 15.20 328.74 12.83 34.63 16.72 15.20 393.83 11.21 12.46 49.25 61.56 12.77 12.83 12.46 476.00 11.40 15.20 32.65 10.96 243.36 446.25 226.16 266.14 12.90 36150327 ANTI-NUCLEAR ANTIBODY SCREEN 86038 300 $63.00 23.28 10.64 69.22 17.25 43.53 12.69 43.53 15.00 34.81 12.45 33.63 16.50 15.00 41.70 10.88 12.09 55.38 69.22 12.39 12.45 12.09 50.40 11.06 15.00 31.68 10.64 25.77 47.25 23.95 28.18 12.51 36150335 ANTI-NUCLEAR ANTIBODY TITER 86039 300 $59.00 21.81 9.82 89.89 17.25 40.77 11.72 40.77 15.00 32.60 11.49 31.02 16.50 15.00 39.05 10.04 11.16 71.91 89.89 11.44 11.49 11.16 47.20 10.21 15.00 29.24 9.82 24.13 44.25 22.43 26.39 11.55 35707913 ANTI-STREPTOLYSIN O TITER 86060 300 $38.00 14.04 6.42 58.81 8.05 26.26 7.67 26.26 7.00 21.00 7.52 20.32 7.70 7.00 25.15 6.57 7.30 47.05 58.81 7.48 7.52 7.30 30.40 6.68 7.00 19.13 6.42 15.54 28.50 14.44 17.00 7.56 36940573 ANTISTREPTOLYSIN O TITER 86060 300 $38.00 14.04 6.42 58.81 8.05 26.26 7.67 26.26 7.00 21.00 7.52 20.32 7.70 7.00 25.15 6.57 7.30 47.05 58.81 7.48 7.52 7.30 30.40 6.68 7.00 19.13 6.42 15.54 28.50 14.44 17.00 7.56 35600591 INVSTG TRNSF REACTION 86078 300 $783.00 289.40 41.56 626.40 47.79 541.05 155.56 541.05 41.56 432.61 152.59 108.14 45.72 41.56 518.27 133.34 148.15 209.88 262.35 151.85 152.59 148.15 626.40 135.56 41.56 390.80 130.37 320.25 587.25 297.62 350.24 153.34 35707875 CRP QUANTITATION 86140 300 $27.00 9.98 3.00 29.65 3.45 18.66 5.44 18.66 3.00 14.92 5.34 14.38 3.30 3.00 17.87 4.66 5.18 23.72 29.65 5.31 5.34 5.18 21.60 4.74 3.00 13.57 4.56 11.04 20.25 10.26 12.08 5.36 36982462 C REACTIVE PROTEIN 86140 300 $27.00 9.98 3.00 29.65 3.45 18.66 5.44 18.66 3.00 14.92 5.34 14.38 3.30 3.00 17.87 4.66 5.18 23.72 29.65 5.31 5.34 5.18 21.60 4.74 3.00 13.57 4.56 11.04 20.25 10.26 12.08 5.36 35708243 CRP HIGH SENSITIVITY 86141 300 $68.00 25.13 10.53 101.91 12.11 46.99 13.60 46.99 10.53 37.57 13.34 35.98 11.58 10.53 45.01 11.66 12.95 81.53 101.91 13.27 13.34 12.95 54.40 11.85 10.53 33.93 11.40 27.81 51.00 25.85 30.42 13.40 36150203 BETA-2 GLYCOPROTEIN IGG 86146 300 $134.00 49.53 22.40 200.23 32.35 92.59 26.72 92.59 28.13 74.04 26.21 70.74 30.94 28.13 88.69 22.91 25.45 160.18 200.23 26.09 26.21 25.45 107.20 23.29 28.13 66.68 22.40 54.81 100.50 50.93 59.94 26.34 36150211 BETA-2 GLYCOPROTEIN IGA 86146 300 $134.00 49.53 22.40 200.23 32.35 92.59 26.72 92.59 28.13 74.04 26.21 70.74 30.94 28.13 88.69 22.91 25.45 160.18 200.23 26.09 26.21 25.45 107.20 23.29 28.13 66.68 22.40 54.81 100.50 50.93 59.94 26.34 36150220 BETA-2 GLYCOPROTEIN IGM 86146 300 $134.00 49.53 22.40 200.23 32.35 92.59 26.72 92.59 28.13 74.04 26.21 70.74 30.94 28.13 88.69 22.91 25.45 160.18 200.23 26.09 26.21 25.45 107.20 23.29 28.13 66.68 22.40 54.81 100.50 50.93 59.94 26.34 36982624 BETA 2 GLYCOPROTEIN AB IGG 86146 300 $134.00 49.53 22.40 200.23 32.35 92.59 26.72 92.59 28.13 74.04 26.21 70.74 30.94 28.13 88.69 22.91 25.45 160.18 200.23 26.09 26.21 25.45 107.20 23.29 28.13 66.68 22.40 54.81 100.50 50.93 59.94 26.34 36982632 BETA 2 GLYCOPROTEIN AB IGM 86146 300 $134.00 49.53 22.40 200.23 32.35 92.59 26.72 92.59 28.13 74.04 26.21 70.74 30.94 28.13 88.69 22.91 25.45 160.18 200.23 26.09 26.21 25.45 107.20 23.29 28.13 66.68 22.40 54.81 100.50 50.93 59.94 26.34 36982641 BETA 2 GLYCOPROTEIN AB IGA 86146 300 $134.00 49.53 22.40 200.23 32.35 92.59 26.72 92.59 28.13 74.04 26.21 70.74 30.94 28.13 88.69 22.91 25.45 160.18 200.23 26.09 26.21 25.45 107.20 23.29 28.13 66.68 22.40 54.81 100.50 50.93 59.94 26.34 36982781 BETA-2-GLYCOPROTEIN I AB (IGM) 86146 300 $134.00 49.53 22.40 200.23 32.35 92.59 26.72 92.59 28.13 74.04 26.21 70.74 30.94 28.13 88.69 22.91 25.45 160.18 200.23 26.09 26.21 25.45 107.20 23.29 28.13 66.68 22.40 54.81 100.50 50.93 59.94 26.34 36982799 BETA-2-GLYCOPROTEIN I AB (IGG) 86146 300 $134.00 49.53 22.40 200.23 32.35 92.59 26.72 92.59 28.13 74.04 26.21 70.74 30.94 28.13 88.69 22.91 25.45 160.18 200.23 26.09 26.21 25.45 107.20 23.29 28.13 66.68 22.40 54.81 100.50 50.93 59.94 26.34 36150254 ANTI-CARDIOLIPIN IGG AB 86147 300 $134.00 49.53 22.40 149.03 40.43 92.59 26.72 92.59 35.16 74.04 26.21 70.74 38.68 35.16 88.69 22.91 25.45 119.22 149.03 26.09 26.21 25.45 107.20 23.29 35.16 66.68 22.40 54.81 100.50 50.93 59.94 26.34 36150262 ANTI-CARDIOLIPIN IGA AB 86147 300 $134.00 49.53 22.40 149.03 40.43 92.59 26.72 92.59 35.16 74.04 26.21 70.74 38.68 35.16 88.69 22.91 25.45 119.22 149.03 26.09 26.21 25.45 107.20 23.29 35.16 66.68 22.40 54.81 100.50 50.93 59.94 26.34 36150271 ANTI-CARDIOLIPIN IGM AB 86147 300 $134.00 49.53 22.40 149.03 40.43 92.59 26.72 92.59 35.16 74.04 26.21 70.74 38.68 35.16 88.69 22.91 25.45 119.22 149.03 26.09 26.21 25.45 107.20 23.29 35.16 66.68 22.40 54.81 100.50 50.93 59.94 26.34 36982659 CARDIOLIPIN (PHOSPHOLIP) IGG 86147 300 $134.00 49.53 22.40 149.03 40.43 92.59 26.72 92.59 35.16 74.04 26.21 70.74 38.68 35.16 88.69 22.91 25.45 119.22 149.03 26.09 26.21 25.45 107.20 23.29 35.16 66.68 22.40 54.81 100.50 50.93 59.94 26.34 36982667 CARDIOLIPIN (PHOSPHOLIP) IGM 86147 300 $134.00 49.53 22.40 149.03 40.43 92.59 26.72 92.59 35.16 74.04 26.21 70.74 38.68 35.16 88.69 22.91 25.45 119.22 149.03 26.09 26.21 25.45 107.20 23.29 35.16 66.68 22.40 54.81 100.50 50.93 59.94 26.34 36982675 CARDIOLIPIN (PHOSPHOLIP) IGA 86147 300 $134.00 49.53 22.40 149.03 40.43 92.59 26.72 92.59 35.16 74.04 26.21 70.74 38.68 35.16 88.69 22.91 25.45 119.22 149.03 26.09 26.21 25.45 107.20 23.29 35.16 66.68 22.40 54.81 100.50 50.93 59.94 26.34 36982802 CARDIOLIPIN ANTIBODIES (IGG) 86147 300 $134.00 49.53 22.40 149.03 40.43 92.59 26.72 92.59 35.16 74.04 26.21 70.74 38.68 35.16 88.69 22.91 25.45 119.22 149.03 26.09 26.21 25.45 107.20 23.29 35.16 66.68 22.40 54.81 100.50 50.93 59.94 26.34 36982811 CARDIOLIPIN ANTIBODIES (IGM) 86147 300 $134.00 49.53 22.40 149.03 40.43 92.59 26.72 92.59 35.16 74.04 26.21 70.74 38.68 35.16 88.69 22.91 25.45 119.22 149.03 26.09 26.21 25.45 107.20 23.29 35.16 66.68 22.40 54.81 100.50 50.93 59.94 26.34 36940417 PHOSPHATIDYLSERINE IGA AB 86148 300 $102.00 37.70 - 235.89 - 70.48 16.87 70.48 - 56.36 16.55 44.68 - - 67.51 14.46 16.07 188.71 235.89 16.47 16.55 16.07 81.60 14.70 - 42.10 14.14 41.72 76.50 38.77 45.62 16.63 36940425 PHOSPHATIDYLSERINE IGG AB 86148 300 $106.00 39.18 - 235.89 - 73.25 16.87 73.25 - 58.57 16.55 44.68 - - 70.16 14.46 16.07 188.71 235.89 16.47 16.55 16.07 84.80 14.70 - 42.10 14.14 43.35 79.50 40.29 47.41 16.63 36940433 PHOSPHATIDYLSERINE IGM AB 86148 300 $102.00 37.70 - 235.89 - 70.48 16.87 70.48 - 56.36 16.55 44.68 - - 67.51 14.46 16.07 188.71 235.89 16.47 16.55 16.07 81.60 14.70 - 42.10 14.14 41.72 76.50 38.77 45.62 16.63 36938463 CIRCULATING TUMOR CELLS 86152 300 "$1,676.00" 619.45 - " 1,340.80 " - " 1,158.12 " 263.32 " 1,158.12 " - 925.99 258.30 683.14 - - " 1,109.34 " 225.70 250.78 536.11 670.14 257.05 258.30 250.78 " 1,340.80 " 229.46 - 657.04 220.69 685.48 " 1,257.00 " 637.05 749.67 259.56 36938501 CIRCULATING TUMOR CELLS 86152 300 "$1,676.00" 619.45 - " 1,340.80 " - " 1,158.12 " 263.32 " 1,158.12 " - 925.99 258.30 683.14 - - " 1,109.34 " 225.70 250.78 536.11 670.14 257.05 258.30 250.78 " 1,340.80 " 229.46 - 657.04 220.69 685.48 " 1,257.00 " 637.05 749.67 259.56 36938528 CIRCULATING TUMOR CELLS 86152 300 "$1,994.00" 736.98 - " 1,595.20 " - " 1,377.85 " 263.32 " 1,377.85 " - " 1,101.69 " 258.30 683.14 - - " 1,319.83 " 225.70 250.78 536.11 670.14 257.05 258.30 250.78 " 1,595.20 " 229.46 - 657.04 220.69 815.55 " 1,495.50 " 757.92 891.92 259.56 36938471 INTERP AND REPORT 86153 300 "$1,676.00" 619.45 - " 1,340.80 " - " 1,158.12 " N/A " 1,158.12 " - 925.99 N/A 39.88 - N/A " 1,109.34 " - N/A 888.11 " 1,110.18 " N/A N/A N/A " 1,340.80 " N/A - " 1,122.92 " N/A 685.48 " 1,257.00 " 637.05 749.67 N/A 36938510 INTERP AND REPORT 86153 300 "$1,676.00" 619.45 - " 1,340.80 " - " 1,158.12 " N/A " 1,158.12 " - 925.99 N/A 39.88 - N/A " 1,109.34 " - N/A 888.11 " 1,110.18 " N/A N/A N/A " 1,340.80 " N/A - " 1,122.92 " N/A 685.48 " 1,257.00 " 637.05 749.67 N/A 36938536 INTERP AND REPORT 86153 300 "$1,994.00" 736.98 - " 1,595.20 " - " 1,377.85 " N/A " 1,377.85 " - " 1,101.69 " N/A 39.88 - N/A " 1,319.83 " - N/A " 1,056.62 " " 1,320.83 " N/A N/A N/A " 1,595.20 " N/A - " 1,335.98 " N/A 815.55 " 1,495.50 " 757.92 891.92 N/A 36917270 COLD AGGLUTININS TITER 86157 300 $42.00 15.52 7.09 45.97 12.81 29.02 8.46 29.02 11.14 23.21 8.30 22.42 12.25 11.14 27.80 7.25 8.06 36.78 45.97 8.26 8.30 8.06 33.60 7.37 11.14 21.12 7.09 17.18 31.50 15.96 18.79 8.34 35707824 COMPLEMENT 3 86160 300 $63.00 23.28 10.56 68.84 19.08 43.53 12.60 43.53 16.59 34.81 12.36 33.38 18.25 16.59 41.70 10.80 12.00 55.07 68.84 12.30 12.36 12.00 50.40 10.98 16.59 31.44 10.56 25.77 47.25 23.95 28.18 12.42 35707832 COMPLEMENT 4 86160 300 $63.00 23.28 10.56 68.84 19.08 43.53 12.60 43.53 16.59 34.81 12.36 33.38 18.25 16.59 41.70 10.80 12.00 55.07 68.84 12.30 12.36 12.00 50.40 10.98 16.59 31.44 10.56 25.77 47.25 23.95 28.18 12.42 36900865 C1 ESTERASE INHIB 86160 300 $262.00 96.84 10.56 209.60 19.08 181.04 12.60 181.04 16.59 144.76 12.36 33.38 18.25 16.59 173.42 10.80 12.00 55.07 68.84 12.30 12.36 12.00 209.60 10.98 16.59 31.44 10.56 107.16 196.50 99.59 117.19 12.42 36903783 COMPLEMENT C5 86160 300 $161.00 59.51 10.56 128.80 19.08 111.25 12.60 111.25 16.59 88.95 12.36 33.38 18.25 16.59 106.57 10.80 12.00 55.07 68.84 12.30 12.36 12.00 128.80 10.98 16.59 31.44 10.56 65.85 120.75 61.20 72.02 12.42 36924861 COMPLEMENT AG C2 COMPONENT 86160 300 "$1,120.00" 413.95 10.56 896.00 19.08 773.92 12.60 773.92 16.59 618.80 12.36 33.38 18.25 16.59 741.33 10.80 12.00 55.07 68.84 12.30 12.36 12.00 896.00 10.98 16.59 31.44 10.56 458.08 840.00 425.71 500.98 12.42 36904593 C1 ESTERASE INHIBITOR FUNCTION 86161 300 $229.00 84.64 10.56 183.20 19.08 158.24 12.60 158.24 16.59 126.52 12.36 33.38 18.25 16.59 151.58 10.80 12.00 77.42 96.78 12.30 12.36 12.00 183.20 10.98 16.59 31.44 10.56 93.66 171.75 87.04 102.43 12.42 36931388 MBL PATHWAY FUNCTION 86161 300 $790.00 291.98 10.56 632.00 19.08 545.89 12.60 545.89 16.59 436.48 12.36 33.38 18.25 16.59 522.90 10.80 12.00 77.42 96.78 12.30 12.36 12.00 632.00 10.98 16.59 31.44 10.56 323.11 592.50 300.28 353.37 12.42 36944439 COMP ALT PATH AH50 FUNC SERUM 86161 300 $404.00 149.32 10.56 323.20 19.08 279.16 12.60 279.16 16.59 223.21 12.36 33.38 18.25 16.59 267.41 10.80 12.00 77.42 96.78 12.30 12.36 12.00 323.20 10.98 16.59 31.44 10.56 165.24 303.00 153.56 180.71 12.42 36923687 COMPLEMENT ANTIGEN CH54 86162 300 $322.00 119.01 17.88 257.60 23.00 222.50 21.34 222.50 20.00 177.91 20.93 56.49 22.00 20.00 213.13 18.29 20.32 93.12 116.40 20.83 20.93 20.32 257.60 18.59 20.00 53.24 17.88 131.70 241.50 122.39 144.03 21.03 36101261 CYCLIC CITRULLINATED PEPTID AB 86200 300 $68.00 25.13 11.40 99.70 16.64 46.99 13.60 46.99 14.47 37.57 13.34 35.98 15.92 14.47 45.01 11.66 12.95 79.76 99.70 13.27 13.34 12.95 54.40 11.85 14.47 33.93 11.40 27.81 51.00 25.85 30.42 13.40 36903678 ANTI-STREP DNASE B 86215 300 $184.00 68.01 11.66 147.20 16.68 127.14 13.91 127.14 14.50 101.66 13.65 36.83 15.95 14.50 121.79 11.93 13.25 85.45 106.81 13.58 13.65 13.25 147.20 12.12 14.50 34.72 11.66 75.26 138.00 69.94 82.30 13.71 36100087 DNA ANTIBODY DOUBLE STRANDED 86225 300 $72.00 26.61 12.09 78.76 16.68 49.75 14.43 49.75 14.50 39.78 14.15 38.18 15.95 14.50 47.66 12.37 13.74 63.01 78.76 14.08 14.15 13.74 57.60 12.57 14.50 36.00 12.09 29.45 54.00 27.37 32.21 14.22 36909641 SINGLE STRANDED DNA ANTIBODIES 86226 300 $622.00 229.89 10.66 497.60 19.24 429.80 12.72 429.80 16.73 343.66 12.47 33.66 18.40 16.73 411.70 10.90 12.11 55.51 69.39 12.41 12.47 12.11 497.60 11.08 16.73 31.73 10.66 254.40 466.50 236.42 278.22 12.53 36100729 JO1 ANTIBODY 86235 300 $94.00 34.74 15.78 102.79 20.70 64.95 18.83 64.95 18.00 51.94 18.47 49.86 19.80 18.00 62.22 16.14 17.93 82.23 102.79 18.38 18.47 17.93 75.20 16.41 18.00 46.98 15.78 38.45 70.50 35.73 42.05 18.56 36100737 SCL70 AB 86235 300 $94.00 34.74 15.78 102.79 20.70 64.95 18.83 64.95 18.00 51.94 18.47 49.86 19.80 18.00 62.22 16.14 17.93 82.23 102.79 18.38 18.47 17.93 75.20 16.41 18.00 46.98 15.78 38.45 70.50 35.73 42.05 18.56 36104368 RNP ANTIBODY 86235 300 $94.00 34.74 15.78 102.79 20.70 64.95 18.83 64.95 18.00 51.94 18.47 49.86 19.80 18.00 62.22 16.14 17.93 82.23 102.79 18.38 18.47 17.93 75.20 16.41 18.00 46.98 15.78 38.45 70.50 35.73 42.05 18.56 36104376 SM ANTIBODY 86235 300 $94.00 34.74 15.78 102.79 20.70 64.95 18.83 64.95 18.00 51.94 18.47 49.86 19.80 18.00 62.22 16.14 17.93 82.23 102.79 18.38 18.47 17.93 75.20 16.41 18.00 46.98 15.78 38.45 70.50 35.73 42.05 18.56 36110384 SSA - EXP 86235 300 $94.00 34.74 15.78 102.79 20.70 64.95 18.83 64.95 18.00 51.94 18.47 49.86 19.80 18.00 62.22 16.14 17.93 82.23 102.79 18.38 18.47 17.93 75.20 16.41 18.00 46.98 15.78 38.45 70.50 35.73 42.05 18.56 36110392 SSB - EXP 86235 300 $94.00 34.74 15.78 102.79 20.70 64.95 18.83 64.95 18.00 51.94 18.47 49.86 19.80 18.00 62.22 16.14 17.93 82.23 102.79 18.38 18.47 17.93 75.20 16.41 18.00 46.98 15.78 38.45 70.50 35.73 42.05 18.56 36910925 POLYMYOSITIS AB 86235 300 $430.00 158.93 15.78 344.00 20.70 297.13 18.83 297.13 18.00 237.58 18.47 49.86 19.80 18.00 284.62 16.14 17.93 82.23 102.79 18.38 18.47 17.93 344.00 16.41 18.00 46.98 15.78 175.87 322.50 163.44 192.34 18.56 36914432 SCL-70 ANTIBODY 86235 300 $299.00 110.51 15.78 239.20 20.70 206.61 18.83 206.61 18.00 165.20 18.47 49.86 19.80 18.00 197.91 16.14 17.93 82.23 102.79 18.38 18.47 17.93 239.20 16.41 18.00 46.98 15.78 122.29 224.25 113.65 133.74 18.56 36914441 JO-1 ANTIBODY 86235 300 $239.00 88.33 15.78 191.20 20.70 165.15 18.83 165.15 18.00 132.05 18.47 49.86 19.80 18.00 158.19 16.14 17.93 82.23 102.79 18.38 18.47 17.93 191.20 16.41 18.00 46.98 15.78 97.75 179.25 90.84 106.90 18.56 36914823 JO1 AUTOANTIBODIES 86235 300 $233.00 86.12 15.78 186.40 20.70 161.00 18.83 161.00 18.00 128.73 18.47 49.86 19.80 18.00 154.22 16.14 17.93 82.23 102.79 18.38 18.47 17.93 186.40 16.41 18.00 46.98 15.78 95.30 174.75 88.56 104.22 18.56 36914831 KU AUTOANTIBODIES 86235 300 $233.00 86.12 15.78 186.40 20.70 161.00 18.83 161.00 18.00 128.73 18.47 49.86 19.80 18.00 154.22 16.14 17.93 82.23 102.79 18.38 18.47 17.93 186.40 16.41 18.00 46.98 15.78 95.30 174.75 88.56 104.22 18.56 36914840 MI-2 AUTOANTIBODIES 86235 300 $233.00 86.12 15.78 186.40 20.70 161.00 18.83 161.00 18.00 128.73 18.47 49.86 19.80 18.00 154.22 16.14 17.93 82.23 102.79 18.38 18.47 17.93 186.40 16.41 18.00 46.98 15.78 95.30 174.75 88.56 104.22 18.56 36914858 PM-SCL AUTOANTIBODIES 86235 300 $233.00 86.12 15.78 186.40 20.70 161.00 18.83 161.00 18.00 128.73 18.47 49.86 19.80 18.00 154.22 16.14 17.93 82.23 102.79 18.38 18.47 17.93 186.40 16.41 18.00 46.98 15.78 95.30 174.75 88.56 104.22 18.56 36914866 SRP AUTOANTIBODIES 86235 300 $233.00 86.12 15.78 186.40 20.70 161.00 18.83 161.00 18.00 128.73 18.47 49.86 19.80 18.00 154.22 16.14 17.93 82.23 102.79 18.38 18.47 17.93 186.40 16.41 18.00 46.98 15.78 95.30 174.75 88.56 104.22 18.56 36914874 U1-RNP AUTOANTIBODIES 86235 300 $233.00 86.12 15.78 186.40 20.70 161.00 18.83 161.00 18.00 128.73 18.47 49.86 19.80 18.00 154.22 16.14 17.93 82.23 102.79 18.38 18.47 17.93 186.40 16.41 18.00 46.98 15.78 95.30 174.75 88.56 104.22 18.56 36914882 P17 AUTOANTIBODIES 86235 300 $233.00 86.12 15.78 186.40 20.70 161.00 18.83 161.00 18.00 128.73 18.47 49.86 19.80 18.00 154.22 16.14 17.93 82.23 102.79 18.38 18.47 17.93 186.40 16.41 18.00 46.98 15.78 95.30 174.75 88.56 104.22 18.56 36914891 PI-12 AUTOANTIBODIES 86235 300 $233.00 86.12 15.78 186.40 20.70 161.00 18.83 161.00 18.00 128.73 18.47 49.86 19.80 18.00 154.22 16.14 17.93 82.23 102.79 18.38 18.47 17.93 186.40 16.41 18.00 46.98 15.78 95.30 174.75 88.56 104.22 18.56 36914904 EJ AUTOANTIBODIES 86235 300 $233.00 86.12 15.78 186.40 20.70 161.00 18.83 161.00 18.00 128.73 18.47 49.86 19.80 18.00 154.22 16.14 17.93 82.23 102.79 18.38 18.47 17.93 186.40 16.41 18.00 46.98 15.78 95.30 174.75 88.56 104.22 18.56 36914912 OJ AUTOANTIBODIES 86235 300 $233.00 86.12 15.78 186.40 20.70 161.00 18.83 161.00 18.00 128.73 18.47 49.86 19.80 18.00 154.22 16.14 17.93 82.23 102.79 18.38 18.47 17.93 186.40 16.41 18.00 46.98 15.78 95.30 174.75 88.56 104.22 18.56 36936274 NUCLEAR ANTIGEN ANTIBODY 86235 300 $321.00 118.64 15.78 256.80 20.70 221.81 18.83 221.81 18.00 177.35 18.47 49.86 19.80 18.00 212.47 16.14 17.93 82.23 102.79 18.38 18.47 17.93 256.80 16.41 18.00 46.98 15.78 131.29 240.75 122.01 143.58 18.56 36936282 NUCLEAR ANTIGEN ANTIBODY 86235 300 $321.00 118.64 15.78 256.80 20.70 221.81 18.83 221.81 18.00 177.35 18.47 49.86 19.80 18.00 212.47 16.14 17.93 82.23 102.79 18.38 18.47 17.93 256.80 16.41 18.00 46.98 15.78 131.29 240.75 122.01 143.58 18.56 36939192 CHROMATIN (NUCLEOSOMAL) AB 86235 300 $343.00 126.77 15.78 274.40 20.70 237.01 18.83 237.01 18.00 189.51 18.47 49.86 19.80 18.00 227.03 16.14 17.93 82.23 102.79 18.38 18.47 17.93 274.40 16.41 18.00 46.98 15.78 140.29 257.25 130.37 153.42 18.56 36100761 ANIT-CENTROMERE AB SCREEN 86255 300 $63.00 23.28 10.60 69.06 18.91 43.53 12.65 43.53 16.44 34.81 12.41 33.50 18.08 16.44 41.70 10.85 12.05 55.25 69.06 12.35 12.41 12.05 50.40 11.03 16.44 31.57 10.60 25.77 47.25 23.95 28.18 12.47 36103701 ANCA SCREEN IFA 86255 300 $63.00 23.28 10.60 69.06 18.91 43.53 12.65 43.53 16.44 34.81 12.41 33.50 18.08 16.44 41.70 10.85 12.05 55.25 69.06 12.35 12.41 12.05 50.40 11.03 16.44 31.57 10.60 25.77 47.25 23.95 28.18 12.47 36900857 ANTI-STRIATED MUSCLE AB W RFLX 86255 300 $290.00 107.18 10.60 232.00 18.91 200.39 12.65 200.39 16.44 160.23 12.41 33.50 18.08 16.44 191.95 10.85 12.05 55.25 69.06 12.35 12.41 12.05 232.00 11.03 16.44 31.57 10.60 118.61 217.50 110.23 129.72 12.47 36909625 NEURONAL (HU) AB SCREEN 86255 300 $560.00 206.98 10.60 448.00 18.91 386.96 12.65 386.96 16.44 309.40 12.41 33.50 18.08 16.44 370.66 10.85 12.05 55.25 69.06 12.35 12.41 12.05 448.00 11.03 16.44 31.57 10.60 229.04 420.00 212.86 250.49 12.47 36910445 ADRENAL AB WITH REFLEX 86255 300 $317.00 117.16 10.60 253.60 18.91 219.05 12.65 219.05 16.44 175.14 12.41 33.50 18.08 16.44 209.82 10.85 12.05 55.25 69.06 12.35 12.41 12.05 253.60 11.03 16.44 31.57 10.60 129.65 237.75 120.49 141.79 12.47 36933356 NEURONAL AB (HU) FLUOR 86255 300 $576.00 212.89 10.60 460.80 18.91 398.02 12.65 398.02 16.44 318.24 12.41 33.50 18.08 16.44 381.25 10.85 12.05 55.25 69.06 12.35 12.41 12.05 460.80 11.03 16.44 31.57 10.60 235.58 432.00 218.94 257.64 12.47 36933381 NR1 IMMUNO FLUO AB 86255 300 $931.00 344.10 10.60 744.80 18.91 643.32 12.65 643.32 16.44 514.38 12.41 33.50 18.08 16.44 616.23 10.85 12.05 55.25 69.06 12.35 12.41 12.05 744.80 11.03 16.44 31.57 10.60 380.78 698.25 353.87 416.44 12.47 36933470 FLUORESCENT NON INF AB SCRN EA 86255 300 "$1,850.00" 683.76 10.60 " 1,480.00 " 18.91 " 1,278.35 " 12.65 " 1,278.35 " 16.44 " 1,022.13 " 12.41 33.50 18.08 16.44 " 1,224.52 " 10.85 12.05 55.25 69.06 12.35 12.41 12.05 " 1,480.00 " 11.03 16.44 31.57 10.60 756.65 " 1,387.50 " 703.19 827.51 12.47 36933577 ANTI HU CSF FLUOR NON INF AB 86255 300 $427.00 157.82 10.60 341.60 18.91 295.06 12.65 295.06 16.44 235.92 12.41 33.50 18.08 16.44 282.63 10.85 12.05 55.25 69.06 12.35 12.41 12.05 341.60 11.03 16.44 31.57 10.60 174.64 320.25 162.30 191.00 12.47 36933585 NEURONAL NUCLEAR AB FLUOR EA 86255 300 $752.00 277.94 10.60 601.60 18.91 519.63 12.65 519.63 16.44 415.48 12.41 33.50 18.08 16.44 497.75 10.85 12.05 55.25 69.06 12.35 12.41 12.05 601.60 11.03 16.44 31.57 10.60 307.57 564.00 285.84 336.37 12.47 36937131 ANTI SKIN AB 86255 300 $506.00 187.02 10.60 404.80 18.91 349.65 12.65 349.65 16.44 279.57 12.41 33.50 18.08 16.44 334.92 10.85 12.05 55.25 69.06 12.35 12.41 12.05 404.80 11.03 16.44 31.57 10.60 206.95 379.50 192.33 226.33 12.47 36937505 FLUORESCENT AB SCREEN 86255 300 "$1,156.00" 427.26 10.60 924.80 18.91 798.80 12.65 798.80 16.44 638.69 12.41 33.50 18.08 16.44 765.16 10.85 12.05 55.25 69.06 12.35 12.41 12.05 924.80 11.03 16.44 31.57 10.60 472.80 867.00 439.40 517.08 12.47 36937513 FLUORESCENT AB SCREEN 86255 300 "$1,156.00" 427.26 10.60 924.80 18.91 798.80 12.65 798.80 16.44 638.69 12.41 33.50 18.08 16.44 765.16 10.85 12.05 55.25 69.06 12.35 12.41 12.05 924.80 11.03 16.44 31.57 10.60 472.80 867.00 439.40 517.08 12.47 36937521 FLUORESCENT AB SCREEN 86255 300 "$1,156.00" 427.26 10.60 924.80 18.91 798.80 12.65 798.80 16.44 638.69 12.41 33.50 18.08 16.44 765.16 10.85 12.05 55.25 69.06 12.35 12.41 12.05 924.80 11.03 16.44 31.57 10.60 472.80 867.00 439.40 517.08 12.47 36937581 FLUORESCENT NON INF AB SCRN EA 86255 300 "$1,850.00" 683.76 10.60 " 1,480.00 " 18.91 " 1,278.35 " 12.65 " 1,278.35 " 16.44 " 1,022.13 " 12.41 33.50 18.08 16.44 " 1,224.52 " 10.85 12.05 55.25 69.06 12.35 12.41 12.05 " 1,480.00 " 11.03 16.44 31.57 10.60 756.65 " 1,387.50 " 703.19 827.51 12.47 36937599 FLUORESCENT NON INF AB SCRN EA 86255 300 "$1,850.00" 683.76 10.60 " 1,480.00 " 18.91 " 1,278.35 " 12.65 " 1,278.35 " 16.44 " 1,022.13 " 12.41 33.50 18.08 16.44 " 1,224.52 " 10.85 12.05 55.25 69.06 12.35 12.41 12.05 " 1,480.00 " 11.03 16.44 31.57 10.60 756.65 " 1,387.50 " 703.19 827.51 12.47 36938269 NEUROMYELITIS OPTICA FLUOR 86255 300 "$2,464.00" 910.69 10.60 " 1,971.20 " 18.91 " 1,702.62 " 12.65 " 1,702.62 " 16.44 " 1,361.36 " 12.41 33.50 18.08 16.44 " 1,630.92 " 10.85 12.05 55.25 69.06 12.35 12.41 12.05 " 1,971.20 " 11.03 16.44 31.57 10.60 " 1,007.78 " " 1,848.00 " 936.57 " 1,102.15 " 12.47 36938404 NMDA RECEPTOR AB FLUOR 86255 300 "$2,074.00" 766.55 10.60 " 1,659.20 " 18.91 " 1,433.13 " 12.65 " 1,433.13 " 16.44 " 1,145.89 " 12.41 33.50 18.08 16.44 " 1,372.78 " 10.85 12.05 55.25 69.06 12.35 12.41 12.05 " 1,659.20 " 11.03 16.44 31.57 10.60 848.27 " 1,555.50 " 788.33 927.70 12.47 36938412 AMPA RECEPTOR AB FLUOR 86255 300 "$2,074.00" 766.55 10.60 " 1,659.20 " 18.91 " 1,433.13 " 12.65 " 1,433.13 " 16.44 " 1,145.89 " 12.41 33.50 18.08 16.44 " 1,372.78 " 10.85 12.05 55.25 69.06 12.35 12.41 12.05 " 1,659.20 " 11.03 16.44 31.57 10.60 848.27 " 1,555.50 " 788.33 927.70 12.47 36938498 GABA-B RECEPT AB FLOUR NONINF 86255 300 "$2,074.00" 766.55 10.60 " 1,659.20 " 18.91 " 1,433.13 " 12.65 " 1,433.13 " 16.44 " 1,145.89 " 12.41 33.50 18.08 16.44 " 1,372.78 " 10.85 12.05 55.25 69.06 12.35 12.41 12.05 " 1,659.20 " 11.03 16.44 31.57 10.60 848.27 " 1,555.50 " 788.33 927.70 12.47 36939354 FLUORESCENT NONINFECT AGENT AB 86255 300 $899.00 332.27 10.60 719.20 18.91 621.21 12.65 621.21 16.44 496.70 12.41 33.50 18.08 16.44 595.05 10.85 12.05 55.25 69.06 12.35 12.41 12.05 719.20 11.03 16.44 31.57 10.60 367.69 674.25 341.71 402.12 12.47 36939362 FLUORESCENT NONINFECT AGENT AB 86255 300 $899.00 332.27 10.60 719.20 18.91 621.21 12.65 621.21 16.44 496.70 12.41 33.50 18.08 16.44 595.05 10.85 12.05 55.25 69.06 12.35 12.41 12.05 719.20 11.03 16.44 31.57 10.60 367.69 674.25 341.71 402.12 12.47 36939371 FLUORESCENT NONINFECT AGENT AB 86255 300 $899.00 332.27 10.60 719.20 18.91 621.21 12.65 621.21 16.44 496.70 12.41 33.50 18.08 16.44 595.05 10.85 12.05 55.25 69.06 12.35 12.41 12.05 719.20 11.03 16.44 31.57 10.60 367.69 674.25 341.71 402.12 12.47 36939524 FLUORESCENT NONINFECT AGENT AB 86255 300 $550.00 203.28 10.60 440.00 18.91 380.05 12.65 380.05 16.44 303.88 12.41 33.50 18.08 16.44 364.05 10.85 12.05 55.25 69.06 12.35 12.41 12.05 440.00 11.03 16.44 31.57 10.60 224.95 412.50 209.06 246.02 12.47 36939532 FLUORESCENT NONINFECT AGENT AB 86255 300 $550.00 203.28 10.60 440.00 18.91 380.05 12.65 380.05 16.44 303.88 12.41 33.50 18.08 16.44 364.05 10.85 12.05 55.25 69.06 12.35 12.41 12.05 440.00 11.03 16.44 31.57 10.60 224.95 412.50 209.06 246.02 12.47 36939541 FLUORESCENT NONINFECT AGENT AB 86255 300 $550.00 203.28 10.60 440.00 18.91 380.05 12.65 380.05 16.44 303.88 12.41 33.50 18.08 16.44 364.05 10.85 12.05 55.25 69.06 12.35 12.41 12.05 440.00 11.03 16.44 31.57 10.60 224.95 412.50 209.06 246.02 12.47 36939729 FLUORESCENT NONINFECT AGENT AB 86255 300 $573.00 211.78 10.60 458.40 18.91 395.94 12.65 395.94 16.44 316.58 12.41 33.50 18.08 16.44 379.27 10.85 12.05 55.25 69.06 12.35 12.41 12.05 458.40 11.03 16.44 31.57 10.60 234.36 429.75 217.80 256.30 12.47 36939737 FLUORESCENT NONINFECT AGENT AB 86255 300 $573.00 211.78 10.60 458.40 18.91 395.94 12.65 395.94 16.44 316.58 12.41 33.50 18.08 16.44 379.27 10.85 12.05 55.25 69.06 12.35 12.41 12.05 458.40 11.03 16.44 31.57 10.60 234.36 429.75 217.80 256.30 12.47 36939745 FLUORESCENT NONINFECT AGENT AB 86255 300 $573.00 211.78 10.60 458.40 18.91 395.94 12.65 395.94 16.44 316.58 12.41 33.50 18.08 16.44 379.27 10.85 12.05 55.25 69.06 12.35 12.41 12.05 458.40 11.03 16.44 31.57 10.60 234.36 429.75 217.80 256.30 12.47 36939907 NMDA RECEPTOR AB 86255 300 "$3,389.00" " 1,252.57 " 10.60 " 2,711.20 " 18.91 " 2,341.80 " 12.65 " 2,341.80 " 16.44 " 1,872.42 " 12.41 33.50 18.08 16.44 " 2,243.18 " 10.85 12.05 55.25 69.06 12.35 12.41 12.05 " 2,711.20 " 11.03 16.44 31.57 10.60 " 1,386.10 " " 2,541.75 " " 1,288.16 " " 1,515.90 " 12.47 36940018 CASPR2 FLUORESCENT AB SCRN 86255 300 "$3,221.00" " 1,190.48 " 10.60 " 2,576.80 " 18.91 " 2,225.71 " 12.65 " 2,225.71 " 16.44 " 1,779.60 " 12.41 33.50 18.08 16.44 " 2,131.98 " 10.85 12.05 55.25 69.06 12.35 12.41 12.05 " 2,576.80 " 11.03 16.44 31.57 10.60 " 1,317.39 " " 2,415.75 " " 1,224.30 " " 1,440.75 " 12.47 36940026 LGI1 FLUORESCENT AB SCRN 86255 300 "$3,290.00" " 1,215.98 " 10.60 " 2,632.00 " 18.91 " 2,273.39 " 12.65 " 2,273.39 " 16.44 " 1,817.73 " 12.41 33.50 18.08 16.44 " 2,177.65 " 10.85 12.05 55.25 69.06 12.35 12.41 12.05 " 2,632.00 " 11.03 16.44 31.57 10.60 " 1,345.61 " " 2,467.50 " " 1,250.53 " " 1,471.62 " 12.47 36940174 FLUORESCENT AB SCREEN 86255 300 "$2,583.00" 954.68 10.60 " 2,066.40 " 18.91 " 1,784.85 " 12.65 " 1,784.85 " 16.44 " 1,427.11 " 12.41 33.50 18.08 16.44 " 1,709.69 " 10.85 12.05 55.25 69.06 12.35 12.41 12.05 " 2,066.40 " 11.03 16.44 31.57 10.60 " 1,056.45 " " 1,937.25 " 981.80 " 1,155.38 " 12.47 36940395 ENDOMYSIAL IGA FLUOR AB SCRN 86255 300 $253.00 93.51 10.60 202.40 18.91 174.82 12.65 174.82 16.44 139.78 12.41 33.50 18.08 16.44 167.46 10.85 12.05 55.25 69.06 12.35 12.41 12.05 202.40 11.03 16.44 31.57 10.60 103.48 189.75 96.17 113.17 12.47 36941651 FLUORESCENT AB SCREEN 86255 300 $278.00 102.75 10.60 222.40 18.91 192.10 12.65 192.10 16.44 153.60 12.41 33.50 18.08 16.44 184.01 10.85 12.05 55.25 69.06 12.35 12.41 12.05 222.40 11.03 16.44 31.57 10.60 113.70 208.50 105.67 124.35 12.47 36941669 FLUORESCENT AB SCREEN 86255 300 $278.00 102.75 10.60 222.40 18.91 192.10 12.65 192.10 16.44 153.60 12.41 33.50 18.08 16.44 184.01 10.85 12.05 55.25 69.06 12.35 12.41 12.05 222.40 11.03 16.44 31.57 10.60 113.70 208.50 105.67 124.35 12.47 36941677 FLUORESCENT AB SCREEN 86255 300 $278.00 102.75 10.60 222.40 18.91 192.10 12.65 192.10 16.44 153.60 12.41 33.50 18.08 16.44 184.01 10.85 12.05 55.25 69.06 12.35 12.41 12.05 222.40 11.03 16.44 31.57 10.60 113.70 208.50 105.67 124.35 12.47 36941685 FLUORESCENT AB SCREEN 86255 300 $278.00 102.75 10.60 222.40 18.91 192.10 12.65 192.10 16.44 153.60 12.41 33.50 18.08 16.44 184.01 10.85 12.05 55.25 69.06 12.35 12.41 12.05 222.40 11.03 16.44 31.57 10.60 113.70 208.50 105.67 124.35 12.47 36941693 FLUORESCENT AB SCREEN 86255 300 $278.00 102.75 10.60 222.40 18.91 192.10 12.65 192.10 16.44 153.60 12.41 33.50 18.08 16.44 184.01 10.85 12.05 55.25 69.06 12.35 12.41 12.05 222.40 11.03 16.44 31.57 10.60 113.70 208.50 105.67 124.35 12.47 36941707 FLUORESCENT AB SCREEN 86255 300 $278.00 102.75 10.60 222.40 18.91 192.10 12.65 192.10 16.44 153.60 12.41 33.50 18.08 16.44 184.01 10.85 12.05 55.25 69.06 12.35 12.41 12.05 222.40 11.03 16.44 31.57 10.60 113.70 208.50 105.67 124.35 12.47 36941715 FLUORESCENT AB SCREEN 86255 300 $278.00 102.75 10.60 222.40 18.91 192.10 12.65 192.10 16.44 153.60 12.41 33.50 18.08 16.44 184.01 10.85 12.05 55.25 69.06 12.35 12.41 12.05 222.40 11.03 16.44 31.57 10.60 113.70 208.50 105.67 124.35 12.47 36941723 FLUORESCENT AB SCREEN 86255 300 $278.00 102.75 10.60 222.40 18.91 192.10 12.65 192.10 16.44 153.60 12.41 33.50 18.08 16.44 184.01 10.85 12.05 55.25 69.06 12.35 12.41 12.05 222.40 11.03 16.44 31.57 10.60 113.70 208.50 105.67 124.35 12.47 36941731 FLUORESCENT AB SCREEN 86255 300 $278.00 102.75 10.60 222.40 18.91 192.10 12.65 192.10 16.44 153.60 12.41 33.50 18.08 16.44 184.01 10.85 12.05 55.25 69.06 12.35 12.41 12.05 222.40 11.03 16.44 31.57 10.60 113.70 208.50 105.67 124.35 12.47 36941740 FLUORESCENT AB SCREEN 86255 300 $278.00 102.75 10.60 222.40 18.91 192.10 12.65 192.10 16.44 153.60 12.41 33.50 18.08 16.44 184.01 10.85 12.05 55.25 69.06 12.35 12.41 12.05 222.40 11.03 16.44 31.57 10.60 113.70 208.50 105.67 124.35 12.47 36941863 AQUAPORIN-4 AB CBA 86255 300 "$2,343.00" 865.97 10.60 " 1,874.40 " 18.91 " 1,619.01 " 12.65 " 1,619.01 " 16.44 " 1,294.51 " 12.41 33.50 18.08 16.44 " 1,550.83 " 10.85 12.05 55.25 69.06 12.35 12.41 12.05 " 1,874.40 " 11.03 16.44 31.57 10.60 958.29 " 1,757.25 " 890.57 " 1,048.02 " 12.47 36941871 FLUORESCENT AB SCREEN 86255 300 "$1,740.00" 643.10 10.60 " 1,392.00 " 18.91 " 1,202.34 " 12.65 " 1,202.34 " 16.44 961.35 12.41 33.50 18.08 16.44 " 1,151.71 " 10.85 12.05 55.25 69.06 12.35 12.41 12.05 " 1,392.00 " 11.03 16.44 31.57 10.60 711.66 " 1,305.00 " 661.37 778.30 12.47 36941880 FLUORESCENT AB SCREEN 86255 300 "$1,740.00" 643.10 10.60 " 1,392.00 " 18.91 " 1,202.34 " 12.65 " 1,202.34 " 16.44 961.35 12.41 33.50 18.08 16.44 " 1,151.71 " 10.85 12.05 55.25 69.06 12.35 12.41 12.05 " 1,392.00 " 11.03 16.44 31.57 10.60 711.66 " 1,305.00 " 661.37 778.30 12.47 36941898 FLUORESCENT AB SCREEN 86255 300 "$1,740.00" 643.10 10.60 " 1,392.00 " 18.91 " 1,202.34 " 12.65 " 1,202.34 " 16.44 961.35 12.41 33.50 18.08 16.44 " 1,151.71 " 10.85 12.05 55.25 69.06 12.35 12.41 12.05 " 1,392.00 " 11.03 16.44 31.57 10.60 711.66 " 1,305.00 " 661.37 778.30 12.47 36941901 FLUORESCENT AB SCREEN 86255 300 "$1,741.00" 643.47 10.60 " 1,392.80 " 18.91 " 1,203.03 " 12.65 " 1,203.03 " 16.44 961.90 12.41 33.50 18.08 16.44 " 1,152.37 " 10.85 12.05 55.25 69.06 12.35 12.41 12.05 " 1,392.80 " 11.03 16.44 31.57 10.60 712.07 " 1,305.75 " 661.75 778.75 12.47 36942878 NMO AQP4 IGG CSF FLUOR AB SCRN 86255 300 "$2,383.00" 880.76 10.60 " 1,906.40 " 18.91 " 1,646.65 " 12.65 " 1,646.65 " 16.44 " 1,316.61 " 12.41 33.50 18.08 16.44 " 1,577.31 " 10.85 12.05 55.25 69.06 12.35 12.41 12.05 " 1,906.40 " 11.03 16.44 31.57 10.60 974.65 " 1,787.25 " 905.78 " 1,065.92 " 12.47 36942983 FLUOR NONINFECT AGENT AB 86255 300 $551.00 203.65 10.60 440.80 18.91 380.74 12.65 380.74 16.44 304.43 12.41 33.50 18.08 16.44 364.71 10.85 12.05 55.25 69.06 12.35 12.41 12.05 440.80 11.03 16.44 31.57 10.60 225.36 413.25 209.44 246.46 12.47 36942991 FLUOR NONINFECT AGENT AB 86255 300 $551.00 203.65 10.60 440.80 18.91 380.74 12.65 380.74 16.44 304.43 12.41 33.50 18.08 16.44 364.71 10.85 12.05 55.25 69.06 12.35 12.41 12.05 440.80 11.03 16.44 31.57 10.60 225.36 413.25 209.44 246.46 12.47 36943009 FLUOR NONINFECT AGENT AB 86255 300 $551.00 203.65 10.60 440.80 18.91 380.74 12.65 380.74 16.44 304.43 12.41 33.50 18.08 16.44 364.71 10.85 12.05 55.25 69.06 12.35 12.41 12.05 440.80 11.03 16.44 31.57 10.60 225.36 413.25 209.44 246.46 12.47 36943017 FLUOR NONINFECT AGENT AB 86255 300 $551.00 203.65 10.60 440.80 18.91 380.74 12.65 380.74 16.44 304.43 12.41 33.50 18.08 16.44 364.71 10.85 12.05 55.25 69.06 12.35 12.41 12.05 440.80 11.03 16.44 31.57 10.60 225.36 413.25 209.44 246.46 12.47 36943025 FLUOR NONINFECT AGENT AB 86255 300 $551.00 203.65 10.60 440.80 18.91 380.74 12.65 380.74 16.44 304.43 12.41 33.50 18.08 16.44 364.71 10.85 12.05 55.25 69.06 12.35 12.41 12.05 440.80 11.03 16.44 31.57 10.60 225.36 413.25 209.44 246.46 12.47 36943033 FLUOR NONINFECT AGENT AB 86255 300 $551.00 203.65 10.60 440.80 18.91 380.74 12.65 380.74 16.44 304.43 12.41 33.50 18.08 16.44 364.71 10.85 12.05 55.25 69.06 12.35 12.41 12.05 440.80 11.03 16.44 31.57 10.60 225.36 413.25 209.44 246.46 12.47 36943041 FLUOR NONINFECT AGENT AB 86255 300 $551.00 203.65 10.60 440.80 18.91 380.74 12.65 380.74 16.44 304.43 12.41 33.50 18.08 16.44 364.71 10.85 12.05 55.25 69.06 12.35 12.41 12.05 440.80 11.03 16.44 31.57 10.60 225.36 413.25 209.44 246.46 12.47 36943050 FLUOR NONINFECT AGENT AB 86255 300 $551.00 203.65 10.60 440.80 18.91 380.74 12.65 380.74 16.44 304.43 12.41 33.50 18.08 16.44 364.71 10.85 12.05 55.25 69.06 12.35 12.41 12.05 440.80 11.03 16.44 31.57 10.60 225.36 413.25 209.44 246.46 12.47 36943068 FLUOR NONINFECT AGENT AB 86255 300 $551.00 203.65 10.60 440.80 18.91 380.74 12.65 380.74 16.44 304.43 12.41 33.50 18.08 16.44 364.71 10.85 12.05 55.25 69.06 12.35 12.41 12.05 440.80 11.03 16.44 31.57 10.60 225.36 413.25 209.44 246.46 12.47 36943076 FLUOR NONINFECT AGENT AB 86255 300 $551.00 203.65 10.60 440.80 18.91 380.74 12.65 380.74 16.44 304.43 12.41 33.50 18.08 16.44 364.71 10.85 12.05 55.25 69.06 12.35 12.41 12.05 440.80 11.03 16.44 31.57 10.60 225.36 413.25 209.44 246.46 12.47 36943084 FLUOR NONINFECT AGENT AB 86255 300 $551.00 203.65 10.60 440.80 18.91 380.74 12.65 380.74 16.44 304.43 12.41 33.50 18.08 16.44 364.71 10.85 12.05 55.25 69.06 12.35 12.41 12.05 440.80 11.03 16.44 31.57 10.60 225.36 413.25 209.44 246.46 12.47 36943092 FLUOR NONINFECT AGENT AB 86255 300 $573.00 211.78 10.60 458.40 18.91 395.94 12.65 395.94 16.44 316.58 12.41 33.50 18.08 16.44 379.27 10.85 12.05 55.25 69.06 12.35 12.41 12.05 458.40 11.03 16.44 31.57 10.60 234.36 429.75 217.80 256.30 12.47 36943106 FLUOR NONINFECT AGENT AB 86255 300 $573.00 211.78 10.60 458.40 18.91 395.94 12.65 395.94 16.44 316.58 12.41 33.50 18.08 16.44 379.27 10.85 12.05 55.25 69.06 12.35 12.41 12.05 458.40 11.03 16.44 31.57 10.60 234.36 429.75 217.80 256.30 12.47 36943114 FLUOR NONINFECT AGENT AB 86255 300 $573.00 211.78 10.60 458.40 18.91 395.94 12.65 395.94 16.44 316.58 12.41 33.50 18.08 16.44 379.27 10.85 12.05 55.25 69.06 12.35 12.41 12.05 458.40 11.03 16.44 31.57 10.60 234.36 429.75 217.80 256.30 12.47 36943122 FLUOR NONINFECT AGENT AB 86255 300 $573.00 211.78 10.60 458.40 18.91 395.94 12.65 395.94 16.44 316.58 12.41 33.50 18.08 16.44 379.27 10.85 12.05 55.25 69.06 12.35 12.41 12.05 458.40 11.03 16.44 31.57 10.60 234.36 429.75 217.80 256.30 12.47 36943131 FLUOR NONINFECT AGENT AB 86255 300 $573.00 211.78 10.60 458.40 18.91 395.94 12.65 395.94 16.44 316.58 12.41 33.50 18.08 16.44 379.27 10.85 12.05 55.25 69.06 12.35 12.41 12.05 458.40 11.03 16.44 31.57 10.60 234.36 429.75 217.80 256.30 12.47 36943149 FLUOR NONINFECT AGENT AB 86255 300 $573.00 211.78 10.60 458.40 18.91 395.94 12.65 395.94 16.44 316.58 12.41 33.50 18.08 16.44 379.27 10.85 12.05 55.25 69.06 12.35 12.41 12.05 458.40 11.03 16.44 31.57 10.60 234.36 429.75 217.80 256.30 12.47 36943157 FLUOR NONINFECT AGENT AB 86255 300 $574.00 212.15 10.60 459.20 18.91 396.63 12.65 396.63 16.44 317.14 12.41 33.50 18.08 16.44 379.93 10.85 12.05 55.25 69.06 12.35 12.41 12.05 459.20 11.03 16.44 31.57 10.60 234.77 430.50 218.18 256.75 12.47 36943165 FLUOR NONINFECT AGENT AB 86255 300 $574.00 212.15 10.60 459.20 18.91 396.63 12.65 396.63 16.44 317.14 12.41 33.50 18.08 16.44 379.93 10.85 12.05 55.25 69.06 12.35 12.41 12.05 459.20 11.03 16.44 31.57 10.60 234.77 430.50 218.18 256.75 12.47 36943173 FLUOR NONINFECT AGENT AB 86255 300 $574.00 212.15 10.60 459.20 18.91 396.63 12.65 396.63 16.44 317.14 12.41 33.50 18.08 16.44 379.93 10.85 12.05 55.25 69.06 12.35 12.41 12.05 459.20 11.03 16.44 31.57 10.60 234.77 430.50 218.18 256.75 12.47 36943181 FLUOR NONINFECT AGENT AB 86255 300 $574.00 212.15 10.60 459.20 18.91 396.63 12.65 396.63 16.44 317.14 12.41 33.50 18.08 16.44 379.93 10.85 12.05 55.25 69.06 12.35 12.41 12.05 459.20 11.03 16.44 31.57 10.60 234.77 430.50 218.18 256.75 12.47 36943831 FLUORESCENT NONINFECT AGENT AB 86255 300 $551.00 203.65 10.60 440.80 18.91 380.74 12.65 380.74 16.44 304.43 12.41 33.50 18.08 16.44 364.71 10.85 12.05 55.25 69.06 12.35 12.41 12.05 440.80 11.03 16.44 31.57 10.60 225.36 413.25 209.44 246.46 12.47 36944013 PURKINJE DNER FLUOR AB SCREEN 86255 300 "$1,533.00" 566.60 10.60 " 1,226.40 " 18.91 " 1,059.30 " 12.65 " 1,059.30 " 16.44 846.98 12.41 33.50 18.08 16.44 " 1,014.69 " 10.85 12.05 55.25 69.06 12.35 12.41 12.05 " 1,226.40 " 11.03 16.44 31.57 10.60 627.00 " 1,149.75 " 582.69 685.71 12.47 36944129 FLUORESCENT NONINFECT AB SCRN 86255 300 "$1,748.00" 646.06 10.60 " 1,398.40 " 18.91 " 1,207.87 " 12.65 " 1,207.87 " 16.44 965.77 12.41 33.50 18.08 16.44 " 1,157.00 " 10.85 12.05 55.25 69.06 12.35 12.41 12.05 " 1,398.40 " 11.03 16.44 31.57 10.60 714.93 " 1,311.00 " 664.41 781.88 12.47 36944421 COPEPTIN FLUOR NONINF AB SCRN 86255 300 $68.00 25.13 10.60 69.06 18.91 46.99 12.65 46.99 16.44 37.57 12.41 33.50 18.08 16.44 45.01 10.85 12.05 55.25 69.06 12.35 12.41 12.05 54.40 11.03 16.44 31.57 10.60 27.81 51.00 25.85 30.42 12.47 36945281 FLUOR NONINF AGT AB SCN EA 86255 300 $74.00 27.35 10.60 69.06 18.91 51.13 12.65 51.13 16.44 40.89 12.41 33.50 18.08 16.44 48.98 10.85 12.05 55.25 69.06 12.35 12.41 12.05 59.20 11.03 16.44 31.57 10.60 30.27 55.50 28.13 33.10 12.47 36917091 RETICULIN IGG ANTIBODY TITER 86256 300 $286.00 105.71 9.11 228.80 10.48 197.63 12.65 197.63 9.11 158.02 12.41 33.50 10.02 9.11 189.30 10.85 12.05 37.08 46.35 12.35 12.41 12.05 228.80 11.03 9.11 31.57 10.60 116.97 214.50 108.71 127.93 12.47 36917105 RETICULIN IGA ANTIBODY TITER 86256 300 $286.00 105.71 9.11 228.80 10.48 197.63 12.65 197.63 9.11 158.02 12.41 33.50 10.02 9.11 189.30 10.85 12.05 37.08 46.35 12.35 12.41 12.05 228.80 11.03 9.11 31.57 10.60 116.97 214.50 108.71 127.93 12.47 36936126 FLUOR NONINF AGENT AB TITER 86256 300 $286.00 105.71 9.11 228.80 10.48 197.63 12.65 197.63 9.11 158.02 12.41 33.50 10.02 9.11 189.30 10.85 12.05 37.08 46.35 12.35 12.41 12.05 228.80 11.03 9.11 31.57 10.60 116.97 214.50 108.71 127.93 12.47 36938129 FLUOR NONINF TITER 86256 300 $287.00 106.08 9.11 229.60 10.48 198.32 12.65 198.32 9.11 158.57 12.41 33.50 10.02 9.11 189.97 10.85 12.05 37.08 46.35 12.35 12.41 12.05 229.60 11.03 9.11 31.57 10.60 117.38 215.25 109.09 128.38 12.47 36938137 FLUOR NONINF TITER 86256 300 $287.00 106.08 9.11 229.60 10.48 198.32 12.65 198.32 9.11 158.57 12.41 33.50 10.02 9.11 189.97 10.85 12.05 37.08 46.35 12.35 12.41 12.05 229.60 11.03 9.11 31.57 10.60 117.38 215.25 109.09 128.38 12.47 36938145 FLUOR NONINF TITER 86256 300 $287.00 106.08 9.11 229.60 10.48 198.32 12.65 198.32 9.11 158.57 12.41 33.50 10.02 9.11 189.97 10.85 12.05 37.08 46.35 12.35 12.41 12.05 229.60 11.03 9.11 31.57 10.60 117.38 215.25 109.09 128.38 12.47 36938153 FLUOR NONINF TITER 86256 300 $287.00 106.08 9.11 229.60 10.48 198.32 12.65 198.32 9.11 158.57 12.41 33.50 10.02 9.11 189.97 10.85 12.05 37.08 46.35 12.35 12.41 12.05 229.60 11.03 9.11 31.57 10.60 117.38 215.25 109.09 128.38 12.47 36938161 FLUOR NONINF TITER 86256 300 $287.00 106.08 9.11 229.60 10.48 198.32 12.65 198.32 9.11 158.57 12.41 33.50 10.02 9.11 189.97 10.85 12.05 37.08 46.35 12.35 12.41 12.05 229.60 11.03 9.11 31.57 10.60 117.38 215.25 109.09 128.38 12.47 36938170 FLUOR NONINF TITER 86256 300 $287.00 106.08 9.11 229.60 10.48 198.32 12.65 198.32 9.11 158.57 12.41 33.50 10.02 9.11 189.97 10.85 12.05 37.08 46.35 12.35 12.41 12.05 229.60 11.03 9.11 31.57 10.60 117.38 215.25 109.09 128.38 12.47 36938188 FLUOR NONINF TITER 86256 300 $287.00 106.08 9.11 229.60 10.48 198.32 12.65 198.32 9.11 158.57 12.41 33.50 10.02 9.11 189.97 10.85 12.05 37.08 46.35 12.35 12.41 12.05 229.60 11.03 9.11 31.57 10.60 117.38 215.25 109.09 128.38 12.47 36938196 FLUOR NONINF TITER 86256 300 $287.00 106.08 9.11 229.60 10.48 198.32 12.65 198.32 9.11 158.57 12.41 33.50 10.02 9.11 189.97 10.85 12.05 37.08 46.35 12.35 12.41 12.05 229.60 11.03 9.11 31.57 10.60 117.38 215.25 109.09 128.38 12.47 36938200 FLUOR NONINF TITER 86256 300 $287.00 106.08 9.11 229.60 10.48 198.32 12.65 198.32 9.11 158.57 12.41 33.50 10.02 9.11 189.97 10.85 12.05 37.08 46.35 12.35 12.41 12.05 229.60 11.03 9.11 31.57 10.60 117.38 215.25 109.09 128.38 12.47 36938668 STRIATED MUSCLE AB TITER 86256 300 $286.00 105.71 9.11 228.80 10.48 197.63 12.65 197.63 9.11 158.02 12.41 33.50 10.02 9.11 189.30 10.85 12.05 37.08 46.35 12.35 12.41 12.05 228.80 11.03 9.11 31.57 10.60 116.97 214.50 108.71 127.93 12.47 36939109 HU AB TITER CSF 86256 300 $286.00 105.71 9.11 228.80 10.48 197.63 12.65 197.63 9.11 158.02 12.41 33.50 10.02 9.11 189.30 10.85 12.05 37.08 46.35 12.35 12.41 12.05 228.80 11.03 9.11 31.57 10.60 116.97 214.50 108.71 127.93 12.47 36939389 FLUORSCNT NONINFCT AGENT TITER 86256 300 $655.00 242.09 9.11 524.00 10.48 452.61 12.65 452.61 9.11 361.89 12.41 33.50 10.02 9.11 433.54 10.85 12.05 37.08 46.35 12.35 12.41 12.05 524.00 11.03 9.11 31.57 10.60 267.90 491.25 248.97 292.98 12.47 36939397 FLUORSCNT NONINFCT AGENT TITER 86256 300 $655.00 242.09 9.11 524.00 10.48 452.61 12.65 452.61 9.11 361.89 12.41 33.50 10.02 9.11 433.54 10.85 12.05 37.08 46.35 12.35 12.41 12.05 524.00 11.03 9.11 31.57 10.60 267.90 491.25 248.97 292.98 12.47 36939401 FLUORSCNT NONINFCT AGENT TITER 86256 300 $655.00 242.09 9.11 524.00 10.48 452.61 12.65 452.61 9.11 361.89 12.41 33.50 10.02 9.11 433.54 10.85 12.05 37.08 46.35 12.35 12.41 12.05 524.00 11.03 9.11 31.57 10.60 267.90 491.25 248.97 292.98 12.47 36939419 FLUORSCNT NONINFCT AGENT TITER 86256 300 $655.00 242.09 9.11 524.00 10.48 452.61 12.65 452.61 9.11 361.89 12.41 33.50 10.02 9.11 433.54 10.85 12.05 37.08 46.35 12.35 12.41 12.05 524.00 11.03 9.11 31.57 10.60 267.90 491.25 248.97 292.98 12.47 36939427 FLUORSCNT NONINFCT AGENT TITER 86256 300 $655.00 242.09 9.11 524.00 10.48 452.61 12.65 452.61 9.11 361.89 12.41 33.50 10.02 9.11 433.54 10.85 12.05 37.08 46.35 12.35 12.41 12.05 524.00 11.03 9.11 31.57 10.60 267.90 491.25 248.97 292.98 12.47 36939435 FLUORSCNT NONINFCT AGENT TITER 86256 300 $655.00 242.09 9.11 524.00 10.48 452.61 12.65 452.61 9.11 361.89 12.41 33.50 10.02 9.11 433.54 10.85 12.05 37.08 46.35 12.35 12.41 12.05 524.00 11.03 9.11 31.57 10.60 267.90 491.25 248.97 292.98 12.47 36939443 FLUORSCNT NONINFCT AGENT TITER 86256 300 $655.00 242.09 9.11 524.00 10.48 452.61 12.65 452.61 9.11 361.89 12.41 33.50 10.02 9.11 433.54 10.85 12.05 37.08 46.35 12.35 12.41 12.05 524.00 11.03 9.11 31.57 10.60 267.90 491.25 248.97 292.98 12.47 36939451 FLUORSCNT NONINFCT AGENT TITER 86256 300 $655.00 242.09 9.11 524.00 10.48 452.61 12.65 452.61 9.11 361.89 12.41 33.50 10.02 9.11 433.54 10.85 12.05 37.08 46.35 12.35 12.41 12.05 524.00 11.03 9.11 31.57 10.60 267.90 491.25 248.97 292.98 12.47 36939605 FLUORSCNT NONINFCT AGENT TITER 86256 300 $625.00 231.00 9.11 500.00 10.48 431.88 12.65 431.88 9.11 345.31 12.41 33.50 10.02 9.11 413.69 10.85 12.05 37.08 46.35 12.35 12.41 12.05 500.00 11.03 9.11 31.57 10.60 255.63 468.75 237.56 279.56 12.47 36939613 FLUORSCNT NONINFCT AGENT TITER 86256 300 $625.00 231.00 9.11 500.00 10.48 431.88 12.65 431.88 9.11 345.31 12.41 33.50 10.02 9.11 413.69 10.85 12.05 37.08 46.35 12.35 12.41 12.05 500.00 11.03 9.11 31.57 10.60 255.63 468.75 237.56 279.56 12.47 36939621 FLUORSCNT NONINFCT AGENT TITER 86256 300 $625.00 231.00 9.11 500.00 10.48 431.88 12.65 431.88 9.11 345.31 12.41 33.50 10.02 9.11 413.69 10.85 12.05 37.08 46.35 12.35 12.41 12.05 500.00 11.03 9.11 31.57 10.60 255.63 468.75 237.56 279.56 12.47 36939630 FLUORSCNT NONINFCT AGENT TITER 86256 300 $625.00 231.00 9.11 500.00 10.48 431.88 12.65 431.88 9.11 345.31 12.41 33.50 10.02 9.11 413.69 10.85 12.05 37.08 46.35 12.35 12.41 12.05 500.00 11.03 9.11 31.57 10.60 255.63 468.75 237.56 279.56 12.47 36939648 FLUORSCNT NONINFCT AGENT TITER 86256 300 $625.00 231.00 9.11 500.00 10.48 431.88 12.65 431.88 9.11 345.31 12.41 33.50 10.02 9.11 413.69 10.85 12.05 37.08 46.35 12.35 12.41 12.05 500.00 11.03 9.11 31.57 10.60 255.63 468.75 237.56 279.56 12.47 36939656 FLUORSCNT NONINFCT AGENT TITER 86256 300 $625.00 231.00 9.11 500.00 10.48 431.88 12.65 431.88 9.11 345.31 12.41 33.50 10.02 9.11 413.69 10.85 12.05 37.08 46.35 12.35 12.41 12.05 500.00 11.03 9.11 31.57 10.60 255.63 468.75 237.56 279.56 12.47 36939664 FLUORSCNT NONINFCT AGENT TITER 86256 300 $625.00 231.00 9.11 500.00 10.48 431.88 12.65 431.88 9.11 345.31 12.41 33.50 10.02 9.11 413.69 10.85 12.05 37.08 46.35 12.35 12.41 12.05 500.00 11.03 9.11 31.57 10.60 255.63 468.75 237.56 279.56 12.47 36939672 FLUORSCNT NONINFCT AGENT TITER 86256 300 $625.00 231.00 9.11 500.00 10.48 431.88 12.65 431.88 9.11 345.31 12.41 33.50 10.02 9.11 413.69 10.85 12.05 37.08 46.35 12.35 12.41 12.05 500.00 11.03 9.11 31.57 10.60 255.63 468.75 237.56 279.56 12.47 36939681 FLUORSCNT NONINFCT AGENT TITER 86256 300 $625.00 231.00 9.11 500.00 10.48 431.88 12.65 431.88 9.11 345.31 12.41 33.50 10.02 9.11 413.69 10.85 12.05 37.08 46.35 12.35 12.41 12.05 500.00 11.03 9.11 31.57 10.60 255.63 468.75 237.56 279.56 12.47 36939699 AMPARA-R AB IF TITER 86256 300 "$1,194.00" 441.30 9.11 955.20 10.48 825.05 12.65 825.05 9.11 659.69 12.41 33.50 10.02 9.11 790.31 10.85 12.05 37.08 46.35 12.35 12.41 12.05 955.20 11.03 9.11 31.57 10.60 488.35 895.50 453.84 534.08 12.47 36939702 NMDA-R AB IF TITER 86256 300 "$1,366.00" 504.87 9.11 " 1,092.80 " 10.48 943.91 12.65 943.91 9.11 754.72 12.41 33.50 10.02 9.11 904.16 10.85 12.05 37.08 46.35 12.35 12.41 12.05 " 1,092.80 " 11.03 9.11 31.57 10.60 558.69 " 1,024.50 " 519.22 611.01 12.47 36939800 FLUORSCNT NONINFCT AGENT TITER 86256 300 $655.00 242.09 9.11 524.00 10.48 452.61 12.65 452.61 9.11 361.89 12.41 33.50 10.02 9.11 433.54 10.85 12.05 37.08 46.35 12.35 12.41 12.05 524.00 11.03 9.11 31.57 10.60 267.90 491.25 248.97 292.98 12.47 36939818 FLUORSCNT NONINFCT AGENT TITER 86256 300 $655.00 242.09 9.11 524.00 10.48 452.61 12.65 452.61 9.11 361.89 12.41 33.50 10.02 9.11 433.54 10.85 12.05 37.08 46.35 12.35 12.41 12.05 524.00 11.03 9.11 31.57 10.60 267.90 491.25 248.97 292.98 12.47 36939826 FLUORSCNT NONINFCT AGENT TITER 86256 300 $655.00 242.09 9.11 524.00 10.48 452.61 12.65 452.61 9.11 361.89 12.41 33.50 10.02 9.11 433.54 10.85 12.05 37.08 46.35 12.35 12.41 12.05 524.00 11.03 9.11 31.57 10.60 267.90 491.25 248.97 292.98 12.47 36939834 FLUORSCNT NONINFCT AGENT TITER 86256 300 $655.00 242.09 9.11 524.00 10.48 452.61 12.65 452.61 9.11 361.89 12.41 33.50 10.02 9.11 433.54 10.85 12.05 37.08 46.35 12.35 12.41 12.05 524.00 11.03 9.11 31.57 10.60 267.90 491.25 248.97 292.98 12.47 36939842 FLUORSCNT NONINFCT AGENT TITER 86256 300 $655.00 242.09 9.11 524.00 10.48 452.61 12.65 452.61 9.11 361.89 12.41 33.50 10.02 9.11 433.54 10.85 12.05 37.08 46.35 12.35 12.41 12.05 524.00 11.03 9.11 31.57 10.60 267.90 491.25 248.97 292.98 12.47 36939851 FLUORSCNT NONINFCT AGENT TITER 86256 300 $655.00 242.09 9.11 524.00 10.48 452.61 12.65 452.61 9.11 361.89 12.41 33.50 10.02 9.11 433.54 10.85 12.05 37.08 46.35 12.35 12.41 12.05 524.00 11.03 9.11 31.57 10.60 267.90 491.25 248.97 292.98 12.47 36939869 FLUORSCNT NONINFCT AGENT TITER 86256 300 $655.00 242.09 9.11 524.00 10.48 452.61 12.65 452.61 9.11 361.89 12.41 33.50 10.02 9.11 433.54 10.85 12.05 37.08 46.35 12.35 12.41 12.05 524.00 11.03 9.11 31.57 10.60 267.90 491.25 248.97 292.98 12.47 36939877 FLUORSCNT NONINFCT AGENT TITER 86256 300 $655.00 242.09 9.11 524.00 10.48 452.61 12.65 452.61 9.11 361.89 12.41 33.50 10.02 9.11 433.54 10.85 12.05 37.08 46.35 12.35 12.41 12.05 524.00 11.03 9.11 31.57 10.60 267.90 491.25 248.97 292.98 12.47 36939885 GABA-B-R AB IF TITER 86256 300 "$1,194.00" 441.30 9.11 955.20 10.48 825.05 12.65 825.05 9.11 659.69 12.41 33.50 10.02 9.11 790.31 10.85 12.05 37.08 46.35 12.35 12.41 12.05 955.20 11.03 9.11 31.57 10.60 488.35 895.50 453.84 534.08 12.47 36939893 PURKINJE CELL CYTO AB1 S TITR 86256 300 $951.00 351.49 9.11 760.80 10.48 657.14 12.65 657.14 9.11 525.43 12.41 33.50 10.02 9.11 629.47 10.85 12.05 37.08 46.35 12.35 12.41 12.05 760.80 11.03 9.11 31.57 10.60 388.96 713.25 361.48 425.38 12.47 36940409 ENDOMYSIAL IGA AB TITER 86256 300 $286.00 105.71 9.11 228.80 10.48 197.63 12.65 197.63 9.11 158.02 12.41 33.50 10.02 9.11 189.30 10.85 12.05 37.08 46.35 12.35 12.41 12.05 228.80 11.03 9.11 31.57 10.60 116.97 214.50 108.71 127.93 12.47 36941910 NEURONAL NUCLEAR AB T3 86256 300 "$3,760.00" " 1,389.70 " 9.11 " 3,008.00 " 10.48 " 2,598.16 " 12.65 " 2,598.16 " 9.11 " 2,077.40 " 12.41 33.50 10.02 9.11 " 2,488.74 " 10.85 12.05 37.08 46.35 12.35 12.41 12.05 " 3,008.00 " 11.03 9.11 31.57 10.60 " 1,537.84 " " 2,820.00 " " 1,429.18 " " 1,681.85 " 12.47 36941928 PURKINJE CELL AB TYPE 2 86256 300 "$3,760.00" " 1,389.70 " 9.11 " 3,008.00 " 10.48 " 2,598.16 " 12.65 " 2,598.16 " 9.11 " 2,077.40 " 12.41 33.50 10.02 9.11 " 2,488.74 " 10.85 12.05 37.08 46.35 12.35 12.41 12.05 " 3,008.00 " 11.03 9.11 31.57 10.60 " 1,537.84 " " 2,820.00 " " 1,429.18 " " 1,681.85 " 12.47 36943840 ANNA3 FLUORESCENT AB TITER 86256 300 "$3,313.00" " 1,224.48 " 9.11 " 2,650.40 " 10.48 " 2,289.28 " 12.65 " 2,289.28 " 9.11 " 1,830.43 " 12.41 33.50 10.02 9.11 " 2,192.87 " 10.85 12.05 37.08 46.35 12.35 12.41 12.05 " 2,650.40 " 11.03 9.11 31.57 10.60 " 1,355.02 " " 2,484.75 " " 1,259.27 " " 1,481.90 " 12.47 36943858 PCA2 FLUORESCENT AB TITER 86256 300 "$3,313.00" " 1,224.48 " 9.11 " 2,650.40 " 10.48 " 2,289.28 " 12.65 " 2,289.28 " 9.11 " 1,830.43 " 12.41 33.50 10.02 9.11 " 2,192.87 " 10.85 12.05 37.08 46.35 12.35 12.41 12.05 " 2,650.40 " 11.03 9.11 31.57 10.60 " 1,355.02 " " 2,484.75 " " 1,259.27 " " 1,481.90 " 12.47 36943963 AQP4 FLUORESCENT AB TITER 86256 300 "$3,313.00" " 1,224.48 " 9.11 " 2,650.40 " 10.48 " 2,289.28 " 12.65 " 2,289.28 " 9.11 " 1,830.43 " 12.41 33.50 10.02 9.11 " 2,192.87 " 10.85 12.05 37.08 46.35 12.35 12.41 12.05 " 2,650.40 " 11.03 9.11 31.57 10.60 " 1,355.02 " " 2,484.75 " " 1,259.27 " " 1,481.90 " 12.47 36943971 MYELIN FLUORESCENT AB TITER 86256 300 "$3,009.00" " 1,112.13 " 9.11 " 2,407.20 " 10.48 " 2,079.22 " 12.65 " 2,079.22 " 9.11 " 1,662.47 " 12.41 33.50 10.02 9.11 " 1,991.66 " 10.85 12.05 37.08 46.35 12.35 12.41 12.05 " 2,407.20 " 11.03 9.11 31.57 10.60 " 1,230.68 " " 2,256.75 " " 1,143.72 " " 1,345.93 " 12.47 36944021 PCA TR FLUORESCENT AB TITER 86256 300 "$3,009.00" " 1,112.13 " 9.11 " 2,407.20 " 10.48 " 2,079.22 " 12.65 " 2,079.22 " 9.11 " 1,662.47 " 12.41 33.50 10.02 9.11 " 1,991.66 " 10.85 12.05 37.08 46.35 12.35 12.41 12.05 " 2,407.20 " 11.03 9.11 31.57 10.60 " 1,230.68 " " 2,256.75 " " 1,143.72 " " 1,345.93 " 12.47 36944030 NMDAR1 FLUORESCENT AB TITER 86256 300 "$3,314.00" " 1,224.85 " 9.11 " 2,651.20 " 10.48 " 2,289.97 " 12.65 " 2,289.97 " 9.11 " 1,830.99 " 12.41 33.50 10.02 9.11 " 2,193.54 " 10.85 12.05 37.08 46.35 12.35 12.41 12.05 " 2,651.20 " 11.03 9.11 31.57 10.60 " 1,355.43 " " 2,485.50 " " 1,259.65 " " 1,482.35 " 12.47 36944048 AMPAR1 FLUORESCENT AB TITER 86256 300 "$3,314.00" " 1,224.85 " 9.11 " 2,651.20 " 10.48 " 2,289.97 " 12.65 " 2,289.97 " 9.11 " 1,830.99 " 12.41 33.50 10.02 9.11 " 2,193.54 " 10.85 12.05 37.08 46.35 12.35 12.41 12.05 " 2,651.20 " 11.03 9.11 31.57 10.60 " 1,355.43 " " 2,485.50 " " 1,259.65 " " 1,482.35 " 12.47 36944056 AMPAR2 FLUORESCENT AB TITER 86256 300 "$3,314.00" " 1,224.85 " 9.11 " 2,651.20 " 10.48 " 2,289.97 " 12.65 " 2,289.97 " 9.11 " 1,830.99 " 12.41 33.50 10.02 9.11 " 2,193.54 " 10.85 12.05 37.08 46.35 12.35 12.41 12.05 " 2,651.20 " 11.03 9.11 31.57 10.60 " 1,355.43 " " 2,485.50 " " 1,259.65 " " 1,482.35 " 12.47 36944064 GABABR FLUORESCENT AB TITER 86256 300 "$3,314.00" " 1,224.85 " 9.11 " 2,651.20 " 10.48 " 2,289.97 " 12.65 " 2,289.97 " 9.11 " 1,830.99 " 12.41 33.50 10.02 9.11 " 2,193.54 " 10.85 12.05 37.08 46.35 12.35 12.41 12.05 " 2,651.20 " 11.03 9.11 31.57 10.60 " 1,355.43 " " 2,485.50 " " 1,259.65 " " 1,482.35 " 12.47 36944072 LGI1 FLUORESCENT AB TITER 86256 300 "$3,314.00" " 1,224.85 " 9.11 " 2,651.20 " 10.48 " 2,289.97 " 12.65 " 2,289.97 " 9.11 " 1,830.99 " 12.41 33.50 10.02 9.11 " 2,193.54 " 10.85 12.05 37.08 46.35 12.35 12.41 12.05 " 2,651.20 " 11.03 9.11 31.57 10.60 " 1,355.43 " " 2,485.50 " " 1,259.65 " " 1,482.35 " 12.47 36944081 CASPR2 FLUORESCENT AB TITER 86256 300 "$3,314.00" " 1,224.85 " 9.11 " 2,651.20 " 10.48 " 2,289.97 " 12.65 " 2,289.97 " 9.11 " 1,830.99 " 12.41 33.50 10.02 9.11 " 2,193.54 " 10.85 12.05 37.08 46.35 12.35 12.41 12.05 " 2,651.20 " 11.03 9.11 31.57 10.60 " 1,355.43 " " 2,485.50 " " 1,259.65 " " 1,482.35 " 12.47 36944099 DPPX FLUORESCENT AB TITER 86256 300 "$3,009.00" " 1,112.13 " 9.11 " 2,407.20 " 10.48 " 2,079.22 " 12.65 " 2,079.22 " 9.11 " 1,662.47 " 12.41 33.50 10.02 9.11 " 1,991.66 " 10.85 12.05 37.08 46.35 12.35 12.41 12.05 " 2,407.20 " 11.03 9.11 31.57 10.60 " 1,230.68 " " 2,256.75 " " 1,143.72 " " 1,345.93 " 12.47 36944102 ADRENAL AB TITER 86256 300 $286.00 105.71 9.11 228.80 10.48 197.63 12.65 197.63 9.11 158.02 12.41 33.50 10.02 9.11 189.30 10.85 12.05 37.08 46.35 12.35 12.41 12.05 228.80 11.03 9.11 31.57 10.60 116.97 214.50 108.71 127.93 12.47 36944161 STRIATED MUSCLE TITER 86256 300 $286.00 105.71 9.11 228.80 10.48 197.63 12.65 197.63 9.11 158.02 12.41 33.50 10.02 9.11 189.30 10.85 12.05 37.08 46.35 12.35 12.41 12.05 228.80 11.03 9.11 31.57 10.60 116.97 214.50 108.71 127.93 12.47 36937963 GROWTH HORMONE ANTIBODY 86277 300 $447.00 165.21 8.00 357.60 9.20 308.88 16.53 308.88 8.00 246.97 16.21 43.77 8.80 8.00 295.87 14.17 15.74 101.46 126.82 16.13 16.21 15.74 357.60 14.40 8.00 41.24 13.85 182.82 335.25 169.90 199.94 16.29 35707786 CANCER ANTIGEN 15-3 86300 300 $109.00 40.29 18.31 163.80 26.46 75.32 21.85 75.32 23.01 60.22 21.43 57.87 25.31 23.01 72.15 18.73 20.81 131.04 163.80 21.33 21.43 20.81 87.20 19.04 23.01 54.52 18.31 44.58 81.75 41.43 48.76 21.54 35790535 CANCER ANTIGEN 27-29 ASSAY 86300 300 $109.00 40.29 18.31 163.80 26.46 75.32 21.85 75.32 23.01 60.22 21.43 57.87 25.31 23.01 72.15 18.73 20.81 131.04 163.80 21.33 21.43 20.81 87.20 19.04 23.01 54.52 18.31 44.58 81.75 41.43 48.76 21.54 36920653 CA27.29 TUMOR ANTIGEN ASSAY 86300 300 $189.00 69.85 18.31 163.80 26.46 130.60 21.85 130.60 23.01 104.42 21.43 57.87 25.31 23.01 125.10 18.73 20.81 131.04 163.80 21.33 21.43 20.81 151.20 19.04 23.01 54.52 18.31 77.30 141.75 71.84 84.54 21.54 36941057 IMMUNOASSAY TUMOR CA 15-3 86300 300 $109.00 40.29 18.31 163.80 26.46 75.32 21.85 75.32 23.01 60.22 21.43 57.87 25.31 23.01 72.15 18.73 20.81 131.04 163.80 21.33 21.43 20.81 87.20 19.04 23.01 54.52 18.31 44.58 81.75 41.43 48.76 21.54 36941065 IMMUNOASSAY TUMOR CA 27.29 86300 300 $109.00 40.29 18.31 163.80 26.46 75.32 21.85 75.32 23.01 60.22 21.43 57.87 25.31 23.01 72.15 18.73 20.81 131.04 163.80 21.33 21.43 20.81 87.20 19.04 23.01 54.52 18.31 44.58 81.75 41.43 48.76 21.54 35707778 CANCER ANTIGEN 19-9 86301 300 $109.00 40.29 18.31 163.80 26.46 75.32 21.85 75.32 23.01 60.22 21.43 57.87 25.31 23.01 72.15 18.73 20.81 131.04 163.80 21.33 21.43 20.81 87.20 19.04 23.01 54.52 18.31 44.58 81.75 41.43 48.76 21.54 35705180 CA 125 86304 300 $109.00 40.29 18.31 163.80 26.46 75.32 21.85 75.32 23.01 60.22 21.43 57.87 25.31 23.01 72.15 18.73 20.81 131.04 163.80 21.33 21.43 20.81 87.20 19.04 23.01 54.52 18.31 44.58 81.75 41.43 48.76 21.54 36940336 HE4 OVARIAN CANCER 86305 300 "$1,305.00" 482.33 18.31 " 1,044.00 " 27.43 901.76 21.85 901.76 23.85 721.01 21.43 57.87 26.24 23.85 863.78 18.73 20.81 131.44 164.30 21.33 21.43 20.81 " 1,044.00 " 19.04 23.85 54.52 18.31 533.75 978.75 496.03 583.73 21.54 35709096 MONOTEST 86308 300 $27.00 9.98 4.56 29.65 8.22 18.66 5.44 18.66 7.15 14.92 5.34 14.38 7.87 7.15 17.87 4.66 5.18 23.72 29.65 5.31 5.34 5.18 21.60 4.74 7.15 13.57 4.56 11.04 20.25 10.26 12.08 5.36 36917318 NEURON SPECIFIC ENOLASE 86316 300 $836.00 308.99 18.31 668.80 33.07 577.68 21.85 577.68 28.76 461.89 21.43 57.87 31.64 28.76 553.35 18.73 20.81 95.42 119.27 21.33 21.43 20.81 668.80 19.04 28.76 54.52 18.31 341.92 627.00 317.76 373.94 21.54 36922176 CHROMOGRANIN A:TUMOR AG ASSAY 86316 300 $691.00 255.39 18.31 552.80 33.07 477.48 21.85 477.48 28.76 381.78 21.43 57.87 31.64 28.76 457.37 18.73 20.81 95.42 119.27 21.33 21.43 20.81 552.80 19.04 28.76 54.52 18.31 282.62 518.25 262.65 309.08 21.54 36943301 CHROMOGRANIN A 86316 300 $227.00 83.90 18.31 181.60 33.07 156.86 21.85 156.86 28.76 125.42 21.43 57.87 31.64 28.76 150.25 18.73 20.81 95.42 119.27 21.33 21.43 20.81 181.60 19.04 28.76 54.52 18.31 92.84 170.25 86.28 101.54 21.54 36944391 P2PSA IA FOR TUMER AG QUANT 86316 300 $487.00 180.00 18.31 389.60 33.07 336.52 21.85 336.52 28.76 269.07 21.43 57.87 31.64 28.76 322.35 18.73 20.81 95.42 119.27 21.33 21.43 20.81 389.60 19.04 28.76 54.52 18.31 199.18 365.25 185.11 217.84 21.54 35709487 HEP B SURFACE AB QUANT 86317 300 $79.00 29.20 13.19 85.92 23.56 54.59 15.74 54.59 20.49 43.65 15.44 41.67 22.54 20.49 52.29 13.49 14.99 68.74 85.92 15.36 15.44 14.99 63.20 13.72 20.49 39.27 13.19 32.31 59.25 30.03 35.34 15.51 35709673 EXPOSURE HEP B SURF AB 86317 300 $79.00 29.20 13.19 85.92 23.56 54.59 15.74 54.59 20.49 43.65 15.44 41.67 22.54 20.49 52.29 13.49 14.99 68.74 85.92 15.36 15.44 14.99 63.20 13.72 20.49 39.27 13.19 32.31 59.25 30.03 35.34 15.51 36903741 RABIES TITER 86317 300 $364.00 134.53 13.19 291.20 23.56 251.52 15.74 251.52 20.49 201.11 15.44 41.67 22.54 20.49 240.93 13.49 14.99 68.74 85.92 15.36 15.44 14.99 291.20 13.72 20.49 39.27 13.19 148.88 273.00 138.36 162.82 15.51 36923717 PNEUMOCOCCAL IGG ABS TYPE 1 86317 300 $113.00 41.76 13.19 90.40 23.56 78.08 15.74 78.08 20.49 62.43 15.44 41.67 22.54 20.49 74.79 13.49 14.99 68.74 85.92 15.36 15.44 14.99 90.40 13.72 20.49 39.27 13.19 46.22 84.75 42.95 50.54 15.51 36923725 PNEUMOCOCCAL IGG ABS TYPE 3 86317 300 $113.00 41.76 13.19 90.40 23.56 78.08 15.74 78.08 20.49 62.43 15.44 41.67 22.54 20.49 74.79 13.49 14.99 68.74 85.92 15.36 15.44 14.99 90.40 13.72 20.49 39.27 13.19 46.22 84.75 42.95 50.54 15.51 36923733 PNEUMOCOCCAL IGG ABS TYPE 4 86317 300 $113.00 41.76 13.19 90.40 23.56 78.08 15.74 78.08 20.49 62.43 15.44 41.67 22.54 20.49 74.79 13.49 14.99 68.74 85.92 15.36 15.44 14.99 90.40 13.72 20.49 39.27 13.19 46.22 84.75 42.95 50.54 15.51 36923741 PNEUMOCOCCAL IGG ABS TYPE 5 86317 300 $113.00 41.76 13.19 90.40 23.56 78.08 15.74 78.08 20.49 62.43 15.44 41.67 22.54 20.49 74.79 13.49 14.99 68.74 85.92 15.36 15.44 14.99 90.40 13.72 20.49 39.27 13.19 46.22 84.75 42.95 50.54 15.51 36923750 PNEUMOCOCCAL IGG ABS TYPE 8 86317 300 $113.00 41.76 13.19 90.40 23.56 78.08 15.74 78.08 20.49 62.43 15.44 41.67 22.54 20.49 74.79 13.49 14.99 68.74 85.92 15.36 15.44 14.99 90.40 13.72 20.49 39.27 13.19 46.22 84.75 42.95 50.54 15.51 36923768 PNEUMOCOCCAL IGG ABS TYPE 9 86317 300 $113.00 41.76 13.19 90.40 23.56 78.08 15.74 78.08 20.49 62.43 15.44 41.67 22.54 20.49 74.79 13.49 14.99 68.74 85.92 15.36 15.44 14.99 90.40 13.72 20.49 39.27 13.19 46.22 84.75 42.95 50.54 15.51 36923776 PNEUMOCOCCAL IGG ABS TYPE 12 86317 300 $113.00 41.76 13.19 90.40 23.56 78.08 15.74 78.08 20.49 62.43 15.44 41.67 22.54 20.49 74.79 13.49 14.99 68.74 85.92 15.36 15.44 14.99 90.40 13.72 20.49 39.27 13.19 46.22 84.75 42.95 50.54 15.51 36923784 PNEUMOCOCCAL IGG ABS TYPE 14 86317 300 $113.00 41.76 13.19 90.40 23.56 78.08 15.74 78.08 20.49 62.43 15.44 41.67 22.54 20.49 74.79 13.49 14.99 68.74 85.92 15.36 15.44 14.99 90.40 13.72 20.49 39.27 13.19 46.22 84.75 42.95 50.54 15.51 36923792 PNEUMOCOCCAL IGG ABS TYPE 19 86317 300 $113.00 41.76 13.19 90.40 23.56 78.08 15.74 78.08 20.49 62.43 15.44 41.67 22.54 20.49 74.79 13.49 14.99 68.74 85.92 15.36 15.44 14.99 90.40 13.72 20.49 39.27 13.19 46.22 84.75 42.95 50.54 15.51 36923806 PNEUMOCOCCAL IGG ABS TYPE 23 86317 300 $113.00 41.76 13.19 90.40 23.56 78.08 15.74 78.08 20.49 62.43 15.44 41.67 22.54 20.49 74.79 13.49 14.99 68.74 85.92 15.36 15.44 14.99 90.40 13.72 20.49 39.27 13.19 46.22 84.75 42.95 50.54 15.51 36923814 PNEUMOCOCCAL IGG ABS TYPE 51 86317 300 $113.00 41.76 13.19 90.40 23.56 78.08 15.74 78.08 20.49 62.43 15.44 41.67 22.54 20.49 74.79 13.49 14.99 68.74 85.92 15.36 15.44 14.99 90.40 13.72 20.49 39.27 13.19 46.22 84.75 42.95 50.54 15.51 36923822 PNEUMOCOCCAL IGG ABS TYPE 56 86317 300 $113.00 41.76 13.19 90.40 23.56 78.08 15.74 78.08 20.49 62.43 15.44 41.67 22.54 20.49 74.79 13.49 14.99 68.74 85.92 15.36 15.44 14.99 90.40 13.72 20.49 39.27 13.19 46.22 84.75 42.95 50.54 15.51 36923831 PNEUMOCOCCAL IGG AGS TYPE 68 86317 300 $116.00 42.87 13.19 92.80 23.56 80.16 15.74 80.16 20.49 64.09 15.44 41.67 22.54 20.49 76.78 13.49 14.99 68.74 85.92 15.36 15.44 14.99 92.80 13.72 20.49 39.27 13.19 47.44 87.00 44.09 51.89 15.51 36923849 PNEUMOCOCCAL IGG ABS TYPE 26 86317 300 $116.00 42.87 13.19 92.80 23.56 80.16 15.74 80.16 20.49 64.09 15.44 41.67 22.54 20.49 76.78 13.49 14.99 68.74 85.92 15.36 15.44 14.99 92.80 13.72 20.49 39.27 13.19 47.44 87.00 44.09 51.89 15.51 36923857 PNEUMO AB IMMUNOASSAY QUANT 86317 300 $125.00 46.20 13.19 100.00 23.56 86.38 15.74 86.38 20.49 69.06 15.44 41.67 22.54 20.49 82.74 13.49 14.99 68.74 85.92 15.36 15.44 14.99 100.00 13.72 20.49 39.27 13.19 51.13 93.75 47.51 55.91 15.51 36923865 PNEUMO AB IMMUNOASSAY QUANT 86317 300 $125.00 46.20 13.19 100.00 23.56 86.38 15.74 86.38 20.49 69.06 15.44 41.67 22.54 20.49 82.74 13.49 14.99 68.74 85.92 15.36 15.44 14.99 100.00 13.72 20.49 39.27 13.19 51.13 93.75 47.51 55.91 15.51 36923873 PNEUMO AB IMMUNOASSAY QUANT 86317 300 $125.00 46.20 13.19 100.00 23.56 86.38 15.74 86.38 20.49 69.06 15.44 41.67 22.54 20.49 82.74 13.49 14.99 68.74 85.92 15.36 15.44 14.99 100.00 13.72 20.49 39.27 13.19 51.13 93.75 47.51 55.91 15.51 36923881 PNEUMO AB IMMUNOASSAY QUANT 86317 300 $125.00 46.20 13.19 100.00 23.56 86.38 15.74 86.38 20.49 69.06 15.44 41.67 22.54 20.49 82.74 13.49 14.99 68.74 85.92 15.36 15.44 14.99 100.00 13.72 20.49 39.27 13.19 51.13 93.75 47.51 55.91 15.51 36923890 PNEUMO AB IMMUNOASSAY QUANT 86317 300 $125.00 46.20 13.19 100.00 23.56 86.38 15.74 86.38 20.49 69.06 15.44 41.67 22.54 20.49 82.74 13.49 14.99 68.74 85.92 15.36 15.44 14.99 100.00 13.72 20.49 39.27 13.19 51.13 93.75 47.51 55.91 15.51 36923903 PNEUMO AB IMMUNOASSAY QUANT 86317 300 $125.00 46.20 13.19 100.00 23.56 86.38 15.74 86.38 20.49 69.06 15.44 41.67 22.54 20.49 82.74 13.49 14.99 68.74 85.92 15.36 15.44 14.99 100.00 13.72 20.49 39.27 13.19 51.13 93.75 47.51 55.91 15.51 36930993 IMMUNOASSAY INFECT ANTIBODY 86317 300 $86.00 31.79 13.19 85.92 23.56 59.43 15.74 59.43 20.49 47.52 15.44 41.67 22.54 20.49 56.92 13.49 14.99 68.74 85.92 15.36 15.44 14.99 68.80 13.72 20.49 39.27 13.19 35.17 64.50 32.69 38.47 15.51 36931001 IMMUNOASSAY INFECT ANTIBODY 86317 300 $86.00 31.79 13.19 85.92 23.56 59.43 15.74 59.43 20.49 47.52 15.44 41.67 22.54 20.49 56.92 13.49 14.99 68.74 85.92 15.36 15.44 14.99 68.80 13.72 20.49 39.27 13.19 35.17 64.50 32.69 38.47 15.51 36931019 IMMUNOASSAY INFECT ANTIBODY 86317 300 $86.00 31.79 13.19 85.92 23.56 59.43 15.74 59.43 20.49 47.52 15.44 41.67 22.54 20.49 56.92 13.49 14.99 68.74 85.92 15.36 15.44 14.99 68.80 13.72 20.49 39.27 13.19 35.17 64.50 32.69 38.47 15.51 36931027 IMMUNOASSAY INFECT ANTIBODY 86317 300 $86.00 31.79 13.19 85.92 23.56 59.43 15.74 59.43 20.49 47.52 15.44 41.67 22.54 20.49 56.92 13.49 14.99 68.74 85.92 15.36 15.44 14.99 68.80 13.72 20.49 39.27 13.19 35.17 64.50 32.69 38.47 15.51 36931035 IMMUNOASSAY INFECT ANTIBODY 86317 300 $86.00 31.79 13.19 85.92 23.56 59.43 15.74 59.43 20.49 47.52 15.44 41.67 22.54 20.49 56.92 13.49 14.99 68.74 85.92 15.36 15.44 14.99 68.80 13.72 20.49 39.27 13.19 35.17 64.50 32.69 38.47 15.51 36931043 IMMUNOASSAY INFECT ANTIBODY 86317 300 $86.00 31.79 13.19 85.92 23.56 59.43 15.74 59.43 20.49 47.52 15.44 41.67 22.54 20.49 56.92 13.49 14.99 68.74 85.92 15.36 15.44 14.99 68.80 13.72 20.49 39.27 13.19 35.17 64.50 32.69 38.47 15.51 36931051 IMMUNOASSAY INFECT ANTIBODY 86317 300 $86.00 31.79 13.19 85.92 23.56 59.43 15.74 59.43 20.49 47.52 15.44 41.67 22.54 20.49 56.92 13.49 14.99 68.74 85.92 15.36 15.44 14.99 68.80 13.72 20.49 39.27 13.19 35.17 64.50 32.69 38.47 15.51 36931060 IMMUNOASSAY INFECT ANTIBODY 86317 300 $86.00 31.79 13.19 85.92 23.56 59.43 15.74 59.43 20.49 47.52 15.44 41.67 22.54 20.49 56.92 13.49 14.99 68.74 85.92 15.36 15.44 14.99 68.80 13.72 20.49 39.27 13.19 35.17 64.50 32.69 38.47 15.51 36931078 IMMUNOASSAY INFECT ANTIBODY 86317 300 $86.00 31.79 13.19 85.92 23.56 59.43 15.74 59.43 20.49 47.52 15.44 41.67 22.54 20.49 56.92 13.49 14.99 68.74 85.92 15.36 15.44 14.99 68.80 13.72 20.49 39.27 13.19 35.17 64.50 32.69 38.47 15.51 36931086 IMMUNOASSAY INFECT ANTIBODY 86317 300 $86.00 31.79 13.19 85.92 23.56 59.43 15.74 59.43 20.49 47.52 15.44 41.67 22.54 20.49 56.92 13.49 14.99 68.74 85.92 15.36 15.44 14.99 68.80 13.72 20.49 39.27 13.19 35.17 64.50 32.69 38.47 15.51 36931094 IMMUNOASSAY INFECT ANTIBODY 86317 300 $86.00 31.79 13.19 85.92 23.56 59.43 15.74 59.43 20.49 47.52 15.44 41.67 22.54 20.49 56.92 13.49 14.99 68.74 85.92 15.36 15.44 14.99 68.80 13.72 20.49 39.27 13.19 35.17 64.50 32.69 38.47 15.51 36931108 IMMUNOASSAY INFECT ANTIBODY 86317 300 $83.00 30.68 13.19 85.92 23.56 57.35 15.74 57.35 20.49 45.86 15.44 41.67 22.54 20.49 54.94 13.49 14.99 68.74 85.92 15.36 15.44 14.99 66.40 13.72 20.49 39.27 13.19 33.95 62.25 31.55 37.13 15.51 36940514 IA FOR CJD AB 86317 300 $147.00 54.33 13.19 117.60 23.56 101.58 15.74 101.58 20.49 81.22 15.44 41.67 22.54 20.49 97.30 13.49 14.99 68.74 85.92 15.36 15.44 14.99 117.60 13.72 20.49 39.27 13.19 60.12 110.25 55.87 65.75 15.51 36914416 TEICHOIC ACID ANTIBODY ID 86329 300 $161.00 59.51 12.36 128.80 19.55 111.25 14.75 111.25 17.00 88.95 14.47 39.03 18.70 17.00 106.57 12.65 14.05 90.83 113.54 14.40 14.47 14.05 128.80 12.86 17.00 36.81 12.36 65.85 120.75 61.20 72.02 14.54 36918713 C4 BINDING PROTEIN 86329 300 $691.00 255.39 12.36 552.80 19.55 477.48 14.75 477.48 17.00 381.78 14.47 39.03 18.70 17.00 457.37 12.65 14.05 90.83 113.54 14.40 14.47 14.05 552.80 12.86 17.00 36.81 12.36 282.62 518.25 262.65 309.08 14.54 36922095 TEICHOIC ACID AB SCREEN 86331 300 $111.00 41.03 8.00 88.80 9.20 76.70 12.58 76.70 8.00 61.33 12.34 33.32 8.80 8.00 73.47 10.78 11.98 54.94 68.67 12.28 12.34 11.98 88.80 10.96 8.00 31.39 10.54 45.40 83.25 42.19 49.65 12.40 36922931 GEL DIFFUSION QUAL 1 86331 300 $83.00 30.68 8.00 68.67 9.20 57.35 12.58 57.35 8.00 45.86 12.34 33.32 8.80 8.00 54.94 10.78 11.98 54.94 68.67 12.28 12.34 11.98 66.40 10.96 8.00 31.39 10.54 33.95 62.25 31.55 37.13 12.40 36922940 GEL DIFFUSION QUAL 2 86331 300 $83.00 30.68 8.00 68.67 9.20 57.35 12.58 57.35 8.00 45.86 12.34 33.32 8.80 8.00 54.94 10.78 11.98 54.94 68.67 12.28 12.34 11.98 66.40 10.96 8.00 31.39 10.54 33.95 62.25 31.55 37.13 12.40 36910674 C3B BINDING ASSAY 86332 300 $258.00 95.36 21.45 206.40 34.50 178.28 25.59 178.28 30.00 142.55 25.10 67.76 33.00 30.00 170.77 21.93 24.37 111.73 139.66 24.98 25.10 24.37 206.40 22.30 30.00 63.85 21.45 105.52 193.50 98.07 115.40 25.22 36911077 IMMUNE COMPLEX DETECTION 86332 300 $243.00 89.81 21.45 194.40 34.50 167.91 25.59 167.91 30.00 134.26 25.10 67.76 33.00 30.00 160.84 21.93 24.37 111.73 139.66 24.98 25.10 24.37 194.40 22.30 30.00 63.85 21.45 99.39 182.25 92.36 108.69 25.22 36100508 IMMUNOFIXATION ELECTROPHORESIS 86334 300 $117.00 43.24 19.66 127.98 32.20 80.85 23.46 80.85 28.00 64.64 23.01 62.14 30.80 28.00 77.44 20.11 22.34 102.38 127.98 22.90 23.01 22.34 93.60 20.44 28.00 58.53 19.66 47.85 87.75 44.47 52.33 23.12 36100150 BENCE-JONES PROT IEP URINE QNT 86335 300 $154.00 56.92 25.83 123.20 37.72 106.41 30.82 106.41 32.80 85.09 30.23 81.58 36.08 32.80 101.93 26.42 29.35 40.78 50.98 30.08 30.23 29.35 123.20 26.86 32.80 76.90 25.83 62.99 115.50 58.54 68.88 30.38 36911557 BETA 2 TRANSFERRIN 86335 300 "$1,435.00" 530.38 25.83 " 1,148.00 " 37.72 991.59 30.82 991.59 32.80 792.84 30.23 81.58 36.08 32.80 949.83 26.42 29.35 40.78 50.98 30.08 30.23 29.35 " 1,148.00 " 26.86 32.80 76.90 25.83 586.92 " 1,076.25 " 545.44 641.88 30.38 35708651 INHIBIN A 86336 300 $82.00 30.31 - 752.32 - 56.66 16.37 56.66 - 45.31 16.06 43.33 - - 54.28 14.03 15.59 601.86 752.32 15.98 16.06 15.59 65.60 14.26 - 40.85 13.72 33.54 61.50 31.17 36.68 16.14 36942614 INHIBIN A 86336 300 $82.00 30.31 - 752.32 - 56.66 16.37 56.66 - 45.31 16.06 43.33 - - 54.28 14.03 15.59 601.86 752.32 15.98 16.06 15.59 65.60 14.26 - 40.85 13.72 33.54 61.50 31.17 36.68 16.14 36917288 INSULIN AUTOANTIBODIES 86337 300 $175.00 64.68 11.00 140.00 12.65 120.93 22.48 120.93 11.00 96.69 22.05 59.50 12.10 11.00 115.83 19.27 21.41 59.17 73.96 21.95 22.05 21.41 140.00 19.59 11.00 56.09 18.84 71.58 131.25 66.52 78.28 22.16 36901128 INTRINSIC FACTOR BLOCKING AB 86340 300 $147.00 54.33 13.27 121.47 23.95 101.58 15.83 101.58 20.83 81.22 15.53 41.92 22.91 20.83 97.30 13.57 15.08 97.18 121.47 15.46 15.53 15.08 117.60 13.80 20.83 39.51 13.27 60.12 110.25 55.87 65.75 15.61 36910721 ANTI-ISLET CELL ANTIBODY 86341 300 $343.00 126.77 20.74 274.40 31.44 237.01 24.75 237.01 27.34 189.51 24.28 55.01 30.07 27.34 227.03 21.21 23.57 127.56 159.45 24.16 24.28 23.57 274.40 21.57 27.34 61.75 20.74 140.29 257.25 130.37 153.42 24.39 36933275 ISLET CELL ANTIBODY TITER 86341 300 $343.00 126.77 20.74 274.40 31.44 237.01 24.75 237.01 27.34 189.51 24.28 55.01 30.07 27.34 227.03 21.21 23.57 127.56 159.45 24.16 24.28 23.57 274.40 21.57 27.34 61.75 20.74 140.29 257.25 130.37 153.42 24.39 36937378 GAD 65 AB IMM NON AB 86341 300 "$1,409.00" 520.77 20.74 " 1,127.20 " 31.44 973.62 24.75 973.62 27.34 778.47 24.28 55.01 30.07 27.34 932.62 21.21 23.57 127.56 159.45 24.16 24.28 23.57 " 1,127.20 " 21.57 27.34 61.75 20.74 576.28 " 1,056.75 " 535.56 630.25 24.39 36938226 ACH RECEPTOR MOD AB IS CELL 86341 300 "$1,305.00" 482.33 20.74 " 1,044.00 " 31.44 901.76 24.75 901.76 27.34 721.01 24.28 55.01 30.07 27.34 863.78 21.21 23.57 127.56 159.45 24.16 24.28 23.57 " 1,044.00 " 21.57 27.34 61.75 20.74 533.75 978.75 496.03 583.73 24.39 36938251 GAD65 AB MAYO IS CELL 86341 300 "$1,053.00" 389.19 20.74 842.40 31.44 727.62 24.75 727.62 27.34 581.78 24.28 55.01 30.07 27.34 696.98 21.21 23.57 127.56 159.45 24.16 24.28 23.57 842.40 21.57 27.34 61.75 20.74 430.68 789.75 400.25 471.01 24.39 36939460 ISLET CELL ANTIBODY 86341 300 "$1,471.00" 543.68 20.74 " 1,176.80 " 31.44 " 1,016.46 " 24.75 " 1,016.46 " 27.34 812.73 24.28 55.01 30.07 27.34 973.65 21.21 23.57 127.56 159.45 24.16 24.28 23.57 " 1,176.80 " 21.57 27.34 61.75 20.74 601.64 " 1,103.25 " 559.13 657.98 24.39 36939516 ISLET CELL ANTIBODY 86341 300 "$1,325.00" 489.72 20.74 " 1,060.00 " 31.44 915.58 24.75 915.58 27.34 732.06 24.28 55.01 30.07 27.34 877.02 21.21 23.57 127.56 159.45 24.16 24.28 23.57 " 1,060.00 " 21.57 27.34 61.75 20.74 541.93 993.75 503.63 592.67 24.39 36939711 ISLET CELL ANTIBODY 86341 300 "$1,381.00" 510.42 20.74 " 1,104.80 " 31.44 954.27 24.75 954.27 27.34 763.00 24.28 55.01 30.07 27.34 914.08 21.21 23.57 127.56 159.45 24.16 24.28 23.57 " 1,104.80 " 21.57 27.34 61.75 20.74 564.83 " 1,035.75 " 524.92 617.72 24.39 36940794 GAD65 INSULIN DEPENDENCE AB 86341 300 $343.00 126.77 20.74 274.40 31.44 237.01 24.75 237.01 27.34 189.51 24.28 55.01 30.07 27.34 227.03 21.21 23.57 127.56 159.45 24.16 24.28 23.57 274.40 21.57 27.34 61.75 20.74 140.29 257.25 130.37 153.42 24.39 36943955 ISLET CELL ANTIBODY 86341 300 $440.00 162.62 20.74 352.00 31.44 304.04 24.75 304.04 27.34 243.10 24.28 55.01 30.07 27.34 291.24 21.21 23.57 127.56 159.45 24.16 24.28 23.57 352.00 21.57 27.34 61.75 20.74 179.96 330.00 167.24 196.81 24.39 36944455 ISLET CELL ANTIBODY IA2 86341 300 $435.00 160.78 20.74 348.00 31.44 300.59 24.75 300.59 27.34 240.34 24.28 55.01 30.07 27.34 287.93 21.21 23.57 127.56 159.45 24.16 24.28 23.57 348.00 21.57 27.34 61.75 20.74 177.92 326.25 165.34 194.58 24.39 36930934 LEUKOCYTE HISTAMINE RELEASE 86343 300 $236.00 87.23 - 188.80 - 163.08 13.08 163.08 - 130.39 12.83 34.67 - - 156.21 11.21 12.46 80.34 100.42 12.77 12.83 12.46 188.80 11.40 - 32.65 10.96 96.52 177.00 89.70 105.56 12.90 36944978 LEUKOCYTE HISTAMINE RELEASE CU 86343 300 $94.00 34.74 - 100.42 - 64.95 13.08 64.95 - 51.94 12.83 34.67 - - 62.22 11.21 12.46 80.34 100.42 12.77 12.83 12.46 75.20 11.40 - 32.65 10.96 38.45 70.50 35.73 42.05 12.90 36934476 IMMUNE CELL FUNC ASSAY W/STIM 86352 300 $801.00 296.05 77.84 640.80 89.52 553.49 142.65 553.49 77.84 442.55 139.94 377.74 85.62 77.84 530.18 122.27 135.86 429.02 536.27 139.26 139.94 135.86 640.80 124.31 77.84 355.95 119.56 327.61 600.75 304.46 358.29 140.62 36931213 LYMPHOCYTE TRANSFORMATION 86353 300 $660.00 243.94 43.15 528.00 77.91 456.06 51.48 456.06 67.75 364.65 50.50 136.31 74.53 67.75 436.85 44.13 49.03 316.05 395.06 50.26 50.50 49.03 528.00 44.86 67.75 128.46 43.15 269.94 495.00 250.87 295.22 50.75 36931221 LYMPHOCYTE TRANSFORMATION 86353 300 $660.00 243.94 43.15 528.00 77.91 456.06 51.48 456.06 67.75 364.65 50.50 136.31 74.53 67.75 436.85 44.13 49.03 316.05 395.06 50.26 50.50 49.03 528.00 44.86 67.75 128.46 43.15 269.94 495.00 250.87 295.22 50.75 36931230 LYMPHOCYTE TRANSFORMATION 86353 300 $666.00 246.15 43.15 532.80 77.91 460.21 51.48 460.21 67.75 367.97 50.50 136.31 74.53 67.75 440.83 44.13 49.03 316.05 395.06 50.26 50.50 49.03 532.80 44.86 67.75 128.46 43.15 272.39 499.50 253.15 297.90 50.75 36931248 LYMPHOCYTE TRANSFORMATION 86353 300 $666.00 246.15 43.15 532.80 77.91 460.21 51.48 460.21 67.75 367.97 50.50 136.31 74.53 67.75 440.83 44.13 49.03 316.05 395.06 50.26 50.50 49.03 532.80 44.86 67.75 128.46 43.15 272.39 499.50 253.15 297.90 50.75 36931256 LYMPHOCYTE TRANSFORMATION 86353 300 $666.00 246.15 43.15 532.80 77.91 460.21 51.48 460.21 67.75 367.97 50.50 136.31 74.53 67.75 440.83 44.13 49.03 316.05 395.06 50.26 50.50 49.03 532.80 44.86 67.75 128.46 43.15 272.39 499.50 253.15 297.90 50.75 36931264 LYMPHOCYTE TRANSFORMATION 86353 300 $666.00 246.15 43.15 532.80 77.91 460.21 51.48 460.21 67.75 367.97 50.50 136.31 74.53 67.75 440.83 44.13 49.03 316.05 395.06 50.26 50.50 49.03 532.80 44.86 67.75 128.46 43.15 272.39 499.50 253.15 297.90 50.75 36931272 LYMPHOCYTE TRANSFORMATION 86353 300 $666.00 246.15 43.15 532.80 77.91 460.21 51.48 460.21 67.75 367.97 50.50 136.31 74.53 67.75 440.83 44.13 49.03 316.05 395.06 50.26 50.50 49.03 532.80 44.86 67.75 128.46 43.15 272.39 499.50 253.15 297.90 50.75 36931281 LYMPHOCYTE TRANSFORMATION 86353 300 $666.00 246.15 43.15 532.80 77.91 460.21 51.48 460.21 67.75 367.97 50.50 136.31 74.53 67.75 440.83 44.13 49.03 316.05 395.06 50.26 50.50 49.03 532.80 44.86 67.75 128.46 43.15 272.39 499.50 253.15 297.90 50.75 36931299 LYMPHOCYTE TRANSFORMATION 86353 300 $663.00 245.04 43.15 530.40 77.91 458.13 51.48 458.13 67.75 366.31 50.50 136.31 74.53 67.75 438.84 44.13 49.03 316.05 395.06 50.26 50.50 49.03 530.40 44.86 67.75 128.46 43.15 271.17 497.25 252.01 296.56 50.75 36150173 FLOW CD19 (B CELL TOTAL COUNT) 86355 300 $198.00 73.18 33.20 290.46 48.48 136.82 39.62 136.82 42.16 109.40 38.86 104.88 46.38 42.16 131.06 33.96 37.73 232.37 290.46 38.67 38.86 37.73 158.40 34.52 42.16 98.85 33.20 80.98 148.50 75.26 88.57 39.05 36998563 B CELLS TOTAL COUNT 86355 300 $198.00 73.18 33.20 290.46 48.48 136.82 39.62 136.82 42.16 109.40 38.86 104.88 46.38 42.16 131.06 33.96 37.73 232.37 290.46 38.67 38.86 37.73 158.40 34.52 42.16 98.85 33.20 80.98 148.50 75.26 88.57 39.05 36150181 FLOW CD56 (NK TOTAL COUNT) 86357 300 $198.00 73.18 33.20 290.46 48.48 136.82 39.62 136.82 42.16 109.40 38.86 104.88 46.38 42.16 131.06 33.96 37.73 232.37 290.46 38.67 38.86 37.73 158.40 34.52 42.16 98.85 33.20 80.98 148.50 75.26 88.57 39.05 36998571 NATURAL KILLER CELLS TOTAL 86357 300 $198.00 73.18 33.20 290.46 48.48 136.82 39.62 136.82 42.16 109.40 38.86 104.88 46.38 42.16 131.06 33.96 37.73 232.37 290.46 38.67 38.86 37.73 158.40 34.52 42.16 98.85 33.20 80.98 148.50 75.26 88.57 39.05 36103779 FLOW CYTO T CELLS TOTAL COUNT 86359 300 $198.00 73.18 33.20 284.78 57.50 136.82 39.62 136.82 50.00 109.40 38.86 104.88 55.00 50.00 131.06 33.96 37.73 227.82 284.78 38.67 38.86 37.73 158.40 34.52 50.00 98.85 33.20 80.98 148.50 75.26 88.57 39.05 36150343 FLOW CD3 (T CELLS TOTAL COUNT) 86359 300 $198.00 73.18 33.20 284.78 57.50 136.82 39.62 136.82 50.00 109.40 38.86 104.88 55.00 50.00 131.06 33.96 37.73 227.82 284.78 38.67 38.86 37.73 158.40 34.52 50.00 98.85 33.20 80.98 148.50 75.26 88.57 39.05 36910607 CD18 86359 300 $328.00 121.23 33.20 284.78 57.50 226.65 39.62 226.65 50.00 181.22 38.86 104.88 55.00 50.00 217.10 33.96 37.73 227.82 284.78 38.67 38.86 37.73 262.40 34.52 50.00 98.85 33.20 134.15 246.00 124.67 146.71 39.05 36998580 T CELLS TOTAL COUNT 86359 300 $198.00 73.18 33.20 284.78 57.50 136.82 39.62 136.82 50.00 109.40 38.86 104.88 55.00 50.00 131.06 33.96 37.73 227.82 284.78 38.67 38.86 37.73 158.40 34.52 50.00 98.85 33.20 80.98 148.50 75.26 88.57 39.05 36150599 FLOW CYTO ABS CD4/CD8 RATIO 86360 300 $247.00 91.29 41.34 374.62 73.88 170.68 49.33 170.68 64.24 136.47 48.39 130.66 70.66 64.24 163.49 42.28 46.98 299.70 374.62 48.15 48.39 46.98 197.60 42.99 64.24 123.09 41.34 101.02 185.25 93.88 110.48 48.62 36998598 T CELLS ABSOLUTE CD4 CD8 W RAT 86360 300 $247.00 91.29 41.34 374.62 73.88 170.68 49.33 170.68 64.24 136.47 48.39 130.66 70.66 64.24 163.49 42.28 46.98 299.70 374.62 48.15 48.39 46.98 197.60 42.99 64.24 123.09 41.34 101.02 185.25 93.88 110.48 48.62 36104228 CD34 TOTAL COUNT 86367 300 $408.00 150.80 42.16 326.40 48.48 281.93 81.67 281.93 42.16 225.42 80.11 104.88 46.38 42.16 270.06 70.00 77.78 232.37 290.46 79.72 80.11 77.78 326.40 71.17 42.16 203.78 68.45 166.87 306.00 155.08 182.50 80.50 35708201 MICROSOMAL ANTIBODY (THYROID) 86376 300 $76.00 28.09 7.91 60.80 9.10 52.52 15.28 52.52 7.91 41.99 14.99 40.44 8.70 7.91 50.30 13.10 14.55 42.33 52.91 14.91 14.99 14.55 60.80 13.31 7.91 38.12 12.80 31.08 57.00 28.89 33.99 15.06 36921404 LIVER KIDNEY MICROSOMAL ANTIBO 86376 300 $327.00 120.86 7.91 261.60 9.10 225.96 15.28 225.96 7.91 180.67 14.99 40.44 8.70 7.91 216.44 13.10 14.55 42.33 52.91 14.91 14.99 14.55 261.60 13.31 7.91 38.12 12.80 133.74 245.25 124.29 146.27 15.06 36930969 MICROSOMAL ANTIBODY 86376 300 $272.00 100.53 7.91 217.60 9.10 187.95 15.28 187.95 7.91 150.28 14.99 40.44 8.70 7.91 180.04 13.10 14.55 42.33 52.91 14.91 14.99 14.55 217.60 13.31 7.91 38.12 12.80 111.25 204.00 103.39 121.67 15.06 36944986 MICROSOM ANTI THYROID PERX IGG 86376 300 $110.00 40.66 7.91 88.00 9.10 76.01 15.28 76.01 7.91 60.78 14.99 40.44 8.70 7.91 72.81 13.10 14.55 42.33 52.91 14.91 14.99 14.55 88.00 13.31 7.91 38.12 12.80 44.99 82.50 41.81 49.20 15.06 36917245 NABFERON NEUTRALIZATION AB 86382 300 "$1,818.00" 671.93 - " 1,454.40 " - " 1,256.24 " 17.76 " 1,256.24 " - " 1,004.45 " 17.42 47.04 - - " 1,203.33 " 15.22 16.91 108.99 136.24 17.33 17.42 16.91 " 1,454.40 " 15.47 - 44.30 14.88 743.56 " 1,363.50 " 691.02 813.19 17.50 36938374 NEUTRALIZATION TEST VIRAL 86382 300 $307.00 113.47 - 245.60 - 212.14 17.76 212.14 - 169.62 17.42 47.04 - - 203.20 15.22 16.91 108.99 136.24 17.33 17.42 16.91 245.60 15.47 - 44.30 14.88 125.56 230.25 116.69 137.32 17.50 36938382 NEUTRALIZATION TEST VIRAL 86382 300 $307.00 113.47 - 245.60 - 212.14 17.76 212.14 - 169.62 17.42 47.04 - - 203.20 15.22 16.91 108.99 136.24 17.33 17.42 16.91 245.60 15.47 - 44.30 14.88 125.56 230.25 116.69 137.32 17.50 36938391 NEUTRALIZATION TEST VIRAL 86382 300 $307.00 113.47 - 245.60 - 212.14 17.76 212.14 - 169.62 17.42 47.04 - - 203.20 15.22 16.91 108.99 136.24 17.33 17.42 16.91 245.60 15.47 - 44.30 14.88 125.56 230.25 116.69 137.32 17.50 36910348 H INFLUENZAE TYPE B ANTIGENS 86403 300 $109.00 40.29 10.16 87.20 16.19 75.32 12.12 75.32 14.08 60.22 11.89 28.32 15.49 14.08 72.15 10.39 11.54 46.70 58.37 11.83 11.89 11.54 87.20 10.56 14.08 30.23 10.16 44.58 81.75 41.43 48.76 11.94 36910399 CANDIDIASIS AG 86403 300 $400.00 147.84 10.16 320.00 16.19 276.40 12.12 276.40 14.08 221.00 11.89 28.32 15.49 14.08 264.76 10.39 11.54 46.70 58.37 11.83 11.89 11.54 320.00 10.56 14.08 30.23 10.16 163.60 300.00 152.04 178.92 11.94 36912201 STREP GROUP B AG PART AGGL 86403 300 $61.00 22.55 10.16 58.37 16.19 42.15 12.12 42.15 14.08 33.70 11.89 28.32 15.49 14.08 40.38 10.39 11.54 46.70 58.37 11.83 11.89 11.54 48.80 10.56 14.08 30.23 10.16 24.95 45.75 23.19 27.29 11.94 36912219 STREP PNEUM AGS PART AGGL 86403 300 $61.00 22.55 10.16 58.37 16.19 42.15 12.12 42.15 14.08 33.70 11.89 28.32 15.49 14.08 40.38 10.39 11.54 46.70 58.37 11.83 11.89 11.54 48.80 10.56 14.08 30.23 10.16 24.95 45.75 23.19 27.29 11.94 36912227 HAEM INFLU TYPE B PART AGGL 86403 300 $61.00 22.55 10.16 58.37 16.19 42.15 12.12 42.15 14.08 33.70 11.89 28.32 15.49 14.08 40.38 10.39 11.54 46.70 58.37 11.83 11.89 11.54 48.80 10.56 14.08 30.23 10.16 24.95 45.75 23.19 27.29 11.94 36912243 NEIS MEN B/E COLI K1 PAR AGGL 86403 300 $61.00 22.55 10.16 58.37 16.19 42.15 12.12 42.15 14.08 33.70 11.89 28.32 15.49 14.08 40.38 10.39 11.54 46.70 58.37 11.83 11.89 11.54 48.80 10.56 14.08 30.23 10.16 24.95 45.75 23.19 27.29 11.94 36912251 NEIS MEN A C Y W135 86403 300 $61.00 22.55 10.16 58.37 16.19 42.15 12.12 42.15 14.08 33.70 11.89 28.32 15.49 14.08 40.38 10.39 11.54 46.70 58.37 11.83 11.89 11.54 48.80 10.56 14.08 30.23 10.16 24.95 45.75 23.19 27.29 11.94 36914394 STREPTOZYME 86403 300 $122.00 45.09 10.16 97.60 16.19 84.30 12.12 84.30 14.08 67.41 11.89 28.32 15.49 14.08 80.75 10.39 11.54 46.70 58.37 11.83 11.89 11.54 97.60 10.56 14.08 30.23 10.16 49.90 91.50 46.37 54.57 11.94 36930241 NEIS MEN A/Y PART AGGL 86403 300 $61.00 22.55 10.16 58.37 16.19 42.15 12.12 42.15 14.08 33.70 11.89 28.32 15.49 14.08 40.38 10.39 11.54 46.70 58.37 11.83 11.89 11.54 48.80 10.56 14.08 30.23 10.16 24.95 45.75 23.19 27.29 11.94 36937092 STREP TITER EA AB 86406 300 $79.00 29.20 9.36 82.12 16.77 54.59 11.17 54.59 14.58 43.65 10.96 29.58 16.04 14.58 52.29 9.58 10.64 65.70 82.12 10.91 10.96 10.64 63.20 9.74 14.58 27.88 9.36 32.31 59.25 30.03 35.34 11.01 35707930 RHEUMATOID FACTOR QUANT 86431 300 $30.00 11.09 4.99 32.02 8.89 20.73 5.95 20.73 7.73 16.58 5.84 15.76 8.50 7.73 19.86 5.10 5.67 25.62 32.02 5.81 5.84 5.67 24.00 5.19 7.73 14.86 4.99 12.27 22.50 11.40 13.42 5.87 36900610 QUANTIFERON GOLD TB TEST 86480 300 $325.00 120.12 54.54 477.24 81.67 224.58 65.08 224.58 71.02 179.56 63.84 172.32 78.12 71.02 215.12 55.78 61.98 381.79 477.24 63.53 63.84 61.98 260.00 56.71 71.02 162.39 54.54 132.93 243.75 123.53 145.37 64.15 36944650 QUANTIFERON TB GOLD PLUS 86480 300 $325.00 120.12 54.54 477.24 81.67 224.58 65.08 224.58 71.02 179.56 63.84 172.32 78.12 71.02 215.12 55.78 61.98 381.79 477.24 63.53 63.84 61.98 260.00 56.71 71.02 162.39 54.54 132.93 243.75 123.53 145.37 64.15 35709100 RPR QUALITATIVE 86592 300 $22.00 8.13 3.76 24.47 4.60 15.20 4.48 15.20 4.00 12.16 4.40 11.87 4.40 4.00 14.56 3.84 4.27 19.58 24.47 4.38 4.40 4.27 17.60 3.91 4.00 11.19 3.76 9.00 16.50 8.36 9.84 4.42 36922702 RPR 86592 300 $102.00 37.70 3.76 81.60 4.60 70.48 4.48 70.48 4.00 56.36 4.40 11.87 4.40 4.00 67.51 3.84 4.27 19.58 24.47 4.38 4.40 4.27 81.60 3.91 4.00 11.19 3.76 41.72 76.50 38.77 45.62 4.42 36924039 VDRL QUALITATIVE 86592 300 $123.00 45.46 3.76 98.40 4.60 84.99 4.48 84.99 4.00 67.96 4.40 11.87 4.40 4.00 81.41 3.84 4.27 19.58 24.47 4.38 4.40 4.27 98.40 3.91 4.00 11.19 3.76 50.31 92.25 46.75 55.02 4.42 36942304 RPR QUALITATIVE 86592 300 $22.00 8.13 3.76 24.47 4.60 15.20 4.48 15.20 4.00 12.16 4.40 11.87 4.40 4.00 14.56 3.84 4.27 19.58 24.47 4.38 4.40 4.27 17.60 3.91 4.00 11.19 3.76 9.00 16.50 8.36 9.84 4.42 35709118 RPR QUANTITATIVE 86593 300 $23.00 8.50 3.87 35.49 7.00 15.89 4.62 15.89 6.09 12.71 4.53 12.21 6.70 6.09 15.22 3.96 4.40 28.39 35.49 4.51 4.53 4.40 18.40 4.03 6.09 11.53 3.87 9.41 17.25 8.74 10.29 4.55 36922885 ADENOVIRUS ANTIBODY SERUM 86603 300 $108.00 39.92 11.33 86.40 20.46 74.63 13.51 74.63 17.79 59.67 13.26 35.76 19.57 17.79 71.49 11.58 12.87 59.04 73.80 13.19 13.26 12.87 86.40 11.78 17.79 33.72 11.33 44.17 81.00 41.05 48.31 13.32 36900644 ASPERGILLUS NIGER ANTIBODY 86606 300 $147.00 54.33 13.24 121.31 23.92 101.58 15.80 101.58 20.80 81.22 15.50 41.86 22.88 20.80 97.30 13.55 15.05 97.05 121.31 15.43 15.50 15.05 117.60 13.77 20.80 39.43 13.24 60.12 110.25 55.87 65.75 15.58 36900652 ASPERGILLUS FUMIGATUS ANTIBODY 86606 300 $147.00 54.33 13.24 121.31 23.92 101.58 15.80 101.58 20.80 81.22 15.50 41.86 22.88 20.80 97.30 13.55 15.05 97.05 121.31 15.43 15.50 15.05 117.60 13.77 20.80 39.43 13.24 60.12 110.25 55.87 65.75 15.58 36901969 ASPER FUMIGATE CF 86606 300 $150.00 55.44 13.24 121.31 23.92 103.65 15.80 103.65 20.80 82.88 15.50 41.86 22.88 20.80 99.29 13.55 15.05 97.05 121.31 15.43 15.50 15.05 120.00 13.77 20.80 39.43 13.24 61.35 112.50 57.02 67.10 15.58 36913541 ASPERGILLUS FLAVUS ANTIBODY 86606 300 $311.00 114.95 13.24 248.80 23.92 214.90 15.80 214.90 20.80 171.83 15.50 41.86 22.88 20.80 205.85 13.55 15.05 97.05 121.31 15.43 15.50 15.05 248.80 13.77 20.80 39.43 13.24 127.20 233.25 118.21 139.11 15.58 36922958 ASPERGILLUS 1 86606 300 $147.00 54.33 13.24 121.31 23.92 101.58 15.80 101.58 20.80 81.22 15.50 41.86 22.88 20.80 97.30 13.55 15.05 97.05 121.31 15.43 15.50 15.05 117.60 13.77 20.80 39.43 13.24 60.12 110.25 55.87 65.75 15.58 36922966 ASPERGILLUS 2 86606 300 $147.00 54.33 13.24 121.31 23.92 101.58 15.80 101.58 20.80 81.22 15.50 41.86 22.88 20.80 97.30 13.55 15.05 97.05 121.31 15.43 15.50 15.05 117.60 13.77 20.80 39.43 13.24 60.12 110.25 55.87 65.75 15.58 36922974 ASPERGILLUS 3 86606 300 $147.00 54.33 13.24 121.31 23.92 101.58 15.80 101.58 20.80 81.22 15.50 41.86 22.88 20.80 97.30 13.55 15.05 97.05 121.31 15.43 15.50 15.05 117.60 13.77 20.80 39.43 13.24 60.12 110.25 55.87 65.75 15.58 36928140 BACTERIUM 1 NOT SPECIFIED 86609 300 $83.00 30.68 - 103.89 - 57.35 13.52 57.35 - 45.86 13.27 35.83 - - 54.94 11.59 12.88 83.11 103.89 13.20 13.27 12.88 66.40 11.79 - 33.75 11.33 33.95 62.25 31.55 37.13 13.33 36928158 BACTERIUM 2 NOT SPECIFIED 86609 300 $83.00 30.68 - 103.89 - 57.35 13.52 57.35 - 45.86 13.27 35.83 - - 54.94 11.59 12.88 83.11 103.89 13.20 13.27 12.88 66.40 11.79 - 33.75 11.33 33.95 62.25 31.55 37.13 13.33 36931116 BACTERIUM ANTIBODY 86609 300 $103.00 38.07 - 103.89 - 71.17 13.52 71.17 - 56.91 13.27 35.83 - - 68.18 11.59 12.88 83.11 103.89 13.20 13.27 12.88 82.40 11.79 - 33.75 11.33 42.13 77.25 39.15 46.07 13.33 36931124 BACTERIUM ANTIBODY 86609 300 $103.00 38.07 - 103.89 - 71.17 13.52 71.17 - 56.91 13.27 35.83 - - 68.18 11.59 12.88 83.11 103.89 13.20 13.27 12.88 82.40 11.79 - 33.75 11.33 42.13 77.25 39.15 46.07 13.33 36931132 BACTERIUM ANTIBODY 86609 300 $103.00 38.07 - 103.89 - 71.17 13.52 71.17 - 56.91 13.27 35.83 - - 68.18 11.59 12.88 83.11 103.89 13.20 13.27 12.88 82.40 11.79 - 33.75 11.33 42.13 77.25 39.15 46.07 13.33 36931141 BACTERIUM ANTIBODY 86609 300 $103.00 38.07 - 103.89 - 71.17 13.52 71.17 - 56.91 13.27 35.83 - - 68.18 11.59 12.88 83.11 103.89 13.20 13.27 12.88 82.40 11.79 - 33.75 11.33 42.13 77.25 39.15 46.07 13.33 36931159 BACTERIUM ANTIBODY 86609 300 $96.00 35.48 - 103.89 - 66.34 13.52 66.34 - 53.04 13.27 35.83 - - 63.54 11.59 12.88 83.11 103.89 13.20 13.27 12.88 76.80 11.79 - 33.75 11.33 39.26 72.00 36.49 42.94 13.33 36931167 BACTERIUM ANTIBODY 86609 300 $96.00 35.48 - 103.89 - 66.34 13.52 66.34 - 53.04 13.27 35.83 - - 63.54 11.59 12.88 83.11 103.89 13.20 13.27 12.88 76.80 11.79 - 33.75 11.33 39.26 72.00 36.49 42.94 13.33 36931175 BACTERIUM ANTIBODY 86609 300 $96.00 35.48 - 103.89 - 66.34 13.52 66.34 - 53.04 13.27 35.83 - - 63.54 11.59 12.88 83.11 103.89 13.20 13.27 12.88 76.80 11.79 - 33.75 11.33 39.26 72.00 36.49 42.94 13.33 36931183 BACTERIUM ANTIBODY 86609 300 $96.00 35.48 - 103.89 - 66.34 13.52 66.34 - 53.04 13.27 35.83 - - 63.54 11.59 12.88 83.11 103.89 13.20 13.27 12.88 76.80 11.79 - 33.75 11.33 39.26 72.00 36.49 42.94 13.33 36931981 BACTERIUM ANTIBODY 86609 300 $105.00 38.81 - 103.89 - 72.56 13.52 72.56 - 58.01 13.27 35.83 - - 69.50 11.59 12.88 83.11 103.89 13.20 13.27 12.88 84.00 11.79 - 33.75 11.33 42.95 78.75 39.91 46.97 13.33 36931990 BACTERIUM ANTIBODY 86609 300 $105.00 38.81 - 103.89 - 72.56 13.52 72.56 - 58.01 13.27 35.83 - - 69.50 11.59 12.88 83.11 103.89 13.20 13.27 12.88 84.00 11.79 - 33.75 11.33 42.95 78.75 39.91 46.97 13.33 36932007 BACTERIUM ANTIBODY 86609 300 $105.00 38.81 - 103.89 - 72.56 13.52 72.56 - 58.01 13.27 35.83 - - 69.50 11.59 12.88 83.11 103.89 13.20 13.27 12.88 84.00 11.79 - 33.75 11.33 42.95 78.75 39.91 46.97 13.33 36932015 BACTERIUM ANTIBODY 86609 300 $105.00 38.81 - 103.89 - 72.56 13.52 72.56 - 58.01 13.27 35.83 - - 69.50 11.59 12.88 83.11 103.89 13.20 13.27 12.88 84.00 11.79 - 33.75 11.33 42.95 78.75 39.91 46.97 13.33 36932023 BACTERIUM ANTIBODY 86609 300 $105.00 38.81 - 103.89 - 72.56 13.52 72.56 - 58.01 13.27 35.83 - - 69.50 11.59 12.88 83.11 103.89 13.20 13.27 12.88 84.00 11.79 - 33.75 11.33 42.95 78.75 39.91 46.97 13.33 36932031 BACTERIUM ANTIBODY 86609 300 $105.00 38.81 - 103.89 - 72.56 13.52 72.56 - 58.01 13.27 35.83 - - 69.50 11.59 12.88 83.11 103.89 13.20 13.27 12.88 84.00 11.79 - 33.75 11.33 42.95 78.75 39.91 46.97 13.33 36932040 BACTERIUM ANTIBODY 86609 300 $105.00 38.81 - 103.89 - 72.56 13.52 72.56 - 58.01 13.27 35.83 - - 69.50 11.59 12.88 83.11 103.89 13.20 13.27 12.88 84.00 11.79 - 33.75 11.33 42.95 78.75 39.91 46.97 13.33 36932058 BACTERIUM ANTIBODY 86609 300 $105.00 38.81 - 103.89 - 72.56 13.52 72.56 - 58.01 13.27 35.83 - - 69.50 11.59 12.88 83.11 103.89 13.20 13.27 12.88 84.00 11.79 - 33.75 11.33 42.95 78.75 39.91 46.97 13.33 36932066 BACTERIUM ANTIBODY 86609 300 $105.00 38.81 - 103.89 - 72.56 13.52 72.56 - 58.01 13.27 35.83 - - 69.50 11.59 12.88 83.11 103.89 13.20 13.27 12.88 84.00 11.79 - 33.75 11.33 42.95 78.75 39.91 46.97 13.33 36932074 BACTERIUM ANTIBODY 86609 300 $105.00 38.81 - 103.89 - 72.56 13.52 72.56 - 58.01 13.27 35.83 - - 69.50 11.59 12.88 83.11 103.89 13.20 13.27 12.88 84.00 11.79 - 33.75 11.33 42.95 78.75 39.91 46.97 13.33 36932082 BACTERIUM ANTIBODY 86609 300 $105.00 38.81 - 103.89 - 72.56 13.52 72.56 - 58.01 13.27 35.83 - - 69.50 11.59 12.88 83.11 103.89 13.20 13.27 12.88 84.00 11.79 - 33.75 11.33 42.95 78.75 39.91 46.97 13.33 36932091 BACTERIUM ANTIBODY 86609 300 $105.00 38.81 - 103.89 - 72.56 13.52 72.56 - 58.01 13.27 35.83 - - 69.50 11.59 12.88 83.11 103.89 13.20 13.27 12.88 84.00 11.79 - 33.75 11.33 42.95 78.75 39.91 46.97 13.33 36932104 BACTERIUM ANTIBODY 86609 300 $105.00 38.81 - 103.89 - 72.56 13.52 72.56 - 58.01 13.27 35.83 - - 69.50 11.59 12.88 83.11 103.89 13.20 13.27 12.88 84.00 11.79 - 33.75 11.33 42.95 78.75 39.91 46.97 13.33 36932112 BACTERIUM ANTIBODY 86609 300 $105.00 38.81 - 103.89 - 72.56 13.52 72.56 - 58.01 13.27 35.83 - - 69.50 11.59 12.88 83.11 103.89 13.20 13.27 12.88 84.00 11.79 - 33.75 11.33 42.95 78.75 39.91 46.97 13.33 36932121 BACTERIUM ANTIBODY 86609 300 $105.00 38.81 - 103.89 - 72.56 13.52 72.56 - 58.01 13.27 35.83 - - 69.50 11.59 12.88 83.11 103.89 13.20 13.27 12.88 84.00 11.79 - 33.75 11.33 42.95 78.75 39.91 46.97 13.33 36932139 BACTERIUM ANTIBODY 86609 300 $105.00 38.81 - 103.89 - 72.56 13.52 72.56 - 58.01 13.27 35.83 - - 69.50 11.59 12.88 83.11 103.89 13.20 13.27 12.88 84.00 11.79 - 33.75 11.33 42.95 78.75 39.91 46.97 13.33 36932147 BACTERIUM ANTIBODY 86609 300 $105.00 38.81 - 103.89 - 72.56 13.52 72.56 - 58.01 13.27 35.83 - - 69.50 11.59 12.88 83.11 103.89 13.20 13.27 12.88 84.00 11.79 - 33.75 11.33 42.95 78.75 39.91 46.97 13.33 36932155 BACTERIUM ANTIBODY 86609 300 $105.00 38.81 - 103.89 - 72.56 13.52 72.56 - 58.01 13.27 35.83 - - 69.50 11.59 12.88 83.11 103.89 13.20 13.27 12.88 84.00 11.79 - 33.75 11.33 42.95 78.75 39.91 46.97 13.33 36932163 BACTERIUM ANTIBODY 86609 300 $96.00 35.48 - 103.89 - 66.34 13.52 66.34 - 53.04 13.27 35.83 - - 63.54 11.59 12.88 83.11 103.89 13.20 13.27 12.88 76.80 11.79 - 33.75 11.33 39.26 72.00 36.49 42.94 13.33 36932171 BACTERIUM ANTIBODY 86609 300 $96.00 35.48 - 103.89 - 66.34 13.52 66.34 - 53.04 13.27 35.83 - - 63.54 11.59 12.88 83.11 103.89 13.20 13.27 12.88 76.80 11.79 - 33.75 11.33 39.26 72.00 36.49 42.94 13.33 36932180 BACTERIUM ANTIBODY 86609 300 $96.00 35.48 - 103.89 - 66.34 13.52 66.34 - 53.04 13.27 35.83 - - 63.54 11.59 12.88 83.11 103.89 13.20 13.27 12.88 76.80 11.79 - 33.75 11.33 39.26 72.00 36.49 42.94 13.33 36932198 BACTERIUM ANTIBODY 86609 300 $96.00 35.48 - 103.89 - 66.34 13.52 66.34 - 53.04 13.27 35.83 - - 63.54 11.59 12.88 83.11 103.89 13.20 13.27 12.88 76.80 11.79 - 33.75 11.33 39.26 72.00 36.49 42.94 13.33 36932201 BACTERIUM ANTIBODY 86609 300 $96.00 35.48 - 103.89 - 66.34 13.52 66.34 - 53.04 13.27 35.83 - - 63.54 11.59 12.88 83.11 103.89 13.20 13.27 12.88 76.80 11.79 - 33.75 11.33 39.26 72.00 36.49 42.94 13.33 36932210 BACTERIUM ANTIBODY 86609 300 $98.00 36.22 - 103.89 - 67.72 13.52 67.72 - 54.15 13.27 35.83 - - 64.87 11.59 12.88 83.11 103.89 13.20 13.27 12.88 78.40 11.79 - 33.75 11.33 40.08 73.50 37.25 43.84 13.33 36932228 BACTERIUM ANTIBODY 86609 300 $98.00 36.22 - 103.89 - 67.72 13.52 67.72 - 54.15 13.27 35.83 - - 64.87 11.59 12.88 83.11 103.89 13.20 13.27 12.88 78.40 11.79 - 33.75 11.33 40.08 73.50 37.25 43.84 13.33 36932236 BACTERIUM ANTIBODY 86609 300 $98.00 36.22 - 103.89 - 67.72 13.52 67.72 - 54.15 13.27 35.83 - - 64.87 11.59 12.88 83.11 103.89 13.20 13.27 12.88 78.40 11.79 - 33.75 11.33 40.08 73.50 37.25 43.84 13.33 36932244 BACTERIUM ANTIBODY 86609 300 $98.00 36.22 - 103.89 - 67.72 13.52 67.72 - 54.15 13.27 35.83 - - 64.87 11.59 12.88 83.11 103.89 13.20 13.27 12.88 78.40 11.79 - 33.75 11.33 40.08 73.50 37.25 43.84 13.33 36932252 BACTERIUM ANTIBODY 86609 300 $98.00 36.22 - 103.89 - 67.72 13.52 67.72 - 54.15 13.27 35.83 - - 64.87 11.59 12.88 83.11 103.89 13.20 13.27 12.88 78.40 11.79 - 33.75 11.33 40.08 73.50 37.25 43.84 13.33 36932261 BACTERIUM ANTIBODY 86609 300 $98.00 36.22 - 103.89 - 67.72 13.52 67.72 - 54.15 13.27 35.83 - - 64.87 11.59 12.88 83.11 103.89 13.20 13.27 12.88 78.40 11.79 - 33.75 11.33 40.08 73.50 37.25 43.84 13.33 36932279 BACTERIUM ANTIBODY 86609 300 $98.00 36.22 - 103.89 - 67.72 13.52 67.72 - 54.15 13.27 35.83 - - 64.87 11.59 12.88 83.11 103.89 13.20 13.27 12.88 78.40 11.79 - 33.75 11.33 40.08 73.50 37.25 43.84 13.33 36918888 BARTONELLA HENSELAE IGG 86611 300 $80.00 29.57 8.96 80.08 12.94 55.28 10.69 55.28 11.25 44.20 10.49 28.32 12.38 11.25 52.95 9.16 10.18 64.06 80.08 10.43 10.49 10.18 64.00 9.31 11.25 26.67 8.96 32.72 60.00 30.41 35.78 10.54 36918896 BARTONELLA HENSELAE IGM 86611 300 $80.00 29.57 8.96 80.08 12.94 55.28 10.69 55.28 11.25 44.20 10.49 28.32 12.38 11.25 52.95 9.16 10.18 64.06 80.08 10.43 10.49 10.18 64.00 9.31 11.25 26.67 8.96 32.72 60.00 30.41 35.78 10.54 36918900 BARTONELLA QUINTANA IGG 86611 300 $80.00 29.57 8.96 80.08 12.94 55.28 10.69 55.28 11.25 44.20 10.49 28.32 12.38 11.25 52.95 9.16 10.18 64.06 80.08 10.43 10.49 10.18 64.00 9.31 11.25 26.67 8.96 32.72 60.00 30.41 35.78 10.54 36918918 BARTONELLA QUINTANA IGM 86611 300 $80.00 29.57 8.96 80.08 12.94 55.28 10.69 55.28 11.25 44.20 10.49 28.32 12.38 11.25 52.95 9.16 10.18 64.06 80.08 10.43 10.49 10.18 64.00 9.31 11.25 26.67 8.96 32.72 60.00 30.41 35.78 10.54 36929995 B HENSELAE IGG TITER 86611 300 $122.00 45.09 8.96 97.60 12.94 84.30 10.69 84.30 11.25 67.41 10.49 28.32 12.38 11.25 80.75 9.16 10.18 64.06 80.08 10.43 10.49 10.18 97.60 9.31 11.25 26.67 8.96 49.90 91.50 46.37 54.57 10.54 36930004 B HENSELAE IGM TITER 86611 300 $122.00 45.09 8.96 97.60 12.94 84.30 10.69 84.30 11.25 67.41 10.49 28.32 12.38 11.25 80.75 9.16 10.18 64.06 80.08 10.43 10.49 10.18 97.60 9.31 11.25 26.67 8.96 49.90 91.50 46.37 54.57 10.54 36930012 B QUINTANA IGG TITER 86611 300 $122.00 45.09 8.96 97.60 12.94 84.30 10.69 84.30 11.25 67.41 10.49 28.32 12.38 11.25 80.75 9.16 10.18 64.06 80.08 10.43 10.49 10.18 97.60 9.31 11.25 26.67 8.96 49.90 91.50 46.37 54.57 10.54 36930021 B QUINTANA IGM TITER 86611 300 $122.00 45.09 8.96 97.60 12.94 84.30 10.69 84.30 11.25 67.41 10.49 28.32 12.38 11.25 80.75 9.16 10.18 64.06 80.08 10.43 10.49 10.18 97.60 9.31 11.25 26.67 8.96 49.90 91.50 46.37 54.57 10.54 36909200 BLASTOMYCES DERMATITIDIS 86612 300 $171.00 63.20 11.35 136.80 20.50 118.16 13.55 118.16 17.83 94.48 13.29 35.89 19.61 17.83 113.18 11.61 12.90 85.01 106.26 13.22 13.29 12.90 136.80 11.80 17.83 33.80 11.35 69.94 128.25 65.00 76.49 13.35 36912189 BLASTOMYCES DERMATITIDIS CF 86612 300 $171.00 63.20 11.35 136.80 20.50 118.16 13.55 118.16 17.83 94.48 13.29 35.89 19.61 17.83 113.18 11.61 12.90 85.01 106.26 13.22 13.29 12.90 136.80 11.80 17.83 33.80 11.35 69.94 128.25 65.00 76.49 13.35 36912197 BLASTOMYCES DERMATITIDIS ID 86612 300 $171.00 63.20 11.35 136.80 20.50 118.16 13.55 118.16 17.83 94.48 13.29 35.89 19.61 17.83 113.18 11.61 12.90 85.01 106.26 13.22 13.29 12.90 136.80 11.80 17.83 33.80 11.35 69.94 128.25 65.00 76.49 13.35 36913550 BLASTO DERMATITIDIS 86612 300 $291.00 107.55 11.35 232.80 20.50 201.08 13.55 201.08 17.83 160.78 13.29 35.89 19.61 17.83 192.61 11.61 12.90 85.01 106.26 13.22 13.29 12.90 232.80 11.80 17.83 33.80 11.35 119.02 218.25 110.61 130.16 13.35 36916320 BORD PERTUSSIS FILAM HEMAG IGA 86615 300 $304.00 112.36 11.61 243.20 20.96 210.06 13.85 210.06 18.23 167.96 13.59 36.68 20.05 18.23 201.22 11.87 13.19 60.45 75.56 13.52 13.59 13.19 243.20 12.07 18.23 34.56 11.61 124.34 228.00 115.55 135.98 13.65 36916338 BORD PERTUSSIS FILAM HEMAG IGG 86615 300 $304.00 112.36 11.61 243.20 20.96 210.06 13.85 210.06 18.23 167.96 13.59 36.68 20.05 18.23 201.22 11.87 13.19 60.45 75.56 13.52 13.59 13.19 243.20 12.07 18.23 34.56 11.61 124.34 228.00 115.55 135.98 13.65 36916346 BORD PERTUSSIS PERT TOXIN IGA 86615 300 $304.00 112.36 11.61 243.20 20.96 210.06 13.85 210.06 18.23 167.96 13.59 36.68 20.05 18.23 201.22 11.87 13.19 60.45 75.56 13.52 13.59 13.19 243.20 12.07 18.23 34.56 11.61 124.34 228.00 115.55 135.98 13.65 36916354 BORD PERTUSSIS PERT TOXIN IGG 86615 300 $304.00 112.36 11.61 243.20 20.96 210.06 13.85 210.06 18.23 167.96 13.59 36.68 20.05 18.23 201.22 11.87 13.19 60.45 75.56 13.52 13.59 13.19 243.20 12.07 18.23 34.56 11.61 124.34 228.00 115.55 135.98 13.65 36981881 BORDETELLA PERTUSSIS IGG AB 86615 300 $217.00 80.20 11.61 173.60 20.96 149.95 13.85 149.95 18.23 119.89 13.59 36.68 20.05 18.23 143.63 11.87 13.19 60.45 75.56 13.52 13.59 13.19 173.60 12.07 18.23 34.56 11.61 88.75 162.75 82.48 97.06 13.65 36981890 BORDETELLA PERTUSSIS IGA AB 86615 300 $217.00 80.20 11.61 173.60 20.96 149.95 13.85 149.95 18.23 119.89 13.59 36.68 20.05 18.23 143.63 11.87 13.19 60.45 75.56 13.52 13.59 13.19 173.60 12.07 18.23 34.56 11.61 88.75 162.75 82.48 97.06 13.65 36104180 LYME IGM WESTERN BLOT 86617 300 $81.00 29.94 13.63 137.24 24.61 55.97 16.26 55.97 21.40 44.75 15.95 43.08 23.54 21.40 53.61 13.94 15.49 109.79 137.24 15.88 15.95 15.49 64.80 14.17 21.40 40.58 13.63 33.13 60.75 30.79 36.23 16.03 36104198 LYME IGG WESTERN BLOT 86617 300 $81.00 29.94 13.63 137.24 24.61 55.97 16.26 55.97 21.40 44.75 15.95 43.08 23.54 21.40 53.61 13.94 15.49 109.79 137.24 15.88 15.95 15.49 64.80 14.17 21.40 40.58 13.63 33.13 60.75 30.79 36.23 16.03 36936029 LYME DISEASE WESTERN BLOT SER 86617 300 "$1,439.00" 531.85 13.63 " 1,151.20 " 24.61 994.35 16.26 994.35 21.40 795.05 15.95 43.08 23.54 21.40 952.47 13.94 15.49 109.79 137.24 15.88 15.95 15.49 " 1,151.20 " 14.17 21.40 40.58 13.63 588.55 " 1,079.25 " 546.96 643.66 16.03 36936037 LYME DISEASE WESTERN BLOT FLD 86617 300 "$1,439.00" 531.85 13.63 " 1,151.20 " 24.61 994.35 16.26 994.35 21.40 795.05 15.95 43.08 23.54 21.40 952.47 13.94 15.49 109.79 137.24 15.88 15.95 15.49 " 1,151.20 " 14.17 21.40 40.58 13.63 588.55 " 1,079.25 " 546.96 643.66 16.03 36936860 LYME DISEASE IGG AB WB 86617 300 $115.00 42.50 13.63 137.24 24.61 79.47 16.26 79.47 21.40 63.54 15.95 43.08 23.54 21.40 76.12 13.94 15.49 109.79 137.24 15.88 15.95 15.49 92.00 14.17 21.40 40.58 13.63 47.04 86.25 43.71 51.44 16.03 36936878 LYME DISEASE IGM AB WB 86617 300 $109.00 40.29 13.63 137.24 24.61 75.32 16.26 75.32 21.40 60.22 15.95 43.08 23.54 21.40 72.15 13.94 15.49 109.79 137.24 15.88 15.95 15.49 87.20 14.17 21.40 40.58 13.63 44.58 81.75 41.43 48.76 16.03 36942851 LYME DISEASE IGM AB 86617 300 $321.00 118.64 13.63 256.80 24.61 221.81 16.26 221.81 21.40 177.35 15.95 43.08 23.54 21.40 212.47 13.94 15.49 109.79 137.24 15.88 15.95 15.49 256.80 14.17 21.40 40.58 13.63 131.29 240.75 122.01 143.58 16.03 36942860 LYME DISEASE IGG AB 86617 300 $322.00 119.01 13.63 257.60 24.61 222.50 16.26 222.50 21.40 177.91 15.95 43.08 23.54 21.40 213.13 13.94 15.49 109.79 137.24 15.88 15.95 15.49 257.60 14.17 21.40 40.58 13.63 131.70 241.50 122.39 144.03 16.03 36101105 LYME EIA 86618 300 $89.00 32.89 14.99 97.55 27.07 61.50 17.88 61.50 23.54 49.17 17.54 47.35 25.89 23.54 58.91 15.33 17.03 78.04 97.55 17.46 17.54 17.03 71.20 15.58 23.54 44.62 14.99 36.40 66.75 33.83 39.81 17.63 36936002 LYME DISEASE ANTIBODY 86618 300 $675.00 249.48 14.99 540.00 27.07 466.43 17.88 466.43 23.54 372.94 17.54 47.35 25.89 23.54 446.78 15.33 17.03 78.04 97.55 17.46 17.54 17.03 540.00 15.58 23.54 44.62 14.99 276.08 506.25 256.57 301.93 17.63 36936011 LYME DISEASE ANTIBODY 86618 300 $675.00 249.48 14.99 540.00 27.07 466.43 17.88 466.43 23.54 372.94 17.54 47.35 25.89 23.54 446.78 15.33 17.03 78.04 97.55 17.46 17.54 17.03 540.00 15.58 23.54 44.62 14.99 276.08 506.25 256.57 301.93 17.63 36936851 LYMEC6 ANTIBODIES 86618 300 $89.00 32.89 14.99 97.55 27.07 61.50 17.88 61.50 23.54 49.17 17.54 47.35 25.89 23.54 58.91 15.33 17.03 78.04 97.55 17.46 17.54 17.03 71.20 15.58 23.54 44.62 14.99 36.40 66.75 33.83 39.81 17.63 36909765 CAMPYLOBACTER JEJUNI TOTAL ABS 86625 300 "$1,036.00" 382.91 11.55 828.80 20.85 715.88 13.78 715.88 18.13 572.39 13.51 36.49 19.94 18.13 685.73 11.81 13.12 84.79 105.99 13.45 13.51 13.12 828.80 12.00 18.13 34.37 11.55 423.72 777.00 393.78 463.40 13.58 36910381 CHLAMYDIA PNEUMONIAE IGG AB 86631 300 $633.00 233.96 9.88 506.40 11.36 437.40 12.41 437.40 9.88 349.73 12.17 32.88 10.87 9.88 418.98 10.64 11.82 37.04 46.30 12.12 12.17 11.82 506.40 10.82 9.88 30.97 10.40 258.90 474.75 240.60 283.14 12.23 36911328 CHLAMYDIA PNEUMONIAE IGG AB 86631 300 $564.00 208.45 9.88 451.20 11.36 389.72 12.41 389.72 9.88 311.61 12.17 32.88 10.87 9.88 373.31 10.64 11.82 37.04 46.30 12.12 12.17 11.82 451.20 10.82 9.88 30.97 10.40 230.68 423.00 214.38 252.28 12.23 36911891 CHLAMYDIA PSITTACI IGG ANTIBDY 86631 300 $309.00 114.21 9.88 247.20 11.36 213.52 12.41 213.52 9.88 170.72 12.17 32.88 10.87 9.88 204.53 10.64 11.82 37.04 46.30 12.12 12.17 11.82 247.20 10.82 9.88 30.97 10.40 126.38 231.75 117.45 138.22 12.23 36918659 CHLAMYDIA IGG ANTIBODY 86631 300 $309.00 114.21 9.88 247.20 11.36 213.52 12.41 213.52 9.88 170.72 12.17 32.88 10.87 9.88 204.53 10.64 11.82 37.04 46.30 12.12 12.17 11.82 247.20 10.82 9.88 30.97 10.40 126.38 231.75 117.45 138.22 12.23 36919264 CHLAMYDIA PSITTACI IGA ANTIBDY 86631 300 $309.00 114.21 9.88 247.20 11.36 213.52 12.41 213.52 9.88 170.72 12.17 32.88 10.87 9.88 204.53 10.64 11.82 37.04 46.30 12.12 12.17 11.82 247.20 10.82 9.88 30.97 10.40 126.38 231.75 117.45 138.22 12.23 36919272 CHLAMYDIA PNEUMONIAE IGG 86631 300 $309.00 114.21 9.88 247.20 11.36 213.52 12.41 213.52 9.88 170.72 12.17 32.88 10.87 9.88 204.53 10.64 11.82 37.04 46.30 12.12 12.17 11.82 247.20 10.82 9.88 30.97 10.40 126.38 231.75 117.45 138.22 12.23 36919281 CHLAMYDIA PNEUMONIAE IGA 86631 300 $309.00 114.21 9.88 247.20 11.36 213.52 12.41 213.52 9.88 170.72 12.17 32.88 10.87 9.88 204.53 10.64 11.82 37.04 46.30 12.12 12.17 11.82 247.20 10.82 9.88 30.97 10.40 126.38 231.75 117.45 138.22 12.23 36919302 CHLAMYDIA TRACHOMATIS IGG 86631 300 $309.00 114.21 9.88 247.20 11.36 213.52 12.41 213.52 9.88 170.72 12.17 32.88 10.87 9.88 204.53 10.64 11.82 37.04 46.30 12.12 12.17 11.82 247.20 10.82 9.88 30.97 10.40 126.38 231.75 117.45 138.22 12.23 36919311 CHLAMYDIA TRACHOMATIS IGA 86631 300 $309.00 114.21 9.88 247.20 11.36 213.52 12.41 213.52 9.88 170.72 12.17 32.88 10.87 9.88 204.53 10.64 11.82 37.04 46.30 12.12 12.17 11.82 247.20 10.82 9.88 30.97 10.40 126.38 231.75 117.45 138.22 12.23 36919337 CHLAMYDIA PSITTACI IGG 86631 300 $309.00 114.21 9.88 247.20 11.36 213.52 12.41 213.52 9.88 170.72 12.17 32.88 10.87 9.88 204.53 10.64 11.82 37.04 46.30 12.12 12.17 11.82 247.20 10.82 9.88 30.97 10.40 126.38 231.75 117.45 138.22 12.23 36919345 CHLAMYDIA PSITTACI IGA 86631 300 $309.00 114.21 9.88 247.20 11.36 213.52 12.41 213.52 9.88 170.72 12.17 32.88 10.87 9.88 204.53 10.64 11.82 37.04 46.30 12.12 12.17 11.82 247.20 10.82 9.88 30.97 10.40 126.38 231.75 117.45 138.22 12.23 36919400 CHLAMYDIA PNEUMONIAE IGA AB 86631 300 $564.00 208.45 9.88 451.20 11.36 389.72 12.41 389.72 9.88 311.61 12.17 32.88 10.87 9.88 373.31 10.64 11.82 37.04 46.30 12.12 12.17 11.82 451.20 10.82 9.88 30.97 10.40 230.68 423.00 214.38 252.28 12.23 36929855 CHLAMYDIA TRACHOMATIS IGG 86631 300 $309.00 114.21 9.88 247.20 11.36 213.52 12.41 213.52 9.88 170.72 12.17 32.88 10.87 9.88 204.53 10.64 11.82 37.04 46.30 12.12 12.17 11.82 247.20 10.82 9.88 30.97 10.40 126.38 231.75 117.45 138.22 12.23 36937980 CHLAMYDIA IGG AB 86631 300 $62.00 22.92 9.88 49.60 11.36 42.84 12.41 42.84 9.88 34.26 12.17 32.88 10.87 9.88 41.04 10.64 11.82 37.04 46.30 12.12 12.17 11.82 49.60 10.82 9.88 30.97 10.40 25.36 46.50 23.57 27.73 12.23 36937998 CHLAMYDIA IGA AB 86631 300 $309.00 114.21 9.88 247.20 11.36 213.52 12.41 213.52 9.88 170.72 12.17 32.88 10.87 9.88 204.53 10.64 11.82 37.04 46.30 12.12 12.17 11.82 247.20 10.82 9.88 30.97 10.40 126.38 231.75 117.45 138.22 12.23 36910372 CHLAMYDIA PNEUMONIAE IGM AB 86632 300 $680.00 251.33 11.16 544.00 20.18 469.88 13.31 469.88 17.55 375.70 13.06 35.26 19.31 17.55 450.09 11.41 12.68 83.20 104.00 13.00 13.06 12.68 544.00 11.60 17.55 33.22 11.16 278.12 510.00 258.47 304.16 13.12 36911310 CHLAMYDIA PNEUMONIAE IGM AB 86632 300 $822.00 303.81 11.16 657.60 20.18 568.00 13.31 568.00 17.55 454.16 13.06 35.26 19.31 17.55 544.08 11.41 12.68 83.20 104.00 13.00 13.06 12.68 657.60 11.60 17.55 33.22 11.16 336.20 616.50 312.44 367.68 13.12 36911905 CHLAMYDIA PSITTACI IGM ANTIBDY 86632 300 $680.00 251.33 11.16 544.00 20.18 469.88 13.31 469.88 17.55 375.70 13.06 35.26 19.31 17.55 450.09 11.41 12.68 83.20 104.00 13.00 13.06 12.68 544.00 11.60 17.55 33.22 11.16 278.12 510.00 258.47 304.16 13.12 36919299 CHALMYDIA PNEUMONIAE IGM 86632 300 $680.00 251.33 11.16 544.00 20.18 469.88 13.31 469.88 17.55 375.70 13.06 35.26 19.31 17.55 450.09 11.41 12.68 83.20 104.00 13.00 13.06 12.68 544.00 11.60 17.55 33.22 11.16 278.12 510.00 258.47 304.16 13.12 36919329 CHLAMYDIA TRACHOMATIS IGM 86632 300 $680.00 251.33 11.16 544.00 20.18 469.88 13.31 469.88 17.55 375.70 13.06 35.26 19.31 17.55 450.09 11.41 12.68 83.20 104.00 13.00 13.06 12.68 544.00 11.60 17.55 33.22 11.16 278.12 510.00 258.47 304.16 13.12 36919353 CHLAMYDIA PSITTACI IGM 86632 300 $680.00 251.33 11.16 544.00 20.18 469.88 13.31 469.88 17.55 375.70 13.06 35.26 19.31 17.55 450.09 11.41 12.68 83.20 104.00 13.00 13.06 12.68 544.00 11.60 17.55 33.22 11.16 278.12 510.00 258.47 304.16 13.12 36922281 CHLAMYDIA TRACHOMATIS IGM 86632 300 $680.00 251.33 11.16 544.00 20.18 469.88 13.31 469.88 17.55 375.70 13.06 35.26 19.31 17.55 450.09 11.41 12.68 83.20 104.00 13.00 13.06 12.68 544.00 11.60 17.55 33.22 11.16 278.12 510.00 258.47 304.16 13.12 36928131 CHLAMYDIA IGM AB 86632 300 $680.00 251.33 11.16 544.00 20.18 469.88 13.31 469.88 17.55 375.70 13.06 35.26 19.31 17.55 450.09 11.41 12.68 83.20 104.00 13.00 13.06 12.68 544.00 11.60 17.55 33.22 11.16 278.12 510.00 258.47 304.16 13.12 36938005 CHLAMYDIA IGM AB 86632 300 $680.00 251.33 11.16 544.00 20.18 469.88 13.31 469.88 17.55 375.70 13.06 35.26 19.31 17.55 450.09 11.41 12.68 83.20 104.00 13.00 13.06 12.68 544.00 11.60 17.55 33.22 11.16 278.12 510.00 258.47 304.16 13.12 36909218 COCCIDIODES IMMITIS CF 86635 300 $197.00 72.81 10.09 157.60 18.23 136.13 12.04 136.13 15.85 108.84 11.81 31.90 17.44 15.85 130.39 10.32 11.47 75.00 93.75 11.76 11.81 11.47 157.60 10.50 15.85 30.05 10.09 80.57 147.75 74.88 88.12 11.87 36913533 COCCIDIOIDES IMMITIS 86635 300 $281.00 103.86 10.09 224.80 18.23 194.17 12.04 194.17 15.85 155.25 11.81 31.90 17.44 15.85 185.99 10.32 11.47 75.00 93.75 11.76 11.81 11.47 224.80 10.50 15.85 30.05 10.09 114.93 210.75 106.81 125.69 11.87 36912146 Q-FEVER IGG PHASE 1 86638 300 $64.00 23.65 10.67 101.74 19.26 44.22 12.73 44.22 16.75 35.36 12.48 33.69 18.43 16.75 42.36 10.91 12.12 81.39 101.74 12.42 12.48 12.12 51.20 11.09 16.75 31.75 10.67 26.18 48.00 24.33 28.63 12.54 36912154 Q-FEVER IGG PHASE 2 86638 300 $64.00 23.65 10.67 101.74 19.26 44.22 12.73 44.22 16.75 35.36 12.48 33.69 18.43 16.75 42.36 10.91 12.12 81.39 101.74 12.42 12.48 12.12 51.20 11.09 16.75 31.75 10.67 26.18 48.00 24.33 28.63 12.54 36912162 Q-FEVER IGM PHASE 1 86638 300 $161.00 59.51 10.67 128.80 19.26 111.25 12.73 111.25 16.75 88.95 12.48 33.69 18.43 16.75 106.57 10.91 12.12 81.39 101.74 12.42 12.48 12.12 128.80 11.09 16.75 31.75 10.67 65.85 120.75 61.20 72.02 12.54 36912171 Q-FEVER IGM PHASE 2 86638 300 $161.00 59.51 10.67 128.80 19.26 111.25 12.73 111.25 16.75 88.95 12.48 33.69 18.43 16.75 106.57 10.91 12.12 81.39 101.74 12.42 12.48 12.12 128.80 11.09 16.75 31.75 10.67 65.85 120.75 61.20 72.02 12.54 36937785 COXIELLA BURNETTI (Q FEVER) 86638 300 $64.00 23.65 10.67 101.74 19.26 44.22 12.73 44.22 16.75 35.36 12.48 33.69 18.43 16.75 42.36 10.91 12.12 81.39 101.74 12.42 12.48 12.12 51.20 11.09 16.75 31.75 10.67 26.18 48.00 24.33 28.63 12.54 36937793 COXIELLA BURNETTI (Q FEVER) 86638 300 $64.00 23.65 10.67 101.74 19.26 44.22 12.73 44.22 16.75 35.36 12.48 33.69 18.43 16.75 42.36 10.91 12.12 81.39 101.74 12.42 12.48 12.12 51.20 11.09 16.75 31.75 10.67 26.18 48.00 24.33 28.63 12.54 36937807 COXIELLA BURNETTI (Q FEVER) 86638 300 $64.00 23.65 10.67 101.74 19.26 44.22 12.73 44.22 16.75 35.36 12.48 33.69 18.43 16.75 42.36 10.91 12.12 81.39 101.74 12.42 12.48 12.12 51.20 11.09 16.75 31.75 10.67 26.18 48.00 24.33 28.63 12.54 36937815 COXIELLA BURNETTI (Q FEVER) 86638 300 $64.00 23.65 10.67 101.74 19.26 44.22 12.73 44.22 16.75 35.36 12.48 33.69 18.43 16.75 42.36 10.91 12.12 81.39 101.74 12.42 12.48 12.12 51.20 11.09 16.75 31.75 10.67 26.18 48.00 24.33 28.63 12.54 36937823 Q FEVER IGG PHASE I TITER 86638 300 $140.00 51.74 10.67 112.00 19.26 96.74 12.73 96.74 16.75 77.35 12.48 33.69 18.43 16.75 92.67 10.91 12.12 81.39 101.74 12.42 12.48 12.12 112.00 11.09 16.75 31.75 10.67 57.26 105.00 53.21 62.62 12.54 36937831 Q FEVER IGG PHASE II TITER 86638 300 $140.00 51.74 10.67 112.00 19.26 96.74 12.73 96.74 16.75 77.35 12.48 33.69 18.43 16.75 92.67 10.91 12.12 81.39 101.74 12.42 12.48 12.12 112.00 11.09 16.75 31.75 10.67 57.26 105.00 53.21 62.62 12.54 36937840 Q FEVER IGM PHASE I TITER 86638 300 $109.00 40.29 10.67 101.74 19.26 75.32 12.73 75.32 16.75 60.22 12.48 33.69 18.43 16.75 72.15 10.91 12.12 81.39 101.74 12.42 12.48 12.12 87.20 11.09 16.75 31.75 10.67 44.58 81.75 41.43 48.76 12.54 36937858 Q FEVER IGM PHASE II TITER 86638 300 $109.00 40.29 10.67 101.74 19.26 75.32 12.73 75.32 16.75 60.22 12.48 33.69 18.43 16.75 72.15 10.91 12.12 81.39 101.74 12.42 12.48 12.12 87.20 11.09 16.75 31.75 10.67 44.58 81.75 41.43 48.76 12.54 35600736 CMV AB TESTING (ARC) 86644 300 $76.00 28.09 12.66 82.23 22.80 52.52 15.11 52.52 19.83 41.99 14.82 40.04 21.81 19.83 50.30 12.95 14.39 65.78 82.23 14.75 14.82 14.39 60.80 13.17 19.83 37.70 12.66 31.08 57.00 28.89 33.99 14.89 36100648 CMV IGG AB 86644 300 $76.00 28.09 12.66 82.23 22.80 52.52 15.11 52.52 19.83 41.99 14.82 40.04 21.81 19.83 50.30 12.95 14.39 65.78 82.23 14.75 14.82 14.39 60.80 13.17 19.83 37.70 12.66 31.08 57.00 28.89 33.99 14.89 36925108 CMV ANTIBODY 86644 300 $76.00 28.09 12.66 82.23 22.80 52.52 15.11 52.52 19.83 41.99 14.82 40.04 21.81 19.83 50.30 12.95 14.39 65.78 82.23 14.75 14.82 14.39 60.80 13.17 19.83 37.70 12.66 31.08 57.00 28.89 33.99 14.89 36942312 CMV ANTIBODY 86644 300 $76.00 28.09 12.66 82.23 22.80 52.52 15.11 52.52 19.83 41.99 14.82 40.04 21.81 19.83 50.30 12.95 14.39 65.78 82.23 14.75 14.82 14.39 60.80 13.17 19.83 37.70 12.66 31.08 57.00 28.89 33.99 14.89 36100222 CMV IGM ANTIBODY 86645 300 $88.00 32.52 14.83 100.42 26.77 60.81 17.69 60.81 23.28 48.62 17.36 46.85 25.61 23.28 58.25 15.17 16.85 80.34 100.42 17.27 17.36 16.85 70.40 15.42 23.28 44.15 14.83 35.99 66.00 33.45 39.36 17.44 36903228 DIPHTHERIA 86648 300 $123.00 45.46 13.38 125.11 24.17 84.99 15.97 84.99 21.02 67.96 15.67 42.30 23.12 21.02 81.41 13.69 15.21 100.09 125.11 15.59 15.67 15.21 98.40 13.92 21.02 39.85 13.38 50.31 92.25 46.75 55.02 15.74 36942908 ENCEPHALITIS CALIFORNIA AB 86651 300 $307.00 113.47 11.61 245.60 20.95 212.14 13.85 212.14 18.22 169.62 13.59 36.68 20.04 18.22 203.20 11.87 13.19 85.01 106.26 13.52 13.59 13.19 245.60 12.07 18.22 34.56 11.61 125.56 230.25 116.69 137.32 13.65 36942916 ENCEPHALITIS CALIFORNIA AB 86651 300 $307.00 113.47 11.61 245.60 20.95 212.14 13.85 212.14 18.22 169.62 13.59 36.68 20.04 18.22 203.20 11.87 13.19 85.01 106.26 13.52 13.59 13.19 245.60 12.07 18.22 34.56 11.61 125.56 230.25 116.69 137.32 13.65 36942924 ENCEPHALITIS EASTERN EQUINE AB 86652 300 $307.00 113.47 11.61 245.60 20.95 212.14 13.85 212.14 18.22 169.62 13.59 36.68 20.04 18.22 203.20 11.87 13.19 85.01 106.26 13.52 13.59 13.19 245.60 12.07 18.22 34.56 11.61 125.56 230.25 116.69 137.32 13.65 36942932 ENCEPHALITIS EASTERN EQUINE AB 86652 300 $307.00 113.47 11.61 245.60 20.95 212.14 13.85 212.14 18.22 169.62 13.59 36.68 20.04 18.22 203.20 11.87 13.19 85.01 106.26 13.52 13.59 13.19 245.60 12.07 18.22 34.56 11.61 125.56 230.25 116.69 137.32 13.65 36942941 ENCEPHALITIS ST LOUIS AB 86653 300 $307.00 113.47 11.61 245.60 20.95 212.14 13.85 212.14 18.22 169.62 13.59 36.68 20.04 18.22 203.20 11.87 13.19 85.01 106.26 13.52 13.59 13.19 245.60 12.07 18.22 34.56 11.61 125.56 230.25 116.69 137.32 13.65 36942959 ENCEPHALITIS ST LOUIS AB 86653 300 $307.00 113.47 11.61 245.60 20.95 212.14 13.85 212.14 18.22 169.62 13.59 36.68 20.04 18.22 203.20 11.87 13.19 85.01 106.26 13.52 13.59 13.19 245.60 12.07 18.22 34.56 11.61 125.56 230.25 116.69 137.32 13.65 36942967 ENCEPHALITIS WEST EQUINE AB 86654 300 $307.00 113.47 11.61 245.60 20.95 212.14 13.85 212.14 18.22 169.62 13.59 36.68 20.04 18.22 203.20 11.87 13.19 85.01 106.26 13.52 13.59 13.19 245.60 12.07 18.22 34.56 11.61 125.56 230.25 116.69 137.32 13.65 36942975 ENCEPHALITIS WEST EQUINE AB 86654 300 $307.00 113.47 11.61 245.60 20.95 212.14 13.85 212.14 18.22 169.62 13.59 36.68 20.04 18.22 203.20 11.87 13.19 85.01 106.26 13.52 13.59 13.19 245.60 12.07 18.22 34.56 11.61 125.56 230.25 116.69 137.32 13.65 36900946 COXSACKIE B1-B6 AB CF 86658 300 $181.00 66.90 - 144.80 - 125.07 13.68 125.07 - 100.00 13.42 36.24 - - 119.80 11.73 13.03 60.45 75.56 13.36 13.42 13.03 144.80 11.92 - 34.14 11.47 74.03 135.75 68.80 80.96 13.49 36909269 POLIOVIRUS 1 86658 300 $119.00 43.98 - 95.20 - 82.23 13.68 82.23 - 65.75 13.42 36.24 - - 78.77 11.73 13.03 60.45 75.56 13.36 13.42 13.03 95.20 11.92 - 34.14 11.47 48.67 89.25 45.23 53.23 13.49 36909277 POLIOVIRUS 2 86658 300 $119.00 43.98 - 95.20 - 82.23 13.68 82.23 - 65.75 13.42 36.24 - - 78.77 11.73 13.03 60.45 75.56 13.36 13.42 13.03 95.20 11.92 - 34.14 11.47 48.67 89.25 45.23 53.23 13.49 36909285 POLIOVIRUS 3 86658 300 $119.00 43.98 - 95.20 - 82.23 13.68 82.23 - 65.75 13.42 36.24 - - 78.77 11.73 13.03 60.45 75.56 13.36 13.42 13.03 95.20 11.92 - 34.14 11.47 48.67 89.25 45.23 53.23 13.49 36913967 ECHOVIRUS 4 ANTIBODY 86658 300 $181.00 66.90 - 144.80 - 125.07 13.68 125.07 - 100.00 13.42 36.24 - - 119.80 11.73 13.03 60.45 75.56 13.36 13.42 13.03 144.80 11.92 - 34.14 11.47 74.03 135.75 68.80 80.96 13.49 36913975 ECHOVIRUS 9 ANTIBODY 86658 300 $181.00 66.90 - 144.80 - 125.07 13.68 125.07 - 100.00 13.42 36.24 - - 119.80 11.73 13.03 60.45 75.56 13.36 13.42 13.03 144.80 11.92 - 34.14 11.47 74.03 135.75 68.80 80.96 13.49 36913983 ECHOVIRUS 11 ANTIBODY 86658 300 $181.00 66.90 - 144.80 - 125.07 13.68 125.07 - 100.00 13.42 36.24 - - 119.80 11.73 13.03 60.45 75.56 13.36 13.42 13.03 144.80 11.92 - 34.14 11.47 74.03 135.75 68.80 80.96 13.49 36913991 ECHOVIRUS 30 ANTIBODY 86658 300 $181.00 66.90 - 144.80 - 125.07 13.68 125.07 - 100.00 13.42 36.24 - - 119.80 11.73 13.03 60.45 75.56 13.36 13.42 13.03 144.80 11.92 - 34.14 11.47 74.03 135.75 68.80 80.96 13.49 36916176 ECHOVIRUS 7 ANTIBODY 86658 300 $171.00 63.20 - 136.80 - 118.16 13.68 118.16 - 94.48 13.42 36.24 - - 113.18 11.73 13.03 60.45 75.56 13.36 13.42 13.03 136.80 11.92 - 34.14 11.47 69.94 128.25 65.00 76.49 13.49 36916231 COXSACKIE A2 ANTIBODIES 86658 300 $181.00 66.90 - 144.80 - 125.07 13.68 125.07 - 100.00 13.42 36.24 - - 119.80 11.73 13.03 60.45 75.56 13.36 13.42 13.03 144.80 11.92 - 34.14 11.47 74.03 135.75 68.80 80.96 13.49 36916249 COXSACKIE A4 ANTIBODIES 86658 300 $181.00 66.90 - 144.80 - 125.07 13.68 125.07 - 100.00 13.42 36.24 - - 119.80 11.73 13.03 60.45 75.56 13.36 13.42 13.03 144.80 11.92 - 34.14 11.47 74.03 135.75 68.80 80.96 13.49 36916257 COXSACKIE A7 ANTIBODIES 86658 300 $181.00 66.90 - 144.80 - 125.07 13.68 125.07 - 100.00 13.42 36.24 - - 119.80 11.73 13.03 60.45 75.56 13.36 13.42 13.03 144.80 11.92 - 34.14 11.47 74.03 135.75 68.80 80.96 13.49 36916265 COXSACKIE A9 ANTIBODIES 86658 300 $181.00 66.90 - 144.80 - 125.07 13.68 125.07 - 100.00 13.42 36.24 - - 119.80 11.73 13.03 60.45 75.56 13.36 13.42 13.03 144.80 11.92 - 34.14 11.47 74.03 135.75 68.80 80.96 13.49 36916273 COXSACKIE A10 ANTIBODIES 86658 300 $181.00 66.90 - 144.80 - 125.07 13.68 125.07 - 100.00 13.42 36.24 - - 119.80 11.73 13.03 60.45 75.56 13.36 13.42 13.03 144.80 11.92 - 34.14 11.47 74.03 135.75 68.80 80.96 13.49 36916281 COXSACKIE A16 ANTIBODIES 86658 300 $181.00 66.90 - 144.80 - 125.07 13.68 125.07 - 100.00 13.42 36.24 - - 119.80 11.73 13.03 60.45 75.56 13.36 13.42 13.03 144.80 11.92 - 34.14 11.47 74.03 135.75 68.80 80.96 13.49 36933062 COXSACKIE ANTIBODY 86658 300 $68.00 25.13 - 75.56 - 46.99 13.68 46.99 - 37.57 13.42 36.24 - - 45.01 11.73 13.03 60.45 75.56 13.36 13.42 13.03 54.40 11.92 - 34.14 11.47 27.81 51.00 25.85 30.42 13.49 36933071 COXSACKIE ANTIBODY 86658 300 $68.00 25.13 - 75.56 - 46.99 13.68 46.99 - 37.57 13.42 36.24 - - 45.01 11.73 13.03 60.45 75.56 13.36 13.42 13.03 54.40 11.92 - 34.14 11.47 27.81 51.00 25.85 30.42 13.49 36933089 COXSACKIE ANTIBODY 86658 300 $68.00 25.13 - 75.56 - 46.99 13.68 46.99 - 37.57 13.42 36.24 - - 45.01 11.73 13.03 60.45 75.56 13.36 13.42 13.03 54.40 11.92 - 34.14 11.47 27.81 51.00 25.85 30.42 13.49 36933097 COXSACKIE ANTIBODY 86658 300 $68.00 25.13 - 75.56 - 46.99 13.68 46.99 - 37.57 13.42 36.24 - - 45.01 11.73 13.03 60.45 75.56 13.36 13.42 13.03 54.40 11.92 - 34.14 11.47 27.81 51.00 25.85 30.42 13.49 36933101 COXSACKIE ANTIBODY 86658 300 $68.00 25.13 - 75.56 - 46.99 13.68 46.99 - 37.57 13.42 36.24 - - 45.01 11.73 13.03 60.45 75.56 13.36 13.42 13.03 54.40 11.92 - 34.14 11.47 27.81 51.00 25.85 30.42 13.49 36150751 EBV EARLY ANTIGEN 86663 300 $69.00 25.50 11.55 75.56 20.85 47.68 13.78 47.68 18.13 38.12 13.51 36.49 19.94 18.13 45.67 11.81 13.12 60.45 75.56 13.45 13.51 13.12 55.20 12.00 18.13 34.37 11.55 28.22 51.75 26.23 30.86 13.58 36915633 EBV EARLY ANTIGEN EIA 86663 300 $115.00 42.50 11.55 92.00 20.85 79.47 13.78 79.47 18.13 63.54 13.51 36.49 19.94 18.13 76.12 11.81 13.12 60.45 75.56 13.45 13.51 13.12 92.00 12.00 18.13 34.37 11.55 47.04 86.25 43.71 51.44 13.58 36100851 EBV-EBNA 86664 300 $80.00 29.57 13.46 88.96 24.31 55.28 16.05 55.28 21.14 44.20 15.75 42.55 23.25 21.14 52.95 13.76 15.29 71.17 88.96 15.67 15.75 15.29 64.00 13.99 21.14 40.06 13.46 32.72 60.00 30.41 35.78 15.83 36100257 EB-VCA IGG ANTIBODY 86665 300 $95.00 35.11 15.96 103.95 28.83 65.65 19.05 65.65 25.07 52.49 18.68 50.46 27.58 25.07 62.88 16.33 18.14 83.16 103.95 18.59 18.68 18.14 76.00 16.60 25.07 47.53 15.96 38.86 71.25 36.11 42.49 18.77 36100869 EBV-IGM 86665 300 $95.00 35.11 15.96 103.95 28.83 65.65 19.05 65.65 25.07 52.49 18.68 50.46 27.58 25.07 62.88 16.33 18.14 83.16 103.95 18.59 18.68 18.14 76.00 16.60 25.07 47.53 15.96 38.86 71.25 36.11 42.49 18.77 36911468 EHRLICHIA CHAFFEENSIS IGG AB 86666 300 $343.00 126.77 8.96 274.40 12.94 237.01 10.69 237.01 11.25 189.51 10.49 28.32 12.38 11.25 227.03 9.16 10.18 64.06 80.08 10.43 10.49 10.18 274.40 9.31 11.25 26.67 8.96 140.29 257.25 130.37 153.42 10.54 36911476 EHRLICHIA CHAFFEENSIS IGM AB 86666 300 $343.00 126.77 8.96 274.40 12.94 237.01 10.69 237.01 11.25 189.51 10.49 28.32 12.38 11.25 227.03 9.16 10.18 64.06 80.08 10.43 10.49 10.18 274.40 9.31 11.25 26.67 8.96 140.29 257.25 130.37 153.42 10.54 36943742 EHRLICHIA AB 86666 300 $343.00 126.77 8.96 274.40 12.94 237.01 10.69 237.01 11.25 189.51 10.49 28.32 12.38 11.25 227.03 9.16 10.18 64.06 80.08 10.43 10.49 10.18 274.40 9.31 11.25 26.67 8.96 140.29 257.25 130.37 153.42 10.54 36943751 EHRLICHIA AB 86666 300 $343.00 126.77 8.96 274.40 12.94 237.01 10.69 237.01 11.25 189.51 10.49 28.32 12.38 11.25 227.03 9.16 10.18 64.06 80.08 10.43 10.49 10.18 274.40 9.31 11.25 26.67 8.96 140.29 257.25 130.37 153.42 10.54 36943769 EHRLICHIA AB 86666 300 $343.00 126.77 8.96 274.40 12.94 237.01 10.69 237.01 11.25 189.51 10.49 28.32 12.38 11.25 227.03 9.16 10.18 64.06 80.08 10.43 10.49 10.18 274.40 9.31 11.25 26.67 8.96 140.29 257.25 130.37 153.42 10.54 36943777 EHRLICHIA AB 86666 300 $343.00 126.77 8.96 274.40 12.94 237.01 10.69 237.01 11.25 189.51 10.49 28.32 12.38 11.25 227.03 9.16 10.18 64.06 80.08 10.43 10.49 10.18 274.40 9.31 11.25 26.67 8.96 140.29 257.25 130.37 153.42 10.54 36922982 FUNGUS NOS 1 86671 300 $83.00 30.68 - 103.89 - 57.35 12.86 57.35 - 45.86 12.62 34.07 - - 54.94 11.03 12.25 83.11 103.89 12.56 12.62 12.25 66.40 11.21 - 32.10 10.78 33.95 62.25 31.55 37.13 12.68 36922991 FUNGUS NOS 2 86671 300 $83.00 30.68 - 103.89 - 57.35 12.86 57.35 - 45.86 12.62 34.07 - - 54.94 11.03 12.25 83.11 103.89 12.56 12.62 12.25 66.40 11.21 - 32.10 10.78 33.95 62.25 31.55 37.13 12.68 36941073 ASCA IGA AB 86671 300 $141.00 52.11 - 112.80 - 97.43 12.86 97.43 - 77.90 12.62 34.07 - - 93.33 11.03 12.25 83.11 103.89 12.56 12.62 12.25 112.80 11.21 - 32.10 10.78 57.67 105.75 53.59 63.07 12.68 36941081 ASCA IGG AB 86671 300 $141.00 52.11 - 112.80 - 97.43 12.86 97.43 - 77.90 12.62 34.07 - - 93.33 11.03 12.25 83.11 103.89 12.56 12.62 12.25 112.80 11.21 - 32.10 10.78 57.67 105.75 53.59 63.07 12.68 36910356 GIARDIA LAMBLIA IGG ANTIBODY 86674 300 $347.00 128.25 - 277.60 - 239.78 15.46 239.78 - 191.72 15.16 40.91 - - 229.68 13.25 14.72 66.66 83.33 15.09 15.16 14.72 277.60 13.47 - 38.57 12.95 141.92 260.25 131.89 155.21 15.24 36911930 GIARDIA LAMBLIA IGA ANTIBODY 86674 300 $347.00 128.25 - 277.60 - 239.78 15.46 239.78 - 191.72 15.16 40.91 - - 229.68 13.25 14.72 66.66 83.33 15.09 15.16 14.72 277.60 13.47 - 38.57 12.95 141.92 260.25 131.89 155.21 15.24 36911948 GIARDIA LAMBLIA IGM ANTIBODY 86674 300 $347.00 128.25 - 277.60 - 239.78 15.46 239.78 - 191.72 15.16 40.91 - - 229.68 13.25 14.72 66.66 83.33 15.09 15.16 14.72 277.60 13.47 - 38.57 12.95 141.92 260.25 131.89 155.21 15.24 36941031 GIARDI LAMBLIA ANTIBODY 86674 300 $209.00 77.25 - 167.20 - 144.42 15.46 144.42 - 115.47 15.16 40.91 - - 138.34 13.25 14.72 66.66 83.33 15.09 15.16 14.72 167.20 13.47 - 38.57 12.95 85.48 156.75 79.44 93.49 15.24 35708413 HELICOBACTER PYLORI IGG AB 86677 300 $88.00 32.52 14.83 85.32 23.06 60.81 17.69 60.81 20.05 48.62 17.36 40.35 22.06 20.05 58.25 15.17 16.85 68.26 85.32 17.27 17.36 16.85 70.40 15.42 20.05 44.15 14.83 35.99 66.00 33.45 39.36 17.44 36922371 HELICOBACTOR PYLORI IGG AB 86677 300 $136.00 50.27 14.83 108.80 23.06 93.98 17.69 93.98 20.05 75.14 17.36 40.35 22.06 20.05 90.02 15.17 16.85 68.26 85.32 17.27 17.36 16.85 108.80 15.42 20.05 44.15 14.83 55.62 102.00 51.69 60.83 17.44 36922389 HELICOBACTOR PYLORI IGA AB 86677 300 $136.00 50.27 14.83 108.80 23.06 93.98 17.69 93.98 20.05 75.14 17.36 40.35 22.06 20.05 90.02 15.17 16.85 68.26 85.32 17.27 17.36 16.85 108.80 15.42 20.05 44.15 14.83 55.62 102.00 51.69 60.83 17.44 36922397 HELICOBACTOR PYLORI IGM AB 86677 300 $136.00 50.27 14.83 108.80 23.06 93.98 17.69 93.98 20.05 75.14 17.36 40.35 22.06 20.05 90.02 15.17 16.85 68.26 85.32 17.27 17.36 16.85 108.80 15.42 20.05 44.15 14.83 55.62 102.00 51.69 60.83 17.44 36940310 H. PYLORI IGA 86677 300 $88.00 32.52 14.83 85.32 23.06 60.81 17.69 60.81 20.05 48.62 17.36 40.35 22.06 20.05 58.25 15.17 16.85 68.26 85.32 17.27 17.36 16.85 70.40 15.42 20.05 44.15 14.83 35.99 66.00 33.45 39.36 17.44 36940328 H. PYLORI IGM 86677 300 $88.00 32.52 14.83 85.32 23.06 60.81 17.69 60.81 20.05 48.62 17.36 40.35 22.06 20.05 58.25 15.17 16.85 68.26 85.32 17.27 17.36 16.85 70.40 15.42 20.05 44.15 14.83 35.99 66.00 33.45 39.36 17.44 36900041 TOXOCARA ANTIBODY QUAL ELISA 86682 300 $614.00 226.93 - 491.20 - 424.27 13.66 424.27 - 339.24 13.40 36.17 - - 406.41 11.71 13.01 84.66 105.82 13.34 13.40 13.01 491.20 11.90 - 34.09 11.45 251.13 460.50 233.38 274.64 13.47 36909862 STRONGYLOIDES EIA 86682 300 $614.00 226.93 - 491.20 - 424.27 13.66 424.27 - 339.24 13.40 36.17 - - 406.41 11.71 13.01 84.66 105.82 13.34 13.40 13.01 491.20 11.90 - 34.09 11.45 251.13 460.50 233.38 274.64 13.47 36910453 FILARIA IGG AB 86682 300 $782.00 289.03 - 625.60 - 540.36 13.66 540.36 - 432.06 13.40 36.17 - - 517.61 11.71 13.01 84.66 105.82 13.34 13.40 13.01 625.60 11.90 - 34.09 11.45 319.84 586.50 297.24 349.79 13.47 36910771 CYSTICERCOSIS AB 86682 300 $614.00 226.93 - 491.20 - 424.27 13.66 424.27 - 339.24 13.40 36.17 - - 406.41 11.71 13.01 84.66 105.82 13.34 13.40 13.01 491.20 11.90 - 34.09 11.45 251.13 460.50 233.38 274.64 13.47 36942886 CYSTICERCUS IGG AB W BLOT CSF 86682 300 $614.00 226.93 - 491.20 - 424.27 13.66 424.27 - 339.24 13.40 36.17 - - 406.41 11.71 13.01 84.66 105.82 13.34 13.40 13.01 491.20 11.90 - 34.09 11.45 251.13 460.50 233.38 274.64 13.47 36910623 HAEMOPHILUS INFLUENZAE IGG AB 86684 300 $212.00 78.36 13.94 169.60 24.67 146.49 16.63 146.49 21.45 117.13 16.32 44.05 23.60 21.45 140.32 14.26 15.84 100.09 125.11 16.24 16.32 15.84 169.60 14.49 21.45 41.50 13.94 86.71 159.00 80.58 94.83 16.39 36914459 HTLV-I AB 86687 300 $289.00 106.81 8.00 231.20 13.34 199.70 9.54 199.70 11.60 159.67 9.36 23.33 12.76 11.60 191.29 8.18 9.09 54.10 67.63 9.32 9.36 9.09 231.20 8.32 11.60 23.82 8.00 118.20 216.75 109.85 129.27 9.41 36942266 HTLV-I ANTIBODY 86687 300 $48.00 17.74 8.00 67.63 13.34 33.17 9.54 33.17 11.60 26.52 9.36 23.33 12.76 11.60 31.77 8.18 9.09 54.10 67.63 9.32 9.36 9.09 38.40 8.32 11.60 23.82 8.00 19.63 36.00 18.24 21.47 9.41 36914467 HTLV-II AB 86688 300 $365.00 134.90 12.32 292.00 15.90 252.22 14.70 252.22 13.83 201.66 14.42 38.94 15.21 13.83 241.59 12.60 14.00 63.01 78.76 14.35 14.42 14.00 292.00 12.81 13.83 36.68 12.32 149.29 273.75 138.74 163.26 14.49 36942274 HTLV -II ANTIBODY 86688 300 $74.00 27.35 12.32 78.76 15.90 51.13 14.70 51.13 13.83 40.89 14.42 38.94 15.21 13.83 48.98 12.60 14.00 63.01 78.76 14.35 14.42 14.00 59.20 12.81 13.83 36.68 12.32 30.27 55.50 28.13 33.10 14.49 36912341 HTLV1/2 WESTERN BLOT 86689 300 $211.00 77.99 17.03 168.80 30.76 145.80 20.32 145.80 26.75 116.58 19.93 53.82 29.43 26.75 139.66 17.42 19.35 88.71 110.89 19.83 19.93 19.35 168.80 17.71 26.75 50.70 17.03 86.30 158.25 80.20 94.38 20.03 36918667 HIV PROG WEST BLOT CONF (1>2) 86689 300 $211.00 77.99 17.03 168.80 30.76 145.80 20.32 145.80 26.75 116.58 19.93 53.82 29.43 26.75 139.66 17.42 19.35 88.71 110.89 19.83 19.93 19.35 168.80 17.71 26.75 50.70 17.03 86.30 158.25 80.20 94.38 20.03 36923695 HIV 2 IMMUNOBLOT 86689 300 $482.00 178.15 17.03 385.60 30.76 333.06 20.32 333.06 26.75 266.31 19.93 53.82 29.43 26.75 319.04 17.42 19.35 88.71 110.89 19.83 19.93 19.35 385.60 17.71 26.75 50.70 17.03 197.14 361.50 183.21 215.60 20.03 36110571 HERPES SIMPLEX AB-NON SPECIFIC 86694 300 $76.00 28.09 12.66 82.23 22.80 52.52 15.11 52.52 19.83 41.99 14.82 40.04 21.81 19.83 50.30 12.95 14.39 65.78 82.23 14.75 14.82 14.39 60.80 13.17 19.83 37.70 12.66 31.08 57.00 28.89 33.99 14.89 36104384 HERPES SIMPLEX TYPE I IGG 86695 300 $69.00 25.50 11.61 75.56 20.95 47.68 13.85 47.68 18.22 38.12 13.59 36.68 20.04 18.22 45.67 11.87 13.19 60.45 75.56 13.52 13.59 13.19 55.20 12.07 18.22 34.56 11.61 28.22 51.75 26.23 30.86 13.65 36104406 HERPES SIMPLEX TYPE I IGM 86695 300 $69.00 25.50 11.61 75.56 20.95 47.68 13.85 47.68 18.22 38.12 13.59 36.68 20.04 18.22 45.67 11.87 13.19 60.45 75.56 13.52 13.59 13.19 55.20 12.07 18.22 34.56 11.61 28.22 51.75 26.23 30.86 13.65 36998610 HSV 1 IGM SCREEN 86695 300 $69.00 25.50 11.61 75.56 20.95 47.68 13.85 47.68 18.22 38.12 13.59 36.68 20.04 18.22 45.67 11.87 13.19 60.45 75.56 13.52 13.59 13.19 55.20 12.07 18.22 34.56 11.61 28.22 51.75 26.23 30.86 13.65 36998636 HSV 1 IGM TITER 86695 300 $69.00 25.50 11.61 75.56 20.95 47.68 13.85 47.68 18.22 38.12 13.59 36.68 20.04 18.22 45.67 11.87 13.19 60.45 75.56 13.52 13.59 13.19 55.20 12.07 18.22 34.56 11.61 28.22 51.75 26.23 30.86 13.65 36998687 HSV 1 IGG SCREEN 86695 300 $69.00 25.50 11.61 75.56 20.95 47.68 13.85 47.68 18.22 38.12 13.59 36.68 20.04 18.22 45.67 11.87 13.19 60.45 75.56 13.52 13.59 13.19 55.20 12.07 18.22 34.56 11.61 28.22 51.75 26.23 30.86 13.65 36104392 HERPES SIMPLEX TYPE II IGG 86696 300 $102.00 37.70 17.03 152.34 24.61 70.48 20.32 70.48 21.40 56.36 19.93 53.82 23.54 21.40 67.51 17.42 19.35 121.87 152.34 19.83 19.93 19.35 81.60 17.71 21.40 50.70 17.03 41.72 76.50 38.77 45.62 20.03 36104414 HERPES SIMPLEX TYPE II IGM 86696 300 $102.00 37.70 17.03 152.34 24.61 70.48 20.32 70.48 21.40 56.36 19.93 53.82 23.54 21.40 67.51 17.42 19.35 121.87 152.34 19.83 19.93 19.35 81.60 17.71 21.40 50.70 17.03 41.72 76.50 38.77 45.62 20.03 36922346 HSV TYP 2 IGG IMMUNOASSAY QUAL 86696 300 $102.00 37.70 17.03 152.34 24.61 70.48 20.32 70.48 21.40 56.36 19.93 53.82 23.54 21.40 67.51 17.42 19.35 121.87 152.34 19.83 19.93 19.35 81.60 17.71 21.40 50.70 17.03 41.72 76.50 38.77 45.62 20.03 36998628 HSV 2 IGM SCREEN 86696 300 $102.00 37.70 17.03 152.34 24.61 70.48 20.32 70.48 21.40 56.36 19.93 53.82 23.54 21.40 67.51 17.42 19.35 121.87 152.34 19.83 19.93 19.35 81.60 17.71 21.40 50.70 17.03 41.72 76.50 38.77 45.62 20.03 36998644 HSV 2 IGM TITER 86696 300 $102.00 37.70 17.03 152.34 24.61 70.48 20.32 70.48 21.40 56.36 19.93 53.82 23.54 21.40 67.51 17.42 19.35 121.87 152.34 19.83 19.93 19.35 81.60 17.71 21.40 50.70 17.03 41.72 76.50 38.77 45.62 20.03 36998695 HSV 2 IGG SCREEN 86696 300 $102.00 37.70 17.03 152.34 24.61 70.48 20.32 70.48 21.40 56.36 19.93 53.82 23.54 21.40 67.51 17.42 19.35 121.87 152.34 19.83 19.93 19.35 81.60 17.71 21.40 50.70 17.03 41.72 76.50 38.77 45.62 20.03 36909188 HISTOPLASMA CAPS 86698 300 $122.00 45.09 12.14 97.60 19.87 84.30 14.48 84.30 17.28 67.41 14.20 34.73 19.01 17.28 80.75 12.41 13.79 57.90 72.37 14.13 14.20 13.79 97.60 12.62 17.28 36.13 12.14 49.90 91.50 46.37 54.57 14.27 36909196 HISTOPLASMA CAPS 86698 300 $122.00 45.09 12.14 97.60 19.87 84.30 14.48 84.30 17.28 67.41 14.20 34.73 19.01 17.28 80.75 12.41 13.79 57.90 72.37 14.13 14.20 13.79 97.60 12.62 17.28 36.13 12.14 49.90 91.50 46.37 54.57 14.27 36913568 HISTOPLASMA ANTIBODY 86698 300 $291.00 107.55 12.14 232.80 19.87 201.08 14.48 201.08 17.28 160.78 14.20 34.73 19.01 17.28 192.61 12.41 13.79 57.90 72.37 14.13 14.20 13.79 232.80 12.62 17.28 36.13 12.14 119.02 218.25 110.61 130.16 14.27 35750908 HIV-1 86701 300 $47.00 17.37 7.82 50.93 13.94 32.48 9.33 32.48 12.12 25.97 9.16 24.71 13.33 12.12 31.11 8.00 8.89 40.74 50.93 9.11 9.16 8.89 37.60 8.13 12.12 23.29 7.82 19.22 35.25 17.86 21.02 9.20 36938641 HIV 1 ANTIBODY 86701 300 $138.00 51.00 7.82 110.40 13.94 95.36 9.33 95.36 12.12 76.25 9.16 24.71 13.33 12.12 91.34 8.00 8.89 40.74 50.93 9.11 9.16 8.89 110.40 8.13 12.12 23.29 7.82 56.44 103.50 52.45 61.73 9.20 36982837 HIV-1 AB DIFFERENTIATION 86701 300 $47.00 17.37 7.82 50.93 13.94 32.48 9.33 32.48 12.12 25.97 9.16 24.71 13.33 12.12 31.11 8.00 8.89 40.74 50.93 9.11 9.16 8.89 37.60 8.13 12.12 23.29 7.82 19.22 35.25 17.86 21.02 9.20 35750916 HIV-2 86702 300 $71.00 26.24 11.90 78.76 15.90 49.06 14.20 49.06 13.83 39.23 13.93 37.59 15.21 13.83 46.99 12.17 13.52 63.01 78.76 13.86 13.93 13.52 56.80 12.37 13.83 35.42 11.90 29.04 53.25 26.99 31.76 13.99 36930233 HIV 2 ANTIBODY BY EIA 86702 300 $171.00 63.20 11.90 136.80 15.90 118.16 14.20 118.16 13.83 94.48 13.93 37.59 15.21 13.83 113.18 12.17 13.52 63.01 78.76 13.86 13.93 13.52 136.80 12.37 13.83 35.42 11.90 69.94 128.25 65.00 76.49 13.99 36938650 HIV 2 ANTIBODY 86702 300 $163.00 60.24 11.90 130.40 15.90 112.63 14.20 112.63 13.83 90.06 13.93 37.59 15.21 13.83 107.89 12.17 13.52 63.01 78.76 13.86 13.93 13.52 130.40 12.37 13.83 35.42 11.90 66.67 122.25 61.96 72.91 13.99 36982845 HIV-2 AB DIFFERENTIATION 86702 300 $71.00 26.24 11.90 78.76 15.90 49.06 14.20 49.06 13.83 39.23 13.93 37.59 15.21 13.83 46.99 12.17 13.52 63.01 78.76 13.86 13.93 13.52 56.80 12.37 13.83 35.42 11.90 29.04 53.25 26.99 31.76 13.99 35705309 HIV1/HIV2 COMBO SINGLE ASSAY 86703 300 $72.00 26.61 12.06 113.92 21.51 49.75 14.40 49.75 18.70 39.78 14.12 38.12 20.57 18.70 47.66 12.34 13.71 91.14 113.92 14.05 14.12 13.71 57.60 12.54 18.70 35.92 12.06 29.45 54.00 27.37 32.21 14.19 35709681 EXPOSURE HIV1 HIV2 86703 300 $72.00 26.61 12.06 113.92 21.51 49.75 14.40 49.75 18.70 39.78 14.12 38.12 20.57 18.70 47.66 12.34 13.71 91.14 113.92 14.05 14.12 13.71 57.60 12.54 18.70 35.92 12.06 29.45 54.00 27.37 32.21 14.19 36302810 HIV1 & HIV2 SINGLE ASSAY 86703 300 $72.00 26.61 12.06 113.92 21.51 49.75 14.40 49.75 18.70 39.78 14.12 38.12 20.57 18.70 47.66 12.34 13.71 91.14 113.92 14.05 14.12 13.71 57.60 12.54 18.70 35.92 12.06 29.45 54.00 27.37 32.21 14.19 36303735 EXPOSURE RAPID HIV 1 & 2 86703 300 $72.00 26.61 12.06 113.92 21.51 49.75 14.40 49.75 18.70 39.78 14.12 38.12 20.57 18.70 47.66 12.34 13.71 91.14 113.92 14.05 14.12 13.71 57.60 12.54 18.70 35.92 12.06 29.45 54.00 27.37 32.21 14.19 36922711 HIV TYPES 1&2 86703 300 $163.00 60.24 12.06 130.40 21.51 112.63 14.40 112.63 18.70 90.06 14.12 38.12 20.57 18.70 107.89 12.34 13.71 91.14 113.92 14.05 14.12 13.71 130.40 12.54 18.70 35.92 12.06 66.67 122.25 61.96 72.91 14.19 36942240 HIV-1 HIV-2 ANTIBODY 86703 300 $72.00 26.61 12.06 113.92 21.51 49.75 14.40 49.75 18.70 39.78 14.12 38.12 20.57 18.70 47.66 12.34 13.71 91.14 113.92 14.05 14.12 13.71 57.60 12.54 18.70 35.92 12.06 29.45 54.00 27.37 32.21 14.19 35700129 HEPATITIS B CORE ANTIBODY G&M 86704 300 $63.00 23.28 10.60 91.82 17.25 43.53 12.65 43.53 15.00 34.81 12.41 33.50 16.50 15.00 41.70 10.85 12.05 73.46 91.82 12.35 12.41 12.05 50.40 11.03 15.00 31.57 10.60 25.77 47.25 23.95 28.18 12.47 36922427 HEPATITIS B CORE AB TOTAL 86704 300 $141.00 52.11 10.60 112.80 17.25 97.43 12.65 97.43 15.00 77.90 12.41 33.50 16.50 15.00 93.33 10.85 12.05 73.46 91.82 12.35 12.41 12.05 112.80 11.03 15.00 31.57 10.60 57.67 105.75 53.59 63.07 12.47 36922672 HEPATITIS B CORE AB G&M 86704 300 $141.00 52.11 10.60 112.80 17.25 97.43 12.65 97.43 15.00 77.90 12.41 33.50 16.50 15.00 93.33 10.85 12.05 73.46 91.82 12.35 12.41 12.05 112.80 11.03 15.00 31.57 10.60 57.67 105.75 53.59 63.07 12.47 36942258 HEPATITIS B CORE AB TOTAL 86704 300 $63.00 23.28 10.60 91.82 17.25 43.53 12.65 43.53 15.00 34.81 12.41 33.50 16.50 15.00 41.70 10.85 12.05 73.46 91.82 12.35 12.41 12.05 50.40 11.03 15.00 31.57 10.60 25.77 47.25 23.95 28.18 12.47 35708332 HEPATITIS B CORE ANTIBODY IGM 86705 300 $62.00 22.92 10.36 89.67 18.69 42.84 12.36 42.84 16.25 34.26 12.12 32.75 17.88 16.25 41.04 10.59 11.77 71.74 89.67 12.06 12.12 11.77 49.60 10.77 16.25 30.84 10.36 25.36 46.50 23.57 27.73 12.18 36922435 HEPATITIS B CORE AB IGM 86705 300 $144.00 53.22 10.36 115.20 18.69 99.50 12.36 99.50 16.25 79.56 12.12 32.75 17.88 16.25 95.31 10.59 11.77 71.74 89.67 12.06 12.12 11.77 115.20 10.77 16.25 30.84 10.36 58.90 108.00 54.73 64.41 12.18 35700111 HEPATITIS B SURFACE AB 86706 300 $56.00 20.70 9.45 81.79 15.16 38.70 11.28 38.70 13.18 30.94 11.06 29.86 14.50 13.18 37.07 9.67 10.74 65.43 81.79 11.01 11.06 10.74 44.80 9.83 13.18 28.14 9.45 22.90 42.00 21.29 25.05 11.12 36918721 HEPATITIS B POST VACCINE AB 86706 300 $105.00 38.81 9.45 84.00 15.16 72.56 11.28 72.56 13.18 58.01 11.06 29.86 14.50 13.18 69.50 9.67 10.74 65.43 81.79 11.01 11.06 10.74 84.00 9.83 13.18 28.14 9.45 42.95 78.75 39.91 46.97 11.12 36922443 HEPATITIS B SURFACE AB 86706 300 $141.00 52.11 9.45 112.80 15.16 97.43 11.28 97.43 13.18 77.90 11.06 29.86 14.50 13.18 93.33 9.67 10.74 65.43 81.79 11.01 11.06 10.74 112.80 9.83 13.18 28.14 9.45 57.67 105.75 53.59 63.07 11.12 35700161 HEPATITIS BE ANTIBODY 86707 300 $73.00 26.98 10.18 88.07 17.25 50.44 12.15 50.44 15.00 40.33 11.92 32.15 16.50 15.00 48.32 10.41 11.57 70.46 88.07 11.86 11.92 11.57 58.40 10.59 15.00 30.31 10.18 29.86 54.75 27.75 32.65 11.97 36922451 HEPATITIS BE ANTIBODY 86707 300 $73.00 26.98 10.18 88.07 17.25 50.44 12.15 50.44 15.00 40.33 11.92 32.15 16.50 15.00 48.32 10.41 11.57 70.46 88.07 11.86 11.92 11.57 58.40 10.59 15.00 30.31 10.18 29.86 54.75 27.75 32.65 11.97 36938587 HEP BE ANTIBODY 86707 300 $73.00 26.98 10.18 88.07 17.25 50.44 12.15 50.44 15.00 40.33 11.92 32.15 16.50 15.00 48.32 10.41 11.57 70.46 88.07 11.86 11.92 11.57 58.40 10.59 15.00 30.31 10.18 29.86 54.75 27.75 32.65 11.97 35708316 HEPATITIS A ANTIBODY IGG & IGM 86708 300 $65.00 24.02 10.90 94.36 17.25 44.92 13.01 44.92 15.00 35.91 12.76 34.45 16.50 15.00 43.02 11.15 12.39 75.49 94.36 12.70 12.76 12.39 52.00 11.34 15.00 32.46 10.90 26.59 48.75 24.71 29.07 12.82 36922460 HEPATITIS A AB TOTAL 86708 300 $98.00 36.22 10.90 94.36 17.25 67.72 13.01 67.72 15.00 54.15 12.76 34.45 16.50 15.00 64.87 11.15 12.39 75.49 94.36 12.70 12.76 12.39 78.40 11.34 15.00 32.46 10.90 40.08 73.50 37.25 43.84 12.82 35708324 HEPATITIS A ANTIBODY IGM 86709 300 $59.00 21.81 9.91 85.70 17.48 40.77 11.82 40.77 15.20 32.60 11.60 31.27 16.72 15.20 39.05 10.13 11.26 68.56 85.70 11.54 11.60 11.26 47.20 10.30 15.20 29.50 9.91 24.13 44.25 22.43 26.39 11.65 36922478 HEPATITIS A AB IGM 86709 300 $102.00 37.70 9.91 85.70 17.48 70.48 11.82 70.48 15.20 56.36 11.60 31.27 16.72 15.20 67.51 10.13 11.26 68.56 85.70 11.54 11.60 11.26 81.60 10.30 15.20 29.50 9.91 41.72 76.50 38.77 45.62 11.65 36938447 ANTIBODY INFLUENZA VIRUS 86710 300 $71.00 26.24 - 111.33 - 49.06 14.23 49.06 - 39.23 13.96 37.68 - - 46.99 12.20 13.55 89.06 111.33 13.89 13.96 13.55 56.80 12.40 - 35.50 11.92 29.04 53.25 26.99 31.76 14.02 36938455 ANTIBODY INFLUENZA VIRUS 86710 300 $71.00 26.24 - 111.33 - 49.06 14.23 49.06 - 39.23 13.96 37.68 - - 46.99 12.20 13.55 89.06 111.33 13.89 13.96 13.55 56.80 12.40 - 35.50 11.92 29.04 53.25 26.99 31.76 14.02 36909617 L PNEUMOPHILA SEROGROUP 1 86713 300 $164.00 60.61 13.46 131.20 23.98 113.32 16.07 113.32 20.85 90.61 15.76 42.55 22.94 20.85 108.55 13.77 15.30 69.14 86.42 15.68 15.76 15.30 131.20 14.00 20.85 40.09 13.46 67.08 123.00 62.34 73.36 15.84 36909706 LEGIONELLA PNEUMOPHILA IGM 86713 300 $361.00 133.43 13.46 288.80 23.98 249.45 16.07 249.45 20.85 199.45 15.76 42.55 22.94 20.85 238.95 13.77 15.30 69.14 86.42 15.68 15.76 15.30 288.80 14.00 20.85 40.09 13.46 147.65 270.75 137.22 161.48 15.84 36932589 L PNEUMOPHILA SEROGROUP 2-6;8 86713 300 $164.00 60.61 13.46 131.20 23.98 113.32 16.07 113.32 20.85 90.61 15.76 42.55 22.94 20.85 108.55 13.77 15.30 69.14 86.42 15.68 15.76 15.30 131.20 14.00 20.85 40.09 13.46 67.08 123.00 62.34 73.36 15.84 36936177 LEGIONELLA IGM SERO 2-6; 8 86713 300 $80.00 29.57 13.46 86.42 23.98 55.28 16.07 55.28 20.85 44.20 15.76 42.55 22.94 20.85 52.95 13.77 15.30 69.14 86.42 15.68 15.76 15.30 64.00 14.00 20.85 40.09 13.46 32.72 60.00 30.41 35.78 15.84 36942797 LEGIONELLA IGM AB 86713 300 $80.00 29.57 13.46 86.42 23.98 55.28 16.07 55.28 20.85 44.20 15.76 42.55 22.94 20.85 52.95 13.77 15.30 69.14 86.42 15.68 15.76 15.30 64.00 14.00 20.85 40.09 13.46 32.72 60.00 30.41 35.78 15.84 36942801 LEGIONELLA IGG AB 86713 300 $80.00 29.57 13.46 86.42 23.98 55.28 16.07 55.28 20.85 44.20 15.76 42.55 22.94 20.85 52.95 13.77 15.30 69.14 86.42 15.68 15.76 15.30 64.00 14.00 20.85 40.09 13.46 32.72 60.00 30.41 35.78 15.84 36901144 LEPTOSPIRA AB AGGLU 86720 300 $221.00 81.68 14.26 176.80 20.95 152.71 17.01 152.71 18.22 122.10 16.69 36.68 20.04 18.22 146.28 14.58 16.20 85.01 106.26 16.61 16.69 16.20 176.80 14.82 18.22 42.44 14.26 90.39 165.75 84.00 98.85 16.77 36104287 MUMPS IGG ANTIBODY EIA 86735 300 $69.00 25.50 - 75.56 - 47.68 13.70 47.68 - 38.12 13.44 36.27 - - 45.67 11.75 13.05 60.45 75.56 13.38 13.44 13.05 55.20 11.94 - 34.19 11.48 28.22 51.75 26.23 30.86 13.51 36110597 EXPOSURE MUMPS IGG AB EIA 86735 300 $69.00 25.50 - 75.56 - 47.68 13.70 47.68 - 38.12 13.44 36.27 - - 45.67 11.75 13.05 60.45 75.56 13.38 13.44 13.05 55.20 11.94 - 34.19 11.48 28.22 51.75 26.23 30.86 13.51 36910861 MUMPS IGM AB 86735 300 $208.00 76.88 - 166.40 - 143.73 13.70 143.73 - 114.92 13.44 36.27 - - 137.68 11.75 13.05 60.45 75.56 13.38 13.44 13.05 166.40 11.94 - 34.19 11.48 85.07 156.00 79.06 93.04 13.51 36900580 MYCOPLASMA PNEUMONIA IGG AB 86738 300 $208.00 76.88 11.65 166.40 20.95 143.73 13.90 143.73 18.22 114.92 13.64 36.83 20.04 18.22 137.68 11.92 13.24 60.45 75.56 13.57 13.64 13.24 166.40 12.11 18.22 34.69 11.65 85.07 156.00 79.06 93.04 13.70 36900598 MYCOPLASMA PNEUMONIA IGM AB 86738 300 $208.00 76.88 11.65 166.40 20.95 143.73 13.90 143.73 18.22 114.92 13.64 36.83 20.04 18.22 137.68 11.92 13.24 60.45 75.56 13.57 13.64 13.24 166.40 12.11 18.22 34.69 11.65 85.07 156.00 79.06 93.04 13.70 36923008 NOCARDIA 86744 300 $84.00 31.05 14.07 106.26 20.95 58.04 16.79 58.04 18.22 46.41 16.47 36.68 20.04 18.22 55.60 14.39 15.99 85.01 106.26 16.39 16.47 15.99 67.20 14.63 18.22 41.89 14.07 34.36 63.00 31.93 37.57 16.55 36922842 PARVOVIRUS IGG 86747 300 $189.00 69.85 13.23 151.20 23.89 130.60 15.78 130.60 20.77 104.42 15.48 41.79 22.85 20.77 125.10 13.53 15.03 69.00 86.25 15.41 15.48 15.03 151.20 13.75 20.77 39.38 13.23 77.30 141.75 71.84 84.54 15.56 36922851 PARVOVIRUS IGM 86747 300 $189.00 69.85 13.23 151.20 23.89 130.60 15.78 130.60 20.77 104.42 15.48 41.79 22.85 20.77 125.10 13.53 15.03 69.00 86.25 15.41 15.48 15.03 151.20 13.75 20.77 39.38 13.23 77.30 141.75 71.84 84.54 15.56 36910429 ENTAMOEBA HISTOLYTICA IGG AB 86753 300 $154.00 56.92 - 123.20 - 106.41 13.01 106.41 - 85.09 12.76 34.45 - - 101.93 11.15 12.39 81.39 101.74 12.70 12.76 12.39 123.20 11.34 - 32.46 10.90 62.99 115.50 58.54 68.88 12.82 36942282 TRYPANOSOMA CRUZI 86753 300 $65.00 24.02 - 101.74 - 44.92 13.01 44.92 - 35.91 12.76 34.45 - - 43.02 11.15 12.39 81.39 101.74 12.70 12.76 12.39 52.00 11.34 - 32.46 10.90 26.59 48.75 24.71 29.07 12.82 36911158 ROCKY MT SPOTTED FEVER IGG AB 86757 300 $102.00 37.70 17.03 152.34 24.61 70.48 20.32 70.48 21.40 56.36 19.93 53.82 23.54 21.40 67.51 17.42 19.35 121.87 152.34 19.83 19.93 19.35 81.60 17.71 21.40 50.70 17.03 41.72 76.50 38.77 45.62 20.03 36911166 TYPHUS FEVER IGG AB 86757 300 $102.00 37.70 17.03 152.34 24.61 70.48 20.32 70.48 21.40 56.36 19.93 53.82 23.54 21.40 67.51 17.42 19.35 121.87 152.34 19.83 19.93 19.35 81.60 17.71 21.40 50.70 17.03 41.72 76.50 38.77 45.62 20.03 36932287 RICKETTSIA RMSF IGG AB 86757 300 $102.00 37.70 17.03 152.34 24.61 70.48 20.32 70.48 21.40 56.36 19.93 53.82 23.54 21.40 67.51 17.42 19.35 121.87 152.34 19.83 19.93 19.35 81.60 17.71 21.40 50.70 17.03 41.72 76.50 38.77 45.62 20.03 36932295 RICKETTSIA RMSF IGM AB 86757 300 $102.00 37.70 17.03 152.34 24.61 70.48 20.32 70.48 21.40 56.36 19.93 53.82 23.54 21.40 67.51 17.42 19.35 121.87 152.34 19.83 19.93 19.35 81.60 17.71 21.40 50.70 17.03 41.72 76.50 38.77 45.62 20.03 36932309 RICKETTSIA TYPHUS IGG AB 86757 300 $102.00 37.70 17.03 152.34 24.61 70.48 20.32 70.48 21.40 56.36 19.93 53.82 23.54 21.40 67.51 17.42 19.35 121.87 152.34 19.83 19.93 19.35 81.60 17.71 21.40 50.70 17.03 41.72 76.50 38.77 45.62 20.03 36932317 RICKETTSIA TYPHUS IGM AB 86757 300 $102.00 37.70 17.03 152.34 24.61 70.48 20.32 70.48 21.40 56.36 19.93 53.82 23.54 21.40 67.51 17.42 19.35 121.87 152.34 19.83 19.93 19.35 81.60 17.71 21.40 50.70 17.03 41.72 76.50 38.77 45.62 20.03 36932325 RICKETTSIA IGG TITER 86757 300 $102.00 37.70 17.03 152.34 24.61 70.48 20.32 70.48 21.40 56.36 19.93 53.82 23.54 21.40 67.51 17.42 19.35 121.87 152.34 19.83 19.93 19.35 81.60 17.71 21.40 50.70 17.03 41.72 76.50 38.77 45.62 20.03 36932341 RICKETTSIA IGM TITER 86757 300 $102.00 37.70 17.03 152.34 24.61 70.48 20.32 70.48 21.40 56.36 19.93 53.82 23.54 21.40 67.51 17.42 19.35 121.87 152.34 19.83 19.93 19.35 81.60 17.71 21.40 50.70 17.03 41.72 76.50 38.77 45.62 20.03 36932350 RICKETTSIA TYPHI IGG TITER 86757 300 $102.00 37.70 17.03 152.34 24.61 70.48 20.32 70.48 21.40 56.36 19.93 53.82 23.54 21.40 67.51 17.42 19.35 121.87 152.34 19.83 19.93 19.35 81.60 17.71 21.40 50.70 17.03 41.72 76.50 38.77 45.62 20.03 36932368 RICKETTSIA TYPHI IGM TITER 86757 300 $102.00 37.70 17.03 152.34 24.61 70.48 20.32 70.48 21.40 56.36 19.93 53.82 23.54 21.40 67.51 17.42 19.35 121.87 152.34 19.83 19.93 19.35 81.60 17.71 21.40 50.70 17.03 41.72 76.50 38.77 45.62 20.03 35707565 RUBELLA IGG AB 86762 300 $76.00 28.09 12.66 78.54 22.59 52.52 15.11 52.52 19.64 41.99 14.82 40.04 21.60 19.64 50.30 12.95 14.39 62.83 78.54 14.75 14.82 14.39 60.80 13.17 19.64 37.70 12.66 31.08 57.00 28.89 33.99 14.89 35751149 EXPOSURE RUBELLA IGG AB 86762 300 $76.00 28.09 12.66 78.54 22.59 52.52 15.11 52.52 19.64 41.99 14.82 40.04 21.60 19.64 50.30 12.95 14.39 62.83 78.54 14.75 14.82 14.39 60.80 13.17 19.64 37.70 12.66 31.08 57.00 28.89 33.99 14.89 36103931 RUBELLA IGM AB 86762 300 $76.00 28.09 12.66 78.54 22.59 52.52 15.11 52.52 19.64 41.99 14.82 40.04 21.60 19.64 50.30 12.95 14.39 62.83 78.54 14.75 14.82 14.39 60.80 13.17 19.64 37.70 12.66 31.08 57.00 28.89 33.99 14.89 36110619 EXPOSURE RUBELLA IGM 86762 300 $76.00 28.09 12.66 78.54 22.59 52.52 15.11 52.52 19.64 41.99 14.82 40.04 21.60 19.64 50.30 12.95 14.39 62.83 78.54 14.75 14.82 14.39 60.80 13.17 19.64 37.70 12.66 31.08 57.00 28.89 33.99 14.89 36100753 RUBEOLA IGG AB 86765 300 $68.00 25.13 11.33 54.40 13.57 46.99 13.52 46.99 11.80 37.57 13.27 35.83 12.98 11.80 45.01 11.59 12.88 41.49 51.86 13.20 13.27 12.88 54.40 11.79 11.80 33.75 11.33 27.81 51.00 25.85 30.42 13.33 36110601 EXPOSURE RUBEOLA IGG AB 86765 300 $68.00 25.13 11.33 54.40 13.57 46.99 13.52 46.99 11.80 37.57 13.27 35.83 12.98 11.80 45.01 11.59 12.88 41.49 51.86 13.20 13.27 12.88 54.40 11.79 11.80 33.75 11.33 27.81 51.00 25.85 30.42 13.33 36922290 RUBEOLA IGM ANTIBODY 86765 300 $273.00 100.90 11.33 218.40 13.57 188.64 13.52 188.64 11.80 150.83 13.27 35.83 12.98 11.80 180.70 11.59 12.88 41.49 51.86 13.20 13.27 12.88 218.40 11.79 11.80 33.75 11.33 111.66 204.75 103.77 122.11 13.33 35751181 SARS COV2 AB IA 86769 300 $192.00 70.96 11.16 153.60 12.83 132.67 44.24 132.67 11.16 106.08 43.39 126.72 12.28 11.16 127.08 37.92 42.13 101.74 127.18 43.18 43.39 42.13 153.60 38.55 11.16 128.64 37.07 78.53 144.00 72.98 85.88 43.60 36903139 TETANUS AB 86774 300 $123.00 45.46 - 98.40 - 84.99 15.54 84.99 - 67.96 15.24 41.13 - - 81.41 13.32 14.80 68.26 85.32 15.17 15.24 14.80 98.40 13.54 - 38.78 13.02 50.31 92.25 46.75 55.02 15.32 36100567 TOXOPLASMA IGG 86777 300 $76.00 28.09 12.66 82.23 22.80 52.52 15.11 52.52 19.83 41.99 14.82 40.04 21.81 19.83 50.30 12.95 14.39 65.78 82.23 14.75 14.82 14.39 60.80 13.17 19.83 37.70 12.66 31.08 57.00 28.89 33.99 14.89 36100575 TOXOPLASMA IGM 86778 300 $76.00 28.09 12.68 85.32 22.89 52.52 15.13 52.52 19.90 41.99 14.84 40.04 21.89 19.90 50.30 12.97 14.41 68.26 85.32 14.77 14.84 14.41 60.80 13.19 19.90 37.75 12.68 31.08 57.00 28.89 33.99 14.91 35709461 TREPONEMA PALLIDUM AB SCREEN 86780 300 $70.00 25.87 11.65 104.55 17.46 48.37 13.90 48.37 15.18 38.68 13.64 36.80 16.70 15.18 46.33 11.92 13.24 83.64 104.55 13.57 13.64 13.24 56.00 12.11 15.18 34.69 11.65 28.63 52.50 26.61 31.31 13.70 36900601 FTA ABS;CONFIRMATION 86780 300 $70.00 25.87 11.65 104.55 17.46 48.37 13.90 48.37 15.18 38.68 13.64 36.80 16.70 15.18 46.33 11.92 13.24 83.64 104.55 13.57 13.64 13.24 56.00 12.11 15.18 34.69 11.65 28.63 52.50 26.61 31.31 13.70 36902736 TREPONEMA PALLIDUM AB 86780 300 $138.00 51.00 11.65 110.40 17.46 95.36 13.90 95.36 15.18 76.25 13.64 36.80 16.70 15.18 91.34 11.92 13.24 83.64 104.55 13.57 13.64 13.24 110.40 12.11 15.18 34.69 11.65 56.44 103.50 52.45 61.73 13.70 36924896 TRICHINELLA ANTIBODY 86784 300 $564.00 208.45 11.05 451.20 19.96 389.72 13.19 389.72 17.36 311.61 12.94 34.92 19.10 17.36 373.31 11.30 12.56 81.39 101.74 12.87 12.94 12.56 451.20 11.49 17.36 32.91 11.05 230.68 423.00 214.38 252.28 13.00 36100613 VARICELLA ZOSTER IGG 86787 300 $68.00 25.13 11.33 73.85 20.48 46.99 13.52 46.99 17.81 37.57 13.27 35.83 19.59 17.81 45.01 11.59 12.88 59.08 73.85 13.20 13.27 12.88 54.40 11.79 17.81 33.75 11.33 27.81 51.00 25.85 30.42 13.33 36110627 EXPOSURE VARICELLA ZOSTER IGG 86787 300 $68.00 25.13 11.33 73.85 20.48 46.99 13.52 46.99 17.81 37.57 13.27 35.83 19.59 17.81 45.01 11.59 12.88 59.08 73.85 13.20 13.27 12.88 54.40 11.79 17.81 33.75 11.33 27.81 51.00 25.85 30.42 13.33 36904330 VARICELLA ZSTR IGM AB 86787 300 $470.00 173.71 11.33 376.00 20.48 324.77 13.52 324.77 17.81 259.68 13.27 35.83 19.59 17.81 311.09 11.59 12.88 59.08 73.85 13.20 13.27 12.88 376.00 11.79 17.81 33.75 11.33 192.23 352.50 178.65 210.23 13.33 36938897 VARICELLA ZOSTER IGM CSF 86787 300 $122.00 45.09 11.33 97.60 20.48 84.30 13.52 84.30 17.81 67.41 13.27 35.83 19.59 17.81 80.75 11.59 12.88 59.08 73.85 13.20 13.27 12.88 97.60 11.79 17.81 33.75 11.33 49.90 91.50 46.37 54.57 13.33 36939001 VARICELLA ZOSTER IGG AB CSF 86787 300 $122.00 45.09 11.33 97.60 20.48 84.30 13.52 84.30 17.81 67.41 13.27 35.83 19.59 17.81 80.75 11.59 12.88 59.08 73.85 13.20 13.27 12.88 97.60 11.79 17.81 33.75 11.33 49.90 91.50 46.37 54.57 13.33 36911913 HERPES TYPE 6 IGG ANTIBODIES 86790 300 $208.00 76.88 - 166.40 - 143.73 13.52 143.73 - 114.92 13.27 35.83 - - 137.68 11.59 12.88 83.11 103.89 13.20 13.27 12.88 166.40 11.79 - 33.75 11.33 85.07 156.00 79.06 93.04 13.33 36911921 HERPES TYPE 6 IGM ANTIBODIES 86790 300 $208.00 76.88 - 166.40 - 143.73 13.52 143.73 - 114.92 13.27 35.83 - - 137.68 11.59 12.88 83.11 103.89 13.20 13.27 12.88 166.40 11.79 - 33.75 11.33 85.07 156.00 79.06 93.04 13.33 36925094 HTLV I/II ANTIBODY 86790 300 $208.00 76.88 - 166.40 - 143.73 13.52 143.73 - 114.92 13.27 35.83 - - 137.68 11.59 12.88 83.11 103.89 13.20 13.27 12.88 166.40 11.79 - 33.75 11.33 85.07 156.00 79.06 93.04 13.33 36940115 STRATIFY JCV AB IA 86790 300 "$3,959.00" " 1,463.25 " - " 3,167.20 " - " 2,735.67 " 13.52 " 2,735.67 " - " 2,187.35 " 13.27 35.83 - - " 2,620.46 " 11.59 12.88 83.11 103.89 13.20 13.27 12.88 " 3,167.20 " 11.79 - 33.75 11.33 " 1,619.23 " " 2,969.25 " " 1,504.82 " " 1,770.86 " 13.33 36943319 HTLV I/II AB 86790 300 $208.00 76.88 - 166.40 - 143.73 13.52 143.73 - 114.92 13.27 35.83 - - 137.68 11.59 12.88 83.11 103.89 13.20 13.27 12.88 166.40 11.79 - 33.75 11.33 85.07 156.00 79.06 93.04 13.33 36942088 ZIKA IGM 86794 300 $433.00 160.04 14.83 346.40 19.14 299.20 17.69 299.20 16.64 239.23 17.36 285.78 18.30 16.64 286.60 15.17 16.85 91.71 114.64 17.27 17.36 16.85 346.40 15.42 16.64 44.15 14.83 177.10 324.75 164.58 193.68 17.44 36944731 ZIKA VIRUS AB IGM 86794 300 "$1,054.00" 389.56 14.83 843.20 19.14 728.31 17.69 728.31 16.64 582.34 17.36 695.64 18.30 16.64 697.64 15.17 16.85 91.71 114.64 17.27 17.36 16.85 843.20 15.42 16.64 44.15 14.83 431.09 790.50 400.63 471.45 17.44 35708219 THYROGLOBULIN ANTIBODY 86800 300 $84.00 31.05 14.00 86.31 21.22 58.04 16.71 58.04 18.45 46.41 16.39 44.24 20.30 18.45 55.60 14.32 15.91 69.05 86.31 16.31 16.39 15.91 67.20 14.56 18.45 41.68 14.00 34.36 63.00 31.93 37.57 16.47 35710175 AB TO THYROGLOBULIN 86800 300 $84.00 31.05 14.00 86.31 21.22 58.04 16.71 58.04 18.45 46.41 16.39 44.24 20.30 18.45 55.60 14.32 15.91 69.05 86.31 16.31 16.39 15.91 67.20 14.56 18.45 41.68 14.00 34.36 63.00 31.93 37.57 16.47 36930985 THYROGLOBULIN ANTIBODY 86800 300 $228.00 84.27 14.00 182.40 21.22 157.55 16.71 157.55 18.45 125.97 16.39 44.24 20.30 18.45 150.91 14.32 15.91 69.05 86.31 16.31 16.39 15.91 182.40 14.56 18.45 41.68 14.00 93.25 171.00 86.66 101.98 16.47 36944994 THYROGLOBULIN ANTIBODY 86800 300 $120.00 44.35 14.00 96.00 21.22 82.92 16.71 82.92 18.45 66.30 16.39 44.24 20.30 18.45 79.43 14.32 15.91 69.05 86.31 16.31 16.39 15.91 96.00 14.56 18.45 41.68 14.00 49.08 90.00 45.61 53.68 16.47 36982926 THYROGLOBULIN ANTIBODY 86800 300 $84.00 31.05 14.00 86.31 21.22 58.04 16.71 58.04 18.45 46.41 16.39 44.24 20.30 18.45 55.60 14.32 15.91 69.05 86.31 16.31 16.39 15.91 67.20 14.56 18.45 41.68 14.00 34.36 63.00 31.93 37.57 16.47 35708961 HEPATITIS C ANTIBODY 86803 300 $75.00 27.72 12.56 108.74 21.85 51.83 14.98 51.83 19.00 41.44 14.70 39.69 20.90 19.00 49.64 12.84 14.27 86.99 108.74 14.63 14.70 14.27 60.00 13.06 19.00 37.39 12.56 30.68 56.25 28.51 33.55 14.77 35709347 HEPATITIS C VIRUS PROGRESSIVE 86803 300 $75.00 27.72 12.56 108.74 21.85 51.83 14.98 51.83 19.00 41.44 14.70 39.69 20.90 19.00 49.64 12.84 14.27 86.99 108.74 14.63 14.70 14.27 60.00 13.06 19.00 37.39 12.56 30.68 56.25 28.51 33.55 14.77 35709703 EXPOSURE HEPATITIS C AB 86803 300 $75.00 27.72 12.56 108.74 21.85 51.83 14.98 51.83 19.00 41.44 14.70 39.69 20.90 19.00 49.64 12.84 14.27 86.99 108.74 14.63 14.70 14.27 60.00 13.06 19.00 37.39 12.56 30.68 56.25 28.51 33.55 14.77 35710132 EXPOSURE HCV PROG 86803 300 $75.00 27.72 12.56 108.74 21.85 51.83 14.98 51.83 19.00 41.44 14.70 39.69 20.90 19.00 49.64 12.84 14.27 86.99 108.74 14.63 14.70 14.27 60.00 13.06 19.00 37.39 12.56 30.68 56.25 28.51 33.55 14.77 36922486 HEPATITIS C ANTIBODY 86803 300 $141.00 52.11 12.56 112.80 21.85 97.43 14.98 97.43 19.00 77.90 14.70 39.69 20.90 19.00 93.33 12.84 14.27 86.99 108.74 14.63 14.70 14.27 112.80 13.06 19.00 37.39 12.56 57.67 105.75 53.59 63.07 14.77 36922699 HEPATITIS C ANTIBODY 86803 300 $141.00 52.11 12.56 112.80 21.85 97.43 14.98 97.43 19.00 77.90 14.70 39.69 20.90 19.00 93.33 12.84 14.27 86.99 108.74 14.63 14.70 14.27 112.80 13.06 19.00 37.39 12.56 57.67 105.75 53.59 63.07 14.77 36942231 HEPATITIS C ANTIBODY 86803 300 $75.00 27.72 12.56 108.74 21.85 51.83 14.98 51.83 19.00 41.44 14.70 39.69 20.90 19.00 49.64 12.84 14.27 86.99 108.74 14.63 14.70 14.27 60.00 13.06 19.00 37.39 12.56 30.68 56.25 28.51 33.55 14.77 36922621 HEPATITIS C AB RIBA IMMUNOBLOT 86804 300 $223.00 82.42 13.63 178.40 24.61 154.09 16.26 154.09 21.40 123.21 15.95 43.08 23.54 21.40 147.60 13.94 15.49 94.36 117.95 15.88 15.95 15.49 178.40 14.17 21.40 40.58 13.63 91.21 167.25 84.76 99.75 16.03 36770015 T CELL FLOW CROSSMATCH 86805 300 $995.00 367.75 44.07 796.00 50.68 687.55 198.99 687.55 44.07 549.74 195.20 145.38 48.48 44.07 658.59 170.56 189.51 200.79 250.99 194.25 195.20 189.51 796.00 173.40 44.07 496.52 166.77 406.96 746.25 378.20 445.06 196.14 36770023 B CELL FLOW CROSSMATCH 86805 300 $995.00 367.75 44.07 796.00 50.68 687.55 198.99 687.55 44.07 549.74 195.20 145.38 48.48 44.07 658.59 170.56 189.51 200.79 250.99 194.25 195.20 189.51 796.00 173.40 44.07 496.52 166.77 406.96 746.25 378.20 445.06 196.14 36770449 B CELL FLOW XMATCH 86805 300 $995.00 367.75 44.07 796.00 50.68 687.55 198.99 687.55 44.07 549.74 195.20 145.38 48.48 44.07 658.59 170.56 189.51 200.79 250.99 194.25 195.20 189.51 796.00 173.40 44.07 496.52 166.77 406.96 746.25 378.20 445.06 196.14 36770457 T CELL FLOW XMATCH 86805 300 $995.00 367.75 44.07 796.00 50.68 687.55 198.99 687.55 44.07 549.74 195.20 145.38 48.48 44.07 658.59 170.56 189.51 200.79 250.99 194.25 195.20 189.51 796.00 173.40 44.07 496.52 166.77 406.96 746.25 378.20 445.06 196.14 36770694 WBC XM LYMPHOCYTOTOX 86805 300 $995.00 367.75 44.07 796.00 50.68 687.55 198.99 687.55 44.07 549.74 195.20 145.38 48.48 44.07 658.59 170.56 189.51 200.79 250.99 194.25 195.20 189.51 796.00 173.40 44.07 496.52 166.77 406.96 746.25 378.20 445.06 196.14 36926210 LYMCYTOX XM WITH TITRATE R 86805 300 "$2,877.00" " 1,063.34 " 44.07 " 2,301.60 " 50.68 " 1,988.01 " 198.99 " 1,988.01 " 44.07 " 1,589.54 " 195.20 145.38 48.48 44.07 " 1,904.29 " 170.56 189.51 200.79 250.99 194.25 195.20 189.51 " 2,301.60 " 173.40 44.07 496.52 166.77 " 1,176.69 " " 2,157.75 " " 1,093.55 " " 1,286.88 " 196.14 36926252 LYMCYTOX XM WITH TITRATE R 86805 300 "$2,877.00" " 1,063.34 " 44.07 " 2,301.60 " 50.68 " 1,988.01 " 198.99 " 1,988.01 " 44.07 " 1,589.54 " 195.20 145.38 48.48 44.07 " 1,904.29 " 170.56 189.51 200.79 250.99 194.25 195.20 189.51 " 2,301.60 " 173.40 44.07 496.52 166.77 " 1,176.69 " " 2,157.75 " " 1,093.55 " " 1,286.88 " 196.14 36926490 LYMCYTOX XM WITH TITRATE R 86805 300 $995.00 367.75 44.07 796.00 50.68 687.55 198.99 687.55 44.07 549.74 195.20 145.38 48.48 44.07 658.59 170.56 189.51 200.79 250.99 194.25 195.20 189.51 796.00 173.40 44.07 496.52 166.77 406.96 746.25 378.20 445.06 196.14 36926503 LYMCYTOX XM WITH TITRATE R 86805 300 $995.00 367.75 44.07 796.00 50.68 687.55 198.99 687.55 44.07 549.74 195.20 145.38 48.48 44.07 658.59 170.56 189.51 200.79 250.99 194.25 195.20 189.51 796.00 173.40 44.07 496.52 166.77 406.96 746.25 378.20 445.06 196.14 36926511 LYMCYTOX XM WITH TITRATE R 86805 300 $995.00 367.75 44.07 796.00 50.68 687.55 198.99 687.55 44.07 549.74 195.20 145.38 48.48 44.07 658.59 170.56 189.51 200.79 250.99 194.25 195.20 189.51 796.00 173.40 44.07 496.52 166.77 406.96 746.25 378.20 445.06 196.14 36770040 HLA LEUK ANTIBODY SCRN (PRA) 86807 300 $413.00 152.64 54.69 330.40 62.89 285.38 82.58 285.38 54.69 228.18 81.01 110.03 60.16 54.69 273.36 70.79 78.65 255.16 318.95 80.62 81.01 78.65 330.40 71.96 54.69 206.06 69.21 168.92 309.75 156.98 184.73 81.40 36770431 HLA LEUK ANTIBODY SCRN (PRA) 86807 300 $413.00 152.64 54.69 330.40 62.89 285.38 82.58 285.38 54.69 228.18 81.01 110.03 60.16 54.69 273.36 70.79 78.65 255.16 318.95 80.62 81.01 78.65 330.40 71.96 54.69 206.06 69.21 168.92 309.75 156.98 184.73 81.40 35610693 HLA TYPING A B OR C SINGLE AG 86812 300 $136.00 50.27 12.00 147.87 13.80 93.98 27.10 93.98 12.00 75.14 26.58 71.75 13.20 12.00 90.02 23.23 25.81 118.30 147.87 26.46 26.58 25.81 108.80 23.62 12.00 67.62 22.71 55.62 102.00 51.69 60.83 26.71 36150823 HLA B27 ANTIGEN 86812 300 $136.00 50.27 12.00 147.87 13.80 93.98 27.10 93.98 12.00 75.14 26.58 71.75 13.20 12.00 90.02 23.23 25.81 118.30 147.87 26.46 26.58 25.81 108.80 23.62 12.00 67.62 22.71 55.62 102.00 51.69 60.83 26.71 36770082 HLA CLASS 1 SINGLE ANTIGEN 86812 300 $136.00 50.27 12.00 147.87 13.80 93.98 27.10 93.98 12.00 75.14 26.58 71.75 13.20 12.00 90.02 23.23 25.81 118.30 147.87 26.46 26.58 25.81 108.80 23.62 12.00 67.62 22.71 55.62 102.00 51.69 60.83 26.71 36917334 HLA B27 ANTIGEN 86812 300 $292.00 107.92 12.00 233.60 13.80 201.77 27.10 201.77 12.00 161.33 26.58 71.75 13.20 12.00 193.27 23.23 25.81 118.30 147.87 26.46 26.58 25.81 233.60 23.62 12.00 67.62 22.71 119.43 219.00 110.99 130.61 26.71 35601112 HLA TYPING (ARC) 86813 300 $305.00 112.73 51.04 332.29 90.28 210.76 60.90 210.76 78.50 168.51 59.74 161.24 86.35 78.50 201.88 52.20 58.00 265.83 332.29 59.45 59.74 58.00 244.00 53.07 78.50 151.96 51.04 124.75 228.75 115.93 136.43 60.03 36770091 HLA CLASS 2 SINGLE ANTIGEN 86816 300 $158.00 58.40 26.55 159.61 40.25 109.18 31.68 109.18 35.00 87.30 31.08 77.46 38.50 35.00 104.58 27.15 30.17 127.69 159.61 30.92 31.08 30.17 126.40 27.61 35.00 79.05 26.55 64.62 118.50 60.06 70.67 31.23 36770481 HLA FLOW XM NON-CYTO 1ST 86825 300 $575.00 212.52 92.03 634.04 105.83 397.33 114.96 397.33 92.03 317.69 112.77 223.32 101.23 92.03 380.59 98.54 109.49 507.23 634.04 112.23 112.77 109.49 460.00 100.18 92.03 286.86 96.35 235.18 431.25 218.56 257.20 113.32 36770708 FLOW T & B HLA XM 1ST 86825 300 $575.00 212.52 92.03 634.04 105.83 397.33 114.96 397.33 92.03 317.69 112.77 223.32 101.23 92.03 380.59 98.54 109.49 507.23 634.04 112.23 112.77 109.49 460.00 100.18 92.03 286.86 96.35 235.18 431.25 218.56 257.20 113.32 36930322 HLA XMATCH NON CYTO IST SAMP 86825 300 "$2,508.00" 926.96 92.03 " 2,006.40 " 105.83 " 1,733.03 " 114.96 " 1,733.03 " 92.03 " 1,385.67 " 112.77 223.32 101.23 92.03 " 1,660.05 " 98.54 109.49 507.23 634.04 112.23 112.77 109.49 " 2,006.40 " 100.18 92.03 286.86 96.35 " 1,025.77 " " 1,881.00 " 953.29 " 1,121.83 " 113.32 36930331 HLA XMATCH NON CYTO IST SAMP 86825 300 "$2,508.00" 926.96 92.03 " 2,006.40 " 105.83 " 1,733.03 " 114.96 " 1,733.03 " 92.03 " 1,385.67 " 112.77 223.32 101.23 92.03 " 1,660.05 " 98.54 109.49 507.23 634.04 112.23 112.77 109.49 " 2,006.40 " 100.18 92.03 286.86 96.35 " 1,025.77 " " 1,881.00 " 953.29 " 1,121.83 " 113.32 36942631 HLA RECIP FLOW CROSSMATCH 86825 300 "$1,793.00" 662.69 92.03 " 1,434.40 " 105.83 " 1,238.96 " 114.96 " 1,238.96 " 92.03 990.63 112.77 223.32 101.23 92.03 " 1,186.79 " 98.54 109.49 507.23 634.04 112.23 112.77 109.49 " 1,434.40 " 100.18 92.03 286.86 96.35 733.34 " 1,344.75 " 681.52 802.01 113.32 36770490 HLA FLOW ADDL SAMPLE 86826 300 $192.00 70.96 30.68 211.37 35.28 132.67 38.36 132.67 30.68 106.08 37.63 74.45 33.75 30.68 127.08 32.88 36.53 169.10 211.37 37.44 37.63 36.53 153.60 33.42 30.68 95.71 32.15 78.53 144.00 72.98 85.88 37.81 36770589 HLA FLOW ADDL SAMPLE 86826 300 $192.00 70.96 30.68 211.37 35.28 132.67 38.36 132.67 30.68 106.08 37.63 74.45 33.75 30.68 127.08 32.88 36.53 169.10 211.37 37.44 37.63 36.53 153.60 33.42 30.68 95.71 32.15 78.53 144.00 72.98 85.88 37.81 36770597 HLA FLOW ADDL SAMPLE 86826 300 $192.00 70.96 30.68 211.37 35.28 132.67 38.36 132.67 30.68 106.08 37.63 74.45 33.75 30.68 127.08 32.88 36.53 169.10 211.37 37.44 37.63 36.53 153.60 33.42 30.68 95.71 32.15 78.53 144.00 72.98 85.88 37.81 36770601 HLA FLOW ADDL SAMPLE 86826 300 $192.00 70.96 30.68 211.37 35.28 132.67 38.36 132.67 30.68 106.08 37.63 74.45 33.75 30.68 127.08 32.88 36.53 169.10 211.37 37.44 37.63 36.53 153.60 33.42 30.68 95.71 32.15 78.53 144.00 72.98 85.88 37.81 36770767 T & B CROSSMATCH ADDL 86826 300 $192.00 70.96 30.68 211.37 35.28 132.67 38.36 132.67 30.68 106.08 37.63 74.45 33.75 30.68 127.08 32.88 36.53 169.10 211.37 37.44 37.63 36.53 153.60 33.42 30.68 95.71 32.15 78.53 144.00 72.98 85.88 37.81 36937190 HLA XM NON CYTO ADDL SAMP 86826 300 $270.00 99.79 30.68 216.00 35.28 186.57 38.36 186.57 30.68 149.18 37.63 74.45 33.75 30.68 178.71 32.88 36.53 169.10 211.37 37.44 37.63 36.53 216.00 33.42 30.68 95.71 32.15 110.43 202.50 102.63 120.77 37.81 36770660 LEUKOCYTE CLASS 1 AND CLASS 2 86828 300 $337.00 124.56 43.52 269.60 50.05 232.87 67.40 232.87 43.52 186.19 66.12 110.03 47.87 43.52 223.06 57.77 64.19 110.01 137.51 65.79 66.12 64.19 269.60 58.73 43.52 168.18 56.49 137.83 252.75 128.09 150.74 66.44 36770678 HLA CLASS I AB 86830 300 $501.00 185.17 84.06 400.80 97.44 346.19 100.30 346.19 84.73 276.80 98.39 224.48 93.20 84.73 331.61 85.97 95.52 214.20 267.75 97.91 98.39 95.52 400.80 87.40 84.73 250.26 84.06 204.91 375.75 190.43 224.10 98.86 36770686 HLA CLASS II AB 86831 300 $430.00 158.93 72.05 344.00 83.51 297.13 85.97 297.13 72.62 237.58 84.34 192.42 79.88 72.62 284.62 73.69 81.88 183.60 229.50 83.93 84.34 81.88 344.00 74.92 72.62 214.53 72.05 175.87 322.50 163.44 192.34 84.75 36770643 HLA CLASS I AB 86832 300 "$1,700.00" 628.32 133.14 " 1,360.00 " 153.11 " 1,174.70 " 339.94 " 1,174.70 " 133.14 939.25 333.46 352.75 146.45 133.14 " 1,125.23 " 291.38 323.75 336.60 420.75 331.84 333.46 323.75 " 1,360.00 " 296.23 133.14 848.23 284.90 695.30 " 1,275.00 " 646.17 760.41 335.08 36770783 HLA CLASS I HI DEF 86832 300 "$1,700.00" 628.32 133.14 " 1,360.00 " 153.11 " 1,174.70 " 339.94 " 1,174.70 " 133.14 939.25 333.46 352.75 146.45 133.14 " 1,125.23 " 291.38 323.75 336.60 420.75 331.84 333.46 323.75 " 1,360.00 " 296.23 133.14 848.23 284.90 695.30 " 1,275.00 " 646.17 760.41 335.08 36936924 HLA CLS I HIGH DEF QUAL AB 86832 300 "$8,068.00" " 2,981.93 " 133.14 " 6,454.40 " 153.11 " 5,574.99 " 339.94 " 5,574.99 " 133.14 " 4,457.57 " 333.46 352.75 146.45 133.14 " 5,340.21 " 291.38 323.75 336.60 420.75 331.84 333.46 323.75 " 6,454.40 " 296.23 133.14 848.23 284.90 " 3,299.81 " " 6,051.00 " " 3,066.65 " " 3,608.82 " 335.08 36942622 HLA CLASS I AND II AB SCREEN 86832 300 "$1,790.00" 661.58 133.14 " 1,432.00 " 153.11 " 1,236.89 " 339.94 " 1,236.89 " 133.14 988.98 333.46 352.75 146.45 133.14 " 1,184.80 " 291.38 323.75 336.60 420.75 331.84 333.46 323.75 " 1,432.00 " 296.23 133.14 848.23 284.90 732.11 " 1,342.50 " 680.38 800.67 335.08 36770651 HLA CLASS 2 AB 86833 300 "$1,710.00" 632.02 121.04 " 1,368.00 " 139.20 " 1,181.61 " 342.09 " 1,181.61 " 121.04 944.78 335.57 320.69 133.14 121.04 " 1,131.85 " 293.22 325.80 306.00 382.50 333.95 335.57 325.80 " 1,368.00 " 298.11 121.04 853.60 286.70 699.39 " 1,282.50 " 649.97 764.88 337.20 36770732 HLA CLASS II HIGH DEF 86833 300 "$1,710.00" 632.02 121.04 " 1,368.00 " 139.20 " 1,181.61 " 342.09 " 1,181.61 " 121.04 944.78 335.57 320.69 133.14 121.04 " 1,131.85 " 293.22 325.80 306.00 382.50 333.95 335.57 325.80 " 1,368.00 " 298.11 121.04 853.60 286.70 699.39 " 1,282.50 " 649.97 764.88 337.20 36936932 HLA CLS II HIGH DEF QUAL AB 86833 300 "$8,068.00" " 2,981.93 " 121.04 " 6,454.40 " 139.20 " 5,574.99 " 342.09 " 5,574.99 " 121.04 " 4,457.57 " 335.57 320.69 133.14 121.04 " 5,340.21 " 293.22 325.80 306.00 382.50 333.95 335.57 325.80 " 6,454.40 " 298.11 121.04 853.60 286.70 " 3,299.81 " " 6,051.00 " " 3,066.65 " " 3,608.82 " 337.20 36982454 HLA CLASS II AB QUAL 86833 300 "$1,790.00" 661.58 121.04 " 1,432.00 " 139.20 " 1,236.89 " 342.09 " 1,236.89 " 121.04 988.98 335.57 320.69 133.14 121.04 " 1,184.80 " 293.22 325.80 306.00 382.50 333.95 335.57 325.80 " 1,432.00 " 298.11 121.04 853.60 286.70 732.11 " 1,342.50 " 680.38 800.67 337.20 36770741 HLA CLASS I SEMIQUANT 86834 300 "$1,877.00" 693.74 314.65 " 1,501.60 " 431.50 " 1,297.01 " 375.44 " 1,297.01 " 375.22 " 1,037.04 " 368.29 994.12 412.74 375.22 " 1,242.39 " 321.80 357.56 948.64 " 1,185.80 " 366.50 368.29 357.56 " 1,501.60 " 327.17 375.22 936.81 314.65 767.69 " 1,407.75 " 713.45 839.58 370.07 36770775 HLA CLASS I DIL SEMIQUANT 86834 300 "$1,877.00" 693.74 314.65 " 1,501.60 " 431.50 " 1,297.01 " 375.44 " 1,297.01 " 375.22 " 1,037.04 " 368.29 994.12 412.74 375.22 " 1,242.39 " 321.80 357.56 948.64 " 1,185.80 " 366.50 368.29 357.56 " 1,501.60 " 327.17 375.22 936.81 314.65 767.69 " 1,407.75 " 713.45 839.58 370.07 36770759 HLA CLASS II SEMIQUANT 86835 300 "$1,696.00" 626.84 284.20 " 1,356.80 " 389.75 " 1,171.94 " 339.11 " 1,171.94 " 338.91 937.04 332.65 897.88 372.80 338.91 " 1,122.58 " 290.66 322.96 856.84 " 1,071.05 " 331.03 332.65 322.96 " 1,356.80 " 295.51 338.91 846.16 284.20 693.66 " 1,272.00 " 644.65 758.62 334.26 36770813 HLA CLASS II DIL SEMIQUANT 86835 300 "$1,696.00" 626.84 284.20 " 1,356.80 " 389.75 " 1,171.94 " 339.11 " 1,171.94 " 338.91 937.04 332.65 897.88 372.80 338.91 " 1,122.58 " 290.66 322.96 856.84 " 1,071.05 " 331.03 332.65 322.96 " 1,356.80 " 295.51 338.91 846.16 284.20 693.66 " 1,272.00 " 644.65 758.62 334.26 36770058 CADV DONOR RECIP XMATCH 86849 300 $561.00 207.35 - 448.80 - 387.65 - 387.65 - 309.95 - 39.88 - - 371.33 - - 19.58 24.47 - - - 448.80 - - 375.87 - 229.45 420.75 213.24 250.94 - 36925086 NAT HIV-1/HCV DONOR TESTING 86849 300 $70.00 25.87 - 56.00 - 48.37 - 48.37 - 38.68 - 39.88 - - 46.33 - - 19.58 24.47 - - - 56.00 - - 46.90 - 28.63 52.50 26.61 31.31 - 35600043 ANTIBODY SCREEN 86850 300 $261.00 96.47 8.45 208.80 9.72 180.35 51.83 180.35 8.45 144.20 50.84 10.64 9.30 8.45 172.76 44.42 49.36 21.38 26.73 50.59 50.84 49.36 208.80 45.16 8.45 25.60 43.44 106.75 195.75 99.21 116.75 51.09 35600434 COLD ANTIBODY SCREEN 86850 300 $261.00 96.47 8.45 208.80 9.72 180.35 51.83 180.35 8.45 144.20 50.84 10.64 9.30 8.45 172.76 44.42 49.36 21.38 26.73 50.59 50.84 49.36 208.80 45.16 8.45 25.60 43.44 106.75 195.75 99.21 116.75 51.09 36942291 RBC ANTIBODY SCREEN 86850 300 $261.00 96.47 8.45 208.80 9.72 180.35 51.83 180.35 8.45 144.20 50.84 10.64 9.30 8.45 172.76 44.42 49.36 21.38 26.73 50.59 50.84 49.36 208.80 45.16 8.45 25.60 43.44 106.75 195.75 99.21 116.75 51.09 35600566 ACID ELUTION 86860 300 $783.00 289.40 8.45 626.40 9.72 541.05 155.56 541.05 8.45 432.61 152.59 62.11 9.30 8.45 518.27 133.34 148.15 49.91 62.39 151.85 152.59 148.15 626.40 135.56 8.45 390.80 130.37 320.25 587.25 297.62 350.24 153.34 35601228 LUI ELUTION 86860 300 $783.00 289.40 8.45 626.40 9.72 541.05 155.56 541.05 8.45 432.61 152.59 62.11 9.30 8.45 518.27 133.34 148.15 49.91 62.39 151.85 152.59 148.15 626.40 135.56 8.45 390.80 130.37 320.25 587.25 297.62 350.24 153.34 35600035 ANTIBODY IDENTIFICATION 86870 300 "$1,529.00" 565.12 8.45 " 1,223.20 " 9.72 " 1,056.54 " 303.78 " 1,056.54 " 8.45 844.77 297.99 85.50 9.30 8.45 " 1,012.05 " 260.38 289.31 68.34 85.43 296.54 297.99 289.31 " 1,223.20 " 264.72 8.45 763.10 254.59 625.36 " 1,146.75 " 581.17 683.92 299.44 35600761 ANTIBODY ID (ARC) 86870 300 "$1,529.00" 565.12 8.45 " 1,223.20 " 9.72 " 1,056.54 " 303.78 " 1,056.54 " 8.45 844.77 297.99 85.50 9.30 8.45 " 1,012.05 " 260.38 289.31 68.34 85.43 296.54 297.99 289.31 " 1,223.20 " 264.72 8.45 763.10 254.59 625.36 " 1,146.75 " 581.17 683.92 299.44 35600108 DIRECT COOMBS (DAT) 86880 300 $292.00 107.92 7.43 233.60 8.54 201.77 58.05 201.77 7.43 161.33 56.95 14.95 8.17 7.43 193.27 49.76 55.29 24.60 30.75 56.67 56.95 55.29 233.60 50.59 7.43 14.12 48.66 119.43 219.00 110.99 130.61 57.23 35610502 DIRECT ANTIHUMAN GLOBULIN IGG 86880 300 $292.00 107.92 7.43 233.60 8.54 201.77 58.05 201.77 7.43 161.33 56.95 14.95 8.17 7.43 193.27 49.76 55.29 24.60 30.75 56.67 56.95 55.29 233.60 50.59 7.43 14.12 48.66 119.43 219.00 110.99 130.61 57.23 35610511 DIRECT ANTIHUMAN GLOBULIN C3 86880 300 $292.00 107.92 7.43 233.60 8.54 201.77 58.05 201.77 7.43 161.33 56.95 14.95 8.17 7.43 193.27 49.76 55.29 24.60 30.75 56.67 56.95 55.29 233.60 50.59 7.43 14.12 48.66 119.43 219.00 110.99 130.61 57.23 35600329 ANTIBODY TITER 86886 300 $783.00 289.40 7.15 626.40 8.22 541.05 155.56 541.05 7.15 432.61 152.59 14.38 7.87 7.15 518.27 133.34 148.15 33.34 41.67 151.85 152.59 148.15 626.40 135.56 7.15 13.57 130.37 320.25 587.25 297.62 350.24 153.34 35601503 ANTIBODY TITER (TA) 86886 300 $783.00 289.40 7.15 626.40 8.22 541.05 155.56 541.05 7.15 432.61 152.59 14.38 7.87 7.15 518.27 133.34 148.15 33.34 41.67 151.85 152.59 148.15 626.40 135.56 7.15 13.57 130.37 320.25 587.25 297.62 350.24 153.34 35601511 ANTIBODY TITER (TA) 86886 300 $783.00 289.40 7.15 626.40 8.22 541.05 155.56 541.05 7.15 432.61 152.59 14.38 7.87 7.15 518.27 133.34 148.15 33.34 41.67 151.85 152.59 148.15 626.40 135.56 7.15 13.57 130.37 320.25 587.25 297.62 350.24 153.34 35601520 ANTIBODY TITER (TA) 86886 300 $783.00 289.40 7.15 626.40 8.22 541.05 155.56 541.05 7.15 432.61 152.59 14.38 7.87 7.15 518.27 133.34 148.15 33.34 41.67 151.85 152.59 148.15 626.40 135.56 7.15 13.57 130.37 320.25 587.25 297.62 350.24 153.34 35601538 ANTIBODY TITER (TA) 86886 300 $783.00 289.40 7.15 626.40 8.22 541.05 155.56 541.05 7.15 432.61 152.59 14.38 7.87 7.15 518.27 133.34 148.15 33.34 41.67 151.85 152.59 148.15 626.40 135.56 7.15 13.57 130.37 320.25 587.25 297.62 350.24 153.34 35600639 AUTOLOGOUS BLOOD COLLECT (ARC) 86890 390 $783.00 289.40 - 626.40 - 541.05 155.56 541.05 - 432.61 152.59 196.56 - - 518.27 133.34 148.15 208.86 261.08 151.85 152.59 148.15 626.40 135.56 - 390.80 130.37 320.25 587.25 297.62 350.24 153.34 35600914 BLOOD TYPING; ABO 86900 300 $588.00 217.32 4.12 470.40 4.74 406.31 117.61 406.31 4.12 324.87 115.37 8.32 4.53 4.12 389.20 100.81 112.01 13.67 17.09 114.81 115.37 112.01 470.40 102.49 4.12 7.83 98.57 240.49 441.00 223.50 263.01 115.93 36942321 ABO 86900 300 $588.00 217.32 4.12 470.40 4.74 406.31 117.61 406.31 4.12 324.87 115.37 8.32 4.53 4.12 389.20 100.81 112.01 13.67 17.09 114.81 115.37 112.01 470.40 102.49 4.12 7.83 98.57 240.49 441.00 223.50 263.01 115.93 35600922 BLOOD TYPING; RH 86901 300 $178.00 65.79 4.17 142.40 4.80 123.00 35.30 123.00 4.17 98.35 34.63 8.32 4.59 4.17 117.82 30.26 33.62 48.59 60.74 34.46 34.63 33.62 142.40 30.76 4.17 7.83 29.59 72.80 133.50 67.66 79.62 34.80 36942339 RH 86901 300 $178.00 65.79 4.17 142.40 4.80 123.00 35.30 123.00 4.17 98.35 34.63 8.32 4.59 4.17 117.82 30.26 33.62 48.59 60.74 34.46 34.63 33.62 142.40 30.76 4.17 7.83 29.59 72.80 133.50 67.66 79.62 34.80 35602054 ANTIGEN TYPING ON UNITS 86902 300 "$1,529.00" 565.12 2.82 " 1,223.20 " 3.24 " 1,056.54 " 303.78 " 1,056.54 " 2.82 844.77 297.99 10.64 3.10 2.82 " 1,012.05 " 260.38 289.31 15.57 19.46 296.54 297.99 289.31 " 1,223.20 " 264.72 2.82 16.64 254.59 625.36 " 1,146.75 " 581.17 683.92 299.44 35602062 ADDITIONAL AG TYPING 1 86902 300 "$1,529.00" 565.12 2.82 " 1,223.20 " 3.24 " 1,056.54 " 303.78 " 1,056.54 " 2.82 844.77 297.99 10.64 3.10 2.82 " 1,012.05 " 260.38 289.31 15.57 19.46 296.54 297.99 289.31 " 1,223.20 " 264.72 2.82 16.64 254.59 625.36 " 1,146.75 " 581.17 683.92 299.44 35602071 ADDITIONAL AG TYPING 2 86902 300 "$1,529.00" 565.12 2.82 " 1,223.20 " 3.24 " 1,056.54 " 303.78 " 1,056.54 " 2.82 844.77 297.99 10.64 3.10 2.82 " 1,012.05 " 260.38 289.31 15.57 19.46 296.54 297.99 289.31 " 1,223.20 " 264.72 2.82 16.64 254.59 625.36 " 1,146.75 " 581.17 683.92 299.44 35602089 ADDITIONAL AG TYPING 3 86902 300 "$1,529.00" 565.12 2.82 " 1,223.20 " 3.24 " 1,056.54 " 303.78 " 1,056.54 " 2.82 844.77 297.99 10.64 3.10 2.82 " 1,012.05 " 260.38 289.31 15.57 19.46 296.54 297.99 289.31 " 1,223.20 " 264.72 2.82 16.64 254.59 625.36 " 1,146.75 " 581.17 683.92 299.44 35602097 ADDITIONAL AG TYPING 4 86902 300 "$1,529.00" 565.12 2.82 " 1,223.20 " 3.24 " 1,056.54 " 303.78 " 1,056.54 " 2.82 844.77 297.99 10.64 3.10 2.82 " 1,012.05 " 260.38 289.31 15.57 19.46 296.54 297.99 289.31 " 1,223.20 " 264.72 2.82 16.64 254.59 625.36 " 1,146.75 " 581.17 683.92 299.44 35602101 ADDITIONAL AG TYPING 5 86902 300 "$1,529.00" 565.12 2.82 " 1,223.20 " 3.24 " 1,056.54 " 303.78 " 1,056.54 " 2.82 844.77 297.99 10.64 3.10 2.82 " 1,012.05 " 260.38 289.31 15.57 19.46 296.54 297.99 289.31 " 1,223.20 " 264.72 2.82 16.64 254.59 625.36 " 1,146.75 " 581.17 683.92 299.44 35602119 ADDITIONAL AG TYPING 6 86902 300 "$1,529.00" 565.12 2.82 " 1,223.20 " 3.24 " 1,056.54 " 303.78 " 1,056.54 " 2.82 844.77 297.99 10.64 3.10 2.82 " 1,012.05 " 260.38 289.31 15.57 19.46 296.54 297.99 289.31 " 1,223.20 " 264.72 2.82 16.64 254.59 625.36 " 1,146.75 " 581.17 683.92 299.44 35602127 ADDITIONAL AG TYPING 7 86902 300 "$1,529.00" 565.12 2.82 " 1,223.20 " 3.24 " 1,056.54 " 303.78 " 1,056.54 " 2.82 844.77 297.99 10.64 3.10 2.82 " 1,012.05 " 260.38 289.31 15.57 19.46 296.54 297.99 289.31 " 1,223.20 " 264.72 2.82 16.64 254.59 625.36 " 1,146.75 " 581.17 683.92 299.44 35602135 ADDITIONAL AG TYPING 8 86902 300 "$1,529.00" 565.12 2.82 " 1,223.20 " 3.24 " 1,056.54 " 303.78 " 1,056.54 " 2.82 844.77 297.99 10.64 3.10 2.82 " 1,012.05 " 260.38 289.31 15.57 19.46 296.54 297.99 289.31 " 1,223.20 " 264.72 2.82 16.64 254.59 625.36 " 1,146.75 " 581.17 683.92 299.44 35602143 ADDITIONAL AG TYPING 9 86902 300 "$1,529.00" 565.12 2.82 " 1,223.20 " 3.24 " 1,056.54 " 303.78 " 1,056.54 " 2.82 844.77 297.99 10.64 3.10 2.82 " 1,012.05 " 260.38 289.31 15.57 19.46 296.54 297.99 289.31 " 1,223.20 " 264.72 2.82 16.64 254.59 625.36 " 1,146.75 " 581.17 683.92 299.44 35602151 A1 LECTIN (RBC ANTIGEN) 86905 390 "$1,529.00" 565.12 3.28 " 1,223.20 " 3.77 " 1,056.54 " 303.78 " 1,056.54 " 3.84 844.77 297.99 10.64 3.67 3.28 " 1,012.05 " 260.38 289.31 14.94 18.68 296.54 297.99 289.31 " 1,223.20 " 264.72 3.28 10.03 254.59 625.36 " 1,146.75 " 581.17 683.92 299.44 35602178 ANTIGEN PHENOTYPING PATIENT 86905 300 "$1,529.00" 565.12 3.28 " 1,223.20 " 3.77 " 1,056.54 " 303.78 " 1,056.54 " 3.28 844.77 297.99 10.64 3.61 3.28 " 1,012.05 " 260.38 289.31 14.94 18.68 296.54 297.99 289.31 " 1,223.20 " 264.72 3.28 10.03 254.59 625.36 " 1,146.75 " 581.17 683.92 299.44 35610715 PATERNAL PHENOTYPING 86905 300 "$1,529.00" 565.12 3.28 " 1,223.20 " 3.77 " 1,056.54 " 303.78 " 1,056.54 " 3.28 844.77 297.99 10.64 3.61 3.28 " 1,012.05 " 260.38 289.31 14.94 18.68 296.54 297.99 289.31 " 1,223.20 " 264.72 3.28 10.03 254.59 625.36 " 1,146.75 " 581.17 683.92 299.44 35600400 RH PHENOTYPING COMPLETE 86906 300 $178.00 65.79 10.50 142.40 12.08 123.00 35.30 123.00 10.50 98.35 34.63 21.54 11.55 10.50 117.82 30.26 33.62 50.00 62.50 34.46 34.63 33.62 142.40 30.76 10.50 20.31 29.59 72.80 133.50 67.66 79.62 34.80 35601732 COMPATIBILITY CROSSMATCH; SPIN 86920 300 $783.00 289.40 21.00 626.40 24.15 541.05 155.56 541.05 21.00 432.61 152.59 69.43 23.10 21.00 518.27 133.34 148.15 82.27 102.84 151.85 152.59 148.15 626.40 135.56 21.00 390.80 130.37 320.25 587.25 297.62 350.24 153.34 35600906 COMPATIBILITY ANTIGLOBULIN 86922 300 $783.00 289.40 21.00 626.40 24.15 541.05 155.56 541.05 21.00 432.61 152.59 73.82 23.10 21.00 518.27 133.34 148.15 164.02 205.03 151.85 152.59 148.15 626.40 135.56 21.00 390.80 130.37 320.25 587.25 297.62 350.24 153.34 35610545 ELECTRONIC CROSSMATCH 86923 300 $783.00 289.40 21.00 626.40 24.15 541.05 155.56 541.05 21.00 432.61 152.59 55.55 23.10 21.00 518.27 133.34 148.15 111.11 138.89 151.85 152.59 148.15 626.40 135.56 21.00 390.80 130.37 320.25 587.25 297.62 350.24 153.34 35602038 FRESH FROZEN PLASMA THAWING 86927 300 $783.00 289.40 - 626.40 - 541.05 155.56 541.05 - 432.61 152.59 39.47 - - 518.27 133.34 148.15 75.88 94.85 151.85 152.59 148.15 626.40 135.56 - 390.80 130.37 320.25 587.25 297.62 350.24 153.34 35602046 FR FROZEN PLASMA THAWING SPLIT 86927 300 $783.00 289.40 - 626.40 - 541.05 155.56 541.05 - 432.61 152.59 39.47 - - 518.27 133.34 148.15 75.88 94.85 151.85 152.59 148.15 626.40 135.56 - 390.80 130.37 320.25 587.25 297.62 350.24 153.34 35600167 CRYO/RBC PREP FEE 86931 300 "$1,529.00" 565.12 - " 1,223.20 " - " 1,056.54 " 303.78 " 1,056.54 " - 844.77 297.99 173.20 - - " 1,012.05 " 260.38 289.31 810.22 " 1,012.81 " 296.54 297.99 289.31 " 1,223.20 " 264.72 - 763.10 254.59 625.36 " 1,146.75 " 581.17 683.92 299.44 35601279 DEGLYCEROLIZATION 86931 390 "$1,529.00" 565.12 - " 1,223.20 " - " 1,056.54 " 303.78 " 1,056.54 " - 844.77 297.99 173.20 - - " 1,012.05 " 260.38 289.31 810.22 " 1,012.81 " 296.54 297.99 289.31 " 1,223.20 " 264.72 - 763.10 254.59 625.36 " 1,146.75 " 581.17 683.92 299.44 35706461 SUCROSE WATER TEST 86940 300 $46.00 17.00 7.72 44.64 9.02 31.79 9.21 31.79 7.84 25.42 9.03 22.80 8.62 7.84 30.45 7.89 8.77 35.71 44.64 8.99 9.03 8.77 36.80 8.02 7.84 22.98 7.72 18.81 34.50 17.48 20.58 9.08 35600442 IRRADIATION FEE 86945 300 $178.00 65.79 - 142.40 - 123.00 35.30 123.00 - 98.35 34.63 57.74 - - 117.82 30.26 33.62 90.26 112.82 34.46 34.63 33.62 142.40 30.76 - 88.66 29.59 72.80 133.50 67.66 79.62 34.80 35602020 IRRADIATION FEE SPLIT 86945 390 $178.00 65.79 - 142.40 - 123.00 35.30 123.00 - 98.35 34.63 57.74 - - 117.82 30.26 33.62 90.26 112.82 34.46 34.63 33.62 142.40 30.76 - 88.66 29.59 72.80 133.50 67.66 79.62 34.80 35640185 VOLUME REDUCTION BLD PRD EA UN 86960 300 $783.00 289.40 - 626.40 - 541.05 155.56 541.05 - 432.61 152.59 64.31 - - 518.27 133.34 148.15 64.82 81.02 151.85 152.59 148.15 626.40 135.56 - 390.80 130.37 320.25 587.25 297.62 350.24 153.34 35601341 POOLING FEE 86965 300 $783.00 289.40 - 626.40 - 541.05 155.56 541.05 - 432.61 152.59 64.31 - - 518.27 133.34 148.15 113.27 141.59 151.85 152.59 148.15 626.40 135.56 - 390.80 130.37 320.25 587.25 297.62 350.24 153.34 35610740 DTT TREATMENT OF RBCS 86970 300 $178.00 65.79 - 143.02 - 123.00 35.30 123.00 - 98.35 34.63 57.74 - - 117.82 30.26 33.62 114.42 143.02 34.46 34.63 33.62 142.40 30.76 - 88.66 29.59 72.80 133.50 67.66 79.62 34.80 35600540 COLD AUTO ABSORPTION 86978 300 $178.00 65.79 - 142.40 - 123.00 35.30 123.00 - 98.35 34.63 69.43 - - 117.82 30.26 33.62 50.00 62.50 34.46 34.63 33.62 142.40 30.76 - 88.66 29.59 72.80 133.50 67.66 79.62 34.80 35600558 WARM AUTO ABSORPTION 86978 300 $178.00 65.79 - 142.40 - 123.00 35.30 123.00 - 98.35 34.63 69.43 - - 117.82 30.26 33.62 50.00 62.50 34.46 34.63 33.62 142.40 30.76 - 88.66 29.59 72.80 133.50 67.66 79.62 34.80 35601694 SPLITTING PROCEDURE 86985 390 $783.00 289.40 - 626.40 - 541.05 155.56 541.05 - 432.61 152.59 51.15 - - 518.27 133.34 148.15 241.76 302.20 151.85 152.59 148.15 626.40 135.56 - 390.80 130.37 320.25 587.25 297.62 350.24 153.34 35601457 WASHING COMPONENTS 86999 300 $130.00 48.05 - 104.00 - 89.83 25.77 89.83 - 71.83 25.28 39.88 - - 86.05 22.09 24.54 27.51 34.39 25.15 25.28 24.54 104.00 22.45 - 64.64 21.60 53.17 97.50 49.41 58.15 25.40 35602011 WASHING COMPONENTS SPLIT UNIT 86999 300 $130.00 48.05 - 104.00 - 89.83 25.77 89.83 - 71.83 25.28 39.88 - - 86.05 22.09 24.54 27.51 34.39 25.15 25.28 24.54 104.00 22.45 - 64.64 21.60 53.17 97.50 49.41 58.15 25.40 36301899 AFB CONCENTRATION 87015 300 $35.00 12.94 5.88 56.38 8.63 24.19 7.01 24.19 7.50 19.34 6.88 18.56 8.25 7.50 23.17 6.01 6.68 45.10 56.38 6.85 6.88 6.68 28.00 6.11 7.50 17.50 5.88 14.32 26.25 13.30 15.66 6.91 36303212 CONCENTRATION BROTH ENRICHMENT 87015 300 $35.00 12.94 5.88 56.38 8.63 24.19 7.01 24.19 7.50 19.34 6.88 18.56 8.25 7.50 23.17 6.01 6.68 45.10 56.38 6.85 6.88 6.68 28.00 6.11 7.50 17.50 5.88 14.32 26.25 13.30 15.66 6.91 36305053 CONCENTRATION INFEC AGENT 87015 300 $35.00 12.94 5.88 56.38 8.63 24.19 7.01 24.19 7.50 19.34 6.88 18.56 8.25 7.50 23.17 6.01 6.68 45.10 56.38 6.85 6.88 6.68 28.00 6.11 7.50 17.50 5.88 14.32 26.25 13.30 15.66 6.91 36924578 INFECTIOUS AGENT CONCENTRATION 87015 300 $67.00 24.76 5.88 56.38 8.63 46.30 7.01 46.30 7.50 37.02 6.88 18.56 8.25 7.50 44.35 6.01 6.68 45.10 56.38 6.85 6.88 6.68 53.60 6.11 7.50 17.50 5.88 27.40 50.25 25.47 29.97 6.91 36924969 CONCENTRATION INFECTIOUS AGENT 87015 300 $67.00 24.76 5.88 56.38 8.63 46.30 7.01 46.30 7.50 37.02 6.88 18.56 8.25 7.50 44.35 6.01 6.68 45.10 56.38 6.85 6.88 6.68 53.60 6.11 7.50 17.50 5.88 27.40 50.25 25.47 29.97 6.91 36300078 ROUTINE BLOOD CULTURE 87040 300 $54.00 19.96 9.08 59.19 16.10 37.31 10.84 37.31 14.00 29.84 10.63 28.73 15.40 14.00 35.74 9.29 10.32 47.35 59.19 10.58 10.63 10.32 43.20 9.44 14.00 27.04 9.08 22.09 40.50 20.53 24.15 10.68 36300094 ROUTINE STOOL CULT SALM/SHIG 87045 300 $50.00 18.48 6.90 54.07 7.94 34.55 9.91 34.55 6.90 27.63 9.72 26.25 7.59 6.90 33.10 8.50 9.44 43.26 54.07 9.68 9.72 9.44 40.00 8.64 6.90 24.73 8.31 20.45 37.50 19.01 22.37 9.77 36301996 VIBRIO SCREEN STOOL 87046 300 $50.00 18.48 2.61 40.00 3.00 34.55 9.91 34.55 2.61 27.63 9.72 26.25 2.87 2.61 33.10 8.50 9.44 14.86 18.57 9.68 9.72 9.44 40.00 8.64 2.61 24.73 8.31 20.45 37.50 19.01 22.37 9.77 36302143 STOOL YERSINIA & AEROMONAS 87046 300 $50.00 18.48 2.61 40.00 3.00 34.55 9.91 34.55 2.61 27.63 9.72 26.25 2.87 2.61 33.10 8.50 9.44 14.86 18.57 9.68 9.72 9.44 40.00 8.64 2.61 24.73 8.31 20.45 37.50 19.01 22.37 9.77 36305045 STOOL CULT AEROBIC EA PLT 87046 300 $50.00 18.48 2.61 40.00 3.00 34.55 9.91 34.55 2.61 27.63 9.72 26.25 2.87 2.61 33.10 8.50 9.44 14.86 18.57 9.68 9.72 9.44 40.00 8.64 2.61 24.73 8.31 20.45 37.50 19.01 22.37 9.77 36300051 ROUTINE CULTURE 87070 300 $45.00 16.63 6.90 49.33 7.94 31.10 9.05 31.10 6.90 24.86 8.88 23.96 7.59 6.90 29.79 7.76 8.62 39.46 49.33 8.84 8.88 8.62 36.00 7.89 6.90 22.58 7.59 18.41 33.75 17.10 20.13 8.92 36300906 CULTURE AEROBIC 87070 300 $45.00 16.63 6.90 49.33 7.94 31.10 9.05 31.10 6.90 24.86 8.88 23.96 7.59 6.90 29.79 7.76 8.62 39.46 49.33 8.84 8.88 8.62 36.00 7.89 6.90 22.58 7.59 18.41 33.75 17.10 20.13 8.92 36300922 CULTURE CYSTIC FIBROSIS 87070 300 $45.00 16.63 6.90 49.33 7.94 31.10 9.05 31.10 6.90 24.86 8.88 23.96 7.59 6.90 29.79 7.76 8.62 39.46 49.33 8.84 8.88 8.62 36.00 7.89 6.90 22.58 7.59 18.41 33.75 17.10 20.13 8.92 36300949 CULTURE RESPIRATORY 87070 300 $45.00 16.63 6.90 49.33 7.94 31.10 9.05 31.10 6.90 24.86 8.88 23.96 7.59 6.90 29.79 7.76 8.62 39.46 49.33 8.84 8.88 8.62 36.00 7.89 6.90 22.58 7.59 18.41 33.75 17.10 20.13 8.92 36303247 CULTURE AEROBIC OTHER 87070 300 $45.00 16.63 6.90 49.33 7.94 31.10 9.05 31.10 6.90 24.86 8.88 23.96 7.59 6.90 29.79 7.76 8.62 39.46 49.33 8.84 8.88 8.62 36.00 7.89 6.90 22.58 7.59 18.41 33.75 17.10 20.13 8.92 36300485 QUANT DUODENAL ASPIRATE 87071 300 $52.00 19.22 5.22 41.60 6.00 35.93 10.38 35.93 5.22 28.73 10.19 26.25 5.74 5.22 34.42 8.90 9.89 29.72 37.15 10.14 10.19 9.89 41.60 9.05 5.22 25.91 8.70 21.27 39.00 19.77 23.26 10.24 36300931 CULTURE QUANT BRONCH 87071 300 $52.00 19.22 5.22 41.60 6.00 35.93 10.38 35.93 5.22 28.73 10.19 26.25 5.74 5.22 34.42 8.90 9.89 29.72 37.15 10.14 10.19 9.89 41.60 9.05 5.22 25.91 8.70 21.27 39.00 19.77 23.26 10.24 36300060 CULTURE ANAEROBIC (OUTSIDE) 87075 300 $50.00 18.48 8.33 54.23 11.50 34.55 9.94 34.55 10.00 27.63 9.75 26.34 11.00 10.00 33.10 8.52 9.47 43.38 54.23 9.71 9.75 9.47 40.00 8.67 10.00 24.81 8.33 20.45 37.50 19.01 22.37 9.80 36303255 CULTURE ANAEROBIC OTHER 87075 300 $50.00 18.48 8.33 54.23 11.50 34.55 9.94 34.55 10.00 27.63 9.75 26.34 11.00 10.00 33.10 8.52 9.47 43.38 54.23 9.71 9.75 9.47 40.00 8.67 10.00 24.81 8.33 20.45 37.50 19.01 22.37 9.80 36301406 ANAEROBIC IDENTIFICATION 1 87076 300 $42.00 15.52 7.11 103.78 10.06 29.02 8.48 29.02 8.75 23.21 8.32 22.45 9.63 8.75 27.80 7.27 8.08 83.02 103.78 8.28 8.32 8.08 33.60 7.39 8.75 21.17 7.11 17.18 31.50 15.96 18.79 8.36 36301414 ANAEROBIC IDENTIFICATION 2 87076 300 $42.00 15.52 7.11 103.78 10.06 29.02 8.48 29.02 8.75 23.21 8.32 22.45 9.63 8.75 27.80 7.27 8.08 83.02 103.78 8.28 8.32 8.08 33.60 7.39 8.75 21.17 7.11 17.18 31.50 15.96 18.79 8.36 36301422 ANAEROBIC IDENTIFICATION 3 87076 300 $42.00 15.52 7.11 103.78 10.06 29.02 8.48 29.02 8.75 23.21 8.32 22.45 9.63 8.75 27.80 7.27 8.08 83.02 103.78 8.28 8.32 8.08 33.60 7.39 8.75 21.17 7.11 17.18 31.50 15.96 18.79 8.36 36301902 ANAEROBIC ID-OUTREACH 87076 300 $42.00 15.52 7.11 103.78 10.06 29.02 8.48 29.02 8.75 23.21 8.32 22.45 9.63 8.75 27.80 7.27 8.08 83.02 103.78 8.28 8.32 8.08 33.60 7.39 8.75 21.17 7.11 17.18 31.50 15.96 18.79 8.36 36304545 ANAEROBE ID 1 (NON- GMC) 87076 300 $42.00 15.52 7.11 103.78 10.06 29.02 8.48 29.02 8.75 23.21 8.32 22.45 9.63 8.75 27.80 7.27 8.08 83.02 103.78 8.28 8.32 8.08 33.60 7.39 8.75 21.17 7.11 17.18 31.50 15.96 18.79 8.36 36304553 ANAEROBE ID 2 (NON- GMC) 87076 300 $42.00 15.52 7.11 103.78 10.06 29.02 8.48 29.02 8.75 23.21 8.32 22.45 9.63 8.75 27.80 7.27 8.08 83.02 103.78 8.28 8.32 8.08 33.60 7.39 8.75 21.17 7.11 17.18 31.50 15.96 18.79 8.36 36304561 ANAEROBE ID 3 (NON- GMC) 87076 300 $42.00 15.52 7.11 103.78 10.06 29.02 8.48 29.02 8.75 23.21 8.32 22.45 9.63 8.75 27.80 7.27 8.08 83.02 103.78 8.28 8.32 8.08 33.60 7.39 8.75 21.17 7.11 17.18 31.50 15.96 18.79 8.36 36301201 BACTERIAL IDENTIFICATION 87077 300 $42.00 15.52 7.10 50.54 8.17 29.02 8.48 29.02 7.10 23.21 8.32 22.45 7.81 7.10 27.80 7.27 8.08 40.43 50.54 8.28 8.32 8.08 33.60 7.39 7.10 21.17 7.11 17.18 31.50 15.96 18.79 8.36 36301341 BACTERIAL IDENTIFICATION 1 87077 300 $42.00 15.52 7.10 50.54 8.17 29.02 8.48 29.02 7.10 23.21 8.32 22.45 7.81 7.10 27.80 7.27 8.08 40.43 50.54 8.28 8.32 8.08 33.60 7.39 7.10 21.17 7.11 17.18 31.50 15.96 18.79 8.36 36301350 BACTERIAL IDENTIFICATION 2 87077 300 $42.00 15.52 7.10 50.54 8.17 29.02 8.48 29.02 7.10 23.21 8.32 22.45 7.81 7.10 27.80 7.27 8.08 40.43 50.54 8.28 8.32 8.08 33.60 7.39 7.10 21.17 7.11 17.18 31.50 15.96 18.79 8.36 36301368 BACTERIAL IDENTIFICATION 3 87077 300 $42.00 15.52 7.10 50.54 8.17 29.02 8.48 29.02 7.10 23.21 8.32 22.45 7.81 7.10 27.80 7.27 8.08 40.43 50.54 8.28 8.32 8.08 33.60 7.39 7.10 21.17 7.11 17.18 31.50 15.96 18.79 8.36 36301376 BACTERIAL IDENTIFICATION 4 87077 300 $42.00 15.52 7.10 50.54 8.17 29.02 8.48 29.02 7.10 23.21 8.32 22.45 7.81 7.10 27.80 7.27 8.08 40.43 50.54 8.28 8.32 8.08 33.60 7.39 7.10 21.17 7.11 17.18 31.50 15.96 18.79 8.36 36301384 BACTERIAL IDENTIFICATION 5 87077 300 $42.00 15.52 7.10 50.54 8.17 29.02 8.48 29.02 7.10 23.21 8.32 22.45 7.81 7.10 27.80 7.27 8.08 40.43 50.54 8.28 8.32 8.08 33.60 7.39 7.10 21.17 7.11 17.18 31.50 15.96 18.79 8.36 36301392 BACTERIAL IDENTIFICATION 6 87077 300 $42.00 15.52 7.10 50.54 8.17 29.02 8.48 29.02 7.10 23.21 8.32 22.45 7.81 7.10 27.80 7.27 8.08 40.43 50.54 8.28 8.32 8.08 33.60 7.39 7.10 21.17 7.11 17.18 31.50 15.96 18.79 8.36 36303638 AEROBIC ISOLATE 87077 300 $42.00 15.52 7.10 50.54 8.17 29.02 8.48 29.02 7.10 23.21 8.32 22.45 7.81 7.10 27.80 7.27 8.08 40.43 50.54 8.28 8.32 8.08 33.60 7.39 7.10 21.17 7.11 17.18 31.50 15.96 18.79 8.36 36303808 MASS SPEC ID 87077 300 $42.00 15.52 7.10 50.54 8.17 29.02 8.48 29.02 7.10 23.21 8.32 22.45 7.81 7.10 27.80 7.27 8.08 40.43 50.54 8.28 8.32 8.08 33.60 7.39 7.10 21.17 7.11 17.18 31.50 15.96 18.79 8.36 36303913 BACTERIAL IDENTIFICATION 1 87077 300 $42.00 15.52 7.10 50.54 8.17 29.02 8.48 29.02 7.10 23.21 8.32 22.45 7.81 7.10 27.80 7.27 8.08 40.43 50.54 8.28 8.32 8.08 33.60 7.39 7.10 21.17 7.11 17.18 31.50 15.96 18.79 8.36 36303921 BACTERIAL IDENTIFICATION 2 87077 300 $42.00 15.52 7.10 50.54 8.17 29.02 8.48 29.02 7.10 23.21 8.32 22.45 7.81 7.10 27.80 7.27 8.08 40.43 50.54 8.28 8.32 8.08 33.60 7.39 7.10 21.17 7.11 17.18 31.50 15.96 18.79 8.36 36303930 BACTERIAL IDENTIFICATION 3 87077 300 $42.00 15.52 7.10 50.54 8.17 29.02 8.48 29.02 7.10 23.21 8.32 22.45 7.81 7.10 27.80 7.27 8.08 40.43 50.54 8.28 8.32 8.08 33.60 7.39 7.10 21.17 7.11 17.18 31.50 15.96 18.79 8.36 36303948 BACTERIAL IDENTIFICATION 4 87077 300 $42.00 15.52 7.10 50.54 8.17 29.02 8.48 29.02 7.10 23.21 8.32 22.45 7.81 7.10 27.80 7.27 8.08 40.43 50.54 8.28 8.32 8.08 33.60 7.39 7.10 21.17 7.11 17.18 31.50 15.96 18.79 8.36 36303956 BACTERIAL IDENTIFICATION 5 87077 300 $42.00 15.52 7.10 50.54 8.17 29.02 8.48 29.02 7.10 23.21 8.32 22.45 7.81 7.10 27.80 7.27 8.08 40.43 50.54 8.28 8.32 8.08 33.60 7.39 7.10 21.17 7.11 17.18 31.50 15.96 18.79 8.36 36303964 BACTERIAL IDENTIFICATION 6 87077 300 $42.00 15.52 7.10 50.54 8.17 29.02 8.48 29.02 7.10 23.21 8.32 22.45 7.81 7.10 27.80 7.27 8.08 40.43 50.54 8.28 8.32 8.08 33.60 7.39 7.10 21.17 7.11 17.18 31.50 15.96 18.79 8.36 36300108 GC CULTURE 87081 300 $35.00 12.94 5.20 34.01 5.98 24.19 6.96 24.19 5.20 19.34 6.83 18.43 5.72 5.20 23.17 5.97 6.63 27.21 34.01 6.80 6.83 6.63 28.00 6.07 5.20 17.37 5.83 14.32 26.25 13.30 15.66 6.86 36300116 LEGIONELLA CULTURE 87081 300 $35.00 12.94 5.20 34.01 5.98 24.19 6.96 24.19 5.20 19.34 6.83 18.43 5.72 5.20 23.17 5.97 6.63 27.21 34.01 6.80 6.83 6.63 28.00 6.07 5.20 17.37 5.83 14.32 26.25 13.30 15.66 6.86 36300566 GROUP A STREP CULTURE 87081 300 $35.00 12.94 5.20 34.01 5.98 24.19 6.96 24.19 5.20 19.34 6.83 18.43 5.72 5.20 23.17 5.97 6.63 27.21 34.01 6.80 6.83 6.63 28.00 6.07 5.20 17.37 5.83 14.32 26.25 13.30 15.66 6.86 36300973 GROUP B STREP CULTURE 87081 300 $35.00 12.94 5.20 34.01 5.98 24.19 6.96 24.19 5.20 19.34 6.83 18.43 5.72 5.20 23.17 5.97 6.63 27.21 34.01 6.80 6.83 6.63 28.00 6.07 5.20 17.37 5.83 14.32 26.25 13.30 15.66 6.86 36301058 CULTURE BORDETELLA 87081 300 $35.00 12.94 5.20 34.01 5.98 24.19 6.96 24.19 5.20 19.34 6.83 18.43 5.72 5.20 23.17 5.97 6.63 27.21 34.01 6.80 6.83 6.63 28.00 6.07 5.20 17.37 5.83 14.32 26.25 13.30 15.66 6.86 36301911 STREP GROUP B CULTURE 87081 300 $35.00 12.94 5.20 34.01 5.98 24.19 6.96 24.19 5.20 19.34 6.83 18.43 5.72 5.20 23.17 5.97 6.63 27.21 34.01 6.80 6.83 6.63 28.00 6.07 5.20 17.37 5.83 14.32 26.25 13.30 15.66 6.86 36302771 VRE CULTURE SCREEN 87081 300 $35.00 12.94 5.20 34.01 5.98 24.19 6.96 24.19 5.20 19.34 6.83 18.43 5.72 5.20 23.17 5.97 6.63 27.21 34.01 6.80 6.83 6.63 28.00 6.07 5.20 17.37 5.83 14.32 26.25 13.30 15.66 6.86 36302780 NASAL MRSA CULTURE SCREEN 87081 300 $35.00 12.94 5.20 34.01 5.98 24.19 6.96 24.19 5.20 19.34 6.83 18.43 5.72 5.20 23.17 5.97 6.63 27.21 34.01 6.80 6.83 6.63 28.00 6.07 5.20 17.37 5.83 14.32 26.25 13.30 15.66 6.86 36302798 TRICHOMONAS VAGINALIS CULTURE 87081 300 $35.00 12.94 5.20 34.01 5.98 24.19 6.96 24.19 5.20 19.34 6.83 18.43 5.72 5.20 23.17 5.97 6.63 27.21 34.01 6.80 6.83 6.63 28.00 6.07 5.20 17.37 5.83 14.32 26.25 13.30 15.66 6.86 36303204 NOCARDIA CULTURE 87081 300 $35.00 12.94 5.20 34.01 5.98 24.19 6.96 24.19 5.20 19.34 6.83 18.43 5.72 5.20 23.17 5.97 6.63 27.21 34.01 6.80 6.83 6.63 28.00 6.07 5.20 17.37 5.83 14.32 26.25 13.30 15.66 6.86 36302933 QUANTITATIVE URINE CULTURE 87086 300 $42.00 15.52 7.10 45.64 9.20 29.02 8.47 29.02 8.00 23.21 8.31 22.45 8.80 8.00 27.80 7.26 8.07 36.51 45.64 8.27 8.31 8.07 33.60 7.38 8.00 21.14 7.10 17.18 31.50 15.96 18.79 8.35 36302925 ISOLATION/PRESUM ID URINE 87088 300 $42.00 15.52 7.12 46.35 9.20 29.02 8.49 29.02 8.00 23.21 8.33 22.51 8.80 8.00 27.80 7.28 8.09 37.08 46.35 8.29 8.33 8.09 33.60 7.40 8.00 21.20 7.12 17.18 31.50 15.96 18.79 8.37 36302950 ISOLATION/PRESUM ID URINE 2 87088 300 $42.00 15.52 7.12 46.35 9.20 29.02 8.49 29.02 8.00 23.21 8.33 22.51 8.80 8.00 27.80 7.28 8.09 37.08 46.35 8.29 8.33 8.09 33.60 7.40 8.00 21.20 7.12 17.18 31.50 15.96 18.79 8.37 36302968 ISOLATION/PRESUM ID URINE 3 87088 300 $42.00 15.52 7.12 46.35 9.20 29.02 8.49 29.02 8.00 23.21 8.33 22.51 8.80 8.00 27.80 7.28 8.09 37.08 46.35 8.29 8.33 8.09 33.60 7.40 8.00 21.20 7.12 17.18 31.50 15.96 18.79 8.37 36302976 ISOLATION/PRESUM ID URINE 4 87088 300 $42.00 15.52 7.12 46.35 9.20 29.02 8.49 29.02 8.00 23.21 8.33 22.51 8.80 8.00 27.80 7.28 8.09 37.08 46.35 8.29 8.33 8.09 33.60 7.40 8.00 21.20 7.12 17.18 31.50 15.96 18.79 8.37 36303875 ISOLATION/PRESUM ID URINE 87088 300 $42.00 15.52 7.12 46.35 9.20 29.02 8.49 29.02 8.00 23.21 8.33 22.51 8.80 8.00 27.80 7.28 8.09 37.08 46.35 8.29 8.33 8.09 33.60 7.40 8.00 21.20 7.12 17.18 31.50 15.96 18.79 8.37 36303883 ISOLATION/PRESUM ID URINE 2 87088 300 $42.00 15.52 7.12 46.35 9.20 29.02 8.49 29.02 8.00 23.21 8.33 22.51 8.80 8.00 27.80 7.28 8.09 37.08 46.35 8.29 8.33 8.09 33.60 7.40 8.00 21.20 7.12 17.18 31.50 15.96 18.79 8.37 36303891 ISOLATION/PRESUM ID URINE 3 87088 300 $42.00 15.52 7.12 46.35 9.20 29.02 8.49 29.02 8.00 23.21 8.33 22.51 8.80 8.00 27.80 7.28 8.09 37.08 46.35 8.29 8.33 8.09 33.60 7.40 8.00 21.20 7.12 17.18 31.50 15.96 18.79 8.37 36303905 ISOLATION/PRESUM ID URINE 4 87088 300 $42.00 15.52 7.12 46.35 9.20 29.02 8.49 29.02 8.00 23.21 8.33 22.51 8.80 8.00 27.80 7.28 8.09 37.08 46.35 8.29 8.33 8.09 33.60 7.40 8.00 21.20 7.12 17.18 31.50 15.96 18.79 8.37 36300841 FUNGUS CULTURE DERM SPECIMENS 87101 300 $40.00 14.78 6.78 62.11 11.16 27.64 8.10 27.64 9.70 22.10 7.94 21.45 10.67 9.70 26.48 6.94 7.71 49.69 62.11 7.90 7.94 7.71 32.00 7.05 9.70 20.20 6.78 16.36 30.00 15.20 17.89 7.98 36302020 FUNGAL ID DERMAT (OUTREACH) 87101 300 $40.00 14.78 6.78 62.11 11.16 27.64 8.10 27.64 9.70 22.10 7.94 21.45 10.67 9.70 26.48 6.94 7.71 49.69 62.11 7.90 7.94 7.71 32.00 7.05 9.70 20.20 6.78 16.36 30.00 15.20 17.89 7.98 36300698 FUNGUS CULTURE OTHER SPECIMENS 87102 300 $44.00 16.26 7.40 48.17 11.16 30.40 8.83 30.40 9.70 24.31 8.66 23.36 10.67 9.70 29.12 7.57 8.41 38.54 48.17 8.62 8.66 8.41 35.20 7.70 9.70 22.03 7.40 18.00 33.00 16.72 19.68 8.70 36302038 FUNGAL ID OTHER (OUTREACH) 87102 300 $44.00 16.26 7.40 48.17 11.16 30.40 8.83 30.40 9.70 24.31 8.66 23.36 10.67 9.70 29.12 7.57 8.41 38.54 48.17 8.62 8.66 8.41 35.20 7.70 9.70 22.03 7.40 18.00 33.00 16.72 19.68 8.70 36300833 FUNGUS CULTURE BLOOD 87103 300 $107.00 39.55 12.46 85.60 14.33 73.94 21.48 73.94 12.46 59.12 21.07 25.06 13.71 12.46 70.82 18.41 20.46 58.16 72.70 20.97 21.07 20.46 85.60 18.72 12.46 53.61 18.00 43.76 80.25 40.67 47.86 21.18 36938773 FUNGAL CULTURE BLOOD 87103 300 $107.00 39.55 12.46 85.60 14.33 73.94 21.48 73.94 12.46 59.12 21.07 25.06 13.71 12.46 70.82 18.41 20.46 58.16 72.70 20.97 21.07 20.46 85.60 18.72 12.46 53.61 18.00 43.76 80.25 40.67 47.86 21.18 36301937 YEAST IDENTIFICATION 1 87106 300 $54.00 19.96 9.08 83.22 11.16 37.31 10.84 37.31 9.70 29.84 10.63 28.73 10.67 9.70 35.74 9.29 10.32 66.58 83.22 10.58 10.63 10.32 43.20 9.44 9.70 27.04 9.08 22.09 40.50 20.53 24.15 10.68 36301945 YEAST IDENTIFICATION 2 87106 300 $54.00 19.96 9.08 83.22 11.16 37.31 10.84 37.31 9.70 29.84 10.63 28.73 10.67 9.70 35.74 9.29 10.32 66.58 83.22 10.58 10.63 10.32 43.20 9.44 9.70 27.04 9.08 22.09 40.50 20.53 24.15 10.68 36301953 YEAST IDENTIFICATION 3 87106 300 $54.00 19.96 9.08 83.22 11.16 37.31 10.84 37.31 9.70 29.84 10.63 28.73 10.67 9.70 35.74 9.29 10.32 66.58 83.22 10.58 10.63 10.32 43.20 9.44 9.70 27.04 9.08 22.09 40.50 20.53 24.15 10.68 36303816 MASS SPEC ID YEAST 87106 300 $54.00 19.96 9.08 83.22 11.16 37.31 10.84 37.31 9.70 29.84 10.63 28.73 10.67 9.70 35.74 9.29 10.32 66.58 83.22 10.58 10.63 10.32 43.20 9.44 9.70 27.04 9.08 22.09 40.50 20.53 24.15 10.68 36304570 YEAST ID 1 (NON- GMC) 87106 300 $54.00 19.96 9.08 83.22 11.16 37.31 10.84 37.31 9.70 29.84 10.63 28.73 10.67 9.70 35.74 9.29 10.32 66.58 83.22 10.58 10.63 10.32 43.20 9.44 9.70 27.04 9.08 22.09 40.50 20.53 24.15 10.68 36304588 YEAST ID 2 (NON- GMC) 87106 300 $54.00 19.96 9.08 83.22 11.16 37.31 10.84 37.31 9.70 29.84 10.63 28.73 10.67 9.70 35.74 9.29 10.32 66.58 83.22 10.58 10.63 10.32 43.20 9.44 9.70 27.04 9.08 22.09 40.50 20.53 24.15 10.68 36304596 YEAST ID 3 (NON- GMC) 87106 300 $54.00 19.96 9.08 83.22 11.16 37.31 10.84 37.31 9.70 29.84 10.63 28.73 10.67 9.70 35.74 9.29 10.32 66.58 83.22 10.58 10.63 10.32 43.20 9.44 9.70 27.04 9.08 22.09 40.50 20.53 24.15 10.68 36301961 MOLD IDENTIFICATION 1 87107 300 $54.00 19.96 9.08 81.29 13.13 37.31 10.84 37.31 11.42 29.84 10.63 28.73 12.56 11.42 35.74 9.29 10.32 65.03 81.29 10.58 10.63 10.32 43.20 9.44 11.42 27.04 9.08 22.09 40.50 20.53 24.15 10.68 36301970 MOLD IDENTIFICATION 2 87107 300 $54.00 19.96 9.08 81.29 13.13 37.31 10.84 37.31 11.42 29.84 10.63 28.73 12.56 11.42 35.74 9.29 10.32 65.03 81.29 10.58 10.63 10.32 43.20 9.44 11.42 27.04 9.08 22.09 40.50 20.53 24.15 10.68 36301988 MOLD IDENTIFICATION 3 87107 300 $54.00 19.96 9.08 81.29 13.13 37.31 10.84 37.31 11.42 29.84 10.63 28.73 12.56 11.42 35.74 9.29 10.32 65.03 81.29 10.58 10.63 10.32 43.20 9.44 11.42 27.04 9.08 22.09 40.50 20.53 24.15 10.68 36909609 UREAPLASMA AGAR CULTURE CONFIR 87109 300 $129.00 47.68 13.54 103.20 18.40 89.14 16.16 89.14 16.00 71.27 15.85 42.77 17.60 16.00 85.39 13.85 15.39 70.54 88.18 15.77 15.85 15.39 103.20 14.08 16.00 40.32 13.54 52.76 96.75 49.03 57.70 15.93 36924837 UREAPLMA CULTURE (MYCOPLASMA) 87109 300 $576.00 212.89 13.54 460.80 18.40 398.02 16.16 398.02 16.00 318.24 15.85 42.77 17.60 16.00 381.25 13.85 15.39 70.54 88.18 15.77 15.85 15.39 460.80 14.08 16.00 40.32 13.54 235.58 432.00 218.94 257.64 15.93 36934573 MYCOPLASMA PNEUMONIAE CULT 87109 300 $129.00 47.68 13.54 103.20 18.40 89.14 16.16 89.14 16.00 71.27 15.85 42.77 17.60 16.00 85.39 13.85 15.39 70.54 88.18 15.77 15.85 15.39 103.20 14.08 16.00 40.32 13.54 52.76 96.75 49.03 57.70 15.93 36981661 MYCOPLASMA CULTURE 87109 300 $129.00 47.68 13.54 103.20 18.40 89.14 16.16 89.14 16.00 71.27 15.85 42.77 17.60 16.00 85.39 13.85 15.39 70.54 88.18 15.77 15.85 15.39 103.20 14.08 16.00 40.32 13.54 52.76 96.75 49.03 57.70 15.93 36909510 CHLAMYDIA TRACHOMATIS CULTURE 87110 300 $193.00 71.33 17.25 154.40 30.02 133.36 20.58 133.36 26.10 106.63 20.19 54.48 28.71 26.10 127.75 17.64 19.60 86.24 107.80 20.09 20.19 19.60 154.40 17.93 26.10 51.35 17.25 78.94 144.75 73.36 86.33 20.29 36300132 AFB CULTURE 87116 300 $57.00 21.07 7.50 86.92 8.63 39.39 11.34 39.39 7.50 31.49 11.12 30.02 8.25 7.50 37.73 9.72 10.80 69.54 86.92 11.07 11.12 10.80 45.60 9.88 7.50 28.30 9.50 23.31 42.75 21.67 25.50 11.18 36940263 MYCOBACTERIA BLOOD CULTURE 87116 300 $165.00 60.98 7.50 132.00 8.63 114.02 11.34 114.02 7.50 91.16 11.12 30.02 8.25 7.50 109.21 9.72 10.80 69.54 86.92 11.07 11.12 10.80 132.00 9.88 7.50 28.30 9.50 67.49 123.75 62.72 73.80 11.18 36933003 CULTURE TYP IMMUNOFLUORESCENCE 87140 300 $29.00 10.72 3.00 34.67 3.45 20.04 5.85 20.04 3.00 16.02 5.74 15.48 3.30 3.00 19.20 5.01 5.57 27.74 34.67 5.71 5.74 5.57 23.20 5.10 3.00 14.59 4.90 11.86 21.75 11.02 12.97 5.76 36938692 HSV CULT TYPE 1 IMMUNOFL 87140 300 $29.00 10.72 3.00 34.67 3.45 20.04 5.85 20.04 3.00 16.02 5.74 15.48 3.30 3.00 19.20 5.01 5.57 27.74 34.67 5.71 5.74 5.57 23.20 5.10 3.00 14.59 4.90 11.86 21.75 11.02 12.97 5.76 36938706 HSV CULT TYPE 2 IMMUNOFL 87140 300 $29.00 10.72 3.00 34.67 3.45 20.04 5.85 20.04 3.00 16.02 5.74 15.48 3.30 3.00 19.20 5.01 5.57 27.74 34.67 5.71 5.74 5.57 23.20 5.10 3.00 14.59 4.90 11.86 21.75 11.02 12.97 5.76 36301279 STREPTOCOCCUS A 87147 300 $27.00 9.98 3.00 45.19 3.45 18.66 5.44 18.66 3.00 14.92 5.34 14.38 3.30 3.00 17.87 4.66 5.18 36.15 45.19 5.31 5.34 5.18 21.60 4.74 3.00 13.57 4.56 11.04 20.25 10.26 12.08 5.36 36301287 STREPTOCOCCUS B 87147 300 $27.00 9.98 3.00 45.19 3.45 18.66 5.44 18.66 3.00 14.92 5.34 14.38 3.30 3.00 17.87 4.66 5.18 36.15 45.19 5.31 5.34 5.18 21.60 4.74 3.00 13.57 4.56 11.04 20.25 10.26 12.08 5.36 36301295 STREPTOCOCCUS C 87147 300 $27.00 9.98 3.00 45.19 3.45 18.66 5.44 18.66 3.00 14.92 5.34 14.38 3.30 3.00 17.87 4.66 5.18 36.15 45.19 5.31 5.34 5.18 21.60 4.74 3.00 13.57 4.56 11.04 20.25 10.26 12.08 5.36 36301309 STREPTOCOCCUS F 87147 300 $27.00 9.98 3.00 45.19 3.45 18.66 5.44 18.66 3.00 14.92 5.34 14.38 3.30 3.00 17.87 4.66 5.18 36.15 45.19 5.31 5.34 5.18 21.60 4.74 3.00 13.57 4.56 11.04 20.25 10.26 12.08 5.36 36301317 STREPTOCOCCUS G 87147 300 $27.00 9.98 3.00 45.19 3.45 18.66 5.44 18.66 3.00 14.92 5.34 14.38 3.30 3.00 17.87 4.66 5.18 36.15 45.19 5.31 5.34 5.18 21.60 4.74 3.00 13.57 4.56 11.04 20.25 10.26 12.08 5.36 36301325 PARTIAL STREP TYPING 87147 300 $27.00 9.98 3.00 45.19 3.45 18.66 5.44 18.66 3.00 14.92 5.34 14.38 3.30 3.00 17.87 4.66 5.18 36.15 45.19 5.31 5.34 5.18 21.60 4.74 3.00 13.57 4.56 11.04 20.25 10.26 12.08 5.36 36302763 PENICILLIN BIND PROT AGGLUTINA 87147 300 $27.00 9.98 3.00 45.19 3.45 18.66 5.44 18.66 3.00 14.92 5.34 14.38 3.30 3.00 17.87 4.66 5.18 36.15 45.19 5.31 5.34 5.18 21.60 4.74 3.00 13.57 4.56 11.04 20.25 10.26 12.08 5.36 36303361 CULTURE TYPING IMMUNOLOGIC 87147 300 $27.00 9.98 3.00 45.19 3.45 18.66 5.44 18.66 3.00 14.92 5.34 14.38 3.30 3.00 17.87 4.66 5.18 36.15 45.19 5.31 5.34 5.18 21.60 4.74 3.00 13.57 4.56 11.04 20.25 10.26 12.08 5.36 36303379 CULTURE TYPING IMMUNOLOGIC 87147 300 $27.00 9.98 3.00 45.19 3.45 18.66 5.44 18.66 3.00 14.92 5.34 14.38 3.30 3.00 17.87 4.66 5.18 36.15 45.19 5.31 5.34 5.18 21.60 4.74 3.00 13.57 4.56 11.04 20.25 10.26 12.08 5.36 36303387 CULTURE TYPING IMMUNOLOGIC 87147 300 $27.00 9.98 3.00 45.19 3.45 18.66 5.44 18.66 3.00 14.92 5.34 14.38 3.30 3.00 17.87 4.66 5.18 36.15 45.19 5.31 5.34 5.18 21.60 4.74 3.00 13.57 4.56 11.04 20.25 10.26 12.08 5.36 36303395 CULTURE TYPING IMMUNOLOGIC 87147 300 $27.00 9.98 3.00 45.19 3.45 18.66 5.44 18.66 3.00 14.92 5.34 14.38 3.30 3.00 17.87 4.66 5.18 36.15 45.19 5.31 5.34 5.18 21.60 4.74 3.00 13.57 4.56 11.04 20.25 10.26 12.08 5.36 36303409 SALMONELLA TYPING IMMUNOLOGIC 87147 300 $27.00 9.98 3.00 45.19 3.45 18.66 5.44 18.66 3.00 14.92 5.34 14.38 3.30 3.00 17.87 4.66 5.18 36.15 45.19 5.31 5.34 5.18 21.60 4.74 3.00 13.57 4.56 11.04 20.25 10.26 12.08 5.36 36303972 PARTIAL STREP TYPING 87147 300 $27.00 9.98 3.00 45.19 3.45 18.66 5.44 18.66 3.00 14.92 5.34 14.38 3.30 3.00 17.87 4.66 5.18 36.15 45.19 5.31 5.34 5.18 21.60 4.74 3.00 13.57 4.56 11.04 20.25 10.26 12.08 5.36 36303981 STREPTOCOCCUS A 87147 300 $27.00 9.98 3.00 45.19 3.45 18.66 5.44 18.66 3.00 14.92 5.34 14.38 3.30 3.00 17.87 4.66 5.18 36.15 45.19 5.31 5.34 5.18 21.60 4.74 3.00 13.57 4.56 11.04 20.25 10.26 12.08 5.36 36303999 STREPTOCOCCUS B 87147 300 $27.00 9.98 3.00 45.19 3.45 18.66 5.44 18.66 3.00 14.92 5.34 14.38 3.30 3.00 17.87 4.66 5.18 36.15 45.19 5.31 5.34 5.18 21.60 4.74 3.00 13.57 4.56 11.04 20.25 10.26 12.08 5.36 36304006 STREPTOCOCCUS C 87147 300 $27.00 9.98 3.00 45.19 3.45 18.66 5.44 18.66 3.00 14.92 5.34 14.38 3.30 3.00 17.87 4.66 5.18 36.15 45.19 5.31 5.34 5.18 21.60 4.74 3.00 13.57 4.56 11.04 20.25 10.26 12.08 5.36 36304014 STREPTOCOCCUS F 87147 300 $27.00 9.98 3.00 45.19 3.45 18.66 5.44 18.66 3.00 14.92 5.34 14.38 3.30 3.00 17.87 4.66 5.18 36.15 45.19 5.31 5.34 5.18 21.60 4.74 3.00 13.57 4.56 11.04 20.25 10.26 12.08 5.36 36304022 STREPTOCOCCUS G 87147 300 $27.00 9.98 3.00 45.19 3.45 18.66 5.44 18.66 3.00 14.92 5.34 14.38 3.30 3.00 17.87 4.66 5.18 36.15 45.19 5.31 5.34 5.18 21.60 4.74 3.00 13.57 4.56 11.04 20.25 10.26 12.08 5.36 36304472 PENICILLIN BINDING PROT AGGL 87147 300 $27.00 9.98 3.00 45.19 3.45 18.66 5.44 18.66 3.00 14.92 5.34 14.38 3.30 3.00 17.87 4.66 5.18 36.15 45.19 5.31 5.34 5.18 21.60 4.74 3.00 13.57 4.56 11.04 20.25 10.26 12.08 5.36 36301252 AFB TB PROBE IDENTIFICATION 87149 300 $105.00 38.81 17.64 157.79 25.50 72.56 21.05 72.56 22.17 58.01 20.65 55.77 24.39 22.17 69.50 18.05 20.05 126.23 157.79 20.55 20.65 20.05 84.00 18.35 22.17 52.53 17.64 42.95 78.75 39.91 46.97 20.75 36301261 AFB AVIUM PROBE IDENTIFICATION 87149 300 $105.00 38.81 17.64 157.79 25.50 72.56 21.05 72.56 22.17 58.01 20.65 55.77 24.39 22.17 69.50 18.05 20.05 126.23 157.79 20.55 20.65 20.05 84.00 18.35 22.17 52.53 17.64 42.95 78.75 39.91 46.97 20.75 36301678 AFB MYCOBACT GORDONAE PROBE ID 87149 300 $105.00 38.81 17.64 157.79 25.50 72.56 21.05 72.56 22.17 58.01 20.65 55.77 24.39 22.17 69.50 18.05 20.05 126.23 157.79 20.55 20.65 20.05 84.00 18.35 22.17 52.53 17.64 42.95 78.75 39.91 46.97 20.75 36304073 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304081 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304090 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304103 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304111 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304120 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304138 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304146 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304154 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304162 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304171 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304189 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304197 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304201 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304219 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304227 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304235 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304243 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304251 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304260 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304278 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304286 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304294 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304308 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304316 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304324 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304332 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304341 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304359 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304367 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304375 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304383 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304391 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304405 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304413 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304421 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304430 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304448 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304456 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304464 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304634 DNA RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304642 DNA RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304651 DNA RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304669 DNA RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304677 DNA RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304685 DNA RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304693 DNA RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304707 DNA RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304715 DNA RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304723 DNA RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304731 DNA RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304740 DNA RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304758 DNA RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304766 DNA RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304774 DNA RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304782 DNA RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304791 DNA RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304804 DNA RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304812 DNA RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304821 DNA RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304839 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304847 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304855 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304863 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304871 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304880 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304898 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304901 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304910 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304928 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304936 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304944 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304952 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304961 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304979 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304987 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304995 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36305002 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36305011 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36305029 DNA/RNA ID BY AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36305177 GRP B STREP CULT TYP AMP PROBE 87150 300 $184.00 68.01 30.88 277.06 46.25 127.14 36.84 127.14 40.22 101.66 36.14 97.56 44.24 40.22 121.79 31.58 35.09 221.65 277.06 35.97 36.14 35.09 147.20 32.11 40.22 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36909650 TICK ID FOR LYME 87168 300 $136.00 50.27 - 108.80 - 93.98 4.48 93.98 - 75.14 4.40 11.87 - - 90.02 3.84 4.27 26.90 33.62 4.38 4.40 4.27 108.80 3.91 - 11.19 3.76 55.62 102.00 51.69 60.83 4.42 36981466 TICK ID W REFLEX LYME DIS DNA 87168 300 $190.00 70.22 - 152.00 - 131.29 4.48 131.29 - 104.98 4.40 11.87 - - 125.76 3.84 4.27 26.90 33.62 4.38 4.40 4.27 152.00 3.91 - 11.19 3.76 77.71 142.50 72.22 84.99 4.42 36302313 WORM IDENTIFICATION 87169 300 $23.00 8.50 - 33.62 - 15.89 4.53 15.89 - 12.71 4.44 11.87 - - 15.22 3.88 4.31 26.90 33.62 4.42 4.44 4.31 18.40 3.94 - 11.29 3.79 9.41 17.25 8.74 10.29 4.46 36300264 PINWORM SMEAR 87172 300 $22.00 8.13 - 33.62 - 15.20 4.48 15.20 - 12.16 4.40 11.87 - - 14.56 3.84 4.27 26.90 33.62 4.38 4.40 4.27 17.60 3.91 - 11.19 3.76 9.00 16.50 8.36 9.84 4.42 36305169 HOMOGENIZATION TISSUE CULTURE 87176 300 $31.00 11.46 5.17 47.45 8.34 21.42 6.17 21.42 7.25 17.13 6.06 16.36 7.98 7.25 20.52 5.29 5.88 37.96 47.45 6.03 6.06 5.88 24.80 5.38 7.25 15.41 5.17 12.68 23.25 11.78 13.87 6.09 36300639 O&P SMEAR/CONCENTRATE (EXP) 87177 300 $47.00 17.37 7.50 50.76 8.63 32.48 9.35 32.48 7.50 25.97 9.17 24.74 8.25 7.50 31.11 8.01 8.90 40.61 50.76 9.12 9.17 8.90 37.60 8.14 7.50 23.32 7.83 19.22 35.25 17.86 21.02 9.21 36923253 O&P SMEAR/CONCENTRATE 87177 300 $47.00 17.37 7.50 50.76 8.63 32.48 9.35 32.48 7.50 25.97 9.17 24.74 8.25 7.50 31.11 8.01 8.90 40.61 50.76 9.12 9.17 8.90 37.60 8.14 7.50 23.32 7.83 19.22 35.25 17.86 21.02 9.21 36300159 ETEST 1 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36300167 ANTIBIOTIC GRADIENT STRIP 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36300175 ANTIBIOTIC GRADIENT STRIP 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36300183 ANTIBIOTIC GRADIENT STRIP 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36300191 ANTIBIOTIC GRADIENT STRIP 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36300205 ANTIBIOTIC GRADIENT STRIP 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36300213 ANTIBIOTIC GRADIENT STRIP 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36300281 ANTIBIOTIC GRADIENT STRIP 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36300311 ANTIBIOTIC GRADIENT STRIP 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36300329 ANTIBIOTIC GRADIENT STRIP 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36300337 ANTIBIOTIC GRADIENT STRIP 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36300353 ANTIBIOTIC GRADIENT STRIP 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36300361 ANTIBIOTIC GRADIENT STRIP 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36300396 ANTIBIOTIC GRADIENT STRIP 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36300400 ANTIBIOTIC GRADIENT STRIP 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36300418 ANTIBIOTIC GRADIENT STRIP 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36300426 ANTIBIOTIC GRADIENT STRIP 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36300434 ANTIBIOTIC GRADIENT STRIP 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36300442 ANTIBIOTIC GRADIENT STRIP 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36300469 ANTIBIOTIC GRADIENT STRIP 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36300477 ANTIBIOTIC GRADIENT STRIP 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36300493 ANTIBIOTIC GRADIENT STRIP 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36300507 ANTIBIOTIC GRADIENT STRIP 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36300523 ANTIBIOTIC GRADIENT STRIP 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36300531 ANTIBIOTIC GRADIENT STRIP 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36300540 ANTIBIOTIC GRADIENT STRIP 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36300591 ANTIBIOTIC GRADIENT STRIP 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36300604 ANTIBIOTIC GRADIENT STRIP 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36300809 ANTIBIOTIC GRADIENT STRIP 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36300817 ANTIBIOTIC GRADIENT STRIP 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36302178 GRADIENT STRIP PENICILLIN 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36302186 GRADIENT STRIP CEFTRIAXONE 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36302194 GRADIENT STRIP AMOX/PEN 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36302828 ANTIBIOTIC GRADIENT STRIP 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36302836 ANTIBIOTIC GRADIENT STRIP 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36302844 ANTIBIOTIC GRADIENT STRIP 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36302852 ANTIBIOTIC GRADIENT STRIP 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36302861 ANTIBIOTIC GRADIENT STRIP 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36302879 ANTIBIOTIC GRADIENT STRIP 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36302887 ANTIBIOTIC GRADIENT STRIP 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36302895 ANTIBIOTIC GRADIENT STRIP 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36302909 ANTIBIOTIC GRADIENT STRIP 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36302917 ANTIBIOTIC GRADIENT STRIP 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36302992 ANTIBIOTIC GRADIENT STRIP 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36304481 ETEST 1 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36304499 ANTIBIOTIC GRADIENT STRIP 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36304502 ANTIBIOTIC GRADIENT STRIP 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36304511 ANTIBIOTIC GRADIENT STRIP 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36304529 ANTIBIOTIC GRADIENT STRIP 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36304537 ANTIBIOTIC GRADIENT STRIP 87181 300 $25.00 9.24 4.18 38.25 6.90 17.28 4.99 17.28 6.00 13.81 4.89 13.22 6.60 6.00 16.55 4.28 4.75 30.60 38.25 4.87 4.89 4.75 20.00 4.35 6.00 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36300612 SUSCEPTIBLITY KIRBY-BAUER 87184 300 $39.00 14.41 6.58 39.52 9.20 26.95 7.85 26.95 8.00 21.55 7.70 19.15 8.80 8.00 25.81 6.73 7.48 31.62 39.52 7.67 7.70 7.48 31.20 6.84 8.00 19.60 6.58 15.95 29.25 14.82 17.44 7.74 36303174 RAPID GROWER DISC DIFFUSION 87184 300 $39.00 14.41 6.58 39.52 9.20 26.95 7.85 26.95 8.00 21.55 7.70 19.15 8.80 8.00 25.81 6.73 7.48 31.62 39.52 7.67 7.70 7.48 31.20 6.84 8.00 19.60 6.58 15.95 29.25 14.82 17.44 7.74 36303344 KPC CONF SUSCEP <=12 DISC 87184 300 $39.00 14.41 6.58 39.52 9.20 26.95 7.85 26.95 8.00 21.55 7.70 19.15 8.80 8.00 25.81 6.73 7.48 31.62 39.52 7.67 7.70 7.48 31.20 6.84 8.00 19.60 6.58 15.95 29.25 14.82 17.44 7.74 36303352 ESBL CONF SUSCEP <=12 DISC 87184 300 $39.00 14.41 6.58 39.52 9.20 26.95 7.85 26.95 8.00 21.55 7.70 19.15 8.80 8.00 25.81 6.73 7.48 31.62 39.52 7.67 7.70 7.48 31.20 6.84 8.00 19.60 6.58 15.95 29.25 14.82 17.44 7.74 36302160 BETA LACTAMASE 87185 300 $25.00 9.24 4.18 37.37 6.04 17.28 4.99 17.28 5.25 13.81 4.89 13.22 5.78 5.25 16.55 4.28 4.75 29.90 37.37 4.87 4.89 4.75 20.00 4.35 5.25 12.45 4.18 10.23 18.75 9.50 11.18 4.92 36300370 MIC (EXP) 87186 300 $45.00 16.63 7.61 49.55 9.20 31.10 9.08 31.10 8.00 24.86 8.91 24.05 8.80 8.00 29.79 7.79 8.65 39.64 49.55 8.87 8.91 8.65 36.00 7.91 8.00 22.66 7.61 18.41 33.75 17.10 20.13 8.95 36301091 VITEK 87186 300 $45.00 16.63 7.61 49.55 9.20 31.10 9.08 31.10 8.00 24.86 8.91 24.05 8.80 8.00 29.79 7.79 8.65 39.64 49.55 8.87 8.91 8.65 36.00 7.91 8.00 22.66 7.61 18.41 33.75 17.10 20.13 8.95 36302623 VITEK-STREP 87186 300 $45.00 16.63 7.61 49.55 9.20 31.10 9.08 31.10 8.00 24.86 8.91 24.05 8.80 8.00 29.79 7.79 8.65 39.64 49.55 8.87 8.91 8.65 36.00 7.91 8.00 22.66 7.61 18.41 33.75 17.10 20.13 8.95 36303166 RAPID GROWER MICRODILUTION 87186 300 $45.00 16.63 7.61 49.55 9.20 31.10 9.08 31.10 8.00 24.86 8.91 24.05 8.80 8.00 29.79 7.79 8.65 39.64 49.55 8.87 8.91 8.65 36.00 7.91 8.00 22.66 7.61 18.41 33.75 17.10 20.13 8.95 36303719 GROUP B STREP SUSCEP MICRODIL 87186 300 $45.00 16.63 7.61 49.55 9.20 31.10 9.08 31.10 8.00 24.86 8.91 24.05 8.80 8.00 29.79 7.79 8.65 39.64 49.55 8.87 8.91 8.65 36.00 7.91 8.00 22.66 7.61 18.41 33.75 17.10 20.13 8.95 36303867 PHOENIX SENSITIVITY 87186 300 $45.00 16.63 7.61 49.55 9.20 31.10 9.08 31.10 8.00 24.86 8.91 24.05 8.80 8.00 29.79 7.79 8.65 39.64 49.55 8.87 8.91 8.65 36.00 7.91 8.00 22.66 7.61 18.41 33.75 17.10 20.13 8.95 36304600 VITEK SENSITIVITY 87186 300 $45.00 16.63 7.61 49.55 9.20 31.10 9.08 31.10 8.00 24.86 8.91 24.05 8.80 8.00 29.79 7.79 8.65 39.64 49.55 8.87 8.91 8.65 36.00 7.91 8.00 22.66 7.61 18.41 33.75 17.10 20.13 8.95 36305134 SENSITITRE TREK MIC 87186 300 $45.00 16.63 7.61 49.55 9.20 31.10 9.08 31.10 8.00 24.86 8.91 24.05 8.80 8.00 29.79 7.79 8.65 39.64 49.55 8.87 8.91 8.65 36.00 7.91 8.00 22.66 7.61 18.41 33.75 17.10 20.13 8.95 35200118 GRAM STAIN 87205 300 $22.00 8.13 3.76 24.47 5.18 15.20 4.48 15.20 4.50 12.16 4.40 11.87 4.95 4.50 14.56 3.84 4.27 19.58 24.47 4.38 4.40 4.27 17.60 3.91 4.50 11.19 3.76 9.00 16.50 8.36 9.84 4.42 35709410 EOSINOPHIL COUNT URINE 87205 300 $22.00 8.13 3.76 24.47 5.18 15.20 4.48 15.20 4.50 12.16 4.40 11.87 4.95 4.50 14.56 3.84 4.27 19.58 24.47 4.38 4.40 4.27 17.60 3.91 4.50 11.19 3.76 9.00 16.50 8.36 9.84 4.42 36300302 GRAM STAIN 87205 300 $22.00 8.13 3.76 24.47 5.18 15.20 4.48 15.20 4.50 12.16 4.40 11.87 4.95 4.50 14.56 3.84 4.27 19.58 24.47 4.38 4.40 4.27 17.60 3.91 4.50 11.19 3.76 9.00 16.50 8.36 9.84 4.42 36303191 NOCARDIA SMEAR 87205 300 $22.00 8.13 3.76 24.47 5.18 15.20 4.48 15.20 4.50 12.16 4.40 11.87 4.95 4.50 14.56 3.84 4.27 19.58 24.47 4.38 4.40 4.27 17.60 3.91 4.50 11.19 3.76 9.00 16.50 8.36 9.84 4.42 36300299 FUNGUS SMEAR 87206 300 $28.00 10.35 3.00 24.64 3.45 19.35 5.66 19.35 3.00 15.47 5.55 14.95 3.30 3.00 18.53 4.85 5.39 19.71 24.64 5.52 5.55 5.39 22.40 4.93 3.00 14.12 4.74 11.45 21.00 10.64 12.52 5.58 36300345 AFB SMEAR 87206 300 $28.00 10.35 3.00 24.64 3.45 19.35 5.66 19.35 3.00 15.47 5.55 14.95 3.30 3.00 18.53 4.85 5.39 19.71 24.64 5.52 5.55 5.39 22.40 4.93 3.00 14.12 4.74 11.45 21.00 10.64 12.52 5.58 36300574 PNEUMOCYSTIS SMEAR 87206 300 $28.00 10.35 3.00 24.64 3.45 19.35 5.66 19.35 3.00 15.47 5.55 14.95 3.30 3.00 18.53 4.85 5.39 19.71 24.64 5.52 5.55 5.39 22.40 4.93 3.00 14.12 4.74 11.45 21.00 10.64 12.52 5.58 36302283 SPECIAL STAIN CRYPTOSPORIDIA 87206 300 $28.00 10.35 3.00 24.64 3.45 19.35 5.66 19.35 3.00 15.47 5.55 14.95 3.30 3.00 18.53 4.85 5.39 19.71 24.64 5.52 5.55 5.39 22.40 4.93 3.00 14.12 4.74 11.45 21.00 10.64 12.52 5.58 36302291 SPECIAL STAIN CYCLOSPORA 87206 300 $28.00 10.35 3.00 24.64 3.45 19.35 5.66 19.35 3.00 15.47 5.55 14.95 3.30 3.00 18.53 4.85 5.39 19.71 24.64 5.52 5.55 5.39 22.40 4.93 3.00 14.12 4.74 11.45 21.00 10.64 12.52 5.58 36305207 SMEAR FLUOR AND/OR AF STAIN 87206 300 $28.00 10.35 3.00 24.64 3.45 19.35 5.66 19.35 3.00 15.47 5.55 14.95 3.30 3.00 18.53 4.85 5.39 19.71 24.64 5.52 5.55 5.39 22.40 4.93 3.00 14.12 4.74 11.45 21.00 10.64 12.52 5.58 35200029 TZANCK SMEAR 87207 300 $31.00 11.46 4.50 34.34 5.18 21.42 6.29 21.42 4.50 17.13 6.17 16.64 4.95 4.50 20.52 5.39 5.99 27.47 34.34 6.14 6.17 5.99 24.80 5.48 4.50 15.69 5.27 12.68 23.25 11.78 13.87 6.20 35706321 MALARIA SMEAR 87207 300 $31.00 11.46 4.50 34.34 5.18 21.42 6.29 21.42 4.50 17.13 6.17 16.64 4.95 4.50 20.52 5.39 5.99 27.47 34.34 6.14 6.17 5.99 24.80 5.48 4.50 15.69 5.27 12.68 23.25 11.78 13.87 6.20 36917784 MICROSPORIDIA STAIN 87207 300 $365.00 134.90 4.50 292.00 5.18 252.22 6.29 252.22 4.50 201.66 6.17 16.64 4.95 4.50 241.59 5.39 5.99 27.47 34.34 6.14 6.17 5.99 292.00 5.48 4.50 15.69 5.27 149.29 273.75 138.74 163.26 6.20 36924977 SMEAR SPEC STAIN PARASITE 87207 300 $324.00 119.75 4.50 259.20 5.18 223.88 6.29 223.88 4.50 179.01 6.17 16.64 4.95 4.50 214.46 5.39 5.99 27.47 34.34 6.14 6.17 5.99 259.20 5.48 4.50 15.69 5.27 132.52 243.00 123.15 144.93 6.20 36300647 O&P PERMANENT STAIN (EXP) 87209 300 $94.00 34.74 15.82 138.39 23.10 64.95 18.88 64.95 20.09 51.94 18.52 49.99 22.10 20.09 62.22 16.18 17.98 110.71 138.39 18.43 18.52 17.98 75.20 16.45 20.09 47.11 15.82 38.45 70.50 35.73 42.05 18.61 36923261 TRICHROME STAIN 87209 300 $94.00 34.74 15.82 138.39 23.10 64.95 18.88 64.95 20.09 51.94 18.52 49.99 22.10 20.09 62.22 16.18 17.98 110.71 138.39 18.43 18.52 17.98 75.20 16.45 20.09 47.11 15.82 38.45 70.50 35.73 42.05 18.61 35200011 WET PREP/KOH (GRL) 87210 300 $31.00 11.46 5.12 34.39 6.69 21.42 6.11 21.42 5.82 17.13 5.99 11.87 6.40 5.82 20.52 5.24 5.82 27.51 34.39 5.97 5.99 5.82 24.80 5.33 5.82 15.25 5.12 12.68 23.25 11.78 13.87 6.02 35200177 PROSTATE SECRETION EXAM 87210 300 $31.00 11.46 5.12 34.39 6.69 21.42 6.11 21.42 5.82 17.13 5.99 11.87 6.40 5.82 20.52 5.24 5.82 27.51 34.39 5.97 5.99 5.82 24.80 5.33 5.82 15.25 5.12 12.68 23.25 11.78 13.87 6.02 35751173 VAGINAL WET PREP PROFILE 87210 300 $31.00 11.46 5.12 34.39 6.69 21.42 6.11 21.42 5.82 17.13 5.99 11.87 6.40 5.82 20.52 5.24 5.82 27.51 34.39 5.97 5.99 5.82 24.80 5.33 5.82 15.25 5.12 12.68 23.25 11.78 13.87 6.02 36300451 TRICHOMONAS SMEAR 87210 300 $31.00 11.46 5.12 34.39 6.69 21.42 6.11 21.42 5.82 17.13 5.99 11.87 6.40 5.82 20.52 5.24 5.82 27.51 34.39 5.97 5.99 5.82 24.80 5.33 5.82 15.25 5.12 12.68 23.25 11.78 13.87 6.02 35200525 KOH PREP SKIN HAIR NAILS (GRL) 87220 300 $22.00 8.13 3.76 25.74 4.49 15.20 4.48 15.20 3.90 12.16 4.40 11.87 4.29 3.90 14.56 3.84 4.27 20.59 25.74 4.38 4.40 4.27 17.60 3.91 3.90 11.19 3.76 9.00 16.50 8.36 9.84 4.42 36300892 CULTURE VIRAL 87252 300 $137.00 50.64 22.94 149.36 41.42 94.67 27.37 94.67 36.02 75.69 26.85 72.47 39.62 36.02 90.68 23.46 26.07 119.49 149.36 26.72 26.85 26.07 109.60 23.85 36.02 68.30 22.94 56.03 102.75 52.07 61.28 26.98 36930276 TISSUE CULTURE PRESUMP ID 87252 300 $137.00 50.64 22.94 149.36 41.42 94.67 27.37 94.67 36.02 75.69 26.85 72.47 39.62 36.02 90.68 23.46 26.07 119.49 149.36 26.72 26.85 26.07 109.60 23.85 36.02 68.30 22.94 56.03 102.75 52.07 61.28 26.98 36302062 VIROLOGY FA STAIN 1 87253 300 $106.00 39.18 17.78 162.75 30.45 73.25 21.21 73.25 26.48 58.57 20.81 56.17 29.13 26.48 70.16 18.18 20.20 130.20 162.75 20.71 20.81 20.20 84.80 18.48 26.48 52.92 17.78 43.35 79.50 40.29 47.41 20.91 36302119 HEMADSORPTION ADDITIONAL 87253 300 $106.00 39.18 17.78 162.75 30.45 73.25 21.21 73.25 26.48 58.57 20.81 56.17 29.13 26.48 70.16 18.18 20.20 130.20 162.75 20.71 20.81 20.20 84.80 18.48 26.48 52.92 17.78 43.35 79.50 40.29 47.41 20.91 36302127 HEMADSORPTION ADDITIONAL 87253 300 $106.00 39.18 17.78 162.75 30.45 73.25 21.21 73.25 26.48 58.57 20.81 56.17 29.13 26.48 70.16 18.18 20.20 130.20 162.75 20.71 20.81 20.20 84.80 18.48 26.48 52.92 17.78 43.35 79.50 40.29 47.41 20.91 36302135 HEMADSORPTION ADDITIONAL 87253 300 $106.00 39.18 17.78 162.75 30.45 73.25 21.21 73.25 26.48 58.57 20.81 56.17 29.13 26.48 70.16 18.18 20.20 130.20 162.75 20.71 20.81 20.20 84.80 18.48 26.48 52.92 17.78 43.35 79.50 40.29 47.41 20.91 36932911 TISSUE CULTURE DEFINITIVE ID 87253 300 $106.00 39.18 17.78 162.75 30.45 73.25 21.21 73.25 26.48 58.57 20.81 56.17 29.13 26.48 70.16 18.18 20.20 130.20 162.75 20.71 20.81 20.20 84.80 18.48 26.48 52.92 17.78 43.35 79.50 40.29 47.41 20.91 36302089 CMV DRAM 87254 300 $126.00 46.57 5.41 100.80 6.22 87.07 20.54 87.07 5.41 69.62 20.15 54.38 5.95 5.41 83.40 17.60 19.56 30.82 38.53 20.05 20.15 19.56 100.80 17.90 5.41 51.25 17.21 51.53 94.50 47.89 56.36 20.24 36302208 NEG RESPIRATORY MIX DRAM 87254 300 $126.00 46.57 5.41 100.80 6.22 87.07 20.54 87.07 5.41 69.62 20.15 54.38 5.95 5.41 83.40 17.60 19.56 30.82 38.53 20.05 20.15 19.56 100.80 17.90 5.41 51.25 17.21 51.53 94.50 47.89 56.36 20.24 36302216 ADENOVIRUS STAIN 87254 300 $126.00 46.57 5.41 100.80 6.22 87.07 20.54 87.07 5.41 69.62 20.15 54.38 5.95 5.41 83.40 17.60 19.56 30.82 38.53 20.05 20.15 19.56 100.80 17.90 5.41 51.25 17.21 51.53 94.50 47.89 56.36 20.24 36302224 INFLUENZA VIRUS TYPE A STAIN 87254 300 $126.00 46.57 5.41 100.80 6.22 87.07 20.54 87.07 5.41 69.62 20.15 54.38 5.95 5.41 83.40 17.60 19.56 30.82 38.53 20.05 20.15 19.56 100.80 17.90 5.41 51.25 17.21 51.53 94.50 47.89 56.36 20.24 36302232 INFLUENZA VIRUS TYPE B STAIN 87254 300 $126.00 46.57 5.41 100.80 6.22 87.07 20.54 87.07 5.41 69.62 20.15 54.38 5.95 5.41 83.40 17.60 19.56 30.82 38.53 20.05 20.15 19.56 100.80 17.90 5.41 51.25 17.21 51.53 94.50 47.89 56.36 20.24 36302241 PARAINFLU VIRUS 1 2 3 STAIN 87254 300 $126.00 46.57 5.41 100.80 6.22 87.07 20.54 87.07 5.41 69.62 20.15 54.38 5.95 5.41 83.40 17.60 19.56 30.82 38.53 20.05 20.15 19.56 100.80 17.90 5.41 51.25 17.21 51.53 94.50 47.89 56.36 20.24 36303000 VZ RAPID SHELL VIAL 87254 300 $126.00 46.57 5.41 100.80 6.22 87.07 20.54 87.07 5.41 69.62 20.15 54.38 5.95 5.41 83.40 17.60 19.56 30.82 38.53 20.05 20.15 19.56 100.80 17.90 5.41 51.25 17.21 51.53 94.50 47.89 56.36 20.24 36303018 ENTEROVIRUS RAPID SHELL VIAL 87254 300 $126.00 46.57 5.41 100.80 6.22 87.07 20.54 87.07 5.41 69.62 20.15 54.38 5.95 5.41 83.40 17.60 19.56 30.82 38.53 20.05 20.15 19.56 100.80 17.90 5.41 51.25 17.21 51.53 94.50 47.89 56.36 20.24 36303026 HSV RAPID SHELL VIAL 87254 300 $126.00 46.57 5.41 100.80 6.22 87.07 20.54 87.07 5.41 69.62 20.15 54.38 5.95 5.41 83.40 17.60 19.56 30.82 38.53 20.05 20.15 19.56 100.80 17.90 5.41 51.25 17.21 51.53 94.50 47.89 56.36 20.24 36303182 RMIX METAPNEUMOVIRUS 87254 300 $126.00 46.57 5.41 100.80 6.22 87.07 20.54 87.07 5.41 69.62 20.15 54.38 5.95 5.41 83.40 17.60 19.56 30.82 38.53 20.05 20.15 19.56 100.80 17.90 5.41 51.25 17.21 51.53 94.50 47.89 56.36 20.24 36303425 HSV VIRAL CULTURE 87254 300 $126.00 46.57 5.41 100.80 6.22 87.07 20.54 87.07 5.41 69.62 20.15 54.38 5.95 5.41 83.40 17.60 19.56 30.82 38.53 20.05 20.15 19.56 100.80 17.90 5.41 51.25 17.21 51.53 94.50 47.89 56.36 20.24 36303433 VZV VIRAL CULTURE 87254 300 $126.00 46.57 5.41 100.80 6.22 87.07 20.54 87.07 5.41 69.62 20.15 54.38 5.95 5.41 83.40 17.60 19.56 30.82 38.53 20.05 20.15 19.56 100.80 17.90 5.41 51.25 17.21 51.53 94.50 47.89 56.36 20.24 36303441 CMV VIRAL CULTURE 87254 300 $126.00 46.57 5.41 100.80 6.22 87.07 20.54 87.07 5.41 69.62 20.15 54.38 5.95 5.41 83.40 17.60 19.56 30.82 38.53 20.05 20.15 19.56 100.80 17.90 5.41 51.25 17.21 51.53 94.50 47.89 56.36 20.24 36303450 EV VIRAL CULTURE 87254 300 $126.00 46.57 5.41 100.80 6.22 87.07 20.54 87.07 5.41 69.62 20.15 54.38 5.95 5.41 83.40 17.60 19.56 30.82 38.53 20.05 20.15 19.56 100.80 17.90 5.41 51.25 17.21 51.53 94.50 47.89 56.36 20.24 36938676 CMV CULTURE (SHELL VIAL) 87254 300 $126.00 46.57 5.41 100.80 6.22 87.07 20.54 87.07 5.41 69.62 20.15 54.38 5.95 5.41 83.40 17.60 19.56 30.82 38.53 20.05 20.15 19.56 100.80 17.90 5.41 51.25 17.21 51.53 94.50 47.89 56.36 20.24 36938714 ENTEROVIRUS CLTR (SHELL VIAL) 87254 300 $353.00 130.47 5.41 282.40 6.22 243.92 20.54 243.92 5.41 195.03 20.15 54.38 5.95 5.41 233.65 17.60 19.56 30.82 38.53 20.05 20.15 19.56 282.40 17.90 5.41 51.25 17.21 144.38 264.75 134.18 157.90 20.24 36938684 HSV CULTURE 87255 300 $178.00 65.79 29.80 269.46 43.53 123.00 35.55 123.00 37.85 98.35 34.88 94.14 41.64 37.85 117.82 30.47 33.86 215.57 269.46 34.71 34.88 33.86 142.40 30.98 37.85 88.71 29.80 72.80 133.50 67.66 79.62 35.05 36302721 ADENOVIRUS DFA 87260 300 $76.00 28.09 - 92.98 - 52.52 15.15 52.52 - 41.99 14.86 33.32 - - 50.30 12.99 14.43 74.38 92.98 14.79 14.86 14.43 60.80 13.20 - 37.81 12.70 31.08 57.00 28.89 33.99 14.94 36302658 INFLUENZA B 87275 300 $64.00 23.65 10.78 86.70 14.01 44.22 12.86 44.22 12.18 35.36 12.62 33.32 13.40 12.18 42.36 11.03 12.25 69.36 86.70 12.56 12.62 12.25 51.20 11.21 12.18 32.10 10.78 26.18 48.00 24.33 28.63 12.68 36302666 INFLUENZA A 87276 300 $84.00 31.05 - 86.70 - 58.04 16.87 58.04 - 46.41 16.55 33.32 - - 55.60 14.46 16.07 69.36 86.70 16.47 16.55 16.07 67.20 14.70 - 42.10 14.14 34.36 63.00 31.93 37.57 16.63 36302674 PARAINFLUENZA: TYPE 1 DFA 87279 300 $86.00 31.79 12.18 86.70 14.01 59.43 17.25 59.43 12.18 47.52 16.92 33.32 13.40 12.18 56.92 14.79 16.43 69.36 86.70 16.84 16.92 16.43 68.80 15.03 12.18 43.05 14.46 35.17 64.50 32.69 38.47 17.01 36302682 PARAINFLUENZA: TYPE 2 DFA 87279 300 $86.00 31.79 12.18 86.70 14.01 59.43 17.25 59.43 12.18 47.52 16.92 33.32 13.40 12.18 56.92 14.79 16.43 69.36 86.70 16.84 16.92 16.43 68.80 15.03 12.18 43.05 14.46 35.17 64.50 32.69 38.47 17.01 36302691 PARAINFLUENZA: TYPE 3 DFA 87279 300 $86.00 31.79 12.18 86.70 14.01 59.43 17.25 59.43 12.18 47.52 16.92 33.32 13.40 12.18 56.92 14.79 16.43 69.36 86.70 16.84 16.92 16.43 68.80 15.03 12.18 43.05 14.46 35.17 64.50 32.69 38.47 17.01 36302739 PARAINFLUENZA VIRUS DFA 87279 300 $86.00 31.79 12.18 86.70 14.01 59.43 17.25 59.43 12.18 47.52 16.92 33.32 13.40 12.18 56.92 14.79 16.43 69.36 86.70 16.84 16.92 16.43 68.80 15.03 12.18 43.05 14.46 35.17 64.50 32.69 38.47 17.01 36302747 RESPIRATORY SYNCYTIAL DFA 87280 300 $70.00 25.87 - 92.98 - 48.37 14.09 48.37 - 38.68 13.82 33.32 - - 46.33 12.08 13.42 74.38 92.98 13.76 13.82 13.42 56.00 12.28 - 35.16 11.81 28.63 52.50 26.61 31.31 13.89 36302615 NEGATIVE RESPIRATORY POOL DFA 87300 300 $63.00 23.28 6.09 50.40 7.00 43.53 12.58 43.53 6.09 34.81 12.34 33.32 6.70 6.09 41.70 10.78 11.98 34.66 43.32 12.28 12.34 11.98 50.40 10.96 6.09 31.39 10.54 25.77 47.25 23.95 28.18 12.40 36302755 RESP DFA:FLU A&B ADENO PARA1-3 87300 300 $63.00 23.28 6.09 50.40 7.00 43.53 12.58 43.53 6.09 34.81 12.34 33.32 6.70 6.09 41.70 10.78 11.98 34.66 43.32 12.28 12.34 11.98 50.40 10.96 6.09 31.39 10.54 25.77 47.25 23.95 28.18 12.40 36929863 ASPERGILLUS ANTIGEN 87305 300 $523.00 193.30 10.54 418.40 14.16 361.39 12.58 361.39 12.31 288.96 12.34 33.32 13.54 12.31 346.17 10.78 11.98 67.86 84.82 12.28 12.34 11.98 418.40 10.96 12.31 31.39 10.54 213.91 392.25 198.79 233.94 12.40 36930365 ASPERGILLUS GALACTOMANNAN SER 87305 300 $587.00 216.96 10.54 469.60 14.16 405.62 12.58 405.62 12.31 324.32 12.34 33.32 13.54 12.31 388.54 10.78 11.98 67.86 84.82 12.28 12.34 11.98 469.60 10.96 12.31 31.39 10.54 240.08 440.25 223.12 262.57 12.40 36944749 ASPERGILLUS AG EIA BAL 87305 300 $523.00 193.30 10.54 418.40 14.16 361.39 12.58 361.39 12.31 288.96 12.34 33.32 13.54 12.31 346.17 10.78 11.98 67.86 84.82 12.28 12.34 11.98 418.40 10.96 12.31 31.39 10.54 213.91 392.25 198.79 233.94 12.40 36300795 C.DIFFICILE TOXIN ASSAY 87324 300 $63.00 23.28 - 93.20 - 43.53 12.58 43.53 - 34.81 12.34 33.32 - - 41.70 10.78 11.98 74.56 93.20 12.28 12.34 11.98 50.40 10.96 - 31.39 10.54 25.77 47.25 23.95 28.18 12.40 36302984 CRYPTOSPORIDIUM IMMUNOASSAY 87328 300 $73.00 26.98 - 58.40 - 50.44 14.51 50.44 - 40.33 14.23 33.32 - - 48.32 12.44 13.82 37.74 47.18 14.17 14.23 13.82 58.40 12.65 - 36.21 12.16 29.86 54.75 27.75 32.65 14.30 36304626 CRYPTOSPORIDIUM 87328 300 $73.00 26.98 - 58.40 - 50.44 14.51 50.44 - 40.33 14.23 33.32 - - 48.32 12.44 13.82 37.74 47.18 14.17 14.23 13.82 58.40 12.65 - 36.21 12.16 29.86 54.75 27.75 32.65 14.30 36300582 GIARDIA ELISA 87329 300 $63.00 23.28 10.54 87.63 14.16 43.53 12.58 43.53 12.31 34.81 12.34 33.32 13.54 12.31 41.70 10.78 11.98 70.10 87.63 12.28 12.34 11.98 50.40 10.96 12.31 31.39 10.54 25.77 47.25 23.95 28.18 12.40 36304618 GIARDIA 87329 300 $63.00 23.28 10.54 87.63 14.16 43.53 12.58 43.53 12.31 34.81 12.34 33.32 13.54 12.31 41.70 10.78 11.98 70.10 87.63 12.28 12.34 11.98 50.40 10.96 12.31 31.39 10.54 25.77 47.25 23.95 28.18 12.40 36918853 HELICOBACTER PYLORI AG STOOL 87338 300 $705.00 260.57 - 564.00 - 487.16 15.10 487.16 - 389.51 14.81 39.97 - - 466.64 12.94 14.38 60.85 76.06 14.74 14.81 14.38 564.00 13.16 - 37.68 12.65 288.35 528.75 267.97 315.35 14.88 35700102 HEPATITIS B SURFACE ANTIGEN 87340 300 $54.00 19.96 9.09 78.65 16.30 37.31 10.85 37.31 14.17 29.84 10.64 28.73 15.59 14.17 35.74 9.30 10.33 62.92 78.65 10.59 10.64 10.33 43.20 9.45 14.17 27.06 9.09 22.09 40.50 20.53 24.15 10.69 35709690 EXPOSURE HEP B SURF AG 87340 300 $54.00 19.96 9.09 78.65 16.30 37.31 10.85 37.31 14.17 29.84 10.64 28.73 15.59 14.17 35.74 9.30 10.33 62.92 78.65 10.59 10.64 10.33 43.20 9.45 14.17 27.06 9.09 22.09 40.50 20.53 24.15 10.69 36922494 HEPATITIS B SURFACE ANTIGEN 87340 300 $105.00 38.81 9.09 84.00 16.30 72.56 10.85 72.56 14.17 58.01 10.64 28.73 15.59 14.17 69.50 9.30 10.33 62.92 78.65 10.59 10.64 10.33 84.00 9.45 14.17 27.06 9.09 42.95 78.75 39.91 46.97 10.69 36922681 HEPATITIS B SURFACE AG 87340 300 $141.00 52.11 9.09 112.80 16.30 97.43 10.85 97.43 14.17 77.90 10.64 28.73 15.59 14.17 93.33 9.30 10.33 62.92 78.65 10.59 10.64 10.33 112.80 9.45 14.17 27.06 9.09 57.67 105.75 53.59 63.07 10.69 36942223 HEPATITIS B SURFACE ANTIGEN 87340 300 $54.00 19.96 9.09 78.65 16.30 37.31 10.85 37.31 14.17 29.84 10.64 28.73 15.59 14.17 35.74 9.30 10.33 62.92 78.65 10.59 10.64 10.33 43.20 9.45 14.17 27.06 9.09 22.09 40.50 20.53 24.15 10.69 35700099 HEPATITIS B SURFACE AG NEUTRAL 87341 300 $54.00 19.96 9.09 81.29 13.13 37.31 10.85 37.31 11.42 29.84 10.64 28.73 12.56 11.42 35.74 9.30 10.33 65.03 81.29 10.59 10.64 10.33 43.20 9.45 11.42 27.06 9.09 22.09 40.50 20.53 24.15 10.69 35709711 EXPOSURE HEP B SUR AG NEUT 87341 300 $54.00 19.96 9.09 81.29 13.13 37.31 10.85 37.31 11.42 29.84 10.64 28.73 12.56 11.42 35.74 9.30 10.33 65.03 81.29 10.59 10.64 10.33 43.20 9.45 11.42 27.06 9.09 22.09 40.50 20.53 24.15 10.69 35700170 HEPATITIS BE ANTIGEN 87350 300 $63.00 23.28 10.00 87.74 11.50 43.53 12.11 43.53 10.00 34.81 11.88 32.06 11.00 10.00 41.70 10.38 11.53 70.19 87.74 11.82 11.88 11.53 50.40 10.55 10.00 30.21 10.15 25.77 47.25 23.95 28.18 11.93 36922508 HEPATITIS BE ANTIGEN 87350 300 $63.00 23.28 10.00 87.74 11.50 43.53 12.11 43.53 10.00 34.81 11.88 32.06 11.00 10.00 41.70 10.38 11.53 70.19 87.74 11.82 11.88 11.53 50.40 10.55 10.00 30.21 10.15 25.77 47.25 23.95 28.18 11.93 36938579 HEPATITIS BE ANTIGEN 87350 300 $63.00 23.28 10.00 87.74 11.50 43.53 12.11 43.53 10.00 34.81 11.88 32.06 11.00 10.00 41.70 10.38 11.53 70.19 87.74 11.82 11.88 11.53 50.40 10.55 10.00 30.21 10.15 25.77 47.25 23.95 28.18 11.93 36944536 HISTOPLASMA CAPSULATUM 87385 300 $350.00 129.36 - 280.00 - 241.85 13.91 241.85 - 193.38 13.65 33.32 - - 231.67 11.93 13.25 87.13 108.91 13.58 13.65 13.25 280.00 12.12 - 34.72 11.66 143.15 262.50 133.04 156.56 13.71 35710086 HIV AG & AB COMBO 87389 300 $126.00 46.57 21.19 128.86 31.40 87.07 25.28 87.07 27.30 69.62 24.80 66.94 30.03 27.30 83.40 21.67 24.08 103.09 128.86 24.68 24.80 24.08 100.80 22.03 27.30 63.09 21.19 51.53 94.50 47.89 56.36 24.92 36982829 HIV AG/AB 4TH GEN W REFLEX 87389 300 $126.00 46.57 21.19 128.86 31.40 87.07 25.28 87.07 27.30 69.62 24.80 66.94 30.03 27.30 83.40 21.67 24.08 103.09 128.86 24.68 24.80 24.08 100.80 22.03 27.30 63.09 21.19 51.53 94.50 47.89 56.36 24.92 36923644 HIV P24 ANTIGEN EIA QUAL 87390 300 $506.00 187.02 10.50 404.80 12.08 349.65 25.26 349.65 10.50 279.57 24.78 49.05 11.55 10.50 334.92 21.65 24.06 107.50 134.37 24.66 24.78 24.06 404.80 22.01 10.50 63.04 21.17 206.95 379.50 192.33 226.33 24.90 36303051 RAPID RSV EIA QUAL 87420 300 $73.00 26.98 - 92.98 - 50.44 14.61 50.44 - 40.33 14.33 33.32 - - 48.32 12.52 13.91 74.38 92.98 14.26 14.33 13.91 58.40 12.73 - 36.44 12.24 29.86 54.75 27.75 32.65 14.40 36303778 RAPID RSV EIA QUAL 87420 300 $73.00 26.98 - 92.98 - 50.44 14.61 50.44 - 40.33 14.33 33.32 - - 48.32 12.52 13.91 74.38 92.98 14.26 14.33 13.91 58.40 12.73 - 36.44 12.24 29.86 54.75 27.75 32.65 14.40 36302941 ROTAVIRUS ANTIGEN EIA 87425 300 $63.00 23.28 - 92.98 - 43.53 12.58 43.53 - 34.81 12.34 33.32 - - 41.70 10.78 11.98 74.38 92.98 12.28 12.34 11.98 50.40 10.96 - 31.39 10.54 25.77 47.25 23.95 28.18 12.40 36916222 ROTAVIRUS EIA 87425 300 $129.00 47.68 - 103.20 - 89.14 12.58 89.14 - 71.27 12.34 33.32 - - 85.39 10.78 11.98 74.38 92.98 12.28 12.34 11.98 103.20 10.96 - 31.39 10.54 52.76 96.75 49.03 57.70 12.40 35791621 INF AGT AG DETECT IA SARSCOV2 87426 300 $226.00 83.53 - 180.80 40.18 156.17 N/A 156.17 34.94 124.87 N/A 149.16 38.43 N/A 149.59 - N/A 119.76 149.70 N/A N/A N/A 180.80 N/A 34.94 151.42 N/A 92.43 169.50 85.90 101.09 N/A 36104201 LEGIONELLA AG EIA URINE 87449 300 $63.00 23.28 - 86.70 - 43.53 12.58 43.53 - 34.81 12.34 33.32 - - 41.70 10.78 11.98 69.36 86.70 12.28 12.34 11.98 50.40 10.96 - 31.39 10.54 25.77 47.25 23.95 28.18 12.40 36940727 FUNGITELL 87449 300 "$1,159.00" 428.37 - 927.20 - 800.87 12.58 800.87 - 640.35 12.34 33.32 - - 767.14 10.78 11.98 69.36 86.70 12.28 12.34 11.98 927.20 10.96 - 31.39 10.54 474.03 869.25 440.54 518.42 12.40 36944528 INFECT AG DET NOS EIA EA ORG 87449 300 $227.00 83.90 - 181.60 - 156.86 12.58 156.86 - 125.42 12.34 33.32 - - 150.25 10.78 11.98 69.36 86.70 12.28 12.34 11.98 181.60 10.96 - 31.39 10.54 92.84 170.25 86.28 101.54 12.40 36932961 BARTONELLA DNA PCR 87471 300 "$1,168.00" 431.69 30.88 934.40 45.74 807.09 36.84 807.09 39.77 645.32 36.14 97.56 43.75 39.77 773.10 31.58 35.09 213.85 267.31 35.97 36.14 35.09 934.40 32.11 39.77 91.94 30.88 477.71 876.00 443.96 522.45 36.32 36916052 LYME DNA PCR CSF 87476 300 $533.00 197.00 30.88 426.40 45.74 368.30 36.84 368.30 39.77 294.48 36.14 97.56 43.75 39.77 352.79 31.58 35.09 213.85 267.31 35.97 36.14 35.09 426.40 32.11 39.77 91.94 30.88 218.00 399.75 202.59 238.41 36.32 36922419 BORRELIA BURGDORFERI AMPL DNA 87476 300 "$1,515.00" 559.94 30.88 " 1,212.00 " 45.74 " 1,046.87 " 36.84 " 1,046.87 " 39.77 837.04 36.14 97.56 43.75 39.77 " 1,002.78 " 31.58 35.09 213.85 267.31 35.97 36.14 35.09 " 1,212.00 " 32.11 39.77 91.94 30.88 619.64 " 1,136.25 " 575.85 677.66 36.32 36934239 BORRELIA BURG AMP PROBE QUAL 87476 300 "$1,293.00" 477.89 30.88 " 1,034.40 " 45.74 893.46 36.84 893.46 39.77 714.38 36.14 97.56 43.75 39.77 855.84 31.58 35.09 213.85 267.31 35.97 36.14 35.09 " 1,034.40 " 32.11 39.77 91.94 30.88 528.84 969.75 491.47 578.36 36.32 36981091 BORRELIA BURGD AMP PROBE 87476 300 $828.00 306.03 30.88 662.40 45.74 572.15 36.84 572.15 39.77 457.47 36.14 97.56 43.75 39.77 548.05 31.58 35.09 213.85 267.31 35.97 36.14 35.09 662.40 32.11 39.77 91.94 30.88 338.65 621.00 314.72 370.36 36.32 36933127 CANDIDA SP DIRECT PROBE 87480 300 $273.00 100.90 17.64 218.40 26.13 188.64 21.05 188.64 22.72 150.83 20.65 55.77 24.99 22.72 180.70 18.05 20.05 122.18 152.72 20.55 20.65 20.05 218.40 18.35 22.72 52.53 17.64 111.66 204.75 103.77 122.11 20.75 36305118 CANDIDA ALBICANS SPEC AMP PROB 87481 300 $184.00 68.01 30.88 267.31 45.74 127.14 36.84 127.14 39.77 101.66 36.14 97.56 43.75 39.77 121.79 31.58 35.09 213.85 267.31 35.97 36.14 35.09 147.20 32.11 39.77 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36305126 CANDIDA GALBRATA SPEC AMP PROB 87481 300 $184.00 68.01 30.88 267.31 45.74 127.14 36.84 127.14 39.77 101.66 36.14 97.56 43.75 39.77 121.79 31.58 35.09 213.85 267.31 35.97 36.14 35.09 147.20 32.11 39.77 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36303620 C PNEUMONIA DNA AMP PROBE 87486 300 $184.00 68.01 30.88 267.31 45.74 127.14 36.84 127.14 39.77 101.66 36.14 97.56 43.75 39.77 121.79 31.58 35.09 213.85 267.31 35.97 36.14 35.09 147.20 32.11 39.77 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304049 C PNEUMONIA DNA AMP PROBE 87486 300 $184.00 68.01 30.88 267.31 45.74 127.14 36.84 127.14 39.77 101.66 36.14 97.56 43.75 39.77 121.79 31.58 35.09 213.85 267.31 35.97 36.14 35.09 147.20 32.11 39.77 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36923059 CHLAMYDIA PNEU AMPLIFIED PROBE 87486 300 $871.00 321.92 30.88 696.80 45.74 601.86 36.84 601.86 39.77 481.23 36.14 97.56 43.75 39.77 576.51 31.58 35.09 213.85 267.31 35.97 36.14 35.09 696.80 32.11 39.77 91.94 30.88 356.24 653.25 331.07 389.60 36.32 36934247 CHYLMD TRACH DNA DIR PROBE 87490 300 $119.00 43.98 20.02 152.72 26.13 82.23 23.89 82.23 22.72 65.75 23.43 55.77 24.99 22.72 78.77 20.48 22.75 122.18 152.72 23.32 23.43 22.75 95.20 20.82 22.72 59.61 20.02 48.67 89.25 45.23 53.23 23.55 36301686 CHLAMYDIA TRACHOMATIS AMP PROB 87491 300 $184.00 68.01 23.19 267.31 26.67 127.14 36.84 127.14 23.19 101.66 36.14 97.56 25.51 23.19 121.79 31.58 35.09 213.85 267.31 35.97 36.14 35.09 147.20 32.11 23.19 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36928981 CHLAMYDIA TRACH DNA SDA PAP 87491 300 $299.00 110.51 23.19 267.31 26.67 206.61 36.84 206.61 23.19 165.20 36.14 97.56 25.51 23.19 197.91 31.58 35.09 213.85 267.31 35.97 36.14 35.09 239.20 32.11 23.19 91.94 30.88 122.29 224.25 113.65 133.74 36.32 36929511 CHLAMYDIA DNA SDA PAP VIAL 87491 300 $184.00 68.01 23.19 267.31 26.67 127.14 36.84 127.14 23.19 101.66 36.14 97.56 25.51 23.19 121.79 31.58 35.09 213.85 267.31 35.97 36.14 35.09 147.20 32.11 23.19 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36938439 C. TRACHOMATIS RNA AMP PROB 87491 300 $299.00 110.51 23.19 267.31 26.67 206.61 36.84 206.61 23.19 165.20 36.14 97.56 25.51 23.19 197.91 31.58 35.09 213.85 267.31 35.97 36.14 35.09 239.20 32.11 23.19 91.94 30.88 122.29 224.25 113.65 133.74 36.32 36940531 CHLAMYDIA T AMP PROBE ALT TG 87491 300 $184.00 68.01 23.19 267.31 26.67 127.14 36.84 127.14 23.19 101.66 36.14 97.56 25.51 23.19 121.79 31.58 35.09 213.85 267.31 35.97 36.14 35.09 147.20 32.11 23.19 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36303034 C DIFFICILE PCR 87493 300 $196.00 72.44 32.80 277.06 46.25 135.44 39.13 135.44 40.22 108.29 38.39 97.56 44.24 40.22 129.73 33.54 37.27 221.65 277.06 38.20 38.39 37.27 156.80 34.10 40.22 97.65 32.80 80.16 147.00 74.50 87.67 38.57 36303654 C. DIFF AMPLIFIED PROBE 87493 300 $196.00 72.44 32.80 277.06 46.25 135.44 39.13 135.44 40.22 108.29 38.39 97.56 44.24 40.22 129.73 33.54 37.27 221.65 277.06 38.20 38.39 37.27 156.80 34.10 40.22 97.65 32.80 80.16 147.00 74.50 87.67 38.57 36303662 C. DIFF AMPLIFIED PROBE 87493 300 $196.00 72.44 32.80 277.06 46.25 135.44 39.13 135.44 40.22 108.29 38.39 97.56 44.24 40.22 129.73 33.54 37.27 221.65 277.06 38.20 38.39 37.27 156.80 34.10 40.22 97.65 32.80 80.16 147.00 74.50 87.67 38.57 36930411 CMV PCR 87497 300 $468.00 172.97 37.70 374.40 55.82 323.39 44.98 323.39 48.54 258.57 44.13 119.10 53.39 48.54 309.77 38.56 42.84 269.71 337.14 43.91 44.13 42.84 374.40 39.20 48.54 112.24 37.70 191.41 351.00 177.89 209.34 44.34 36944803 CYTOMEGALOVIRUS DNA QNT RT PCR 87497 300 $468.00 172.97 37.70 374.40 55.82 323.39 44.98 323.39 48.54 258.57 44.13 119.10 53.39 48.54 309.77 38.56 42.84 269.71 337.14 43.91 44.13 42.84 374.40 39.20 48.54 112.24 37.70 191.41 351.00 177.89 209.34 44.34 36981610 CMV DNA QUANTITATIVE PCR 87497 300 $468.00 172.97 37.70 374.40 55.82 323.39 44.98 323.39 48.54 258.57 44.13 119.10 53.39 48.54 309.77 38.56 42.84 269.71 337.14 43.91 44.13 42.84 374.40 39.20 48.54 112.24 37.70 191.41 351.00 177.89 209.34 44.34 36303417 ENTEROVIRUS NUC ACID AMP PROBE 87498 300 $184.00 68.01 30.88 270.28 45.11 127.14 36.84 127.14 39.23 101.66 36.14 97.56 43.15 39.23 121.79 31.58 35.09 216.22 270.28 35.97 36.14 35.09 147.20 32.11 39.23 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36930284 ENTEROVIRUS RNA QUAL PCR 87498 300 $827.00 305.66 30.88 661.60 45.11 571.46 36.84 571.46 39.23 456.92 36.14 97.56 43.15 39.23 547.39 31.58 35.09 216.22 270.28 35.97 36.14 35.09 661.60 32.11 39.23 91.94 30.88 338.24 620.25 314.34 369.92 36.32 36944684 ENTEROVIRUS RNA PCR 87498 300 $950.00 351.12 30.88 760.00 45.11 656.45 36.84 656.45 39.23 524.88 36.14 97.56 43.15 39.23 628.81 31.58 35.09 216.22 270.28 35.97 36.14 35.09 760.00 32.11 39.23 91.94 30.88 388.55 712.50 361.10 424.94 36.32 36303671 VANCOMYCIN RESIST PCR (VRE) 87500 300 $184.00 68.01 30.88 270.28 45.11 127.14 36.84 127.14 39.23 101.66 36.14 97.56 43.15 39.23 121.79 31.58 35.09 216.22 270.28 35.97 36.14 35.09 147.20 32.11 39.23 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36998784 INFLUENZA VIRUS A/B 87502 300 $503.00 185.91 84.30 660.00 110.17 347.57 100.59 347.57 95.80 277.91 98.67 236.60 105.38 95.80 332.94 86.22 95.80 528.00 660.00 98.20 98.67 95.80 402.40 87.66 95.80 251.00 84.30 205.73 377.25 191.19 224.99 99.15 36305037 GI PATHOGEN 6-11 TARGETS 87506 300 "$1,381.00" 510.42 - " 1,104.80 " - 954.27 276.14 954.27 - 763.00 270.88 593.40 - - 914.08 236.69 262.99 465.70 582.12 269.56 270.88 262.99 " 1,104.80 " 240.64 - 689.03 231.43 564.83 " 1,035.75 " 524.92 617.72 272.19 36933135 GARDNERELLA VAGINALIS DIR PRB 87510 300 $273.00 100.90 16.04 218.40 18.45 188.64 21.05 188.64 16.04 150.83 20.65 55.77 17.64 16.04 180.70 18.05 20.05 122.18 152.72 20.55 20.65 20.05 218.40 18.35 16.04 52.53 17.64 111.66 204.75 103.77 122.11 20.75 36305096 GARDNERELLA VAGINALIS AMP PRB 87511 300 $184.00 68.01 - 267.31 - 127.14 36.84 127.14 - 101.66 36.14 97.56 - - 121.79 31.58 35.09 213.85 267.31 35.97 36.14 35.09 147.20 32.11 - 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36922893 HEPATITIS B VIRAL DNA QUAL 87516 300 "$1,090.00" 402.86 - 872.00 - 753.19 36.84 753.19 - 602.23 36.14 97.56 - - 721.47 31.58 35.09 213.85 267.31 35.97 36.14 35.09 872.00 32.11 - 91.94 30.88 445.81 817.50 414.31 487.56 36.32 36910631 HEPATITIS B VIRAL LOAD QUANT 87517 300 "$1,084.00" 400.65 37.70 867.20 45.60 749.04 44.98 749.04 39.65 598.91 44.13 119.10 43.62 39.65 717.50 38.56 42.84 269.71 337.14 43.91 44.13 42.84 867.20 39.20 39.65 112.24 37.70 443.36 813.00 412.03 484.87 44.34 35100300 HEPATITIS C RNA QUANTITATIVE 87522 300 $225.00 83.16 37.70 337.14 45.60 155.48 44.98 155.48 39.65 124.31 44.13 119.10 43.62 39.65 148.93 38.56 42.84 269.71 337.14 43.91 44.13 42.84 180.00 39.20 39.65 112.24 37.70 92.03 168.75 85.52 100.64 44.34 35101721 EXPOSURE HCV RNA QUANT 87522 300 $225.00 83.16 37.70 337.14 45.60 155.48 44.98 155.48 39.65 124.31 44.13 119.10 43.62 39.65 148.93 38.56 42.84 269.71 337.14 43.91 44.13 42.84 180.00 39.20 39.65 112.24 37.70 92.03 168.75 85.52 100.64 44.34 35101829 EXPOSURE HCV RNA QUANT 87522 300 $225.00 83.16 37.70 337.14 45.60 155.48 44.98 155.48 39.65 124.31 44.13 119.10 43.62 39.65 148.93 38.56 42.84 269.71 337.14 43.91 44.13 42.84 180.00 39.20 39.65 112.24 37.70 92.03 168.75 85.52 100.64 44.34 35101845 DONOR HCV RNA QUANT 87522 300 $225.00 83.16 37.70 337.14 45.60 155.48 44.98 155.48 39.65 124.31 44.13 119.10 43.62 39.65 148.93 38.56 42.84 269.71 337.14 43.91 44.13 42.84 180.00 39.20 39.65 112.24 37.70 92.03 168.75 85.52 100.64 44.34 36303280 HERPES SIMPLEX PCR 1 87529 300 $184.00 68.01 - 267.31 - 127.14 36.84 127.14 - 101.66 36.14 97.56 - - 121.79 31.58 35.09 213.85 267.31 35.97 36.14 35.09 147.20 32.11 - 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36303298 HERPES SIMPLEX PCR 2 87529 300 $184.00 68.01 - 267.31 - 127.14 36.84 127.14 - 101.66 36.14 97.56 - - 121.79 31.58 35.09 213.85 267.31 35.97 36.14 35.09 147.20 32.11 - 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36303328 VARICELLA ZOSTER PCR 87529 300 $184.00 68.01 - 267.31 - 127.14 36.84 127.14 - 101.66 36.14 97.56 - - 121.79 31.58 35.09 213.85 267.31 35.97 36.14 35.09 147.20 32.11 - 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36303476 HSV AMPLIFIED PROBE 87529 300 $184.00 68.01 - 267.31 - 127.14 36.84 127.14 - 101.66 36.14 97.56 - - 121.79 31.58 35.09 213.85 267.31 35.97 36.14 35.09 147.20 32.11 - 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36303484 HSV AMPLIFIED PROBE 87529 300 $184.00 68.01 - 267.31 - 127.14 36.84 127.14 - 101.66 36.14 97.56 - - 121.79 31.58 35.09 213.85 267.31 35.97 36.14 35.09 147.20 32.11 - 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36930454 HSV 1/2 FLUID PCR QUANT 87530 300 $556.00 205.50 - 444.80 - 384.20 44.98 384.20 - 307.19 44.13 119.10 - - 368.02 38.56 42.84 269.71 337.14 43.91 44.13 42.84 444.80 39.20 - 112.24 37.70 227.40 417.00 211.34 248.70 44.34 36944706 HERPES SIMPLEX VIRUS 1 QNT 87530 300 $405.00 149.69 - 337.14 - 279.86 44.98 279.86 - 223.76 44.13 119.10 - - 268.07 38.56 42.84 269.71 337.14 43.91 44.13 42.84 324.00 39.20 - 112.24 37.70 165.65 303.75 153.94 181.16 44.34 36944714 HERPES SIMPLEX VIRUS 2 QNT 87530 300 $405.00 149.69 - 337.14 - 279.86 44.98 279.86 - 223.76 44.13 119.10 - - 268.07 38.56 42.84 269.71 337.14 43.91 44.13 42.84 324.00 39.20 - 112.24 37.70 165.65 303.75 153.94 181.16 44.34 36938358 CSF HERPES VIRUS 6 DNA QUAN 87533 300 "$1,446.00" 534.44 - " 1,156.80 " - 999.19 43.85 999.19 - 798.92 43.01 116.09 - - 957.11 37.58 41.76 262.83 328.54 42.80 43.01 41.76 " 1,156.80 " 38.21 - 109.41 36.75 591.41 " 1,084.50 " 549.62 646.80 43.22 36982853 HIV-1 RNA QUAL TMA 87535 300 $205.00 75.77 - 267.31 - 141.66 36.84 141.66 - 113.26 36.14 97.56 - - 135.69 31.58 35.09 213.85 267.31 35.97 36.14 35.09 164.00 32.11 - 91.94 30.88 83.85 153.75 77.92 91.70 36.32 35100474 HIV-1 QUANTIFICATION 87536 300 $447.00 165.21 74.89 669.70 133.50 308.88 89.36 308.88 116.09 246.97 87.65 236.60 127.70 116.09 295.87 76.59 85.10 535.76 669.70 87.23 87.65 85.10 357.60 77.87 116.09 222.96 74.89 182.82 335.25 169.90 199.94 88.08 36942894 HIV1 RNA QUANT PCR CSF 87536 300 $475.00 175.56 74.89 669.70 133.50 328.23 89.36 328.23 116.09 262.44 87.65 236.60 127.70 116.09 314.40 76.59 85.10 535.76 669.70 87.23 87.65 85.10 380.00 77.87 116.09 222.96 74.89 194.28 356.25 180.55 212.47 88.08 36940131 NON TB MYCOBACTERIA PCR 87551 300 "$2,074.00" 766.55 - " 1,659.20 " - " 1,433.13 " 50.65 " 1,433.13 " - " 1,145.89 " 49.69 97.56 - - " 1,372.78 " 43.42 48.24 213.85 267.31 49.45 49.69 48.24 " 1,659.20 " 44.14 - 126.39 42.45 848.27 " 1,555.50 " 788.33 927.70 49.93 36940204 MYCOBACTERIA AMP PROBE 87551 300 "$1,725.00" 637.56 - " 1,380.00 " - " 1,191.98 " 50.65 " 1,191.98 " - 953.06 49.69 97.56 - - " 1,141.78 " 43.42 48.24 213.85 267.31 49.45 49.69 48.24 " 1,380.00 " 44.14 - 126.39 42.45 705.53 " 1,293.75 " 655.67 771.59 49.93 36303743 M TUBERCULOSIS AMP PROBE 87556 300 $219.00 80.94 - 267.31 - 151.33 43.76 151.33 - 121.00 42.93 97.56 - - 144.96 37.51 41.68 213.85 267.31 42.72 42.93 41.68 175.20 38.14 - 109.20 36.68 89.57 164.25 83.24 97.96 43.14 36910682 AFB MYCOBACTERIUM TB DNA PCR 87556 300 "$1,950.00" 720.72 - " 1,560.00 " - " 1,347.45 " 43.76 " 1,347.45 " - " 1,077.38 " 42.93 97.56 - - " 1,290.71 " 37.51 41.68 213.85 267.31 42.72 42.93 41.68 " 1,560.00 " 38.14 - 109.20 36.68 797.55 " 1,462.50 " 741.20 872.24 43.14 36940077 MYCO TB COMPLEX PCR 87556 300 "$1,376.00" 508.57 - " 1,100.80 " - 950.82 43.76 950.82 - 760.24 42.93 97.56 - - 910.77 37.51 41.68 213.85 267.31 42.72 42.93 41.68 " 1,100.80 " 38.14 - 109.20 36.68 562.78 " 1,032.00 " 523.02 615.48 43.14 36940212 M TUBERCULOSIS AMP PROBE 87556 300 "$1,726.00" 637.93 - " 1,380.80 " - " 1,192.67 " 43.76 " 1,192.67 " - 953.62 42.93 97.56 - - " 1,142.44 " 37.51 41.68 213.85 267.31 42.72 42.93 41.68 " 1,380.80 " 38.14 - 109.20 36.68 705.93 " 1,294.50 " 656.05 772.04 43.14 36940069 M AVIUM COMPLEX PCR 87561 300 "$1,376.00" 508.57 - " 1,100.80 " - 950.82 36.84 950.82 - 760.24 36.14 97.56 - - 910.77 31.58 35.09 213.85 267.31 35.97 36.14 35.09 " 1,100.80 " 32.11 - 91.94 30.88 562.78 " 1,032.00 " 523.02 615.48 36.32 36303590 MYCO PNEUM AMPLIFIED PROBE 87581 300 $184.00 68.01 - 267.31 - 127.14 36.84 127.14 - 101.66 36.14 97.56 - - 121.79 31.58 35.09 213.85 267.31 35.97 36.14 35.09 147.20 32.11 - 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304057 MYCO PNEUM AMPLIFIED PROBE 87581 300 $184.00 68.01 - 267.31 - 127.14 36.84 127.14 - 101.66 36.14 97.56 - - 121.79 31.58 35.09 213.85 267.31 35.97 36.14 35.09 147.20 32.11 - 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36302399 N GONORRHOEAE AMPLIFIED PROBE 87591 300 $184.00 68.01 23.19 267.31 26.67 127.14 36.84 127.14 23.19 101.66 36.14 97.56 25.51 23.19 121.79 31.58 35.09 213.85 267.31 35.97 36.14 35.09 147.20 32.11 23.19 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36928972 NEISSERIA GONORR DNA SDA PAP 87591 300 $299.00 110.51 23.19 267.31 26.67 206.61 36.84 206.61 23.19 165.20 36.14 97.56 25.51 23.19 197.91 31.58 35.09 213.85 267.31 35.97 36.14 35.09 239.20 32.11 23.19 91.94 30.88 122.29 224.25 113.65 133.74 36.32 36929774 N GONORRHOEAE DNA SDA PAP VIAL 87591 300 $184.00 68.01 23.19 267.31 26.67 127.14 36.84 127.14 23.19 101.66 36.14 97.56 25.51 23.19 121.79 31.58 35.09 213.85 267.31 35.97 36.14 35.09 147.20 32.11 23.19 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36938421 N. GONORRHOEAE RNA AMP PROB 87591 300 $299.00 110.51 23.19 267.31 26.67 206.61 36.84 206.61 23.19 165.20 36.14 97.56 25.51 23.19 197.91 31.58 35.09 213.85 267.31 35.97 36.14 35.09 239.20 32.11 23.19 91.94 30.88 122.29 224.25 113.65 133.74 36.32 36940565 N GONORRHOEAE AMP PROBE ALT TG 87591 300 $184.00 68.01 23.19 267.31 26.67 127.14 36.84 127.14 23.19 101.66 36.14 97.56 25.51 23.19 121.79 31.58 35.09 213.85 267.31 35.97 36.14 35.09 147.20 32.11 23.19 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36301856 HUMAN PAPILLOMA VIRUS PROBE 87624 300 $184.00 68.01 30.88 147.20 43.94 127.14 36.84 127.14 38.21 101.66 36.14 97.56 42.03 38.21 121.79 31.58 35.09 76.58 95.73 35.97 36.14 35.09 147.20 32.11 38.21 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36922729 HPV ANAL HIGH RISK AMP PROBE 87624 300 $254.00 93.88 30.88 203.20 43.94 175.51 36.84 175.51 38.21 140.34 36.14 97.56 42.03 38.21 168.12 31.58 35.09 76.58 95.73 35.97 36.14 35.09 203.20 32.11 38.21 91.94 30.88 103.89 190.50 96.55 113.61 36.32 36939095 HPV TYPE 16 AND 18 87625 300 $213.00 78.72 35.68 170.40 43.94 147.18 42.58 147.18 38.21 117.68 41.77 97.56 42.03 38.21 140.98 36.50 40.55 76.58 95.73 41.56 41.77 40.55 170.40 37.10 38.21 106.24 35.68 87.12 159.75 80.96 95.27 41.97 36303603 RESPIRATORY VIRAL TARG 3-5 87631 300 $749.00 276.83 125.51 599.20 162.23 517.56 149.76 517.56 141.07 413.82 146.91 356.67 155.18 141.07 495.76 128.37 142.63 356.66 445.83 146.20 146.91 142.63 599.20 130.51 141.07 373.69 125.51 306.34 561.75 284.69 335.03 147.62 36303611 RESPIRATORY VIRAL TARG 12-25 87633 300 "$2,188.00" 808.68 366.77 " 1,750.40 " 527.08 " 1,511.91 " 437.62 " 1,511.91 " 458.33 " 1,208.87 " 429.28 " 1,158.79 " 504.16 458.33 " 1,448.24 " 375.10 416.78 " 1,158.74 " " 1,448.42 " 427.20 429.28 416.78 " 1,750.40 " 381.35 458.33 " 1,091.96 " 366.77 894.89 " 1,641.00 " 831.66 978.69 431.37 36304065 RESPIRATORY VIRAL TARG 12-25 87633 300 "$2,188.00" 808.68 366.77 " 1,750.40 " 527.08 " 1,511.91 " 437.62 " 1,511.91 " 458.33 " 1,208.87 " 429.28 " 1,158.79 " 504.16 458.33 " 1,448.24 " 375.10 416.78 " 1,158.74 " " 1,448.42 " 427.20 429.28 416.78 " 1,750.40 " 381.35 458.33 " 1,091.96 " 366.77 894.89 " 1,641.00 " 831.66 978.69 431.37 36305151 INF AGT NOS AMP PRB 2019 NCOV 87635 300 $106.00 39.18 35.49 84.80 40.81 73.25 53.88 73.25 35.49 58.57 52.85 69.96 39.04 35.49 70.16 46.18 51.31 56.17 70.21 52.59 52.85 51.31 84.80 46.95 35.49 71.02 45.15 43.35 79.50 40.29 47.41 53.11 36982543 INF AGT AMP PRB 2019 NCOV REF 87635 300 $106.00 39.18 35.49 84.80 40.81 73.25 53.88 73.25 35.49 58.57 52.85 69.96 39.04 35.49 70.16 46.18 51.31 56.17 70.21 52.59 52.85 51.31 84.80 46.95 35.49 71.02 45.15 43.35 79.50 40.29 47.41 53.11 36303841 STAPH AUREUS AMP PROBE 87640 300 $184.00 68.01 30.88 270.28 45.11 127.14 36.84 127.14 39.23 101.66 36.14 97.56 43.15 39.23 121.79 31.58 35.09 216.22 270.28 35.97 36.14 35.09 147.20 32.11 39.23 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36302801 MRSA ADMISSION SCREEN 87641 300 $184.00 68.01 30.88 270.28 45.11 127.14 36.84 127.14 39.23 101.66 36.14 97.56 43.15 39.23 121.79 31.58 35.09 216.22 270.28 35.97 36.14 35.09 147.20 32.11 39.23 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36303646 MRSA AMPLIFIED PROBE 87641 300 $184.00 68.01 30.88 270.28 45.11 127.14 36.84 127.14 39.23 101.66 36.14 97.56 43.15 39.23 121.79 31.58 35.09 216.22 270.28 35.97 36.14 35.09 147.20 32.11 39.23 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36303859 MRSA AMP PROBE 87641 300 $184.00 68.01 30.88 270.28 45.11 127.14 36.84 127.14 39.23 101.66 36.14 97.56 43.15 39.23 121.79 31.58 35.09 216.22 270.28 35.97 36.14 35.09 147.20 32.11 39.23 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36300728 MOLECULAR PROBE-GROUP A STREP 87650 300 $105.00 38.81 - 152.72 - 72.56 21.05 72.56 - 58.01 20.65 55.77 - - 69.50 18.05 20.05 122.18 152.72 20.55 20.65 20.05 84.00 18.35 - 52.53 17.64 42.95 78.75 39.91 46.97 20.75 36303760 GROUP A STREP PCR AMP PROBE 87651 300 $184.00 68.01 - 267.31 - 127.14 36.84 127.14 - 101.66 36.14 97.56 - - 121.79 31.58 35.09 213.85 267.31 35.97 36.14 35.09 147.20 32.11 - 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36301929 STREP GRP B AMPLIFIED PROBE 87653 300 $184.00 68.01 30.88 270.28 45.11 127.14 36.84 127.14 39.23 101.66 36.14 97.56 43.15 39.23 121.79 31.58 35.09 216.22 270.28 35.97 36.14 35.09 147.20 32.11 39.23 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36933143 TRICHOMONAS VAGINALIS DIR PRB 87660 300 $273.00 100.90 17.64 218.40 25.78 188.64 21.05 188.64 22.42 150.83 20.65 55.77 24.66 22.42 180.70 18.05 20.05 127.65 159.56 20.55 20.65 20.05 218.40 18.35 22.42 52.53 17.64 111.66 204.75 103.77 122.11 20.75 36303701 TRICH VAG AMPLIFIED PROBE 87661 300 $184.00 68.01 30.88 147.20 44.05 127.14 36.84 127.14 38.30 101.66 36.14 97.56 42.13 38.30 121.79 31.58 35.09 83.78 104.72 35.97 36.14 35.09 147.20 32.11 38.30 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36305100 TRICHOMONAS VAGINALIS AMP PRB 87661 300 $184.00 68.01 30.88 147.20 44.05 127.14 36.84 127.14 38.30 101.66 36.14 97.56 42.13 38.30 121.79 31.58 35.09 83.78 104.72 35.97 36.14 35.09 147.20 32.11 38.30 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36938633 T VAGINALIS MALES 87661 300 $496.00 183.32 30.88 396.80 44.05 342.74 36.84 342.74 38.30 274.04 36.14 97.56 42.13 38.30 328.30 31.58 35.09 83.78 104.72 35.97 36.14 35.09 396.80 32.11 38.30 91.94 30.88 202.86 372.00 188.53 221.86 36.32 36941324 ZIKA PCR URINE 87662 300 $433.00 160.04 45.15 349.15 58.28 299.20 53.88 299.20 50.68 239.23 52.85 285.78 55.75 50.68 286.60 46.18 51.31 279.32 349.15 52.59 52.85 51.31 346.40 46.95 50.68 134.43 45.15 177.10 324.75 164.58 193.68 53.11 36941332 ZIKA PCR SERUM 87662 300 $433.00 160.04 45.15 349.15 58.28 299.20 53.88 299.20 50.68 239.23 52.85 285.78 55.75 50.68 286.60 46.18 51.31 279.32 349.15 52.59 52.85 51.31 346.40 46.95 50.68 134.43 45.15 177.10 324.75 164.58 193.68 53.11 36944846 ZIKA VIRUS RNA QUAL RT PCR 87662 300 "$1,531.00" 565.86 45.15 " 1,224.80 " 58.28 " 1,057.92 " 53.88 " 1,057.92 " 50.68 845.88 52.85 " 1,010.46 " 55.75 50.68 " 1,013.37 " 46.18 51.31 279.32 349.15 52.59 52.85 51.31 " 1,224.80 " 46.95 50.68 134.43 45.15 626.18 " 1,148.25 " 581.93 684.82 53.11 36944854 ZIKA RNA QUAL RT PCR SERUM 87662 300 "$1,342.00" 496.00 45.15 " 1,073.60 " 58.28 927.32 53.88 927.32 50.68 741.46 52.85 885.72 55.75 50.68 888.27 46.18 51.31 279.32 349.15 52.59 52.85 51.31 " 1,073.60 " 46.95 50.68 134.43 45.15 548.88 " 1,006.50 " 510.09 600.28 53.11 36944862 ZIKA RNA QUAL RT PCR URINE 87662 300 "$1,342.00" 496.00 45.15 " 1,073.60 " 58.28 927.32 53.88 927.32 50.68 741.46 52.85 885.72 55.75 50.68 888.27 46.18 51.31 279.32 349.15 52.59 52.85 51.31 " 1,073.60 " 46.95 50.68 134.43 45.15 548.88 " 1,006.50 " 510.09 600.28 53.11 36303158 AMPLIFIED PROBE EACH ORGANISM 87798 300 $184.00 68.01 23.19 267.31 26.67 127.14 36.84 127.14 23.19 101.66 36.14 97.56 25.51 23.19 121.79 31.58 35.09 213.85 267.31 35.97 36.14 35.09 147.20 32.11 23.19 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36303468 VZV PCR AMP PROBE 87798 300 $184.00 68.01 23.19 267.31 26.67 127.14 36.84 127.14 23.19 101.66 36.14 97.56 25.51 23.19 121.79 31.58 35.09 213.85 267.31 35.97 36.14 35.09 147.20 32.11 23.19 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36303492 AMPLIFIED PROBE EACH ORG 87798 300 $184.00 68.01 23.19 267.31 26.67 127.14 36.84 127.14 23.19 101.66 36.14 97.56 25.51 23.19 121.79 31.58 35.09 213.85 267.31 35.97 36.14 35.09 147.20 32.11 23.19 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36303549 AMPLIFIED PROBE EACH ORGANISM 87798 300 $184.00 68.01 23.19 267.31 26.67 127.14 36.84 127.14 23.19 101.66 36.14 97.56 25.51 23.19 121.79 31.58 35.09 213.85 267.31 35.97 36.14 35.09 147.20 32.11 23.19 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36303751 AMPLIFIED PROBE TECHNIQUE 87798 300 $184.00 68.01 23.19 267.31 26.67 127.14 36.84 127.14 23.19 101.66 36.14 97.56 25.51 23.19 121.79 31.58 35.09 213.85 267.31 35.97 36.14 35.09 147.20 32.11 23.19 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36304031 AMP PROBE EA ORG B PERTUSSIS 87798 300 $184.00 68.01 23.19 267.31 26.67 127.14 36.84 127.14 23.19 101.66 36.14 97.56 25.51 23.19 121.79 31.58 35.09 213.85 267.31 35.97 36.14 35.09 147.20 32.11 23.19 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36305061 AMP PRB EA ORG B PARAPERTUSSIS 87798 300 $184.00 68.01 23.19 267.31 26.67 127.14 36.84 127.14 23.19 101.66 36.14 97.56 25.51 23.19 121.79 31.58 35.09 213.85 267.31 35.97 36.14 35.09 147.20 32.11 23.19 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36910640 PARVOVIRUS B19 DNA PCR 87798 300 "$1,388.00" 513.00 23.19 " 1,110.40 " 26.67 959.11 36.84 959.11 23.19 766.87 36.14 97.56 25.51 23.19 918.72 31.58 35.09 213.85 267.31 35.97 36.14 35.09 " 1,110.40 " 32.11 23.19 91.94 30.88 567.69 " 1,041.00 " 527.58 620.85 36.32 36919434 EBV(EPSTEIN-BARR VIRUS)DNA PCR 87798 300 "$1,723.00" 636.82 23.19 " 1,378.40 " 26.67 " 1,190.59 " 36.84 " 1,190.59 " 23.19 951.96 36.14 97.56 25.51 23.19 " 1,140.45 " 31.58 35.09 213.85 267.31 35.97 36.14 35.09 " 1,378.40 " 32.11 23.19 91.94 30.88 704.71 " 1,292.25 " 654.91 770.70 36.32 36930292 B. PERTUSSIS DNA PCR 87798 300 $606.00 223.98 23.19 484.80 26.67 418.75 36.84 418.75 23.19 334.82 36.14 97.56 25.51 23.19 401.11 31.58 35.09 213.85 267.31 35.97 36.14 35.09 484.80 32.11 23.19 91.94 30.88 247.85 454.50 230.34 271.06 36.32 36930306 B. PARAPERTUSSIS DNA PCR 87798 300 $606.00 223.98 23.19 484.80 26.67 418.75 36.84 418.75 23.19 334.82 36.14 97.56 25.51 23.19 401.11 31.58 35.09 213.85 267.31 35.97 36.14 35.09 484.80 32.11 23.19 91.94 30.88 247.85 454.50 230.34 271.06 36.32 36934450 WEST NILE VIRUS RNA- AMP PRB 87798 300 "$1,505.00" 556.25 23.19 " 1,204.00 " 26.67 " 1,039.96 " 36.84 " 1,039.96 " 23.19 831.51 36.14 97.56 25.51 23.19 996.16 31.58 35.09 213.85 267.31 35.97 36.14 35.09 " 1,204.00 " 32.11 23.19 91.94 30.88 615.55 " 1,128.75 " 572.05 673.19 36.32 36940093 ASPER FUMIGATUS PCR 87798 300 "$2,659.00" 982.77 23.19 " 2,127.20 " 26.67 " 1,837.37 " 36.84 " 1,837.37 " 23.19 " 1,469.10 " 36.14 97.56 25.51 23.19 " 1,759.99 " 31.58 35.09 213.85 267.31 35.97 36.14 35.09 " 2,127.20 " 32.11 23.19 91.94 30.88 " 1,087.53 " " 1,994.25 " " 1,010.69 " " 1,189.37 " 36.32 36940883 LEPTOSPIRA DNA PCR 87798 300 "$1,507.00" 556.99 23.19 " 1,205.60 " 26.67 " 1,041.34 " 36.84 " 1,041.34 " 23.19 832.62 36.14 97.56 25.51 23.19 997.48 31.58 35.09 213.85 267.31 35.97 36.14 35.09 " 1,205.60 " 32.11 23.19 91.94 30.88 616.36 " 1,130.25 " 572.81 674.08 36.32 36942355 WEST NILE VIRUS AMP PROBE 87798 300 $184.00 68.01 23.19 267.31 26.67 127.14 36.84 127.14 23.19 101.66 36.14 97.56 25.51 23.19 121.79 31.58 35.09 213.85 267.31 35.97 36.14 35.09 147.20 32.11 23.19 91.94 30.88 75.26 138.00 69.94 82.30 36.32 36943785 INFECT AGENT NOS AMP PROBE 87798 300 $685.00 253.18 23.19 548.00 26.67 473.34 36.84 473.34 23.19 378.46 36.14 97.56 25.51 23.19 453.40 31.58 35.09 213.85 267.31 35.97 36.14 35.09 548.00 32.11 23.19 91.94 30.88 280.17 513.75 260.37 306.40 36.32 36943793 INFECT AGENT NOS AMP PROBE 87798 300 $685.00 253.18 23.19 548.00 26.67 473.34 36.84 473.34 23.19 378.46 36.14 97.56 25.51 23.19 453.40 31.58 35.09 213.85 267.31 35.97 36.14 35.09 548.00 32.11 23.19 91.94 30.88 280.17 513.75 260.37 306.40 36.32 36943807 INFECT AGENT NOS AMP PROBE 87798 300 $685.00 253.18 23.19 548.00 26.67 473.34 36.84 473.34 23.19 378.46 36.14 97.56 25.51 23.19 453.40 31.58 35.09 213.85 267.31 35.97 36.14 35.09 548.00 32.11 23.19 91.94 30.88 280.17 513.75 260.37 306.40 36.32 36943815 INFECT AGENT NOS AMP PROBE 87798 300 $685.00 253.18 23.19 548.00 26.67 473.34 36.84 473.34 23.19 378.46 36.14 97.56 25.51 23.19 453.40 31.58 35.09 213.85 267.31 35.97 36.14 35.09 548.00 32.11 23.19 91.94 30.88 280.17 513.75 260.37 306.40 36.32 36944447 INFECT AGT NOS DNA AMP EA ORG 87798 300 "$1,051.00" 388.45 23.19 840.80 26.67 726.24 36.84 726.24 23.19 580.68 36.14 97.56 25.51 23.19 695.66 31.58 35.09 213.85 267.31 35.97 36.14 35.09 840.80 32.11 23.19 91.94 30.88 429.86 788.25 399.49 470.11 36.32 36944510 INFECT AGT NOS DNA AMP EACH 87798 300 $677.00 250.22 23.19 541.60 26.67 467.81 36.84 467.81 23.19 374.04 36.14 97.56 25.51 23.19 448.11 31.58 35.09 213.85 267.31 35.97 36.14 35.09 541.60 32.11 23.19 91.94 30.88 276.89 507.75 257.33 302.82 36.32 36982527 A PHAGOCYT INF AMP PROB EA NOS 87798 300 $279.00 103.12 23.19 267.31 26.67 192.79 36.84 192.79 23.19 154.15 36.14 97.56 25.51 23.19 184.67 31.58 35.09 213.85 267.31 35.97 36.14 35.09 223.20 32.11 23.19 91.94 30.88 114.11 209.25 106.05 124.80 36.32 36922109 BK VIRUS DNA QUANT PCR 87799 300 "$1,722.00" 636.45 - " 1,377.60 " - " 1,189.90 " 44.98 " 1,189.90 " - 951.41 44.13 119.10 - - " 1,139.79 " 38.56 42.84 269.71 337.14 43.91 44.13 42.84 " 1,377.60 " 39.20 - 112.24 37.70 704.30 " 1,291.50 " 654.53 770.25 44.34 36926724 BK VIRUS DNA PCR QUANT URINE 87799 300 "$1,722.00" 636.45 - " 1,377.60 " - " 1,189.90 " 44.98 " 1,189.90 " - 951.41 44.13 119.10 - - " 1,139.79 " 38.56 42.84 269.71 337.14 43.91 44.13 42.84 " 1,377.60 " 39.20 - 112.24 37.70 704.30 " 1,291.50 " 654.53 770.25 44.34 36930136 EPSTEIN BARR VIRUS DNA QNT PCR 87799 300 "$1,722.00" 636.45 - " 1,377.60 " - " 1,189.90 " 44.98 " 1,189.90 " - 951.41 44.13 119.10 - - " 1,139.79 " 38.56 42.84 269.71 337.14 43.91 44.13 42.84 " 1,377.60 " 39.20 - 112.24 37.70 704.30 " 1,291.50 " 654.53 770.25 44.34 36930225 JC POLYOMA VIRUS DNA PCR QNT 87799 300 "$1,722.00" 636.45 - " 1,377.60 " - " 1,189.90 " 44.98 " 1,189.90 " - 951.41 44.13 119.10 - - " 1,139.79 " 38.56 42.84 269.71 337.14 43.91 44.13 42.84 " 1,377.60 " 39.20 - 112.24 37.70 704.30 " 1,291.50 " 654.53 770.25 44.34 36930349 ENTEROVIRUS PCR PLASMA 87799 300 "$1,722.00" 636.45 - " 1,377.60 " - " 1,189.90 " 44.98 " 1,189.90 " - 951.41 44.13 119.10 - - " 1,139.79 " 38.56 42.84 269.71 337.14 43.91 44.13 42.84 " 1,377.60 " 39.20 - 112.24 37.70 704.30 " 1,291.50 " 654.53 770.25 44.34 36930357 PARVO B19 PCR PLASMA 87799 300 "$1,722.00" 636.45 - " 1,377.60 " - " 1,189.90 " 44.98 " 1,189.90 " - 951.41 44.13 119.10 - - " 1,139.79 " 38.56 42.84 269.71 337.14 43.91 44.13 42.84 " 1,377.60 " 39.20 - 112.24 37.70 704.30 " 1,291.50 " 654.53 770.25 44.34 36930373 BK VIRUS PCR 87799 300 "$1,722.00" 636.45 - " 1,377.60 " - " 1,189.90 " 44.98 " 1,189.90 " - 951.41 44.13 119.10 - - " 1,139.79 " 38.56 42.84 269.71 337.14 43.91 44.13 42.84 " 1,377.60 " 39.20 - 112.24 37.70 704.30 " 1,291.50 " 654.53 770.25 44.34 36930381 JC VIRUS PCR 87799 300 "$1,722.00" 636.45 - " 1,377.60 " - " 1,189.90 " 44.98 " 1,189.90 " - 951.41 44.13 119.10 - - " 1,139.79 " 38.56 42.84 269.71 337.14 43.91 44.13 42.84 " 1,377.60 " 39.20 - 112.24 37.70 704.30 " 1,291.50 " 654.53 770.25 44.34 36930390 JC VIRUS URINE 87799 300 "$1,722.00" 636.45 - " 1,377.60 " - " 1,189.90 " 44.98 " 1,189.90 " - 951.41 44.13 119.10 - - " 1,139.79 " 38.56 42.84 269.71 337.14 43.91 44.13 42.84 " 1,377.60 " 39.20 - 112.24 37.70 704.30 " 1,291.50 " 654.53 770.25 44.34 36930403 EBV PCR CSF 87799 300 "$1,722.00" 636.45 - " 1,377.60 " - " 1,189.90 " 44.98 " 1,189.90 " - 951.41 44.13 119.10 - - " 1,139.79 " 38.56 42.84 269.71 337.14 43.91 44.13 42.84 " 1,377.60 " 39.20 - 112.24 37.70 704.30 " 1,291.50 " 654.53 770.25 44.34 36930420 ADENOVIRUS PCR 87799 300 "$1,722.00" 636.45 - " 1,377.60 " - " 1,189.90 " 44.98 " 1,189.90 " - 951.41 44.13 119.10 - - " 1,139.79 " 38.56 42.84 269.71 337.14 43.91 44.13 42.84 " 1,377.60 " 39.20 - 112.24 37.70 704.30 " 1,291.50 " 654.53 770.25 44.34 36930438 VZV PCR PLASMA 87799 300 "$1,722.00" 636.45 - " 1,377.60 " - " 1,189.90 " 44.98 " 1,189.90 " - 951.41 44.13 119.10 - - " 1,139.79 " 38.56 42.84 269.71 337.14 43.91 44.13 42.84 " 1,377.60 " 39.20 - 112.24 37.70 704.30 " 1,291.50 " 654.53 770.25 44.34 36930446 VARICELLA ZOSTER PCR 87799 300 "$1,722.00" 636.45 - " 1,377.60 " - " 1,189.90 " 44.98 " 1,189.90 " - 951.41 44.13 119.10 - - " 1,139.79 " 38.56 42.84 269.71 337.14 43.91 44.13 42.84 " 1,377.60 " 39.20 - 112.24 37.70 704.30 " 1,291.50 " 654.53 770.25 44.34 36931922 TOXOPLASMA GONDII PCR CSF 87799 300 "$1,722.00" 636.45 - " 1,377.60 " - " 1,189.90 " 44.98 " 1,189.90 " - 951.41 44.13 119.10 - - " 1,139.79 " 38.56 42.84 269.71 337.14 43.91 44.13 42.84 " 1,377.60 " 39.20 - 112.24 37.70 704.30 " 1,291.50 " 654.53 770.25 44.34 36938340 JCV ULTRASENSITIVE DNA PCR QNT 87799 300 "$1,722.00" 636.45 - " 1,377.60 " - " 1,189.90 " 44.98 " 1,189.90 " - 951.41 44.13 119.10 - - " 1,139.79 " 38.56 42.84 269.71 337.14 43.91 44.13 42.84 " 1,377.60 " 39.20 - 112.24 37.70 704.30 " 1,291.50 " 654.53 770.25 44.34 36944692 JC POLYOMA VIRUS DNA 87799 300 "$1,722.00" 636.45 - " 1,377.60 " - " 1,189.90 " 44.98 " 1,189.90 " - 951.41 44.13 119.10 - - " 1,139.79 " 38.56 42.84 269.71 337.14 43.91 44.13 42.84 " 1,377.60 " 39.20 - 112.24 37.70 704.30 " 1,291.50 " 654.53 770.25 44.34 36944722 TOXOPLASMA GONDII DNA QNT EA 87799 300 "$1,722.00" 636.45 - " 1,377.60 " - " 1,189.90 " 44.98 " 1,189.90 " - 951.41 44.13 119.10 - - " 1,139.79 " 38.56 42.84 269.71 337.14 43.91 44.13 42.84 " 1,377.60 " 39.20 - 112.24 37.70 704.30 " 1,291.50 " 654.53 770.25 44.34 36944757 BK VIRUS DNA QNT RT PCR URINE 87799 300 "$1,722.00" 636.45 - " 1,377.60 " - " 1,189.90 " 44.98 " 1,189.90 " - 951.41 44.13 119.10 - - " 1,139.79 " 38.56 42.84 269.71 337.14 43.91 44.13 42.84 " 1,377.60 " 39.20 - 112.24 37.70 704.30 " 1,291.50 " 654.53 770.25 44.34 36944765 PARVOVIRUS B19 DNA QNT PCR 87799 300 "$1,722.00" 636.45 - " 1,377.60 " - " 1,189.90 " 44.98 " 1,189.90 " - 951.41 44.13 119.10 - - " 1,139.79 " 38.56 42.84 269.71 337.14 43.91 44.13 42.84 " 1,377.60 " 39.20 - 112.24 37.70 704.30 " 1,291.50 " 654.53 770.25 44.34 36944773 JC POLY VIR DNA QT RT PCR URN 87799 300 "$1,722.00" 636.45 - " 1,377.60 " - " 1,189.90 " 44.98 " 1,189.90 " - 951.41 44.13 119.10 - - " 1,139.79 " 38.56 42.84 269.71 337.14 43.91 44.13 42.84 " 1,377.60 " 39.20 - 112.24 37.70 704.30 " 1,291.50 " 654.53 770.25 44.34 36944781 BK VIRUS DNA QNT RT PCR CSF 87799 300 "$1,722.00" 636.45 - " 1,377.60 " - " 1,189.90 " 44.98 " 1,189.90 " - 951.41 44.13 119.10 - - " 1,139.79 " 38.56 42.84 269.71 337.14 43.91 44.13 42.84 " 1,377.60 " 39.20 - 112.24 37.70 704.30 " 1,291.50 " 654.53 770.25 44.34 36944790 ADENOVIRUS DNA QNT RT PCR 87799 300 $995.00 367.75 - 796.00 - 687.55 44.98 687.55 - 549.74 44.13 119.10 - - 658.59 38.56 42.84 269.71 337.14 43.91 44.13 42.84 796.00 39.20 - 112.24 37.70 406.96 746.25 378.20 445.06 44.34 36944811 EBV DNA QUANT RT PCR 87799 300 "$1,722.00" 636.45 - " 1,377.60 " - " 1,189.90 " 44.98 " 1,189.90 " - 951.41 44.13 119.10 - - " 1,139.79 " 38.56 42.84 269.71 337.14 43.91 44.13 42.84 " 1,377.60 " 39.20 - 112.24 37.70 704.30 " 1,291.50 " 654.53 770.25 44.34 36944820 VARICELLA ZOSTER DNA QT RT PCR 87799 300 $795.00 293.83 - 636.00 - 549.35 44.98 549.35 - 439.24 44.13 119.10 - - 526.21 38.56 42.84 269.71 337.14 43.91 44.13 42.84 636.00 39.20 - 112.24 37.70 325.16 596.25 302.18 355.60 44.34 36944838 JC POLYOMA DNA QNT RT PCR S/P 87799 300 "$1,722.00" 636.45 - " 1,377.60 " - " 1,189.90 " 44.98 " 1,189.90 " - 951.41 44.13 119.10 - - " 1,139.79 " 38.56 42.84 269.71 337.14 43.91 44.13 42.84 " 1,377.60 " 39.20 - 112.24 37.70 704.30 " 1,291.50 " 654.53 770.25 44.34 36944889 BK VIRUS DNA QNT RT PCR PLASMA 87799 300 "$1,722.00" 636.45 - " 1,377.60 " - " 1,189.90 " 44.98 " 1,189.90 " - 951.41 44.13 119.10 - - " 1,139.79 " 38.56 42.84 269.71 337.14 43.91 44.13 42.84 " 1,377.60 " 39.20 - 112.24 37.70 704.30 " 1,291.50 " 654.53 770.25 44.34 36923300 CHLAMYDIA/GC DIRECT PROBE 87800 300 $229.00 84.64 22.17 183.20 25.50 158.24 45.85 158.24 22.17 126.52 44.98 111.53 24.39 22.17 151.58 39.30 43.67 126.23 157.79 44.76 44.98 43.67 183.20 39.96 22.17 114.42 38.43 93.66 171.75 87.04 102.43 45.20 36936061 TICK AGENT DETECT AMPL PROBE 87801 300 "$1,293.00" 477.89 38.80 " 1,034.40 " 44.62 893.46 73.71 893.46 38.80 714.38 72.31 195.15 42.68 38.80 855.84 63.18 70.20 220.99 276.24 71.96 72.31 70.20 " 1,034.40 " 64.23 38.80 183.92 61.78 528.84 969.75 491.47 578.36 72.66 36936070 LYME BLD AGENT DETECT AMPL PRB 87801 300 $828.00 306.03 38.80 662.40 44.62 572.15 73.71 572.15 38.80 457.47 72.31 195.15 42.68 38.80 548.05 63.18 70.20 220.99 276.24 71.96 72.31 70.20 662.40 64.23 38.80 183.92 61.78 338.65 621.00 314.72 370.36 72.66 36936088 LYME FLD AGENT DETECT AMPL PRB 87801 300 "$1,189.00" 439.45 38.80 951.20 44.62 821.60 73.71 821.60 38.80 656.92 72.31 195.15 42.68 38.80 787.00 63.18 70.20 220.99 276.24 71.96 72.31 70.20 951.20 64.23 38.80 183.92 61.78 486.30 891.75 451.94 531.84 72.66 36940042 FUNGAL DETECTION PCR 87801 300 "$3,054.00" " 1,128.76 " 38.80 " 2,443.20 " 44.62 " 2,110.31 " 73.71 " 2,110.31 " 38.80 " 1,687.34 " 72.31 195.15 42.68 38.80 " 2,021.44 " 63.18 70.20 220.99 276.24 71.96 72.31 70.20 " 2,443.20 " 64.23 38.80 183.92 61.78 " 1,249.09 " " 2,290.50 " " 1,160.83 " " 1,366.05 " 72.66 36940085 HISTOPLASMA SP PCR 87801 300 "$1,925.00" 711.48 38.80 " 1,540.00 " 44.62 " 1,330.18 " 73.71 " 1,330.18 " 38.80 " 1,063.56 " 72.31 195.15 42.68 38.80 " 1,274.16 " 63.18 70.20 220.99 276.24 71.96 72.31 70.20 " 1,540.00 " 64.23 38.80 183.92 61.78 787.33 " 1,443.75 " 731.69 861.05 72.66 36940123 CRYPTOCOCCUS PCR 87801 300 "$1,925.00" 711.48 38.80 " 1,540.00 " 44.62 " 1,330.18 " 73.71 " 1,330.18 " 38.80 " 1,063.56 " 72.31 195.15 42.68 38.80 " 1,274.16 " 63.18 70.20 220.99 276.24 71.96 72.31 70.20 " 1,540.00 " 64.23 38.80 183.92 61.78 787.33 " 1,443.75 " 731.69 861.05 72.66 36940221 AMPLIFIED PROBE PCR 87801 300 "$4,368.00" " 1,614.41 " 38.80 " 3,494.40 " 44.62 " 3,018.29 " 73.71 " 3,018.29 " 38.80 " 2,413.32 " 72.31 195.15 42.68 38.80 " 2,891.18 " 63.18 70.20 220.99 276.24 71.96 72.31 70.20 " 3,494.40 " 64.23 38.80 183.92 61.78 " 1,786.51 " " 3,276.00 " " 1,660.28 " " 1,953.81 " 72.66 36940239 AMPLIFIED PROBE PCR 87801 300 "$4,369.00" " 1,614.78 " 38.80 " 3,495.20 " 44.62 " 3,018.98 " 73.71 " 3,018.98 " 38.80 " 2,413.87 " 72.31 195.15 42.68 38.80 " 2,891.84 " 63.18 70.20 220.99 276.24 71.96 72.31 70.20 " 3,495.20 " 64.23 38.80 183.92 61.78 " 1,786.92 " " 3,276.75 " " 1,660.66 " " 1,954.25 " 72.66 36940255 ZYGOMYCETE DETECTION PCR 87801 300 "$1,925.00" 711.48 38.80 " 1,540.00 " 44.62 " 1,330.18 " 73.71 " 1,330.18 " 38.80 " 1,063.56 " 72.31 195.15 42.68 38.80 " 1,274.16 " 63.18 70.20 220.99 276.24 71.96 72.31 70.20 " 1,540.00 " 64.23 38.80 183.92 61.78 787.33 " 1,443.75 " 731.69 861.05 72.66 36942347 HIV-1/HCV/HBV (NAT) AMP PROBE 87801 300 "$1,189.00" 439.45 38.80 951.20 44.62 821.60 73.71 821.60 38.80 656.92 72.31 195.15 42.68 38.80 787.00 63.18 70.20 220.99 276.24 71.96 72.31 70.20 951.20 64.23 38.80 183.92 61.78 486.30 891.75 451.94 531.84 72.66 36943823 INFECT AGENT MULT AMP PROBE 87801 300 "$1,366.00" 504.87 38.80 " 1,092.80 " 44.62 943.91 73.71 943.91 38.80 754.72 72.31 195.15 42.68 38.80 904.16 63.18 70.20 220.99 276.24 71.96 72.31 70.20 " 1,092.80 " 64.23 38.80 183.92 61.78 558.69 " 1,024.50 " 519.22 611.01 72.66 35290613 INF AGT AG IA DIRECT OPT FLU A 87804 300 $87.00 32.16 11.35 86.70 13.05 60.12 17.38 60.12 11.35 48.07 17.05 33.32 12.49 11.35 57.59 14.90 16.55 69.36 86.70 16.96 17.05 16.55 69.60 15.14 11.35 43.36 14.56 35.58 65.25 33.07 38.92 17.13 35290621 INF AGT AG IA DIRECT OPT FLU B 87804 300 $87.00 32.16 11.35 86.70 13.05 60.12 17.38 60.12 11.35 48.07 17.05 33.32 12.49 11.35 57.59 14.90 16.55 69.36 86.70 16.96 17.05 16.55 69.60 15.14 11.35 43.36 14.56 35.58 65.25 33.07 38.92 17.13 36301139 RESP SYNCYTIAL VIRUS EIA 87807 300 $69.00 25.50 11.53 87.63 14.16 47.68 13.76 47.68 12.31 38.12 13.49 33.32 13.54 12.31 45.67 11.79 13.10 70.10 87.63 13.43 13.49 13.10 55.20 11.99 12.31 34.32 11.53 28.22 51.75 26.23 30.86 13.56 36303832 RESP SYNCYTIAL VIRUS EIA 87807 300 $69.00 25.50 11.53 87.63 14.16 47.68 13.76 47.68 12.31 38.12 13.49 33.32 13.54 12.31 45.67 11.79 13.10 70.10 87.63 13.43 13.49 13.10 55.20 11.99 12.31 34.32 11.53 28.22 51.75 26.23 30.86 13.56 35200215 RAPID GRP A STREP 87880 300 $87.00 32.16 6.30 69.60 7.25 60.12 17.36 60.12 6.30 48.07 17.03 33.32 6.93 6.30 57.59 14.88 16.53 37.74 47.18 16.94 17.03 16.53 69.60 15.12 6.30 43.31 14.55 35.58 65.25 33.07 38.92 17.11 36300558 RAPID SCREEN GRP A STREP 87880 300 $87.00 32.16 6.30 69.60 7.25 60.12 17.36 60.12 6.30 48.07 17.03 33.32 6.93 6.30 57.59 14.88 16.53 37.74 47.18 16.94 17.03 16.53 69.60 15.12 6.30 43.31 14.55 35.58 65.25 33.07 38.92 17.11 36300868 CRYPTOCOCCAL AG CSF 87899 300 $84.00 31.05 - 86.70 - 58.04 16.87 58.04 - 46.41 16.55 33.32 - - 55.60 14.46 16.07 69.36 86.70 16.47 16.55 16.07 67.20 14.70 - 42.10 14.14 34.36 63.00 31.93 37.57 16.63 36300884 CRYPTOCOCCAL AG SERUM 87899 300 $84.00 31.05 - 86.70 - 58.04 16.87 58.04 - 46.41 16.55 33.32 - - 55.60 14.46 16.07 69.36 86.70 16.47 16.55 16.07 67.20 14.70 - 42.10 14.14 34.36 63.00 31.93 37.57 16.63 36302011 EIA INFECTIOUS AGENT 87899 300 $84.00 31.05 - 86.70 - 58.04 16.87 58.04 - 46.41 16.55 33.32 - - 55.60 14.46 16.07 69.36 86.70 16.47 16.55 16.07 67.20 14.70 - 42.10 14.14 34.36 63.00 31.93 37.57 16.63 36303221 EIA INFECTIOUS AGENT 87899 300 $84.00 31.05 - 86.70 - 58.04 16.87 58.04 - 46.41 16.55 33.32 - - 55.60 14.46 16.07 69.36 86.70 16.47 16.55 16.07 67.20 14.70 - 42.10 14.14 34.36 63.00 31.93 37.57 16.63 36303239 EIA INFECTIOUS AGENT 87899 300 $84.00 31.05 - 86.70 - 58.04 16.87 58.04 - 46.41 16.55 33.32 - - 55.60 14.46 16.07 69.36 86.70 16.47 16.55 16.07 67.20 14.70 - 42.10 14.14 34.36 63.00 31.93 37.57 16.63 36940808 STREP PNEUM AG URINE 87899 300 $99.00 36.59 - 86.70 - 68.41 16.87 68.41 - 54.70 16.55 33.32 - - 65.53 14.46 16.07 69.36 86.70 16.47 16.55 16.07 79.20 14.70 - 42.10 14.14 40.49 74.25 37.63 44.28 16.63 36942827 INFECTIOUS AGENT DRUG SUSEPT 87900 300 $684.00 252.81 114.71 " 1,003.70 " 167.54 472.64 136.87 472.64 145.69 377.91 134.26 362.39 160.26 145.69 452.74 117.32 130.35 802.96 " 1,003.70 " 133.61 134.26 130.35 547.20 119.27 145.69 341.52 114.71 279.76 513.00 259.99 305.95 134.91 36920661 HIV-1 GENOTYPING 87901 300 "$2,388.00" 882.60 226.56 " 2,026.25 " 327.31 " 1,650.11 " 270.32 " 1,650.11 " 284.62 " 1,319.37 " 265.17 715.76 313.08 284.62 " 1,580.62 " 231.71 257.45 " 1,621.00 " " 2,026.25 " 263.89 265.17 257.45 " 1,910.40 " 235.57 284.62 674.52 226.56 976.69 " 1,791.00 " 907.68 " 1,068.15 " 266.46 36942835 HIV-1 REVERSE TRANSCRIPTASE 87901 300 "$1,352.00" 499.70 226.56 " 2,026.25 " 327.31 934.23 270.32 934.23 284.62 746.98 265.17 715.76 313.08 284.62 894.89 231.71 257.45 " 1,621.00 " " 2,026.25 " 263.89 265.17 257.45 " 1,081.60 " 235.57 284.62 674.52 226.56 552.97 " 1,014.00 " 513.90 604.75 266.46 35100946 HCV GENOTYPE 87902 300 "$1,352.00" 499.70 - " 2,026.25 " - 934.23 270.32 934.23 - 746.98 265.17 715.76 - - 894.89 231.71 257.45 " 1,621.00 " " 2,026.25 " 263.89 265.17 257.45 " 1,081.60 " 235.57 - 674.52 226.56 552.97 " 1,014.00 " 513.90 604.75 266.46 35101837 DONOR HCV GENOTYPE 87902 300 "$1,352.00" 499.70 - " 2,026.25 " - 934.23 270.32 934.23 - 746.98 265.17 715.76 - - 894.89 231.71 257.45 " 1,621.00 " " 2,026.25 " 263.89 265.17 257.45 " 1,081.60 " 235.57 - 674.52 226.56 552.97 " 1,014.00 " 513.90 604.75 266.46 36941111 HCV GEN REFLEX NS5A 87902 300 "$1,352.00" 499.70 - " 2,026.25 " - 934.23 270.32 934.23 - 746.98 265.17 715.76 - - 894.89 231.71 257.45 " 1,621.00 " " 2,026.25 " 263.89 265.17 257.45 " 1,081.60 " 235.57 - 674.52 226.56 552.97 " 1,014.00 " 513.90 604.75 266.46 36941120 HCV NS5A DRUG RESIST 87902 300 "$2,713.00" " 1,002.72 " - " 2,170.40 " - " 1,874.68 " 270.32 " 1,874.68 " - " 1,498.93 " 265.17 715.76 - - " 1,795.73 " 231.71 257.45 " 1,621.00 " " 2,026.25 " 263.89 265.17 257.45 " 2,170.40 " 235.57 - 674.52 226.56 " 1,109.62 " " 2,034.75 " " 1,031.21 " " 1,213.52 " 266.46 36942843 HIV-1 OTHER REGION 87906 300 $676.00 249.85 113.28 998.35 166.65 467.12 135.17 467.12 144.91 373.49 132.59 357.90 159.40 144.91 447.44 115.86 128.73 798.68 998.35 131.95 132.59 128.73 540.80 117.79 144.91 337.27 113.28 276.48 507.00 256.95 302.37 133.24 36936380 HEPATITIS B PCR GENOTYPE 87912 300 "$1,508.00" 557.36 226.56 " 1,206.40 " 325.57 " 1,042.03 " 270.32 " 1,042.03 " 283.10 833.17 265.17 715.76 311.41 283.10 998.15 231.71 257.45 715.74 894.68 263.89 265.17 257.45 " 1,206.40 " 235.57 283.10 674.52 226.56 616.77 " 1,131.00 " 573.19 674.53 266.46 36300876 WATER ANALYSIS COLONY COUNT 87999 300 $69.00 25.50 - 273.26 - 47.68 - 47.68 - 38.12 - 39.88 - - 45.67 - - 218.61 273.26 - - - 55.20 - - 46.23 - 28.22 51.75 26.23 30.86 - 36301805 ATTEST CULTURE (OUTREACH) 87999 300 $35.00 12.94 - 273.26 - 24.19 - 24.19 - 19.34 - 39.88 - - 23.17 - - 218.61 273.26 - - - 28.00 - - 23.45 - 14.32 26.25 13.30 15.66 - 36913886 WATER ANALYSIS-TOT COLIFORM CT 87999 300 $147.00 54.33 - 273.26 - 101.58 - 101.58 - 81.22 - 39.88 - - 97.30 - - 218.61 273.26 - - - 117.60 - - 98.49 - 60.12 110.25 55.87 65.75 - 35900365 FLUID CYTOSPIN 88104 310 $178.00 65.79 26.50 142.40 30.48 123.00 35.30 123.00 26.50 98.35 34.63 94.99 29.15 26.50 117.82 30.26 33.62 28.74 35.93 34.46 34.63 33.62 142.40 30.76 26.50 88.66 29.59 72.80 133.50 67.66 79.62 34.80 35900357 SMEARS CONCENTRATE INTERPR 88108 310 $178.00 65.79 16.00 142.40 18.40 123.00 35.30 123.00 16.00 98.35 34.63 100.86 17.60 16.00 117.82 30.26 33.62 33.25 41.56 34.46 34.63 33.62 142.40 30.76 16.00 88.66 29.59 72.80 133.50 67.66 79.62 34.80 35900411 SPUTUM-BRONCHIAL CY 49/46 88108 311 $178.00 65.79 16.00 142.40 18.40 123.00 35.30 123.00 16.00 98.35 34.63 100.86 17.60 16.00 117.82 30.26 33.62 33.25 41.56 34.46 34.63 33.62 142.40 30.76 16.00 88.66 29.59 72.80 133.50 67.66 79.62 34.80 35900969 CYTOSPIN OUTREACH 88108 311 $178.00 65.79 16.00 142.40 18.40 123.00 35.30 123.00 16.00 98.35 34.63 100.86 17.60 16.00 117.82 30.26 33.62 33.25 41.56 34.46 34.63 33.62 142.40 30.76 16.00 88.66 29.59 72.80 133.50 67.66 79.62 34.80 35900951 LIQUID BASED PREP NON CERVICAL 88112 311 $261.00 96.47 43.44 297.62 105.89 180.35 51.83 180.35 92.08 144.20 50.84 88.42 101.29 92.08 172.76 44.42 49.36 238.10 297.62 50.59 50.84 49.36 208.80 45.16 92.08 130.37 43.44 106.75 195.75 99.21 116.75 51.09 08900001 FISH UR MORPH ANAL 3-5 PRB MAN 88120 310 $783.00 289.40 130.37 " 2,133.83 " 404.01 541.05 155.56 541.05 351.31 432.61 152.59 " 1,183.12 " 386.44 351.31 518.27 133.34 148.15 " 1,707.06 " " 2,133.83 " 151.85 152.59 148.15 626.40 135.56 351.31 390.80 130.37 320.25 587.25 297.62 350.24 153.34 36933402 FISH VYS UROVYS MORPH ANAL MAN 88120 300 "$1,731.00" 639.78 130.37 " 2,133.83 " 404.01 " 1,196.12 " 155.56 " 1,196.12 " 351.31 956.38 152.59 " 1,183.12 " 386.44 351.31 " 1,145.75 " 133.34 148.15 " 1,707.06 " " 2,133.83 " 151.85 152.59 148.15 " 1,384.80 " 135.56 351.31 390.80 130.37 707.98 " 1,298.25 " 657.95 774.28 153.34 08900019 FISH UR MORH ANAL 3-5 PRB AUTO 88121 310 "$1,529.00" 565.12 254.59 " 1,788.87 " 341.07 " 1,056.54 " 303.78 " 1,056.54 " 296.58 844.77 297.99 " 1,034.03 " 326.24 296.58 " 1,012.05 " 260.38 289.31 " 1,431.10 " " 1,788.87 " 296.54 297.99 289.31 " 1,223.20 " 264.72 296.58 763.10 254.59 625.36 " 1,146.75 " 581.17 683.92 299.44 35900624 THIN LAYER PAP DIAG NORMAL 88142 311 $106.00 39.18 16.00 132.50 18.40 73.25 21.27 73.25 16.00 58.57 20.87 56.33 17.60 16.00 70.16 18.23 20.26 106.00 132.50 20.77 20.87 20.26 84.80 18.54 16.00 53.08 17.83 43.35 79.50 40.29 47.41 20.97 35900632 THIN LAYER PAP DIAG ABNORMAL 88142 311 $106.00 39.18 16.00 132.50 18.40 73.25 21.27 73.25 16.00 58.57 20.87 56.33 17.60 16.00 70.16 18.23 20.26 106.00 132.50 20.77 20.87 20.26 84.80 18.54 16.00 53.08 17.83 43.35 79.50 40.29 47.41 20.97 35900802 THINPREP PAP DIAG NORMAL 88142 311 $106.00 39.18 16.00 132.50 18.40 73.25 21.27 73.25 16.00 58.57 20.87 56.33 17.60 16.00 70.16 18.23 20.26 106.00 132.50 20.77 20.87 20.26 84.80 18.54 16.00 53.08 17.83 43.35 79.50 40.29 47.41 20.97 35900811 THINPREP PAP DIAG ABNORMAL 88142 311 $106.00 39.18 16.00 132.50 18.40 73.25 21.27 73.25 16.00 58.57 20.87 56.33 17.60 16.00 70.16 18.23 20.26 106.00 132.50 20.77 20.87 20.26 84.80 18.54 16.00 53.08 17.83 43.35 79.50 40.29 47.41 20.97 35900586 PAP AUTO W/MAN RSCRN DIAG ABNM 88148 311 $84.00 31.05 - 83.11 - 58.04 16.80 58.04 - 46.41 16.48 42.26 - - 55.60 14.40 16.00 66.49 83.11 16.40 16.48 16.00 67.20 14.64 - 41.92 14.08 34.36 63.00 31.93 37.57 16.56 35900250 MATURATION INDEX 88155 310 $77.00 28.46 6.50 61.60 7.48 53.21 15.38 53.21 6.50 42.54 15.09 16.64 7.15 6.50 50.97 13.19 14.65 37.74 47.18 15.02 15.09 14.65 61.60 13.40 6.50 38.38 12.89 31.49 57.75 29.27 34.44 15.16 35901027 CYTO SMEARS OTHER SOURCE 88160 310 $130.00 48.05 12.50 104.00 14.38 89.83 25.77 89.83 12.50 71.83 25.28 93.54 13.75 12.50 86.05 22.09 24.54 22.40 28.00 25.15 25.28 24.54 104.00 22.45 12.50 64.64 21.60 53.17 97.50 49.41 58.15 25.40 35900381 BRUSHING;SMEARS;NO CENTRIFUGAT 88161 311 $130.00 48.05 16.00 104.00 18.40 89.83 25.77 89.83 16.00 71.83 25.28 80.38 17.60 16.00 86.05 22.09 24.54 28.44 35.55 25.15 25.28 24.54 104.00 22.45 16.00 64.64 21.60 53.17 97.50 49.41 58.15 25.40 35900985 SLIDES OUTREACH 88161 311 $130.00 48.05 16.00 104.00 18.40 89.83 25.77 89.83 16.00 71.83 25.28 80.38 17.60 16.00 86.05 22.09 24.54 28.44 35.55 25.15 25.28 24.54 104.00 22.45 16.00 64.64 21.60 53.17 97.50 49.41 58.15 25.40 35900501 MULTIPLE STAINS >5 SLIDES 88162 310 $261.00 96.47 19.00 208.80 21.85 180.35 51.83 180.35 19.00 144.20 50.84 131.53 20.90 19.00 172.76 44.42 49.36 48.63 60.79 50.59 50.84 49.36 208.80 45.16 19.00 130.37 43.44 106.75 195.75 99.21 116.75 51.09 35900390 PAP SMEAR DIAGNOSTIC NORMAL 88164 311 $80.00 29.57 7.15 83.11 8.22 55.28 16.72 55.28 7.15 44.20 16.40 29.36 7.87 7.15 52.95 14.33 15.92 66.49 83.11 16.32 16.40 15.92 64.00 14.57 7.15 39.69 14.01 32.72 60.00 30.41 35.78 16.48 35900471 PAP SMEAR DIAGNOSTIC ABNORMAL 88164 311 $80.00 29.57 7.15 83.11 8.22 55.28 16.72 55.28 7.15 44.20 16.40 29.36 7.87 7.15 52.95 14.33 15.92 66.49 83.11 16.32 16.40 15.92 64.00 14.57 7.15 39.69 14.01 32.72 60.00 30.41 35.78 16.48 35900403 FNA ADEQUACY 1ST EVAL EPISODE 88172 310 $783.00 289.40 - 626.40 - 541.05 155.56 541.05 - 432.61 152.59 40.91 - - 518.27 133.34 148.15 47.88 59.85 151.85 152.59 148.15 626.40 135.56 - 390.80 130.37 320.25 587.25 297.62 350.24 153.34 35900446 FNA INTERPRETATION 88173 310 $261.00 96.47 - 208.80 - 180.35 51.83 180.35 - 144.20 50.84 165.89 - - 172.76 44.42 49.36 60.06 75.07 50.59 50.84 49.36 208.80 45.16 - 130.37 43.44 106.75 195.75 99.21 116.75 51.09 35900764 AUTO THIN LAYER MAN DIAG NORM 88175 311 $140.00 51.74 23.42 210.37 33.98 96.74 27.94 96.74 29.55 77.35 27.41 73.66 32.51 29.55 92.67 23.95 26.61 168.30 210.37 27.28 27.41 26.61 112.00 24.35 29.55 69.72 23.42 57.26 105.00 53.21 62.62 27.54 35900772 AUTO THIN LAYER MAN DIAG ABNM 88175 311 $140.00 51.74 23.42 210.37 33.98 96.74 27.94 96.74 29.55 77.35 27.41 73.66 32.51 29.55 92.67 23.95 26.61 168.30 210.37 27.28 27.41 26.61 112.00 24.35 29.55 69.72 23.42 57.26 105.00 53.21 62.62 27.54 35901019 FNA ADEQUACY ADDL EVAL EPISODE 88177 300 $39.00 14.41 - 34.34 - 26.95 - 26.95 - 21.55 - 15.35 - - 25.81 - - 27.47 34.34 - - - 31.20 - - 19.20 - 15.95 29.25 14.82 17.44 - 36150394 FLOW CYTOMETRY 1ST MARKER 88184 300 "$1,529.00" 565.12 37.14 " 1,223.20 " 42.71 " 1,056.54 " 303.78 " 1,056.54 " 37.14 844.77 297.99 155.65 40.85 37.14 " 1,012.05 " 260.38 289.31 204.72 255.90 296.54 297.99 289.31 " 1,223.20 " 264.72 37.14 763.10 254.59 625.36 " 1,146.75 " 581.17 683.92 299.44 36150688 FLOW CYTO 1ST MARKER ZAP70 88184 300 "$1,529.00" 565.12 37.14 " 1,223.20 " 42.71 " 1,056.54 " 303.78 " 1,056.54 " 37.14 844.77 297.99 155.65 40.85 37.14 " 1,012.05 " 260.38 289.31 204.72 255.90 296.54 297.99 289.31 " 1,223.20 " 264.72 37.14 763.10 254.59 625.36 " 1,146.75 " 581.17 683.92 299.44 36923156 CD59 FLOW CYTOMETRY 88184 300 "$1,529.00" 565.12 37.14 " 1,223.20 " 42.71 " 1,056.54 " 303.78 " 1,056.54 " 37.14 844.77 297.99 155.65 40.85 37.14 " 1,012.05 " 260.38 289.31 204.72 255.90 296.54 297.99 289.31 " 1,223.20 " 264.72 37.14 763.10 254.59 625.36 " 1,146.75 " 581.17 683.92 299.44 36929383 FLOW CYTOMETRY 1ST MARKER 88184 300 "$1,529.00" 565.12 37.14 " 1,223.20 " 42.71 " 1,056.54 " 303.78 " 1,056.54 " 37.14 844.77 297.99 155.65 40.85 37.14 " 1,012.05 " 260.38 289.31 204.72 255.90 296.54 297.99 289.31 " 1,223.20 " 264.72 37.14 763.10 254.59 625.36 " 1,146.75 " 581.17 683.92 299.44 36933178 FLOW CYTO 1ST MARKER 88184 300 "$1,529.00" 565.12 37.14 " 1,223.20 " 42.71 " 1,056.54 " 303.78 " 1,056.54 " 37.14 844.77 297.99 155.65 40.85 37.14 " 1,012.05 " 260.38 289.31 204.72 255.90 296.54 297.99 289.31 " 1,223.20 " 264.72 37.14 763.10 254.59 625.36 " 1,146.75 " 581.17 683.92 299.44 36937611 FLOW CYTO 1ST MARKER 88184 300 "$4,334.00" " 1,601.85 " 37.14 " 3,467.20 " 42.71 " 2,994.79 " 303.78 " 2,994.79 " 37.14 " 2,394.54 " 297.99 155.65 40.85 37.14 " 2,868.67 " 260.38 289.31 204.72 255.90 296.54 297.99 289.31 " 3,467.20 " 264.72 37.14 763.10 254.59 " 1,772.61 " " 3,250.50 " " 1,647.35 " " 1,938.60 " 299.44 36938790 FLOW CYTOMETRY FIRST MARKER 88184 300 "$1,529.00" 565.12 37.14 " 1,223.20 " 42.71 " 1,056.54 " 303.78 " 1,056.54 " 37.14 844.77 297.99 155.65 40.85 37.14 " 1,012.05 " 260.38 289.31 204.72 255.90 296.54 297.99 289.31 " 1,223.20 " 264.72 37.14 763.10 254.59 625.36 " 1,146.75 " 581.17 683.92 299.44 36942142 FLOW CYTO FIRST MARKER 88184 300 "$1,529.00" 565.12 37.14 " 1,223.20 " 42.71 " 1,056.54 " 303.78 " 1,056.54 " 37.14 844.77 297.99 155.65 40.85 37.14 " 1,012.05 " 260.38 289.31 204.72 255.90 296.54 297.99 289.31 " 1,223.20 " 264.72 37.14 763.10 254.59 625.36 " 1,146.75 " 581.17 683.92 299.44 36150017 FLOW CYTOMETRY TDT ADDL MARKER 88185 300 $34.00 12.57 - 125.83 21.00 23.49 - 23.49 18.26 18.79 - 94.99 20.09 18.26 22.50 - - 100.66 125.83 - - - 27.20 - 18.26 60.34 - 13.91 25.50 12.92 15.21 - 36150050 FLOW CYTOMETRY ADDL MARKER 88185 300 $34.00 12.57 - 125.83 21.00 23.49 - 23.49 18.26 18.79 - 94.99 20.09 18.26 22.50 - - 100.66 125.83 - - - 27.20 - 18.26 60.34 - 13.91 25.50 12.92 15.21 - 36150068 FLOW CYTOMETRY ADDL MARKER 88185 300 $34.00 12.57 - 125.83 21.00 23.49 - 23.49 18.26 18.79 - 94.99 20.09 18.26 22.50 - - 100.66 125.83 - - - 27.20 - 18.26 60.34 - 13.91 25.50 12.92 15.21 - 36150076 FLOW CYTOMETRY ADDL MARKER 88185 300 $34.00 12.57 - 125.83 21.00 23.49 - 23.49 18.26 18.79 - 94.99 20.09 18.26 22.50 - - 100.66 125.83 - - - 27.20 - 18.26 60.34 - 13.91 25.50 12.92 15.21 - 36150084 FLOW CYTOMETRY ADDL MARKER 88185 300 $34.00 12.57 - 125.83 21.00 23.49 - 23.49 18.26 18.79 - 94.99 20.09 18.26 22.50 - - 100.66 125.83 - - - 27.20 - 18.26 60.34 - 13.91 25.50 12.92 15.21 - 36150386 FLOW CYTOMETRY ADDL MARKER 88185 300 $34.00 12.57 - 125.83 21.00 23.49 - 23.49 18.26 18.79 - 94.99 20.09 18.26 22.50 - - 100.66 125.83 - - - 27.20 - 18.26 60.34 - 13.91 25.50 12.92 15.21 - 36150408 FLOW CYTOMETRY ADDL MARKER 88185 300 $34.00 12.57 - 125.83 21.00 23.49 - 23.49 18.26 18.79 - 94.99 20.09 18.26 22.50 - - 100.66 125.83 - - - 27.20 - 18.26 60.34 - 13.91 25.50 12.92 15.21 - 36150416 FLOW CYTOMETRY ADDL MARKER 88185 300 $34.00 12.57 - 125.83 21.00 23.49 - 23.49 18.26 18.79 - 94.99 20.09 18.26 22.50 - - 100.66 125.83 - - - 27.20 - 18.26 60.34 - 13.91 25.50 12.92 15.21 - 36150424 FLOW CYTOMETRY ADDL MARKER 88185 300 $34.00 12.57 - 125.83 21.00 23.49 - 23.49 18.26 18.79 - 94.99 20.09 18.26 22.50 - - 100.66 125.83 - - - 27.20 - 18.26 60.34 - 13.91 25.50 12.92 15.21 - 36150432 FLOW CYTOMETRY ADDL MARKER 88185 300 $34.00 12.57 - 125.83 21.00 23.49 - 23.49 18.26 18.79 - 94.99 20.09 18.26 22.50 - - 100.66 125.83 - - - 27.20 - 18.26 60.34 - 13.91 25.50 12.92 15.21 - 36150441 FLOW CYTOMETRY ADDL MARKER 88185 300 $34.00 12.57 - 125.83 21.00 23.49 - 23.49 18.26 18.79 - 94.99 20.09 18.26 22.50 - - 100.66 125.83 - - - 27.20 - 18.26 60.34 - 13.91 25.50 12.92 15.21 - 36150459 FLOW CYTOMETRY ADDL MARKER 88185 300 $34.00 12.57 - 125.83 21.00 23.49 - 23.49 18.26 18.79 - 94.99 20.09 18.26 22.50 - - 100.66 125.83 - - - 27.20 - 18.26 60.34 - 13.91 25.50 12.92 15.21 - 36150467 FLOW CYTOMETRY ADDL MARKER 88185 300 $34.00 12.57 - 125.83 21.00 23.49 - 23.49 18.26 18.79 - 94.99 20.09 18.26 22.50 - - 100.66 125.83 - - - 27.20 - 18.26 60.34 - 13.91 25.50 12.92 15.21 - 36150475 FLOW CYTOMETRY ADDL MARKER 88185 300 $34.00 12.57 - 125.83 21.00 23.49 - 23.49 18.26 18.79 - 94.99 20.09 18.26 22.50 - - 100.66 125.83 - - - 27.20 - 18.26 60.34 - 13.91 25.50 12.92 15.21 - 36150483 FLOW CYTOMETRY ADDL MARKER 88185 300 $34.00 12.57 - 125.83 21.00 23.49 - 23.49 18.26 18.79 - 94.99 20.09 18.26 22.50 - - 100.66 125.83 - - - 27.20 - 18.26 60.34 - 13.91 25.50 12.92 15.21 - 36150491 FLOW CYTOMETRY ADDL MARKER 88185 300 $34.00 12.57 - 125.83 21.00 23.49 - 23.49 18.26 18.79 - 94.99 20.09 18.26 22.50 - - 100.66 125.83 - - - 27.20 - 18.26 60.34 - 13.91 25.50 12.92 15.21 - 36150505 FLOW CYTOMETRY ADDL MARKER 88185 300 $34.00 12.57 - 125.83 21.00 23.49 - 23.49 18.26 18.79 - 94.99 20.09 18.26 22.50 - - 100.66 125.83 - - - 27.20 - 18.26 60.34 - 13.91 25.50 12.92 15.21 - 36150513 FLOW CYTOMETRY ADDL MARKER 88185 300 $34.00 12.57 - 125.83 21.00 23.49 - 23.49 18.26 18.79 - 94.99 20.09 18.26 22.50 - - 100.66 125.83 - - - 27.20 - 18.26 60.34 - 13.91 25.50 12.92 15.21 - 36150521 FLOW CYTOMETRY ADDL MARKER 88185 300 $34.00 12.57 - 125.83 21.00 23.49 - 23.49 18.26 18.79 - 94.99 20.09 18.26 22.50 - - 100.66 125.83 - - - 27.20 - 18.26 60.34 - 13.91 25.50 12.92 15.21 - 36150530 FLOW CYTOMETRY ADDL MARKER 88185 300 $34.00 12.57 - 125.83 21.00 23.49 - 23.49 18.26 18.79 - 94.99 20.09 18.26 22.50 - - 100.66 125.83 - - - 27.20 - 18.26 60.34 - 13.91 25.50 12.92 15.21 - 36150548 FLOW CYTOMETRY ADDL MARKER 88185 300 $34.00 12.57 - 125.83 21.00 23.49 - 23.49 18.26 18.79 - 94.99 20.09 18.26 22.50 - - 100.66 125.83 - - - 27.20 - 18.26 60.34 - 13.91 25.50 12.92 15.21 - 36150556 FLOW CYTOMETRY ADDL MARKER 88185 300 $34.00 12.57 - 125.83 21.00 23.49 - 23.49 18.26 18.79 - 94.99 20.09 18.26 22.50 - - 100.66 125.83 - - - 27.20 - 18.26 60.34 - 13.91 25.50 12.92 15.21 - 36150564 FLOW CYTOMETRY ADDL MARKER 88185 300 $34.00 12.57 - 125.83 21.00 23.49 - 23.49 18.26 18.79 - 94.99 20.09 18.26 22.50 - - 100.66 125.83 - - - 27.20 - 18.26 60.34 - 13.91 25.50 12.92 15.21 - 36150572 FLOW CYTOMETRY ADDL MARKER 88185 300 $34.00 12.57 - 125.83 21.00 23.49 - 23.49 18.26 18.79 - 94.99 20.09 18.26 22.50 - - 100.66 125.83 - - - 27.20 - 18.26 60.34 - 13.91 25.50 12.92 15.21 - 36150581 FLOW CYTOMETRY ADDL MARKER 88185 300 $34.00 12.57 - 125.83 21.00 23.49 - 23.49 18.26 18.79 - 94.99 20.09 18.26 22.50 - - 100.66 125.83 - - - 27.20 - 18.26 60.34 - 13.91 25.50 12.92 15.21 - 36150611 FLOW CYTOMETRY ADDL MARKER 88185 300 $34.00 12.57 - 125.83 21.00 23.49 - 23.49 18.26 18.79 - 94.99 20.09 18.26 22.50 - - 100.66 125.83 - - - 27.20 - 18.26 60.34 - 13.91 25.50 12.92 15.21 - 36150637 FLOW CYTOMETRY ADDL MARKER 88185 300 $34.00 12.57 - 125.83 21.00 23.49 - 23.49 18.26 18.79 - 94.99 20.09 18.26 22.50 - - 100.66 125.83 - - - 27.20 - 18.26 60.34 - 13.91 25.50 12.92 15.21 - 36150645 FLOW CYTOMETRY ADDL MARKER 88185 300 $34.00 12.57 - 125.83 21.00 23.49 - 23.49 18.26 18.79 - 94.99 20.09 18.26 22.50 - - 100.66 125.83 - - - 27.20 - 18.26 60.34 - 13.91 25.50 12.92 15.21 - 36150653 FLOW CYTOMETRY ADDL MARKER 88185 300 $34.00 12.57 - 125.83 21.00 23.49 - 23.49 18.26 18.79 - 94.99 20.09 18.26 22.50 - - 100.66 125.83 - - - 27.20 - 18.26 60.34 - 13.91 25.50 12.92 15.21 - 36150661 FLOW CYTOMETRY ADDL MARKER 88185 300 $34.00 12.57 - 125.83 21.00 23.49 - 23.49 18.26 18.79 - 94.99 20.09 18.26 22.50 - - 100.66 125.83 - - - 27.20 - 18.26 60.34 - 13.91 25.50 12.92 15.21 - 36150670 FLOW CYTOMETRY ADDL MARKER 88185 300 $34.00 12.57 - 125.83 21.00 23.49 - 23.49 18.26 18.79 - 94.99 20.09 18.26 22.50 - - 100.66 125.83 - - - 27.20 - 18.26 60.34 - 13.91 25.50 12.92 15.21 - 36150696 FLOW CYTO ADDL MARKER ZAP70 88185 300 $34.00 12.57 - 125.83 21.00 23.49 - 23.49 18.26 18.79 - 94.99 20.09 18.26 22.50 - - 100.66 125.83 - - - 27.20 - 18.26 60.34 - 13.91 25.50 12.92 15.21 - 36150734 FLOW CYTO ADDL MARKER ZAP70 88185 300 $34.00 12.57 - 125.83 21.00 23.49 - 23.49 18.26 18.79 - 94.99 20.09 18.26 22.50 - - 100.66 125.83 - - - 27.20 - 18.26 60.34 - 13.91 25.50 12.92 15.21 - 36150742 FLOW CYTO ADDL MARKER ZAP70 88185 300 $34.00 12.57 - 125.83 21.00 23.49 - 23.49 18.26 18.79 - 94.99 20.09 18.26 22.50 - - 100.66 125.83 - - - 27.20 - 18.26 60.34 - 13.91 25.50 12.92 15.21 - 36150769 FLOW CYTOMETRY ADDL MARKER 88185 300 $34.00 12.57 - 125.83 21.00 23.49 - 23.49 18.26 18.79 - 94.99 20.09 18.26 22.50 - - 100.66 125.83 - - - 27.20 - 18.26 60.34 - 13.91 25.50 12.92 15.21 - 36150777 FLOW CYTOMETRY ADDL MARKER 88185 300 $34.00 12.57 - 125.83 21.00 23.49 - 23.49 18.26 18.79 - 94.99 20.09 18.26 22.50 - - 100.66 125.83 - - - 27.20 - 18.26 60.34 - 13.91 25.50 12.92 15.21 - 36150785 FLOW CYTOMETRY ADDL MARKER 88185 300 $34.00 12.57 - 125.83 21.00 23.49 - 23.49 18.26 18.79 - 94.99 20.09 18.26 22.50 - - 100.66 125.83 - - - 27.20 - 18.26 60.34 - 13.91 25.50 12.92 15.21 - 36150793 FLOW CYTOMETRY ADDL MARKER 88185 300 $34.00 12.57 - 125.83 21.00 23.49 - 23.49 18.26 18.79 - 94.99 20.09 18.26 22.50 - - 100.66 125.83 - - - 27.20 - 18.26 60.34 - 13.91 25.50 12.92 15.21 - 36150807 FLOW CYTOMETRY ADDL MARKER 88185 300 $34.00 12.57 - 125.83 21.00 23.49 - 23.49 18.26 18.79 - 94.99 20.09 18.26 22.50 - - 100.66 125.83 - - - 27.20 - 18.26 60.34 - 13.91 25.50 12.92 15.21 - 36150840 FLOW CYTO ADDL MARKER ZAP70 88185 300 $34.00 12.57 - 125.83 21.00 23.49 - 23.49 18.26 18.79 - 94.99 20.09 18.26 22.50 - - 100.66 125.83 - - - 27.20 - 18.26 60.34 - 13.91 25.50 12.92 15.21 - 36929391 FLOW CYTOMETRY ADDL MARKER 88185 300 $141.00 52.11 - 125.83 21.00 97.43 - 97.43 18.26 77.90 - 94.99 20.09 18.26 93.33 - - 100.66 125.83 - - - 112.80 - 18.26 60.34 - 57.67 105.75 53.59 63.07 - 36933186 FLOW CYTO ADDL MARKER 88185 300 $141.00 52.11 - 125.83 21.00 97.43 - 97.43 18.26 77.90 - 94.99 20.09 18.26 93.33 - - 100.66 125.83 - - - 112.80 - 18.26 60.34 - 57.67 105.75 53.59 63.07 - 36933194 FLOW CYTO ADDL MARKER 88185 300 $141.00 52.11 - 125.83 21.00 97.43 - 97.43 18.26 77.90 - 94.99 20.09 18.26 93.33 - - 100.66 125.83 - - - 112.80 - 18.26 60.34 - 57.67 105.75 53.59 63.07 - 36933208 FLOW CYTO ADDL MARKER 88185 300 $141.00 52.11 - 125.83 21.00 97.43 - 97.43 18.26 77.90 - 94.99 20.09 18.26 93.33 - - 100.66 125.83 - - - 112.80 - 18.26 60.34 - 57.67 105.75 53.59 63.07 - 36933216 FLOW CYTO ADDL MARKER 88185 300 $141.00 52.11 - 125.83 21.00 97.43 - 97.43 18.26 77.90 - 94.99 20.09 18.26 93.33 - - 100.66 125.83 - - - 112.80 - 18.26 60.34 - 57.67 105.75 53.59 63.07 - 36933224 FLOW CYTO ADDL MARKER 88185 300 $141.00 52.11 - 125.83 21.00 97.43 - 97.43 18.26 77.90 - 94.99 20.09 18.26 93.33 - - 100.66 125.83 - - - 112.80 - 18.26 60.34 - 57.67 105.75 53.59 63.07 - 36933232 FLOW CYTO ADDL MARKER 88185 300 $141.00 52.11 - 125.83 21.00 97.43 - 97.43 18.26 77.90 - 94.99 20.09 18.26 93.33 - - 100.66 125.83 - - - 112.80 - 18.26 60.34 - 57.67 105.75 53.59 63.07 - 36933241 FLOW CYTO ADDL MARKER 88185 300 $141.00 52.11 - 125.83 21.00 97.43 - 97.43 18.26 77.90 - 94.99 20.09 18.26 93.33 - - 100.66 125.83 - - - 112.80 - 18.26 60.34 - 57.67 105.75 53.59 63.07 - 36933259 FLOW CYTO ADDL MARKER 88185 300 $141.00 52.11 - 125.83 21.00 97.43 - 97.43 18.26 77.90 - 94.99 20.09 18.26 93.33 - - 100.66 125.83 - - - 112.80 - 18.26 60.34 - 57.67 105.75 53.59 63.07 - 36937629 FLOW CYTO ADDL MARKER 88185 300 "$4,330.00" " 1,600.37 " - " 3,464.00 " 21.00 " 2,992.03 " - " 2,992.03 " 18.26 " 2,392.33 " - 94.99 20.09 18.26 " 2,866.03 " - - 100.66 125.83 - - - " 3,464.00 " - 18.26 60.34 - " 1,770.97 " " 3,247.50 " " 1,645.83 " " 1,936.81 " - 36937637 FLOW CYTO ADDL MARKER 88185 300 "$4,330.00" " 1,600.37 " - " 3,464.00 " 21.00 " 2,992.03 " - " 2,992.03 " 18.26 " 2,392.33 " - 94.99 20.09 18.26 " 2,866.03 " - - 100.66 125.83 - - - " 3,464.00 " - 18.26 60.34 - " 1,770.97 " " 3,247.50 " " 1,645.83 " " 1,936.81 " - 36937645 FLOW CYTO ADDL MARKER 88185 300 "$4,330.00" " 1,600.37 " - " 3,464.00 " 21.00 " 2,992.03 " - " 2,992.03 " 18.26 " 2,392.33 " - 94.99 20.09 18.26 " 2,866.03 " - - 100.66 125.83 - - - " 3,464.00 " - 18.26 60.34 - " 1,770.97 " " 3,247.50 " " 1,645.83 " " 1,936.81 " - 36937653 FLOW CYTO ADDL MARKER 88185 300 "$4,330.00" " 1,600.37 " - " 3,464.00 " 21.00 " 2,992.03 " - " 2,992.03 " 18.26 " 2,392.33 " - 94.99 20.09 18.26 " 2,866.03 " - - 100.66 125.83 - - - " 3,464.00 " - 18.26 60.34 - " 1,770.97 " " 3,247.50 " " 1,645.83 " " 1,936.81 " - 36937661 FLOW CYTO ADDL MARKER 88185 300 "$4,330.00" " 1,600.37 " - " 3,464.00 " 21.00 " 2,992.03 " - " 2,992.03 " 18.26 " 2,392.33 " - 94.99 20.09 18.26 " 2,866.03 " - - 100.66 125.83 - - - " 3,464.00 " - 18.26 60.34 - " 1,770.97 " " 3,247.50 " " 1,645.83 " " 1,936.81 " - 36938803 FLOW CYTO EACH ADDL MARKER 88185 300 $441.00 162.99 - 352.80 21.00 304.73 - 304.73 18.26 243.65 - 94.99 20.09 18.26 291.90 - - 100.66 125.83 - - - 352.80 - 18.26 60.34 - 180.37 330.75 167.62 197.26 - 36942151 FLOW CYTO ADDL MARKER 88185 300 $169.00 62.46 - 135.20 21.00 116.78 - 116.78 18.26 93.37 - 94.99 20.09 18.26 111.86 - - 100.66 125.83 - - - 135.20 - 18.26 60.34 - 69.12 126.75 64.24 75.59 - 36942169 FLOW CYTO ADDL MARKER 88185 300 $169.00 62.46 - 135.20 21.00 116.78 - 116.78 18.26 93.37 - 94.99 20.09 18.26 111.86 - - 100.66 125.83 - - - 135.20 - 18.26 60.34 - 69.12 126.75 64.24 75.59 - 36942177 FLOW CYTO ADDL MARKER 88185 300 $169.00 62.46 - 135.20 21.00 116.78 - 116.78 18.26 93.37 - 94.99 20.09 18.26 111.86 - - 100.66 125.83 - - - 135.20 - 18.26 60.34 - 69.12 126.75 64.24 75.59 - 36942185 FLOW CYTO ADDL MARKER 88185 300 $169.00 62.46 - 135.20 21.00 116.78 - 116.78 18.26 93.37 - 94.99 20.09 18.26 111.86 - - 100.66 125.83 - - - 135.20 - 18.26 60.34 - 69.12 126.75 64.24 75.59 - 36942193 FLOW CYTO ADDL MARKER 88185 300 $171.00 63.20 - 136.80 21.00 118.16 - 118.16 18.26 94.48 - 94.99 20.09 18.26 113.18 - - 100.66 125.83 - - - 136.80 - 18.26 60.34 - 69.94 128.25 65.00 76.49 - 36942207 FLOW CYTO ADDL MARKER 88185 300 $171.00 63.20 - 136.80 21.00 118.16 - 118.16 18.26 94.48 - 94.99 20.09 18.26 113.18 - - 100.66 125.83 - - - 136.80 - 18.26 60.34 - 69.94 128.25 65.00 76.49 - 36929405 INTERPRETATION 2-8 MARKERS 88187 300 $270.00 99.79 - 371.86 62.08 186.57 N/A 186.57 53.98 149.18 N/A 149.09 59.38 N/A 178.71 - N/A 297.49 371.86 N/A N/A N/A 216.00 N/A 53.98 96.00 N/A 110.43 202.50 102.63 120.77 N/A 36942215 FLOW CYTO INTERP 2-8 MARKERS 88187 300 $261.00 96.47 - 371.86 62.08 180.35 N/A 180.35 53.98 144.20 N/A 149.09 59.38 N/A 172.76 - N/A 297.49 371.86 N/A N/A N/A 208.80 N/A 53.98 96.00 N/A 106.75 195.75 99.21 116.75 N/A 36933267 FLOW CYTO INTERP 9-15 MARKERS 88188 300 $217.00 80.20 - 463.74 77.41 149.95 N/A 149.95 67.31 119.89 N/A 190.00 74.04 N/A 143.63 - N/A 370.99 463.74 N/A N/A N/A 173.60 N/A 67.31 164.56 N/A 88.75 162.75 82.48 97.06 N/A 36907681 LYMPHOCYTE CULTURE 88230 300 "$1,447.00" 534.81 102.51 " 1,157.60 " 185.15 999.88 122.31 999.88 161.00 799.47 119.98 323.89 177.10 161.00 957.77 104.84 116.49 534.09 667.61 119.40 119.98 116.49 " 1,157.60 " 106.59 161.00 305.20 102.51 591.82 " 1,085.25 " 550.00 647.24 120.57 36918497 TISSUE CULTURE LYMPHOCYTE 88230 300 "$3,417.00" " 1,262.92 " 102.51 " 2,733.60 " 185.15 " 2,361.15 " 122.31 " 2,361.15 " 161.00 " 1,887.89 " 119.98 323.89 177.10 161.00 " 2,261.71 " 104.84 116.49 534.09 667.61 119.40 119.98 116.49 " 2,733.60 " 106.59 161.00 305.20 102.51 " 1,397.55 " " 2,562.75 " " 1,298.80 " " 1,528.42 " 120.57 36923954 BLOOD TISSUE CULTURE 88230 300 $947.00 350.01 102.51 757.60 185.15 654.38 122.31 654.38 161.00 523.22 119.98 323.89 177.10 161.00 626.82 104.84 116.49 534.09 667.61 119.40 119.98 116.49 757.60 106.59 161.00 305.20 102.51 387.32 710.25 359.95 423.59 120.57 36926767 TISSUE CULTURE LYMPHOCYTE 88230 300 $766.00 283.11 102.51 667.61 185.15 529.31 122.31 529.31 161.00 423.22 119.98 323.89 177.10 161.00 507.02 104.84 116.49 534.09 667.61 119.40 119.98 116.49 612.80 106.59 161.00 305.20 102.51 313.29 574.50 291.16 342.63 120.57 36926791 TISSUE CULTURE LYMPHOCYTE 88230 300 $954.00 352.60 102.51 763.20 185.15 659.21 122.31 659.21 161.00 527.09 119.98 323.89 177.10 161.00 631.45 104.84 116.49 534.09 667.61 119.40 119.98 116.49 763.20 106.59 161.00 305.20 102.51 390.19 715.50 362.62 426.72 120.57 36929243 TISSUE CULTURE LYMPHOCYTE 88230 300 $827.00 305.66 102.51 667.61 185.15 571.46 122.31 571.46 161.00 456.92 119.98 323.89 177.10 161.00 547.39 104.84 116.49 534.09 667.61 119.40 119.98 116.49 661.60 106.59 161.00 305.20 102.51 338.24 620.25 314.34 369.92 120.57 36934361 TISSUE CULTURE NON-NEOPLASTIC 88230 300 $729.00 269.44 102.51 667.61 185.15 503.74 122.31 503.74 161.00 402.77 119.98 323.89 177.10 161.00 482.53 104.84 116.49 534.09 667.61 119.40 119.98 116.49 583.20 106.59 161.00 305.20 102.51 298.16 546.75 277.09 326.08 120.57 36907886 SKIN OR TISSUE BX 88233 300 "$1,455.00" 537.77 123.84 " 1,164.00 " 217.35 " 1,005.41 " 147.77 " 1,005.41 " 189.00 803.89 144.95 391.28 207.90 189.00 963.06 126.66 140.73 907.37 " 1,134.21 " 144.25 144.95 140.73 " 1,164.00 " 128.77 189.00 368.71 123.84 595.10 " 1,091.25 " 553.05 650.82 145.66 36927640 CHROMOSOME TISSUE 88233 300 "$1,455.00" 537.77 123.84 " 1,164.00 " 217.35 " 1,005.41 " 147.77 " 1,005.41 " 189.00 803.89 144.95 391.28 207.90 189.00 963.06 126.66 140.73 907.37 " 1,134.21 " 144.25 144.95 140.73 " 1,164.00 " 128.77 189.00 368.71 123.84 595.10 " 1,091.25 " 553.05 650.82 145.66 36907941 AMNIOTIC FL/CHOR VILLUS CULT 88235 300 "$1,280.00" 473.09 132.26 " 1,024.00 " 217.35 884.48 157.82 884.48 189.00 707.20 154.81 409.42 207.90 189.00 847.23 135.27 150.30 647.89 809.86 154.06 154.81 150.30 " 1,024.00 " 137.52 189.00 393.79 132.26 523.52 960.00 486.53 572.54 155.56 36923393 TISSUE CULTURE AMNIOTIC FLUID 88235 300 $846.00 312.68 132.26 809.86 217.35 584.59 157.82 584.59 189.00 467.42 154.81 409.42 207.90 189.00 559.97 135.27 150.30 647.89 809.86 154.06 154.81 150.30 676.80 137.52 189.00 393.79 132.26 346.01 634.50 321.56 378.42 155.56 36923598 TISSUE CULTURE PLACENTA 88235 300 "$1,410.00" 521.14 132.26 " 1,128.00 " 217.35 974.31 157.82 974.31 189.00 779.03 154.81 409.42 207.90 189.00 933.28 135.27 150.30 647.89 809.86 154.06 154.81 150.30 " 1,128.00 " 137.52 189.00 393.79 132.26 576.69 " 1,057.50 " 535.94 630.69 155.56 36927828 TISSUE CULTURE PLACENTA 88235 300 $837.00 309.36 132.26 809.86 217.35 578.37 157.82 578.37 189.00 462.44 154.81 409.42 207.90 189.00 554.01 135.27 150.30 647.89 809.86 154.06 154.81 150.30 669.60 137.52 189.00 393.79 132.26 342.33 627.75 318.14 374.39 155.56 36938854 TISSUE CULTURE 88235 300 "$2,849.00" " 1,052.99 " 132.26 " 2,279.20 " 217.35 " 1,968.66 " 157.82 " 1,968.66 " 189.00 " 1,574.07 " 154.81 409.42 207.90 189.00 " 1,885.75 " 135.27 150.30 647.89 809.86 154.06 154.81 150.30 " 2,279.20 " 137.52 189.00 393.79 132.26 " 1,165.24 " " 2,136.75 " " 1,082.90 " " 1,274.36 " 155.56 36945435 AF CHOR VILLUS CELL TISS CULT 88235 300 $789.00 291.61 132.26 809.86 217.35 545.20 157.82 545.20 189.00 435.92 154.81 409.42 207.90 189.00 522.24 135.27 150.30 647.89 809.86 154.06 154.81 150.30 631.20 137.52 189.00 393.79 132.26 322.70 591.75 299.90 352.92 155.56 36907711 MARROW CULT 88237 300 $755.00 279.05 126.50 " 1,017.97 " 200.74 521.71 150.94 521.71 174.56 417.14 148.06 351.18 192.02 174.56 499.73 129.38 143.75 814.38 " 1,017.97 " 147.34 148.06 143.75 604.00 131.53 174.56 376.63 126.50 308.80 566.25 286.98 337.71 148.78 36919825 TISSUE CULTURE BLOOD 88237 300 "$1,038.00" 383.64 126.50 " 1,017.97 " 200.74 717.26 150.94 717.26 174.56 573.50 148.06 351.18 192.02 174.56 687.05 129.38 143.75 814.38 " 1,017.97 " 147.34 148.06 143.75 830.40 131.53 174.56 376.63 126.50 424.54 778.50 394.54 464.30 148.78 36920149 TISSUE CULTURE 88237 300 "$1,038.00" 383.64 126.50 " 1,017.97 " 200.74 717.26 150.94 717.26 174.56 573.50 148.06 351.18 192.02 174.56 687.05 129.38 143.75 814.38 " 1,017.97 " 147.34 148.06 143.75 830.40 131.53 174.56 376.63 126.50 424.54 778.50 394.54 464.30 148.78 36923911 HEMATOLOGIC DIS CULTURE 88237 300 "$2,216.00" 819.03 126.50 " 1,772.80 " 200.74 " 1,531.26 " 150.94 " 1,531.26 " 174.56 " 1,224.34 " 148.06 351.18 192.02 174.56 " 1,466.77 " 129.38 143.75 814.38 " 1,017.97 " 147.34 148.06 143.75 " 1,772.80 " 131.53 174.56 376.63 126.50 906.34 " 1,662.00 " 842.30 991.22 148.78 36923920 CULTURE HEMATOLOGIC 88237 300 "$2,233.00" 825.32 126.50 " 1,786.40 " 200.74 " 1,543.00 " 150.94 " 1,543.00 " 174.56 " 1,233.73 " 148.06 351.18 192.02 174.56 " 1,478.02 " 129.38 143.75 814.38 " 1,017.97 " 147.34 148.06 143.75 " 1,786.40 " 131.53 174.56 376.63 126.50 913.30 " 1,674.75 " 848.76 998.82 148.78 36936045 TISSUE CULTURE BONE MARROW 88237 300 $755.00 279.05 126.50 " 1,017.97 " 200.74 521.71 150.94 521.71 174.56 417.14 148.06 351.18 192.02 174.56 499.73 129.38 143.75 814.38 " 1,017.97 " 147.34 148.06 143.75 604.00 131.53 174.56 376.63 126.50 308.80 566.25 286.98 337.71 148.78 36981474 TISSUE CULTURE 88237 300 "$1,038.00" 383.64 126.50 " 1,017.97 " 200.74 717.26 150.94 717.26 174.56 573.50 148.06 351.18 192.02 174.56 687.05 129.38 143.75 814.38 " 1,017.97 " 147.34 148.06 143.75 830.40 131.53 174.56 376.63 126.50 424.54 778.50 394.54 464.30 148.78 36919892 TISSUE CULTURE;SOLID TUMOR 88239 300 "$1,458.00" 538.88 129.82 " 1,166.40 " 217.35 " 1,007.48 " 154.90 " 1,007.48 " 189.00 805.55 151.95 410.15 207.90 189.00 965.05 132.77 147.52 911.21 " 1,139.01 " 151.21 151.95 147.52 " 1,166.40 " 134.98 189.00 386.50 129.82 596.32 " 1,093.50 " 554.19 652.16 152.68 36927658 SOLID TUMOR CULTURE 88239 300 "$1,439.00" 531.85 129.82 " 1,151.20 " 217.35 994.35 154.90 994.35 189.00 795.05 151.95 410.15 207.90 189.00 952.47 132.77 147.52 911.21 " 1,139.01 " 151.21 151.95 147.52 " 1,151.20 " 134.98 189.00 386.50 129.82 588.55 " 1,079.25 " 546.96 643.66 152.68 36926775 CHROM COUNT 100 CELLS 88249 300 "$1,127.00" 416.54 152.39 " 1,362.99 " 220.18 778.76 181.83 778.76 191.46 622.67 178.37 481.49 210.61 191.46 745.96 155.85 173.17 " 1,090.39 " " 1,362.99 " 177.50 178.37 173.17 901.60 158.45 191.46 453.71 152.39 460.94 845.25 428.37 504.11 179.23 36907690 KARYOTYPE BLOOD 88262 300 "$2,282.00" 843.43 110.43 " 1,825.60 " 198.09 " 1,576.86 " 131.76 " 1,576.86 " 172.25 " 1,260.81 " 129.25 346.53 189.48 172.25 " 1,510.46 " 112.94 125.49 571.39 714.24 128.63 129.25 125.49 " 1,825.60 " 114.82 172.25 328.78 110.43 933.34 " 1,711.50 " 867.39 " 1,020.74 " 129.88 36907894 KARYOTYPE SKIN 88262 300 "$2,282.00" 843.43 110.43 " 1,825.60 " 198.09 " 1,576.86 " 131.76 " 1,576.86 " 172.25 " 1,260.81 " 129.25 346.53 189.48 172.25 " 1,510.46 " 112.94 125.49 571.39 714.24 128.63 129.25 125.49 " 1,825.60 " 114.82 172.25 328.78 110.43 933.34 " 1,711.50 " 867.39 " 1,020.74 " 129.88 36918501 KARYOTYPES BLOOD 88262 300 "$2,282.00" 843.43 110.43 " 1,825.60 " 198.09 " 1,576.86 " 131.76 " 1,576.86 " 172.25 " 1,260.81 " 129.25 346.53 189.48 172.25 " 1,510.46 " 112.94 125.49 571.39 714.24 128.63 129.25 125.49 " 1,825.60 " 114.82 172.25 328.78 110.43 933.34 " 1,711.50 " 867.39 " 1,020.74 " 129.88 36929251 CHROM COUNT 15-20 CELLS 88262 300 "$2,282.00" 843.43 110.43 " 1,825.60 " 198.09 " 1,576.86 " 131.76 " 1,576.86 " 172.25 " 1,260.81 " 129.25 346.53 189.48 172.25 " 1,510.46 " 112.94 125.49 571.39 714.24 128.63 129.25 125.49 " 1,825.60 " 114.82 172.25 328.78 110.43 933.34 " 1,711.50 " 867.39 " 1,020.74 " 129.88 36926805 CHROM COUNT 45 CELLS 88263 300 "$1,225.00" 452.76 132.26 " 1,211.15 " 238.82 846.48 157.80 846.48 207.67 676.81 154.80 417.84 228.44 207.67 810.83 135.26 150.29 968.92 " 1,211.15 " 154.05 154.80 150.29 980.00 137.52 207.67 393.76 132.26 501.03 918.75 465.62 547.94 155.55 36919833 ANALYZE 20-25 CELLS 88264 300 "$1,036.00" 382.91 127.26 980.99 158.47 715.88 151.84 715.88 137.80 572.39 148.95 346.53 151.58 137.80 685.73 130.15 144.61 784.79 980.99 148.23 148.95 144.61 828.80 132.32 137.80 378.88 127.26 423.72 777.00 393.78 463.40 149.67 36919868 ANALYZE 20-25 CELLS 88264 300 $759.00 280.53 127.26 980.99 158.47 524.47 151.84 524.47 137.80 419.35 148.95 346.53 151.58 137.80 502.38 130.15 144.61 784.79 980.99 148.23 148.95 144.61 607.20 132.32 137.80 378.88 127.26 310.43 569.25 288.50 339.50 149.67 36919906 ANALYZE 20-25 CELLS 88264 300 "$1,225.00" 452.76 127.26 980.99 158.47 846.48 151.84 846.48 137.80 676.81 148.95 346.53 151.58 137.80 810.83 130.15 144.61 784.79 980.99 148.23 148.95 144.61 980.00 132.32 137.80 378.88 127.26 501.03 918.75 465.62 547.94 149.67 36920157 ANALYZE 20-25 CELLS 88264 300 "$1,120.00" 413.95 127.26 980.99 158.47 773.92 151.84 773.92 137.80 618.80 148.95 346.53 151.58 137.80 741.33 130.15 144.61 784.79 980.99 148.23 148.95 144.61 896.00 132.32 137.80 378.88 127.26 458.08 840.00 425.71 500.98 149.67 36981482 CHROMOSOME ANAL 20 -25 CELLS 88264 300 "$1,038.00" 383.64 127.26 980.99 158.47 717.26 151.84 717.26 137.80 573.50 148.95 346.53 151.58 137.80 687.05 130.15 144.61 784.79 980.99 148.23 148.95 144.61 830.40 132.32 137.80 378.88 127.26 424.54 778.50 394.54 464.30 149.67 36923601 CHROMOSOME ANALYSIS PLACENTA 88267 300 "$1,776.00" 656.41 165.94 " 1,420.80 " 285.71 " 1,227.22 " 198.00 " 1,227.22 " 248.44 981.24 194.23 499.83 273.28 248.44 " 1,175.53 " 169.71 188.57 824.12 " 1,030.15 " 193.28 194.23 188.57 " 1,420.80 " 172.54 248.44 494.05 165.94 726.38 " 1,332.00 " 675.06 794.40 195.17 36907959 KARYOTYPE AMNIOTIC 88269 300 "$1,627.00" 601.34 152.82 " 1,340.45 " 264.33 " 1,124.26 " 182.34 " 1,124.26 " 229.85 898.92 178.87 462.43 252.84 229.85 " 1,076.91 " 156.29 173.66 " 1,072.36 " " 1,340.45 " 178.00 178.87 173.66 " 1,301.60 " 158.90 229.85 454.99 152.82 665.44 " 1,220.25 " 618.42 727.76 179.74 36923407 CHROMOSOME ANALYSIS 88269 300 $951.00 351.49 152.82 " 1,340.45 " 264.33 657.14 182.34 657.14 229.85 525.43 178.87 462.43 252.84 229.85 629.47 156.29 173.66 " 1,072.36 " " 1,340.45 " 178.00 178.87 173.66 760.80 158.90 229.85 454.99 152.82 388.96 713.25 361.48 425.38 179.74 36927836 CHROM ANAL AMNIOTIC FLUID 88269 300 $912.00 337.08 152.82 " 1,340.45 " 264.33 630.19 182.34 630.19 229.85 503.88 178.87 462.43 252.84 229.85 603.65 156.29 173.66 " 1,072.36 " " 1,340.45 " 178.00 178.87 173.66 729.60 158.90 229.85 454.99 152.82 373.01 684.00 346.65 407.94 179.74 36945443 KARYOTYPE AF CHROM ANALYSIS 88269 300 $912.00 337.08 152.82 " 1,340.45 " 264.33 630.19 182.34 630.19 229.85 503.88 178.87 462.43 252.84 229.85 603.65 156.29 173.66 " 1,072.36 " " 1,340.45 " 178.00 178.87 173.66 729.60 158.90 229.85 454.99 152.82 373.01 684.00 346.65 407.94 179.74 36919744 DNA PROBE EACH:FISH 88271 300 "$1,086.00" 401.39 - 868.80 - 750.43 22.49 750.43 - 600.02 22.06 59.53 - - 718.82 19.28 21.42 75.93 94.91 21.96 22.06 21.42 868.80 19.60 - 56.12 18.85 444.17 814.50 412.79 485.77 22.17 36920262 DNA PROBE 88271 300 $782.00 289.03 - 625.60 - 540.36 22.49 540.36 - 432.06 22.06 59.53 - - 517.61 19.28 21.42 75.93 94.91 21.96 22.06 21.42 625.60 19.60 - 56.12 18.85 319.84 586.50 297.24 349.79 22.17 36920327 DNA PROBE EACH 88271 300 $380.00 140.45 - 304.00 - 262.58 22.49 262.58 - 209.95 22.06 59.53 - - 251.52 19.28 21.42 75.93 94.91 21.96 22.06 21.42 304.00 19.60 - 56.12 18.85 155.42 285.00 144.44 169.97 22.17 36920335 DNA PROBE EACH 88271 300 $380.00 140.45 - 304.00 - 262.58 22.49 262.58 - 209.95 22.06 59.53 - - 251.52 19.28 21.42 75.93 94.91 21.96 22.06 21.42 304.00 19.60 - 56.12 18.85 155.42 285.00 144.44 169.97 22.17 36920343 DNA PROBE EACH 88271 300 $380.00 140.45 - 304.00 - 262.58 22.49 262.58 - 209.95 22.06 59.53 - - 251.52 19.28 21.42 75.93 94.91 21.96 22.06 21.42 304.00 19.60 - 56.12 18.85 155.42 285.00 144.44 169.97 22.17 36920351 DNA PROBE EACH 88271 300 $380.00 140.45 - 304.00 - 262.58 22.49 262.58 - 209.95 22.06 59.53 - - 251.52 19.28 21.42 75.93 94.91 21.96 22.06 21.42 304.00 19.60 - 56.12 18.85 155.42 285.00 144.44 169.97 22.17 36920360 DNA PROBE EACH 88271 300 $380.00 140.45 - 304.00 - 262.58 22.49 262.58 - 209.95 22.06 59.53 - - 251.52 19.28 21.42 75.93 94.91 21.96 22.06 21.42 304.00 19.60 - 56.12 18.85 155.42 285.00 144.44 169.97 22.17 36920378 DNA PROBE EACH 88271 300 $380.00 140.45 - 304.00 - 262.58 22.49 262.58 - 209.95 22.06 59.53 - - 251.52 19.28 21.42 75.93 94.91 21.96 22.06 21.42 304.00 19.60 - 56.12 18.85 155.42 285.00 144.44 169.97 22.17 36920386 DNA PROBE EACH 88271 300 $380.00 140.45 - 304.00 - 262.58 22.49 262.58 - 209.95 22.06 59.53 - - 251.52 19.28 21.42 75.93 94.91 21.96 22.06 21.42 304.00 19.60 - 56.12 18.85 155.42 285.00 144.44 169.97 22.17 36920394 DNA PROBE EACH 88271 300 $380.00 140.45 - 304.00 - 262.58 22.49 262.58 - 209.95 22.06 59.53 - - 251.52 19.28 21.42 75.93 94.91 21.96 22.06 21.42 304.00 19.60 - 56.12 18.85 155.42 285.00 144.44 169.97 22.17 36920408 DNA PROBE EACH 88271 300 $380.00 140.45 - 304.00 - 262.58 22.49 262.58 - 209.95 22.06 59.53 - - 251.52 19.28 21.42 75.93 94.91 21.96 22.06 21.42 304.00 19.60 - 56.12 18.85 155.42 285.00 144.44 169.97 22.17 36920416 DNA PROBE EACH 88271 300 $380.00 140.45 - 304.00 - 262.58 22.49 262.58 - 209.95 22.06 59.53 - - 251.52 19.28 21.42 75.93 94.91 21.96 22.06 21.42 304.00 19.60 - 56.12 18.85 155.42 285.00 144.44 169.97 22.17 36920424 DNA PROBE EACH 88271 300 $380.00 140.45 - 304.00 - 262.58 22.49 262.58 - 209.95 22.06 59.53 - - 251.52 19.28 21.42 75.93 94.91 21.96 22.06 21.42 304.00 19.60 - 56.12 18.85 155.42 285.00 144.44 169.97 22.17 36920432 DNA PROBE EACH 88271 300 $380.00 140.45 - 304.00 - 262.58 22.49 262.58 - 209.95 22.06 59.53 - - 251.52 19.28 21.42 75.93 94.91 21.96 22.06 21.42 304.00 19.60 - 56.12 18.85 155.42 285.00 144.44 169.97 22.17 36920441 DNA PROBE EACH 88271 300 $380.00 140.45 - 304.00 - 262.58 22.49 262.58 - 209.95 22.06 59.53 - - 251.52 19.28 21.42 75.93 94.91 21.96 22.06 21.42 304.00 19.60 - 56.12 18.85 155.42 285.00 144.44 169.97 22.17 36920459 DNA PROBE EACH 88271 300 $380.00 140.45 - 304.00 - 262.58 22.49 262.58 - 209.95 22.06 59.53 - - 251.52 19.28 21.42 75.93 94.91 21.96 22.06 21.42 304.00 19.60 - 56.12 18.85 155.42 285.00 144.44 169.97 22.17 36920467 DNA PROBE EACH 88271 300 $380.00 140.45 - 304.00 - 262.58 22.49 262.58 - 209.95 22.06 59.53 - - 251.52 19.28 21.42 75.93 94.91 21.96 22.06 21.42 304.00 19.60 - 56.12 18.85 155.42 285.00 144.44 169.97 22.17 36920475 DNA PROBE EACH 88271 300 $380.00 140.45 - 304.00 - 262.58 22.49 262.58 - 209.95 22.06 59.53 - - 251.52 19.28 21.42 75.93 94.91 21.96 22.06 21.42 304.00 19.60 - 56.12 18.85 155.42 285.00 144.44 169.97 22.17 36920483 DNA PROBE EACH 88271 300 $380.00 140.45 - 304.00 - 262.58 22.49 262.58 - 209.95 22.06 59.53 - - 251.52 19.28 21.42 75.93 94.91 21.96 22.06 21.42 304.00 19.60 - 56.12 18.85 155.42 285.00 144.44 169.97 22.17 36920491 DNA PROBE EACH 88271 300 $476.00 175.93 - 380.80 - 328.92 22.49 328.92 - 262.99 22.06 59.53 - - 315.06 19.28 21.42 75.93 94.91 21.96 22.06 21.42 380.80 19.60 - 56.12 18.85 194.68 357.00 180.93 212.91 22.17 36920505 DNA PROBE EACH 88271 300 $476.00 175.93 - 380.80 - 328.92 22.49 328.92 - 262.99 22.06 59.53 - - 315.06 19.28 21.42 75.93 94.91 21.96 22.06 21.42 380.80 19.60 - 56.12 18.85 194.68 357.00 180.93 212.91 22.17 36920530 DNA PROBE 88271 300 $740.00 273.50 - 592.00 - 511.34 22.49 511.34 - 408.85 22.06 59.53 - - 489.81 19.28 21.42 75.93 94.91 21.96 22.06 21.42 592.00 19.60 - 56.12 18.85 302.66 555.00 281.27 331.00 22.17 36920564 DNA PROBE EACH 88271 300 $663.00 245.04 - 530.40 - 458.13 22.49 458.13 - 366.31 22.06 59.53 - - 438.84 19.28 21.42 75.93 94.91 21.96 22.06 21.42 530.40 19.60 - 56.12 18.85 271.17 497.25 252.01 296.56 22.17 36920572 DNA PROBE EACH 88271 300 $663.00 245.04 - 530.40 - 458.13 22.49 458.13 - 366.31 22.06 59.53 - - 438.84 19.28 21.42 75.93 94.91 21.96 22.06 21.42 530.40 19.60 - 56.12 18.85 271.17 497.25 252.01 296.56 22.17 36920602 DNA PROBE EACH 88271 300 $691.00 255.39 - 552.80 - 477.48 22.49 477.48 - 381.78 22.06 59.53 - - 457.37 19.28 21.42 75.93 94.91 21.96 22.06 21.42 552.80 19.60 - 56.12 18.85 282.62 518.25 262.65 309.08 22.17 36920611 DNA PROBE EACH 88271 300 $691.00 255.39 - 552.80 - 477.48 22.49 477.48 - 381.78 22.06 59.53 - - 457.37 19.28 21.42 75.93 94.91 21.96 22.06 21.42 552.80 19.60 - 56.12 18.85 282.62 518.25 262.65 309.08 22.17 36923326 CYTOGENETICS DNA PROBE 88271 300 $309.00 114.21 - 247.20 - 213.52 22.49 213.52 - 170.72 22.06 59.53 - - 204.53 19.28 21.42 75.93 94.91 21.96 22.06 21.42 247.20 19.60 - 56.12 18.85 126.38 231.75 117.45 138.22 22.17 36923334 CYTOGENETICS DNA PROBE 88271 300 $309.00 114.21 - 247.20 - 213.52 22.49 213.52 - 170.72 22.06 59.53 - - 204.53 19.28 21.42 75.93 94.91 21.96 22.06 21.42 247.20 19.60 - 56.12 18.85 126.38 231.75 117.45 138.22 22.17 36923342 CYTOGENETICS DNA PROBE 88271 300 $309.00 114.21 - 247.20 - 213.52 22.49 213.52 - 170.72 22.06 59.53 - - 204.53 19.28 21.42 75.93 94.91 21.96 22.06 21.42 247.20 19.60 - 56.12 18.85 126.38 231.75 117.45 138.22 22.17 36923351 CYTOGENETICS DNA PROBE 88271 300 $309.00 114.21 - 247.20 - 213.52 22.49 213.52 - 170.72 22.06 59.53 - - 204.53 19.28 21.42 75.93 94.91 21.96 22.06 21.42 247.20 19.60 - 56.12 18.85 126.38 231.75 117.45 138.22 22.17 36923369 CYTOGENETICS DNA PROBE 88271 300 $309.00 114.21 - 247.20 - 213.52 22.49 213.52 - 170.72 22.06 59.53 - - 204.53 19.28 21.42 75.93 94.91 21.96 22.06 21.42 247.20 19.60 - 56.12 18.85 126.38 231.75 117.45 138.22 22.17 36923474 CYTOLOGY DNA PROBE 88271 300 $327.00 120.86 - 261.60 - 225.96 22.49 225.96 - 180.67 22.06 59.53 - - 216.44 19.28 21.42 75.93 94.91 21.96 22.06 21.42 261.60 19.60 - 56.12 18.85 133.74 245.25 124.29 146.27 22.17 36923482 CYTOLOGY DNA PROBE 88271 300 $327.00 120.86 - 261.60 - 225.96 22.49 225.96 - 180.67 22.06 59.53 - - 216.44 19.28 21.42 75.93 94.91 21.96 22.06 21.42 261.60 19.60 - 56.12 18.85 133.74 245.25 124.29 146.27 22.17 36923563 MOLECULAR CYTOG DNA PROBE 88271 300 $692.00 255.76 - 553.60 - 478.17 22.49 478.17 - 382.33 22.06 59.53 - - 458.03 19.28 21.42 75.93 94.91 21.96 22.06 21.42 553.60 19.60 - 56.12 18.85 283.03 519.00 263.03 309.53 22.17 36923946 DNA PROBE EACH 88271 300 $380.00 140.45 - 304.00 - 262.58 22.49 262.58 - 209.95 22.06 59.53 - - 251.52 19.28 21.42 75.93 94.91 21.96 22.06 21.42 304.00 19.60 - 56.12 18.85 155.42 285.00 144.44 169.97 22.17 36926732 MOLECULAR CYTO DNA PROBE 88271 300 $422.00 155.97 - 337.60 - 291.60 22.49 291.60 - 233.16 22.06 59.53 - - 279.32 19.28 21.42 75.93 94.91 21.96 22.06 21.42 337.60 19.60 - 56.12 18.85 172.60 316.50 160.40 188.76 22.17 36926821 MOLECULAR CYTO DNA PROBE 88271 300 $161.00 59.51 - 128.80 - 111.25 22.49 111.25 - 88.95 22.06 59.53 - - 106.57 19.28 21.42 75.93 94.91 21.96 22.06 21.42 128.80 19.60 - 56.12 18.85 65.85 120.75 61.20 72.02 22.17 36926830 MOLECULAR CYTO DNA PROBE 88271 300 $161.00 59.51 - 128.80 - 111.25 22.49 111.25 - 88.95 22.06 59.53 - - 106.57 19.28 21.42 75.93 94.91 21.96 22.06 21.42 128.80 19.60 - 56.12 18.85 65.85 120.75 61.20 72.02 22.17 36926848 MOLECULAR CYTO DNA PROBE 88271 300 $161.00 59.51 - 128.80 - 111.25 22.49 111.25 - 88.95 22.06 59.53 - - 106.57 19.28 21.42 75.93 94.91 21.96 22.06 21.42 128.80 19.60 - 56.12 18.85 65.85 120.75 61.20 72.02 22.17 36926856 MOLECULAR CYTO DNA PROBE 88271 300 $161.00 59.51 - 128.80 - 111.25 22.49 111.25 - 88.95 22.06 59.53 - - 106.57 19.28 21.42 75.93 94.91 21.96 22.06 21.42 128.80 19.60 - 56.12 18.85 65.85 120.75 61.20 72.02 22.17 36926864 MOLECULAR CYTO DNA PROBE 88271 300 $161.00 59.51 - 128.80 - 111.25 22.49 111.25 - 88.95 22.06 59.53 - - 106.57 19.28 21.42 75.93 94.91 21.96 22.06 21.42 128.80 19.60 - 56.12 18.85 65.85 120.75 61.20 72.02 22.17 36926872 MOLECULAR CYTO DNA PROBE 88271 300 $161.00 59.51 - 128.80 - 111.25 22.49 111.25 - 88.95 22.06 59.53 - - 106.57 19.28 21.42 75.93 94.91 21.96 22.06 21.42 128.80 19.60 - 56.12 18.85 65.85 120.75 61.20 72.02 22.17 36926881 MOLECULAR CYTO DNA PROBE 88271 300 $161.00 59.51 - 128.80 - 111.25 22.49 111.25 - 88.95 22.06 59.53 - - 106.57 19.28 21.42 75.93 94.91 21.96 22.06 21.42 128.80 19.60 - 56.12 18.85 65.85 120.75 61.20 72.02 22.17 36926937 MOLECULAR CYTO DNA PROBE 88271 300 $315.00 116.42 - 252.00 - 217.67 22.49 217.67 - 174.04 22.06 59.53 - - 208.50 19.28 21.42 75.93 94.91 21.96 22.06 21.42 252.00 19.60 - 56.12 18.85 128.84 236.25 119.73 140.90 22.17 36926945 MOLECULAR CYTO DNA PROBE 88271 300 $315.00 116.42 - 252.00 - 217.67 22.49 217.67 - 174.04 22.06 59.53 - - 208.50 19.28 21.42 75.93 94.91 21.96 22.06 21.42 252.00 19.60 - 56.12 18.85 128.84 236.25 119.73 140.90 22.17 36926953 MOLECULAR CYTO DNA PROBE 88271 300 $315.00 116.42 - 252.00 - 217.67 22.49 217.67 - 174.04 22.06 59.53 - - 208.50 19.28 21.42 75.93 94.91 21.96 22.06 21.42 252.00 19.60 - 56.12 18.85 128.84 236.25 119.73 140.90 22.17 36926988 MOLECULAR CYTO DNA PROBE 88271 300 $243.00 89.81 - 194.40 - 167.91 22.49 167.91 - 134.26 22.06 59.53 - - 160.84 19.28 21.42 75.93 94.91 21.96 22.06 21.42 194.40 19.60 - 56.12 18.85 99.39 182.25 92.36 108.69 22.17 36926996 MOLECULAR CYTO DNA PROBE 88271 300 $243.00 89.81 - 194.40 - 167.91 22.49 167.91 - 134.26 22.06 59.53 - - 160.84 19.28 21.42 75.93 94.91 21.96 22.06 21.42 194.40 19.60 - 56.12 18.85 99.39 182.25 92.36 108.69 22.17 36927003 MOLECULAR CYTO DNA PROBE 88271 300 $243.00 89.81 - 194.40 - 167.91 22.49 167.91 - 134.26 22.06 59.53 - - 160.84 19.28 21.42 75.93 94.91 21.96 22.06 21.42 194.40 19.60 - 56.12 18.85 99.39 182.25 92.36 108.69 22.17 36927038 MOLECULAR CYTO DNA PROBE 88271 300 $161.00 59.51 - 128.80 - 111.25 22.49 111.25 - 88.95 22.06 59.53 - - 106.57 19.28 21.42 75.93 94.91 21.96 22.06 21.42 128.80 19.60 - 56.12 18.85 65.85 120.75 61.20 72.02 22.17 36927046 MOLECULAR CYTO DNA PROBE 88271 300 $161.00 59.51 - 128.80 - 111.25 22.49 111.25 - 88.95 22.06 59.53 - - 106.57 19.28 21.42 75.93 94.91 21.96 22.06 21.42 128.80 19.60 - 56.12 18.85 65.85 120.75 61.20 72.02 22.17 36927054 MOLECULAR CYTO DNA PROBE 88271 300 $161.00 59.51 - 128.80 - 111.25 22.49 111.25 - 88.95 22.06 59.53 - - 106.57 19.28 21.42 75.93 94.91 21.96 22.06 21.42 128.80 19.60 - 56.12 18.85 65.85 120.75 61.20 72.02 22.17 36927062 MOLECULAR CYTO DNA PROBE 88271 300 $161.00 59.51 - 128.80 - 111.25 22.49 111.25 - 88.95 22.06 59.53 - - 106.57 19.28 21.42 75.93 94.91 21.96 22.06 21.42 128.80 19.60 - 56.12 18.85 65.85 120.75 61.20 72.02 22.17 36927127 MOLECULAR CYTO DNA PROBE 88271 300 $565.00 208.82 - 452.00 - 390.42 22.49 390.42 - 312.16 22.06 59.53 - - 373.97 19.28 21.42 75.93 94.91 21.96 22.06 21.42 452.00 19.60 - 56.12 18.85 231.09 423.75 214.76 252.72 22.17 36927135 MOLECULAR CYTO DNA PROBE 88271 300 $565.00 208.82 - 452.00 - 390.42 22.49 390.42 - 312.16 22.06 59.53 - - 373.97 19.28 21.42 75.93 94.91 21.96 22.06 21.42 452.00 19.60 - 56.12 18.85 231.09 423.75 214.76 252.72 22.17 36927160 MOLECULAR CYTO DNA PROBE 88271 300 $326.00 120.49 - 260.80 - 225.27 22.49 225.27 - 180.12 22.06 59.53 - - 215.78 19.28 21.42 75.93 94.91 21.96 22.06 21.42 260.80 19.60 - 56.12 18.85 133.33 244.50 123.91 145.82 22.17 36927178 MOLECULAR CYTO DNA PROBE 88271 300 $326.00 120.49 - 260.80 - 225.27 22.49 225.27 - 180.12 22.06 59.53 - - 215.78 19.28 21.42 75.93 94.91 21.96 22.06 21.42 260.80 19.60 - 56.12 18.85 133.33 244.50 123.91 145.82 22.17 36927208 MOLECULAR CYTO DNA PROBE 88271 300 $251.00 92.77 - 200.80 - 173.44 22.49 173.44 - 138.68 22.06 59.53 - - 166.14 19.28 21.42 75.93 94.91 21.96 22.06 21.42 200.80 19.60 - 56.12 18.85 102.66 188.25 95.41 112.27 22.17 36927216 MOLECULAR CYTO DNA PROBE 88271 300 $251.00 92.77 - 200.80 - 173.44 22.49 173.44 - 138.68 22.06 59.53 - - 166.14 19.28 21.42 75.93 94.91 21.96 22.06 21.42 200.80 19.60 - 56.12 18.85 102.66 188.25 95.41 112.27 22.17 36927241 MOLECULAR CYTO DNA PROBE 88271 300 $326.00 120.49 - 260.80 - 225.27 22.49 225.27 - 180.12 22.06 59.53 - - 215.78 19.28 21.42 75.93 94.91 21.96 22.06 21.42 260.80 19.60 - 56.12 18.85 133.33 244.50 123.91 145.82 22.17 36927259 MOLECULAR CYTO DNA PROBE 88271 300 $326.00 120.49 - 260.80 - 225.27 22.49 225.27 - 180.12 22.06 59.53 - - 215.78 19.28 21.42 75.93 94.91 21.96 22.06 21.42 260.80 19.60 - 56.12 18.85 133.33 244.50 123.91 145.82 22.17 36927666 MOL CYTO DNA PROBE 88271 300 $309.00 114.21 - 247.20 - 213.52 22.49 213.52 - 170.72 22.06 59.53 - - 204.53 19.28 21.42 75.93 94.91 21.96 22.06 21.42 247.20 19.60 - 56.12 18.85 126.38 231.75 117.45 138.22 22.17 36927674 MOL CYTO DNA PROBE 88271 300 $309.00 114.21 - 247.20 - 213.52 22.49 213.52 - 170.72 22.06 59.53 - - 204.53 19.28 21.42 75.93 94.91 21.96 22.06 21.42 247.20 19.60 - 56.12 18.85 126.38 231.75 117.45 138.22 22.17 36927682 MOL CYTO DNA PROBE 88271 300 $309.00 114.21 - 247.20 - 213.52 22.49 213.52 - 170.72 22.06 59.53 - - 204.53 19.28 21.42 75.93 94.91 21.96 22.06 21.42 247.20 19.60 - 56.12 18.85 126.38 231.75 117.45 138.22 22.17 36927712 MOL CYTO DNA PROBE 88271 300 $549.00 202.91 - 439.20 - 379.36 22.49 379.36 - 303.32 22.06 59.53 - - 363.38 19.28 21.42 75.93 94.91 21.96 22.06 21.42 439.20 19.60 - 56.12 18.85 224.54 411.75 208.67 245.57 22.17 36927721 MOL CYTO DNA PROBE 88271 300 $549.00 202.91 - 439.20 - 379.36 22.49 379.36 - 303.32 22.06 59.53 - - 363.38 19.28 21.42 75.93 94.91 21.96 22.06 21.42 439.20 19.60 - 56.12 18.85 224.54 411.75 208.67 245.57 22.17 36927739 MOL CYTO DNA PROBE 88271 300 $549.00 202.91 - 439.20 - 379.36 22.49 379.36 - 303.32 22.06 59.53 - - 363.38 19.28 21.42 75.93 94.91 21.96 22.06 21.42 439.20 19.60 - 56.12 18.85 224.54 411.75 208.67 245.57 22.17 36927747 MOL CYTO DNA PROBE 88271 300 $549.00 202.91 - 439.20 - 379.36 22.49 379.36 - 303.32 22.06 59.53 - - 363.38 19.28 21.42 75.93 94.91 21.96 22.06 21.42 439.20 19.60 - 56.12 18.85 224.54 411.75 208.67 245.57 22.17 36927755 MOL CYTO DNA PROBE 88271 300 $549.00 202.91 - 439.20 - 379.36 22.49 379.36 - 303.32 22.06 59.53 - - 363.38 19.28 21.42 75.93 94.91 21.96 22.06 21.42 439.20 19.60 - 56.12 18.85 224.54 411.75 208.67 245.57 22.17 36927763 MOL CYTO DNA PROBE 88271 300 $549.00 202.91 - 439.20 - 379.36 22.49 379.36 - 303.32 22.06 59.53 - - 363.38 19.28 21.42 75.93 94.91 21.96 22.06 21.42 439.20 19.60 - 56.12 18.85 224.54 411.75 208.67 245.57 22.17 36927861 MOLECULAR CYTO DNA PROBE 88271 300 $297.00 109.77 - 237.60 - 205.23 22.49 205.23 - 164.09 22.06 59.53 - - 196.58 19.28 21.42 75.93 94.91 21.96 22.06 21.42 237.60 19.60 - 56.12 18.85 121.47 222.75 112.89 132.85 22.17 36927879 MOLECULAR CYTO DNA PROBE 88271 300 $297.00 109.77 - 237.60 - 205.23 22.49 205.23 - 164.09 22.06 59.53 - - 196.58 19.28 21.42 75.93 94.91 21.96 22.06 21.42 237.60 19.60 - 56.12 18.85 121.47 222.75 112.89 132.85 22.17 36927909 MOL CYTO DNA PROBE 88271 300 $398.00 147.10 - 318.40 - 275.02 22.49 275.02 - 219.90 22.06 59.53 - - 263.44 19.28 21.42 75.93 94.91 21.96 22.06 21.42 318.40 19.60 - 56.12 18.85 162.78 298.50 151.28 178.03 22.17 36927933 MOL CYTO DNA PROBE 88271 300 $400.00 147.84 - 320.00 - 276.40 22.49 276.40 - 221.00 22.06 59.53 - - 264.76 19.28 21.42 75.93 94.91 21.96 22.06 21.42 320.00 19.60 - 56.12 18.85 163.60 300.00 152.04 178.92 22.17 36927968 MOL CYTO DNA PROBE 88271 300 $289.00 106.81 - 231.20 - 199.70 22.49 199.70 - 159.67 22.06 59.53 - - 191.29 19.28 21.42 75.93 94.91 21.96 22.06 21.42 231.20 19.60 - 56.12 18.85 118.20 216.75 109.85 129.27 22.17 36927976 MOL CYTO DNA PROBE 88271 300 $289.00 106.81 - 231.20 - 199.70 22.49 199.70 - 159.67 22.06 59.53 - - 191.29 19.28 21.42 75.93 94.91 21.96 22.06 21.42 231.20 19.60 - 56.12 18.85 118.20 216.75 109.85 129.27 22.17 36928000 MOL CYTO DNA PROBE 88271 300 $347.00 128.25 - 277.60 - 239.78 22.49 239.78 - 191.72 22.06 59.53 - - 229.68 19.28 21.42 75.93 94.91 21.96 22.06 21.42 277.60 19.60 - 56.12 18.85 141.92 260.25 131.89 155.21 22.17 36928018 MOL CYTO DNA PROBE 88271 300 $347.00 128.25 - 277.60 - 239.78 22.49 239.78 - 191.72 22.06 59.53 - - 229.68 19.28 21.42 75.93 94.91 21.96 22.06 21.42 277.60 19.60 - 56.12 18.85 141.92 260.25 131.89 155.21 22.17 36928042 MOL CYTO DNA PROBE 88271 300 $476.00 175.93 - 380.80 - 328.92 22.49 328.92 - 262.99 22.06 59.53 - - 315.06 19.28 21.42 75.93 94.91 21.96 22.06 21.42 380.80 19.60 - 56.12 18.85 194.68 357.00 180.93 212.91 22.17 36928077 MOL CYTO DNA PROBE 88271 300 $350.00 129.36 - 280.00 - 241.85 22.49 241.85 - 193.38 22.06 59.53 - - 231.67 19.28 21.42 75.93 94.91 21.96 22.06 21.42 280.00 19.60 - 56.12 18.85 143.15 262.50 133.04 156.56 22.17 36928107 MOL CYTO DNA PROBE 88271 300 $573.00 211.78 - 458.40 - 395.94 22.49 395.94 - 316.58 22.06 59.53 - - 379.27 19.28 21.42 75.93 94.91 21.96 22.06 21.42 458.40 19.60 - 56.12 18.85 234.36 429.75 217.80 256.30 22.17 36928182 MOL CYTO DNA PROBE 88271 300 $240.00 88.70 - 192.00 - 165.84 22.49 165.84 - 132.60 22.06 59.53 - - 158.86 19.28 21.42 75.93 94.91 21.96 22.06 21.42 192.00 19.60 - 56.12 18.85 98.16 180.00 91.22 107.35 22.17 36928212 MOL CYTO DNA PROBE 88271 300 $350.00 129.36 - 280.00 - 241.85 22.49 241.85 - 193.38 22.06 59.53 - - 231.67 19.28 21.42 75.93 94.91 21.96 22.06 21.42 280.00 19.60 - 56.12 18.85 143.15 262.50 133.04 156.56 22.17 36928221 MOL CYTO DNA PROBE 88271 300 $350.00 129.36 - 280.00 - 241.85 22.49 241.85 - 193.38 22.06 59.53 - - 231.67 19.28 21.42 75.93 94.91 21.96 22.06 21.42 280.00 19.60 - 56.12 18.85 143.15 262.50 133.04 156.56 22.17 36928859 MOLECULAR CYTO DNA PROBE 88271 300 $269.00 99.42 - 215.20 - 185.88 22.49 185.88 - 148.62 22.06 59.53 - - 178.05 19.28 21.42 75.93 94.91 21.96 22.06 21.42 215.20 19.60 - 56.12 18.85 110.02 201.75 102.25 120.32 22.17 36928867 MOLECULAR CYTO DNA PROBE 88271 300 $269.00 99.42 - 215.20 - 185.88 22.49 185.88 - 148.62 22.06 59.53 - - 178.05 19.28 21.42 75.93 94.91 21.96 22.06 21.42 215.20 19.60 - 56.12 18.85 110.02 201.75 102.25 120.32 22.17 36928913 MOL CYTO DNA PROBE 88271 300 $500.00 184.80 - 400.00 - 345.50 22.49 345.50 - 276.25 22.06 59.53 - - 330.95 19.28 21.42 75.93 94.91 21.96 22.06 21.42 400.00 19.60 - 56.12 18.85 204.50 375.00 190.05 223.65 22.17 36929413 CYTOLOGY DNA PROBE 88271 300 $270.00 99.79 - 216.00 - 186.57 22.49 186.57 - 149.18 22.06 59.53 - - 178.71 19.28 21.42 75.93 94.91 21.96 22.06 21.42 216.00 19.60 - 56.12 18.85 110.43 202.50 102.63 120.77 22.17 36929421 MOL CYTO DNA PROBE 88271 300 $364.00 134.53 - 291.20 - 251.52 22.49 251.52 - 201.11 22.06 59.53 - - 240.93 19.28 21.42 75.93 94.91 21.96 22.06 21.42 291.20 19.60 - 56.12 18.85 148.88 273.00 138.36 162.82 22.17 36929430 MOL CYTO DNA PROBE 88271 300 $364.00 134.53 - 291.20 - 251.52 22.49 251.52 - 201.11 22.06 59.53 - - 240.93 19.28 21.42 75.93 94.91 21.96 22.06 21.42 291.20 19.60 - 56.12 18.85 148.88 273.00 138.36 162.82 22.17 36929464 MOL CYTO DNA PROBE 88271 300 $378.00 139.71 - 302.40 - 261.20 22.49 261.20 - 208.85 22.06 59.53 - - 250.20 19.28 21.42 75.93 94.91 21.96 22.06 21.42 302.40 19.60 - 56.12 18.85 154.60 283.50 143.68 169.08 22.17 36929472 MOL CYTO DNA PROBE 88271 300 $380.00 140.45 - 304.00 - 262.58 22.49 262.58 - 209.95 22.06 59.53 - - 251.52 19.28 21.42 75.93 94.91 21.96 22.06 21.42 304.00 19.60 - 56.12 18.85 155.42 285.00 144.44 169.97 22.17 36929529 MOL CYTO DNA PROBE 88271 300 $232.00 85.75 - 185.60 - 160.31 22.49 160.31 - 128.18 22.06 59.53 - - 153.56 19.28 21.42 75.93 94.91 21.96 22.06 21.42 185.60 19.60 - 56.12 18.85 94.89 174.00 88.18 103.77 22.17 36929537 MOL CYTO DNA PROBE 88271 300 $232.00 85.75 - 185.60 - 160.31 22.49 160.31 - 128.18 22.06 59.53 - - 153.56 19.28 21.42 75.93 94.91 21.96 22.06 21.42 185.60 19.60 - 56.12 18.85 94.89 174.00 88.18 103.77 22.17 36929545 MOL CYTO DNA PROBE 88271 300 $229.00 84.64 - 183.20 - 158.24 22.49 158.24 - 126.52 22.06 59.53 - - 151.58 19.28 21.42 75.93 94.91 21.96 22.06 21.42 183.20 19.60 - 56.12 18.85 93.66 171.75 87.04 102.43 22.17 36929553 MOL CYTO DNA PROBE 88271 300 $232.00 85.75 - 185.60 - 160.31 22.49 160.31 - 128.18 22.06 59.53 - - 153.56 19.28 21.42 75.93 94.91 21.96 22.06 21.42 185.60 19.60 - 56.12 18.85 94.89 174.00 88.18 103.77 22.17 36929561 MOL CYTO DNA PROBE 88271 300 $232.00 85.75 - 185.60 - 160.31 22.49 160.31 - 128.18 22.06 59.53 - - 153.56 19.28 21.42 75.93 94.91 21.96 22.06 21.42 185.60 19.60 - 56.12 18.85 94.89 174.00 88.18 103.77 22.17 36929570 MOL CYTO DNA PROBE 88271 300 $232.00 85.75 - 185.60 - 160.31 22.49 160.31 - 128.18 22.06 59.53 - - 153.56 19.28 21.42 75.93 94.91 21.96 22.06 21.42 185.60 19.60 - 56.12 18.85 94.89 174.00 88.18 103.77 22.17 36929588 MOL CYTO DNA PROBE 88271 300 $232.00 85.75 - 185.60 - 160.31 22.49 160.31 - 128.18 22.06 59.53 - - 153.56 19.28 21.42 75.93 94.91 21.96 22.06 21.42 185.60 19.60 - 56.12 18.85 94.89 174.00 88.18 103.77 22.17 36929596 MOL CYTO DNA PROBE 88271 300 $232.00 85.75 - 185.60 - 160.31 22.49 160.31 - 128.18 22.06 59.53 - - 153.56 19.28 21.42 75.93 94.91 21.96 22.06 21.42 185.60 19.60 - 56.12 18.85 94.89 174.00 88.18 103.77 22.17 36929600 MOL CYTO DNA PROBE 88271 300 $232.00 85.75 - 185.60 - 160.31 22.49 160.31 - 128.18 22.06 59.53 - - 153.56 19.28 21.42 75.93 94.91 21.96 22.06 21.42 185.60 19.60 - 56.12 18.85 94.89 174.00 88.18 103.77 22.17 36929669 MOL CYTO DNA PROBE 88271 300 $371.00 137.12 - 296.80 - 256.36 22.49 256.36 - 204.98 22.06 59.53 - - 245.56 19.28 21.42 75.93 94.91 21.96 22.06 21.42 296.80 19.60 - 56.12 18.85 151.74 278.25 141.02 165.95 22.17 36929677 MOL CYTO DNA PROBE 88271 300 $371.00 137.12 - 296.80 - 256.36 22.49 256.36 - 204.98 22.06 59.53 - - 245.56 19.28 21.42 75.93 94.91 21.96 22.06 21.42 296.80 19.60 - 56.12 18.85 151.74 278.25 141.02 165.95 22.17 36929685 MOL CYTO DNA PROBE 88271 300 $371.00 137.12 - 296.80 - 256.36 22.49 256.36 - 204.98 22.06 59.53 - - 245.56 19.28 21.42 75.93 94.91 21.96 22.06 21.42 296.80 19.60 - 56.12 18.85 151.74 278.25 141.02 165.95 22.17 36929731 MOL CYTO DNA PROBE 88271 300 $461.00 170.39 - 368.80 - 318.55 22.49 318.55 - 254.70 22.06 59.53 - - 305.14 19.28 21.42 75.93 94.91 21.96 22.06 21.42 368.80 19.60 - 56.12 18.85 188.55 345.75 175.23 206.21 22.17 36929847 MOL CYTO DNA PROBE 88271 300 $240.00 88.70 - 192.00 - 165.84 22.49 165.84 - 132.60 22.06 59.53 - - 158.86 19.28 21.42 75.93 94.91 21.96 22.06 21.42 192.00 19.60 - 56.12 18.85 98.16 180.00 91.22 107.35 22.17 36933038 MOLECULAR CYTO DNA PROBE EA 88271 300 $161.00 59.51 - 128.80 - 111.25 22.49 111.25 - 88.95 22.06 59.53 - - 106.57 19.28 21.42 75.93 94.91 21.96 22.06 21.42 128.80 19.60 - 56.12 18.85 65.85 120.75 61.20 72.02 22.17 36938315 MOLECULAR CYTOGEN DNA PROBE 88271 300 $323.00 119.38 - 258.40 - 223.19 22.49 223.19 - 178.46 22.06 59.53 - - 213.79 19.28 21.42 75.93 94.91 21.96 22.06 21.42 258.40 19.60 - 56.12 18.85 132.11 242.25 122.77 144.48 22.17 36938323 MOLECULAR CYTOGEN DNA PROBE 88271 300 $323.00 119.38 - 258.40 - 223.19 22.49 223.19 - 178.46 22.06 59.53 - - 213.79 19.28 21.42 75.93 94.91 21.96 22.06 21.42 258.40 19.60 - 56.12 18.85 132.11 242.25 122.77 144.48 22.17 36945338 MOLECULAR CYTO DNA PRB FISH PH 88271 300 $292.00 107.92 - 233.60 - 201.77 22.49 201.77 - 161.33 22.06 59.53 - - 193.27 19.28 21.42 75.93 94.91 21.96 22.06 21.42 233.60 19.60 - 56.12 18.85 119.43 219.00 110.99 130.61 22.17 36945346 MOLECULAR CYTO DNA PRB FISH PH 88271 300 $292.00 107.92 - 233.60 - 201.77 22.49 201.77 - 161.33 22.06 59.53 - - 193.27 19.28 21.42 75.93 94.91 21.96 22.06 21.42 233.60 19.60 - 56.12 18.85 119.43 219.00 110.99 130.61 22.17 36945354 MOLECULAR CYTO DNA PRB FISH PH 88271 300 $292.00 107.92 - 233.60 - 201.77 22.49 201.77 - 161.33 22.06 59.53 - - 193.27 19.28 21.42 75.93 94.91 21.96 22.06 21.42 233.60 19.60 - 56.12 18.85 119.43 219.00 110.99 130.61 22.17 36945362 MOLECULAR CYTO DNA PRB FISH PH 88271 300 $292.00 107.92 - 233.60 - 201.77 22.49 201.77 - 161.33 22.06 59.53 - - 193.27 19.28 21.42 75.93 94.91 21.96 22.06 21.42 233.60 19.60 - 56.12 18.85 119.43 219.00 110.99 130.61 22.17 36945371 MOLECULAR CYTO DNA PRB FISH PH 88271 300 $292.00 107.92 - 233.60 - 201.77 22.49 201.77 - 161.33 22.06 59.53 - - 193.27 19.28 21.42 75.93 94.91 21.96 22.06 21.42 233.60 19.60 - 56.12 18.85 119.43 219.00 110.99 130.61 22.17 36945389 MOLECULAR CYTO DNA PRB FISH PH 88271 300 $292.00 107.92 - 233.60 - 201.77 22.49 201.77 - 161.33 22.06 59.53 - - 193.27 19.28 21.42 75.93 94.91 21.96 22.06 21.42 233.60 19.60 - 56.12 18.85 119.43 219.00 110.99 130.61 22.17 36981431 DNA PROBE EACH 88271 300 $454.00 167.80 - 363.20 - 313.71 22.49 313.71 - 250.84 22.06 59.53 - - 300.50 19.28 21.42 75.93 94.91 21.96 22.06 21.42 363.20 19.60 - 56.12 18.85 185.69 340.50 172.57 203.07 22.17 36981911 CYTOGENETICS DNA PROBE 88271 300 "$1,471.00" 543.68 - " 1,176.80 " - " 1,016.46 " 22.49 " 1,016.46 " - 812.73 22.06 59.53 - - 973.65 19.28 21.42 75.93 94.91 21.96 22.06 21.42 " 1,176.80 " 19.60 - 56.12 18.85 601.64 " 1,103.25 " 559.13 657.98 22.17 36982551 MOLECULAR CYTOGEN DNA PRB EA 88271 300 $229.00 84.64 - 183.20 - 158.24 22.49 158.24 - 126.52 22.06 59.53 - - 151.58 19.28 21.42 75.93 94.91 21.96 22.06 21.42 183.20 19.60 - 56.12 18.85 93.66 171.75 87.04 102.43 22.17 36982560 MOLECULAR CYTOGEN DNA PRB EA 88271 300 $229.00 84.64 - 183.20 - 158.24 22.49 158.24 - 126.52 22.06 59.53 - - 151.58 19.28 21.42 75.93 94.91 21.96 22.06 21.42 183.20 19.60 - 56.12 18.85 93.66 171.75 87.04 102.43 22.17 36919761 ANALYZE 10-30 CELLS 88273 300 "$1,947.00" 719.61 - " 1,557.60 " - " 1,345.38 " 36.55 " 1,345.38 " - " 1,075.72 " 35.85 89.33 - - " 1,288.72 " 31.33 34.81 159.44 199.30 35.68 35.85 34.81 " 1,557.60 " 31.85 - 91.20 30.63 796.32 " 1,460.25 " 740.05 870.89 36.03 36923571 CHROMOSOMAL IN SITU HYBRID 88273 300 $924.00 341.51 - 739.20 - 638.48 36.55 638.48 - 510.51 35.85 89.33 - - 611.60 31.33 34.81 159.44 199.30 35.68 35.85 34.81 739.20 31.85 - 91.20 30.63 377.92 693.00 351.21 413.31 36.03 36923938 IN SITU HYBRID 10-30 CELLS 88273 300 "$1,009.00" 372.93 - 807.20 - 697.22 36.55 697.22 - 557.47 35.85 89.33 - - 667.86 31.33 34.81 159.44 199.30 35.68 35.85 34.81 807.20 31.85 - 91.20 30.63 412.68 756.75 383.52 451.33 36.03 36926741 IN SITU HYBRIDZTION 10-30CELLS 88273 300 $887.00 327.84 - 709.60 - 612.92 36.55 612.92 - 490.07 35.85 89.33 - - 587.11 31.33 34.81 159.44 199.30 35.68 35.85 34.81 709.60 31.85 - 91.20 30.63 362.78 665.25 337.15 396.76 36.03 36927887 IN SITU HYBRIDIZTN 10-30 CELLS 88273 300 $718.00 265.37 - 574.40 - 496.14 36.55 496.14 - 396.70 35.85 89.33 - - 475.24 31.33 34.81 159.44 199.30 35.68 35.85 34.81 574.40 31.85 - 91.20 30.63 293.66 538.50 272.91 321.16 36.03 36981440 INSITU HYBRID ANAL 10-30 CELLS 88273 300 $958.00 354.08 - 766.40 - 661.98 36.55 661.98 - 529.30 35.85 89.33 - - 634.10 31.33 34.81 159.44 199.30 35.68 35.85 34.81 766.40 31.85 - 91.20 30.63 391.82 718.50 364.14 428.51 36.03 36926899 IN SITU HYBRIDZTION 25-99CELLS 88274 300 $436.00 161.15 - 348.80 - 301.28 44.50 301.28 - 240.89 43.65 96.77 - - 288.59 38.14 42.38 205.02 256.28 43.44 43.65 42.38 348.80 38.78 - 111.04 37.29 178.32 327.00 165.72 195.02 43.86 36926902 IN SITU HYBRIDZTION 25-99CELLS 88274 300 $436.00 161.15 - 348.80 - 301.28 44.50 301.28 - 240.89 43.65 96.77 - - 288.59 38.14 42.38 205.02 256.28 43.44 43.65 42.38 348.80 38.78 - 111.04 37.29 178.32 327.00 165.72 195.02 43.86 36926911 IN SITU HYBRIDZTION 25-99CELLS 88274 300 $436.00 161.15 - 348.80 - 301.28 44.50 301.28 - 240.89 43.65 96.77 - - 288.59 38.14 42.38 205.02 256.28 43.44 43.65 42.38 348.80 38.78 - 111.04 37.29 178.32 327.00 165.72 195.02 43.86 36933011 MOL CYTO IN SITU 25-99 CELLS 88274 300 $436.00 161.15 - 348.80 - 301.28 44.50 301.28 - 240.89 43.65 96.77 - - 288.59 38.14 42.38 205.02 256.28 43.44 43.65 42.38 348.80 38.78 - 111.04 37.29 178.32 327.00 165.72 195.02 43.86 36933020 MOL CYTO IN SITU 25-99 CELLS 88274 300 $436.00 161.15 - 348.80 - 301.28 44.50 301.28 - 240.89 43.65 96.77 - - 288.59 38.14 42.38 205.02 256.28 43.44 43.65 42.38 348.80 38.78 - 111.04 37.29 178.32 327.00 165.72 195.02 43.86 36920271 IN-SITU HYBRIDIZATION 88275 300 "$2,233.00" 825.32 - " 1,786.40 " - " 1,543.00 " 53.75 " 1,543.00 " - " 1,233.73 " 52.73 111.66 - - " 1,478.02 " 46.07 51.19 250.62 313.27 52.47 52.73 51.19 " 1,786.40 " 46.84 - 134.12 45.05 913.30 " 1,674.75 " 848.76 998.82 52.98 36920513 IN SITU-HYBRIDIZATION 88275 300 "$1,735.00" 641.26 - " 1,388.00 " - " 1,198.89 " 53.75 " 1,198.89 " - 958.59 52.73 111.66 - - " 1,148.40 " 46.07 51.19 250.62 313.27 52.47 52.73 51.19 " 1,388.00 " 46.84 - 134.12 45.05 709.62 " 1,301.25 " 659.47 776.07 52.98 36920548 IN-SITU HYBRIDIZATION 88275 300 "$2,304.00" 851.56 - " 1,843.20 " - " 1,592.06 " 53.75 " 1,592.06 " - " 1,272.96 " 52.73 111.66 - - " 1,525.02 " 46.07 51.19 250.62 313.27 52.47 52.73 51.19 " 1,843.20 " 46.84 - 134.12 45.05 942.34 " 1,728.00 " 875.75 " 1,030.58 " 52.98 36920581 IN SITU-HYBRIDIZATION 88275 300 "$1,719.00" 635.34 - " 1,375.20 " - " 1,187.83 " 53.75 " 1,187.83 " - 949.75 52.73 111.66 - - " 1,137.81 " 46.07 51.19 250.62 313.27 52.47 52.73 51.19 " 1,375.20 " 46.84 - 134.12 45.05 703.07 " 1,289.25 " 653.39 768.91 52.98 36920629 IN SITU-HYBRIDIZATION 88275 300 "$1,719.00" 635.34 - " 1,375.20 " - " 1,187.83 " 53.75 " 1,187.83 " - 949.75 52.73 111.66 - - " 1,137.81 " 46.07 51.19 250.62 313.27 52.47 52.73 51.19 " 1,375.20 " 46.84 - 134.12 45.05 703.07 " 1,289.25 " 653.39 768.91 52.98 36923491 CHROM IN SITU HYBRIDIZATION 88275 300 "$1,319.00" 487.50 - " 1,055.20 " - 911.43 53.75 911.43 - 728.75 52.73 111.66 - - 873.05 46.07 51.19 250.62 313.27 52.47 52.73 51.19 " 1,055.20 " 46.84 - 134.12 45.05 539.47 989.25 501.35 589.99 52.98 36926961 IN SITU HYBRDZTION 100-300CELL 88275 300 $999.00 369.23 - 799.20 - 690.31 53.75 690.31 - 551.95 52.73 111.66 - - 661.24 46.07 51.19 250.62 313.27 52.47 52.73 51.19 799.20 46.84 - 134.12 45.05 408.59 749.25 379.72 446.85 52.98 36927011 IN SITU HYBRDZTION 100-300CELL 88275 300 $798.00 294.94 - 638.40 - 551.42 53.75 551.42 - 440.90 52.73 111.66 - - 528.20 46.07 51.19 250.62 313.27 52.47 52.73 51.19 638.40 46.84 - 134.12 45.05 326.38 598.50 303.32 356.95 52.98 36927071 IN SITU HYBRDZTION 100-300CELL 88275 300 $423.00 156.34 - 338.40 - 292.29 53.75 292.29 - 233.71 52.73 111.66 - - 279.98 46.07 51.19 250.62 313.27 52.47 52.73 51.19 338.40 46.84 - 134.12 45.05 173.01 317.25 160.78 189.21 52.98 36927089 IN SITU HYBRDZTION 100-300CELL 88275 300 $423.00 156.34 - 338.40 - 292.29 53.75 292.29 - 233.71 52.73 111.66 - - 279.98 46.07 51.19 250.62 313.27 52.47 52.73 51.19 338.40 46.84 - 134.12 45.05 173.01 317.25 160.78 189.21 52.98 36927097 IN SITU HYBRDZTION 100-300CELL 88275 300 $423.00 156.34 - 338.40 - 292.29 53.75 292.29 - 233.71 52.73 111.66 - - 279.98 46.07 51.19 250.62 313.27 52.47 52.73 51.19 338.40 46.84 - 134.12 45.05 173.01 317.25 160.78 189.21 52.98 36927101 IN SITU HYBRDZTION 100-300CELL 88275 300 $423.00 156.34 - 338.40 - 292.29 53.75 292.29 - 233.71 52.73 111.66 - - 279.98 46.07 51.19 250.62 313.27 52.47 52.73 51.19 338.40 46.84 - 134.12 45.05 173.01 317.25 160.78 189.21 52.98 36927143 IN SITU HYBRDZTION 100-300CELL 88275 300 "$1,877.00" 693.74 - " 1,501.60 " - " 1,297.01 " 53.75 " 1,297.01 " - " 1,037.04 " 52.73 111.66 - - " 1,242.39 " 46.07 51.19 250.62 313.27 52.47 52.73 51.19 " 1,501.60 " 46.84 - 134.12 45.05 767.69 " 1,407.75 " 713.45 839.58 52.98 36927186 IN SITU HYBRDZTION 100-300CELL 88275 300 "$1,063.00" 392.88 - 850.40 - 734.53 53.75 734.53 - 587.31 52.73 111.66 - - 703.60 46.07 51.19 250.62 313.27 52.47 52.73 51.19 850.40 46.84 - 134.12 45.05 434.77 797.25 404.05 475.48 52.98 36927224 IN SITU HYBRDZTION 100-300CELL 88275 300 $816.00 301.59 - 652.80 - 563.86 53.75 563.86 - 450.84 52.73 111.66 - - 540.11 46.07 51.19 250.62 313.27 52.47 52.73 51.19 652.80 46.84 - 134.12 45.05 333.74 612.00 310.16 365.00 52.98 36927267 IN SITU HYBRDZTION 100-300CELL 88275 300 "$1,063.00" 392.88 - 850.40 - 734.53 53.75 734.53 - 587.31 52.73 111.66 - - 703.60 46.07 51.19 250.62 313.27 52.47 52.73 51.19 850.40 46.84 - 134.12 45.05 434.77 797.25 404.05 475.48 52.98 36927691 IN SITU HYBRID 100-300 CELLS 88275 300 "$1,000.00" 369.60 - 800.00 - 691.00 53.75 691.00 - 552.50 52.73 111.66 - - 661.90 46.07 51.19 250.62 313.27 52.47 52.73 51.19 800.00 46.84 - 134.12 45.05 409.00 750.00 380.10 447.30 52.98 36927771 IN SITU HYBRID 100-300 CELLS 88275 300 "$1,749.00" 646.43 - " 1,399.20 " - " 1,208.56 " 53.75 " 1,208.56 " - 966.32 52.73 111.66 - - " 1,157.66 " 46.07 51.19 250.62 313.27 52.47 52.73 51.19 " 1,399.20 " 46.84 - 134.12 45.05 715.34 " 1,311.75 " 664.79 782.33 52.98 36927780 IN SITU HYBRID 100-300 CELLS 88275 300 "$1,749.00" 646.43 - " 1,399.20 " - " 1,208.56 " 53.75 " 1,208.56 " - 966.32 52.73 111.66 - - " 1,157.66 " 46.07 51.19 250.62 313.27 52.47 52.73 51.19 " 1,399.20 " 46.84 - 134.12 45.05 715.34 " 1,311.75 " 664.79 782.33 52.98 36927798 IN SITU HYBRID 100-300 CELLS 88275 300 "$1,749.00" 646.43 - " 1,399.20 " - " 1,208.56 " 53.75 " 1,208.56 " - 966.32 52.73 111.66 - - " 1,157.66 " 46.07 51.19 250.62 313.27 52.47 52.73 51.19 " 1,399.20 " 46.84 - 134.12 45.05 715.34 " 1,311.75 " 664.79 782.33 52.98 36927917 IN SITU HYBRID 100-300 CELLS 88275 300 "$1,291.00" 477.15 - " 1,032.80 " - 892.08 53.75 892.08 - 713.28 52.73 111.66 - - 854.51 46.07 51.19 250.62 313.27 52.47 52.73 51.19 " 1,032.80 " 46.84 - 134.12 45.05 528.02 968.25 490.71 577.46 52.98 36927941 IN SITU HYBRID 100-300 CELLS 88275 300 "$1,169.00" 432.06 - 935.20 - 807.78 53.75 807.78 - 645.87 52.73 111.66 - - 773.76 46.07 51.19 250.62 313.27 52.47 52.73 51.19 935.20 46.84 - 134.12 45.05 478.12 876.75 444.34 522.89 52.98 36927984 IN SITU HYBRID 100-300 CELLS 88275 300 "$1,116.00" 412.47 - 892.80 - 771.16 53.75 771.16 - 616.59 52.73 111.66 - - 738.68 46.07 51.19 250.62 313.27 52.47 52.73 51.19 892.80 46.84 - 134.12 45.05 456.44 837.00 424.19 499.19 52.98 36928026 IN SITU HYBRID 100-300 CELLS 88275 300 "$1,109.00" 409.89 - 887.20 - 766.32 53.75 766.32 - 612.72 52.73 111.66 - - 734.05 46.07 51.19 250.62 313.27 52.47 52.73 51.19 887.20 46.84 - 134.12 45.05 453.58 831.75 421.53 496.06 52.98 36928051 IN SITU HYBRID 100-300 CELLS 88275 300 "$1,400.00" 517.44 - " 1,120.00 " - 967.40 53.75 967.40 - 773.50 52.73 111.66 - - 926.66 46.07 51.19 250.62 313.27 52.47 52.73 51.19 " 1,120.00 " 46.84 - 134.12 45.05 572.60 " 1,050.00 " 532.14 626.22 52.98 36928085 IN SITU HYBRID 100-300 CELLS 88275 300 "$1,223.00" 452.02 - 978.40 - 845.09 53.75 845.09 - 675.71 52.73 111.66 - - 809.50 46.07 51.19 250.62 313.27 52.47 52.73 51.19 978.40 46.84 - 134.12 45.05 500.21 917.25 464.86 547.05 52.98 36928115 IN SITU HYBRID 100-300 CELLS 88275 300 "$1,682.00" 621.67 - " 1,345.60 " - " 1,162.26 " 53.75 " 1,162.26 " - 929.31 52.73 111.66 - - " 1,113.32 " 46.07 51.19 250.62 313.27 52.47 52.73 51.19 " 1,345.60 " 46.84 - 134.12 45.05 687.94 " 1,261.50 " 639.33 752.36 52.98 36928191 IN SITU HYBRID 100-300 CELLS 88275 300 "$1,307.00" 483.07 - " 1,045.60 " - 903.14 53.75 903.14 - 722.12 52.73 111.66 - - 865.10 46.07 51.19 250.62 313.27 52.47 52.73 51.19 " 1,045.60 " 46.84 - 134.12 45.05 534.56 980.25 496.79 584.62 52.98 36928239 IN SITU HYBRID 100-300 CELLS 88275 300 "$1,229.00" 454.24 - 983.20 - 849.24 53.75 849.24 - 679.02 52.73 111.66 - - 813.48 46.07 51.19 250.62 313.27 52.47 52.73 51.19 983.20 46.84 - 134.12 45.05 502.66 921.75 467.14 549.73 52.98 36928875 IN SITU HYBRIDIZN 100-300 CELL 88275 300 $882.00 325.99 - 705.60 - 609.46 53.75 609.46 - 487.31 52.73 111.66 - - 583.80 46.07 51.19 250.62 313.27 52.47 52.73 51.19 705.60 46.84 - 134.12 45.05 360.74 661.50 335.25 394.52 52.98 36928921 IN SITU HYBRID 100-300 CELLS 88275 300 "$1,455.00" 537.77 - " 1,164.00 " - " 1,005.41 " 53.75 " 1,005.41 " - 803.89 52.73 111.66 - - 963.06 46.07 51.19 250.62 313.27 52.47 52.73 51.19 " 1,164.00 " 46.84 - 134.12 45.05 595.10 " 1,091.25 " 553.05 650.82 52.98 36929448 IN SITU HYBRID 100-300 CELLS 88275 300 "$1,141.00" 421.71 - 912.80 - 788.43 53.75 788.43 - 630.40 52.73 111.66 - - 755.23 46.07 51.19 250.62 313.27 52.47 52.73 51.19 912.80 46.84 - 134.12 45.05 466.67 855.75 433.69 510.37 52.98 36929481 IN SITU HYBRID 100-300 CELLS 88275 300 "$1,213.00" 448.32 - 970.40 - 838.18 53.75 838.18 - 670.18 52.73 111.66 - - 802.88 46.07 51.19 250.62 313.27 52.47 52.73 51.19 970.40 46.84 - 134.12 45.05 496.12 909.75 461.06 542.57 52.98 36929499 IN SITU HYBRID 100-300 CELLS 88275 300 "$1,213.00" 448.32 - 970.40 - 838.18 53.75 838.18 - 670.18 52.73 111.66 - - 802.88 46.07 51.19 250.62 313.27 52.47 52.73 51.19 970.40 46.84 - 134.12 45.05 496.12 909.75 461.06 542.57 52.98 36929618 IN SITU HYBRID 100-300 CELLS 88275 300 $812.00 300.12 - 649.60 - 561.09 53.75 561.09 - 448.63 52.73 111.66 - - 537.46 46.07 51.19 250.62 313.27 52.47 52.73 51.19 649.60 46.84 - 134.12 45.05 332.11 609.00 308.64 363.21 52.98 36929626 IN SITU HYBRID 100-300 CELLS 88275 300 $812.00 300.12 - 649.60 - 561.09 53.75 561.09 - 448.63 52.73 111.66 - - 537.46 46.07 51.19 250.62 313.27 52.47 52.73 51.19 649.60 46.84 - 134.12 45.05 332.11 609.00 308.64 363.21 52.98 36929634 IN SITU HYBRID 100-300 CELLS 88275 300 $812.00 300.12 - 649.60 - 561.09 53.75 561.09 - 448.63 52.73 111.66 - - 537.46 46.07 51.19 250.62 313.27 52.47 52.73 51.19 649.60 46.84 - 134.12 45.05 332.11 609.00 308.64 363.21 52.98 36929642 IN SITU HYBRID 100-300 CELLS 88275 300 $812.00 300.12 - 649.60 - 561.09 53.75 561.09 - 448.63 52.73 111.66 - - 537.46 46.07 51.19 250.62 313.27 52.47 52.73 51.19 649.60 46.84 - 134.12 45.05 332.11 609.00 308.64 363.21 52.98 36929693 IN SITU HYBRID 100-300 CELLS 88275 300 "$1,285.00" 474.94 - " 1,028.00 " - 887.94 53.75 887.94 - 709.96 52.73 111.66 - - 850.54 46.07 51.19 250.62 313.27 52.47 52.73 51.19 " 1,028.00 " 46.84 - 134.12 45.05 525.57 963.75 488.43 574.78 52.98 36929707 IN SITU HYBRID 100-300 CELLS 88275 300 "$1,285.00" 474.94 - " 1,028.00 " - 887.94 53.75 887.94 - 709.96 52.73 111.66 - - 850.54 46.07 51.19 250.62 313.27 52.47 52.73 51.19 " 1,028.00 " 46.84 - 134.12 45.05 525.57 963.75 488.43 574.78 52.98 36929715 IN SITU HYBRID 100-300 CELLS 88275 300 "$1,285.00" 474.94 - " 1,028.00 " - 887.94 53.75 887.94 - 709.96 52.73 111.66 - - 850.54 46.07 51.19 250.62 313.27 52.47 52.73 51.19 " 1,028.00 " 46.84 - 134.12 45.05 525.57 963.75 488.43 574.78 52.98 36929740 IN SITU HYBRID 100-300 CELLS 88275 300 "$1,356.00" 501.18 - " 1,084.80 " - 937.00 53.75 937.00 - 749.19 52.73 111.66 - - 897.54 46.07 51.19 250.62 313.27 52.47 52.73 51.19 " 1,084.80 " 46.84 - 134.12 45.05 554.60 " 1,017.00 " 515.42 606.54 52.98 36933046 MOL CYTO IN SITU 100-300 CELLS 88275 300 $598.00 221.02 - 478.40 - 413.22 53.75 413.22 - 330.40 52.73 111.66 - - 395.82 46.07 51.19 250.62 313.27 52.47 52.73 51.19 478.40 46.84 - 134.12 45.05 244.58 448.50 227.30 267.49 52.98 36938331 CYTOGENETICS 100-300 CELLS 88275 300 "$1,049.00" 387.71 - 839.20 - 724.86 53.75 724.86 - 579.57 52.73 111.66 - - 694.33 46.07 51.19 250.62 313.27 52.47 52.73 51.19 839.20 46.84 - 134.12 45.05 429.04 786.75 398.72 469.22 52.98 36945397 CHROM IN SITU HYBR 100-300 CLS 88275 300 $682.00 252.07 - 545.60 - 471.26 53.75 471.26 - 376.81 52.73 111.66 - - 451.42 46.07 51.19 250.62 313.27 52.47 52.73 51.19 545.60 46.84 - 134.12 45.05 278.94 511.50 259.23 305.06 52.98 36945401 CHROM IN SITU HYBR 100-300 CLS 88275 300 $682.00 252.07 - 545.60 - 471.26 53.75 471.26 - 376.81 52.73 111.66 - - 451.42 46.07 51.19 250.62 313.27 52.47 52.73 51.19 545.60 46.84 - 134.12 45.05 278.94 511.50 259.23 305.06 52.98 36945419 CHROM IN SITU HYBR 100-300 CLS 88275 300 $682.00 252.07 - 545.60 - 471.26 53.75 471.26 - 376.81 52.73 111.66 - - 451.42 46.07 51.19 250.62 313.27 52.47 52.73 51.19 545.60 46.84 - 134.12 45.05 278.94 511.50 259.23 305.06 52.98 36982578 CYTOGENETICS 100-300 88275 300 $546.00 201.80 - 436.80 - 377.29 53.75 377.29 - 301.67 52.73 111.66 - - 361.40 46.07 51.19 250.62 313.27 52.47 52.73 51.19 436.80 46.84 - 134.12 45.05 223.31 409.50 207.53 244.23 52.98 36907967 ADDL KARYOTYPES 88280 300 $303.00 111.99 29.45 242.40 39.88 209.37 35.14 209.37 34.68 167.41 34.47 69.77 38.15 34.68 200.56 30.12 33.47 115.04 143.80 34.31 34.47 33.47 242.40 30.63 34.68 87.69 29.45 123.93 227.25 115.17 135.53 34.64 36919841 ADDITIONAL KARYOTYPES EA 88280 300 $212.00 78.36 29.45 169.60 39.88 146.49 35.14 146.49 34.68 117.13 34.47 69.77 38.15 34.68 140.32 30.12 33.47 115.04 143.80 34.31 34.47 33.47 169.60 30.63 34.68 87.69 29.45 86.71 159.00 80.58 94.83 34.64 36919850 ADDITIONAL KARYOTYPES EA 88280 300 $212.00 78.36 29.45 169.60 39.88 146.49 35.14 146.49 34.68 117.13 34.47 69.77 38.15 34.68 140.32 30.12 33.47 115.04 143.80 34.31 34.47 33.47 169.60 30.63 34.68 87.69 29.45 86.71 159.00 80.58 94.83 34.64 36923415 CHROMOSOME ANALYSIS ADDITIONAL 88280 300 $183.00 67.64 29.45 146.40 39.88 126.45 35.14 126.45 34.68 101.11 34.47 69.77 38.15 34.68 121.13 30.12 33.47 115.04 143.80 34.31 34.47 33.47 146.40 30.63 34.68 87.69 29.45 74.85 137.25 69.56 81.86 34.64 36923610 CHROMOSOME KARYOTYPE 88280 300 $256.00 94.62 29.45 204.80 39.88 176.90 35.14 176.90 34.68 141.44 34.47 69.77 38.15 34.68 169.45 30.12 33.47 115.04 143.80 34.31 34.47 33.47 204.80 30.63 34.68 87.69 29.45 104.70 192.00 97.31 114.51 34.64 36927844 CHROMOSOME KARYOTYPE 88280 300 $176.00 65.05 29.45 143.80 39.88 121.62 35.14 121.62 34.68 97.24 34.47 69.77 38.15 34.68 116.49 30.12 33.47 115.04 143.80 34.31 34.47 33.47 140.80 30.63 34.68 87.69 29.45 71.98 132.00 66.90 78.72 34.64 36945451 ADD KARYOTYPE CHROM ANALYS EA 88280 300 $176.00 65.05 29.45 143.80 39.88 121.62 35.14 121.62 34.68 97.24 34.47 69.77 38.15 34.68 116.49 30.12 33.47 115.04 143.80 34.31 34.47 33.47 140.80 30.63 34.68 87.69 29.45 71.98 132.00 66.90 78.72 34.64 36918527 ADDITIONAL HIGH RESOLUTION 88289 300 $390.00 144.14 30.30 312.00 46.63 269.49 36.15 269.49 40.55 215.48 35.46 95.74 44.61 40.55 258.14 30.99 34.43 221.96 277.45 35.29 35.46 34.43 312.00 31.50 40.55 90.21 30.30 159.51 292.50 148.24 174.45 35.64 36923423 CYTOGENETICS INTER/REPORT 88291 300 $360.00 133.06 - 288.00 - 248.76 N/A 248.76 - 198.90 N/A 65.78 - N/A 238.28 - N/A 25.22 31.53 N/A N/A N/A 288.00 N/A - 88.69 N/A 147.24 270.00 136.84 161.03 N/A 36927020 INTERPRETATION AND REPORT 88291 300 $401.00 148.21 - 320.80 - 277.09 N/A 277.09 - 221.55 N/A 65.78 - N/A 265.42 - N/A 25.22 31.53 N/A N/A N/A 320.80 N/A - 88.69 N/A 164.01 300.75 152.42 179.37 N/A 36927925 INTERPERETATION AND REPORT 88291 300 $568.00 209.93 - 454.40 - 392.49 N/A 392.49 - 313.82 N/A 65.78 - N/A 375.96 - N/A 25.22 31.53 N/A N/A N/A 454.40 N/A - 88.69 N/A 232.31 426.00 215.90 254.07 N/A 36600594 LVL 1 SURG PATH 88300 310 $130.00 48.05 5.48 104.00 6.30 89.83 25.77 89.83 5.48 71.83 25.28 21.92 6.03 5.48 86.05 22.09 24.54 17.06 21.33 25.15 25.28 24.54 104.00 22.45 5.48 64.64 21.60 53.17 97.50 49.41 58.15 25.40 36600543 LVL 2 SURG PATH 88302 310 $130.00 48.05 11.29 104.00 12.98 89.83 25.77 89.83 11.29 71.83 25.28 51.87 12.42 11.29 86.05 22.09 24.54 37.17 46.46 25.15 25.28 24.54 104.00 22.45 11.29 64.64 21.60 53.17 97.50 49.41 58.15 25.40 36600519 LVL 3 SURG PATH 88304 310 $261.00 96.47 16.53 208.80 19.01 180.35 51.83 180.35 16.53 144.20 50.84 70.15 18.18 16.53 172.76 44.42 49.36 48.02 60.02 50.59 50.84 49.36 208.80 45.16 16.53 130.37 43.44 106.75 195.75 99.21 116.75 51.09 35900594 LEVEL 4 SURG PATH-CYTOLOGY 88305 310 $261.00 96.47 34.00 208.80 39.10 180.35 51.83 180.35 34.00 144.20 50.84 70.15 37.40 34.00 172.76 44.42 49.36 78.53 98.16 50.59 50.84 49.36 208.80 45.16 34.00 130.37 43.44 106.75 195.75 99.21 116.75 51.09 35900977 CELL BLOCK OUTREACH 88305 310 $261.00 96.47 34.00 208.80 39.10 180.35 51.83 180.35 34.00 144.20 50.84 70.15 37.40 34.00 172.76 44.42 49.36 78.53 98.16 50.59 50.84 49.36 208.80 45.16 34.00 130.37 43.44 106.75 195.75 99.21 116.75 51.09 36600501 LVL 4 SURG PATH 88305 310 $261.00 96.47 34.00 208.80 39.10 180.35 51.83 180.35 34.00 144.20 50.84 70.15 37.40 34.00 172.76 44.42 49.36 78.53 98.16 50.59 50.84 49.36 208.80 45.16 34.00 130.37 43.44 106.75 195.75 99.21 116.75 51.09 36600497 LVL 5 SURG PATH 88307 310 "$1,529.00" 565.12 45.50 " 1,223.20 " 52.33 " 1,056.54 " 303.78 " 1,056.54 " 45.50 844.77 297.99 458.91 50.05 45.50 " 1,012.05 " 260.38 289.31 116.36 145.45 296.54 297.99 289.31 " 1,223.20 " 264.72 45.50 763.10 254.59 625.36 " 1,146.75 " 581.17 683.92 299.44 36600632 LVL V X-RAY LOCALIZATION 88307 310 "$1,529.00" 565.12 45.50 " 1,223.20 " 52.33 " 1,056.54 " 303.78 " 1,056.54 " 45.50 844.77 297.99 458.91 50.05 45.50 " 1,012.05 " 260.38 289.31 116.36 145.45 296.54 297.99 289.31 " 1,223.20 " 264.72 45.50 763.10 254.59 625.36 " 1,146.75 " 581.17 683.92 299.44 36600535 LVL 6 SURG PATH 88309 310 "$3,445.00" " 1,273.27 " 67.60 " 2,756.00 " 77.74 " 2,380.50 " 683.53 " 2,380.50 " 67.60 " 1,903.36 " 670.51 651.83 74.36 67.60 " 2,280.25 " 585.88 650.98 158.42 198.03 667.25 670.51 650.98 " 2,756.00 " 595.65 67.60 " 1,719.11 " 572.86 " 1,409.01 " " 2,583.75 " " 1,309.44 " " 1,540.95 " 673.76 36600608 DECALCIFICATION 88311 310 $25.00 9.24 - 95.35 19.23 17.28 - 17.28 16.72 13.81 - 17.55 18.39 16.72 16.55 - - 76.28 95.35 - - - 20.00 - 16.72 22.85 - 10.23 18.75 9.50 11.18 - 36600551 GRP 1 STAIN MICRO 88312 310 $261.00 96.47 18.82 208.80 84.72 180.35 51.83 180.35 73.67 144.20 50.84 143.97 81.04 73.67 172.76 44.42 49.36 18.82 23.53 50.59 50.84 49.36 208.80 45.16 73.67 130.37 43.44 106.75 195.75 99.21 116.75 51.09 35900454 OTHER SPECIAL STAINS 88313 310 $178.00 65.79 14.82 142.40 58.66 123.00 35.30 123.00 51.01 98.35 34.63 115.46 56.11 51.01 117.82 30.26 33.62 14.82 18.52 34.46 34.63 33.62 142.40 30.76 51.01 88.66 29.59 72.80 133.50 67.66 79.62 34.80 36600560 GRP 2 STAIN OTHER 88313 310 $178.00 65.79 14.82 142.40 58.66 123.00 35.30 123.00 51.01 98.35 34.63 115.46 56.11 51.01 117.82 30.26 33.62 14.82 18.52 34.46 34.63 33.62 142.40 30.76 51.01 88.66 29.59 72.80 133.50 67.66 79.62 34.80 36930314 GROUP II STAINS 88313 300 $443.00 163.73 14.82 354.40 58.66 306.11 35.30 306.11 51.01 244.76 34.63 115.46 56.11 51.01 293.22 30.26 33.62 14.82 18.52 34.46 34.63 33.62 354.40 30.76 51.01 88.66 29.59 181.19 332.25 168.38 198.15 34.80 36600578 SPECIAL STAIN FROZEN 88314 310 $156.00 57.66 - 209.36 34.63 107.80 - 107.80 30.11 86.19 - 111.06 33.12 30.11 103.26 - - 46.52 58.15 - - - 124.80 - 30.11 209.36 - 63.80 117.00 59.30 69.78 - 36600527 SPECIAL STAIN ENZYME HISTOCHEM 88319 310 "$3,445.00" " 1,273.27 " 117.05 " 2,756.00 " 134.61 " 2,380.50 " 683.53 " 2,380.50 " 117.05 " 1,903.36 " 670.51 125.69 128.76 117.05 " 2,280.25 " 585.88 650.98 244.58 305.72 667.25 670.51 650.98 " 2,756.00 " 595.65 117.05 " 1,719.11 " 572.86 " 1,409.01 " " 2,583.75 " " 1,309.44 " " 1,540.95 " 673.76 36600691 SPEC ST ENZ HISTOCHM-TECH ONLY 88319 310 "$3,445.00" " 1,273.27 " 117.05 " 2,756.00 " 134.61 " 2,380.50 " 683.53 " 2,380.50 " 117.05 " 1,903.36 " 670.51 125.69 128.76 117.05 " 2,280.25 " 585.88 650.98 244.58 305.72 667.25 670.51 650.98 " 2,756.00 " 595.65 117.05 " 1,719.11 " 572.86 " 1,409.01 " " 2,583.75 " " 1,309.44 " " 1,540.95 " 673.76 36922524 CONSULTATIVE REPORT REF SLIDES 88321 300 "$1,812.00" 669.72 - " 1,449.60 " - " 1,252.09 " 35.30 " 1,252.09 " - " 1,001.13 " 34.63 179.04 - - " 1,199.36 " 30.26 33.62 142.15 177.69 34.46 34.63 33.62 " 1,449.60 " 30.76 - 88.66 29.59 741.11 " 1,359.00 " 688.74 810.51 34.80 36600276 CONSULT REFERRED WET 88323 310 $261.00 96.47 39.29 208.80 72.98 180.35 51.83 180.35 63.46 144.20 50.84 103.78 69.81 63.46 172.76 44.42 49.36 39.29 49.11 50.59 50.84 49.36 208.80 45.16 63.46 130.37 43.44 106.75 195.75 99.21 116.75 51.09 36600438 FROZEN TISSUE SECTION 88331 310 $783.00 289.40 32.50 626.40 37.38 541.05 155.56 541.05 32.50 432.61 152.59 64.31 35.75 32.50 518.27 133.34 148.15 93.08 116.35 151.85 152.59 148.15 626.40 135.56 32.50 390.80 130.37 320.25 587.25 297.62 350.24 153.34 36600446 FROZEN SECTION TISSUE EA ADDL 88332 310 $37.00 13.68 - 63.09 41.37 25.57 - 25.57 35.97 20.44 - 38.72 39.57 35.97 24.49 - - 46.52 58.15 - - - 29.60 - 35.97 63.09 - 15.13 27.75 14.06 16.55 - 36601086 CYTOEX TOUCH-SQ PREP INITIAL 88333 300 "$3,445.00" " 1,273.27 " 67.87 " 2,756.00 " 78.05 " 2,380.50 " 683.53 " 2,380.50 " 67.87 " 1,903.36 " 670.51 73.07 74.66 67.87 " 2,280.25 " 585.88 650.98 88.27 110.34 667.25 670.51 650.98 " 2,756.00 " 595.65 67.87 " 1,719.11 " 572.86 " 1,409.01 " " 2,583.75 " " 1,309.44 " " 1,540.95 " 673.76 36601094 CYTOEX TOUCH-SQ PREP ADDL 88334 300 $140.00 51.74 - 112.00 40.56 96.74 - 96.74 35.27 77.35 - 45.31 38.80 35.27 92.67 - - 53.93 67.41 - - - 112.00 - 35.27 50.28 - 57.26 105.00 53.21 62.62 - 36601248 IMMUNOHISTOCHEM EA ADDL 88341 310 $135.00 49.90 - 170.96 58.78 93.29 - 93.29 51.11 74.59 - 127.14 56.22 51.11 89.36 - - 68.21 85.26 - - - 108.00 - 51.11 170.96 - 55.22 101.25 51.31 60.39 - 36600462 IMMUNOHISTOCHEMISTRY EACH 88342 310 $783.00 289.40 68.68 626.40 78.98 541.05 155.56 541.05 68.68 432.61 152.59 143.22 75.55 68.68 518.27 133.34 148.15 92.99 116.24 151.85 152.59 148.15 626.40 135.56 68.68 390.80 130.37 320.25 587.25 297.62 350.24 153.34 36600616 HERCEPT-IMMUNOPEROXIDASE TEST 88342 310 $783.00 289.40 68.68 626.40 78.98 541.05 155.56 541.05 68.68 432.61 152.59 143.22 75.55 68.68 518.27 133.34 148.15 92.99 116.24 151.85 152.59 148.15 626.40 135.56 68.68 390.80 130.37 320.25 587.25 297.62 350.24 153.34 36601256 IMMUNOHISTOCHEM EA MULTIPLEX 88344 310 "$1,529.00" 565.12 88.49 " 1,223.20 " 101.76 " 1,056.54 " 303.78 " 1,056.54 " 88.49 844.77 297.99 271.83 97.34 88.49 " 1,012.05 " 260.38 289.31 114.55 143.19 296.54 297.99 289.31 " 1,223.20 " 264.72 88.49 763.10 254.59 625.36 " 1,146.75 " 581.17 683.92 299.44 36600471 IMMUNOFLUOR INITIAL AB STAIN 88346 310 "$1,529.00" 565.12 25.50 " 1,223.20 " 29.33 " 1,056.54 " 303.78 " 1,056.54 " 25.50 844.77 297.99 113.26 28.05 25.50 " 1,012.05 " 260.38 289.31 46.56 58.20 296.54 297.99 289.31 " 1,223.20 " 264.72 25.50 763.10 254.59 625.36 " 1,146.75 " 581.17 683.92 299.44 36930144 IMMUNOFLUOR STUDY EA AB DIRECT 88346 300 "$1,529.00" 565.12 25.50 " 1,223.20 " 29.33 " 1,056.54 " 303.78 " 1,056.54 " 25.50 844.77 297.99 113.26 28.05 25.50 " 1,012.05 " 260.38 289.31 46.56 58.20 296.54 297.99 289.31 " 1,223.20 " 264.72 25.50 763.10 254.59 625.36 " 1,146.75 " 581.17 683.92 299.44 36930152 IMMUNOFLUOR STUDY EA AB DIRECT 88346 300 "$1,529.00" 565.12 25.50 " 1,223.20 " 29.33 " 1,056.54 " 303.78 " 1,056.54 " 25.50 844.77 297.99 113.26 28.05 25.50 " 1,012.05 " 260.38 289.31 46.56 58.20 296.54 297.99 289.31 " 1,223.20 " 264.72 25.50 763.10 254.59 625.36 " 1,146.75 " 581.17 683.92 299.44 09100008 ELECTRON MICROSCOPY DIAGNOSTIC 88348 300 "$3,445.00" " 1,273.27 " 69.00 " 2,756.00 " 79.35 " 2,380.50 " 683.53 " 2,380.50 " 69.00 " 1,903.36 " 670.51 550.25 75.90 69.00 " 2,280.25 " 585.88 650.98 349.03 436.29 667.25 670.51 650.98 " 2,756.00 " 595.65 69.00 " 1,719.11 " 572.86 " 1,409.01 " " 2,583.75 " " 1,309.44 " " 1,540.95 " 673.76 36601264 IMMUNOFLUOR EA ADDL AB STAIN 88350 300 $447.00 165.21 - 357.60 22.59 308.88 - 308.88 19.64 246.97 - 89.14 21.60 19.64 295.87 - - 178.93 223.66 - - - 357.60 - 19.64 213.01 - 182.82 335.25 169.90 199.94 - 36941049 ANALYSIS TUMOR 88358 300 $783.00 289.40 62.49 626.40 71.86 541.05 155.56 541.05 62.49 432.61 152.59 81.11 68.74 62.49 518.27 133.34 148.15 198.68 248.35 151.85 152.59 148.15 626.40 135.56 62.49 390.80 130.37 320.25 587.25 297.62 350.24 153.34 36601175 IMMUNOHISTOCHEMISTRY QNT MAN 88360 300 $783.00 289.40 83.35 626.40 95.85 541.05 155.56 541.05 83.35 432.61 152.59 133.01 91.69 83.35 518.27 133.34 148.15 195.55 244.44 151.85 152.59 148.15 626.40 135.56 83.35 390.80 130.37 320.25 587.25 297.62 350.24 153.34 36600781 IMMUNOHISTOCHEMISTRY QUANT 88361 310 "$1,529.00" 565.12 104.43 " 1,223.20 " 120.09 " 1,056.54 " 303.78 " 1,056.54 " 104.43 844.77 297.99 181.24 114.87 104.43 " 1,012.05 " 260.38 289.31 465.17 581.46 296.54 297.99 289.31 " 1,223.20 " 264.72 104.43 763.10 254.59 625.36 " 1,146.75 " 581.17 683.92 299.44 36930161 MORPHOMETRIC ANALYSIS CAT 88361 300 "$1,529.00" 565.12 104.43 " 1,223.20 " 120.09 " 1,056.54 " 303.78 " 1,056.54 " 104.43 844.77 297.99 181.24 114.87 104.43 " 1,012.05 " 260.38 289.31 465.17 581.46 296.54 297.99 289.31 " 1,223.20 " 264.72 104.43 763.10 254.59 625.36 " 1,146.75 " 581.17 683.92 299.44 36941138 TCBAR IMMUNOHISTOCHEM QUANT 88361 300 "$1,529.00" 565.12 104.43 " 1,223.20 " 120.09 " 1,056.54 " 303.78 " 1,056.54 " 104.43 844.77 297.99 181.24 114.87 104.43 " 1,012.05 " 260.38 289.31 465.17 581.46 296.54 297.99 289.31 " 1,223.20 " 264.72 104.43 763.10 254.59 625.36 " 1,146.75 " 581.17 683.92 299.44 36601213 IN-SITU HYBRID EA ADDL 88364 310 $157.00 58.03 - 287.05 84.39 108.49 - 108.49 73.38 86.74 - 204.60 80.72 73.38 103.92 - - 104.41 130.51 - - - 125.60 - 73.38 287.05 - 64.21 117.75 59.68 70.23 - 36601191 IN-SITU HYBRIDIZATION QUAL 88365 300 $783.00 289.40 52.61 626.40 60.50 541.05 155.56 541.05 52.61 432.61 152.59 270.39 57.87 52.61 518.27 133.34 148.15 62.22 77.77 151.85 152.59 148.15 626.40 135.56 52.61 390.80 130.37 320.25 587.25 297.62 350.24 153.34 36601221 IN-SITU HYBRID EA MULTIPLEX 88366 310 "$1,529.00" 565.12 113.62 " 1,223.20 " 130.66 " 1,056.54 " 303.78 " 1,056.54 " 113.62 844.77 297.99 404.84 124.98 113.62 " 1,012.05 " 260.38 289.31 128.93 161.16 296.54 297.99 289.31 " 1,223.20 " 264.72 113.62 763.10 254.59 625.36 " 1,146.75 " 581.17 683.92 299.44 36935901 FISH MORH ANALYSIS AUTO 88367 300 "$1,529.00" 565.12 145.41 " 1,223.20 " 179.96 " 1,056.54 " 303.78 " 1,056.54 " 156.49 844.77 297.99 145.41 172.14 156.49 " 1,012.05 " 260.38 289.31 554.50 693.13 296.54 297.99 289.31 " 1,223.20 " 264.72 156.49 763.10 254.59 625.36 " 1,146.75 " 581.17 683.92 299.44 08900027 MORPH ANALYSIS IN SITU MANUAL 88368 310 "$1,529.00" 565.12 123.94 " 1,223.20 " 142.53 " 1,056.54 " 303.78 " 1,056.54 " 123.94 844.77 297.99 149.81 136.33 123.94 " 1,012.05 " 260.38 289.31 451.94 564.93 296.54 297.99 289.31 " 1,223.20 " 264.72 123.94 763.10 254.59 625.36 " 1,146.75 " 581.17 683.92 299.44 35100482 MORPH ANALYSIS IN SITU MANUAL 88368 310 "$1,529.00" 565.12 123.94 " 1,223.20 " 142.53 " 1,056.54 " 303.78 " 1,056.54 " 123.94 844.77 297.99 149.81 136.33 123.94 " 1,012.05 " 260.38 289.31 451.94 564.93 296.54 297.99 289.31 " 1,223.20 " 264.72 123.94 763.10 254.59 625.36 " 1,146.75 " 581.17 683.92 299.44 36600772 CHROMOSOMAL IN-SITU HYBRID 88368 300 "$1,529.00" 565.12 123.94 " 1,223.20 " 142.53 " 1,056.54 " 303.78 " 1,056.54 " 123.94 844.77 297.99 149.81 136.33 123.94 " 1,012.05 " 260.38 289.31 451.94 564.93 296.54 297.99 289.31 " 1,223.20 " 264.72 123.94 763.10 254.59 625.36 " 1,146.75 " 581.17 683.92 299.44 36601183 MORPH ANAL IN SITU HYBRID MAN 88368 310 "$1,529.00" 565.12 123.94 " 1,223.20 " 142.53 " 1,056.54 " 303.78 " 1,056.54 " 123.94 844.77 297.99 149.81 136.33 123.94 " 1,012.05 " 260.38 289.31 451.94 564.93 296.54 297.99 289.31 " 1,223.20 " 264.72 123.94 763.10 254.59 625.36 " 1,146.75 " 581.17 683.92 299.44 36935898 FISH MORH ANALYSIS MANUAL 88368 300 "$1,529.00" 565.12 123.94 " 1,223.20 " 142.53 " 1,056.54 " 303.78 " 1,056.54 " 123.94 844.77 297.99 149.81 136.33 123.94 " 1,012.05 " 260.38 289.31 451.94 564.93 296.54 297.99 289.31 " 1,223.20 " 264.72 123.94 763.10 254.59 625.36 " 1,146.75 " 581.17 683.92 299.44 36938285 MORPH ANAL IN SITU HYBRID MAN 88368 300 "$1,529.00" 565.12 123.94 " 1,223.20 " 142.53 " 1,056.54 " 303.78 " 1,056.54 " 123.94 844.77 297.99 149.81 136.33 123.94 " 1,012.05 " 260.38 289.31 451.94 564.93 296.54 297.99 289.31 " 1,223.20 " 264.72 123.94 763.10 254.59 625.36 " 1,146.75 " 581.17 683.92 299.44 36938293 MORPH ANAL IN SITU HYBRID MAN 88368 300 "$1,529.00" 565.12 123.94 " 1,223.20 " 142.53 " 1,056.54 " 303.78 " 1,056.54 " 123.94 844.77 297.99 149.81 136.33 123.94 " 1,012.05 " 260.38 289.31 451.94 564.93 296.54 297.99 289.31 " 1,223.20 " 264.72 123.94 763.10 254.59 625.36 " 1,146.75 " 581.17 683.92 299.44 08900051 MORPH ANAL IN SITU ADD STAIN 88369 310 "$1,981.00" 732.18 - " 1,584.80 " 64.23 " 1,368.87 " - " 1,368.87 " 55.85 " 1,094.50 " - 156.37 61.44 55.85 " 1,311.22 " - - 72.44 90.55 - - - " 1,584.80 " - 55.85 224.90 - 810.23 " 1,485.75 " 752.98 886.10 - 08900078 MORPH ANAL IN SITU ADD STAIN 88369 310 "$1,981.00" 732.18 - " 1,584.80 " 64.23 " 1,368.87 " - " 1,368.87 " 55.85 " 1,094.50 " - 156.37 61.44 55.85 " 1,311.22 " - - 72.44 90.55 - - - " 1,584.80 " - 55.85 224.90 - 810.23 " 1,485.75 " 752.98 886.10 - 36939079 MORPH ANAL IN SITU ADDL STAIN 88369 310 $768.00 283.85 - 614.40 64.23 530.69 - 530.69 55.85 424.32 - 156.37 61.44 55.85 508.34 - - 72.44 90.55 - - - 614.40 - 55.85 224.90 - 314.11 576.00 291.92 343.53 - 36939052 FISH MORPH ANAL EA ADDL STAIN 88373 310 $961.00 355.19 - 768.80 52.69 664.05 - 664.05 45.82 530.95 - 109.62 50.40 45.82 636.09 - - 58.60 73.25 - - - 768.80 - 45.82 123.43 - 393.05 720.75 365.28 429.86 - 36939061 FISH MORPH ANAL EA MULTIPLEX 88374 310 "$3,939.00" " 1,455.85 " 130.37 " 3,151.20 " 177.00 " 2,721.85 " 155.56 " 2,721.85 " 153.91 " 2,176.30 " 152.59 611.64 169.30 153.91 " 2,607.22 " 133.34 148.15 237.57 296.96 151.85 152.59 148.15 " 3,151.20 " 135.56 153.91 390.80 130.37 " 1,611.05 " " 2,954.25 " " 1,497.21 " " 1,761.91 " 153.34 08900060 MORPH ANAL IN SITU MULTIPLEX 88377 310 $783.00 289.40 130.37 705.18 186.05 541.05 155.56 541.05 161.78 432.61 152.59 705.18 177.96 161.78 518.27 133.34 148.15 221.03 276.29 151.85 152.59 148.15 626.40 135.56 161.78 390.80 130.37 320.25 587.25 297.62 350.24 153.34 08900086 MORPH ANAL IN SITU MULTIPLEX 88377 310 $783.00 289.40 130.37 705.18 186.05 541.05 155.56 541.05 161.78 432.61 152.59 705.18 177.96 161.78 518.27 133.34 148.15 221.03 276.29 151.85 152.59 148.15 626.40 135.56 161.78 390.80 130.37 320.25 587.25 297.62 350.24 153.34 36939087 MORPH ANAL IN SITU MULTIPLEX 88377 310 "$2,518.00" 930.65 130.37 " 2,014.40 " 186.05 " 1,739.94 " 155.56 " 1,739.94 " 161.78 " 1,391.20 " 152.59 705.18 177.96 161.78 " 1,666.66 " 133.34 148.15 221.03 276.29 151.85 152.59 148.15 " 2,014.40 " 135.56 161.78 390.80 130.37 " 1,029.86 " " 1,888.50 " 957.09 " 1,126.30 " 153.34 36601272 MICRODISSECTION MANUAL USCF 88381 300 "$1,350.00" 498.96 - " 1,080.00 " - 932.85 - 932.85 - 745.88 - 188.53 - - 893.57 - - 640.13 800.16 - - - " 1,080.00 " - - 471.73 - 552.15 " 1,012.50 " 513.14 603.86 - 36600179 MISC SURGICAL PATHOLOGY 88399 300 $261.00 96.47 - 208.80 - 180.35 51.83 180.35 - 144.20 50.84 149.94 - - 172.76 44.42 49.36 6.39 7.99 50.59 50.84 49.36 208.80 45.16 - 130.37 43.44 106.75 195.75 99.21 116.75 51.09 35290087 BILIRUBIN TOTAL TRANSCUTANEOUS 88720 300 $26.00 9.61 4.42 20.80 6.61 17.97 5.27 17.97 5.75 14.37 5.17 13.94 6.33 5.75 17.21 4.52 5.02 15.83 19.79 5.15 5.17 5.02 20.80 4.59 5.75 13.15 4.42 10.63 19.50 9.88 11.63 5.20 35706721 BODY FLUID CELL COUNT 89050 300 $25.00 9.24 4.15 27.12 5.18 17.28 4.96 17.28 4.50 13.81 4.86 13.16 4.95 4.50 16.55 4.25 4.72 21.70 27.12 4.84 4.86 4.72 20.00 4.32 4.50 12.37 4.15 10.23 18.75 9.50 11.18 4.89 36150831 CELL COUNT/ VIABILITY FOR TBCS 89050 300 $25.00 9.24 4.15 27.12 5.18 17.28 4.96 17.28 4.50 13.81 4.86 13.16 4.95 4.50 16.55 4.25 4.72 21.70 27.12 4.84 4.86 4.72 20.00 4.32 4.50 12.37 4.15 10.23 18.75 9.50 11.18 4.89 35706836 CELL COUNT W/DIFF BODY FLUID 89051 300 $29.00 10.72 4.93 44.42 8.05 20.04 5.88 20.04 7.00 16.02 5.77 15.32 7.70 7.00 19.20 5.04 5.60 35.54 44.42 5.74 5.77 5.60 23.20 5.12 7.00 14.67 4.93 11.86 21.75 11.02 12.97 5.80 35900331 CELL COUNT DIFF (BAL) 89051 300 $29.00 10.72 4.93 44.42 8.05 20.04 5.88 20.04 7.00 16.02 5.77 15.32 7.70 7.00 19.20 5.04 5.60 35.54 44.42 5.74 5.77 5.60 23.20 5.12 7.00 14.67 4.93 11.86 21.75 11.02 12.97 5.80 36300388 FECAL LEUKOCYTES 89055 300 $22.00 8.13 3.76 33.95 5.49 15.20 4.48 15.20 4.77 12.16 4.40 11.87 5.25 4.77 14.56 3.84 4.27 27.16 33.95 4.38 4.40 4.27 17.60 3.91 4.77 11.19 3.76 9.00 16.50 8.36 9.84 4.42 35200037 MICRO EXAM BODY FLUID 89060 300 $38.00 14.04 6.45 40.95 8.63 26.26 7.70 26.26 7.50 21.00 7.55 19.91 8.25 7.50 25.15 6.60 7.33 32.76 40.95 7.51 7.55 7.33 30.40 6.71 7.50 19.20 6.45 15.54 28.50 14.44 17.00 7.59 35703799 SYNOVIAL CRYSTALS 89060 300 $38.00 14.04 6.45 40.95 8.63 26.26 7.70 26.26 7.50 21.00 7.55 19.91 8.25 7.50 25.15 6.60 7.33 32.76 40.95 7.51 7.55 7.33 30.40 6.71 7.50 19.20 6.45 15.54 28.50 14.44 17.00 7.59 35200100 HANSEL SMEAR 89190 300 $30.00 11.09 5.10 27.17 7.64 20.73 6.08 20.73 6.64 16.58 5.96 13.22 7.30 6.64 19.86 5.21 5.79 21.74 27.17 5.93 5.96 5.79 24.00 5.30 6.64 15.17 5.10 12.27 22.50 11.40 13.42 5.99 35706267 HANSEL STAIN 89190 300 $30.00 11.09 5.10 27.17 7.64 20.73 6.08 20.73 6.64 16.58 5.96 13.22 7.30 6.64 19.86 5.21 5.79 21.74 27.17 5.93 5.96 5.79 24.00 5.30 6.64 15.17 5.10 12.27 22.50 11.40 13.42 5.99 36200103 COLLECTION FROM SITE 1 89230 300 $261.00 96.47 2.98 208.80 3.43 180.35 51.83 180.35 2.98 144.20 50.84 10.96 3.28 2.98 172.76 44.42 49.36 59.57 74.46 50.59 50.84 49.36 208.80 45.16 2.98 130.37 43.44 106.75 195.75 99.21 116.75 51.09 36200111 COLLECTION FROM SITE 2 89230 300 $261.00 96.47 2.98 208.80 3.43 180.35 51.83 180.35 2.98 144.20 50.84 10.96 3.28 2.98 172.76 44.42 49.36 59.57 74.46 50.59 50.84 49.36 208.80 45.16 2.98 130.37 43.44 106.75 195.75 99.21 116.75 51.09 35707701 SPERM COUNT 89321 300 $63.00 23.28 - 94.91 - 43.53 12.65 43.53 - 34.81 12.41 33.50 - - 41.70 10.85 12.05 75.93 94.91 12.35 12.41 12.05 50.40 11.03 - 31.57 10.60 25.77 47.25 23.95 28.18 12.47 33212992 RABIES IMM GLOBULIN 150 U 90375 636 "$1,433.00" 529.64 10.00 " 1,146.40 " 11.50 990.20 272.99 990.20 11.70 791.73 267.79 945.78 11.20 10.41 948.50 233.99 259.99 553.52 691.90 266.49 267.79 259.99 " 1,146.40 " 237.89 10.00 960.11 228.79 586.10 " 1,074.75 " 544.68 640.98 269.09 33213000 RABIES IMM GLOBULIN HT 150 U 90376 636 "$1,742.00" 643.84 10.00 " 1,393.60 " 11.50 " 1,203.72 " 293.49 " 1,203.72 " 11.70 962.46 287.90 " 1,149.72 " 11.20 10.41 " 1,153.03 " 251.56 279.51 543.81 679.76 286.50 287.90 279.51 " 1,393.60 " 255.75 10.00 " 1,167.14 " 245.97 712.48 " 1,306.50 " 662.13 779.20 289.29 33231083 PALIVIZUMAB PER 50MG INJ 90378 636 "$9,653.00" " 3,567.75 " 10.00 " 7,722.40 " 11.50 " 6,670.22 " " 1,210.89 " " 6,670.22 " 11.70 " 5,333.28 " " 1,187.83 " " 6,370.98 " 11.20 10.41 " 6,389.32 " " 1,037.91 " " 1,153.23 " " 3,813.40 " " 4,766.75 " " 1,182.06 " " 1,187.83 " " 1,153.23 " " 7,722.40 " " 1,055.21 " 10.00 " 6,467.51 " " 1,014.84 " " 3,948.08 " " 7,239.75 " " 3,669.11 " " 4,317.79 " " 1,193.59 " 37000078 ADMIN VACCINE SINGLE 90471 771 $325.00 120.12 - 260.00 - 224.58 64.67 224.58 - 179.56 63.44 214.50 - - 215.12 55.43 61.59 6.26 7.83 63.13 63.44 61.59 260.00 56.35 - 217.75 54.20 132.93 243.75 123.53 145.37 63.75 41900415 ADMIN VACCINE SINGLE 90471 771 $325.00 120.12 - 260.00 - 224.58 64.67 224.58 - 179.56 63.44 214.50 - - 215.12 55.43 61.59 6.26 7.83 63.13 63.44 61.59 260.00 56.35 - 217.75 54.20 132.93 243.75 123.53 145.37 63.75 17390104 INFLUENZA VACC ADJUVANTED 65+ 90653 636 $60.00 22.18 - 146.41 - 41.46 N/A 41.46 - 33.15 N/A 39.60 - N/A 39.71 - N/A 117.13 146.41 N/A N/A N/A 48.00 N/A - 40.20 N/A 24.54 45.00 22.81 26.84 N/A 18200279 INFLUENZA VACC ADJUVANTED 65+ 90653 636 $60.00 22.18 - 146.41 - 41.46 N/A 41.46 - 33.15 N/A 39.60 - N/A 39.71 - N/A 117.13 146.41 N/A N/A N/A 48.00 N/A - 40.20 N/A 24.54 45.00 22.81 26.84 N/A 24771016 INFLUENZA VACC ADJUVANTED 65+ 90653 636 $60.00 22.18 - 146.41 - 41.46 N/A 41.46 - 33.15 N/A 39.60 - N/A 39.71 - N/A 117.13 146.41 N/A N/A N/A 48.00 N/A - 40.20 N/A 24.54 45.00 22.81 26.84 N/A 24900258 INFLUENZA VACC ADJUVANTED 65+ 90653 636 $60.00 22.18 - 146.41 - 41.46 N/A 41.46 - 33.15 N/A 39.60 - N/A 39.71 - N/A 117.13 146.41 N/A N/A N/A 48.00 N/A - 40.20 N/A 24.54 45.00 22.81 26.84 N/A 25000617 INFLUENZA VACC ADJUVANTED 65+ 90653 636 $60.00 22.18 - 146.41 - 41.46 N/A 41.46 - 33.15 N/A 39.60 - N/A 39.71 - N/A 117.13 146.41 N/A N/A N/A 48.00 N/A - 40.20 N/A 24.54 45.00 22.81 26.84 N/A 25400615 INFLUENZA VACC ADJUVANTED 65+ 90653 636 $60.00 22.18 - 146.41 - 41.46 N/A 41.46 - 33.15 N/A 39.60 - N/A 39.71 - N/A 117.13 146.41 N/A N/A N/A 48.00 N/A - 40.20 N/A 24.54 45.00 22.81 26.84 N/A 31200881 INFLUENZA VACC ADJUVANTED 65+ 90653 636 $60.00 22.18 - 146.41 - 41.46 N/A 41.46 - 33.15 N/A 39.60 - N/A 39.71 - N/A 117.13 146.41 N/A N/A N/A 48.00 N/A - 40.20 N/A 24.54 45.00 22.81 26.84 N/A 31901065 INFLUENZA VACC ADJUVANTED 65+ 90653 636 $60.00 22.18 - 146.41 - 41.46 N/A 41.46 - 33.15 N/A 39.60 - N/A 39.71 - N/A 117.13 146.41 N/A N/A N/A 48.00 N/A - 40.20 N/A 24.54 45.00 22.81 26.84 N/A 32900321 INFLUENZA VACC ADJUVANTED 65+ 90653 636 $60.00 22.18 - 146.41 - 41.46 N/A 41.46 - 33.15 N/A 39.60 - N/A 39.71 - N/A 117.13 146.41 N/A N/A N/A 48.00 N/A - 40.20 N/A 24.54 45.00 22.81 26.84 N/A 34500428 INFLUENZA VACC ADJUVANTED 65+ 90653 636 $60.00 22.18 - 146.41 - 41.46 N/A 41.46 - 33.15 N/A 39.60 - N/A 39.71 - N/A 117.13 146.41 N/A N/A N/A 48.00 N/A - 40.20 N/A 24.54 45.00 22.81 26.84 N/A 37010189 INFLUENZA VACC ADJUVANTED 65+ 90653 636 $60.00 22.18 - 146.41 - 41.46 N/A 41.46 - 33.15 N/A 39.60 - N/A 39.71 - N/A 117.13 146.41 N/A N/A N/A 48.00 N/A - 40.20 N/A 24.54 45.00 22.81 26.84 N/A 43100157 INFLUENZA VACC ADJUVANTED 65+ 90653 636 $60.00 22.18 - 146.41 - 41.46 N/A 41.46 - 33.15 N/A 39.60 - N/A 39.71 - N/A 117.13 146.41 N/A N/A N/A 48.00 N/A - 40.20 N/A 24.54 45.00 22.81 26.84 N/A 43900382 INFLUENZA VACC ADJUVANTED 65+ 90653 636 $60.00 22.18 - 146.41 - 41.46 N/A 41.46 - 33.15 N/A 39.60 - N/A 39.71 - N/A 117.13 146.41 N/A N/A N/A 48.00 N/A - 40.20 N/A 24.54 45.00 22.81 26.84 N/A 45521036 INFLUENZA VACC ADJUVANTED 65+ 90653 636 $60.00 22.18 - 146.41 - 41.46 N/A 41.46 - 33.15 N/A 39.60 - N/A 39.71 - N/A 117.13 146.41 N/A N/A N/A 48.00 N/A - 40.20 N/A 24.54 45.00 22.81 26.84 N/A 51600941 INFLUENZA VACC ADJUVANTED 65+ 90653 636 $60.00 22.18 - 146.41 - 41.46 N/A 41.46 - 33.15 N/A 39.60 - N/A 39.71 - N/A 117.13 146.41 N/A N/A N/A 48.00 N/A - 40.20 N/A 24.54 45.00 22.81 26.84 N/A 64201336 INFLUENZA VACC ADJUVANTED 65+ 90653 636 $60.00 22.18 - 146.41 - 41.46 N/A 41.46 - 33.15 N/A 39.60 - N/A 39.71 - N/A 117.13 146.41 N/A N/A N/A 48.00 N/A - 40.20 N/A 24.54 45.00 22.81 26.84 N/A 39100746 INFLUENZA VAC CC TRIV 0.5ML IM 90661 636 $40.00 14.78 - 32.12 - 27.64 N/A 27.64 - 22.10 N/A 26.40 - N/A 26.48 - N/A 25.70 32.12 N/A N/A N/A 32.00 N/A - 26.80 N/A 16.36 30.00 15.20 17.89 N/A 39100754 INFLUENZA VAC HIGH DOSE 65+ 90662 636 $60.00 22.18 - 228.86 11.50 41.46 N/A 41.46 11.70 33.15 N/A 39.60 11.20 N/A 39.71 - N/A 183.09 228.86 N/A N/A N/A 48.00 N/A 10.00 40.20 N/A 24.54 45.00 22.81 26.84 N/A 39100720 INFLUNZA VIR VAC LIVE INTRNAS 90672 636 $53.00 19.59 - 42.40 11.50 36.62 N/A 36.62 11.70 29.28 N/A 34.98 11.20 N/A 35.08 - N/A 30.58 38.23 N/A N/A N/A 42.40 N/A 10.00 35.51 N/A 21.68 39.75 20.15 23.71 N/A 33218524 RABIES VACC (RABAVERT) 90675 636 "$1,592.00" 588.40 10.00 " 1,273.60 " 11.50 " 1,100.07 " 334.50 " 1,100.07 " 11.70 879.58 328.13 " 1,050.72 " 11.20 10.41 " 1,053.74 " 286.71 318.57 430.85 538.56 326.53 328.13 318.57 " 1,273.60 " 291.49 10.00 " 1,066.64 " 280.34 651.13 " 1,194.00 " 605.12 712.10 329.72 33240040 RABIES VACCINE 1ML INJ 90675 636 "$1,592.00" 588.40 10.00 " 1,273.60 " 11.50 " 1,100.07 " 334.50 " 1,100.07 " 11.70 879.58 328.13 " 1,050.72 " 11.20 10.41 " 1,053.74 " 286.71 318.57 430.85 538.56 326.53 328.13 318.57 " 1,273.60 " 291.49 10.00 " 1,066.64 " 280.34 651.13 " 1,194.00 " 605.12 712.10 329.72 39100711 INFLUNZA VAC QUAD PF 0.25ML IM 90685 636 $27.50 10.16 - 36.11 11.50 19.00 N/A 19.00 11.70 15.19 N/A 18.15 11.20 N/A 18.20 - N/A 28.89 36.11 N/A N/A N/A 22.00 N/A 10.00 18.43 N/A 11.25 20.63 10.45 12.30 N/A 17390091 INFLUENZA VAC QUAD PF 0.5ML IM 90686 636 $35.00 12.94 - 30.16 11.50 24.19 N/A 24.19 11.70 19.34 N/A 23.10 11.20 N/A 23.17 - N/A 24.13 30.16 N/A N/A N/A 28.00 N/A 10.00 23.45 N/A 14.32 26.25 13.30 15.66 N/A 18200261 INFLUENZA VAC QUAD PF 0.5ML IM 90686 636 $35.00 12.94 - 30.16 11.50 24.19 N/A 24.19 11.70 19.34 N/A 23.10 11.20 N/A 23.17 - N/A 24.13 30.16 N/A N/A N/A 28.00 N/A 10.00 23.45 N/A 14.32 26.25 13.30 15.66 N/A 24771008 INFLUENZA VAC QUAD PF 0.5ML IM 90686 636 $35.00 12.94 - 30.16 11.50 24.19 N/A 24.19 11.70 19.34 N/A 23.10 11.20 N/A 23.17 - N/A 24.13 30.16 N/A N/A N/A 28.00 N/A 10.00 23.45 N/A 14.32 26.25 13.30 15.66 N/A 24900240 INFLUENZA VAC QUAD PF 0.5ML IM 90686 636 $35.00 12.94 - 30.16 11.50 24.19 N/A 24.19 11.70 19.34 N/A 23.10 11.20 N/A 23.17 - N/A 24.13 30.16 N/A N/A N/A 28.00 N/A 10.00 23.45 N/A 14.32 26.25 13.30 15.66 N/A 25000609 INFLUENZA VAC QUAD PF 0.5ML IM 90686 636 $35.00 12.94 - 30.16 11.50 24.19 N/A 24.19 11.70 19.34 N/A 23.10 11.20 N/A 23.17 - N/A 24.13 30.16 N/A N/A N/A 28.00 N/A 10.00 23.45 N/A 14.32 26.25 13.30 15.66 N/A 25400607 INFLUENZA VAC QUAD PF 0.5ML IM 90686 636 $35.00 12.94 - 30.16 11.50 24.19 N/A 24.19 11.70 19.34 N/A 23.10 11.20 N/A 23.17 - N/A 24.13 30.16 N/A N/A N/A 28.00 N/A 10.00 23.45 N/A 14.32 26.25 13.30 15.66 N/A 31200873 INFLUENZA VAC QUAD PF 0.5ML IM 90686 636 $35.00 12.94 - 30.16 11.50 24.19 N/A 24.19 11.70 19.34 N/A 23.10 11.20 N/A 23.17 - N/A 24.13 30.16 N/A N/A N/A 28.00 N/A 10.00 23.45 N/A 14.32 26.25 13.30 15.66 N/A 31901057 INFLUENZA VAC QUAD PF 0.5ML IM 90686 636 $35.00 12.94 - 30.16 11.50 24.19 N/A 24.19 11.70 19.34 N/A 23.10 11.20 N/A 23.17 - N/A 24.13 30.16 N/A N/A N/A 28.00 N/A 10.00 23.45 N/A 14.32 26.25 13.30 15.66 N/A 32900313 INFLUENZA VAC QUAD PF 0.5ML IM 90686 636 $35.00 12.94 - 30.16 11.50 24.19 N/A 24.19 11.70 19.34 N/A 23.10 11.20 N/A 23.17 - N/A 24.13 30.16 N/A N/A N/A 28.00 N/A 10.00 23.45 N/A 14.32 26.25 13.30 15.66 N/A 34500410 INFLUENZA VAC QUAD PF 0.5ML IM 90686 636 $35.00 12.94 - 30.16 11.50 24.19 N/A 24.19 11.70 19.34 N/A 23.10 11.20 N/A 23.17 - N/A 24.13 30.16 N/A N/A N/A 28.00 N/A 10.00 23.45 N/A 14.32 26.25 13.30 15.66 N/A 37010171 INFLUENZA VAC QUAD PF 0.5ML IM 90686 636 $35.00 12.94 - 30.16 11.50 24.19 N/A 24.19 11.70 19.34 N/A 23.10 11.20 N/A 23.17 - N/A 24.13 30.16 N/A N/A N/A 28.00 N/A 10.00 23.45 N/A 14.32 26.25 13.30 15.66 N/A 39100738 INFLUENZA VAC QUAD PF 0.5ML IM 90686 636 $35.00 12.94 - 30.16 11.50 24.19 N/A 24.19 11.70 19.34 N/A 23.10 11.20 N/A 23.17 - N/A 24.13 30.16 N/A N/A N/A 28.00 N/A 10.00 23.45 N/A 14.32 26.25 13.30 15.66 N/A 43100149 INFLUENZA VAC QUAD PF 0.5ML IM 90686 636 $35.00 12.94 - 30.16 11.50 24.19 N/A 24.19 11.70 19.34 N/A 23.10 11.20 N/A 23.17 - N/A 24.13 30.16 N/A N/A N/A 28.00 N/A 10.00 23.45 N/A 14.32 26.25 13.30 15.66 N/A 43900374 INFLUENZA VAC QUAD PF 0.5ML IM 90686 636 $35.00 12.94 - 30.16 11.50 24.19 N/A 24.19 11.70 19.34 N/A 23.10 11.20 N/A 23.17 - N/A 24.13 30.16 N/A N/A N/A 28.00 N/A 10.00 23.45 N/A 14.32 26.25 13.30 15.66 N/A 45521028 INFLUENZA VAC QUAD PF 0.5ML IM 90686 636 $35.00 12.94 - 30.16 11.50 24.19 N/A 24.19 11.70 19.34 N/A 23.10 11.20 N/A 23.17 - N/A 24.13 30.16 N/A N/A N/A 28.00 N/A 10.00 23.45 N/A 14.32 26.25 13.30 15.66 N/A 51600932 INFLUENZA VAC QUAD PF 0.5ML IM 90686 636 $35.00 12.94 - 30.16 11.50 24.19 N/A 24.19 11.70 19.34 N/A 23.10 11.20 N/A 23.17 - N/A 24.13 30.16 N/A N/A N/A 28.00 N/A 10.00 23.45 N/A 14.32 26.25 13.30 15.66 N/A 64201328 INFLUENZA VAC QUAD PF 0.5ML IM 90686 636 $35.00 12.94 - 30.16 11.50 24.19 N/A 24.19 11.70 19.34 N/A 23.10 11.20 N/A 23.17 - N/A 24.13 30.16 N/A N/A N/A 28.00 N/A 10.00 23.45 N/A 14.32 26.25 13.30 15.66 N/A 17354523 FLU VACC AIIV4 NOPRSRV 0.5MLIM 90694 636 $60.00 22.18 - 48.00 - 41.46 N/A 41.46 - 33.15 N/A 39.60 - N/A 39.71 - N/A 31.79 39.74 N/A N/A N/A 48.00 N/A - 40.20 N/A 24.54 45.00 22.81 26.84 N/A 18254522 FLU VACC AIIV4 NOPRSRV 0.5MLIM 90694 636 $60.00 22.18 - 48.00 - 41.46 N/A 41.46 - 33.15 N/A 39.60 - N/A 39.71 - N/A 31.79 39.74 N/A N/A N/A 48.00 N/A - 40.20 N/A 24.54 45.00 22.81 26.84 N/A 24754529 FLU VACC AIIV4 NOPRSRV 0.5MLIM 90694 636 $60.00 22.18 - 48.00 - 41.46 N/A 41.46 - 33.15 N/A 39.60 - N/A 39.71 - N/A 31.79 39.74 N/A N/A N/A 48.00 N/A - 40.20 N/A 24.54 45.00 22.81 26.84 N/A 24954528 FLU VACC AIIV4 NOPRSRV 0.5MLIM 90694 636 $60.00 22.18 - 48.00 - 41.46 N/A 41.46 - 33.15 N/A 39.60 - N/A 39.71 - N/A 31.79 39.74 N/A N/A N/A 48.00 N/A - 40.20 N/A 24.54 45.00 22.81 26.84 N/A 25054521 FLU VACC AIIV4 NOPRSRV 0.5MLIM 90694 636 $60.00 22.18 - 48.00 - 41.46 N/A 41.46 - 33.15 N/A 39.60 - N/A 39.71 - N/A 31.79 39.74 N/A N/A N/A 48.00 N/A - 40.20 N/A 24.54 45.00 22.81 26.84 N/A 25454529 FLU VACC AIIV4 NOPRSRV 0.5MLIM 90694 636 $60.00 22.18 - 48.00 - 41.46 N/A 41.46 - 33.15 N/A 39.60 - N/A 39.71 - N/A 31.79 39.74 N/A N/A N/A 48.00 N/A - 40.20 N/A 24.54 45.00 22.81 26.84 N/A 31254523 FLU VACC AIIV4 NOPRSRV 0.5MLIM 90694 636 $60.00 22.18 - 48.00 - 41.46 N/A 41.46 - 33.15 N/A 39.60 - N/A 39.71 - N/A 31.79 39.74 N/A N/A N/A 48.00 N/A - 40.20 N/A 24.54 45.00 22.81 26.84 N/A 31954525 FLU VACC AIIV4 NOPRSRV 0.5MLIM 90694 636 $60.00 22.18 - 48.00 - 41.46 N/A 41.46 - 33.15 N/A 39.60 - N/A 39.71 - N/A 31.79 39.74 N/A N/A N/A 48.00 N/A - 40.20 N/A 24.54 45.00 22.81 26.84 N/A 32954529 FLU VACC AIIV4 NOPRSRV 0.5MLIM 90694 636 $60.00 22.18 - 48.00 - 41.46 N/A 41.46 - 33.15 N/A 39.60 - N/A 39.71 - N/A 31.79 39.74 N/A N/A N/A 48.00 N/A - 40.20 N/A 24.54 45.00 22.81 26.84 N/A 34554528 FLU VACC AIIV4 NOPRSRV 0.5MLIM 90694 636 $60.00 22.18 - 48.00 - 41.46 N/A 41.46 - 33.15 N/A 39.60 - N/A 39.71 - N/A 31.79 39.74 N/A N/A N/A 48.00 N/A - 40.20 N/A 24.54 45.00 22.81 26.84 N/A 37054526 FLU VACC AIIV4 NOPRSRV 0.5MLIM 90694 636 $60.00 22.18 - 48.00 - 41.46 N/A 41.46 - 33.15 N/A 39.60 - N/A 39.71 - N/A 31.79 39.74 N/A N/A N/A 48.00 N/A - 40.20 N/A 24.54 45.00 22.81 26.84 N/A 43154524 FLU VACC AIIV4 NOPRSRV 0.5MLIM 90694 636 $60.00 22.18 - 48.00 - 41.46 N/A 41.46 - 33.15 N/A 39.60 - N/A 39.71 - N/A 31.79 39.74 N/A N/A N/A 48.00 N/A - 40.20 N/A 24.54 45.00 22.81 26.84 N/A 43954521 FLU VACC AIIV4 NOPRSRV 0.5MLIM 90694 636 $60.00 22.18 - 48.00 - 41.46 N/A 41.46 - 33.15 N/A 39.60 - N/A 39.71 - N/A 31.79 39.74 N/A N/A N/A 48.00 N/A - 40.20 N/A 24.54 45.00 22.81 26.84 N/A 45554520 FLU VACC AIIV4 NOPRSRV 0.5MLIM 90694 636 $60.00 22.18 - 48.00 - 41.46 N/A 41.46 - 33.15 N/A 39.60 - N/A 39.71 - N/A 31.79 39.74 N/A N/A N/A 48.00 N/A - 40.20 N/A 24.54 45.00 22.81 26.84 N/A 51654528 FLU VACC AIIV4 NOPRSRV 0.5MLIM 90694 636 $60.00 22.18 - 48.00 - 41.46 N/A 41.46 - 33.15 N/A 39.60 - N/A 39.71 - N/A 31.79 39.74 N/A N/A N/A 48.00 N/A - 40.20 N/A 24.54 45.00 22.81 26.84 N/A 64254529 FLU VACC AIIV4 NOPRSRV 0.5MLIM 90694 636 $60.00 22.18 - 48.00 - 41.46 N/A 41.46 - 33.15 N/A 39.60 - N/A 39.71 - N/A 31.79 39.74 N/A N/A N/A 48.00 N/A - 40.20 N/A 24.54 45.00 22.81 26.84 N/A 43100009 PSYCH DIAGNOSTIC EVALUATION 90791 914 $702.00 259.46 - " 1,544.39 " - 485.08 139.56 485.08 - 387.86 136.90 463.32 - - 464.65 119.62 132.91 " 1,235.51 " " 1,544.39 " 136.23 136.90 132.91 561.60 121.61 - 470.34 116.96 287.12 526.50 266.83 314.00 137.56 43900242 PSYCH DIAGNOSTIC EVALUATION 90791 914 $702.00 259.46 - " 1,544.39 " - 485.08 139.56 485.08 - 387.86 136.90 463.32 - - 464.65 119.62 132.91 " 1,235.51 " " 1,544.39 " 136.23 136.90 132.91 561.60 121.61 - 470.34 116.96 287.12 526.50 266.83 314.00 137.56 45520692 PSYCH DIAGNOSTIC EVALUATION 90791 914 $702.00 259.46 - " 1,544.39 " - 485.08 139.56 485.08 - 387.86 136.90 463.32 - - 464.65 119.62 132.91 " 1,235.51 " " 1,544.39 " 136.23 136.90 132.91 561.60 121.61 - 470.34 116.96 287.12 526.50 266.83 314.00 137.56 43100017 PSYCH DX EVAL W/MED SERVICES 90792 914 $702.00 259.46 - " 1,644.03 " - 485.08 139.56 485.08 - 387.86 136.90 463.32 - - 464.65 119.62 132.91 " 1,315.22 " " 1,644.03 " 136.23 136.90 132.91 561.60 121.61 - 470.34 116.96 287.12 526.50 266.83 314.00 137.56 43900251 PSYCH DX EVAL W/MED SERVICES 90792 914 $702.00 259.46 - " 1,644.03 " - 485.08 139.56 485.08 - 387.86 136.90 463.32 - - 464.65 119.62 132.91 " 1,315.22 " " 1,644.03 " 136.23 136.90 132.91 561.60 121.61 - 470.34 116.96 287.12 526.50 266.83 314.00 137.56 45520706 PSYCH DX EVAL W/MED SERVICES 90792 914 $702.00 259.46 - " 1,644.03 " - 485.08 139.56 485.08 - 387.86 136.90 463.32 - - 464.65 119.62 132.91 " 1,315.22 " " 1,644.03 " 136.23 136.90 132.91 561.60 121.61 - 470.34 116.96 287.12 526.50 266.83 314.00 137.56 43100025 PSYTX PT/FAMILY 30 MIN 90832 916 $702.00 259.46 - 637.68 - 485.08 139.56 485.08 - 387.86 136.90 463.32 - - 464.65 119.62 132.91 510.14 637.68 136.23 136.90 132.91 561.60 121.61 - 470.34 116.96 287.12 526.50 266.83 314.00 137.56 43900269 PSYTX PT/FAMILY 30 MIN 90832 916 $702.00 259.46 - 637.68 - 485.08 139.56 485.08 - 387.86 136.90 463.32 - - 464.65 119.62 132.91 510.14 637.68 136.23 136.90 132.91 561.60 121.61 - 470.34 116.96 287.12 526.50 266.83 314.00 137.56 45520595 PSYTX PT/FAMILY 30 MIN 90832 916 $702.00 259.46 - 637.68 - 485.08 139.56 485.08 - 387.86 136.90 463.32 - - 464.65 119.62 132.91 510.14 637.68 136.23 136.90 132.91 561.60 121.61 - 470.34 116.96 287.12 526.50 266.83 314.00 137.56 43100033 PSYTX PT/FAMILY 45 MIN 90834 916 $702.00 259.46 - 941.58 - 485.08 139.56 485.08 - 387.86 136.90 463.32 - - 464.65 119.62 132.91 753.26 941.58 136.23 136.90 132.91 561.60 121.61 - 470.34 116.96 287.12 526.50 266.83 314.00 137.56 43900277 PSYTX PT/FAMILY 45 MIN 90834 916 $702.00 259.46 - 941.58 - 485.08 139.56 485.08 - 387.86 136.90 463.32 - - 464.65 119.62 132.91 753.26 941.58 136.23 136.90 132.91 561.60 121.61 - 470.34 116.96 287.12 526.50 266.83 314.00 137.56 45520617 PSYTX PT/FAMILY 45 MIN 90834 916 $702.00 259.46 - 941.58 - 485.08 139.56 485.08 - 387.86 136.90 463.32 - - 464.65 119.62 132.91 753.26 941.58 136.23 136.90 132.91 561.60 121.61 - 470.34 116.96 287.12 526.50 266.83 314.00 137.56 45520633 PSYTX PT/FAMILY 60 MIN 90837 914 $702.00 259.46 - " 1,375.00 " - 485.08 139.56 485.08 - 387.86 136.90 463.32 - - 464.65 119.62 132.91 " 1,100.00 " " 1,375.00 " 136.23 136.90 132.91 561.60 121.61 - 470.34 116.96 287.12 526.50 266.83 314.00 137.56 43100041 FAM PSYTX W/O PATIENT 50 MIN 90846 916 $702.00 259.46 - 561.60 - 485.08 139.56 485.08 - 387.86 136.90 463.32 - - 464.65 119.62 132.91 312.70 390.88 136.23 136.90 132.91 561.60 121.61 - 470.34 116.96 287.12 526.50 266.83 314.00 137.56 43900285 FAM PSYTX W/O PATIENT 50 MIN 90846 916 $702.00 259.46 - 561.60 - 485.08 139.56 485.08 - 387.86 136.90 463.32 - - 464.65 119.62 132.91 312.70 390.88 136.23 136.90 132.91 561.60 121.61 - 470.34 116.96 287.12 526.50 266.83 314.00 137.56 45520382 FAM PSYTX W/O PATIENT 50 MIN 90846 916 $702.00 259.46 - 561.60 - 485.08 139.56 485.08 - 387.86 136.90 463.32 - - 464.65 119.62 132.91 312.70 390.88 136.23 136.90 132.91 561.60 121.61 - 470.34 116.96 287.12 526.50 266.83 314.00 137.56 43100050 FAMILY PSYTX W/PATIENT 50 MIN 90847 916 $702.00 259.46 - 561.60 - 485.08 139.56 485.08 - 387.86 136.90 463.32 - - 464.65 119.62 132.91 363.80 454.75 136.23 136.90 132.91 561.60 121.61 - 470.34 116.96 287.12 526.50 266.83 314.00 137.56 43900293 FAMILY PSYTX W/PATIENT 50 MIN 90847 916 $702.00 259.46 - 561.60 - 485.08 139.56 485.08 - 387.86 136.90 463.32 - - 464.65 119.62 132.91 363.80 454.75 136.23 136.90 132.91 561.60 121.61 - 470.34 116.96 287.12 526.50 266.83 314.00 137.56 45520391 FAMILY PSYTX W/PATIENT 50 MIN 90847 916 $702.00 259.46 - 561.60 - 485.08 139.56 485.08 - 387.86 136.90 463.32 - - 464.65 119.62 132.91 363.80 454.75 136.23 136.90 132.91 561.60 121.61 - 470.34 116.96 287.12 526.50 266.83 314.00 137.56 43100068 GROUP PSYCHOTHERAPY 90853 915 $393.00 145.25 - 576.80 - 271.56 78.05 271.56 - 217.13 76.56 259.38 - - 260.13 66.90 74.33 461.44 576.80 76.19 76.56 74.33 314.40 68.01 - 263.31 65.41 160.74 294.75 149.38 175.79 76.93 43900307 GROUP PSYCHOTHERAPY 90853 915 $393.00 145.25 - 576.80 - 271.56 78.05 271.56 - 217.13 76.56 259.38 - - 260.13 66.90 74.33 461.44 576.80 76.19 76.56 74.33 314.40 68.01 - 263.31 65.41 160.74 294.75 149.38 175.79 76.93 45520412 GROUP PSYCHOTHERAPY 90853 915 $393.00 145.25 - 576.80 - 271.56 78.05 271.56 - 217.13 76.56 259.38 - - 260.13 66.90 74.33 461.44 576.80 76.19 76.56 74.33 314.40 68.01 - 263.31 65.41 160.74 294.75 149.38 175.79 76.93 27600735 ELECTROCONVULSIVE THERAPY 90870 901 "$2,561.00" 946.55 45.00 " 2,048.80 " 51.75 " 1,769.65 " 509.13 " 1,769.65 " 52.65 " 1,414.95 " 499.44 " 1,690.26 " 50.40 46.86 " 1,695.13 " 436.40 484.89 " 1,394.78 " " 1,743.47 " 497.01 499.44 484.89 " 2,048.80 " 443.67 45.00 " 1,715.87 " 426.70 " 1,047.45 " " 1,920.75 " 973.44 " 1,145.54 " 501.86 32900216 UNL PSYCH SERVICE/THERAPY 90899 900 $138.00 51.00 - 110.40 - 95.36 27.42 95.36 - 76.25 26.89 91.08 - - 91.34 23.50 26.11 79.71 99.64 26.76 26.89 26.11 110.40 23.89 - 92.46 22.98 56.44 103.50 52.45 61.73 27.02 32900224 UNL PSYCH SERVICE/THERAPY 90899 900 $138.00 51.00 - 110.40 - 95.36 27.42 95.36 - 76.25 26.89 91.08 - - 91.34 23.50 26.11 79.71 99.64 26.76 26.89 26.11 110.40 23.89 - 92.46 22.98 56.44 103.50 52.45 61.73 27.02 32900232 UNL PSYCH SERVICE/THERAPY 90899 900 $138.00 51.00 - 110.40 - 95.36 27.42 95.36 - 76.25 26.89 91.08 - - 91.34 23.50 26.11 79.71 99.64 26.76 26.89 26.11 110.40 23.89 - 92.46 22.98 56.44 103.50 52.45 61.73 27.02 34000204 ESOPHAGEAL MOTILITY 91010 750 "$2,561.00" 946.55 27.50 " 2,048.80 " 31.63 " 1,769.65 " 509.13 " 1,769.65 " 32.18 " 1,414.95 " 499.44 " 1,690.26 " 30.80 28.64 " 1,695.13 " 436.40 484.89 464.31 580.39 497.01 499.44 484.89 " 2,048.80 " 443.67 27.50 " 1,715.87 " 426.70 " 1,047.45 " " 1,920.75 " 973.44 " 1,145.54 " 501.86 34154643 ESOPHAGEAL MOTILITY 91010 750 "$2,561.00" 946.55 27.50 " 2,048.80 " 31.63 " 1,769.65 " 509.13 " 1,769.65 " 32.18 " 1,414.95 " 499.44 " 1,690.26 " 30.80 28.64 " 1,695.13 " 436.40 484.89 464.31 580.39 497.01 499.44 484.89 " 2,048.80 " 443.67 27.50 " 1,715.87 " 426.70 " 1,047.45 " " 1,920.75 " 973.44 " 1,145.54 " 501.86 34054681 ESOPHAGEAL MOTIL W/STIM 2D 91013 750 "$1,606.00" 593.58 - " 1,284.80 " 20.68 " 1,109.75 " - " 1,109.75 " 21.04 887.32 - " 1,059.96 " 20.14 18.72 " 1,063.01 " - - 101.55 126.94 - - - " 1,284.80 " - 17.98 " 1,076.02 " - 656.85 " 1,204.50 " 610.44 718.36 - 34054738 REFLUX TEST W/NASAL CATH PLACE 91034 750 "$2,561.00" 946.55 172.10 " 2,048.80 " 197.92 " 1,769.65 " 509.13 " 1,769.65 " 201.36 " 1,414.95 " 499.44 " 1,690.26 " 192.75 179.21 " 1,695.13 " 436.40 484.89 575.59 719.49 497.01 499.44 484.89 " 2,048.80 " 443.67 172.10 " 1,715.87 " 426.70 " 1,047.45 " " 1,920.75 " 973.44 " 1,145.54 " 501.86 34154678 REFLUX TEST W/NASAL CATH PLACE 91034 750 "$2,561.00" 946.55 172.10 " 2,048.80 " 197.92 " 1,769.65 " 509.13 " 1,769.65 " 201.36 " 1,414.95 " 499.44 " 1,690.26 " 192.75 179.21 " 1,695.13 " 436.40 484.89 575.59 719.49 497.01 499.44 484.89 " 2,048.80 " 443.67 172.10 " 1,715.87 " 426.70 " 1,047.45 " " 1,920.75 " 973.44 " 1,145.54 " 501.86 34054746 REFLUX TEST W/MUCOS PH ELEC PL 91035 750 "$2,561.00" 946.55 351.06 " 2,048.80 " 403.72 " 1,769.65 " 509.13 " 1,769.65 " 410.74 " 1,414.95 " 499.44 " 1,690.26 " 393.19 365.56 " 1,695.13 " 436.40 484.89 " 1,196.22 " " 1,495.27 " 497.01 499.44 484.89 " 2,048.80 " 443.67 351.06 " 1,715.87 " 426.70 " 1,047.45 " " 1,920.75 " 973.44 " 1,145.54 " 501.86 34054690 COLON MOTIL 6+HRS W/INTERP 91117 750 "$1,397.00" 516.33 120.41 " 1,412.07 " 138.47 965.33 277.55 965.33 140.88 771.84 272.26 922.02 134.86 125.38 924.67 237.90 264.33 " 1,129.66 " " 1,412.07 " 270.94 272.26 264.33 " 1,117.60 " 241.86 120.41 935.99 232.61 571.37 " 1,047.75 " 531.00 624.88 273.58 34154503 COLON MOTIL 6+HRS W/INTERP 91117 750 "$1,397.00" 516.33 120.41 " 1,412.07 " 138.47 965.33 277.55 965.33 140.88 771.84 272.26 922.02 134.86 125.38 924.67 237.90 264.33 " 1,129.66 " " 1,412.07 " 270.94 272.26 264.33 " 1,117.60 " 241.86 120.41 935.99 232.61 571.37 " 1,047.75 " 531.00 624.88 273.58 34000247 RECTAL MOTILITY 91122 750 "$1,397.00" 516.33 68.50 " 1,117.60 " 78.78 965.33 277.55 965.33 80.15 771.84 272.26 922.02 76.72 71.33 924.67 237.90 264.33 503.21 629.01 270.94 272.26 264.33 " 1,117.60 " 241.86 68.50 935.99 232.61 571.37 " 1,047.75 " 531.00 624.88 273.58 34154694 RECTAL MOTILITY 91122 750 "$1,397.00" 516.33 68.50 " 1,117.60 " 78.78 965.33 277.55 965.33 80.15 771.84 272.26 922.02 76.72 71.33 924.67 237.90 264.33 503.21 629.01 270.94 272.26 264.33 " 1,117.60 " 241.86 68.50 935.99 232.61 571.37 " 1,047.75 " 531.00 624.88 273.58 28174667 NEW EYE EXAM & TREATMENT 92018 360 "$10,512.00" " 3,885.24 " 100.00 " 8,409.60 " 115.00 " 7,263.79 " " 2,087.17 " " 7,263.79 " 117.00 " 5,807.88 " " 2,047.41 " " 6,937.92 " 112.00 104.13 " 6,957.89 " " 1,789.00 " " 1,987.78 " " 2,444.08 " " 3,055.10 " " 2,037.47 " " 2,047.41 " " 1,987.78 " " 8,409.60 " " 1,818.82 " 100.00 " 7,043.04 " " 1,749.25 " " 4,299.41 " " 7,884.00 " " 3,995.61 " " 4,702.02 " " 2,057.35 " 31200067 VISUAL FIELD EXAM EXTENDED 92083 920 $588.00 217.32 63.00 470.40 72.45 406.31 117.61 406.31 73.71 324.87 115.37 388.08 70.56 65.60 389.20 100.81 112.01 170.26 212.83 114.81 115.37 112.01 470.40 102.49 63.00 393.96 98.57 240.49 441.00 223.50 263.01 115.93 31200776 NEEDLE OCULOELECTROMYGRAPHY 92265 920 $292.00 107.92 48.00 233.60 55.20 201.77 58.05 201.77 56.16 161.33 56.95 192.72 53.76 49.98 193.27 49.76 55.29 141.41 176.76 56.67 56.95 55.29 233.60 50.59 48.00 195.64 48.66 119.43 219.00 110.99 130.61 57.23 28174675 EAR AND THROAT EXAMINATION 92502 360 "$2,375.00" 877.80 100.00 " 1,900.00 " 115.00 " 1,641.13 " 471.72 " 1,641.13 " 117.00 " 1,312.19 " 462.74 " 1,567.50 " 112.00 104.13 " 1,572.01 " 404.33 449.26 198.80 248.50 460.49 462.74 449.26 " 1,900.00 " 411.07 100.00 " 1,591.25 " 395.35 971.38 " 1,781.25 " 902.74 " 1,062.34 " 464.98 28900040 SPEECH/HEARING THERAPY 92507 440 $399.00 147.47 21.70 319.20 24.96 275.71 79.91 275.71 25.39 220.45 78.38 263.34 24.30 22.60 264.10 68.49 76.10 164.60 205.75 78.00 78.38 76.10 319.20 69.63 21.70 267.33 66.97 163.19 299.25 151.66 178.47 78.76 28901330 GROUP THERAPY 92508 440 $122.00 45.09 - 112.91 - 84.30 24.60 84.30 - 67.41 24.13 80.52 - - 80.75 21.09 23.43 90.33 112.91 24.02 24.13 23.43 97.60 21.44 - 81.74 20.62 49.90 91.50 46.37 54.57 24.25 28901232 EVAL SPEECH FLUENCY 92521 440 $698.00 257.98 - 558.40 - 482.32 138.55 482.32 - 385.65 135.91 460.68 - - 462.01 118.76 131.95 209.93 262.41 135.25 135.91 131.95 558.40 120.73 - 467.66 116.12 285.48 523.50 265.31 312.22 136.57 28901241 EVAL SPEECH SOUND PRODUCTION 92522 440 $585.00 216.22 - 468.00 - 404.24 116.34 404.24 - 323.21 114.12 386.10 - - 387.21 99.72 110.80 170.83 213.54 113.57 114.12 110.80 468.00 101.38 - 391.95 97.50 239.27 438.75 222.36 261.67 114.68 28901259 EVAL SPEECH SOUND W/LANG COMP 92523 440 "$1,201.00" 443.89 - 960.80 - 829.89 236.55 829.89 - 663.55 232.05 792.66 - - 794.94 202.76 225.29 354.31 442.89 230.92 232.05 225.29 960.80 206.14 - 804.67 198.26 491.21 900.75 456.50 537.21 233.18 28901267 ANALYSIS VOICE/RESONANCE 92524 440 $573.00 211.78 - 458.40 - 395.94 114.64 395.94 - 316.58 112.46 378.18 - - 379.27 98.26 109.18 178.21 222.76 111.91 112.46 109.18 458.40 99.90 - 383.91 96.08 234.36 429.75 217.80 256.30 113.00 28900767 ORAL FUNCTION THERAPY 92526 440 $441.00 162.99 - 772.39 - 304.73 88.52 304.73 - 243.65 86.83 291.06 - - 291.90 75.87 84.30 617.91 772.39 86.41 86.83 84.30 352.80 77.13 - 295.47 74.18 180.37 330.75 167.62 197.26 87.25 29121192 ORAL FUNCTION THERAPY 92526 430 $441.00 162.99 - 772.39 - 304.73 88.52 304.73 - 243.65 86.83 291.06 - - 291.90 75.87 84.30 617.91 772.39 86.41 86.83 84.30 352.80 77.13 - 295.47 74.18 180.37 330.75 167.62 197.26 87.25 28901283 PURE TONE AUDIOMETRY AIR ONLY 92552 471 $588.00 217.32 8.00 470.40 9.20 406.31 117.61 406.31 9.36 324.87 115.37 388.08 8.96 8.33 389.20 100.81 112.01 56.35 70.44 114.81 115.37 112.01 470.40 102.49 8.00 393.96 98.57 240.49 441.00 223.50 263.01 115.93 28900295 EVAL SWALLOWING FUNCTION 92610 444 $363.00 134.16 - " 1,196.05 " - 250.83 73.04 250.83 - 200.56 71.65 239.58 - - 240.27 62.60 69.56 956.84 " 1,196.05 " 71.30 71.65 69.56 290.40 63.65 - 243.21 61.21 148.47 272.25 137.98 162.37 71.99 28900775 MOTION FLUOROSCOPY/SWALLOW 92611 444 $477.00 176.30 42.32 " 1,196.05 " 48.67 329.61 95.27 329.61 49.51 263.54 93.45 314.82 47.40 44.07 315.73 81.66 90.73 956.84 " 1,196.05 " 93.00 93.45 90.73 381.60 83.02 42.32 319.59 79.84 195.09 357.75 181.31 213.36 93.91 31202248 AEP HEARING STATUS DETER I&R 92651 480 $733.00 270.92 70.30 586.40 80.85 506.50 145.62 506.50 82.25 404.98 142.85 483.78 78.74 73.20 485.17 124.82 138.69 388.42 485.54 142.16 142.85 138.69 586.40 126.90 70.30 491.11 122.05 299.80 549.75 278.61 327.87 143.54 31202256 AEP THRSHLD EST MLT FREQ I&R 92652 480 "$1,388.00" 513.00 92.34 " 1,110.40 " 106.19 959.11 276.03 959.11 108.04 766.87 270.78 916.08 103.42 96.15 918.72 236.60 262.89 735.50 919.41 269.46 270.78 262.89 " 1,110.40 " 240.54 92.34 929.96 231.34 567.69 " 1,041.00 " 527.58 620.85 272.09 31202264 AEP NEURODIAGNOSTIC I&R 92653 480 "$1,388.00" 513.00 67.51 " 1,110.40 " 77.64 959.11 276.03 959.11 78.99 766.87 270.78 916.08 75.61 70.30 918.72 236.60 262.89 735.50 919.41 269.46 270.78 262.89 " 1,110.40 " 240.54 67.51 929.96 231.34 567.69 " 1,041.00 " 527.58 620.85 272.09 29811369 PRQ CARDIAC ANGIOPLAST 1 ART 92920 481 "$26,023.00" " 9,618.10 " 776.00 " 20,818.40 " 892.40 " 17,981.89 " " 5,169.57 " " 17,981.89 " 907.92 " 14,377.71 " " 5,071.10 " " 17,175.18 " 869.12 808.05 " 17,224.62 " " 4,431.06 " " 4,923.40 " " 4,760.78 " " 5,950.98 " " 5,046.49 " " 5,071.10 " " 4,923.40 " " 20,818.40 " " 4,504.91 " 776.00 " 17,435.41 " " 4,332.59 " " 10,643.41 " " 19,517.25 " " 9,891.34 " " 11,640.09 " " 5,095.72 " 29811377 PRQ CARDIAC ANGIO ADDL ART 92921 481 "$1,894.00" 700.02 - " 1,515.20 " - " 1,308.75 " - " 1,308.75 " - " 1,046.44 " - " 1,250.04 " - - " 1,253.64 " - - 522.74 653.43 - - - " 1,515.20 " - - " 1,268.98 " - 774.65 " 1,420.50 " 719.91 847.19 - 29811407 PRQ CARD ANGIO/ATHRECT 1 ART 92924 481 "$52,725.00" " 19,487.16 " 776.00 " 42,180.00 " 892.40 " 36,432.98 " " 10,476.71 " " 36,432.98 " 907.92 " 29,130.56 " " 10,277.15 " " 34,798.50 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 2,156.17 " " 2,695.21 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 29811385 PRQ CARD STENT W/ANGIO 1 VSL 92928 481 "$52,725.00" " 19,487.16 " 776.00 " 42,180.00 " 892.40 " 36,432.98 " " 10,476.71 " " 36,432.98 " 907.92 " 29,130.56 " " 10,277.15 " " 34,798.50 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 11,279.02 " " 14,098.78 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 29811393 PRQ CARD STENT W/ANGIO ADDL 92929 481 "$2,179.00" 805.36 - " 7,049.39 " - " 1,505.69 " - " 1,505.69 " - " 1,203.90 " - " 1,438.14 " - - " 1,442.28 " - - " 5,639.51 " " 7,049.39 " - - - " 1,743.20 " - - " 1,459.93 " - 891.21 " 1,634.25 " 828.24 974.67 - 29811661 PRQ CARD STENT/ATH/ANGIO 92933 481 "$84,336.00" " 31,170.59 " 776.00 " 67,468.80 " 892.40 " 58,276.18 " " 16,751.22 " " 58,276.18 " 907.92 " 46,595.64 " " 16,432.15 " " 55,661.76 " 869.12 808.05 " 55,822.00 " " 14,358.19 " " 15,953.54 " " 13,435.18 " " 16,793.98 " " 16,352.38 " " 16,432.15 " " 15,953.54 " " 67,468.80 " " 14,597.49 " 776.00 " 56,505.12 " " 14,039.12 " " 34,493.42 " " 63,252.00 " " 32,056.11 " " 37,723.49 " " 16,511.91 " 29811679 PRQ CARD STENT/ATH/ANGIO ADDL 92934 481 "$25,619.00" " 9,468.78 " - " 20,495.20 " - " 17,702.73 " - " 17,702.73 " - " 14,154.50 " - " 16,908.54 " - - " 16,957.22 " - - " 6,717.59 " " 8,396.99 " - - - " 20,495.20 " - - " 17,164.73 " - " 10,478.17 " " 19,214.25 " " 9,737.78 " " 11,459.38 " - 29811652 PRQ REVASC BYP GRAFT 1 VSL 92937 481 "$52,725.00" " 19,487.16 " 776.00 " 42,180.00 " 892.40 " 36,432.98 " " 10,476.71 " " 36,432.98 " 907.92 " 29,130.56 " " 10,277.15 " " 34,798.50 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 2,200.09 " " 2,750.11 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 29811474 PRQ CARD REVASC MI 1 VSL 92941 481 "$12,603.00" " 4,658.07 " - " 10,082.40 " - " 8,708.67 " N/A " 8,708.67 " - " 6,963.16 " N/A " 8,317.98 " - N/A " 8,341.93 " - N/A " 2,467.99 " " 3,084.99 " N/A N/A N/A " 10,082.40 " N/A - " 8,444.01 " N/A " 5,154.63 " " 9,452.25 " " 4,790.40 " " 5,637.32 " N/A 29811482 PRQ CARD REVASC CHRONIC 1VSL 92943 481 "$52,725.00" " 19,487.16 " 776.00 " 42,180.00 " 892.40 " 36,432.98 " " 10,476.71 " " 36,432.98 " 907.92 " 29,130.56 " " 10,277.15 " " 34,798.50 " 869.12 808.05 " 34,898.68 " " 8,980.04 " " 9,977.82 " " 2,467.99 " " 3,084.99 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " 776.00 " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 29811491 PRQ CARD REVASC CHRONIC ADDL 92944 481 "$19,584.00" " 7,238.25 " - " 15,667.20 " - " 13,532.54 " - " 13,532.54 " - " 10,820.16 " - " 12,925.44 " - - " 12,962.65 " - - " 1,210.24 " " 1,512.80 " - - - " 15,667.20 " - - " 13,121.28 " - " 8,009.86 " " 14,688.00 " " 7,443.88 " " 8,759.92 " - 24770800 CARDIO PULMONARY RESUSCITATION 92950 480 "$1,388.00" 513.00 - " 1,110.40 " - 959.11 276.03 959.11 - 766.87 270.78 916.08 - - 918.72 236.60 262.89 608.03 760.04 269.46 270.78 262.89 " 1,110.40 " 240.54 - 929.96 231.34 567.69 " 1,041.00 " 527.58 620.85 272.09 29803536 CARDIO PULMONARY RESUSCITATION 92950 481 "$1,388.00" 513.00 - " 1,110.40 " - 959.11 276.03 959.11 - 766.87 270.78 916.08 - - 918.72 236.60 262.89 608.03 760.04 269.46 270.78 262.89 " 1,110.40 " 240.54 - 929.96 231.34 567.69 " 1,041.00 " 527.58 620.85 272.09 37005037 HEART/LUNG RESUSCITATION CPR 92950 450 "$1,388.00" 513.00 - " 1,110.40 " - 959.11 276.03 959.11 - 766.87 270.78 916.08 - - 918.72 236.60 262.89 608.03 760.04 269.46 270.78 262.89 " 1,110.40 " 240.54 - 929.96 231.34 567.69 " 1,041.00 " 527.58 620.85 272.09 05938350 CARDIOVERSION 92960 480 "$2,950.00" " 1,090.32 " 491.07 " 2,360.00 " 892.40 " 2,038.45 " 585.93 " 2,038.45 " 907.92 " 1,629.88 " 574.77 " 1,947.00 " 869.12 808.05 " 1,952.61 " 502.23 558.03 " 1,481.34 " " 1,851.67 " 571.98 574.77 558.03 " 2,360.00 " 510.60 776.00 " 1,976.50 " 491.07 " 1,206.55 " " 2,212.50 " " 1,121.30 " " 1,319.54 " 577.56 27601154 CARDIOVERSION 92960 360 "$2,950.00" " 1,090.32 " 491.07 " 2,360.00 " 892.40 " 2,038.45 " 585.93 " 2,038.45 " 907.92 " 1,629.88 " 574.77 " 1,947.00 " 869.12 808.05 " 1,952.61 " 502.23 558.03 " 1,481.34 " " 1,851.67 " 571.98 574.77 558.03 " 2,360.00 " 510.60 776.00 " 1,976.50 " 491.07 " 1,206.55 " " 2,212.50 " " 1,121.30 " " 1,319.54 " 577.56 28175744 "CARDIOVERSION, EXTERNAL" 92960 360 "$2,950.00" " 1,090.32 " 491.07 " 2,360.00 " 892.40 " 2,038.45 " 585.93 " 2,038.45 " 907.92 " 1,629.88 " 574.77 " 1,947.00 " 869.12 808.05 " 1,952.61 " 502.23 558.03 " 1,481.34 " " 1,851.67 " 571.98 574.77 558.03 " 2,360.00 " 510.60 776.00 " 1,976.50 " 491.07 " 1,206.55 " " 2,212.50 " " 1,121.30 " " 1,319.54 " 577.56 29803544 CARDIOVERSION 92960 480 "$2,950.00" " 1,090.32 " 491.07 " 2,360.00 " 892.40 " 2,038.45 " 585.93 " 2,038.45 " 907.92 " 1,629.88 " 574.77 " 1,947.00 " 869.12 808.05 " 1,952.61 " 502.23 558.03 " 1,481.34 " " 1,851.67 " 571.98 574.77 558.03 " 2,360.00 " 510.60 776.00 " 1,976.50 " 491.07 " 1,206.55 " " 2,212.50 " " 1,121.30 " " 1,319.54 " 577.56 30100425 CARDIOVERSION 92960 480 "$2,950.00" " 1,090.32 " 491.07 " 2,360.00 " 892.40 " 2,038.45 " 585.93 " 2,038.45 " 907.92 " 1,629.88 " 574.77 " 1,947.00 " 869.12 808.05 " 1,952.61 " 502.23 558.03 " 1,481.34 " " 1,851.67 " 571.98 574.77 558.03 " 2,360.00 " 510.60 776.00 " 1,976.50 " 491.07 " 1,206.55 " " 2,212.50 " " 1,121.30 " " 1,319.54 " 577.56 30600584 CARDIOVERSION 92960 480 "$2,950.00" " 1,090.32 " 491.07 " 2,360.00 " 892.40 " 2,038.45 " 585.93 " 2,038.45 " 907.92 " 1,629.88 " 574.77 " 1,947.00 " 869.12 808.05 " 1,952.61 " 502.23 558.03 " 1,481.34 " " 1,851.67 " 571.98 574.77 558.03 " 2,360.00 " 510.60 776.00 " 1,976.50 " 491.07 " 1,206.55 " " 2,212.50 " " 1,121.30 " " 1,319.54 " 577.56 37089907 CARDIOVERSION 92960 450 "$2,950.00" " 1,090.32 " 491.07 " 2,360.00 " 892.40 " 2,038.45 " 585.93 " 2,038.45 " 907.92 " 1,629.88 " 574.77 " 1,947.00 " 869.12 808.05 " 1,952.61 " 502.23 558.03 " 1,481.34 " " 1,851.67 " 571.98 574.77 558.03 " 2,360.00 " 510.60 776.00 " 1,976.50 " 491.07 " 1,206.55 " " 2,212.50 " " 1,121.30 " " 1,319.54 " 577.56 29805041 CARDIOASSIST INTERNAL 92970 481 "$10,084.00" " 3,727.05 " - " 8,067.20 " - " 6,968.04 " N/A " 6,968.04 " - " 5,571.41 " N/A " 6,655.44 " - N/A " 6,674.60 " - N/A 583.72 729.65 N/A N/A N/A " 8,067.20 " N/A - " 6,756.28 " N/A " 4,124.36 " " 7,563.00 " " 3,832.93 " " 4,510.57 " N/A 29803226 PRQ CORONARY THROMBECTOMY 92973 481 $498.00 184.06 - " 1,238.37 " 192.46 344.12 - 344.12 195.81 275.15 - 328.68 187.44 174.27 329.63 - - 990.70 " 1,238.37 " - - - 398.40 - 167.36 333.66 - 203.68 373.50 189.29 222.76 - 29803552 THROMBOLYSIS INTRACORONARY 92975 481 "$3,335.00" " 1,232.62 " - " 2,668.00 " - " 2,304.49 " N/A " 2,304.49 " - " 1,842.59 " N/A " 2,201.10 " - N/A " 2,207.44 " - N/A " 1,257.99 " " 1,572.49 " N/A N/A N/A " 2,668.00 " N/A - " 2,234.45 " N/A " 1,364.02 " " 2,501.25 " " 1,267.63 " " 1,491.75 " N/A 29801487 IVUS OR CORON ART INITIAL 92978 481 $565.00 208.82 - 674.55 276.06 390.42 - 390.42 280.86 312.16 - 372.90 268.86 249.96 373.97 - - 539.64 674.55 - - - 452.00 - 240.05 378.55 - 231.09 423.75 214.76 252.72 - 29801983 IVUS OR CORON ART EA ADDL 92979 481 "$1,206.00" 445.74 - 964.80 - 833.35 - 833.35 - 666.32 - 795.96 - - 798.25 - - 271.34 339.17 - - - 964.80 - - 808.02 - 493.25 904.50 458.40 539.44 - 29804362 BALLOON DILATION AORTIC VALVE 92986 481 "$26,023.00" " 9,618.10 " 776.00 " 20,818.40 " 892.40 " 17,981.89 " " 5,169.57 " " 17,981.89 " 907.92 " 14,377.71 " " 5,071.10 " " 17,175.18 " 869.12 808.05 " 17,224.62 " " 4,431.06 " " 4,923.40 " " 4,205.92 " " 5,257.40 " " 5,046.49 " " 5,071.10 " " 4,923.40 " " 20,818.40 " " 4,504.91 " 776.00 " 17,435.41 " " 4,332.59 " " 10,643.41 " " 19,517.25 " " 9,891.34 " " 11,640.09 " " 5,095.72 " 05930006 ECG TRACING ONLY 93005 730 $292.00 107.92 10.46 233.60 12.03 201.77 58.05 201.77 12.24 161.33 56.95 192.72 11.72 10.89 193.27 49.76 55.29 71.26 89.08 56.67 56.95 55.29 233.60 50.59 10.46 195.64 48.66 119.43 219.00 110.99 130.61 57.23 05938201 CARDIO STRESS TEST W/O PHARM 93017 482 "$1,388.00" 513.00 46.50 " 1,110.40 " 53.48 959.11 276.03 959.11 54.41 766.87 270.78 916.08 52.08 48.42 918.72 236.60 262.89 209.64 262.05 269.46 270.78 262.89 " 1,110.40 " 240.54 46.50 929.96 231.34 567.69 " 1,041.00 " 527.58 620.85 272.09 05938317 CARDIO STRESS TEST W/PHARM 93017 482 "$1,388.00" 513.00 46.50 " 1,110.40 " 53.48 959.11 276.03 959.11 54.41 766.87 270.78 916.08 52.08 48.42 918.72 236.60 262.89 209.64 262.05 269.46 270.78 262.89 " 1,110.40 " 240.54 46.50 929.96 231.34 567.69 " 1,041.00 " 527.58 620.85 272.09 30100522 CARDIO STRESS TEST W/PHARM 93017 482 "$1,388.00" 513.00 46.50 " 1,110.40 " 53.48 959.11 276.03 959.11 54.41 766.87 270.78 916.08 52.08 48.42 918.72 236.60 262.89 209.64 262.05 269.46 270.78 262.89 " 1,110.40 " 240.54 46.50 929.96 231.34 567.69 " 1,041.00 " 527.58 620.85 272.09 30100531 CARDIO STRESS TEST W/O PHARM 93017 482 "$1,388.00" 513.00 46.50 " 1,110.40 " 53.48 959.11 276.03 959.11 54.41 766.87 270.78 916.08 52.08 48.42 918.72 236.60 262.89 209.64 262.05 269.46 270.78 262.89 " 1,110.40 " 240.54 46.50 929.96 231.34 567.69 " 1,041.00 " 527.58 620.85 272.09 53938205 CARDIO STRESS TEST W/O PHARM 93017 482 "$1,388.00" 513.00 46.50 " 1,110.40 " 53.48 959.11 276.03 959.11 54.41 766.87 270.78 916.08 52.08 48.42 918.72 236.60 262.89 209.64 262.05 269.46 270.78 262.89 " 1,110.40 " 240.54 46.50 929.96 231.34 567.69 " 1,041.00 " 527.58 620.85 272.09 53938311 CARDIO STRESS TEST W/PHARM 93017 482 "$1,388.00" 513.00 46.50 " 1,110.40 " 53.48 959.11 276.03 959.11 54.41 766.87 270.78 916.08 52.08 48.42 918.72 236.60 262.89 209.64 262.05 269.46 270.78 262.89 " 1,110.40 " 240.54 46.50 929.96 231.34 567.69 " 1,041.00 " 527.58 620.85 272.09 05930405 RHYTHM ECG TRACING 93041 730 $292.00 107.92 5.06 233.60 5.82 201.77 58.05 201.77 5.92 161.33 56.95 192.72 5.67 5.27 193.27 49.76 55.29 39.62 49.52 56.67 56.95 55.29 233.60 50.59 5.06 195.64 48.66 119.43 219.00 110.99 130.61 57.23 05931002 ECG MONITOR ANALYSIS 93225 731 $588.00 217.32 18.25 470.40 20.99 406.31 117.61 406.31 21.35 324.87 115.37 388.08 20.44 19.00 389.20 100.81 112.01 357.34 446.68 114.81 115.37 112.01 470.40 102.49 18.25 393.96 98.57 240.49 441.00 223.50 263.01 115.93 05930014 ECG MONITOR ANALYSIS W/REPORT 93226 731 $588.00 217.32 39.76 788.54 45.72 406.31 117.61 406.31 46.52 324.87 115.37 388.08 44.53 41.40 389.20 100.81 112.01 630.83 788.54 114.81 115.37 112.01 470.40 102.49 39.76 393.96 98.57 240.49 441.00 223.50 263.01 115.93 05938473 EXT ECG >48 HRS-7 DAYS HOOKUP 93242 480 $178.00 65.79 - 142.40 - 123.00 58.05 123.00 - 98.35 56.95 117.48 - - 117.82 49.76 55.29 94.32 117.91 56.67 56.95 55.29 142.40 50.59 - 119.26 48.66 72.80 133.50 67.66 79.62 57.23 05938490 EXT ECG >7 DAYS-15 DAYS HOOKUP 93246 480 $292.00 107.92 - 233.60 - 201.77 58.05 201.77 - 161.33 56.95 192.72 - - 193.27 49.76 55.29 154.73 193.42 56.67 56.95 55.29 233.60 50.59 - 195.64 48.66 119.43 219.00 110.99 130.61 57.23 05900361 INTERROGTN EVAL IMPL SUBQ DFB 93261 480 $195.00 72.07 - 156.00 - 134.75 38.84 134.75 - 107.74 38.10 128.70 - - 129.07 33.29 36.99 69.50 86.88 37.91 38.10 36.99 156.00 33.85 - 130.65 32.55 79.76 146.25 74.12 87.22 38.28 05900409 PRGRMG EVAL SGL LEAD DFB SYS 93282 480 $195.00 72.07 32.55 224.98 46.81 134.75 38.84 134.75 47.62 107.74 38.10 128.70 45.58 42.38 129.07 33.29 36.99 179.98 224.98 37.91 38.10 36.99 156.00 33.85 40.70 130.65 32.55 79.76 146.25 74.12 87.22 38.28 30612272 PERIOP PM EVAL & PROG W/RPT 93286 480 "$1,300.00" 480.48 - " 1,040.00 " - 898.30 - 898.30 - 718.25 - 858.00 - - 860.47 - - 91.35 114.19 - - - " 1,040.00 " - - 871.00 - 531.70 975.00 494.13 581.49 - 05938074 TELE ANALYSIS SGL/DUAL EVAL 93293 732 $195.00 72.07 32.50 401.74 37.38 134.75 38.84 134.75 38.03 107.74 38.10 128.70 36.40 33.84 129.07 33.29 36.99 321.39 401.74 37.91 38.10 36.99 156.00 33.85 32.50 130.65 32.55 79.76 146.25 74.12 87.22 38.28 05938295 TTE CONGENITAL COMPLETE 93303 480 "$2,535.00" 936.94 157.25 " 2,028.00 " 180.84 " 1,751.69 " 503.98 " 1,751.69 " 183.98 " 1,400.59 " 494.38 " 1,673.10 " 176.12 163.74 " 1,677.92 " 431.98 479.98 660.80 826.00 491.98 494.38 479.98 " 2,028.00 " 439.18 157.25 " 1,698.45 " 422.38 " 1,036.82 " " 1,901.25 " 963.55 " 1,133.91 " 496.78 30100352 TTE CONGENITAL COMPLETE 93303 480 "$2,535.00" 936.94 157.25 " 2,028.00 " 180.84 " 1,751.69 " 503.98 " 1,751.69 " 183.98 " 1,400.59 " 494.38 " 1,673.10 " 176.12 163.74 " 1,677.92 " 431.98 479.98 660.80 826.00 491.98 494.38 479.98 " 2,028.00 " 439.18 157.25 " 1,698.45 " 422.38 " 1,036.82 " " 1,901.25 " 963.55 " 1,133.91 " 496.78 05938309 TTE CONGENITAL LIMITED 93304 480 "$2,535.00" 936.94 36.50 " 2,028.00 " 41.98 " 1,751.69 " 503.98 " 1,751.69 " 42.71 " 1,400.59 " 494.38 " 1,673.10 " 40.88 38.01 " 1,677.92 " 431.98 479.98 361.81 452.26 491.98 494.38 479.98 " 2,028.00 " 439.18 36.50 " 1,698.45 " 422.38 " 1,036.82 " " 1,901.25 " 963.55 " 1,133.91 " 496.78 30100573 TTE CONGENITAL LIMITED 93304 480 "$2,535.00" 936.94 36.50 " 2,028.00 " 41.98 " 1,751.69 " 503.98 " 1,751.69 " 42.71 " 1,400.59 " 494.38 " 1,673.10 " 40.88 38.01 " 1,677.92 " 431.98 479.98 361.81 452.26 491.98 494.38 479.98 " 2,028.00 " 439.18 36.50 " 1,698.45 " 422.38 " 1,036.82 " " 1,901.25 " 963.55 " 1,133.91 " 496.78 05938341 2D TTE DOPPLER COLOR FLOW CPL 93306 483 "$2,535.00" 936.94 141.02 " 2,028.00 " 162.17 " 1,751.69 " 503.98 " 1,751.69 " 164.99 " 1,400.59 " 494.38 " 1,673.10 " 157.94 146.84 " 1,677.92 " 431.98 479.98 " 1,458.78 " " 1,823.48 " 491.98 494.38 479.98 " 2,028.00 " 439.18 141.02 " 1,698.45 " 422.38 " 1,036.82 " " 1,901.25 " 963.55 " 1,133.91 " 496.78 30100379 2D TTE DOPPLER COLOR FLOW CPL 93306 483 "$2,535.00" 936.94 141.02 " 2,028.00 " 162.17 " 1,751.69 " 503.98 " 1,751.69 " 164.99 " 1,400.59 " 494.38 " 1,673.10 " 157.94 146.84 " 1,677.92 " 431.98 479.98 " 1,458.78 " " 1,823.48 " 491.98 494.38 479.98 " 2,028.00 " 439.18 141.02 " 1,698.45 " 422.38 " 1,036.82 " " 1,901.25 " 963.55 " 1,133.91 " 496.78 05938368 2D TTE W/O DOPPLER/COLOR FLOW 93307 480 "$1,208.00" 446.48 140.38 988.91 161.44 834.73 240.00 834.73 164.24 667.42 235.43 797.28 157.23 146.18 799.58 205.71 228.57 791.13 988.91 234.28 235.43 228.57 966.40 209.14 140.38 809.36 201.14 494.07 906.00 459.16 540.34 236.57 30100018 2D TTE W/O DOPPLER/COLOR FLOW 93307 480 "$1,208.00" 446.48 140.38 988.91 161.44 834.73 240.00 834.73 164.24 667.42 235.43 797.28 157.23 146.18 799.58 205.71 228.57 791.13 988.91 234.28 235.43 228.57 966.40 209.14 140.38 809.36 201.14 494.07 906.00 459.16 540.34 236.57 05938210 2D TTE LIMITED 93308 483 "$1,208.00" 446.48 36.50 966.40 41.98 834.73 240.00 834.73 42.71 667.42 235.43 797.28 40.88 38.01 799.58 205.71 228.57 403.58 504.47 234.28 235.43 228.57 966.40 209.14 36.50 809.36 201.14 494.07 906.00 459.16 540.34 236.57 30100336 2D TTE LIMITED 93308 483 "$1,208.00" 446.48 36.50 966.40 41.98 834.73 240.00 834.73 42.71 667.42 235.43 797.28 40.88 38.01 799.58 205.71 228.57 403.58 504.47 234.28 235.43 228.57 966.40 209.14 36.50 809.36 201.14 494.07 906.00 459.16 540.34 236.57 37003859 2D ECHO LIMITED 93308 483 "$1,208.00" 446.48 36.50 966.40 41.98 834.73 240.00 834.73 42.71 667.42 235.43 797.28 40.88 38.01 799.58 205.71 228.57 403.58 504.47 234.28 235.43 228.57 966.40 209.14 36.50 809.36 201.14 494.07 906.00 459.16 540.34 236.57 05938236 2D TEE PROBE PLCMNT/REPORT I&A 93312 480 "$2,535.00" 936.94 239.49 " 2,028.00 " 275.41 " 1,751.69 " 503.98 " 1,751.69 " 280.20 " 1,400.59 " 494.38 " 1,673.10 " 268.23 249.38 " 1,677.92 " 431.98 479.98 " 1,097.46 " " 1,371.82 " 491.98 494.38 479.98 " 2,028.00 " 439.18 239.49 " 1,698.45 " 422.38 " 1,036.82 " " 1,901.25 " 963.55 " 1,133.91 " 496.78 27000312 TEE2D PROBE PLCE/IMAGE I&A 93312 483 "$2,535.00" 936.94 239.49 " 2,028.00 " 275.41 " 1,751.69 " 503.98 " 1,751.69 " 280.20 " 1,400.59 " 494.38 " 1,673.10 " 268.23 249.38 " 1,677.92 " 431.98 479.98 " 1,097.46 " " 1,371.82 " 491.98 494.38 479.98 " 2,028.00 " 439.18 239.49 " 1,698.45 " 422.38 " 1,036.82 " " 1,901.25 " 963.55 " 1,133.91 " 496.78 30100085 2D TEE PROBE PLCMNT/REPORT I&A 93312 480 "$2,535.00" 936.94 239.49 " 2,028.00 " 275.41 " 1,751.69 " 503.98 " 1,751.69 " 280.20 " 1,400.59 " 494.38 " 1,673.10 " 268.23 249.38 " 1,677.92 " 431.98 479.98 " 1,097.46 " " 1,371.82 " 491.98 494.38 479.98 " 2,028.00 " 439.18 239.49 " 1,698.45 " 422.38 " 1,036.82 " " 1,901.25 " 963.55 " 1,133.91 " 496.78 27000517 PLCMNT TEE PROBE 93313 483 "$2,535.00" 936.94 - " 2,028.00 " - " 1,751.69 " 503.98 " 1,751.69 " - " 1,400.59 " 494.38 " 1,673.10 " - - " 1,677.92 " 431.98 479.98 " 1,086.38 " " 1,357.97 " 491.98 494.38 479.98 " 2,028.00 " 439.18 - " 1,698.45 " 422.38 " 1,036.82 " " 1,901.25 " 963.55 " 1,133.91 " 496.78 28176694 ECHO TRANSESOPHAGEAL 93314 360 $750.00 277.20 - 853.70 216.71 518.25 - 518.25 220.47 414.38 - 495.00 211.05 196.22 496.43 - - 682.96 853.70 - - - 600.00 - 188.44 502.50 - 306.75 562.50 285.08 335.48 - 30100743 TEE CONGENITAL PROBE PLCMT/RPT 93315 483 "$2,535.00" 936.94 264.00 " 2,028.00 " 303.60 " 1,751.69 " 503.98 " 1,751.69 " 308.88 " 1,400.59 " 494.38 " 1,673.10 " 295.68 274.90 " 1,677.92 " 431.98 479.98 850.91 " 1,063.64 " 491.98 494.38 479.98 " 2,028.00 " 439.18 264.00 " 1,698.45 " 422.38 " 1,036.82 " " 1,901.25 " 963.55 " 1,133.91 " 496.78 05938376 DOPPLER ECHO COMPLETE 93320 480 $194.00 71.70 - 456.34 69.61 134.05 - 134.05 70.82 107.19 - 128.04 67.79 63.03 128.41 - - 365.07 456.34 - - - 155.20 - 60.53 129.98 - 79.35 145.50 73.74 86.78 - 27000525 DOPPLER ECHO 93320 483 $194.00 71.70 - 456.34 69.61 134.05 - 134.05 70.82 107.19 - 128.04 67.79 63.03 128.41 - - 365.07 456.34 - - - 155.20 - 60.53 129.98 - 79.35 145.50 73.74 86.78 - 30100077 DOPPLER ECHO COMPLETE 93320 480 $194.00 71.70 - 456.34 69.61 134.05 - 134.05 70.82 107.19 - 128.04 67.79 63.03 128.41 - - 365.07 456.34 - - - 155.20 - 60.53 129.98 - 79.35 145.50 73.74 86.78 - 05938287 DOPPLER ECHO LIMITED 93321 483 $194.00 71.70 - 275.40 32.55 134.05 - 134.05 33.11 107.19 - 128.04 31.70 29.47 128.41 - - 220.32 275.40 - - - 155.20 - 28.30 129.98 - 79.35 145.50 73.74 86.78 - 30100417 DOPPLER ECHO LIMITED 93321 483 $194.00 71.70 - 275.40 32.55 134.05 - 134.05 33.11 107.19 - 128.04 31.70 29.47 128.41 - - 220.32 275.40 - - - 155.20 - 28.30 129.98 - 79.35 145.50 73.74 86.78 - 05938333 DOPPLER ECHO COLOR FLOW ADD-ON 93325 483 $194.00 71.70 - 476.87 - 134.05 - 134.05 - 107.19 - 128.04 - - 128.41 - - 381.50 476.87 - - - 155.20 - - 129.98 - 79.35 145.50 73.74 86.78 - 27000533 DOPPLER COLOR FLOW 93325 480 $194.00 71.70 - 476.87 - 134.05 - 134.05 - 107.19 - 128.04 - - 128.41 - - 381.50 476.87 - - - 155.20 - - 129.98 - 79.35 145.50 73.74 86.78 - 30100140 DOPPLER ECHO COLOR FLOW ADD-ON 93325 483 $194.00 71.70 - 476.87 - 134.05 - 134.05 - 107.19 - 128.04 - - 128.41 - - 381.50 476.87 - - - 155.20 - - 129.98 - 79.35 145.50 73.74 86.78 - 05938244 2D TTE STRESS W/DOBUT W/O SUP 93350 480 "$2,535.00" 936.94 76.50 " 2,028.00 " 87.98 " 1,751.69 " 503.98 " 1,751.69 " 89.51 " 1,400.59 " 494.38 " 1,673.10 " 85.68 79.66 " 1,677.92 " 431.98 479.98 702.81 878.51 491.98 494.38 479.98 " 2,028.00 " 439.18 76.50 " 1,698.45 " 422.38 " 1,036.82 " " 1,901.25 " 963.55 " 1,133.91 " 496.78 05938252 2D TTE STRESS EXERCISE W/O SUP 93350 480 "$2,535.00" 936.94 76.50 " 2,028.00 " 87.98 " 1,751.69 " 503.98 " 1,751.69 " 89.51 " 1,400.59 " 494.38 " 1,673.10 " 85.68 79.66 " 1,677.92 " 431.98 479.98 702.81 878.51 491.98 494.38 479.98 " 2,028.00 " 439.18 76.50 " 1,698.45 " 422.38 " 1,036.82 " " 1,901.25 " 963.55 " 1,133.91 " 496.78 30100123 2D TTE STRESS W/DOBUT W/O SUP 93350 480 "$2,535.00" 936.94 76.50 " 2,028.00 " 87.98 " 1,751.69 " 503.98 " 1,751.69 " 89.51 " 1,400.59 " 494.38 " 1,673.10 " 85.68 79.66 " 1,677.92 " 431.98 479.98 702.81 878.51 491.98 494.38 479.98 " 2,028.00 " 439.18 76.50 " 1,698.45 " 422.38 " 1,036.82 " " 1,901.25 " 963.55 " 1,133.91 " 496.78 30100131 2D TTE STRESS EXERCISE W/O SUP 93350 480 "$2,535.00" 936.94 76.50 " 2,028.00 " 87.98 " 1,751.69 " 503.98 " 1,751.69 " 89.51 " 1,400.59 " 494.38 " 1,673.10 " 85.68 79.66 " 1,677.92 " 431.98 479.98 702.81 878.51 491.98 494.38 479.98 " 2,028.00 " 439.18 76.50 " 1,698.45 " 422.38 " 1,036.82 " " 1,901.25 " 963.55 " 1,133.91 " 496.78 05938261 2D TTE STRESS W/DOBUT W/SUP 93351 480 "$2,535.00" 936.94 185.54 " 2,618.59 " 213.37 " 1,751.69 " 503.98 " 1,751.69 " 217.08 " 1,400.59 " 494.38 " 1,673.10 " 207.80 193.20 " 1,677.92 " 431.98 479.98 " 2,094.87 " " 2,618.59 " 491.98 494.38 479.98 " 2,028.00 " 439.18 185.54 " 1,698.45 " 422.38 " 1,036.82 " " 1,901.25 " 963.55 " 1,133.91 " 496.78 05938279 2D TTE STRESS EXERCISE W/SUP 93351 480 "$2,535.00" 936.94 185.54 " 2,618.59 " 213.37 " 1,751.69 " 503.98 " 1,751.69 " 217.08 " 1,400.59 " 494.38 " 1,673.10 " 207.80 193.20 " 1,677.92 " 431.98 479.98 " 2,094.87 " " 2,618.59 " 491.98 494.38 479.98 " 2,028.00 " 439.18 185.54 " 1,698.45 " 422.38 " 1,036.82 " " 1,901.25 " 963.55 " 1,133.91 " 496.78 30100387 2D TTE STRESS W/DOBUT W/SUP 93351 480 "$2,535.00" 936.94 185.54 " 2,618.59 " 213.37 " 1,751.69 " 503.98 " 1,751.69 " 217.08 " 1,400.59 " 494.38 " 1,673.10 " 207.80 193.20 " 1,677.92 " 431.98 479.98 " 2,094.87 " " 2,618.59 " 491.98 494.38 479.98 " 2,028.00 " 439.18 185.54 " 1,698.45 " 422.38 " 1,036.82 " " 1,901.25 " 963.55 " 1,133.91 " 496.78 30100395 2D TTE STRESS EXERCISE W/SUP 93351 480 "$2,535.00" 936.94 185.54 " 2,618.59 " 213.37 " 1,751.69 " 503.98 " 1,751.69 " 217.08 " 1,400.59 " 494.38 " 1,673.10 " 207.80 193.20 " 1,677.92 " 431.98 479.98 " 2,094.87 " " 2,618.59 " 491.98 494.38 479.98 " 2,028.00 " 439.18 185.54 " 1,698.45 " 422.38 " 1,036.82 " " 1,901.25 " 963.55 " 1,133.91 " 496.78 30113489 MYOCARD STRAIN IMG SPEC TRACK 93356 480 $321.00 118.64 - 386.30 - 221.81 - 221.81 - 177.35 - 211.86 - - 212.47 - - 309.04 386.30 - - - 256.80 - - 215.07 - 131.29 240.75 122.01 143.58 - 29801347 RIGHT HEART CATH 93451 481 "$15,220.00" " 5,625.31 " 776.00 " 12,176.00 " 892.40 " 1,469.00 " " 3,024.51 " " 1,469.00 " 907.92 " 8,409.05 " " 2,966.90 " " 10,045.20 " 869.12 808.05 " 10,074.12 " " 2,592.44 " " 2,880.49 " " 4,697.26 " " 5,871.57 " " 2,952.50 " " 2,966.90 " " 2,880.49 " " 12,176.00 " " 2,635.65 " 776.00 " 10,197.40 " " 2,534.83 " " 6,224.98 " " 11,415.00 " " 5,785.12 " " 6,807.91 " " 2,981.31 " 29810729 LEFT HEART CATH 93452 481 "$15,220.00" " 5,625.31 " 776.00 " 12,176.00 " 892.40 " 4,435.00 " " 3,024.51 " " 4,435.00 " 907.92 " 8,409.05 " " 2,966.90 " " 10,045.20 " 869.12 808.05 " 10,074.12 " " 2,592.44 " " 2,880.49 " " 4,487.06 " " 5,608.82 " " 2,952.50 " " 2,966.90 " " 2,880.49 " " 12,176.00 " " 2,635.65 " 776.00 " 10,197.40 " " 2,534.83 " " 6,224.98 " " 11,415.00 " " 5,785.12 " " 6,807.91 " " 2,981.31 " 29810737 RIGHT AND LEFT HEART CATH 93453 481 "$15,220.00" " 5,625.31 " 776.00 " 12,176.00 " 892.40 " 4,435.00 " " 3,024.51 " " 4,435.00 " 907.92 " 8,409.05 " " 2,966.90 " " 10,045.20 " 869.12 808.05 " 10,074.12 " " 2,592.44 " " 2,880.49 " " 5,867.80 " " 7,334.75 " " 2,952.50 " " 2,966.90 " " 2,880.49 " " 12,176.00 " " 2,635.65 " 776.00 " 10,197.40 " " 2,534.83 " " 6,224.98 " " 11,415.00 " " 5,785.12 " " 6,807.91 " " 2,981.31 " 29810745 CORONARY ARTERY ANGIO S&I 93454 481 "$15,220.00" " 5,625.31 " 776.00 " 12,176.00 " 892.40 " 4,435.00 " " 3,024.51 " " 4,435.00 " 907.92 " 8,409.05 " " 2,966.90 " " 10,045.20 " 869.12 808.05 " 10,074.12 " " 2,592.44 " " 2,880.49 " " 4,673.90 " " 5,842.37 " " 2,952.50 " " 2,966.90 " " 2,880.49 " " 12,176.00 " " 2,635.65 " 776.00 " 10,197.40 " " 2,534.83 " " 6,224.98 " " 11,415.00 " " 5,785.12 " " 6,807.91 " " 2,981.31 " 29810753 CORONARY ART/GRFT ANGIO S&I 93455 481 "$15,220.00" " 5,625.31 " 776.00 " 12,176.00 " 892.40 " 4,435.00 " " 3,024.51 " " 4,435.00 " 907.92 " 8,409.05 " " 2,966.90 " " 10,045.20 " 869.12 808.05 " 10,074.12 " " 2,592.44 " " 2,880.49 " " 5,478.58 " " 6,848.22 " " 2,952.50 " " 2,966.90 " " 2,880.49 " " 12,176.00 " " 2,635.65 " 776.00 " 10,197.40 " " 2,534.83 " " 6,224.98 " " 11,415.00 " " 5,785.12 " " 6,807.91 " " 2,981.31 " 29810761 RT HEART CORONARY ARTERY ANGIO 93456 481 "$15,220.00" " 5,625.31 " 776.00 " 12,176.00 " 892.40 " 4,435.00 " " 3,024.51 " " 4,435.00 " 907.92 " 8,409.05 " " 2,966.90 " " 10,045.20 " 869.12 808.05 " 10,074.12 " " 2,592.44 " " 2,880.49 " " 5,792.55 " " 7,240.69 " " 2,952.50 " " 2,966.90 " " 2,880.49 " " 12,176.00 " " 2,635.65 " 776.00 " 10,197.40 " " 2,534.83 " " 6,224.98 " " 11,415.00 " " 5,785.12 " " 6,807.91 " " 2,981.31 " 29810770 RT HEART ART BYPASS GRFT ANGIO 93457 481 "$15,220.00" " 5,625.31 " 776.00 " 12,176.00 " 892.40 " 4,435.00 " " 3,024.51 " " 4,435.00 " 907.92 " 8,409.05 " " 2,966.90 " " 10,045.20 " 869.12 808.05 " 10,074.12 " " 2,592.44 " " 2,880.49 " " 6,594.20 " " 8,242.75 " " 2,952.50 " " 2,966.90 " " 2,880.49 " " 12,176.00 " " 2,635.65 " 776.00 " 10,197.40 " " 2,534.83 " " 6,224.98 " " 11,415.00 " " 5,785.12 " " 6,807.91 " " 2,981.31 " 29810788 LT HEART ART/VENTRICLE ANGIO 93458 481 "$15,220.00" " 5,625.31 " 776.00 " 12,176.00 " 892.40 " 4,435.00 " " 3,024.51 " " 4,435.00 " 907.92 " 8,409.05 " " 2,966.90 " " 10,045.20 " 869.12 808.05 " 10,074.12 " " 2,592.44 " " 2,880.49 " " 5,613.53 " " 7,016.91 " " 2,952.50 " " 2,966.90 " " 2,880.49 " " 12,176.00 " " 2,635.65 " 776.00 " 10,197.40 " " 2,534.83 " " 6,224.98 " " 11,415.00 " " 5,785.12 " " 6,807.91 " " 2,981.31 " 29810796 LT HEART ART/GRAFT ANGIO 93459 481 "$15,220.00" " 5,625.31 " 776.00 " 12,176.00 " 892.40 " 4,435.00 " " 3,024.51 " " 4,435.00 " 907.92 " 8,409.05 " " 2,966.90 " " 10,045.20 " 869.12 808.05 " 10,074.12 " " 2,592.44 " " 2,880.49 " " 6,147.98 " " 7,684.98 " " 2,952.50 " " 2,966.90 " " 2,880.49 " " 12,176.00 " " 2,635.65 " 776.00 " 10,197.40 " " 2,534.83 " " 6,224.98 " " 11,415.00 " " 5,785.12 " " 6,807.91 " " 2,981.31 " 29810800 RT LT HEART ART/VENT ANGIO 93460 481 "$15,220.00" " 5,625.31 " 776.00 " 12,176.00 " 892.40 " 4,435.00 " " 3,024.51 " " 4,435.00 " 907.92 " 8,409.05 " " 2,966.90 " " 10,045.20 " 869.12 808.05 " 10,074.12 " " 2,592.44 " " 2,880.49 " " 6,459.34 " " 8,074.17 " " 2,952.50 " " 2,966.90 " " 2,880.49 " " 12,176.00 " " 2,635.65 " 776.00 " 10,197.40 " " 2,534.83 " " 6,224.98 " " 11,415.00 " " 5,785.12 " " 6,807.91 " " 2,981.31 " 29810818 RT LT HEART ANGIO BYPASS GRAFT 93461 481 "$15,220.00" " 5,625.31 " 776.00 " 12,176.00 " 892.40 " 4,435.00 " " 3,024.51 " " 4,435.00 " 907.92 " 8,409.05 " " 2,966.90 " " 10,045.20 " 869.12 808.05 " 10,074.12 " " 2,592.44 " " 2,880.49 " " 7,531.28 " " 9,414.10 " " 2,952.50 " " 2,966.90 " " 2,880.49 " " 12,176.00 " " 2,635.65 " 776.00 " 10,197.40 " " 2,534.83 " " 6,224.98 " " 11,415.00 " " 5,785.12 " " 6,807.91 " " 2,981.31 " 29810826 LT HEART CATH TRNSPTL PUNCTURE 93462 481 $948.00 350.38 - " 2,037.70 " - " 1,469.00 " - " 1,469.00 " - 523.77 - 625.68 - - 627.48 - - " 1,630.16 " " 2,037.70 " - - - 758.40 - - 635.16 - 387.73 711.00 360.33 424.04 - 30601947 LT HEART CATH TRNSPTL PUNCTURE 93462 481 $948.00 350.38 - " 2,037.70 " - " 1,469.00 " - " 1,469.00 " - 523.77 - 625.68 - - 627.48 - - " 1,630.16 " " 2,037.70 " - - - 758.40 - - 635.16 - 387.73 711.00 360.33 424.04 - 29810834 PHARMACOLOGIC AGENT ADMIN 93463 481 "$1,093.00" 403.97 - " 1,078.68 " - 755.26 - 755.26 - 603.88 - 721.38 - - 723.46 - - 862.94 " 1,078.68 " - - - 874.40 - - 732.31 - 447.04 819.75 415.45 488.90 - 29810842 PHYSIOLOGIC EXERCISE STUDY 93464 481 "$1,604.00" 592.84 - " 1,498.85 " - " 1,108.36 " - " 1,108.36 " - 886.21 - " 1,058.64 " - - " 1,061.69 " - - " 1,199.08 " " 1,498.85 " - - - " 1,283.20 " - - " 1,074.68 " - 656.04 " 1,203.00 " 609.68 717.47 - 27000541 INSERT/PLACE HEART CATHETER 93503 481 "$7,382.00" " 2,728.39 " 776.00 " 5,905.60 " 892.40 " 1,469.00 " " 1,466.71 " " 1,469.00 " 907.92 " 4,078.56 " " 1,438.78 " " 4,872.12 " 869.12 808.05 " 4,886.15 " " 1,257.18 " " 1,396.87 " 974.22 " 1,217.78 " " 1,431.79 " " 1,438.78 " " 1,396.87 " " 5,905.60 " " 1,278.14 " 776.00 " 4,945.94 " " 1,229.25 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,445.76 " 29802360 INSERT/PLACE HEART CATHETER 93503 481 "$7,382.00" " 2,728.39 " 776.00 " 5,905.60 " 892.40 " 1,469.00 " " 1,466.71 " " 1,469.00 " 907.92 " 4,078.56 " " 1,438.78 " " 4,872.12 " 869.12 808.05 " 4,886.15 " " 1,257.18 " " 1,396.87 " 974.22 " 1,217.78 " " 1,431.79 " " 1,438.78 " " 1,396.87 " " 5,905.60 " " 1,278.14 " 776.00 " 4,945.94 " " 1,229.25 " " 3,019.24 " " 5,536.50 " " 2,805.90 " " 3,301.97 " " 1,445.76 " 29803595 INJ PROC SUPRAVALV AORTOGRAPHY 93567 481 $648.00 239.50 - " 4,878.00 " - " 4,878.00 " - " 4,878.00 " - 358.02 - 427.68 - - 428.91 - - " 1,080.47 " " 1,350.59 " - - - 518.40 - - 434.16 - 265.03 486.00 246.30 289.85 - 29801479 INTRAVAS DOPPLER VELOCITY/FLOW 93571 481 $565.00 208.82 - " 1,016.71 " - 390.42 - 390.42 - 312.16 - 372.90 - - 373.97 - - 813.37 " 1,016.71 " - - - 452.00 - - 378.55 - 231.09 423.75 214.76 252.72 - 29801975 INTRAVAS DOPPLER FLOW MEASURE 93572 481 $565.00 208.82 - 936.30 - 390.42 - 390.42 - 312.16 - 372.90 - - 373.97 - - 749.04 936.30 - - - 452.00 - - 378.55 - 231.09 423.75 214.76 252.72 - 29802491 PRQ TRANSCATH ASD CLOSURE 93580 481 "$84,336.00" " 31,170.59 " 776.00 " 67,468.80 " 892.40 " 4,878.00 " " 16,751.22 " " 4,878.00 " 907.92 " 46,595.64 " " 16,432.15 " " 55,661.76 " 869.12 808.05 " 55,822.00 " " 14,358.19 " " 15,953.54 " " 5,487.00 " " 6,858.75 " " 16,352.38 " " 16,432.15 " " 15,953.54 " " 67,468.80 " " 14,597.49 " 776.00 " 56,505.12 " " 14,039.12 " " 34,493.42 " " 63,252.00 " " 32,056.11 " " 37,723.49 " " 16,511.91 " 29812225 PRQ TRANSCATH PDA CLOSURE 93582 481 "$84,336.00" " 31,170.59 " 776.00 " 67,468.80 " 892.40 " 4,878.00 " " 16,751.22 " " 4,878.00 " 907.92 " 46,595.64 " " 16,432.15 " " 55,661.76 " 869.12 808.05 " 55,822.00 " " 14,358.19 " " 15,953.54 " " 1,541.37 " " 1,926.71 " " 16,352.38 " " 16,432.15 " " 15,953.54 " " 67,468.80 " " 14,597.49 " 776.00 " 56,505.12 " " 14,039.12 " " 34,493.42 " " 63,252.00 " " 32,056.11 " " 37,723.49 " " 16,511.91 " 29813132 PRQ TRANSCATH CLS PARA MITRAL 93590 481 "$84,336.00" " 31,170.59 " - " 67,468.80 " - " 58,276.18 " " 16,751.22 " " 58,276.18 " - " 46,595.64 " " 16,432.15 " " 55,661.76 " - - " 55,822.00 " " 14,358.19 " " 15,953.54 " " 6,908.21 " " 8,635.26 " " 16,352.38 " " 16,432.15 " " 15,953.54 " " 67,468.80 " " 14,597.49 " - " 56,505.12 " " 14,039.12 " " 34,493.42 " " 63,252.00 " " 32,056.11 " " 37,723.49 " " 16,511.91 " 29812951 PRQ TRANSCATH CLS PARA AORTIC 93591 481 "$84,336.00" " 31,170.59 " - " 67,468.80 " - " 58,276.18 " " 16,751.22 " " 58,276.18 " - " 46,595.64 " " 16,432.15 " " 55,661.76 " - - " 55,822.00 " " 14,358.19 " " 15,953.54 " " 5,733.06 " " 7,166.32 " " 16,352.38 " " 16,432.15 " " 15,953.54 " " 67,468.80 " " 14,597.49 " - " 56,505.12 " " 14,039.12 " " 34,493.42 " " 63,252.00 " " 32,056.11 " " 37,723.49 " " 16,511.91 " 29812969 PRQ TRANSCATH CLS PARA EA ADD 93592 481 "$3,689.00" " 1,363.45 " - " 3,159.53 " - " 2,549.10 " - " 2,549.10 " - " 2,038.17 " - " 2,434.74 " - - " 2,441.75 " - - " 2,527.62 " " 3,159.53 " - - - " 2,951.20 " - - " 2,471.63 " - " 1,508.80 " " 2,766.75 " " 1,402.19 " " 1,650.09 " - 30653629 HIS BUNDLE RECORDING 93600 480 "$31,912.00" " 11,794.68 " 121.50 " 25,529.60 " 139.73 " 4,435.00 " " 6,339.89 " " 4,435.00 " 142.16 " 17,631.38 " " 6,219.13 " " 21,061.92 " 136.08 126.52 " 21,122.55 " " 5,434.19 " " 6,037.99 " 855.38 " 1,069.22 " " 6,188.94 " " 6,219.13 " " 6,037.99 " " 25,529.60 " " 5,524.76 " 121.50 " 21,381.04 " " 5,313.43 " " 13,052.01 " " 23,934.00 " " 12,129.75 " " 14,274.24 " " 6,249.32 " 30612281 RIGHT VENTRICULAR RECORDING 93603 480 "$5,842.00" " 2,159.20 " - " 4,673.60 " - " 4,036.82 " " 1,161.72 " " 4,036.82 " - " 3,227.71 " " 1,139.59 " " 3,855.72 " - - " 3,866.82 " 995.76 " 1,106.40 " 746.49 933.11 " 1,134.06 " " 1,139.59 " " 1,106.40 " " 4,673.60 " " 1,012.36 " - " 3,914.14 " 973.63 " 2,389.38 " " 4,381.50 " " 2,220.54 " " 2,613.13 " " 1,145.12 " 30601157 TACHYCARDIA MAPPING ADD-ON 93609 480 "$4,755.00" " 1,757.45 " - " 4,435.00 " 269.10 " 4,435.00 " - " 4,435.00 " 273.78 " 2,627.14 " - " 3,138.30 " 262.08 243.66 " 3,147.33 " - - " 2,030.86 " " 2,538.58 " - - - " 3,804.00 " - 234.00 " 3,185.85 " - " 1,944.80 " " 3,566.25 " " 1,807.38 " " 2,126.91 " - 30600100 INTRA ATRIAL PACING 93610 480 "$31,912.00" " 11,794.68 " 187.50 " 25,529.60 " 215.63 " 22,051.19 " " 6,339.89 " " 22,051.19 " 219.38 " 17,631.38 " " 6,219.13 " " 21,061.92 " 210.00 195.24 " 21,122.55 " " 5,434.19 " " 6,037.99 " 909.82 " 1,137.27 " " 6,188.94 " " 6,219.13 " " 6,037.99 " " 25,529.60 " " 5,524.76 " 187.50 " 21,381.04 " " 5,313.43 " " 13,052.01 " " 23,934.00 " " 12,129.75 " " 14,274.24 " " 6,249.32 " 30600096 INTRAVENTICULAR PACING 93612 480 "$31,912.00" " 11,794.68 " 187.50 " 25,529.60 " 215.63 " 22,051.19 " " 6,339.89 " " 22,051.19 " 219.38 " 17,631.38 " " 6,219.13 " " 21,061.92 " 210.00 195.24 " 21,122.55 " " 5,434.19 " " 6,037.99 " 935.96 " 1,169.95 " " 6,188.94 " " 6,219.13 " " 6,037.99 " " 25,529.60 " " 5,524.76 " 187.50 " 21,381.04 " " 5,313.43 " " 13,052.01 " " 23,934.00 " " 12,129.75 " " 14,274.24 " " 6,249.32 " 30601149 INTRACARDIAC 3D MAPPING 93613 480 "$3,903.00" " 1,442.55 " - " 3,122.40 " - " 2,696.97 " - " 2,696.97 " - " 2,156.41 " - " 2,575.98 " - - " 2,583.40 " - - " 1,213.35 " " 1,516.69 " - - - " 3,122.40 " - - " 2,615.01 " - " 1,596.33 " " 2,927.25 " " 1,483.53 " " 1,745.81 " - 30600134 EP EVAL RT ATRIAL/VENTR 93619 480 "$31,912.00" " 11,794.68 " 776.00 " 25,529.60 " 892.40 " 4,435.00 " " 6,339.89 " " 4,435.00 " 907.92 " 17,631.38 " " 6,219.13 " " 21,061.92 " 869.12 808.05 " 21,122.55 " " 5,434.19 " " 6,037.99 " " 3,103.21 " " 3,879.01 " " 6,188.94 " " 6,219.13 " " 6,037.99 " " 25,529.60 " " 5,524.76 " 776.00 " 21,381.04 " " 5,313.43 " " 13,052.01 " " 23,934.00 " " 12,129.75 " " 14,274.24 " " 6,249.32 " 30600142 EP EVAL RT ATRIAL/VENT W/ARR 93620 480 "$31,912.00" " 11,794.68 " 776.00 " 25,529.60 " 892.40 " 4,435.00 " " 6,339.89 " " 4,435.00 " 907.92 " 17,631.38 " " 6,219.13 " " 21,061.92 " 869.12 808.05 " 21,122.55 " " 5,434.19 " " 6,037.99 " " 4,244.98 " " 5,306.22 " " 6,188.94 " " 6,219.13 " " 6,037.99 " " 25,529.60 " " 5,524.76 " 776.00 " 21,381.04 " " 5,313.43 " " 13,052.01 " " 23,934.00 " " 12,129.75 " " 14,274.24 " " 6,249.32 " 30600151 EP EVAL LT ATRIAL PACING ADDL 93621 480 $193.00 71.33 - " 4,435.00 " - " 4,435.00 " - " 4,435.00 " - 106.63 - 127.38 - - 127.75 - - 892.76 " 1,115.95 " - - - 154.40 - - 129.31 - 78.94 144.75 73.36 86.33 - 30601181 EP EVAL LT VENTR PACING ADDL 93622 480 "$4,471.00" " 1,652.48 " - " 4,435.00 " - " 4,435.00 " - " 4,435.00 " - " 2,470.23 " - " 2,950.86 " - - " 2,959.35 " - - " 1,422.83 " " 1,778.54 " - - - " 3,576.80 " - - " 2,995.57 " - " 1,828.64 " " 3,353.25 " " 1,699.43 " " 1,999.88 " - 30601173 PROGRAM STIM PACING W/IV DRUG 93623 480 "$1,983.00" 732.92 - " 1,586.40 " - " 1,370.25 " - " 1,370.25 " - " 1,095.61 " - " 1,308.78 " - - " 1,312.55 " - - " 1,199.64 " " 1,499.55 " - - - " 1,586.40 " - - " 1,328.61 " - 811.05 " 1,487.25 " 753.74 887.00 - 30600118 EP EVAL SVT INDUCT ARRHYTHMIA 93624 480 "$31,912.00" " 11,794.68 " 776.00 " 25,529.60 " 892.40 " 22,051.19 " " 6,339.89 " " 22,051.19 " 907.92 " 17,631.38 " " 6,219.13 " " 21,061.92 " 869.12 808.05 " 21,122.55 " " 5,434.19 " " 6,037.99 " " 1,205.38 " " 1,506.73 " " 6,188.94 " " 6,219.13 " " 6,037.99 " " 25,529.60 " " 5,524.76 " 776.00 " 21,381.04 " " 5,313.43 " " 13,052.01 " " 23,934.00 " " 12,129.75 " " 14,274.24 " " 6,249.32 " 29818975 EP EVAL ICD/LEADS/DEFB IMP/REP 93641 480 $971.00 358.88 - " 4,435.00 " 892.40 " 4,435.00 " - " 4,435.00 " 907.92 536.48 - 640.86 869.12 808.05 642.70 - - " 2,152.18 " " 2,690.23 " - - - 776.80 - 776.00 650.57 - 397.14 728.25 369.08 434.33 - 30601114 EP EVAL CARDIO DEFIB LEADS 93641 480 $971.00 358.88 - " 4,435.00 " 892.40 " 4,435.00 " - " 4,435.00 " 907.92 536.48 - 640.86 869.12 808.05 642.70 - - " 2,152.18 " " 2,690.23 " - - - 776.80 - 776.00 650.57 - 397.14 728.25 369.08 434.33 - 30601360 EP EVAL CARDIO DEFIB PACING 93642 480 "$5,842.00" " 2,159.20 " 776.00 " 4,673.60 " 892.40 " 4,435.00 " " 1,161.72 " " 4,435.00 " 907.92 " 3,227.71 " " 1,139.59 " " 3,855.72 " 869.12 808.05 " 3,866.82 " 995.76 " 1,106.40 " " 2,045.29 " " 2,556.61 " " 1,134.06 " " 1,139.59 " " 1,106.40 " " 4,673.60 " " 1,012.36 " 776.00 " 3,914.14 " 973.63 " 2,389.38 " " 4,381.50 " " 2,220.54 " " 2,613.13 " " 1,145.12 " 30603052 EP EVAL SUBQ DEFIB 93644 480 "$3,605.00" " 1,332.41 " - " 2,884.00 " - " 2,491.06 " - " 2,491.06 " - " 1,991.76 " - " 2,379.30 " - - " 2,386.15 " - - 539.32 674.15 - - - " 2,884.00 " - - " 2,415.35 " - " 1,474.45 " " 2,703.75 " " 1,370.26 " " 1,612.52 " - 30600703 CATH ABLATION AV NODE FUNCTION 93650 480 "$31,912.00" " 11,794.68 " 776.00 " 25,529.60 " 892.40 " 4,435.00 " " 6,339.89 " " 4,435.00 " 907.92 " 17,631.38 " " 6,219.13 " " 21,061.92 " 869.12 808.05 " 21,122.55 " " 5,434.19 " " 6,037.99 " " 1,893.20 " " 2,366.50 " " 6,188.94 " " 6,219.13 " " 6,037.99 " " 25,529.60 " " 5,524.76 " 776.00 " 21,381.04 " " 5,313.43 " " 13,052.01 " " 23,934.00 " " 12,129.75 " " 14,274.24 " " 6,249.32 " 30602552 EP EVAL ABLATE SUPRAVENT TACHY 93653 480 "$112,688.00" " 41,649.48 " 776.00 " 90,150.40 " 892.40 " 4,435.00 " " 22,381.77 " " 4,435.00 " 907.92 " 62,260.12 " " 21,955.45 " " 74,374.08 " 869.12 808.05 " 74,588.19 " " 19,184.37 " " 21,315.97 " " 2,994.16 " " 3,742.70 " " 21,848.87 " " 21,955.45 " " 21,315.97 " " 90,150.40 " " 19,504.11 " 776.00 " 75,500.96 " " 18,758.05 " " 46,089.39 " " 84,516.00 " " 42,832.71 " " 50,405.34 " " 22,062.03 " 30602471 EP EVAL ABLATE VENTR TACHY 93654 480 "$112,688.00" " 41,649.48 " 776.00 " 90,150.40 " 892.40 " 4,435.00 " " 22,381.77 " " 4,435.00 " 907.92 " 62,260.12 " " 21,955.45 " " 74,374.08 " 869.12 808.05 " 74,588.19 " " 19,184.37 " " 21,315.97 " " 3,995.56 " " 4,994.45 " " 21,848.87 " " 21,955.45 " " 21,315.97 " " 90,150.40 " " 19,504.11 " 776.00 " 75,500.96 " " 18,758.05 " " 46,089.39 " " 84,516.00 " " 42,832.71 " " 50,405.34 " " 22,062.03 " 30602480 CATH ABLATION ARRHYTHMIA ADDL 93655 480 "$3,933.00" " 1,453.64 " - " 3,146.40 " - " 1,469.00 " - " 1,469.00 " - " 2,172.98 " - " 2,595.78 " - - " 2,603.25 " - - " 1,496.96 " " 1,871.20 " - - - " 3,146.40 " - - " 2,635.11 " - " 1,608.60 " " 2,949.75 " " 1,494.93 " " 1,759.23 " - 30602498 EP EVAL FIB PULM VEIN ISOL 93656 480 "$112,688.00" " 41,649.48 " 776.00 " 90,150.40 " 892.40 " 4,435.00 " " 22,381.77 " " 4,435.00 " 907.92 " 62,260.12 " " 21,955.45 " " 74,374.08 " 869.12 808.05 " 74,588.19 " " 19,184.37 " " 21,315.97 " " 3,996.92 " " 4,996.15 " " 21,848.87 " " 21,955.45 " " 21,315.97 " " 90,150.40 " " 19,504.11 " 776.00 " 75,500.96 " " 18,758.05 " " 46,089.39 " " 84,516.00 " " 42,832.71 " " 50,405.34 " " 22,062.03 " 29818983 TX ATRIAL FIB PULM VEIN ADDL 93657 480 "$14,543.00" " 5,375.09 " - " 11,634.40 " - " 1,469.00 " - " 1,469.00 " - " 8,035.01 " - " 9,598.38 " - - " 9,626.01 " - - " 1,498.32 " " 1,872.90 " - - - " 11,634.40 " - - " 9,743.81 " - " 5,948.09 " " 10,907.25 " " 5,527.79 " " 6,505.08 " - 30602501 CATH ABLATE FIB PULM VEIN ADDL 93657 480 "$14,543.00" " 5,375.09 " - " 11,634.40 " - " 1,469.00 " - " 1,469.00 " - " 8,035.01 " - " 9,598.38 " - - " 9,626.01 " - - " 1,498.32 " " 1,872.90 " - - - " 11,634.40 " - - " 9,743.81 " - " 5,948.09 " " 10,907.25 " " 5,527.79 " " 6,505.08 " - 05938228 TILT TABLE EVALUATION 93660 480 "$2,561.00" 946.55 - " 2,048.80 " - " 1,769.65 " 509.13 " 1,769.65 " - " 1,414.95 " 499.44 " 1,690.26 " - - " 1,695.13 " 436.40 484.89 " 1,580.42 " " 1,975.52 " 497.01 499.44 484.89 " 2,048.80 " 443.67 - " 1,715.87 " 426.70 " 1,047.45 " " 1,920.75 " 973.44 " 1,145.54 " 501.86 30100620 TILT TABLE EVALUATION 93660 480 "$2,561.00" 946.55 - " 2,048.80 " - " 1,769.65 " 509.13 " 1,769.65 " - " 1,414.95 " 499.44 " 1,690.26 " - - " 1,695.13 " 436.40 484.89 " 1,580.42 " " 1,975.52 " 497.01 499.44 484.89 " 2,048.80 " 443.67 - " 1,715.87 " 426.70 " 1,047.45 " " 1,920.75 " 973.44 " 1,145.54 " 501.86 30600622 TILT TABLE EVALUATION 93660 480 "$2,561.00" 946.55 - " 2,048.80 " - " 1,769.65 " 509.13 " 1,769.65 " - " 1,414.95 " 499.44 " 1,690.26 " - - " 1,695.13 " 436.40 484.89 " 1,580.42 " " 1,975.52 " 497.01 499.44 484.89 " 2,048.80 " 443.67 - " 1,715.87 " 426.70 " 1,047.45 " " 1,920.75 " 973.44 " 1,145.54 " 501.86 05900018 INTRACARDIAC ECHO 93662 480 "$3,061.00" " 1,131.35 " - " 2,448.80 " - " 2,115.15 " - " 2,115.15 " - " 1,691.20 " - " 2,020.26 " - - " 2,026.08 " - - " 1,014.39 " " 1,267.99 " - - - " 2,448.80 " - - " 2,050.87 " - " 1,251.95 " " 2,295.75 " " 1,163.49 " " 1,369.19 " - 28174683 INTRACARDIAC ECHO 93662 360 "$3,061.00" " 1,131.35 " - " 2,448.80 " - " 2,115.15 " - " 2,115.15 " - " 1,691.20 " - " 2,020.26 " - - " 2,026.08 " - - " 1,014.39 " " 1,267.99 " - - - " 2,448.80 " - - " 2,050.87 " - " 1,251.95 " " 2,295.75 " " 1,163.49 " " 1,369.19 " - 29802611 INTRACARDIAC ECHO 93662 480 "$3,061.00" " 1,131.35 " - " 2,448.80 " - " 2,115.15 " - " 2,115.15 " - " 1,691.20 " - " 2,020.26 " - - " 2,026.08 " - - " 1,014.39 " " 1,267.99 " - - - " 2,448.80 " - - " 2,050.87 " - " 1,251.95 " " 2,295.75 " " 1,163.49 " " 1,369.19 " - 30100735 INTRACARDIAC ECHO 93662 480 "$3,061.00" " 1,131.35 " - " 2,448.80 " - " 2,115.15 " - " 2,115.15 " - " 1,691.20 " - " 2,020.26 " - - " 2,026.08 " - - " 1,014.39 " " 1,267.99 " - - - " 2,448.80 " - - " 2,050.87 " - " 1,251.95 " " 2,295.75 " " 1,163.49 " " 1,369.19 " - 30600011 INTRACARDIAC ECHO 93662 480 "$3,061.00" " 1,131.35 " - " 2,448.80 " - " 2,115.15 " - " 2,115.15 " - " 1,691.20 " - " 2,020.26 " - - " 2,026.08 " - - " 1,014.39 " " 1,267.99 " - - - " 2,448.80 " - - " 2,050.87 " - " 1,251.95 " " 2,295.75 " " 1,163.49 " " 1,369.19 " - 29700206 PAD VASC REHAB PER SESSION 93668 943 $292.00 107.92 - 288.95 - 201.77 58.05 201.77 - 161.33 56.95 192.72 - - 193.27 49.76 55.29 231.16 288.95 56.67 56.95 55.29 233.60 50.59 - 195.64 48.66 119.43 219.00 110.99 130.61 57.23 29700079 CARDIAC REHAB WITHOUT ECG 93797 943 $609.00 225.09 - 487.20 - 420.82 121.08 420.82 - 336.47 118.77 401.94 50.00 - 403.10 103.78 115.31 50.62 63.27 118.19 118.77 115.31 487.20 105.51 - 408.03 101.47 249.08 456.75 231.48 272.41 119.35 29700087 CARDIAC REHAB WITH ECG 93798 943 $609.00 225.09 - 487.20 - 420.82 121.08 420.82 - 336.47 118.77 401.94 50.00 - 403.10 103.78 115.31 163.97 204.96 118.19 118.77 115.31 487.20 105.51 - 408.03 101.47 249.08 456.75 231.48 272.41 119.35 29805059 UNL MAINTNCE IMPELLA 93799 481 $733.00 270.92 - 586.40 - 506.50 145.62 506.50 - 404.98 142.85 483.78 - - 485.17 124.82 138.69 388.42 485.54 142.16 142.85 138.69 586.40 126.90 - 491.11 122.05 299.80 549.75 278.61 327.87 143.54 29805067 UNL REMOVAL IMPELLA 93799 481 $733.00 270.92 - 586.40 - 506.50 145.62 506.50 - 404.98 142.85 483.78 - - 485.17 124.82 138.69 388.42 485.54 142.16 142.85 138.69 586.40 126.90 - 491.11 122.05 299.80 549.75 278.61 327.87 143.54 54008287 DUP EXTRAC/CAROTID BILAT CPL 93880 920 "$1,208.00" 446.48 147.86 966.40 170.04 834.73 240.00 834.73 173.00 667.42 235.43 797.28 165.60 153.97 799.58 205.71 228.57 688.54 860.67 234.28 235.43 228.57 966.40 209.14 147.86 809.36 201.14 494.07 906.00 459.16 540.34 236.57 67908287 DUP EXTRAC/CAROTID BILAT CPL 93880 920 "$1,208.00" 446.48 147.86 966.40 170.04 834.73 240.00 834.73 173.00 667.42 235.43 797.28 165.60 153.97 799.58 205.71 228.57 688.54 860.67 234.28 235.43 228.57 966.40 209.14 147.86 809.36 201.14 494.07 906.00 459.16 540.34 236.57 80508280 DUP EXTRAC/CAROTID BILAT CPL 93880 920 "$1,208.00" 446.48 147.86 966.40 170.04 834.73 240.00 834.73 173.00 667.42 235.43 797.28 165.60 153.97 799.58 205.71 228.57 688.54 860.67 234.28 235.43 228.57 966.40 209.14 147.86 809.36 201.14 494.07 906.00 459.16 540.34 236.57 81408289 DUP EXTRAC/CAROTID BILAT CPL 93880 920 "$1,208.00" 446.48 147.86 966.40 170.04 834.73 240.00 834.73 173.00 667.42 235.43 797.28 165.60 153.97 799.58 205.71 228.57 688.54 860.67 234.28 235.43 228.57 966.40 209.14 147.86 809.36 201.14 494.07 906.00 459.16 540.34 236.57 81608288 DUP EXTRAC/CAROTID BILAT CPL 93880 920 "$1,208.00" 446.48 147.86 966.40 170.04 834.73 240.00 834.73 173.00 667.42 235.43 797.28 165.60 153.97 799.58 205.71 228.57 688.54 860.67 234.28 235.43 228.57 966.40 209.14 147.86 809.36 201.14 494.07 906.00 459.16 540.34 236.57 81708282 DUP EXTRAC/CAROTID BILAT CPL 93880 920 "$1,208.00" 446.48 147.86 966.40 170.04 834.73 240.00 834.73 173.00 667.42 235.43 797.28 165.60 153.97 799.58 205.71 228.57 688.54 860.67 234.28 235.43 228.57 966.40 209.14 147.86 809.36 201.14 494.07 906.00 459.16 540.34 236.57 82608281 DUP EXTRAC/CAROTID BILAT CPL 93880 920 "$1,208.00" 446.48 147.86 966.40 170.04 834.73 240.00 834.73 173.00 667.42 235.43 797.28 165.60 153.97 799.58 205.71 228.57 688.54 860.67 234.28 235.43 228.57 966.40 209.14 147.86 809.36 201.14 494.07 906.00 459.16 540.34 236.57 82908285 DUP EXTRAC/CAROTID BILAT CPL 93880 920 "$1,208.00" 446.48 147.86 966.40 170.04 834.73 240.00 834.73 173.00 667.42 235.43 797.28 165.60 153.97 799.58 205.71 228.57 688.54 860.67 234.28 235.43 228.57 966.40 209.14 147.86 809.36 201.14 494.07 906.00 459.16 540.34 236.57 83008288 DUP EXTRAC/CAROTID BILAT CPL 93880 920 "$1,208.00" 446.48 147.86 966.40 170.04 834.73 240.00 834.73 173.00 667.42 235.43 797.28 165.60 153.97 799.58 205.71 228.57 688.54 860.67 234.28 235.43 228.57 966.40 209.14 147.86 809.36 201.14 494.07 906.00 459.16 540.34 236.57 54008295 DUP EXCRANIAL/CAROTID UNI/LTD 93882 921 $572.00 211.41 95.17 715.00 158.78 395.25 113.56 395.25 161.54 316.03 111.39 377.52 154.64 143.77 378.61 97.34 108.15 572.00 715.00 110.85 111.39 108.15 457.60 98.96 138.07 383.24 95.17 233.95 429.00 217.42 255.86 111.94 67908295 DUP EXCRANIAL/CAROTID UNI/LTD 93882 920 $572.00 211.41 95.17 715.00 158.78 395.25 113.56 395.25 161.54 316.03 111.39 377.52 154.64 143.77 378.61 97.34 108.15 572.00 715.00 110.85 111.39 108.15 457.60 98.96 138.07 383.24 95.17 233.95 429.00 217.42 255.86 111.94 80508298 DUP EXCRANIAL/CAROTID UNI/LTD 93882 920 $572.00 211.41 95.17 715.00 158.78 395.25 113.56 395.25 161.54 316.03 111.39 377.52 154.64 143.77 378.61 97.34 108.15 572.00 715.00 110.85 111.39 108.15 457.60 98.96 138.07 383.24 95.17 233.95 429.00 217.42 255.86 111.94 81408297 DUP EXCRANIAL/CAROTID UNI/LTD 93882 920 $572.00 211.41 95.17 715.00 158.78 395.25 113.56 395.25 161.54 316.03 111.39 377.52 154.64 143.77 378.61 97.34 108.15 572.00 715.00 110.85 111.39 108.15 457.60 98.96 138.07 383.24 95.17 233.95 429.00 217.42 255.86 111.94 81608296 DUP EXCRANIAL/CAROTID UNI/LTD 93882 920 $572.00 211.41 95.17 715.00 158.78 395.25 113.56 395.25 161.54 316.03 111.39 377.52 154.64 143.77 378.61 97.34 108.15 572.00 715.00 110.85 111.39 108.15 457.60 98.96 138.07 383.24 95.17 233.95 429.00 217.42 255.86 111.94 81708291 DUP EXCRANIAL/CAROTID UNI/LTD 93882 920 $572.00 211.41 95.17 715.00 158.78 395.25 113.56 395.25 161.54 316.03 111.39 377.52 154.64 143.77 378.61 97.34 108.15 572.00 715.00 110.85 111.39 108.15 457.60 98.96 138.07 383.24 95.17 233.95 429.00 217.42 255.86 111.94 82608290 DUP EXCRANIAL/CAROTID UNI/LTD 93882 920 $572.00 211.41 95.17 715.00 158.78 395.25 113.56 395.25 161.54 316.03 111.39 377.52 154.64 143.77 378.61 97.34 108.15 572.00 715.00 110.85 111.39 108.15 457.60 98.96 138.07 383.24 95.17 233.95 429.00 217.42 255.86 111.94 82908293 DUP EXCRANIAL/CAROTID UNI/LTD 93882 920 $572.00 211.41 95.17 715.00 158.78 395.25 113.56 395.25 161.54 316.03 111.39 377.52 154.64 143.77 378.61 97.34 108.15 572.00 715.00 110.85 111.39 108.15 457.60 98.96 138.07 383.24 95.17 233.95 429.00 217.42 255.86 111.94 83008296 DUP EXCRANIAL/CAROTID UNI/LTD 93882 920 $572.00 211.41 95.17 715.00 158.78 395.25 113.56 395.25 161.54 316.03 111.39 377.52 154.64 143.77 378.61 97.34 108.15 572.00 715.00 110.85 111.39 108.15 457.60 98.96 138.07 383.24 95.17 233.95 429.00 217.42 255.86 111.94 31200181 TRANSCRANIAL DOPPLER COMPLETE 93886 920 "$1,208.00" 446.48 164.24 966.40 188.88 834.73 240.00 834.73 192.16 667.42 235.43 797.28 183.95 171.02 799.58 205.71 228.57 719.54 899.43 234.28 235.43 228.57 966.40 209.14 164.24 809.36 201.14 494.07 906.00 459.16 540.34 236.57 31200318 TRANSCRANIAL DOPPLER LIMITED 93888 920 $572.00 211.41 82.84 600.02 95.27 395.25 113.56 395.25 96.92 316.03 111.39 377.52 92.78 86.26 378.61 97.34 108.15 480.02 600.02 110.85 111.39 108.15 457.60 98.96 82.84 383.24 95.17 233.95 429.00 217.42 255.86 111.94 31200253 TRANSCRANIAL DOPPLER VASOREACT 93890 920 "$1,208.00" 446.48 130.78 966.40 150.40 834.73 240.00 834.73 153.01 667.42 235.43 797.28 146.47 136.18 799.58 205.71 228.57 562.83 703.54 234.28 235.43 228.57 966.40 209.14 130.78 809.36 201.14 494.07 906.00 459.16 540.34 236.57 31200261 TRNSCRN DOP EMBOLI DETCT WO/IV 93892 920 $572.00 211.41 95.17 732.64 157.52 395.25 113.56 395.25 160.25 316.03 111.39 377.52 153.41 142.63 378.61 97.34 108.15 586.11 732.64 110.85 111.39 108.15 457.60 98.96 136.97 383.24 95.17 233.95 429.00 217.42 255.86 111.94 31200270 TRNSCRN DOP EMBOLI DETCT W/IV 93893 920 $572.00 211.41 95.17 713.81 157.52 395.25 113.56 395.25 160.25 316.03 111.39 377.52 153.41 142.63 378.61 97.34 108.15 571.05 713.81 110.85 111.39 108.15 457.60 98.96 136.97 383.24 95.17 233.95 429.00 217.42 255.86 111.94 54008376 ART DOP UPR/LWR EXTR 1-2 LVLS 93922 920 $588.00 217.32 48.79 470.40 56.11 406.31 117.61 406.31 57.08 324.87 115.37 388.08 54.64 50.81 389.20 100.81 112.01 323.86 404.83 114.81 115.37 112.01 470.40 102.49 48.79 393.96 98.57 240.49 441.00 223.50 263.01 115.93 67908376 ART DOP UPR/LWR EXTR 1-2 LVLS 93922 920 $588.00 217.32 48.79 470.40 56.11 406.31 117.61 406.31 57.08 324.87 115.37 388.08 54.64 50.81 389.20 100.81 112.01 323.86 404.83 114.81 115.37 112.01 470.40 102.49 48.79 393.96 98.57 240.49 441.00 223.50 263.01 115.93 80508379 ART DOP UPR/LWR EXTR 1-2 LVLS 93922 920 $588.00 217.32 48.79 470.40 56.11 406.31 117.61 406.31 57.08 324.87 115.37 388.08 54.64 50.81 389.20 100.81 112.01 323.86 404.83 114.81 115.37 112.01 470.40 102.49 48.79 393.96 98.57 240.49 441.00 223.50 263.01 115.93 81408378 ART DOP UPR/LWR EXTR 1-2 LVLS 93922 920 $588.00 217.32 48.79 470.40 56.11 406.31 117.61 406.31 57.08 324.87 115.37 388.08 54.64 50.81 389.20 100.81 112.01 323.86 404.83 114.81 115.37 112.01 470.40 102.49 48.79 393.96 98.57 240.49 441.00 223.50 263.01 115.93 81608377 ART DOP UPR/LWR EXTR 1-2 LVLS 93922 920 $588.00 217.32 48.79 470.40 56.11 406.31 117.61 406.31 57.08 324.87 115.37 388.08 54.64 50.81 389.20 100.81 112.01 323.86 404.83 114.81 115.37 112.01 470.40 102.49 48.79 393.96 98.57 240.49 441.00 223.50 263.01 115.93 81708371 ART DOP UPR/LWR EXTR 1-2 LVLS 93922 920 $588.00 217.32 48.79 470.40 56.11 406.31 117.61 406.31 57.08 324.87 115.37 388.08 54.64 50.81 389.20 100.81 112.01 323.86 404.83 114.81 115.37 112.01 470.40 102.49 48.79 393.96 98.57 240.49 441.00 223.50 263.01 115.93 82608371 ART DOP UPR/LWR EXTR 1-2 LVLS 93922 920 $588.00 217.32 48.79 470.40 56.11 406.31 117.61 406.31 57.08 324.87 115.37 388.08 54.64 50.81 389.20 100.81 112.01 323.86 404.83 114.81 115.37 112.01 470.40 102.49 48.79 393.96 98.57 240.49 441.00 223.50 263.01 115.93 82708375 ART DOP UPR/LWR EXTR 1-2 LVLS 93922 920 $588.00 217.32 48.79 470.40 56.11 406.31 117.61 406.31 57.08 324.87 115.37 388.08 54.64 50.81 389.20 100.81 112.01 323.86 404.83 114.81 115.37 112.01 470.40 102.49 48.79 393.96 98.57 240.49 441.00 223.50 263.01 115.93 82908374 ART DOP UPR/LWR EXTR 1-2 LVLS 93922 920 $588.00 217.32 48.79 470.40 56.11 406.31 117.61 406.31 57.08 324.87 115.37 388.08 54.64 50.81 389.20 100.81 112.01 323.86 404.83 114.81 115.37 112.01 470.40 102.49 48.79 393.96 98.57 240.49 441.00 223.50 263.01 115.93 83008377 ART DOP UPR/LWR EXTR 1-2 LVLS 93922 920 $588.00 217.32 48.79 470.40 56.11 406.31 117.61 406.31 57.08 324.87 115.37 388.08 54.64 50.81 389.20 100.81 112.01 323.86 404.83 114.81 115.37 112.01 470.40 102.49 48.79 393.96 98.57 240.49 441.00 223.50 263.01 115.93 54008384 ART DOP UPR/LWR EXTR 3+ LVLS 93923 920 $733.00 270.92 91.55 586.40 105.28 506.50 145.62 506.50 107.11 404.98 142.85 483.78 102.54 95.33 485.17 124.82 138.69 455.70 569.63 142.16 142.85 138.69 586.40 126.90 91.55 491.11 122.05 299.80 549.75 278.61 327.87 143.54 67908384 ART DOP UPR/LWR EXTR 3+ LVLS 93923 920 $733.00 270.92 91.55 586.40 105.28 506.50 145.62 506.50 107.11 404.98 142.85 483.78 102.54 95.33 485.17 124.82 138.69 455.70 569.63 142.16 142.85 138.69 586.40 126.90 91.55 491.11 122.05 299.80 549.75 278.61 327.87 143.54 80508387 ART DOP UPR/LWR EXTR 3+ LVLS 93923 920 $733.00 270.92 91.55 586.40 105.28 506.50 145.62 506.50 107.11 404.98 142.85 483.78 102.54 95.33 485.17 124.82 138.69 455.70 569.63 142.16 142.85 138.69 586.40 126.90 91.55 491.11 122.05 299.80 549.75 278.61 327.87 143.54 81408386 ART DOP UPR/LWR EXTR 3+ LVLS 93923 920 $733.00 270.92 91.55 586.40 105.28 506.50 145.62 506.50 107.11 404.98 142.85 483.78 102.54 95.33 485.17 124.82 138.69 455.70 569.63 142.16 142.85 138.69 586.40 126.90 91.55 491.11 122.05 299.80 549.75 278.61 327.87 143.54 81608385 ART DOP UPR/LWR EXTR 3+ LVLS 93923 920 $733.00 270.92 91.55 586.40 105.28 506.50 145.62 506.50 107.11 404.98 142.85 483.78 102.54 95.33 485.17 124.82 138.69 455.70 569.63 142.16 142.85 138.69 586.40 126.90 91.55 491.11 122.05 299.80 549.75 278.61 327.87 143.54 81708380 ART DOP UPR/LWR EXTR 3+ LVLS 93923 920 $733.00 270.92 91.55 586.40 105.28 506.50 145.62 506.50 107.11 404.98 142.85 483.78 102.54 95.33 485.17 124.82 138.69 455.70 569.63 142.16 142.85 138.69 586.40 126.90 91.55 491.11 122.05 299.80 549.75 278.61 327.87 143.54 82608389 ART DOP UPR/LWR EXTR 3+ LVLS 93923 920 $733.00 270.92 91.55 586.40 105.28 506.50 145.62 506.50 107.11 404.98 142.85 483.78 102.54 95.33 485.17 124.82 138.69 455.70 569.63 142.16 142.85 138.69 586.40 126.90 91.55 491.11 122.05 299.80 549.75 278.61 327.87 143.54 82908382 ART DOP UPR/LWR EXTR 3+ LVLS 93923 920 $733.00 270.92 91.55 586.40 105.28 506.50 145.62 506.50 107.11 404.98 142.85 483.78 102.54 95.33 485.17 124.82 138.69 455.70 569.63 142.16 142.85 138.69 586.40 126.90 91.55 491.11 122.05 299.80 549.75 278.61 327.87 143.54 83008385 ART DOP UPR/LWR EXTR 3+ LVLS 93923 920 $733.00 270.92 91.55 586.40 105.28 506.50 145.62 506.50 107.11 404.98 142.85 483.78 102.54 95.33 485.17 124.82 138.69 455.70 569.63 142.16 142.85 138.69 586.40 126.90 91.55 491.11 122.05 299.80 549.75 278.61 327.87 143.54 54090064 ART DOP LWR EXTR BILAT CPL 93924 920 "$1,388.00" 513.00 100.97 " 1,110.40 " 116.12 959.11 276.03 959.11 118.13 766.87 270.78 916.08 113.09 105.14 918.72 236.60 262.89 475.31 594.14 269.46 270.78 262.89 " 1,110.40 " 240.54 100.97 929.96 231.34 567.69 " 1,041.00 " 527.58 620.85 272.09 54008333 ART DUPLEX LWR EXTR BILAT CPL 93925 920 "$1,208.00" 446.48 146.81 966.40 168.83 834.73 240.00 834.73 171.77 667.42 235.43 797.28 164.43 152.87 799.58 205.71 228.57 610.34 762.93 234.28 235.43 228.57 966.40 209.14 146.81 809.36 201.14 494.07 906.00 459.16 540.34 236.57 67908333 ART DUPLEX LWR EXTR BILAT CPL 93925 920 "$1,208.00" 446.48 146.81 966.40 168.83 834.73 240.00 834.73 171.77 667.42 235.43 797.28 164.43 152.87 799.58 205.71 228.57 610.34 762.93 234.28 235.43 228.57 966.40 209.14 146.81 809.36 201.14 494.07 906.00 459.16 540.34 236.57 80508336 ART DUPLEX LWR EXTR BILAT CPL 93925 920 "$1,208.00" 446.48 146.81 966.40 168.83 834.73 240.00 834.73 171.77 667.42 235.43 797.28 164.43 152.87 799.58 205.71 228.57 610.34 762.93 234.28 235.43 228.57 966.40 209.14 146.81 809.36 201.14 494.07 906.00 459.16 540.34 236.57 81408335 ART DUPLEX LWR EXTR BILAT CPL 93925 920 "$1,208.00" 446.48 146.81 966.40 168.83 834.73 240.00 834.73 171.77 667.42 235.43 797.28 164.43 152.87 799.58 205.71 228.57 610.34 762.93 234.28 235.43 228.57 966.40 209.14 146.81 809.36 201.14 494.07 906.00 459.16 540.34 236.57 81608334 ART DUPLEX LWR EXTR BILAT CPL 93925 920 "$1,208.00" 446.48 146.81 966.40 168.83 834.73 240.00 834.73 171.77 667.42 235.43 797.28 164.43 152.87 799.58 205.71 228.57 610.34 762.93 234.28 235.43 228.57 966.40 209.14 146.81 809.36 201.14 494.07 906.00 459.16 540.34 236.57 81708339 ART DUPLEX LWR EXTR BILAT CPL 93925 920 "$1,208.00" 446.48 146.81 966.40 168.83 834.73 240.00 834.73 171.77 667.42 235.43 797.28 164.43 152.87 799.58 205.71 228.57 610.34 762.93 234.28 235.43 228.57 966.40 209.14 146.81 809.36 201.14 494.07 906.00 459.16 540.34 236.57 82608338 ART DUPLEX LWR EXTR BILAT CPL 93925 920 "$1,208.00" 446.48 146.81 966.40 168.83 834.73 240.00 834.73 171.77 667.42 235.43 797.28 164.43 152.87 799.58 205.71 228.57 610.34 762.93 234.28 235.43 228.57 966.40 209.14 146.81 809.36 201.14 494.07 906.00 459.16 540.34 236.57 82908331 ART DUPLEX LWR EXTR BILAT CPL 93925 920 "$1,208.00" 446.48 146.81 966.40 168.83 834.73 240.00 834.73 171.77 667.42 235.43 797.28 164.43 152.87 799.58 205.71 228.57 610.34 762.93 234.28 235.43 228.57 966.40 209.14 146.81 809.36 201.14 494.07 906.00 459.16 540.34 236.57 83008334 ART DUPLEX LWR EXTR BILAT CPL 93925 920 "$1,208.00" 446.48 146.81 966.40 168.83 834.73 240.00 834.73 171.77 667.42 235.43 797.28 164.43 152.87 799.58 205.71 228.57 610.34 762.93 234.28 235.43 228.57 966.40 209.14 146.81 809.36 201.14 494.07 906.00 459.16 540.34 236.57 54008341 ART DUPLEX LWR UNI/LTD STUDY 93926 920 $572.00 211.41 95.17 510.45 111.73 395.25 113.56 395.25 113.68 316.03 111.39 377.52 108.82 101.17 378.61 97.34 108.15 408.36 510.45 110.85 111.39 108.15 457.60 98.96 97.16 383.24 95.17 233.95 429.00 217.42 255.86 111.94 67908341 ART DUPLEX LWR UNI/LTD STUDY 93926 920 $572.00 211.41 95.17 510.45 111.73 395.25 113.56 395.25 113.68 316.03 111.39 377.52 108.82 101.17 378.61 97.34 108.15 408.36 510.45 110.85 111.39 108.15 457.60 98.96 97.16 383.24 95.17 233.95 429.00 217.42 255.86 111.94 80508344 ART DUPLEX LWR UNI/LTD STUDY 93926 920 $572.00 211.41 95.17 510.45 111.73 395.25 113.56 395.25 113.68 316.03 111.39 377.52 108.82 101.17 378.61 97.34 108.15 408.36 510.45 110.85 111.39 108.15 457.60 98.96 97.16 383.24 95.17 233.95 429.00 217.42 255.86 111.94 81408343 ART DUPLEX LWR UNI/LTD STUDY 93926 920 $572.00 211.41 95.17 510.45 111.73 395.25 113.56 395.25 113.68 316.03 111.39 377.52 108.82 101.17 378.61 97.34 108.15 408.36 510.45 110.85 111.39 108.15 457.60 98.96 97.16 383.24 95.17 233.95 429.00 217.42 255.86 111.94 81608342 ART DUPLEX LWR UNI/LTD STUDY 93926 920 $572.00 211.41 95.17 510.45 111.73 395.25 113.56 395.25 113.68 316.03 111.39 377.52 108.82 101.17 378.61 97.34 108.15 408.36 510.45 110.85 111.39 108.15 457.60 98.96 97.16 383.24 95.17 233.95 429.00 217.42 255.86 111.94 81708347 ART DUPLEX LWR UNI/LTD STUDY 93926 920 $572.00 211.41 95.17 510.45 111.73 395.25 113.56 395.25 113.68 316.03 111.39 377.52 108.82 101.17 378.61 97.34 108.15 408.36 510.45 110.85 111.39 108.15 457.60 98.96 97.16 383.24 95.17 233.95 429.00 217.42 255.86 111.94 82608346 ART DUPLEX LWR UNI/LTD STUDY 93926 920 $572.00 211.41 95.17 510.45 111.73 395.25 113.56 395.25 113.68 316.03 111.39 377.52 108.82 101.17 378.61 97.34 108.15 408.36 510.45 110.85 111.39 108.15 457.60 98.96 97.16 383.24 95.17 233.95 429.00 217.42 255.86 111.94 82908340 ART DUPLEX LWR UNI/LTD STUDY 93926 920 $572.00 211.41 95.17 510.45 111.73 395.25 113.56 395.25 113.68 316.03 111.39 377.52 108.82 101.17 378.61 97.34 108.15 408.36 510.45 110.85 111.39 108.15 457.60 98.96 97.16 383.24 95.17 233.95 429.00 217.42 255.86 111.94 83008342 ART DUPLEX LWR UNI/LTD STUDY 93926 920 $572.00 211.41 95.17 510.45 111.73 395.25 113.56 395.25 113.68 316.03 111.39 377.52 108.82 101.17 378.61 97.34 108.15 408.36 510.45 110.85 111.39 108.15 457.60 98.96 97.16 383.24 95.17 233.95 429.00 217.42 255.86 111.94 54090251 ART DUPLEX UPR EXTR BILAT CPL 93930 921 "$1,208.00" 446.48 141.56 966.40 162.79 834.73 240.00 834.73 165.63 667.42 235.43 797.28 158.55 147.41 799.58 205.71 228.57 627.08 783.85 234.28 235.43 228.57 966.40 209.14 141.56 809.36 201.14 494.07 906.00 459.16 540.34 236.57 67990251 ART DUPLEX UPR EXTR BILAT CPL 93930 920 "$1,208.00" 446.48 141.56 966.40 162.79 834.73 240.00 834.73 165.63 667.42 235.43 797.28 158.55 147.41 799.58 205.71 228.57 627.08 783.85 234.28 235.43 228.57 966.40 209.14 141.56 809.36 201.14 494.07 906.00 459.16 540.34 236.57 80590253 ART DUPLEX UPR EXTR BILAT CPL 93930 920 "$1,208.00" 446.48 141.56 966.40 162.79 834.73 240.00 834.73 165.63 667.42 235.43 797.28 158.55 147.41 799.58 205.71 228.57 627.08 783.85 234.28 235.43 228.57 966.40 209.14 141.56 809.36 201.14 494.07 906.00 459.16 540.34 236.57 81490252 ART DUPLEX UPR EXTR BILAT CPL 93930 920 "$1,208.00" 446.48 141.56 966.40 162.79 834.73 240.00 834.73 165.63 667.42 235.43 797.28 158.55 147.41 799.58 205.71 228.57 627.08 783.85 234.28 235.43 228.57 966.40 209.14 141.56 809.36 201.14 494.07 906.00 459.16 540.34 236.57 81690251 ART DUPLEX UPR EXTR BILAT CPL 93930 920 "$1,208.00" 446.48 141.56 966.40 162.79 834.73 240.00 834.73 165.63 667.42 235.43 797.28 158.55 147.41 799.58 205.71 228.57 627.08 783.85 234.28 235.43 228.57 966.40 209.14 141.56 809.36 201.14 494.07 906.00 459.16 540.34 236.57 81790256 ART DUPLEX UPR EXTR BILAT CPL 93930 920 "$1,208.00" 446.48 141.56 966.40 162.79 834.73 240.00 834.73 165.63 667.42 235.43 797.28 158.55 147.41 799.58 205.71 228.57 627.08 783.85 234.28 235.43 228.57 966.40 209.14 141.56 809.36 201.14 494.07 906.00 459.16 540.34 236.57 82690255 ART DUPLEX UPR EXTR BILAT CPL 93930 920 "$1,208.00" 446.48 141.56 966.40 162.79 834.73 240.00 834.73 165.63 667.42 235.43 797.28 158.55 147.41 799.58 205.71 228.57 627.08 783.85 234.28 235.43 228.57 966.40 209.14 141.56 809.36 201.14 494.07 906.00 459.16 540.34 236.57 82790250 ART DUPLEX UPR EXTR BILAT CPL 93930 920 "$1,208.00" 446.48 141.56 966.40 162.79 834.73 240.00 834.73 165.63 667.42 235.43 797.28 158.55 147.41 799.58 205.71 228.57 627.08 783.85 234.28 235.43 228.57 966.40 209.14 141.56 809.36 201.14 494.07 906.00 459.16 540.34 236.57 82990259 ART DUPLEX UPR EXTR BILAT CPL 93930 920 "$1,208.00" 446.48 141.56 966.40 162.79 834.73 240.00 834.73 165.63 667.42 235.43 797.28 158.55 147.41 799.58 205.71 228.57 627.08 783.85 234.28 235.43 228.57 966.40 209.14 141.56 809.36 201.14 494.07 906.00 459.16 540.34 236.57 83090251 ART DUPLEX UPR EXTR BILAT CPL 93930 920 "$1,208.00" 446.48 141.56 966.40 162.79 834.73 240.00 834.73 165.63 667.42 235.43 797.28 158.55 147.41 799.58 205.71 228.57 627.08 783.85 234.28 235.43 228.57 966.40 209.14 141.56 809.36 201.14 494.07 906.00 459.16 540.34 236.57 54090358 ART DUPLEX UNI/LTD STUDY 93931 921 $572.00 211.41 93.44 521.41 107.46 395.25 113.56 395.25 109.32 316.03 111.39 377.52 104.65 97.30 378.61 97.34 108.15 417.13 521.41 110.85 111.39 108.15 457.60 98.96 93.44 383.24 95.17 233.95 429.00 217.42 255.86 111.94 67990358 ART DUPLEX UNI/LTD STUDY 93931 920 $572.00 211.41 93.44 521.41 107.46 395.25 113.56 395.25 109.32 316.03 111.39 377.52 104.65 97.30 378.61 97.34 108.15 417.13 521.41 110.85 111.39 108.15 457.60 98.96 93.44 383.24 95.17 233.95 429.00 217.42 255.86 111.94 80390351 ART DUPLEX UNI/LTD STUDY 93931 920 $572.00 211.41 93.44 521.41 107.46 395.25 113.56 395.25 109.32 316.03 111.39 377.52 104.65 97.30 378.61 97.34 108.15 417.13 521.41 110.85 111.39 108.15 457.60 98.96 93.44 383.24 95.17 233.95 429.00 217.42 255.86 111.94 80590351 ART DUPLEX UNI/LTD STUDY 93931 920 $572.00 211.41 93.44 521.41 107.46 395.25 113.56 395.25 109.32 316.03 111.39 377.52 104.65 97.30 378.61 97.34 108.15 417.13 521.41 110.85 111.39 108.15 457.60 98.96 93.44 383.24 95.17 233.95 429.00 217.42 255.86 111.94 81490350 ART DUPLEX UNI/LTD STUDY 93931 920 $572.00 211.41 93.44 521.41 107.46 395.25 113.56 395.25 109.32 316.03 111.39 377.52 104.65 97.30 378.61 97.34 108.15 417.13 521.41 110.85 111.39 108.15 457.60 98.96 93.44 383.24 95.17 233.95 429.00 217.42 255.86 111.94 81690359 ART DUPLEX UNI/LTD STUDY 93931 920 $572.00 211.41 93.44 521.41 107.46 395.25 113.56 395.25 109.32 316.03 111.39 377.52 104.65 97.30 378.61 97.34 108.15 417.13 521.41 110.85 111.39 108.15 457.60 98.96 93.44 383.24 95.17 233.95 429.00 217.42 255.86 111.94 81790353 ART DUPLEX UNI/LTD STUDY 93931 920 $572.00 211.41 93.44 521.41 107.46 395.25 113.56 395.25 109.32 316.03 111.39 377.52 104.65 97.30 378.61 97.34 108.15 417.13 521.41 110.85 111.39 108.15 457.60 98.96 93.44 383.24 95.17 233.95 429.00 217.42 255.86 111.94 82690352 ART DUPLEX UNI/LTD STUDY 93931 920 $572.00 211.41 93.44 521.41 107.46 395.25 113.56 395.25 109.32 316.03 111.39 377.52 104.65 97.30 378.61 97.34 108.15 417.13 521.41 110.85 111.39 108.15 457.60 98.96 93.44 383.24 95.17 233.95 429.00 217.42 255.86 111.94 82790357 ART DUPLEX UNI/LTD STUDY 93931 920 $572.00 211.41 93.44 521.41 107.46 395.25 113.56 395.25 109.32 316.03 111.39 377.52 104.65 97.30 378.61 97.34 108.15 417.13 521.41 110.85 111.39 108.15 457.60 98.96 93.44 383.24 95.17 233.95 429.00 217.42 255.86 111.94 82990356 ART DUPLEX UNI/LTD STUDY 93931 920 $572.00 211.41 93.44 521.41 107.46 395.25 113.56 395.25 109.32 316.03 111.39 377.52 104.65 97.30 378.61 97.34 108.15 417.13 521.41 110.85 111.39 108.15 457.60 98.96 93.44 383.24 95.17 233.95 429.00 217.42 255.86 111.94 83090359 ART DUPLEX UNI/LTD STUDY 93931 920 $572.00 211.41 93.44 521.41 107.46 395.25 113.56 395.25 109.32 316.03 111.39 377.52 104.65 97.30 378.61 97.34 108.15 417.13 521.41 110.85 111.39 108.15 457.60 98.96 93.44 383.24 95.17 233.95 429.00 217.42 255.86 111.94 54008252 VENOUS DUPLEX BILAT CPL STUDY 93970 920 "$1,208.00" 446.48 146.66 966.40 168.66 834.73 240.00 834.73 171.59 667.42 235.43 797.28 164.26 152.72 799.58 205.71 228.57 677.38 846.72 234.28 235.43 228.57 966.40 209.14 146.66 809.36 201.14 494.07 906.00 459.16 540.34 236.57 67908252 VENOUS DUPLEX BILAT CPL STUDY 93970 921 "$1,208.00" 446.48 146.66 966.40 168.66 834.73 240.00 834.73 171.59 667.42 235.43 797.28 164.26 152.72 799.58 205.71 228.57 677.38 846.72 234.28 235.43 228.57 966.40 209.14 146.66 809.36 201.14 494.07 906.00 459.16 540.34 236.57 80508255 VENOUS DUPLEX BILAT CPL STUDY 93970 921 "$1,208.00" 446.48 146.66 966.40 168.66 834.73 240.00 834.73 171.59 667.42 235.43 797.28 164.26 152.72 799.58 205.71 228.57 677.38 846.72 234.28 235.43 228.57 966.40 209.14 146.66 809.36 201.14 494.07 906.00 459.16 540.34 236.57 81408254 VENOUS DUPLEX BILAT CPL STUDY 93970 921 "$1,208.00" 446.48 146.66 966.40 168.66 834.73 240.00 834.73 171.59 667.42 235.43 797.28 164.26 152.72 799.58 205.71 228.57 677.38 846.72 234.28 235.43 228.57 966.40 209.14 146.66 809.36 201.14 494.07 906.00 459.16 540.34 236.57 81608253 VENOUS DUPLEX BILAT CPL STUDY 93970 921 "$1,208.00" 446.48 146.66 966.40 168.66 834.73 240.00 834.73 171.59 667.42 235.43 797.28 164.26 152.72 799.58 205.71 228.57 677.38 846.72 234.28 235.43 228.57 966.40 209.14 146.66 809.36 201.14 494.07 906.00 459.16 540.34 236.57 81708258 VENOUS DUPLEX BILAT CPL STUDY 93970 921 "$1,208.00" 446.48 146.66 966.40 168.66 834.73 240.00 834.73 171.59 667.42 235.43 797.28 164.26 152.72 799.58 205.71 228.57 677.38 846.72 234.28 235.43 228.57 966.40 209.14 146.66 809.36 201.14 494.07 906.00 459.16 540.34 236.57 82608257 VENOUS DUPLEX BILAT CPL STUDY 93970 921 "$1,208.00" 446.48 146.66 966.40 168.66 834.73 240.00 834.73 171.59 667.42 235.43 797.28 164.26 152.72 799.58 205.71 228.57 677.38 846.72 234.28 235.43 228.57 966.40 209.14 146.66 809.36 201.14 494.07 906.00 459.16 540.34 236.57 82908251 VENOUS DUPLEX BILAT CPL STUDY 93970 921 "$1,208.00" 446.48 146.66 966.40 168.66 834.73 240.00 834.73 171.59 667.42 235.43 797.28 164.26 152.72 799.58 205.71 228.57 677.38 846.72 234.28 235.43 228.57 966.40 209.14 146.66 809.36 201.14 494.07 906.00 459.16 540.34 236.57 83008253 VENOUS DUPLEX BILAT CPL STUDY 93970 921 "$1,208.00" 446.48 146.66 966.40 168.66 834.73 240.00 834.73 171.59 667.42 235.43 797.28 164.26 152.72 799.58 205.71 228.57 677.38 846.72 234.28 235.43 228.57 966.40 209.14 146.66 809.36 201.14 494.07 906.00 459.16 540.34 236.57 37003867 VENOUS DUPLEX UNI/LTD STUDY 93971 929 $572.00 211.41 95.17 564.45 114.77 395.25 113.56 395.25 116.77 316.03 111.39 377.52 111.78 103.92 378.61 97.34 108.15 451.56 564.45 110.85 111.39 108.15 457.60 98.96 99.80 383.24 95.17 233.95 429.00 217.42 255.86 111.94 54008261 VENOUS DUPLEX UNI/LTD STUDY 93971 920 $572.00 211.41 95.17 564.45 114.77 395.25 113.56 395.25 116.77 316.03 111.39 377.52 111.78 103.92 378.61 97.34 108.15 451.56 564.45 110.85 111.39 108.15 457.60 98.96 99.80 383.24 95.17 233.95 429.00 217.42 255.86 111.94 67908261 VENOUS DUPLEX UNI/LTD STUDY 93971 921 $572.00 211.41 95.17 564.45 114.77 395.25 113.56 395.25 116.77 316.03 111.39 377.52 111.78 103.92 378.61 97.34 108.15 451.56 564.45 110.85 111.39 108.15 457.60 98.96 99.80 383.24 95.17 233.95 429.00 217.42 255.86 111.94 80508263 VENOUS DUPLEX UNI/LTD STUDY 93971 921 $572.00 211.41 95.17 564.45 114.77 395.25 113.56 395.25 116.77 316.03 111.39 377.52 111.78 103.92 378.61 97.34 108.15 451.56 564.45 110.85 111.39 108.15 457.60 98.96 99.80 383.24 95.17 233.95 429.00 217.42 255.86 111.94 81408262 VENOUS DUPLEX UNI/LTD STUDY 93971 921 $572.00 211.41 95.17 564.45 114.77 395.25 113.56 395.25 116.77 316.03 111.39 377.52 111.78 103.92 378.61 97.34 108.15 451.56 564.45 110.85 111.39 108.15 457.60 98.96 99.80 383.24 95.17 233.95 429.00 217.42 255.86 111.94 81608261 VENOUS DUPLEX UNI/LTD STUDY 93971 921 $572.00 211.41 95.17 564.45 114.77 395.25 113.56 395.25 116.77 316.03 111.39 377.52 111.78 103.92 378.61 97.34 108.15 451.56 564.45 110.85 111.39 108.15 457.60 98.96 99.80 383.24 95.17 233.95 429.00 217.42 255.86 111.94 81708266 VENOUS DUPLEX UNI/LTD STUDY 93971 921 $572.00 211.41 95.17 564.45 114.77 395.25 113.56 395.25 116.77 316.03 111.39 377.52 111.78 103.92 378.61 97.34 108.15 451.56 564.45 110.85 111.39 108.15 457.60 98.96 99.80 383.24 95.17 233.95 429.00 217.42 255.86 111.94 82608265 VENOUS DUPLEX UNI/LTD STUDY 93971 921 $572.00 211.41 95.17 564.45 114.77 395.25 113.56 395.25 116.77 316.03 111.39 377.52 111.78 103.92 378.61 97.34 108.15 451.56 564.45 110.85 111.39 108.15 457.60 98.96 99.80 383.24 95.17 233.95 429.00 217.42 255.86 111.94 82908269 VENOUS DUPLEX UNI/LTD STUDY 93971 921 $572.00 211.41 95.17 564.45 114.77 395.25 113.56 395.25 116.77 316.03 111.39 377.52 111.78 103.92 378.61 97.34 108.15 451.56 564.45 110.85 111.39 108.15 457.60 98.96 99.80 383.24 95.17 233.95 429.00 217.42 255.86 111.94 83008261 VENOUS DUPLEX UNI/LTD STUDY 93971 921 $572.00 211.41 95.17 564.45 114.77 395.25 113.56 395.25 116.77 316.03 111.39 377.52 111.78 103.92 378.61 97.34 108.15 451.56 564.45 110.85 111.39 108.15 457.60 98.96 99.80 383.24 95.17 233.95 429.00 217.42 255.86 111.94 54008686 VASC DUPLEX SCAN CPL STUDY 93975 921 "$1,208.00" 446.48 182.45 " 1,104.99 " 209.82 834.73 240.00 834.73 213.47 667.42 235.43 797.28 204.34 189.99 799.58 205.71 228.57 883.99 " 1,104.99 " 234.28 235.43 228.57 966.40 209.14 182.45 809.36 201.14 494.07 906.00 459.16 540.34 236.57 67908686 VASC DUPLEX SCAN CPL STUDY 93975 921 "$1,208.00" 446.48 182.45 " 1,104.99 " 209.82 834.73 240.00 834.73 213.47 667.42 235.43 797.28 204.34 189.99 799.58 205.71 228.57 883.99 " 1,104.99 " 234.28 235.43 228.57 966.40 209.14 182.45 809.36 201.14 494.07 906.00 459.16 540.34 236.57 80508689 VASC DUPLEX SCAN CPL STUDY 93975 921 "$1,208.00" 446.48 182.45 " 1,104.99 " 209.82 834.73 240.00 834.73 213.47 667.42 235.43 797.28 204.34 189.99 799.58 205.71 228.57 883.99 " 1,104.99 " 234.28 235.43 228.57 966.40 209.14 182.45 809.36 201.14 494.07 906.00 459.16 540.34 236.57 81408688 VASC DUPLEX SCAN CPL STUDY 93975 921 "$1,208.00" 446.48 182.45 " 1,104.99 " 209.82 834.73 240.00 834.73 213.47 667.42 235.43 797.28 204.34 189.99 799.58 205.71 228.57 883.99 " 1,104.99 " 234.28 235.43 228.57 966.40 209.14 182.45 809.36 201.14 494.07 906.00 459.16 540.34 236.57 81608687 VASC DUPLEX SCAN CPL STUDY 93975 921 "$1,208.00" 446.48 182.45 " 1,104.99 " 209.82 834.73 240.00 834.73 213.47 667.42 235.43 797.28 204.34 189.99 799.58 205.71 228.57 883.99 " 1,104.99 " 234.28 235.43 228.57 966.40 209.14 182.45 809.36 201.14 494.07 906.00 459.16 540.34 236.57 81708681 VASC DUPLEX SCAN CPL STUDY 93975 921 "$1,208.00" 446.48 182.45 " 1,104.99 " 209.82 834.73 240.00 834.73 213.47 667.42 235.43 797.28 204.34 189.99 799.58 205.71 228.57 883.99 " 1,104.99 " 234.28 235.43 228.57 966.40 209.14 182.45 809.36 201.14 494.07 906.00 459.16 540.34 236.57 82608681 VASC DUPLEX SCAN CPL STUDY 93975 921 "$1,208.00" 446.48 182.45 " 1,104.99 " 209.82 834.73 240.00 834.73 213.47 667.42 235.43 797.28 204.34 189.99 799.58 205.71 228.57 883.99 " 1,104.99 " 234.28 235.43 228.57 966.40 209.14 182.45 809.36 201.14 494.07 906.00 459.16 540.34 236.57 82708685 VASC DUPLEX SCAN CPL STUDY 93975 921 "$1,208.00" 446.48 182.45 " 1,104.99 " 209.82 834.73 240.00 834.73 213.47 667.42 235.43 797.28 204.34 189.99 799.58 205.71 228.57 883.99 " 1,104.99 " 234.28 235.43 228.57 966.40 209.14 182.45 809.36 201.14 494.07 906.00 459.16 540.34 236.57 82908684 VASC DUPLEX SCAN CPL STUDY 93975 921 "$1,208.00" 446.48 182.45 " 1,104.99 " 209.82 834.73 240.00 834.73 213.47 667.42 235.43 797.28 204.34 189.99 799.58 205.71 228.57 883.99 " 1,104.99 " 234.28 235.43 228.57 966.40 209.14 182.45 809.36 201.14 494.07 906.00 459.16 540.34 236.57 83008687 VASC DUPLEX SCAN CPL STUDY 93975 921 "$1,208.00" 446.48 182.45 " 1,104.99 " 209.82 834.73 240.00 834.73 213.47 667.42 235.43 797.28 204.34 189.99 799.58 205.71 228.57 883.99 " 1,104.99 " 234.28 235.43 228.57 966.40 209.14 182.45 809.36 201.14 494.07 906.00 459.16 540.34 236.57 54008309 VASC DUPLEX SCAN LTD STUDY 93976 921 $572.00 211.41 95.17 739.31 150.65 395.25 113.56 395.25 153.27 316.03 111.39 377.52 146.72 136.41 378.61 97.34 108.15 591.45 739.31 110.85 111.39 108.15 457.60 98.96 131.00 383.24 95.17 233.95 429.00 217.42 255.86 111.94 67908309 VASC DUPLEX SCAN LTD STUDY 93976 921 $572.00 211.41 95.17 739.31 150.65 395.25 113.56 395.25 153.27 316.03 111.39 377.52 146.72 136.41 378.61 97.34 108.15 591.45 739.31 110.85 111.39 108.15 457.60 98.96 131.00 383.24 95.17 233.95 429.00 217.42 255.86 111.94 80508301 VASC DUPLEX SCAN LTD STUDY 93976 921 $572.00 211.41 95.17 739.31 150.65 395.25 113.56 395.25 153.27 316.03 111.39 377.52 146.72 136.41 378.61 97.34 108.15 591.45 739.31 110.85 111.39 108.15 457.60 98.96 131.00 383.24 95.17 233.95 429.00 217.42 255.86 111.94 81408301 VASC DUPLEX SCAN LTD STUDY 93976 921 $572.00 211.41 95.17 739.31 150.65 395.25 113.56 395.25 153.27 316.03 111.39 377.52 146.72 136.41 378.61 97.34 108.15 591.45 739.31 110.85 111.39 108.15 457.60 98.96 131.00 383.24 95.17 233.95 429.00 217.42 255.86 111.94 81608300 VASC DUPLEX SCAN LTD STUDY 93976 921 $572.00 211.41 95.17 739.31 150.65 395.25 113.56 395.25 153.27 316.03 111.39 377.52 146.72 136.41 378.61 97.34 108.15 591.45 739.31 110.85 111.39 108.15 457.60 98.96 131.00 383.24 95.17 233.95 429.00 217.42 255.86 111.94 81708304 VASC DUPLEX SCAN LTD STUDY 93976 921 $572.00 211.41 95.17 739.31 150.65 395.25 113.56 395.25 153.27 316.03 111.39 377.52 146.72 136.41 378.61 97.34 108.15 591.45 739.31 110.85 111.39 108.15 457.60 98.96 131.00 383.24 95.17 233.95 429.00 217.42 255.86 111.94 82608303 VASC DUPLEX SCAN LTD STUDY 93976 921 $572.00 211.41 95.17 739.31 150.65 395.25 113.56 395.25 153.27 316.03 111.39 377.52 146.72 136.41 378.61 97.34 108.15 591.45 739.31 110.85 111.39 108.15 457.60 98.96 131.00 383.24 95.17 233.95 429.00 217.42 255.86 111.94 82908307 VASC DUPLEX SCAN LTD STUDY 93976 921 $572.00 211.41 95.17 739.31 150.65 395.25 113.56 395.25 153.27 316.03 111.39 377.52 146.72 136.41 378.61 97.34 108.15 591.45 739.31 110.85 111.39 108.15 457.60 98.96 131.00 383.24 95.17 233.95 429.00 217.42 255.86 111.94 83008300 VASC DUPLEX SCAN LTD STUDY 93976 921 $572.00 211.41 95.17 739.31 150.65 395.25 113.56 395.25 153.27 316.03 111.39 377.52 146.72 136.41 378.61 97.34 108.15 591.45 739.31 110.85 111.39 108.15 457.60 98.96 131.00 383.24 95.17 233.95 429.00 217.42 255.86 111.94 54008317 VASC DUPLEX AORTA CPL STUDY 93978 920 "$1,208.00" 446.48 121.95 966.40 140.24 834.73 240.00 834.73 142.68 667.42 235.43 797.28 136.58 126.99 799.58 205.71 228.57 635.29 794.11 234.28 235.43 228.57 966.40 209.14 121.95 809.36 201.14 494.07 906.00 459.16 540.34 236.57 67908317 VASC DUPLEX AORTA CPL STUDY 93978 921 "$1,208.00" 446.48 121.95 966.40 140.24 834.73 240.00 834.73 142.68 667.42 235.43 797.28 136.58 126.99 799.58 205.71 228.57 635.29 794.11 234.28 235.43 228.57 966.40 209.14 121.95 809.36 201.14 494.07 906.00 459.16 540.34 236.57 80508310 VASC DUPLEX AORTA CPL STUDY 93978 921 "$1,208.00" 446.48 121.95 966.40 140.24 834.73 240.00 834.73 142.68 667.42 235.43 797.28 136.58 126.99 799.58 205.71 228.57 635.29 794.11 234.28 235.43 228.57 966.40 209.14 121.95 809.36 201.14 494.07 906.00 459.16 540.34 236.57 81408319 VASC DUPLEX AORTA CPL STUDY 93978 921 "$1,208.00" 446.48 121.95 966.40 140.24 834.73 240.00 834.73 142.68 667.42 235.43 797.28 136.58 126.99 799.58 205.71 228.57 635.29 794.11 234.28 235.43 228.57 966.40 209.14 121.95 809.36 201.14 494.07 906.00 459.16 540.34 236.57 81608318 VASC DUPLEX AORTA CPL STUDY 93978 921 "$1,208.00" 446.48 121.95 966.40 140.24 834.73 240.00 834.73 142.68 667.42 235.43 797.28 136.58 126.99 799.58 205.71 228.57 635.29 794.11 234.28 235.43 228.57 966.40 209.14 121.95 809.36 201.14 494.07 906.00 459.16 540.34 236.57 81708312 VASC DUPLEX AORTA CPL STUDY 93978 921 "$1,208.00" 446.48 121.95 966.40 140.24 834.73 240.00 834.73 142.68 667.42 235.43 797.28 136.58 126.99 799.58 205.71 228.57 635.29 794.11 234.28 235.43 228.57 966.40 209.14 121.95 809.36 201.14 494.07 906.00 459.16 540.34 236.57 82608311 VASC DUPLEX AORTA CPL STUDY 93978 921 "$1,208.00" 446.48 121.95 966.40 140.24 834.73 240.00 834.73 142.68 667.42 235.43 797.28 136.58 126.99 799.58 205.71 228.57 635.29 794.11 234.28 235.43 228.57 966.40 209.14 121.95 809.36 201.14 494.07 906.00 459.16 540.34 236.57 82908315 VASC DUPLEX AORTA CPL STUDY 93978 921 "$1,208.00" 446.48 121.95 966.40 140.24 834.73 240.00 834.73 142.68 667.42 235.43 797.28 136.58 126.99 799.58 205.71 228.57 635.29 794.11 234.28 235.43 228.57 966.40 209.14 121.95 809.36 201.14 494.07 906.00 459.16 540.34 236.57 83008318 VASC DUPLEX AORTA CPL STUDY 93978 921 "$1,208.00" 446.48 121.95 966.40 140.24 834.73 240.00 834.73 142.68 667.42 235.43 797.28 136.58 126.99 799.58 205.71 228.57 635.29 794.11 234.28 235.43 228.57 966.40 209.14 121.95 809.36 201.14 494.07 906.00 459.16 540.34 236.57 54008325 VASC DUPLEX SCAN UNI/LTD STUDY 93979 920 $572.00 211.41 95.17 528.68 114.71 395.25 113.56 395.25 116.71 316.03 111.39 377.52 111.72 103.87 378.61 97.34 108.15 422.94 528.68 110.85 111.39 108.15 457.60 98.96 99.75 383.24 95.17 233.95 429.00 217.42 255.86 111.94 67908325 VASC DUPLEX SCAN UNI/LTD STUDY 93979 921 $572.00 211.41 95.17 528.68 114.71 395.25 113.56 395.25 116.71 316.03 111.39 377.52 111.72 103.87 378.61 97.34 108.15 422.94 528.68 110.85 111.39 108.15 457.60 98.96 99.75 383.24 95.17 233.95 429.00 217.42 255.86 111.94 80508328 VASC DUPLEX SCAN UNI/LTD STUDY 93979 921 $572.00 211.41 95.17 528.68 114.71 395.25 113.56 395.25 116.71 316.03 111.39 377.52 111.72 103.87 378.61 97.34 108.15 422.94 528.68 110.85 111.39 108.15 457.60 98.96 99.75 383.24 95.17 233.95 429.00 217.42 255.86 111.94 81408327 VASC DUPLEX SCAN UNI/LTD STUDY 93979 921 $572.00 211.41 95.17 528.68 114.71 395.25 113.56 395.25 116.71 316.03 111.39 377.52 111.72 103.87 378.61 97.34 108.15 422.94 528.68 110.85 111.39 108.15 457.60 98.96 99.75 383.24 95.17 233.95 429.00 217.42 255.86 111.94 81608326 VASC DUPLEX SCAN UNI/LTD STUDY 93979 921 $572.00 211.41 95.17 528.68 114.71 395.25 113.56 395.25 116.71 316.03 111.39 377.52 111.72 103.87 378.61 97.34 108.15 422.94 528.68 110.85 111.39 108.15 457.60 98.96 99.75 383.24 95.17 233.95 429.00 217.42 255.86 111.94 81708321 VASC DUPLEX SCAN UNI/LTD STUDY 93979 921 $572.00 211.41 95.17 528.68 114.71 395.25 113.56 395.25 116.71 316.03 111.39 377.52 111.72 103.87 378.61 97.34 108.15 422.94 528.68 110.85 111.39 108.15 457.60 98.96 99.75 383.24 95.17 233.95 429.00 217.42 255.86 111.94 82608320 VASC DUPLEX SCAN UNI/LTD STUDY 93979 921 $572.00 211.41 95.17 528.68 114.71 395.25 113.56 395.25 116.71 316.03 111.39 377.52 111.72 103.87 378.61 97.34 108.15 422.94 528.68 110.85 111.39 108.15 457.60 98.96 99.75 383.24 95.17 233.95 429.00 217.42 255.86 111.94 82908323 VASC DUPLEX SCAN UNI/LTD STUDY 93979 921 $572.00 211.41 95.17 528.68 114.71 395.25 113.56 395.25 116.71 316.03 111.39 377.52 111.72 103.87 378.61 97.34 108.15 422.94 528.68 110.85 111.39 108.15 457.60 98.96 99.75 383.24 95.17 233.95 429.00 217.42 255.86 111.94 83008326 VASC DUPLEX SCAN UNI/LTD STUDY 93979 921 $572.00 211.41 95.17 528.68 114.71 395.25 113.56 395.25 116.71 316.03 111.39 377.52 111.72 103.87 378.61 97.34 108.15 422.94 528.68 110.85 111.39 108.15 457.60 98.96 99.75 383.24 95.17 233.95 429.00 217.42 255.86 111.94 54008414 VASC DUPLEX PENILE CPL STUDY 93980 920 $572.00 211.41 95.17 976.35 176.78 395.25 113.56 395.25 179.85 316.03 111.39 377.52 172.17 160.07 378.61 97.34 108.15 781.08 976.35 110.85 111.39 108.15 457.60 98.96 153.72 383.24 95.17 233.95 429.00 217.42 255.86 111.94 54090536 DUP SCAN HEMO COMP BILAT STDY 93985 920 "$1,208.00" 446.48 201.14 " 2,166.73 " 236.03 834.73 240.00 834.73 240.13 667.42 235.43 797.28 229.87 213.72 799.58 205.71 228.57 " 1,733.38 " " 2,166.73 " 234.28 235.43 228.57 966.40 209.14 205.24 809.36 201.14 494.07 906.00 459.16 540.34 236.57 80590539 DUP SCAN HEMO COMP BILAT STDY 93985 402 "$1,208.00" 446.48 201.14 " 2,166.73 " 236.03 834.73 240.00 834.73 240.13 667.42 235.43 797.28 229.87 213.72 799.58 205.71 228.57 " 1,733.38 " " 2,166.73 " 234.28 235.43 228.57 966.40 209.14 205.24 809.36 201.14 494.07 906.00 459.16 540.34 236.57 54090544 DUP SCAN HEMO COMP UNI STDY 93986 920 $572.00 211.41 95.17 457.60 137.08 395.25 113.56 395.25 139.46 316.03 111.39 377.52 133.50 124.12 378.61 97.34 108.15 303.10 378.89 110.85 111.39 108.15 457.60 98.96 119.20 383.24 95.17 233.95 429.00 217.42 255.86 111.94 80590547 DUP SCAN HEMO COMP UNI STDY 93986 402 $572.00 211.41 95.17 457.60 137.08 395.25 113.56 395.25 139.46 316.03 111.39 377.52 133.50 124.12 378.61 97.34 108.15 303.10 378.89 110.85 111.39 108.15 457.60 98.96 119.20 383.24 95.17 233.95 429.00 217.42 255.86 111.94 54090391 DUPLEX OF HEMODIALYSIS ACCESS 93990 921 $572.00 211.41 92.49 477.27 106.36 395.25 113.56 395.25 108.21 316.03 111.39 377.52 103.59 96.31 378.61 97.34 108.15 381.82 477.27 110.85 111.39 108.15 457.60 98.96 92.49 383.24 95.17 233.95 429.00 217.42 255.86 111.94 80590393 DUPLEX HEMODIALYSIS ACCESS 93990 921 $572.00 211.41 92.49 477.27 106.36 395.25 113.56 395.25 108.21 316.03 111.39 377.52 103.59 96.31 378.61 97.34 108.15 381.82 477.27 110.85 111.39 108.15 457.60 98.96 92.49 383.24 95.17 233.95 429.00 217.42 255.86 111.94 81490392 DUPLEX HEMODIALYSIS ACCESS 93990 921 $572.00 211.41 92.49 477.27 106.36 395.25 113.56 395.25 108.21 316.03 111.39 377.52 103.59 96.31 378.61 97.34 108.15 381.82 477.27 110.85 111.39 108.15 457.60 98.96 92.49 383.24 95.17 233.95 429.00 217.42 255.86 111.94 81690391 DUPLEX HEMODIALYSIS ACCESS 93990 921 $572.00 211.41 92.49 477.27 106.36 395.25 113.56 395.25 108.21 316.03 111.39 377.52 103.59 96.31 378.61 97.34 108.15 381.82 477.27 110.85 111.39 108.15 457.60 98.96 92.49 383.24 95.17 233.95 429.00 217.42 255.86 111.94 81790396 DUPLEX HEMODIALYSIS ACCESS 93990 921 $572.00 211.41 92.49 477.27 106.36 395.25 113.56 395.25 108.21 316.03 111.39 377.52 103.59 96.31 378.61 97.34 108.15 381.82 477.27 110.85 111.39 108.15 457.60 98.96 92.49 383.24 95.17 233.95 429.00 217.42 255.86 111.94 82690395 DUPLEX HEMODIALYSIS ACCESS 93990 921 $572.00 211.41 92.49 477.27 106.36 395.25 113.56 395.25 108.21 316.03 111.39 377.52 103.59 96.31 378.61 97.34 108.15 381.82 477.27 110.85 111.39 108.15 457.60 98.96 92.49 383.24 95.17 233.95 429.00 217.42 255.86 111.94 82990399 DUPLEX HEMODIALYSIS ACCESS 93990 921 $572.00 211.41 92.49 477.27 106.36 395.25 113.56 395.25 108.21 316.03 111.39 377.52 103.59 96.31 378.61 97.34 108.15 381.82 477.27 110.85 111.39 108.15 457.60 98.96 92.49 383.24 95.17 233.95 429.00 217.42 255.86 111.94 83090391 DUPLEX HEMODIALYSIS ACCESS 93990 921 $572.00 211.41 92.49 477.27 106.36 395.25 113.56 395.25 108.21 316.03 111.39 377.52 103.59 96.31 378.61 97.34 108.15 381.82 477.27 110.85 111.39 108.15 457.60 98.96 92.49 383.24 95.17 233.95 429.00 217.42 255.86 111.94 24700071 CMV IP VENT MGT/INITIAL DAY 94002 410 "$2,548.00" 941.74 - " 2,038.40 " - " 1,760.67 " 508.13 " 1,760.67 " - " 1,407.77 " 498.45 " 1,681.68 " - - " 1,686.52 " 435.54 483.93 655.14 818.92 496.03 498.45 483.93 " 2,038.40 " 442.80 - " 1,707.16 " 425.86 " 1,042.13 " " 1,911.00 " 968.49 " 1,139.72 " 500.87 24700119 HFJV IP VENT MGT/INITIAL DAY 94002 410 "$2,548.00" 941.74 - " 2,038.40 " - " 1,760.67 " 508.13 " 1,760.67 " - " 1,407.77 " 498.45 " 1,681.68 " - - " 1,686.52 " 435.54 483.93 655.14 818.92 496.03 498.45 483.93 " 2,038.40 " 442.80 - " 1,707.16 " 425.86 " 1,042.13 " " 1,911.00 " 968.49 " 1,139.72 " 500.87 24700062 CMV IP VENT MGT/EA SUBSQ DAY 94003 410 "$2,548.00" 941.74 - " 2,038.40 " - " 1,760.67 " 508.13 " 1,760.67 " - " 1,407.77 " 498.45 " 1,681.68 " - - " 1,686.52 " 435.54 483.93 476.03 595.04 496.03 498.45 483.93 " 2,038.40 " 442.80 - " 1,707.16 " 425.86 " 1,042.13 " " 1,911.00 " 968.49 " 1,139.72 " 500.87 24700101 HFJV IP VENT MGT/EA SUBSQ DAY 94003 410 "$2,548.00" 941.74 - " 2,038.40 " - " 1,760.67 " 508.13 " 1,760.67 " - " 1,407.77 " 498.45 " 1,681.68 " - - " 1,686.52 " 435.54 483.93 476.03 595.04 496.03 498.45 483.93 " 2,038.40 " 442.80 - " 1,707.16 " 425.86 " 1,042.13 " " 1,911.00 " 968.49 " 1,139.72 " 500.87 24701069 PEAK FLOW MEASUREMENT 94010 410 $733.00 270.92 15.00 586.40 17.25 506.50 145.62 506.50 17.55 404.98 142.85 483.78 16.80 15.62 485.17 124.82 138.69 118.37 147.96 142.16 142.85 138.69 586.40 126.90 15.00 491.11 122.05 299.80 549.75 278.61 327.87 143.54 24901190 SCREENING SPIROMETRY 94010 460 $733.00 270.92 15.00 586.40 17.25 506.50 145.62 506.50 17.55 404.98 142.85 483.78 16.80 15.62 485.17 124.82 138.69 118.37 147.96 142.16 142.85 138.69 586.40 126.90 15.00 491.11 122.05 299.80 549.75 278.61 327.87 143.54 24951138 SPIRO-PRE/POST BRONCHODILATOR 94060 460 "$1,388.00" 513.00 19.00 " 1,110.40 " 21.85 959.11 276.03 959.11 22.23 766.87 270.78 916.08 21.28 19.78 918.72 236.60 262.89 210.20 262.75 269.46 270.78 262.89 " 1,110.40 " 240.54 19.00 929.96 231.34 567.69 " 1,041.00 " 527.58 620.85 272.09 24951090 BRONCHIAL PROVOCATION 94070 460 "$1,388.00" 513.00 19.00 " 1,110.40 " 21.85 959.11 276.03 959.11 22.23 766.87 270.78 916.08 21.28 19.78 918.72 236.60 262.89 285.68 357.10 269.46 270.78 262.89 " 1,110.40 " 240.54 19.00 929.96 231.34 567.69 " 1,041.00 " 527.58 620.85 272.09 24901963 MAX VOLVENTILATION 94200 460 $292.00 107.92 9.00 233.60 10.35 201.77 58.05 201.77 10.53 161.33 56.95 192.72 10.08 9.37 193.27 49.76 55.29 78.59 98.24 56.67 56.95 55.29 233.60 50.59 9.00 195.64 48.66 119.43 219.00 110.99 130.61 57.23 24901955 FLOW VOLUME LOOP 94375 460 "$1,388.00" 513.00 31.47 " 1,110.40 " 36.19 959.11 276.03 959.11 36.82 766.87 270.78 916.08 35.25 32.77 918.72 236.60 262.89 131.68 164.60 269.46 270.78 262.89 " 1,110.40 " 240.54 31.47 929.96 231.34 567.69 " 1,041.00 " 527.58 620.85 272.09 24700127 SURFACTANT INSTILLATION 94610 460 $986.00 364.43 - 788.80 - 681.33 196.06 681.33 - 544.77 192.32 650.76 - - 652.63 168.05 186.72 472.05 590.06 191.39 192.32 186.72 788.80 170.85 - 660.62 164.31 403.27 739.50 374.78 441.04 193.26 24700810 PULMONARY STRESS TESTING 94618 410 $588.00 217.32 27.12 470.40 31.19 406.31 117.61 406.31 31.73 324.87 115.37 388.08 30.37 28.24 389.20 100.81 112.01 86.25 107.81 114.81 115.37 112.01 470.40 102.49 27.12 393.96 98.57 240.49 441.00 223.50 263.01 115.93 24900819 PULMONARY STRESS TESTING 94618 460 $588.00 217.32 27.12 470.40 31.19 406.31 117.61 406.31 31.73 324.87 115.37 388.08 30.37 28.24 389.20 100.81 112.01 86.25 107.81 114.81 115.37 112.01 470.40 102.49 27.12 393.96 98.57 240.49 441.00 223.50 263.01 115.93 24700500 METER DOSE INHALER 94640 410 $986.00 364.43 - 788.80 - 681.33 196.06 681.33 - 544.77 192.32 650.76 - - 652.63 168.05 186.72 105.78 132.22 191.39 192.32 186.72 788.80 170.85 - 660.62 164.31 403.27 739.50 374.78 441.04 193.26 24700712 HELIOX ADMINISTRATION 94640 410 $986.00 364.43 - 788.80 - 681.33 196.06 681.33 - 544.77 192.32 650.76 - - 652.63 168.05 186.72 105.78 132.22 191.39 192.32 186.72 788.80 170.85 - 660.62 164.31 403.27 739.50 374.78 441.04 193.26 24700836 IPV INHALATION TREATMENT 94640 410 $986.00 364.43 - 788.80 - 681.33 196.06 681.33 - 544.77 192.32 650.76 - - 652.63 168.05 186.72 105.78 132.22 191.39 192.32 186.72 788.80 170.85 - 660.62 164.31 403.27 739.50 374.78 441.04 193.26 24701204 HHN INHALATION TREATMENT 94640 410 $986.00 364.43 - 788.80 - 681.33 196.06 681.33 - 544.77 192.32 650.76 - - 652.63 168.05 186.72 105.78 132.22 191.39 192.32 186.72 788.80 170.85 - 660.62 164.31 403.27 739.50 374.78 441.04 193.26 24701212 IPPB INHALATION TREATMENT 94640 410 $986.00 364.43 - 788.80 - 681.33 196.06 681.33 - 544.77 192.32 650.76 - - 652.63 168.05 186.72 105.78 132.22 191.39 192.32 186.72 788.80 170.85 - 660.62 164.31 403.27 739.50 374.78 441.04 193.26 24701531 EZPAP TREATMENT 94640 410 $986.00 364.43 - 788.80 - 681.33 196.06 681.33 - 544.77 192.32 650.76 - - 652.63 168.05 186.72 105.78 132.22 191.39 192.32 186.72 788.80 170.85 - 660.62 164.31 403.27 739.50 374.78 441.04 193.26 24701778 NEBULIZER CONTROL MOD AND TX 94640 410 $986.00 364.43 - 788.80 - 681.33 196.06 681.33 - 544.77 192.32 650.76 - - 652.63 168.05 186.72 105.78 132.22 191.39 192.32 186.72 788.80 170.85 - 660.62 164.31 403.27 739.50 374.78 441.04 193.26 24701875 INDUCTION SPUTUM DX PURPOSES 94640 410 $986.00 364.43 - 788.80 - 681.33 196.06 681.33 - 544.77 192.32 650.76 - - 652.63 168.05 186.72 105.78 132.22 191.39 192.32 186.72 788.80 170.85 - 660.62 164.31 403.27 739.50 374.78 441.04 193.26 24730751 OXYHOOD (PER DAY) 94640 410 $986.00 364.43 - 788.80 - 681.33 196.06 681.33 - 544.77 192.32 650.76 - - 652.63 168.05 186.72 105.78 132.22 191.39 192.32 186.72 788.80 170.85 - 660.62 164.31 403.27 739.50 374.78 441.04 193.26 24900509 METER DOSE INHALER 94640 460 $986.00 364.43 - 788.80 - 681.33 196.06 681.33 - 544.77 192.32 650.76 - - 652.63 168.05 186.72 105.78 132.22 191.39 192.32 186.72 788.80 170.85 - 660.62 164.31 403.27 739.50 374.78 441.04 193.26 24901203 HHN INHALATION TREATMENT 94640 460 $986.00 364.43 - 788.80 - 681.33 196.06 681.33 - 544.77 192.32 650.76 - - 652.63 168.05 186.72 105.78 132.22 191.39 192.32 186.72 788.80 170.85 - 660.62 164.31 403.27 739.50 374.78 441.04 193.26 24901874 INDUCTION SPUTUM DX PURPOSES 94640 460 $986.00 364.43 - 788.80 - 681.33 196.06 681.33 - 544.77 192.32 650.76 - - 652.63 168.05 186.72 105.78 132.22 191.39 192.32 186.72 788.80 170.85 - 660.62 164.31 403.27 739.50 374.78 441.04 193.26 24902013 AEROSOL INHALTN PENTAMIDINE TX 94642 460 $986.00 364.43 31.20 788.80 35.88 681.33 196.06 681.33 36.50 544.77 192.32 650.76 34.94 32.49 652.63 168.05 186.72 624.77 780.96 191.39 192.32 186.72 788.80 170.85 31.20 660.62 164.31 403.27 739.50 374.78 441.04 193.26 24700097 INHALATION TX/INITIAL HOUR 94644 410 $588.00 217.32 25.70 470.40 29.56 406.31 117.61 406.31 30.07 324.87 115.37 388.08 28.78 26.76 389.20 100.81 112.01 256.03 320.04 114.81 115.37 112.01 470.40 102.49 25.70 393.96 98.57 240.49 441.00 223.50 263.01 115.93 24701433 INHALATION TX EA ADDL HOUR 94645 410 $64.00 23.65 - 122.06 11.27 44.22 - 44.22 11.47 35.36 - 42.24 10.98 10.20 42.36 - - 97.65 122.06 - - - 51.20 - 9.80 42.88 - 26.18 48.00 24.33 28.63 - 24700976 CPAP/BIPAP INITIAL 94660 410 $986.00 364.43 - 896.64 - 681.33 196.06 681.33 - 544.77 192.32 650.76 - - 652.63 168.05 186.72 717.31 896.64 191.39 192.32 186.72 788.80 170.85 - 660.62 164.31 403.27 739.50 374.78 441.04 193.26 24700984 CPAP/BIPAP SUBSQ 94660 410 $986.00 364.43 - 896.64 - 681.33 196.06 681.33 - 544.77 192.32 650.76 - - 652.63 168.05 186.72 717.31 896.64 191.39 192.32 186.72 788.80 170.85 - 660.62 164.31 403.27 739.50 374.78 441.04 193.26 24701573 HF OXYGEN THERAPY/INITIAL 94660 410 $986.00 364.43 - 896.64 - 681.33 196.06 681.33 - 544.77 192.32 650.76 - - 652.63 168.05 186.72 717.31 896.64 191.39 192.32 186.72 788.80 170.85 - 660.62 164.31 403.27 739.50 374.78 441.04 193.26 24701581 HF OXYGEN THERAPY/SUBSQ 94660 410 $986.00 364.43 - 896.64 - 681.33 196.06 681.33 - 544.77 192.32 650.76 - - 652.63 168.05 186.72 717.31 896.64 191.39 192.32 186.72 788.80 170.85 - 660.62 164.31 403.27 739.50 374.78 441.04 193.26 24700020 MEDICATED DEMO/INITIAL 94664 410 $986.00 364.43 11.82 788.80 13.59 681.33 196.06 681.33 13.83 544.77 192.32 650.76 13.24 12.31 652.63 168.05 186.72 128.10 160.12 191.39 192.32 186.72 788.80 170.85 11.82 660.62 164.31 403.27 739.50 374.78 441.04 193.26 24700208 IPPB DEMO/INITIAL 94664 410 $986.00 364.43 11.82 788.80 13.59 681.33 196.06 681.33 13.83 544.77 192.32 650.76 13.24 12.31 652.63 168.05 186.72 128.10 160.12 191.39 192.32 186.72 788.80 170.85 11.82 660.62 164.31 403.27 739.50 374.78 441.04 193.26 24700372 METER DOSE INHALER INSTRUCTION 94664 410 $986.00 364.43 11.82 788.80 13.59 681.33 196.06 681.33 13.83 544.77 192.32 650.76 13.24 12.31 652.63 168.05 186.72 128.10 160.12 191.39 192.32 186.72 788.80 170.85 11.82 660.62 164.31 403.27 739.50 374.78 441.04 193.26 24900029 MEDICATED DEMO/INITIAL 94664 460 $986.00 364.43 11.82 788.80 13.59 681.33 196.06 681.33 13.83 544.77 192.32 650.76 13.24 12.31 652.63 168.05 186.72 128.10 160.12 191.39 192.32 186.72 788.80 170.85 11.82 660.62 164.31 403.27 739.50 374.78 441.04 193.26 24900371 METER DOSE INHALER INSTRUCTION 94664 460 $986.00 364.43 11.82 788.80 13.59 681.33 196.06 681.33 13.83 544.77 192.32 650.76 13.24 12.31 652.63 168.05 186.72 128.10 160.12 191.39 192.32 186.72 788.80 170.85 11.82 660.62 164.31 403.27 739.50 374.78 441.04 193.26 24700054 CHEST PHYSICAL TX/INITIAL 94667 410 $588.00 217.32 - 470.40 - 406.31 117.61 406.31 - 324.87 115.37 388.08 - - 389.20 100.81 112.01 178.31 222.89 114.81 115.37 112.01 470.40 102.49 - 393.96 98.57 240.49 441.00 223.50 263.01 115.93 24700755 IN-EXSUFFLATOR 94667 410 $588.00 217.32 - 470.40 - 406.31 117.61 406.31 - 324.87 115.37 388.08 - - 389.20 100.81 112.01 178.31 222.89 114.81 115.37 112.01 470.40 102.49 - 393.96 98.57 240.49 441.00 223.50 263.01 115.93 24700046 CHEST PHYSICAL THPY <16 MIN 94668 410 $588.00 217.32 - 470.40 - 406.31 117.61 406.31 - 324.87 115.37 388.08 - - 389.20 100.81 112.01 132.00 165.00 114.81 115.37 112.01 470.40 102.49 - 393.96 98.57 240.49 441.00 223.50 263.01 115.93 24700771 IN-EXSUFFLATOR TX SUBSQ 94668 410 $588.00 217.32 - 470.40 - 406.31 117.61 406.31 - 324.87 115.37 388.08 - - 389.20 100.81 112.01 132.00 165.00 114.81 115.37 112.01 470.40 102.49 - 393.96 98.57 240.49 441.00 223.50 263.01 115.93 24700801 CHEST PHYSICAL TX/SUBSQ 94668 410 $588.00 217.32 - 470.40 - 406.31 117.61 406.31 - 324.87 115.37 388.08 - - 389.20 100.81 112.01 132.00 165.00 114.81 115.37 112.01 470.40 102.49 - 393.96 98.57 240.49 441.00 223.50 263.01 115.93 24701239 PEP/FLUTTER TX/SUBSQ 94668 410 $588.00 217.32 - 470.40 - 406.31 117.61 406.31 - 324.87 115.37 388.08 - - 389.20 100.81 112.01 132.00 165.00 114.81 115.37 112.01 470.40 102.49 - 393.96 98.57 240.49 441.00 223.50 263.01 115.93 24770818 MECH CHESTWALL OSC W/VEST 94669 410 $986.00 364.43 - 788.80 - 681.33 196.06 681.33 - 544.77 192.32 650.76 - - 652.63 168.05 186.72 103.46 129.33 191.39 192.32 186.72 788.80 170.85 - 660.62 164.31 403.27 739.50 374.78 441.04 193.26 24771032 MECH CHESTWALL OSC SUBSQ 94669 410 $986.00 364.43 - 788.80 - 681.33 196.06 681.33 - 544.77 192.32 650.76 - - 652.63 168.05 186.72 103.46 129.33 191.39 192.32 186.72 788.80 170.85 - 660.62 164.31 403.27 739.50 374.78 441.04 193.26 24900282 PLETHYSMGR LUNG VOL/AIRWAY RES 94726 460 "$1,388.00" 513.00 40.06 " 1,110.40 " 46.07 959.11 276.03 959.11 46.87 766.87 270.78 916.08 44.87 41.71 918.72 236.60 262.89 147.30 184.13 269.46 270.78 262.89 " 1,110.40 " 240.54 40.06 929.96 231.34 567.69 " 1,041.00 " 527.58 620.85 272.09 24970736 GAS DIL/WASHOUT LUNG VOL 94727 460 $733.00 270.92 31.56 586.40 36.29 506.50 145.62 506.50 36.93 404.98 142.85 483.78 35.35 32.86 485.17 124.82 138.69 147.30 184.13 142.16 142.85 138.69 586.40 126.90 31.56 491.11 122.05 299.80 549.75 278.61 327.87 143.54 24970752 DIFFUSE CAPACITY CO2/MEMBRANE 94729 460 $119.00 43.98 - 194.29 45.47 82.23 - 82.23 46.26 65.75 - 78.54 44.28 41.17 78.77 - - 155.43 194.29 - - - 95.20 - 39.54 79.73 - 48.67 89.25 45.23 53.23 - 24771083 MEASURE BLOOD OXYGEN LEVEL 94761 410 $81.00 29.94 - 90.27 4.44 55.97 - 55.97 4.52 44.75 - 53.46 4.32 4.02 53.61 - - 72.22 90.27 - - - 64.80 - 3.86 54.27 - 33.13 60.75 30.79 36.23 - 24701131 NOCTURNAL OXIMETRY 94762 410 $733.00 270.92 - 586.40 - 506.50 145.62 506.50 - 404.98 142.85 483.78 - - 485.17 124.82 138.69 135.50 169.38 142.16 142.85 138.69 586.40 126.90 - 491.11 122.05 299.80 549.75 278.61 327.87 143.54 25000307 NOCTURNAL OXIMETRY: HOME STUDY 94762 460 $733.00 270.92 - 586.40 - 506.50 145.62 506.50 - 404.98 142.85 483.78 - - 485.17 124.82 138.69 135.50 169.38 142.16 142.85 138.69 586.40 126.90 - 491.11 122.05 299.80 549.75 278.61 327.87 143.54 25400321 NOCTURNAL HOME OXIMETRY STUDY 94762 460 $733.00 270.92 - 586.40 - 506.50 145.62 506.50 - 404.98 142.85 483.78 - - 485.17 124.82 138.69 135.50 169.38 142.16 142.85 138.69 586.40 126.90 - 491.11 122.05 299.80 549.75 278.61 327.87 143.54 24701247 ENTIDAL CO2 MONITORING 94770 410 $289.00 106.81 - 231.20 - 199.70 N/A 199.70 - 159.67 N/A 190.74 - N/A 191.29 - N/A 79.63 99.54 N/A N/A N/A 231.20 N/A - 193.63 N/A 118.20 216.75 109.85 129.27 N/A 24900231 INHALE BRONCH CHAL NO PFTS 95070 924 "$2,561.00" 946.55 21.50 " 2,048.80 " 24.73 " 1,769.65 " 509.13 " 1,769.65 " 25.16 " 1,414.95 " 499.44 " 1,690.26 " 24.08 22.39 " 1,695.13 " 436.40 484.89 261.45 326.81 497.01 499.44 484.89 " 2,048.80 " 443.67 21.50 " 1,715.87 " 426.70 " 1,047.45 " " 1,920.75 " 973.44 " 1,145.54 " 501.86 28700342 SNSR PLCMT/HU/CALIB/TRAIN 95249 920 $292.00 107.92 42.14 524.79 48.46 201.77 58.05 201.77 49.30 161.33 56.95 192.72 47.20 43.88 193.27 49.76 55.29 419.83 524.79 56.67 56.95 55.29 233.60 50.59 42.14 195.64 48.66 119.43 219.00 110.99 130.61 57.23 34800251 GLUCOSE MONITOR BY QHP 72HRS/> 95250 920 $623.00 230.26 88.26 596.83 101.50 430.49 123.93 430.49 103.26 344.21 121.57 411.18 98.85 91.91 412.36 106.23 118.03 477.46 596.83 120.98 121.57 118.03 498.40 108.00 88.26 417.41 103.87 254.81 467.25 236.80 278.67 122.16 31202001 VEEG CONT REC TECH MIN 8 CHAN 95700 740 "$1,388.00" 513.00 200.00 " 3,240.83 " 230.00 959.11 276.03 959.11 234.00 766.87 270.78 916.08 224.00 208.26 918.72 236.60 262.89 " 2,592.66 " " 3,240.83 " 269.46 270.78 262.89 " 1,110.40 " 240.54 200.00 929.96 231.34 567.69 " 1,041.00 " 527.58 620.85 272.09 31202019 EEG WO VID TECH 2-12HR UNMON 95705 740 "$1,388.00" 513.00 80.00 " 3,240.83 " 92.00 959.11 276.03 959.11 93.60 766.87 270.78 916.08 89.60 83.30 918.72 236.60 262.89 " 2,592.66 " " 3,240.83 " 269.46 270.78 262.89 " 1,110.40 " 240.54 80.00 929.96 231.34 567.69 " 1,041.00 " 527.58 620.85 272.09 31202027 EEG WO VID TECH 2-12HR INT MON 95706 740 "$1,388.00" 513.00 231.34 " 3,240.83 " 382.72 959.11 276.03 959.11 389.38 766.87 270.78 916.08 372.74 346.54 918.72 236.60 262.89 " 2,592.66 " " 3,240.83 " 269.46 270.78 262.89 " 1,110.40 " 240.54 332.80 929.96 231.34 567.69 " 1,041.00 " 527.58 620.85 272.09 31202035 EEG WO VID TECH 2-12HR CON MON 95707 740 "$1,388.00" 513.00 231.34 " 3,240.83 " 478.40 959.11 276.03 959.11 486.72 766.87 270.78 916.08 465.92 433.18 918.72 236.60 262.89 " 2,592.66 " " 3,240.83 " 269.46 270.78 262.89 " 1,110.40 " 240.54 416.00 929.96 231.34 567.69 " 1,041.00 " 527.58 620.85 272.09 31202043 EEG WO VID TECH EA 12-26HR U/M 95708 740 "$2,561.00" 946.55 120.00 " 2,048.80 " 138.00 " 1,769.65 " 509.13 " 1,769.65 " 140.40 " 1,414.95 " 499.44 " 1,690.26 " 134.40 124.96 " 1,695.13 " 436.40 484.89 " 1,357.07 " " 1,696.41 " 497.01 499.44 484.89 " 2,048.80 " 443.67 120.00 " 1,715.87 " 426.70 " 1,047.45 " " 1,920.75 " 973.44 " 1,145.54 " 501.86 31202051 EEG WO VID TECH EA 12-26HR INT 95709 740 "$2,561.00" 946.55 426.70 " 2,048.80 " 764.52 " 1,769.65 " 509.13 " 1,769.65 " 777.82 " 1,414.95 " 499.44 " 1,690.26 " 744.58 692.26 " 1,695.13 " 436.40 484.89 " 1,357.07 " " 1,696.41 " 497.01 499.44 484.89 " 2,048.80 " 443.67 664.80 " 1,715.87 " 426.70 " 1,047.45 " " 1,920.75 " 973.44 " 1,145.54 " 501.86 31202060 EEG WO VID TECH EA 12-26HR CON 95710 740 "$2,561.00" 946.55 426.70 " 2,048.80 " 955.88 " 1,769.65 " 509.13 " 1,769.65 " 972.50 " 1,414.95 " 499.44 " 1,690.26 " 930.94 865.53 " 1,695.13 " 436.40 484.89 " 1,357.07 " " 1,696.41 " 497.01 499.44 484.89 " 2,048.80 " 443.67 831.20 " 1,715.87 " 426.70 " 1,047.45 " " 1,920.75 " 973.44 " 1,145.54 " 501.86 31202078 VEEG TECH 2-12HR UNMON 95711 740 "$1,388.00" 513.00 100.00 " 1,110.40 " 115.00 959.11 276.03 959.11 117.00 766.87 270.78 916.08 112.00 104.13 918.72 236.60 262.89 735.50 919.41 269.46 270.78 262.89 " 1,110.40 " 240.54 100.00 929.96 231.34 567.69 " 1,041.00 " 527.58 620.85 272.09 31202086 VEEG TECH 2-12HR INT MON 95712 740 "$1,388.00" 513.00 231.34 " 1,110.40 " 460.00 959.11 276.03 959.11 468.00 766.87 270.78 916.08 448.00 416.52 918.72 236.60 262.89 735.50 919.41 269.46 270.78 262.89 " 1,110.40 " 240.54 400.00 929.96 231.34 567.69 " 1,041.00 " 527.58 620.85 272.09 31202094 VEEG TECH 2-12HR CON MON 95713 740 "$2,561.00" 946.55 426.70 " 2,048.80 " 575.00 " 1,769.65 " 509.13 " 1,769.65 " 585.00 " 1,414.95 " 499.44 " 1,690.26 " 560.00 520.65 " 1,695.13 " 436.40 484.89 " 1,357.07 " " 1,696.41 " 497.01 499.44 484.89 " 2,048.80 " 443.67 500.00 " 1,715.87 " 426.70 " 1,047.45 " " 1,920.75 " 973.44 " 1,145.54 " 501.86 31202108 VEEG TECH EA 12-26HR UNMON 95714 740 "$2,561.00" 946.55 160.00 " 2,048.80 " 184.00 " 1,769.65 " 509.13 " 1,769.65 " 187.20 " 1,414.95 " 499.44 " 1,690.26 " 179.20 166.61 " 1,695.13 " 436.40 484.89 " 1,357.07 " " 1,696.41 " 497.01 499.44 484.89 " 2,048.80 " 443.67 160.00 " 1,715.87 " 426.70 " 1,047.45 " " 1,920.75 " 973.44 " 1,145.54 " 501.86 31202116 VEEG TECH EA 12-26HR INT MON 95715 740 "$2,561.00" 946.55 426.70 " 2,048.80 " 920.00 " 1,769.65 " 509.13 " 1,769.65 " 936.00 " 1,414.95 " 499.44 " 1,690.26 " 896.00 833.04 " 1,695.13 " 436.40 484.89 " 1,357.07 " " 1,696.41 " 497.01 499.44 484.89 " 2,048.80 " 443.67 800.00 " 1,715.87 " 426.70 " 1,047.45 " " 1,920.75 " 973.44 " 1,145.54 " 501.86 31202124 VEEG TECH EA 12-26HR CON MON 95716 740 "$4,829.00" " 1,784.80 " 804.23 " 3,863.20 " " 1,150.00 " " 3,336.84 " 959.60 " 3,336.84 " " 1,170.00 " " 2,668.02 " 941.32 " 3,187.14 " " 1,120.00 " " 1,041.30 " " 3,196.32 " 822.51 913.90 " 2,558.89 " " 3,198.73 " 936.75 941.32 913.90 " 3,863.20 " 836.22 " 1,000.00 " " 3,235.43 " 804.23 " 1,975.06 " " 3,621.75 " " 1,835.50 " " 2,160.01 " 945.89 31202132 EEG PHYS/QHP 2-12HR WO VID 95717 740 "$2,260.00" 835.30 - " 1,808.00 " 94.50 " 1,561.66 " N/A " 1,561.66 " 96.14 " 1,248.65 " N/A " 1,491.60 " 92.03 N/A " 1,495.89 " - N/A 829.54 " 1,036.93 " N/A N/A N/A " 1,808.00 " N/A 82.17 " 1,514.20 " N/A 924.34 " 1,695.00 " 859.03 " 1,010.90 " N/A 31202141 EEG PHYS/QHP 2-12HR W/VEEG 95718 740 "$4,699.00" " 1,736.75 " - " 3,759.20 " 123.90 " 3,247.01 " N/A " 3,247.01 " 126.06 " 2,596.20 " N/A " 3,101.34 " 120.67 N/A " 3,110.27 " - N/A " 1,089.64 " " 1,362.05 " N/A N/A N/A " 3,759.20 " N/A 107.74 " 3,148.33 " N/A " 1,921.89 " " 3,524.25 " " 1,786.09 " " 2,101.86 " N/A 31202159 EEG PHYS/QHP EA >12HR<26HR 95719 740 "$5,550.00" " 2,051.28 " - " 4,440.00 " 146.44 " 3,835.05 " N/A " 3,835.05 " 148.99 " 3,066.38 " N/A " 3,663.00 " 142.62 N/A " 3,673.55 " - N/A " 1,282.22 " " 1,602.78 " N/A N/A N/A " 4,440.00 " N/A 127.34 " 3,718.50 " N/A " 2,269.95 " " 4,162.50 " " 2,109.56 " " 2,482.52 " N/A 31202167 VEEG PHYS/QHP EA INCR>12HR<26H 95720 740 "$6,555.00" " 2,422.73 " - " 5,244.00 " 191.84 " 4,529.51 " N/A " 4,529.51 " 195.18 " 3,621.64 " N/A " 4,326.30 " 186.84 N/A " 4,338.75 " - N/A " 1,686.43 " " 2,108.04 " N/A N/A N/A " 5,244.00 " N/A 166.82 " 4,391.85 " N/A " 2,681.00 " " 4,916.25 " " 2,491.56 " " 2,932.05 " N/A 31202175 EEG COMPLETE PHYS/QHP>36HR 95721 740 "$7,742.00" " 2,861.44 " - " 6,193.60 " 192.46 " 5,349.72 " N/A " 5,349.72 " 195.81 " 4,277.46 " N/A " 5,109.72 " 187.44 N/A " 5,124.43 " - N/A " 1,699.90 " " 2,124.88 " N/A N/A N/A " 6,193.60 " N/A 167.36 " 5,187.14 " N/A " 3,166.48 " " 5,806.50 " " 2,942.73 " " 3,463.00 " N/A 31202183 VEEG COMPLETE PHYS/QHP>36HR 95722 740 "$9,145.00" " 3,379.99 " - " 7,316.00 " 234.09 " 6,319.20 " N/A " 6,319.20 " 238.17 " 5,052.61 " N/A " 6,035.70 " 227.99 N/A " 6,053.08 " - N/A " 2,063.30 " " 2,579.13 " N/A N/A N/A " 7,316.00 " N/A 203.56 " 6,127.15 " N/A " 3,740.31 " " 6,858.75 " " 3,476.01 " " 4,090.56 " N/A 31202191 EEG COMPLETE PHYS/QHP>60HR 95723 740 "$10,800.00" " 3,991.68 " - " 8,640.00 " 238.26 " 7,462.80 " N/A " 7,462.80 " 242.40 " 5,967.00 " N/A " 7,128.00 " 232.04 N/A " 7,148.52 " - N/A " 2,107.46 " " 2,634.33 " N/A N/A N/A " 8,640.00 " N/A 207.18 " 7,236.00 " N/A " 4,417.20 " " 8,100.00 " " 4,105.08 " " 4,830.84 " N/A 31202205 VEEG COMPLETE PHYS/QHP>60HR 95724 740 "$12,756.00" " 4,714.62 " - " 10,204.80 " 298.48 " 8,814.40 " N/A " 8,814.40 " 303.67 " 7,047.69 " N/A " 8,418.96 " 290.70 N/A " 8,443.20 " - N/A " 2,634.59 " " 3,293.24 " N/A N/A N/A " 10,204.80 " N/A 259.55 " 8,546.52 " N/A " 5,217.20 " " 9,567.00 " " 4,848.56 " " 5,705.76 " N/A 31202213 EEG COMPLETE PHYS/QHP>84HR 95725 740 "$15,067.00" " 5,568.76 " - " 12,053.60 " 271.08 " 10,411.30 " N/A " 10,411.30 " 275.79 " 8,324.52 " N/A " 9,944.22 " 264.01 N/A " 9,972.85 " - N/A " 2,405.26 " " 3,006.58 " N/A N/A N/A " 12,053.60 " N/A 235.72 " 10,094.89 " N/A " 6,162.40 " " 11,300.25 " " 5,726.97 " " 6,739.47 " N/A 31202221 VEEG COMPLETE PHYS/QHP>84HR 95726 740 "$17,795.00" " 6,577.03 " - " 14,236.00 " 377.17 " 12,296.35 " N/A " 12,296.35 " 383.72 " 9,831.74 " N/A " 11,744.70 " 367.33 N/A " 11,778.51 " - N/A " 3,329.82 " " 4,162.28 " N/A N/A N/A " 14,236.00 " N/A 327.97 " 11,922.65 " N/A " 7,278.16 " " 13,346.25 " " 6,763.88 " " 7,959.70 " N/A 25000358 POLYSOM NOCTURNAL UNDER 6 95782 920 "$4,829.00" " 1,784.80 " 771.22 " 3,863.20 " 886.90 " 3,336.84 " 959.60 " 3,336.84 " 902.33 " 2,668.02 " 941.32 " 3,187.14 " 863.77 803.07 " 3,196.32 " 822.51 913.90 " 3,068.22 " " 3,835.27 " 936.75 941.32 913.90 " 3,863.20 " 836.22 771.22 " 3,235.43 " 804.23 " 1,975.06 " " 3,621.75 " " 1,835.50 " " 2,160.01 " 945.89 25400356 POLYSOM NOCTURNAL UNDER 6 95782 920 "$4,829.00" " 1,784.80 " 771.22 " 3,863.20 " 886.90 " 3,336.84 " 959.60 " 3,336.84 " 902.33 " 2,668.02 " 941.32 " 3,187.14 " 863.77 803.07 " 3,196.32 " 822.51 913.90 " 3,068.22 " " 3,835.27 " 936.75 941.32 913.90 " 3,863.20 " 836.22 771.22 " 3,235.43 " 804.23 " 1,975.06 " " 3,621.75 " " 1,835.50 " " 2,160.01 " 945.89 25000366 POLYSOM NOCTURNAL CPAP UNDER 6 95783 920 "$4,829.00" " 1,784.80 " 804.23 " 4,080.18 " 946.94 " 3,336.84 " 959.60 " 3,336.84 " 963.41 " 2,668.02 " 941.32 " 3,187.14 " 922.24 857.44 " 3,196.32 " 822.51 913.90 " 3,264.14 " " 4,080.18 " 936.75 941.32 913.90 " 3,863.20 " 836.22 823.43 " 3,235.43 " 804.23 " 1,975.06 " " 3,621.75 " " 1,835.50 " " 2,160.01 " 945.89 25400364 POLYSOM NOCTURNAL CPAP UNDER 6 95783 920 "$4,829.00" " 1,784.80 " 804.23 " 4,080.18 " 946.94 " 3,336.84 " 959.60 " 3,336.84 " 963.41 " 2,668.02 " 941.32 " 3,187.14 " 922.24 857.44 " 3,196.32 " 822.51 913.90 " 3,264.14 " " 4,080.18 " 936.75 941.32 913.90 " 3,863.20 " 836.22 823.43 " 3,235.43 " 804.23 " 1,975.06 " " 3,621.75 " " 1,835.50 " " 2,160.01 " 945.89 25000331 SLP STD UN W/MIN HRT O2 RES AN 95801 920 $588.00 217.32 - 470.40 - 406.31 117.61 406.31 - 324.87 115.37 388.08 - - 389.20 100.81 112.01 348.02 435.02 114.81 115.37 112.01 470.40 102.49 - 393.96 98.57 240.49 441.00 223.50 263.01 115.93 25400330 SLP STD UN W/MIN HRT O2 RES AN 95801 920 $588.00 217.32 - 470.40 - 406.31 117.61 406.31 - 324.87 115.37 388.08 - - 389.20 100.81 112.01 348.02 435.02 114.81 115.37 112.01 470.40 102.49 - 393.96 98.57 240.49 441.00 223.50 263.01 115.93 25000013 MULTI SLEEP LATENCY/MWT 95805 920 "$2,561.00" 946.55 236.85 " 2,048.80 " 272.38 " 1,769.65 " 509.13 " 1,769.65 " 277.11 " 1,414.95 " 499.44 " 1,690.26 " 265.27 246.63 " 1,695.13 " 436.40 484.89 " 1,419.72 " " 1,774.65 " 497.01 499.44 484.89 " 2,048.80 " 443.67 236.85 " 1,715.87 " 426.70 " 1,047.45 " " 1,920.75 " 973.44 " 1,145.54 " 501.86 25400151 MULTI SLEEP LATENCY/MWT 95805 920 "$2,561.00" 946.55 236.85 " 2,048.80 " 272.38 " 1,769.65 " 509.13 " 1,769.65 " 277.11 " 1,414.95 " 499.44 " 1,690.26 " 265.27 246.63 " 1,695.13 " 436.40 484.89 " 1,419.72 " " 1,774.65 " 497.01 499.44 484.89 " 2,048.80 " 443.67 236.85 " 1,715.87 " 426.70 " 1,047.45 " " 1,920.75 " 973.44 " 1,145.54 " 501.86 25000561 SLP STD UN W/MIN HR O2 RES TAM 95806 920 $733.00 270.92 - " 1,126.41 " - 506.50 145.62 506.50 - 404.98 142.85 483.78 - - 485.17 124.82 138.69 901.13 " 1,126.41 " 142.16 142.85 138.69 586.40 126.90 - 491.11 122.05 299.80 549.75 278.61 327.87 143.54 25400569 SLP STD UN W/MIN HR O2 RES TAM 95806 920 $733.00 270.92 - " 1,126.41 " - 506.50 145.62 506.50 - 404.98 142.85 483.78 - - 485.17 124.82 138.69 901.13 " 1,126.41 " 142.16 142.85 138.69 586.40 126.90 - 491.11 122.05 299.80 549.75 278.61 327.87 143.54 25000340 SLEEP STUDY ATTENDED 4 METRICS 95807 920 "$2,561.00" 946.55 335.70 " 3,682.02 " 386.06 " 1,769.65 " 509.13 " 1,769.65 " 392.77 " 1,414.95 " 499.44 " 1,690.26 " 375.98 349.56 " 1,695.13 " 436.40 484.89 " 2,945.62 " " 3,682.02 " 497.01 499.44 484.89 " 2,048.80 " 443.67 335.70 " 1,715.87 " 426.70 " 1,047.45 " " 1,920.75 " 973.44 " 1,145.54 " 501.86 25400313 SLEEP STUDY ATTENDED 4 METRICS 95807 920 "$2,561.00" 946.55 335.70 " 3,682.02 " 386.06 " 1,769.65 " 509.13 " 1,769.65 " 392.77 " 1,414.95 " 499.44 " 1,690.26 " 375.98 349.56 " 1,695.13 " 436.40 484.89 " 2,945.62 " " 3,682.02 " 497.01 499.44 484.89 " 2,048.80 " 443.67 335.70 " 1,715.87 " 426.70 " 1,047.45 " " 1,920.75 " 973.44 " 1,145.54 " 501.86 25000021 POLYSOM INCOMPLETE 95810 920 "$4,829.00" " 1,784.80 " 346.56 " 3,863.20 " 398.54 " 3,336.84 " 959.60 " 3,336.84 " 405.48 " 2,668.02 " 941.32 " 3,187.14 " 388.15 360.87 " 3,196.32 " 822.51 913.90 " 2,163.66 " " 2,704.57 " 936.75 941.32 913.90 " 3,863.20 " 836.22 346.56 " 3,235.43 " 804.23 " 1,975.06 " " 3,621.75 " " 1,835.50 " " 2,160.01 " 945.89 25400101 POLYSOM INCOMPLETE 95810 920 "$4,829.00" " 1,784.80 " 346.56 " 3,863.20 " 398.54 " 3,336.84 " 959.60 " 3,336.84 " 405.48 " 2,668.02 " 941.32 " 3,187.14 " 388.15 360.87 " 3,196.32 " 822.51 913.90 " 2,163.66 " " 2,704.57 " 936.75 941.32 913.90 " 3,863.20 " 836.22 346.56 " 3,235.43 " 804.23 " 1,975.06 " " 3,621.75 " " 1,835.50 " " 2,160.01 " 945.89 25000102 POLYSOM W/CPAP 95811 920 "$4,829.00" " 1,784.80 " 647.56 " 3,863.20 " 744.69 " 3,336.84 " 959.60 " 3,336.84 " 757.65 " 2,668.02 " 941.32 " 3,187.14 " 725.27 674.30 " 3,196.32 " 822.51 913.90 " 2,432.20 " " 3,040.25 " 936.75 941.32 913.90 " 3,863.20 " 836.22 647.56 " 3,235.43 " 804.23 " 1,975.06 " " 3,621.75 " " 1,835.50 " " 2,160.01 " 945.89 25400119 POLYSOM W/CPAP 95811 920 "$4,829.00" " 1,784.80 " 647.56 " 3,863.20 " 744.69 " 3,336.84 " 959.60 " 3,336.84 " 757.65 " 2,668.02 " 941.32 " 3,187.14 " 725.27 674.30 " 3,196.32 " 822.51 913.90 " 2,432.20 " " 3,040.25 " 936.75 941.32 913.90 " 3,863.20 " 836.22 647.56 " 3,235.43 " 804.23 " 1,975.06 " " 3,621.75 " " 1,835.50 " " 2,160.01 " 945.89 31200211 EEG EXT MONITOR 41-60 95812 740 "$1,388.00" 513.00 90.48 " 1,110.40 " 104.05 959.11 276.03 959.11 105.86 766.87 270.78 916.08 101.34 94.22 918.72 236.60 262.89 381.58 476.97 269.46 270.78 262.89 " 1,110.40 " 240.54 90.48 929.96 231.34 567.69 " 1,041.00 " 527.58 620.85 272.09 31200202 EEG EXT MONITOR 61-119MIN 95813 740 "$1,388.00" 513.00 116.87 " 1,110.40 " 134.40 959.11 276.03 959.11 136.74 766.87 270.78 916.08 130.89 121.70 918.72 236.60 262.89 448.69 560.86 269.46 270.78 262.89 " 1,110.40 " 240.54 116.87 929.96 231.34 567.69 " 1,041.00 " 527.58 620.85 272.09 31200024 EEG 95816 740 "$1,388.00" 513.00 22.50 " 1,110.40 " 25.88 959.11 276.03 959.11 26.33 766.87 270.78 916.08 25.20 23.43 918.72 236.60 262.89 353.43 441.79 269.46 270.78 262.89 " 1,110.40 " 240.54 22.50 929.96 231.34 567.69 " 1,041.00 " 527.58 620.85 272.09 31200016 EEG AWAKE/SLEEP 95819 740 "$1,388.00" 513.00 22.50 " 1,110.40 " 25.88 959.11 276.03 959.11 26.33 766.87 270.78 916.08 25.20 23.43 918.72 236.60 262.89 375.83 469.79 269.46 270.78 262.89 " 1,110.40 " 240.54 22.50 929.96 231.34 567.69 " 1,041.00 " 527.58 620.85 272.09 31200326 EEG RECORD IN COMA/SLEEP ONLY 95822 740 "$1,388.00" 513.00 22.50 " 1,110.40 " 25.88 959.11 276.03 959.11 26.33 766.87 270.78 916.08 25.20 23.43 918.72 236.60 262.89 427.81 534.76 269.46 270.78 262.89 " 1,110.40 " 240.54 22.50 929.96 231.34 567.69 " 1,041.00 " 527.58 620.85 272.09 31200334 CEREBRAL DEATH RECORDING 95824 740 "$2,561.00" 946.55 - " 2,048.80 " - " 1,769.65 " 509.13 " 1,769.65 " - " 1,414.95 " 499.44 " 1,690.26 " - - " 1,695.13 " 436.40 484.89 215.30 269.12 497.01 499.44 484.89 " 2,048.80 " 443.67 - " 1,715.87 " 426.70 " 1,047.45 " " 1,920.75 " 973.44 " 1,145.54 " 501.86 31200431 ELECTROCORTICOGRAM AT SURGERY 95829 740 "$1,355.00" 500.81 - " 1,084.00 " - 936.31 - 936.31 - 748.64 - 894.30 - - 896.87 - - 684.79 855.99 - - - " 1,084.00 " - - 907.85 - 554.20 " 1,016.25 " 515.04 606.09 - 29120382 ROM EACH EXTREMITY OR TRUNK 95851 430 $40.00 14.78 6.86 154.54 8.95 27.64 8.18 27.64 9.10 22.10 8.02 26.40 8.71 8.10 26.48 7.01 7.79 123.63 154.54 7.98 8.02 7.79 32.00 7.13 7.78 26.80 6.86 16.36 30.00 15.20 17.89 8.06 29220531 ROM EACH EXTREMITY OR TRUNK 95851 420 $40.00 14.78 6.86 154.54 8.95 27.64 8.18 27.64 9.10 22.10 8.02 26.40 8.71 8.10 26.48 7.01 7.79 123.63 154.54 7.98 8.02 7.79 32.00 7.13 7.78 26.80 6.86 16.36 30.00 15.20 17.89 8.06 29585130 ROM EACH EXTREMITY OR TRUNK 95851 420 $40.00 14.78 6.86 154.54 8.95 27.64 8.18 27.64 9.10 22.10 8.02 26.40 8.71 8.10 26.48 7.01 7.79 123.63 154.54 7.98 8.02 7.79 32.00 7.13 7.78 26.80 6.86 16.36 30.00 15.20 17.89 8.06 31900140 ROM EACH EXTREMITY OR TRUNK 95851 420 $40.00 14.78 6.86 154.54 8.95 27.64 8.18 27.64 9.10 22.10 8.02 26.40 8.71 8.10 26.48 7.01 7.79 123.63 154.54 7.98 8.02 7.79 32.00 7.13 7.78 26.80 6.86 16.36 30.00 15.20 17.89 8.06 64200241 ROM EACH EXTREMITY OR TRUNK 95851 420 $40.00 14.78 6.86 154.54 8.95 27.64 8.18 27.64 9.10 22.10 8.02 26.40 8.71 8.10 26.48 7.01 7.79 123.63 154.54 7.98 8.02 7.79 32.00 7.13 7.78 26.80 6.86 16.36 30.00 15.20 17.89 8.06 29120374 ROM HAND 95852 430 $29.00 10.72 4.76 133.12 6.39 20.04 5.68 20.04 6.51 16.02 5.57 19.14 6.23 5.79 19.20 4.87 5.41 106.50 133.12 5.55 5.57 5.41 23.20 4.95 5.56 19.43 4.76 11.86 21.75 11.02 12.97 5.60 29220522 ROM HAND 95852 420 $29.00 10.72 4.76 133.12 6.39 20.04 5.68 20.04 6.51 16.02 5.57 19.14 6.23 5.79 19.20 4.87 5.41 106.50 133.12 5.55 5.57 5.41 23.20 4.95 5.56 19.43 4.76 11.86 21.75 11.02 12.97 5.60 29585121 ROM HAND 95852 420 $29.00 10.72 4.76 133.12 6.39 20.04 5.68 20.04 6.51 16.02 5.57 19.14 6.23 5.79 19.20 4.87 5.41 106.50 133.12 5.55 5.57 5.41 23.20 4.95 5.56 19.43 4.76 11.86 21.75 11.02 12.97 5.60 31900158 ROM HAND 95852 420 $29.00 10.72 4.76 133.12 6.39 20.04 5.68 20.04 6.51 16.02 5.57 19.14 6.23 5.79 19.20 4.87 5.41 106.50 133.12 5.55 5.57 5.41 23.20 4.95 5.56 19.43 4.76 11.86 21.75 11.02 12.97 5.60 64200259 ROM HAND 95852 420 $29.00 10.72 4.76 133.12 6.39 20.04 5.68 20.04 6.51 16.02 5.57 19.14 6.23 5.79 19.20 4.87 5.41 106.50 133.12 5.55 5.57 5.41 23.20 4.95 5.56 19.43 4.76 11.86 21.75 11.02 12.97 5.60 31200440 EMG 1 EXTREMITY 95860 922 $588.00 217.32 30.00 470.40 34.50 406.31 117.61 406.31 35.10 324.87 115.37 388.08 33.60 31.24 389.20 100.81 112.01 262.01 327.51 114.81 115.37 112.01 470.40 102.49 30.00 393.96 98.57 240.49 441.00 223.50 263.01 115.93 31200458 EMG 2 EXTREMITIES 95861 922 $588.00 217.32 37.50 552.59 43.13 406.31 117.61 406.31 43.88 324.87 115.37 388.08 42.00 39.05 389.20 100.81 112.01 442.07 552.59 114.81 115.37 112.01 470.40 102.49 37.50 393.96 98.57 240.49 441.00 223.50 263.01 115.93 31200466 EMG 3 EXTREMITIES 95863 922 $733.00 270.92 42.50 654.42 48.88 506.50 145.62 506.50 49.73 404.98 142.85 483.78 47.60 44.26 485.17 124.82 138.69 523.54 654.42 142.16 142.85 138.69 586.40 126.90 42.50 491.11 122.05 299.80 549.75 278.61 327.87 143.54 31200474 EMG 4 EXTREMITIES 95864 922 $733.00 270.92 49.00 861.27 56.35 506.50 145.62 506.50 57.33 404.98 142.85 483.78 54.88 51.02 485.17 124.82 138.69 689.02 861.27 142.16 142.85 138.69 586.40 126.90 49.00 491.11 122.05 299.80 549.75 278.61 327.87 143.54 31200296 EMG LARYNX 95865 922 $588.00 217.32 83.09 470.40 95.55 406.31 117.61 406.31 97.22 324.87 115.37 388.08 93.06 86.52 389.20 100.81 112.01 192.58 240.73 114.81 115.37 112.01 470.40 102.49 83.09 393.96 98.57 240.49 441.00 223.50 263.01 115.93 31200300 EMG HEMIDIAPHRAGM 95866 922 $733.00 270.92 56.46 586.40 64.93 506.50 145.62 506.50 66.06 404.98 142.85 483.78 63.24 58.79 485.17 124.82 138.69 61.78 77.22 142.16 142.85 138.69 586.40 126.90 56.46 491.11 122.05 299.80 549.75 278.61 327.87 143.54 31200482 EMG CRANIAL NERVE UNILATERAL 95867 922 "$1,388.00" 513.00 25.00 " 1,110.40 " 28.75 959.11 276.03 959.11 29.25 766.87 270.78 916.08 28.00 26.03 918.72 236.60 262.89 202.94 253.68 269.46 270.78 262.89 " 1,110.40 " 240.54 25.00 929.96 231.34 567.69 " 1,041.00 " 527.58 620.85 272.09 31200342 EMG CRANIAL NERVE BILATERAL 95868 922 "$1,388.00" 513.00 56.46 " 1,110.40 " 64.93 959.11 276.03 959.11 66.06 766.87 270.78 916.08 63.24 58.79 918.72 236.60 262.89 422.62 528.28 269.46 270.78 262.89 " 1,110.40 " 240.54 56.46 929.96 231.34 567.69 " 1,041.00 " 527.58 620.85 272.09 31200491 EMG THORACIC PARASPINAL 95869 922 $733.00 270.92 21.79 586.40 25.06 506.50 145.62 506.50 25.49 404.98 142.85 483.78 24.40 22.69 485.17 124.82 138.69 178.31 222.89 142.16 142.85 138.69 586.40 126.90 21.79 491.11 122.05 299.80 549.75 278.61 327.87 143.54 31200504 EMG LMTD STDY NONPARASPINAL 95870 922 $588.00 217.32 28.79 470.40 33.11 406.31 117.61 406.31 33.68 324.87 115.37 388.08 32.24 29.98 389.20 100.81 112.01 105.86 132.32 114.81 115.37 112.01 470.40 102.49 28.79 393.96 98.57 240.49 441.00 223.50 263.01 115.93 31200512 EMG SINGLE FIBER 95872 922 $733.00 270.92 35.00 586.40 40.25 506.50 145.62 506.50 40.95 404.98 142.85 483.78 39.20 36.45 485.17 124.82 138.69 343.63 429.54 142.16 142.85 138.69 586.40 126.90 35.00 491.11 122.05 299.80 549.75 278.61 327.87 143.54 31200628 MUSC TST DONE W/NERV TST LTD 95885 922 $76.00 28.09 - 238.13 47.97 52.52 - 52.52 48.80 41.99 - 50.16 46.72 43.43 50.30 - - 190.50 238.13 - - - 60.80 - 41.71 50.92 - 31.08 57.00 28.89 33.99 - 31200636 MUSC TEST DONE W/N TEST CPL 95886 922 $186.00 68.75 - 250.79 76.23 128.53 - 128.53 77.56 102.77 - 122.76 74.24 69.03 123.11 - - 200.63 250.79 - - - 148.80 - 66.29 124.62 - 76.07 139.50 70.70 83.20 - 31200644 MUSC TST DONE W/N TST NONEXT 95887 922 $153.00 56.55 - 255.07 67.65 105.72 - 105.72 68.83 84.53 - 100.98 65.89 61.26 101.27 - - 204.06 255.07 - - - 122.40 - 58.83 102.51 - 62.58 114.75 58.16 68.44 - 31200679 NERVE CNDCTN TEST 1-2 STUDIES 95907 922 $733.00 270.92 71.79 586.40 82.56 506.50 145.62 506.50 83.99 404.98 142.85 483.78 80.40 74.75 485.17 124.82 138.69 143.88 179.85 142.16 142.85 138.69 586.40 126.90 71.79 491.11 122.05 299.80 549.75 278.61 327.87 143.54 31200687 NERVE CNDCTN TEST 3-4 STUDIES 95908 922 "$1,388.00" 513.00 88.60 " 1,110.40 " 101.89 959.11 276.03 959.11 103.66 766.87 270.78 916.08 99.23 92.26 918.72 236.60 262.89 173.45 216.81 269.46 270.78 262.89 " 1,110.40 " 240.54 88.60 929.96 231.34 567.69 " 1,041.00 " 527.58 620.85 272.09 31200695 NERVE CNDCTN TEST 5-6 STUDIES 95909 922 "$1,388.00" 513.00 106.20 " 1,110.40 " 122.13 959.11 276.03 959.11 124.25 766.87 270.78 916.08 118.94 110.59 918.72 236.60 262.89 209.16 261.45 269.46 270.78 262.89 " 1,110.40 " 240.54 106.20 929.96 231.34 567.69 " 1,041.00 " 527.58 620.85 272.09 31200709 NERVE CNDCTN TEST 7-8 STUDIES 95910 922 "$1,388.00" 513.00 139.86 " 1,110.40 " 160.84 959.11 276.03 959.11 163.64 766.87 270.78 916.08 156.64 145.64 918.72 236.60 262.89 269.66 337.08 269.46 270.78 262.89 " 1,110.40 " 240.54 139.86 929.96 231.34 567.69 " 1,041.00 " 527.58 620.85 272.09 31200717 NERVE CNDCTN TEST 9-10 STUDIES 95911 922 "$2,561.00" 946.55 169.54 " 2,048.80 " 194.97 " 1,769.65 " 509.13 " 1,769.65 " 198.36 " 1,414.95 " 499.44 " 1,690.26 " 189.88 176.54 " 1,695.13 " 436.40 484.89 313.26 391.58 497.01 499.44 484.89 " 2,048.80 " 443.67 169.54 " 1,715.87 " 426.70 " 1,047.45 " " 1,920.75 " 973.44 " 1,145.54 " 501.86 31200725 NERVE CNDCTN TEST 11-12 STDS 95912 922 "$2,561.00" 946.55 198.73 " 2,048.80 " 228.54 " 1,769.65 " 509.13 " 1,769.65 " 232.51 " 1,414.95 " 499.44 " 1,690.26 " 222.58 206.94 " 1,695.13 " 436.40 484.89 354.47 443.09 497.01 499.44 484.89 " 2,048.80 " 443.67 198.73 " 1,715.87 " 426.70 " 1,047.45 " " 1,920.75 " 973.44 " 1,145.54 " 501.86 31200733 NERVE CNDCTN TEST 13/> STUDIES 95913 922 "$2,561.00" 946.55 230.55 " 2,048.80 " 265.13 " 1,769.65 " 509.13 " 1,769.65 " 269.74 " 1,414.95 " 499.44 " 1,690.26 " 258.22 240.07 " 1,695.13 " 436.40 484.89 396.96 496.20 497.01 499.44 484.89 " 2,048.80 " 443.67 230.55 " 1,715.87 " 426.70 " 1,047.45 " " 1,920.75 " 973.44 " 1,145.54 " 501.86 31200563 SOMATOSENSORY UPPER 95925 922 "$1,388.00" 513.00 27.50 " 1,110.40 " 31.63 959.11 276.03 959.11 32.18 766.87 270.78 916.08 30.80 28.64 918.72 236.60 262.89 377.43 471.79 269.46 270.78 262.89 " 1,110.40 " 240.54 27.50 929.96 231.34 567.69 " 1,041.00 " 527.58 620.85 272.09 31200571 SOMATOSENSORY LOWER 95926 922 "$1,388.00" 513.00 58.43 " 1,110.40 " 67.19 959.11 276.03 959.11 68.36 766.87 270.78 916.08 65.44 60.84 918.72 236.60 262.89 626.76 783.45 269.46 270.78 262.89 " 1,110.40 " 240.54 58.43 929.96 231.34 567.69 " 1,041.00 " 527.58 620.85 272.09 31200806 SOMATOSENORY TRUNK/HEAD 95927 922 "$1,388.00" 513.00 59.48 " 1,110.40 " 68.40 959.11 276.03 959.11 69.59 766.87 270.78 916.08 66.62 61.94 918.72 236.60 262.89 626.76 783.45 269.46 270.78 262.89 " 1,110.40 " 240.54 59.48 929.96 231.34 567.69 " 1,041.00 " 527.58 620.85 272.09 31200237 C MOTOR EVOKED UPPER LIMBS 95928 922 "$4,829.00" " 1,784.80 " 131.54 " 3,863.20 " 151.27 " 3,336.84 " 959.60 " 3,336.84 " 153.90 " 2,668.02 " 941.32 " 3,187.14 " 147.32 136.97 " 3,196.32 " 822.51 913.90 278.51 348.14 936.75 941.32 913.90 " 3,863.20 " 836.22 131.54 " 3,235.43 " 804.23 " 1,975.06 " " 3,621.75 " " 1,835.50 " " 2,160.01 " 945.89 31200245 C MOTOR EVOKED LOWER LIMBS 95929 922 "$2,561.00" 946.55 136.82 " 2,048.80 " 157.34 " 1,769.65 " 509.13 " 1,769.65 " 160.08 " 1,414.95 " 499.44 " 1,690.26 " 153.24 142.47 " 1,695.13 " 436.40 484.89 300.58 375.73 497.01 499.44 484.89 " 2,048.80 " 443.67 136.82 " 1,715.87 " 426.70 " 1,047.45 " " 1,920.75 " 973.44 " 1,145.54 " 501.86 31200580 VISUAL EVOKED POTENTIAL TEST 95930 922 "$1,388.00" 513.00 74.26 " 1,110.40 " 85.40 959.11 276.03 959.11 86.88 766.87 270.78 916.08 83.17 77.33 918.72 236.60 262.89 354.23 442.79 269.46 270.78 262.89 " 1,110.40 " 240.54 74.26 929.96 231.34 567.69 " 1,041.00 " 527.58 620.85 272.09 31200598 BLINK REFLEX TEST 95933 922 $292.00 107.92 21.50 294.43 24.73 201.77 58.05 201.77 25.16 161.33 56.95 192.72 24.08 22.39 193.27 49.76 55.29 235.54 294.43 56.67 56.95 55.29 233.60 50.59 21.50 195.64 48.66 119.43 219.00 110.99 130.61 57.23 31200610 NEUROMUSCULAR JUNCTION TEST 95937 922 $733.00 270.92 19.73 586.40 22.69 506.50 145.62 506.50 23.08 404.98 142.85 483.78 22.10 20.54 485.17 124.82 138.69 173.77 217.21 142.16 142.85 138.69 586.40 126.90 19.73 491.11 122.05 299.80 549.75 278.61 327.87 143.54 31200652 SOMATOSENSORY TESTING 95938 922 "$2,561.00" 946.55 218.48 " 2,048.80 " 251.25 " 1,769.65 " 509.13 " 1,769.65 " 255.62 " 1,414.95 " 499.44 " 1,690.26 " 244.70 227.50 " 1,695.13 " 436.40 484.89 " 1,258.86 " " 1,573.58 " 497.01 499.44 484.89 " 2,048.80 " 443.67 218.48 " 1,715.87 " 426.70 " 1,047.45 " " 1,920.75 " 973.44 " 1,145.54 " 501.86 31200661 C MOTOR EVOKED UPR&LWR LIMBS 95939 922 "$4,829.00" " 1,784.80 " 344.30 " 3,863.20 " 395.95 " 3,336.84 " 959.60 " 3,336.84 " 402.83 " 2,668.02 " 941.32 " 3,187.14 " 385.62 358.52 " 3,196.32 " 822.51 913.90 " 1,737.93 " " 2,172.41 " 936.75 941.32 913.90 " 3,863.20 " 836.22 344.30 " 3,235.43 " 804.23 " 1,975.06 " " 3,621.75 " " 1,835.50 " " 2,160.01 " 945.89 31200741 IONM IN OPERATNG ROOM 15 MIN 95940 920 $247.00 91.29 - 197.60 - 170.68 - 170.68 - 136.47 - 163.02 - - 163.49 - - 149.78 187.22 - - - 197.60 - - 165.49 - 101.02 185.25 93.88 110.48 - 31200750 IONM REMOTE/>1 PT OR PER HR 95941 920 $776.00 286.81 - 748.98 - 536.22 - 536.22 - 428.74 - 512.16 - - 513.63 - - 599.18 748.98 - - - 620.80 - - 519.92 - 317.38 582.00 294.96 347.10 - 31200369 EEG PHARMACOLOGICAL ACTVTN 95954 740 "$2,561.00" 946.55 50.00 " 2,048.80 " 57.50 " 1,769.65 " 509.13 " 1,769.65 " 58.50 " 1,414.95 " 499.44 " 1,690.26 " 56.00 52.07 " 1,695.13 " 436.40 484.89 610.50 763.13 497.01 499.44 484.89 " 2,048.80 " 443.67 50.00 " 1,715.87 " 426.70 " 1,047.45 " " 1,920.75 " 973.44 " 1,145.54 " 501.86 31200105 EEG NONINTRACRANIAL SURGERY 95955 740 $218.00 80.57 - 640.67 137.25 150.64 - 150.64 139.64 120.45 - 143.88 133.67 124.28 144.29 - - 512.54 640.67 - - - 174.40 - 119.35 146.06 - 89.16 163.50 82.86 97.51 - 31200377 EEG DIGITAL ANALYSIS 95957 740 $387.00 143.04 - 663.29 158.76 267.42 - 267.42 161.52 213.82 - 255.42 154.62 143.75 256.16 - - 530.63 663.29 - - - 309.60 - 138.05 259.29 - 158.28 290.25 147.10 173.11 - 31200385 WADA ACTIVATION TEST W/EEG 95958 740 "$4,829.00" " 1,784.80 " 108.99 " 3,863.20 " 125.34 " 3,336.84 " 959.60 " 3,336.84 " 127.52 " 2,668.02 " 941.32 " 3,187.14 " 122.07 113.49 " 3,196.32 " 822.51 913.90 " 1,059.59 " " 1,324.49 " 936.75 941.32 913.90 " 3,863.20 " 836.22 108.99 " 3,235.43 " 804.23 " 1,975.06 " " 3,621.75 " " 1,835.50 " " 2,160.01 " 945.89 31200393 FUNCT CORTICAL MAP INIT HR 95961 740 "$4,829.00" " 1,784.80 " 178.20 " 3,863.20 " 204.93 " 3,336.84 " 959.60 " 3,336.84 " 208.49 " 2,668.02 " 941.32 " 3,187.14 " 199.58 185.56 " 3,196.32 " 822.51 913.90 700.82 876.02 936.75 941.32 913.90 " 3,863.20 " 836.22 178.20 " 3,235.43 " 804.23 " 1,975.06 " " 3,621.75 " " 1,835.50 " " 2,160.01 " 945.89 31200407 FUNCT CORTICAL MAP EA AD HR 95962 740 $697.00 257.61 - 911.49 213.79 481.63 - 481.63 217.50 385.09 - 460.02 208.21 193.58 461.34 - - 729.19 911.49 - - - 557.60 - 185.90 466.99 - 285.07 522.75 264.93 311.77 - 31200857 ANL SIMPLE CRANIAL NEUROSTM 95976 920 $195.00 72.07 32.30 409.11 37.15 134.75 38.84 134.75 37.79 107.74 38.10 128.70 36.18 33.63 129.07 33.29 36.99 327.29 409.11 37.91 38.10 36.99 156.00 33.85 32.30 130.65 32.55 79.76 146.25 74.12 87.22 38.28 31200865 ANL COMPLEX CRANIAL NEUROSTM 95977 920 $527.00 194.78 43.06 543.03 49.52 364.16 104.71 364.16 50.38 291.17 102.71 347.82 48.23 44.84 348.82 89.75 99.72 434.42 543.03 102.21 102.71 99.72 421.60 91.24 43.06 353.09 87.75 215.54 395.25 200.31 235.73 103.21 29107025 CANALITH REPOSITIONING PER DAY 95992 430 $192.00 70.96 - 238.63 - 132.67 38.09 132.67 - 106.08 37.37 126.72 - - 127.08 32.65 36.28 190.90 238.63 37.19 37.37 36.28 153.60 33.20 - 128.64 31.93 78.53 144.00 72.98 85.88 37.55 29207020 CANALITH REPOSITIONING PER DAY 95992 420 $192.00 70.96 - 238.63 - 132.67 38.09 132.67 - 106.08 37.37 126.72 - - 127.08 32.65 36.28 190.90 238.63 37.19 37.37 36.28 153.60 33.20 - 128.64 31.93 78.53 144.00 72.98 85.88 37.55 29220603 CANALITH REPOSITIONING PER DAY 95992 420 $192.00 70.96 - 238.63 - 132.67 38.09 132.67 - 106.08 37.37 126.72 - - 127.08 32.65 36.28 190.90 238.63 37.19 37.37 36.28 153.60 33.20 - 128.64 31.93 78.53 144.00 72.98 85.88 37.55 29507023 CANALITH REPOSITIONING PER DAY 95992 420 $192.00 70.96 - 238.63 - 132.67 38.09 132.67 - 106.08 37.37 126.72 - - 127.08 32.65 36.28 190.90 238.63 37.19 37.37 36.28 153.60 33.20 - 128.64 31.93 78.53 144.00 72.98 85.88 37.55 29585199 CANALITH REPOSITIONING PER DAY 95992 420 $192.00 70.96 - 238.63 - 132.67 38.09 132.67 - 106.08 37.37 126.72 - - 127.08 32.65 36.28 190.90 238.63 37.19 37.37 36.28 153.60 33.20 - 128.64 31.93 78.53 144.00 72.98 85.88 37.55 31900166 CANALITH REPOSITIONING PER DAY 95992 420 $192.00 70.96 - 238.63 - 132.67 38.09 132.67 - 106.08 37.37 126.72 - - 127.08 32.65 36.28 190.90 238.63 37.19 37.37 36.28 153.60 33.20 - 128.64 31.93 78.53 144.00 72.98 85.88 37.55 31907021 CANALITH REPOSITIONING PER DAY 95992 420 $192.00 70.96 - 238.63 - 132.67 38.09 132.67 - 106.08 37.37 126.72 - - 127.08 32.65 36.28 190.90 238.63 37.19 37.37 36.28 153.60 33.20 - 128.64 31.93 78.53 144.00 72.98 85.88 37.55 64200291 CANALITH REPOSITIONING PER DAY 95992 420 $192.00 70.96 - 238.63 - 132.67 38.09 132.67 - 106.08 37.37 126.72 - - 127.08 32.65 36.28 190.90 238.63 37.19 37.37 36.28 153.60 33.20 - 128.64 31.93 78.53 144.00 72.98 85.88 37.55 64207024 CANALITH REPOSITIONING PER DAY 95992 420 $192.00 70.96 - 238.63 - 132.67 38.09 132.67 - 106.08 37.37 126.72 - - 127.08 32.65 36.28 190.90 238.63 37.19 37.37 36.28 153.60 33.20 - 128.64 31.93 78.53 144.00 72.98 85.88 37.55 28901291 DEVELOPMENTAL SCREEN W/SCORE 96110 440 $193.00 71.33 - 154.40 8.04 133.36 N/A 133.36 8.18 106.63 N/A 127.38 7.83 N/A 127.75 - N/A 39.38 49.22 N/A N/A N/A 154.40 N/A 6.99 129.31 N/A 78.94 144.75 73.36 86.33 N/A 29121087 NEUROBEHAVIORAL STAT EX 1ST HR 96116 918 "$1,388.00" 513.00 - " 1,110.40 " - 959.11 276.03 959.11 - 766.87 270.78 916.08 - - 918.72 236.60 262.89 831.86 " 1,039.82 " 269.46 270.78 262.89 " 1,110.40 " 240.54 - 929.96 231.34 567.69 " 1,041.00 " 527.58 620.85 272.09 28900783 COG TEST BY HC PRO PER HOUR 96125 440 $546.00 201.80 - 889.77 - 377.29 108.01 377.29 - 301.67 105.96 360.36 - - 361.40 92.58 102.87 711.82 889.77 105.44 105.96 102.87 436.80 94.13 - 365.82 90.53 223.31 409.50 207.53 244.23 106.47 32900348 HLTH BHV ASSMT/REASSESSMENT 96156 900 $393.00 145.25 61.14 985.19 70.31 271.56 78.05 271.56 71.53 217.13 76.56 259.38 68.48 63.67 260.13 66.90 74.33 788.15 985.19 76.19 76.56 74.33 314.40 68.01 61.14 263.31 65.41 160.74 294.75 149.38 175.79 76.93 43100173 HLTH BHV ASSMT/REASSESSMENT 96156 900 $393.00 145.25 61.14 985.19 70.31 271.56 78.05 271.56 71.53 217.13 76.56 259.38 68.48 63.67 260.13 66.90 74.33 788.15 985.19 76.19 76.56 74.33 314.40 68.01 61.14 263.31 65.41 160.74 294.75 149.38 175.79 76.93 43900404 HLTH BHV ASSMT/REASSESSMENT 96156 900 $393.00 145.25 61.14 985.19 70.31 271.56 78.05 271.56 71.53 217.13 76.56 259.38 68.48 63.67 260.13 66.90 74.33 788.15 985.19 76.19 76.56 74.33 314.40 68.01 61.14 263.31 65.41 160.74 294.75 149.38 175.79 76.93 45521052 HLTH BHV ASSMT/REASSESSMENT 96156 900 $393.00 145.25 61.14 985.19 70.31 271.56 78.05 271.56 71.53 217.13 76.56 259.38 68.48 63.67 260.13 66.90 74.33 788.15 985.19 76.19 76.56 74.33 314.40 68.01 61.14 263.31 65.41 160.74 294.75 149.38 175.79 76.93 32900461 HLTH BHV INTVNTN INDIV 1ST 30 96158 914 $393.00 145.25 39.20 672.49 45.08 271.56 78.05 271.56 45.86 217.13 76.56 259.38 43.90 40.82 260.13 66.90 74.33 537.99 672.49 76.19 76.56 74.33 314.40 68.01 39.20 263.31 65.41 160.74 294.75 149.38 175.79 76.93 43100181 HLTH BHV INTVNTN INDIV 1ST 30 96158 914 $393.00 145.25 39.20 672.49 45.08 271.56 78.05 271.56 45.86 217.13 76.56 259.38 43.90 40.82 260.13 66.90 74.33 537.99 672.49 76.19 76.56 74.33 314.40 68.01 39.20 263.31 65.41 160.74 294.75 149.38 175.79 76.93 43900412 HLTH BHV INTVNTN INDIV 1ST 30 96158 914 $393.00 145.25 39.20 672.49 45.08 271.56 78.05 271.56 45.86 217.13 76.56 259.38 43.90 40.82 260.13 66.90 74.33 537.99 672.49 76.19 76.56 74.33 314.40 68.01 39.20 263.31 65.41 160.74 294.75 149.38 175.79 76.93 45521061 HLTH BHV INTVNTN INDIV 1ST 30 96158 914 $393.00 145.25 39.20 672.49 45.08 271.56 78.05 271.56 45.86 217.13 76.56 259.38 43.90 40.82 260.13 66.90 74.33 537.99 672.49 76.19 76.56 74.33 314.40 68.01 39.20 263.31 65.41 160.74 294.75 149.38 175.79 76.93 32900364 HLTH BHV INTVNTN INDIV EA ADDL 96159 914 $301.00 111.25 - 240.80 22.54 207.99 - 207.99 22.93 166.30 - 198.66 21.95 20.41 199.23 - - 187.76 234.70 - - - 240.80 - 19.60 201.67 - 123.11 225.75 114.41 134.64 - 43100190 HLTH BHV INTVNTN INDIV EA ADDL 96159 914 $301.00 111.25 - 240.80 22.54 207.99 - 207.99 22.93 166.30 - 198.66 21.95 20.41 199.23 - - 187.76 234.70 - - - 240.80 - 19.60 201.67 - 123.11 225.75 114.41 134.64 - 43900421 HLTH BHV INTVNTN INDIV EA ADDL 96159 914 $301.00 111.25 - 240.80 22.54 207.99 - 207.99 22.93 166.30 - 198.66 21.95 20.41 199.23 - - 187.76 234.70 - - - 240.80 - 19.60 201.67 - 123.11 225.75 114.41 134.64 - 45521079 HLTH BHV INTVNTN INDIV EA ADDL 96159 914 $301.00 111.25 - 240.80 22.54 207.99 - 207.99 22.93 166.30 - 198.66 21.95 20.41 199.23 - - 187.76 234.70 - - - 240.80 - 19.60 201.67 - 123.11 225.75 114.41 134.64 - 32900372 HLTH BHV INTVNTN GRP 1ST 30 96164 915 $138.00 51.00 8.94 110.40 10.28 95.36 27.42 95.36 10.46 76.25 26.89 91.08 10.01 9.31 91.34 23.50 26.11 79.60 99.50 26.76 26.89 26.11 110.40 23.89 8.94 92.46 22.98 56.44 103.50 52.45 61.73 27.02 43100203 HLTH BHV INTVNTN GRP 1ST 30 96164 915 $138.00 51.00 8.94 110.40 10.28 95.36 27.42 95.36 10.46 76.25 26.89 91.08 10.01 9.31 91.34 23.50 26.11 79.60 99.50 26.76 26.89 26.11 110.40 23.89 8.94 92.46 22.98 56.44 103.50 52.45 61.73 27.02 43900439 HLTH BHV INTVNTN GRP 1ST 30 96164 915 $138.00 51.00 8.94 110.40 10.28 95.36 27.42 95.36 10.46 76.25 26.89 91.08 10.01 9.31 91.34 23.50 26.11 79.60 99.50 26.76 26.89 26.11 110.40 23.89 8.94 92.46 22.98 56.44 103.50 52.45 61.73 27.02 45521087 HLTH BHV INTVNTN GRP 1ST 30 96164 915 $138.00 51.00 8.94 110.40 10.28 95.36 27.42 95.36 10.46 76.25 26.89 91.08 10.01 9.31 91.34 23.50 26.11 79.60 99.50 26.76 26.89 26.11 110.40 23.89 8.94 92.46 22.98 56.44 103.50 52.45 61.73 27.02 32900381 HLTH BHV INTVNTN GRP EA ADDL 96165 915 $173.00 63.94 - 138.40 4.54 119.54 - 119.54 4.62 95.58 - 114.18 4.42 4.11 114.51 - - 36.96 46.20 - - - 138.40 - 3.95 115.91 - 70.76 129.75 65.76 77.38 - 43100211 HLTH BHV INTVNTN GRP EA ADDL 96165 915 $173.00 63.94 - 138.40 4.54 119.54 - 119.54 4.62 95.58 - 114.18 4.42 4.11 114.51 - - 36.96 46.20 - - - 138.40 - 3.95 115.91 - 70.76 129.75 65.76 77.38 - 43900447 HLTH BHV INTVNTN GRP EA ADDL 96165 915 $173.00 63.94 - 138.40 4.54 119.54 - 119.54 4.62 95.58 - 114.18 4.42 4.11 114.51 - - 36.96 46.20 - - - 138.40 - 3.95 115.91 - 70.76 129.75 65.76 77.38 - 45521095 HLTH BHV INTVNTN GRP EA ADDL 96165 915 $173.00 63.94 - 138.40 4.54 119.54 - 119.54 4.62 95.58 - 114.18 4.42 4.11 114.51 - - 36.96 46.20 - - - 138.40 - 3.95 115.91 - 70.76 129.75 65.76 77.38 - 32900399 HLTH BHV INTVNTN FAM 1ST 30 96167 916 $138.00 51.00 22.98 722.19 42.76 95.36 27.42 95.36 43.50 76.25 26.89 91.08 41.64 38.72 91.34 23.50 26.11 577.75 722.19 26.76 26.89 26.11 110.40 23.89 37.18 92.46 22.98 56.44 103.50 52.45 61.73 27.02 43100220 HLTH BHV INTVNTN FAM 1ST 30 96167 916 $138.00 51.00 22.98 722.19 42.76 95.36 27.42 95.36 43.50 76.25 26.89 91.08 41.64 38.72 91.34 23.50 26.11 577.75 722.19 26.76 26.89 26.11 110.40 23.89 37.18 92.46 22.98 56.44 103.50 52.45 61.73 27.02 43900455 HLTH BHV INTVNTN FAM 1ST 30 96167 916 $138.00 51.00 22.98 722.19 42.76 95.36 27.42 95.36 43.50 76.25 26.89 91.08 41.64 38.72 91.34 23.50 26.11 577.75 722.19 26.76 26.89 26.11 110.40 23.89 37.18 92.46 22.98 56.44 103.50 52.45 61.73 27.02 45521109 HLTH BHV INTVNTN FAM 1ST 30 96167 916 $138.00 51.00 22.98 722.19 42.76 95.36 27.42 95.36 43.50 76.25 26.89 91.08 41.64 38.72 91.34 23.50 26.11 577.75 722.19 26.76 26.89 26.11 110.40 23.89 37.18 92.46 22.98 56.44 103.50 52.45 61.73 27.02 32900470 HLTH BHV INTVNTN FAM EA ADDL 96168 916 $236.00 87.23 - 256.10 21.38 163.08 - 163.08 21.75 130.39 - 155.76 20.82 19.36 156.21 - - 204.88 256.10 - - - 188.80 - 18.59 158.12 - 96.52 177.00 89.70 105.56 - 43100238 HLTH BHV INTVNTN FAM EA ADDL 96168 916 $236.00 87.23 - 256.10 21.38 163.08 - 163.08 21.75 130.39 - 155.76 20.82 19.36 156.21 - - 204.88 256.10 - - - 188.80 - 18.59 158.12 - 96.52 177.00 89.70 105.56 - 43900463 HLTH BHV INTVNTN FAM EA ADDL 96168 916 $236.00 87.23 - 256.10 21.38 163.08 - 163.08 21.75 130.39 - 155.76 20.82 19.36 156.21 - - 204.88 256.10 - - - 188.80 - 18.59 158.12 - 96.52 177.00 89.70 105.56 - 45521117 HLTH BHV INTVNTN FAM EA ADDL 96168 916 $236.00 87.23 - 256.10 21.38 163.08 - 163.08 21.75 130.39 - 155.76 20.82 19.36 156.21 - - 204.88 256.10 - - - 188.80 - 18.59 158.12 - 96.52 177.00 89.70 105.56 - 32900411 HLTH BHV INTVNTN FAM WO PT 1ST 96170 916 $326.00 120.49 - 812.79 - 225.27 N/A 225.27 - 180.12 N/A 215.16 - N/A 215.78 - N/A 650.23 812.79 N/A N/A N/A 260.80 N/A - 218.42 N/A 133.33 244.50 123.91 145.82 N/A 43100246 HLTH BHV INTVNTN FAM WO PT 1ST 96170 916 $326.00 120.49 - 812.79 - 225.27 N/A 225.27 - 180.12 N/A 215.16 - N/A 215.78 - N/A 650.23 812.79 N/A N/A N/A 260.80 N/A - 218.42 N/A 133.33 244.50 123.91 145.82 N/A 43900471 HLTH BHV INTVNTN FAM WO PT 1ST 96170 916 $326.00 120.49 - 812.79 - 225.27 N/A 225.27 - 180.12 N/A 215.16 - N/A 215.78 - N/A 650.23 812.79 N/A N/A N/A 260.80 N/A - 218.42 N/A 133.33 244.50 123.91 145.82 N/A 45521125 HLTH BHV INTVNTN FAM WO PT 1ST 96170 916 $326.00 120.49 - 812.79 - 225.27 N/A 225.27 - 180.12 N/A 215.16 - N/A 215.78 - N/A 650.23 812.79 N/A N/A N/A 260.80 N/A - 218.42 N/A 133.33 244.50 123.91 145.82 N/A 32900429 HLTH BHV INTVNTN FAM W/O PT EA 96171 916 $326.00 120.49 - 296.70 - 225.27 N/A 225.27 - 180.12 N/A 215.16 - N/A 215.78 - N/A 237.36 296.70 N/A N/A N/A 260.80 N/A - 218.42 N/A 133.33 244.50 123.91 145.82 N/A 43100254 HLTH BHV INTVNTN FAM W/O PT EA 96171 916 $326.00 120.49 - 296.70 - 225.27 N/A 225.27 - 180.12 N/A 215.16 - N/A 215.78 - N/A 237.36 296.70 N/A N/A N/A 260.80 N/A - 218.42 N/A 133.33 244.50 123.91 145.82 N/A 43900480 HLTH BHV INTVNTN FAM W/O PT EA 96171 916 $326.00 120.49 - 296.70 - 225.27 N/A 225.27 - 180.12 N/A 215.16 - N/A 215.78 - N/A 237.36 296.70 N/A N/A N/A 260.80 N/A - 218.42 N/A 133.33 244.50 123.91 145.82 N/A 45521133 HLTH BHV INTVNTN FAM W/O PT EA 96171 916 $326.00 120.49 - 296.70 - 225.27 N/A 225.27 - 180.12 N/A 215.16 - N/A 215.78 - N/A 237.36 296.70 N/A N/A N/A 260.80 N/A - 218.42 N/A 133.33 244.50 123.91 145.82 N/A 10588219 IV HYDRAT INIT 31-60 MIN W/HL 96360 260 "$1,068.00" 394.73 31.63 854.40 36.37 737.99 213.37 737.99 37.01 590.07 209.31 704.88 35.43 32.94 706.91 182.89 203.21 180.05 225.06 208.29 209.31 203.21 854.40 185.94 31.63 715.56 178.82 436.81 801.00 405.95 477.72 210.32 10688205 IV HYDRAT INIT 31-60 MIN W/HL 96360 260 "$1,068.00" 394.73 31.63 854.40 36.37 737.99 213.37 737.99 37.01 590.07 209.31 704.88 35.43 32.94 706.91 182.89 203.21 180.05 225.06 208.29 209.31 203.21 854.40 185.94 31.63 715.56 178.82 436.81 801.00 405.95 477.72 210.32 11288219 IV HYDRAT INIT 31-60 MIN W/HL 96360 260 "$1,068.00" 394.73 31.63 854.40 36.37 737.99 213.37 737.99 37.01 590.07 209.31 704.88 35.43 32.94 706.91 182.89 203.21 180.05 225.06 208.29 209.31 203.21 854.40 185.94 31.63 715.56 178.82 436.81 801.00 405.95 477.72 210.32 15288221 IV HYDRAT INIT 31-60 MIN W/HL 96360 260 "$1,068.00" 394.73 31.63 854.40 36.37 737.99 213.37 737.99 37.01 590.07 209.31 704.88 35.43 32.94 706.91 182.89 203.21 180.05 225.06 208.29 209.31 203.21 854.40 185.94 31.63 715.56 178.82 436.81 801.00 405.95 477.72 210.32 17100076 IV HYDRAT INIT 31-60 MIN W/HL 96360 260 "$1,068.00" 394.73 31.63 854.40 36.37 737.99 213.37 737.99 37.01 590.07 209.31 704.88 35.43 32.94 706.91 182.89 203.21 180.05 225.06 208.29 209.31 203.21 854.40 185.94 31.63 715.56 178.82 436.81 801.00 405.95 477.72 210.32 17288113 IV HYDRAT INIT 31-60 MIN W/HL 96360 260 "$1,068.00" 394.73 31.63 854.40 36.37 737.99 213.37 737.99 37.01 590.07 209.31 704.88 35.43 32.94 706.91 182.89 203.21 180.05 225.06 208.29 209.31 203.21 854.40 185.94 31.63 715.56 178.82 436.81 801.00 405.95 477.72 210.32 17380125 IV HYDRAT INIT 31-60 MIN W/HL 96360 260 "$1,068.00" 394.73 31.63 854.40 36.37 737.99 213.37 737.99 37.01 590.07 209.31 704.88 35.43 32.94 706.91 182.89 203.21 180.05 225.06 208.29 209.31 203.21 854.40 185.94 31.63 715.56 178.82 436.81 801.00 405.95 477.72 210.32 18200104 IV HYDRAT INIT 31-60 MIN W/HL 96360 260 "$1,068.00" 394.73 31.63 854.40 36.37 737.99 213.37 737.99 37.01 590.07 209.31 704.88 35.43 32.94 706.91 182.89 203.21 180.05 225.06 208.29 209.31 203.21 854.40 185.94 31.63 715.56 178.82 436.81 801.00 405.95 477.72 210.32 19000168 IV HYDRAT INIT 31-60 MIN W/HL 96360 260 "$1,068.00" 394.73 31.63 854.40 36.37 737.99 213.37 737.99 37.01 590.07 209.31 704.88 35.43 32.94 706.91 182.89 203.21 180.05 225.06 208.29 209.31 203.21 854.40 185.94 31.63 715.56 178.82 436.81 801.00 405.95 477.72 210.32 19388212 IV HYDRAT INIT 31-60 MIN W/HL 96360 260 "$1,068.00" 394.73 31.63 854.40 36.37 737.99 213.37 737.99 37.01 590.07 209.31 704.88 35.43 32.94 706.91 182.89 203.21 180.05 225.06 208.29 209.31 203.21 854.40 185.94 31.63 715.56 178.82 436.81 801.00 405.95 477.72 210.32 19488217 IV HYDRAT INIT 31-60 MIN W/HL 96360 260 "$1,068.00" 394.73 31.63 854.40 36.37 737.99 213.37 737.99 37.01 590.07 209.31 704.88 35.43 32.94 706.91 182.89 203.21 180.05 225.06 208.29 209.31 203.21 854.40 185.94 31.63 715.56 178.82 436.81 801.00 405.95 477.72 210.32 29817731 IV HYDRAT INIT 31-60 MIN W/HL 96360 260 "$1,068.00" 394.73 31.63 854.40 36.37 737.99 213.37 737.99 37.01 590.07 209.31 704.88 35.43 32.94 706.91 182.89 203.21 180.05 225.06 208.29 209.31 203.21 854.40 185.94 31.63 715.56 178.82 436.81 801.00 405.95 477.72 210.32 37000132 IV HYDRAT INIT 31-60 MIN W/HL 96360 260 "$1,068.00" 394.73 31.63 854.40 36.37 737.99 213.37 737.99 37.01 590.07 209.31 704.88 35.43 32.94 706.91 182.89 203.21 180.05 225.06 208.29 209.31 203.21 854.40 185.94 31.63 715.56 178.82 436.81 801.00 405.95 477.72 210.32 39100444 IV HYDRAT INIT 31-60 MIN W/HL 96360 260 "$1,068.00" 394.73 31.63 854.40 36.37 737.99 213.37 737.99 37.01 590.07 209.31 704.88 35.43 32.94 706.91 182.89 203.21 180.05 225.06 208.29 209.31 203.21 854.40 185.94 31.63 715.56 178.82 436.81 801.00 405.95 477.72 210.32 41900083 IV HYDRAT INIT 31-60 MIN W/HL 96360 260 "$1,068.00" 394.73 31.63 854.40 36.37 737.99 213.37 737.99 37.01 590.07 209.31 704.88 35.43 32.94 706.91 182.89 203.21 180.05 225.06 208.29 209.31 203.21 854.40 185.94 31.63 715.56 178.82 436.81 801.00 405.95 477.72 210.32 80010346 IV INF HYDRATION INT 31-60 MIN 96360 260 "$1,068.00" 394.73 31.63 854.40 36.37 737.99 213.37 737.99 37.01 590.07 209.31 704.88 35.43 32.94 706.91 182.89 203.21 180.05 225.06 208.29 209.31 203.21 854.40 185.94 31.63 715.56 178.82 436.81 801.00 405.95 477.72 210.32 10588227 IV HYDRATION EA ADDL HOUR 96361 260 $210.00 77.62 9.00 168.00 10.35 145.11 41.74 145.11 10.53 116.03 40.94 138.60 10.08 9.37 139.00 35.78 39.75 57.38 71.72 40.74 40.94 39.75 168.00 36.37 9.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 10688213 IV HYDRATION EA ADDL HOUR 96361 260 $210.00 77.62 9.00 168.00 10.35 145.11 41.74 145.11 10.53 116.03 40.94 138.60 10.08 9.37 139.00 35.78 39.75 57.38 71.72 40.74 40.94 39.75 168.00 36.37 9.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 11288227 IV HYDRATION EA ADDL HOUR 96361 260 $210.00 77.62 9.00 168.00 10.35 145.11 41.74 145.11 10.53 116.03 40.94 138.60 10.08 9.37 139.00 35.78 39.75 57.38 71.72 40.74 40.94 39.75 168.00 36.37 9.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 15288230 IV HYDRATION EA ADDL HOUR 96361 260 $210.00 77.62 9.00 168.00 10.35 145.11 41.74 145.11 10.53 116.03 40.94 138.60 10.08 9.37 139.00 35.78 39.75 57.38 71.72 40.74 40.94 39.75 168.00 36.37 9.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 17100084 IV HYDRATION EA ADDL HOUR 96361 260 $210.00 77.62 9.00 168.00 10.35 145.11 41.74 145.11 10.53 116.03 40.94 138.60 10.08 9.37 139.00 35.78 39.75 57.38 71.72 40.74 40.94 39.75 168.00 36.37 9.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 17288121 IV HYDRATION EA ADDL HOUR 96361 260 $210.00 77.62 9.00 168.00 10.35 145.11 41.74 145.11 10.53 116.03 40.94 138.60 10.08 9.37 139.00 35.78 39.75 57.38 71.72 40.74 40.94 39.75 168.00 36.37 9.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 17380133 IV HYDRATION EA ADDL HOUR 96361 260 $210.00 77.62 9.00 168.00 10.35 145.11 41.74 145.11 10.53 116.03 40.94 138.60 10.08 9.37 139.00 35.78 39.75 57.38 71.72 40.74 40.94 39.75 168.00 36.37 9.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 18200112 IV HYDRATION EA ADDL HOUR 96361 260 $210.00 77.62 9.00 168.00 10.35 145.11 41.74 145.11 10.53 116.03 40.94 138.60 10.08 9.37 139.00 35.78 39.75 57.38 71.72 40.74 40.94 39.75 168.00 36.37 9.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 19000176 IV HYDRATION EA ADDL HOUR 96361 260 $210.00 77.62 9.00 168.00 10.35 145.11 41.74 145.11 10.53 116.03 40.94 138.60 10.08 9.37 139.00 35.78 39.75 57.38 71.72 40.74 40.94 39.75 168.00 36.37 9.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 19388221 IV HYDRATION EA ADDL HOUR 96361 260 $210.00 77.62 9.00 168.00 10.35 145.11 41.74 145.11 10.53 116.03 40.94 138.60 10.08 9.37 139.00 35.78 39.75 57.38 71.72 40.74 40.94 39.75 168.00 36.37 9.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 19488225 IV HYDRATION EA ADDL HOUR 96361 260 $210.00 77.62 9.00 168.00 10.35 145.11 41.74 145.11 10.53 116.03 40.94 138.60 10.08 9.37 139.00 35.78 39.75 57.38 71.72 40.74 40.94 39.75 168.00 36.37 9.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 29817740 IV HYDRATION EA ADDL HOUR 96361 260 $210.00 77.62 9.00 168.00 10.35 145.11 41.74 145.11 10.53 116.03 40.94 138.60 10.08 9.37 139.00 35.78 39.75 57.38 71.72 40.74 40.94 39.75 168.00 36.37 9.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 37000141 IV HYDRATION EA ADDL HOUR 96361 260 $210.00 77.62 9.00 168.00 10.35 145.11 41.74 145.11 10.53 116.03 40.94 138.60 10.08 9.37 139.00 35.78 39.75 57.38 71.72 40.74 40.94 39.75 168.00 36.37 9.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 39100452 IV HYDRATION EA ADDL HOUR 96361 260 $210.00 77.62 9.00 168.00 10.35 145.11 41.74 145.11 10.53 116.03 40.94 138.60 10.08 9.37 139.00 35.78 39.75 57.38 71.72 40.74 40.94 39.75 168.00 36.37 9.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 41900091 IV HYDRATION EA ADDL HOUR 96361 260 $210.00 77.62 9.00 168.00 10.35 145.11 41.74 145.11 10.53 116.03 40.94 138.60 10.08 9.37 139.00 35.78 39.75 57.38 71.72 40.74 40.94 39.75 168.00 36.37 9.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 80010532 IV INF HYDRATION EA ADDL HOUR 96361 260 $210.00 77.62 9.00 168.00 10.35 145.11 41.74 145.11 10.53 116.03 40.94 138.60 10.08 9.37 139.00 35.78 39.75 57.38 71.72 40.74 40.94 39.75 168.00 36.37 9.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 10588235 IV INF TX/DX UP TO 1 HR W/HL 96365 260 "$1,068.00" 394.73 39.30 854.40 45.20 737.99 213.37 737.99 45.98 590.07 209.31 704.88 44.02 40.92 706.91 182.89 203.21 220.15 275.19 208.29 209.31 203.21 854.40 185.94 39.30 715.56 178.82 436.81 801.00 405.95 477.72 210.32 10688221 IV INF TX/DX UP TO 1 HR W/HL 96365 260 "$1,068.00" 394.73 39.30 854.40 45.20 737.99 213.37 737.99 45.98 590.07 209.31 704.88 44.02 40.92 706.91 182.89 203.21 220.15 275.19 208.29 209.31 203.21 854.40 185.94 39.30 715.56 178.82 436.81 801.00 405.95 477.72 210.32 11288235 IV INF TX/DX UP TO 1 HR W/HL 96365 260 "$1,068.00" 394.73 39.30 854.40 45.20 737.99 213.37 737.99 45.98 590.07 209.31 704.88 44.02 40.92 706.91 182.89 203.21 220.15 275.19 208.29 209.31 203.21 854.40 185.94 39.30 715.56 178.82 436.81 801.00 405.95 477.72 210.32 15288248 IV INF TX/DX UP TO 1 HR W/HL 96365 260 "$1,068.00" 394.73 39.30 854.40 45.20 737.99 213.37 737.99 45.98 590.07 209.31 704.88 44.02 40.92 706.91 182.89 203.21 220.15 275.19 208.29 209.31 203.21 854.40 185.94 39.30 715.56 178.82 436.81 801.00 405.95 477.72 210.32 17100092 IV INF TX/DX UP TO 1 HR W/HL 96365 260 "$1,068.00" 394.73 39.30 854.40 45.20 737.99 213.37 737.99 45.98 590.07 209.31 704.88 44.02 40.92 706.91 182.89 203.21 220.15 275.19 208.29 209.31 203.21 854.40 185.94 39.30 715.56 178.82 436.81 801.00 405.95 477.72 210.32 17288130 IV INF TX/DX UP TO 1 HR W/HL 96365 260 "$1,068.00" 394.73 39.30 854.40 45.20 737.99 213.37 737.99 45.98 590.07 209.31 704.88 44.02 40.92 706.91 182.89 203.21 220.15 275.19 208.29 209.31 203.21 854.40 185.94 39.30 715.56 178.82 436.81 801.00 405.95 477.72 210.32 17380141 IV INF TX/DX UP TO 1 HR W/HL 96365 260 "$1,068.00" 394.73 39.30 854.40 45.20 737.99 213.37 737.99 45.98 590.07 209.31 704.88 44.02 40.92 706.91 182.89 203.21 220.15 275.19 208.29 209.31 203.21 854.40 185.94 39.30 715.56 178.82 436.81 801.00 405.95 477.72 210.32 18200121 IV INF TX/DX UP TO 1 HR W/HL 96365 260 "$1,068.00" 394.73 39.30 854.40 45.20 737.99 213.37 737.99 45.98 590.07 209.31 704.88 44.02 40.92 706.91 182.89 203.21 220.15 275.19 208.29 209.31 203.21 854.40 185.94 39.30 715.56 178.82 436.81 801.00 405.95 477.72 210.32 19000184 IV INF TX/DX UP TO 1 HR W/HL 96365 260 "$1,068.00" 394.73 39.30 854.40 45.20 737.99 213.37 737.99 45.98 590.07 209.31 704.88 44.02 40.92 706.91 182.89 203.21 220.15 275.19 208.29 209.31 203.21 854.40 185.94 39.30 715.56 178.82 436.81 801.00 405.95 477.72 210.32 19388239 IV INF TX/DX UP TO 1 HR W/HL 96365 260 "$1,068.00" 394.73 39.30 854.40 45.20 737.99 213.37 737.99 45.98 590.07 209.31 704.88 44.02 40.92 706.91 182.89 203.21 220.15 275.19 208.29 209.31 203.21 854.40 185.94 39.30 715.56 178.82 436.81 801.00 405.95 477.72 210.32 19488233 IV INF TX/DX UP TO 1 HR W/HL 96365 260 "$1,068.00" 394.73 39.30 854.40 45.20 737.99 213.37 737.99 45.98 590.07 209.31 704.88 44.02 40.92 706.91 182.89 203.21 220.15 275.19 208.29 209.31 203.21 854.40 185.94 39.30 715.56 178.82 436.81 801.00 405.95 477.72 210.32 29817758 IV INF TX/DX UP TO 1 HR W/HL 96365 260 "$1,068.00" 394.73 39.30 854.40 45.20 737.99 213.37 737.99 45.98 590.07 209.31 704.88 44.02 40.92 706.91 182.89 203.21 220.15 275.19 208.29 209.31 203.21 854.40 185.94 39.30 715.56 178.82 436.81 801.00 405.95 477.72 210.32 30601696 IV INF TX/DX UP TO 1 HR W/HL 96365 260 "$1,068.00" 394.73 39.30 854.40 45.20 737.99 213.37 737.99 45.98 590.07 209.31 704.88 44.02 40.92 706.91 182.89 203.21 220.15 275.19 208.29 209.31 203.21 854.40 185.94 39.30 715.56 178.82 436.81 801.00 405.95 477.72 210.32 37000167 IV INF TX/DX UP TO 1 HR W/HL 96365 260 "$1,068.00" 394.73 39.30 854.40 45.20 737.99 213.37 737.99 45.98 590.07 209.31 704.88 44.02 40.92 706.91 182.89 203.21 220.15 275.19 208.29 209.31 203.21 854.40 185.94 39.30 715.56 178.82 436.81 801.00 405.95 477.72 210.32 39100461 IV INF TX/DX UP TO 1 HR W/HL 96365 260 "$1,068.00" 394.73 39.30 854.40 45.20 737.99 213.37 737.99 45.98 590.07 209.31 704.88 44.02 40.92 706.91 182.89 203.21 220.15 275.19 208.29 209.31 203.21 854.40 185.94 39.30 715.56 178.82 436.81 801.00 405.95 477.72 210.32 41900105 IV INF TX/DX UP TO 1 HR W/HL 96365 260 "$1,068.00" 394.73 39.30 854.40 45.20 737.99 213.37 737.99 45.98 590.07 209.31 704.88 44.02 40.92 706.91 182.89 203.21 220.15 275.19 208.29 209.31 203.21 854.40 185.94 39.30 715.56 178.82 436.81 801.00 405.95 477.72 210.32 80010761 IV INF TX/DX UP TO 1 HR INIT 96365 260 "$1,068.00" 394.73 39.30 854.40 45.20 737.99 213.37 737.99 45.98 590.07 209.31 704.88 44.02 40.92 706.91 182.89 203.21 220.15 275.19 208.29 209.31 203.21 854.40 185.94 39.30 715.56 178.82 436.81 801.00 405.95 477.72 210.32 10588243 IV INF TX/DX EA ADDL HR 96366 260 $210.00 77.62 12.29 168.00 14.13 145.11 41.74 145.11 14.38 116.03 40.94 138.60 13.76 12.80 139.00 35.78 39.75 74.48 93.10 40.74 40.94 39.75 168.00 36.37 12.29 140.70 34.98 85.89 157.50 79.82 93.93 41.14 10688230 IV INF TX/DX EA ADDL HR 96366 260 $210.00 77.62 12.29 168.00 14.13 145.11 41.74 145.11 14.38 116.03 40.94 138.60 13.76 12.80 139.00 35.78 39.75 74.48 93.10 40.74 40.94 39.75 168.00 36.37 12.29 140.70 34.98 85.89 157.50 79.82 93.93 41.14 11288243 IV INF TX/DX EA ADDL HR 96366 260 $210.00 77.62 12.29 168.00 14.13 145.11 41.74 145.11 14.38 116.03 40.94 138.60 13.76 12.80 139.00 35.78 39.75 74.48 93.10 40.74 40.94 39.75 168.00 36.37 12.29 140.70 34.98 85.89 157.50 79.82 93.93 41.14 15288256 IV INF TX/DX EA ADDL HR 96366 260 $210.00 77.62 12.29 168.00 14.13 145.11 41.74 145.11 14.38 116.03 40.94 138.60 13.76 12.80 139.00 35.78 39.75 74.48 93.10 40.74 40.94 39.75 168.00 36.37 12.29 140.70 34.98 85.89 157.50 79.82 93.93 41.14 17100106 IV INF TX/DX EA ADDL HR 96366 260 $210.00 77.62 12.29 168.00 14.13 145.11 41.74 145.11 14.38 116.03 40.94 138.60 13.76 12.80 139.00 35.78 39.75 74.48 93.10 40.74 40.94 39.75 168.00 36.37 12.29 140.70 34.98 85.89 157.50 79.82 93.93 41.14 17288148 IV INF TX/DX EA ADDL HR 96366 260 $210.00 77.62 12.29 168.00 14.13 145.11 41.74 145.11 14.38 116.03 40.94 138.60 13.76 12.80 139.00 35.78 39.75 74.48 93.10 40.74 40.94 39.75 168.00 36.37 12.29 140.70 34.98 85.89 157.50 79.82 93.93 41.14 17380150 IV INF TX/DX EA ADDL HR 96366 260 $210.00 77.62 12.29 168.00 14.13 145.11 41.74 145.11 14.38 116.03 40.94 138.60 13.76 12.80 139.00 35.78 39.75 74.48 93.10 40.74 40.94 39.75 168.00 36.37 12.29 140.70 34.98 85.89 157.50 79.82 93.93 41.14 18200139 IV INF TX/DX EA ADDL HR 96366 260 $210.00 77.62 12.29 168.00 14.13 145.11 41.74 145.11 14.38 116.03 40.94 138.60 13.76 12.80 139.00 35.78 39.75 74.48 93.10 40.74 40.94 39.75 168.00 36.37 12.29 140.70 34.98 85.89 157.50 79.82 93.93 41.14 19000192 IV INF TX/DX EA ADDL HR 96366 260 $210.00 77.62 12.29 168.00 14.13 145.11 41.74 145.11 14.38 116.03 40.94 138.60 13.76 12.80 139.00 35.78 39.75 74.48 93.10 40.74 40.94 39.75 168.00 36.37 12.29 140.70 34.98 85.89 157.50 79.82 93.93 41.14 19388247 IV INF TX/DX EA ADDL HR 96366 260 $210.00 77.62 12.29 168.00 14.13 145.11 41.74 145.11 14.38 116.03 40.94 138.60 13.76 12.80 139.00 35.78 39.75 74.48 93.10 40.74 40.94 39.75 168.00 36.37 12.29 140.70 34.98 85.89 157.50 79.82 93.93 41.14 19488241 IV INF TX/DX EA ADDL HR 96366 260 $210.00 77.62 12.29 168.00 14.13 145.11 41.74 145.11 14.38 116.03 40.94 138.60 13.76 12.80 139.00 35.78 39.75 74.48 93.10 40.74 40.94 39.75 168.00 36.37 12.29 140.70 34.98 85.89 157.50 79.82 93.93 41.14 29817766 IV INF TX/DX EA ADDL HR 96366 260 $210.00 77.62 12.29 168.00 14.13 145.11 41.74 145.11 14.38 116.03 40.94 138.60 13.76 12.80 139.00 35.78 39.75 74.48 93.10 40.74 40.94 39.75 168.00 36.37 12.29 140.70 34.98 85.89 157.50 79.82 93.93 41.14 30601700 IV INF TX/DX EA ADDL HR 96366 260 $210.00 77.62 12.29 168.00 14.13 145.11 41.74 145.11 14.38 116.03 40.94 138.60 13.76 12.80 139.00 35.78 39.75 74.48 93.10 40.74 40.94 39.75 168.00 36.37 12.29 140.70 34.98 85.89 157.50 79.82 93.93 41.14 37000175 IV INF TX/DX EA ADDL HR 96366 260 $210.00 77.62 12.29 168.00 14.13 145.11 41.74 145.11 14.38 116.03 40.94 138.60 13.76 12.80 139.00 35.78 39.75 74.48 93.10 40.74 40.94 39.75 168.00 36.37 12.29 140.70 34.98 85.89 157.50 79.82 93.93 41.14 39100479 IV INF TX/DX EA ADDL HR 96366 260 $210.00 77.62 12.29 168.00 14.13 145.11 41.74 145.11 14.38 116.03 40.94 138.60 13.76 12.80 139.00 35.78 39.75 74.48 93.10 40.74 40.94 39.75 168.00 36.37 12.29 140.70 34.98 85.89 157.50 79.82 93.93 41.14 41900113 IV INF TX/DX EA ADDL HR 96366 260 $210.00 77.62 12.29 168.00 14.13 145.11 41.74 145.11 14.38 116.03 40.94 138.60 13.76 12.80 139.00 35.78 39.75 74.48 93.10 40.74 40.94 39.75 168.00 36.37 12.29 140.70 34.98 85.89 157.50 79.82 93.93 41.14 80010770 IV INF TX/DX EA ADDL HOUR 96366 260 $210.00 77.62 12.29 168.00 14.13 145.11 41.74 145.11 14.38 116.03 40.94 138.60 13.76 12.80 139.00 35.78 39.75 74.48 93.10 40.74 40.94 39.75 168.00 36.37 12.29 140.70 34.98 85.89 157.50 79.82 93.93 41.14 10588251 IV INF TX/DX ADDL SEQ 1HR W/HL 96367 260 $325.00 120.12 19.24 260.00 22.13 224.58 64.67 224.58 22.51 179.56 63.44 214.50 21.55 20.03 215.12 55.43 61.59 121.74 152.17 63.13 63.44 61.59 260.00 56.35 19.24 217.75 54.20 132.93 243.75 123.53 145.37 63.75 10688248 IV INF TX/DX ADDL SEQ 1HR W/HL 96367 260 $325.00 120.12 19.24 260.00 22.13 224.58 64.67 224.58 22.51 179.56 63.44 214.50 21.55 20.03 215.12 55.43 61.59 121.74 152.17 63.13 63.44 61.59 260.00 56.35 19.24 217.75 54.20 132.93 243.75 123.53 145.37 63.75 11288251 IV INF TX/DX ADDL SEQ 1HR W/HL 96367 260 $325.00 120.12 19.24 260.00 22.13 224.58 64.67 224.58 22.51 179.56 63.44 214.50 21.55 20.03 215.12 55.43 61.59 121.74 152.17 63.13 63.44 61.59 260.00 56.35 19.24 217.75 54.20 132.93 243.75 123.53 145.37 63.75 15288264 IV INF TX/DX ADDL SEQ 1HR W/HL 96367 260 $325.00 120.12 19.24 260.00 22.13 224.58 64.67 224.58 22.51 179.56 63.44 214.50 21.55 20.03 215.12 55.43 61.59 121.74 152.17 63.13 63.44 61.59 260.00 56.35 19.24 217.75 54.20 132.93 243.75 123.53 145.37 63.75 17100114 IV INF TX/DX ADDL SEQ 1HR W/HL 96367 260 $325.00 120.12 19.24 260.00 22.13 224.58 64.67 224.58 22.51 179.56 63.44 214.50 21.55 20.03 215.12 55.43 61.59 121.74 152.17 63.13 63.44 61.59 260.00 56.35 19.24 217.75 54.20 132.93 243.75 123.53 145.37 63.75 17288156 IV INF TX/DX ADDL SEQ 1HR W/HL 96367 260 $325.00 120.12 19.24 260.00 22.13 224.58 64.67 224.58 22.51 179.56 63.44 214.50 21.55 20.03 215.12 55.43 61.59 121.74 152.17 63.13 63.44 61.59 260.00 56.35 19.24 217.75 54.20 132.93 243.75 123.53 145.37 63.75 17380168 IV INF TX/DX ADDL SEQ 1HR W/HL 96367 260 $325.00 120.12 19.24 260.00 22.13 224.58 64.67 224.58 22.51 179.56 63.44 214.50 21.55 20.03 215.12 55.43 61.59 121.74 152.17 63.13 63.44 61.59 260.00 56.35 19.24 217.75 54.20 132.93 243.75 123.53 145.37 63.75 18200147 IV INF TX/DX ADDL SEQ 1HR W/HL 96367 260 $325.00 120.12 19.24 260.00 22.13 224.58 64.67 224.58 22.51 179.56 63.44 214.50 21.55 20.03 215.12 55.43 61.59 121.74 152.17 63.13 63.44 61.59 260.00 56.35 19.24 217.75 54.20 132.93 243.75 123.53 145.37 63.75 19000206 IV INF TX/DX ADDL SEQ 1HR W/HL 96367 260 $325.00 120.12 19.24 260.00 22.13 224.58 64.67 224.58 22.51 179.56 63.44 214.50 21.55 20.03 215.12 55.43 61.59 121.74 152.17 63.13 63.44 61.59 260.00 56.35 19.24 217.75 54.20 132.93 243.75 123.53 145.37 63.75 19388255 IV INF TX/DX ADDL SEQ 1HR W/HL 96367 260 $325.00 120.12 19.24 260.00 22.13 224.58 64.67 224.58 22.51 179.56 63.44 214.50 21.55 20.03 215.12 55.43 61.59 121.74 152.17 63.13 63.44 61.59 260.00 56.35 19.24 217.75 54.20 132.93 243.75 123.53 145.37 63.75 19488250 IV INF TX/DX ADDL SEQ 1HR W/HL 96367 260 $325.00 120.12 19.24 260.00 22.13 224.58 64.67 224.58 22.51 179.56 63.44 214.50 21.55 20.03 215.12 55.43 61.59 121.74 152.17 63.13 63.44 61.59 260.00 56.35 19.24 217.75 54.20 132.93 243.75 123.53 145.37 63.75 29817774 IV INF TX/DX ADDL SEQ 1HR W/HL 96367 260 $325.00 120.12 19.24 260.00 22.13 224.58 64.67 224.58 22.51 179.56 63.44 214.50 21.55 20.03 215.12 55.43 61.59 121.74 152.17 63.13 63.44 61.59 260.00 56.35 19.24 217.75 54.20 132.93 243.75 123.53 145.37 63.75 37000183 IV INF TX/DX ADDL SEQ 1HR W/HL 96367 260 $325.00 120.12 19.24 260.00 22.13 224.58 64.67 224.58 22.51 179.56 63.44 214.50 21.55 20.03 215.12 55.43 61.59 121.74 152.17 63.13 63.44 61.59 260.00 56.35 19.24 217.75 54.20 132.93 243.75 123.53 145.37 63.75 39100487 IV INF TX/DX ADDL SEQ 1HR W/HL 96367 260 $325.00 120.12 19.24 260.00 22.13 224.58 64.67 224.58 22.51 179.56 63.44 214.50 21.55 20.03 215.12 55.43 61.59 121.74 152.17 63.13 63.44 61.59 260.00 56.35 19.24 217.75 54.20 132.93 243.75 123.53 145.37 63.75 41900121 IV INF TX/DX ADDL SEQ 1HR W/HL 96367 260 $325.00 120.12 19.24 260.00 22.13 224.58 64.67 224.58 22.51 179.56 63.44 214.50 21.55 20.03 215.12 55.43 61.59 121.74 152.17 63.13 63.44 61.59 260.00 56.35 19.24 217.75 54.20 132.93 243.75 123.53 145.37 63.75 80010788 IV INF SEQUENTIAL UP TO 1 HR 96367 260 $325.00 120.12 19.24 260.00 22.13 224.58 64.67 224.58 22.51 179.56 63.44 214.50 21.55 20.03 215.12 55.43 61.59 121.74 152.17 63.13 63.44 61.59 260.00 56.35 19.24 217.75 54.20 132.93 243.75 123.53 145.37 63.75 10588260 TX/DX CONCURRENT INF W/HL 96368 260 $138.00 51.00 - 110.40 13.14 95.36 - 95.36 13.37 76.25 - 91.08 12.80 11.90 91.34 - - 71.16 88.95 - - - 110.40 - 11.43 92.46 - 56.44 103.50 52.45 61.73 - 10688256 TX/DX CONCURRENT INF W/HL 96368 260 $138.00 51.00 - 110.40 13.14 95.36 - 95.36 13.37 76.25 - 91.08 12.80 11.90 91.34 - - 71.16 88.95 - - - 110.40 - 11.43 92.46 - 56.44 103.50 52.45 61.73 - 11288260 TX/DX CONCURRENT INF W/HL 96368 260 $138.00 51.00 - 110.40 13.14 95.36 - 95.36 13.37 76.25 - 91.08 12.80 11.90 91.34 - - 71.16 88.95 - - - 110.40 - 11.43 92.46 - 56.44 103.50 52.45 61.73 - 15288272 TX/DX CONCURRENT INF W/HL 96368 260 $138.00 51.00 - 110.40 13.14 95.36 - 95.36 13.37 76.25 - 91.08 12.80 11.90 91.34 - - 71.16 88.95 - - - 110.40 - 11.43 92.46 - 56.44 103.50 52.45 61.73 - 17100122 TX/DX CONCURRENT INF W/HL 96368 260 $138.00 51.00 - 110.40 13.14 95.36 - 95.36 13.37 76.25 - 91.08 12.80 11.90 91.34 - - 71.16 88.95 - - - 110.40 - 11.43 92.46 - 56.44 103.50 52.45 61.73 - 17288164 TX/DX CONCURRENT INF W/HL 96368 260 $138.00 51.00 - 110.40 13.14 95.36 - 95.36 13.37 76.25 - 91.08 12.80 11.90 91.34 - - 71.16 88.95 - - - 110.40 - 11.43 92.46 - 56.44 103.50 52.45 61.73 - 17380176 TX/DX CONCURRENT INF W/HL 96368 260 $138.00 51.00 - 110.40 13.14 95.36 - 95.36 13.37 76.25 - 91.08 12.80 11.90 91.34 - - 71.16 88.95 - - - 110.40 - 11.43 92.46 - 56.44 103.50 52.45 61.73 - 18200155 TX/DX CONCURRENT INF W/HL 96368 260 $138.00 51.00 - 110.40 13.14 95.36 - 95.36 13.37 76.25 - 91.08 12.80 11.90 91.34 - - 71.16 88.95 - - - 110.40 - 11.43 92.46 - 56.44 103.50 52.45 61.73 - 19000214 TX/DX CONCURRENT INF W/HL 96368 260 $138.00 51.00 - 110.40 13.14 95.36 - 95.36 13.37 76.25 - 91.08 12.80 11.90 91.34 - - 71.16 88.95 - - - 110.40 - 11.43 92.46 - 56.44 103.50 52.45 61.73 - 19388263 TX/DX CONCURRENT INF W/HL 96368 260 $138.00 51.00 - 110.40 13.14 95.36 - 95.36 13.37 76.25 - 91.08 12.80 11.90 91.34 - - 71.16 88.95 - - - 110.40 - 11.43 92.46 - 56.44 103.50 52.45 61.73 - 19488268 TX/DX CONCURRENT INF W/HL 96368 260 $138.00 51.00 - 110.40 13.14 95.36 - 95.36 13.37 76.25 - 91.08 12.80 11.90 91.34 - - 71.16 88.95 - - - 110.40 - 11.43 92.46 - 56.44 103.50 52.45 61.73 - 29817782 TX/DX CONCURRENT INF W/HL 96368 260 $138.00 51.00 - 110.40 13.14 95.36 - 95.36 13.37 76.25 - 91.08 12.80 11.90 91.34 - - 71.16 88.95 - - - 110.40 - 11.43 92.46 - 56.44 103.50 52.45 61.73 - 37000191 TX/DX CONCURRENT INF W/HL 96368 260 $138.00 51.00 - 110.40 13.14 95.36 - 95.36 13.37 76.25 - 91.08 12.80 11.90 91.34 - - 71.16 88.95 - - - 110.40 - 11.43 92.46 - 56.44 103.50 52.45 61.73 - 39100495 TX/DX CONCURRENT INF W/HL 96368 260 $138.00 51.00 - 110.40 13.14 95.36 - 95.36 13.37 76.25 - 91.08 12.80 11.90 91.34 - - 71.16 88.95 - - - 110.40 - 11.43 92.46 - 56.44 103.50 52.45 61.73 - 41900130 TX/DX CONCURRENT INF W/HL 96368 260 $138.00 51.00 - 110.40 13.14 95.36 - 95.36 13.37 76.25 - 91.08 12.80 11.90 91.34 - - 71.16 88.95 - - - 110.40 - 11.43 92.46 - 56.44 103.50 52.45 61.73 - 80010796 IV INF TX/DX CONCURRENT INF 96368 260 $138.00 51.00 - 110.40 13.14 95.36 - 95.36 13.37 76.25 - 91.08 12.80 11.90 91.34 - - 71.16 88.95 - - - 110.40 - 11.43 92.46 - 56.44 103.50 52.45 61.73 - 10588278 TX/PRO/DX SC/IM INJ 96372 260 $325.00 120.12 12.70 260.00 14.61 224.58 64.67 224.58 14.86 179.56 63.44 214.50 14.22 13.22 215.12 55.43 61.59 54.34 67.92 63.13 63.44 61.59 260.00 56.35 12.70 217.75 54.20 132.93 243.75 123.53 145.37 63.75 10688264 TX/PRO/DX SC/IM INJ 96372 260 $325.00 120.12 12.70 260.00 14.61 224.58 64.67 224.58 14.86 179.56 63.44 214.50 14.22 13.22 215.12 55.43 61.59 54.34 67.92 63.13 63.44 61.59 260.00 56.35 12.70 217.75 54.20 132.93 243.75 123.53 145.37 63.75 11288278 TX/PRO/DX SC/IM INJ 96372 260 $325.00 120.12 12.70 260.00 14.61 224.58 64.67 224.58 14.86 179.56 63.44 214.50 14.22 13.22 215.12 55.43 61.59 54.34 67.92 63.13 63.44 61.59 260.00 56.35 12.70 217.75 54.20 132.93 243.75 123.53 145.37 63.75 15288281 TX/PRO/DX SC/IM INJ 96372 260 $325.00 120.12 12.70 260.00 14.61 224.58 64.67 224.58 14.86 179.56 63.44 214.50 14.22 13.22 215.12 55.43 61.59 54.34 67.92 63.13 63.44 61.59 260.00 56.35 12.70 217.75 54.20 132.93 243.75 123.53 145.37 63.75 17100131 TX/PRO/DX SC/IM INJ 96372 260 $325.00 120.12 12.70 260.00 14.61 224.58 64.67 224.58 14.86 179.56 63.44 214.50 14.22 13.22 215.12 55.43 61.59 54.34 67.92 63.13 63.44 61.59 260.00 56.35 12.70 217.75 54.20 132.93 243.75 123.53 145.37 63.75 17288172 TX/PRO/DX SC/IM INJ 96372 260 $325.00 120.12 12.70 260.00 14.61 224.58 64.67 224.58 14.86 179.56 63.44 214.50 14.22 13.22 215.12 55.43 61.59 54.34 67.92 63.13 63.44 61.59 260.00 56.35 12.70 217.75 54.20 132.93 243.75 123.53 145.37 63.75 17380184 TX/PRO/DX SC/IM INJ 96372 260 $325.00 120.12 12.70 260.00 14.61 224.58 64.67 224.58 14.86 179.56 63.44 214.50 14.22 13.22 215.12 55.43 61.59 54.34 67.92 63.13 63.44 61.59 260.00 56.35 12.70 217.75 54.20 132.93 243.75 123.53 145.37 63.75 18200163 TX/PRO/DX SC/IM INJ 96372 260 $325.00 120.12 12.70 260.00 14.61 224.58 64.67 224.58 14.86 179.56 63.44 214.50 14.22 13.22 215.12 55.43 61.59 54.34 67.92 63.13 63.44 61.59 260.00 56.35 12.70 217.75 54.20 132.93 243.75 123.53 145.37 63.75 19000222 TX/PRO/DX SC/IM INJ 96372 260 $325.00 120.12 12.70 260.00 14.61 224.58 64.67 224.58 14.86 179.56 63.44 214.50 14.22 13.22 215.12 55.43 61.59 54.34 67.92 63.13 63.44 61.59 260.00 56.35 12.70 217.75 54.20 132.93 243.75 123.53 145.37 63.75 19388271 TX/PRO/DX SC/IM INJ 96372 260 $325.00 120.12 12.70 260.00 14.61 224.58 64.67 224.58 14.86 179.56 63.44 214.50 14.22 13.22 215.12 55.43 61.59 54.34 67.92 63.13 63.44 61.59 260.00 56.35 12.70 217.75 54.20 132.93 243.75 123.53 145.37 63.75 19488276 TX/PRO/DX SC/IM INJ 96372 260 $325.00 120.12 12.70 260.00 14.61 224.58 64.67 224.58 14.86 179.56 63.44 214.50 14.22 13.22 215.12 55.43 61.59 54.34 67.92 63.13 63.44 61.59 260.00 56.35 12.70 217.75 54.20 132.93 243.75 123.53 145.37 63.75 27600476 TX/PRO/DX SC/IM INJ 96372 260 $325.00 120.12 12.70 260.00 14.61 224.58 64.67 224.58 14.86 179.56 63.44 214.50 14.22 13.22 215.12 55.43 61.59 54.34 67.92 63.13 63.44 61.59 260.00 56.35 12.70 217.75 54.20 132.93 243.75 123.53 145.37 63.75 27700195 TX/PRO/DX SC/IM INJ 96372 260 $325.00 120.12 12.70 260.00 14.61 224.58 64.67 224.58 14.86 179.56 63.44 214.50 14.22 13.22 215.12 55.43 61.59 54.34 67.92 63.13 63.44 61.59 260.00 56.35 12.70 217.75 54.20 132.93 243.75 123.53 145.37 63.75 29817791 TX/PRO/DX SC/IM INJ 96372 260 $325.00 120.12 12.70 260.00 14.61 224.58 64.67 224.58 14.86 179.56 63.44 214.50 14.22 13.22 215.12 55.43 61.59 54.34 67.92 63.13 63.44 61.59 260.00 56.35 12.70 217.75 54.20 132.93 243.75 123.53 145.37 63.75 37002976 TX/PRO/DX SC/IM INJ 96372 260 $325.00 120.12 12.70 260.00 14.61 224.58 64.67 224.58 14.86 179.56 63.44 214.50 14.22 13.22 215.12 55.43 61.59 54.34 67.92 63.13 63.44 61.59 260.00 56.35 12.70 217.75 54.20 132.93 243.75 123.53 145.37 63.75 39100509 TX/PRO/DX SC/IM INJ 96372 260 $325.00 120.12 12.70 260.00 14.61 224.58 64.67 224.58 14.86 179.56 63.44 214.50 14.22 13.22 215.12 55.43 61.59 54.34 67.92 63.13 63.44 61.59 260.00 56.35 12.70 217.75 54.20 132.93 243.75 123.53 145.37 63.75 41900148 TX/PRO/DX SC/IM INJ 96372 260 $325.00 120.12 12.70 260.00 14.61 224.58 64.67 224.58 14.86 179.56 63.44 214.50 14.22 13.22 215.12 55.43 61.59 54.34 67.92 63.13 63.44 61.59 260.00 56.35 12.70 217.75 54.20 132.93 243.75 123.53 145.37 63.75 43100076 TX/PRO/DX SC/IM INJ 96372 260 $325.00 120.12 12.70 260.00 14.61 224.58 64.67 224.58 14.86 179.56 63.44 214.50 14.22 13.22 215.12 55.43 61.59 54.34 67.92 63.13 63.44 61.59 260.00 56.35 12.70 217.75 54.20 132.93 243.75 123.53 145.37 63.75 43900315 TX/PRO/DX SC/IM INJ 96372 260 $325.00 120.12 12.70 260.00 14.61 224.58 64.67 224.58 14.86 179.56 63.44 214.50 14.22 13.22 215.12 55.43 61.59 54.34 67.92 63.13 63.44 61.59 260.00 56.35 12.70 217.75 54.20 132.93 243.75 123.53 145.37 63.75 45500250 TX/PRO/DX SC/IM INJ 96372 260 $325.00 120.12 12.70 260.00 14.61 224.58 64.67 224.58 14.86 179.56 63.44 214.50 14.22 13.22 215.12 55.43 61.59 54.34 67.92 63.13 63.44 61.59 260.00 56.35 12.70 217.75 54.20 132.93 243.75 123.53 145.37 63.75 51600436 TX/PRO/DX SC/IM INJ 96372 260 $325.00 120.12 12.70 260.00 14.61 224.58 64.67 224.58 14.86 179.56 63.44 214.50 14.22 13.22 215.12 55.43 61.59 54.34 67.92 63.13 63.44 61.59 260.00 56.35 12.70 217.75 54.20 132.93 243.75 123.53 145.37 63.75 80003587 TX/PRO/DX SC/IM INJ 96372 260 $325.00 120.12 12.70 260.00 14.61 224.58 64.67 224.58 14.86 179.56 63.44 214.50 14.22 13.22 215.12 55.43 61.59 54.34 67.92 63.13 63.44 61.59 260.00 56.35 12.70 217.75 54.20 132.93 243.75 123.53 145.37 63.75 10588286 TX IV PUSH INITIAL W/HL 96374 260 "$1,068.00" 394.73 31.02 854.40 35.67 737.99 213.37 737.99 36.29 590.07 209.31 704.88 34.74 32.30 706.91 182.89 203.21 164.44 205.55 208.29 209.31 203.21 854.40 185.94 31.02 715.56 178.82 436.81 801.00 405.95 477.72 210.32 10688272 TX IV PUSH INITIAL W/HL 96374 260 "$1,068.00" 394.73 31.02 854.40 35.67 737.99 213.37 737.99 36.29 590.07 209.31 704.88 34.74 32.30 706.91 182.89 203.21 164.44 205.55 208.29 209.31 203.21 854.40 185.94 31.02 715.56 178.82 436.81 801.00 405.95 477.72 210.32 11288286 TX IV PUSH INITIAL W/HL 96374 260 "$1,068.00" 394.73 31.02 854.40 35.67 737.99 213.37 737.99 36.29 590.07 209.31 704.88 34.74 32.30 706.91 182.89 203.21 164.44 205.55 208.29 209.31 203.21 854.40 185.94 31.02 715.56 178.82 436.81 801.00 405.95 477.72 210.32 15288299 TX IV PUSH INITIAL W/HL 96374 260 "$1,068.00" 394.73 31.02 854.40 35.67 737.99 213.37 737.99 36.29 590.07 209.31 704.88 34.74 32.30 706.91 182.89 203.21 164.44 205.55 208.29 209.31 203.21 854.40 185.94 31.02 715.56 178.82 436.81 801.00 405.95 477.72 210.32 17100149 TX IV PUSH INITIAL W/HL 96374 260 "$1,068.00" 394.73 31.02 854.40 35.67 737.99 213.37 737.99 36.29 590.07 209.31 704.88 34.74 32.30 706.91 182.89 203.21 164.44 205.55 208.29 209.31 203.21 854.40 185.94 31.02 715.56 178.82 436.81 801.00 405.95 477.72 210.32 17288181 TX IV PUSH INITIAL W/HL 96374 260 "$1,068.00" 394.73 31.02 854.40 35.67 737.99 213.37 737.99 36.29 590.07 209.31 704.88 34.74 32.30 706.91 182.89 203.21 164.44 205.55 208.29 209.31 203.21 854.40 185.94 31.02 715.56 178.82 436.81 801.00 405.95 477.72 210.32 17380192 TX IV PUSH INITIAL W/HL 96374 260 "$1,068.00" 394.73 31.02 854.40 35.67 737.99 213.37 737.99 36.29 590.07 209.31 704.88 34.74 32.30 706.91 182.89 203.21 164.44 205.55 208.29 209.31 203.21 854.40 185.94 31.02 715.56 178.82 436.81 801.00 405.95 477.72 210.32 18200171 TX IV PUSH INITIAL W/HL 96374 260 "$1,068.00" 394.73 31.02 854.40 35.67 737.99 213.37 737.99 36.29 590.07 209.31 704.88 34.74 32.30 706.91 182.89 203.21 164.44 205.55 208.29 209.31 203.21 854.40 185.94 31.02 715.56 178.82 436.81 801.00 405.95 477.72 210.32 19000231 TX IV PUSH INITIAL W/HL 96374 260 "$1,068.00" 394.73 31.02 854.40 35.67 737.99 213.37 737.99 36.29 590.07 209.31 704.88 34.74 32.30 706.91 182.89 203.21 164.44 205.55 208.29 209.31 203.21 854.40 185.94 31.02 715.56 178.82 436.81 801.00 405.95 477.72 210.32 19388280 TX IV PUSH INITIAL W/HL 96374 260 "$1,068.00" 394.73 31.02 854.40 35.67 737.99 213.37 737.99 36.29 590.07 209.31 704.88 34.74 32.30 706.91 182.89 203.21 164.44 205.55 208.29 209.31 203.21 854.40 185.94 31.02 715.56 178.82 436.81 801.00 405.95 477.72 210.32 19488284 TX IV PUSH INITIAL W/HL 96374 260 "$1,068.00" 394.73 31.02 854.40 35.67 737.99 213.37 737.99 36.29 590.07 209.31 704.88 34.74 32.30 706.91 182.89 203.21 164.44 205.55 208.29 209.31 203.21 854.40 185.94 31.02 715.56 178.82 436.81 801.00 405.95 477.72 210.32 27700551 TX IV PUSH INITIAL W/HL 96374 260 "$1,068.00" 394.73 31.02 854.40 35.67 737.99 213.37 737.99 36.29 590.07 209.31 704.88 34.74 32.30 706.91 182.89 203.21 164.44 205.55 208.29 209.31 203.21 854.40 185.94 31.02 715.56 178.82 436.81 801.00 405.95 477.72 210.32 29817804 TX IV PUSH INITIAL W/HL 96374 260 "$1,068.00" 394.73 31.02 854.40 35.67 737.99 213.37 737.99 36.29 590.07 209.31 704.88 34.74 32.30 706.91 182.89 203.21 164.44 205.55 208.29 209.31 203.21 854.40 185.94 31.02 715.56 178.82 436.81 801.00 405.95 477.72 210.32 30601718 TX IV PUSH INITIAL W/HL 96374 260 "$1,068.00" 394.73 31.02 854.40 35.67 737.99 213.37 737.99 36.29 590.07 209.31 704.88 34.74 32.30 706.91 182.89 203.21 164.44 205.55 208.29 209.31 203.21 854.40 185.94 31.02 715.56 178.82 436.81 801.00 405.95 477.72 210.32 37000205 TX IV PUSH INITIAL W/HL 96374 260 "$1,068.00" 394.73 31.02 854.40 35.67 737.99 213.37 737.99 36.29 590.07 209.31 704.88 34.74 32.30 706.91 182.89 203.21 164.44 205.55 208.29 209.31 203.21 854.40 185.94 31.02 715.56 178.82 436.81 801.00 405.95 477.72 210.32 39100517 TX IV PUSH INITIAL W/HL 96374 260 "$1,068.00" 394.73 31.02 854.40 35.67 737.99 213.37 737.99 36.29 590.07 209.31 704.88 34.74 32.30 706.91 182.89 203.21 164.44 205.55 208.29 209.31 203.21 854.40 185.94 31.02 715.56 178.82 436.81 801.00 405.95 477.72 210.32 41900156 TX IV PUSH INITIAL W/HL 96374 260 "$1,068.00" 394.73 31.02 854.40 35.67 737.99 213.37 737.99 36.29 590.07 209.31 704.88 34.74 32.30 706.91 182.89 203.21 164.44 205.55 208.29 209.31 203.21 854.40 185.94 31.02 715.56 178.82 436.81 801.00 405.95 477.72 210.32 80010800 TX/PRO/DX INJ IV PUSH SNGL/INI 96374 260 "$1,068.00" 394.73 31.02 854.40 35.67 737.99 213.37 737.99 36.29 590.07 209.31 704.88 34.74 32.30 706.91 182.89 203.21 164.44 205.55 208.29 209.31 203.21 854.40 185.94 31.02 715.56 178.82 436.81 801.00 405.95 477.72 210.32 10588294 TX/PRO/DX INJ EA ADDL PUSH 96375 260 $210.00 77.62 13.01 168.00 14.96 145.11 41.74 145.11 15.22 116.03 40.94 138.60 14.57 13.55 139.00 35.78 39.75 76.77 95.96 40.74 40.94 39.75 168.00 36.37 13.01 140.70 34.98 85.89 157.50 79.82 93.93 41.14 10688281 TX/PRO/DX INJ EA ADDL PUSH 96375 260 $210.00 77.62 13.01 168.00 14.96 145.11 41.74 145.11 15.22 116.03 40.94 138.60 14.57 13.55 139.00 35.78 39.75 76.77 95.96 40.74 40.94 39.75 168.00 36.37 13.01 140.70 34.98 85.89 157.50 79.82 93.93 41.14 11288294 TX/PRO/DX INJ EA ADDL PUSH 96375 260 $210.00 77.62 13.01 168.00 14.96 145.11 41.74 145.11 15.22 116.03 40.94 138.60 14.57 13.55 139.00 35.78 39.75 76.77 95.96 40.74 40.94 39.75 168.00 36.37 13.01 140.70 34.98 85.89 157.50 79.82 93.93 41.14 15288302 TX/PRO/DX INJ EA ADDL PUSH 96375 260 $210.00 77.62 13.01 168.00 14.96 145.11 41.74 145.11 15.22 116.03 40.94 138.60 14.57 13.55 139.00 35.78 39.75 76.77 95.96 40.74 40.94 39.75 168.00 36.37 13.01 140.70 34.98 85.89 157.50 79.82 93.93 41.14 17100157 TX/PRO/DX INJ EA ADDL PUSH 96375 260 $210.00 77.62 13.01 168.00 14.96 145.11 41.74 145.11 15.22 116.03 40.94 138.60 14.57 13.55 139.00 35.78 39.75 76.77 95.96 40.74 40.94 39.75 168.00 36.37 13.01 140.70 34.98 85.89 157.50 79.82 93.93 41.14 17288199 TX/PRO/DX INJ EA ADDL PUSH 96375 260 $210.00 77.62 13.01 168.00 14.96 145.11 41.74 145.11 15.22 116.03 40.94 138.60 14.57 13.55 139.00 35.78 39.75 76.77 95.96 40.74 40.94 39.75 168.00 36.37 13.01 140.70 34.98 85.89 157.50 79.82 93.93 41.14 17380206 TX/PRO/DX INJ EA ADDL PUSH 96375 260 $210.00 77.62 13.01 168.00 14.96 145.11 41.74 145.11 15.22 116.03 40.94 138.60 14.57 13.55 139.00 35.78 39.75 76.77 95.96 40.74 40.94 39.75 168.00 36.37 13.01 140.70 34.98 85.89 157.50 79.82 93.93 41.14 18200180 TX/PRO/DX INJ EA ADDL PUSH 96375 260 $210.00 77.62 13.01 168.00 14.96 145.11 41.74 145.11 15.22 116.03 40.94 138.60 14.57 13.55 139.00 35.78 39.75 76.77 95.96 40.74 40.94 39.75 168.00 36.37 13.01 140.70 34.98 85.89 157.50 79.82 93.93 41.14 19000249 TX/PRO/DX INJ EA ADDL PUSH 96375 260 $210.00 77.62 13.01 168.00 14.96 145.11 41.74 145.11 15.22 116.03 40.94 138.60 14.57 13.55 139.00 35.78 39.75 76.77 95.96 40.74 40.94 39.75 168.00 36.37 13.01 140.70 34.98 85.89 157.50 79.82 93.93 41.14 19388298 TX/PRO/DX INJ EA ADDL PUSH 96375 260 $210.00 77.62 13.01 168.00 14.96 145.11 41.74 145.11 15.22 116.03 40.94 138.60 14.57 13.55 139.00 35.78 39.75 76.77 95.96 40.74 40.94 39.75 168.00 36.37 13.01 140.70 34.98 85.89 157.50 79.82 93.93 41.14 19488292 TX/PRO/DX INJ EA ADDL PUSH 96375 260 $210.00 77.62 13.01 168.00 14.96 145.11 41.74 145.11 15.22 116.03 40.94 138.60 14.57 13.55 139.00 35.78 39.75 76.77 95.96 40.74 40.94 39.75 168.00 36.37 13.01 140.70 34.98 85.89 157.50 79.82 93.93 41.14 27700560 TX/PRO/DX INJ EA ADDL PUSH 96375 260 $210.00 77.62 13.01 168.00 14.96 145.11 41.74 145.11 15.22 116.03 40.94 138.60 14.57 13.55 139.00 35.78 39.75 76.77 95.96 40.74 40.94 39.75 168.00 36.37 13.01 140.70 34.98 85.89 157.50 79.82 93.93 41.14 29817812 THER/PROP/DIAG INJ EA ADD PUSH 96375 260 $210.00 77.62 13.01 168.00 14.96 145.11 41.74 145.11 15.22 116.03 40.94 138.60 14.57 13.55 139.00 35.78 39.75 76.77 95.96 40.74 40.94 39.75 168.00 36.37 13.01 140.70 34.98 85.89 157.50 79.82 93.93 41.14 30601726 TX/PRO/DX INJ EA ADDL PUSH 96375 260 $210.00 77.62 13.01 168.00 14.96 145.11 41.74 145.11 15.22 116.03 40.94 138.60 14.57 13.55 139.00 35.78 39.75 76.77 95.96 40.74 40.94 39.75 168.00 36.37 13.01 140.70 34.98 85.89 157.50 79.82 93.93 41.14 37000213 TX/PRO/DX INJ EA ADDL PUSH 96375 260 $210.00 77.62 13.01 168.00 14.96 145.11 41.74 145.11 15.22 116.03 40.94 138.60 14.57 13.55 139.00 35.78 39.75 76.77 95.96 40.74 40.94 39.75 168.00 36.37 13.01 140.70 34.98 85.89 157.50 79.82 93.93 41.14 39100525 TX/PRO/DX INJ EA ADDL PUSH 96375 260 $210.00 77.62 13.01 168.00 14.96 145.11 41.74 145.11 15.22 116.03 40.94 138.60 14.57 13.55 139.00 35.78 39.75 76.77 95.96 40.74 40.94 39.75 168.00 36.37 13.01 140.70 34.98 85.89 157.50 79.82 93.93 41.14 41900164 TX/PRO/DX INJ EA ADDL PUSH 96375 260 $210.00 77.62 13.01 168.00 14.96 145.11 41.74 145.11 15.22 116.03 40.94 138.60 14.57 13.55 139.00 35.78 39.75 76.77 95.96 40.74 40.94 39.75 168.00 36.37 13.01 140.70 34.98 85.89 157.50 79.82 93.93 41.14 80010818 TX/PRO/DX INJ EA ADD PUSH NEW 96375 260 $210.00 77.62 13.01 168.00 14.96 145.11 41.74 145.11 15.22 116.03 40.94 138.60 14.57 13.55 139.00 35.78 39.75 76.77 95.96 40.74 40.94 39.75 168.00 36.37 13.01 140.70 34.98 85.89 157.50 79.82 93.93 41.14 10588308 TX/PRO/DX INJ SAME DRUG ADD ON 96376 260 $50.00 18.48 - 40.00 - 34.55 - 34.55 - 27.63 - 33.00 - - 33.10 - - 26.50 33.12 - - - 40.00 - - 33.50 - 20.45 37.50 19.01 22.37 - 10688299 TX/PRO/DX INJ SAME DRUG ADD ON 96376 260 $50.00 18.48 - 40.00 - 34.55 - 34.55 - 27.63 - 33.00 - - 33.10 - - 26.50 33.12 - - - 40.00 - - 33.50 - 20.45 37.50 19.01 22.37 - 11288308 TX/PRO/DX INJ SAME DRUG ADD ON 96376 260 $50.00 18.48 - 40.00 - 34.55 - 34.55 - 27.63 - 33.00 - - 33.10 - - 26.50 33.12 - - - 40.00 - - 33.50 - 20.45 37.50 19.01 22.37 - 15288311 TX/PRO/DX INJ SAME DRUG ADD ON 96376 260 $50.00 18.48 - 40.00 - 34.55 - 34.55 - 27.63 - 33.00 - - 33.10 - - 26.50 33.12 - - - 40.00 - - 33.50 - 20.45 37.50 19.01 22.37 - 17100165 TX/PRO/DX INJ SAME DRUG ADD ON 96376 260 $50.00 18.48 - 40.00 - 34.55 - 34.55 - 27.63 - 33.00 - - 33.10 - - 26.50 33.12 - - - 40.00 - - 33.50 - 20.45 37.50 19.01 22.37 - 17288202 TX/PRO/DX INJ SAME DRUG ADD ON 96376 260 $50.00 18.48 - 40.00 - 34.55 - 34.55 - 27.63 - 33.00 - - 33.10 - - 26.50 33.12 - - - 40.00 - - 33.50 - 20.45 37.50 19.01 22.37 - 17380214 TX/PRO/DX INJ SAME DRUG ADD ON 96376 260 $50.00 18.48 - 40.00 - 34.55 - 34.55 - 27.63 - 33.00 - - 33.10 - - 26.50 33.12 - - - 40.00 - - 33.50 - 20.45 37.50 19.01 22.37 - 18200198 TX/PRO/DX INJ SAME DRUG ADD ON 96376 260 $50.00 18.48 - 40.00 - 34.55 - 34.55 - 27.63 - 33.00 - - 33.10 - - 26.50 33.12 - - - 40.00 - - 33.50 - 20.45 37.50 19.01 22.37 - 19000257 TX/PRO/DX INJ SAME DRUG ADD ON 96376 260 $50.00 18.48 - 40.00 - 34.55 - 34.55 - 27.63 - 33.00 - - 33.10 - - 26.50 33.12 - - - 40.00 - - 33.50 - 20.45 37.50 19.01 22.37 - 19388301 TX/PRO/DX INJ SAME DRUG ADD ON 96376 260 $50.00 18.48 - 40.00 - 34.55 - 34.55 - 27.63 - 33.00 - - 33.10 - - 26.50 33.12 - - - 40.00 - - 33.50 - 20.45 37.50 19.01 22.37 - 19488306 TX/PRO/DX INJ SAME DRUG ADD ON 96376 260 $50.00 18.48 - 40.00 - 34.55 - 34.55 - 27.63 - 33.00 - - 33.10 - - 26.50 33.12 - - - 40.00 - - 33.50 - 20.45 37.50 19.01 22.37 - 29817821 TX/PRO/DX INJ SAME DRUG ADD ON 96376 260 $50.00 18.48 - 40.00 - 34.55 - 34.55 - 27.63 - 33.00 - - 33.10 - - 26.50 33.12 - - - 40.00 - - 33.50 - 20.45 37.50 19.01 22.37 - 37089940 TX/PRO/DX INJ SAME DRUG ADD ON 96376 260 $50.00 18.48 - 40.00 - 34.55 - 34.55 - 27.63 - 33.00 - - 33.10 - - 26.50 33.12 - - - 40.00 - - 33.50 - 20.45 37.50 19.01 22.37 - 39100533 TX/PRO/DX INJ SAME DRUG ADD ON 96376 260 $50.00 18.48 - 40.00 - 34.55 - 34.55 - 27.63 - 33.00 - - 33.10 - - 26.50 33.12 - - - 40.00 - - 33.50 - 20.45 37.50 19.01 22.37 - 41900172 TX/PRO/DX INJ SAME DRUG ADD ON 96376 260 $50.00 18.48 - 40.00 - 34.55 - 34.55 - 27.63 - 33.00 - - 33.10 - - 26.50 33.12 - - - 40.00 - - 33.50 - 20.45 37.50 19.01 22.37 - 80010826 TX/PRO/DX INJ EA ADD PUSH SAME 96376 260 $50.00 18.48 - 40.00 - 34.55 - 34.55 - 27.63 - 33.00 - - 33.10 - - 26.50 33.12 - - - 40.00 - - 33.50 - 20.45 37.50 19.01 22.37 - 41900181 CHEMO ADMIN NON-HORMONAL SQ/IM 96401 331 $325.00 120.12 50.23 260.00 57.76 224.58 64.67 224.58 58.77 179.56 63.44 214.50 56.26 52.30 215.12 55.43 61.59 151.22 189.02 63.13 63.44 61.59 260.00 56.35 50.23 217.75 54.20 132.93 243.75 123.53 145.37 63.75 80010605 CHEMO ADMIN NON HORMONAL SC/IM 96401 331 $325.00 120.12 50.23 260.00 57.76 224.58 64.67 224.58 58.77 179.56 63.44 214.50 56.26 52.30 215.12 55.43 61.59 151.22 189.02 63.13 63.44 61.59 260.00 56.35 50.23 217.75 54.20 132.93 243.75 123.53 145.37 63.75 80010320 CHEMO ADMIN HORMONAL SQ/IM 96402 331 $325.00 120.12 31.76 260.00 36.52 224.58 64.67 224.58 37.16 179.56 63.44 214.50 35.57 33.07 215.12 55.43 61.59 131.70 164.62 63.13 63.44 61.59 260.00 56.35 31.76 217.75 54.20 132.93 243.75 123.53 145.37 63.75 41900229 INIT CHEMO INFUS 1ST HR W/HL 96413 335 "$1,631.00" 602.82 124.80 " 1,304.80 " 143.52 " 1,127.02 " 332.57 " 1,127.02 " 146.02 901.13 326.23 " 1,076.46 " 139.78 129.95 " 1,079.56 " 285.06 316.73 490.79 613.49 324.65 326.23 316.73 " 1,304.80 " 289.81 124.80 " 1,092.77 " 278.72 667.08 " 1,223.25 " 619.94 729.55 327.82 41900237 CHEMO IV INFUSION EA ADDL HR 96415 335 $325.00 120.12 28.28 260.00 32.52 224.58 64.67 224.58 33.09 179.56 63.44 214.50 31.67 29.45 215.12 55.43 61.59 111.74 139.67 63.13 63.44 61.59 260.00 56.35 28.28 217.75 54.20 132.93 243.75 123.53 145.37 63.75 41900288 IRRIGATN IMPLANT VAD DRUG DEL 96523 335 $292.00 107.92 19.48 233.60 22.40 201.77 58.05 201.77 22.79 161.33 56.95 192.72 21.82 20.28 193.27 49.76 55.29 79.62 99.53 56.67 56.95 55.29 233.60 50.59 19.48 195.64 48.66 119.43 219.00 110.99 130.61 57.23 80010265 IRRIGATN IMPLANT VAD DRUG DEL 96523 335 $292.00 107.92 19.48 233.60 22.40 201.77 58.05 201.77 22.79 161.33 56.95 192.72 21.82 20.28 193.27 49.76 55.29 79.62 99.53 56.67 56.95 55.29 233.60 50.59 19.48 195.64 48.66 119.43 219.00 110.99 130.61 57.23 29107033 HOT/COLD PACK THERAPY 97010 430 $204.00 75.40 - 163.20 - 140.96 6.26 140.96 - 112.71 6.14 134.64 - - 135.03 5.36 5.96 52.57 65.71 6.11 6.14 5.96 163.20 5.45 - 136.68 5.24 83.44 153.00 77.54 91.25 6.17 29120218 HOT/COLD PACK THERAPY 97010 430 $204.00 75.40 - 163.20 - 140.96 6.26 140.96 - 112.71 6.14 134.64 - - 135.03 5.36 5.96 52.57 65.71 6.11 6.14 5.96 163.20 5.45 - 136.68 5.24 83.44 153.00 77.54 91.25 6.17 29207038 HOT/COLD PACK THERAPY 97010 420 $204.00 75.40 - 163.20 - 140.96 6.26 140.96 - 112.71 6.14 134.64 - - 135.03 5.36 5.96 52.57 65.71 6.11 6.14 5.96 163.20 5.45 - 136.68 5.24 83.44 153.00 77.54 91.25 6.17 29220395 HOT/COLD PACK THERAPY 97010 420 $204.00 75.40 - 163.20 - 140.96 6.26 140.96 - 112.71 6.14 134.64 - - 135.03 5.36 5.96 52.57 65.71 6.11 6.14 5.96 163.20 5.45 - 136.68 5.24 83.44 153.00 77.54 91.25 6.17 29507031 HOT/COLD PACK THERAPY 97010 420 $204.00 75.40 - 163.20 - 140.96 6.26 140.96 - 112.71 6.14 134.64 - - 135.03 5.36 5.96 52.57 65.71 6.11 6.14 5.96 163.20 5.45 - 136.68 5.24 83.44 153.00 77.54 91.25 6.17 29585105 HOT/COLD PACK THERAPY 97010 420 $204.00 75.40 - 163.20 - 140.96 6.26 140.96 - 112.71 6.14 134.64 - - 135.03 5.36 5.96 52.57 65.71 6.11 6.14 5.96 163.20 5.45 - 136.68 5.24 83.44 153.00 77.54 91.25 6.17 31900191 HOT/COLD PACK THERAPY 97010 420 $204.00 75.40 - 163.20 - 140.96 6.26 140.96 - 112.71 6.14 134.64 - - 135.03 5.36 5.96 52.57 65.71 6.11 6.14 5.96 163.20 5.45 - 136.68 5.24 83.44 153.00 77.54 91.25 6.17 31907039 HOT/COLD PACK THERAPY 97010 420 $204.00 75.40 - 163.20 - 140.96 6.26 140.96 - 112.71 6.14 134.64 - - 135.03 5.36 5.96 52.57 65.71 6.11 6.14 5.96 163.20 5.45 - 136.68 5.24 83.44 153.00 77.54 91.25 6.17 64200020 HOT/COLD PACK THERAPY 97010 420 $204.00 75.40 - 163.20 - 140.96 6.26 140.96 - 112.71 6.14 134.64 - - 135.03 5.36 5.96 52.57 65.71 6.11 6.14 5.96 163.20 5.45 - 136.68 5.24 83.44 153.00 77.54 91.25 6.17 64207032 HOT/COLD PACK THERAPY 97010 420 $204.00 75.40 - 163.20 - 140.96 6.26 140.96 - 112.71 6.14 134.64 - - 135.03 5.36 5.96 52.57 65.71 6.11 6.14 5.96 163.20 5.45 - 136.68 5.24 83.44 153.00 77.54 91.25 6.17 29121206 MECHANICAL TRACTION THERAPY 97012 430 $77.00 28.46 - 69.48 - 53.21 14.87 53.21 - 42.54 14.58 50.82 - - 50.97 12.74 14.16 55.58 69.48 14.51 14.58 14.16 61.60 12.96 - 51.59 12.46 31.49 57.75 29.27 34.44 14.66 29221120 MECHANICAL TRACTION THERAPY 97012 420 $77.00 28.46 - 69.48 - 53.21 14.87 53.21 - 42.54 14.58 50.82 - - 50.97 12.74 14.16 55.58 69.48 14.51 14.58 14.16 61.60 12.96 - 51.59 12.46 31.49 57.75 29.27 34.44 14.66 29585695 MECHANICAL TRACTION THERAPY 97012 420 $77.00 28.46 - 69.48 - 53.21 14.87 53.21 - 42.54 14.58 50.82 - - 50.97 12.74 14.16 55.58 69.48 14.51 14.58 14.16 61.60 12.96 - 51.59 12.46 31.49 57.75 29.27 34.44 14.66 31900204 MECHANICAL TRACTION THERAPY 97012 420 $77.00 28.46 - 69.48 - 53.21 14.87 53.21 - 42.54 14.58 50.82 - - 50.97 12.74 14.16 55.58 69.48 14.51 14.58 14.16 61.60 12.96 - 51.59 12.46 31.49 57.75 29.27 34.44 14.66 64200305 MECHANICAL TRACTION THERAPY 97012 420 $77.00 28.46 - 69.48 - 53.21 14.87 53.21 - 42.54 14.58 50.82 - - 50.97 12.74 14.16 55.58 69.48 14.51 14.58 14.16 61.60 12.96 - 51.59 12.46 31.49 57.75 29.27 34.44 14.66 29120901 VASOPNEUMATIC DEVICE THERAPY 97016 430 $62.00 22.92 - 123.99 - 42.84 12.33 42.84 - 34.26 12.09 40.92 - - 41.04 10.57 11.74 99.19 123.99 12.03 12.09 11.74 49.60 10.74 - 41.54 10.33 25.36 46.50 23.57 27.73 12.15 29221316 VASOPNEUMATIC DEVICE THERAPY 97016 420 $62.00 22.92 - 123.99 - 42.84 12.33 42.84 - 34.26 12.09 40.92 - - 41.04 10.57 11.74 99.19 123.99 12.03 12.09 11.74 49.60 10.74 - 41.54 10.33 25.36 46.50 23.57 27.73 12.15 29585849 VASOPNEUMATIC DEVICE THERAPY 97016 420 $62.00 22.92 - 123.99 - 42.84 12.33 42.84 - 34.26 12.09 40.92 - - 41.04 10.57 11.74 99.19 123.99 12.03 12.09 11.74 49.60 10.74 - 41.54 10.33 25.36 46.50 23.57 27.73 12.15 31900212 VASOPNEUMATIC DEVICE THERAPY 97016 420 $62.00 22.92 - 123.99 - 42.84 12.33 42.84 - 34.26 12.09 40.92 - - 41.04 10.57 11.74 99.19 123.99 12.03 12.09 11.74 49.60 10.74 - 41.54 10.33 25.36 46.50 23.57 27.73 12.15 64200321 VASOPNEUMATIC DEVICE THERAPY 97016 420 $62.00 22.92 - 123.99 - 42.84 12.33 42.84 - 34.26 12.09 40.92 - - 41.04 10.57 11.74 99.19 123.99 12.03 12.09 11.74 49.60 10.74 - 41.54 10.33 25.36 46.50 23.57 27.73 12.15 29120919 PARAFIN BATH THERAPY 97018 430 $30.00 11.09 - 91.88 - 20.73 5.91 20.73 - 16.58 5.80 19.80 - - 19.86 5.07 5.63 73.50 91.88 5.77 5.80 5.63 24.00 5.15 - 20.10 4.95 12.27 22.50 11.40 13.42 5.83 29221138 PARAFIN BATH THERAPY 97018 420 $30.00 11.09 - 91.88 - 20.73 5.91 20.73 - 16.58 5.80 19.80 - - 19.86 5.07 5.63 73.50 91.88 5.77 5.80 5.63 24.00 5.15 - 20.10 4.95 12.27 22.50 11.40 13.42 5.83 29585709 PARAFIN BATH THERAPY 97018 420 $30.00 11.09 - 91.88 - 20.73 5.91 20.73 - 16.58 5.80 19.80 - - 19.86 5.07 5.63 73.50 91.88 5.77 5.80 5.63 24.00 5.15 - 20.10 4.95 12.27 22.50 11.40 13.42 5.83 31900221 PARAFIN BATH THERAPY 97018 420 $30.00 11.09 - 91.88 - 20.73 5.91 20.73 - 16.58 5.80 19.80 - - 19.86 5.07 5.63 73.50 91.88 5.77 5.80 5.63 24.00 5.15 - 20.10 4.95 12.27 22.50 11.40 13.42 5.83 64200038 PARAFIN BATH THERAPY 97018 420 $30.00 11.09 - 91.88 - 20.73 5.91 20.73 - 16.58 5.80 19.80 - - 19.86 5.07 5.63 73.50 91.88 5.77 5.80 5.63 24.00 5.15 - 20.10 4.95 12.27 22.50 11.40 13.42 5.83 29120927 WHIRLPOOL THERAPY 97022 430 $91.00 33.63 - 106.62 - 62.88 17.76 62.88 - 50.28 17.42 60.06 - - 60.23 15.22 16.91 85.30 106.62 17.33 17.42 16.91 72.80 15.47 - 60.97 14.88 37.22 68.25 34.59 40.70 17.50 29221324 WHIRLPOOL THERAPY 97022 420 $91.00 33.63 - 106.62 - 62.88 17.76 62.88 - 50.28 17.42 60.06 - - 60.23 15.22 16.91 85.30 106.62 17.33 17.42 16.91 72.80 15.47 - 60.97 14.88 37.22 68.25 34.59 40.70 17.50 29585857 WHIRLPOOL THERAPY 97022 420 $91.00 33.63 - 106.62 - 62.88 17.76 62.88 - 50.28 17.42 60.06 - - 60.23 15.22 16.91 85.30 106.62 17.33 17.42 16.91 72.80 15.47 - 60.97 14.88 37.22 68.25 34.59 40.70 17.50 31900239 WHIRLPOOL THERAPY 97022 420 $91.00 33.63 - 106.62 - 62.88 17.76 62.88 - 50.28 17.42 60.06 - - 60.23 15.22 16.91 85.30 106.62 17.33 17.42 16.91 72.80 15.47 - 60.97 14.88 37.22 68.25 34.59 40.70 17.50 64200861 WHIRLPOOL THERAPY 97022 420 $91.00 33.63 - 106.62 - 62.88 17.76 62.88 - 50.28 17.42 60.06 - - 60.23 15.22 16.91 85.30 106.62 17.33 17.42 16.91 72.80 15.47 - 60.97 14.88 37.22 68.25 34.59 40.70 17.50 29221332 INFRARED THERAPY 97026 420 $33.00 12.20 - 118.54 - 22.80 6.59 22.80 - 18.23 6.47 21.78 - - 21.84 5.65 6.28 94.83 118.54 6.44 6.47 6.28 26.40 5.75 - 22.11 5.53 13.50 24.75 12.54 14.76 6.50 29585865 INFRARED THERAPY 97026 420 $33.00 12.20 - 118.54 - 22.80 6.59 22.80 - 18.23 6.47 21.78 - - 21.84 5.65 6.28 94.83 118.54 6.44 6.47 6.28 26.40 5.75 - 22.11 5.53 13.50 24.75 12.54 14.76 6.50 31900247 INFRARED THERAPY 97026 420 $33.00 12.20 - 118.54 - 22.80 6.59 22.80 - 18.23 6.47 21.78 - - 21.84 5.65 6.28 94.83 118.54 6.44 6.47 6.28 26.40 5.75 - 22.11 5.53 13.50 24.75 12.54 14.76 6.50 64201000 INFRARED THERAPY 97026 420 $33.00 12.20 - 118.54 - 22.80 6.59 22.80 - 18.23 6.47 21.78 - - 21.84 5.65 6.28 94.83 118.54 6.44 6.47 6.28 26.40 5.75 - 22.11 5.53 13.50 24.75 12.54 14.76 6.50 28900741 E STIM ATTND PER 15 MIN 97032 440 $77.00 28.46 - 82.12 - 53.21 15.20 53.21 - 42.54 14.91 50.82 - - 50.97 13.03 14.48 65.70 82.12 14.84 14.91 14.48 61.60 13.25 - 51.59 12.74 31.49 57.75 29.27 34.44 14.99 29120935 E STIM ATTND PER 15 MIN 97032 430 $77.00 28.46 - 82.12 - 53.21 15.20 53.21 - 42.54 14.91 50.82 - - 50.97 13.03 14.48 65.70 82.12 14.84 14.91 14.48 61.60 13.25 - 51.59 12.74 31.49 57.75 29.27 34.44 14.99 29221219 E STIM ATTND PER 15 MIN 97032 420 $77.00 28.46 - 82.12 - 53.21 15.20 53.21 - 42.54 14.91 50.82 - - 50.97 13.03 14.48 65.70 82.12 14.84 14.91 14.48 61.60 13.25 - 51.59 12.74 31.49 57.75 29.27 34.44 14.99 29585741 E STIM ATTND PER 15 MIN 97032 420 $77.00 28.46 - 82.12 - 53.21 15.20 53.21 - 42.54 14.91 50.82 - - 50.97 13.03 14.48 65.70 82.12 14.84 14.91 14.48 61.60 13.25 - 51.59 12.74 31.49 57.75 29.27 34.44 14.99 31900255 E STIM ATTND PER 15 MIN 97032 420 $77.00 28.46 - 82.12 - 53.21 15.20 53.21 - 42.54 14.91 50.82 - - 50.97 13.03 14.48 65.70 82.12 14.84 14.91 14.48 61.60 13.25 - 51.59 12.74 31.49 57.75 29.27 34.44 14.99 64200046 E STIM ATTND PER 15 MIN 97032 420 $77.00 28.46 - 82.12 - 53.21 15.20 53.21 - 42.54 14.91 50.82 - - 50.97 13.03 14.48 65.70 82.12 14.84 14.91 14.48 61.60 13.25 - 51.59 12.74 31.49 57.75 29.27 34.44 14.99 29121095 IONTOPHORESIS 15 MIN 97033 430 $104.00 38.44 - 83.20 - 71.86 20.35 71.86 - 57.46 19.96 68.64 - - 68.84 17.44 19.38 65.70 82.12 19.86 19.96 19.38 83.20 17.73 - 69.68 17.05 42.54 78.00 39.53 46.52 20.06 29221146 IONTOPHORESIS 15 MIN 97033 420 $104.00 38.44 - 83.20 - 71.86 20.35 71.86 - 57.46 19.96 68.64 - - 68.84 17.44 19.38 65.70 82.12 19.86 19.96 19.38 83.20 17.73 - 69.68 17.05 42.54 78.00 39.53 46.52 20.06 29585717 IONTOPHORESIS 15 MIN 97033 420 $104.00 38.44 - 83.20 - 71.86 20.35 71.86 - 57.46 19.96 68.64 - - 68.84 17.44 19.38 65.70 82.12 19.86 19.96 19.38 83.20 17.73 - 69.68 17.05 42.54 78.00 39.53 46.52 20.06 31900263 IONTOPHORESIS 15 MIN 97033 420 $104.00 38.44 - 83.20 - 71.86 20.35 71.86 - 57.46 19.96 68.64 - - 68.84 17.44 19.38 65.70 82.12 19.86 19.96 19.38 83.20 17.73 - 69.68 17.05 42.54 78.00 39.53 46.52 20.06 64200062 IONTOPHORESIS 15 MIN 97033 420 $104.00 38.44 - 83.20 - 71.86 20.35 71.86 - 57.46 19.96 68.64 - - 68.84 17.44 19.38 65.70 82.12 19.86 19.96 19.38 83.20 17.73 - 69.68 17.05 42.54 78.00 39.53 46.52 20.06 29121109 CONTRAST BATH THERAPY 15 MIN 97034 430 $76.00 28.09 - 82.12 - 52.52 15.12 52.52 - 41.99 14.83 50.16 - - 50.30 12.96 14.40 65.70 82.12 14.76 14.83 14.40 60.80 13.18 - 50.92 12.67 31.08 57.00 28.89 33.99 14.90 29221341 CONTRAST BATH THERAPY 15 MIN 97034 420 $76.00 28.09 - 82.12 - 52.52 15.12 52.52 - 41.99 14.83 50.16 - - 50.30 12.96 14.40 65.70 82.12 14.76 14.83 14.40 60.80 13.18 - 50.92 12.67 31.08 57.00 28.89 33.99 14.90 29585873 CONTRAST BATH THERAPY 15 MIN 97034 420 $76.00 28.09 - 82.12 - 52.52 15.12 52.52 - 41.99 14.83 50.16 - - 50.30 12.96 14.40 65.70 82.12 14.76 14.83 14.40 60.80 13.18 - 50.92 12.67 31.08 57.00 28.89 33.99 14.90 31900271 CONTRAST BATH THERAPY 15 MIN 97034 420 $76.00 28.09 - 82.12 - 52.52 15.12 52.52 - 41.99 14.83 50.16 - - 50.30 12.96 14.40 65.70 82.12 14.76 14.83 14.40 60.80 13.18 - 50.92 12.67 31.08 57.00 28.89 33.99 14.90 64200071 CONTRAST BATH THERAPY 15 MIN 97034 420 $76.00 28.09 - 82.12 - 52.52 15.12 52.52 - 41.99 14.83 50.16 - - 50.30 12.96 14.40 65.70 82.12 14.76 14.83 14.40 60.80 13.18 - 50.92 12.67 31.08 57.00 28.89 33.99 14.90 29120943 ULTRASOUND THERAPY 15 MIN 97035 430 $74.00 27.35 - 82.12 - 51.13 14.77 51.13 - 40.89 14.49 48.84 - - 48.98 12.66 14.07 65.70 82.12 14.42 14.49 14.07 59.20 12.87 - 49.58 12.38 30.27 55.50 28.13 33.10 14.56 29221154 ULTRASOUND THERAPY 15 MIN 97035 420 $74.00 27.35 - 82.12 - 51.13 14.77 51.13 - 40.89 14.49 48.84 - - 48.98 12.66 14.07 65.70 82.12 14.42 14.49 14.07 59.20 12.87 - 49.58 12.38 30.27 55.50 28.13 33.10 14.56 29585725 ULTRASOUND THERAPY 15 MIN 97035 420 $74.00 27.35 - 82.12 - 51.13 14.77 51.13 - 40.89 14.49 48.84 - - 48.98 12.66 14.07 65.70 82.12 14.42 14.49 14.07 59.20 12.87 - 49.58 12.38 30.27 55.50 28.13 33.10 14.56 31900280 ULTRASOUND THERAPY 15 MIN 97035 420 $74.00 27.35 - 82.12 - 51.13 14.77 51.13 - 40.89 14.49 48.84 - - 48.98 12.66 14.07 65.70 82.12 14.42 14.49 14.07 59.20 12.87 - 49.58 12.38 30.27 55.50 28.13 33.10 14.56 64200089 ULTRASOUND THERAPY 15 MIN 97035 420 $74.00 27.35 - 82.12 - 51.13 14.77 51.13 - 40.89 14.49 48.84 - - 48.98 12.66 14.07 65.70 82.12 14.42 14.49 14.07 59.20 12.87 - 49.58 12.38 30.27 55.50 28.13 33.10 14.56 29121117 UNL PHYSICAL THERAPY TREATMENT 97039 430 $55.00 20.33 - 82.12 - 38.01 N/A 38.01 - 30.39 N/A 36.30 - N/A 36.40 - N/A 65.70 82.12 N/A N/A N/A 44.00 N/A - 36.85 N/A 22.50 41.25 20.91 24.60 N/A 29107041 THERAPEUTIC PROC 15 MIN 97110 430 $155.00 57.29 - 124.00 - 107.11 30.65 107.11 - 85.64 30.07 102.30 - - 102.59 26.27 29.19 65.70 82.12 29.92 30.07 29.19 124.00 26.71 - 103.85 25.69 63.40 116.25 58.92 69.33 30.21 29120277 THERAPEUTIC PROCEDURE 15 MIN 97110 430 $155.00 57.29 - 124.00 - 107.11 30.65 107.11 - 85.64 30.07 102.30 - - 102.59 26.27 29.19 65.70 82.12 29.92 30.07 29.19 124.00 26.71 - 103.85 25.69 63.40 116.25 58.92 69.33 30.21 29207046 THERAPEUTIC PROC 15 MIN 97110 420 $155.00 57.29 - 124.00 - 107.11 30.65 107.11 - 85.64 30.07 102.30 - - 102.59 26.27 29.19 65.70 82.12 29.92 30.07 29.19 124.00 26.71 - 103.85 25.69 63.40 116.25 58.92 69.33 30.21 29220263 THERAPEUTIC PROCEDURE 15 MIN 97110 420 $155.00 57.29 - 124.00 - 107.11 30.65 107.11 - 85.64 30.07 102.30 - - 102.59 26.27 29.19 65.70 82.12 29.92 30.07 29.19 124.00 26.71 - 103.85 25.69 63.40 116.25 58.92 69.33 30.21 29507040 THERAPEUTIC PROC 15 MIN 97110 420 $155.00 57.29 - 124.00 - 107.11 30.65 107.11 - 85.64 30.07 102.30 - - 102.59 26.27 29.19 65.70 82.12 29.92 30.07 29.19 124.00 26.71 - 103.85 25.69 63.40 116.25 58.92 69.33 30.21 29585083 THERAPEUTIC PROCEDURE 15 MIN 97110 420 $155.00 57.29 - 124.00 - 107.11 30.65 107.11 - 85.64 30.07 102.30 - - 102.59 26.27 29.19 65.70 82.12 29.92 30.07 29.19 124.00 26.71 - 103.85 25.69 63.40 116.25 58.92 69.33 30.21 31900298 THERAPEUTIC PROCEDURE 15 MIN 97110 420 $155.00 57.29 - 124.00 - 107.11 30.65 107.11 - 85.64 30.07 102.30 - - 102.59 26.27 29.19 65.70 82.12 29.92 30.07 29.19 124.00 26.71 - 103.85 25.69 63.40 116.25 58.92 69.33 30.21 31907047 THERAPEUTIC PROC 15 MIN 97110 420 $155.00 57.29 - 124.00 - 107.11 30.65 107.11 - 85.64 30.07 102.30 - - 102.59 26.27 29.19 65.70 82.12 29.92 30.07 29.19 124.00 26.71 - 103.85 25.69 63.40 116.25 58.92 69.33 30.21 64200097 THERAPEUTIC PROCEDURE 15 MIN 97110 420 $155.00 57.29 - 124.00 - 107.11 30.65 107.11 - 85.64 30.07 102.30 - - 102.59 26.27 29.19 65.70 82.12 29.92 30.07 29.19 124.00 26.71 - 103.85 25.69 63.40 116.25 58.92 69.33 30.21 64207041 THERAPEUTIC PROC 15 MIN 97110 420 $155.00 57.29 - 124.00 - 107.11 30.65 107.11 - 85.64 30.07 102.30 - - 102.59 26.27 29.19 65.70 82.12 29.92 30.07 29.19 124.00 26.71 - 103.85 25.69 63.40 116.25 58.92 69.33 30.21 29101426 NEUROMUSCULAR RE-ED 15 MIN 97112 430 $179.00 66.16 - 143.20 - 123.69 35.53 123.69 - 98.90 34.86 118.14 - - 118.48 30.46 33.84 65.70 82.12 34.69 34.86 33.84 143.20 30.96 - 119.93 29.78 73.21 134.25 68.04 80.07 35.02 29107050 NEUROMUSCULAR RE-ED 15 MIN 97112 430 $179.00 66.16 - 143.20 - 123.69 35.53 123.69 - 98.90 34.86 118.14 - - 118.48 30.46 33.84 65.70 82.12 34.69 34.86 33.84 143.20 30.96 - 119.93 29.78 73.21 134.25 68.04 80.07 35.02 29207054 NEUROMUSCULAR RE-ED 15 MIN 97112 420 $179.00 66.16 - 143.20 - 123.69 35.53 123.69 - 98.90 34.86 118.14 - - 118.48 30.46 33.84 65.70 82.12 34.69 34.86 33.84 143.20 30.96 - 119.93 29.78 73.21 134.25 68.04 80.07 35.02 29210110 NEUROMUSCULAR RE-ED 15 MIN 97112 420 $179.00 66.16 - 143.20 - 123.69 35.53 123.69 - 98.90 34.86 118.14 - - 118.48 30.46 33.84 65.70 82.12 34.69 34.86 33.84 143.20 30.96 - 119.93 29.78 73.21 134.25 68.04 80.07 35.02 29507058 NEUROMUSCULAR RE-ED 15 MIN 97112 420 $179.00 66.16 - 143.20 - 123.69 35.53 123.69 - 98.90 34.86 118.14 - - 118.48 30.46 33.84 65.70 82.12 34.69 34.86 33.84 143.20 30.96 - 119.93 29.78 73.21 134.25 68.04 80.07 35.02 29585032 NEUROMUSCULAR RE-ED 15 MIN 97112 420 $179.00 66.16 - 143.20 - 123.69 35.53 123.69 - 98.90 34.86 118.14 - - 118.48 30.46 33.84 65.70 82.12 34.69 34.86 33.84 143.20 30.96 - 119.93 29.78 73.21 134.25 68.04 80.07 35.02 31900301 NEUROMUSCULAR RE-ED 15 MIN 97112 420 $179.00 66.16 - 143.20 - 123.69 35.53 123.69 - 98.90 34.86 118.14 - - 118.48 30.46 33.84 65.70 82.12 34.69 34.86 33.84 143.20 30.96 - 119.93 29.78 73.21 134.25 68.04 80.07 35.02 31907055 NEUROMUSCULAR RE-ED 15 MIN 97112 420 $179.00 66.16 - 143.20 - 123.69 35.53 123.69 - 98.90 34.86 118.14 - - 118.48 30.46 33.84 65.70 82.12 34.69 34.86 33.84 143.20 30.96 - 119.93 29.78 73.21 134.25 68.04 80.07 35.02 64200101 NEUROMUSCULAR RE-ED 15 MIN 97112 420 $179.00 66.16 - 143.20 - 123.69 35.53 123.69 - 98.90 34.86 118.14 - - 118.48 30.46 33.84 65.70 82.12 34.69 34.86 33.84 143.20 30.96 - 119.93 29.78 73.21 134.25 68.04 80.07 35.02 64207059 NEUROMUSCULAR RE-ED 15 MIN 97112 420 $179.00 66.16 - 143.20 - 123.69 35.53 123.69 - 98.90 34.86 118.14 - - 118.48 30.46 33.84 65.70 82.12 34.69 34.86 33.84 143.20 30.96 - 119.93 29.78 73.21 134.25 68.04 80.07 35.02 29107068 GAIT TRAINING 15 MIN 97116 430 $155.00 57.29 - 124.00 - 107.11 30.65 107.11 - 85.64 30.07 102.30 - - 102.59 26.27 29.19 65.70 82.12 29.92 30.07 29.19 124.00 26.71 - 103.85 25.69 63.40 116.25 58.92 69.33 30.21 29121214 GAIT TRAINING 15 MIN 97116 430 $155.00 57.29 - 124.00 - 107.11 30.65 107.11 - 85.64 30.07 102.30 - - 102.59 26.27 29.19 65.70 82.12 29.92 30.07 29.19 124.00 26.71 - 103.85 25.69 63.40 116.25 58.92 69.33 30.21 29207062 GAIT TRAINING 15 MIN 97116 420 $155.00 57.29 - 124.00 - 107.11 30.65 107.11 - 85.64 30.07 102.30 - - 102.59 26.27 29.19 65.70 82.12 29.92 30.07 29.19 124.00 26.71 - 103.85 25.69 63.40 116.25 58.92 69.33 30.21 29210101 GAIT TRAINING 15 MIN 97116 420 $155.00 57.29 - 124.00 - 107.11 30.65 107.11 - 85.64 30.07 102.30 - - 102.59 26.27 29.19 65.70 82.12 29.92 30.07 29.19 124.00 26.71 - 103.85 25.69 63.40 116.25 58.92 69.33 30.21 29507066 GAIT TRAINING 15 MIN 97116 420 $155.00 57.29 - 124.00 - 107.11 30.65 107.11 - 85.64 30.07 102.30 - - 102.59 26.27 29.19 65.70 82.12 29.92 30.07 29.19 124.00 26.71 - 103.85 25.69 63.40 116.25 58.92 69.33 30.21 29585024 GAIT TRAINING 15 MIN 97116 420 $155.00 57.29 - 124.00 - 107.11 30.65 107.11 - 85.64 30.07 102.30 - - 102.59 26.27 29.19 65.70 82.12 29.92 30.07 29.19 124.00 26.71 - 103.85 25.69 63.40 116.25 58.92 69.33 30.21 31900310 GAIT TRAINING 15 MIN 97116 420 $155.00 57.29 - 124.00 - 107.11 30.65 107.11 - 85.64 30.07 102.30 - - 102.59 26.27 29.19 65.70 82.12 29.92 30.07 29.19 124.00 26.71 - 103.85 25.69 63.40 116.25 58.92 69.33 30.21 31907063 GAIT TRAINING 15 MIN 97116 420 $155.00 57.29 - 124.00 - 107.11 30.65 107.11 - 85.64 30.07 102.30 - - 102.59 26.27 29.19 65.70 82.12 29.92 30.07 29.19 124.00 26.71 - 103.85 25.69 63.40 116.25 58.92 69.33 30.21 64200119 GAIT TRAINING 15 MIN 97116 420 $155.00 57.29 - 124.00 - 107.11 30.65 107.11 - 85.64 30.07 102.30 - - 102.59 26.27 29.19 65.70 82.12 29.92 30.07 29.19 124.00 26.71 - 103.85 25.69 63.40 116.25 58.92 69.33 30.21 64207067 GAIT TRAINING 15 MIN 97116 420 $155.00 57.29 - 124.00 - 107.11 30.65 107.11 - 85.64 30.07 102.30 - - 102.59 26.27 29.19 65.70 82.12 29.92 30.07 29.19 124.00 26.71 - 103.85 25.69 63.40 116.25 58.92 69.33 30.21 29120951 MASSAGE THERAPY 15 MIN 97124 430 $150.00 55.44 - 120.00 - 103.65 30.79 103.65 - 82.88 30.20 99.00 - - 99.29 26.39 29.32 65.70 82.12 30.05 30.20 29.32 120.00 26.83 - 100.50 25.80 61.35 112.50 57.02 67.10 30.35 29221171 MASSAGE THERAPY 15 MIN 97124 420 $150.00 55.44 - 120.00 - 103.65 30.79 103.65 - 82.88 30.20 99.00 - - 99.29 26.39 29.32 65.70 82.12 30.05 30.20 29.32 120.00 26.83 - 100.50 25.80 61.35 112.50 57.02 67.10 30.35 29585733 MASSAGE THERAPY 15 MIN 97124 420 $150.00 55.44 - 120.00 - 103.65 30.79 103.65 - 82.88 30.20 99.00 - - 99.29 26.39 29.32 65.70 82.12 30.05 30.20 29.32 120.00 26.83 - 100.50 25.80 61.35 112.50 57.02 67.10 30.35 31900328 MASSAGE THERAPY 15 MIN 97124 420 $150.00 55.44 - 120.00 - 103.65 30.79 103.65 - 82.88 30.20 99.00 - - 99.29 26.39 29.32 65.70 82.12 30.05 30.20 29.32 120.00 26.83 - 100.50 25.80 61.35 112.50 57.02 67.10 30.35 64200127 MASSAGE THERAPY 15 MIN 97124 420 $150.00 55.44 - 120.00 - 103.65 30.79 103.65 - 82.88 30.20 99.00 - - 99.29 26.39 29.32 65.70 82.12 30.05 30.20 29.32 120.00 26.83 - 100.50 25.80 61.35 112.50 57.02 67.10 30.35 29121451 THER IVNT W/FOCUS COG FUNC 97127 430 $735.00 271.66 - 588.00 - 507.89 N/A 507.89 - 406.09 N/A 485.10 - N/A 486.50 - N/A 389.48 486.86 N/A N/A N/A 588.00 N/A - 492.45 N/A 300.62 551.25 279.37 328.77 N/A 28902000 THER IVNTJ 1ST 15 MIN 97129 440 $121.00 44.72 - 144.65 - 83.61 23.93 83.61 - 66.85 23.47 79.86 - - 80.09 20.51 22.79 115.72 144.65 23.36 23.47 22.79 96.80 20.85 - 81.07 20.06 49.49 90.75 45.99 54.12 23.59 29102007 THER IVNTJ 1ST 15 MIN 97129 430 $121.00 44.72 - 144.65 - 83.61 23.93 83.61 - 66.85 23.47 79.86 - - 80.09 20.51 22.79 115.72 144.65 23.36 23.47 22.79 96.80 20.85 - 81.07 20.06 49.49 90.75 45.99 54.12 23.59 29107009 THER IVNTJ 1ST 15 MIN 97129 430 $121.00 44.72 - 144.65 - 83.61 23.93 83.61 - 66.85 23.47 79.86 - - 80.09 20.51 22.79 115.72 144.65 23.36 23.47 22.79 96.80 20.85 - 81.07 20.06 49.49 90.75 45.99 54.12 23.59 29202001 THER IVNTJ 1ST 15 MIN 97129 420 $121.00 44.72 - 144.65 - 83.61 23.93 83.61 - 66.85 23.47 79.86 - - 80.09 20.51 22.79 115.72 144.65 23.36 23.47 22.79 96.80 20.85 - 81.07 20.06 49.49 90.75 45.99 54.12 23.59 29207003 THER IVNTJ 1ST 15 MIN 97129 420 $121.00 44.72 - 144.65 - 83.61 23.93 83.61 - 66.85 23.47 79.86 - - 80.09 20.51 22.79 115.72 144.65 23.36 23.47 22.79 96.80 20.85 - 81.07 20.06 49.49 90.75 45.99 54.12 23.59 29502005 THER IVNTJ 1ST 15 MIN 97129 420 $121.00 44.72 - 144.65 - 83.61 23.93 83.61 - 66.85 23.47 79.86 - - 80.09 20.51 22.79 115.72 144.65 23.36 23.47 22.79 96.80 20.85 - 81.07 20.06 49.49 90.75 45.99 54.12 23.59 29507007 THER IVNTJ 1ST 15 MIN 97129 420 $121.00 44.72 - 144.65 - 83.61 23.93 83.61 - 66.85 23.47 79.86 - - 80.09 20.51 22.79 115.72 144.65 23.36 23.47 22.79 96.80 20.85 - 81.07 20.06 49.49 90.75 45.99 54.12 23.59 31902002 THER IVNTJ 1ST 15 MIN 97129 420 $121.00 44.72 - 144.65 - 83.61 23.93 83.61 - 66.85 23.47 79.86 - - 80.09 20.51 22.79 115.72 144.65 23.36 23.47 22.79 96.80 20.85 - 81.07 20.06 49.49 90.75 45.99 54.12 23.59 31907004 THER IVNTJ 1ST 15 MIN 97129 420 $121.00 44.72 - 144.65 - 83.61 23.93 83.61 - 66.85 23.47 79.86 - - 80.09 20.51 22.79 115.72 144.65 23.36 23.47 22.79 96.80 20.85 - 81.07 20.06 49.49 90.75 45.99 54.12 23.59 64202006 THER IVNTJ 1ST 15 MIN 97129 420 $121.00 44.72 - 144.65 - 83.61 23.93 83.61 - 66.85 23.47 79.86 - - 80.09 20.51 22.79 115.72 144.65 23.36 23.47 22.79 96.80 20.85 - 81.07 20.06 49.49 90.75 45.99 54.12 23.59 64207008 THER IVNTJ 1ST 15 MIN 97129 420 $121.00 44.72 - 144.65 - 83.61 23.93 83.61 - 66.85 23.47 79.86 - - 80.09 20.51 22.79 115.72 144.65 23.36 23.47 22.79 96.80 20.85 - 81.07 20.06 49.49 90.75 45.99 54.12 23.59 28902018 THER IVNTJ EA ADDL 15 MIN 97130 440 $115.00 42.50 - 138.30 - 79.47 22.86 79.47 - 63.54 22.42 75.90 - - 76.12 19.59 21.77 110.64 138.30 22.31 22.42 21.77 92.00 19.92 - 77.05 19.16 47.04 86.25 43.71 51.44 22.53 29102015 THER IVNTJ EA ADDL 15 MIN 97130 430 $115.00 42.50 - 138.30 - 79.47 22.86 79.47 - 63.54 22.42 75.90 - - 76.12 19.59 21.77 110.64 138.30 22.31 22.42 21.77 92.00 19.92 - 77.05 19.16 47.04 86.25 43.71 51.44 22.53 29107017 THER IVNTJ EA ADDL 15 MIN 97130 430 $115.00 42.50 - 138.30 - 79.47 22.86 79.47 - 63.54 22.42 75.90 - - 76.12 19.59 21.77 110.64 138.30 22.31 22.42 21.77 92.00 19.92 - 77.05 19.16 47.04 86.25 43.71 51.44 22.53 29202010 THER IVNTJ EA ADDL 15 MIN 97130 420 $115.00 42.50 - 138.30 - 79.47 22.86 79.47 - 63.54 22.42 75.90 - - 76.12 19.59 21.77 110.64 138.30 22.31 22.42 21.77 92.00 19.92 - 77.05 19.16 47.04 86.25 43.71 51.44 22.53 29207011 THER IVNTJ EA ADDL 15 MIN 97130 420 $115.00 42.50 - 138.30 - 79.47 22.86 79.47 - 63.54 22.42 75.90 - - 76.12 19.59 21.77 110.64 138.30 22.31 22.42 21.77 92.00 19.92 - 77.05 19.16 47.04 86.25 43.71 51.44 22.53 29502013 THER IVNTJ EA ADDL 15 MIN 97130 420 $115.00 42.50 - 138.30 - 79.47 22.86 79.47 - 63.54 22.42 75.90 - - 76.12 19.59 21.77 110.64 138.30 22.31 22.42 21.77 92.00 19.92 - 77.05 19.16 47.04 86.25 43.71 51.44 22.53 29507015 THER IVNTJ EA ADDL 15 MIN 97130 420 $115.00 42.50 - 138.30 - 79.47 22.86 79.47 - 63.54 22.42 75.90 - - 76.12 19.59 21.77 110.64 138.30 22.31 22.42 21.77 92.00 19.92 - 77.05 19.16 47.04 86.25 43.71 51.44 22.53 31902011 THER IVNTJ EA ADDL 15 MIN 97130 420 $115.00 42.50 - 138.30 - 79.47 22.86 79.47 - 63.54 22.42 75.90 - - 76.12 19.59 21.77 110.64 138.30 22.31 22.42 21.77 92.00 19.92 - 77.05 19.16 47.04 86.25 43.71 51.44 22.53 31907012 THER IVNTJ EA ADDL 15 MIN 97130 420 $115.00 42.50 - 138.30 - 79.47 22.86 79.47 - 63.54 22.42 75.90 - - 76.12 19.59 21.77 110.64 138.30 22.31 22.42 21.77 92.00 19.92 - 77.05 19.16 47.04 86.25 43.71 51.44 22.53 64202014 THER IVNTJ EA ADDL 15 MIN 97130 420 $115.00 42.50 - 138.30 - 79.47 22.86 79.47 - 63.54 22.42 75.90 - - 76.12 19.59 21.77 110.64 138.30 22.31 22.42 21.77 92.00 19.92 - 77.05 19.16 47.04 86.25 43.71 51.44 22.53 64207016 THER IVNTJ EA ADDL 15 MIN 97130 420 $115.00 42.50 - 138.30 - 79.47 22.86 79.47 - 63.54 22.42 75.90 - - 76.12 19.59 21.77 110.64 138.30 22.31 22.42 21.77 92.00 19.92 - 77.05 19.16 47.04 86.25 43.71 51.44 22.53 29101434 MANUAL THERAPY 15 MIN 97140 430 $142.00 52.48 - 113.60 - 98.12 28.21 98.12 - 78.46 27.68 93.72 - - 93.99 24.18 26.87 62.30 77.87 27.54 27.68 26.87 113.60 24.59 - 95.14 23.65 58.08 106.50 53.97 63.52 27.81 29107076 MANUAL THERAPY 15 MIN 97140 430 $142.00 52.48 - 113.60 - 98.12 28.21 98.12 - 78.46 27.68 93.72 - - 93.99 24.18 26.87 62.30 77.87 27.54 27.68 26.87 113.60 24.59 - 95.14 23.65 58.08 106.50 53.97 63.52 27.81 29207071 MANUAL THERAPY 15 MIN 97140 420 $142.00 52.48 - 113.60 - 98.12 28.21 98.12 - 78.46 27.68 93.72 - - 93.99 24.18 26.87 62.30 77.87 27.54 27.68 26.87 113.60 24.59 - 95.14 23.65 58.08 106.50 53.97 63.52 27.81 29210365 MANUAL THERAPY 15 MIN 97140 420 $142.00 52.48 - 113.60 - 98.12 28.21 98.12 - 78.46 27.68 93.72 - - 93.99 24.18 26.87 62.30 77.87 27.54 27.68 26.87 113.60 24.59 - 95.14 23.65 58.08 106.50 53.97 63.52 27.81 29507074 MANUAL THERAPY 15 MIN 97140 420 $142.00 52.48 - 113.60 - 98.12 28.21 98.12 - 78.46 27.68 93.72 - - 93.99 24.18 26.87 62.30 77.87 27.54 27.68 26.87 113.60 24.59 - 95.14 23.65 58.08 106.50 53.97 63.52 27.81 29585067 MANUAL THERAPY 15 MIN 97140 420 $142.00 52.48 - 113.60 - 98.12 28.21 98.12 - 78.46 27.68 93.72 - - 93.99 24.18 26.87 62.30 77.87 27.54 27.68 26.87 113.60 24.59 - 95.14 23.65 58.08 106.50 53.97 63.52 27.81 31900336 MANUAL THERAPY 15 MIN 97140 420 $142.00 52.48 - 113.60 - 98.12 28.21 98.12 - 78.46 27.68 93.72 - - 93.99 24.18 26.87 62.30 77.87 27.54 27.68 26.87 113.60 24.59 - 95.14 23.65 58.08 106.50 53.97 63.52 27.81 31907071 MANUAL THERAPY 15 MIN 97140 420 $142.00 52.48 - 113.60 - 98.12 28.21 98.12 - 78.46 27.68 93.72 - - 93.99 24.18 26.87 62.30 77.87 27.54 27.68 26.87 113.60 24.59 - 95.14 23.65 58.08 106.50 53.97 63.52 27.81 64200135 MANUAL THERAPY 15 MIN 97140 420 $142.00 52.48 - 113.60 - 98.12 28.21 98.12 - 78.46 27.68 93.72 - - 93.99 24.18 26.87 62.30 77.87 27.54 27.68 26.87 113.60 24.59 - 95.14 23.65 58.08 106.50 53.97 63.52 27.81 64207075 MANUAL THERAPY 15 MIN 97140 420 $142.00 52.48 - 113.60 - 98.12 28.21 98.12 - 78.46 27.68 93.72 - - 93.99 24.18 26.87 62.30 77.87 27.54 27.68 26.87 113.60 24.59 - 95.14 23.65 58.08 106.50 53.97 63.52 27.81 29101361 GROUP THERAPY 97150 430 $93.00 34.37 - 82.12 - 64.26 18.36 64.26 - 51.38 18.01 61.38 - - 61.56 15.74 17.49 65.70 82.12 17.93 18.01 17.49 74.40 16.00 - 62.31 15.39 38.04 69.75 35.35 41.60 18.10 29107084 GROUP THERAPY 97150 430 $93.00 34.37 - 82.12 - 64.26 18.36 64.26 - 51.38 18.01 61.38 - - 61.56 15.74 17.49 65.70 82.12 17.93 18.01 17.49 74.40 16.00 - 62.31 15.39 38.04 69.75 35.35 41.60 18.10 29200599 GROUP THERAPY 97150 420 $93.00 34.37 - 82.12 - 64.26 18.36 64.26 - 51.38 18.01 61.38 - - 61.56 15.74 17.49 65.70 82.12 17.93 18.01 17.49 74.40 16.00 - 62.31 15.39 38.04 69.75 35.35 41.60 18.10 29207089 GROUP THERAPY 97150 420 $93.00 34.37 - 82.12 - 64.26 18.36 64.26 - 51.38 18.01 61.38 - - 61.56 15.74 17.49 65.70 82.12 17.93 18.01 17.49 74.40 16.00 - 62.31 15.39 38.04 69.75 35.35 41.60 18.10 29507082 GROUP THERAPY 97150 420 $93.00 34.37 - 82.12 - 64.26 18.36 64.26 - 51.38 18.01 61.38 - - 61.56 15.74 17.49 65.70 82.12 17.93 18.01 17.49 74.40 16.00 - 62.31 15.39 38.04 69.75 35.35 41.60 18.10 29585008 GROUP THERAPY 97150 420 $93.00 34.37 - 82.12 - 64.26 18.36 64.26 - 51.38 18.01 61.38 - - 61.56 15.74 17.49 65.70 82.12 17.93 18.01 17.49 74.40 16.00 - 62.31 15.39 38.04 69.75 35.35 41.60 18.10 31900344 GROUP THERAPY 97150 420 $93.00 34.37 - 82.12 - 64.26 18.36 64.26 - 51.38 18.01 61.38 - - 61.56 15.74 17.49 65.70 82.12 17.93 18.01 17.49 74.40 16.00 - 62.31 15.39 38.04 69.75 35.35 41.60 18.10 31907080 GROUP THERAPY 97150 420 $93.00 34.37 - 82.12 - 64.26 18.36 64.26 - 51.38 18.01 61.38 - - 61.56 15.74 17.49 65.70 82.12 17.93 18.01 17.49 74.40 16.00 - 62.31 15.39 38.04 69.75 35.35 41.60 18.10 64200267 GROUP THERAPY 97150 420 $93.00 34.37 - 82.12 - 64.26 18.36 64.26 - 51.38 18.01 61.38 - - 61.56 15.74 17.49 65.70 82.12 17.93 18.01 17.49 74.40 16.00 - 62.31 15.39 38.04 69.75 35.35 41.60 18.10 64207083 GROUP THERAPY 97150 420 $93.00 34.37 - 82.12 - 64.26 18.36 64.26 - 51.38 18.01 61.38 - - 61.56 15.74 17.49 65.70 82.12 17.93 18.01 17.49 74.40 16.00 - 62.31 15.39 38.04 69.75 35.35 41.60 18.10 29221502 PT EVAL LOW COMPLEXITY 97161 420 $519.00 191.82 63.61 476.25 73.15 358.63 104.28 358.63 74.42 286.75 102.29 342.54 71.24 66.24 343.53 89.38 99.31 381.00 476.25 101.79 102.29 99.31 415.20 90.87 63.61 347.73 87.39 212.27 389.25 197.27 232.15 102.79 29585997 PT EVAL LOW COMPLEXITY 97161 420 $519.00 191.82 63.61 476.25 73.15 358.63 104.28 358.63 74.42 286.75 102.29 342.54 71.24 66.24 343.53 89.38 99.31 381.00 476.25 101.79 102.29 99.31 415.20 90.87 63.61 347.73 87.39 212.27 389.25 197.27 232.15 102.79 31900981 PT EVAL LOW COMPLEXITY 97161 420 $519.00 191.82 63.61 476.25 73.15 358.63 104.28 358.63 74.42 286.75 102.29 342.54 71.24 66.24 343.53 89.38 99.31 381.00 476.25 101.79 102.29 99.31 415.20 90.87 63.61 347.73 87.39 212.27 389.25 197.27 232.15 102.79 64201107 PT EVAL LOW COMPLEXITY 97161 420 $519.00 191.82 63.61 476.25 73.15 358.63 104.28 358.63 74.42 286.75 102.29 342.54 71.24 66.24 343.53 89.38 99.31 381.00 476.25 101.79 102.29 99.31 415.20 90.87 63.61 347.73 87.39 212.27 389.25 197.27 232.15 102.79 29221511 PT EVAL MOD COMPLEXITY 97162 420 $519.00 191.82 63.61 476.25 73.15 358.63 104.28 358.63 74.42 286.75 102.29 342.54 71.24 66.24 343.53 89.38 99.31 381.00 476.25 101.79 102.29 99.31 415.20 90.87 63.61 347.73 87.39 212.27 389.25 197.27 232.15 102.79 29586004 PT EVAL MOD COMPLEXITY 97162 420 $519.00 191.82 63.61 476.25 73.15 358.63 104.28 358.63 74.42 286.75 102.29 342.54 71.24 66.24 343.53 89.38 99.31 381.00 476.25 101.79 102.29 99.31 415.20 90.87 63.61 347.73 87.39 212.27 389.25 197.27 232.15 102.79 31900999 PT EVAL MOD COMPLEXITY 97162 420 $519.00 191.82 63.61 476.25 73.15 358.63 104.28 358.63 74.42 286.75 102.29 342.54 71.24 66.24 343.53 89.38 99.31 381.00 476.25 101.79 102.29 99.31 415.20 90.87 63.61 347.73 87.39 212.27 389.25 197.27 232.15 102.79 64201115 PT EVAL MOD COMPLEXITY 97162 420 $519.00 191.82 63.61 476.25 73.15 358.63 104.28 358.63 74.42 286.75 102.29 342.54 71.24 66.24 343.53 89.38 99.31 381.00 476.25 101.79 102.29 99.31 415.20 90.87 63.61 347.73 87.39 212.27 389.25 197.27 232.15 102.79 29221529 PT EVAL HIGH COMPLEXITY 97163 420 $519.00 191.82 63.61 476.25 73.15 358.63 104.28 358.63 74.42 286.75 102.29 342.54 71.24 66.24 343.53 89.38 99.31 381.00 476.25 101.79 102.29 99.31 415.20 90.87 63.61 347.73 87.39 212.27 389.25 197.27 232.15 102.79 29586012 PT EVAL HIGH COMPLEXITY 97163 420 $519.00 191.82 63.61 476.25 73.15 358.63 104.28 358.63 74.42 286.75 102.29 342.54 71.24 66.24 343.53 89.38 99.31 381.00 476.25 101.79 102.29 99.31 415.20 90.87 63.61 347.73 87.39 212.27 389.25 197.27 232.15 102.79 31901006 PT EVAL HIGH COMPLEXITY 97163 420 $519.00 191.82 63.61 476.25 73.15 358.63 104.28 358.63 74.42 286.75 102.29 342.54 71.24 66.24 343.53 89.38 99.31 381.00 476.25 101.79 102.29 99.31 415.20 90.87 63.61 347.73 87.39 212.27 389.25 197.27 232.15 102.79 64201123 PT EVAL HIGH COMPLEXITY 97163 420 $519.00 191.82 63.61 476.25 73.15 358.63 104.28 358.63 74.42 286.75 102.29 342.54 71.24 66.24 343.53 89.38 99.31 381.00 476.25 101.79 102.29 99.31 415.20 90.87 63.61 347.73 87.39 212.27 389.25 197.27 232.15 102.79 29221537 PT RE-EVAL 97164 420 $354.00 130.84 43.12 322.85 49.59 244.61 71.66 244.61 50.45 195.59 70.30 233.64 48.29 44.90 234.31 61.43 68.25 258.28 322.85 69.96 70.30 68.25 283.20 62.45 43.12 237.18 60.06 144.79 265.50 134.56 158.34 70.64 29585989 PT RE-EVAL 97164 420 $354.00 130.84 43.12 322.85 49.59 244.61 71.66 244.61 50.45 195.59 70.30 233.64 48.29 44.90 234.31 61.43 68.25 258.28 322.85 69.96 70.30 68.25 283.20 62.45 43.12 237.18 60.06 144.79 265.50 134.56 158.34 70.64 31901014 PT RE-EVAL 97164 420 $354.00 130.84 43.12 322.85 49.59 244.61 71.66 244.61 50.45 195.59 70.30 233.64 48.29 44.90 234.31 61.43 68.25 258.28 322.85 69.96 70.30 68.25 283.20 62.45 43.12 237.18 60.06 144.79 265.50 134.56 158.34 70.64 64201131 PT RE-EVAL 97164 420 $354.00 130.84 43.12 322.85 49.59 244.61 71.66 244.61 50.45 195.59 70.30 233.64 48.29 44.90 234.31 61.43 68.25 258.28 322.85 69.96 70.30 68.25 283.20 62.45 43.12 237.18 60.06 144.79 265.50 134.56 158.34 70.64 29121311 OT EVAL LOW COMPLEXITY 97165 430 $504.00 186.28 61.73 462.17 70.99 348.26 104.96 348.26 72.22 278.46 102.96 332.64 69.14 64.28 333.60 89.96 99.96 369.74 462.17 102.46 102.96 99.96 403.20 91.46 61.73 337.68 87.96 206.14 378.00 191.57 225.44 103.46 29121320 OT EVAL MOD COMPLEXITY 97166 430 $504.00 186.28 61.73 462.17 70.99 348.26 104.96 348.26 72.22 278.46 102.96 332.64 69.14 64.28 333.60 89.96 99.96 369.74 462.17 102.46 102.96 99.96 403.20 91.46 61.73 337.68 87.96 206.14 378.00 191.57 225.44 103.46 29121338 OT EVAL HIGH COMPLEXITY 97167 430 $504.00 186.28 61.73 462.17 70.99 348.26 104.96 348.26 72.22 278.46 102.96 332.64 69.14 64.28 333.60 89.96 99.96 369.74 462.17 102.46 102.96 99.96 403.20 91.46 61.73 337.68 87.96 206.14 378.00 191.57 225.44 103.46 29121346 OT RE-EVAL 97168 430 $339.00 125.29 40.69 304.64 46.79 234.25 72.00 234.25 47.61 187.30 70.63 223.74 45.57 42.37 224.38 61.71 68.57 243.71 304.64 70.28 70.63 68.57 271.20 62.74 40.69 227.13 60.34 138.65 254.25 128.85 151.63 70.97 29107092 THERAPEUTIC ACTIVITY 15 MIN 97530 430 $199.00 73.55 - 159.20 - 137.51 38.47 137.51 - 109.95 37.74 131.34 - - 131.72 32.98 36.64 52.57 65.71 37.56 37.74 36.64 159.20 33.53 - 133.33 32.24 81.39 149.25 75.64 89.01 37.92 29120200 THERAPEUTIC ACTIVITY 15 MIN 97530 430 $199.00 73.55 - 159.20 - 137.51 38.47 137.51 - 109.95 37.74 131.34 - - 131.72 32.98 36.64 52.57 65.71 37.56 37.74 36.64 159.20 33.53 - 133.33 32.24 81.39 149.25 75.64 89.01 37.92 29207097 THERAPEUTIC ACTIVITY 15 MIN 97530 420 $199.00 73.55 - 159.20 - 137.51 38.47 137.51 - 109.95 37.74 131.34 - - 131.72 32.98 36.64 52.57 65.71 37.56 37.74 36.64 159.20 33.53 - 133.33 32.24 81.39 149.25 75.64 89.01 37.92 29220387 THERAPEUTIC ACTIVITY 15 MIN 97530 420 $199.00 73.55 - 159.20 - 137.51 38.47 137.51 - 109.95 37.74 131.34 - - 131.72 32.98 36.64 52.57 65.71 37.56 37.74 36.64 159.20 33.53 - 133.33 32.24 81.39 149.25 75.64 89.01 37.92 29507091 THERAPEUTIC ACTIVITY 15 MIN 97530 420 $199.00 73.55 - 159.20 - 137.51 38.47 137.51 - 109.95 37.74 131.34 - - 131.72 32.98 36.64 52.57 65.71 37.56 37.74 36.64 159.20 33.53 - 133.33 32.24 81.39 149.25 75.64 89.01 37.92 29585091 THERAPEUTIC ACTIVITY 15 MIN 97530 420 $199.00 73.55 - 159.20 - 137.51 38.47 137.51 - 109.95 37.74 131.34 - - 131.72 32.98 36.64 52.57 65.71 37.56 37.74 36.64 159.20 33.53 - 133.33 32.24 81.39 149.25 75.64 89.01 37.92 31900352 THERAPEUTIC ACTIVITY 15 MIN 97530 420 $199.00 73.55 - 159.20 - 137.51 38.47 137.51 - 109.95 37.74 131.34 - - 131.72 32.98 36.64 52.57 65.71 37.56 37.74 36.64 159.20 33.53 - 133.33 32.24 81.39 149.25 75.64 89.01 37.92 31907098 THERAPEUTIC ACTIVITY 15 MIN 97530 420 $199.00 73.55 - 159.20 - 137.51 38.47 137.51 - 109.95 37.74 131.34 - - 131.72 32.98 36.64 52.57 65.71 37.56 37.74 36.64 159.20 33.53 - 133.33 32.24 81.39 149.25 75.64 89.01 37.92 64200275 THERAPEUTIC ACTIVITY 15 MIN 97530 420 $199.00 73.55 - 159.20 - 137.51 38.47 137.51 - 109.95 37.74 131.34 - - 131.72 32.98 36.64 52.57 65.71 37.56 37.74 36.64 159.20 33.53 - 133.33 32.24 81.39 149.25 75.64 89.01 37.92 64207091 THERAPEUTIC ACTIVITY 15 MIN 97530 420 $199.00 73.55 - 159.20 - 137.51 38.47 137.51 - 109.95 37.74 131.34 - - 131.72 32.98 36.64 52.57 65.71 37.56 37.74 36.64 159.20 33.53 - 133.33 32.24 81.39 149.25 75.64 89.01 37.92 29121125 SENSORY INTEGRATION 15 MIN 97533 430 $305.00 112.73 - 244.00 - 210.76 66.19 210.76 - 168.51 64.93 201.30 - - 201.88 56.74 63.04 121.28 151.60 64.62 64.93 63.04 244.00 57.68 - 204.35 55.48 124.75 228.75 115.93 136.43 65.25 29107106 SELF-CARE TRAINING 15 MIN 97535 430 $172.00 63.57 - 137.60 - 118.85 34.06 118.85 - 95.03 33.41 113.52 - - 113.85 29.20 32.44 65.70 82.12 33.25 33.41 32.44 137.60 29.68 - 115.24 28.55 70.35 129.00 65.38 76.94 33.58 29120021 SELF CARE ADL TRAINING 15 MIN 97535 430 $172.00 63.57 - 137.60 - 118.85 34.06 118.85 - 95.03 33.41 113.52 - - 113.85 29.20 32.44 65.70 82.12 33.25 33.41 32.44 137.60 29.68 - 115.24 28.55 70.35 129.00 65.38 76.94 33.58 29207101 SELF-CARE TRAINING 15 MIN 97535 420 $172.00 63.57 - 137.60 - 118.85 34.06 118.85 - 95.03 33.41 113.52 - - 113.85 29.20 32.44 65.70 82.12 33.25 33.41 32.44 137.60 29.68 - 115.24 28.55 70.35 129.00 65.38 76.94 33.58 29221359 SELF CARE ADL TRAINING 15 MIN 97535 420 $172.00 63.57 - 137.60 - 118.85 34.06 118.85 - 95.03 33.41 113.52 - - 113.85 29.20 32.44 65.70 82.12 33.25 33.41 32.44 137.60 29.68 - 115.24 28.55 70.35 129.00 65.38 76.94 33.58 29507104 SELF-CARE TRAINING 15 MIN 97535 420 $172.00 63.57 - 137.60 - 118.85 34.06 118.85 - 95.03 33.41 113.52 - - 113.85 29.20 32.44 65.70 82.12 33.25 33.41 32.44 137.60 29.68 - 115.24 28.55 70.35 129.00 65.38 76.94 33.58 29585881 SELF CARE ADL TRAINING 15 MIN 97535 420 $172.00 63.57 - 137.60 - 118.85 34.06 118.85 - 95.03 33.41 113.52 - - 113.85 29.20 32.44 65.70 82.12 33.25 33.41 32.44 137.60 29.68 - 115.24 28.55 70.35 129.00 65.38 76.94 33.58 31900361 SELF CARE ADL TRAINING 15 MIN 97535 420 $172.00 63.57 - 137.60 - 118.85 34.06 118.85 - 95.03 33.41 113.52 - - 113.85 29.20 32.44 65.70 82.12 33.25 33.41 32.44 137.60 29.68 - 115.24 28.55 70.35 129.00 65.38 76.94 33.58 31907101 SELF-CARE TRAINING 15 MIN 97535 420 $172.00 63.57 - 137.60 - 118.85 34.06 118.85 - 95.03 33.41 113.52 - - 113.85 29.20 32.44 65.70 82.12 33.25 33.41 32.44 137.60 29.68 - 115.24 28.55 70.35 129.00 65.38 76.94 33.58 64200143 SELF CARE ADL TRAINING 15 MIN 97535 420 $172.00 63.57 - 137.60 - 118.85 34.06 118.85 - 95.03 33.41 113.52 - - 113.85 29.20 32.44 65.70 82.12 33.25 33.41 32.44 137.60 29.68 - 115.24 28.55 70.35 129.00 65.38 76.94 33.58 64207105 SELF-CARE TRAINING 15 MIN 97535 420 $172.00 63.57 - 137.60 - 118.85 34.06 118.85 - 95.03 33.41 113.52 - - 113.85 29.20 32.44 65.70 82.12 33.25 33.41 32.44 137.60 29.68 - 115.24 28.55 70.35 129.00 65.38 76.94 33.58 29107114 REINTEGRATION TRAINING 15 MIN 97537 430 $165.00 60.98 - 132.00 - 114.02 33.10 114.02 - 91.16 32.47 108.90 - - 109.21 28.37 31.52 65.70 82.12 32.31 32.47 31.52 132.00 28.84 - 110.55 27.74 67.49 123.75 62.72 73.80 32.62 29120960 REINTEGRATION TRAINING 15 MIN 97537 430 $165.00 60.98 - 132.00 - 114.02 33.10 114.02 - 91.16 32.47 108.90 - - 109.21 28.37 31.52 65.70 82.12 32.31 32.47 31.52 132.00 28.84 - 110.55 27.74 67.49 123.75 62.72 73.80 32.62 29207119 REINTEGRATION TRAINING 15 MIN 97537 420 $165.00 60.98 - 132.00 - 114.02 33.10 114.02 - 91.16 32.47 108.90 - - 109.21 28.37 31.52 65.70 82.12 32.31 32.47 31.52 132.00 28.84 - 110.55 27.74 67.49 123.75 62.72 73.80 32.62 29221367 REINTEGRATION TRAINING 15 MIN 97537 420 $165.00 60.98 - 132.00 - 114.02 33.10 114.02 - 91.16 32.47 108.90 - - 109.21 28.37 31.52 65.70 82.12 32.31 32.47 31.52 132.00 28.84 - 110.55 27.74 67.49 123.75 62.72 73.80 32.62 29507112 REINTEGRATION TRAINING 15 MIN 97537 420 $165.00 60.98 - 132.00 - 114.02 33.10 114.02 - 91.16 32.47 108.90 - - 109.21 28.37 31.52 65.70 82.12 32.31 32.47 31.52 132.00 28.84 - 110.55 27.74 67.49 123.75 62.72 73.80 32.62 29585890 REINTEGRATION TRAINING 15 MIN 97537 420 $165.00 60.98 - 132.00 - 114.02 33.10 114.02 - 91.16 32.47 108.90 - - 109.21 28.37 31.52 65.70 82.12 32.31 32.47 31.52 132.00 28.84 - 110.55 27.74 67.49 123.75 62.72 73.80 32.62 31900379 REINTEGRATION TRAINING 15 MIN 97537 420 $165.00 60.98 - 132.00 - 114.02 33.10 114.02 - 91.16 32.47 108.90 - - 109.21 28.37 31.52 65.70 82.12 32.31 32.47 31.52 132.00 28.84 - 110.55 27.74 67.49 123.75 62.72 73.80 32.62 31907110 REINTEGRATION TRAINING 15 MIN 97537 420 $165.00 60.98 - 132.00 - 114.02 33.10 114.02 - 91.16 32.47 108.90 - - 109.21 28.37 31.52 65.70 82.12 32.31 32.47 31.52 132.00 28.84 - 110.55 27.74 67.49 123.75 62.72 73.80 32.62 64201018 REINTEGRATION TRAINING 15 MIN 97537 420 $165.00 60.98 - 132.00 - 114.02 33.10 114.02 - 91.16 32.47 108.90 - - 109.21 28.37 31.52 65.70 82.12 32.31 32.47 31.52 132.00 28.84 - 110.55 27.74 67.49 123.75 62.72 73.80 32.62 64207113 REINTEGRATION TRAINING 15 MIN 97537 420 $165.00 60.98 - 132.00 - 114.02 33.10 114.02 - 91.16 32.47 108.90 - - 109.21 28.37 31.52 65.70 82.12 32.31 32.47 31.52 132.00 28.84 - 110.55 27.74 67.49 123.75 62.72 73.80 32.62 29107122 WHEELCHAIR MANAGEMENT 15 MIN 97542 430 $167.00 61.72 - 133.60 - 115.40 33.10 115.40 - 92.27 32.47 110.22 - - 110.54 28.37 31.52 65.70 82.12 32.31 32.47 31.52 133.60 28.84 - 111.89 27.74 68.30 125.25 63.48 74.70 32.62 29120978 WHEELCHAIR MANAGEMENT 15 MIN 97542 430 $167.00 61.72 - 133.60 - 115.40 33.10 115.40 - 92.27 32.47 110.22 - - 110.54 28.37 31.52 65.70 82.12 32.31 32.47 31.52 133.60 28.84 - 111.89 27.74 68.30 125.25 63.48 74.70 32.62 29200602 WHEELCHAIR MANAGEMENT 15 MIN 97542 420 $167.00 61.72 - 133.60 - 115.40 33.10 115.40 - 92.27 32.47 110.22 - - 110.54 28.37 31.52 65.70 82.12 32.31 32.47 31.52 133.60 28.84 - 111.89 27.74 68.30 125.25 63.48 74.70 32.62 29207127 WHEELCHAIR MANAGEMENT 15 MIN 97542 420 $167.00 61.72 - 133.60 - 115.40 33.10 115.40 - 92.27 32.47 110.22 - - 110.54 28.37 31.52 65.70 82.12 32.31 32.47 31.52 133.60 28.84 - 111.89 27.74 68.30 125.25 63.48 74.70 32.62 29507121 WHEELCHAIR MANAGEMENT 15 MIN 97542 420 $167.00 61.72 - 133.60 - 115.40 33.10 115.40 - 92.27 32.47 110.22 - - 110.54 28.37 31.52 65.70 82.12 32.31 32.47 31.52 133.60 28.84 - 111.89 27.74 68.30 125.25 63.48 74.70 32.62 29585016 WHEELCHAIR MANAGEMENT 15 MIN 97542 420 $167.00 61.72 - 133.60 - 115.40 33.10 115.40 - 92.27 32.47 110.22 - - 110.54 28.37 31.52 65.70 82.12 32.31 32.47 31.52 133.60 28.84 - 111.89 27.74 68.30 125.25 63.48 74.70 32.62 31900387 WHEELCHAIR MANAGEMENT 15 MIN 97542 420 $167.00 61.72 - 133.60 - 115.40 33.10 115.40 - 92.27 32.47 110.22 - - 110.54 28.37 31.52 65.70 82.12 32.31 32.47 31.52 133.60 28.84 - 111.89 27.74 68.30 125.25 63.48 74.70 32.62 31907128 WHEELCHAIR MANAGEMENT 15 MIN 97542 420 $167.00 61.72 - 133.60 - 115.40 33.10 115.40 - 92.27 32.47 110.22 - - 110.54 28.37 31.52 65.70 82.12 32.31 32.47 31.52 133.60 28.84 - 111.89 27.74 68.30 125.25 63.48 74.70 32.62 64200151 WHEELCHAIR MANAGEMENT 15 MIN 97542 420 $167.00 61.72 - 133.60 - 115.40 33.10 115.40 - 92.27 32.47 110.22 - - 110.54 28.37 31.52 65.70 82.12 32.31 32.47 31.52 133.60 28.84 - 111.89 27.74 68.30 125.25 63.48 74.70 32.62 64207121 WHEELCHAIR MANAGEMENT 15 MIN 97542 420 $167.00 61.72 - 133.60 - 115.40 33.10 115.40 - 92.27 32.47 110.22 - - 110.54 28.37 31.52 65.70 82.12 32.31 32.47 31.52 133.60 28.84 - 111.89 27.74 68.30 125.25 63.48 74.70 32.62 28116772 DBRDMNT OPEN WOUND 20 SQCM/< 97597 360 $943.00 348.53 31.54 754.40 36.27 651.61 187.30 651.61 36.90 521.01 183.73 622.38 35.32 32.84 624.17 160.54 178.38 259.17 323.96 182.84 183.73 178.38 754.40 163.22 31.54 631.81 156.97 385.69 707.25 358.43 421.80 184.62 29120854 DBRDMNT OPEN WOUND 20 SQCM/< 97597 430 $943.00 348.53 31.54 754.40 36.27 651.61 187.30 651.61 36.90 521.01 183.73 622.38 35.32 32.84 624.17 160.54 178.38 259.17 323.96 182.84 183.73 178.38 754.40 163.22 31.54 631.81 156.97 385.69 707.25 358.43 421.80 184.62 29221057 DBRDMNT OPEN WOUND 20 SQCM/< 97597 420 $943.00 348.53 31.54 754.40 36.27 651.61 187.30 651.61 36.90 521.01 183.73 622.38 35.32 32.84 624.17 160.54 178.38 259.17 323.96 182.84 183.73 178.38 754.40 163.22 31.54 631.81 156.97 385.69 707.25 358.43 421.80 184.62 29585628 DBRDMNT OPEN WOUND 20 SQCM/< 97597 420 $943.00 348.53 31.54 754.40 36.27 651.61 187.30 651.61 36.90 521.01 183.73 622.38 35.32 32.84 624.17 160.54 178.38 259.17 323.96 182.84 183.73 178.38 754.40 163.22 31.54 631.81 156.97 385.69 707.25 358.43 421.80 184.62 31900395 DBRDMNT OPEN WOUND 20 SQCM/< 97597 420 $943.00 348.53 31.54 754.40 36.27 651.61 187.30 651.61 36.90 521.01 183.73 622.38 35.32 32.84 624.17 160.54 178.38 259.17 323.96 182.84 183.73 178.38 754.40 163.22 31.54 631.81 156.97 385.69 707.25 358.43 421.80 184.62 51600444 DBRDMNT OPEN WOUND 20 SQCM/< 97597 510 $943.00 348.53 31.54 754.40 36.27 651.61 187.30 651.61 36.90 521.01 183.73 622.38 35.32 32.84 624.17 160.54 178.38 259.17 323.96 182.84 183.73 178.38 754.40 163.22 31.54 631.81 156.97 385.69 707.25 358.43 421.80 184.62 64200925 DBRDMNT OPEN WOUND 20 SQCM/< 97597 420 $943.00 348.53 31.54 754.40 36.27 651.61 187.30 651.61 36.90 521.01 183.73 622.38 35.32 32.84 624.17 160.54 178.38 259.17 323.96 182.84 183.73 178.38 754.40 163.22 31.54 631.81 156.97 385.69 707.25 358.43 421.80 184.62 28174705 DBRDMNT OPEN WOUND ADD 20 SQCM 97598 360 $60.00 22.18 - 413.82 13.29 41.46 - 41.46 13.53 33.15 - 39.60 12.95 12.04 39.71 - - 331.06 413.82 - - - 48.00 - 11.56 40.20 - 24.54 45.00 22.81 26.84 - 29120862 DBRDMNT OPEN WOUND ADD 20 SQCM 97598 430 $60.00 22.18 - 413.82 13.29 41.46 - 41.46 13.53 33.15 - 39.60 12.95 12.04 39.71 - - 331.06 413.82 - - - 48.00 - 11.56 40.20 - 24.54 45.00 22.81 26.84 - 29221065 DBRDMNT OPEN WOUND ADD 20 SQCM 97598 420 $60.00 22.18 - 413.82 13.29 41.46 - 41.46 13.53 33.15 - 39.60 12.95 12.04 39.71 - - 331.06 413.82 - - - 48.00 - 11.56 40.20 - 24.54 45.00 22.81 26.84 - 29585636 DBRDMNT OPEN WOUND ADD 20 SQCM 97598 420 $60.00 22.18 - 413.82 13.29 41.46 - 41.46 13.53 33.15 - 39.60 12.95 12.04 39.71 - - 331.06 413.82 - - - 48.00 - 11.56 40.20 - 24.54 45.00 22.81 26.84 - 31900409 DBRDMNT OPEN WOUND ADD 20 SQCM 97598 420 $60.00 22.18 - 413.82 13.29 41.46 - 41.46 13.53 33.15 - 39.60 12.95 12.04 39.71 - - 331.06 413.82 - - - 48.00 - 11.56 40.20 - 24.54 45.00 22.81 26.84 - 51600452 DBRDMNT OPEN WOUND ADD 20 SQCM 97598 510 $60.00 22.18 - 413.82 13.29 41.46 - 41.46 13.53 33.15 - 39.60 12.95 12.04 39.71 - - 331.06 413.82 - - - 48.00 - 11.56 40.20 - 24.54 45.00 22.81 26.84 - 64201026 DBRDMNT OPEN WOUND ADD 20 SQCM 97598 420 $60.00 22.18 - 413.82 13.29 41.46 - 41.46 13.53 33.15 - 39.60 12.95 12.04 39.71 - - 331.06 413.82 - - - 48.00 - 11.56 40.20 - 24.54 45.00 22.81 26.84 - 29107131 NONSELECT DBRDMNT WOUND CARE 97602 430 $943.00 348.53 27.00 754.40 31.05 651.61 187.30 651.61 31.59 521.01 183.73 622.38 30.24 28.12 624.17 160.54 178.38 96.37 120.46 182.84 183.73 178.38 754.40 163.22 27.00 631.81 156.97 385.69 707.25 358.43 421.80 184.62 29120871 NONSELECT DBRDMNT WOUND CARE 97602 430 $943.00 348.53 27.00 754.40 31.05 651.61 187.30 651.61 31.59 521.01 183.73 622.38 30.24 28.12 624.17 160.54 178.38 96.37 120.46 182.84 183.73 178.38 754.40 163.22 27.00 631.81 156.97 385.69 707.25 358.43 421.80 184.62 29207135 NONSELECT DBRDMNT WOUND CARE 97602 420 $943.00 348.53 27.00 754.40 31.05 651.61 187.30 651.61 31.59 521.01 183.73 622.38 30.24 28.12 624.17 160.54 178.38 96.37 120.46 182.84 183.73 178.38 754.40 163.22 27.00 631.81 156.97 385.69 707.25 358.43 421.80 184.62 29221073 NONSELECT DBRDMNT WOUND CARE 97602 420 $943.00 348.53 27.00 754.40 31.05 651.61 187.30 651.61 31.59 521.01 183.73 622.38 30.24 28.12 624.17 160.54 178.38 96.37 120.46 182.84 183.73 178.38 754.40 163.22 27.00 631.81 156.97 385.69 707.25 358.43 421.80 184.62 29507139 NONSELECT DBRDMNT WOUND CARE 97602 420 $943.00 348.53 27.00 754.40 31.05 651.61 187.30 651.61 31.59 521.01 183.73 622.38 30.24 28.12 624.17 160.54 178.38 96.37 120.46 182.84 183.73 178.38 754.40 163.22 27.00 631.81 156.97 385.69 707.25 358.43 421.80 184.62 29585644 NONSELECT DBRDMNT WOUND CARE 97602 420 $943.00 348.53 27.00 754.40 31.05 651.61 187.30 651.61 31.59 521.01 183.73 622.38 30.24 28.12 624.17 160.54 178.38 96.37 120.46 182.84 183.73 178.38 754.40 163.22 27.00 631.81 156.97 385.69 707.25 358.43 421.80 184.62 31900417 NONSELECT DBRDMNT WOUND CARE 97602 420 $943.00 348.53 27.00 754.40 31.05 651.61 187.30 651.61 31.59 521.01 183.73 622.38 30.24 28.12 624.17 160.54 178.38 96.37 120.46 182.84 183.73 178.38 754.40 163.22 27.00 631.81 156.97 385.69 707.25 358.43 421.80 184.62 31907136 NONSELECT DBRDMNT WOUND CARE 97602 420 $943.00 348.53 27.00 754.40 31.05 651.61 187.30 651.61 31.59 521.01 183.73 622.38 30.24 28.12 624.17 160.54 178.38 96.37 120.46 182.84 183.73 178.38 754.40 163.22 27.00 631.81 156.97 385.69 707.25 358.43 421.80 184.62 51600461 NONSELECT DBRDMNT WOUND CARE 97602 510 $943.00 348.53 27.00 754.40 31.05 651.61 187.30 651.61 31.59 521.01 183.73 622.38 30.24 28.12 624.17 160.54 178.38 96.37 120.46 182.84 183.73 178.38 754.40 163.22 27.00 631.81 156.97 385.69 707.25 358.43 421.80 184.62 64201034 NONSELECT DBRDMNT WOUND CARE 97602 420 $943.00 348.53 27.00 754.40 31.05 651.61 187.30 651.61 31.59 521.01 183.73 622.38 30.24 28.12 624.17 160.54 178.38 96.37 120.46 182.84 183.73 178.38 754.40 163.22 27.00 631.81 156.97 385.69 707.25 358.43 421.80 184.62 64207130 NONSELECT DBRDMNT WOUND CARE 97602 420 $943.00 348.53 27.00 754.40 31.05 651.61 187.30 651.61 31.59 521.01 183.73 622.38 30.24 28.12 624.17 160.54 178.38 96.37 120.46 182.84 183.73 178.38 754.40 163.22 27.00 631.81 156.97 385.69 707.25 358.43 421.80 184.62 28174713 NEG PRESS WND TX DME <=50 SQCM 97605 360 $943.00 348.53 - 754.40 - 651.61 187.30 651.61 - 521.01 183.73 622.38 - - 624.17 160.54 178.38 263.68 329.60 182.84 183.73 178.38 754.40 163.22 - 631.81 156.97 385.69 707.25 358.43 421.80 184.62 29107149 NEG PRESS WND TX DME <=50 SQCM 97605 430 $943.00 348.53 - 754.40 - 651.61 187.30 651.61 - 521.01 183.73 622.38 - - 624.17 160.54 178.38 263.68 329.60 182.84 183.73 178.38 754.40 163.22 - 631.81 156.97 385.69 707.25 358.43 421.80 184.62 29207143 NEG PRESS WND TX DME <=50 SQCM 97605 420 $943.00 348.53 - 754.40 - 651.61 187.30 651.61 - 521.01 183.73 622.38 - - 624.17 160.54 178.38 263.68 329.60 182.84 183.73 178.38 754.40 163.22 - 631.81 156.97 385.69 707.25 358.43 421.80 184.62 29221081 NEG PRESS WND TX DME <=50 SQCM 97605 420 $943.00 348.53 - 754.40 - 651.61 187.30 651.61 - 521.01 183.73 622.38 - - 624.17 160.54 178.38 263.68 329.60 182.84 183.73 178.38 754.40 163.22 - 631.81 156.97 385.69 707.25 358.43 421.80 184.62 29507147 NEG PRESS WND TX DME <=50 SQCM 97605 420 $943.00 348.53 - 754.40 - 651.61 187.30 651.61 - 521.01 183.73 622.38 - - 624.17 160.54 178.38 263.68 329.60 182.84 183.73 178.38 754.40 163.22 - 631.81 156.97 385.69 707.25 358.43 421.80 184.62 29585652 NEG PRESS WND TX DME <=50 SQCM 97605 420 $943.00 348.53 - 754.40 - 651.61 187.30 651.61 - 521.01 183.73 622.38 - - 624.17 160.54 178.38 263.68 329.60 182.84 183.73 178.38 754.40 163.22 - 631.81 156.97 385.69 707.25 358.43 421.80 184.62 31900425 NEG PRESS WND TX DME <=50 SQCM 97605 420 $943.00 348.53 - 754.40 - 651.61 187.30 651.61 - 521.01 183.73 622.38 - - 624.17 160.54 178.38 263.68 329.60 182.84 183.73 178.38 754.40 163.22 - 631.81 156.97 385.69 707.25 358.43 421.80 184.62 31907144 NEG PRESS WND TX DME <=50 SQCM 97605 420 $943.00 348.53 - 754.40 - 651.61 187.30 651.61 - 521.01 183.73 622.38 - - 624.17 160.54 178.38 263.68 329.60 182.84 183.73 178.38 754.40 163.22 - 631.81 156.97 385.69 707.25 358.43 421.80 184.62 51600479 NEG PRESS WND TX DME <=50 SQCM 97605 510 $943.00 348.53 - 754.40 - 651.61 187.30 651.61 - 521.01 183.73 622.38 - - 624.17 160.54 178.38 263.68 329.60 182.84 183.73 178.38 754.40 163.22 - 631.81 156.97 385.69 707.25 358.43 421.80 184.62 64201042 NEG PRESS WND TX DME <=50 SQCM 97605 420 $943.00 348.53 - 754.40 - 651.61 187.30 651.61 - 521.01 183.73 622.38 - - 624.17 160.54 178.38 263.68 329.60 182.84 183.73 178.38 754.40 163.22 - 631.81 156.97 385.69 707.25 358.43 421.80 184.62 64207148 NEG PRESS WND TX DME <=50 SQCM 97605 420 $943.00 348.53 - 754.40 - 651.61 187.30 651.61 - 521.01 183.73 622.38 - - 624.17 160.54 178.38 263.68 329.60 182.84 183.73 178.38 754.40 163.22 - 631.81 156.97 385.69 707.25 358.43 421.80 184.62 29107157 NEG PRESS WND TX DME >50 SQCM 97606 430 "$1,816.00" 671.19 - " 1,452.80 " - " 1,254.86 " 360.51 " 1,254.86 " - " 1,003.34 " 353.64 " 1,198.56 " - - " 1,202.01 " 309.01 343.34 283.93 354.91 351.92 353.64 343.34 " 1,452.80 " 314.16 - " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 29207151 NEG PRESS WND TX DME >50 SQCM 97606 420 "$1,816.00" 671.19 - " 1,452.80 " - " 1,254.86 " 360.51 " 1,254.86 " - " 1,003.34 " 353.64 " 1,198.56 " - - " 1,202.01 " 309.01 343.34 283.93 354.91 351.92 353.64 343.34 " 1,452.80 " 314.16 - " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 29221090 NEG PRESS WND TX DME >50 SQ CM 97606 420 "$1,816.00" 671.19 - " 1,452.80 " - " 1,254.86 " 360.51 " 1,254.86 " - " 1,003.34 " 353.64 " 1,198.56 " - - " 1,202.01 " 309.01 343.34 283.93 354.91 351.92 353.64 343.34 " 1,452.80 " 314.16 - " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 29507155 NEG PRESS WND TX DME >50 SQCM 97606 420 "$1,816.00" 671.19 - " 1,452.80 " - " 1,254.86 " 360.51 " 1,254.86 " - " 1,003.34 " 353.64 " 1,198.56 " - - " 1,202.01 " 309.01 343.34 283.93 354.91 351.92 353.64 343.34 " 1,452.80 " 314.16 - " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 29585661 NEG PRESS WND TX DME >50 SQ CM 97606 420 "$1,816.00" 671.19 - " 1,452.80 " - " 1,254.86 " 360.51 " 1,254.86 " - " 1,003.34 " 353.64 " 1,198.56 " - - " 1,202.01 " 309.01 343.34 283.93 354.91 351.92 353.64 343.34 " 1,452.80 " 314.16 - " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 31900433 NEG PRESS WND TX DME >50 SQ CM 97606 420 "$1,816.00" 671.19 - " 1,452.80 " - " 1,254.86 " 360.51 " 1,254.86 " - " 1,003.34 " 353.64 " 1,198.56 " - - " 1,202.01 " 309.01 343.34 283.93 354.91 351.92 353.64 343.34 " 1,452.80 " 314.16 - " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 31907152 NEG PRESS WND TX DME >50 SQCM 97606 420 "$1,816.00" 671.19 - " 1,452.80 " - " 1,254.86 " 360.51 " 1,254.86 " - " 1,003.34 " 353.64 " 1,198.56 " - - " 1,202.01 " 309.01 343.34 283.93 354.91 351.92 353.64 343.34 " 1,452.80 " 314.16 - " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 51600487 NEG PRESS WND TX DME >50 SQ CM 97606 510 "$1,816.00" 671.19 - " 1,452.80 " - " 1,254.86 " 360.51 " 1,254.86 " - " 1,003.34 " 353.64 " 1,198.56 " - - " 1,202.01 " 309.01 343.34 283.93 354.91 351.92 353.64 343.34 " 1,452.80 " 314.16 - " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 64201051 NEG PRESS WND TX DME >50 SQ CM 97606 420 "$1,816.00" 671.19 - " 1,452.80 " - " 1,254.86 " 360.51 " 1,254.86 " - " 1,003.34 " 353.64 " 1,198.56 " - - " 1,202.01 " 309.01 343.34 283.93 354.91 351.92 353.64 343.34 " 1,452.80 " 314.16 - " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 64207156 NEG PRESS WND TX DME >50 SQCM 97606 420 "$1,816.00" 671.19 - " 1,452.80 " - " 1,254.86 " 360.51 " 1,254.86 " - " 1,003.34 " 353.64 " 1,198.56 " - - " 1,202.01 " 309.01 343.34 283.93 354.91 351.92 353.64 343.34 " 1,452.80 " 314.16 - " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 28175752 NEG PRESS WND TX 50 SQCM 97608 430 "$1,816.00" 671.19 - " 1,452.80 " - " 1,254.86 " 360.51 " 1,254.86 " - " 1,003.34 " 353.64 " 1,198.56 " - - " 1,202.01 " 309.01 343.34 402.54 503.17 351.92 353.64 343.34 " 1,452.80 " 314.16 - " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 29207178 NEG PRESS WND TX DISP >50 SQCM 97608 420 "$1,816.00" 671.19 - " 1,452.80 " - " 1,254.86 " 360.51 " 1,254.86 " - " 1,003.34 " 353.64 " 1,198.56 " - - " 1,202.01 " 309.01 343.34 402.54 503.17 351.92 353.64 343.34 " 1,452.80 " 314.16 - " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 29221383 NEG PRESS WND TX DISP >50 SQCM 97608 420 "$1,816.00" 671.19 - " 1,452.80 " - " 1,254.86 " 360.51 " 1,254.86 " - " 1,003.34 " 353.64 " 1,198.56 " - - " 1,202.01 " 309.01 343.34 402.54 503.17 351.92 353.64 343.34 " 1,452.80 " 314.16 - " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 29507171 NEG PRESS WND TX DISP >50 SQCM 97608 420 "$1,816.00" 671.19 - " 1,452.80 " - " 1,254.86 " 360.51 " 1,254.86 " - " 1,003.34 " 353.64 " 1,198.56 " - - " 1,202.01 " 309.01 343.34 402.54 503.17 351.92 353.64 343.34 " 1,452.80 " 314.16 - " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 29585911 NEG PRESS WND TX DISP >50 SQCM 97608 420 "$1,816.00" 671.19 - " 1,452.80 " - " 1,254.86 " 360.51 " 1,254.86 " - " 1,003.34 " 353.64 " 1,198.56 " - - " 1,202.01 " 309.01 343.34 402.54 503.17 351.92 353.64 343.34 " 1,452.80 " 314.16 - " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 31900450 NEG PRESS WND TX DISP >50 SQCM 97608 420 "$1,816.00" 671.19 - " 1,452.80 " - " 1,254.86 " 360.51 " 1,254.86 " - " 1,003.34 " 353.64 " 1,198.56 " - - " 1,202.01 " 309.01 343.34 402.54 503.17 351.92 353.64 343.34 " 1,452.80 " 314.16 - " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 31907179 NEG PRESS WND TX DISP >50 SQCM 97608 420 "$1,816.00" 671.19 - " 1,452.80 " - " 1,254.86 " 360.51 " 1,254.86 " - " 1,003.34 " 353.64 " 1,198.56 " - - " 1,202.01 " 309.01 343.34 402.54 503.17 351.92 353.64 343.34 " 1,452.80 " 314.16 - " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 51600509 NEG PRESS WND TX DISP >50 SQCM 97608 510 "$1,816.00" 671.19 - " 1,452.80 " - " 1,254.86 " 360.51 " 1,254.86 " - " 1,003.34 " 353.64 " 1,198.56 " - - " 1,202.01 " 309.01 343.34 402.54 503.17 351.92 353.64 343.34 " 1,452.80 " 314.16 - " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 64201077 NEG PRESS WND TX DISP >50 SQCM 97608 420 "$1,816.00" 671.19 - " 1,452.80 " - " 1,254.86 " 360.51 " 1,254.86 " - " 1,003.34 " 353.64 " 1,198.56 " - - " 1,202.01 " 309.01 343.34 402.54 503.17 351.92 353.64 343.34 " 1,452.80 " 314.16 - " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 64207172 NEG PRESS WND TX DISP >50 SQCM 97608 420 "$1,816.00" 671.19 - " 1,452.80 " - " 1,254.86 " 360.51 " 1,254.86 " - " 1,003.34 " 353.64 " 1,198.56 " - - " 1,202.01 " 309.01 343.34 402.54 503.17 351.92 353.64 343.34 " 1,452.80 " 314.16 - " 1,216.72 " 302.14 742.74 " 1,362.00 " 690.26 812.30 355.36 29107181 LOW FREQUENCY ULTRASOUND 97610 430 $943.00 348.53 - 754.40 - 651.61 187.30 651.61 - 521.01 183.73 622.38 - - 624.17 160.54 178.38 469.66 587.07 182.84 183.73 178.38 754.40 163.22 - 631.81 156.97 385.69 707.25 358.43 421.80 184.62 29207186 LOW FREQUENCY ULTRASOUND 97610 420 $943.00 348.53 - 754.40 - 651.61 187.30 651.61 - 521.01 183.73 622.38 - - 624.17 160.54 178.38 469.66 587.07 182.84 183.73 178.38 754.40 163.22 - 631.81 156.97 385.69 707.25 358.43 421.80 184.62 29221391 LOW FREQUENCY ULTRASOUND 97610 940 $943.00 348.53 - 754.40 - 651.61 187.30 651.61 - 521.01 183.73 622.38 - - 624.17 160.54 178.38 469.66 587.07 182.84 183.73 178.38 754.40 163.22 - 631.81 156.97 385.69 707.25 358.43 421.80 184.62 29507180 LOW FREQUENCY ULTRASOUND 97610 420 $943.00 348.53 - 754.40 - 651.61 187.30 651.61 - 521.01 183.73 622.38 - - 624.17 160.54 178.38 469.66 587.07 182.84 183.73 178.38 754.40 163.22 - 631.81 156.97 385.69 707.25 358.43 421.80 184.62 29585920 LOW FREQUENCY ULTRASOUND 97610 940 $943.00 348.53 - 754.40 - 651.61 187.30 651.61 - 521.01 183.73 622.38 - - 624.17 160.54 178.38 469.66 587.07 182.84 183.73 178.38 754.40 163.22 - 631.81 156.97 385.69 707.25 358.43 421.80 184.62 31900468 LOW FREQUENCY ULTRASOUND 97610 940 $943.00 348.53 - 754.40 - 651.61 187.30 651.61 - 521.01 183.73 622.38 - - 624.17 160.54 178.38 469.66 587.07 182.84 183.73 178.38 754.40 163.22 - 631.81 156.97 385.69 707.25 358.43 421.80 184.62 31907187 LOW FREQUENCY ULTRASOUND 97610 420 $943.00 348.53 - 754.40 - 651.61 187.30 651.61 - 521.01 183.73 622.38 - - 624.17 160.54 178.38 469.66 587.07 182.84 183.73 178.38 754.40 163.22 - 631.81 156.97 385.69 707.25 358.43 421.80 184.62 64201085 LOW FREQUENCY ULTRASOUND 97610 940 $943.00 348.53 - 754.40 - 651.61 187.30 651.61 - 521.01 183.73 622.38 - - 624.17 160.54 178.38 469.66 587.07 182.84 183.73 178.38 754.40 163.22 - 631.81 156.97 385.69 707.25 358.43 421.80 184.62 64207181 LOW FREQUENCY ULTRASOUND 97610 420 $943.00 348.53 - 754.40 - 651.61 187.30 651.61 - 521.01 183.73 622.38 - - 624.17 160.54 178.38 469.66 587.07 182.84 183.73 178.38 754.40 163.22 - 631.81 156.97 385.69 707.25 358.43 421.80 184.62 29120986 PHYS PERFORMANCE TEST 15 MIN 97750 430 $175.00 64.68 - 140.00 - 120.93 34.73 120.93 - 96.69 34.07 115.50 - - 115.83 29.77 33.08 65.70 82.12 33.91 34.07 33.08 140.00 30.27 - 117.25 29.11 71.58 131.25 66.52 78.28 34.24 29221405 PHYS PERFORMANCE TEST 15 MIN 97750 420 $175.00 64.68 - 140.00 - 120.93 34.73 120.93 - 96.69 34.07 115.50 - - 115.83 29.77 33.08 65.70 82.12 33.91 34.07 33.08 140.00 30.27 - 117.25 29.11 71.58 131.25 66.52 78.28 34.24 29585938 PHYS PERFORMANCE TEST 15 MIN 97750 420 $175.00 64.68 - 140.00 - 120.93 34.73 120.93 - 96.69 34.07 115.50 - - 115.83 29.77 33.08 65.70 82.12 33.91 34.07 33.08 140.00 30.27 - 117.25 29.11 71.58 131.25 66.52 78.28 34.24 31900476 PHYS PERFORMANCE TEST 15 MIN 97750 420 $175.00 64.68 - 140.00 - 120.93 34.73 120.93 - 96.69 34.07 115.50 - - 115.83 29.77 33.08 65.70 82.12 33.91 34.07 33.08 140.00 30.27 - 117.25 29.11 71.58 131.25 66.52 78.28 34.24 64200160 PHYS PERFORMANCE TEST 15 MIN 97750 420 $175.00 64.68 - 140.00 - 120.93 34.73 120.93 - 96.69 34.07 115.50 - - 115.83 29.77 33.08 65.70 82.12 33.91 34.07 33.08 140.00 30.27 - 117.25 29.11 71.58 131.25 66.52 78.28 34.24 29121222 ASSIST TECHNO ASSESS 15 MIN 97755 430 $198.00 73.18 - 158.40 - 136.82 39.55 136.82 - 109.40 38.80 130.68 - - 131.06 33.90 37.67 71.88 89.85 38.61 38.80 37.67 158.40 34.47 - 132.66 33.15 80.98 148.50 75.26 88.57 38.99 29221456 ASSIST TECHNO ASSESS 15 MIN 97755 420 $198.00 73.18 - 158.40 - 136.82 39.55 136.82 - 109.40 38.80 130.68 - - 131.06 33.90 37.67 71.88 89.85 38.61 38.80 37.67 158.40 34.47 - 132.66 33.15 80.98 148.50 75.26 88.57 38.99 29585971 ASSIST TECHNO ASSESS 15 MIN 97755 420 $198.00 73.18 - 158.40 - 136.82 39.55 136.82 - 109.40 38.80 130.68 - - 131.06 33.90 37.67 71.88 89.85 38.61 38.80 37.67 158.40 34.47 - 132.66 33.15 80.98 148.50 75.26 88.57 38.99 31900972 ASSIST TECHNO ASSESS 15 MIN 97755 420 $198.00 73.18 - 158.40 - 136.82 39.55 136.82 - 109.40 38.80 130.68 - - 131.06 33.90 37.67 71.88 89.85 38.61 38.80 37.67 158.40 34.47 - 132.66 33.15 80.98 148.50 75.26 88.57 38.99 64200887 ASSIST TECHNO ASSESS 15 MIN 97755 420 $198.00 73.18 - 158.40 - 136.82 39.55 136.82 - 109.40 38.80 130.68 - - 131.06 33.90 37.67 71.88 89.85 38.61 38.80 37.67 158.40 34.47 - 132.66 33.15 80.98 148.50 75.26 88.57 38.99 29120391 ORTHOTICS FIT/TRAIN 15 MIN 97760 430 $253.00 93.51 - 202.40 - 174.82 50.20 174.82 - 139.78 49.24 166.98 - - 167.46 43.03 47.81 141.79 177.24 49.01 49.24 47.81 202.40 43.75 - 169.51 42.07 103.48 189.75 96.17 113.17 49.48 29220581 ORTHOTICS FIT/TRAIN 15 MIN 97760 420 $253.00 93.51 - 202.40 - 174.82 50.20 174.82 - 139.78 49.24 166.98 - - 167.46 43.03 47.81 141.79 177.24 49.01 49.24 47.81 202.40 43.75 - 169.51 42.07 103.48 189.75 96.17 113.17 49.48 29585181 ORTHOTICS FIT/TRAIN 15 MIN 97760 420 $253.00 93.51 - 202.40 - 174.82 50.20 174.82 - 139.78 49.24 166.98 - - 167.46 43.03 47.81 141.79 177.24 49.01 49.24 47.81 202.40 43.75 - 169.51 42.07 103.48 189.75 96.17 113.17 49.48 31900484 ORTHOTICS FIT/TRAIN 15 MIN 97760 420 $253.00 93.51 - 202.40 - 174.82 50.20 174.82 - 139.78 49.24 166.98 - - 167.46 43.03 47.81 141.79 177.24 49.01 49.24 47.81 202.40 43.75 - 169.51 42.07 103.48 189.75 96.17 113.17 49.48 64200178 ORTHOTICS FIT/TRAIN 15 MIN 97760 420 $253.00 93.51 - 202.40 - 174.82 50.20 174.82 - 139.78 49.24 166.98 - - 167.46 43.03 47.81 141.79 177.24 49.01 49.24 47.81 202.40 43.75 - 169.51 42.07 103.48 189.75 96.17 113.17 49.48 29121231 PROSTHETIC TRAINING 15 MIN 97761 430 $215.00 79.46 - 172.00 - 148.57 43.04 148.57 - 118.79 42.22 141.90 - - 142.31 36.89 40.99 130.53 163.16 42.01 42.22 40.99 172.00 37.51 - 144.05 36.07 87.94 161.25 81.72 96.17 42.42 29210144 PROSTHETIC TRAINING 15 MIN 97761 420 $215.00 79.46 - 172.00 - 148.57 43.04 148.57 - 118.79 42.22 141.90 - - 142.31 36.89 40.99 130.53 163.16 42.01 42.22 40.99 172.00 37.51 - 144.05 36.07 87.94 161.25 81.72 96.17 42.42 29585041 PROSTHETIC TRAINING 15 MIN 97761 420 $215.00 79.46 - 172.00 - 148.57 43.04 148.57 - 118.79 42.22 141.90 - - 142.31 36.89 40.99 130.53 163.16 42.01 42.22 40.99 172.00 37.51 - 144.05 36.07 87.94 161.25 81.72 96.17 42.42 31900492 PROSTHETIC TRAINING 15 MIN 97761 420 $215.00 79.46 - 172.00 - 148.57 43.04 148.57 - 118.79 42.22 141.90 - - 142.31 36.89 40.99 130.53 163.16 42.01 42.22 40.99 172.00 37.51 - 144.05 36.07 87.94 161.25 81.72 96.17 42.42 64200186 PROSTHETIC TRAINING 15 MIN 97761 420 $215.00 79.46 - 172.00 - 148.57 43.04 148.57 - 118.79 42.22 141.90 - - 142.31 36.89 40.99 130.53 163.16 42.01 42.22 40.99 172.00 37.51 - 144.05 36.07 87.94 161.25 81.72 96.17 42.42 29107190 ORTHC/PROSTC MGMT SBSQ 15 MIN 97763 430 $277.00 102.38 - 282.54 - 191.41 55.62 191.41 - 153.04 54.56 182.82 - - 183.35 47.67 52.97 226.03 282.54 54.29 54.56 52.97 221.60 48.47 - 185.59 46.61 113.29 207.75 105.29 123.90 54.82 29120081 ORTHC/PROSTC MGMT SBSQ 15 MIN 97763 430 $277.00 102.38 - 282.54 - 191.41 55.62 191.41 - 153.04 54.56 182.82 - - 183.35 47.67 52.97 226.03 282.54 54.29 54.56 52.97 221.60 48.47 - 185.59 46.61 113.29 207.75 105.29 123.90 54.82 29207194 ORTHC/PROSTC MGMT SBSQ 15 MIN 97763 420 $277.00 102.38 - 282.54 - 191.41 55.62 191.41 - 153.04 54.56 182.82 - - 183.35 47.67 52.97 226.03 282.54 54.29 54.56 52.97 221.60 48.47 - 185.59 46.61 113.29 207.75 105.29 123.90 54.82 29220441 ORTHC/PROSTC MGMT SBSQ 15 MIN 97763 420 $277.00 102.38 - 282.54 - 191.41 55.62 191.41 - 153.04 54.56 182.82 - - 183.35 47.67 52.97 226.03 282.54 54.29 54.56 52.97 221.60 48.47 - 185.59 46.61 113.29 207.75 105.29 123.90 54.82 29507198 ORTHC/PROSTC MGMT SBSQ 15 MIN 97763 420 $277.00 102.38 - 282.54 - 191.41 55.62 191.41 - 153.04 54.56 182.82 - - 183.35 47.67 52.97 226.03 282.54 54.29 54.56 52.97 221.60 48.47 - 185.59 46.61 113.29 207.75 105.29 123.90 54.82 29585113 ORTHC/PROSTC MGMT SBSQ 15 MIN 97763 420 $277.00 102.38 - 282.54 - 191.41 55.62 191.41 - 153.04 54.56 182.82 - - 183.35 47.67 52.97 226.03 282.54 54.29 54.56 52.97 221.60 48.47 - 185.59 46.61 113.29 207.75 105.29 123.90 54.82 31900506 ORTHC/PROSTC MGMT SBSQ 15 MIN 97763 420 $277.00 102.38 - 282.54 - 191.41 55.62 191.41 - 153.04 54.56 182.82 - - 183.35 47.67 52.97 226.03 282.54 54.29 54.56 52.97 221.60 48.47 - 185.59 46.61 113.29 207.75 105.29 123.90 54.82 31907195 ORTHC/PROSTC MGMT SBSQ 15 MIN 97763 420 $277.00 102.38 - 282.54 - 191.41 55.62 191.41 - 153.04 54.56 182.82 - - 183.35 47.67 52.97 226.03 282.54 54.29 54.56 52.97 221.60 48.47 - 185.59 46.61 113.29 207.75 105.29 123.90 54.82 64200283 ORTHC/PROSTC MGMT SBSQ 15 MIN 97763 420 $277.00 102.38 - 282.54 - 191.41 55.62 191.41 - 153.04 54.56 182.82 - - 183.35 47.67 52.97 226.03 282.54 54.29 54.56 52.97 221.60 48.47 - 185.59 46.61 113.29 207.75 105.29 123.90 54.82 64207199 ORTHC/PROSTC MGMT SBSQ 15 MIN 97763 420 $277.00 102.38 - 282.54 - 191.41 55.62 191.41 - 153.04 54.56 182.82 - - 183.35 47.67 52.97 226.03 282.54 54.29 54.56 52.97 221.60 48.47 - 185.59 46.61 113.29 207.75 105.29 123.90 54.82 28700156 MNT TX 15 MIN 97802 942 $58.00 21.44 - 69.55 - 40.08 33.55 40.08 - 32.05 32.91 38.28 - - 38.39 28.76 31.95 55.64 69.55 32.75 32.91 31.95 46.40 29.23 - 38.86 28.12 23.72 43.50 22.05 25.94 33.07 28700229 CH OBSTY MNT TX 15 MIN 97802 942 $58.00 21.44 - 69.55 - 40.08 33.55 40.08 - 32.05 32.91 38.28 - - 38.39 28.76 31.95 55.64 69.55 32.75 32.91 31.95 46.40 29.23 - 38.86 28.12 23.72 43.50 22.05 25.94 33.07 34800146 MNT TX 15 MIN 97802 942 $58.00 21.44 - 69.55 - 40.08 33.55 40.08 - 32.05 32.91 38.28 - - 38.39 28.76 31.95 55.64 69.55 32.75 32.91 31.95 46.40 29.23 - 38.86 28.12 23.72 43.50 22.05 25.94 33.07 28700164 MNT RE-ASSESS 15 MIN 97803 942 $58.00 21.44 - 69.55 - 40.08 28.60 40.08 - 32.05 28.06 38.28 - - 38.39 24.52 27.24 55.64 69.55 27.92 28.06 27.24 46.40 24.92 - 38.86 23.97 23.72 43.50 22.05 25.94 28.19 28700253 CH OBSTY MNT RE-ASSESS 15 MIN 97803 942 $58.00 21.44 - 69.55 - 40.08 28.60 40.08 - 32.05 28.06 38.28 - - 38.39 24.52 27.24 55.64 69.55 27.92 28.06 27.24 46.40 24.92 - 38.86 23.97 23.72 43.50 22.05 25.94 28.19 34800171 MNT RE-ASSESS 15 MIN 97803 942 $58.00 21.44 - 69.55 - 40.08 28.60 40.08 - 32.05 28.06 38.28 - - 38.39 24.52 27.24 55.64 69.55 27.92 28.06 27.24 46.40 24.92 - 38.86 23.97 23.72 43.50 22.05 25.94 28.19 28700172 MNT GRP 30 MIN 97804 942 $80.00 29.57 - 64.00 - 55.28 15.89 55.28 - 44.20 15.58 52.80 - - 52.95 13.62 15.13 21.92 27.40 15.51 15.58 15.13 64.00 13.84 - 53.60 13.31 32.72 60.00 30.41 35.78 15.66 34800201 MNT GRP 30 MIN 97804 942 $80.00 29.57 - 64.00 - 55.28 15.89 55.28 - 44.20 15.58 52.80 - - 52.95 13.62 15.13 21.92 27.40 15.51 15.58 15.13 64.00 13.84 - 53.60 13.31 32.72 60.00 30.41 35.78 15.66 28902026 TELEPHONE VST NON-PHYS 5-10MN 98966 440 $66.00 24.39 - 118.70 - 45.61 11.79 45.61 - 36.47 11.57 43.56 - - 43.69 10.11 11.23 94.96 118.70 11.51 11.57 11.23 52.80 10.28 - 44.22 9.88 26.99 49.50 25.09 29.52 11.62 29100004 TELEPHONE VST NON-PHYS 5-10MN 98966 430 $66.00 24.39 - 118.70 - 45.61 11.79 45.61 - 36.47 11.57 43.56 - - 43.69 10.11 11.23 94.96 118.70 11.51 11.57 11.23 52.80 10.28 - 44.22 9.88 26.99 49.50 25.09 29.52 11.62 29203008 TELEPHONE VST NON-PHYS 5-10MN 98966 420 $66.00 24.39 - 118.70 - 45.61 11.79 45.61 - 36.47 11.57 43.56 - - 43.69 10.11 11.23 94.96 118.70 11.51 11.57 11.23 52.80 10.28 - 44.22 9.88 26.99 49.50 25.09 29.52 11.62 29502021 TELEPHONE VST NON-PHYS 5-10MN 98966 420 $66.00 24.39 - 118.70 - 45.61 11.79 45.61 - 36.47 11.57 43.56 - - 43.69 10.11 11.23 94.96 118.70 11.51 11.57 11.23 52.80 10.28 - 44.22 9.88 26.99 49.50 25.09 29.52 11.62 31902029 TELEPHONE VST NON-PHYS 5-10MN 98966 420 $66.00 24.39 - 118.70 - 45.61 11.79 45.61 - 36.47 11.57 43.56 - - 43.69 10.11 11.23 94.96 118.70 11.51 11.57 11.23 52.80 10.28 - 44.22 9.88 26.99 49.50 25.09 29.52 11.62 64202022 TELEPHONE VST NON-PHYS 5-10MN 98966 420 $66.00 24.39 - 118.70 - 45.61 11.79 45.61 - 36.47 11.57 43.56 - - 43.69 10.11 11.23 94.96 118.70 11.51 11.57 11.23 52.80 10.28 - 44.22 9.88 26.99 49.50 25.09 29.52 11.62 28902034 TELEPHONE VST NON-PHYS 11-20MN 98967 440 $131.00 48.42 - 223.50 - 90.52 22.91 90.52 - 72.38 22.47 86.46 - - 86.71 19.64 21.82 178.80 223.50 22.37 22.47 21.82 104.80 19.97 - 87.77 19.20 53.58 98.25 49.79 58.60 22.58 29100012 TELEPHONE VST NON-PHYS 11-20MN 98967 430 $131.00 48.42 - 223.50 - 90.52 22.91 90.52 - 72.38 22.47 86.46 - - 86.71 19.64 21.82 178.80 223.50 22.37 22.47 21.82 104.80 19.97 - 87.77 19.20 53.58 98.25 49.79 58.60 22.58 29203016 TELEPHONE VST NON-PHYS 11-20MN 98967 420 $131.00 48.42 - 223.50 - 90.52 22.91 90.52 - 72.38 22.47 86.46 - - 86.71 19.64 21.82 178.80 223.50 22.37 22.47 21.82 104.80 19.97 - 87.77 19.20 53.58 98.25 49.79 58.60 22.58 29502030 TELEPHONE VST NON-PHYS 11-20MN 98967 420 $131.00 48.42 - 223.50 - 90.52 22.91 90.52 - 72.38 22.47 86.46 - - 86.71 19.64 21.82 178.80 223.50 22.37 22.47 21.82 104.80 19.97 - 87.77 19.20 53.58 98.25 49.79 58.60 22.58 31902037 TELEPHONE VST NON-PHYS 11-20MN 98967 420 $131.00 48.42 - 223.50 - 90.52 22.91 90.52 - 72.38 22.47 86.46 - - 86.71 19.64 21.82 178.80 223.50 22.37 22.47 21.82 104.80 19.97 - 87.77 19.20 53.58 98.25 49.79 58.60 22.58 64202031 TELEPHONE VST NON-PHYS 11-20MN 98967 420 $131.00 48.42 - 223.50 - 90.52 22.91 90.52 - 72.38 22.47 86.46 - - 86.71 19.64 21.82 178.80 223.50 22.37 22.47 21.82 104.80 19.97 - 87.77 19.20 53.58 98.25 49.79 58.60 22.58 28902042 TELEPHONE VST NON-PHYS 21-30MN 98968 440 $195.00 72.07 - 331.70 - 134.75 33.32 134.75 - 107.74 32.68 128.70 - - 129.07 28.56 31.73 265.36 331.70 32.52 32.68 31.73 156.00 29.03 - 130.65 27.92 79.76 146.25 74.12 87.22 32.84 29100021 TELEPHONE VST NON-PHYS 21-30MN 98968 430 $195.00 72.07 - 331.70 - 134.75 33.32 134.75 - 107.74 32.68 128.70 - - 129.07 28.56 31.73 265.36 331.70 32.52 32.68 31.73 156.00 29.03 - 130.65 27.92 79.76 146.25 74.12 87.22 32.84 29203024 TELEPHONE VST NON-PHYS 21-30MN 98968 420 $195.00 72.07 - 331.70 - 134.75 33.32 134.75 - 107.74 32.68 128.70 - - 129.07 28.56 31.73 265.36 331.70 32.52 32.68 31.73 156.00 29.03 - 130.65 27.92 79.76 146.25 74.12 87.22 32.84 29502048 TELEPHONE VST NON-PHYS 21-30MN 98968 420 $195.00 72.07 - 331.70 - 134.75 33.32 134.75 - 107.74 32.68 128.70 - - 129.07 28.56 31.73 265.36 331.70 32.52 32.68 31.73 156.00 29.03 - 130.65 27.92 79.76 146.25 74.12 87.22 32.84 31902045 TELEPHONE VST NON-PHYS 21-30MN 98968 420 $195.00 72.07 - 331.70 - 134.75 33.32 134.75 - 107.74 32.68 128.70 - - 129.07 28.56 31.73 265.36 331.70 32.52 32.68 31.73 156.00 29.03 - 130.65 27.92 79.76 146.25 74.12 87.22 32.84 64202049 TELEPHONE VST NON-PHYS 21-30MN 98968 420 $195.00 72.07 - 331.70 - 134.75 33.32 134.75 - 107.74 32.68 128.70 - - 129.07 28.56 31.73 265.36 331.70 32.52 32.68 31.73 156.00 29.03 - 130.65 27.92 79.76 146.25 74.12 87.22 32.84 36000171 DAU COLLECTION 99001 300 $64.00 23.65 - 51.20 - 44.22 N/A 44.22 - 35.36 N/A 42.24 - N/A 42.36 - N/A 24.71 30.89 N/A N/A N/A 51.20 N/A - 42.88 N/A 26.18 48.00 24.33 28.63 N/A 36301660 TB PANEL SENS-PROCESSING FEE 99001 300 $64.00 23.65 - 51.20 - 44.22 N/A 44.22 - 35.36 N/A 42.24 - N/A 42.36 - N/A 24.71 30.89 N/A N/A N/A 51.20 N/A - 42.88 N/A 26.18 48.00 24.33 28.63 N/A 36601141 STAINED SLIDE; HANDLING 99001 300 $64.00 23.65 - 51.20 - 44.22 N/A 44.22 - 35.36 N/A 42.24 - N/A 42.36 - N/A 24.71 30.89 N/A N/A N/A 51.20 N/A - 42.88 N/A 26.18 48.00 24.33 28.63 N/A 36601159 UNSTAINED SLIDE; HANDLING 99001 300 $64.00 23.65 - 51.20 - 44.22 N/A 44.22 - 35.36 N/A 42.24 - N/A 42.36 - N/A 24.71 30.89 N/A N/A N/A 51.20 N/A - 42.88 N/A 26.18 48.00 24.33 28.63 N/A 36980010 PROCESSING FEE 99001 300 $64.00 23.65 - 51.20 - 44.22 N/A 44.22 - 35.36 N/A 42.24 - N/A 42.36 - N/A 24.71 30.89 N/A N/A N/A 51.20 N/A - 42.88 N/A 26.18 48.00 24.33 28.63 N/A 36980028 FROZEN PROCESSING FEE 99001 300 $64.00 23.65 - 51.20 - 44.22 N/A 44.22 - 35.36 N/A 42.24 - N/A 42.36 - N/A 24.71 30.89 N/A N/A N/A 51.20 N/A - 42.88 N/A 26.18 48.00 24.33 28.63 N/A 30610971 MOD CS SAME QHP<5YR 1ST 15MIN 99151 370 $271.00 100.16 - 216.80 21.87 187.26 - 187.26 22.25 149.73 - 178.86 21.30 19.81 179.37 - - 143.60 179.51 - - - 216.80 - 19.02 181.57 - 110.84 203.25 103.01 121.22 - 37004219 MOD CS SAME QHP<5YR 1ST 15MIN 99151 370 $271.00 100.16 - 216.80 21.87 187.26 - 187.26 22.25 149.73 - 178.86 21.30 19.81 179.37 - - 143.60 179.51 - - - 216.80 - 19.02 181.57 - 110.84 203.25 103.01 121.22 - 80335903 MOD CS SAME QHP< 5YR 1ST 15MIN 99151 370 $271.00 100.16 - 216.80 21.87 187.26 - 187.26 22.25 149.73 - 178.86 21.30 19.81 179.37 - - 143.60 179.51 - - - 216.80 - 19.02 181.57 - 110.84 203.25 103.01 121.22 - 80535902 MOD CS SAME QHP< 5YR 1ST 15MIN 99151 370 $271.00 100.16 - 216.80 21.87 187.26 - 187.26 22.25 149.73 - 178.86 21.30 19.81 179.37 - - 143.60 179.51 - - - 216.80 - 19.02 181.57 - 110.84 203.25 103.01 121.22 - 80635907 MOD CS SAME QHP< 5YR 1ST 15MIN 99151 370 $271.00 100.16 - 216.80 21.87 187.26 - 187.26 22.25 149.73 - 178.86 21.30 19.81 179.37 - - 143.60 179.51 - - - 216.80 - 19.02 181.57 - 110.84 203.25 103.01 121.22 - 29812918 MOD CS SAME QHP>5YR 1ST 15MIN 99152 370 $102.00 37.70 - 81.60 11.39 70.48 - 70.48 11.58 56.36 - 67.32 11.09 10.31 67.51 - - 54.05 67.56 - - - 81.60 - 9.90 68.34 - 41.72 76.50 38.77 45.62 - 30610989 MOD CS SAME QHP>5YR 1ST 15MIN 99152 370 $102.00 37.70 - 81.60 11.39 70.48 - 70.48 11.58 56.36 - 67.32 11.09 10.31 67.51 - - 54.05 67.56 - - - 81.60 - 9.90 68.34 - 41.72 76.50 38.77 45.62 - 37004227 MOD CS SAME QHP>5YR 1ST 15MIN 99152 370 $102.00 37.70 - 81.60 11.39 70.48 - 70.48 11.58 56.36 - 67.32 11.09 10.31 67.51 - - 54.05 67.56 - - - 81.60 - 9.90 68.34 - 41.72 76.50 38.77 45.62 - 80235917 MOD CS SAME QHP> 5YR 1ST 15MIN 99152 370 $102.00 37.70 - 81.60 11.39 70.48 - 70.48 11.58 56.36 - 67.32 11.09 10.31 67.51 - - 54.05 67.56 - - - 81.60 - 9.90 68.34 - 41.72 76.50 38.77 45.62 - 80335911 MOD CS SAME QHP> 5YR 1ST 15MIN 99152 370 $102.00 37.70 - 81.60 11.39 70.48 - 70.48 11.58 56.36 - 67.32 11.09 10.31 67.51 - - 54.05 67.56 - - - 81.60 - 9.90 68.34 - 41.72 76.50 38.77 45.62 - 80535911 MOD CS SAME QHP> 5YR 1ST 15MIN 99152 370 $102.00 37.70 - 81.60 11.39 70.48 - 70.48 11.58 56.36 - 67.32 11.09 10.31 67.51 - - 54.05 67.56 - - - 81.60 - 9.90 68.34 - 41.72 76.50 38.77 45.62 - 80635915 MOD CS SAME QHP> 5YR 1ST 15MIN 99152 370 $102.00 37.70 - 81.60 11.39 70.48 - 70.48 11.58 56.36 - 67.32 11.09 10.31 67.51 - - 54.05 67.56 - - - 81.60 - 9.90 68.34 - 41.72 76.50 38.77 45.62 - 29812926 MOD CS SAME QHP ADDL 15MIN 99153 370 $79.00 29.20 - 63.20 9.58 54.59 - 54.59 9.75 43.65 - 52.14 9.33 8.67 52.29 - - 41.86 52.33 - - - 63.20 - 8.33 52.93 - 32.31 59.25 30.03 35.34 - 30610997 MOD CS SAME QHP ADDL 15MIN 99153 370 $79.00 29.20 - 63.20 9.58 54.59 - 54.59 9.75 43.65 - 52.14 9.33 8.67 52.29 - - 41.86 52.33 - - - 63.20 - 8.33 52.93 - 32.31 59.25 30.03 35.34 - 37004235 MOD CS SAME QHP ADDL 15MIN 99153 370 $79.00 29.20 - 63.20 9.58 54.59 - 54.59 9.75 43.65 - 52.14 9.33 8.67 52.29 - - 41.86 52.33 - - - 63.20 - 8.33 52.93 - 32.31 59.25 30.03 35.34 - 80235925 MOD CS SAME QHP ADD 15MIN 99153 370 $79.00 29.20 - 63.20 9.58 54.59 - 54.59 9.75 43.65 - 52.14 9.33 8.67 52.29 - - 41.86 52.33 - - - 63.20 - 8.33 52.93 - 32.31 59.25 30.03 35.34 - 80335920 MOD CS SAME QHP ADD 15MIN 99153 370 $79.00 29.20 - 63.20 9.58 54.59 - 54.59 9.75 43.65 - 52.14 9.33 8.67 52.29 - - 41.86 52.33 - - - 63.20 - 8.33 52.93 - 32.31 59.25 30.03 35.34 - 80535929 MOD CS SAME QHP ADD 15MIN 99153 370 $79.00 29.20 - 63.20 9.58 54.59 - 54.59 9.75 43.65 - 52.14 9.33 8.67 52.29 - - 41.86 52.33 - - - 63.20 - 8.33 52.93 - 32.31 59.25 30.03 35.34 - 80635923 MOD CS SAME QHP ADD 15MIN 99153 370 $79.00 29.20 - 63.20 9.58 54.59 - 54.59 9.75 43.65 - 52.14 9.33 8.67 52.29 - - 41.86 52.33 - - - 63.20 - 8.33 52.93 - 32.31 59.25 30.03 35.34 - 37004243 MOD CS OTH QHP <5YR 1ST 15MIN 99155 370 $128.00 47.31 - 102.40 85.65 88.45 - 88.45 87.14 70.72 - 84.48 83.42 77.56 84.72 - - 67.83 84.79 - - - 102.40 - 74.48 85.76 - 52.35 96.00 48.65 57.25 - 80335938 MOD CS OTH QHP< 5YR 1ST 15MIN 99155 370 $128.00 47.31 - 102.40 85.65 88.45 - 88.45 87.14 70.72 - 84.48 83.42 77.56 84.72 - - 67.83 84.79 - - - 102.40 - 74.48 85.76 - 52.35 96.00 48.65 57.25 - 80535937 MOD CS OTH QHP< 5YR 1ST 15MIN 99155 370 $128.00 47.31 - 102.40 85.65 88.45 - 88.45 87.14 70.72 - 84.48 83.42 77.56 84.72 - - 67.83 84.79 - - - 102.40 - 74.48 85.76 - 52.35 96.00 48.65 57.25 - 80635931 MOD CS OTH QHP< 5YR 1ST 15MIN 99155 370 $128.00 47.31 - 102.40 85.65 88.45 - 88.45 87.14 70.72 - 84.48 83.42 77.56 84.72 - - 67.83 84.79 - - - 102.40 - 74.48 85.76 - 52.35 96.00 48.65 57.25 - 37004251 MOD CS OTH QHP >5YR 1ST 15MIN 99156 370 $307.00 113.47 - 245.60 70.27 212.14 - 212.14 71.49 169.62 - 202.62 68.43 63.62 203.20 - - 162.68 203.36 - - - 245.60 - 61.10 205.69 - 125.56 230.25 116.69 137.32 - 80335946 MOD CS OTH QHP> 5YR 1ST 15MIN 99156 370 $307.00 113.47 - 245.60 70.27 212.14 - 212.14 71.49 169.62 - 202.62 68.43 63.62 203.20 - - 162.68 203.36 - - - 245.60 - 61.10 205.69 - 125.56 230.25 116.69 137.32 - 80535945 MOD CS OTH QHP> 5YR 1ST 15MIN 99156 370 $307.00 113.47 - 245.60 70.27 212.14 - 212.14 71.49 169.62 - 202.62 68.43 63.62 203.20 - - 162.68 203.36 - - - 245.60 - 61.10 205.69 - 125.56 230.25 116.69 137.32 - 80635940 MOD CS OTH QHP> 5YR 1ST 15MIN 99156 370 $307.00 113.47 - 245.60 70.27 212.14 - 212.14 71.49 169.62 - 202.62 68.43 63.62 203.20 - - 162.68 203.36 - - - 245.60 - 61.10 205.69 - 125.56 230.25 116.69 137.32 - 37004260 MOD CS OTH QHP ADDL 15MIN 99157 370 $131.00 48.42 - 104.80 53.26 90.52 - 90.52 54.18 72.38 - 86.46 51.87 48.22 86.71 - - 69.42 86.77 - - - 104.80 - 46.31 87.77 - 53.58 98.25 49.79 58.60 - 80335954 MOD CS OTH QHP ADD 15MIN 99157 370 $131.00 48.42 - 104.80 53.26 90.52 - 90.52 54.18 72.38 - 86.46 51.87 48.22 86.71 - - 69.42 86.77 - - - 104.80 - 46.31 87.77 - 53.58 98.25 49.79 58.60 - 80535953 MOD CS OTH QHP ADD 15MIN 99157 370 $131.00 48.42 - 104.80 53.26 90.52 - 90.52 54.18 72.38 - 86.46 51.87 48.22 86.71 - - 69.42 86.77 - - - 104.80 - 46.31 87.77 - 53.58 98.25 49.79 58.60 - 80635958 MOD CS OTH QHP ADD 15MIN 99157 370 $131.00 48.42 - 104.80 53.26 90.52 - 90.52 54.18 72.38 - 86.46 51.87 48.22 86.71 - - 69.42 86.77 - - - 104.80 - 46.31 87.77 - 53.58 98.25 49.79 58.60 - 21090387 HEAD OR BODY HYPOTHERMIA 99184 940 $875.00 323.40 - 841.04 - 604.63 N/A 604.63 - 483.44 N/A 577.50 - N/A 579.16 - N/A 672.83 841.04 N/A N/A N/A 700.00 N/A - 586.25 N/A 357.88 656.25 332.59 391.39 N/A 09700021 THERAPEUTIC PHLEBOTOMY 99195 940 $588.00 217.32 10.00 470.40 11.50 406.31 117.61 406.31 11.70 324.87 115.37 388.08 11.20 10.41 389.20 100.81 112.01 226.22 282.77 114.81 115.37 112.01 470.40 102.49 10.00 393.96 98.57 240.49 441.00 223.50 263.01 115.93 27700594 THERAPEUTIC PHLEBOTOMY 99195 940 $588.00 217.32 10.00 470.40 11.50 406.31 117.61 406.31 11.70 324.87 115.37 388.08 11.20 10.41 389.20 100.81 112.01 226.22 282.77 114.81 115.37 112.01 470.40 102.49 10.00 393.96 98.57 240.49 441.00 223.50 263.01 115.93 39100690 FETAL MONITOR CHARGE PER HOUR 99199 929 $894.00 330.42 - 715.20 - 617.75 N/A 617.75 - 493.94 N/A 590.04 - N/A 591.74 - N/A 24.71 30.89 N/A N/A N/A 715.20 N/A - 598.98 N/A 365.65 670.50 339.81 399.89 N/A 37002950 EMERGENT LVL 1 99281 450 $381.00 140.82 16.19 915.00 18.62 915.00 75.65 915.00 18.95 210.50 74.21 251.46 17.81 16.86 252.18 64.85 72.05 236.08 295.10 73.85 74.21 72.05 304.80 65.93 16.19 255.27 63.40 155.83 285.75 144.82 170.42 74.57 37002054 EMERGENT LVL 2 99282 450 $691.00 255.39 26.85 915.00 30.88 915.00 137.00 915.00 31.40 381.78 134.39 456.06 29.54 27.96 457.37 117.43 130.48 357.44 446.80 133.74 134.39 130.48 552.80 119.39 26.85 462.97 114.82 282.62 518.25 262.65 309.08 135.05 37002062 EMERGENT LVL 3 99283 450 "$1,216.00" 449.43 35.00 " 1,330.00 " 40.25 " 1,330.00 " 241.37 " 1,330.00 " 40.95 671.84 236.78 802.56 38.50 36.45 804.87 206.89 229.88 480.79 600.99 235.63 236.78 229.88 972.80 210.34 35.00 814.72 202.29 497.34 912.00 462.20 543.92 237.93 37002071 EMERGENT LVL 4 99284 450 "$1,910.00" 705.94 50.00 " 1,553.00 " 57.50 " 1,553.00 " 379.43 " 1,553.00 " 58.50 " 1,055.28 " 372.20 " 1,260.60 " 55.00 52.07 " 1,264.23 " 325.22 361.36 611.03 763.79 370.39 372.20 361.36 " 1,528.00 " 330.64 50.00 " 1,279.70 " 318.00 781.19 " 1,432.50 " 725.99 854.34 374.01 37002089 EMERGENT LVL 5 99285 450 "$2,741.00" " 1,013.07 " 50.00 " 2,192.80 " 57.50 " 1,663.00 " 544.61 " 1,663.00 " 58.50 " 1,514.40 " 534.24 " 1,809.06 " 55.00 52.07 " 1,814.27 " 466.81 518.68 749.75 937.19 531.65 534.24 518.68 " 2,192.80 " 474.59 50.00 " 1,836.47 " 456.44 " 1,121.07 " " 2,055.75 " " 1,041.85 " " 1,226.05 " 536.83 37002097 CRITICAL CARE FIRST 30-74 MIN 99291 450 "$3,637.00" " 1,344.24 " 151.63 " 2,909.60 " 174.37 " 2,513.17 " 776.93 " 2,513.17 " 177.41 " 2,009.44 " 762.13 " 2,400.42 " 166.79 157.89 " 2,407.33 " 665.94 739.93 820.15 " 1,025.19 " 758.43 762.13 739.93 " 2,909.60 " 677.04 151.63 " 2,436.79 " 651.14 " 1,487.53 " " 2,727.75 " " 1,382.42 " " 1,626.83 " 765.83 37089419 CRITICAL CARE ADDL 30 MINS 99292 450 $410.00 151.54 - 385.50 85.56 283.31 - 283.31 87.05 226.53 - 270.60 81.84 77.47 271.38 - - 308.40 385.50 - - - 328.00 - 74.40 274.70 - 167.69 307.50 155.84 183.39 - 24700330 TOBACCO-USE COUNSEL 3-10 MIN 99406 410 $138.00 51.00 - 118.40 - 95.36 27.42 95.36 - 76.25 26.89 91.08 - - 91.34 23.50 26.11 94.72 118.40 26.76 26.89 26.11 110.40 23.89 - 92.46 22.98 56.44 103.50 52.45 61.73 27.02 24700003 TOBACCO-USE COUNSEL >10 MIN 99407 410 $138.00 51.00 19.33 233.80 22.23 95.36 27.42 95.36 22.62 76.25 26.89 91.08 21.65 20.13 91.34 23.50 26.11 187.04 233.80 26.76 26.89 26.11 110.40 23.89 19.33 92.46 22.98 56.44 103.50 52.45 61.73 27.02 10588391 0001A COVID19 1ST ADMIN PFIZER 0001A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 10688329 0001A COVID19 1ST ADMIN PFIZER 0001A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 11288391 0001A COVID19 1ST ADMIN PFIZER 0001A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 14088326 0001A COVID19 1ST ADMIN PFIZER 0001A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 15288345 0001A COVID19 1ST ADMIN PFIZER 0001A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 17188046 0001A COVID19 1ST ADMIN PFIZER 0001A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 17299913 0001A COVID19 1ST ADMIN PFIZER 0001A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 17399934 0001A COVID19 1ST ADMIN PFIZER 0001A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 18288028 0001A COVID19 1ST ADMIN PFIZER 0001A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 19000401 0001A COVID19 1ST ADMIN PFIZER 0001A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 19388310 0001A COVID19 1ST ADMIN PFIZER 0001A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 19488314 0001A COVID19 1ST ADMIN PFIZER 0001A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 24770907 0001A COVID19 1ST ADMIN PFIZER 0001A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 24970949 0001A COVID19 1ST ADMIN PFIZER 0001A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 25000374 0001A COVID19 1ST ADMIN PFIZER 0001A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 25400372 0001A COVID19 1ST ADMIN PFIZER 0001A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 29821283 0001A COVID19 1ST ADMIN PFIZER 0001A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 31202272 0001A COVID19 1ST ADMIN PFIZER 0001A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 31907217 0001A COVID19 1ST ADMIN PFIZER 0001A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 32900437 0001A COVID19 1ST ADMIN PFIZER 0001A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 33299869 0001A COVID19 1ST ADMIN PFIZER 0001A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 34500444 0001A COVID19 1ST ADMIN PFIZER 0001A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 37090361 0001A COVID19 1ST ADMIN PFIZER 0001A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 39190338 0001A COVID19 1ST ADMIN PFIZER 0001A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 43100271 0001A COVID19 1ST ADMIN PFIZER 0001A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 43900501 0001A COVID19 1ST ADMIN PFIZER 0001A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 45521141 0001A COVID19 1ST ADMIN PFIZER 0001A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 51600967 0001A COVID19 1ST ADMIN PFIZER 0001A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 64207211 0001A COVID19 1ST ADMIN PFIZER 0001A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 10588405 0002A COVID19 2ND ADMIN PFIZER 0002A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 10688337 0002A COVID19 2ND ADMIN PFIZER 0002A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 11288405 0002A COVID19 2ND ADMIN PFIZER 0002A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 14088334 0002A COVID19 2ND ADMIN PFIZER 0002A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 15288353 0002A COVID19 2ND ADMIN PFIZER 0002A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 17188054 0002A COVID19 2ND ADMIN PFIZER 0002A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 17299921 0002A COVID19 2ND ADMIN PFIZER 0002A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 17399942 0002A COVID19 2ND ADMIN PFIZER 0002A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 18288036 0002A COVID19 2ND ADMIN PFIZER 0002A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 19000419 0002A COVID19 2ND ADMIN PFIZER 0002A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 19388328 0002A COVID19 2ND ADMIN PFIZER 0002A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 19488322 0002A COVID19 2ND ADMIN PFIZER 0002A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 24770915 0002A COVID19 2ND ADMIN PFIZER 0002A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 24970957 0002A COVID19 2ND ADMIN PFIZER 0002A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 25000382 0002A COVID19 2ND ADMIN PFIZER 0002A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 25400381 0002A COVID19 2ND ADMIN PFIZER 0002A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 29821291 0002A COVID19 2ND ADMIN PFIZER 0002A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 31202281 0002A COVID19 2ND ADMIN PFIZER 0002A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 31907225 0002A COVID19 2ND ADMIN PFIZER 0002A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 32900445 0002A COVID19 2ND ADMIN PFIZER 0002A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 33299877 0002A COVID19 2ND ADMIN PFIZER 0002A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 34500452 0002A COVID19 2ND ADMIN PFIZER 0002A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 37090379 0002A COVID19 2ND ADMIN PFIZER 0002A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 39190346 0002A COVID19 2ND ADMIN PFIZER 0002A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 43100289 0002A COVID19 2ND ADMIN PFIZER 0002A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 43900510 0002A COVID19 2ND ADMIN PFIZER 0002A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 45521150 0002A COVID19 2ND ADMIN PFIZER 0002A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 51600975 0002A COVID19 2ND ADMIN PFIZER 0002A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 64207229 0002A COVID19 2ND ADMIN PFIZER 0002A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 10588464 0003A COVID19 BOOSTER PFIZER 0003A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 10688442 0003A COVID19 BOOSTER PFIZER 0003A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 11288464 0003A COVID19 BOOSTER PFIZER 0003A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 14088415 0003A COVID19 BOOSTER PFIZER 0003A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 15288418 0003A COVID19 BOOSTER PFIZER 0003A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 17188119 0003A COVID19 BOOSTER PFIZER 0003A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 17299891 0003A COVID19 BOOSTER PFIZER 0003A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 17390112 0003A COVID19 BOOSTER PFIZER 0003A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 18288095 0003A COVID19 BOOSTER PFIZER 0003A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 19000427 0003A COVID19 BOOSTER PFIZER 0003A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 19388425 0003A COVID19 BOOSTER PFIZER 0003A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 19488420 0003A COVID19 BOOSTER PFIZER 0003A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 24771041 0003A COVID19 BOOSTER PFIZER 0003A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 24971007 0003A COVID19 BOOSTER PFIZER 0003A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 25000633 0003A COVID19 BOOSTER PFIZER 0003A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 25400631 0003A COVID19 BOOSTER PFIZER 0003A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 29821330 0003A COVID19 BOOSTER PFIZER 0003A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 31202311 0003A COVID19 BOOSTER PFIZER 0003A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 31907250 0003A COVID19 BOOSTER PFIZER 0003A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 32900500 0003A COVID19 BOOSTER PFIZER 0003A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 33299907 0003A COVID19 BOOSTER PFIZER 0003A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 34500487 0003A COVID19 BOOSTER PFIZER 0003A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 37090671 0003A COVID19 BOOSTER PFIZER 0003A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 39190401 0003A COVID19 BOOSTER PFIZER 0003A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 43100319 0003A COVID19 BOOSTER PFIZER 0003A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 43900544 0003A COVID19 BOOSTER PFIZER 0003A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 45521184 0003A COVID19 BOOSTER PFIZER 0003A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 51601009 0003A COVID19 BOOSTER PFIZER 0003A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 64207253 0003A COVID19 BOOSTER PFIZER 0003A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 10588413 0011A COVID19 1STADMIN MODERNA 0011A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 10688345 0011A COVID19 1STADMIN MODERNA 0011A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 11288413 0011A COVID19 1STADMIN MODERNA 0011A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 14088342 0011A COVID19 1STADMIN MODERNA 0011A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 15288361 0011A COVID19 1STADMIN MODERNA 0011A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 17188062 0011A COVID19 1STADMIN MODERNA 0011A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 17299930 0011A COVID19 1STADMIN MODERNA 0011A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 17399951 0011A COVID19 1STADMIN MODERNA 0011A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 18288044 0011A COVID19 1STADMIN MODERNA 0011A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 19000346 0011A COVID19 1STADMIN MODERNA 0011A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 19388336 0011A COVID19 1STADMIN MODERNA 0011A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 19488331 0011A COVID19 1STADMIN MODERNA 0011A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 24770940 0011A COVID19 1STADMIN MODERNA 0011A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 24970965 0011A COVID19 1STADMIN MODERNA 0011A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 25000391 0011A COVID19 1STADMIN MODERNA 0011A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 25400399 0011A COVID19 1STADMIN MODERNA 0011A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 29821305 0011A COVID19 1STADMIN MODERNA 0011A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 31202299 0011A COVID19 1STADMIN MODERNA 0011A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 31907233 0011A COVID19 1STADMIN MODERNA 0011A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 32900453 0011A COVID19 1STADMIN MODERNA 0011A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 33299885 0011A COVID19 1STADMIN MODERNA 0011A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 34500461 0011A COVID19 1STADMIN MODERNA 0011A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 37090387 0011A COVID19 1STADMIN MODERNA 0011A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 39190354 0011A COVID19 1STADMIN MODERNA 0011A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 43100297 0011A COVID19 1STADMIN MODERNA 0011A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 43900528 0011A COVID19 1STADMIN MODERNA 0011A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 45521168 0011A COVID19 1STADMIN MODERNA 0011A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 51600983 0011A COVID19 1STADMIN MODERNA 0011A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 64207237 0011A COVID19 1STADMIN MODERNA 0011A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 10588421 0012A COVID19 2NDADMIN MODERNA 0012A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 10688400 0012A COVID19 2NDADMIN MODERNA 0012A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 11288421 0012A COVID19 2NDADMIN MODERNA 0012A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 14088351 0012A COVID19 2NDADMIN MODERNA 0012A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 15288400 0012A COVID19 2NDADMIN MODERNA 0012A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 17188071 0012A COVID19 2NDADMIN MODERNA 0012A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 17299948 0012A COVID19 2NDADMIN MODERNA 0012A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 17399969 0012A COVID19 2NDADMIN MODERNA 0012A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 18288052 0012A COVID19 2NDADMIN MODERNA 0012A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 19000354 0012A COVID19 2NDADMIN MODERNA 0012A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 19388344 0012A COVID19 2NDADMIN MODERNA 0012A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 19488349 0012A COVID19 2NDADMIN MODERNA 0012A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 24770958 0012A COVID19 2NDADMIN MODERNA 0012A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 24970973 0012A COVID19 2NDADMIN MODERNA 0012A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 25000404 0012A COVID19 2NDADMIN MODERNA 0012A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 25400402 0012A COVID19 2NDADMIN MODERNA 0012A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 29821313 0012A COVID19 2NDADMIN MODERNA 0012A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 31202302 0012A COVID19 2NDADMIN MODERNA 0012A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 31907241 0012A COVID19 2NDADMIN MODERNA 0012A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 32900496 0012A COVID19 2NDADMIN MODERNA 0012A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 33299893 0012A COVID19 2NDADMIN MODERNA 0012A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 34500479 0012A COVID19 2NDADMIN MODERNA 0012A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 37090395 0012A COVID19 2NDADMIN MODERNA 0012A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 39190362 0012A COVID19 2NDADMIN MODERNA 0012A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 43100301 0012A COVID19 2NDADMIN MODERNA 0012A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 43900536 0012A COVID19 2NDADMIN MODERNA 0012A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 45521176 0012A COVID19 2NDADMIN MODERNA 0012A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 51600991 0012A COVID19 2NDADMIN MODERNA 0012A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 64207245 0012A COVID19 2NDADMIN MODERNA 0012A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 10588472 0013A COVID19 BOOSTER MODERNA 0013A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 10688451 0013A COVID19 BOOSTER MODERNA 0013A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 11288472 0013A COVID19 BOOSTER MODERNA 0013A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 14088423 0013A COVID19 BOOSTER MODERNA 0013A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 15288426 0013A COVID19 BOOSTER MODERNA 0013A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 17188127 0013A COVID19 BOOSTER MODERNA 0013A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 17299905 0013A COVID19 BOOSTER MODERNA 0013A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 17390121 0013A COVID19 BOOSTER MODERNA 0013A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 18288109 0013A COVID19 BOOSTER MODERNA 0013A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 19000435 0013A COVID19 BOOSTER MODERNA 0013A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 19388433 0013A COVID19 BOOSTER MODERNA 0013A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 19488438 0013A COVID19 BOOSTER MODERNA 0013A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 24771059 0013A COVID19 BOOSTER MODERNA 0013A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 24971015 0013A COVID19 BOOSTER MODERNA 0013A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 25000641 0013A COVID19 BOOSTER MODERNA 0013A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 25400640 0013A COVID19 BOOSTER MODERNA 0013A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 29821348 0013A COVID19 BOOSTER MODERNA 0013A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 31202329 0013A COVID19 BOOSTER MODERNA 0013A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 31907268 0013A COVID19 BOOSTER MODERNA 0013A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 32900518 0013A COVID19 BOOSTER MODERNA 0013A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 33299915 0013A COVID19 BOOSTER MODERNA 0013A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 34500495 0013A COVID19 BOOSTER MODERNA 0013A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 37090689 0013A COVID19 BOOSTER MODERNA 0013A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 39190419 0013A COVID19 BOOSTER MODERNA 0013A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 43100327 0013A COVID19 BOOSTER MODERNA 0013A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 43900552 0013A COVID19 BOOSTER MODERNA 0013A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 45521192 0013A COVID19 BOOSTER MODERNA 0013A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 51601017 0013A COVID19 BOOSTER MODERNA 0013A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 64207261 0013A COVID19 BOOSTER MODERNA 0013A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 10588430 0021ACOVID19 1STAD ASTRAZENECA 0021A 771 $210.00 77.62 - 168.00 46.00 145.11 N/A 145.11 46.80 116.03 N/A 138.60 44.80 N/A 139.00 - N/A 111.28 139.10 N/A N/A N/A 168.00 N/A 40.00 140.70 N/A 85.89 157.50 79.82 93.93 N/A 10688418 0021ACOVID19 1STAD ASTRAZENECA 0021A 771 $210.00 77.62 - 168.00 46.00 145.11 N/A 145.11 46.80 116.03 N/A 138.60 44.80 N/A 139.00 - N/A 111.28 139.10 N/A N/A N/A 168.00 N/A 40.00 140.70 N/A 85.89 157.50 79.82 93.93 N/A 11288430 0021ACOVID19 1STAD ASTRAZENECA 0021A 771 $210.00 77.62 - 168.00 46.00 145.11 N/A 145.11 46.80 116.03 N/A 138.60 44.80 N/A 139.00 - N/A 111.28 139.10 N/A N/A N/A 168.00 N/A 40.00 140.70 N/A 85.89 157.50 79.82 93.93 N/A 14088385 0021ACOVID19 1STAD ASTRAZENECA 0021A 771 $210.00 77.62 - 168.00 46.00 145.11 N/A 145.11 46.80 116.03 N/A 138.60 44.80 N/A 139.00 - N/A 111.28 139.10 N/A N/A N/A 168.00 N/A 40.00 140.70 N/A 85.89 157.50 79.82 93.93 N/A 17188089 0021ACOVID19 1STAD ASTRAZENECA 0021A 771 $210.00 77.62 - 168.00 46.00 145.11 N/A 145.11 46.80 116.03 N/A 138.60 44.80 N/A 139.00 - N/A 111.28 139.10 N/A N/A N/A 168.00 N/A 40.00 140.70 N/A 85.89 157.50 79.82 93.93 N/A 17277014 0021ACOVID19 1STAD ASTRAZENECA 0021A 771 $210.00 77.62 - 168.00 46.00 145.11 N/A 145.11 46.80 116.03 N/A 138.60 44.80 N/A 139.00 - N/A 111.28 139.10 N/A N/A N/A 168.00 N/A 40.00 140.70 N/A 85.89 157.50 79.82 93.93 N/A 17377019 0021ACOVID19 1STAD ASTRAZENECA 0021A 771 $210.00 77.62 - 168.00 46.00 145.11 N/A 145.11 46.80 116.03 N/A 138.60 44.80 N/A 139.00 - N/A 111.28 139.10 N/A N/A N/A 168.00 N/A 40.00 140.70 N/A 85.89 157.50 79.82 93.93 N/A 18288061 0021ACOVID19 1STAD ASTRAZENECA 0021A 771 $210.00 77.62 - 168.00 46.00 145.11 N/A 145.11 46.80 116.03 N/A 138.60 44.80 N/A 139.00 - N/A 111.28 139.10 N/A N/A N/A 168.00 N/A 40.00 140.70 N/A 85.89 157.50 79.82 93.93 N/A 19388395 0021ACOVID19 1STAD ASTRAZENECA 0021A 771 $210.00 77.62 - 168.00 46.00 145.11 N/A 145.11 46.80 116.03 N/A 138.60 44.80 N/A 139.00 - N/A 111.28 139.10 N/A N/A N/A 168.00 N/A 40.00 140.70 N/A 85.89 157.50 79.82 93.93 N/A 19488390 0021ACOVID19 1STAD ASTRAZENECA 0021A 771 $210.00 77.62 - 168.00 46.00 145.11 N/A 145.11 46.80 116.03 N/A 138.60 44.80 N/A 139.00 - N/A 111.28 139.10 N/A N/A N/A 168.00 N/A 40.00 140.70 N/A 85.89 157.50 79.82 93.93 N/A 33200145 0021ACOVID19 1STAD ASTRAZENECA 0021A 771 $210.00 77.62 - 168.00 46.00 145.11 N/A 145.11 46.80 116.03 N/A 138.60 44.80 N/A 139.00 - N/A 111.28 139.10 N/A N/A N/A 168.00 N/A 40.00 140.70 N/A 85.89 157.50 79.82 93.93 N/A 37090441 0021ACOVID19 1STAD ASTRAZENECA 0021A 771 $210.00 77.62 - 168.00 46.00 145.11 N/A 145.11 46.80 116.03 N/A 138.60 44.80 N/A 139.00 - N/A 111.28 139.10 N/A N/A N/A 168.00 N/A 40.00 140.70 N/A 85.89 157.50 79.82 93.93 N/A 39190371 0021ACOVID19 1STAD ASTRAZENECA 0021A 771 $210.00 77.62 - 168.00 46.00 145.11 N/A 145.11 46.80 116.03 N/A 138.60 44.80 N/A 139.00 - N/A 111.28 139.10 N/A N/A N/A 168.00 N/A 40.00 140.70 N/A 85.89 157.50 79.82 93.93 N/A 10588448 0022ACOVID19 2 ADM ASTRAZENECA 0022A 771 $210.00 77.62 - 168.00 46.00 145.11 N/A 145.11 46.80 116.03 N/A 138.60 44.80 N/A 139.00 - N/A 111.28 139.10 N/A N/A N/A 168.00 N/A 40.00 140.70 N/A 85.89 157.50 79.82 93.93 N/A 10688426 0022ACOVID19 2 ADM ASTRAZENECA 0022A 771 $210.00 77.62 - 168.00 46.00 145.11 N/A 145.11 46.80 116.03 N/A 138.60 44.80 N/A 139.00 - N/A 111.28 139.10 N/A N/A N/A 168.00 N/A 40.00 140.70 N/A 85.89 157.50 79.82 93.93 N/A 11288448 0022ACOVID19 2 ADM ASTRAZENECA 0022A 771 $210.00 77.62 - 168.00 46.00 145.11 N/A 145.11 46.80 116.03 N/A 138.60 44.80 N/A 139.00 - N/A 111.28 139.10 N/A N/A N/A 168.00 N/A 40.00 140.70 N/A 85.89 157.50 79.82 93.93 N/A 14088393 0022ACOVID19 2 ADM ASTRAZENECA 0022A 771 $210.00 77.62 - 168.00 46.00 145.11 N/A 145.11 46.80 116.03 N/A 138.60 44.80 N/A 139.00 - N/A 111.28 139.10 N/A N/A N/A 168.00 N/A 40.00 140.70 N/A 85.89 157.50 79.82 93.93 N/A 17188097 0022ACOVID19 2 ADM ASTRAZENECA 0022A 771 $210.00 77.62 - 168.00 46.00 145.11 N/A 145.11 46.80 116.03 N/A 138.60 44.80 N/A 139.00 - N/A 111.28 139.10 N/A N/A N/A 168.00 N/A 40.00 140.70 N/A 85.89 157.50 79.82 93.93 N/A 17277022 0022ACOVID19 2 ADM ASTRAZENECA 0022A 771 $210.00 77.62 - 168.00 46.00 145.11 N/A 145.11 46.80 116.03 N/A 138.60 44.80 N/A 139.00 - N/A 111.28 139.10 N/A N/A N/A 168.00 N/A 40.00 140.70 N/A 85.89 157.50 79.82 93.93 N/A 17377027 0022ACOVID19 2 ADM ASTRAZENECA 0022A 771 $210.00 77.62 - 168.00 46.00 145.11 N/A 145.11 46.80 116.03 N/A 138.60 44.80 N/A 139.00 - N/A 111.28 139.10 N/A N/A N/A 168.00 N/A 40.00 140.70 N/A 85.89 157.50 79.82 93.93 N/A 18288079 0022ACOVID19 2 ADM ASTRAZENECA 0022A 771 $210.00 77.62 - 168.00 46.00 145.11 N/A 145.11 46.80 116.03 N/A 138.60 44.80 N/A 139.00 - N/A 111.28 139.10 N/A N/A N/A 168.00 N/A 40.00 140.70 N/A 85.89 157.50 79.82 93.93 N/A 19388409 0022ACOVID19 2 ADM ASTRAZENECA 0022A 771 $210.00 77.62 - 168.00 46.00 145.11 N/A 145.11 46.80 116.03 N/A 138.60 44.80 N/A 139.00 - N/A 111.28 139.10 N/A N/A N/A 168.00 N/A 40.00 140.70 N/A 85.89 157.50 79.82 93.93 N/A 19488403 0022ACOVID19 2 ADM ASTRAZENECA 0022A 771 $210.00 77.62 - 168.00 46.00 145.11 N/A 145.11 46.80 116.03 N/A 138.60 44.80 N/A 139.00 - N/A 111.28 139.10 N/A N/A N/A 168.00 N/A 40.00 140.70 N/A 85.89 157.50 79.82 93.93 N/A 33200153 0022ACOVID19 2 ADM ASTRAZENECA 0022A 771 $210.00 77.62 - 168.00 46.00 145.11 N/A 145.11 46.80 116.03 N/A 138.60 44.80 N/A 139.00 - N/A 111.28 139.10 N/A N/A N/A 168.00 N/A 40.00 140.70 N/A 85.89 157.50 79.82 93.93 N/A 37090450 0022ACOVID19 2 ADM ASTRAZENECA 0022A 771 $210.00 77.62 - 168.00 46.00 145.11 N/A 145.11 46.80 116.03 N/A 138.60 44.80 N/A 139.00 - N/A 111.28 139.10 N/A N/A N/A 168.00 N/A 40.00 140.70 N/A 85.89 157.50 79.82 93.93 N/A 39190389 0022ACOVID19 2 ADM ASTRAZENECA 0022A 771 $210.00 77.62 - 168.00 46.00 145.11 N/A 145.11 46.80 116.03 N/A 138.60 44.80 N/A 139.00 - N/A 111.28 139.10 N/A N/A N/A 168.00 N/A 40.00 140.70 N/A 85.89 157.50 79.82 93.93 N/A 36982519 ONC THYR DNA MRNA 112 GNS REF1 0026U 300 "$18,900.00" " 6,985.44 " - " 19,841.40 " - " 13,059.90 " " 3,780.00 " " 13,059.90 " - " 10,442.25 " " 3,708.00 " " 12,474.00 " - - " 12,509.91 " " 3,240.00 " " 3,600.00 " " 15,873.12 " " 19,841.40 " " 3,690.00 " " 3,708.00 " " 3,600.00 " " 15,120.00 " " 3,294.00 " - " 9,432.00 " " 3,168.00 " " 7,730.10 " " 14,175.00 " " 7,183.89 " " 8,453.97 " " 3,726.00 " 10588456 0031ACOVID19 SINGLE AD JANSSEN 0031A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 10688434 0031ACOVID19 SINGLE AD JANSSEN 0031A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 11288456 0031ACOVID19 SINGLE AD JANSSEN 0031A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 14088407 0031ACOVID19 SINGLE AD JANSSEN 0031A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 17188101 0031ACOVID19 SINGLE AD JANSSEN 0031A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 17277031 0031ACOVID19 SINGLE AD JANSSEN 0031A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 17377035 0031ACOVID19 SINGLE AD JANSSEN 0031A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 18288087 0031ACOVID19 SINGLE AD JANSSEN 0031A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 19388417 0031ACOVID19 SINGLE AD JANSSEN 0031A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 19488411 0031ACOVID19 SINGLE AD JANSSEN 0031A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 33255471 0031ACOVID19 SINGLE AD JANSSEN 0031A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 37090468 0031ACOVID19 SINGLE AD JANSSEN 0031A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 39190397 0031ACOVID19 SINGLE AD JANSSEN 0031A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 36945494 NEURO CSF PRION PROT QUAL 0035U 300 "$2,840.00" " 1,049.66 " - " 2,272.00 " - " 1,962.44 " 568.04 " 1,962.44 " - " 1,569.10 " 557.22 " 1,874.40 " - - " 1,879.80 " 486.89 540.99 312.92 391.15 554.51 557.22 540.99 " 2,272.00 " 495.01 - " 1,417.39 " 476.07 " 1,161.56 " " 2,130.00 " " 1,079.48 " " 1,270.33 " 559.92 36944137 ONC PROSTATE MRNA 17 GENE REF1 0047U 300 "$20,333.00" " 7,515.08 " - " 21,346.04 " - " 14,050.10 " " 4,066.65 " " 14,050.10 " - " 11,233.98 " " 3,989.19 " " 13,419.78 " - - " 13,458.41 " " 3,485.70 " " 3,873.00 " " 17,076.83 " " 21,346.04 " " 3,969.83 " " 3,989.19 " " 3,873.00 " " 16,266.40 " " 3,543.80 " - " 10,147.26 " " 3,408.24 " " 8,316.20 " " 15,249.75 " " 7,728.57 " " 9,094.95 " " 4,008.56 " 10588481 COVID-19 1ST ADMIN (5Y-11Y) 0071A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 10688469 COVID-19 1ST ADMIN (5Y-11Y) 0071A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 11288481 COVID-19 1ST ADMIN (5Y-11Y) 0071A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 14088431 COVID-19 1ST ADMIN (5Y-11Y) 0071A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 15288434 COVID-19 1ST ADMIN (5Y-11Y) 0071A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 17188135 COVID-19 1ST ADMIN (5Y-11Y) 0071A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 17215001 COVID-19 1ST ADMIN (5Y-11Y) 0071A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 17315005 COVID-19 1ST ADMIN (5Y-11Y) 0071A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 18288117 COVID-19 1ST ADMIN (5Y-11Y) 0071A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 19010015 COVID-19 1ST ADMIN (5Y-11Y) 0071A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 19388441 COVID-19 1ST ADMIN (5Y-11Y) 0071A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 19488446 COVID-19 1ST ADMIN (5Y-11Y) 0071A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 24771067 COVID-19 1ST ADMIN (5Y-11Y) 0071A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 24971023 COVID-19 1ST ADMIN (5Y-11Y) 0071A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 25054539 COVID-19 1ST ADMIN (5Y-11Y) 0071A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 25454537 COVID-19 1ST ADMIN (5Y-11Y) 0071A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 29810001 COVID-19 1ST ADMIN (5Y-11Y) 0071A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 31210003 COVID-19 1ST ADMIN (5Y-11Y) 0071A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 31910005 COVID-19 1ST ADMIN (5Y-11Y) 0071A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 32910009 COVID-19 1ST ADMIN (5Y-11Y) 0071A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 33210027 COVID-19 1ST ADMIN (5Y-11Y) 0071A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 34554536 COVID-19 1ST ADMIN (5Y-11Y) 0071A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 37010006 COVID-19 1ST ADMIN (5Y-11Y) 0071A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 39110008 COVID-19 1ST ADMIN (5Y-11Y) 0071A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 43110004 COVID-19 1ST ADMIN (5Y-11Y) 0071A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 43910001 COVID-19 1ST ADMIN (5Y-11Y) 0071A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 45510000 COVID-19 1ST ADMIN (5Y-11Y) 0071A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 51610008 COVID-19 1ST ADMIN (5Y-11Y) 0071A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 64210009 COVID-19 1ST ADMIN (5Y-11Y) 0071A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 10588499 COVID-19 2ND ADMIN (5Y-11Y) 0072A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 10688477 COVID-19 2ND ADMIN (5Y-11Y) 0072A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 11288499 COVID-19 2ND ADMIN (5Y-11Y) 0072A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 14088440 COVID-19 2ND ADMIN (5Y-11Y) 0072A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 15288442 COVID-19 2ND ADMIN (5Y-11Y) 0072A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 17188143 COVID-19 2ND ADMIN (5Y-11Y) 0072A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 17210009 COVID-19 2ND ADMIN (5Y-11Y) 0072A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 17310003 COVID-19 2ND ADMIN (5Y-11Y) 0072A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 18288125 COVID-19 2ND ADMIN (5Y-11Y) 0072A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 19010007 COVID-19 2ND ADMIN (5Y-11Y) 0072A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 19388450 COVID-19 2ND ADMIN (5Y-11Y) 0072A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 19488454 COVID-19 2ND ADMIN (5Y-11Y) 0072A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 24771075 COVID-19 2ND ADMIN (5Y-11Y) 0072A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 24971031 COVID-19 2ND ADMIN (5Y-11Y) 0072A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 25054547 COVID-19 2ND ADMIN (5Y-11Y) 0072A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 25454545 COVID-19 2ND ADMIN (5Y-11Y) 0072A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 29810010 COVID-19 2ND ADMIN (5Y-11Y) 0072A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 31210011 COVID-19 2ND ADMIN (5Y-11Y) 0072A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 31910013 COVID-19 2ND ADMIN (5Y-11Y) 0072A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 32910017 COVID-19 2ND ADMIN (5Y-11Y) 0072A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 33210035 COVID-19 2ND ADMIN (5Y-11Y) 0072A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 34554544 COVID-19 2ND ADMIN (5Y-11Y) 0072A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 37010014 COVID-19 2ND ADMIN (5Y-11Y) 0072A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 39115000 COVID-19 2ND ADMIN (5Y-11Y) 0072A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 43110012 COVID-19 2ND ADMIN (5Y-11Y) 0072A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 43910019 COVID-19 2ND ADMIN (5Y-11Y) 0072A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 45510018 COVID-19 2ND ADMIN (5Y-11Y) 0072A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 51610016 COVID-19 2ND ADMIN (5Y-11Y) 0072A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 64210017 COVID-19 2ND ADMIN (5Y-11Y) 0072A 771 $210.00 77.62 34.24 168.00 46.00 145.11 40.86 145.11 46.80 116.03 40.08 138.60 44.80 41.65 139.00 35.02 38.91 111.28 139.10 39.88 40.08 38.91 168.00 35.60 40.00 140.70 34.24 85.89 157.50 79.82 93.93 40.27 29803617 PRQ TRANSCATH STENT VERT ART 0075T 481 "$19,641.00" " 7,259.31 " - " 15,712.80 " - " 13,571.93 " N/A " 13,571.93 " - " 10,851.65 " N/A " 12,963.06 " - N/A " 13,000.38 " - N/A " 6,064.77 " " 7,580.96 " N/A N/A N/A " 15,712.80 " N/A - " 13,159.47 " N/A " 8,033.17 " " 14,730.75 " " 7,465.54 " " 8,785.42 " N/A 29803609 PRQ TRANSCATH STNT VRT ART ADD 0076T 481 "$10,994.00" " 4,063.38 " - " 8,795.20 " - " 7,596.85 " N/A " 7,596.85 " - " 6,074.19 " N/A " 7,256.04 " - N/A " 7,276.93 " - N/A " 3,032.42 " " 3,790.53 " N/A N/A N/A " 8,795.20 " N/A - " 7,365.98 " N/A " 4,496.55 " " 8,245.50 " " 4,178.82 " " 4,917.62 " N/A 36305088 INF DIS ID 6 TARGTS RRNA MIC 0086U 300 "$1,050.00" 388.08 - 840.00 - 725.55 210.00 725.55 - 580.13 206.00 693.00 - - 695.00 180.00 200.00 131.18 163.97 205.00 206.00 200.00 840.00 183.00 - 524.00 176.00 429.45 787.50 399.11 469.67 207.00 80629028 PERC SACRAL AUGMT UNI INJ 0200T 350 "$32,891.00" " 12,156.51 " - " 26,312.80 " - " 22,727.68 " " 6,533.13 " " 22,727.68 " - " 18,172.28 " " 6,408.69 " " 6,540.00 " - - " 21,770.55 " " 5,599.83 " " 6,222.03 " " 2,555.30 " " 3,194.12 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " - " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 80629036 PERC SACRAL AUGMT BILAT INJ 0201T 350 "$32,891.00" " 12,156.51 " - " 26,312.80 " - " 22,727.68 " " 6,533.13 " " 22,727.68 " - " 18,172.28 " " 6,408.69 " " 6,576.00 " - - " 21,770.55 " " 5,599.83 " " 6,222.03 " " 3,071.10 " " 3,838.87 " " 6,377.58 " " 6,408.69 " " 6,222.03 " " 26,312.80 " " 5,693.16 " - " 22,036.97 " " 5,475.39 " " 13,452.42 " " 24,668.25 " " 12,501.87 " " 14,712.14 " " 6,439.80 " 36305070 RESP PATH 22 TARGETS AMP PRB 0202U 300 "$1,568.00" 579.53 - " 1,254.40 " - " 1,083.49 " 437.62 " 1,083.49 " - 866.32 429.28 " 1,034.88 " - - " 1,037.86 " 375.10 416.78 830.88 " 1,038.64 " 427.20 429.28 416.78 " 1,254.40 " 381.35 - " 1,091.96 " 366.77 641.31 " 1,176.00 " 596.00 701.37 431.37 29811067 TRLUML PERIPH ATHER RENAL ART 0234T 481 "$52,725.00" " 19,487.16 " - " 42,180.00 " - " 2,773.00 " " 10,476.71 " " 2,773.00 " - " 29,130.56 " " 10,277.15 " " 34,798.50 " - - " 34,898.68 " " 8,980.04 " " 9,977.82 " " 6,793.84 " " 8,492.30 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " - " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 29811075 TRLUML PERIPH ATHER VISCERAL 0235T 481 "$11,191.00" " 4,136.19 " - " 8,952.80 " - " 7,732.98 " N/A " 7,732.98 " - " 6,183.03 " N/A " 7,386.06 " - N/A " 7,407.32 " - N/A " 6,676.83 " " 8,346.04 " N/A N/A N/A " 8,952.80 " N/A - " 7,497.97 " N/A " 4,577.12 " " 8,393.25 " " 4,253.70 " " 5,005.73 " N/A 29811083 TRLUML PERIPH ATHER ABD AORTA 0236T 481 "$52,725.00" " 19,487.16 " - " 42,180.00 " - " 2,773.00 " " 10,476.71 " " 2,773.00 " - " 29,130.56 " " 10,277.15 " " 34,798.50 " - - " 34,898.68 " " 8,980.04 " " 9,977.82 " " 3,949.06 " " 4,936.32 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " - " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 29811091 TRLUML PERIPH ATHER BRACHCEPH 0237T 481 "$52,725.00" " 19,487.16 " - " 42,180.00 " - " 2,773.00 " " 10,476.71 " " 2,773.00 " - " 29,130.56 " " 10,277.15 " " 34,798.50 " - - " 34,898.68 " " 8,980.04 " " 9,977.82 " " 5,821.21 " " 7,276.51 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " - " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 80329121 TPA PERC BRACHIOCEPHALIC 0237T 320 "$52,725.00" " 19,487.16 " - " 42,180.00 " - " 2,773.00 " " 10,476.71 " " 2,773.00 " - " 29,130.56 " " 10,277.15 " " 34,798.50 " - - " 34,898.68 " " 8,980.04 " " 9,977.82 " " 5,821.21 " " 7,276.51 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " - " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 29811059 TRLUML PERIPH ATHER ILIAC ART 0238T 481 "$84,336.00" " 31,170.59 " - " 67,468.80 " - " 58,276.18 " " 16,751.22 " " 58,276.18 " - " 46,595.64 " " 16,432.15 " " 55,661.76 " - - " 55,822.00 " " 14,358.19 " " 15,953.54 " " 4,088.01 " " 5,110.01 " " 16,352.38 " " 16,432.15 " " 15,953.54 " " 67,468.80 " " 14,597.49 " - " 56,505.12 " " 14,039.12 " " 34,493.42 " " 63,252.00 " " 32,056.11 " " 37,723.49 " " 16,511.91 " 80335890 TPA PERC ILIAC EACH VESSEL 0238T 320 "$84,336.00" " 31,170.59 " - " 67,468.80 " - " 58,276.18 " " 16,751.22 " " 58,276.18 " - " 46,595.64 " " 16,432.15 " " 55,661.76 " - - " 55,822.00 " " 14,358.19 " " 15,953.54 " " 4,088.01 " " 5,110.01 " " 16,352.38 " " 16,432.15 " " 15,953.54 " " 67,468.80 " " 14,597.49 " - " 56,505.12 " " 14,039.12 " " 34,493.42 " " 63,252.00 " " 32,056.11 " " 37,723.49 " " 16,511.91 " 36303786 RESP VRL TARG FLU AB RSV SARS2 0241U 300 $358.00 132.32 - 286.40 - 247.38 149.76 247.38 - 197.80 146.91 236.28 - - 236.96 128.37 142.63 189.70 237.14 146.20 146.91 142.63 286.40 130.51 - 239.86 125.51 146.42 268.50 136.08 160.13 147.62 29812241 TRANSCATH RENAL SYMP DENRV UNL 0338T 481 "$26,023.00" " 9,618.10 " - " 20,818.40 " - " 17,981.89 " " 5,169.57 " " 17,981.89 " - " 14,377.71 " " 5,071.10 " " 6,576.00 " - - " 17,224.62 " " 4,431.06 " " 4,923.40 " - - " 5,046.49 " " 5,071.10 " " 4,923.40 " " 20,818.40 " " 4,504.91 " - " 17,435.41 " " 4,332.59 " " 10,643.41 " " 19,517.25 " " 9,891.34 " " 11,640.09 " " 5,095.72 " 29812250 TRANSCATH RENAL SYMP DENRV BIL 0339T 481 "$26,023.00" " 9,618.10 " - " 20,818.40 " - " 17,981.89 " " 5,169.57 " " 17,981.89 " - " 14,377.71 " " 5,071.10 " " 6,576.00 " - - " 17,224.62 " " 4,431.06 " " 4,923.40 " - - " 5,046.49 " " 5,071.10 " " 4,923.40 " " 20,818.40 " " 4,504.91 " - " 17,435.41 " " 4,332.59 " " 10,643.41 " " 19,517.25 " " 9,891.34 " " 11,640.09 " " 5,095.72 " 80641401 CTA CORONARY FFR ANALYSIS MDL 0503T 350 "$4,990.00" " 1,844.30 " - " 3,992.00 " - " 1,774.00 " 970.71 " 1,774.00 " - " 2,756.98 " 952.22 725.00 - - " 3,302.88 " 832.04 924.49 247.10 308.88 947.60 952.22 924.49 " 3,992.00 " 845.91 - " 3,343.30 " 813.55 " 2,040.91 " " 3,742.50 " " 1,896.70 " " 2,232.03 " 956.85 80336721 EV CATH DIR CHEM ABLT W/IMG 0524T 320 "$15,024.00" " 5,552.87 " - " 12,019.20 " - " 10,381.58 " " 2,985.82 " " 10,381.58 " - " 8,300.76 " " 2,928.95 " " 9,915.84 " - - " 9,944.39 " " 2,559.28 " " 2,843.64 " - - " 2,914.73 " " 2,928.95 " " 2,843.64 " " 12,019.20 " " 2,601.93 " - " 10,066.08 " " 2,502.40 " " 6,144.82 " " 11,268.00 " " 5,710.62 " " 6,720.24 " " 2,943.17 " 80336934 PRQ TRANSCATH PLCMT ANAST IMPL 0553T 320 "$2,952.00" " 1,091.06 " - " 2,361.60 " - " 2,039.83 " N/A " 2,039.83 " - " 1,630.98 " N/A " 1,948.32 " - N/A " 1,953.93 " - N/A " 1,564.26 " " 1,955.40 " N/A N/A N/A " 2,361.60 " N/A - " 1,977.84 " N/A " 1,207.37 " " 2,214.00 " " 1,122.06 " " 1,320.43 " N/A 80636938 PRQ TRANSCATH PLCMT ANAST IMPL 0553T 350 "$2,952.00" " 1,091.06 " - " 2,361.60 " - " 2,039.83 " N/A " 2,039.83 " - " 1,630.98 " N/A " 1,948.32 " - N/A " 1,953.93 " - N/A " 1,564.26 " " 1,955.40 " N/A N/A N/A " 2,361.60 " N/A - " 1,977.84 " N/A " 1,207.37 " " 2,214.00 " " 1,122.06 " " 1,320.43 " N/A 29821216 TTVR PERQ 1ST PROSTHESIS 0569T 481 "$16,084.00" " 5,944.65 " - " 12,867.20 " - " 11,114.04 " N/A " 11,114.04 " - " 8,886.41 " N/A " 10,615.44 " - N/A " 10,646.00 " - N/A - - N/A N/A N/A " 12,867.20 " N/A - " 10,776.28 " N/A " 6,578.36 " " 12,063.00 " " 6,113.53 " " 7,194.37 " N/A 29821224 TTVR PERQ EA ADDL PROSTHESIS 0570T 481 "$6,599.00" " 2,438.99 " - " 5,279.20 " - " 4,559.91 " N/A " 4,559.91 " - " 3,645.95 " N/A " 4,355.34 " - N/A " 4,367.88 " - N/A - - N/A N/A N/A " 5,279.20 " N/A - " 4,421.33 " N/A " 2,698.99 " " 4,949.25 " " 2,508.28 " " 2,951.73 " N/A 28119615 DRNBLE PCH W/ATT BARR LVL008 A4389 272 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - 32.76 40.95 - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 28108958 IMP TISS MARKER LVL010 A4648 278 "$2,375.00" 877.80 - " 1,900.00 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - " 1,258.51 " " 1,573.20 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 80165102 IMPLANT TISSUE MARKER LVL001 A4648 278 $200.00 73.92 - 160.00 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 105.98 132.48 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 80165111 IMPLANT TISSUE MARKER LVL002 A4648 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 238.46 298.08 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 80165129 IMPLANT TISSUE MARKER LVL003 A4648 278 $750.00 277.20 - 600.00 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 397.43 496.80 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 80165595 IMPLANT TISSUE MARKER LVL004 A4648 278 "$1,050.00" 388.08 - 840.00 - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 556.40 695.52 - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 80165609 IMPLANT TISSUE MARKER LVL005 A4648 278 "$1,350.00" 498.96 - " 1,080.00 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 715.37 894.24 - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 80165617 IMPLANT TISSUE MARKER LVL006 A4648 278 "$1,375.00" 508.20 - " 1,100.00 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - 728.61 910.80 - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 80465106 IMPLANT TISSUE MARKER LVL001 A4648 278 $200.00 73.92 - 160.00 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 105.98 132.48 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 80465114 IMPLANT TISSUE MARKER LVL002 A4648 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 238.46 298.08 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 80465122 IMPLANT TISSUE MARKER LVL003 A4648 278 $750.00 277.20 - 600.00 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 397.43 496.80 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 80565101 IMPLANT TISSUE MARKER LVL001 A4648 278 $200.00 73.92 - 160.00 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 105.98 132.48 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 80565119 IMPLANT TISSUE MARKER LVL002 A4648 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 238.46 298.08 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 80565127 IMPLANT TISSUE MARKER LVL003 A4648 278 $750.00 277.20 - 600.00 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 397.43 496.80 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 80565593 IMPLANT TISSUE MARKER LVL004 A4648 278 "$1,050.00" 388.08 - 840.00 - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 556.40 695.52 - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 80565607 IMPLANT TISSUE MARKER LVL005 A4648 278 "$1,350.00" 498.96 - " 1,080.00 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 715.37 894.24 - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 80565615 IMPLANT TISSUE MARKER LVL006 A4648 278 "$1,375.00" 508.20 - " 1,100.00 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - 728.61 910.80 - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 81465100 IMPLANT TISSUE MARKER LVL001 A4648 278 $317.00 117.16 - 253.60 - 219.05 - 219.05 - 175.14 - 209.22 - - 209.82 - - 167.98 209.98 - - - 253.60 - - 212.39 - 129.65 237.75 120.49 141.79 - 83065109 IMPLANT TISSUE MARKER LVL001 A4648 278 $213.00 78.72 - 170.40 - 147.18 - 147.18 - 117.68 - 140.58 - - 140.98 - - 112.87 141.09 - - - 170.40 - - 142.71 - 87.12 159.75 80.96 95.27 - 83065117 IMPLANT TISSUE MARKER LVL002 A4648 278 $479.00 177.04 - 383.20 - 330.99 - 330.99 - 264.65 - 316.14 - - 317.05 - - 253.82 317.29 - - - 383.20 - - 320.93 - 195.91 359.25 182.07 214.26 - 83065125 IMPLANT TISSUE MARKER LVL003 A4648 278 $799.00 295.31 - 639.20 - 552.11 - 552.11 - 441.45 - 527.34 - - 528.86 - - 423.39 529.26 - - - 639.20 - - 535.33 - 326.79 599.25 303.70 357.39 - 28112424 NPWT DRSG SET LVL001 A6550 272 $200.00 73.92 - 160.00 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 121.22 151.52 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 28112441 NPWT DRSG SET LVL003 A6550 272 $750.00 277.20 - 600.00 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 121.22 151.52 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 28112459 NPWT DRSG SET LVL004 A6550 272 "$1,050.00" 388.08 - 840.00 - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 121.22 151.52 - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 28120133 NPWT DRSG SET LVL006 A6550 272 "$1,375.00" 508.20 - " 1,100.00 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - 121.22 151.52 - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 28120141 NPWT DRSG SET LVL007 A6550 272 "$1,625.00" 600.60 - " 1,300.00 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - 121.22 151.52 - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 28120150 NPWT DRSG SET LVL008 A6550 272 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - 121.22 151.52 - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 29121176 REACHING/GRABBING DEVICE A9281 270 $45.00 16.63 - 172.65 - 31.10 N/A 31.10 - 24.86 N/A 29.70 - N/A 29.79 - N/A 138.12 172.65 N/A N/A N/A 36.00 N/A - 30.15 N/A 18.41 33.75 17.10 20.13 N/A 29121435 HIP/KNEE KIT A9281 270 $105.00 38.81 - 172.65 - 72.56 N/A 72.56 - 58.01 N/A 69.30 - N/A 69.50 - N/A 138.12 172.65 N/A N/A N/A 84.00 N/A - 70.35 N/A 42.95 78.75 39.91 46.97 N/A 33249764 TC99M SESTAMIBI STUDY DOSE A9500 636 $68.00 25.13 - 476.67 - 46.99 - 46.99 - 37.57 - 44.88 - - 45.01 - - 381.34 476.67 - - - 54.40 - - 45.56 - 27.81 51.00 25.85 30.42 - 33249772 TC99M TETROFOSMIN STUDY DOSE A9502 636 $667.00 246.52 - 533.60 - 460.90 - 460.90 - 368.52 - 440.22 - - 441.49 - - 201.17 251.46 - - - 533.60 - - 446.89 - 272.80 500.25 253.53 298.35 - 33249934 TC99M MEDRONATE UP TO 30 MCI A9503 636 $71.00 26.24 - 174.42 - 49.06 - 49.06 - 39.23 - 46.86 - - 46.99 - - 139.54 174.42 - - - 56.80 - - 47.57 - 29.04 53.25 26.99 31.76 - 33249951 THALLIUM TI-201 PER MCI A9505 636 $32.00 11.83 - 158.55 - 22.11 - 22.11 - 17.68 - 21.12 - - 21.18 - - 126.84 158.55 - - - 25.60 - - 21.44 - 13.09 24.00 12.16 14.31 - 33250037 IODINEI131 IODOBENG PER 0.5MCI A9508 636 "$4,929.34" " 1,821.88 " - " 3,943.47 " - " 3,406.17 " - " 3,406.17 " - " 2,723.46 " - " 3,253.36 " - - " 3,262.73 " - - 776.56 970.70 - - - " 3,943.47 " - - " 3,302.66 " - " 2,016.10 " " 3,697.01 " " 1,873.64 " " 2,204.89 " - 33250151 TC99M PERTECHNETATE PER MCI A9512 636 $39.00 14.41 - 31.20 - 26.95 - 26.95 - 21.55 - 25.74 - - 25.81 - - 5.70 7.13 - - - 31.20 - - 26.13 - 15.95 29.25 14.82 17.44 - 33250177 IODINE I-123 DIAG UP TO 999UCI A9516 636 $138.00 51.00 - 253.14 - 95.36 - 95.36 - 76.25 - 91.08 - - 91.34 - - 202.51 253.14 - - - 110.40 - - 92.46 - 56.44 103.50 52.45 61.73 - 33250398 IODINE I-131 CAP THER PER MCI A9517 636 $109.00 40.29 - 159.41 - 75.32 20.55 75.32 - 60.22 20.16 71.94 - - 72.15 17.61 19.57 127.53 159.41 20.06 20.16 19.57 87.20 17.91 - 73.03 17.22 44.58 81.75 41.43 48.76 20.25 33256604 TC99 TILMANOCEPT DIAG 0.5MCI A9520 636 $600.00 221.76 - " 2,005.91 " - 414.60 - 414.60 - 331.50 - 396.00 - - 397.14 - - " 1,604.73 " " 2,005.91 " - - - 480.00 - - 402.00 - 245.40 450.00 228.06 268.38 - 33250631 TC 99M EXAMETAZIME UP TO 25MCI A9521 636 "$3,032.92" " 1,120.97 " - " 3,488.42 " - " 2,095.75 " - " 2,095.75 " - " 1,675.69 " - " 2,001.73 " - - " 2,007.49 " - - " 2,790.74 " " 3,488.42 " - - - " 2,426.34 " - - " 2,032.06 " - " 1,240.46 " " 2,274.69 " " 1,152.81 " " 1,356.63 " - 33250771 TC99M MEBROFENIN UP TO 15MCI A9537 636 $156.00 57.66 - 210.96 - 107.80 - 107.80 - 86.19 - 102.96 - - 103.26 - - 168.77 210.96 - - - 124.80 - - 104.52 - 63.80 117.00 59.30 69.78 - 33251378 TC 99M PYROPHOS UP TO 25MCI A9538 636 $103.22 38.15 - 128.63 - 71.33 - 71.33 - 57.03 - 68.13 - - 68.32 - - 102.90 128.63 - - - 82.58 - - 69.16 - 42.22 77.42 39.23 46.17 - 33250789 TC 99M PENTETATE UP TO 25MCI A9539 636 $157.00 58.03 - 125.60 - 108.49 - 108.49 - 86.74 - 103.62 - - 103.92 - - 50.92 63.65 - - - 125.60 - - 105.19 - 64.21 117.75 59.68 70.23 - 33251181 TC 99M ALBUMIN(MAA) TO 10MCI A9540 636 $95.00 35.11 - 85.97 - 65.65 - 65.65 - 52.49 - 62.70 - - 62.88 - - 68.78 85.97 - - - 76.00 - - 63.65 - 38.86 71.25 36.11 42.49 - 33250860 TC 99M SULFUR COLLOID TO 20MCI A9541 636 $150.00 55.44 - 251.77 - 103.65 - 103.65 - 82.88 - 99.00 - - 99.29 - - 201.42 251.77 - - - 120.00 - - 100.50 - 61.35 112.50 57.02 67.10 - 33250878 TC 99M SULFUR COLLOID MULT SYR A9541 636 $568.00 209.93 - 454.40 - 392.49 - 392.49 - 313.82 - 374.88 - - 375.96 - - 201.42 251.77 - - - 454.40 - - 380.56 - 232.31 426.00 215.90 254.07 - 33250924 INDIUM-111 PENTETATE PER0.5MCI A9548 636 "$3,936.00" " 1,454.75 " - " 3,148.80 " - " 2,719.78 " - " 2,719.78 " - " 2,174.64 " - " 2,597.76 " - - " 2,605.24 " - - 50.92 63.65 - - - " 3,148.80 " - - " 2,637.12 " - " 1,609.82 " " 2,952.00 " " 1,496.07 " " 1,760.57 " - 33250932 TC99M SUCCIMER UP TO 10 MCI A9551 636 "$1,019.67" 376.87 - 815.74 - 704.59 - 704.59 - 563.37 - 672.98 - - 674.92 - - 396.78 495.98 - - - 815.74 - - 683.18 - 417.05 764.75 387.58 456.10 - 33250941 FDG F-18 UP TO 45 MCI A9552 636 $299.00 110.51 - 893.03 - 206.61 - 206.61 - 165.20 - 197.34 - - 197.91 - - 714.42 893.03 - - - 239.20 - - 200.33 - 122.29 224.25 113.65 133.74 - 33250959 GALLIUM GA-67 CITRATE PER MCI A9556 636 $149.72 55.34 - 125.46 - 103.46 - 103.46 - 82.72 - 98.82 - - 99.10 - - 100.37 125.46 - - - 119.78 - - 100.31 - 61.24 112.29 56.91 66.97 - 33250975 TC99M RBC UP TO 30 MCI A9560 636 $156.00 57.66 - 300.97 - 107.80 - 107.80 - 86.19 - 102.96 - - 103.26 - - 240.78 300.97 - - - 124.80 - - 104.52 - 63.80 117.00 59.30 69.78 - 33250991 TC 99M OXIDRONATE UP TO 30MCI A9561 636 $123.64 45.70 - 128.59 - 85.44 - 85.44 - 68.31 - 81.60 - - 81.84 - - 102.87 128.59 - - - 98.91 - - 82.84 - 50.57 92.73 47.00 55.30 - 33251351 TC 99M MERTIATIDE UP TO 15MCI A9562 636 $524.00 193.67 - " 1,744.97 " - 362.08 - 362.08 - 289.51 - 345.84 - - 346.84 - - " 1,395.98 " " 1,744.97 " - - - 419.20 - - 351.08 - 214.32 393.00 199.17 234.39 - 33251386 TC 99M PENTE AERO UP TO 75MCI A9567 636 $488.86 180.68 - 391.09 - 337.80 - 337.80 - 270.10 - 322.65 - - 323.58 - - 50.92 63.65 - - - 391.09 - - 327.54 - 199.94 366.65 185.82 218.67 - 33251408 TC99M EXAMETAZIME LAB WBC DOSE A9569 636 "$4,572.07" " 1,689.84 " - " 3,657.66 " - " 3,159.30 " - " 3,159.30 " - " 2,526.07 " - " 3,017.57 " - - " 3,026.25 " - - " 2,422.74 " " 3,028.54 " - - - " 3,657.66 " - - " 3,063.29 " - " 1,869.98 " " 3,429.05 " " 1,737.84 " " 2,045.09 " - 33251491 INDIUM IN-111 WBC STUDY DOSE A9570 636 "$3,820.00" " 1,411.87 " - " 3,056.00 " - " 2,639.62 " - " 2,639.62 " - " 2,110.55 " - " 2,521.20 " - - " 2,528.46 " - - " 2,024.22 " " 2,530.37 " - - - " 3,056.00 " - - " 2,559.40 " - " 1,562.38 " " 2,865.00 " " 1,451.98 " " 1,708.69 " - 33251505 INDIUM IN111 PENTETREO TO 6MCI A9572 636 "$1,063.90" 393.22 - " 11,162.88 " - 735.15 - 735.15 - 587.80 - 702.17 - - 704.20 - - " 8,930.30 " " 11,162.88 " - - - 851.12 - - 712.81 - 435.14 797.93 404.39 475.88 - 33251777 GADOBENATE (MULTIHANCE) PER ML A9577 636 $19.29 7.13 - 27.26 - 13.33 - 13.33 - 10.66 - 12.73 - - 12.77 - - 21.81 27.26 - - - 15.43 - - 12.92 - 7.89 14.47 7.33 8.63 - 33252285 MAGNEVIST CONTRAST PER ML INJ A9579 636 $19.29 7.13 - 15.43 - 13.33 - 13.33 - 10.66 - 12.73 - - 12.77 - - 7.99 9.99 - - - 15.43 - - 12.92 - 7.89 14.47 7.33 8.63 - 33251645 SODIUM FLUORIDE F-18 TO 30MCI A9580 636 $408.32 150.92 - 326.66 - 282.15 - 282.15 - 225.60 - 269.49 - - 270.27 - - 216.37 270.47 - - - 326.66 - - 273.57 - 167.00 306.24 155.20 182.64 - 33251661 GADOXETATE (EOVIST) PER ML INJ A9581 636 $68.00 25.13 - 54.40 - 46.99 - 46.99 - 37.57 - 44.88 - - 45.01 - - 27.86 34.82 - - - 54.40 - - 45.56 - 27.81 51.00 25.85 30.42 - 33251670 IODINE I123 IOBENGUAN TO 15MCI A9582 636 "$10,695.74" " 3,953.15 " - " 8,556.59 " - " 7,390.76 " - " 7,390.76 " - " 5,909.40 " - " 7,059.19 " - - " 7,079.51 " - - " 5,667.67 " " 7,084.86 " - - - " 8,556.59 " - - " 7,166.15 " - " 4,374.56 " " 8,021.81 " " 4,065.45 " " 4,784.20 " - 33251696 GADOBUTROL PER 0.1 ML INJ A9585 636 $1.00 0.37 - 2.55 - 0.69 - 0.69 - 0.55 - 0.66 - - 0.66 - - 2.04 2.55 - - - 0.80 - - 0.67 - 0.41 0.75 0.38 0.45 - 33252005 GALLIUM GA-68 DOTAT DX 0.1 MCI A9587 636 $320.99 118.64 - 281.15 - 221.80 - 221.80 - 177.35 - 211.85 - - 212.46 - - 224.92 281.15 - - - 256.79 - - 215.06 - 131.28 240.74 122.01 143.58 - 33252013 FLUCICLOVINE F-18 DX 1 MCI A9588 636 "$2,063.16" 762.54 - " 1,650.53 " - " 1,425.64 " - " 1,425.64 " - " 1,139.90 " - " 1,361.69 " - - " 1,365.61 " - - " 1,312.75 " " 1,640.94 " - - - " 1,650.53 " - - " 1,382.32 " - 843.83 " 1,547.37 " 784.21 922.85 - 33251700 SAMARIUM LEXIDRONAM TO 150MCI A9604 636 "$90,614.00" " 33,490.93 " - " 72,491.20 " - " 62,614.27 " " 17,627.00 " " 62,614.27 " - " 50,064.24 " " 17,291.25 " " 59,805.24 " - - " 59,977.41 " " 15,108.86 " " 16,787.62 " " 17,905.61 " " 22,382.01 " " 17,207.31 " " 17,291.25 " " 16,787.62 " " 72,491.20 " " 15,360.67 " - " 60,711.38 " " 14,773.11 " " 37,061.13 " " 67,960.50 " " 34,442.38 " " 40,531.64 " " 17,375.19 " 33251718 RADIUM RA223 XOFIGO PER UCI A9606 636 $740.00 273.50 - 743.41 - 511.34 148.75 511.34 - 408.85 145.92 488.40 - - 489.81 127.50 141.67 594.73 743.41 145.21 145.92 141.67 592.00 129.63 - 495.80 124.67 302.66 555.00 281.27 331.00 146.63 28106513 GASTRO/JEJUNO TB (STD) LVL 001 B4087 278 $200.00 73.92 - 237.56 - 138.20 N/A 138.20 - 110.50 N/A 132.00 - N/A 132.38 - N/A 190.05 237.56 N/A N/A N/A 160.00 N/A - 134.00 N/A 81.80 150.00 76.02 89.46 N/A 28106530 GASTRO/JEJUNO TB (STD) LVL 003 B4087 278 $750.00 277.20 - 600.00 - 518.25 N/A 518.25 - 414.38 N/A 495.00 - N/A 496.43 - N/A 190.05 237.56 N/A N/A N/A 600.00 N/A - 502.50 N/A 306.75 562.50 285.08 335.48 N/A 34005451 GASTRO/JEJUNO TB (STD) LVL001 B4087 278 $200.00 73.92 - 237.56 - 138.20 N/A 138.20 - 110.50 N/A 132.00 - N/A 132.38 - N/A 190.05 237.56 N/A N/A N/A 160.00 N/A - 134.00 N/A 81.80 150.00 76.02 89.46 N/A 34005478 GASTRO/JEJUNO TB (STD) LVL003 B4087 278 $750.00 277.20 - 600.00 - 518.25 N/A 518.25 - 414.38 N/A 495.00 - N/A 496.43 - N/A 190.05 237.56 N/A N/A N/A 600.00 N/A - 502.50 N/A 306.75 562.50 285.08 335.48 N/A 80363451 GASTRO/JEJUNO TB (STD) LVL001 B4087 278 $200.00 73.92 - 237.56 - 138.20 N/A 138.20 - 110.50 N/A 132.00 - N/A 132.38 - N/A 190.05 237.56 N/A N/A N/A 160.00 N/A - 134.00 N/A 81.80 150.00 76.02 89.46 N/A 80363460 GASTRO/JEJUNO TB (STD) LVL002 B4087 278 $450.00 166.32 - 360.00 - 310.95 N/A 310.95 - 248.63 N/A 297.00 - N/A 297.86 - N/A 190.05 237.56 N/A N/A N/A 360.00 N/A - 301.50 N/A 184.05 337.50 171.05 201.29 N/A 80363478 GASTRO/JEJUNO TB (STD) LVL003 B4087 278 $750.00 277.20 - 600.00 - 518.25 N/A 518.25 - 414.38 N/A 495.00 - N/A 496.43 - N/A 190.05 237.56 N/A N/A N/A 600.00 N/A - 502.50 N/A 306.75 562.50 285.08 335.48 N/A 80363486 GASTRO/JEJUNO TB (STD) LVL004 B4087 278 "$1,050.00" 388.08 - 840.00 - 725.55 N/A 725.55 - 580.13 N/A 693.00 - N/A 695.00 - N/A 190.05 237.56 N/A N/A N/A 840.00 N/A - 703.50 N/A 429.45 787.50 399.11 469.67 N/A 80363494 GASTRO/JEJUNO TB (STD) LVL005 B4087 278 "$1,350.00" 498.96 - " 1,080.00 " - 932.85 N/A 932.85 - 745.88 N/A 891.00 - N/A 893.57 - N/A 190.05 237.56 N/A N/A N/A " 1,080.00 " N/A - 904.50 N/A 552.15 " 1,012.50 " 513.14 603.86 N/A 80363508 GASTRO/JEJUNO TB (STD) LVL006 B4087 278 "$1,375.00" 508.20 - " 1,100.00 " - 950.13 N/A 950.13 - 759.69 N/A 907.50 - N/A 910.11 - N/A 190.05 237.56 N/A N/A N/A " 1,100.00 " N/A - 921.25 N/A 562.38 " 1,031.25 " 522.64 615.04 N/A 80363516 GASTRO/JEJUNO TB (STD) LVL007 B4087 278 "$1,625.00" 600.60 - " 1,300.00 " - " 1,122.88 " N/A " 1,122.88 " - 897.81 N/A " 1,072.50 " - N/A " 1,075.59 " - N/A 190.05 237.56 N/A N/A N/A " 1,300.00 " N/A - " 1,088.75 " N/A 664.63 " 1,218.75 " 617.66 726.86 N/A 80363524 GASTRO/JEJUNO TB (STD) LVL008 B4087 278 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " N/A " 1,295.63 " - " 1,035.94 " N/A " 1,237.50 " - N/A " 1,241.06 " - N/A 190.05 237.56 N/A N/A N/A " 1,500.00 " N/A - " 1,256.25 " N/A 766.88 " 1,406.25 " 712.69 838.69 N/A 80363532 GASTRO/JEJUNO TB (STD) LVL009 B4087 278 "$2,125.00" 785.40 - " 1,700.00 " - " 1,468.38 " N/A " 1,468.38 " - " 1,174.06 " N/A " 1,402.50 " - N/A " 1,406.54 " - N/A 190.05 237.56 N/A N/A N/A " 1,700.00 " N/A - " 1,423.75 " N/A 869.13 " 1,593.75 " 807.71 950.51 N/A 80363541 GASTRO/JEJUNO TB (L/P) LVL001 B4088 278 $200.00 73.92 - 237.56 - 138.20 N/A 138.20 - 110.50 N/A 132.00 - N/A 132.38 - N/A 190.05 237.56 N/A N/A N/A 160.00 N/A - 134.00 N/A 81.80 150.00 76.02 89.46 N/A 80363559 GASTRO/JEJUNO TB (L/P) LVL002 B4088 278 $450.00 166.32 - 360.00 - 310.95 N/A 310.95 - 248.63 N/A 297.00 - N/A 297.86 - N/A 190.05 237.56 N/A N/A N/A 360.00 N/A - 301.50 N/A 184.05 337.50 171.05 201.29 N/A 80363567 GASTRO/JEJUNO TB (L/P) LVL003 B4088 278 $750.00 277.20 - 600.00 - 518.25 N/A 518.25 - 414.38 N/A 495.00 - N/A 496.43 - N/A 190.05 237.56 N/A N/A N/A 600.00 N/A - 502.50 N/A 306.75 562.50 285.08 335.48 N/A 80363575 GASTRO/JEJUNO TB (L/P) LVL004 B4088 278 "$1,050.00" 388.08 - 840.00 - 725.55 N/A 725.55 - 580.13 N/A 693.00 - N/A 695.00 - N/A 190.05 237.56 N/A N/A N/A 840.00 N/A - 703.50 N/A 429.45 787.50 399.11 469.67 N/A 80363583 GASTRO/JEJUNO TB (L/P) LVL005 B4088 278 "$1,350.00" 498.96 - " 1,080.00 " - 932.85 N/A 932.85 - 745.88 N/A 891.00 - N/A 893.57 - N/A 190.05 237.56 N/A N/A N/A " 1,080.00 " N/A - 904.50 N/A 552.15 " 1,012.50 " 513.14 603.86 N/A 80363591 GASTRO/JEJUNO TB (L/P) LVL006 B4088 278 "$1,375.00" 508.20 - " 1,100.00 " - 950.13 N/A 950.13 - 759.69 N/A 907.50 - N/A 910.11 - N/A 190.05 237.56 N/A N/A N/A " 1,100.00 " N/A - 921.25 N/A 562.38 " 1,031.25 " 522.64 615.04 N/A 80363605 GASTRO/JEJUNO TB (L/P) LVL007 B4088 278 "$1,625.00" 600.60 - " 1,300.00 " - " 1,122.88 " N/A " 1,122.88 " - 897.81 N/A " 1,072.50 " - N/A " 1,075.59 " - N/A 190.05 237.56 N/A N/A N/A " 1,300.00 " N/A - " 1,088.75 " N/A 664.63 " 1,218.75 " 617.66 726.86 N/A 80363613 GASTRO/JEJUNO TB (L/P) LVL008 B4088 278 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " N/A " 1,295.63 " - " 1,035.94 " N/A " 1,237.50 " - N/A " 1,241.06 " - N/A 190.05 237.56 N/A N/A N/A " 1,500.00 " N/A - " 1,256.25 " N/A 766.88 " 1,406.25 " 712.69 838.69 N/A 80363621 GASTRO/JEJUNO TB (L/P) LVL009 B4088 278 "$2,125.00" 785.40 - " 1,700.00 " - " 1,468.38 " N/A " 1,468.38 " - " 1,174.06 " N/A " 1,402.50 " - N/A " 1,406.54 " - N/A 190.05 237.56 N/A N/A N/A " 1,700.00 " N/A - " 1,423.75 " N/A 869.13 " 1,593.75 " 807.71 950.51 N/A 80363630 GASTRO/JEJUNO TB (L/P) LVL010 B4088 278 "$2,375.00" 877.80 - " 1,900.00 " - " 1,641.13 " N/A " 1,641.13 " - " 1,312.19 " N/A " 1,567.50 " - N/A " 1,572.01 " - N/A 190.05 237.56 N/A N/A N/A " 1,900.00 " N/A - " 1,591.25 " N/A 971.38 " 1,781.25 " 902.74 " 1,062.34 " N/A 28101953 ANCHOR BN/BN TIS/BN LVL001 C1713 278 $200.00 73.92 - 653.16 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 522.53 653.16 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 28101961 ANCHOR BN/BN TIS/BN LVL002 C1713 278 $450.00 166.32 - 653.16 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 522.53 653.16 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 28101970 ANCHOR BN/BN TIS/BN LVL003 C1713 278 $750.00 277.20 - 653.16 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 522.53 653.16 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 28101988 ANCHOR BN/BN TIS/BN LVL004 C1713 278 "$1,050.00" 388.08 - 840.00 - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 522.53 653.16 - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 28101996 ANCHOR BN/BN TIS/BN LVL005 C1713 278 "$1,350.00" 498.96 - " 1,080.00 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 522.53 653.16 - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 28102003 ANCHOR BN/BN TIS/BN LVL006 C1713 278 "$1,375.00" 508.20 - " 1,100.00 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - 522.53 653.16 - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 28102011 ANCHOR BN/BN TIS/BN LVL007 C1713 278 "$1,625.00" 600.60 - " 1,300.00 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - 522.53 653.16 - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 28102020 ANCHOR BN/BN TIS/BN LVL008 C1713 278 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - 522.53 653.16 - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 28102038 ANCHOR BN/BN TIS/BN LVL009 C1713 278 "$2,125.00" 785.40 - " 1,700.00 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - 522.53 653.16 - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 28102046 ANCHOR BN/BN TIS/BN LVL010 C1713 278 "$2,375.00" 877.80 - " 1,900.00 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - 522.53 653.16 - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 28102054 ANCHOR BN/BN TIS/BN LVL011 C1713 278 "$2,625.00" 970.20 - " 2,100.00 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - 522.53 653.16 - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 28102062 ANCHOR BN/BN TIS/BN LVL012 C1713 278 "$2,875.00" " 1,062.60 " - " 2,300.00 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - 522.53 653.16 - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 28102071 ANCHOR BN/BN TIS/BN LVL013 C1713 278 "$3,125.00" " 1,155.00 " - " 2,500.00 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - 522.53 653.16 - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 28102089 ANCHOR BN/BN TIS/BN LVL014 C1713 278 "$3,375.00" " 1,247.40 " - " 2,700.00 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - 522.53 653.16 - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 28102097 ANCHOR BN/BN TIS/BN LVL015 C1713 278 "$3,625.00" " 1,339.80 " - " 2,900.00 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - 522.53 653.16 - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 28102101 ANCHOR BN/BN TIS/BN LVL016 C1713 278 "$3,875.00" " 1,432.20 " - " 3,100.00 " - " 2,677.63 " - " 2,677.63 " - " 2,140.94 " - " 2,557.50 " - - " 2,564.86 " - - 522.53 653.16 - - - " 3,100.00 " - - " 2,596.25 " - " 1,584.88 " " 2,906.25 " " 1,472.89 " " 1,733.29 " - 28102119 ANCHOR BN/BN TIS/BN LVL017 C1713 278 "$4,125.00" " 1,524.60 " - " 3,300.00 " - " 2,850.38 " - " 2,850.38 " - " 2,279.06 " - " 2,722.50 " - - " 2,730.34 " - - 522.53 653.16 - - - " 3,300.00 " - - " 2,763.75 " - " 1,687.13 " " 3,093.75 " " 1,567.91 " " 1,845.11 " - 28102127 ANCHOR BN/BN TIS/BN LVL018 C1713 278 "$4,375.00" " 1,617.00 " - " 3,500.00 " - " 3,023.13 " - " 3,023.13 " - " 2,417.19 " - " 2,887.50 " - - " 2,895.81 " - - 522.53 653.16 - - - " 3,500.00 " - - " 2,931.25 " - " 1,789.38 " " 3,281.25 " " 1,662.94 " " 1,956.94 " - 28102135 ANCHOR BN/BN TIS/BN LVL019 C1713 278 "$4,625.00" " 1,709.40 " - " 3,700.00 " - " 3,195.88 " - " 3,195.88 " - " 2,555.31 " - " 3,052.50 " - - " 3,061.29 " - - 522.53 653.16 - - - " 3,700.00 " - - " 3,098.75 " - " 1,891.63 " " 3,468.75 " " 1,757.96 " " 2,068.76 " - 28102143 ANCHOR BN/BN TIS/BN LVL020 C1713 278 "$4,875.00" " 1,801.80 " - " 3,900.00 " - " 3,368.63 " - " 3,368.63 " - " 2,693.44 " - " 3,217.50 " - - " 3,226.76 " - - 522.53 653.16 - - - " 3,900.00 " - - " 3,266.25 " - " 1,993.88 " " 3,656.25 " " 1,852.99 " " 2,180.59 " - 28102151 ANCHOR BN/BN TIS/BN LVL021 C1713 278 "$5,125.00" " 1,894.20 " - " 4,100.00 " - " 3,541.38 " - " 3,541.38 " - " 2,831.56 " - " 3,382.50 " - - " 3,392.24 " - - 522.53 653.16 - - - " 4,100.00 " - - " 3,433.75 " - " 2,096.13 " " 3,843.75 " " 1,948.01 " " 2,292.41 " - 28102160 ANCHOR BN/BN TIS/BN LVL022 C1713 278 "$5,375.00" " 1,986.60 " - " 4,300.00 " - " 3,714.13 " - " 3,714.13 " - " 2,969.69 " - " 3,547.50 " - - " 3,557.71 " - - 522.53 653.16 - - - " 4,300.00 " - - " 3,601.25 " - " 2,198.38 " " 4,031.25 " " 2,043.04 " " 2,404.24 " - 28102178 ANCHOR BN/BN TIS/BN LVL023 C1713 278 "$5,625.00" " 2,079.00 " - " 4,500.00 " - " 3,886.88 " - " 3,886.88 " - " 3,107.81 " - " 3,712.50 " - - " 3,723.19 " - - 522.53 653.16 - - - " 4,500.00 " - - " 3,768.75 " - " 2,300.63 " " 4,218.75 " " 2,138.06 " " 2,516.06 " - 28102186 ANCHOR BN/BN TIS/BN LVL024 C1713 278 "$5,875.00" " 2,171.40 " - " 4,700.00 " - " 4,059.63 " - " 4,059.63 " - " 3,245.94 " - " 3,877.50 " - - " 3,888.66 " - - 522.53 653.16 - - - " 4,700.00 " - - " 3,936.25 " - " 2,402.88 " " 4,406.25 " " 2,233.09 " " 2,627.89 " - 28102194 ANCHOR BN/BN TIS/BN LVL025 C1713 278 "$6,125.00" " 2,263.80 " - " 4,900.00 " - " 4,232.38 " - " 4,232.38 " - " 3,384.06 " - " 4,042.50 " - - " 4,054.14 " - - 522.53 653.16 - - - " 4,900.00 " - - " 4,103.75 " - " 2,505.13 " " 4,593.75 " " 2,328.11 " " 2,739.71 " - 28102208 ANCHOR BN/BN TIS/BN LVL026 C1713 278 "$6,375.00" " 2,356.20 " - " 5,100.00 " - " 4,405.13 " - " 4,405.13 " - " 3,522.19 " - " 4,207.50 " - - " 4,219.61 " - - 522.53 653.16 - - - " 5,100.00 " - - " 4,271.25 " - " 2,607.38 " " 4,781.25 " " 2,423.14 " " 2,851.54 " - 28102216 ANCHOR BN/BN TIS/BN LVL027 C1713 278 "$6,625.00" " 2,448.60 " - " 5,300.00 " - " 4,577.88 " - " 4,577.88 " - " 3,660.31 " - " 4,372.50 " - - " 4,385.09 " - - 522.53 653.16 - - - " 5,300.00 " - - " 4,438.75 " - " 2,709.63 " " 4,968.75 " " 2,518.16 " " 2,963.36 " - 28102224 ANCHOR BN/BN TIS/BN LVL028 C1713 278 "$6,875.00" " 2,541.00 " - " 5,500.00 " - " 4,750.63 " - " 4,750.63 " - " 3,798.44 " - " 4,537.50 " - - " 4,550.56 " - - 522.53 653.16 - - - " 5,500.00 " - - " 4,606.25 " - " 2,811.88 " " 5,156.25 " " 2,613.19 " " 3,075.19 " - 28102232 ANCHOR BN/BN TIS/BN LVL029 C1713 278 "$7,125.00" " 2,633.40 " - " 5,700.00 " - " 4,923.38 " - " 4,923.38 " - " 3,936.56 " - " 4,702.50 " - - " 4,716.04 " - - 522.53 653.16 - - - " 5,700.00 " - - " 4,773.75 " - " 2,914.13 " " 5,343.75 " " 2,708.21 " " 3,187.01 " - 28102241 ANCHOR BN/BN TIS/BN LVL030 C1713 278 "$7,375.00" " 2,725.80 " - " 5,900.00 " - " 5,096.13 " - " 5,096.13 " - " 4,074.69 " - " 4,867.50 " - - " 4,881.51 " - - 522.53 653.16 - - - " 5,900.00 " - - " 4,941.25 " - " 3,016.38 " " 5,531.25 " " 2,803.24 " " 3,298.84 " - 28102259 ANCHOR BN/BN TIS/BN LVL031 C1713 278 "$7,625.00" " 2,818.20 " - " 6,100.00 " - " 5,268.88 " - " 5,268.88 " - " 4,212.81 " - " 5,032.50 " - - " 5,046.99 " - - 522.53 653.16 - - - " 6,100.00 " - - " 5,108.75 " - " 3,118.63 " " 5,718.75 " " 2,898.26 " " 3,410.66 " - 28102267 ANCHOR BN/BN TIS/BN LVL032 C1713 278 "$7,875.00" " 2,910.60 " - " 6,300.00 " - " 5,441.63 " - " 5,441.63 " - " 4,350.94 " - " 5,197.50 " - - " 5,212.46 " - - 522.53 653.16 - - - " 6,300.00 " - - " 5,276.25 " - " 3,220.88 " " 5,906.25 " " 2,993.29 " " 3,522.49 " - 28102275 ANCHOR BN/BN TIS/BN LVL033 C1713 278 "$8,125.00" " 3,003.00 " - " 6,500.00 " - " 5,614.38 " - " 5,614.38 " - " 4,489.06 " - " 5,362.50 " - - " 5,377.94 " - - 522.53 653.16 - - - " 6,500.00 " - - " 5,443.75 " - " 3,323.13 " " 6,093.75 " " 3,088.31 " " 3,634.31 " - 28102283 ANCHOR BN/BN TIS/BN LVL034 C1713 278 "$8,375.00" " 3,095.40 " - " 6,700.00 " - " 5,787.13 " - " 5,787.13 " - " 4,627.19 " - " 5,527.50 " - - " 5,543.41 " - - 522.53 653.16 - - - " 6,700.00 " - - " 5,611.25 " - " 3,425.38 " " 6,281.25 " " 3,183.34 " " 3,746.14 " - 28102291 ANCHOR BN/BN TIS/BN LVL035 C1713 278 "$8,625.00" " 3,187.80 " - " 6,900.00 " - " 5,959.88 " - " 5,959.88 " - " 4,765.31 " - " 5,692.50 " - - " 5,708.89 " - - 522.53 653.16 - - - " 6,900.00 " - - " 5,778.75 " - " 3,527.63 " " 6,468.75 " " 3,278.36 " " 3,857.96 " - 28102305 ANCHOR BN/BN TIS/BN LVL036 C1713 278 "$8,875.00" " 3,280.20 " - " 7,100.00 " - " 6,132.63 " - " 6,132.63 " - " 4,903.44 " - " 5,857.50 " - - " 5,874.36 " - - 522.53 653.16 - - - " 7,100.00 " - - " 5,946.25 " - " 3,629.88 " " 6,656.25 " " 3,373.39 " " 3,969.79 " - 28102313 ANCHOR BN/BN TIS/BN LVL037 C1713 278 "$9,125.00" " 3,372.60 " - " 7,300.00 " - " 6,305.38 " - " 6,305.38 " - " 5,041.56 " - " 6,022.50 " - - " 6,039.84 " - - 522.53 653.16 - - - " 7,300.00 " - - " 6,113.75 " - " 3,732.13 " " 6,843.75 " " 3,468.41 " " 4,081.61 " - 28102321 ANCHOR BN/BN TIS/BN LVL038 C1713 278 "$9,375.00" " 3,465.00 " - " 7,500.00 " - " 6,478.13 " - " 6,478.13 " - " 5,179.69 " - " 6,187.50 " - - " 6,205.31 " - - 522.53 653.16 - - - " 7,500.00 " - - " 6,281.25 " - " 3,834.38 " " 7,031.25 " " 3,563.44 " " 4,193.44 " - 28102330 ANCHOR BN/BN TIS/BN LVL039 C1713 278 "$9,625.00" " 3,557.40 " - " 7,700.00 " - " 6,650.88 " - " 6,650.88 " - " 5,317.81 " - " 6,352.50 " - - " 6,370.79 " - - 522.53 653.16 - - - " 7,700.00 " - - " 6,448.75 " - " 3,936.63 " " 7,218.75 " " 3,658.46 " " 4,305.26 " - 28102348 ANCHOR BN/BN TIS/BN LVL040 C1713 278 "$9,875.00" " 3,649.80 " - " 7,900.00 " - " 6,823.63 " - " 6,823.63 " - " 5,455.94 " - " 6,517.50 " - - " 6,536.26 " - - 522.53 653.16 - - - " 7,900.00 " - - " 6,616.25 " - " 4,038.88 " " 7,406.25 " " 3,753.49 " " 4,417.09 " - 28102356 ANCHOR BN/BN TIS/BN LVL041 C1713 278 "$10,125.00" " 3,742.20 " - " 8,100.00 " - " 6,996.38 " - " 6,996.38 " - " 5,594.06 " - " 6,682.50 " - - " 6,701.74 " - - 522.53 653.16 - - - " 8,100.00 " - - " 6,783.75 " - " 4,141.13 " " 7,593.75 " " 3,848.51 " " 4,528.91 " - 28102364 ANCHOR BN/BN TIS/BN LVL042 C1713 278 "$10,375.00" " 3,834.60 " - " 8,300.00 " - " 7,169.13 " - " 7,169.13 " - " 5,732.19 " - " 6,847.50 " - - " 6,867.21 " - - 522.53 653.16 - - - " 8,300.00 " - - " 6,951.25 " - " 4,243.38 " " 7,781.25 " " 3,943.54 " " 4,640.74 " - 28102372 ANCHOR BN/BN TIS/BN LVL043 C1713 278 "$10,625.00" " 3,927.00 " - " 8,500.00 " - " 7,341.88 " - " 7,341.88 " - " 5,870.31 " - " 7,012.50 " - - " 7,032.69 " - - 522.53 653.16 - - - " 8,500.00 " - - " 7,118.75 " - " 4,345.63 " " 7,968.75 " " 4,038.56 " " 4,752.56 " - 28102381 ANCHOR BN/BN TIS/BN LVL044 C1713 278 "$10,875.00" " 4,019.40 " - " 8,700.00 " - " 7,514.63 " - " 7,514.63 " - " 6,008.44 " - " 7,177.50 " - - " 7,198.16 " - - 522.53 653.16 - - - " 8,700.00 " - - " 7,286.25 " - " 4,447.88 " " 8,156.25 " " 4,133.59 " " 4,864.39 " - 28102411 ANCHOR BN/BN TIS/BN LVL047 C1713 278 "$11,625.00" " 4,296.60 " - " 9,300.00 " - " 8,032.88 " - " 8,032.88 " - " 6,422.81 " - " 7,672.50 " - - " 7,694.59 " - - 522.53 653.16 - - - " 9,300.00 " - - " 7,788.75 " - " 4,754.63 " " 8,718.75 " " 4,418.66 " " 5,199.86 " - 28102437 ANCHOR BN/BN TIS/BN LVL049 C1713 278 "$12,125.00" " 4,481.40 " - " 9,700.00 " - " 8,378.38 " - " 8,378.38 " - " 6,699.06 " - " 8,002.50 " - - " 8,025.54 " - - 522.53 653.16 - - - " 9,700.00 " - - " 8,123.75 " - " 4,959.13 " " 9,093.75 " " 4,608.71 " " 5,423.51 " - 28102445 ANCHOR BN/BN TIS/BN LVL050 C1713 278 "$12,375.00" " 4,573.80 " - " 9,900.00 " - " 8,551.13 " - " 8,551.13 " - " 6,837.19 " - " 8,167.50 " - - " 8,191.01 " - - 522.53 653.16 - - - " 9,900.00 " - - " 8,291.25 " - " 5,061.38 " " 9,281.25 " " 4,703.74 " " 5,535.34 " - 28102453 ANCHOR BN/BN TIS/BN LVL051 C1713 278 "$12,625.00" " 4,666.20 " - " 10,100.00 " - " 8,723.88 " - " 8,723.88 " - " 6,975.31 " - " 8,332.50 " - - " 8,356.49 " - - 522.53 653.16 - - - " 10,100.00 " - - " 8,458.75 " - " 5,163.63 " " 9,468.75 " " 4,798.76 " " 5,647.16 " - 28102461 ANCHOR BN/BN TIS/BN LVL052 C1713 278 "$12,875.00" " 4,758.60 " - " 10,300.00 " - " 8,896.63 " - " 8,896.63 " - " 7,113.44 " - " 8,497.50 " - - " 8,521.96 " - - 522.53 653.16 - - - " 10,300.00 " - - " 8,626.25 " - " 5,265.88 " " 9,656.25 " " 4,893.79 " " 5,758.99 " - 28102470 ANCHOR BN/BN TIS/BN LVL053 C1713 278 "$13,125.00" " 4,851.00 " - " 10,500.00 " - " 9,069.38 " - " 9,069.38 " - " 7,251.56 " - " 8,662.50 " - - " 8,687.44 " - - 522.53 653.16 - - - " 10,500.00 " - - " 8,793.75 " - " 5,368.13 " " 9,843.75 " " 4,988.81 " " 5,870.81 " - 28102488 ANCHOR BN/BN TIS/BN LVL054 C1713 278 "$13,375.00" " 4,943.40 " - " 10,700.00 " - " 9,242.13 " - " 9,242.13 " - " 7,389.69 " - " 8,827.50 " - - " 8,852.91 " - - 522.53 653.16 - - - " 10,700.00 " - - " 8,961.25 " - " 5,470.38 " " 10,031.25 " " 5,083.84 " " 5,982.64 " - 28102496 ANCHOR BN/BN TIS/BN LVL055 C1713 278 "$13,625.00" " 5,035.80 " - " 10,900.00 " - " 9,414.88 " - " 9,414.88 " - " 7,527.81 " - " 8,992.50 " - - " 9,018.39 " - - 522.53 653.16 - - - " 10,900.00 " - - " 9,128.75 " - " 5,572.63 " " 10,218.75 " " 5,178.86 " " 6,094.46 " - 28102500 ANCHOR BN/BN TIS/BN LVL056 C1713 278 "$13,875.00" " 5,128.20 " - " 11,100.00 " - " 9,587.63 " - " 9,587.63 " - " 7,665.94 " - " 9,157.50 " - - " 9,183.86 " - - 522.53 653.16 - - - " 11,100.00 " - - " 9,296.25 " - " 5,674.88 " " 10,406.25 " " 5,273.89 " " 6,206.29 " - 28102526 ANCHOR BN/BN TIS/BN LVL058 C1713 278 "$14,375.00" " 5,313.00 " - " 11,500.00 " - " 9,933.13 " - " 9,933.13 " - " 7,942.19 " - " 9,487.50 " - - " 9,514.81 " - - 522.53 653.16 - - - " 11,500.00 " - - " 9,631.25 " - " 5,879.38 " " 10,781.25 " " 5,463.94 " " 6,429.94 " - 28102534 ANCHOR BN/BN TIS/BN LVL059 C1713 278 "$14,625.00" " 5,405.40 " - " 11,700.00 " - " 10,105.88 " - " 10,105.88 " - " 8,080.31 " - " 9,652.50 " - - " 9,680.29 " - - 522.53 653.16 - - - " 11,700.00 " - - " 9,798.75 " - " 5,981.63 " " 10,968.75 " " 5,558.96 " " 6,541.76 " - 28102542 ANCHOR BN/BN TIS/BN LVL060 C1713 278 "$14,875.00" " 5,497.80 " - " 11,900.00 " - " 10,278.63 " - " 10,278.63 " - " 8,218.44 " - " 9,817.50 " - - " 9,845.76 " - - 522.53 653.16 - - - " 11,900.00 " - - " 9,966.25 " - " 6,083.88 " " 11,156.25 " " 5,653.99 " " 6,653.59 " - 28102577 ANCHOR BN/BN TIS/BN LVL063 C1713 278 "$15,625.00" " 5,775.00 " - " 12,500.00 " - " 10,796.88 " - " 10,796.88 " - " 8,632.81 " - " 10,312.50 " - - " 10,342.19 " - - 522.53 653.16 - - - " 12,500.00 " - - " 10,468.75 " - " 6,390.63 " " 11,718.75 " " 5,939.06 " " 6,989.06 " - 28102615 ANCHOR BN/BN TIS/BN LVL067 C1713 278 "$16,625.00" " 6,144.60 " - " 13,300.00 " - " 11,487.88 " - " 11,487.88 " - " 9,185.31 " - " 10,972.50 " - - " 11,004.09 " - - 522.53 653.16 - - - " 13,300.00 " - - " 11,138.75 " - " 6,799.63 " " 12,468.75 " " 6,319.16 " " 7,436.36 " - 28102828 ANCHOR BN/BN TIS/BN LVL088 C1713 278 "$21,875.00" " 8,085.00 " - " 17,500.00 " - " 15,115.63 " - " 15,115.63 " - " 12,085.94 " - " 14,437.50 " - - " 14,479.06 " - - 522.53 653.16 - - - " 17,500.00 " - - " 14,656.25 " - " 8,946.88 " " 16,406.25 " " 8,314.69 " " 9,784.69 " - 28102941 ANCHOR BN/BN TIS/BN LVL100 C1713 278 "$24,875.00" " 9,193.80 " - " 19,900.00 " - " 17,188.63 " - " 17,188.63 " - " 13,743.44 " - " 16,417.50 " - - " 16,464.76 " - - 522.53 653.16 - - - " 19,900.00 " - - " 16,666.25 " - " 10,173.88 " " 18,656.25 " " 9,454.99 " " 11,126.59 " - 80365187 ANCHOR BN/BN TIS/BN LVL037 C1713 278 "$9,125.00" " 3,372.60 " - " 7,300.00 " - " 6,305.38 " - " 6,305.38 " - " 5,041.56 " - " 6,022.50 " - - " 6,039.84 " - - 522.53 653.16 - - - " 7,300.00 " - - " 6,113.75 " - " 3,732.13 " " 6,843.75 " " 3,468.41 " " 4,081.61 " - 80365195 ANCHOR BN/BN TIS/BN LVL038 C1713 278 "$9,375.00" " 3,465.00 " - " 7,500.00 " - " 6,478.13 " - " 6,478.13 " - " 5,179.69 " - " 6,187.50 " - - " 6,205.31 " - - 522.53 653.16 - - - " 7,500.00 " - - " 6,281.25 " - " 3,834.38 " " 7,031.25 " " 3,563.44 " " 4,193.44 " - 80365209 ANCHOR BN/BN TIS/BN LVL039 C1713 278 "$9,625.00" " 3,557.40 " - " 7,700.00 " - " 6,650.88 " - " 6,650.88 " - " 5,317.81 " - " 6,352.50 " - - " 6,370.79 " - - 522.53 653.16 - - - " 7,700.00 " - - " 6,448.75 " - " 3,936.63 " " 7,218.75 " " 3,658.46 " " 4,305.26 " - 80365632 ANCHOR BN/BN TIS/BN LVL001 C1713 278 $200.00 73.92 - 653.16 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 522.53 653.16 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 80365641 ANCHOR BN/BN TIS/BN LVL002 C1713 278 $450.00 166.32 - 653.16 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 522.53 653.16 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 80365659 ANCHOR BN/BN TIS/BN LVL003 C1713 278 $750.00 277.20 - 653.16 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 522.53 653.16 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 80365667 ANCHOR BN/BN TIS/BN LVL004 C1713 278 "$1,050.00" 388.08 - 840.00 - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 522.53 653.16 - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 80365675 ANCHOR BN/BN TIS/BN LVL005 C1713 278 "$1,350.00" 498.96 - " 1,080.00 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 522.53 653.16 - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 80365683 ANCHOR BN/BN TIS/BN LVL006 C1713 278 "$1,375.00" 508.20 - " 1,100.00 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - 522.53 653.16 - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 80365691 ANCHOR BN/BN TIS/BN LVL007 C1713 278 "$1,625.00" 600.60 - " 1,300.00 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - 522.53 653.16 - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 80365705 ANCHOR BN/BN TIS/BN LVL008 C1713 278 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - 522.53 653.16 - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 80365713 ANCHOR BN/BN TIS/BN LVL009 C1713 278 "$2,125.00" 785.40 - " 1,700.00 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - 522.53 653.16 - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 80365721 ANCHOR BN/BN TIS/BN LVL010 C1713 278 "$2,375.00" 877.80 - " 1,900.00 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - 522.53 653.16 - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 28120435 CATH TRANS ATHEREC DIR LVL016 C1714 278 "$3,875.00" " 1,432.20 " - " 3,100.00 " - " 2,677.63 " - " 2,677.63 " - " 2,140.94 " - " 2,557.50 " - - " 2,564.86 " - - " 1,283.94 " " 1,604.93 " - - - " 3,100.00 " - - " 2,596.25 " - " 1,584.88 " " 2,906.25 " " 1,472.89 " " 1,733.29 " - 29813353 CATH TRANS ATHEREC DIR LVL031 C1714 278 "$7,625.00" " 2,818.20 " - " 6,100.00 " - " 5,268.88 " - " 5,268.88 " - " 4,212.81 " - " 5,032.50 " - - " 5,046.99 " - - " 1,283.94 " " 1,604.93 " - - - " 6,100.00 " - - " 5,108.75 " - " 3,118.63 " " 5,718.75 " " 2,898.26 " " 3,410.66 " - 29813361 CATH TRANS ATHEREC DIR LVL032 C1714 278 "$7,875.00" " 2,910.60 " - " 6,300.00 " - " 5,441.63 " - " 5,441.63 " - " 4,350.94 " - " 5,197.50 " - - " 5,212.46 " - - " 1,283.94 " " 1,604.93 " - - - " 6,300.00 " - - " 5,276.25 " - " 3,220.88 " " 5,906.25 " " 2,993.29 " " 3,522.49 " - 29813370 CATH TRANS ATHEREC DIR LVL033 C1714 278 "$8,125.00" " 3,003.00 " - " 6,500.00 " - " 5,614.38 " - " 5,614.38 " - " 4,489.06 " - " 5,362.50 " - - " 5,377.94 " - - " 1,283.94 " " 1,604.93 " - - - " 6,500.00 " - - " 5,443.75 " - " 3,323.13 " " 6,093.75 " " 3,088.31 " " 3,634.31 " - 29813388 CATH TRANS ATHEREC DIR LVL034 C1714 278 "$8,375.00" " 3,095.40 " - " 6,700.00 " - " 5,787.13 " - " 5,787.13 " - " 4,627.19 " - " 5,527.50 " - - " 5,543.41 " - - " 1,283.94 " " 1,604.93 " - - - " 6,700.00 " - - " 5,611.25 " - " 3,425.38 " " 6,281.25 " " 3,183.34 " " 3,746.14 " - 29813396 CATH TRANS ATHEREC DIR LVL035 C1714 278 "$8,625.00" " 3,187.80 " - " 6,900.00 " - " 5,959.88 " - " 5,959.88 " - " 4,765.31 " - " 5,692.50 " - - " 5,708.89 " - - " 1,283.94 " " 1,604.93 " - - - " 6,900.00 " - - " 5,778.75 " - " 3,527.63 " " 6,468.75 " " 3,278.36 " " 3,857.96 " - 29813400 CATH TRANS ATHEREC DIR LVL036 C1714 278 "$8,875.00" " 3,280.20 " - " 7,100.00 " - " 6,132.63 " - " 6,132.63 " - " 4,903.44 " - " 5,857.50 " - - " 5,874.36 " - - " 1,283.94 " " 1,604.93 " - - - " 7,100.00 " - - " 5,946.25 " - " 3,629.88 " " 6,656.25 " " 3,373.39 " " 3,969.79 " - 29813418 CATH TRANS ATHEREC DIR LVL037 C1714 278 "$9,125.00" " 3,372.60 " - " 7,300.00 " - " 6,305.38 " - " 6,305.38 " - " 5,041.56 " - " 6,022.50 " - - " 6,039.84 " - - " 1,283.94 " " 1,604.93 " - - - " 7,300.00 " - - " 6,113.75 " - " 3,732.13 " " 6,843.75 " " 3,468.41 " " 4,081.61 " - 29813426 CATH TRANS ATHEREC DIR LVL038 C1714 278 "$9,375.00" " 3,465.00 " - " 7,500.00 " - " 6,478.13 " - " 6,478.13 " - " 5,179.69 " - " 6,187.50 " - - " 6,205.31 " - - " 1,283.94 " " 1,604.93 " - - - " 7,500.00 " - - " 6,281.25 " - " 3,834.38 " " 7,031.25 " " 3,563.44 " " 4,193.44 " - 29813434 CATH TRANS ATHEREC DIR LVL039 C1714 278 "$9,625.00" " 3,557.40 " - " 7,700.00 " - " 6,650.88 " - " 6,650.88 " - " 5,317.81 " - " 6,352.50 " - - " 6,370.79 " - - " 1,283.94 " " 1,604.93 " - - - " 7,700.00 " - - " 6,448.75 " - " 3,936.63 " " 7,218.75 " " 3,658.46 " " 4,305.26 " - 29813442 CATH TRANS ATHEREC DIR LVL040 C1714 278 "$9,875.00" " 3,649.80 " - " 7,900.00 " - " 6,823.63 " - " 6,823.63 " - " 5,455.94 " - " 6,517.50 " - - " 6,536.26 " - - " 1,283.94 " " 1,604.93 " - - - " 7,900.00 " - - " 6,616.25 " - " 4,038.88 " " 7,406.25 " " 3,753.49 " " 4,417.09 " - 29813451 CATH TRANS ATHEREC DIR LVL041 C1714 278 "$10,125.00" " 3,742.20 " - " 8,100.00 " - " 6,996.38 " - " 6,996.38 " - " 5,594.06 " - " 6,682.50 " - - " 6,701.74 " - - " 1,283.94 " " 1,604.93 " - - - " 8,100.00 " - - " 6,783.75 " - " 4,141.13 " " 7,593.75 " " 3,848.51 " " 4,528.91 " - 29813469 CATH TRANS ATHEREC DIR LVL042 C1714 278 "$10,375.00" " 3,834.60 " - " 8,300.00 " - " 7,169.13 " - " 7,169.13 " - " 5,732.19 " - " 6,847.50 " - - " 6,867.21 " - - " 1,283.94 " " 1,604.93 " - - - " 8,300.00 " - - " 6,951.25 " - " 4,243.38 " " 7,781.25 " " 3,943.54 " " 4,640.74 " - 29813477 CATH TRANS ATHEREC DIR LVL043 C1714 278 "$10,625.00" " 3,927.00 " - " 8,500.00 " - " 7,341.88 " - " 7,341.88 " - " 5,870.31 " - " 7,012.50 " - - " 7,032.69 " - - " 1,283.94 " " 1,604.93 " - - - " 8,500.00 " - - " 7,118.75 " - " 4,345.63 " " 7,968.75 " " 4,038.56 " " 4,752.56 " - 29816590 CATH TRANS ATHEREC DIR LVL025 C1714 278 "$6,125.00" " 2,263.80 " - " 4,900.00 " - " 4,232.38 " - " 4,232.38 " - " 3,384.06 " - " 4,042.50 " - - " 4,054.14 " - - " 1,283.94 " " 1,604.93 " - - - " 4,900.00 " - - " 4,103.75 " - " 2,505.13 " " 4,593.75 " " 2,328.11 " " 2,739.71 " - 29816603 CATH TRANS ATHEREC DIR LVL026 C1714 278 "$6,375.00" " 2,356.20 " - " 5,100.00 " - " 4,405.13 " - " 4,405.13 " - " 3,522.19 " - " 4,207.50 " - - " 4,219.61 " - - " 1,283.94 " " 1,604.93 " - - - " 5,100.00 " - - " 4,271.25 " - " 2,607.38 " " 4,781.25 " " 2,423.14 " " 2,851.54 " - 29816611 CATH TRANS ATHEREC DIR LVL027 C1714 278 "$6,625.00" " 2,448.60 " - " 5,300.00 " - " 4,577.88 " - " 4,577.88 " - " 3,660.31 " - " 4,372.50 " - - " 4,385.09 " - - " 1,283.94 " " 1,604.93 " - - - " 5,300.00 " - - " 4,438.75 " - " 2,709.63 " " 4,968.75 " " 2,518.16 " " 2,963.36 " - 29816620 CATH TRANS ATHEREC DIR LVL028 C1714 278 "$6,875.00" " 2,541.00 " - " 5,500.00 " - " 4,750.63 " - " 4,750.63 " - " 3,798.44 " - " 4,537.50 " - - " 4,550.56 " - - " 1,283.94 " " 1,604.93 " - - - " 5,500.00 " - - " 4,606.25 " - " 2,811.88 " " 5,156.25 " " 2,613.19 " " 3,075.19 " - 29816638 CATH TRANS ATHEREC DIR LVL029 C1714 278 "$7,125.00" " 2,633.40 " - " 5,700.00 " - " 4,923.38 " - " 4,923.38 " - " 3,936.56 " - " 4,702.50 " - - " 4,716.04 " - - " 1,283.94 " " 1,604.93 " - - - " 5,700.00 " - - " 4,773.75 " - " 2,914.13 " " 5,343.75 " " 2,708.21 " " 3,187.01 " - 29816646 CATH TRANS ATHEREC DIR LVL030 C1714 278 "$7,375.00" " 2,725.80 " - " 5,900.00 " - " 5,096.13 " - " 5,096.13 " - " 4,074.69 " - " 4,867.50 " - - " 4,881.51 " - - " 1,283.94 " " 1,604.93 " - - - " 5,900.00 " - - " 4,941.25 " - " 3,016.38 " " 5,531.25 " " 2,803.24 " " 3,298.84 " - 29816654 CATH TRANS ATHEREC DIR LVL044 C1714 278 "$10,875.00" " 4,019.40 " - " 8,700.00 " - " 7,514.63 " - " 7,514.63 " - " 6,008.44 " - " 7,177.50 " - - " 7,198.16 " - - " 1,283.94 " " 1,604.93 " - - - " 8,700.00 " - - " 7,286.25 " - " 4,447.88 " " 8,156.25 " " 4,133.59 " " 4,864.39 " - 29816662 CATH TRANS ATHEREC DIR LVL045 C1714 278 "$11,125.00" " 4,111.80 " - " 8,900.00 " - " 7,687.38 " - " 7,687.38 " - " 6,146.56 " - " 7,342.50 " - - " 7,363.64 " - - " 1,283.94 " " 1,604.93 " - - - " 8,900.00 " - - " 7,453.75 " - " 4,550.13 " " 8,343.75 " " 4,228.61 " " 4,976.21 " - 80010311 BRACHYTX NON-STRND HDR IR-192 C1717 278 "$1,130.00" 417.65 - 904.00 - 780.83 348.99 780.83 - 624.33 342.34 745.80 - - 747.95 299.13 332.37 603.41 754.26 340.68 342.34 332.37 904.00 304.12 - 757.10 292.49 462.17 847.50 429.51 505.45 344.00 28101538 AICD (D-CHAMBER) LVL131 C1721 275 "$32,625.00" " 12,058.20 " - " 63,429.72 " - " 22,543.88 " - " 22,543.88 " - " 18,025.31 " - " 21,532.50 " - - " 21,594.49 " - - " 50,743.78 " " 63,429.72 " - - - " 26,100.00 " - - " 21,858.75 " - " 13,343.63 " " 24,468.75 " " 12,400.76 " " 14,593.16 " - 30603303 AICD (D-CHAMBER) LVL114 C1721 275 "$28,375.00" " 10,487.40 " - " 63,429.72 " - " 19,607.13 " - " 19,607.13 " - " 15,677.19 " - " 18,727.50 " - - " 18,781.41 " - - " 50,743.78 " " 63,429.72 " - - - " 22,700.00 " - - " 19,011.25 " - " 11,605.38 " " 21,281.25 " " 10,785.34 " " 12,692.14 " - 30603311 AICD (D-CHAMBER) LVL115 C1721 275 "$28,625.00" " 10,579.80 " - " 63,429.72 " - " 19,779.88 " - " 19,779.88 " - " 15,815.31 " - " 18,892.50 " - - " 18,946.89 " - - " 50,743.78 " " 63,429.72 " - - - " 22,900.00 " - - " 19,178.75 " - " 11,707.63 " " 21,468.75 " " 10,880.36 " " 12,803.96 " - 30603320 AICD (D-CHAMBER) LVL116 C1721 275 "$28,875.00" " 10,672.20 " - " 63,429.72 " - " 19,952.63 " - " 19,952.63 " - " 15,953.44 " - " 19,057.50 " - - " 19,112.36 " - - " 50,743.78 " " 63,429.72 " - - - " 23,100.00 " - - " 19,346.25 " - " 11,809.88 " " 21,656.25 " " 10,975.39 " " 12,915.79 " - 30603338 AICD (D-CHAMBER) LVL117 C1721 275 "$29,125.00" " 10,764.60 " - " 63,429.72 " - " 20,125.38 " - " 20,125.38 " - " 16,091.56 " - " 19,222.50 " - - " 19,277.84 " - - " 50,743.78 " " 63,429.72 " - - - " 23,300.00 " - - " 19,513.75 " - " 11,912.13 " " 21,843.75 " " 11,070.41 " " 13,027.61 " - 30603346 AICD (D-CHAMBER) LVL118 C1721 275 "$29,375.00" " 10,857.00 " - " 63,429.72 " - " 20,298.13 " - " 20,298.13 " - " 16,229.69 " - " 19,387.50 " - - " 19,443.31 " - - " 50,743.78 " " 63,429.72 " - - - " 23,500.00 " - - " 19,681.25 " - " 12,014.38 " " 22,031.25 " " 11,165.44 " " 13,139.44 " - 30603354 AICD (D-CHAMBER) LVL124 C1721 275 "$30,875.00" " 11,411.40 " - " 63,429.72 " - " 21,334.63 " - " 21,334.63 " - " 17,058.44 " - " 20,377.50 " - - " 20,436.16 " - - " 50,743.78 " " 63,429.72 " - - - " 24,700.00 " - - " 20,686.25 " - " 12,627.88 " " 23,156.25 " " 11,735.59 " " 13,810.39 " - 30603362 AICD (D-CHAMBER) LVL125 C1721 275 "$31,125.00" " 11,503.80 " - " 63,429.72 " - " 21,507.38 " - " 21,507.38 " - " 17,196.56 " - " 20,542.50 " - - " 20,601.64 " - - " 50,743.78 " " 63,429.72 " - - - " 24,900.00 " - - " 20,853.75 " - " 12,730.13 " " 23,343.75 " " 11,830.61 " " 13,922.21 " - 30603371 AICD (D-CHAMBER) LVL126 C1721 275 "$31,375.00" " 11,596.20 " - " 63,429.72 " - " 21,680.13 " - " 21,680.13 " - " 17,334.69 " - " 20,707.50 " - - " 20,767.11 " - - " 50,743.78 " " 63,429.72 " - - - " 25,100.00 " - - " 21,021.25 " - " 12,832.38 " " 23,531.25 " " 11,925.64 " " 14,034.04 " - 30603389 AICD (D-CHAMBER) LVL127 C1721 275 "$31,625.00" " 11,688.60 " - " 63,429.72 " - " 21,852.88 " - " 21,852.88 " - " 17,472.81 " - " 20,872.50 " - - " 20,932.59 " - - " 50,743.78 " " 63,429.72 " - - - " 25,300.00 " - - " 21,188.75 " - " 12,934.63 " " 23,718.75 " " 12,020.66 " " 14,145.86 " - 30603397 AICD (D-CHAMBER) LVL128 C1721 275 "$31,875.00" " 11,781.00 " - " 63,429.72 " - " 22,025.63 " - " 22,025.63 " - " 17,610.94 " - " 21,037.50 " - - " 21,098.06 " - - " 50,743.78 " " 63,429.72 " - - - " 25,500.00 " - - " 21,356.25 " - " 13,036.88 " " 23,906.25 " " 12,115.69 " " 14,257.69 " - 30603401 AICD (D-CHAMBER) LVL129 C1721 275 "$32,125.00" " 11,873.40 " - " 63,429.72 " - " 22,198.38 " - " 22,198.38 " - " 17,749.06 " - " 21,202.50 " - - " 21,263.54 " - - " 50,743.78 " " 63,429.72 " - - - " 25,700.00 " - - " 21,523.75 " - " 13,139.13 " " 24,093.75 " " 12,210.71 " " 14,369.51 " - 30603419 AICD (D-CHAMBER) LVL137 C1721 275 "$34,125.00" " 12,612.60 " - " 63,429.72 " - " 23,580.38 " - " 23,580.38 " - " 18,854.06 " - " 22,522.50 " - - " 22,587.34 " - - " 50,743.78 " " 63,429.72 " - - - " 27,300.00 " - - " 22,863.75 " - " 13,957.13 " " 25,593.75 " " 12,970.91 " " 15,264.11 " - 30603427 AICD (D-CHAMBER) LVL138 C1721 275 "$34,375.00" " 12,705.00 " - " 63,429.72 " - " 23,753.13 " - " 23,753.13 " - " 18,992.19 " - " 22,687.50 " - - " 22,752.81 " - - " 50,743.78 " " 63,429.72 " - - - " 27,500.00 " - - " 23,031.25 " - " 14,059.38 " " 25,781.25 " " 13,065.94 " " 15,375.94 " - 30603435 AICD (D-CHAMBER) LVL140 C1721 275 "$34,875.00" " 12,889.80 " - " 63,429.72 " - " 24,098.63 " - " 24,098.63 " - " 19,268.44 " - " 23,017.50 " - - " 23,083.76 " - - " 50,743.78 " " 63,429.72 " - - - " 27,900.00 " - - " 23,366.25 " - " 14,263.88 " " 26,156.25 " " 13,255.99 " " 15,599.59 " - 30603443 AICD (D-CHAMBER) LVL141 C1721 275 "$35,125.00" " 12,982.20 " - " 63,429.72 " - " 24,271.38 " - " 24,271.38 " - " 19,406.56 " - " 23,182.50 " - - " 23,249.24 " - - " 50,743.78 " " 63,429.72 " - - - " 28,100.00 " - - " 23,533.75 " - " 14,366.13 " " 26,343.75 " " 13,351.01 " " 15,711.41 " - 30603451 AICD (D-CHAMBER) LVL142 C1721 275 "$35,375.00" " 13,074.60 " - " 63,429.72 " - " 24,444.13 " - " 24,444.13 " - " 19,544.69 " - " 23,347.50 " - - " 23,414.71 " - - " 50,743.78 " " 63,429.72 " - - - " 28,300.00 " - - " 23,701.25 " - " 14,468.38 " " 26,531.25 " " 13,446.04 " " 15,823.24 " - 30603460 AICD (D-CHAMBER) LVL143 C1721 275 "$35,625.00" " 13,167.00 " - " 63,429.72 " - " 24,616.88 " - " 24,616.88 " - " 19,682.81 " - " 23,512.50 " - - " 23,580.19 " - - " 50,743.78 " " 63,429.72 " - - - " 28,500.00 " - - " 23,868.75 " - " 14,570.63 " " 26,718.75 " " 13,541.06 " " 15,935.06 " - 30603478 AICD (D-CHAMBER) LVL149 C1721 275 "$37,125.00" " 13,721.40 " - " 63,429.72 " - " 25,653.38 " - " 25,653.38 " - " 20,511.56 " - " 24,502.50 " - - " 24,573.04 " - - " 50,743.78 " " 63,429.72 " - - - " 29,700.00 " - - " 24,873.75 " - " 15,184.13 " " 27,843.75 " " 14,111.21 " " 16,606.01 " - 30603486 AICD (D-CHAMBER) LVL150 C1721 275 "$37,375.00" " 13,813.80 " - " 63,429.72 " - " 25,826.13 " - " 25,826.13 " - " 20,649.69 " - " 24,667.50 " - - " 24,738.51 " - - " 50,743.78 " " 63,429.72 " - - - " 29,900.00 " - - " 25,041.25 " - " 15,286.38 " " 28,031.25 " " 14,206.24 " " 16,717.84 " - 30603494 AICD (D-CHAMBER) LVL151 C1721 275 "$37,625.00" " 13,906.20 " - " 63,429.72 " - " 25,998.88 " - " 25,998.88 " - " 20,787.81 " - " 24,832.50 " - - " 24,903.99 " - - " 50,743.78 " " 63,429.72 " - - - " 30,100.00 " - - " 25,208.75 " - " 15,388.63 " " 28,218.75 " " 14,301.26 " " 16,829.66 " - 30603508 AICD (D-CHAMBER) LVL152 C1721 275 "$37,875.00" " 13,998.60 " - " 63,429.72 " - " 26,171.63 " - " 26,171.63 " - " 20,925.94 " - " 24,997.50 " - - " 25,069.46 " - - " 50,743.78 " " 63,429.72 " - - - " 30,300.00 " - - " 25,376.25 " - " 15,490.88 " " 28,406.25 " " 14,396.29 " " 16,941.49 " - 30603516 AICD (D-CHAMBER) LVL153 C1721 275 "$38,125.00" " 14,091.00 " - " 63,429.72 " - " 26,344.38 " - " 26,344.38 " - " 21,064.06 " - " 25,162.50 " - - " 25,234.94 " - - " 50,743.78 " " 63,429.72 " - - - " 30,500.00 " - - " 25,543.75 " - " 15,593.13 " " 28,593.75 " " 14,491.31 " " 17,053.31 " - 30603524 AICD (D-CHAMBER) LVL154 C1721 275 "$38,375.00" " 14,183.40 " - " 63,429.72 " - " 26,517.13 " - " 26,517.13 " - " 21,202.19 " - " 25,327.50 " - - " 25,400.41 " - - " 50,743.78 " " 63,429.72 " - - - " 30,700.00 " - - " 25,711.25 " - " 15,695.38 " " 28,781.25 " " 14,586.34 " " 17,165.14 " - 30603532 AICD (D-CHAMBER) LVL155 C1721 275 "$38,625.00" " 14,275.80 " - " 63,429.72 " - " 26,689.88 " - " 26,689.88 " - " 21,340.31 " - " 25,492.50 " - - " 25,565.89 " - - " 50,743.78 " " 63,429.72 " - - - " 30,900.00 " - - " 25,878.75 " - " 15,797.63 " " 28,968.75 " " 14,681.36 " " 17,276.96 " - 30603541 AICD (D-CHAMBER) LVL158 C1721 275 "$39,375.00" " 14,553.00 " - " 63,429.72 " - " 27,208.13 " - " 27,208.13 " - " 21,754.69 " - " 25,987.50 " - - " 26,062.31 " - - " 50,743.78 " " 63,429.72 " - - - " 31,500.00 " - - " 26,381.25 " - " 16,104.38 " " 29,531.25 " " 14,966.44 " " 17,612.44 " - 30603559 AICD (D-CHAMBER) LVL159 C1721 275 "$39,625.00" " 14,645.40 " - " 63,429.72 " - " 27,380.88 " - " 27,380.88 " - " 21,892.81 " - " 26,152.50 " - - " 26,227.79 " - - " 50,743.78 " " 63,429.72 " - - - " 31,700.00 " - - " 26,548.75 " - " 16,206.63 " " 29,718.75 " " 15,061.46 " " 17,724.26 " - 30603567 AICD (D-CHAMBER) LVL160 C1721 275 "$39,875.00" " 14,737.80 " - " 63,429.72 " - " 27,553.63 " - " 27,553.63 " - " 22,030.94 " - " 26,317.50 " - - " 26,393.26 " - - " 50,743.78 " " 63,429.72 " - - - " 31,900.00 " - - " 26,716.25 " - " 16,308.88 " " 29,906.25 " " 15,156.49 " " 17,836.09 " - 30603575 AICD (D-CHAMBER) LVL162 C1721 275 "$40,375.00" " 14,922.60 " - " 63,429.72 " - " 27,899.13 " - " 27,899.13 " - " 22,307.19 " - " 26,647.50 " - - " 26,724.21 " - - " 50,743.78 " " 63,429.72 " - - - " 32,300.00 " - - " 27,051.25 " - " 16,513.38 " " 30,281.25 " " 15,346.54 " " 18,059.74 " - 30603583 AICD (D-CHAMBER) LVL163 C1721 275 "$40,625.00" " 15,015.00 " - " 63,429.72 " - " 28,071.88 " - " 28,071.88 " - " 22,445.31 " - " 26,812.50 " - - " 26,889.69 " - - " 50,743.78 " " 63,429.72 " - - - " 32,500.00 " - - " 27,218.75 " - " 16,615.63 " " 30,468.75 " " 15,441.56 " " 18,171.56 " - 30603591 AICD (D-CHAMBER) LVL164 C1721 275 "$40,875.00" " 15,107.40 " - " 63,429.72 " - " 28,244.63 " - " 28,244.63 " - " 22,583.44 " - " 26,977.50 " - - " 27,055.16 " - - " 50,743.78 " " 63,429.72 " - - - " 32,700.00 " - - " 27,386.25 " - " 16,717.88 " " 30,656.25 " " 15,536.59 " " 18,283.39 " - 30603605 AICD (D-CHAMBER) LVL165 C1721 275 "$41,125.00" " 15,199.80 " - " 63,429.72 " - " 28,417.38 " - " 28,417.38 " - " 22,721.56 " - " 27,142.50 " - - " 27,220.64 " - - " 50,743.78 " " 63,429.72 " - - - " 32,900.00 " - - " 27,553.75 " - " 16,820.13 " " 30,843.75 " " 15,631.61 " " 18,395.21 " - 30603613 AICD (D-CHAMBER) LVL166 C1721 275 "$41,375.00" " 15,292.20 " - " 63,429.72 " - " 28,590.13 " - " 28,590.13 " - " 22,859.69 " - " 27,307.50 " - - " 27,386.11 " - - " 50,743.78 " " 63,429.72 " - - - " 33,100.00 " - - " 27,721.25 " - " 16,922.38 " " 31,031.25 " " 15,726.64 " " 18,507.04 " - 30603621 AICD (D-CHAMBER) LVL167 C1721 275 "$41,625.00" " 15,384.60 " - " 63,429.72 " - " 28,762.88 " - " 28,762.88 " - " 22,997.81 " - " 27,472.50 " - - " 27,551.59 " - - " 50,743.78 " " 63,429.72 " - - - " 33,300.00 " - - " 27,888.75 " - " 17,024.63 " " 31,218.75 " " 15,821.66 " " 18,618.86 " - 30603630 AICD (D-CHAMBER) LVL168 C1721 275 "$41,875.00" " 15,477.00 " - " 63,429.72 " - " 28,935.63 " - " 28,935.63 " - " 23,135.94 " - " 27,637.50 " - - " 27,717.06 " - - " 50,743.78 " " 63,429.72 " - - - " 33,500.00 " - - " 28,056.25 " - " 17,126.88 " " 31,406.25 " " 15,916.69 " " 18,730.69 " - 30603648 AICD (D-CHAMBER) LVL169 C1721 275 "$42,125.00" " 15,569.40 " - " 63,429.72 " - " 29,108.38 " - " 29,108.38 " - " 23,274.06 " - " 27,802.50 " - - " 27,882.54 " - - " 50,743.78 " " 63,429.72 " - - - " 33,700.00 " - - " 28,223.75 " - " 17,229.13 " " 31,593.75 " " 16,011.71 " " 18,842.51 " - 30603656 AICD (D-CHAMBER) LVL170 C1721 275 "$42,375.00" " 15,661.80 " - " 63,429.72 " - " 29,281.13 " - " 29,281.13 " - " 23,412.19 " - " 27,967.50 " - - " 28,048.01 " - - " 50,743.78 " " 63,429.72 " - - - " 33,900.00 " - - " 28,391.25 " - " 17,331.38 " " 31,781.25 " " 16,106.74 " " 18,954.34 " - 30603664 AICD (D-CHAMBER) LVL171 C1721 275 "$42,625.00" " 15,754.20 " - " 63,429.72 " - " 29,453.88 " - " 29,453.88 " - " 23,550.31 " - " 28,132.50 " - - " 28,213.49 " - - " 50,743.78 " " 63,429.72 " - - - " 34,100.00 " - - " 28,558.75 " - " 17,433.63 " " 31,968.75 " " 16,201.76 " " 19,066.16 " - 30603672 AICD (D-CHAMBER) LVL172 C1721 275 "$42,875.00" " 15,846.60 " - " 63,429.72 " - " 29,626.63 " - " 29,626.63 " - " 23,688.44 " - " 28,297.50 " - - " 28,378.96 " - - " 50,743.78 " " 63,429.72 " - - - " 34,300.00 " - - " 28,726.25 " - " 17,535.88 " " 32,156.25 " " 16,296.79 " " 19,177.99 " - 30603681 AICD (D-CHAMBER) LVL173 C1721 275 "$43,125.00" " 15,939.00 " - " 63,429.72 " - " 29,799.38 " - " 29,799.38 " - " 23,826.56 " - " 28,462.50 " - - " 28,544.44 " - - " 50,743.78 " " 63,429.72 " - - - " 34,500.00 " - - " 28,893.75 " - " 17,638.13 " " 32,343.75 " " 16,391.81 " " 19,289.81 " - 30603699 AICD (D-CHAMBER) LVL174 C1721 275 "$43,375.00" " 16,031.40 " - " 63,429.72 " - " 29,972.13 " - " 29,972.13 " - " 23,964.69 " - " 28,627.50 " - - " 28,709.91 " - - " 50,743.78 " " 63,429.72 " - - - " 34,700.00 " - - " 29,061.25 " - " 17,740.38 " " 32,531.25 " " 16,486.84 " " 19,401.64 " - 30607210 AICD (D-CHAMBER) LVL107 C1721 275 "$26,625.00" " 9,840.60 " - " 63,429.72 " - " 18,397.88 " - " 18,397.88 " - " 14,710.31 " - " 17,572.50 " - - " 17,623.09 " - - " 50,743.78 " " 63,429.72 " - - - " 21,300.00 " - - " 17,838.75 " - " 10,889.63 " " 19,968.75 " " 10,120.16 " " 11,909.36 " - 30607228 AICD (D-CHAMBER) LVL108 C1721 275 "$26,875.00" " 9,933.00 " - " 63,429.72 " - " 18,570.63 " - " 18,570.63 " - " 14,848.44 " - " 17,737.50 " - - " 17,788.56 " - - " 50,743.78 " " 63,429.72 " - - - " 21,500.00 " - - " 18,006.25 " - " 10,991.88 " " 20,156.25 " " 10,215.19 " " 12,021.19 " - 30607236 AICD (D-CHAMBER) LVL109 C1721 275 "$27,125.00" " 10,025.40 " - " 63,429.72 " - " 18,743.38 " - " 18,743.38 " - " 14,986.56 " - " 17,902.50 " - - " 17,954.04 " - - " 50,743.78 " " 63,429.72 " - - - " 21,700.00 " - - " 18,173.75 " - " 11,094.13 " " 20,343.75 " " 10,310.21 " " 12,133.01 " - 30607244 AICD (D-CHAMBER) LVL110 C1721 275 "$27,375.00" " 10,117.80 " - " 63,429.72 " - " 18,916.13 " - " 18,916.13 " - " 15,124.69 " - " 18,067.50 " - - " 18,119.51 " - - " 50,743.78 " " 63,429.72 " - - - " 21,900.00 " - - " 18,341.25 " - " 11,196.38 " " 20,531.25 " " 10,405.24 " " 12,244.84 " - 30607252 AICD (D-CHAMBER) LVL111 C1721 275 "$27,625.00" " 10,210.20 " - " 63,429.72 " - " 19,088.88 " - " 19,088.88 " - " 15,262.81 " - " 18,232.50 " - - " 18,284.99 " - - " 50,743.78 " " 63,429.72 " - - - " 22,100.00 " - - " 18,508.75 " - " 11,298.63 " " 20,718.75 " " 10,500.26 " " 12,356.66 " - 30607261 AICD (D-CHAMBER) LVL112 C1721 275 "$27,875.00" " 10,302.60 " - " 63,429.72 " - " 19,261.63 " - " 19,261.63 " - " 15,400.94 " - " 18,397.50 " - - " 18,450.46 " - - " 50,743.78 " " 63,429.72 " - - - " 22,300.00 " - - " 18,676.25 " - " 11,400.88 " " 20,906.25 " " 10,595.29 " " 12,468.49 " - 30607279 AICD (D-CHAMBER) LVL113 C1721 275 "$28,125.00" " 10,395.00 " - " 63,429.72 " - " 19,434.38 " - " 19,434.38 " - " 15,539.06 " - " 18,562.50 " - - " 18,615.94 " - - " 50,743.78 " " 63,429.72 " - - - " 22,500.00 " - - " 18,843.75 " - " 11,503.13 " " 21,093.75 " " 10,690.31 " " 12,580.31 " - 30607287 AICD (D-CHAMBER) LVL119 C1721 275 "$29,625.00" " 10,949.40 " - " 63,429.72 " - " 20,470.88 " - " 20,470.88 " - " 16,367.81 " - " 19,552.50 " - - " 19,608.79 " - - " 50,743.78 " " 63,429.72 " - - - " 23,700.00 " - - " 19,848.75 " - " 12,116.63 " " 22,218.75 " " 11,260.46 " " 13,251.26 " - 30607295 AICD (D-CHAMBER) LVL120 C1721 275 "$29,875.00" " 11,041.80 " - " 63,429.72 " - " 20,643.63 " - " 20,643.63 " - " 16,505.94 " - " 19,717.50 " - - " 19,774.26 " - - " 50,743.78 " " 63,429.72 " - - - " 23,900.00 " - - " 20,016.25 " - " 12,218.88 " " 22,406.25 " " 11,355.49 " " 13,363.09 " - 30607309 AICD (D-CHAMBER) LVL121 C1721 275 "$30,125.00" " 11,134.20 " - " 63,429.72 " - " 20,816.38 " - " 20,816.38 " - " 16,644.06 " - " 19,882.50 " - - " 19,939.74 " - - " 50,743.78 " " 63,429.72 " - - - " 24,100.00 " - - " 20,183.75 " - " 12,321.13 " " 22,593.75 " " 11,450.51 " " 13,474.91 " - 30607317 AICD (D-CHAMBER) LVL122 C1721 275 "$30,375.00" " 11,226.60 " - " 63,429.72 " - " 20,989.13 " - " 20,989.13 " - " 16,782.19 " - " 20,047.50 " - - " 20,105.21 " - - " 50,743.78 " " 63,429.72 " - - - " 24,300.00 " - - " 20,351.25 " - " 12,423.38 " " 22,781.25 " " 11,545.54 " " 13,586.74 " - 30607325 AICD (D-CHAMBER) LVL123 C1721 275 "$30,625.00" " 11,319.00 " - " 63,429.72 " - " 21,161.88 " - " 21,161.88 " - " 16,920.31 " - " 20,212.50 " - - " 20,270.69 " - - " 50,743.78 " " 63,429.72 " - - - " 24,500.00 " - - " 20,518.75 " - " 12,525.63 " " 22,968.75 " " 11,640.56 " " 13,698.56 " - 30607368 AICD (D-CHAMBER) LVL100 C1721 275 "$24,875.00" " 9,193.80 " - " 63,429.72 " - " 17,188.63 " - " 17,188.63 " - " 13,743.44 " - " 16,417.50 " - - " 16,464.76 " - - " 50,743.78 " " 63,429.72 " - - - " 19,900.00 " - - " 16,666.25 " - " 10,173.88 " " 18,656.25 " " 9,454.99 " " 11,126.59 " - 30607376 AICD (D-CHAMBER) LVL101 C1721 275 "$25,125.00" " 9,286.20 " - " 63,429.72 " - " 17,361.38 " - " 17,361.38 " - " 13,881.56 " - " 16,582.50 " - - " 16,630.24 " - - " 50,743.78 " " 63,429.72 " - - - " 20,100.00 " - - " 16,833.75 " - " 10,276.13 " " 18,843.75 " " 9,550.01 " " 11,238.41 " - 30607384 AICD (D-CHAMBER) LVL102 C1721 275 "$25,375.00" " 9,378.60 " - " 63,429.72 " - " 17,534.13 " - " 17,534.13 " - " 14,019.69 " - " 16,747.50 " - - " 16,795.71 " - - " 50,743.78 " " 63,429.72 " - - - " 20,300.00 " - - " 17,001.25 " - " 10,378.38 " " 19,031.25 " " 9,645.04 " " 11,350.24 " - 30607392 AICD (D-CHAMBER) LVL103 C1721 275 "$25,625.00" " 9,471.00 " - " 63,429.72 " - " 17,706.88 " - " 17,706.88 " - " 14,157.81 " - " 16,912.50 " - - " 16,961.19 " - - " 50,743.78 " " 63,429.72 " - - - " 20,500.00 " - - " 17,168.75 " - " 10,480.63 " " 19,218.75 " " 9,740.06 " " 11,462.06 " - 30607406 AICD (D-CHAMBER) LVL104 C1721 275 "$25,875.00" " 9,563.40 " - " 63,429.72 " - " 17,879.63 " - " 17,879.63 " - " 14,295.94 " - " 17,077.50 " - - " 17,126.66 " - - " 50,743.78 " " 63,429.72 " - - - " 20,700.00 " - - " 17,336.25 " - " 10,582.88 " " 19,406.25 " " 9,835.09 " " 11,573.89 " - 30607414 AICD (D-CHAMBER) LVL105 C1721 275 "$26,125.00" " 9,655.80 " - " 63,429.72 " - " 18,052.38 " - " 18,052.38 " - " 14,434.06 " - " 17,242.50 " - - " 17,292.14 " - - " 50,743.78 " " 63,429.72 " - - - " 20,900.00 " - - " 17,503.75 " - " 10,685.13 " " 19,593.75 " " 9,930.11 " " 11,685.71 " - 30607422 AICD (D-CHAMBER) LVL106 C1721 275 "$26,375.00" " 9,748.20 " - " 63,429.72 " - " 18,225.13 " - " 18,225.13 " - " 14,572.19 " - " 17,407.50 " - - " 17,457.61 " - - " 50,743.78 " " 63,429.72 " - - - " 21,100.00 " - - " 17,671.25 " - " 10,787.38 " " 19,781.25 " " 10,025.14 " " 11,797.54 " - 30607431 AICD (D-CHAMBER) LVL130 C1721 275 "$32,375.00" " 11,965.80 " - " 63,429.72 " - " 22,371.13 " - " 22,371.13 " - " 17,887.19 " - " 21,367.50 " - - " 21,429.01 " - - " 50,743.78 " " 63,429.72 " - - - " 25,900.00 " - - " 21,691.25 " - " 13,241.38 " " 24,281.25 " " 12,305.74 " " 14,481.34 " - 30607449 AICD (D-CHAMBER) LVL131 C1721 275 "$32,625.00" " 12,058.20 " - " 63,429.72 " - " 22,543.88 " - " 22,543.88 " - " 18,025.31 " - " 21,532.50 " - - " 21,594.49 " - - " 50,743.78 " " 63,429.72 " - - - " 26,100.00 " - - " 21,858.75 " - " 13,343.63 " " 24,468.75 " " 12,400.76 " " 14,593.16 " - 30607457 AICD (D-CHAMBER) LVL132 C1721 275 "$32,875.00" " 12,150.60 " - " 63,429.72 " - " 22,716.63 " - " 22,716.63 " - " 18,163.44 " - " 21,697.50 " - - " 21,759.96 " - - " 50,743.78 " " 63,429.72 " - - - " 26,300.00 " - - " 22,026.25 " - " 13,445.88 " " 24,656.25 " " 12,495.79 " " 14,704.99 " - 30607465 AICD (D-CHAMBER) LVL133 C1721 275 "$33,125.00" " 12,243.00 " - " 63,429.72 " - " 22,889.38 " - " 22,889.38 " - " 18,301.56 " - " 21,862.50 " - - " 21,925.44 " - - " 50,743.78 " " 63,429.72 " - - - " 26,500.00 " - - " 22,193.75 " - " 13,548.13 " " 24,843.75 " " 12,590.81 " " 14,816.81 " - 30607473 AICD (D-CHAMBER) LVL134 C1721 275 "$33,375.00" " 12,335.40 " - " 63,429.72 " - " 23,062.13 " - " 23,062.13 " - " 18,439.69 " - " 22,027.50 " - - " 22,090.91 " - - " 50,743.78 " " 63,429.72 " - - - " 26,700.00 " - - " 22,361.25 " - " 13,650.38 " " 25,031.25 " " 12,685.84 " " 14,928.64 " - 30607481 AICD (D-CHAMBER) LVL135 C1721 275 "$33,625.00" " 12,427.80 " - " 63,429.72 " - " 23,234.88 " - " 23,234.88 " - " 18,577.81 " - " 22,192.50 " - - " 22,256.39 " - - " 50,743.78 " " 63,429.72 " - - - " 26,900.00 " - - " 22,528.75 " - " 13,752.63 " " 25,218.75 " " 12,780.86 " " 15,040.46 " - 30607490 AICD (D-CHAMBER) LVL136 C1721 275 "$33,875.00" " 12,520.20 " - " 63,429.72 " - " 23,407.63 " - " 23,407.63 " - " 18,715.94 " - " 22,357.50 " - - " 22,421.86 " - - " 50,743.78 " " 63,429.72 " - - - " 27,100.00 " - - " 22,696.25 " - " 13,854.88 " " 25,406.25 " " 12,875.89 " " 15,152.29 " - 30607503 AICD (D-CHAMBER) LVL139 C1721 275 "$34,625.00" " 12,797.40 " - " 63,429.72 " - " 23,925.88 " - " 23,925.88 " - " 19,130.31 " - " 22,852.50 " - - " 22,918.29 " - - " 50,743.78 " " 63,429.72 " - - - " 27,700.00 " - - " 23,198.75 " - " 14,161.63 " " 25,968.75 " " 13,160.96 " " 15,487.76 " - 30607511 AICD (D-CHAMBER) LVL144 C1721 275 "$35,875.00" " 13,259.40 " - " 63,429.72 " - " 24,789.63 " - " 24,789.63 " - " 19,820.94 " - " 23,677.50 " - - " 23,745.66 " - - " 50,743.78 " " 63,429.72 " - - - " 28,700.00 " - - " 24,036.25 " - " 14,672.88 " " 26,906.25 " " 13,636.09 " " 16,046.89 " - 30607520 AICD (D-CHAMBER) LVL145 C1721 275 "$36,125.00" " 13,351.80 " - " 63,429.72 " - " 24,962.38 " - " 24,962.38 " - " 19,959.06 " - " 23,842.50 " - - " 23,911.14 " - - " 50,743.78 " " 63,429.72 " - - - " 28,900.00 " - - " 24,203.75 " - " 14,775.13 " " 27,093.75 " " 13,731.11 " " 16,158.71 " - 30607538 AICD (D-CHAMBER) LVL146 C1721 275 "$36,375.00" " 13,444.20 " - " 63,429.72 " - " 25,135.13 " - " 25,135.13 " - " 20,097.19 " - " 24,007.50 " - - " 24,076.61 " - - " 50,743.78 " " 63,429.72 " - - - " 29,100.00 " - - " 24,371.25 " - " 14,877.38 " " 27,281.25 " " 13,826.14 " " 16,270.54 " - 30607546 AICD (D-CHAMBER) LVL147 C1721 275 "$36,625.00" " 13,536.60 " - " 63,429.72 " - " 25,307.88 " - " 25,307.88 " - " 20,235.31 " - " 24,172.50 " - - " 24,242.09 " - - " 50,743.78 " " 63,429.72 " - - - " 29,300.00 " - - " 24,538.75 " - " 14,979.63 " " 27,468.75 " " 13,921.16 " " 16,382.36 " - 30607554 AICD (D-CHAMBER) LVL148 C1721 275 "$36,875.00" " 13,629.00 " - " 63,429.72 " - " 25,480.63 " - " 25,480.63 " - " 20,373.44 " - " 24,337.50 " - - " 24,407.56 " - - " 50,743.78 " " 63,429.72 " - - - " 29,500.00 " - - " 24,706.25 " - " 15,081.88 " " 27,656.25 " " 14,016.19 " " 16,494.19 " - 30607562 AICD (D-CHAMBER) LVL156 C1721 275 "$38,875.00" " 14,368.20 " - " 63,429.72 " - " 26,862.63 " - " 26,862.63 " - " 21,478.44 " - " 25,657.50 " - - " 25,731.36 " - - " 50,743.78 " " 63,429.72 " - - - " 31,100.00 " - - " 26,046.25 " - " 15,899.88 " " 29,156.25 " " 14,776.39 " " 17,388.79 " - 30607571 AICD (D-CHAMBER) LVL157 C1721 275 "$39,125.00" " 14,460.60 " - " 63,429.72 " - " 27,035.38 " - " 27,035.38 " - " 21,616.56 " - " 25,822.50 " - - " 25,896.84 " - - " 50,743.78 " " 63,429.72 " - - - " 31,300.00 " - - " 26,213.75 " - " 16,002.13 " " 29,343.75 " " 14,871.41 " " 17,500.61 " - 30607589 AICD (D-CHAMBER) LVL161 C1721 275 "$40,125.00" " 14,830.20 " - " 63,429.72 " - " 27,726.38 " - " 27,726.38 " - " 22,169.06 " - " 26,482.50 " - - " 26,558.74 " - - " 50,743.78 " " 63,429.72 " - - - " 32,100.00 " - - " 26,883.75 " - " 16,411.13 " " 30,093.75 " " 15,251.51 " " 17,947.91 " - 30607597 AICD (D-CHAMBER) LVL175 C1721 275 "$43,625.00" " 16,123.80 " - " 63,429.72 " - " 30,144.88 " - " 30,144.88 " - " 24,102.81 " - " 28,792.50 " - - " 28,875.39 " - - " 50,743.78 " " 63,429.72 " - - - " 34,900.00 " - - " 29,228.75 " - " 17,842.63 " " 32,718.75 " " 16,581.86 " " 19,513.46 " - 30610865 AICD (D-CHAMBER) LVL191 C1721 275 "$47,625.00" " 17,602.20 " - " 63,429.72 " - " 32,908.88 " - " 32,908.88 " - " 26,312.81 " - " 31,432.50 " - - " 31,522.99 " - - " 50,743.78 " " 63,429.72 " - - - " 38,100.00 " - - " 31,908.75 " - " 19,478.63 " " 35,718.75 " " 18,102.26 " " 21,302.66 " - 30603702 AICD (S-CHAMBER) LVL081 C1722 275 "$20,125.00" " 7,438.20 " - " 61,740.33 " - " 13,906.38 " - " 13,906.38 " - " 11,119.06 " - " 13,282.50 " - - " 13,320.74 " - - " 49,392.26 " " 61,740.33 " - - - " 16,100.00 " - - " 13,483.75 " - " 8,231.13 " " 15,093.75 " " 7,649.51 " " 9,001.91 " - 30603711 AICD (S-CHAMBER) LVL082 C1722 275 "$20,375.00" " 7,530.60 " - " 61,740.33 " - " 14,079.13 " - " 14,079.13 " - " 11,257.19 " - " 13,447.50 " - - " 13,486.21 " - - " 49,392.26 " " 61,740.33 " - - - " 16,300.00 " - - " 13,651.25 " - " 8,333.38 " " 15,281.25 " " 7,744.54 " " 9,113.74 " - 30603729 AICD (S-CHAMBER) LVL083 C1722 275 "$20,625.00" " 7,623.00 " - " 61,740.33 " - " 14,251.88 " - " 14,251.88 " - " 11,395.31 " - " 13,612.50 " - - " 13,651.69 " - - " 49,392.26 " " 61,740.33 " - - - " 16,500.00 " - - " 13,818.75 " - " 8,435.63 " " 15,468.75 " " 7,839.56 " " 9,225.56 " - 30603737 AICD (S-CHAMBER) LVL086 C1722 275 "$21,375.00" " 7,900.20 " - " 61,740.33 " - " 14,770.13 " - " 14,770.13 " - " 11,809.69 " - " 14,107.50 " - - " 14,148.11 " - - " 49,392.26 " " 61,740.33 " - - - " 17,100.00 " - - " 14,321.25 " - " 8,742.38 " " 16,031.25 " " 8,124.64 " " 9,561.04 " - 30603745 AICD (S-CHAMBER) LVL087 C1722 275 "$21,625.00" " 7,992.60 " - " 61,740.33 " - " 14,942.88 " - " 14,942.88 " - " 11,947.81 " - " 14,272.50 " - - " 14,313.59 " - - " 49,392.26 " " 61,740.33 " - - - " 17,300.00 " - - " 14,488.75 " - " 8,844.63 " " 16,218.75 " " 8,219.66 " " 9,672.86 " - 30603753 AICD (S-CHAMBER) LVL089 C1722 275 "$22,125.00" " 8,177.40 " - " 61,740.33 " - " 15,288.38 " - " 15,288.38 " - " 12,224.06 " - " 14,602.50 " - - " 14,644.54 " - - " 49,392.26 " " 61,740.33 " - - - " 17,700.00 " - - " 14,823.75 " - " 9,049.13 " " 16,593.75 " " 8,409.71 " " 9,896.51 " - 30603761 AICD (S-CHAMBER) LVL090 C1722 275 "$22,375.00" " 8,269.80 " - " 61,740.33 " - " 15,461.13 " - " 15,461.13 " - " 12,362.19 " - " 14,767.50 " - - " 14,810.01 " - - " 49,392.26 " " 61,740.33 " - - - " 17,900.00 " - - " 14,991.25 " - " 9,151.38 " " 16,781.25 " " 8,504.74 " " 10,008.34 " - 30603770 AICD (S-CHAMBER) LVL091 C1722 275 "$22,625.00" " 8,362.20 " - " 61,740.33 " - " 15,633.88 " - " 15,633.88 " - " 12,500.31 " - " 14,932.50 " - - " 14,975.49 " - - " 49,392.26 " " 61,740.33 " - - - " 18,100.00 " - - " 15,158.75 " - " 9,253.63 " " 16,968.75 " " 8,599.76 " " 10,120.16 " - 30603788 AICD (S-CHAMBER) LVL092 C1722 275 "$22,875.00" " 8,454.60 " - " 61,740.33 " - " 15,806.63 " - " 15,806.63 " - " 12,638.44 " - " 15,097.50 " - - " 15,140.96 " - - " 49,392.26 " " 61,740.33 " - - - " 18,300.00 " - - " 15,326.25 " - " 9,355.88 " " 17,156.25 " " 8,694.79 " " 10,231.99 " - 30603796 AICD (S-CHAMBER) LVL095 C1722 275 "$23,625.00" " 8,731.80 " - " 61,740.33 " - " 16,324.88 " - " 16,324.88 " - " 13,052.81 " - " 15,592.50 " - - " 15,637.39 " - - " 49,392.26 " " 61,740.33 " - - - " 18,900.00 " - - " 15,828.75 " - " 9,662.63 " " 17,718.75 " " 8,979.86 " " 10,567.46 " - 30603800 AICD (S-CHAMBER) LVL096 C1722 275 "$23,875.00" " 8,824.20 " - " 61,740.33 " - " 16,497.63 " - " 16,497.63 " - " 13,190.94 " - " 15,757.50 " - - " 15,802.86 " - - " 49,392.26 " " 61,740.33 " - - - " 19,100.00 " - - " 15,996.25 " - " 9,764.88 " " 17,906.25 " " 9,074.89 " " 10,679.29 " - 30603818 AICD (S-CHAMBER) LVL097 C1722 275 "$24,125.00" " 8,916.60 " - " 61,740.33 " - " 16,670.38 " - " 16,670.38 " - " 13,329.06 " - " 15,922.50 " - - " 15,968.34 " - - " 49,392.26 " " 61,740.33 " - - - " 19,300.00 " - - " 16,163.75 " - " 9,867.13 " " 18,093.75 " " 9,169.91 " " 10,791.11 " - 30603826 AICD (S-CHAMBER) LVL098 C1722 275 "$24,375.00" " 9,009.00 " - " 61,740.33 " - " 16,843.13 " - " 16,843.13 " - " 13,467.19 " - " 16,087.50 " - - " 16,133.81 " - - " 49,392.26 " " 61,740.33 " - - - " 19,500.00 " - - " 16,331.25 " - " 9,969.38 " " 18,281.25 " " 9,264.94 " " 10,902.94 " - 30603834 AICD (S-CHAMBER) LVL106 C1722 275 "$26,375.00" " 9,748.20 " - " 61,740.33 " - " 18,225.13 " - " 18,225.13 " - " 14,572.19 " - " 17,407.50 " - - " 17,457.61 " - - " 49,392.26 " " 61,740.33 " - - - " 21,100.00 " - - " 17,671.25 " - " 10,787.38 " " 19,781.25 " " 10,025.14 " " 11,797.54 " - 30603842 AICD (S-CHAMBER) LVL107 C1722 275 "$26,625.00" " 9,840.60 " - " 61,740.33 " - " 18,397.88 " - " 18,397.88 " - " 14,710.31 " - " 17,572.50 " - - " 17,623.09 " - - " 49,392.26 " " 61,740.33 " - - - " 21,300.00 " - - " 17,838.75 " - " 10,889.63 " " 19,968.75 " " 10,120.16 " " 11,909.36 " - 30603851 AICD (S-CHAMBER) LVL108 C1722 275 "$26,875.00" " 9,933.00 " - " 61,740.33 " - " 18,570.63 " - " 18,570.63 " - " 14,848.44 " - " 17,737.50 " - - " 17,788.56 " - - " 49,392.26 " " 61,740.33 " - - - " 21,500.00 " - - " 18,006.25 " - " 10,991.88 " " 20,156.25 " " 10,215.19 " " 12,021.19 " - 30603869 AICD (S-CHAMBER) LVL109 C1722 275 "$27,125.00" " 10,025.40 " - " 61,740.33 " - " 18,743.38 " - " 18,743.38 " - " 14,986.56 " - " 17,902.50 " - - " 17,954.04 " - - " 49,392.26 " " 61,740.33 " - - - " 21,700.00 " - - " 18,173.75 " - " 11,094.13 " " 20,343.75 " " 10,310.21 " " 12,133.01 " - 30603877 AICD (S-CHAMBER) LVL110 C1722 275 "$27,375.00" " 10,117.80 " - " 61,740.33 " - " 18,916.13 " - " 18,916.13 " - " 15,124.69 " - " 18,067.50 " - - " 18,119.51 " - - " 49,392.26 " " 61,740.33 " - - - " 21,900.00 " - - " 18,341.25 " - " 11,196.38 " " 20,531.25 " " 10,405.24 " " 12,244.84 " - 30603885 AICD (S-CHAMBER) LVL111 C1722 275 "$27,625.00" " 10,210.20 " - " 61,740.33 " - " 19,088.88 " - " 19,088.88 " - " 15,262.81 " - " 18,232.50 " - - " 18,284.99 " - - " 49,392.26 " " 61,740.33 " - - - " 22,100.00 " - - " 18,508.75 " - " 11,298.63 " " 20,718.75 " " 10,500.26 " " 12,356.66 " - 30603893 AICD (S-CHAMBER) LVL112 C1722 275 "$27,875.00" " 10,302.60 " - " 61,740.33 " - " 19,261.63 " - " 19,261.63 " - " 15,400.94 " - " 18,397.50 " - - " 18,450.46 " - - " 49,392.26 " " 61,740.33 " - - - " 22,300.00 " - - " 18,676.25 " - " 11,400.88 " " 20,906.25 " " 10,595.29 " " 12,468.49 " - 30603907 AICD (S-CHAMBER) LVL126 C1722 275 "$31,375.00" " 11,596.20 " - " 61,740.33 " - " 21,680.13 " - " 21,680.13 " - " 17,334.69 " - " 20,707.50 " - - " 20,767.11 " - - " 49,392.26 " " 61,740.33 " - - - " 25,100.00 " - - " 21,021.25 " - " 12,832.38 " " 23,531.25 " " 11,925.64 " " 14,034.04 " - 30603915 AICD (S-CHAMBER) LVL127 C1722 275 "$31,625.00" " 11,688.60 " - " 61,740.33 " - " 21,852.88 " - " 21,852.88 " - " 17,472.81 " - " 20,872.50 " - - " 20,932.59 " - - " 49,392.26 " " 61,740.33 " - - - " 25,300.00 " - - " 21,188.75 " - " 12,934.63 " " 23,718.75 " " 12,020.66 " " 14,145.86 " - 30603923 AICD (S-CHAMBER) LVL128 C1722 275 "$31,875.00" " 11,781.00 " - " 61,740.33 " - " 22,025.63 " - " 22,025.63 " - " 17,610.94 " - " 21,037.50 " - - " 21,098.06 " - - " 49,392.26 " " 61,740.33 " - - - " 25,500.00 " - - " 21,356.25 " - " 13,036.88 " " 23,906.25 " " 12,115.69 " " 14,257.69 " - 30603931 AICD (S-CHAMBER) LVL130 C1722 275 "$32,375.00" " 11,965.80 " - " 61,740.33 " - " 22,371.13 " - " 22,371.13 " - " 17,887.19 " - " 21,367.50 " - - " 21,429.01 " - - " 49,392.26 " " 61,740.33 " - - - " 25,900.00 " - - " 21,691.25 " - " 13,241.38 " " 24,281.25 " " 12,305.74 " " 14,481.34 " - 30603940 AICD (S-CHAMBER) LVL131 C1722 275 "$32,625.00" " 12,058.20 " - " 61,740.33 " - " 22,543.88 " - " 22,543.88 " - " 18,025.31 " - " 21,532.50 " - - " 21,594.49 " - - " 49,392.26 " " 61,740.33 " - - - " 26,100.00 " - - " 21,858.75 " - " 13,343.63 " " 24,468.75 " " 12,400.76 " " 14,593.16 " - 30603958 AICD (S-CHAMBER) LVL132 C1722 275 "$32,875.00" " 12,150.60 " - " 61,740.33 " - " 22,716.63 " - " 22,716.63 " - " 18,163.44 " - " 21,697.50 " - - " 21,759.96 " - - " 49,392.26 " " 61,740.33 " - - - " 26,300.00 " - - " 22,026.25 " - " 13,445.88 " " 24,656.25 " " 12,495.79 " " 14,704.99 " - 30603966 AICD (S-CHAMBER) LVL136 C1722 275 "$33,875.00" " 12,520.20 " - " 61,740.33 " - " 23,407.63 " - " 23,407.63 " - " 18,715.94 " - " 22,357.50 " - - " 22,421.86 " - - " 49,392.26 " " 61,740.33 " - - - " 27,100.00 " - - " 22,696.25 " - " 13,854.88 " " 25,406.25 " " 12,875.89 " " 15,152.29 " - 30603974 AICD (S-CHAMBER) LVL138 C1722 275 "$34,375.00" " 12,705.00 " - " 61,740.33 " - " 23,753.13 " - " 23,753.13 " - " 18,992.19 " - " 22,687.50 " - - " 22,752.81 " - - " 49,392.26 " " 61,740.33 " - - - " 27,500.00 " - - " 23,031.25 " - " 14,059.38 " " 25,781.25 " " 13,065.94 " " 15,375.94 " - 30603982 AICD (S-CHAMBER) LVL139 C1722 275 "$34,625.00" " 12,797.40 " - " 61,740.33 " - " 23,925.88 " - " 23,925.88 " - " 19,130.31 " - " 22,852.50 " - - " 22,918.29 " - - " 49,392.26 " " 61,740.33 " - - - " 27,700.00 " - - " 23,198.75 " - " 14,161.63 " " 25,968.75 " " 13,160.96 " " 15,487.76 " - 30603991 AICD (S-CHAMBER) LVL140 C1722 275 "$34,875.00" " 12,889.80 " - " 61,740.33 " - " 24,098.63 " - " 24,098.63 " - " 19,268.44 " - " 23,017.50 " - - " 23,083.76 " - - " 49,392.26 " " 61,740.33 " - - - " 27,900.00 " - - " 23,366.25 " - " 14,263.88 " " 26,156.25 " " 13,255.99 " " 15,599.59 " - 30604008 AICD (S-CHAMBER) LVL142 C1722 275 "$35,375.00" " 13,074.60 " - " 61,740.33 " - " 24,444.13 " - " 24,444.13 " - " 19,544.69 " - " 23,347.50 " - - " 23,414.71 " - - " 49,392.26 " " 61,740.33 " - - - " 28,300.00 " - - " 23,701.25 " - " 14,468.38 " " 26,531.25 " " 13,446.04 " " 15,823.24 " - 30604016 AICD (S-CHAMBER) LVL143 C1722 275 "$35,625.00" " 13,167.00 " - " 61,740.33 " - " 24,616.88 " - " 24,616.88 " - " 19,682.81 " - " 23,512.50 " - - " 23,580.19 " - - " 49,392.26 " " 61,740.33 " - - - " 28,500.00 " - - " 23,868.75 " - " 14,570.63 " " 26,718.75 " " 13,541.06 " " 15,935.06 " - 30604024 AICD (S-CHAMBER) LVL144 C1722 275 "$35,875.00" " 13,259.40 " - " 61,740.33 " - " 24,789.63 " - " 24,789.63 " - " 19,820.94 " - " 23,677.50 " - - " 23,745.66 " - - " 49,392.26 " " 61,740.33 " - - - " 28,700.00 " - - " 24,036.25 " - " 14,672.88 " " 26,906.25 " " 13,636.09 " " 16,046.89 " - 30604032 AICD (S-CHAMBER) LVL151 C1722 275 "$37,625.00" " 13,906.20 " - " 61,740.33 " - " 25,998.88 " - " 25,998.88 " - " 20,787.81 " - " 24,832.50 " - - " 24,903.99 " - - " 49,392.26 " " 61,740.33 " - - - " 30,100.00 " - - " 25,208.75 " - " 15,388.63 " " 28,218.75 " " 14,301.26 " " 16,829.66 " - 30604041 AICD (S-CHAMBER) LVL152 C1722 275 "$37,875.00" " 13,998.60 " - " 61,740.33 " - " 26,171.63 " - " 26,171.63 " - " 20,925.94 " - " 24,997.50 " - - " 25,069.46 " - - " 49,392.26 " " 61,740.33 " - - - " 30,300.00 " - - " 25,376.25 " - " 15,490.88 " " 28,406.25 " " 14,396.29 " " 16,941.49 " - 30607601 AICD (S-CHAMBER) LVL075 C1722 275 "$18,625.00" " 6,883.80 " - " 61,740.33 " - " 12,869.88 " - " 12,869.88 " - " 10,290.31 " - " 12,292.50 " - - " 12,327.89 " - - " 49,392.26 " " 61,740.33 " - - - " 14,900.00 " - - " 12,478.75 " - " 7,617.63 " " 13,968.75 " " 7,079.36 " " 8,330.96 " - 30607619 AICD (S-CHAMBER) LVL076 C1722 275 "$18,875.00" " 6,976.20 " - " 61,740.33 " - " 13,042.63 " - " 13,042.63 " - " 10,428.44 " - " 12,457.50 " - - " 12,493.36 " - - " 49,392.26 " " 61,740.33 " - - - " 15,100.00 " - - " 12,646.25 " - " 7,719.88 " " 14,156.25 " " 7,174.39 " " 8,442.79 " - 30607627 AICD (S-CHAMBER) LVL077 C1722 275 "$19,125.00" " 7,068.60 " - " 61,740.33 " - " 13,215.38 " - " 13,215.38 " - " 10,566.56 " - " 12,622.50 " - - " 12,658.84 " - - " 49,392.26 " " 61,740.33 " - - - " 15,300.00 " - - " 12,813.75 " - " 7,822.13 " " 14,343.75 " " 7,269.41 " " 8,554.61 " - 30607635 AICD (S-CHAMBER) LVL078 C1722 275 "$19,375.00" " 7,161.00 " - " 61,740.33 " - " 13,388.13 " - " 13,388.13 " - " 10,704.69 " - " 12,787.50 " - - " 12,824.31 " - - " 49,392.26 " " 61,740.33 " - - - " 15,500.00 " - - " 12,981.25 " - " 7,924.38 " " 14,531.25 " " 7,364.44 " " 8,666.44 " - 30607643 AICD (S-CHAMBER) LVL079 C1722 275 "$19,625.00" " 7,253.40 " - " 61,740.33 " - " 13,560.88 " - " 13,560.88 " - " 10,842.81 " - " 12,952.50 " - - " 12,989.79 " - - " 49,392.26 " " 61,740.33 " - - - " 15,700.00 " - - " 13,148.75 " - " 8,026.63 " " 14,718.75 " " 7,459.46 " " 8,778.26 " - 30607651 AICD (S-CHAMBER) LVL080 C1722 275 "$19,875.00" " 7,345.80 " - " 61,740.33 " - " 13,733.63 " - " 13,733.63 " - " 10,980.94 " - " 13,117.50 " - - " 13,155.26 " - - " 49,392.26 " " 61,740.33 " - - - " 15,900.00 " - - " 13,316.25 " - " 8,128.88 " " 14,906.25 " " 7,554.49 " " 8,890.09 " - 30607660 AICD (S-CHAMBER) LVL084 C1722 275 "$20,875.00" " 7,715.40 " - " 61,740.33 " - " 14,424.63 " - " 14,424.63 " - " 11,533.44 " - " 13,777.50 " - - " 13,817.16 " - - " 49,392.26 " " 61,740.33 " - - - " 16,700.00 " - - " 13,986.25 " - " 8,537.88 " " 15,656.25 " " 7,934.59 " " 9,337.39 " - 30607678 AICD (S-CHAMBER) LVL085 C1722 275 "$21,125.00" " 7,807.80 " - " 61,740.33 " - " 14,597.38 " - " 14,597.38 " - " 11,671.56 " - " 13,942.50 " - - " 13,982.64 " - - " 49,392.26 " " 61,740.33 " - - - " 16,900.00 " - - " 14,153.75 " - " 8,640.13 " " 15,843.75 " " 8,029.61 " " 9,449.21 " - 30607686 AICD (S-CHAMBER) LVL088 C1722 275 "$21,875.00" " 8,085.00 " - " 61,740.33 " - " 15,115.63 " - " 15,115.63 " - " 12,085.94 " - " 14,437.50 " - - " 14,479.06 " - - " 49,392.26 " " 61,740.33 " - - - " 17,500.00 " - - " 14,656.25 " - " 8,946.88 " " 16,406.25 " " 8,314.69 " " 9,784.69 " - 30607694 AICD (S-CHAMBER) LVL093 C1722 275 "$23,125.00" " 8,547.00 " - " 61,740.33 " - " 15,979.38 " - " 15,979.38 " - " 12,776.56 " - " 15,262.50 " - - " 15,306.44 " - - " 49,392.26 " " 61,740.33 " - - - " 18,500.00 " - - " 15,493.75 " - " 9,458.13 " " 17,343.75 " " 8,789.81 " " 10,343.81 " - 30607708 AICD (S-CHAMBER) LVL094 C1722 275 "$23,375.00" " 8,639.40 " - " 61,740.33 " - " 16,152.13 " - " 16,152.13 " - " 12,914.69 " - " 15,427.50 " - - " 15,471.91 " - - " 49,392.26 " " 61,740.33 " - - - " 18,700.00 " - - " 15,661.25 " - " 9,560.38 " " 17,531.25 " " 8,884.84 " " 10,455.64 " - 30607716 AICD (S-CHAMBER) LVL099 C1722 275 "$24,625.00" " 9,101.40 " - " 61,740.33 " - " 17,015.88 " - " 17,015.88 " - " 13,605.31 " - " 16,252.50 " - - " 16,299.29 " - - " 49,392.26 " " 61,740.33 " - - - " 19,700.00 " - - " 16,498.75 " - " 10,071.63 " " 18,468.75 " " 9,359.96 " " 11,014.76 " - 30607724 AICD (S-CHAMBER) LVL100 C1722 275 "$24,875.00" " 9,193.80 " - " 61,740.33 " - " 17,188.63 " - " 17,188.63 " - " 13,743.44 " - " 16,417.50 " - - " 16,464.76 " - - " 49,392.26 " " 61,740.33 " - - - " 19,900.00 " - - " 16,666.25 " - " 10,173.88 " " 18,656.25 " " 9,454.99 " " 11,126.59 " - 30607732 AICD (S-CHAMBER) LVL101 C1722 275 "$25,125.00" " 9,286.20 " - " 61,740.33 " - " 17,361.38 " - " 17,361.38 " - " 13,881.56 " - " 16,582.50 " - - " 16,630.24 " - - " 49,392.26 " " 61,740.33 " - - - " 20,100.00 " - - " 16,833.75 " - " 10,276.13 " " 18,843.75 " " 9,550.01 " " 11,238.41 " - 30607741 AICD (S-CHAMBER) LVL102 C1722 275 "$25,375.00" " 9,378.60 " - " 61,740.33 " - " 17,534.13 " - " 17,534.13 " - " 14,019.69 " - " 16,747.50 " - - " 16,795.71 " - - " 49,392.26 " " 61,740.33 " - - - " 20,300.00 " - - " 17,001.25 " - " 10,378.38 " " 19,031.25 " " 9,645.04 " " 11,350.24 " - 30607759 AICD (S-CHAMBER) LVL103 C1722 275 "$25,625.00" " 9,471.00 " - " 61,740.33 " - " 17,706.88 " - " 17,706.88 " - " 14,157.81 " - " 16,912.50 " - - " 16,961.19 " - - " 49,392.26 " " 61,740.33 " - - - " 20,500.00 " - - " 17,168.75 " - " 10,480.63 " " 19,218.75 " " 9,740.06 " " 11,462.06 " - 30607767 AICD (S-CHAMBER) LVL104 C1722 275 "$25,875.00" " 9,563.40 " - " 61,740.33 " - " 17,879.63 " - " 17,879.63 " - " 14,295.94 " - " 17,077.50 " - - " 17,126.66 " - - " 49,392.26 " " 61,740.33 " - - - " 20,700.00 " - - " 17,336.25 " - " 10,582.88 " " 19,406.25 " " 9,835.09 " " 11,573.89 " - 30607775 AICD (S-CHAMBER) LVL105 C1722 275 "$26,125.00" " 9,655.80 " - " 61,740.33 " - " 18,052.38 " - " 18,052.38 " - " 14,434.06 " - " 17,242.50 " - - " 17,292.14 " - - " 49,392.26 " " 61,740.33 " - - - " 20,900.00 " - - " 17,503.75 " - " 10,685.13 " " 19,593.75 " " 9,930.11 " " 11,685.71 " - 30607783 AICD (S-CHAMBER) LVL113 C1722 275 "$28,125.00" " 10,395.00 " - " 61,740.33 " - " 19,434.38 " - " 19,434.38 " - " 15,539.06 " - " 18,562.50 " - - " 18,615.94 " - - " 49,392.26 " " 61,740.33 " - - - " 22,500.00 " - - " 18,843.75 " - " 11,503.13 " " 21,093.75 " " 10,690.31 " " 12,580.31 " - 30607791 AICD (S-CHAMBER) LVL114 C1722 275 "$28,375.00" " 10,487.40 " - " 61,740.33 " - " 19,607.13 " - " 19,607.13 " - " 15,677.19 " - " 18,727.50 " - - " 18,781.41 " - - " 49,392.26 " " 61,740.33 " - - - " 22,700.00 " - - " 19,011.25 " - " 11,605.38 " " 21,281.25 " " 10,785.34 " " 12,692.14 " - 30607805 AICD (S-CHAMBER) LVL115 C1722 275 "$28,625.00" " 10,579.80 " - " 61,740.33 " - " 19,779.88 " - " 19,779.88 " - " 15,815.31 " - " 18,892.50 " - - " 18,946.89 " - - " 49,392.26 " " 61,740.33 " - - - " 22,900.00 " - - " 19,178.75 " - " 11,707.63 " " 21,468.75 " " 10,880.36 " " 12,803.96 " - 30607813 AICD (S-CHAMBER) LVL116 C1722 275 "$28,875.00" " 10,672.20 " - " 61,740.33 " - " 19,952.63 " - " 19,952.63 " - " 15,953.44 " - " 19,057.50 " - - " 19,112.36 " - - " 49,392.26 " " 61,740.33 " - - - " 23,100.00 " - - " 19,346.25 " - " 11,809.88 " " 21,656.25 " " 10,975.39 " " 12,915.79 " - 30607821 AICD (S-CHAMBER) LVL117 C1722 275 "$29,125.00" " 10,764.60 " - " 61,740.33 " - " 20,125.38 " - " 20,125.38 " - " 16,091.56 " - " 19,222.50 " - - " 19,277.84 " - - " 49,392.26 " " 61,740.33 " - - - " 23,300.00 " - - " 19,513.75 " - " 11,912.13 " " 21,843.75 " " 11,070.41 " " 13,027.61 " - 30607830 AICD (S-CHAMBER) LVL118 C1722 275 "$29,375.00" " 10,857.00 " - " 61,740.33 " - " 20,298.13 " - " 20,298.13 " - " 16,229.69 " - " 19,387.50 " - - " 19,443.31 " - - " 49,392.26 " " 61,740.33 " - - - " 23,500.00 " - - " 19,681.25 " - " 12,014.38 " " 22,031.25 " " 11,165.44 " " 13,139.44 " - 30607848 AICD (S-CHAMBER) LVL119 C1722 275 "$29,625.00" " 10,949.40 " - " 61,740.33 " - " 20,470.88 " - " 20,470.88 " - " 16,367.81 " - " 19,552.50 " - - " 19,608.79 " - - " 49,392.26 " " 61,740.33 " - - - " 23,700.00 " - - " 19,848.75 " - " 12,116.63 " " 22,218.75 " " 11,260.46 " " 13,251.26 " - 30607856 AICD (S-CHAMBER) LVL120 C1722 275 "$29,875.00" " 11,041.80 " - " 61,740.33 " - " 20,643.63 " - " 20,643.63 " - " 16,505.94 " - " 19,717.50 " - - " 19,774.26 " - - " 49,392.26 " " 61,740.33 " - - - " 23,900.00 " - - " 20,016.25 " - " 12,218.88 " " 22,406.25 " " 11,355.49 " " 13,363.09 " - 30607864 AICD (S-CHAMBER) LVL121 C1722 275 "$30,125.00" " 11,134.20 " - " 61,740.33 " - " 20,816.38 " - " 20,816.38 " - " 16,644.06 " - " 19,882.50 " - - " 19,939.74 " - - " 49,392.26 " " 61,740.33 " - - - " 24,100.00 " - - " 20,183.75 " - " 12,321.13 " " 22,593.75 " " 11,450.51 " " 13,474.91 " - 30607872 AICD (S-CHAMBER) LVL122 C1722 275 "$30,375.00" " 11,226.60 " - " 61,740.33 " - " 20,989.13 " - " 20,989.13 " - " 16,782.19 " - " 20,047.50 " - - " 20,105.21 " - - " 49,392.26 " " 61,740.33 " - - - " 24,300.00 " - - " 20,351.25 " - " 12,423.38 " " 22,781.25 " " 11,545.54 " " 13,586.74 " - 30607881 AICD (S-CHAMBER) LVL123 C1722 275 "$30,625.00" " 11,319.00 " - " 61,740.33 " - " 21,161.88 " - " 21,161.88 " - " 16,920.31 " - " 20,212.50 " - - " 20,270.69 " - - " 49,392.26 " " 61,740.33 " - - - " 24,500.00 " - - " 20,518.75 " - " 12,525.63 " " 22,968.75 " " 11,640.56 " " 13,698.56 " - 30607899 AICD (S-CHAMBER) LVL124 C1722 275 "$30,875.00" " 11,411.40 " - " 61,740.33 " - " 21,334.63 " - " 21,334.63 " - " 17,058.44 " - " 20,377.50 " - - " 20,436.16 " - - " 49,392.26 " " 61,740.33 " - - - " 24,700.00 " - - " 20,686.25 " - " 12,627.88 " " 23,156.25 " " 11,735.59 " " 13,810.39 " - 30607902 AICD (S-CHAMBER) LVL125 C1722 275 "$31,125.00" " 11,503.80 " - " 61,740.33 " - " 21,507.38 " - " 21,507.38 " - " 17,196.56 " - " 20,542.50 " - - " 20,601.64 " - - " 49,392.26 " " 61,740.33 " - - - " 24,900.00 " - - " 20,853.75 " - " 12,730.13 " " 23,343.75 " " 11,830.61 " " 13,922.21 " - 30607911 AICD (S-CHAMBER) LVL129 C1722 275 "$32,125.00" " 11,873.40 " - " 61,740.33 " - " 22,198.38 " - " 22,198.38 " - " 17,749.06 " - " 21,202.50 " - - " 21,263.54 " - - " 49,392.26 " " 61,740.33 " - - - " 25,700.00 " - - " 21,523.75 " - " 13,139.13 " " 24,093.75 " " 12,210.71 " " 14,369.51 " - 30607929 AICD (S-CHAMBER) LVL133 C1722 275 "$33,125.00" " 12,243.00 " - " 61,740.33 " - " 22,889.38 " - " 22,889.38 " - " 18,301.56 " - " 21,862.50 " - - " 21,925.44 " - - " 49,392.26 " " 61,740.33 " - - - " 26,500.00 " - - " 22,193.75 " - " 13,548.13 " " 24,843.75 " " 12,590.81 " " 14,816.81 " - 30607937 AICD (S-CHAMBER) LVL134 C1722 275 "$33,375.00" " 12,335.40 " - " 61,740.33 " - " 23,062.13 " - " 23,062.13 " - " 18,439.69 " - " 22,027.50 " - - " 22,090.91 " - - " 49,392.26 " " 61,740.33 " - - - " 26,700.00 " - - " 22,361.25 " - " 13,650.38 " " 25,031.25 " " 12,685.84 " " 14,928.64 " - 30607945 AICD (S-CHAMBER) LVL135 C1722 275 "$33,625.00" " 12,427.80 " - " 61,740.33 " - " 23,234.88 " - " 23,234.88 " - " 18,577.81 " - " 22,192.50 " - - " 22,256.39 " - - " 49,392.26 " " 61,740.33 " - - - " 26,900.00 " - - " 22,528.75 " - " 13,752.63 " " 25,218.75 " " 12,780.86 " " 15,040.46 " - 30607953 AICD (S-CHAMBER) LVL137 C1722 275 "$34,125.00" " 12,612.60 " - " 61,740.33 " - " 23,580.38 " - " 23,580.38 " - " 18,854.06 " - " 22,522.50 " - - " 22,587.34 " - - " 49,392.26 " " 61,740.33 " - - - " 27,300.00 " - - " 22,863.75 " - " 13,957.13 " " 25,593.75 " " 12,970.91 " " 15,264.11 " - 30607961 AICD (S-CHAMBER) LVL141 C1722 275 "$35,125.00" " 12,982.20 " - " 61,740.33 " - " 24,271.38 " - " 24,271.38 " - " 19,406.56 " - " 23,182.50 " - - " 23,249.24 " - - " 49,392.26 " " 61,740.33 " - - - " 28,100.00 " - - " 23,533.75 " - " 14,366.13 " " 26,343.75 " " 13,351.01 " " 15,711.41 " - 30607970 AICD (S-CHAMBER) LVL145 C1722 275 "$36,125.00" " 13,351.80 " - " 61,740.33 " - " 24,962.38 " - " 24,962.38 " - " 19,959.06 " - " 23,842.50 " - - " 23,911.14 " - - " 49,392.26 " " 61,740.33 " - - - " 28,900.00 " - - " 24,203.75 " - " 14,775.13 " " 27,093.75 " " 13,731.11 " " 16,158.71 " - 30607988 AICD (S-CHAMBER) LVL146 C1722 275 "$36,375.00" " 13,444.20 " - " 61,740.33 " - " 25,135.13 " - " 25,135.13 " - " 20,097.19 " - " 24,007.50 " - - " 24,076.61 " - - " 49,392.26 " " 61,740.33 " - - - " 29,100.00 " - - " 24,371.25 " - " 14,877.38 " " 27,281.25 " " 13,826.14 " " 16,270.54 " - 30607996 AICD (S-CHAMBER) LVL147 C1722 275 "$36,625.00" " 13,536.60 " - " 61,740.33 " - " 25,307.88 " - " 25,307.88 " - " 20,235.31 " - " 24,172.50 " - - " 24,242.09 " - - " 49,392.26 " " 61,740.33 " - - - " 29,300.00 " - - " 24,538.75 " - " 14,979.63 " " 27,468.75 " " 13,921.16 " " 16,382.36 " - 30608003 AICD (S-CHAMBER) LVL148 C1722 275 "$36,875.00" " 13,629.00 " - " 61,740.33 " - " 25,480.63 " - " 25,480.63 " - " 20,373.44 " - " 24,337.50 " - - " 24,407.56 " - - " 49,392.26 " " 61,740.33 " - - - " 29,500.00 " - - " 24,706.25 " - " 15,081.88 " " 27,656.25 " " 14,016.19 " " 16,494.19 " - 30608011 AICD (S-CHAMBER) LVL149 C1722 275 "$37,125.00" " 13,721.40 " - " 61,740.33 " - " 25,653.38 " - " 25,653.38 " - " 20,511.56 " - " 24,502.50 " - - " 24,573.04 " - - " 49,392.26 " " 61,740.33 " - - - " 29,700.00 " - - " 24,873.75 " - " 15,184.13 " " 27,843.75 " " 14,111.21 " " 16,606.01 " - 30608020 AICD (S-CHAMBER) LVL150 C1722 275 "$37,375.00" " 13,813.80 " - " 61,740.33 " - " 25,826.13 " - " 25,826.13 " - " 20,649.69 " - " 24,667.50 " - - " 24,738.51 " - - " 49,392.26 " " 61,740.33 " - - - " 29,900.00 " - - " 25,041.25 " - " 15,286.38 " " 28,031.25 " " 14,206.24 " " 16,717.84 " - 30608038 AICD (S-CHAMBER) LVL153 C1722 275 "$38,125.00" " 14,091.00 " - " 61,740.33 " - " 26,344.38 " - " 26,344.38 " - " 21,064.06 " - " 25,162.50 " - - " 25,234.94 " - - " 49,392.26 " " 61,740.33 " - - - " 30,500.00 " - - " 25,543.75 " - " 15,593.13 " " 28,593.75 " " 14,491.31 " " 17,053.31 " - 30608046 AICD (S-CHAMBER) LVL154 C1722 275 "$38,375.00" " 14,183.40 " - " 61,740.33 " - " 26,517.13 " - " 26,517.13 " - " 21,202.19 " - " 25,327.50 " - - " 25,400.41 " - - " 49,392.26 " " 61,740.33 " - - - " 30,700.00 " - - " 25,711.25 " - " 15,695.38 " " 28,781.25 " " 14,586.34 " " 17,165.14 " - 30608054 AICD (S-CHAMBER) LVL155 C1722 275 "$38,625.00" " 14,275.80 " - " 61,740.33 " - " 26,689.88 " - " 26,689.88 " - " 21,340.31 " - " 25,492.50 " - - " 25,565.89 " - - " 49,392.26 " " 61,740.33 " - - - " 30,900.00 " - - " 25,878.75 " - " 15,797.63 " " 28,968.75 " " 14,681.36 " " 17,276.96 " - 30608062 AICD (S-CHAMBER) LVL156 C1722 275 "$38,875.00" " 14,368.20 " - " 61,740.33 " - " 26,862.63 " - " 26,862.63 " - " 21,478.44 " - " 25,657.50 " - - " 25,731.36 " - - " 49,392.26 " " 61,740.33 " - - - " 31,100.00 " - - " 26,046.25 " - " 15,899.88 " " 29,156.25 " " 14,776.39 " " 17,388.79 " - 30608071 AICD (S-CHAMBER) LVL157 C1722 275 "$39,125.00" " 14,460.60 " - " 61,740.33 " - " 27,035.38 " - " 27,035.38 " - " 21,616.56 " - " 25,822.50 " - - " 25,896.84 " - - " 49,392.26 " " 61,740.33 " - - - " 31,300.00 " - - " 26,213.75 " - " 16,002.13 " " 29,343.75 " " 14,871.41 " " 17,500.61 " - 30608089 AICD (S-CHAMBER) LVL158 C1722 275 "$39,375.00" " 14,553.00 " - " 61,740.33 " - " 27,208.13 " - " 27,208.13 " - " 21,754.69 " - " 25,987.50 " - - " 26,062.31 " - - " 49,392.26 " " 61,740.33 " - - - " 31,500.00 " - - " 26,381.25 " - " 16,104.38 " " 29,531.25 " " 14,966.44 " " 17,612.44 " - 30608097 AICD (S-CHAMBER) LVL159 C1722 275 "$39,625.00" " 14,645.40 " - " 61,740.33 " - " 27,380.88 " - " 27,380.88 " - " 21,892.81 " - " 26,152.50 " - - " 26,227.79 " - - " 49,392.26 " " 61,740.33 " - - - " 31,700.00 " - - " 26,548.75 " - " 16,206.63 " " 29,718.75 " " 15,061.46 " " 17,724.26 " - 30608101 AICD (S-CHAMBER) LVL160 C1722 275 "$39,875.00" " 14,737.80 " - " 61,740.33 " - " 27,553.63 " - " 27,553.63 " - " 22,030.94 " - " 26,317.50 " - - " 26,393.26 " - - " 49,392.26 " " 61,740.33 " - - - " 31,900.00 " - - " 26,716.25 " - " 16,308.88 " " 29,906.25 " " 15,156.49 " " 17,836.09 " - 30611888 AICD (S-CHAMBER) LVL219 C1722 278 "$54,625.00" " 20,189.40 " - " 61,740.33 " - " 37,745.88 " - " 37,745.88 " - " 30,180.31 " - " 36,052.50 " - - " 36,156.29 " - - " 49,392.26 " " 61,740.33 " - - - " 43,700.00 " - - " 36,598.75 " - " 22,341.63 " " 40,968.75 " " 20,762.96 " " 24,433.76 " - 30611896 AICD (S-CHAMBER) LVL220 C1722 278 "$54,875.00" " 20,281.80 " - " 61,740.33 " - " 37,918.63 " - " 37,918.63 " - " 30,318.44 " - " 36,217.50 " - - " 36,321.76 " - - " 49,392.26 " " 61,740.33 " - - - " 43,900.00 " - - " 36,766.25 " - " 22,443.88 " " 41,156.25 " " 20,857.99 " " 24,545.59 " - 30611900 AICD (S-CHAMBER) LVL221 C1722 278 "$55,125.00" " 20,374.20 " - " 61,740.33 " - " 38,091.38 " - " 38,091.38 " - " 30,456.56 " - " 36,382.50 " - - " 36,487.24 " - - " 49,392.26 " " 61,740.33 " - - - " 44,100.00 " - - " 36,933.75 " - " 22,546.13 " " 41,343.75 " " 20,953.01 " " 24,657.41 " - 30612493 AICD (S-CHAMBER) LVL200 C1722 275 "$49,875.00" " 18,433.80 " - " 61,740.33 " - " 34,463.63 " - " 34,463.63 " - " 27,555.94 " - " 32,917.50 " - - " 33,012.26 " - - " 49,392.26 " " 61,740.33 " - - - " 39,900.00 " - - " 33,416.25 " - " 20,398.88 " " 37,406.25 " " 18,957.49 " " 22,309.09 " - 30612507 AICD (S-CHAMBER) LVL201 C1722 275 "$50,125.00" " 18,526.20 " - " 61,740.33 " - " 34,636.38 " - " 34,636.38 " - " 27,694.06 " - " 33,082.50 " - - " 33,177.74 " - - " 49,392.26 " " 61,740.33 " - - - " 40,100.00 " - - " 33,583.75 " - " 20,501.13 " " 37,593.75 " " 19,052.51 " " 22,420.91 " - 30612515 AICD (S-CHAMBER) LVL202 C1722 275 "$50,375.00" " 18,618.60 " - " 61,740.33 " - " 34,809.13 " - " 34,809.13 " - " 27,832.19 " - " 33,247.50 " - - " 33,343.21 " - - " 49,392.26 " " 61,740.33 " - - - " 40,300.00 " - - " 33,751.25 " - " 20,603.38 " " 37,781.25 " " 19,147.54 " " 22,532.74 " - 30612523 AICD (S-CHAMBER) LVL203 C1722 275 "$50,625.00" " 18,711.00 " - " 61,740.33 " - " 34,981.88 " - " 34,981.88 " - " 27,970.31 " - " 33,412.50 " - - " 33,508.69 " - - " 49,392.26 " " 61,740.33 " - - - " 40,500.00 " - - " 33,918.75 " - " 20,705.63 " " 37,968.75 " " 19,242.56 " " 22,644.56 " - 30612531 AICD (S-CHAMBER) LVL204 C1722 275 "$50,875.00" " 18,803.40 " - " 61,740.33 " - " 35,154.63 " - " 35,154.63 " - " 28,108.44 " - " 33,577.50 " - - " 33,674.16 " - - " 49,392.26 " " 61,740.33 " - - - " 40,700.00 " - - " 34,086.25 " - " 20,807.88 " " 38,156.25 " " 19,337.59 " " 22,756.39 " - 30612540 AICD (S-CHAMBER) LVL205 C1722 275 "$51,125.00" " 18,895.80 " - " 61,740.33 " - " 35,327.38 " - " 35,327.38 " - " 28,246.56 " - " 33,742.50 " - - " 33,839.64 " - - " 49,392.26 " " 61,740.33 " - - - " 40,900.00 " - - " 34,253.75 " - " 20,910.13 " " 38,343.75 " " 19,432.61 " " 22,868.21 " - 30612566 AICD (S-CHAMBER) LVL443 C1722 275 "$110,625.00" " 40,887.00 " - " 88,500.00 " - " 76,441.88 " - " 76,441.88 " - " 61,120.31 " - " 73,012.50 " - - " 73,222.69 " - - " 49,392.26 " " 61,740.33 " - - - " 88,500.00 " - - " 74,118.75 " - " 45,245.63 " " 82,968.75 " " 42,048.56 " " 49,482.56 " - 29813485 CATH TRANS ATHEREC ROT LVL009 C1724 278 "$2,125.00" 785.40 - " 1,955.47 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - " 1,564.38 " " 1,955.47 " - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 29813493 CATH TRANS ATHEREC ROT LVL010 C1724 278 "$2,375.00" 877.80 - " 1,955.47 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - " 1,564.38 " " 1,955.47 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 29813507 CATH TRANS ATHEREC ROT LVL011 C1724 278 "$2,625.00" 970.20 - " 2,100.00 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - " 1,564.38 " " 1,955.47 " - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 29813515 CATH TRANS ATHEREC ROT LVL012 C1724 278 "$2,875.00" " 1,062.60 " - " 2,300.00 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - " 1,564.38 " " 1,955.47 " - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 29816671 CATH TRANS ATHEREC ROT LVL005 C1724 278 "$1,350.00" 498.96 - " 1,955.47 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - " 1,564.38 " " 1,955.47 " - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 29816689 CATH TRANS ATHEREC ROT LVL006 C1724 278 "$1,375.00" 508.20 - " 1,955.47 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - " 1,564.38 " " 1,955.47 " - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 29816697 CATH TRANS ATHEREC ROT LVL007 C1724 278 "$1,625.00" 600.60 - " 1,955.47 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - " 1,564.38 " " 1,955.47 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 29816701 CATH TRANS ATHEREC ROT LVL008 C1724 278 "$1,875.00" 693.00 - " 1,955.47 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - " 1,564.38 " " 1,955.47 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 29816719 CATH TRANS ATHEREC ROT LVL013 C1724 278 "$3,125.00" " 1,155.00 " - " 2,500.00 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - " 1,564.38 " " 1,955.47 " - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 29816727 CATH TRANS ATHEREC ROT LVL014 C1724 278 "$3,375.00" " 1,247.40 " - " 2,700.00 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - " 1,564.38 " " 1,955.47 " - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 29816735 CATH TRANS ATHEREC ROT LVL015 C1724 278 "$3,625.00" " 1,339.80 " - " 2,900.00 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - " 1,564.38 " " 1,955.47 " - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 29816743 CATH TRANS ATHEREC ROT LVL016 C1724 278 "$3,875.00" " 1,432.20 " - " 3,100.00 " - " 2,677.63 " - " 2,677.63 " - " 2,140.94 " - " 2,557.50 " - - " 2,564.86 " - - " 1,564.38 " " 1,955.47 " - - - " 3,100.00 " - - " 2,596.25 " - " 1,584.88 " " 2,906.25 " " 1,472.89 " " 1,733.29 " - 29816751 CATH TRANS ATHEREC ROT LVL017 C1724 278 "$4,125.00" " 1,524.60 " - " 3,300.00 " - " 2,850.38 " - " 2,850.38 " - " 2,279.06 " - " 2,722.50 " - - " 2,730.34 " - - " 1,564.38 " " 1,955.47 " - - - " 3,300.00 " - - " 2,763.75 " - " 1,687.13 " " 3,093.75 " " 1,567.91 " " 1,845.11 " - 29816760 CATH TRANS ATHEREC ROT LVL018 C1724 278 "$4,375.00" " 1,617.00 " - " 3,500.00 " - " 3,023.13 " - " 3,023.13 " - " 2,417.19 " - " 2,887.50 " - - " 2,895.81 " - - " 1,564.38 " " 1,955.47 " - - - " 3,500.00 " - - " 2,931.25 " - " 1,789.38 " " 3,281.25 " " 1,662.94 " " 1,956.94 " - 29816778 CATH TRANS ATHEREC ROT LVL019 C1724 278 "$4,625.00" " 1,709.40 " - " 3,700.00 " - " 3,195.88 " - " 3,195.88 " - " 2,555.31 " - " 3,052.50 " - - " 3,061.29 " - - " 1,564.38 " " 1,955.47 " - - - " 3,700.00 " - - " 3,098.75 " - " 1,891.63 " " 3,468.75 " " 1,757.96 " " 2,068.76 " - 29816786 CATH TRANS ATHEREC ROT LVL020 C1724 278 "$4,875.00" " 1,801.80 " - " 3,900.00 " - " 3,368.63 " - " 3,368.63 " - " 2,693.44 " - " 3,217.50 " - - " 3,226.76 " - - " 1,564.38 " " 1,955.47 " - - - " 3,900.00 " - - " 3,266.25 " - " 1,993.88 " " 3,656.25 " " 1,852.99 " " 2,180.59 " - 29817065 CATH TRANS ATHEREC ROT LVL038 C1724 278 "$9,375.00" " 3,465.00 " - " 7,500.00 " - " 6,478.13 " - " 6,478.13 " - " 5,179.69 " - " 6,187.50 " - - " 6,205.31 " - - " 1,564.38 " " 1,955.47 " - - - " 7,500.00 " - - " 6,281.25 " - " 3,834.38 " " 7,031.25 " " 3,563.44 " " 4,193.44 " - 29817871 CATH TRANS ATHEREC ROT LVL035 C1724 278 "$8,625.00" " 3,187.80 " - " 6,900.00 " - " 5,959.88 " - " 5,959.88 " - " 4,765.31 " - " 5,692.50 " - - " 5,708.89 " - - " 1,564.38 " " 1,955.47 " - - - " 6,900.00 " - - " 5,778.75 " - " 3,527.63 " " 6,468.75 " " 3,278.36 " " 3,857.96 " - 29817880 CATH TRANS ATHEREC ROT LVL036 C1724 278 "$8,875.00" " 3,280.20 " - " 7,100.00 " - " 6,132.63 " - " 6,132.63 " - " 4,903.44 " - " 5,857.50 " - - " 5,874.36 " - - " 1,564.38 " " 1,955.47 " - - - " 7,100.00 " - - " 5,946.25 " - " 3,629.88 " " 6,656.25 " " 3,373.39 " " 3,969.79 " - 29817898 CATH TRANS ATHEREC ROT LVL037 C1724 278 "$9,125.00" " 3,372.60 " - " 7,300.00 " - " 6,305.38 " - " 6,305.38 " - " 5,041.56 " - " 6,022.50 " - - " 6,039.84 " - - " 1,564.38 " " 1,955.47 " - - - " 7,300.00 " - - " 6,113.75 " - " 3,732.13 " " 6,843.75 " " 3,468.41 " " 4,081.61 " - 29817901 CATH TRANS ATHEREC ROT LVL039 C1724 278 "$9,625.00" " 3,557.40 " - " 7,700.00 " - " 6,650.88 " - " 6,650.88 " - " 5,317.81 " - " 6,352.50 " - - " 6,370.79 " - - " 1,564.38 " " 1,955.47 " - - - " 7,700.00 " - - " 6,448.75 " - " 3,936.63 " " 7,218.75 " " 3,658.46 " " 4,305.26 " - 29817910 CATH TRANS ATHEREC ROT LVL040 C1724 278 "$9,875.00" " 3,649.80 " - " 7,900.00 " - " 6,823.63 " - " 6,823.63 " - " 5,455.94 " - " 6,517.50 " - - " 6,536.26 " - - " 1,564.38 " " 1,955.47 " - - - " 7,900.00 " - - " 6,616.25 " - " 4,038.88 " " 7,406.25 " " 3,753.49 " " 4,417.09 " - 29818665 CATH TRANS ATHEREC ROT LVL021 C1724 278 "$5,125.00" " 1,894.20 " - " 4,100.00 " - " 3,541.38 " - " 3,541.38 " - " 2,831.56 " - " 3,382.50 " - - " 3,392.24 " - - " 1,564.38 " " 1,955.47 " - - - " 4,100.00 " - - " 3,433.75 " - " 2,096.13 " " 3,843.75 " " 1,948.01 " " 2,292.41 " - 29818673 CATH TRANS ATHEREC ROT LVL022 C1724 278 "$5,375.00" " 1,986.60 " - " 4,300.00 " - " 3,714.13 " - " 3,714.13 " - " 2,969.69 " - " 3,547.50 " - - " 3,557.71 " - - " 1,564.38 " " 1,955.47 " - - - " 4,300.00 " - - " 3,601.25 " - " 2,198.38 " " 4,031.25 " " 2,043.04 " " 2,404.24 " - 29818681 CATH TRANS ATHEREC ROT LVL023 C1724 278 "$5,625.00" " 2,079.00 " - " 4,500.00 " - " 3,886.88 " - " 3,886.88 " - " 3,107.81 " - " 3,712.50 " - - " 3,723.19 " - - " 1,564.38 " " 1,955.47 " - - - " 4,500.00 " - - " 3,768.75 " - " 2,300.63 " " 4,218.75 " " 2,138.06 " " 2,516.06 " - 29818690 CATH TRANS ATHEREC ROT LVL024 C1724 278 "$5,875.00" " 2,171.40 " - " 4,700.00 " - " 4,059.63 " - " 4,059.63 " - " 3,245.94 " - " 3,877.50 " - - " 3,888.66 " - - " 1,564.38 " " 1,955.47 " - - - " 4,700.00 " - - " 3,936.25 " - " 2,402.88 " " 4,406.25 " " 2,233.09 " " 2,627.89 " - 29818703 CATH TRANS ATHEREC ROT LVL025 C1724 278 "$6,125.00" " 2,263.80 " - " 4,900.00 " - " 4,232.38 " - " 4,232.38 " - " 3,384.06 " - " 4,042.50 " - - " 4,054.14 " - - " 1,564.38 " " 1,955.47 " - - - " 4,900.00 " - - " 4,103.75 " - " 2,505.13 " " 4,593.75 " " 2,328.11 " " 2,739.71 " - 29818711 CATH TRANS ATHEREC ROT LVL026 C1724 278 "$6,375.00" " 2,356.20 " - " 5,100.00 " - " 4,405.13 " - " 4,405.13 " - " 3,522.19 " - " 4,207.50 " - - " 4,219.61 " - - " 1,564.38 " " 1,955.47 " - - - " 5,100.00 " - - " 4,271.25 " - " 2,607.38 " " 4,781.25 " " 2,423.14 " " 2,851.54 " - 29818720 CATH TRANS ATHEREC ROT LVL027 C1724 278 "$6,625.00" " 2,448.60 " - " 5,300.00 " - " 4,577.88 " - " 4,577.88 " - " 3,660.31 " - " 4,372.50 " - - " 4,385.09 " - - " 1,564.38 " " 1,955.47 " - - - " 5,300.00 " - - " 4,438.75 " - " 2,709.63 " " 4,968.75 " " 2,518.16 " " 2,963.36 " - 29818738 CATH TRANS ATHEREC ROT LVL028 C1724 278 "$6,875.00" " 2,541.00 " - " 5,500.00 " - " 4,750.63 " - " 4,750.63 " - " 3,798.44 " - " 4,537.50 " - - " 4,550.56 " - - " 1,564.38 " " 1,955.47 " - - - " 5,500.00 " - - " 4,606.25 " - " 2,811.88 " " 5,156.25 " " 2,613.19 " " 3,075.19 " - 29818746 CATH TRANS ATHEREC ROT LVL029 C1724 278 "$7,125.00" " 2,633.40 " - " 5,700.00 " - " 4,923.38 " - " 4,923.38 " - " 3,936.56 " - " 4,702.50 " - - " 4,716.04 " - - " 1,564.38 " " 1,955.47 " - - - " 5,700.00 " - - " 4,773.75 " - " 2,914.13 " " 5,343.75 " " 2,708.21 " " 3,187.01 " - 29818754 CATH TRANS ATHEREC ROT LVL030 C1724 278 "$7,375.00" " 2,725.80 " - " 5,900.00 " - " 5,096.13 " - " 5,096.13 " - " 4,074.69 " - " 4,867.50 " - - " 4,881.51 " - - " 1,564.38 " " 1,955.47 " - - - " 5,900.00 " - - " 4,941.25 " - " 3,016.38 " " 5,531.25 " " 2,803.24 " " 3,298.84 " - 29818762 CATH TRANS ATHEREC ROT LVL031 C1724 278 "$7,625.00" " 2,818.20 " - " 6,100.00 " - " 5,268.88 " - " 5,268.88 " - " 4,212.81 " - " 5,032.50 " - - " 5,046.99 " - - " 1,564.38 " " 1,955.47 " - - - " 6,100.00 " - - " 5,108.75 " - " 3,118.63 " " 5,718.75 " " 2,898.26 " " 3,410.66 " - 29818771 CATH TRANS ATHEREC ROT LVL032 C1724 278 "$7,875.00" " 2,910.60 " - " 6,300.00 " - " 5,441.63 " - " 5,441.63 " - " 4,350.94 " - " 5,197.50 " - - " 5,212.46 " - - " 1,564.38 " " 1,955.47 " - - - " 6,300.00 " - - " 5,276.25 " - " 3,220.88 " " 5,906.25 " " 2,993.29 " " 3,522.49 " - 29818789 CATH TRANS ATHEREC ROT LVL033 C1724 278 "$8,125.00" " 3,003.00 " - " 6,500.00 " - " 5,614.38 " - " 5,614.38 " - " 4,489.06 " - " 5,362.50 " - - " 5,377.94 " - - " 1,564.38 " " 1,955.47 " - - - " 6,500.00 " - - " 5,443.75 " - " 3,323.13 " " 6,093.75 " " 3,088.31 " " 3,634.31 " - 29818797 CATH TRANS ATHEREC ROT LVL034 C1724 278 "$8,375.00" " 3,095.40 " - " 6,700.00 " - " 5,787.13 " - " 5,787.13 " - " 4,627.19 " - " 5,527.50 " - - " 5,543.41 " - - " 1,564.38 " " 1,955.47 " - - - " 6,700.00 " - - " 5,611.25 " - " 3,425.38 " " 6,281.25 " " 3,183.34 " " 3,746.14 " - 29818827 G160267 REVOLTN CATH TRANS ATH C1724 624 $1.00 0.37 - " 1,955.47 " - 0.69 - 0.69 - 0.55 - 0.66 - - 0.66 - - " 1,564.38 " " 1,955.47 " - - - 0.80 - - 0.67 - 0.41 0.75 0.38 0.45 - 29819742 CATH TRANS ATHEREC ROT LVL001 C1724 278 $200.00 73.92 - " 1,955.47 " - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - " 1,564.38 " " 1,955.47 " - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 29819751 CATH TRANS ATHEREC ROT LVL002 C1724 278 $450.00 166.32 - " 1,955.47 " - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - " 1,564.38 " " 1,955.47 " - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 29819769 CATH TRANS ATHEREC ROT LVL003 C1724 278 $750.00 277.20 - " 1,955.47 " - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - " 1,564.38 " " 1,955.47 " - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 29819777 CATH TRANS ATHEREC ROT LVL004 C1724 278 "$1,050.00" 388.08 - " 1,955.47 " - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - " 1,564.38 " " 1,955.47 " - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 28104669 CATH TRANS N-LASER LVL001 C1725 278 $200.00 73.92 - " 1,264.61 " - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - " 1,011.69 " " 1,264.61 " - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 28104677 CATH TRANS N-LASER LVL002 C1725 278 $450.00 166.32 - " 1,264.61 " - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - " 1,011.69 " " 1,264.61 " - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 28104685 CATH TRANS N-LASER LVL003 C1725 278 $750.00 277.20 - " 1,264.61 " - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - " 1,011.69 " " 1,264.61 " - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 28104693 CATH TRANS N-LASER LVL004 C1725 278 "$1,050.00" 388.08 - " 1,264.61 " - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - " 1,011.69 " " 1,264.61 " - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 28104707 CATH TRANS N-LASER LVL005 C1725 278 "$1,350.00" 498.96 - " 1,264.61 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - " 1,011.69 " " 1,264.61 " - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 28104723 CATH TRANS N-LASER LVL007 C1725 278 "$1,625.00" 600.60 - " 1,300.00 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - " 1,011.69 " " 1,264.61 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 28104731 CATH TRANS N-LASER LVL008 C1725 278 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - " 1,011.69 " " 1,264.61 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 28104855 CATH TRANS N-LASER LVL020 C1725 278 "$4,875.00" " 1,801.80 " - " 3,900.00 " - " 3,368.63 " - " 3,368.63 " - " 2,693.44 " - " 3,217.50 " - - " 3,226.76 " - - " 1,011.69 " " 1,264.61 " - - - " 3,900.00 " - - " 3,266.25 " - " 1,993.88 " " 3,656.25 " " 1,852.99 " " 2,180.59 " - 29813523 CATH TRANS N-LASER LVL001 C1725 278 $200.00 73.92 - " 1,264.61 " - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - " 1,011.69 " " 1,264.61 " - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 29813531 CATH TRANS N-LASER LVL002 C1725 278 $450.00 166.32 - " 1,264.61 " - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - " 1,011.69 " " 1,264.61 " - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 29813540 CATH TRANS N-LASER LVL003 C1725 278 $750.00 277.20 - " 1,264.61 " - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - " 1,011.69 " " 1,264.61 " - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 29813558 CATH TRANS N-LASER LVL004 C1725 278 "$1,050.00" 388.08 - " 1,264.61 " - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - " 1,011.69 " " 1,264.61 " - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 29813566 CATH TRANS N-LASER LVL005 C1725 278 "$1,350.00" 498.96 - " 1,264.61 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - " 1,011.69 " " 1,264.61 " - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 29813574 CATH TRANS N-LASER LVL006 C1725 278 "$1,375.00" 508.20 - " 1,264.61 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - " 1,011.69 " " 1,264.61 " - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 29813582 CATH TRANS N-LASER LVL007 C1725 278 "$1,625.00" 600.60 - " 1,300.00 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - " 1,011.69 " " 1,264.61 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 29813591 CATH TRANS N-LASER LVL008 C1725 278 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - " 1,011.69 " " 1,264.61 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 29813604 CATH TRANS N-LASER LVL009 C1725 278 "$2,125.00" 785.40 - " 1,700.00 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - " 1,011.69 " " 1,264.61 " - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 29813612 CATH TRANS N-LASER LVL010 C1725 278 "$2,375.00" 877.80 - " 1,900.00 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - " 1,011.69 " " 1,264.61 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 29813621 CATH TRANS N-LASER LVL011 C1725 278 "$2,625.00" 970.20 - " 2,100.00 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - " 1,011.69 " " 1,264.61 " - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 29813639 CATH TRANS N-LASER LVL014 C1725 278 "$3,375.00" " 1,247.40 " - " 2,700.00 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - " 1,011.69 " " 1,264.61 " - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 29813647 CATH TRANS N-LASER LVL015 C1725 278 "$3,625.00" " 1,339.80 " - " 2,900.00 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - " 1,011.69 " " 1,264.61 " - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 29813655 CATH TRANS N-LASER LVL016 C1725 278 "$3,875.00" " 1,432.20 " - " 3,100.00 " - " 2,677.63 " - " 2,677.63 " - " 2,140.94 " - " 2,557.50 " - - " 2,564.86 " - - " 1,011.69 " " 1,264.61 " - - - " 3,100.00 " - - " 2,596.25 " - " 1,584.88 " " 2,906.25 " " 1,472.89 " " 1,733.29 " - 29813663 CATH TRANS N-LASER LVL012 C1725 278 "$2,875.00" " 1,062.60 " - " 2,300.00 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - " 1,011.69 " " 1,264.61 " - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 29813671 CATH TRANS N-LASER LVL013 C1725 278 "$3,125.00" " 1,155.00 " - " 2,500.00 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - " 1,011.69 " " 1,264.61 " - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 29813680 CATH TRANS N-LASER LVL018 C1725 278 "$4,375.00" " 1,617.00 " - " 3,500.00 " - " 3,023.13 " - " 3,023.13 " - " 2,417.19 " - " 2,887.50 " - - " 2,895.81 " - - " 1,011.69 " " 1,264.61 " - - - " 3,500.00 " - - " 2,931.25 " - " 1,789.38 " " 3,281.25 " " 1,662.94 " " 1,956.94 " - 29813698 CATH TRANS N-LASER LVL019 C1725 278 "$4,625.00" " 1,709.40 " - " 3,700.00 " - " 3,195.88 " - " 3,195.88 " - " 2,555.31 " - " 3,052.50 " - - " 3,061.29 " - - " 1,011.69 " " 1,264.61 " - - - " 3,700.00 " - - " 3,098.75 " - " 1,891.63 " " 3,468.75 " " 1,757.96 " " 2,068.76 " - 29813701 CATH TRANS N-LASER LVL020 C1725 278 "$4,875.00" " 1,801.80 " - " 3,900.00 " - " 3,368.63 " - " 3,368.63 " - " 2,693.44 " - " 3,217.50 " - - " 3,226.76 " - - " 1,011.69 " " 1,264.61 " - - - " 3,900.00 " - - " 3,266.25 " - " 1,993.88 " " 3,656.25 " " 1,852.99 " " 2,180.59 " - 29813710 CATH TRANS N-LASER LVL017 C1725 278 "$4,125.00" " 1,524.60 " - " 3,300.00 " - " 2,850.38 " - " 2,850.38 " - " 2,279.06 " - " 2,722.50 " - - " 2,730.34 " - - " 1,011.69 " " 1,264.61 " - - - " 3,300.00 " - - " 2,763.75 " - " 1,687.13 " " 3,093.75 " " 1,567.91 " " 1,845.11 " - 29820031 CATH TRANS N-LASER LVL021 C1725 278 "$5,125.00" " 1,894.20 " - " 4,100.00 " - " 3,541.38 " - " 3,541.38 " - " 2,831.56 " - " 3,382.50 " - - " 3,392.24 " - - " 1,011.69 " " 1,264.61 " - - - " 4,100.00 " - - " 3,433.75 " - " 2,096.13 " " 3,843.75 " " 1,948.01 " " 2,292.41 " - 29820040 CATH TRANS N-LASER LVL022 C1725 278 "$5,375.00" " 1,986.60 " - " 4,300.00 " - " 3,714.13 " - " 3,714.13 " - " 2,969.69 " - " 3,547.50 " - - " 3,557.71 " - - " 1,011.69 " " 1,264.61 " - - - " 4,300.00 " - - " 3,601.25 " - " 2,198.38 " " 4,031.25 " " 2,043.04 " " 2,404.24 " - 29820058 CATH TRANS N-LASER LVL023 C1725 278 "$5,625.00" " 2,079.00 " - " 4,500.00 " - " 3,886.88 " - " 3,886.88 " - " 3,107.81 " - " 3,712.50 " - - " 3,723.19 " - - " 1,011.69 " " 1,264.61 " - - - " 4,500.00 " - - " 3,768.75 " - " 2,300.63 " " 4,218.75 " " 2,138.06 " " 2,516.06 " - 29820066 CATH TRANS N-LASER LVL024 C1725 278 "$5,875.00" " 2,171.40 " - " 4,700.00 " - " 4,059.63 " - " 4,059.63 " - " 3,245.94 " - " 3,877.50 " - - " 3,888.66 " - - " 1,011.69 " " 1,264.61 " - - - " 4,700.00 " - - " 3,936.25 " - " 2,402.88 " " 4,406.25 " " 2,233.09 " " 2,627.89 " - 29820074 CATH TRANS N-LASER LVL025 C1725 278 "$6,125.00" " 2,263.80 " - " 4,900.00 " - " 4,232.38 " - " 4,232.38 " - " 3,384.06 " - " 4,042.50 " - - " 4,054.14 " - - " 1,011.69 " " 1,264.61 " - - - " 4,900.00 " - - " 4,103.75 " - " 2,505.13 " " 4,593.75 " " 2,328.11 " " 2,739.71 " - 29820449 CATH TRANS N-LASER LVL026 C1725 278 "$6,375.00" " 2,356.20 " - " 5,100.00 " - " 4,405.13 " - " 4,405.13 " - " 3,522.19 " - " 4,207.50 " - - " 4,219.61 " - - " 1,011.69 " " 1,264.61 " - - - " 5,100.00 " - - " 4,271.25 " - " 2,607.38 " " 4,781.25 " " 2,423.14 " " 2,851.54 " - 29820457 CATH TRANS N-LASER LVL027 C1725 278 "$6,625.00" " 2,448.60 " - " 5,300.00 " - " 4,577.88 " - " 4,577.88 " - " 3,660.31 " - " 4,372.50 " - - " 4,385.09 " - - " 1,011.69 " " 1,264.61 " - - - " 5,300.00 " - - " 4,438.75 " - " 2,709.63 " " 4,968.75 " " 2,518.16 " " 2,963.36 " - 29820465 CATH TRANS N-LASER LVL028 C1725 278 "$6,875.00" " 2,541.00 " - " 5,500.00 " - " 4,750.63 " - " 4,750.63 " - " 3,798.44 " - " 4,537.50 " - - " 4,550.56 " - - " 1,011.69 " " 1,264.61 " - - - " 5,500.00 " - - " 4,606.25 " - " 2,811.88 " " 5,156.25 " " 2,613.19 " " 3,075.19 " - 29820473 CATH TRANS N-LASER LVL029 C1725 278 "$7,125.00" " 2,633.40 " - " 5,700.00 " - " 4,923.38 " - " 4,923.38 " - " 3,936.56 " - " 4,702.50 " - - " 4,716.04 " - - " 1,011.69 " " 1,264.61 " - - - " 5,700.00 " - - " 4,773.75 " - " 2,914.13 " " 5,343.75 " " 2,708.21 " " 3,187.01 " - 29820481 CATH TRANS N-LASER LVL030 C1725 278 "$7,375.00" " 2,725.80 " - " 5,900.00 " - " 5,096.13 " - " 5,096.13 " - " 4,074.69 " - " 4,867.50 " - - " 4,881.51 " - - " 1,011.69 " " 1,264.61 " - - - " 5,900.00 " - - " 4,941.25 " - " 3,016.38 " " 5,531.25 " " 2,803.24 " " 3,298.84 " - 30611322 CATH TRANS N-LASER LVL001 C1725 278 $200.00 73.92 - " 1,264.61 " - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - " 1,011.69 " " 1,264.61 " - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 30611331 CATH TRANS N-LASER LVL002 C1725 278 $450.00 166.32 - " 1,264.61 " - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - " 1,011.69 " " 1,264.61 " - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 30611349 CATH TRANS N-LASER LVL003 C1725 278 $750.00 277.20 - " 1,264.61 " - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - " 1,011.69 " " 1,264.61 " - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 30611357 CATH TRANS N-LASER LVL004 C1725 278 "$1,050.00" 388.08 - " 1,264.61 " - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - " 1,011.69 " " 1,264.61 " - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 30611365 CATH TRANS N-LASER LVL005 C1725 278 "$1,350.00" 498.96 - " 1,264.61 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - " 1,011.69 " " 1,264.61 " - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 80361190 CATH TRANS N-LASER LVL001 C1725 278 $200.00 73.92 - " 1,264.61 " - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - " 1,011.69 " " 1,264.61 " - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 80361203 CATH TRANS N-LASER LVL002 C1725 278 $450.00 166.32 - " 1,264.61 " - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - " 1,011.69 " " 1,264.61 " - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 80361211 CATH TRANS N-LASER LVL003 C1725 278 $750.00 277.20 - " 1,264.61 " - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - " 1,011.69 " " 1,264.61 " - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 80361220 CATH TRANS N-LASER LVL004 C1725 278 "$1,050.00" 388.08 - " 1,264.61 " - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - " 1,011.69 " " 1,264.61 " - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 80361238 CATH TRANS N-LASER LVL005 C1725 278 "$1,350.00" 498.96 - " 1,264.61 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - " 1,011.69 " " 1,264.61 " - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 80361246 CATH TRANS N-LASER LVL006 C1725 278 "$1,375.00" 508.20 - " 1,264.61 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - " 1,011.69 " " 1,264.61 " - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 80361254 CATH TRANS N-LASER LVL007 C1725 278 "$1,625.00" 600.60 - " 1,300.00 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - " 1,011.69 " " 1,264.61 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 80361262 CATH TRANS N-LASER LVL008 C1725 278 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - " 1,011.69 " " 1,264.61 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 80361271 CATH TRANS N-LASER LVL009 C1725 278 "$2,125.00" 785.40 - " 1,700.00 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - " 1,011.69 " " 1,264.61 " - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 80361289 CATH TRANS N-LASER LVL010 C1725 278 "$2,375.00" 877.80 - " 1,900.00 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - " 1,011.69 " " 1,264.61 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 80361297 CATH TRANS N-LASER LVL011 C1725 278 "$2,625.00" 970.20 - " 2,100.00 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - " 1,011.69 " " 1,264.61 " - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 80361301 CATH TRANS N-LASER LVL012 C1725 278 "$2,875.00" " 1,062.60 " - " 2,300.00 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - " 1,011.69 " " 1,264.61 " - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 80361319 CATH TRANS N-LASER LVL013 C1725 278 "$3,125.00" " 1,155.00 " - " 2,500.00 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - " 1,011.69 " " 1,264.61 " - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 80361327 CATH TRANS N-LASER LVL014 C1725 278 "$3,375.00" " 1,247.40 " - " 2,700.00 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - " 1,011.69 " " 1,264.61 " - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 28103000 CATH BAL DIL NON-VASC LVL001 C1726 278 $200.00 73.92 - 160.00 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 105.98 132.48 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 28103018 CATH BAL DIL NON-VASC LVL002 C1726 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 238.46 298.08 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 28103026 CATH BAL DIL NON-VASC LVL003 C1726 278 $750.00 277.20 - 600.00 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 397.43 496.80 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 28103077 CATH BAL DIL NON-VASC LVL008 C1726 278 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - 993.56 " 1,242.00 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 28103093 CATH BAL DIL NON-VASC LVL010 C1726 278 "$2,375.00" 877.80 - " 1,900.00 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - " 1,258.51 " " 1,573.20 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 28103115 CATH BAL DIL NON-VASC LVL017 C1726 278 "$4,125.00" " 1,524.60 " - " 3,300.00 " - " 2,850.38 " - " 2,850.38 " - " 2,279.06 " - " 2,722.50 " - - " 2,730.34 " - - " 2,185.84 " " 2,732.40 " - - - " 3,300.00 " - - " 2,763.75 " - " 1,687.13 " " 3,093.75 " " 1,567.91 " " 1,845.11 " - 28103123 CATH BAL DIL NON-VASC LVL018 C1726 278 "$4,375.00" " 1,617.00 " - " 3,500.00 " - " 3,023.13 " - " 3,023.13 " - " 2,417.19 " - " 2,887.50 " - - " 2,895.81 " - - " 2,318.31 " " 2,898.00 " - - - " 3,500.00 " - - " 2,931.25 " - " 1,789.38 " " 3,281.25 " " 1,662.94 " " 1,956.94 " - 28103131 CATH BAL DIL NON-VASC LVL019 C1726 278 "$4,625.00" " 1,709.40 " - " 3,700.00 " - " 3,195.88 " - " 3,195.88 " - " 2,555.31 " - " 3,052.50 " - - " 3,061.29 " - - " 2,450.79 " " 3,063.60 " - - - " 3,700.00 " - - " 3,098.75 " - " 1,891.63 " " 3,468.75 " " 1,757.96 " " 2,068.76 " - 28103140 CATH BAL DIL NON-VASC LVL020 C1726 278 "$4,875.00" " 1,801.80 " - " 3,900.00 " - " 3,368.63 " - " 3,368.63 " - " 2,693.44 " - " 3,217.50 " - - " 3,226.76 " - - " 2,583.26 " " 3,229.20 " - - - " 3,900.00 " - - " 3,266.25 " - " 1,993.88 " " 3,656.25 " " 1,852.99 " " 2,180.59 " - 29817928 CATH BAL DIL NON-VASC LVL036 C1726 278 "$8,875.00" " 3,280.20 " - " 7,100.00 " - " 6,132.63 " - " 6,132.63 " - " 4,903.44 " - " 5,857.50 " - - " 5,874.36 " - - " 4,702.86 " " 5,878.80 " - - - " 7,100.00 " - - " 5,946.25 " - " 3,629.88 " " 6,656.25 " " 3,373.39 " " 3,969.79 " - 29817936 CATH BAL DIL NON-VASC LVL037 C1726 278 "$9,125.00" " 3,372.60 " - " 7,300.00 " - " 6,305.38 " - " 6,305.38 " - " 5,041.56 " - " 6,022.50 " - - " 6,039.84 " - - " 4,835.34 " " 6,044.40 " - - - " 7,300.00 " - - " 6,113.75 " - " 3,732.13 " " 6,843.75 " " 3,468.41 " " 4,081.61 " - 29817944 CATH BAL DIL NON-VASC LVL038 C1726 278 "$9,375.00" " 3,465.00 " - " 7,500.00 " - " 6,478.13 " - " 6,478.13 " - " 5,179.69 " - " 6,187.50 " - - " 6,205.31 " - - " 4,967.81 " " 6,210.00 " - - - " 7,500.00 " - - " 6,281.25 " - " 3,834.38 " " 7,031.25 " " 3,563.44 " " 4,193.44 " - 29819092 CATH BAL DIL NON-VASC LVL003 C1726 278 $750.00 277.20 - 600.00 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 397.43 496.80 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 29819106 CATH BAL DIL NON-VASC LVL004 C1726 278 "$1,050.00" 388.08 - 840.00 - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 556.40 695.52 - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 29819114 CATH BAL DIL NON-VASC LVL005 C1726 278 "$1,350.00" 498.96 - " 1,080.00 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 715.37 894.24 - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 29819122 CATH BAL DIL NON-VASC LVL006 C1726 278 "$1,375.00" 508.20 - " 1,100.00 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - 728.61 910.80 - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 29819131 CATH BAL DIL NON-VASC LVL007 C1726 278 "$1,625.00" 600.60 - " 1,300.00 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - 861.09 " 1,076.40 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 29819149 CATH BAL DIL NON-VASC LVL008 C1726 278 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - 993.56 " 1,242.00 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 29819157 CATH BAL DIL NON-VASC LVL009 C1726 278 "$2,125.00" 785.40 - " 1,700.00 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - " 1,126.04 " " 1,407.60 " - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 29819165 CATH BAL DIL NON-VASC LVL010 C1726 278 "$2,375.00" 877.80 - " 1,900.00 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - " 1,258.51 " " 1,573.20 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 29819173 CATH BAL DIL NON-VASC LVL011 C1726 278 "$2,625.00" 970.20 - " 2,100.00 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - " 1,390.99 " " 1,738.80 " - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 29819181 CATH BAL DIL NON-VASC LVL012 C1726 278 "$2,875.00" " 1,062.60 " - " 2,300.00 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - " 1,523.46 " " 1,904.40 " - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 29819190 CATH BAL DIL NON-VASC LVL013 C1726 278 "$3,125.00" " 1,155.00 " - " 2,500.00 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - " 1,655.94 " " 2,070.00 " - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 29819203 CATH BAL DIL NON-VASC LVL014 C1726 278 "$3,375.00" " 1,247.40 " - " 2,700.00 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - " 1,788.41 " " 2,235.60 " - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 29819211 CATH BAL DIL NON-VASC LVL015 C1726 278 "$3,625.00" " 1,339.80 " - " 2,900.00 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - " 1,920.89 " " 2,401.20 " - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 80363648 CATH BAL DIL NON-VASC LVL001 C1726 278 $200.00 73.92 - 160.00 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 105.98 132.48 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 80363656 CATH BAL DIL NON-VASC LVL002 C1726 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 238.46 298.08 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 80363664 CATH BAL DIL NON-VASC LVL003 C1726 278 $750.00 277.20 - 600.00 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 397.43 496.80 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 80363672 CATH BAL DIL NON-VASC LVL004 C1726 278 "$1,050.00" 388.08 - 840.00 - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 556.40 695.52 - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 80363681 CATH BAL DIL NON-VASC LVL005 C1726 278 "$1,350.00" 498.96 - " 1,080.00 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 715.37 894.24 - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 80363699 CATH BAL DIL NON-VASC LVL006 C1726 278 "$1,375.00" 508.20 - " 1,100.00 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - 728.61 910.80 - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 80363702 CATH BAL DIL NON-VASC LVL007 C1726 278 "$1,625.00" 600.60 - " 1,300.00 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - 861.09 " 1,076.40 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 80363711 CATH BAL DIL NON-VASC LVL008 C1726 278 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - 993.56 " 1,242.00 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 80364806 CATH BAL DIL NON-VASC LVL016 C1726 278 "$3,875.00" " 1,432.20 " - " 3,100.00 " - " 2,677.63 " - " 2,677.63 " - " 2,140.94 " - " 2,557.50 " - - " 2,564.86 " - - " 2,053.36 " " 2,566.80 " - - - " 3,100.00 " - - " 2,596.25 " - " 1,584.88 " " 2,906.25 " " 1,472.89 " " 1,733.29 " - 80364814 CATH BAL DIL NON-VASC LVL017 C1726 278 "$4,125.00" " 1,524.60 " - " 3,300.00 " - " 2,850.38 " - " 2,850.38 " - " 2,279.06 " - " 2,722.50 " - - " 2,730.34 " - - " 2,185.84 " " 2,732.40 " - - - " 3,300.00 " - - " 2,763.75 " - " 1,687.13 " " 3,093.75 " " 1,567.91 " " 1,845.11 " - 80364822 CATH BAL DIL NON-VASC LVL018 C1726 278 "$4,375.00" " 1,617.00 " - " 3,500.00 " - " 3,023.13 " - " 3,023.13 " - " 2,417.19 " - " 2,887.50 " - - " 2,895.81 " - - " 2,318.31 " " 2,898.00 " - - - " 3,500.00 " - - " 2,931.25 " - " 1,789.38 " " 3,281.25 " " 1,662.94 " " 1,956.94 " - 80364831 CATH BAL DIL NON-VASC LVL019 C1726 278 "$4,625.00" " 1,709.40 " - " 3,700.00 " - " 3,195.88 " - " 3,195.88 " - " 2,555.31 " - " 3,052.50 " - - " 3,061.29 " - - " 2,450.79 " " 3,063.60 " - - - " 3,700.00 " - - " 3,098.75 " - " 1,891.63 " " 3,468.75 " " 1,757.96 " " 2,068.76 " - 80364849 CATH BAL DIL NON-VASC LVL020 C1726 278 "$4,875.00" " 1,801.80 " - " 3,900.00 " - " 3,368.63 " - " 3,368.63 " - " 2,693.44 " - " 3,217.50 " - - " 3,226.76 " - - " 2,583.26 " " 3,229.20 " - - - " 3,900.00 " - - " 3,266.25 " - " 1,993.88 " " 3,656.25 " " 1,852.99 " " 2,180.59 " - 80364857 CATH BAL DIL NON-VASC LVL021 C1726 278 "$5,125.00" " 1,894.20 " - " 4,100.00 " - " 3,541.38 " - " 3,541.38 " - " 2,831.56 " - " 3,382.50 " - - " 3,392.24 " - - " 2,715.74 " " 3,394.80 " - - - " 4,100.00 " - - " 3,433.75 " - " 2,096.13 " " 3,843.75 " " 1,948.01 " " 2,292.41 " - 80364865 CATH BAL DIL NON-VASC LVL022 C1726 278 "$5,375.00" " 1,986.60 " - " 4,300.00 " - " 3,714.13 " - " 3,714.13 " - " 2,969.69 " - " 3,547.50 " - - " 3,557.71 " - - " 2,848.21 " " 3,560.40 " - - - " 4,300.00 " - - " 3,601.25 " - " 2,198.38 " " 4,031.25 " " 2,043.04 " " 2,404.24 " - 80364873 CATH BAL DIL NON-VASC LVL023 C1726 278 "$5,625.00" " 2,079.00 " - " 4,500.00 " - " 3,886.88 " - " 3,886.88 " - " 3,107.81 " - " 3,712.50 " - - " 3,723.19 " - - " 2,980.69 " " 3,726.00 " - - - " 4,500.00 " - - " 3,768.75 " - " 2,300.63 " " 4,218.75 " " 2,138.06 " " 2,516.06 " - 80364881 CATH BAL DIL NON-VASC LVL024 C1726 278 "$5,875.00" " 2,171.40 " - " 4,700.00 " - " 4,059.63 " - " 4,059.63 " - " 3,245.94 " - " 3,877.50 " - - " 3,888.66 " - - " 3,113.16 " " 3,891.60 " - - - " 4,700.00 " - - " 3,936.25 " - " 2,402.88 " " 4,406.25 " " 2,233.09 " " 2,627.89 " - 80364890 CATH BAL DIL NON-VASC LVL025 C1726 278 "$6,125.00" " 2,263.80 " - " 4,900.00 " - " 4,232.38 " - " 4,232.38 " - " 3,384.06 " - " 4,042.50 " - - " 4,054.14 " - - " 3,245.64 " " 4,057.20 " - - - " 4,900.00 " - - " 4,103.75 " - " 2,505.13 " " 4,593.75 " " 2,328.11 " " 2,739.71 " - 80364903 CATH BAL DIL NON-VASC LVL026 C1726 278 "$6,375.00" " 2,356.20 " - " 5,100.00 " - " 4,405.13 " - " 4,405.13 " - " 3,522.19 " - " 4,207.50 " - - " 4,219.61 " - - " 3,378.11 " " 4,222.80 " - - - " 5,100.00 " - - " 4,271.25 " - " 2,607.38 " " 4,781.25 " " 2,423.14 " " 2,851.54 " - 80364911 CATH BAL DIL NON-VASC LVL027 C1726 278 "$6,625.00" " 2,448.60 " - " 5,300.00 " - " 4,577.88 " - " 4,577.88 " - " 3,660.31 " - " 4,372.50 " - - " 4,385.09 " - - " 3,510.59 " " 4,388.40 " - - - " 5,300.00 " - - " 4,438.75 " - " 2,709.63 " " 4,968.75 " " 2,518.16 " " 2,963.36 " - 80364920 CATH BAL DIL NON-VASC LVL028 C1726 278 "$6,875.00" " 2,541.00 " - " 5,500.00 " - " 4,750.63 " - " 4,750.63 " - " 3,798.44 " - " 4,537.50 " - - " 4,550.56 " - - " 3,643.06 " " 4,554.00 " - - - " 5,500.00 " - - " 4,606.25 " - " 2,811.88 " " 5,156.25 " " 2,613.19 " " 3,075.19 " - 80364938 CATH BAL DIL NON-VASC LVL029 C1726 278 "$7,125.00" " 2,633.40 " - " 5,700.00 " - " 4,923.38 " - " 4,923.38 " - " 3,936.56 " - " 4,702.50 " - - " 4,716.04 " - - " 3,775.54 " " 4,719.60 " - - - " 5,700.00 " - - " 4,773.75 " - " 2,914.13 " " 5,343.75 " " 2,708.21 " " 3,187.01 " - 80364946 CATH BAL DIL NON-VASC LVL030 C1726 278 "$7,375.00" " 2,725.80 " - " 5,900.00 " - " 5,096.13 " - " 5,096.13 " - " 4,074.69 " - " 4,867.50 " - - " 4,881.51 " - - " 3,908.01 " " 4,885.20 " - - - " 5,900.00 " - - " 4,941.25 " - " 3,016.38 " " 5,531.25 " " 2,803.24 " " 3,298.84 " - 80364954 CATH BAL DIL NON-VASC LVL031 C1726 278 "$7,625.00" " 2,818.20 " - " 6,100.00 " - " 5,268.88 " - " 5,268.88 " - " 4,212.81 " - " 5,032.50 " - - " 5,046.99 " - - " 4,040.49 " " 5,050.80 " - - - " 6,100.00 " - - " 5,108.75 " - " 3,118.63 " " 5,718.75 " " 2,898.26 " " 3,410.66 " - 80364962 CATH BAL DIL NON-VASC LVL032 C1726 278 "$7,875.00" " 2,910.60 " - " 6,300.00 " - " 5,441.63 " - " 5,441.63 " - " 4,350.94 " - " 5,197.50 " - - " 5,212.46 " - - " 4,172.96 " " 5,216.40 " - - - " 6,300.00 " - - " 5,276.25 " - " 3,220.88 " " 5,906.25 " " 2,993.29 " " 3,522.49 " - 80364971 CATH BAL DIL NON-VASC LVL033 C1726 278 "$8,125.00" " 3,003.00 " - " 6,500.00 " - " 5,614.38 " - " 5,614.38 " - " 4,489.06 " - " 5,362.50 " - - " 5,377.94 " - - " 4,305.44 " " 5,382.00 " - - - " 6,500.00 " - - " 5,443.75 " - " 3,323.13 " " 6,093.75 " " 3,088.31 " " 3,634.31 " - 80364989 CATH BAL DIL NON-VASC LVL034 C1726 278 "$8,375.00" " 3,095.40 " - " 6,700.00 " - " 5,787.13 " - " 5,787.13 " - " 4,627.19 " - " 5,527.50 " - - " 5,543.41 " - - " 4,437.91 " " 5,547.60 " - - - " 6,700.00 " - - " 5,611.25 " - " 3,425.38 " " 6,281.25 " " 3,183.34 " " 3,746.14 " - 80364997 CATH BAL DIL NON-VASC LVL035 C1726 278 "$8,625.00" " 3,187.80 " - " 6,900.00 " - " 5,959.88 " - " 5,959.88 " - " 4,765.31 " - " 5,692.50 " - - " 5,708.89 " - - " 4,570.39 " " 5,713.20 " - - - " 6,900.00 " - - " 5,778.75 " - " 3,527.63 " " 6,468.75 " " 3,278.36 " " 3,857.96 " - 28103204 CATH BAL TIS DS N-VASC LVL005 C1727 278 "$1,350.00" 498.96 - " 1,080.00 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 698.77 873.46 - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 28103263 CATH DRAINAGE LVL001 C1729 278 $200.00 73.92 - 287.15 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 229.72 287.15 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 28103271 CATH DRAINAGE LVL002 C1729 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 229.72 287.15 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 28103280 CATH DRAINAGE LVL003 C1729 278 $750.00 277.20 - 600.00 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 229.72 287.15 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 28103298 CATH DRAINAGE LVL004 C1729 278 "$1,050.00" 388.08 - 840.00 - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 229.72 287.15 - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 28103395 CATH DRAINAGE LVL014 C1729 278 "$3,375.00" " 1,247.40 " - " 2,700.00 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - 229.72 287.15 - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 28103476 CATH DRAINAGE LVL028 C1729 278 "$6,875.00" " 2,541.00 " - " 5,500.00 " - " 4,750.63 " - " 4,750.63 " - " 3,798.44 " - " 4,537.50 " - - " 4,550.56 " - - 229.72 287.15 - - - " 5,500.00 " - - " 4,606.25 " - " 2,811.88 " " 5,156.25 " " 2,613.19 " " 3,075.19 " - 29819220 CATH DRAINAGE LVL001 C1729 278 $200.00 73.92 - 287.15 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 229.72 287.15 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 29819238 CATH DRAINAGE LVL002 C1729 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 229.72 287.15 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 29819246 CATH DRAINAGE LVL003 C1729 278 $750.00 277.20 - 600.00 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 229.72 287.15 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 30612574 CATH DRAINAGE LVL001 C1729 278 $200.00 73.92 - 287.15 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 229.72 287.15 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 30612582 CATH DRAINAGE LVL002 C1729 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 229.72 287.15 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 30612591 CATH DRAINAGE LVL003 C1729 278 $750.00 277.20 - 600.00 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 229.72 287.15 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 30612604 CATH DRAINAGE LVL004 C1729 278 "$1,050.00" 388.08 - 840.00 - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 229.72 287.15 - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 30612612 CATH DRAINAGE LVL005 C1729 278 "$1,350.00" 498.96 - " 1,080.00 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 229.72 287.15 - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 80363729 CATH DRAINAGE LVL001 C1729 278 $200.00 73.92 - 287.15 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 229.72 287.15 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 80363737 CATH DRAINAGE LVL002 C1729 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 229.72 287.15 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 80363745 CATH DRAINAGE LVL003 C1729 278 $750.00 277.20 - 600.00 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 229.72 287.15 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 80363753 CATH DRAINAGE LVL004 C1729 278 "$1,050.00" 388.08 - 840.00 - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 229.72 287.15 - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 80363761 CATH DRAINAGE LVL005 C1729 278 "$1,350.00" 498.96 - " 1,080.00 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 229.72 287.15 - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 80363770 CATH DRAINAGE LVL006 C1729 278 "$1,375.00" 508.20 - " 1,100.00 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - 229.72 287.15 - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 80363788 CATH DRAINAGE LVL007 C1729 278 "$1,625.00" 600.60 - " 1,300.00 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - 229.72 287.15 - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 80363796 CATH DRAINAGE LVL008 C1729 278 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - 229.72 287.15 - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 80363800 CATH DRAINAGE LVL009 C1729 278 "$2,125.00" 785.40 - " 1,700.00 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - 229.72 287.15 - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 80363818 CATH DRAINAGE LVL010 C1729 278 "$2,375.00" 877.80 - " 1,900.00 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - 229.72 287.15 - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 80363826 CATH DRAINAGE LVL011 C1729 278 "$2,625.00" 970.20 - " 2,100.00 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - 229.72 287.15 - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 80663722 CATH DRAINAGE LVL001 C1729 278 $200.00 73.92 - 287.15 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 229.72 287.15 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 80663731 CATH DRAINAGE LVL002 C1729 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 229.72 287.15 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 80663749 CATH DRAINAGE LVL003 C1729 278 $750.00 277.20 - 600.00 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 229.72 287.15 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 80663757 CATH DRAINAGE LVL004 C1729 278 "$1,050.00" 388.08 - 840.00 - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 229.72 287.15 - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 80663765 CATH DRAINAGE LVL005 C1729 278 "$1,350.00" 498.96 - " 1,080.00 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 229.72 287.15 - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 80663773 CATH DRAINAGE LVL006 C1729 278 "$1,375.00" 508.20 - " 1,100.00 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - 229.72 287.15 - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 30604059 CATH EP <=19 ELECT LVL001 C1730 278 $200.00 73.92 - " 1,111.30 " - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 889.04 " 1,111.30 " - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 30604067 CATH EP <=19 ELECT LVL002 C1730 278 $450.00 166.32 - " 1,111.30 " - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 889.04 " 1,111.30 " - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 30604075 CATH EP <=19 ELECT LVL003 C1730 278 $750.00 277.20 - " 1,111.30 " - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 889.04 " 1,111.30 " - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 30604083 CATH EP <=19 ELECT LVL004 C1730 278 "$1,050.00" 388.08 - " 1,111.30 " - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 889.04 " 1,111.30 " - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 30604091 CATH EP <=19 ELECT LVL005 C1730 278 "$1,350.00" 498.96 - " 1,111.30 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 889.04 " 1,111.30 " - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 30604105 CATH EP <=19 ELECT LVL006 C1730 278 "$1,375.00" 508.20 - " 1,111.30 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - 889.04 " 1,111.30 " - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 30604113 CATH EP <=19 ELECT LVL007 C1730 278 "$1,625.00" 600.60 - " 1,300.00 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - 889.04 " 1,111.30 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 30604121 CATH EP <=19 ELECT LVL009 C1730 278 "$2,125.00" 785.40 - " 1,700.00 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - 889.04 " 1,111.30 " - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 30604130 CATH EP <=19 ELECT LVL010 C1730 278 "$2,375.00" 877.80 - " 1,900.00 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - 889.04 " 1,111.30 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 30608119 CATH EP <=19 ELECT LVL008 C1730 278 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - 889.04 " 1,111.30 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 30604148 CATH EP 20+ ELECT LVL006 C1731 278 "$1,375.00" 508.20 - " 4,106.04 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - " 3,284.83 " " 4,106.04 " - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 30604156 CATH EP 20+ ELECT LVL007 C1731 278 "$1,625.00" 600.60 - " 4,106.04 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - " 3,284.83 " " 4,106.04 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 30604164 CATH EP 20+ ELECT LVL008 C1731 278 "$1,875.00" 693.00 - " 4,106.04 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - " 3,284.83 " " 4,106.04 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 30604172 CATH EP 20+ ELECT LVL009 C1731 278 "$2,125.00" 785.40 - " 4,106.04 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - " 3,284.83 " " 4,106.04 " - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 30604181 CATH EP 20+ ELECT LVL010 C1731 278 "$2,375.00" 877.80 - " 4,106.04 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - " 3,284.83 " " 4,106.04 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 30604199 CATH EP 20+ ELECT LVL011 C1731 278 "$2,625.00" 970.20 - " 4,106.04 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - " 3,284.83 " " 4,106.04 " - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 30604202 CATH EP 20+ ELECT LVL012 C1731 278 "$2,875.00" " 1,062.60 " - " 4,106.04 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - " 3,284.83 " " 4,106.04 " - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 30604211 CATH EP 20+ ELECT LVL014 C1731 278 "$3,375.00" " 1,247.40 " - " 4,106.04 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - " 3,284.83 " " 4,106.04 " - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 30604229 CATH EP 20+ ELECT LVL015 C1731 278 "$3,625.00" " 1,339.80 " - " 4,106.04 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - " 3,284.83 " " 4,106.04 " - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 30604237 CATH EP 20+ ELECT LVL016 C1731 278 "$3,875.00" " 1,432.20 " - " 4,106.04 " - " 2,677.63 " - " 2,677.63 " - " 2,140.94 " - " 2,557.50 " - - " 2,564.86 " - - " 3,284.83 " " 4,106.04 " - - - " 3,100.00 " - - " 2,596.25 " - " 1,584.88 " " 2,906.25 " " 1,472.89 " " 1,733.29 " - 30604245 CATH EP 20+ ELECT LVL017 C1731 278 "$4,125.00" " 1,524.60 " - " 4,106.04 " - " 2,850.38 " - " 2,850.38 " - " 2,279.06 " - " 2,722.50 " - - " 2,730.34 " - - " 3,284.83 " " 4,106.04 " - - - " 3,300.00 " - - " 2,763.75 " - " 1,687.13 " " 3,093.75 " " 1,567.91 " " 1,845.11 " - 30608127 CATH EP 20+ ELECT LVL001 C1731 278 $200.00 73.92 - " 4,106.04 " - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - " 3,284.83 " " 4,106.04 " - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 30608135 CATH EP 20+ ELECT LVL002 C1731 278 $450.00 166.32 - " 4,106.04 " - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - " 3,284.83 " " 4,106.04 " - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 30608143 CATH EP 20+ ELECT LVL003 C1731 278 $750.00 277.20 - " 4,106.04 " - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - " 3,284.83 " " 4,106.04 " - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 30608151 CATH EP 20+ ELECT LVL004 C1731 278 "$1,050.00" 388.08 - " 4,106.04 " - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - " 3,284.83 " " 4,106.04 " - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 30608160 CATH EP 20+ ELECT LVL005 C1731 278 "$1,350.00" 498.96 - " 4,106.04 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - " 3,284.83 " " 4,106.04 " - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 30608178 CATH EP 20+ ELECT LVL013 C1731 278 "$3,125.00" " 1,155.00 " - " 4,106.04 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - " 3,284.83 " " 4,106.04 " - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 30608186 CATH EP 20+ ELECT LVL018 C1731 278 "$4,375.00" " 1,617.00 " - " 4,106.04 " - " 3,023.13 " - " 3,023.13 " - " 2,417.19 " - " 2,887.50 " - - " 2,895.81 " - - " 3,284.83 " " 4,106.04 " - - - " 3,500.00 " - - " 2,931.25 " - " 1,789.38 " " 3,281.25 " " 1,662.94 " " 1,956.94 " - 30608194 CATH EP 20+ ELECT LVL019 C1731 278 "$4,625.00" " 1,709.40 " - " 4,106.04 " - " 3,195.88 " - " 3,195.88 " - " 2,555.31 " - " 3,052.50 " - - " 3,061.29 " - - " 3,284.83 " " 4,106.04 " - - - " 3,700.00 " - - " 3,098.75 " - " 1,891.63 " " 3,468.75 " " 1,757.96 " " 2,068.76 " - 30608208 CATH EP 20+ ELECT LVL020 C1731 278 "$4,875.00" " 1,801.80 " - " 4,106.04 " - " 3,368.63 " - " 3,368.63 " - " 2,693.44 " - " 3,217.50 " - - " 3,226.76 " - - " 3,284.83 " " 4,106.04 " - - - " 3,900.00 " - - " 3,266.25 " - " 1,993.88 " " 3,656.25 " " 1,852.99 " " 2,180.59 " - 30613155 CATH EP 20+ ELECT LVL030 C1731 278 "$7,375.00" " 2,725.80 " - " 5,900.00 " - " 5,096.13 " - " 5,096.13 " - " 4,074.69 " - " 4,867.50 " - - " 4,881.51 " - - " 3,284.83 " " 4,106.04 " - - - " 5,900.00 " - - " 4,941.25 " - " 3,016.38 " " 5,531.25 " " 2,803.24 " " 3,298.84 " - 30613163 CATH EP 20+ ELECT LVL031 C1731 278 "$7,625.00" " 2,818.20 " - " 6,100.00 " - " 5,268.88 " - " 5,268.88 " - " 4,212.81 " - " 5,032.50 " - - " 5,046.99 " - - " 3,284.83 " " 4,106.04 " - - - " 6,100.00 " - - " 5,108.75 " - " 3,118.63 " " 5,718.75 " " 2,898.26 " " 3,410.66 " - 30613171 CATH EP 20+ ELECT LVL032 C1731 278 "$7,875.00" " 2,910.60 " - " 6,300.00 " - " 5,441.63 " - " 5,441.63 " - " 4,350.94 " - " 5,197.50 " - - " 5,212.46 " - - " 3,284.83 " " 4,106.04 " - - - " 6,300.00 " - - " 5,276.25 " - " 3,220.88 " " 5,906.25 " " 2,993.29 " " 3,522.49 " - 30613180 CATH EP 20+ ELECT LVL033 C1731 278 "$8,125.00" " 3,003.00 " - " 6,500.00 " - " 5,614.38 " - " 5,614.38 " - " 4,489.06 " - " 5,362.50 " - - " 5,377.94 " - - " 3,284.83 " " 4,106.04 " - - - " 6,500.00 " - - " 5,443.75 " - " 3,323.13 " " 6,093.75 " " 3,088.31 " " 3,634.31 " - 30613198 CATH EP 20+ ELECT LVL034 C1731 278 "$8,375.00" " 3,095.40 " - " 6,700.00 " - " 5,787.13 " - " 5,787.13 " - " 4,627.19 " - " 5,527.50 " - - " 5,543.41 " - - " 3,284.83 " " 4,106.04 " - - - " 6,700.00 " - - " 5,611.25 " - " 3,425.38 " " 6,281.25 " " 3,183.34 " " 3,746.14 " - 30613201 CATH EP 20+ ELECT LVL035 C1731 278 "$8,625.00" " 3,187.80 " - " 6,900.00 " - " 5,959.88 " - " 5,959.88 " - " 4,765.31 " - " 5,692.50 " - - " 5,708.89 " - - " 3,284.83 " " 4,106.04 " - - - " 6,900.00 " - - " 5,778.75 " - " 3,527.63 " " 6,468.75 " " 3,278.36 " " 3,857.96 " - 30604253 CATH EP DIAG ABL 3D LVL006 C1732 278 "$1,375.00" 508.20 - " 7,700.84 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - " 6,160.67 " " 7,700.84 " - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 30604261 CATH EP DIAG ABL 3D LVL007 C1732 278 "$1,625.00" 600.60 - " 7,700.84 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - " 6,160.67 " " 7,700.84 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 30604270 CATH EP DIAG ABL 3D LVL008 C1732 278 "$1,875.00" 693.00 - " 7,700.84 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - " 6,160.67 " " 7,700.84 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 30604288 CATH EP DIAG ABL 3D LVL009 C1732 278 "$2,125.00" 785.40 - " 7,700.84 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - " 6,160.67 " " 7,700.84 " - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 30604296 CATH EP DIAG ABL 3D LVL010 C1732 278 "$2,375.00" 877.80 - " 7,700.84 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - " 6,160.67 " " 7,700.84 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 30604300 CATH EP DIAG ABL 3D LVL011 C1732 278 "$2,625.00" 970.20 - " 7,700.84 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - " 6,160.67 " " 7,700.84 " - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 30604318 CATH EP DIAG ABL 3D LVL012 C1732 278 "$2,875.00" " 1,062.60 " - " 7,700.84 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - " 6,160.67 " " 7,700.84 " - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 30604326 CATH EP DIAG ABL 3D LVL013 C1732 278 "$3,125.00" " 1,155.00 " - " 7,700.84 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - " 6,160.67 " " 7,700.84 " - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 30604334 CATH EP DIAG ABL 3D LVL014 C1732 278 "$3,375.00" " 1,247.40 " - " 7,700.84 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - " 6,160.67 " " 7,700.84 " - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 30604342 CATH EP DIAG ABL 3D LVL015 C1732 278 "$3,625.00" " 1,339.80 " - " 7,700.84 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - " 6,160.67 " " 7,700.84 " - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 30604351 CATH EP DIAG ABL 3D LVL016 C1732 278 "$3,875.00" " 1,432.20 " - " 7,700.84 " - " 2,677.63 " - " 2,677.63 " - " 2,140.94 " - " 2,557.50 " - - " 2,564.86 " - - " 6,160.67 " " 7,700.84 " - - - " 3,100.00 " - - " 2,596.25 " - " 1,584.88 " " 2,906.25 " " 1,472.89 " " 1,733.29 " - 30604369 CATH EP DIAG ABL 3D LVL018 C1732 278 "$4,375.00" " 1,617.00 " - " 7,700.84 " - " 3,023.13 " - " 3,023.13 " - " 2,417.19 " - " 2,887.50 " - - " 2,895.81 " - - " 6,160.67 " " 7,700.84 " - - - " 3,500.00 " - - " 2,931.25 " - " 1,789.38 " " 3,281.25 " " 1,662.94 " " 1,956.94 " - 30604377 CATH EP DIAG ABL 3D LVL019 C1732 278 "$4,625.00" " 1,709.40 " - " 7,700.84 " - " 3,195.88 " - " 3,195.88 " - " 2,555.31 " - " 3,052.50 " - - " 3,061.29 " - - " 6,160.67 " " 7,700.84 " - - - " 3,700.00 " - - " 3,098.75 " - " 1,891.63 " " 3,468.75 " " 1,757.96 " " 2,068.76 " - 30604385 CATH EP DIAG ABL 3D LVL020 C1732 278 "$4,875.00" " 1,801.80 " - " 7,700.84 " - " 3,368.63 " - " 3,368.63 " - " 2,693.44 " - " 3,217.50 " - - " 3,226.76 " - - " 6,160.67 " " 7,700.84 " - - - " 3,900.00 " - - " 3,266.25 " - " 1,993.88 " " 3,656.25 " " 1,852.99 " " 2,180.59 " - 30604393 CATH EP DIAG ABL 3D LVL028 C1732 278 "$6,875.00" " 2,541.00 " - " 7,700.84 " - " 4,750.63 " - " 4,750.63 " - " 3,798.44 " - " 4,537.50 " - - " 4,550.56 " - - " 6,160.67 " " 7,700.84 " - - - " 5,500.00 " - - " 4,606.25 " - " 2,811.88 " " 5,156.25 " " 2,613.19 " " 3,075.19 " - 30604407 CATH EP DIAG ABL 3D LVL032 C1732 278 "$7,875.00" " 2,910.60 " - " 7,700.84 " - " 5,441.63 " - " 5,441.63 " - " 4,350.94 " - " 5,197.50 " - - " 5,212.46 " - - " 6,160.67 " " 7,700.84 " - - - " 6,300.00 " - - " 5,276.25 " - " 3,220.88 " " 5,906.25 " " 2,993.29 " " 3,522.49 " - 30604415 CATH EP DIAG ABL 3D LVL033 C1732 278 "$8,125.00" " 3,003.00 " - " 7,700.84 " - " 5,614.38 " - " 5,614.38 " - " 4,489.06 " - " 5,362.50 " - - " 5,377.94 " - - " 6,160.67 " " 7,700.84 " - - - " 6,500.00 " - - " 5,443.75 " - " 3,323.13 " " 6,093.75 " " 3,088.31 " " 3,634.31 " - 30608216 CATH EP DIAG ABL 3D LVL001 C1732 278 $200.00 73.92 - " 7,700.84 " - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - " 6,160.67 " " 7,700.84 " - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 30608224 CATH EP DIAG ABL 3D LVL002 C1732 278 $450.00 166.32 - " 7,700.84 " - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - " 6,160.67 " " 7,700.84 " - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 30608232 CATH EP DIAG ABL 3D LVL003 C1732 278 $750.00 277.20 - " 7,700.84 " - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - " 6,160.67 " " 7,700.84 " - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 30608241 CATH EP DIAG ABL 3D LVL004 C1732 278 "$1,050.00" 388.08 - " 7,700.84 " - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - " 6,160.67 " " 7,700.84 " - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 30608259 CATH EP DIAG ABL 3D LVL005 C1732 278 "$1,350.00" 498.96 - " 7,700.84 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - " 6,160.67 " " 7,700.84 " - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 30608267 CATH EP DIAG ABL 3D LVL017 C1732 278 "$4,125.00" " 1,524.60 " - " 7,700.84 " - " 2,850.38 " - " 2,850.38 " - " 2,279.06 " - " 2,722.50 " - - " 2,730.34 " - - " 6,160.67 " " 7,700.84 " - - - " 3,300.00 " - - " 2,763.75 " - " 1,687.13 " " 3,093.75 " " 1,567.91 " " 1,845.11 " - 30608275 CATH EP DIAG ABL 3D LVL021 C1732 278 "$5,125.00" " 1,894.20 " - " 7,700.84 " - " 3,541.38 " - " 3,541.38 " - " 2,831.56 " - " 3,382.50 " - - " 3,392.24 " - - " 6,160.67 " " 7,700.84 " - - - " 4,100.00 " - - " 3,433.75 " - " 2,096.13 " " 3,843.75 " " 1,948.01 " " 2,292.41 " - 30608283 CATH EP DIAG ABL 3D LVL022 C1732 278 "$5,375.00" " 1,986.60 " - " 7,700.84 " - " 3,714.13 " - " 3,714.13 " - " 2,969.69 " - " 3,547.50 " - - " 3,557.71 " - - " 6,160.67 " " 7,700.84 " - - - " 4,300.00 " - - " 3,601.25 " - " 2,198.38 " " 4,031.25 " " 2,043.04 " " 2,404.24 " - 30608291 CATH EP DIAG ABL 3D LVL023 C1732 278 "$5,625.00" " 2,079.00 " - " 7,700.84 " - " 3,886.88 " - " 3,886.88 " - " 3,107.81 " - " 3,712.50 " - - " 3,723.19 " - - " 6,160.67 " " 7,700.84 " - - - " 4,500.00 " - - " 3,768.75 " - " 2,300.63 " " 4,218.75 " " 2,138.06 " " 2,516.06 " - 30608305 CATH EP DIAG ABL 3D LVL024 C1732 278 "$5,875.00" " 2,171.40 " - " 7,700.84 " - " 4,059.63 " - " 4,059.63 " - " 3,245.94 " - " 3,877.50 " - - " 3,888.66 " - - " 6,160.67 " " 7,700.84 " - - - " 4,700.00 " - - " 3,936.25 " - " 2,402.88 " " 4,406.25 " " 2,233.09 " " 2,627.89 " - 30608313 CATH EP DIAG ABL 3D LVL025 C1732 278 "$6,125.00" " 2,263.80 " - " 7,700.84 " - " 4,232.38 " - " 4,232.38 " - " 3,384.06 " - " 4,042.50 " - - " 4,054.14 " - - " 6,160.67 " " 7,700.84 " - - - " 4,900.00 " - - " 4,103.75 " - " 2,505.13 " " 4,593.75 " " 2,328.11 " " 2,739.71 " - 30608321 CATH EP DIAG ABL 3D LVL026 C1732 278 "$6,375.00" " 2,356.20 " - " 7,700.84 " - " 4,405.13 " - " 4,405.13 " - " 3,522.19 " - " 4,207.50 " - - " 4,219.61 " - - " 6,160.67 " " 7,700.84 " - - - " 5,100.00 " - - " 4,271.25 " - " 2,607.38 " " 4,781.25 " " 2,423.14 " " 2,851.54 " - 30608330 CATH EP DIAG ABL 3D LVL027 C1732 278 "$6,625.00" " 2,448.60 " - " 7,700.84 " - " 4,577.88 " - " 4,577.88 " - " 3,660.31 " - " 4,372.50 " - - " 4,385.09 " - - " 6,160.67 " " 7,700.84 " - - - " 5,300.00 " - - " 4,438.75 " - " 2,709.63 " " 4,968.75 " " 2,518.16 " " 2,963.36 " - 30608348 CATH EP DIAG ABL 3D LVL029 C1732 278 "$7,125.00" " 2,633.40 " - " 7,700.84 " - " 4,923.38 " - " 4,923.38 " - " 3,936.56 " - " 4,702.50 " - - " 4,716.04 " - - " 6,160.67 " " 7,700.84 " - - - " 5,700.00 " - - " 4,773.75 " - " 2,914.13 " " 5,343.75 " " 2,708.21 " " 3,187.01 " - 30608356 CATH EP DIAG ABL 3D LVL030 C1732 278 "$7,375.00" " 2,725.80 " - " 7,700.84 " - " 5,096.13 " - " 5,096.13 " - " 4,074.69 " - " 4,867.50 " - - " 4,881.51 " - - " 6,160.67 " " 7,700.84 " - - - " 5,900.00 " - - " 4,941.25 " - " 3,016.38 " " 5,531.25 " " 2,803.24 " " 3,298.84 " - 30608364 CATH EP DIAG ABL 3D LVL031 C1732 278 "$7,625.00" " 2,818.20 " - " 7,700.84 " - " 5,268.88 " - " 5,268.88 " - " 4,212.81 " - " 5,032.50 " - - " 5,046.99 " - - " 6,160.67 " " 7,700.84 " - - - " 6,100.00 " - - " 5,108.75 " - " 3,118.63 " " 5,718.75 " " 2,898.26 " " 3,410.66 " - 30608372 CATH EP DIAG ABL 3D LVL034 C1732 278 "$8,375.00" " 3,095.40 " - " 7,700.84 " - " 5,787.13 " - " 5,787.13 " - " 4,627.19 " - " 5,527.50 " - - " 5,543.41 " - - " 6,160.67 " " 7,700.84 " - - - " 6,700.00 " - - " 5,611.25 " - " 3,425.38 " " 6,281.25 " " 3,183.34 " " 3,746.14 " - 30608381 CATH EP DIAG ABL 3D LVL035 C1732 278 "$8,625.00" " 3,187.80 " - " 7,700.84 " - " 5,959.88 " - " 5,959.88 " - " 4,765.31 " - " 5,692.50 " - - " 5,708.89 " - - " 6,160.67 " " 7,700.84 " - - - " 6,900.00 " - - " 5,778.75 " - " 3,527.63 " " 6,468.75 " " 3,278.36 " " 3,857.96 " - 30608399 CATH EP DIAG ABL 3D LVL036 C1732 278 "$8,875.00" " 3,280.20 " - " 7,700.84 " - " 6,132.63 " - " 6,132.63 " - " 4,903.44 " - " 5,857.50 " - - " 5,874.36 " - - " 6,160.67 " " 7,700.84 " - - - " 7,100.00 " - - " 5,946.25 " - " 3,629.88 " " 6,656.25 " " 3,373.39 " " 3,969.79 " - 30608402 CATH EP DIAG ABL 3D LVL037 C1732 278 "$9,125.00" " 3,372.60 " - " 7,700.84 " - " 6,305.38 " - " 6,305.38 " - " 5,041.56 " - " 6,022.50 " - - " 6,039.84 " - - " 6,160.67 " " 7,700.84 " - - - " 7,300.00 " - - " 6,113.75 " - " 3,732.13 " " 6,843.75 " " 3,468.41 " " 4,081.61 " - 30608411 CATH EP DIAG ABL 3D LVL038 C1732 278 "$9,375.00" " 3,465.00 " - " 7,700.84 " - " 6,478.13 " - " 6,478.13 " - " 5,179.69 " - " 6,187.50 " - - " 6,205.31 " - - " 6,160.67 " " 7,700.84 " - - - " 7,500.00 " - - " 6,281.25 " - " 3,834.38 " " 7,031.25 " " 3,563.44 " " 4,193.44 " - 30608429 CATH EP DIAG ABL 3D LVL039 C1732 278 "$9,625.00" " 3,557.40 " - " 7,700.84 " - " 6,650.88 " - " 6,650.88 " - " 5,317.81 " - " 6,352.50 " - - " 6,370.79 " - - " 6,160.67 " " 7,700.84 " - - - " 7,700.00 " - - " 6,448.75 " - " 3,936.63 " " 7,218.75 " " 3,658.46 " " 4,305.26 " - 30608437 CATH EP DIAG ABL 3D LVL040 C1732 278 "$9,875.00" " 3,649.80 " - " 7,900.00 " - " 6,823.63 " - " 6,823.63 " - " 5,455.94 " - " 6,517.50 " - - " 6,536.26 " - - " 6,160.67 " " 7,700.84 " - - - " 7,900.00 " - - " 6,616.25 " - " 4,038.88 " " 7,406.25 " " 3,753.49 " " 4,417.09 " - 30611853 CATH EP DIAG ABL 3D LVL048 C1732 278 "$11,875.00" " 4,389.00 " - " 9,500.00 " - " 8,205.63 " - " 8,205.63 " - " 6,560.94 " - " 7,837.50 " - - " 7,860.06 " - - " 6,160.67 " " 7,700.84 " - - - " 9,500.00 " - - " 7,956.25 " - " 4,856.88 " " 8,906.25 " " 4,513.69 " " 5,311.69 " - 30611861 CATH EP DIAG ABL 3D LVL049 C1732 278 "$12,125.00" " 4,481.40 " - " 9,700.00 " - " 8,378.38 " - " 8,378.38 " - " 6,699.06 " - " 8,002.50 " - - " 8,025.54 " - - " 6,160.67 " " 7,700.84 " - - - " 9,700.00 " - - " 8,123.75 " - " 4,959.13 " " 9,093.75 " " 4,608.71 " " 5,423.51 " - 30611870 CATH EP DIAG ABL 3D LVL050 C1732 278 "$12,375.00" " 4,573.80 " - " 9,900.00 " - " 8,551.13 " - " 8,551.13 " - " 6,837.19 " - " 8,167.50 " - - " 8,191.01 " - - " 6,160.67 " " 7,700.84 " - - - " 9,900.00 " - - " 8,291.25 " - " 5,061.38 " " 9,281.25 " " 4,703.74 " " 5,535.34 " - 28136757 CATH EP OTH NO CL-TIP LVL007 C1733 278 "$1,625.00" 600.60 - " 3,356.75 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - " 2,685.40 " " 3,356.75 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 28136790 CATH EP OTH NO CL-TIP LVL011 C1733 278 "$2,625.00" 970.20 - " 3,356.75 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - " 2,685.40 " " 3,356.75 " - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 29817952 CATH EP OTH NO CL-TIP LVL001 C1733 278 $200.00 73.92 - " 3,356.75 " - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - " 2,685.40 " " 3,356.75 " - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 29817961 CATH EP OTH NO CL-TIP LVL002 C1733 278 $450.00 166.32 - " 3,356.75 " - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - " 2,685.40 " " 3,356.75 " - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 29817979 CATH EP OTH NO CL-TIP LVL003 C1733 278 $750.00 277.20 - " 3,356.75 " - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - " 2,685.40 " " 3,356.75 " - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 30604423 CATH EP OTH NO CL-TIP LVL003 C1733 278 $750.00 277.20 - " 3,356.75 " - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - " 2,685.40 " " 3,356.75 " - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 30604431 CATH EP OTH NO CL-TIP LVL004 C1733 278 "$1,050.00" 388.08 - " 3,356.75 " - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - " 2,685.40 " " 3,356.75 " - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 30604440 CATH EP OTH NO CL-TIP LVL005 C1733 278 "$1,350.00" 498.96 - " 3,356.75 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - " 2,685.40 " " 3,356.75 " - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 30604458 CATH EP OTH NO CL-TIP LVL006 C1733 278 "$1,375.00" 508.20 - " 3,356.75 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - " 2,685.40 " " 3,356.75 " - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 30604466 CATH EP OTH NO CL-TIP LVL007 C1733 278 "$1,625.00" 600.60 - " 3,356.75 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - " 2,685.40 " " 3,356.75 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 30604474 CATH EP OTH NO CL-TIP LVL008 C1733 278 "$1,875.00" 693.00 - " 3,356.75 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - " 2,685.40 " " 3,356.75 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 30604482 CATH EP OTH NO CL-TIP LVL009 C1733 278 "$2,125.00" 785.40 - " 3,356.75 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - " 2,685.40 " " 3,356.75 " - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 30604491 CATH EP OTH NO CL-TIP LVL010 C1733 278 "$2,375.00" 877.80 - " 3,356.75 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - " 2,685.40 " " 3,356.75 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 30604504 CATH EP OTH NO CL-TIP LVL011 C1733 278 "$2,625.00" 970.20 - " 3,356.75 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - " 2,685.40 " " 3,356.75 " - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 30604512 CATH EP OTH NO CL-TIP LVL012 C1733 278 "$2,875.00" " 1,062.60 " - " 3,356.75 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - " 2,685.40 " " 3,356.75 " - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 30604521 CATH EP OTH NO CL-TIP LVL013 C1733 278 "$3,125.00" " 1,155.00 " - " 3,356.75 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - " 2,685.40 " " 3,356.75 " - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 30604539 CATH EP OTH NO CL-TIP LVL016 C1733 278 "$3,875.00" " 1,432.20 " - " 3,356.75 " - " 2,677.63 " - " 2,677.63 " - " 2,140.94 " - " 2,557.50 " - - " 2,564.86 " - - " 2,685.40 " " 3,356.75 " - - - " 3,100.00 " - - " 2,596.25 " - " 1,584.88 " " 2,906.25 " " 1,472.89 " " 1,733.29 " - 30604547 CATH EP OTH NO CL-TIP LVL017 C1733 278 "$4,125.00" " 1,524.60 " - " 3,356.75 " - " 2,850.38 " - " 2,850.38 " - " 2,279.06 " - " 2,722.50 " - - " 2,730.34 " - - " 2,685.40 " " 3,356.75 " - - - " 3,300.00 " - - " 2,763.75 " - " 1,687.13 " " 3,093.75 " " 1,567.91 " " 1,845.11 " - 30604555 CATH EP OTH NO CL-TIP LVL018 C1733 278 "$4,375.00" " 1,617.00 " - " 3,500.00 " - " 3,023.13 " - " 3,023.13 " - " 2,417.19 " - " 2,887.50 " - - " 2,895.81 " - - " 2,685.40 " " 3,356.75 " - - - " 3,500.00 " - - " 2,931.25 " - " 1,789.38 " " 3,281.25 " " 1,662.94 " " 1,956.94 " - 30604563 CATH EP OTH NO CL-TIP LVL023 C1733 278 "$5,625.00" " 2,079.00 " - " 4,500.00 " - " 3,886.88 " - " 3,886.88 " - " 3,107.81 " - " 3,712.50 " - - " 3,723.19 " - - " 2,685.40 " " 3,356.75 " - - - " 4,500.00 " - - " 3,768.75 " - " 2,300.63 " " 4,218.75 " " 2,138.06 " " 2,516.06 " - 30604571 CATH EP OTH NO CL-TIP LVL024 C1733 278 "$5,875.00" " 2,171.40 " - " 4,700.00 " - " 4,059.63 " - " 4,059.63 " - " 3,245.94 " - " 3,877.50 " - - " 3,888.66 " - - " 2,685.40 " " 3,356.75 " - - - " 4,700.00 " - - " 3,936.25 " - " 2,402.88 " " 4,406.25 " " 2,233.09 " " 2,627.89 " - 30604580 CATH EP OTH NO CL-TIP LVL026 C1733 278 "$6,375.00" " 2,356.20 " - " 5,100.00 " - " 4,405.13 " - " 4,405.13 " - " 3,522.19 " - " 4,207.50 " - - " 4,219.61 " - - " 2,685.40 " " 3,356.75 " - - - " 5,100.00 " - - " 4,271.25 " - " 2,607.38 " " 4,781.25 " " 2,423.14 " " 2,851.54 " - 30604598 CATH EP OTH NO CL-TIP LVL027 C1733 278 "$6,625.00" " 2,448.60 " - " 5,300.00 " - " 4,577.88 " - " 4,577.88 " - " 3,660.31 " - " 4,372.50 " - - " 4,385.09 " - - " 2,685.40 " " 3,356.75 " - - - " 5,300.00 " - - " 4,438.75 " - " 2,709.63 " " 4,968.75 " " 2,518.16 " " 2,963.36 " - 30604601 CATH EP OTH NO CL-TIP LVL028 C1733 278 "$6,875.00" " 2,541.00 " - " 5,500.00 " - " 4,750.63 " - " 4,750.63 " - " 3,798.44 " - " 4,537.50 " - - " 4,550.56 " - - " 2,685.40 " " 3,356.75 " - - - " 5,500.00 " - - " 4,606.25 " - " 2,811.88 " " 5,156.25 " " 2,613.19 " " 3,075.19 " - 30604610 CATH EP OTH NO CL-TIP LVL029 C1733 278 "$7,125.00" " 2,633.40 " - " 5,700.00 " - " 4,923.38 " - " 4,923.38 " - " 3,936.56 " - " 4,702.50 " - - " 4,716.04 " - - " 2,685.40 " " 3,356.75 " - - - " 5,700.00 " - - " 4,773.75 " - " 2,914.13 " " 5,343.75 " " 2,708.21 " " 3,187.01 " - 30604628 CATH EP OTH NO CL-TIP LVL030 C1733 278 "$7,375.00" " 2,725.80 " - " 5,900.00 " - " 5,096.13 " - " 5,096.13 " - " 4,074.69 " - " 4,867.50 " - - " 4,881.51 " - - " 2,685.40 " " 3,356.75 " - - - " 5,900.00 " - - " 4,941.25 " - " 3,016.38 " " 5,531.25 " " 2,803.24 " " 3,298.84 " - 30604636 CATH EP OTH NO CL-TIP LVL031 C1733 278 "$7,625.00" " 2,818.20 " - " 6,100.00 " - " 5,268.88 " - " 5,268.88 " - " 4,212.81 " - " 5,032.50 " - - " 5,046.99 " - - " 2,685.40 " " 3,356.75 " - - - " 6,100.00 " - - " 5,108.75 " - " 3,118.63 " " 5,718.75 " " 2,898.26 " " 3,410.66 " - 30604644 CATH EP OTH NO CL-TIP LVL032 C1733 278 "$7,875.00" " 2,910.60 " - " 6,300.00 " - " 5,441.63 " - " 5,441.63 " - " 4,350.94 " - " 5,197.50 " - - " 5,212.46 " - - " 2,685.40 " " 3,356.75 " - - - " 6,300.00 " - - " 5,276.25 " - " 3,220.88 " " 5,906.25 " " 2,993.29 " " 3,522.49 " - 30604652 CATH EP OTH NO CL-TIP LVL033 C1733 278 "$8,125.00" " 3,003.00 " - " 6,500.00 " - " 5,614.38 " - " 5,614.38 " - " 4,489.06 " - " 5,362.50 " - - " 5,377.94 " - - " 2,685.40 " " 3,356.75 " - - - " 6,500.00 " - - " 5,443.75 " - " 3,323.13 " " 6,093.75 " " 3,088.31 " " 3,634.31 " - 30608445 CATH EP OTH NO CL-TIP LVL001 C1733 278 $200.00 73.92 - " 3,356.75 " - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - " 2,685.40 " " 3,356.75 " - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 30608453 CATH EP OTH NO CL-TIP LVL002 C1733 278 $450.00 166.32 - " 3,356.75 " - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - " 2,685.40 " " 3,356.75 " - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 30608461 CATH EP OTH NO CL-TIP LVL014 C1733 278 "$3,375.00" " 1,247.40 " - " 3,356.75 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - " 2,685.40 " " 3,356.75 " - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 30608470 CATH EP OTH NO CL-TIP LVL015 C1733 278 "$3,625.00" " 1,339.80 " - " 3,356.75 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - " 2,685.40 " " 3,356.75 " - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 30608488 CATH EP OTH NO CL-TIP LVL019 C1733 278 "$4,625.00" " 1,709.40 " - " 3,700.00 " - " 3,195.88 " - " 3,195.88 " - " 2,555.31 " - " 3,052.50 " - - " 3,061.29 " - - " 2,685.40 " " 3,356.75 " - - - " 3,700.00 " - - " 3,098.75 " - " 1,891.63 " " 3,468.75 " " 1,757.96 " " 2,068.76 " - 30608496 CATH EP OTH NO CL-TIP LVL020 C1733 278 "$4,875.00" " 1,801.80 " - " 3,900.00 " - " 3,368.63 " - " 3,368.63 " - " 2,693.44 " - " 3,217.50 " - - " 3,226.76 " - - " 2,685.40 " " 3,356.75 " - - - " 3,900.00 " - - " 3,266.25 " - " 1,993.88 " " 3,656.25 " " 1,852.99 " " 2,180.59 " - 30608500 CATH EP OTH NO CL-TIP LVL021 C1733 278 "$5,125.00" " 1,894.20 " - " 4,100.00 " - " 3,541.38 " - " 3,541.38 " - " 2,831.56 " - " 3,382.50 " - - " 3,392.24 " - - " 2,685.40 " " 3,356.75 " - - - " 4,100.00 " - - " 3,433.75 " - " 2,096.13 " " 3,843.75 " " 1,948.01 " " 2,292.41 " - 30608518 CATH EP OTH NO CL-TIP LVL022 C1733 278 "$5,375.00" " 1,986.60 " - " 4,300.00 " - " 3,714.13 " - " 3,714.13 " - " 2,969.69 " - " 3,547.50 " - - " 3,557.71 " - - " 2,685.40 " " 3,356.75 " - - - " 4,300.00 " - - " 3,601.25 " - " 2,198.38 " " 4,031.25 " " 2,043.04 " " 2,404.24 " - 30608526 CATH EP OTH NO CL-TIP LVL025 C1733 278 "$6,125.00" " 2,263.80 " - " 4,900.00 " - " 4,232.38 " - " 4,232.38 " - " 3,384.06 " - " 4,042.50 " - - " 4,054.14 " - - " 2,685.40 " " 3,356.75 " - - - " 4,900.00 " - - " 4,103.75 " - " 2,505.13 " " 4,593.75 " " 2,328.11 " " 2,739.71 " - 30608534 CATH EP OTH NO CL-TIP LVL034 C1733 278 "$8,375.00" " 3,095.40 " - " 6,700.00 " - " 5,787.13 " - " 5,787.13 " - " 4,627.19 " - " 5,527.50 " - - " 5,543.41 " - - " 2,685.40 " " 3,356.75 " - - - " 6,700.00 " - - " 5,611.25 " - " 3,425.38 " " 6,281.25 " " 3,183.34 " " 3,746.14 " - 30608542 CATH EP OTH NO CL-TIP LVL035 C1733 278 "$8,625.00" " 3,187.80 " - " 6,900.00 " - " 5,959.88 " - " 5,959.88 " - " 4,765.31 " - " 5,692.50 " - - " 5,708.89 " - - " 2,685.40 " " 3,356.75 " - - - " 6,900.00 " - - " 5,778.75 " - " 3,527.63 " " 6,468.75 " " 3,278.36 " " 3,857.96 " - 30611705 CATH EP OTH NO CL-TIP LVL046 C1733 278 "$11,375.00" " 4,204.20 " - " 9,100.00 " - " 7,860.13 " - " 7,860.13 " - " 6,284.69 " - " 7,507.50 " - - " 7,529.11 " - - " 2,685.40 " " 3,356.75 " - - - " 9,100.00 " - - " 7,621.25 " - " 4,652.38 " " 8,531.25 " " 4,323.64 " " 5,088.04 " - 30611713 CATH EP OTH NO CL-TIP LVL047 C1733 278 "$11,625.00" " 4,296.60 " - " 9,300.00 " - " 8,032.88 " - " 8,032.88 " - " 6,422.81 " - " 7,672.50 " - - " 7,694.59 " - - " 2,685.40 " " 3,356.75 " - - - " 9,300.00 " - - " 7,788.75 " - " 4,754.63 " " 8,718.75 " " 4,418.66 " " 5,199.86 " - 30611721 CATH EP OTH NO CL-TIP LVL048 C1733 278 "$11,875.00" " 4,389.00 " - " 9,500.00 " - " 8,205.63 " - " 8,205.63 " - " 6,560.94 " - " 7,837.50 " - - " 7,860.06 " - - " 2,685.40 " " 3,356.75 " - - - " 9,500.00 " - - " 7,956.25 " - " 4,856.88 " " 8,906.25 " " 4,513.69 " " 5,311.69 " - 80363940 CATH EP OTH NO CL-TIP LVL008 C1733 278 "$1,875.00" 693.00 - " 3,356.75 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - " 2,685.40 " " 3,356.75 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 80363958 CATH EP OTH NO CL-TIP LVL009 C1733 278 "$2,125.00" 785.40 - " 3,356.75 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - " 2,685.40 " " 3,356.75 " - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 80363966 CATH EP OTH NO CL-TIP LVL010 C1733 278 "$2,375.00" 877.80 - " 3,356.75 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - " 2,685.40 " " 3,356.75 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 80363974 CATH EP OTH NO CL-TIP LVL011 C1733 278 "$2,625.00" 970.20 - " 3,356.75 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - " 2,685.40 " " 3,356.75 " - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 80363982 CATH EP OTH NO CL-TIP LVL012 C1733 278 "$2,875.00" " 1,062.60 " - " 3,356.75 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - " 2,685.40 " " 3,356.75 " - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 80363991 CATH EP OTH NO CL-TIP LVL013 C1733 278 "$3,125.00" " 1,155.00 " - " 3,356.75 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - " 2,685.40 " " 3,356.75 " - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 80364008 CATH EP OTH NO CL-TIP LVL014 C1733 278 "$3,375.00" " 1,247.40 " - " 3,356.75 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - " 2,685.40 " " 3,356.75 " - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 80364016 CATH EP OTH NO CL-TIP LVL015 C1733 278 "$3,625.00" " 1,339.80 " - " 3,356.75 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - " 2,685.40 " " 3,356.75 " - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 80364024 CATH EP OTH NO CL-TIP LVL016 C1733 278 "$3,875.00" " 1,432.20 " - " 3,356.75 " - " 2,677.63 " - " 2,677.63 " - " 2,140.94 " - " 2,557.50 " - - " 2,564.86 " - - " 2,685.40 " " 3,356.75 " - - - " 3,100.00 " - - " 2,596.25 " - " 1,584.88 " " 2,906.25 " " 1,472.89 " " 1,733.29 " - 28103727 CATH HEMO LNG-TRM LVL002 C1750 278 $450.00 166.32 - " 1,249.55 " - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 999.64 " 1,249.55 " - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 28103786 CATH HEMO LNG-TRM LVL003 C1750 278 $750.00 277.20 - " 1,249.55 " - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 999.64 " 1,249.55 " - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 80363133 CATH HEMO LONG TERM LVL001 C1750 278 $200.00 73.92 - " 1,249.55 " - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 999.64 " 1,249.55 " - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 80363141 CATH HEMO LONG TERM LVL002 C1750 278 $450.00 166.32 - " 1,249.55 " - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 999.64 " 1,249.55 " - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 80363150 CATH HEMO LONG TERM LVL003 C1750 278 $750.00 277.20 - " 1,249.55 " - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 999.64 " 1,249.55 " - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 80363168 CATH HEMO LONG TERM LVL004 C1750 278 "$1,050.00" 388.08 - " 1,249.55 " - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 999.64 " 1,249.55 " - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 80363176 CATH HEMO LONG TERM LVL005 C1750 278 "$1,350.00" 498.96 - " 1,249.55 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 999.64 " 1,249.55 " - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 80363184 CATH HEMO LONG TERM LVL006 C1750 278 "$1,375.00" 508.20 - " 1,249.55 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - 999.64 " 1,249.55 " - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 80363192 CATH HEMO LONG TERM LVL007 C1750 278 "$1,625.00" 600.60 - " 1,300.00 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - 999.64 " 1,249.55 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 80363206 CATH HEMO LONG TERM LVL008 C1750 278 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - 999.64 " 1,249.55 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 80363214 CATH HEMO LONG TERM LVL009 C1750 278 "$2,125.00" 785.40 - " 1,700.00 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - 999.64 " 1,249.55 " - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 80363222 CATH HEMO LONG TERM LVL010 C1750 278 "$2,375.00" 877.80 - " 1,900.00 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - 999.64 " 1,249.55 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 80363231 CATH HEMO LONG TERM LVL011 C1750 278 "$2,625.00" 970.20 - " 2,100.00 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - 999.64 " 1,249.55 " - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 80363249 CATH HEMO LONG TERM LVL012 C1750 278 "$2,875.00" " 1,062.60 " - " 2,300.00 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - 999.64 " 1,249.55 " - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 28104014 CATH INF PER/CENT/MID LVL001 C1751 278 $200.00 73.92 - 160.00 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 105.98 132.48 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 28104022 CATH INF PER/CENT/MID LVL002 C1751 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 238.46 298.08 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 29813892 CATH INF PER/CENT/MID LVL001 C1751 278 $200.00 73.92 - 160.00 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 105.98 132.48 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 29813906 CATH INF PER/CENT/MID LVL002 C1751 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 238.46 298.08 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 29813914 CATH INF PER/CENT/MID LVL003 C1751 278 $750.00 277.20 - 600.00 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 397.43 496.80 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 29813922 CATH INF PER/CENT/MID LVL004 C1751 278 "$1,050.00" 388.08 - 840.00 - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 556.40 695.52 - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 29813931 CATH INF PER/CENT/MID LVL005 C1751 278 "$1,350.00" 498.96 - " 1,080.00 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 715.37 894.24 - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 29813949 CATH INF PER/CENT/MID LVL006 C1751 278 "$1,375.00" 508.20 - " 1,100.00 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - 728.61 910.80 - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 29813957 CATH INF PER/CENT/MID LVL007 C1751 278 "$1,625.00" 600.60 - " 1,300.00 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - 861.09 " 1,076.40 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 29813965 CATH INF PER/CENT/MID LVL008 C1751 278 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - 993.56 " 1,242.00 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 29813973 CATH INF PER/CENT/MID LVL009 C1751 278 "$2,125.00" 785.40 - " 1,700.00 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - " 1,126.04 " " 1,407.60 " - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 29813981 CATH INF PER/CENT/MID LVL010 C1751 278 "$2,375.00" 877.80 - " 1,900.00 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - " 1,258.51 " " 1,573.20 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 29813990 CATH INF PER/CENT/MID LVL011 C1751 278 "$2,625.00" 970.20 - " 2,100.00 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - " 1,390.99 " " 1,738.80 " - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 29814007 CATH INF PER/CENT/MID LVL012 C1751 278 "$2,875.00" " 1,062.60 " - " 2,300.00 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - " 1,523.46 " " 1,904.40 " - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 29814015 CATH INF PER/CENT/MID LVL013 C1751 278 "$3,125.00" " 1,155.00 " - " 2,500.00 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - " 1,655.94 " " 2,070.00 " - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 29814023 CATH INF PER/CENT/MID LVL014 C1751 278 "$3,375.00" " 1,247.40 " - " 2,700.00 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - " 1,788.41 " " 2,235.60 " - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 29814031 CATH INF PER/CENT/MID LVL015 C1751 278 "$3,625.00" " 1,339.80 " - " 2,900.00 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - " 1,920.89 " " 2,401.20 " - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 29819823 CATH INF PER/CENT/MID LVL025 C1751 278 "$6,125.00" " 2,263.80 " - " 4,900.00 " - " 4,232.38 " - " 4,232.38 " - " 3,384.06 " - " 4,042.50 " - - " 4,054.14 " - - " 3,245.64 " " 4,057.20 " - - - " 4,900.00 " - - " 4,103.75 " - " 2,505.13 " " 4,593.75 " " 2,328.11 " " 2,739.71 " - 29819831 CATH INF PER/CENT/MID LVL026 C1751 278 "$6,375.00" " 2,356.20 " - " 5,100.00 " - " 4,405.13 " - " 4,405.13 " - " 3,522.19 " - " 4,207.50 " - - " 4,219.61 " - - " 3,378.11 " " 4,222.80 " - - - " 5,100.00 " - - " 4,271.25 " - " 2,607.38 " " 4,781.25 " " 2,423.14 " " 2,851.54 " - 29819840 CATH INF PER/CENT/MID LVL027 C1751 278 "$6,625.00" " 2,448.60 " - " 5,300.00 " - " 4,577.88 " - " 4,577.88 " - " 3,660.31 " - " 4,372.50 " - - " 4,385.09 " - - " 3,510.59 " " 4,388.40 " - - - " 5,300.00 " - - " 4,438.75 " - " 2,709.63 " " 4,968.75 " " 2,518.16 " " 2,963.36 " - 29819858 CATH INF PER/CENT/MID LVL028 C1751 278 "$6,875.00" " 2,541.00 " - " 5,500.00 " - " 4,750.63 " - " 4,750.63 " - " 3,798.44 " - " 4,537.50 " - - " 4,550.56 " - - " 3,643.06 " " 4,554.00 " - - - " 5,500.00 " - - " 4,606.25 " - " 2,811.88 " " 5,156.25 " " 2,613.19 " " 3,075.19 " - 29819866 CATH INF PER/CENT/MID LVL029 C1751 278 "$7,125.00" " 2,633.40 " - " 5,700.00 " - " 4,923.38 " - " 4,923.38 " - " 3,936.56 " - " 4,702.50 " - - " 4,716.04 " - - " 3,775.54 " " 4,719.60 " - - - " 5,700.00 " - - " 4,773.75 " - " 2,914.13 " " 5,343.75 " " 2,708.21 " " 3,187.01 " - 29819874 CATH INF PER/CENT/MID LVL030 C1751 278 "$7,375.00" " 2,725.80 " - " 5,900.00 " - " 5,096.13 " - " 5,096.13 " - " 4,074.69 " - " 4,867.50 " - - " 4,881.51 " - - " 3,908.01 " " 4,885.20 " - - - " 5,900.00 " - - " 4,941.25 " - " 3,016.38 " " 5,531.25 " " 2,803.24 " " 3,298.84 " - 29820201 CATH INF PER/CENT/MID LVL016 C1751 278 "$3,875.00" " 1,432.20 " - " 3,100.00 " - " 2,677.63 " - " 2,677.63 " - " 2,140.94 " - " 2,557.50 " - - " 2,564.86 " - - " 2,053.36 " " 2,566.80 " - - - " 3,100.00 " - - " 2,596.25 " - " 1,584.88 " " 2,906.25 " " 1,472.89 " " 1,733.29 " - 29820210 CATH INF PER/CENT/MID LVL017 C1751 278 "$4,125.00" " 1,524.60 " - " 3,300.00 " - " 2,850.38 " - " 2,850.38 " - " 2,279.06 " - " 2,722.50 " - - " 2,730.34 " - - " 2,185.84 " " 2,732.40 " - - - " 3,300.00 " - - " 2,763.75 " - " 1,687.13 " " 3,093.75 " " 1,567.91 " " 1,845.11 " - 29820228 CATH INF PER/CENT/MID LVL018 C1751 278 "$4,375.00" " 1,617.00 " - " 3,500.00 " - " 3,023.13 " - " 3,023.13 " - " 2,417.19 " - " 2,887.50 " - - " 2,895.81 " - - " 2,318.31 " " 2,898.00 " - - - " 3,500.00 " - - " 2,931.25 " - " 1,789.38 " " 3,281.25 " " 1,662.94 " " 1,956.94 " - 29820236 CATH INF PER/CENT/MID LVL019 C1751 278 "$4,625.00" " 1,709.40 " - " 3,700.00 " - " 3,195.88 " - " 3,195.88 " - " 2,555.31 " - " 3,052.50 " - - " 3,061.29 " - - " 2,450.79 " " 3,063.60 " - - - " 3,700.00 " - - " 3,098.75 " - " 1,891.63 " " 3,468.75 " " 1,757.96 " " 2,068.76 " - 29820244 CATH INF PER/CENT/MID LVL020 C1751 278 "$4,875.00" " 1,801.80 " - " 3,900.00 " - " 3,368.63 " - " 3,368.63 " - " 2,693.44 " - " 3,217.50 " - - " 3,226.76 " - - " 2,583.26 " " 3,229.20 " - - - " 3,900.00 " - - " 3,266.25 " - " 1,993.88 " " 3,656.25 " " 1,852.99 " " 2,180.59 " - 29820252 CATH INF PER/CENT/MID LVL021 C1751 278 "$5,125.00" " 1,894.20 " - " 4,100.00 " - " 3,541.38 " - " 3,541.38 " - " 2,831.56 " - " 3,382.50 " - - " 3,392.24 " - - " 2,715.74 " " 3,394.80 " - - - " 4,100.00 " - - " 3,433.75 " - " 2,096.13 " " 3,843.75 " " 1,948.01 " " 2,292.41 " - 29820261 CATH INF PER/CENT/MID LVL022 C1751 278 "$5,375.00" " 1,986.60 " - " 4,300.00 " - " 3,714.13 " - " 3,714.13 " - " 2,969.69 " - " 3,547.50 " - - " 3,557.71 " - - " 2,848.21 " " 3,560.40 " - - - " 4,300.00 " - - " 3,601.25 " - " 2,198.38 " " 4,031.25 " " 2,043.04 " " 2,404.24 " - 29820279 CATH INF PER/CENT/MID LVL023 C1751 278 "$5,625.00" " 2,079.00 " - " 4,500.00 " - " 3,886.88 " - " 3,886.88 " - " 3,107.81 " - " 3,712.50 " - - " 3,723.19 " - - " 2,980.69 " " 3,726.00 " - - - " 4,500.00 " - - " 3,768.75 " - " 2,300.63 " " 4,218.75 " " 2,138.06 " " 2,516.06 " - 29820287 CATH INF PER/CENT/MID LVL024 C1751 278 "$5,875.00" " 2,171.40 " - " 4,700.00 " - " 4,059.63 " - " 4,059.63 " - " 3,245.94 " - " 3,877.50 " - - " 3,888.66 " - - " 3,113.16 " " 3,891.60 " - - - " 4,700.00 " - - " 3,936.25 " - " 2,402.88 " " 4,406.25 " " 2,233.09 " " 2,627.89 " - 30604661 CATH INF PER/CENT/MID LVL001 C1751 278 $200.00 73.92 - 160.00 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 105.98 132.48 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 30604679 CATH INF PER/CENT/MID LVL002 C1751 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 238.46 298.08 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 30604687 CATH INF PER/CENT/MID LVL003 C1751 278 $750.00 277.20 - 600.00 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 397.43 496.80 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 30608551 CATH INF PER/CENT/MID LVL004 C1751 278 "$1,050.00" 388.08 - 840.00 - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 556.40 695.52 - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 30608569 CATH INF PER/CENT/MID LVL005 C1751 278 "$1,350.00" 498.96 - " 1,080.00 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 715.37 894.24 - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 34300224 5FR PICC KIT C1751 270 $891.00 329.31 - 712.80 - 615.68 - 615.68 - 492.28 - 588.06 - - 589.75 - - 472.14 590.20 - - - 712.80 - - 596.97 - 364.42 668.25 338.67 398.54 - 34300348 6FR POWER SOLO PICC KIT C1751 278 "$1,128.00" 416.91 - 902.40 - 779.45 - 779.45 - 623.22 - 744.48 - - 746.62 - - 597.73 747.19 - - - 902.40 - - 755.76 - 461.35 846.00 428.75 504.55 - 34300607 GROSHONG MIDLINE C1751 278 "$1,003.00" 370.71 - 802.40 - 693.07 - 693.07 - 554.16 - 661.98 - - 663.89 - - 531.49 664.39 - - - 802.40 - - 672.01 - 410.23 752.25 381.24 448.64 - 80360126 CATH INF PER/CENT/MID LVL001 C1751 278 $200.00 73.92 - 160.00 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 105.98 132.48 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 80360134 CATH INF PER/CENT/MID LVL002 C1751 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 238.46 298.08 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 80360142 CATH INF PER/CENT/MID LVL003 C1751 278 $750.00 277.20 - 600.00 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 397.43 496.80 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 80360151 CATH INF PER/CENT/MID LVL004 C1751 278 "$1,050.00" 388.08 - 840.00 - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 556.40 695.52 - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 80360169 CATH INF PER/CENT/MID LVL005 C1751 278 "$1,350.00" 498.96 - " 1,080.00 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 715.37 894.24 - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 80360177 CATH INF PER/CENT/MID LVL006 C1751 278 "$1,375.00" 508.20 - " 1,100.00 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - 728.61 910.80 - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 80360185 CATH INF PER/CENT/MID LVL007 C1751 278 "$1,625.00" 600.60 - " 1,300.00 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - 861.09 " 1,076.40 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 80360193 CATH INF PER/CENT/MID LVL008 C1751 278 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - 993.56 " 1,242.00 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 80360207 CATH INF PER/CENT/MID LVL009 C1751 278 "$2,125.00" 785.40 - " 1,700.00 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - " 1,126.04 " " 1,407.60 " - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 80360215 CATH INF PER/CENT/MID LVL010 C1751 278 "$2,375.00" 877.80 - " 1,900.00 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - " 1,258.51 " " 1,573.20 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 80360223 CATH INF PER/CENT/MID LVL023 C1751 278 "$5,625.00" " 2,079.00 " - " 4,500.00 " - " 3,886.88 " - " 3,886.88 " - " 3,107.81 " - " 3,712.50 " - - " 3,723.19 " - - " 2,980.69 " " 3,726.00 " - - - " 4,500.00 " - - " 3,768.75 " - " 2,300.63 " " 4,218.75 " " 2,138.06 " " 2,516.06 " - 80360231 CATH INF PER/CENT/MID LVL024 C1751 278 "$5,875.00" " 2,171.40 " - " 4,700.00 " - " 4,059.63 " - " 4,059.63 " - " 3,245.94 " - " 3,877.50 " - - " 3,888.66 " - - " 3,113.16 " " 3,891.60 " - - - " 4,700.00 " - - " 3,936.25 " - " 2,402.88 " " 4,406.25 " " 2,233.09 " " 2,627.89 " - 80360240 CATH INF PER/CENT/MID LVL025 C1751 278 "$6,125.00" " 2,263.80 " - " 4,900.00 " - " 4,232.38 " - " 4,232.38 " - " 3,384.06 " - " 4,042.50 " - - " 4,054.14 " - - " 3,245.64 " " 4,057.20 " - - - " 4,900.00 " - - " 4,103.75 " - " 2,505.13 " " 4,593.75 " " 2,328.11 " " 2,739.71 " - 80360258 CATH INF PER/CENT/MID LVL026 C1751 278 "$6,375.00" " 2,356.20 " - " 5,100.00 " - " 4,405.13 " - " 4,405.13 " - " 3,522.19 " - " 4,207.50 " - - " 4,219.61 " - - " 3,378.11 " " 4,222.80 " - - - " 5,100.00 " - - " 4,271.25 " - " 2,607.38 " " 4,781.25 " " 2,423.14 " " 2,851.54 " - 80360266 CATH INF PER/CENT/MID LVL027 C1751 278 "$6,625.00" " 2,448.60 " - " 5,300.00 " - " 4,577.88 " - " 4,577.88 " - " 3,660.31 " - " 4,372.50 " - - " 4,385.09 " - - " 3,510.59 " " 4,388.40 " - - - " 5,300.00 " - - " 4,438.75 " - " 2,709.63 " " 4,968.75 " " 2,518.16 " " 2,963.36 " - 80360274 CATH INF PER/CENT/MID LVL028 C1751 278 "$6,875.00" " 2,541.00 " - " 5,500.00 " - " 4,750.63 " - " 4,750.63 " - " 3,798.44 " - " 4,537.50 " - - " 4,550.56 " - - " 3,643.06 " " 4,554.00 " - - - " 5,500.00 " - - " 4,606.25 " - " 2,811.88 " " 5,156.25 " " 2,613.19 " " 3,075.19 " - 80360282 CATH INF PER/CENT/MID LVL029 C1751 278 "$7,125.00" " 2,633.40 " - " 5,700.00 " - " 4,923.38 " - " 4,923.38 " - " 3,936.56 " - " 4,702.50 " - - " 4,716.04 " - - " 3,775.54 " " 4,719.60 " - - - " 5,700.00 " - - " 4,773.75 " - " 2,914.13 " " 5,343.75 " " 2,708.21 " " 3,187.01 " - 80360291 CATH INF PER/CENT/MID LVL030 C1751 278 "$7,375.00" " 2,725.80 " - " 5,900.00 " - " 5,096.13 " - " 5,096.13 " - " 4,074.69 " - " 4,867.50 " - - " 4,881.51 " - - " 3,908.01 " " 4,885.20 " - - - " 5,900.00 " - - " 4,941.25 " - " 3,016.38 " " 5,531.25 " " 2,803.24 " " 3,298.84 " - 80360304 CATH INF PER/CENT/MID LVL031 C1751 278 "$7,625.00" " 2,818.20 " - " 6,100.00 " - " 5,268.88 " - " 5,268.88 " - " 4,212.81 " - " 5,032.50 " - - " 5,046.99 " - - " 4,040.49 " " 5,050.80 " - - - " 6,100.00 " - - " 5,108.75 " - " 3,118.63 " " 5,718.75 " " 2,898.26 " " 3,410.66 " - 80360312 CATH INF PER/CENT/MID LVL032 C1751 278 "$7,875.00" " 2,910.60 " - " 6,300.00 " - " 5,441.63 " - " 5,441.63 " - " 4,350.94 " - " 5,197.50 " - - " 5,212.46 " - - " 4,172.96 " " 5,216.40 " - - - " 6,300.00 " - - " 5,276.25 " - " 3,220.88 " " 5,906.25 " " 2,993.29 " " 3,522.49 " - 80360321 CATH INF PER/CENT/MID LVL033 C1751 278 "$8,125.00" " 3,003.00 " - " 6,500.00 " - " 5,614.38 " - " 5,614.38 " - " 4,489.06 " - " 5,362.50 " - - " 5,377.94 " - - " 4,305.44 " " 5,382.00 " - - - " 6,500.00 " - - " 5,443.75 " - " 3,323.13 " " 6,093.75 " " 3,088.31 " " 3,634.31 " - 28103905 CATH HEMO SHORT-TRM LVL002 C1752 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 238.46 298.08 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 80363257 CATH HEMO SHORT TERM LVL001 C1752 278 $200.00 73.92 - 160.00 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 105.98 132.48 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 80363265 CATH HEMO SHORT TERM LVL002 C1752 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 238.46 298.08 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 80363273 CATH HEMO SHORT TERM LVL003 C1752 278 $750.00 277.20 - 600.00 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 397.43 496.80 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 80363281 CATH HEMO SHORT TERM LVL004 C1752 278 "$1,050.00" 388.08 - 840.00 - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 556.40 695.52 - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 80363290 CATH HEMO SHORT TERM LVL005 C1752 278 "$1,350.00" 498.96 - " 1,080.00 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 715.37 894.24 - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 80363303 CATH HEMO SHORT TERM LVL006 C1752 278 "$1,375.00" 508.20 - " 1,100.00 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - 728.61 910.80 - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 80363311 CATH HEMO SHORT TERM LVL007 C1752 278 "$1,625.00" 600.60 - " 1,300.00 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - 861.09 " 1,076.40 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 28122101 CATH INTRAVAS US LVL008 C1753 278 "$1,875.00" 693.00 - " 2,243.04 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - " 1,794.43 " " 2,243.04 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 28122128 CATH INTRAVAS US LVL010 C1753 278 "$2,375.00" 877.80 - " 2,243.04 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - " 1,794.43 " " 2,243.04 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 29814040 CATH INTRAVAS US LVL005 C1753 278 "$1,350.00" 498.96 - " 2,243.04 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - " 1,794.43 " " 2,243.04 " - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 29814058 CATH INTRAVAS US LVL006 C1753 278 "$1,375.00" 508.20 - " 2,243.04 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - " 1,794.43 " " 2,243.04 " - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 29814066 CATH INTRAVAS US LVL007 C1753 278 "$1,625.00" 600.60 - " 2,243.04 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - " 1,794.43 " " 2,243.04 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 29814074 CATH INTRAVAS US LVL008 C1753 278 "$1,875.00" 693.00 - " 2,243.04 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - " 1,794.43 " " 2,243.04 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 29814082 CATH INTRAVAS US LVL009 C1753 278 "$2,125.00" 785.40 - " 2,243.04 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - " 1,794.43 " " 2,243.04 " - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 29814091 CATH INTRAVAS US LVL010 C1753 278 "$2,375.00" 877.80 - " 2,243.04 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - " 1,794.43 " " 2,243.04 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 29814104 CATH INTRAVAS US LVL011 C1753 278 "$2,625.00" 970.20 - " 2,243.04 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - " 1,794.43 " " 2,243.04 " - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 29814112 CATH INTRAVAS US LVL012 C1753 278 "$2,875.00" " 1,062.60 " - " 2,300.00 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - " 1,794.43 " " 2,243.04 " - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 29814121 CATH INTRAVAS US LVL013 C1753 278 "$3,125.00" " 1,155.00 " - " 2,500.00 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - " 1,794.43 " " 2,243.04 " - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 29814139 CATH INTRAVAS US LVL014 C1753 278 "$3,375.00" " 1,247.40 " - " 2,700.00 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - " 1,794.43 " " 2,243.04 " - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 29814147 CATH INTRAVAS US LVL015 C1753 278 "$3,625.00" " 1,339.80 " - " 2,900.00 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - " 1,794.43 " " 2,243.04 " - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 29819033 CATH INTRAVAS US LVL031 C1753 278 "$7,625.00" " 2,818.20 " - " 6,100.00 " - " 5,268.88 " - " 5,268.88 " - " 4,212.81 " - " 5,032.50 " - - " 5,046.99 " - - " 1,794.43 " " 2,243.04 " - - - " 6,100.00 " - - " 5,108.75 " - " 3,118.63 " " 5,718.75 " " 2,898.26 " " 3,410.66 " - 29819041 CATH INTRAVAS US LVL032 C1753 278 "$7,875.00" " 2,910.60 " - " 6,300.00 " - " 5,441.63 " - " 5,441.63 " - " 4,350.94 " - " 5,197.50 " - - " 5,212.46 " - - " 1,794.43 " " 2,243.04 " - - - " 6,300.00 " - - " 5,276.25 " - " 3,220.88 " " 5,906.25 " " 2,993.29 " " 3,522.49 " - 29819050 CATH INTRAVAS US LVL033 C1753 278 "$8,125.00" " 3,003.00 " - " 6,500.00 " - " 5,614.38 " - " 5,614.38 " - " 4,489.06 " - " 5,362.50 " - - " 5,377.94 " - - " 1,794.43 " " 2,243.04 " - - - " 6,500.00 " - - " 5,443.75 " - " 3,323.13 " " 6,093.75 " " 3,088.31 " " 3,634.31 " - 29819068 CATH INTRAVAS US LVL034 C1753 278 "$8,375.00" " 3,095.40 " - " 6,700.00 " - " 5,787.13 " - " 5,787.13 " - " 4,627.19 " - " 5,527.50 " - - " 5,543.41 " - - " 1,794.43 " " 2,243.04 " - - - " 6,700.00 " - - " 5,611.25 " - " 3,425.38 " " 6,281.25 " " 3,183.34 " " 3,746.14 " - 29819076 CATH INTRAVAS US LVL035 C1753 278 "$8,625.00" " 3,187.80 " - " 6,900.00 " - " 5,959.88 " - " 5,959.88 " - " 4,765.31 " - " 5,692.50 " - - " 5,708.89 " - - " 1,794.43 " " 2,243.04 " - - - " 6,900.00 " - - " 5,778.75 " - " 3,527.63 " " 6,468.75 " " 3,278.36 " " 3,857.96 " - 28104278 CATH INTRASPINAL LVL003 C1755 278 $750.00 277.20 - " 1,599.06 " - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - " 1,279.25 " " 1,599.06 " - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 28104464 CATH THROMB/EMB LVL001 C1757 278 $200.00 73.92 - " 1,245.06 " - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 996.05 " 1,245.06 " - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 28104529 CATH THROMB/EMB LVL007 C1757 278 "$1,625.00" 600.60 - " 1,300.00 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - 996.05 " 1,245.06 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 28104618 CATH THROMB/EMB LVL016 C1757 278 "$3,875.00" " 1,432.20 " - " 3,100.00 " - " 2,677.63 " - " 2,677.63 " - " 2,140.94 " - " 2,557.50 " - - " 2,564.86 " - - 996.05 " 1,245.06 " - - - " 3,100.00 " - - " 2,596.25 " - " 1,584.88 " " 2,906.25 " " 1,472.89 " " 1,733.29 " - 28104626 CATH THROMB/EMB LVL017 C1757 278 "$4,125.00" " 1,524.60 " - " 3,300.00 " - " 2,850.38 " - " 2,850.38 " - " 2,279.06 " - " 2,722.50 " - - " 2,730.34 " - - 996.05 " 1,245.06 " - - - " 3,300.00 " - - " 2,763.75 " - " 1,687.13 " " 3,093.75 " " 1,567.91 " " 1,845.11 " - 28104634 CATH THROMB/EMB LVL018 C1757 278 "$4,375.00" " 1,617.00 " - " 3,500.00 " - " 3,023.13 " - " 3,023.13 " - " 2,417.19 " - " 2,887.50 " - - " 2,895.81 " - - 996.05 " 1,245.06 " - - - " 3,500.00 " - - " 2,931.25 " - " 1,789.38 " " 3,281.25 " " 1,662.94 " " 1,956.94 " - 28104651 CATH THROMB/EMB LVL020 C1757 278 "$4,875.00" " 1,801.80 " - " 3,900.00 " - " 3,368.63 " - " 3,368.63 " - " 2,693.44 " - " 3,217.50 " - - " 3,226.76 " - - 996.05 " 1,245.06 " - - - " 3,900.00 " - - " 3,266.25 " - " 1,993.88 " " 3,656.25 " " 1,852.99 " " 2,180.59 " - 28159536 CATH THROMB EMB LVL029 C1757 278 "$7,125.00" " 2,633.40 " - " 5,700.00 " - " 4,923.38 " - " 4,923.38 " - " 3,936.56 " - " 4,702.50 " - - " 4,716.04 " - - 996.05 " 1,245.06 " - - - " 5,700.00 " - - " 4,773.75 " - " 2,914.13 " " 5,343.75 " " 2,708.21 " " 3,187.01 " - 29814376 CATH THROMB EMB LVL001 C1757 278 $200.00 73.92 - " 1,245.06 " - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 996.05 " 1,245.06 " - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 29814384 CATH THROMB EMB LVL002 C1757 278 $450.00 166.32 - " 1,245.06 " - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 996.05 " 1,245.06 " - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 29814392 CATH THROMB EMB LVL003 C1757 278 $750.00 277.20 - " 1,245.06 " - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 996.05 " 1,245.06 " - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 29814406 CATH THROMB EMB LVL005 C1757 278 "$1,350.00" 498.96 - " 1,245.06 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 996.05 " 1,245.06 " - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 29814414 CATH THROMB EMB LVL006 C1757 278 "$1,375.00" 508.20 - " 1,245.06 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - 996.05 " 1,245.06 " - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 29814422 CATH THROMB EMB LVL007 C1757 278 "$1,625.00" 600.60 - " 1,300.00 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - 996.05 " 1,245.06 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 29814431 CATH THROMB EMB LVL008 C1757 278 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - 996.05 " 1,245.06 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 29814449 CATH THROMB EMB LVL009 C1757 278 "$2,125.00" 785.40 - " 1,700.00 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - 996.05 " 1,245.06 " - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 29814457 CATH THROMB EMB LVL004 C1757 278 "$1,050.00" 388.08 - " 1,245.06 " - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 996.05 " 1,245.06 " - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 29814465 CATH THROMB EMB LVL010 C1757 278 "$2,375.00" 877.80 - " 1,900.00 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - 996.05 " 1,245.06 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 29814473 CATH THROMB EMB LVL011 C1757 278 "$2,625.00" 970.20 - " 2,100.00 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - 996.05 " 1,245.06 " - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 29814481 CATH THROMB EMB LVL012 C1757 278 "$2,875.00" " 1,062.60 " - " 2,300.00 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - 996.05 " 1,245.06 " - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 29814490 CATH THROMB EMB LVL013 C1757 278 "$3,125.00" " 1,155.00 " - " 2,500.00 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - 996.05 " 1,245.06 " - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 29814503 CATH THROMB EMB LVL014 C1757 278 "$3,375.00" " 1,247.40 " - " 2,700.00 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - 996.05 " 1,245.06 " - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 29814511 CATH THROMB EMB LVL015 C1757 278 "$3,625.00" " 1,339.80 " - " 2,900.00 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - 996.05 " 1,245.06 " - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 29814520 CATH THROMB EMB LVL018 C1757 278 "$4,375.00" " 1,617.00 " - " 3,500.00 " - " 3,023.13 " - " 3,023.13 " - " 2,417.19 " - " 2,887.50 " - - " 2,895.81 " - - 996.05 " 1,245.06 " - - - " 3,500.00 " - - " 2,931.25 " - " 1,789.38 " " 3,281.25 " " 1,662.94 " " 1,956.94 " - 29814538 CATH THROMB EMB LVL019 C1757 278 "$4,625.00" " 1,709.40 " - " 3,700.00 " - " 3,195.88 " - " 3,195.88 " - " 2,555.31 " - " 3,052.50 " - - " 3,061.29 " - - 996.05 " 1,245.06 " - - - " 3,700.00 " - - " 3,098.75 " - " 1,891.63 " " 3,468.75 " " 1,757.96 " " 2,068.76 " - 29814546 CATH THROMB EMB LVL020 C1757 278 "$4,875.00" " 1,801.80 " - " 3,900.00 " - " 3,368.63 " - " 3,368.63 " - " 2,693.44 " - " 3,217.50 " - - " 3,226.76 " - - 996.05 " 1,245.06 " - - - " 3,900.00 " - - " 3,266.25 " - " 1,993.88 " " 3,656.25 " " 1,852.99 " " 2,180.59 " - 29814554 CATH THROMB EMB LVL021 C1757 278 "$5,125.00" " 1,894.20 " - " 4,100.00 " - " 3,541.38 " - " 3,541.38 " - " 2,831.56 " - " 3,382.50 " - - " 3,392.24 " - - 996.05 " 1,245.06 " - - - " 4,100.00 " - - " 3,433.75 " - " 2,096.13 " " 3,843.75 " " 1,948.01 " " 2,292.41 " - 29814562 CATH THROMB EMB LVL022 C1757 278 "$5,375.00" " 1,986.60 " - " 4,300.00 " - " 3,714.13 " - " 3,714.13 " - " 2,969.69 " - " 3,547.50 " - - " 3,557.71 " - - 996.05 " 1,245.06 " - - - " 4,300.00 " - - " 3,601.25 " - " 2,198.38 " " 4,031.25 " " 2,043.04 " " 2,404.24 " - 29814571 CATH THROMB EMB LVL023 C1757 278 "$5,625.00" " 2,079.00 " - " 4,500.00 " - " 3,886.88 " - " 3,886.88 " - " 3,107.81 " - " 3,712.50 " - - " 3,723.19 " - - 996.05 " 1,245.06 " - - - " 4,500.00 " - - " 3,768.75 " - " 2,300.63 " " 4,218.75 " " 2,138.06 " " 2,516.06 " - 29814589 CATH THROMB EMB LVL024 C1757 278 "$5,875.00" " 2,171.40 " - " 4,700.00 " - " 4,059.63 " - " 4,059.63 " - " 3,245.94 " - " 3,877.50 " - - " 3,888.66 " - - 996.05 " 1,245.06 " - - - " 4,700.00 " - - " 3,936.25 " - " 2,402.88 " " 4,406.25 " " 2,233.09 " " 2,627.89 " - 29814597 CATH THROMB EMB LVL025 C1757 278 "$6,125.00" " 2,263.80 " - " 4,900.00 " - " 4,232.38 " - " 4,232.38 " - " 3,384.06 " - " 4,042.50 " - - " 4,054.14 " - - 996.05 " 1,245.06 " - - - " 4,900.00 " - - " 4,103.75 " - " 2,505.13 " " 4,593.75 " " 2,328.11 " " 2,739.71 " - 29814651 CATH THROMB EMB LVL026 C1757 278 "$6,375.00" " 2,356.20 " - " 5,100.00 " - " 4,405.13 " - " 4,405.13 " - " 3,522.19 " - " 4,207.50 " - - " 4,219.61 " - - 996.05 " 1,245.06 " - - - " 5,100.00 " - - " 4,271.25 " - " 2,607.38 " " 4,781.25 " " 2,423.14 " " 2,851.54 " - 29814741 CATH THROMB EMB LVL016 C1757 278 "$3,875.00" " 1,432.20 " - " 3,100.00 " - " 2,677.63 " - " 2,677.63 " - " 2,140.94 " - " 2,557.50 " - - " 2,564.86 " - - 996.05 " 1,245.06 " - - - " 3,100.00 " - - " 2,596.25 " - " 1,584.88 " " 2,906.25 " " 1,472.89 " " 1,733.29 " - 29814759 CATH THROMB EMB LVL017 C1757 278 "$4,125.00" " 1,524.60 " - " 3,300.00 " - " 2,850.38 " - " 2,850.38 " - " 2,279.06 " - " 2,722.50 " - - " 2,730.34 " - - 996.05 " 1,245.06 " - - - " 3,300.00 " - - " 2,763.75 " - " 1,687.13 " " 3,093.75 " " 1,567.91 " " 1,845.11 " - 29814767 CATH THROMB EMB LVL027 C1757 278 "$6,625.00" " 2,448.60 " - " 5,300.00 " - " 4,577.88 " - " 4,577.88 " - " 3,660.31 " - " 4,372.50 " - - " 4,385.09 " - - 996.05 " 1,245.06 " - - - " 5,300.00 " - - " 4,438.75 " - " 2,709.63 " " 4,968.75 " " 2,518.16 " " 2,963.36 " - 29814775 CATH THROMB EMB LVL028 C1757 278 "$6,875.00" " 2,541.00 " - " 5,500.00 " - " 4,750.63 " - " 4,750.63 " - " 3,798.44 " - " 4,537.50 " - - " 4,550.56 " - - 996.05 " 1,245.06 " - - - " 5,500.00 " - - " 4,606.25 " - " 2,811.88 " " 5,156.25 " " 2,613.19 " " 3,075.19 " - 29814783 CATH THROMB EMB LVL029 C1757 278 "$7,125.00" " 2,633.40 " - " 5,700.00 " - " 4,923.38 " - " 4,923.38 " - " 3,936.56 " - " 4,702.50 " - - " 4,716.04 " - - 996.05 " 1,245.06 " - - - " 5,700.00 " - - " 4,773.75 " - " 2,914.13 " " 5,343.75 " " 2,708.21 " " 3,187.01 " - 29814791 CATH THROMB EMB LVL030 C1757 278 "$7,375.00" " 2,725.80 " - " 5,900.00 " - " 5,096.13 " - " 5,096.13 " - " 4,074.69 " - " 4,867.50 " - - " 4,881.51 " - - 996.05 " 1,245.06 " - - - " 5,900.00 " - - " 4,941.25 " - " 3,016.38 " " 5,531.25 " " 2,803.24 " " 3,298.84 " - 80361335 CATH THROMB EMB LVL001 C1757 278 $200.00 73.92 - " 1,245.06 " - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 996.05 " 1,245.06 " - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 80361343 CATH THROMB EMB LVL002 C1757 278 $450.00 166.32 - " 1,245.06 " - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 996.05 " 1,245.06 " - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 80361351 CATH THROMB EMB LVL003 C1757 278 $750.00 277.20 - " 1,245.06 " - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 996.05 " 1,245.06 " - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 80361360 CATH THROMB EMB LVL004 C1757 278 "$1,050.00" 388.08 - " 1,245.06 " - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 996.05 " 1,245.06 " - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 80361378 CATH THROMB EMB LVL005 C1757 278 "$1,350.00" 498.96 - " 1,245.06 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 996.05 " 1,245.06 " - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 80361386 CATH THROMB EMB LVL006 C1757 278 "$1,375.00" 508.20 - " 1,245.06 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - 996.05 " 1,245.06 " - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 80361394 CATH THROMB EMB LVL007 C1757 278 "$1,625.00" 600.60 - " 1,300.00 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - 996.05 " 1,245.06 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 80361408 CATH THROMB EMB LVL008 C1757 278 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - 996.05 " 1,245.06 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 80361416 CATH THROMB EMB LVL009 C1757 278 "$2,125.00" 785.40 - " 1,700.00 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - 996.05 " 1,245.06 " - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 80361424 CATH THROMB EMB LVL010 C1757 278 "$2,375.00" 877.80 - " 1,900.00 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - 996.05 " 1,245.06 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 80361432 CATH THROMB EMB LVL011 C1757 278 "$2,625.00" 970.20 - " 2,100.00 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - 996.05 " 1,245.06 " - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 80361441 CATH THROMB EMB LVL012 C1757 278 "$2,875.00" " 1,062.60 " - " 2,300.00 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - 996.05 " 1,245.06 " - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 80361459 CATH THROMB EMB LVL013 C1757 278 "$3,125.00" " 1,155.00 " - " 2,500.00 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - 996.05 " 1,245.06 " - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 80361467 CATH THROMB EMB LVL014 C1757 278 "$3,375.00" " 1,247.40 " - " 2,700.00 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - 996.05 " 1,245.06 " - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 80361475 CATH THROMB EMB LVL015 C1757 278 "$3,625.00" " 1,339.80 " - " 2,900.00 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - 996.05 " 1,245.06 " - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 80361483 CATH THROMB EMB LVL016 C1757 278 "$3,875.00" " 1,432.20 " - " 3,100.00 " - " 2,677.63 " - " 2,677.63 " - " 2,140.94 " - " 2,557.50 " - - " 2,564.86 " - - 996.05 " 1,245.06 " - - - " 3,100.00 " - - " 2,596.25 " - " 1,584.88 " " 2,906.25 " " 1,472.89 " " 1,733.29 " - 80361491 CATH THROMB EMB LVL017 C1757 278 "$4,125.00" " 1,524.60 " - " 3,300.00 " - " 2,850.38 " - " 2,850.38 " - " 2,279.06 " - " 2,722.50 " - - " 2,730.34 " - - 996.05 " 1,245.06 " - - - " 3,300.00 " - - " 2,763.75 " - " 1,687.13 " " 3,093.75 " " 1,567.91 " " 1,845.11 " - 80361505 CATH THROMB EMB LVL018 C1757 278 "$4,375.00" " 1,617.00 " - " 3,500.00 " - " 3,023.13 " - " 3,023.13 " - " 2,417.19 " - " 2,887.50 " - - " 2,895.81 " - - 996.05 " 1,245.06 " - - - " 3,500.00 " - - " 2,931.25 " - " 1,789.38 " " 3,281.25 " " 1,662.94 " " 1,956.94 " - 80361513 CATH THROMB EMB LVL019 C1757 278 "$4,625.00" " 1,709.40 " - " 3,700.00 " - " 3,195.88 " - " 3,195.88 " - " 2,555.31 " - " 3,052.50 " - - " 3,061.29 " - - 996.05 " 1,245.06 " - - - " 3,700.00 " - - " 3,098.75 " - " 1,891.63 " " 3,468.75 " " 1,757.96 " " 2,068.76 " - 80361521 CATH THROMB EMB LVL020 C1757 278 "$4,875.00" " 1,801.80 " - " 3,900.00 " - " 3,368.63 " - " 3,368.63 " - " 2,693.44 " - " 3,217.50 " - - " 3,226.76 " - - 996.05 " 1,245.06 " - - - " 3,900.00 " - - " 3,266.25 " - " 1,993.88 " " 3,656.25 " " 1,852.99 " " 2,180.59 " - 80361530 CATH THROMB EMB LVL021 C1757 278 "$5,125.00" " 1,894.20 " - " 4,100.00 " - " 3,541.38 " - " 3,541.38 " - " 2,831.56 " - " 3,382.50 " - - " 3,392.24 " - - 996.05 " 1,245.06 " - - - " 4,100.00 " - - " 3,433.75 " - " 2,096.13 " " 3,843.75 " " 1,948.01 " " 2,292.41 " - 80361548 CATH THROMB EMB LVL022 C1757 278 "$5,375.00" " 1,986.60 " - " 4,300.00 " - " 3,714.13 " - " 3,714.13 " - " 2,969.69 " - " 3,547.50 " - - " 3,557.71 " - - 996.05 " 1,245.06 " - - - " 4,300.00 " - - " 3,601.25 " - " 2,198.38 " " 4,031.25 " " 2,043.04 " " 2,404.24 " - 80361556 CATH THROMB EMB LVL023 C1757 278 "$5,625.00" " 2,079.00 " - " 4,500.00 " - " 3,886.88 " - " 3,886.88 " - " 3,107.81 " - " 3,712.50 " - - " 3,723.19 " - - 996.05 " 1,245.06 " - - - " 4,500.00 " - - " 3,768.75 " - " 2,300.63 " " 4,218.75 " " 2,138.06 " " 2,516.06 " - 80361564 CATH THROMB EMB LVL024 C1757 278 "$5,875.00" " 2,171.40 " - " 4,700.00 " - " 4,059.63 " - " 4,059.63 " - " 3,245.94 " - " 3,877.50 " - - " 3,888.66 " - - 996.05 " 1,245.06 " - - - " 4,700.00 " - - " 3,936.25 " - " 2,402.88 " " 4,406.25 " " 2,233.09 " " 2,627.89 " - 80361572 CATH THROMB EMB LVL025 C1757 278 "$6,125.00" " 2,263.80 " - " 4,900.00 " - " 4,232.38 " - " 4,232.38 " - " 3,384.06 " - " 4,042.50 " - - " 4,054.14 " - - 996.05 " 1,245.06 " - - - " 4,900.00 " - - " 4,103.75 " - " 2,505.13 " " 4,593.75 " " 2,328.11 " " 2,739.71 " - 80361581 CATH THROMB EMB LVL026 C1757 278 "$6,375.00" " 2,356.20 " - " 5,100.00 " - " 4,405.13 " - " 4,405.13 " - " 3,522.19 " - " 4,207.50 " - - " 4,219.61 " - - 996.05 " 1,245.06 " - - - " 5,100.00 " - - " 4,271.25 " - " 2,607.38 " " 4,781.25 " " 2,423.14 " " 2,851.54 " - 80361599 CATH THROMB EMB LVL027 C1757 278 "$6,625.00" " 2,448.60 " - " 5,300.00 " - " 4,577.88 " - " 4,577.88 " - " 3,660.31 " - " 4,372.50 " - - " 4,385.09 " - - 996.05 " 1,245.06 " - - - " 5,300.00 " - - " 4,438.75 " - " 2,709.63 " " 4,968.75 " " 2,518.16 " " 2,963.36 " - 80361602 CATH THROMB EMB LVL028 C1757 278 "$6,875.00" " 2,541.00 " - " 5,500.00 " - " 4,750.63 " - " 4,750.63 " - " 3,798.44 " - " 4,537.50 " - - " 4,550.56 " - - 996.05 " 1,245.06 " - - - " 5,500.00 " - - " 4,606.25 " - " 2,811.88 " " 5,156.25 " " 2,613.19 " " 3,075.19 " - 80361611 CATH THROMB EMB LVL029 C1757 278 "$7,125.00" " 2,633.40 " - " 5,700.00 " - " 4,923.38 " - " 4,923.38 " - " 3,936.56 " - " 4,702.50 " - - " 4,716.04 " - - 996.05 " 1,245.06 " - - - " 5,700.00 " - - " 4,773.75 " - " 2,914.13 " " 5,343.75 " " 2,708.21 " " 3,187.01 " - 80361629 CATH THROMB EMB LVL030 C1757 278 "$7,375.00" " 2,725.80 " - " 5,900.00 " - " 5,096.13 " - " 5,096.13 " - " 4,074.69 " - " 4,867.50 " - - " 4,881.51 " - - 996.05 " 1,245.06 " - - - " 5,900.00 " - - " 4,941.25 " - " 3,016.38 " " 5,531.25 " " 2,803.24 " " 3,298.84 " - 80361637 CATH THROMB EMB LVL031 C1757 278 "$7,625.00" " 2,818.20 " - " 6,100.00 " - " 5,268.88 " - " 5,268.88 " - " 4,212.81 " - " 5,032.50 " - - " 5,046.99 " - - 996.05 " 1,245.06 " - - - " 6,100.00 " - - " 5,108.75 " - " 3,118.63 " " 5,718.75 " " 2,898.26 " " 3,410.66 " - 80361645 CATH THROMB EMB LVL032 C1757 278 "$7,875.00" " 2,910.60 " - " 6,300.00 " - " 5,441.63 " - " 5,441.63 " - " 4,350.94 " - " 5,197.50 " - - " 5,212.46 " - - 996.05 " 1,245.06 " - - - " 6,300.00 " - - " 5,276.25 " - " 3,220.88 " " 5,906.25 " " 2,993.29 " " 3,522.49 " - 80361653 CATH THROMB EMB LVL033 C1757 278 "$8,125.00" " 3,003.00 " - " 6,500.00 " - " 5,614.38 " - " 5,614.38 " - " 4,489.06 " - " 5,362.50 " - - " 5,377.94 " - - 996.05 " 1,245.06 " - - - " 6,500.00 " - - " 5,443.75 " - " 3,323.13 " " 6,093.75 " " 3,088.31 " " 3,634.31 " - 80361661 CATH THROMB EMB LVL034 C1757 278 "$8,375.00" " 3,095.40 " - " 6,700.00 " - " 5,787.13 " - " 5,787.13 " - " 4,627.19 " - " 5,527.50 " - - " 5,543.41 " - - 996.05 " 1,245.06 " - - - " 6,700.00 " - - " 5,611.25 " - " 3,425.38 " " 6,281.25 " " 3,183.34 " " 3,746.14 " - 80361670 CATH THROMB EMB LVL035 C1757 278 "$8,625.00" " 3,187.80 " - " 6,900.00 " - " 5,959.88 " - " 5,959.88 " - " 4,765.31 " - " 5,692.50 " - - " 5,708.89 " - - 996.05 " 1,245.06 " - - - " 6,900.00 " - - " 5,778.75 " - " 3,527.63 " " 6,468.75 " " 3,278.36 " " 3,857.96 " - 80361688 CATH THROMB EMB LVL062 C1757 278 "$15,375.00" " 5,682.60 " - " 12,300.00 " - " 10,624.13 " - " 10,624.13 " - " 8,494.69 " - " 10,147.50 " - - " 10,176.71 " - - 996.05 " 1,245.06 " - - - " 12,300.00 " - - " 10,301.25 " - " 6,288.38 " " 11,531.25 " " 5,844.04 " " 6,877.24 " - 80361696 CATH THROMB EMB LVL063 C1757 278 "$15,625.00" " 5,775.00 " - " 12,500.00 " - " 10,796.88 " - " 10,796.88 " - " 8,632.81 " - " 10,312.50 " - - " 10,342.19 " - - 996.05 " 1,245.06 " - - - " 12,500.00 " - - " 10,468.75 " - " 6,390.63 " " 11,718.75 " " 5,939.06 " " 6,989.06 " - 80361700 CATH THROMB EMB LVL064 C1757 278 "$15,875.00" " 5,867.40 " - " 12,700.00 " - " 10,969.63 " - " 10,969.63 " - " 8,770.94 " - " 10,477.50 " - - " 10,507.66 " - - 996.05 " 1,245.06 " - - - " 12,700.00 " - - " 10,636.25 " - " 6,492.88 " " 11,906.25 " " 6,034.09 " " 7,100.89 " - 80361718 CATH THROMB EMB LVL065 C1757 278 "$16,125.00" " 5,959.80 " - " 12,900.00 " - " 11,142.38 " - " 11,142.38 " - " 8,909.06 " - " 10,642.50 " - - " 10,673.14 " - - 996.05 " 1,245.06 " - - - " 12,900.00 " - - " 10,803.75 " - " 6,595.13 " " 12,093.75 " " 6,129.11 " " 7,212.71 " - 80361726 CATH THROMB EMB LVL066 C1757 278 "$16,375.00" " 6,052.20 " - " 13,100.00 " - " 11,315.13 " - " 11,315.13 " - " 9,047.19 " - " 10,807.50 " - - " 10,838.61 " - - 996.05 " 1,245.06 " - - - " 13,100.00 " - - " 10,971.25 " - " 6,697.38 " " 12,281.25 " " 6,224.14 " " 7,324.54 " - 80361734 CATH THROMB EMB LVL067 C1757 278 "$16,625.00" " 6,144.60 " - " 13,300.00 " - " 11,487.88 " - " 11,487.88 " - " 9,185.31 " - " 10,972.50 " - - " 11,004.09 " - - 996.05 " 1,245.06 " - - - " 13,300.00 " - - " 11,138.75 " - " 6,799.63 " " 12,468.75 " " 6,319.16 " " 7,436.36 " - 80361742 CATH THROMB EMB LVL068 C1757 278 "$16,875.00" " 6,237.00 " - " 13,500.00 " - " 11,660.63 " - " 11,660.63 " - " 9,323.44 " - " 11,137.50 " - - " 11,169.56 " - - 996.05 " 1,245.06 " - - - " 13,500.00 " - - " 11,306.25 " - " 6,901.88 " " 12,656.25 " " 6,414.19 " " 7,548.19 " - 80361751 CATH THROMB EMB LVL069 C1757 278 "$17,125.00" " 6,329.40 " - " 13,700.00 " - " 11,833.38 " - " 11,833.38 " - " 9,461.56 " - " 11,302.50 " - - " 11,335.04 " - - 996.05 " 1,245.06 " - - - " 13,700.00 " - - " 11,473.75 " - " 7,004.13 " " 12,843.75 " " 6,509.21 " " 7,660.01 " - 80361769 CATH THROMB EMB LVL070 C1757 278 "$17,375.00" " 6,421.80 " - " 13,900.00 " - " 12,006.13 " - " 12,006.13 " - " 9,599.69 " - " 11,467.50 " - - " 11,500.51 " - - 996.05 " 1,245.06 " - - - " 13,900.00 " - - " 11,641.25 " - " 7,106.38 " " 13,031.25 " " 6,604.24 " " 7,771.84 " - 80361777 CATH THROMB EMB LVL071 C1757 278 "$17,625.00" " 6,514.20 " - " 14,100.00 " - " 12,178.88 " - " 12,178.88 " - " 9,737.81 " - " 11,632.50 " - - " 11,665.99 " - - 996.05 " 1,245.06 " - - - " 14,100.00 " - - " 11,808.75 " - " 7,208.63 " " 13,218.75 " " 6,699.26 " " 7,883.66 " - 80361785 CATH THROMB EMB LVL072 C1757 278 "$17,875.00" " 6,606.60 " - " 14,300.00 " - " 12,351.63 " - " 12,351.63 " - " 9,875.94 " - " 11,797.50 " - - " 11,831.46 " - - 996.05 " 1,245.06 " - - - " 14,300.00 " - - " 11,976.25 " - " 7,310.88 " " 13,406.25 " " 6,794.29 " " 7,995.49 " - 80361793 CATH THROMB EMB LVL073 C1757 278 "$18,125.00" " 6,699.00 " - " 14,500.00 " - " 12,524.38 " - " 12,524.38 " - " 10,014.06 " - " 11,962.50 " - - " 11,996.94 " - - 996.05 " 1,245.06 " - - - " 14,500.00 " - - " 12,143.75 " - " 7,413.13 " " 13,593.75 " " 6,889.31 " " 8,107.31 " - 80361807 CATH THROMB EMB LVL074 C1757 278 "$18,375.00" " 6,791.40 " - " 14,700.00 " - " 12,697.13 " - " 12,697.13 " - " 10,152.19 " - " 12,127.50 " - - " 12,162.41 " - - 996.05 " 1,245.06 " - - - " 14,700.00 " - - " 12,311.25 " - " 7,515.38 " " 13,781.25 " " 6,984.34 " " 8,219.14 " - 80361815 CATH THROMB EMB LVL075 C1757 278 "$18,625.00" " 6,883.80 " - " 14,900.00 " - " 12,869.88 " - " 12,869.88 " - " 10,290.31 " - " 12,292.50 " - - " 12,327.89 " - - 996.05 " 1,245.06 " - - - " 14,900.00 " - - " 12,478.75 " - " 7,617.63 " " 13,968.75 " " 7,079.36 " " 8,330.96 " - 80361823 CATH THROMB EMB LVL076 C1757 278 "$18,875.00" " 6,976.20 " - " 15,100.00 " - " 13,042.63 " - " 13,042.63 " - " 10,428.44 " - " 12,457.50 " - - " 12,493.36 " - - 996.05 " 1,245.06 " - - - " 15,100.00 " - - " 12,646.25 " - " 7,719.88 " " 14,156.25 " " 7,174.39 " " 8,442.79 " - 80361831 CATH THROMB EMB LVL077 C1757 278 "$19,125.00" " 7,068.60 " - " 15,300.00 " - " 13,215.38 " - " 13,215.38 " - " 10,566.56 " - " 12,622.50 " - - " 12,658.84 " - - 996.05 " 1,245.06 " - - - " 15,300.00 " - - " 12,813.75 " - " 7,822.13 " " 14,343.75 " " 7,269.41 " " 8,554.61 " - 80361840 CATH THROMB EMB LVL078 C1757 278 "$19,375.00" " 7,161.00 " - " 15,500.00 " - " 13,388.13 " - " 13,388.13 " - " 10,704.69 " - " 12,787.50 " - - " 12,824.31 " - - 996.05 " 1,245.06 " - - - " 15,500.00 " - - " 12,981.25 " - " 7,924.38 " " 14,531.25 " " 7,364.44 " " 8,666.44 " - 28104863 CATH URETERAL LVL001 C1758 278 $200.00 73.92 - 160.00 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 96.07 120.09 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 28104871 CATH URETERAL LVL002 C1758 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 96.07 120.09 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 28104880 CATH URETERAL LVL003 C1758 278 $750.00 277.20 - 600.00 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 96.07 120.09 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 28137354 CATH INTRA ECHOCARDIO LVL007 C1759 278 "$1,625.00" 600.60 - " 4,164.33 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - " 3,331.46 " " 4,164.33 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 29818461 CATH INTRA ECHOCARDIO LVL005 C1759 278 "$1,350.00" 498.96 - " 4,164.33 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - " 3,331.46 " " 4,164.33 " - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 29818479 CATH INTRA ECHOCARDIO LVL006 C1759 278 "$1,375.00" 508.20 - " 4,164.33 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - " 3,331.46 " " 4,164.33 " - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 29818487 CATH INTRA ECHOCARDIO LVL007 C1759 278 "$1,625.00" 600.60 - " 4,164.33 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - " 3,331.46 " " 4,164.33 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 29818495 CATH INTRA ECHOCARDIO LVL008 C1759 278 "$1,875.00" 693.00 - " 4,164.33 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - " 3,331.46 " " 4,164.33 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 29818509 CATH INTRA ECHOCARDIO LVL009 C1759 278 "$2,125.00" 785.40 - " 4,164.33 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - " 3,331.46 " " 4,164.33 " - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 29818517 CATH INTRA ECHOCARDIO LVL010 C1759 278 "$2,375.00" 877.80 - " 4,164.33 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - " 3,331.46 " " 4,164.33 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 29818525 CATH INTRA ECHOCARDIO LVL025 C1759 278 "$6,125.00" " 2,263.80 " - " 4,900.00 " - " 4,232.38 " - " 4,232.38 " - " 3,384.06 " - " 4,042.50 " - - " 4,054.14 " - - " 3,331.46 " " 4,164.33 " - - - " 4,900.00 " - - " 4,103.75 " - " 2,505.13 " " 4,593.75 " " 2,328.11 " " 2,739.71 " - 29818533 CATH INTRA ECHOCARDIO LVL026 C1759 278 "$6,375.00" " 2,356.20 " - " 5,100.00 " - " 4,405.13 " - " 4,405.13 " - " 3,522.19 " - " 4,207.50 " - - " 4,219.61 " - - " 3,331.46 " " 4,164.33 " - - - " 5,100.00 " - - " 4,271.25 " - " 2,607.38 " " 4,781.25 " " 2,423.14 " " 2,851.54 " - 29818541 CATH INTRA ECHOCARDIO LVL027 C1759 278 "$6,625.00" " 2,448.60 " - " 5,300.00 " - " 4,577.88 " - " 4,577.88 " - " 3,660.31 " - " 4,372.50 " - - " 4,385.09 " - - " 3,331.46 " " 4,164.33 " - - - " 5,300.00 " - - " 4,438.75 " - " 2,709.63 " " 4,968.75 " " 2,518.16 " " 2,963.36 " - 29818550 CATH INTRA ECHOCARDIO LVL028 C1759 278 "$6,875.00" " 2,541.00 " - " 5,500.00 " - " 4,750.63 " - " 4,750.63 " - " 3,798.44 " - " 4,537.50 " - - " 4,550.56 " - - " 3,331.46 " " 4,164.33 " - - - " 5,500.00 " - - " 4,606.25 " - " 2,811.88 " " 5,156.25 " " 2,613.19 " " 3,075.19 " - 29818568 CATH INTRA ECHOCARDIO LVL029 C1759 278 "$7,125.00" " 2,633.40 " - " 5,700.00 " - " 4,923.38 " - " 4,923.38 " - " 3,936.56 " - " 4,702.50 " - - " 4,716.04 " - - " 3,331.46 " " 4,164.33 " - - - " 5,700.00 " - - " 4,773.75 " - " 2,914.13 " " 5,343.75 " " 2,708.21 " " 3,187.01 " - 29818576 CATH INTRA ECHOCARDIO LVL030 C1759 278 "$7,375.00" " 2,725.80 " - " 5,900.00 " - " 5,096.13 " - " 5,096.13 " - " 4,074.69 " - " 4,867.50 " - - " 4,881.51 " - - " 3,331.46 " " 4,164.33 " - - - " 5,900.00 " - - " 4,941.25 " - " 3,016.38 " " 5,531.25 " " 2,803.24 " " 3,298.84 " - 30606680 CATH INTRA ECHOCARDIO LVL015 C1759 278 "$3,625.00" " 1,339.80 " - " 4,164.33 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - " 3,331.46 " " 4,164.33 " - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 30606698 CATH INTRA ECHOCARDIO LVL025 C1759 278 "$6,125.00" " 2,263.80 " - " 4,900.00 " - " 4,232.38 " - " 4,232.38 " - " 3,384.06 " - " 4,042.50 " - - " 4,054.14 " - - " 3,331.46 " " 4,164.33 " - - - " 4,900.00 " - - " 4,103.75 " - " 2,505.13 " " 4,593.75 " " 2,328.11 " " 2,739.71 " - 30606701 CATH INTRA ECHOCARDIO LVL026 C1759 278 "$6,375.00" " 2,356.20 " - " 5,100.00 " - " 4,405.13 " - " 4,405.13 " - " 3,522.19 " - " 4,207.50 " - - " 4,219.61 " - - " 3,331.46 " " 4,164.33 " - - - " 5,100.00 " - - " 4,271.25 " - " 2,607.38 " " 4,781.25 " " 2,423.14 " " 2,851.54 " - 30606710 CATH INTRA ECHOCARDIO LVL027 C1759 278 "$6,625.00" " 2,448.60 " - " 5,300.00 " - " 4,577.88 " - " 4,577.88 " - " 3,660.31 " - " 4,372.50 " - - " 4,385.09 " - - " 3,331.46 " " 4,164.33 " - - - " 5,300.00 " - - " 4,438.75 " - " 2,709.63 " " 4,968.75 " " 2,518.16 " " 2,963.36 " - 30606728 CATH INTRA ECHOCARDIO LVL028 C1759 278 "$6,875.00" " 2,541.00 " - " 5,500.00 " - " 4,750.63 " - " 4,750.63 " - " 3,798.44 " - " 4,537.50 " - - " 4,550.56 " - - " 3,331.46 " " 4,164.33 " - - - " 5,500.00 " - - " 4,606.25 " - " 2,811.88 " " 5,156.25 " " 2,613.19 " " 3,075.19 " - 30606736 CATH INTRA ECHOCARDIO LVL029 C1759 278 "$7,125.00" " 2,633.40 " - " 5,700.00 " - " 4,923.38 " - " 4,923.38 " - " 3,936.56 " - " 4,702.50 " - - " 4,716.04 " - - " 3,331.46 " " 4,164.33 " - - - " 5,700.00 " - - " 4,773.75 " - " 2,914.13 " " 5,343.75 " " 2,708.21 " " 3,187.01 " - 30606744 CATH INTRA ECHOCARDIO LVL030 C1759 278 "$7,375.00" " 2,725.80 " - " 5,900.00 " - " 5,096.13 " - " 5,096.13 " - " 4,074.69 " - " 4,867.50 " - - " 4,881.51 " - - " 3,331.46 " " 4,164.33 " - - - " 5,900.00 " - - " 4,941.25 " - " 3,016.38 " " 5,531.25 " " 2,803.24 " " 3,298.84 " - 30606752 CATH INTRA ECHOCARDIO LVL031 C1759 278 "$7,625.00" " 2,818.20 " - " 6,100.00 " - " 5,268.88 " - " 5,268.88 " - " 4,212.81 " - " 5,032.50 " - - " 5,046.99 " - - " 3,331.46 " " 4,164.33 " - - - " 6,100.00 " - - " 5,108.75 " - " 3,118.63 " " 5,718.75 " " 2,898.26 " " 3,410.66 " - 30606761 CATH INTRA ECHOCARDIO LVL032 C1759 278 "$7,875.00" " 2,910.60 " - " 6,300.00 " - " 5,441.63 " - " 5,441.63 " - " 4,350.94 " - " 5,197.50 " - - " 5,212.46 " - - " 3,331.46 " " 4,164.33 " - - - " 6,300.00 " - - " 5,276.25 " - " 3,220.88 " " 5,906.25 " " 2,993.29 " " 3,522.49 " - 30606779 CATH INTRA ECHOCARDIO LVL033 C1759 278 "$8,125.00" " 3,003.00 " - " 6,500.00 " - " 5,614.38 " - " 5,614.38 " - " 4,489.06 " - " 5,362.50 " - - " 5,377.94 " - - " 3,331.46 " " 4,164.33 " - - - " 6,500.00 " - - " 5,443.75 " - " 3,323.13 " " 6,093.75 " " 3,088.31 " " 3,634.31 " - 30606787 CATH INTRA ECHOCARDIO LVL034 C1759 278 "$8,375.00" " 3,095.40 " - " 6,700.00 " - " 5,787.13 " - " 5,787.13 " - " 4,627.19 " - " 5,527.50 " - - " 5,543.41 " - - " 3,331.46 " " 4,164.33 " - - - " 6,700.00 " - - " 5,611.25 " - " 3,425.38 " " 6,281.25 " " 3,183.34 " " 3,746.14 " - 30608577 CATH INTRA ECHOCARDIO LVL016 C1759 278 "$3,875.00" " 1,432.20 " - " 4,164.33 " - " 2,677.63 " - " 2,677.63 " - " 2,140.94 " - " 2,557.50 " - - " 2,564.86 " - - " 3,331.46 " " 4,164.33 " - - - " 3,100.00 " - - " 2,596.25 " - " 1,584.88 " " 2,906.25 " " 1,472.89 " " 1,733.29 " - 30608585 CATH INTRA ECHOCARDIO LVL017 C1759 278 "$4,125.00" " 1,524.60 " - " 4,164.33 " - " 2,850.38 " - " 2,850.38 " - " 2,279.06 " - " 2,722.50 " - - " 2,730.34 " - - " 3,331.46 " " 4,164.33 " - - - " 3,300.00 " - - " 2,763.75 " - " 1,687.13 " " 3,093.75 " " 1,567.91 " " 1,845.11 " - 30608593 CATH INTRA ECHOCARDIO LVL018 C1759 278 "$4,375.00" " 1,617.00 " - " 4,164.33 " - " 3,023.13 " - " 3,023.13 " - " 2,417.19 " - " 2,887.50 " - - " 2,895.81 " - - " 3,331.46 " " 4,164.33 " - - - " 3,500.00 " - - " 2,931.25 " - " 1,789.38 " " 3,281.25 " " 1,662.94 " " 1,956.94 " - 30608607 CATH INTRA ECHOCARDIO LVL019 C1759 278 "$4,625.00" " 1,709.40 " - " 4,164.33 " - " 3,195.88 " - " 3,195.88 " - " 2,555.31 " - " 3,052.50 " - - " 3,061.29 " - - " 3,331.46 " " 4,164.33 " - - - " 3,700.00 " - - " 3,098.75 " - " 1,891.63 " " 3,468.75 " " 1,757.96 " " 2,068.76 " - 30608615 CATH INTRA ECHOCARDIO LVL020 C1759 278 "$4,875.00" " 1,801.80 " - " 4,164.33 " - " 3,368.63 " - " 3,368.63 " - " 2,693.44 " - " 3,217.50 " - - " 3,226.76 " - - " 3,331.46 " " 4,164.33 " - - - " 3,900.00 " - - " 3,266.25 " - " 1,993.88 " " 3,656.25 " " 1,852.99 " " 2,180.59 " - 30608623 CATH INTRA ECHOCARDIO LVL021 C1759 278 "$5,125.00" " 1,894.20 " - " 4,164.33 " - " 3,541.38 " - " 3,541.38 " - " 2,831.56 " - " 3,382.50 " - - " 3,392.24 " - - " 3,331.46 " " 4,164.33 " - - - " 4,100.00 " - - " 3,433.75 " - " 2,096.13 " " 3,843.75 " " 1,948.01 " " 2,292.41 " - 30608631 CATH INTRA ECHOCARDIO LVL022 C1759 278 "$5,375.00" " 1,986.60 " - " 4,300.00 " - " 3,714.13 " - " 3,714.13 " - " 2,969.69 " - " 3,547.50 " - - " 3,557.71 " - - " 3,331.46 " " 4,164.33 " - - - " 4,300.00 " - - " 3,601.25 " - " 2,198.38 " " 4,031.25 " " 2,043.04 " " 2,404.24 " - 30608640 CATH INTRA ECHOCARDIO LVL023 C1759 278 "$5,625.00" " 2,079.00 " - " 4,500.00 " - " 3,886.88 " - " 3,886.88 " - " 3,107.81 " - " 3,712.50 " - - " 3,723.19 " - - " 3,331.46 " " 4,164.33 " - - - " 4,500.00 " - - " 3,768.75 " - " 2,300.63 " " 4,218.75 " " 2,138.06 " " 2,516.06 " - 30608658 CATH INTRA ECHOCARDIO LVL024 C1759 278 "$5,875.00" " 2,171.40 " - " 4,700.00 " - " 4,059.63 " - " 4,059.63 " - " 3,245.94 " - " 3,877.50 " - - " 3,888.66 " - - " 3,331.46 " " 4,164.33 " - - - " 4,700.00 " - - " 3,936.25 " - " 2,402.88 " " 4,406.25 " " 2,233.09 " " 2,627.89 " - 30608666 CATH INTRA ECHOCARDIO LVL035 C1759 278 "$8,625.00" " 3,187.80 " - " 6,900.00 " - " 5,959.88 " - " 5,959.88 " - " 4,765.31 " - " 5,692.50 " - - " 5,708.89 " - - " 3,331.46 " " 4,164.33 " - - - " 6,900.00 " - - " 5,778.75 " - " 3,527.63 " " 6,468.75 " " 3,278.36 " " 3,857.96 " - 30612981 CATH INTRA ECHOCARDIO LVL007 C1759 278 "$1,625.00" 600.60 - " 4,164.33 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - " 3,331.46 " " 4,164.33 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 30613210 CATH INTRA ECHOCARDIO LVL005 C1759 278 "$1,350.00" 498.96 - " 4,164.33 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - " 3,331.46 " " 4,164.33 " - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 30613228 CATH INTRA ECHOCARDIO LVL006 C1759 278 "$1,375.00" 508.20 - " 4,164.33 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - " 3,331.46 " " 4,164.33 " - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 30613236 CATH INTRA ECHOCARDIO LVL008 C1759 278 "$1,875.00" 693.00 - " 4,164.33 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - " 3,331.46 " " 4,164.33 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 30613244 CATH INTRA ECHOCARDIO LVL009 C1759 278 "$2,125.00" 785.40 - " 4,164.33 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - " 3,331.46 " " 4,164.33 " - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 30613252 CATH INTRA ECHOCARDIO LVL010 C1759 278 "$2,375.00" 877.80 - " 4,164.33 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - " 3,331.46 " " 4,164.33 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 30613261 CATH INTRA ECHOCARDIO LVL011 C1759 278 "$2,625.00" 970.20 - " 4,164.33 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - " 3,331.46 " " 4,164.33 " - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 30613279 CATH INTRA ECHOCARDIO LVL012 C1759 278 "$2,875.00" " 1,062.60 " - " 4,164.33 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - " 3,331.46 " " 4,164.33 " - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 30613287 CATH INTRA ECHOCARDIO LVL013 C1759 278 "$3,125.00" " 1,155.00 " - " 4,164.33 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - " 3,331.46 " " 4,164.33 " - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 30613295 CATH INTRA ECHOCARDIO LVL014 C1759 278 "$3,375.00" " 1,247.40 " - " 4,164.33 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - " 3,331.46 " " 4,164.33 " - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 28104961 CLOSURE DEV (VASC) LVL002 C1760 278 $450.00 166.32 - 874.91 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 699.93 874.91 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 28104979 CLOSURE DEV (VASC) LVL003 C1760 278 $750.00 277.20 - 874.91 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 699.93 874.91 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 28105070 CLOSURE DEV (VASC) LVL013 C1760 278 "$3,125.00" " 1,155.00 " - " 2,500.00 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - 699.93 874.91 - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 29814953 CLOSURE DEV VASC LVL001 C1760 278 $200.00 73.92 - 874.91 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 699.93 874.91 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 29814961 CLOSURE DEV VASC LVL002 C1760 278 $450.00 166.32 - 874.91 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 699.93 874.91 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 29814970 CLOSURE DEV VASC LVL003 C1760 278 $750.00 277.20 - 874.91 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 699.93 874.91 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 29815054 CLOSURE DEV VASC LVL004 C1760 278 "$1,050.00" 388.08 - 874.91 - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 699.93 874.91 - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 29815135 CLOSURE DEV VASC LVL005 C1760 278 "$1,350.00" 498.96 - " 1,080.00 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 699.93 874.91 - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 29815151 CLOSURE DEV VASC LVL006 C1760 278 "$1,375.00" 508.20 - " 1,100.00 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - 699.93 874.91 - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 29815267 CLOSURE DEV VASC LVL007 C1760 278 "$1,625.00" 600.60 - " 1,300.00 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - 699.93 874.91 - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 29815291 CLOSURE DEV VASC LVL008 C1760 278 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - 699.93 874.91 - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 29816794 CLOSURE DEV VASC LVL009 C1760 278 "$2,125.00" 785.40 - " 1,700.00 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - 699.93 874.91 - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 29816808 CLOSURE DEV VASC LVL010 C1760 278 "$2,375.00" 877.80 - " 1,900.00 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - 699.93 874.91 - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 29816816 CLOSURE DEV VASC LVL011 C1760 278 "$2,625.00" 970.20 - " 2,100.00 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - 699.93 874.91 - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 29816824 CLOSURE DEV VASC LVL012 C1760 278 "$2,875.00" " 1,062.60 " - " 2,300.00 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - 699.93 874.91 - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 29816832 CLOSURE DEV VASC LVL013 C1760 278 "$3,125.00" " 1,155.00 " - " 2,500.00 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - 699.93 874.91 - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 29816841 CLOSURE DEV VASC LVL014 C1760 278 "$3,375.00" " 1,247.40 " - " 2,700.00 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - 699.93 874.91 - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 29816859 CLOSURE DEV VASC LVL015 C1760 278 "$3,625.00" " 1,339.80 " - " 2,900.00 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - 699.93 874.91 - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 30612728 CLOSURE DEV VASC LVL001 C1760 278 $200.00 73.92 - 874.91 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 699.93 874.91 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 30612736 CLOSURE DEV VASC LVL002 C1760 278 $450.00 166.32 - 874.91 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 699.93 874.91 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 30612744 CLOSURE DEV VASC LVL003 C1760 278 $750.00 277.20 - 874.91 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 699.93 874.91 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 30613139 CLOSURE DEV VASC LVL004 C1760 278 "$1,050.00" 388.08 - 874.91 - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 699.93 874.91 - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 30613147 CLOSURE DEV VASC LVL005 C1760 278 "$1,350.00" 498.96 - " 1,080.00 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 699.93 874.91 - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 80361858 CLOSURE DEV VASC LVL001 C1760 278 $200.00 73.92 - 874.91 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 699.93 874.91 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 80361866 CLOSURE DEV VASC LVL002 C1760 278 $450.00 166.32 - 874.91 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 699.93 874.91 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 80361874 CLOSURE DEV VASC LVL003 C1760 278 $750.00 277.20 - 874.91 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 699.93 874.91 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 80361882 CLOSURE DEV VASC LVL004 C1760 278 "$1,050.00" 388.08 - 874.91 - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 699.93 874.91 - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 80361891 CLOSURE DEV VASC LVL005 C1760 278 "$1,350.00" 498.96 - " 1,080.00 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 699.93 874.91 - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 80361904 CLOSURE DEV VASC LVL006 C1760 278 "$1,375.00" 508.20 - " 1,100.00 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - 699.93 874.91 - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 80361912 CLOSURE DEV VASC LVL007 C1760 278 "$1,625.00" 600.60 - " 1,300.00 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - 699.93 874.91 - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 80361921 CLOSURE DEV VASC LVL008 C1760 278 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - 699.93 874.91 - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 29821321 CATH TRANS INTRA LITHO LVL047 C1761 278 "$11,625.00" " 4,296.60 " - " 9,300.00 " - " 8,032.88 " N/A " 8,032.88 " - " 6,422.81 " N/A " 7,672.50 " - N/A " 7,694.59 " - N/A " 6,160.09 " " 7,700.40 " N/A N/A N/A " 9,300.00 " N/A - " 7,788.75 " N/A " 4,754.63 " " 8,718.75 " " 4,418.66 " " 5,199.86 " N/A 28105142 CONN TIS HUMAN W/FASCIA LVL006 C1762 278 "$1,375.00" 508.20 - " 2,216.86 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - " 1,773.49 " " 2,216.86 " - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 28105185 CONN TIS HUMAN W/FASCIA LVL010 C1762 278 "$2,375.00" 877.80 - " 2,216.86 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - " 1,773.49 " " 2,216.86 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 28105193 CONN TIS HUMAN W/FASCIA LVL011 C1762 278 "$2,625.00" 970.20 - " 2,216.86 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - " 1,773.49 " " 2,216.86 " - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 28105207 CONN TIS HUMAN W/FASCIA LVL012 C1762 278 "$2,875.00" " 1,062.60 " - " 2,300.00 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - " 1,773.49 " " 2,216.86 " - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 28105215 CONN TIS HUMAN W/FASCIA LVL013 C1762 278 "$3,125.00" " 1,155.00 " - " 2,500.00 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - " 1,773.49 " " 2,216.86 " - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 28105231 CONN TIS HUMAN W/FASCIA LVL015 C1762 278 "$3,625.00" " 1,339.80 " - " 2,900.00 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - " 1,773.49 " " 2,216.86 " - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 28105240 CONN TIS HUMAN W/FASCIA LVL016 C1762 278 "$3,875.00" " 1,432.20 " - " 3,100.00 " - " 2,677.63 " - " 2,677.63 " - " 2,140.94 " - " 2,557.50 " - - " 2,564.86 " - - " 1,773.49 " " 2,216.86 " - - - " 3,100.00 " - - " 2,596.25 " - " 1,584.88 " " 2,906.25 " " 1,472.89 " " 1,733.29 " - 28105258 CONN TIS HUMAN W/FASCIA LVL017 C1762 278 "$4,125.00" " 1,524.60 " - " 3,300.00 " - " 2,850.38 " - " 2,850.38 " - " 2,279.06 " - " 2,722.50 " - - " 2,730.34 " - - " 1,773.49 " " 2,216.86 " - - - " 3,300.00 " - - " 2,763.75 " - " 1,687.13 " " 3,093.75 " " 1,567.91 " " 1,845.11 " - 28105274 CONN TIS HUMAN W/FASCIA LVL019 C1762 278 "$4,625.00" " 1,709.40 " - " 3,700.00 " - " 3,195.88 " - " 3,195.88 " - " 2,555.31 " - " 3,052.50 " - - " 3,061.29 " - - " 1,773.49 " " 2,216.86 " - - - " 3,700.00 " - - " 3,098.75 " - " 1,891.63 " " 3,468.75 " " 1,757.96 " " 2,068.76 " - 28105312 CONN TIS HUMAN W/FASCIA LVL023 C1762 278 "$5,625.00" " 2,079.00 " - " 4,500.00 " - " 3,886.88 " - " 3,886.88 " - " 3,107.81 " - " 3,712.50 " - - " 3,723.19 " - - " 1,773.49 " " 2,216.86 " - - - " 4,500.00 " - - " 3,768.75 " - " 2,300.63 " " 4,218.75 " " 2,138.06 " " 2,516.06 " - 28105347 CONN TIS HUMAN W/FASCIA LVL030 C1762 278 "$7,375.00" " 2,725.80 " - " 5,900.00 " - " 5,096.13 " - " 5,096.13 " - " 4,074.69 " - " 4,867.50 " - - " 4,881.51 " - - " 1,773.49 " " 2,216.86 " - - - " 5,900.00 " - - " 4,941.25 " - " 3,016.38 " " 5,531.25 " " 2,803.24 " " 3,298.84 " - 28105428 CONN TIS HUMAN W/FASCIA LVL038 C1762 278 "$9,375.00" " 3,465.00 " - " 7,500.00 " - " 6,478.13 " - " 6,478.13 " - " 5,179.69 " - " 6,187.50 " - - " 6,205.31 " - - " 1,773.49 " " 2,216.86 " - - - " 7,500.00 " - - " 6,281.25 " - " 3,834.38 " " 7,031.25 " " 3,563.44 " " 4,193.44 " - 28105479 CONN TIS HUMAN W/FASCIA LVL043 C1762 278 "$10,625.00" " 3,927.00 " - " 8,500.00 " - " 7,341.88 " - " 7,341.88 " - " 5,870.31 " - " 7,012.50 " - - " 7,032.69 " - - " 1,773.49 " " 2,216.86 " - - - " 8,500.00 " - - " 7,118.75 " - " 4,345.63 " " 7,968.75 " " 4,038.56 " " 4,752.56 " - 28123043 CONN TIS HUMAN W/FASCIA LVL027 C1762 278 "$6,625.00" " 2,448.60 " - " 5,300.00 " - " 4,577.88 " - " 4,577.88 " - " 3,660.31 " - " 4,372.50 " - - " 4,385.09 " - - " 1,773.49 " " 2,216.86 " - - - " 5,300.00 " - - " 4,438.75 " - " 2,709.63 " " 4,968.75 " " 2,518.16 " " 2,963.36 " - 28123060 CONN TIS HUMAN W/FASCIA LVL029 C1762 278 "$7,125.00" " 2,633.40 " - " 5,700.00 " - " 4,923.38 " - " 4,923.38 " - " 3,936.56 " - " 4,702.50 " - - " 4,716.04 " - - " 1,773.49 " " 2,216.86 " - - - " 5,700.00 " - - " 4,773.75 " - " 2,914.13 " " 5,343.75 " " 2,708.21 " " 3,187.01 " - 28123108 CONN TIS HUMAN W/FASCIA LVL047 C1762 278 "$11,625.00" " 4,296.60 " - " 9,300.00 " - " 8,032.88 " - " 8,032.88 " - " 6,422.81 " - " 7,672.50 " - - " 7,694.59 " - - " 1,773.49 " " 2,216.86 " - - - " 9,300.00 " - - " 7,788.75 " - " 4,754.63 " " 8,718.75 " " 4,418.66 " " 5,199.86 " - 28123132 CONN TIS HUMAN W/FASCIA LVL050 C1762 278 "$12,375.00" " 4,573.80 " - " 9,900.00 " - " 8,551.13 " - " 8,551.13 " - " 6,837.19 " - " 8,167.50 " - - " 8,191.01 " - - " 1,773.49 " " 2,216.86 " - - - " 9,900.00 " - - " 8,291.25 " - " 5,061.38 " " 9,281.25 " " 4,703.74 " " 5,535.34 " - 28123400 CONN TIS HUMAN W/FASCIA LVL077 C1762 278 "$19,125.00" " 7,068.60 " - " 15,300.00 " - " 13,215.38 " - " 13,215.38 " - " 10,566.56 " - " 12,622.50 " - - " 12,658.84 " - - " 1,773.49 " " 2,216.86 " - - - " 15,300.00 " - - " 12,813.75 " - " 7,822.13 " " 14,343.75 " " 7,269.41 " " 8,554.61 " - 28105622 CONN TISS NON-HUMANLVL013 C1763 278 "$3,125.00" " 1,155.00 " - " 2,500.00 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - " 1,484.99 " " 1,856.24 " - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 29818894 EVENT RECORD CARD IMP LVL050 C1764 278 "$12,375.00" " 4,573.80 " - " 9,900.00 " - " 8,551.13 " - " 8,551.13 " - " 6,837.19 " - " 8,167.50 " - - " 8,191.01 " - - " 7,011.14 " " 8,763.93 " - - - " 9,900.00 " - - " 8,291.25 " - " 5,061.38 " " 9,281.25 " " 4,703.74 " " 5,535.34 " - 29818908 EVENT RECORD CARD IMP LVL051 C1764 278 "$12,625.00" " 4,666.20 " - " 10,100.00 " - " 8,723.88 " - " 8,723.88 " - " 6,975.31 " - " 8,332.50 " - - " 8,356.49 " - - " 7,011.14 " " 8,763.93 " - - - " 10,100.00 " - - " 8,458.75 " - " 5,163.63 " " 9,468.75 " " 4,798.76 " " 5,647.16 " - 29818916 EVENT RECORD CARD IMP LVL052 C1764 278 "$12,875.00" " 4,758.60 " - " 10,300.00 " - " 8,896.63 " - " 8,896.63 " - " 7,113.44 " - " 8,497.50 " - - " 8,521.96 " - - " 7,011.14 " " 8,763.93 " - - - " 10,300.00 " - - " 8,626.25 " - " 5,265.88 " " 9,656.25 " " 4,893.79 " " 5,758.99 " - 29818924 EVENT RECORD CARD IMP LVL053 C1764 278 "$13,125.00" " 4,851.00 " - " 10,500.00 " - " 9,069.38 " - " 9,069.38 " - " 7,251.56 " - " 8,662.50 " - - " 8,687.44 " - - " 7,011.14 " " 8,763.93 " - - - " 10,500.00 " - - " 8,793.75 " - " 5,368.13 " " 9,843.75 " " 4,988.81 " " 5,870.81 " - 29818932 EVENT RECORD CARD IMP LVL054 C1764 278 "$13,375.00" " 4,943.40 " - " 10,700.00 " - " 9,242.13 " - " 9,242.13 " - " 7,389.69 " - " 8,827.50 " - - " 8,852.91 " - - " 7,011.14 " " 8,763.93 " - - - " 10,700.00 " - - " 8,961.25 " - " 5,470.38 " " 10,031.25 " " 5,083.84 " " 5,982.64 " - 29818941 EVENT RECORD CARD IMP LVL055 C1764 278 "$13,625.00" " 5,035.80 " - " 10,900.00 " - " 9,414.88 " - " 9,414.88 " - " 7,527.81 " - " 8,992.50 " - - " 9,018.39 " - - " 7,011.14 " " 8,763.93 " - - - " 10,900.00 " - - " 9,128.75 " - " 5,572.63 " " 10,218.75 " " 5,178.86 " " 6,094.46 " - 30604695 EVENT RECORD CARD IMP LVL032 C1764 278 "$7,875.00" " 2,910.60 " - " 8,763.93 " - " 5,441.63 " - " 5,441.63 " - " 4,350.94 " - " 5,197.50 " - - " 5,212.46 " - - " 7,011.14 " " 8,763.93 " - - - " 6,300.00 " - - " 5,276.25 " - " 3,220.88 " " 5,906.25 " " 2,993.29 " " 3,522.49 " - 30604709 EVENT RECORD CARD IMP LVL033 C1764 278 "$8,125.00" " 3,003.00 " - " 8,763.93 " - " 5,614.38 " - " 5,614.38 " - " 4,489.06 " - " 5,362.50 " - - " 5,377.94 " - - " 7,011.14 " " 8,763.93 " - - - " 6,500.00 " - - " 5,443.75 " - " 3,323.13 " " 6,093.75 " " 3,088.31 " " 3,634.31 " - 30604717 EVENT RECORD CARD IMP LVL034 C1764 278 "$8,375.00" " 3,095.40 " - " 8,763.93 " - " 5,787.13 " - " 5,787.13 " - " 4,627.19 " - " 5,527.50 " - - " 5,543.41 " - - " 7,011.14 " " 8,763.93 " - - - " 6,700.00 " - - " 5,611.25 " - " 3,425.38 " " 6,281.25 " " 3,183.34 " " 3,746.14 " - 30604725 EVENT RECORD CARD IMP LVL035 C1764 278 "$8,625.00" " 3,187.80 " - " 8,763.93 " - " 5,959.88 " - " 5,959.88 " - " 4,765.31 " - " 5,692.50 " - - " 5,708.89 " - - " 7,011.14 " " 8,763.93 " - - - " 6,900.00 " - - " 5,778.75 " - " 3,527.63 " " 6,468.75 " " 3,278.36 " " 3,857.96 " - 30604733 EVENT RECORD CARD IMP LVL050 C1764 278 "$12,375.00" " 4,573.80 " - " 9,900.00 " - " 8,551.13 " - " 8,551.13 " - " 6,837.19 " - " 8,167.50 " - - " 8,191.01 " - - " 7,011.14 " " 8,763.93 " - - - " 9,900.00 " - - " 8,291.25 " - " 5,061.38 " " 9,281.25 " " 4,703.74 " " 5,535.34 " - 30604741 EVENT RECORD CARD IMP LVL051 C1764 278 "$12,625.00" " 4,666.20 " - " 10,100.00 " - " 8,723.88 " - " 8,723.88 " - " 6,975.31 " - " 8,332.50 " - - " 8,356.49 " - - " 7,011.14 " " 8,763.93 " - - - " 10,100.00 " - - " 8,458.75 " - " 5,163.63 " " 9,468.75 " " 4,798.76 " " 5,647.16 " - 30608674 EVENT RECORD CARD IMP LVL025 C1764 278 "$6,125.00" " 2,263.80 " - " 8,763.93 " - " 4,232.38 " - " 4,232.38 " - " 3,384.06 " - " 4,042.50 " - - " 4,054.14 " - - " 7,011.14 " " 8,763.93 " - - - " 4,900.00 " - - " 4,103.75 " - " 2,505.13 " " 4,593.75 " " 2,328.11 " " 2,739.71 " - 30608682 EVENT RECORD CARD IMP LVL026 C1764 278 "$6,375.00" " 2,356.20 " - " 8,763.93 " - " 4,405.13 " - " 4,405.13 " - " 3,522.19 " - " 4,207.50 " - - " 4,219.61 " - - " 7,011.14 " " 8,763.93 " - - - " 5,100.00 " - - " 4,271.25 " - " 2,607.38 " " 4,781.25 " " 2,423.14 " " 2,851.54 " - 30608691 EVENT RECORD CARD IMP LVL027 C1764 278 "$6,625.00" " 2,448.60 " - " 8,763.93 " - " 4,577.88 " - " 4,577.88 " - " 3,660.31 " - " 4,372.50 " - - " 4,385.09 " - - " 7,011.14 " " 8,763.93 " - - - " 5,300.00 " - - " 4,438.75 " - " 2,709.63 " " 4,968.75 " " 2,518.16 " " 2,963.36 " - 30608704 EVENT RECORD CARD IMP LVL028 C1764 278 "$6,875.00" " 2,541.00 " - " 8,763.93 " - " 4,750.63 " - " 4,750.63 " - " 3,798.44 " - " 4,537.50 " - - " 4,550.56 " - - " 7,011.14 " " 8,763.93 " - - - " 5,500.00 " - - " 4,606.25 " - " 2,811.88 " " 5,156.25 " " 2,613.19 " " 3,075.19 " - 30608712 EVENT RECORD CARD IMP LVL029 C1764 278 "$7,125.00" " 2,633.40 " - " 8,763.93 " - " 4,923.38 " - " 4,923.38 " - " 3,936.56 " - " 4,702.50 " - - " 4,716.04 " - - " 7,011.14 " " 8,763.93 " - - - " 5,700.00 " - - " 4,773.75 " - " 2,914.13 " " 5,343.75 " " 2,708.21 " " 3,187.01 " - 30608721 EVENT RECORD CARD IMP LVL030 C1764 278 "$7,375.00" " 2,725.80 " - " 8,763.93 " - " 5,096.13 " - " 5,096.13 " - " 4,074.69 " - " 4,867.50 " - - " 4,881.51 " - - " 7,011.14 " " 8,763.93 " - - - " 5,900.00 " - - " 4,941.25 " - " 3,016.38 " " 5,531.25 " " 2,803.24 " " 3,298.84 " - 30608739 EVENT RECORD CARD IMP LVL031 C1764 278 "$7,625.00" " 2,818.20 " - " 8,763.93 " - " 5,268.88 " - " 5,268.88 " - " 4,212.81 " - " 5,032.50 " - - " 5,046.99 " - - " 7,011.14 " " 8,763.93 " - - - " 6,100.00 " - - " 5,108.75 " - " 3,118.63 " " 5,718.75 " " 2,898.26 " " 3,410.66 " - 30608747 EVENT RECORD CARD IMP LVL036 C1764 278 "$8,875.00" " 3,280.20 " - " 8,763.93 " - " 6,132.63 " - " 6,132.63 " - " 4,903.44 " - " 5,857.50 " - - " 5,874.36 " - - " 7,011.14 " " 8,763.93 " - - - " 7,100.00 " - - " 5,946.25 " - " 3,629.88 " " 6,656.25 " " 3,373.39 " " 3,969.79 " - 30608755 EVENT RECORD CARD IMP LVL037 C1764 278 "$9,125.00" " 3,372.60 " - " 8,763.93 " - " 6,305.38 " - " 6,305.38 " - " 5,041.56 " - " 6,022.50 " - - " 6,039.84 " - - " 7,011.14 " " 8,763.93 " - - - " 7,300.00 " - - " 6,113.75 " - " 3,732.13 " " 6,843.75 " " 3,468.41 " " 4,081.61 " - 30608763 EVENT RECORD CARD IMP LVL038 C1764 278 "$9,375.00" " 3,465.00 " - " 8,763.93 " - " 6,478.13 " - " 6,478.13 " - " 5,179.69 " - " 6,187.50 " - - " 6,205.31 " - - " 7,011.14 " " 8,763.93 " - - - " 7,500.00 " - - " 6,281.25 " - " 3,834.38 " " 7,031.25 " " 3,563.44 " " 4,193.44 " - 30608771 EVENT RECORD CARD IMP LVL039 C1764 278 "$9,625.00" " 3,557.40 " - " 8,763.93 " - " 6,650.88 " - " 6,650.88 " - " 5,317.81 " - " 6,352.50 " - - " 6,370.79 " - - " 7,011.14 " " 8,763.93 " - - - " 7,700.00 " - - " 6,448.75 " - " 3,936.63 " " 7,218.75 " " 3,658.46 " " 4,305.26 " - 30608780 EVENT RECORD CARD IMP LVL040 C1764 278 "$9,875.00" " 3,649.80 " - " 8,763.93 " - " 6,823.63 " - " 6,823.63 " - " 5,455.94 " - " 6,517.50 " - - " 6,536.26 " - - " 7,011.14 " " 8,763.93 " - - - " 7,900.00 " - - " 6,616.25 " - " 4,038.88 " " 7,406.25 " " 3,753.49 " " 4,417.09 " - 30608798 EVENT RECORD CARD IMP LVL041 C1764 278 "$10,125.00" " 3,742.20 " - " 8,763.93 " - " 6,996.38 " - " 6,996.38 " - " 5,594.06 " - " 6,682.50 " - - " 6,701.74 " - - " 7,011.14 " " 8,763.93 " - - - " 8,100.00 " - - " 6,783.75 " - " 4,141.13 " " 7,593.75 " " 3,848.51 " " 4,528.91 " - 30608801 EVENT RECORD CARD IMP LVL042 C1764 278 "$10,375.00" " 3,834.60 " - " 8,763.93 " - " 7,169.13 " - " 7,169.13 " - " 5,732.19 " - " 6,847.50 " - - " 6,867.21 " - - " 7,011.14 " " 8,763.93 " - - - " 8,300.00 " - - " 6,951.25 " - " 4,243.38 " " 7,781.25 " " 3,943.54 " " 4,640.74 " - 30608810 EVENT RECORD CARD IMP LVL043 C1764 278 "$10,625.00" " 3,927.00 " - " 8,763.93 " - " 7,341.88 " - " 7,341.88 " - " 5,870.31 " - " 7,012.50 " - - " 7,032.69 " - - " 7,011.14 " " 8,763.93 " - - - " 8,500.00 " - - " 7,118.75 " - " 4,345.63 " " 7,968.75 " " 4,038.56 " " 4,752.56 " - 30608828 EVENT RECORD CARD IMP LVL044 C1764 278 "$10,875.00" " 4,019.40 " - " 8,763.93 " - " 7,514.63 " - " 7,514.63 " - " 6,008.44 " - " 7,177.50 " - - " 7,198.16 " - - " 7,011.14 " " 8,763.93 " - - - " 8,700.00 " - - " 7,286.25 " - " 4,447.88 " " 8,156.25 " " 4,133.59 " " 4,864.39 " - 30608836 EVENT RECORD CARD IMP LVL045 C1764 278 "$11,125.00" " 4,111.80 " - " 8,900.00 " - " 7,687.38 " - " 7,687.38 " - " 6,146.56 " - " 7,342.50 " - - " 7,363.64 " - - " 7,011.14 " " 8,763.93 " - - - " 8,900.00 " - - " 7,453.75 " - " 4,550.13 " " 8,343.75 " " 4,228.61 " " 4,976.21 " - 30608844 EVENT RECORD CARD IMP LVL046 C1764 278 "$11,375.00" " 4,204.20 " - " 9,100.00 " - " 7,860.13 " - " 7,860.13 " - " 6,284.69 " - " 7,507.50 " - - " 7,529.11 " - - " 7,011.14 " " 8,763.93 " - - - " 9,100.00 " - - " 7,621.25 " - " 4,652.38 " " 8,531.25 " " 4,323.64 " " 5,088.04 " - 30608852 EVENT RECORD CARD IMP LVL047 C1764 278 "$11,625.00" " 4,296.60 " - " 9,300.00 " - " 8,032.88 " - " 8,032.88 " - " 6,422.81 " - " 7,672.50 " - - " 7,694.59 " - - " 7,011.14 " " 8,763.93 " - - - " 9,300.00 " - - " 7,788.75 " - " 4,754.63 " " 8,718.75 " " 4,418.66 " " 5,199.86 " - 30608861 EVENT RECORD CARD IMP LVL048 C1764 278 "$11,875.00" " 4,389.00 " - " 9,500.00 " - " 8,205.63 " - " 8,205.63 " - " 6,560.94 " - " 7,837.50 " - - " 7,860.06 " - - " 7,011.14 " " 8,763.93 " - - - " 9,500.00 " - - " 7,956.25 " - " 4,856.88 " " 8,906.25 " " 4,513.69 " " 5,311.69 " - 30608879 EVENT RECORD CARD IMP LVL049 C1764 278 "$12,125.00" " 4,481.40 " - " 9,700.00 " - " 8,378.38 " - " 8,378.38 " - " 6,699.06 " - " 8,002.50 " - - " 8,025.54 " - - " 7,011.14 " " 8,763.93 " - - - " 9,700.00 " - - " 8,123.75 " - " 4,959.13 " " 9,093.75 " " 4,608.71 " " 5,423.51 " - 30608887 EVENT RECORD CARD IMP LVL052 C1764 278 "$12,875.00" " 4,758.60 " - " 10,300.00 " - " 8,896.63 " - " 8,896.63 " - " 7,113.44 " - " 8,497.50 " - - " 8,521.96 " - - " 7,011.14 " " 8,763.93 " - - - " 10,300.00 " - - " 8,626.25 " - " 5,265.88 " " 9,656.25 " " 4,893.79 " " 5,758.99 " - 30608895 EVENT RECORD CARD IMP LVL053 C1764 278 "$13,125.00" " 4,851.00 " - " 10,500.00 " - " 9,069.38 " - " 9,069.38 " - " 7,251.56 " - " 8,662.50 " - - " 8,687.44 " - - " 7,011.14 " " 8,763.93 " - - - " 10,500.00 " - - " 8,793.75 " - " 5,368.13 " " 9,843.75 " " 4,988.81 " " 5,870.81 " - 30608909 EVENT RECORD CARD IMP LVL054 C1764 278 "$13,375.00" " 4,943.40 " - " 10,700.00 " - " 9,242.13 " - " 9,242.13 " - " 7,389.69 " - " 8,827.50 " - - " 8,852.91 " - - " 7,011.14 " " 8,763.93 " - - - " 10,700.00 " - - " 8,961.25 " - " 5,470.38 " " 10,031.25 " " 5,083.84 " " 5,982.64 " - 30608917 EVENT RECORD CARD IMP LVL055 C1764 278 "$13,625.00" " 5,035.80 " - " 10,900.00 " - " 9,414.88 " - " 9,414.88 " - " 7,527.81 " - " 8,992.50 " - - " 9,018.39 " - - " 7,011.14 " " 8,763.93 " - - - " 10,900.00 " - - " 9,128.75 " - " 5,572.63 " " 10,218.75 " " 5,178.86 " " 6,094.46 " - 30608925 EVENT RECORD CARD IMP LVL056 C1764 278 "$13,875.00" " 5,128.20 " - " 11,100.00 " - " 9,587.63 " - " 9,587.63 " - " 7,665.94 " - " 9,157.50 " - - " 9,183.86 " - - " 7,011.14 " " 8,763.93 " - - - " 11,100.00 " - - " 9,296.25 " - " 5,674.88 " " 10,406.25 " " 5,273.89 " " 6,206.29 " - 30608933 EVENT RECORD CARD IMP LVL057 C1764 278 "$14,125.00" " 5,220.60 " - " 11,300.00 " - " 9,760.38 " - " 9,760.38 " - " 7,804.06 " - " 9,322.50 " - - " 9,349.34 " - - " 7,011.14 " " 8,763.93 " - - - " 11,300.00 " - - " 9,463.75 " - " 5,777.13 " " 10,593.75 " " 5,368.91 " " 6,318.11 " - 30608941 EVENT RECORD CARD IMP LVL058 C1764 278 "$14,375.00" " 5,313.00 " - " 11,500.00 " - " 9,933.13 " - " 9,933.13 " - " 7,942.19 " - " 9,487.50 " - - " 9,514.81 " - - " 7,011.14 " " 8,763.93 " - - - " 11,500.00 " - - " 9,631.25 " - " 5,879.38 " " 10,781.25 " " 5,463.94 " " 6,429.94 " - 30608950 EVENT RECORD CARD IMP LVL059 C1764 278 "$14,625.00" " 5,405.40 " - " 11,700.00 " - " 10,105.88 " - " 10,105.88 " - " 8,080.31 " - " 9,652.50 " - - " 9,680.29 " - - " 7,011.14 " " 8,763.93 " - - - " 11,700.00 " - - " 9,798.75 " - " 5,981.63 " " 10,968.75 " " 5,558.96 " " 6,541.76 " - 30608968 EVENT RECORD CARD IMP LVL060 C1764 278 "$14,875.00" " 5,497.80 " - " 11,900.00 " - " 10,278.63 " - " 10,278.63 " - " 8,218.44 " - " 9,817.50 " - - " 9,845.76 " - - " 7,011.14 " " 8,763.93 " - - - " 11,900.00 " - - " 9,966.25 " - " 6,083.88 " " 11,156.25 " " 5,653.99 " " 6,653.59 " - 28101287 ADHESION BARRIER LVL001 C1765 278 $200.00 73.92 - 486.80 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 389.44 486.80 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 28101295 ADHESION BARRIER LVL002 C1765 278 $450.00 166.32 - 486.80 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 389.44 486.80 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 28101309 ADHESION BARRIER LVL003 C1765 278 $750.00 277.20 - 600.00 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 389.44 486.80 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 28101317 ADHESION BARRIER LVL004 C1765 278 "$1,050.00" 388.08 - 840.00 - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 389.44 486.80 - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 28101350 ADHESION BARRIER LVL008 C1765 278 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - 389.44 486.80 - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 28101376 ADHESION BARRIER LVL010 C1765 278 "$2,375.00" 877.80 - " 1,900.00 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - 389.44 486.80 - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 28101392 ADHESION BARRIER LVL012 C1765 278 "$2,875.00" " 1,062.60 " - " 2,300.00 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - 389.44 486.80 - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 28101406 ADHESION BARRIER LVL013 C1765 278 "$3,125.00" " 1,155.00 " - " 2,500.00 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - 389.44 486.80 - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 28101414 ADHESION BARRIER LVL014 C1765 278 "$3,375.00" " 1,247.40 " - " 2,700.00 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - 389.44 486.80 - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 28124015 ADHESION BARRIER LVL020 C1765 278 "$4,875.00" " 1,801.80 " - " 3,900.00 " - " 3,368.63 " - " 3,368.63 " - " 2,693.44 " - " 3,217.50 " - - " 3,226.76 " - - 389.44 486.80 - - - " 3,900.00 " - - " 3,266.25 " - " 1,993.88 " " 3,656.25 " " 1,852.99 " " 2,180.59 " - 29817987 INT SHTH STRBL N-PEEL LVL001 C1766 278 $200.00 73.92 - 222.44 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 177.95 222.44 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 29817995 INT SHTH STRBL N-PEEL LVL002 C1766 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 177.95 222.44 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 29818002 INT SHTH STRBL N-PEEL LVL003 C1766 278 $750.00 277.20 - 600.00 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 177.95 222.44 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 29820139 INT SHTH STRBL N-PEEL LVL004 C1766 278 "$1,050.00" 388.08 - 840.00 - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 177.95 222.44 - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 29820147 INT SHTH STRBL N-PEEL LVL005 C1766 278 "$1,350.00" 498.96 - " 1,080.00 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 177.95 222.44 - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 29820155 INT SHTH STRBL N-PEEL LVL006 C1766 278 "$1,375.00" 508.20 - " 1,100.00 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - 177.95 222.44 - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 29820163 INT SHTH STRBL N-PEEL LVL007 C1766 278 "$1,625.00" 600.60 - " 1,300.00 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - 177.95 222.44 - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 29820171 INT SHTH STRBL N-PEEL LVL008 C1766 278 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - 177.95 222.44 - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 29820180 INT SHTH STRBL N-PEEL LVL009 C1766 278 "$2,125.00" 785.40 - " 1,700.00 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - 177.95 222.44 - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 29820198 INT SHTH STRBL N-PEEL LVL010 C1766 278 "$2,375.00" 877.80 - " 1,900.00 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - 177.95 222.44 - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 30606582 INT SHTH STRBL N-PEEL LVL001 C1766 278 $200.00 73.92 - 222.44 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 177.95 222.44 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 30606591 INT SHTH STRBL N-PEEL LVL002 C1766 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 177.95 222.44 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 30606604 INT SHTH STRBL N-PEEL LVL003 C1766 278 $750.00 277.20 - 600.00 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 177.95 222.44 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 30606612 INT SHTH STRBL N-PEEL LVL004 C1766 278 "$1,050.00" 388.08 - 840.00 - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 177.95 222.44 - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 30606621 INT SHTH STRBL N-PEEL LVL009 C1766 278 "$2,125.00" 785.40 - " 1,700.00 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - 177.95 222.44 - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 30606639 INT SHTH STRBL N-PEEL LVL010 C1766 278 "$2,375.00" 877.80 - " 1,900.00 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - 177.95 222.44 - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 30606647 INT SHTH STRBL N-PEEL LVL011 C1766 278 "$2,625.00" 970.20 - " 2,100.00 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - 177.95 222.44 - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 30606655 INT SHTH STRBL N-PEEL LVL012 C1766 278 "$2,875.00" " 1,062.60 " - " 2,300.00 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - 177.95 222.44 - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 30606663 INT SHTH STRBL N-PEEL LVL013 C1766 278 "$3,125.00" " 1,155.00 " - " 2,500.00 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - 177.95 222.44 - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 30606671 INT SHTH STRBL N-PEEL LVL014 C1766 278 "$3,375.00" " 1,247.40 " - " 2,700.00 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - 177.95 222.44 - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 30608976 INT SHTH STRBL N-PEEL LVL005 C1766 278 "$1,350.00" 498.96 - " 1,080.00 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 177.95 222.44 - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 30608984 INT SHTH STRBL N-PEEL LVL006 C1766 278 "$1,375.00" 508.20 - " 1,100.00 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - 177.95 222.44 - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 30608992 INT SHTH STRBL N-PEEL LVL007 C1766 278 "$1,625.00" 600.60 - " 1,300.00 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - 177.95 222.44 - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 30609000 INT SHTH STRBL N-PEEL LVL008 C1766 278 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - 177.95 222.44 - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 30609018 INT SHTH STRBL N-PEEL LVL015 C1766 278 "$3,625.00" " 1,339.80 " - " 2,900.00 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - 177.95 222.44 - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 30609026 INT SHTH STRBL N-PEEL LVL016 C1766 278 "$3,875.00" " 1,432.20 " - " 3,100.00 " - " 2,677.63 " - " 2,677.63 " - " 2,140.94 " - " 2,557.50 " - - " 2,564.86 " - - 177.95 222.44 - - - " 3,100.00 " - - " 2,596.25 " - " 1,584.88 " " 2,906.25 " " 1,472.89 " " 1,733.29 " - 30609034 INT SHTH STRBL N-PEEL LVL017 C1766 278 "$4,125.00" " 1,524.60 " - " 3,300.00 " - " 2,850.38 " - " 2,850.38 " - " 2,279.06 " - " 2,722.50 " - - " 2,730.34 " - - 177.95 222.44 - - - " 3,300.00 " - - " 2,763.75 " - " 1,687.13 " " 3,093.75 " " 1,567.91 " " 1,845.11 " - 30609042 INT SHTH STRBL N-PEEL LVL018 C1766 278 "$4,375.00" " 1,617.00 " - " 3,500.00 " - " 3,023.13 " - " 3,023.13 " - " 2,417.19 " - " 2,887.50 " - - " 2,895.81 " - - 177.95 222.44 - - - " 3,500.00 " - - " 2,931.25 " - " 1,789.38 " " 3,281.25 " " 1,662.94 " " 1,956.94 " - 30609051 INT SHTH STRBL N-PEEL LVL019 C1766 278 "$4,625.00" " 1,709.40 " - " 3,700.00 " - " 3,195.88 " - " 3,195.88 " - " 2,555.31 " - " 3,052.50 " - - " 3,061.29 " - - 177.95 222.44 - - - " 3,700.00 " - - " 3,098.75 " - " 1,891.63 " " 3,468.75 " " 1,757.96 " " 2,068.76 " - 30609069 INT SHTH STRBL N-PEEL LVL020 C1766 278 "$4,875.00" " 1,801.80 " - " 3,900.00 " - " 3,368.63 " - " 3,368.63 " - " 2,693.44 " - " 3,217.50 " - - " 3,226.76 " - - 177.95 222.44 - - - " 3,900.00 " - - " 3,266.25 " - " 1,993.88 " " 3,656.25 " " 1,852.99 " " 2,180.59 " - 28106793 GEN NEURO N-RCHG IMP LVL100 C1767 278 "$24,875.00" " 9,193.80 " - " 35,533.96 " - " 17,188.63 " - " 17,188.63 " - " 13,743.44 " - " 16,417.50 " - - " 16,464.76 " - - " 28,427.17 " " 35,533.96 " - - - " 19,900.00 " - - " 16,666.25 " - " 10,173.88 " " 18,656.25 " " 9,454.99 " " 11,126.59 " - 28106807 GEN NEURO N-RCHG IMP LVL108 C1767 278 "$26,875.00" " 9,933.00 " - " 35,533.96 " - " 18,570.63 " - " 18,570.63 " - " 14,848.44 " - " 17,737.50 " - - " 17,788.56 " - - " 28,427.17 " " 35,533.96 " - - - " 21,500.00 " - - " 18,006.25 " - " 10,991.88 " " 20,156.25 " " 10,215.19 " " 12,021.19 " - 28106858 GEN NEURO N-RCHG IMP LVL113 C1767 278 "$28,125.00" " 10,395.00 " - " 35,533.96 " - " 19,434.38 " - " 19,434.38 " - " 15,539.06 " - " 18,562.50 " - - " 18,615.94 " - - " 28,427.17 " " 35,533.96 " - - - " 22,500.00 " - - " 18,843.75 " - " 11,503.13 " " 21,093.75 " " 10,690.31 " " 12,580.31 " - 28107161 GEN NEURO N-RCHG IMP LVL164 C1767 278 "$40,875.00" " 15,107.40 " - " 35,533.96 " - " 28,244.63 " - " 28,244.63 " - " 22,583.44 " - " 26,977.50 " - - " 27,055.16 " - - " 28,427.17 " " 35,533.96 " - - - " 32,700.00 " - - " 27,386.25 " - " 16,717.88 " " 30,656.25 " " 15,536.59 " " 18,283.39 " - 28124830 GEN NEURO N-RCHG IMP LVL181 C1767 278 "$45,125.00" " 16,678.20 " - " 36,100.00 " - " 31,181.38 " - " 31,181.38 " - " 24,931.56 " - " 29,782.50 " - - " 29,868.24 " - - " 28,427.17 " " 35,533.96 " - - - " 36,100.00 " - - " 30,233.75 " - " 18,456.13 " " 33,843.75 " " 17,152.01 " " 20,184.41 " - 28156464 GEN NEURO N-RCHG IMP LVL280 C1767 278 "$69,875.00" " 25,825.80 " - " 55,900.00 " - " 48,283.63 " - " 48,283.63 " - " 38,605.94 " - " 46,117.50 " - - " 46,250.26 " - - " 28,427.17 " " 35,533.96 " - - - " 55,900.00 " - - " 46,816.25 " - " 28,578.88 " " 52,406.25 " " 26,559.49 " " 31,255.09 " - 28162286 GEN NEURO N-RCHG IMP LVL309 C1767 278 "$77,125.00" " 28,505.40 " - " 61,700.00 " - " 53,293.38 " - " 53,293.38 " - " 42,611.56 " - " 50,902.50 " - - " 51,049.04 " - - " 28,427.17 " " 35,533.96 " - - - " 61,700.00 " - - " 51,673.75 " - " 31,544.13 " " 57,843.75 " " 29,315.21 " " 34,498.01 " - 28107587 GRAFT VASC IMP LVL001 C1768 278 $200.00 73.92 - " 2,364.65 " - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - " 1,891.72 " " 2,364.65 " - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 28107595 GRAFT VASC IMP LVL002 C1768 278 $450.00 166.32 - " 2,364.65 " - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - " 1,891.72 " " 2,364.65 " - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 28107609 GRAFT VASC IMP LVL003 C1768 278 $750.00 277.20 - " 2,364.65 " - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - " 1,891.72 " " 2,364.65 " - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 28107633 GRAFT VASC IMP LVL006 C1768 278 "$1,375.00" 508.20 - " 2,364.65 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - " 1,891.72 " " 2,364.65 " - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 28107641 GRAFT VASC IMP LVL007 C1768 278 "$1,625.00" 600.60 - " 2,364.65 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - " 1,891.72 " " 2,364.65 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 28107650 GRAFT VASC IMP LVL008 C1768 278 "$1,875.00" 693.00 - " 2,364.65 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - " 1,891.72 " " 2,364.65 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 28107668 GRAFT VASC IMP LVL009 C1768 278 "$2,125.00" 785.40 - " 2,364.65 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - " 1,891.72 " " 2,364.65 " - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 28107676 GRAFT VASC IMP LVL010 C1768 278 "$2,375.00" 877.80 - " 2,364.65 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - " 1,891.72 " " 2,364.65 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 28107722 GRAFT VASC IMP LVL015 C1768 278 "$3,625.00" " 1,339.80 " - " 2,900.00 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - " 1,891.72 " " 2,364.65 " - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 28107731 GRAFT VASC IMP LVL016 C1768 278 "$3,875.00" " 1,432.20 " - " 3,100.00 " - " 2,677.63 " - " 2,677.63 " - " 2,140.94 " - " 2,557.50 " - - " 2,564.86 " - - " 1,891.72 " " 2,364.65 " - - - " 3,100.00 " - - " 2,596.25 " - " 1,584.88 " " 2,906.25 " " 1,472.89 " " 1,733.29 " - 28107749 GRAFT VASC IMP LVL017 C1768 278 "$4,125.00" " 1,524.60 " - " 3,300.00 " - " 2,850.38 " - " 2,850.38 " - " 2,279.06 " - " 2,722.50 " - - " 2,730.34 " - - " 1,891.72 " " 2,364.65 " - - - " 3,300.00 " - - " 2,763.75 " - " 1,687.13 " " 3,093.75 " " 1,567.91 " " 1,845.11 " - 28107757 GRAFT VASC IMP LVL018 C1768 278 "$4,375.00" " 1,617.00 " - " 3,500.00 " - " 3,023.13 " - " 3,023.13 " - " 2,417.19 " - " 2,887.50 " - - " 2,895.81 " - - " 1,891.72 " " 2,364.65 " - - - " 3,500.00 " - - " 2,931.25 " - " 1,789.38 " " 3,281.25 " " 1,662.94 " " 1,956.94 " - 28107765 GRAFT VASC IMP LVL019 C1768 278 "$4,625.00" " 1,709.40 " - " 3,700.00 " - " 3,195.88 " - " 3,195.88 " - " 2,555.31 " - " 3,052.50 " - - " 3,061.29 " - - " 1,891.72 " " 2,364.65 " - - - " 3,700.00 " - - " 3,098.75 " - " 1,891.63 " " 3,468.75 " " 1,757.96 " " 2,068.76 " - 28107781 GRAFT VASC IMP LVL021 C1768 278 "$5,125.00" " 1,894.20 " - " 4,100.00 " - " 3,541.38 " - " 3,541.38 " - " 2,831.56 " - " 3,382.50 " - - " 3,392.24 " - - " 1,891.72 " " 2,364.65 " - - - " 4,100.00 " - - " 3,433.75 " - " 2,096.13 " " 3,843.75 " " 1,948.01 " " 2,292.41 " - 28107790 GRAFT VASC IMP LVL022 C1768 278 "$5,375.00" " 1,986.60 " - " 4,300.00 " - " 3,714.13 " - " 3,714.13 " - " 2,969.69 " - " 3,547.50 " - - " 3,557.71 " - - " 1,891.72 " " 2,364.65 " - - - " 4,300.00 " - - " 3,601.25 " - " 2,198.38 " " 4,031.25 " " 2,043.04 " " 2,404.24 " - 28107811 GRAFT VASC IMP LVL024 C1768 278 "$5,875.00" " 2,171.40 " - " 4,700.00 " - " 4,059.63 " - " 4,059.63 " - " 3,245.94 " - " 3,877.50 " - - " 3,888.66 " - - " 1,891.72 " " 2,364.65 " - - - " 4,700.00 " - - " 3,936.25 " - " 2,402.88 " " 4,406.25 " " 2,233.09 " " 2,627.89 " - 28107854 GRAFT VASC IMP LVL028 C1768 278 "$6,875.00" " 2,541.00 " - " 5,500.00 " - " 4,750.63 " - " 4,750.63 " - " 3,798.44 " - " 4,537.50 " - - " 4,550.56 " - - " 1,891.72 " " 2,364.65 " - - - " 5,500.00 " - - " 4,606.25 " - " 2,811.88 " " 5,156.25 " " 2,613.19 " " 3,075.19 " - 28107871 GRAFT VASC IMP LVL030 C1768 278 "$7,375.00" " 2,725.80 " - " 5,900.00 " - " 5,096.13 " - " 5,096.13 " - " 4,074.69 " - " 4,867.50 " - - " 4,881.51 " - - " 1,891.72 " " 2,364.65 " - - - " 5,900.00 " - - " 4,941.25 " - " 3,016.38 " " 5,531.25 " " 2,803.24 " " 3,298.84 " - 28107978 GRAFT VASC IMP LVL040 C1768 278 "$9,875.00" " 3,649.80 " - " 7,900.00 " - " 6,823.63 " - " 6,823.63 " - " 5,455.94 " - " 6,517.50 " - - " 6,536.26 " - - " 1,891.72 " " 2,364.65 " - - - " 7,900.00 " - - " 6,616.25 " - " 4,038.88 " " 7,406.25 " " 3,753.49 " " 4,417.09 " - 28108010 GRAFT VASC IMP LVL044 C1768 278 "$10,875.00" " 4,019.40 " - " 8,700.00 " - " 7,514.63 " - " 7,514.63 " - " 6,008.44 " - " 7,177.50 " - - " 7,198.16 " - - " 1,891.72 " " 2,364.65 " - - - " 8,700.00 " - - " 7,286.25 " - " 4,447.88 " " 8,156.25 " " 4,133.59 " " 4,864.39 " - 28108044 GRAFT VASC IMP LVL047 C1768 278 "$11,625.00" " 4,296.60 " - " 9,300.00 " - " 8,032.88 " - " 8,032.88 " - " 6,422.81 " - " 7,672.50 " - - " 7,694.59 " - - " 1,891.72 " " 2,364.65 " - - - " 9,300.00 " - - " 7,788.75 " - " 4,754.63 " " 8,718.75 " " 4,418.66 " " 5,199.86 " - 28108061 GRAFT VASC IMP LVL049 C1768 278 "$12,125.00" " 4,481.40 " - " 9,700.00 " - " 8,378.38 " - " 8,378.38 " - " 6,699.06 " - " 8,002.50 " - - " 8,025.54 " - - " 1,891.72 " " 2,364.65 " - - - " 9,700.00 " - - " 8,123.75 " - " 4,959.13 " " 9,093.75 " " 4,608.71 " " 5,423.51 " - 28108192 GRAFT VASC IMP LVL062 C1768 278 "$15,375.00" " 5,682.60 " - " 12,300.00 " - " 10,624.13 " - " 10,624.13 " - " 8,494.69 " - " 10,147.50 " - - " 10,176.71 " - - " 1,891.72 " " 2,364.65 " - - - " 12,300.00 " - - " 10,301.25 " - " 6,288.38 " " 11,531.25 " " 5,844.04 " " 6,877.24 " - 28108206 GRAFT VASC IMP LVL063 C1768 278 "$15,625.00" " 5,775.00 " - " 12,500.00 " - " 10,796.88 " - " 10,796.88 " - " 8,632.81 " - " 10,312.50 " - - " 10,342.19 " - - " 1,891.72 " " 2,364.65 " - - - " 12,500.00 " - - " 10,468.75 " - " 6,390.63 " " 11,718.75 " " 5,939.06 " " 6,989.06 " - 28108338 GRAFT VASC IMP LVL076 C1768 278 "$18,875.00" " 6,976.20 " - " 15,100.00 " - " 13,042.63 " - " 13,042.63 " - " 10,428.44 " - " 12,457.50 " - - " 12,493.36 " - - " 1,891.72 " " 2,364.65 " - - - " 15,100.00 " - - " 12,646.25 " - " 7,719.88 " " 14,156.25 " " 7,174.39 " " 8,442.79 " - 28108362 GRAFT VASC IMP LVL079 C1768 278 "$19,625.00" " 7,253.40 " - " 15,700.00 " - " 13,560.88 " - " 13,560.88 " - " 10,842.81 " - " 12,952.50 " - - " 12,989.79 " - - " 1,891.72 " " 2,364.65 " - - - " 15,700.00 " - - " 13,148.75 " - " 8,026.63 " " 14,718.75 " " 7,459.46 " " 8,778.26 " - 28108575 GRAFT VASC IMP LVL100 C1768 278 "$24,875.00" " 9,193.80 " - " 19,900.00 " - " 17,188.63 " - " 17,188.63 " - " 13,743.44 " - " 16,417.50 " - - " 16,464.76 " - - " 1,891.72 " " 2,364.65 " - - - " 19,900.00 " - - " 16,666.25 " - " 10,173.88 " " 18,656.25 " " 9,454.99 " " 11,126.59 " - 28125216 GRAFT VASC IMP LVL108 C1768 278 "$26,875.00" " 9,933.00 " - " 21,500.00 " - " 18,570.63 " - " 18,570.63 " - " 14,848.44 " - " 17,737.50 " - - " 17,788.56 " - - " 1,891.72 " " 2,364.65 " - - - " 21,500.00 " - - " 18,006.25 " - " 10,991.88 " " 20,156.25 " " 10,215.19 " " 12,021.19 " - 28108711 GUIDE WIRE LVL001 C1769 278 $200.00 73.92 - 227.14 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 181.71 227.14 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 28108729 GUIDE WIRE LVL002 C1769 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 181.71 227.14 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 28108737 GUIDE WIRE LVL003 C1769 278 $750.00 277.20 - 600.00 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 181.71 227.14 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 28108745 GUIDE WIRE LVL004 C1769 278 "$1,050.00" 388.08 - 840.00 - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 181.71 227.14 - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 29815305 GUIDE WIRE LVL001 C1769 278 $200.00 73.92 - 227.14 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 181.71 227.14 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 29815330 GUIDE WIRE LVL002 C1769 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 181.71 227.14 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 29815364 GUIDE WIRE LVL003 C1769 278 $750.00 277.20 - 600.00 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 181.71 227.14 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 29815381 GUIDE WIRE LVL004 C1769 278 "$1,050.00" 388.08 - 840.00 - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 181.71 227.14 - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 29815445 GUIDE WIRE LVL005 C1769 278 "$1,350.00" 498.96 - " 1,080.00 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 181.71 227.14 - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 29815453 GUIDE WIRE LVL006 C1769 278 "$1,375.00" 508.20 - " 1,100.00 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - 181.71 227.14 - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 29815518 GUIDE WIRE LVL007 C1769 278 "$1,625.00" 600.60 - " 1,300.00 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - 181.71 227.14 - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 29815526 GUIDE WIRE LVL008 C1769 278 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - 181.71 227.14 - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 29816867 GUIDE WIRE LVL009 C1769 278 "$2,125.00" 785.40 - " 1,700.00 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - 181.71 227.14 - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 29816875 GUIDE WIRE LVL010 C1769 278 "$2,375.00" 877.80 - " 1,900.00 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - 181.71 227.14 - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 29816883 GUIDE WIRE LVL011 C1769 278 "$2,625.00" 970.20 - " 2,100.00 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - 181.71 227.14 - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 29816891 GUIDE WIRE LVL012 C1769 278 "$2,875.00" " 1,062.60 " - " 2,300.00 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - 181.71 227.14 - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 29816905 GUIDE WIRE LVL013 C1769 278 "$3,125.00" " 1,155.00 " - " 2,500.00 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - 181.71 227.14 - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 29816913 GUIDE WIRE LVL014 C1769 278 "$3,375.00" " 1,247.40 " - " 2,700.00 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - 181.71 227.14 - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 29816921 GUIDE WIRE LVL015 C1769 278 "$3,625.00" " 1,339.80 " - " 2,900.00 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - 181.71 227.14 - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 29818011 GUIDE WIRE LVL016 C1769 278 "$3,875.00" " 1,432.20 " - " 3,100.00 " - " 2,677.63 " - " 2,677.63 " - " 2,140.94 " - " 2,557.50 " - - " 2,564.86 " - - 181.71 227.14 - - - " 3,100.00 " - - " 2,596.25 " - " 1,584.88 " " 2,906.25 " " 1,472.89 " " 1,733.29 " - 29818029 GUIDE WIRE LVL017 C1769 278 "$4,125.00" " 1,524.60 " - " 3,300.00 " - " 2,850.38 " - " 2,850.38 " - " 2,279.06 " - " 2,722.50 " - - " 2,730.34 " - - 181.71 227.14 - - - " 3,300.00 " - - " 2,763.75 " - " 1,687.13 " " 3,093.75 " " 1,567.91 " " 1,845.11 " - 29818037 GUIDE WIRE LVL018 C1769 278 "$4,375.00" " 1,617.00 " - " 3,500.00 " - " 3,023.13 " - " 3,023.13 " - " 2,417.19 " - " 2,887.50 " - - " 2,895.81 " - - 181.71 227.14 - - - " 3,500.00 " - - " 2,931.25 " - " 1,789.38 " " 3,281.25 " " 1,662.94 " " 1,956.94 " - 29818045 GUIDE WIRE LVL019 C1769 278 "$4,625.00" " 1,709.40 " - " 3,700.00 " - " 3,195.88 " - " 3,195.88 " - " 2,555.31 " - " 3,052.50 " - - " 3,061.29 " - - 181.71 227.14 - - - " 3,700.00 " - - " 3,098.75 " - " 1,891.63 " " 3,468.75 " " 1,757.96 " " 2,068.76 " - 29818053 GUIDE WIRE LVL020 C1769 278 "$4,875.00" " 1,801.80 " - " 3,900.00 " - " 3,368.63 " - " 3,368.63 " - " 2,693.44 " - " 3,217.50 " - - " 3,226.76 " - - 181.71 227.14 - - - " 3,900.00 " - - " 3,266.25 " - " 1,993.88 " " 3,656.25 " " 1,852.99 " " 2,180.59 " - 29818061 GUIDE WIRE LVL021 C1769 278 "$5,125.00" " 1,894.20 " - " 4,100.00 " - " 3,541.38 " - " 3,541.38 " - " 2,831.56 " - " 3,382.50 " - - " 3,392.24 " - - 181.71 227.14 - - - " 4,100.00 " - - " 3,433.75 " - " 2,096.13 " " 3,843.75 " " 1,948.01 " " 2,292.41 " - 29818070 GUIDE WIRE LVL022 C1769 278 "$5,375.00" " 1,986.60 " - " 4,300.00 " - " 3,714.13 " - " 3,714.13 " - " 2,969.69 " - " 3,547.50 " - - " 3,557.71 " - - 181.71 227.14 - - - " 4,300.00 " - - " 3,601.25 " - " 2,198.38 " " 4,031.25 " " 2,043.04 " " 2,404.24 " - 30604750 GUIDE WIRE LVL001 C1769 278 $200.00 73.92 - 227.14 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 181.71 227.14 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 30604768 GUIDE WIRE LVL002 C1769 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 181.71 227.14 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 30604776 GUIDE WIRE LVL005 C1769 278 "$1,350.00" 498.96 - " 1,080.00 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 181.71 227.14 - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 30604784 GUIDE WIRE LVL006 C1769 278 "$1,375.00" 508.20 - " 1,100.00 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - 181.71 227.14 - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 30604792 GUIDE WIRE LVL007 C1769 278 "$1,625.00" 600.60 - " 1,300.00 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - 181.71 227.14 - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 30604806 GUIDE WIRE LVL008 C1769 278 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - 181.71 227.14 - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 30609077 GUIDE WIRE LVL003 C1769 278 $750.00 277.20 - 600.00 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 181.71 227.14 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 30609085 GUIDE WIRE LVL004 C1769 278 "$1,050.00" 388.08 - 840.00 - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 181.71 227.14 - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 30609093 GUIDE WIRE LVL009 C1769 278 "$2,125.00" 785.40 - " 1,700.00 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - 181.71 227.14 - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 30609107 GUIDE WIRE LVL010 C1769 278 "$2,375.00" 877.80 - " 1,900.00 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - 181.71 227.14 - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 30611462 GUIDE WIRE LVL011 C1769 278 "$2,625.00" 970.20 - " 2,100.00 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - 181.71 227.14 - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 30611471 GUIDE WIRE LVL012 C1769 278 "$2,875.00" " 1,062.60 " - " 2,300.00 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - 181.71 227.14 - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 30611489 GUIDE WIRE LVL013 C1769 278 "$3,125.00" " 1,155.00 " - " 2,500.00 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - 181.71 227.14 - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 30611497 GUIDE WIRE LVL014 C1769 278 "$3,375.00" " 1,247.40 " - " 2,700.00 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - 181.71 227.14 - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 30611501 GUIDE WIRE LVL015 C1769 278 "$3,625.00" " 1,339.80 " - " 2,900.00 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - 181.71 227.14 - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 30611519 GUIDE WIRE LVL016 C1769 278 "$3,875.00" " 1,432.20 " - " 3,100.00 " - " 2,677.63 " - " 2,677.63 " - " 2,140.94 " - " 2,557.50 " - - " 2,564.86 " - - 181.71 227.14 - - - " 3,100.00 " - - " 2,596.25 " - " 1,584.88 " " 2,906.25 " " 1,472.89 " " 1,733.29 " - 30611527 GUIDE WIRE LVL017 C1769 278 "$4,125.00" " 1,524.60 " - " 3,300.00 " - " 2,850.38 " - " 2,850.38 " - " 2,279.06 " - " 2,722.50 " - - " 2,730.34 " - - 181.71 227.14 - - - " 3,300.00 " - - " 2,763.75 " - " 1,687.13 " " 3,093.75 " " 1,567.91 " " 1,845.11 " - 30611535 GUIDE WIRE LVL018 C1769 278 "$4,375.00" " 1,617.00 " - " 3,500.00 " - " 3,023.13 " - " 3,023.13 " - " 2,417.19 " - " 2,887.50 " - - " 2,895.81 " - - 181.71 227.14 - - - " 3,500.00 " - - " 2,931.25 " - " 1,789.38 " " 3,281.25 " " 1,662.94 " " 1,956.94 " - 30611543 GUIDE WIRE LVL019 C1769 278 "$4,625.00" " 1,709.40 " - " 3,700.00 " - " 3,195.88 " - " 3,195.88 " - " 2,555.31 " - " 3,052.50 " - - " 3,061.29 " - - 181.71 227.14 - - - " 3,700.00 " - - " 3,098.75 " - " 1,891.63 " " 3,468.75 " " 1,757.96 " " 2,068.76 " - 30611551 GUIDE WIRE LVL020 C1769 278 "$4,875.00" " 1,801.80 " - " 3,900.00 " - " 3,368.63 " - " 3,368.63 " - " 2,693.44 " - " 3,217.50 " - - " 3,226.76 " - - 181.71 227.14 - - - " 3,900.00 " - - " 3,266.25 " - " 1,993.88 " " 3,656.25 " " 1,852.99 " " 2,180.59 " - 30611560 GUIDE WIRE LVL021 C1769 278 "$5,125.00" " 1,894.20 " - " 4,100.00 " - " 3,541.38 " - " 3,541.38 " - " 2,831.56 " - " 3,382.50 " - - " 3,392.24 " - - 181.71 227.14 - - - " 4,100.00 " - - " 3,433.75 " - " 2,096.13 " " 3,843.75 " " 1,948.01 " " 2,292.41 " - 30611578 GUIDE WIRE LVL022 C1769 278 "$5,375.00" " 1,986.60 " - " 4,300.00 " - " 3,714.13 " - " 3,714.13 " - " 2,969.69 " - " 3,547.50 " - - " 3,557.71 " - - 181.71 227.14 - - - " 4,300.00 " - - " 3,601.25 " - " 2,198.38 " " 4,031.25 " " 2,043.04 " " 2,404.24 " - 34005125 GUIDE WIRE LVL002 C1769 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 181.71 227.14 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 34300615 NITINOL WIRES-45CM C1769 278 $156.00 57.66 - 227.14 - 107.80 - 107.80 - 86.19 - 102.96 - - 103.26 - - 181.71 227.14 - - - 124.80 - - 104.52 - 63.80 117.00 59.30 69.78 - 80360339 GUIDE WIRE LVL001 C1769 278 $200.00 73.92 - 227.14 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 181.71 227.14 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 80360347 GUIDE WIRE LVL002 C1769 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 181.71 227.14 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 80360355 GUIDE WIRE LVL003 C1769 278 $750.00 277.20 - 600.00 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 181.71 227.14 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 80360363 GUIDE WIRE LVL004 C1769 278 "$1,050.00" 388.08 - 840.00 - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 181.71 227.14 - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 80360371 GUIDE WIRE LVL005 C1769 278 "$1,350.00" 498.96 - " 1,080.00 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 181.71 227.14 - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 80360380 GUIDE WIRE LVL006 C1769 278 "$1,375.00" 508.20 - " 1,100.00 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - 181.71 227.14 - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 80360398 GUIDE WIRE LVL007 C1769 278 "$1,625.00" 600.60 - " 1,300.00 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - 181.71 227.14 - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 80360401 GUIDE WIRE LVL008 C1769 278 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - 181.71 227.14 - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 80360410 GUIDE WIRE LVL009 C1769 278 "$2,125.00" 785.40 - " 1,700.00 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - 181.71 227.14 - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 80360428 GUIDE WIRE LVL010 C1769 278 "$2,375.00" 877.80 - " 1,900.00 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - 181.71 227.14 - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 80360436 GUIDE WIRE LVL011 C1769 278 "$2,625.00" 970.20 - " 2,100.00 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - 181.71 227.14 - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 80360444 GUIDE WIRE LVL012 C1769 278 "$2,875.00" " 1,062.60 " - " 2,300.00 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - 181.71 227.14 - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 80660332 GUIDE WIRE LVL001 C1769 278 $200.00 73.92 - 227.14 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 181.71 227.14 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 80660341 GUIDE WIRE LVL002 C1769 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 181.71 227.14 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 80660359 GUIDE WIRE LVL003 C1769 278 $750.00 277.20 - 600.00 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 181.71 227.14 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 80660367 GUIDE WIRE LVL004 C1769 278 "$1,050.00" 388.08 - 840.00 - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 181.71 227.14 - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 80660375 GUIDE WIRE LVL005 C1769 278 "$1,350.00" 498.96 - " 1,080.00 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 181.71 227.14 - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 80660383 GUIDE WIRE LVL006 C1769 278 "$1,375.00" 508.20 - " 1,100.00 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - 181.71 227.14 - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 28113536 REP DEV URINE W/SLING LVL007 C1771 278 "$1,625.00" 600.60 - " 3,289.69 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - " 2,631.75 " " 3,289.69 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 28113579 REP DEV URINE W/SLING LVL011 C1771 278 "$2,625.00" 970.20 - " 3,289.69 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - " 2,631.75 " " 3,289.69 " - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 28113722 RET DEV (INSERT) LVL001 C1773 278 $200.00 73.92 - " 1,118.76 " - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 895.01 " 1,118.76 " - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 28113757 RET DEV (INSERT) LVL004 C1773 278 "$1,050.00" 388.08 - " 1,118.76 " - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 895.01 " 1,118.76 " - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 29815534 RET DEV (INSERT) LVL001 C1773 278 $200.00 73.92 - " 1,118.76 " - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 895.01 " 1,118.76 " - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 29815542 RET DEV (INSERT) LVL002 C1773 278 $450.00 166.32 - " 1,118.76 " - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 895.01 " 1,118.76 " - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 29815551 RET DEV (INSERT) LVL003 C1773 278 $750.00 277.20 - " 1,118.76 " - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 895.01 " 1,118.76 " - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 29815569 RET DEV (INSERT) LVL004 C1773 278 "$1,050.00" 388.08 - " 1,118.76 " - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 895.01 " 1,118.76 " - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 29815577 RET DEV (INSERT) LVL005 C1773 278 "$1,350.00" 498.96 - " 1,118.76 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 895.01 " 1,118.76 " - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 29815585 RET DEV (INSERT) LVL006 C1773 278 "$1,375.00" 508.20 - " 1,118.76 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - 895.01 " 1,118.76 " - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 29815593 RET DEV (INSERT) LVL007 C1773 278 "$1,625.00" 600.60 - " 1,300.00 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - 895.01 " 1,118.76 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 29815607 RET DEV (INSERT) LVL008 C1773 278 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - 895.01 " 1,118.76 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 29815615 RET DEV (INSERT) LVL009 C1773 278 "$2,125.00" 785.40 - " 1,700.00 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - 895.01 " 1,118.76 " - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 29816930 RET DEV (INSERT) LVL010 C1773 278 "$2,375.00" 877.80 - " 1,900.00 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - 895.01 " 1,118.76 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 29816948 RET DEV (INSERT) LVL011 C1773 278 "$2,625.00" 970.20 - " 2,100.00 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - 895.01 " 1,118.76 " - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 29816956 RET DEV (INSERT) LVL012 C1773 278 "$2,875.00" " 1,062.60 " - " 2,300.00 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - 895.01 " 1,118.76 " - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 29816964 RET DEV (INSERT) LVL013 C1773 278 "$3,125.00" " 1,155.00 " - " 2,500.00 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - 895.01 " 1,118.76 " - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 29816972 RET DEV (INSERT) LVL014 C1773 278 "$3,375.00" " 1,247.40 " - " 2,700.00 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - 895.01 " 1,118.76 " - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 29816981 RET DEV (INSERT) LVL015 C1773 278 "$3,625.00" " 1,339.80 " - " 2,900.00 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - 895.01 " 1,118.76 " - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 30609115 RET DEV (INSERT) LVL005 C1773 278 "$1,350.00" 498.96 - " 1,118.76 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 895.01 " 1,118.76 " - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 30609123 RET DEV (INSERT) LVL006 C1773 278 "$1,375.00" 508.20 - " 1,118.76 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - 895.01 " 1,118.76 " - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 30609131 RET DEV (INSERT) LVL007 C1773 278 "$1,625.00" 600.60 - " 1,300.00 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - 895.01 " 1,118.76 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 30609140 RET DEV (INSERT) LVL008 C1773 278 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - 895.01 " 1,118.76 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 30609158 RET DEV (INSERT) LVL009 C1773 278 "$2,125.00" 785.40 - " 1,700.00 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - 895.01 " 1,118.76 " - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 30609166 RET DEV (INSERT) LVL010 C1773 278 "$2,375.00" 877.80 - " 1,900.00 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - 895.01 " 1,118.76 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 30609174 RET DEV (INSERT) LVL011 C1773 278 "$2,625.00" 970.20 - " 2,100.00 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - 895.01 " 1,118.76 " - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 30611373 RET DEV (INSERT) LVL012 C1773 278 "$2,875.00" " 1,062.60 " - " 2,300.00 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - 895.01 " 1,118.76 " - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 30611381 RET DEV (INSERT) LVL013 C1773 278 "$3,125.00" " 1,155.00 " - " 2,500.00 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - 895.01 " 1,118.76 " - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 30611390 RET DEV (INSERT) LVL014 C1773 278 "$3,375.00" " 1,247.40 " - " 2,700.00 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - 895.01 " 1,118.76 " - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 30611403 RET DEV (INSERT) LVL015 C1773 278 "$3,625.00" " 1,339.80 " - " 2,900.00 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - 895.01 " 1,118.76 " - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 30611411 RET DEV (INSERT) LVL016 C1773 278 "$3,875.00" " 1,432.20 " - " 3,100.00 " - " 2,677.63 " - " 2,677.63 " - " 2,140.94 " - " 2,557.50 " - - " 2,564.86 " - - 895.01 " 1,118.76 " - - - " 3,100.00 " - - " 2,596.25 " - " 1,584.88 " " 2,906.25 " " 1,472.89 " " 1,733.29 " - 30611420 RET DEV (INSERT) LVL017 C1773 278 "$4,125.00" " 1,524.60 " - " 3,300.00 " - " 2,850.38 " - " 2,850.38 " - " 2,279.06 " - " 2,722.50 " - - " 2,730.34 " - - 895.01 " 1,118.76 " - - - " 3,300.00 " - - " 2,763.75 " - " 1,687.13 " " 3,093.75 " " 1,567.91 " " 1,845.11 " - 30611438 RET DEV (INSERT) LVL018 C1773 278 "$4,375.00" " 1,617.00 " - " 3,500.00 " - " 3,023.13 " - " 3,023.13 " - " 2,417.19 " - " 2,887.50 " - - " 2,895.81 " - - 895.01 " 1,118.76 " - - - " 3,500.00 " - - " 2,931.25 " - " 1,789.38 " " 3,281.25 " " 1,662.94 " " 1,956.94 " - 30611446 RET DEV (INSERT) LVL019 C1773 278 "$4,625.00" " 1,709.40 " - " 3,700.00 " - " 3,195.88 " - " 3,195.88 " - " 2,555.31 " - " 3,052.50 " - - " 3,061.29 " - - 895.01 " 1,118.76 " - - - " 3,700.00 " - - " 3,098.75 " - " 1,891.63 " " 3,468.75 " " 1,757.96 " " 2,068.76 " - 30611454 RET DEV (INSERT) LVL020 C1773 278 "$4,875.00" " 1,801.80 " - " 3,900.00 " - " 3,368.63 " - " 3,368.63 " - " 2,693.44 " - " 3,217.50 " - - " 3,226.76 " - - 895.01 " 1,118.76 " - - - " 3,900.00 " - - " 3,266.25 " - " 1,993.88 " " 3,656.25 " " 1,852.99 " " 2,180.59 " - 30612337 RET DEV (INSERT) LVL001 C1773 278 $200.00 73.92 - " 1,118.76 " - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 895.01 " 1,118.76 " - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 30612345 RET DEV (INSERT) LVL002 C1773 278 $450.00 166.32 - " 1,118.76 " - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 895.01 " 1,118.76 " - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 30612353 RET DEV (INSERT) LVL003 C1773 278 $750.00 277.20 - " 1,118.76 " - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 895.01 " 1,118.76 " - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 30612361 RET DEV (INSERT) LVL004 C1773 278 "$1,050.00" 388.08 - " 1,118.76 " - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 895.01 " 1,118.76 " - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 30612370 RET DEV (INSERT) LVL021 C1773 278 "$5,125.00" " 1,894.20 " - " 4,100.00 " - " 3,541.38 " - " 3,541.38 " - " 2,831.56 " - " 3,382.50 " - - " 3,392.24 " - - 895.01 " 1,118.76 " - - - " 4,100.00 " - - " 3,433.75 " - " 2,096.13 " " 3,843.75 " " 1,948.01 " " 2,292.41 " - 30612388 RET DEV (INSERT) LVL022 C1773 278 "$5,375.00" " 1,986.60 " - " 4,300.00 " - " 3,714.13 " - " 3,714.13 " - " 2,969.69 " - " 3,547.50 " - - " 3,557.71 " - - 895.01 " 1,118.76 " - - - " 4,300.00 " - - " 3,601.25 " - " 2,198.38 " " 4,031.25 " " 2,043.04 " " 2,404.24 " - 30612396 RET DEV (INSERT) LVL023 C1773 278 "$5,625.00" " 2,079.00 " - " 4,500.00 " - " 3,886.88 " - " 3,886.88 " - " 3,107.81 " - " 3,712.50 " - - " 3,723.19 " - - 895.01 " 1,118.76 " - - - " 4,500.00 " - - " 3,768.75 " - " 2,300.63 " " 4,218.75 " " 2,138.06 " " 2,516.06 " - 30612400 RET DEV (INSERT) LVL024 C1773 278 "$5,875.00" " 2,171.40 " - " 4,700.00 " - " 4,059.63 " - " 4,059.63 " - " 3,245.94 " - " 3,877.50 " - - " 3,888.66 " - - 895.01 " 1,118.76 " - - - " 4,700.00 " - - " 3,936.25 " - " 2,402.88 " " 4,406.25 " " 2,233.09 " " 2,627.89 " - 30612418 RET DEV (INSERT) LVL025 C1773 278 "$6,125.00" " 2,263.80 " - " 4,900.00 " - " 4,232.38 " - " 4,232.38 " - " 3,384.06 " - " 4,042.50 " - - " 4,054.14 " - - 895.01 " 1,118.76 " - - - " 4,900.00 " - - " 4,103.75 " - " 2,505.13 " " 4,593.75 " " 2,328.11 " " 2,739.71 " - 80360860 RET DEV (INSERT) LVL001 C1773 278 $200.00 73.92 - " 1,118.76 " - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 895.01 " 1,118.76 " - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 80360878 RET DEV (INSERT) LVL002 C1773 278 $450.00 166.32 - " 1,118.76 " - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 895.01 " 1,118.76 " - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 80360886 RET DEV (INSERT) LVL003 C1773 278 $750.00 277.20 - " 1,118.76 " - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 895.01 " 1,118.76 " - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 80360894 RET DEV (INSERT) LVL004 C1773 278 "$1,050.00" 388.08 - " 1,118.76 " - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 895.01 " 1,118.76 " - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 80360908 RET DEV (INSERT) LVL005 C1773 278 "$1,350.00" 498.96 - " 1,118.76 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 895.01 " 1,118.76 " - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 80360916 RET DEV (INSERT) LVL006 C1773 278 "$1,375.00" 508.20 - " 1,118.76 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - 895.01 " 1,118.76 " - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 80360924 RET DEV (INSERT) LVL007 C1773 278 "$1,625.00" 600.60 - " 1,300.00 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - 895.01 " 1,118.76 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 80360932 RET DEV (INSERT) LVL008 C1773 278 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - 895.01 " 1,118.76 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 80360941 RET DEV (INSERT) LVL009 C1773 278 "$2,125.00" 785.40 - " 1,700.00 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - 895.01 " 1,118.76 " - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 80360959 RET DEV (INSERT) LVL010 C1773 278 "$2,375.00" 877.80 - " 1,900.00 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - 895.01 " 1,118.76 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 80360967 RET DEV (INSERT) LVL011 C1773 278 "$2,625.00" 970.20 - " 2,100.00 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - 895.01 " 1,118.76 " - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 80360975 RET DEV (INSERT) LVL012 C1773 278 "$2,875.00" " 1,062.60 " - " 2,300.00 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - 895.01 " 1,118.76 " - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 80360983 RET DEV (INSERT) LVL025 C1773 278 "$6,125.00" " 2,263.80 " - " 4,900.00 " - " 4,232.38 " - " 4,232.38 " - " 3,384.06 " - " 4,042.50 " - - " 4,054.14 " - - 895.01 " 1,118.76 " - - - " 4,900.00 " - - " 4,103.75 " - " 2,505.13 " " 4,593.75 " " 2,328.11 " " 2,739.71 " - 80360991 RET DEV (INSERT) LVL026 C1773 278 "$6,375.00" " 2,356.20 " - " 5,100.00 " - " 4,405.13 " - " 4,405.13 " - " 3,522.19 " - " 4,207.50 " - - " 4,219.61 " - - 895.01 " 1,118.76 " - - - " 5,100.00 " - - " 4,271.25 " - " 2,607.38 " " 4,781.25 " " 2,423.14 " " 2,851.54 " - 80361009 RET DEV (INSERT) LVL027 C1773 278 "$6,625.00" " 2,448.60 " - " 5,300.00 " - " 4,577.88 " - " 4,577.88 " - " 3,660.31 " - " 4,372.50 " - - " 4,385.09 " - - 895.01 " 1,118.76 " - - - " 5,300.00 " - - " 4,438.75 " - " 2,709.63 " " 4,968.75 " " 2,518.16 " " 2,963.36 " - 80361017 RET DEV (INSERT) LVL028 C1773 278 "$6,875.00" " 2,541.00 " - " 5,500.00 " - " 4,750.63 " - " 4,750.63 " - " 3,798.44 " - " 4,537.50 " - - " 4,550.56 " - - 895.01 " 1,118.76 " - - - " 5,500.00 " - - " 4,606.25 " - " 2,811.88 " " 5,156.25 " " 2,613.19 " " 3,075.19 " - 80361025 RET DEV (INSERT) LVL029 C1773 278 "$7,125.00" " 2,633.40 " - " 5,700.00 " - " 4,923.38 " - " 4,923.38 " - " 3,936.56 " - " 4,702.50 " - - " 4,716.04 " - - 895.01 " 1,118.76 " - - - " 5,700.00 " - - " 4,773.75 " - " 2,914.13 " " 5,343.75 " " 2,708.21 " " 3,187.01 " - 80361033 RET DEV (INSERT) LVL030 C1773 278 "$7,375.00" " 2,725.80 " - " 5,900.00 " - " 5,096.13 " - " 5,096.13 " - " 4,074.69 " - " 4,867.50 " - - " 4,881.51 " - - 895.01 " 1,118.76 " - - - " 5,900.00 " - - " 4,941.25 " - " 3,016.38 " " 5,531.25 " " 2,803.24 " " 3,298.84 " - 80361041 RET DEV (INSERT) LVL031 C1773 278 "$7,625.00" " 2,818.20 " - " 6,100.00 " - " 5,268.88 " - " 5,268.88 " - " 4,212.81 " - " 5,032.50 " - - " 5,046.99 " - - 895.01 " 1,118.76 " - - - " 6,100.00 " - - " 5,108.75 " - " 3,118.63 " " 5,718.75 " " 2,898.26 " " 3,410.66 " - 80361050 RET DEV (INSERT) LVL032 C1773 278 "$7,875.00" " 2,910.60 " - " 6,300.00 " - " 5,441.63 " - " 5,441.63 " - " 4,350.94 " - " 5,197.50 " - - " 5,212.46 " - - 895.01 " 1,118.76 " - - - " 6,300.00 " - - " 5,276.25 " - " 3,220.88 " " 5,906.25 " " 2,993.29 " " 3,522.49 " - 80361068 RET DEV (INSERT) LVL033 C1773 278 "$8,125.00" " 3,003.00 " - " 6,500.00 " - " 5,614.38 " - " 5,614.38 " - " 4,489.06 " - " 5,362.50 " - - " 5,377.94 " - - 895.01 " 1,118.76 " - - - " 6,500.00 " - - " 5,443.75 " - " 3,323.13 " " 6,093.75 " " 3,088.31 " " 3,634.31 " - 80361076 RET DEV (INSERT) LVL034 C1773 278 "$8,375.00" " 3,095.40 " - " 6,700.00 " - " 5,787.13 " - " 5,787.13 " - " 4,627.19 " - " 5,527.50 " - - " 5,543.41 " - - 895.01 " 1,118.76 " - - - " 6,700.00 " - - " 5,611.25 " - " 3,425.38 " " 6,281.25 " " 3,183.34 " " 3,746.14 " - 80361084 RET DEV (INSERT) LVL035 C1773 278 "$8,625.00" " 3,187.80 " - " 6,900.00 " - " 5,959.88 " - " 5,959.88 " - " 4,765.31 " - " 5,692.50 " - - " 5,708.89 " - - 895.01 " 1,118.76 " - - - " 6,900.00 " - - " 5,778.75 " - " 3,527.63 " " 6,468.75 " " 3,278.36 " " 3,857.96 " - 80361092 RET DEV (INSERT) LVL067 C1773 278 "$16,625.00" " 6,144.60 " - " 13,300.00 " - " 11,487.88 " - " 11,487.88 " - " 9,185.31 " - " 10,972.50 " - - " 11,004.09 " - - 895.01 " 1,118.76 " - - - " 13,300.00 " - - " 11,138.75 " - " 6,799.63 " " 12,468.75 " " 6,319.16 " " 7,436.36 " - 80361106 RET DEV (INSERT) LVL068 C1773 278 "$16,875.00" " 6,237.00 " - " 13,500.00 " - " 11,660.63 " - " 11,660.63 " - " 9,323.44 " - " 11,137.50 " - - " 11,169.56 " - - 895.01 " 1,118.76 " - - - " 13,500.00 " - - " 11,306.25 " - " 6,901.88 " " 12,656.25 " " 6,414.19 " " 7,548.19 " - 80361114 RET DEV (INSERT) LVL069 C1773 278 "$17,125.00" " 6,329.40 " - " 13,700.00 " - " 11,833.38 " - " 11,833.38 " - " 9,461.56 " - " 11,302.50 " - - " 11,335.04 " - - 895.01 " 1,118.76 " - - - " 13,700.00 " - - " 11,473.75 " - " 7,004.13 " " 12,843.75 " " 6,509.21 " " 7,660.01 " - 80361122 RET DEV (INSERT) LVL070 C1773 278 "$17,375.00" " 6,421.80 " - " 13,900.00 " - " 12,006.13 " - " 12,006.13 " - " 9,599.69 " - " 11,467.50 " - - " 11,500.51 " - - 895.01 " 1,118.76 " - - - " 13,900.00 " - - " 11,641.25 " - " 7,106.38 " " 13,031.25 " " 6,604.24 " " 7,771.84 " - 80361131 RET DEV (INSERT) LVL071 C1773 278 "$17,625.00" " 6,514.20 " - " 14,100.00 " - " 12,178.88 " - " 12,178.88 " - " 9,737.81 " - " 11,632.50 " - - " 11,665.99 " - - 895.01 " 1,118.76 " - - - " 14,100.00 " - - " 11,808.75 " - " 7,208.63 " " 13,218.75 " " 6,699.26 " " 7,883.66 " - 80361149 RET DEV (INSERT) LVL072 C1773 278 "$17,875.00" " 6,606.60 " - " 14,300.00 " - " 12,351.63 " - " 12,351.63 " - " 9,875.94 " - " 11,797.50 " - - " 11,831.46 " - - 895.01 " 1,118.76 " - - - " 14,300.00 " - - " 11,976.25 " - " 7,310.88 " " 13,406.25 " " 6,794.29 " " 7,995.49 " - 80361157 RET DEV (INSERT) LVL073 C1773 278 "$18,125.00" " 6,699.00 " - " 14,500.00 " - " 12,524.38 " - " 12,524.38 " - " 10,014.06 " - " 11,962.50 " - - " 11,996.94 " - - 895.01 " 1,118.76 " - - - " 14,500.00 " - - " 12,143.75 " - " 7,413.13 " " 13,593.75 " " 6,889.31 " " 8,107.31 " - 80361165 RET DEV (INSERT) LVL074 C1773 278 "$18,375.00" " 6,791.40 " - " 14,700.00 " - " 12,697.13 " - " 12,697.13 " - " 10,152.19 " - " 12,127.50 " - - " 12,162.41 " - - 895.01 " 1,118.76 " - - - " 14,700.00 " - - " 12,311.25 " - " 7,515.38 " " 13,781.25 " " 6,984.34 " " 8,219.14 " - 80361173 RET DEV (INSERT) LVL075 C1773 278 "$18,625.00" " 6,883.80 " - " 14,900.00 " - " 12,869.88 " - " 12,869.88 " - " 10,290.31 " - " 12,292.50 " - - " 12,327.89 " - - 895.01 " 1,118.76 " - - - " 14,900.00 " - - " 12,478.75 " - " 7,617.63 " " 13,968.75 " " 7,079.36 " " 8,330.96 " - 80361181 RET DEV (INSERT) LVL076 C1773 278 "$18,875.00" " 6,976.20 " - " 15,100.00 " - " 13,042.63 " - " 13,042.63 " - " 10,428.44 " - " 12,457.50 " - - " 12,493.36 " - - 895.01 " 1,118.76 " - - - " 15,100.00 " - - " 12,646.25 " - " 7,719.88 " " 14,156.25 " " 7,174.39 " " 8,442.79 " - 28109822 JOINT DEVICE IMP LVL001 C1776 278 $200.00 73.92 - " 2,966.15 " - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - " 2,372.92 " " 2,966.15 " - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 28109831 JOINT DEVICE IMP LVL002 C1776 278 $450.00 166.32 - " 2,966.15 " - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - " 2,372.92 " " 2,966.15 " - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 28109849 JOINT DEVICE IMP LVL003 C1776 278 $750.00 277.20 - " 2,966.15 " - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - " 2,372.92 " " 2,966.15 " - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 28109857 JOINT DEVICE IMP LVL004 C1776 278 "$1,050.00" 388.08 - " 2,966.15 " - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - " 2,372.92 " " 2,966.15 " - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 28109865 JOINT DEVICE IMP LVL005 C1776 278 "$1,350.00" 498.96 - " 2,966.15 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - " 2,372.92 " " 2,966.15 " - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 28109873 JOINT DEVICE IMP LVL006 C1776 278 "$1,375.00" 508.20 - " 2,966.15 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - " 2,372.92 " " 2,966.15 " - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 28109881 JOINT DEVICE IMP LVL007 C1776 278 "$1,625.00" 600.60 - " 2,966.15 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - " 2,372.92 " " 2,966.15 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 28109890 JOINT DEVICE IMP LVL008 C1776 278 "$1,875.00" 693.00 - " 2,966.15 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - " 2,372.92 " " 2,966.15 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 28109903 JOINT DEVICE IMP LVL009 C1776 278 "$2,125.00" 785.40 - " 2,966.15 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - " 2,372.92 " " 2,966.15 " - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 28109911 JOINT DEVICE IMP LVL010 C1776 278 "$2,375.00" 877.80 - " 2,966.15 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - " 2,372.92 " " 2,966.15 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 28109920 JOINT DEVICE IMP LVL011 C1776 278 "$2,625.00" 970.20 - " 2,966.15 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - " 2,372.92 " " 2,966.15 " - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 28109938 JOINT DEVICE IMP LVL012 C1776 278 "$2,875.00" " 1,062.60 " - " 2,966.15 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - " 2,372.92 " " 2,966.15 " - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 28109946 JOINT DEVICE IMP LVL013 C1776 278 "$3,125.00" " 1,155.00 " - " 2,966.15 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - " 2,372.92 " " 2,966.15 " - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 28109954 JOINT DEVICE IMP LVL014 C1776 278 "$3,375.00" " 1,247.40 " - " 2,966.15 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - " 2,372.92 " " 2,966.15 " - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 28109962 JOINT DEVICE IMP LVL015 C1776 278 "$3,625.00" " 1,339.80 " - " 2,966.15 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - " 2,372.92 " " 2,966.15 " - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 28109971 JOINT DEVICE IMP LVL016 C1776 278 "$3,875.00" " 1,432.20 " - " 3,100.00 " - " 2,677.63 " - " 2,677.63 " - " 2,140.94 " - " 2,557.50 " - - " 2,564.86 " - - " 2,372.92 " " 2,966.15 " - - - " 3,100.00 " - - " 2,596.25 " - " 1,584.88 " " 2,906.25 " " 1,472.89 " " 1,733.29 " - 28109989 JOINT DEVICE IMP LVL017 C1776 278 "$4,125.00" " 1,524.60 " - " 3,300.00 " - " 2,850.38 " - " 2,850.38 " - " 2,279.06 " - " 2,722.50 " - - " 2,730.34 " - - " 2,372.92 " " 2,966.15 " - - - " 3,300.00 " - - " 2,763.75 " - " 1,687.13 " " 3,093.75 " " 1,567.91 " " 1,845.11 " - 28109997 JOINT DEVICE IMP LVL018 C1776 278 "$4,375.00" " 1,617.00 " - " 3,500.00 " - " 3,023.13 " - " 3,023.13 " - " 2,417.19 " - " 2,887.50 " - - " 2,895.81 " - - " 2,372.92 " " 2,966.15 " - - - " 3,500.00 " - - " 2,931.25 " - " 1,789.38 " " 3,281.25 " " 1,662.94 " " 1,956.94 " - 28110006 JOINT DEVICE IMP LVL019 C1776 278 "$4,625.00" " 1,709.40 " - " 3,700.00 " - " 3,195.88 " - " 3,195.88 " - " 2,555.31 " - " 3,052.50 " - - " 3,061.29 " - - " 2,372.92 " " 2,966.15 " - - - " 3,700.00 " - - " 3,098.75 " - " 1,891.63 " " 3,468.75 " " 1,757.96 " " 2,068.76 " - 28110014 JOINT DEVICE IMP LVL020 C1776 278 "$4,875.00" " 1,801.80 " - " 3,900.00 " - " 3,368.63 " - " 3,368.63 " - " 2,693.44 " - " 3,217.50 " - - " 3,226.76 " - - " 2,372.92 " " 2,966.15 " - - - " 3,900.00 " - - " 3,266.25 " - " 1,993.88 " " 3,656.25 " " 1,852.99 " " 2,180.59 " - 28110022 JOINT DEVICE IMP LVL021 C1776 278 "$5,125.00" " 1,894.20 " - " 4,100.00 " - " 3,541.38 " - " 3,541.38 " - " 2,831.56 " - " 3,382.50 " - - " 3,392.24 " - - " 2,372.92 " " 2,966.15 " - - - " 4,100.00 " - - " 3,433.75 " - " 2,096.13 " " 3,843.75 " " 1,948.01 " " 2,292.41 " - 28110031 JOINT DEVICE IMP LVL022 C1776 278 "$5,375.00" " 1,986.60 " - " 4,300.00 " - " 3,714.13 " - " 3,714.13 " - " 2,969.69 " - " 3,547.50 " - - " 3,557.71 " - - " 2,372.92 " " 2,966.15 " - - - " 4,300.00 " - - " 3,601.25 " - " 2,198.38 " " 4,031.25 " " 2,043.04 " " 2,404.24 " - 28110049 JOINT DEVICE IMP LVL023 C1776 278 "$5,625.00" " 2,079.00 " - " 4,500.00 " - " 3,886.88 " - " 3,886.88 " - " 3,107.81 " - " 3,712.50 " - - " 3,723.19 " - - " 2,372.92 " " 2,966.15 " - - - " 4,500.00 " - - " 3,768.75 " - " 2,300.63 " " 4,218.75 " " 2,138.06 " " 2,516.06 " - 28110057 JOINT DEVICE IMP LVL024 C1776 278 "$5,875.00" " 2,171.40 " - " 4,700.00 " - " 4,059.63 " - " 4,059.63 " - " 3,245.94 " - " 3,877.50 " - - " 3,888.66 " - - " 2,372.92 " " 2,966.15 " - - - " 4,700.00 " - - " 3,936.25 " - " 2,402.88 " " 4,406.25 " " 2,233.09 " " 2,627.89 " - 28110065 JOINT DEVICE IMP LVL025 C1776 278 "$6,125.00" " 2,263.80 " - " 4,900.00 " - " 4,232.38 " - " 4,232.38 " - " 3,384.06 " - " 4,042.50 " - - " 4,054.14 " - - " 2,372.92 " " 2,966.15 " - - - " 4,900.00 " - - " 4,103.75 " - " 2,505.13 " " 4,593.75 " " 2,328.11 " " 2,739.71 " - 28110073 JOINT DEVICE IMP LVL026 C1776 278 "$6,375.00" " 2,356.20 " - " 5,100.00 " - " 4,405.13 " - " 4,405.13 " - " 3,522.19 " - " 4,207.50 " - - " 4,219.61 " - - " 2,372.92 " " 2,966.15 " - - - " 5,100.00 " - - " 4,271.25 " - " 2,607.38 " " 4,781.25 " " 2,423.14 " " 2,851.54 " - 28110081 JOINT DEVICE IMP LVL027 C1776 278 "$6,625.00" " 2,448.60 " - " 5,300.00 " - " 4,577.88 " - " 4,577.88 " - " 3,660.31 " - " 4,372.50 " - - " 4,385.09 " - - " 2,372.92 " " 2,966.15 " - - - " 5,300.00 " - - " 4,438.75 " - " 2,709.63 " " 4,968.75 " " 2,518.16 " " 2,963.36 " - 28110090 JOINT DEVICE IMP LVL028 C1776 278 "$6,875.00" " 2,541.00 " - " 5,500.00 " - " 4,750.63 " - " 4,750.63 " - " 3,798.44 " - " 4,537.50 " - - " 4,550.56 " - - " 2,372.92 " " 2,966.15 " - - - " 5,500.00 " - - " 4,606.25 " - " 2,811.88 " " 5,156.25 " " 2,613.19 " " 3,075.19 " - 28110103 JOINT DEVICE IMP LVL029 C1776 278 "$7,125.00" " 2,633.40 " - " 5,700.00 " - " 4,923.38 " - " 4,923.38 " - " 3,936.56 " - " 4,702.50 " - - " 4,716.04 " - - " 2,372.92 " " 2,966.15 " - - - " 5,700.00 " - - " 4,773.75 " - " 2,914.13 " " 5,343.75 " " 2,708.21 " " 3,187.01 " - 28110111 JOINT DEVICE IMP LVL030 C1776 278 "$7,375.00" " 2,725.80 " - " 5,900.00 " - " 5,096.13 " - " 5,096.13 " - " 4,074.69 " - " 4,867.50 " - - " 4,881.51 " - - " 2,372.92 " " 2,966.15 " - - - " 5,900.00 " - - " 4,941.25 " - " 3,016.38 " " 5,531.25 " " 2,803.24 " " 3,298.84 " - 28110120 JOINT DEVICE IMP LVL031 C1776 278 "$7,625.00" " 2,818.20 " - " 6,100.00 " - " 5,268.88 " - " 5,268.88 " - " 4,212.81 " - " 5,032.50 " - - " 5,046.99 " - - " 2,372.92 " " 2,966.15 " - - - " 6,100.00 " - - " 5,108.75 " - " 3,118.63 " " 5,718.75 " " 2,898.26 " " 3,410.66 " - 28110138 JOINT DEVICE IMP LVL032 C1776 278 "$7,875.00" " 2,910.60 " - " 6,300.00 " - " 5,441.63 " - " 5,441.63 " - " 4,350.94 " - " 5,197.50 " - - " 5,212.46 " - - " 2,372.92 " " 2,966.15 " - - - " 6,300.00 " - - " 5,276.25 " - " 3,220.88 " " 5,906.25 " " 2,993.29 " " 3,522.49 " - 28110146 JOINT DEVICE IMP LVL033 C1776 278 "$8,125.00" " 3,003.00 " - " 6,500.00 " - " 5,614.38 " - " 5,614.38 " - " 4,489.06 " - " 5,362.50 " - - " 5,377.94 " - - " 2,372.92 " " 2,966.15 " - - - " 6,500.00 " - - " 5,443.75 " - " 3,323.13 " " 6,093.75 " " 3,088.31 " " 3,634.31 " - 28110154 JOINT DEVICE IMP LVL034 C1776 278 "$8,375.00" " 3,095.40 " - " 6,700.00 " - " 5,787.13 " - " 5,787.13 " - " 4,627.19 " - " 5,527.50 " - - " 5,543.41 " - - " 2,372.92 " " 2,966.15 " - - - " 6,700.00 " - - " 5,611.25 " - " 3,425.38 " " 6,281.25 " " 3,183.34 " " 3,746.14 " - 28110162 JOINT DEVICE IMP LVL035 C1776 278 "$8,625.00" " 3,187.80 " - " 6,900.00 " - " 5,959.88 " - " 5,959.88 " - " 4,765.31 " - " 5,692.50 " - - " 5,708.89 " - - " 2,372.92 " " 2,966.15 " - - - " 6,900.00 " - - " 5,778.75 " - " 3,527.63 " " 6,468.75 " " 3,278.36 " " 3,857.96 " - 28110171 JOINT DEVICE IMP LVL036 C1776 278 "$8,875.00" " 3,280.20 " - " 7,100.00 " - " 6,132.63 " - " 6,132.63 " - " 4,903.44 " - " 5,857.50 " - - " 5,874.36 " - - " 2,372.92 " " 2,966.15 " - - - " 7,100.00 " - - " 5,946.25 " - " 3,629.88 " " 6,656.25 " " 3,373.39 " " 3,969.79 " - 28110189 JOINT DEVICE IMP LVL037 C1776 278 "$9,125.00" " 3,372.60 " - " 7,300.00 " - " 6,305.38 " - " 6,305.38 " - " 5,041.56 " - " 6,022.50 " - - " 6,039.84 " - - " 2,372.92 " " 2,966.15 " - - - " 7,300.00 " - - " 6,113.75 " - " 3,732.13 " " 6,843.75 " " 3,468.41 " " 4,081.61 " - 28110197 JOINT DEVICE IMP LVL038 C1776 278 "$9,375.00" " 3,465.00 " - " 7,500.00 " - " 6,478.13 " - " 6,478.13 " - " 5,179.69 " - " 6,187.50 " - - " 6,205.31 " - - " 2,372.92 " " 2,966.15 " - - - " 7,500.00 " - - " 6,281.25 " - " 3,834.38 " " 7,031.25 " " 3,563.44 " " 4,193.44 " - 28110219 JOINT DEVICE IMP LVL040 C1776 278 "$9,875.00" " 3,649.80 " - " 7,900.00 " - " 6,823.63 " - " 6,823.63 " - " 5,455.94 " - " 6,517.50 " - - " 6,536.26 " - - " 2,372.92 " " 2,966.15 " - - - " 7,900.00 " - - " 6,616.25 " - " 4,038.88 " " 7,406.25 " " 3,753.49 " " 4,417.09 " - 28110227 JOINT DEVICE IMP LVL041 C1776 278 "$10,125.00" " 3,742.20 " - " 8,100.00 " - " 6,996.38 " - " 6,996.38 " - " 5,594.06 " - " 6,682.50 " - - " 6,701.74 " - - " 2,372.92 " " 2,966.15 " - - - " 8,100.00 " - - " 6,783.75 " - " 4,141.13 " " 7,593.75 " " 3,848.51 " " 4,528.91 " - 28110235 JOINT DEVICE IMP LVL042 C1776 278 "$10,375.00" " 3,834.60 " - " 8,300.00 " - " 7,169.13 " - " 7,169.13 " - " 5,732.19 " - " 6,847.50 " - - " 6,867.21 " - - " 2,372.92 " " 2,966.15 " - - - " 8,300.00 " - - " 6,951.25 " - " 4,243.38 " " 7,781.25 " " 3,943.54 " " 4,640.74 " - 28110243 JOINT DEVICE IMP LVL043 C1776 278 "$10,625.00" " 3,927.00 " - " 8,500.00 " - " 7,341.88 " - " 7,341.88 " - " 5,870.31 " - " 7,012.50 " - - " 7,032.69 " - - " 2,372.92 " " 2,966.15 " - - - " 8,500.00 " - - " 7,118.75 " - " 4,345.63 " " 7,968.75 " " 4,038.56 " " 4,752.56 " - 28110251 JOINT DEVICE IMP LVL044 C1776 278 "$10,875.00" " 4,019.40 " - " 8,700.00 " - " 7,514.63 " - " 7,514.63 " - " 6,008.44 " - " 7,177.50 " - - " 7,198.16 " - - " 2,372.92 " " 2,966.15 " - - - " 8,700.00 " - - " 7,286.25 " - " 4,447.88 " " 8,156.25 " " 4,133.59 " " 4,864.39 " - 28110260 JOINT DEVICE IMP LVL045 C1776 278 "$11,125.00" " 4,111.80 " - " 8,900.00 " - " 7,687.38 " - " 7,687.38 " - " 6,146.56 " - " 7,342.50 " - - " 7,363.64 " - - " 2,372.92 " " 2,966.15 " - - - " 8,900.00 " - - " 7,453.75 " - " 4,550.13 " " 8,343.75 " " 4,228.61 " " 4,976.21 " - 28110278 JOINT DEVICE IMP LVL046 C1776 278 "$11,375.00" " 4,204.20 " - " 9,100.00 " - " 7,860.13 " - " 7,860.13 " - " 6,284.69 " - " 7,507.50 " - - " 7,529.11 " - - " 2,372.92 " " 2,966.15 " - - - " 9,100.00 " - - " 7,621.25 " - " 4,652.38 " " 8,531.25 " " 4,323.64 " " 5,088.04 " - 28110286 JOINT DEVICE IMP LVL047 C1776 278 "$11,625.00" " 4,296.60 " - " 9,300.00 " - " 8,032.88 " - " 8,032.88 " - " 6,422.81 " - " 7,672.50 " - - " 7,694.59 " - - " 2,372.92 " " 2,966.15 " - - - " 9,300.00 " - - " 7,788.75 " - " 4,754.63 " " 8,718.75 " " 4,418.66 " " 5,199.86 " - 28110294 JOINT DEVICE IMP LVL048 C1776 278 "$11,875.00" " 4,389.00 " - " 9,500.00 " - " 8,205.63 " - " 8,205.63 " - " 6,560.94 " - " 7,837.50 " - - " 7,860.06 " - - " 2,372.92 " " 2,966.15 " - - - " 9,500.00 " - - " 7,956.25 " - " 4,856.88 " " 8,906.25 " " 4,513.69 " " 5,311.69 " - 28110308 JOINT DEVICE IMP LVL049 C1776 278 "$12,125.00" " 4,481.40 " - " 9,700.00 " - " 8,378.38 " - " 8,378.38 " - " 6,699.06 " - " 8,002.50 " - - " 8,025.54 " - - " 2,372.92 " " 2,966.15 " - - - " 9,700.00 " - - " 8,123.75 " - " 4,959.13 " " 9,093.75 " " 4,608.71 " " 5,423.51 " - 28110316 JOINT DEVICE IMP LVL050 C1776 278 "$12,375.00" " 4,573.80 " - " 9,900.00 " - " 8,551.13 " - " 8,551.13 " - " 6,837.19 " - " 8,167.50 " - - " 8,191.01 " - - " 2,372.92 " " 2,966.15 " - - - " 9,900.00 " - - " 8,291.25 " - " 5,061.38 " " 9,281.25 " " 4,703.74 " " 5,535.34 " - 28110324 JOINT DEVICE IMP LVL051 C1776 278 "$12,625.00" " 4,666.20 " - " 10,100.00 " - " 8,723.88 " - " 8,723.88 " - " 6,975.31 " - " 8,332.50 " - - " 8,356.49 " - - " 2,372.92 " " 2,966.15 " - - - " 10,100.00 " - - " 8,458.75 " - " 5,163.63 " " 9,468.75 " " 4,798.76 " " 5,647.16 " - 28110359 JOINT DEVICE IMP LVL054 C1776 278 "$13,375.00" " 4,943.40 " - " 10,700.00 " - " 9,242.13 " - " 9,242.13 " - " 7,389.69 " - " 8,827.50 " - - " 8,852.91 " - - " 2,372.92 " " 2,966.15 " - - - " 10,700.00 " - - " 8,961.25 " - " 5,470.38 " " 10,031.25 " " 5,083.84 " " 5,982.64 " - 28110391 JOINT DEVICE IMP LVL058 C1776 278 "$14,375.00" " 5,313.00 " - " 11,500.00 " - " 9,933.13 " - " 9,933.13 " - " 7,942.19 " - " 9,487.50 " - - " 9,514.81 " - - " 2,372.92 " " 2,966.15 " - - - " 11,500.00 " - - " 9,631.25 " - " 5,879.38 " " 10,781.25 " " 5,463.94 " " 6,429.94 " - 28110405 JOINT DEVICE IMP LVL059 C1776 278 "$14,625.00" " 5,405.40 " - " 11,700.00 " - " 10,105.88 " - " 10,105.88 " - " 8,080.31 " - " 9,652.50 " - - " 9,680.29 " - - " 2,372.92 " " 2,966.15 " - - - " 11,700.00 " - - " 9,798.75 " - " 5,981.63 " " 10,968.75 " " 5,558.96 " " 6,541.76 " - 28110421 JOINT DEVICE IMP LVL061 C1776 278 "$15,125.00" " 5,590.20 " - " 12,100.00 " - " 10,451.38 " - " 10,451.38 " - " 8,356.56 " - " 9,982.50 " - - " 10,011.24 " - - " 2,372.92 " " 2,966.15 " - - - " 12,100.00 " - - " 10,133.75 " - " 6,186.13 " " 11,343.75 " " 5,749.01 " " 6,765.41 " - 28110448 JOINT DEVICE IMP LVL063 C1776 278 "$15,625.00" " 5,775.00 " - " 12,500.00 " - " 10,796.88 " - " 10,796.88 " - " 8,632.81 " - " 10,312.50 " - - " 10,342.19 " - - " 2,372.92 " " 2,966.15 " - - - " 12,500.00 " - - " 10,468.75 " - " 6,390.63 " " 11,718.75 " " 5,939.06 " " 6,989.06 " - 28110499 JOINT DEVICE IMP LVL068 C1776 278 "$16,875.00" " 6,237.00 " - " 13,500.00 " - " 11,660.63 " - " 11,660.63 " - " 9,323.44 " - " 11,137.50 " - - " 11,169.56 " - - " 2,372.92 " " 2,966.15 " - - - " 13,500.00 " - - " 11,306.25 " - " 6,901.88 " " 12,656.25 " " 6,414.19 " " 7,548.19 " - 28110529 JOINT DEVICE IMP LVL071 C1776 278 "$17,625.00" " 6,514.20 " - " 14,100.00 " - " 12,178.88 " - " 12,178.88 " - " 9,737.81 " - " 11,632.50 " - - " 11,665.99 " - - " 2,372.92 " " 2,966.15 " - - - " 14,100.00 " - - " 11,808.75 " - " 7,208.63 " " 13,218.75 " " 6,699.26 " " 7,883.66 " - 28110561 JOINT DEVICE IMP LVL075 C1776 278 "$18,625.00" " 6,883.80 " - " 14,900.00 " - " 12,869.88 " - " 12,869.88 " - " 10,290.31 " - " 12,292.50 " - - " 12,327.89 " - - " 2,372.92 " " 2,966.15 " - - - " 14,900.00 " - - " 12,478.75 " - " 7,617.63 " " 13,968.75 " " 7,079.36 " " 8,330.96 " - 28110570 JOINT DEVICE IMP LVL076 C1776 278 "$18,875.00" " 6,976.20 " - " 15,100.00 " - " 13,042.63 " - " 13,042.63 " - " 10,428.44 " - " 12,457.50 " - - " 12,493.36 " - - " 2,372.92 " " 2,966.15 " - - - " 15,100.00 " - - " 12,646.25 " - " 7,719.88 " " 14,156.25 " " 7,174.39 " " 8,442.79 " - 28110588 JOINT DEVICE IMP LVL077 C1776 278 "$19,125.00" " 7,068.60 " - " 15,300.00 " - " 13,215.38 " - " 13,215.38 " - " 10,566.56 " - " 12,622.50 " - - " 12,658.84 " - - " 2,372.92 " " 2,966.15 " - - - " 15,300.00 " - - " 12,813.75 " - " 7,822.13 " " 14,343.75 " " 7,269.41 " " 8,554.61 " - 28110642 JOINT DEVICE IMP LVL083 C1776 278 "$20,625.00" " 7,623.00 " - " 16,500.00 " - " 14,251.88 " - " 14,251.88 " - " 11,395.31 " - " 13,612.50 " - - " 13,651.69 " - - " 2,372.92 " " 2,966.15 " - - - " 16,500.00 " - - " 13,818.75 " - " 8,435.63 " " 15,468.75 " " 7,839.56 " " 9,225.56 " - 28110669 JOINT DEVICE IMP LVL085 C1776 278 "$21,125.00" " 7,807.80 " - " 16,900.00 " - " 14,597.38 " - " 14,597.38 " - " 11,671.56 " - " 13,942.50 " - - " 13,982.64 " - - " 2,372.92 " " 2,966.15 " - - - " 16,900.00 " - - " 14,153.75 " - " 8,640.13 " " 15,843.75 " " 8,029.61 " " 9,449.21 " - 28110677 JOINT DEVICE IMP LVL086 C1776 278 "$21,375.00" " 7,900.20 " - " 17,100.00 " - " 14,770.13 " - " 14,770.13 " - " 11,809.69 " - " 14,107.50 " - - " 14,148.11 " - - " 2,372.92 " " 2,966.15 " - - - " 17,100.00 " - - " 14,321.25 " - " 8,742.38 " " 16,031.25 " " 8,124.64 " " 9,561.04 " - 28110723 JOINT DEVICE IMP LVL091 C1776 278 "$22,625.00" " 8,362.20 " - " 18,100.00 " - " 15,633.88 " - " 15,633.88 " - " 12,500.31 " - " 14,932.50 " - - " 14,975.49 " - - " 2,372.92 " " 2,966.15 " - - - " 18,100.00 " - - " 15,158.75 " - " 9,253.63 " " 16,968.75 " " 8,599.76 " " 10,120.16 " - 28126964 JOINT DEVICE IMP LVL134 C1776 278 "$33,375.00" " 12,335.40 " - " 26,700.00 " - " 23,062.13 " - " 23,062.13 " - " 18,439.69 " - " 22,027.50 " - - " 22,090.91 " - - " 2,372.92 " " 2,966.15 " - - - " 26,700.00 " - - " 22,361.25 " - " 13,650.38 " " 25,031.25 " " 12,685.84 " " 14,928.64 " - 30604814 LEAD AICD ENDO S-COIL LVL024 C1777 275 "$5,875.00" " 2,171.40 " - " 14,460.26 " - " 4,059.63 " - " 4,059.63 " - " 3,245.94 " - " 3,877.50 " - - " 3,888.66 " - - " 11,568.21 " " 14,460.26 " - - - " 4,700.00 " - - " 3,936.25 " - " 2,402.88 " " 4,406.25 " " 2,233.09 " " 2,627.89 " - 30604822 LEAD AICD ENDO S-COIL LVL025 C1777 275 "$6,125.00" " 2,263.80 " - " 14,460.26 " - " 4,232.38 " - " 4,232.38 " - " 3,384.06 " - " 4,042.50 " - - " 4,054.14 " - - " 11,568.21 " " 14,460.26 " - - - " 4,900.00 " - - " 4,103.75 " - " 2,505.13 " " 4,593.75 " " 2,328.11 " " 2,739.71 " - 30604831 LEAD AICD ENDO S-COIL LVL033 C1777 275 "$8,125.00" " 3,003.00 " - " 14,460.26 " - " 5,614.38 " - " 5,614.38 " - " 4,489.06 " - " 5,362.50 " - - " 5,377.94 " - - " 11,568.21 " " 14,460.26 " - - - " 6,500.00 " - - " 5,443.75 " - " 3,323.13 " " 6,093.75 " " 3,088.31 " " 3,634.31 " - 30604849 LEAD AICD ENDO S-COIL LVL037 C1777 275 "$9,125.00" " 3,372.60 " - " 14,460.26 " - " 6,305.38 " - " 6,305.38 " - " 5,041.56 " - " 6,022.50 " - - " 6,039.84 " - - " 11,568.21 " " 14,460.26 " - - - " 7,300.00 " - - " 6,113.75 " - " 3,732.13 " " 6,843.75 " " 3,468.41 " " 4,081.61 " - 30604857 LEAD AICD ENDO S-COIL LVL038 C1777 275 "$9,375.00" " 3,465.00 " - " 14,460.26 " - " 6,478.13 " - " 6,478.13 " - " 5,179.69 " - " 6,187.50 " - - " 6,205.31 " - - " 11,568.21 " " 14,460.26 " - - - " 7,500.00 " - - " 6,281.25 " - " 3,834.38 " " 7,031.25 " " 3,563.44 " " 4,193.44 " - 30604865 LEAD AICD ENDO S-COIL LVL039 C1777 275 "$9,625.00" " 3,557.40 " - " 14,460.26 " - " 6,650.88 " - " 6,650.88 " - " 5,317.81 " - " 6,352.50 " - - " 6,370.79 " - - " 11,568.21 " " 14,460.26 " - - - " 7,700.00 " - - " 6,448.75 " - " 3,936.63 " " 7,218.75 " " 3,658.46 " " 4,305.26 " - 30604873 LEAD AICD ENDO S-COIL LVL044 C1777 275 "$10,875.00" " 4,019.40 " - " 14,460.26 " - " 7,514.63 " - " 7,514.63 " - " 6,008.44 " - " 7,177.50 " - - " 7,198.16 " - - " 11,568.21 " " 14,460.26 " - - - " 8,700.00 " - - " 7,286.25 " - " 4,447.88 " " 8,156.25 " " 4,133.59 " " 4,864.39 " - 30604881 LEAD AICD ENDO S-COIL LVL045 C1777 275 "$11,125.00" " 4,111.80 " - " 14,460.26 " - " 7,687.38 " - " 7,687.38 " - " 6,146.56 " - " 7,342.50 " - - " 7,363.64 " - - " 11,568.21 " " 14,460.26 " - - - " 8,900.00 " - - " 7,453.75 " - " 4,550.13 " " 8,343.75 " " 4,228.61 " " 4,976.21 " - 30604890 LEAD AICD ENDO S-COIL LVL046 C1777 275 "$11,375.00" " 4,204.20 " - " 14,460.26 " - " 7,860.13 " - " 7,860.13 " - " 6,284.69 " - " 7,507.50 " - - " 7,529.11 " - - " 11,568.21 " " 14,460.26 " - - - " 9,100.00 " - - " 7,621.25 " - " 4,652.38 " " 8,531.25 " " 4,323.64 " " 5,088.04 " - 30604903 LEAD AICD ENDO S-COIL LVL047 C1777 275 "$11,625.00" " 4,296.60 " - " 14,460.26 " - " 8,032.88 " - " 8,032.88 " - " 6,422.81 " - " 7,672.50 " - - " 7,694.59 " - - " 11,568.21 " " 14,460.26 " - - - " 9,300.00 " - - " 7,788.75 " - " 4,754.63 " " 8,718.75 " " 4,418.66 " " 5,199.86 " - 30604911 LEAD AICD ENDO S-COIL LVL049 C1777 275 "$12,125.00" " 4,481.40 " - " 14,460.26 " - " 8,378.38 " - " 8,378.38 " - " 6,699.06 " - " 8,002.50 " - - " 8,025.54 " - - " 11,568.21 " " 14,460.26 " - - - " 9,700.00 " - - " 8,123.75 " - " 4,959.13 " " 9,093.75 " " 4,608.71 " " 5,423.51 " - 30604920 LEAD AICD ENDO S-COIL LVL050 C1777 275 "$12,375.00" " 4,573.80 " - " 14,460.26 " - " 8,551.13 " - " 8,551.13 " - " 6,837.19 " - " 8,167.50 " - - " 8,191.01 " - - " 11,568.21 " " 14,460.26 " - - - " 9,900.00 " - - " 8,291.25 " - " 5,061.38 " " 9,281.25 " " 4,703.74 " " 5,535.34 " - 30609182 LEAD AICD ENDO S-COIL LVL015 C1777 275 "$3,625.00" " 1,339.80 " - " 14,460.26 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - " 11,568.21 " " 14,460.26 " - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 30609191 LEAD AICD ENDO S-COIL LVL016 C1777 275 "$3,875.00" " 1,432.20 " - " 14,460.26 " - " 2,677.63 " - " 2,677.63 " - " 2,140.94 " - " 2,557.50 " - - " 2,564.86 " - - " 11,568.21 " " 14,460.26 " - - - " 3,100.00 " - - " 2,596.25 " - " 1,584.88 " " 2,906.25 " " 1,472.89 " " 1,733.29 " - 30609204 LEAD AICD ENDO S-COIL LVL017 C1777 275 "$4,125.00" " 1,524.60 " - " 14,460.26 " - " 2,850.38 " - " 2,850.38 " - " 2,279.06 " - " 2,722.50 " - - " 2,730.34 " - - " 11,568.21 " " 14,460.26 " - - - " 3,300.00 " - - " 2,763.75 " - " 1,687.13 " " 3,093.75 " " 1,567.91 " " 1,845.11 " - 30609212 LEAD AICD ENDO S-COIL LVL018 C1777 275 "$4,375.00" " 1,617.00 " - " 14,460.26 " - " 3,023.13 " - " 3,023.13 " - " 2,417.19 " - " 2,887.50 " - - " 2,895.81 " - - " 11,568.21 " " 14,460.26 " - - - " 3,500.00 " - - " 2,931.25 " - " 1,789.38 " " 3,281.25 " " 1,662.94 " " 1,956.94 " - 30609221 LEAD AICD ENDO S-COIL LVL019 C1777 275 "$4,625.00" " 1,709.40 " - " 14,460.26 " - " 3,195.88 " - " 3,195.88 " - " 2,555.31 " - " 3,052.50 " - - " 3,061.29 " - - " 11,568.21 " " 14,460.26 " - - - " 3,700.00 " - - " 3,098.75 " - " 1,891.63 " " 3,468.75 " " 1,757.96 " " 2,068.76 " - 30609239 LEAD AICD ENDO S-COIL LVL020 C1777 275 "$4,875.00" " 1,801.80 " - " 14,460.26 " - " 3,368.63 " - " 3,368.63 " - " 2,693.44 " - " 3,217.50 " - - " 3,226.76 " - - " 11,568.21 " " 14,460.26 " - - - " 3,900.00 " - - " 3,266.25 " - " 1,993.88 " " 3,656.25 " " 1,852.99 " " 2,180.59 " - 30609247 LEAD AICD ENDO S-COIL LVL021 C1777 275 "$5,125.00" " 1,894.20 " - " 14,460.26 " - " 3,541.38 " - " 3,541.38 " - " 2,831.56 " - " 3,382.50 " - - " 3,392.24 " - - " 11,568.21 " " 14,460.26 " - - - " 4,100.00 " - - " 3,433.75 " - " 2,096.13 " " 3,843.75 " " 1,948.01 " " 2,292.41 " - 30609255 LEAD AICD ENDO S-COIL LVL022 C1777 275 "$5,375.00" " 1,986.60 " - " 14,460.26 " - " 3,714.13 " - " 3,714.13 " - " 2,969.69 " - " 3,547.50 " - - " 3,557.71 " - - " 11,568.21 " " 14,460.26 " - - - " 4,300.00 " - - " 3,601.25 " - " 2,198.38 " " 4,031.25 " " 2,043.04 " " 2,404.24 " - 30609263 LEAD AICD ENDO S-COIL LVL023 C1777 275 "$5,625.00" " 2,079.00 " - " 14,460.26 " - " 3,886.88 " - " 3,886.88 " - " 3,107.81 " - " 3,712.50 " - - " 3,723.19 " - - " 11,568.21 " " 14,460.26 " - - - " 4,500.00 " - - " 3,768.75 " - " 2,300.63 " " 4,218.75 " " 2,138.06 " " 2,516.06 " - 30609271 LEAD AICD ENDO S-COIL LVL026 C1777 275 "$6,375.00" " 2,356.20 " - " 14,460.26 " - " 4,405.13 " - " 4,405.13 " - " 3,522.19 " - " 4,207.50 " - - " 4,219.61 " - - " 11,568.21 " " 14,460.26 " - - - " 5,100.00 " - - " 4,271.25 " - " 2,607.38 " " 4,781.25 " " 2,423.14 " " 2,851.54 " - 30609280 LEAD AICD ENDO S-COIL LVL027 C1777 275 "$6,625.00" " 2,448.60 " - " 14,460.26 " - " 4,577.88 " - " 4,577.88 " - " 3,660.31 " - " 4,372.50 " - - " 4,385.09 " - - " 11,568.21 " " 14,460.26 " - - - " 5,300.00 " - - " 4,438.75 " - " 2,709.63 " " 4,968.75 " " 2,518.16 " " 2,963.36 " - 30609298 LEAD AICD ENDO S-COIL LVL028 C1777 275 "$6,875.00" " 2,541.00 " - " 14,460.26 " - " 4,750.63 " - " 4,750.63 " - " 3,798.44 " - " 4,537.50 " - - " 4,550.56 " - - " 11,568.21 " " 14,460.26 " - - - " 5,500.00 " - - " 4,606.25 " - " 2,811.88 " " 5,156.25 " " 2,613.19 " " 3,075.19 " - 30609301 LEAD AICD ENDO S-COIL LVL029 C1777 275 "$7,125.00" " 2,633.40 " - " 14,460.26 " - " 4,923.38 " - " 4,923.38 " - " 3,936.56 " - " 4,702.50 " - - " 4,716.04 " - - " 11,568.21 " " 14,460.26 " - - - " 5,700.00 " - - " 4,773.75 " - " 2,914.13 " " 5,343.75 " " 2,708.21 " " 3,187.01 " - 30609310 LEAD AICD ENDO S-COIL LVL030 C1777 275 "$7,375.00" " 2,725.80 " - " 14,460.26 " - " 5,096.13 " - " 5,096.13 " - " 4,074.69 " - " 4,867.50 " - - " 4,881.51 " - - " 11,568.21 " " 14,460.26 " - - - " 5,900.00 " - - " 4,941.25 " - " 3,016.38 " " 5,531.25 " " 2,803.24 " " 3,298.84 " - 30609328 LEAD AICD ENDO S-COIL LVL031 C1777 275 "$7,625.00" " 2,818.20 " - " 14,460.26 " - " 5,268.88 " - " 5,268.88 " - " 4,212.81 " - " 5,032.50 " - - " 5,046.99 " - - " 11,568.21 " " 14,460.26 " - - - " 6,100.00 " - - " 5,108.75 " - " 3,118.63 " " 5,718.75 " " 2,898.26 " " 3,410.66 " - 30609336 LEAD AICD ENDO S-COIL LVL032 C1777 275 "$7,875.00" " 2,910.60 " - " 14,460.26 " - " 5,441.63 " - " 5,441.63 " - " 4,350.94 " - " 5,197.50 " - - " 5,212.46 " - - " 11,568.21 " " 14,460.26 " - - - " 6,300.00 " - - " 5,276.25 " - " 3,220.88 " " 5,906.25 " " 2,993.29 " " 3,522.49 " - 30609344 LEAD AICD ENDO S-COIL LVL034 C1777 275 "$8,375.00" " 3,095.40 " - " 14,460.26 " - " 5,787.13 " - " 5,787.13 " - " 4,627.19 " - " 5,527.50 " - - " 5,543.41 " - - " 11,568.21 " " 14,460.26 " - - - " 6,700.00 " - - " 5,611.25 " - " 3,425.38 " " 6,281.25 " " 3,183.34 " " 3,746.14 " - 30609352 LEAD AICD ENDO S-COIL LVL035 C1777 275 "$8,625.00" " 3,187.80 " - " 14,460.26 " - " 5,959.88 " - " 5,959.88 " - " 4,765.31 " - " 5,692.50 " - - " 5,708.89 " - - " 11,568.21 " " 14,460.26 " - - - " 6,900.00 " - - " 5,778.75 " - " 3,527.63 " " 6,468.75 " " 3,278.36 " " 3,857.96 " - 30609361 LEAD AICD ENDO S-COIL LVL036 C1777 275 "$8,875.00" " 3,280.20 " - " 14,460.26 " - " 6,132.63 " - " 6,132.63 " - " 4,903.44 " - " 5,857.50 " - - " 5,874.36 " - - " 11,568.21 " " 14,460.26 " - - - " 7,100.00 " - - " 5,946.25 " - " 3,629.88 " " 6,656.25 " " 3,373.39 " " 3,969.79 " - 30609379 LEAD AICD ENDO S-COIL LVL040 C1777 275 "$9,875.00" " 3,649.80 " - " 14,460.26 " - " 6,823.63 " - " 6,823.63 " - " 5,455.94 " - " 6,517.50 " - - " 6,536.26 " - - " 11,568.21 " " 14,460.26 " - - - " 7,900.00 " - - " 6,616.25 " - " 4,038.88 " " 7,406.25 " " 3,753.49 " " 4,417.09 " - 30609387 LEAD AICD ENDO S-COIL LVL041 C1777 275 "$10,125.00" " 3,742.20 " - " 14,460.26 " - " 6,996.38 " - " 6,996.38 " - " 5,594.06 " - " 6,682.50 " - - " 6,701.74 " - - " 11,568.21 " " 14,460.26 " - - - " 8,100.00 " - - " 6,783.75 " - " 4,141.13 " " 7,593.75 " " 3,848.51 " " 4,528.91 " - 30609395 LEAD AICD ENDO S-COIL LVL042 C1777 275 "$10,375.00" " 3,834.60 " - " 14,460.26 " - " 7,169.13 " - " 7,169.13 " - " 5,732.19 " - " 6,847.50 " - - " 6,867.21 " - - " 11,568.21 " " 14,460.26 " - - - " 8,300.00 " - - " 6,951.25 " - " 4,243.38 " " 7,781.25 " " 3,943.54 " " 4,640.74 " - 30609409 LEAD AICD ENDO S-COIL LVL043 C1777 275 "$10,625.00" " 3,927.00 " - " 14,460.26 " - " 7,341.88 " - " 7,341.88 " - " 5,870.31 " - " 7,012.50 " - - " 7,032.69 " - - " 11,568.21 " " 14,460.26 " - - - " 8,500.00 " - - " 7,118.75 " - " 4,345.63 " " 7,968.75 " " 4,038.56 " " 4,752.56 " - 30609417 LEAD AICD ENDO S-COIL LVL048 C1777 275 "$11,875.00" " 4,389.00 " - " 14,460.26 " - " 8,205.63 " - " 8,205.63 " - " 6,560.94 " - " 7,837.50 " - - " 7,860.06 " - - " 11,568.21 " " 14,460.26 " - - - " 9,500.00 " - - " 7,956.25 " - " 4,856.88 " " 8,906.25 " " 4,513.69 " " 5,311.69 " - 28111053 LEAD NEUROSTIM IMP LVL001 C1778 278 $200.00 73.92 - " 8,001.11 " - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - " 6,400.89 " " 8,001.11 " - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 28111070 LEAD NEUROSTIM IMP LVL003 C1778 278 $750.00 277.20 - " 8,001.11 " - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - " 6,400.89 " " 8,001.11 " - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 28111100 LEAD NEUROSTIM IMP LVL006 C1778 278 "$1,375.00" 508.20 - " 8,001.11 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - " 6,400.89 " " 8,001.11 " - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 28111207 LEAD NEUROSTIM IMP LVL014 C1778 278 "$3,375.00" " 1,247.40 " - " 8,001.11 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - " 6,400.89 " " 8,001.11 " - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 28111410 LEAD NEUROSTIM IMP LVL035 C1778 278 "$8,625.00" " 3,187.80 " - " 8,001.11 " - " 5,959.88 " - " 5,959.88 " - " 4,765.31 " - " 5,692.50 " - - " 5,708.89 " - - " 6,400.89 " " 8,001.11 " - - - " 6,900.00 " - - " 5,778.75 " - " 3,527.63 " " 6,468.75 " " 3,278.36 " " 3,857.96 " - 28111436 LEAD NEUROSTIM IMP LVL037 C1778 278 "$9,125.00" " 3,372.60 " - " 8,001.11 " - " 6,305.38 " - " 6,305.38 " - " 5,041.56 " - " 6,022.50 " - - " 6,039.84 " - - " 6,400.89 " " 8,001.11 " - - - " 7,300.00 " - - " 6,113.75 " - " 3,732.13 " " 6,843.75 " " 3,468.41 " " 4,081.61 " - 28111444 LEAD NEUROSTIM IMP LVL039 C1778 278 "$9,625.00" " 3,557.40 " - " 8,001.11 " - " 6,650.88 " - " 6,650.88 " - " 5,317.81 " - " 6,352.50 " - - " 6,370.79 " - - " 6,400.89 " " 8,001.11 " - - - " 7,700.00 " - - " 6,448.75 " - " 3,936.63 " " 7,218.75 " " 3,658.46 " " 4,305.26 " - 28111452 LEAD NEUROSTIM IMP LVL046 C1778 278 "$11,375.00" " 4,204.20 " - " 9,100.00 " - " 7,860.13 " - " 7,860.13 " - " 6,284.69 " - " 7,507.50 " - - " 7,529.11 " - - " 6,400.89 " " 8,001.11 " - - - " 9,100.00 " - - " 7,621.25 " - " 4,652.38 " " 8,531.25 " " 4,323.64 " " 5,088.04 " - 28111461 LEAD NEUROSTIM IMP LVL052 C1778 278 "$12,875.00" " 4,758.60 " - " 10,300.00 " - " 8,896.63 " - " 8,896.63 " - " 7,113.44 " - " 8,497.50 " - - " 8,521.96 " - - " 6,400.89 " " 8,001.11 " - - - " 10,300.00 " - - " 8,626.25 " - " 5,265.88 " " 9,656.25 " " 4,893.79 " " 5,758.99 " - 28111487 LEAD NEUROSTIM IMP LVL057 C1778 278 "$14,125.00" " 5,220.60 " - " 11,300.00 " - " 9,760.38 " - " 9,760.38 " - " 7,804.06 " - " 9,322.50 " - - " 9,349.34 " - - " 6,400.89 " " 8,001.11 " - - - " 11,300.00 " - - " 9,463.75 " - " 5,777.13 " " 10,593.75 " " 5,368.91 " " 6,318.11 " - 28111495 LEAD NEUROSTIM IMP LVL059 C1778 278 "$14,625.00" " 5,405.40 " - " 11,700.00 " - " 10,105.88 " - " 10,105.88 " - " 8,080.31 " - " 9,652.50 " - - " 9,680.29 " - - " 6,400.89 " " 8,001.11 " - - - " 11,700.00 " - - " 9,798.75 " - " 5,981.63 " " 10,968.75 " " 5,558.96 " " 6,541.76 " - 28111525 LEAD NEUROSTIM IMP LVL065 C1778 278 "$16,125.00" " 5,959.80 " - " 12,900.00 " - " 11,142.38 " - " 11,142.38 " - " 8,909.06 " - " 10,642.50 " - - " 10,673.14 " - - " 6,400.89 " " 8,001.11 " - - - " 12,900.00 " - - " 10,803.75 " - " 6,595.13 " " 12,093.75 " " 6,129.11 " " 7,212.71 " - 28127308 LEAD NEUROSTIM IMP LVL045 C1778 278 "$11,125.00" " 4,111.80 " - " 8,900.00 " - " 7,687.38 " - " 7,687.38 " - " 6,146.56 " - " 7,342.50 " - - " 7,363.64 " - - " 6,400.89 " " 8,001.11 " - - - " 8,900.00 " - - " 7,453.75 " - " 4,550.13 " " 8,343.75 " " 4,228.61 " " 4,976.21 " - 28127324 LEAD NEUROSTIM IMP LVL048 C1778 278 "$11,875.00" " 4,389.00 " - " 9,500.00 " - " 8,205.63 " - " 8,205.63 " - " 6,560.94 " - " 7,837.50 " - - " 7,860.06 " - - " 6,400.89 " " 8,001.11 " - - - " 9,500.00 " - - " 7,956.25 " - " 4,856.88 " " 8,906.25 " " 4,513.69 " " 5,311.69 " - 28127391 LEAD NEUROSTIM IMP LVL058 C1778 278 "$14,375.00" " 5,313.00 " - " 11,500.00 " - " 9,933.13 " - " 9,933.13 " - " 7,942.19 " - " 9,487.50 " - - " 9,514.81 " - - " 6,400.89 " " 8,001.11 " - - - " 11,500.00 " - - " 9,631.25 " - " 5,879.38 " " 10,781.25 " " 5,463.94 " " 6,429.94 " - 28127413 LEAD NEUROSTIM IMP LVL061 C1778 278 "$15,125.00" " 5,590.20 " - " 12,100.00 " - " 10,451.38 " - " 10,451.38 " - " 8,356.56 " - " 9,982.50 " - - " 10,011.24 " - - " 6,400.89 " " 8,001.11 " - - - " 12,100.00 " - - " 10,133.75 " - " 6,186.13 " " 11,343.75 " " 5,749.01 " " 6,765.41 " - 28127481 LEAD NEUROSTIM IMP LVL071 C1778 278 "$17,625.00" " 6,514.20 " - " 14,100.00 " - " 12,178.88 " - " 12,178.88 " - " 9,737.81 " - " 11,632.50 " - - " 11,665.99 " - - " 6,400.89 " " 8,001.11 " - - - " 14,100.00 " - - " 11,808.75 " - " 7,208.63 " " 13,218.75 " " 6,699.26 " " 7,883.66 " - 28127499 LEAD NEUROSTIM IMP LVL072 C1778 278 "$17,875.00" " 6,606.60 " - " 14,300.00 " - " 12,351.63 " - " 12,351.63 " - " 9,875.94 " - " 11,797.50 " - - " 11,831.46 " - - " 6,400.89 " " 8,001.11 " - - - " 14,300.00 " - - " 11,976.25 " - " 7,310.88 " " 13,406.25 " " 6,794.29 " " 7,995.49 " - 28127529 LEAD NEUROSTIM IMP LVL075 C1778 278 "$18,625.00" " 6,883.80 " - " 14,900.00 " - " 12,869.88 " - " 12,869.88 " - " 10,290.31 " - " 12,292.50 " - - " 12,327.89 " - - " 6,400.89 " " 8,001.11 " - - - " 14,900.00 " - - " 12,478.75 " - " 7,617.63 " " 13,968.75 " " 7,079.36 " " 8,330.96 " - 28112033 MESH/IMP LVL001 C1781 278 $200.00 73.92 - 777.67 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 622.14 777.67 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 28112041 MESH/IMP LVL002 C1781 278 $450.00 166.32 - 777.67 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 622.14 777.67 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 28112050 MESH/IMP LVL003 C1781 278 $750.00 277.20 - 777.67 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 622.14 777.67 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 28112068 MESH/IMP LVL004 C1781 278 "$1,050.00" 388.08 - 840.00 - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 622.14 777.67 - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 28112076 MESH/IMP LVL005 C1781 278 "$1,350.00" 498.96 - " 1,080.00 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 622.14 777.67 - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 28112084 MESH/IMP LVL006 C1781 278 "$1,375.00" 508.20 - " 1,100.00 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - 622.14 777.67 - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 28112092 MESH/IMP LVL007 C1781 278 "$1,625.00" 600.60 - " 1,300.00 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - 622.14 777.67 - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 28112106 MESH/IMP LVL008 C1781 278 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - 622.14 777.67 - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 28112114 MESH/IMP LVL009 C1781 278 "$2,125.00" 785.40 - " 1,700.00 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - 622.14 777.67 - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 28112122 MESH/IMP LVL010 C1781 278 "$2,375.00" 877.80 - " 1,900.00 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - 622.14 777.67 - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 28112149 MESH/IMP LVL012 C1781 278 "$2,875.00" " 1,062.60 " - " 2,300.00 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - 622.14 777.67 - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 28112157 MESH/IMP LVL013 C1781 278 "$3,125.00" " 1,155.00 " - " 2,500.00 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - 622.14 777.67 - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 28112165 MESH/IMP LVL014 C1781 278 "$3,375.00" " 1,247.40 " - " 2,700.00 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - 622.14 777.67 - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 28112173 MESH/IMP LVL015 C1781 278 "$3,625.00" " 1,339.80 " - " 2,900.00 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - 622.14 777.67 - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 28112181 MESH/IMP LVL016 C1781 278 "$3,875.00" " 1,432.20 " - " 3,100.00 " - " 2,677.63 " - " 2,677.63 " - " 2,140.94 " - " 2,557.50 " - - " 2,564.86 " - - 622.14 777.67 - - - " 3,100.00 " - - " 2,596.25 " - " 1,584.88 " " 2,906.25 " " 1,472.89 " " 1,733.29 " - 28112246 MESH/IMP LVL022 C1781 278 "$5,375.00" " 1,986.60 " - " 4,300.00 " - " 3,714.13 " - " 3,714.13 " - " 2,969.69 " - " 3,547.50 " - - " 3,557.71 " - - 622.14 777.67 - - - " 4,300.00 " - - " 3,601.25 " - " 2,198.38 " " 4,031.25 " " 2,043.04 " " 2,404.24 " - 28112289 MESH/IMP LVL026 C1781 278 "$6,375.00" " 2,356.20 " - " 5,100.00 " - " 4,405.13 " - " 4,405.13 " - " 3,522.19 " - " 4,207.50 " - - " 4,219.61 " - - 622.14 777.67 - - - " 5,100.00 " - - " 4,271.25 " - " 2,607.38 " " 4,781.25 " " 2,423.14 " " 2,851.54 " - 28112351 MESH/IMP LVL033 C1781 278 "$8,125.00" " 3,003.00 " - " 6,500.00 " - " 5,614.38 " - " 5,614.38 " - " 4,489.06 " - " 5,362.50 " - - " 5,377.94 " - - 622.14 777.67 - - - " 6,500.00 " - - " 5,443.75 " - " 3,323.13 " " 6,093.75 " " 3,088.31 " " 3,634.31 " - 28127863 MESH/IMP LVL035 C1781 278 "$8,625.00" " 3,187.80 " - " 6,900.00 " - " 5,959.88 " - " 5,959.88 " - " 4,765.31 " - " 5,692.50 " - - " 5,708.89 " - - 622.14 777.67 - - - " 6,900.00 " - - " 5,778.75 " - " 3,527.63 " " 6,468.75 " " 3,278.36 " " 3,857.96 " - 28127898 MESH/IMP LVL038 C1781 278 "$9,375.00" " 3,465.00 " - " 7,500.00 " - " 6,478.13 " - " 6,478.13 " - " 5,179.69 " - " 6,187.50 " - - " 6,205.31 " - - 622.14 777.67 - - - " 7,500.00 " - - " 6,281.25 " - " 3,834.38 " " 7,031.25 " " 3,563.44 " " 4,193.44 " - 28127910 MESH/IMP LVL040 C1781 278 "$9,875.00" " 3,649.80 " - " 7,900.00 " - " 6,823.63 " - " 6,823.63 " - " 5,455.94 " - " 6,517.50 " - - " 6,536.26 " - - 622.14 777.67 - - - " 7,900.00 " - - " 6,616.25 " - " 4,038.88 " " 7,406.25 " " 3,753.49 " " 4,417.09 " - 28152591 MESH IMP LVL043 C1781 278 "$10,625.00" " 3,927.00 " - " 8,500.00 " - " 7,341.88 " - " 7,341.88 " - " 5,870.31 " - " 7,012.50 " - - " 7,032.69 " - - 622.14 777.67 - - - " 8,500.00 " - - " 7,118.75 " - " 4,345.63 " " 7,968.75 " " 4,038.56 " " 4,752.56 " - 30611918 MESH IMP LVL010 C1781 278 "$2,375.00" 877.80 - " 1,900.00 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - 622.14 777.67 - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 30611926 MESH IMP LVL011 C1781 278 "$2,625.00" 970.20 - " 2,100.00 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - 622.14 777.67 - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 30611934 MESH IMP LVL012 C1781 278 "$2,875.00" " 1,062.60 " - " 2,300.00 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - 622.14 777.67 - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 30611942 MESH IMP LVL013 C1781 278 "$3,125.00" " 1,155.00 " - " 2,500.00 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - 622.14 777.67 - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 30611951 MESH IMP LVL014 C1781 278 "$3,375.00" " 1,247.40 " - " 2,700.00 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - 622.14 777.67 - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 30611969 MESH IMP LVL015 C1781 278 "$3,625.00" " 1,339.80 " - " 2,900.00 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - 622.14 777.67 - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 30604946 D-PMKR RATE RESP IMP LVL026 C1785 275 "$6,375.00" " 2,356.20 " - " 16,276.79 " - " 4,405.13 " - " 4,405.13 " - " 3,522.19 " - " 4,207.50 " - - " 4,219.61 " - - " 13,021.43 " " 16,276.79 " - - - " 5,100.00 " - - " 4,271.25 " - " 2,607.38 " " 4,781.25 " " 2,423.14 " " 2,851.54 " - 30604954 D-PMKR RATE RESP IMP LVL027 C1785 275 "$6,625.00" " 2,448.60 " - " 16,276.79 " - " 4,577.88 " - " 4,577.88 " - " 3,660.31 " - " 4,372.50 " - - " 4,385.09 " - - " 13,021.43 " " 16,276.79 " - - - " 5,300.00 " - - " 4,438.75 " - " 2,709.63 " " 4,968.75 " " 2,518.16 " " 2,963.36 " - 30604962 D-PMKR RATE RESP IMP LVL028 C1785 275 "$6,875.00" " 2,541.00 " - " 16,276.79 " - " 4,750.63 " - " 4,750.63 " - " 3,798.44 " - " 4,537.50 " - - " 4,550.56 " - - " 13,021.43 " " 16,276.79 " - - - " 5,500.00 " - - " 4,606.25 " - " 2,811.88 " " 5,156.25 " " 2,613.19 " " 3,075.19 " - 30604971 D-PMKR RATE RESP IMP LVL029 C1785 275 "$7,125.00" " 2,633.40 " - " 16,276.79 " - " 4,923.38 " - " 4,923.38 " - " 3,936.56 " - " 4,702.50 " - - " 4,716.04 " - - " 13,021.43 " " 16,276.79 " - - - " 5,700.00 " - - " 4,773.75 " - " 2,914.13 " " 5,343.75 " " 2,708.21 " " 3,187.01 " - 30604989 D-PMKR RATE RESP IMP LVL030 C1785 275 "$7,375.00" " 2,725.80 " - " 16,276.79 " - " 5,096.13 " - " 5,096.13 " - " 4,074.69 " - " 4,867.50 " - - " 4,881.51 " - - " 13,021.43 " " 16,276.79 " - - - " 5,900.00 " - - " 4,941.25 " - " 3,016.38 " " 5,531.25 " " 2,803.24 " " 3,298.84 " - 30604997 D-PMKR RATE RESP IMP LVL031 C1785 275 "$7,625.00" " 2,818.20 " - " 16,276.79 " - " 5,268.88 " - " 5,268.88 " - " 4,212.81 " - " 5,032.50 " - - " 5,046.99 " - - " 13,021.43 " " 16,276.79 " - - - " 6,100.00 " - - " 5,108.75 " - " 3,118.63 " " 5,718.75 " " 2,898.26 " " 3,410.66 " - 30605004 D-PMKR RATE RESP IMP LVL033 C1785 275 "$8,125.00" " 3,003.00 " - " 16,276.79 " - " 5,614.38 " - " 5,614.38 " - " 4,489.06 " - " 5,362.50 " - - " 5,377.94 " - - " 13,021.43 " " 16,276.79 " - - - " 6,500.00 " - - " 5,443.75 " - " 3,323.13 " " 6,093.75 " " 3,088.31 " " 3,634.31 " - 30605012 D-PMKR RATE RESP IMP LVL034 C1785 275 "$8,375.00" " 3,095.40 " - " 16,276.79 " - " 5,787.13 " - " 5,787.13 " - " 4,627.19 " - " 5,527.50 " - - " 5,543.41 " - - " 13,021.43 " " 16,276.79 " - - - " 6,700.00 " - - " 5,611.25 " - " 3,425.38 " " 6,281.25 " " 3,183.34 " " 3,746.14 " - 30605021 D-PMKR RATE RESP IMP LVL035 C1785 275 "$8,625.00" " 3,187.80 " - " 16,276.79 " - " 5,959.88 " - " 5,959.88 " - " 4,765.31 " - " 5,692.50 " - - " 5,708.89 " - - " 13,021.43 " " 16,276.79 " - - - " 6,900.00 " - - " 5,778.75 " - " 3,527.63 " " 6,468.75 " " 3,278.36 " " 3,857.96 " - 30605039 D-PMKR RATE RESP IMP LVL036 C1785 275 "$8,875.00" " 3,280.20 " - " 16,276.79 " - " 6,132.63 " - " 6,132.63 " - " 4,903.44 " - " 5,857.50 " - - " 5,874.36 " - - " 13,021.43 " " 16,276.79 " - - - " 7,100.00 " - - " 5,946.25 " - " 3,629.88 " " 6,656.25 " " 3,373.39 " " 3,969.79 " - 30605047 D-PMKR RATE RESP IMP LVL037 C1785 275 "$9,125.00" " 3,372.60 " - " 16,276.79 " - " 6,305.38 " - " 6,305.38 " - " 5,041.56 " - " 6,022.50 " - - " 6,039.84 " - - " 13,021.43 " " 16,276.79 " - - - " 7,300.00 " - - " 6,113.75 " - " 3,732.13 " " 6,843.75 " " 3,468.41 " " 4,081.61 " - 30605055 D-PMKR RATE RESP IMP LVL038 C1785 275 "$9,375.00" " 3,465.00 " - " 16,276.79 " - " 6,478.13 " - " 6,478.13 " - " 5,179.69 " - " 6,187.50 " - - " 6,205.31 " - - " 13,021.43 " " 16,276.79 " - - - " 7,500.00 " - - " 6,281.25 " - " 3,834.38 " " 7,031.25 " " 3,563.44 " " 4,193.44 " - 30605063 D-PMKR RATE RESP IMP LVL040 C1785 275 "$9,875.00" " 3,649.80 " - " 16,276.79 " - " 6,823.63 " - " 6,823.63 " - " 5,455.94 " - " 6,517.50 " - - " 6,536.26 " - - " 13,021.43 " " 16,276.79 " - - - " 7,900.00 " - - " 6,616.25 " - " 4,038.88 " " 7,406.25 " " 3,753.49 " " 4,417.09 " - 30605071 D-PMKR RATE RESP IMP LVL041 C1785 275 "$10,125.00" " 3,742.20 " - " 16,276.79 " - " 6,996.38 " - " 6,996.38 " - " 5,594.06 " - " 6,682.50 " - - " 6,701.74 " - - " 13,021.43 " " 16,276.79 " - - - " 8,100.00 " - - " 6,783.75 " - " 4,141.13 " " 7,593.75 " " 3,848.51 " " 4,528.91 " - 30605080 D-PMKR RATE RESP IMP LVL042 C1785 275 "$10,375.00" " 3,834.60 " - " 16,276.79 " - " 7,169.13 " - " 7,169.13 " - " 5,732.19 " - " 6,847.50 " - - " 6,867.21 " - - " 13,021.43 " " 16,276.79 " - - - " 8,300.00 " - - " 6,951.25 " - " 4,243.38 " " 7,781.25 " " 3,943.54 " " 4,640.74 " - 30605098 D-PMKR RATE RESP IMP LVL043 C1785 275 "$10,625.00" " 3,927.00 " - " 16,276.79 " - " 7,341.88 " - " 7,341.88 " - " 5,870.31 " - " 7,012.50 " - - " 7,032.69 " - - " 13,021.43 " " 16,276.79 " - - - " 8,500.00 " - - " 7,118.75 " - " 4,345.63 " " 7,968.75 " " 4,038.56 " " 4,752.56 " - 30605101 D-PMKR RATE RESP IMP LVL045 C1785 275 "$11,125.00" " 4,111.80 " - " 16,276.79 " - " 7,687.38 " - " 7,687.38 " - " 6,146.56 " - " 7,342.50 " - - " 7,363.64 " - - " 13,021.43 " " 16,276.79 " - - - " 8,900.00 " - - " 7,453.75 " - " 4,550.13 " " 8,343.75 " " 4,228.61 " " 4,976.21 " - 30605110 D-PMKR RATE RESP IMP LVL046 C1785 275 "$11,375.00" " 4,204.20 " - " 16,276.79 " - " 7,860.13 " - " 7,860.13 " - " 6,284.69 " - " 7,507.50 " - - " 7,529.11 " - - " 13,021.43 " " 16,276.79 " - - - " 9,100.00 " - - " 7,621.25 " - " 4,652.38 " " 8,531.25 " " 4,323.64 " " 5,088.04 " - 30605128 D-PMKR RATE RESP IMP LVL048 C1785 275 "$11,875.00" " 4,389.00 " - " 16,276.79 " - " 8,205.63 " - " 8,205.63 " - " 6,560.94 " - " 7,837.50 " - - " 7,860.06 " - - " 13,021.43 " " 16,276.79 " - - - " 9,500.00 " - - " 7,956.25 " - " 4,856.88 " " 8,906.25 " " 4,513.69 " " 5,311.69 " - 30605136 D-PMKR RATE RESP IMP LVL049 C1785 275 "$12,125.00" " 4,481.40 " - " 16,276.79 " - " 8,378.38 " - " 8,378.38 " - " 6,699.06 " - " 8,002.50 " - - " 8,025.54 " - - " 13,021.43 " " 16,276.79 " - - - " 9,700.00 " - - " 8,123.75 " - " 4,959.13 " " 9,093.75 " " 4,608.71 " " 5,423.51 " - 30605144 D-PMKR RATE RESP IMP LVL051 C1785 275 "$12,625.00" " 4,666.20 " - " 16,276.79 " - " 8,723.88 " - " 8,723.88 " - " 6,975.31 " - " 8,332.50 " - - " 8,356.49 " - - " 13,021.43 " " 16,276.79 " - - - " 10,100.00 " - - " 8,458.75 " - " 5,163.63 " " 9,468.75 " " 4,798.76 " " 5,647.16 " - 30605152 D-PMKR RATE RESP IMP LVL052 C1785 275 "$12,875.00" " 4,758.60 " - " 16,276.79 " - " 8,896.63 " - " 8,896.63 " - " 7,113.44 " - " 8,497.50 " - - " 8,521.96 " - - " 13,021.43 " " 16,276.79 " - - - " 10,300.00 " - - " 8,626.25 " - " 5,265.88 " " 9,656.25 " " 4,893.79 " " 5,758.99 " - 30605161 D-PMKR RATE RESP IMP LVL053 C1785 275 "$13,125.00" " 4,851.00 " - " 16,276.79 " - " 9,069.38 " - " 9,069.38 " - " 7,251.56 " - " 8,662.50 " - - " 8,687.44 " - - " 13,021.43 " " 16,276.79 " - - - " 10,500.00 " - - " 8,793.75 " - " 5,368.13 " " 9,843.75 " " 4,988.81 " " 5,870.81 " - 30605179 D-PMKR RATE RESP IMP LVL054 C1785 275 "$13,375.00" " 4,943.40 " - " 16,276.79 " - " 9,242.13 " - " 9,242.13 " - " 7,389.69 " - " 8,827.50 " - - " 8,852.91 " - - " 13,021.43 " " 16,276.79 " - - - " 10,700.00 " - - " 8,961.25 " - " 5,470.38 " " 10,031.25 " " 5,083.84 " " 5,982.64 " - 30606795 D-PMKR RATE RESP IMP LVL039 C1785 275 "$9,625.00" " 3,557.40 " - " 16,276.79 " - " 6,650.88 " - " 6,650.88 " - " 5,317.81 " - " 6,352.50 " - - " 6,370.79 " - - " 13,021.43 " " 16,276.79 " - - - " 7,700.00 " - - " 6,448.75 " - " 3,936.63 " " 7,218.75 " " 3,658.46 " " 4,305.26 " - 30606809 D-PMKR RATE RESP IMP LVL044 C1785 275 "$10,875.00" " 4,019.40 " - " 16,276.79 " - " 7,514.63 " - " 7,514.63 " - " 6,008.44 " - " 7,177.50 " - - " 7,198.16 " - - " 13,021.43 " " 16,276.79 " - - - " 8,700.00 " - - " 7,286.25 " - " 4,447.88 " " 8,156.25 " " 4,133.59 " " 4,864.39 " - 30606817 D-PMKR RATE RESP IMP LVL047 C1785 275 "$11,625.00" " 4,296.60 " - " 16,276.79 " - " 8,032.88 " - " 8,032.88 " - " 6,422.81 " - " 7,672.50 " - - " 7,694.59 " - - " 13,021.43 " " 16,276.79 " - - - " 9,300.00 " - - " 7,788.75 " - " 4,754.63 " " 8,718.75 " " 4,418.66 " " 5,199.86 " - 30606825 D-PMKR RATE RESP IMP LVL050 C1785 275 "$12,375.00" " 4,573.80 " - " 16,276.79 " - " 8,551.13 " - " 8,551.13 " - " 6,837.19 " - " 8,167.50 " - - " 8,191.01 " - - " 13,021.43 " " 16,276.79 " - - - " 9,900.00 " - - " 8,291.25 " - " 5,061.38 " " 9,281.25 " " 4,703.74 " " 5,535.34 " - 30606833 D-PMKR RATE RESP IMP LVL055 C1785 275 "$13,625.00" " 5,035.80 " - " 16,276.79 " - " 9,414.88 " - " 9,414.88 " - " 7,527.81 " - " 8,992.50 " - - " 9,018.39 " - - " 13,021.43 " " 16,276.79 " - - - " 10,900.00 " - - " 9,128.75 " - " 5,572.63 " " 10,218.75 " " 5,178.86 " " 6,094.46 " - 30606841 D-PMKR RATE RESP IMP LVL056 C1785 275 "$13,875.00" " 5,128.20 " - " 16,276.79 " - " 9,587.63 " - " 9,587.63 " - " 7,665.94 " - " 9,157.50 " - - " 9,183.86 " - - " 13,021.43 " " 16,276.79 " - - - " 11,100.00 " - - " 9,296.25 " - " 5,674.88 " " 10,406.25 " " 5,273.89 " " 6,206.29 " - 30609476 D-PMKR RATE RESP IMP LVL020 C1785 275 "$4,875.00" " 1,801.80 " - " 16,276.79 " - " 3,368.63 " - " 3,368.63 " - " 2,693.44 " - " 3,217.50 " - - " 3,226.76 " - - " 13,021.43 " " 16,276.79 " - - - " 3,900.00 " - - " 3,266.25 " - " 1,993.88 " " 3,656.25 " " 1,852.99 " " 2,180.59 " - 30609484 D-PMKR RATE RESP IMP LVL021 C1785 275 "$5,125.00" " 1,894.20 " - " 16,276.79 " - " 3,541.38 " - " 3,541.38 " - " 2,831.56 " - " 3,382.50 " - - " 3,392.24 " - - " 13,021.43 " " 16,276.79 " - - - " 4,100.00 " - - " 3,433.75 " - " 2,096.13 " " 3,843.75 " " 1,948.01 " " 2,292.41 " - 30609492 D-PMKR RATE RESP IMP LVL022 C1785 275 "$5,375.00" " 1,986.60 " - " 16,276.79 " - " 3,714.13 " - " 3,714.13 " - " 2,969.69 " - " 3,547.50 " - - " 3,557.71 " - - " 13,021.43 " " 16,276.79 " - - - " 4,300.00 " - - " 3,601.25 " - " 2,198.38 " " 4,031.25 " " 2,043.04 " " 2,404.24 " - 30609506 D-PMKR RATE RESP IMP LVL023 C1785 275 "$5,625.00" " 2,079.00 " - " 16,276.79 " - " 3,886.88 " - " 3,886.88 " - " 3,107.81 " - " 3,712.50 " - - " 3,723.19 " - - " 13,021.43 " " 16,276.79 " - - - " 4,500.00 " - - " 3,768.75 " - " 2,300.63 " " 4,218.75 " " 2,138.06 " " 2,516.06 " - 30609514 D-PMKR RATE RESP IMP LVL024 C1785 275 "$5,875.00" " 2,171.40 " - " 16,276.79 " - " 4,059.63 " - " 4,059.63 " - " 3,245.94 " - " 3,877.50 " - - " 3,888.66 " - - " 13,021.43 " " 16,276.79 " - - - " 4,700.00 " - - " 3,936.25 " - " 2,402.88 " " 4,406.25 " " 2,233.09 " " 2,627.89 " - 30609522 D-PMKR RATE RESP IMP LVL025 C1785 275 "$6,125.00" " 2,263.80 " - " 16,276.79 " - " 4,232.38 " - " 4,232.38 " - " 3,384.06 " - " 4,042.50 " - - " 4,054.14 " - - " 13,021.43 " " 16,276.79 " - - - " 4,900.00 " - - " 4,103.75 " - " 2,505.13 " " 4,593.75 " " 2,328.11 " " 2,739.71 " - 30609531 D-PMKR RATE RESP IMP LVL032 C1785 275 "$7,875.00" " 2,910.60 " - " 16,276.79 " - " 5,441.63 " - " 5,441.63 " - " 4,350.94 " - " 5,197.50 " - - " 5,212.46 " - - " 13,021.43 " " 16,276.79 " - - - " 6,300.00 " - - " 5,276.25 " - " 3,220.88 " " 5,906.25 " " 2,993.29 " " 3,522.49 " - 30609549 D-PMKR RATE RESP IMP LVL057 C1785 275 "$14,125.00" " 5,220.60 " - " 16,276.79 " - " 9,760.38 " - " 9,760.38 " - " 7,804.06 " - " 9,322.50 " - - " 9,349.34 " - - " 13,021.43 " " 16,276.79 " - - - " 11,300.00 " - - " 9,463.75 " - " 5,777.13 " " 10,593.75 " " 5,368.91 " " 6,318.11 " - 30609557 D-PMKR RATE RESP IMP LVL058 C1785 275 "$14,375.00" " 5,313.00 " - " 16,276.79 " - " 9,933.13 " - " 9,933.13 " - " 7,942.19 " - " 9,487.50 " - - " 9,514.81 " - - " 13,021.43 " " 16,276.79 " - - - " 11,500.00 " - - " 9,631.25 " - " 5,879.38 " " 10,781.25 " " 5,463.94 " " 6,429.94 " - 30609565 D-PMKR RATE RESP IMP LVL059 C1785 275 "$14,625.00" " 5,405.40 " - " 16,276.79 " - " 10,105.88 " - " 10,105.88 " - " 8,080.31 " - " 9,652.50 " - - " 9,680.29 " - - " 13,021.43 " " 16,276.79 " - - - " 11,700.00 " - - " 9,798.75 " - " 5,981.63 " " 10,968.75 " " 5,558.96 " " 6,541.76 " - 30609573 D-PMKR RATE RESP IMP LVL060 C1785 275 "$14,875.00" " 5,497.80 " - " 16,276.79 " - " 10,278.63 " - " 10,278.63 " - " 8,218.44 " - " 9,817.50 " - - " 9,845.76 " - - " 13,021.43 " " 16,276.79 " - - - " 11,900.00 " - - " 9,966.25 " - " 6,083.88 " " 11,156.25 " " 5,653.99 " " 6,653.59 " - 30613660 D-PMKR RATE RESP IMP LVL081 C1785 275 "$20,125.00" " 7,438.20 " - " 16,276.79 " - " 13,906.38 " - " 13,906.38 " - " 11,119.06 " - " 13,282.50 " - - " 13,320.74 " - - " 13,021.43 " " 16,276.79 " - - - " 16,100.00 " - - " 13,483.75 " - " 8,231.13 " " 15,093.75 " " 7,649.51 " " 9,001.91 " - 30604938 S-PMKR RATE RESP IMP LVL125 C1786 275 "$31,125.00" " 11,503.80 " - " 24,900.00 " - " 21,507.38 " - " 21,507.38 " - " 17,196.56 " - " 20,542.50 " - - " 20,601.64 " - - " 10,083.38 " " 12,604.23 " - - - " 24,900.00 " - - " 20,853.75 " - " 12,730.13 " " 23,343.75 " " 11,830.61 " " 13,922.21 " - 30605187 S-PMKR RATE RESP IMP LVL021 C1786 275 "$5,125.00" " 1,894.20 " - " 12,604.23 " - " 3,541.38 " - " 3,541.38 " - " 2,831.56 " - " 3,382.50 " - - " 3,392.24 " - - " 10,083.38 " " 12,604.23 " - - - " 4,100.00 " - - " 3,433.75 " - " 2,096.13 " " 3,843.75 " " 1,948.01 " " 2,292.41 " - 30605195 S-PMKR RATE RESP IMP LVL022 C1786 275 "$5,375.00" " 1,986.60 " - " 12,604.23 " - " 3,714.13 " - " 3,714.13 " - " 2,969.69 " - " 3,547.50 " - - " 3,557.71 " - - " 10,083.38 " " 12,604.23 " - - - " 4,300.00 " - - " 3,601.25 " - " 2,198.38 " " 4,031.25 " " 2,043.04 " " 2,404.24 " - 30605209 S-PMKR RATE RESP IMP LVL023 C1786 275 "$5,625.00" " 2,079.00 " - " 12,604.23 " - " 3,886.88 " - " 3,886.88 " - " 3,107.81 " - " 3,712.50 " - - " 3,723.19 " - - " 10,083.38 " " 12,604.23 " - - - " 4,500.00 " - - " 3,768.75 " - " 2,300.63 " " 4,218.75 " " 2,138.06 " " 2,516.06 " - 30605217 S-PMKR RATE RESP IMP LVL024 C1786 275 "$5,875.00" " 2,171.40 " - " 12,604.23 " - " 4,059.63 " - " 4,059.63 " - " 3,245.94 " - " 3,877.50 " - - " 3,888.66 " - - " 10,083.38 " " 12,604.23 " - - - " 4,700.00 " - - " 3,936.25 " - " 2,402.88 " " 4,406.25 " " 2,233.09 " " 2,627.89 " - 30605225 S-PMKR RATE RESP IMP LVL025 C1786 275 "$6,125.00" " 2,263.80 " - " 12,604.23 " - " 4,232.38 " - " 4,232.38 " - " 3,384.06 " - " 4,042.50 " - - " 4,054.14 " - - " 10,083.38 " " 12,604.23 " - - - " 4,900.00 " - - " 4,103.75 " - " 2,505.13 " " 4,593.75 " " 2,328.11 " " 2,739.71 " - 30605233 S-PMKR RATE RESP IMP LVL029 C1786 275 "$7,125.00" " 2,633.40 " - " 12,604.23 " - " 4,923.38 " - " 4,923.38 " - " 3,936.56 " - " 4,702.50 " - - " 4,716.04 " - - " 10,083.38 " " 12,604.23 " - - - " 5,700.00 " - - " 4,773.75 " - " 2,914.13 " " 5,343.75 " " 2,708.21 " " 3,187.01 " - 30605241 S-PMKR RATE RESP IMP LVL030 C1786 275 "$7,375.00" " 2,725.80 " - " 12,604.23 " - " 5,096.13 " - " 5,096.13 " - " 4,074.69 " - " 4,867.50 " - - " 4,881.51 " - - " 10,083.38 " " 12,604.23 " - - - " 5,900.00 " - - " 4,941.25 " - " 3,016.38 " " 5,531.25 " " 2,803.24 " " 3,298.84 " - 30605250 S-PMKR RATE RESP IMP LVL031 C1786 275 "$7,625.00" " 2,818.20 " - " 12,604.23 " - " 5,268.88 " - " 5,268.88 " - " 4,212.81 " - " 5,032.50 " - - " 5,046.99 " - - " 10,083.38 " " 12,604.23 " - - - " 6,100.00 " - - " 5,108.75 " - " 3,118.63 " " 5,718.75 " " 2,898.26 " " 3,410.66 " - 30605268 S-PMKR RATE RESP IMP LVL032 C1786 275 "$7,875.00" " 2,910.60 " - " 12,604.23 " - " 5,441.63 " - " 5,441.63 " - " 4,350.94 " - " 5,197.50 " - - " 5,212.46 " - - " 10,083.38 " " 12,604.23 " - - - " 6,300.00 " - - " 5,276.25 " - " 3,220.88 " " 5,906.25 " " 2,993.29 " " 3,522.49 " - 30605276 S-PMKR RATE RESP IMP LVL040 C1786 275 "$9,875.00" " 3,649.80 " - " 12,604.23 " - " 6,823.63 " - " 6,823.63 " - " 5,455.94 " - " 6,517.50 " - - " 6,536.26 " - - " 10,083.38 " " 12,604.23 " - - - " 7,900.00 " - - " 6,616.25 " - " 4,038.88 " " 7,406.25 " " 3,753.49 " " 4,417.09 " - 30605284 S-PMKR RATE RESP IMP LVL041 C1786 275 "$10,125.00" " 3,742.20 " - " 12,604.23 " - " 6,996.38 " - " 6,996.38 " - " 5,594.06 " - " 6,682.50 " - - " 6,701.74 " - - " 10,083.38 " " 12,604.23 " - - - " 8,100.00 " - - " 6,783.75 " - " 4,141.13 " " 7,593.75 " " 3,848.51 " " 4,528.91 " - 30605292 S-PMKR RATE RESP IMP LVL042 C1786 275 "$10,375.00" " 3,834.60 " - " 12,604.23 " - " 7,169.13 " - " 7,169.13 " - " 5,732.19 " - " 6,847.50 " - - " 6,867.21 " - - " 10,083.38 " " 12,604.23 " - - - " 8,300.00 " - - " 6,951.25 " - " 4,243.38 " " 7,781.25 " " 3,943.54 " " 4,640.74 " - 30605306 S-PMKR RATE RESP IMP LVL043 C1786 275 "$10,625.00" " 3,927.00 " - " 12,604.23 " - " 7,341.88 " - " 7,341.88 " - " 5,870.31 " - " 7,012.50 " - - " 7,032.69 " - - " 10,083.38 " " 12,604.23 " - - - " 8,500.00 " - - " 7,118.75 " - " 4,345.63 " " 7,968.75 " " 4,038.56 " " 4,752.56 " - 30605314 S-PMKR RATE RESP IMP LVL044 C1786 275 "$10,875.00" " 4,019.40 " - " 12,604.23 " - " 7,514.63 " - " 7,514.63 " - " 6,008.44 " - " 7,177.50 " - - " 7,198.16 " - - " 10,083.38 " " 12,604.23 " - - - " 8,700.00 " - - " 7,286.25 " - " 4,447.88 " " 8,156.25 " " 4,133.59 " " 4,864.39 " - 30605322 S-PMKR RATE RESP IMP LVL045 C1786 275 "$11,125.00" " 4,111.80 " - " 12,604.23 " - " 7,687.38 " - " 7,687.38 " - " 6,146.56 " - " 7,342.50 " - - " 7,363.64 " - - " 10,083.38 " " 12,604.23 " - - - " 8,900.00 " - - " 7,453.75 " - " 4,550.13 " " 8,343.75 " " 4,228.61 " " 4,976.21 " - 30605331 S-PMKR RATE RESP IMP LVL046 C1786 275 "$11,375.00" " 4,204.20 " - " 12,604.23 " - " 7,860.13 " - " 7,860.13 " - " 6,284.69 " - " 7,507.50 " - - " 7,529.11 " - - " 10,083.38 " " 12,604.23 " - - - " 9,100.00 " - - " 7,621.25 " - " 4,652.38 " " 8,531.25 " " 4,323.64 " " 5,088.04 " - 30609581 S-PMKR RATE RESP IMP LVL015 C1786 275 "$3,625.00" " 1,339.80 " - " 12,604.23 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - " 10,083.38 " " 12,604.23 " - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 30609590 S-PMKR RATE RESP IMP LVL016 C1786 275 "$3,875.00" " 1,432.20 " - " 12,604.23 " - " 2,677.63 " - " 2,677.63 " - " 2,140.94 " - " 2,557.50 " - - " 2,564.86 " - - " 10,083.38 " " 12,604.23 " - - - " 3,100.00 " - - " 2,596.25 " - " 1,584.88 " " 2,906.25 " " 1,472.89 " " 1,733.29 " - 30609603 S-PMKR RATE RESP IMP LVL017 C1786 275 "$4,125.00" " 1,524.60 " - " 12,604.23 " - " 2,850.38 " - " 2,850.38 " - " 2,279.06 " - " 2,722.50 " - - " 2,730.34 " - - " 10,083.38 " " 12,604.23 " - - - " 3,300.00 " - - " 2,763.75 " - " 1,687.13 " " 3,093.75 " " 1,567.91 " " 1,845.11 " - 30609611 S-PMKR RATE RESP IMP LVL018 C1786 275 "$4,375.00" " 1,617.00 " - " 12,604.23 " - " 3,023.13 " - " 3,023.13 " - " 2,417.19 " - " 2,887.50 " - - " 2,895.81 " - - " 10,083.38 " " 12,604.23 " - - - " 3,500.00 " - - " 2,931.25 " - " 1,789.38 " " 3,281.25 " " 1,662.94 " " 1,956.94 " - 30609620 S-PMKR RATE RESP IMP LVL019 C1786 275 "$4,625.00" " 1,709.40 " - " 12,604.23 " - " 3,195.88 " - " 3,195.88 " - " 2,555.31 " - " 3,052.50 " - - " 3,061.29 " - - " 10,083.38 " " 12,604.23 " - - - " 3,700.00 " - - " 3,098.75 " - " 1,891.63 " " 3,468.75 " " 1,757.96 " " 2,068.76 " - 30609638 S-PMKR RATE RESP IMP LVL020 C1786 275 "$4,875.00" " 1,801.80 " - " 12,604.23 " - " 3,368.63 " - " 3,368.63 " - " 2,693.44 " - " 3,217.50 " - - " 3,226.76 " - - " 10,083.38 " " 12,604.23 " - - - " 3,900.00 " - - " 3,266.25 " - " 1,993.88 " " 3,656.25 " " 1,852.99 " " 2,180.59 " - 30609646 S-PMKR RATE RESP IMP LVL026 C1786 275 "$6,375.00" " 2,356.20 " - " 12,604.23 " - " 4,405.13 " - " 4,405.13 " - " 3,522.19 " - " 4,207.50 " - - " 4,219.61 " - - " 10,083.38 " " 12,604.23 " - - - " 5,100.00 " - - " 4,271.25 " - " 2,607.38 " " 4,781.25 " " 2,423.14 " " 2,851.54 " - 30609654 S-PMKR RATE RESP IMP LVL027 C1786 275 "$6,625.00" " 2,448.60 " - " 12,604.23 " - " 4,577.88 " - " 4,577.88 " - " 3,660.31 " - " 4,372.50 " - - " 4,385.09 " - - " 10,083.38 " " 12,604.23 " - - - " 5,300.00 " - - " 4,438.75 " - " 2,709.63 " " 4,968.75 " " 2,518.16 " " 2,963.36 " - 30609662 S-PMKR RATE RESP IMP LVL028 C1786 275 "$6,875.00" " 2,541.00 " - " 12,604.23 " - " 4,750.63 " - " 4,750.63 " - " 3,798.44 " - " 4,537.50 " - - " 4,550.56 " - - " 10,083.38 " " 12,604.23 " - - - " 5,500.00 " - - " 4,606.25 " - " 2,811.88 " " 5,156.25 " " 2,613.19 " " 3,075.19 " - 30609671 S-PMKR RATE RESP IMP LVL033 C1786 275 "$8,125.00" " 3,003.00 " - " 12,604.23 " - " 5,614.38 " - " 5,614.38 " - " 4,489.06 " - " 5,362.50 " - - " 5,377.94 " - - " 10,083.38 " " 12,604.23 " - - - " 6,500.00 " - - " 5,443.75 " - " 3,323.13 " " 6,093.75 " " 3,088.31 " " 3,634.31 " - 30609689 S-PMKR RATE RESP IMP LVL034 C1786 275 "$8,375.00" " 3,095.40 " - " 12,604.23 " - " 5,787.13 " - " 5,787.13 " - " 4,627.19 " - " 5,527.50 " - - " 5,543.41 " - - " 10,083.38 " " 12,604.23 " - - - " 6,700.00 " - - " 5,611.25 " - " 3,425.38 " " 6,281.25 " " 3,183.34 " " 3,746.14 " - 30609697 S-PMKR RATE RESP IMP LVL035 C1786 275 "$8,625.00" " 3,187.80 " - " 12,604.23 " - " 5,959.88 " - " 5,959.88 " - " 4,765.31 " - " 5,692.50 " - - " 5,708.89 " - - " 10,083.38 " " 12,604.23 " - - - " 6,900.00 " - - " 5,778.75 " - " 3,527.63 " " 6,468.75 " " 3,278.36 " " 3,857.96 " - 30609701 S-PMKR RATE RESP IMP LVL036 C1786 275 "$8,875.00" " 3,280.20 " - " 12,604.23 " - " 6,132.63 " - " 6,132.63 " - " 4,903.44 " - " 5,857.50 " - - " 5,874.36 " - - " 10,083.38 " " 12,604.23 " - - - " 7,100.00 " - - " 5,946.25 " - " 3,629.88 " " 6,656.25 " " 3,373.39 " " 3,969.79 " - 30609719 S-PMKR RATE RESP IMP LVL037 C1786 275 "$9,125.00" " 3,372.60 " - " 12,604.23 " - " 6,305.38 " - " 6,305.38 " - " 5,041.56 " - " 6,022.50 " - - " 6,039.84 " - - " 10,083.38 " " 12,604.23 " - - - " 7,300.00 " - - " 6,113.75 " - " 3,732.13 " " 6,843.75 " " 3,468.41 " " 4,081.61 " - 30609727 S-PMKR RATE RESP IMP LVL038 C1786 275 "$9,375.00" " 3,465.00 " - " 12,604.23 " - " 6,478.13 " - " 6,478.13 " - " 5,179.69 " - " 6,187.50 " - - " 6,205.31 " - - " 10,083.38 " " 12,604.23 " - - - " 7,500.00 " - - " 6,281.25 " - " 3,834.38 " " 7,031.25 " " 3,563.44 " " 4,193.44 " - 30609735 S-PMKR RATE RESP IMP LVL039 C1786 275 "$9,625.00" " 3,557.40 " - " 12,604.23 " - " 6,650.88 " - " 6,650.88 " - " 5,317.81 " - " 6,352.50 " - - " 6,370.79 " - - " 10,083.38 " " 12,604.23 " - - - " 7,700.00 " - - " 6,448.75 " - " 3,936.63 " " 7,218.75 " " 3,658.46 " " 4,305.26 " - 30609743 S-PMKR RATE RESP IMP LVL047 C1786 275 "$11,625.00" " 4,296.60 " - " 12,604.23 " - " 8,032.88 " - " 8,032.88 " - " 6,422.81 " - " 7,672.50 " - - " 7,694.59 " - - " 10,083.38 " " 12,604.23 " - - - " 9,300.00 " - - " 7,788.75 " - " 4,754.63 " " 8,718.75 " " 4,418.66 " " 5,199.86 " - 30609751 S-PMKR RATE RESP IMP LVL048 C1786 275 "$11,875.00" " 4,389.00 " - " 12,604.23 " - " 8,205.63 " - " 8,205.63 " - " 6,560.94 " - " 7,837.50 " - - " 7,860.06 " - - " 10,083.38 " " 12,604.23 " - - - " 9,500.00 " - - " 7,956.25 " - " 4,856.88 " " 8,906.25 " " 4,513.69 " " 5,311.69 " - 30609760 S-PMKR RATE RESP IMP LVL049 C1786 275 "$12,125.00" " 4,481.40 " - " 12,604.23 " - " 8,378.38 " - " 8,378.38 " - " 6,699.06 " - " 8,002.50 " - - " 8,025.54 " - - " 10,083.38 " " 12,604.23 " - - - " 9,700.00 " - - " 8,123.75 " - " 4,959.13 " " 9,093.75 " " 4,608.71 " " 5,423.51 " - 30609778 S-PMKR RATE RESP IMP LVL050 C1786 275 "$12,375.00" " 4,573.80 " - " 12,604.23 " - " 8,551.13 " - " 8,551.13 " - " 6,837.19 " - " 8,167.50 " - - " 8,191.01 " - - " 10,083.38 " " 12,604.23 " - - - " 9,900.00 " - - " 8,291.25 " - " 5,061.38 " " 9,281.25 " " 4,703.74 " " 5,535.34 " - 30610202 S-PMKR RATE RESP IMP LVL108 C1786 275 "$26,875.00" " 9,933.00 " - " 21,500.00 " - " 18,570.63 " - " 18,570.63 " - " 14,848.44 " - " 17,737.50 " - - " 17,788.56 " - - " 10,083.38 " " 12,604.23 " - - - " 21,500.00 " - - " 18,006.25 " - " 10,991.88 " " 20,156.25 " " 10,215.19 " " 12,021.19 " - 28112581 PAT PROGR NEUROSTIM LVL011 C1787 278 "$2,625.00" 970.20 - " 3,272.91 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - " 2,618.33 " " 3,272.91 " - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 28112599 PAT PROGR NEUROSTIM LVL012 C1787 278 "$2,875.00" " 1,062.60 " - " 3,272.91 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - " 2,618.33 " " 3,272.91 " - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 28112645 PORT INDWELLING IMP LVL003 C1788 278 $750.00 277.20 - " 1,372.62 " - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - " 1,098.10 " " 1,372.62 " - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 28112653 PORT INDWELLING IMP LVL004 C1788 278 "$1,050.00" 388.08 - " 1,372.62 " - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - " 1,098.10 " " 1,372.62 " - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 28112688 PORT INDWELLING IMP LVL007 C1788 278 "$1,625.00" 600.60 - " 1,372.62 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - " 1,098.10 " " 1,372.62 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 80363834 PORT INDWELLING IMP LVL001 C1788 278 $200.00 73.92 - " 1,372.62 " - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - " 1,098.10 " " 1,372.62 " - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 80363842 PORT INDWELLING IMP LVL002 C1788 278 $450.00 166.32 - " 1,372.62 " - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - " 1,098.10 " " 1,372.62 " - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 80363851 PORT INDWELLING IMP LVL003 C1788 278 $750.00 277.20 - " 1,372.62 " - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - " 1,098.10 " " 1,372.62 " - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 80363869 PORT INDWELLING IMP LVL004 C1788 278 "$1,050.00" 388.08 - " 1,372.62 " - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - " 1,098.10 " " 1,372.62 " - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 80363877 PORT INDWELLING IMP LVL005 C1788 278 "$1,350.00" 498.96 - " 1,372.62 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - " 1,098.10 " " 1,372.62 " - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 80363885 PORT INDWELLING IMP LVL006 C1788 278 "$1,375.00" 508.20 - " 1,372.62 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - " 1,098.10 " " 1,372.62 " - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 80363893 PORT INDWELLING IMP LVL007 C1788 278 "$1,625.00" 600.60 - " 1,372.62 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - " 1,098.10 " " 1,372.62 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 80363907 PORT INDWELLING IMP LVL008 C1788 278 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - " 1,098.10 " " 1,372.62 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 80363915 PORT INDWELLING IMP LVL009 C1788 278 "$2,125.00" 785.40 - " 1,700.00 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - " 1,098.10 " " 1,372.62 " - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 80363923 PORT INDWELLING IMP LVL010 C1788 278 "$2,375.00" 877.80 - " 1,900.00 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - " 1,098.10 " " 1,372.62 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 80363931 PORT INDWELLING IMP LVL011 C1788 278 "$2,625.00" 970.20 - " 2,100.00 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - " 1,098.10 " " 1,372.62 " - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 28113293 PROSTHESIS BREAST IMP LVL001 C1789 278 $200.00 73.92 - " 2,146.01 " - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - " 1,716.81 " " 2,146.01 " - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 28113307 PROSTHESIS BREAST IMP LVL002 C1789 278 $450.00 166.32 - " 2,146.01 " - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - " 1,716.81 " " 2,146.01 " - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 28113323 PROSTHESIS BREAST IMP LVL004 C1789 278 "$1,050.00" 388.08 - " 2,146.01 " - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - " 1,716.81 " " 2,146.01 " - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 28113340 PROSTHESIS BREAST IMP LVL006 C1789 278 "$1,375.00" 508.20 - " 2,146.01 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - " 1,716.81 " " 2,146.01 " - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 28113358 PROSTHESIS BREAST IMP LVL007 C1789 278 "$1,625.00" 600.60 - " 2,146.01 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - " 1,716.81 " " 2,146.01 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 28113366 PROSTHESIS BREAST IMP LVL008 C1789 278 "$1,875.00" 693.00 - " 2,146.01 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - " 1,716.81 " " 2,146.01 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 28113374 PROSTHESIS BREAST IMP LVL009 C1789 278 "$2,125.00" 785.40 - " 2,146.01 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - " 1,716.81 " " 2,146.01 " - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 28113382 PROSTHESIS BREAST IMP LVL010 C1789 278 "$2,375.00" 877.80 - " 2,146.01 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - " 1,716.81 " " 2,146.01 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 28113391 PROSTHESIS BREAST IMP LVL011 C1789 278 "$2,625.00" 970.20 - " 2,146.01 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - " 1,716.81 " " 2,146.01 " - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 28113412 PROSTHESIS BREAST IMP LVL013 C1789 278 "$3,125.00" " 1,155.00 " - " 2,500.00 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - " 1,716.81 " " 2,146.01 " - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 28113421 PROSTHESIS BREAST IMP LVL014 C1789 278 "$3,375.00" " 1,247.40 " - " 2,700.00 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - " 1,716.81 " " 2,146.01 " - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 28113447 PROSTHESIS BREAST IMP LVL016 C1789 278 "$3,875.00" " 1,432.20 " - " 3,100.00 " - " 2,677.63 " - " 2,677.63 " - " 2,140.94 " - " 2,557.50 " - - " 2,564.86 " - - " 1,716.81 " " 2,146.01 " - - - " 3,100.00 " - - " 2,596.25 " - " 1,584.88 " " 2,906.25 " " 1,472.89 " " 1,733.29 " - 28113480 PROSTHESIS BREAST IMP LVL020 C1789 278 "$4,875.00" " 1,801.80 " - " 3,900.00 " - " 3,368.63 " - " 3,368.63 " - " 2,693.44 " - " 3,217.50 " - - " 3,226.76 " - - " 1,716.81 " " 2,146.01 " - - - " 3,900.00 " - - " 3,266.25 " - " 1,993.88 " " 3,656.25 " " 1,852.99 " " 2,180.59 " - 28129017 PROSTHESIS BREAST IMP LVL022 C1789 278 "$5,375.00" " 1,986.60 " - " 4,300.00 " - " 3,714.13 " - " 3,714.13 " - " 2,969.69 " - " 3,547.50 " - - " 3,557.71 " - - " 1,716.81 " " 2,146.01 " - - - " 4,300.00 " - - " 3,601.25 " - " 2,198.38 " " 4,031.25 " " 2,043.04 " " 2,404.24 " - 28129025 PROSTHESIS BREAST IMP LVL023 C1789 278 "$5,625.00" " 2,079.00 " - " 4,500.00 " - " 3,886.88 " - " 3,886.88 " - " 3,107.81 " - " 3,712.50 " - - " 3,723.19 " - - " 1,716.81 " " 2,146.01 " - - - " 4,500.00 " - - " 3,768.75 " - " 2,300.63 " " 4,218.75 " " 2,138.06 " " 2,516.06 " - 28113200 PROSTH PENILE INFLATAB LVL008 C1813 278 "$1,875.00" 693.00 - " 13,594.68 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - " 10,875.74 " " 13,594.68 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 28113218 PROSTH PENILE INFLATAB LVL009 C1813 278 "$2,125.00" 785.40 - " 13,594.68 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - " 10,875.74 " " 13,594.68 " - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 28113226 PROSTH PENILE INFLATAB LVL010 C1813 278 "$2,375.00" 877.80 - " 13,594.68 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - " 10,875.74 " " 13,594.68 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 28113285 PROSTH PENILE INFLATAB LVL075 C1813 278 "$18,625.00" " 6,883.80 " - " 14,900.00 " - " 12,869.88 " - " 12,869.88 " - " 10,290.31 " - " 12,292.50 " - - " 12,327.89 " - - " 10,875.74 " " 13,594.68 " - - - " 14,900.00 " - - " 12,478.75 " - " 7,617.63 " " 13,968.75 " " 7,079.36 " " 8,330.96 " - 28129181 PROSTH PENILE INFLATAB LVL026 C1813 278 "$6,375.00" " 2,356.20 " - " 13,594.68 " - " 4,405.13 " - " 4,405.13 " - " 3,522.19 " - " 4,207.50 " - - " 4,219.61 " - - " 10,875.74 " " 13,594.68 " - - - " 5,100.00 " - - " 4,271.25 " - " 2,607.38 " " 4,781.25 " " 2,423.14 " " 2,851.54 " - 28113927 RETINAL TAMP SLCN OIL LVL004 C1814 278 "$1,050.00" 388.08 - " 1,069.59 " - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 855.67 " 1,069.59 " - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 29817006 SEPTAL DEFECT IMP SYS LVL075 C1817 278 "$18,625.00" " 6,883.80 " - " 14,900.00 " - " 12,869.88 " - " 12,869.88 " - " 10,290.31 " - " 12,292.50 " - - " 12,327.89 " - - " 10,722.05 " " 13,402.56 " - - - " 14,900.00 " - - " 12,478.75 " - " 7,617.63 " " 13,968.75 " " 7,079.36 " " 8,330.96 " - 29817669 SEPTAL DEFECT IMP SYS LVL100 C1817 278 "$24,875.00" " 9,193.80 " - " 19,900.00 " - " 17,188.63 " - " 17,188.63 " - " 13,743.44 " - " 16,417.50 " - - " 16,464.76 " - - " 10,722.05 " " 13,402.56 " - - - " 19,900.00 " - - " 16,666.25 " - " 10,173.88 " " 18,656.25 " " 9,454.99 " " 11,126.59 " - 29819254 SEPTAL DEFECT IMP SYS LVL070 C1817 278 "$17,375.00" " 6,421.80 " - " 13,900.00 " - " 12,006.13 " - " 12,006.13 " - " 9,599.69 " - " 11,467.50 " - - " 11,500.51 " - - " 10,722.05 " " 13,402.56 " - - - " 13,900.00 " - - " 11,641.25 " - " 7,106.38 " " 13,031.25 " " 6,604.24 " " 7,771.84 " - 29819262 SEPTAL DEFECT IMP SYS LVL071 C1817 278 "$17,625.00" " 6,514.20 " - " 14,100.00 " - " 12,178.88 " - " 12,178.88 " - " 9,737.81 " - " 11,632.50 " - - " 11,665.99 " - - " 10,722.05 " " 13,402.56 " - - - " 14,100.00 " - - " 11,808.75 " - " 7,208.63 " " 13,218.75 " " 6,699.26 " " 7,883.66 " - 29819271 SEPTAL DEFECT IMP SYS LVL072 C1817 278 "$17,875.00" " 6,606.60 " - " 14,300.00 " - " 12,351.63 " - " 12,351.63 " - " 9,875.94 " - " 11,797.50 " - - " 11,831.46 " - - " 10,722.05 " " 13,402.56 " - - - " 14,300.00 " - - " 11,976.25 " - " 7,310.88 " " 13,406.25 " " 6,794.29 " " 7,995.49 " - 29819289 SEPTAL DEFECT IMP SYS LVL073 C1817 278 "$18,125.00" " 6,699.00 " - " 14,500.00 " - " 12,524.38 " - " 12,524.38 " - " 10,014.06 " - " 11,962.50 " - - " 11,996.94 " - - " 10,722.05 " " 13,402.56 " - - - " 14,500.00 " - - " 12,143.75 " - " 7,413.13 " " 13,593.75 " " 6,889.31 " " 8,107.31 " - 29819297 SEPTAL DEFECT IMP SYS LVL074 C1817 278 "$18,375.00" " 6,791.40 " - " 14,700.00 " - " 12,697.13 " - " 12,697.13 " - " 10,152.19 " - " 12,127.50 " - - " 12,162.41 " - - " 10,722.05 " " 13,402.56 " - - - " 14,700.00 " - - " 12,311.25 " - " 7,515.38 " " 13,781.25 " " 6,984.34 " " 8,219.14 " - 29819408 SEPTAL DEFECT IMP SYS LVL008 C1817 278 "$1,875.00" 693.00 - " 13,402.56 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - " 10,722.05 " " 13,402.56 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 29819416 SEPTAL DEFECT IMP SYS LVL009 C1817 278 "$2,125.00" 785.40 - " 13,402.56 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - " 10,722.05 " " 13,402.56 " - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 29819424 SEPTAL DEFECT IMP SYS LVL010 C1817 278 "$2,375.00" 877.80 - " 13,402.56 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - " 10,722.05 " " 13,402.56 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 29819432 SEPTAL DEFECT IMP SYS LVL011 C1817 278 "$2,625.00" 970.20 - " 13,402.56 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - " 10,722.05 " " 13,402.56 " - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 29819441 SEPTAL DEFECT IMP SYS LVL012 C1817 278 "$2,875.00" " 1,062.60 " - " 13,402.56 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - " 10,722.05 " " 13,402.56 " - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 29819459 SEPTAL DEFECT IMP SYS LVL046 C1817 278 "$11,375.00" " 4,204.20 " - " 13,402.56 " - " 7,860.13 " - " 7,860.13 " - " 6,284.69 " - " 7,507.50 " - - " 7,529.11 " - - " 10,722.05 " " 13,402.56 " - - - " 9,100.00 " - - " 7,621.25 " - " 4,652.38 " " 8,531.25 " " 4,323.64 " " 5,088.04 " - 29819467 SEPTAL DEFECT IMP SYS LVL047 C1817 278 "$11,625.00" " 4,296.60 " - " 13,402.56 " - " 8,032.88 " - " 8,032.88 " - " 6,422.81 " - " 7,672.50 " - - " 7,694.59 " - - " 10,722.05 " " 13,402.56 " - - - " 9,300.00 " - - " 7,788.75 " - " 4,754.63 " " 8,718.75 " " 4,418.66 " " 5,199.86 " - 29819475 SEPTAL DEFECT IMP SYS LVL048 C1817 278 "$11,875.00" " 4,389.00 " - " 13,402.56 " - " 8,205.63 " - " 8,205.63 " - " 6,560.94 " - " 7,837.50 " - - " 7,860.06 " - - " 10,722.05 " " 13,402.56 " - - - " 9,500.00 " - - " 7,956.25 " - " 4,856.88 " " 8,906.25 " " 4,513.69 " " 5,311.69 " - 29819483 SEPTAL DEFECT IMP SYS LVL049 C1817 278 "$12,125.00" " 4,481.40 " - " 13,402.56 " - " 8,378.38 " - " 8,378.38 " - " 6,699.06 " - " 8,002.50 " - - " 8,025.54 " - - " 10,722.05 " " 13,402.56 " - - - " 9,700.00 " - - " 8,123.75 " - " 4,959.13 " " 9,093.75 " " 4,608.71 " " 5,423.51 " - 29819491 SEPTAL DEFECT IMP SYS LVL050 C1817 278 "$12,375.00" " 4,573.80 " - " 13,402.56 " - " 8,551.13 " - " 8,551.13 " - " 6,837.19 " - " 8,167.50 " - - " 8,191.01 " - - " 10,722.05 " " 13,402.56 " - - - " 9,900.00 " - - " 8,291.25 " - " 5,061.38 " " 9,281.25 " " 4,703.74 " " 5,535.34 " - 29819939 SEPTAL DEFECT IMP SYS LVL090 C1817 278 "$22,375.00" " 8,269.80 " - " 17,900.00 " - " 15,461.13 " - " 15,461.13 " - " 12,362.19 " - " 14,767.50 " - - " 14,810.01 " - - " 10,722.05 " " 13,402.56 " - - - " 17,900.00 " - - " 14,991.25 " - " 9,151.38 " " 16,781.25 " " 8,504.74 " " 10,008.34 " - 29819947 SEPTAL DEFECT IMP SYS LVL091 C1817 278 "$22,625.00" " 8,362.20 " - " 18,100.00 " - " 15,633.88 " - " 15,633.88 " - " 12,500.31 " - " 14,932.50 " - - " 14,975.49 " - - " 10,722.05 " " 13,402.56 " - - - " 18,100.00 " - - " 15,158.75 " - " 9,253.63 " " 16,968.75 " " 8,599.76 " " 10,120.16 " - 29819955 SEPTAL DEFECT IMP SYS LVL092 C1817 278 "$22,875.00" " 8,454.60 " - " 18,300.00 " - " 15,806.63 " - " 15,806.63 " - " 12,638.44 " - " 15,097.50 " - - " 15,140.96 " - - " 10,722.05 " " 13,402.56 " - - - " 18,300.00 " - - " 15,326.25 " - " 9,355.88 " " 17,156.25 " " 8,694.79 " " 10,231.99 " - 29819963 SEPTAL DEFECT IMP SYS LVL093 C1817 278 "$23,125.00" " 8,547.00 " - " 18,500.00 " - " 15,979.38 " - " 15,979.38 " - " 12,776.56 " - " 15,262.50 " - - " 15,306.44 " - - " 10,722.05 " " 13,402.56 " - - - " 18,500.00 " - - " 15,493.75 " - " 9,458.13 " " 17,343.75 " " 8,789.81 " " 10,343.81 " - 29819971 SEPTAL DEFECT IMP SYS LVL094 C1817 278 "$23,375.00" " 8,639.40 " - " 18,700.00 " - " 16,152.13 " - " 16,152.13 " - " 12,914.69 " - " 15,427.50 " - - " 15,471.91 " - - " 10,722.05 " " 13,402.56 " - - - " 18,700.00 " - - " 15,661.25 " - " 9,560.38 " " 17,531.25 " " 8,884.84 " " 10,455.64 " - 29819980 SEPTAL DEFECT IMP SYS LVL095 C1817 278 "$23,625.00" " 8,731.80 " - " 18,900.00 " - " 16,324.88 " - " 16,324.88 " - " 13,052.81 " - " 15,592.50 " - - " 15,637.39 " - - " 10,722.05 " " 13,402.56 " - - - " 18,900.00 " - - " 15,828.75 " - " 9,662.63 " " 17,718.75 " " 8,979.86 " " 10,567.46 " - 29819998 SEPTAL DEFECT IMP SYS LVL096 C1817 278 "$23,875.00" " 8,824.20 " - " 19,100.00 " - " 16,497.63 " - " 16,497.63 " - " 13,190.94 " - " 15,757.50 " - - " 15,802.86 " - - " 10,722.05 " " 13,402.56 " - - - " 19,100.00 " - - " 15,996.25 " - " 9,764.88 " " 17,906.25 " " 9,074.89 " " 10,679.29 " - 29820007 SEPTAL DEFECT IMP SYS LVL097 C1817 278 "$24,125.00" " 8,916.60 " - " 19,300.00 " - " 16,670.38 " - " 16,670.38 " - " 13,329.06 " - " 15,922.50 " - - " 15,968.34 " - - " 10,722.05 " " 13,402.56 " - - - " 19,300.00 " - - " 16,163.75 " - " 9,867.13 " " 18,093.75 " " 9,169.91 " " 10,791.11 " - 29820015 SEPTAL DEFECT IMP SYS LVL098 C1817 278 "$24,375.00" " 9,009.00 " - " 19,500.00 " - " 16,843.13 " - " 16,843.13 " - " 13,467.19 " - " 16,087.50 " - - " 16,133.81 " - - " 10,722.05 " " 13,402.56 " - - - " 19,500.00 " - - " 16,331.25 " - " 9,969.38 " " 18,281.25 " " 9,264.94 " " 10,902.94 " - 29820023 SEPTAL DEFECT IMP SYS LVL099 C1817 278 "$24,625.00" " 9,101.40 " - " 19,700.00 " - " 17,015.88 " - " 17,015.88 " - " 13,605.31 " - " 16,252.50 " - - " 16,299.29 " - - " 10,722.05 " " 13,402.56 " - - - " 19,700.00 " - - " 16,498.75 " - " 10,071.63 " " 18,468.75 " " 9,359.96 " " 11,014.76 " - 29820082 SEPTAL DEFECT IMP SYS LVL076 C1817 278 "$18,875.00" " 6,976.20 " - " 15,100.00 " - " 13,042.63 " - " 13,042.63 " - " 10,428.44 " - " 12,457.50 " - - " 12,493.36 " - - " 10,722.05 " " 13,402.56 " - - - " 15,100.00 " - - " 12,646.25 " - " 7,719.88 " " 14,156.25 " " 7,174.39 " " 8,442.79 " - 29820091 SEPTAL DEFECT IMP SYS LVL077 C1817 278 "$19,125.00" " 7,068.60 " - " 15,300.00 " - " 13,215.38 " - " 13,215.38 " - " 10,566.56 " - " 12,622.50 " - - " 12,658.84 " - - " 10,722.05 " " 13,402.56 " - - - " 15,300.00 " - - " 12,813.75 " - " 7,822.13 " " 14,343.75 " " 7,269.41 " " 8,554.61 " - 29820104 SEPTAL DEFECT IMP SYS LVL078 C1817 278 "$19,375.00" " 7,161.00 " - " 15,500.00 " - " 13,388.13 " - " 13,388.13 " - " 10,704.69 " - " 12,787.50 " - - " 12,824.31 " - - " 10,722.05 " " 13,402.56 " - - - " 15,500.00 " - - " 12,981.25 " - " 7,924.38 " " 14,531.25 " " 7,364.44 " " 8,666.44 " - 29820112 SEPTAL DEFECT IMP SYS LVL079 C1817 278 "$19,625.00" " 7,253.40 " - " 15,700.00 " - " 13,560.88 " - " 13,560.88 " - " 10,842.81 " - " 12,952.50 " - - " 12,989.79 " - - " 10,722.05 " " 13,402.56 " - - - " 15,700.00 " - - " 13,148.75 " - " 8,026.63 " " 14,718.75 " " 7,459.46 " " 8,778.26 " - 29820121 SEPTAL DEFECT IMP SYS LVL080 C1817 278 "$19,875.00" " 7,345.80 " - " 15,900.00 " - " 13,733.63 " - " 13,733.63 " - " 10,980.94 " - " 13,117.50 " - - " 13,155.26 " - - " 10,722.05 " " 13,402.56 " - - - " 15,900.00 " - - " 13,316.25 " - " 8,128.88 " " 14,906.25 " " 7,554.49 " " 8,890.09 " - 28135548 GEN NEURO IMP RCHG BAT LVL202 C1820 278 "$50,375.00" " 18,618.60 " - " 40,300.00 " - " 34,809.13 " - " 34,809.13 " - " 27,832.19 " - " 33,247.50 " - - " 33,343.21 " - - " 26,693.71 " " 33,368.40 " - - - " 40,300.00 " - - " 33,751.25 " - " 20,603.38 " " 37,781.25 " " 19,147.54 " " 22,532.74 " - 28135921 GEN NEURO IMP RCHG BAT LVL240 C1820 278 "$59,875.00" " 22,129.80 " - " 47,900.00 " - " 41,373.63 " - " 41,373.63 " - " 33,080.94 " - " 39,517.50 " - - " 39,631.26 " - - " 31,727.76 " " 39,661.20 " - - - " 47,900.00 " - - " 40,116.25 " - " 24,488.88 " " 44,906.25 " " 22,758.49 " " 26,782.09 " - 28138351 INTERSPINOUS IMP LVL026 C1821 278 "$6,375.00" " 2,356.20 " - " 5,100.00 " - " 4,405.13 " - " 4,405.13 " - " 3,522.19 " - " 4,207.50 " - - " 4,219.61 " - - " 3,378.11 " " 4,222.80 " - - - " 5,100.00 " - - " 4,271.25 " - " 2,607.38 " " 4,781.25 " " 2,423.14 " " 2,851.54 " - 28114630 STENT COAT W/DEL SYS LVL001 C1874 278 $200.00 73.92 - " 6,239.27 " - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - " 4,991.42 " " 6,239.27 " - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 28114648 STENT COAT W/DEL SYS LVL002 C1874 278 $450.00 166.32 - " 6,239.27 " - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - " 4,991.42 " " 6,239.27 " - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 28114699 STENT COAT W/DEL SYS LVL007 C1874 278 "$1,625.00" 600.60 - " 6,239.27 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - " 4,991.42 " " 6,239.27 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 28114711 STENT COAT W/DEL SYS LVL009 C1874 278 "$2,125.00" 785.40 - " 6,239.27 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - " 4,991.42 " " 6,239.27 " - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 28114729 STENT COAT W/DEL SYS LVL010 C1874 278 "$2,375.00" 877.80 - " 6,239.27 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - " 4,991.42 " " 6,239.27 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 28114761 STENT COAT W/DEL SYS LVL014 C1874 278 "$3,375.00" " 1,247.40 " - " 6,239.27 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - " 4,991.42 " " 6,239.27 " - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 28114770 STENT COAT W/DEL SYS LVL024 C1874 278 "$5,875.00" " 2,171.40 " - " 6,239.27 " - " 4,059.63 " - " 4,059.63 " - " 3,245.94 " - " 3,877.50 " - - " 3,888.66 " - - " 4,991.42 " " 6,239.27 " - - - " 4,700.00 " - - " 3,936.25 " - " 2,402.88 " " 4,406.25 " " 2,233.09 " " 2,627.89 " - 28114788 STENT COAT W/DEL SYS LVL025 C1874 278 "$6,125.00" " 2,263.80 " - " 6,239.27 " - " 4,232.38 " - " 4,232.38 " - " 3,384.06 " - " 4,042.50 " - - " 4,054.14 " - - " 4,991.42 " " 6,239.27 " - - - " 4,900.00 " - - " 4,103.75 " - " 2,505.13 " " 4,593.75 " " 2,328.11 " " 2,739.71 " - 28114796 STENT COAT W/DEL SYS LVL026 C1874 278 "$6,375.00" " 2,356.20 " - " 6,239.27 " - " 4,405.13 " - " 4,405.13 " - " 3,522.19 " - " 4,207.50 " - - " 4,219.61 " - - " 4,991.42 " " 6,239.27 " - - - " 5,100.00 " - - " 4,271.25 " - " 2,607.38 " " 4,781.25 " " 2,423.14 " " 2,851.54 " - 28114826 STENT COAT W/DEL SYS LVL029 C1874 278 "$7,125.00" " 2,633.40 " - " 6,239.27 " - " 4,923.38 " - " 4,923.38 " - " 3,936.56 " - " 4,702.50 " - - " 4,716.04 " - - " 4,991.42 " " 6,239.27 " - - - " 5,700.00 " - - " 4,773.75 " - " 2,914.13 " " 5,343.75 " " 2,708.21 " " 3,187.01 " - 28114834 STENT COAT W/DEL SYS LVL030 C1874 278 "$7,375.00" " 2,725.80 " - " 6,239.27 " - " 5,096.13 " - " 5,096.13 " - " 4,074.69 " - " 4,867.50 " - - " 4,881.51 " - - " 4,991.42 " " 6,239.27 " - - - " 5,900.00 " - - " 4,941.25 " - " 3,016.38 " " 5,531.25 " " 2,803.24 " " 3,298.84 " - 28114842 STENT COAT W/DEL SYS LVL031 C1874 278 "$7,625.00" " 2,818.20 " - " 6,239.27 " - " 5,268.88 " - " 5,268.88 " - " 4,212.81 " - " 5,032.50 " - - " 5,046.99 " - - " 4,991.42 " " 6,239.27 " - - - " 6,100.00 " - - " 5,108.75 " - " 3,118.63 " " 5,718.75 " " 2,898.26 " " 3,410.66 " - 28114851 STENT COAT W/DEL SYS LVL032 C1874 278 "$7,875.00" " 2,910.60 " - " 6,300.00 " - " 5,441.63 " - " 5,441.63 " - " 4,350.94 " - " 5,197.50 " - - " 5,212.46 " - - " 4,991.42 " " 6,239.27 " - - - " 6,300.00 " - - " 5,276.25 " - " 3,220.88 " " 5,906.25 " " 2,993.29 " " 3,522.49 " - 28114869 STENT COAT W/DEL SYS LVL033 C1874 278 "$8,125.00" " 3,003.00 " - " 6,500.00 " - " 5,614.38 " - " 5,614.38 " - " 4,489.06 " - " 5,362.50 " - - " 5,377.94 " - - " 4,991.42 " " 6,239.27 " - - - " 6,500.00 " - - " 5,443.75 " - " 3,323.13 " " 6,093.75 " " 3,088.31 " " 3,634.31 " - 28114877 STENT COAT W/DEL SYS LVL034 C1874 278 "$8,375.00" " 3,095.40 " - " 6,700.00 " - " 5,787.13 " - " 5,787.13 " - " 4,627.19 " - " 5,527.50 " - - " 5,543.41 " - - " 4,991.42 " " 6,239.27 " - - - " 6,700.00 " - - " 5,611.25 " - " 3,425.38 " " 6,281.25 " " 3,183.34 " " 3,746.14 " - 28114893 STENT COAT W/DEL SYS LVL036 C1874 278 "$8,875.00" " 3,280.20 " - " 7,100.00 " - " 6,132.63 " - " 6,132.63 " - " 4,903.44 " - " 5,857.50 " - - " 5,874.36 " - - " 4,991.42 " " 6,239.27 " - - - " 7,100.00 " - - " 5,946.25 " - " 3,629.88 " " 6,656.25 " " 3,373.39 " " 3,969.79 " - 28114907 STENT COAT W/DEL SYS LVL037 C1874 278 "$9,125.00" " 3,372.60 " - " 7,300.00 " - " 6,305.38 " - " 6,305.38 " - " 5,041.56 " - " 6,022.50 " - - " 6,039.84 " - - " 4,991.42 " " 6,239.27 " - - - " 7,300.00 " - - " 6,113.75 " - " 3,732.13 " " 6,843.75 " " 3,468.41 " " 4,081.61 " - 28114923 STENT COAT W/DEL SYS LVL039 C1874 278 "$9,625.00" " 3,557.40 " - " 7,700.00 " - " 6,650.88 " - " 6,650.88 " - " 5,317.81 " - " 6,352.50 " - - " 6,370.79 " - - " 4,991.42 " " 6,239.27 " - - - " 7,700.00 " - - " 6,448.75 " - " 3,936.63 " " 7,218.75 " " 3,658.46 " " 4,305.26 " - 28114958 STENT COAT W/DEL SYS LVL042 C1874 278 "$10,375.00" " 3,834.60 " - " 8,300.00 " - " 7,169.13 " - " 7,169.13 " - " 5,732.19 " - " 6,847.50 " - - " 6,867.21 " - - " 4,991.42 " " 6,239.27 " - - - " 8,300.00 " - - " 6,951.25 " - " 4,243.38 " " 7,781.25 " " 3,943.54 " " 4,640.74 " - 28114966 STENT COAT W/DEL SYS LVL043 C1874 278 "$10,625.00" " 3,927.00 " - " 8,500.00 " - " 7,341.88 " - " 7,341.88 " - " 5,870.31 " - " 7,012.50 " - - " 7,032.69 " - - " 4,991.42 " " 6,239.27 " - - - " 8,500.00 " - - " 7,118.75 " - " 4,345.63 " " 7,968.75 " " 4,038.56 " " 4,752.56 " - 28114974 STENT COAT W/DEL SYS LVL044 C1874 278 "$10,875.00" " 4,019.40 " - " 8,700.00 " - " 7,514.63 " - " 7,514.63 " - " 6,008.44 " - " 7,177.50 " - - " 7,198.16 " - - " 4,991.42 " " 6,239.27 " - - - " 8,700.00 " - - " 7,286.25 " - " 4,447.88 " " 8,156.25 " " 4,133.59 " " 4,864.39 " - 28114982 STENT COAT W/DEL SYS LVL045 C1874 278 "$11,125.00" " 4,111.80 " - " 8,900.00 " - " 7,687.38 " - " 7,687.38 " - " 6,146.56 " - " 7,342.50 " - - " 7,363.64 " - - " 4,991.42 " " 6,239.27 " - - - " 8,900.00 " - - " 7,453.75 " - " 4,550.13 " " 8,343.75 " " 4,228.61 " " 4,976.21 " - 28114991 STENT COAT W/DEL SYS LVL046 C1874 278 "$11,375.00" " 4,204.20 " - " 9,100.00 " - " 7,860.13 " - " 7,860.13 " - " 6,284.69 " - " 7,507.50 " - - " 7,529.11 " - - " 4,991.42 " " 6,239.27 " - - - " 9,100.00 " - - " 7,621.25 " - " 4,652.38 " " 8,531.25 " " 4,323.64 " " 5,088.04 " - 28115008 STENT COAT W/DEL SYS LVL047 C1874 278 "$11,625.00" " 4,296.60 " - " 9,300.00 " - " 8,032.88 " - " 8,032.88 " - " 6,422.81 " - " 7,672.50 " - - " 7,694.59 " - - " 4,991.42 " " 6,239.27 " - - - " 9,300.00 " - - " 7,788.75 " - " 4,754.63 " " 8,718.75 " " 4,418.66 " " 5,199.86 " - 28115016 STENT COAT W/DEL SYS LVL048 C1874 278 "$11,875.00" " 4,389.00 " - " 9,500.00 " - " 8,205.63 " - " 8,205.63 " - " 6,560.94 " - " 7,837.50 " - - " 7,860.06 " - - " 4,991.42 " " 6,239.27 " - - - " 9,500.00 " - - " 7,956.25 " - " 4,856.88 " " 8,906.25 " " 4,513.69 " " 5,311.69 " - 28115032 STENT COAT W/DEL SYS LVL050 C1874 278 "$12,375.00" " 4,573.80 " - " 9,900.00 " - " 8,551.13 " - " 8,551.13 " - " 6,837.19 " - " 8,167.50 " - - " 8,191.01 " - - " 4,991.42 " " 6,239.27 " - - - " 9,900.00 " - - " 8,291.25 " - " 5,061.38 " " 9,281.25 " " 4,703.74 " " 5,535.34 " - 28115113 STENT COAT W/DEL SYS LVL058 C1874 278 "$14,375.00" " 5,313.00 " - " 11,500.00 " - " 9,933.13 " - " 9,933.13 " - " 7,942.19 " - " 9,487.50 " - - " 9,514.81 " - - " 4,991.42 " " 6,239.27 " - - - " 11,500.00 " - - " 9,631.25 " - " 5,879.38 " " 10,781.25 " " 5,463.94 " " 6,429.94 " - 28115164 STENT COAT W/DEL SYS LVL063 C1874 278 "$15,625.00" " 5,775.00 " - " 12,500.00 " - " 10,796.88 " - " 10,796.88 " - " 8,632.81 " - " 10,312.50 " - - " 10,342.19 " - - " 4,991.42 " " 6,239.27 " - - - " 12,500.00 " - - " 10,468.75 " - " 6,390.63 " " 11,718.75 " " 5,939.06 " " 6,989.06 " - 28115288 STENT COAT W/DEL SYS LVL075 C1874 278 "$18,625.00" " 6,883.80 " - " 14,900.00 " - " 12,869.88 " - " 12,869.88 " - " 10,290.31 " - " 12,292.50 " - - " 12,327.89 " - - " 4,991.42 " " 6,239.27 " - - - " 14,900.00 " - - " 12,478.75 " - " 7,617.63 " " 13,968.75 " " 7,079.36 " " 8,330.96 " - 28115296 STENT COAT W/DEL SYS LVL076 C1874 278 "$18,875.00" " 6,976.20 " - " 15,100.00 " - " 13,042.63 " - " 13,042.63 " - " 10,428.44 " - " 12,457.50 " - - " 12,493.36 " - - " 4,991.42 " " 6,239.27 " - - - " 15,100.00 " - - " 12,646.25 " - " 7,719.88 " " 14,156.25 " " 7,174.39 " " 8,442.79 " - 28115300 STENT COAT W/DEL SYS LVL077 C1874 278 "$19,125.00" " 7,068.60 " - " 15,300.00 " - " 13,215.38 " - " 13,215.38 " - " 10,566.56 " - " 12,622.50 " - - " 12,658.84 " - - " 4,991.42 " " 6,239.27 " - - - " 15,300.00 " - - " 12,813.75 " - " 7,822.13 " " 14,343.75 " " 7,269.41 " " 8,554.61 " - 28115318 STENT COAT W/DEL SYS LVL078 C1874 278 "$19,375.00" " 7,161.00 " - " 15,500.00 " - " 13,388.13 " - " 13,388.13 " - " 10,704.69 " - " 12,787.50 " - - " 12,824.31 " - - " 4,991.42 " " 6,239.27 " - - - " 15,500.00 " - - " 12,981.25 " - " 7,924.38 " " 14,531.25 " " 7,364.44 " " 8,666.44 " - 28130392 STENT COAT W/DEL SYS LVL015 C1874 278 "$3,625.00" " 1,339.80 " - " 6,239.27 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - " 4,991.42 " " 6,239.27 " - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 28130449 STENT COAT W/DEL SYS LVL020 C1874 278 "$4,875.00" " 1,801.80 " - " 6,239.27 " - " 3,368.63 " - " 3,368.63 " - " 2,693.44 " - " 3,217.50 " - - " 3,226.76 " - - " 4,991.42 " " 6,239.27 " - - - " 3,900.00 " - - " 3,266.25 " - " 1,993.88 " " 3,656.25 " " 1,852.99 " " 2,180.59 " - 28130465 STENT COAT W/DEL SYS LVL022 C1874 278 "$5,375.00" " 1,986.60 " - " 6,239.27 " - " 3,714.13 " - " 3,714.13 " - " 2,969.69 " - " 3,547.50 " - - " 3,557.71 " - - " 4,991.42 " " 6,239.27 " - - - " 4,300.00 " - - " 3,601.25 " - " 2,198.38 " " 4,031.25 " " 2,043.04 " " 2,404.24 " - 28138512 STENT COAT W/DEL SYS LVL080 C1874 278 "$19,875.00" " 7,345.80 " - " 15,900.00 " - " 13,733.63 " - " 13,733.63 " - " 10,980.94 " - " 13,117.50 " - - " 13,155.26 " - - " 4,991.42 " " 6,239.27 " - - - " 15,900.00 " - - " 13,316.25 " - " 8,128.88 " " 14,906.25 " " 7,554.49 " " 8,890.09 " - 28138539 STENT COAT W/DEL SYS LVL082 C1874 278 "$20,375.00" " 7,530.60 " - " 16,300.00 " - " 14,079.13 " - " 14,079.13 " - " 11,257.19 " - " 13,447.50 " - - " 13,486.21 " - - " 4,991.42 " " 6,239.27 " - - - " 16,300.00 " - - " 13,651.25 " - " 8,333.38 " " 15,281.25 " " 7,744.54 " " 9,113.74 " - 28138555 STENT COAT W/DEL SYS LVL084 C1874 278 "$20,875.00" " 7,715.40 " - " 16,700.00 " - " 14,424.63 " - " 14,424.63 " - " 11,533.44 " - " 13,777.50 " - - " 13,817.16 " - - " 4,991.42 " " 6,239.27 " - - - " 16,700.00 " - - " 13,986.25 " - " 8,537.88 " " 15,656.25 " " 7,934.59 " " 9,337.39 " - 28138644 STENT COAT W/DEL SYS LVL093 C1874 278 "$23,125.00" " 8,547.00 " - " 18,500.00 " - " 15,979.38 " - " 15,979.38 " - " 12,776.56 " - " 15,262.50 " - - " 15,306.44 " - - " 4,991.42 " " 6,239.27 " - - - " 18,500.00 " - - " 15,493.75 " - " 9,458.13 " " 17,343.75 " " 8,789.81 " " 10,343.81 " - 28138717 STENT COAT W/DEL SYS LVL100 C1874 278 "$24,875.00" " 9,193.80 " - " 19,900.00 " - " 17,188.63 " - " 17,188.63 " - " 13,743.44 " - " 16,417.50 " - - " 16,464.76 " - - " 4,991.42 " " 6,239.27 " - - - " 19,900.00 " - - " 16,666.25 " - " 10,173.88 " " 18,656.25 " " 9,454.99 " " 11,126.59 " - 28138806 STENT COAT W/DEL SYS LVL109 C1874 278 "$27,125.00" " 10,025.40 " - " 21,700.00 " - " 18,743.38 " - " 18,743.38 " - " 14,986.56 " - " 17,902.50 " - - " 17,954.04 " - - " 4,991.42 " " 6,239.27 " - - - " 21,700.00 " - - " 18,173.75 " - " 11,094.13 " " 20,343.75 " " 10,310.21 " " 12,133.01 " - 28138814 STENT COAT W/DEL SYS LVL110 C1874 278 "$27,375.00" " 10,117.80 " - " 21,900.00 " - " 18,916.13 " - " 18,916.13 " - " 15,124.69 " - " 18,067.50 " - - " 18,119.51 " - - " 4,991.42 " " 6,239.27 " - - - " 21,900.00 " - - " 18,341.25 " - " 11,196.38 " " 20,531.25 " " 10,405.24 " " 12,244.84 " - 28138954 STENT COAT W/DEL SYS LVL124 C1874 278 "$30,875.00" " 11,411.40 " - " 24,700.00 " - " 21,334.63 " - " 21,334.63 " - " 17,058.44 " - " 20,377.50 " - - " 20,436.16 " - - " 4,991.42 " " 6,239.27 " - - - " 24,700.00 " - - " 20,686.25 " - " 12,627.88 " " 23,156.25 " " 11,735.59 " " 13,810.39 " - 28139411 STENT COAT W/DEL SYS LVL170 C1874 278 "$42,375.00" " 15,661.80 " - " 33,900.00 " - " 29,281.13 " - " 29,281.13 " - " 23,412.19 " - " 27,967.50 " - - " 28,048.01 " - - " 4,991.42 " " 6,239.27 " - - - " 33,900.00 " - - " 28,391.25 " - " 17,331.38 " " 31,781.25 " " 16,106.74 " " 18,954.34 " - 29815631 STENT COAT W/DEL SYS LVL008 C1874 278 "$1,875.00" 693.00 - " 6,239.27 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - " 4,991.42 " " 6,239.27 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 29815640 STENT COAT W/DEL SYS LVL009 C1874 278 "$2,125.00" 785.40 - " 6,239.27 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - " 4,991.42 " " 6,239.27 " - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 29815658 STENT COAT W/DEL SYS LVL010 C1874 278 "$2,375.00" 877.80 - " 6,239.27 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - " 4,991.42 " " 6,239.27 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 29815666 STENT COAT W/DEL SYS LVL011 C1874 278 "$2,625.00" 970.20 - " 6,239.27 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - " 4,991.42 " " 6,239.27 " - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 29815674 STENT COAT W/DEL SYS LVL012 C1874 278 "$2,875.00" " 1,062.60 " - " 6,239.27 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - " 4,991.42 " " 6,239.27 " - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 29815682 STENT COAT W/DEL SYS LVL013 C1874 278 "$3,125.00" " 1,155.00 " - " 6,239.27 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - " 4,991.42 " " 6,239.27 " - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 29815691 STENT COAT W/DEL SYS LVL014 C1874 278 "$3,375.00" " 1,247.40 " - " 6,239.27 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - " 4,991.42 " " 6,239.27 " - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 29815704 STENT COAT W/DEL SYS LVL015 C1874 278 "$3,625.00" " 1,339.80 " - " 6,239.27 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - " 4,991.42 " " 6,239.27 " - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 29815712 STENT COAT W/DEL SYS LVL016 C1874 278 "$3,875.00" " 1,432.20 " - " 6,239.27 " - " 2,677.63 " - " 2,677.63 " - " 2,140.94 " - " 2,557.50 " - - " 2,564.86 " - - " 4,991.42 " " 6,239.27 " - - - " 3,100.00 " - - " 2,596.25 " - " 1,584.88 " " 2,906.25 " " 1,472.89 " " 1,733.29 " - 29815721 STENT COAT W/DEL SYS LVL017 C1874 278 "$4,125.00" " 1,524.60 " - " 6,239.27 " - " 2,850.38 " - " 2,850.38 " - " 2,279.06 " - " 2,722.50 " - - " 2,730.34 " - - " 4,991.42 " " 6,239.27 " - - - " 3,300.00 " - - " 2,763.75 " - " 1,687.13 " " 3,093.75 " " 1,567.91 " " 1,845.11 " - 29815739 STENT COAT W/DEL SYS LVL018 C1874 278 "$4,375.00" " 1,617.00 " - " 6,239.27 " - " 3,023.13 " - " 3,023.13 " - " 2,417.19 " - " 2,887.50 " - - " 2,895.81 " - - " 4,991.42 " " 6,239.27 " - - - " 3,500.00 " - - " 2,931.25 " - " 1,789.38 " " 3,281.25 " " 1,662.94 " " 1,956.94 " - 29815747 STENT COAT W/DEL SYS LVL019 C1874 278 "$4,625.00" " 1,709.40 " - " 6,239.27 " - " 3,195.88 " - " 3,195.88 " - " 2,555.31 " - " 3,052.50 " - - " 3,061.29 " - - " 4,991.42 " " 6,239.27 " - - - " 3,700.00 " - - " 3,098.75 " - " 1,891.63 " " 3,468.75 " " 1,757.96 " " 2,068.76 " - 29815755 STENT COAT W/DEL SYS LVL020 C1874 278 "$4,875.00" " 1,801.80 " - " 6,239.27 " - " 3,368.63 " - " 3,368.63 " - " 2,693.44 " - " 3,217.50 " - - " 3,226.76 " - - " 4,991.42 " " 6,239.27 " - - - " 3,900.00 " - - " 3,266.25 " - " 1,993.88 " " 3,656.25 " " 1,852.99 " " 2,180.59 " - 29815763 STENT COAT W/DEL SYS LVL023 C1874 278 "$5,625.00" " 2,079.00 " - " 6,239.27 " - " 3,886.88 " - " 3,886.88 " - " 3,107.81 " - " 3,712.50 " - - " 3,723.19 " - - " 4,991.42 " " 6,239.27 " - - - " 4,500.00 " - - " 3,768.75 " - " 2,300.63 " " 4,218.75 " " 2,138.06 " " 2,516.06 " - 29815771 STENT COAT W/DEL SYS LVL024 C1874 278 "$5,875.00" " 2,171.40 " - " 6,239.27 " - " 4,059.63 " - " 4,059.63 " - " 3,245.94 " - " 3,877.50 " - - " 3,888.66 " - - " 4,991.42 " " 6,239.27 " - - - " 4,700.00 " - - " 3,936.25 " - " 2,402.88 " " 4,406.25 " " 2,233.09 " " 2,627.89 " - 29815780 STENT COAT W/DEL SYS LVL025 C1874 278 "$6,125.00" " 2,263.80 " - " 6,239.27 " - " 4,232.38 " - " 4,232.38 " - " 3,384.06 " - " 4,042.50 " - - " 4,054.14 " - - " 4,991.42 " " 6,239.27 " - - - " 4,900.00 " - - " 4,103.75 " - " 2,505.13 " " 4,593.75 " " 2,328.11 " " 2,739.71 " - 29815798 STENT COAT W/DEL SYS LVL026 C1874 278 "$6,375.00" " 2,356.20 " - " 6,239.27 " - " 4,405.13 " - " 4,405.13 " - " 3,522.19 " - " 4,207.50 " - - " 4,219.61 " - - " 4,991.42 " " 6,239.27 " - - - " 5,100.00 " - - " 4,271.25 " - " 2,607.38 " " 4,781.25 " " 2,423.14 " " 2,851.54 " - 29815801 STENT COAT W/DEL SYS LVL027 C1874 278 "$6,625.00" " 2,448.60 " - " 6,239.27 " - " 4,577.88 " - " 4,577.88 " - " 3,660.31 " - " 4,372.50 " - - " 4,385.09 " - - " 4,991.42 " " 6,239.27 " - - - " 5,300.00 " - - " 4,438.75 " - " 2,709.63 " " 4,968.75 " " 2,518.16 " " 2,963.36 " - 29815810 STENT COAT W/DEL SYS LVL028 C1874 278 "$6,875.00" " 2,541.00 " - " 6,239.27 " - " 4,750.63 " - " 4,750.63 " - " 3,798.44 " - " 4,537.50 " - - " 4,550.56 " - - " 4,991.42 " " 6,239.27 " - - - " 5,500.00 " - - " 4,606.25 " - " 2,811.88 " " 5,156.25 " " 2,613.19 " " 3,075.19 " - 29815828 STENT COAT W/DEL SYS LVL029 C1874 278 "$7,125.00" " 2,633.40 " - " 6,239.27 " - " 4,923.38 " - " 4,923.38 " - " 3,936.56 " - " 4,702.50 " - - " 4,716.04 " - - " 4,991.42 " " 6,239.27 " - - - " 5,700.00 " - - " 4,773.75 " - " 2,914.13 " " 5,343.75 " " 2,708.21 " " 3,187.01 " - 29815836 STENT COAT W/DEL SYS LVL030 C1874 278 "$7,375.00" " 2,725.80 " - " 6,239.27 " - " 5,096.13 " - " 5,096.13 " - " 4,074.69 " - " 4,867.50 " - - " 4,881.51 " - - " 4,991.42 " " 6,239.27 " - - - " 5,900.00 " - - " 4,941.25 " - " 3,016.38 " " 5,531.25 " " 2,803.24 " " 3,298.84 " - 29815844 STENT COAT W/DEL SYS LVL031 C1874 278 "$7,625.00" " 2,818.20 " - " 6,239.27 " - " 5,268.88 " - " 5,268.88 " - " 4,212.81 " - " 5,032.50 " - - " 5,046.99 " - - " 4,991.42 " " 6,239.27 " - - - " 6,100.00 " - - " 5,108.75 " - " 3,118.63 " " 5,718.75 " " 2,898.26 " " 3,410.66 " - 29815852 STENT COAT W/DEL SYS LVL032 C1874 278 "$7,875.00" " 2,910.60 " - " 6,300.00 " - " 5,441.63 " - " 5,441.63 " - " 4,350.94 " - " 5,197.50 " - - " 5,212.46 " - - " 4,991.42 " " 6,239.27 " - - - " 6,300.00 " - - " 5,276.25 " - " 3,220.88 " " 5,906.25 " " 2,993.29 " " 3,522.49 " - 29817014 STENT COAT W/DEL SYS LVL021 C1874 278 "$5,125.00" " 1,894.20 " - " 6,239.27 " - " 3,541.38 " - " 3,541.38 " - " 2,831.56 " - " 3,382.50 " - - " 3,392.24 " - - " 4,991.42 " " 6,239.27 " - - - " 4,100.00 " - - " 3,433.75 " - " 2,096.13 " " 3,843.75 " " 1,948.01 " " 2,292.41 " - 29817022 STENT COAT W/DEL SYS LVL022 C1874 278 "$5,375.00" " 1,986.60 " - " 6,239.27 " - " 3,714.13 " - " 3,714.13 " - " 2,969.69 " - " 3,547.50 " - - " 3,557.71 " - - " 4,991.42 " " 6,239.27 " - - - " 4,300.00 " - - " 3,601.25 " - " 2,198.38 " " 4,031.25 " " 2,043.04 " " 2,404.24 " - 29817383 STENT COAT W/DEL SYS LVL033 C1874 278 "$8,125.00" " 3,003.00 " - " 6,500.00 " - " 5,614.38 " - " 5,614.38 " - " 4,489.06 " - " 5,362.50 " - - " 5,377.94 " - - " 4,991.42 " " 6,239.27 " - - - " 6,500.00 " - - " 5,443.75 " - " 3,323.13 " " 6,093.75 " " 3,088.31 " " 3,634.31 " - 29817391 STENT COAT W/DEL SYS LVL034 C1874 278 "$8,375.00" " 3,095.40 " - " 6,700.00 " - " 5,787.13 " - " 5,787.13 " - " 4,627.19 " - " 5,527.50 " - - " 5,543.41 " - - " 4,991.42 " " 6,239.27 " - - - " 6,700.00 " - - " 5,611.25 " - " 3,425.38 " " 6,281.25 " " 3,183.34 " " 3,746.14 " - 29817405 STENT COAT W/DEL SYS LVL035 C1874 278 "$8,625.00" " 3,187.80 " - " 6,900.00 " - " 5,959.88 " - " 5,959.88 " - " 4,765.31 " - " 5,692.50 " - - " 5,708.89 " - - " 4,991.42 " " 6,239.27 " - - - " 6,900.00 " - - " 5,778.75 " - " 3,527.63 " " 6,468.75 " " 3,278.36 " " 3,857.96 " - 29817413 STENT COAT W/DEL SYS LVL036 C1874 278 "$8,875.00" " 3,280.20 " - " 7,100.00 " - " 6,132.63 " - " 6,132.63 " - " 4,903.44 " - " 5,857.50 " - - " 5,874.36 " - - " 4,991.42 " " 6,239.27 " - - - " 7,100.00 " - - " 5,946.25 " - " 3,629.88 " " 6,656.25 " " 3,373.39 " " 3,969.79 " - 29817421 STENT COAT W/DEL SYS LVL037 C1874 278 "$9,125.00" " 3,372.60 " - " 7,300.00 " - " 6,305.38 " - " 6,305.38 " - " 5,041.56 " - " 6,022.50 " - - " 6,039.84 " - - " 4,991.42 " " 6,239.27 " - - - " 7,300.00 " - - " 6,113.75 " - " 3,732.13 " " 6,843.75 " " 3,468.41 " " 4,081.61 " - 29817430 STENT COAT W/DEL SYS LVL038 C1874 278 "$9,375.00" " 3,465.00 " - " 7,500.00 " - " 6,478.13 " - " 6,478.13 " - " 5,179.69 " - " 6,187.50 " - - " 6,205.31 " - - " 4,991.42 " " 6,239.27 " - - - " 7,500.00 " - - " 6,281.25 " - " 3,834.38 " " 7,031.25 " " 3,563.44 " " 4,193.44 " - 29817448 STENT COAT W/DEL SYS LVL039 C1874 278 "$9,625.00" " 3,557.40 " - " 7,700.00 " - " 6,650.88 " - " 6,650.88 " - " 5,317.81 " - " 6,352.50 " - - " 6,370.79 " - - " 4,991.42 " " 6,239.27 " - - - " 7,700.00 " - - " 6,448.75 " - " 3,936.63 " " 7,218.75 " " 3,658.46 " " 4,305.26 " - 29817456 STENT COAT W/DEL SYS LVL040 C1874 278 "$9,875.00" " 3,649.80 " - " 7,900.00 " - " 6,823.63 " - " 6,823.63 " - " 5,455.94 " - " 6,517.50 " - - " 6,536.26 " - - " 4,991.42 " " 6,239.27 " - - - " 7,900.00 " - - " 6,616.25 " - " 4,038.88 " " 7,406.25 " " 3,753.49 " " 4,417.09 " - 29817464 STENT COAT W/DEL SYS LVL041 C1874 278 "$10,125.00" " 3,742.20 " - " 8,100.00 " - " 6,996.38 " - " 6,996.38 " - " 5,594.06 " - " 6,682.50 " - - " 6,701.74 " - - " 4,991.42 " " 6,239.27 " - - - " 8,100.00 " - - " 6,783.75 " - " 4,141.13 " " 7,593.75 " " 3,848.51 " " 4,528.91 " - 29817472 STENT COAT W/DEL SYS LVL042 C1874 278 "$10,375.00" " 3,834.60 " - " 8,300.00 " - " 7,169.13 " - " 7,169.13 " - " 5,732.19 " - " 6,847.50 " - - " 6,867.21 " - - " 4,991.42 " " 6,239.27 " - - - " 8,300.00 " - - " 6,951.25 " - " 4,243.38 " " 7,781.25 " " 3,943.54 " " 4,640.74 " - 29817481 STENT COAT W/DEL SYS LVL043 C1874 278 "$10,625.00" " 3,927.00 " - " 8,500.00 " - " 7,341.88 " - " 7,341.88 " - " 5,870.31 " - " 7,012.50 " - - " 7,032.69 " - - " 4,991.42 " " 6,239.27 " - - - " 8,500.00 " - - " 7,118.75 " - " 4,345.63 " " 7,968.75 " " 4,038.56 " " 4,752.56 " - 29817499 STENT COAT W/DEL SYS LVL044 C1874 278 "$10,875.00" " 4,019.40 " - " 8,700.00 " - " 7,514.63 " - " 7,514.63 " - " 6,008.44 " - " 7,177.50 " - - " 7,198.16 " - - " 4,991.42 " " 6,239.27 " - - - " 8,700.00 " - - " 7,286.25 " - " 4,447.88 " " 8,156.25 " " 4,133.59 " " 4,864.39 " - 29817502 STENT COAT W/DEL SYS LVL045 C1874 278 "$11,125.00" " 4,111.80 " - " 8,900.00 " - " 7,687.38 " - " 7,687.38 " - " 6,146.56 " - " 7,342.50 " - - " 7,363.64 " - - " 4,991.42 " " 6,239.27 " - - - " 8,900.00 " - - " 7,453.75 " - " 4,550.13 " " 8,343.75 " " 4,228.61 " " 4,976.21 " - 29817511 STENT COAT W/DEL SYS LVL046 C1874 278 "$11,375.00" " 4,204.20 " - " 9,100.00 " - " 7,860.13 " - " 7,860.13 " - " 6,284.69 " - " 7,507.50 " - - " 7,529.11 " - - " 4,991.42 " " 6,239.27 " - - - " 9,100.00 " - - " 7,621.25 " - " 4,652.38 " " 8,531.25 " " 4,323.64 " " 5,088.04 " - 29817529 STENT COAT W/DEL SYS LVL047 C1874 278 "$11,625.00" " 4,296.60 " - " 9,300.00 " - " 8,032.88 " - " 8,032.88 " - " 6,422.81 " - " 7,672.50 " - - " 7,694.59 " - - " 4,991.42 " " 6,239.27 " - - - " 9,300.00 " - - " 7,788.75 " - " 4,754.63 " " 8,718.75 " " 4,418.66 " " 5,199.86 " - 29817537 STENT COAT W/DEL SYS LVL048 C1874 278 "$11,875.00" " 4,389.00 " - " 9,500.00 " - " 8,205.63 " - " 8,205.63 " - " 6,560.94 " - " 7,837.50 " - - " 7,860.06 " - - " 4,991.42 " " 6,239.27 " - - - " 9,500.00 " - - " 7,956.25 " - " 4,856.88 " " 8,906.25 " " 4,513.69 " " 5,311.69 " - 29817545 STENT COAT W/DEL SYS LVL049 C1874 278 "$12,125.00" " 4,481.40 " - " 9,700.00 " - " 8,378.38 " - " 8,378.38 " - " 6,699.06 " - " 8,002.50 " - - " 8,025.54 " - - " 4,991.42 " " 6,239.27 " - - - " 9,700.00 " - - " 8,123.75 " - " 4,959.13 " " 9,093.75 " " 4,608.71 " " 5,423.51 " - 29817553 STENT COAT W/DEL SYS LVL050 C1874 278 "$12,375.00" " 4,573.80 " - " 9,900.00 " - " 8,551.13 " - " 8,551.13 " - " 6,837.19 " - " 8,167.50 " - - " 8,191.01 " - - " 4,991.42 " " 6,239.27 " - - - " 9,900.00 " - - " 8,291.25 " - " 5,061.38 " " 9,281.25 " " 4,703.74 " " 5,535.34 " - 29817561 STENT COAT W/DEL SYS LVL051 C1874 278 "$12,625.00" " 4,666.20 " - " 10,100.00 " - " 8,723.88 " - " 8,723.88 " - " 6,975.31 " - " 8,332.50 " - - " 8,356.49 " - - " 4,991.42 " " 6,239.27 " - - - " 10,100.00 " - - " 8,458.75 " - " 5,163.63 " " 9,468.75 " " 4,798.76 " " 5,647.16 " - 29817570 STENT COAT W/DEL SYS LVL052 C1874 278 "$12,875.00" " 4,758.60 " - " 10,300.00 " - " 8,896.63 " - " 8,896.63 " - " 7,113.44 " - " 8,497.50 " - - " 8,521.96 " - - " 4,991.42 " " 6,239.27 " - - - " 10,300.00 " - - " 8,626.25 " - " 5,265.88 " " 9,656.25 " " 4,893.79 " " 5,758.99 " - 29817588 STENT COAT W/DEL SYS LVL053 C1874 278 "$13,125.00" " 4,851.00 " - " 10,500.00 " - " 9,069.38 " - " 9,069.38 " - " 7,251.56 " - " 8,662.50 " - - " 8,687.44 " - - " 4,991.42 " " 6,239.27 " - - - " 10,500.00 " - - " 8,793.75 " - " 5,368.13 " " 9,843.75 " " 4,988.81 " " 5,870.81 " - 29817596 STENT COAT W/DEL SYS LVL054 C1874 278 "$13,375.00" " 4,943.40 " - " 10,700.00 " - " 9,242.13 " - " 9,242.13 " - " 7,389.69 " - " 8,827.50 " - - " 8,852.91 " - - " 4,991.42 " " 6,239.27 " - - - " 10,700.00 " - - " 8,961.25 " - " 5,470.38 " " 10,031.25 " " 5,083.84 " " 5,982.64 " - 29817600 STENT COAT W/DEL SYS LVL055 C1874 278 "$13,625.00" " 5,035.80 " - " 10,900.00 " - " 9,414.88 " - " 9,414.88 " - " 7,527.81 " - " 8,992.50 " - - " 9,018.39 " - - " 4,991.42 " " 6,239.27 " - - - " 10,900.00 " - - " 9,128.75 " - " 5,572.63 " " 10,218.75 " " 5,178.86 " " 6,094.46 " - 29817618 STENT COAT W/DEL SYS LVL056 C1874 278 "$13,875.00" " 5,128.20 " - " 11,100.00 " - " 9,587.63 " - " 9,587.63 " - " 7,665.94 " - " 9,157.50 " - - " 9,183.86 " - - " 4,991.42 " " 6,239.27 " - - - " 11,100.00 " - - " 9,296.25 " - " 5,674.88 " " 10,406.25 " " 5,273.89 " " 6,206.29 " - 29817626 STENT COAT W/DEL SYS LVL057 C1874 278 "$14,125.00" " 5,220.60 " - " 11,300.00 " - " 9,760.38 " - " 9,760.38 " - " 7,804.06 " - " 9,322.50 " - - " 9,349.34 " - - " 4,991.42 " " 6,239.27 " - - - " 11,300.00 " - - " 9,463.75 " - " 5,777.13 " " 10,593.75 " " 5,368.91 " " 6,318.11 " - 29817634 STENT COAT W/DEL SYS LVL058 C1874 278 "$14,375.00" " 5,313.00 " - " 11,500.00 " - " 9,933.13 " - " 9,933.13 " - " 7,942.19 " - " 9,487.50 " - - " 9,514.81 " - - " 4,991.42 " " 6,239.27 " - - - " 11,500.00 " - - " 9,631.25 " - " 5,879.38 " " 10,781.25 " " 5,463.94 " " 6,429.94 " - 29817642 STENT COAT W/DEL SYS LVL059 C1874 278 "$14,625.00" " 5,405.40 " - " 11,700.00 " - " 10,105.88 " - " 10,105.88 " - " 8,080.31 " - " 9,652.50 " - - " 9,680.29 " - - " 4,991.42 " " 6,239.27 " - - - " 11,700.00 " - - " 9,798.75 " - " 5,981.63 " " 10,968.75 " " 5,558.96 " " 6,541.76 " - 29817651 STENT COAT W/DEL SYS LVL060 C1874 278 "$14,875.00" " 5,497.80 " - " 11,900.00 " - " 10,278.63 " - " 10,278.63 " - " 8,218.44 " - " 9,817.50 " - - " 9,845.76 " - - " 4,991.42 " " 6,239.27 " - - - " 11,900.00 " - - " 9,966.25 " - " 6,083.88 " " 11,156.25 " " 5,653.99 " " 6,653.59 " - 29818088 STENT COAT W/DEL SYS LVL061 C1874 278 "$15,125.00" " 5,590.20 " - " 12,100.00 " - " 10,451.38 " - " 10,451.38 " - " 8,356.56 " - " 9,982.50 " - - " 10,011.24 " - - " 4,991.42 " " 6,239.27 " - - - " 12,100.00 " - - " 10,133.75 " - " 6,186.13 " " 11,343.75 " " 5,749.01 " " 6,765.41 " - 29818096 STENT COAT W/DEL SYS LVL062 C1874 278 "$15,375.00" " 5,682.60 " - " 12,300.00 " - " 10,624.13 " - " 10,624.13 " - " 8,494.69 " - " 10,147.50 " - - " 10,176.71 " - - " 4,991.42 " " 6,239.27 " - - - " 12,300.00 " - - " 10,301.25 " - " 6,288.38 " " 11,531.25 " " 5,844.04 " " 6,877.24 " - 29818100 STENT COAT W/DEL SYS LVL063 C1874 278 "$15,625.00" " 5,775.00 " - " 12,500.00 " - " 10,796.88 " - " 10,796.88 " - " 8,632.81 " - " 10,312.50 " - - " 10,342.19 " - - " 4,991.42 " " 6,239.27 " - - - " 12,500.00 " - - " 10,468.75 " - " 6,390.63 " " 11,718.75 " " 5,939.06 " " 6,989.06 " - 29818118 STENT COAT W/DEL SYS LVL064 C1874 278 "$15,875.00" " 5,867.40 " - " 12,700.00 " - " 10,969.63 " - " 10,969.63 " - " 8,770.94 " - " 10,477.50 " - - " 10,507.66 " - - " 4,991.42 " " 6,239.27 " - - - " 12,700.00 " - - " 10,636.25 " - " 6,492.88 " " 11,906.25 " " 6,034.09 " " 7,100.89 " - 29818126 STENT COAT W/DEL SYS LVL065 C1874 278 "$16,125.00" " 5,959.80 " - " 12,900.00 " - " 11,142.38 " - " 11,142.38 " - " 8,909.06 " - " 10,642.50 " - - " 10,673.14 " - - " 4,991.42 " " 6,239.27 " - - - " 12,900.00 " - - " 10,803.75 " - " 6,595.13 " " 12,093.75 " " 6,129.11 " " 7,212.71 " - 29820597 STENT COAT W/DEL SYS LVL005 C1874 278 "$1,350.00" 498.96 - " 6,239.27 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - " 4,991.42 " " 6,239.27 " - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 29820601 STENT COAT W/DEL SYS LVL006 C1874 278 "$1,375.00" 508.20 - " 6,239.27 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - " 4,991.42 " " 6,239.27 " - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 29820619 STENT COAT W/DEL SYS LVL007 C1874 278 "$1,625.00" 600.60 - " 6,239.27 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - " 4,991.42 " " 6,239.27 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 80364032 STENT COAT W/DEL SYS LVL009 C1874 278 "$2,125.00" 785.40 - " 6,239.27 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - " 4,991.42 " " 6,239.27 " - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 80364041 STENT COAT W/DEL SYS LVL010 C1874 278 "$2,375.00" 877.80 - " 6,239.27 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - " 4,991.42 " " 6,239.27 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 80364059 STENT COAT W/DEL SYS LVL011 C1874 278 "$2,625.00" 970.20 - " 6,239.27 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - " 4,991.42 " " 6,239.27 " - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 80364067 STENT COAT W/DEL SYS LVL012 C1874 278 "$2,875.00" " 1,062.60 " - " 6,239.27 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - " 4,991.42 " " 6,239.27 " - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 80364075 STENT COAT W/DEL SYS LVL013 C1874 278 "$3,125.00" " 1,155.00 " - " 6,239.27 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - " 4,991.42 " " 6,239.27 " - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 80364083 STENT COAT W/DEL SYS LVL014 C1874 278 "$3,375.00" " 1,247.40 " - " 6,239.27 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - " 4,991.42 " " 6,239.27 " - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 80364091 STENT COAT W/DEL SYS LVL015 C1874 278 "$3,625.00" " 1,339.80 " - " 6,239.27 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - " 4,991.42 " " 6,239.27 " - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 80364105 STENT COAT W/DEL SYS LVL016 C1874 278 "$3,875.00" " 1,432.20 " - " 6,239.27 " - " 2,677.63 " - " 2,677.63 " - " 2,140.94 " - " 2,557.50 " - - " 2,564.86 " - - " 4,991.42 " " 6,239.27 " - - - " 3,100.00 " - - " 2,596.25 " - " 1,584.88 " " 2,906.25 " " 1,472.89 " " 1,733.29 " - 80364113 STENT COAT W/DEL SYS LVL017 C1874 278 "$4,125.00" " 1,524.60 " - " 6,239.27 " - " 2,850.38 " - " 2,850.38 " - " 2,279.06 " - " 2,722.50 " - - " 2,730.34 " - - " 4,991.42 " " 6,239.27 " - - - " 3,300.00 " - - " 2,763.75 " - " 1,687.13 " " 3,093.75 " " 1,567.91 " " 1,845.11 " - 80364121 STENT COAT W/DEL SYS LVL018 C1874 278 "$4,375.00" " 1,617.00 " - " 6,239.27 " - " 3,023.13 " - " 3,023.13 " - " 2,417.19 " - " 2,887.50 " - - " 2,895.81 " - - " 4,991.42 " " 6,239.27 " - - - " 3,500.00 " - - " 2,931.25 " - " 1,789.38 " " 3,281.25 " " 1,662.94 " " 1,956.94 " - 80364130 STENT COAT W/DEL SYS LVL019 C1874 278 "$4,625.00" " 1,709.40 " - " 6,239.27 " - " 3,195.88 " - " 3,195.88 " - " 2,555.31 " - " 3,052.50 " - - " 3,061.29 " - - " 4,991.42 " " 6,239.27 " - - - " 3,700.00 " - - " 3,098.75 " - " 1,891.63 " " 3,468.75 " " 1,757.96 " " 2,068.76 " - 80364148 STENT COAT W/DEL SYS LVL020 C1874 278 "$4,875.00" " 1,801.80 " - " 6,239.27 " - " 3,368.63 " - " 3,368.63 " - " 2,693.44 " - " 3,217.50 " - - " 3,226.76 " - - " 4,991.42 " " 6,239.27 " - - - " 3,900.00 " - - " 3,266.25 " - " 1,993.88 " " 3,656.25 " " 1,852.99 " " 2,180.59 " - 80364156 STENT COAT W/DEL SYS LVL021 C1874 278 "$5,125.00" " 1,894.20 " - " 6,239.27 " - " 3,541.38 " - " 3,541.38 " - " 2,831.56 " - " 3,382.50 " - - " 3,392.24 " - - " 4,991.42 " " 6,239.27 " - - - " 4,100.00 " - - " 3,433.75 " - " 2,096.13 " " 3,843.75 " " 1,948.01 " " 2,292.41 " - 80364164 STENT COAT W/DEL SYS LVL022 C1874 278 "$5,375.00" " 1,986.60 " - " 6,239.27 " - " 3,714.13 " - " 3,714.13 " - " 2,969.69 " - " 3,547.50 " - - " 3,557.71 " - - " 4,991.42 " " 6,239.27 " - - - " 4,300.00 " - - " 3,601.25 " - " 2,198.38 " " 4,031.25 " " 2,043.04 " " 2,404.24 " - 80364172 STENT COAT W/DEL SYS LVL023 C1874 278 "$5,625.00" " 2,079.00 " - " 6,239.27 " - " 3,886.88 " - " 3,886.88 " - " 3,107.81 " - " 3,712.50 " - - " 3,723.19 " - - " 4,991.42 " " 6,239.27 " - - - " 4,500.00 " - - " 3,768.75 " - " 2,300.63 " " 4,218.75 " " 2,138.06 " " 2,516.06 " - 80364181 STENT COAT W/DEL SYS LVL024 C1874 278 "$5,875.00" " 2,171.40 " - " 6,239.27 " - " 4,059.63 " - " 4,059.63 " - " 3,245.94 " - " 3,877.50 " - - " 3,888.66 " - - " 4,991.42 " " 6,239.27 " - - - " 4,700.00 " - - " 3,936.25 " - " 2,402.88 " " 4,406.25 " " 2,233.09 " " 2,627.89 " - 80364199 STENT COAT W/DEL SYS LVL025 C1874 278 "$6,125.00" " 2,263.80 " - " 6,239.27 " - " 4,232.38 " - " 4,232.38 " - " 3,384.06 " - " 4,042.50 " - - " 4,054.14 " - - " 4,991.42 " " 6,239.27 " - - - " 4,900.00 " - - " 4,103.75 " - " 2,505.13 " " 4,593.75 " " 2,328.11 " " 2,739.71 " - 80364202 STENT COAT W/DEL SYS LVL026 C1874 278 "$6,375.00" " 2,356.20 " - " 6,239.27 " - " 4,405.13 " - " 4,405.13 " - " 3,522.19 " - " 4,207.50 " - - " 4,219.61 " - - " 4,991.42 " " 6,239.27 " - - - " 5,100.00 " - - " 4,271.25 " - " 2,607.38 " " 4,781.25 " " 2,423.14 " " 2,851.54 " - 80364211 STENT COAT W/DEL SYS LVL027 C1874 278 "$6,625.00" " 2,448.60 " - " 6,239.27 " - " 4,577.88 " - " 4,577.88 " - " 3,660.31 " - " 4,372.50 " - - " 4,385.09 " - - " 4,991.42 " " 6,239.27 " - - - " 5,300.00 " - - " 4,438.75 " - " 2,709.63 " " 4,968.75 " " 2,518.16 " " 2,963.36 " - 80364229 STENT COAT W/DEL SYS LVL028 C1874 278 "$6,875.00" " 2,541.00 " - " 6,239.27 " - " 4,750.63 " - " 4,750.63 " - " 3,798.44 " - " 4,537.50 " - - " 4,550.56 " - - " 4,991.42 " " 6,239.27 " - - - " 5,500.00 " - - " 4,606.25 " - " 2,811.88 " " 5,156.25 " " 2,613.19 " " 3,075.19 " - 80364237 STENT COAT W/DEL SYS LVL029 C1874 278 "$7,125.00" " 2,633.40 " - " 6,239.27 " - " 4,923.38 " - " 4,923.38 " - " 3,936.56 " - " 4,702.50 " - - " 4,716.04 " - - " 4,991.42 " " 6,239.27 " - - - " 5,700.00 " - - " 4,773.75 " - " 2,914.13 " " 5,343.75 " " 2,708.21 " " 3,187.01 " - 80364245 STENT COAT W/DEL SYS LVL030 C1874 278 "$7,375.00" " 2,725.80 " - " 6,239.27 " - " 5,096.13 " - " 5,096.13 " - " 4,074.69 " - " 4,867.50 " - - " 4,881.51 " - - " 4,991.42 " " 6,239.27 " - - - " 5,900.00 " - - " 4,941.25 " - " 3,016.38 " " 5,531.25 " " 2,803.24 " " 3,298.84 " - 80364253 STENT COAT W/DEL SYS LVL031 C1874 278 "$7,625.00" " 2,818.20 " - " 6,239.27 " - " 5,268.88 " - " 5,268.88 " - " 4,212.81 " - " 5,032.50 " - - " 5,046.99 " - - " 4,991.42 " " 6,239.27 " - - - " 6,100.00 " - - " 5,108.75 " - " 3,118.63 " " 5,718.75 " " 2,898.26 " " 3,410.66 " - 80364261 STENT COAT W/DEL SYS LVL032 C1874 278 "$7,875.00" " 2,910.60 " - " 6,300.00 " - " 5,441.63 " - " 5,441.63 " - " 4,350.94 " - " 5,197.50 " - - " 5,212.46 " - - " 4,991.42 " " 6,239.27 " - - - " 6,300.00 " - - " 5,276.25 " - " 3,220.88 " " 5,906.25 " " 2,993.29 " " 3,522.49 " - 80364270 STENT COAT W/DEL SYS LVL033 C1874 278 "$8,125.00" " 3,003.00 " - " 6,500.00 " - " 5,614.38 " - " 5,614.38 " - " 4,489.06 " - " 5,362.50 " - - " 5,377.94 " - - " 4,991.42 " " 6,239.27 " - - - " 6,500.00 " - - " 5,443.75 " - " 3,323.13 " " 6,093.75 " " 3,088.31 " " 3,634.31 " - 80364288 STENT COAT W/DEL SYS LVL034 C1874 278 "$8,375.00" " 3,095.40 " - " 6,700.00 " - " 5,787.13 " - " 5,787.13 " - " 4,627.19 " - " 5,527.50 " - - " 5,543.41 " - - " 4,991.42 " " 6,239.27 " - - - " 6,700.00 " - - " 5,611.25 " - " 3,425.38 " " 6,281.25 " " 3,183.34 " " 3,746.14 " - 80364296 STENT COAT W/DEL SYS LVL035 C1874 278 "$8,625.00" " 3,187.80 " - " 6,900.00 " - " 5,959.88 " - " 5,959.88 " - " 4,765.31 " - " 5,692.50 " - - " 5,708.89 " - - " 4,991.42 " " 6,239.27 " - - - " 6,900.00 " - - " 5,778.75 " - " 3,527.63 " " 6,468.75 " " 3,278.36 " " 3,857.96 " - 80364300 STENT COAT W/DEL SYS LVL036 C1874 278 "$8,875.00" " 3,280.20 " - " 7,100.00 " - " 6,132.63 " - " 6,132.63 " - " 4,903.44 " - " 5,857.50 " - - " 5,874.36 " - - " 4,991.42 " " 6,239.27 " - - - " 7,100.00 " - - " 5,946.25 " - " 3,629.88 " " 6,656.25 " " 3,373.39 " " 3,969.79 " - 80364318 STENT COAT W/DEL SYS LVL037 C1874 278 "$9,125.00" " 3,372.60 " - " 7,300.00 " - " 6,305.38 " - " 6,305.38 " - " 5,041.56 " - " 6,022.50 " - - " 6,039.84 " - - " 4,991.42 " " 6,239.27 " - - - " 7,300.00 " - - " 6,113.75 " - " 3,732.13 " " 6,843.75 " " 3,468.41 " " 4,081.61 " - 80364326 STENT COAT W/DEL SYS LVL038 C1874 278 "$9,375.00" " 3,465.00 " - " 7,500.00 " - " 6,478.13 " - " 6,478.13 " - " 5,179.69 " - " 6,187.50 " - - " 6,205.31 " - - " 4,991.42 " " 6,239.27 " - - - " 7,500.00 " - - " 6,281.25 " - " 3,834.38 " " 7,031.25 " " 3,563.44 " " 4,193.44 " - 80364334 STENT COAT W/DEL SYS LVL039 C1874 278 "$9,625.00" " 3,557.40 " - " 7,700.00 " - " 6,650.88 " - " 6,650.88 " - " 5,317.81 " - " 6,352.50 " - - " 6,370.79 " - - " 4,991.42 " " 6,239.27 " - - - " 7,700.00 " - - " 6,448.75 " - " 3,936.63 " " 7,218.75 " " 3,658.46 " " 4,305.26 " - 80364342 STENT COAT W/DEL SYS LVL040 C1874 278 "$9,875.00" " 3,649.80 " - " 7,900.00 " - " 6,823.63 " - " 6,823.63 " - " 5,455.94 " - " 6,517.50 " - - " 6,536.26 " - - " 4,991.42 " " 6,239.27 " - - - " 7,900.00 " - - " 6,616.25 " - " 4,038.88 " " 7,406.25 " " 3,753.49 " " 4,417.09 " - 80364351 STENT COAT W/DEL SYS LVL041 C1874 278 "$10,125.00" " 3,742.20 " - " 8,100.00 " - " 6,996.38 " - " 6,996.38 " - " 5,594.06 " - " 6,682.50 " - - " 6,701.74 " - - " 4,991.42 " " 6,239.27 " - - - " 8,100.00 " - - " 6,783.75 " - " 4,141.13 " " 7,593.75 " " 3,848.51 " " 4,528.91 " - 80364369 STENT COAT W/DEL SYS LVL042 C1874 278 "$10,375.00" " 3,834.60 " - " 8,300.00 " - " 7,169.13 " - " 7,169.13 " - " 5,732.19 " - " 6,847.50 " - - " 6,867.21 " - - " 4,991.42 " " 6,239.27 " - - - " 8,300.00 " - - " 6,951.25 " - " 4,243.38 " " 7,781.25 " " 3,943.54 " " 4,640.74 " - 80364377 STENT COAT W/DEL SYS LVL043 C1874 278 "$10,625.00" " 3,927.00 " - " 8,500.00 " - " 7,341.88 " - " 7,341.88 " - " 5,870.31 " - " 7,012.50 " - - " 7,032.69 " - - " 4,991.42 " " 6,239.27 " - - - " 8,500.00 " - - " 7,118.75 " - " 4,345.63 " " 7,968.75 " " 4,038.56 " " 4,752.56 " - 80364385 STENT COAT W/DEL SYS LVL044 C1874 278 "$10,875.00" " 4,019.40 " - " 8,700.00 " - " 7,514.63 " - " 7,514.63 " - " 6,008.44 " - " 7,177.50 " - - " 7,198.16 " - - " 4,991.42 " " 6,239.27 " - - - " 8,700.00 " - - " 7,286.25 " - " 4,447.88 " " 8,156.25 " " 4,133.59 " " 4,864.39 " - 80364393 STENT COAT W/DEL SYS LVL045 C1874 278 "$11,125.00" " 4,111.80 " - " 8,900.00 " - " 7,687.38 " - " 7,687.38 " - " 6,146.56 " - " 7,342.50 " - - " 7,363.64 " - - " 4,991.42 " " 6,239.27 " - - - " 8,900.00 " - - " 7,453.75 " - " 4,550.13 " " 8,343.75 " " 4,228.61 " " 4,976.21 " - 80364407 STENT COAT W/DEL SYS LVL046 C1874 278 "$11,375.00" " 4,204.20 " - " 9,100.00 " - " 7,860.13 " - " 7,860.13 " - " 6,284.69 " - " 7,507.50 " - - " 7,529.11 " - - " 4,991.42 " " 6,239.27 " - - - " 9,100.00 " - - " 7,621.25 " - " 4,652.38 " " 8,531.25 " " 4,323.64 " " 5,088.04 " - 80364415 STENT COAT W/DEL SYS LVL047 C1874 278 "$11,625.00" " 4,296.60 " - " 9,300.00 " - " 8,032.88 " - " 8,032.88 " - " 6,422.81 " - " 7,672.50 " - - " 7,694.59 " - - " 4,991.42 " " 6,239.27 " - - - " 9,300.00 " - - " 7,788.75 " - " 4,754.63 " " 8,718.75 " " 4,418.66 " " 5,199.86 " - 80364423 STENT COAT W/DEL SYS LVL048 C1874 278 "$11,875.00" " 4,389.00 " - " 9,500.00 " - " 8,205.63 " - " 8,205.63 " - " 6,560.94 " - " 7,837.50 " - - " 7,860.06 " - - " 4,991.42 " " 6,239.27 " - - - " 9,500.00 " - - " 7,956.25 " - " 4,856.88 " " 8,906.25 " " 4,513.69 " " 5,311.69 " - 80364431 STENT COAT W/DEL SYS LVL049 C1874 278 "$12,125.00" " 4,481.40 " - " 9,700.00 " - " 8,378.38 " - " 8,378.38 " - " 6,699.06 " - " 8,002.50 " - - " 8,025.54 " - - " 4,991.42 " " 6,239.27 " - - - " 9,700.00 " - - " 8,123.75 " - " 4,959.13 " " 9,093.75 " " 4,608.71 " " 5,423.51 " - 80364440 STENT COAT W/DEL SYS LVL050 C1874 278 "$12,375.00" " 4,573.80 " - " 9,900.00 " - " 8,551.13 " - " 8,551.13 " - " 6,837.19 " - " 8,167.50 " - - " 8,191.01 " - - " 4,991.42 " " 6,239.27 " - - - " 9,900.00 " - - " 8,291.25 " - " 5,061.38 " " 9,281.25 " " 4,703.74 " " 5,535.34 " - 28115610 STENT NO-COAT W/DEL SYS LVL006 C1876 278 "$1,375.00" 508.20 - " 4,261.84 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - " 3,409.47 " " 4,261.84 " - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 28115636 STENT NO-COAT W/DEL SYS LVL008 C1876 278 "$1,875.00" 693.00 - " 4,261.84 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - " 3,409.47 " " 4,261.84 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 28115652 STENT NO-COAT W/DEL SYS LVL010 C1876 278 "$2,375.00" 877.80 - " 4,261.84 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - " 3,409.47 " " 4,261.84 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 28115679 STENT NO-COAT W/DEL SYS LVL012 C1876 278 "$2,875.00" " 1,062.60 " - " 4,261.84 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - " 3,409.47 " " 4,261.84 " - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 28115695 STENT NO-COAT W/DEL SYS LVL014 C1876 278 "$3,375.00" " 1,247.40 " - " 4,261.84 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - " 3,409.47 " " 4,261.84 " - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 28115717 STENT NO-COAT W/DEL SYS LVL016 C1876 278 "$3,875.00" " 1,432.20 " - " 4,261.84 " - " 2,677.63 " - " 2,677.63 " - " 2,140.94 " - " 2,557.50 " - - " 2,564.86 " - - " 3,409.47 " " 4,261.84 " - - - " 3,100.00 " - - " 2,596.25 " - " 1,584.88 " " 2,906.25 " " 1,472.89 " " 1,733.29 " - 28115750 STENT NO-COAT W/DEL SYS LVL020 C1876 278 "$4,875.00" " 1,801.80 " - " 4,261.84 " - " 3,368.63 " - " 3,368.63 " - " 2,693.44 " - " 3,217.50 " - - " 3,226.76 " - - " 3,409.47 " " 4,261.84 " - - - " 3,900.00 " - - " 3,266.25 " - " 1,993.88 " " 3,656.25 " " 1,852.99 " " 2,180.59 " - 28115768 STENT NO-COAT W/DEL SYS LVL021 C1876 278 "$5,125.00" " 1,894.20 " - " 4,261.84 " - " 3,541.38 " - " 3,541.38 " - " 2,831.56 " - " 3,382.50 " - - " 3,392.24 " - - " 3,409.47 " " 4,261.84 " - - - " 4,100.00 " - - " 3,433.75 " - " 2,096.13 " " 3,843.75 " " 1,948.01 " " 2,292.41 " - 28115784 STENT NO-COAT W/DEL SYS LVL023 C1876 278 "$5,625.00" " 2,079.00 " - " 4,500.00 " - " 3,886.88 " - " 3,886.88 " - " 3,107.81 " - " 3,712.50 " - - " 3,723.19 " - - " 3,409.47 " " 4,261.84 " - - - " 4,500.00 " - - " 3,768.75 " - " 2,300.63 " " 4,218.75 " " 2,138.06 " " 2,516.06 " - 28115792 STENT NO-COAT W/DEL SYS LVL024 C1876 278 "$5,875.00" " 2,171.40 " - " 4,700.00 " - " 4,059.63 " - " 4,059.63 " - " 3,245.94 " - " 3,877.50 " - - " 3,888.66 " - - " 3,409.47 " " 4,261.84 " - - - " 4,700.00 " - - " 3,936.25 " - " 2,402.88 " " 4,406.25 " " 2,233.09 " " 2,627.89 " - 28139446 STENT NO-COAT W/DEL SYS LVL028 C1876 278 "$6,875.00" " 2,541.00 " - " 5,500.00 " - " 4,750.63 " - " 4,750.63 " - " 3,798.44 " - " 4,537.50 " - - " 4,550.56 " - - " 3,409.47 " " 4,261.84 " - - - " 5,500.00 " - - " 4,606.25 " - " 2,811.88 " " 5,156.25 " " 2,613.19 " " 3,075.19 " - 28139772 STENT NO-COAT W/DEL SYS LVL061 C1876 278 "$15,125.00" " 5,590.20 " - " 12,100.00 " - " 10,451.38 " - " 10,451.38 " - " 8,356.56 " - " 9,982.50 " - - " 10,011.24 " - - " 3,409.47 " " 4,261.84 " - - - " 12,100.00 " - - " 10,133.75 " - " 6,186.13 " " 11,343.75 " " 5,749.01 " " 6,765.41 " - 29815861 STENT NO-COAT W/DEL SYS LVL001 C1876 278 $200.00 73.92 - " 4,261.84 " - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - " 3,409.47 " " 4,261.84 " - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 29815879 STENT NO-COAT W/DEL SYS LVL002 C1876 278 $450.00 166.32 - " 4,261.84 " - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - " 3,409.47 " " 4,261.84 " - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 29815887 STENT NO-COAT W/DEL SYS LVL003 C1876 278 $750.00 277.20 - " 4,261.84 " - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - " 3,409.47 " " 4,261.84 " - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 29815895 STENT NO-COAT W/DEL SYS LVL004 C1876 278 "$1,050.00" 388.08 - " 4,261.84 " - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - " 3,409.47 " " 4,261.84 " - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 29815909 STENT NO-COAT W/DEL SYS LVL005 C1876 278 "$1,350.00" 498.96 - " 4,261.84 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - " 3,409.47 " " 4,261.84 " - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 29815917 STENT NO-COAT W/DEL SYS LVL006 C1876 278 "$1,375.00" 508.20 - " 4,261.84 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - " 3,409.47 " " 4,261.84 " - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 29815925 STENT NO-COAT W/DEL SYS LVL007 C1876 278 "$1,625.00" 600.60 - " 4,261.84 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - " 3,409.47 " " 4,261.84 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 29815933 STENT NO-COAT W/DEL SYS LVL008 C1876 278 "$1,875.00" 693.00 - " 4,261.84 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - " 3,409.47 " " 4,261.84 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 29815941 STENT NO-COAT W/DEL SYS LVL009 C1876 278 "$2,125.00" 785.40 - " 4,261.84 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - " 3,409.47 " " 4,261.84 " - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 29815950 STENT NO-COAT W/DEL SYS LVL010 C1876 278 "$2,375.00" 877.80 - " 4,261.84 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - " 3,409.47 " " 4,261.84 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 29815968 STENT NO-COAT W/DEL SYS LVL011 C1876 278 "$2,625.00" 970.20 - " 4,261.84 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - " 3,409.47 " " 4,261.84 " - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 29815976 STENT NO-COAT W/DEL SYS LVL012 C1876 278 "$2,875.00" " 1,062.60 " - " 4,261.84 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - " 3,409.47 " " 4,261.84 " - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 29815984 STENT NO-COAT W/DEL SYS LVL013 C1876 278 "$3,125.00" " 1,155.00 " - " 4,261.84 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - " 3,409.47 " " 4,261.84 " - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 29815992 STENT NO-COAT W/DEL SYS LVL014 C1876 278 "$3,375.00" " 1,247.40 " - " 4,261.84 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - " 3,409.47 " " 4,261.84 " - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 29816000 STENT NO-COAT W/DEL SYS LVL016 C1876 278 "$3,875.00" " 1,432.20 " - " 4,261.84 " - " 2,677.63 " - " 2,677.63 " - " 2,140.94 " - " 2,557.50 " - - " 2,564.86 " - - " 3,409.47 " " 4,261.84 " - - - " 3,100.00 " - - " 2,596.25 " - " 1,584.88 " " 2,906.25 " " 1,472.89 " " 1,733.29 " - 29816018 STENT NO-COAT W/DEL SYS LVL017 C1876 278 "$4,125.00" " 1,524.60 " - " 4,261.84 " - " 2,850.38 " - " 2,850.38 " - " 2,279.06 " - " 2,722.50 " - - " 2,730.34 " - - " 3,409.47 " " 4,261.84 " - - - " 3,300.00 " - - " 2,763.75 " - " 1,687.13 " " 3,093.75 " " 1,567.91 " " 1,845.11 " - 29816026 STENT NO-COAT W/DEL SYS LVL018 C1876 278 "$4,375.00" " 1,617.00 " - " 4,261.84 " - " 3,023.13 " - " 3,023.13 " - " 2,417.19 " - " 2,887.50 " - - " 2,895.81 " - - " 3,409.47 " " 4,261.84 " - - - " 3,500.00 " - - " 2,931.25 " - " 1,789.38 " " 3,281.25 " " 1,662.94 " " 1,956.94 " - 29816034 STENT NO-COAT W/DEL SYS LVL019 C1876 278 "$4,625.00" " 1,709.40 " - " 4,261.84 " - " 3,195.88 " - " 3,195.88 " - " 2,555.31 " - " 3,052.50 " - - " 3,061.29 " - - " 3,409.47 " " 4,261.84 " - - - " 3,700.00 " - - " 3,098.75 " - " 1,891.63 " " 3,468.75 " " 1,757.96 " " 2,068.76 " - 29816042 STENT NO-COAT W/DEL SYS LVL020 C1876 278 "$4,875.00" " 1,801.80 " - " 4,261.84 " - " 3,368.63 " - " 3,368.63 " - " 2,693.44 " - " 3,217.50 " - - " 3,226.76 " - - " 3,409.47 " " 4,261.84 " - - - " 3,900.00 " - - " 3,266.25 " - " 1,993.88 " " 3,656.25 " " 1,852.99 " " 2,180.59 " - 29816051 STENT NO-COAT W/DEL SYS LVL021 C1876 278 "$5,125.00" " 1,894.20 " - " 4,261.84 " - " 3,541.38 " - " 3,541.38 " - " 2,831.56 " - " 3,382.50 " - - " 3,392.24 " - - " 3,409.47 " " 4,261.84 " - - - " 4,100.00 " - - " 3,433.75 " - " 2,096.13 " " 3,843.75 " " 1,948.01 " " 2,292.41 " - 29816069 STENT NO-COAT W/DEL SYS LVL022 C1876 278 "$5,375.00" " 1,986.60 " - " 4,300.00 " - " 3,714.13 " - " 3,714.13 " - " 2,969.69 " - " 3,547.50 " - - " 3,557.71 " - - " 3,409.47 " " 4,261.84 " - - - " 4,300.00 " - - " 3,601.25 " - " 2,198.38 " " 4,031.25 " " 2,043.04 " " 2,404.24 " - 29816077 STENT NO-COAT W/DEL SYS LVL023 C1876 278 "$5,625.00" " 2,079.00 " - " 4,500.00 " - " 3,886.88 " - " 3,886.88 " - " 3,107.81 " - " 3,712.50 " - - " 3,723.19 " - - " 3,409.47 " " 4,261.84 " - - - " 4,500.00 " - - " 3,768.75 " - " 2,300.63 " " 4,218.75 " " 2,138.06 " " 2,516.06 " - 29816085 STENT NO-COAT W/DEL SYS LVL024 C1876 278 "$5,875.00" " 2,171.40 " - " 4,700.00 " - " 4,059.63 " - " 4,059.63 " - " 3,245.94 " - " 3,877.50 " - - " 3,888.66 " - - " 3,409.47 " " 4,261.84 " - - - " 4,700.00 " - - " 3,936.25 " - " 2,402.88 " " 4,406.25 " " 2,233.09 " " 2,627.89 " - 29816093 STENT NO-COAT W/DEL SYS LVL025 C1876 278 "$6,125.00" " 2,263.80 " - " 4,900.00 " - " 4,232.38 " - " 4,232.38 " - " 3,384.06 " - " 4,042.50 " - - " 4,054.14 " - - " 3,409.47 " " 4,261.84 " - - - " 4,900.00 " - - " 4,103.75 " - " 2,505.13 " " 4,593.75 " " 2,328.11 " " 2,739.71 " - 29816107 STENT NO-COAT W/DEL SYS LVL026 C1876 278 "$6,375.00" " 2,356.20 " - " 5,100.00 " - " 4,405.13 " - " 4,405.13 " - " 3,522.19 " - " 4,207.50 " - - " 4,219.61 " - - " 3,409.47 " " 4,261.84 " - - - " 5,100.00 " - - " 4,271.25 " - " 2,607.38 " " 4,781.25 " " 2,423.14 " " 2,851.54 " - 29816115 STENT NO-COAT W/DEL SYS LVL027 C1876 278 "$6,625.00" " 2,448.60 " - " 5,300.00 " - " 4,577.88 " - " 4,577.88 " - " 3,660.31 " - " 4,372.50 " - - " 4,385.09 " - - " 3,409.47 " " 4,261.84 " - - - " 5,300.00 " - - " 4,438.75 " - " 2,709.63 " " 4,968.75 " " 2,518.16 " " 2,963.36 " - 29816123 STENT NO-COAT W/DEL SYS LVL028 C1876 278 "$6,875.00" " 2,541.00 " - " 5,500.00 " - " 4,750.63 " - " 4,750.63 " - " 3,798.44 " - " 4,537.50 " - - " 4,550.56 " - - " 3,409.47 " " 4,261.84 " - - - " 5,500.00 " - - " 4,606.25 " - " 2,811.88 " " 5,156.25 " " 2,613.19 " " 3,075.19 " - 29817031 STENT NO-COAT W/DEL SYS LVL015 C1876 278 "$3,625.00" " 1,339.80 " - " 4,261.84 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - " 3,409.47 " " 4,261.84 " - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 29817049 STENT NO-COAT W/DEL SYS LVL029 C1876 278 "$7,125.00" " 2,633.40 " - " 5,700.00 " - " 4,923.38 " - " 4,923.38 " - " 3,936.56 " - " 4,702.50 " - - " 4,716.04 " - - " 3,409.47 " " 4,261.84 " - - - " 5,700.00 " - - " 4,773.75 " - " 2,914.13 " " 5,343.75 " " 2,708.21 " " 3,187.01 " - 29817057 STENT NO-COAT W/DEL SYS LVL030 C1876 278 "$7,375.00" " 2,725.80 " - " 5,900.00 " - " 5,096.13 " - " 5,096.13 " - " 4,074.69 " - " 4,867.50 " - - " 4,881.51 " - - " 3,409.47 " " 4,261.84 " - - - " 5,900.00 " - - " 4,941.25 " - " 3,016.38 " " 5,531.25 " " 2,803.24 " " 3,298.84 " - 29818134 STENT NO-COAT W/DEL SYS LVL040 C1876 278 "$9,875.00" " 3,649.80 " - " 7,900.00 " - " 6,823.63 " - " 6,823.63 " - " 5,455.94 " - " 6,517.50 " - - " 6,536.26 " - - " 3,409.47 " " 4,261.84 " - - - " 7,900.00 " - - " 6,616.25 " - " 4,038.88 " " 7,406.25 " " 3,753.49 " " 4,417.09 " - 29818142 STENT NO-COAT W/DEL SYS LVL041 C1876 278 "$10,125.00" " 3,742.20 " - " 8,100.00 " - " 6,996.38 " - " 6,996.38 " - " 5,594.06 " - " 6,682.50 " - - " 6,701.74 " - - " 3,409.47 " " 4,261.84 " - - - " 8,100.00 " - - " 6,783.75 " - " 4,141.13 " " 7,593.75 " " 3,848.51 " " 4,528.91 " - 29818151 STENT NO-COAT W/DEL SYS LVL042 C1876 278 "$10,375.00" " 3,834.60 " - " 8,300.00 " - " 7,169.13 " - " 7,169.13 " - " 5,732.19 " - " 6,847.50 " - - " 6,867.21 " - - " 3,409.47 " " 4,261.84 " - - - " 8,300.00 " - - " 6,951.25 " - " 4,243.38 " " 7,781.25 " " 3,943.54 " " 4,640.74 " - 29818169 STENT NO-COAT W/DEL SYS LVL043 C1876 278 "$10,625.00" " 3,927.00 " - " 8,500.00 " - " 7,341.88 " - " 7,341.88 " - " 5,870.31 " - " 7,012.50 " - - " 7,032.69 " - - " 3,409.47 " " 4,261.84 " - - - " 8,500.00 " - - " 7,118.75 " - " 4,345.63 " " 7,968.75 " " 4,038.56 " " 4,752.56 " - 29818177 STENT NO-COAT W/DEL SYS LVL044 C1876 278 "$10,875.00" " 4,019.40 " - " 8,700.00 " - " 7,514.63 " - " 7,514.63 " - " 6,008.44 " - " 7,177.50 " - - " 7,198.16 " - - " 3,409.47 " " 4,261.84 " - - - " 8,700.00 " - - " 7,286.25 " - " 4,447.88 " " 8,156.25 " " 4,133.59 " " 4,864.39 " - 29818185 STENT NO-COAT W/DEL SYS LVL045 C1876 278 "$11,125.00" " 4,111.80 " - " 8,900.00 " - " 7,687.38 " - " 7,687.38 " - " 6,146.56 " - " 7,342.50 " - - " 7,363.64 " - - " 3,409.47 " " 4,261.84 " - - - " 8,900.00 " - - " 7,453.75 " - " 4,550.13 " " 8,343.75 " " 4,228.61 " " 4,976.21 " - 29818835 G140249 ROADSAVER STENT SYS C1876 624 "$5,561.00" " 2,055.35 " - " 4,448.80 " - " 3,842.65 " - " 3,842.65 " - " 3,072.45 " - " 3,670.26 " - - " 3,680.83 " - - " 3,409.47 " " 4,261.84 " - - - " 4,448.80 " - - " 3,725.87 " - " 2,274.45 " " 4,170.75 " " 2,113.74 " " 2,487.44 " - 29818860 G010262 XACT CAROTID STENT SYS C1876 624 "$7,064.00" " 2,610.85 " - " 5,651.20 " - " 4,881.22 " - " 4,881.22 " - " 3,902.86 " - " 4,662.24 " - - " 4,675.66 " - - " 3,409.47 " " 4,261.84 " - - - " 5,651.20 " - - " 4,732.88 " - " 2,889.18 " " 5,298.00 " " 2,685.03 " " 3,159.73 " - 29820295 STENT NO-COAT W/DEL SYS LVL031 C1876 278 "$7,625.00" " 2,818.20 " - " 6,100.00 " - " 5,268.88 " - " 5,268.88 " - " 4,212.81 " - " 5,032.50 " - - " 5,046.99 " - - " 3,409.47 " " 4,261.84 " - - - " 6,100.00 " - - " 5,108.75 " - " 3,118.63 " " 5,718.75 " " 2,898.26 " " 3,410.66 " - 29820309 STENT NO-COAT W/DEL SYS LVL032 C1876 278 "$7,875.00" " 2,910.60 " - " 6,300.00 " - " 5,441.63 " - " 5,441.63 " - " 4,350.94 " - " 5,197.50 " - - " 5,212.46 " - - " 3,409.47 " " 4,261.84 " - - - " 6,300.00 " - - " 5,276.25 " - " 3,220.88 " " 5,906.25 " " 2,993.29 " " 3,522.49 " - 29820317 STENT NO-COAT W/DEL SYS LVL033 C1876 278 "$8,125.00" " 3,003.00 " - " 6,500.00 " - " 5,614.38 " - " 5,614.38 " - " 4,489.06 " - " 5,362.50 " - - " 5,377.94 " - - " 3,409.47 " " 4,261.84 " - - - " 6,500.00 " - - " 5,443.75 " - " 3,323.13 " " 6,093.75 " " 3,088.31 " " 3,634.31 " - 29820325 STENT NO-COAT W/DEL SYS LVL034 C1876 278 "$8,375.00" " 3,095.40 " - " 6,700.00 " - " 5,787.13 " - " 5,787.13 " - " 4,627.19 " - " 5,527.50 " - - " 5,543.41 " - - " 3,409.47 " " 4,261.84 " - - - " 6,700.00 " - - " 5,611.25 " - " 3,425.38 " " 6,281.25 " " 3,183.34 " " 3,746.14 " - 29820333 STENT NO-COAT W/DEL SYS LVL035 C1876 278 "$8,625.00" " 3,187.80 " - " 6,900.00 " - " 5,959.88 " - " 5,959.88 " - " 4,765.31 " - " 5,692.50 " - - " 5,708.89 " - - " 3,409.47 " " 4,261.84 " - - - " 6,900.00 " - - " 5,778.75 " - " 3,527.63 " " 6,468.75 " " 3,278.36 " " 3,857.96 " - 29820341 STENT NO-COAT W/DEL SYS LVL036 C1876 278 "$8,875.00" " 3,280.20 " - " 7,100.00 " - " 6,132.63 " - " 6,132.63 " - " 4,903.44 " - " 5,857.50 " - - " 5,874.36 " - - " 3,409.47 " " 4,261.84 " - - - " 7,100.00 " - - " 5,946.25 " - " 3,629.88 " " 6,656.25 " " 3,373.39 " " 3,969.79 " - 29820350 STENT NO-COAT W/DEL SYS LVL037 C1876 278 "$9,125.00" " 3,372.60 " - " 7,300.00 " - " 6,305.38 " - " 6,305.38 " - " 5,041.56 " - " 6,022.50 " - - " 6,039.84 " - - " 3,409.47 " " 4,261.84 " - - - " 7,300.00 " - - " 6,113.75 " - " 3,732.13 " " 6,843.75 " " 3,468.41 " " 4,081.61 " - 29820368 STENT NO-COAT W/DEL SYS LVL038 C1876 278 "$9,375.00" " 3,465.00 " - " 7,500.00 " - " 6,478.13 " - " 6,478.13 " - " 5,179.69 " - " 6,187.50 " - - " 6,205.31 " - - " 3,409.47 " " 4,261.84 " - - - " 7,500.00 " - - " 6,281.25 " - " 3,834.38 " " 7,031.25 " " 3,563.44 " " 4,193.44 " - 29820376 STENT NO-COAT W/DEL SYS LVL039 C1876 278 "$9,625.00" " 3,557.40 " - " 7,700.00 " - " 6,650.88 " - " 6,650.88 " - " 5,317.81 " - " 6,352.50 " - - " 6,370.79 " - - " 3,409.47 " " 4,261.84 " - - - " 7,700.00 " - - " 6,448.75 " - " 3,936.63 " " 7,218.75 " " 3,658.46 " " 4,305.26 " - 29820970 G130013 MOBIUSHD SYS NO-COAT C1876 624 $1.00 0.37 - " 4,261.84 " - 0.69 - 0.69 - 0.55 - 0.66 - - 0.66 - - " 3,409.47 " " 4,261.84 " - - - 0.80 - - 0.67 - 0.41 0.75 0.38 0.45 - 34005567 STENT NO-COAT W/DEL SYS LVL002 C1876 278 $450.00 166.32 - " 4,261.84 " - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - " 3,409.47 " " 4,261.84 " - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 34005711 STENT NO-COAT W/DEL SYS LVL017 C1876 278 "$4,125.00" " 1,524.60 " - " 4,261.84 " - " 2,850.38 " - " 2,850.38 " - " 2,279.06 " - " 2,722.50 " - - " 2,730.34 " - - " 3,409.47 " " 4,261.84 " - - - " 3,300.00 " - - " 2,763.75 " - " 1,687.13 " " 3,093.75 " " 1,567.91 " " 1,845.11 " - 34005818 STENT NO-COAT W/DEL SYS LVL027 C1876 278 "$6,625.00" " 2,448.60 " - " 5,300.00 " - " 4,577.88 " - " 4,577.88 " - " 3,660.31 " - " 4,372.50 " - - " 4,385.09 " - - " 3,409.47 " " 4,261.84 " - - - " 5,300.00 " - - " 4,438.75 " - " 2,709.63 " " 4,968.75 " " 2,518.16 " " 2,963.36 " - 80361939 STENT NO-COAT W/DEL SYS LVL003 C1876 278 $750.00 277.20 - " 4,261.84 " - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - " 3,409.47 " " 4,261.84 " - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 80361947 STENT NO-COAT W/DEL SYS LVL004 C1876 278 "$1,050.00" 388.08 - " 4,261.84 " - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - " 3,409.47 " " 4,261.84 " - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 80361955 STENT NO-COAT W/DEL SYS LVL005 C1876 278 "$1,350.00" 498.96 - " 4,261.84 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - " 3,409.47 " " 4,261.84 " - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 80361963 STENT NO-COAT W/DEL SYS LVL006 C1876 278 "$1,375.00" 508.20 - " 4,261.84 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - " 3,409.47 " " 4,261.84 " - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 80361971 STENT NO-COAT W/DEL SYS LVL007 C1876 278 "$1,625.00" 600.60 - " 4,261.84 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - " 3,409.47 " " 4,261.84 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 80361980 STENT NO-COAT W/DEL SYS LVL008 C1876 278 "$1,875.00" 693.00 - " 4,261.84 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - " 3,409.47 " " 4,261.84 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 80361998 STENT NO-COAT W/DEL SYS LVL009 C1876 278 "$2,125.00" 785.40 - " 4,261.84 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - " 3,409.47 " " 4,261.84 " - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 80362005 STENT NO-COAT W/DEL SYS LVL010 C1876 278 "$2,375.00" 877.80 - " 4,261.84 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - " 3,409.47 " " 4,261.84 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 80362013 STENT NO-COAT W/DEL SYS LVL011 C1876 278 "$2,625.00" 970.20 - " 4,261.84 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - " 3,409.47 " " 4,261.84 " - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 80362021 STENT NO-COAT W/DEL SYS LVL012 C1876 278 "$2,875.00" " 1,062.60 " - " 4,261.84 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - " 3,409.47 " " 4,261.84 " - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 80362030 STENT NO-COAT W/DEL SYS LVL013 C1876 278 "$3,125.00" " 1,155.00 " - " 4,261.84 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - " 3,409.47 " " 4,261.84 " - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 80362048 STENT NO-COAT W/DEL SYS LVL014 C1876 278 "$3,375.00" " 1,247.40 " - " 4,261.84 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - " 3,409.47 " " 4,261.84 " - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 80362056 STENT NO-COAT W/DEL SYS LVL015 C1876 278 "$3,625.00" " 1,339.80 " - " 4,261.84 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - " 3,409.47 " " 4,261.84 " - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 80362064 STENT NO-COAT W/DEL SYS LVL016 C1876 278 "$3,875.00" " 1,432.20 " - " 4,261.84 " - " 2,677.63 " - " 2,677.63 " - " 2,140.94 " - " 2,557.50 " - - " 2,564.86 " - - " 3,409.47 " " 4,261.84 " - - - " 3,100.00 " - - " 2,596.25 " - " 1,584.88 " " 2,906.25 " " 1,472.89 " " 1,733.29 " - 80362072 STENT NO-COAT W/DEL SYS LVL017 C1876 278 "$4,125.00" " 1,524.60 " - " 4,261.84 " - " 2,850.38 " - " 2,850.38 " - " 2,279.06 " - " 2,722.50 " - - " 2,730.34 " - - " 3,409.47 " " 4,261.84 " - - - " 3,300.00 " - - " 2,763.75 " - " 1,687.13 " " 3,093.75 " " 1,567.91 " " 1,845.11 " - 80362081 STENT NO-COAT W/DEL SYS LVL018 C1876 278 "$4,375.00" " 1,617.00 " - " 4,261.84 " - " 3,023.13 " - " 3,023.13 " - " 2,417.19 " - " 2,887.50 " - - " 2,895.81 " - - " 3,409.47 " " 4,261.84 " - - - " 3,500.00 " - - " 2,931.25 " - " 1,789.38 " " 3,281.25 " " 1,662.94 " " 1,956.94 " - 80362099 STENT NO-COAT W/DEL SYS LVL019 C1876 278 "$4,625.00" " 1,709.40 " - " 4,261.84 " - " 3,195.88 " - " 3,195.88 " - " 2,555.31 " - " 3,052.50 " - - " 3,061.29 " - - " 3,409.47 " " 4,261.84 " - - - " 3,700.00 " - - " 3,098.75 " - " 1,891.63 " " 3,468.75 " " 1,757.96 " " 2,068.76 " - 80362102 STENT NO-COAT W/DEL SYS LVL020 C1876 278 "$4,875.00" " 1,801.80 " - " 4,261.84 " - " 3,368.63 " - " 3,368.63 " - " 2,693.44 " - " 3,217.50 " - - " 3,226.76 " - - " 3,409.47 " " 4,261.84 " - - - " 3,900.00 " - - " 3,266.25 " - " 1,993.88 " " 3,656.25 " " 1,852.99 " " 2,180.59 " - 80362111 STENT NO-COAT W/DEL SYS LVL021 C1876 278 "$5,125.00" " 1,894.20 " - " 4,261.84 " - " 3,541.38 " - " 3,541.38 " - " 2,831.56 " - " 3,382.50 " - - " 3,392.24 " - - " 3,409.47 " " 4,261.84 " - - - " 4,100.00 " - - " 3,433.75 " - " 2,096.13 " " 3,843.75 " " 1,948.01 " " 2,292.41 " - 80362129 STENT NO-COAT W/DEL SYS LVL022 C1876 278 "$5,375.00" " 1,986.60 " - " 4,300.00 " - " 3,714.13 " - " 3,714.13 " - " 2,969.69 " - " 3,547.50 " - - " 3,557.71 " - - " 3,409.47 " " 4,261.84 " - - - " 4,300.00 " - - " 3,601.25 " - " 2,198.38 " " 4,031.25 " " 2,043.04 " " 2,404.24 " - 80362137 STENT NO-COAT W/DEL SYS LVL023 C1876 278 "$5,625.00" " 2,079.00 " - " 4,500.00 " - " 3,886.88 " - " 3,886.88 " - " 3,107.81 " - " 3,712.50 " - - " 3,723.19 " - - " 3,409.47 " " 4,261.84 " - - - " 4,500.00 " - - " 3,768.75 " - " 2,300.63 " " 4,218.75 " " 2,138.06 " " 2,516.06 " - 80362145 STENT NO-COAT W/DEL SYS LVL024 C1876 278 "$5,875.00" " 2,171.40 " - " 4,700.00 " - " 4,059.63 " - " 4,059.63 " - " 3,245.94 " - " 3,877.50 " - - " 3,888.66 " - - " 3,409.47 " " 4,261.84 " - - - " 4,700.00 " - - " 3,936.25 " - " 2,402.88 " " 4,406.25 " " 2,233.09 " " 2,627.89 " - 80362153 STENT NO-COAT W/DEL SYS LVL025 C1876 278 "$6,125.00" " 2,263.80 " - " 4,900.00 " - " 4,232.38 " - " 4,232.38 " - " 3,384.06 " - " 4,042.50 " - - " 4,054.14 " - - " 3,409.47 " " 4,261.84 " - - - " 4,900.00 " - - " 4,103.75 " - " 2,505.13 " " 4,593.75 " " 2,328.11 " " 2,739.71 " - 80362161 STENT NO-COAT W/DEL SYS LVL026 C1876 278 "$6,375.00" " 2,356.20 " - " 5,100.00 " - " 4,405.13 " - " 4,405.13 " - " 3,522.19 " - " 4,207.50 " - - " 4,219.61 " - - " 3,409.47 " " 4,261.84 " - - - " 5,100.00 " - - " 4,271.25 " - " 2,607.38 " " 4,781.25 " " 2,423.14 " " 2,851.54 " - 80362170 STENT NO-COAT W/DEL SYS LVL027 C1876 278 "$6,625.00" " 2,448.60 " - " 5,300.00 " - " 4,577.88 " - " 4,577.88 " - " 3,660.31 " - " 4,372.50 " - - " 4,385.09 " - - " 3,409.47 " " 4,261.84 " - - - " 5,300.00 " - - " 4,438.75 " - " 2,709.63 " " 4,968.75 " " 2,518.16 " " 2,963.36 " - 80362188 STENT NO-COAT W/DEL SYS LVL028 C1876 278 "$6,875.00" " 2,541.00 " - " 5,500.00 " - " 4,750.63 " - " 4,750.63 " - " 3,798.44 " - " 4,537.50 " - - " 4,550.56 " - - " 3,409.47 " " 4,261.84 " - - - " 5,500.00 " - - " 4,606.25 " - " 2,811.88 " " 5,156.25 " " 2,613.19 " " 3,075.19 " - 80362196 STENT NO-COAT W/DEL SYS LVL029 C1876 278 "$7,125.00" " 2,633.40 " - " 5,700.00 " - " 4,923.38 " - " 4,923.38 " - " 3,936.56 " - " 4,702.50 " - - " 4,716.04 " - - " 3,409.47 " " 4,261.84 " - - - " 5,700.00 " - - " 4,773.75 " - " 2,914.13 " " 5,343.75 " " 2,708.21 " " 3,187.01 " - 80362200 STENT NO-COAT W/DEL SYS LVL030 C1876 278 "$7,375.00" " 2,725.80 " - " 5,900.00 " - " 5,096.13 " - " 5,096.13 " - " 4,074.69 " - " 4,867.50 " - - " 4,881.51 " - - " 3,409.47 " " 4,261.84 " - - - " 5,900.00 " - - " 4,941.25 " - " 3,016.38 " " 5,531.25 " " 2,803.24 " " 3,298.84 " - 80362218 STENT NO-COAT W/DEL SYS LVL052 C1876 278 "$12,875.00" " 4,758.60 " - " 10,300.00 " - " 8,896.63 " - " 8,896.63 " - " 7,113.44 " - " 8,497.50 " - - " 8,521.96 " - - " 3,409.47 " " 4,261.84 " - - - " 10,300.00 " - - " 8,626.25 " - " 5,265.88 " " 9,656.25 " " 4,893.79 " " 5,758.99 " - 80362226 STENT NO-COAT W/DEL SYS LVL053 C1876 278 "$13,125.00" " 4,851.00 " - " 10,500.00 " - " 9,069.38 " - " 9,069.38 " - " 7,251.56 " - " 8,662.50 " - - " 8,687.44 " - - " 3,409.47 " " 4,261.84 " - - - " 10,500.00 " - - " 8,793.75 " - " 5,368.13 " " 9,843.75 " " 4,988.81 " " 5,870.81 " - 80362234 STENT NO-COAT W/DEL SYS LVL054 C1876 278 "$13,375.00" " 4,943.40 " - " 10,700.00 " - " 9,242.13 " - " 9,242.13 " - " 7,389.69 " - " 8,827.50 " - - " 8,852.91 " - - " 3,409.47 " " 4,261.84 " - - - " 10,700.00 " - - " 8,961.25 " - " 5,470.38 " " 10,031.25 " " 5,083.84 " " 5,982.64 " - 80362242 STENT NO-COAT W/DEL SYS LVL055 C1876 278 "$13,625.00" " 5,035.80 " - " 10,900.00 " - " 9,414.88 " - " 9,414.88 " - " 7,527.81 " - " 8,992.50 " - - " 9,018.39 " - - " 3,409.47 " " 4,261.84 " - - - " 10,900.00 " - - " 9,128.75 " - " 5,572.63 " " 10,218.75 " " 5,178.86 " " 6,094.46 " - 80362251 STENT NO-COAT W/DEL SYS LVL056 C1876 278 "$13,875.00" " 5,128.20 " - " 11,100.00 " - " 9,587.63 " - " 9,587.63 " - " 7,665.94 " - " 9,157.50 " - - " 9,183.86 " - - " 3,409.47 " " 4,261.84 " - - - " 11,100.00 " - - " 9,296.25 " - " 5,674.88 " " 10,406.25 " " 5,273.89 " " 6,206.29 " - 80362269 STENT NO-COAT W/DEL SYS LVL057 C1876 278 "$14,125.00" " 5,220.60 " - " 11,300.00 " - " 9,760.38 " - " 9,760.38 " - " 7,804.06 " - " 9,322.50 " - - " 9,349.34 " - - " 3,409.47 " " 4,261.84 " - - - " 11,300.00 " - - " 9,463.75 " - " 5,777.13 " " 10,593.75 " " 5,368.91 " " 6,318.11 " - 80362277 STENT NO-COAT W/DEL SYS LVL058 C1876 278 "$14,375.00" " 5,313.00 " - " 11,500.00 " - " 9,933.13 " - " 9,933.13 " - " 7,942.19 " - " 9,487.50 " - - " 9,514.81 " - - " 3,409.47 " " 4,261.84 " - - - " 11,500.00 " - - " 9,631.25 " - " 5,879.38 " " 10,781.25 " " 5,463.94 " " 6,429.94 " - 80362285 STENT NO-COAT W/DEL SYS LVL059 C1876 278 "$14,625.00" " 5,405.40 " - " 11,700.00 " - " 10,105.88 " - " 10,105.88 " - " 8,080.31 " - " 9,652.50 " - - " 9,680.29 " - - " 3,409.47 " " 4,261.84 " - - - " 11,700.00 " - - " 9,798.75 " - " 5,981.63 " " 10,968.75 " " 5,558.96 " " 6,541.76 " - 80362293 STENT NO-COAT W/DEL SYS LVL060 C1876 278 "$14,875.00" " 5,497.80 " - " 11,900.00 " - " 10,278.63 " - " 10,278.63 " - " 8,218.44 " - " 9,817.50 " - - " 9,845.76 " - - " 3,409.47 " " 4,261.84 " - - - " 11,900.00 " - - " 9,966.25 " - " 6,083.88 " " 11,156.25 " " 5,653.99 " " 6,653.59 " - 80362307 STENT NO-COAT W/DEL SYS LVL061 C1876 278 "$15,125.00" " 5,590.20 " - " 12,100.00 " - " 10,451.38 " - " 10,451.38 " - " 8,356.56 " - " 9,982.50 " - - " 10,011.24 " - - " 3,409.47 " " 4,261.84 " - - - " 12,100.00 " - - " 10,133.75 " - " 6,186.13 " " 11,343.75 " " 5,749.01 " " 6,765.41 " - 80362315 STENT NO-COAT W/DEL SYS LVL062 C1876 278 "$15,375.00" " 5,682.60 " - " 12,300.00 " - " 10,624.13 " - " 10,624.13 " - " 8,494.69 " - " 10,147.50 " - - " 10,176.71 " - - " 3,409.47 " " 4,261.84 " - - - " 12,300.00 " - - " 10,301.25 " - " 6,288.38 " " 11,531.25 " " 5,844.04 " " 6,877.24 " - 80362323 STENT NO-COAT W/DEL SYS LVL063 C1876 278 "$15,625.00" " 5,775.00 " - " 12,500.00 " - " 10,796.88 " - " 10,796.88 " - " 8,632.81 " - " 10,312.50 " - - " 10,342.19 " - - " 3,409.47 " " 4,261.84 " - - - " 12,500.00 " - - " 10,468.75 " - " 6,390.63 " " 11,718.75 " " 5,939.06 " " 6,989.06 " - 80362331 STENT NO-COAT W/DEL SYS LVL064 C1876 278 "$15,875.00" " 5,867.40 " - " 12,700.00 " - " 10,969.63 " - " 10,969.63 " - " 8,770.94 " - " 10,477.50 " - - " 10,507.66 " - - " 3,409.47 " " 4,261.84 " - - - " 12,700.00 " - - " 10,636.25 " - " 6,492.88 " " 11,906.25 " " 6,034.09 " " 7,100.89 " - 80362340 STENT NO-COAT W/DEL SYS LVL065 C1876 278 "$16,125.00" " 5,959.80 " - " 12,900.00 " - " 11,142.38 " - " 11,142.38 " - " 8,909.06 " - " 10,642.50 " - - " 10,673.14 " - - " 3,409.47 " " 4,261.84 " - - - " 12,900.00 " - - " 10,803.75 " - " 6,595.13 " " 12,093.75 " " 6,129.11 " " 7,212.71 " - 80362358 STENT NO-COAT W/DEL SYS LVL066 C1876 278 "$16,375.00" " 6,052.20 " - " 13,100.00 " - " 11,315.13 " - " 11,315.13 " - " 9,047.19 " - " 10,807.50 " - - " 10,838.61 " - - " 3,409.47 " " 4,261.84 " - - - " 13,100.00 " - - " 10,971.25 " - " 6,697.38 " " 12,281.25 " " 6,224.14 " " 7,324.54 " - 80362366 STENT NO-COAT W/DEL SYS LVL067 C1876 278 "$16,625.00" " 6,144.60 " - " 13,300.00 " - " 11,487.88 " - " 11,487.88 " - " 9,185.31 " - " 10,972.50 " - - " 11,004.09 " - - " 3,409.47 " " 4,261.84 " - - - " 13,300.00 " - - " 11,138.75 " - " 6,799.63 " " 12,468.75 " " 6,319.16 " " 7,436.36 " - 80362374 STENT NO-COAT W/DEL SYS LVL068 C1876 278 "$16,875.00" " 6,237.00 " - " 13,500.00 " - " 11,660.63 " - " 11,660.63 " - " 9,323.44 " - " 11,137.50 " - - " 11,169.56 " - - " 3,409.47 " " 4,261.84 " - - - " 13,500.00 " - - " 11,306.25 " - " 6,901.88 " " 12,656.25 " " 6,414.19 " " 7,548.19 " - 80362382 STENT NO-COAT W/DEL SYS LVL069 C1876 278 "$17,125.00" " 6,329.40 " - " 13,700.00 " - " 11,833.38 " - " 11,833.38 " - " 9,461.56 " - " 11,302.50 " - - " 11,335.04 " - - " 3,409.47 " " 4,261.84 " - - - " 13,700.00 " - - " 11,473.75 " - " 7,004.13 " " 12,843.75 " " 6,509.21 " " 7,660.01 " - 80362391 STENT NO-COAT W/DEL SYS LVL070 C1876 278 "$17,375.00" " 6,421.80 " - " 13,900.00 " - " 12,006.13 " - " 12,006.13 " - " 9,599.69 " - " 11,467.50 " - - " 11,500.51 " - - " 3,409.47 " " 4,261.84 " - - - " 13,900.00 " - - " 11,641.25 " - " 7,106.38 " " 13,031.25 " " 6,604.24 " " 7,771.84 " - 80362404 STENT NO-COAT W/DEL SYS LVL071 C1876 278 "$17,625.00" " 6,514.20 " - " 14,100.00 " - " 12,178.88 " - " 12,178.88 " - " 9,737.81 " - " 11,632.50 " - - " 11,665.99 " - - " 3,409.47 " " 4,261.84 " - - - " 14,100.00 " - - " 11,808.75 " - " 7,208.63 " " 13,218.75 " " 6,699.26 " " 7,883.66 " - 80362412 STENT NO-COAT W/DEL SYS LVL072 C1876 278 "$17,875.00" " 6,606.60 " - " 14,300.00 " - " 12,351.63 " - " 12,351.63 " - " 9,875.94 " - " 11,797.50 " - - " 11,831.46 " - - " 3,409.47 " " 4,261.84 " - - - " 14,300.00 " - - " 11,976.25 " - " 7,310.88 " " 13,406.25 " " 6,794.29 " " 7,995.49 " - 80362421 STENT NO-COAT W/DEL SYS LVL073 C1876 278 "$18,125.00" " 6,699.00 " - " 14,500.00 " - " 12,524.38 " - " 12,524.38 " - " 10,014.06 " - " 11,962.50 " - - " 11,996.94 " - - " 3,409.47 " " 4,261.84 " - - - " 14,500.00 " - - " 12,143.75 " - " 7,413.13 " " 13,593.75 " " 6,889.31 " " 8,107.31 " - 80362439 STENT NO-COAT W/DEL SYS LVL074 C1876 278 "$18,375.00" " 6,791.40 " - " 14,700.00 " - " 12,697.13 " - " 12,697.13 " - " 10,152.19 " - " 12,127.50 " - - " 12,162.41 " - - " 3,409.47 " " 4,261.84 " - - - " 14,700.00 " - - " 12,311.25 " - " 7,515.38 " " 13,781.25 " " 6,984.34 " " 8,219.14 " - 80362447 STENT NO-COAT W/DEL SYS LVL075 C1876 278 "$18,625.00" " 6,883.80 " - " 14,900.00 " - " 12,869.88 " - " 12,869.88 " - " 10,290.31 " - " 12,292.50 " - - " 12,327.89 " - - " 3,409.47 " " 4,261.84 " - - - " 14,900.00 " - - " 12,478.75 " - " 7,617.63 " " 13,968.75 " " 7,079.36 " " 8,330.96 " - 80362455 STENT NO-COAT W/DEL SYS LVL076 C1876 278 "$18,875.00" " 6,976.20 " - " 15,100.00 " - " 13,042.63 " - " 13,042.63 " - " 10,428.44 " - " 12,457.50 " - - " 12,493.36 " - - " 3,409.47 " " 4,261.84 " - - - " 15,100.00 " - - " 12,646.25 " - " 7,719.88 " " 14,156.25 " " 7,174.39 " " 8,442.79 " - 80362463 STENT NO-COAT W/DEL SYS LVL077 C1876 278 "$19,125.00" " 7,068.60 " - " 15,300.00 " - " 13,215.38 " - " 13,215.38 " - " 10,566.56 " - " 12,622.50 " - - " 12,658.84 " - - " 3,409.47 " " 4,261.84 " - - - " 15,300.00 " - - " 12,813.75 " - " 7,822.13 " " 14,343.75 " " 7,269.41 " " 8,554.61 " - 28140231 STENT NO-COAT W/O DEL LVL007 C1877 278 "$1,625.00" 600.60 - " 2,395.66 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - " 1,916.53 " " 2,395.66 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 29819301 STENT NO-COAT W/O DEL LVL006 C1877 278 "$1,375.00" 508.20 - " 2,395.66 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - " 1,916.53 " " 2,395.66 " - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 29819319 STENT NO-COAT W/O DEL LVL007 C1877 278 "$1,625.00" 600.60 - " 2,395.66 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - " 1,916.53 " " 2,395.66 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 29819327 STENT NO-COAT W/O DEL LVL008 C1877 278 "$1,875.00" 693.00 - " 2,395.66 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - " 1,916.53 " " 2,395.66 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 29819335 STENT NO-COAT W/O DEL LVL009 C1877 278 "$2,125.00" 785.40 - " 2,395.66 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - " 1,916.53 " " 2,395.66 " - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 29819343 STENT NO-COAT W/O DEL LVL010 C1877 278 "$2,375.00" 877.80 - " 2,395.66 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - " 1,916.53 " " 2,395.66 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 29819351 STENT NO-COAT W/O DEL LVL011 C1877 278 "$2,625.00" 970.20 - " 2,395.66 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - " 1,916.53 " " 2,395.66 " - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 29819360 STENT NO-COAT W/O DEL LVL012 C1877 278 "$2,875.00" " 1,062.60 " - " 2,395.66 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - " 1,916.53 " " 2,395.66 " - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 29819378 STENT NO-COAT W/O DEL LVL013 C1877 278 "$3,125.00" " 1,155.00 " - " 2,500.00 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - " 1,916.53 " " 2,395.66 " - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 29819386 STENT NO-COAT W/O DEL LVL014 C1877 278 "$3,375.00" " 1,247.40 " - " 2,700.00 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - " 1,916.53 " " 2,395.66 " - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 29819394 STENT NO-COAT W/O DEL LVL015 C1877 278 "$3,625.00" " 1,339.80 " - " 2,900.00 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - " 1,916.53 " " 2,395.66 " - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 80364458 STENT NO-COAT W/O DEL LVL008 C1877 278 "$1,875.00" 693.00 - " 2,395.66 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - " 1,916.53 " " 2,395.66 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 80364466 STENT NO-COAT W/O DEL LVL009 C1877 278 "$2,125.00" 785.40 - " 2,395.66 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - " 1,916.53 " " 2,395.66 " - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 80364474 STENT NO-COAT W/O DEL LVL010 C1877 278 "$2,375.00" 877.80 - " 2,395.66 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - " 1,916.53 " " 2,395.66 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 80364482 STENT NO-COAT W/O DEL LVL011 C1877 278 "$2,625.00" 970.20 - " 2,395.66 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - " 1,916.53 " " 2,395.66 " - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 80364491 STENT NO-COAT W/O DEL LVL012 C1877 278 "$2,875.00" " 1,062.60 " - " 2,395.66 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - " 1,916.53 " " 2,395.66 " - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 80364504 STENT NO-COAT W/O DEL LVL013 C1877 278 "$3,125.00" " 1,155.00 " - " 2,500.00 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - " 1,916.53 " " 2,395.66 " - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 80364512 STENT NO-COAT W/O DEL LVL014 C1877 278 "$3,375.00" " 1,247.40 " - " 2,700.00 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - " 1,916.53 " " 2,395.66 " - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 80364521 STENT NO-COAT W/O DEL LVL015 C1877 278 "$3,625.00" " 1,339.80 " - " 2,900.00 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - " 1,916.53 " " 2,395.66 " - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 80364539 STENT NO-COAT W/O DEL LVL016 C1877 278 "$3,875.00" " 1,432.20 " - " 3,100.00 " - " 2,677.63 " - " 2,677.63 " - " 2,140.94 " - " 2,557.50 " - - " 2,564.86 " - - " 1,916.53 " " 2,395.66 " - - - " 3,100.00 " - - " 2,596.25 " - " 1,584.88 " " 2,906.25 " " 1,472.89 " " 1,733.29 " - 28116471 VENA CAVA FILTER LVL009 C1880 278 "$2,125.00" 785.40 - " 3,387.48 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - " 2,709.98 " " 3,387.48 " - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 29816131 VENA CAVA FILTER LVL005 C1880 278 "$1,350.00" 498.96 - " 3,387.48 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - " 2,709.98 " " 3,387.48 " - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 29816140 VENA CAVA FILTER LVL006 C1880 278 "$1,375.00" 508.20 - " 3,387.48 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - " 2,709.98 " " 3,387.48 " - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 29816158 VENA CAVA FILTER LVL007 C1880 278 "$1,625.00" 600.60 - " 3,387.48 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - " 2,709.98 " " 3,387.48 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 29816166 VENA CAVA FILTER LVL008 C1880 278 "$1,875.00" 693.00 - " 3,387.48 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - " 2,709.98 " " 3,387.48 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 29816174 VENA CAVA FILTER LVL009 C1880 278 "$2,125.00" 785.40 - " 3,387.48 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - " 2,709.98 " " 3,387.48 " - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 29816182 VENA CAVA FILTER LVL010 C1880 278 "$2,375.00" 877.80 - " 3,387.48 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - " 2,709.98 " " 3,387.48 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 29816191 VENA CAVA FILTER LVL011 C1880 278 "$2,625.00" 970.20 - " 3,387.48 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - " 2,709.98 " " 3,387.48 " - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 29816204 VENA CAVA FILTER LVL012 C1880 278 "$2,875.00" " 1,062.60 " - " 3,387.48 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - " 2,709.98 " " 3,387.48 " - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 29816212 VENA CAVA FILTER LVL013 C1880 278 "$3,125.00" " 1,155.00 " - " 3,387.48 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - " 2,709.98 " " 3,387.48 " - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 29816221 VENA CAVA FILTER LVL014 C1880 278 "$3,375.00" " 1,247.40 " - " 3,387.48 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - " 2,709.98 " " 3,387.48 " - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 29816239 VENA CAVA FILTER LVL015 C1880 278 "$3,625.00" " 1,339.80 " - " 3,387.48 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - " 2,709.98 " " 3,387.48 " - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 80360002 VENA CAVA FILTER LVL006 C1880 278 "$1,375.00" 508.20 - " 3,387.48 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - " 2,709.98 " " 3,387.48 " - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 80360011 VENA CAVA FILTER LVL007 C1880 278 "$1,625.00" 600.60 - " 3,387.48 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - " 2,709.98 " " 3,387.48 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 80360029 VENA CAVA FILTER LVL008 C1880 278 "$1,875.00" 693.00 - " 3,387.48 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - " 2,709.98 " " 3,387.48 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 80360037 VENA CAVA FILTER LVL009 C1880 278 "$2,125.00" 785.40 - " 3,387.48 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - " 2,709.98 " " 3,387.48 " - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 80360045 VENA CAVA FILTER LVL010 C1880 278 "$2,375.00" 877.80 - " 3,387.48 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - " 2,709.98 " " 3,387.48 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 80360053 VENA CAVA FILTER LVL011 C1880 278 "$2,625.00" 970.20 - " 3,387.48 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - " 2,709.98 " " 3,387.48 " - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 80360061 VENA CAVA FILTER LVL012 C1880 278 "$2,875.00" " 1,062.60 " - " 3,387.48 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - " 2,709.98 " " 3,387.48 " - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 80360070 VENA CAVA FILTER LVL013 C1880 278 "$3,125.00" " 1,155.00 " - " 3,387.48 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - " 2,709.98 " " 3,387.48 " - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 80360088 VENA CAVA FILTER LVL014 C1880 278 "$3,375.00" " 1,247.40 " - " 3,387.48 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - " 2,709.98 " " 3,387.48 " - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 80360096 VENA CAVA FILTER LVL015 C1880 278 "$3,625.00" " 1,339.80 " - " 3,387.48 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - " 2,709.98 " " 3,387.48 " - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 80360100 VENA CAVA FILTER LVL016 C1880 278 "$3,875.00" " 1,432.20 " - " 3,387.48 " - " 2,677.63 " - " 2,677.63 " - " 2,140.94 " - " 2,557.50 " - - " 2,564.86 " - - " 2,709.98 " " 3,387.48 " - - - " 3,100.00 " - - " 2,596.25 " - " 1,584.88 " " 2,906.25 " " 1,472.89 " " 1,733.29 " - 80360118 VENA CAVA FILTER LVL017 C1880 278 "$4,125.00" " 1,524.60 " - " 3,387.48 " - " 2,850.38 " - " 2,850.38 " - " 2,279.06 " - " 2,722.50 " - - " 2,730.34 " - - " 2,709.98 " " 3,387.48 " - - - " 3,300.00 " - - " 2,763.75 " - " 1,687.13 " " 3,093.75 " " 1,567.91 " " 1,845.11 " - 30605349 AICD OTH THAN S/D IMP LVL155 C1882 275 "$38,625.00" " 14,275.80 " - " 60,264.75 " - " 26,689.88 " - " 26,689.88 " - " 21,340.31 " - " 25,492.50 " - - " 25,565.89 " - - " 48,211.80 " " 60,264.75 " - - - " 30,900.00 " - - " 25,878.75 " - " 15,797.63 " " 28,968.75 " " 14,681.36 " " 17,276.96 " - 30605357 AICD OTH THAN S/D IMP LVL156 C1882 275 "$38,875.00" " 14,368.20 " - " 60,264.75 " - " 26,862.63 " - " 26,862.63 " - " 21,478.44 " - " 25,657.50 " - - " 25,731.36 " - - " 48,211.80 " " 60,264.75 " - - - " 31,100.00 " - - " 26,046.25 " - " 15,899.88 " " 29,156.25 " " 14,776.39 " " 17,388.79 " - 30605365 AICD OTH THAN S/D IMP LVL157 C1882 275 "$39,125.00" " 14,460.60 " - " 60,264.75 " - " 27,035.38 " - " 27,035.38 " - " 21,616.56 " - " 25,822.50 " - - " 25,896.84 " - - " 48,211.80 " " 60,264.75 " - - - " 31,300.00 " - - " 26,213.75 " - " 16,002.13 " " 29,343.75 " " 14,871.41 " " 17,500.61 " - 30605373 AICD OTH THAN S/D IMP LVL158 C1882 275 "$39,375.00" " 14,553.00 " - " 60,264.75 " - " 27,208.13 " - " 27,208.13 " - " 21,754.69 " - " 25,987.50 " - - " 26,062.31 " - - " 48,211.80 " " 60,264.75 " - - - " 31,500.00 " - - " 26,381.25 " - " 16,104.38 " " 29,531.25 " " 14,966.44 " " 17,612.44 " - 30605381 AICD OTH THAN S/D IMP LVL159 C1882 275 "$39,625.00" " 14,645.40 " - " 60,264.75 " - " 27,380.88 " - " 27,380.88 " - " 21,892.81 " - " 26,152.50 " - - " 26,227.79 " - - " 48,211.80 " " 60,264.75 " - - - " 31,700.00 " - - " 26,548.75 " - " 16,206.63 " " 29,718.75 " " 15,061.46 " " 17,724.26 " - 30605390 AICD OTH THAN S/D IMP LVL160 C1882 275 "$39,875.00" " 14,737.80 " - " 60,264.75 " - " 27,553.63 " - " 27,553.63 " - " 22,030.94 " - " 26,317.50 " - - " 26,393.26 " - - " 48,211.80 " " 60,264.75 " - - - " 31,900.00 " - - " 26,716.25 " - " 16,308.88 " " 29,906.25 " " 15,156.49 " " 17,836.09 " - 30605403 AICD OTH THAN S/D IMP LVL161 C1882 275 "$40,125.00" " 14,830.20 " - " 60,264.75 " - " 27,726.38 " - " 27,726.38 " - " 22,169.06 " - " 26,482.50 " - - " 26,558.74 " - - " 48,211.80 " " 60,264.75 " - - - " 32,100.00 " - - " 26,883.75 " - " 16,411.13 " " 30,093.75 " " 15,251.51 " " 17,947.91 " - 30605411 AICD OTH THAN S/D IMP LVL162 C1882 275 "$40,375.00" " 14,922.60 " - " 60,264.75 " - " 27,899.13 " - " 27,899.13 " - " 22,307.19 " - " 26,647.50 " - - " 26,724.21 " - - " 48,211.80 " " 60,264.75 " - - - " 32,300.00 " - - " 27,051.25 " - " 16,513.38 " " 30,281.25 " " 15,346.54 " " 18,059.74 " - 30605420 AICD OTH THAN S/D IMP LVL163 C1882 275 "$40,625.00" " 15,015.00 " - " 60,264.75 " - " 28,071.88 " - " 28,071.88 " - " 22,445.31 " - " 26,812.50 " - - " 26,889.69 " - - " 48,211.80 " " 60,264.75 " - - - " 32,500.00 " - - " 27,218.75 " - " 16,615.63 " " 30,468.75 " " 15,441.56 " " 18,171.56 " - 30605438 AICD OTH THAN S/D IMP LVL171 C1882 275 "$42,625.00" " 15,754.20 " - " 60,264.75 " - " 29,453.88 " - " 29,453.88 " - " 23,550.31 " - " 28,132.50 " - - " 28,213.49 " - - " 48,211.80 " " 60,264.75 " - - - " 34,100.00 " - - " 28,558.75 " - " 17,433.63 " " 31,968.75 " " 16,201.76 " " 19,066.16 " - 30605446 AICD OTH THAN S/D IMP LVL172 C1882 275 "$42,875.00" " 15,846.60 " - " 60,264.75 " - " 29,626.63 " - " 29,626.63 " - " 23,688.44 " - " 28,297.50 " - - " 28,378.96 " - - " 48,211.80 " " 60,264.75 " - - - " 34,300.00 " - - " 28,726.25 " - " 17,535.88 " " 32,156.25 " " 16,296.79 " " 19,177.99 " - 30605454 AICD OTH THAN S/D IMP LVL173 C1882 275 "$43,125.00" " 15,939.00 " - " 60,264.75 " - " 29,799.38 " - " 29,799.38 " - " 23,826.56 " - " 28,462.50 " - - " 28,544.44 " - - " 48,211.80 " " 60,264.75 " - - - " 34,500.00 " - - " 28,893.75 " - " 17,638.13 " " 32,343.75 " " 16,391.81 " " 19,289.81 " - 30605462 AICD OTH THAN S/D IMP LVL180 C1882 275 "$44,875.00" " 16,585.80 " - " 60,264.75 " - " 31,008.63 " - " 31,008.63 " - " 24,793.44 " - " 29,617.50 " - - " 29,702.76 " - - " 48,211.80 " " 60,264.75 " - - - " 35,900.00 " - - " 30,066.25 " - " 18,353.88 " " 33,656.25 " " 17,056.99 " " 20,072.59 " - 30605471 AICD OTH THAN S/D IMP LVL181 C1882 275 "$45,125.00" " 16,678.20 " - " 60,264.75 " - " 31,181.38 " - " 31,181.38 " - " 24,931.56 " - " 29,782.50 " - - " 29,868.24 " - - " 48,211.80 " " 60,264.75 " - - - " 36,100.00 " - - " 30,233.75 " - " 18,456.13 " " 33,843.75 " " 17,152.01 " " 20,184.41 " - 30605489 AICD OTH THAN S/D IMP LVL185 C1882 275 "$46,125.00" " 17,047.80 " - " 60,264.75 " - " 31,872.38 " - " 31,872.38 " - " 25,484.06 " - " 30,442.50 " - - " 30,530.14 " - - " 48,211.80 " " 60,264.75 " - - - " 36,900.00 " - - " 30,903.75 " - " 18,865.13 " " 34,593.75 " " 17,532.11 " " 20,631.71 " - 30605497 AICD OTH THAN S/D IMP LVL189 C1882 275 "$47,125.00" " 17,417.40 " - " 60,264.75 " - " 32,563.38 " - " 32,563.38 " - " 26,036.56 " - " 31,102.50 " - - " 31,192.04 " - - " 48,211.80 " " 60,264.75 " - - - " 37,700.00 " - - " 31,573.75 " - " 19,274.13 " " 35,343.75 " " 17,912.21 " " 21,079.01 " - 30605501 AICD OTH THAN S/D IMP LVL188 C1882 275 "$46,875.00" " 17,325.00 " - " 60,264.75 " - " 32,390.63 " - " 32,390.63 " - " 25,898.44 " - " 30,937.50 " - - " 31,026.56 " - - " 48,211.80 " " 60,264.75 " - - - " 37,500.00 " - - " 31,406.25 " - " 19,171.88 " " 35,156.25 " " 17,817.19 " " 20,967.19 " - 30605519 AICD OTH THAN S/D IMP LVL190 C1882 275 "$47,375.00" " 17,509.80 " - " 60,264.75 " - " 32,736.13 " - " 32,736.13 " - " 26,174.69 " - " 31,267.50 " - - " 31,357.51 " - - " 48,211.80 " " 60,264.75 " - - - " 37,900.00 " - - " 31,741.25 " - " 19,376.38 " " 35,531.25 " " 18,007.24 " " 21,190.84 " - 30605527 AICD OTH THAN S/D IMP LVL191 C1882 275 "$47,625.00" " 17,602.20 " - " 60,264.75 " - " 32,908.88 " - " 32,908.88 " - " 26,312.81 " - " 31,432.50 " - - " 31,522.99 " - - " 48,211.80 " " 60,264.75 " - - - " 38,100.00 " - - " 31,908.75 " - " 19,478.63 " " 35,718.75 " " 18,102.26 " " 21,302.66 " - 30605535 AICD OTH THAN S/D IMP LVL199 C1882 275 "$49,625.00" " 18,341.40 " - " 60,264.75 " - " 34,290.88 " - " 34,290.88 " - " 27,417.81 " - " 32,752.50 " - - " 32,846.79 " - - " 48,211.80 " " 60,264.75 " - - - " 39,700.00 " - - " 33,248.75 " - " 20,296.63 " " 37,218.75 " " 18,862.46 " " 22,197.26 " - 30605543 AICD OTH THAN S/D IMP LVL200 C1882 275 "$49,875.00" " 18,433.80 " - " 60,264.75 " - " 34,463.63 " - " 34,463.63 " - " 27,555.94 " - " 32,917.50 " - - " 33,012.26 " - - " 48,211.80 " " 60,264.75 " - - - " 39,900.00 " - - " 33,416.25 " - " 20,398.88 " " 37,406.25 " " 18,957.49 " " 22,309.09 " - 30605551 AICD OTH THAN S/D IMP LVL201 C1882 275 "$50,125.00" " 18,526.20 " - " 60,264.75 " - " 34,636.38 " - " 34,636.38 " - " 27,694.06 " - " 33,082.50 " - - " 33,177.74 " - - " 48,211.80 " " 60,264.75 " - - - " 40,100.00 " - - " 33,583.75 " - " 20,501.13 " " 37,593.75 " " 19,052.51 " " 22,420.91 " - 30605560 AICD OTH THAN S/D IMP LVL204 C1882 275 "$50,875.00" " 18,803.40 " - " 60,264.75 " - " 35,154.63 " - " 35,154.63 " - " 28,108.44 " - " 33,577.50 " - - " 33,674.16 " - - " 48,211.80 " " 60,264.75 " - - - " 40,700.00 " - - " 34,086.25 " - " 20,807.88 " " 38,156.25 " " 19,337.59 " " 22,756.39 " - 30605578 AICD OTH THAN S/D IMP LVL205 C1882 275 "$51,125.00" " 18,895.80 " - " 60,264.75 " - " 35,327.38 " - " 35,327.38 " - " 28,246.56 " - " 33,742.50 " - - " 33,839.64 " - - " 48,211.80 " " 60,264.75 " - - - " 40,900.00 " - - " 34,253.75 " - " 20,910.13 " " 38,343.75 " " 19,432.61 " " 22,868.21 " - 30605586 AICD OTH THAN S/D IMP LVL206 C1882 275 "$51,375.00" " 18,988.20 " - " 60,264.75 " - " 35,500.13 " - " 35,500.13 " - " 28,384.69 " - " 33,907.50 " - - " 34,005.11 " - - " 48,211.80 " " 60,264.75 " - - - " 41,100.00 " - - " 34,421.25 " - " 21,012.38 " " 38,531.25 " " 19,527.64 " " 22,980.04 " - 30605594 AICD OTH THAN S/D IMP LVL207 C1882 275 "$51,625.00" " 19,080.60 " - " 60,264.75 " - " 35,672.88 " - " 35,672.88 " - " 28,522.81 " - " 34,072.50 " - - " 34,170.59 " - - " 48,211.80 " " 60,264.75 " - - - " 41,300.00 " - - " 34,588.75 " - " 21,114.63 " " 38,718.75 " " 19,622.66 " " 23,091.86 " - 30605608 AICD OTH THAN S/D IMP LVL215 C1882 275 "$53,625.00" " 19,819.80 " - " 60,264.75 " - " 37,054.88 " - " 37,054.88 " - " 29,627.81 " - " 35,392.50 " - - " 35,494.39 " - - " 48,211.80 " " 60,264.75 " - - - " 42,900.00 " - - " 35,928.75 " - " 21,932.63 " " 40,218.75 " " 20,382.86 " " 23,986.46 " - 30605616 AICD OTH THAN S/D IMP LVL214 C1882 275 "$53,375.00" " 19,727.40 " - " 60,264.75 " - " 36,882.13 " - " 36,882.13 " - " 29,489.69 " - " 35,227.50 " - - " 35,328.91 " - - " 48,211.80 " " 60,264.75 " - - - " 42,700.00 " - - " 35,761.25 " - " 21,830.38 " " 40,031.25 " " 20,287.84 " " 23,874.64 " - 30605624 AICD OTH THAN S/D IMP LVL216 C1882 275 "$53,875.00" " 19,912.20 " - " 60,264.75 " - " 37,227.63 " - " 37,227.63 " - " 29,765.94 " - " 35,557.50 " - - " 35,659.86 " - - " 48,211.80 " " 60,264.75 " - - - " 43,100.00 " - - " 36,096.25 " - " 22,034.88 " " 40,406.25 " " 20,477.89 " " 24,098.29 " - 30605632 AICD OTH THAN S/D IMP LVL217 C1882 275 "$54,125.00" " 20,004.60 " - " 60,264.75 " - " 37,400.38 " - " 37,400.38 " - " 29,904.06 " - " 35,722.50 " - - " 35,825.34 " - - " 48,211.80 " " 60,264.75 " - - - " 43,300.00 " - - " 36,263.75 " - " 22,137.13 " " 40,593.75 " " 20,572.91 " " 24,210.11 " - 30605641 AICD OTH THAN S/D IMP LVL218 C1882 275 "$54,375.00" " 20,097.00 " - " 60,264.75 " - " 37,573.13 " - " 37,573.13 " - " 30,042.19 " - " 35,887.50 " - - " 35,990.81 " - - " 48,211.80 " " 60,264.75 " - - - " 43,500.00 " - - " 36,431.25 " - " 22,239.38 " " 40,781.25 " " 20,667.94 " " 24,321.94 " - 30605659 AICD OTH THAN S/D IMP LVL220 C1882 275 "$54,875.00" " 20,281.80 " - " 60,264.75 " - " 37,918.63 " - " 37,918.63 " - " 30,318.44 " - " 36,217.50 " - - " 36,321.76 " - - " 48,211.80 " " 60,264.75 " - - - " 43,900.00 " - - " 36,766.25 " - " 22,443.88 " " 41,156.25 " " 20,857.99 " " 24,545.59 " - 30605667 AICD OTH THAN S/D IMP LVL221 C1882 275 "$55,125.00" " 20,374.20 " - " 60,264.75 " - " 38,091.38 " - " 38,091.38 " - " 30,456.56 " - " 36,382.50 " - - " 36,487.24 " - - " 48,211.80 " " 60,264.75 " - - - " 44,100.00 " - - " 36,933.75 " - " 22,546.13 " " 41,343.75 " " 20,953.01 " " 24,657.41 " - 30605675 AICD OTH THAN S/D IMP LVL222 C1882 275 "$55,375.00" " 20,466.60 " - " 60,264.75 " - " 38,264.13 " - " 38,264.13 " - " 30,594.69 " - " 36,547.50 " - - " 36,652.71 " - - " 48,211.80 " " 60,264.75 " - - - " 44,300.00 " - - " 37,101.25 " - " 22,648.38 " " 41,531.25 " " 21,048.04 " " 24,769.24 " - 30605683 AICD OTH THAN S/D IMP LVL223 C1882 275 "$55,625.00" " 20,559.00 " - " 60,264.75 " - " 38,436.88 " - " 38,436.88 " - " 30,732.81 " - " 36,712.50 " - - " 36,818.19 " - - " 48,211.80 " " 60,264.75 " - - - " 44,500.00 " - - " 37,268.75 " - " 22,750.63 " " 41,718.75 " " 21,143.06 " " 24,881.06 " - 30605691 AICD OTH THAN S/D IMP LVL224 C1882 275 "$55,875.00" " 20,651.40 " - " 60,264.75 " - " 38,609.63 " - " 38,609.63 " - " 30,870.94 " - " 36,877.50 " - - " 36,983.66 " - - " 48,211.80 " " 60,264.75 " - - - " 44,700.00 " - - " 37,436.25 " - " 22,852.88 " " 41,906.25 " " 21,238.09 " " 24,992.89 " - 30605705 AICD OTH THAN S/D IMP LVL225 C1882 275 "$56,125.00" " 20,743.80 " - " 60,264.75 " - " 38,782.38 " - " 38,782.38 " - " 31,009.06 " - " 37,042.50 " - - " 37,149.14 " - - " 48,211.80 " " 60,264.75 " - - - " 44,900.00 " - - " 37,603.75 " - " 22,955.13 " " 42,093.75 " " 21,333.11 " " 25,104.71 " - 30605713 AICD OTH THAN S/D IMP LVL226 C1882 275 "$56,375.00" " 20,836.20 " - " 60,264.75 " - " 38,955.13 " - " 38,955.13 " - " 31,147.19 " - " 37,207.50 " - - " 37,314.61 " - - " 48,211.80 " " 60,264.75 " - - - " 45,100.00 " - - " 37,771.25 " - " 23,057.38 " " 42,281.25 " " 21,428.14 " " 25,216.54 " - 30605721 AICD OTH THAN S/D IMP LVL227 C1882 275 "$56,625.00" " 20,928.60 " - " 60,264.75 " - " 39,127.88 " - " 39,127.88 " - " 31,285.31 " - " 37,372.50 " - - " 37,480.09 " - - " 48,211.80 " " 60,264.75 " - - - " 45,300.00 " - - " 37,938.75 " - " 23,159.63 " " 42,468.75 " " 21,523.16 " " 25,328.36 " - 30609786 AICD OTH THAN S/D IMP LVL150 C1882 275 "$37,375.00" " 13,813.80 " - " 60,264.75 " - " 25,826.13 " - " 25,826.13 " - " 20,649.69 " - " 24,667.50 " - - " 24,738.51 " - - " 48,211.80 " " 60,264.75 " - - - " 29,900.00 " - - " 25,041.25 " - " 15,286.38 " " 28,031.25 " " 14,206.24 " " 16,717.84 " - 30609794 AICD OTH THAN S/D IMP LVL151 C1882 275 "$37,625.00" " 13,906.20 " - " 60,264.75 " - " 25,998.88 " - " 25,998.88 " - " 20,787.81 " - " 24,832.50 " - - " 24,903.99 " - - " 48,211.80 " " 60,264.75 " - - - " 30,100.00 " - - " 25,208.75 " - " 15,388.63 " " 28,218.75 " " 14,301.26 " " 16,829.66 " - 30609808 AICD OTH THAN S/D IMP LVL152 C1882 275 "$37,875.00" " 13,998.60 " - " 60,264.75 " - " 26,171.63 " - " 26,171.63 " - " 20,925.94 " - " 24,997.50 " - - " 25,069.46 " - - " 48,211.80 " " 60,264.75 " - - - " 30,300.00 " - - " 25,376.25 " - " 15,490.88 " " 28,406.25 " " 14,396.29 " " 16,941.49 " - 30609816 AICD OTH THAN S/D IMP LVL153 C1882 275 "$38,125.00" " 14,091.00 " - " 60,264.75 " - " 26,344.38 " - " 26,344.38 " - " 21,064.06 " - " 25,162.50 " - - " 25,234.94 " - - " 48,211.80 " " 60,264.75 " - - - " 30,500.00 " - - " 25,543.75 " - " 15,593.13 " " 28,593.75 " " 14,491.31 " " 17,053.31 " - 30609824 AICD OTH THAN S/D IMP LVL154 C1882 275 "$38,375.00" " 14,183.40 " - " 60,264.75 " - " 26,517.13 " - " 26,517.13 " - " 21,202.19 " - " 25,327.50 " - - " 25,400.41 " - - " 48,211.80 " " 60,264.75 " - - - " 30,700.00 " - - " 25,711.25 " - " 15,695.38 " " 28,781.25 " " 14,586.34 " " 17,165.14 " - 30609832 AICD OTH THAN S/D IMP LVL164 C1882 275 "$40,875.00" " 15,107.40 " - " 60,264.75 " - " 28,244.63 " - " 28,244.63 " - " 22,583.44 " - " 26,977.50 " - - " 27,055.16 " - - " 48,211.80 " " 60,264.75 " - - - " 32,700.00 " - - " 27,386.25 " - " 16,717.88 " " 30,656.25 " " 15,536.59 " " 18,283.39 " - 30609841 AICD OTH THAN S/D IMP LVL165 C1882 275 "$41,125.00" " 15,199.80 " - " 60,264.75 " - " 28,417.38 " - " 28,417.38 " - " 22,721.56 " - " 27,142.50 " - - " 27,220.64 " - - " 48,211.80 " " 60,264.75 " - - - " 32,900.00 " - - " 27,553.75 " - " 16,820.13 " " 30,843.75 " " 15,631.61 " " 18,395.21 " - 30609859 AICD OTH THAN S/D IMP LVL166 C1882 275 "$41,375.00" " 15,292.20 " - " 60,264.75 " - " 28,590.13 " - " 28,590.13 " - " 22,859.69 " - " 27,307.50 " - - " 27,386.11 " - - " 48,211.80 " " 60,264.75 " - - - " 33,100.00 " - - " 27,721.25 " - " 16,922.38 " " 31,031.25 " " 15,726.64 " " 18,507.04 " - 30609867 AICD OTH THAN S/D IMP LVL167 C1882 275 "$41,625.00" " 15,384.60 " - " 60,264.75 " - " 28,762.88 " - " 28,762.88 " - " 22,997.81 " - " 27,472.50 " - - " 27,551.59 " - - " 48,211.80 " " 60,264.75 " - - - " 33,300.00 " - - " 27,888.75 " - " 17,024.63 " " 31,218.75 " " 15,821.66 " " 18,618.86 " - 30609875 AICD OTH THAN S/D IMP LVL168 C1882 275 "$41,875.00" " 15,477.00 " - " 60,264.75 " - " 28,935.63 " - " 28,935.63 " - " 23,135.94 " - " 27,637.50 " - - " 27,717.06 " - - " 48,211.80 " " 60,264.75 " - - - " 33,500.00 " - - " 28,056.25 " - " 17,126.88 " " 31,406.25 " " 15,916.69 " " 18,730.69 " - 30609883 AICD OTH THAN S/D IMP LVL169 C1882 275 "$42,125.00" " 15,569.40 " - " 60,264.75 " - " 29,108.38 " - " 29,108.38 " - " 23,274.06 " - " 27,802.50 " - - " 27,882.54 " - - " 48,211.80 " " 60,264.75 " - - - " 33,700.00 " - - " 28,223.75 " - " 17,229.13 " " 31,593.75 " " 16,011.71 " " 18,842.51 " - 30609891 AICD OTH THAN S/D IMP LVL170 C1882 275 "$42,375.00" " 15,661.80 " - " 60,264.75 " - " 29,281.13 " - " 29,281.13 " - " 23,412.19 " - " 27,967.50 " - - " 28,048.01 " - - " 48,211.80 " " 60,264.75 " - - - " 33,900.00 " - - " 28,391.25 " - " 17,331.38 " " 31,781.25 " " 16,106.74 " " 18,954.34 " - 30609905 AICD OTH THAN S/D IMP LVL174 C1882 275 "$43,375.00" " 16,031.40 " - " 60,264.75 " - " 29,972.13 " - " 29,972.13 " - " 23,964.69 " - " 28,627.50 " - - " 28,709.91 " - - " 48,211.80 " " 60,264.75 " - - - " 34,700.00 " - - " 29,061.25 " - " 17,740.38 " " 32,531.25 " " 16,486.84 " " 19,401.64 " - 30609913 AICD OTH THAN S/D IMP LVL175 C1882 275 "$43,625.00" " 16,123.80 " - " 60,264.75 " - " 30,144.88 " - " 30,144.88 " - " 24,102.81 " - " 28,792.50 " - - " 28,875.39 " - - " 48,211.80 " " 60,264.75 " - - - " 34,900.00 " - - " 29,228.75 " - " 17,842.63 " " 32,718.75 " " 16,581.86 " " 19,513.46 " - 30609921 AICD OTH THAN S/D IMP LVL176 C1882 275 "$43,875.00" " 16,216.20 " - " 60,264.75 " - " 30,317.63 " - " 30,317.63 " - " 24,240.94 " - " 28,957.50 " - - " 29,040.86 " - - " 48,211.80 " " 60,264.75 " - - - " 35,100.00 " - - " 29,396.25 " - " 17,944.88 " " 32,906.25 " " 16,676.89 " " 19,625.29 " - 30609930 AICD OTH THAN S/D IMP LVL177 C1882 275 "$44,125.00" " 16,308.60 " - " 60,264.75 " - " 30,490.38 " - " 30,490.38 " - " 24,379.06 " - " 29,122.50 " - - " 29,206.34 " - - " 48,211.80 " " 60,264.75 " - - - " 35,300.00 " - - " 29,563.75 " - " 18,047.13 " " 33,093.75 " " 16,771.91 " " 19,737.11 " - 30609948 AICD OTH THAN S/D IMP LVL178 C1882 275 "$44,375.00" " 16,401.00 " - " 60,264.75 " - " 30,663.13 " - " 30,663.13 " - " 24,517.19 " - " 29,287.50 " - - " 29,371.81 " - - " 48,211.80 " " 60,264.75 " - - - " 35,500.00 " - - " 29,731.25 " - " 18,149.38 " " 33,281.25 " " 16,866.94 " " 19,848.94 " - 30609956 AICD OTH THAN S/D IMP LVL179 C1882 275 "$44,625.00" " 16,493.40 " - " 60,264.75 " - " 30,835.88 " - " 30,835.88 " - " 24,655.31 " - " 29,452.50 " - - " 29,537.29 " - - " 48,211.80 " " 60,264.75 " - - - " 35,700.00 " - - " 29,898.75 " - " 18,251.63 " " 33,468.75 " " 16,961.96 " " 19,960.76 " - 30609964 AICD OTH THAN S/D IMP LVL182 C1882 275 "$45,375.00" " 16,770.60 " - " 60,264.75 " - " 31,354.13 " - " 31,354.13 " - " 25,069.69 " - " 29,947.50 " - - " 30,033.71 " - - " 48,211.80 " " 60,264.75 " - - - " 36,300.00 " - - " 30,401.25 " - " 18,558.38 " " 34,031.25 " " 17,247.04 " " 20,296.24 " - 30609972 AICD OTH THAN S/D IMP LVL183 C1882 275 "$45,625.00" " 16,863.00 " - " 60,264.75 " - " 31,526.88 " - " 31,526.88 " - " 25,207.81 " - " 30,112.50 " - - " 30,199.19 " - - " 48,211.80 " " 60,264.75 " - - - " 36,500.00 " - - " 30,568.75 " - " 18,660.63 " " 34,218.75 " " 17,342.06 " " 20,408.06 " - 30609981 AICD OTH THAN S/D IMP LVL184 C1882 275 "$45,875.00" " 16,955.40 " - " 60,264.75 " - " 31,699.63 " - " 31,699.63 " - " 25,345.94 " - " 30,277.50 " - - " 30,364.66 " - - " 48,211.80 " " 60,264.75 " - - - " 36,700.00 " - - " 30,736.25 " - " 18,762.88 " " 34,406.25 " " 17,437.09 " " 20,519.89 " - 30609999 AICD OTH THAN S/D IMP LVL186 C1882 275 "$46,375.00" " 17,140.20 " - " 60,264.75 " - " 32,045.13 " - " 32,045.13 " - " 25,622.19 " - " 30,607.50 " - - " 30,695.61 " - - " 48,211.80 " " 60,264.75 " - - - " 37,100.00 " - - " 31,071.25 " - " 18,967.38 " " 34,781.25 " " 17,627.14 " " 20,743.54 " - 30610008 AICD OTH THAN S/D IMP LVL187 C1882 275 "$46,625.00" " 17,232.60 " - " 60,264.75 " - " 32,217.88 " - " 32,217.88 " - " 25,760.31 " - " 30,772.50 " - - " 30,861.09 " - - " 48,211.80 " " 60,264.75 " - - - " 37,300.00 " - - " 31,238.75 " - " 19,069.63 " " 34,968.75 " " 17,722.16 " " 20,855.36 " - 30610016 AICD OTH THAN S/D IMP LVL192 C1882 275 "$47,875.00" " 17,694.60 " - " 60,264.75 " - " 33,081.63 " - " 33,081.63 " - " 26,450.94 " - " 31,597.50 " - - " 31,688.46 " - - " 48,211.80 " " 60,264.75 " - - - " 38,300.00 " - - " 32,076.25 " - " 19,580.88 " " 35,906.25 " " 18,197.29 " " 21,414.49 " - 30610024 AICD OTH THAN S/D IMP LVL193 C1882 275 "$48,125.00" " 17,787.00 " - " 60,264.75 " - " 33,254.38 " - " 33,254.38 " - " 26,589.06 " - " 31,762.50 " - - " 31,853.94 " - - " 48,211.80 " " 60,264.75 " - - - " 38,500.00 " - - " 32,243.75 " - " 19,683.13 " " 36,093.75 " " 18,292.31 " " 21,526.31 " - 30610032 AICD OTH THAN S/D IMP LVL194 C1882 275 "$48,375.00" " 17,879.40 " - " 60,264.75 " - " 33,427.13 " - " 33,427.13 " - " 26,727.19 " - " 31,927.50 " - - " 32,019.41 " - - " 48,211.80 " " 60,264.75 " - - - " 38,700.00 " - - " 32,411.25 " - " 19,785.38 " " 36,281.25 " " 18,387.34 " " 21,638.14 " - 30610041 AICD OTH THAN S/D IMP LVL195 C1882 275 "$48,625.00" " 17,971.80 " - " 60,264.75 " - " 33,599.88 " - " 33,599.88 " - " 26,865.31 " - " 32,092.50 " - - " 32,184.89 " - - " 48,211.80 " " 60,264.75 " - - - " 38,900.00 " - - " 32,578.75 " - " 19,887.63 " " 36,468.75 " " 18,482.36 " " 21,749.96 " - 30610059 AICD OTH THAN S/D IMP LVL196 C1882 275 "$48,875.00" " 18,064.20 " - " 60,264.75 " - " 33,772.63 " - " 33,772.63 " - " 27,003.44 " - " 32,257.50 " - - " 32,350.36 " - - " 48,211.80 " " 60,264.75 " - - - " 39,100.00 " - - " 32,746.25 " - " 19,989.88 " " 36,656.25 " " 18,577.39 " " 21,861.79 " - 30610067 AICD OTH THAN S/D IMP LVL197 C1882 275 "$49,125.00" " 18,156.60 " - " 60,264.75 " - " 33,945.38 " - " 33,945.38 " - " 27,141.56 " - " 32,422.50 " - - " 32,515.84 " - - " 48,211.80 " " 60,264.75 " - - - " 39,300.00 " - - " 32,913.75 " - " 20,092.13 " " 36,843.75 " " 18,672.41 " " 21,973.61 " - 30610075 AICD OTH THAN S/D IMP LVL198 C1882 275 "$49,375.00" " 18,249.00 " - " 60,264.75 " - " 34,118.13 " - " 34,118.13 " - " 27,279.69 " - " 32,587.50 " - - " 32,681.31 " - - " 48,211.80 " " 60,264.75 " - - - " 39,500.00 " - - " 33,081.25 " - " 20,194.38 " " 37,031.25 " " 18,767.44 " " 22,085.44 " - 30610083 AICD OTH THAN S/D IMP LVL202 C1882 275 "$50,375.00" " 18,618.60 " - " 60,264.75 " - " 34,809.13 " - " 34,809.13 " - " 27,832.19 " - " 33,247.50 " - - " 33,343.21 " - - " 48,211.80 " " 60,264.75 " - - - " 40,300.00 " - - " 33,751.25 " - " 20,603.38 " " 37,781.25 " " 19,147.54 " " 22,532.74 " - 30610091 AICD OTH THAN S/D IMP LVL203 C1882 275 "$50,625.00" " 18,711.00 " - " 60,264.75 " - " 34,981.88 " - " 34,981.88 " - " 27,970.31 " - " 33,412.50 " - - " 33,508.69 " - - " 48,211.80 " " 60,264.75 " - - - " 40,500.00 " - - " 33,918.75 " - " 20,705.63 " " 37,968.75 " " 19,242.56 " " 22,644.56 " - 30610105 AICD OTH THAN S/D IMP LVL208 C1882 275 "$51,875.00" " 19,173.00 " - " 60,264.75 " - " 35,845.63 " - " 35,845.63 " - " 28,660.94 " - " 34,237.50 " - - " 34,336.06 " - - " 48,211.80 " " 60,264.75 " - - - " 41,500.00 " - - " 34,756.25 " - " 21,216.88 " " 38,906.25 " " 19,717.69 " " 23,203.69 " - 30610113 AICD OTH THAN S/D IMP LVL209 C1882 275 "$52,125.00" " 19,265.40 " - " 60,264.75 " - " 36,018.38 " - " 36,018.38 " - " 28,799.06 " - " 34,402.50 " - - " 34,501.54 " - - " 48,211.80 " " 60,264.75 " - - - " 41,700.00 " - - " 34,923.75 " - " 21,319.13 " " 39,093.75 " " 19,812.71 " " 23,315.51 " - 30610121 AICD OTH THAN S/D IMP LVL210 C1882 275 "$52,375.00" " 19,357.80 " - " 60,264.75 " - " 36,191.13 " - " 36,191.13 " - " 28,937.19 " - " 34,567.50 " - - " 34,667.01 " - - " 48,211.80 " " 60,264.75 " - - - " 41,900.00 " - - " 35,091.25 " - " 21,421.38 " " 39,281.25 " " 19,907.74 " " 23,427.34 " - 30610130 AICD OTH THAN S/D IMP LVL211 C1882 275 "$52,625.00" " 19,450.20 " - " 60,264.75 " - " 36,363.88 " - " 36,363.88 " - " 29,075.31 " - " 34,732.50 " - - " 34,832.49 " - - " 48,211.80 " " 60,264.75 " - - - " 42,100.00 " - - " 35,258.75 " - " 21,523.63 " " 39,468.75 " " 20,002.76 " " 23,539.16 " - 30610148 AICD OTH THAN S/D IMP LVL212 C1882 275 "$52,875.00" " 19,542.60 " - " 60,264.75 " - " 36,536.63 " - " 36,536.63 " - " 29,213.44 " - " 34,897.50 " - - " 34,997.96 " - - " 48,211.80 " " 60,264.75 " - - - " 42,300.00 " - - " 35,426.25 " - " 21,625.88 " " 39,656.25 " " 20,097.79 " " 23,650.99 " - 30610156 AICD OTH THAN S/D IMP LVL213 C1882 275 "$53,125.00" " 19,635.00 " - " 60,264.75 " - " 36,709.38 " - " 36,709.38 " - " 29,351.56 " - " 35,062.50 " - - " 35,163.44 " - - " 48,211.80 " " 60,264.75 " - - - " 42,500.00 " - - " 35,593.75 " - " 21,728.13 " " 39,843.75 " " 20,192.81 " " 23,762.81 " - 30610164 AICD OTH THAN S/D IMP LVL219 C1882 275 "$54,625.00" " 20,189.40 " - " 60,264.75 " - " 37,745.88 " - " 37,745.88 " - " 30,180.31 " - " 36,052.50 " - - " 36,156.29 " - - " 48,211.80 " " 60,264.75 " - - - " 43,700.00 " - - " 36,598.75 " - " 22,341.63 " " 40,968.75 " " 20,762.96 " " 24,433.76 " - 30610172 AICD OTH THAN S/D IMP LVL228 C1882 275 "$56,875.00" " 21,021.00 " - " 60,264.75 " - " 39,300.63 " - " 39,300.63 " - " 31,423.44 " - " 37,537.50 " - - " 37,645.56 " - - " 48,211.80 " " 60,264.75 " - - - " 45,500.00 " - - " 38,106.25 " - " 23,261.88 " " 42,656.25 " " 21,618.19 " " 25,440.19 " - 30610181 AICD OTH THAN S/D IMP LVL229 C1882 275 "$57,125.00" " 21,113.40 " - " 60,264.75 " - " 39,473.38 " - " 39,473.38 " - " 31,561.56 " - " 37,702.50 " - - " 37,811.04 " - - " 48,211.80 " " 60,264.75 " - - - " 45,700.00 " - - " 38,273.75 " - " 23,364.13 " " 42,843.75 " " 21,713.21 " " 25,552.01 " - 30610199 AICD OTH THAN S/D IMP LVL230 C1882 275 "$57,375.00" " 21,205.80 " - " 60,264.75 " - " 39,646.13 " - " 39,646.13 " - " 31,699.69 " - " 37,867.50 " - - " 37,976.51 " - - " 48,211.80 " " 60,264.75 " - - - " 45,900.00 " - - " 38,441.25 " - " 23,466.38 " " 43,031.25 " " 21,808.24 " " 25,663.84 " - 30613309 AICD OTH THAN S/D IMP LVL231 C1882 275 "$57,625.00" " 21,298.20 " - " 60,264.75 " - " 39,818.88 " - " 39,818.88 " - " 31,837.81 " - " 38,032.50 " - - " 38,141.99 " - - " 48,211.80 " " 60,264.75 " - - - " 46,100.00 " - - " 38,608.75 " - " 23,568.63 " " 43,218.75 " " 21,903.26 " " 25,775.66 " - 30613317 AICD OTH THAN S/D IMP LVL232 C1882 275 "$57,875.00" " 21,390.60 " - " 60,264.75 " - " 39,991.63 " - " 39,991.63 " - " 31,975.94 " - " 38,197.50 " - - " 38,307.46 " - - " 48,211.80 " " 60,264.75 " - - - " 46,300.00 " - - " 38,776.25 " - " 23,670.88 " " 43,406.25 " " 21,998.29 " " 25,887.49 " - 30613325 AICD OTH THAN S/D IMP LVL233 C1882 275 "$58,125.00" " 21,483.00 " - " 60,264.75 " - " 40,164.38 " - " 40,164.38 " - " 32,114.06 " - " 38,362.50 " - - " 38,472.94 " - - " 48,211.80 " " 60,264.75 " - - - " 46,500.00 " - - " 38,943.75 " - " 23,773.13 " " 43,593.75 " " 22,093.31 " " 25,999.31 " - 30613333 AICD OTH THAN S/D IMP LVL234 C1882 275 "$58,375.00" " 21,575.40 " - " 60,264.75 " - " 40,337.13 " - " 40,337.13 " - " 32,252.19 " - " 38,527.50 " - - " 38,638.41 " - - " 48,211.80 " " 60,264.75 " - - - " 46,700.00 " - - " 39,111.25 " - " 23,875.38 " " 43,781.25 " " 22,188.34 " " 26,111.14 " - 30613341 AICD OTH THAN S/D IMP LVL235 C1882 275 "$58,625.00" " 21,667.80 " - " 60,264.75 " - " 40,509.88 " - " 40,509.88 " - " 32,390.31 " - " 38,692.50 " - - " 38,803.89 " - - " 48,211.80 " " 60,264.75 " - - - " 46,900.00 " - - " 39,278.75 " - " 23,977.63 " " 43,968.75 " " 22,283.36 " " 26,222.96 " - 30613350 AICD OTH THAN S/D IMP LVL236 C1882 275 "$58,875.00" " 21,760.20 " - " 60,264.75 " - " 40,682.63 " - " 40,682.63 " - " 32,528.44 " - " 38,857.50 " - - " 38,969.36 " - - " 48,211.80 " " 60,264.75 " - - - " 47,100.00 " - - " 39,446.25 " - " 24,079.88 " " 44,156.25 " " 22,378.39 " " 26,334.79 " - 30613368 AICD OTH THAN S/D IMP LVL237 C1882 275 "$59,125.00" " 21,852.60 " - " 60,264.75 " - " 40,855.38 " - " 40,855.38 " - " 32,666.56 " - " 39,022.50 " - - " 39,134.84 " - - " 48,211.80 " " 60,264.75 " - - - " 47,300.00 " - - " 39,613.75 " - " 24,182.13 " " 44,343.75 " " 22,473.41 " " 26,446.61 " - 30613376 AICD OTH THAN S/D IMP LVL238 C1882 275 "$59,375.00" " 21,945.00 " - " 60,264.75 " - " 41,028.13 " - " 41,028.13 " - " 32,804.69 " - " 39,187.50 " - - " 39,300.31 " - - " 48,211.80 " " 60,264.75 " - - - " 47,500.00 " - - " 39,781.25 " - " 24,284.38 " " 44,531.25 " " 22,568.44 " " 26,558.44 " - 30613384 AICD OTH THAN S/D IMP LVL239 C1882 275 "$59,625.00" " 22,037.40 " - " 60,264.75 " - " 41,200.88 " - " 41,200.88 " - " 32,942.81 " - " 39,352.50 " - - " 39,465.79 " - - " 48,211.80 " " 60,264.75 " - - - " 47,700.00 " - - " 39,948.75 " - " 24,386.63 " " 44,718.75 " " 22,663.46 " " 26,670.26 " - 28101091 ADAPT PACE NEURO LEAD LVL018 C1883 275 "$4,375.00" " 1,617.00 " - " 3,500.00 " - " 3,023.13 " - " 3,023.13 " - " 2,417.19 " - " 2,887.50 " - - " 2,895.81 " - - " 2,398.62 " " 2,998.27 " - - - " 3,500.00 " - - " 2,931.25 " - " 1,789.38 " " 3,281.25 " " 1,662.94 " " 1,956.94 " - 28142048 EMBOLIZ PROTECT SYS LVL002 C1884 278 $450.00 166.32 - " 6,318.55 " - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - " 5,054.84 " " 6,318.55 " - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 28142137 EMBOLIZ PROTECT SYS LVL011 C1884 278 "$2,625.00" 970.20 - " 6,318.55 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - " 5,054.84 " " 6,318.55 " - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 28142196 EMBOLIZ PROTECT SYS LVL017 C1884 278 "$4,125.00" " 1,524.60 " - " 6,318.55 " - " 2,850.38 " - " 2,850.38 " - " 2,279.06 " - " 2,722.50 " - - " 2,730.34 " - - " 5,054.84 " " 6,318.55 " - - - " 3,300.00 " - - " 2,763.75 " - " 1,687.13 " " 3,093.75 " " 1,567.91 " " 1,845.11 " - 29816255 EMBOLIZ PROTECT SYS LVL010 C1884 278 "$2,375.00" 877.80 - " 6,318.55 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - " 5,054.84 " " 6,318.55 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 29816263 EMBOLIZ PROTECT SYS LVL011 C1884 278 "$2,625.00" 970.20 - " 6,318.55 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - " 5,054.84 " " 6,318.55 " - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 29816271 EMBOLIZ PROTECT SYS LVL012 C1884 278 "$2,875.00" " 1,062.60 " - " 6,318.55 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - " 5,054.84 " " 6,318.55 " - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 29816280 EMBOLIZ PROTECT SYS LVL013 C1884 278 "$3,125.00" " 1,155.00 " - " 6,318.55 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - " 5,054.84 " " 6,318.55 " - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 29816298 EMBOLIZ PROTECT SYS LVL014 C1884 278 "$3,375.00" " 1,247.40 " - " 6,318.55 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - " 5,054.84 " " 6,318.55 " - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 29816301 EMBOLIZ PROTECT SYS LVL015 C1884 278 "$3,625.00" " 1,339.80 " - " 6,318.55 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - " 5,054.84 " " 6,318.55 " - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 29817073 EMBOLIZ PROTECT SYS LVL016 C1884 278 "$3,875.00" " 1,432.20 " - " 6,318.55 " - " 2,677.63 " - " 2,677.63 " - " 2,140.94 " - " 2,557.50 " - - " 2,564.86 " - - " 5,054.84 " " 6,318.55 " - - - " 3,100.00 " - - " 2,596.25 " - " 1,584.88 " " 2,906.25 " " 1,472.89 " " 1,733.29 " - 29817081 EMBOLIZ PROTECT SYS LVL017 C1884 278 "$4,125.00" " 1,524.60 " - " 6,318.55 " - " 2,850.38 " - " 2,850.38 " - " 2,279.06 " - " 2,722.50 " - - " 2,730.34 " - - " 5,054.84 " " 6,318.55 " - - - " 3,300.00 " - - " 2,763.75 " - " 1,687.13 " " 3,093.75 " " 1,567.91 " " 1,845.11 " - 29817090 EMBOLIZ PROTECT SYS LVL018 C1884 278 "$4,375.00" " 1,617.00 " - " 6,318.55 " - " 3,023.13 " - " 3,023.13 " - " 2,417.19 " - " 2,887.50 " - - " 2,895.81 " - - " 5,054.84 " " 6,318.55 " - - - " 3,500.00 " - - " 2,931.25 " - " 1,789.38 " " 3,281.25 " " 1,662.94 " " 1,956.94 " - 29817103 EMBOLIZ PROTECT SYS LVL019 C1884 278 "$4,625.00" " 1,709.40 " - " 6,318.55 " - " 3,195.88 " - " 3,195.88 " - " 2,555.31 " - " 3,052.50 " - - " 3,061.29 " - - " 5,054.84 " " 6,318.55 " - - - " 3,700.00 " - - " 3,098.75 " - " 1,891.63 " " 3,468.75 " " 1,757.96 " " 2,068.76 " - 29817111 EMBOLIZ PROTECT SYS LVL020 C1884 278 "$4,875.00" " 1,801.80 " - " 6,318.55 " - " 3,368.63 " - " 3,368.63 " - " 2,693.44 " - " 3,217.50 " - - " 3,226.76 " - - " 5,054.84 " " 6,318.55 " - - - " 3,900.00 " - - " 3,266.25 " - " 1,993.88 " " 3,656.25 " " 1,852.99 " " 2,180.59 " - 29818193 EMBOLIZ PROTECT SYS LVL001 C1884 278 $200.00 73.92 - " 6,318.55 " - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - " 5,054.84 " " 6,318.55 " - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 29818207 EMBOLIZ PROTECT SYS LVL002 C1884 278 $450.00 166.32 - " 6,318.55 " - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - " 5,054.84 " " 6,318.55 " - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 29818215 EMBOLIZ PROTECT SYS LVL003 C1884 278 $750.00 277.20 - " 6,318.55 " - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - " 5,054.84 " " 6,318.55 " - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 29818223 EMBOLIZ PROTECT SYS LVL004 C1884 278 "$1,050.00" 388.08 - " 6,318.55 " - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - " 5,054.84 " " 6,318.55 " - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 29818231 EMBOLIZ PROTECT SYS LVL005 C1884 278 "$1,350.00" 498.96 - " 6,318.55 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - " 5,054.84 " " 6,318.55 " - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 29818240 EMBOLIZ PROTECT SYS LVL006 C1884 278 "$1,375.00" 508.20 - " 6,318.55 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - " 5,054.84 " " 6,318.55 " - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 29818258 EMBOLIZ PROTECT SYS LVL007 C1884 278 "$1,625.00" 600.60 - " 6,318.55 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - " 5,054.84 " " 6,318.55 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 29818266 EMBOLIZ PROTECT SYS LVL008 C1884 278 "$1,875.00" 693.00 - " 6,318.55 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - " 5,054.84 " " 6,318.55 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 29818274 EMBOLIZ PROTECT SYS LVL009 C1884 278 "$2,125.00" 785.40 - " 6,318.55 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - " 5,054.84 " " 6,318.55 " - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 29818843 G140249 NANOPARASOL EMBOL SYS C1884 624 "$3,757.00" " 1,388.59 " - " 6,318.55 " - " 2,596.09 " - " 2,596.09 " - " 2,075.74 " - " 2,479.62 " - - " 2,486.76 " - - " 5,054.84 " " 6,318.55 " - - - " 3,005.60 " - - " 2,517.19 " - " 1,536.61 " " 2,817.75 " " 1,428.04 " " 1,680.51 " - 29818878 G010262 EMBOSHLD EMB PROT SYS C1884 624 "$5,561.00" " 2,055.35 " - " 6,318.55 " - " 3,842.65 " - " 3,842.65 " - " 3,072.45 " - " 3,670.26 " - - " 3,680.83 " - - " 5,054.84 " " 6,318.55 " - - - " 4,448.80 " - - " 3,725.87 " - " 2,274.45 " " 4,170.75 " " 2,113.74 " " 2,487.44 " - 80362471 EMBOLIZ PROTECT SYS LVL008 C1884 278 "$1,875.00" 693.00 - " 6,318.55 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - " 5,054.84 " " 6,318.55 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 80362480 EMBOLIZ PROTECT SYS LVL009 C1884 278 "$2,125.00" 785.40 - " 6,318.55 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - " 5,054.84 " " 6,318.55 " - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 80362498 EMBOLIZ PROTECT SYS LVL010 C1884 278 "$2,375.00" 877.80 - " 6,318.55 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - " 5,054.84 " " 6,318.55 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 80362501 EMBOLIZ PROTECT SYS LVL011 C1884 278 "$2,625.00" 970.20 - " 6,318.55 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - " 5,054.84 " " 6,318.55 " - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 80362510 EMBOLIZ PROTECT SYS LVL012 C1884 278 "$2,875.00" " 1,062.60 " - " 6,318.55 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - " 5,054.84 " " 6,318.55 " - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 80362528 EMBOLIZ PROTECT SYS LVL013 C1884 278 "$3,125.00" " 1,155.00 " - " 6,318.55 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - " 5,054.84 " " 6,318.55 " - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 80362536 EMBOLIZ PROTECT SYS LVL014 C1884 278 "$3,375.00" " 1,247.40 " - " 6,318.55 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - " 5,054.84 " " 6,318.55 " - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 80362544 EMBOLIZ PROTECT SYS LVL015 C1884 278 "$3,625.00" " 1,339.80 " - " 6,318.55 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - " 5,054.84 " " 6,318.55 " - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 80362552 EMBOLIZ PROTECT SYS LVL016 C1884 278 "$3,875.00" " 1,432.20 " - " 6,318.55 " - " 2,677.63 " - " 2,677.63 " - " 2,140.94 " - " 2,557.50 " - - " 2,564.86 " - - " 5,054.84 " " 6,318.55 " - - - " 3,100.00 " - - " 2,596.25 " - " 1,584.88 " " 2,906.25 " " 1,472.89 " " 1,733.29 " - 80362561 EMBOLIZ PROTECT SYS LVL017 C1884 278 "$4,125.00" " 1,524.60 " - " 6,318.55 " - " 2,850.38 " - " 2,850.38 " - " 2,279.06 " - " 2,722.50 " - - " 2,730.34 " - - " 5,054.84 " " 6,318.55 " - - - " 3,300.00 " - - " 2,763.75 " - " 1,687.13 " " 3,093.75 " " 1,567.91 " " 1,845.11 " - 80362579 EMBOLIZ PROTECT SYS LVL018 C1884 278 "$4,375.00" " 1,617.00 " - " 6,318.55 " - " 3,023.13 " - " 3,023.13 " - " 2,417.19 " - " 2,887.50 " - - " 2,895.81 " - - " 5,054.84 " " 6,318.55 " - - - " 3,500.00 " - - " 2,931.25 " - " 1,789.38 " " 3,281.25 " " 1,662.94 " " 1,956.94 " - 80362587 EMBOLIZ PROTECT SYS LVL019 C1884 278 "$4,625.00" " 1,709.40 " - " 6,318.55 " - " 3,195.88 " - " 3,195.88 " - " 2,555.31 " - " 3,052.50 " - - " 3,061.29 " - - " 5,054.84 " " 6,318.55 " - - - " 3,700.00 " - - " 3,098.75 " - " 1,891.63 " " 3,468.75 " " 1,757.96 " " 2,068.76 " - 80362595 EMBOLIZ PROTECT SYS LVL020 C1884 278 "$4,875.00" " 1,801.80 " - " 6,318.55 " - " 3,368.63 " - " 3,368.63 " - " 2,693.44 " - " 3,217.50 " - - " 3,226.76 " - - " 5,054.84 " " 6,318.55 " - - - " 3,900.00 " - - " 3,266.25 " - " 1,993.88 " " 3,656.25 " " 1,852.99 " " 2,180.59 " - 80362609 EMBOLIZ PROTECT SYS LVL021 C1884 278 "$5,125.00" " 1,894.20 " - " 6,318.55 " - " 3,541.38 " - " 3,541.38 " - " 2,831.56 " - " 3,382.50 " - - " 3,392.24 " - - " 5,054.84 " " 6,318.55 " - - - " 4,100.00 " - - " 3,433.75 " - " 2,096.13 " " 3,843.75 " " 1,948.01 " " 2,292.41 " - 28142498 CATH TRANS ANGIO LASER LVL022 C1885 278 "$5,375.00" " 1,986.60 " - " 5,767.67 " - " 3,714.13 " - " 3,714.13 " - " 2,969.69 " - " 3,547.50 " - - " 3,557.71 " - - " 4,614.14 " " 5,767.67 " - - - " 4,300.00 " - - " 3,601.25 " - " 2,198.38 " " 4,031.25 " " 2,043.04 " " 2,404.24 " - 28142510 CATH TRANS ANGIO LASER LVL024 C1885 278 "$5,875.00" " 2,171.40 " - " 5,767.67 " - " 4,059.63 " - " 4,059.63 " - " 3,245.94 " - " 3,877.50 " - - " 3,888.66 " - - " 4,614.14 " " 5,767.67 " - - - " 4,700.00 " - - " 3,936.25 " - " 2,402.88 " " 4,406.25 " " 2,233.09 " " 2,627.89 " - 28142528 CATH TRANS ANGIO LASER LVL025 C1885 278 "$6,125.00" " 2,263.80 " - " 5,767.67 " - " 4,232.38 " - " 4,232.38 " - " 3,384.06 " - " 4,042.50 " - - " 4,054.14 " - - " 4,614.14 " " 5,767.67 " - - - " 4,900.00 " - - " 4,103.75 " - " 2,505.13 " " 4,593.75 " " 2,328.11 " " 2,739.71 " - 28142536 CATH TRANS ANGIO LASER LVL026 C1885 278 "$6,375.00" " 2,356.20 " - " 5,767.67 " - " 4,405.13 " - " 4,405.13 " - " 3,522.19 " - " 4,207.50 " - - " 4,219.61 " - - " 4,614.14 " " 5,767.67 " - - - " 5,100.00 " - - " 4,271.25 " - " 2,607.38 " " 4,781.25 " " 2,423.14 " " 2,851.54 " - 28142587 CATH TRANS ANGIO LASER LVL031 C1885 278 "$7,625.00" " 2,818.20 " - " 6,100.00 " - " 5,268.88 " - " 5,268.88 " - " 4,212.81 " - " 5,032.50 " - - " 5,046.99 " - - " 4,614.14 " " 5,767.67 " - - - " 6,100.00 " - - " 5,108.75 " - " 3,118.63 " " 5,718.75 " " 2,898.26 " " 3,410.66 " - 29817120 CATH TRANS ANGIO LASER LVL020 C1885 278 "$4,875.00" " 1,801.80 " - " 5,767.67 " - " 3,368.63 " - " 3,368.63 " - " 2,693.44 " - " 3,217.50 " - - " 3,226.76 " - - " 4,614.14 " " 5,767.67 " - - - " 3,900.00 " - - " 3,266.25 " - " 1,993.88 " " 3,656.25 " " 1,852.99 " " 2,180.59 " - 29817138 CATH TRANS ANGIO LASER LVL021 C1885 278 "$5,125.00" " 1,894.20 " - " 5,767.67 " - " 3,541.38 " - " 3,541.38 " - " 2,831.56 " - " 3,382.50 " - - " 3,392.24 " - - " 4,614.14 " " 5,767.67 " - - - " 4,100.00 " - - " 3,433.75 " - " 2,096.13 " " 3,843.75 " " 1,948.01 " " 2,292.41 " - 29817146 CATH TRANS ANGIO LASER LVL022 C1885 278 "$5,375.00" " 1,986.60 " - " 5,767.67 " - " 3,714.13 " - " 3,714.13 " - " 2,969.69 " - " 3,547.50 " - - " 3,557.71 " - - " 4,614.14 " " 5,767.67 " - - - " 4,300.00 " - - " 3,601.25 " - " 2,198.38 " " 4,031.25 " " 2,043.04 " " 2,404.24 " - 29817154 CATH TRANS ANGIO LASER LVL023 C1885 278 "$5,625.00" " 2,079.00 " - " 5,767.67 " - " 3,886.88 " - " 3,886.88 " - " 3,107.81 " - " 3,712.50 " - - " 3,723.19 " - - " 4,614.14 " " 5,767.67 " - - - " 4,500.00 " - - " 3,768.75 " - " 2,300.63 " " 4,218.75 " " 2,138.06 " " 2,516.06 " - 29817162 CATH TRANS ANGIO LASER LVL024 C1885 278 "$5,875.00" " 2,171.40 " - " 5,767.67 " - " 4,059.63 " - " 4,059.63 " - " 3,245.94 " - " 3,877.50 " - - " 3,888.66 " - - " 4,614.14 " " 5,767.67 " - - - " 4,700.00 " - - " 3,936.25 " - " 2,402.88 " " 4,406.25 " " 2,233.09 " " 2,627.89 " - 29817171 CATH TRANS ANGIO LASER LVL025 C1885 278 "$6,125.00" " 2,263.80 " - " 5,767.67 " - " 4,232.38 " - " 4,232.38 " - " 3,384.06 " - " 4,042.50 " - - " 4,054.14 " - - " 4,614.14 " " 5,767.67 " - - - " 4,900.00 " - - " 4,103.75 " - " 2,505.13 " " 4,593.75 " " 2,328.11 " " 2,739.71 " - 29817189 CATH TRANS ANGIO LASER LVL026 C1885 278 "$6,375.00" " 2,356.20 " - " 5,767.67 " - " 4,405.13 " - " 4,405.13 " - " 3,522.19 " - " 4,207.50 " - - " 4,219.61 " - - " 4,614.14 " " 5,767.67 " - - - " 5,100.00 " - - " 4,271.25 " - " 2,607.38 " " 4,781.25 " " 2,423.14 " " 2,851.54 " - 29817197 CATH TRANS ANGIO LASER LVL027 C1885 278 "$6,625.00" " 2,448.60 " - " 5,767.67 " - " 4,577.88 " - " 4,577.88 " - " 3,660.31 " - " 4,372.50 " - - " 4,385.09 " - - " 4,614.14 " " 5,767.67 " - - - " 5,300.00 " - - " 4,438.75 " - " 2,709.63 " " 4,968.75 " " 2,518.16 " " 2,963.36 " - 29818584 CATH TRANS ANGIO LASER LVL028 C1885 278 "$6,875.00" " 2,541.00 " - " 5,767.67 " - " 4,750.63 " - " 4,750.63 " - " 3,798.44 " - " 4,537.50 " - - " 4,550.56 " - - " 4,614.14 " " 5,767.67 " - - - " 5,500.00 " - - " 4,606.25 " - " 2,811.88 " " 5,156.25 " " 2,613.19 " " 3,075.19 " - 29818592 CATH TRANS ANGIO LASER LVL029 C1885 278 "$7,125.00" " 2,633.40 " - " 5,767.67 " - " 4,923.38 " - " 4,923.38 " - " 3,936.56 " - " 4,702.50 " - - " 4,716.04 " - - " 4,614.14 " " 5,767.67 " - - - " 5,700.00 " - - " 4,773.75 " - " 2,914.13 " " 5,343.75 " " 2,708.21 " " 3,187.01 " - 29818606 CATH TRANS ANGIO LASER LVL030 C1885 278 "$7,375.00" " 2,725.80 " - " 5,900.00 " - " 5,096.13 " - " 5,096.13 " - " 4,074.69 " - " 4,867.50 " - - " 4,881.51 " - - " 4,614.14 " " 5,767.67 " - - - " 5,900.00 " - - " 4,941.25 " - " 3,016.38 " " 5,531.25 " " 2,803.24 " " 3,298.84 " - 29818614 CATH TRANS ANGIO LASER LVL031 C1885 278 "$7,625.00" " 2,818.20 " - " 6,100.00 " - " 5,268.88 " - " 5,268.88 " - " 4,212.81 " - " 5,032.50 " - - " 5,046.99 " - - " 4,614.14 " " 5,767.67 " - - - " 6,100.00 " - - " 5,108.75 " - " 3,118.63 " " 5,718.75 " " 2,898.26 " " 3,410.66 " - 29818622 CATH TRANS ANGIO LASER LVL032 C1885 278 "$7,875.00" " 2,910.60 " - " 6,300.00 " - " 5,441.63 " - " 5,441.63 " - " 4,350.94 " - " 5,197.50 " - - " 5,212.46 " - - " 4,614.14 " " 5,767.67 " - - - " 6,300.00 " - - " 5,276.25 " - " 3,220.88 " " 5,906.25 " " 2,993.29 " " 3,522.49 " - 29818631 CATH TRANS ANGIO LASER LVL033 C1885 278 "$8,125.00" " 3,003.00 " - " 6,500.00 " - " 5,614.38 " - " 5,614.38 " - " 4,489.06 " - " 5,362.50 " - - " 5,377.94 " - - " 4,614.14 " " 5,767.67 " - - - " 6,500.00 " - - " 5,443.75 " - " 3,323.13 " " 6,093.75 " " 3,088.31 " " 3,634.31 " - 29818649 CATH TRANS ANGIO LASER LVL034 C1885 278 "$8,375.00" " 3,095.40 " - " 6,700.00 " - " 5,787.13 " - " 5,787.13 " - " 4,627.19 " - " 5,527.50 " - - " 5,543.41 " - - " 4,614.14 " " 5,767.67 " - - - " 6,700.00 " - - " 5,611.25 " - " 3,425.38 " " 6,281.25 " " 3,183.34 " " 3,746.14 " - 29818657 CATH TRANS ANGIO LASER LVL035 C1885 278 "$8,625.00" " 3,187.80 " - " 6,900.00 " - " 5,959.88 " - " 5,959.88 " - " 4,765.31 " - " 5,692.50 " - - " 5,708.89 " - - " 4,614.14 " " 5,767.67 " - - - " 6,900.00 " - - " 5,778.75 " - " 3,527.63 " " 6,468.75 " " 3,278.36 " " 3,857.96 " - 29820813 CATH TRANS ANGIO LASER LVL015 C1885 278 "$3,625.00" " 1,339.80 " - " 5,767.67 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - " 4,614.14 " " 5,767.67 " - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 29820821 CATH TRANS ANGIO LASER LVL016 C1885 278 "$3,875.00" " 1,432.20 " - " 5,767.67 " - " 2,677.63 " - " 2,677.63 " - " 2,140.94 " - " 2,557.50 " - - " 2,564.86 " - - " 4,614.14 " " 5,767.67 " - - - " 3,100.00 " - - " 2,596.25 " - " 1,584.88 " " 2,906.25 " " 1,472.89 " " 1,733.29 " - 29820830 CATH TRANS ANGIO LASER LVL017 C1885 278 "$4,125.00" " 1,524.60 " - " 5,767.67 " - " 2,850.38 " - " 2,850.38 " - " 2,279.06 " - " 2,722.50 " - - " 2,730.34 " - - " 4,614.14 " " 5,767.67 " - - - " 3,300.00 " - - " 2,763.75 " - " 1,687.13 " " 3,093.75 " " 1,567.91 " " 1,845.11 " - 29820848 CATH TRANS ANGIO LASER LVL018 C1885 278 "$4,375.00" " 1,617.00 " - " 5,767.67 " - " 3,023.13 " - " 3,023.13 " - " 2,417.19 " - " 2,887.50 " - - " 2,895.81 " - - " 4,614.14 " " 5,767.67 " - - - " 3,500.00 " - - " 2,931.25 " - " 1,789.38 " " 3,281.25 " " 1,662.94 " " 1,956.94 " - 29820856 CATH TRANS ANGIO LASER LVL019 C1885 278 "$4,625.00" " 1,709.40 " - " 5,767.67 " - " 3,195.88 " - " 3,195.88 " - " 2,555.31 " - " 3,052.50 " - - " 3,061.29 " - - " 4,614.14 " " 5,767.67 " - - - " 3,700.00 " - - " 3,098.75 " - " 1,891.63 " " 3,468.75 " " 1,757.96 " " 2,068.76 " - 30611641 CATH TRANS ANGIO LASER LVL027 C1885 278 "$6,625.00" " 2,448.60 " - " 5,767.67 " - " 4,577.88 " - " 4,577.88 " - " 3,660.31 " - " 4,372.50 " - - " 4,385.09 " - - " 4,614.14 " " 5,767.67 " - - - " 5,300.00 " - - " 4,438.75 " - " 2,709.63 " " 4,968.75 " " 2,518.16 " " 2,963.36 " - 30611659 CATH TRANS ANGIO LASER LVL028 C1885 278 "$6,875.00" " 2,541.00 " - " 5,767.67 " - " 4,750.63 " - " 4,750.63 " - " 3,798.44 " - " 4,537.50 " - - " 4,550.56 " - - " 4,614.14 " " 5,767.67 " - - - " 5,500.00 " - - " 4,606.25 " - " 2,811.88 " " 5,156.25 " " 2,613.19 " " 3,075.19 " - 30611667 CATH TRANS ANGIO LASER LVL029 C1885 278 "$7,125.00" " 2,633.40 " - " 5,767.67 " - " 4,923.38 " - " 4,923.38 " - " 3,936.56 " - " 4,702.50 " - - " 4,716.04 " - - " 4,614.14 " " 5,767.67 " - - - " 5,700.00 " - - " 4,773.75 " - " 2,914.13 " " 5,343.75 " " 2,708.21 " " 3,187.01 " - 80365276 CATH ABLATION LVL044 C1886 278 "$10,875.00" " 4,019.40 " - " 8,700.00 " - " 7,514.63 " - " 7,514.63 " - " 6,008.44 " - " 7,177.50 " - - " 7,198.16 " - - " 5,762.66 " " 7,203.60 " - - - " 8,700.00 " - - " 7,286.25 " - " 4,447.88 " " 8,156.25 " " 4,133.59 " " 4,864.39 " - 80365284 CATH ABLATION LVL045 C1886 278 "$11,125.00" " 4,111.80 " - " 8,900.00 " - " 7,687.38 " - " 7,687.38 " - " 6,146.56 " - " 7,342.50 " - - " 7,363.64 " - - " 5,895.14 " " 7,369.20 " - - - " 8,900.00 " - - " 7,453.75 " - " 4,550.13 " " 8,343.75 " " 4,228.61 " " 4,976.21 " - 80365292 CATH ABLATION LVL046 C1886 278 "$11,375.00" " 4,204.20 " - " 9,100.00 " - " 7,860.13 " - " 7,860.13 " - " 6,284.69 " - " 7,507.50 " - - " 7,529.11 " - - " 6,027.61 " " 7,534.80 " - - - " 9,100.00 " - - " 7,621.25 " - " 4,652.38 " " 8,531.25 " " 4,323.64 " " 5,088.04 " - 80365306 CATH ABLATION LVL047 C1886 278 "$11,625.00" " 4,296.60 " - " 9,300.00 " - " 8,032.88 " - " 8,032.88 " - " 6,422.81 " - " 7,672.50 " - - " 7,694.59 " - - " 6,160.09 " " 7,700.40 " - - - " 9,300.00 " - - " 7,788.75 " - " 4,754.63 " " 8,718.75 " " 4,418.66 " " 5,199.86 " - 80365314 CATH ABLATION LVL048 C1886 278 "$11,875.00" " 4,389.00 " - " 9,500.00 " - " 8,205.63 " - " 8,205.63 " - " 6,560.94 " - " 7,837.50 " - - " 7,860.06 " - - " 6,292.56 " " 7,866.00 " - - - " 9,500.00 " - - " 7,956.25 " - " 4,856.88 " " 8,906.25 " " 4,513.69 " " 5,311.69 " - 80365322 CATH ABLATION LVL049 C1886 278 "$12,125.00" " 4,481.40 " - " 9,700.00 " - " 8,378.38 " - " 8,378.38 " - " 6,699.06 " - " 8,002.50 " - - " 8,025.54 " - - " 6,425.04 " " 8,031.60 " - - - " 9,700.00 " - - " 8,123.75 " - " 4,959.13 " " 9,093.75 " " 4,608.71 " " 5,423.51 " - 80365331 CATH ABLATION LVL050 C1886 278 "$12,375.00" " 4,573.80 " - " 9,900.00 " - " 8,551.13 " - " 8,551.13 " - " 6,837.19 " - " 8,167.50 " - - " 8,191.01 " - - " 6,557.51 " " 8,197.20 " - - - " 9,900.00 " - - " 8,291.25 " - " 5,061.38 " " 9,281.25 " " 4,703.74 " " 5,535.34 " - 80365349 CATH ABLATION LVL051 C1886 278 "$12,625.00" " 4,666.20 " - " 10,100.00 " - " 8,723.88 " - " 8,723.88 " - " 6,975.31 " - " 8,332.50 " - - " 8,356.49 " - - " 6,689.99 " " 8,362.80 " - - - " 10,100.00 " - - " 8,458.75 " - " 5,163.63 " " 9,468.75 " " 4,798.76 " " 5,647.16 " - 80365357 CATH ABLATION LVL052 C1886 278 "$12,875.00" " 4,758.60 " - " 10,300.00 " - " 8,896.63 " - " 8,896.63 " - " 7,113.44 " - " 8,497.50 " - - " 8,521.96 " - - " 6,822.46 " " 8,528.40 " - - - " 10,300.00 " - - " 8,626.25 " - " 5,265.88 " " 9,656.25 " " 4,893.79 " " 5,758.99 " - 80365365 CATH ABLATION LVL053 C1886 278 "$13,125.00" " 4,851.00 " - " 10,500.00 " - " 9,069.38 " - " 9,069.38 " - " 7,251.56 " - " 8,662.50 " - - " 8,687.44 " - - " 6,954.94 " " 8,694.00 " - - - " 10,500.00 " - - " 8,793.75 " - " 5,368.13 " " 9,843.75 " " 4,988.81 " " 5,870.81 " - 80365373 CATH ABLATION LVL054 C1886 278 "$13,375.00" " 4,943.40 " - " 10,700.00 " - " 9,242.13 " - " 9,242.13 " - " 7,389.69 " - " 8,827.50 " - - " 8,852.91 " - - " 7,087.41 " " 8,859.60 " - - - " 10,700.00 " - - " 8,961.25 " - " 5,470.38 " " 10,031.25 " " 5,083.84 " " 5,982.64 " - 80365381 CATH ABLATION LVL055 C1886 278 "$13,625.00" " 5,035.80 " - " 10,900.00 " - " 9,414.88 " - " 9,414.88 " - " 7,527.81 " - " 8,992.50 " - - " 9,018.39 " - - " 7,219.89 " " 9,025.20 " - - - " 10,900.00 " - - " 9,128.75 " - " 5,572.63 " " 10,218.75 " " 5,178.86 " " 6,094.46 " - 80365594 CATH ABLATION LVL040 C1886 278 "$9,875.00" " 3,649.80 " - " 7,900.00 " - " 6,823.63 " - " 6,823.63 " - " 5,455.94 " - " 6,517.50 " - - " 6,536.26 " - - " 5,232.76 " " 6,541.20 " - - - " 7,900.00 " - - " 6,616.25 " - " 4,038.88 " " 7,406.25 " " 3,753.49 " " 4,417.09 " - 80365608 CATH ABLATION LVL041 C1886 278 "$10,125.00" " 3,742.20 " - " 8,100.00 " - " 6,996.38 " - " 6,996.38 " - " 5,594.06 " - " 6,682.50 " - - " 6,701.74 " - - " 5,365.24 " " 6,706.80 " - - - " 8,100.00 " - - " 6,783.75 " - " 4,141.13 " " 7,593.75 " " 3,848.51 " " 4,528.91 " - 80365616 CATH ABLATION LVL042 C1886 278 "$10,375.00" " 3,834.60 " - " 8,300.00 " - " 7,169.13 " - " 7,169.13 " - " 5,732.19 " - " 6,847.50 " - - " 6,867.21 " - - " 5,497.71 " " 6,872.40 " - - - " 8,300.00 " - - " 6,951.25 " - " 4,243.38 " " 7,781.25 " " 3,943.54 " " 4,640.74 " - 80365624 CATH ABLATION LVL043 C1886 278 "$10,625.00" " 3,927.00 " - " 8,500.00 " - " 7,341.88 " - " 7,341.88 " - " 5,870.31 " - " 7,012.50 " - - " 7,032.69 " - - " 5,630.19 " " 7,038.00 " - - - " 8,500.00 " - - " 7,118.75 " - " 4,345.63 " " 7,968.75 " " 4,038.56 " " 4,752.56 " - 80365764 CATH ABLATION LVL005 C1886 278 "$1,350.00" 498.96 - " 1,080.00 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 715.37 894.24 - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 80365772 CATH ABLATION LVL006 C1886 278 "$1,375.00" 508.20 - " 1,100.00 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - 728.61 910.80 - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 80365781 CATH ABLATION LVL007 C1886 278 "$1,625.00" 600.60 - " 1,300.00 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - 861.09 " 1,076.40 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 80365799 CATH ABLATION LVL008 C1886 278 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - 993.56 " 1,242.00 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 80365802 CATH ABLATION LVL009 C1886 278 "$2,125.00" 785.40 - " 1,700.00 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - " 1,126.04 " " 1,407.60 " - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 80365811 CATH ABLATION LVL010 C1886 278 "$2,375.00" 877.80 - " 1,900.00 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - " 1,258.51 " " 1,573.20 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 28103557 CATH GUIDING LVL001 C1887 278 $200.00 73.92 - 289.43 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 231.54 289.43 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 28103565 CATH GUIDING LVL002 C1887 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 231.54 289.43 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 28103581 CATH GUIDING LVL004 C1887 278 "$1,050.00" 388.08 - 840.00 - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 231.54 289.43 - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 28103620 CATH GUIDING LVL008 C1887 278 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - 231.54 289.43 - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 29816310 CATH GUIDING LVL001 C1887 278 $200.00 73.92 - 289.43 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 231.54 289.43 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 29816328 CATH GUIDING LVL002 C1887 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 231.54 289.43 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 29816336 CATH GUIDING LVL003 C1887 278 $750.00 277.20 - 600.00 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 231.54 289.43 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 29816344 CATH GUIDING LVL004 C1887 278 "$1,050.00" 388.08 - 840.00 - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 231.54 289.43 - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 29816352 CATH GUIDING LVL005 C1887 278 "$1,350.00" 498.96 - " 1,080.00 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 231.54 289.43 - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 29816361 CATH GUIDING LVL006 C1887 278 "$1,375.00" 508.20 - " 1,100.00 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - 231.54 289.43 - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 29816379 CATH GUIDING LVL007 C1887 278 "$1,625.00" 600.60 - " 1,300.00 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - 231.54 289.43 - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 29816387 CATH GUIDING LVL010 C1887 278 "$2,375.00" 877.80 - " 1,900.00 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - 231.54 289.43 - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 29816395 CATH GUIDING LVL008 C1887 278 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - 231.54 289.43 - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 29817201 CATH GUIDING LVL009 C1887 278 "$2,125.00" 785.40 - " 1,700.00 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - 231.54 289.43 - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 30605730 CATH GUIDING LVL001 C1887 278 $200.00 73.92 - 289.43 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 231.54 289.43 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 30605748 CATH GUIDING LVL002 C1887 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 231.54 289.43 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 30605756 CATH GUIDING LVL003 C1887 278 $750.00 277.20 - 600.00 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 231.54 289.43 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 30605764 CATH GUIDING LVL004 C1887 278 "$1,050.00" 388.08 - 840.00 - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 231.54 289.43 - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 30605772 CATH GUIDING LVL005 C1887 278 "$1,350.00" 498.96 - " 1,080.00 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 231.54 289.43 - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 30605781 CATH GUIDING LVL006 C1887 278 "$1,375.00" 508.20 - " 1,100.00 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - 231.54 289.43 - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 30610211 CATH GUIDING LVL007 C1887 278 "$1,625.00" 600.60 - " 1,300.00 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - 231.54 289.43 - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 30610229 CATH GUIDING LVL008 C1887 278 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - 231.54 289.43 - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 30610237 CATH GUIDING LVL009 C1887 278 "$2,125.00" 785.40 - " 1,700.00 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - 231.54 289.43 - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 30610245 CATH GUIDING LVL010 C1887 278 "$2,375.00" 877.80 - " 1,900.00 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - 231.54 289.43 - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 80360568 CATH GUIDING LVL001 C1887 278 $200.00 73.92 - 289.43 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 231.54 289.43 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 80360576 CATH GUIDING LVL002 C1887 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 231.54 289.43 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 80360584 CATH GUIDING LVL003 C1887 278 $750.00 277.20 - 600.00 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 231.54 289.43 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 80360592 CATH GUIDING LVL004 C1887 278 "$1,050.00" 388.08 - 840.00 - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 231.54 289.43 - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 80360606 CATH GUIDING LVL005 C1887 278 "$1,350.00" 498.96 - " 1,080.00 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 231.54 289.43 - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 80360614 CATH GUIDING LVL006 C1887 278 "$1,375.00" 508.20 - " 1,100.00 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - 231.54 289.43 - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 80360622 CATH GUIDING LVL007 C1887 278 "$1,625.00" 600.60 - " 1,300.00 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - 231.54 289.43 - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 80360631 CATH GUIDING LVL008 C1887 278 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - 231.54 289.43 - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 80360649 CATH GUIDING LVL009 C1887 278 "$2,125.00" 785.40 - " 1,700.00 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - 231.54 289.43 - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 80360657 CATH GUIDING LVL010 C1887 278 "$2,375.00" 877.80 - " 1,900.00 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - 231.54 289.43 - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 80360665 CATH GUIDING LVL011 C1887 278 "$2,625.00" 970.20 - " 2,100.00 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - 231.54 289.43 - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 80360673 CATH GUIDING LVL012 C1887 278 "$2,875.00" " 1,062.60 " - " 2,300.00 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - 231.54 289.43 - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 80360681 CATH GUIDING LVL013 C1887 278 "$3,125.00" " 1,155.00 " - " 2,500.00 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - 231.54 289.43 - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 80360690 CATH GUIDING LVL014 C1887 278 "$3,375.00" " 1,247.40 " - " 2,700.00 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - 231.54 289.43 - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 80360703 CATH GUIDING LVL015 C1887 278 "$3,625.00" " 1,339.80 " - " 2,900.00 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - 231.54 289.43 - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 80360711 CATH GUIDING LVL016 C1887 278 "$3,875.00" " 1,432.20 " - " 3,100.00 " - " 2,677.63 " - " 2,677.63 " - " 2,140.94 " - " 2,557.50 " - - " 2,564.86 " - - 231.54 289.43 - - - " 3,100.00 " - - " 2,596.25 " - " 1,584.88 " " 2,906.25 " " 1,472.89 " " 1,733.29 " - 80360720 CATH GUIDING LVL017 C1887 278 "$4,125.00" " 1,524.60 " - " 3,300.00 " - " 2,850.38 " - " 2,850.38 " - " 2,279.06 " - " 2,722.50 " - - " 2,730.34 " - - 231.54 289.43 - - - " 3,300.00 " - - " 2,763.75 " - " 1,687.13 " " 3,093.75 " " 1,567.91 " " 1,845.11 " - 80360738 CATH GUIDING LVL018 C1887 278 "$4,375.00" " 1,617.00 " - " 3,500.00 " - " 3,023.13 " - " 3,023.13 " - " 2,417.19 " - " 2,887.50 " - - " 2,895.81 " - - 231.54 289.43 - - - " 3,500.00 " - - " 2,931.25 " - " 1,789.38 " " 3,281.25 " " 1,662.94 " " 1,956.94 " - 80360746 CATH GUIDING LVL019 C1887 278 "$4,625.00" " 1,709.40 " - " 3,700.00 " - " 3,195.88 " - " 3,195.88 " - " 2,555.31 " - " 3,052.50 " - - " 3,061.29 " - - 231.54 289.43 - - - " 3,700.00 " - - " 3,098.75 " - " 1,891.63 " " 3,468.75 " " 1,757.96 " " 2,068.76 " - 80360754 CATH GUIDING LVL020 C1887 278 "$4,875.00" " 1,801.80 " - " 3,900.00 " - " 3,368.63 " - " 3,368.63 " - " 2,693.44 " - " 3,217.50 " - - " 3,226.76 " - - 231.54 289.43 - - - " 3,900.00 " - - " 3,266.25 " - " 1,993.88 " " 3,656.25 " " 1,852.99 " " 2,180.59 " - 80360762 CATH GUIDING LVL021 C1887 278 "$5,125.00" " 1,894.20 " - " 4,100.00 " - " 3,541.38 " - " 3,541.38 " - " 2,831.56 " - " 3,382.50 " - - " 3,392.24 " - - 231.54 289.43 - - - " 4,100.00 " - - " 3,433.75 " - " 2,096.13 " " 3,843.75 " " 1,948.01 " " 2,292.41 " - 80360771 CATH GUIDING LVL022 C1887 278 "$5,375.00" " 1,986.60 " - " 4,300.00 " - " 3,714.13 " - " 3,714.13 " - " 2,969.69 " - " 3,547.50 " - - " 3,557.71 " - - 231.54 289.43 - - - " 4,300.00 " - - " 3,601.25 " - " 2,198.38 " " 4,031.25 " " 2,043.04 " " 2,404.24 " - 80360789 CATH GUIDING LVL023 C1887 278 "$5,625.00" " 2,079.00 " - " 4,500.00 " - " 3,886.88 " - " 3,886.88 " - " 3,107.81 " - " 3,712.50 " - - " 3,723.19 " - - 231.54 289.43 - - - " 4,500.00 " - - " 3,768.75 " - " 2,300.63 " " 4,218.75 " " 2,138.06 " " 2,516.06 " - 80360797 CATH GUIDING LVL024 C1887 278 "$5,875.00" " 2,171.40 " - " 4,700.00 " - " 4,059.63 " - " 4,059.63 " - " 3,245.94 " - " 3,877.50 " - - " 3,888.66 " - - 231.54 289.43 - - - " 4,700.00 " - - " 3,936.25 " - " 2,402.88 " " 4,406.25 " " 2,233.09 " " 2,627.89 " - 80360801 CATH GUIDING LVL025 C1887 278 "$6,125.00" " 2,263.80 " - " 4,900.00 " - " 4,232.38 " - " 4,232.38 " - " 3,384.06 " - " 4,042.50 " - - " 4,054.14 " - - 231.54 289.43 - - - " 4,900.00 " - - " 4,103.75 " - " 2,505.13 " " 4,593.75 " " 2,328.11 " " 2,739.71 " - 80360819 CATH GUIDING LVL026 C1887 278 "$6,375.00" " 2,356.20 " - " 5,100.00 " - " 4,405.13 " - " 4,405.13 " - " 3,522.19 " - " 4,207.50 " - - " 4,219.61 " - - 231.54 289.43 - - - " 5,100.00 " - - " 4,271.25 " - " 2,607.38 " " 4,781.25 " " 2,423.14 " " 2,851.54 " - 80360827 CATH GUIDING LVL027 C1887 278 "$6,625.00" " 2,448.60 " - " 5,300.00 " - " 4,577.88 " - " 4,577.88 " - " 3,660.31 " - " 4,372.50 " - - " 4,385.09 " - - 231.54 289.43 - - - " 5,300.00 " - - " 4,438.75 " - " 2,709.63 " " 4,968.75 " " 2,518.16 " " 2,963.36 " - 80360835 CATH GUIDING LVL028 C1887 278 "$6,875.00" " 2,541.00 " - " 5,500.00 " - " 4,750.63 " - " 4,750.63 " - " 3,798.44 " - " 4,537.50 " - - " 4,550.56 " - - 231.54 289.43 - - - " 5,500.00 " - - " 4,606.25 " - " 2,811.88 " " 5,156.25 " " 2,613.19 " " 3,075.19 " - 80360843 CATH GUIDING LVL029 C1887 278 "$7,125.00" " 2,633.40 " - " 5,700.00 " - " 4,923.38 " - " 4,923.38 " - " 3,936.56 " - " 4,702.50 " - - " 4,716.04 " - - 231.54 289.43 - - - " 5,700.00 " - - " 4,773.75 " - " 2,914.13 " " 5,343.75 " " 2,708.21 " " 3,187.01 " - 80360851 CATH GUIDING LVL030 C1887 278 "$7,375.00" " 2,725.80 " - " 5,900.00 " - " 5,096.13 " - " 5,096.13 " - " 4,074.69 " - " 4,867.50 " - - " 4,881.51 " - - 231.54 289.43 - - - " 5,900.00 " - - " 4,941.25 " - " 3,016.38 " " 5,531.25 " " 2,803.24 " " 3,298.84 " - 28142994 CATH ABL ENDVAS N-CARD LVL002 C1888 278 $450.00 166.32 - " 2,386.89 " - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - " 1,909.51 " " 2,386.89 " - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 28109636 INT SHTH FIX PEEL-AWAY LVL001 C1892 278 $200.00 73.92 - 205.24 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 164.19 205.24 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 28109644 INT SHTH FIX PEEL-AWAY LVL002 C1892 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 164.19 205.24 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 29818282 INT SHTH FIX PEEL-AWAY LVL001 C1892 278 $200.00 73.92 - 205.24 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 164.19 205.24 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 29818291 INT SHTH FIX PEEL-AWAY LVL002 C1892 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 164.19 205.24 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 29818304 INT SHTH FIX PEEL-AWAY LVL003 C1892 278 $750.00 277.20 - 600.00 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 164.19 205.24 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 29818312 INT SHTH FIX PEEL-AWAY LVL004 C1892 278 "$1,050.00" 388.08 - 840.00 - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 164.19 205.24 - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 29818321 INT SHTH FIX PEEL-AWAY LVL005 C1892 278 "$1,350.00" 498.96 - " 1,080.00 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 164.19 205.24 - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 29818339 INT SHTH FIX PEEL-AWAY LVL006 C1892 278 "$1,375.00" 508.20 - " 1,100.00 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - 164.19 205.24 - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 29818347 INT SHTH FIX PEEL-AWAY LVL007 C1892 278 "$1,625.00" 600.60 - " 1,300.00 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - 164.19 205.24 - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 29818355 INT SHTH FIX PEEL-AWAY LVL008 C1892 278 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - 164.19 205.24 - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 29818363 INT SHTH FIX PEEL-AWAY LVL009 C1892 278 "$2,125.00" 785.40 - " 1,700.00 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - 164.19 205.24 - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 29818371 INT SHTH FIX PEEL-AWAY LVL010 C1892 278 "$2,375.00" 877.80 - " 1,900.00 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - 164.19 205.24 - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 29818380 INT SHTH FIX PEEL-AWAY LVL011 C1892 278 "$2,625.00" 970.20 - " 2,100.00 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - 164.19 205.24 - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 29818398 INT SHTH FIX PEEL-AWAY LVL012 C1892 278 "$2,875.00" " 1,062.60 " - " 2,300.00 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - 164.19 205.24 - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 29818401 INT SHTH FIX PEEL-AWAY LVL013 C1892 278 "$3,125.00" " 1,155.00 " - " 2,500.00 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - 164.19 205.24 - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 29818410 INT SHTH FIX PEEL-AWAY LVL014 C1892 278 "$3,375.00" " 1,247.40 " - " 2,700.00 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - 164.19 205.24 - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 29818428 INT SHTH FIX PEEL-AWAY LVL015 C1892 278 "$3,625.00" " 1,339.80 " - " 2,900.00 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - 164.19 205.24 - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 30605799 INT SHTH FIX PEEL-AWAY LVL001 C1892 278 $200.00 73.92 - 205.24 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 164.19 205.24 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 30605802 INT SHTH FIX PEEL-AWAY LVL002 C1892 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 164.19 205.24 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 30605811 INT SHTH FIX PEEL-AWAY LVL003 C1892 278 $750.00 277.20 - 600.00 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 164.19 205.24 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 30605829 INT SHTH FIX PEEL-AWAY LVL004 C1892 278 "$1,050.00" 388.08 - 840.00 - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 164.19 205.24 - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 30605837 INT SHTH FIX PEEL-AWAY LVL005 C1892 278 "$1,350.00" 498.96 - " 1,080.00 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 164.19 205.24 - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 30605845 INT SHTH FIX PEEL-AWAY LVL006 C1892 278 "$1,375.00" 508.20 - " 1,100.00 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - 164.19 205.24 - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 30605853 INT SHTH FIX PEEL-AWAY LVL007 C1892 278 "$1,625.00" 600.60 - " 1,300.00 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - 164.19 205.24 - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 30605861 INT SHTH FIX PEEL-AWAY LVL008 C1892 278 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - 164.19 205.24 - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 30605870 INT SHTH FIX PEEL-AWAY LVL009 C1892 278 "$2,125.00" 785.40 - " 1,700.00 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - 164.19 205.24 - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 30610253 INT SHTH FIX PEEL-AWAY LVL010 C1892 278 "$2,375.00" 877.80 - " 1,900.00 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - 164.19 205.24 - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 30611161 INT SHTH FIX PEEL-AWAY LVL011 C1892 278 "$2,625.00" 970.20 - " 2,100.00 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - 164.19 205.24 - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 30611179 INT SHTH FIX PEEL-AWAY LVL012 C1892 278 "$2,875.00" " 1,062.60 " - " 2,300.00 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - 164.19 205.24 - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 30611187 INT SHTH FIX PEEL-AWAY LVL013 C1892 278 "$3,125.00" " 1,155.00 " - " 2,500.00 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - 164.19 205.24 - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 30611195 INT SHTH FIX PEEL-AWAY LVL014 C1892 278 "$3,375.00" " 1,247.40 " - " 2,700.00 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - 164.19 205.24 - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 30611209 INT SHTH FIX PEEL-AWAY LVL015 C1892 278 "$3,625.00" " 1,339.80 " - " 2,900.00 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - 164.19 205.24 - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 80364547 INT SHTH FIX PEEL-AWAY LVL001 C1892 278 $200.00 73.92 - 205.24 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 164.19 205.24 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 80364555 INT SHTH FIX PEEL-AWAY LVL002 C1892 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 164.19 205.24 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 80364563 INT SHTH FIX PEEL-AWAY LVL003 C1892 278 $750.00 277.20 - 600.00 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 164.19 205.24 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 80364571 INT SHTH FIX PEEL-AWAY LVL004 C1892 278 "$1,050.00" 388.08 - 840.00 - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 164.19 205.24 - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 80364580 INT SHTH FIX PEEL-AWAY LVL005 C1892 278 "$1,350.00" 498.96 - " 1,080.00 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 164.19 205.24 - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 80364598 INT SHTH FIX PEEL-AWAY LVL006 C1892 278 "$1,375.00" 508.20 - " 1,100.00 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - 164.19 205.24 - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 80364601 INT SHTH FIX PEEL-AWAY LVL007 C1892 278 "$1,625.00" 600.60 - " 1,300.00 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - 164.19 205.24 - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 80364610 INT SHTH FIX PEEL-AWAY LVL008 C1892 278 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - 164.19 205.24 - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 80364628 INT SHTH FIX PEEL-AWAY LVL009 C1892 278 "$2,125.00" 785.40 - " 1,700.00 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - 164.19 205.24 - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 28109521 INT SHTH FIX NON-PEEL LVL001 C1893 278 $200.00 73.92 - 269.19 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 215.35 269.19 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 28109555 INT SHTH FIX NON-PEEL LVL004 C1893 278 "$1,050.00" 388.08 - 840.00 - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 215.35 269.19 - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 28109571 INT SHTH FIX NON-PEEL LVL006 C1893 278 "$1,375.00" 508.20 - " 1,100.00 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - 215.35 269.19 - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 29816409 INT SHTH FIX NON-PEEL LVL001 C1893 278 $200.00 73.92 - 269.19 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 215.35 269.19 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 29816417 INT SHTH FIX NON-PEEL LVL002 C1893 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 215.35 269.19 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 29816425 INT SHTH FIX NON-PEEL LVL003 C1893 278 $750.00 277.20 - 600.00 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 215.35 269.19 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 29816433 INT SHTH FIX NON-PEEL LVL004 C1893 278 "$1,050.00" 388.08 - 840.00 - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 215.35 269.19 - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 29816441 INT SHTH FIX NON-PEEL LVL005 C1893 278 "$1,350.00" 498.96 - " 1,080.00 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 215.35 269.19 - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 29816450 INT SHTH FIX NON-PEEL LVL006 C1893 278 "$1,375.00" 508.20 - " 1,100.00 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - 215.35 269.19 - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 29817219 INT SHTH FIX NON-PEEL LVL007 C1893 278 "$1,625.00" 600.60 - " 1,300.00 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - 215.35 269.19 - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 29817227 INT SHTH FIX NON-PEEL LVL008 C1893 278 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - 215.35 269.19 - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 29817235 INT SHTH FIX NON-PEEL LVL009 C1893 278 "$2,125.00" 785.40 - " 1,700.00 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - 215.35 269.19 - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 29817243 INT SHTH FIX NON-PEEL LVL010 C1893 278 "$2,375.00" 877.80 - " 1,900.00 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - 215.35 269.19 - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 30605888 INT SHTH FIX NON-PEEL LVL001 C1893 278 $200.00 73.92 - 269.19 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 215.35 269.19 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 30605896 INT SHTH FIX NON-PEEL LVL002 C1893 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 215.35 269.19 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 30605900 INT SHTH FIX NON-PEEL LVL003 C1893 278 $750.00 277.20 - 600.00 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 215.35 269.19 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 30605918 INT SHTH FIX NON-PEEL LVL004 C1893 278 "$1,050.00" 388.08 - 840.00 - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 215.35 269.19 - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 30605926 INT SHTH FIX NON-PEEL LVL005 C1893 278 "$1,350.00" 498.96 - " 1,080.00 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 215.35 269.19 - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 28109725 INTRO SHEATH N-LASER LVL001 C1894 278 $200.00 73.92 - 177.97 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 142.38 177.97 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 28109733 INTRO SHEATH N-LASER LVL002 C1894 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 142.38 177.97 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 28109750 INTRO SHEATH N-LASER LVL004 C1894 278 "$1,050.00" 388.08 - 840.00 - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 142.38 177.97 - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 28109814 INTRO SHEATH N-LASER LVL010 C1894 278 "$2,375.00" 877.80 - " 1,900.00 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - 142.38 177.97 - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 29816468 INTRO SHEATH N-LASER LVL001 C1894 278 $200.00 73.92 - 177.97 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 142.38 177.97 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 29816476 INTRO SHEATH N-LASER LVL002 C1894 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 142.38 177.97 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 29816484 INTRO SHEATH N-LASER LVL003 C1894 278 $750.00 277.20 - 600.00 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 142.38 177.97 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 29816492 INTRO SHEATH N-LASER LVL004 C1894 278 "$1,050.00" 388.08 - 840.00 - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 142.38 177.97 - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 29816506 INTRO SHEATH N-LASER LVL005 C1894 278 "$1,350.00" 498.96 - " 1,080.00 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 142.38 177.97 - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 29816514 INTRO SHEATH N-LASER LVL006 C1894 278 "$1,375.00" 508.20 - " 1,100.00 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - 142.38 177.97 - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 29816522 INTRO SHEATH N-LASER LVL007 C1894 278 "$1,625.00" 600.60 - " 1,300.00 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - 142.38 177.97 - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 29817251 INTRO SHEATH N-LASER LVL008 C1894 278 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - 142.38 177.97 - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 29817260 INTRO SHEATH N-LASER LVL009 C1894 278 "$2,125.00" 785.40 - " 1,700.00 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - 142.38 177.97 - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 29817278 INTRO SHEATH N-LASER LVL010 C1894 278 "$2,375.00" 877.80 - " 1,900.00 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - 142.38 177.97 - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 30605934 INTRO SHEATH N-LASER LVL001 C1894 278 $200.00 73.92 - 177.97 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 142.38 177.97 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 30605942 INTRO SHEATH N-LASER LVL002 C1894 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 142.38 177.97 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 30605951 INTRO SHEATH N-LASER LVL003 C1894 278 $750.00 277.20 - 600.00 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 142.38 177.97 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 30605969 INTRO SHEATH N-LASER LVL004 C1894 278 "$1,050.00" 388.08 - 840.00 - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 142.38 177.97 - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 30605977 INTRO SHEATH N-LASER LVL005 C1894 278 "$1,350.00" 498.96 - " 1,080.00 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 142.38 177.97 - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 30605985 INTRO SHEATH N-LASER LVL006 C1894 278 "$1,375.00" 508.20 - " 1,100.00 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - 142.38 177.97 - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 30605993 INTRO SHEATH N-LASER LVL007 C1894 278 "$1,625.00" 600.60 - " 1,300.00 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - 142.38 177.97 - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 30606001 INTRO SHEATH N-LASER LVL008 C1894 278 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - 142.38 177.97 - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 30606019 INTRO SHEATH N-LASER LVL009 C1894 278 "$2,125.00" 785.40 - " 1,700.00 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - 142.38 177.97 - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 30610261 INTRO SHEATH N-LASER LVL010 C1894 278 "$2,375.00" 877.80 - " 1,900.00 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - 142.38 177.97 - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 30611225 INTRO SHEATH N-LASER LVL011 C1894 278 "$2,625.00" 970.20 - " 2,100.00 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - 142.38 177.97 - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 30611233 INTRO SHEATH N-LASER LVL012 C1894 278 "$2,875.00" " 1,062.60 " - " 2,300.00 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - 142.38 177.97 - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 30611241 INTRO SHEATH N-LASER LVL013 C1894 278 "$3,125.00" " 1,155.00 " - " 2,500.00 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - 142.38 177.97 - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 30611250 INTRO SHEATH N-LASER LVL014 C1894 278 "$3,375.00" " 1,247.40 " - " 2,700.00 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - 142.38 177.97 - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 30611268 INTRO SHEATH N-LASER LVL015 C1894 278 "$3,625.00" " 1,339.80 " - " 2,900.00 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - 142.38 177.97 - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 30611276 INTRO SHEATH N-LASER LVL016 C1894 278 "$3,875.00" " 1,432.20 " - " 3,100.00 " - " 2,677.63 " - " 2,677.63 " - " 2,140.94 " - " 2,557.50 " - - " 2,564.86 " - - 142.38 177.97 - - - " 3,100.00 " - - " 2,596.25 " - " 1,584.88 " " 2,906.25 " " 1,472.89 " " 1,733.29 " - 30611284 INTRO SHEATH N-LASER LVL017 C1894 278 "$4,125.00" " 1,524.60 " - " 3,300.00 " - " 2,850.38 " - " 2,850.38 " - " 2,279.06 " - " 2,722.50 " - - " 2,730.34 " - - 142.38 177.97 - - - " 3,300.00 " - - " 2,763.75 " - " 1,687.13 " " 3,093.75 " " 1,567.91 " " 1,845.11 " - 30611292 INTRO SHEATH N-LASER LVL018 C1894 278 "$4,375.00" " 1,617.00 " - " 3,500.00 " - " 3,023.13 " - " 3,023.13 " - " 2,417.19 " - " 2,887.50 " - - " 2,895.81 " - - 142.38 177.97 - - - " 3,500.00 " - - " 2,931.25 " - " 1,789.38 " " 3,281.25 " " 1,662.94 " " 1,956.94 " - 30611306 INTRO SHEATH N-LASER LVL019 C1894 278 "$4,625.00" " 1,709.40 " - " 3,700.00 " - " 3,195.88 " - " 3,195.88 " - " 2,555.31 " - " 3,052.50 " - - " 3,061.29 " - - 142.38 177.97 - - - " 3,700.00 " - - " 3,098.75 " - " 1,891.63 " " 3,468.75 " " 1,757.96 " " 2,068.76 " - 30611314 INTRO SHEATH N-LASER LVL020 C1894 278 "$4,875.00" " 1,801.80 " - " 3,900.00 " - " 3,368.63 " - " 3,368.63 " - " 2,693.44 " - " 3,217.50 " - - " 3,226.76 " - - 142.38 177.97 - - - " 3,900.00 " - - " 3,266.25 " - " 1,993.88 " " 3,656.25 " " 1,852.99 " " 2,180.59 " - 34300267 MICRO INTRODUCERS C1894 270 $372.00 137.49 - 297.60 - 257.05 - 257.05 - 205.53 - 245.52 - - 246.23 - - 142.38 177.97 - - - 297.60 - - 249.24 - 152.15 279.00 141.40 166.40 - 80360452 INTRO SHEATH N-LASER LVL001 C1894 278 $200.00 73.92 - 177.97 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 142.38 177.97 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 80360461 INTRO SHEATH N-LASER LVL002 C1894 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 142.38 177.97 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 80360479 INTRO SHEATH N-LASER LVL003 C1894 278 $750.00 277.20 - 600.00 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 142.38 177.97 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 80360487 INTRO SHEATH N-LASER LVL004 C1894 278 "$1,050.00" 388.08 - 840.00 - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 142.38 177.97 - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 80360495 INTRO SHEATH N-LASER LVL005 C1894 278 "$1,350.00" 498.96 - " 1,080.00 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 142.38 177.97 - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 80360509 INTRO SHEATH N-LASER LVL006 C1894 278 "$1,375.00" 508.20 - " 1,100.00 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - 142.38 177.97 - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 80360517 INTRO SHEATH N-LASER LVL007 C1894 278 "$1,625.00" 600.60 - " 1,300.00 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - 142.38 177.97 - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 80360525 INTRO SHEATH N-LASER LVL008 C1894 278 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - 142.38 177.97 - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 80360533 INTRO SHEATH N-LASER LVL009 C1894 278 "$2,125.00" 785.40 - " 1,700.00 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - 142.38 177.97 - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 80360541 INTRO SHEATH N-LASER LVL010 C1894 278 "$2,375.00" 877.80 - " 1,900.00 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - 142.38 177.97 - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 80360550 INTRO SHEATH N-LASER LVL011 C1894 278 "$2,625.00" 970.20 - " 2,100.00 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - 142.38 177.97 - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 80660456 INTRO SHEATH N-LASER LVL001 C1894 278 $200.00 73.92 - 177.97 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 142.38 177.97 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 80660464 INTRO SHEATH N-LASER LVL002 C1894 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 142.38 177.97 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 80660472 INTRO SHEATH N-LASER LVL003 C1894 278 $750.00 277.20 - 600.00 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 142.38 177.97 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 80660481 INTRO SHEATH N-LASER LVL004 C1894 278 "$1,050.00" 388.08 - 840.00 - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 142.38 177.97 - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 28110928 LEAD AICD ENDO D-COIL LVL004 C1895 275 "$1,050.00" 388.08 - " 17,173.66 " - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - " 13,738.93 " " 17,173.66 " - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 30606027 LEAD AICD ENDO D-COIL LVL025 C1895 275 "$6,125.00" " 2,263.80 " - " 17,173.66 " - " 4,232.38 " - " 4,232.38 " - " 3,384.06 " - " 4,042.50 " - - " 4,054.14 " - - " 13,738.93 " " 17,173.66 " - - - " 4,900.00 " - - " 4,103.75 " - " 2,505.13 " " 4,593.75 " " 2,328.11 " " 2,739.71 " - 30606035 LEAD AICD ENDO D-COIL LVL026 C1895 275 "$6,375.00" " 2,356.20 " - " 17,173.66 " - " 4,405.13 " - " 4,405.13 " - " 3,522.19 " - " 4,207.50 " - - " 4,219.61 " - - " 13,738.93 " " 17,173.66 " - - - " 5,100.00 " - - " 4,271.25 " - " 2,607.38 " " 4,781.25 " " 2,423.14 " " 2,851.54 " - 30606043 LEAD AICD ENDO D-COIL LVL027 C1895 275 "$6,625.00" " 2,448.60 " - " 17,173.66 " - " 4,577.88 " - " 4,577.88 " - " 3,660.31 " - " 4,372.50 " - - " 4,385.09 " - - " 13,738.93 " " 17,173.66 " - - - " 5,300.00 " - - " 4,438.75 " - " 2,709.63 " " 4,968.75 " " 2,518.16 " " 2,963.36 " - 30606051 LEAD AICD ENDO D-COIL LVL029 C1895 275 "$7,125.00" " 2,633.40 " - " 17,173.66 " - " 4,923.38 " - " 4,923.38 " - " 3,936.56 " - " 4,702.50 " - - " 4,716.04 " - - " 13,738.93 " " 17,173.66 " - - - " 5,700.00 " - - " 4,773.75 " - " 2,914.13 " " 5,343.75 " " 2,708.21 " " 3,187.01 " - 30606060 LEAD AICD ENDO D-COIL LVL030 C1895 275 "$7,375.00" " 2,725.80 " - " 17,173.66 " - " 5,096.13 " - " 5,096.13 " - " 4,074.69 " - " 4,867.50 " - - " 4,881.51 " - - " 13,738.93 " " 17,173.66 " - - - " 5,900.00 " - - " 4,941.25 " - " 3,016.38 " " 5,531.25 " " 2,803.24 " " 3,298.84 " - 30606078 LEAD AICD ENDO D-COIL LVL033 C1895 275 "$8,125.00" " 3,003.00 " - " 17,173.66 " - " 5,614.38 " - " 5,614.38 " - " 4,489.06 " - " 5,362.50 " - - " 5,377.94 " - - " 13,738.93 " " 17,173.66 " - - - " 6,500.00 " - - " 5,443.75 " - " 3,323.13 " " 6,093.75 " " 3,088.31 " " 3,634.31 " - 30606086 LEAD AICD ENDO D-COIL LVL034 C1895 275 "$8,375.00" " 3,095.40 " - " 17,173.66 " - " 5,787.13 " - " 5,787.13 " - " 4,627.19 " - " 5,527.50 " - - " 5,543.41 " - - " 13,738.93 " " 17,173.66 " - - - " 6,700.00 " - - " 5,611.25 " - " 3,425.38 " " 6,281.25 " " 3,183.34 " " 3,746.14 " - 30606094 LEAD AICD ENDO D-COIL LVL037 C1895 275 "$9,125.00" " 3,372.60 " - " 17,173.66 " - " 6,305.38 " - " 6,305.38 " - " 5,041.56 " - " 6,022.50 " - - " 6,039.84 " - - " 13,738.93 " " 17,173.66 " - - - " 7,300.00 " - - " 6,113.75 " - " 3,732.13 " " 6,843.75 " " 3,468.41 " " 4,081.61 " - 30606108 LEAD AICD ENDO D-COIL LVL038 C1895 275 "$9,375.00" " 3,465.00 " - " 17,173.66 " - " 6,478.13 " - " 6,478.13 " - " 5,179.69 " - " 6,187.50 " - - " 6,205.31 " - - " 13,738.93 " " 17,173.66 " - - - " 7,500.00 " - - " 6,281.25 " - " 3,834.38 " " 7,031.25 " " 3,563.44 " " 4,193.44 " - 30606116 LEAD AICD ENDO D-COIL LVL039 C1895 275 "$9,625.00" " 3,557.40 " - " 17,173.66 " - " 6,650.88 " - " 6,650.88 " - " 5,317.81 " - " 6,352.50 " - - " 6,370.79 " - - " 13,738.93 " " 17,173.66 " - - - " 7,700.00 " - - " 6,448.75 " - " 3,936.63 " " 7,218.75 " " 3,658.46 " " 4,305.26 " - 30606124 LEAD AICD ENDO D-COIL LVL040 C1895 275 "$9,875.00" " 3,649.80 " - " 17,173.66 " - " 6,823.63 " - " 6,823.63 " - " 5,455.94 " - " 6,517.50 " - - " 6,536.26 " - - " 13,738.93 " " 17,173.66 " - - - " 7,900.00 " - - " 6,616.25 " - " 4,038.88 " " 7,406.25 " " 3,753.49 " " 4,417.09 " - 30606132 LEAD AICD ENDO D-COIL LVL043 C1895 275 "$10,625.00" " 3,927.00 " - " 17,173.66 " - " 7,341.88 " - " 7,341.88 " - " 5,870.31 " - " 7,012.50 " - - " 7,032.69 " - - " 13,738.93 " " 17,173.66 " - - - " 8,500.00 " - - " 7,118.75 " - " 4,345.63 " " 7,968.75 " " 4,038.56 " " 4,752.56 " - 30606141 LEAD AICD ENDO D-COIL LVL044 C1895 275 "$10,875.00" " 4,019.40 " - " 17,173.66 " - " 7,514.63 " - " 7,514.63 " - " 6,008.44 " - " 7,177.50 " - - " 7,198.16 " - - " 13,738.93 " " 17,173.66 " - - - " 8,700.00 " - - " 7,286.25 " - " 4,447.88 " " 8,156.25 " " 4,133.59 " " 4,864.39 " - 30606159 LEAD AICD ENDO D-COIL LVL045 C1895 275 "$11,125.00" " 4,111.80 " - " 17,173.66 " - " 7,687.38 " - " 7,687.38 " - " 6,146.56 " - " 7,342.50 " - - " 7,363.64 " - - " 13,738.93 " " 17,173.66 " - - - " 8,900.00 " - - " 7,453.75 " - " 4,550.13 " " 8,343.75 " " 4,228.61 " " 4,976.21 " - 30606167 LEAD AICD ENDO D-COIL LVL046 C1895 275 "$11,375.00" " 4,204.20 " - " 17,173.66 " - " 7,860.13 " - " 7,860.13 " - " 6,284.69 " - " 7,507.50 " - - " 7,529.11 " - - " 13,738.93 " " 17,173.66 " - - - " 9,100.00 " - - " 7,621.25 " - " 4,652.38 " " 8,531.25 " " 4,323.64 " " 5,088.04 " - 30606175 LEAD AICD ENDO D-COIL LVL047 C1895 275 "$11,625.00" " 4,296.60 " - " 17,173.66 " - " 8,032.88 " - " 8,032.88 " - " 6,422.81 " - " 7,672.50 " - - " 7,694.59 " - - " 13,738.93 " " 17,173.66 " - - - " 9,300.00 " - - " 7,788.75 " - " 4,754.63 " " 8,718.75 " " 4,418.66 " " 5,199.86 " - 30610270 LEAD AICD ENDO D-COIL LVL028 C1895 275 "$6,875.00" " 2,541.00 " - " 17,173.66 " - " 4,750.63 " - " 4,750.63 " - " 3,798.44 " - " 4,537.50 " - - " 4,550.56 " - - " 13,738.93 " " 17,173.66 " - - - " 5,500.00 " - - " 4,606.25 " - " 2,811.88 " " 5,156.25 " " 2,613.19 " " 3,075.19 " - 30610288 LEAD AICD ENDO D-COIL LVL031 C1895 275 "$7,625.00" " 2,818.20 " - " 17,173.66 " - " 5,268.88 " - " 5,268.88 " - " 4,212.81 " - " 5,032.50 " - - " 5,046.99 " - - " 13,738.93 " " 17,173.66 " - - - " 6,100.00 " - - " 5,108.75 " - " 3,118.63 " " 5,718.75 " " 2,898.26 " " 3,410.66 " - 30610296 LEAD AICD ENDO D-COIL LVL032 C1895 275 "$7,875.00" " 2,910.60 " - " 17,173.66 " - " 5,441.63 " - " 5,441.63 " - " 4,350.94 " - " 5,197.50 " - - " 5,212.46 " - - " 13,738.93 " " 17,173.66 " - - - " 6,300.00 " - - " 5,276.25 " - " 3,220.88 " " 5,906.25 " " 2,993.29 " " 3,522.49 " - 30610300 LEAD AICD ENDO D-COIL LVL035 C1895 275 "$8,625.00" " 3,187.80 " - " 17,173.66 " - " 5,959.88 " - " 5,959.88 " - " 4,765.31 " - " 5,692.50 " - - " 5,708.89 " - - " 13,738.93 " " 17,173.66 " - - - " 6,900.00 " - - " 5,778.75 " - " 3,527.63 " " 6,468.75 " " 3,278.36 " " 3,857.96 " - 30610318 LEAD AICD ENDO D-COIL LVL036 C1895 275 "$8,875.00" " 3,280.20 " - " 17,173.66 " - " 6,132.63 " - " 6,132.63 " - " 4,903.44 " - " 5,857.50 " - - " 5,874.36 " - - " 13,738.93 " " 17,173.66 " - - - " 7,100.00 " - - " 5,946.25 " - " 3,629.88 " " 6,656.25 " " 3,373.39 " " 3,969.79 " - 30610326 LEAD AICD ENDO D-COIL LVL041 C1895 275 "$10,125.00" " 3,742.20 " - " 17,173.66 " - " 6,996.38 " - " 6,996.38 " - " 5,594.06 " - " 6,682.50 " - - " 6,701.74 " - - " 13,738.93 " " 17,173.66 " - - - " 8,100.00 " - - " 6,783.75 " - " 4,141.13 " " 7,593.75 " " 3,848.51 " " 4,528.91 " - 30610334 LEAD AICD ENDO D-COIL LVL042 C1895 275 "$10,375.00" " 3,834.60 " - " 17,173.66 " - " 7,169.13 " - " 7,169.13 " - " 5,732.19 " - " 6,847.50 " - - " 6,867.21 " - - " 13,738.93 " " 17,173.66 " - - - " 8,300.00 " - - " 6,951.25 " - " 4,243.38 " " 7,781.25 " " 3,943.54 " " 4,640.74 " - 30610342 LEAD AICD ENDO D-COIL LVL048 C1895 275 "$11,875.00" " 4,389.00 " - " 17,173.66 " - " 8,205.63 " - " 8,205.63 " - " 6,560.94 " - " 7,837.50 " - - " 7,860.06 " - - " 13,738.93 " " 17,173.66 " - - - " 9,500.00 " - - " 7,956.25 " - " 4,856.88 " " 8,906.25 " " 4,513.69 " " 5,311.69 " - 30610351 LEAD AICD ENDO D-COIL LVL049 C1895 275 "$12,125.00" " 4,481.40 " - " 17,173.66 " - " 8,378.38 " - " 8,378.38 " - " 6,699.06 " - " 8,002.50 " - - " 8,025.54 " - - " 13,738.93 " " 17,173.66 " - - - " 9,700.00 " - - " 8,123.75 " - " 4,959.13 " " 9,093.75 " " 4,608.71 " " 5,423.51 " - 30610369 LEAD AICD ENDO D-COIL LVL050 C1895 275 "$12,375.00" " 4,573.80 " - " 17,173.66 " - " 8,551.13 " - " 8,551.13 " - " 6,837.19 " - " 8,167.50 " - - " 8,191.01 " - - " 13,738.93 " " 17,173.66 " - - - " 9,900.00 " - - " 8,291.25 " - " 5,061.38 " " 9,281.25 " " 4,703.74 " " 5,535.34 " - 30606884 LEAD AICD NON-S/D LVL020 C1896 275 "$4,875.00" " 1,801.80 " - " 10,359.82 " - " 3,368.63 " - " 3,368.63 " - " 2,693.44 " - " 3,217.50 " - - " 3,226.76 " - - " 8,287.86 " " 10,359.82 " - - - " 3,900.00 " - - " 3,266.25 " - " 1,993.88 " " 3,656.25 " " 1,852.99 " " 2,180.59 " - 30606892 LEAD AICD NON-S/D LVL021 C1896 275 "$5,125.00" " 1,894.20 " - " 10,359.82 " - " 3,541.38 " - " 3,541.38 " - " 2,831.56 " - " 3,382.50 " - - " 3,392.24 " - - " 8,287.86 " " 10,359.82 " - - - " 4,100.00 " - - " 3,433.75 " - " 2,096.13 " " 3,843.75 " " 1,948.01 " " 2,292.41 " - 30606906 LEAD AICD NON-S/D LVL022 C1896 275 "$5,375.00" " 1,986.60 " - " 10,359.82 " - " 3,714.13 " - " 3,714.13 " - " 2,969.69 " - " 3,547.50 " - - " 3,557.71 " - - " 8,287.86 " " 10,359.82 " - - - " 4,300.00 " - - " 3,601.25 " - " 2,198.38 " " 4,031.25 " " 2,043.04 " " 2,404.24 " - 30606914 LEAD AICD NON-S/D LVL023 C1896 275 "$5,625.00" " 2,079.00 " - " 10,359.82 " - " 3,886.88 " - " 3,886.88 " - " 3,107.81 " - " 3,712.50 " - - " 3,723.19 " - - " 8,287.86 " " 10,359.82 " - - - " 4,500.00 " - - " 3,768.75 " - " 2,300.63 " " 4,218.75 " " 2,138.06 " " 2,516.06 " - 30606922 LEAD AICD NON-S/D LVL024 C1896 275 "$5,875.00" " 2,171.40 " - " 10,359.82 " - " 4,059.63 " - " 4,059.63 " - " 3,245.94 " - " 3,877.50 " - - " 3,888.66 " - - " 8,287.86 " " 10,359.82 " - - - " 4,700.00 " - - " 3,936.25 " - " 2,402.88 " " 4,406.25 " " 2,233.09 " " 2,627.89 " - 30606931 LEAD AICD NON-S/D LVL025 C1896 275 "$6,125.00" " 2,263.80 " - " 10,359.82 " - " 4,232.38 " - " 4,232.38 " - " 3,384.06 " - " 4,042.50 " - - " 4,054.14 " - - " 8,287.86 " " 10,359.82 " - - - " 4,900.00 " - - " 4,103.75 " - " 2,505.13 " " 4,593.75 " " 2,328.11 " " 2,739.71 " - 30606949 LEAD AICD NON-S/D LVL026 C1896 275 "$6,375.00" " 2,356.20 " - " 10,359.82 " - " 4,405.13 " - " 4,405.13 " - " 3,522.19 " - " 4,207.50 " - - " 4,219.61 " - - " 8,287.86 " " 10,359.82 " - - - " 5,100.00 " - - " 4,271.25 " - " 2,607.38 " " 4,781.25 " " 2,423.14 " " 2,851.54 " - 30606957 LEAD AICD NON-S/D LVL027 C1896 275 "$6,625.00" " 2,448.60 " - " 10,359.82 " - " 4,577.88 " - " 4,577.88 " - " 3,660.31 " - " 4,372.50 " - - " 4,385.09 " - - " 8,287.86 " " 10,359.82 " - - - " 5,300.00 " - - " 4,438.75 " - " 2,709.63 " " 4,968.75 " " 2,518.16 " " 2,963.36 " - 30606965 LEAD AICD NON-S/D LVL028 C1896 275 "$6,875.00" " 2,541.00 " - " 10,359.82 " - " 4,750.63 " - " 4,750.63 " - " 3,798.44 " - " 4,537.50 " - - " 4,550.56 " - - " 8,287.86 " " 10,359.82 " - - - " 5,500.00 " - - " 4,606.25 " - " 2,811.88 " " 5,156.25 " " 2,613.19 " " 3,075.19 " - 30606973 LEAD AICD NON-S/D LVL029 C1896 275 "$7,125.00" " 2,633.40 " - " 10,359.82 " - " 4,923.38 " - " 4,923.38 " - " 3,936.56 " - " 4,702.50 " - - " 4,716.04 " - - " 8,287.86 " " 10,359.82 " - - - " 5,700.00 " - - " 4,773.75 " - " 2,914.13 " " 5,343.75 " " 2,708.21 " " 3,187.01 " - 30606981 LEAD AICD NON-S/D LVL030 C1896 275 "$7,375.00" " 2,725.80 " - " 10,359.82 " - " 5,096.13 " - " 5,096.13 " - " 4,074.69 " - " 4,867.50 " - - " 4,881.51 " - - " 8,287.86 " " 10,359.82 " - - - " 5,900.00 " - - " 4,941.25 " - " 3,016.38 " " 5,531.25 " " 2,803.24 " " 3,298.84 " - 30606990 LEAD AICD NON-S/D LVL031 C1896 275 "$7,625.00" " 2,818.20 " - " 10,359.82 " - " 5,268.88 " - " 5,268.88 " - " 4,212.81 " - " 5,032.50 " - - " 5,046.99 " - - " 8,287.86 " " 10,359.82 " - - - " 6,100.00 " - - " 5,108.75 " - " 3,118.63 " " 5,718.75 " " 2,898.26 " " 3,410.66 " - 30607007 LEAD AICD NON-S/D LVL032 C1896 275 "$7,875.00" " 2,910.60 " - " 10,359.82 " - " 5,441.63 " - " 5,441.63 " - " 4,350.94 " - " 5,197.50 " - - " 5,212.46 " - - " 8,287.86 " " 10,359.82 " - - - " 6,300.00 " - - " 5,276.25 " - " 3,220.88 " " 5,906.25 " " 2,993.29 " " 3,522.49 " - 30607015 LEAD AICD NON-S/D LVL033 C1896 275 "$8,125.00" " 3,003.00 " - " 10,359.82 " - " 5,614.38 " - " 5,614.38 " - " 4,489.06 " - " 5,362.50 " - - " 5,377.94 " - - " 8,287.86 " " 10,359.82 " - - - " 6,500.00 " - - " 5,443.75 " - " 3,323.13 " " 6,093.75 " " 3,088.31 " " 3,634.31 " - 30607023 LEAD AICD NON-S/D LVL049 C1896 275 "$12,125.00" " 4,481.40 " - " 10,359.82 " - " 8,378.38 " - " 8,378.38 " - " 6,699.06 " - " 8,002.50 " - - " 8,025.54 " - - " 8,287.86 " " 10,359.82 " - - - " 9,700.00 " - - " 8,123.75 " - " 4,959.13 " " 9,093.75 " " 4,608.71 " " 5,423.51 " - 30607031 LEAD AICD NON-S/D LVL050 C1896 275 "$12,375.00" " 4,573.80 " - " 10,359.82 " - " 8,551.13 " - " 8,551.13 " - " 6,837.19 " - " 8,167.50 " - - " 8,191.01 " - - " 8,287.86 " " 10,359.82 " - - - " 9,900.00 " - - " 8,291.25 " - " 5,061.38 " " 9,281.25 " " 4,703.74 " " 5,535.34 " - 30607040 LEAD AICD NON-S/D LVL051 C1896 275 "$12,625.00" " 4,666.20 " - " 10,359.82 " - " 8,723.88 " - " 8,723.88 " - " 6,975.31 " - " 8,332.50 " - - " 8,356.49 " - - " 8,287.86 " " 10,359.82 " - - - " 10,100.00 " - - " 8,458.75 " - " 5,163.63 " " 9,468.75 " " 4,798.76 " " 5,647.16 " - 30607058 LEAD AICD NON-S/D LVL052 C1896 275 "$12,875.00" " 4,758.60 " - " 10,359.82 " - " 8,896.63 " - " 8,896.63 " - " 7,113.44 " - " 8,497.50 " - - " 8,521.96 " - - " 8,287.86 " " 10,359.82 " - - - " 10,300.00 " - - " 8,626.25 " - " 5,265.88 " " 9,656.25 " " 4,893.79 " " 5,758.99 " - 30607066 LEAD AICD NON-S/D LVL053 C1896 275 "$13,125.00" " 4,851.00 " - " 10,500.00 " - " 9,069.38 " - " 9,069.38 " - " 7,251.56 " - " 8,662.50 " - - " 8,687.44 " - - " 8,287.86 " " 10,359.82 " - - - " 10,500.00 " - - " 8,793.75 " - " 5,368.13 " " 9,843.75 " " 4,988.81 " " 5,870.81 " - 30607074 LEAD AICD NON-S/D LVL054 C1896 275 "$13,375.00" " 4,943.40 " - " 10,700.00 " - " 9,242.13 " - " 9,242.13 " - " 7,389.69 " - " 8,827.50 " - - " 8,852.91 " - - " 8,287.86 " " 10,359.82 " - - - " 10,700.00 " - - " 8,961.25 " - " 5,470.38 " " 10,031.25 " " 5,083.84 " " 5,982.64 " - 30607082 LEAD AICD NON-S/D LVL055 C1896 275 "$13,625.00" " 5,035.80 " - " 10,900.00 " - " 9,414.88 " - " 9,414.88 " - " 7,527.81 " - " 8,992.50 " - - " 9,018.39 " - - " 8,287.86 " " 10,359.82 " - - - " 10,900.00 " - - " 9,128.75 " - " 5,572.63 " " 10,218.75 " " 5,178.86 " " 6,094.46 " - 30607091 LEAD AICD NON-S/D LVL056 C1896 275 "$13,875.00" " 5,128.20 " - " 11,100.00 " - " 9,587.63 " - " 9,587.63 " - " 7,665.94 " - " 9,157.50 " - - " 9,183.86 " - - " 8,287.86 " " 10,359.82 " - - - " 11,100.00 " - - " 9,296.25 " - " 5,674.88 " " 10,406.25 " " 5,273.89 " " 6,206.29 " - 30607104 LEAD AICD NON-S/D LVL057 C1896 275 "$14,125.00" " 5,220.60 " - " 11,300.00 " - " 9,760.38 " - " 9,760.38 " - " 7,804.06 " - " 9,322.50 " - - " 9,349.34 " - - " 8,287.86 " " 10,359.82 " - - - " 11,300.00 " - - " 9,463.75 " - " 5,777.13 " " 10,593.75 " " 5,368.91 " " 6,318.11 " - 30607112 LEAD AICD NON-S/D LVL058 C1896 275 "$14,375.00" " 5,313.00 " - " 11,500.00 " - " 9,933.13 " - " 9,933.13 " - " 7,942.19 " - " 9,487.50 " - - " 9,514.81 " - - " 8,287.86 " " 10,359.82 " - - - " 11,500.00 " - - " 9,631.25 " - " 5,879.38 " " 10,781.25 " " 5,463.94 " " 6,429.94 " - 30610377 LEAD AICD NON-S/D LVL059 C1896 278 "$14,625.00" " 5,405.40 " - " 11,700.00 " - " 10,105.88 " - " 10,105.88 " - " 8,080.31 " - " 9,652.50 " - - " 9,680.29 " - - " 8,287.86 " " 10,359.82 " - - - " 11,700.00 " - - " 9,798.75 " - " 5,981.63 " " 10,968.75 " " 5,558.96 " " 6,541.76 " - 30612639 LEAD AICD NON-S/D LVL040 C1896 275 "$9,875.00" " 3,649.80 " - " 10,359.82 " - " 6,823.63 " - " 6,823.63 " - " 5,455.94 " - " 6,517.50 " - - " 6,536.26 " - - " 8,287.86 " " 10,359.82 " - - - " 7,900.00 " - - " 6,616.25 " - " 4,038.88 " " 7,406.25 " " 3,753.49 " " 4,417.09 " - 30612647 LEAD AICD NON-S/D LVL041 C1896 275 "$10,125.00" " 3,742.20 " - " 10,359.82 " - " 6,996.38 " - " 6,996.38 " - " 5,594.06 " - " 6,682.50 " - - " 6,701.74 " - - " 8,287.86 " " 10,359.82 " - - - " 8,100.00 " - - " 6,783.75 " - " 4,141.13 " " 7,593.75 " " 3,848.51 " " 4,528.91 " - 30612655 LEAD AICD NON-S/D LVL042 C1896 275 "$10,375.00" " 3,834.60 " - " 10,359.82 " - " 7,169.13 " - " 7,169.13 " - " 5,732.19 " - " 6,847.50 " - - " 6,867.21 " - - " 8,287.86 " " 10,359.82 " - - - " 8,300.00 " - - " 6,951.25 " - " 4,243.38 " " 7,781.25 " " 3,943.54 " " 4,640.74 " - 30612663 LEAD AICD NON-S/D LVL043 C1896 275 "$10,625.00" " 3,927.00 " - " 10,359.82 " - " 7,341.88 " - " 7,341.88 " - " 5,870.31 " - " 7,012.50 " - - " 7,032.69 " - - " 8,287.86 " " 10,359.82 " - - - " 8,500.00 " - - " 7,118.75 " - " 4,345.63 " " 7,968.75 " " 4,038.56 " " 4,752.56 " - 30612671 LEAD AICD NON-S/D LVL044 C1896 275 "$10,875.00" " 4,019.40 " - " 10,359.82 " - " 7,514.63 " - " 7,514.63 " - " 6,008.44 " - " 7,177.50 " - - " 7,198.16 " - - " 8,287.86 " " 10,359.82 " - - - " 8,700.00 " - - " 7,286.25 " - " 4,447.88 " " 8,156.25 " " 4,133.59 " " 4,864.39 " - 30612680 LEAD AICD NON-S/D LVL045 C1896 275 "$11,125.00" " 4,111.80 " - " 10,359.82 " - " 7,687.38 " - " 7,687.38 " - " 6,146.56 " - " 7,342.50 " - - " 7,363.64 " - - " 8,287.86 " " 10,359.82 " - - - " 8,900.00 " - - " 7,453.75 " - " 4,550.13 " " 8,343.75 " " 4,228.61 " " 4,976.21 " - 30612698 LEAD AICD NON-S/D LVL046 C1896 275 "$11,375.00" " 4,204.20 " - " 10,359.82 " - " 7,860.13 " - " 7,860.13 " - " 6,284.69 " - " 7,507.50 " - - " 7,529.11 " - - " 8,287.86 " " 10,359.82 " - - - " 9,100.00 " - - " 7,621.25 " - " 4,652.38 " " 8,531.25 " " 4,323.64 " " 5,088.04 " - 30612701 LEAD AICD NON-S/D LVL047 C1896 275 "$11,625.00" " 4,296.60 " - " 10,359.82 " - " 8,032.88 " - " 8,032.88 " - " 6,422.81 " - " 7,672.50 " - - " 7,694.59 " - - " 8,287.86 " " 10,359.82 " - - - " 9,300.00 " - - " 7,788.75 " - " 4,754.63 " " 8,718.75 " " 4,418.66 " " 5,199.86 " - 30612710 LEAD AICD NON-S/D LVL048 C1896 275 "$11,875.00" " 4,389.00 " - " 10,359.82 " - " 8,205.63 " - " 8,205.63 " - " 6,560.94 " - " 7,837.50 " - - " 7,860.06 " - - " 8,287.86 " " 10,359.82 " - - - " 9,500.00 " - - " 7,956.25 " - " 4,856.88 " " 8,906.25 " " 4,513.69 " " 5,311.69 " - 28111584 LEAD NEUROSTIM TEST KIT LVL003 C1897 278 $750.00 277.20 - " 1,577.17 " - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - " 1,261.74 " " 1,577.17 " - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 28111746 LEAD PMKR OTH N-TRANS LVL001 C1898 275 $200.00 73.92 - " 2,843.02 " - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - " 2,274.42 " " 2,843.02 " - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 29820996 LEAD PMKR OTH N-TRANS LVL001 C1898 275 $200.00 73.92 - " 2,843.02 " - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - " 2,274.42 " " 2,843.02 " - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 29821003 LEAD PMKR OTH N-TRANS LVL002 C1898 275 $450.00 166.32 - " 2,843.02 " - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - " 2,274.42 " " 2,843.02 " - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 29821011 LEAD PMKR OTH N-TRANS LVL003 C1898 275 $750.00 277.20 - " 2,843.02 " - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - " 2,274.42 " " 2,843.02 " - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 29821020 LEAD PMKR OTH N-TRANS LVL004 C1898 275 "$1,050.00" 388.08 - " 2,843.02 " - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - " 2,274.42 " " 2,843.02 " - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 30606183 LEAD PMKR OTH N-TRANS LVL001 C1898 275 $200.00 73.92 - " 2,843.02 " - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - " 2,274.42 " " 2,843.02 " - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 30606191 LEAD PMKR OTH N-TRANS LVL002 C1898 275 $450.00 166.32 - " 2,843.02 " - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - " 2,274.42 " " 2,843.02 " - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 30606205 LEAD PMKR OTH N-TRANS LVL005 C1898 275 "$1,350.00" 498.96 - " 2,843.02 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - " 2,274.42 " " 2,843.02 " - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 30606213 LEAD PMKR OTH N-TRANS LVL006 C1898 275 "$1,375.00" 508.20 - " 2,843.02 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - " 2,274.42 " " 2,843.02 " - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 30606221 LEAD PMKR OTH N-TRANS LVL007 C1898 275 "$1,625.00" 600.60 - " 2,843.02 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - " 2,274.42 " " 2,843.02 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 30606230 LEAD PMKR OTH N-TRANS LVL008 C1898 275 "$1,875.00" 693.00 - " 2,843.02 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - " 2,274.42 " " 2,843.02 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 30606248 LEAD PMKR OTH N-TRANS LVL009 C1898 275 "$2,125.00" 785.40 - " 2,843.02 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - " 2,274.42 " " 2,843.02 " - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 30610385 LEAD PMKR OTH N-TRANS LVL003 C1898 275 $750.00 277.20 - " 2,843.02 " - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - " 2,274.42 " " 2,843.02 " - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 30610393 LEAD PMKR OTH N-TRANS LVL004 C1898 275 "$1,050.00" 388.08 - " 2,843.02 " - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - " 2,274.42 " " 2,843.02 " - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 30610407 LEAD PMKR OTH N-TRANS LVL010 C1898 275 "$2,375.00" 877.80 - " 2,843.02 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - " 2,274.42 " " 2,843.02 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 30610415 LEAD PMKR OTH N-TRANS LVL011 C1898 275 "$2,625.00" 970.20 - " 2,843.02 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - " 2,274.42 " " 2,843.02 " - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 30610423 LEAD PMKR OTH N-TRANS LVL012 C1898 275 "$2,875.00" " 1,062.60 " - " 2,843.02 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - " 2,274.42 " " 2,843.02 " - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 30610431 LEAD PMKR OTH N-TRANS LVL013 C1898 275 "$3,125.00" " 1,155.00 " - " 2,843.02 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - " 2,274.42 " " 2,843.02 " - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 30610440 LEAD PMKR OTH N-TRANS LVL014 C1898 275 "$3,375.00" " 1,247.40 " - " 2,843.02 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - " 2,274.42 " " 2,843.02 " - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 30610458 LEAD PMKR OTH N-TRANS LVL015 C1898 275 "$3,625.00" " 1,339.80 " - " 2,900.00 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - " 2,274.42 " " 2,843.02 " - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 30606256 LEAD CORONOARY VENOUS LVL010 C1900 275 "$2,375.00" 877.80 - " 8,628.09 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - " 6,902.47 " " 8,628.09 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 30606264 LEAD CORONOARY VENOUS LVL011 C1900 275 "$2,625.00" 970.20 - " 8,628.09 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - " 6,902.47 " " 8,628.09 " - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 30606272 LEAD CORONOARY VENOUS LVL012 C1900 275 "$2,875.00" " 1,062.60 " - " 8,628.09 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - " 6,902.47 " " 8,628.09 " - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 30606281 LEAD CORONOARY VENOUS LVL013 C1900 275 "$3,125.00" " 1,155.00 " - " 8,628.09 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - " 6,902.47 " " 8,628.09 " - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 30606299 LEAD CORONOARY VENOUS LVL015 C1900 275 "$3,625.00" " 1,339.80 " - " 8,628.09 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - " 6,902.47 " " 8,628.09 " - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 30606302 LEAD CORONOARY VENOUS LVL017 C1900 275 "$4,125.00" " 1,524.60 " - " 8,628.09 " - " 2,850.38 " - " 2,850.38 " - " 2,279.06 " - " 2,722.50 " - - " 2,730.34 " - - " 6,902.47 " " 8,628.09 " - - - " 3,300.00 " - - " 2,763.75 " - " 1,687.13 " " 3,093.75 " " 1,567.91 " " 1,845.11 " - 30606311 LEAD CORONOARY VENOUS LVL018 C1900 275 "$4,375.00" " 1,617.00 " - " 8,628.09 " - " 3,023.13 " - " 3,023.13 " - " 2,417.19 " - " 2,887.50 " - - " 2,895.81 " - - " 6,902.47 " " 8,628.09 " - - - " 3,500.00 " - - " 2,931.25 " - " 1,789.38 " " 3,281.25 " " 1,662.94 " " 1,956.94 " - 30606329 LEAD CORONOARY VENOUS LVL019 C1900 275 "$4,625.00" " 1,709.40 " - " 8,628.09 " - " 3,195.88 " - " 3,195.88 " - " 2,555.31 " - " 3,052.50 " - - " 3,061.29 " - - " 6,902.47 " " 8,628.09 " - - - " 3,700.00 " - - " 3,098.75 " - " 1,891.63 " " 3,468.75 " " 1,757.96 " " 2,068.76 " - 30606337 LEAD CORONOARY VENOUS LVL022 C1900 275 "$5,375.00" " 1,986.60 " - " 8,628.09 " - " 3,714.13 " - " 3,714.13 " - " 2,969.69 " - " 3,547.50 " - - " 3,557.71 " - - " 6,902.47 " " 8,628.09 " - - - " 4,300.00 " - - " 3,601.25 " - " 2,198.38 " " 4,031.25 " " 2,043.04 " " 2,404.24 " - 30606345 LEAD CORONOARY VENOUS LVL023 C1900 275 "$5,625.00" " 2,079.00 " - " 8,628.09 " - " 3,886.88 " - " 3,886.88 " - " 3,107.81 " - " 3,712.50 " - - " 3,723.19 " - - " 6,902.47 " " 8,628.09 " - - - " 4,500.00 " - - " 3,768.75 " - " 2,300.63 " " 4,218.75 " " 2,138.06 " " 2,516.06 " - 30606353 LEAD CORONOARY VENOUS LVL025 C1900 275 "$6,125.00" " 2,263.80 " - " 8,628.09 " - " 4,232.38 " - " 4,232.38 " - " 3,384.06 " - " 4,042.50 " - - " 4,054.14 " - - " 6,902.47 " " 8,628.09 " - - - " 4,900.00 " - - " 4,103.75 " - " 2,505.13 " " 4,593.75 " " 2,328.11 " " 2,739.71 " - 30606361 LEAD CORONOARY VENOUS LVL026 C1900 275 "$6,375.00" " 2,356.20 " - " 8,628.09 " - " 4,405.13 " - " 4,405.13 " - " 3,522.19 " - " 4,207.50 " - - " 4,219.61 " - - " 6,902.47 " " 8,628.09 " - - - " 5,100.00 " - - " 4,271.25 " - " 2,607.38 " " 4,781.25 " " 2,423.14 " " 2,851.54 " - 30606370 LEAD CORONOARY VENOUS LVL027 C1900 275 "$6,625.00" " 2,448.60 " - " 8,628.09 " - " 4,577.88 " - " 4,577.88 " - " 3,660.31 " - " 4,372.50 " - - " 4,385.09 " - - " 6,902.47 " " 8,628.09 " - - - " 5,300.00 " - - " 4,438.75 " - " 2,709.63 " " 4,968.75 " " 2,518.16 " " 2,963.36 " - 30606388 LEAD CORONOARY VENOUS LVL028 C1900 275 "$6,875.00" " 2,541.00 " - " 8,628.09 " - " 4,750.63 " - " 4,750.63 " - " 3,798.44 " - " 4,537.50 " - - " 4,550.56 " - - " 6,902.47 " " 8,628.09 " - - - " 5,500.00 " - - " 4,606.25 " - " 2,811.88 " " 5,156.25 " " 2,613.19 " " 3,075.19 " - 30606396 LEAD CORONOARY VENOUS LVL033 C1900 275 "$8,125.00" " 3,003.00 " - " 8,628.09 " - " 5,614.38 " - " 5,614.38 " - " 4,489.06 " - " 5,362.50 " - - " 5,377.94 " - - " 6,902.47 " " 8,628.09 " - - - " 6,500.00 " - - " 5,443.75 " - " 3,323.13 " " 6,093.75 " " 3,088.31 " " 3,634.31 " - 30606400 LEAD CORONOARY VENOUS LVL034 C1900 275 "$8,375.00" " 3,095.40 " - " 8,628.09 " - " 5,787.13 " - " 5,787.13 " - " 4,627.19 " - " 5,527.50 " - - " 5,543.41 " - - " 6,902.47 " " 8,628.09 " - - - " 6,700.00 " - - " 5,611.25 " - " 3,425.38 " " 6,281.25 " " 3,183.34 " " 3,746.14 " - 30610521 LEAD CORONOARY VENOUS LVL014 C1900 275 "$3,375.00" " 1,247.40 " - " 8,628.09 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - " 6,902.47 " " 8,628.09 " - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 30610539 LEAD CORONOARY VENOUS LVL016 C1900 275 "$3,875.00" " 1,432.20 " - " 8,628.09 " - " 2,677.63 " - " 2,677.63 " - " 2,140.94 " - " 2,557.50 " - - " 2,564.86 " - - " 6,902.47 " " 8,628.09 " - - - " 3,100.00 " - - " 2,596.25 " - " 1,584.88 " " 2,906.25 " " 1,472.89 " " 1,733.29 " - 30610547 LEAD CORONOARY VENOUS LVL020 C1900 275 "$4,875.00" " 1,801.80 " - " 8,628.09 " - " 3,368.63 " - " 3,368.63 " - " 2,693.44 " - " 3,217.50 " - - " 3,226.76 " - - " 6,902.47 " " 8,628.09 " - - - " 3,900.00 " - - " 3,266.25 " - " 1,993.88 " " 3,656.25 " " 1,852.99 " " 2,180.59 " - 30610555 LEAD CORONOARY VENOUS LVL021 C1900 275 "$5,125.00" " 1,894.20 " - " 8,628.09 " - " 3,541.38 " - " 3,541.38 " - " 2,831.56 " - " 3,382.50 " - - " 3,392.24 " - - " 6,902.47 " " 8,628.09 " - - - " 4,100.00 " - - " 3,433.75 " - " 2,096.13 " " 3,843.75 " " 1,948.01 " " 2,292.41 " - 30610563 LEAD CORONOARY VENOUS LVL024 C1900 275 "$5,875.00" " 2,171.40 " - " 8,628.09 " - " 4,059.63 " - " 4,059.63 " - " 3,245.94 " - " 3,877.50 " - - " 3,888.66 " - - " 6,902.47 " " 8,628.09 " - - - " 4,700.00 " - - " 3,936.25 " - " 2,402.88 " " 4,406.25 " " 2,233.09 " " 2,627.89 " - 30610571 LEAD CORONOARY VENOUS LVL029 C1900 275 "$7,125.00" " 2,633.40 " - " 8,628.09 " - " 4,923.38 " - " 4,923.38 " - " 3,936.56 " - " 4,702.50 " - - " 4,716.04 " - - " 6,902.47 " " 8,628.09 " - - - " 5,700.00 " - - " 4,773.75 " - " 2,914.13 " " 5,343.75 " " 2,708.21 " " 3,187.01 " - 30610580 LEAD CORONOARY VENOUS LVL030 C1900 275 "$7,375.00" " 2,725.80 " - " 8,628.09 " - " 5,096.13 " - " 5,096.13 " - " 4,074.69 " - " 4,867.50 " - - " 4,881.51 " - - " 6,902.47 " " 8,628.09 " - - - " 5,900.00 " - - " 4,941.25 " - " 3,016.38 " " 5,531.25 " " 2,803.24 " " 3,298.84 " - 30610598 LEAD CORONOARY VENOUS LVL031 C1900 275 "$7,625.00" " 2,818.20 " - " 8,628.09 " - " 5,268.88 " - " 5,268.88 " - " 4,212.81 " - " 5,032.50 " - - " 5,046.99 " - - " 6,902.47 " " 8,628.09 " - - - " 6,100.00 " - - " 5,108.75 " - " 3,118.63 " " 5,718.75 " " 2,898.26 " " 3,410.66 " - 30610601 LEAD CORONOARY VENOUS LVL032 C1900 275 "$7,875.00" " 2,910.60 " - " 8,628.09 " - " 5,441.63 " - " 5,441.63 " - " 4,350.94 " - " 5,197.50 " - - " 5,212.46 " - - " 6,902.47 " " 8,628.09 " - - - " 6,300.00 " - - " 5,276.25 " - " 3,220.88 " " 5,906.25 " " 2,993.29 " " 3,522.49 " - 30610610 LEAD CORONOARY VENOUS LVL035 C1900 275 "$8,625.00" " 3,187.80 " - " 8,628.09 " - " 5,959.88 " - " 5,959.88 " - " 4,765.31 " - " 5,692.50 " - - " 5,708.89 " - - " 6,902.47 " " 8,628.09 " - - - " 6,900.00 " - - " 5,778.75 " - " 3,527.63 " " 6,468.75 " " 3,278.36 " " 3,857.96 " - 30610628 LEAD CORONOARY VENOUS LVL036 C1900 275 "$8,875.00" " 3,280.20 " - " 8,628.09 " - " 6,132.63 " - " 6,132.63 " - " 4,903.44 " - " 5,857.50 " - - " 5,874.36 " - - " 6,902.47 " " 8,628.09 " - - - " 7,100.00 " - - " 5,946.25 " - " 3,629.88 " " 6,656.25 " " 3,373.39 " " 3,969.79 " - 30610636 LEAD CORONOARY VENOUS LVL037 C1900 275 "$9,125.00" " 3,372.60 " - " 8,628.09 " - " 6,305.38 " - " 6,305.38 " - " 5,041.56 " - " 6,022.50 " - - " 6,039.84 " - - " 6,902.47 " " 8,628.09 " - - - " 7,300.00 " - - " 6,113.75 " - " 3,732.13 " " 6,843.75 " " 3,468.41 " " 4,081.61 " - 30610644 LEAD CORONOARY VENOUS LVL038 C1900 275 "$9,375.00" " 3,465.00 " - " 8,628.09 " - " 6,478.13 " - " 6,478.13 " - " 5,179.69 " - " 6,187.50 " - - " 6,205.31 " - - " 6,902.47 " " 8,628.09 " - - - " 7,500.00 " - - " 6,281.25 " - " 3,834.38 " " 7,031.25 " " 3,563.44 " " 4,193.44 " - 30610652 LEAD CORONOARY VENOUS LVL039 C1900 275 "$9,625.00" " 3,557.40 " - " 8,628.09 " - " 6,650.88 " - " 6,650.88 " - " 5,317.81 " - " 6,352.50 " - - " 6,370.79 " - - " 6,902.47 " " 8,628.09 " - - - " 7,700.00 " - - " 6,448.75 " - " 3,936.63 " " 7,218.75 " " 3,658.46 " " 4,305.26 " - 30610661 LEAD CORONOARY VENOUS LVL040 C1900 275 "$9,875.00" " 3,649.80 " - " 8,628.09 " - " 6,823.63 " - " 6,823.63 " - " 5,455.94 " - " 6,517.50 " - - " 6,536.26 " - - " 6,902.47 " " 8,628.09 " - - - " 7,900.00 " - - " 6,616.25 " - " 4,038.88 " " 7,406.25 " " 3,753.49 " " 4,417.09 " - 80365217 LUNG BX PLUG W/DEL SYS LVL003 C2613 278 "$1,125.00" 415.80 - 900.00 - 777.38 - 777.38 - 621.56 - 742.50 - - 744.64 - - 596.14 745.20 - - - 900.00 - - 753.75 - 460.13 843.75 427.61 503.21 - 80365225 LUNG BX PLUG W/DEL SYS LVL004 C2613 278 "$1,575.00" 582.12 - " 1,260.00 " - " 1,088.33 " - " 1,088.33 " - 870.19 - " 1,039.50 " - - " 1,042.49 " - - 834.59 " 1,043.28 " - - - " 1,260.00 " - - " 1,055.25 " - 644.18 " 1,181.25 " 598.66 704.50 - 80365233 LUNG BX PLUG W/DEL SYS LVL005 C2613 278 "$2,025.00" 748.44 - " 1,620.00 " - " 1,399.28 " - " 1,399.28 " - " 1,118.81 " - " 1,336.50 " - - " 1,340.35 " - - " 1,073.05 " " 1,341.36 " - - - " 1,620.00 " - - " 1,356.75 " - 828.23 " 1,518.75 " 769.70 905.78 - 80665211 LUNG BX PLUG W/DEL SYS LVL003 C2613 278 "$1,125.00" 415.80 - 900.00 - 777.38 - 777.38 - 621.56 - 742.50 - - 744.64 - - 596.14 745.20 - - - 900.00 - - 753.75 - 460.13 843.75 427.61 503.21 - 80665229 LUNG BX PLUG W/DEL SYS LVL004 C2613 278 "$1,575.00" 582.12 - " 1,260.00 " - " 1,088.33 " - " 1,088.33 " - 870.19 - " 1,039.50 " - - " 1,042.49 " - - 834.59 " 1,043.28 " - - - " 1,260.00 " - - " 1,055.25 " - 644.18 " 1,181.25 " 598.66 704.50 - 80665237 LUNG BX PLUG W/DEL SYS LVL005 C2613 278 "$2,025.00" 748.44 - " 1,620.00 " - " 1,399.28 " - " 1,399.28 " - " 1,118.81 " - " 1,336.50 " - - " 1,340.35 " - - " 1,073.05 " " 1,341.36 " - - - " 1,620.00 " - - " 1,356.75 " - 828.23 " 1,518.75 " 769.70 905.78 - 28113994 SEALANT PULM LIQ LVL006 C2615 278 "$1,375.00" 508.20 - " 1,100.00 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - 524.96 656.20 - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 28114028 SEALANT PULM LIQ LVL009 C2615 278 "$2,125.00" 785.40 - " 1,700.00 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - 524.96 656.20 - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 28115334 STENT N-COR TEM NO-DEL LVL002 C2617 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 238.46 298.08 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 28115393 STENT N-COR TEM NO-DEL LVL007 C2617 278 "$1,625.00" 600.60 - " 1,300.00 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - 861.09 " 1,076.40 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 28115415 STENT N-COR TEM NO-DEL LVL009 C2617 278 "$2,125.00" 785.40 - " 1,700.00 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - " 1,126.04 " " 1,407.60 " - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 28115423 STENT N-COR TEM NO-DEL LVL011 C2617 278 "$2,625.00" 970.20 - " 2,100.00 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - " 1,390.99 " " 1,738.80 " - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 80364636 STENT N-COR TEM NO-DEL LVL001 C2617 278 $200.00 73.92 - 160.00 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 105.98 132.48 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 80364644 STENT N-COR TEM NO-DEL LVL002 C2617 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 238.46 298.08 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 80364652 STENT N-COR TEM NO-DEL LVL003 C2617 278 $750.00 277.20 - 600.00 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 397.43 496.80 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 80364661 STENT N-COR TEM NO-DEL LVL004 C2617 278 "$1,050.00" 388.08 - 840.00 - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 556.40 695.52 - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 80364679 STENT N-COR TEM NO-DEL LVL005 C2617 278 "$1,350.00" 498.96 - " 1,080.00 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 715.37 894.24 - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 80364687 STENT N-COR TEM NO-DEL LVL006 C2617 278 "$1,375.00" 508.20 - " 1,100.00 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - 728.61 910.80 - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 80364695 STENT N-COR TEM NO-DEL LVL007 C2617 278 "$1,625.00" 600.60 - " 1,300.00 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - 861.09 " 1,076.40 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 28113072 PROBE/NDL CRYOBLATION LVL026 C2618 278 "$6,375.00" " 2,356.20 " - " 5,100.00 " - " 4,405.13 " - " 4,405.13 " - " 3,522.19 " - " 4,207.50 " - - " 4,219.61 " - - " 2,554.52 " " 3,193.15 " - - - " 5,100.00 " - - " 4,271.25 " - " 2,607.38 " " 4,781.25 " " 2,423.14 " " 2,851.54 " - 80364709 PROBE/NDL CRYOBLATION LVL004 C2618 278 "$1,050.00" 388.08 - " 3,193.15 " - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - " 2,554.52 " " 3,193.15 " - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 80364717 PROBE/NDL CRYOBLATION LVL005 C2618 278 "$1,350.00" 498.96 - " 3,193.15 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - " 2,554.52 " " 3,193.15 " - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 80364725 PROBE/NDL CRYOBLATION LVL006 C2618 278 "$1,375.00" 508.20 - " 3,193.15 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - " 2,554.52 " " 3,193.15 " - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 80364733 PROBE/NDL CRYOBLATION LVL007 C2618 278 "$1,625.00" 600.60 - " 3,193.15 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - " 2,554.52 " " 3,193.15 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 80364741 PROBE/NDL CRYOBLATION LVL008 C2618 278 "$1,875.00" 693.00 - " 3,193.15 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - " 2,554.52 " " 3,193.15 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 80364750 PROBE/NDL CRYOBLATION LVL009 C2618 278 "$2,125.00" 785.40 - " 3,193.15 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - " 2,554.52 " " 3,193.15 " - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 80364768 PROBE/NDL CRYOBLATION LVL010 C2618 278 "$2,375.00" 877.80 - " 3,193.15 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - " 2,554.52 " " 3,193.15 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 80364776 PROBE/NDL CRYOBLATION LVL011 C2618 278 "$2,625.00" 970.20 - " 3,193.15 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - " 2,554.52 " " 3,193.15 " - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 80364784 PROBE/NDL CRYOBLATION LVL012 C2618 278 "$2,875.00" " 1,062.60 " - " 3,193.15 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - " 2,554.52 " " 3,193.15 " - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 80364792 PROBE/NDL CRYOBLATION LVL013 C2618 278 "$5,625.00" " 2,079.00 " - " 4,500.00 " - " 3,886.88 " - " 3,886.88 " - " 3,107.81 " - " 3,712.50 " - - " 3,723.19 " - - " 2,554.52 " " 3,193.15 " - - - " 4,500.00 " - - " 3,768.75 " - " 2,300.63 " " 4,218.75 " " 2,138.06 " " 2,516.06 " - 80365730 PROBE/NDL CRYOBLATION LVL014 C2618 278 "$3,375.00" " 1,247.40 " - " 3,193.15 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - " 2,554.52 " " 3,193.15 " - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 80365748 PROBE/NDL CRYOBLATION LVL015 C2618 278 "$3,625.00" " 1,339.80 " - " 3,193.15 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - " 2,554.52 " " 3,193.15 " - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 80365756 PROBE/NDL CRYOBLATION LVL016 C2618 278 "$3,875.00" " 1,432.20 " - " 3,193.15 " - " 2,677.63 " - " 2,677.63 " - " 2,140.94 " - " 2,557.50 " - - " 2,564.86 " - - " 2,554.52 " " 3,193.15 " - - - " 3,100.00 " - - " 2,596.25 " - " 1,584.88 " " 2,906.25 " " 1,472.89 " " 1,733.29 " - 80664737 PROBE/NDL CRYOBLATION LVL007 C2618 278 "$1,625.00" 600.60 - " 3,193.15 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - " 2,554.52 " " 3,193.15 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 80664745 PROBE/NDL CRYOBLATION LVL008 C2618 278 "$1,875.00" 693.00 - " 3,193.15 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - " 2,554.52 " " 3,193.15 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 80664753 PROBE/NDL CRYOBLATION LVL009 C2618 278 "$2,125.00" 785.40 - " 3,193.15 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - " 2,554.52 " " 3,193.15 " - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 80664796 PROBE/NDL CRYOBLATION LVL013 C2618 278 "$5,625.00" " 2,079.00 " - " 4,500.00 " - " 3,886.88 " - " 3,886.88 " - " 3,107.81 " - " 3,712.50 " - - " 3,723.19 " - - " 2,554.52 " " 3,193.15 " - - - " 4,500.00 " - - " 3,768.75 " - " 2,300.63 " " 4,218.75 " " 2,138.06 " " 2,516.06 " - 30606418 PMKR NOT SING/DUAL IMP LVL045 C2621 275 "$11,125.00" " 4,111.80 " - " 22,820.82 " - " 7,687.38 " - " 7,687.38 " - " 6,146.56 " - " 7,342.50 " - - " 7,363.64 " - - " 18,256.66 " " 22,820.82 " - - - " 8,900.00 " - - " 7,453.75 " - " 4,550.13 " " 8,343.75 " " 4,228.61 " " 4,976.21 " - 30606426 PMKR NOT SING/DUAL IMP LVL046 C2621 275 "$11,375.00" " 4,204.20 " - " 22,820.82 " - " 7,860.13 " - " 7,860.13 " - " 6,284.69 " - " 7,507.50 " - - " 7,529.11 " - - " 18,256.66 " " 22,820.82 " - - - " 9,100.00 " - - " 7,621.25 " - " 4,652.38 " " 8,531.25 " " 4,323.64 " " 5,088.04 " - 30606434 PMKR NOT SING/DUAL IMP LVL047 C2621 275 "$11,625.00" " 4,296.60 " - " 22,820.82 " - " 8,032.88 " - " 8,032.88 " - " 6,422.81 " - " 7,672.50 " - - " 7,694.59 " - - " 18,256.66 " " 22,820.82 " - - - " 9,300.00 " - - " 7,788.75 " - " 4,754.63 " " 8,718.75 " " 4,418.66 " " 5,199.86 " - 30606442 PMKR NOT SING/DUAL IMP LVL052 C2621 275 "$12,875.00" " 4,758.60 " - " 22,820.82 " - " 8,896.63 " - " 8,896.63 " - " 7,113.44 " - " 8,497.50 " - - " 8,521.96 " - - " 18,256.66 " " 22,820.82 " - - - " 10,300.00 " - - " 8,626.25 " - " 5,265.88 " " 9,656.25 " " 4,893.79 " " 5,758.99 " - 30606451 PMKR NOT SING/DUAL IMP LVL053 C2621 275 "$13,125.00" " 4,851.00 " - " 22,820.82 " - " 9,069.38 " - " 9,069.38 " - " 7,251.56 " - " 8,662.50 " - - " 8,687.44 " - - " 18,256.66 " " 22,820.82 " - - - " 10,500.00 " - - " 8,793.75 " - " 5,368.13 " " 9,843.75 " " 4,988.81 " " 5,870.81 " - 30606469 PMKR NOT SING/DUAL IMP LVL054 C2621 275 "$13,375.00" " 4,943.40 " - " 22,820.82 " - " 9,242.13 " - " 9,242.13 " - " 7,389.69 " - " 8,827.50 " - - " 8,852.91 " - - " 18,256.66 " " 22,820.82 " - - - " 10,700.00 " - - " 8,961.25 " - " 5,470.38 " " 10,031.25 " " 5,083.84 " " 5,982.64 " - 30606477 PMKR NOT SING/DUAL IMP LVL061 C2621 275 "$15,125.00" " 5,590.20 " - " 22,820.82 " - " 10,451.38 " - " 10,451.38 " - " 8,356.56 " - " 9,982.50 " - - " 10,011.24 " - - " 18,256.66 " " 22,820.82 " - - - " 12,100.00 " - - " 10,133.75 " - " 6,186.13 " " 11,343.75 " " 5,749.01 " " 6,765.41 " - 30606485 PMKR NOT SING/DUAL IMP LVL062 C2621 275 "$15,375.00" " 5,682.60 " - " 22,820.82 " - " 10,624.13 " - " 10,624.13 " - " 8,494.69 " - " 10,147.50 " - - " 10,176.71 " - - " 18,256.66 " " 22,820.82 " - - - " 12,300.00 " - - " 10,301.25 " - " 6,288.38 " " 11,531.25 " " 5,844.04 " " 6,877.24 " - 30606493 PMKR NOT SING/DUAL IMP LVL063 C2621 275 "$15,625.00" " 5,775.00 " - " 22,820.82 " - " 10,796.88 " - " 10,796.88 " - " 8,632.81 " - " 10,312.50 " - - " 10,342.19 " - - " 18,256.66 " " 22,820.82 " - - - " 12,500.00 " - - " 10,468.75 " - " 6,390.63 " " 11,718.75 " " 5,939.06 " " 6,989.06 " - 30606507 PMKR NOT SING/DUAL IMP LVL064 C2621 275 "$15,875.00" " 5,867.40 " - " 22,820.82 " - " 10,969.63 " - " 10,969.63 " - " 8,770.94 " - " 10,477.50 " - - " 10,507.66 " - - " 18,256.66 " " 22,820.82 " - - - " 12,700.00 " - - " 10,636.25 " - " 6,492.88 " " 11,906.25 " " 6,034.09 " " 7,100.89 " - 30606515 PMKR NOT SING/DUAL IMP LVL065 C2621 275 "$16,125.00" " 5,959.80 " - " 22,820.82 " - " 11,142.38 " - " 11,142.38 " - " 8,909.06 " - " 10,642.50 " - - " 10,673.14 " - - " 18,256.66 " " 22,820.82 " - - - " 12,900.00 " - - " 10,803.75 " - " 6,595.13 " " 12,093.75 " " 6,129.11 " " 7,212.71 " - 30606523 PMKR NOT SING/DUAL IMP LVL071 C2621 275 "$17,625.00" " 6,514.20 " - " 22,820.82 " - " 12,178.88 " - " 12,178.88 " - " 9,737.81 " - " 11,632.50 " - - " 11,665.99 " - - " 18,256.66 " " 22,820.82 " - - - " 14,100.00 " - - " 11,808.75 " - " 7,208.63 " " 13,218.75 " " 6,699.26 " " 7,883.66 " - 30606531 PMKR NOT SING/DUAL IMP LVL072 C2621 275 "$17,875.00" " 6,606.60 " - " 22,820.82 " - " 12,351.63 " - " 12,351.63 " - " 9,875.94 " - " 11,797.50 " - - " 11,831.46 " - - " 18,256.66 " " 22,820.82 " - - - " 14,300.00 " - - " 11,976.25 " - " 7,310.88 " " 13,406.25 " " 6,794.29 " " 7,995.49 " - 30606540 PMKR NOT SING/DUAL IMP LVL073 C2621 275 "$18,125.00" " 6,699.00 " - " 22,820.82 " - " 12,524.38 " - " 12,524.38 " - " 10,014.06 " - " 11,962.50 " - - " 11,996.94 " - - " 18,256.66 " " 22,820.82 " - - - " 14,500.00 " - - " 12,143.75 " - " 7,413.13 " " 13,593.75 " " 6,889.31 " " 8,107.31 " - 30606558 PMKR NOT SING/DUAL IMP LVL074 C2621 275 "$18,375.00" " 6,791.40 " - " 22,820.82 " - " 12,697.13 " - " 12,697.13 " - " 10,152.19 " - " 12,127.50 " - - " 12,162.41 " - - " 18,256.66 " " 22,820.82 " - - - " 14,700.00 " - - " 12,311.25 " - " 7,515.38 " " 13,781.25 " " 6,984.34 " " 8,219.14 " - 30606566 PMKR NOT SING/DUAL IMP LVL075 C2621 275 "$18,625.00" " 6,883.80 " - " 22,820.82 " - " 12,869.88 " - " 12,869.88 " - " 10,290.31 " - " 12,292.50 " - - " 12,327.89 " - - " 18,256.66 " " 22,820.82 " - - - " 14,900.00 " - - " 12,478.75 " - " 7,617.63 " " 13,968.75 " " 7,079.36 " " 8,330.96 " - 30606574 PMKR NOT SING/DUAL IMP LVL076 C2621 275 "$18,875.00" " 6,976.20 " - " 22,820.82 " - " 13,042.63 " - " 13,042.63 " - " 10,428.44 " - " 12,457.50 " - - " 12,493.36 " - - " 18,256.66 " " 22,820.82 " - - - " 15,100.00 " - - " 12,646.25 " - " 7,719.88 " " 14,156.25 " " 7,174.39 " " 8,442.79 " - 30610679 PMKR NOT SING/DUAL IMP LVL048 C2621 275 "$11,875.00" " 4,389.00 " - " 22,820.82 " - " 8,205.63 " - " 8,205.63 " - " 6,560.94 " - " 7,837.50 " - - " 7,860.06 " - - " 18,256.66 " " 22,820.82 " - - - " 9,500.00 " - - " 7,956.25 " - " 4,856.88 " " 8,906.25 " " 4,513.69 " " 5,311.69 " - 30610687 PMKR NOT SING/DUAL IMP LVL049 C2621 275 "$12,125.00" " 4,481.40 " - " 22,820.82 " - " 8,378.38 " - " 8,378.38 " - " 6,699.06 " - " 8,002.50 " - - " 8,025.54 " - - " 18,256.66 " " 22,820.82 " - - - " 9,700.00 " - - " 8,123.75 " - " 4,959.13 " " 9,093.75 " " 4,608.71 " " 5,423.51 " - 30610695 PMKR NOT SING/DUAL IMP LVL050 C2621 275 "$12,375.00" " 4,573.80 " - " 22,820.82 " - " 8,551.13 " - " 8,551.13 " - " 6,837.19 " - " 8,167.50 " - - " 8,191.01 " - - " 18,256.66 " " 22,820.82 " - - - " 9,900.00 " - - " 8,291.25 " - " 5,061.38 " " 9,281.25 " " 4,703.74 " " 5,535.34 " - 30610709 PMKR NOT SING/DUAL IMP LVL051 C2621 275 "$12,625.00" " 4,666.20 " - " 22,820.82 " - " 8,723.88 " - " 8,723.88 " - " 6,975.31 " - " 8,332.50 " - - " 8,356.49 " - - " 18,256.66 " " 22,820.82 " - - - " 10,100.00 " - - " 8,458.75 " - " 5,163.63 " " 9,468.75 " " 4,798.76 " " 5,647.16 " - 30610717 PMKR NOT SING/DUAL IMP LVL055 C2621 275 "$13,625.00" " 5,035.80 " - " 22,820.82 " - " 9,414.88 " - " 9,414.88 " - " 7,527.81 " - " 8,992.50 " - - " 9,018.39 " - - " 18,256.66 " " 22,820.82 " - - - " 10,900.00 " - - " 9,128.75 " - " 5,572.63 " " 10,218.75 " " 5,178.86 " " 6,094.46 " - 30610725 PMKR NOT SING/DUAL IMP LVL056 C2621 275 "$13,875.00" " 5,128.20 " - " 22,820.82 " - " 9,587.63 " - " 9,587.63 " - " 7,665.94 " - " 9,157.50 " - - " 9,183.86 " - - " 18,256.66 " " 22,820.82 " - - - " 11,100.00 " - - " 9,296.25 " - " 5,674.88 " " 10,406.25 " " 5,273.89 " " 6,206.29 " - 30610733 PMKR NOT SING/DUAL IMP LVL057 C2621 275 "$14,125.00" " 5,220.60 " - " 22,820.82 " - " 9,760.38 " - " 9,760.38 " - " 7,804.06 " - " 9,322.50 " - - " 9,349.34 " - - " 18,256.66 " " 22,820.82 " - - - " 11,300.00 " - - " 9,463.75 " - " 5,777.13 " " 10,593.75 " " 5,368.91 " " 6,318.11 " - 30610741 PMKR NOT SING/DUAL IMP LVL058 C2621 275 "$14,375.00" " 5,313.00 " - " 22,820.82 " - " 9,933.13 " - " 9,933.13 " - " 7,942.19 " - " 9,487.50 " - - " 9,514.81 " - - " 18,256.66 " " 22,820.82 " - - - " 11,500.00 " - - " 9,631.25 " - " 5,879.38 " " 10,781.25 " " 5,463.94 " " 6,429.94 " - 30610750 PMKR NOT SING/DUAL IMP LVL059 C2621 275 "$14,625.00" " 5,405.40 " - " 22,820.82 " - " 10,105.88 " - " 10,105.88 " - " 8,080.31 " - " 9,652.50 " - - " 9,680.29 " - - " 18,256.66 " " 22,820.82 " - - - " 11,700.00 " - - " 9,798.75 " - " 5,981.63 " " 10,968.75 " " 5,558.96 " " 6,541.76 " - 30610768 PMKR NOT SING/DUAL IMP LVL060 C2621 275 "$14,875.00" " 5,497.80 " - " 22,820.82 " - " 10,278.63 " - " 10,278.63 " - " 8,218.44 " - " 9,817.50 " - - " 9,845.76 " - - " 18,256.66 " " 22,820.82 " - - - " 11,900.00 " - - " 9,966.25 " - " 6,083.88 " " 11,156.25 " " 5,653.99 " " 6,653.59 " - 30610776 PMKR NOT SING/DUAL IMP LVL066 C2621 275 "$16,375.00" " 6,052.20 " - " 22,820.82 " - " 11,315.13 " - " 11,315.13 " - " 9,047.19 " - " 10,807.50 " - - " 10,838.61 " - - " 18,256.66 " " 22,820.82 " - - - " 13,100.00 " - - " 10,971.25 " - " 6,697.38 " " 12,281.25 " " 6,224.14 " " 7,324.54 " - 30610784 PMKR NOT SING/DUAL IMP LVL067 C2621 275 "$16,625.00" " 6,144.60 " - " 22,820.82 " - " 11,487.88 " - " 11,487.88 " - " 9,185.31 " - " 10,972.50 " - - " 11,004.09 " - - " 18,256.66 " " 22,820.82 " - - - " 13,300.00 " - - " 11,138.75 " - " 6,799.63 " " 12,468.75 " " 6,319.16 " " 7,436.36 " - 30610792 PMKR NOT SING/DUAL IMP LVL068 C2621 275 "$16,875.00" " 6,237.00 " - " 22,820.82 " - " 11,660.63 " - " 11,660.63 " - " 9,323.44 " - " 11,137.50 " - - " 11,169.56 " - - " 18,256.66 " " 22,820.82 " - - - " 13,500.00 " - - " 11,306.25 " - " 6,901.88 " " 12,656.25 " " 6,414.19 " " 7,548.19 " - 30610806 PMKR NOT SING/DUAL IMP LVL069 C2621 275 "$17,125.00" " 6,329.40 " - " 22,820.82 " - " 11,833.38 " - " 11,833.38 " - " 9,461.56 " - " 11,302.50 " - - " 11,335.04 " - - " 18,256.66 " " 22,820.82 " - - - " 13,700.00 " - - " 11,473.75 " - " 7,004.13 " " 12,843.75 " " 6,509.21 " " 7,660.01 " - 30610814 PMKR NOT SING/DUAL IMP LVL070 C2621 275 "$17,375.00" " 6,421.80 " - " 22,820.82 " - " 12,006.13 " - " 12,006.13 " - " 9,599.69 " - " 11,467.50 " - - " 11,500.51 " - - " 18,256.66 " " 22,820.82 " - - - " 13,900.00 " - - " 11,641.25 " - " 7,106.38 " " 13,031.25 " " 6,604.24 " " 7,771.84 " - 30610822 PMKR NOT SING/DUAL IMP LVL077 C2621 275 "$19,125.00" " 7,068.60 " - " 22,820.82 " - " 13,215.38 " - " 13,215.38 " - " 10,566.56 " - " 12,622.50 " - - " 12,658.84 " - - " 18,256.66 " " 22,820.82 " - - - " 15,300.00 " - - " 12,813.75 " - " 7,822.13 " " 14,343.75 " " 7,269.41 " " 8,554.61 " - 30610831 PMKR NOT SING/DUAL IMP LVL078 C2621 275 "$19,375.00" " 7,161.00 " - " 22,820.82 " - " 13,388.13 " - " 13,388.13 " - " 10,704.69 " - " 12,787.50 " - - " 12,824.31 " - - " 18,256.66 " " 22,820.82 " - - - " 15,500.00 " - - " 12,981.25 " - " 7,924.38 " " 14,531.25 " " 7,364.44 " " 8,666.44 " - 30610849 PMKR NOT SING/DUAL IMP LVL079 C2621 275 "$19,625.00" " 7,253.40 " - " 22,820.82 " - " 13,560.88 " - " 13,560.88 " - " 10,842.81 " - " 12,952.50 " - - " 12,989.79 " - - " 18,256.66 " " 22,820.82 " - - - " 15,700.00 " - - " 13,148.75 " - " 8,026.63 " " 14,718.75 " " 7,459.46 " " 8,778.26 " - 30610857 PMKR NOT SING/DUAL IMP LVL080 C2621 275 "$19,875.00" " 7,345.80 " - " 22,820.82 " - " 13,733.63 " - " 13,733.63 " - " 10,980.94 " - " 13,117.50 " - - " 13,155.26 " - - " 18,256.66 " " 22,820.82 " - - - " 15,900.00 " - - " 13,316.25 " - " 8,128.88 " " 14,906.25 " " 7,554.49 " " 8,890.09 " - 28144172 CATH TRANS COATED LVL008 C2623 278 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - 993.56 " 1,242.00 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 28144237 CATH TRANS COATED LVL014 C2623 278 "$3,375.00" " 1,247.40 " - " 2,700.00 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - " 1,788.41 " " 2,235.60 " - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 28144253 CATH TRANS COATED LVL016 C2623 278 "$3,875.00" " 1,432.20 " - " 3,100.00 " - " 2,677.63 " - " 2,677.63 " - " 2,140.94 " - " 2,557.50 " - - " 2,564.86 " - - " 2,053.36 " " 2,566.80 " - - - " 3,100.00 " - - " 2,596.25 " - " 1,584.88 " " 2,906.25 " " 1,472.89 " " 1,733.29 " - 28144261 CATH TRANS COATED LVL017 C2623 278 "$4,125.00" " 1,524.60 " - " 3,300.00 " - " 2,850.38 " - " 2,850.38 " - " 2,279.06 " - " 2,722.50 " - - " 2,730.34 " - - " 2,185.84 " " 2,732.40 " - - - " 3,300.00 " - - " 2,763.75 " - " 1,687.13 " " 3,093.75 " " 1,567.91 " " 1,845.11 " - 28144351 CATH TRANS COATED LVL026 C2623 278 "$6,375.00" " 2,356.20 " - " 5,100.00 " - " 4,405.13 " - " 4,405.13 " - " 3,522.19 " - " 4,207.50 " - - " 4,219.61 " - - " 3,378.11 " " 4,222.80 " - - - " 5,100.00 " - - " 4,271.25 " - " 2,607.38 " " 4,781.25 " " 2,423.14 " " 2,851.54 " - 29814295 CATH TRANS COATED LVL010 C2623 278 "$2,375.00" 877.80 - " 1,900.00 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - " 1,258.51 " " 1,573.20 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 29814309 CATH TRANS COATED LVL011 C2623 278 "$2,625.00" 970.20 - " 2,100.00 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - " 1,390.99 " " 1,738.80 " - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 29814317 CATH TRANS COATED LVL012 C2623 278 "$2,875.00" " 1,062.60 " - " 2,300.00 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - " 1,523.46 " " 1,904.40 " - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 29814325 CATH TRANS COATED LVL013 C2623 278 "$3,125.00" " 1,155.00 " - " 2,500.00 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - " 1,655.94 " " 2,070.00 " - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 29814333 CATH TRANS COATED LVL014 C2623 278 "$3,375.00" " 1,247.40 " - " 2,700.00 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - " 1,788.41 " " 2,235.60 " - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 29814341 CATH TRANS COATED LVL015 C2623 278 "$3,625.00" " 1,339.80 " - " 2,900.00 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - " 1,920.89 " " 2,401.20 " - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 29814350 CATH TRANS COATED LVL016 C2623 278 "$3,875.00" " 1,432.20 " - " 3,100.00 " - " 2,677.63 " - " 2,677.63 " - " 2,140.94 " - " 2,557.50 " - - " 2,564.86 " - - " 2,053.36 " " 2,566.80 " - - - " 3,100.00 " - - " 2,596.25 " - " 1,584.88 " " 2,906.25 " " 1,472.89 " " 1,733.29 " - 29814368 CATH TRANS COATED LVL017 C2623 278 "$4,125.00" " 1,524.60 " - " 3,300.00 " - " 2,850.38 " - " 2,850.38 " - " 2,279.06 " - " 2,722.50 " - - " 2,730.34 " - - " 2,185.84 " " 2,732.40 " - - - " 3,300.00 " - - " 2,763.75 " - " 1,687.13 " " 3,093.75 " " 1,567.91 " " 1,845.11 " - 29814601 CATH TRANS COATED LVL019 C2623 278 "$4,625.00" " 1,709.40 " - " 3,700.00 " - " 3,195.88 " - " 3,195.88 " - " 2,555.31 " - " 3,052.50 " - - " 3,061.29 " - - " 2,450.79 " " 3,063.60 " - - - " 3,700.00 " - - " 3,098.75 " - " 1,891.63 " " 3,468.75 " " 1,757.96 " " 2,068.76 " - 29814619 CATH TRANS COATED LVL020 C2623 278 "$4,875.00" " 1,801.80 " - " 3,900.00 " - " 3,368.63 " - " 3,368.63 " - " 2,693.44 " - " 3,217.50 " - - " 3,226.76 " - - " 2,583.26 " " 3,229.20 " - - - " 3,900.00 " - - " 3,266.25 " - " 1,993.88 " " 3,656.25 " " 1,852.99 " " 2,180.59 " - 29814627 CATH TRANS COATED LVL021 C2623 278 "$5,125.00" " 1,894.20 " - " 4,100.00 " - " 3,541.38 " - " 3,541.38 " - " 2,831.56 " - " 3,382.50 " - - " 3,392.24 " - - " 2,715.74 " " 3,394.80 " - - - " 4,100.00 " - - " 3,433.75 " - " 2,096.13 " " 3,843.75 " " 1,948.01 " " 2,292.41 " - 29814635 CATH TRANS COATED LVL022 C2623 278 "$5,375.00" " 1,986.60 " - " 4,300.00 " - " 3,714.13 " - " 3,714.13 " - " 2,969.69 " - " 3,547.50 " - - " 3,557.71 " - - " 2,848.21 " " 3,560.40 " - - - " 4,300.00 " - - " 3,601.25 " - " 2,198.38 " " 4,031.25 " " 2,043.04 " " 2,404.24 " - 29814643 CATH TRANS COATED LVL023 C2623 278 "$5,625.00" " 2,079.00 " - " 4,500.00 " - " 3,886.88 " - " 3,886.88 " - " 3,107.81 " - " 3,712.50 " - - " 3,723.19 " - - " 2,980.69 " " 3,726.00 " - - - " 4,500.00 " - - " 3,768.75 " - " 2,300.63 " " 4,218.75 " " 2,138.06 " " 2,516.06 " - 29817359 CATH TRANS COATED LVL018 C2623 278 "$4,375.00" " 1,617.00 " - " 3,500.00 " - " 3,023.13 " - " 3,023.13 " - " 2,417.19 " - " 2,887.50 " - - " 2,895.81 " - - " 2,318.31 " " 2,898.00 " - - - " 3,500.00 " - - " 2,931.25 " - " 1,789.38 " " 3,281.25 " " 1,662.94 " " 1,956.94 " - 29817367 CATH TRANS COATED LVL024 C2623 278 "$5,875.00" " 2,171.40 " - " 4,700.00 " - " 4,059.63 " - " 4,059.63 " - " 3,245.94 " - " 3,877.50 " - - " 3,888.66 " - - " 3,113.16 " " 3,891.60 " - - - " 4,700.00 " - - " 3,936.25 " - " 2,402.88 " " 4,406.25 " " 2,233.09 " " 2,627.89 " - 29817375 CATH TRANS COATED LVL025 C2623 278 "$6,125.00" " 2,263.80 " - " 4,900.00 " - " 4,232.38 " - " 4,232.38 " - " 3,384.06 " - " 4,042.50 " - - " 4,054.14 " - - " 3,245.64 " " 4,057.20 " - - - " 4,900.00 " - - " 4,103.75 " - " 2,505.13 " " 4,593.75 " " 2,328.11 " " 2,739.71 " - 29820562 G150121 SURVEIL DRUG COAT BAL C2623 624 $1.00 0.37 - 0.80 - 0.69 - 0.69 - 0.55 - 0.66 - - 0.66 - - 0.53 0.66 - - - 0.80 - - 0.67 - 0.41 0.75 0.38 0.45 - 80363320 CATH TRANS COATED LVL010 C2623 278 "$2,375.00" 877.80 - " 1,900.00 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - " 1,258.51 " " 1,573.20 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 80363338 CATH TRANS COATED LVL011 C2623 278 "$2,625.00" 970.20 - " 2,100.00 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - " 1,390.99 " " 1,738.80 " - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 80363346 CATH TRANS COATED LVL012 C2623 278 "$2,875.00" " 1,062.60 " - " 2,300.00 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - " 1,523.46 " " 1,904.40 " - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 80363354 CATH TRANS COATED LVL013 C2623 278 "$3,125.00" " 1,155.00 " - " 2,500.00 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - " 1,655.94 " " 2,070.00 " - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 80363362 CATH TRANS COATED LVL014 C2623 278 "$3,375.00" " 1,247.40 " - " 2,700.00 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - " 1,788.41 " " 2,235.60 " - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 80363371 CATH TRANS COATED LVL015 C2623 278 "$3,625.00" " 1,339.80 " - " 2,900.00 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - " 1,920.89 " " 2,401.20 " - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 80363389 CATH TRANS COATED LVL016 C2623 278 "$3,875.00" " 1,432.20 " - " 3,100.00 " - " 2,677.63 " - " 2,677.63 " - " 2,140.94 " - " 2,557.50 " - - " 2,564.86 " - - " 2,053.36 " " 2,566.80 " - - - " 3,100.00 " - - " 2,596.25 " - " 1,584.88 " " 2,906.25 " " 1,472.89 " " 1,733.29 " - 80363397 CATH TRANS COATED LVL017 C2623 278 "$4,125.00" " 1,524.60 " - " 3,300.00 " - " 2,850.38 " - " 2,850.38 " - " 2,279.06 " - " 2,722.50 " - - " 2,730.34 " - - " 2,185.84 " " 2,732.40 " - - - " 3,300.00 " - - " 2,763.75 " - " 1,687.13 " " 3,093.75 " " 1,567.91 " " 1,845.11 " - 80363401 CATH TRANS COATED LVL018 C2623 278 "$4,375.00" " 1,617.00 " - " 3,500.00 " - " 3,023.13 " - " 3,023.13 " - " 2,417.19 " - " 2,887.50 " - - " 2,895.81 " - - " 2,318.31 " " 2,898.00 " - - - " 3,500.00 " - - " 2,931.25 " - " 1,789.38 " " 3,281.25 " " 1,662.94 " " 1,956.94 " - 80363419 CATH TRANS COATED LVL019 C2623 278 "$4,625.00" " 1,709.40 " - " 3,700.00 " - " 3,195.88 " - " 3,195.88 " - " 2,555.31 " - " 3,052.50 " - - " 3,061.29 " - - " 2,450.79 " " 3,063.60 " - - - " 3,700.00 " - - " 3,098.75 " - " 1,891.63 " " 3,468.75 " " 1,757.96 " " 2,068.76 " - 80363427 CATH TRANS COATED LVL020 C2623 278 "$4,875.00" " 1,801.80 " - " 3,900.00 " - " 3,368.63 " - " 3,368.63 " - " 2,693.44 " - " 3,217.50 " - - " 3,226.76 " - - " 2,583.26 " " 3,229.20 " - - - " 3,900.00 " - - " 3,266.25 " - " 1,993.88 " " 3,656.25 " " 1,852.99 " " 2,180.59 " - 80363435 CATH TRANS COATED LVL021 C2623 278 "$5,125.00" " 1,894.20 " - " 4,100.00 " - " 3,541.38 " - " 3,541.38 " - " 2,831.56 " - " 3,382.50 " - - " 3,392.24 " - - " 2,715.74 " " 3,394.80 " - - - " 4,100.00 " - - " 3,433.75 " - " 2,096.13 " " 3,843.75 " " 1,948.01 " " 2,292.41 " - 80363443 CATH TRANS COATED LVL022 C2623 278 "$5,375.00" " 1,986.60 " - " 4,300.00 " - " 3,714.13 " - " 3,714.13 " - " 2,969.69 " - " 3,547.50 " - - " 3,557.71 " - - " 2,848.21 " " 3,560.40 " - - - " 4,300.00 " - - " 3,601.25 " - " 2,198.38 " " 4,031.25 " " 2,043.04 " " 2,404.24 " - 28115431 STENT N-COR TEM W/DEL LVL010 C2625 278 "$2,375.00" 877.80 - " 1,900.00 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - " 1,258.51 " " 1,573.20 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 28115440 STENT N-COR TEM W/DEL LVL011 C2625 278 "$2,625.00" 970.20 - " 2,100.00 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - " 1,390.99 " " 1,738.80 " - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 28115458 STENT N-COR TEM W/DEL LVL012 C2625 278 "$2,875.00" " 1,062.60 " - " 2,300.00 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - " 1,523.46 " " 1,904.40 " - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 28115563 STENT N-COR TEM W/DEL LVL023 C2625 278 "$5,625.00" " 2,079.00 " - " 4,500.00 " - " 3,886.88 " - " 3,886.88 " - " 3,107.81 " - " 3,712.50 " - - " 3,723.19 " - - " 2,980.69 " " 3,726.00 " - - - " 4,500.00 " - - " 3,768.75 " - " 2,300.63 " " 4,218.75 " " 2,138.06 " " 2,516.06 " - 28132956 STENT N-COR TEM W/DEL LVL008 C2625 278 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - 993.56 " 1,242.00 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 28144415 STENT N-COR TEM W/DEL LVL002 C2625 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 238.46 298.08 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 34005273 STENT N-COR TEM W/DEL LVL002 C2625 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 238.46 298.08 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 80365004 STENT N-COR TEM W/DEL LVL001 C2625 278 $200.00 73.92 - 160.00 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 105.98 132.48 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 80365012 STENT N-COR TEM W/DEL LVL002 C2625 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 238.46 298.08 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 80365021 STENT N-COR TEM W/DEL LVL003 C2625 278 $750.00 277.20 - 600.00 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 397.43 496.80 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 80365039 STENT N-COR TEM W/DEL LVL004 C2625 278 "$1,050.00" 388.08 - 840.00 - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 556.40 695.52 - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 80365047 STENT N-COR TEM W/DEL LVL005 C2625 278 "$1,350.00" 498.96 - " 1,080.00 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 715.37 894.24 - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 80365055 STENT N-COR TEM W/DEL LVL006 C2625 278 "$1,375.00" 508.20 - " 1,100.00 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - 728.61 910.80 - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 80365063 STENT N-COR TEM W/DEL LVL007 C2625 278 "$1,625.00" 600.60 - " 1,300.00 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - 861.09 " 1,076.40 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 28144440 CATH SUPRAPUBIC/CYSTO LVL001 C2627 278 $200.00 73.92 - 387.21 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 309.77 387.21 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 28104375 CATH OCCLUSION LVL002 C2628 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 238.46 298.08 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 28104383 CATH OCCLUSION LVL003 C2628 278 $750.00 277.20 - 600.00 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 397.43 496.80 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 30611675 CATH OCCLUSION LVL001 C2628 278 $200.00 73.92 - 160.00 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 105.98 132.48 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 30611683 CATH OCCLUSION LVL002 C2628 278 $450.00 166.32 - 360.00 - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 238.46 298.08 - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 30611691 CATH OCCLUSION LVL003 C2628 278 $750.00 277.20 - 600.00 - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - 397.43 496.80 - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 30612426 CATH OCCLUSION LVL004 C2628 278 "$1,050.00" 388.08 - 840.00 - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 556.40 695.52 - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 30612434 CATH OCCLUSION LVL005 C2628 278 "$1,350.00" 498.96 - " 1,080.00 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 715.37 894.24 - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 30612442 CATH OCCLUSION LVL006 C2628 278 "$1,375.00" 508.20 - " 1,100.00 " - 950.13 - 950.13 - 759.69 - 907.50 - - 910.11 - - 728.61 910.80 - - - " 1,100.00 " - - 921.25 - 562.38 " 1,031.25 " 522.64 615.04 - 30612451 CATH OCCLUSION LVL007 C2628 278 "$1,625.00" 600.60 - " 1,300.00 " - " 1,122.88 " - " 1,122.88 " - 897.81 - " 1,072.50 " - - " 1,075.59 " - - 861.09 " 1,076.40 " - - - " 1,300.00 " - - " 1,088.75 " - 664.63 " 1,218.75 " 617.66 726.86 - 30612469 CATH OCCLUSION LVL008 C2628 278 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - 993.56 " 1,242.00 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 30612477 CATH OCCLUSION LVL009 C2628 278 "$2,125.00" 785.40 - " 1,700.00 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - " 1,126.04 " " 1,407.60 " - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 30612485 CATH OCCLUSION LVL010 C2628 278 "$2,375.00" 877.80 - " 1,900.00 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - " 1,258.51 " " 1,573.20 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 80362617 CATH OCCLUSION LVL008 C2628 278 "$1,875.00" 693.00 - " 1,500.00 " - " 1,295.63 " - " 1,295.63 " - " 1,035.94 " - " 1,237.50 " - - " 1,241.06 " - - 993.56 " 1,242.00 " - - - " 1,500.00 " - - " 1,256.25 " - 766.88 " 1,406.25 " 712.69 838.69 - 80362625 CATH OCCLUSION LVL009 C2628 278 "$2,125.00" 785.40 - " 1,700.00 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - " 1,126.04 " " 1,407.60 " - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 80362633 CATH OCCLUSION LVL010 C2628 278 "$2,375.00" 877.80 - " 1,900.00 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - " 1,258.51 " " 1,573.20 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 80362641 CATH OCCLUSION LVL011 C2628 278 "$2,625.00" 970.20 - " 2,100.00 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - " 1,390.99 " " 1,738.80 " - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 80362650 CATH OCCLUSION LVL012 C2628 278 "$2,875.00" " 1,062.60 " - " 2,300.00 " - " 1,986.63 " - " 1,986.63 " - " 1,588.44 " - " 1,897.50 " - - " 1,902.96 " - - " 1,523.46 " " 1,904.40 " - - - " 2,300.00 " - - " 1,926.25 " - " 1,175.88 " " 2,156.25 " " 1,092.79 " " 1,285.99 " - 80362668 CATH OCCLUSION LVL013 C2628 278 "$3,125.00" " 1,155.00 " - " 2,500.00 " - " 2,159.38 " - " 2,159.38 " - " 1,726.56 " - " 2,062.50 " - - " 2,068.44 " - - " 1,655.94 " " 2,070.00 " - - - " 2,500.00 " - - " 2,093.75 " - " 1,278.13 " " 2,343.75 " " 1,187.81 " " 1,397.81 " - 80362676 CATH OCCLUSION LVL014 C2628 278 "$3,375.00" " 1,247.40 " - " 2,700.00 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - " 1,788.41 " " 2,235.60 " - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 80362684 CATH OCCLUSION LVL015 C2628 278 "$3,625.00" " 1,339.80 " - " 2,900.00 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - " 1,920.89 " " 2,401.20 " - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 80362692 CATH OCCLUSION LVL016 C2628 278 "$3,875.00" " 1,432.20 " - " 3,100.00 " - " 2,677.63 " - " 2,677.63 " - " 2,140.94 " - " 2,557.50 " - - " 2,564.86 " - - " 2,053.36 " " 2,566.80 " - - - " 3,100.00 " - - " 2,596.25 " - " 1,584.88 " " 2,906.25 " " 1,472.89 " " 1,733.29 " - 80362706 CATH OCCLUSION LVL017 C2628 278 "$4,125.00" " 1,524.60 " - " 3,300.00 " - " 2,850.38 " - " 2,850.38 " - " 2,279.06 " - " 2,722.50 " - - " 2,730.34 " - - " 2,185.84 " " 2,732.40 " - - - " 3,300.00 " - - " 2,763.75 " - " 1,687.13 " " 3,093.75 " " 1,567.91 " " 1,845.11 " - 80362714 CATH OCCLUSION LVL018 C2628 278 "$4,375.00" " 1,617.00 " - " 3,500.00 " - " 3,023.13 " - " 3,023.13 " - " 2,417.19 " - " 2,887.50 " - - " 2,895.81 " - - " 2,318.31 " " 2,898.00 " - - - " 3,500.00 " - - " 2,931.25 " - " 1,789.38 " " 3,281.25 " " 1,662.94 " " 1,956.94 " - 80362722 CATH OCCLUSION LVL019 C2628 278 "$4,625.00" " 1,709.40 " - " 3,700.00 " - " 3,195.88 " - " 3,195.88 " - " 2,555.31 " - " 3,052.50 " - - " 3,061.29 " - - " 2,450.79 " " 3,063.60 " - - - " 3,700.00 " - - " 3,098.75 " - " 1,891.63 " " 3,468.75 " " 1,757.96 " " 2,068.76 " - 80362731 CATH OCCLUSION LVL020 C2628 278 "$4,875.00" " 1,801.80 " - " 3,900.00 " - " 3,368.63 " - " 3,368.63 " - " 2,693.44 " - " 3,217.50 " - - " 3,226.76 " - - " 2,583.26 " " 3,229.20 " - - - " 3,900.00 " - - " 3,266.25 " - " 1,993.88 " " 3,656.25 " " 1,852.99 " " 2,180.59 " - 80362749 CATH OCCLUSION LVL021 C2628 278 "$5,125.00" " 1,894.20 " - " 4,100.00 " - " 3,541.38 " - " 3,541.38 " - " 2,831.56 " - " 3,382.50 " - - " 3,392.24 " - - " 2,715.74 " " 3,394.80 " - - - " 4,100.00 " - - " 3,433.75 " - " 2,096.13 " " 3,843.75 " " 1,948.01 " " 2,292.41 " - 30612329 INTRO SHEATH LASER LVL031 C2629 278 "$7,625.00" " 2,818.20 " - " 6,100.00 " - " 5,268.88 " - " 5,268.88 " - " 4,212.81 " - " 5,032.50 " - - " 5,046.99 " - - " 1,724.76 " " 2,155.95 " - - - " 6,100.00 " - - " 5,108.75 " - " 3,118.63 " " 5,718.75 " " 2,898.26 " " 3,410.66 " - 30612868 INTRO SHEATH LASER LVL027 C2629 278 "$6,625.00" " 2,448.60 " - " 5,300.00 " - " 4,577.88 " - " 4,577.88 " - " 3,660.31 " - " 4,372.50 " - - " 4,385.09 " - - " 1,724.76 " " 2,155.95 " - - - " 5,300.00 " - - " 4,438.75 " - " 2,709.63 " " 4,968.75 " " 2,518.16 " " 2,963.36 " - 30612876 INTRO SHEATH LASER LVL028 C2629 278 "$6,875.00" " 2,541.00 " - " 5,500.00 " - " 4,750.63 " - " 4,750.63 " - " 3,798.44 " - " 4,537.50 " - - " 4,550.56 " - - " 1,724.76 " " 2,155.95 " - - - " 5,500.00 " - - " 4,606.25 " - " 2,811.88 " " 5,156.25 " " 2,613.19 " " 3,075.19 " - 30612884 INTRO SHEATH LASER LVL029 C2629 278 "$7,125.00" " 2,633.40 " - " 5,700.00 " - " 4,923.38 " - " 4,923.38 " - " 3,936.56 " - " 4,702.50 " - - " 4,716.04 " - - " 1,724.76 " " 2,155.95 " - - - " 5,700.00 " - - " 4,773.75 " - " 2,914.13 " " 5,343.75 " " 2,708.21 " " 3,187.01 " - 30612892 INTRO SHEATH LASER LVL030 C2629 278 "$7,375.00" " 2,725.80 " - " 5,900.00 " - " 5,096.13 " - " 5,096.13 " - " 4,074.69 " - " 4,867.50 " - - " 4,881.51 " - - " 1,724.76 " " 2,155.95 " - - - " 5,900.00 " - - " 4,941.25 " - " 3,016.38 " " 5,531.25 " " 2,803.24 " " 3,298.84 " - 28144776 INF PUMP NON-PROG IMP LVL003 C2630 278 $750.00 277.20 - " 3,025.47 " - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - " 2,420.38 " " 3,025.47 " - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 30611730 CATH EP COOL-TIP LVL015 C2630 278 "$3,625.00" " 1,339.80 " - " 3,025.47 " - " 2,504.88 " - " 2,504.88 " - " 2,002.81 " - " 2,392.50 " - - " 2,399.39 " - - " 2,420.38 " " 3,025.47 " - - - " 2,900.00 " - - " 2,428.75 " - " 1,482.63 " " 2,718.75 " " 1,377.86 " " 1,621.46 " - 30611748 CATH EP COOL-TIP LVL016 C2630 278 "$3,875.00" " 1,432.20 " - " 3,100.00 " - " 2,677.63 " - " 2,677.63 " - " 2,140.94 " - " 2,557.50 " - - " 2,564.86 " - - " 2,420.38 " " 3,025.47 " - - - " 3,100.00 " - - " 2,596.25 " - " 1,584.88 " " 2,906.25 " " 1,472.89 " " 1,733.29 " - 30611756 CATH EP COOL-TIP LVL017 C2630 278 "$4,125.00" " 1,524.60 " - " 3,300.00 " - " 2,850.38 " - " 2,850.38 " - " 2,279.06 " - " 2,722.50 " - - " 2,730.34 " - - " 2,420.38 " " 3,025.47 " - - - " 3,300.00 " - - " 2,763.75 " - " 1,687.13 " " 3,093.75 " " 1,567.91 " " 1,845.11 " - 30611764 CATH EP COOL-TIP LVL018 C2630 278 "$4,375.00" " 1,617.00 " - " 3,500.00 " - " 3,023.13 " - " 3,023.13 " - " 2,417.19 " - " 2,887.50 " - - " 2,895.81 " - - " 2,420.38 " " 3,025.47 " - - - " 3,500.00 " - - " 2,931.25 " - " 1,789.38 " " 3,281.25 " " 1,662.94 " " 1,956.94 " - 30611772 CATH EP COOL-TIP LVL019 C2630 278 "$4,625.00" " 1,709.40 " - " 3,700.00 " - " 3,195.88 " - " 3,195.88 " - " 2,555.31 " - " 3,052.50 " - - " 3,061.29 " - - " 2,420.38 " " 3,025.47 " - - - " 3,700.00 " - - " 3,098.75 " - " 1,891.63 " " 3,468.75 " " 1,757.96 " " 2,068.76 " - 30611781 CATH EP COOL-TIP LVL020 C2630 278 "$4,875.00" " 1,801.80 " - " 3,900.00 " - " 3,368.63 " - " 3,368.63 " - " 2,693.44 " - " 3,217.50 " - - " 3,226.76 " - - " 2,420.38 " " 3,025.47 " - - - " 3,900.00 " - - " 3,266.25 " - " 1,993.88 " " 3,656.25 " " 1,852.99 " " 2,180.59 " - 30611799 CATH EP COOL-TIP LVL021 C2630 278 "$5,125.00" " 1,894.20 " - " 4,100.00 " - " 3,541.38 " - " 3,541.38 " - " 2,831.56 " - " 3,382.50 " - - " 3,392.24 " - - " 2,420.38 " " 3,025.47 " - - - " 4,100.00 " - - " 3,433.75 " - " 2,096.13 " " 3,843.75 " " 1,948.01 " " 2,292.41 " - 30611802 CATH EP COOL-TIP LVL022 C2630 278 "$5,375.00" " 1,986.60 " - " 4,300.00 " - " 3,714.13 " - " 3,714.13 " - " 2,969.69 " - " 3,547.50 " - - " 3,557.71 " - - " 2,420.38 " " 3,025.47 " - - - " 4,300.00 " - - " 3,601.25 " - " 2,198.38 " " 4,031.25 " " 2,043.04 " " 2,404.24 " - 30611811 CATH EP COOL-TIP LVL023 C2630 278 "$5,625.00" " 2,079.00 " - " 4,500.00 " - " 3,886.88 " - " 3,886.88 " - " 3,107.81 " - " 3,712.50 " - - " 3,723.19 " - - " 2,420.38 " " 3,025.47 " - - - " 4,500.00 " - - " 3,768.75 " - " 2,300.63 " " 4,218.75 " " 2,138.06 " " 2,516.06 " - 30611829 CATH EP COOL-TIP LVL024 C2630 278 "$5,875.00" " 2,171.40 " - " 4,700.00 " - " 4,059.63 " - " 4,059.63 " - " 3,245.94 " - " 3,877.50 " - - " 3,888.66 " - - " 2,420.38 " " 3,025.47 " - - - " 4,700.00 " - - " 3,936.25 " - " 2,402.88 " " 4,406.25 " " 2,233.09 " " 2,627.89 " - 30611837 CATH EP COOL-TIP LVL025 C2630 278 "$6,125.00" " 2,263.80 " - " 4,900.00 " - " 4,232.38 " - " 4,232.38 " - " 3,384.06 " - " 4,042.50 " - - " 4,054.14 " - - " 2,420.38 " " 3,025.47 " - - - " 4,900.00 " - - " 4,103.75 " - " 2,505.13 " " 4,593.75 " " 2,328.11 " " 2,739.71 " - 30611845 CATH EP COOL-TIP LVL026 C2630 278 "$6,375.00" " 2,356.20 " - " 5,100.00 " - " 4,405.13 " - " 4,405.13 " - " 3,522.19 " - " 4,207.50 " - - " 4,219.61 " - - " 2,420.38 " " 3,025.47 " - - - " 5,100.00 " - - " 4,271.25 " - " 2,607.38 " " 4,781.25 " " 2,423.14 " " 2,851.54 " - 30612001 CATH EP COOL-TIP LVL035 C2630 278 "$8,625.00" " 3,187.80 " - " 6,900.00 " - " 5,959.88 " - " 5,959.88 " - " 4,765.31 " - " 5,692.50 " - - " 5,708.89 " - - " 2,420.38 " " 3,025.47 " - - - " 6,900.00 " - - " 5,778.75 " - " 3,527.63 " " 6,468.75 " " 3,278.36 " " 3,857.96 " - 30612906 CATH EP COOL-TIP LVL027 C2630 278 "$6,625.00" " 2,448.60 " - " 5,300.00 " - " 4,577.88 " - " 4,577.88 " - " 3,660.31 " - " 4,372.50 " - - " 4,385.09 " - - " 2,420.38 " " 3,025.47 " - - - " 5,300.00 " - - " 4,438.75 " - " 2,709.63 " " 4,968.75 " " 2,518.16 " " 2,963.36 " - 30612914 CATH EP COOL-TIP LVL028 C2630 278 "$6,875.00" " 2,541.00 " - " 5,500.00 " - " 4,750.63 " - " 4,750.63 " - " 3,798.44 " - " 4,537.50 " - - " 4,550.56 " - - " 2,420.38 " " 3,025.47 " - - - " 5,500.00 " - - " 4,606.25 " - " 2,811.88 " " 5,156.25 " " 2,613.19 " " 3,075.19 " - 30612922 CATH EP COOL-TIP LVL029 C2630 278 "$7,125.00" " 2,633.40 " - " 5,700.00 " - " 4,923.38 " - " 4,923.38 " - " 3,936.56 " - " 4,702.50 " - - " 4,716.04 " - - " 2,420.38 " " 3,025.47 " - - - " 5,700.00 " - - " 4,773.75 " - " 2,914.13 " " 5,343.75 " " 2,708.21 " " 3,187.01 " - 30612931 CATH EP COOL-TIP LVL030 C2630 278 "$7,375.00" " 2,725.80 " - " 5,900.00 " - " 5,096.13 " - " 5,096.13 " - " 4,074.69 " - " 4,867.50 " - - " 4,881.51 " - - " 2,420.38 " " 3,025.47 " - - - " 5,900.00 " - - " 4,941.25 " - " 3,016.38 " " 5,531.25 " " 2,803.24 " " 3,298.84 " - 30612949 CATH EP COOL-TIP LVL031 C2630 278 "$7,625.00" " 2,818.20 " - " 6,100.00 " - " 5,268.88 " - " 5,268.88 " - " 4,212.81 " - " 5,032.50 " - - " 5,046.99 " - - " 2,420.38 " " 3,025.47 " - - - " 6,100.00 " - - " 5,108.75 " - " 3,118.63 " " 5,718.75 " " 2,898.26 " " 3,410.66 " - 30612957 CATH EP COOL-TIP LVL032 C2630 278 "$7,875.00" " 2,910.60 " - " 6,300.00 " - " 5,441.63 " - " 5,441.63 " - " 4,350.94 " - " 5,197.50 " - - " 5,212.46 " - - " 2,420.38 " " 3,025.47 " - - - " 6,300.00 " - - " 5,276.25 " - " 3,220.88 " " 5,906.25 " " 2,993.29 " " 3,522.49 " - 30612965 CATH EP COOL-TIP LVL033 C2630 278 "$8,125.00" " 3,003.00 " - " 6,500.00 " - " 5,614.38 " - " 5,614.38 " - " 4,489.06 " - " 5,362.50 " - - " 5,377.94 " - - " 2,420.38 " " 3,025.47 " - - - " 6,500.00 " - - " 5,443.75 " - " 3,323.13 " " 6,093.75 " " 3,088.31 " " 3,634.31 " - 30612973 CATH EP COOL-TIP LVL034 C2630 278 "$8,375.00" " 3,095.40 " - " 6,700.00 " - " 5,787.13 " - " 5,787.13 " - " 4,627.19 " - " 5,527.50 " - - " 5,543.41 " - - " 2,420.38 " " 3,025.47 " - - - " 6,700.00 " - - " 5,611.25 " - " 3,425.38 " " 6,281.25 " " 3,183.34 " " 3,746.14 " - 51600550 LC SKNSUB TAL 100+/ADDL 25SQCM C5274 510 "$1,871.00" 691.52 - " 1,496.80 " - " 1,469.00 " - " 1,469.00 " - " 1,033.73 " - " 1,234.86 " - - " 1,238.41 " - - - - - - - " 1,496.80 " - - " 1,253.57 " - 765.24 " 1,403.25 " 711.17 836.90 - 51600584 LC SKN SUB HFG 100+/25SQCM/< C5277 510 "$2,752.00" " 1,017.14 " - " 2,201.60 " - " 1,718.00 " 546.27 " 1,718.00 " - " 1,520.48 " 535.87 " 1,775.00 " - - " 1,821.55 " 468.23 520.26 643.66 804.58 533.27 535.87 520.26 " 2,201.60 " 476.04 - " 1,843.84 " 457.83 " 1,125.57 " " 2,064.00 " " 1,046.04 " " 1,230.97 " 538.47 51600592 LC SKN SUB HFG 100+/ADD 25SQCM C5278 510 "$2,610.00" 964.66 - " 2,088.00 " - " 1,469.00 " - " 1,469.00 " - " 1,442.03 " - " 1,722.60 " - - " 1,727.56 " - - - - - - - " 2,088.00 " - - " 1,748.70 " - " 1,067.49 " " 1,957.50 " 992.06 " 1,167.45 " - 80407670 MRA ABDOMEN W/CONTRAST C8900 618 "$1,933.00" 714.44 - " 2,882.00 " - " 2,882.00 " 384.09 " 2,882.00 " - " 1,067.98 " 376.77 " 1,155.00 " - - " 1,279.45 " 329.22 365.80 756.65 945.81 374.95 376.77 365.80 " 1,546.40 " 334.71 - 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81407673 MRA ABDOMEN W/CONTRAST C8900 618 "$1,933.00" 714.44 - " 2,882.00 " - " 2,882.00 " 384.09 " 2,882.00 " - " 1,067.98 " 376.77 " 1,155.00 " - - " 1,279.45 " 329.22 365.80 756.65 945.81 374.95 376.77 365.80 " 1,546.40 " 334.71 - 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81607672 MRA ABDOMEN W/CONTRAST C8900 618 "$1,933.00" 714.44 - " 2,882.00 " - " 2,882.00 " 384.09 " 2,882.00 " - " 1,067.98 " 376.77 " 1,155.00 " - - " 1,279.45 " 329.22 365.80 756.65 945.81 374.95 376.77 365.80 " 1,546.40 " 334.71 - 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 80407441 MRA ABDOMEN W/O CONTRAST C8901 618 "$1,208.00" 446.48 - " 2,882.00 " - " 2,882.00 " 240.00 " 2,882.00 " - 667.42 235.43 " 1,155.00 " - - 799.58 205.71 228.57 611.31 764.14 234.28 235.43 228.57 966.40 209.14 - 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81407444 MRA ABDOMEN W/O CONTRAST C8901 618 "$1,208.00" 446.48 - " 2,882.00 " - " 2,882.00 " 240.00 " 2,882.00 " - 667.42 235.43 " 1,155.00 " - - 799.58 205.71 228.57 611.31 764.14 234.28 235.43 228.57 966.40 209.14 - 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81607443 MRA ABDOMEN W/O CONTRAST C8901 618 "$1,208.00" 446.48 - " 2,882.00 " - " 2,882.00 " 240.00 " 2,882.00 " - 667.42 235.43 " 1,155.00 " - - 799.58 205.71 228.57 611.31 764.14 234.28 235.43 228.57 966.40 209.14 - 602.94 201.14 494.07 906.00 459.16 540.34 236.57 80407688 MRA ABDOMEN WO/W CONTRAST C8902 618 "$1,933.00" 714.44 - " 2,882.00 " - " 2,882.00 " 384.09 " 2,882.00 " - " 1,067.98 " 376.77 " 1,155.00 " - - " 1,279.45 " 329.22 365.80 893.77 " 1,117.21 " 374.95 376.77 365.80 " 1,546.40 " 334.71 - 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81407681 MRA ABDOMEN WO/W CONTRAST C8902 618 "$1,933.00" 714.44 - " 2,882.00 " - " 2,882.00 " 384.09 " 2,882.00 " - " 1,067.98 " 376.77 " 1,155.00 " - - " 1,279.45 " 329.22 365.80 893.77 " 1,117.21 " 374.95 376.77 365.80 " 1,546.40 " 334.71 - 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81607681 MRA ABDOMEN WO/W CONTRAST C8902 618 "$1,933.00" 714.44 - " 2,882.00 " - " 2,882.00 " 384.09 " 2,882.00 " - " 1,067.98 " 376.77 " 1,155.00 " - - " 1,279.45 " 329.22 365.80 893.77 " 1,117.21 " 374.95 376.77 365.80 " 1,546.40 " 334.71 - 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 80407491 MRI BREAST UNI W/CONTRAST C8903 614 $937.00 346.32 - " 2,882.00 " - " 2,882.00 " 186.31 " 2,882.00 " - 517.69 182.76 " 1,155.00 " - - 620.20 159.70 177.44 756.65 945.81 181.88 182.76 177.44 749.60 162.36 - 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81407495 MRI BREAST UNI W/CONTRAST C8903 614 $937.00 346.32 - " 2,882.00 " - " 2,882.00 " 186.31 " 2,882.00 " - 517.69 182.76 " 1,155.00 " - - 620.20 159.70 177.44 756.65 945.81 181.88 182.76 177.44 749.60 162.36 - 467.80 156.15 383.23 702.75 356.15 419.12 183.65 81607494 MRI BREAST UNI W/CONTRAST C8903 614 $937.00 346.32 - " 2,882.00 " - " 2,882.00 " 186.31 " 2,882.00 " - 517.69 182.76 " 1,155.00 " - - 620.20 159.70 177.44 756.65 945.81 181.88 182.76 177.44 749.60 162.36 - 467.80 156.15 383.23 702.75 356.15 419.12 183.65 80407505 MRI BREAST UNI WO/W CONTRAST C8905 614 "$1,933.00" 714.44 - " 2,882.00 " - " 2,882.00 " 384.09 " 2,882.00 " - " 1,067.98 " 376.77 " 1,155.00 " - - " 1,279.45 " 329.22 365.80 893.77 " 1,117.21 " 374.95 376.77 365.80 " 1,546.40 " 334.71 - 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81407509 MRI BREAST UNI WO/W CONTRAST C8905 614 "$1,933.00" 714.44 - " 2,882.00 " - " 2,882.00 " 384.09 " 2,882.00 " - " 1,067.98 " 376.77 " 1,155.00 " - - " 1,279.45 " 329.22 365.80 893.77 " 1,117.21 " 374.95 376.77 365.80 " 1,546.40 " 334.71 - 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81607508 MRI BREAST UNI WO/W CONTRAST C8905 614 "$1,933.00" 714.44 - " 2,882.00 " - " 2,882.00 " 384.09 " 2,882.00 " - " 1,067.98 " 376.77 " 1,155.00 " - - " 1,279.45 " 329.22 365.80 893.77 " 1,117.21 " 374.95 376.77 365.80 " 1,546.40 " 334.71 - 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 80407521 MRI BREAST BILAT W/CONTRAST C8906 614 "$1,933.00" 714.44 - " 2,882.00 " - " 2,882.00 " 384.09 " 2,882.00 " - " 1,067.98 " 376.77 " 1,155.00 " - - " 1,279.45 " 329.22 365.80 756.65 945.81 374.95 376.77 365.80 " 1,546.40 " 334.71 - 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81407525 MRI BREAST BILAT W/CONTRAST C8906 614 "$1,933.00" 714.44 - " 2,882.00 " - " 2,882.00 " 384.09 " 2,882.00 " - " 1,067.98 " 376.77 " 1,155.00 " - - " 1,279.45 " 329.22 365.80 756.65 945.81 374.95 376.77 365.80 " 1,546.40 " 334.71 - 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81607524 MRI BREAST BILAT W/CONTRAST C8906 614 "$1,933.00" 714.44 - " 2,882.00 " - " 2,882.00 " 384.09 " 2,882.00 " - " 1,067.98 " 376.77 " 1,155.00 " - - " 1,279.45 " 329.22 365.80 756.65 945.81 374.95 376.77 365.80 " 1,546.40 " 334.71 - 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 80407530 MRI BREAST BILAT WO/W CONTRAST C8908 614 "$1,933.00" 714.44 - " 2,882.00 " - " 2,882.00 " 384.09 " 2,882.00 " - " 1,067.98 " 376.77 " 1,155.00 " - - " 1,279.45 " 329.22 365.80 893.77 " 1,117.21 " 374.95 376.77 365.80 " 1,546.40 " 334.71 - 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81407533 MRI BREAST BILAT WO/W CONTRAST C8908 614 "$1,933.00" 714.44 - " 2,882.00 " - " 2,882.00 " 384.09 " 2,882.00 " - " 1,067.98 " 376.77 " 1,155.00 " - - " 1,279.45 " 329.22 365.80 893.77 " 1,117.21 " 374.95 376.77 365.80 " 1,546.40 " 334.71 - 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81607532 MRI BREAST BILAT WO/W CONTRAST C8908 614 "$1,933.00" 714.44 - " 2,882.00 " - " 2,882.00 " 384.09 " 2,882.00 " - " 1,067.98 " 376.77 " 1,155.00 " - - " 1,279.45 " 329.22 365.80 893.77 " 1,117.21 " 374.95 376.77 365.80 " 1,546.40 " 334.71 - 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 80407637 MRA CHEST W/CONTRAST C8909 618 "$1,933.00" 714.44 - " 2,882.00 " - " 2,882.00 " 384.09 " 2,882.00 " - " 1,067.98 " 376.77 " 1,155.00 " - - " 1,279.45 " 329.22 365.80 756.65 945.81 374.95 376.77 365.80 " 1,546.40 " 334.71 - 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81407631 MRA CHEST W/CONTRAST C8909 618 "$1,933.00" 714.44 - " 2,882.00 " - " 2,882.00 " 384.09 " 2,882.00 " - " 1,067.98 " 376.77 " 1,155.00 " - - " 1,279.45 " 329.22 365.80 756.65 945.81 374.95 376.77 365.80 " 1,546.40 " 334.71 - 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81607630 MRA CHEST W/CONTRAST C8909 618 "$1,933.00" 714.44 - " 2,882.00 " - " 2,882.00 " 384.09 " 2,882.00 " - " 1,067.98 " 376.77 " 1,155.00 " - - " 1,279.45 " 329.22 365.80 756.65 945.81 374.95 376.77 365.80 " 1,546.40 " 334.71 - 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 80407131 MRA CHEST W/O CONTRAST C8910 618 "$1,208.00" 446.48 - " 2,882.00 " - " 2,882.00 " 240.00 " 2,882.00 " - 667.42 235.43 " 1,155.00 " - - 799.58 205.71 228.57 611.31 764.14 234.28 235.43 228.57 966.40 209.14 - 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81407134 MRA CHEST W/O CONTRAST C8910 618 "$1,208.00" 446.48 - " 2,882.00 " - " 2,882.00 " 240.00 " 2,882.00 " - 667.42 235.43 " 1,155.00 " - - 799.58 205.71 228.57 611.31 764.14 234.28 235.43 228.57 966.40 209.14 - 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81607133 MRA CHEST W/O CONTRAST C8910 618 "$1,208.00" 446.48 - " 2,882.00 " - " 2,882.00 " 240.00 " 2,882.00 " - 667.42 235.43 " 1,155.00 " - - 799.58 205.71 228.57 611.31 764.14 234.28 235.43 228.57 966.40 209.14 - 602.94 201.14 494.07 906.00 459.16 540.34 236.57 80407645 MRA CHEST WO/W CONTRAST C8911 618 "$1,933.00" 714.44 - " 2,882.00 " - " 2,882.00 " 384.09 " 2,882.00 " - " 1,067.98 " 376.77 " 1,155.00 " - - " 1,279.45 " 329.22 365.80 893.77 " 1,117.21 " 374.95 376.77 365.80 " 1,546.40 " 334.71 - 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81407649 MRA CHEST WO/W CONTRAST C8911 618 "$1,933.00" 714.44 - " 2,882.00 " - " 2,882.00 " 384.09 " 2,882.00 " - " 1,067.98 " 376.77 " 1,155.00 " - - " 1,279.45 " 329.22 365.80 893.77 " 1,117.21 " 374.95 376.77 365.80 " 1,546.40 " 334.71 - 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81607648 MRA CHEST WO/W CONTRAST C8911 618 "$1,933.00" 714.44 - " 2,882.00 " - " 2,882.00 " 384.09 " 2,882.00 " - " 1,067.98 " 376.77 " 1,155.00 " - - " 1,279.45 " 329.22 365.80 893.77 " 1,117.21 " 374.95 376.77 365.80 " 1,546.40 " 334.71 - 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 80407653 MRA LOWER EXTR W/CONTRAST C8912 616 "$1,933.00" 714.44 - " 2,882.00 " - " 2,882.00 " 384.09 " 2,882.00 " - " 1,067.98 " 376.77 " 1,155.00 " - - " 1,279.45 " 329.22 365.80 756.65 945.81 374.95 376.77 365.80 " 1,546.40 " 334.71 - 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81407657 MRA LOWER EXTR W/CONTRAST C8912 616 "$1,933.00" 714.44 - " 2,882.00 " - " 2,882.00 " 384.09 " 2,882.00 " - " 1,067.98 " 376.77 " 1,155.00 " - - " 1,279.45 " 329.22 365.80 756.65 945.81 374.95 376.77 365.80 " 1,546.40 " 334.71 - 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81607656 MRA LOWER EXTR W/CONTRAST C8912 616 "$1,933.00" 714.44 - " 2,882.00 " - " 2,882.00 " 384.09 " 2,882.00 " - " 1,067.98 " 376.77 " 1,155.00 " - - " 1,279.45 " 329.22 365.80 756.65 945.81 374.95 376.77 365.80 " 1,546.40 " 334.71 - 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 80407408 MRA LOWER EXTR W/O CONTRAST C8913 616 "$1,208.00" 446.48 - " 2,882.00 " - " 2,882.00 " 240.00 " 2,882.00 " - 667.42 235.43 " 1,155.00 " - - 799.58 205.71 228.57 611.31 764.14 234.28 235.43 228.57 966.40 209.14 - 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81407401 MRA LOWER EXTR W/O CONTRAST C8913 616 "$1,208.00" 446.48 - " 2,882.00 " - " 2,882.00 " 240.00 " 2,882.00 " - 667.42 235.43 " 1,155.00 " - - 799.58 205.71 228.57 611.31 764.14 234.28 235.43 228.57 966.40 209.14 - 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81607401 MRA LOWER EXTR W/O CONTRAST C8913 616 "$1,208.00" 446.48 - " 2,882.00 " - " 2,882.00 " 240.00 " 2,882.00 " - 667.42 235.43 " 1,155.00 " - - 799.58 205.71 228.57 611.31 764.14 234.28 235.43 228.57 966.40 209.14 - 602.94 201.14 494.07 906.00 459.16 540.34 236.57 80407661 MRA LOWER EXTR WO/W CONTRAST C8914 616 "$1,933.00" 714.44 - " 2,882.00 " - " 2,882.00 " 384.09 " 2,882.00 " - " 1,067.98 " 376.77 " 1,155.00 " - - " 1,279.45 " 329.22 365.80 893.77 " 1,117.21 " 374.95 376.77 365.80 " 1,546.40 " 334.71 - 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81407665 MRA LOWER EXTR WO/W CONTRAST C8914 616 "$1,933.00" 714.44 - " 2,882.00 " - " 2,882.00 " 384.09 " 2,882.00 " - " 1,067.98 " 376.77 " 1,155.00 " - - " 1,279.45 " 329.22 365.80 893.77 " 1,117.21 " 374.95 376.77 365.80 " 1,546.40 " 334.71 - 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 80407751 MRA PELVIS W/CONTRAST C8918 618 "$1,933.00" 714.44 - " 2,882.00 " - " 2,882.00 " 384.09 " 2,882.00 " - " 1,067.98 " 376.77 " 1,155.00 " - - " 1,279.45 " 329.22 365.80 756.65 945.81 374.95 376.77 365.80 " 1,546.40 " 334.71 - 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81407754 MRA PELVIS W/CONTRAST C8918 618 "$1,933.00" 714.44 - " 2,882.00 " - " 2,882.00 " 384.09 " 2,882.00 " - " 1,067.98 " 376.77 " 1,155.00 " - - " 1,279.45 " 329.22 365.80 756.65 945.81 374.95 376.77 365.80 " 1,546.40 " 334.71 - 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81607753 MRA PELVIS W/CONTRAST C8918 618 "$1,933.00" 714.44 - " 2,882.00 " - " 2,882.00 " 384.09 " 2,882.00 " - " 1,067.98 " 376.77 " 1,155.00 " - - " 1,279.45 " 329.22 365.80 756.65 945.81 374.95 376.77 365.80 " 1,546.40 " 334.71 - 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 80407271 MRA PELVIS W/O CONTRAST C8919 618 "$1,208.00" 446.48 - " 2,882.00 " - " 2,882.00 " 240.00 " 2,882.00 " - 667.42 235.43 " 1,155.00 " - - 799.58 205.71 228.57 611.31 764.14 234.28 235.43 228.57 966.40 209.14 - 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81407274 MRA PELVIS W/O CONTRAST C8919 618 "$1,208.00" 446.48 - " 2,882.00 " - " 2,882.00 " 240.00 " 2,882.00 " - 667.42 235.43 " 1,155.00 " - - 799.58 205.71 228.57 611.31 764.14 234.28 235.43 228.57 966.40 209.14 - 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81607273 MRA PELVIS W/O CONTRAST C8919 618 "$1,208.00" 446.48 - " 2,882.00 " - " 2,882.00 " 240.00 " 2,882.00 " - 667.42 235.43 " 1,155.00 " - - 799.58 205.71 228.57 611.31 764.14 234.28 235.43 228.57 966.40 209.14 - 602.94 201.14 494.07 906.00 459.16 540.34 236.57 80407769 MRA PELVIS WO/W CONTRAST C8920 618 "$1,933.00" 714.44 - " 2,882.00 " - " 2,882.00 " 384.09 " 2,882.00 " - " 1,067.98 " 376.77 " 1,155.00 " - - " 1,279.45 " 329.22 365.80 893.77 " 1,117.21 " 374.95 376.77 365.80 " 1,546.40 " 334.71 - 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81407762 MRA PELVIS WO/W CONTRAST C8920 618 "$1,933.00" 714.44 - " 2,882.00 " - " 2,882.00 " 384.09 " 2,882.00 " - " 1,067.98 " 376.77 " 1,155.00 " - - " 1,279.45 " 329.22 365.80 893.77 " 1,117.21 " 374.95 376.77 365.80 " 1,546.40 " 334.71 - 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81607761 MRA PELVIS WO/W CONTRAST C8920 618 "$1,933.00" 714.44 - " 2,882.00 " - " 2,882.00 " 384.09 " 2,882.00 " - " 1,067.98 " 376.77 " 1,155.00 " - - " 1,279.45 " 329.22 365.80 893.77 " 1,117.21 " 374.95 376.77 365.80 " 1,546.40 " 334.71 - 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 05938457 TTE W/WO/W CONTRAST CONG CPL C8921 480 "$3,755.00" " 1,387.85 " - " 3,004.00 " - " 2,594.71 " 746.21 " 2,594.71 " - " 2,074.64 " 732.00 " 2,478.30 " - - " 2,485.43 " 639.61 710.68 " 1,854.46 " " 2,318.08 " 728.45 732.00 710.68 " 3,004.00 " 650.27 - " 2,515.85 " 625.40 " 1,535.80 " " 2,816.25 " " 1,427.28 " " 1,679.61 " 735.55 30100581 TTE W/WO/W CONTRAST CONG CPL C8921 480 "$3,755.00" " 1,387.85 " - " 3,004.00 " - " 2,594.71 " 746.21 " 2,594.71 " - " 2,074.64 " 732.00 " 2,478.30 " - - " 2,485.43 " 639.61 710.68 " 1,854.46 " " 2,318.08 " 728.45 732.00 710.68 " 3,004.00 " 650.27 - " 2,515.85 " 625.40 " 1,535.80 " " 2,816.25 " " 1,427.28 " " 1,679.61 " 735.55 05938465 TTE W/WO/W CONTRAST CONG LTD C8922 480 "$3,755.00" " 1,387.85 " - " 3,004.00 " - " 2,594.71 " 746.21 " 2,594.71 " - " 2,074.64 " 732.00 " 2,478.30 " - - " 2,485.43 " 639.61 710.68 " 1,352.05 " " 1,690.06 " 728.45 732.00 710.68 " 3,004.00 " 650.27 - " 2,515.85 " 625.40 " 1,535.80 " " 2,816.25 " " 1,427.28 " " 1,679.61 " 735.55 30100590 TTE W/WO/W CONTRAST CONG LTD C8922 480 "$3,755.00" " 1,387.85 " - " 3,004.00 " - " 2,594.71 " 746.21 " 2,594.71 " - " 2,074.64 " 732.00 " 2,478.30 " - - " 2,485.43 " 639.61 710.68 " 1,352.05 " " 1,690.06 " 728.45 732.00 710.68 " 3,004.00 " 650.27 - " 2,515.85 " 625.40 " 1,535.80 " " 2,816.25 " " 1,427.28 " " 1,679.61 " 735.55 05938392 2D TTE W/WO/W CONTRAST CPL C8923 480 "$3,755.00" " 1,387.85 " - " 3,004.00 " - " 2,594.71 " 746.21 " 2,594.71 " - " 2,074.64 " 732.00 " 2,478.30 " - - " 2,485.43 " 639.61 710.68 " 1,352.05 " " 1,690.06 " 728.45 732.00 710.68 " 3,004.00 " 650.27 - " 2,515.85 " 625.40 " 1,535.80 " " 2,816.25 " " 1,427.28 " " 1,679.61 " 735.55 30100719 2D TTE W/WO/W CONTRAST CPL C8923 480 "$3,755.00" " 1,387.85 " - " 3,004.00 " - " 2,594.71 " 746.21 " 2,594.71 " - " 2,074.64 " 732.00 " 2,478.30 " - - " 2,485.43 " 639.61 710.68 " 1,352.05 " " 1,690.06 " 728.45 732.00 710.68 " 3,004.00 " 650.27 - " 2,515.85 " 625.40 " 1,535.80 " " 2,816.25 " " 1,427.28 " " 1,679.61 " 735.55 05938406 2D TTE W/WO/W CONTRAST LTD C8924 480 "$1,933.00" 714.44 - " 1,690.06 " - " 1,335.70 " 384.09 " 1,335.70 " - " 1,067.98 " 376.77 " 1,275.78 " - - " 1,279.45 " 329.22 365.80 " 1,352.05 " " 1,690.06 " 374.95 376.77 365.80 " 1,546.40 " 334.71 - " 1,295.11 " 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 30100476 2D TTE W/WO/W CONTRAST LTD C8924 480 "$1,933.00" 714.44 - " 1,690.06 " - " 1,335.70 " 384.09 " 1,335.70 " - " 1,067.98 " 376.77 " 1,275.78 " - - " 1,279.45 " 329.22 365.80 " 1,352.05 " " 1,690.06 " 374.95 376.77 365.80 " 1,546.40 " 334.71 - " 1,295.11 " 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 05938414 2D TTE W/WO/W W/DOBUT W/O SUP C8928 480 "$3,755.00" " 1,387.85 " - " 3,004.00 " - " 2,594.71 " 746.21 " 2,594.71 " - " 2,074.64 " 732.00 " 2,478.30 " - - " 2,485.43 " 639.61 710.68 " 1,854.46 " " 2,318.08 " 728.45 732.00 710.68 " 3,004.00 " 650.27 - " 2,515.85 " 625.40 " 1,535.80 " " 2,816.25 " " 1,427.28 " " 1,679.61 " 735.55 05938422 2D TTE W/WO/W EXERCISE W/O SUP C8928 480 "$3,755.00" " 1,387.85 " - " 3,004.00 " - " 2,594.71 " 746.21 " 2,594.71 " - " 2,074.64 " 732.00 " 2,478.30 " - - " 2,485.43 " 639.61 710.68 " 1,854.46 " " 2,318.08 " 728.45 732.00 710.68 " 3,004.00 " 650.27 - " 2,515.85 " 625.40 " 1,535.80 " " 2,816.25 " " 1,427.28 " " 1,679.61 " 735.55 30100484 2D TTE W/WO/W W/DOBUT W/O SUP C8928 480 "$3,755.00" " 1,387.85 " - " 3,004.00 " - " 2,594.71 " 746.21 " 2,594.71 " - " 2,074.64 " 732.00 " 2,478.30 " - - " 2,485.43 " 639.61 710.68 " 1,854.46 " " 2,318.08 " 728.45 732.00 710.68 " 3,004.00 " 650.27 - " 2,515.85 " 625.40 " 1,535.80 " " 2,816.25 " " 1,427.28 " " 1,679.61 " 735.55 30100506 2D TTE W/WO/W EXERCISE W/O SUP C8928 480 "$3,755.00" " 1,387.85 " - " 3,004.00 " - " 2,594.71 " 746.21 " 2,594.71 " - " 2,074.64 " 732.00 " 2,478.30 " - - " 2,485.43 " 639.61 710.68 " 1,854.46 " " 2,318.08 " 728.45 732.00 710.68 " 3,004.00 " 650.27 - " 2,515.85 " 625.40 " 1,535.80 " " 2,816.25 " " 1,427.28 " " 1,679.61 " 735.55 05938384 2D TTE W/WO/W CONT W/DOP/CF C8929 480 "$3,755.00" " 1,387.85 " - " 3,004.00 " - " 2,594.71 " 746.21 " 2,594.71 " - " 2,074.64 " 732.00 " 2,478.30 " - - " 2,485.43 " 639.61 710.68 " 1,854.46 " " 2,318.08 " 728.45 732.00 710.68 " 3,004.00 " 650.27 - " 2,515.85 " 625.40 " 1,535.80 " " 2,816.25 " " 1,427.28 " " 1,679.61 " 735.55 30100468 2D TTE W/WO/W CONT W/DOP/CF C8929 480 "$3,755.00" " 1,387.85 " - " 3,004.00 " - " 2,594.71 " 746.21 " 2,594.71 " - " 2,074.64 " 732.00 " 2,478.30 " - - " 2,485.43 " 639.61 710.68 " 1,854.46 " " 2,318.08 " 728.45 732.00 710.68 " 3,004.00 " 650.27 - " 2,515.85 " 625.40 " 1,535.80 " " 2,816.25 " " 1,427.28 " " 1,679.61 " 735.55 05938431 2D TTE W/WO/W EXERCISE W/SUP C8930 480 "$3,755.00" " 1,387.85 " - " 3,004.00 " - " 2,594.71 " 746.21 " 2,594.71 " - " 2,074.64 " 732.00 " 2,478.30 " - - " 2,485.43 " 639.61 710.68 " 1,854.46 " " 2,318.08 " 728.45 732.00 710.68 " 3,004.00 " 650.27 - " 2,515.85 " 625.40 " 1,535.80 " " 2,816.25 " " 1,427.28 " " 1,679.61 " 735.55 05938449 2D TTE W/WO/W W/DOBUT W/SUP C8930 480 "$3,755.00" " 1,387.85 " - " 3,004.00 " - " 2,594.71 " 746.21 " 2,594.71 " - " 2,074.64 " 732.00 " 2,478.30 " - - " 2,485.43 " 639.61 710.68 " 1,854.46 " " 2,318.08 " 728.45 732.00 710.68 " 3,004.00 " 650.27 - " 2,515.85 " 625.40 " 1,535.80 " " 2,816.25 " " 1,427.28 " " 1,679.61 " 735.55 30100492 2D TTE W/WO/W EXERCISE W/SUP C8930 480 "$3,755.00" " 1,387.85 " - " 3,004.00 " - " 2,594.71 " 746.21 " 2,594.71 " - " 2,074.64 " 732.00 " 2,478.30 " - - " 2,485.43 " 639.61 710.68 " 1,854.46 " " 2,318.08 " 728.45 732.00 710.68 " 3,004.00 " 650.27 - " 2,515.85 " 625.40 " 1,535.80 " " 2,816.25 " " 1,427.28 " " 1,679.61 " 735.55 30100514 2D TTE W/WO/W W/DOBUT W/SUP C8930 480 "$3,755.00" " 1,387.85 " - " 3,004.00 " - " 2,594.71 " 746.21 " 2,594.71 " - " 2,074.64 " 732.00 " 2,478.30 " - - " 2,485.43 " 639.61 710.68 " 1,854.46 " " 2,318.08 " 728.45 732.00 710.68 " 3,004.00 " 650.27 - " 2,515.85 " 625.40 " 1,535.80 " " 2,816.25 " " 1,427.28 " " 1,679.61 " 735.55 80407939 MRA SPINAL CONTENTS W/CONTRAST C8931 618 "$1,933.00" 714.44 - " 2,882.00 " - " 2,882.00 " 384.09 " 2,882.00 " - " 1,067.98 " 376.77 " 1,155.00 " - - " 1,279.45 " 329.22 365.80 756.65 945.81 374.95 376.77 365.80 " 1,546.40 " 334.71 - 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81407932 MRA SPINAL CONTENTS W/CONTRAST C8931 618 "$1,933.00" 714.44 - " 2,882.00 " - " 2,882.00 " 384.09 " 2,882.00 " - " 1,067.98 " 376.77 " 1,155.00 " - - " 1,279.45 " 329.22 365.80 756.65 945.81 374.95 376.77 365.80 " 1,546.40 " 334.71 - 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 80407921 MRA SPINAL CONTENTS W/O CONT C8932 618 "$1,208.00" 446.48 - " 2,882.00 " - " 2,882.00 " 240.00 " 2,882.00 " - 667.42 235.43 " 1,155.00 " - - 799.58 205.71 228.57 611.31 764.14 234.28 235.43 228.57 966.40 209.14 - 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81407924 MRA SPINAL CONTENTS W/O CONT C8932 618 "$1,208.00" 446.48 - " 2,882.00 " - " 2,882.00 " 240.00 " 2,882.00 " - 667.42 235.43 " 1,155.00 " - - 799.58 205.71 228.57 611.31 764.14 234.28 235.43 228.57 966.40 209.14 - 602.94 201.14 494.07 906.00 459.16 540.34 236.57 80407947 MRA SPINAL CONTENTS WO/W CONT C8933 618 "$1,933.00" 714.44 - " 2,882.00 " - " 2,882.00 " 384.09 " 2,882.00 " - " 1,067.98 " 376.77 " 1,155.00 " - - " 1,279.45 " 329.22 365.80 893.77 " 1,117.21 " 374.95 376.77 365.80 " 1,546.40 " 334.71 - 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81407941 MRA SPINAL CONTENTS WO/W CONT C8933 618 "$1,933.00" 714.44 - " 2,882.00 " - " 2,882.00 " 384.09 " 2,882.00 " - " 1,067.98 " 376.77 " 1,155.00 " - - " 1,279.45 " 329.22 365.80 893.77 " 1,117.21 " 374.95 376.77 365.80 " 1,546.40 " 334.71 - 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 80407904 MRA UPPER EXTR W/CONTRAST C8934 618 "$1,933.00" 714.44 - " 2,882.00 " - " 2,882.00 " 384.09 " 2,882.00 " - " 1,067.98 " 376.77 " 1,155.00 " - - " 1,279.45 " 329.22 365.80 756.65 945.81 374.95 376.77 365.80 " 1,546.40 " 334.71 - 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81407908 MRA UPPER EXTR W/CONTRAST C8934 618 "$1,933.00" 714.44 - " 2,882.00 " - " 2,882.00 " 384.09 " 2,882.00 " - " 1,067.98 " 376.77 " 1,155.00 " - - " 1,279.45 " 329.22 365.80 756.65 945.81 374.95 376.77 365.80 " 1,546.40 " 334.71 - 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81607907 MRA UPPER EXTR W/CONTRAST C8934 618 "$1,933.00" 714.44 - " 2,882.00 " - " 2,882.00 " 384.09 " 2,882.00 " - " 1,067.98 " 376.77 " 1,155.00 " - - " 1,279.45 " 329.22 365.80 756.65 945.81 374.95 376.77 365.80 " 1,546.40 " 334.71 - 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 80407891 MRA UPPER EXTR W/O CONTRAST C8935 618 "$1,208.00" 446.48 - " 2,882.00 " - " 2,882.00 " 240.00 " 2,882.00 " - 667.42 235.43 " 1,155.00 " - - 799.58 205.71 228.57 611.31 764.14 234.28 235.43 228.57 966.40 209.14 - 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81407894 MRA UPPER EXTR W/O CONTRAST C8935 618 "$1,208.00" 446.48 - " 2,882.00 " - " 2,882.00 " 240.00 " 2,882.00 " - 667.42 235.43 " 1,155.00 " - - 799.58 205.71 228.57 611.31 764.14 234.28 235.43 228.57 966.40 209.14 - 602.94 201.14 494.07 906.00 459.16 540.34 236.57 81607893 MRA UPPER EXTR W/O CONTRAST C8935 618 "$1,208.00" 446.48 - " 2,882.00 " - " 2,882.00 " 240.00 " 2,882.00 " - 667.42 235.43 " 1,155.00 " - - 799.58 205.71 228.57 611.31 764.14 234.28 235.43 228.57 966.40 209.14 - 602.94 201.14 494.07 906.00 459.16 540.34 236.57 80407912 MRA UPPER EXTR WO/W CONTRAST C8936 618 "$1,933.00" 714.44 - " 2,882.00 " - " 2,882.00 " 384.09 " 2,882.00 " - " 1,067.98 " 376.77 " 1,155.00 " - - " 1,279.45 " 329.22 365.80 893.77 " 1,117.21 " 374.95 376.77 365.80 " 1,546.40 " 334.71 - 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 81407916 MRA UPPER EXTR WO/W CONTRAST C8936 618 "$1,933.00" 714.44 - " 2,882.00 " - " 2,882.00 " 384.09 " 2,882.00 " - " 1,067.98 " 376.77 " 1,155.00 " - - " 1,279.45 " 329.22 365.80 893.77 " 1,117.21 " 374.95 376.77 365.80 " 1,546.40 " 334.71 - 964.47 321.90 790.60 " 1,449.75 " 734.73 864.63 378.60 33254059 COCAINE NASOLN SOL 1MG C9046 636 $6.00 2.22 - 4.80 - 4.15 1.37 4.15 - 3.32 1.34 3.96 - - 3.97 1.17 1.30 2.70 3.37 1.33 1.34 1.30 4.80 1.19 - 4.02 1.14 2.45 4.50 2.28 2.68 1.35 33254717 ROMIDEPSIN NON-LYPOHIL 1MG INJ C9065 636 "$1,730.00" 639.41 - " 1,384.00 " - " 1,195.43 " N/A " 1,195.43 " - 955.83 N/A " 1,141.80 " - N/A " 1,145.09 " - N/A 916.73 " 1,145.95 " N/A N/A N/A " 1,384.00 " N/A - " 1,159.10 " N/A 707.57 " 1,297.50 " 657.57 773.83 N/A 33245491 CLEVIDIPINE BUTYR PER 1MG INJ C9248 636 $15.00 5.54 - 12.00 - 10.37 - 10.37 - 8.29 - 9.90 - - 9.93 - - 4.82 6.03 - - - 12.00 - - 10.05 - 6.14 11.25 5.70 6.71 - 33233493 BEVACIZUMAB PER 0.25MG INJ C9257 636 $10.00 3.70 - 8.00 - 6.91 1.80 6.91 - 5.53 1.76 6.60 - - 6.62 1.54 1.71 2.04 2.55 1.75 1.76 1.71 8.00 1.56 - 6.70 1.50 4.09 7.50 3.80 4.47 1.77 28116730 NEUROMEND WRP 2.5CM/0.5CM LGTH C9361 636 $283.57 104.81 - 226.86 - 195.95 - 195.95 - 156.67 - 187.16 - - 187.69 - - 150.26 187.84 - - - 226.86 - - 189.99 - 115.98 212.68 107.78 126.84 - 28116748 INTEGRA MSHBWM 10X25CM/SQCM C9363 278 $182.00 67.27 - 145.60 - 125.76 - 125.76 - 100.56 - 120.12 - - 120.47 - - 96.44 120.56 - - - 145.60 - - 121.94 - 74.44 136.50 69.18 81.41 - 28116756 INTEGRA MSHBWM 10X12.5CM/SQCM C9363 278 $227.00 83.90 - 181.60 - 156.86 - 156.86 - 125.42 - 149.82 - - 150.25 - - 120.29 150.36 - - - 181.60 - - 152.09 - 92.84 170.25 86.28 101.54 - 28149336 PORCINE IMP 2X50 PER SQCM C9364 278 $241.00 89.07 - 192.80 - 166.53 - 166.53 - 133.15 - 159.06 - - 159.52 - - 127.71 159.64 - - - 192.80 - - 161.47 - 98.57 180.75 91.60 107.80 - 33245181 CANGRELOR INJ PER 1MG C9460 636 $80.00 29.57 - 64.00 - 55.28 16.66 55.28 - 44.20 16.35 52.80 - - 52.95 14.28 15.87 49.76 62.20 16.27 16.35 15.87 64.00 14.52 - 53.60 13.97 32.72 60.00 30.41 35.78 16.43 33249756 SOTALOL PER 1 MG INJ C9482 636 $84.00 31.05 - 67.20 - 58.04 17.96 58.04 - 46.41 17.61 55.44 - - 55.60 15.39 17.10 31.30 39.13 17.53 17.61 17.10 67.20 15.65 - 56.28 15.05 34.36 63.00 31.93 37.57 17.70 33247460 CONIVAPTAN PER 1MG INJ C9488 636 $171.00 63.20 - 136.80 - 118.16 44.88 118.16 - 94.48 44.02 112.86 - - 113.18 38.47 42.74 96.29 120.36 43.81 44.02 42.74 136.80 39.11 - 114.57 37.61 69.94 128.25 65.00 76.49 44.24 29811415 PRQ DRUG-EL COR STENT SINGLE C9600 481 "$52,725.00" " 19,487.16 " - " 42,180.00 " - " 36,432.98 " " 10,476.71 " " 36,432.98 " - " 29,130.56 " " 10,277.15 " " 34,798.50 " - - " 34,898.68 " " 8,980.04 " " 9,977.82 " " 9,189.18 " " 11,486.47 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " - " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 29811423 PRQ DRUG-EL COR STENT BRANCH C9601 481 "$24,058.00" " 8,891.84 " - " 19,246.40 " - " 16,624.08 " - " 16,624.08 " - " 13,292.05 " - " 15,878.28 " - - " 15,923.99 " - - " 9,189.18 " " 11,486.47 " - - - " 19,246.40 " - - " 16,118.86 " - " 9,839.72 " " 18,043.50 " " 9,144.45 " " 10,761.14 " - 29811687 PRQ DRUG-EL COR STNT ATHER SGL C9602 481 "$84,336.00" " 31,170.59 " - " 67,468.80 " - " 58,276.18 " " 16,751.22 " " 58,276.18 " - " 46,595.64 " " 16,432.15 " " 55,661.76 " - - " 55,822.00 " " 14,358.19 " " 15,953.54 " " 9,189.18 " " 11,486.47 " " 16,352.38 " " 16,432.15 " " 15,953.54 " " 67,468.80 " " 14,597.49 " - " 56,505.12 " " 14,039.12 " " 34,493.42 " " 63,252.00 " " 32,056.11 " " 37,723.49 " " 16,511.91 " 29811695 PRQ DRUG-EL COR STENT ATHER BR C9603 481 "$21,026.00" " 7,771.21 " - " 16,820.80 " - " 14,528.97 " - " 14,528.97 " - " 11,616.87 " - " 13,877.16 " - - " 13,917.11 " - - " 9,189.18 " " 11,486.47 " - - - " 16,820.80 " - - " 14,087.42 " - " 8,599.63 " " 15,769.50 " " 7,991.98 " " 9,404.93 " - 29811709 PRQ DRUG-EL COR REVASC SINGLE C9604 481 "$52,725.00" " 19,487.16 " - " 42,180.00 " - " 36,432.98 " " 10,476.71 " " 36,432.98 " - " 29,130.56 " " 10,277.15 " " 34,798.50 " - - " 34,898.68 " " 8,980.04 " " 9,977.82 " " 9,189.18 " " 11,486.47 " " 10,227.27 " " 10,277.15 " " 9,977.82 " " 42,180.00 " " 9,129.71 " - " 35,325.75 " " 8,780.48 " " 21,564.53 " " 39,543.75 " " 20,040.77 " " 23,583.89 " " 10,327.04 " 29811717 PRQ DRUG-EL COR REVASC BRANCH C9605 481 "$27,800.00" " 10,274.88 " - " 22,240.00 " - " 19,209.80 " - " 19,209.80 " - " 15,359.50 " - " 18,348.00 " - - " 18,400.82 " - - " 9,189.18 " " 11,486.47 " - - - " 22,240.00 " - - " 18,626.00 " - " 11,370.20 " " 20,850.00 " " 10,566.78 " " 12,434.94 " - 29811725 PRQ DRUG-EL COR REVASC MI SGL C9606 481 "$19,104.00" " 7,060.84 " - " 15,283.20 " - " 13,200.86 " N/A " 13,200.86 " - " 10,554.96 " N/A " 12,608.64 " - N/A " 12,644.94 " - N/A " 9,189.18 " " 11,486.47 " N/A N/A N/A " 15,283.20 " N/A - " 12,799.68 " N/A " 7,813.54 " " 14,328.00 " " 7,261.43 " " 8,545.22 " N/A 29811733 PRQ DRUG-EL COR REVSC CHRO SGL C9607 481 "$84,336.00" " 31,170.59 " - " 67,468.80 " - " 58,276.18 " " 16,751.22 " " 58,276.18 " - " 46,595.64 " " 16,432.15 " " 55,661.76 " - - " 55,822.00 " " 14,358.19 " " 15,953.54 " " 9,189.18 " " 11,486.47 " " 16,352.38 " " 16,432.15 " " 15,953.54 " " 67,468.80 " " 14,597.49 " - " 56,505.12 " " 14,039.12 " " 34,493.42 " " 63,252.00 " " 32,056.11 " " 37,723.49 " " 16,511.91 " 29811741 PRQ DRUG-EL COR REVSC CHRO ADD C9608 481 "$28,681.00" " 10,600.50 " - " 22,944.80 " - " 19,818.57 " - " 19,818.57 " - " 15,846.25 " - " 18,929.46 " - - " 18,983.95 " - - " 9,189.18 " " 11,486.47 " - - - " 22,944.80 " - - " 19,216.27 " - " 11,730.53 " " 21,510.75 " " 10,901.65 " " 12,829.01 " - 80011351 PLACE DEVICE MARKER NON PRO C9728 333 "$6,626.00" " 2,448.97 " - " 5,300.80 " - " 4,578.57 " " 1,317.10 " " 4,578.57 " - " 3,660.87 " " 1,292.01 " " 4,373.16 " - - " 4,385.75 " " 1,128.94 " " 1,254.38 " " 2,517.83 " " 3,147.29 " " 1,285.74 " " 1,292.01 " " 1,254.38 " " 5,300.80 " " 1,147.76 " - " 4,439.42 " " 1,103.85 " " 2,710.03 " " 4,969.50 " " 2,518.54 " " 2,963.81 " " 1,298.28 " 36200201 COLL PRESURG SARSCOV2 ANY SRC C9803 300 $130.00 48.05 - 104.00 - 89.83 25.77 89.83 - 71.83 25.28 85.80 - - 86.05 22.09 24.54 68.89 86.11 25.15 25.28 24.54 104.00 22.45 - 64.64 21.60 53.17 97.50 49.41 58.15 25.40 36305215 SPC COLL ONLY SCRN SARSCOV2 C9803 300 $130.00 48.05 - 104.00 - 89.83 25.77 89.83 - 71.83 25.28 85.80 - - 86.05 22.09 24.54 68.89 86.11 25.15 25.28 24.54 104.00 22.45 - 64.64 21.60 53.17 97.50 49.41 58.15 25.40 28175779 EXTRACTION ERUPTED TOOTH D7140 360 "$7,316.00" " 2,703.99 " 421.91 " 5,852.80 " 742.90 " 5,055.36 " " 1,446.75 " " 5,055.36 " 755.82 " 4,042.09 " " 1,419.20 " " 4,828.56 " 723.52 672.68 " 4,842.46 " " 1,240.07 " " 1,377.86 " 421.91 527.39 " 1,412.31 " " 1,419.20 " " 1,377.86 " " 5,852.80 " " 1,260.74 " 646.00 " 4,901.72 " " 1,212.52 " " 2,992.24 " " 5,487.00 " " 2,780.81 " " 3,272.45 " " 1,426.09 " 28175787 REM IMP TOOTH W MUCOPER D7210 360 "$7,316.00" " 2,703.99 " 791.00 " 5,852.80 " 909.65 " 5,055.36 " " 1,446.75 " " 5,055.36 " 925.47 " 4,042.09 " " 1,419.20 " " 4,828.56 " 885.92 823.67 " 4,842.46 " " 1,240.07 " " 1,377.86 " " 2,532.97 " " 3,166.21 " " 1,412.31 " " 1,419.20 " " 1,377.86 " " 5,852.80 " " 1,260.74 " 791.00 " 4,901.72 " " 1,212.52 " " 2,992.24 " " 5,487.00 " " 2,780.81 " " 3,272.45 " " 1,426.09 " 28175795 IMPACT TOOTH REMOV COMP BONY D7240 360 "$7,316.00" " 2,703.99 " 782.00 " 6,171.67 " 899.30 " 5,055.36 " " 1,446.75 " " 5,055.36 " 914.94 " 4,042.09 " " 1,419.20 " " 4,828.56 " 875.84 814.30 " 4,842.46 " " 1,240.07 " " 1,377.86 " " 4,937.34 " " 6,171.67 " " 1,412.31 " " 1,419.20 " " 1,377.86 " " 5,852.80 " " 1,260.74 " 782.00 " 4,901.72 " " 1,212.52 " " 2,992.24 " " 5,487.00 " " 2,780.81 " " 3,272.45 " " 1,426.09 " 28175809 ALVEOLOPLASTY WITH EXTRACTIONS D7310 360 $324.00 119.75 - " 1,314.95 " - 223.88 N/A 223.88 - 179.01 N/A 213.84 - N/A 214.46 - N/A " 1,051.96 " " 1,314.95 " N/A N/A N/A 259.20 N/A - 217.08 N/A 132.52 243.00 123.15 144.93 N/A 10588375 ADMIN INFLUENZA VIRUS VACC G0008 771 $210.00 77.62 10.00 168.00 11.50 145.11 41.74 145.11 11.70 116.03 40.94 138.60 11.20 10.41 139.00 35.78 39.75 12.31 15.39 40.74 40.94 39.75 168.00 36.37 10.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 10688361 ADMIN INFLUENZA VIRUS VACC G0008 771 $210.00 77.62 10.00 168.00 11.50 145.11 41.74 145.11 11.70 116.03 40.94 138.60 11.20 10.41 139.00 35.78 39.75 12.31 15.39 40.74 40.94 39.75 168.00 36.37 10.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 11288375 ADMIN INFLUENZA VIRUS VACC G0008 771 $210.00 77.62 10.00 168.00 11.50 145.11 41.74 145.11 11.70 116.03 40.94 138.60 11.20 10.41 139.00 35.78 39.75 12.31 15.39 40.74 40.94 39.75 168.00 36.37 10.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 14088369 ADMIN INFLUENZA VIRUS VACC G0008 771 $210.00 77.62 10.00 168.00 11.50 145.11 41.74 145.11 11.70 116.03 40.94 138.60 11.20 10.41 139.00 35.78 39.75 12.31 15.39 40.74 40.94 39.75 168.00 36.37 10.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 15288388 ADMIN INFLUENZA VIRUS VACC G0008 771 $210.00 77.62 10.00 168.00 11.50 145.11 41.74 145.11 11.70 116.03 40.94 138.60 11.20 10.41 139.00 35.78 39.75 12.31 15.39 40.74 40.94 39.75 168.00 36.37 10.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 17100181 ADMIN INFLUENZA VIRUS VACC G0008 771 $210.00 77.62 10.00 168.00 11.50 145.11 41.74 145.11 11.70 116.03 40.94 138.60 11.20 10.41 139.00 35.78 39.75 12.31 15.39 40.74 40.94 39.75 168.00 36.37 10.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 17288270 ADMIN INFLUENZA VIRUS VACC G0008 771 $210.00 77.62 10.00 168.00 11.50 145.11 41.74 145.11 11.70 116.03 40.94 138.60 11.20 10.41 139.00 35.78 39.75 12.31 15.39 40.74 40.94 39.75 168.00 36.37 10.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 17380281 ADMIN INFLUENZA VIRUS VACC G0008 771 $210.00 77.62 10.00 168.00 11.50 145.11 41.74 145.11 11.70 116.03 40.94 138.60 11.20 10.41 139.00 35.78 39.75 12.31 15.39 40.74 40.94 39.75 168.00 36.37 10.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 18200244 ADMIN INFLUENZA VIRUS VACC G0008 771 $210.00 77.62 10.00 168.00 11.50 145.11 41.74 145.11 11.70 116.03 40.94 138.60 11.20 10.41 139.00 35.78 39.75 12.31 15.39 40.74 40.94 39.75 168.00 36.37 10.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 19000320 ADMIN INFLUENZA VIRUS VACC G0008 771 $210.00 77.62 10.00 168.00 11.50 145.11 41.74 145.11 11.70 116.03 40.94 138.60 11.20 10.41 139.00 35.78 39.75 12.31 15.39 40.74 40.94 39.75 168.00 36.37 10.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 19388379 ADMIN INFLUENZA VIRUS VACC G0008 771 $210.00 77.62 10.00 168.00 11.50 145.11 41.74 145.11 11.70 116.03 40.94 138.60 11.20 10.41 139.00 35.78 39.75 12.31 15.39 40.74 40.94 39.75 168.00 36.37 10.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 19488373 ADMIN INFLUENZA VIRUS VACC G0008 771 $210.00 77.62 10.00 168.00 11.50 145.11 41.74 145.11 11.70 116.03 40.94 138.60 11.20 10.41 139.00 35.78 39.75 12.31 15.39 40.74 40.94 39.75 168.00 36.37 10.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 24771024 ADMIN INFLUENZA VIRUS VACC G0008 771 $210.00 77.62 10.00 168.00 11.50 145.11 41.74 145.11 11.70 116.03 40.94 138.60 11.20 10.41 139.00 35.78 39.75 12.31 15.39 40.74 40.94 39.75 168.00 36.37 10.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 24900266 ADMIN INFLUENZA VIRUS VACC G0008 771 $210.00 77.62 10.00 168.00 11.50 145.11 41.74 145.11 11.70 116.03 40.94 138.60 11.20 10.41 139.00 35.78 39.75 12.31 15.39 40.74 40.94 39.75 168.00 36.37 10.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 25000625 ADMIN INFLUENZA VIRUS VACC G0008 771 $210.00 77.62 10.00 168.00 11.50 145.11 41.74 145.11 11.70 116.03 40.94 138.60 11.20 10.41 139.00 35.78 39.75 12.31 15.39 40.74 40.94 39.75 168.00 36.37 10.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 25400623 ADMIN INFLUENZA VIRUS VACC G0008 771 $210.00 77.62 10.00 168.00 11.50 145.11 41.74 145.11 11.70 116.03 40.94 138.60 11.20 10.41 139.00 35.78 39.75 12.31 15.39 40.74 40.94 39.75 168.00 36.37 10.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 29817847 ADMIN INFLUENZA VIRUS VACC G0008 771 $210.00 77.62 10.00 168.00 11.50 145.11 41.74 145.11 11.70 116.03 40.94 138.60 11.20 10.41 139.00 35.78 39.75 12.31 15.39 40.74 40.94 39.75 168.00 36.37 10.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 31200890 ADMIN INFLUENZA VIRUS VACC G0008 771 $210.00 77.62 10.00 168.00 11.50 145.11 41.74 145.11 11.70 116.03 40.94 138.60 11.20 10.41 139.00 35.78 39.75 12.31 15.39 40.74 40.94 39.75 168.00 36.37 10.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 31901073 ADMIN INFLUENZA VIRUS VACC G0008 771 $210.00 77.62 10.00 168.00 11.50 145.11 41.74 145.11 11.70 116.03 40.94 138.60 11.20 10.41 139.00 35.78 39.75 12.31 15.39 40.74 40.94 39.75 168.00 36.37 10.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 32900330 ADMIN INFLUENZA VIRUS VACC G0008 771 $210.00 77.62 10.00 168.00 11.50 145.11 41.74 145.11 11.70 116.03 40.94 138.60 11.20 10.41 139.00 35.78 39.75 12.31 15.39 40.74 40.94 39.75 168.00 36.37 10.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 34500436 ADMIN INFLUENZA VIRUS VACC G0008 771 $210.00 77.62 10.00 168.00 11.50 145.11 41.74 145.11 11.70 116.03 40.94 138.60 11.20 10.41 139.00 35.78 39.75 12.31 15.39 40.74 40.94 39.75 168.00 36.37 10.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 37089427 ADMIN FLU VRS VAC G0008 771 $210.00 77.62 10.00 168.00 11.50 145.11 41.74 145.11 11.70 116.03 40.94 138.60 11.20 10.41 139.00 35.78 39.75 12.31 15.39 40.74 40.94 39.75 168.00 36.37 10.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 39100762 ADMIN INFLUENZA VIRUS VACC G0008 771 $210.00 77.62 10.00 168.00 11.50 145.11 41.74 145.11 11.70 116.03 40.94 138.60 11.20 10.41 139.00 35.78 39.75 12.31 15.39 40.74 40.94 39.75 168.00 36.37 10.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 43100165 ADMIN INFLUENZA VIRUS VACC G0008 771 $210.00 77.62 10.00 168.00 11.50 145.11 41.74 145.11 11.70 116.03 40.94 138.60 11.20 10.41 139.00 35.78 39.75 12.31 15.39 40.74 40.94 39.75 168.00 36.37 10.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 43900391 ADMIN INFLUENZA VIRUS VACC G0008 771 $210.00 77.62 10.00 168.00 11.50 145.11 41.74 145.11 11.70 116.03 40.94 138.60 11.20 10.41 139.00 35.78 39.75 12.31 15.39 40.74 40.94 39.75 168.00 36.37 10.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 45521044 ADMIN INFLUENZA VIRUS VACC G0008 771 $210.00 77.62 10.00 168.00 11.50 145.11 41.74 145.11 11.70 116.03 40.94 138.60 11.20 10.41 139.00 35.78 39.75 12.31 15.39 40.74 40.94 39.75 168.00 36.37 10.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 51600959 ADMIN INFLUENZA VIRUS VACC G0008 771 $210.00 77.62 10.00 168.00 11.50 145.11 41.74 145.11 11.70 116.03 40.94 138.60 11.20 10.41 139.00 35.78 39.75 12.31 15.39 40.74 40.94 39.75 168.00 36.37 10.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 64201344 ADMIN INFLUENZA VIRUS VACC G0008 771 $210.00 77.62 10.00 168.00 11.50 145.11 41.74 145.11 11.70 116.03 40.94 138.60 11.20 10.41 139.00 35.78 39.75 12.31 15.39 40.74 40.94 39.75 168.00 36.37 10.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 10588383 ADMIN PNEUMOCOCCAL VACC G0009 771 $210.00 77.62 10.00 168.00 11.50 145.11 41.74 145.11 11.70 116.03 40.94 138.60 11.20 10.41 139.00 35.78 39.75 12.69 15.86 40.74 40.94 39.75 168.00 36.37 10.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 10688370 ADMIN PNEUMOCOCCAL VACC G0009 771 $210.00 77.62 10.00 168.00 11.50 145.11 41.74 145.11 11.70 116.03 40.94 138.60 11.20 10.41 139.00 35.78 39.75 12.69 15.86 40.74 40.94 39.75 168.00 36.37 10.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 11288383 ADMIN PNEUMOCOCCAL VACC G0009 771 $210.00 77.62 10.00 168.00 11.50 145.11 41.74 145.11 11.70 116.03 40.94 138.60 11.20 10.41 139.00 35.78 39.75 12.69 15.86 40.74 40.94 39.75 168.00 36.37 10.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 14088377 ADMIN PNEUMOCOCCAL VACC G0009 771 $210.00 77.62 10.00 168.00 11.50 145.11 41.74 145.11 11.70 116.03 40.94 138.60 11.20 10.41 139.00 35.78 39.75 12.69 15.86 40.74 40.94 39.75 168.00 36.37 10.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 15288396 ADMIN PNEUMOCOCCAL VACC G0009 771 $210.00 77.62 10.00 168.00 11.50 145.11 41.74 145.11 11.70 116.03 40.94 138.60 11.20 10.41 139.00 35.78 39.75 12.69 15.86 40.74 40.94 39.75 168.00 36.37 10.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 17100190 ADMIN PNEUMOCOCCAL VACC G0009 771 $210.00 77.62 10.00 168.00 11.50 145.11 41.74 145.11 11.70 116.03 40.94 138.60 11.20 10.41 139.00 35.78 39.75 12.69 15.86 40.74 40.94 39.75 168.00 36.37 10.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 17288288 ADMIN PNEUMOCOCCAL VACC G0009 771 $210.00 77.62 10.00 168.00 11.50 145.11 41.74 145.11 11.70 116.03 40.94 138.60 11.20 10.41 139.00 35.78 39.75 12.69 15.86 40.74 40.94 39.75 168.00 36.37 10.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 17380290 ADMIN PNEUMOCOCCAL VACC G0009 771 $210.00 77.62 10.00 168.00 11.50 145.11 41.74 145.11 11.70 116.03 40.94 138.60 11.20 10.41 139.00 35.78 39.75 12.69 15.86 40.74 40.94 39.75 168.00 36.37 10.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 18200252 ADMIN PNEUMOCOCCAL VACC G0009 771 $210.00 77.62 10.00 168.00 11.50 145.11 41.74 145.11 11.70 116.03 40.94 138.60 11.20 10.41 139.00 35.78 39.75 12.69 15.86 40.74 40.94 39.75 168.00 36.37 10.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 19000338 ADMIN PNEUMOCOCCAL VACC G0009 771 $210.00 77.62 10.00 168.00 11.50 145.11 41.74 145.11 11.70 116.03 40.94 138.60 11.20 10.41 139.00 35.78 39.75 12.69 15.86 40.74 40.94 39.75 168.00 36.37 10.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 19388387 ADMIN PNEUMOCOCCAL VACC G0009 771 $210.00 77.62 10.00 168.00 11.50 145.11 41.74 145.11 11.70 116.03 40.94 138.60 11.20 10.41 139.00 35.78 39.75 12.69 15.86 40.74 40.94 39.75 168.00 36.37 10.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 19488381 ADMIN PNEUMOCOCCAL VACC G0009 771 $210.00 77.62 10.00 168.00 11.50 145.11 41.74 145.11 11.70 116.03 40.94 138.60 11.20 10.41 139.00 35.78 39.75 12.69 15.86 40.74 40.94 39.75 168.00 36.37 10.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 29817855 ADMIN PNEUMOCOCCAL VACC G0009 771 $210.00 77.62 10.00 168.00 11.50 145.11 41.74 145.11 11.70 116.03 40.94 138.60 11.20 10.41 139.00 35.78 39.75 12.69 15.86 40.74 40.94 39.75 168.00 36.37 10.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 37089435 ADMIN PNEUMO VAC G0009 771 $210.00 77.62 10.00 168.00 11.50 145.11 41.74 145.11 11.70 116.03 40.94 138.60 11.20 10.41 139.00 35.78 39.75 12.69 15.86 40.74 40.94 39.75 168.00 36.37 10.00 140.70 34.98 85.89 157.50 79.82 93.93 41.14 35707999 PSA CANCER SCREENING G0103 300 $101.00 37.33 - 144.79 - 69.79 20.28 69.79 - 55.80 19.89 51.15 - - 66.85 17.38 19.31 115.83 144.79 19.79 19.89 19.31 80.80 17.67 - 50.59 16.99 41.31 75.75 38.39 45.18 19.99 34001065 COLORECTAL CANCER SCREENING G0104 750 "$4,167.00" " 1,540.12 " - " 3,333.60 " - " 2,879.40 " 827.73 " 2,879.40 " - " 2,302.27 " 811.96 " 2,750.22 " - - " 2,758.14 " 709.48 788.31 381.42 476.77 808.02 811.96 788.31 " 3,333.60 " 721.30 - " 2,791.89 " 693.71 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 815.90 34101060 COLORECTAL CANCER SCREENING G0104 750 "$4,167.00" " 1,540.12 " - " 3,333.60 " - " 2,879.40 " 827.73 " 2,879.40 " - " 2,302.27 " 811.96 " 2,750.22 " - - " 2,758.14 " 709.48 788.31 381.42 476.77 808.02 811.96 788.31 " 3,333.60 " 721.30 - " 2,791.89 " 693.71 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 815.90 34000751 COLORECTAL SCRN; HI RISK IND G0105 750 "$4,167.00" " 1,540.12 " - " 3,333.60 " - " 1,718.00 " 827.73 " 1,718.00 " - " 2,302.27 " 811.96 " 2,820.00 " - - " 2,758.14 " 709.48 788.31 " 2,376.02 " " 2,970.02 " 808.02 811.96 788.31 " 3,333.60 " 721.30 - " 2,791.89 " 693.71 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 815.90 34100756 COLORECTAL SCRN; HI RISK IND G0105 750 "$4,167.00" " 1,540.12 " - " 3,333.60 " - " 1,718.00 " 827.73 " 1,718.00 " - " 2,302.27 " 811.96 " 2,820.00 " - - " 2,758.14 " 709.48 788.31 " 2,376.02 " " 2,970.02 " 808.02 811.96 788.31 " 3,333.60 " 721.30 - " 2,791.89 " 693.71 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 815.90 28700202 DIAB SLF-MGT TRAIN IND 30 MIN G0108 942 $140.00 51.74 21.41 338.77 24.62 96.74 57.17 96.74 25.05 77.35 56.08 92.40 23.98 22.29 92.67 49.01 54.45 271.02 338.77 55.81 56.08 54.45 112.00 49.82 21.41 93.80 47.92 57.26 105.00 53.21 62.62 56.36 34800219 DIAB SLF-MGT TRAIN IND 30 MIN G0108 942 $140.00 51.74 21.41 338.77 24.62 96.74 57.17 96.74 25.05 77.35 56.08 92.40 23.98 22.29 92.67 49.01 54.45 271.02 338.77 55.81 56.08 54.45 112.00 49.82 21.41 93.80 47.92 57.26 105.00 53.21 62.62 56.36 28700211 DIAB SLF-MGT TRAIN GRP 30 MIN G0109 942 $80.00 29.57 12.07 298.91 13.88 55.28 16.23 55.28 14.12 44.20 15.92 52.80 13.52 12.57 52.95 13.91 15.46 239.13 298.91 15.85 15.92 15.46 64.00 14.15 12.07 53.60 13.60 32.72 60.00 30.41 35.78 16.00 34800227 DIAB SLF-MGT TRAIN GRP 30 MIN G0109 942 $80.00 29.57 12.07 298.91 13.88 55.28 16.23 55.28 14.12 44.20 15.92 52.80 13.52 12.57 52.95 13.91 15.46 239.13 298.91 15.85 15.92 15.46 64.00 14.15 12.07 53.60 13.60 32.72 60.00 30.41 35.78 16.00 34001073 COLONOSCOPY CA SCRN NOT HI RSK G0121 750 "$4,167.00" " 1,540.12 " - " 3,333.60 " - " 1,718.00 " 827.73 " 1,718.00 " - " 2,302.27 " 811.96 " 2,820.00 " - - " 2,758.14 " 709.48 788.31 " 1,878.00 " " 2,347.50 " 808.02 811.96 788.31 " 3,333.60 " 721.30 - " 2,791.89 " 693.71 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 815.90 34101078 COLONOSCOPY CA SCRN NOT HI RSK G0121 750 "$4,167.00" " 1,540.12 " - " 3,333.60 " - " 1,718.00 " 827.73 " 1,718.00 " - " 2,302.27 " 811.96 " 2,820.00 " - - " 2,758.14 " 709.48 788.31 " 1,878.00 " " 2,347.50 " 808.02 811.96 788.31 " 3,333.60 " 721.30 - " 2,791.89 " 693.71 " 1,704.30 " " 3,125.25 " " 1,583.88 " " 1,863.90 " 815.90 35900608 THIN LAYER PAP SCREEN NORMAL G0123 311 $106.00 39.18 - 132.50 - 73.25 21.27 73.25 - 58.57 20.87 56.33 - - 70.16 18.23 20.26 106.00 132.50 20.77 20.87 20.26 84.80 18.54 - 53.08 17.83 43.35 79.50 40.29 47.41 20.97 35900616 THIN LAYER PAP SCREEN ABNORMAL G0123 311 $106.00 39.18 - 132.50 - 73.25 21.27 73.25 - 58.57 20.87 56.33 - - 70.16 18.23 20.26 106.00 132.50 20.77 20.87 20.26 84.80 18.54 - 53.08 17.83 43.35 79.50 40.29 47.41 20.97 35900781 THINPREP PAP SCREEN NORMAL G0123 311 $106.00 39.18 - 132.50 - 73.25 21.27 73.25 - 58.57 20.87 56.33 - - 70.16 18.23 20.26 106.00 132.50 20.77 20.87 20.26 84.80 18.54 - 53.08 17.83 43.35 79.50 40.29 47.41 20.97 35900799 THINPREP PAP SCREEN ABNORMAL G0123 311 $106.00 39.18 - 132.50 - 73.25 21.27 73.25 - 58.57 20.87 56.33 - - 70.16 18.23 20.26 106.00 132.50 20.77 20.87 20.26 84.80 18.54 - 53.08 17.83 43.35 79.50 40.29 47.41 20.97 35900730 AUTO THIN LAYER MAN RESC NORM G0145 311 $139.00 51.37 - 210.37 - 96.05 27.81 96.05 - 76.80 27.28 73.66 - - 92.00 23.84 26.49 168.30 210.37 27.15 27.28 26.49 111.20 24.24 - 69.40 23.31 56.85 104.25 52.83 62.17 27.42 35900748 AUTO THIN LAYER MAN RESC ABNM G0145 311 $139.00 51.37 - 210.37 - 96.05 27.81 96.05 - 76.80 27.28 73.66 - - 92.00 23.84 26.49 168.30 210.37 27.15 27.28 26.49 111.20 24.24 - 69.40 23.31 56.85 104.25 52.83 62.17 27.42 35900543 PAP AUTO W/MAN RESCREEN ABNORM G0148 311 $168.00 62.09 - 134.40 - 116.09 33.54 116.09 - 92.82 32.90 42.26 - - 111.20 28.75 31.94 66.49 83.11 32.74 32.90 31.94 134.40 29.23 - 83.68 28.11 68.71 126.00 63.86 75.15 33.06 24970892 TX STR ENDUR RESP FUNC 15 MIN G0237 460 $130.00 48.05 - 104.00 - 89.83 25.77 89.83 - 71.83 25.28 85.80 - - 86.05 22.09 24.54 56.67 70.84 25.15 25.28 24.54 104.00 22.45 - 87.10 21.60 53.17 97.50 49.41 58.15 25.40 24970922 TX PROCEDURE/IND 15MIN G0238 460 $130.00 48.05 - 104.00 - 89.83 25.77 89.83 - 71.83 25.28 85.80 - - 86.05 22.09 24.54 58.98 73.73 25.15 25.28 24.54 104.00 22.45 - 87.10 21.60 53.17 97.50 49.41 58.15 25.40 24970931 TX PROCEDURE/GROUP G0239 460 $178.00 65.79 - 142.40 - 123.00 35.30 123.00 - 98.35 34.63 117.48 - - 117.82 30.26 33.62 40.42 50.52 34.46 34.63 33.62 142.40 30.76 - 119.26 29.59 72.80 133.50 67.66 79.62 34.80 22501704 OP DIALYSIS ED/CRITICAL CARE G0257 820 "$3,435.00" " 1,269.58 " - " 2,748.00 " - " 2,373.59 " 683.14 " 2,373.59 " - " 1,897.84 " 670.13 " 2,267.10 " - - " 2,273.63 " 585.55 650.61 " 1,820.21 " " 2,275.34 " 666.88 670.13 650.61 " 2,748.00 " 595.31 - " 2,301.45 " 572.54 " 1,404.92 " " 2,576.25 " " 1,305.64 " " 1,536.48 " 673.38 28175817 OCCLUSIVE DEVICE IN VEIN ART G0269 360 $743.00 274.61 - 907.92 892.40 513.41 - 513.41 907.92 410.51 - 490.38 869.12 808.05 491.79 - - - - - - - 594.40 - 776.00 497.81 - 303.89 557.25 282.41 332.34 - 29803374 PLACE OCCLUSIVE DEVICE VEN/ART G0269 320 $743.00 274.61 - 907.92 892.40 513.41 - 513.41 907.92 410.51 - 490.38 869.12 808.05 491.79 - - - - - - - 594.40 - 776.00 497.81 - 303.89 557.25 282.41 332.34 - 80329881 PLACE OCCLUSIVE DEVICE VEN/ART G0269 320 $743.00 274.61 - 907.92 892.40 513.41 - 513.41 907.92 410.51 - 490.38 869.12 808.05 491.79 - - - - - - - 594.40 - 776.00 497.81 - 303.89 557.25 282.41 332.34 - 28700181 MNT RE-ASSESS 2ND REF 15 IND G0270 942 $144.00 53.22 - 115.20 - 99.50 28.60 99.50 - 79.56 28.06 95.04 - - 95.31 24.52 27.24 55.56 69.45 27.92 28.06 27.24 115.20 24.92 - 96.48 23.97 58.90 108.00 54.73 64.41 28.19 28700199 MNT RE-ASSESS 2ND REF 30 GRP G0271 942 $80.00 29.57 - 64.00 - 55.28 15.89 55.28 - 44.20 15.58 52.80 - - 52.95 13.62 15.13 23.04 28.80 15.51 15.58 15.13 64.00 13.84 - 53.60 13.31 32.72 60.00 30.41 35.78 15.66 51600614 HYPERBARIC OXYGEN 30MIN G0277 413 $626.00 231.37 43.89 500.80 50.47 432.57 124.39 432.57 51.35 345.87 122.02 413.16 49.16 45.70 414.35 106.62 118.47 127.22 159.02 121.43 122.02 118.47 500.80 108.40 43.89 419.42 104.25 256.03 469.50 237.94 280.01 122.62 29802777 ILIAC/FEM ART ANGIO CARD CATH G0278 320 "$3,478.00" " 1,285.47 " - " 2,782.40 " - " 2,403.30 " - " 2,403.30 " - " 1,921.60 " - " 2,295.48 " - - " 2,302.09 " - - 42.48 53.10 - - - " 2,782.40 " - - 35.66 - " 1,422.50 " " 2,608.50 " " 1,321.99 " " 1,555.71 " - 81402108 DX DIGTAL BREAST TOMOSYNTHESIS G0279 401 $126.00 46.57 43.51 100.80 50.04 87.07 54.48 87.07 50.91 69.62 53.45 83.16 48.73 45.31 83.40 46.70 51.89 45.57 56.96 53.19 53.45 51.89 100.80 47.48 43.51 66.73 45.66 51.53 94.50 47.89 56.36 53.71 82702105 DX DIGTAL BREAST TOMOSYNTHESIS G0279 401 $126.00 46.57 43.51 100.80 50.04 87.07 54.48 87.07 50.91 69.62 53.45 83.16 48.73 45.31 83.40 46.70 51.89 45.57 56.96 53.19 53.45 51.89 100.80 47.48 43.51 66.73 45.66 51.53 94.50 47.89 56.36 53.71 83002107 DX DIGTAL BREAST TOMOSYNTHESIS G0279 401 $126.00 46.57 43.51 100.80 50.04 87.07 54.48 87.07 50.91 69.62 53.45 83.16 48.73 45.31 83.40 46.70 51.89 45.57 56.96 53.19 53.45 51.89 100.80 47.48 43.51 66.73 45.66 51.53 94.50 47.89 56.36 53.71 29107203 ELECTRIC STIM UNATTENDED WOUND G0281 430 $67.00 24.76 - 108.51 - 46.30 12.66 46.30 - 37.02 12.42 44.22 - - 44.35 10.85 12.06 86.81 108.51 12.36 12.42 12.06 53.60 11.03 - 44.89 10.61 27.40 50.25 25.47 29.97 12.48 29207208 ELECTRIC STIM UNATTENDED WOUND G0281 420 $67.00 24.76 - 108.51 - 46.30 12.66 46.30 - 37.02 12.42 44.22 - - 44.35 10.85 12.06 86.81 108.51 12.36 12.42 12.06 53.60 11.03 - 44.89 10.61 27.40 50.25 25.47 29.97 12.48 29221413 ELECTRIC STIM UNATTENDED WOUND G0281 420 $67.00 24.76 - 108.51 - 46.30 12.66 46.30 - 37.02 12.42 44.22 - - 44.35 10.85 12.06 86.81 108.51 12.36 12.42 12.06 53.60 11.03 - 44.89 10.61 27.40 50.25 25.47 29.97 12.48 29507201 ELECTRIC STIM UNATTENDED WOUND G0281 420 $67.00 24.76 - 108.51 - 46.30 12.66 46.30 - 37.02 12.42 44.22 - - 44.35 10.85 12.06 86.81 108.51 12.36 12.42 12.06 53.60 11.03 - 44.89 10.61 27.40 50.25 25.47 29.97 12.48 29585946 ELECTRIC STIM UNATTENDED WOUND G0281 420 $67.00 24.76 - 108.51 - 46.30 12.66 46.30 - 37.02 12.42 44.22 - - 44.35 10.85 12.06 86.81 108.51 12.36 12.42 12.06 53.60 11.03 - 44.89 10.61 27.40 50.25 25.47 29.97 12.48 31900522 ELECTRIC STIM UNATTENDED WOUND G0281 420 $67.00 24.76 - 108.51 - 46.30 12.66 46.30 - 37.02 12.42 44.22 - - 44.35 10.85 12.06 86.81 108.51 12.36 12.42 12.06 53.60 11.03 - 44.89 10.61 27.40 50.25 25.47 29.97 12.48 31907209 ELECTRIC STIM UNATTENDED WOUND G0281 420 $67.00 24.76 - 108.51 - 46.30 12.66 46.30 - 37.02 12.42 44.22 - - 44.35 10.85 12.06 86.81 108.51 12.36 12.42 12.06 53.60 11.03 - 44.89 10.61 27.40 50.25 25.47 29.97 12.48 64200895 ELECTRIC STIM UNATTENDED WOUND G0281 420 $67.00 24.76 - 108.51 - 46.30 12.66 46.30 - 37.02 12.42 44.22 - - 44.35 10.85 12.06 86.81 108.51 12.36 12.42 12.06 53.60 11.03 - 44.89 10.61 27.40 50.25 25.47 29.97 12.48 64207202 ELECTRIC STIM UNATTENDED WOUND G0281 420 $67.00 24.76 - 108.51 - 46.30 12.66 46.30 - 37.02 12.42 44.22 - - 44.35 10.85 12.06 86.81 108.51 12.36 12.42 12.06 53.60 11.03 - 44.89 10.61 27.40 50.25 25.47 29.97 12.48 28900716 ELECTRIC STIM UNATTENDED OTHER G0283 440 $67.00 24.76 - 108.51 - 46.30 12.66 46.30 - 37.02 12.42 44.22 - - 44.35 10.85 12.06 86.81 108.51 12.36 12.42 12.06 53.60 11.03 - 44.89 10.61 27.40 50.25 25.47 29.97 12.48 29121133 ELECTRIC STIM UNATTENDED OTHER G0283 430 $67.00 24.76 - 108.51 - 46.30 12.66 46.30 - 37.02 12.42 44.22 - - 44.35 10.85 12.06 86.81 108.51 12.36 12.42 12.06 53.60 11.03 - 44.89 10.61 27.40 50.25 25.47 29.97 12.48 29221103 ELECTRIC STIM UNATTENDED OTHER G0283 420 $67.00 24.76 - 108.51 - 46.30 12.66 46.30 - 37.02 12.42 44.22 - - 44.35 10.85 12.06 86.81 108.51 12.36 12.42 12.06 53.60 11.03 - 44.89 10.61 27.40 50.25 25.47 29.97 12.48 29585679 ELECTRIC STIM UNATTENDED OTHER G0283 420 $67.00 24.76 - 108.51 - 46.30 12.66 46.30 - 37.02 12.42 44.22 - - 44.35 10.85 12.06 86.81 108.51 12.36 12.42 12.06 53.60 11.03 - 44.89 10.61 27.40 50.25 25.47 29.97 12.48 31900531 ELECTRIC STIM UNATTENDED OTHER G0283 420 $67.00 24.76 - 108.51 - 46.30 12.66 46.30 - 37.02 12.42 44.22 - - 44.35 10.85 12.06 86.81 108.51 12.36 12.42 12.06 53.60 11.03 - 44.89 10.61 27.40 50.25 25.47 29.97 12.48 64200194 ELECTRIC STIM UNATTENDED OTHER G0283 420 $67.00 24.76 - 108.51 - 46.30 12.66 46.30 - 37.02 12.42 44.22 - - 44.35 10.85 12.06 86.81 108.51 12.36 12.42 12.06 53.60 11.03 - 44.89 10.61 27.40 50.25 25.47 29.97 12.48 80641176 RECON CTA FOR SURG PLANNING G0288 352 "$1,344.00" 496.74 - " 1,774.00 " - " 1,774.00 " - " 1,774.00 " - 742.56 - 725.00 - - 889.59 - - " 1,216.56 " " 1,520.70 " - - - " 1,075.20 " - - 94.16 - 549.70 " 1,008.00 " 510.85 601.17 - 67941071 CT LUNG LOW DOSE SCREENING G0297 352 $281.00 103.86 - " 1,774.00 " - " 1,774.00 " N/A " 1,774.00 " - 155.25 N/A 725.00 - N/A 185.99 - N/A 988.51 " 1,235.64 " N/A N/A N/A 224.80 N/A - 188.27 N/A 114.93 210.75 106.81 125.69 N/A 80641079 CT LUNG LOW DOSE SCREENING G0297 352 $281.00 103.86 - " 1,774.00 " - " 1,774.00 " N/A " 1,774.00 " - 155.25 N/A 725.00 - N/A 185.99 - N/A 988.51 " 1,235.64 " N/A N/A N/A 224.80 N/A - 188.27 N/A 114.93 210.75 106.81 125.69 N/A 81441073 CT LUNG LOW DOSE SCREENING G0297 352 $281.00 103.86 - " 1,774.00 " - " 1,774.00 " N/A " 1,774.00 " - 155.25 N/A 725.00 - N/A 185.99 - N/A 988.51 " 1,235.64 " N/A N/A N/A 224.80 N/A - 188.27 N/A 114.93 210.75 106.81 125.69 N/A 81641072 CT LUNG LOW DOSE SCREENING G0297 352 $281.00 103.86 - " 1,774.00 " - " 1,774.00 " N/A " 1,774.00 " - 155.25 N/A 725.00 - N/A 185.99 - N/A 988.51 " 1,235.64 " N/A N/A N/A 224.80 N/A - 188.27 N/A 114.93 210.75 106.81 125.69 N/A 83041072 CT LUNG LOW DOSE SCREENING G0297 352 $281.00 103.86 - " 1,774.00 " - " 1,774.00 " N/A " 1,774.00 " - 155.25 N/A 725.00 - N/A 185.99 - N/A 988.51 " 1,235.64 " N/A N/A N/A 224.80 N/A - 188.27 N/A 114.93 210.75 106.81 125.69 N/A 35709266 FECAL OCCULT BLOOD BY EIA G0328 300 $95.00 35.11 15.88 103.01 20.95 65.65 18.95 65.65 18.22 52.49 18.59 44.24 20.04 18.97 62.88 16.25 18.05 82.41 103.01 18.50 18.59 18.05 76.00 16.52 18.22 47.29 15.88 38.86 71.25 36.11 42.49 18.68 10588111 TELEMETRY/8M:OBS/HR G0378 762 $138.00 51.00 - " 2,329.00 " " 1,123.02 " " 2,329.00 " - " 2,329.00 " 850.00 76.25 - 91.08 57.01 " 1,016.87 " 91.34 - - 76.68 95.85 - - - 110.40 - 976.54 92.46 - 56.44 103.50 52.45 61.73 - 10688116 MED-SURG/7M:OBS/HR G0378 762 $138.00 51.00 - " 2,329.00 " " 1,123.02 " " 2,329.00 " - " 2,329.00 " 850.00 76.25 - 91.08 57.01 " 1,016.87 " 91.34 - - 76.68 95.85 - - - 110.40 - 976.54 92.46 - 56.44 103.50 52.45 61.73 - 11288111 MED-SURG/7E:OBS/HR G0378 762 $138.00 51.00 - " 2,329.00 " " 1,123.02 " " 2,329.00 " - " 2,329.00 " 850.00 76.25 - 91.08 57.01 " 1,016.87 " 91.34 - - 76.68 95.85 - - - 110.40 - 976.54 92.46 - 56.44 103.50 52.45 61.73 - 15288116 PEDIATRICS/4M:OBS/HR G0378 762 $138.00 51.00 - " 2,329.00 " " 1,123.02 " " 2,329.00 " - " 2,329.00 " 850.00 76.25 - 91.08 57.01 " 1,016.87 " 91.34 - - 76.68 95.85 - - - 110.40 - 976.54 92.46 - 56.44 103.50 52.45 61.73 - 17188003 AICU/8:OBS/HR G0378 762 $138.00 51.00 - " 2,329.00 " " 1,123.02 " " 2,329.00 " - " 2,329.00 " 850.00 76.25 - 91.08 57.01 " 1,016.87 " 91.34 - - 76.68 95.85 - - - 110.40 - 976.54 92.46 - 56.44 103.50 52.45 61.73 - 17288016 AICU/2:OBS/HR G0378 762 $138.00 51.00 - " 2,329.00 " " 1,123.02 " " 2,329.00 " - " 2,329.00 " 850.00 76.25 - 91.08 57.01 " 1,016.87 " 91.34 - - 76.68 95.85 - - - 110.40 - 976.54 92.46 - 56.44 103.50 52.45 61.73 - 17380028 CARDIOVASCULAR ICU/HH2:OBS/HR G0378 762 $138.00 51.00 - " 2,329.00 " " 1,123.02 " " 2,329.00 " - " 2,329.00 " 850.00 76.25 - 91.08 57.01 " 1,016.87 " 91.34 - - 76.68 95.85 - - - 110.40 - 976.54 92.46 - 56.44 103.50 52.45 61.73 - 18288001 ORTHOPAEDICS/6M:OBS/HR G0378 762 $138.00 51.00 - " 2,329.00 " " 1,123.02 " " 2,329.00 " - " 2,329.00 " 850.00 76.25 - 91.08 57.01 " 1,016.87 " 91.34 - - 76.68 95.85 - - - 110.40 - 976.54 92.46 - 56.44 103.50 52.45 61.73 - 19000061 CARDIAC/SCU/HH2:OBS/HR G0378 762 $138.00 51.00 - " 2,329.00 " " 1,123.02 " " 2,329.00 " - " 2,329.00 " 850.00 76.25 - 91.08 57.01 " 1,016.87 " 91.34 - - 76.68 95.85 - - - 110.40 - 976.54 92.46 - 56.44 103.50 52.45 61.73 - 19388115 MED-SURG/4M:OBS/HR G0378 762 $138.00 51.00 - " 2,329.00 " " 1,123.02 " " 2,329.00 " - " 2,329.00 " 850.00 76.25 - 91.08 57.01 " 1,016.87 " 91.34 - - 76.68 95.85 - - - 110.40 - 976.54 92.46 - 56.44 103.50 52.45 61.73 - 19488110 MED-SURG/6M:OBS/HR G0378 762 $138.00 51.00 - " 2,329.00 " " 1,123.02 " " 2,329.00 " - " 2,329.00 " 850.00 76.25 - 91.08 57.01 " 1,016.87 " 91.34 - - 76.68 95.85 - - - 110.40 - 976.54 92.46 - 56.44 103.50 52.45 61.73 - 29817677 CARDIAC OP MON CPU: OBS/HR G0378 762 $138.00 51.00 - " 2,329.00 " " 1,123.02 " " 2,329.00 " - " 2,329.00 " 850.00 76.25 - 91.08 57.01 " 1,016.87 " 91.34 - - 76.68 95.85 - - - 110.40 - 976.54 92.46 - 56.44 103.50 52.45 61.73 - 37003131 ED: OBS/HR G0378 762 $138.00 51.00 - " 2,329.00 " " 1,123.02 " " 2,329.00 " - " 2,329.00 " 850.00 76.25 - 91.08 57.01 " 1,016.87 " 91.34 - - 76.68 95.85 - - - 110.40 - 976.54 92.46 - 56.44 103.50 52.45 61.73 - 39118882 WOMENS/6A:OBS/HR G0378 762 $138.00 51.00 - " 2,329.00 " " 1,123.02 " " 2,329.00 " - " 2,329.00 " 850.00 76.25 - 91.08 57.01 " 1,016.87 " 91.34 - - 76.68 95.85 - - - 110.40 - 976.54 92.46 - 56.44 103.50 52.45 61.73 - 39188821 L&D/3M:OBS/HR G0378 762 $138.00 51.00 - " 2,329.00 " " 1,123.02 " " 2,329.00 " - " 2,329.00 " 850.00 76.25 - 91.08 57.01 " 1,016.87 " 91.34 - - 76.68 95.85 - - - 110.40 - 976.54 92.46 - 56.44 103.50 52.45 61.73 - 10500036 DIRECT REFERRAL-HOSP OBS CARE G0379 762 "$2,741.00" " 1,013.07 " - " 2,192.80 " - " 1,894.03 " 544.61 " 1,894.03 " - " 1,514.40 " 534.24 " 1,809.06 " - - " 1,814.27 " 466.81 518.68 - - 531.65 534.24 518.68 " 2,192.80 " 474.59 - " 1,836.47 " 456.44 " 1,121.07 " " 2,055.75 " " 1,041.85 " " 1,226.05 " 536.83 10600031 DIRECT REFERRAL-HOSP OBS CARE G0379 762 "$2,741.00" " 1,013.07 " - " 2,192.80 " - " 1,894.03 " 544.61 " 1,894.03 " - " 1,514.40 " 534.24 " 1,809.06 " - - " 1,814.27 " 466.81 518.68 - - 531.65 534.24 518.68 " 2,192.80 " 474.59 - " 1,836.47 " 456.44 " 1,121.07 " " 2,055.75 " " 1,041.85 " " 1,226.05 " 536.83 11200036 DIRECT REFERRAL-HOSP OBS CARE G0379 762 "$2,741.00" " 1,013.07 " - " 2,192.80 " - " 1,894.03 " 544.61 " 1,894.03 " - " 1,514.40 " 534.24 " 1,809.06 " - - " 1,814.27 " 466.81 518.68 - - 531.65 534.24 518.68 " 2,192.80 " 474.59 - " 1,836.47 " 456.44 " 1,121.07 " " 2,055.75 " " 1,041.85 " " 1,226.05 " 536.83 15200031 DIRECT REFERRAL-HOSP OBS CARE G0379 762 "$2,741.00" " 1,013.07 " - " 2,192.80 " - " 1,894.03 " 544.61 " 1,894.03 " - " 1,514.40 " 534.24 " 1,809.06 " - - " 1,814.27 " 466.81 518.68 - - 531.65 534.24 518.68 " 2,192.80 " 474.59 - " 1,836.47 " 456.44 " 1,121.07 " " 2,055.75 " " 1,041.85 " " 1,226.05 " 536.83 17188020 AICU/8:DIR REF/HOSP OBS G0379 762 "$2,741.00" " 1,013.07 " - " 2,192.80 " - " 1,894.03 " 544.61 " 1,894.03 " - " 1,514.40 " 534.24 " 1,809.06 " - - " 1,814.27 " 466.81 518.68 - - 531.65 534.24 518.68 " 2,192.80 " 474.59 - " 1,836.47 " 456.44 " 1,121.07 " " 2,055.75 " " 1,041.85 " " 1,226.05 " 536.83 17200046 AICU/2:DIR REF/HOSP OBS G0379 762 "$2,741.00" " 1,013.07 " - " 2,192.80 " - " 1,894.03 " 544.61 " 1,894.03 " - " 1,514.40 " 534.24 " 1,809.06 " - - " 1,814.27 " 466.81 518.68 - - 531.65 534.24 518.68 " 2,192.80 " 474.59 - " 1,836.47 " 456.44 " 1,121.07 " " 2,055.75 " " 1,041.85 " " 1,226.05 " 536.83 17300032 DIRECT REFERRAL-HOSP OBS CARE G0379 762 "$2,741.00" " 1,013.07 " - " 2,192.80 " - " 1,894.03 " 544.61 " 1,894.03 " - " 1,514.40 " 534.24 " 1,809.06 " - - " 1,814.27 " 466.81 518.68 - - 531.65 534.24 518.68 " 2,192.80 " 474.59 - " 1,836.47 " 456.44 " 1,121.07 " " 2,055.75 " " 1,041.85 " " 1,226.05 " 536.83 18200309 DIRECT REFERRAL-HOSP OBS CARE G0379 762 "$2,741.00" " 1,013.07 " - " 2,192.80 " - " 1,894.03 " 544.61 " 1,894.03 " - " 1,514.40 " 534.24 " 1,809.06 " - - " 1,814.27 " 466.81 518.68 - - 531.65 534.24 518.68 " 2,192.80 " 474.59 - " 1,836.47 " 456.44 " 1,121.07 " " 2,055.75 " " 1,041.85 " " 1,226.05 " 536.83 19000362 DIRECT REFERRAL-HOSP OBS CARE G0379 762 "$2,741.00" " 1,013.07 " - " 2,192.80 " - " 1,894.03 " 544.61 " 1,894.03 " - " 1,514.40 " 534.24 " 1,809.06 " - - " 1,814.27 " 466.81 518.68 - - 531.65 534.24 518.68 " 2,192.80 " 474.59 - " 1,836.47 " 456.44 " 1,121.07 " " 2,055.75 " " 1,041.85 " " 1,226.05 " 536.83 19300030 DIRECT REFERRAL-HOSP OBS CARE G0379 762 "$2,741.00" " 1,013.07 " - " 2,192.80 " - " 1,894.03 " 544.61 " 1,894.03 " - " 1,514.40 " 534.24 " 1,809.06 " - - " 1,814.27 " 466.81 518.68 - - 531.65 534.24 518.68 " 2,192.80 " 474.59 - " 1,836.47 " 456.44 " 1,121.07 " " 2,055.75 " " 1,041.85 " " 1,226.05 " 536.83 19400301 DIRECT REFERRAL-HOSP OBS CARE G0379 762 "$2,741.00" " 1,013.07 " - " 2,192.80 " - " 1,894.03 " 544.61 " 1,894.03 " - " 1,514.40 " 534.24 " 1,809.06 " - - " 1,814.27 " 466.81 518.68 - - 531.65 534.24 518.68 " 2,192.80 " 474.59 - " 1,836.47 " 456.44 " 1,121.07 " " 2,055.75 " " 1,041.85 " " 1,226.05 " 536.83 39100576 DIRECT REFERRAL-HOSP OBS CARE G0379 762 "$2,741.00" " 1,013.07 " - " 2,192.80 " - " 1,894.03 " 544.61 " 1,894.03 " - " 1,514.40 " 534.24 " 1,809.06 " - - " 1,814.27 " 466.81 518.68 - - 531.65 534.24 518.68 " 2,192.80 " 474.59 - " 1,836.47 " 456.44 " 1,121.07 " " 2,055.75 " " 1,041.85 " " 1,226.05 " 536.83 37004049 TRAUMA ALERT: W/NOTIFICATION G0390 682 "$4,949.00" " 1,829.15 " - " 4,201.70 " - " 3,419.76 " 993.64 " 3,419.76 " - " 2,734.32 " 974.71 " 4,201.70 " - - " 3,275.74 " 851.69 946.32 " 2,622.48 " " 3,278.22 " 969.98 974.71 946.32 " 3,959.20 " 865.88 - " 3,315.83 " 832.76 " 2,024.14 " " 3,711.75 " " 1,881.11 " " 2,213.69 " 979.44 25000595 HOME SLP STD UN/4 CHANNELS G0399 920 $733.00 270.92 - " 1,195.66 " - 506.50 145.62 506.50 - 404.98 142.85 483.78 - - 485.17 124.82 138.69 956.53 " 1,195.66 " 142.16 142.85 138.69 586.40 126.90 - 491.11 122.05 299.80 549.75 278.61 327.87 143.54 25400593 HOME SLP STD UN/4 CHANNELS G0399 920 $733.00 270.92 - " 1,195.66 " - 506.50 145.62 506.50 - 404.98 142.85 483.78 - - 485.17 124.82 138.69 956.53 " 1,195.66 " 142.16 142.85 138.69 586.40 126.90 - 491.11 122.05 299.80 549.75 278.61 327.87 143.54 36601230 SURG PATH PROSTATE BIOPSY G0416 310 "$1,529.00" 565.12 - " 2,296.70 " - " 1,056.54 " 303.78 " 1,056.54 " - 844.77 297.99 768.04 - - " 1,012.05 " 260.38 289.31 " 1,837.36 " " 2,296.70 " 296.54 297.99 289.31 " 1,223.20 " 264.72 - 763.10 254.59 625.36 " 1,146.75 " 581.17 683.92 299.44 24970884 PRMC-COPD PER HOUR G0424 948 $292.00 107.92 - 233.60 - 201.77 N/A 201.77 - 161.33 N/A 192.72 - N/A 193.27 - N/A 179.98 224.98 N/A N/A N/A 233.60 N/A - 195.64 N/A 119.43 219.00 110.99 130.61 N/A 31200768 CONT INTRAOP NEURO MONITOR G0453 920 $328.00 121.23 - 262.40 - 226.65 - 226.65 - 181.22 - 216.48 - - 217.10 - - 93.66 117.07 - - - 262.40 - - 219.76 - 134.15 246.00 124.67 146.71 - 34054941 PREP/INSTALL FECAL SPECIMEN G0455 750 "$4,250.00" " 1,570.80 " 273.79 " 3,400.00 " 892.40 " 1,469.00 " 843.97 " 1,469.00 " 907.92 " 2,348.13 " 827.89 " 2,805.00 " 869.12 808.05 " 2,813.08 " 723.40 803.78 273.79 342.24 823.87 827.89 803.78 " 3,400.00 " 735.46 776.00 " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 34154945 PREP/INSTALL FECAL SPECIMEN G0455 750 "$4,250.00" " 1,570.80 " 273.79 " 3,400.00 " 892.40 " 1,469.00 " 843.97 " 1,469.00 " 907.92 " 2,348.13 " 827.89 " 2,805.00 " 869.12 808.05 " 2,813.08 " 723.40 803.78 273.79 342.24 823.87 827.89 803.78 " 3,400.00 " 735.46 776.00 " 2,847.50 " 707.33 " 1,738.25 " " 3,187.50 " " 1,615.43 " " 1,901.03 " 831.91 25000153 OP CONSULT LVL 1 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 25000161 OP CONSULT LVL 2 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 25000170 OP CONSULT LVL 3 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 25000188 OP CONSULT LVL 4 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 25000196 OP CONSULT LVL 5 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 25000200 NEW VISIT LVL 1 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 25000218 NEW VISIT LVL 2 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 25000226 NEW VISIT LVL 3 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 25000234 NEW VISIT LVL 4 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 25000242 NEW VISIT LVL 5 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 25000251 EST VISIT LVL 1 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 25000269 EST VISIT LVL 2 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 25000277 EST VISIT LVL 3 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 25000285 EST VISIT LVL 4 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 25000293 EST VISIT LVL 5 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 25400160 NEW VISIT LVL 1 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 25400178 NEW VISIT LVL 2 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 25400186 NEW VISIT LVL 3 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 25400194 NEW VISIT LVL 4 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 25400208 NEW VISIT LVL 5 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 25400216 OP CONSULT LVL 1 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 25400224 OP CONSULT LVL 2 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 25400232 OP CONSULT LVL 3 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 25400241 OP CONSULT LVL 4 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 25400259 OP CONSULT LVL 5 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 25400267 EST VISIT LVL 1 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 25400275 EST VISIT LVL 2 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 25400283 EST VISIT LVL 3 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 25400291 EST VISIT LVL 4 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 25400305 EST VISIT LVL 5 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 29812888 NURSE VISIT LVL 1 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 34000522 NURSE VISIT G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 34100527 NURSE VISIT G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 34500169 NURSE VISIT OSTOMY: BRIEF G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 34500177 NURSE VISIT OSTOMY: INTER G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 34500185 NURSE VISIT OSTOMY: LONG G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 37003247 NURSE VISIT SUTURE REMOVAL G0463 450 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 43100084 OP CONSULT LVL 2 G0463 513 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 43100092 OP CONSULT LVL 3 G0463 513 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 43100106 OP CONSULT LVL 4 G0463 513 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 43100114 OP CONSULT LVL 5 G0463 513 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 43900323 OP CONSULT LVL 2 G0463 513 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 43900331 OP CONSULT LVL 3 G0463 513 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 43900340 OP CONSULT LVL 4 G0463 513 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 43900358 OP CONSULT LVL 5 G0463 513 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 45520081 OP CONSULT LVL 2 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 45520099 OP CONSULT LVL 3 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 45520102 OP CONSULT LVL 4 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 45520111 OP CONSULT LVL 5 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 51600568 NURSE VISIT-SKIN ASSESSMENT G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 51600576 OP CONSULT LVL 1 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 51600622 NEW VISIT LVL 1 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 51600631 NEW VISIT LVL 2 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 51600649 NEW VISIT LVL 3 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 51600657 NEW VISIT LVL 4 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 51600665 NEW VISIT LVL 5 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 51600673 EST VISIT LVL 1 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 51600681 EST VISIT LVL 2 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 51600690 EST VISIT LVL 3 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 51600703 EST VISIT LVL 4 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 51600711 EST VISIT LVL 5 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 51600797 FACILITY VISIT FEE G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 51600801 OP CONSULT LVL 2 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 51600819 OP CONSULT LVL 3 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 51600827 OP CONSULT LVL 4 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 51600835 OP CONSULT LVL 5 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 80010745 WOUND CARE MAMMOSITE CATH SITE G0463 761 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 80011202 OUTPATIENT CONSULT LEVEL 1 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 80011211 OUTPATIENT CONSULT LEVEL 2 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 80011229 OUTPATIENT CONSULT LEVEL 3 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 80011237 OUTPATIENT CONSULT LEVEL 4 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 80011245 OUTPATIENT CONSULT LEVEL 5 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 80011253 NEW VISIT LEVEL 1 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 80011261 NEW VISIT LEVEL 2 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 80011270 NEW VISIT LEVEL 3 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 80011288 NEW VISIT LEVEL 4 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 80011296 NEW VISIT LEVEL 5 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 80011300 ESTABLISHED VISIT LEVEL 1 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 80011318 ESTABLISHED VISIT LEVEL 2 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 80011326 ESTABLISHED VISIT LEVEL 3 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 80011334 ESTABLISHED VISIT LEVEL 4 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 80011342 ESTABLISHED VISIT LEVEL 5 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 80335971 OUTPATIENT CONSULT LEVEL 1 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 80335989 OUTPATIENT CONSULT LEVEL 2 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 80335997 OUTPATIENT CONSULT LEVEL 3 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 80336004 OUTPATIENT CONSULT LEVEL 4 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 80336012 OUTPATIENT CONSULT LEVEL 5 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 80336021 NEW VISIT LEVEL 1 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 80336039 NEW VISIT LEVEL 2 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 80336047 NEW VISIT LEVEL 3 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 80336055 NEW VISIT LEVEL 4 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 80336063 NEW VISIT LEVEL 5 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 80336071 EST VISIT LEVEL 1 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 80336080 EST VISIT LEVEL 2 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 80336098 EST VISIT LEVEL 3 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 80336101 EST VISIT LEVEL 4 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 80336110 EST VISIT LEVEL 5 G0463 510 $623.00 230.26 - 498.40 - 430.49 123.93 430.49 - 344.21 121.57 411.18 - - 412.36 106.23 118.03 - - 120.98 121.57 118.03 498.40 108.00 - 417.41 103.87 254.81 467.25 236.80 278.67 122.16 35702831 AMPHETAMINE CONF FORENSIC G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 35702849 CANNABINOID CONF GC/MS FORE G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 35702865 COCAINE CONFIRMATION FORENSIC G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 35702873 BENZODIAZEPINES G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 35704876 METHADONE FORENSIC CONF G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 35705341 PENTOBARBITAL G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 35706917 ETHANOL FORENSIC G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 35707603 BENZODIAZEPINES G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 35707611 CANNABINOID CONF MEDICAL G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 35707620 COCAINE CONFIRMATION MEDICAL G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 35707654 AMPHETAMINE CONF MEDICAL G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 35708430 HEROIN CONFIRMATION MEDICAL G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 35708448 HEROIN CONFIRMATION FORENSIC G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 35708481 METHADONE MEDICAL CONF G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 35709932 MORPHINE/CODEINE MEDICAL CONF G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 35709941 MORPHINE/CODEINE FORENSIC CONF G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 35750835 OXYCODONE MEDICAL CONF G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 35750843 OXYCODONE FORENSIC CONF G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 35750851 HYDROCOD/HYDROMOR MED CONF G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 35750860 HYDROCOD/HYDROMOR FOR CONF G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 35750924 COTININE CONFIRM UR G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 35750932 COTININE CONFIRM UR FOR G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 35750941 TAPENTADOL BY LCMSMS G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 35750959 TAPENTADOL BY LCMSMS FOR G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 35750967 TRAMADOL BY LCMSMS G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 35750975 TRAMADOL BY LCMSMS FOR G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 35750983 FENTANYL CONFIRMATORY G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 35750991 FENTANYL CONFIRMATORY FOR G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 35751009 RITALIN BY LCMSMS G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 35751017 RITALIN BY LCMSMS FOR G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 35751025 BUPRENORPHINE BY LCMS G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 35751033 BUPRENORPHINE BY LCMS FOR G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 35751041 AMPHETAMINES 5 OR MORE G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 35751050 MDA MEDA MDMA G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 35751068 AMPHETAMINES 5 OR MORE G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 35751076 MDA MEDA MDMA G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 35751084 OPIATES 1 OR MORE G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 35751092 OXYCODONE G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 35751106 HEROIN METABOLITE G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 35751114 OPIATES 1 OR MORE G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 35751122 OXYCODONE G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 35751131 HEROIN METABOLITE G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 35791604 ZOLPIDEM & METABOLITE FOR G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 35791612 ZOLPIDEM & METABOLITE MED G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36901438 CLONAZEPAM (KLONOPIN) G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36901462 MEXILETINE (MEXITIL) G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36901870 LOXAPINE G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36902078 DIAZEPAM (VALIUM) G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36902191 CLORAZEPATE (TRANZENE) G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36902396 TOCAINIDE (TONOCARD) G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36903198 TRIMIPRAMINE G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36904445 CLOMIPRAMINE G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36904500 LORAZEPAM G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36904551 TRAZODONE (DESYREL) G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36906651 ZOLOFT (SERTRALINE) G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36906669 SOTALOL G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36907908 AMPHETAMINE CONF GCMS MECONIUM G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36907932 OPIATE CONF GCMS MECONIUM G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36907983 COCAINE CONF GCMS MECONIUM G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36909129 MARIJUANA GCMS MECONIUM G0480 300 $305.00 112.73 63.95 440.59 73.54 210.76 120.15 210.76 63.95 168.51 117.86 163.15 70.35 66.59 201.88 102.99 114.43 352.47 440.59 117.29 117.86 114.43 244.00 104.70 63.95 299.81 100.70 124.75 228.75 115.93 136.43 118.44 36909757 LSD CONFIRMATION G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36909781 COUMADIN PLASMA G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36909838 PAROXETINE (PAXIL) G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36910411 AMANTADINE (SYMMETREL) G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36910569 NICOTINE/COTININE G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36910763 BUPROPION G0480 300 $621.00 229.52 63.95 496.80 73.54 429.11 120.15 429.11 63.95 343.10 117.86 163.15 70.35 66.59 411.04 102.99 114.43 352.47 440.59 117.29 117.86 114.43 496.80 104.70 63.95 299.81 100.70 253.99 465.75 236.04 277.77 118.44 36910909 RISPERIDONE G0480 300 $611.00 225.83 63.95 488.80 73.54 422.20 120.15 422.20 63.95 337.58 117.86 163.15 70.35 66.59 404.42 102.99 114.43 352.47 440.59 117.29 117.86 114.43 488.80 104.70 63.95 299.81 100.70 249.90 458.25 232.24 273.30 118.44 36912332 NAVANE (THIOTHIXENE) G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36914203 6-THIOGUANINE HPLC G0480 300 "$1,094.00" 404.34 63.95 875.20 73.54 755.95 120.15 755.95 63.95 604.44 117.86 163.15 70.35 66.59 724.12 102.99 114.43 352.47 440.59 117.29 117.86 114.43 875.20 104.70 63.95 299.81 100.70 447.45 820.50 415.83 489.35 118.44 36914211 6-METHYLMERCAPTOPURINE HPLC G0480 300 "$1,094.00" 404.34 63.95 875.20 73.54 755.95 120.15 755.95 63.95 604.44 117.86 163.15 70.35 66.59 724.12 102.99 114.43 352.47 440.59 117.29 117.86 114.43 875.20 104.70 63.95 299.81 100.70 447.45 820.50 415.83 489.35 118.44 36917008 XANAX (ALPRAZOLAM) G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36917211 METFORMIN G0480 300 $641.00 236.91 63.95 512.80 73.54 442.93 120.15 442.93 63.95 354.15 117.86 163.15 70.35 66.59 424.28 102.99 114.43 352.47 440.59 117.29 117.86 114.43 512.80 104.70 63.95 299.81 100.70 262.17 480.75 243.64 286.72 118.44 36917229 ETHOTOIN G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36917300 ACETAZOLAMIDE (DIAMOX) G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36919361 COCAINE CONFIRMATION GCMS G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36920025 NORTRIPTYLINE(PAMELOR) QUANT G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36920033 DESIPRAMINE/NORPRAMINE QUANT G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36920041 DOXEPIN/DESMETHYLDOXEPIN QUANT G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36920050 IMIPRAMINE/DESIPRAMINE QUANT G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36920068 AMITRIPTYLINE/NORTRIPTYLINE G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36922907 CHLORPROMAZINE G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36930128 THIORIDAZINE AND METABOLITE G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36930675 CLOBAZAM G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36932554 BUPRENORPHINE & METAB URINE G0480 300 $677.00 250.22 63.95 541.60 73.54 467.81 120.15 467.81 63.95 374.04 117.86 163.15 70.35 66.59 448.11 102.99 114.43 352.47 440.59 117.29 117.86 114.43 541.60 104.70 63.95 299.81 100.70 276.89 507.75 257.33 302.82 118.44 36932562 NALOXONE URINE G0480 300 $677.00 250.22 63.95 541.60 73.54 467.81 120.15 467.81 63.95 374.04 117.86 163.15 70.35 66.59 448.11 102.99 114.43 352.47 440.59 117.29 117.86 114.43 541.60 104.70 63.95 299.81 100.70 276.89 507.75 257.33 302.82 118.44 36932627 BUPRENORPHINE CONFIRMATION G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36932988 FLUOXETINE (PROZAC) MS QNT G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36932996 BUPIVACAINE QUANTITATION G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36935715 PROPOXYPHENE CONFIRMATN URINE G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36936886 BARBITURATES CONFIRM URINE G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36937939 CLONAZEPAM URINE G0480 300 $733.00 270.92 63.95 586.40 73.54 506.50 120.15 506.50 63.95 404.98 117.86 163.15 70.35 66.59 485.17 102.99 114.43 352.47 440.59 117.29 117.86 114.43 586.40 104.70 63.95 299.81 100.70 299.80 549.75 278.61 327.87 118.44 36937947 TRAMADOL URINE G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36938871 FENTANYL URINE CONFIRMATION G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36938901 THIOPURINE METABOLITES QUANT G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36939966 OPIATES 1 OR MORE G0480 300 $721.00 266.48 63.95 576.80 73.54 498.21 120.15 498.21 63.95 398.35 117.86 163.15 70.35 66.59 477.23 102.99 114.43 352.47 440.59 117.29 117.86 114.43 576.80 104.70 63.95 299.81 100.70 294.89 540.75 274.05 322.50 118.44 36939974 OXYCODONE G0480 300 $721.00 266.48 63.95 576.80 73.54 498.21 120.15 498.21 63.95 398.35 117.86 163.15 70.35 66.59 477.23 102.99 114.43 352.47 440.59 117.29 117.86 114.43 576.80 104.70 63.95 299.81 100.70 294.89 540.75 274.05 322.50 118.44 36939982 AMPHETAMINES 5 OR MORE G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36939991 MDA MDEA MDMA G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36940921 BARBITURATES MECONIUM G0480 300 $893.00 330.05 63.95 714.40 73.54 617.06 120.15 617.06 63.95 493.38 117.86 163.15 70.35 66.59 591.08 102.99 114.43 352.47 440.59 117.29 117.86 114.43 714.40 104.70 63.95 299.81 100.70 365.24 669.75 339.43 399.44 118.44 36940948 CANNABINOIDS MECONIUM G0480 300 $828.00 306.03 63.95 662.40 73.54 572.15 120.15 572.15 63.95 457.47 117.86 163.15 70.35 66.59 548.05 102.99 114.43 352.47 440.59 117.29 117.86 114.43 662.40 104.70 63.95 299.81 100.70 338.65 621.00 314.72 370.36 118.44 36940956 COCAINE & METAB MECONIUM G0480 300 $791.00 292.35 63.95 632.80 73.54 546.58 120.15 546.58 63.95 437.03 117.86 163.15 70.35 66.59 523.56 102.99 114.43 352.47 440.59 117.29 117.86 114.43 632.80 104.70 63.95 299.81 100.70 323.52 593.25 300.66 353.81 118.44 36940964 METHADONE & METAB MECONIUM G0480 300 $861.00 318.23 63.95 688.80 73.54 594.95 120.15 594.95 63.95 475.70 117.86 163.15 70.35 66.59 569.90 102.99 114.43 352.47 440.59 117.29 117.86 114.43 688.80 104.70 63.95 299.81 100.70 352.15 645.75 327.27 385.13 118.44 36940999 OPIATES 1 OR MORE G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36941006 OXYCODONE G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36941014 AMPHETAMINES; 1 OR 2 G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36941022 MDA MDEA MDMA G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36941464 AMPHETAMINES; 1 OR 2 G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36941472 BARBITURATES G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36941499 BUPRENORPHINE G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36941502 CANNABINOIDS NATURAL G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36941511 COCAINE G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36941529 METHADONE G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36941537 MDA MDEA MDMA G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36941545 OPIATES 1 OR MORE G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36941553 OPIOIDS AND OPIATE ANALOGS 1 2 G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36941561 OXYCODONE G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36941570 PROPOXYPHENE G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36941588 TRAMADOL G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36943297 ETHYL GLUCURONIDE G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36981652 STREPTOMYCIN LEVEL HPLC G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36982951 ALCOHOL ETHYL MG/DL G0480 300 $601.00 222.13 63.95 480.80 73.54 415.29 120.15 415.29 63.95 332.05 117.86 163.15 70.35 66.59 397.80 102.99 114.43 352.47 440.59 117.29 117.86 114.43 480.80 104.70 63.95 299.81 100.70 245.81 450.75 228.44 268.83 118.44 36998717 RITALINIC ACID G0480 300 $572.00 211.41 63.95 457.60 73.54 395.25 120.15 395.25 63.95 316.03 117.86 163.15 70.35 66.59 378.61 102.99 114.43 352.47 440.59 117.29 117.86 114.43 457.60 104.70 63.95 299.81 100.70 233.95 429.00 217.42 255.86 118.44 36938889 HYPOGLYCEMIC PNL BLD LC-MS/MS G0481 300 $822.00 303.81 98.39 677.86 113.15 568.00 164.42 568.00 98.39 454.16 161.29 251.01 108.23 102.45 544.08 140.93 156.59 542.29 677.86 160.50 161.29 156.59 657.60 143.28 98.39 410.27 137.80 336.20 616.50 312.44 367.68 162.07 36938919 HYPOGLYCEMIC PNL SER LC-MS/MS G0481 300 $822.00 303.81 98.39 677.86 113.15 568.00 164.42 568.00 98.39 454.16 161.29 251.01 108.23 102.45 544.08 140.93 156.59 542.29 677.86 160.50 161.29 156.59 657.60 143.28 98.39 410.27 137.80 336.20 616.50 312.44 367.68 162.07 36941481 BENZODIAZEPINES; 1-12 G0481 300 $822.00 303.81 98.39 677.86 113.15 568.00 164.42 568.00 98.39 454.16 161.29 251.01 108.23 102.45 544.08 140.93 156.59 542.29 677.86 160.50 161.29 156.59 657.60 143.28 98.39 410.27 137.80 336.20 616.50 312.44 367.68 162.07 36940000 BENZODIAZEPINES 13 OR MORE UR G0482 300 "$1,043.00" 385.49 132.82 915.07 152.74 720.71 208.68 720.71 132.82 576.26 204.70 251.01 146.10 138.31 690.36 178.87 198.74 732.06 915.07 203.71 204.70 198.74 834.40 181.85 132.82 520.70 174.89 426.59 782.25 396.44 466.53 205.70 36940930 BENZODIAZEPINES MECONIUM G0482 300 "$1,043.00" 385.49 132.82 915.07 152.74 720.71 208.68 720.71 132.82 576.26 204.70 251.01 146.10 138.31 690.36 178.87 198.74 732.06 915.07 203.71 204.70 198.74 834.40 181.85 132.82 520.70 174.89 426.59 782.25 396.44 466.53 205.70 53941427 CDSM APPLIED PATHWAYS G1000 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67741421 CDSM APPLIED PATHWAYS G1000 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67741544 CDSM APPLIED PATHWAYS G1000 409 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67941420 CDSM APPLIED PATHWAYS G1000 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80241429 CDSM APPLIED PATHWAYS G1000 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80441428 CDSM APPLIED PATHWAYS G1000 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80641427 CDSM APPLIED PATHWAYS G1000 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81441421 CDSM APPLIED PATHWAYS G1000 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81441669 CDSM APPLIED PATHWAYS G1000 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81641421 CDSM APPLIED PATHWAYS G1000 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81641668 CDSM APPLIED PATHWAYS G1000 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 83041421 CDSM APPLIED PATHWAYS G1000 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 53941435 CDSM EVICORE G1001 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67741439 CDSM EVICORE G1001 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67741552 CDSM EVICORE G1001 409 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67941438 CDSM EVICORE G1001 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80241437 CDSM EVICORE G1001 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80441436 CDSM EVICORE G1001 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80641435 CDSM EVICORE G1001 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81441430 CDSM EVICORE G1001 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81441677 CDSM EVICORE G1001 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81641439 CDSM EVICORE G1001 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81641676 CDSM EVICORE G1001 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 83041439 CDSM EVICORE G1001 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 53941443 CDSM MEDCURRENT G1002 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67741447 CDSM MEDCURRENT G1002 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67741561 CDSM MEDCURRENT G1002 409 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67941446 CDSM MEDCURRENT G1002 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80241445 CDSM MEDCURRENT G1002 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80441444 CDSM MEDCURRENT G1002 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80641443 CDSM MEDCURRENT G1002 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81441448 CDSM MEDCURRENT G1002 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81441685 CDSM MEDCURRENT G1002 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81641447 CDSM MEDCURRENT G1002 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81641684 CDSM MEDCURRENT G1002 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 83041447 CDSM MEDCURRENT G1002 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 53941451 CDSM MEDICALIS G1003 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67741455 CDSM MEDICALIS G1003 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67741579 CDSM MEDICALIS G1003 409 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67941454 CDSM MEDICALIS G1003 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80241453 CDSM MEDICALIS G1003 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80441452 CDSM MEDICALIS G1003 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80641451 CDSM MEDICALIS G1003 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81441456 CDSM MEDICALIS G1003 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81441693 CDSM MEDICALIS G1003 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81641455 CDSM MEDICALIS G1003 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81641692 CDSM MEDICALIS G1003 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 83041455 CDSM MEDICALIS G1003 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 53941460 CDSM NATNL DECISION SUPPORT CO G1004 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67741463 CDSM NATNL DECISION SUPPORT CO G1004 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67741587 CDSM NATNL DECISION SUPPORT CO G1004 409 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67941462 CDSM NATNL DECISION SUPPORT CO G1004 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80241461 CDSM NATNL DECISION SUPPORT CO G1004 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80441461 CDSM NATNL DECISION SUPPORT CO G1004 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80641460 CDSM NATNL DECISION SUPPORT CO G1004 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81441464 CDSM NATNL DECISION SUPPORT CO G1004 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81441707 CDSM NATNL DECISION SUPPORT CO G1004 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81641463 CDSM NATNL DECISION SUPPORT CO G1004 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81641706 CDSM NATNL DECISION SUPPORT CO G1004 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 83041463 CDSM NATNL DECISION SUPPORT CO G1004 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 53941478 CDSM NATNL IMAGING ASSOCIATES G1005 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67741471 CDSM NATNL IMAGING ASSOCIATES G1005 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67741595 CDSM NATNL IMAGING ASSOCIATES G1005 409 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67941471 CDSM NATNL IMAGING ASSOCIATES G1005 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80241470 CDSM NATNL IMAGING ASSOCIATES G1005 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80441479 CDSM NATNL IMAGING ASSOCIATES G1005 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80641478 CDSM NATNL IMAGING ASSOCIATES G1005 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81441472 CDSM NATNL IMAGING ASSOCIATES G1005 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81441715 CDSM NATNL IMAGING ASSOCIATES G1005 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81641471 CDSM NATNL IMAGING ASSOCIATES G1005 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81641714 CDSM NATNL IMAGING ASSOCIATES G1005 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 83041471 CDSM NATNL IMAGING ASSOCIATES G1005 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 53941486 CDSM TEST APPROPRIATE G1006 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67741480 CDSM TEST APPROPRIATE G1006 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67741609 CDSM TEST APPROPRIATE G1006 409 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67941489 CDSM TEST APPROPRIATE G1006 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80241488 CDSM TEST APPROPRIATE G1006 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80441487 CDSM TEST APPROPRIATE G1006 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80641486 CDSM TEST APPROPRIATE G1006 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81441481 CDSM TEST APPROPRIATE G1006 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81441723 CDSM TEST APPROPRIATE G1006 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81641480 CDSM TEST APPROPRIATE G1006 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81641722 CDSM TEST APPROPRIATE G1006 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 83041480 CDSM TEST APPROPRIATE G1006 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 53941494 CDSM AIM SPECIALTY HEALTH G1007 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67741498 CDSM AIM SPECIALTY HEALTH G1007 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67741617 CDSM AIM SPECIALTY HEALTH G1007 409 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67941497 CDSM AIM SPECIALTY HEALTH G1007 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80241496 CDSM AIM SPECIALTY HEALTH G1007 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80441495 CDSM AIM SPECIALTY HEALTH G1007 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80641494 CDSM AIM SPECIALTY HEALTH G1007 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81441499 CDSM AIM SPECIALTY HEALTH G1007 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81441731 CDSM AIM SPECIALTY HEALTH G1007 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81641498 CDSM AIM SPECIALTY HEALTH G1007 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81641731 CDSM AIM SPECIALTY HEALTH G1007 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 83041498 CDSM AIM SPECIALTY HEALTH G1007 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 53941508 CDSM CRANBERRY PEAK G1008 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67741501 CDSM CRANBERRY PEAK G1008 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67741625 CDSM CRANBERRY PEAK G1008 409 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67941501 CDSM CRANBERRY PEAK G1008 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80241500 CDSM CRANBERRY PEAK G1008 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80441509 CDSM CRANBERRY PEAK G1008 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80641508 CDSM CRANBERRY PEAK G1008 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81441502 CDSM CRANBERRY PEAK G1008 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81441740 CDSM CRANBERRY PEAK G1008 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81641501 CDSM CRANBERRY PEAK G1008 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81641749 CDSM CRANBERRY PEAK G1008 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 83041501 CDSM CRANBERRY PEAK G1008 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 53941516 CDSM SAGE HEALTH MGT SOLUTIONS G1009 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67741510 CDSM SAGE HEALTH MGT SOLUTIONS G1009 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67741633 CDSM SAGE HEALTH MGT SOLUTIONS G1009 409 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67941519 CDSM SAGE HEALTH MGT SOLUTIONS G1009 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80241518 CDSM SAGE HEALTH MGT SOLUTIONS G1009 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80441517 CDSM SAGE HEALTH MGT SOLUTIONS G1009 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80641516 CDSM SAGE HEALTH MGT SOLUTIONS G1009 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81441511 CDSM SAGE HEALTH MGT SOLUTIONS G1009 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81441758 CDSM SAGE HEALTH MGT SOLUTIONS G1009 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81641510 CDSM SAGE HEALTH MGT SOLUTIONS G1009 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81641757 CDSM SAGE HEALTH MGT SOLUTIONS G1009 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 83041510 CDSM SAGE HEALTH MGT SOLUTIONS G1009 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 53941524 CDSM STANSON G1010 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67741528 CDSM STANSON G1010 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67741641 CDSM STANSON G1010 409 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67941527 CDSM STANSON G1010 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80241526 CDSM STANSON G1010 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80441525 CDSM STANSON G1010 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80641524 CDSM STANSON G1010 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81441529 CDSM STANSON G1010 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81441766 CDSM STANSON G1010 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81641528 CDSM STANSON G1010 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81641765 CDSM STANSON G1010 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 83041528 CDSM STANSON G1010 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 53941532 CDSM QUALIFIED TOOL NOS G1011 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67741536 CDSM QUALIFIED TOOL NOS G1011 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67741650 CDSM QUALIFIED TOOL NOS G1011 409 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67941535 CDSM QUALIFIED TOOL NOS G1011 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80241534 CDSM QUALIFIED TOOL NOS G1011 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80441533 CDSM QUALIFIED TOOL NOS G1011 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80641532 CDSM QUALIFIED TOOL NOS G1011 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81441537 CDSM QUALIFIED TOOL NOS G1011 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81441774 CDSM STANSON G1011 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81641536 CDSM QUALIFIED TOOL NOS G1011 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81641773 CDSM QUALIFIED TOOL NOS G1011 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 83041536 CDSM QUALIFIED TOOL NOS G1011 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 53941788 CDSM AGILEMD G1012 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67741781 CDSM AGILEMD G1012 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67741862 CDSM AGILEMD G1012 409 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67941781 CDSM AGILEMD G1012 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80241780 CDSM AGILEMD G1012 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80441789 CDSM AGILEMD G1012 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80641788 CDSM AGILEMD G1012 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81441782 CDSM AGILEMD G1012 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81441944 CDSM AGILEMD G1012 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81641781 CDSM AGILEMD G1012 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81641943 CDSM AGILEMD G1012 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 83041781 CDSM AGILEMD G1012 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 53941796 CDSM EVIDENCECARE IMAGING G1013 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67741790 CDSM EVIDENCECARE IMAGING G1013 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67741871 CDSM EVIDENCECARE IMAGING G1013 409 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67941799 CDSM EVIDENCECARE IMAGING G1013 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80241798 CDSM EVIDENCECARE IMAGING G1013 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80441797 CDSM EVIDENCECARE IMAGING G1013 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80641796 CDSM EVIDENCECARE IMAGING G1013 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81441791 CDSM EVIDENCECARE IMAGING G1013 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81441952 CDSM EVIDENCECARE IMAGING G1013 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81641790 CDSM EVIDENCECARE IMAGING G1013 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81641951 CDSM EVIDENCECARE IMAGING G1013 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 83041790 CDSM EVIDENCECARE IMAGING G1013 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 53941800 CDSM INVENIQA SEMANTIC ANSWERS G1014 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67741803 CDSM INVENIQA SEMANTIC ANSWERS G1014 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67741889 CDSM INVENIQA SEMANTIC ANSWERS G1014 409 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67941802 CDSM INVENIQA SEMANTIC ANSWERS G1014 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80241801 CDSM INVENIQA SEMANTIC ANSWERS G1014 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80441801 CDSM INVENIQA SEMANTIC ANSWERS G1014 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80641800 CDSM INVENIQA SEMANTIC ANSWERS G1014 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81441804 CDSM INVENIQA SEMANTIC ANSWERS G1014 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81441961 CDSM INVENIQA SEMANTIC ANSWERS G1014 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81641803 CDSM INVENIQA SEMANTIC ANSWERS G1014 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81641960 CDSM INVENIQA SEMANTIC ANSWERS G1014 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 83041803 CDSM INVENIQA SEMANTIC ANSWERS G1014 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 53941818 CDSM RELIANT MEDICAL GROUP G1015 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67741811 CDSM RELIANT MEDICAL GROUP G1015 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67741897 CDSM RELIANT MEDICAL GROUP G1015 409 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67941811 CDSM RELIANT MEDICAL GROUP G1015 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80241810 CDSM RELIANT MEDICAL GROUP G1015 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80441819 CDSM RELIANT MEDICAL GROUP G1015 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80641818 CDSM RELIANT MEDICAL GROUP G1015 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81441812 CDSM RELIANT MEDICAL GROUP G1015 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81441979 CDSM RELIANT MEDICAL GROUP G1015 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81641811 CDSM RELIANT MEDICAL GROUP G1015 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81641978 CDSM RELIANT MEDICAL GROUP G1015 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 83041811 CDSM RELIANT MEDICAL GROUP G1015 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 53941826 CDSM SPEED OF CARE G1016 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67741820 CDSM SPEED OF CARE G1016 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67741901 CDSM SPEED OF CARE G1016 409 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67941829 CDSM SPEED OF CARE G1016 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80241828 CDSM SPEED OF CARE G1016 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80441827 CDSM SPEED OF CARE G1016 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80641826 CDSM SPEED OF CARE G1016 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81441821 CDSM SPEED OF CARE G1016 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81441987 CDSM SPEED OF CARE G1016 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81641820 CDSM SPEED OF CARE G1016 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81641986 CDSM SPEED OF CARE G1016 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 83041820 CDSM SPEED OF CARE G1016 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 53941834 CDSM HEALTHHELP G1017 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67741838 CDSM HEALTHHELP G1017 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67741919 CDSM HEALTHHELP G1017 409 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67941837 CDSM HEALTHHELP G1017 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80241836 CDSM HEALTHHELP G1017 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80441835 CDSM HEALTHHELP G1017 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80641834 CDSM HEALTHHELP G1017 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81441839 CDSM HEALTHHELP G1017 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81441995 CDSM HEALTHHELP G1017 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81641838 CDSM HEALTHHELP G1017 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81641994 CDSM HEALTHHELP G1017 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 83041838 CDSM HEALTHHELP G1017 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 53941842 CDSM INFINX G1018 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67741846 CDSM INFINX G1018 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67741927 CDSM INFINX G1018 409 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67941845 CDSM INFINX G1018 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80241844 CDSM INFINX G1018 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80441843 CDSM INFINX G1018 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80641842 CDSM INFINX G1018 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81441847 CDSM INFINX G1018 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81442002 CDSM INFINX G1018 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81641846 CDSM INFINX G1018 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81642001 CDSM INFINX G1018 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 83041846 CDSM INFINX G1018 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 53941851 CDSM LOGICNETS AUC SOLUTION G1019 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67741854 CDSM LOGICNETS AUC SOLUTION G1019 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67741935 CDSM LOGICNETS AUC SOLUTION G1019 409 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67941853 CDSM LOGICNETS AUC SOLUTION G1019 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80241852 CDSM LOGICNETS AUC SOLUTION G1019 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80441851 CDSM LOGICNETS AUC SOLUTION G1019 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80641851 CDSM LOGICNETS AUC SOLUTION G1019 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81441855 CDSM LOGICNETS AUC SOLUTION G1019 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81442011 CDSM LOGICNETS AUC SOLUTION G1019 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81641854 CDSM LOGICNETS AUC SOLUTION G1019 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81642010 CDSM LOGICNETS AUC SOLUTION G1019 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 83041854 CDSM LOGICNETS AUC SOLUTION G1019 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 53941869 CDSM CURBSIDE G1020 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67742028 CDSM CURBSIDE G1020 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67742036 CDSM CURBSIDE G1020 409 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67941861 CDSM CURBSIDE G1020 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80241861 CDSM CURBSIDE G1020 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80441860 CDSM CURBSIDE G1020 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80665598 CDSM CURBSIDE G1020 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81490406 CDSM CURBSIDE G1020 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81490414 CDSM CURBSIDE G1020 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81642044 CDSM CURBSIDE G1020 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81642052 CDSM CURBSIDE G1020 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 83041862 CDSM CURBSIDE G1020 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 53941877 CDSM EHEALTHLINE G1021 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67741960 CDSM EHEALTHLINE G1021 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67741978 CDSM EHEALTHLINE G1021 409 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67941870 CDSM EHEALTHLINE G1021 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80241879 CDSM EHEALTHLINE G1021 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80441878 CDSM EHEALTHLINE G1021 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80665601 CDSM EHEALTHLINE G1021 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81490422 CDSM EHEALTHLINE G1021 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81490431 CDSM EHEALTHLINE G1021 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81642061 CDSM EHEALTHLINE G1021 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81642079 CDSM EHEALTHLINE G1021 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 83041871 CDSM EHEALTHLINE G1021 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 53941885 CDSM INTERMOUNTAIN G1022 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67741986 CDSM INTERMOUNTAIN G1022 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67741994 CDSM INTERMOUNTAIN G1022 409 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67941888 CDSM INTERMOUNTAIN G1022 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80241887 CDSM INTERMOUNTAIN G1022 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80441886 CDSM INTERMOUNTAIN G1022 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80665610 CDSM INTERMOUNTAIN G1022 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81490449 CDSM INTERMOUNTAIN G1022 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81490457 CDSM INTERMOUNTAIN G1022 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81642087 CDSM INTERMOUNTAIN G1022 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81642095 CDSM INTERMOUNTAIN G1022 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 83041889 CDSM INTERMOUNTAIN G1022 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 53941893 CDSM PERSIVIA G1023 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67742001 CDSM PERSIVIA G1023 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67742010 CDSM PERSIVIA G1023 409 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 67941896 CDSM PERSIVIA G1023 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80241895 CDSM PERSIVIA G1023 349 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80441894 CDSM PERSIVIA G1023 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 80665628 CDSM PERSIVIA G1023 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81490465 CDSM PERSIVIA G1023 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81490473 CDSM PERSIVIA G1023 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81642109 CDSM PERSIVIA G1023 619 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 81642117 CDSM PERSIVIA G1023 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 83041897 CDSM PERSIVIA G1023 359 $1.00 0.37 - 0.80 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 0.53 0.66 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 36305223 SP COLL SARSCOV2 SNF HHA ANY S G2024 300 $134.00 49.53 - 107.20 - 92.59 N/A 92.59 - 74.04 N/A 88.44 - N/A 88.69 - N/A 71.01 88.76 N/A N/A N/A 107.20 N/A - 66.71 N/A 54.81 100.50 50.93 59.94 N/A 80338368 PERC AV FISTULA CREATION G2171 320 "$84,336.00" " 31,170.59 " - " 67,468.80 " - " 58,276.18 " " 16,751.22 " " 58,276.18 " - " 46,595.64 " " 16,432.15 " " 55,661.76 " - - " 55,822.00 " " 14,358.19 " " 15,953.54 " " 44,689.65 " " 55,864.17 " " 16,352.38 " " 16,432.15 " " 15,953.54 " " 67,468.80 " " 14,597.49 " - " 56,505.12 " " 14,039.12 " " 34,493.42 " " 63,252.00 " " 32,056.11 " " 37,723.49 " " 16,511.91 " 33254997 OMADACYCLINE INJ 1 MG J0121 636 $17.00 6.28 - 15.39 - 11.75 3.37 11.75 - 9.39 3.31 11.22 - - 11.25 2.89 3.21 12.31 15.39 3.29 3.31 3.21 13.60 2.94 - 11.39 2.82 6.95 12.75 6.46 7.60 3.32 33223498 ABATACEPT PER 10MG INJ J0129 636 $305.00 112.73 - 244.00 - 210.76 46.23 210.76 - 168.51 45.35 201.30 - - 201.88 39.63 44.03 64.30 80.37 45.13 45.35 44.03 244.00 40.29 - 204.35 38.75 124.75 228.75 115.93 136.43 45.57 33212569 ADALIMUMAB PER 20MG INJ J0135 636 "$7,512.00" " 2,776.44 " - " 6,009.60 " - " 5,190.79 " " 1,615.22 " " 5,190.79 " - " 4,150.38 " " 1,584.45 " " 4,957.92 " - - " 4,972.19 " " 1,384.47 " " 1,538.30 " " 1,003.20 " " 1,254.00 " " 1,576.76 " " 1,584.45 " " 1,538.30 " " 6,009.60 " " 1,407.54 " - " 5,033.04 " " 1,353.70 " " 3,072.41 " " 5,634.00 " " 2,855.31 " " 3,360.12 " " 1,592.14 " 33241364 AFLIBERCEPT PER 1 MG INJ J0178 636 "$4,873.00" " 1,801.06 " - " 3,898.40 " - " 3,367.24 " 937.47 " 3,367.24 " - " 2,692.33 " 919.61 " 3,216.18 " - - " 3,225.44 " 803.55 892.83 " 1,515.70 " " 1,894.63 " 915.15 919.61 892.83 " 3,898.40 " 816.94 - " 3,264.91 " 785.69 " 1,993.06 " " 3,654.75 " " 1,852.23 " " 2,179.69 " 924.08 33253532 BROLUCIZUMAB-DBLL 1MG INJ J0179 636 "$1,638.00" 605.40 - " 1,310.40 " - " 1,131.86 " 318.64 " 1,131.86 " - 905.00 312.57 " 1,081.08 " - - " 1,084.19 " 273.12 303.47 867.98 " 1,085.01 " 311.06 312.57 303.47 " 1,310.40 " 277.68 - " 1,097.46 " 267.05 669.94 " 1,228.50 " 622.60 732.68 314.09 33243065 AGALSIDASE BETA PER 1 MG INJ J0180 636 $992.00 366.64 - 793.60 - 685.47 202.36 685.47 - 548.08 198.50 654.72 - - 656.60 173.45 192.72 408.10 510.12 197.54 198.50 192.72 793.60 176.34 - 664.64 169.59 405.73 744.00 377.06 443.72 199.47 33252374 APREPITANT PER 1 MG IV INJ J0185 636 $9.00 3.33 - 11.05 - 6.22 1.72 6.22 - 4.97 1.69 5.94 - - 5.96 1.48 1.64 8.84 11.05 1.68 1.69 1.64 7.20 1.50 - 6.03 1.44 3.68 6.75 3.42 4.03 1.70 33245394 ALEMTUZUMAB PER 1 MG INJ J0202 636 "$10,418.00" " 3,850.49 " - " 8,334.40 " - " 7,198.84 " " 2,130.70 " " 7,198.84 " - " 5,755.95 " " 2,090.12 " " 6,875.88 " - - " 6,895.67 " " 1,826.32 " " 2,029.24 " " 5,879.12 " " 7,348.90 " " 2,079.97 " " 2,090.12 " " 2,029.24 " " 8,334.40 " " 1,856.75 " - " 6,980.06 " " 1,785.73 " " 4,260.96 " " 7,813.50 " " 3,959.88 " " 4,659.97 " " 2,100.26 " 33224711 AMIFOSTINE PER 500MG INJ J0207 636 "$5,962.00" " 2,203.56 " - " 4,769.60 " - " 4,119.74 " " 1,159.85 " " 4,119.74 " - " 3,294.01 " " 1,137.76 " " 3,934.92 " - - " 3,946.25 " 994.16 " 1,104.62 " " 1,011.85 " " 1,264.81 " " 1,132.24 " " 1,137.76 " " 1,104.62 " " 4,769.60 " " 1,010.73 " - " 3,994.54 " 972.07 " 2,438.46 " " 4,471.50 " " 2,266.16 " " 2,666.80 " " 1,143.28 " 33252625 PATISIRAN 0.1MG INJ J0222 636 $514.00 189.97 - 424.19 - 355.17 99.83 355.17 - 283.99 97.93 339.24 - - 340.22 85.57 95.08 339.35 424.19 97.46 97.93 95.08 411.20 87.00 - 344.38 83.67 210.23 385.50 195.37 229.91 98.41 33246196 PROTEINASE ALPHA1 PER 10MG INJ J0256 636 $23.00 8.50 - 18.40 - 15.89 4.63 15.89 - 12.71 4.54 15.18 - - 15.22 3.97 4.41 12.22 15.28 4.52 4.54 4.41 18.40 4.04 - 15.41 3.88 9.41 17.25 8.74 10.29 4.56 33250053 AMPHOTERICIN B LIPID COMP 10MG J0287 636 $49.00 18.11 - 92.91 - 33.86 9.70 33.86 - 27.07 9.52 32.34 - - 32.43 8.32 9.24 74.33 92.91 9.47 9.52 9.24 39.20 8.45 - 32.83 8.13 20.04 36.75 18.62 21.92 9.56 33227922 AMPHOTERICIN B LIPO PER 10MG J0289 636 $139.00 51.37 - 140.22 - 96.05 29.36 96.05 - 76.80 28.80 91.74 - - 92.00 25.16 27.96 112.18 140.22 28.66 28.80 27.96 111.20 25.58 - 93.13 24.60 56.85 104.25 52.83 62.17 28.94 33211635 AMOBARBITAL PER 125MG INJ J0300 636 $500.00 184.80 - 400.00 - 345.50 127.88 345.50 - 276.25 125.44 330.00 - - 330.95 109.61 121.79 10.87 13.59 124.83 125.44 121.79 400.00 111.44 - 335.00 107.18 204.50 375.00 190.05 223.65 126.05 33252021 ARIPIPRAZOLE ER PER 1 MG INJ J0401 636 $30.00 11.09 - 24.00 - 20.73 6.13 20.73 - 16.58 6.02 19.80 - - 19.86 5.26 5.84 5.14 6.42 5.99 6.02 5.84 24.00 5.34 - 20.10 5.14 12.27 22.50 11.40 13.42 6.04 33214235 BACLOFEN PER 10MG INJ J0475 636 $901.00 333.01 - 902.82 - 622.59 181.21 622.59 - 497.80 177.76 594.66 - - 596.37 155.32 172.58 722.26 902.82 176.89 177.76 172.58 720.80 157.91 - 603.67 151.87 368.51 675.75 342.47 403.02 178.62 33215274 BACLOFEN PER 10MG INJ J0475 636 $901.00 333.01 - 902.82 - 622.59 181.21 622.59 - 497.80 177.76 594.66 - - 596.37 155.32 172.58 722.26 902.82 176.89 177.76 172.58 720.80 157.91 - 603.67 151.87 368.51 675.75 342.47 403.02 178.62 33248768 BASILIXIMAB PER 20MG INJ J0480 636 "$21,027.00" " 7,771.58 " - " 16,821.60 " - " 14,529.66 " " 4,098.44 " " 14,529.66 " - " 11,617.42 " " 4,020.38 " " 13,877.82 " - - " 13,917.77 " " 3,512.95 " " 3,903.28 " " 5,061.57 " " 6,326.96 " " 4,000.86 " " 4,020.38 " " 3,903.28 " " 16,821.60 " " 3,571.50 " - " 14,088.09 " " 3,434.89 " " 8,600.04 " " 15,770.25 " " 7,992.36 " " 9,405.38 " " 4,039.89 " 33241721 BELATACEPT INJ PER 1 MG J0485 636 $20.00 7.39 - 16.00 - 13.82 3.89 13.82 - 11.05 3.81 13.20 - - 13.24 3.33 3.70 6.05 7.56 3.79 3.81 3.70 16.00 3.39 - 13.40 3.26 8.18 15.00 7.60 8.95 3.83 33239491 BELIMUMAB PER 10MG INJ J0490 636 $242.00 89.44 - 193.60 - 167.22 48.57 167.22 - 133.71 47.65 159.72 - - 160.18 41.63 46.26 90.40 113.00 47.42 47.65 46.26 193.60 42.33 - 162.14 40.71 98.98 181.50 91.98 108.25 47.88 33239092 PCNG BENZ/PROC PER 100000U INJ J0558 636 $63.00 23.28 - 50.40 - 43.53 12.03 43.53 - 34.81 11.80 41.58 - - 41.70 10.31 11.46 11.41 14.26 11.75 11.80 11.46 50.40 10.49 - 42.21 10.08 25.77 47.25 23.95 28.18 11.86 33239106 PCNG BENZ/PROC PER 100000U INJ J0558 636 $63.00 23.28 - 50.40 - 43.53 12.03 43.53 - 34.81 11.80 41.58 - - 41.70 10.31 11.46 11.41 14.26 11.75 11.80 11.46 50.40 10.49 - 42.21 10.08 25.77 47.25 23.95 28.18 11.86 33239114 PCN G BENZ PER 100000U J0561 636 $80.00 29.57 - 64.00 - 55.28 15.27 55.28 - 44.20 14.98 52.80 - - 52.95 13.09 14.54 16.48 20.60 14.90 14.98 14.54 64.00 13.30 - 53.60 12.80 32.72 60.00 30.41 35.78 15.05 33251823 BEZLOTOXUMAB PER 10 MG INJ J0565 636 $208.00 76.88 - 169.68 - 143.73 40.61 143.73 - 114.92 39.84 137.28 - - 137.68 34.81 38.68 135.74 169.68 39.65 39.84 38.68 166.40 35.39 - 139.36 34.04 85.07 156.00 79.06 93.04 40.03 33268785 BOTULINUM TYP A INJ PER UNIT J0585 636 $32.00 11.83 - 25.60 - 22.11 6.22 22.11 - 17.68 6.10 21.12 - - 21.18 5.33 5.92 10.78 13.47 6.07 6.10 5.92 25.60 5.42 - 21.44 5.21 13.09 24.00 12.16 14.31 6.13 33234538 ABOBOTULINUMTOXINA PER 5 UNITS J0586 636 $43.00 15.89 - 34.40 - 29.71 8.59 29.71 - 23.76 8.43 28.38 - - 28.46 7.36 8.18 25.35 31.69 8.38 8.43 8.18 34.40 7.48 - 28.81 7.20 17.59 32.25 16.34 19.23 8.47 33280378 RIMABOTULINUMTOXB PER 100U INJ J0587 636 $63.00 23.28 - 50.40 - 43.53 12.31 43.53 - 34.81 12.07 41.58 - - 41.70 10.55 11.72 27.54 34.43 12.01 12.07 11.72 50.40 10.72 - 42.21 10.31 25.77 47.25 23.95 28.18 12.13 33239700 INCOBOTULINUMTOXINA PER 1 UNIT J0588 636 $26.00 9.61 - 20.80 - 17.97 5.16 17.97 - 14.37 5.06 17.16 - - 17.21 4.42 4.91 10.40 13.00 5.03 5.06 4.91 20.80 4.49 - 17.42 4.32 10.63 19.50 9.88 11.63 5.08 33225083 BUSULFAN PER 1MG INJ J0594 636 $18.00 6.65 - 37.44 - 12.44 1.74 12.44 - 9.95 1.71 11.88 - - 11.91 1.49 1.66 29.95 37.44 1.70 1.71 1.66 14.40 1.52 - 12.06 1.46 7.36 13.50 6.84 8.05 1.72 33244495 C1 ESTERASE INH BERINERT 10 UN J0597 636 $284.00 104.97 - 227.20 - 196.24 58.61 196.24 - 156.91 57.49 187.44 - - 187.98 50.24 55.82 135.52 169.40 57.22 57.49 55.82 227.20 51.08 - 190.28 49.12 116.16 213.00 107.95 127.03 57.77 33245971 C1 ESTERASE(CINRYZE) 10 UN INJ J0598 636 $295.00 109.03 - 236.00 - 203.85 60.18 203.85 - 162.99 59.03 194.70 - - 195.26 51.58 57.31 136.65 170.81 58.74 59.03 57.31 236.00 52.44 - 197.65 50.43 120.66 221.25 112.13 131.95 59.32 33234473 EDET CAL DISOD PER 1000MG INJ J0600 636 "$29,371.00" " 10,855.52 " - " 23,496.80 " - " 20,295.36 " " 5,830.03 " " 20,295.36 " - " 16,227.48 " " 5,718.98 " " 19,384.86 " - - " 19,440.66 " " 4,997.17 " " 5,552.41 " 76.86 96.08 " 5,691.22 " " 5,718.98 " " 5,552.41 " " 23,496.80 " " 5,080.46 " - " 19,678.57 " " 4,886.12 " " 12,012.74 " " 22,028.25 " " 11,163.92 " " 13,137.65 " " 5,746.74 " 33231598 CALCITONIN PER 400 UNITS INJ J0630 636 "$14,906.00" " 5,509.26 " - " 11,924.80 " - " 10,300.05 " " 3,166.76 " " 10,300.05 " - " 8,235.57 " " 3,106.44 " " 9,837.96 " - - " 9,866.28 " " 2,714.36 " " 3,015.96 " 139.66 174.57 " 3,091.36 " " 3,106.44 " " 3,015.96 " " 11,924.80 " " 2,759.60 " - " 9,987.02 " " 2,654.04 " " 6,096.55 " " 11,179.50 " " 5,665.77 " " 6,667.45 " " 3,121.52 " 33229437 LEVOLEUCOVORIN 0.5MG INJ J0641 636 $1.00 0.37 - 5.72 - 0.69 - 0.69 - 0.55 - 0.66 - - 0.66 - - 4.58 5.72 - - - 0.80 - - 0.67 - 0.41 0.75 0.38 0.45 - 33244932 CEFTOLOZANE-TAZ PER 75MG J0695 636 $34.00 12.57 - 27.20 - 23.49 6.78 23.49 - 18.79 6.65 22.44 - - 22.50 5.81 6.46 17.02 21.27 6.62 6.65 6.46 27.20 5.91 - 22.78 5.68 13.91 25.50 12.92 15.21 6.69 33239891 CEFTAROLINE PER 10MG INJ J0712 636 $17.00 6.28 - 13.60 - 11.75 3.58 11.75 - 9.39 3.51 11.22 - - 11.25 3.07 3.41 2.10 2.62 3.50 3.51 3.41 13.60 3.12 - 11.39 3.00 6.95 12.75 6.46 7.60 3.53 33248831 CEFTAZIDIME/AVIBACTAM 0.625G J0714 636 $483.00 178.52 - 386.40 - 333.75 94.36 333.75 - 266.86 92.57 318.78 - - 319.70 80.88 89.87 288.37 360.46 92.12 92.57 89.87 386.40 82.23 - 323.61 79.09 197.55 362.25 183.59 216.05 93.02 33230311 CERTOLIZUMAB PER 1MG INJ J0717 636 $43.00 15.89 - 34.40 - 29.71 6.41 29.71 - 23.76 6.28 28.38 - - 28.46 5.49 6.10 9.81 12.26 6.25 6.28 6.10 34.40 5.58 - 28.81 5.37 17.59 32.25 16.34 19.23 6.31 33281030 CIDOFOVIR PER 375MG INJ J0740 636 "$3,498.00" " 1,292.86 " - " 2,798.40 " - " 2,417.12 " 575.76 " 2,417.12 " - " 1,932.65 " 564.79 " 2,308.68 " - - " 2,315.33 " 493.51 548.34 " 2,214.71 " " 2,768.39 " 562.05 564.79 548.34 " 2,798.40 " 501.73 - " 2,343.66 " 482.54 " 1,430.68 " " 2,623.50 " " 1,329.59 " " 1,564.66 " 567.53 33208456 CODEINE PER 30MG INJ J0745 636 $712.00 263.16 - 569.60 - 491.99 138.53 491.99 - 393.38 135.89 469.92 - - 471.27 118.74 131.93 27.04 33.80 135.23 135.89 131.93 569.60 120.72 - 477.04 116.10 291.21 534.00 270.63 318.48 136.55 33239017 COLLAGENASE CLOSPER 0.01MG INJ J0775 636 $275.00 101.64 - 220.00 - 190.03 57.87 190.03 - 151.94 56.76 181.50 - - 182.02 49.60 55.11 128.98 161.22 56.49 56.76 55.11 220.00 50.43 - 184.25 48.50 112.48 206.25 104.53 123.01 57.04 33229739 CORTICORELIN TRIFLU PER 1MCG J0795 636 $49.00 18.11 - 39.20 - 33.86 9.88 33.86 - 27.07 9.69 32.34 - - 32.43 8.47 9.41 15.38 19.23 9.65 9.69 9.41 39.20 8.61 - 32.83 8.28 20.04 36.75 18.62 21.92 9.74 33239904 CROTALID PV IMM FAB INJ PER 1G J0840 636 "$15,980.00" " 5,906.21 " - " 12,784.00 " - " 11,042.18 " " 2,801.73 " " 11,042.18 " - " 8,828.95 " " 2,748.36 " " 10,546.80 " - - " 10,577.16 " " 2,401.48 " " 2,668.31 " " 4,974.87 " " 6,218.59 " " 2,735.02 " " 2,748.36 " " 2,668.31 " " 12,784.00 " " 2,441.50 " - " 10,706.60 " " 2,348.11 " " 6,535.82 " " 11,985.00 " " 6,074.00 " " 7,147.85 " " 2,761.70 " 33234708 CYTOMEGALOVIRUS IG PER VIAL IV J0850 636 "$7,859.00" " 2,904.69 " - " 6,287.20 " - " 5,430.57 " " 1,571.43 " " 5,430.57 " - " 4,342.10 " " 1,541.50 " " 5,186.94 " - - " 5,201.87 " " 1,346.94 " " 1,496.60 " " 2,316.52 " " 2,895.65 " " 1,534.02 " " 1,541.50 " " 1,496.60 " " 6,287.20 " " 1,369.39 " - " 5,265.53 " " 1,317.01 " " 3,214.33 " " 5,894.25 " " 2,987.21 " " 3,515.33 " " 1,548.98 " 33253346 DALBAVANCIN PER 5 MG INJ J0875 637 $81.00 29.94 - 66.55 - 55.97 16.22 55.97 - 44.75 15.91 53.46 - - 53.61 13.91 15.45 53.24 66.55 15.84 15.91 15.45 64.80 14.14 - 54.27 13.60 33.13 60.75 30.79 36.23 15.99 33206488 DARBEPOETIN NON ESRD PER 1MCG J0881 636 $20.00 7.39 - 19.86 - 13.82 3.22 13.82 - 11.05 3.16 13.20 - - 13.24 2.76 3.07 15.89 19.86 3.15 3.16 3.07 16.00 2.81 - 13.40 2.70 8.18 15.00 7.60 8.95 3.18 33247273 ARGATROBAN 1MG NON ESRD INJ J0883 636 $7.00 2.59 - 20.41 - 4.84 1.23 4.84 - 3.87 1.21 4.62 - - 4.63 1.05 1.17 16.33 20.41 1.20 1.21 1.17 5.60 1.07 - 4.69 1.03 2.86 5.25 2.66 3.13 1.21 33247281 ARGATROBAN 1MG ESRD ONDIALYSIS J0884 636 $7.00 2.59 - 20.41 - 4.84 1.23 4.84 - 3.87 1.21 4.62 - - 4.63 1.05 1.17 16.33 20.41 1.20 1.21 1.17 5.60 1.07 - 4.69 1.03 2.86 5.25 2.66 3.13 1.21 33213701 EPOETIN NON ESRD PER 1000U INJ J0885 636 $48.00 17.74 - 54.33 - 33.17 8.33 33.17 - 26.52 8.17 31.68 - - 31.77 7.14 7.93 43.46 54.33 8.13 8.17 7.93 38.40 7.26 - 32.16 6.98 19.63 36.00 18.24 21.47 8.21 33213751 EPOETIN NON ESRD PER 1000U INJ J0885 636 $48.00 17.74 - 54.33 - 33.17 8.33 33.17 - 26.52 8.17 31.68 - - 31.77 7.14 7.93 43.46 54.33 8.13 8.17 7.93 38.40 7.26 - 32.16 6.98 19.63 36.00 18.24 21.47 8.21 33234074 EPOETIN NON ESRD PER 1000U INJ J0885 636 $48.00 17.74 - 54.33 - 33.17 8.33 33.17 - 26.52 8.17 31.68 - - 31.77 7.14 7.93 43.46 54.33 8.13 8.17 7.93 38.40 7.26 - 32.16 6.98 19.63 36.00 18.24 21.47 8.21 33248407 EPOETIN NON ESRD PER 1000U INJ J0885 636 $48.00 17.74 - 54.33 - 33.17 8.33 33.17 - 26.52 8.17 31.68 - - 31.77 7.14 7.93 43.46 54.33 8.13 8.17 7.93 38.40 7.26 - 32.16 6.98 19.63 36.00 18.24 21.47 8.21 33226381 DECITABINE PER 1MG INJ J0894 636 $22.00 8.13 - 111.63 - 15.20 3.53 15.20 - 12.16 3.46 14.52 - - 14.56 3.02 3.36 89.30 111.63 3.44 3.46 3.36 17.60 3.07 - 14.74 2.96 9.00 16.50 8.36 9.84 3.48 33237847 DENOSUMAB PER 1 MG INJ J0897 636 $106.00 39.18 - 84.80 - 73.25 21.64 73.25 - 58.57 21.23 69.96 - - 70.16 18.55 20.61 33.66 42.07 21.13 21.23 20.61 84.80 18.86 - 71.02 18.14 43.35 79.50 40.29 47.41 21.33 33239238 DENOSUMAB PER 1MG INJ J0897 636 $106.00 39.18 - 84.80 - 73.25 21.64 73.25 - 58.57 21.23 69.96 - - 70.16 18.55 20.61 33.66 42.07 21.13 21.23 20.61 84.80 18.86 - 71.02 18.14 43.35 79.50 40.29 47.41 21.33 33253401 DEXAMETH LACRIMAL INSERT 0.1MG J1096 636 $733.00 270.92 - 601.50 - 506.50 136.13 506.50 - 404.98 133.54 483.78 - - 485.17 116.69 129.65 481.20 601.50 132.89 133.54 129.65 586.40 118.63 - 491.11 114.09 299.80 549.75 278.61 327.87 134.19 33240104 DIGOXIN IMM FAB INJ PER VIAL J1162 636 "$20,854.00" " 7,707.64 " - " 16,683.20 " - " 14,410.11 " " 4,216.00 " " 14,410.11 " - " 11,521.84 " " 4,135.70 " " 13,763.64 " - - " 13,803.26 " " 3,613.72 " " 4,015.24 " " 2,166.81 " " 2,708.51 " " 4,115.62 " " 4,135.70 " " 4,015.24 " " 16,683.20 " " 3,673.94 " - " 13,972.18 " " 3,533.41 " " 8,529.29 " " 15,640.50 " " 7,926.61 " " 9,327.99 " " 4,155.77 " 33209223 DEXRAZOXANE PER 250MG INJ J1190 636 "$1,050.00" 388.08 - 840.00 - 725.55 196.42 725.55 - 580.13 192.68 693.00 - - 695.00 168.36 187.07 624.24 780.30 191.75 192.68 187.07 840.00 171.17 - 703.50 164.62 429.45 787.50 399.11 469.67 193.62 33218435 DEXRAZOXANE PER 250MG INJ J1190 636 "$1,050.00" 388.08 - 840.00 - 725.55 196.42 725.55 - 580.13 192.68 693.00 - - 695.00 168.36 187.07 624.24 780.30 191.75 192.68 187.07 840.00 171.17 - 703.50 164.62 429.45 787.50 399.11 469.67 193.62 33228244 DIMETHYL SULFOXIDE PER 50ML J1212 636 "$3,337.00" " 1,233.36 " - " 2,669.60 " - " 2,305.87 " 650.66 " 2,305.87 " - " 1,843.69 " 638.27 " 2,202.42 " - - " 2,208.76 " 557.71 619.68 84.54 105.68 635.17 638.27 619.68 " 2,669.60 " 567.01 - " 2,235.79 " 545.32 " 1,364.83 " " 2,502.75 " " 1,268.39 " " 1,492.64 " 641.37 33229372 ECULIZUMAB PER 10MG INJ J1300 636 "$1,210.00" 447.22 - 968.00 - 836.11 234.11 836.11 - 668.53 229.65 798.60 - - 800.90 200.66 222.96 594.42 743.02 228.53 229.65 222.96 968.00 204.01 - 810.70 196.20 494.89 907.50 459.92 541.23 230.76 33249667 EDARAVONE PER 1 MG INJ J1301 636 $104.00 38.44 - 83.20 - 71.86 20.95 71.86 - 57.46 20.55 68.64 - - 68.84 17.96 19.95 60.13 75.16 20.45 20.55 19.95 83.20 18.25 - 69.68 17.56 42.54 78.00 39.53 46.52 20.65 33200498 ERYTHRO LACTO PER 500MG INJ J1364 636 $403.00 148.95 - 322.40 - 278.47 - 278.47 - 222.66 - 265.98 - - 266.75 - - 20.30 25.38 - - - 322.40 - - 270.01 - 164.83 302.25 153.18 180.26 - 33201303 ESTROGEN CONJ PER 25MG INJ J1410 636 "$1,710.00" 632.02 - " 1,368.00 " - " 1,181.61 " 348.72 " 1,181.61 " - 944.78 342.07 " 1,128.60 " - - " 1,131.85 " 298.90 332.11 100.62 125.77 340.41 342.07 332.11 " 1,368.00 " 303.88 - " 1,145.70 " 292.26 699.39 " 1,282.50 " 649.97 764.88 343.73 33249900 ETHANOLAMINE PER 100MG INJ J1430 636 "$2,332.00" 861.91 - " 1,865.60 " - " 1,611.41 " 453.55 " 1,611.41 " - " 1,288.43 " 444.91 " 1,539.12 " - - " 1,543.55 " 388.76 431.95 298.27 372.84 442.75 444.91 431.95 " 1,865.60 " 395.23 - " 1,562.44 " 380.12 953.79 " 1,749.00 " 886.39 " 1,043.10 " 447.07 33221860 ETANERCEPT INJ PER 25MG J1438 636 "$3,866.00" " 1,428.87 " - " 3,092.80 " - " 2,671.41 " 807.61 " 2,671.41 " - " 2,135.97 " 792.22 " 2,551.56 " - - " 2,558.91 " 692.24 769.15 409.32 511.65 788.38 792.22 769.15 " 3,092.80 " 703.77 - " 2,590.22 " 676.85 " 1,581.19 " " 2,899.50 " " 1,469.47 " " 1,729.26 " 796.07 33289634 ETANERCEPT PER 25MG INJ J1438 636 "$3,866.00" " 1,428.87 " - " 3,092.80 " - " 2,671.41 " 807.61 " 2,671.41 " - " 2,135.97 " 792.22 " 2,551.56 " - - " 2,558.91 " 692.24 769.15 409.32 511.65 788.38 792.22 769.15 " 3,092.80 " 703.77 - " 2,590.22 " 676.85 " 1,581.19 " " 2,899.50 " " 1,469.47 " " 1,729.26 " 796.07 33245947 FERRIC CARBOXYMALTOSE 1MG INJ J1439 636 $6.00 2.22 - 4.80 - 4.15 1.14 4.15 - 3.32 1.12 3.96 - - 3.97 0.98 1.09 1.44 1.80 1.12 1.12 1.09 4.80 1.00 - 4.02 0.96 2.45 4.50 2.28 2.68 1.13 33242824 FILGRASTIM G-CSF INJ PER 1MCG J1442 636 $5.00 1.85 - 4.00 - 3.46 1.00 3.46 - 2.76 0.98 3.30 - - 3.31 0.86 0.95 1.38 1.72 0.97 0.98 0.95 4.00 0.87 - 3.35 0.84 2.05 3.75 1.90 2.24 0.98 33248814 TBO-FILGRASTIM 1MCG INJ J1447 636 $2.00 0.74 - 4.00 - 1.38 0.46 1.38 - 1.11 0.45 1.32 - - 1.32 0.40 0.44 3.20 4.00 0.45 0.45 0.44 1.60 0.40 - 1.34 0.39 0.82 1.50 0.76 0.89 0.46 33238444 FOMEPIZOLE PER 15MG INJ J1451 636 $28.00 10.35 - 49.43 - 19.35 6.11 19.35 - 15.47 5.99 18.48 - - 18.53 5.24 5.82 39.54 49.43 5.97 5.99 5.82 22.40 5.33 - 18.76 5.12 11.45 21.00 10.64 12.52 6.02 33239173 FOSAPREPITANT PER 1MG INJ J1453 636 $4.00 1.48 - 6.82 - 2.76 - 2.76 - 2.21 - 2.64 - - 2.65 - - 5.46 6.82 - - - 3.20 - - 2.68 - 1.64 3.00 1.52 1.79 - 33249543 FOSCARNET PER 1000MG INJ J1455 636 $432.00 159.67 - 345.60 - 298.51 74.41 298.51 - 238.68 73.00 285.12 - - 285.94 63.78 70.87 37.94 47.43 72.64 73.00 70.87 345.60 64.85 - 289.44 62.37 176.69 324.00 164.20 193.23 73.35 33228252 IMMUNE GLOBULIN PER 500MG INJ J1459 636 $218.00 80.57 - 209.12 - 150.64 45.42 150.64 - 120.45 44.56 143.88 - - 144.29 38.93 43.26 167.30 209.12 44.34 44.56 43.26 174.40 39.58 - 146.06 38.07 89.16 163.50 82.86 97.51 44.77 33221690 GAMMA GLOBULIN IM PER 1ML INJ J1460 636 $225.00 83.16 - 180.00 - 155.48 45.07 155.48 - 124.31 44.21 148.50 - - 148.93 38.63 42.92 6.52 8.15 43.99 44.21 42.92 180.00 39.27 - 150.75 37.77 92.03 168.75 85.52 100.64 44.42 33254547 IMMUNE GLOB(HIZENTRA)100MG INJ J1559 636 $57.00 21.07 - 56.25 - 39.39 11.83 39.39 - 31.49 11.61 37.62 - - 37.73 10.14 11.27 45.00 56.25 11.55 11.61 11.27 45.60 10.31 - 38.19 9.92 23.31 42.75 21.67 25.50 11.66 33227001 IMMUNE GLOBULIN PER 500MG INJ J1561 636 $221.00 81.68 - 193.02 - 152.71 49.25 152.71 - 122.10 48.31 145.86 - - 146.28 42.21 46.90 154.42 193.02 48.07 48.31 46.90 176.80 42.91 - 148.07 41.27 90.39 165.75 84.00 98.85 48.54 33221592 IMMUNE GLOBULIN LYOPH 500MG J1566 636 $359.00 132.69 - 287.20 - 248.07 66.89 248.07 - 198.35 65.61 236.94 - - 237.62 57.33 63.70 150.34 187.93 65.29 65.61 63.70 287.20 58.29 - 240.53 56.06 146.83 269.25 136.46 160.58 65.93 33226985 IMMUNE GLOBULIN PER 500MG INJ J1568 636 $216.00 79.83 - 226.98 - 149.26 42.51 149.26 - 119.34 41.70 142.56 - - 142.97 36.44 40.49 181.58 226.98 41.50 41.70 40.49 172.80 37.05 - 144.72 35.63 88.34 162.00 82.10 96.62 41.91 33226993 IMMUNE GLOBULIN PER 500MG INJ J1569 636 $227.00 83.90 - 226.20 - 156.86 45.43 156.86 - 125.42 44.57 149.82 - - 150.25 38.94 43.27 180.96 226.20 44.35 44.57 43.27 181.60 39.59 - 152.09 38.08 92.84 170.25 86.28 101.54 44.78 33237464 HEPAT B IMM GLOB PER 0.5ML IM J1571 636 $333.00 123.08 - 318.91 - 230.10 72.44 230.10 - 183.98 71.06 219.78 - - 220.41 62.09 68.99 255.13 318.91 70.71 71.06 68.99 266.40 63.13 - 223.11 60.71 136.20 249.75 126.57 148.95 71.40 33242085 HEPAT B IMM GLOB PER 0.5ML IV J1573 636 $346.00 127.88 - 318.91 - 239.09 72.75 239.09 - 191.17 71.37 228.36 - - 229.02 62.36 69.29 255.13 318.91 71.02 71.37 69.29 276.80 63.40 - 231.82 60.98 141.51 259.50 131.51 154.77 71.72 33240635 GLATIRAMER ACET PER 20MG INJ J1595 636 $826.00 305.29 - 660.80 - 570.77 144.30 570.77 - 456.37 141.55 545.16 - - 546.73 123.69 137.43 120.23 150.29 140.87 141.55 137.43 660.80 125.75 - 553.42 120.94 337.83 619.50 313.96 369.47 142.24 33242948 GOLIMUMAB IVSOLN PER 1 MG J1602 636 $100.00 36.96 - 80.00 - 69.10 17.18 69.10 - 55.25 16.85 66.00 - - 66.19 14.72 16.36 56.62 70.78 16.77 16.85 16.36 80.00 14.97 - 67.00 14.40 40.90 75.00 38.01 44.73 16.93 33218672 GLUCAGON INJ PER 1MG J1610 636 "$1,112.00" 411.00 - 889.60 - 768.39 175.39 768.39 - 614.38 172.05 733.92 - - 736.03 150.34 167.04 221.00 276.25 171.22 172.05 167.04 889.60 152.84 - 745.04 147.00 454.81 834.00 422.67 497.40 172.89 33202253 HEMIN PER 1MG INJ J1640 636 $128.00 47.31 - 102.40 - 88.45 27.22 88.45 - 70.72 26.70 84.48 - - 84.72 23.33 25.92 23.38 29.22 26.57 26.70 25.92 102.40 23.72 - 85.76 22.81 52.35 96.00 48.65 57.25 26.83 33208626 TETANUS IG PER 250U INJ J1670 636 "$2,502.00" 924.74 - " 2,001.60 " - " 1,728.88 " 451.10 " 1,728.88 " - " 1,382.36 " 442.51 " 1,651.32 " - - " 1,656.07 " 386.66 429.62 313.34 391.68 440.36 442.51 429.62 " 2,001.60 " 393.10 - " 1,676.34 " 378.07 " 1,023.32 " " 1,876.50 " 951.01 " 1,119.14 " 444.66 33247567 HYDRXYPRG CAPR MAKENA 10MG INJ J1726 636 $83.00 30.68 - 136.54 - 57.35 17.17 57.35 - 45.86 16.84 54.78 - - 54.94 14.72 16.35 109.23 136.54 16.76 16.84 16.35 66.40 14.96 - 55.61 14.39 33.95 62.25 31.55 37.13 16.92 33249730 HYDROXYPROG CAPRT NOS 10MG INJ J1729 636 $57.00 21.07 - 60.91 - 39.39 22.00 39.39 - 31.49 21.58 37.62 - - 37.73 18.86 20.95 48.73 60.91 21.47 21.58 20.95 45.60 19.17 - 38.19 18.44 23.31 42.75 21.67 25.50 21.68 33223277 IBANDRONATE PER 1MG INJ J1740 636 $268.00 99.05 - 600.95 - 185.19 - 185.19 - 148.07 - 176.88 - - 177.39 - - 480.76 600.95 - - - 214.40 - - 179.56 - 109.61 201.00 101.87 119.88 - 33298714 IBUTILIDE FUM INJ PER 1 MG J1742 636 "$1,660.00" 613.54 - " 1,328.00 " - " 1,147.06 " 209.42 " 1,147.06 " - 917.15 205.43 " 1,095.60 " - - " 1,098.75 " 179.51 199.45 492.54 615.68 204.44 205.43 199.45 " 1,328.00 " 182.50 - " 1,112.20 " 175.52 678.94 " 1,245.00 " 630.97 742.52 206.43 33243481 ICATIBANT PER 1MG INJ J1744 636 "$1,452.00" 536.66 - " 1,161.60 " - " 1,003.33 " 209.33 " 1,003.33 " - 802.23 205.34 958.32 - - 961.08 179.42 199.36 371.41 464.26 204.34 205.34 199.36 " 1,161.60 " 182.41 - 972.84 175.44 593.87 " 1,089.00 " 551.91 649.48 206.34 33233108 INFLIXIMAB(NON BIOSIM)10MG INJ J1745 636 $250.00 92.40 - 227.45 - 172.75 40.37 172.75 - 138.13 39.60 165.00 - - 165.48 34.61 38.45 181.96 227.45 39.41 39.60 38.45 200.00 35.18 - 167.50 33.84 102.25 187.50 95.03 111.83 39.80 33207310 IRON DEXTRAN PER 50MG INJ J1750 636 $79.00 29.20 - 70.15 - 54.59 16.17 54.59 - 43.65 15.86 52.14 - - 52.29 13.86 15.40 56.12 70.15 15.79 15.86 15.40 63.20 14.09 - 52.93 13.55 32.31 59.25 30.03 35.34 15.94 33239122 IMIGLUCERASE PER 10UNITS INJ J1786 636 $228.00 84.27 - 182.40 - 157.55 44.98 157.55 - 125.97 44.13 150.48 - - 150.91 38.56 42.84 141.63 177.04 43.91 44.13 42.84 182.40 39.20 - 152.76 37.70 93.25 171.00 86.66 101.98 44.34 33206577 INTERFERON BETA-1B/0.25MG INJ J1830 636 "$2,068.00" 764.33 - " 1,654.40 " - " 1,428.99 " 414.88 " 1,428.99 " - " 1,142.57 " 406.97 " 1,364.88 " - - " 1,368.81 " 355.61 395.12 214.33 267.91 405.00 406.97 395.12 " 1,654.40 " 361.53 - " 1,385.56 " 347.71 845.81 " 1,551.00 " 786.05 925.02 408.95 33251858 ISAVUCONAZONIUM PER 1MG INJ J1833 636 $4.00 1.48 - 3.20 - 2.76 0.84 2.76 - 2.21 0.82 2.64 - - 2.65 0.72 0.80 1.82 2.27 0.82 0.82 0.80 3.20 0.73 - 2.68 0.70 1.64 3.00 1.52 1.79 0.83 33244011 LANREOTIDE PER 1 MG INJ J1930 636 $359.00 132.69 - 287.20 - 248.07 69.08 248.07 - 198.35 67.76 236.94 - - 237.62 59.21 65.79 97.35 121.69 67.43 67.76 65.79 287.20 60.20 - 240.53 57.90 146.83 269.25 136.46 160.58 68.09 33254156 ARIPIP LAUR(ARISTADA INIT)1MG J1943 636 $15.00 5.54 - 13.08 - 10.37 3.12 10.37 - 8.29 3.06 9.90 - - 9.93 2.67 2.97 10.46 13.08 3.04 3.06 2.97 12.00 2.72 - 10.05 2.61 6.14 11.25 5.70 6.71 3.07 33254164 ARIPIPRAZOLE LAUR(ARISTADA)1MG J1944 636 $15.00 5.54 - 13.08 - 10.37 3.06 10.37 - 8.29 3.00 9.90 - - 9.93 2.62 2.91 10.46 13.08 2.98 3.00 2.91 12.00 2.66 - 10.05 2.56 6.14 11.25 5.70 6.71 3.01 33241399 LEUPROLIDE ACE PER 3.75MG J1950 636 "$7,075.00" " 2,614.92 " - " 5,660.00 " - " 4,888.83 " " 1,436.28 " " 4,888.83 " - " 3,908.94 " " 1,408.93 " " 4,669.50 " - - " 4,682.94 " " 1,231.10 " " 1,367.89 " " 1,593.29 " " 1,991.61 " " 1,402.09 " " 1,408.93 " " 1,367.89 " " 5,660.00 " " 1,251.62 " - " 4,740.25 " " 1,203.74 " " 2,893.68 " " 5,306.25 " " 2,689.21 " " 3,164.65 " " 1,415.77 " 33253982 MEROPENEM-VABORBAC 10MG/10MG J2186 636 $9.00 3.33 - 73.68 - 6.22 1.80 6.22 - 4.97 1.76 5.94 - - 5.96 1.54 1.71 58.94 73.68 1.75 1.76 1.71 7.20 1.56 - 6.03 1.50 3.68 6.75 3.42 4.03 1.77 33251866 MICAFUNGIN PER 1 MG INJ J2248 636 $6.00 2.22 - 8.34 - 4.15 - 4.15 - 3.32 - 3.96 - - 3.97 - - 6.67 8.34 - - - 4.80 - - 4.02 - 2.45 4.50 2.28 2.68 - 33239670 NALTREXONE DEPOT PER 1 MG INJ J2315 636 $17.00 6.28 - 13.60 - 11.75 3.60 11.75 - 9.39 3.53 11.22 - - 11.25 3.09 3.43 6.52 8.15 3.52 3.53 3.43 13.60 3.14 - 11.39 3.02 6.95 12.75 6.46 7.60 3.55 33222939 NATALIZUMAB PER 1MG INJ J2323 636 $114.00 42.13 - 91.20 - 78.77 23.73 78.77 - 62.99 23.28 75.24 - - 75.46 20.34 22.60 26.01 32.51 23.17 23.28 22.60 91.20 20.68 - 76.38 19.89 46.63 85.50 43.33 50.99 23.39 33248148 NUSINERSEN 0.1 MG INJ J2326 636 "$5,893.00" " 2,178.05 " - " 4,714.40 " - " 4,072.06 " " 1,145.99 " " 4,072.06 " - " 3,255.88 " " 1,124.16 " " 3,889.38 " - - " 3,900.58 " 982.28 " 1,091.42 " " 3,720.96 " " 4,651.20 " " 1,118.71 " " 1,124.16 " " 1,091.42 " " 4,714.40 " 998.65 - " 3,948.31 " 960.45 " 2,410.24 " " 4,419.75 " " 2,239.93 " " 2,635.94 " " 1,129.62 " 33247486 OCRELIZUMAB PER 1 MG INJ J2350 636 $301.00 111.25 - 241.86 - 207.99 59.54 207.99 - 166.30 58.40 198.66 - - 199.23 51.03 56.70 193.49 241.86 58.12 58.40 56.70 240.80 51.88 - 201.67 49.90 123.11 225.75 114.41 134.64 58.68 33260261 OCTREOTIDE DEPOT 1 MG IM INJ J2353 636 "$1,081.00" 399.54 - 864.80 - 746.97 209.74 746.97 - 597.25 205.74 713.46 - - 715.51 179.78 199.75 290.41 363.01 204.74 205.74 199.75 864.80 182.77 - 724.27 175.78 442.13 810.75 410.89 483.53 206.74 33272880 OCTREOTIDE DEPOT 1 MG IM INJ J2353 636 "$1,081.00" 399.54 - 864.80 - 746.97 209.74 746.97 - 597.25 205.74 713.46 - - 715.51 179.78 199.75 290.41 363.01 204.74 205.74 199.75 864.80 182.77 - 724.27 175.78 442.13 810.75 410.89 483.53 206.74 33212518 OMALIZUMAB PER 5MG INJ J2357 636 $198.00 73.18 - 158.40 - 136.82 38.47 136.82 - 109.40 37.74 130.68 - - 131.06 32.98 36.64 56.37 70.46 37.56 37.74 36.64 158.40 33.53 - 132.66 32.24 80.98 148.50 75.26 88.57 37.92 33232349 PALIFERMIN PER 50MCG INJ J2425 636 $120.00 44.35 - 96.00 - 82.92 24.43 82.92 - 66.30 23.97 79.20 - - 79.43 20.94 23.27 39.30 49.12 23.85 23.97 23.27 96.00 21.29 - 80.40 20.48 49.08 90.00 45.61 53.68 24.08 33244266 PALIPERIDONE PALMITATE 1MG INJ J2426 636 $64.00 23.65 - 51.20 - 44.22 12.94 44.22 - 35.36 12.69 42.24 - - 42.36 11.09 12.32 22.62 28.28 12.63 12.69 12.32 51.20 11.27 - 42.88 10.84 26.18 48.00 24.33 28.63 12.75 33244711 PEGFILGRASTIM 6MG AUTO INJ J2505 636 "$18,751.00" " 6,930.37 " - " 15,000.80 " - " 12,956.94 " N/A " 12,956.94 " - " 10,359.93 " N/A " 12,375.66 " - N/A " 12,411.29 " - N/A " 8,781.46 " " 10,976.83 " N/A N/A N/A " 15,000.80 " N/A - " 12,563.17 " N/A " 7,669.16 " " 14,063.25 " " 7,127.26 " " 8,387.32 " N/A 33239475 PEGLOTICASE PER 1MG INJ J2507 636 "$14,706.00" " 5,435.34 " - " 11,764.80 " - " 10,161.85 " " 3,023.90 " " 10,161.85 " - " 8,125.07 " " 2,966.30 " " 9,705.96 " - - " 9,733.90 " " 2,591.91 " " 2,879.90 " 703.70 879.63 " 2,951.90 " " 2,966.30 " " 2,879.90 " " 11,764.80 " " 2,635.11 " - " 9,853.02 " " 2,534.31 " " 6,014.75 " " 11,029.50 " " 5,589.75 " " 6,577.99 " " 2,980.70 " 33200781 PENTOBARBITAL PER 50MG INJ J2515 636 $178.00 65.79 - 142.40 - 123.00 - 123.00 - 98.35 - 117.48 - - 117.82 - - 5.61 7.01 - - - 142.40 - - 119.26 - 72.80 133.50 67.66 79.62 - 33244053 PERAMIVIR PER 1MG INJ J2547 636 $8.00 2.96 - 7.05 - 5.53 1.71 5.53 - 4.42 1.68 5.28 - - 5.30 1.47 1.63 5.64 7.05 1.67 1.68 1.63 6.40 1.49 - 5.36 1.43 3.27 6.00 3.04 3.58 1.69 33204914 PHENOBARITAL PER 120MG INJ J2560 636 $249.00 92.03 - 199.20 - 172.06 41.08 172.06 - 137.57 40.29 164.34 - - 164.81 35.21 39.12 5.80 7.25 40.10 40.29 39.12 199.20 35.79 - 166.83 34.43 101.84 186.75 94.64 111.38 40.49 33208812 PHENOBARBITAL PER 120MG INJ J2560 636 $249.00 92.03 - 199.20 - 172.06 41.08 172.06 - 137.57 40.29 164.34 - - 164.81 35.21 39.12 5.80 7.25 40.10 40.29 39.12 199.20 35.79 - 166.83 34.43 101.84 186.75 94.64 111.38 40.49 33282214 PHENOBARBITAL PER 120MG INJ J2560 636 $249.00 92.03 - 199.20 - 172.06 41.08 172.06 - 137.57 40.29 164.34 - - 164.81 35.21 39.12 5.80 7.25 40.10 40.29 39.12 199.20 35.79 - 166.83 34.43 101.84 186.75 94.64 111.38 40.49 33230885 PLERIXAFOR PER 1MG INJ J2562 636 "$1,918.00" 708.89 - " 1,534.40 " - " 1,325.34 " 391.00 " 1,325.34 " - " 1,059.70 " 383.55 " 1,265.88 " - - " 1,269.52 " 335.14 372.38 930.22 " 1,162.78 " 381.69 383.55 372.38 " 1,534.40 " 340.73 - " 1,285.06 " 327.69 784.46 " 1,438.50 " 729.03 857.92 385.41 33201591 DDAVP (DESMOPRESSIN ACE) 1MCG J2597 636 $55.00 20.33 - 44.00 - 38.01 9.60 38.01 - 30.39 9.41 36.30 - - 36.40 8.23 9.14 17.02 21.27 9.37 9.41 9.14 44.00 8.36 - 36.85 8.04 22.50 41.25 20.91 24.60 9.46 33273371 DESMOPRESSIN INJ PER 1 MCG J2597 636 $55.00 20.33 - 44.00 - 38.01 9.60 38.01 - 30.39 9.41 36.30 - - 36.40 8.23 9.14 17.02 21.27 9.37 9.41 9.14 44.00 8.36 - 36.85 8.04 22.50 41.25 20.91 24.60 9.46 33273380 DESMOPRESSIN INJ PER 1 MCG J2597 636 $55.00 20.33 - 44.00 - 38.01 9.60 38.01 - 30.39 9.41 36.30 - - 36.40 8.23 9.14 17.02 21.27 9.37 9.41 9.14 44.00 8.36 - 36.85 8.04 22.50 41.25 20.91 24.60 9.46 33203993 PENTOLAMINE PER 5MG INJ J2760 636 "$1,885.00" 696.70 - " 1,508.00 " - " 1,302.54 " 424.85 " 1,302.54 " - " 1,041.46 " 416.76 " 1,244.10 " - - " 1,247.68 " 364.16 404.62 80.75 100.94 414.74 416.76 404.62 " 1,508.00 " 370.23 - " 1,262.95 " 356.07 770.97 " 1,413.75 " 716.49 843.16 418.78 33265506 QUINUPRIS-DALFOPRIS 500MG INJ J2770 636 "$2,405.00" 888.89 - " 1,924.00 " - " 1,661.86 " 454.14 " 1,661.86 " - " 1,328.76 " 445.49 " 1,587.30 " - - " 1,591.87 " 389.26 432.51 329.38 411.73 443.32 445.49 432.51 " 1,924.00 " 395.75 - " 1,611.35 " 380.61 983.65 " 1,803.75 " 914.14 " 1,075.76 " 447.65 33227876 RANIBIZUMAB PER 0.1 MG INJ J2778 636 "$1,702.00" 629.06 - " 1,813.99 " - " 1,176.08 " 325.25 " 1,176.08 " - 940.36 319.05 " 1,123.32 " - - " 1,126.55 " 278.78 309.76 " 1,451.19 " " 1,813.99 " 317.50 319.05 309.76 " 1,361.60 " 283.43 - " 1,140.34 " 272.59 696.12 " 1,276.50 " 646.93 761.30 320.60 33210329 RASBURICASE PER 0.5MG INJ J2783 636 "$1,580.00" 583.97 - " 1,386.08 " - " 1,091.78 " 321.76 " 1,091.78 " - 872.95 315.63 " 1,042.80 " - - " 1,045.80 " 275.80 306.44 " 1,108.86 " " 1,386.08 " 314.10 315.63 306.44 " 1,264.00 " 280.39 - " 1,058.60 " 269.67 646.22 " 1,185.00 " 600.56 706.73 317.17 33224389 RHO IMMUN GLOB PER 100IU INJ J2792 636 $191.00 70.59 - 152.80 - 131.98 32.09 131.98 - 105.53 31.48 126.06 - - 126.42 27.50 30.56 67.78 84.72 31.32 31.48 30.56 152.80 27.96 - 127.97 26.89 78.12 143.25 72.60 85.43 31.63 33212461 RISPERDAL CONSTA 0.5MG INJ J2794 636 $55.00 20.33 - 44.00 - 38.01 11.28 38.01 - 30.39 11.06 36.30 - - 36.40 9.67 10.74 16.26 20.33 11.01 11.06 10.74 44.00 9.83 - 36.85 9.45 22.50 41.25 20.91 24.60 11.12 33231024 ROMIPLOSTIM PER 10MCG INJ J2796 636 $412.00 152.28 - 329.60 - 284.69 85.24 284.69 - 227.63 83.62 271.92 - - 272.70 73.06 81.18 154.86 193.57 83.21 83.62 81.18 329.60 74.28 - 276.04 71.44 168.51 309.00 156.60 184.29 84.02 33206003 SARGRAMOSTIM PER 50 MCG INJ J2820 636 $253.00 93.51 - 786.10 - 174.82 52.65 174.82 - 139.78 51.64 166.98 - - 167.46 45.13 50.14 628.88 786.10 51.39 51.64 50.14 202.40 45.88 - 169.51 44.12 103.48 189.75 96.17 113.17 51.89 33221894 SECRETIN PER 1MCG INJ J2850 636 $183.00 67.64 - 146.40 - 126.45 35.52 126.45 - 101.11 34.84 120.78 - - 121.13 30.45 33.83 72.57 90.71 34.68 34.84 33.83 146.40 30.95 - 122.61 29.77 74.85 137.25 69.56 81.86 35.01 33229143 SECRETIN HUMAN PER 1MCG INJ J2850 636 $183.00 67.64 - 146.40 - 126.45 35.52 126.45 - 101.11 34.84 120.78 - - 121.13 30.45 33.83 72.57 90.71 34.68 34.84 33.83 146.40 30.95 - 122.61 29.77 74.85 137.25 69.56 81.86 35.01 33201737 TPA 1MG (ALTEPLASE) J2997 636 $458.00 169.28 - 366.40 - 316.48 89.62 316.48 - 253.05 87.91 302.28 - - 303.15 76.82 85.35 81.88 102.35 87.48 87.91 85.35 366.40 78.10 - 306.86 75.11 187.32 343.50 174.09 204.86 88.34 33236166 ALTEPLASE PER 1MG INJ J2997 636 $458.00 169.28 - 366.40 - 316.48 89.62 316.48 - 253.05 87.91 302.28 - - 303.15 76.82 85.35 81.88 102.35 87.48 87.91 85.35 366.40 78.10 - 306.86 75.11 187.32 343.50 174.09 204.86 88.34 33236182 ALTEPLASE PER 1MG INJ J2997 636 $458.00 169.28 - 366.40 - 316.48 89.62 316.48 - 253.05 87.91 302.28 - - 303.15 76.82 85.35 81.88 102.35 87.48 87.91 85.35 366.40 78.10 - 306.86 75.11 187.32 343.50 174.09 204.86 88.34 33286872 ALTEPLASE PER 1MG INJ J2997 636 $458.00 169.28 - 366.40 - 316.48 89.62 316.48 - 253.05 87.91 302.28 - - 303.15 76.82 85.35 81.88 102.35 87.48 87.91 85.35 366.40 78.10 - 306.86 75.11 187.32 343.50 174.09 204.86 88.34 33241691 TALIGLUCERASE ALFA PER 10 UNIT J3060 636 $214.00 79.09 - 171.20 - 147.87 42.20 147.87 - 118.24 41.40 141.24 - - 141.65 36.17 40.19 42.18 52.72 41.19 41.40 40.19 171.20 36.77 - 143.38 35.37 87.53 160.50 81.34 95.72 41.60 33239947 TELAVANCIN PER 10MG INJ J3095 636 $27.00 9.98 - 21.60 - 18.66 6.29 18.66 - 14.92 6.17 17.82 - - 17.87 5.39 5.99 7.42 9.28 6.14 6.17 5.99 21.60 5.48 - 18.09 5.27 11.04 20.25 10.26 12.08 6.20 33229445 TENECTEPLASE PER 1MG INJ J3101 636 $679.00 250.96 - 543.20 - 469.19 137.60 469.19 - 375.15 134.98 448.14 - - 449.43 117.95 131.05 178.92 223.65 134.33 134.98 131.05 543.20 119.91 - 454.93 115.32 277.71 509.25 258.09 303.72 135.64 33276729 THYROTROPIN PER 0.9MG INJ J3240 636 "$9,136.00" " 3,376.67 " - " 7,308.80 " - " 6,312.98 " " 1,876.33 " " 6,312.98 " - " 5,047.64 " " 1,840.59 " " 6,029.76 " - - " 6,047.12 " " 1,608.28 " " 1,786.98 " 496.27 620.34 " 1,831.65 " " 1,840.59 " " 1,786.98 " " 7,308.80 " " 1,635.09 " - " 6,121.12 " " 1,572.54 " " 3,736.62 " " 6,852.00 " " 3,472.59 " " 4,086.53 " " 1,849.52 " 33254695 TEPROTUMUMAB-TRBW 10 MG INJ J3241 636 "$1,658.00" 612.80 - " 1,326.40 " - " 1,145.68 " 322.60 " 1,145.68 " - 916.05 316.46 " 1,094.28 " - - " 1,097.43 " 276.52 307.24 878.57 " 1,098.26 " 314.92 316.46 307.24 " 1,326.40 " 281.12 - " 1,110.86 " 270.37 678.12 " 1,243.50 " 630.21 741.62 317.99 33222513 TIGECYCLINE INJ PER 1MG J3243 636 $7.00 2.59 - 5.60 - 4.84 - 4.84 - 3.87 - 4.62 - - 4.63 - - 3.26 4.07 - - - 5.60 - - 4.69 - 2.86 5.25 2.66 3.13 - 33212534 TIROFIBAN PER 0.25MG INJ J3246 636 $12.00 4.44 - 36.90 - 8.29 3.91 8.29 - 6.63 3.83 7.92 - - 7.94 3.35 3.72 29.52 36.90 3.81 3.83 3.72 9.60 3.40 - 8.04 3.27 4.91 9.00 4.56 5.37 3.85 33240058 TREPROSTINIL PER 1MG INJ J3285 636 $330.00 121.97 - 264.00 - 228.03 60.95 228.03 - 182.33 59.79 217.80 - - 218.43 52.25 58.05 193.49 241.86 59.50 59.79 58.05 264.00 53.12 - 221.10 51.08 134.97 247.50 125.43 147.61 60.08 33253028 TRIAMCINOLONE ACE ER 1MG INJ J3304 636 $96.00 35.48 - 79.55 - 66.34 18.12 66.34 - 53.04 17.78 63.36 - - 63.54 15.53 17.26 63.64 79.55 17.69 17.78 17.26 76.80 15.79 - 64.32 15.19 39.26 72.00 36.49 42.94 17.86 33231032 TRIPTORELIN INJ PER 3.75MG J3315 636 "$2,024.00" 748.07 - " 1,626.41 " - " 1,398.58 " 387.99 " 1,398.58 " - " 1,118.26 " 380.60 " 1,335.84 " - - " 1,339.69 " 332.56 369.51 " 1,301.13 " " 1,626.41 " 378.75 380.60 369.51 " 1,619.20 " 338.10 - " 1,356.08 " 325.17 827.82 " 1,518.00 " 769.32 905.34 382.44 33241275 USTEKINUMAB SC PER 1MG INJ J3357 636 $968.00 357.77 - 774.40 - 668.89 180.41 668.89 - 534.82 176.97 638.88 - - 640.72 154.64 171.82 388.30 485.37 176.12 176.97 171.82 774.40 157.22 - 648.56 151.20 395.91 726.00 367.94 432.99 177.83 33247109 USTEKINUMAB PER 1 MG IV INFUS J3358 258 $63.00 23.28 - 54.95 - 43.53 11.93 43.53 - 34.81 11.70 41.58 - - 41.70 10.22 11.36 43.96 54.95 11.64 11.70 11.36 50.40 10.39 - 42.21 10.00 25.77 47.25 23.95 28.18 11.76 33243383 VEDOLIZUMAB PER 1 MG INJ J3380 636 $107.00 39.55 - 85.60 - 73.94 21.74 73.94 - 59.12 21.32 70.62 - - 70.82 18.63 20.70 19.39 24.24 21.22 21.32 20.70 85.60 18.94 - 71.69 18.22 43.76 80.25 40.67 47.86 21.42 33242166 VELAGLUCERASE PER 100 UNITS J3385 636 "$1,817.00" 671.56 - " 1,506.99 " - " 1,255.55 " 366.93 " 1,255.55 " - " 1,003.89 " 359.94 " 1,199.22 " - - " 1,202.67 " 314.51 349.46 " 1,205.59 " " 1,506.99 " 358.20 359.94 349.46 " 1,453.60 " 319.76 - " 1,217.39 " 307.52 743.15 " 1,362.75 " 690.64 812.74 361.69 33212470 VERTEPORFIN PER 0.1MG INJ J3396 636 $59.00 21.81 - 47.20 - 40.77 11.49 40.77 - 32.60 11.27 38.94 - - 39.05 9.85 10.94 33.50 41.87 11.21 11.27 10.94 47.20 10.01 - 39.53 9.63 24.13 44.25 22.43 26.39 11.32 34002274 FECAL SPECIMEN J3490 256 "$2,625.00" 970.20 - " 2,100.00 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - 10.72 13.40 - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 34102279 FECAL SPECIMEN J3490 256 "$2,625.00" 970.20 - " 2,100.00 " - " 1,813.88 " - " 1,813.88 " - " 1,450.31 " - " 1,732.50 " - - " 1,737.49 " - - 10.72 13.40 - - - " 2,100.00 " - - " 1,758.75 " - " 1,073.63 " " 1,968.75 " 997.76 " 1,174.16 " - 33242794 PROTHROMBIN (KCENTRA) PER IU J7168 636 $11.00 4.07 - 8.80 - 7.60 2.03 7.60 - 6.08 1.99 7.26 - - 7.28 1.74 1.93 5.83 7.29 1.98 1.99 1.93 8.80 1.77 - 7.37 1.70 4.50 8.25 4.18 4.92 2.00 33245351 HUMAN FIBRINOGEN CONC NOS 1MG J7178 636 $7.00 2.59 - 5.60 - 4.84 1.32 4.84 - 3.87 1.30 4.62 - - 4.63 1.13 1.26 1.50 1.88 1.29 1.30 1.26 5.60 1.15 - 4.69 1.11 2.86 5.25 2.66 3.13 1.30 33251874 VWF RECOM VONVENDI PER IU INJ J7179 636 $9.00 3.33 - 8.85 - 6.22 1.89 6.22 - 4.97 1.85 5.94 - - 5.96 1.62 1.80 7.08 8.85 1.85 1.85 1.80 7.20 1.65 - 6.03 1.58 3.68 6.75 3.42 4.03 1.86 33252293 FACTOR VIII XYNTHA 1 UNIT INJ J7185 636 $7.00 2.59 - 6.19 - 4.84 1.35 4.84 - 3.87 1.33 4.62 - - 4.63 1.16 1.29 4.95 6.19 1.32 1.33 1.29 5.60 1.18 - 4.69 1.14 2.86 5.25 2.66 3.13 1.34 33244568 ANTIHEMOPH FACTOR/VWF PER U J7186 636 $6.00 2.22 - 4.90 - 4.15 1.16 4.15 - 3.32 1.13 3.96 - - 3.97 0.99 1.10 3.92 4.90 1.13 1.13 1.10 4.80 1.01 - 4.02 0.97 2.45 4.50 2.28 2.68 1.14 33232055 VONWILLEBRND FAC CMPLX PER IU J7187 636 $6.00 2.22 - 4.80 - 4.15 1.29 4.15 - 3.32 1.27 3.96 - - 3.97 1.11 1.23 2.98 3.72 1.26 1.27 1.23 4.80 1.13 - 4.02 1.08 2.45 4.50 2.28 2.68 1.27 33221622 FACTOR VIIA INJ PER 1 MCG J7189 636 $12.00 4.44 - 9.60 - 8.29 2.37 8.29 - 6.63 2.33 7.92 - - 7.94 2.03 2.26 4.58 5.72 2.32 2.33 2.26 9.60 2.07 - 8.04 1.99 4.91 9.00 4.56 5.37 2.34 33242697 FACTOR VIII PER INT UNIT J7190 636 $5.00 1.85 - 4.00 - 3.46 1.14 3.46 - 2.76 1.12 3.30 - - 3.31 0.98 1.09 2.88 3.60 1.12 1.12 1.09 4.00 1.00 - 3.35 0.96 2.05 3.75 1.90 2.24 1.13 33201877 FACTOR VIII RECOMBINANT PER IU J7192 636 $7.00 2.59 - 5.60 - 4.84 1.46 4.84 - 3.87 1.43 4.62 - - 4.63 1.25 1.39 4.30 5.37 1.42 1.43 1.39 5.60 1.27 - 4.69 1.22 2.86 5.25 2.66 3.13 1.44 33228775 ANTIHEMO FACTOR PER 1 UNIT INJ J7192 636 $7.00 2.59 - 5.60 - 4.84 1.46 4.84 - 3.87 1.43 4.62 - - 4.63 1.25 1.39 4.30 5.37 1.42 1.43 1.39 5.60 1.27 - 4.69 1.22 2.86 5.25 2.66 3.13 1.44 33258364 FACTOR VIII RECUMBINANT PER IU J7192 636 $7.00 2.59 - 5.60 - 4.84 1.46 4.84 - 3.87 1.43 4.62 - - 4.63 1.25 1.39 4.30 5.37 1.42 1.43 1.39 5.60 1.27 - 4.69 1.22 2.86 5.25 2.66 3.13 1.44 33226390 PROTHROMBIN COMPLEX PER 1 UNIT J7194 636 $8.00 2.96 - 6.40 - 5.53 1.56 5.53 - 4.42 1.53 5.28 - - 5.30 1.34 1.49 1.63 2.04 1.53 1.53 1.49 6.40 1.36 - 5.36 1.31 3.27 6.00 3.04 3.58 1.54 33232039 FACTOR IX RECOMB PER UNIT INJ J7195 636 $8.00 2.96 - 6.40 - 5.53 1.64 5.53 - 4.42 1.61 5.28 - - 5.30 1.40 1.56 3.51 4.39 1.60 1.61 1.56 6.40 1.43 - 5.36 1.37 3.27 6.00 3.04 3.58 1.61 33256191 ANTITHROMBIN III(HUMAN) PER IU J7197 636 $18.00 6.65 - 14.40 - 12.44 3.28 12.44 - 9.95 3.21 11.88 - - 11.91 2.81 3.12 2.57 3.21 3.20 3.21 3.12 14.40 2.85 - 12.06 2.75 7.36 13.50 6.84 8.05 3.23 33232071 ANTINHIB COAG CPLX PER 1U INJ J7198 636 $11.00 4.07 - 8.80 - 7.60 2.26 7.60 - 6.08 2.21 7.26 - - 7.28 1.94 2.15 4.48 5.60 2.20 2.21 2.15 8.80 1.97 - 7.37 1.89 4.50 8.25 4.18 4.92 2.23 33232691 DEXAMETH INTRAVIT PER 0.1MG J7312 636 "$1,049.00" 387.71 - 839.20 - 724.86 203.94 724.86 - 579.57 200.06 692.34 - - 694.33 174.81 194.23 660.84 826.05 199.09 200.06 194.23 839.20 177.72 - 702.83 170.92 429.04 786.75 398.72 469.22 201.03 33252919 HYALURONAN DUROLANE IA 1MG INJ J7318 636 $90.00 33.26 - 72.58 - 62.19 17.59 62.19 - 49.73 17.25 59.40 - - 59.57 15.08 16.75 58.06 72.58 17.17 17.25 16.75 72.00 15.33 - 60.30 14.74 36.81 67.50 34.21 40.26 17.34 33225059 EUFLEXXA PER DOSE INJ J7323 636 $737.00 272.40 - 589.60 - 509.27 141.77 509.27 - 407.19 139.07 486.42 - - 487.82 121.52 135.02 455.76 569.70 138.40 139.07 135.02 589.60 123.54 - 493.79 118.82 301.43 552.75 280.13 329.66 139.75 33233531 SYNVISC PER 1MG INJ J7325 636 $54.00 19.96 - 70.15 - 37.31 11.48 37.31 - 29.84 11.26 35.64 - - 35.74 9.84 10.93 56.12 70.15 11.20 11.26 10.93 43.20 10.00 - 36.18 9.62 22.09 40.50 20.53 24.15 11.31 33233566 SYNVISC PER 1MG INJ J7325 636 $54.00 19.96 - 70.15 - 37.31 11.48 37.31 - 29.84 11.26 35.64 - - 35.74 9.84 10.93 56.12 70.15 11.20 11.26 10.93 43.20 10.00 - 36.18 9.62 22.09 40.50 20.53 24.15 11.31 33251971 HYALURON GELSYN-3 0.1 MG INJ J7328 636 $11.00 4.07 - 9.17 - 7.60 2.23 7.60 - 6.08 2.18 7.26 - - 7.28 1.91 2.12 7.34 9.17 2.17 2.18 2.12 8.80 1.94 - 7.37 1.87 4.50 8.25 4.18 4.92 2.19 33243740 CAPSAICIN 8% PATCH PER SQCM J7336 636 $17.00 6.28 - " 1,174.02 " - 11.75 3.30 11.75 - 9.39 3.23 11.22 - - 11.25 2.83 3.14 939.22 " 1,174.02 " 3.22 3.23 3.14 13.60 2.87 - 11.39 2.76 6.95 12.75 6.46 7.60 3.25 33222220 AZATHIOPRINE PER 100MG INJ J7501 636 "$1,197.00" 442.41 - 957.60 - 827.13 250.24 827.13 - 661.34 245.47 790.02 - - 792.29 214.49 238.32 262.83 328.54 244.28 245.47 238.32 957.60 218.06 - 801.99 209.72 489.57 897.75 454.98 535.42 246.66 33257856 LYMPHOCYTE IMM GLOB PER 250MG J7504 636 "$11,853.00" " 4,380.87 " - " 9,482.40 " - " 8,190.42 " " 2,405.64 " " 8,190.42 " - " 6,548.78 " " 2,359.82 " " 7,822.98 " - - " 7,845.50 " " 2,061.98 " " 2,291.09 " 909.67 " 1,137.09 " " 2,348.37 " " 2,359.82 " " 2,291.09 " " 9,482.40 " " 2,096.35 " - " 7,941.51 " " 2,016.16 " " 4,847.88 " " 8,889.75 " " 4,505.33 " " 5,301.85 " " 2,371.28 " 33218851 THYMOGLOBULIN PER 25MG INJ J7511 636 "$4,290.00" " 1,585.58 " - " 3,432.00 " - " 2,964.39 " 855.24 " 2,964.39 " - " 2,370.23 " 838.95 " 2,831.40 " - - " 2,839.55 " 733.06 814.51 788.84 986.05 834.87 838.95 814.51 " 3,432.00 " 745.28 - " 2,874.30 " 716.77 " 1,754.61 " " 3,217.50 " " 1,630.63 " " 1,918.92 " 843.02 33235496 TACROLIMUS PER 5MG INJ J7525 636 "$1,113.00" 411.36 - 890.40 - 769.08 223.99 769.08 - 614.93 219.72 734.58 - - 736.69 191.99 213.32 354.55 443.19 218.65 219.72 213.32 890.40 195.19 - 745.71 187.72 455.22 834.75 423.05 497.84 220.79 33210485 ETOPOSIDE PER 50MG PO SOLN J8560 636 $396.00 146.36 - 316.80 - 273.64 77.24 273.64 - 218.79 75.77 261.36 - - 262.11 66.20 73.56 183.09 228.86 75.40 75.77 73.56 316.80 67.31 - 265.32 64.73 161.96 297.00 150.52 177.13 76.13 33252056 ROLAPITANT ORAL PER 1 MG J8670 636 $12.00 4.44 - 13.12 - 8.29 1.79 8.29 - 6.63 1.75 7.92 - - 7.94 1.53 1.70 10.50 13.12 1.74 1.75 1.70 9.60 1.56 - 8.04 1.50 4.91 9.00 4.56 5.37 1.76 33231075 ALDESLEUKIN PER SNGL USE VL J9015 636 "$26,064.00" " 9,633.25 " - " 20,851.20 " - " 18,010.22 " " 3,875.99 " " 18,010.22 " - " 14,400.36 " " 3,802.16 " " 17,202.24 " - - " 17,251.76 " " 3,322.28 " " 3,691.42 " " 2,190.90 " " 2,738.63 " " 3,783.71 " " 3,802.16 " " 3,691.42 " " 20,851.20 " " 3,377.65 " - " 17,462.88 " " 3,248.45 " " 10,660.18 " " 19,548.00 " " 9,906.93 " " 11,658.43 " " 3,820.62 " 33245602 ARSENIC PER 1MG INJ J9017 636 $116.00 42.87 - 102.35 - 80.16 13.40 80.16 - 64.09 13.14 76.56 - - 76.78 11.48 12.76 81.88 102.35 13.08 13.14 12.76 92.80 11.68 - 77.72 11.23 47.44 87.00 44.09 51.89 13.21 33240392 ASPAR ERWIN PER 1000 UNITS INJ J9019 636 "$2,243.00" 829.01 - " 1,794.40 " - " 1,549.91 " 436.36 " 1,549.91 " - " 1,239.26 " 428.05 " 1,480.38 " - - " 1,484.64 " 374.02 415.58 521.41 651.76 425.97 428.05 415.58 " 1,794.40 " 380.26 - " 1,502.81 " 365.71 917.39 " 1,682.25 " 852.56 " 1,003.29 " 430.13 33245963 ATEZOLIZUMAB PER 10MG INJ J9022 636 $411.00 151.91 - 328.80 - 284.00 81.45 284.00 - 227.08 79.90 271.26 - - 272.04 69.81 77.57 237.20 296.50 79.51 79.90 77.57 328.80 70.98 - 275.37 68.26 168.10 308.25 156.22 183.84 80.28 33249608 AVELUMAB PER 10MG INJ J9023 636 $445.00 164.47 - 356.00 - 307.50 88.02 307.50 - 245.86 86.34 293.70 - - 294.55 75.45 83.83 272.64 340.80 85.93 86.34 83.83 356.00 76.70 - 298.15 73.77 182.01 333.75 169.14 199.05 86.76 33212259 AZACITIDINE PER 1MG INJ J9025 636 $4.00 1.48 - 18.41 - 2.76 0.95 2.76 - 2.21 0.93 2.64 - - 2.65 0.81 0.90 14.73 18.41 0.92 0.93 0.90 3.20 0.82 - 2.68 0.79 1.64 3.00 1.52 1.79 0.93 33215894 CLOFARABINE PER 1MG INJ J9027 636 $276.00 102.01 - 502.33 - 190.72 54.27 190.72 - 152.49 53.24 182.16 - - 182.68 46.52 51.69 401.86 502.33 52.98 53.24 51.69 220.80 47.30 - 184.92 45.49 112.88 207.00 104.91 123.45 53.50 33244771 BELINOSTAT PER 10 MG INJ J9032 636 $225.00 83.16 - 180.00 - 155.48 43.68 155.48 - 124.31 42.85 148.50 - - 148.93 37.44 41.60 36.22 45.28 42.64 42.85 41.60 180.00 38.06 - 150.75 36.61 92.03 168.75 85.52 100.64 43.06 33228961 BENDAMUSTINE (TREANDA) 1MG INJ J9033 636 $130.00 48.05 - 104.00 - 89.83 22.48 89.83 - 71.83 22.05 85.80 - - 86.05 19.27 21.41 64.30 80.37 21.95 22.05 21.41 104.00 19.59 - 87.10 18.84 53.17 97.50 49.41 58.15 22.16 33247265 BENDAMUSTINE(BENDEKA) 1MG INJ J9034 636 $106.00 39.18 - 103.83 - 73.25 20.07 73.25 - 58.57 19.68 69.96 - - 70.16 17.20 19.11 83.06 103.83 19.59 19.68 19.11 84.80 17.49 - 71.02 16.82 43.35 79.50 40.29 47.41 19.78 33212496 BEVACIZUMAB PER 10MG INJ J9035 636 $401.00 148.21 - 320.80 - 277.09 71.91 277.09 - 221.55 70.54 264.66 - - 265.42 61.64 68.49 204.65 255.81 70.20 70.54 68.49 320.80 62.67 - 268.67 60.27 164.01 300.75 152.42 179.37 70.89 33212526 BEVACIZUMAB PER 10MG INJ J9035 636 $401.00 148.21 - 320.80 - 277.09 71.91 277.09 - 221.55 70.54 264.66 - - 265.42 61.64 68.49 204.65 255.81 70.20 70.54 68.49 320.80 62.67 - 268.67 60.27 164.01 300.75 152.42 179.37 70.89 33244509 BLINATUMOMAB PER 1MCG INJ J9039 636 $623.00 230.26 - 498.40 - 430.49 126.51 430.49 - 344.21 124.10 411.18 - - 412.36 108.44 120.49 324.41 405.51 123.50 124.10 120.49 498.40 110.25 - 417.41 106.03 254.81 467.25 236.80 278.67 124.71 33212453 BORTEZOMIB (VELCADE) 0.1MG INJ J9041 636 $236.00 87.23 - 188.80 - 163.08 46.13 163.08 - 130.39 45.25 155.76 - - 156.21 39.54 43.93 97.67 122.09 45.03 45.25 43.93 188.80 40.20 - 158.12 38.66 96.52 177.00 89.70 105.56 45.47 33239882 BRENTUXIMAB PER 1MG INJ J9042 636 $920.00 340.03 - 736.00 - 635.72 193.36 635.72 - 508.30 189.67 607.20 - - 608.95 165.74 184.15 152.66 190.83 188.75 189.67 184.15 736.00 168.50 - 616.40 162.05 376.28 690.00 349.69 411.52 190.60 33239181 CABAZITAXEL PER 1MG INJ J9043 636 $953.00 352.23 - 762.40 - 658.52 193.02 658.52 - 526.53 189.34 628.98 - - 630.79 165.45 183.83 329.61 412.01 188.43 189.34 183.83 762.40 168.20 - 638.51 161.77 389.78 714.75 362.24 426.28 190.26 33241704 CARFILZOMIB PER 1MG INJ J9047 636 $206.00 76.14 - 164.80 - 142.35 41.98 142.35 - 113.82 41.18 135.96 - - 136.35 35.98 39.98 39.17 48.96 40.98 41.18 39.98 164.80 36.58 - 138.02 35.18 84.25 154.50 78.30 92.14 41.38 33202032 CARMUSTINE PER 100MG INJ J9050 636 "$10,585.00" " 3,912.22 " - " 8,468.00 " - " 7,314.24 " " 1,260.71 " " 7,314.24 " - " 5,848.21 " " 1,236.70 " " 6,986.10 " - - " 7,006.21 " " 1,080.61 " " 1,200.68 " 474.40 593.00 " 1,230.70 " " 1,236.70 " " 1,200.68 " " 8,468.00 " " 1,098.62 " - " 7,091.95 " " 1,056.60 " " 4,329.27 " " 7,938.75 " " 4,023.36 " " 4,734.67 " " 1,242.70 " 33212488 CETUXIMAB PER 10MG INJ J9055 636 $338.00 124.92 - 270.40 - 233.56 68.12 233.56 - 186.75 66.83 223.08 - - 223.72 58.39 64.88 171.46 214.33 66.50 66.83 64.88 270.40 59.37 - 226.46 57.09 138.24 253.50 128.47 151.19 67.15 33229062 CETUXIMAB PER 10MG INJ J9055 636 $338.00 124.92 - 270.40 - 233.56 68.12 233.56 - 186.75 66.83 223.08 - - 223.72 58.39 64.88 171.46 214.33 66.50 66.83 64.88 270.40 59.37 - 226.46 57.09 138.24 253.50 128.47 151.19 67.15 33266251 CLADRIBINE INJ PER 1MG J9065 636 $103.00 38.07 - 219.81 - 71.17 18.41 71.17 - 56.91 18.06 67.98 - - 68.18 15.78 17.53 175.85 219.81 17.97 18.06 17.53 82.40 16.04 - 69.01 15.43 42.13 77.25 39.15 46.07 18.14 33239131 CYCLOPHOSPHAMIDE PER 100MG INJ J9070 636 $156.00 57.66 - 124.80 - 107.80 29.78 107.80 - 86.19 29.21 102.96 - - 103.26 25.52 28.36 16.76 20.95 29.07 29.21 28.36 124.80 25.95 - 104.52 24.96 63.80 117.00 59.30 69.78 29.35 33252617 CEMIPLIMAB-RWLC PER 1MG INJ J9119 636 $144.00 53.22 - 116.09 - 99.50 28.13 99.50 - 79.56 27.59 95.04 - - 95.31 24.11 26.79 92.87 116.09 27.46 27.59 26.79 115.20 24.51 - 96.48 23.58 58.90 108.00 54.73 64.41 27.73 33214146 DACTINOMYCIN PER 0.5 MG INJ J9120 636 "$5,484.00" " 2,026.89 " - " 4,387.20 " - " 3,789.44 " 909.59 " 3,789.44 " - " 3,029.91 " 892.27 " 3,619.44 " - - " 3,629.86 " 779.65 866.28 42.74 53.43 887.94 892.27 866.28 " 4,387.20 " 792.65 - " 3,674.28 " 762.33 " 2,242.96 " " 4,113.00 " " 2,084.47 " " 2,452.99 " 896.60 33254911 DARATUMUMAB 10MG+HYALURON INJ J9144 636 $228.00 84.27 - 182.40 - 157.55 46.05 157.55 - 125.97 45.18 150.48 - - 150.91 39.47 43.86 120.82 151.03 44.96 45.18 43.86 182.40 40.13 - 152.76 38.60 93.25 171.00 86.66 101.98 45.40 33245793 DARATUMUMAB PER 10MG INJ J9145 636 $296.00 109.40 - 236.80 - 204.54 58.78 204.54 - 163.54 57.66 195.36 - - 195.92 50.38 55.98 165.22 206.53 57.38 57.66 55.98 236.80 51.22 - 198.32 49.26 121.06 222.00 112.51 132.40 57.94 33207239 DAUNORUBICIN PER 10MG INJ J9150 636 $230.00 85.01 - 308.13 - 158.93 41.21 158.93 - 127.08 40.43 151.80 - - 152.24 35.33 39.25 246.50 308.13 40.23 40.43 39.25 184.00 35.91 - 154.10 34.54 94.07 172.50 87.42 102.88 40.62 33207565 DAUNORUBICIN 10MG INJ J9150 636 $230.00 85.01 - 308.13 - 158.93 41.21 158.93 - 127.08 40.43 151.80 - - 152.24 35.33 39.25 246.50 308.13 40.23 40.43 39.25 184.00 35.91 - 154.10 34.54 94.07 172.50 87.42 102.88 40.62 33252048 DAUNORUB-CYTAR LIPO 1 MG INJ J9153 636 "$1,038.00" 383.64 - 830.40 - 717.26 206.90 717.26 - 573.50 202.96 685.08 - - 687.05 177.35 197.05 585.05 731.31 201.98 202.96 197.05 830.40 180.30 - 695.46 173.40 424.54 778.50 394.54 464.30 203.95 33239548 DEGARELIX PER 1MG INJ J9155 636 $20.00 7.39 - 17.39 - 13.82 4.21 13.82 - 11.05 4.13 13.20 - - 13.24 3.61 4.01 13.91 17.39 4.11 4.13 4.01 16.00 3.67 - 13.40 3.53 8.18 15.00 7.60 8.95 4.15 33249683 DURVALUMAB PER 10 MG INJ J9173 636 $399.00 147.47 - 319.20 - 275.71 78.50 275.71 - 220.45 77.00 263.34 - - 264.10 67.28 74.76 230.62 288.28 76.63 77.00 74.76 319.20 68.41 - 267.33 65.79 163.19 299.25 151.66 178.47 77.38 33245475 ELOTUZUMAB PER 1 MG INJ/INF J9176 636 $35.00 12.94 - 28.00 - 24.19 6.92 24.19 - 19.34 6.79 23.10 - - 23.17 5.93 6.59 21.15 26.44 6.75 6.79 6.59 28.00 6.03 - 23.45 5.80 14.32 26.25 13.30 15.66 6.82 33239939 ERIBULIN PER 0.1MG INJ J9179 636 $618.00 228.41 - 494.40 - 427.04 126.57 427.04 - 341.45 124.16 407.88 - - 409.05 108.49 120.54 214.42 268.03 123.55 124.16 120.54 494.40 110.29 - 414.06 106.08 252.76 463.50 234.90 276.43 124.76 33219865 GOSERELIN ACET PER 3.6MG INJ J9202 636 "$2,644.00" 977.22 - " 2,115.20 " - " 1,827.00 " 536.38 " 1,827.00 " - " 1,460.81 " 526.17 " 1,745.04 " - - " 1,750.06 " 459.76 510.84 843.99 " 1,054.99 " 523.61 526.17 510.84 " 2,115.20 " 467.42 - " 1,771.48 " 449.54 " 1,081.40 " " 1,983.00 " " 1,004.98 " " 1,182.66 " 528.72 33249705 GEMTUZUMAB OZOGAM 0.1 MG INJ J9203 636 "$1,078.00" 398.43 - 862.40 - 744.90 212.42 744.90 - 595.60 208.37 711.48 - - 713.53 182.07 202.30 650.94 813.68 207.36 208.37 202.30 862.40 185.10 - 722.26 178.02 440.90 808.50 409.75 482.19 209.38 33245360 IRINOTECAN LIPOSOME PR 1MG INJ J9205 636 $285.00 105.34 - 228.00 - 196.94 58.41 196.94 - 157.46 57.30 188.10 - - 188.64 50.07 55.63 134.58 168.23 57.02 57.30 55.63 228.00 50.90 - 190.95 48.95 116.57 213.75 108.33 127.48 57.58 33228066 IXABEPILONE PER 1MG INJ J9207 636 $531.00 196.26 - 424.80 - 366.92 114.50 366.92 - 293.38 112.32 350.46 - - 351.47 98.15 109.05 219.56 274.45 111.78 112.32 109.05 424.80 99.78 - 355.77 95.96 217.18 398.25 201.83 237.52 112.87 33224524 INTERFERON ALPHA-2B PER 1MU J9214 636 $180.00 66.53 - 144.00 - 124.38 33.95 124.38 - 99.45 33.30 118.80 - - 119.14 29.10 32.33 34.38 42.97 33.14 33.30 32.33 144.00 29.58 - 120.60 28.45 73.62 135.00 68.42 80.51 33.46 33228414 INTERFERON ALFA2B PER 1MU INJ J9214 636 $180.00 66.53 - 144.00 - 124.38 33.95 124.38 - 99.45 33.30 118.80 - - 119.14 29.10 32.33 34.38 42.97 33.14 33.30 32.33 144.00 29.58 - 120.60 28.45 73.62 135.00 68.42 80.51 33.46 33204001 LEUPROLIDE DEPOT PER 7.5MG INJ J9217 636 "$1,178.00" 435.39 - " 1,130.47 " - 814.00 142.04 814.00 - 650.85 139.34 777.48 - - 779.72 121.75 135.28 904.38 " 1,130.47 " 138.66 139.34 135.28 942.40 123.78 - 789.26 119.05 481.80 883.50 447.76 526.92 140.01 33212194 LEUPROLIDE ACE PER 7.5MG INJ J9217 636 "$1,178.00" 435.39 - " 1,130.47 " - 814.00 142.04 814.00 - 650.85 139.34 777.48 - - 779.72 121.75 135.28 904.38 " 1,130.47 " 138.66 139.34 135.28 942.40 123.78 - 789.26 119.05 481.80 883.50 447.76 526.92 140.01 33227078 LEUPROLIDE DEPOT PER 7.5MG J9217 636 "$1,178.00" 435.39 - " 1,130.47 " - 814.00 142.04 814.00 - 650.85 139.34 777.48 - - 779.72 121.75 135.28 904.38 " 1,130.47 " 138.66 139.34 135.28 942.40 123.78 - 789.26 119.05 481.80 883.50 447.76 526.92 140.01 33254989 LURBINECTEDIN INJ 0.1MG J9223 636 $897.00 331.53 - 717.60 - 619.83 177.73 619.83 - 495.59 174.35 592.02 - - 593.72 152.34 169.27 475.32 594.17 173.50 174.35 169.27 717.60 154.88 - 600.99 148.96 366.87 672.75 340.95 401.23 175.19 33230699 HISTRELIN IMPLANT SQ 50MG J9226 636 "$211,244.00" " 78,075.78 " - " 168,995.20 " - " 145,969.60 " " 44,391.66 " " 145,969.60 " - " 116,712.31 " " 43,546.10 " " 139,421.04 " - - " 139,822.40 " " 38,049.99 " " 42,277.77 " " 50,009.70 " " 62,512.13 " " 43,334.71 " " 43,546.10 " " 42,277.77 " " 168,995.20 " " 38,684.16 " - " 141,533.48 " " 37,204.44 " " 86,398.80 " " 158,433.00 " " 80,293.84 " " 94,489.44 " " 43,757.49 " 33254709 ISATUXIMAB-IRFC 10MG INJ J9227 636 $350.00 129.36 - 280.00 - 241.85 69.04 241.85 - 193.38 67.72 231.00 - - 231.67 59.18 65.75 185.47 231.84 67.39 67.72 65.75 280.00 60.16 - 234.50 57.86 143.15 262.50 133.04 156.56 68.05 33239483 IPILMUMAB PER 1MG INJ J9228 636 $826.00 305.29 - 660.80 - 570.77 162.03 570.77 - 456.37 158.94 545.16 - - 546.73 138.88 154.31 293.73 367.16 158.17 158.94 154.31 660.80 141.19 - 553.42 135.79 337.83 619.50 313.96 369.47 159.71 33214065 MECHLORETHAMINE 10MG INJ J9230 636 "$1,724.00" 637.19 - " 1,379.20 " - " 1,191.28 " 11.99 " 1,191.28 " - 952.51 11.76 " 1,137.84 " - - " 1,141.12 " 10.28 11.42 31.65 39.56 11.71 11.76 11.42 " 1,379.20 " 10.45 - " 1,155.08 " 10.05 705.12 " 1,293.00 " 655.29 771.15 11.82 33219385 MELPHALAN PER 50MG INJ J9245 636 "$1,367.00" 505.24 - " 1,093.60 " - 944.60 212.85 944.60 - 755.27 208.79 902.22 - - 904.82 182.44 202.71 574.33 717.91 207.78 208.79 202.71 " 1,093.60 " 185.48 - 915.89 178.38 559.10 " 1,025.25 " 519.60 611.46 209.80 33254369 MELPHALAN INJ(EVOMELA) 1MG INJ J9246 636 $142.00 52.48 - 113.60 - 98.12 18.59 98.12 - 78.46 18.23 93.72 - - 93.99 15.93 17.70 75.25 94.06 18.14 18.23 17.70 113.60 16.20 - 95.14 15.58 58.08 106.50 53.97 63.52 18.32 33225105 NELARABINE PER 50MG INJ J9261 636 $799.00 295.31 - 639.20 - 552.11 159.21 552.11 - 441.45 156.18 527.34 - - 528.86 136.47 151.63 285.77 357.21 155.42 156.18 151.63 639.20 138.74 - 535.33 133.43 326.79 599.25 303.70 357.39 156.94 33212895 PACLITAXEL PROT-BOUND 1MG INJ J9264 636 $70.00 25.87 - 56.00 - 48.37 14.37 48.37 - 38.68 14.10 46.20 - - 46.33 12.32 13.69 30.70 38.38 14.03 14.10 13.69 56.00 12.53 - 46.90 12.05 28.63 52.50 26.61 31.31 14.17 33252102 PEGASPARGASE PER 5ML VIAL INJ J9266 636 "$103,518.00" " 38,260.25 " - " 82,814.40 " - " 71,530.94 " " 22,019.70 " " 71,530.94 " - " 57,193.70 " " 21,600.27 " " 68,321.88 " - - " 68,518.56 " " 18,874.03 " " 20,971.14 " " 4,141.31 " " 5,176.64 " " 21,495.42 " " 21,600.27 " " 20,971.14 " " 82,814.40 " " 19,188.59 " - " 69,357.06 " " 18,454.60 " " 42,338.86 " " 77,638.50 " " 39,347.19 " " 46,303.60 " " 21,705.13 " 33228473 PENTOSTATIN 10MG/5ML INJ J9268 636 "$10,816.00" " 3,997.59 " - " 8,652.80 " - " 7,473.86 " " 1,920.67 " " 7,473.86 " - " 5,975.84 " " 1,884.09 " " 7,138.56 " - - " 7,159.11 " " 1,646.29 " " 1,829.21 " " 5,183.15 " " 6,478.94 " " 1,874.94 " " 1,884.09 " " 1,829.21 " " 8,652.80 " " 1,673.73 " - " 7,246.72 " " 1,609.70 " " 4,423.74 " " 8,112.00 " " 4,111.16 " " 4,838.00 " " 1,893.23 " 33243685 PEMBROLIZUMAB PER 1 MG INJ J9271 636 $267.00 98.68 - 213.60 - 184.50 53.88 184.50 - 147.52 52.85 176.22 - - 176.73 46.18 51.31 52.14 65.18 52.59 52.85 51.31 213.60 46.95 - 178.89 45.15 109.20 200.25 101.49 119.43 53.11 33201931 MITOMYCIN PER 5MG INJ J9280 636 $262.00 96.84 - 653.99 - 181.04 39.45 181.04 - 144.76 38.70 172.92 - - 173.42 33.81 37.57 523.19 653.99 38.51 38.70 37.57 209.60 34.38 - 175.54 33.06 107.16 196.50 99.59 117.19 38.88 33284969 MITOMYCIN PER 5MG INJ J9280 636 $262.00 96.84 - 653.99 - 181.04 39.45 181.04 - 144.76 38.70 172.92 - - 173.42 33.81 37.57 523.19 653.99 38.51 38.70 37.57 209.60 34.38 - 175.54 33.06 107.16 196.50 99.59 117.19 38.88 33247451 OLARATUMAB PER 10MG INJ J9285 636 $273.00 100.90 - 218.40 - 188.64 53.17 188.64 - 150.83 52.16 180.18 - - 180.70 45.58 50.64 168.61 210.76 51.91 52.16 50.64 218.40 46.34 - 182.91 44.56 111.66 204.75 103.77 122.11 52.41 33203241 MITOXANTRONE PER 5MG INJ J9293 636 $151.00 55.81 - " 1,137.63 " - 104.34 26.85 104.34 - 83.43 26.34 99.66 - - 99.95 23.01 25.57 910.10 " 1,137.63 " 26.21 26.34 25.57 120.80 23.40 - 101.17 22.50 61.76 113.25 57.40 67.54 26.46 33245432 NECITUMUMAB PER 1 MG INJ J9295 636 $30.00 11.09 - 24.00 - 20.73 5.86 20.73 - 16.58 5.75 19.80 - - 19.86 5.02 5.58 17.86 22.33 5.72 5.75 5.58 24.00 5.11 - 20.10 4.91 12.27 22.50 11.40 13.42 5.78 33244134 NIVOLUMAB INJ PER 1 MG J9299 636 $150.00 55.44 - 120.00 - 103.65 29.47 103.65 - 82.88 28.91 99.00 - - 99.29 25.26 28.07 86.95 108.69 28.77 28.91 28.07 120.00 25.68 - 100.50 24.70 61.35 112.50 57.02 67.10 29.05 33243154 OBINUTUZUMAB PER 10MG INJ J9301 636 $335.00 123.82 - 268.00 - 231.49 65.91 231.49 - 185.09 64.65 221.10 - - 221.74 56.49 62.77 67.02 83.78 64.34 64.65 62.77 268.00 57.43 - 224.45 55.24 137.02 251.25 127.33 149.85 64.97 33234813 OFATUMUMAB PER 10MG INJ J9302 636 $325.00 120.12 - 260.00 - 224.58 65.32 224.58 - 179.56 64.08 214.50 - - 215.12 55.99 62.21 157.18 196.47 63.77 64.08 62.21 260.00 56.92 - 217.75 54.74 132.93 243.75 123.53 145.37 64.39 33225091 PANITUMUMAB PER 10MG INJ J9303 636 $649.00 239.87 - 519.20 - 448.46 133.15 448.46 - 358.57 130.61 428.34 - - 429.57 114.13 126.81 285.77 357.21 129.98 130.61 126.81 519.20 116.03 - 434.83 111.59 265.44 486.75 246.68 290.30 131.25 33212500 PEMETREXED (NOS) 10MG INJ J9305 636 $377.00 139.34 - 301.60 - 260.51 76.52 260.51 - 208.29 75.07 248.82 - - 249.54 65.59 72.88 145.11 181.39 74.70 75.07 72.88 301.60 66.69 - 252.59 64.13 154.19 282.75 143.30 168.63 75.43 33242930 PERTUZUMAB PER 1MG INJ J9306 636 $68.00 25.13 - 54.40 - 46.99 13.85 46.99 - 37.57 13.59 44.88 - - 45.01 11.87 13.19 13.75 17.19 13.52 13.59 13.19 54.40 12.07 - 45.56 11.61 27.81 51.00 25.85 30.42 13.65 33234520 PRALATREXATE PER 1MG J9307 636 "$1,634.00" 603.93 - " 1,307.20 " - " 1,129.09 " 321.53 " 1,129.09 " - 902.79 315.41 " 1,078.44 " - - " 1,081.54 " 275.60 306.22 558.16 697.70 313.88 315.41 306.22 " 1,307.20 " 280.19 - " 1,094.78 " 269.47 668.31 " 1,225.50 " 621.08 730.89 316.94 33243677 RAMUCIRUMAB PER 5 MG INJ J9308 636 $319.00 117.90 - 255.20 - 220.43 64.02 220.43 - 176.25 62.80 210.54 - - 211.15 54.87 60.97 61.51 76.89 62.49 62.80 60.97 255.20 55.79 - 213.73 53.65 130.47 239.25 121.25 142.69 63.10 33253516 POLATUZUMAB VEDOTIN PIIQ 1MG J9309 636 $581.00 214.74 - 464.80 - 401.47 115.98 401.47 - 321.00 113.77 383.46 - - 384.56 99.41 110.46 307.87 384.85 113.22 113.77 110.46 464.80 101.07 - 389.27 97.20 237.63 435.75 220.84 259.88 114.33 33251891 RITUXIMAB HYAL PER 10 MG INJ J9311 636 $216.00 79.83 - 209.74 - 149.26 38.75 149.26 - 119.34 38.01 142.56 - - 142.97 33.21 36.90 167.79 209.74 37.82 38.01 36.90 172.80 33.76 - 144.72 32.47 88.34 162.00 82.10 96.62 38.19 33252528 RITUXIMAB PER 10MG INJ J9312 636 $486.00 179.63 - 419.49 - 335.83 88.79 335.83 - 268.52 87.10 320.76 - - 321.68 76.10 84.56 335.59 419.49 86.67 87.10 84.56 388.80 77.37 - 325.62 74.41 198.77 364.50 184.73 217.39 87.52 33254946 SACITUZUMAB GOV-HZIY INJ 2.5MG J9317 636 $151.00 55.81 - 120.80 - 104.34 31.00 104.34 - 83.43 30.41 99.66 - - 99.95 26.57 29.52 80.01 100.02 30.26 30.41 29.52 120.80 27.01 - 101.17 25.98 61.76 113.25 57.40 67.54 30.55 33239777 ROMIDEPSIN PER 0.1 MG J9319 636 "$1,767.00" 653.08 - " 1,413.60 " - " 1,221.00 " 34.40 " 1,221.00 " - 976.27 33.74 " 1,166.22 " - - " 1,169.58 " 29.48 32.76 936.33 " 1,170.46 " 33.58 33.74 32.76 " 1,413.60 " 29.98 - " 1,183.89 " 28.83 722.70 " 1,325.25 " 671.64 790.38 33.91 33281471 STREPTOZOCIN PER 1GM INJ J9320 636 "$1,835.00" 678.22 - " 1,468.00 " - " 1,267.99 " 355.92 " 1,267.99 " - " 1,013.84 " 349.14 " 1,211.10 " - - " 1,214.59 " 305.07 338.97 223.29 279.11 347.44 349.14 338.97 " 1,468.00 " 310.16 - " 1,229.45 " 298.29 750.52 " 1,376.25 " 697.48 820.80 350.83 33245424 TALIMOGENE L PER 1 MILL UN INJ J9325 636 $283.00 104.60 - 226.40 - 195.55 58.47 195.55 - 156.36 57.36 186.78 - - 187.32 50.12 55.69 157.18 196.47 57.08 57.36 55.69 226.40 50.96 - 189.61 49.01 115.75 212.25 107.57 126.59 57.64 33227817 TEMISORLIMUS PER 1MG INJ J9330 636 $236.00 87.23 - 205.87 - 163.08 39.06 163.08 - 130.39 38.32 155.76 - - 156.21 33.48 37.20 164.70 205.87 38.13 38.32 37.20 188.80 34.04 - 158.12 32.74 96.52 177.00 89.70 105.56 38.50 33203390 THIOTEPA PER 15MG INJ J9340 636 "$2,496.00" 922.52 - " 1,996.80 " - " 1,724.74 " 312.35 " 1,724.74 " - " 1,379.04 " 306.40 " 1,647.36 " - - " 1,652.10 " 267.73 297.48 348.22 435.27 304.92 306.40 297.48 " 1,996.80 " 272.19 - " 1,672.32 " 261.78 " 1,020.86 " " 1,872.00 " 948.73 " 1,116.46 " 307.89 33241925 ADO-TRASTUZUMAB PER 1MG INJ J9354 636 $172.00 63.57 - 137.60 - 118.85 34.91 118.85 - 95.03 34.25 113.52 - - 113.85 29.93 33.25 39.33 49.16 34.08 34.25 33.25 137.60 30.42 - 115.24 29.26 70.35 129.00 65.38 76.94 34.41 33233744 TRASTUZUMAB EXCL BIOSIMI 10MG J9355 636 $523.00 193.30 - 418.40 - 361.39 91.72 361.39 - 288.96 89.97 345.18 - - 346.17 78.62 87.35 153.07 191.34 89.53 89.97 87.35 418.40 79.93 - 350.41 76.87 213.91 392.25 198.79 233.94 90.41 33254253 TRASTUZUMAB 10MG+HYALURON-OYSK J9356 636 $394.00 145.62 - 347.93 - 272.25 73.38 272.25 - 217.69 71.99 260.04 - - 260.79 62.90 69.89 278.34 347.93 71.64 71.99 69.89 315.20 63.95 - 263.98 61.50 161.15 295.50 149.76 176.24 72.34 33232586 VALRUBICIN PER 200MG INJ J9357 636 "$7,367.00" " 2,722.84 " - " 5,893.60 " - " 5,090.60 " " 1,455.69 " " 5,090.60 " - " 4,070.27 " " 1,427.96 " " 4,862.22 " - - " 4,876.22 " " 1,247.73 " " 1,386.37 " " 1,160.94 " " 1,451.17 " " 1,421.03 " " 1,427.96 " " 1,386.37 " " 5,893.60 " " 1,268.53 " - " 4,935.89 " " 1,220.01 " " 3,013.10 " " 5,525.25 " " 2,800.20 " " 3,295.26 " " 1,434.89 " 33243138 VINCRISTINE LIPOSOME PER 1MG J9371 636 "$17,431.00" " 6,442.50 " - " 13,944.80 " - " 12,044.82 " " 3,441.92 " " 12,044.82 " - " 9,630.63 " " 3,376.36 " " 11,504.46 " - - " 11,537.58 " " 2,950.22 " " 3,278.02 " 445.82 557.28 " 3,359.97 " " 3,376.36 " " 3,278.02 " " 13,944.80 " " 2,999.39 " - " 11,678.77 " " 2,884.66 " " 7,129.28 " " 13,073.25 " " 6,625.52 " " 7,796.89 " " 3,392.75 " 33206593 FULVESTRANT PER 25MG INJ J9395 636 $277.00 102.38 - 351.38 - 191.41 16.32 191.41 - 153.04 16.01 182.82 - - 183.35 13.99 15.54 281.10 351.38 15.93 16.01 15.54 221.60 14.22 - 185.59 13.68 113.29 207.75 105.29 123.90 16.08 33206607 FULVESTRANT PER 25MG INJ J9395 636 $277.00 102.38 - 351.38 - 191.41 16.32 191.41 - 153.04 16.01 182.82 - - 183.35 13.99 15.54 281.10 351.38 15.93 16.01 15.54 221.60 14.22 - 185.59 13.68 113.29 207.75 105.29 123.90 16.08 33241712 ZIV-AFLIBERCEPT PER 1MG INJ J9400 636 $42.00 15.52 - 33.60 - 29.02 8.60 29.02 - 23.21 8.44 27.72 - - 27.80 7.37 8.19 22.69 28.36 8.39 8.44 8.19 33.60 7.49 - 28.14 7.21 17.18 31.50 15.96 18.79 8.48 28150580 KO IMMOB CANVAS LONG PRE OTS L1830 270 $255.00 94.25 - 417.60 - 176.21 76.10 176.21 - 140.89 74.65 168.30 - - 168.78 65.23 72.48 334.08 417.60 74.29 74.65 72.48 204.00 66.32 - 170.85 63.78 104.30 191.25 96.93 114.06 75.02 29121150 METACARP FX ORTHOSIS PRE CST L3917 274 $343.00 126.77 - 521.67 - 237.01 103.99 237.01 - 189.51 102.01 226.38 - - 227.03 89.14 99.04 417.34 521.67 101.52 102.01 99.04 274.40 90.62 - 229.81 87.16 140.29 257.25 130.37 153.42 102.51 28900708 TRACHEOSTOMY SPEAKING VALVE L8501 274 $375.00 138.60 - 579.13 - 259.13 133.31 259.13 - 207.19 130.77 247.50 - - 248.21 114.26 126.96 463.30 579.13 130.13 130.77 126.96 300.00 116.17 - 251.25 111.72 153.38 281.25 142.54 167.74 131.40 28116233 BULK AG SYN IMP UR 1ML LVL004 L8606 278 "$1,050.00" 388.08 - " 1,151.56 " - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - 921.25 " 1,151.56 " - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 28116241 BULK AG SYN IMP UR 1ML LVL005 L8606 278 "$1,350.00" 498.96 - " 1,151.56 " - 932.85 - 932.85 - 745.88 - 891.00 - - 893.57 - - 921.25 " 1,151.56 " - - - " 1,080.00 " - - 904.50 - 552.15 " 1,012.50 " 513.14 603.86 - 28133766 BULK AG SYN IMP UR 1ML LVL010 L8606 278 "$2,375.00" 877.80 - " 1,900.00 " - " 1,641.13 " - " 1,641.13 " - " 1,312.19 " - " 1,567.50 " - - " 1,572.01 " - - 921.25 " 1,151.56 " - - - " 1,900.00 " - - " 1,591.25 " - 971.38 " 1,781.25 " 902.74 " 1,062.34 " - 28112904 OSSICULAR IMP LVL001 L8613 274 $200.00 73.92 - " 1,569.71 " - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - " 1,255.77 " " 1,569.71 " - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 28112921 OSSICULAR IMP LVL003 L8613 274 $750.00 277.20 - " 1,569.71 " - 518.25 - 518.25 - 414.38 - 495.00 - - 496.43 - - " 1,255.77 " " 1,569.71 " - - - 600.00 - - 502.50 - 306.75 562.50 285.08 335.48 - 28112939 OSSICULAR IMP LVL004 L8613 278 "$1,050.00" 388.08 - " 1,569.71 " - 725.55 - 725.55 - 580.13 - 693.00 - - 695.00 - - " 1,255.77 " " 1,569.71 " - - - 840.00 - - 703.50 - 429.45 787.50 399.11 469.67 - 28147465 OSSICULAR IMP LVL014 L8613 274 "$3,375.00" " 1,247.40 " - " 2,700.00 " - " 2,332.13 " - " 2,332.13 " - " 1,864.69 " - " 2,227.50 " - - " 2,233.91 " - - " 1,255.77 " " 1,569.71 " - - - " 2,700.00 " - - " 2,261.25 " - " 1,380.38 " " 2,531.25 " " 1,282.84 " " 1,509.64 " - 28147538 OSSICULAR IMP LVL021 L8613 274 "$5,125.00" " 1,894.20 " - " 4,100.00 " - " 3,541.38 " - " 3,541.38 " - " 2,831.56 " - " 3,382.50 " - - " 3,392.24 " - - " 1,255.77 " " 1,569.71 " - - - " 4,100.00 " - - " 3,433.75 " - " 2,096.13 " " 3,843.75 " " 1,948.01 " " 2,292.41 " - 28147635 COCHLEAR DEVICE LVL100 L8614 278 "$24,875.00" " 9,193.80 " - " 80,753.59 " - " 17,188.63 " - " 17,188.63 " - " 13,743.44 " - " 16,417.50 " - - " 16,464.76 " - - " 64,602.87 " " 80,753.59 " - - - " 19,900.00 " - - " 16,666.25 " - " 10,173.88 " " 18,656.25 " " 9,454.99 " " 11,126.59 " - 28147741 COCHLEAR DEVICE LVL111 L8614 278 "$27,625.00" " 10,210.20 " - " 80,753.59 " - " 19,088.88 " - " 19,088.88 " - " 15,262.81 " - " 18,232.50 " - - " 18,284.99 " - - " 64,602.87 " " 80,753.59 " - - - " 22,100.00 " - - " 18,508.75 " - " 11,298.63 " " 20,718.75 " " 10,500.26 " " 12,356.66 " - 28147864 COCHLEAR DEVICE LVL123 L8614 278 "$30,625.00" " 11,319.00 " - " 80,753.59 " - " 21,161.88 " - " 21,161.88 " - " 16,920.31 " - " 20,212.50 " - - " 20,270.69 " - - " 64,602.87 " " 80,753.59 " - - - " 24,500.00 " - - " 20,518.75 " - " 12,525.63 " " 22,968.75 " " 11,640.56 " " 13,698.56 " - 28147929 COCHLEAR DEVICE LVL129 L8614 278 "$32,125.00" " 11,873.40 " - " 80,753.59 " - " 22,198.38 " - " 22,198.38 " - " 17,749.06 " - " 21,202.50 " - - " 21,263.54 " - - " 64,602.87 " " 80,753.59 " - - - " 25,700.00 " - - " 21,523.75 " - " 13,139.13 " " 24,093.75 " " 12,210.71 " " 14,369.51 " - 28147970 COCHLEAR DEVICE LVL134 L8614 278 "$33,375.00" " 12,335.40 " - " 80,753.59 " - " 23,062.13 " - " 23,062.13 " - " 18,439.69 " - " 22,027.50 " - - " 22,090.91 " - - " 64,602.87 " " 80,753.59 " - - - " 26,700.00 " - - " 22,361.25 " - " 13,650.38 " " 25,031.25 " " 12,685.84 " " 14,928.64 " - 28148011 COCHLEAR DEVICE LVL138 L8614 278 "$34,375.00" " 12,705.00 " - " 80,753.59 " - " 23,753.13 " - " 23,753.13 " - " 18,992.19 " - " 22,687.50 " - - " 22,752.81 " - - " 64,602.87 " " 80,753.59 " - - - " 27,500.00 " - - " 23,031.25 " - " 14,059.38 " " 25,781.25 " " 13,065.94 " " 15,375.94 " - 28148054 COCHLEAR DEVICE LVL142 L8614 278 "$35,375.00" " 13,074.60 " - " 80,753.59 " - " 24,444.13 " - " 24,444.13 " - " 19,544.69 " - " 23,347.50 " - - " 23,414.71 " - - " 64,602.87 " " 80,753.59 " - - - " 28,300.00 " - - " 23,701.25 " - " 14,468.38 " " 26,531.25 " " 13,446.04 " " 15,823.24 " - 28148151 COCHLEAR DEVICE LVL152 L8614 278 "$37,875.00" " 13,998.60 " - " 80,753.59 " - " 26,171.63 " - " 26,171.63 " - " 20,925.94 " - " 24,997.50 " - - " 25,069.46 " - - " 64,602.87 " " 80,753.59 " - - - " 30,300.00 " - - " 25,376.25 " - " 15,490.88 " " 28,406.25 " " 14,396.29 " " 16,941.49 " - 28148160 COCHLEAR DEVICE LVL153 L8614 278 "$38,125.00" " 14,091.00 " - " 80,753.59 " - " 26,344.38 " - " 26,344.38 " - " 21,064.06 " - " 25,162.50 " - - " 25,234.94 " - - " 64,602.87 " " 80,753.59 " - - - " 30,500.00 " - - " 25,543.75 " - " 15,593.13 " " 28,593.75 " " 14,491.31 " " 17,053.31 " - 28148194 COCHLEAR DEVICE LVL156 L8614 278 "$38,875.00" " 14,368.20 " - " 80,753.59 " - " 26,862.63 " - " 26,862.63 " - " 21,478.44 " - " 25,657.50 " - - " 25,731.36 " - - " 64,602.87 " " 80,753.59 " - - - " 31,100.00 " - - " 26,046.25 " - " 15,899.88 " " 29,156.25 " " 14,776.39 " " 17,388.79 " - 28148267 COCHLEAR DEVICE LVL163 L8614 278 "$40,625.00" " 15,015.00 " - " 80,753.59 " - " 28,071.88 " - " 28,071.88 " - " 22,445.31 " - " 26,812.50 " - - " 26,889.69 " - - " 64,602.87 " " 80,753.59 " - - - " 32,500.00 " - - " 27,218.75 " - " 16,615.63 " " 30,468.75 " " 15,441.56 " " 18,171.56 " - 28148275 COCHLEAR DEVICE LVL164 L8614 278 "$40,875.00" " 15,107.40 " - " 80,753.59 " - " 28,244.63 " - " 28,244.63 " - " 22,583.44 " - " 26,977.50 " - - " 27,055.16 " - - " 64,602.87 " " 80,753.59 " - - - " 32,700.00 " - - " 27,386.25 " - " 16,717.88 " " 30,656.25 " " 15,536.59 " " 18,283.39 " - 28148283 COCHLEAR DEVICE LVL165 L8614 278 "$41,125.00" " 15,199.80 " - " 80,753.59 " - " 28,417.38 " - " 28,417.38 " - " 22,721.56 " - " 27,142.50 " - - " 27,220.64 " - - " 64,602.87 " " 80,753.59 " - - - " 32,900.00 " - - " 27,553.75 " - " 16,820.13 " " 30,843.75 " " 15,631.61 " " 18,395.21 " - 28149344 RF TRNS-NEUROSTIM IMP LVL001 L8683 278 $200.00 73.92 - " 28,649.75 " - 138.20 " 5,708.54 " 138.20 - 110.50 " 5,599.80 " 132.00 - - 132.38 " 4,893.03 " " 5,436.70 " " 22,919.80 " " 28,649.75 " " 5,572.62 " " 5,599.80 " " 5,436.70 " 160.00 " 4,974.58 " - 134.00 " 4,784.30 " 81.80 150.00 76.02 89.46 " 5,626.98 " 28148704 AUD OSS DEV INT/EX CMP LVL016 L8690 278 "$3,875.00" " 1,432.20 " - " 27,705.09 " - " 2,677.63 " - " 2,677.63 " - " 2,140.94 " - " 2,557.50 " - - " 2,564.86 " - - " 22,164.07 " " 27,705.09 " - - - " 3,100.00 " - - " 2,596.25 " - " 1,584.88 " " 2,906.25 " " 1,472.89 " " 1,733.29 " - 28148836 AUD OSS DEV INT/EX CMP LVL029 L8690 278 "$7,125.00" " 2,633.40 " - " 27,705.09 " - " 4,923.38 " - " 4,923.38 " - " 3,936.56 " - " 4,702.50 " - - " 4,716.04 " - - " 22,164.07 " " 27,705.09 " - - - " 5,700.00 " - - " 4,773.75 " - " 2,914.13 " " 5,343.75 " " 2,708.21 " " 3,187.01 " - 28148941 AUD OSS DEV INT/EX CMP LVL040 L8690 278 "$9,875.00" " 3,649.80 " - " 27,705.09 " - " 6,823.63 " - " 6,823.63 " - " 5,455.94 " - " 6,517.50 " - - " 6,536.26 " - - " 22,164.07 " " 27,705.09 " - - - " 7,900.00 " - - " 6,616.25 " - " 4,038.88 " " 7,406.25 " " 3,753.49 " " 4,417.09 " - 28149069 OSSEOINT SND PROC RPL LVL036 L8691 274 "$8,875.00" " 3,280.20 " - " 15,529.57 " - " 6,132.63 " " 1,865.63 " " 6,132.63 " - " 4,903.44 " " 1,830.09 " " 5,857.50 " - - " 5,874.36 " " 1,599.11 " " 1,776.79 " " 12,423.66 " " 15,529.57 " " 1,821.21 " " 1,830.09 " " 1,776.79 " " 7,100.00 " " 1,625.76 " - " 5,946.25 " " 1,563.58 " " 3,629.88 " " 6,656.25 " " 3,373.39 " " 3,969.79 " " 1,838.98 " 28149107 OSSEOINT SND PROC RPL LVL040 L8691 274 "$9,875.00" " 3,649.80 " - " 15,529.57 " - " 6,823.63 " " 1,865.63 " " 6,823.63 " - " 5,455.94 " " 1,830.09 " " 6,517.50 " - - " 6,536.26 " " 1,599.11 " " 1,776.79 " " 12,423.66 " " 15,529.57 " " 1,821.21 " " 1,830.09 " " 1,776.79 " " 7,900.00 " " 1,625.76 " - " 6,616.25 " " 1,563.58 " " 4,038.88 " " 7,406.25 " " 3,753.49 " " 4,417.09 " " 1,838.98 " 28149123 OSSEOINT SND PROC RPL LVL042 L8691 274 "$10,375.00" " 3,834.60 " - " 15,529.57 " - " 7,169.13 " " 1,865.63 " " 7,169.13 " - " 5,732.19 " " 1,830.09 " " 6,847.50 " - - " 6,867.21 " " 1,599.11 " " 1,776.79 " " 12,423.66 " " 15,529.57 " " 1,821.21 " " 1,830.09 " " 1,776.79 " " 8,300.00 " " 1,625.76 " - " 6,951.25 " " 1,563.58 " " 4,243.38 " " 7,781.25 " " 3,943.54 " " 4,640.74 " " 1,838.98 " 28151411 PROSTHETIC IMP (NOS) LVL001 L8699 278 $200.00 73.92 - 160.00 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 105.98 132.48 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 80365071 PROSTHETIC IMP NOS LVL147 L8699 278 "$36,625.00" " 13,536.60 " - " 29,300.00 " - " 25,307.88 " - " 25,307.88 " - " 20,235.31 " - " 24,172.50 " - - " 24,242.09 " - - " 19,407.59 " " 24,260.40 " - - - " 29,300.00 " - - " 24,538.75 " - " 14,979.63 " " 27,468.75 " " 13,921.16 " " 16,382.36 " - 80365080 PROSTHETIC IMP NOS LVL160 L8699 278 "$39,875.00" " 14,737.80 " - " 31,900.00 " - " 27,553.63 " - " 27,553.63 " - " 22,030.94 " - " 26,317.50 " - - " 26,393.26 " - - " 21,129.76 " " 26,413.20 " - - - " 31,900.00 " - - " 26,716.25 " - " 16,308.88 " " 29,906.25 " " 15,156.49 " " 17,836.09 " - 37010197 BAMLANIVIMAB INFUSION M0239 771 "$2,363.00" 873.36 - " 1,890.40 " - " 1,632.83 " N/A " 1,632.83 " - " 1,305.56 " N/A " 1,559.58 " - N/A " 1,564.07 " - N/A " 1,252.15 " " 1,565.25 " N/A N/A N/A " 1,890.40 " N/A - " 1,583.21 " N/A 966.47 " 1,772.25 " 898.18 " 1,056.97 " N/A 19000478 CASIRIVI-IMDEVI REPEAT ADMIN M0240 771 "$2,363.00" 873.36 - " 1,890.40 " - " 1,632.83 " 460.08 " 1,632.83 " - " 1,305.56 " 451.32 " 1,559.58 " - - " 1,564.07 " 394.35 438.17 " 1,252.15 " " 1,565.25 " 449.12 451.32 438.17 " 1,890.40 " 400.93 - " 1,583.21 " 385.59 966.47 " 1,772.25 " 898.18 " 1,056.97 " 453.51 37010201 CASIRIVI-IMDEI INFUSION M0243 771 "$2,363.00" 873.36 360.00 " 1,890.40 " 414.00 " 1,632.83 " 460.08 " 1,632.83 " 421.20 " 1,305.56 " 451.32 " 1,559.58 " 403.20 374.87 " 1,564.07 " 394.35 438.17 " 1,252.15 " " 1,565.25 " 449.12 451.32 438.17 " 1,890.40 " 400.93 360.00 " 1,583.21 " 385.59 966.47 " 1,772.25 " 898.18 " 1,056.97 " 453.51 37099911 CASIRIVI-IMDEVI 1200MG ADMIN M0244 771 "$3,938.00" " 1,455.48 " - " 3,150.40 " - " 2,721.16 " 766.47 " 2,721.16 " - " 2,175.75 " 751.87 " 2,599.08 " - - " 2,606.56 " 656.97 729.97 " 2,086.75 " " 2,608.53 " 748.22 751.87 729.97 " 3,150.40 " 667.92 - " 2,638.46 " 642.37 " 1,610.64 " " 2,953.50 " " 1,496.83 " " 1,761.47 " 755.52 37010219 BAMLAN-ESTESEV INFUSION M0245 771 "$2,363.00" 873.36 360.00 " 1,890.40 " 414.00 " 1,632.83 " 460.08 " 1,632.83 " 421.20 " 1,305.56 " 451.32 " 1,559.58 " 403.20 374.87 " 1,564.07 " 394.35 438.17 " 1,252.15 " " 1,565.25 " 449.12 451.32 438.17 " 1,890.40 " 400.93 360.00 " 1,583.21 " 385.59 966.47 " 1,772.25 " 898.18 " 1,056.97 " 453.51 19000451 ADM TOCILIZU COVID-19 1ST M0249 771 "$2,363.00" 873.36 - " 1,890.40 " - " 1,632.83 " 460.08 " 1,632.83 " - " 1,305.56 " 451.32 " 1,559.58 " - - " 1,564.07 " 394.35 438.17 " 1,252.15 " " 1,565.25 " 449.12 451.32 438.17 " 1,890.40 " 400.93 - " 1,583.21 " 385.59 966.47 " 1,772.25 " 898.18 " 1,056.97 " 453.51 19000460 ADM TOCILIZU COVID-19 2ND M0250 771 "$2,363.00" 873.36 - " 1,890.40 " - " 1,632.83 " 460.08 " 1,632.83 " - " 1,305.56 " 451.32 " 1,559.58 " - - " 1,564.07 " 394.35 438.17 " 1,252.15 " " 1,565.25 " 449.12 451.32 438.17 " 1,890.40 " 400.93 - " 1,583.21 " 385.59 966.47 " 1,772.25 " 898.18 " 1,056.97 " 453.51 35900373 PAP SMEAR SCREENING NORMAL P3000 311 $80.00 29.57 - 83.11 - 55.28 16.72 55.28 - 44.20 16.40 29.36 - - 52.95 14.33 15.92 66.49 83.11 16.32 16.40 15.92 64.00 14.57 - 39.69 14.01 32.72 60.00 30.41 35.78 16.48 35900462 PAP SMEAR SCREENING ABNORMAL P3000 311 $80.00 29.57 - 83.11 - 55.28 16.72 55.28 - 44.20 16.40 29.36 - - 52.95 14.33 15.92 66.49 83.11 16.32 16.40 15.92 64.00 14.57 - 39.69 14.01 32.72 60.00 30.41 35.78 16.48 35600299 FRESH WHOLE BLOOD P9010 390 $788.00 291.24 30.00 630.40 34.50 544.51 156.43 544.51 35.10 435.37 153.45 520.08 33.60 31.24 521.58 134.08 148.98 308.65 385.81 152.70 153.45 148.98 630.40 136.32 30.00 527.96 131.10 322.29 591.00 299.52 352.47 154.19 35601678 SPLIT UNIT PLATELETS (ARC) P9011 390 $775.00 286.44 - 620.00 - 535.53 153.90 535.53 - 428.19 150.97 511.50 - - 512.97 131.91 146.57 119.05 148.81 150.23 150.97 146.57 620.00 134.11 - 519.25 128.98 316.98 581.25 294.58 346.66 151.70 35601741 LEUKO REDUCED SPLIT PRC 183 ML P9011 390 $775.00 286.44 - 620.00 - 535.53 153.90 535.53 - 428.19 150.97 511.50 - - 512.97 131.91 146.57 119.05 148.81 150.23 150.97 146.57 620.00 134.11 - 519.25 128.98 316.98 581.25 294.58 346.66 151.70 35601759 LEUKO REDUCED SPLIT PRC 122 ML P9011 390 $775.00 286.44 - 620.00 - 535.53 153.90 535.53 - 428.19 150.97 511.50 - - 512.97 131.91 146.57 119.05 148.81 150.23 150.97 146.57 620.00 134.11 - 519.25 128.98 316.98 581.25 294.58 346.66 151.70 35601767 LEUKO REDUCED SPLIT PRC 92 ML P9011 390 $775.00 286.44 - 620.00 - 535.53 153.90 535.53 - 428.19 150.97 511.50 - - 512.97 131.91 146.57 119.05 148.81 150.23 150.97 146.57 620.00 134.11 - 519.25 128.98 316.98 581.25 294.58 346.66 151.70 35601775 LEUKO REDUCED SPLIT PRC 44 ML P9011 390 $775.00 286.44 - 620.00 - 535.53 153.90 535.53 - 428.19 150.97 511.50 - - 512.97 131.91 146.57 119.05 148.81 150.23 150.97 146.57 620.00 134.11 - 519.25 128.98 316.98 581.25 294.58 346.66 151.70 35601783 LEUKO REDUCED SPLIT PRC 22 ML P9011 390 $775.00 286.44 - 620.00 - 535.53 153.90 535.53 - 428.19 150.97 511.50 - - 512.97 131.91 146.57 119.05 148.81 150.23 150.97 146.57 620.00 134.11 - 519.25 128.98 316.98 581.25 294.58 346.66 151.70 35601791 FRESH FROZEN PLASMA SPLIT 44ML P9011 390 $775.00 286.44 - 620.00 - 535.53 153.90 535.53 - 428.19 150.97 511.50 - - 512.97 131.91 146.57 119.05 148.81 150.23 150.97 146.57 620.00 134.11 - 519.25 128.98 316.98 581.25 294.58 346.66 151.70 35601805 FRESH FROZEN PLASMA SPLIT 22ML P9011 390 $775.00 286.44 - 620.00 - 535.53 153.90 535.53 - 428.19 150.97 511.50 - - 512.97 131.91 146.57 119.05 148.81 150.23 150.97 146.57 620.00 134.11 - 519.25 128.98 316.98 581.25 294.58 346.66 151.70 35601813 SIN/DON PLATELET (ARC) 120 ML P9011 390 $775.00 286.44 - 620.00 - 535.53 153.90 535.53 - 428.19 150.97 511.50 - - 512.97 131.91 146.57 119.05 148.81 150.23 150.97 146.57 620.00 134.11 - 519.25 128.98 316.98 581.25 294.58 346.66 151.70 35601821 SIN/DON PLATELET (ARC) 30 ML P9011 390 $775.00 286.44 - 620.00 - 535.53 153.90 535.53 - 428.19 150.97 511.50 - - 512.97 131.91 146.57 119.05 148.81 150.23 150.97 146.57 620.00 134.11 - 519.25 128.98 316.98 581.25 294.58 346.66 151.70 35601830 PACKED RBC SPLIT PRC 183 ML P9011 390 $775.00 286.44 - 620.00 - 535.53 153.90 535.53 - 428.19 150.97 511.50 - - 512.97 131.91 146.57 119.05 148.81 150.23 150.97 146.57 620.00 134.11 - 519.25 128.98 316.98 581.25 294.58 346.66 151.70 35601848 PACKED RBC SPLIT PRC 122 ML P9011 390 $775.00 286.44 - 620.00 - 535.53 153.90 535.53 - 428.19 150.97 511.50 - - 512.97 131.91 146.57 119.05 148.81 150.23 150.97 146.57 620.00 134.11 - 519.25 128.98 316.98 581.25 294.58 346.66 151.70 35601856 PACKED RBC SPLIT PRC 92 ML P9011 390 $775.00 286.44 - 620.00 - 535.53 153.90 535.53 - 428.19 150.97 511.50 - - 512.97 131.91 146.57 119.05 148.81 150.23 150.97 146.57 620.00 134.11 - 519.25 128.98 316.98 581.25 294.58 346.66 151.70 35601864 PACKED RBC SPLIT PRC 44 ML P9011 390 $775.00 286.44 - 620.00 - 535.53 153.90 535.53 - 428.19 150.97 511.50 - - 512.97 131.91 146.57 119.05 148.81 150.23 150.97 146.57 620.00 134.11 - 519.25 128.98 316.98 581.25 294.58 346.66 151.70 35601872 PACKED RBC SPLIT PRC 22 ML P9011 390 $775.00 286.44 - 620.00 - 535.53 153.90 535.53 - 428.19 150.97 511.50 - - 512.97 131.91 146.57 119.05 148.81 150.23 150.97 146.57 620.00 134.11 - 519.25 128.98 316.98 581.25 294.58 346.66 151.70 35601881 FRESH WHOLE BLOOD 1/2 P9011 390 $775.00 286.44 - 620.00 - 535.53 153.90 535.53 - 428.19 150.97 511.50 - - 512.97 131.91 146.57 119.05 148.81 150.23 150.97 146.57 620.00 134.11 - 519.25 128.98 316.98 581.25 294.58 346.66 151.70 35640126 FRSH FROZEN PLASMA SPLIT 150ML P9011 390 $775.00 286.44 - 620.00 - 535.53 153.90 535.53 - 428.19 150.97 511.50 - - 512.97 131.91 146.57 119.05 148.81 150.23 150.97 146.57 620.00 134.11 - 519.25 128.98 316.98 581.25 294.58 346.66 151.70 35640134 FRSH FROZEN PLASMA SPLIT 100ML P9011 390 $775.00 286.44 - 620.00 - 535.53 153.90 535.53 - 428.19 150.97 511.50 - - 512.97 131.91 146.57 119.05 148.81 150.23 150.97 146.57 620.00 134.11 - 519.25 128.98 316.98 581.25 294.58 346.66 151.70 35640193 SIN /DON PLAT (ARC) 550 ML P9011 390 $775.00 286.44 - 620.00 - 535.53 153.90 535.53 - 428.19 150.97 511.50 - - 512.97 131.91 146.57 119.05 148.81 150.23 150.97 146.57 620.00 134.11 - 519.25 128.98 316.98 581.25 294.58 346.66 151.70 35640207 SIN /DON PLAT 1/2 (ARC) 550 ML P9011 390 $775.00 286.44 - 620.00 - 535.53 153.90 535.53 - 428.19 150.97 511.50 - - 512.97 131.91 146.57 119.05 148.81 150.23 150.97 146.57 620.00 134.11 - 519.25 128.98 316.98 581.25 294.58 346.66 151.70 35600094 CRYOPRECIPITATE (ARC) P9012 390 $419.00 154.86 - 335.20 - 289.53 83.27 289.53 - 231.50 81.68 276.54 - - 277.34 71.37 79.30 238.94 298.67 81.28 81.68 79.30 335.20 72.56 - 280.73 69.78 171.37 314.25 159.26 187.42 82.08 35610707 PP CRYOPRECIPITATE P9012 390 $419.00 154.86 - 335.20 - 289.53 83.27 289.53 - 231.50 81.68 276.54 - - 277.34 71.37 79.30 238.94 298.67 81.28 81.68 79.30 335.20 72.56 - 280.73 69.78 171.37 314.25 159.26 187.42 82.08 35600965 LEUKO-REDUCED PRC (ARC) P9016 390 $990.00 365.90 - " 1,170.64 " - 684.09 196.49 684.09 - 546.98 192.74 653.40 - - 655.28 168.42 187.13 936.51 " 1,170.64 " 191.81 192.74 187.13 792.00 171.22 - 663.30 164.67 404.91 742.50 376.30 442.83 193.68 35600124 FRESH FROZEN PLASMA (ARC) P9017 390 $434.00 160.41 30.00 347.20 34.50 299.89 86.19 299.89 35.10 239.79 84.55 286.44 33.60 31.24 287.26 73.88 82.09 232.98 291.23 84.14 84.55 82.09 347.20 75.11 30.00 290.78 72.24 177.51 325.50 164.96 194.13 84.96 35600264 PLATELET CONCENTRATE (ARC) P9019 390 $374.00 138.23 30.00 410.22 34.50 258.43 74.34 258.43 35.10 206.64 72.92 246.84 33.60 31.24 247.55 63.72 70.80 328.18 410.22 72.57 72.92 70.80 299.20 64.78 30.00 250.58 62.30 152.97 280.50 142.16 167.29 73.28 35600213 PACKED RBC (ARC) P9021 390 $723.00 267.22 30.00 578.40 34.50 499.59 143.52 499.59 35.10 399.46 140.79 477.18 33.60 31.24 478.55 123.02 136.69 191.98 239.97 140.11 140.79 136.69 578.40 125.07 30.00 484.41 120.29 295.71 542.25 274.81 323.40 141.47 35610723 PRE POOLED LR PLTS ACRODOSE P9031 390 $787.00 290.88 - 629.60 - 543.82 156.32 543.82 - 434.82 153.35 519.42 - - 520.92 133.99 148.88 417.03 521.31 152.60 153.35 148.88 629.60 136.23 - 527.29 131.01 321.88 590.25 299.14 352.03 154.09 35601911 PLATELETS PHERESIS S/D P9034 390 "$1,701.00" 628.69 - " 2,314.83 " - " 1,175.39 " 337.84 " 1,175.39 " - 939.80 331.40 " 1,122.66 " - - " 1,125.89 " 289.58 321.75 " 1,851.86 " " 2,314.83 " 329.79 331.40 321.75 " 1,360.80 " 294.40 - " 1,139.67 " 283.14 695.71 " 1,275.75 " 646.55 760.86 333.01 35601953 PLATELETS PHERESIS N/S 1/2 P9034 390 "$1,701.00" 628.69 - " 2,314.83 " - " 1,175.39 " 337.84 " 1,175.39 " - 939.80 331.40 " 1,122.66 " - - " 1,125.89 " 289.58 321.75 " 1,851.86 " " 2,314.83 " 329.79 331.40 321.75 " 1,360.80 " 294.40 - " 1,139.67 " 283.14 695.71 " 1,275.75 " 646.55 760.86 333.01 35600680 SIN/DON PLATELET (ARC) P9035 390 "$2,556.00" 944.70 - " 2,562.85 " - " 1,766.20 " 507.48 " 1,766.20 " - " 1,412.19 " 497.81 " 1,686.96 " - - " 1,691.82 " 434.98 483.31 " 2,050.28 " " 2,562.85 " 495.39 497.81 483.31 " 2,044.80 " 442.23 - " 1,712.52 " 425.31 " 1,045.40 " " 1,917.00 " 971.54 " 1,143.30 " 500.23 35601392 SNGLE DONOR PLATLETS 1/2(ARC) P9035 390 "$2,556.00" 944.70 - " 2,562.85 " - " 1,766.20 " 507.48 " 1,766.20 " - " 1,412.19 " 497.81 " 1,686.96 " - - " 1,691.82 " 434.98 483.31 " 2,050.28 " " 2,562.85 " 495.39 497.81 483.31 " 2,044.80 " 442.23 - " 1,712.52 " 425.31 " 1,045.40 " " 1,917.00 " 971.54 " 1,143.30 " 500.23 35601899 SIN/DON PLATELET WASH LEUK P9035 390 "$2,556.00" 944.70 - " 2,562.85 " - " 1,766.20 " 507.48 " 1,766.20 " - " 1,412.19 " 497.81 " 1,686.96 " - - " 1,691.82 " 434.98 483.31 " 2,050.28 " " 2,562.85 " 495.39 497.81 483.31 " 2,044.80 " 442.23 - " 1,712.52 " 425.31 " 1,045.40 " " 1,917.00 " 971.54 " 1,143.30 " 500.23 35601929 PLATELETS PHERESIS IRR S/D P9036 390 "$3,176.00" " 1,173.85 " - " 2,540.80 " - " 2,194.62 " 630.75 " 2,194.62 " - " 1,754.74 " 618.73 " 2,096.16 " - - " 2,102.19 " 540.64 600.71 " 2,017.21 " " 2,521.51 " 615.73 618.73 600.71 " 2,540.80 " 549.65 - " 2,127.92 " 528.62 " 1,298.98 " " 2,382.00 " " 1,207.20 " " 1,420.62 " 621.73 35601961 PLATELETS PHERESIS S/D IR N/S P9036 390 "$3,176.00" " 1,173.85 " - " 2,540.80 " - " 2,194.62 " 630.75 " 2,194.62 " - " 1,754.74 " 618.73 " 2,096.16 " - - " 2,102.19 " 540.64 600.71 " 2,017.21 " " 2,521.51 " 615.73 618.73 600.71 " 2,540.80 " 549.65 - " 2,127.92 " 528.62 " 1,298.98 " " 2,382.00 " " 1,207.20 " " 1,420.62 " 621.73 33284845 ALBUMIN 5% INJ PER 50 ML P9041 636 $55.00 20.33 - 117.70 - 38.01 10.71 38.01 - 30.39 10.51 36.30 - - 36.40 9.18 10.20 94.16 117.70 10.46 10.51 10.20 44.00 9.33 - 36.85 8.98 22.50 41.25 20.91 24.60 10.56 33224796 PLASMA PROT FRAC PER 50ML INJ P9043 636 $42.00 15.52 - 116.29 - 29.02 8.35 29.02 - 23.21 8.19 27.72 - - 27.80 7.16 7.95 93.03 116.29 8.15 8.19 7.95 33.60 7.27 - 28.14 7.00 17.18 31.50 15.96 18.79 8.23 35601627 CRYOPOOR PLASMA (ARC) P9044 390 $345.00 127.51 - 276.00 - 238.40 68.50 238.40 - 190.61 67.20 227.70 - - 228.36 58.72 65.24 146.61 183.26 66.87 67.20 65.24 276.00 59.69 - 231.15 57.41 141.11 258.75 131.13 154.32 67.52 33284586 ALBUMIN 5% INJ PER 250ML P9045 636 $275.00 101.64 - 325.60 - 190.03 53.56 190.03 - 151.94 52.54 181.50 - - 182.02 45.91 51.01 260.48 325.60 52.29 52.54 51.01 220.00 46.67 - 184.25 44.89 112.48 206.25 104.53 123.01 52.80 33284829 ALBUMIN 5% INJ PER 250ML P9045 636 $275.00 101.64 - 325.60 - 190.03 53.56 190.03 - 151.94 52.54 181.50 - - 182.02 45.91 51.01 260.48 325.60 52.29 52.54 51.01 220.00 46.67 - 184.25 44.89 112.48 206.25 104.53 123.01 52.80 33284578 ALBUMIN 25% PER 50ML INJ P9047 636 $275.00 101.64 - 334.89 - 190.03 53.56 190.03 - 151.94 52.54 181.50 - - 182.02 45.91 51.01 267.91 334.89 52.29 52.54 51.01 220.00 46.67 - 184.25 44.89 112.48 206.25 104.53 123.01 52.80 33284837 ALBUMIN 25% PER 50ML INJ P9047 636 $275.00 101.64 - 334.89 - 190.03 53.56 190.03 - 151.94 52.54 181.50 - - 182.02 45.91 51.01 267.91 334.89 52.29 52.54 51.01 220.00 46.67 - 184.25 44.89 112.48 206.25 104.53 123.01 52.80 35610529 GRANULOCYTE CONC P9050 390 "$3,854.00" " 1,424.44 " - " 3,083.20 " - " 2,663.11 " N/A " 2,663.11 " - " 2,129.34 " N/A " 2,543.64 " - N/A " 2,550.96 " - N/A " 1,880.06 " " 2,350.08 " N/A N/A N/A " 3,083.20 " N/A - " 2,582.18 " N/A " 1,576.29 " " 2,890.50 " " 1,464.91 " " 1,723.89 " N/A 35610731 WHOLE BLOOD LEUKOREDUCED EA UN P9051 390 "$1,114.00" 411.73 30.00 956.25 34.50 769.77 221.29 769.77 35.10 615.49 217.07 735.24 33.60 31.24 737.36 189.68 210.75 765.00 956.25 216.02 217.07 210.75 891.20 192.84 30.00 746.38 185.46 455.63 835.50 423.43 498.29 218.13 35600141 FROZEN RED CELLS (ARC) P9054 390 "$1,631.00" 602.82 30.00 " 2,609.70 " 34.50 " 1,127.02 " 323.97 " 1,127.02 " 35.10 901.13 317.80 " 1,076.46 " 33.60 31.24 " 1,079.56 " 277.69 308.54 " 2,087.76 " " 2,609.70 " 316.25 317.80 308.54 " 1,304.80 " 282.31 30.00 " 1,092.77 " 271.52 667.08 " 1,223.25 " 619.94 729.55 319.34 35601635 PLASMA FROZEN W/I 24 HRS(ARC) P9059 390 $374.00 138.23 30.00 299.20 34.50 258.43 74.18 258.43 35.10 206.64 72.77 246.84 33.60 31.24 247.55 63.59 70.65 217.82 272.27 72.42 72.77 70.65 299.20 64.64 30.00 250.58 62.17 152.97 280.50 142.16 167.29 73.12 35640215 PLT PHERESIS PATHOGEN REDUCED P9073 390 "$3,065.00" " 1,132.82 " - " 2,452.00 " - " 2,117.92 " 608.81 " 2,117.92 " - " 1,693.41 " 597.21 " 2,022.90 " - - " 2,028.72 " 521.84 579.82 46.30 57.87 594.32 597.21 579.82 " 2,452.00 " 530.54 - " 2,053.55 " 510.24 " 1,253.59 " " 2,298.75 " " 1,165.01 " " 1,370.97 " 600.11 35640223 PATHOGEN TEST FOR PLATELETS P9100 300 $178.00 65.79 - 142.40 - 123.00 58.05 123.00 - 98.35 56.95 117.48 - - 117.82 49.76 55.29 46.30 57.87 56.67 56.95 55.29 142.40 50.59 - 88.66 48.66 72.80 133.50 67.66 79.62 57.23 35300074 TRAVEL-ACTUAL MILEAGE P9603 300 $24.00 8.87 - 19.20 - 16.58 N/A 16.58 - 13.26 N/A 15.84 - N/A 15.89 - N/A 7.41 9.26 N/A N/A N/A 19.20 N/A - 16.08 N/A 9.82 18.00 9.12 10.74 N/A 35300066 TRAVEL PRORATED TRIP P9604 300 $12.00 4.44 - 165.35 - 8.29 N/A 8.29 - 6.63 N/A 7.92 - N/A 7.94 - N/A 132.28 165.35 N/A N/A N/A 9.60 N/A - 8.04 N/A 4.91 9.00 4.56 5.37 N/A 35300112 TRAVEL PRORATED TRIP #2 P9604 300 $12.00 4.44 - 165.35 - 8.29 N/A 8.29 - 6.63 N/A 7.92 - N/A 7.94 - N/A 132.28 165.35 N/A N/A N/A 9.60 N/A - 8.04 N/A 4.91 9.00 4.56 5.37 N/A 10688396 CATHETERIZE FOR URINE SPEC P9612 360 $16.00 5.91 - 16.53 - 11.06 3.15 11.06 - 8.84 3.09 6.12 - - 10.59 2.70 3.00 13.22 16.53 3.08 3.09 3.00 12.80 2.75 - 7.86 2.64 6.54 12.00 6.08 7.16 3.11 19400069 CATHETERIZE FOR URINE SPEC P9612 360 $16.00 5.91 - 16.53 - 11.06 3.15 11.06 - 8.84 3.09 6.12 - - 10.59 2.70 3.00 13.22 16.53 3.08 3.09 3.00 12.80 2.75 - 7.86 2.64 6.54 12.00 6.08 7.16 3.11 35200151 FERN TEST Q0114 300 $51.00 18.85 8.57 54.45 11.49 35.24 10.23 35.24 9.99 28.18 10.03 19.91 10.99 10.40 33.76 8.77 9.74 43.56 54.45 9.98 10.03 9.74 40.80 8.91 9.99 25.52 8.57 20.86 38.25 19.39 22.81 10.08 33253974 FERUMOXYTOL (NON-ESRD) 1MG INJ Q0138 636 $5.00 1.85 - 4.00 - 3.46 1.02 3.46 - 2.76 1.00 3.30 - - 3.31 0.87 0.97 2.76 3.45 0.99 1.00 0.97 4.00 0.89 - 3.35 0.85 2.05 3.75 1.90 2.24 1.00 33253966 FERUMOXYTOL ESRD-DIALYSIS 1MG Q0139 636 $5.00 1.85 - 4.00 - 3.46 1.02 3.46 - 2.76 1.00 3.30 - - 3.31 0.87 0.97 2.76 3.45 0.99 1.00 0.97 4.00 0.89 - 3.35 0.85 2.05 3.75 1.90 2.24 1.00 33236883 "TOCILIZUMAB FOR COVID-19, 1MG" Q0249 636 $28.00 10.35 - 22.40 - 19.35 N/A 19.35 - 15.47 N/A 18.48 - N/A 18.53 - N/A 14.84 18.55 N/A N/A N/A 22.40 N/A - 18.76 N/A 11.45 21.00 10.64 12.52 N/A 33239688 SIPULEUCEL-T PER INFUSION IV Q2043 636 "$260,777.00" " 96,383.18 " - " 208,621.60 " - " 180,196.91 " " 54,145.37 " " 180,196.91 " - " 144,079.29 " " 53,114.03 " " 172,112.82 " - - " 172,608.30 " " 46,410.32 " " 51,567.02 " " 75,877.60 " " 94,847.00 " " 52,856.20 " " 53,114.03 " " 51,567.02 " " 208,621.60 " " 47,183.82 " - " 174,720.59 " " 45,378.98 " " 106,657.79 " " 195,582.75 " " 99,121.34 " " 116,645.55 " " 53,371.87 " 33241381 DOXOR LIP LIPODOX PER 10MG INJ Q2049 636 "$2,531.00" 935.46 - " 2,024.80 " - " 1,748.92 " 317.66 " 1,748.92 " - " 1,398.38 " 311.61 " 1,670.46 " - - " 1,675.27 " 272.28 302.53 785.96 982.45 310.09 311.61 302.53 " 2,024.80 " 276.81 - " 1,695.77 " 266.23 " 1,035.18 " " 1,898.25 " 962.03 " 1,132.12 " 313.12 33241372 DOXORUBICIN LIPOSOM PER 10MG Q2050 636 "$1,658.00" 612.80 - " 1,326.40 " - " 1,145.68 " 239.00 " 1,145.68 " - 916.05 234.45 " 1,094.28 " - - " 1,097.43 " 204.86 227.62 686.78 858.48 233.31 234.45 227.62 " 1,326.40 " 208.27 - " 1,110.86 " 200.31 678.12 " 1,243.50 " 630.21 741.62 235.59 32900488 TELEHEALTH FACILITY FEE Q3014 780 $137.00 50.64 - 109.60 - 94.67 N/A 94.67 - 75.69 N/A 90.42 - N/A 90.68 - N/A 66.96 83.70 N/A N/A N/A 109.60 N/A - 91.79 N/A 56.03 102.75 52.07 61.28 N/A 43100262 TELEHEALTH FACILITY FEE Q3014 780 $137.00 50.64 - 109.60 - 94.67 N/A 94.67 - 75.69 N/A 90.42 - N/A 90.68 - N/A 66.96 83.70 N/A N/A N/A 109.60 N/A - 91.79 N/A 56.03 102.75 52.07 61.28 N/A 43900498 TELEHEALTH FACILITY FEE Q3014 780 $137.00 50.64 - 109.60 - 94.67 N/A 94.67 - 75.69 N/A 90.42 - N/A 90.68 - N/A 66.96 83.70 N/A N/A N/A 109.60 N/A - 91.79 N/A 56.03 102.75 52.07 61.28 N/A 45554139 TELEHEALTH FACILITY FEE Q3014 780 $137.00 50.64 - 109.60 - 94.67 N/A 94.67 - 75.69 N/A 90.42 - N/A 90.68 - N/A 66.96 83.70 N/A N/A N/A 109.60 N/A - 91.79 N/A 56.03 102.75 52.07 61.28 N/A 33242891 INTERFERON BETA IM 1MCG INJ Q3027 636 $285.00 105.34 - 228.00 - 196.94 56.47 196.94 - 157.46 55.39 188.10 - - 188.64 48.40 53.78 53.67 67.09 55.12 55.39 53.78 228.00 49.21 - 190.95 47.33 116.57 213.75 108.33 127.48 55.66 51600720 APLIGRAF PER SQCM Q4101 636 $149.00 55.07 - 216.78 - 102.96 - 102.96 - 82.32 - 98.34 - - 98.62 - - 173.42 216.78 - - - 119.20 - - 99.83 - 60.94 111.75 56.63 66.65 - 51600738 OASIS WND MATRIX PER SQCM Q4102 636 $5.00 1.85 - 30.11 - 3.46 - 3.46 - 2.76 - 3.30 - - 3.31 - - 24.09 30.11 - - - 4.00 - - 3.35 - 2.05 3.75 1.90 2.24 - 51600746 DERMAGRAFT PER SQ CM Q4106 636 $65.00 24.02 - 265.53 - 44.92 - 44.92 - 35.91 - 42.90 - - 43.02 - - 212.42 265.53 - - - 52.00 - - 43.55 - 26.59 48.75 24.71 29.07 - 28149441 INTEGRA FL MATRX 1CC LVL009 Q4114 636 "$2,125.00" 785.40 - " 6,195.42 " - " 1,468.38 " - " 1,468.38 " - " 1,174.06 " - " 1,402.50 " - - " 1,406.54 " - - " 4,956.34 " " 6,195.42 " - - - " 1,700.00 " - - " 1,423.75 " - 869.13 " 1,593.75 " 807.71 950.51 - 28116764 ALLODERM 6X16 PER SQCM Q4116 636 $200.00 73.92 - 223.68 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 178.94 223.68 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 28116837 ALLODERM 6X12 PER SQCM Q4116 636 $130.00 48.05 - 223.68 - 89.83 - 89.83 - 71.83 - 85.80 - - 86.05 - - 178.94 223.68 - - - 104.00 - - 87.10 - 53.17 97.50 49.41 58.15 - 28149450 ALLODERM 16X20 PER SQCM Q4116 636 $200.00 73.92 - 223.68 - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 178.94 223.68 - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 51600754 THERASKIN PER SQCM Q4121 636 $132.00 48.79 - 105.60 - 91.21 - 91.21 - 72.93 - 87.12 - - 87.37 - - 50.72 63.40 - - - 105.60 - - 88.44 - 53.99 99.00 50.17 59.04 - 51600762 OASIS TRI WND MATRIX PER SQCM Q4124 636 $22.00 8.13 - 17.60 - 15.20 - 15.20 - 12.16 - 14.52 - - 14.56 - - 11.66 14.57 - - - 17.60 - - 14.74 - 9.00 16.50 8.36 9.84 - 28116811 STRATTICE 10X16 PER SQCM Q4130 636 $146.00 53.96 - 116.80 - 100.89 - 100.89 - 80.67 - 96.36 - - 96.64 - - 77.37 96.71 - - - 116.80 - - 97.82 - 59.71 109.50 55.49 65.31 - 28116829 STRATTICE 16X20 PER SQCM Q4130 636 $146.00 53.96 - 116.80 - 100.89 - 100.89 - 80.67 - 96.36 - - 96.64 - - 77.37 96.71 - - - 116.80 - - 97.82 - 59.71 109.50 55.49 65.31 - 51600771 GRFX/GRFXPL CR PER SQCM Q4132 636 $556.00 205.50 - " 1,107.84 " - 384.20 - 384.20 - 307.19 - 366.96 - - 368.02 - - 886.27 " 1,107.84 " - - - 444.80 - - 372.52 - 227.40 417.00 211.34 248.70 - 51600789 GRFX/GRFXPL STRVX/PL PER SQCM Q4133 636 $513.00 189.60 - 927.39 - 354.48 - 354.48 - 283.43 - 338.58 - - 339.55 - - 741.91 927.39 - - - 410.40 - - 343.71 - 209.82 384.75 194.99 229.46 - 51600525 BIOVANCE PER SQCM Q4154 636 $389.00 143.77 - 793.76 - 268.80 - 268.80 - 214.92 - 256.74 - - 257.48 - - 635.01 793.76 - - - 311.20 - - 260.63 - 159.10 291.75 147.86 174.00 - 34500401 NUSHIELD 1 SQUARE CM Q4160 636 "$1,185.00" 437.98 - 948.00 - 818.84 - 818.84 - 654.71 - 782.10 - - 784.35 - - 559.43 699.29 - - - 948.00 - - 793.95 - 484.67 888.75 450.42 530.05 - 51600916 PURAPLY PER SQ CM Q4195 636 $420.00 155.23 - 523.95 - 290.22 - 290.22 - 232.05 - 277.20 - - 278.00 - - 419.16 523.95 - - - 336.00 - - 281.40 - 171.78 315.00 159.64 187.87 - 51600924 PURAPLY AM PER SQ CM Q4196 636 "$1,865.00" 689.30 - " 1,492.00 " - " 1,288.72 " - " 1,288.72 " - " 1,030.41 " - " 1,230.90 " - - " 1,234.44 " - - 330.43 413.04 - - - " 1,492.00 " - - " 1,249.55 " - 762.79 " 1,398.75 " 708.89 834.21 - 33247478 INFLIXIMAB DYYB INFLECTRA 10MG Q5103 636 $230.00 85.01 - 422.51 - 158.93 42.06 158.93 - 127.08 41.26 151.80 - - 152.24 36.05 40.06 338.01 422.51 41.06 41.26 40.06 184.00 36.65 - 154.10 35.25 94.07 172.50 87.42 102.88 41.46 33253389 INFLIXIMAB-ABDA(RENFLEXIS)10MG Q5104 636 $234.00 86.49 - 336.41 - 161.69 39.62 161.69 - 129.29 38.86 154.44 - - 154.88 33.96 37.73 269.13 336.41 38.67 38.86 37.73 187.20 34.52 - 156.78 33.20 95.71 175.50 88.94 104.67 39.05 33253184 EPO ALF-EPBX(RETACRIT)ESRD100U Q5105 634 $5.00 1.85 - 4.90 - 3.46 - 3.46 - 2.76 - 3.30 - - 3.31 - - 3.92 4.90 - - - 4.00 - - 3.35 - 2.05 3.75 1.90 2.24 - 33253206 EPO-EPBX(RETACRIT)NONESRD1000U Q5106 636 $45.00 16.63 - 49.27 - 31.10 8.84 31.10 - 24.86 8.67 29.70 - - 29.79 7.58 8.42 39.42 49.27 8.63 8.67 8.42 36.00 7.70 - 30.15 7.41 18.41 33.75 17.10 20.13 8.71 33253419 BEVACIZUMAB-AWWB PER 10 MG INJ Q5107 636 $320.00 118.27 - 302.49 - 221.12 45.51 221.12 - 176.80 44.64 211.20 - - 211.81 39.01 43.34 241.99 302.49 44.42 44.64 43.34 256.00 39.66 - 214.40 38.14 130.88 240.00 121.63 143.14 44.86 33253834 PEGFILGRAS-JMDB(FULPHILA)0.5MG Q5108 636 "$1,412.00" 521.88 - " 1,553.48 " - 975.69 215.68 975.69 - 780.13 211.57 931.92 - - 934.60 184.87 205.41 " 1,242.78 " " 1,553.48 " 210.55 211.57 205.41 " 1,129.60 " 187.95 - 946.04 180.76 577.51 " 1,059.00 " 536.70 631.59 212.60 33253311 PEGFILGRAST-CBQV(UDENYCA)0.5MG Q5111 636 "$1,505.00" 556.25 - " 1,553.48 " - " 1,039.96 " 227.10 " 1,039.96 " - 831.51 222.78 993.30 - - 996.16 194.66 216.29 " 1,242.78 " " 1,553.48 " 221.70 222.78 216.29 " 1,204.00 " 197.91 - " 1,008.35 " 190.34 615.55 " 1,128.75 " 572.05 673.19 223.86 33254491 ONTRUZANT 10MG INJ Q5112 636 $485.00 179.26 - 388.00 - 335.14 67.97 335.14 - 267.96 66.67 320.10 - - 321.02 58.26 64.73 257.00 321.26 66.35 66.67 64.73 388.00 59.23 - 324.95 56.96 198.37 363.75 184.35 216.94 67.00 33253427 TRASTUZUMAB-ANNS(KANJINTI)10MG Q5117 636 $413.00 152.64 - 393.09 - 285.38 54.32 285.38 - 228.18 53.28 272.58 - - 273.36 46.56 51.73 314.47 393.09 53.02 53.28 51.73 330.40 47.33 - 276.71 45.52 168.92 309.75 156.98 184.73 53.54 33254229 BEVACIZUMAB-BVZR(ZIRABEV) 10MG Q5118 636 $327.00 120.86 - 261.60 - 225.96 53.49 225.96 - 180.67 52.47 215.82 - - 216.44 45.85 50.94 173.28 216.60 52.21 52.47 50.94 261.60 46.61 - 219.09 44.83 133.74 245.25 124.29 146.27 52.72 33254610 RITUXIMAB-PVVR(RUXIENCE) 10 MG Q5119 636 $372.00 137.49 - 297.60 - 257.05 60.05 257.05 - 205.53 58.91 245.52 - - 246.23 51.47 57.19 197.12 246.41 58.62 58.91 57.19 297.60 52.33 - 249.24 50.33 152.15 279.00 141.40 166.40 59.19 33254148 PEGFILGRAS-BMEZZIEXTENZO 0.5MG Q5120 636 "$1,604.00" 592.84 - " 1,283.20 " - " 1,108.36 " 250.66 " 1,108.36 " - 886.21 245.88 " 1,058.64 " - - " 1,061.69 " 214.85 238.72 849.96 " 1,062.49 " 244.69 245.88 238.72 " 1,283.20 " 218.43 - " 1,074.68 " 210.07 656.04 " 1,203.00 " 609.68 717.47 247.08 30138481 SULF HEXA LIPID MICROSPH 1ML Q9950 636 $103.00 38.07 - 129.49 - 71.17 - 71.17 - 56.91 - 67.98 - - 68.18 - - 103.59 129.49 - - - 82.40 - - 69.01 - 42.13 77.25 39.15 46.07 - 53938485 SULF HEXA LIPID MICROSPH 1ML Q9950 636 $103.00 38.07 - 129.49 - 71.17 - 71.17 - 56.91 - 67.98 - - 68.18 - - 103.59 129.49 - - - 82.40 - - 69.01 - 42.13 77.25 39.15 46.07 - 33251734 ORAL MR CONT AGENT PER 100ML Q9954 636 $11.00 4.07 - 35.17 - 7.60 - 7.60 - 6.08 - 7.26 - - 7.28 - - 28.14 35.17 - - - 8.80 - - 7.37 - 4.50 8.25 4.18 4.92 - 05938325 PERFLUTREN LIP MICROS ML INJ Q9957 636 $665.00 245.78 - 532.00 - 459.52 - 459.52 - 367.41 - 438.90 - - 440.16 - - 232.18 290.23 - - - 532.00 - - 445.55 - 271.99 498.75 252.77 297.45 - 30100158 PERFLUTREN LIP MICROS ML INJ Q9957 636 $665.00 245.78 - 532.00 - 459.52 - 459.52 - 367.41 - 438.90 - - 440.16 - - 232.18 290.23 - - - 532.00 - - 445.55 - 271.99 498.75 252.77 297.45 - 33251742 HOCM TO 149 MG/ML PER ML Q9958 636 $2.00 0.74 - 1.60 - 1.38 - 1.38 - 1.11 - 1.32 - - 1.32 - - 0.28 0.35 - - - 1.60 - - 1.34 - 0.82 1.50 0.76 0.89 - 33251751 HOCM 250-299 MG/ML PER ML Q9961 636 $27.22 10.06 - 21.78 - 18.81 - 18.81 - 15.04 - 17.97 - - 18.02 - - 0.31 0.39 - - - 21.78 - - 18.24 - 11.13 20.42 10.35 12.18 - 34006857 HOCM 250-299MG/ML IODINE 1ML Q9961 636 $27.22 10.06 - 21.78 - 18.81 - 18.81 - 15.04 - 17.97 - - 18.02 - - 0.31 0.39 - - - 21.78 - - 18.24 - 11.13 20.42 10.35 12.18 - 33251769 HOCM 300-349 MG/ML PER ML Q9962 636 $4.54 1.68 - 3.63 - 3.14 - 3.14 - 2.51 - 3.00 - - 3.01 - - 0.31 0.39 - - - 3.63 - - 3.04 - 1.86 3.41 1.73 2.03 - 33251785 HOCM 350-399 MG/ML PER ML Q9963 636 $8.00 2.96 - 6.40 - 5.53 - 5.53 - 4.42 - 5.28 - - 5.30 - - 0.31 0.39 - - - 6.40 - - 5.36 - 3.27 6.00 3.04 3.58 - 33251793 LOCM 100-199 MG/MLPER ML Q9965 636 $4.54 1.68 - 3.63 - 3.14 - 3.14 - 2.51 - 3.00 - - 3.01 - - 2.45 3.06 - - - 3.63 - - 3.04 - 1.86 3.41 1.73 2.03 - 33251807 LOCM 200-299 MG/ML PER ML Q9966 636 $2.00 0.74 - 3.45 - 1.38 - 1.38 - 1.11 - 1.32 - - 1.32 - - 2.76 3.45 - - - 1.60 - - 1.34 - 0.82 1.50 0.76 0.89 - 28116594 OMNIPAQUE 300 30ML PACK Q9967 254 $4.00 1.48 - 4.47 - 2.76 - 2.76 - 2.21 - 2.64 - - 2.65 - - 3.58 4.47 - - - 3.20 - - 2.68 - 1.64 3.00 1.52 1.79 - 29816557 LOCM 300-399MG/ML IODINE 1ML Q9967 636 $4.00 1.48 - 4.47 - 2.76 - 2.76 - 2.21 - 2.64 - - 2.65 - - 3.58 4.47 - - - 3.20 - - 2.68 - 1.64 3.00 1.52 1.79 - 30603281 LOCM 300-399MG/ML IODINE1 ML Q9967 636 $4.00 1.48 - 4.47 - 2.76 - 2.76 - 2.21 - 2.64 - - 2.65 - - 3.58 4.47 - - - 3.20 - - 2.68 - 1.64 3.00 1.52 1.79 - 30603290 LOCM 300-399MG/ML IODINE1 ML Q9967 636 $4.00 1.48 - 4.47 - 2.76 - 2.76 - 2.21 - 2.64 - - 2.65 - - 3.58 4.47 - - - 3.20 - - 2.68 - 1.64 3.00 1.52 1.79 - 33251815 LOCM 300-399 MG/ML PER ML Q9967 636 $4.00 1.48 - 4.47 - 2.76 - 2.76 - 2.21 - 2.64 - - 2.65 - - 3.58 4.47 - - - 3.20 - - 2.68 - 1.64 3.00 1.52 1.79 - 34006903 LOCM 300-399MG/ML IODINE 1ML Q9967 636 $4.00 1.48 - 4.47 - 2.76 - 2.76 - 2.21 - 2.64 - - 2.65 - - 3.58 4.47 - - - 3.20 - - 2.68 - 1.64 3.00 1.52 1.79 - 33223544 METHYLENE 1% BLUE PER 1MG Q9968 636 $40.00 14.78 - 32.00 - 27.64 6.87 27.64 - 22.10 6.74 26.40 - - 26.48 5.89 6.54 0.91 1.14 6.70 6.74 6.54 32.00 5.98 - 26.80 5.76 16.36 30.00 15.20 17.89 6.77 33223587 METHYLENE 1% BLUE PER 1MG Q9968 636 $40.00 14.78 - 32.00 - 27.64 6.87 27.64 - 22.10 6.74 26.40 - - 26.48 5.89 6.54 0.91 1.14 6.70 6.74 6.54 32.00 5.98 - 26.80 5.76 16.36 30.00 15.20 17.89 6.77 33247290 METHYLENE BLUE 0.5% INJ 1 MG Q9968 636 $40.00 14.78 - 32.00 - 27.64 6.87 27.64 - 22.10 6.74 26.40 - - 26.48 5.89 6.54 0.91 1.14 6.70 6.74 6.54 32.00 5.98 - 26.80 5.76 16.36 30.00 15.20 17.89 6.77 33282541 ISOSULFAN BLUE 1% PER 1MG INJ Q9968 636 $40.00 14.78 - 32.00 - 27.64 6.87 27.64 - 22.10 6.74 26.40 - - 26.48 5.89 6.54 0.91 1.14 6.70 6.74 6.54 32.00 5.98 - 26.80 5.76 16.36 30.00 15.20 17.89 6.77 32900534 PARTIAL HOSPITALIZATION SERV S0201 913 $702.00 259.46 - 561.60 - 485.08 N/A 485.08 - 538.24 N/A 463.32 - N/A 464.65 - N/A 371.99 465.00 N/A N/A N/A 561.60 N/A - 470.34 N/A 287.12 526.50 266.83 314.00 N/A 36943734 STAT LAB REQUEST EXOME S3600 300 $1.00 0.37 - 137.79 - 0.69 N/A 0.69 - 0.55 N/A 0.66 - N/A 0.66 - N/A 110.23 137.79 N/A N/A N/A 0.80 N/A - 0.67 N/A 0.41 0.75 0.38 0.45 N/A 32900526 INTENSIVE OUTPATIENT PSYCHIA S9480 905 $702.00 259.46 - 561.60 - 485.08 N/A 485.08 - 387.86 N/A 463.32 - N/A 464.65 - N/A 371.99 465.00 N/A N/A N/A 561.60 N/A - 470.34 N/A 287.12 526.50 266.83 314.00 N/A 36305185 INF AGT AMP PB SARSCOV2 HI THR U0003 300 $394.00 145.62 66.00 315.20 92.00 272.25 78.75 272.25 80.00 217.69 77.25 260.04 88.00 83.30 260.79 67.50 75.00 208.78 260.99 76.88 77.25 75.00 315.20 68.63 80.00 196.50 66.00 161.15 295.50 149.76 176.24 77.63 36945273 INF AGT AMP PRB 2019 NCOV REF U0003 300 $394.00 145.62 66.00 315.20 92.00 272.25 78.75 272.25 80.00 217.69 77.25 260.04 88.00 83.30 260.79 67.50 75.00 208.78 260.99 76.88 77.25 75.00 315.20 68.63 80.00 196.50 66.00 161.15 295.50 149.76 176.24 77.63 36305193 SARSCOV2 ANY TECH NOCDC HI THR U0004 300 $394.00 145.62 66.00 315.20 92.00 272.25 78.75 272.25 80.00 217.69 77.25 260.04 88.00 83.30 260.79 67.50 75.00 208.78 260.99 76.88 77.25 75.00 315.20 68.63 80.00 196.50 66.00 161.15 295.50 149.76 176.24 77.63 28134649 PST CHMBR INTRAOC LENS LVL001 V2632 276 $200.00 73.92 - " 1,035.89 " - 138.20 - 138.20 - 110.50 - 132.00 - - 132.38 - - 828.71 " 1,035.89 " - - - 160.00 - - 134.00 - 81.80 150.00 76.02 89.46 - 28134657 PST CHMBR INTRAOC LENS LVL002 V2632 276 $450.00 166.32 - " 1,035.89 " - 310.95 - 310.95 - 248.63 - 297.00 - - 297.86 - - 828.71 " 1,035.89 " - - - 360.00 - - 301.50 - 184.05 337.50 171.05 201.29 - 28149590 MID-EAR HRG PROTHS(IMP) LVL004 V5095 278 "$1,050.00" 388.08 - 840.00 - 725.55 N/A 725.55 - 580.13 N/A 693.00 - N/A 695.00 - N/A 556.40 695.52 N/A N/A N/A 840.00 N/A - 703.50 N/A 429.45 787.50 399.11 469.67 N/A 10588120 TELEMETRY/8M:SORU/HR 710 $688.00 254.28 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 10688388 MED-SURG/7M:SORU/HR 710 $494.00 182.58 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 11288120 MED-SURG/7E:SORU/HR 710 $494.00 182.58 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 15288132 PEDIATRICS/4M:SORU/HR 710 $494.00 182.58 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 17188011 AICU/8:SORU/HR 710 $741.00 273.87 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 17188038 AICU/8:ORGAN DONOR BED 812 "$4,292.00" " 1,586.32 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 17288008 AICU/2:ORGAN DONOR BED 812 "$4,292.00" " 1,586.32 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 17288024 AICU/2:SORU/HR 710 $741.00 273.87 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 17380010 CVICU/HH2:ORGAN DONOR BED 812 "$4,292.00" " 1,586.32 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 17380036 CARDIOVASCULAR ICU/HH2:SORU/HR 710 $741.00 273.87 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 18288010 ORTHOPAEDICS/6M:SORU/HR 710 $494.00 182.58 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 19000079 CARDIAC/SCU/HH2:SORU/HR 710 $741.00 273.87 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 19388123 MED-SURG/4M:SORU/HR 710 $494.00 182.58 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 19488128 MED-SURG/6M:SORU/HR 710 $494.00 182.58 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 22502085 IP CAPD 803 "$1,234.00" 456.09 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 22502093 IP CCPD 804 "$1,234.00" 456.09 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 22502344 IP DIALYSYS 7AM-7PM 801 "$1,791.00" 661.95 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 22502352 IP DIALYSYS 7PM-7AM 801 "$2,122.00" 784.29 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 23100002 IP CRRT MACHINE SETUP (DAVITA) 809 $483.00 178.52 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 23100011 IP CRRT MACHINE/24HR (DAVITA) 809 $699.00 258.35 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 23100029 IP CRRT NURSING SVC 000-060MIN 809 $372.00 137.49 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 23100037 IP CRRT NURSING SVC 061-120MIN 809 $642.00 237.28 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 23100045 IP CRRT NURSING SVC 121-180MIN 809 $959.00 354.45 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 24970981 PULM REHAB THR SELFPAY/MONTH 460 $54.00 19.96 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 24970990 PULM REHAB THR SELFPAY/SESSION 460 $5.00 1.85 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27000029 ANES DIS 000-030 MIN 370 "$1,911.00" 706.31 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27000037 ANES DIS 031-090 MIN 370 "$2,049.00" 757.31 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27000045 ANES DIS 091-150 MIN 370 "$2,243.00" 829.01 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27000053 ANES DIS 151-210 MIN 370 "$2,389.00" 882.97 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27000061 ANES DIS 211-270 MIN 370 "$2,461.00" 909.59 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27000070 ANES DIS 271-330 MIN 370 "$2,995.00" " 1,106.95 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27000088 ANES DIS 331-390 MIN 370 "$3,555.00" " 1,313.93 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27000096 ANES DIS 391-450 MIN 370 "$3,896.00" " 1,439.96 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27000100 ANES DIS 451-510 MIN 370 "$4,251.00" " 1,571.17 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27000118 ANES DIS 511-570 MIN 370 "$4,621.00" " 1,707.92 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27000126 ANES DIS 571-630 MIN 370 "$5,000.00" " 1,848.00 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27000134 ANES DIS 631-690 MIN 370 "$5,343.00" " 1,974.77 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27000193 ANES DIS OVER 690 MIN 370 "$5,686.00" " 2,101.55 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27600166 RECOVERY 000-030 MIN 710 $743.00 274.61 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27600174 RECOVERY 031-060 MIN 710 $992.00 366.64 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27600182 RECOVERY 061-090 MIN 710 "$1,074.00" 396.95 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27600191 RECOVERY 091-120 MIN 710 "$1,280.00" 473.09 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27600204 RECOVERY 121-150 MIN 710 "$1,651.00" 610.21 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27600212 RECOVERY 151-180 MIN 710 "$1,889.00" 698.17 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27600221 RECOVERY 181-210 MIN 710 "$2,025.00" 748.44 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27600239 RECOVERY 211-240 MIN 710 "$2,357.00" 871.15 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27600247 RECOVERY 241-270 MIN 710 "$2,643.00" 976.85 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27600255 RECOVERY 271-300 MIN 710 "$2,726.00" " 1,007.53 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27600492 PRE-OP PREP 000-030 MIN 360 $597.00 220.65 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27600506 PRE-OP PREP 031-060 MIN 360 $896.00 331.16 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27600514 PRE-OP PREP 061-090 MIN 360 "$1,059.00" 391.41 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27600522 PRE-OP PREP 091-120 MIN 360 "$1,271.00" 469.76 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27600531 RECOVERY 301-330 MIN 710 "$2,808.00" " 1,037.84 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27600549 RECOVERY 331-360 MIN 710 "$2,891.00" " 1,068.51 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27600557 RECOVERY 361-390 MIN 710 "$2,973.00" " 1,098.82 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27600565 RECOVERY 391-420 MIN 710 "$3,056.00" " 1,129.50 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27600573 RECOVERY 421-450 MIN 710 "$3,220.00" " 1,190.11 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27600581 RECOVERY 451-480 MIN 710 "$3,387.00" " 1,251.84 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27600590 RECOVERY 481-540 MIN 710 "$3,553.00" " 1,313.19 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27600603 RECOVERY 541-600 MIN 710 "$3,717.00" " 1,373.80 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27600611 RECOVERY 601-660 MIN 710 "$3,883.00" " 1,435.16 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27600620 RECOVERY 661-720 MIN 710 "$4,048.00" " 1,496.14 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27600646 PRE-OP PREP 121-150 MIN 360 "$1,376.00" 508.57 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27600654 PRE-OP PREP 151-180 MIN 360 "$1,535.00" 567.34 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27600662 PRE-OP PREP 181-210 MIN 360 "$1,695.00" 626.47 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27600671 PRE-OP PREP 241-270 MIN 360 "$1,853.00" 684.87 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27600689 PRE-OP PREP 211-240 MIN 360 "$1,800.00" 665.28 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27600697 PRE-OP PREP 271-300 MIN 360 "$1,906.00" 704.46 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27600701 PRE-OP PREP 301-330 MIN 360 "$1,959.00" 724.05 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27600719 PRE-OP PREP 331-360 MIN 360 "$2,065.00" 763.22 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27600921 EXT RECOVERY PER HOUR 710 "$1,278.00" 472.35 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27700225 PRE-OP PREP 000-030 MIN 360 $434.00 160.41 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27700233 PRE-OP PREP 031-060 MIN 360 $652.00 240.98 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27700241 PRE-OP PREP 061-090 MIN 360 $770.00 284.59 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27700250 PRE-OP PREP 091-120 MIN 360 $923.00 341.14 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27700268 RECOVERY 000-030 MIN 710 $541.00 199.95 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27700276 RECOVERY 031-060 MIN 710 $812.00 300.12 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27700284 RECOVERY 061-090 MIN 710 $976.00 360.73 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27700292 RECOVERY 091-120 MIN 710 "$1,280.00" 473.09 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27700306 RECOVERY 121-150 MIN 710 "$1,651.00" 610.21 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27700314 RECOVERY 151-180 MIN 710 "$1,889.00" 698.17 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27700322 RECOVERY 181-210 MIN 710 "$2,025.00" 748.44 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27700331 RECOVERY 211-240 MIN 710 "$2,357.00" 871.15 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27700349 RECOVERY 241-270 MIN 710 "$2,643.00" 976.85 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27700357 RECOVERY 271-300 MIN 710 "$2,726.00" " 1,007.53 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27700365 RECOVERY 301-330 MIN 710 "$2,808.00" " 1,037.84 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27700373 RECOVERY 331-360 MIN 710 "$2,891.00" " 1,068.51 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27700381 RECOVERY 361-390 MIN 710 "$2,973.00" " 1,098.82 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27700390 RECOVERY 391-420 MIN 710 "$3,056.00" " 1,129.50 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27700403 RECOVERY 421-450 MIN 710 "$3,220.00" " 1,190.11 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27700411 RECOVERY 451-480 MIN 710 "$3,387.00" " 1,251.84 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27700420 RECOVERY 481-540 MIN 710 "$3,553.00" " 1,313.19 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27700438 RECOVERY 541-600 MIN 710 "$3,717.00" " 1,373.80 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27700446 RECOVERY 601-660 MIN 710 "$3,883.00" " 1,435.16 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27700454 RECOVERY 661-720 MIN 710 "$4,048.00" " 1,496.14 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27700462 PRE-OP PREP 121-150 MIN 360 "$1,001.00" 369.97 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27700471 PRE-OP PREP 151-180 MIN 360 "$1,116.00" 412.47 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27700489 PRE-OP PREP 181-210 MIN 360 "$1,232.00" 455.35 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27700497 PRE-OP PREP 211-240 MIN 360 "$1,308.00" 483.44 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27700501 PRE-OP PREP 241-270 MIN 360 "$1,347.00" 497.85 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27700519 PRE-OP PREP 271-300 MIN 360 "$1,385.00" 511.90 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27700527 PRE-OP PREP 301-330 MIN 360 "$1,603.00" 592.47 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 27700535 PRE-OP PREP 331-360 MIN 360 "$1,689.00" 624.25 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 28100965 WARRANTIED DEVICE 027 $1.00 0.37 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 28100973 RECALLED DEVICE 027 $1.00 0.37 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 28100981 FREE SAMPLE ITEM 027 $1.00 0.37 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 28108915 CV PERF OPEN HEART W/WO BYPASS 360 "$16,236.00" " 6,000.83 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 28116136 IABP MONITORING PER HOUR 360 $303.00 111.99 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 28116144 IABP SET UP 360 "$1,713.00" 633.12 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 28116152 OPEN HEART STAND BY 360 "$3,631.00" " 1,342.02 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 28116161 PERCUTANEOUS BYPASS 360 "$5,558.00" " 2,054.24 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 28116179 SSEP MONITORING PER MINUTE 360 $21.00 7.76 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 28116659 SUTURE LVL001 278 $200.00 73.92 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 28116667 SUTURE LVL002 278 $450.00 166.32 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 28116675 SUTURE LVL003 278 $750.00 277.20 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 28116721 TISSUEMEND 5X6 636 "$1,100.00" 406.56 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 28117761 VALVE HEART LVL033 278 "$8,125.00" " 3,003.00 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 28117825 VALVE HEART LVL039 278 "$9,625.00" " 3,557.40 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 28117833 VALVE HEART LVL040 278 "$9,875.00" " 3,649.80 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 28117850 VALVE HEART LVL042 278 "$10,375.00" " 3,834.60 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 28117906 VALVE HEART LVL047 278 "$11,625.00" " 4,296.60 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 28117981 VALVE HEART LVL060 278 "$14,875.00" " 5,497.80 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 28118007 VALVE HEART LVL062 278 "$15,375.00" " 5,682.60 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 28118422 SHUNT COROTID LVL001 278 $200.00 73.92 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 28118678 RING HEART LVL015 278 "$3,625.00" " 1,339.80 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 28118716 RING HEART LVL019 278 "$4,625.00" " 1,709.40 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 28118724 RING HEART LVL020 278 "$4,875.00" " 1,801.80 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 28119020 STAPLE CLOSURE LVL001 278 $200.00 73.92 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 28119038 STAPLE CLOSURE LVL002 278 $450.00 166.32 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 28119054 STAPLE CLOSURE LVL004 278 "$1,050.00" 388.08 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 28124091 EMBOLIZATION COIL LVL008 278 "$1,875.00" 693.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 28145250 VALVE HEART LVL132 278 "$32,875.00" " 12,150.60 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 28146931 VALVE HEART LVL300 278 "$74,875.00" " 27,673.80 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 28147180 VALVE HEART LVL325 278 "$81,125.00" " 29,983.80 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 28149760 SEALANT TISSEEL 4ML 278 $960.00 354.82 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 28149786 AUTO TRANSFUSION SERVICES 360 "$4,096.00" " 1,513.88 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 28149794 CANCELLATION FEE 360 "$1,713.00" 633.12 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 28149808 CELL SAVER FEE 360 "$3,381.00" " 1,249.62 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 28149816 FREE DEVICE 027 $1.00 0.37 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 28151047 STAPLE CLOSURE LVL011 278 "$2,625.00" 970.20 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 28158670 EMBOLIZATION COIL LVL011 278 "$2,625.00" 970.20 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 28161026 ATRICLIP LVL020 278 "$4,875.00" " 1,801.80 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 28174721 NASAL IMPLANT SYSTEM 278 "$5,875.00" " 2,171.40 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29586021 PT WELLNESS INITIAL VISIT 510 $14.00 5.17 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29700109 CARDIAC MAINTNCE PER SESSION 990 $5.00 1.85 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29700117 CARDIAC MAINTNCE PER MONTH 990 $48.00 17.74 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29803234 WARRANTIED DEVICE 027 $1.00 0.37 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29803242 FREE SAMPLE ITEM 027 $1.00 0.37 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29803251 RECALLED DEVICE 027 $1.00 0.37 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29813167 FREE DEVICE 027 $1.00 0.37 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29813175 G160085 CHOCO PTA BALLOON CATH 624 $1.00 0.37 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29816573 IMPELLA CP HEART PUMP SET 278 "$100,834.00" " 37,268.25 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29817685 CARDIAC OP MON CPU: SORU/HR 710 $741.00 273.87 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29818436 IMPELLA 2.5 INFUSION PUMP SET 278 "$91,551.00" " 33,837.25 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29819505 CATH IMP (NOS) LVL001 278 $200.00 73.92 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29819513 CATH IMP (NOS) LVL002 278 $450.00 166.32 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29819521 CATH IMP (NOS) LVL003 278 $750.00 277.20 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29819530 CATH IMP (NOS) LVL004 278 "$1,050.00" 388.08 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29819548 CATH IMP (NOS) LVL005 278 "$1,350.00" 498.96 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29819556 CATH IMP (DIAGNOSTIC) LVL001 278 $200.00 73.92 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29819564 CATH IMP (DIAGNOSTIC) LVL002 278 $450.00 166.32 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29819572 CATH IMP (DIAGNOSTIC) LVL003 278 $750.00 277.20 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29819581 CATH BLADE SEPTOSTOMY LVL017 278 "$4,125.00" " 1,524.60 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29819599 CATH BLADE SEPTOSTOMY LVL018 278 "$4,375.00" " 1,617.00 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29819602 CATH BLADE SEPTOSTOMY LVL019 278 "$4,625.00" " 1,709.40 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29819637 EMBOLIZATION COIL LVL011 278 "$2,625.00" 970.20 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29819645 EMBOLIZATION COIL LVL001 278 $200.00 73.92 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29819653 EMBOLIZATION COIL LVL002 278 $450.00 166.32 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29819661 EMBOLIZATION COIL LVL003 278 $750.00 277.20 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29819670 EMBOLIZATION COIL LVL004 278 "$1,050.00" 388.08 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29819688 EMBOLIZATION COIL LVL005 278 "$1,350.00" 498.96 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29819696 EMBOLIZATION COIL LVL006 278 "$1,375.00" 508.20 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29819700 EMBOLIZATION COIL LVL007 278 "$1,625.00" 600.60 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29819718 EMBOLIZATION COIL LVL008 278 "$1,875.00" 693.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29819726 EMBOLIZATION COIL LVL009 278 "$2,125.00" 785.40 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29819734 EMBOLIZATION COIL LVL010 278 "$2,375.00" 877.80 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29819785 DILATOR VESSEL LVL001 278 $200.00 73.92 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29819793 DILATOR VESSEL LVL002 278 $450.00 166.32 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29819807 DILATOR VESSEL LVL003 278 $750.00 277.20 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29819882 CATH IMP (NOS) LVL006 278 "$1,375.00" 508.20 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29819891 CATH IMP (NOS) LVL007 278 "$1,625.00" 600.60 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29819904 CATH IMP (NOS) LVL008 278 "$1,875.00" 693.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29819912 CATH IMP (NOS) LVL009 278 "$2,125.00" 785.40 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29819921 CATH IMP (NOS) LVL010 278 "$2,375.00" 877.80 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29820490 CATH IMP (DIAGNOSTIC) LVL004 278 "$1,050.00" 388.08 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29820503 CATH IMP (DIAGNOSTIC) LVL005 278 "$1,350.00" 498.96 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29820511 CATH IMP (DIAGNOSTIC) LVL006 278 "$1,375.00" 508.20 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29820520 CATH IMP (DIAGNOSTIC) LVL007 278 "$1,625.00" 600.60 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29820538 CATH IMP (DIAGNOSTIC) LVL008 278 "$1,875.00" 693.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29820546 CATH IMP (DIAGNOSTIC) LVL009 278 "$2,125.00" 785.40 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29820554 CATH IMP (DIAGNOSTIC) LVL010 278 "$2,375.00" 877.80 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29820635 CATH IMP (NOS) LVL006 278 "$1,375.00" 508.20 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29820643 CATH IMP (NOS) LVL007 278 "$1,625.00" 600.60 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29820651 CATH IMP (NOS) LVL008 278 "$1,875.00" 693.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29820660 CATH IMP (NOS) LVL009 278 "$2,125.00" 785.40 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29820678 CATH IMP (NOS) LVL010 278 "$2,375.00" 877.80 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29820686 CATH IMP (NOS) LVL011 278 "$2,625.00" 970.20 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29820694 CATH IMP (NOS) LVL012 278 "$2,875.00" " 1,062.60 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29820708 CATH IMP (NOS) LVL013 278 "$3,125.00" " 1,155.00 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29820716 CATH IMP (NOS) LVL014 278 "$3,375.00" " 1,247.40 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29820724 CATH IMP (NOS) LVL015 278 "$3,625.00" " 1,339.80 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29820732 CATH IMP (NOS) LVL016 278 "$3,875.00" " 1,432.20 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29820741 CATH IMP (NOS) LVL017 278 "$4,125.00" " 1,524.60 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29820759 CATH IMP (NOS) LVL018 278 "$4,375.00" " 1,617.00 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29820767 CATH IMP (NOS) LVL019 278 "$4,625.00" " 1,709.40 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29820775 CATH IMP (NOS) LVL020 278 "$4,875.00" " 1,801.80 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29821101 DILATOR VESSEL LVL004 278 "$1,050.00" 388.08 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29821119 DILATOR VESSEL LVL005 278 "$1,350.00" 498.96 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29821127 DILATOR VESSEL LVL006 278 "$1,375.00" 508.20 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29821135 DILATOR VESSEL LVL007 278 "$1,625.00" 600.60 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29821143 DILATOR VESSEL LVL008 278 "$1,875.00" 693.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 29821275 G150144 RECOR PARADISE RNL SYS 624 $1.00 0.37 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 30600029 FREE DEVICE 027 $1.00 0.37 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 30601386 WARRANTIED DEVICE 027 $1.00 0.37 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 30601394 FREE SAMPLE ITEM 027 $1.00 0.37 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 30601408 RECALLED DEVICE 027 $1.00 0.37 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 30611004 WATCHMAN LFT ATRL APNDGE DEVCE 278 "$90,271.00" " 33,364.16 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 30611055 WATCHMAN ACCESS SYSTEM 278 "$6,049.00" " 2,235.71 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 30611063 PROBE TEMP ESOPHAGEAL 278 "$1,600.00" 591.36 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 30612990 DILATOR VESSEL LVL001 278 $200.00 73.92 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 30613007 DILATOR VESSEL LVL002 278 $450.00 166.32 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 30613015 DILATOR VESSEL LVL003 278 $750.00 277.20 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 30613023 WIRE STYLET LVL001 278 $200.00 73.92 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 30613031 WIRE STYLET LVL002 278 $450.00 166.32 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 30613040 WIRE STYLET LVL003 278 $750.00 277.20 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 30613058 LEAD EXTENDER LVL001 278 $200.00 73.92 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 30613066 LEAD EXTENDER LVL002 278 $450.00 166.32 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 30613074 LEAD EXTENDER LVL003 278 $750.00 277.20 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 30613082 LEAD EXTENDER LVL004 278 "$1,050.00" 388.08 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 30613091 LEAD EXTENDER LVL005 278 "$1,350.00" 498.96 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 30613104 CATH IMP (DIAGNOSTIC) LVL001 278 $200.00 73.92 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 30613112 CATH IMP (DIAGNOSTIC) LVL002 278 $450.00 166.32 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 30613121 CATH IMP (DIAGNOSTIC) LVL003 278 $750.00 277.20 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 31901022 PT WELLNESS INITIAL VISIT 510 $14.00 5.17 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 32800122 TARGETED CASE MANAGEMENT 15MIN $46.00 17.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 32800131 TARGETED CASE MANAGEMENT 30MIN $81.00 29.94 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 34000026 ENEMA PREP 750 $655.00 242.09 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 34000310 IV SOLUTION 258 $45.00 16.63 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 34000573 YAG LASER FEE 750 "$1,608.00" 594.32 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 34300623 VASCULAR POSITIONING KIT 272 $563.00 208.08 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 34900035 PREPRD CHILDBIRTH 942 $70.00 25.87 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 34900043 REFRSH CHILDBIRTH 942 $77.00 28.46 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 34900060 BREASTFEED CLASS 942 $15.00 5.54 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 34900078 PARENT BASIC SKILL 942 $35.00 12.94 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 34900086 SIBLING CLASS 942 $15.00 5.54 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 35610553 BLOOD BANK STAT FEE (CLIENT) $41.00 15.15 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 35708952 DAU MEDICAL REVIEW OFFICER 300 $111.00 41.03 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 36000163 PATERNITY TESTING/PHLEB/PHOTO 300 $104.00 38.44 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 36200022 PATERNITY TESTING/PHLEB/PHOTO 300 $104.00 38.44 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 36601124 H&E FROM PARAFFIN-CLIENT ONLY $32.00 11.83 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 36601132 H&E FROM FORMALIN-CLIENT ONLY $66.00 24.39 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 37004294 EMER DEPT:SORU/HR 710 $494.00 182.58 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 37004359 TRAUMA ALERT: W/O NOTIFICATION 450 "$9,225.00" " 3,409.56 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 39100380 OPER RM 000-030 MIN 360 "$2,973.00" " 1,098.82 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 39100631 VAGINAL DELIVERY SERVICE 720 "$1,741.00" 643.47 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 39100851 EXT RECOVERY PER HR (>180 MIN) 710 "$1,278.00" 472.35 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 39190052 L&D/3M:SORU/HR 710 $496.00 183.32 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 39190087 OPER RM 031-045 MIN 360 "$7,990.00" " 2,953.10 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 39190095 OPER RM 046-060 MIN 360 "$9,133.00" " 3,375.56 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 39190109 OPER RM 061-075 MIN 360 "$11,111.00" " 4,106.63 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 39190117 OPER RM 076-090 MIN 360 "$11,873.00" " 4,388.26 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 39190125 OPER RM 091-105 MIN 360 "$13,171.00" " 4,868.00 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 39190133 OPER RM 106-120 MIN 360 "$15,317.00" " 5,661.16 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 39190141 OPER RM 121-135 MIN 360 "$16,449.00" " 6,079.55 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 39190150 OPER RM 136-150 MIN 360 "$16,853.00" " 6,228.87 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 39190168 OPER RM 151-165 MIN 360 "$17,667.00" " 6,529.72 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 39190176 OPER RM 166-180 MIN 360 "$18,212.00" " 6,731.16 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 39190184 OPER RM 181-195 MIN 360 "$19,029.00" " 7,033.12 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 39190192 OPER RM 196-210 MIN 360 "$20,056.00" " 7,412.70 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 39190206 OPER RM 211-225 MIN 360 "$20,647.00" " 7,631.13 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 39190214 OPER RM 226-240 MIN 360 "$21,237.00" " 7,849.20 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 39190222 RECOVERY 000-030 MIN 710 "$1,352.00" 499.70 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 39190231 RECOVERY 031-045 MIN 710 "$1,804.00" 666.76 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 39190249 RECOVERY 046-060 MIN 710 "$1,804.00" 666.76 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 39190257 RECOVERY 061-075 MIN 710 "$1,953.00" 721.83 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 39190265 RECOVERY 076-090 MIN 710 "$1,953.00" 721.83 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 39190273 RECOVERY 091-105 MIN 710 "$2,328.00" 860.43 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 39190281 RECOVERY 106-120 MIN 710 "$2,328.00" 860.43 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 39190290 RECOVERY 121-135 MIN 710 "$3,003.00" " 1,109.91 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 39190303 RECOVERY 136-150 MIN 710 "$3,003.00" " 1,109.91 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 39190311 RECOVERY 151-165 MIN 710 "$3,435.00" " 1,269.58 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 39190320 RECOVERY 166-180 MIN 710 "$3,435.00" " 1,269.58 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 45520749 BRIDGE ON DISCHARGE 513 $117.00 43.24 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 64201158 PT WELLNESS INITIAL VISIT 510 $14.00 5.17 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80000022 FREE DEVICE 027 $1.00 0.37 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80010061 FREE SAMPLE ITEM 027 $1.00 0.37 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80010079 RECALLED DEVICE 027 $1.00 0.37 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80010231 WARRANTIED DEVICE 027 $1.00 0.37 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80362757 EMBOLIZATION COIL LVL001 278 $200.00 73.92 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80362765 EMBOLIZATION COIL LVL002 278 $450.00 166.32 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80362773 EMBOLIZATION COIL LVL003 278 $750.00 277.20 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80362781 EMBOLIZATION COIL LVL004 278 "$1,050.00" 388.08 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80362790 EMBOLIZATION COIL LVL005 278 "$1,350.00" 498.96 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80362803 EMBOLIZATION COIL LVL006 278 "$1,375.00" 508.20 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80362811 EMBOLIZATION COIL LVL007 278 "$1,625.00" 600.60 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80362820 EMBOLIZATION COIL LVL008 278 "$1,875.00" 693.00 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80362838 EMBOLIZATION COIL LVL009 278 "$2,125.00" 785.40 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80362846 EMBOLIZATION COIL LVL010 278 "$2,375.00" 877.80 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80362854 EMBOLIZATION COIL LVL011 278 "$2,625.00" 970.20 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80362862 EMBOLIZATION COIL LVL012 278 "$2,875.00" " 1,062.60 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80362871 EMBOLIZATION COIL LVL013 278 "$3,125.00" " 1,155.00 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80362889 EMBOLIZATION COIL LVL014 278 "$3,375.00" " 1,247.40 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80362897 EMBOLIZATION COIL LVL015 278 "$3,625.00" " 1,339.80 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80362901 EMBOLIZATION COIL LVL016 278 "$3,875.00" " 1,432.20 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80362919 EMBOLIZATION COIL LVL017 278 "$4,125.00" " 1,524.60 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80362927 EMBOLIZATION COIL LVL018 278 "$4,375.00" " 1,617.00 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80362935 EMBOLIZATION COIL LVL019 278 "$4,625.00" " 1,709.40 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80362943 EMBOLIZATION COIL LVL020 278 "$4,875.00" " 1,801.80 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80362951 EMBOLIZATION COIL LVL021 278 "$5,125.00" " 1,894.20 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80362960 EMBOLIZATION COIL LVL022 278 "$5,375.00" " 1,986.60 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80362978 EMBOLIZATION COIL LVL023 278 "$5,625.00" " 2,079.00 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80362986 EMBOLIZATION COIL LVL024 278 "$5,875.00" " 2,171.40 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80362994 EMBOLIZATION COIL LVL025 278 "$6,125.00" " 2,263.80 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80363001 EMBOLIZATION COIL LVL026 278 "$6,375.00" " 2,356.20 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80363010 EMBOLIZATION COIL LVL027 278 "$6,625.00" " 2,448.60 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80363028 EMBOLIZATION COIL LVL028 278 "$6,875.00" " 2,541.00 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80363036 EMBOLIZATION COIL LVL029 278 "$7,125.00" " 2,633.40 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80363044 EMBOLIZATION COIL LVL030 278 "$7,375.00" " 2,725.80 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80363052 EMBOLIZATION COIL LVL031 278 "$7,625.00" " 2,818.20 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80363061 EMBOLIZATION COIL LVL032 278 "$7,875.00" " 2,910.60 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80363079 EMBOLIZATION COIL LVL033 278 "$8,125.00" " 3,003.00 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80363087 EMBOLIZATION COIL LVL034 278 "$8,375.00" " 3,095.40 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80363095 EMBOLIZATION COIL LVL035 278 "$8,625.00" " 3,187.80 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80363109 EMBOLIZATION COIL LVL036 278 "$8,875.00" " 3,280.20 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80363117 EMBOLIZATION COIL LVL037 278 "$9,125.00" " 3,372.60 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80363125 EMBOLIZATION COIL LVL038 278 "$9,375.00" " 3,465.00 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80365098 EMBOLIC LIQUID/GLUE LVL027 278 "$6,625.00" " 2,448.60 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80365241 MICROSPHERES EMBOSPHERE LVL003 278 $750.00 277.20 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80365250 MICROSPHERES EMBOSPHERE LVL004 278 "$1,050.00" 388.08 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80365268 MICROSPHERES EMBOSPHERE LVL005 278 "$1,350.00" 498.96 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80365489 CATH IMP (DIAGNOSTIC) LVL001 278 $200.00 73.92 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80365497 CATH IMP (DIAGNOSTIC) LVL002 278 $450.00 166.32 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80365501 CATH IMP (DIAGNOSTIC) LVL003 278 $750.00 277.20 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80365519 CATH IMP (NOS) LVL001 278 $200.00 73.92 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80365527 CATH IMP (NOS) LVL002 278 $450.00 166.32 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80365535 CATH IMP (NOS) LVL003 278 $750.00 277.20 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80365543 CATH IMP (NOS) LVL004 278 "$1,050.00" 388.08 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80365551 CATH IMP (NOS) LVL005 278 "$1,350.00" 498.96 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80365560 DILATOR VESSEL LVL001 278 $200.00 73.92 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80365578 DILATOR VESSEL LVL002 278 $450.00 166.32 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80365586 DILATOR VESSEL LVL003 278 $750.00 277.20 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80365829 KYPHOPLASTY BALLOON KIT LVL019 272 "$4,625.00" " 1,709.40 " N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80365837 INFLATABLE BONE TAMP LVL011 272 "$2,625.00" 970.20 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80611081 NEEDLE CHIBA 278 $73.00 26.98 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80611595 NEEDLE BIOPSY TEMNO 278 $236.00 87.23 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80616309 TRAY ARTHROGRAM 272 $91.00 33.63 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80665563 DILATOR VESSEL LVL001 278 $200.00 73.92 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80665571 DILATOR VESSEL LVL002 278 $450.00 166.32 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A 80665580 DILATOR VESSEL LVL003 278 $750.00 277.20 N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A DRG 3 " 553,100.28 " " 174,281.90 " " 124,610.32 " " 442,480.23 " N/A " 287,021.93 " " 130,840.84 " " 287,021.93 " N/A " 277,536.00 " " 128,348.63 " " 272,253.38 " N/A " 124,610.32 " " 315,377.78 " N/A " 124,610.32 " " 198,844.68 " " 248,555.82 " " 128,348.63 " " 128,348.63 " " 124,610.32 " " 442,480.23 " N/A N/A " 334,346.25 " N/A N/A " 414,825.21 " N/A N/A " 128,348.63 " DRG 4 " 676,860.23 " " 213,278.66 " " 78,051.50 " " 541,488.19 " N/A " 179,111.72 " " 81,954.08 " " 179,111.72 " N/A " 170,760.00 " " 80,393.05 " " 169,895.63 " N/A " 78,051.50 " " 385,945.70 " N/A " 78,051.50 " " 134,557.52 " " 168,196.88 " " 80,393.05 " " 80,393.05 " " 78,051.50 " " 541,488.19 " N/A N/A " 208,643.75 " N/A N/A " 507,645.17 " N/A N/A " 80,393.05 " DRG 11 " 86,133.94 " " 27,140.80 " " 33,319.89 " " 87,874.50 " N/A " 75,436.49 " " 34,985.88 " " 75,436.49 " N/A " 74,545.00 " " 34,319.49 " " 71,554.95 " N/A " 33,319.89 " " 49,113.57 " N/A " 33,319.89 " " 56,561.85 " " 70,702.31 " " 34,319.49 " " 34,319.49 " " 33,319.89 " " 68,907.15 " N/A N/A " 87,874.50 " N/A N/A " 64,600.46 " N/A N/A " 34,319.49 " DRG 12 " 97,374.44 " " 30,682.69 " " 25,615.61 " " 77,899.55 " N/A " 57,580.15 " " 26,896.39 " " 57,580.15 " N/A " 52,382.00 " " 26,384.08 " " 54,617.40 " N/A " 25,615.61 " " 55,522.91 " N/A " 25,615.61 " " 45,338.02 " " 56,672.51 " " 26,384.08 " " 26,384.08 " " 25,615.61 " " 77,899.55 " N/A N/A " 67,074.00 " N/A N/A " 73,030.83 " N/A N/A " 26,384.08 " DRG 13 No Current Volume N/A " 18,427.29 " " 47,666.50 " N/A " 40,919.65 " " 19,348.65 " " 40,919.65 " N/A " 33,602.00 " " 18,980.11 " " 38,814.15 " N/A " 18,427.29 " N/A N/A " 18,427.29 " " 35,913.42 " " 44,891.77 " " 18,980.11 " " 18,980.11 " " 18,427.29 " N/A N/A N/A " 47,666.50 " N/A N/A N/A N/A N/A " 18,980.11 " DRG 20 No Current Volume N/A " 67,774.59 " " 180,897.50 " N/A " 155,292.75 " " 71,163.32 " " 155,292.75 " N/A " 148,560.00 " " 69,807.83 " " 147,302.25 " N/A " 67,774.59 " N/A N/A " 67,774.59 " " 117,664.65 " " 147,080.79 " " 69,807.83 " " 69,807.83 " " 67,774.59 " N/A N/A N/A " 180,897.50 " N/A N/A N/A N/A N/A " 69,807.83 " DRG 21 No Current Volume N/A " 49,667.66 " " 132,011.25 " N/A " 113,326.00 " " 52,151.04 " " 113,326.00 " N/A " 112,579.00 " " 51,157.69 " " 107,494.88 " N/A " 49,667.66 " N/A N/A " 49,667.66 " " 103,727.67 " " 129,659.57 " " 51,157.69 " " 51,157.69 " " 49,667.66 " N/A N/A N/A " 132,011.25 " N/A N/A N/A N/A N/A " 51,157.69 " DRG 22 No Current Volume N/A " 32,162.24 " " 87,802.23 " N/A " 72,753.38 " " 33,770.35 " " 72,753.38 " N/A " 70,695.00 " " 33,127.11 " " 69,009.90 " N/A " 32,162.24 " N/A N/A " 32,162.24 " " 70,241.80 " " 87,802.23 " " 33,127.11 " " 33,127.11 " " 32,162.24 " N/A N/A N/A " 84,749.00 " N/A N/A N/A N/A N/A " 33,127.11 " DRG 23 " 153,998.34 " " 48,524.88 " " 37,536.31 " " 123,198.67 " N/A " 85,208.95 " " 39,413.13 " " 85,208.95 " N/A " 83,290.00 " " 38,662.40 " " 80,824.58 " N/A " 37,536.31 " " 87,809.85 " N/A " 37,536.31 " " 64,929.75 " " 81,162.18 " " 38,662.40 " " 38,662.40 " " 37,536.31 " " 123,198.67 " N/A N/A " 99,258.25 " N/A N/A " 115,498.75 " N/A N/A " 38,662.40 " DRG 24 No Current Volume N/A " 26,303.98 " " 68,932.50 " N/A " 59,175.60 " " 27,619.18 " " 59,175.60 " N/A " 58,940.00 " " 27,093.10 " " 56,130.75 " N/A " 26,303.98 " N/A N/A " 26,303.98 " " 44,081.40 " " 55,101.75 " " 27,093.10 " " 27,093.10 " " 26,303.98 " N/A N/A N/A " 68,932.50 " N/A N/A N/A N/A N/A " 27,093.10 " DRG 25 " 119,886.08 " " 37,776.10 " " 29,923.42 " " 95,908.87 " N/A " 67,564.44 " " 31,419.59 " " 67,564.44 " N/A " 68,244.00 " " 30,821.12 " " 64,087.95 " N/A " 29,923.42 " " 68,359.04 " N/A " 29,923.42 " " 46,137.68 " " 57,672.09 " " 30,821.12 " " 30,821.12 " " 29,923.42 " " 95,908.87 " N/A N/A " 78,704.50 " N/A N/A " 89,914.56 " N/A N/A " 30,821.12 " DRG 26 " 72,441.05 " " 22,826.17 " " 20,619.44 " " 57,952.84 " N/A " 46,000.43 " " 21,650.41 " " 46,000.43 " N/A " 47,218.00 " " 21,238.02 " " 43,633.50 " N/A " 20,619.44 " " 41,305.89 " N/A " 20,619.44 " " 33,114.60 " " 41,393.25 " " 21,238.02 " " 21,238.02 " " 20,619.44 " " 57,952.84 " N/A N/A " 53,585.00 " N/A N/A " 54,330.79 " N/A N/A " 21,238.02 " DRG 27 " 59,498.15 " " 18,747.87 " " 17,069.35 " " 47,598.52 " N/A " 37,772.33 " " 17,922.82 " " 37,772.33 " N/A " 35,911.00 " " 17,581.43 " " 35,828.78 " N/A " 17,069.35 " " 33,925.84 " N/A " 17,069.35 " " 30,847.72 " " 38,559.67 " " 17,581.43 " " 17,581.43 " " 17,069.35 " " 47,598.52 " N/A N/A " 44,000.25 " N/A N/A " 44,623.61 " N/A N/A " 17,581.43 " DRG 28 " 367,297.67 " " 115,735.49 " " 38,516.36 " " 293,838.13 " N/A " 87,480.43 " " 40,442.18 " " 87,480.43 " N/A " 84,910.00 " " 39,671.85 " " 82,979.18 " N/A " 38,516.36 " " 209,433.13 " N/A " 38,516.36 " " 59,631.99 " " 74,539.97 " " 39,671.85 " " 39,671.85 " " 38,516.36 " " 293,838.13 " N/A N/A " 101,904.25 " N/A N/A " 275,473.25 " N/A N/A " 39,671.85 " DRG 29 " 145,915.42 " " 45,977.95 " " 22,141.36 " " 116,732.34 " N/A " 49,527.83 " " 23,248.43 " " 49,527.83 " N/A " 49,675.00 " " 22,805.60 " " 46,979.40 " N/A " 22,141.36 " " 83,200.97 " N/A " 22,141.36 " " 31,515.28 " " 39,394.09 " " 22,805.60 " " 22,805.60 " " 22,141.36 " " 116,732.34 " N/A N/A " 57,694.00 " N/A N/A " 109,436.57 " N/A N/A " 22,805.60 " DRG 30 " 91,409.01 " " 28,802.98 " " 16,048.47 " " 73,127.21 " N/A " 35,406.21 " " 16,850.89 " " 35,406.21 " N/A " 28,061.00 " " 16,529.92 " " 33,584.40 " N/A " 16,048.47 " " 52,121.42 " N/A " 16,048.47 " " 22,452.56 " " 28,065.71 " " 16,529.92 " " 16,529.92 " " 16,048.47 " " 73,127.21 " N/A N/A " 41,244.00 " N/A N/A " 68,556.76 " N/A N/A " 16,529.92 " DRG 31 " 86,466.04 " " 27,245.45 " " 29,108.66 " " 76,504.75 " N/A " 65,676.05 " " 30,564.09 " " 65,676.05 " N/A " 65,282.00 " " 29,981.92 " " 62,296.73 " N/A " 29,108.66 " " 49,302.93 " N/A " 29,108.66 " " 38,083.93 " " 47,604.91 " " 29,981.92 " " 29,981.92 " " 29,108.66 " " 69,172.83 " N/A N/A " 76,504.75 " N/A N/A " 64,849.53 " N/A N/A " 29,981.92 " DRG 32 " 108,890.52 " " 34,311.40 " " 15,139.07 " " 87,112.42 " N/A " 33,298.48 " " 15,896.02 " " 33,298.48 " N/A " 31,978.00 " " 15,593.24 " " 31,585.13 " N/A " 15,139.07 " " 62,089.37 " N/A " 15,139.07 " " 26,085.55 " " 32,606.96 " " 15,593.24 " " 15,593.24 " " 15,139.07 " " 87,112.42 " N/A N/A " 38,788.75 " N/A N/A " 81,667.89 " N/A N/A " 15,593.24 " DRG 33 " 48,174.88 " " 15,179.90 " " 11,935.11 " " 38,539.90 " N/A " 25,872.61 " " 12,531.87 " " 25,872.61 " N/A " 24,547.00 " " 12,293.16 " " 24,541.35 " N/A " 11,935.11 " " 27,469.32 " N/A " 11,935.11 " " 23,107.15 " " 28,883.96 " " 12,293.16 " " 12,293.16 " " 11,935.11 " " 38,539.90 " N/A N/A " 30,138.50 " N/A N/A " 36,131.16 " N/A N/A " 12,293.16 " DRG 34 " 189,991.06 " " 59,866.18 " " 26,557.42 " " 151,992.85 " N/A " 59,763.00 " " 27,885.29 " " 59,763.00 " N/A " 58,226.00 " " 27,354.14 " " 56,687.93 " N/A " 26,557.42 " " 108,332.90 " N/A " 26,557.42 " " 55,148.16 " " 68,935.19 " " 27,354.14 " " 27,354.14 " " 26,557.42 " " 151,992.85 " N/A N/A " 69,616.75 " N/A N/A " 142,493.30 " N/A N/A " 27,354.14 " DRG 35 " 68,008.25 " " 21,429.40 " " 15,937.63 " " 54,406.60 " N/A " 35,149.31 " " 16,734.51 " " 35,149.31 " N/A " 34,785.00 " " 16,415.76 " " 33,340.73 " N/A " 15,937.63 " " 38,778.30 " N/A " 15,937.63 " " 29,815.99 " " 37,269.99 " " 16,415.76 " " 16,415.76 " " 15,937.63 " " 54,406.60 " N/A N/A " 40,944.75 " N/A N/A " 51,006.19 " N/A N/A " 16,415.76 " DRG 36 " 55,578.49 " " 17,512.78 " " 12,778.39 " " 44,462.80 " N/A " 27,827.10 " " 13,417.31 " " 27,827.10 " N/A " 27,240.00 " " 13,161.74 " " 26,395.28 " N/A " 12,778.39 " " 31,690.86 " N/A " 12,778.39 " " 23,107.15 " " 28,883.96 " " 13,161.74 " " 13,161.74 " " 12,778.39 " " 44,462.80 " N/A N/A " 32,415.25 " N/A N/A " 41,683.87 " N/A N/A " 13,161.74 " DRG 37 " 79,812.34 " " 25,148.87 " " 22,016.91 " " 63,849.87 " N/A " 49,239.38 " " 23,117.76 " " 49,239.38 " N/A " 49,498.00 " " 22,677.42 " " 46,705.80 " N/A " 22,016.91 " " 45,508.99 " N/A " 22,016.91 " " 38,840.76 " " 48,550.94 " " 22,677.42 " " 22,677.42 " " 22,016.91 " " 63,849.87 " N/A N/A " 57,358.00 " N/A N/A " 59,859.25 " N/A N/A " 22,677.42 " DRG 38 " 32,860.68 " " 10,354.40 " " 11,524.16 " " 31,113.67 " N/A " 24,920.15 " " 12,100.37 " " 24,920.15 " N/A " 24,968.00 " " 11,869.88 " " 23,637.90 " N/A " 11,524.16 " " 18,737.16 " N/A " 11,524.16 " " 24,890.92 " " 31,113.67 " " 11,869.88 " " 11,869.88 " " 11,524.16 " " 26,288.54 " N/A N/A " 29,029.00 " N/A N/A " 24,645.51 " N/A N/A " 11,869.88 " DRG 39 " 27,606.73 " " 8,698.88 " " 8,155.57 " " 22,085.38 " N/A " 17,112.70 " " 8,563.35 " " 17,112.70 " N/A " 16,648.00 " " 8,400.24 " " 16,232.18 " N/A " 8,155.57 " " 15,741.36 " N/A " 8,155.57 " " 17,166.72 " " 21,458.41 " " 8,400.24 " " 8,400.24 " " 8,155.57 " " 22,085.38 " N/A N/A " 19,934.25 " N/A N/A " 20,705.05 " N/A N/A " 8,400.24 " DRG 40 " 102,758.01 " " 32,379.05 " " 25,823.03 " " 82,206.41 " N/A " 58,060.89 " " 27,114.18 " " 58,060.89 " N/A " 59,724.00 " " 26,597.72 " " 55,073.40 " N/A " 25,823.03 " " 58,592.62 " N/A " 25,823.03 " " 38,483.76 " " 48,104.70 " " 26,597.72 " " 26,597.72 " " 25,823.03 " " 82,206.41 " N/A N/A " 67,634.00 " N/A N/A " 77,068.51 " N/A N/A " 26,597.72 " DRG 41 " 110,930.52 " " 34,954.21 " " 16,002.44 " " 88,744.42 " N/A " 35,299.54 " " 16,802.56 " " 35,299.54 " N/A " 33,460.00 " " 16,482.51 " " 33,483.23 " N/A " 16,002.44 " " 63,252.58 " N/A " 16,002.44 " " 30,340.41 " " 37,925.54 " " 16,482.51 " " 16,482.51 " " 16,002.44 " " 88,744.42 " N/A N/A " 41,119.75 " N/A N/A " 83,197.89 " N/A N/A " 16,482.51 " DRG 42 " 114,357.35 " " 36,034.00 " " 13,095.35 " " 91,485.88 " N/A " 28,561.73 " " 13,750.12 " " 28,561.73 " N/A " 29,241.00 " " 13,488.21 " " 27,092.10 " N/A " 13,095.35 " " 65,206.56 " N/A " 13,095.35 " " 20,161.48 " " 25,201.87 " " 13,488.21 " " 13,488.21 " " 13,095.35 " " 91,485.88 " N/A N/A " 33,271.00 " N/A N/A " 85,768.01 " N/A N/A " 13,488.21 " DRG 52 " 79,335.98 " " 24,998.77 " " 12,786.17 " " 63,468.78 " N/A " 27,845.13 " " 13,425.48 " " 27,845.13 " N/A " 24,880.00 " " 13,169.76 " " 26,412.38 " N/A " 12,786.17 " " 45,237.38 " N/A " 12,786.17 " " 28,442.09 " " 35,552.63 " " 13,169.76 " " 13,169.76 " " 12,786.17 " " 63,468.78 " N/A N/A " 32,436.25 " N/A N/A " 59,501.99 " N/A N/A " 13,169.76 " DRG 53 No Current Volume N/A " 8,138.07 " " 21,151.57 " N/A " 17,072.14 " " 8,544.97 " " 17,072.14 " N/A " 14,622.00 " " 8,382.21 " " 16,193.70 " N/A " 8,138.07 " N/A N/A " 8,138.07 " " 16,921.24 " " 21,151.57 " " 8,382.21 " " 8,382.21 " " 8,138.07 " N/A N/A N/A " 19,887.00 " N/A N/A N/A N/A N/A " 8,382.21 " DRG 54 " 38,720.73 " " 12,200.90 " " 9,641.20 " " 30,976.58 " N/A " 20,555.97 " " 10,123.26 " " 20,555.97 " N/A " 20,529.00 " " 9,930.44 " " 19,498.28 " N/A " 9,641.20 " " 22,078.56 " N/A " 9,641.20 " " 14,613.80 " " 18,267.26 " " 9,930.44 " " 9,930.44 " " 9,641.20 " " 30,976.58 " N/A N/A " 23,945.25 " N/A N/A " 29,040.55 " N/A N/A " 9,930.44 " DRG 55 " 31,217.04 " " 9,836.49 " " 7,543.04 " " 24,973.63 " N/A " 15,693.03 " " 7,920.19 " " 15,693.03 " N/A " 16,034.00 " " 7,769.33 " " 14,885.55 " N/A " 7,543.04 " " 17,799.95 " N/A " 7,543.04 " " 12,208.17 " " 15,260.22 " " 7,769.33 " " 7,769.33 " " 7,543.04 " " 24,973.63 " N/A N/A " 18,280.50 " N/A N/A " 23,412.78 " N/A N/A " 7,769.33 " DRG 56 " 74,116.66 " " 23,354.16 " " 15,001.65 " " 59,293.33 " N/A " 32,979.99 " " 15,751.73 " " 32,979.99 " N/A " 27,716.00 " " 15,451.70 " " 31,283.03 " N/A " 15,001.65 " " 42,261.32 " N/A " 15,001.65 " " 27,934.78 " " 34,918.49 " " 15,451.70 " " 15,451.70 " " 15,001.65 " " 59,293.33 " N/A N/A " 38,417.75 " N/A N/A " 55,587.50 " N/A N/A " 15,451.70 " DRG 57 " 113,387.63 " " 35,728.44 " " 8,987.83 " " 90,710.11 " N/A " 19,041.65 " " 9,437.22 " " 19,041.65 " N/A " 15,889.00 " " 9,257.46 " " 18,061.88 " N/A " 8,987.83 " " 64,653.63 " N/A " 8,987.83 " " 17,003.07 " " 21,253.85 " " 9,257.46 " " 9,257.46 " " 8,987.83 " " 90,710.11 " N/A N/A " 22,181.25 " N/A N/A " 85,040.73 " N/A N/A " 9,257.46 " DRG 58 " 107,937.63 " " 34,011.15 " " 12,036.23 " " 86,350.10 " N/A " 26,106.97 " " 12,638.04 " " 26,106.97 " N/A " 25,703.00 " " 12,397.32 " " 24,763.65 " N/A " 12,036.23 " " 61,546.04 " N/A " 12,036.23 " " 28,409.36 " " 35,511.72 " " 12,397.32 " " 12,397.32 " " 12,036.23 " " 86,350.10 " N/A N/A " 30,411.50 " N/A N/A " 80,953.22 " N/A N/A " 12,397.32 " DRG 59 " 129,218.75 " " 40,716.83 " " 8,079.08 " " 103,375.00 " N/A " 16,935.43 " " 8,483.03 " " 16,935.43 " N/A " 16,191.00 " " 8,321.45 " " 16,064.03 " N/A " 8,079.08 " " 73,680.53 " N/A " 8,079.08 " " 13,730.10 " " 17,162.63 " " 8,321.45 " " 8,321.45 " " 8,079.08 " " 103,375.00 " N/A N/A " 19,727.75 " N/A N/A " 96,914.06 " N/A N/A " 8,321.45 " DRG 60 " 26,323.76 " " 8,294.62 " " 6,720.50 " " 21,059.01 " N/A " 13,786.61 " " 7,056.53 " " 13,786.61 " N/A " 12,378.00 " " 6,922.12 " " 13,077.23 " N/A " 6,720.50 " " 15,009.81 " N/A " 6,720.50 " " 11,946.33 " " 14,932.92 " " 6,922.12 " " 6,922.12 " " 6,720.50 " " 21,059.01 " N/A N/A " 16,059.75 " N/A N/A " 19,742.82 " N/A N/A " 6,922.12 " DRG 61 " 109,432.56 " " 34,482.20 " " 19,512.34 " " 87,546.05 " N/A " 43,434.50 " " 20,487.96 " " 43,434.50 " N/A " 43,379.00 " " 20,097.71 " " 41,199.60 " N/A " 19,512.34 " " 62,398.45 " N/A " 19,512.34 " " 38,083.93 " " 47,604.91 " " 20,097.71 " " 20,097.71 " " 19,512.34 " " 87,546.05 " N/A N/A " 50,596.00 " N/A N/A " 82,074.42 " N/A N/A " 20,097.71 " DRG 62 " 79,001.03 " " 24,893.23 " " 13,659.92 " " 63,200.83 " N/A " 29,870.23 " " 14,342.92 " " 29,870.23 " N/A " 29,194.00 " " 14,069.72 " " 28,333.28 " N/A " 13,659.92 " " 45,046.39 " N/A " 13,659.92 " " 32,042.36 " " 40,052.97 " " 14,069.72 " " 14,069.72 " " 13,659.92 " " 63,200.83 " N/A N/A " 34,795.25 " N/A N/A " 59,250.77 " N/A N/A " 14,069.72 " DRG 63 " 69,771.59 " " 21,985.03 " " 11,854.09 " " 55,817.27 " N/A " 25,684.82 " " 12,446.79 " " 25,684.82 " N/A " 23,756.00 " " 12,209.71 " " 24,363.23 " N/A " 11,854.09 " " 39,783.76 " N/A " 11,854.09 " " 29,947.66 " " 37,434.59 " " 12,209.71 " " 12,209.71 " " 11,854.09 " " 55,817.27 " N/A N/A " 29,919.75 " N/A N/A " 52,328.69 " N/A N/A " 12,209.71 " DRG 64 " 72,982.72 " " 22,996.85 " " 13,210.08 " " 58,386.17 " N/A " 28,827.63 " " 13,870.58 " " 28,827.63 " N/A " 27,345.00 " " 13,606.38 " " 27,344.33 " N/A " 13,210.08 " " 41,614.75 " N/A " 13,210.08 " " 25,643.70 " " 32,054.65 " " 13,606.38 " " 13,606.38 " " 13,210.08 " " 58,386.17 " N/A N/A " 33,580.75 " N/A N/A " 54,737.04 " N/A N/A " 13,606.38 " DRG 65 " 38,863.49 " " 12,245.89 " " 7,383.58 " " 31,090.80 " N/A " 15,323.46 " " 7,752.76 " " 15,323.46 " N/A " 16,745.00 " " 7,605.09 " " 14,535.00 " N/A " 7,383.58 " " 22,159.96 " N/A " 7,383.58 " " 16,135.73 " " 20,169.68 " " 7,605.09 " " 7,605.09 " " 7,383.58 " " 31,090.80 " N/A N/A " 17,850.00 " N/A N/A " 29,147.62 " N/A N/A " 7,605.09 " DRG 66 " 30,131.38 " " 9,494.40 " " 5,384.59 " " 24,105.11 " N/A " 10,690.37 " " 5,653.82 " " 10,690.37 " N/A " 11,846.00 " " 5,546.13 " " 10,140.30 " N/A " 5,384.59 " " 17,180.91 " N/A " 5,384.59 " " 13,190.06 " " 16,487.58 " " 5,546.13 " " 5,546.13 " " 5,384.59 " " 24,105.11 " N/A N/A " 12,453.00 " N/A N/A " 22,598.54 " N/A N/A " 5,546.13 " DRG 67 " 62,806.61 " " 19,790.36 " " 10,013.90 " " 50,245.29 " N/A " 21,419.79 " " 10,514.60 " " 21,419.79 " N/A " 22,856.00 " " 10,314.32 " " 20,317.65 " N/A " 10,013.90 " " 35,812.33 " N/A " 10,013.90 " " 23,499.91 " " 29,374.90 " " 10,314.32 " " 10,314.32 " " 10,013.90 " " 50,245.29 " N/A N/A " 24,951.50 " N/A N/A " 47,104.96 " N/A N/A " 10,314.32 " DRG 68 " 45,865.65 " " 14,452.27 " " 6,533.82 " " 36,692.52 " N/A " 13,353.94 " " 6,860.51 " " 13,353.94 " N/A " 13,210.00 " " 6,729.83 " " 12,666.83 " N/A " 6,533.82 " " 26,152.60 " N/A " 6,533.82 " " 13,304.61 " " 16,630.78 " " 6,729.83 " " 6,729.83 " " 6,533.82 " " 36,692.52 " N/A N/A " 15,555.75 " N/A N/A " 34,399.24 " N/A N/A " 6,729.83 " DRG 69 " 34,290.64 " " 10,804.98 " " 5,873.97 " " 27,432.51 " N/A " 11,824.60 " " 6,167.67 " " 11,824.60 " N/A " 10,990.00 " " 6,050.19 " " 11,216.18 " N/A " 5,873.97 " " 19,552.52 " N/A " 5,873.97 " " 11,733.59 " " 14,667.00 " " 6,050.19 " " 6,050.19 " " 5,873.97 " " 27,432.51 " N/A N/A " 13,774.25 " N/A N/A " 25,717.98 " N/A N/A " 6,050.19 " DRG 70 " 102,899.76 " " 32,423.71 " " 11,658.98 " " 82,319.81 " N/A " 25,232.63 " " 12,241.93 " " 25,232.63 " N/A " 25,863.00 " " 12,008.75 " " 23,934.30 " N/A " 11,658.98 " " 58,673.44 " N/A " 11,658.98 " " 21,339.75 " " 26,674.70 " " 12,008.75 " " 12,008.75 " " 11,658.98 " " 82,319.81 " N/A N/A " 29,393.00 " N/A N/A " 77,174.82 " N/A N/A " 12,008.75 " DRG 71 " 40,544.76 " " 12,775.65 " " 7,330.43 " " 32,435.81 " N/A " 15,200.27 " " 7,696.95 " " 15,200.27 " N/A " 15,337.00 " " 7,550.34 " " 14,418.15 " N/A " 7,330.43 " " 23,118.62 " N/A " 7,330.43 " " 14,450.15 " " 18,062.70 " " 7,550.34 " " 7,550.34 " " 7,330.43 " " 32,435.81 " N/A N/A " 17,706.50 " N/A N/A " 30,408.57 " N/A N/A " 7,550.34 " DRG 72 " 23,365.16 " " 7,362.36 " " 5,774.15 " " 18,692.13 " N/A " 11,593.25 " " 6,062.86 " " 11,593.25 " N/A " 10,930.00 " " 5,947.37 " " 10,996.73 " N/A " 5,774.15 " " 13,322.81 " N/A " 5,774.15 " " 10,817.16 " " 13,521.46 " " 5,947.37 " " 5,947.37 " " 5,774.15 " " 18,692.13 " N/A N/A " 13,504.75 " N/A N/A " 17,523.87 " N/A N/A " 5,947.37 " DRG 73 No Current Volume N/A " 10,189.56 " " 30,131.78 " N/A " 21,826.92 " " 10,699.04 " " 21,826.92 " N/A " 20,910.00 " " 10,495.25 " " 20,703.83 " N/A " 10,189.56 " N/A N/A " 10,189.56 " " 24,105.41 " " 30,131.78 " " 10,495.25 " " 10,495.25 " " 10,189.56 " N/A N/A N/A " 25,425.75 " N/A N/A N/A N/A N/A " 10,495.25 " DRG 74 " 51,055.00 " " 16,087.43 " " 7,377.10 " " 40,844.00 " N/A " 15,308.44 " " 7,745.96 " " 15,308.44 " N/A " 13,919.00 " " 7,598.41 " " 14,520.75 " N/A " 7,377.10 " " 29,111.56 " N/A " 7,377.10 " " 12,584.56 " " 15,730.71 " " 7,598.41 " " 7,598.41 " " 7,377.10 " " 40,844.00 " N/A N/A " 17,832.50 " N/A N/A " 38,291.25 " N/A N/A " 7,598.41 " DRG 75 No Current Volume N/A " 11,318.04 " " 28,472.50 " N/A " 24,442.42 " " 11,883.94 " " 24,442.42 " N/A " 26,109.00 " " 11,657.58 " " 23,184.75 " N/A " 11,318.04 " N/A N/A " 11,318.04 " " 13,484.63 " " 16,855.79 " " 11,657.58 " " 11,657.58 " " 11,318.04 " N/A N/A N/A " 28,472.50 " N/A N/A N/A N/A N/A " 11,657.58 " DRG 76 No Current Volume N/A " 7,156.07 " " 17,235.75 " N/A " 14,796.15 " " 7,513.87 " " 14,796.15 " N/A " 13,577.00 " " 7,370.75 " " 14,034.83 " N/A " 7,156.07 " N/A N/A " 7,156.07 " " 9,818.90 " " 12,273.64 " " 7,370.75 " " 7,370.75 " " 7,156.07 " N/A N/A N/A " 17,235.75 " N/A N/A N/A N/A N/A " 7,370.75 " DRG 77 " 31,554.71 " " 9,942.89 " " 10,708.10 " " 31,563.70 " N/A " 23,028.76 " " 11,243.51 " " 23,028.76 " N/A " 25,559.00 " " 11,029.34 " " 21,843.83 " N/A " 10,708.10 " " 17,992.50 " N/A " 10,708.10 " " 25,250.95 " " 31,563.70 " " 11,029.34 " " 11,029.34 " " 10,708.10 " " 25,243.77 " N/A N/A " 26,825.75 " N/A N/A " 23,666.03 " N/A N/A " 11,029.34 " DRG 78 " 37,419.92 " " 11,791.02 " " 6,929.21 " " 29,935.94 " N/A " 14,270.35 " " 7,275.67 " " 14,270.35 " N/A " 14,728.00 " " 7,137.09 " " 13,536.08 " N/A " 6,929.21 " " 21,336.84 " N/A " 6,929.21 " " 15,726.61 " " 19,658.27 " " 7,137.09 " " 7,137.09 " " 6,929.21 " " 29,935.94 " N/A N/A " 16,623.25 " N/A N/A " 28,064.94 " N/A N/A " 7,137.09 " DRG 79 No Current Volume N/A " 5,496.08 " " 14,973.84 " N/A " 10,948.76 " " 5,770.88 " " 10,948.76 " N/A " 10,507.00 " " 5,660.96 " " 10,385.40 " N/A " 5,496.08 " N/A N/A " 5,496.08 " " 11,979.06 " " 14,973.84 " " 5,660.96 " " 5,660.96 " " 5,496.08 " N/A N/A N/A " 12,754.00 " N/A N/A N/A N/A N/A " 5,660.96 " DRG 80 " 25,404.82 " " 8,005.06 " " 14,354.12 " " 39,521.11 " N/A " 31,479.19 " " 15,071.83 " " 31,479.19 " N/A " 20,123.00 " " 14,784.74 " " 29,859.45 " N/A " 14,354.12 " " 14,485.83 " N/A " 14,354.12 " " 31,616.87 " " 39,521.11 " " 14,784.74 " " 14,784.74 " " 14,354.12 " " 20,323.86 " N/A N/A " 36,669.50 " N/A N/A " 19,053.62 " N/A N/A " 14,784.74 " DRG 81 No Current Volume N/A " 5,783.87 " " 16,323.94 " N/A " 11,615.78 " " 6,073.06 " " 11,615.78 " N/A " 12,350.00 " " 5,957.39 " " 11,018.10 " N/A " 5,783.87 " N/A N/A " 5,783.87 " " 13,059.14 " " 16,323.94 " " 5,957.39 " " 5,957.39 " " 5,783.87 " N/A N/A N/A " 13,531.00 " N/A N/A N/A N/A N/A " 5,957.39 " DRG 82 " 105,605.38 " " 33,276.26 " " 15,446.31 " " 84,484.30 " N/A " 34,010.57 " " 16,218.63 " " 34,010.57 " N/A " 30,118.00 " " 15,909.70 " " 32,260.58 " N/A " 15,446.31 " " 60,216.19 " N/A " 15,446.31 " " 31,387.76 " " 39,234.72 " " 15,909.70 " " 15,909.70 " " 15,446.31 " " 84,484.30 " N/A N/A " 39,618.25 " N/A N/A " 79,204.04 " N/A N/A " 15,909.70 " DRG 83 " 54,401.55 " " 17,141.93 " " 9,483.69 " " 43,521.24 " N/A " 20,190.91 " " 9,957.87 " " 20,190.91 " N/A " 19,511.00 " " 9,768.20 " " 19,152.00 " N/A " 9,483.69 " " 31,019.76 " N/A " 9,483.69 " " 18,934.12 " " 23,667.66 " " 9,768.20 " " 9,768.20 " " 9,483.69 " " 43,521.24 " N/A N/A " 23,520.00 " N/A N/A " 40,801.16 " N/A N/A " 9,768.20 " DRG 84 " 28,079.92 " " 8,847.98 " " 6,642.07 " " 22,463.94 " N/A " 13,604.83 " " 6,974.17 " " 13,604.83 " N/A " 13,518.00 " " 6,841.33 " " 12,904.80 " N/A " 6,642.07 " " 16,011.17 " N/A " 6,642.07 " " 12,355.45 " " 15,444.33 " " 6,841.33 " " 6,841.33 " " 6,642.07 " " 22,463.94 " N/A N/A " 15,848.00 " N/A N/A " 21,059.94 " N/A N/A " 6,841.33 " DRG 85 " 88,245.95 " " 27,806.30 " " 15,756.14 " " 70,596.76 " N/A " 34,728.67 " " 16,543.95 " " 34,728.67 " N/A " 31,104.00 " " 16,228.82 " " 32,941.73 " N/A " 15,756.14 " " 50,317.84 " N/A " 15,756.14 " " 25,938.27 " " 32,422.86 " " 16,228.82 " " 16,228.82 " " 15,756.14 " " 70,596.76 " N/A N/A " 40,454.75 " N/A N/A " 66,184.46 " N/A N/A " 16,228.82 " DRG 86 " 52,980.22 " " 16,694.07 " " 9,033.20 " " 42,384.18 " N/A " 19,146.81 " " 9,484.86 " " 19,146.81 " N/A " 17,592.00 " " 9,304.20 " " 18,161.63 " N/A " 9,033.20 " " 30,209.32 " N/A " 9,033.20 " " 14,859.27 " " 18,574.10 " " 9,304.20 " " 9,304.20 " " 9,033.20 " " 42,384.18 " N/A N/A " 22,303.75 " N/A N/A " 39,735.17 " N/A N/A " 9,304.20 " DRG 87 " 26,312.60 " " 8,291.10 " " 6,369.83 " " 21,050.08 " N/A " 12,973.86 " " 6,688.32 " " 12,973.86 " N/A " 11,737.00 " " 6,560.92 " " 12,306.30 " N/A " 6,369.83 " " 15,003.44 " N/A " 6,369.83 " " 10,048.01 " " 12,560.02 " " 6,560.92 " " 6,560.92 " " 6,369.83 " " 21,050.08 " N/A N/A " 15,113.00 " N/A N/A " 19,734.45 " N/A N/A " 6,560.92 " DRG 88 " 14,466.94 " " 4,558.53 " " 8,249.05 " " 27,983.89 " N/A " 21,861.47 " " 10,714.69 " " 21,861.47 " N/A " 24,714.00 " " 10,510.60 " " 20,736.60 " N/A " 10,204.47 " " 8,249.05 " N/A " 10,204.47 " " 22,387.10 " " 27,983.89 " " 10,510.60 " " 10,510.60 " " 10,204.47 " " 11,573.55 " N/A N/A " 25,466.00 " N/A N/A " 10,850.21 " N/A N/A " 10,510.60 " DRG 89 " 21,037.33 " " 6,628.86 " " 7,665.54 " " 18,611.25 " N/A " 15,976.96 " " 8,048.82 " " 15,976.96 " N/A " 15,084.00 " " 7,895.51 " " 15,154.88 " N/A " 7,665.54 " " 11,995.48 " N/A " 7,665.54 " " 13,059.14 " " 16,323.94 " " 7,895.51 " " 7,895.51 " " 7,665.54 " " 16,829.86 " N/A N/A " 18,611.25 " N/A N/A " 15,778.00 " N/A N/A " 7,895.51 " DRG 90 " 22,070.29 " " 6,954.35 " " 6,311.49 " " 17,656.23 " N/A " 12,838.66 " " 6,627.06 " " 12,838.66 " N/A " 11,568.00 " " 6,500.83 " " 12,178.05 " N/A " 6,311.49 " " 12,584.48 " N/A " 6,311.49 " " 10,440.77 " " 13,050.97 " " 6,500.83 " " 6,500.83 " " 6,311.49 " " 17,656.23 " N/A N/A " 14,955.50 " N/A N/A " 16,552.72 " N/A N/A " 6,500.83 " DRG 91 " 44,127.07 " " 13,904.44 " " 11,472.31 " " 35,301.66 " N/A " 24,799.97 " " 12,045.93 " " 24,799.97 " N/A " 25,139.00 " " 11,816.48 " " 23,523.90 " N/A " 11,472.31 " " 25,161.26 " N/A " 11,472.31 " " 20,881.54 " " 26,101.93 " " 11,816.48 " " 11,816.48 " " 11,472.31 " " 35,301.66 " N/A N/A " 28,889.00 " N/A N/A " 33,095.31 " N/A N/A " 11,816.48 " DRG 92 " 46,573.23 " " 14,675.22 " " 7,182.00 " " 37,258.58 " N/A " 14,856.24 " " 7,541.10 " " 14,856.24 " N/A " 14,143.00 " " 7,397.46 " " 14,091.83 " N/A " 7,182.00 " " 26,556.05 " N/A " 7,182.00 " " 14,973.83 " " 18,717.29 " " 7,397.46 " " 7,397.46 " " 7,182.00 " " 37,258.58 " N/A N/A " 17,305.75 " N/A N/A " 34,929.92 " N/A N/A " 7,397.46 " DRG 93 " 36,007.21 " " 11,345.87 " " 5,842.21 " " 28,805.76 " N/A " 11,750.99 " " 6,134.32 " " 11,750.99 " N/A " 10,671.00 " " 6,017.48 " " 11,146.35 " N/A " 5,842.21 " " 20,531.31 " N/A " 5,842.21 " " 11,586.31 " " 14,482.89 " " 6,017.48 " " 6,017.48 " " 5,842.21 " " 28,805.76 " N/A N/A " 13,688.50 " N/A N/A " 27,005.40 " N/A N/A " 6,017.48 " DRG 94 No Current Volume N/A " 24,352.31 " " 63,663.25 " N/A " 54,652.17 " " 25,569.93 " " 54,652.17 " N/A " 52,482.00 " " 25,082.88 " " 51,840.08 " N/A " 24,352.31 " N/A N/A " 24,352.31 " " 36,356.09 " " 45,445.11 " " 25,082.88 " " 25,082.88 " " 24,352.31 " N/A N/A N/A " 63,663.25 " N/A N/A N/A N/A N/A " 25,082.88 " DRG 95 " 44,590.49 " " 14,050.46 " " 17,023.98 " " 43,877.75 " N/A " 37,667.17 " " 17,875.18 " " 37,667.17 " N/A " 37,515.00 " " 17,534.70 " " 35,729.03 " N/A " 17,023.98 " " 25,425.50 " N/A " 17,023.98 " " 30,215.82 " " 37,769.77 " " 17,534.70 " " 17,534.70 " " 17,023.98 " " 35,672.39 " N/A N/A " 43,877.75 " N/A N/A " 33,442.87 " N/A N/A " 17,534.70 " DRG 96 No Current Volume N/A " 15,892.25 " " 40,822.25 " N/A " 35,044.15 " " 16,686.86 " " 35,044.15 " N/A " 32,610.00 " " 16,369.02 " " 33,240.98 " N/A " 15,892.25 " N/A N/A " 15,892.25 " " 31,764.15 " " 39,705.21 " " 16,369.02 " " 16,369.02 " " 15,892.25 " N/A N/A N/A " 40,822.25 " N/A N/A N/A N/A N/A " 16,369.02 " DRG 97 No Current Volume N/A " 25,146.33 " " 65,807.00 " N/A " 56,492.49 " " 26,403.65 " " 56,492.49 " N/A " 49,757.00 " " 25,900.72 " " 53,585.70 " N/A " 25,146.33 " N/A N/A " 25,146.33 " " 49,350.61 " " 61,688.25 " " 25,900.72 " " 25,900.72 " " 25,146.33 " N/A N/A N/A " 65,807.00 " N/A N/A N/A N/A N/A " 25,900.72 " DRG 98 No Current Volume N/A " 14,464.96 " " 36,968.75 " N/A " 31,736.09 " " 15,188.21 " " 31,736.09 " N/A " 27,044.00 " " 14,898.91 " " 30,103.13 " N/A " 14,464.96 " N/A N/A " 14,464.96 " " 21,143.37 " " 26,429.23 " " 14,898.91 " " 14,898.91 " " 14,464.96 " N/A N/A N/A " 36,968.75 " N/A N/A N/A N/A N/A " 14,898.91 " DRG 99 " 19,205.45 " " 6,051.64 " " 9,858.99 " " 24,533.25 " N/A " 21,060.74 " " 10,351.94 " " 21,060.74 " N/A " 18,263.00 " " 10,154.76 " " 19,977.08 " N/A " 9,858.99 " " 10,950.95 " N/A " 9,858.99 " " 14,973.83 " " 18,717.29 " " 10,154.76 " " 10,154.76 " " 9,858.99 " " 15,364.36 " N/A N/A " 24,533.25 " N/A N/A " 14,404.09 " N/A N/A " 10,154.76 " DRG 100 " 59,128.66 " " 18,631.44 " " 12,934.60 " " 47,302.92 " N/A " 28,189.16 " " 13,581.33 " " 28,189.16 " N/A " 24,078.00 " " 13,322.64 " " 26,738.70 " N/A " 12,934.60 " " 33,715.16 " N/A " 12,934.60 " " 21,290.66 " " 26,613.33 " " 13,322.64 " " 13,322.64 " " 12,934.60 " " 47,302.92 " N/A N/A " 32,837.00 " N/A N/A " 44,346.49 " N/A N/A " 13,322.64 " DRG 101 " 35,822.31 " " 11,287.61 " " 6,530.58 " " 28,657.85 " N/A " 13,346.43 " " 6,857.11 " " 13,346.43 " N/A " 11,905.00 " " 6,726.50 " " 12,659.70 " N/A " 6,530.58 " " 20,425.88 " N/A " 6,530.58 " " 9,491.61 " " 11,864.51 " " 6,726.50 " " 6,726.50 " " 6,530.58 " " 28,657.85 " N/A N/A " 15,547.00 " N/A N/A " 26,866.73 " N/A N/A " 6,726.50 " DRG 102 No Current Volume N/A " 8,246.31 " " 20,179.25 " N/A " 17,323.02 " " 8,658.63 " " 17,323.02 " N/A " 15,848.00 " " 8,493.70 " " 16,431.68 " N/A " 8,246.31 " N/A N/A " 8,246.31 " " 13,730.10 " " 17,162.63 " " 8,493.70 " " 8,493.70 " " 8,246.31 " N/A N/A N/A " 20,179.25 " N/A N/A N/A N/A N/A " 8,493.70 " DRG 103 " 37,878.82 " " 11,935.62 " " 6,148.80 " " 30,303.06 " N/A " 12,461.58 " " 6,456.24 " " 12,461.58 " N/A " 10,878.00 " " 6,333.26 " " 11,820.38 " N/A " 6,148.80 " " 21,598.50 " N/A " 6,148.80 " " 10,162.57 " " 12,703.21 " " 6,333.26 " " 6,333.26 " " 6,148.80 " " 30,303.06 " N/A N/A " 14,516.25 " N/A N/A " 28,409.12 " N/A N/A " 6,333.26 " DRG 113 No Current Volume N/A " 14,995.82 " " 38,947.85 " N/A " 32,966.47 " " 15,745.61 " " 32,966.47 " N/A " 29,280.00 " " 15,445.69 " " 31,270.20 " N/A " 14,995.82 " N/A N/A " 14,995.82 " " 31,158.28 " " 38,947.85 " " 15,445.69 " " 15,445.69 " " 14,995.82 " N/A N/A N/A " 38,402.00 " N/A N/A N/A N/A N/A " 15,445.69 " DRG 114 No Current Volume N/A " 10,155.21 " " 27,206.56 " N/A " 21,747.29 " " 10,662.97 " " 21,747.29 " N/A " 18,201.00 " " 10,459.87 " " 20,628.30 " N/A " 10,155.21 " N/A N/A " 10,155.21 " " 21,765.24 " " 27,206.56 " " 10,459.87 " " 10,459.87 " " 10,155.21 " N/A N/A N/A " 25,333.00 " N/A N/A N/A N/A N/A " 10,459.87 " DRG 115 No Current Volume N/A " 10,213.54 " " 28,638.48 " N/A " 21,882.50 " " 10,724.22 " " 21,882.50 " N/A " 20,108.00 " " 10,519.95 " " 20,756.55 " N/A " 10,213.54 " N/A N/A " 10,213.54 " " 22,910.78 " " 28,638.48 " " 10,519.95 " " 10,519.95 " " 10,213.54 " N/A N/A N/A " 25,490.50 " N/A N/A N/A N/A N/A " 10,519.95 " DRG 116 No Current Volume N/A " 12,975.44 " " 37,230.03 " N/A " 28,283.80 " " 13,624.21 " " 28,283.80 " N/A " 22,036.00 " " 13,364.70 " " 26,828.48 " N/A " 12,975.44 " N/A N/A " 12,975.44 " " 29,784.01 " " 37,230.03 " " 13,364.70 " " 13,364.70 " " 12,975.44 " N/A N/A N/A " 32,947.25 " N/A N/A N/A N/A N/A " 13,364.70 " DRG 117 No Current Volume N/A " 7,521.00 " " 21,090.20 " N/A " 15,641.95 " " 7,897.05 " " 15,641.95 " N/A " 12,963.00 " " 7,746.63 " " 14,837.10 " N/A " 7,521.00 " N/A N/A " 7,521.00 " " 16,872.15 " " 21,090.20 " " 7,746.63 " " 7,746.63 " " 7,521.00 " N/A N/A N/A " 18,221.00 " N/A N/A N/A N/A N/A " 7,746.63 " DRG 121 No Current Volume N/A " 8,489.38 " " 20,835.50 " N/A " 17,886.38 " " 8,913.85 " " 17,886.38 " N/A " 16,733.00 " " 8,744.06 " " 16,966.05 " N/A " 8,489.38 " N/A N/A " 8,489.38 " " 13,157.33 " " 16,446.67 " " 8,744.06 " " 8,744.06 " " 8,489.38 " N/A N/A N/A " 20,835.50 " N/A N/A N/A N/A N/A " 8,744.06 " DRG 122 No Current Volume N/A " 4,956.15 " " 11,296.25 " N/A " 9,697.35 " " 5,203.96 " " 9,697.35 " N/A " 9,993.00 " " 5,104.83 " " 9,198.38 " N/A " 4,956.15 " N/A N/A " 4,956.15 " " 7,789.66 " " 9,737.08 " " 5,104.83 " " 5,104.83 " " 4,956.15 " N/A N/A N/A " 11,296.25 " N/A N/A N/A N/A N/A " 5,104.83 " DRG 123 " 23,369.91 " " 7,363.86 " " 5,742.39 " " 18,695.93 " N/A " 11,519.64 " " 6,029.51 " " 11,519.64 " N/A " 10,592.00 " " 5,914.66 " " 10,926.90 " N/A " 5,742.39 " " 13,325.52 " N/A " 5,742.39 " " 11,684.50 " " 14,605.63 " " 5,914.66 " " 5,914.66 " " 5,742.39 " " 18,695.93 " N/A N/A " 13,419.00 " N/A N/A " 17,527.43 " N/A N/A " 5,914.66 " DRG 124 " 130,198.99 " " 41,025.70 " " 9,859.63 " " 104,159.19 " N/A " 21,062.25 " " 10,352.61 " " 21,062.25 " N/A " 17,987.00 " " 10,155.42 " " 19,978.50 " N/A " 9,859.63 " " 74,239.46 " N/A " 9,859.63 " " 22,387.10 " " 27,983.89 " " 10,155.42 " " 10,155.42 " " 9,859.63 " " 104,159.19 " N/A N/A " 24,535.00 " N/A N/A " 97,649.24 " N/A N/A " 10,155.42 " DRG 125 No Current Volume N/A " 6,197.41 " " 14,647.50 " N/A " 12,574.25 " " 6,507.28 " " 12,574.25 " N/A " 10,780.00 " " 6,383.33 " " 11,927.25 " N/A " 6,197.41 " N/A N/A " 6,197.41 " " 9,115.22 " " 11,394.03 " " 6,383.33 " " 6,383.33 " " 6,197.41 " N/A N/A N/A " 14,647.50 " N/A N/A N/A N/A N/A " 6,383.33 " DRG 135 No Current Volume N/A " 14,665.90 " " 39,072.80 " N/A " 32,201.80 " " 15,399.20 " " 32,201.80 " N/A " 30,129.00 " " 15,105.88 " " 30,544.88 " N/A " 14,665.90 " N/A N/A " 14,665.90 " " 31,258.24 " " 39,072.80 " " 15,105.88 " " 15,105.88 " " 14,665.90 " N/A N/A N/A " 37,511.25 " N/A N/A N/A N/A N/A " 15,105.88 " DRG 136 No Current Volume N/A " 8,910.05 " " 24,997.31 " N/A " 18,861.38 " " 9,355.55 " " 18,861.38 " N/A " 16,534.00 " " 9,177.35 " " 17,890.88 " N/A " 8,910.05 " N/A N/A " 8,910.05 " " 19,997.83 " " 24,997.31 " " 9,177.35 " " 9,177.35 " " 8,910.05 " N/A N/A N/A " 21,971.25 " N/A N/A N/A N/A N/A " 9,177.35 " DRG 137 " 54,367.40 " " 17,131.17 " " 10,557.73 " " 43,493.92 " N/A " 22,680.22 " " 11,085.62 " " 22,680.22 " N/A " 21,609.00 " " 10,874.46 " " 21,513.23 " N/A " 10,557.73 " " 31,000.29 " N/A " 10,557.73 " " 13,010.05 " " 16,262.57 " " 10,874.46 " " 10,874.46 " " 10,557.73 " " 43,493.92 " N/A N/A " 26,419.75 " N/A N/A " 40,775.55 " N/A N/A " 10,874.46 " DRG 138 No Current Volume N/A " 6,323.81 " " 14,988.75 " N/A " 12,867.20 " " 6,640.00 " " 12,867.20 " N/A " 12,409.00 " " 6,513.52 " " 12,205.13 " N/A " 6,323.81 " N/A N/A " 6,323.81 " " 11,880.87 " " 14,851.10 " " 6,513.52 " " 6,513.52 " " 6,323.81 " N/A N/A N/A " 14,988.75 " N/A N/A N/A N/A N/A " 6,513.52 " DRG 139 No Current Volume N/A " 8,771.34 " " 24,424.54 " N/A " 18,539.88 " " 9,209.91 " " 18,539.88 " N/A " 15,505.00 " " 9,034.48 " " 17,585.93 " N/A " 8,771.34 " N/A N/A " 8,771.34 " " 19,539.62 " " 24,424.54 " " 9,034.48 " " 9,034.48 " " 8,771.34 " N/A N/A N/A " 21,596.75 " N/A N/A N/A N/A N/A " 9,034.48 " DRG 140 " 120,566.01 " " 37,990.35 " " 26,556.12 " " 96,452.81 " N/A " 59,759.99 " " 27,883.93 " " 59,759.99 " N/A " 62,630.00 " " 27,352.80 " " 56,685.08 " N/A " 26,556.12 " " 68,746.74 " N/A " 26,556.12 " " 56,847.45 " " 71,059.30 " " 27,352.80 " " 27,352.80 " " 26,556.12 " " 96,452.81 " N/A N/A " 69,613.25 " N/A N/A " 90,424.51 " N/A N/A " 27,352.80 " DRG 141 " 90,845.28 " " 28,625.35 " " 15,071.66 " " 72,676.22 " N/A " 33,142.24 " " 15,825.24 " " 33,142.24 " N/A " 34,733.00 " " 15,523.81 " " 31,436.93 " N/A " 15,071.66 " " 51,799.98 " N/A " 15,071.66 " " 27,836.59 " " 34,795.76 " " 15,523.81 " " 15,523.81 " " 15,071.66 " " 72,676.22 " N/A N/A " 38,606.75 " N/A N/A " 68,133.96 " N/A N/A " 15,523.81 " DRG 142 " 75,755.22 " " 23,870.47 " " 11,176.09 " " 60,604.18 " N/A " 24,113.42 " " 11,734.89 " " 24,113.42 " N/A " 25,313.00 " " 11,511.37 " " 22,872.68 " N/A " 11,176.09 " " 43,195.63 " N/A " 11,176.09 " " 24,792.73 " " 30,990.93 " " 11,511.37 " " 11,511.37 " " 11,176.09 " " 60,604.18 " N/A N/A " 28,089.25 " N/A N/A " 56,816.42 " N/A N/A " 11,511.37 " DRG 143 No Current Volume N/A " 20,086.63 " " 52,906.24 " N/A " 44,765.54 " " 21,090.96 " " 44,765.54 " N/A " 46,632.00 " " 20,689.23 " " 42,462.15 " N/A " 20,086.63 " N/A N/A " 20,086.63 " " 42,325.00 " " 52,906.24 " " 20,689.23 " " 20,689.23 " " 20,086.63 " N/A N/A N/A " 52,146.50 " N/A N/A N/A N/A N/A " 20,689.23 " DRG 144 " 125,588.99 " " 39,573.09 " " 12,189.84 " " 100,471.19 " N/A " 26,463.01 " " 12,799.33 " " 26,463.01 " N/A " 27,541.00 " " 12,555.54 " " 25,101.38 " N/A " 12,189.84 " " 71,610.84 " N/A " 12,189.84 " " 16,152.10 " " 20,190.13 " " 12,555.54 " " 12,555.54 " " 12,189.84 " " 100,471.19 " N/A N/A " 30,826.25 " N/A N/A " 94,191.74 " N/A N/A " 12,555.54 " DRG 145 " 23,224.94 " " 7,318.18 " " 8,709.76 " " 21,430.50 " N/A " 18,397.17 " " 9,145.25 " " 18,397.17 " N/A " 19,093.00 " " 8,971.05 " " 17,450.55 " N/A " 8,709.76 " " 13,242.86 " N/A " 8,709.76 " " 11,684.50 " " 14,605.63 " " 8,971.05 " " 8,971.05 " " 8,709.76 " " 18,579.95 " N/A N/A " 21,430.50 " N/A N/A " 17,418.71 " N/A N/A " 8,971.05 " DRG 146 No Current Volume N/A " 14,002.16 " " 39,480.20 " N/A " 30,663.45 " " 14,702.27 " " 30,663.45 " N/A " 31,072.00 " " 14,422.22 " " 29,085.68 " N/A " 14,002.16 " N/A N/A " 14,002.16 " " 31,584.14 " " 39,480.20 " " 14,422.22 " " 14,422.22 " " 14,002.16 " N/A N/A N/A " 35,719.25 " N/A N/A N/A N/A N/A " 14,422.22 " DRG 147 No Current Volume N/A " 9,205.62 " " 22,769.25 " N/A " 19,546.43 " " 9,665.90 " " 19,546.43 " N/A " 20,248.00 " " 9,481.79 " " 18,540.68 " N/A " 9,205.62 " N/A N/A " 9,205.62 " " 15,824.80 " " 19,781.01 " " 9,481.79 " " 9,481.79 " " 9,205.62 " N/A N/A N/A " 22,769.25 " N/A N/A N/A N/A N/A " 9,481.79 " DRG 148 No Current Volume N/A " 5,873.32 " " 15,689.80 " N/A " 11,823.10 " " 6,166.99 " " 11,823.10 " N/A " 12,910.00 " " 6,049.52 " " 11,214.75 " N/A " 5,873.32 " N/A N/A " 5,873.32 " " 12,551.83 " " 15,689.80 " " 6,049.52 " " 6,049.52 " " 5,873.32 " N/A N/A N/A " 13,772.50 " N/A N/A N/A N/A N/A " 6,049.52 " DRG 149 " 34,130.89 " " 10,754.64 " " 5,549.23 " " 27,304.71 " N/A " 11,071.95 " " 5,826.69 " " 11,071.95 " N/A " 9,979.00 " " 5,715.71 " " 10,502.25 " N/A " 5,549.23 " " 19,461.43 " N/A " 5,549.23 " " 9,737.08 " " 12,171.36 " " 5,715.71 " " 5,715.71 " " 5,549.23 " " 27,304.71 " N/A N/A " 12,897.50 " N/A N/A " 25,598.17 " N/A N/A " 5,715.71 " DRG 150 No Current Volume N/A " 9,376.74 " " 26,981.54 " N/A " 19,943.03 " " 9,845.58 " " 19,943.03 " N/A " 20,364.00 " " 9,658.04 " " 18,916.88 " N/A " 9,376.74 " N/A N/A " 9,376.74 " " 21,585.22 " " 26,981.54 " " 9,658.04 " " 9,658.04 " " 9,376.74 " N/A N/A N/A " 23,231.25 " N/A N/A N/A N/A N/A " 9,658.04 " DRG 151 No Current Volume N/A " 5,558.31 " " 12,922.00 " N/A " 11,092.98 " " 5,836.23 " " 11,092.98 " N/A " 10,526.00 " " 5,725.06 " " 10,522.20 " N/A " 5,558.31 " N/A N/A " 5,558.31 " " 9,229.77 " " 11,537.22 " " 5,725.06 " " 5,725.06 " " 5,558.31 " N/A N/A N/A " 12,922.00 " N/A N/A N/A N/A N/A " 5,725.06 " DRG 152 " 62,523.03 " " 19,701.01 " " 7,775.73 " " 50,018.42 " N/A " 16,232.35 " " 8,164.52 " " 16,232.35 " N/A " 15,989.00 " " 8,009.00 " " 15,397.13 " N/A " 7,775.73 " " 35,650.63 " N/A " 7,775.73 " " 12,748.21 " " 15,935.27 " " 8,009.00 " " 8,009.00 " " 7,775.73 " " 50,018.42 " N/A N/A " 18,908.75 " N/A N/A " 46,892.27 " N/A N/A " 8,009.00 " DRG 153 " 20,812.01 " " 6,557.86 " " 5,394.97 " " 16,649.61 " N/A " 10,714.40 " " 5,664.72 " " 10,714.40 " N/A " 10,831.00 " " 5,556.82 " " 10,163.10 " N/A " 5,394.97 " " 11,867.01 " N/A " 5,394.97 " " 6,316.83 " " 7,896.04 " " 5,556.82 " " 5,556.82 " " 5,394.97 " " 16,649.61 " N/A N/A " 12,481.00 " N/A N/A " 15,609.01 " N/A N/A " 5,556.82 " DRG 154 No Current Volume N/A " 10,798.20 " " 27,069.00 " N/A " 23,237.58 " " 11,338.11 " " 23,237.58 " N/A " 21,559.00 " " 11,122.15 " " 22,041.90 " N/A " 10,798.20 " N/A N/A " 10,798.20 " " 21,454.31 " " 26,817.89 " " 11,122.15 " " 11,122.15 " " 10,798.20 " N/A N/A N/A " 27,069.00 " N/A N/A N/A N/A N/A " 11,122.15 " DRG 155 " 31,308.06 " " 9,865.17 " " 6,667.34 " " 25,046.45 " N/A " 13,663.42 " " 7,000.71 " " 13,663.42 " N/A " 13,921.00 " " 6,867.36 " " 12,960.38 " N/A " 6,667.34 " " 17,851.86 " N/A " 6,667.34 " " 8,689.73 " " 10,862.17 " " 6,867.36 " " 6,867.36 " " 6,667.34 " " 25,046.45 " N/A N/A " 15,916.25 " N/A N/A " 23,481.05 " N/A N/A " 6,867.36 " DRG 156 " 28,476.45 " " 8,972.93 " " 5,039.76 " " 22,781.16 " N/A " 9,891.14 " " 5,291.75 " " 9,891.14 " N/A " 10,252.00 " " 5,190.95 " " 9,382.20 " N/A " 5,039.76 " " 16,237.27 " N/A " 5,039.76 " " 7,282.35 " " 9,102.95 " " 5,190.95 " " 5,190.95 " " 5,039.76 " " 22,781.16 " N/A N/A " 11,522.00 " N/A N/A " 21,357.34 " N/A N/A " 5,190.95 " DRG 157 " 39,626.54 " " 12,486.32 " " 10,988.77 " " 31,701.23 " N/A " 23,679.25 " " 11,538.21 " " 23,679.25 " N/A " 24,881.00 " " 11,318.43 " " 22,460.85 " N/A " 10,988.77 " " 22,595.05 " N/A " 10,988.77 " " 25,349.14 " " 31,686.44 " " 11,318.43 " " 11,318.43 " " 10,988.77 " " 31,701.23 " N/A N/A " 27,583.50 " N/A N/A " 29,719.91 " N/A N/A " 11,318.43 " DRG 158 " 19,448.69 " " 6,128.28 " " 6,607.06 " " 15,753.50 " N/A " 13,523.70 " " 6,937.41 " " 13,523.70 " N/A " 13,404.00 " " 6,805.27 " " 12,827.85 " N/A " 6,607.06 " " 11,089.64 " N/A " 6,607.06 " " 9,622.53 " " 12,028.16 " " 6,805.27 " " 6,805.27 " " 6,607.06 " " 15,558.95 " N/A N/A " 15,753.50 " N/A N/A " 14,586.51 " N/A N/A " 6,805.27 " DRG 159 " 28,832.10 " " 9,084.99 " " 5,070.23 " " 23,065.68 " N/A " 9,961.75 " " 5,323.74 " " 9,961.75 " N/A " 9,337.00 " " 5,222.34 " " 9,449.18 " N/A " 5,070.23 " " 16,440.06 " N/A " 5,070.23 " " 7,020.52 " " 8,775.65 " " 5,222.34 " " 5,222.34 " " 5,070.23 " " 23,065.68 " N/A N/A " 11,604.25 " N/A N/A " 21,624.08 " N/A N/A " 5,222.34 " DRG 163 " 232,595.32 " " 73,290.78 " " 33,225.26 " " 186,076.25 " N/A " 75,217.16 " " 34,886.52 " " 75,217.16 " N/A " 79,191.00 " " 34,222.02 " " 71,346.90 " N/A " 33,225.26 " " 132,625.85 " N/A " 33,225.26 " " 49,764.72 " " 62,205.89 " " 34,222.02 " " 34,222.02 " " 33,225.26 " " 186,076.25 " N/A N/A " 87,619.00 " N/A N/A " 174,446.49 " N/A N/A " 34,222.02 " DRG 164 No Current Volume N/A " 17,985.23 " " 46,473.00 " N/A " 39,895.08 " " 18,884.49 " " 39,895.08 " N/A " 40,922.00 " " 18,524.79 " " 37,842.30 " N/A " 17,985.23 " N/A N/A " 17,985.23 " " 32,058.72 " " 40,073.42 " " 18,524.79 " " 18,524.79 " " 17,985.23 " N/A N/A N/A " 46,473.00 " N/A N/A N/A N/A N/A " 18,524.79 " DRG 165 No Current Volume N/A " 13,195.17 " " 33,540.50 " N/A " 28,793.08 " " 13,854.93 " " 28,793.08 " N/A " 28,667.00 " " 13,591.03 " " 27,311.55 " N/A " 13,195.17 " N/A N/A " 13,195.17 " " 24,743.64 " " 30,929.56 " " 13,591.03 " " 13,591.03 " " 13,195.17 " N/A N/A N/A " 33,540.50 " N/A N/A N/A N/A N/A " 13,591.03 " DRG 166 " 308,868.52 " " 97,324.47 " " 24,907.15 " " 247,094.82 " N/A " 55,938.14 " " 26,152.51 " " 55,938.14 " N/A " 57,599.00 " " 25,654.36 " " 53,059.88 " N/A " 24,907.15 " " 176,116.83 " N/A " 24,907.15 " " 37,241.43 " " 46,551.78 " " 25,654.36 " " 25,654.36 " " 24,907.15 " " 247,094.82 " N/A N/A " 65,161.25 " N/A N/A " 231,651.39 " N/A N/A " 25,654.36 " DRG 167 " 100,360.38 " " 31,623.56 " " 12,560.60 " " 80,288.30 " N/A " 27,322.33 " " 13,188.63 " " 27,322.33 " N/A " 31,180.00 " " 12,937.42 " " 25,916.48 " N/A " 12,560.60 " " 57,225.49 " N/A " 12,560.60 " " 24,138.14 " " 30,172.69 " " 12,937.42 " " 12,937.42 " " 12,560.60 " " 80,288.30 " N/A N/A " 31,827.25 " N/A N/A " 75,270.28 " N/A N/A " 12,937.42 " DRG 168 " 36,714.58 " " 11,568.77 " " 9,551.10 " " 29,371.67 " N/A " 20,347.15 " " 10,028.66 " " 20,347.15 " N/A " 20,911.00 " " 9,837.63 " " 19,300.20 " N/A " 9,551.10 " " 20,934.66 " N/A " 9,551.10 " " 18,017.69 " " 22,522.12 " " 9,837.63 " " 9,837.63 " " 9,551.10 " " 29,371.67 " N/A N/A " 23,702.00 " N/A N/A " 27,535.94 " N/A N/A " 9,837.63 " DRG 175 " 52,870.93 " " 16,659.63 " " 10,793.02 " " 42,296.74 " N/A " 23,225.56 " " 11,332.67 " " 23,225.56 " N/A " 24,027.00 " " 11,116.81 " " 22,030.50 " N/A " 10,793.02 " " 30,147.00 " N/A " 10,793.02 " " 17,935.86 " " 22,419.84 " " 11,116.81 " " 11,116.81 " " 10,793.02 " " 42,296.74 " N/A N/A " 27,055.00 " N/A N/A " 39,653.20 " N/A N/A " 11,116.81 " DRG 176 " 31,692.45 " " 9,986.29 " " 6,526.69 " " 25,353.96 " N/A " 13,337.42 " " 6,853.02 " " 13,337.42 " N/A " 15,215.00 " " 6,722.49 " " 12,651.15 " N/A " 6,526.69 " " 18,071.04 " N/A " 6,526.69 " " 10,604.42 " " 13,255.53 " " 6,722.49 " " 6,722.49 " " 6,526.69 " " 25,353.96 " N/A N/A " 15,536.50 " N/A N/A " 23,769.34 " N/A N/A " 6,722.49 " DRG 177 " 83,855.84 " " 26,422.98 " " 12,757.65 " " 67,084.67 " N/A " 27,779.03 " " 13,395.53 " " 27,779.03 " N/A " 30,668.00 " " 13,140.38 " " 26,349.68 " N/A " 12,757.65 " " 47,814.60 " N/A " 12,757.65 " " 21,028.82 " " 26,286.04 " " 13,140.38 " " 13,140.38 " " 12,757.65 " " 67,084.67 " N/A N/A " 32,359.25 " N/A N/A " 62,891.88 " N/A N/A " 13,140.38 " DRG 178 " 45,923.60 " " 14,470.53 " " 8,600.87 " " 36,738.88 " N/A " 18,144.78 " " 9,030.91 " " 18,144.78 " N/A " 21,883.00 " " 8,858.90 " " 17,211.15 " N/A " 8,600.87 " " 26,185.64 " N/A " 8,600.87 " " 16,135.73 " " 20,169.68 " " 8,858.90 " " 8,858.90 " " 8,600.87 " " 36,738.88 " N/A N/A " 21,136.50 " N/A N/A " 34,442.70 " N/A N/A " 8,858.90 " DRG 179 " 28,573.79 " " 9,003.60 " " 6,428.81 " " 22,859.03 " N/A " 13,110.57 " " 6,750.25 " " 13,110.57 " N/A " 15,250.00 " " 6,621.67 " " 12,435.98 " N/A " 6,428.81 " " 16,292.78 " N/A " 6,428.81 " " 11,291.74 " " 14,114.68 " " 6,621.67 " " 6,621.67 " " 6,428.81 " " 22,859.03 " N/A N/A " 15,272.25 " N/A N/A " 21,430.34 " N/A N/A " 6,621.67 " DRG 180 " 70,250.38 " " 22,135.89 " " 12,049.84 " " 56,200.30 " N/A " 26,138.52 " " 12,652.33 " " 26,138.52 " N/A " 26,542.00 " " 12,411.34 " " 24,793.58 " N/A " 12,049.84 " " 40,056.77 " N/A " 12,049.84 " " 22,076.17 " " 27,595.22 " " 12,411.34 " " 12,411.34 " " 12,049.84 " " 56,200.30 " N/A N/A " 30,448.25 " N/A N/A " 52,687.79 " N/A N/A " 12,411.34 " DRG 181 " 45,141.98 " " 14,224.24 " " 8,032.41 " " 36,113.59 " N/A " 16,827.26 " " 8,434.03 " " 16,827.26 " N/A " 18,223.00 " " 8,273.38 " " 15,961.43 " N/A " 8,032.41 " " 25,739.96 " N/A " 8,032.41 " " 15,022.92 " " 18,778.66 " " 8,273.38 " " 8,273.38 " " 8,032.41 " " 36,113.59 " N/A N/A " 19,601.75 " N/A N/A " 33,856.49 " N/A N/A " 8,273.38 " DRG 182 " 27,697.32 " " 8,727.43 " " 5,905.73 " " 22,157.86 " N/A " 11,898.22 " " 6,201.02 " " 11,898.22 " N/A " 12,724.00 " " 6,082.90 " " 11,286.00 " N/A " 5,905.73 " " 15,793.01 " N/A " 5,905.73 " " 13,026.41 " " 16,283.02 " " 6,082.90 " " 6,082.90 " " 5,905.73 " " 22,157.86 " N/A N/A " 13,860.00 " N/A N/A " 20,772.99 " N/A N/A " 6,082.90 " DRG 183 " 73,290.96 " " 23,093.98 " " 10,876.63 " " 58,632.77 " N/A " 23,419.35 " " 11,420.46 " " 23,419.35 " N/A " 23,760.00 " " 11,202.93 " " 22,214.33 " N/A " 10,876.63 " " 41,790.50 " N/A " 10,876.63 " " 18,639.55 " " 23,299.45 " " 11,202.93 " " 11,202.93 " " 10,876.63 " " 58,632.77 " N/A N/A " 27,280.75 " N/A N/A " 54,968.22 " N/A N/A " 11,202.93 " DRG 184 " 37,653.16 " " 11,864.51 " " 7,519.05 " " 30,122.53 " N/A " 15,637.44 " " 7,895.00 " " 15,637.44 " N/A " 15,558.00 " " 7,744.62 " " 14,832.83 " N/A " 7,519.05 " " 21,469.83 " N/A " 7,519.05 " " 13,746.47 " " 17,183.09 " " 7,744.62 " " 7,744.62 " " 7,519.05 " " 30,122.53 " N/A N/A " 18,215.75 " N/A N/A " 28,239.87 " N/A N/A " 7,744.62 " DRG 185 " 61,406.40 " " 19,349.16 " " 5,794.89 " " 49,125.12 " N/A " 11,641.32 " " 6,084.63 " " 11,641.32 " N/A " 10,428.00 " " 5,968.74 " " 11,042.33 " N/A " 5,794.89 " " 35,013.93 " N/A " 5,794.89 " " 10,604.42 " " 13,255.53 " " 5,968.74 " " 5,968.74 " " 5,794.89 " " 49,125.12 " N/A N/A " 13,560.75 " N/A N/A " 46,054.80 " N/A N/A " 5,968.74 " DRG 186 " 80,254.06 " " 25,288.05 " " 10,778.76 " " 64,203.24 " N/A " 23,192.51 " " 11,317.70 " " 23,192.51 " N/A " 24,312.00 " " 11,102.12 " " 21,999.15 " N/A " 10,778.76 " " 45,760.86 " N/A " 10,778.76 " " 17,706.76 " " 22,133.46 " " 11,102.12 " " 11,102.12 " " 10,778.76 " " 64,203.24 " N/A N/A " 27,016.50 " N/A N/A " 60,190.54 " N/A N/A " 11,102.12 " DRG 187 " 37,277.10 " " 11,746.01 " " 7,467.20 " " 29,821.68 " N/A " 15,517.26 " " 7,840.56 " " 15,517.26 " N/A " 16,819.00 " " 7,691.22 " " 14,718.83 " N/A " 7,467.20 " " 21,255.40 " N/A " 7,467.20 " " 13,861.02 " " 17,326.28 " " 7,691.22 " " 7,691.22 " " 7,467.20 " " 29,821.68 " N/A N/A " 18,075.75 " N/A N/A " 27,957.83 " N/A N/A " 7,691.22 " DRG 188 " 182,187.59 " " 57,407.31 " " 5,500.62 " " 145,750.07 " N/A " 10,959.28 " " 5,775.65 " " 10,959.28 " N/A " 11,971.00 " " 5,665.64 " " 10,395.38 " N/A " 5,500.62 " " 103,883.36 " N/A " 5,500.62 " " 9,638.89 " " 12,048.62 " " 5,665.64 " " 5,665.64 " " 5,500.62 " " 145,750.07 " N/A N/A " 12,766.25 " N/A N/A " 136,640.69 " N/A N/A " 5,665.64 " DRG 189 " 68,761.83 " " 21,666.85 " " 8,719.48 " " 55,009.47 " N/A " 18,419.70 " " 9,155.45 " " 18,419.70 " N/A " 19,094.00 " " 8,981.06 " " 17,471.93 " N/A " 8,719.48 " " 39,208.00 " N/A " 8,719.48 " " 14,777.45 " " 18,471.82 " " 8,981.06 " " 8,981.06 " " 8,719.48 " " 55,009.47 " N/A N/A " 21,456.75 " N/A N/A " 51,571.37 " N/A N/A " 8,981.06 " DRG 190 " 58,836.05 " " 18,539.24 " " 8,064.82 " " 47,068.84 " N/A " 16,902.38 " " 8,468.06 " " 16,902.38 " N/A " 18,476.00 " " 8,306.76 " " 16,032.68 " N/A " 8,064.82 " " 33,548.32 " N/A " 8,064.82 " " 13,010.05 " " 16,262.57 " " 8,306.76 " " 8,306.76 " " 8,064.82 " " 47,068.84 " N/A N/A " 19,689.25 " N/A N/A " 44,127.04 " N/A N/A " 8,306.76 " DRG 191 " 43,811.23 " " 13,804.92 " " 6,504.00 " " 35,048.99 " N/A " 13,284.84 " " 6,829.20 " " 13,284.84 " N/A " 14,742.00 " " 6,699.12 " " 12,601.28 " N/A " 6,504.00 " " 24,981.17 " N/A " 6,504.00 " " 10,948.08 " " 13,685.10 " " 6,699.12 " " 6,699.12 " " 6,504.00 " " 35,048.99 " N/A N/A " 15,475.25 " N/A N/A " 32,858.43 " N/A N/A " 6,699.12 " DRG 192 " 42,689.22 " " 13,451.37 " " 5,280.89 " " 34,151.37 " N/A " 10,450.00 " " 5,544.93 " " 10,450.00 " N/A " 11,312.00 " " 5,439.32 " " 9,912.30 " N/A " 5,280.89 " " 24,341.39 " N/A " 5,280.89 " " 8,853.38 " " 11,066.73 " " 5,439.32 " " 5,439.32 " " 5,280.89 " " 34,151.37 " N/A N/A " 12,173.00 " N/A N/A " 32,016.91 " N/A N/A " 5,439.32 " DRG 193 " 49,064.66 " " 15,460.27 " " 9,276.27 " " 39,251.73 " N/A " 19,710.18 " " 9,740.08 " " 19,710.18 " N/A " 22,798.00 " " 9,554.56 " " 18,696.00 " N/A " 9,276.27 " " 27,976.67 " N/A " 9,276.27 " " 15,775.71 " " 19,719.64 " " 9,554.56 " " 9,554.56 " " 9,276.27 " " 39,251.73 " N/A N/A " 22,960.00 " N/A N/A " 36,798.49 " N/A N/A " 9,554.56 " DRG 194 " 39,024.27 " " 12,296.55 " " 6,371.77 " " 31,219.41 " N/A " 12,978.37 " " 6,690.36 " " 12,978.37 " N/A " 15,243.00 " " 6,562.92 " " 12,310.58 " N/A " 6,371.77 " " 22,251.64 " N/A " 6,371.77 " " 10,195.30 " " 12,744.13 " " 6,562.92 " " 6,562.92 " " 6,371.77 " " 31,219.41 " N/A N/A " 15,118.25 " N/A N/A " 29,268.20 " N/A N/A " 6,562.92 " DRG 195 " 34,199.69 " " 10,776.32 " " 5,087.73 " " 27,359.75 " N/A " 10,002.31 " " 5,342.12 " " 10,002.31 " N/A " 11,083.00 " " 5,240.36 " " 9,487.65 " N/A " 5,087.73 " " 19,500.66 " N/A " 5,087.73 " " 7,495.10 " " 9,368.88 " " 5,240.36 " " 5,240.36 " " 5,087.73 " " 27,359.75 " N/A N/A " 11,651.50 " N/A N/A " 25,649.77 " N/A N/A " 5,240.36 " DRG 196 " 70,817.74 " " 22,314.67 " " 12,041.41 " " 56,654.19 " N/A " 26,118.99 " " 12,643.48 " " 26,118.99 " N/A " 26,172.00 " " 12,402.65 " " 24,775.05 " N/A " 12,041.41 " " 40,380.27 " N/A " 12,041.41 " " 21,307.02 " " 26,633.79 " " 12,402.65 " " 12,402.65 " " 12,041.41 " " 56,654.19 " N/A N/A " 30,425.50 " N/A N/A " 53,113.30 " N/A N/A " 12,402.65 " DRG 197 " 59,546.38 " " 18,763.06 " " 7,299.32 " " 47,637.10 " N/A " 15,128.16 " " 7,664.29 " " 15,128.16 " N/A " 16,701.00 " " 7,518.30 " " 14,349.75 " N/A " 7,299.32 " " 33,953.35 " N/A " 7,299.32 " " 14,744.72 " " 18,430.91 " " 7,518.30 " " 7,518.30 " " 7,299.32 " " 47,637.10 " N/A N/A " 17,622.50 " N/A N/A " 44,659.79 " N/A N/A " 7,518.30 " DRG 198 No Current Volume N/A " 5,590.72 " " 14,892.01 " N/A " 11,168.10 " " 5,870.26 " " 11,168.10 " N/A " 12,673.00 " " 5,758.44 " " 10,593.45 " N/A " 5,590.72 " N/A N/A " 5,590.72 " " 11,913.60 " " 14,892.01 " " 5,758.44 " " 5,758.44 " " 5,590.72 " N/A N/A N/A " 13,009.50 " N/A N/A N/A N/A N/A " 5,758.44 " DRG 199 " 86,552.13 " " 27,272.58 " " 12,374.58 " " 69,241.70 " N/A " 26,891.17 " " 12,993.31 " " 26,891.17 " N/A " 28,862.00 " " 12,745.82 " " 25,507.50 " N/A " 12,374.58 " " 49,352.03 " N/A " 12,374.58 " " 18,361.35 " " 22,951.70 " " 12,745.82 " " 12,745.82 " " 12,374.58 " " 69,241.70 " N/A N/A " 31,325.00 " N/A N/A " 64,914.10 " N/A N/A " 12,745.82 " DRG 200 " 44,461.83 " " 14,009.92 " " 7,749.81 " " 35,569.46 " N/A " 16,172.26 " " 8,137.30 " " 16,172.26 " N/A " 15,865.00 " " 7,982.30 " " 15,340.13 " N/A " 7,749.81 " " 25,352.13 " N/A " 7,749.81 " " 12,764.58 " " 15,955.73 " " 7,982.30 " " 7,982.30 " " 7,749.81 " " 35,569.46 " N/A N/A " 18,838.75 " N/A N/A " 33,346.37 " N/A N/A " 7,982.30 " DRG 201 " 36,943.00 " " 11,640.74 " " 5,371.63 " " 29,554.40 " N/A " 10,660.32 " " 5,640.21 " " 10,660.32 " N/A " 11,164.00 " " 5,532.78 " " 10,111.80 " N/A " 5,371.63 " " 21,064.90 " N/A " 5,371.63 " " 7,462.37 " " 9,327.96 " " 5,532.78 " " 5,532.78 " " 5,371.63 " " 29,554.40 " N/A N/A " 12,418.00 " N/A N/A " 27,707.25 " N/A N/A " 5,532.78 " DRG 202 " 36,317.81 " " 11,443.74 " " 7,040.05 " " 29,054.25 " N/A " 14,527.24 " " 7,392.05 " " 14,527.24 " N/A " 13,807.00 " " 7,251.25 " " 13,779.75 " N/A " 7,040.05 " " 20,708.41 " N/A " 7,040.05 " " 10,244.39 " " 12,805.49 " " 7,251.25 " " 7,251.25 " " 7,040.05 " " 29,054.25 " N/A N/A " 16,922.50 " N/A N/A " 27,238.35 " N/A N/A " 7,251.25 " DRG 203 " 46,385.32 " " 14,616.01 " " 5,354.78 " " 37,108.25 " N/A " 10,621.26 " " 5,622.52 " " 10,621.26 " N/A " 10,281.00 " " 5,515.42 " " 10,074.75 " N/A " 5,354.78 " " 26,448.91 " N/A " 5,354.78 " " 6,578.67 " " 8,223.34 " " 5,515.42 " " 5,515.42 " " 5,354.78 " " 37,108.25 " N/A N/A " 12,372.50 " N/A N/A " 34,788.99 " N/A N/A " 5,515.42 " DRG 204 " 278,252.07 " " 87,677.23 " " 5,916.10 " " 222,601.66 " N/A " 11,922.25 " " 6,211.91 " " 11,922.25 " N/A " 11,077.00 " " 6,093.58 " " 11,308.80 " N/A " 5,916.10 " " 158,659.33 " N/A " 5,916.10 " " 10,228.03 " " 12,785.04 " " 6,093.58 " " 6,093.58 " " 5,916.10 " " 222,601.66 " N/A N/A " 13,888.00 " N/A N/A " 208,689.05 " N/A N/A " 6,093.58 " DRG 205 " 93,317.53 " " 29,404.35 " " 11,692.69 " " 74,654.03 " N/A " 25,310.75 " " 12,277.32 " " 25,310.75 " N/A " 22,025.00 " " 12,043.47 " " 24,008.40 " N/A " 11,692.69 " " 53,209.66 " N/A " 11,692.69 " " 18,083.15 " " 22,603.95 " " 12,043.47 " " 12,043.47 " " 11,692.69 " " 74,654.03 " N/A N/A " 29,484.00 " N/A N/A " 69,988.15 " N/A N/A " 12,043.47 " DRG 206 " 36,852.27 " " 11,612.15 " " 6,515.02 " " 29,481.82 " N/A " 13,310.38 " " 6,840.77 " " 13,310.38 " N/A " 12,495.00 " " 6,710.47 " " 12,625.50 " N/A " 6,515.02 " " 21,013.16 " N/A " 6,515.02 " " 10,244.39 " " 12,805.49 " " 6,710.47 " " 6,710.47 " " 6,515.02 " " 29,481.82 " N/A N/A " 15,505.00 " N/A N/A " 27,639.20 " N/A N/A " 6,710.47 " DRG 207 " 241,526.27 " " 76,104.93 " " 37,952.44 " " 193,221.02 " N/A " 86,173.43 " " 39,850.06 " " 86,173.43 " N/A " 84,056.00 " " 39,091.01 " " 81,739.43 " N/A " 37,952.44 " " 137,718.28 " N/A " 37,952.44 " " 68,571.07 " " 85,713.83 " " 39,091.01 " " 39,091.01 " " 37,952.44 " " 193,221.02 " N/A N/A " 100,381.75 " N/A N/A " 181,144.70 " N/A N/A " 39,091.01 " DRG 208 " 101,013.94 " " 31,829.49 " " 17,267.05 " " 80,811.15 " N/A " 38,230.53 " " 18,130.40 " " 38,230.53 " N/A " 36,140.00 " " 17,785.06 " " 36,263.40 " N/A " 17,267.05 " " 57,598.15 " N/A " 17,267.05 " " 30,258.59 " " 37,823.25 " " 17,785.06 " " 17,785.06 " " 17,267.05 " " 80,811.15 " N/A N/A " 44,534.00 " N/A N/A " 75,760.46 " N/A N/A " 17,785.06 " DRG 215 " 331,154.03 " " 104,346.63 " " 69,209.66 " " 264,923.22 " N/A " 158,618.84 " " 72,670.14 " " 158,618.84 " N/A " 242,842.00 " " 71,285.95 " " 150,457.20 " N/A " 69,209.66 " " 188,824.03 " N/A " 69,209.66 " " 107,711.70 " " 134,639.61 " " 71,285.95 " " 71,285.95 " " 69,209.66 " " 264,923.22 " N/A N/A " 184,772.00 " N/A N/A " 248,365.52 " N/A N/A " 71,285.95 " DRG 216 " 330,171.07 " " 104,036.90 " " 65,844.96 " " 264,136.86 " N/A " 150,820.40 " " 69,137.21 " " 150,820.40 " N/A " 149,840.00 " " 67,820.31 " " 143,060.03 " N/A " 65,844.96 " " 188,263.54 " N/A " 65,844.96 " " 96,887.70 " " 121,109.60 " " 67,820.31 " " 67,820.31 " " 65,844.96 " " 264,136.86 " N/A N/A " 175,687.75 " N/A N/A " 247,628.30 " N/A N/A " 67,820.31 " DRG 217 " 257,799.49 " " 81,232.62 " " 42,796.94 " " 206,239.59 " N/A " 97,401.62 " " 44,936.79 " " 97,401.62 " N/A " 99,579.00 " " 44,080.85 " " 92,389.88 " N/A " 42,796.94 " " 146,997.27 " N/A " 42,796.94 " " 62,045.25 " " 77,556.56 " " 44,080.85 " " 44,080.85 " " 42,796.94 " " 206,239.59 " N/A N/A " 113,461.25 " N/A N/A " 193,349.61 " N/A N/A " 44,080.85 " DRG 218 No Current Volume N/A " 40,371.45 " " 106,912.75 " N/A " 91,780.01 " " 42,390.02 " " 91,780.01 " N/A " 87,625.00 " " 41,582.59 " " 87,057.53 " N/A " 40,371.45 " N/A N/A " 40,371.45 " " 51,435.44 " " 64,294.30 " " 41,582.59 " " 41,582.59 " " 40,371.45 " N/A N/A N/A " 106,912.75 " N/A N/A N/A N/A N/A " 41,582.59 " DRG 219 " 154,899.85 " " 48,808.94 " " 52,999.96 " " 141,008.00 " N/A " 121,049.32 " " 55,649.96 " " 121,049.32 " N/A " 121,254.00 " " 54,589.96 " " 114,820.80 " N/A " 52,999.96 " " 88,323.89 " N/A " 52,999.96 " " 74,525.70 " " 93,157.11 " " 54,589.96 " " 54,589.96 " " 52,999.96 " " 123,919.88 " N/A N/A " 141,008.00 " N/A N/A " 116,174.89 " N/A N/A " 54,589.96 " DRG 220 " 151,622.29 " " 47,776.18 " " 35,808.26 " " 121,297.83 " N/A " 81,203.82 " " 37,598.67 " " 81,203.82 " N/A " 81,901.00 " " 36,882.51 " " 77,025.53 " N/A " 35,808.26 " " 86,455.03 " N/A " 35,808.26 " " 57,461.47 " " 71,826.83 " " 36,882.51 " " 36,882.51 " " 35,808.26 " " 121,297.83 " N/A N/A " 94,592.75 " N/A N/A " 113,716.72 " N/A N/A " 36,882.51 " DRG 221 No Current Volume N/A " 30,458.17 " " 80,148.25 " N/A " 68,803.84 " " 31,981.08 " " 68,803.84 " N/A " 72,921.00 " " 31,371.92 " " 65,263.58 " N/A " 30,458.17 " N/A N/A " 30,458.17 " " 44,395.56 " " 55,494.44 " " 31,371.92 " " 31,371.92 " " 30,458.17 " N/A N/A N/A " 80,148.25 " N/A N/A N/A N/A N/A " 31,371.92 " DRG 222 " 406,412.18 " " 128,060.48 " " 52,309.00 " " 325,129.75 " N/A " 119,447.87 " " 54,924.45 " " 119,447.87 " N/A " 136,204.00 " " 53,878.27 " " 113,301.75 " N/A " 52,309.00 " " 231,736.23 " N/A " 52,309.00 " " 110,867.51 " " 138,584.37 " " 53,878.27 " " 53,878.27 " " 52,309.00 " " 325,129.75 " N/A N/A " 139,142.50 " N/A N/A " 304,809.14 " N/A N/A " 53,878.27 " DRG 223 " 354,137.00 " " 111,588.57 " " 38,357.55 " " 283,309.60 " N/A " 87,112.37 " " 40,275.43 " " 87,112.37 " N/A " 99,001.00 " " 39,508.28 " " 82,630.05 " N/A " 38,357.55 " " 201,928.92 " N/A " 38,357.55 " " 88,733.99 " " 110,917.48 " " 39,508.28 " " 39,508.28 " " 38,357.55 " " 283,309.60 " N/A N/A " 101,475.50 " N/A N/A " 265,602.75 " N/A N/A " 39,508.28 " DRG 224 " 449,329.51 " " 141,583.73 " " 49,509.50 " " 359,463.61 " N/A " 112,959.44 " " 51,984.98 " " 112,959.44 " N/A " 120,727.00 " " 50,994.79 " " 107,147.18 " N/A " 49,509.50 " " 256,207.69 " N/A " 49,509.50 " " 91,218.66 " " 114,023.31 " " 50,994.79 " " 50,994.79 " " 49,509.50 " " 359,463.61 " N/A N/A " 131,584.25 " N/A N/A " 336,997.13 " N/A N/A " 50,994.79 " DRG 225 " 295,051.61 " " 92,970.76 " " 37,185.64 " " 236,041.29 " N/A " 84,396.21 " " 39,044.92 " " 84,396.21 " N/A " 92,214.00 " " 38,301.21 " " 80,053.65 " N/A " 37,185.64 " " 168,238.43 " N/A " 37,185.64 " " 62,459.36 " " 78,074.19 " " 38,301.21 " " 38,301.21 " " 37,185.64 " " 236,041.29 " N/A N/A " 98,311.50 " N/A N/A " 221,288.71 " N/A N/A " 38,301.21 " DRG 226 " 311,178.34 " " 98,052.29 " " 43,325.21 " " 248,942.67 " N/A " 98,626.00 " " 45,491.47 " " 98,626.00 " N/A " 109,461.00 " " 44,624.97 " " 93,551.25 " N/A " 43,325.21 " " 177,433.89 " N/A " 43,325.21 " " 80,451.77 " " 100,564.70 " " 44,624.97 " " 44,624.97 " " 43,325.21 " " 248,942.67 " N/A N/A " 114,887.50 " N/A N/A " 233,383.75 " N/A N/A " 44,624.97 " DRG 227 " 285,682.84 " " 90,018.66 " " 34,555.97 " " 228,546.27 " N/A " 78,301.38 " " 36,283.77 " " 78,301.38 " N/A " 85,737.00 " " 35,592.65 " " 74,272.43 " N/A " 34,555.97 " " 162,896.35 " N/A " 34,555.97 " " 56,476.17 " " 70,595.21 " " 35,592.65 " " 35,592.65 " " 34,555.97 " " 228,546.27 " N/A N/A " 91,211.75 " N/A N/A " 214,262.13 " N/A N/A " 35,592.65 " DRG 228 " 214,194.51 " " 67,492.69 " " 35,322.12 " " 171,355.60 " N/A " 80,077.10 " " 37,088.23 " " 80,077.10 " N/A " 115,030.00 " " 36,381.78 " " 75,956.78 " N/A " 35,322.12 " " 122,133.71 " N/A " 35,322.12 " " 83,307.71 " " 104,134.62 " " 36,381.78 " " 36,381.78 " " 35,322.12 " " 171,355.60 " N/A N/A " 93,280.25 " N/A N/A " 160,645.88 " N/A N/A " 36,381.78 " DRG 229 " 222,021.03 " " 69,958.83 " " 23,077.34 " " 177,616.83 " N/A " 51,697.15 " " 24,231.21 " " 51,697.15 " N/A " 70,181.00 " " 23,769.66 " " 49,037.10 " N/A " 23,077.34 " " 126,596.39 " N/A " 23,077.34 " " 50,078.87 " " 62,598.58 " " 23,769.66 " " 23,769.66 " " 23,077.34 " " 177,616.83 " N/A N/A " 60,221.00 " N/A N/A " 166,515.78 " N/A N/A " 23,769.66 " DRG 231 " 562,601.09 " " 177,275.60 " " 57,266.93 " " 450,080.87 " N/A " 130,938.97 " " 60,130.28 " " 130,938.97 " N/A " 121,536.00 " " 58,984.94 " " 124,201.58 " N/A " 57,266.93 " " 320,795.14 " N/A " 57,266.93 " " 96,273.67 " " 120,342.07 " " 58,984.94 " " 58,984.94 " " 57,266.93 " " 450,080.87 " N/A N/A " 152,528.25 " N/A N/A " 421,950.82 " N/A N/A " 58,984.94 " DRG 232 " 223,545.15 " " 70,439.08 " " 39,363.53 " " 178,836.12 " N/A " 89,443.94 " " 41,331.71 " " 89,443.94 " N/A " 88,070.00 " " 40,544.44 " " 84,841.65 " N/A " 39,363.53 " " 127,465.44 " N/A " 39,363.53 " " 70,998.62 " " 88,748.26 " " 40,544.44 " " 40,544.44 " " 39,363.53 " " 178,836.12 " N/A N/A " 104,191.50 " N/A N/A " 167,658.86 " N/A N/A " 40,544.44 " DRG 233 " 191,732.97 " " 60,415.06 " " 52,122.97 " " 153,386.38 " N/A " 119,016.71 " " 54,729.12 " " 119,016.71 " N/A " 115,629.00 " " 53,686.66 " " 112,892.78 " N/A " 52,122.97 " " 109,326.14 " N/A " 52,122.97 " " 73,697.48 " " 92,121.84 " " 53,686.66 " " 53,686.66 " " 52,122.97 " " 153,386.38 " N/A N/A " 138,640.25 " N/A N/A " 143,799.73 " N/A N/A " 53,686.66 " DRG 234 " 154,925.45 " " 48,817.01 " " 35,359.07 " " 123,940.36 " N/A " 80,162.73 " " 37,127.02 " " 80,162.73 " N/A " 76,804.00 " " 36,419.84 " " 76,038.00 " N/A " 35,359.07 " " 88,338.49 " N/A " 35,359.07 " " 57,547.15 " " 71,933.93 " " 36,419.84 " " 36,419.84 " " 35,359.07 " " 123,940.36 " N/A N/A " 93,380.00 " N/A N/A " 116,194.08 " N/A N/A " 36,419.84 " DRG 235 " 213,165.78 " " 67,168.54 " " 40,337.74 " " 170,532.62 " N/A " 91,701.89 " " 42,354.63 " " 91,701.89 " N/A " 89,822.00 " " 41,547.87 " " 86,983.43 " N/A " 40,337.74 " " 121,547.13 " N/A " 40,337.74 " " 55,933.55 " " 69,916.92 " " 41,547.87 " " 41,547.87 " " 40,337.74 " " 170,532.62 " N/A N/A " 106,821.75 " N/A N/A " 159,874.33 " N/A N/A " 41,547.87 " DRG 236 " 126,462.79 " " 39,848.43 " " 27,328.11 " " 101,170.23 " N/A " 61,549.23 " " 28,694.52 " " 61,549.23 " N/A " 59,712.00 " " 28,147.95 " " 58,382.25 " N/A " 27,328.11 " " 72,109.08 " N/A " 27,328.11 " " 43,353.14 " " 54,191.42 " " 28,147.95 " " 28,147.95 " " 27,328.11 " " 101,170.23 " N/A N/A " 71,697.50 " N/A N/A " 94,847.10 " N/A N/A " 28,147.95 " DRG 239 " 220,814.16 " " 69,578.54 " " 31,988.53 " " 176,651.33 " N/A " 72,350.77 " " 33,587.96 " " 72,350.77 " N/A " 74,877.00 " " 32,948.19 " " 68,628.00 " N/A " 31,988.53 " " 125,908.23 " N/A " 31,988.53 " " 50,235.95 " " 62,794.93 " " 32,948.19 " " 32,948.19 " " 31,988.53 " " 176,651.33 " N/A N/A " 84,280.00 " N/A N/A " 165,610.62 " N/A N/A " 32,948.19 " DRG 240 " 105,490.96 " " 33,240.20 " " 18,848.61 " " 84,392.77 " N/A " 41,896.14 " " 19,791.04 " " 41,896.14 " N/A " 43,416.00 " " 19,414.07 " " 39,740.40 " N/A " 18,848.61 " " 60,150.95 " N/A " 18,848.61 " " 32,304.19 " " 40,380.26 " " 19,414.07 " " 19,414.07 " " 18,848.61 " " 84,392.77 " N/A N/A " 48,804.00 " N/A N/A " 79,118.22 " N/A N/A " 19,414.07 " DRG 241 " 62,610.28 " " 19,728.50 " " 11,093.77 " " 50,088.22 " N/A " 23,922.63 " " 11,648.46 " " 23,922.63 " N/A " 22,200.00 " " 11,426.58 " " 22,691.70 " N/A " 11,093.77 " " 35,700.38 " N/A " 11,093.77 " " 25,463.69 " " 31,829.63 " " 11,426.58 " " 11,426.58 " " 11,093.77 " " 50,088.22 " N/A N/A " 27,867.00 " N/A N/A " 46,957.71 " N/A N/A " 11,426.58 " DRG 242 " 168,312.68 " " 53,035.33 " " 24,933.73 " " 134,650.15 " N/A " 55,999.73 " " 26,180.42 " " 55,999.73 " N/A " 58,597.00 " " 25,681.74 " " 53,118.30 " N/A " 24,933.73 " " 95,971.89 " N/A " 24,933.73 " " 40,611.44 " " 50,764.29 " " 25,681.74 " " 25,681.74 " " 24,933.73 " " 134,650.15 " N/A N/A " 65,233.00 " N/A N/A " 126,234.51 " N/A N/A " 25,681.74 " DRG 243 " 153,627.43 " " 48,408.00 " " 17,096.57 " " 122,901.95 " N/A " 37,835.43 " " 17,951.40 " " 37,835.43 " N/A " 42,001.00 " " 17,609.47 " " 35,888.63 " N/A " 17,096.57 " " 87,598.36 " N/A " 17,096.57 " " 29,501.84 " " 36,877.29 " " 17,609.47 " " 17,609.47 " " 17,096.57 " " 122,901.95 " N/A N/A " 44,073.75 " N/A N/A " 115,220.57 " N/A N/A " 17,609.47 " DRG 244 " 117,114.11 " " 36,902.66 " " 14,146.05 " " 93,691.29 " N/A " 30,996.96 " " 14,853.35 " " 30,996.96 " N/A " 33,913.00 " " 14,570.43 " " 29,402.03 " N/A " 14,146.05 " " 66,778.46 " N/A " 14,146.05 " " 31,305.94 " " 39,132.44 " " 14,570.43 " " 14,570.43 " " 14,146.05 " " 93,691.29 " N/A N/A " 36,107.75 " N/A N/A " 87,835.58 " N/A N/A " 14,570.43 " DRG 245 " 236,214.22 " " 74,431.10 " " 35,889.28 " " 188,971.38 " N/A " 81,391.61 " " 37,683.74 " " 81,391.61 " N/A " 73,137.00 " " 36,965.96 " " 77,203.65 " N/A " 35,889.28 " " 134,689.35 " N/A " 35,889.28 " " 71,883.96 " " 89,854.94 " " 36,965.96 " " 36,965.96 " " 35,889.28 " " 188,971.38 " N/A N/A " 94,811.50 " N/A N/A " 177,160.67 " N/A N/A " 36,965.96 " DRG 246 " 146,581.56 " " 46,187.85 " " 21,023.25 " " 117,265.25 " N/A " 46,936.36 " " 22,074.41 " " 46,936.36 " N/A " 50,927.00 " " 21,653.95 " " 44,521.28 " N/A " 21,023.25 " " 83,580.80 " N/A " 21,023.25 " " 38,683.68 " " 48,354.59 " " 21,653.95 " " 21,653.95 " " 21,023.25 " " 117,265.25 " N/A N/A " 54,675.25 " N/A N/A " 109,936.17 " N/A N/A " 21,653.95 " DRG 247 " 99,217.03 " " 31,263.29 " " 13,562.04 " " 79,373.63 " N/A " 29,643.38 " " 14,240.14 " " 29,643.38 " N/A " 32,390.00 " " 13,968.90 " " 28,118.10 " N/A " 13,562.04 " " 56,573.55 " N/A " 13,562.04 " " 32,811.50 " " 41,014.40 " " 13,968.90 " " 13,968.90 " " 13,562.04 " " 79,373.63 " N/A N/A " 34,531.00 " N/A N/A " 74,412.78 " N/A N/A " 13,968.90 " DRG 248 " 151,258.03 " " 47,661.41 " " 21,268.91 " " 121,006.42 " N/A " 47,505.73 " " 22,332.36 " " 47,505.73 " N/A " 47,846.00 " " 21,906.98 " " 45,061.35 " N/A " 21,268.91 " " 86,247.33 " N/A " 21,268.91 " " 35,984.82 " " 44,981.02 " " 21,906.98 " " 21,906.98 " " 21,268.91 " " 121,006.42 " N/A N/A " 55,338.50 " N/A N/A " 113,443.52 " N/A N/A " 21,906.98 " DRG 249 " 88,596.60 " " 27,916.79 " " 12,917.10 " " 70,877.28 " N/A " 28,148.60 " " 13,562.96 " " 28,148.60 " N/A " 29,591.00 " " 13,304.61 " " 26,700.23 " N/A " 12,917.10 " " 50,517.78 " N/A " 12,917.10 " " 31,453.22 " " 39,316.55 " " 13,304.61 " " 13,304.61 " " 12,917.10 " " 70,877.28 " N/A N/A " 32,789.75 " N/A N/A " 66,447.45 " N/A N/A " 13,304.61 " DRG 250 " 67,960.22 " " 21,414.26 " " 17,117.96 " " 54,368.17 " N/A " 37,885.00 " " 17,973.86 " " 37,885.00 " N/A " 47,019.00 " " 17,631.50 " " 35,935.65 " N/A " 17,117.96 " " 38,750.92 " N/A " 17,117.96 " " 32,058.72 " " 40,073.42 " " 17,631.50 " " 17,631.50 " " 17,117.96 " " 54,368.17 " N/A N/A " 44,131.50 " N/A N/A " 50,970.16 " N/A N/A " 17,631.50 " DRG 251 " 73,010.53 " " 23,005.62 " " 11,521.57 " " 58,408.42 " N/A " 24,914.14 " " 12,097.65 " " 24,914.14 " N/A " 32,094.00 " " 11,867.22 " " 23,632.20 " N/A " 11,521.57 " " 41,630.60 " N/A " 11,521.57 " " 26,740.15 " " 33,425.20 " " 11,867.22 " " 11,867.22 " " 11,521.57 " " 58,408.42 " N/A N/A " 29,022.00 " N/A N/A " 54,757.89 " N/A N/A " 11,867.22 " DRG 252 " 144,181.09 " " 45,431.46 " " 22,328.69 " " 115,344.87 " N/A " 49,961.99 " " 23,445.12 " " 49,961.99 " N/A " 51,364.00 " " 22,998.55 " " 47,391.23 " N/A " 22,328.69 " " 82,212.06 " N/A " 22,328.69 " " 45,695.01 " " 57,118.75 " " 22,998.55 " " 22,998.55 " " 22,328.69 " " 115,344.87 " N/A N/A " 58,199.75 " N/A N/A " 108,135.82 " N/A N/A " 22,998.55 " DRG 253 " 77,259.33 " " 24,344.42 " " 17,972.27 " " 61,807.47 " N/A " 39,865.03 " " 18,870.88 " " 39,865.03 " N/A " 40,170.00 " " 18,511.44 " " 37,813.80 " N/A " 17,972.27 " " 44,053.27 " N/A " 17,972.27 " " 31,872.27 " " 39,840.33 " " 18,511.44 " " 18,511.44 " " 17,972.27 " " 61,807.47 " N/A N/A " 46,438.00 " N/A N/A " 57,944.50 " N/A N/A " 18,511.44 " DRG 254 " 54,355.86 " " 17,127.53 " " 12,542.46 " " 43,484.69 " N/A " 27,280.27 " " 13,169.58 " " 27,280.27 " N/A " 27,224.00 " " 12,918.73 " " 25,876.58 " N/A " 12,542.46 " " 30,993.71 " N/A " 12,542.46 " " 26,265.57 " " 32,831.98 " " 12,918.73 " " 12,918.73 " " 12,542.46 " " 43,484.69 " N/A N/A " 31,778.25 " N/A N/A " 40,766.90 " N/A N/A " 12,918.73 " DRG 255 " 91,314.81 " " 28,773.30 " " 17,205.47 " " 73,051.85 " N/A " 38,087.81 " " 18,065.74 " " 38,087.81 " N/A " 40,990.00 " " 17,721.63 " " 36,128.03 " N/A " 17,205.47 " " 52,067.70 " N/A " 17,205.47 " " 29,914.93 " " 37,393.68 " " 17,721.63 " " 17,721.63 " " 17,205.47 " " 73,051.85 " N/A N/A " 44,367.75 " N/A N/A " 68,486.11 " N/A N/A " 17,721.63 " DRG 256 No Current Volume N/A " 11,429.53 " " 28,773.50 " N/A " 24,700.82 " " 12,001.01 " " 24,700.82 " N/A " 26,725.00 " " 11,772.42 " " 23,429.85 " N/A " 11,429.53 " N/A N/A " 11,429.53 " " 18,606.82 " " 23,258.54 " " 11,772.42 " " 11,772.42 " " 11,429.53 " N/A N/A N/A " 28,773.50 " N/A N/A N/A N/A N/A " 11,772.42 " DRG 257 No Current Volume N/A " 8,324.74 " " 20,391.00 " N/A " 17,504.80 " " 8,740.98 " " 17,504.80 " N/A " 16,612.00 " " 8,574.48 " " 16,604.10 " N/A " 8,324.74 " N/A N/A " 8,324.74 " " 13,255.52 " " 16,569.41 " " 8,574.48 " " 8,574.48 " " 8,324.74 " N/A N/A N/A " 20,391.00 " N/A N/A N/A N/A N/A " 8,574.48 " DRG 258 No Current Volume N/A " 21,307.16 " " 55,690.78 " N/A " 47,594.37 " " 22,372.52 " " 47,594.37 " N/A " 43,444.00 " " 21,946.37 " " 45,145.43 " N/A " 21,307.16 " N/A N/A " 21,307.16 " " 44,552.63 " " 55,690.78 " " 21,946.37 " " 21,946.37 " " 21,307.16 " N/A N/A N/A " 55,441.75 " N/A N/A N/A N/A N/A " 21,946.37 " DRG 259 No Current Volume N/A " 14,313.93 " " 37,394.93 " N/A " 31,386.05 " " 15,029.63 " " 31,386.05 " N/A " 31,347.00 " " 14,743.35 " " 29,771.10 " N/A " 14,313.93 " N/A N/A " 14,313.93 " " 29,915.95 " " 37,394.93 " " 14,743.35 " " 14,743.35 " " 14,313.93 " N/A N/A N/A " 36,561.00 " N/A N/A N/A N/A N/A " 14,743.35 " DRG 260 " 170,690.52 " " 53,784.58 " " 23,894.69 " " 136,552.42 " N/A " 53,591.55 " " 25,089.42 " " 53,591.55 " N/A " 58,933.00 " " 24,611.53 " " 50,834.03 " N/A " 23,894.69 " " 97,327.73 " N/A " 23,894.69 " " 40,568.60 " " 50,710.74 " " 24,611.53 " " 24,611.53 " " 23,894.69 " " 136,552.42 " N/A N/A " 62,427.75 " N/A N/A " 128,017.89 " N/A N/A " 24,611.53 " DRG 261 " 86,712.73 " " 27,323.18 " " 13,696.22 " " 69,370.18 " N/A " 29,954.36 " " 14,381.03 " " 29,954.36 " N/A " 29,189.00 " " 14,107.11 " " 28,413.08 " N/A " 13,696.22 " " 49,443.60 " N/A " 13,696.22 " " 25,185.49 " " 31,481.88 " " 14,107.11 " " 14,107.11 " " 13,696.22 " " 69,370.18 " N/A N/A " 34,893.25 " N/A N/A " 65,034.54 " N/A N/A " 14,107.11 " DRG 262 " 90,473.80 " " 28,508.29 " " 11,831.40 " " 72,379.04 " N/A " 25,632.24 " " 12,422.97 " " 25,632.24 " N/A " 21,993.00 " " 12,186.34 " " 24,313.35 " N/A " 11,831.40 " " 51,588.16 " N/A " 11,831.40 " " 20,472.41 " " 25,590.53 " " 12,186.34 " " 12,186.34 " " 11,831.40 " " 72,379.04 " N/A N/A " 29,858.50 " N/A N/A " 67,855.35 " N/A N/A " 12,186.34 " DRG 263 No Current Volume N/A " 15,765.86 " " 41,179.05 " N/A " 34,751.20 " " 16,554.15 " " 34,751.20 " N/A " 29,365.00 " " 16,238.84 " " 32,963.10 " N/A " 15,765.86 " N/A N/A " 15,765.86 " " 32,943.24 " " 41,179.05 " " 16,238.84 " " 16,238.84 " " 15,765.86 " N/A N/A N/A " 40,481.00 " N/A N/A N/A N/A N/A " 16,238.84 " DRG 264 " 228,648.55 " " 72,047.16 " " 21,861.35 " " 182,918.84 " N/A " 48,878.83 " " 22,954.42 " " 48,878.83 " N/A " 44,513.00 " " 22,517.19 " " 46,363.80 " N/A " 21,861.35 " " 130,375.40 " N/A " 21,861.35 " " 30,798.63 " " 38,498.30 " " 22,517.19 " " 22,517.19 " " 21,861.35 " " 182,918.84 " N/A N/A " 56,938.00 " N/A N/A " 171,486.41 " N/A N/A " 22,517.19 " DRG 265 No Current Volume N/A " 22,586.67 " " 58,896.25 " N/A " 50,559.91 " " 23,716.00 " " 50,559.91 " N/A " 45,061.00 " " 23,264.27 " " 47,958.38 " N/A " 22,586.67 " N/A N/A " 22,586.67 " " 46,508.95 " " 58,136.18 " " 23,264.27 " " 23,264.27 " " 22,586.67 " N/A N/A N/A " 58,896.25 " N/A N/A N/A N/A N/A " 23,264.27 " DRG 266 " 222,596.56 " " 70,140.18 " " 46,455.28 " " 178,077.25 " N/A " 105,880.60 " " 48,778.04 " " 105,880.60 " N/A " 141,475.00 " " 47,848.94 " " 100,432.58 " N/A " 46,455.28 " " 126,924.56 " N/A " 46,455.28 " " 78,081.34 " " 97,601.67 " " 47,848.94 " " 47,848.94 " " 46,455.28 " " 178,077.25 " N/A N/A " 123,338.25 " N/A N/A " 166,947.42 " N/A N/A " 47,848.94 " DRG 267 " 146,725.17 " " 46,233.10 " " 37,057.30 " " 117,380.14 " N/A " 84,098.75 " " 38,910.17 " " 84,098.75 " N/A " 106,226.00 " " 38,169.02 " " 79,771.50 " N/A " 37,057.30 " " 83,662.69 " N/A " 37,057.30 " " 63,501.78 " " 79,377.22 " " 38,169.02 " " 38,169.02 " " 37,057.30 " " 117,380.14 " N/A N/A " 97,965.00 " N/A N/A " 110,043.88 " N/A N/A " 38,169.02 " DRG 268 " 171,131.33 " " 53,923.48 " " 45,906.91 " " 136,905.06 " N/A " 104,609.66 " " 48,202.26 " " 104,609.66 " N/A " 98,817.00 " " 47,284.12 " " 99,227.03 " N/A " 45,906.91 " " 97,579.08 " N/A " 45,906.91 " " 86,120.81 " " 107,651.00 " " 47,284.12 " " 47,284.12 " " 45,906.91 " " 136,905.06 " N/A N/A " 121,857.75 " N/A N/A " 128,348.50 " N/A N/A " 47,284.12 " DRG 269 " 78,244.55 " " 24,654.86 " " 28,741.79 " " 75,514.25 " N/A " 64,825.75 " " 30,178.88 " " 64,825.75 " N/A " 61,426.00 " " 29,604.04 " " 61,490.18 " N/A " 28,741.79 " " 44,615.04 " N/A " 28,741.79 " " 42,353.56 " " 52,941.94 " " 29,604.04 " " 29,604.04 " " 28,741.79 " " 62,595.64 " N/A N/A " 75,514.25 " N/A N/A " 58,683.41 " N/A N/A " 29,604.04 " DRG 270 " 192,308.84 " " 60,596.52 " " 34,393.28 " " 153,847.07 " N/A " 77,924.30 " " 36,112.94 " " 77,924.30 " N/A " 74,495.00 " " 35,425.08 " " 73,914.75 " N/A " 34,393.28 " " 109,654.50 " N/A " 34,393.28 " " 52,392.18 " " 65,490.22 " " 35,425.08 " " 35,425.08 " " 34,393.28 " " 153,847.07 " N/A N/A " 90,772.50 " N/A N/A " 144,231.63 " N/A N/A " 35,425.08 " DRG 271 " 144,830.60 " " 45,636.12 " " 23,882.38 " " 115,864.48 " N/A " 53,563.00 " " 25,076.50 " " 53,563.00 " N/A " 49,444.00 " " 24,598.85 " " 50,806.95 " N/A " 23,882.38 " " 82,582.41 " N/A " 23,882.38 " " 42,096.53 " " 52,620.65 " " 24,598.85 " " 24,598.85 " " 23,882.38 " " 115,864.48 " N/A N/A " 62,394.50 " N/A N/A " 108,622.95 " N/A N/A " 24,598.85 " DRG 272 " 120,108.81 " " 37,846.29 " " 18,197.18 " " 96,087.05 " N/A " 40,386.33 " " 19,107.04 " " 40,386.33 " N/A " 35,412.00 " " 18,743.10 " " 38,308.28 " N/A " 18,197.18 " " 68,486.04 " N/A " 18,197.18 " " 32,986.08 " " 41,232.60 " " 18,743.10 " " 18,743.10 " " 18,197.18 " " 96,087.05 " N/A N/A " 47,045.25 " N/A N/A " 90,081.61 " N/A N/A " 18,743.10 " DRG 273 " 162,346.03 " " 51,155.23 " " 25,576.08 " " 129,876.82 " N/A " 57,488.51 " " 26,854.88 " " 57,488.51 " N/A " 55,850.00 " " 26,343.36 " " 54,530.48 " N/A " 25,576.08 " " 92,569.71 " N/A " 25,576.08 " " 54,134.30 " " 67,667.87 " " 26,343.36 " " 26,343.36 " " 25,576.08 " " 129,876.82 " N/A N/A " 66,967.25 " N/A N/A " 121,759.52 " N/A N/A " 26,343.36 " DRG 274 " 166,805.49 " " 52,560.41 " " 22,075.25 " " 133,444.39 " N/A " 49,374.59 " " 23,179.01 " " 49,374.59 " N/A " 38,071.00 " " 22,737.51 " " 46,834.05 " N/A " 22,075.25 " " 95,112.49 " N/A " 22,075.25 " " 38,940.71 " " 48,675.89 " " 22,737.51 " " 22,737.51 " " 22,075.25 " " 133,444.39 " N/A N/A " 57,515.50 " N/A N/A " 125,104.12 " N/A N/A " 22,737.51 " DRG 280 " 60,580.18 " " 19,088.81 " " 11,187.76 " " 48,464.14 " N/A " 24,140.46 " " 11,747.15 " " 24,140.46 " N/A " 27,201.00 " " 11,523.39 " " 22,898.33 " N/A " 11,187.76 " " 34,542.82 " N/A " 11,187.76 " " 20,292.40 " " 25,365.51 " " 11,523.39 " " 11,523.39 " " 11,187.76 " " 48,464.14 " N/A N/A " 28,120.75 " N/A N/A " 45,435.13 " N/A N/A " 11,523.39 " DRG 281 " 40,392.58 " " 12,727.70 " " 6,804.11 " " 32,314.07 " N/A " 13,980.40 " " 7,144.32 " " 13,980.40 " N/A " 16,120.00 " " 7,008.23 " " 13,261.05 " N/A " 6,804.11 " " 23,031.85 " N/A " 6,804.11 " " 13,435.53 " " 16,794.43 " " 7,008.23 " " 7,008.23 " " 6,804.11 " " 32,314.07 " N/A N/A " 16,285.50 " N/A N/A " 30,294.44 " N/A N/A " 7,008.23 " DRG 282 " 58,369.17 " " 18,392.13 " " 5,478.58 " " 46,695.34 " N/A " 10,908.20 " " 5,752.51 " " 10,908.20 " N/A " 11,898.00 " " 5,642.94 " " 10,346.93 " N/A " 5,478.58 " " 33,282.10 " N/A " 5,478.58 " " 12,240.90 " " 15,301.13 " " 5,642.94 " " 5,642.94 " " 5,478.58 " " 46,695.34 " N/A N/A " 12,706.75 " N/A N/A " 43,776.88 " N/A N/A " 5,642.94 " DRG 283 " 69,898.93 " " 22,025.15 " " 12,858.77 " " 55,919.14 " N/A " 28,013.39 " " 13,501.71 " " 28,013.39 " N/A " 26,358.00 " " 13,244.53 " " 26,571.98 " N/A " 12,858.77 " " 39,856.37 " N/A " 12,858.77 " " 32,500.57 " " 40,625.74 " " 13,244.53 " " 13,244.53 " " 12,858.77 " " 55,919.14 " N/A N/A " 32,632.25 " N/A N/A " 52,424.20 " N/A N/A " 13,244.53 " DRG 284 " 33,324.60 " " 10,500.58 " " 5,461.08 " " 26,659.68 " N/A " 10,867.64 " " 5,734.13 " " 10,867.64 " N/A " 12,119.00 " " 5,624.91 " " 10,308.45 " N/A " 5,461.08 " " 19,001.69 " N/A " 5,461.08 " " 12,109.98 " " 15,137.48 " " 5,624.91 " " 5,624.91 " " 5,461.08 " " 26,659.68 " N/A N/A " 12,659.50 " N/A N/A " 24,993.45 " N/A N/A " 5,624.91 " DRG 285 No Current Volume N/A " 3,978.69 " " 10,596.24 " N/A " 7,431.88 " " 4,177.62 " " 7,431.88 " N/A " 7,970.00 " " 4,098.05 " " 7,049.48 " N/A " 3,978.69 " N/A N/A " 3,978.69 " " 8,476.99 " " 10,596.24 " " 4,098.05 " " 4,098.05 " " 3,978.69 " N/A N/A N/A " 8,657.25 " N/A N/A N/A N/A N/A " 4,098.05 " DRG 286 " 71,658.67 " " 22,579.65 " " 14,619.23 " " 57,326.93 " N/A " 32,093.63 " " 15,350.19 " " 32,093.63 " N/A " 33,418.00 " " 15,057.81 " " 30,442.28 " N/A " 14,619.23 " " 40,859.77 " N/A " 14,619.23 " " 24,760.00 " " 30,950.02 " " 15,057.81 " " 15,057.81 " " 14,619.23 " " 57,326.93 " N/A N/A " 37,385.25 " N/A N/A " 53,744.00 " N/A N/A " 15,057.81 " DRG 287 " 48,790.70 " " 15,373.95 " " 8,000.00 " " 39,032.56 " N/A " 16,752.15 " " 8,400.00 " " 16,752.15 " N/A " 17,763.00 " " 8,240.00 " " 15,890.18 " N/A " 8,000.00 " " 27,820.46 " N/A " 8,000.00 " " 15,432.04 " " 19,290.06 " " 8,240.00 " " 8,240.00 " " 8,000.00 " " 39,032.56 " N/A N/A " 19,514.25 " N/A N/A " 36,593.03 " N/A N/A " 8,240.00 " DRG 288 " 88,998.34 " " 28,043.38 " " 18,178.39 " " 71,198.67 " N/A " 40,342.76 " " 19,087.31 " " 40,342.76 " N/A " 42,698.00 " " 18,723.74 " " 38,266.95 " N/A " 18,178.39 " " 50,746.85 " N/A " 18,178.39 " " 29,087.73 " " 36,359.66 " " 18,723.74 " " 18,723.74 " " 18,178.39 " " 71,198.67 " N/A N/A " 46,994.50 " N/A N/A " 66,748.76 " N/A N/A " 18,723.74 " DRG 289 No Current Volume N/A " 11,425.64 " " 28,763.00 " N/A " 24,691.80 " " 11,996.92 " " 24,691.80 " N/A " 26,733.00 " " 11,768.41 " " 23,421.30 " N/A " 11,425.64 " N/A N/A " 11,425.64 " " 20,897.90 " " 26,122.39 " " 11,768.41 " " 11,768.41 " " 11,425.64 " N/A N/A N/A " 28,763.00 " N/A N/A N/A N/A N/A " 11,768.41 " DRG 290 No Current Volume N/A " 7,428.31 " " 26,592.88 " N/A " 15,427.12 " " 7,799.73 " " 15,427.12 " N/A " 19,630.00 " " 7,651.16 " " 14,633.33 " N/A " 7,428.31 " N/A N/A " 7,428.31 " " 21,274.29 " " 26,592.88 " " 7,651.16 " " 7,651.16 " " 7,428.31 " N/A N/A N/A " 17,970.75 " N/A N/A N/A N/A N/A " 7,651.16 " DRG 291 " 57,579.96 " " 18,143.45 " " 8,993.02 " " 46,063.97 " N/A " 19,053.67 " " 9,442.67 " " 19,053.67 " N/A " 23,754.00 " " 9,262.81 " " 18,073.28 " N/A " 8,993.02 " " 32,832.09 " N/A " 8,993.02 " " 15,595.69 " " 19,494.63 " " 9,262.81 " " 9,262.81 " " 8,993.02 " " 46,063.97 " N/A N/A " 22,195.25 " N/A N/A " 43,184.97 " N/A N/A " 9,262.81 " DRG 292 " 39,758.81 " " 12,528.00 " " 6,369.18 " " 31,807.05 " N/A " 12,972.36 " " 6,687.64 " " 12,972.36 " N/A " 15,459.00 " " 6,560.26 " " 12,304.88 " N/A " 6,369.18 " " 22,670.47 " N/A " 6,369.18 " " 10,882.62 " " 13,603.28 " " 6,560.26 " " 6,560.26 " " 6,369.18 " " 31,807.05 " N/A N/A " 15,111.25 " N/A N/A " 29,819.11 " N/A N/A " 6,560.26 " DRG 293 " 30,401.82 " " 9,579.61 " " 4,595.76 " " 24,321.46 " N/A " 8,862.07 " " 4,825.55 " " 8,862.07 " N/A " 10,637.00 " " 4,733.63 " " 8,406.08 " N/A " 4,595.76 " " 17,335.12 " N/A " 4,595.76 " " 8,509.72 " " 10,637.15 " " 4,733.63 " " 4,733.63 " " 4,595.76 " " 24,321.46 " N/A N/A " 10,323.25 " N/A N/A " 22,801.37 " N/A N/A " 4,733.63 " DRG 294 No Current Volume N/A " 9,087.00 " " 25,385.97 " N/A " 19,271.50 " " 9,541.35 " " 19,271.50 " N/A " 16,489.00 " " 9,359.61 " " 18,279.90 " N/A " 9,087.00 " N/A N/A " 9,087.00 " " 20,308.77 " " 25,385.97 " " 9,359.61 " " 9,359.61 " " 9,087.00 " N/A N/A N/A " 22,449.00 " N/A N/A N/A N/A N/A " 9,359.61 " DRG 295 No Current Volume N/A " 7,150.89 " " 17,221.75 " N/A " 14,784.13 " " 7,508.43 " " 14,784.13 " N/A " 10,896.00 " " 7,365.42 " " 14,023.43 " N/A " 7,150.89 " N/A N/A " 7,150.89 " " 12,960.95 " " 16,201.20 " " 7,365.42 " " 7,365.42 " " 7,150.89 " N/A N/A N/A " 17,221.75 " N/A N/A N/A N/A N/A " 7,365.42 " DRG 296 " 101,110.25 " " 31,859.84 " " 11,111.92 " " 80,888.20 " N/A " 23,964.69 " " 11,667.52 " " 23,964.69 " N/A " 19,424.00 " " 11,445.28 " " 22,731.60 " N/A " 11,111.92 " " 57,653.06 " N/A " 11,111.92 " " 24,514.53 " " 30,643.18 " " 11,445.28 " " 11,445.28 " " 11,111.92 " " 80,888.20 " N/A N/A " 27,916.00 " N/A N/A " 75,832.69 " N/A N/A " 11,445.28 " DRG 297 No Current Volume N/A " 5,354.78 " " 14,135.14 " N/A " 10,621.26 " " 5,622.52 " " 10,621.26 " N/A " 10,189.00 " " 5,515.42 " " 10,074.75 " N/A " 5,354.78 " N/A N/A " 5,354.78 " " 11,308.10 " " 14,135.14 " " 5,515.42 " " 5,515.42 " " 5,354.78 " N/A N/A N/A " 12,372.50 " N/A N/A N/A N/A N/A " 5,515.42 " DRG 298 No Current Volume N/A " 3,940.45 " " 9,962.10 " N/A " 7,343.24 " " 4,137.47 " " 7,343.24 " N/A " 6,650.00 " " 4,058.66 " " 6,965.40 " N/A " 3,940.45 " N/A N/A " 3,940.45 " " 7,969.68 " " 9,962.10 " " 4,058.66 " " 4,058.66 " " 3,940.45 " N/A N/A N/A " 8,554.00 " N/A N/A N/A N/A N/A " 4,058.66 " DRG 299 " 45,296.68 " " 14,272.98 " " 10,706.16 " " 36,237.34 " N/A " 23,024.25 " " 11,241.47 " " 23,024.25 " N/A " 22,176.00 " " 11,027.34 " " 21,839.55 " N/A " 10,706.16 " " 25,828.17 " N/A " 10,706.16 " " 14,941.10 " " 18,676.38 " " 11,027.34 " " 11,027.34 " " 10,706.16 " " 36,237.34 " N/A N/A " 26,820.50 " N/A N/A " 33,972.51 " N/A N/A " 11,027.34 " DRG 300 " 40,272.26 " " 12,689.79 " " 7,537.85 " " 32,217.81 " N/A " 15,681.01 " " 7,914.74 " " 15,681.01 " N/A " 15,373.00 " " 7,763.99 " " 14,874.15 " N/A " 7,537.85 " " 22,963.24 " N/A " 7,537.85 " " 10,866.25 " " 13,582.82 " " 7,763.99 " " 7,763.99 " " 7,537.85 " " 32,217.81 " N/A N/A " 18,266.50 " N/A N/A " 30,204.20 " N/A N/A " 7,763.99 " DRG 301 " 51,590.88 " " 16,256.29 " " 5,588.77 " " 41,272.71 " N/A " 11,163.59 " " 5,868.21 " " 11,163.59 " N/A " 10,660.00 " " 5,756.43 " " 10,589.18 " N/A " 5,588.77 " " 29,417.12 " N/A " 5,588.77 " " 8,002.41 " " 10,003.01 " " 5,756.43 " " 5,756.43 " " 5,588.77 " " 41,272.71 " N/A N/A " 13,004.25 " N/A N/A " 38,693.16 " N/A N/A " 5,756.43 " DRG 302 No Current Volume N/A " 7,868.42 " " 23,585.84 " N/A " 16,447.18 " " 8,261.84 " " 16,447.18 " N/A " 16,222.00 " " 8,104.47 " " 15,600.90 " N/A " 7,868.42 " N/A N/A " 7,868.42 " " 18,868.66 " " 23,585.84 " " 8,104.47 " " 8,104.47 " " 7,868.42 " N/A N/A N/A " 19,159.00 " N/A N/A N/A N/A N/A " 8,104.47 " DRG 303 " 60,484.11 " " 19,058.54 " " 5,164.21 " " 48,387.29 " N/A " 10,179.58 " " 5,422.42 " " 10,179.58 " N/A " 9,598.00 " " 5,319.14 " " 9,655.80 " N/A " 5,164.21 " " 34,488.04 " N/A " 5,164.21 " " 9,982.55 " " 12,478.20 " " 5,319.14 " " 5,319.14 " " 5,164.21 " " 48,387.29 " N/A N/A " 11,858.00 " N/A N/A " 45,363.08 " N/A N/A " 5,319.14 " DRG 304 " 46,654.03 " " 14,700.69 " " 7,882.68 " " 37,323.22 " N/A " 16,480.23 " " 8,276.81 " " 16,480.23 " N/A " 15,758.00 " " 8,119.16 " " 15,632.25 " N/A " 7,882.68 " " 26,602.13 " N/A " 7,882.68 " " 14,515.61 " " 18,144.53 " " 8,119.16 " " 8,119.16 " " 7,882.68 " " 37,323.22 " N/A N/A " 19,197.50 " N/A N/A " 34,990.52 " N/A N/A " 8,119.16 " DRG 305 " 28,401.17 " " 8,949.21 " " 5,568.03 " " 22,720.94 " N/A " 11,115.52 " " 5,846.43 " " 11,115.52 " N/A " 9,869.00 " " 5,735.07 " " 10,543.58 " N/A " 5,568.03 " " 16,194.35 " N/A " 5,568.03 " " 9,475.24 " " 11,844.06 " " 5,735.07 " " 5,735.07 " " 5,568.03 " " 22,720.94 " N/A N/A " 12,948.25 " N/A N/A " 21,300.88 " N/A N/A " 5,735.07 " DRG 306 " 17,222.17 " " 5,426.71 " " 9,820.08 " " 31,952.37 " N/A " 22,645.67 " " 11,069.96 " " 22,645.67 " N/A " 21,535.00 " " 10,859.10 " " 21,480.45 " N/A " 10,542.82 " " 9,820.08 " N/A " 10,542.82 " " 25,561.88 " " 31,952.37 " " 10,859.10 " " 10,859.10 " " 10,542.82 " " 13,777.74 " N/A N/A " 26,379.50 " N/A N/A " 12,916.63 " N/A N/A " 10,859.10 " DRG 307 " 108,936.69 " " 34,325.95 " " 6,413.91 " " 87,149.35 " N/A " 13,076.02 " " 6,734.61 " " 13,076.02 " N/A " 12,111.00 " " 6,606.33 " " 12,403.20 " N/A " 6,413.91 " " 62,115.70 " N/A " 6,413.91 " " 14,613.80 " " 18,267.26 " " 6,606.33 " " 6,606.33 " " 6,413.91 " " 87,149.35 " N/A N/A " 15,232.00 " N/A N/A " 81,702.52 " N/A N/A " 6,606.33 " DRG 308 " 43,385.93 " " 13,670.91 " " 8,556.14 " " 34,708.74 " N/A " 18,041.12 " " 8,983.95 " " 18,041.12 " N/A " 19,048.00 " " 8,812.82 " " 17,112.83 " N/A " 8,556.14 " " 24,738.66 " N/A " 8,556.14 " " 13,664.64 " " 17,080.81 " " 8,812.82 " " 8,812.82 " " 8,556.14 " " 34,708.74 " N/A N/A " 21,015.75 " N/A N/A " 32,539.45 " N/A N/A " 8,812.82 " DRG 309 " 31,702.79 " " 9,989.55 " " 5,636.74 " " 25,362.23 " N/A " 11,274.76 " " 5,918.58 " " 11,274.76 " N/A " 12,374.00 " " 5,805.84 " " 10,694.63 " N/A " 5,636.74 " " 18,076.93 " N/A " 5,636.74 " " 8,624.27 " " 10,780.34 " " 5,805.84 " " 5,805.84 " " 5,636.74 " " 25,362.23 " N/A N/A " 13,133.75 " N/A N/A " 23,777.09 " N/A N/A " 5,805.84 " DRG 310 " 23,460.96 " " 7,392.55 " " 4,396.77 " " 18,768.77 " N/A " 8,400.86 " " 4,616.61 " " 8,400.86 " N/A " 8,642.00 " " 4,528.67 " " 7,968.60 " N/A " 4,396.77 " " 13,377.44 " N/A " 4,396.77 " " 6,971.42 " " 8,714.28 " " 4,528.67 " " 4,528.67 " " 4,396.77 " " 18,768.77 " N/A N/A " 9,786.00 " N/A N/A " 17,595.72 " N/A N/A " 4,528.67 " DRG 311 " 68,991.10 " " 21,739.10 " " 5,299.68 " " 55,192.88 " N/A " 10,493.57 " " 5,564.66 " " 10,493.57 " N/A " 8,908.00 " " 5,458.67 " " 9,953.63 " N/A " 5,299.68 " " 39,338.73 " N/A " 5,299.68 " " 9,164.31 " " 11,455.39 " " 5,458.67 " " 5,458.67 " " 5,299.68 " " 55,192.88 " N/A N/A " 12,223.75 " N/A N/A " 51,743.33 " N/A N/A " 5,458.67 " DRG 312 " 38,226.97 " " 12,045.32 " " 6,208.43 " " 30,581.58 " N/A " 12,599.79 " " 6,518.85 " " 12,599.79 " N/A " 11,679.00 " " 6,394.68 " " 11,951.48 " N/A " 6,208.43 " " 21,797.02 " N/A " 6,208.43 " " 9,786.17 " " 12,232.72 " " 6,394.68 " " 6,394.68 " " 6,208.43 " " 30,581.58 " N/A N/A " 14,677.25 " N/A N/A " 28,670.23 " N/A N/A " 6,394.68 " DRG 313 " 30,582.68 " " 9,636.60 " " 5,448.12 " " 24,466.14 " N/A " 10,837.59 " " 5,720.53 " " 10,837.59 " N/A " 9,656.00 " " 5,611.56 " " 10,279.95 " N/A " 5,448.12 " " 17,438.24 " N/A " 5,448.12 " " 9,131.58 " " 11,414.48 " " 5,611.56 " " 5,611.56 " " 5,448.12 " " 24,466.14 " N/A N/A " 12,624.50 " N/A N/A " 22,937.01 " N/A N/A " 5,611.56 " DRG 314 " 78,785.64 " " 24,825.35 " " 14,284.77 " " 63,028.51 " N/A " 31,318.45 " " 14,999.01 " " 31,318.45 " N/A " 30,202.00 " " 14,713.31 " " 29,706.98 " N/A " 14,284.77 " " 44,923.57 " N/A " 14,284.77 " " 24,825.46 " " 31,031.84 " " 14,713.31 " " 14,713.31 " " 14,284.77 " " 63,028.51 " N/A N/A " 36,482.25 " N/A N/A " 59,089.23 " N/A N/A " 14,713.31 " DRG 315 " 37,770.96 " " 11,901.63 " " 7,081.53 " " 30,216.77 " N/A " 14,623.39 " " 7,435.61 " " 14,623.39 " N/A " 15,125.00 " " 7,293.98 " " 13,870.95 " N/A " 7,081.53 " " 21,537.00 " N/A " 7,081.53 " " 12,519.10 " " 15,648.89 " " 7,293.98 " " 7,293.98 " " 7,081.53 " " 30,216.77 " N/A N/A " 17,034.50 " N/A N/A " 28,328.22 " N/A N/A " 7,293.98 " DRG 316 " 18,492.42 " " 5,826.96 " " 5,461.08 " " 14,793.94 " N/A " 10,867.64 " " 5,734.13 " " 10,867.64 " N/A " 9,770.00 " " 5,624.91 " " 10,308.45 " N/A " 5,461.08 " " 10,544.38 " N/A " 5,461.08 " " 10,080.74 " " 12,600.93 " " 5,624.91 " " 5,624.91 " " 5,461.08 " " 14,793.94 " N/A N/A " 12,659.50 " N/A N/A " 13,869.32 " N/A N/A " 5,624.91 " DRG 319 No Current Volume N/A " 28,759.94 " " 75,563.25 " N/A " 64,867.81 " " 30,197.94 " " 64,867.81 " N/A " 64,516.00 " " 29,622.74 " " 61,530.08 " N/A " 28,759.94 " N/A N/A " 28,759.94 " " 60,103.22 " " 75,129.01 " " 29,622.74 " " 29,622.74 " " 28,759.94 " N/A N/A N/A " 75,563.25 " N/A N/A N/A N/A N/A " 29,622.74 " DRG 320 No Current Volume N/A " 16,364.78 " " 42,767.67 " N/A " 36,139.33 " " 17,183.02 " " 36,139.33 " N/A " 36,937.00 " " 16,855.72 " " 34,279.80 " N/A " 16,364.78 " N/A N/A " 16,364.78 " " 34,214.14 " " 42,767.67 " " 16,855.72 " " 16,855.72 " " 16,364.78 " N/A N/A N/A " 42,098.00 " N/A N/A N/A N/A N/A " 16,855.72 " DRG 326 " 167,238.86 " " 52,696.96 " " 35,231.38 " " 133,791.09 " N/A " 79,866.77 " " 36,992.95 " " 79,866.77 " N/A " 84,719.00 " " 36,288.32 " " 75,757.28 " N/A " 35,231.38 " " 95,359.60 " N/A " 35,231.38 " " 56,133.46 " " 70,166.82 " " 36,288.32 " " 36,288.32 " " 35,231.38 " " 133,791.09 " N/A N/A " 93,035.25 " N/A N/A " 125,429.15 " N/A N/A " 36,288.32 " DRG 327 " 86,591.35 " " 27,284.94 " " 17,396.03 " " 69,273.08 " N/A " 38,529.49 " " 18,265.83 " " 38,529.49 " N/A " 41,745.00 " " 17,917.91 " " 36,546.98 " N/A " 17,396.03 " " 49,374.39 " N/A " 17,396.03 " " 31,845.98 " " 39,807.49 " " 17,917.91 " " 17,917.91 " " 17,396.03 " " 69,273.08 " N/A N/A " 44,882.25 " N/A N/A " 64,943.51 " N/A N/A " 17,917.91 " DRG 328 " 43,868.69 " " 13,823.02 " " 11,576.67 " " 35,094.95 " N/A " 25,041.84 " " 12,155.50 " " 25,041.84 " N/A " 23,522.00 " " 11,923.97 " " 23,753.33 " N/A " 11,576.67 " " 25,013.93 " N/A " 11,576.67 " " 19,457.79 " " 24,322.26 " " 11,923.97 " " 11,923.97 " " 11,576.67 " " 35,094.95 " N/A N/A " 29,170.75 " N/A N/A " 32,901.52 " N/A N/A " 11,923.97 " DRG 329 " 160,349.69 " " 50,526.19 " " 32,443.55 " " 128,279.75 " N/A " 73,405.38 " " 34,065.73 " " 73,405.38 " N/A " 79,888.00 " " 33,416.86 " " 69,628.35 " N/A " 32,443.55 " " 91,431.39 " N/A " 32,443.55 " " 44,981.02 " " 56,226.27 " " 33,416.86 " " 33,416.86 " " 32,443.55 " " 128,279.75 " N/A N/A " 85,508.50 " N/A N/A " 120,262.26 " N/A N/A " 33,416.86 " DRG 330 " 86,883.56 " " 27,377.01 " " 17,296.21 " " 69,506.85 " N/A " 38,298.13 " " 18,161.02 " " 38,298.13 " N/A " 40,106.00 " " 17,815.10 " " 36,327.53 " N/A " 17,296.21 " " 49,541.00 " N/A " 17,296.21 " " 30,013.12 " " 37,516.41 " " 17,815.10 " " 17,815.10 " " 17,296.21 " " 69,506.85 " N/A N/A " 44,612.75 " N/A N/A " 65,162.67 " N/A N/A " 17,815.10 " DRG 331 " 51,930.70 " " 16,363.36 " " 11,859.27 " " 41,544.56 " N/A " 25,696.84 " " 12,452.23 " " 25,696.84 " N/A " 26,087.00 " " 12,215.05 " " 24,374.63 " N/A " 11,859.27 " " 29,610.88 " N/A " 11,859.27 " " 22,354.37 " " 27,942.98 " " 12,215.05 " " 12,215.05 " " 11,859.27 " " 41,544.56 " N/A N/A " 29,933.75 " N/A N/A " 38,948.02 " N/A N/A " 12,215.05 " DRG 332 No Current Volume N/A " 27,746.18 " " 74,024.00 " N/A " 62,518.21 " " 29,133.49 " " 62,518.21 " N/A " 74,024.00 " " 28,578.57 " " 59,301.38 " N/A " 27,746.18 " N/A N/A " 27,746.18 " " 56,333.38 " " 70,416.71 " " 28,578.57 " " 28,578.57 " " 27,746.18 " N/A N/A N/A " 72,826.25 " N/A N/A N/A N/A N/A " 28,578.57 " DRG 333 No Current Volume N/A " 14,651.64 " " 38,905.00 " N/A " 32,168.75 " " 15,384.22 " " 32,168.75 " N/A " 38,905.00 " " 15,091.19 " " 30,513.53 " N/A " 14,651.64 " N/A N/A " 14,651.64 " " 30,172.98 " " 37,716.23 " " 15,091.19 " " 15,091.19 " " 14,651.64 " N/A N/A N/A " 37,472.75 " N/A N/A N/A N/A N/A " 15,091.19 " DRG 334 No Current Volume N/A " 11,198.78 " " 29,333.99 " N/A " 24,166.00 " " 11,758.72 " " 24,166.00 " N/A " 25,223.00 " " 11,534.74 " " 22,922.55 " N/A " 11,198.78 " N/A N/A " 11,198.78 " " 23,467.18 " " 29,333.99 " " 11,534.74 " " 11,534.74 " " 11,198.78 " N/A N/A N/A " 28,150.50 " N/A N/A N/A N/A N/A " 11,534.74 " DRG 335 " 88,941.76 " " 28,025.55 " " 26,138.70 " " 71,153.41 " N/A " 58,792.51 " " 27,445.64 " " 58,792.51 " N/A " 67,466.00 " " 26,922.86 " " 55,767.38 " N/A " 26,138.70 " " 50,714.59 " N/A " 26,138.70 " " 33,928.54 " " 42,410.67 " " 26,922.86 " " 26,922.86 " " 26,138.70 " " 71,153.41 " N/A N/A " 68,486.25 " N/A N/A " 66,706.32 " N/A N/A " 26,922.86 " DRG 336 " 86,739.37 " " 27,331.58 " " 15,623.91 " " 69,391.50 " N/A " 34,422.20 " " 16,405.11 " " 34,422.20 " N/A " 37,036.00 " " 16,092.63 " " 32,651.03 " N/A " 15,623.91 " " 49,458.79 " N/A " 15,623.91 " " 26,494.68 " " 33,118.36 " " 16,092.63 " " 16,092.63 " " 15,623.91 " " 69,391.50 " N/A N/A " 40,097.75 " N/A N/A " 65,054.53 " N/A N/A " 16,092.63 " DRG 337 No Current Volume N/A " 11,384.80 " " 28,652.75 " N/A " 24,597.16 " " 11,954.04 " " 24,597.16 " N/A " 24,538.00 " " 11,726.34 " " 23,331.53 " N/A " 11,384.80 " N/A N/A " 11,384.80 " " 20,063.29 " " 25,079.13 " " 11,726.34 " " 11,726.34 " " 11,384.80 " N/A N/A N/A " 28,652.75 " N/A N/A N/A N/A N/A " 11,726.34 " DRG 338 No Current Volume N/A " 18,903.70 " " 48,952.75 " N/A " 42,023.84 " " 19,848.89 " " 42,023.84 " N/A " 48,304.00 " " 19,470.81 " " 39,861.53 " N/A " 18,903.70 " N/A N/A " 18,903.70 " " 37,241.43 " " 46,551.78 " " 19,470.81 " " 19,470.81 " " 18,903.70 " N/A N/A N/A " 48,952.75 " N/A N/A N/A N/A N/A " 19,470.81 " DRG 339 " 66,792.88 " " 21,046.44 " " 11,774.36 " " 53,434.30 " N/A " 25,500.04 " " 12,363.08 " " 25,500.04 " N/A " 27,282.00 " " 12,127.59 " " 24,187.95 " N/A " 11,774.36 " " 38,085.30 " N/A " 11,774.36 " " 21,568.86 " " 26,961.09 " " 12,127.59 " " 12,127.59 " " 11,774.36 " " 53,434.30 " N/A N/A " 29,704.50 " N/A N/A " 50,094.66 " N/A N/A " 12,127.59 " DRG 340 " 53,604.24 " " 16,890.70 " " 8,733.74 " " 42,883.39 " N/A " 18,452.75 " " 9,170.43 " " 18,452.75 " N/A " 19,096.00 " " 8,995.75 " " 17,503.28 " N/A " 8,733.74 " " 30,565.14 " N/A " 8,733.74 " " 17,330.37 " " 21,662.97 " " 8,995.75 " " 8,995.75 " " 8,733.74 " " 42,883.39 " N/A N/A " 21,495.25 " N/A N/A " 40,203.18 " N/A N/A " 8,995.75 " DRG 341 No Current Volume N/A " 15,825.49 " " 40,642.00 " N/A " 34,889.42 " " 16,616.76 " " 34,889.42 " N/A " 35,969.00 " " 16,300.25 " " 33,094.20 " N/A " 15,825.49 " N/A N/A " 15,825.49 " " 32,435.11 " " 40,543.91 " " 16,300.25 " " 16,300.25 " " 15,825.49 " N/A N/A N/A " 40,642.00 " N/A N/A N/A N/A N/A " 16,300.25 " DRG 342 " 54,467.70 " " 17,162.77 " " 10,059.92 " " 43,574.16 " N/A " 21,526.46 " " 10,562.92 " " 21,526.46 " N/A " 20,629.00 " " 10,361.72 " " 20,418.83 " N/A " 10,059.92 " " 31,057.48 " N/A " 10,059.92 " " 19,081.40 " " 23,851.77 " " 10,361.72 " " 10,361.72 " " 10,059.92 " " 43,574.16 " N/A N/A " 25,075.75 " N/A N/A " 40,850.77 " N/A N/A " 10,361.72 " DRG 343 " 41,617.15 " " 13,113.56 " " 7,957.87 " " 33,293.72 " N/A " 16,654.50 " " 8,355.76 " " 16,654.50 " N/A " 14,794.00 " " 8,196.61 " " 15,797.55 " N/A " 7,957.87 " " 23,730.10 " N/A " 7,957.87 " " 14,335.60 " " 17,919.51 " " 8,196.61 " " 8,196.61 " " 7,957.87 " " 33,293.72 " N/A N/A " 19,400.50 " N/A N/A " 31,212.86 " N/A N/A " 8,196.61 " DRG 344 No Current Volume N/A " 19,040.47 " " 52,046.00 " N/A " 42,340.82 " " 19,992.49 " " 42,340.82 " N/A " 52,046.00 " " 19,611.68 " " 40,162.20 " N/A " 19,040.47 " N/A N/A " 19,040.47 " " 40,482.92 " " 50,603.64 " " 19,611.68 " " 19,611.68 " " 19,040.47 " N/A N/A N/A " 49,322.00 " N/A N/A N/A N/A N/A " 19,611.68 " DRG 345 " 69,327.03 " " 21,844.95 " " 11,005.62 " " 55,461.62 " N/A " 23,718.31 " " 11,555.90 " " 23,718.31 " N/A " 26,915.00 " " 11,335.79 " " 22,497.90 " N/A " 11,005.62 " " 39,530.27 " N/A " 11,005.62 " " 18,295.89 " " 22,869.88 " " 11,335.79 " " 11,335.79 " " 11,005.62 " " 55,461.62 " N/A N/A " 27,629.00 " N/A N/A " 51,995.27 " N/A N/A " 11,335.79 " DRG 346 " 41,568.46 " " 13,098.22 " " 9,039.04 " " 33,254.77 " N/A " 19,160.33 " " 9,490.99 " " 19,160.33 " N/A " 18,867.00 " " 9,310.21 " " 18,174.45 " N/A " 9,039.04 " " 23,702.34 " N/A " 9,039.04 " " 16,332.11 " " 20,415.15 " " 9,310.21 " " 9,310.21 " " 9,039.04 " " 33,254.77 " N/A N/A " 22,319.50 " N/A N/A " 31,176.35 " N/A N/A " 9,310.21 " DRG 347 No Current Volume N/A " 16,747.85 " " 44,748.97 " N/A " 37,027.19 " " 17,585.24 " " 37,027.19 " N/A " 41,262.00 " " 17,250.29 " " 35,121.98 " N/A " 16,747.85 " N/A N/A " 16,747.85 " " 35,799.18 " " 44,748.97 " " 17,250.29 " " 17,250.29 " " 16,747.85 " N/A N/A N/A " 43,132.25 " N/A N/A N/A N/A N/A " 17,250.29 " DRG 348 " 31,535.28 " " 9,936.77 " " 9,510.27 " " 25,228.22 " N/A " 20,252.51 " " 9,985.78 " " 20,252.51 " N/A " 21,753.00 " " 9,795.58 " " 19,210.43 " N/A " 9,510.27 " " 17,981.42 " N/A " 9,510.27 " " 16,675.77 " " 20,844.73 " " 9,795.58 " " 9,795.58 " " 9,510.27 " " 25,228.22 " N/A N/A " 23,591.75 " N/A N/A " 23,651.46 " N/A N/A " 9,795.58 " DRG 349 No Current Volume N/A " 7,119.77 " " 17,137.75 " N/A " 14,712.02 " " 7,475.76 " " 14,712.02 " N/A " 14,283.00 " " 7,333.36 " " 13,955.03 " N/A " 7,119.77 " N/A N/A " 7,119.77 " " 12,388.18 " " 15,485.24 " " 7,333.36 " " 7,333.36 " " 7,119.77 " N/A N/A N/A " 17,137.75 " N/A N/A N/A N/A N/A " 7,333.36 " DRG 350 " 203,087.95 " " 63,993.01 " " 16,683.68 " " 162,470.36 " N/A " 36,878.46 " " 17,517.86 " " 36,878.46 " N/A " 38,806.00 " " 17,184.19 " " 34,980.90 " N/A " 16,683.68 " " 115,800.75 " N/A " 16,683.68 " " 34,928.12 " " 43,660.15 " " 17,184.19 " " 17,184.19 " " 16,683.68 " " 162,470.36 " N/A N/A " 42,959.00 " N/A N/A " 152,315.96 " N/A N/A " 17,184.19 " DRG 351 " 182,830.81 " " 57,609.99 " " 10,447.53 " " 146,264.65 " N/A " 22,424.83 " " 10,969.91 " " 22,424.83 " N/A " 22,065.00 " " 10,760.96 " " 21,270.98 " N/A " 10,447.53 " " 104,250.13 " N/A " 10,447.53 " " 21,421.58 " " 26,776.98 " " 10,760.96 " " 10,760.96 " " 10,447.53 " " 146,264.65 " N/A N/A " 26,122.25 " N/A N/A " 137,123.11 " N/A N/A " 10,760.96 " DRG 352 " 41,731.48 " " 13,149.59 " " 7,930.65 " " 33,385.18 " N/A " 16,591.40 " " 8,327.18 " " 16,591.40 " N/A " 14,613.00 " " 8,168.57 " " 15,737.70 " N/A " 7,930.65 " " 23,795.29 " N/A " 7,930.65 " " 13,910.11 " " 17,387.65 " " 8,168.57 " " 8,168.57 " " 7,930.65 " " 33,385.18 " N/A N/A " 19,327.00 " N/A N/A " 31,298.61 " N/A N/A " 8,168.57 " DRG 353 " 98,522.47 " " 31,044.43 " " 20,378.96 " " 78,817.98 " N/A " 45,443.07 " " 21,397.91 " " 45,443.07 " N/A " 45,749.00 " " 20,990.33 " " 43,104.83 " N/A " 20,378.96 " " 56,177.51 " N/A " 20,378.96 " " 28,930.65 " " 36,163.31 " " 20,990.33 " " 20,990.33 " " 20,378.96 " " 78,817.98 " N/A N/A " 52,935.75 " N/A N/A " 73,891.85 " N/A N/A " 20,990.33 " DRG 354 " 76,987.27 " " 24,258.69 " " 12,340.87 " " 61,589.82 " N/A " 26,813.05 " " 12,957.91 " " 26,813.05 " N/A " 26,613.00 " " 12,711.10 " " 25,433.40 " N/A " 12,340.87 " " 43,898.14 " N/A " 12,340.87 " " 20,734.25 " " 25,917.83 " " 12,711.10 " " 12,711.10 " " 12,340.87 " " 61,589.82 " N/A N/A " 31,234.00 " N/A N/A " 57,740.45 " N/A N/A " 12,711.10 " DRG 355 " 39,342.06 " " 12,396.68 " " 9,588.70 " " 31,473.65 " N/A " 20,434.28 " " 10,068.14 " " 20,434.28 " N/A " 19,701.00 " " 9,876.36 " " 19,382.85 " N/A " 9,588.70 " " 22,432.84 " N/A " 9,588.70 " " 17,657.66 " " 22,072.09 " " 9,876.36 " " 9,876.36 " " 9,588.70 " " 31,473.65 " N/A N/A " 23,803.50 " N/A N/A " 29,506.54 " N/A N/A " 9,876.36 " DRG 356 " 166,939.69 " " 52,602.70 " " 28,694.47 " " 133,551.75 " N/A " 64,716.08 " " 30,129.19 " " 64,716.08 " N/A " 60,688.00 " " 29,555.30 " " 61,386.15 " N/A " 28,694.47 " " 95,189.01 " N/A " 28,694.47 " " 41,596.74 " " 51,995.91 " " 29,555.30 " " 29,555.30 " " 28,694.47 " " 133,551.75 " N/A N/A " 75,386.50 " N/A N/A " 125,204.77 " N/A N/A " 29,555.30 " DRG 357 " 101,392.93 " " 31,948.91 " " 15,476.12 " " 81,114.34 " N/A " 34,079.68 " " 16,249.93 " " 34,079.68 " N/A " 33,153.00 " " 15,940.40 " " 32,326.13 " N/A " 15,476.12 " " 57,814.25 " N/A " 15,476.12 " " 24,285.42 " " 30,356.79 " " 15,940.40 " " 15,940.40 " " 15,476.12 " " 81,114.34 " N/A N/A " 39,698.75 " N/A N/A " 76,044.70 " N/A N/A " 15,940.40 " DRG 358 " 51,407.99 " " 16,198.66 " " 9,516.75 " " 41,126.39 " N/A " 20,267.53 " " 9,992.59 " " 20,267.53 " N/A " 21,613.00 " " 9,802.25 " " 19,224.68 " N/A " 9,516.75 " " 29,312.83 " N/A " 9,516.75 " " 18,214.07 " " 22,767.59 " " 9,802.25 " " 9,802.25 " " 9,516.75 " " 41,126.39 " N/A N/A " 23,609.25 " N/A N/A " 38,555.99 " N/A N/A " 9,802.25 " DRG 368 " 60,595.20 " " 19,093.55 " " 13,405.83 " " 48,476.16 " N/A " 29,281.33 " " 14,076.12 " " 29,281.33 " N/A " 29,329.00 " " 13,808.00 " " 27,774.68 " N/A " 13,405.83 " " 34,551.38 " N/A " 13,405.83 " " 24,874.56 " " 31,093.21 " " 13,808.00 " " 13,808.00 " " 13,405.83 " " 48,476.16 " N/A N/A " 34,109.25 " N/A N/A " 45,446.40 " N/A N/A " 13,808.00 " DRG 369 No Current Volume N/A " 7,754.34 " " 18,851.00 " N/A " 16,182.78 " " 8,142.06 " " 16,182.78 " N/A " 16,839.00 " " 7,986.97 " " 15,350.10 " N/A " 7,754.34 " N/A N/A " 7,754.34 " " 13,484.63 " " 16,855.79 " " 7,986.97 " " 7,986.97 " " 7,754.34 " N/A N/A N/A " 18,851.00 " N/A N/A N/A N/A N/A " 7,986.97 " DRG 370 No Current Volume N/A " 5,621.18 " " 13,173.70 " N/A " 11,238.71 " " 5,902.24 " " 11,238.71 " N/A " 11,627.00 " " 5,789.82 " " 10,660.43 " N/A " 5,621.18 " N/A N/A " 5,621.18 " " 10,538.96 " " 13,173.70 " " 5,789.82 " " 5,789.82 " " 5,621.18 " N/A N/A N/A " 13,091.75 " N/A N/A N/A N/A N/A " 5,789.82 " DRG 371 " 75,770.54 " " 23,875.30 " " 11,993.45 " " 60,616.43 " N/A " 26,007.82 " " 12,593.12 " " 26,007.82 " N/A " 29,316.00 " " 12,353.25 " " 24,669.60 " N/A " 11,993.45 " " 43,204.36 " N/A " 11,993.45 " " 19,621.44 " " 24,526.82 " " 12,353.25 " " 12,353.25 " " 11,993.45 " " 60,616.43 " N/A N/A " 30,296.00 " N/A N/A " 56,827.90 " N/A N/A " 12,353.25 " DRG 372 " 42,731.42 " " 13,464.67 " " 7,443.87 " " 34,185.13 " N/A " 15,463.17 " " 7,816.06 " " 15,463.17 " N/A " 17,847.00 " " 7,667.19 " " 14,667.53 " N/A " 7,443.87 " " 24,365.45 " N/A " 7,443.87 " " 11,308.10 " " 14,135.14 " " 7,667.19 " " 7,667.19 " " 7,443.87 " " 34,185.13 " N/A N/A " 18,012.75 " N/A N/A " 32,048.56 " N/A N/A " 7,667.19 " DRG 373 " 40,718.30 " " 12,830.34 " " 5,598.49 " " 32,574.64 " N/A " 11,186.13 " " 5,878.41 " " 11,186.13 " N/A " 12,605.00 " " 5,766.44 " " 10,610.55 " N/A " 5,598.49 " " 23,217.58 " N/A " 5,598.49 " " 9,295.23 " " 11,619.04 " " 5,766.44 " " 5,766.44 " " 5,598.49 " " 32,574.64 " N/A N/A " 13,030.50 " N/A N/A " 30,538.73 " N/A N/A " 5,766.44 " DRG 374 " 58,378.85 " " 18,395.18 " " 14,213.47 " " 46,703.08 " N/A " 31,153.20 " " 14,924.14 " " 31,153.20 " N/A " 31,752.00 " " 14,639.87 " " 29,550.23 " N/A " 14,213.47 " " 33,287.62 " N/A " 14,213.47 " " 23,663.56 " " 29,579.46 " " 14,639.87 " " 14,639.87 " " 14,213.47 " " 46,703.08 " N/A N/A " 36,289.75 " N/A N/A " 43,784.14 " N/A N/A " 14,639.87 " DRG 375 " 42,540.51 " " 13,404.51 " " 8,599.57 " " 34,032.40 " N/A " 18,141.77 " " 9,029.55 " " 18,141.77 " N/A " 19,554.00 " " 8,857.56 " " 17,208.30 " N/A " 8,599.57 " " 24,256.60 " N/A " 8,599.57 " " 14,793.82 " " 18,492.28 " " 8,857.56 " " 8,857.56 " " 8,599.57 " " 34,032.40 " N/A N/A " 21,133.00 " N/A N/A " 31,905.38 " N/A N/A " 8,857.56 " DRG 376 " 32,205.82 " " 10,148.05 " " 6,598.64 " " 25,764.66 " N/A " 13,504.17 " " 6,928.57 " " 13,504.17 " N/A " 14,194.00 " " 6,796.60 " " 12,809.33 " N/A " 6,598.64 " " 18,363.76 " N/A " 6,598.64 " " 11,799.05 " " 14,748.82 " " 6,796.60 " " 6,796.60 " " 6,598.64 " " 25,764.66 " N/A N/A " 15,730.75 " N/A N/A " 24,154.37 " N/A N/A " 6,796.60 " DRG 377 " 73,528.43 " " 23,168.81 " " 12,447.17 " " 58,822.75 " N/A " 27,059.43 " " 13,069.53 " " 27,059.43 " N/A " 27,965.00 " " 12,820.59 " " 25,667.10 " N/A " 12,447.17 " " 41,925.91 " N/A " 12,447.17 " " 23,107.15 " " 28,883.96 " " 12,820.59 " " 12,820.59 " " 12,447.17 " " 58,822.75 " N/A N/A " 31,521.00 " N/A N/A " 55,146.32 " N/A N/A " 12,820.59 " DRG 378 " 45,851.62 " " 14,447.85 " " 7,211.82 " " 36,681.30 " N/A " 14,925.35 " " 7,572.41 " " 14,925.35 " N/A " 15,765.00 " " 7,428.17 " " 14,157.38 " N/A " 7,211.82 " " 26,144.60 " N/A " 7,211.82 " " 12,797.30 " " 15,996.64 " " 7,428.17 " " 7,428.17 " " 7,211.82 " " 36,681.30 " N/A N/A " 17,386.25 " N/A N/A " 34,388.72 " N/A N/A " 7,428.17 " DRG 379 " 38,106.18 " " 12,007.26 " " 4,902.35 " " 30,484.94 " N/A " 9,572.66 " " 5,147.47 " " 9,572.66 " N/A " 10,660.00 " " 5,049.42 " " 9,080.10 " N/A " 4,902.35 " " 21,728.14 " N/A " 4,902.35 " " 9,049.76 " " 11,312.20 " " 5,049.42 " " 5,049.42 " " 4,902.35 " " 30,484.94 " N/A N/A " 11,151.00 " N/A N/A " 28,579.63 " N/A N/A " 5,049.42 " DRG 380 " 58,228.08 " " 18,347.67 " " 13,000.72 " " 46,582.46 " N/A " 28,342.39 " " 13,650.76 " " 28,342.39 " N/A " 30,311.00 " " 13,390.74 " " 26,884.05 " N/A " 13,000.72 " " 33,201.65 " N/A " 13,000.72 " " 23,025.33 " " 28,781.68 " " 13,390.74 " " 13,390.74 " " 13,000.72 " " 46,582.46 " N/A N/A " 33,015.50 " N/A N/A " 43,671.06 " N/A N/A " 13,390.74 " DRG 381 " 24,688.66 " " 7,779.40 " " 7,638.32 " " 19,750.93 " N/A " 15,913.86 " " 8,020.24 " " 15,913.86 " N/A " 17,110.00 " " 7,867.47 " " 15,095.03 " N/A " 7,638.32 " " 14,077.47 " N/A " 7,638.32 " " 12,780.94 " " 15,976.18 " " 7,867.47 " " 7,867.47 " " 7,638.32 " " 19,750.93 " N/A N/A " 18,537.75 " N/A N/A " 18,516.49 " N/A N/A " 7,867.47 " DRG 382 No Current Volume N/A " 5,754.06 " " 13,450.50 " N/A " 11,546.68 " " 6,041.76 " " 11,546.68 " N/A " 11,944.00 " " 5,926.68 " " 10,952.55 " N/A " 5,754.06 " N/A N/A " 5,754.06 " " 9,655.26 " " 12,069.08 " " 5,926.68 " " 5,926.68 " " 5,754.06 " N/A N/A N/A " 13,450.50 " N/A N/A N/A N/A N/A " 5,926.68 " DRG 383 No Current Volume N/A " 9,280.16 " " 27,042.91 " N/A " 19,719.19 " " 9,744.17 " " 19,719.19 " N/A " 20,791.00 " " 9,558.56 " " 18,704.55 " N/A " 9,280.16 " N/A N/A " 9,280.16 " " 21,634.32 " " 27,042.91 " " 9,558.56 " " 9,558.56 " " 9,280.16 " N/A N/A N/A " 22,970.50 " N/A N/A N/A N/A N/A " 9,558.56 " DRG 384 " 44,932.75 " " 14,158.31 " " 6,559.10 " " 35,946.20 " N/A " 13,412.53 " " 6,887.06 " " 13,412.53 " N/A " 13,390.00 " " 6,755.87 " " 12,722.40 " N/A " 6,559.10 " " 25,620.65 " N/A " 6,559.10 " " 10,784.43 " " 13,480.54 " " 6,755.87 " " 6,755.87 " " 6,559.10 " " 35,946.20 " N/A N/A " 15,624.00 " N/A N/A " 33,699.56 " N/A N/A " 6,755.87 " DRG 385 " 77,094.96 " " 24,292.62 " " 11,287.58 " " 61,675.96 " N/A " 24,371.81 " " 11,851.96 " " 24,371.81 " N/A " 27,767.00 " " 11,626.21 " " 23,117.78 " N/A " 11,287.58 " " 43,959.54 " N/A " 11,287.58 " " 17,854.04 " " 22,317.56 " " 11,626.21 " " 11,626.21 " " 11,287.58 " " 61,675.96 " N/A N/A " 28,390.25 " N/A N/A " 57,821.22 " N/A N/A " 11,626.21 " DRG 386 " 23,990.72 " " 7,559.48 " " 7,222.19 " " 19,192.57 " N/A " 14,949.39 " " 7,583.30 " " 14,949.39 " N/A " 15,797.00 " " 7,438.86 " " 14,180.18 " N/A " 7,222.19 " " 13,679.51 " N/A " 7,222.19 " " 11,520.85 " " 14,401.07 " " 7,438.86 " " 7,438.86 " " 7,222.19 " " 19,192.57 " N/A N/A " 17,414.25 " N/A N/A " 17,993.04 " N/A N/A " 7,438.86 " DRG 387 " 20,393.26 " " 6,425.92 " " 5,404.69 " " 16,314.61 " N/A " 10,736.94 " " 5,674.92 " " 10,736.94 " N/A " 11,720.00 " " 5,566.83 " " 10,184.48 " N/A " 5,404.69 " " 11,628.24 " N/A " 5,404.69 " " 8,787.92 " " 10,984.90 " " 5,566.83 " " 5,566.83 " " 5,404.69 " " 16,314.61 " N/A N/A " 12,507.25 " N/A N/A " 15,294.95 " N/A N/A " 5,566.83 " DRG 388 " 47,951.06 " " 15,109.38 " " 10,589.49 " " 38,360.85 " N/A " 22,753.84 " " 11,118.96 " " 22,753.84 " N/A " 25,332.00 " " 10,907.17 " " 21,583.05 " N/A " 10,589.49 " " 27,341.69 " N/A " 10,589.49 " " 15,170.21 " " 18,962.77 " " 10,907.17 " " 10,907.17 " " 10,589.49 " " 38,360.85 " N/A N/A " 26,505.50 " N/A N/A " 35,963.29 " N/A N/A " 10,907.17 " DRG 389 " 20,475.42 " " 6,451.80 " " 6,107.96 " " 16,380.33 " N/A " 12,366.93 " " 6,413.36 " " 12,366.93 " N/A " 13,716.00 " " 6,291.20 " " 11,730.60 " N/A " 6,107.96 " " 11,675.08 " N/A " 6,107.96 " " 8,787.92 " " 10,984.90 " " 6,291.20 " " 6,291.20 " " 6,107.96 " " 16,380.33 " N/A N/A " 14,406.00 " N/A N/A " 15,356.56 " N/A N/A " 6,291.20 " DRG 390 " 19,422.34 " " 6,119.98 " " 4,551.68 " " 15,537.87 " N/A " 8,759.91 " " 4,779.26 " " 8,759.91 " N/A " 9,494.00 " " 4,688.23 " " 8,309.18 " N/A " 4,551.68 " " 11,074.62 " N/A " 4,551.68 " " 6,955.06 " " 8,693.83 " " 4,688.23 " " 4,688.23 " " 4,551.68 " " 15,537.87 " N/A N/A " 10,204.25 " N/A N/A " 14,566.75 " N/A N/A " 4,688.23 " DRG 391 " 49,444.06 " " 15,579.82 " " 8,869.21 " " 39,555.25 " N/A " 18,766.73 " " 9,312.67 " " 18,766.73 " N/A " 18,842.00 " " 9,135.29 " " 17,801.10 " N/A " 8,869.21 " " 28,193.00 " N/A " 8,869.21 " " 14,384.69 " " 17,980.88 " " 9,135.29 " " 9,135.29 " " 8,869.21 " " 39,555.25 " N/A N/A " 21,861.00 " N/A N/A " 37,083.04 " N/A N/A " 9,135.29 " DRG 392 " 31,558.71 " " 9,944.15 " " 5,735.91 " " 25,246.97 " N/A " 11,504.61 " " 6,022.71 " " 11,504.61 " N/A " 11,623.00 " " 5,907.99 " " 10,912.65 " N/A " 5,735.91 " " 17,994.78 " N/A " 5,735.91 " " 8,837.01 " " 11,046.27 " " 5,907.99 " " 5,907.99 " " 5,735.91 " " 25,246.97 " N/A N/A " 13,401.50 " N/A N/A " 23,669.04 " N/A N/A " 5,907.99 " DRG 393 " 60,950.44 " " 19,205.48 " " 11,539.72 " " 48,760.35 " N/A " 24,956.21 " " 12,116.71 " " 24,956.21 " N/A " 26,577.00 " " 11,885.91 " " 23,672.10 " N/A " 11,539.72 " " 34,753.94 " N/A " 11,539.72 " " 18,950.48 " " 23,688.12 " " 11,885.91 " " 11,885.91 " " 11,539.72 " " 48,760.35 " N/A N/A " 29,071.00 " N/A N/A " 45,712.83 " N/A N/A " 11,885.91 " DRG 394 " 32,976.87 " " 10,391.01 " " 6,870.87 " " 26,381.49 " N/A " 14,135.14 " " 7,214.41 " " 14,135.14 " N/A " 14,866.00 " " 7,077.00 " " 13,407.83 " N/A " 6,870.87 " " 18,803.41 " N/A " 6,870.87 " " 11,520.85 " " 14,401.07 " " 7,077.00 " " 7,077.00 " " 6,870.87 " " 26,381.49 " N/A N/A " 16,465.75 " N/A N/A " 24,732.65 " N/A N/A " 7,077.00 " DRG 395 " 34,911.01 " " 11,000.46 " " 4,995.04 " " 27,928.81 " N/A " 9,787.48 " " 5,244.79 " " 9,787.48 " N/A " 10,345.00 " " 5,144.89 " " 9,283.88 " N/A " 4,995.04 " " 19,906.26 " N/A " 4,995.04 " " 9,786.17 " " 12,232.72 " " 5,144.89 " " 5,144.89 " " 4,995.04 " " 27,928.81 " N/A N/A " 11,401.25 " N/A N/A " 26,183.26 " N/A N/A " 5,144.89 " DRG 405 " 229,189.69 " " 72,217.67 " " 37,962.16 " " 183,351.75 " N/A " 86,195.96 " " 39,860.27 " " 86,195.96 " N/A " 87,144.00 " " 39,101.02 " " 81,760.80 " N/A " 37,962.16 " " 130,683.96 " N/A " 37,962.16 " " 58,061.22 " " 72,576.51 " " 39,101.02 " " 39,101.02 " " 37,962.16 " " 183,351.75 " N/A N/A " 100,408.00 " N/A N/A " 171,892.27 " N/A N/A " 39,101.02 " DRG 406 No Current Volume N/A " 19,445.58 " " 50,415.75 " N/A " 43,279.76 " " 20,417.86 " " 43,279.76 " N/A " 44,158.00 " " 20,028.95 " " 41,052.83 " N/A " 19,445.58 " N/A N/A " 19,445.58 " " 32,900.41 " " 41,125.50 " " 20,028.95 " " 20,028.95 " " 19,445.58 " N/A N/A N/A " 50,415.75 " N/A N/A N/A N/A N/A " 20,028.95 " DRG 407 No Current Volume N/A " 14,500.61 " " 37,065.00 " N/A " 31,818.71 " " 15,225.64 " " 31,818.71 " N/A " 30,635.00 " " 14,935.63 " " 30,181.50 " N/A " 14,500.61 " N/A N/A " 14,500.61 " " 28,425.73 " " 35,532.18 " " 14,935.63 " " 14,935.63 " " 14,500.61 " N/A N/A N/A " 37,065.00 " N/A N/A N/A N/A N/A " 14,935.63 " DRG 408 No Current Volume N/A " 25,097.72 " " 67,132.38 " N/A " 56,379.82 " " 26,352.61 " " 56,379.82 " N/A " 61,308.00 " " 25,850.65 " " 53,478.83 " N/A " 25,097.72 " N/A N/A " 25,097.72 " " 53,705.91 " " 67,132.38 " " 25,850.65 " " 25,850.65 " " 25,097.72 " N/A N/A N/A " 65,675.75 " N/A N/A N/A N/A N/A " 25,850.65 " DRG 409 " 52,573.99 " " 16,566.06 " " 14,490.24 " " 42,059.19 " N/A " 31,794.68 " " 15,214.75 " " 31,794.68 " N/A " 34,955.00 " " 14,924.95 " " 30,158.70 " N/A " 14,490.24 " " 29,977.69 " N/A " 14,490.24 " " 30,831.36 " " 38,539.22 " " 14,924.95 " " 14,924.95 " " 14,490.24 " " 42,059.19 " N/A N/A " 37,037.00 " N/A N/A " 39,430.49 " N/A N/A " 14,924.95 " DRG 410 No Current Volume N/A " 10,937.56 " " 32,095.56 " N/A " 23,560.57 " " 11,484.44 " " 23,560.57 " N/A " 25,498.00 " " 11,265.69 " " 22,348.28 " N/A " 10,937.56 " N/A N/A " 10,937.56 " " 25,676.43 " " 32,095.56 " " 11,265.69 " " 11,265.69 " " 10,937.56 " N/A N/A N/A " 27,445.25 " N/A N/A N/A N/A N/A " 11,265.69 " DRG 411 No Current Volume N/A " 25,101.61 " " 67,310.88 " N/A " 56,388.83 " " 26,356.69 " " 56,388.83 " N/A " 57,051.00 " " 25,854.66 " " 53,487.38 " N/A " 25,101.61 " N/A N/A " 25,101.61 " " 53,848.71 " " 67,310.88 " " 25,854.66 " " 25,854.66 " " 25,101.61 " N/A N/A N/A " 65,686.25 " N/A N/A N/A N/A N/A " 25,854.66 " DRG 412 No Current Volume N/A " 15,534.46 " " 41,536.04 " N/A " 34,214.88 " " 16,311.18 " " 34,214.88 " N/A " 38,021.00 " " 16,000.49 " " 32,454.38 " N/A " 15,534.46 " N/A N/A " 15,534.46 " " 33,228.84 " " 41,536.04 " " 16,000.49 " " 16,000.49 " " 15,534.46 " N/A N/A N/A " 39,856.25 " N/A N/A N/A N/A N/A " 16,000.49 " DRG 413 No Current Volume N/A " 11,991.50 " " 34,795.76 " N/A " 26,003.31 " " 12,591.08 " " 26,003.31 " N/A " 27,861.00 " " 12,351.25 " " 24,665.33 " N/A " 11,991.50 " N/A N/A " 11,991.50 " " 27,836.59 " " 34,795.76 " " 12,351.25 " " 12,351.25 " " 11,991.50 " N/A N/A N/A " 30,290.75 " N/A N/A N/A N/A N/A " 12,351.25 " DRG 414 No Current Volume N/A " 24,290.08 " " 63,495.25 " N/A " 54,507.95 " " 25,504.58 " " 54,507.95 " N/A " 55,925.00 " " 25,018.78 " " 51,703.28 " N/A " 24,290.08 " N/A N/A " 24,290.08 " " 34,142.74 " " 42,678.42 " " 25,018.78 " " 25,018.78 " " 24,290.08 " N/A N/A N/A " 63,495.25 " N/A N/A N/A N/A N/A " 25,018.78 " DRG 415 " 98,450.15 " " 31,021.64 " " 13,941.23 " " 78,760.12 " N/A " 30,522.23 " " 14,638.29 " " 30,522.23 " N/A " 31,887.00 " " 14,359.47 " " 28,951.73 " N/A " 13,941.23 " " 56,136.28 " N/A " 13,941.23 " " 25,038.21 " " 31,297.77 " " 14,359.47 " " 14,359.47 " " 13,941.23 " " 78,760.12 " N/A N/A " 35,554.75 " N/A N/A " 73,837.61 " N/A N/A " 14,359.47 " DRG 416 No Current Volume N/A " 9,991.22 " " 24,890.25 " N/A " 21,367.21 " " 10,490.78 " " 21,367.21 " N/A " 21,185.00 " " 10,290.96 " " 20,267.78 " N/A " 9,991.22 " N/A N/A " 9,991.22 " " 19,425.07 " " 24,281.34 " " 10,290.96 " " 10,290.96 " " 9,991.22 " N/A N/A N/A " 24,890.25 " N/A N/A N/A N/A N/A " 10,290.96 " DRG 417 " 94,644.64 " " 29,822.53 " " 16,485.99 " " 75,715.71 " N/A " 36,420.26 " " 17,310.29 " " 36,420.26 " N/A " 38,315.00 " " 16,980.57 " " 34,546.28 " N/A " 16,485.99 " " 53,966.37 " N/A " 16,485.99 " " 24,170.87 " " 30,213.60 " " 16,980.57 " " 16,980.57 " " 16,485.99 " " 75,715.71 " N/A N/A " 42,425.25 " N/A N/A " 70,983.48 " N/A N/A " 16,980.57 " DRG 418 " 78,144.74 " " 24,623.41 " " 11,719.91 " " 62,515.80 " N/A " 25,373.85 " " 12,305.91 " " 25,373.85 " N/A " 26,118.00 " " 12,071.51 " " 24,068.25 " N/A " 11,719.91 " " 44,558.13 " N/A " 11,719.91 " " 20,406.96 " " 25,508.71 " " 12,071.51 " " 12,071.51 " " 11,719.91 " " 62,515.80 " N/A N/A " 29,557.50 " N/A N/A " 58,608.56 " N/A N/A " 12,071.51 " DRG 419 " 52,637.28 " " 16,586.01 " " 9,297.66 " " 42,109.83 " N/A " 19,759.75 " " 9,762.54 " " 19,759.75 " N/A " 19,378.00 " " 9,576.59 " " 18,743.03 " N/A " 9,297.66 " " 30,013.78 " N/A " 9,297.66 " " 17,363.10 " " 21,703.88 " " 9,576.59 " " 9,576.59 " " 9,297.66 " " 42,109.83 " N/A N/A " 23,017.75 " N/A N/A " 39,477.96 " N/A N/A " 9,576.59 " DRG 420 No Current Volume N/A " 23,565.42 " " 61,538.75 " N/A " 52,828.38 " " 24,743.69 " " 52,828.38 " N/A " 54,471.00 " " 24,272.38 " " 50,110.13 " N/A " 23,565.42 " N/A N/A " 23,565.42 " " 48,508.11 " " 60,635.13 " " 24,272.38 " " 24,272.38 " " 23,565.42 " N/A N/A N/A " 61,538.75 " N/A N/A N/A N/A N/A " 24,272.38 " DRG 421 No Current Volume N/A " 13,136.19 " " 33,381.25 " N/A " 28,656.37 " " 13,793.00 " " 28,656.37 " N/A " 27,847.00 " " 13,530.28 " " 27,181.88 " N/A " 13,136.19 " N/A N/A " 13,136.19 " " 26,232.84 " " 32,791.06 " " 13,530.28 " " 13,530.28 " " 13,136.19 " N/A N/A N/A " 33,381.25 " N/A N/A N/A N/A N/A " 13,530.28 " DRG 422 No Current Volume N/A " 10,194.10 " " 28,597.57 " N/A " 21,837.43 " " 10,703.81 " " 21,837.43 " N/A " 19,434.00 " " 10,499.92 " " 20,713.80 " N/A " 10,194.10 " N/A N/A " 10,194.10 " " 22,878.05 " " 28,597.57 " " 10,499.92 " " 10,499.92 " " 10,194.10 " N/A N/A N/A " 25,438.00 " N/A N/A N/A N/A N/A " 10,499.92 " DRG 423 " 102,422.25 " " 32,273.25 " " 27,904.34 " " 81,937.80 " N/A " 62,884.78 " " 29,299.56 " " 62,884.78 " N/A " 66,020.00 " " 28,741.47 " " 59,649.08 " N/A " 27,904.34 " " 58,401.17 " N/A " 27,904.34 " " 58,361.09 " " 72,951.36 " " 28,741.47 " " 28,741.47 " " 27,904.34 " " 81,937.80 " N/A N/A " 73,253.25 " N/A N/A " 76,816.69 " N/A N/A " 28,741.47 " DRG 424 " 106,399.93 " " 33,526.62 " " 15,577.24 " " 85,119.94 " N/A " 34,314.03 " " 16,356.10 " " 34,314.03 " N/A " 36,175.00 " " 16,044.56 " " 32,548.43 " N/A " 15,577.24 " " 60,669.24 " N/A " 15,577.24 " " 32,400.62 " " 40,500.77 " " 16,044.56 " " 16,044.56 " " 15,577.24 " " 85,119.94 " N/A N/A " 39,971.75 " N/A N/A " 79,799.95 " N/A N/A " 16,044.56 " DRG 425 No Current Volume N/A " 10,771.63 " " 31,031.84 " N/A " 23,175.98 " " 11,310.21 " " 23,175.98 " N/A " 21,702.00 " " 11,094.78 " " 21,983.48 " N/A " 10,771.63 " N/A N/A " 10,771.63 " " 24,825.46 " " 31,031.84 " " 11,094.78 " " 11,094.78 " " 10,771.63 " N/A N/A N/A " 26,997.25 " N/A N/A N/A N/A N/A " 11,094.78 " DRG 432 " 88,516.30 " " 27,891.49 " " 12,963.12 " " 70,813.04 " N/A " 28,255.26 " " 13,611.28 " " 28,255.26 " N/A " 26,290.00 " " 13,352.01 " " 26,801.40 " N/A " 12,963.12 " " 50,472.00 " N/A " 12,963.12 " " 23,483.55 " " 29,354.45 " " 13,352.01 " " 13,352.01 " " 12,963.12 " " 70,813.04 " N/A N/A " 32,914.00 " N/A N/A " 66,387.23 " N/A N/A " 13,352.01 " DRG 433 " 39,410.32 " " 12,418.19 " " 7,447.75 " " 31,528.26 " N/A " 15,472.19 " " 7,820.14 " " 15,472.19 " N/A " 14,432.00 " " 7,671.18 " " 14,676.08 " N/A " 7,447.75 " " 22,471.77 " N/A " 7,447.75 " " 13,010.05 " " 16,262.57 " " 7,671.18 " " 7,671.18 " " 7,447.75 " " 31,528.26 " N/A N/A " 18,023.25 " N/A N/A " 29,557.74 " N/A N/A " 7,671.18 " DRG 434 No Current Volume N/A " 4,795.40 " " 10,862.25 " N/A " 9,324.78 " " 5,035.17 " " 9,324.78 " N/A " 9,799.00 " " 4,939.26 " " 8,844.98 " N/A " 4,795.40 " N/A N/A " 4,795.40 " " 8,035.14 " " 10,043.93 " " 4,939.26 " " 4,939.26 " " 4,795.40 " N/A N/A N/A " 10,862.25 " N/A N/A N/A N/A N/A " 4,939.26 " DRG 435 " 109,818.79 " " 34,603.90 " " 12,137.34 " " 87,855.03 " N/A " 26,341.33 " " 12,744.21 " " 26,341.33 " N/A " 27,570.00 " " 12,501.46 " " 24,985.95 " N/A " 12,137.34 " " 62,618.67 " N/A " 12,137.34 " " 21,683.41 " " 27,104.28 " " 12,501.46 " " 12,501.46 " " 12,137.34 " " 87,855.03 " N/A N/A " 30,684.50 " N/A N/A " 82,364.09 " N/A N/A " 12,501.46 " DRG 436 No Current Volume N/A " 8,041.49 " " 19,626.25 " N/A " 16,848.29 " " 8,443.56 " " 16,848.29 " N/A " 18,313.00 " " 8,282.73 " " 15,981.38 " N/A " 8,041.49 " N/A N/A " 8,041.49 " " 14,204.68 " " 17,755.86 " " 8,282.73 " " 8,282.73 " " 8,041.49 " N/A N/A N/A " 19,626.25 " N/A N/A N/A N/A N/A " 8,282.73 " DRG 437 " 42,954.15 " " 13,534.85 " " 6,579.19 " " 34,363.32 " N/A " 13,459.11 " " 6,908.15 " " 13,459.11 " N/A " 14,114.00 " " 6,776.57 " " 12,766.58 " N/A " 6,579.19 " " 24,492.46 " N/A " 6,579.19 " " 11,389.93 " " 14,237.42 " " 6,776.57 " " 6,776.57 " " 6,579.19 " " 34,363.32 " N/A N/A " 15,678.25 " N/A N/A " 32,215.61 " N/A N/A " 6,776.57 " DRG 438 " 52,206.26 " " 16,450.19 " " 11,128.77 " " 41,765.01 " N/A " 24,003.75 " " 11,685.21 " " 24,003.75 " N/A " 26,782.00 " " 11,462.63 " " 22,768.65 " N/A " 11,128.77 " " 29,768.01 " N/A " 11,128.77 " " 22,550.75 " " 28,188.45 " " 11,462.63 " " 11,462.63 " " 11,128.77 " " 41,765.01 " N/A N/A " 27,961.50 " N/A N/A " 39,154.69 " N/A N/A " 11,462.63 " DRG 439 " 22,398.19 " " 7,057.67 " " 6,250.56 " " 17,918.55 " N/A " 12,697.44 " " 6,563.09 " " 12,697.44 " N/A " 14,273.00 " " 6,438.08 " " 12,044.10 " N/A " 6,250.56 " " 12,771.45 " N/A " 6,250.56 " " 10,784.43 " " 13,480.54 " " 6,438.08 " " 6,438.08 " " 6,250.56 " " 17,918.55 " N/A N/A " 14,791.00 " N/A N/A " 16,798.64 " N/A N/A " 6,438.08 " DRG 440 " 19,593.42 " " 6,173.89 " " 4,702.06 " " 15,674.74 " N/A " 9,108.44 " " 4,937.16 " " 9,108.44 " N/A " 10,106.00 " " 4,843.12 " " 8,639.78 " N/A " 4,702.06 " " 11,172.17 " N/A " 4,702.06 " " 8,116.96 " " 10,146.21 " " 4,843.12 " " 4,843.12 " " 4,702.06 " " 15,674.74 " N/A N/A " 10,610.25 " N/A N/A " 14,695.07 " N/A N/A " 4,843.12 " DRG 441 " 62,255.01 " " 19,616.55 " " 12,954.70 " " 49,804.01 " N/A " 28,235.73 " " 13,602.44 " " 28,235.73 " N/A " 29,634.00 " " 13,343.34 " " 26,782.88 " N/A " 12,954.70 " " 35,497.81 " N/A " 12,954.70 " " 24,825.46 " " 31,031.84 " " 13,343.34 " " 13,343.34 " " 12,954.70 " " 49,804.01 " N/A N/A " 32,891.25 " N/A N/A " 46,691.26 " N/A N/A " 13,343.34 " DRG 442 " 44,346.26 " " 13,973.51 " " 6,800.22 " " 35,477.01 " N/A " 13,971.39 " " 7,140.23 " " 13,971.39 " N/A " 14,579.00 " " 7,004.23 " " 13,252.50 " N/A " 6,800.22 " " 25,286.24 " N/A " 6,800.22 " " 12,044.52 " " 15,055.66 " " 7,004.23 " " 7,004.23 " " 6,800.22 " " 35,477.01 " N/A N/A " 16,275.00 " N/A N/A " 33,259.69 " N/A N/A " 7,004.23 " DRG 443 " 41,648.56 " " 13,123.46 " " 5,070.88 " " 33,318.85 " N/A " 9,963.25 " " 5,324.42 " " 9,963.25 " N/A " 10,245.00 " " 5,223.01 " " 9,450.60 " N/A " 5,070.88 " " 23,748.01 " N/A " 5,070.88 " " 10,326.21 " " 12,907.77 " " 5,223.01 " " 5,223.01 " " 5,070.88 " " 33,318.85 " N/A N/A " 11,606.00 " N/A N/A " 31,236.42 " N/A N/A " 5,223.01 " DRG 444 " 103,293.27 " " 32,547.71 " " 11,607.13 " " 82,634.62 " N/A " 25,112.45 " " 12,187.49 " " 25,112.45 " N/A " 25,508.00 " " 11,955.34 " " 23,820.30 " N/A " 11,607.13 " " 58,897.82 " N/A " 11,607.13 " " 18,934.12 " " 23,667.66 " " 11,955.34 " " 11,955.34 " " 11,607.13 " " 82,634.62 " N/A N/A " 29,253.00 " N/A N/A " 77,469.96 " N/A N/A " 11,955.34 " DRG 445 " 46,832.75 " " 14,757.00 " " 7,756.29 " " 37,466.20 " N/A " 16,187.28 " " 8,144.10 " " 16,187.28 " N/A " 16,764.00 " " 7,988.98 " " 15,354.38 " N/A " 7,756.29 " " 26,704.03 " N/A " 7,756.29 " " 14,122.86 " " 17,653.58 " " 7,988.98 " " 7,988.98 " " 7,756.29 " " 37,466.20 " N/A N/A " 18,856.25 " N/A N/A " 35,124.56 " N/A N/A " 7,988.98 " DRG 446 " 27,658.20 " " 8,715.10 " " 6,065.18 " " 22,126.56 " N/A " 12,267.78 " " 6,368.44 " " 12,267.78 " N/A " 11,907.00 " " 6,247.14 " " 11,636.55 " N/A " 6,065.18 " " 15,770.70 " N/A " 6,065.18 " " 11,062.63 " " 13,828.30 " " 6,247.14 " " 6,247.14 " " 6,065.18 " " 22,126.56 " N/A N/A " 14,290.50 " N/A N/A " 20,743.65 " N/A N/A " 6,247.14 " DRG 453 No Current Volume N/A " 60,326.99 " " 175,642.00 " N/A " 138,031.32 " " 63,343.34 " " 138,031.32 " N/A " 175,642.00 " " 62,136.80 " " 130,929.00 " N/A " 60,326.99 " N/A N/A " 60,326.99 " " 100,557.58 " " 125,696.95 " " 62,136.80 " " 62,136.80 " " 60,326.99 " N/A N/A N/A " 160,790.00 " N/A N/A N/A N/A N/A " 62,136.80 " DRG 454 " 127,106.81 " " 40,051.36 " " 40,266.44 " " 126,157.00 " N/A " 91,536.64 " " 42,279.76 " " 91,536.64 " N/A " 126,157.00 " " 41,474.43 " " 86,826.68 " N/A " 40,266.44 " " 72,476.30 " N/A " 40,266.44 " " 63,344.70 " " 79,180.87 " " 41,474.43 " " 41,474.43 " " 40,266.44 " " 101,685.45 " N/A N/A " 106,629.25 " N/A N/A " 95,330.11 " N/A N/A " 41,474.43 " DRG 455 " 153,381.38 " " 48,330.47 " " 31,763.61 " " 122,705.10 " N/A " 71,829.47 " " 33,351.79 " " 71,829.47 " N/A " 98,338.00 " " 32,716.52 " " 68,133.53 " N/A " 31,763.61 " " 87,458.06 " N/A " 31,763.61 " " 52,006.63 " " 65,008.28 " " 32,716.52 " " 32,716.52 " " 31,763.61 " " 122,705.10 " N/A N/A " 83,672.75 " N/A N/A " 115,036.04 " N/A N/A " 32,716.52 " DRG 456 " 278,203.72 " " 87,661.99 " " 56,515.69 " " 222,562.97 " N/A " 129,197.80 " " 59,341.47 " " 129,197.80 " N/A " 147,956.00 " " 58,211.16 " " 122,550.00 " N/A " 56,515.69 " " 158,631.76 " N/A " 56,515.69 " " 115,494.13 " " 144,367.65 " " 58,211.16 " " 58,211.16 " " 56,515.69 " " 222,562.97 " N/A N/A " 150,500.00 " N/A N/A " 208,652.79 " N/A N/A " 58,211.16 " DRG 457 " 164,260.94 " " 51,758.62 " " 42,877.32 " " 131,408.75 " N/A " 97,587.91 " " 45,021.19 " " 97,587.91 " N/A " 108,678.00 " " 44,163.64 " " 92,566.58 " N/A " 42,877.32 " " 93,661.59 " N/A " 42,877.32 " " 83,964.58 " " 104,955.71 " " 44,163.64 " " 44,163.64 " " 42,877.32 " " 131,408.75 " N/A N/A " 113,678.25 " N/A N/A " 123,195.70 " N/A N/A " 44,163.64 " DRG 458 No Current Volume N/A " 33,230.44 " " 89,783.54 " N/A " 75,229.17 " " 34,891.96 " " 75,229.17 " N/A " 82,817.00 " " 34,227.35 " " 71,358.30 " N/A " 33,230.44 " N/A N/A " 33,230.44 " " 71,826.84 " " 89,783.54 " " 34,227.35 " " 34,227.35 " " 33,230.44 " N/A N/A N/A " 87,633.00 " N/A N/A N/A N/A N/A " 34,227.35 " DRG 459 " 204,073.48 " " 64,303.55 " " 44,417.39 " " 163,258.78 " N/A " 101,157.37 " " 46,638.26 " " 101,157.37 " N/A " 104,920.00 " " 45,749.91 " " 95,952.38 " N/A " 44,417.39 " " 116,362.70 " N/A " 44,417.39 " " 62,430.80 " " 78,038.49 " " 45,749.91 " " 45,749.91 " " 44,417.39 " " 163,258.78 " N/A N/A " 117,836.25 " N/A N/A " 153,055.11 " N/A N/A " 45,749.91 " DRG 460 " 119,986.64 " " 37,807.79 " " 26,250.18 " " 95,989.31 " N/A " 59,050.91 " " 27,562.69 " " 59,050.91 " N/A " 62,930.00 " " 27,037.69 " " 56,012.48 " N/A " 26,250.18 " " 68,416.38 " N/A " 26,250.18 " " 34,242.70 " " 42,803.36 " " 27,037.69 " " 27,037.69 " " 26,250.18 " " 95,989.31 " N/A N/A " 68,787.25 " N/A N/A " 89,989.98 " N/A N/A " 27,037.69 " DRG 461 No Current Volume N/A " 40,192.55 " " 106,429.75 " N/A " 91,365.38 " " 42,202.18 " " 91,365.38 " N/A " 78,986.00 " " 41,398.33 " " 86,664.23 " N/A " 40,192.55 " N/A N/A " 40,192.55 " " 79,652.11 " " 99,565.12 " " 41,398.33 " " 41,398.33 " " 40,192.55 " N/A N/A N/A " 106,429.75 " N/A N/A N/A N/A N/A " 41,398.33 " DRG 462 No Current Volume N/A " 21,134.09 " " 54,974.50 " N/A " 47,193.25 " " 22,190.79 " " 47,193.25 " N/A " 54,917.00 " " 21,768.11 " " 44,764.95 " N/A " 21,134.09 " N/A N/A " 21,134.09 " " 30,858.41 " " 38,573.01 " " 21,768.11 " " 21,768.11 " " 21,134.09 " N/A N/A N/A " 54,974.50 " N/A N/A N/A N/A N/A " 21,768.11 " DRG 463 " 83,735.41 " " 26,385.03 " " 35,581.39 " " 93,980.25 " N/A " 80,678.02 " " 37,360.46 " " 80,678.02 " N/A " 83,928.00 " " 36,648.83 " " 76,526.78 " N/A " 35,581.39 " " 47,745.93 " N/A " 35,581.39 " " 51,292.65 " " 64,115.80 " " 36,648.83 " " 36,648.83 " " 35,581.39 " " 66,988.32 " N/A N/A " 93,980.25 " N/A N/A " 62,801.55 " N/A N/A " 36,648.83 " DRG 464 " 119,304.83 " " 37,592.95 " " 20,061.35 " " 95,443.86 " N/A " 44,706.95 " " 21,064.42 " " 44,706.95 " N/A " 47,335.00 " " 20,663.19 " " 42,406.58 " N/A " 20,061.35 " " 68,027.61 " N/A " 20,061.35 " " 29,044.89 " " 36,306.11 " " 20,663.19 " " 20,663.19 " " 20,061.35 " " 95,443.86 " N/A N/A " 52,078.25 " N/A N/A " 89,478.62 " N/A N/A " 20,663.19 " DRG 465 " 105,347.91 " " 33,195.13 " " 12,725.24 " " 84,278.33 " N/A " 27,703.91 " " 13,361.50 " " 27,703.91 " N/A " 30,624.00 " " 13,107.00 " " 26,278.43 " N/A " 12,725.24 " " 60,069.38 " N/A " 12,725.24 " " 22,681.67 " " 28,352.10 " " 13,107.00 " " 13,107.00 " " 12,725.24 " " 84,278.33 " N/A N/A " 32,271.75 " N/A N/A " 79,010.93 " N/A N/A " 13,107.00 " DRG 466 " 175,679.60 " " 55,356.64 " " 35,421.94 " " 140,543.68 " N/A " 80,308.45 " " 37,193.04 " " 80,308.45 " N/A " 81,047.00 " " 36,484.60 " " 76,176.23 " N/A " 35,421.94 " " 100,172.51 " N/A " 35,421.94 " " 45,552.21 " " 56,940.26 " " 36,484.60 " " 36,484.60 " " 35,421.94 " " 140,543.68 " N/A N/A " 93,549.75 " N/A N/A " 131,759.70 " N/A N/A " 36,484.60 " DRG 467 " 127,456.28 " " 40,161.47 " " 23,960.81 " " 101,965.03 " N/A " 53,744.78 " " 25,158.85 " " 53,744.78 " N/A " 53,857.00 " " 24,679.63 " " 50,979.38 " N/A " 23,960.81 " " 72,675.57 " N/A " 23,960.81 " " 31,429.60 " " 39,286.99 " " 24,679.63 " " 24,679.63 " " 23,960.81 " " 101,965.03 " N/A N/A " 62,606.25 " N/A N/A " 95,592.21 " N/A N/A " 24,679.63 " DRG 468 " 119,815.24 " " 37,753.78 " " 18,936.76 " " 95,852.19 " N/A " 42,100.46 " " 19,883.60 " " 42,100.46 " N/A " 43,505.00 " " 19,504.86 " " 39,934.20 " N/A " 18,936.76 " " 68,318.65 " N/A " 18,936.76 " " 30,356.78 " " 37,945.99 " " 19,504.86 " " 19,504.86 " " 18,936.76 " " 95,852.19 " N/A N/A " 49,042.00 " N/A N/A " 89,861.43 " N/A N/A " 19,504.86 " DRG 469 " 119,582.57 " " 37,680.47 " " 20,774.35 " " 95,666.06 " N/A " 46,359.48 " " 21,813.07 " " 46,359.48 " N/A " 53,344.00 " " 21,397.58 " " 43,974.08 " N/A " 20,774.35 " " 68,185.98 " N/A " 20,774.35 " " 32,876.96 " " 41,096.22 " " 21,397.58 " " 21,397.58 " " 20,774.35 " " 95,666.06 " N/A N/A " 54,003.25 " N/A N/A " 89,686.93 " N/A N/A " 21,397.58 " DRG 470 " 125,110.41 " " 39,422.29 " " 13,089.52 " " 100,088.33 " N/A " 28,548.21 " " 13,744.00 " " 28,548.21 " N/A " 33,258.00 " " 13,482.21 " " 27,079.28 " N/A " 13,089.52 " " 71,337.96 " N/A " 13,089.52 " " 22,059.80 " " 27,574.77 " " 13,482.21 " " 13,482.21 " " 13,089.52 " " 100,088.33 " N/A N/A " 33,255.25 " N/A N/A " 93,832.81 " N/A N/A " 13,482.21 " DRG 471 " 289,632.10 " " 91,263.07 " " 33,308.87 " " 231,705.68 " N/A " 75,410.95 " " 34,974.31 " " 75,410.95 " N/A " 76,681.00 " " 34,308.14 " " 71,530.73 " N/A " 33,308.87 " " 165,148.22 " N/A " 33,308.87 " " 42,496.36 " " 53,120.44 " " 34,308.14 " " 34,308.14 " " 33,308.87 " " 231,705.68 " N/A N/A " 87,844.75 " N/A N/A " 217,224.08 " N/A N/A " 34,308.14 " DRG 472 " 111,517.38 " " 35,139.13 " " 20,565.64 " " 89,213.90 " N/A " 45,875.74 " " 21,593.92 " " 45,875.74 " N/A " 45,887.00 " " 21,182.61 " " 43,515.23 " N/A " 20,565.64 " " 63,587.21 " N/A " 20,565.64 " " 29,130.57 " " 36,413.20 " " 21,182.61 " " 21,182.61 " " 20,565.64 " " 89,213.90 " N/A N/A " 53,439.75 " N/A N/A " 83,638.03 " N/A N/A " 21,182.61 " DRG 473 No Current Volume N/A " 17,229.45 " " 44,432.50 " N/A " 38,143.40 " " 18,090.92 " " 38,143.40 " N/A " 35,643.00 " " 17,746.33 " " 36,180.75 " N/A " 17,229.45 " N/A N/A " 17,229.45 " " 26,167.38 " " 32,709.24 " " 17,746.33 " " 17,746.33 " " 17,229.45 " N/A N/A N/A " 44,432.50 " N/A N/A N/A N/A N/A " 17,746.33 " DRG 474 " 147,576.62 " " 46,501.39 " " 27,192.64 " " 118,061.30 " N/A " 61,235.25 " " 28,552.27 " " 61,235.25 " N/A " 56,551.00 " " 28,008.42 " " 58,084.43 " N/A " 27,192.64 " " 84,148.19 " N/A " 27,192.64 " " 55,419.48 " " 69,274.34 " " 28,008.42 " " 28,008.42 " " 27,192.64 " " 118,061.30 " N/A N/A " 71,331.75 " N/A N/A " 110,682.47 " N/A N/A " 28,008.42 " DRG 475 No Current Volume N/A " 15,008.14 " " 38,435.25 " N/A " 32,995.01 " " 15,758.55 " " 32,995.01 " N/A " 32,259.00 " " 15,458.38 " " 31,297.28 " N/A " 15,008.14 " N/A N/A " 15,008.14 " " 27,312.92 " " 34,141.16 " " 15,458.38 " " 15,458.38 " " 15,008.14 " N/A N/A N/A " 38,435.25 " N/A N/A N/A N/A N/A " 15,458.38 " DRG 476 " 59,053.93 " " 18,607.89 " " 8,292.98 " " 47,243.14 " N/A " 17,431.19 " " 8,707.63 " " 17,431.19 " N/A " 17,602.00 " " 8,541.77 " " 16,534.28 " N/A " 8,292.98 " " 33,672.55 " N/A " 8,292.98 " " 18,721.38 " " 23,401.73 " " 8,541.77 " " 8,541.77 " " 8,292.98 " " 47,243.14 " N/A N/A " 20,305.25 " N/A N/A " 44,290.45 " N/A N/A " 8,541.77 " DRG 477 " 141,199.55 " " 44,491.98 " " 22,543.89 " " 112,959.64 " N/A " 50,460.75 " " 23,671.08 " " 50,460.75 " N/A " 49,778.00 " " 23,220.21 " " 47,864.33 " N/A " 22,543.89 " " 80,511.99 " N/A " 22,543.89 " " 35,028.08 " " 43,785.09 " " 23,220.21 " " 23,220.21 " " 22,543.89 " " 112,959.64 " N/A N/A " 58,780.75 " N/A N/A " 105,899.67 " N/A N/A " 23,220.21 " DRG 478 " 99,618.72 " " 31,389.86 " " 16,058.84 " " 79,694.98 " N/A " 35,430.24 " " 16,861.78 " " 35,430.24 " N/A " 35,308.00 " " 16,540.61 " " 33,607.20 " N/A " 16,058.84 " " 56,802.59 " N/A " 16,058.84 " " 29,047.59 " " 36,309.51 " " 16,540.61 " " 16,540.61 " " 16,058.84 " " 79,694.98 " N/A N/A " 41,272.00 " N/A N/A " 74,714.04 " N/A N/A " 16,540.61 " DRG 479 No Current Volume N/A " 12,500.97 " " 31,666.25 " N/A " 27,184.12 " " 13,126.02 " " 27,184.12 " N/A " 27,239.00 " " 12,876.00 " " 25,785.38 " N/A " 12,500.97 " N/A N/A " 12,500.97 " " 19,801.46 " " 24,751.83 " " 12,876.00 " " 12,876.00 " " 12,500.97 " N/A N/A N/A " 31,666.25 " N/A N/A N/A N/A N/A " 12,876.00 " DRG 480 " 144,901.10 " " 45,658.34 " " 20,384.79 " " 115,920.88 " N/A " 45,456.59 " " 21,404.03 " " 45,456.59 " N/A " 47,283.00 " " 20,996.33 " " 43,117.65 " N/A " 20,384.79 " " 82,622.61 " N/A " 20,384.79 " " 38,026.81 " " 47,533.51 " " 20,996.33 " " 20,996.33 " " 20,384.79 " " 115,920.88 " N/A N/A " 52,951.50 " N/A N/A " 108,675.83 " N/A N/A " 20,996.33 " DRG 481 " 83,760.27 " " 26,392.86 " " 14,358.66 " " 67,008.21 " N/A " 31,489.71 " " 15,076.59 " " 31,489.71 " N/A " 31,115.00 " " 14,789.42 " " 29,869.43 " N/A " 14,358.66 " " 47,760.11 " N/A " 14,358.66 " " 29,473.08 " " 36,841.36 " " 14,789.42 " " 14,789.42 " " 14,358.66 " " 67,008.21 " N/A N/A " 36,681.75 " N/A N/A " 62,820.20 " N/A N/A " 14,789.42 " DRG 482 " 65,499.41 " " 20,638.86 " " 11,439.90 " " 52,399.52 " N/A " 24,724.85 " " 12,011.90 " " 24,724.85 " N/A " 25,556.00 " " 11,783.10 " " 23,452.65 " N/A " 11,439.90 " " 37,347.76 " N/A " 11,439.90 " " 21,405.21 " " 26,756.53 " " 11,783.10 " " 11,783.10 " " 11,439.90 " " 52,399.52 " N/A N/A " 28,801.50 " N/A N/A " 49,124.55 " N/A N/A " 11,783.10 " DRG 483 " 118,988.35 " " 37,493.23 " " 16,235.79 " " 95,190.68 " N/A " 35,840.37 " " 17,047.58 " " 35,840.37 " N/A " 38,082.00 " " 16,722.86 " " 33,996.23 " N/A " 16,235.79 " " 67,847.16 " N/A " 16,235.79 " " 27,443.84 " " 34,304.81 " " 16,722.86 " " 16,722.86 " " 16,235.79 " " 95,190.68 " N/A N/A " 41,749.75 " N/A N/A " 89,241.26 " N/A N/A " 16,722.86 " DRG 485 " 223,274.26 " " 70,353.72 " " 22,872.51 " " 178,619.41 " N/A " 51,222.42 " " 24,016.14 " " 51,222.42 " N/A " 48,694.00 " " 23,558.69 " " 48,586.80 " N/A " 22,872.51 " " 127,310.98 " N/A " 22,872.51 " " 47,522.81 " " 59,403.50 " " 23,558.69 " " 23,558.69 " " 22,872.51 " " 178,619.41 " N/A N/A " 59,668.00 " N/A N/A " 167,455.70 " N/A N/A " 23,558.69 " DRG 486 " 79,532.75 " " 25,060.77 " " 14,704.14 " " 63,626.20 " N/A " 32,290.44 " " 15,439.35 " " 32,290.44 " N/A " 32,499.00 " " 15,145.26 " " 30,628.95 " N/A " 14,704.14 " " 45,349.58 " N/A " 14,704.14 " " 23,254.44 " " 29,068.06 " " 15,145.26 " " 15,145.26 " " 14,704.14 " " 63,626.20 " N/A N/A " 37,614.50 " N/A N/A " 59,649.56 " N/A N/A " 15,145.26 " DRG 487 " 75,315.91 " " 23,732.04 " " 11,403.60 " " 60,252.73 " N/A " 24,640.72 " " 11,973.78 " " 24,640.72 " N/A " 24,589.00 " " 11,745.71 " " 23,372.85 " N/A " 11,403.60 " " 42,945.13 " N/A " 11,403.60 " " 17,854.04 " " 22,317.56 " " 11,745.71 " " 11,745.71 " " 11,403.60 " " 60,252.73 " N/A N/A " 28,703.50 " N/A N/A " 56,486.93 " N/A N/A " 11,745.71 " DRG 488 " 98,525.13 " " 31,045.27 " " 13,578.25 " " 78,820.10 " N/A " 29,680.94 " " 14,257.16 " " 29,680.94 " N/A " 27,101.00 " " 13,985.60 " " 28,153.73 " N/A " 13,578.25 " " 56,179.03 " N/A " 13,578.25 " " 25,103.66 " " 31,379.60 " " 13,985.60 " " 13,985.60 " " 13,578.25 " " 78,820.10 " N/A N/A " 34,574.75 " N/A N/A " 73,893.84 " N/A N/A " 13,985.60 " DRG 489 " 75,640.23 " " 23,834.24 " " 9,186.82 " " 60,512.18 " N/A " 19,502.86 " " 9,646.16 " " 19,502.86 " N/A " 20,747.00 " " 9,462.42 " " 18,499.35 " N/A " 9,186.82 " " 43,130.06 " N/A " 9,186.82 " " 16,528.49 " " 20,660.62 " " 9,462.42 " " 9,462.42 " " 9,186.82 " " 60,512.18 " N/A N/A " 22,718.50 " N/A N/A " 56,730.17 " N/A N/A " 9,462.42 " DRG 492 " 221,941.24 " " 69,933.69 " " 23,264.01 " " 177,553.00 " N/A " 52,129.81 " " 24,427.21 " " 52,129.81 " N/A " 50,148.00 " " 23,961.93 " " 49,447.50 " N/A " 23,264.01 " " 126,550.90 " N/A " 23,264.01 " " 35,385.07 " " 44,231.33 " " 23,961.93 " " 23,961.93 " " 23,264.01 " " 177,553.00 " N/A N/A " 60,725.00 " N/A N/A " 166,455.93 " N/A N/A " 23,961.93 " DRG 493 " 130,726.27 " " 41,191.85 " " 15,847.53 " " 104,581.01 " N/A " 34,940.49 " " 16,639.91 " " 34,940.49 " N/A " 32,023.00 " " 16,322.96 " " 33,142.65 " N/A " 15,847.53 " " 74,540.12 " N/A " 15,847.53 " " 30,160.40 " " 37,700.52 " " 16,322.96 " " 16,322.96 " " 15,847.53 " " 104,581.01 " N/A N/A " 40,701.50 " N/A N/A " 98,044.70 " N/A N/A " 16,322.96 " DRG 494 " 111,275.61 " " 35,062.94 " " 12,774.50 " " 89,020.49 " N/A " 27,818.09 " " 13,413.23 " " 27,818.09 " N/A " 24,225.00 " " 13,157.74 " " 26,386.73 " N/A " 12,774.50 " " 63,449.35 " N/A " 12,774.50 " " 21,372.48 " " 26,715.61 " " 13,157.74 " " 13,157.74 " " 12,774.50 " " 89,020.49 " N/A N/A " 32,404.75 " N/A N/A " 83,456.71 " N/A N/A " 13,157.74 " DRG 495 " 81,350.89 " " 25,633.67 " " 24,378.24 " " 65,080.71 " N/A " 54,712.26 " " 25,597.15 " " 54,712.26 " N/A " 47,949.00 " " 25,109.59 " " 51,897.08 " N/A " 24,378.24 " " 46,386.28 " N/A " 24,378.24 " " 47,994.04 " " 59,992.54 " " 25,109.59 " " 25,109.59 " " 24,378.24 " " 65,080.71 " N/A N/A " 63,733.25 " N/A N/A " 61,013.17 " N/A N/A " 25,109.59 " DRG 496 " 122,078.92 " " 38,467.07 " " 13,647.60 " " 97,663.14 " N/A " 29,841.69 " " 14,329.98 " " 29,841.69 " N/A " 27,201.00 " " 14,057.03 " " 28,306.20 " N/A " 13,647.60 " " 69,609.40 " N/A " 13,647.60 " " 25,070.93 " " 31,338.68 " " 14,057.03 " " 14,057.03 " " 13,647.60 " " 97,663.14 " N/A N/A " 34,762.00 " N/A N/A " 91,559.19 " N/A N/A " 14,057.03 " DRG 497 " 53,907.09 " " 16,986.12 " " 10,180.48 " " 43,125.67 " N/A " 21,805.88 " " 10,689.50 " " 21,805.88 " N/A " 19,241.00 " " 10,485.89 " " 20,683.88 " N/A " 10,180.48 " " 30,737.82 " N/A " 10,180.48 " " 19,785.09 " " 24,731.38 " " 10,485.89 " " 10,485.89 " " 10,180.48 " " 43,125.67 " N/A N/A " 25,401.25 " N/A N/A " 40,430.31 " N/A N/A " 10,485.89 " DRG 498 No Current Volume N/A " 17,519.19 " " 45,214.75 " N/A " 38,814.93 " " 18,395.15 " " 38,814.93 " N/A " 33,696.00 " " 18,044.77 " " 36,817.73 " N/A " 17,519.19 " N/A N/A " 17,519.19 " " 34,685.37 " " 43,356.70 " " 18,044.77 " " 18,044.77 " " 17,519.19 " N/A N/A N/A " 45,214.75 " N/A N/A N/A N/A N/A " 18,044.77 " DRG 499 No Current Volume N/A " 8,543.83 " " 23,994.96 " N/A " 18,012.58 " " 8,971.02 " " 18,012.58 " N/A " 16,919.00 " " 8,800.14 " " 17,085.75 " N/A " 8,543.83 " N/A N/A " 8,543.83 " " 19,195.96 " " 23,994.96 " " 8,800.14 " " 8,800.14 " " 8,543.83 " N/A N/A N/A " 20,982.50 " N/A N/A N/A N/A N/A " 8,800.14 " DRG 500 " 225,801.74 " " 71,150.13 " " 21,445.87 " " 180,641.39 " N/A " 47,915.86 " " 22,518.16 " " 47,915.86 " N/A " 51,008.00 " " 22,089.25 " " 45,450.38 " N/A " 21,445.87 " " 128,752.15 " N/A " 21,445.87 " " 36,570.29 " " 45,712.85 " " 22,089.25 " " 22,089.25 " " 21,445.87 " " 180,641.39 " N/A N/A " 55,816.25 " N/A N/A " 169,351.30 " N/A N/A " 22,089.25 " DRG 501 " 95,084.06 " " 29,960.99 " " 12,141.88 " " 76,067.25 " N/A " 26,351.84 " " 12,748.97 " " 26,351.84 " N/A " 25,919.00 " " 12,506.14 " " 24,995.93 " N/A " 12,141.88 " " 54,216.93 " N/A " 12,141.88 " " 20,685.16 " " 25,856.46 " " 12,506.14 " " 12,506.14 " " 12,141.88 " " 76,067.25 " N/A N/A " 30,696.75 " N/A N/A " 71,313.04 " N/A N/A " 12,506.14 " DRG 502 " 86,478.20 " " 27,249.28 " " 9,411.09 " " 69,182.56 " N/A " 20,022.65 " " 9,881.64 " " 20,022.65 " N/A " 18,246.00 " " 9,693.42 " " 18,992.40 " N/A " 9,411.09 " " 49,309.87 " N/A " 9,411.09 " " 15,857.53 " " 19,821.92 " " 9,693.42 " " 9,693.42 " " 9,411.09 " " 69,182.56 " N/A N/A " 23,324.00 " N/A N/A " 64,858.65 " N/A N/A " 9,693.42 " DRG 503 " 162,522.29 " " 51,210.77 " " 17,888.00 " " 130,017.83 " N/A " 39,669.73 " " 18,782.40 " " 39,669.73 " N/A " 36,719.00 " " 18,424.64 " " 37,628.55 " N/A " 17,888.00 " " 92,670.21 " N/A " 17,888.00 " " 37,398.51 " " 46,748.13 " " 18,424.64 " " 18,424.64 " " 17,888.00 " " 130,017.83 " N/A N/A " 46,210.50 " N/A N/A " 121,891.72 " N/A N/A " 18,424.64 " DRG 504 " 95,981.49 " " 30,243.77 " " 12,277.35 " " 76,785.19 " N/A " 26,665.83 " " 12,891.22 " " 26,665.83 " N/A " 24,688.00 " " 12,645.67 " " 25,293.75 " N/A " 12,277.35 " " 54,728.64 " N/A " 12,277.35 " " 22,338.01 " " 27,922.52 " " 12,645.67 " " 12,645.67 " " 12,277.35 " " 76,785.19 " N/A N/A " 31,062.50 " N/A N/A " 71,986.12 " N/A N/A " 12,645.67 " DRG 505 " 102,281.93 " " 32,229.04 " " 12,277.35 " " 81,825.54 " N/A " 26,665.83 " " 12,891.22 " " 26,665.83 " N/A " 19,627.00 " " 12,645.67 " " 25,293.75 " N/A " 12,277.35 " " 58,321.16 " N/A " 12,277.35 " " 20,456.05 " " 25,570.08 " " 12,645.67 " " 12,645.67 " " 12,277.35 " " 81,825.54 " N/A N/A " 31,062.50 " N/A N/A " 76,711.45 " N/A N/A " 12,645.67 " DRG 506 " 36,126.30 " " 11,383.40 " " 10,388.55 " " 28,901.04 " N/A " 22,288.12 " " 10,907.98 " " 22,288.12 " N/A " 20,265.00 " " 10,700.21 " " 21,141.30 " N/A " 10,388.55 " " 20,599.22 " N/A " 10,388.55 " " 22,288.91 " " 27,861.15 " " 10,700.21 " " 10,700.21 " " 10,388.55 " " 28,901.04 " N/A N/A " 25,963.00 " N/A N/A " 27,094.73 " N/A N/A " 10,700.21 " DRG 507 " 151,521.43 " " 47,744.40 " " 14,130.50 " " 121,217.14 " N/A " 30,960.90 " " 14,837.03 " " 30,960.90 " N/A " 30,138.00 " " 14,554.42 " " 29,367.83 " N/A " 14,130.50 " " 86,397.52 " N/A " 14,130.50 " " 28,859.25 " " 36,074.06 " " 14,554.42 " " 14,554.42 " " 14,130.50 " " 121,217.14 " N/A N/A " 36,065.75 " N/A N/A " 113,641.07 " N/A N/A " 14,554.42 " DRG 508 No Current Volume N/A " 9,909.54 " " 30,356.79 " N/A " 21,177.92 " " 10,405.02 " " 21,177.92 " N/A " 23,911.00 " " 10,206.83 " " 20,088.23 " N/A " 9,909.54 " N/A N/A " 9,909.54 " " 24,285.42 " " 30,356.79 " " 10,206.83 " " 10,206.83 " " 9,909.54 " N/A N/A N/A " 24,669.75 " N/A N/A N/A N/A N/A " 10,206.83 " DRG 509 No Current Volume N/A " 11,703.71 " " 33,077.45 " N/A " 25,336.29 " " 12,288.90 " " 25,336.29 " N/A " 24,378.00 " " 12,054.82 " " 24,032.63 " N/A " 11,703.71 " N/A N/A " 11,703.71 " " 26,461.95 " " 33,077.45 " " 12,054.82 " " 12,054.82 " " 11,703.71 " N/A N/A N/A " 29,513.75 " N/A N/A N/A N/A N/A " 12,054.82 " DRG 510 " 90,991.25 " " 28,671.34 " " 18,556.28 " " 72,793.00 " N/A " 41,218.61 " " 19,484.09 " " 41,218.61 " N/A " 35,963.00 " " 19,112.97 " " 39,097.73 " N/A " 18,556.28 " " 51,883.21 " N/A " 18,556.28 " " 38,726.52 " " 48,408.14 " " 19,112.97 " " 19,112.97 " " 18,556.28 " " 72,793.00 " N/A N/A " 48,014.75 " N/A N/A " 68,243.44 " N/A N/A " 19,112.97 " DRG 511 " 84,376.49 " " 26,587.03 " " 13,524.45 " " 67,501.19 " N/A " 29,556.25 " " 14,200.67 " " 29,556.25 " N/A " 25,975.00 " " 13,930.18 " " 28,035.45 " N/A " 13,524.45 " " 48,111.47 " N/A " 13,524.45 " " 25,267.31 " " 31,584.16 " " 13,930.18 " " 13,930.18 " " 13,524.45 " " 67,501.19 " N/A N/A " 34,429.50 " N/A N/A " 63,282.37 " N/A N/A " 13,930.18 " DRG 512 " 75,692.29 " " 23,850.64 " " 10,848.11 " " 60,553.83 " N/A " 23,353.25 " " 11,390.52 " " 23,353.25 " N/A " 20,394.00 " " 11,173.55 " " 22,151.63 " N/A " 10,848.11 " " 43,159.74 " N/A " 10,848.11 " " 18,344.99 " " 22,931.24 " " 11,173.55 " " 11,173.55 " " 10,848.11 " " 60,553.83 " N/A N/A " 27,203.75 " N/A N/A " 56,769.21 " N/A N/A " 11,173.55 " DRG 513 No Current Volume N/A " 10,961.54 " " 27,510.00 " N/A " 23,616.16 " " 11,509.62 " " 23,616.16 " N/A " 22,753.00 " " 11,290.39 " " 22,401.00 " N/A " 10,961.54 " N/A N/A " 10,961.54 " " 17,870.41 " " 22,338.02 " " 11,290.39 " " 11,290.39 " " 10,961.54 " N/A N/A N/A " 27,510.00 " N/A N/A N/A N/A N/A " 11,290.39 " DRG 514 No Current Volume N/A " 7,248.11 " " 17,484.25 " N/A " 15,009.48 " " 7,610.52 " " 15,009.48 " N/A " 14,152.00 " " 7,465.55 " " 14,237.18 " N/A " 7,248.11 " N/A N/A " 7,248.11 " " 13,337.34 " " 16,671.69 " " 7,465.55 " " 7,465.55 " " 7,248.11 " N/A N/A N/A " 17,484.25 " N/A N/A N/A N/A N/A " 7,465.55 " DRG 515 " 128,543.64 " " 40,504.10 " " 21,128.91 " " 102,834.91 " N/A " 47,181.23 " " 22,185.36 " " 47,181.23 " N/A " 50,717.00 " " 21,762.78 " " 44,753.55 " N/A " 21,128.91 " " 73,295.58 " N/A " 21,128.91 " " 35,142.32 " " 43,927.89 " " 21,762.78 " " 21,762.78 " " 21,128.91 " " 102,834.91 " N/A N/A " 54,960.50 " N/A N/A " 96,407.73 " N/A N/A " 21,762.78 " DRG 516 " 89,873.13 " " 28,319.02 " " 13,494.63 " " 71,898.51 " N/A " 29,487.14 " " 14,169.36 " " 29,487.14 " N/A " 32,150.00 " " 13,899.47 " " 27,969.90 " N/A " 13,494.63 " " 51,245.66 " N/A " 13,494.63 " " 27,116.54 " " 33,895.69 " " 13,899.47 " " 13,899.47 " " 13,494.63 " " 71,898.51 " N/A N/A " 34,349.00 " N/A N/A " 67,404.85 " N/A N/A " 13,899.47 " DRG 517 " 79,655.60 " " 25,099.48 " " 9,835.00 " " 63,724.48 " N/A " 21,005.16 " " 10,326.75 " " 21,005.16 " N/A " 27,143.00 " " 10,130.05 " " 19,924.35 " N/A " 9,835.00 " " 45,419.62 " N/A " 9,835.00 " " 17,084.89 " " 21,356.13 " " 10,130.05 " " 10,130.05 " " 9,835.00 " " 63,724.48 " N/A N/A " 24,468.50 " N/A N/A " 59,741.70 " N/A N/A " 10,130.05 " DRG 518 " 144,028.82 " " 45,383.48 " " 24,021.74 " " 115,223.05 " N/A " 53,886.00 " " 25,222.83 " " 53,886.00 " N/A " 48,189.00 " " 24,742.39 " " 51,113.33 " N/A " 24,021.74 " " 82,125.23 " N/A " 24,021.74 " " 31,502.32 " " 39,377.92 " " 24,742.39 " " 24,742.39 " " 24,021.74 " " 115,223.05 " N/A N/A " 62,770.75 " N/A N/A " 108,021.61 " N/A N/A " 24,742.39 " DRG 519 " 87,796.28 " " 27,664.61 " " 13,476.48 " " 70,237.02 " N/A " 29,445.08 " " 14,150.30 " " 29,445.08 " N/A " 25,908.00 " " 13,880.77 " " 27,930.00 " N/A " 13,476.48 " " 50,061.44 " N/A " 13,476.48 " " 21,323.39 " " 26,654.25 " " 13,880.77 " " 13,880.77 " " 13,476.48 " " 70,237.02 " N/A N/A " 34,300.00 " N/A N/A " 65,847.21 " N/A N/A " 13,880.77 " DRG 520 " 71,035.62 " " 22,383.33 " " 9,965.29 " " 56,828.50 " N/A " 21,307.12 " " 10,463.55 " " 21,307.12 " N/A " 17,930.00 " " 10,264.25 " " 20,210.78 " N/A " 9,965.29 " " 40,504.51 " N/A " 9,965.29 " " 16,512.12 " " 20,640.16 " " 10,264.25 " " 10,264.25 " " 9,965.29 " " 56,828.50 " N/A N/A " 24,820.25 " N/A N/A " 53,276.72 " N/A N/A " 10,264.25 " DRG 521 " 164,981.05 " " 51,985.53 " " 20,646.66 " " 131,984.84 " N/A " 46,063.52 " " 21,678.99 " " 46,063.52 " N/A " 48,199.00 " " 21,266.06 " " 43,693.35 " N/A " 20,646.66 " " 94,072.19 " N/A " 20,646.66 " " 43,738.69 " " 54,673.36 " " 21,266.06 " " 21,266.06 " " 20,646.66 " " 131,984.84 " N/A N/A " 53,658.50 " N/A N/A " 123,735.79 " N/A N/A " 21,266.06 " DRG 522 " 83,216.67 " " 26,221.57 " " 14,963.41 " " 66,573.34 " N/A " 32,891.36 " " 15,711.58 " " 32,891.36 " N/A " 34,443.00 " " 15,412.31 " " 31,198.95 " N/A " 14,963.41 " " 47,450.15 " N/A " 14,963.41 " " 27,836.59 " " 34,795.76 " " 15,412.31 " " 15,412.31 " " 14,963.41 " " 66,573.34 " N/A N/A " 38,314.50 " N/A N/A " 62,412.50 " N/A N/A " 15,412.31 " DRG 533 No Current Volume N/A " 9,951.68 " " 29,374.90 " N/A " 21,275.57 " " 10,449.26 " " 21,275.57 " N/A " 22,806.00 " " 10,250.23 " " 20,180.85 " N/A " 9,951.68 " N/A N/A " 9,951.68 " " 23,499.91 " " 29,374.90 " " 10,250.23 " " 10,250.23 " " 9,951.68 " N/A N/A N/A " 24,783.50 " N/A N/A N/A N/A N/A " 10,250.23 " DRG 534 " 30,816.85 " " 9,710.39 " " 5,894.06 " " 24,653.48 " N/A " 11,871.17 " " 6,188.76 " " 11,871.17 " N/A " 11,948.00 " " 6,070.88 " " 11,260.35 " N/A " 5,894.06 " " 17,571.77 " N/A " 5,894.06 " " 12,339.09 " " 15,423.87 " " 6,070.88 " " 6,070.88 " " 5,894.06 " " 24,653.48 " N/A N/A " 13,828.50 " N/A N/A " 23,112.64 " N/A N/A " 6,070.88 " DRG 535 " 76,061.69 " " 23,967.04 " " 8,762.91 " " 60,849.35 " N/A " 18,520.35 " " 9,201.06 " " 18,520.35 " N/A " 19,525.00 " " 9,025.80 " " 17,567.40 " N/A " 8,762.91 " " 43,370.37 " N/A " 8,762.91 " " 20,161.48 " " 25,201.87 " " 9,025.80 " " 9,025.80 " " 8,762.91 " " 60,849.35 " N/A N/A " 21,574.00 " N/A N/A " 57,046.27 " N/A N/A " 9,025.80 " DRG 536 " 33,967.47 " " 10,703.15 " " 5,774.15 " " 27,173.98 " N/A " 11,593.25 " " 6,062.86 " " 11,593.25 " N/A " 11,330.00 " " 5,947.37 " " 10,996.73 " N/A " 5,774.15 " " 19,368.25 " N/A " 5,774.15 " " 9,851.63 " " 12,314.55 " " 5,947.37 " " 5,947.37 " " 5,774.15 " " 27,173.98 " N/A N/A " 13,504.75 " N/A N/A " 25,475.61 " N/A N/A " 5,947.37 " DRG 537 No Current Volume N/A " 6,835.22 " " 18,921.86 " N/A " 14,052.51 " " 7,176.98 " " 14,052.51 " N/A " 14,121.00 " " 7,040.28 " " 13,329.45 " N/A " 6,835.22 " N/A N/A " 6,835.22 " " 15,137.48 " " 18,921.86 " " 7,040.28 " " 7,040.28 " " 6,835.22 " N/A N/A N/A " 16,369.50 " N/A N/A N/A N/A N/A " 7,040.28 " DRG 538 No Current Volume N/A " 5,459.78 " " 14,707.91 " N/A " 10,864.63 " " 5,732.77 " " 10,864.63 " N/A " 10,883.00 " " 5,623.57 " " 10,305.60 " N/A " 5,459.78 " N/A N/A " 5,459.78 " " 11,766.32 " " 14,707.91 " " 5,623.57 " " 5,623.57 " " 5,459.78 " N/A N/A N/A " 12,656.00 " N/A N/A N/A N/A N/A " 5,623.57 " DRG 539 " 97,086.82 " " 30,592.06 " " 13,396.76 " " 77,669.45 " N/A " 29,260.30 " " 14,066.60 " " 29,260.30 " N/A " 28,753.00 " " 13,798.66 " " 27,754.73 " N/A " 13,396.76 " " 55,358.90 " N/A " 13,396.76 " " 21,716.14 " " 27,145.19 " " 13,798.66 " " 13,798.66 " " 13,396.76 " " 77,669.45 " N/A N/A " 34,084.75 " N/A N/A " 72,815.11 " N/A N/A " 13,798.66 " DRG 540 " 74,012.14 " " 23,321.23 " " 9,208.86 " " 59,209.71 " N/A " 19,553.94 " " 9,669.30 " " 19,553.94 " N/A " 20,404.00 " " 9,485.13 " " 18,547.80 " N/A " 9,208.86 " " 42,201.72 " N/A " 9,208.86 " " 13,877.38 " " 17,346.74 " " 9,485.13 " " 9,485.13 " " 9,208.86 " " 59,209.71 " N/A N/A " 22,778.00 " N/A N/A " 55,509.11 " N/A N/A " 9,485.13 " DRG 541 " 28,945.80 " " 9,120.82 " " 6,237.60 " " 23,156.64 " N/A " 12,667.39 " " 6,549.48 " " 12,667.39 " N/A " 14,504.00 " " 6,424.73 " " 12,015.60 " N/A " 6,237.60 " " 16,504.90 " N/A " 6,237.60 " " 8,657.00 " " 10,821.26 " " 6,424.73 " " 6,424.73 " " 6,237.60 " " 23,156.64 " N/A N/A " 14,756.00 " N/A N/A " 21,709.35 " N/A N/A " 6,424.73 " DRG 542 " 138,748.89 " " 43,719.77 " " 12,499.03 " " 110,999.11 " N/A " 27,179.61 " " 13,123.98 " " 27,179.61 " N/A " 30,635.00 " " 12,874.00 " " 25,781.10 " N/A " 12,499.03 " " 79,114.62 " N/A " 12,499.03 " " 26,429.22 " " 33,036.54 " " 12,874.00 " " 12,874.00 " " 12,499.03 " " 110,999.11 " N/A N/A " 31,661.00 " N/A N/A " 104,061.67 " N/A N/A " 12,874.00 " DRG 543 " 49,689.01 " " 15,657.01 " " 7,546.93 " " 39,751.21 " N/A " 15,702.04 " " 7,924.28 " " 15,702.04 " N/A " 17,664.00 " " 7,773.34 " " 14,894.10 " N/A " 7,546.93 " " 28,332.67 " N/A " 7,546.93 " " 15,792.07 " " 19,740.10 " " 7,773.34 " " 7,773.34 " " 7,546.93 " " 39,751.21 " N/A N/A " 18,291.00 " N/A N/A " 37,266.75 " N/A N/A " 7,773.34 " DRG 544 " 23,975.38 " " 7,554.64 " " 5,813.04 " " 19,180.30 " N/A " 11,683.39 " " 6,103.69 " " 11,683.39 " N/A " 12,486.00 " " 5,987.43 " " 11,082.23 " N/A " 5,813.04 " " 13,670.76 " N/A " 5,813.04 " " 12,584.56 " " 15,730.71 " " 5,987.43 " " 5,987.43 " " 5,813.04 " " 19,180.30 " N/A N/A " 13,609.75 " N/A N/A " 17,981.54 " N/A N/A " 5,987.43 " DRG 545 " 28,840.79 " " 9,087.73 " " 16,445.02 " " 43,804.25 " N/A " 37,604.07 " " 17,846.59 " " 37,604.07 " N/A " 39,869.00 " " 17,506.65 " " 35,669.18 " N/A " 16,996.75 " " 16,445.02 " N/A " 16,996.75 " " 34,114.18 " " 42,642.72 " " 17,506.65 " " 17,506.65 " " 16,996.75 " " 23,072.63 " N/A N/A " 43,804.25 " N/A N/A " 21,630.59 " N/A N/A " 17,506.65 " DRG 546 " 23,192.47 " " 7,307.95 " " 8,602.16 " " 21,417.49 " N/A " 18,147.78 " " 9,032.27 " " 18,147.78 " N/A " 18,426.00 " " 8,860.22 " " 17,214.00 " N/A " 8,602.16 " " 13,224.35 " N/A " 8,602.16 " " 17,133.99 " " 21,417.49 " " 8,860.22 " " 8,860.22 " " 8,602.16 " " 18,553.98 " N/A N/A " 21,140.00 " N/A N/A " 17,394.35 " N/A N/A " 8,860.22 " DRG 547 No Current Volume N/A " 6,175.38 " " 17,899.05 " N/A " 12,523.17 " " 6,484.15 " " 12,523.17 " N/A " 12,563.00 " " 6,360.64 " " 11,878.80 " N/A " 6,175.38 " N/A N/A " 6,175.38 " " 14,319.24 " " 17,899.05 " " 6,360.64 " " 6,360.64 " " 6,175.38 " N/A N/A N/A " 14,588.00 " N/A N/A N/A N/A N/A " 6,360.64 " DRG 548 No Current Volume N/A " 14,065.03 " " 39,684.76 " N/A " 30,809.17 " " 14,768.28 " " 30,809.17 " N/A " 30,087.00 " " 14,486.98 " " 29,223.90 " N/A " 14,065.03 " N/A N/A " 14,065.03 " " 31,747.79 " " 39,684.76 " " 14,486.98 " " 14,486.98 " " 14,065.03 " N/A N/A N/A " 35,889.00 " N/A N/A N/A N/A N/A " 14,486.98 " DRG 549 " 41,505.11 " " 13,078.26 " " 8,873.75 " " 33,204.09 " N/A " 18,777.25 " " 9,317.44 " " 18,777.25 " N/A " 18,116.00 " " 9,139.96 " " 17,811.08 " N/A " 8,873.75 " " 23,666.21 " N/A " 8,873.75 " " 15,677.52 " " 19,596.91 " " 9,139.96 " " 9,139.96 " " 8,873.75 " " 33,204.09 " N/A N/A " 21,873.25 " N/A N/A " 31,128.83 " N/A N/A " 9,139.96 " DRG 550 No Current Volume N/A " 6,469.00 " " 16,119.38 " N/A " 13,203.71 " " 6,792.45 " " 13,203.71 " N/A " 13,200.00 " " 6,663.07 " " 12,524.33 " N/A " 6,469.00 " N/A N/A " 6,469.00 " " 12,895.49 " " 16,119.38 " " 6,663.07 " " 6,663.07 " " 6,469.00 " N/A N/A N/A " 15,380.75 " N/A N/A N/A N/A N/A " 6,663.07 " DRG 551 " 77,088.71 " " 24,290.65 " " 11,320.63 " " 61,670.96 " N/A " 24,448.43 " " 11,886.66 " " 24,448.43 " N/A " 24,475.00 " " 11,660.25 " " 23,190.45 " N/A " 11,320.63 " " 43,955.98 " N/A " 11,320.63 " " 17,739.49 " " 22,174.37 " " 11,660.25 " " 11,660.25 " " 11,320.63 " " 61,670.96 " N/A N/A " 28,479.50 " N/A N/A " 57,816.53 " N/A N/A " 11,660.25 " DRG 552 " 40,692.21 " " 12,822.12 " " 6,887.08 " " 32,553.77 " N/A " 14,172.70 " " 7,231.43 " " 14,172.70 " N/A " 13,686.00 " " 7,093.69 " " 13,443.45 " N/A " 6,887.08 " " 23,202.70 " N/A " 6,887.08 " " 11,684.50 " " 14,605.63 " " 7,093.69 " " 7,093.69 " " 6,887.08 " " 32,553.77 " N/A N/A " 16,509.50 " N/A N/A " 30,519.16 " N/A N/A " 7,093.69 " DRG 553 No Current Volume N/A " 9,013.76 " " 26,081.48 " N/A " 19,101.74 " " 9,464.45 " " 19,101.74 " N/A " 19,174.00 " " 9,284.17 " " 18,118.88 " N/A " 9,013.76 " N/A N/A " 9,013.76 " " 20,865.17 " " 26,081.48 " " 9,284.17 " " 9,284.17 " " 9,013.76 " N/A N/A N/A " 22,251.25 " N/A N/A N/A N/A N/A " 9,284.17 " DRG 554 " 56,410.44 " " 17,774.93 " " 5,908.97 " " 45,128.35 " N/A " 11,905.73 " " 6,204.42 " " 11,905.73 " N/A " 11,444.00 " " 6,086.24 " " 11,293.13 " N/A " 5,908.97 " " 32,165.23 " N/A " 5,908.97 " " 12,240.90 " " 15,301.13 " " 6,086.24 " " 6,086.24 " " 5,908.97 " " 45,128.35 " N/A N/A " 13,868.75 " N/A N/A " 42,307.83 " N/A N/A " 6,086.24 " DRG 555 " 52,807.69 " " 16,639.70 " " 9,642.49 " " 42,246.15 " N/A " 20,558.98 " " 10,124.61 " " 20,558.98 " N/A " 19,880.00 " " 9,931.76 " " 19,501.13 " N/A " 9,642.49 " " 30,110.94 " N/A " 9,642.49 " " 21,912.52 " " 27,390.66 " " 9,931.76 " " 9,931.76 " " 9,642.49 " " 42,246.15 " N/A N/A " 23,948.75 " N/A N/A " 39,605.77 " N/A N/A " 9,931.76 " DRG 556 " 63,576.47 " " 20,032.95 " " 6,013.98 " " 50,861.18 " N/A " 12,149.10 " " 6,314.68 " " 12,149.10 " N/A " 11,303.00 " " 6,194.40 " " 11,523.98 " N/A " 6,013.98 " " 36,251.31 " N/A " 6,013.98 " " 11,586.31 " " 14,482.89 " " 6,194.40 " " 6,194.40 " " 6,013.98 " " 50,861.18 " N/A N/A " 14,152.25 " N/A N/A " 47,682.36 " N/A N/A " 6,194.40 " DRG 557 " 39,851.69 " " 12,557.27 " " 9,840.84 " " 31,881.35 " N/A " 21,018.68 " " 10,332.88 " " 21,018.68 " N/A " 22,450.00 " " 10,136.07 " " 19,937.18 " N/A " 9,840.84 " " 22,723.43 " N/A " 9,840.84 " " 18,263.16 " " 22,828.96 " " 10,136.07 " " 10,136.07 " " 9,840.84 " " 31,881.35 " N/A N/A " 24,484.25 " N/A N/A " 29,888.77 " N/A N/A " 10,136.07 " DRG 558 " 28,827.56 " " 9,083.56 " " 6,355.57 " " 23,062.05 " N/A " 12,940.81 " " 6,673.35 " " 12,940.81 " N/A " 13,408.00 " " 6,546.24 " " 12,274.95 " N/A " 6,355.57 " " 16,437.47 " N/A " 6,355.57 " " 7,576.92 " " 9,471.16 " " 6,546.24 " " 6,546.24 " " 6,355.57 " " 23,062.05 " N/A N/A " 15,074.50 " N/A N/A " 21,620.67 " N/A N/A " 6,546.24 " DRG 559 " 51,448.99 " " 16,211.58 " " 12,862.66 " " 41,159.19 " N/A " 28,022.40 " " 13,505.79 " " 28,022.40 " N/A " 29,194.00 " " 13,248.54 " " 26,580.53 " N/A " 12,862.66 " " 29,336.21 " N/A " 12,862.66 " " 22,288.91 " " 27,861.15 " " 13,248.54 " " 13,248.54 " " 12,862.66 " " 41,159.19 " N/A N/A " 32,642.75 " N/A N/A " 38,586.74 " N/A N/A " 13,248.54 " DRG 560 " 57,518.60 " " 18,124.11 " " 7,746.57 " " 46,014.88 " N/A " 16,164.75 " " 8,133.90 " " 16,164.75 " N/A " 16,923.00 " " 7,978.97 " " 15,333.00 " N/A " 7,746.57 " " 32,797.11 " N/A " 7,746.57 " " 13,746.47 " " 17,183.09 " " 7,978.97 " " 7,978.97 " " 7,746.57 " " 46,014.88 " N/A N/A " 18,830.00 " N/A N/A " 43,138.95 " N/A N/A " 7,978.97 " DRG 561 " 54,149.75 " " 17,062.59 " " 5,908.32 " " 43,319.80 " N/A " 11,904.23 " " 6,203.74 " " 11,904.23 " N/A " 10,524.00 " " 6,085.57 " " 11,291.70 " N/A " 5,908.32 " " 30,876.19 " N/A " 5,908.32 " " 11,160.82 " " 13,951.03 " " 6,085.57 " " 6,085.57 " " 5,908.32 " " 43,319.80 " N/A N/A " 13,867.00 " N/A N/A " 40,612.31 " N/A N/A " 6,085.57 " DRG 562 " 69,007.34 " " 21,744.21 " " 9,923.16 " " 55,205.87 " N/A " 21,209.47 " " 10,419.32 " " 21,209.47 " N/A " 21,565.00 " " 10,220.85 " " 20,118.15 " N/A " 9,923.16 " " 39,347.98 " N/A " 9,923.16 " " 19,719.63 " " 24,649.55 " " 10,220.85 " " 10,220.85 " " 9,923.16 " " 55,205.87 " N/A N/A " 24,706.50 " N/A N/A " 51,755.50 " N/A N/A " 10,220.85 " DRG 563 " 47,069.90 " " 14,831.73 " " 6,425.57 " " 37,655.92 " N/A " 13,103.06 " " 6,746.85 " " 13,103.06 " N/A " 12,202.00 " " 6,618.34 " " 12,428.85 " N/A " 6,425.57 " " 26,839.26 " N/A " 6,425.57 " " 11,062.63 " " 13,828.30 " " 6,618.34 " " 6,618.34 " " 6,425.57 " " 37,655.92 " N/A N/A " 15,263.50 " N/A N/A " 35,302.43 " N/A N/A " 6,618.34 " DRG 564 " 54,769.88 " " 17,257.99 " " 10,647.82 " " 43,815.90 " N/A " 22,889.04 " " 11,180.21 " " 22,889.04 " N/A " 23,656.00 " " 10,967.25 " " 21,711.30 " N/A " 10,647.82 " " 31,229.78 " N/A " 10,647.82 " " 19,457.79 " " 24,322.26 " " 10,967.25 " " 10,967.25 " " 10,647.82 " " 43,815.90 " N/A N/A " 26,663.00 " N/A N/A " 41,077.41 " N/A N/A " 10,967.25 " DRG 565 " 35,762.00 " " 11,268.61 " " 7,314.23 " " 28,609.60 " N/A " 15,162.71 " " 7,679.94 " " 15,162.71 " N/A " 14,787.00 " " 7,533.66 " " 14,382.53 " N/A " 7,314.23 " " 20,391.49 " N/A " 7,314.23 " " 11,880.87 " " 14,851.10 " " 7,533.66 " " 7,533.66 " " 7,314.23 " " 28,609.60 " N/A N/A " 17,662.75 " N/A N/A " 26,821.50 " N/A N/A " 7,533.66 " DRG 566 " 52,887.48 " " 16,664.84 " " 5,645.81 " " 42,309.98 " N/A " 11,295.79 " " 5,928.10 " " 11,295.79 " N/A " 10,810.00 " " 5,815.18 " " 10,714.58 " N/A " 5,645.81 " " 30,156.44 " N/A " 5,645.81 " " 10,228.03 " " 12,785.04 " " 5,815.18 " " 5,815.18 " " 5,645.81 " " 42,309.98 " N/A N/A " 13,158.25 " N/A N/A " 39,665.61 " N/A N/A " 5,815.18 " DRG 570 " 104,148.88 " " 32,817.31 " " 19,191.49 " " 83,319.10 " N/A " 42,690.86 " " 20,151.06 " " 42,690.86 " N/A " 37,685.00 " " 19,767.23 " " 40,494.23 " N/A " 19,191.49 " " 59,385.69 " N/A " 19,191.49 " " 30,045.85 " " 37,557.33 " " 19,767.23 " " 19,767.23 " " 19,191.49 " " 83,319.10 " N/A N/A " 49,729.75 " N/A N/A " 78,111.66 " N/A N/A " 19,767.23 " DRG 571 " 89,264.39 " " 28,127.21 " " 11,372.49 " " 71,411.51 " N/A " 24,568.61 " " 11,941.11 " " 24,568.61 " N/A " 23,070.00 " " 11,713.66 " " 23,304.45 " N/A " 11,372.49 " " 50,898.56 " N/A " 11,372.49 " " 18,001.32 " " 22,501.67 " " 11,713.66 " " 11,713.66 " " 11,372.49 " " 71,411.51 " N/A N/A " 28,619.50 " N/A N/A " 66,948.29 " N/A N/A " 11,713.66 " DRG 572 " 57,177.17 " " 18,016.53 " " 7,930.65 " " 45,741.74 " N/A " 16,591.40 " " 8,327.18 " " 16,591.40 " N/A " 15,605.00 " " 8,168.57 " " 15,737.70 " N/A " 7,930.65 " " 32,602.42 " N/A " 7,930.65 " " 12,928.22 " " 16,160.29 " " 8,168.57 " " 8,168.57 " " 7,930.65 " " 45,741.74 " N/A N/A " 19,327.00 " N/A N/A " 42,882.88 " N/A N/A " 8,168.57 " DRG 573 " 187,268.72 " " 59,008.37 " " 36,675.52 " " 149,814.98 " N/A " 83,213.90 " " 38,509.30 " " 83,213.90 " N/A " 58,329.00 " " 37,775.79 " " 78,932.18 " N/A " 36,675.52 " " 106,780.62 " N/A " 36,675.52 " " 55,419.48 " " 69,274.34 " " 37,775.79 " " 37,775.79 " " 36,675.52 " " 149,814.98 " N/A N/A " 96,934.25 " N/A N/A " 140,451.54 " N/A N/A " 37,775.79 " DRG 574 No Current Volume N/A " 21,815.33 " " 56,813.75 " N/A " 48,772.17 " " 22,906.10 " " 48,772.17 " N/A " 41,375.00 " " 22,469.79 " " 46,262.63 " N/A " 21,815.33 " N/A N/A " 21,815.33 " " 33,657.23 " " 42,071.53 " " 22,469.79 " " 22,469.79 " " 21,815.33 " N/A N/A N/A " 56,813.75 " N/A N/A N/A N/A N/A " 22,469.79 " DRG 575 No Current Volume N/A " 12,200.86 " " 30,856.00 " N/A " 26,488.55 " " 12,810.90 " " 26,488.55 " N/A " 23,483.00 " " 12,566.89 " " 25,125.60 " N/A " 12,200.86 " N/A N/A " 12,200.86 " " 21,356.12 " " 26,695.16 " " 12,566.89 " " 12,566.89 " " 12,200.86 " N/A N/A N/A " 30,856.00 " N/A N/A N/A N/A N/A " 12,566.89 " DRG 576 No Current Volume N/A " 33,594.07 " " 88,614.75 " N/A " 76,071.97 " " 35,273.77 " " 76,071.97 " N/A " 65,174.00 " " 34,601.89 " " 72,157.73 " N/A " 33,594.07 " N/A N/A " 33,594.07 " " 69,899.08 " " 87,373.84 " " 34,601.89 " " 34,601.89 " " 33,594.07 " N/A N/A N/A " 88,614.75 " N/A N/A N/A N/A N/A " 34,601.89 " DRG 577 No Current Volume N/A " 17,298.16 " " 44,618.00 " N/A " 38,302.64 " " 18,163.07 " " 38,302.64 " N/A " 31,172.00 " " 17,817.10 " " 36,331.80 " N/A " 17,298.16 " N/A N/A " 17,298.16 " " 32,140.55 " " 40,175.70 " " 17,817.10 " " 17,817.10 " " 17,298.16 " N/A N/A N/A " 44,618.00 " N/A N/A N/A N/A N/A " 17,817.10 " DRG 578 " 65,293.90 " " 20,574.11 " " 11,111.92 " " 52,235.12 " N/A " 23,964.69 " " 11,667.52 " " 23,964.69 " N/A " 20,707.00 " " 11,445.28 " " 22,731.60 " N/A " 11,111.92 " " 37,230.58 " N/A " 11,111.92 " " 24,890.92 " " 31,113.67 " " 11,445.28 " " 11,445.28 " " 11,111.92 " " 52,235.12 " N/A N/A " 27,916.00 " N/A N/A " 48,970.43 " N/A N/A " 11,445.28 " DRG 579 " 96,329.98 " " 30,353.58 " " 21,156.78 " " 77,063.98 " N/A " 47,245.83 " " 22,214.62 " " 47,245.83 " N/A " 42,893.00 " " 21,791.48 " " 44,814.83 " N/A " 21,156.78 " " 54,927.35 " N/A " 21,156.78 " " 29,187.69 " " 36,484.60 " " 21,791.48 " " 21,791.48 " " 21,156.78 " " 77,063.98 " N/A N/A " 55,035.75 " N/A N/A " 72,247.49 " N/A N/A " 21,791.48 " DRG 580 " 51,930.15 " " 16,363.19 " " 11,977.89 " " 41,544.12 " N/A " 25,971.76 " " 12,576.78 " " 25,971.76 " N/A " 24,744.00 " " 12,337.23 " " 24,635.40 " N/A " 11,977.89 " " 29,610.57 " N/A " 11,977.89 " " 18,344.99 " " 22,931.24 " " 12,337.23 " " 12,337.23 " " 11,977.89 " " 41,544.12 " N/A N/A " 30,254.00 " N/A N/A " 38,947.61 " N/A N/A " 12,337.23 " DRG 581 " 48,172.02 " " 15,179.00 " " 9,696.29 " " 38,537.62 " N/A " 20,683.67 " " 10,181.10 " " 20,683.67 " N/A " 17,839.00 " " 9,987.18 " " 19,619.40 " N/A " 9,696.29 " " 27,467.69 " N/A " 9,696.29 " " 14,777.45 " " 18,471.82 " " 9,987.18 " " 9,987.18 " " 9,696.29 " " 38,537.62 " N/A N/A " 24,094.00 " N/A N/A " 36,129.02 " N/A N/A " 9,987.18 " DRG 582 No Current Volume N/A " 11,422.40 " " 34,836.67 " N/A " 24,684.29 " " 11,993.52 " " 24,684.29 " N/A " 20,457.00 " " 11,765.07 " " 23,414.18 " N/A " 11,422.40 " N/A N/A " 11,422.40 " " 27,869.32 " " 34,836.67 " " 11,765.07 " " 11,765.07 " " 11,422.40 " N/A N/A N/A " 28,754.25 " N/A N/A N/A N/A N/A " 11,765.07 " DRG 583 No Current Volume N/A " 10,763.85 " " 33,016.08 " N/A " 23,157.95 " " 11,302.04 " " 23,157.95 " N/A " 17,202.00 " " 11,086.77 " " 21,966.38 " N/A " 10,763.85 " N/A N/A " 10,763.85 " " 26,412.85 " " 33,016.08 " " 11,086.77 " " 11,086.77 " " 10,763.85 " N/A N/A N/A " 26,976.25 " N/A N/A N/A N/A N/A " 11,086.77 " DRG 584 No Current Volume N/A " 12,677.28 " " 37,127.75 " N/A " 27,592.74 " " 13,311.14 " " 27,592.74 " N/A " 27,820.00 " " 13,057.60 " " 26,172.98 " N/A " 12,677.28 " N/A N/A " 12,677.28 " " 29,702.18 " " 37,127.75 " " 13,057.60 " " 13,057.60 " " 12,677.28 " N/A N/A N/A " 32,142.25 " N/A N/A N/A N/A N/A " 13,057.60 " DRG 585 " 49,687.99 " " 15,656.69 " " 12,047.89 " " 39,750.39 " N/A " 26,134.01 " " 12,650.28 " " 26,134.01 " N/A " 21,636.00 " " 12,409.33 " " 24,789.30 " N/A " 12,047.89 " " 28,332.09 " N/A " 12,047.89 " " 25,709.16 " " 32,136.47 " " 12,409.33 " " 12,409.33 " " 12,047.89 " " 39,750.39 " N/A N/A " 30,443.00 " N/A N/A " 37,265.99 " N/A N/A " 12,409.33 " DRG 592 " 40,675.74 " " 12,816.93 " " 11,754.27 " " 32,540.59 " N/A " 25,453.47 " " 12,341.98 " " 25,453.47 " N/A " 22,418.00 " " 12,106.90 " " 24,143.78 " N/A " 11,754.27 " " 23,193.31 " N/A " 11,754.27 " " 17,968.59 " " 22,460.75 " " 12,106.90 " " 12,106.90 " " 11,754.27 " " 32,540.59 " N/A N/A " 29,650.25 " N/A N/A " 30,506.81 " N/A N/A " 12,106.90 " DRG 593 " 70,031.78 " " 22,067.01 " " 8,165.29 " " 56,025.42 " N/A " 17,135.23 " " 8,573.55 " " 17,135.23 " N/A " 16,041.00 " " 8,410.25 " " 16,253.55 " N/A " 8,165.29 " " 39,932.12 " N/A " 8,165.29 " " 11,929.97 " " 14,912.47 " " 8,410.25 " " 8,410.25 " " 8,165.29 " " 56,025.42 " N/A N/A " 19,960.50 " N/A N/A " 52,523.84 " N/A N/A " 8,410.25 " DRG 594 " 35,028.73 " " 11,037.55 " " 6,061.30 " " 28,022.98 " N/A " 12,258.77 " " 6,364.37 " " 12,258.77 " N/A " 11,209.00 " " 6,243.14 " " 11,628.00 " N/A " 6,061.30 " " 19,973.38 " N/A " 6,061.30 " " 8,542.45 " " 10,678.06 " " 6,243.14 " " 6,243.14 " " 6,061.30 " " 28,022.98 " N/A N/A " 14,280.00 " N/A N/A " 26,271.55 " N/A N/A " 6,243.14 " DRG 595 " 64,004.53 " " 20,167.83 " " 13,842.71 " " 51,203.62 " N/A " 30,293.88 " " 14,534.85 " " 30,293.88 " N/A " 30,882.00 " " 14,257.99 " " 28,735.13 " N/A " 13,842.71 " " 36,495.38 " N/A " 13,842.71 " " 28,830.69 " " 36,038.36 " " 14,257.99 " " 14,257.99 " " 13,842.71 " " 51,203.62 " N/A N/A " 35,288.75 " N/A N/A " 48,003.40 " N/A N/A " 14,257.99 " DRG 596 No Current Volume N/A " 7,219.59 " " 17,407.25 " N/A " 14,943.38 " " 7,580.57 " " 14,943.38 " N/A " 14,990.00 " " 7,436.18 " " 14,174.48 " N/A " 7,219.59 " N/A N/A " 7,219.59 " " 8,018.77 " " 10,023.47 " " 7,436.18 " " 7,436.18 " " 7,219.59 " N/A N/A N/A " 17,407.25 " N/A N/A N/A N/A N/A " 7,436.18 " DRG 597 No Current Volume N/A " 11,428.23 " " 30,725.00 " N/A " 24,697.81 " " 11,999.64 " " 24,697.81 " N/A " 26,367.00 " " 11,771.08 " " 23,427.00 " N/A " 11,428.23 " N/A N/A " 11,428.23 " " 24,579.99 " " 30,725.00 " " 11,771.08 " " 11,771.08 " " 11,428.23 " N/A N/A N/A " 28,770.00 " N/A N/A N/A N/A N/A " 11,771.08 " DRG 598 " 21,770.82 " " 6,859.99 " " 7,985.74 " " 19,475.75 " N/A " 16,719.10 " " 8,385.03 " " 16,719.10 " N/A " 17,678.00 " " 8,225.31 " " 15,858.83 " N/A " 7,985.74 " " 12,413.72 " N/A " 7,985.74 " " 14,892.00 " " 18,615.01 " " 8,225.31 " " 8,225.31 " " 7,985.74 " " 17,416.66 " N/A N/A " 19,475.75 " N/A N/A " 16,328.12 " N/A N/A " 8,225.31 " DRG 599 No Current Volume N/A " 5,124.03 " " 14,482.89 " N/A " 10,086.44 " " 5,380.23 " " 10,086.44 " N/A " 11,420.00 " " 5,277.75 " " 9,567.45 " N/A " 5,124.03 " N/A N/A " 5,124.03 " " 11,586.31 " " 14,482.89 " " 5,277.75 " " 5,277.75 " " 5,124.03 " N/A N/A N/A " 11,749.50 " N/A N/A N/A N/A N/A " 5,277.75 " DRG 600 " 40,010.00 " " 12,607.15 " " 7,233.85 " " 32,008.00 " N/A " 14,976.43 " " 7,595.54 " " 14,976.43 " N/A " 15,422.00 " " 7,450.87 " " 14,205.83 " N/A " 7,233.85 " " 22,813.70 " N/A " 7,233.85 " " 10,162.57 " " 12,703.21 " " 7,450.87 " " 7,450.87 " " 7,233.85 " " 32,008.00 " N/A N/A " 17,445.75 " N/A N/A " 30,007.50 " N/A N/A " 7,450.87 " DRG 601 " 11,206.59 " " 3,531.20 " " 5,223.85 " " 12,019.00 " N/A " 10,317.80 " " 5,485.04 " " 10,317.80 " N/A " 9,934.00 " " 5,380.57 " " 9,786.90 " N/A " 5,223.85 " " 6,390.00 " N/A " 5,223.85 " " 5,989.53 " " 7,486.92 " " 5,380.57 " " 5,380.57 " " 5,223.85 " " 8,965.27 " N/A N/A " 12,019.00 " N/A N/A " 8,404.94 " N/A N/A " 5,380.57 " DRG 602 " 73,706.98 " " 23,225.07 " " 10,170.76 " " 58,965.58 " N/A " 21,783.35 " " 10,679.30 " " 21,783.35 " N/A " 22,902.00 " " 10,475.88 " " 20,662.50 " N/A " 10,170.76 " " 42,027.72 " N/A " 10,170.76 " " 14,908.37 " " 18,635.47 " " 10,475.88 " " 10,475.88 " " 10,170.76 " " 58,965.58 " N/A N/A " 25,375.00 " N/A N/A " 55,280.23 " N/A N/A " 10,475.88 " DRG 603 " 35,107.30 " " 11,062.31 " " 6,305.01 " " 28,085.84 " N/A " 12,823.63 " " 6,620.26 " " 12,823.63 " N/A " 13,291.00 " " 6,494.16 " " 12,163.80 " N/A " 6,305.01 " " 20,018.18 " N/A " 6,305.01 " " 7,233.26 " " 9,041.58 " " 6,494.16 " " 6,494.16 " " 6,305.01 " " 28,085.84 " N/A N/A " 14,938.00 " N/A N/A " 26,330.47 " N/A N/A " 6,494.16 " DRG 604 " 49,115.91 " " 15,476.42 " " 10,351.60 " " 39,292.72 " N/A " 22,202.49 " " 10,869.18 " " 22,202.49 " N/A " 19,862.00 " " 10,662.15 " " 21,060.08 " N/A " 10,351.60 " " 28,005.89 " N/A " 10,351.60 " " 18,443.17 " " 23,053.98 " " 10,662.15 " " 10,662.15 " " 10,351.60 " " 39,292.72 " N/A N/A " 25,863.25 " N/A N/A " 36,836.93 " N/A N/A " 10,662.15 " DRG 605 " 26,546.23 " " 8,364.72 " " 6,631.05 " " 21,236.98 " N/A " 13,579.29 " " 6,962.60 " " 13,579.29 " N/A " 12,058.00 " " 6,829.98 " " 12,880.58 " N/A " 6,631.05 " " 15,136.66 " N/A " 6,631.05 " " 10,228.03 " " 12,785.04 " " 6,829.98 " " 6,829.98 " " 6,631.05 " " 21,236.98 " N/A N/A " 15,818.25 " N/A N/A " 19,909.67 " N/A N/A " 6,829.98 " DRG 606 " 28,422.11 " " 8,955.81 " " 10,573.28 " " 30,234.06 " N/A " 22,716.28 " " 11,101.94 " " 22,716.28 " N/A " 21,498.00 " " 10,890.48 " " 21,547.43 " N/A " 10,573.28 " " 16,206.29 " N/A " 10,573.28 " " 24,187.23 " " 30,234.06 " " 10,890.48 " " 10,890.48 " " 10,573.28 " " 22,737.69 " N/A N/A " 26,461.75 " N/A N/A " 21,316.58 " N/A N/A " 10,890.48 " DRG 607 " 24,282.73 " " 7,651.49 " " 6,140.37 " " 19,426.18 " N/A " 12,442.05 " " 6,447.39 " " 12,442.05 " N/A " 11,480.00 " " 6,324.58 " " 11,801.85 " N/A " 6,140.37 " " 13,846.01 " N/A " 6,140.37 " " 7,380.54 " " 9,225.68 " " 6,324.58 " " 6,324.58 " " 6,140.37 " " 19,426.18 " N/A N/A " 14,493.50 " N/A N/A " 18,212.05 " N/A N/A " 6,324.58 " DRG 614 " 92,365.88 " " 29,104.49 " " 16,261.72 " " 73,892.70 " N/A " 35,900.46 " " 17,074.81 " " 35,900.46 " N/A " 38,771.00 " " 16,749.57 " " 34,053.23 " N/A " 16,261.72 " " 52,667.02 " N/A " 16,261.72 " " 29,573.24 " " 36,966.54 " " 16,749.57 " " 16,749.57 " " 16,261.72 " " 73,892.70 " N/A N/A " 41,819.75 " N/A N/A " 69,274.41 " N/A N/A " 16,749.57 " DRG 615 No Current Volume N/A " 10,980.99 " " 31,481.88 " N/A " 23,661.23 " " 11,530.04 " " 23,661.23 " N/A " 22,410.00 " " 11,310.42 " " 22,443.75 " N/A " 10,980.99 " N/A N/A " 10,980.99 " " 25,185.49 " " 31,481.88 " " 11,310.42 " " 11,310.42 " " 10,980.99 " N/A N/A N/A " 27,562.50 " N/A N/A N/A N/A N/A " 11,310.42 " DRG 616 " 160,744.23 " " 50,650.51 " " 26,480.29 " " 128,595.38 " N/A " 59,584.22 " " 27,804.30 " " 59,584.22 " N/A " 65,468.00 " " 27,274.70 " " 56,518.35 " N/A " 26,480.29 " " 91,656.36 " N/A " 26,480.29 " " 35,042.36 " " 43,802.94 " " 27,274.70 " " 27,274.70 " " 26,480.29 " " 128,595.38 " N/A N/A " 69,408.50 " N/A N/A " 120,558.17 " N/A N/A " 27,274.70 " DRG 617 " 75,044.59 " " 23,646.55 " " 13,928.91 " " 60,035.67 " N/A " 30,493.69 " " 14,625.36 " " 30,493.69 " N/A " 31,399.00 " " 14,346.78 " " 28,924.65 " N/A " 13,928.91 " " 42,790.43 " N/A " 13,928.91 " " 20,914.27 " " 26,142.84 " " 14,346.78 " " 14,346.78 " " 13,928.91 " " 60,035.67 " N/A N/A " 35,521.50 " N/A N/A " 56,283.45 " N/A N/A " 14,346.78 " DRG 618 No Current Volume N/A " 9,219.23 " " 22,806.00 " N/A " 19,577.97 " " 9,680.19 " " 19,577.97 " N/A " 21,259.00 " " 9,495.81 " " 18,570.60 " N/A " 9,219.23 " N/A N/A " 9,219.23 " " 16,659.41 " " 20,824.27 " " 9,495.81 " " 9,495.81 " " 9,219.23 " N/A N/A N/A " 22,806.00 " N/A N/A N/A N/A N/A " 9,495.81 " DRG 619 No Current Volume N/A " 20,617.49 " " 53,579.75 " N/A " 45,995.92 " " 21,648.36 " " 45,995.92 " N/A " 51,748.00 " " 21,236.01 " " 43,629.23 " N/A " 20,617.49 " N/A N/A " 20,617.49 " " 29,287.64 " " 36,609.55 " " 21,236.01 " " 21,236.01 " " 20,617.49 " N/A N/A N/A " 53,579.75 " N/A N/A N/A N/A N/A " 21,236.01 " DRG 620 " 42,858.01 " " 13,504.56 " " 12,197.62 " " 34,286.41 " N/A " 26,481.04 " " 12,807.50 " " 26,481.04 " N/A " 29,060.00 " " 12,563.55 " " 25,118.48 " N/A " 12,197.62 " " 24,437.64 " N/A " 12,197.62 " " 20,750.62 " " 25,938.28 " " 12,563.55 " " 12,563.55 " " 12,197.62 " " 34,286.41 " N/A N/A " 30,847.25 " N/A N/A " 32,143.51 " N/A N/A " 12,563.55 " DRG 621 " 41,321.09 " " 13,020.28 " " 11,124.24 " " 33,056.87 " N/A " 23,993.23 " " 11,680.45 " " 23,993.23 " N/A " 24,284.00 " " 11,457.97 " " 22,758.68 " N/A " 11,124.24 " " 23,561.29 " N/A " 11,124.24 " " 18,115.88 " " 22,644.86 " " 11,457.97 " " 11,457.97 " " 11,124.24 " " 33,056.87 " N/A N/A " 27,949.25 " N/A N/A " 30,990.82 " N/A N/A " 11,457.97 " DRG 622 " 227,749.47 " " 71,763.86 " " 24,203.23 " " 182,199.57 " N/A " 54,306.64 " " 25,413.39 " " 54,306.64 " N/A " 59,862.00 " " 24,929.33 " " 51,512.33 " N/A " 24,203.23 " " 129,862.75 " N/A " 24,203.23 " " 50,307.35 " " 62,884.18 " " 24,929.33 " " 24,929.33 " " 24,203.23 " " 182,199.57 " N/A N/A " 63,260.75 " N/A N/A " 170,812.10 " N/A N/A " 24,929.33 " DRG 623 " 126,432.58 " " 39,838.91 " " 12,902.84 " " 101,146.06 " N/A " 28,115.54 " " 13,547.98 " " 28,115.54 " N/A " 28,803.00 " " 13,289.93 " " 26,668.88 " N/A " 12,902.84 " " 72,091.86 " N/A " 12,902.84 " " 19,686.90 " " 24,608.64 " " 13,289.93 " " 13,289.93 " " 12,902.84 " " 101,146.06 " N/A N/A " 32,751.25 " N/A N/A " 94,824.43 " N/A N/A " 13,289.93 " DRG 624 No Current Volume N/A " 7,895.00 " " 21,847.07 " N/A " 16,508.77 " " 8,289.75 " " 16,508.77 " N/A " 17,801.00 " " 8,131.85 " " 15,659.33 " N/A " 7,895.00 " N/A N/A " 7,895.00 " " 17,477.65 " " 21,847.07 " " 8,131.85 " " 8,131.85 " " 7,895.00 " N/A N/A N/A " 19,230.75 " N/A N/A N/A N/A N/A " 8,131.85 " DRG 625 No Current Volume N/A " 19,181.77 " " 50,603.64 " N/A " 42,668.32 " " 20,140.86 " " 42,668.32 " N/A " 39,170.00 " " 19,757.22 " " 40,472.85 " N/A " 19,181.77 " N/A N/A " 19,181.77 " " 40,482.92 " " 50,603.64 " " 19,757.22 " " 19,757.22 " " 19,181.77 " N/A N/A N/A " 49,703.50 " N/A N/A N/A N/A N/A " 19,757.22 " DRG 626 " 63,968.83 " " 20,156.58 " " 11,485.92 " " 51,175.06 " N/A " 24,831.52 " " 12,060.22 " " 24,831.52 " N/A " 20,580.00 " " 11,830.50 " " 23,553.83 " N/A " 11,485.92 " " 36,475.03 " N/A " 11,485.92 " " 20,112.39 " " 25,140.50 " " 11,830.50 " " 11,830.50 " " 11,485.92 " " 51,175.06 " N/A N/A " 28,925.75 " N/A N/A " 47,976.62 " N/A N/A " 11,830.50 " DRG 627 No Current Volume N/A " 8,438.82 " " 20,699.00 " N/A " 17,769.20 " " 8,860.76 " " 17,769.20 " N/A " 13,630.00 " " 8,691.98 " " 16,854.90 " N/A " 8,438.82 " N/A N/A " 8,438.82 " " 15,235.67 " " 19,044.59 " " 8,691.98 " " 8,691.98 " " 8,438.82 " N/A N/A N/A " 20,699.00 " N/A N/A N/A N/A N/A " 8,691.98 " DRG 628 " 146,913.71 " " 46,292.51 " " 24,621.30 " " 117,530.97 " N/A " 55,275.63 " " 25,852.37 " " 55,275.63 " N/A " 51,819.00 " " 25,359.94 " " 52,431.45 " N/A " 24,621.30 " " 83,770.20 " N/A " 24,621.30 " " 40,297.29 " " 50,371.60 " " 25,359.94 " " 25,359.94 " " 24,621.30 " " 117,530.97 " N/A N/A " 64,389.50 " N/A N/A " 110,185.28 " N/A N/A " 25,359.94 " DRG 629 " 84,534.84 " " 26,636.93 " " 15,973.92 " " 67,627.87 " N/A " 35,233.44 " " 16,772.62 " " 35,233.44 " N/A " 35,354.00 " " 16,453.14 " " 33,420.53 " N/A " 15,973.92 " " 48,201.77 " N/A " 15,973.92 " " 24,923.65 " " 31,154.58 " " 16,453.14 " " 16,453.14 " " 15,973.92 " " 67,627.87 " N/A N/A " 41,042.75 " N/A N/A " 63,401.13 " N/A N/A " 16,453.14 " DRG 630 No Current Volume N/A " 9,906.95 " " 28,270.27 " N/A " 21,171.91 " " 10,402.30 " " 21,171.91 " N/A " 22,507.00 " " 10,204.16 " " 20,082.53 " N/A " 9,906.95 " N/A N/A " 9,906.95 " " 22,616.21 " " 28,270.27 " " 10,204.16 " " 10,204.16 " " 9,906.95 " N/A N/A N/A " 24,662.75 " N/A N/A N/A N/A N/A " 10,204.16 " DRG 637 " 63,319.50 " " 19,951.97 " " 9,695.00 " " 50,655.60 " N/A " 20,680.66 " " 10,179.75 " " 20,680.66 " N/A " 21,940.00 " " 9,985.85 " " 19,616.55 " N/A " 9,695.00 " " 36,104.78 " N/A " 9,695.00 " " 16,348.48 " " 20,435.60 " " 9,985.85 " " 9,985.85 " " 9,695.00 " " 50,655.60 " N/A N/A " 24,090.50 " N/A N/A " 47,489.62 " N/A N/A " 9,985.85 " DRG 638 " 40,956.70 " " 12,905.46 " " 6,472.24 " " 32,765.36 " N/A " 13,211.23 " " 6,795.85 " " 13,211.23 " N/A " 12,998.00 " " 6,666.41 " " 12,531.45 " N/A " 6,472.24 " " 23,353.51 " N/A " 6,472.24 " " 9,164.31 " " 11,455.39 " " 6,666.41 " " 6,666.41 " " 6,472.24 " " 32,765.36 " N/A N/A " 15,389.50 " N/A N/A " 30,717.53 " N/A N/A " 6,666.41 " DRG 639 " 24,399.82 " " 7,688.38 " " 4,723.45 " " 19,519.86 " N/A " 9,158.02 " " 4,959.62 " " 9,158.02 " N/A " 9,545.00 " " 4,865.15 " " 8,686.80 " N/A " 4,723.45 " " 13,912.78 " N/A " 4,723.45 " " 7,036.88 " " 8,796.11 " " 4,865.15 " " 4,865.15 " " 4,723.45 " " 19,519.86 " N/A N/A " 10,668.00 " N/A N/A " 18,299.87 " N/A N/A " 4,865.15 " DRG 640 " 48,538.41 " " 15,294.45 " " 8,749.95 " " 38,830.73 " N/A " 18,490.31 " " 9,187.45 " " 18,490.31 " N/A " 17,376.00 " " 9,012.45 " " 17,538.90 " N/A " 8,749.95 " " 27,676.60 " N/A " 8,749.95 " " 15,202.94 " " 19,003.68 " " 9,012.45 " " 9,012.45 " " 8,749.95 " " 38,830.73 " N/A N/A " 21,539.00 " N/A N/A " 36,403.81 " N/A N/A " 9,012.45 " DRG 641 " 35,758.79 " " 11,267.59 " " 5,660.72 " " 28,607.03 " N/A " 11,330.35 " " 5,943.76 " " 11,330.35 " N/A " 11,093.00 " " 5,830.54 " " 10,747.35 " N/A " 5,660.72 " " 20,389.66 " N/A " 5,660.72 " " 8,984.30 " " 11,230.38 " " 5,830.54 " " 5,830.54 " " 5,660.72 " " 28,607.03 " N/A N/A " 13,198.50 " N/A N/A " 26,819.09 " N/A N/A " 5,830.54 " DRG 642 " 10,206.21 " " 3,215.98 " " 5,819.58 " " 22,571.50 " N/A " 19,376.67 " " 9,589.00 " " 19,376.67 " N/A " 17,982.00 " " 9,406.35 " " 18,379.65 " N/A " 9,132.38 " " 5,819.58 " N/A " 9,132.38 " " 10,326.21 " " 12,907.77 " " 9,406.35 " " 9,406.35 " " 9,132.38 " " 8,164.97 " N/A N/A " 22,571.50 " N/A N/A " 7,654.66 " N/A N/A " 9,406.35 " DRG 643 " 66,171.47 " " 20,850.63 " " 11,581.85 " " 52,937.17 " N/A " 25,053.86 " " 12,160.94 " " 25,053.86 " N/A " 25,897.00 " " 11,929.31 " " 23,764.73 " N/A " 11,581.85 " " 37,730.97 " N/A " 11,581.85 " " 20,145.12 " " 25,181.41 " " 11,929.31 " " 11,929.31 " " 11,581.85 " " 52,937.17 " N/A N/A " 29,184.75 " N/A N/A " 49,628.60 " N/A N/A " 11,929.31 " DRG 644 " 31,602.18 " " 9,957.85 " " 7,382.29 " " 25,281.75 " N/A " 15,320.46 " " 7,751.40 " " 15,320.46 " N/A " 16,046.00 " " 7,603.76 " " 14,532.15 " N/A " 7,382.29 " " 18,019.56 " N/A " 7,382.29 " " 12,322.72 " " 15,403.41 " " 7,603.76 " " 7,603.76 " " 7,382.29 " " 25,281.75 " N/A N/A " 17,846.50 " N/A N/A " 23,701.64 " N/A N/A " 7,603.76 " DRG 645 " 33,812.24 " " 10,654.24 " " 5,754.06 " " 27,049.79 " N/A " 11,546.68 " " 6,041.76 " " 11,546.68 " N/A " 11,296.00 " " 5,926.68 " " 10,952.55 " N/A " 5,754.06 " " 19,279.74 " N/A " 5,754.06 " " 7,871.49 " " 9,839.36 " " 5,926.68 " " 5,926.68 " " 5,754.06 " " 27,049.79 " N/A N/A " 13,450.50 " N/A N/A " 25,359.18 " N/A N/A " 5,926.68 " DRG 653 No Current Volume N/A " 36,157.63 " " 95,536.00 " N/A " 82,013.56 " " 37,965.51 " " 82,013.56 " N/A " 91,188.00 " " 37,242.36 " " 77,793.60 " N/A " 36,157.63 " N/A N/A " 36,157.63 " " 76,224.99 " " 95,281.22 " " 37,242.36 " " 37,242.36 " " 36,157.63 " N/A N/A N/A " 95,536.00 " N/A N/A N/A N/A N/A " 37,242.36 " DRG 654 No Current Volume N/A " 19,587.53 " " 50,799.00 " N/A " 43,608.76 " " 20,566.91 " " 43,608.76 " N/A " 48,730.00 " " 20,175.16 " " 41,364.90 " N/A " 19,587.53 " N/A N/A " 19,587.53 " " 32,714.77 " " 40,893.46 " " 20,175.16 " " 20,175.16 " " 19,587.53 " N/A N/A N/A " 50,799.00 " N/A N/A N/A N/A N/A " 20,175.16 " DRG 655 No Current Volume N/A " 14,256.25 " " 36,405.25 " N/A " 31,252.35 " " 14,969.06 " " 31,252.35 " N/A " 35,541.00 " " 14,683.94 " " 29,644.28 " N/A " 14,256.25 " N/A N/A " 14,256.25 " " 26,740.15 " " 33,425.20 " " 14,683.94 " " 14,683.94 " " 14,256.25 " N/A N/A N/A " 36,405.25 " N/A N/A N/A N/A N/A " 14,683.94 " DRG 656 " 122,598.85 " " 38,630.90 " " 22,064.88 " " 98,079.08 " N/A " 49,350.56 " " 23,168.12 " " 49,350.56 " N/A " 54,306.00 " " 22,726.83 " " 46,811.25 " N/A " 22,064.88 " " 69,905.86 " N/A " 22,064.88 " " 37,327.11 " " 46,658.88 " " 22,726.83 " " 22,726.83 " " 22,064.88 " " 98,079.08 " N/A N/A " 57,487.50 " N/A N/A " 91,949.14 " N/A N/A " 22,726.83 " DRG 657 " 45,989.23 " " 14,491.21 " " 13,312.49 " " 36,791.38 " N/A " 29,065.00 " " 13,978.11 " " 29,065.00 " N/A " 31,641.00 " " 13,711.86 " " 27,569.48 " N/A " 13,312.49 " " 26,223.06 " N/A " 13,312.49 " " 23,549.00 " " 29,436.27 " " 13,711.86 " " 13,711.86 " " 13,312.49 " " 36,791.38 " N/A N/A " 33,857.25 " N/A N/A " 34,491.92 " N/A N/A " 13,711.86 " DRG 658 " 48,451.01 " " 15,266.91 " " 10,999.78 " " 38,760.81 " N/A " 23,704.79 " " 11,549.77 " " 23,704.79 " N/A " 24,071.00 " " 11,329.77 " " 22,485.08 " N/A " 10,999.78 " " 27,626.77 " N/A " 10,999.78 " " 20,308.77 " " 25,385.97 " " 11,329.77 " " 11,329.77 " " 10,999.78 " " 38,760.81 " N/A N/A " 27,613.25 " N/A N/A " 36,338.26 " N/A N/A " 11,329.77 " DRG 659 " 169,206.48 " " 53,316.96 " " 18,055.23 " " 135,365.18 " N/A " 40,057.33 " " 18,957.99 " " 40,057.33 " N/A " 53,198.00 " " 18,596.89 " " 37,996.20 " N/A " 18,055.23 " " 96,481.53 " N/A " 18,055.23 " " 26,167.38 " " 32,709.24 " " 18,596.89 " " 18,596.89 " " 18,055.23 " " 135,365.18 " N/A N/A " 46,662.00 " N/A N/A " 126,904.86 " N/A N/A " 18,596.89 " DRG 660 " 58,920.73 " " 18,565.92 " " 10,126.04 " " 47,136.59 " N/A " 21,679.69 " " 10,632.34 " " 21,679.69 " N/A " 29,717.00 " " 10,429.82 " " 20,564.18 " N/A " 10,126.04 " " 33,596.60 " N/A " 10,126.04 " " 15,906.62 " " 19,883.29 " " 10,429.82 " " 10,429.82 " " 10,126.04 " " 47,136.59 " N/A N/A " 25,254.25 " N/A N/A " 44,190.55 " N/A N/A " 10,429.82 " DRG 661 " 38,308.97 " " 12,071.16 " " 7,666.84 " " 30,647.17 " N/A " 15,979.97 " " 8,050.18 " " 15,979.97 " N/A " 21,231.00 " " 7,896.85 " " 15,157.73 " N/A " 7,666.84 " " 21,843.77 " N/A " 7,666.84 " " 12,944.59 " " 16,180.74 " " 7,896.85 " " 7,896.85 " " 7,666.84 " " 30,647.17 " N/A N/A " 18,614.75 " N/A N/A " 28,731.73 " N/A N/A " 7,896.85 " DRG 662 " 119,450.37 " " 37,638.81 " " 19,811.15 " " 95,560.30 " N/A " 44,127.06 " " 20,801.71 " " 44,127.06 " N/A " 47,268.00 " " 20,405.48 " " 41,856.53 " N/A " 19,811.15 " " 68,110.60 " N/A " 19,811.15 " " 43,124.66 " " 53,905.82 " " 20,405.48 " " 20,405.48 " " 19,811.15 " " 95,560.30 " N/A N/A " 51,402.75 " N/A N/A " 89,587.78 " N/A N/A " 20,405.48 " DRG 663 No Current Volume N/A " 11,139.79 " " 32,341.03 " N/A " 24,029.29 " " 11,696.78 " " 24,029.29 " N/A " 24,049.00 " " 11,473.98 " " 22,792.88 " N/A " 11,139.79 " N/A N/A " 11,139.79 " " 25,872.81 " " 32,341.03 " " 11,473.98 " " 11,473.98 " " 11,139.79 " N/A N/A N/A " 27,991.25 " N/A N/A N/A N/A N/A " 11,473.98 " DRG 664 No Current Volume N/A " 8,445.30 " " 23,974.50 " N/A " 17,784.23 " " 8,867.57 " " 17,784.23 " N/A " 19,520.00 " " 8,698.66 " " 16,869.15 " N/A " 8,445.30 " N/A N/A " 8,445.30 " " 19,179.59 " " 23,974.50 " " 8,698.66 " " 8,698.66 " " 8,445.30 " N/A N/A N/A " 20,716.50 " N/A N/A N/A N/A N/A " 8,698.66 " DRG 665 " 114,390.19 " " 36,044.35 " " 20,487.86 " " 91,512.15 " N/A " 45,695.46 " " 21,512.25 " " 45,695.46 " N/A " 49,694.00 " " 21,102.50 " " 43,344.23 " N/A " 20,487.86 " " 65,225.29 " N/A " 20,487.86 " " 43,453.10 " " 54,316.36 " " 21,102.50 " " 21,102.50 " " 20,487.86 " " 91,512.15 " N/A N/A " 53,229.75 " N/A N/A " 85,792.64 " N/A N/A " 21,102.50 " DRG 666 No Current Volume N/A " 12,048.54 " " 35,818.56 " N/A " 26,135.51 " " 12,650.97 " " 26,135.51 " N/A " 27,553.00 " " 12,410.00 " " 24,790.73 " N/A " 12,048.54 " N/A N/A " 12,048.54 " " 28,654.83 " " 35,818.56 " " 12,410.00 " " 12,410.00 " " 12,048.54 " N/A N/A N/A " 30,444.75 " N/A N/A N/A N/A N/A " 12,410.00 " DRG 667 No Current Volume N/A " 7,237.74 " " 20,312.87 " N/A " 14,985.44 " " 7,599.63 " " 14,985.44 " N/A " 15,246.00 " " 7,454.87 " " 14,214.38 " N/A " 7,237.74 " N/A N/A " 7,237.74 " " 16,250.29 " " 20,312.87 " " 7,454.87 " " 7,454.87 " " 7,237.74 " N/A N/A N/A " 17,456.25 " N/A N/A N/A N/A N/A " 7,454.87 " DRG 668 " 85,484.16 " " 26,936.06 " " 18,962.04 " " 68,387.33 " N/A " 42,159.04 " " 19,910.14 " " 42,159.04 " N/A " 39,315.00 " " 19,530.90 " " 39,989.78 " N/A " 18,962.04 " " 48,743.07 " N/A " 18,962.04 " " 37,441.35 " " 46,801.68 " " 19,530.90 " " 19,530.90 " " 18,962.04 " " 68,387.33 " N/A N/A " 49,110.25 " N/A N/A " 64,113.12 " N/A N/A " 19,530.90 " DRG 669 " 65,056.28 " " 20,499.23 " " 10,906.45 " " 52,045.02 " N/A " 23,488.46 " " 11,451.77 " " 23,488.46 " N/A " 19,921.00 " " 11,233.64 " " 22,279.88 " N/A " 10,906.45 " " 37,095.09 " N/A " 10,906.45 " " 15,661.15 " " 19,576.45 " " 11,233.64 " " 11,233.64 " " 10,906.45 " " 52,045.02 " N/A N/A " 27,361.25 " N/A N/A " 48,792.21 " N/A N/A " 11,233.64 " DRG 670 " 83,259.94 " " 26,235.21 " " 7,114.59 " " 66,607.95 " N/A " 14,700.01 " " 7,470.32 " " 14,700.01 " N/A " 14,092.00 " " 7,328.03 " " 13,943.63 " N/A " 7,114.59 " " 47,474.82 " N/A " 7,114.59 " " 11,635.40 " " 14,544.26 " " 7,328.03 " " 7,328.03 " " 7,114.59 " " 66,607.95 " N/A N/A " 17,123.75 " N/A N/A " 62,444.96 " N/A N/A " 7,328.03 " DRG 671 No Current Volume N/A " 12,318.18 " " 35,818.56 " N/A " 26,760.47 " " 12,934.09 " " 26,760.47 " N/A " 25,442.00 " " 12,687.73 " " 25,383.53 " N/A " 12,318.18 " N/A N/A " 12,318.18 " " 28,654.83 " " 35,818.56 " " 12,687.73 " " 12,687.73 " " 12,318.18 " N/A N/A N/A " 31,172.75 " N/A N/A N/A N/A N/A " 12,687.73 " DRG 672 No Current Volume N/A " 8,228.81 " " 22,297.11 " N/A " 17,282.46 " " 8,640.25 " " 17,282.46 " N/A " 13,367.00 " " 8,475.67 " " 16,393.20 " N/A " 8,228.81 " N/A N/A " 8,228.81 " " 17,837.68 " " 22,297.11 " " 8,475.67 " " 8,475.67 " " 8,228.81 " N/A N/A N/A " 20,132.00 " N/A N/A N/A N/A N/A " 8,475.67 " DRG 673 " 146,598.03 " " 46,193.04 " " 23,252.99 " " 117,278.42 " N/A " 52,104.27 " " 24,415.64 " " 52,104.27 " N/A " 55,103.00 " " 23,950.58 " " 49,423.28 " N/A " 23,252.99 " " 83,590.20 " N/A " 23,252.99 " " 34,985.24 " " 43,731.54 " " 23,950.58 " " 23,950.58 " " 23,252.99 " " 117,278.42 " N/A N/A " 60,695.25 " N/A N/A " 109,948.52 " N/A N/A " 23,950.58 " DRG 674 " 68,373.80 " " 21,544.58 " " 16,219.59 " " 54,699.04 " N/A " 35,802.81 " " 17,030.57 " " 35,802.81 " N/A " 35,558.00 " " 16,706.18 " " 33,960.60 " N/A " 16,219.59 " " 38,986.74 " N/A " 16,219.59 " " 28,474.82 " " 35,593.54 " " 16,706.18 " " 16,706.18 " " 16,219.59 " " 54,699.04 " N/A N/A " 41,706.00 " N/A N/A " 51,280.35 " N/A N/A " 16,706.18 " DRG 675 No Current Volume N/A " 12,145.77 " " 34,448.01 " N/A " 26,360.86 " " 12,753.06 " " 26,360.86 " N/A " 22,723.00 " " 12,510.14 " " 25,004.48 " N/A " 12,145.77 " N/A N/A " 12,145.77 " " 27,558.39 " " 34,448.01 " " 12,510.14 " " 12,510.14 " " 12,145.77 " N/A N/A N/A " 30,707.25 " N/A N/A N/A N/A N/A " 12,510.14 " DRG 682 " 62,609.65 " " 19,728.30 " " 10,317.90 " " 50,087.72 " N/A " 22,124.37 " " 10,833.80 " " 22,124.37 " N/A " 23,905.00 " " 10,627.44 " " 20,985.98 " N/A " 10,317.90 " " 35,700.03 " N/A " 10,317.90 " " 17,674.03 " " 22,092.54 " " 10,627.44 " " 10,627.44 " " 10,317.90 " " 50,087.72 " N/A N/A " 25,772.25 " N/A N/A " 46,957.24 " N/A N/A " 10,627.44 " DRG 683 " 33,808.93 " " 10,653.19 " " 6,471.59 " " 27,047.14 " N/A " 13,209.72 " " 6,795.17 " " 13,209.72 " N/A " 14,965.00 " " 6,665.74 " " 12,530.03 " N/A " 6,471.59 " " 19,277.85 " N/A " 6,471.59 " " 9,769.81 " " 12,212.27 " " 6,665.74 " " 6,665.74 " " 6,471.59 " " 27,047.14 " N/A N/A " 15,387.75 " N/A N/A " 25,356.69 " N/A N/A " 6,665.74 " DRG 684 " 20,182.76 " " 6,359.59 " " 4,712.43 " " 16,146.21 " N/A " 9,132.48 " " 4,948.05 " " 9,132.48 " N/A " 9,574.00 " " 4,853.80 " " 8,662.58 " N/A " 4,712.43 " " 11,508.21 " N/A " 4,712.43 " " 6,922.33 " " 8,652.91 " " 4,853.80 " " 4,853.80 " " 4,712.43 " " 16,146.21 " N/A N/A " 10,638.25 " N/A N/A " 15,137.07 " N/A N/A " 4,853.80 " DRG 686 No Current Volume N/A " 12,927.47 " " 34,407.09 " N/A " 28,172.63 " " 13,573.84 " " 28,172.63 " N/A " 27,748.00 " " 13,315.29 " " 26,723.03 " N/A " 12,927.47 " N/A N/A " 12,927.47 " " 27,525.66 " " 34,407.09 " " 13,315.29 " " 13,315.29 " " 12,927.47 " N/A N/A N/A " 32,817.75 " N/A N/A N/A N/A N/A " 13,315.29 " DRG 687 No Current Volume N/A " 7,578.69 " " 19,187.78 " N/A " 15,775.65 " " 7,957.62 " " 15,775.65 " N/A " 15,817.00 " " 7,806.05 " " 14,963.93 " N/A " 7,578.69 " N/A N/A " 7,578.69 " " 15,350.22 " " 19,187.78 " " 7,806.05 " " 7,806.05 " " 7,578.69 " N/A N/A N/A " 18,376.75 " N/A N/A N/A N/A N/A " 7,806.05 " DRG 688 No Current Volume N/A " 5,217.36 " " 14,462.43 " N/A " 10,302.77 " " 5,478.23 " " 10,302.77 " N/A " 10,873.00 " " 5,373.88 " " 9,772.65 " N/A " 5,217.36 " N/A N/A " 5,217.36 " " 11,569.94 " " 14,462.43 " " 5,373.88 " " 5,373.88 " " 5,217.36 " N/A N/A N/A " 12,001.50 " N/A N/A N/A N/A N/A " 5,373.88 " DRG 689 " 45,013.30 " " 14,183.69 " " 7,994.17 " " 36,010.64 " N/A " 16,738.63 " " 8,393.88 " " 16,738.63 " N/A " 17,576.00 " " 8,234.00 " " 15,877.35 " N/A " 7,994.17 " " 25,666.58 " N/A " 7,994.17 " " 14,073.76 " " 17,592.21 " " 8,234.00 " " 8,234.00 " " 7,994.17 " " 36,010.64 " N/A N/A " 19,498.50 " N/A N/A " 33,759.97 " N/A N/A " 8,234.00 " DRG 690 " 35,917.54 " " 11,317.62 " " 5,918.70 " " 28,734.03 " N/A " 11,928.26 " " 6,214.64 " " 11,928.26 " N/A " 12,262.00 " " 6,096.26 " " 11,314.50 " N/A " 5,918.70 " " 20,480.18 " N/A " 5,918.70 " " 7,855.12 " " 9,818.91 " " 6,096.26 " " 6,096.26 " " 5,918.70 " " 28,734.03 " N/A N/A " 13,895.00 " N/A N/A " 26,938.15 " N/A N/A " 6,096.26 " DRG 693 " 55,427.25 " " 17,465.13 " " 9,428.59 " " 44,341.80 " N/A " 20,063.22 " " 9,900.02 " " 20,063.22 " N/A " 21,136.00 " " 9,711.45 " " 19,030.88 " N/A " 9,428.59 " " 31,604.62 " N/A " 9,428.59 " " 20,636.06 " " 25,795.09 " " 9,711.45 " " 9,711.45 " " 9,428.59 " " 44,341.80 " N/A N/A " 23,371.25 " N/A N/A " 41,570.44 " N/A N/A " 9,711.45 " DRG 694 " 29,714.55 " " 9,363.05 " " 5,770.91 " " 23,771.64 " N/A " 11,585.74 " " 6,059.46 " " 11,585.74 " N/A " 10,791.00 " " 5,944.04 " " 10,989.60 " N/A " 5,770.91 " " 16,943.23 " N/A " 5,770.91 " " 7,576.92 " " 9,471.16 " " 5,944.04 " " 5,944.04 " " 5,770.91 " " 23,771.64 " N/A N/A " 13,496.00 " N/A N/A " 22,285.91 " N/A N/A " 5,944.04 " DRG 695 No Current Volume N/A " 8,146.49 " " 23,647.21 " N/A " 17,091.67 " " 8,553.81 " " 17,091.67 " N/A " 19,588.00 " " 8,390.88 " " 16,212.23 " N/A " 8,146.49 " N/A N/A " 8,146.49 " " 18,917.76 " " 23,647.21 " " 8,390.88 " " 8,390.88 " " 8,146.49 " N/A N/A N/A " 19,909.75 " N/A N/A N/A N/A N/A " 8,390.88 " DRG 696 " 20,605.52 " " 6,492.80 " " 5,256.90 " " 16,484.41 " N/A " 10,394.41 " " 5,519.75 " " 10,394.41 " N/A " 10,414.00 " " 5,414.61 " " 9,859.58 " N/A " 5,256.90 " " 11,749.26 " N/A " 5,256.90 " " 7,331.45 " " 9,164.31 " " 5,414.61 " " 5,414.61 " " 5,256.90 " " 16,484.41 " N/A N/A " 12,108.25 " N/A N/A " 15,454.14 " N/A N/A " 5,414.61 " DRG 697 No Current Volume N/A " 7,249.41 " " 19,924.20 " N/A " 15,012.48 " " 7,611.88 " " 15,012.48 " N/A " 14,519.00 " " 7,466.89 " " 14,240.03 " N/A " 7,249.41 " N/A N/A " 7,249.41 " " 15,939.35 " " 19,924.20 " " 7,466.89 " " 7,466.89 " " 7,249.41 " N/A N/A N/A " 17,487.75 " N/A N/A N/A N/A N/A " 7,466.89 " DRG 698 " 66,248.35 " " 20,874.86 " " 11,211.74 " " 52,998.68 " N/A " 24,196.04 " " 11,772.33 " " 24,196.04 " N/A " 24,584.00 " " 11,548.09 " " 22,951.05 " N/A " 11,211.74 " " 37,774.81 " N/A " 11,211.74 " " 19,212.32 " " 24,015.41 " " 11,548.09 " " 11,548.09 " " 11,211.74 " " 52,998.68 " N/A N/A " 28,185.50 " N/A N/A " 49,686.27 " N/A N/A " 11,548.09 " DRG 699 " 32,681.31 " " 10,297.88 " " 7,428.96 " " 26,145.05 " N/A " 15,428.62 " " 7,800.41 " " 15,428.62 " N/A " 16,001.00 " " 7,651.83 " " 14,634.75 " N/A " 7,428.96 " " 18,634.88 " N/A " 7,428.96 " " 11,749.96 " " 14,687.45 " " 7,651.83 " " 7,651.83 " " 7,428.96 " " 26,145.05 " N/A N/A " 17,972.50 " N/A N/A " 24,510.98 " N/A N/A " 7,651.83 " DRG 700 " 23,126.48 " " 7,287.15 " " 5,610.81 " " 18,501.18 " N/A " 11,214.67 " " 5,891.35 " " 11,214.67 " N/A " 11,187.00 " " 5,779.13 " " 10,637.63 " N/A " 5,610.81 " " 13,186.72 " N/A " 5,610.81 " " 9,818.90 " " 12,273.64 " " 5,779.13 " " 5,779.13 " " 5,610.81 " " 18,501.18 " N/A N/A " 13,063.75 " N/A N/A " 17,344.86 " N/A N/A " 5,779.13 " DRG 707 No Current Volume N/A " 13,231.47 " " 33,638.50 " N/A " 28,877.21 " " 13,893.04 " " 28,877.21 " N/A " 28,563.00 " " 13,628.41 " " 27,391.35 " N/A " 13,231.47 " N/A N/A " 13,231.47 " " 23,892.67 " " 29,865.85 " " 13,628.41 " " 13,628.41 " " 13,231.47 " N/A N/A N/A " 33,638.50 " N/A N/A N/A N/A N/A " 13,628.41 " DRG 708 No Current Volume N/A " 10,437.81 " " 26,096.00 " N/A " 22,402.30 " " 10,959.70 " " 22,402.30 " N/A " 20,867.00 " " 10,750.94 " " 21,249.60 " N/A " 10,437.81 " N/A N/A " 10,437.81 " " 20,292.40 " " 25,365.51 " " 10,750.94 " " 10,750.94 " " 10,437.81 " N/A N/A N/A " 26,096.00 " N/A N/A N/A N/A N/A " 10,750.94 " DRG 709 No Current Volume N/A " 15,783.36 " " 40,822.06 " N/A " 34,791.77 " " 16,572.53 " " 34,791.77 " N/A " 33,577.00 " " 16,256.86 " " 33,001.58 " N/A " 15,783.36 " N/A N/A " 15,783.36 " " 32,657.65 " " 40,822.06 " " 16,256.86 " " 16,256.86 " " 15,783.36 " N/A N/A N/A " 40,528.25 " N/A N/A N/A N/A N/A " 16,256.86 " DRG 710 No Current Volume N/A " 11,153.40 " " 32,279.66 " N/A " 24,060.84 " " 11,711.07 " " 24,060.84 " N/A " 20,372.00 " " 11,488.00 " " 22,822.80 " N/A " 11,153.40 " N/A N/A " 11,153.40 " " 25,823.72 " " 32,279.66 " " 11,488.00 " " 11,488.00 " " 11,153.40 " N/A N/A N/A " 28,028.00 " N/A N/A N/A N/A N/A " 11,488.00 " DRG 711 " 46,429.08 " " 14,629.80 " " 14,588.76 " " 37,912.57 " N/A " 32,023.03 " " 15,318.20 " " 32,023.03 " N/A " 35,474.00 " " 15,026.42 " " 30,375.30 " N/A " 14,588.76 " " 26,473.86 " N/A " 14,588.76 " " 30,330.06 " " 37,912.57 " " 15,026.42 " " 15,026.42 " " 14,588.76 " " 37,143.26 " N/A N/A " 37,303.00 " N/A N/A " 34,821.81 " N/A N/A " 15,026.42 " DRG 712 No Current Volume N/A " 7,642.86 " " 21,458.41 " N/A " 15,924.38 " " 8,025.00 " " 15,924.38 " N/A " 16,728.00 " " 7,872.15 " " 15,105.00 " N/A " 7,642.86 " N/A N/A " 7,642.86 " " 17,166.72 " " 21,458.41 " " 7,872.15 " " 7,872.15 " " 7,642.86 " N/A N/A N/A " 18,550.00 " N/A N/A N/A N/A N/A " 7,872.15 " DRG 713 " 55,409.80 " " 17,459.63 " " 10,452.07 " " 44,327.84 " N/A " 22,435.35 " " 10,974.67 " " 22,435.35 " N/A " 23,331.00 " " 10,765.63 " " 21,280.95 " N/A " 10,452.07 " " 31,594.67 " N/A " 10,452.07 " " 17,723.12 " " 22,153.91 " " 10,765.63 " " 10,765.63 " " 10,452.07 " " 44,327.84 " N/A N/A " 26,134.50 " N/A N/A " 41,557.35 " N/A N/A " 10,765.63 " DRG 714 No Current Volume N/A " 6,792.44 " " 17,346.74 " N/A " 13,953.36 " " 7,132.06 " " 13,953.36 " N/A " 12,482.00 " " 6,996.21 " " 13,235.40 " N/A " 6,792.44 " N/A N/A " 6,792.44 " " 13,877.38 " " 17,346.74 " " 6,996.21 " " 6,996.21 " " 6,792.44 " N/A N/A N/A " 16,254.00 " N/A N/A N/A N/A N/A " 6,996.21 " DRG 715 No Current Volume N/A " 13,875.76 " " 37,162.89 " N/A " 30,370.50 " " 14,569.55 " " 30,370.50 " N/A " 31,547.00 " " 14,292.03 " " 28,807.80 " N/A " 13,875.76 " N/A N/A " 13,875.76 " " 29,730.31 " " 37,162.89 " " 14,292.03 " " 14,292.03 " " 13,875.76 " N/A N/A N/A " 35,378.00 " N/A N/A N/A N/A N/A " 14,292.03 " DRG 716 No Current Volume N/A " 9,041.63 " " 27,533.86 " N/A " 19,166.34 " " 9,493.71 " " 19,166.34 " N/A " 18,656.00 " " 9,312.88 " " 18,180.15 " N/A " 9,041.63 " N/A N/A " 9,041.63 " " 22,027.07 " " 27,533.86 " " 9,312.88 " " 9,312.88 " " 9,041.63 " N/A N/A N/A " 22,326.50 " N/A N/A N/A N/A N/A " 9,312.88 " DRG 717 " 67,478.64 " " 21,262.52 " " 12,443.28 " " 53,982.91 " N/A " 27,050.41 " " 13,065.44 " " 27,050.41 " N/A " 27,874.00 " " 12,816.58 " " 25,658.55 " N/A " 12,443.28 " " 38,476.32 " N/A " 12,443.28 " " 19,605.08 " " 24,506.36 " " 12,816.58 " " 12,816.58 " " 12,443.28 " " 53,982.91 " N/A N/A " 31,510.50 " N/A N/A " 50,608.98 " N/A N/A " 12,816.58 " DRG 718 No Current Volume N/A " 8,774.58 " " 21,605.50 " N/A " 18,547.40 " " 9,213.31 " " 18,547.40 " N/A " 15,889.00 " " 9,037.82 " " 17,593.05 " N/A " 8,774.58 " N/A N/A " 8,774.58 " " 13,173.70 " " 16,467.13 " " 9,037.82 " " 9,037.82 " " 8,774.58 " N/A N/A N/A " 21,605.50 " N/A N/A N/A N/A N/A " 9,037.82 " DRG 722 No Current Volume N/A " 11,872.88 " " 35,327.62 " N/A " 25,728.39 " " 12,466.52 " " 25,728.39 " N/A " 27,641.00 " " 12,229.07 " " 24,404.55 " N/A " 11,872.88 " N/A N/A " 11,872.88 " " 28,262.08 " " 35,327.62 " " 12,229.07 " " 12,229.07 " " 11,872.88 " N/A N/A N/A " 29,970.50 " N/A N/A N/A N/A N/A " 12,229.07 " DRG 723 " 29,995.02 " " 9,451.43 " " 7,849.63 " " 23,996.02 " N/A " 16,403.61 " " 8,242.11 " " 16,403.61 " N/A " 16,733.00 " " 8,085.12 " " 15,559.58 " N/A " 7,849.63 " " 17,103.16 " N/A " 7,849.63 " " 17,984.96 " " 22,481.21 " " 8,085.12 " " 8,085.12 " " 7,849.63 " " 23,996.02 " N/A N/A " 19,108.25 " N/A N/A " 22,496.27 " N/A N/A " 8,085.12 " DRG 724 " 11,965.23 " " 3,770.24 " " 4,973.00 " " 13,541.91 " N/A " 9,736.41 " " 5,221.65 " " 9,736.41 " N/A " 10,089.00 " " 5,122.19 " " 9,235.43 " N/A " 4,973.00 " " 6,822.57 " N/A " 4,973.00 " " 10,833.52 " " 13,541.91 " " 5,122.19 " " 5,122.19 " " 4,973.00 " " 9,572.18 " N/A N/A " 11,341.75 " N/A N/A " 8,973.92 " N/A N/A " 5,122.19 " DRG 725 No Current Volume N/A " 9,104.50 " " 25,999.65 " N/A " 19,312.07 " " 9,559.73 " " 19,312.07 " N/A " 18,550.00 " " 9,377.64 " " 18,318.38 " N/A " 9,104.50 " N/A N/A " 9,104.50 " " 20,799.71 " " 25,999.65 " " 9,377.64 " " 9,377.64 " " 9,104.50 " N/A N/A N/A " 22,496.25 " N/A N/A N/A N/A N/A " 9,377.64 " DRG 726 No Current Volume N/A " 5,599.14 " " 15,280.68 " N/A " 11,187.63 " " 5,879.10 " " 11,187.63 " N/A " 11,059.00 " " 5,767.11 " " 10,611.98 " N/A " 5,599.14 " N/A N/A " 5,599.14 " " 12,224.54 " " 15,280.68 " " 5,767.11 " " 5,767.11 " " 5,599.14 " N/A N/A N/A " 13,032.25 " N/A N/A N/A N/A N/A " 5,767.11 " DRG 727 No Current Volume N/A " 9,982.79 " " 29,047.61 " N/A " 21,347.68 " " 10,481.93 " " 21,347.68 " N/A " 22,333.00 " " 10,282.27 " " 20,249.25 " N/A " 9,982.79 " N/A N/A " 9,982.79 " " 23,238.07 " " 29,047.61 " " 10,282.27 " " 10,282.27 " " 9,982.79 " N/A N/A N/A " 24,867.50 " N/A N/A N/A N/A N/A " 10,282.27 " DRG 728 " 29,995.76 " " 9,451.66 " " 5,994.53 " " 23,996.60 " N/A " 12,104.03 " " 6,294.26 " " 12,104.03 " N/A " 12,596.00 " " 6,174.37 " " 11,481.23 " N/A " 5,994.53 " " 17,103.58 " N/A " 5,994.53 " " 8,231.51 " " 10,289.40 " " 6,174.37 " " 6,174.37 " " 5,994.53 " " 23,996.60 " N/A N/A " 14,099.75 " N/A N/A " 22,496.82 " N/A N/A " 6,174.37 " DRG 729 No Current Volume N/A " 7,302.56 " " 21,274.30 " N/A " 15,135.67 " " 7,667.69 " " 15,135.67 " N/A " 16,348.00 " " 7,521.64 " " 14,356.88 " N/A " 7,302.56 " N/A N/A " 7,302.56 " " 17,019.43 " " 21,274.30 " " 7,521.64 " " 7,521.64 " " 7,302.56 " N/A N/A N/A " 17,631.25 " N/A N/A N/A N/A N/A " 7,521.64 " DRG 730 No Current Volume N/A " 4,459.64 " " 12,150.90 " N/A " 8,546.58 " " 4,682.62 " " 8,546.58 " N/A " 10,477.00 " " 4,593.43 " " 8,106.83 " N/A " 4,459.64 " N/A N/A " 4,459.64 " " 9,720.71 " " 12,150.90 " " 4,593.43 " " 4,593.43 " " 4,459.64 " N/A N/A N/A " 9,955.75 " N/A N/A N/A N/A N/A " 4,593.43 " DRG 734 No Current Volume N/A " 15,189.63 " " 40,441.00 " N/A " 33,415.66 " " 15,949.11 " " 33,415.66 " N/A " 40,441.00 " " 15,645.32 " " 31,696.28 " N/A " 15,189.63 " N/A N/A " 15,189.63 " " 25,692.80 " " 32,116.01 " " 15,645.32 " " 15,645.32 " " 15,189.63 " N/A N/A N/A " 38,925.25 " N/A N/A N/A N/A N/A " 15,645.32 " DRG 735 No Current Volume N/A " 9,934.82 " " 25,222.32 " N/A " 21,236.51 " " 10,431.56 " " 21,236.51 " N/A " 19,297.00 " " 10,232.86 " " 20,143.80 " N/A " 9,934.82 " N/A N/A " 9,934.82 " " 20,177.85 " " 25,222.32 " " 10,232.86 " " 10,232.86 " " 9,934.82 " N/A N/A N/A " 24,738.00 " N/A N/A N/A N/A N/A " 10,232.86 " DRG 736 " 271,943.00 " " 85,689.24 " " 28,389.18 " " 217,554.40 " N/A " 64,008.50 " " 29,808.64 " " 64,008.50 " N/A " 69,764.00 " " 29,240.86 " " 60,714.98 " N/A " 28,389.18 " " 155,061.90 " N/A " 28,389.18 " " 59,332.11 " " 74,165.13 " " 29,240.86 " " 29,240.86 " " 28,389.18 " " 217,554.40 " N/A N/A " 74,562.25 " N/A N/A " 203,957.25 " N/A N/A " 29,240.86 " DRG 737 No Current Volume N/A " 14,112.35 " " 36,016.75 " N/A " 30,918.84 " " 14,817.97 " " 30,918.84 " N/A " 31,778.00 " " 14,535.72 " " 29,327.93 " N/A " 14,112.35 " N/A N/A " 14,112.35 " " 27,852.96 " " 34,816.21 " " 14,535.72 " " 14,535.72 " " 14,112.35 " N/A N/A N/A " 36,016.75 " N/A N/A N/A N/A N/A " 14,535.72 " DRG 738 No Current Volume N/A " 10,338.64 " " 25,828.25 " N/A " 22,172.45 " " 10,855.57 " " 22,172.45 " N/A " 20,053.00 " " 10,648.80 " " 21,031.58 " N/A " 10,338.64 " N/A N/A " 10,338.64 " " 18,541.36 " " 23,176.72 " " 10,648.80 " " 10,648.80 " " 10,338.64 " N/A N/A N/A " 25,828.25 " N/A N/A N/A N/A N/A " 10,648.80 " DRG 739 No Current Volume N/A " 25,558.57 " " 66,920.00 " N/A " 57,447.95 " " 26,836.50 " " 57,447.95 " N/A " 52,131.00 " " 26,325.33 " " 54,492.00 " N/A " 25,558.57 " N/A N/A " 25,558.57 " " 53,348.92 " " 66,686.14 " " 26,325.33 " " 26,325.33 " " 25,558.57 " N/A N/A N/A " 66,920.00 " N/A N/A N/A N/A N/A " 26,325.33 " DRG 740 No Current Volume N/A " 12,449.77 " " 31,528.00 " N/A " 27,065.44 " " 13,072.26 " " 27,065.44 " N/A " 25,282.00 " " 12,823.26 " " 25,672.80 " N/A " 12,449.77 " N/A N/A " 12,449.77 " " 23,990.86 " " 29,988.58 " " 12,823.26 " " 12,823.26 " " 12,449.77 " N/A N/A N/A " 31,528.00 " N/A N/A N/A N/A N/A " 12,823.26 " DRG 741 No Current Volume N/A " 9,068.21 " " 22,398.25 " N/A " 19,227.94 " " 9,521.62 " " 19,227.94 " N/A " 18,639.00 " " 9,340.26 " " 18,238.58 " N/A " 9,068.21 " N/A N/A " 9,068.21 " " 16,512.12 " " 20,640.16 " " 9,340.26 " " 9,340.26 " " 9,068.21 " N/A N/A N/A " 22,398.25 " N/A N/A N/A N/A N/A " 9,340.26 " DRG 742 No Current Volume N/A " 11,908.53 " " 30,066.75 " N/A " 25,811.02 " " 12,503.96 " " 25,811.02 " N/A " 24,286.00 " " 12,265.79 " " 24,482.93 " N/A " 11,908.53 " N/A N/A " 11,908.53 " " 20,079.66 " " 25,099.59 " " 12,265.79 " " 12,265.79 " " 11,908.53 " N/A N/A N/A " 30,066.75 " N/A N/A N/A N/A N/A " 12,265.79 " DRG 743 " 40,020.10 " " 12,610.33 " " 8,114.73 " " 32,016.08 " N/A " 17,018.05 " " 8,520.47 " " 17,018.05 " N/A " 15,660.00 " " 8,358.17 " " 16,142.40 " N/A " 8,114.73 " " 22,819.46 " N/A " 8,114.73 " " 14,057.40 " " 17,571.76 " " 8,358.17 " " 8,358.17 " " 8,114.73 " " 32,016.08 " N/A N/A " 19,824.00 " N/A N/A " 30,015.08 " N/A N/A " 8,358.17 " DRG 744 " 51,206.55 " " 16,135.18 " " 12,409.58 " " 40,965.24 " N/A " 26,972.29 " " 13,030.06 " " 26,972.29 " N/A " 27,507.00 " " 12,781.87 " " 25,584.45 " N/A " 12,409.58 " " 29,197.98 " N/A " 12,409.58 " " 16,577.58 " " 20,721.99 " " 12,781.87 " " 12,781.87 " " 12,409.58 " " 40,965.24 " N/A N/A " 31,419.50 " N/A N/A " 38,404.91 " N/A N/A " 12,781.87 " DRG 745 " 35,579.59 " " 11,211.13 " " 8,355.86 " " 28,463.67 " N/A " 17,576.91 " " 8,773.65 " " 17,576.91 " N/A " 15,030.00 " " 8,606.54 " " 16,672.50 " N/A " 8,355.86 " " 20,287.48 " N/A " 8,355.86 " " 11,504.48 " " 14,380.61 " " 8,606.54 " " 8,606.54 " " 8,355.86 " " 28,463.67 " N/A N/A " 20,475.00 " N/A N/A " 26,684.69 " N/A N/A " 8,606.54 " DRG 746 No Current Volume N/A " 11,217.57 " " 28,201.25 " N/A " 24,209.56 " " 11,778.45 " " 24,209.56 " N/A " 22,371.00 " " 11,554.10 " " 22,963.88 " N/A " 11,217.57 " N/A N/A " 11,217.57 " " 18,623.19 " " 23,279.00 " " 11,554.10 " " 11,554.10 " " 11,217.57 " N/A N/A N/A " 28,201.25 " N/A N/A N/A N/A N/A " 11,554.10 " DRG 747 " 39,393.42 " " 12,412.87 " " 6,859.21 " " 31,514.74 " N/A " 14,108.10 " " 7,202.17 " " 14,108.10 " N/A " 13,989.00 " " 7,064.99 " " 13,382.18 " N/A " 6,859.21 " " 22,462.13 " N/A " 6,859.21 " " 12,764.58 " " 15,955.73 " " 7,064.99 " " 7,064.99 " " 6,859.21 " " 31,514.74 " N/A N/A " 16,434.25 " N/A N/A " 29,545.07 " N/A N/A " 7,064.99 " DRG 748 No Current Volume N/A " 9,507.02 " " 23,583.00 " N/A " 20,244.99 " " 9,982.37 " " 20,244.99 " N/A " 17,063.00 " " 9,792.23 " " 19,203.30 " N/A " 9,507.02 " N/A N/A " 9,507.02 " " 15,399.31 " " 19,249.15 " " 9,792.23 " " 9,792.23 " " 9,507.02 " N/A N/A N/A " 23,583.00 " N/A N/A N/A N/A N/A " 9,792.23 " DRG 749 No Current Volume N/A " 18,362.47 " " 47,491.50 " N/A " 40,769.42 " " 19,280.59 " " 40,769.42 " N/A " 40,186.00 " " 18,913.34 " " 38,671.65 " N/A " 18,362.47 " N/A N/A " 18,362.47 " " 28,605.74 " " 35,757.19 " " 18,913.34 " " 18,913.34 " " 18,362.47 " N/A N/A N/A " 47,491.50 " N/A N/A N/A N/A N/A " 18,913.34 " DRG 750 No Current Volume N/A " 10,260.21 " " 27,533.86 " N/A " 21,990.67 " " 10,773.22 " " 21,990.67 " N/A " 18,729.00 " " 10,568.02 " " 20,859.15 " N/A " 10,260.21 " N/A N/A " 10,260.21 " " 22,027.07 " " 27,533.86 " " 10,568.02 " " 10,568.02 " " 10,260.21 " N/A N/A N/A " 25,616.50 " N/A N/A N/A N/A N/A " 10,568.02 " DRG 754 " 68,320.88 " " 21,527.91 " " 12,609.22 " " 54,656.70 " N/A " 27,435.00 " " 13,239.68 " " 27,435.00 " N/A " 30,879.00 " " 12,987.50 " " 26,023.35 " N/A " 12,609.22 " " 38,956.57 " N/A " 12,609.22 " " 23,679.92 " " 29,599.92 " " 12,987.50 " " 12,987.50 " " 12,609.22 " " 54,656.70 " N/A N/A " 31,958.50 " N/A N/A " 51,240.66 " N/A N/A " 12,987.50 " DRG 755 " 27,185.90 " " 8,566.28 " " 8,092.05 " " 21,748.72 " N/A " 16,965.47 " " 8,496.65 " " 16,965.47 " N/A " 17,412.00 " " 8,334.81 " " 16,092.53 " N/A " 8,092.05 " " 15,501.40 " N/A " 8,092.05 " " 13,681.01 " " 17,101.27 " " 8,334.81 " " 8,334.81 " " 8,092.05 " " 21,748.72 " N/A N/A " 19,762.75 " N/A N/A " 20,389.42 " N/A N/A " 8,334.81 " DRG 756 No Current Volume N/A " 6,725.03 " " 16,072.00 " N/A " 13,797.12 " " 7,061.28 " " 13,797.12 " N/A " 10,467.00 " " 6,926.78 " " 13,087.20 " N/A " 6,725.03 " N/A N/A " 6,725.03 " " 11,095.36 " " 13,869.21 " " 6,926.78 " " 6,926.78 " " 6,725.03 " N/A N/A N/A " 16,072.00 " N/A N/A N/A N/A N/A " 6,926.78 " DRG 757 " 57,348.94 " " 18,070.65 " " 10,654.95 " " 45,879.15 " N/A " 22,905.57 " " 11,187.70 " " 22,905.57 " N/A " 24,225.00 " " 10,974.60 " " 21,726.98 " N/A " 10,654.95 " " 32,700.37 " N/A " 10,654.95 " " 24,187.23 " " 30,234.06 " " 10,974.60 " " 10,974.60 " " 10,654.95 " " 45,879.15 " N/A N/A " 26,682.25 " N/A N/A " 43,011.71 " N/A N/A " 10,974.60 " DRG 758 No Current Volume N/A " 7,057.55 " " 16,969.75 " N/A " 14,567.80 " " 7,410.43 " " 14,567.80 " N/A " 16,548.00 " " 7,269.28 " " 13,818.23 " N/A " 7,057.55 " N/A N/A " 7,057.55 " " 9,868.00 " " 12,335.00 " " 7,269.28 " " 7,269.28 " " 7,057.55 " N/A N/A N/A " 16,969.75 " N/A N/A N/A N/A N/A " 7,269.28 " DRG 759 No Current Volume N/A " 5,201.81 " " 11,959.50 " N/A " 10,266.72 " " 5,461.90 " " 10,266.72 " N/A " 10,905.00 " " 5,357.86 " " 9,738.45 " N/A " 5,201.81 " N/A N/A " 5,201.81 " " 7,871.49 " " 9,839.36 " " 5,357.86 " " 5,357.86 " " 5,201.81 " N/A N/A N/A " 11,959.50 " N/A N/A N/A N/A N/A " 5,357.86 " DRG 760 " 39,106.70 " " 12,322.52 " " 6,736.05 " " 31,285.36 " N/A " 13,822.66 " " 7,072.85 " " 13,822.66 " N/A " 13,214.00 " " 6,938.13 " " 13,111.43 " N/A " 6,736.05 " " 22,298.64 " N/A " 6,736.05 " " 9,720.71 " " 12,150.90 " " 6,938.13 " " 6,938.13 " " 6,736.05 " " 31,285.36 " N/A N/A " 16,101.75 " N/A N/A " 29,330.03 " N/A N/A " 6,938.13 " DRG 761 No Current Volume N/A " 4,601.59 " " 10,339.00 " N/A " 8,875.59 " " 4,831.67 " " 8,875.59 " N/A " 7,849.00 " " 4,739.64 " " 8,418.90 " N/A " 4,601.59 " N/A N/A " 4,601.59 " " 6,889.60 " " 8,612.00 " " 4,739.64 " " 4,739.64 " " 4,601.59 " N/A N/A N/A " 10,339.00 " N/A N/A N/A N/A N/A " 4,739.64 " DRG 768 " 16,719.46 " " 5,268.30 " " 7,567.85 " " 20,468.00 " N/A " 17,570.90 " " 8,770.92 " " 17,570.90 " N/A " 17,596.00 " " 8,603.86 " " 16,666.80 " N/A " 8,353.26 " " 9,533.44 " N/A " 8,353.26 " " 7,567.85 " " 9,459.82 " " 8,603.86 " " 8,603.86 " " 8,353.26 " " 13,375.57 " N/A N/A " 20,468.00 " N/A N/A " 12,539.59 " N/A N/A " 8,603.86 " DRG 769 " 36,745.05 " " 11,578.37 " " 11,257.11 " " 29,784.00 " N/A " 24,301.20 " " 11,819.97 " " 24,301.20 " N/A " 29,784.00 " " 11,594.82 " " 23,050.80 " N/A " 11,257.11 " " 20,952.03 " N/A " 11,257.11 " " 17,003.07 " " 21,253.85 " " 11,594.82 " " 11,594.82 " " 11,257.11 " " 29,396.04 " N/A N/A " 28,308.00 " N/A N/A " 27,558.79 " N/A N/A " 11,594.82 " DRG 770 No Current Volume N/A " 6,539.65 " " 15,571.50 " N/A " 13,367.47 " " 6,866.63 " " 13,367.47 " N/A " 12,633.00 " " 6,735.84 " " 12,679.65 " N/A " 6,539.65 " N/A N/A " 6,539.65 " " 9,491.61 " " 11,864.51 " " 6,735.84 " " 6,735.84 " " 6,539.65 " N/A N/A N/A " 15,571.50 " N/A N/A N/A N/A N/A " 6,735.84 " DRG 776 " 15,439.24 " " 4,864.91 " " 5,792.30 " " 13,553.75 " N/A " 11,635.31 " " 6,081.92 " " 11,635.31 " N/A " 12,771.00 " " 5,966.07 " " 11,036.63 " N/A " 5,792.30 " " 8,803.46 " N/A " 5,792.30 " " 6,480.48 " " 8,100.60 " " 5,966.07 " " 5,966.07 " " 5,792.30 " " 12,351.39 " N/A N/A " 13,553.75 " N/A N/A " 11,579.43 " N/A N/A " 5,966.07 " DRG 779 No Current Volume N/A " 6,938.69 " " 18,532.50 " N/A " 15,909.36 " " 8,018.19 " " 15,909.36 " N/A " 10,052.00 " " 7,865.46 " " 15,090.75 " N/A " 7,636.37 " N/A N/A " 7,636.37 " " 6,938.69 " " 8,673.37 " " 7,865.46 " " 7,865.46 " " 7,636.37 " N/A N/A N/A " 18,532.50 " N/A N/A N/A N/A N/A " 7,865.46 " DRG 783 No Current Volume N/A " 10,326.62 " " 32,810.75 " N/A " 28,166.62 " " 13,571.12 " " 28,166.62 " N/A " 17,187.00 " " 13,312.63 " " 26,717.33 " N/A " 12,924.88 " N/A N/A " 12,924.88 " " 10,326.62 " " 12,908.27 " " 13,312.63 " " 13,312.63 " " 12,924.88 " N/A N/A N/A " 32,810.75 " N/A N/A N/A N/A N/A " 13,312.63 " DRG 784 No Current Volume N/A " 7,875.55 " " 19,178.25 " N/A " 16,463.71 " " 8,269.33 " " 16,463.71 " N/A " 17,187.00 " " 8,111.82 " " 15,616.58 " N/A " 7,875.55 " N/A N/A " 7,875.55 " " 8,501.51 " " 10,626.88 " " 8,111.82 " " 8,111.82 " " 7,875.55 " N/A N/A N/A " 19,178.25 " N/A N/A N/A N/A N/A " 8,111.82 " DRG 785 No Current Volume N/A " 6,714.66 " " 16,044.00 " N/A " 13,773.09 " " 7,050.39 " " 13,773.09 " N/A " 11,898.00 " " 6,916.10 " " 13,064.40 " N/A " 6,714.66 " N/A N/A " 6,714.66 " " 7,218.04 " " 9,022.54 " " 6,916.10 " " 6,916.10 " " 6,714.66 " N/A N/A N/A " 16,044.00 " N/A N/A N/A N/A N/A " 6,916.10 " DRG 786 " 52,668.05 " " 16,595.70 " " 9,985.15 " " 42,134.44 " N/A " 23,952.67 " " 11,662.07 " " 23,952.67 " N/A " 17,187.00 " " 11,439.93 " " 22,720.20 " N/A " 11,106.73 " " 30,031.32 " N/A " 11,106.73 " " 9,985.15 " " 12,481.43 " " 11,439.93 " " 11,439.93 " " 11,106.73 " " 42,134.44 " N/A N/A " 27,902.00 " N/A N/A " 39,501.04 " N/A N/A " 11,439.93 " DRG 787 " 32,725.67 " " 10,311.86 " " 7,671.38 " " 26,180.53 " N/A " 15,990.48 " " 8,054.95 " " 15,990.48 " N/A " 17,187.00 " " 7,901.52 " " 15,167.70 " N/A " 7,671.38 " " 18,660.17 " N/A " 7,671.38 " " 8,784.11 " " 10,980.13 " " 7,901.52 " " 7,901.52 " " 7,671.38 " " 26,180.53 " N/A N/A " 18,627.00 " N/A N/A " 24,544.25 " N/A N/A " 7,901.52 " DRG 788 " 29,353.38 " " 9,249.25 " " 6,524.10 " " 23,482.70 " N/A " 13,331.41 " " 6,850.31 " " 13,331.41 " N/A " 11,898.00 " " 6,719.82 " " 12,645.45 " N/A " 6,524.10 " " 16,737.30 " N/A " 6,524.10 " " 7,736.14 " " 9,670.17 " " 6,719.82 " " 6,719.82 " " 6,524.10 " " 23,482.70 " N/A N/A " 15,529.50 " N/A N/A " 22,015.04 " N/A N/A " 6,719.82 " DRG 789 " 65,790.27 " " 20,730.51 " " 11,920.85 " " 52,632.22 " N/A " 25,839.56 " " 12,516.89 " " 25,839.56 " N/A " 24,461.00 " " 12,278.48 " " 24,510.00 " N/A " 11,920.85 " " 37,513.61 " N/A " 11,920.85 " " 14,166.91 " " 17,708.69 " " 12,278.48 " " 12,278.48 " " 11,920.85 " " 52,632.22 " N/A N/A " 39,474.16 " N/A N/A " 49,342.70 " N/A N/A " 12,278.48 " DRG 790 " 430,009.92 " " 135,496.13 " " 37,537.60 " " 344,007.93 " N/A " 85,211.96 " " 39,414.48 " " 85,211.96 " N/A " 80,661.00 " " 38,663.73 " " 80,827.43 " N/A " 37,537.60 " " 245,191.65 " N/A " 37,537.60 " " 85,161.38 " " 106,452.03 " " 38,663.73 " " 38,663.73 " " 37,537.60 " " 344,007.93 " N/A N/A " 258,005.95 " N/A N/A " 322,507.44 " N/A N/A " 38,663.73 " DRG 791 " 210,627.61 " " 66,368.76 " " 25,881.37 " " 168,502.09 " N/A " 58,196.10 " " 27,175.44 " " 58,196.10 " N/A " 55,090.00 " " 26,657.81 " " 55,201.65 " N/A " 25,881.37 " " 120,099.86 " N/A " 25,881.37 " " 29,919.77 " " 37,399.81 " " 26,657.81 " " 26,657.81 " " 25,881.37 " " 168,502.09 " N/A N/A " 126,376.57 " N/A N/A " 157,970.71 " N/A N/A " 26,657.81 " DRG 792 " 53,602.31 " " 16,890.09 " " 9,009.25 " " 42,881.85 " N/A " 35,114.76 " " 16,718.86 " " 35,114.76 " N/A " 33,240.00 " " 16,400.40 " " 33,307.95 " N/A " 15,922.72 " " 30,564.04 " N/A " 15,922.72 " " 9,009.25 " " 11,261.59 " " 16,400.40 " " 16,400.40 " " 15,922.72 " " 42,881.85 " N/A N/A " 32,161.39 " N/A N/A " 40,201.73 " N/A N/A " 16,400.40 " DRG 793 " 41,919.31 " " 13,208.77 " " 10,955.03 " " 59,779.52 " N/A " 59,779.52 " " 27,892.78 " " 59,779.52 " N/A " 56,590.00 " " 27,361.49 " " 56,703.60 " N/A " 26,564.55 " " 23,902.39 " N/A " 26,564.55 " " 10,955.03 " " 13,693.83 " " 27,361.49 " " 27,361.49 " " 26,564.55 " " 33,535.45 " N/A N/A " 25,151.58 " N/A N/A " 31,439.48 " N/A N/A " 27,361.49 " DRG 794 " 17,371.47 " " 5,473.75 " " 2,718.77 " " 21,158.39 " N/A " 21,158.39 " " 10,396.18 " " 21,158.39 " N/A " 20,030.00 " " 10,198.15 " " 20,069.70 " N/A " 9,901.12 " " 9,905.21 " N/A " 9,901.12 " " 2,718.77 " " 3,398.47 " " 10,198.15 " " 10,198.15 " " 9,901.12 " " 13,897.18 " N/A N/A " 10,422.88 " N/A N/A " 13,028.60 " N/A N/A " 10,198.15 " DRG 795 " 13,435.87 " " 4,233.64 " " 1,662.89 " " 10,748.69 " N/A " 2,864.89 " " 2,108.63 " " 2,864.89 " N/A " 2,711.00 " " 2,068.47 " " 2,717.48 " N/A " 2,008.22 " " 7,661.13 " N/A " 2,008.22 " " 1,662.89 " " 2,078.62 " " 2,068.47 " " 2,068.47 " " 2,008.22 " " 10,748.69 " N/A N/A " 3,337.25 " N/A N/A " 10,076.90 " N/A N/A " 2,068.47 " DRG 796 No Current Volume N/A " 7,712.86 " " 20,334.35 " N/A " 16,086.63 " " 8,098.50 " " 16,086.63 " N/A " 13,393.00 " " 7,944.25 " " 15,258.90 " N/A " 7,712.86 " N/A N/A " 7,712.86 " " 16,267.47 " " 20,334.35 " " 7,944.25 " " 7,944.25 " " 7,712.86 " N/A N/A N/A " 18,739.00 " N/A N/A N/A N/A N/A " 7,944.25 " DRG 797 No Current Volume N/A " 6,731.51 " " 16,089.50 " N/A " 13,812.15 " " 7,068.09 " " 13,812.15 " N/A " 13,393.00 " " 6,933.46 " " 13,101.45 " N/A " 6,731.51 " N/A N/A " 6,731.51 " " 11,426.78 " " 14,283.48 " " 6,933.46 " " 6,933.46 " " 6,731.51 " N/A N/A N/A " 16,089.50 " N/A N/A N/A N/A N/A " 6,933.46 " DRG 798 No Current Volume N/A " 6,135.84 " " 14,481.25 " N/A " 12,431.53 " " 6,442.63 " " 12,431.53 " N/A " 13,393.00 " " 6,319.92 " " 11,791.88 " N/A " 6,135.84 " N/A N/A " 6,135.84 " " 10,226.83 " " 12,783.54 " " 6,319.92 " " 6,319.92 " " 6,135.84 " N/A N/A N/A " 14,481.25 " N/A N/A N/A N/A N/A " 6,319.92 " DRG 799 " 62,642.50 " " 19,738.65 " " 34,136.60 " " 90,079.50 " N/A " 77,329.39 " " 35,843.43 " " 77,329.39 " N/A " 78,873.00 " " 35,160.70 " " 73,350.45 " N/A " 34,136.60 " " 35,718.75 " N/A " 34,136.60 " " 57,632.83 " " 72,041.03 " " 35,160.70 " " 35,160.70 " " 34,136.60 " " 50,114.00 " N/A N/A " 90,079.50 " N/A N/A " 46,981.88 " N/A N/A " 35,160.70 " DRG 800 No Current Volume N/A " 19,918.75 " " 51,693.25 " N/A " 44,376.44 " " 20,914.69 " " 44,376.44 " N/A " 41,540.00 " " 20,516.31 " " 42,093.08 " N/A " 19,918.75 " N/A N/A " 19,918.75 " " 39,511.90 " " 49,389.87 " " 20,516.31 " " 20,516.31 " " 19,918.75 " N/A N/A N/A " 51,693.25 " N/A N/A N/A N/A N/A " 20,516.31 " DRG 801 " 74,624.61 " " 23,514.21 " " 11,687.50 " " 59,699.69 " N/A " 25,298.73 " " 12,271.88 " " 25,298.73 " N/A " 24,352.00 " " 12,038.13 " " 23,997.00 " N/A " 11,687.50 " " 42,550.95 " N/A " 11,687.50 " " 26,789.24 " " 33,486.57 " " 12,038.13 " " 12,038.13 " " 11,687.50 " " 59,699.69 " N/A N/A " 29,470.00 " N/A N/A " 55,968.46 " N/A N/A " 12,038.13 " DRG 802 " 170,505.84 " " 53,726.39 " " 24,830.67 " " 136,404.67 " N/A " 55,760.87 " " 26,072.20 " " 55,760.87 " N/A " 52,865.00 " " 25,575.59 " " 52,891.73 " N/A " 24,830.67 " " 97,222.43 " N/A " 24,830.67 " " 49,407.73 " " 61,759.65 " " 25,575.59 " " 25,575.59 " " 24,830.67 " " 136,404.67 " N/A N/A " 64,954.75 " N/A N/A " 127,879.38 " N/A N/A " 25,575.59 " DRG 803 No Current Volume N/A " 13,000.07 " " 33,013.75 " N/A " 28,340.89 " " 13,650.07 " " 28,340.89 " N/A " 29,013.00 " " 13,390.07 " " 26,882.63 " N/A " 13,000.07 " N/A N/A " 13,000.07 " " 25,610.97 " " 32,013.73 " " 13,390.07 " " 13,390.07 " " 13,000.07 " N/A N/A N/A " 33,013.75 " N/A N/A N/A N/A N/A " 13,390.07 " DRG 804 No Current Volume N/A " 9,625.64 " " 23,903.25 " N/A " 20,519.92 " " 10,106.92 " " 20,519.92 " N/A " 19,297.00 " " 9,914.41 " " 19,464.08 " N/A " 9,625.64 " N/A N/A " 9,625.64 " " 17,264.91 " " 21,581.14 " " 9,914.41 " " 9,914.41 " " 9,625.64 " N/A N/A N/A " 23,903.25 " N/A N/A N/A N/A N/A " 9,914.41 " DRG 805 " 15,232.87 " " 4,799.88 " " 7,447.75 " " 18,023.25 " N/A " 15,472.19 " " 7,820.14 " " 15,472.19 " N/A " 11,277.00 " " 7,671.18 " " 14,676.08 " N/A " 7,447.75 " " 8,685.79 " N/A " 7,447.75 " " 8,113.28 " " 10,141.61 " " 7,671.18 " " 7,671.18 " " 7,447.75 " " 12,186.30 " N/A N/A " 18,023.25 " N/A N/A " 11,424.66 " N/A N/A " 7,671.18 " DRG 806 " 16,372.09 " " 5,158.85 " " 5,533.68 " " 13,097.67 " N/A " 11,035.90 " " 5,810.36 " " 11,035.90 " N/A " 11,277.00 " " 5,699.69 " " 10,468.05 " N/A " 5,533.68 " " 9,335.37 " N/A " 5,533.68 " " 6,763.34 " " 8,454.18 " " 5,699.69 " " 5,699.69 " " 5,533.68 " " 13,097.67 " N/A N/A " 12,855.50 " N/A N/A " 12,279.07 " N/A N/A " 5,699.69 " DRG 807 " 13,448.42 " " 4,237.60 " " 4,935.41 " " 11,240.25 " N/A " 9,649.27 " " 5,182.18 " " 9,649.27 " N/A " 8,877.00 " " 5,083.47 " " 9,152.78 " N/A " 4,935.41 " " 7,668.29 " N/A " 4,935.41 " " 5,999.74 " " 7,499.68 " " 5,083.47 " " 5,083.47 " " 4,935.41 " " 10,758.73 " N/A N/A " 11,240.25 " N/A N/A " 10,086.31 " N/A N/A " 5,083.47 " DRG 808 " 27,814.02 " " 8,764.20 " " 14,940.08 " " 38,251.50 " N/A " 32,837.27 " " 15,687.08 " " 32,837.27 " N/A " 35,022.00 " " 15,388.28 " " 31,147.65 " N/A " 14,940.08 " " 15,859.55 " N/A " 14,940.08 " " 25,365.50 " " 31,706.89 " " 15,388.28 " " 15,388.28 " " 14,940.08 " " 22,251.22 " N/A N/A " 38,251.50 " N/A N/A " 20,860.52 " N/A N/A " 15,388.28 " DRG 809 " 45,886.17 " " 14,458.73 " " 8,701.98 " " 36,708.94 " N/A " 18,379.14 " " 9,137.08 " " 18,379.14 " N/A " 18,937.00 " " 8,963.04 " " 17,433.45 " N/A " 8,701.98 " " 26,164.30 " N/A " 8,701.98 " " 14,515.61 " " 18,144.53 " " 8,963.04 " " 8,963.04 " " 8,701.98 " " 36,708.94 " N/A N/A " 21,409.50 " N/A N/A " 34,414.63 " N/A N/A " 8,963.04 " DRG 810 " 41,724.03 " " 13,147.24 " " 7,005.69 " " 33,379.22 " N/A " 14,447.62 " " 7,355.97 " " 14,447.62 " N/A " 13,230.00 " " 7,215.86 " " 13,704.23 " N/A " 7,005.69 " " 23,791.04 " N/A " 7,005.69 " " 10,588.05 " " 13,235.07 " " 7,215.86 " " 7,215.86 " " 7,005.69 " " 33,379.22 " N/A N/A " 16,829.75 " N/A N/A " 31,293.02 " N/A N/A " 7,215.86 " DRG 811 " 65,122.06 " " 20,519.96 " " 9,712.50 " " 52,097.65 " N/A " 20,721.22 " " 10,198.13 " " 20,721.22 " N/A " 20,184.00 " " 10,003.88 " " 19,655.03 " N/A " 9,712.50 " " 37,132.60 " N/A " 9,712.50 " " 17,624.93 " " 22,031.18 " " 10,003.88 " " 10,003.88 " " 9,712.50 " " 52,097.65 " N/A N/A " 24,137.75 " N/A N/A " 48,841.55 " N/A N/A " 10,003.88 " DRG 812 " 37,798.86 " " 11,910.42 " " 6,478.08 " " 30,239.09 " N/A " 13,224.75 " " 6,801.98 " " 13,224.75 " N/A " 12,843.00 " " 6,672.42 " " 12,544.28 " N/A " 6,478.08 " " 21,552.91 " N/A " 6,478.08 " " 11,177.19 " " 13,971.49 " " 6,672.42 " " 6,672.42 " " 6,478.08 " " 30,239.09 " N/A N/A " 15,405.25 " N/A N/A " 28,349.15 " N/A N/A " 6,672.42 " DRG 813 " 75,965.71 " " 23,936.80 " " 10,787.18 " " 60,772.57 " N/A " 23,212.04 " " 11,326.54 " " 23,212.04 " N/A " 26,014.00 " " 11,110.80 " " 22,017.68 " N/A " 10,787.18 " " 43,315.65 " N/A " 10,787.18 " " 21,568.86 " " 26,961.09 " " 11,110.80 " " 11,110.80 " " 10,787.18 " " 60,772.57 " N/A N/A " 27,039.25 " N/A N/A " 56,974.29 " N/A N/A " 11,110.80 " DRG 814 No Current Volume N/A " 13,033.78 " " 33,104.75 " N/A " 28,419.01 " " 13,685.47 " " 28,419.01 " N/A " 26,823.00 " " 13,424.79 " " 26,956.73 " N/A " 13,033.78 " N/A N/A " 13,033.78 " " 24,890.92 " " 31,113.67 " " 13,424.79 " " 13,424.79 " " 13,033.78 " N/A N/A N/A " 33,104.75 " N/A N/A N/A N/A N/A " 13,424.79 " DRG 815 " 139,188.65 " " 43,858.34 " " 7,211.17 " " 111,350.92 " N/A " 14,923.85 " " 7,571.73 " " 14,923.85 " N/A " 15,653.00 " " 7,427.51 " " 14,155.95 " N/A " 7,211.17 " " 79,365.37 " N/A " 7,211.17 " " 13,140.97 " " 16,426.22 " " 7,427.51 " " 7,427.51 " " 7,211.17 " " 111,350.92 " N/A N/A " 17,384.50 " N/A N/A " 104,391.49 " N/A N/A " 7,427.51 " DRG 816 " 24,372.48 " " 7,679.77 " " 5,057.26 " " 19,497.98 " N/A " 9,931.71 " " 5,310.12 " " 9,931.71 " N/A " 10,827.00 " " 5,208.98 " " 9,420.68 " N/A " 5,057.26 " " 13,897.19 " N/A " 5,057.26 " " 9,180.68 " " 11,475.85 " " 5,208.98 " " 5,208.98 " " 5,057.26 " " 19,497.98 " N/A N/A " 11,569.25 " N/A N/A " 18,279.36 " N/A N/A " 5,208.98 " DRG 817 " 34,760.32 " " 10,952.98 " " 15,724.37 " " 40,369.00 " N/A " 34,655.06 " " 16,510.59 " " 34,655.06 " N/A " 39,832.00 " " 16,196.10 " " 32,871.90 " N/A " 15,724.37 " " 19,820.33 " N/A " 15,724.37 " " 21,061.55 " " 26,326.95 " " 16,196.10 " " 16,196.10 " " 15,724.37 " " 27,808.26 " N/A N/A " 40,369.00 " N/A N/A " 26,070.24 " N/A N/A " 16,196.10 " DRG 818 " 44,200.29 " " 13,927.51 " " 9,586.10 " " 35,360.23 " N/A " 20,428.28 " " 10,065.41 " " 20,428.28 " N/A " 21,373.00 " " 9,873.68 " " 19,377.15 " N/A " 9,586.10 " " 25,203.01 " N/A " 9,586.10 " " 12,273.63 " " 15,342.05 " " 9,873.68 " " 9,873.68 " " 9,586.10 " " 35,360.23 " N/A N/A " 23,796.50 " N/A N/A " 33,150.22 " N/A N/A " 9,873.68 " DRG 819 No Current Volume N/A " 7,170.98 " " 17,276.00 " N/A " 14,830.71 " " 7,529.53 " " 14,830.71 " N/A " 13,200.00 " " 7,386.11 " " 14,067.60 " N/A " 7,170.98 " N/A N/A " 7,170.98 " " 8,787.92 " " 10,984.90 " " 7,386.11 " " 7,386.11 " " 7,170.98 " N/A N/A N/A " 17,276.00 " N/A N/A N/A N/A N/A " 7,386.11 " DRG 820 No Current Volume N/A " 37,664.65 " " 99,604.75 " N/A " 85,506.41 " " 39,547.88 " " 85,506.41 " N/A " 86,890.00 " " 38,794.59 " " 81,106.73 " N/A " 37,664.65 " N/A N/A " 37,664.65 " " 68,613.91 " " 85,767.38 " " 38,794.59 " " 38,794.59 " " 37,664.65 " N/A N/A N/A " 99,604.75 " N/A N/A N/A N/A N/A " 38,794.59 " DRG 821 No Current Volume N/A " 14,741.73 " " 37,716.00 " N/A " 32,377.57 " " 15,478.82 " " 32,377.57 " N/A " 36,288.00 " " 15,183.98 " " 30,711.60 " N/A " 14,741.73 " N/A N/A " 14,741.73 " " 27,951.15 " " 34,938.95 " " 15,183.98 " " 15,183.98 " " 14,741.73 " N/A N/A N/A " 37,716.00 " N/A N/A N/A N/A N/A " 15,183.98 " DRG 822 No Current Volume N/A " 8,884.12 " " 21,901.25 " N/A " 18,801.28 " " 9,328.33 " " 18,801.28 " N/A " 20,147.00 " " 9,150.64 " " 17,833.88 " N/A " 8,884.12 " N/A N/A " 8,884.12 " " 17,281.27 " " 21,601.60 " " 9,150.64 " " 9,150.64 " " 8,884.12 " N/A N/A N/A " 21,901.25 " N/A N/A N/A N/A N/A " 9,150.64 " DRG 823 " 80,822.91 " " 25,467.30 " " 29,951.94 " " 78,781.50 " N/A " 67,630.54 " " 31,449.54 " " 67,630.54 " N/A " 70,206.00 " " 30,850.50 " " 64,150.65 " N/A " 29,951.94 " " 46,085.22 " N/A " 29,951.94 " " 52,078.03 " " 65,097.53 " " 30,850.50 " " 30,850.50 " " 29,951.94 " " 64,658.33 " N/A N/A " 78,781.50 " N/A N/A " 60,617.18 " N/A N/A " 30,850.50 " DRG 824 " 93,423.29 " " 29,437.68 " " 16,097.73 " " 74,738.63 " N/A " 35,520.38 " " 16,902.62 " " 35,520.38 " N/A " 36,109.00 " " 16,580.66 " " 33,692.70 " N/A " 16,097.73 " " 53,269.96 " N/A " 16,097.73 " " 32,827.87 " " 41,034.86 " " 16,580.66 " " 16,580.66 " " 16,097.73 " " 74,738.63 " N/A N/A " 41,377.00 " N/A N/A " 70,067.47 " N/A N/A " 16,580.66 " DRG 825 No Current Volume N/A " 9,856.39 " " 25,856.46 " N/A " 21,054.73 " " 10,349.21 " " 21,054.73 " N/A " 21,717.00 " " 10,152.08 " " 19,971.38 " N/A " 9,856.39 " N/A N/A " 9,856.39 " " 20,685.16 " " 25,856.46 " " 10,152.08 " " 10,152.08 " " 9,856.39 " N/A N/A N/A " 24,526.25 " N/A N/A N/A N/A N/A " 10,152.08 " DRG 826 No Current Volume N/A " 33,469.62 " " 88,302.02 " N/A " 75,783.52 " " 35,143.10 " " 75,783.52 " N/A " 80,084.00 " " 34,473.71 " " 71,884.13 " N/A " 33,469.62 " N/A N/A " 33,469.62 " " 70,641.63 " " 88,302.02 " " 34,473.71 " " 34,473.71 " " 33,469.62 " N/A N/A N/A " 88,278.75 " N/A N/A N/A N/A N/A " 34,473.71 " DRG 827 " 132,409.43 " " 41,722.21 " " 16,980.55 " " 105,927.54 " N/A " 37,566.51 " " 17,829.58 " " 37,566.51 " N/A " 36,524.00 " " 17,489.97 " " 35,633.55 " N/A " 16,980.55 " " 75,499.86 " N/A " 16,980.55 " " 31,101.16 " " 38,876.45 " " 17,489.97 " " 17,489.97 " " 16,980.55 " " 105,927.54 " N/A N/A " 43,760.50 " N/A N/A " 99,307.07 " N/A N/A " 17,489.97 " DRG 828 No Current Volume N/A " 11,622.69 " " 29,620.37 " N/A " 25,148.50 " " 12,203.82 " " 25,148.50 " N/A " 24,104.00 " " 11,971.37 " " 23,854.50 " N/A " 11,622.69 " N/A N/A " 11,622.69 " " 23,696.29 " " 29,620.37 " " 11,971.37 " " 11,971.37 " " 11,622.69 " N/A N/A N/A " 29,295.00 " N/A N/A N/A N/A N/A " 11,971.37 " DRG 829 " 72,255.85 " " 22,767.82 " " 21,568.37 " " 57,804.68 " N/A " 48,199.79 " " 22,646.79 " " 48,199.79 " N/A " 53,857.00 " " 22,215.42 " " 45,719.70 " N/A " 21,568.37 " " 41,200.29 " N/A " 21,568.37 " " 32,566.03 " " 40,707.56 " " 22,215.42 " " 22,215.42 " " 21,568.37 " " 57,804.68 " N/A N/A " 56,147.00 " N/A N/A " 54,191.89 " N/A N/A " 22,215.42 " DRG 830 No Current Volume N/A " 10,378.18 " " 29,886.30 " N/A " 22,264.09 " " 10,897.09 " " 22,264.09 " N/A " 19,703.00 " " 10,689.53 " " 21,118.50 " N/A " 10,378.18 " N/A N/A " 10,378.18 " " 23,909.03 " " 29,886.30 " " 10,689.53 " " 10,689.53 " " 10,378.18 " N/A N/A N/A " 25,935.00 " N/A N/A N/A N/A N/A " 10,689.53 " DRG 831 " 35,032.87 " " 11,038.86 " " 8,043.43 " " 28,026.29 " N/A " 16,852.80 " " 8,445.60 " " 16,852.80 " N/A " 16,175.00 " " 8,284.73 " " 15,985.65 " N/A " 8,043.43 " " 19,975.74 " N/A " 8,043.43 " " 8,722.46 " " 10,903.08 " " 8,284.73 " " 8,284.73 " " 8,043.43 " " 28,026.29 " N/A N/A " 19,631.50 " N/A N/A " 26,274.65 " N/A N/A " 8,284.73 " DRG 832 " 15,233.72 " " 4,800.15 " " 5,816.93 " " 13,620.25 " N/A " 11,692.40 " " 6,107.78 " " 11,692.40 " N/A " 11,309.00 " " 5,991.44 " " 11,090.78 " N/A " 5,816.93 " " 8,686.27 " N/A " 5,816.93 " " 6,693.22 " " 8,366.53 " " 5,991.44 " " 5,991.44 " " 5,816.93 " " 12,186.98 " N/A N/A " 13,620.25 " N/A N/A " 11,425.29 " N/A N/A " 5,991.44 " DRG 833 " 11,624.25 " " 3,662.80 " " 4,252.87 " " 9,397.50 " N/A " 8,067.35 " " 4,465.51 " " 8,067.35 " N/A " 7,557.00 " " 4,380.46 " " 7,652.25 " N/A " 4,252.87 " " 6,628.15 " N/A " 4,252.87 " " 5,089.47 " " 6,361.83 " " 4,380.46 " " 4,380.46 " " 4,252.87 " " 9,299.40 " N/A N/A " 9,397.50 " N/A N/A " 8,718.19 " N/A N/A " 4,380.46 " DRG 834 " 90,760.86 " " 28,598.75 " " 40,001.34 " " 136,388.87 " N/A " 90,922.20 " " 42,001.41 " " 90,922.20 " N/A " 82,970.00 " " 41,201.38 " " 86,243.85 " N/A " 40,001.34 " " 51,751.84 " N/A " 40,001.34 " " 109,111.11 " " 136,388.87 " " 41,201.38 " " 41,201.38 " " 40,001.34 " " 72,608.69 " N/A N/A " 105,913.50 " N/A N/A " 68,070.65 " N/A N/A " 41,201.38 " DRG 835 " 11,135.67 " " 3,508.85 " " 6,349.56 " " 48,336.74 " N/A " 31,754.12 " " 15,196.38 " " 31,754.12 " N/A " 33,106.00 " " 14,906.92 " " 30,120.23 " N/A " 14,472.74 " " 6,349.56 " N/A " 14,472.74 " " 38,669.40 " " 48,336.74 " " 14,906.92 " " 14,906.92 " " 14,472.74 " " 8,908.54 " N/A N/A " 36,989.75 " N/A N/A " 8,351.75 " N/A N/A " 14,906.92 " DRG 836 No Current Volume N/A " 8,378.54 " " 34,079.80 " N/A " 17,629.49 " " 8,797.47 " " 17,629.49 " N/A " 18,397.00 " " 8,629.90 " " 16,722.38 " N/A " 8,378.54 " N/A N/A " 8,378.54 " " 27,263.82 " " 34,079.80 " " 8,629.90 " " 8,629.90 " " 8,378.54 " N/A N/A N/A " 20,536.25 " N/A N/A N/A N/A N/A " 8,629.90 " DRG 837 No Current Volume N/A " 37,713.91 " " 101,687.00 " N/A " 85,620.58 " " 39,599.61 " " 85,620.58 " N/A " 101,687.00 " " 38,845.33 " " 81,215.03 " N/A " 37,713.91 " N/A N/A " 37,713.91 " " 40,640.00 " " 50,799.99 " " 38,845.33 " " 38,845.33 " " 37,713.91 " N/A N/A N/A " 99,737.75 " N/A N/A N/A N/A N/A " 38,845.33 " DRG 838 " 2,960.86 " 932.97 " 1,688.28 " " 43,933.00 " N/A " 33,954.98 " " 16,193.44 " " 33,954.98 " N/A " 43,933.00 " " 15,884.99 " " 32,207.85 " N/A " 15,422.32 " " 1,688.28 " N/A " 15,422.32 " " 24,956.38 " " 31,195.49 " " 15,884.99 " " 15,884.99 " " 15,422.32 " " 2,368.69 " N/A N/A " 39,553.50 " N/A N/A " 2,220.65 " N/A N/A " 15,884.99 " DRG 839 No Current Volume N/A " 10,411.88 " " 26,026.00 " N/A " 22,342.21 " " 10,932.47 " " 22,342.21 " N/A " 19,706.00 " " 10,724.24 " " 21,192.60 " N/A " 10,411.88 " N/A N/A " 10,411.88 " " 14,466.52 " " 18,083.16 " " 10,724.24 " " 10,724.24 " " 10,411.88 " N/A N/A N/A " 26,026.00 " N/A N/A N/A N/A N/A " 10,724.24 " DRG 840 " 89,835.56 " " 28,307.18 " " 21,646.80 " " 71,868.44 " N/A " 48,381.57 " " 22,729.14 " " 48,381.57 " N/A " 48,865.00 " " 22,296.20 " " 45,892.13 " N/A " 21,646.80 " " 51,224.23 " N/A " 21,646.80 " " 43,081.82 " " 53,852.27 " " 22,296.20 " " 22,296.20 " " 21,646.80 " " 71,868.44 " N/A N/A " 56,358.75 " N/A N/A " 67,376.67 " N/A N/A " 22,296.20 " DRG 841 " 70,831.07 " " 22,318.87 " " 11,283.04 " " 56,664.85 " N/A " 24,361.30 " " 11,847.19 " " 24,361.30 " N/A " 25,530.00 " " 11,621.53 " " 23,107.80 " N/A " 11,283.04 " " 40,387.87 " N/A " 11,283.04 " " 24,596.35 " " 30,745.46 " " 11,621.53 " " 11,621.53 " " 11,283.04 " " 56,664.85 " N/A N/A " 28,378.00 " N/A N/A " 53,123.30 " N/A N/A " 11,621.53 " DRG 842 " 27,003.98 " " 8,508.95 " " 7,882.68 " " 21,806.16 " N/A " 16,480.23 " " 8,276.81 " " 16,480.23 " N/A " 16,956.00 " " 8,119.16 " " 15,632.25 " N/A " 7,882.68 " " 15,397.67 " N/A " 7,882.68 " " 17,444.92 " " 21,806.16 " " 8,119.16 " " 8,119.16 " " 7,882.68 " " 21,603.18 " N/A N/A " 19,197.50 " N/A N/A " 20,252.99 " N/A N/A " 8,119.16 " DRG 843 No Current Volume N/A " 13,136.84 " " 33,383.00 " N/A " 28,657.87 " " 13,793.68 " " 28,657.87 " N/A " 28,166.00 " " 13,530.95 " " 27,183.30 " N/A " 13,136.84 " N/A N/A " 13,136.84 " " 24,579.99 " " 30,725.00 " " 13,530.95 " " 13,530.95 " " 13,136.84 " N/A N/A N/A " 33,383.00 " N/A N/A N/A N/A N/A " 13,530.95 " DRG 844 " 92,497.61 " " 29,146.00 " " 8,447.90 " " 73,998.08 " N/A " 17,790.24 " " 8,870.30 " " 17,790.24 " N/A " 18,974.00 " " 8,701.34 " " 16,874.85 " N/A " 8,447.90 " " 52,742.13 " N/A " 8,447.90 " " 17,232.18 " " 21,540.23 " " 8,701.34 " " 8,701.34 " " 8,447.90 " " 73,998.08 " N/A N/A " 20,723.50 " N/A N/A " 69,373.20 " N/A N/A " 8,701.34 " DRG 845 No Current Volume N/A " 6,274.55 " " 17,592.21 " N/A " 12,753.02 " " 6,588.28 " " 12,753.02 " N/A " 13,454.00 " " 6,462.79 " " 12,096.83 " N/A " 6,274.55 " N/A N/A " 6,274.55 " " 14,073.76 " " 17,592.21 " " 6,462.79 " " 6,462.79 " " 6,274.55 " N/A N/A N/A " 14,855.75 " N/A N/A N/A N/A N/A " 6,462.79 " DRG 846 No Current Volume N/A " 18,097.36 " " 46,775.75 " N/A " 40,154.98 " " 19,002.23 " " 40,154.98 " N/A " 36,604.00 " " 18,640.28 " " 38,088.83 " N/A " 18,097.36 " N/A N/A " 18,097.36 " " 20,717.89 " " 25,897.37 " " 18,640.28 " " 18,640.28 " " 18,097.36 " N/A N/A N/A " 46,775.75 " N/A N/A N/A N/A N/A " 18,640.28 " DRG 847 " 23,255.75 " " 7,327.89 " " 9,432.48 " " 23,381.75 " N/A " 20,072.23 " " 9,904.10 " " 20,072.23 " N/A " 18,202.00 " " 9,715.45 " " 19,039.43 " N/A " 9,432.48 " " 13,260.43 " N/A " 9,432.48 " " 13,304.61 " " 16,630.78 " " 9,715.45 " " 9,715.45 " " 9,432.48 " " 18,604.60 " N/A N/A " 23,381.75 " N/A N/A " 17,441.81 " N/A N/A " 9,715.45 " DRG 848 No Current Volume N/A " 7,463.31 " " 18,065.25 " N/A " 15,508.24 " " 7,836.48 " " 15,508.24 " N/A " 13,301.00 " " 7,687.21 " " 14,710.28 " N/A " 7,463.31 " N/A N/A " 7,463.31 " " 7,691.47 " " 9,614.35 " " 7,687.21 " " 7,687.21 " " 7,463.31 " N/A N/A N/A " 18,065.25 " N/A N/A N/A N/A N/A " 7,687.21 " DRG 849 No Current Volume N/A " 16,935.18 " " 43,638.00 " N/A " 37,461.35 " " 17,781.94 " " 37,461.35 " N/A " 23,060.00 " " 17,443.24 " " 35,533.80 " N/A " 16,935.18 " N/A N/A " 16,935.18 " " 32,029.34 " " 40,036.68 " " 17,443.24 " " 17,443.24 " " 16,935.18 " N/A N/A N/A " 43,638.00 " N/A N/A N/A N/A N/A " 17,443.24 " DRG 853 " 195,690.90 " " 61,662.20 " " 32,972.47 " " 156,552.72 " N/A " 74,631.26 " " 34,621.09 " " 74,631.26 " N/A " 81,921.00 " " 33,961.64 " " 70,791.15 " N/A " 32,972.47 " " 111,582.95 " N/A " 32,972.47 " " 51,464.00 " " 64,329.99 " " 33,961.64 " " 33,961.64 " " 32,972.47 " " 156,552.72 " N/A N/A " 86,936.50 " N/A N/A " 146,768.17 " N/A N/A " 33,961.64 " DRG 854 " 81,066.35 " " 25,544.01 " " 14,527.83 " " 64,853.08 " N/A " 31,881.81 " " 15,254.22 " " 31,881.81 " N/A " 37,566.00 " " 14,963.66 " " 30,241.35 " N/A " 14,527.83 " " 46,224.03 " N/A " 14,527.83 " " 24,367.25 " " 30,459.07 " " 14,963.66 " " 14,963.66 " " 14,527.83 " " 64,853.08 " N/A N/A " 37,138.50 " N/A N/A " 60,799.76 " N/A N/A " 14,963.66 " DRG 855 " 72,563.69 " " 22,864.82 " " 10,623.19 " " 58,050.95 " N/A " 22,831.96 " " 11,154.35 " " 22,831.96 " N/A " 26,835.00 " " 10,941.89 " " 21,657.15 " N/A " 10,623.19 " " 41,375.82 " N/A " 10,623.19 " " 17,674.03 " " 22,092.54 " " 10,941.89 " " 10,941.89 " " 10,623.19 " " 58,050.95 " N/A N/A " 26,596.50 " N/A N/A " 54,422.77 " N/A N/A " 10,941.89 " DRG 856 " 125,747.79 " " 39,623.13 " " 31,002.64 " " 100,598.23 " N/A " 70,065.77 " " 32,552.77 " " 70,065.77 " N/A " 75,798.00 " " 31,932.72 " " 66,460.58 " N/A " 31,002.64 " " 71,701.39 " N/A " 31,002.64 " " 39,097.79 " " 48,872.23 " " 31,932.72 " " 31,932.72 " " 31,002.64 " " 100,598.23 " N/A N/A " 81,618.25 " N/A N/A " 94,310.84 " N/A N/A " 31,932.72 " DRG 857 " 84,160.22 " " 26,518.89 " " 14,399.49 " " 67,328.18 " N/A " 31,584.36 " " 15,119.46 " " 31,584.36 " N/A " 32,255.00 " " 14,831.47 " " 29,959.20 " N/A " 14,399.49 " " 47,988.16 " N/A " 14,399.49 " " 21,879.79 " " 27,349.75 " " 14,831.47 " " 14,831.47 " " 14,399.49 " " 67,328.18 " N/A N/A " 36,792.00 " N/A N/A " 63,120.17 " N/A N/A " 14,831.47 " DRG 858 No Current Volume N/A " 9,584.81 " " 23,793.00 " N/A " 20,425.27 " " 10,064.05 " " 20,425.27 " N/A " 21,066.00 " " 9,872.35 " " 19,374.30 " N/A " 9,584.81 " N/A N/A " 9,584.81 " " 18,001.32 " " 22,501.67 " " 9,872.35 " " 9,872.35 " " 9,584.81 " N/A N/A N/A " 23,793.00 " N/A N/A N/A N/A N/A " 9,872.35 " DRG 862 " 38,635.65 " " 12,174.09 " " 13,066.19 " " 33,192.25 " N/A " 28,494.12 " " 13,719.50 " " 28,494.12 " N/A " 29,116.00 " " 13,458.18 " " 27,027.98 " N/A " 13,066.19 " " 22,030.05 " N/A " 13,066.19 " " 15,202.94 " " 19,003.68 " " 13,458.18 " " 13,458.18 " " 13,066.19 " " 30,908.52 " N/A N/A " 33,192.25 " N/A N/A " 28,976.74 " N/A N/A " 13,458.18 " DRG 863 " 33,058.73 " " 10,416.80 " " 7,327.84 " " 26,446.98 " N/A " 15,194.26 " " 7,694.23 " " 15,194.26 " N/A " 15,476.00 " " 7,547.68 " " 14,412.45 " N/A " 7,327.84 " " 18,850.08 " N/A " 7,327.84 " " 10,178.93 " " 12,723.67 " " 7,547.68 " " 7,547.68 " " 7,327.84 " " 26,446.98 " N/A N/A " 17,699.50 " N/A N/A " 24,794.04 " N/A N/A " 7,547.68 " DRG 864 " 31,807.38 " " 10,022.51 " " 6,453.44 " " 25,445.91 " N/A " 13,167.66 " " 6,776.11 " " 13,167.66 " N/A " 13,246.00 " " 6,647.04 " " 12,490.13 " N/A " 6,453.44 " " 18,136.57 " N/A " 6,453.44 " " 9,687.99 " " 12,109.99 " " 6,647.04 " " 6,647.04 " " 6,453.44 " " 25,445.91 " N/A N/A " 15,338.75 " N/A N/A " 23,855.54 " N/A N/A " 6,647.04 " DRG 865 No Current Volume N/A " 10,350.96 " " 25,861.50 " N/A " 22,200.99 " " 10,868.51 " " 22,200.99 " N/A " 23,807.00 " " 10,661.49 " " 21,058.65 " N/A " 10,350.96 " N/A N/A " 10,350.96 " " 16,430.30 " " 20,537.88 " " 10,661.49 " " 10,661.49 " " 10,350.96 " N/A N/A N/A " 25,861.50 " N/A N/A N/A N/A N/A " 10,661.49 " DRG 866 " 49,437.04 " " 15,577.61 " " 6,210.38 " " 39,549.63 " N/A " 12,604.30 " " 6,520.90 " " 12,604.30 " N/A " 11,682.00 " " 6,396.69 " " 11,955.75 " N/A " 6,210.38 " " 28,189.00 " N/A " 6,210.38 " " 8,640.64 " " 10,800.80 " " 6,396.69 " " 6,396.69 " " 6,210.38 " " 39,549.63 " N/A N/A " 14,682.50 " N/A N/A " 37,077.78 " N/A N/A " 6,396.69 " DRG 867 " 31,662.34 " " 9,976.80 " " 15,272.59 " " 42,865.00 " N/A " 33,607.95 " " 16,036.22 " " 33,607.95 " N/A " 42,865.00 " " 15,730.77 " " 31,878.68 " N/A " 15,272.59 " " 18,053.87 " N/A " 15,272.59 " " 28,393.00 " " 35,491.26 " " 15,730.77 " " 15,730.77 " " 15,272.59 " " 25,329.87 " N/A N/A " 39,149.25 " N/A N/A " 23,746.76 " N/A N/A " 15,730.77 " DRG 868 " 39,145.55 " " 12,334.76 " " 7,681.75 " " 31,316.44 " N/A " 16,014.52 " " 8,065.84 " " 16,014.52 " N/A " 17,145.00 " " 7,912.20 " " 15,190.50 " N/A " 7,681.75 " " 22,320.79 " N/A " 7,681.75 " " 11,079.00 " " 13,848.75 " " 7,912.20 " " 7,912.20 " " 7,681.75 " " 31,316.44 " N/A N/A " 18,655.00 " N/A N/A " 29,359.16 " N/A N/A " 7,912.20 " DRG 869 " 40,989.47 " " 12,915.78 " " 5,494.14 " " 32,791.57 " N/A " 10,944.26 " " 5,768.85 " " 10,944.26 " N/A " 10,821.00 " " 5,658.96 " " 10,381.13 " N/A " 5,494.14 " " 23,372.19 " N/A " 5,494.14 " " 9,442.51 " " 11,803.15 " " 5,658.96 " " 5,658.96 " " 5,494.14 " " 32,791.57 " N/A N/A " 12,748.75 " N/A N/A " 30,742.10 " N/A N/A " 5,658.96 " DRG 870 " 400,855.82 " " 126,309.67 " " 42,508.50 " " 320,684.65 " N/A " 96,733.10 " " 44,633.93 " " 96,733.10 " N/A " 92,352.00 " " 43,783.76 " " 91,755.75 " N/A " 42,508.50 " " 228,567.99 " N/A " 42,508.50 " " 76,482.02 " " 95,602.51 " " 43,783.76 " " 43,783.76 " " 42,508.50 " " 320,684.65 " N/A N/A " 112,682.50 " N/A N/A " 300,641.86 " N/A N/A " 43,783.76 " DRG 871 " 88,633.81 " " 27,928.51 " " 12,907.38 " " 70,907.05 " N/A " 28,126.06 " " 13,552.75 " " 28,126.06 " N/A " 28,435.00 " " 13,294.60 " " 26,678.85 " N/A " 12,907.38 " " 50,539.00 " N/A " 12,907.38 " " 21,896.16 " " 27,370.21 " " 13,294.60 " " 13,294.60 " " 12,907.38 " " 70,907.05 " N/A N/A " 32,763.50 " N/A N/A " 66,475.36 " N/A N/A " 13,294.60 " DRG 872 " 42,071.48 " " 13,256.72 " " 7,424.42 " " 33,657.19 " N/A " 15,418.10 " " 7,795.64 " " 15,418.10 " N/A " 16,565.00 " " 7,647.15 " " 14,624.78 " N/A " 7,424.42 " " 23,989.16 " N/A " 7,424.42 " " 11,569.94 " " 14,462.43 " " 7,647.15 " " 7,647.15 " " 7,424.42 " " 33,657.19 " N/A N/A " 17,960.25 " N/A N/A " 31,553.61 " N/A N/A " 7,647.15 " DRG 876 " 78,462.03 " " 24,723.38 " - " 62,769.62 " N/A " 49,095.16 " " 23,052.42 " " 49,095.16 " N/A - " 22,613.33 " " 46,569.00 " N/A " 21,954.69 " " 44,739.05 " N/A " 21,954.69 " " 48,322.47 " " 60,403.08 " " 22,613.33 " " 22,613.33 " " 21,954.69 " " 62,769.62 " N/A N/A " 57,190.00 " N/A N/A " 58,846.52 " N/A N/A " 22,613.33 " DRG 880 " 24,397.26 " " 7,687.58 " - " 19,517.81 " N/A " 12,987.38 " " 6,694.44 " " 12,987.38 " N/A - " 6,566.93 " " 12,319.13 " N/A " 6,375.66 " " 13,911.32 " N/A " 6,375.66 " " 9,622.53 " " 12,028.16 " " 6,566.93 " " 6,566.93 " " 6,375.66 " " 19,517.81 " N/A N/A " 15,128.75 " N/A N/A " 18,297.94 " N/A N/A " 6,566.93 " DRG 881 " 23,707.50 " " 7,470.23 " - " 18,966.00 " N/A " 12,048.45 " " 6,269.08 " " 12,048.45 " N/A - " 6,149.67 " " 11,428.50 " N/A " 5,970.55 " " 13,518.02 " N/A " 5,970.55 " " 5,580.41 " " 6,975.52 " " 6,149.67 " " 6,149.67 " " 5,970.55 " " 18,966.00 " N/A N/A " 14,035.00 " N/A N/A " 17,780.63 " N/A N/A " 6,149.67 " DRG 882 " 22,294.16 " " 7,024.89 " - " 17,835.33 " N/A " 12,372.94 " " 6,416.09 " " 12,372.94 " N/A - " 6,293.88 " " 11,736.30 " N/A " 6,110.56 " " 12,712.13 " N/A " 6,110.56 " " 5,498.59 " " 6,873.24 " " 6,293.88 " " 6,293.88 " " 6,110.56 " " 17,835.33 " N/A N/A " 14,413.00 " N/A N/A " 16,720.62 " N/A N/A " 6,293.88 " DRG 883 " 28,939.37 " " 9,118.80 " - " 27,681.50 " N/A " 23,763.38 " " 11,576.31 " " 23,763.38 " N/A - " 11,355.81 " " 22,540.65 " N/A " 11,025.06 " " 16,501.23 " N/A " 11,025.06 " " 12,519.10 " " 15,648.89 " " 11,355.81 " " 11,355.81 " " 11,025.06 " " 23,151.50 " N/A N/A " 27,681.50 " N/A N/A " 21,704.53 " N/A N/A " 11,355.81 " DRG 884 " 64,354.24 " " 20,278.02 " - " 51,483.39 " N/A " 21,742.79 " " 10,660.92 " " 21,742.79 " N/A - " 10,457.86 " " 20,624.03 " N/A " 10,153.26 " " 36,694.79 " N/A " 10,153.26 " " 9,131.58 " " 11,414.48 " " 10,457.86 " " 10,457.86 " " 10,153.26 " " 51,483.39 " N/A N/A " 25,327.75 " N/A N/A " 48,265.68 " N/A N/A " 10,457.86 " DRG 885 " 45,209.08 " " 14,245.38 " - " 36,167.27 " N/A " 18,619.51 " " 9,245.97 " " 18,619.51 " N/A - " 9,069.86 " " 17,661.45 " N/A " 8,805.69 " " 25,778.22 " N/A " 8,805.69 " " 7,560.56 " " 9,450.70 " " 9,069.86 " " 9,069.86 " " 8,805.69 " " 36,167.27 " N/A N/A " 21,689.50 " N/A N/A " 33,906.81 " N/A N/A " 9,069.86 " DRG 886 " 23,143.01 " " 7,292.36 " - " 21,414.75 " N/A " 18,383.65 " " 9,139.13 " " 18,383.65 " N/A - " 8,965.05 " " 17,437.73 " N/A " 8,703.93 " " 13,196.14 " N/A " 8,703.93 " " 4,909.45 " " 6,136.82 " " 8,965.05 " " 8,965.05 " " 8,703.93 " " 18,514.41 " N/A N/A " 21,414.75 " N/A N/A " 17,357.26 " N/A N/A " 8,965.05 " DRG 887 No Current Volume N/A - " 20,947.01 " N/A " 16,221.84 " " 8,159.76 " " 16,221.84 " N/A - " 8,004.34 " " 15,387.15 " N/A " 7,771.20 " N/A N/A " 7,771.20 " " 16,757.60 " " 20,947.01 " " 8,004.34 " " 8,004.34 " " 7,771.20 " N/A N/A N/A " 18,896.50 " N/A N/A N/A N/A N/A " 8,004.34 " DRG 894 " 19,018.26 " " 5,992.65 " " 4,330.65 " " 15,214.61 " N/A " 8,247.63 " " 4,547.18 " " 8,247.63 " N/A " 7,000.00 " " 4,460.57 " " 7,823.25 " N/A " 4,330.65 " " 10,844.21 " N/A " 4,330.65 " " 5,809.52 " " 7,261.90 " " 4,460.57 " " 4,460.57 " " 4,330.65 " " 15,214.61 " N/A N/A " 9,607.50 " N/A N/A " 14,263.70 " N/A N/A " 4,460.57 " DRG 895 No Current Volume N/A " 11,137.85 " " 28,311.19 " N/A " 24,024.78 " " 11,694.74 " " 24,024.78 " N/A " 19,119.00 " " 11,471.99 " " 22,788.60 " N/A " 11,137.85 " N/A N/A " 11,137.85 " " 22,648.94 " " 28,311.19 " " 11,471.99 " " 11,471.99 " " 11,137.85 " N/A N/A N/A " 27,986.00 " N/A N/A N/A N/A N/A " 11,471.99 " DRG 896 " 71,813.00 " " 22,628.28 " " 12,311.70 " " 57,450.40 " N/A " 26,745.45 " " 12,927.29 " " 26,745.45 " N/A " 23,984.00 " " 12,681.05 " " 25,369.28 " N/A " 12,311.70 " " 40,947.77 " N/A " 12,311.70 " " 21,094.28 " " 26,367.86 " " 12,681.05 " " 12,681.05 " " 12,311.70 " " 57,450.40 " N/A N/A " 31,155.25 " N/A N/A " 53,859.75 " N/A N/A " 12,681.05 " DRG 897 " 29,974.47 " " 9,444.96 " " 6,132.60 " " 23,979.58 " N/A " 12,424.02 " " 6,439.23 " " 12,424.02 " N/A " 10,864.00 " " 6,316.58 " " 11,784.75 " N/A " 6,132.60 " " 17,091.44 " N/A " 6,132.60 " " 7,855.12 " " 9,818.91 " " 6,316.58 " " 6,316.58 " " 6,132.60 " " 23,979.58 " N/A N/A " 14,472.50 " N/A N/A " 22,480.85 " N/A N/A " 6,316.58 " DRG 901 " 86,267.51 " " 27,182.89 " " 28,441.03 " " 74,950.51 " N/A " 64,128.68 " " 29,863.08 " " 64,128.68 " N/A " 62,821.00 " " 29,294.26 " " 60,828.98 " N/A " 28,441.03 " " 49,189.73 " N/A " 28,441.03 " " 59,960.42 " " 74,950.51 " " 29,294.26 " " 29,294.26 " " 28,441.03 " " 69,014.00 " N/A N/A " 74,702.25 " N/A N/A " 64,700.63 " N/A N/A " 29,294.26 " DRG 902 " 61,951.59 " " 19,520.95 " " 13,504.36 " " 49,561.27 " N/A " 29,509.68 " " 14,179.58 " " 29,509.68 " N/A " 27,427.00 " " 13,909.49 " " 27,991.28 " N/A " 13,504.36 " " 35,324.80 " N/A " 13,504.36 " " 20,276.04 " " 25,345.06 " " 13,909.49 " " 13,909.49 " " 13,504.36 " " 49,561.27 " N/A N/A " 34,375.25 " N/A N/A " 46,463.69 " N/A N/A " 13,909.49 " DRG 903 No Current Volume N/A " 8,130.94 " " 19,867.75 " N/A " 17,055.61 " " 8,537.49 " " 17,055.61 " N/A " 17,748.00 " " 8,374.87 " " 16,178.03 " N/A " 8,130.94 " N/A N/A " 8,130.94 " " 15,072.02 " " 18,840.03 " " 8,374.87 " " 8,374.87 " " 8,130.94 " N/A N/A N/A " 19,867.75 " N/A N/A N/A N/A N/A " 8,374.87 " DRG 904 " 87,471.32 " " 27,562.21 " " 24,929.84 " " 69,977.06 " N/A " 55,990.72 " " 26,176.33 " " 55,990.72 " N/A " 52,922.00 " " 25,677.74 " " 53,109.75 " N/A " 24,929.84 " " 49,876.15 " N/A " 24,929.84 " " 48,950.78 " " 61,188.46 " " 25,677.74 " " 25,677.74 " " 24,929.84 " " 69,977.06 " N/A N/A " 65,222.50 " N/A N/A " 65,603.49 " N/A N/A " 25,677.74 " DRG 905 No Current Volume N/A " 11,467.12 " " 33,425.20 " N/A " 24,787.95 " " 12,040.48 " " 24,787.95 " N/A " 21,852.00 " " 11,811.13 " " 23,512.50 " N/A " 11,467.12 " N/A N/A " 11,467.12 " " 26,740.15 " " 33,425.20 " " 11,811.13 " " 11,811.13 " " 11,467.12 " N/A N/A N/A " 28,875.00 " N/A N/A N/A N/A N/A " 11,811.13 " DRG 906 No Current Volume N/A " 12,464.03 " " 31,566.50 " N/A " 27,098.49 " " 13,087.23 " " 27,098.49 " N/A " 18,549.00 " " 12,837.95 " " 25,704.15 " N/A " 12,464.03 " N/A N/A " 12,464.03 " " 21,667.05 " " 27,083.82 " " 12,837.95 " " 12,837.95 " " 12,464.03 " N/A N/A N/A " 31,566.50 " N/A N/A N/A N/A N/A " 12,837.95 " DRG 907 " 209,188.15 " " 65,915.19 " " 26,363.61 " " 167,350.52 " N/A " 59,313.81 " " 27,681.79 " " 59,313.81 " N/A " 59,589.00 " " 27,154.52 " " 56,261.85 " N/A " 26,363.61 " " 119,279.08 " N/A " 26,363.61 " " 42,310.72 " " 52,888.39 " " 27,154.52 " " 27,154.52 " " 26,363.61 " " 167,350.52 " N/A N/A " 69,093.50 " N/A N/A " 156,891.11 " N/A N/A " 27,154.52 " DRG 908 " 76,394.37 " " 24,071.87 " " 14,062.44 " " 61,115.50 " N/A " 30,803.16 " " 14,765.56 " " 30,803.16 " N/A " 30,799.00 " " 14,484.31 " " 29,218.20 " N/A " 14,062.44 " " 43,560.07 " N/A " 14,062.44 " " 22,534.38 " " 28,167.99 " " 14,484.31 " " 14,484.31 " " 14,062.44 " " 61,115.50 " N/A N/A " 35,882.00 " N/A N/A " 57,295.78 " N/A N/A " 14,484.31 " DRG 909 " 60,084.16 " " 18,932.52 " " 9,658.70 " " 48,067.33 " N/A " 20,596.53 " " 10,141.64 " " 20,596.53 " N/A " 19,755.00 " " 9,948.46 " " 19,536.75 " N/A " 9,658.70 " " 34,259.99 " N/A " 9,658.70 " " 15,432.04 " " 19,290.06 " " 9,948.46 " " 9,948.46 " " 9,658.70 " " 48,067.33 " N/A N/A " 23,992.50 " N/A N/A " 45,063.12 " N/A N/A " 9,948.46 " DRG 913 No Current Volume N/A " 11,393.23 " " 31,338.68 " N/A " 24,616.69 " " 11,962.89 " " 24,616.69 " N/A " 17,951.00 " " 11,735.03 " " 23,350.05 " N/A " 11,393.23 " N/A N/A " 11,393.23 " " 25,070.93 " " 31,338.68 " " 11,735.03 " " 11,735.03 " " 11,393.23 " N/A N/A N/A " 28,675.50 " N/A N/A N/A N/A N/A " 11,735.03 " DRG 914 " 58,503.89 " " 18,434.58 " " 6,520.86 " " 46,803.12 " N/A " 13,323.90 " " 6,846.90 " " 13,323.90 " N/A " 11,028.00 " " 6,716.49 " " 12,638.33 " N/A " 6,520.86 " " 33,358.92 " N/A " 6,520.86 " " 11,929.97 " " 14,912.47 " " 6,716.49 " " 6,716.49 " " 6,520.86 " " 46,803.12 " N/A N/A " 15,520.75 " N/A N/A " 43,877.92 " N/A N/A " 6,716.49 " DRG 915 " 74,551.50 " " 23,491.18 " " 11,787.97 " " 59,641.20 " N/A " 25,531.59 " " 12,377.37 " " 25,531.59 " N/A " 24,201.00 " " 12,141.61 " " 24,217.88 " N/A " 11,787.97 " " 42,509.26 " N/A " 11,787.97 " " 17,084.89 " " 21,356.13 " " 12,141.61 " " 12,141.61 " " 11,787.97 " " 59,641.20 " N/A N/A " 29,741.25 " N/A N/A " 55,913.62 " N/A N/A " 12,141.61 " DRG 916 " 51,230.46 " " 16,142.72 " " 5,039.76 " " 40,984.37 " N/A " 9,891.14 " " 5,291.75 " " 9,891.14 " N/A " 8,083.00 " " 5,190.95 " " 9,382.20 " N/A " 5,039.76 " " 29,211.61 " N/A " 5,039.76 " " 7,658.75 " " 9,573.44 " " 5,190.95 " " 5,190.95 " " 5,039.76 " " 40,984.37 " N/A N/A " 11,522.00 " N/A N/A " 38,422.85 " N/A N/A " 5,190.95 " DRG 917 " 82,587.58 " " 26,023.35 " " 10,355.49 " " 66,070.06 " N/A " 22,211.51 " " 10,873.26 " " 22,211.51 " N/A " 22,106.00 " " 10,666.15 " " 21,068.63 " N/A " 10,355.49 " " 47,091.44 " N/A " 10,355.49 " " 16,544.85 " " 20,681.08 " " 10,666.15 " " 10,666.15 " " 10,355.49 " " 66,070.06 " N/A N/A " 25,873.75 " N/A N/A " 61,940.69 " N/A N/A " 10,666.15 " DRG 918 " 25,569.66 " " 8,057.00 " " 5,903.14 " " 20,455.73 " N/A " 11,892.21 " " 6,198.30 " " 11,892.21 " N/A " 10,089.00 " " 6,080.23 " " 11,280.30 " N/A " 5,903.14 " " 14,579.82 " N/A " 5,903.14 " " 7,806.03 " " 9,757.54 " " 6,080.23 " " 6,080.23 " " 5,903.14 " " 20,455.73 " N/A N/A " 13,853.00 " N/A N/A " 19,177.24 " N/A N/A " 6,080.23 " DRG 919 " 60,477.55 " " 19,056.48 " " 12,725.24 " " 48,382.04 " N/A " 27,703.91 " " 13,361.50 " " 27,703.91 " N/A " 26,354.00 " " 13,107.00 " " 26,278.43 " N/A " 12,725.24 " " 34,484.30 " N/A " 12,725.24 " " 19,768.73 " " 24,710.92 " " 13,107.00 " " 13,107.00 " " 12,725.24 " " 48,382.04 " N/A N/A " 32,271.75 " N/A N/A " 45,358.17 " N/A N/A " 13,107.00 " DRG 920 " 48,700.73 " " 15,345.60 " " 7,413.40 " " 38,960.58 " N/A " 15,392.57 " " 7,784.07 " " 15,392.57 " N/A " 15,498.00 " " 7,635.80 " " 14,600.55 " N/A " 7,413.40 " " 27,769.15 " N/A " 7,413.40 " " 12,126.35 " " 15,157.94 " " 7,635.80 " " 7,635.80 " " 7,413.40 " " 38,960.58 " N/A N/A " 17,930.50 " N/A N/A " 36,525.54 " N/A N/A " 7,635.80 " DRG 921 No Current Volume N/A " 5,295.79 " " 12,213.25 " N/A " 10,484.55 " " 5,560.58 " " 10,484.55 " N/A " 10,386.00 " " 5,454.66 " " 9,945.08 " N/A " 5,295.79 " N/A N/A " 5,295.79 " " 8,689.73 " " 10,862.17 " " 5,454.66 " " 5,454.66 " " 5,295.79 " N/A N/A N/A " 12,213.25 " N/A N/A N/A N/A N/A " 5,454.66 " DRG 922 " 88,573.08 " " 27,909.38 " " 11,066.55 " " 70,858.46 " N/A " 23,859.53 " " 11,619.88 " " 23,859.53 " N/A " 23,527.00 " " 11,398.55 " " 22,631.85 " N/A " 11,066.55 " " 50,504.37 " N/A " 11,066.55 " " 23,090.79 " " 28,863.50 " " 11,398.55 " " 11,398.55 " " 11,066.55 " " 70,858.46 " N/A N/A " 27,793.50 " N/A N/A " 66,429.81 " N/A N/A " 11,398.55 " DRG 923 " 48,428.16 " " 15,259.71 " " 6,863.74 " " 38,742.53 " N/A " 14,118.62 " " 7,206.93 " " 14,118.62 " N/A " 11,562.00 " " 7,069.65 " " 13,392.15 " N/A " 6,863.74 " " 27,613.74 " N/A " 6,863.74 " " 9,475.24 " " 11,844.06 " " 7,069.65 " " 7,069.65 " " 6,863.74 " " 38,742.53 " N/A N/A " 16,446.50 " N/A N/A " 36,321.12 " N/A N/A " 7,069.65 " DRG 927 No Current Volume N/A " 137,481.90 " " 369,097.75 " N/A " 316,854.60 " " 144,356.00 " " 316,854.60 " N/A " 244,654.00 " " 141,606.36 " " 300,551.03 " N/A " 137,481.90 " N/A N/A " 137,481.90 " " 281,081.42 " " 351,351.72 " " 141,606.36 " " 141,606.36 " " 137,481.90 " N/A N/A N/A " 369,097.75 " N/A N/A N/A N/A N/A " 141,606.36 " DRG 928 No Current Volume N/A " 30,558.54 " " 114,303.00 " N/A " 98,124.23 " " 45,264.16 " " 98,124.23 " N/A " 84,678.00 " " 44,401.98 " " 93,075.30 " N/A " 43,108.72 " N/A N/A " 43,108.72 " " 30,558.54 " " 38,198.17 " " 44,401.98 " " 44,401.98 " " 43,108.72 " N/A N/A N/A " 114,303.00 " N/A N/A N/A N/A N/A " 44,401.98 " DRG 929 No Current Volume N/A " 19,081.40 " " 52,743.25 " N/A " 45,277.82 " " 21,323.04 " " 45,277.82 " N/A " 36,728.00 " " 20,916.89 " " 42,948.08 " N/A " 20,307.66 " N/A N/A " 20,307.66 " " 19,081.40 " " 23,851.77 " " 20,916.89 " " 20,916.89 " " 20,307.66 " N/A N/A N/A " 52,743.25 " N/A N/A N/A N/A N/A " 20,916.89 " DRG 933 No Current Volume N/A " 15,439.82 " " 47,604.91 " N/A " 33,995.55 " " 16,211.81 " " 33,995.55 " N/A " 43,357.00 " " 15,903.01 " " 32,246.33 " N/A " 15,439.82 " N/A N/A " 15,439.82 " " 38,083.93 " " 47,604.91 " " 15,903.01 " " 15,903.01 " " 15,439.82 " N/A N/A N/A " 39,600.75 " N/A N/A N/A N/A N/A " 15,903.01 " DRG 934 " 21,576.13 " " 6,798.64 " " 12,302.71 " " 35,552.63 " N/A " 29,158.14 " " 14,020.31 " " 29,158.14 " N/A " 24,777.00 " " 13,753.26 " " 27,657.83 " N/A " 13,352.68 " " 12,302.71 " N/A " 13,352.68 " " 28,442.09 " " 35,552.63 " " 13,753.26 " " 13,753.26 " " 13,352.68 " " 17,260.90 " N/A N/A " 33,965.75 " N/A N/A " 16,182.10 " N/A N/A " 13,753.26 " DRG 935 " 50,764.06 " " 15,995.76 " " 13,300.83 " " 40,611.25 " N/A " 29,037.96 " " 13,965.87 " " 29,037.96 " N/A " 23,155.00 " " 13,699.85 " " 27,543.83 " N/A " 13,300.83 " " 28,945.67 " N/A " 13,300.83 " " 14,564.71 " " 18,205.89 " " 13,699.85 " " 13,699.85 " " 13,300.83 " " 40,611.25 " N/A N/A " 33,825.75 " N/A N/A " 38,073.05 " N/A N/A " 13,699.85 " DRG 939 " 94,549.21 " " 29,792.46 " " 22,645.65 " " 75,639.37 " N/A " 50,696.62 " " 23,777.93 " " 50,696.62 " N/A " 43,499.00 " " 23,325.02 " " 48,088.05 " N/A " 22,645.65 " " 53,911.96 " N/A " 22,645.65 " " 49,065.01 " " 61,331.26 " " 23,325.02 " " 23,325.02 " " 22,645.65 " " 75,639.37 " N/A N/A " 59,055.50 " N/A N/A " 70,911.91 " N/A N/A " 23,325.02 " DRG 940 No Current Volume N/A " 15,167.59 " " 38,865.75 " N/A " 33,364.58 " " 15,925.97 " " 33,364.58 " N/A " 28,751.00 " " 15,622.62 " " 31,647.83 " N/A " 15,167.59 " N/A N/A " 15,167.59 " " 29,865.83 " " 37,332.31 " " 15,622.62 " " 15,622.62 " " 15,167.59 " N/A N/A N/A " 38,865.75 " N/A N/A N/A N/A N/A " 15,622.62 " DRG 941 No Current Volume N/A " 13,237.31 " " 33,654.25 " N/A " 28,890.73 " " 13,899.18 " " 28,890.73 " N/A " 21,288.00 " " 13,634.43 " " 27,404.18 " N/A " 13,237.31 " N/A N/A " 13,237.31 " " 19,212.32 " " 24,015.41 " " 13,634.43 " " 13,634.43 " " 13,237.31 " N/A N/A N/A " 33,654.25 " N/A N/A N/A N/A N/A " 13,634.43 " DRG 945 No Current Volume N/A " 10,377.53 " " 29,559.01 " N/A " 22,262.58 " " 10,896.41 " " 22,262.58 " N/A " 19,995.00 " " 10,688.86 " " 21,117.08 " N/A " 10,377.53 " N/A N/A " 10,377.53 " " 23,647.19 " " 29,559.01 " " 10,688.86 " " 10,688.86 " " 10,377.53 " N/A N/A N/A " 25,933.25 " N/A N/A N/A N/A N/A " 10,688.86 " DRG 946 No Current Volume N/A " 8,071.95 " " 22,031.18 " N/A " 16,918.90 " " 8,475.55 " " 16,918.90 " N/A " 16,775.00 " " 8,314.11 " " 16,048.35 " N/A " 8,071.95 " N/A N/A " 8,071.95 " " 17,624.93 " " 22,031.18 " " 8,314.11 " " 8,314.11 " " 8,071.95 " N/A N/A N/A " 19,708.50 " N/A N/A N/A N/A N/A " 8,314.11 " DRG 947 " 35,573.08 " " 11,209.08 " " 8,511.42 " " 28,458.47 " N/A " 17,937.46 " " 8,936.99 " " 17,937.46 " N/A " 17,885.00 " " 8,766.76 " " 17,014.50 " N/A " 8,511.42 " " 20,283.77 " N/A " 8,511.42 " " 14,319.24 " " 17,899.05 " " 8,766.76 " " 8,766.76 " " 8,511.42 " " 28,458.47 " N/A N/A " 20,895.00 " N/A N/A " 26,679.81 " N/A N/A " 8,766.76 " DRG 948 " 44,835.00 " " 14,127.51 " " 5,873.97 " " 35,868.00 " N/A " 11,824.60 " " 6,167.67 " " 11,824.60 " N/A " 11,220.00 " " 6,050.19 " " 11,216.18 " N/A " 5,873.97 " " 25,564.92 " N/A " 5,873.97 " " 10,260.75 " " 12,825.95 " " 6,050.19 " " 6,050.19 " " 5,873.97 " " 35,868.00 " N/A N/A " 13,774.25 " N/A N/A " 33,626.25 " N/A N/A " 6,050.19 " DRG 949 No Current Volume N/A " 7,966.30 " " 19,423.25 " N/A " 16,674.03 " " 8,364.62 " " 16,674.03 " N/A " 16,559.00 " " 8,205.29 " " 15,816.08 " N/A " 7,966.30 " N/A N/A " 7,966.30 " " 14,777.45 " " 18,471.82 " " 8,205.29 " " 8,205.29 " " 7,966.30 " N/A N/A N/A " 19,423.25 " N/A N/A N/A N/A N/A " 8,205.29 " DRG 950 No Current Volume N/A " 5,569.97 " " 13,991.95 " N/A " 11,120.02 " " 5,848.47 " " 11,120.02 " N/A " 8,664.00 " " 5,737.07 " " 10,547.85 " N/A " 5,569.97 " N/A N/A " 5,569.97 " " 11,193.55 " " 13,991.95 " " 5,737.07 " " 5,737.07 " " 5,569.97 " N/A N/A N/A " 12,953.50 " N/A N/A N/A N/A N/A " 5,737.07 " DRG 951 " 15,206.47 " " 4,791.56 " " 4,399.36 " " 14,456.00 " N/A " 8,406.87 " " 4,619.33 " " 8,406.87 " N/A " 14,456.00 " " 4,531.34 " " 7,974.30 " N/A " 4,399.36 " " 8,670.73 " N/A " 4,399.36 " " 6,104.09 " " 7,630.11 " " 4,531.34 " " 4,531.34 " " 4,399.36 " " 12,165.18 " N/A N/A " 9,793.00 " N/A N/A " 11,404.85 " N/A N/A " 4,531.34 " DRG 955 " 289,314.33 " " 91,162.95 " " 41,538.18 " " 231,451.47 " N/A " 94,484.15 " " 43,615.09 " " 94,484.15 " N/A " 87,678.00 " " 42,784.33 " " 89,622.53 " N/A " 41,538.18 " " 164,967.03 " N/A " 41,538.18 " " 85,463.94 " " 106,829.92 " " 42,784.33 " " 42,784.33 " " 41,538.18 " " 231,451.47 " N/A N/A " 110,062.75 " N/A N/A " 216,985.75 " N/A N/A " 42,784.33 " DRG 956 " 235,734.27 " " 74,279.87 " " 25,727.10 " " 188,587.41 " N/A " 57,838.55 " " 27,013.46 " " 57,838.55 " N/A " 57,729.00 " " 26,498.91 " " 54,862.50 " N/A " 25,727.10 " " 134,415.68 " N/A " 25,727.10 " " 64,929.75 " " 81,162.18 " " 26,498.91 " " 26,498.91 " " 25,727.10 " " 188,587.41 " N/A N/A " 67,375.00 " N/A N/A " 176,800.70 " N/A N/A " 26,498.91 " DRG 957 " 244,898.51 " " 77,167.52 " " 48,872.99 " " 195,918.81 " N/A " 111,484.18 " " 51,316.64 " " 111,484.18 " N/A " 107,701.00 " " 50,339.18 " " 105,747.83 " N/A " 48,872.99 " " 139,641.13 " N/A " 48,872.99 " " 94,817.14 " " 118,521.41 " " 50,339.18 " " 50,339.18 " " 48,872.99 " " 195,918.81 " N/A N/A " 129,865.75 " N/A N/A " 183,673.88 " N/A N/A " 50,339.18 " DRG 958 " 181,398.37 " " 57,158.63 " " 28,032.68 " " 145,118.70 " N/A " 63,182.23 " " 29,434.31 " " 63,182.23 " N/A " 60,734.00 " " 28,873.66 " " 59,931.23 " N/A " 28,032.68 " " 103,433.35 " N/A " 28,032.68 " " 46,680.31 " " 58,350.38 " " 28,873.66 " " 28,873.66 " " 28,032.68 " " 145,118.70 " N/A N/A " 73,599.75 " N/A N/A " 136,048.78 " N/A N/A " 28,873.66 " DRG 959 " 127,951.94 " " 40,317.66 " " 18,507.02 " " 102,361.55 " N/A " 41,104.43 " " 19,432.37 " " 41,104.43 " N/A " 40,038.00 " " 19,062.23 " " 38,989.43 " N/A " 18,507.02 " " 72,958.20 " N/A " 18,507.02 " " 37,726.94 " " 47,158.67 " " 19,062.23 " " 19,062.23 " " 18,507.02 " " 102,361.55 " N/A N/A " 47,881.75 " N/A N/A " 95,963.96 " N/A N/A " 19,062.23 " DRG 963 " 135,220.81 " " 42,608.08 " " 18,466.83 " " 108,176.65 " N/A " 41,011.29 " " 19,390.17 " " 41,011.29 " N/A " 42,592.00 " " 19,020.83 " " 38,901.08 " N/A " 18,466.83 " " 77,102.91 " N/A " 18,466.83 " " 32,857.57 " " 41,071.95 " " 19,020.83 " " 19,020.83 " " 18,466.83 " " 108,176.65 " N/A N/A " 47,773.25 " N/A N/A " 101,415.61 " N/A N/A " 19,020.83 " DRG 964 " 63,362.07 " " 19,965.39 " " 10,441.70 " " 50,689.66 " N/A " 22,411.31 " " 10,963.79 " " 22,411.31 " N/A " 23,236.00 " " 10,754.95 " " 21,258.15 " N/A " 10,441.70 " " 36,129.05 " N/A " 10,441.70 " " 18,672.28 " " 23,340.36 " " 10,754.95 " " 10,754.95 " " 10,441.70 " " 50,689.66 " N/A N/A " 26,106.50 " N/A N/A " 47,521.55 " N/A N/A " 10,754.95 " DRG 965 " 33,365.17 " " 10,513.36 " " 6,686.79 " " 26,692.13 " N/A " 13,708.49 " " 7,021.13 " " 13,708.49 " N/A " 14,818.00 " " 6,887.39 " " 13,003.13 " N/A " 6,686.79 " " 19,024.82 " N/A " 6,686.79 " " 12,404.55 " " 15,505.69 " " 6,887.39 " " 6,887.39 " " 6,686.79 " " 26,692.13 " N/A N/A " 15,968.75 " N/A N/A " 25,023.87 " N/A N/A " 6,887.39 " DRG 969 No Current Volume N/A " 38,703.03 " " 102,920.85 " N/A " 87,913.09 " " 40,638.18 " " 87,913.09 " N/A " 95,683.00 " " 39,864.12 " " 83,389.58 " N/A " 38,703.03 " N/A N/A " 38,703.03 " " 82,336.69 " " 102,920.85 " " 39,864.12 " " 39,864.12 " " 38,703.03 " N/A N/A N/A " 102,408.25 " N/A N/A N/A N/A N/A " 39,864.12 " DRG 970 No Current Volume N/A " 20,144.32 " " 52,302.25 " N/A " 44,899.24 " " 21,151.54 " " 44,899.24 " N/A " 34,748.00 " " 20,748.65 " " 42,588.98 " N/A " 20,144.32 " N/A N/A " 20,144.32 " " 40,811.35 " " 51,014.19 " " 20,748.65 " " 20,748.65 " " 20,144.32 " N/A N/A N/A " 52,302.25 " N/A N/A N/A N/A N/A " 20,748.65 " DRG 974 " 100,177.07 " " 31,565.79 " " 18,211.44 " " 80,141.65 " N/A " 40,419.38 " " 19,122.01 " " 40,419.38 " N/A " 42,243.00 " " 18,757.78 " " 38,339.63 " N/A " 18,211.44 " " 57,120.96 " N/A " 18,211.44 " " 34,471.17 " " 43,088.96 " " 18,757.78 " " 18,757.78 " " 18,211.44 " " 80,141.65 " N/A N/A " 47,083.75 " N/A N/A " 75,132.80 " N/A N/A " 18,757.78 " DRG 975 " 35,943.60 " " 11,325.83 " " 9,082.47 " " 28,754.88 " N/A " 19,260.99 " " 9,536.59 " " 19,260.99 " N/A " 20,526.00 " " 9,354.94 " " 18,269.93 " N/A " 9,082.47 " " 20,495.04 " N/A " 9,082.47 " " 19,310.51 " " 24,138.15 " " 9,354.94 " " 9,354.94 " " 9,082.47 " " 28,754.88 " N/A N/A " 22,436.75 " N/A N/A " 26,957.70 " N/A N/A " 9,354.94 " DRG 976 No Current Volume N/A " 6,927.26 " " 17,674.04 " N/A " 14,265.84 " " 7,273.62 " " 14,265.84 " N/A " 13,806.00 " " 7,135.08 " " 13,531.80 " N/A " 6,927.26 " N/A N/A " 6,927.26 " " 14,139.22 " " 17,674.04 " " 7,135.08 " " 7,135.08 " " 6,927.26 " N/A N/A N/A " 16,618.00 " N/A N/A N/A N/A N/A " 7,135.08 " DRG 977 No Current Volume N/A " 9,356.00 " " 25,631.44 " N/A " 19,894.96 " " 9,823.80 " " 19,894.96 " N/A " 17,786.00 " " 9,636.68 " " 18,871.28 " N/A " 9,356.00 " N/A N/A " 9,356.00 " " 20,505.14 " " 25,631.44 " " 9,636.68 " " 9,636.68 " " 9,356.00 " N/A N/A N/A " 23,175.25 " N/A N/A N/A N/A N/A " 9,636.68 " DRG 981 " 203,844.88 " " 64,231.52 " " 30,682.44 " " 163,075.91 " N/A " 69,323.63 " " 32,216.56 " " 69,323.63 " N/A " 78,617.00 " " 31,602.91 " " 65,756.63 " N/A " 30,682.44 " " 116,232.35 " N/A " 30,682.44 " " 52,534.98 " " 65,668.72 " " 31,602.91 " " 31,602.91 " " 30,682.44 " " 163,075.91 " N/A N/A " 80,753.75 " N/A N/A " 152,883.66 " N/A N/A " 31,602.91 " DRG 982 " 149,914.50 " " 47,238.06 " " 17,213.89 " " 119,931.60 " N/A " 38,107.34 " " 18,074.58 " " 38,107.34 " N/A " 44,290.00 " " 17,730.31 " " 36,146.55 " N/A " 17,213.89 " " 85,481.25 " N/A " 17,213.89 " " 30,062.21 " " 37,577.78 " " 17,730.31 " " 17,730.31 " " 17,213.89 " " 119,931.60 " N/A N/A " 44,390.50 " N/A N/A " 112,435.87 " N/A N/A " 17,730.31 " DRG 983 " 46,293.63 " " 14,587.12 " " 11,482.03 " " 37,034.90 " N/A " 24,822.50 " " 12,056.13 " " 24,822.50 " N/A " 28,381.00 " " 11,826.49 " " 23,545.28 " N/A " 11,482.03 " " 26,396.63 " N/A " 11,482.03 " " 21,765.24 " " 27,206.56 " " 11,826.49 " " 11,826.49 " " 11,482.03 " " 37,034.90 " N/A N/A " 28,915.25 " N/A N/A " 34,720.22 " N/A N/A " 11,826.49 " DRG 987 " 201,403.29 " " 63,462.18 " " 22,005.90 " " 161,122.63 " N/A " 49,213.85 " " 23,106.20 " " 49,213.85 " N/A " 51,932.00 " " 22,666.08 " " 46,681.58 " N/A " 22,005.90 " " 114,840.15 " N/A " 22,005.90 " " 35,813.46 " " 44,766.82 " " 22,666.08 " " 22,666.08 " " 22,005.90 " " 161,122.63 " N/A N/A " 57,328.25 " N/A N/A " 151,052.47 " N/A N/A " 22,666.08 " DRG 988 " 66,499.58 " " 20,954.02 " " 11,832.70 " " 53,199.66 " N/A " 25,635.25 " " 12,424.34 " " 25,635.25 " N/A " 27,760.00 " " 12,187.68 " " 24,316.20 " N/A " 11,832.70 " " 37,918.06 " N/A " 11,832.70 " " 20,505.14 " " 25,631.44 " " 12,187.68 " " 12,187.68 " " 11,832.70 " " 53,199.66 " N/A N/A " 29,862.00 " N/A N/A " 49,874.68 " N/A N/A " 12,187.68 " DRG 989 " 44,571.43 " " 14,044.46 " " 8,055.10 " " 35,657.14 " N/A " 16,879.84 " " 8,457.86 " " 16,879.84 " N/A " 16,449.00 " " 8,296.75 " " 16,011.30 " N/A " 8,055.10 " " 25,414.63 " N/A " 8,055.10 " " 14,646.53 " " 18,308.17 " " 8,296.75 " " 8,296.75 " " 8,055.10 " " 35,657.14 " N/A N/A " 19,663.00 " N/A N/A " 33,428.57 " N/A N/A " 8,296.75 " DRG 4.1 No Current Volume N/A " 50,413.86 " " 90,689.49 " " 63,239.15 " N/A N/A N/A " 52,272.33 " N/A N/A N/A " 62,941.70 " N/A N/A " 50,413.86 " N/A N/A N/A N/A N/A N/A N/A " 53,690.76 " " 50,413.86 " N/A " 50,413.86 " " 75,620.79 " N/A " 90,689.49 " " 89,807.25 " N/A DRG 4.2 No Current Volume N/A " 63,012.02 " " 113,352.32 " " 79,042.28 " N/A N/A N/A " 65,334.91 " N/A N/A N/A " 78,670.51 " N/A N/A " 63,012.02 " N/A N/A N/A N/A N/A N/A N/A " 67,107.80 " " 63,012.02 " N/A " 63,012.02 " " 94,518.03 " N/A " 113,352.32 " " 112,249.61 " N/A DRG 4.3 No Current Volume N/A " 82,159.88 " " 147,797.41 " " 103,061.35 " N/A N/A N/A " 85,188.64 " N/A N/A N/A " 102,576.61 " N/A N/A " 82,159.88 " N/A N/A N/A N/A N/A N/A N/A " 87,500.27 " " 82,159.88 " N/A " 82,159.88 " " 123,239.82 " N/A " 147,797.41 " " 146,359.61 " N/A DRG 4.4 No Current Volume N/A " 113,764.84 " " 204,651.57 " " 142,706.62 " N/A N/A N/A " 117,958.69 " N/A N/A N/A " 142,035.40 " N/A N/A " 113,764.84 " N/A N/A N/A N/A N/A N/A N/A " 121,159.55 " " 113,764.84 " N/A " 113,764.84 " " 170,647.26 " N/A " 204,651.57 " " 202,660.69 " N/A DRG 5.1 No Current Volume N/A " 42,639.82 " " 76,704.77 " " 53,487.39 " N/A N/A N/A " 44,211.70 " N/A N/A N/A " 53,235.82 " N/A N/A " 42,639.82 " N/A N/A N/A N/A N/A N/A N/A " 45,411.41 " " 42,639.82 " N/A " 42,639.82 " " 63,959.73 " N/A " 76,704.77 " " 75,958.58 " N/A DRG 5.2 No Current Volume N/A " 47,378.34 " " 85,228.90 " " 59,431.39 " N/A N/A N/A " 49,124.90 " N/A N/A N/A " 59,151.86 " N/A N/A " 47,378.34 " N/A N/A N/A N/A N/A N/A N/A " 50,457.93 " " 47,378.34 " N/A " 47,378.34 " " 71,067.51 " N/A " 85,228.90 " " 84,399.77 " N/A DRG 5.3 No Current Volume N/A " 59,601.93 " " 107,217.91 " " 74,764.66 " N/A N/A N/A " 61,799.11 " N/A N/A N/A " 74,413.01 " N/A N/A " 59,601.93 " N/A N/A N/A N/A N/A N/A N/A " 63,476.06 " " 59,601.93 " N/A " 59,601.93 " " 89,402.90 " N/A " 107,217.91 " " 106,174.88 " N/A DRG 5.4 No Current Volume N/A " 76,448.33 " " 137,522.90 " " 95,896.79 " N/A N/A N/A " 79,266.53 " N/A N/A N/A " 95,445.74 " N/A N/A " 76,448.33 " N/A N/A N/A N/A N/A N/A N/A " 81,417.47 " " 76,448.33 " N/A " 76,448.33 " " 114,672.50 " N/A " 137,522.90 " " 136,185.06 " N/A DRG 9.1 No Current Volume N/A " 44,282.55 " " 79,659.88 " " 55,548.03 " N/A N/A N/A " 45,914.99 " N/A N/A N/A " 55,286.76 " N/A N/A " 44,282.55 " N/A N/A N/A N/A N/A N/A N/A " 47,160.92 " " 44,282.55 " N/A " 44,282.55 " " 66,423.83 " N/A " 79,659.88 " " 78,884.93 " N/A DRG 9.2 No Current Volume N/A " 49,202.53 " " 88,510.43 " " 61,719.65 " N/A N/A N/A " 51,016.34 " N/A N/A N/A " 61,429.36 " N/A N/A " 49,202.53 " N/A N/A N/A N/A N/A N/A N/A " 52,400.69 " " 49,202.53 " N/A " 49,202.53 " " 73,803.80 " N/A " 88,510.43 " " 87,649.39 " N/A DRG 9.3 No Current Volume N/A " 69,501.47 " " 125,026.19 " " 87,182.64 " N/A N/A N/A " 72,063.58 " N/A N/A N/A " 86,772.59 " N/A N/A " 69,501.47 " N/A N/A N/A N/A N/A N/A N/A " 74,019.07 " " 69,501.47 " N/A " 69,501.47 " " 104,252.21 " N/A " 125,026.19 " " 123,809.92 " N/A DRG 9.4 No Current Volume N/A " 122,635.19 " " 220,608.44 " " 153,833.58 " N/A N/A N/A " 127,156.03 " N/A N/A N/A " 153,110.03 " N/A N/A " 122,635.19 " N/A N/A N/A N/A N/A N/A N/A " 130,606.48 " " 122,635.19 " N/A " 122,635.19 " " 183,952.79 " N/A " 220,608.44 " " 218,462.33 " N/A DRG 20.1 No Current Volume N/A " 17,349.69 " " 31,210.36 " " 21,763.45 " N/A N/A N/A " 17,989.27 " N/A N/A N/A " 21,661.09 " N/A N/A " 17,349.69 " N/A N/A N/A N/A N/A N/A N/A " 18,477.42 " " 17,349.69 " N/A " 17,349.69 " " 26,024.54 " N/A " 31,210.36 " " 30,906.74 " N/A DRG 20.2 No Current Volume N/A " 21,284.99 " " 38,289.57 " " 26,699.89 " N/A N/A N/A " 22,069.64 " N/A N/A N/A " 26,574.31 " N/A N/A " 21,284.99 " N/A N/A N/A N/A N/A N/A N/A " 22,668.51 " " 21,284.99 " N/A " 21,284.99 " " 31,927.49 " N/A " 38,289.57 " " 37,917.08 " N/A DRG 20.3 No Current Volume N/A " 27,469.71 " " 49,415.26 " " 34,458.00 " N/A N/A N/A " 28,482.36 " N/A N/A N/A " 34,295.93 " N/A N/A " 27,469.71 " N/A N/A N/A N/A N/A N/A N/A " 29,255.24 " " 27,469.71 " N/A " 27,469.71 " " 41,204.57 " N/A " 49,415.26 " " 48,934.54 " N/A DRG 20.4 No Current Volume N/A " 45,852.70 " " 82,484.42 " " 57,517.63 " N/A N/A N/A " 47,543.02 " N/A N/A N/A " 57,247.10 " N/A N/A " 45,852.70 " N/A N/A N/A N/A N/A N/A N/A " 48,833.13 " " 45,852.70 " N/A " 45,852.70 " " 68,779.05 " N/A " 82,484.42 " " 81,682.00 " N/A DRG 21.1 No Current Volume N/A " 16,178.07 " " 29,102.73 " " 20,293.77 " N/A N/A N/A " 16,774.46 " N/A N/A N/A " 20,198.32 " N/A N/A " 16,178.07 " N/A N/A N/A N/A N/A N/A N/A " 17,229.64 " " 16,178.07 " N/A " 16,178.07 " " 24,267.11 " N/A " 29,102.73 " " 28,819.61 " N/A DRG 21.2 No Current Volume N/A " 22,219.68 " " 39,970.98 " " 27,872.37 " N/A N/A N/A " 23,038.79 " N/A N/A N/A " 27,741.27 " N/A N/A " 22,219.68 " N/A N/A N/A N/A N/A N/A N/A " 23,663.96 " " 22,219.68 " N/A " 22,219.68 " " 33,329.52 " N/A " 39,970.98 " " 39,582.14 " N/A DRG 21.3 No Current Volume N/A " 32,372.57 " " 58,235.02 " " 40,608.15 " N/A N/A N/A " 33,565.96 " N/A N/A N/A " 40,417.15 " N/A N/A " 32,372.57 " N/A N/A N/A N/A N/A N/A N/A " 34,476.79 " " 32,372.57 " N/A " 32,372.57 " " 48,558.86 " N/A " 58,235.02 " " 57,668.50 " N/A DRG 21.4 No Current Volume N/A " 53,969.81 " " 97,086.29 " " 67,699.73 " N/A N/A N/A " 55,959.36 " N/A N/A N/A " 67,381.31 " N/A N/A " 53,969.81 " N/A N/A N/A N/A N/A N/A N/A " 57,477.85 " " 53,969.81 " N/A " 53,969.81 " " 80,954.72 " N/A " 97,086.29 " " 96,141.82 " N/A DRG 22.1 No Current Volume N/A " 10,044.02 " " 18,068.19 " " 12,599.22 " N/A N/A N/A " 10,414.28 " N/A N/A N/A " 12,539.96 " N/A N/A " 10,044.02 " N/A N/A N/A N/A N/A N/A N/A " 10,696.88 " " 10,044.02 " N/A " 10,044.02 " " 15,066.03 " N/A " 18,068.19 " " 17,892.42 " N/A DRG 22.2 No Current Volume N/A " 12,327.68 " " 22,176.26 " " 15,463.84 " N/A N/A N/A " 12,782.13 " N/A N/A N/A " 15,391.11 " N/A N/A " 12,327.68 " N/A N/A N/A N/A N/A N/A N/A " 13,128.98 " " 12,327.68 " N/A " 12,327.68 " " 18,491.52 " N/A " 22,176.26 " " 21,960.53 " N/A DRG 22.3 " 79,415.92 " " 25,023.96 " " 19,036.24 " " 34,244.29 " " 23,879.06 " N/A N/A N/A " 19,738.00 " N/A N/A N/A " 23,766.75 " N/A N/A " 19,036.24 " N/A N/A N/A N/A N/A N/A N/A " 20,273.60 " " 19,036.24 " N/A " 19,036.24 " " 28,554.36 " N/A " 34,244.29 " " 33,911.16 " N/A DRG 22.4 No Current Volume N/A " 48,789.62 " " 87,767.65 " " 61,201.70 " N/A N/A N/A " 50,588.21 " N/A N/A N/A " 60,913.84 " N/A N/A " 48,789.62 " N/A N/A N/A N/A N/A N/A N/A " 51,960.95 " " 48,789.62 " N/A " 48,789.62 " " 73,184.43 " N/A " 87,767.65 " " 86,913.83 " N/A DRG 23.1 No Current Volume N/A " 11,869.58 " " 21,352.19 " " 14,889.20 " N/A N/A N/A " 12,307.14 " N/A N/A N/A " 14,819.17 " N/A N/A " 11,869.58 " N/A N/A N/A N/A N/A N/A N/A " 12,641.10 " " 11,869.58 " N/A " 11,869.58 " " 17,804.37 " N/A " 21,352.19 " " 21,144.47 " N/A DRG 23.2 No Current Volume N/A " 15,891.16 " " 28,586.61 " " 19,933.87 " N/A N/A N/A " 16,476.97 " N/A N/A N/A " 19,840.11 " N/A N/A " 15,891.16 " N/A N/A N/A N/A N/A N/A N/A " 16,924.09 " " 15,891.16 " N/A " 15,891.16 " " 23,836.74 " N/A " 28,586.61 " " 28,308.51 " N/A DRG 23.3 No Current Volume N/A " 27,708.69 " " 49,845.16 " " 34,757.78 " N/A N/A N/A " 28,730.15 " N/A N/A N/A " 34,594.30 " N/A N/A " 27,708.69 " N/A N/A N/A N/A N/A N/A N/A " 29,509.75 " " 27,708.69 " N/A " 27,708.69 " " 41,563.04 " N/A " 49,845.16 " " 49,360.26 " N/A DRG 23.4 No Current Volume N/A " 48,969.71 " " 88,091.61 " " 61,427.60 " N/A N/A N/A " 50,774.94 " N/A N/A N/A " 61,138.68 " N/A N/A " 48,969.71 " N/A N/A N/A N/A N/A N/A N/A " 52,152.74 " " 48,969.71 " N/A " 48,969.71 " " 73,454.57 " N/A " 88,091.61 " " 87,234.64 " N/A DRG 24.1 No Current Volume N/A " 7,552.87 " " 13,586.86 " " 9,474.32 " N/A N/A N/A " 7,831.30 " N/A N/A N/A " 9,429.76 " N/A N/A " 7,552.87 " N/A N/A N/A N/A N/A N/A N/A " 8,043.81 " " 7,552.87 " N/A " 7,552.87 " " 11,329.31 " N/A " 13,586.86 " " 13,454.68 " N/A DRG 24.2 No Current Volume N/A " 9,787.92 " " 17,607.49 " " 12,277.97 " N/A N/A N/A " 10,148.74 " N/A N/A N/A " 12,220.22 " N/A N/A " 9,787.92 " N/A N/A N/A N/A N/A N/A N/A " 10,424.13 " " 9,787.92 " N/A " 9,787.92 " " 14,681.88 " N/A " 17,607.49 " " 17,436.20 " N/A DRG 24.3 No Current Volume N/A " 17,631.12 " " 31,716.62 " " 22,116.48 " N/A N/A N/A " 18,281.08 " N/A N/A N/A " 22,012.45 " N/A N/A " 17,631.12 " N/A N/A N/A N/A N/A N/A N/A " 18,777.14 " " 17,631.12 " N/A " 17,631.12 " " 26,446.68 " N/A " 31,716.62 " " 31,408.08 " N/A DRG 24.4 No Current Volume N/A " 32,395.85 " " 58,276.89 " " 40,637.35 " N/A N/A N/A " 33,590.10 " N/A N/A N/A " 40,446.22 " N/A N/A " 32,395.85 " N/A N/A N/A N/A N/A N/A N/A " 34,501.58 " " 32,395.85 " N/A " 32,395.85 " " 48,593.78 " N/A " 58,276.89 " " 57,709.97 " N/A DRG 26.1 No Current Volume N/A " 11,240.97 " " 20,221.38 " " 14,100.67 " N/A N/A N/A " 11,655.36 " N/A N/A N/A " 14,034.35 " N/A N/A " 11,240.97 " N/A N/A N/A N/A N/A N/A N/A " 11,971.63 " " 11,240.97 " N/A " 11,240.97 " " 16,861.46 " N/A " 20,221.38 " " 20,024.66 " N/A DRG 26.2 No Current Volume N/A " 14,900.31 " " 26,804.17 " " 18,690.95 " N/A N/A N/A " 15,449.60 " N/A N/A N/A " 18,603.04 " N/A N/A " 14,900.31 " N/A N/A N/A N/A N/A N/A N/A " 15,868.83 " " 14,900.31 " N/A " 14,900.31 " " 22,350.47 " N/A " 26,804.17 " " 26,543.41 " N/A DRG 26.3 No Current Volume N/A " 20,013.39 " " 36,002.09 " " 25,104.80 " N/A N/A N/A " 20,751.17 " N/A N/A N/A " 24,986.72 " N/A N/A " 20,013.39 " N/A N/A N/A N/A N/A N/A N/A " 21,314.26 " " 20,013.39 " N/A " 20,013.39 " " 30,020.09 " N/A " 36,002.09 " " 35,651.85 " N/A DRG 26.4 No Current Volume N/A " 38,236.15 " " 68,783.01 " " 47,963.43 " N/A N/A N/A " 39,645.69 " N/A N/A N/A " 47,737.83 " N/A N/A " 38,236.15 " N/A N/A N/A N/A N/A N/A N/A " 40,721.50 " " 38,236.15 " N/A " 38,236.15 " " 57,354.23 " N/A " 68,783.01 " " 68,113.88 " N/A DRG 27.1 No Current Volume N/A " 12,695.39 " " 22,837.74 " " 15,925.10 " N/A N/A N/A " 13,163.40 " N/A N/A N/A " 15,850.19 " N/A N/A " 12,695.39 " N/A N/A N/A N/A N/A N/A N/A " 13,520.59 " " 12,695.39 " N/A " 12,695.39 " " 19,043.09 " N/A " 22,837.74 " " 22,615.57 " N/A DRG 27.2 No Current Volume N/A " 15,938.40 " " 28,671.59 " " 19,993.13 " N/A N/A N/A " 16,525.96 " N/A N/A N/A " 19,899.09 " N/A N/A " 15,938.40 " N/A N/A N/A N/A N/A N/A N/A " 16,974.40 " " 15,938.40 " N/A " 15,938.40 " " 23,907.60 " N/A " 28,671.59 " " 28,392.67 " N/A DRG 27.3 No Current Volume N/A " 22,476.46 " " 40,432.90 " " 28,194.47 " N/A N/A N/A " 23,305.04 " N/A N/A N/A " 28,061.86 " N/A N/A " 22,476.46 " N/A N/A N/A N/A N/A N/A N/A " 23,937.43 " " 22,476.46 " N/A " 22,476.46 " " 33,714.69 " N/A " 40,432.90 " " 40,039.57 " N/A DRG 27.4 No Current Volume N/A " 47,295.48 " " 85,079.84 " " 59,327.45 " N/A N/A N/A " 49,038.99 " N/A N/A N/A " 59,048.41 " N/A N/A " 47,295.48 " N/A N/A N/A N/A N/A N/A N/A " 50,369.69 " " 47,295.48 " N/A " 47,295.48 " " 70,943.22 " N/A " 85,079.84 " " 84,252.17 " N/A DRG 29.1 No Current Volume N/A " 14,198.44 " " 25,541.57 " " 17,810.52 " N/A N/A N/A " 14,721.85 " N/A N/A N/A " 17,726.75 " N/A N/A " 14,198.44 " N/A N/A N/A N/A N/A N/A N/A " 15,121.34 " " 14,198.44 " N/A " 14,198.44 " " 21,297.66 " N/A " 25,541.57 " " 25,293.10 " N/A DRG 29.2 No Current Volume N/A " 15,776.12 " " 28,379.66 " " 19,789.56 " N/A N/A N/A " 16,357.69 " N/A N/A N/A " 19,696.49 " N/A N/A " 15,776.12 " N/A N/A N/A N/A N/A N/A N/A " 16,801.57 " " 15,776.12 " N/A " 15,776.12 " " 23,664.18 " N/A " 28,379.66 " " 28,103.58 " N/A DRG 29.3 No Current Volume N/A " 21,541.09 " " 38,750.27 " " 27,021.14 " N/A N/A N/A " 22,335.18 " N/A N/A N/A " 26,894.05 " N/A N/A " 21,541.09 " N/A N/A N/A N/A N/A N/A N/A " 22,941.26 " " 21,541.09 " N/A " 21,541.09 " " 32,311.64 " N/A " 38,750.27 " " 38,373.30 " N/A DRG 29.4 No Current Volume N/A " 37,650.68 " " 67,729.81 " " 47,229.01 " N/A N/A N/A " 39,038.64 " N/A N/A N/A " 47,006.87 " N/A N/A " 37,650.68 " N/A N/A N/A N/A N/A N/A N/A " 40,097.97 " " 37,650.68 " N/A " 37,650.68 " " 56,476.02 " N/A " 67,729.81 " " 67,070.92 " N/A DRG 30.1 No Current Volume N/A " 14,777.74 " " 26,583.68 " " 18,537.20 " N/A N/A N/A " 15,322.51 " N/A N/A N/A " 18,450.01 " N/A N/A " 14,777.74 " N/A N/A N/A N/A N/A N/A N/A " 15,738.29 " " 14,777.74 " N/A " 14,777.74 " " 22,166.61 " N/A " 26,583.68 " " 26,325.07 " N/A DRG 30.2 No Current Volume N/A " 20,604.34 " " 37,065.15 " " 25,846.08 " N/A N/A N/A " 21,363.90 " N/A N/A N/A " 25,724.52 " N/A N/A " 20,604.34 " N/A N/A N/A N/A N/A N/A N/A " 21,943.62 " " 20,604.34 " N/A " 20,604.34 " " 30,906.51 " N/A " 37,065.15 " " 36,704.57 " N/A DRG 30.3 No Current Volume N/A " 30,970.19 " " 55,712.27 " " 38,849.01 " N/A N/A N/A " 32,111.88 " N/A N/A N/A " 38,666.28 " N/A N/A " 30,970.19 " N/A N/A N/A N/A N/A N/A N/A " 32,983.25 " " 30,970.19 " N/A " 30,970.19 " " 46,455.29 " N/A " 55,712.27 " " 55,170.30 " N/A DRG 30.4 No Current Volume N/A " 42,180.35 " " 75,878.23 " " 52,911.03 " N/A N/A N/A " 43,735.29 " N/A N/A N/A " 52,662.17 " N/A N/A " 42,180.35 " N/A N/A N/A N/A N/A N/A N/A " 44,922.07 " " 42,180.35 " N/A " 42,180.35 " " 63,270.53 " N/A " 75,878.23 " " 75,140.08 " N/A DRG 40.1 No Current Volume N/A " 8,262.96 " " 14,864.24 " " 10,365.06 " N/A N/A N/A " 8,567.57 " N/A N/A N/A " 10,316.31 " N/A N/A " 8,262.96 " N/A N/A N/A N/A N/A N/A N/A " 8,800.05 " " 8,262.96 " N/A " 8,262.96 " " 12,394.44 " N/A " 14,864.24 " " 14,719.64 " N/A DRG 40.2 No Current Volume N/A " 9,688.63 " " 17,428.88 " " 12,153.42 " N/A N/A N/A " 10,045.79 " N/A N/A N/A " 12,096.25 " N/A N/A " 9,688.63 " N/A N/A N/A N/A N/A N/A N/A " 10,318.39 " " 9,688.63 " N/A " 9,688.63 " " 14,532.95 " N/A " 17,428.88 " " 17,259.33 " N/A DRG 40.3 No Current Volume N/A " 15,488.52 " " 27,862.30 " " 19,428.80 " N/A N/A N/A " 16,059.49 " N/A N/A N/A " 19,337.42 " N/A N/A " 15,488.52 " N/A N/A N/A N/A N/A N/A N/A " 16,495.27 " " 15,488.52 " N/A " 15,488.52 " " 23,232.78 " N/A " 27,862.30 " " 27,591.25 " N/A DRG 40.4 No Current Volume N/A " 27,596.39 " " 49,643.15 " " 34,616.91 " N/A N/A N/A " 28,613.71 " N/A N/A N/A " 34,454.09 " N/A N/A " 27,596.39 " N/A N/A N/A N/A N/A N/A N/A " 29,390.16 " " 27,596.39 " N/A " 27,596.39 " " 41,394.59 " N/A " 49,643.15 " " 49,160.21 " N/A DRG 41.1 No Current Volume N/A " 6,460.00 " " 11,620.89 " " 8,103.42 " N/A N/A N/A " 6,698.14 " N/A N/A N/A " 8,065.31 " N/A N/A " 6,460.00 " N/A N/A N/A N/A N/A N/A N/A " 6,879.90 " " 6,460.00 " N/A " 6,460.00 " " 9,690.00 " N/A " 11,620.89 " " 11,507.84 " N/A DRG 41.2 No Current Volume N/A " 7,111.20 " " 12,792.34 " " 8,920.29 " N/A N/A N/A " 7,373.35 " N/A N/A N/A " 8,878.33 " N/A N/A " 7,111.20 " N/A N/A N/A N/A N/A N/A N/A " 7,573.43 " " 7,111.20 " N/A " 7,111.20 " " 10,666.80 " N/A " 12,792.34 " " 12,667.89 " N/A DRG 41.3 No Current Volume N/A " 9,449.65 " " 16,998.98 " " 11,853.64 " N/A N/A N/A " 9,798.00 " N/A N/A N/A " 11,797.89 " N/A N/A " 9,449.65 " N/A N/A N/A N/A N/A N/A N/A " 10,063.88 " " 9,449.65 " N/A " 9,449.65 " " 14,174.48 " N/A " 16,998.98 " " 16,833.61 " N/A DRG 41.4 No Current Volume N/A " 15,451.54 " " 27,795.78 " " 19,382.41 " N/A N/A N/A " 16,021.15 " N/A N/A N/A " 19,291.25 " N/A N/A " 15,451.54 " N/A N/A N/A N/A N/A N/A N/A " 16,455.89 " " 15,451.54 " N/A " 15,451.54 " " 23,177.31 " N/A " 27,795.78 " " 27,525.37 " N/A DRG 42.1 No Current Volume N/A " 5,168.55 " " 9,297.70 " " 6,483.43 " N/A N/A N/A " 5,359.08 " N/A N/A N/A " 6,452.93 " N/A N/A " 5,168.55 " N/A N/A N/A N/A N/A N/A N/A " 5,504.51 " " 5,168.55 " N/A " 5,168.55 " " 7,752.83 " N/A " 9,297.70 " " 9,207.25 " N/A DRG 42.2 No Current Volume N/A " 6,258.68 " " 11,258.74 " " 7,850.89 " N/A N/A N/A " 6,489.40 " N/A N/A N/A " 7,813.96 " N/A N/A " 6,258.68 " N/A N/A N/A N/A N/A N/A N/A " 6,665.49 " " 6,258.68 " N/A " 6,258.68 " " 9,388.02 " N/A " 11,258.74 " " 11,149.21 " N/A DRG 42.3 No Current Volume N/A " 9,475.67 " " 17,045.78 " " 11,886.28 " N/A N/A N/A " 9,824.98 " N/A N/A N/A " 11,830.37 " N/A N/A " 9,475.67 " N/A N/A N/A N/A N/A N/A N/A " 10,091.59 " " 9,475.67 " N/A " 9,475.67 " " 14,213.51 " N/A " 17,045.78 " " 16,879.96 " N/A DRG 42.4 No Current Volume N/A " 22,824.32 " " 41,058.67 " " 28,630.83 " N/A N/A N/A " 23,665.72 " N/A N/A N/A " 28,496.16 " N/A N/A " 22,824.32 " N/A N/A N/A N/A N/A N/A N/A " 24,307.90 " " 22,824.32 " N/A " 22,824.32 " " 34,236.48 " N/A " 41,058.67 " " 40,659.24 " N/A DRG 43.1 No Current Volume N/A " 6,341.53 " " 11,407.78 " " 7,954.82 " N/A N/A N/A " 6,575.31 " N/A N/A N/A " 7,917.40 " N/A N/A " 6,341.53 " N/A N/A N/A N/A N/A N/A N/A " 6,753.73 " " 6,341.53 " N/A " 6,341.53 " " 9,512.30 " N/A " 11,407.78 " " 11,296.80 " N/A DRG 43.2 No Current Volume N/A " 8,362.94 " " 15,044.09 " " 10,490.47 " N/A N/A N/A " 8,671.23 " N/A N/A N/A " 10,441.13 " N/A N/A " 8,362.94 " N/A N/A N/A N/A N/A N/A N/A " 8,906.53 " " 8,362.94 " N/A " 8,362.94 " " 12,544.41 " N/A " 15,044.09 " " 14,897.74 " N/A DRG 43.3 No Current Volume N/A " 13,347.97 " " 24,011.66 " " 16,743.69 " N/A N/A N/A " 13,840.03 " N/A N/A N/A " 16,664.94 " N/A N/A " 13,347.97 " N/A N/A N/A N/A N/A N/A N/A " 14,215.59 " " 13,347.97 " N/A " 13,347.97 " " 20,021.96 " N/A " 24,011.66 " " 23,778.07 " N/A DRG 43.4 No Current Volume N/A " 25,325.05 " " 45,557.23 " " 31,767.74 " N/A N/A N/A " 26,258.64 " N/A N/A N/A " 31,618.32 " N/A N/A " 25,325.05 " N/A N/A N/A N/A N/A N/A N/A " 26,971.18 " " 25,325.05 " N/A " 25,325.05 " " 37,987.58 " N/A " 45,557.23 " " 45,114.04 " N/A DRG 44.1 No Current Volume N/A " 6,275.11 " " 11,288.30 " " 7,871.50 " N/A N/A N/A " 6,506.44 " N/A N/A N/A " 7,834.47 " N/A N/A " 6,275.11 " N/A N/A N/A N/A N/A N/A N/A " 6,682.99 " " 6,275.11 " N/A " 6,275.11 " " 9,412.67 " N/A " 11,288.30 " " 11,178.48 " N/A DRG 44.2 No Current Volume N/A " 7,902.78 " " 14,216.31 " " 9,913.25 " N/A N/A N/A " 8,194.11 " N/A N/A N/A " 9,866.62 " N/A N/A " 7,902.78 " N/A N/A N/A N/A N/A N/A N/A " 8,416.46 " " 7,902.78 " N/A " 7,902.78 " " 11,854.17 " N/A " 14,216.31 " " 14,078.01 " N/A DRG 44.3 No Current Volume N/A " 10,845.18 " " 19,509.39 " " 13,604.19 " N/A N/A N/A " 11,244.98 " N/A N/A N/A " 13,540.21 " N/A N/A " 10,845.18 " N/A N/A N/A N/A N/A N/A N/A " 11,550.12 " " 10,845.18 " N/A " 10,845.18 " " 16,267.77 " N/A " 19,509.39 " " 19,319.60 " N/A DRG 44.4 No Current Volume N/A " 16,200.67 " " 29,143.39 " " 20,322.12 " N/A N/A N/A " 16,797.89 " N/A N/A N/A " 20,226.54 " N/A N/A " 16,200.67 " N/A N/A N/A N/A N/A N/A N/A " 17,253.71 " " 16,200.67 " N/A " 16,200.67 " " 24,301.01 " N/A " 29,143.39 " " 28,859.87 " N/A DRG 45.1 No Current Volume N/A " 5,662.94 " " 10,187.06 " " 7,103.59 " N/A N/A N/A " 5,871.70 " N/A N/A N/A " 7,070.18 " N/A N/A " 5,662.94 " N/A N/A N/A N/A N/A N/A N/A " 6,031.03 " " 5,662.94 " N/A " 5,662.94 " " 8,494.41 " N/A " 10,187.06 " " 10,087.96 " N/A DRG 45.2 No Current Volume N/A " 7,174.88 " " 12,906.89 " " 9,000.17 " N/A N/A N/A " 7,439.38 " N/A N/A N/A " 8,957.84 " N/A N/A " 7,174.88 " N/A N/A N/A N/A N/A N/A N/A " 7,641.25 " " 7,174.88 " N/A " 7,174.88 " " 10,762.32 " N/A " 12,906.89 " " 12,781.33 " N/A DRG 45.3 No Current Volume N/A " 10,458.29 " " 18,813.42 " " 13,118.88 " N/A N/A N/A " 10,843.83 " N/A N/A N/A " 13,057.18 " N/A N/A " 10,458.29 " N/A N/A N/A N/A N/A N/A N/A " 11,138.08 " " 10,458.29 " N/A " 10,458.29 " " 15,687.44 " N/A " 18,813.42 " " 18,630.40 " N/A DRG 45.4 No Current Volume N/A " 18,543.90 " " 33,358.62 " " 23,261.47 " N/A N/A N/A " 19,227.51 " N/A N/A N/A " 23,152.06 " N/A N/A " 18,543.90 " N/A N/A N/A N/A N/A N/A N/A " 19,749.25 " " 18,543.90 " N/A " 18,543.90 " " 27,815.85 " N/A " 33,358.62 " " 33,034.10 " N/A DRG 46.1 No Current Volume N/A " 5,891.65 " " 10,598.49 " " 7,390.49 " N/A N/A N/A " 6,108.84 " N/A N/A N/A " 7,355.73 " N/A N/A " 5,891.65 " N/A N/A N/A N/A N/A N/A N/A " 6,274.61 " " 5,891.65 " N/A " 5,891.65 " " 8,837.48 " N/A " 10,598.49 " " 10,495.39 " N/A DRG 46.2 No Current Volume N/A " 6,940.70 " " 12,485.63 " " 8,706.41 " N/A N/A N/A " 7,196.56 " N/A N/A N/A " 8,665.46 " N/A N/A " 6,940.70 " N/A N/A N/A N/A N/A N/A N/A " 7,391.85 " " 6,940.70 " N/A " 6,940.70 " " 10,411.05 " N/A " 12,485.63 " " 12,364.16 " N/A DRG 46.3 No Current Volume N/A " 8,832.68 " " 15,889.11 " " 11,079.71 " N/A N/A N/A " 9,158.29 " N/A N/A N/A " 11,027.60 " N/A N/A " 8,832.68 " N/A N/A N/A N/A N/A N/A N/A " 9,406.80 " " 8,832.68 " N/A " 8,832.68 " " 13,249.02 " N/A " 15,889.11 " " 15,734.54 " N/A DRG 46.4 No Current Volume N/A " 18,821.92 " " 33,858.75 " " 23,610.22 " N/A N/A N/A " 19,515.77 " N/A N/A N/A " 23,499.17 " N/A N/A " 18,821.92 " N/A N/A N/A N/A N/A N/A N/A " 20,045.34 " " 18,821.92 " N/A " 18,821.92 " " 28,232.88 " N/A " 33,858.75 " " 33,529.37 " N/A DRG 47.1 No Current Volume N/A " 5,128.15 " " 9,225.03 " " 6,432.75 " N/A N/A N/A " 5,317.19 " N/A N/A N/A " 6,402.50 " N/A N/A " 5,128.15 " N/A N/A N/A N/A N/A N/A N/A " 5,461.48 " " 5,128.15 " N/A " 5,128.15 " " 7,692.23 " N/A " 9,225.03 " " 9,135.29 " N/A DRG 47.2 No Current Volume N/A " 5,710.87 " " 10,273.28 " " 7,163.72 " N/A N/A N/A " 5,921.40 " N/A N/A N/A " 7,130.02 " N/A N/A " 5,710.87 " N/A N/A N/A N/A N/A N/A N/A " 6,082.08 " " 5,710.87 " N/A " 5,710.87 " " 8,566.31 " N/A " 10,273.28 " " 10,173.34 " N/A DRG 47.3 No Current Volume N/A " 7,400.85 " " 13,313.39 " " 9,283.63 " N/A N/A N/A " 7,673.68 " N/A N/A N/A " 9,239.96 " N/A N/A " 7,400.85 " N/A N/A N/A N/A N/A N/A N/A " 7,881.91 " " 7,400.85 " N/A " 7,400.85 " " 11,101.28 " N/A " 13,313.39 " " 13,183.87 " N/A DRG 47.4 No Current Volume N/A " 13,108.30 " " 23,580.52 " " 16,443.05 " N/A N/A N/A " 13,591.53 " N/A N/A N/A " 16,365.71 " N/A N/A " 13,108.30 " N/A N/A N/A N/A N/A N/A N/A " 13,960.34 " " 13,108.30 " N/A " 13,108.30 " " 19,662.45 " N/A " 23,580.52 " " 23,351.13 " N/A DRG 48.1 No Current Volume N/A " 5,196.62 " " 9,348.20 " " 6,518.64 " N/A N/A N/A " 5,388.19 " N/A N/A N/A " 6,487.98 " N/A N/A " 5,196.62 " N/A N/A N/A N/A N/A N/A N/A " 5,534.40 " " 5,196.62 " N/A " 5,196.62 " " 7,794.93 " N/A " 9,348.20 " " 9,257.26 " N/A DRG 48.2 No Current Volume N/A " 5,730.05 " " 10,307.79 " " 7,187.77 " N/A N/A N/A " 5,941.28 " N/A N/A N/A " 7,153.97 " N/A N/A " 5,730.05 " N/A N/A N/A N/A N/A N/A N/A " 6,102.50 " " 5,730.05 " N/A " 5,730.05 " " 8,595.08 " N/A " 10,307.79 " " 10,207.51 " N/A DRG 48.3 No Current Volume N/A " 7,936.33 " " 14,276.66 " " 9,955.33 " N/A N/A N/A " 8,228.90 " N/A N/A N/A " 9,908.51 " N/A N/A " 7,936.33 " N/A N/A N/A N/A N/A N/A N/A " 8,452.19 " " 7,936.33 " N/A " 7,936.33 " " 11,904.50 " N/A " 14,276.66 " " 14,137.78 " N/A DRG 48.4 No Current Volume N/A " 18,652.78 " " 33,554.49 " " 23,398.05 " N/A N/A N/A " 19,340.40 " N/A N/A N/A " 23,288.00 " N/A N/A " 18,652.78 " N/A N/A N/A N/A N/A N/A N/A " 19,865.21 " " 18,652.78 " N/A " 18,652.78 " " 27,979.17 " N/A " 33,554.49 " " 33,228.06 " N/A DRG 49.1 No Current Volume N/A " 9,233.26 " " 16,609.71 " " 11,582.20 " N/A N/A N/A " 9,573.64 " N/A N/A N/A " 11,527.73 " N/A N/A " 9,233.26 " N/A N/A N/A N/A N/A N/A N/A " 9,833.42 " " 9,233.26 " N/A " 9,233.26 " " 13,849.89 " N/A " 16,609.71 " " 16,448.13 " N/A DRG 49.2 No Current Volume N/A " 15,187.23 " " 27,320.31 " " 19,050.86 " N/A N/A N/A " 15,747.09 " N/A N/A N/A " 18,961.26 " N/A N/A " 15,187.23 " N/A N/A N/A N/A N/A N/A N/A " 16,174.40 " " 15,187.23 " N/A " 15,187.23 " " 22,780.85 " N/A " 27,320.31 " " 27,054.53 " N/A DRG 49.3 No Current Volume N/A " 17,736.58 " " 31,906.33 " " 22,248.77 " N/A N/A N/A " 18,390.42 " N/A N/A N/A " 22,144.12 " N/A N/A " 17,736.58 " N/A N/A N/A N/A N/A N/A N/A " 18,889.46 " " 17,736.58 " N/A " 17,736.58 " " 26,604.87 " N/A " 31,906.33 " " 31,595.94 " N/A DRG 49.4 No Current Volume N/A " 34,370.69 " " 61,829.43 " " 43,114.59 " N/A N/A N/A " 35,637.74 " N/A N/A N/A " 42,911.81 " N/A N/A " 34,370.69 " N/A N/A N/A N/A N/A N/A N/A " 36,604.78 " " 34,370.69 " N/A " 34,370.69 " " 51,556.04 " N/A " 61,829.43 " " 61,227.95 " N/A DRG 50.1 No Current Volume N/A " 5,265.78 " " 9,472.61 " " 6,605.39 " N/A N/A N/A " 5,459.90 " N/A N/A N/A " 6,574.33 " N/A N/A " 5,265.78 " N/A N/A N/A N/A N/A N/A N/A " 5,608.06 " " 5,265.78 " N/A " 5,265.78 " " 7,898.67 " N/A " 9,472.61 " " 9,380.46 " N/A DRG 50.2 No Current Volume N/A " 10,930.78 " " 19,663.38 " " 13,711.57 " N/A N/A N/A " 11,333.73 " N/A N/A N/A " 13,647.08 " N/A N/A " 10,930.78 " N/A N/A N/A N/A N/A N/A N/A " 11,641.28 " " 10,930.78 " N/A " 10,930.78 " " 16,396.17 " N/A " 19,663.38 " " 19,472.09 " N/A DRG 50.3 No Current Volume N/A " 17,897.49 " " 32,195.79 " " 22,450.61 " N/A N/A N/A " 18,557.27 " N/A N/A N/A " 22,345.02 " N/A N/A " 17,897.49 " N/A N/A N/A N/A N/A N/A N/A " 19,060.83 " " 17,897.49 " N/A " 17,897.49 " " 26,846.24 " N/A " 32,195.79 " " 31,882.59 " N/A DRG 50.4 No Current Volume N/A " 37,241.19 " " 66,993.18 " " 46,715.35 " N/A N/A N/A " 38,614.06 " N/A N/A N/A " 46,495.63 " N/A N/A " 37,241.19 " N/A N/A N/A N/A N/A N/A N/A " 39,661.87 " " 37,241.19 " N/A " 37,241.19 " " 55,861.79 " N/A " 66,993.18 " " 66,341.46 " N/A DRG 51.1 No Current Volume N/A " 3,240.27 " " 5,828.92 " " 4,064.59 " N/A N/A N/A " 3,359.72 " N/A N/A N/A " 4,045.48 " N/A N/A " 3,240.27 " N/A N/A N/A N/A N/A N/A N/A " 3,450.89 " " 3,240.27 " N/A " 3,240.27 " " 4,860.41 " N/A " 5,828.92 " " 5,772.22 " N/A DRG 51.2 No Current Volume N/A " 5,469.84 " " 9,839.70 " " 6,861.37 " N/A N/A N/A " 5,671.48 " N/A N/A N/A " 6,829.10 " N/A N/A " 5,469.84 " N/A N/A N/A N/A N/A N/A N/A " 5,825.38 " " 5,469.84 " N/A " 5,469.84 " " 8,204.76 " N/A " 9,839.70 " " 9,743.97 " N/A DRG 51.3 No Current Volume N/A " 10,725.35 " " 19,293.83 " " 13,453.88 " N/A N/A N/A " 11,120.73 " N/A N/A N/A " 13,390.60 " N/A N/A " 10,725.35 " N/A N/A N/A N/A N/A N/A N/A " 11,422.50 " " 10,725.35 " N/A " 10,725.35 " " 16,088.03 " N/A " 19,293.83 " " 19,106.14 " N/A DRG 51.4 No Current Volume N/A " 22,574.38 " " 40,609.05 " " 28,317.30 " N/A N/A N/A " 23,406.57 " N/A N/A N/A " 28,184.11 " N/A N/A " 22,574.38 " N/A N/A N/A N/A N/A N/A N/A " 24,041.71 " " 22,574.38 " N/A " 22,574.38 " " 33,861.57 " N/A " 40,609.05 " " 40,214.00 " N/A DRG 52.1 No Current Volume N/A " 4,826.85 " " 8,683.02 " " 6,054.80 " N/A N/A N/A " 5,004.79 " N/A N/A N/A " 6,026.32 " N/A N/A " 4,826.85 " N/A N/A N/A N/A N/A N/A N/A " 5,140.60 " " 4,826.85 " N/A " 4,826.85 " " 7,240.28 " N/A " 8,683.02 " " 8,598.55 " N/A DRG 52.2 No Current Volume N/A " 5,486.96 " " 9,870.49 " " 6,882.84 " N/A N/A N/A " 5,689.23 " N/A N/A N/A " 6,850.47 " N/A N/A " 5,486.96 " N/A N/A N/A N/A N/A N/A N/A " 5,843.61 " " 5,486.96 " N/A " 5,486.96 " " 8,230.44 " N/A " 9,870.49 " " 9,774.47 " N/A DRG 52.3 No Current Volume N/A " 7,201.59 " " 12,954.94 " " 9,033.67 " N/A N/A N/A " 7,467.07 " N/A N/A N/A " 8,991.19 " N/A N/A " 7,201.59 " N/A N/A N/A N/A N/A N/A N/A " 7,669.69 " " 7,201.59 " N/A " 7,201.59 " " 10,802.39 " N/A " 12,954.94 " " 12,828.91 " N/A DRG 52.4 No Current Volume N/A " 16,615.63 " " 29,889.86 " " 20,842.65 " N/A N/A N/A " 17,228.15 " N/A N/A N/A " 20,744.61 " N/A N/A " 16,615.63 " N/A N/A N/A N/A N/A N/A N/A " 17,695.65 " " 16,615.63 " N/A " 16,615.63 " " 24,923.45 " N/A " 29,889.86 " " 29,599.08 " N/A DRG 53.1 No Current Volume N/A " 4,258.50 " " 7,660.62 " " 5,341.86 " N/A N/A N/A " 4,415.49 " N/A N/A N/A " 5,316.74 " N/A N/A " 4,258.50 " N/A N/A N/A N/A N/A N/A N/A " 4,535.30 " " 4,258.50 " N/A " 4,258.50 " " 6,387.75 " N/A " 7,660.62 " " 7,586.09 " N/A DRG 53.2 No Current Volume N/A " 5,349.32 " " 9,622.89 " " 6,710.19 " N/A N/A N/A " 5,546.52 " N/A N/A N/A " 6,678.63 " N/A N/A " 5,349.32 " N/A N/A N/A N/A N/A N/A N/A " 5,697.03 " " 5,349.32 " N/A " 5,349.32 " " 8,023.98 " N/A " 9,622.89 " " 9,529.28 " N/A DRG 53.3 No Current Volume N/A " 7,224.87 " " 12,996.82 " " 9,062.88 " N/A N/A N/A " 7,491.21 " N/A N/A N/A " 9,020.25 " N/A N/A " 7,224.87 " N/A N/A N/A N/A N/A N/A N/A " 7,694.49 " " 7,224.87 " N/A " 7,224.87 " " 10,837.31 " N/A " 12,996.82 " " 12,870.38 " N/A DRG 53.4 No Current Volume N/A " 18,847.94 " " 33,905.56 " " 23,642.86 " N/A N/A N/A " 19,542.75 " N/A N/A N/A " 23,531.65 " N/A N/A " 18,847.94 " N/A N/A N/A N/A N/A N/A N/A " 20,073.06 " " 18,847.94 " N/A " 18,847.94 " " 28,271.91 " N/A " 33,905.56 " " 33,575.72 " N/A DRG 54.1 No Current Volume N/A " 4,233.85 " " 7,616.27 " " 5,310.94 " N/A N/A N/A " 4,389.93 " N/A N/A N/A " 5,285.96 " N/A N/A " 4,233.85 " N/A N/A N/A N/A N/A N/A N/A " 4,509.05 " " 4,233.85 " N/A " 4,233.85 " " 6,350.78 " N/A " 7,616.27 " " 7,542.18 " N/A DRG 54.2 No Current Volume N/A " 5,142.53 " " 9,250.90 " " 6,450.79 " N/A N/A N/A " 5,332.10 " N/A N/A N/A " 6,420.45 " N/A N/A " 5,142.53 " N/A N/A N/A N/A N/A N/A N/A " 5,476.79 " " 5,142.53 " N/A " 5,142.53 " " 7,713.80 " N/A " 9,250.90 " " 9,160.90 " N/A DRG 54.3 No Current Volume N/A " 6,728.42 " " 12,103.75 " " 8,440.13 " N/A N/A N/A " 6,976.46 " N/A N/A N/A " 8,400.43 " N/A N/A " 6,728.42 " N/A N/A N/A N/A N/A N/A N/A " 7,165.77 " " 6,728.42 " N/A " 6,728.42 " " 10,092.63 " N/A " 12,103.75 " " 11,986.01 " N/A DRG 54.4 No Current Volume N/A " 14,731.18 " " 26,499.92 " " 18,478.79 " N/A N/A N/A " 15,274.23 " N/A N/A N/A " 18,391.88 " N/A N/A " 14,731.18 " N/A N/A N/A N/A N/A N/A N/A " 15,688.71 " " 14,731.18 " N/A " 14,731.18 " " 22,096.77 " N/A " 26,499.92 " " 26,242.12 " N/A DRG 55.1 No Current Volume N/A " 5,553.38 " " 9,989.98 " " 6,966.16 " N/A N/A N/A " 5,758.10 " N/A N/A N/A " 6,933.39 " N/A N/A " 5,553.38 " N/A N/A N/A N/A N/A N/A N/A " 5,914.35 " " 5,553.38 " N/A " 5,553.38 " " 8,330.07 " N/A " 9,989.98 " " 9,892.79 " N/A DRG 55.2 No Current Volume N/A " 7,613.13 " " 13,695.26 " " 9,549.91 " N/A N/A N/A " 7,893.78 " N/A N/A N/A " 9,504.99 " N/A N/A " 7,613.13 " N/A N/A N/A N/A N/A N/A N/A " 8,107.98 " " 7,613.13 " N/A " 7,613.13 " " 11,419.70 " N/A " 13,695.26 " " 13,562.03 " N/A DRG 55.3 No Current Volume N/A " 11,245.08 " " 20,228.77 " " 14,105.83 " N/A N/A N/A " 11,659.62 " N/A N/A N/A " 14,039.48 " N/A N/A " 11,245.08 " N/A N/A N/A N/A N/A N/A N/A " 11,976.01 " " 11,245.08 " N/A " 11,245.08 " " 16,867.62 " N/A " 20,228.77 " " 20,031.99 " N/A DRG 55.4 No Current Volume N/A " 23,111.23 " " 41,574.79 " " 28,990.73 " N/A N/A N/A " 23,963.21 " N/A N/A N/A " 28,854.37 " N/A N/A " 23,111.23 " N/A N/A N/A N/A N/A N/A N/A " 24,613.46 " " 23,111.23 " N/A " 23,111.23 " " 34,666.85 " N/A " 41,574.79 " " 41,170.35 " N/A DRG 56.1 No Current Volume N/A " 5,334.94 " " 9,597.02 " " 6,692.15 " N/A N/A N/A " 5,531.61 " N/A N/A N/A " 6,660.67 " N/A N/A " 5,334.94 " N/A N/A N/A N/A N/A N/A N/A " 5,681.71 " " 5,334.94 " N/A " 5,334.94 " " 8,002.41 " N/A " 9,597.02 " " 9,503.66 " N/A DRG 56.2 No Current Volume N/A " 7,297.46 " " 13,127.40 " " 9,153.93 " N/A N/A N/A " 7,566.47 " N/A N/A N/A " 9,110.88 " N/A N/A " 7,297.46 " N/A N/A N/A N/A N/A N/A N/A " 7,771.79 " " 7,297.46 " N/A " 7,297.46 " " 10,946.19 " N/A " 13,127.40 " " 12,999.70 " N/A DRG 56.3 No Current Volume N/A " 10,797.93 " " 19,424.40 " " 13,544.92 " N/A N/A N/A " 11,195.99 " N/A N/A N/A " 13,481.22 " N/A N/A " 10,797.93 " N/A N/A N/A N/A N/A N/A N/A " 11,499.80 " " 10,797.93 " N/A " 10,797.93 " " 16,196.90 " N/A " 19,424.40 " " 19,235.43 " N/A DRG 56.4 No Current Volume N/A " 21,161.05 " " 38,066.61 " " 26,544.42 " N/A N/A N/A " 21,941.13 " N/A N/A N/A " 26,419.57 " N/A N/A " 21,161.05 " N/A N/A N/A N/A N/A N/A N/A " 22,536.52 " " 21,161.05 " N/A " 21,161.05 " " 31,741.58 " N/A " 38,066.61 " " 37,696.29 " N/A DRG 57.1 No Current Volume N/A " 4,372.17 " " 7,865.10 " " 5,484.45 " N/A N/A N/A " 4,533.35 " N/A N/A N/A " 5,458.65 " N/A N/A " 4,372.17 " N/A N/A N/A N/A N/A N/A N/A " 4,656.36 " " 4,372.17 " N/A " 4,372.17 " " 6,558.26 " N/A " 7,865.10 " " 7,788.58 " N/A DRG 57.2 No Current Volume N/A " 6,580.51 " " 11,837.68 " " 8,254.59 " N/A N/A N/A " 6,823.10 " N/A N/A N/A " 8,215.77 " N/A N/A " 6,580.51 " N/A N/A N/A N/A N/A N/A N/A " 7,008.24 " " 6,580.51 " N/A " 6,580.51 " " 9,870.77 " N/A " 11,837.68 " " 11,722.52 " N/A DRG 57.3 No Current Volume N/A " 9,482.51 " " 17,058.09 " " 11,894.86 " N/A N/A N/A " 9,832.08 " N/A N/A N/A " 11,838.91 " N/A N/A " 9,482.51 " N/A N/A N/A N/A N/A N/A N/A " 10,098.87 " " 9,482.51 " N/A " 9,482.51 " " 14,223.77 " N/A " 17,058.09 " " 16,892.14 " N/A DRG 57.4 No Current Volume N/A " 17,214.79 " " 30,967.69 " " 21,594.23 " N/A N/A N/A " 17,849.40 " N/A N/A N/A " 21,492.67 " N/A N/A " 17,214.79 " N/A N/A N/A N/A N/A N/A N/A " 18,333.75 " " 17,214.79 " N/A " 17,214.79 " " 25,822.19 " N/A " 30,967.69 " " 30,666.43 " N/A DRG 58.1 No Current Volume N/A " 5,295.23 " " 9,525.59 " " 6,642.34 " N/A N/A N/A " 5,490.43 " N/A N/A N/A " 6,611.09 " N/A N/A " 5,295.23 " N/A N/A N/A N/A N/A N/A N/A " 5,639.42 " " 5,295.23 " N/A " 5,295.23 " " 7,942.85 " N/A " 9,525.59 " " 9,432.92 " N/A DRG 58.2 No Current Volume N/A " 6,534.64 " " 11,755.16 " " 8,197.05 " N/A N/A N/A " 6,775.53 " N/A N/A N/A " 8,158.50 " N/A N/A " 6,534.64 " N/A N/A N/A N/A N/A N/A N/A " 6,959.39 " " 6,534.64 " N/A " 6,534.64 " " 9,801.96 " N/A " 11,755.16 " " 11,640.81 " N/A DRG 58.3 No Current Volume N/A " 9,345.56 " " 16,811.73 " " 11,723.07 " N/A N/A N/A " 9,690.08 " N/A N/A N/A " 11,667.93 " N/A N/A " 9,345.56 " N/A N/A N/A N/A N/A N/A N/A " 9,953.02 " " 9,345.56 " N/A " 9,345.56 " " 14,018.34 " N/A " 16,811.73 " " 16,648.18 " N/A DRG 58.4 No Current Volume N/A " 19,129.37 " " 34,411.82 " " 23,995.88 " N/A N/A N/A " 19,834.56 " N/A N/A N/A " 23,883.02 " N/A N/A " 19,129.37 " N/A N/A N/A N/A N/A N/A N/A " 20,372.78 " " 19,129.37 " N/A " 19,129.37 " " 28,694.06 " N/A " 34,411.82 " " 34,077.06 " N/A DRG 59.1 No Current Volume N/A " 5,506.82 " " 9,906.22 " " 6,907.76 " N/A N/A N/A " 5,709.82 " N/A N/A N/A " 6,875.26 " N/A N/A " 5,506.82 " N/A N/A N/A N/A N/A N/A N/A " 5,864.76 " " 5,506.82 " N/A " 5,506.82 " " 8,260.23 " N/A " 9,906.22 " " 9,809.85 " N/A DRG 59.2 No Current Volume N/A " 7,261.16 " " 13,062.10 " " 9,108.40 " N/A N/A N/A " 7,528.84 " N/A N/A N/A " 9,065.56 " N/A N/A " 7,261.16 " N/A N/A N/A N/A N/A N/A N/A " 7,733.14 " " 7,261.16 " N/A " 7,261.16 " " 10,891.74 " N/A " 13,062.10 " " 12,935.03 " N/A DRG 59.3 No Current Volume N/A " 10,936.94 " " 19,674.46 " " 13,719.30 " N/A N/A N/A " 11,340.12 " N/A N/A N/A " 13,654.77 " N/A N/A " 10,936.94 " N/A N/A N/A N/A N/A N/A N/A " 11,647.84 " " 10,936.94 " N/A " 10,936.94 " " 16,405.41 " N/A " 19,674.46 " " 19,483.06 " N/A DRG 59.4 No Current Volume N/A " 17,850.93 " " 32,112.04 " " 22,392.21 " N/A N/A N/A " 18,508.99 " N/A N/A N/A " 22,286.89 " N/A N/A " 17,850.93 " N/A N/A N/A N/A N/A N/A N/A " 19,011.24 " " 17,850.93 " N/A " 17,850.93 " " 26,776.40 " N/A " 32,112.04 " " 31,799.65 " N/A DRG 73.1 No Current Volume N/A " 7,709.68 " " 13,868.94 " " 9,671.02 " N/A N/A N/A " 7,993.89 " N/A N/A N/A " 9,625.54 " N/A N/A " 7,709.68 " N/A N/A N/A N/A N/A N/A N/A " 8,210.81 " " 7,709.68 " N/A " 7,709.68 " " 11,564.52 " N/A " 13,868.94 " " 13,734.02 " N/A DRG 73.2 No Current Volume N/A " 10,359.00 " " 18,634.81 " " 12,994.33 " N/A N/A N/A " 10,740.88 " N/A N/A N/A " 12,933.21 " N/A N/A " 10,359.00 " N/A N/A N/A N/A N/A N/A N/A " 11,032.34 " " 10,359.00 " N/A " 10,359.00 " " 15,538.50 " N/A " 18,634.81 " " 18,453.52 " N/A DRG 73.3 No Current Volume N/A " 17,095.64 " " 30,753.35 " " 21,444.77 " N/A N/A N/A " 17,725.86 " N/A N/A N/A " 21,343.91 " N/A N/A " 17,095.64 " N/A N/A N/A N/A N/A N/A N/A " 18,206.86 " " 17,095.64 " N/A " 17,095.64 " " 25,643.46 " N/A " 30,753.35 " " 30,454.17 " N/A DRG 73.4 No Current Volume N/A " 38,043.73 " " 68,436.87 " " 47,722.05 " N/A N/A N/A " 39,446.18 " N/A N/A N/A " 47,497.60 " N/A N/A " 38,043.73 " N/A N/A N/A N/A N/A N/A N/A " 40,516.57 " " 38,043.73 " N/A " 38,043.73 " " 57,065.60 " N/A " 68,436.87 " " 67,771.10 " N/A DRG 82.1 No Current Volume N/A " 4,246.18 " " 7,638.45 " " 5,326.41 " N/A N/A N/A " 4,402.71 " N/A N/A N/A " 5,301.36 " N/A N/A " 4,246.18 " N/A N/A N/A N/A N/A N/A N/A " 4,522.18 " " 4,246.18 " N/A " 4,246.18 " " 6,369.27 " N/A " 7,638.45 " " 7,564.15 " N/A DRG 82.2 No Current Volume N/A " 5,542.42 " " 9,970.26 " " 6,952.41 " N/A N/A N/A " 5,746.74 " N/A N/A N/A " 6,919.71 " N/A N/A " 5,542.42 " N/A N/A N/A N/A N/A N/A N/A " 5,902.68 " " 5,542.42 " N/A " 5,542.42 " " 8,313.63 " N/A " 9,970.26 " " 9,873.27 " N/A DRG 82.3 No Current Volume N/A " 8,564.94 " " 15,407.47 " " 10,743.86 " N/A N/A N/A " 8,880.68 " N/A N/A N/A " 10,693.33 " N/A N/A " 8,564.94 " N/A N/A N/A N/A N/A N/A N/A " 9,121.66 " " 8,564.94 " N/A " 8,564.94 " " 12,847.41 " N/A " 15,407.47 " " 15,257.58 " N/A DRG 82.4 No Current Volume N/A " 23,146.84 " " 41,638.85 " " 29,035.40 " N/A N/A N/A " 24,000.13 " N/A N/A N/A " 28,898.83 " N/A N/A " 23,146.84 " N/A N/A N/A N/A N/A N/A N/A " 24,651.38 " " 23,146.84 " N/A " 23,146.84 " " 34,720.26 " N/A " 41,638.85 " " 41,233.78 " N/A DRG 89.1 No Current Volume N/A " 14,098.46 " " 25,361.72 " " 17,685.11 " N/A N/A N/A " 14,618.19 " N/A N/A N/A " 17,601.93 " N/A N/A " 14,098.46 " N/A N/A N/A N/A N/A N/A N/A " 15,014.86 " " 14,098.46 " N/A " 14,098.46 " " 21,147.69 " N/A " 25,361.72 " " 25,115.00 " N/A DRG 89.2 No Current Volume N/A " 18,777.41 " " 33,778.68 " " 23,554.38 " N/A N/A N/A " 19,469.62 " N/A N/A N/A " 23,443.60 " N/A N/A " 18,777.41 " N/A N/A N/A N/A N/A N/A N/A " 19,997.94 " " 18,777.41 " N/A " 18,777.41 " " 28,166.12 " N/A " 33,778.68 " " 33,450.08 " N/A DRG 89.3 No Current Volume N/A " 30,168.34 " " 54,269.83 " " 37,843.17 " N/A N/A N/A " 31,280.47 " N/A N/A N/A " 37,665.17 " N/A N/A " 30,168.34 " N/A N/A N/A N/A N/A N/A N/A " 32,129.28 " " 30,168.34 " N/A " 30,168.34 " " 45,252.51 " N/A " 54,269.83 " " 53,741.88 " N/A DRG 89.4 No Current Volume N/A " 52,388.02 " " 94,240.81 " " 65,715.53 " N/A N/A N/A " 54,319.26 " N/A N/A N/A " 65,406.44 " N/A N/A " 52,388.02 " N/A N/A N/A N/A N/A N/A N/A " 55,793.24 " " 52,388.02 " N/A " 52,388.02 " " 78,582.03 " N/A " 94,240.81 " " 93,324.02 " N/A DRG 91.1 No Current Volume N/A " 10,506.23 " " 18,899.66 " " 13,179.01 " N/A N/A N/A " 10,893.53 " N/A N/A N/A " 13,117.03 " N/A N/A " 10,506.23 " N/A N/A N/A N/A N/A N/A N/A " 11,189.13 " " 10,506.23 " N/A " 10,506.23 " " 15,759.35 " N/A " 18,899.66 " " 18,715.80 " N/A DRG 91.2 No Current Volume N/A " 16,968.96 " " 30,525.46 " " 21,285.86 " N/A N/A N/A " 17,594.51 " N/A N/A N/A " 21,185.75 " N/A N/A " 16,968.96 " N/A N/A N/A N/A N/A N/A N/A " 18,071.94 " " 16,968.96 " N/A " 16,968.96 " " 25,453.44 " N/A " 30,525.46 " " 30,228.51 " N/A DRG 91.3 No Current Volume N/A " 29,590.40 " " 53,230.17 " " 37,118.20 " N/A N/A N/A " 30,681.23 " N/A N/A N/A " 36,943.61 " N/A N/A " 29,590.40 " N/A N/A N/A N/A N/A N/A N/A " 31,513.78 " " 29,590.40 " N/A " 29,590.40 " " 44,385.60 " N/A " 53,230.17 " " 52,712.34 " N/A DRG 91.4 No Current Volume N/A " 56,297.98 " " 101,274.44 " " 70,620.19 " N/A N/A N/A " 58,373.36 " N/A N/A N/A " 70,288.03 " N/A N/A " 56,297.98 " N/A N/A N/A N/A N/A N/A N/A " 59,957.35 " " 56,297.98 " N/A " 56,297.98 " " 84,446.97 " N/A " 101,274.44 " " 100,289.22 " N/A DRG 92.1 No Current Volume N/A " 9,570.16 " " 17,215.76 " " 12,004.81 " N/A N/A N/A " 9,922.96 " N/A N/A N/A " 11,948.34 " N/A N/A " 9,570.16 " N/A N/A N/A N/A N/A N/A N/A " 10,192.22 " " 9,570.16 " N/A " 9,570.16 " " 14,355.24 " N/A " 17,215.76 " " 17,048.28 " N/A DRG 92.2 No Current Volume N/A " 13,630.77 " " 24,520.39 " " 17,098.44 " N/A N/A N/A " 14,133.26 " N/A N/A N/A " 17,018.02 " N/A N/A " 13,630.77 " N/A N/A N/A N/A N/A N/A N/A " 14,516.77 " " 13,630.77 " N/A " 13,630.77 " " 20,446.16 " N/A " 24,520.39 " " 24,281.85 " N/A DRG 92.3 No Current Volume N/A " 23,325.56 " " 41,960.35 " " 29,259.58 " N/A N/A N/A " 24,185.44 " N/A N/A N/A " 29,121.96 " N/A N/A " 23,325.56 " N/A N/A N/A N/A N/A N/A N/A " 24,841.72 " " 23,325.56 " N/A " 23,325.56 " " 34,988.34 " N/A " 41,960.35 " " 41,552.15 " N/A DRG 92.4 No Current Volume N/A " 51,519.06 " " 92,677.64 " " 64,625.51 " N/A N/A N/A " 53,418.27 " N/A N/A N/A " 64,321.55 " N/A N/A " 51,519.06 " N/A N/A N/A N/A N/A N/A N/A " 54,867.80 " " 51,519.06 " N/A " 51,519.06 " " 77,278.59 " N/A " 92,677.64 " " 91,776.05 " N/A DRG 95.1 No Current Volume N/A " 6,639.40 " " 11,943.62 " " 8,328.46 " N/A N/A N/A " 6,884.16 " N/A N/A N/A " 8,289.29 " N/A N/A " 6,639.40 " N/A N/A N/A N/A N/A N/A N/A " 7,070.96 " " 6,639.40 " N/A " 6,639.40 " " 9,959.10 " N/A " 11,943.62 " " 11,827.43 " N/A DRG 95.2 No Current Volume N/A " 7,783.63 " " 14,001.97 " " 9,763.79 " N/A N/A N/A " 8,070.57 " N/A N/A N/A " 9,717.86 " N/A N/A " 7,783.63 " N/A N/A N/A N/A N/A N/A N/A " 8,289.57 " " 7,783.63 " N/A " 7,783.63 " " 11,675.45 " N/A " 14,001.97 " " 13,865.76 " N/A DRG 95.3 No Current Volume N/A " 12,887.13 " " 23,182.66 " " 16,165.62 " N/A N/A N/A " 13,362.20 " N/A N/A N/A " 16,089.58 " N/A N/A " 12,887.13 " N/A N/A N/A N/A N/A N/A N/A " 13,724.79 " " 12,887.13 " N/A " 12,887.13 " " 19,330.70 " N/A " 23,182.66 " " 22,957.13 " N/A DRG 95.4 No Current Volume N/A " 28,870.04 " " 51,934.31 " " 36,214.58 " N/A N/A N/A " 29,934.31 " N/A N/A N/A " 36,044.24 " N/A N/A " 28,870.04 " N/A N/A N/A N/A N/A N/A N/A " 30,746.59 " " 28,870.04 " N/A " 28,870.04 " " 43,305.06 " N/A " 51,934.31 " " 51,429.09 " N/A DRG 97.1 No Current Volume N/A " 4,576.92 " " 8,233.42 " " 5,741.29 " N/A N/A N/A " 4,745.64 " N/A N/A N/A " 5,714.28 " N/A N/A " 4,576.92 " N/A N/A N/A N/A N/A N/A N/A " 4,874.42 " " 4,576.92 " N/A " 4,576.92 " " 6,865.38 " N/A " 8,233.42 " " 8,153.33 " N/A DRG 97.2 No Current Volume N/A " 6,559.97 " " 11,800.73 " " 8,228.83 " N/A N/A N/A " 6,801.80 " N/A N/A N/A " 8,190.12 " N/A N/A " 6,559.97 " N/A N/A N/A N/A N/A N/A N/A " 6,986.37 " " 6,559.97 " N/A " 6,559.97 " " 9,839.96 " N/A " 11,800.73 " " 11,685.93 " N/A DRG 97.3 No Current Volume N/A " 11,459.41 " " 20,614.33 " " 14,374.68 " N/A N/A N/A " 11,881.85 " N/A N/A N/A " 14,307.07 " N/A N/A " 11,459.41 " N/A N/A N/A N/A N/A N/A N/A " 12,204.27 " " 11,459.41 " N/A " 11,459.41 " " 17,189.12 " N/A " 20,614.33 " " 20,413.79 " N/A DRG 97.4 No Current Volume N/A " 27,931.24 " " 50,245.51 " " 35,036.95 " N/A N/A N/A " 28,960.90 " N/A N/A N/A " 34,872.15 " N/A N/A " 27,931.24 " N/A N/A N/A N/A N/A N/A N/A " 29,746.77 " " 27,931.24 " N/A " 27,931.24 " " 41,896.86 " N/A " 50,245.51 " " 49,756.71 " N/A DRG 98.1 No Current Volume N/A " 7,806.91 " " 14,043.85 " " 9,792.99 " N/A N/A N/A " 8,094.71 " N/A N/A N/A " 9,746.93 " N/A N/A " 7,806.91 " N/A N/A N/A N/A N/A N/A N/A " 8,314.36 " " 7,806.91 " N/A " 7,806.91 " " 11,710.37 " N/A " 14,043.85 " " 13,907.23 " N/A DRG 98.2 No Current Volume N/A " 10,483.63 " " 18,859.00 " " 13,150.67 " N/A N/A N/A " 10,870.10 " N/A N/A N/A " 13,088.81 " N/A N/A " 10,483.63 " N/A N/A N/A N/A N/A N/A N/A " 11,165.07 " " 10,483.63 " N/A " 10,483.63 " " 15,725.45 " N/A " 18,859.00 " " 18,675.54 " N/A DRG 98.3 No Current Volume N/A " 18,163.86 " " 32,674.97 " " 22,784.75 " N/A N/A N/A " 18,833.46 " N/A N/A N/A " 22,677.58 " N/A N/A " 18,163.86 " N/A N/A N/A N/A N/A N/A N/A " 19,344.51 " " 18,163.86 " N/A " 18,163.86 " " 27,245.79 " N/A " 32,674.97 " " 32,357.10 " N/A DRG 98.4 No Current Volume N/A " 34,251.55 " " 61,615.11 " " 42,965.14 " N/A N/A N/A " 35,514.20 " N/A N/A N/A " 42,763.06 " N/A N/A " 34,251.55 " N/A N/A N/A N/A N/A N/A N/A " 36,477.90 " " 34,251.55 " N/A " 34,251.55 " " 51,377.33 " N/A " 61,615.11 " " 61,015.71 " N/A DRG 110.1 No Current Volume N/A " 6,840.72 " " 12,305.77 " " 8,581.00 " N/A N/A N/A " 7,092.90 " N/A N/A N/A " 8,540.64 " N/A N/A " 6,840.72 " N/A N/A N/A N/A N/A N/A N/A " 7,285.37 " " 6,840.72 " N/A " 6,840.72 " " 10,261.08 " N/A " 12,305.77 " " 12,186.06 " N/A DRG 110.2 No Current Volume N/A " 7,787.74 " " 14,009.37 " " 9,768.94 " N/A N/A N/A " 8,074.83 " N/A N/A N/A " 9,722.99 " N/A N/A " 7,787.74 " N/A N/A N/A N/A N/A N/A N/A " 8,293.94 " " 7,787.74 " N/A " 7,787.74 " " 11,681.61 " N/A " 14,009.37 " " 13,873.08 " N/A DRG 110.3 No Current Volume N/A " 11,106.07 " " 19,978.71 " " 13,931.45 " N/A N/A N/A " 11,515.49 " N/A N/A N/A " 13,865.93 " N/A N/A " 11,106.07 " N/A N/A N/A N/A N/A N/A N/A " 11,827.96 " " 11,106.07 " N/A " 11,106.07 " " 16,659.11 " N/A " 19,978.71 " " 19,784.35 " N/A DRG 110.4 No Current Volume N/A " 18,858.21 " " 33,924.03 " " 23,655.74 " N/A N/A N/A " 19,553.40 " N/A N/A N/A " 23,544.48 " N/A N/A " 18,858.21 " N/A N/A N/A N/A N/A N/A N/A " 20,083.99 " " 18,858.21 " N/A " 18,858.21 " " 28,287.32 " N/A " 33,924.03 " " 33,594.02 " N/A DRG 111.1 No Current Volume N/A " 4,691.27 " " 8,439.13 " " 5,884.73 " N/A N/A N/A " 4,864.21 " N/A N/A N/A " 5,857.05 " N/A N/A " 4,691.27 " N/A N/A N/A N/A N/A N/A N/A " 4,996.20 " " 4,691.27 " N/A " 4,691.27 " " 7,036.91 " N/A " 8,439.13 " " 8,357.03 " N/A DRG 111.2 No Current Volume N/A " 5,109.66 " " 9,191.77 " " 6,409.56 " N/A N/A N/A " 5,298.02 " N/A N/A N/A " 6,379.41 " N/A N/A " 5,109.66 " N/A N/A N/A N/A N/A N/A N/A " 5,441.79 " " 5,109.66 " N/A " 5,109.66 " " 7,664.49 " N/A " 9,191.77 " " 9,102.35 " N/A DRG 111.3 No Current Volume N/A " 6,508.62 " " 11,708.36 " " 8,164.41 " N/A N/A N/A " 6,748.55 " N/A N/A N/A " 8,126.01 " N/A N/A " 6,508.62 " N/A N/A N/A N/A N/A N/A N/A " 6,931.68 " " 6,508.62 " N/A " 6,508.62 " " 9,762.93 " N/A " 11,708.36 " " 11,594.46 " N/A DRG 111.4 No Current Volume N/A " 10,472.67 " " 18,839.29 " " 13,136.92 " N/A N/A N/A " 10,858.74 " N/A N/A N/A " 13,075.13 " N/A N/A " 10,472.67 " N/A N/A N/A N/A N/A N/A N/A " 11,153.39 " " 10,472.67 " N/A " 10,472.67 " " 15,709.01 " N/A " 18,839.29 " " 18,656.01 " N/A DRG 113.1 " 14,297.57 " " 4,505.16 " " 2,770.53 " " 4,983.91 " " 3,475.35 " N/A N/A N/A " 2,872.66 " N/A N/A N/A " 3,459.01 " N/A N/A " 2,770.53 " N/A N/A N/A N/A N/A N/A N/A " 2,950.61 " " 2,770.53 " N/A " 2,770.53 " " 4,155.80 " N/A " 4,983.91 " " 4,935.42 " N/A DRG 113.2 No Current Volume N/A " 4,054.45 " " 7,293.55 " " 5,085.90 " N/A N/A N/A " 4,203.91 " N/A N/A N/A " 5,061.98 " N/A N/A " 4,054.45 " N/A N/A N/A N/A N/A N/A N/A " 4,317.99 " " 4,054.45 " N/A " 4,054.45 " " 6,081.68 " N/A " 7,293.55 " " 7,222.60 " N/A DRG 113.3 No Current Volume N/A " 6,527.10 " " 11,741.60 " " 8,187.59 " N/A N/A N/A " 6,767.72 " N/A N/A N/A " 8,149.08 " N/A N/A " 6,527.10 " N/A N/A N/A N/A N/A N/A N/A " 6,951.36 " " 6,527.10 " N/A " 6,527.10 " " 9,790.65 " N/A " 11,741.60 " " 11,627.38 " N/A DRG 113.4 No Current Volume N/A " 13,642.41 " " 24,541.33 " " 17,113.04 " N/A N/A N/A " 14,145.33 " N/A N/A N/A " 17,032.55 " N/A N/A " 13,642.41 " N/A N/A N/A N/A N/A N/A N/A " 14,529.17 " " 13,642.41 " N/A " 13,642.41 " " 20,463.62 " N/A " 24,541.33 " " 24,302.59 " N/A DRG 114.1 " 12,430.27 " " 3,916.78 " " 3,505.27 " " 6,305.63 " " 4,397.01 " N/A N/A N/A " 3,634.49 " N/A N/A N/A " 4,376.33 " N/A N/A " 3,505.27 " N/A N/A N/A N/A N/A N/A N/A " 3,733.11 " " 3,505.27 " N/A " 3,505.27 " " 5,257.91 " N/A " 6,305.63 " " 6,244.29 " N/A DRG 114.2 No Current Volume N/A " 4,940.52 " " 8,887.50 " " 6,197.39 " N/A N/A N/A " 5,122.65 " N/A N/A N/A " 6,168.24 " N/A N/A " 4,940.52 " N/A N/A N/A N/A N/A N/A N/A " 5,261.65 " " 4,940.52 " N/A " 4,940.52 " " 7,410.78 " N/A " 8,887.50 " " 8,801.04 " N/A DRG 114.3 " 78,455.38 " " 24,721.29 " " 8,508.79 " " 15,306.46 " " 10,673.43 " N/A N/A N/A " 8,822.46 " N/A N/A N/A " 10,623.22 " N/A N/A " 8,508.79 " N/A N/A N/A N/A N/A N/A N/A " 9,061.86 " " 8,508.79 " N/A " 8,508.79 " " 12,763.19 " N/A " 15,306.46 " " 15,157.56 " N/A DRG 114.4 No Current Volume N/A " 19,868.22 " " 35,740.94 " " 24,922.70 " N/A N/A N/A " 20,600.65 " N/A N/A N/A " 24,805.47 " N/A N/A " 19,868.22 " N/A N/A N/A N/A N/A N/A N/A " 21,159.65 " " 19,868.22 " N/A " 19,868.22 " " 29,802.33 " N/A " 35,740.94 " " 35,393.25 " N/A DRG 115.1 " 24,007.64 " " 7,564.81 " " 4,014.73 " " 7,222.10 " " 5,036.08 " N/A N/A N/A " 4,162.73 " N/A N/A N/A " 5,012.39 " N/A N/A " 4,014.73 " N/A N/A N/A N/A N/A N/A N/A " 4,275.69 " " 4,014.73 " N/A " 4,014.73 " " 6,022.10 " N/A " 7,222.10 " " 7,151.84 " N/A DRG 115.2 " 52,518.63 " " 16,548.62 " " 5,565.70 " " 10,012.14 " " 6,981.61 " N/A N/A N/A " 5,770.88 " N/A N/A N/A " 6,948.78 " N/A N/A " 5,565.70 " N/A N/A N/A N/A N/A N/A N/A " 5,927.47 " " 5,565.70 " N/A " 5,565.70 " " 8,348.55 " N/A " 10,012.14 " " 9,914.74 " N/A DRG 115.3 " 58,315.25 " " 18,375.14 " " 8,925.12 " " 16,055.40 " " 11,195.67 " N/A N/A N/A " 9,254.14 " N/A N/A N/A " 11,143.01 " N/A N/A " 8,925.12 " N/A N/A N/A N/A N/A N/A N/A " 9,505.25 " " 8,925.12 " N/A " 8,925.12 " " 13,387.68 " N/A " 16,055.40 " " 15,899.21 " N/A DRG 115.4 " 138,016.40 " " 43,488.97 " " 18,267.26 " " 32,860.97 " " 22,914.45 " N/A N/A N/A " 18,940.67 " N/A N/A N/A " 22,806.67 " N/A N/A " 18,267.26 " N/A N/A N/A N/A N/A N/A N/A " 19,454.63 " " 18,267.26 " N/A " 18,267.26 " " 27,400.89 " N/A " 32,860.97 " " 32,541.30 " N/A DRG 120.1 No Current Volume N/A " 14,255.27 " " 25,643.81 " " 17,881.81 " N/A N/A N/A " 14,780.78 " N/A N/A N/A " 17,797.70 " N/A N/A " 14,255.27 " N/A N/A N/A N/A N/A N/A N/A " 15,181.86 " " 14,255.27 " N/A " 14,255.27 " " 21,382.91 " N/A " 25,643.81 " " 25,394.34 " N/A DRG 120.2 No Current Volume N/A " 17,448.29 " " 31,387.73 " " 21,887.13 " N/A N/A N/A " 18,091.51 " N/A N/A N/A " 21,784.19 " N/A N/A " 17,448.29 " N/A N/A N/A N/A N/A N/A N/A " 18,582.43 " " 17,448.29 " N/A " 17,448.29 " " 26,172.44 " N/A " 31,387.73 " " 31,082.38 " N/A DRG 120.3 No Current Volume N/A " 26,594.59 " " 47,841.01 " " 33,360.25 " N/A N/A N/A " 27,574.98 " N/A N/A N/A " 33,203.35 " N/A N/A " 26,594.59 " N/A N/A N/A N/A N/A N/A N/A " 28,323.24 " " 26,594.59 " N/A " 26,594.59 " " 39,891.89 " N/A " 47,841.01 " " 47,375.60 " N/A DRG 120.4 No Current Volume N/A " 49,836.61 " " 89,651.08 " " 62,515.04 " N/A N/A N/A " 51,673.80 " N/A N/A N/A " 62,221.01 " N/A N/A " 49,836.61 " N/A N/A N/A N/A N/A N/A N/A " 53,075.99 " " 49,836.61 " N/A " 49,836.61 " " 74,754.92 " N/A " 89,651.08 " " 88,778.94 " N/A DRG 121.1 No Current Volume N/A " 10,650.71 " " 19,159.56 " " 13,360.25 " N/A N/A N/A " 11,043.34 " N/A N/A N/A " 13,297.41 " N/A N/A " 10,650.71 " N/A N/A N/A N/A N/A N/A N/A " 11,343.01 " " 10,650.71 " N/A " 10,650.71 " " 15,976.07 " N/A " 19,159.56 " " 18,973.17 " N/A DRG 121.2 " 28,333.84 " " 8,927.99 " " 13,599.27 " " 24,463.73 " " 17,058.92 " N/A N/A N/A " 14,100.60 " N/A N/A N/A " 16,978.69 " N/A N/A " 13,599.27 " N/A N/A N/A N/A N/A N/A N/A " 14,483.22 " " 13,599.27 " N/A " 13,599.27 " " 20,398.91 " N/A " 24,463.73 " " 24,225.74 " N/A DRG 121.3 " 85,826.42 " " 27,043.90 " " 21,595.87 " " 38,848.81 " " 27,089.86 " N/A N/A N/A " 22,391.98 " N/A N/A N/A " 26,962.44 " N/A N/A " 21,595.87 " N/A N/A N/A N/A N/A N/A N/A " 22,999.60 " " 21,595.87 " N/A " 21,595.87 " " 32,393.81 " N/A " 38,848.81 " " 38,470.88 " N/A DRG 121.4 " 119,858.11 " " 37,767.29 " " 39,728.23 " " 71,467.11 " " 49,835.09 " N/A N/A N/A " 41,192.78 " N/A N/A N/A " 49,600.70 " N/A N/A " 39,728.23 " N/A N/A N/A N/A N/A N/A N/A " 42,310.56 " " 39,728.23 " N/A " 39,728.23 " " 59,592.35 " N/A " 71,467.11 " " 70,771.87 " N/A DRG 130.1 No Current Volume N/A " 25,097.03 " " 45,147.05 " " 31,481.71 " N/A N/A N/A " 26,022.21 " N/A N/A N/A " 31,333.64 " N/A N/A " 25,097.03 " N/A N/A N/A N/A N/A N/A N/A " 26,728.34 " " 25,097.03 " N/A " 25,097.03 " " 37,645.55 " N/A " 45,147.05 " " 44,707.85 " N/A DRG 130.2 " 39,587.54 " " 12,474.03 " " 27,927.13 " " 50,238.11 " " 35,031.79 " N/A N/A N/A " 28,956.64 " N/A N/A N/A " 34,867.02 " N/A N/A " 27,927.13 " N/A N/A N/A N/A N/A N/A N/A " 29,742.39 " " 27,927.13 " N/A " 27,927.13 " " 41,890.70 " N/A " 50,238.11 " " 49,749.39 " N/A DRG 130.3 No Current Volume N/A " 34,078.99 " " 61,304.70 " " 42,748.69 " N/A N/A N/A " 35,335.28 " N/A N/A N/A " 42,547.62 " N/A N/A " 34,078.99 " N/A N/A N/A N/A N/A N/A N/A " 36,294.12 " " 34,078.99 " N/A " 34,078.99 " " 51,118.49 " N/A " 61,304.70 " " 60,708.31 " N/A DRG 130.4 " 265,140.98 " " 83,545.92 " " 45,013.87 " " 80,975.45 " " 56,465.40 " N/A N/A N/A " 46,673.27 " N/A N/A N/A " 56,199.82 " N/A N/A " 45,013.87 " N/A N/A N/A N/A N/A N/A N/A " 47,939.77 " " 45,013.87 " N/A " 45,013.87 " " 67,520.81 " N/A " 80,975.45 " " 80,187.71 " N/A DRG 131.1 No Current Volume N/A " 10,574.70 " " 19,022.83 " " 13,264.90 " N/A N/A N/A " 10,964.53 " N/A N/A N/A " 13,202.51 " N/A N/A " 10,574.70 " N/A N/A N/A N/A N/A N/A N/A " 11,262.06 " " 10,574.70 " N/A " 10,574.70 " " 15,862.05 " N/A " 19,022.83 " " 18,837.77 " N/A DRG 131.2 No Current Volume N/A " 15,644.64 " " 28,143.14 " " 19,624.64 " N/A N/A N/A " 16,221.37 " N/A N/A N/A " 19,532.33 " N/A N/A " 15,644.64 " N/A N/A N/A N/A N/A N/A N/A " 16,661.54 " " 15,644.64 " N/A " 15,644.64 " " 23,466.96 " N/A " 28,143.14 " " 27,869.36 " N/A DRG 131.3 No Current Volume N/A " 21,010.40 " " 37,795.61 " " 26,355.45 " N/A N/A N/A " 21,784.93 " N/A N/A N/A " 26,231.48 " N/A N/A " 21,010.40 " N/A N/A N/A N/A N/A N/A N/A " 22,376.08 " " 21,010.40 " N/A " 21,010.40 " " 31,515.60 " N/A " 37,795.61 " " 37,427.93 " N/A DRG 131.4 No Current Volume N/A " 31,023.60 " " 55,808.35 " " 38,916.00 " N/A N/A N/A " 32,167.26 " N/A N/A N/A " 38,732.96 " N/A N/A " 31,023.60 " N/A N/A N/A N/A N/A N/A N/A " 33,040.13 " " 31,023.60 " N/A " 31,023.60 " " 46,535.40 " N/A " 55,808.35 " " 55,265.44 " N/A DRG 132.1 No Current Volume N/A " 3,819.57 " " 6,871.02 " " 4,791.27 " N/A N/A N/A " 3,960.38 " N/A N/A N/A " 4,768.73 " N/A N/A " 3,819.57 " N/A N/A N/A N/A N/A N/A N/A " 4,067.84 " " 3,819.57 " N/A " 3,819.57 " " 5,729.36 " N/A " 6,871.02 " " 6,804.18 " N/A DRG 132.2 No Current Volume N/A " 5,434.92 " " 9,776.88 " " 6,817.56 " N/A N/A N/A " 5,635.27 " N/A N/A N/A " 6,785.50 " N/A N/A " 5,434.92 " N/A N/A N/A N/A N/A N/A N/A " 5,788.19 " " 5,434.92 " N/A " 5,434.92 " " 8,152.38 " N/A " 9,776.88 " " 9,681.77 " N/A DRG 132.3 No Current Volume N/A " 9,783.81 " " 17,600.10 " " 12,272.81 " N/A N/A N/A " 10,144.48 " N/A N/A N/A " 12,215.09 " N/A N/A " 9,783.81 " N/A N/A N/A N/A N/A N/A N/A " 10,419.76 " " 9,783.81 " N/A " 9,783.81 " " 14,675.72 " N/A " 17,600.10 " " 17,428.88 " N/A DRG 132.4 No Current Volume N/A " 16,291.05 " " 29,305.97 " " 20,435.49 " N/A N/A N/A " 16,891.61 " N/A N/A N/A " 20,339.38 " N/A N/A " 16,291.05 " N/A N/A N/A N/A N/A N/A N/A " 17,349.97 " " 16,291.05 " N/A " 16,291.05 " " 24,436.58 " N/A " 29,305.97 " " 29,020.88 " N/A DRG 133.1 " 128,961.23 " " 40,635.68 " " 3,597.03 " " 6,470.70 " " 4,512.11 " N/A N/A N/A " 3,729.63 " N/A N/A N/A " 4,490.89 " N/A N/A " 3,597.03 " N/A N/A N/A N/A N/A N/A N/A " 3,830.84 " " 3,597.03 " N/A " 3,597.03 " " 5,395.55 " N/A " 6,470.70 " " 6,407.75 " N/A DRG 133.2 " 70,676.17 " " 22,270.06 " " 5,990.25 " " 10,775.86 " " 7,514.17 " N/A N/A N/A " 6,211.08 " N/A N/A N/A " 7,478.83 " N/A N/A " 5,990.25 " N/A N/A N/A N/A N/A N/A N/A " 6,379.62 " " 5,990.25 " N/A " 5,990.25 " " 8,985.38 " N/A " 10,775.86 " " 10,671.03 " N/A DRG 133.3 " 94,140.87 " " 29,663.79 " " 8,858.70 " " 15,935.92 " " 11,112.35 " N/A N/A N/A " 9,185.27 " N/A N/A N/A " 11,060.09 " N/A N/A " 8,858.70 " N/A N/A N/A N/A N/A N/A N/A " 9,434.52 " " 8,858.70 " N/A " 8,858.70 " " 13,288.05 " N/A " 15,935.92 " " 15,780.89 " N/A DRG 133.4 " 106,697.61 " " 33,620.42 " " 14,933.87 " " 26,864.54 " " 18,733.05 " N/A N/A N/A " 15,484.39 " N/A N/A N/A " 18,644.94 " N/A N/A " 14,933.87 " N/A N/A N/A N/A N/A N/A N/A " 15,904.57 " " 14,933.87 " N/A " 14,933.87 " " 22,400.81 " N/A " 26,864.54 " " 26,603.20 " N/A DRG 134.1 " 30,550.10 " " 9,626.34 " " 4,862.46 " " 8,747.08 " " 6,099.47 " N/A N/A N/A " 5,041.71 " N/A N/A N/A " 6,070.78 " N/A N/A " 4,862.46 " N/A N/A N/A N/A N/A N/A N/A " 5,178.52 " " 4,862.46 " N/A " 4,862.46 " " 7,293.69 " N/A " 8,747.08 " " 8,661.99 " N/A DRG 134.2 " 30,718.86 " " 9,679.51 " " 6,428.50 " " 11,564.23 " " 8,063.91 " N/A N/A N/A " 6,665.48 " N/A N/A N/A " 8,025.98 " N/A N/A " 6,428.50 " N/A N/A N/A N/A N/A N/A N/A " 6,846.35 " " 6,428.50 " N/A " 6,428.50 " " 9,642.75 " N/A " 11,564.23 " " 11,451.73 " N/A DRG 134.3 No Current Volume N/A " 9,159.31 " " 16,476.68 " " 11,489.44 " N/A N/A N/A " 9,496.96 " N/A N/A N/A " 11,435.40 " N/A N/A " 9,159.31 " N/A N/A N/A N/A N/A N/A N/A " 9,754.67 " " 9,159.31 " N/A " 9,159.31 " " 13,738.97 " N/A " 16,476.68 " " 16,316.39 " N/A DRG 134.4 " 179,014.54 " " 56,407.48 " " 13,701.30 " " 24,647.27 " " 17,186.91 " N/A N/A N/A " 14,206.39 " N/A N/A N/A " 17,106.07 " N/A N/A " 13,701.30 " N/A N/A N/A N/A N/A N/A N/A " 14,591.88 " " 13,701.30 " N/A " 13,701.30 " " 20,551.95 " N/A " 24,647.27 " " 24,407.50 " N/A DRG 135.1 " 37,902.20 " " 11,942.98 " " 6,008.06 " " 10,807.90 " " 7,536.51 " N/A N/A N/A " 6,229.54 " N/A N/A N/A " 7,501.06 " N/A N/A " 6,008.06 " N/A N/A N/A N/A N/A N/A N/A " 6,398.58 " " 6,008.06 " N/A " 6,008.06 " " 9,012.09 " N/A " 10,807.90 " " 10,702.76 " N/A DRG 135.2 " 40,165.82 " " 12,656.25 " " 6,464.11 " " 11,628.29 " " 8,108.58 " N/A N/A N/A " 6,702.40 " N/A N/A N/A " 8,070.44 " N/A N/A " 6,464.11 " N/A N/A N/A N/A N/A N/A N/A " 6,884.28 " " 6,464.11 " N/A " 6,464.11 " " 9,696.17 " N/A " 11,628.29 " " 11,515.17 " N/A DRG 135.3 " 84,733.37 " " 26,699.48 " " 9,661.24 " " 17,379.60 " " 12,119.06 " N/A N/A N/A " 10,017.39 " N/A N/A N/A " 12,062.06 " N/A N/A " 9,661.24 " N/A N/A N/A N/A N/A N/A N/A " 10,289.22 " " 9,661.24 " N/A " 9,661.24 " " 14,491.86 " N/A " 17,379.60 " " 17,210.53 " N/A DRG 135.4 " 78,597.89 " " 24,766.20 " " 16,814.21 " " 30,247.08 " " 21,091.75 " N/A N/A N/A " 17,434.05 " N/A N/A N/A " 20,992.54 " N/A N/A " 16,814.21 " N/A N/A N/A N/A N/A N/A N/A " 17,907.13 " " 16,814.21 " N/A " 16,814.21 " " 25,221.32 " N/A " 30,247.08 " " 29,952.83 " N/A DRG 136.1 No Current Volume N/A " 7,026.29 " " 12,639.59 " " 8,813.78 " N/A N/A N/A " 7,285.31 " N/A N/A N/A " 8,772.32 " N/A N/A " 7,026.29 " N/A N/A N/A N/A N/A N/A N/A " 7,483.00 " " 7,026.29 " N/A " 7,026.29 " " 10,539.44 " N/A " 12,639.59 " " 12,516.63 " N/A DRG 136.2 No Current Volume N/A " 7,719.95 " " 13,887.42 " " 9,683.91 " N/A N/A N/A " 8,004.54 " N/A N/A N/A " 9,638.36 " N/A N/A " 7,719.95 " N/A N/A N/A N/A N/A N/A N/A " 8,221.75 " " 7,719.95 " N/A " 7,719.95 " " 11,579.93 " N/A " 13,887.42 " " 13,752.32 " N/A DRG 136.3 " 41,918.44 " " 13,208.50 " " 10,556.21 " " 18,989.57 " " 13,241.71 " N/A N/A N/A " 10,945.36 " N/A N/A N/A " 13,179.43 " N/A N/A " 10,556.21 " N/A N/A N/A N/A N/A N/A N/A " 11,242.36 " " 10,556.21 " N/A " 10,556.21 " " 15,834.32 " N/A " 18,989.57 " " 18,804.83 " N/A DRG 136.4 No Current Volume N/A " 15,393.34 " " 27,691.08 " " 19,309.41 " N/A N/A N/A " 15,960.80 " N/A N/A N/A " 19,218.58 " N/A N/A " 15,393.34 " N/A N/A N/A N/A N/A N/A N/A " 16,393.91 " " 15,393.34 " N/A " 15,393.34 " " 23,090.01 " N/A " 27,691.08 " " 27,421.70 " N/A DRG 137.1 No Current Volume N/A " 5,196.62 " " 9,348.20 " " 6,518.64 " N/A N/A N/A " 5,388.19 " N/A N/A N/A " 6,487.98 " N/A N/A " 5,196.62 " N/A N/A N/A N/A N/A N/A N/A " 5,534.40 " " 5,196.62 " N/A " 5,196.62 " " 7,794.93 " N/A " 9,348.20 " " 9,257.26 " N/A DRG 137.2 " 38,062.32 " " 11,993.44 " " 6,642.14 " " 11,948.55 " " 8,331.90 " N/A N/A N/A " 6,887.00 " N/A N/A N/A " 8,292.71 " N/A N/A " 6,642.14 " N/A N/A N/A N/A N/A N/A N/A " 7,073.88 " " 6,642.14 " N/A " 6,642.14 " " 9,963.21 " N/A " 11,948.55 " " 11,832.31 " N/A DRG 137.3 " 57,953.34 " " 18,261.10 " " 9,526.34 " " 17,136.93 " " 11,949.84 " N/A N/A N/A " 9,877.52 " N/A N/A N/A " 11,893.64 " N/A N/A " 9,526.34 " N/A N/A N/A N/A N/A N/A N/A " 10,145.55 " " 9,526.34 " N/A " 9,526.34 " " 14,289.51 " N/A " 17,136.93 " " 16,970.22 " N/A DRG 137.4 " 93,834.24 " " 29,567.17 " " 13,980.00 " " 25,148.62 " " 17,536.51 " N/A N/A N/A " 14,495.36 " N/A N/A N/A " 17,454.03 " N/A N/A " 13,980.00 " N/A N/A N/A N/A N/A N/A N/A " 14,888.70 " " 13,980.00 " N/A " 13,980.00 " " 20,970.00 " N/A " 25,148.62 " " 24,903.97 " N/A DRG 138.1 No Current Volume N/A " 2,899.95 " " 5,216.72 " " 3,637.70 " N/A N/A N/A " 3,006.85 " N/A N/A N/A " 3,620.59 " N/A N/A " 2,899.95 " N/A N/A N/A N/A N/A N/A N/A " 3,088.45 " " 2,899.95 " N/A " 2,899.95 " " 4,349.93 " N/A " 5,216.72 " " 5,165.97 " N/A DRG 138.2 No Current Volume N/A " 4,274.94 " " 7,690.19 " " 5,362.48 " N/A N/A N/A " 4,432.53 " N/A N/A N/A " 5,337.26 " N/A N/A " 4,274.94 " N/A N/A N/A N/A N/A N/A N/A " 4,552.81 " " 4,274.94 " N/A " 4,274.94 " " 6,412.41 " N/A " 7,690.19 " " 7,615.38 " N/A DRG 138.3 " 35,947.45 " " 11,327.04 " " 7,780.21 " " 13,995.82 " " 9,759.50 " N/A N/A N/A " 8,067.02 " N/A N/A N/A " 9,713.59 " N/A N/A " 7,780.21 " N/A N/A N/A N/A N/A N/A N/A " 8,285.92 " " 7,780.21 " N/A " 7,780.21 " " 11,670.32 " N/A " 13,995.82 " " 13,859.67 " N/A DRG 138.4 No Current Volume N/A " 16,832.01 " " 30,279.10 " " 21,114.07 " N/A N/A N/A " 17,452.51 " N/A N/A N/A " 21,014.76 " N/A N/A " 16,832.01 " N/A N/A N/A N/A N/A N/A N/A " 17,926.09 " " 16,832.01 " N/A " 16,832.01 " " 25,248.02 " N/A " 30,279.10 " " 29,984.54 " N/A DRG 139.1 " 16,505.44 " " 5,200.86 " " 3,623.05 " " 6,517.50 " " 4,544.75 " N/A N/A N/A " 3,756.61 " N/A N/A N/A " 4,523.38 " N/A N/A " 3,623.05 " N/A N/A N/A N/A N/A N/A N/A " 3,858.55 " " 3,623.05 " N/A " 3,623.05 " " 5,434.58 " N/A " 6,517.50 " " 6,454.10 " N/A DRG 139.2 " 40,590.83 " " 12,790.17 " " 5,014.48 " " 9,020.55 " " 6,290.16 " N/A N/A N/A " 5,199.33 " N/A N/A N/A " 6,260.58 " N/A N/A " 5,014.48 " N/A N/A N/A N/A N/A N/A N/A " 5,340.42 " " 5,014.48 " N/A " 5,014.48 " " 7,521.72 " N/A " 9,020.55 " " 8,932.79 " N/A DRG 139.3 " 38,320.07 " " 12,074.66 " " 7,444.68 " " 13,392.23 " " 9,338.61 " N/A N/A N/A " 7,719.12 " N/A N/A N/A " 9,294.68 " N/A N/A " 7,444.68 " N/A N/A N/A N/A N/A N/A N/A " 7,928.58 " " 7,444.68 " N/A " 7,444.68 " " 11,167.02 " N/A " 13,392.23 " " 13,261.95 " N/A DRG 139.4 " 144,960.51 " " 45,677.06 " " 11,832.60 " " 21,285.66 " " 14,842.81 " N/A N/A N/A " 12,268.80 " N/A N/A N/A " 14,773.00 " N/A N/A " 11,832.60 " N/A N/A N/A N/A N/A N/A N/A " 12,601.72 " " 11,832.60 " N/A " 11,832.60 " " 17,748.90 " N/A " 21,285.66 " " 21,078.59 " N/A DRG 140.1 " 41,749.42 " " 13,155.24 " " 4,209.89 " " 7,573.17 " " 5,280.89 " N/A N/A N/A " 4,365.08 " N/A N/A N/A " 5,256.05 " N/A N/A " 4,209.89 " N/A N/A N/A N/A N/A N/A N/A " 4,483.53 " " 4,209.89 " N/A " 4,209.89 " " 6,314.84 " N/A " 7,573.17 " " 7,499.50 " N/A DRG 140.2 " 48,767.71 " " 15,366.70 " " 5,289.06 " " 9,514.49 " " 6,634.60 " N/A N/A N/A " 5,484.04 " N/A N/A N/A " 6,603.39 " N/A N/A " 5,289.06 " N/A N/A N/A N/A N/A N/A N/A " 5,632.85 " " 5,289.06 " N/A " 5,289.06 " " 7,933.59 " N/A " 9,514.49 " " 9,421.93 " N/A DRG 140.3 " 90,805.28 " " 28,612.74 " " 6,597.63 " " 11,868.48 " " 8,276.07 " N/A N/A N/A " 6,840.85 " N/A N/A N/A " 8,237.14 " N/A N/A " 6,597.63 " N/A N/A N/A N/A N/A N/A N/A " 7,026.48 " " 6,597.63 " N/A " 6,597.63 " " 9,896.45 " N/A " 11,868.48 " " 11,753.02 " N/A DRG 140.4 " 61,322.91 " " 19,322.85 " " 10,248.07 " " 18,435.25 " " 12,855.18 " N/A N/A N/A " 10,625.86 " N/A N/A N/A " 12,794.72 " N/A N/A " 10,248.07 " N/A N/A N/A N/A N/A N/A N/A " 10,914.19 " " 10,248.07 " N/A " 10,248.07 " " 15,372.11 " N/A " 18,435.25 " " 18,255.91 " N/A DRG 141.1 " 52,868.44 " " 16,658.85 " " 3,240.27 " " 5,828.92 " " 4,064.59 " N/A N/A N/A " 3,359.72 " N/A N/A N/A " 4,045.48 " N/A N/A " 3,240.27 " N/A N/A N/A N/A N/A N/A N/A " 3,450.89 " " 3,240.27 " N/A " 3,240.27 " " 4,860.41 " N/A " 5,828.92 " " 5,772.22 " N/A DRG 141.2 " 58,029.90 " " 18,285.22 " " 4,668.67 " " 8,398.47 " " 5,856.38 " N/A N/A N/A " 4,840.78 " N/A N/A N/A " 5,828.83 " N/A N/A " 4,668.67 " N/A N/A N/A N/A N/A N/A N/A " 4,972.13 " " 4,668.67 " N/A " 4,668.67 " " 7,003.01 " N/A " 8,398.47 " " 8,316.77 " N/A DRG 141.3 " 27,283.25 " " 8,596.95 " " 6,655.84 " " 11,973.19 " " 8,349.09 " N/A N/A N/A " 6,901.20 " N/A N/A N/A " 8,309.82 " N/A N/A " 6,655.84 " N/A N/A N/A N/A N/A N/A N/A " 7,088.47 " " 6,655.84 " N/A " 6,655.84 " " 9,983.76 " N/A " 11,973.19 " " 11,856.71 " N/A DRG 141.4 No Current Volume N/A " 11,624.43 " " 20,911.19 " " 14,581.68 " N/A N/A N/A " 12,052.96 " N/A N/A N/A " 14,513.10 " N/A N/A " 11,624.43 " N/A N/A N/A N/A N/A N/A N/A " 12,380.02 " " 11,624.43 " N/A " 11,624.43 " " 17,436.65 " N/A " 20,911.19 " " 20,707.76 " N/A DRG 142.1 No Current Volume N/A " 5,005.57 " " 9,004.52 " " 6,278.99 " N/A N/A N/A " 5,190.10 " N/A N/A N/A " 6,249.45 " N/A N/A " 5,005.57 " N/A N/A N/A N/A N/A N/A N/A " 5,330.93 " " 5,005.57 " N/A " 5,005.57 " " 7,508.36 " N/A " 9,004.52 " " 8,916.92 " N/A DRG 142.2 No Current Volume N/A " 6,137.48 " " 11,040.71 " " 7,698.85 " N/A N/A N/A " 6,363.73 " N/A N/A N/A " 7,662.64 " N/A N/A " 6,137.48 " N/A N/A N/A N/A N/A N/A N/A " 6,536.42 " " 6,137.48 " N/A " 6,137.48 " " 9,206.22 " N/A " 11,040.71 " " 10,933.31 " N/A DRG 142.3 " 57,696.64 " " 18,180.21 " " 8,542.34 " " 15,366.82 " " 10,715.51 " N/A N/A N/A " 8,857.25 " N/A N/A N/A " 10,665.11 " N/A N/A " 8,542.34 " N/A N/A N/A N/A N/A N/A N/A " 9,097.59 " " 8,542.34 " N/A " 8,542.34 " " 12,813.51 " N/A " 15,366.82 " " 15,217.32 " N/A DRG 142.4 " 48,730.00 " " 15,354.82 " " 13,217.86 " " 23,777.61 " " 16,580.48 " N/A N/A N/A " 13,705.13 " N/A N/A N/A " 16,502.50 " N/A N/A " 13,217.86 " N/A N/A N/A N/A N/A N/A N/A " 14,077.02 " " 13,217.86 " N/A " 13,217.86 " " 19,826.79 " N/A " 23,777.61 " " 23,546.30 " N/A DRG 143.1 No Current Volume N/A " 4,064.72 " " 7,312.02 " " 5,098.78 " N/A N/A N/A " 4,214.56 " N/A N/A N/A " 5,074.80 " N/A N/A " 4,064.72 " N/A N/A N/A N/A N/A N/A N/A " 4,328.93 " " 4,064.72 " N/A " 4,064.72 " " 6,097.08 " N/A " 7,312.02 " " 7,240.89 " N/A DRG 143.2 " 97,487.30 " " 30,718.25 " " 5,793.73 " " 10,422.34 " " 7,267.65 " N/A N/A N/A " 6,007.31 " N/A N/A N/A " 7,233.47 " N/A N/A " 5,793.73 " N/A N/A N/A N/A N/A N/A N/A " 6,170.32 " " 5,793.73 " N/A " 5,793.73 " " 8,690.60 " N/A " 10,422.34 " " 10,320.95 " N/A DRG 143.3 " 211,758.91 " " 66,725.23 " " 8,791.60 " " 15,815.21 " " 11,028.18 " N/A N/A N/A " 9,115.69 " N/A N/A N/A " 10,976.31 " N/A N/A " 8,791.60 " N/A N/A N/A N/A N/A N/A N/A " 9,363.05 " " 8,791.60 " N/A " 8,791.60 " " 13,187.40 " N/A " 15,815.21 " " 15,661.36 " N/A DRG 143.4 " 124,491.73 " " 39,227.34 " " 13,797.17 " " 24,819.73 " " 17,307.17 " N/A N/A N/A " 14,305.79 " N/A N/A N/A " 17,225.77 " N/A N/A " 13,797.17 " N/A N/A N/A N/A N/A N/A N/A " 14,693.99 " " 13,797.17 " N/A " 13,797.17 " " 20,695.76 " N/A " 24,819.73 " " 24,578.28 " N/A DRG 144.1 " 36,932.45 " " 11,637.41 " " 4,268.78 " " 7,679.11 " " 5,354.76 " N/A N/A N/A " 4,426.14 " N/A N/A N/A " 5,329.57 " N/A N/A " 4,268.78 " N/A N/A N/A N/A N/A N/A N/A " 4,546.25 " " 4,268.78 " N/A " 4,268.78 " " 6,403.17 " N/A " 7,679.11 " " 7,604.40 " N/A DRG 144.2 " 76,237.89 " " 24,022.56 " " 5,580.08 " " 10,038.01 " " 6,999.65 " N/A N/A N/A " 5,785.79 " N/A N/A N/A " 6,966.73 " N/A N/A " 5,580.08 " N/A N/A N/A N/A N/A N/A N/A " 5,942.79 " " 5,580.08 " N/A " 5,580.08 " " 8,370.12 " N/A " 10,038.01 " " 9,940.35 " N/A DRG 144.3 " 16,338.20 " " 5,148.17 " " 8,128.07 " " 14,621.59 " " 10,195.85 " N/A N/A N/A " 8,427.70 " N/A N/A N/A " 10,147.90 " N/A N/A " 8,128.07 " N/A N/A N/A N/A N/A N/A N/A " 8,656.39 " " 8,128.07 " N/A " 8,128.07 " " 12,192.11 " N/A " 14,621.59 " " 14,479.34 " N/A DRG 144.4 No Current Volume N/A " 13,336.33 " " 23,990.72 " " 16,729.09 " N/A N/A N/A " 13,827.96 " N/A N/A N/A " 16,650.41 " N/A N/A " 13,336.33 " N/A N/A N/A N/A N/A N/A N/A " 14,203.19 " " 13,336.33 " N/A " 13,336.33 " " 20,004.50 " N/A " 23,990.72 " " 23,757.34 " N/A DRG 145.1 " 4,795,117.99 " " 1,510,941.68 " " 4,042.12 " " 7,271.37 " " 5,070.44 " N/A N/A N/A " 4,191.13 " N/A N/A N/A " 5,046.59 " N/A N/A " 4,042.12 " N/A N/A N/A N/A N/A N/A N/A " 4,304.86 " " 4,042.12 " N/A " 4,042.12 " " 6,063.18 " N/A " 7,271.37 " " 7,200.63 " N/A DRG 145.2 " 27,936.92 " " 8,802.92 " " 4,874.10 " " 8,768.02 " " 6,114.07 " N/A N/A N/A " 5,053.78 " N/A N/A N/A " 6,085.31 " N/A N/A " 4,874.10 " N/A N/A N/A N/A N/A N/A N/A " 5,190.92 " " 4,874.10 " N/A " 4,874.10 " " 7,311.15 " N/A " 8,768.02 " " 8,682.72 " N/A DRG 145.3 " 108,725.22 " " 34,259.32 " " 6,776.36 " " 12,189.99 " " 8,500.27 " N/A N/A N/A " 7,026.16 " N/A N/A N/A " 8,460.29 " N/A N/A " 6,776.36 " N/A N/A N/A N/A N/A N/A N/A " 7,216.82 " " 6,776.36 " N/A " 6,776.36 " " 10,164.54 " N/A " 12,189.99 " " 12,071.41 " N/A DRG 145.4 No Current Volume N/A " 11,909.29 " " 21,423.62 " " 14,939.01 " N/A N/A N/A " 12,348.32 " N/A N/A N/A " 14,868.75 " N/A N/A " 11,909.29 " N/A N/A N/A N/A N/A N/A N/A " 12,683.39 " " 11,909.29 " N/A " 11,909.29 " " 17,863.94 " N/A " 21,423.62 " " 21,215.21 " N/A DRG 160.1 No Current Volume N/A " 29,033.70 " " 52,228.72 " " 36,419.87 " N/A N/A N/A " 30,104.00 " N/A N/A N/A " 36,248.57 " N/A N/A " 29,033.70 " N/A N/A N/A N/A N/A N/A N/A " 30,920.89 " " 29,033.70 " N/A " 29,033.70 " " 43,550.55 " N/A " 52,228.72 " " 51,720.63 " N/A DRG 160.2 No Current Volume N/A " 33,661.28 " " 60,553.28 " " 42,224.71 " N/A N/A N/A " 34,902.18 " N/A N/A N/A " 42,026.11 " N/A N/A " 33,661.28 " N/A N/A N/A N/A N/A N/A N/A " 35,849.26 " " 33,661.28 " N/A " 33,661.28 " " 50,491.92 " N/A " 60,553.28 " " 59,964.20 " N/A DRG 160.3 No Current Volume N/A " 48,076.10 " " 86,484.10 " " 60,306.66 " N/A N/A N/A " 49,848.39 " N/A N/A N/A " 60,023.01 " N/A N/A " 48,076.10 " N/A N/A N/A N/A N/A N/A N/A " 51,201.05 " " 48,076.10 " N/A " 48,076.10 " " 72,114.15 " N/A " 86,484.10 " " 85,642.76 " N/A DRG 160.4 No Current Volume N/A " 94,501.26 " " 169,998.32 " " 118,542.38 " N/A N/A N/A " 97,984.97 " N/A N/A N/A " 117,984.82 " N/A N/A " 94,501.26 " N/A N/A N/A N/A N/A N/A N/A " 100,643.84 " " 94,501.26 " N/A " 94,501.26 " " 141,751.89 " N/A " 169,998.32 " " 168,344.54 " N/A DRG 161.1 No Current Volume N/A " 97,766.87 " " 175,872.82 " " 122,638.76 " N/A N/A N/A " 101,370.96 " N/A N/A N/A " 122,061.94 " N/A N/A " 97,766.87 " N/A N/A N/A N/A N/A N/A N/A " 104,121.72 " " 97,766.87 " N/A " 97,766.87 " " 146,650.31 " N/A " 175,872.82 " " 174,161.90 " N/A DRG 161.2 No Current Volume N/A " 101,534.40 " " 182,650.23 " " 127,364.75 " N/A N/A N/A " 105,277.38 " N/A N/A N/A " 126,765.70 " N/A N/A " 101,534.40 " N/A N/A N/A N/A N/A N/A N/A " 108,134.14 " " 101,534.40 " N/A " 101,534.40 " " 152,301.60 " N/A " 182,650.23 " " 180,873.38 " N/A DRG 161.3 No Current Volume N/A " 140,665.52 " " 253,043.20 " " 176,450.83 " N/A N/A N/A " 145,851.04 " N/A N/A N/A " 175,620.90 " N/A N/A " 140,665.52 " N/A N/A N/A N/A N/A N/A N/A " 149,808.78 " " 140,665.52 " N/A " 140,665.52 " " 210,998.28 " N/A " 253,043.20 " " 250,581.56 " N/A DRG 161.4 No Current Volume N/A " 176,079.10 " " 316,748.69 " " 220,873.62 " N/A N/A N/A " 182,570.11 " N/A N/A N/A " 219,834.76 " N/A N/A " 176,079.10 " N/A N/A N/A N/A N/A N/A N/A " 187,524.24 " " 176,079.10 " N/A " 176,079.10 " " 264,118.65 " N/A " 316,748.69 " " 313,667.31 " N/A DRG 162.1 No Current Volume N/A " 36,664.63 " " 65,956.00 " " 45,992.11 " N/A N/A N/A " 38,016.24 " N/A N/A N/A " 45,775.79 " N/A N/A " 36,664.63 " N/A N/A N/A N/A N/A N/A N/A " 39,047.83 " " 36,664.63 " N/A " 36,664.63 " " 54,996.95 " N/A " 65,956.00 " " 65,314.37 " N/A DRG 162.2 No Current Volume N/A " 40,432.16 " " 72,733.41 " " 50,718.10 " N/A N/A N/A " 41,922.66 " N/A N/A N/A " 50,479.55 " N/A N/A " 40,432.16 " N/A N/A N/A N/A N/A N/A N/A " 43,060.25 " " 40,432.16 " N/A " 40,432.16 " " 60,648.24 " N/A " 72,733.41 " " 72,025.85 " N/A DRG 162.3 No Current Volume N/A " 54,221.80 " " 97,539.60 " " 68,015.83 " N/A N/A N/A " 56,220.64 " N/A N/A N/A " 67,695.92 " N/A N/A " 54,221.80 " N/A N/A N/A N/A N/A N/A N/A " 57,746.22 " " 54,221.80 " N/A " 54,221.80 " " 81,332.70 " N/A " 97,539.60 " " 96,590.71 " N/A DRG 162.4 No Current Volume N/A " 81,920.90 " " 147,367.51 " " 102,761.58 " N/A N/A N/A " 84,940.85 " N/A N/A N/A " 102,278.24 " N/A N/A " 81,920.90 " N/A N/A N/A N/A N/A N/A N/A " 87,245.76 " " 81,920.90 " N/A " 81,920.90 " " 122,881.35 " N/A " 147,367.51 " " 145,933.89 " N/A DRG 163.1 No Current Volume N/A " 29,818.43 " " 53,640.37 " " 37,404.24 " N/A N/A N/A " 30,917.66 " N/A N/A N/A " 37,228.31 " N/A N/A " 29,818.43 " N/A N/A N/A N/A N/A N/A N/A " 31,756.63 " " 29,818.43 " N/A " 29,818.43 " " 44,727.65 " N/A " 53,640.37 " " 53,118.55 " N/A DRG 163.2 No Current Volume N/A " 32,992.96 " " 59,351.04 " " 41,386.37 " N/A N/A N/A " 34,209.22 " N/A N/A N/A " 41,191.71 " N/A N/A " 32,992.96 " N/A N/A N/A N/A N/A N/A N/A " 35,137.50 " " 32,992.96 " N/A " 32,992.96 " " 49,489.44 " N/A " 59,351.04 " " 58,773.66 " N/A DRG 163.3 No Current Volume N/A " 43,141.75 " " 77,607.69 " " 54,117.01 " N/A N/A N/A " 44,732.13 " N/A N/A N/A " 53,862.47 " N/A N/A " 43,141.75 " N/A N/A N/A N/A N/A N/A N/A " 45,945.96 " " 43,141.75 " N/A " 43,141.75 " " 64,712.63 " N/A " 77,607.69 " " 76,852.71 " N/A DRG 163.4 No Current Volume N/A " 68,934.49 " " 124,006.25 " " 86,471.42 " N/A N/A N/A " 71,475.70 " N/A N/A N/A " 86,064.71 " N/A N/A " 68,934.49 " N/A N/A N/A N/A N/A N/A N/A " 73,415.23 " " 68,934.49 " N/A " 68,934.49 " " 103,401.74 " N/A " 124,006.25 " " 122,799.90 " N/A DRG 165.1 No Current Volume N/A " 27,797.71 " " 50,005.30 " " 34,869.45 " N/A N/A N/A " 28,822.45 " N/A N/A N/A " 34,705.44 " N/A N/A " 27,797.71 " N/A N/A N/A N/A N/A N/A N/A " 29,604.56 " " 27,797.71 " N/A " 27,797.71 " " 41,696.57 " N/A " 50,005.30 " " 49,518.84 " N/A DRG 165.2 No Current Volume N/A " 32,185.63 " " 57,898.73 " " 40,373.65 " N/A N/A N/A " 33,372.13 " N/A N/A N/A " 40,183.76 " N/A N/A " 32,185.63 " N/A N/A N/A N/A N/A N/A N/A " 34,277.70 " " 32,185.63 " N/A " 32,185.63 " " 48,278.45 " N/A " 57,898.73 " " 57,335.48 " N/A DRG 165.3 " 168,499.37 " " 53,094.15 " " 41,596.93 " " 74,828.72 " " 52,179.19 " N/A N/A N/A " 43,130.37 " N/A N/A N/A " 51,933.77 " N/A N/A " 41,596.93 " N/A N/A N/A N/A N/A N/A N/A " 44,300.73 " " 41,596.93 " N/A " 41,596.93 " " 62,395.40 " N/A " 74,828.72 " " 74,100.77 " N/A DRG 165.4 " 213,138.02 " " 67,159.79 " " 60,401.73 " " 108,656.67 " " 75,767.93 " N/A N/A N/A " 62,628.39 " N/A N/A N/A " 75,411.56 " N/A N/A " 60,401.73 " N/A N/A N/A N/A N/A N/A N/A " 64,327.84 " " 60,401.73 " N/A " 60,401.73 " " 90,602.60 " N/A " 108,656.67 " " 107,599.64 " N/A DRG 166.1 " 296,344.26 " " 93,378.08 " " 24,848.46 " " 44,699.89 " " 31,169.91 " N/A N/A N/A " 25,764.48 " N/A N/A N/A " 31,023.30 " N/A N/A " 24,848.46 " N/A N/A N/A N/A N/A N/A N/A " 26,463.61 " " 24,848.46 " N/A " 24,848.46 " " 37,272.69 " N/A " 44,699.89 " " 44,265.05 " N/A DRG 166.2 No Current Volume N/A " 27,464.92 " " 49,406.64 " " 34,452.00 " N/A N/A N/A " 28,477.39 " N/A N/A N/A " 34,289.95 " N/A N/A " 27,464.92 " N/A N/A N/A N/A N/A N/A N/A " 29,250.14 " " 27,464.92 " N/A " 27,464.92 " " 41,197.38 " N/A " 49,406.64 " " 48,926.01 " N/A DRG 166.3 " 151,675.05 " " 47,792.81 " " 34,405.62 " " 61,892.27 " " 43,158.41 " N/A N/A N/A " 35,673.95 " N/A N/A N/A " 42,955.42 " N/A N/A " 34,405.62 " N/A N/A N/A N/A N/A N/A N/A " 36,641.99 " " 34,405.62 " N/A " 34,405.62 " " 51,608.43 " N/A " 61,892.27 " " 61,290.17 " N/A DRG 166.4 No Current Volume N/A " 54,911.35 " " 98,780.03 " " 68,880.80 " N/A N/A N/A " 56,935.61 " N/A N/A N/A " 68,556.82 " N/A N/A " 54,911.35 " N/A N/A N/A N/A N/A N/A N/A " 58,480.59 " " 54,911.35 " N/A " 54,911.35 " " 82,367.03 " N/A " 98,780.03 " " 97,819.08 " N/A DRG 167.1 No Current Volume N/A " 24,323.94 " " 43,756.34 " " 30,511.95 " N/A N/A N/A " 25,220.62 " N/A N/A N/A " 30,368.44 " N/A N/A " 24,323.94 " N/A N/A N/A N/A N/A N/A N/A " 25,905.00 " " 24,323.94 " N/A " 24,323.94 " " 36,485.91 " N/A " 43,756.34 " " 43,330.67 " N/A DRG 167.2 " 135,713.79 " " 42,763.42 " " 27,475.19 " " 49,425.12 " " 34,464.88 " N/A N/A N/A " 28,488.04 " N/A N/A N/A " 34,302.77 " N/A N/A " 27,475.19 " N/A N/A N/A N/A N/A N/A N/A " 29,261.08 " " 27,475.19 " N/A " 27,475.19 " " 41,212.79 " N/A " 49,425.12 " " 48,944.30 " N/A DRG 167.3 No Current Volume N/A " 34,550.10 " " 62,152.17 " " 43,339.65 " N/A N/A N/A " 35,823.76 " N/A N/A N/A " 43,135.80 " N/A N/A " 34,550.10 " N/A N/A N/A N/A N/A N/A N/A " 36,795.86 " " 34,550.10 " N/A " 34,550.10 " " 51,825.15 " N/A " 62,152.17 " " 61,547.55 " N/A DRG 167.4 " 96,432.27 " " 30,385.81 " " 66,769.97 " " 120,112.50 " " 83,756.25 " N/A N/A N/A " 69,231.39 " N/A N/A N/A " 83,362.31 " N/A N/A " 66,769.97 " N/A N/A N/A N/A N/A N/A N/A " 71,110.02 " " 66,769.97 " N/A " 66,769.97 " " 100,154.96 " N/A " 120,112.50 " " 118,944.02 " N/A DRG 169.1 " 280,774.63 " " 88,472.09 " " 15,281.04 " " 27,489.06 " " 19,168.54 " N/A N/A N/A " 15,844.36 " N/A N/A N/A " 19,078.38 " N/A N/A " 15,281.04 " N/A N/A N/A N/A N/A N/A N/A " 16,274.31 " " 15,281.04 " N/A " 15,281.04 " " 22,921.56 " N/A " 27,489.06 " " 27,221.64 " N/A DRG 169.2 " 145,500.93 " " 45,847.34 " " 20,087.35 " " 36,135.13 " " 25,197.57 " N/A N/A N/A " 20,827.85 " N/A N/A N/A " 25,079.06 " N/A N/A " 20,087.35 " N/A N/A N/A N/A N/A N/A N/A " 21,393.03 " " 20,087.35 " N/A " 20,087.35 " " 30,131.03 " N/A " 36,135.13 " " 35,783.61 " N/A DRG 169.3 " 151,074.84 " " 47,603.68 " " 31,846.68 " " 57,288.99 " " 39,948.48 " N/A N/A N/A " 33,020.68 " N/A N/A N/A " 39,760.58 " N/A N/A " 31,846.68 " N/A N/A N/A N/A N/A N/A N/A " 33,916.71 " " 31,846.68 " N/A " 31,846.68 " " 47,770.02 " N/A " 57,288.99 " " 56,731.68 " N/A DRG 169.4 No Current Volume N/A " 54,010.21 " " 97,158.97 " " 67,750.41 " N/A N/A N/A " 56,001.25 " N/A N/A N/A " 67,431.75 " N/A N/A " 54,010.21 " N/A N/A N/A N/A N/A N/A N/A " 57,520.87 " " 54,010.21 " N/A " 54,010.21 " " 81,015.32 " N/A " 97,158.97 " " 96,213.79 " N/A DRG 170.1 No Current Volume N/A " 16,319.13 " " 29,356.48 " " 20,470.72 " N/A N/A N/A " 16,920.72 " N/A N/A N/A " 20,374.43 " N/A N/A " 16,319.13 " N/A N/A N/A N/A N/A N/A N/A " 17,379.87 " " 16,319.13 " N/A " 16,319.13 " " 24,478.70 " N/A " 29,356.48 " " 29,070.90 " N/A DRG 170.2 No Current Volume N/A " 17,840.66 " " 32,093.56 " " 22,379.32 " N/A N/A N/A " 18,498.34 " N/A N/A N/A " 22,274.06 " N/A N/A " 17,840.66 " N/A N/A N/A N/A N/A N/A N/A " 19,000.30 " " 17,840.66 " N/A " 17,840.66 " " 26,760.99 " N/A " 32,093.56 " " 31,781.35 " N/A DRG 170.3 No Current Volume N/A " 23,018.79 " " 41,408.50 " " 28,874.77 " N/A N/A N/A " 23,867.36 " N/A N/A N/A " 28,738.96 " N/A N/A " 23,018.79 " N/A N/A N/A N/A N/A N/A N/A " 24,515.01 " " 23,018.79 " N/A " 23,018.79 " " 34,528.19 " N/A " 41,408.50 " " 41,005.67 " N/A DRG 170.4 No Current Volume N/A " 32,892.30 " " 59,169.96 " " 41,260.10 " N/A N/A N/A " 34,104.85 " N/A N/A N/A " 41,066.04 " N/A N/A " 32,892.30 " N/A N/A N/A N/A N/A N/A N/A " 35,030.30 " " 32,892.30 " N/A " 32,892.30 " " 49,338.45 " N/A " 59,169.96 " " 58,594.34 " N/A DRG 171.1 No Current Volume N/A " 12,695.39 " " 22,837.74 " " 15,925.10 " N/A N/A N/A " 13,163.40 " N/A N/A N/A " 15,850.19 " N/A N/A " 12,695.39 " N/A N/A N/A N/A N/A N/A N/A " 13,520.59 " " 12,695.39 " N/A " 12,695.39 " " 19,043.09 " N/A " 22,837.74 " " 22,615.57 " N/A DRG 171.2 No Current Volume N/A " 14,598.33 " " 26,260.94 " " 18,312.15 " N/A N/A N/A " 15,136.49 " N/A N/A N/A " 18,226.02 " N/A N/A " 14,598.33 " N/A N/A N/A N/A N/A N/A N/A " 15,547.22 " " 14,598.33 " N/A " 14,598.33 " " 21,897.50 " N/A " 26,260.94 " " 26,005.47 " N/A DRG 171.3 No Current Volume N/A " 18,361.76 " " 33,030.97 " " 23,032.99 " N/A N/A N/A " 19,038.65 " N/A N/A N/A " 22,924.66 " N/A N/A " 18,361.76 " N/A N/A N/A N/A N/A N/A N/A " 19,555.27 " " 18,361.76 " N/A " 18,361.76 " " 27,542.64 " N/A " 33,030.97 " " 32,709.64 " N/A DRG 171.4 No Current Volume N/A " 29,687.64 " " 53,405.10 " " 37,240.18 " N/A N/A N/A " 30,782.05 " N/A N/A N/A " 37,065.02 " N/A N/A " 29,687.64 " N/A N/A N/A N/A N/A N/A N/A " 31,617.34 " " 29,687.64 " N/A " 29,687.64 " " 44,531.46 " N/A " 53,405.10 " " 52,885.56 " N/A DRG 174.1 " 68,257.96 " " 21,508.08 " " 14,677.77 " " 26,403.84 " " 18,411.79 " N/A N/A N/A " 15,218.85 " N/A N/A N/A " 18,325.20 " N/A N/A " 14,677.77 " N/A N/A N/A N/A N/A N/A N/A " 15,631.83 " " 14,677.77 " N/A " 14,677.77 " " 22,016.66 " N/A " 26,403.84 " " 26,146.98 " N/A DRG 174.2 " 92,031.46 " " 28,999.11 " " 16,519.76 " " 29,717.40 " " 20,722.39 " N/A N/A N/A " 17,128.75 " N/A N/A N/A " 20,624.92 " N/A N/A " 16,519.76 " N/A N/A N/A N/A N/A N/A N/A " 17,593.54 " " 16,519.76 " N/A " 16,519.76 " " 24,779.64 " N/A " 29,717.40 " " 29,428.30 " N/A DRG 174.3 " 194,400.83 " " 61,255.70 " " 21,283.62 " " 38,287.10 " " 26,698.17 " N/A N/A N/A " 22,068.22 " N/A N/A N/A " 26,572.60 " N/A N/A " 21,283.62 " N/A N/A N/A N/A N/A N/A N/A " 22,667.06 " " 21,283.62 " N/A " 21,283.62 " " 31,925.43 " N/A " 38,287.10 " " 37,914.64 " N/A DRG 174.4 " 173,675.61 " " 54,725.18 " " 30,043.71 " " 54,045.63 " " 37,686.83 " N/A N/A N/A " 31,151.25 " N/A N/A N/A " 37,509.57 " N/A N/A " 30,043.71 " N/A N/A N/A N/A N/A N/A N/A " 31,996.55 " " 30,043.71 " N/A " 30,043.71 " " 45,065.57 " N/A " 54,045.63 " " 53,519.86 " N/A DRG 175.1 " 88,596.60 " " 27,916.79 " " 17,372.29 " " 31,251.01 " " 21,791.80 " N/A N/A N/A " 18,012.70 " N/A N/A N/A " 21,689.30 " N/A N/A " 17,372.29 " N/A N/A N/A N/A N/A N/A N/A " 18,501.49 " " 17,372.29 " N/A " 17,372.29 " " 26,058.44 " N/A " 31,251.01 " " 30,947.00 " N/A DRG 175.2 " 91,754.48 " " 28,911.84 " " 18,782.20 " " 33,787.30 " " 23,560.39 " N/A N/A N/A " 19,474.59 " N/A N/A N/A " 23,449.58 " N/A N/A " 18,782.20 " N/A N/A N/A N/A N/A N/A N/A " 20,003.04 " " 18,782.20 " N/A " 18,782.20 " " 28,173.30 " N/A " 33,787.30 " " 33,458.61 " N/A DRG 175.3 " 144,526.43 " " 45,540.28 " " 23,161.22 " " 41,664.72 " " 29,053.43 " N/A N/A N/A " 24,015.04 " N/A N/A N/A " 28,916.78 " N/A N/A " 23,161.22 " N/A N/A N/A N/A N/A N/A N/A " 24,666.70 " " 23,161.22 " N/A " 23,161.22 " " 34,741.83 " N/A " 41,664.72 " " 41,259.40 " N/A DRG 175.4 " 260,438.06 " " 82,064.03 " " 35,408.78 " " 63,696.85 " " 44,416.77 " N/A N/A N/A " 36,714.10 " N/A N/A N/A " 44,207.86 " N/A N/A " 35,408.78 " N/A N/A N/A N/A N/A N/A N/A " 37,710.35 " " 35,408.78 " N/A " 35,408.78 " " 53,113.17 " N/A " 63,696.85 " " 63,077.20 " N/A DRG 176.1 No Current Volume N/A " 14,336.07 " " 25,789.16 " " 17,983.17 " N/A N/A N/A " 14,864.56 " N/A N/A N/A " 17,898.58 " N/A N/A " 14,336.07 " N/A N/A N/A N/A N/A N/A N/A " 15,267.91 " " 14,336.07 " N/A " 14,336.07 " " 21,504.11 " N/A " 25,789.16 " " 25,538.28 " N/A DRG 176.2 No Current Volume N/A " 17,314.77 " " 31,147.54 " " 21,719.65 " N/A N/A N/A " 17,953.06 " N/A N/A N/A " 21,617.49 " N/A N/A " 17,314.77 " N/A N/A N/A N/A N/A N/A N/A " 18,440.23 " " 17,314.77 " N/A " 17,314.77 " " 25,972.16 " N/A " 31,147.54 " " 30,844.53 " N/A DRG 176.3 No Current Volume N/A " 25,735.91 " " 46,296.33 " " 32,283.13 " N/A N/A N/A " 26,684.64 " N/A N/A N/A " 32,131.28 " N/A N/A " 25,735.91 " N/A N/A N/A N/A N/A N/A N/A " 27,408.74 " " 25,735.91 " N/A " 25,735.91 " " 38,603.87 " N/A " 46,296.33 " " 45,845.95 " N/A DRG 176.4 No Current Volume N/A " 43,506.04 " " 78,263.02 " " 54,573.98 " N/A N/A N/A " 45,109.85 " N/A N/A N/A " 54,317.29 " N/A N/A " 43,506.04 " N/A N/A N/A N/A N/A N/A N/A " 46,333.93 " " 43,506.04 " N/A " 43,506.04 " " 65,259.06 " N/A " 78,263.02 " " 77,501.66 " N/A DRG 177.1 No Current Volume N/A " 10,314.49 " " 18,554.74 " " 12,938.50 " N/A N/A N/A " 10,694.73 " N/A N/A N/A " 12,877.64 " N/A N/A " 10,314.49 " N/A N/A N/A N/A N/A N/A N/A " 10,984.93 " " 10,314.49 " N/A " 10,314.49 " " 15,471.74 " N/A " 18,554.74 " " 18,374.23 " N/A DRG 177.2 No Current Volume N/A " 14,822.93 " " 26,664.97 " " 18,593.88 " N/A N/A N/A " 15,369.37 " N/A N/A N/A " 18,506.43 " N/A N/A " 14,822.93 " N/A N/A N/A N/A N/A N/A N/A " 15,786.42 " " 14,822.93 " N/A " 14,822.93 " " 22,234.40 " N/A " 26,664.97 " " 26,405.57 " N/A DRG 177.3 No Current Volume N/A " 18,403.53 " " 33,106.11 " " 23,085.39 " N/A N/A N/A " 19,081.96 " N/A N/A N/A " 22,976.81 " N/A N/A " 18,403.53 " N/A N/A N/A N/A N/A N/A N/A " 19,599.76 " " 18,403.53 " N/A " 18,403.53 " " 27,605.30 " N/A " 33,106.11 " " 32,784.05 " N/A DRG 177.4 No Current Volume N/A " 26,804.81 " " 48,219.17 " " 33,623.95 " N/A N/A N/A " 27,792.95 " N/A N/A N/A " 33,465.81 " N/A N/A " 26,804.81 " N/A N/A N/A N/A N/A N/A N/A " 28,547.12 " " 26,804.81 " N/A " 26,804.81 " " 40,207.22 " N/A " 48,219.17 " " 47,750.09 " N/A DRG 178.1 No Current Volume N/A " 39,213.98 " " 70,542.03 " " 49,190.02 " N/A N/A N/A " 40,659.57 " N/A N/A N/A " 48,958.65 " N/A N/A " 39,213.98 " N/A N/A N/A N/A N/A N/A N/A " 41,762.89 " " 39,213.98 " N/A " 39,213.98 " " 58,820.97 " N/A " 70,542.03 " " 69,855.78 " N/A DRG 178.2 No Current Volume N/A " 42,170.08 " " 75,859.76 " " 52,898.15 " N/A N/A N/A " 43,724.64 " N/A N/A N/A " 52,649.34 " N/A N/A " 42,170.08 " N/A N/A N/A N/A N/A N/A N/A " 44,911.14 " " 42,170.08 " N/A " 42,170.08 " " 63,255.12 " N/A " 75,859.76 " " 75,121.78 " N/A DRG 178.3 No Current Volume N/A " 48,499.28 " " 87,245.35 " " 60,837.50 " N/A N/A N/A " 50,287.17 " N/A N/A N/A " 60,551.35 " N/A N/A " 48,499.28 " N/A N/A N/A N/A N/A N/A N/A " 51,651.73 " " 48,499.28 " N/A " 48,499.28 " " 72,748.92 " N/A " 87,245.35 " " 86,396.62 " N/A DRG 178.4 " 167,497.61 " " 52,778.50 " " 69,602.81 " " 125,208.49 " " 87,309.76 " N/A N/A N/A " 72,168.66 " N/A N/A N/A " 86,899.11 " N/A N/A " 69,602.81 " N/A N/A N/A N/A N/A N/A N/A " 74,126.99 " " 69,602.81 " N/A " 69,602.81 " " 104,404.22 " N/A " 125,208.49 " " 123,990.45 " N/A DRG 179.1 No Current Volume N/A " 30,623.70 " " 55,088.97 " " 38,414.37 " N/A N/A N/A " 31,752.62 " N/A N/A N/A " 38,233.69 " N/A N/A " 30,623.70 " N/A N/A N/A N/A N/A N/A N/A " 32,614.24 " " 30,623.70 " N/A " 30,623.70 " " 45,935.55 " N/A " 55,088.97 " " 54,553.06 " N/A DRG 179.2 " 265,129.90 " " 83,542.43 " " 33,764.68 " " 60,739.28 " " 42,354.41 " N/A N/A N/A " 35,009.39 " N/A N/A N/A " 42,155.20 " N/A N/A " 33,764.68 " N/A N/A N/A N/A N/A N/A N/A " 35,959.38 " " 33,764.68 " N/A " 33,764.68 " " 50,647.02 " N/A " 60,739.28 " " 60,148.40 " N/A DRG 179.3 No Current Volume N/A " 40,112.38 " " 72,158.16 " " 50,316.97 " N/A N/A N/A " 41,591.09 " N/A N/A N/A " 50,080.31 " N/A N/A " 40,112.38 " N/A N/A N/A N/A N/A N/A N/A " 42,719.68 " " 40,112.38 " N/A " 40,112.38 " " 60,168.57 " N/A " 72,158.16 " " 71,456.19 " N/A DRG 179.4 " 364,872.68 " " 114,971.38 " " 55,718.68 " " 100,232.33 " " 69,893.51 " N/A N/A N/A " 57,772.70 " N/A N/A N/A " 69,564.77 " N/A N/A " 55,718.68 " N/A N/A N/A N/A N/A N/A N/A " 59,340.39 " " 55,718.68 " N/A " 55,718.68 " " 83,578.02 " N/A " 100,232.33 " " 99,257.26 " N/A DRG 180.1 No Current Volume N/A " 9,896.79 " " 17,803.34 " " 12,414.53 " N/A N/A N/A " 10,261.63 " N/A N/A N/A " 12,356.14 " N/A N/A " 9,896.79 " N/A N/A N/A N/A N/A N/A N/A " 10,540.08 " " 9,896.79 " N/A " 9,896.79 " " 14,845.19 " N/A " 17,803.34 " " 17,630.14 " N/A DRG 180.2 No Current Volume N/A " 12,479.01 " " 22,448.49 " " 15,653.67 " N/A N/A N/A " 12,939.04 " N/A N/A N/A " 15,580.04 " N/A N/A " 12,479.01 " N/A N/A N/A N/A N/A N/A N/A " 13,290.15 " " 12,479.01 " N/A " 12,479.01 " " 18,718.52 " N/A " 22,448.49 " " 22,230.11 " N/A DRG 180.3 " 122,752.48 " " 38,679.31 " " 17,870.79 " " 32,147.76 " " 22,417.12 " N/A N/A N/A " 18,529.58 " N/A N/A N/A " 22,311.68 " N/A N/A " 17,870.79 " N/A N/A N/A N/A N/A N/A N/A " 19,032.39 " " 17,870.79 " N/A " 17,870.79 " " 26,806.19 " N/A " 32,147.76 " " 31,835.03 " N/A DRG 180.4 No Current Volume N/A " 32,601.28 " " 58,646.44 " " 40,895.05 " N/A N/A N/A " 33,803.10 " N/A N/A N/A " 40,702.70 " N/A N/A " 32,601.28 " N/A N/A N/A N/A N/A N/A N/A " 34,720.36 " " 32,601.28 " N/A " 32,601.28 " " 48,901.92 " N/A " 58,646.44 " " 58,075.92 " N/A DRG 181.1 " 41,360.77 " " 13,032.78 " " 11,675.79 " " 21,003.58 " " 14,646.11 " N/A N/A N/A " 12,106.21 " N/A N/A N/A " 14,577.22 " N/A N/A " 11,675.79 " N/A N/A N/A N/A N/A N/A N/A " 12,434.72 " " 11,675.79 " N/A " 11,675.79 " " 17,513.69 " N/A " 21,003.58 " " 20,799.25 " N/A DRG 181.2 " 77,973.04 " " 24,569.30 " " 16,431.43 " " 29,558.50 " " 20,611.59 " N/A N/A N/A " 17,037.16 " N/A N/A N/A " 20,514.64 " N/A N/A " 16,431.43 " N/A N/A N/A N/A N/A N/A N/A " 17,499.47 " " 16,431.43 " N/A " 16,431.43 " " 24,647.15 " N/A " 29,558.50 " " 29,270.95 " N/A DRG 181.3 " 77,305.50 " " 24,358.96 " " 26,507.63 " " 47,684.58 " " 33,251.17 " N/A N/A N/A " 27,484.81 " N/A N/A N/A " 33,094.78 " N/A N/A " 26,507.63 " N/A N/A N/A N/A N/A N/A N/A " 28,230.63 " " 26,507.63 " N/A " 26,507.63 " " 39,761.45 " N/A " 47,684.58 " " 47,220.69 " N/A DRG 181.4 No Current Volume N/A " 43,167.77 " " 77,654.50 " " 54,149.65 " N/A N/A N/A " 44,759.11 " N/A N/A N/A " 53,894.96 " N/A N/A " 43,167.77 " N/A N/A N/A N/A N/A N/A N/A " 45,973.68 " " 43,167.77 " N/A " 43,167.77 " " 64,751.66 " N/A " 77,654.50 " " 76,899.07 " N/A DRG 182.1 " 88,372.06 " " 27,846.03 " " 19,291.66 " " 34,703.77 " " 24,199.46 " N/A N/A N/A " 20,002.83 " N/A N/A N/A " 24,085.64 " N/A N/A " 19,291.66 " N/A N/A N/A N/A N/A N/A N/A " 20,545.62 " " 19,291.66 " N/A " 19,291.66 " " 28,937.49 " N/A " 34,703.77 " " 34,366.16 " N/A DRG 182.2 " 178,938.58 " " 56,383.55 " " 19,581.31 " " 35,224.82 " " 24,562.80 " N/A N/A N/A " 20,303.16 " N/A N/A N/A " 24,447.27 " N/A N/A " 19,581.31 " N/A N/A N/A N/A N/A N/A N/A " 20,854.10 " " 19,581.31 " N/A " 19,581.31 " " 29,371.97 " N/A " 35,224.82 " " 34,882.15 " N/A DRG 182.3 " 275,093.07 " " 86,681.82 " " 22,180.65 " " 39,900.77 " " 27,823.41 " N/A N/A N/A " 22,998.32 " N/A N/A N/A " 27,692.54 " N/A N/A " 22,180.65 " N/A N/A N/A N/A N/A N/A N/A " 23,622.39 " " 22,180.65 " N/A " 22,180.65 " " 33,270.98 " N/A " 39,900.77 " " 39,512.61 " N/A DRG 182.4 " 231,895.54 " " 73,070.28 " " 41,476.42 " " 74,611.93 " " 52,028.02 " N/A N/A N/A " 43,005.41 " N/A N/A N/A " 51,783.31 " N/A N/A " 41,476.42 " N/A N/A N/A N/A N/A N/A N/A " 44,172.39 " " 41,476.42 " N/A " 41,476.42 " " 62,214.63 " N/A " 74,611.93 " " 73,886.09 " N/A DRG 183.1 No Current Volume N/A " 35,300.59 " " 63,502.23 " " 44,281.06 " N/A N/A N/A " 36,601.92 " N/A N/A N/A " 44,072.79 " N/A N/A " 35,300.59 " N/A N/A N/A N/A N/A N/A N/A " 37,595.13 " " 35,300.59 " N/A " 35,300.59 " " 52,950.89 " N/A " 63,502.23 " " 62,884.47 " N/A DRG 183.2 No Current Volume N/A " 37,076.85 " " 66,697.55 " " 46,509.20 " N/A N/A N/A " 38,443.66 " N/A N/A N/A " 46,290.45 " N/A N/A " 37,076.85 " N/A N/A N/A N/A N/A N/A N/A " 39,486.85 " " 37,076.85 " N/A " 37,076.85 " " 55,615.28 " N/A " 66,697.55 " " 66,048.70 " N/A DRG 183.3 No Current Volume N/A " 44,064.80 " " 79,268.17 " " 55,274.89 " N/A N/A N/A " 45,689.21 " N/A N/A N/A " 55,014.90 " N/A N/A " 44,064.80 " N/A N/A N/A N/A N/A N/A N/A " 46,929.01 " " 44,064.80 " N/A " 44,064.80 " " 66,097.20 " N/A " 79,268.17 " " 78,497.03 " N/A DRG 183.4 No Current Volume N/A " 65,112.17 " " 117,130.28 " " 81,676.71 " N/A N/A N/A " 67,512.48 " N/A N/A N/A " 81,292.54 " N/A N/A " 65,112.17 " N/A N/A N/A N/A N/A N/A N/A " 69,344.46 " " 65,112.17 " N/A " 65,112.17 " " 97,668.26 " N/A " 117,130.28 " " 115,990.82 " N/A DRG 190.1 No Current Volume N/A " 5,388.35 " " 9,693.10 " " 6,759.15 " N/A N/A N/A " 5,586.99 " N/A N/A N/A " 6,727.35 " N/A N/A " 5,388.35 " N/A N/A N/A N/A N/A N/A N/A " 5,738.59 " " 5,388.35 " N/A " 5,388.35 " " 8,082.53 " N/A " 9,693.10 " " 9,598.81 " N/A DRG 190.2 " 32,240.47 " " 10,158.97 " " 6,548.33 " " 11,779.79 " " 8,214.23 " N/A N/A N/A " 6,789.73 " N/A N/A N/A " 8,175.59 " N/A N/A " 6,548.33 " N/A N/A N/A N/A N/A N/A N/A " 6,973.97 " " 6,548.33 " N/A " 6,548.33 " " 9,822.50 " N/A " 11,779.79 " " 11,665.20 " N/A DRG 190.3 No Current Volume N/A " 9,031.26 " " 16,246.33 " " 11,328.81 " N/A N/A N/A " 9,364.19 " N/A N/A N/A " 11,275.53 " N/A N/A " 9,031.26 " N/A N/A N/A N/A N/A N/A N/A " 9,618.29 " " 9,031.26 " N/A " 9,031.26 " " 13,546.89 " N/A " 16,246.33 " " 16,088.29 " N/A DRG 190.4 No Current Volume N/A " 13,589.00 " " 24,445.25 " " 17,046.04 " N/A N/A N/A " 14,089.95 " N/A N/A N/A " 16,965.87 " N/A N/A " 13,589.00 " N/A N/A N/A N/A N/A N/A N/A " 14,472.29 " " 13,589.00 " N/A " 13,589.00 " " 20,383.50 " N/A " 24,445.25 " " 24,207.44 " N/A DRG 191.1 No Current Volume N/A " 7,509.05 " " 13,508.03 " " 9,419.35 " N/A N/A N/A " 7,785.86 " N/A N/A N/A " 9,375.05 " N/A N/A " 7,509.05 " N/A N/A N/A N/A N/A N/A N/A " 7,997.14 " " 7,509.05 " N/A " 7,509.05 " " 11,263.58 " N/A " 13,508.03 " " 13,376.62 " N/A DRG 191.2 " 42,812.26 " " 13,490.14 " " 8,727.23 " " 15,699.41 " " 10,947.44 " N/A N/A N/A " 9,048.95 " N/A N/A N/A " 10,895.95 " N/A N/A " 8,727.23 " N/A N/A N/A N/A N/A N/A N/A " 9,294.50 " " 8,727.23 " N/A " 8,727.23 " " 13,090.85 " N/A " 15,699.41 " " 15,546.69 " N/A DRG 191.3 No Current Volume N/A " 11,451.88 " " 20,600.79 " " 14,365.24 " N/A N/A N/A " 11,874.04 " N/A N/A N/A " 14,297.67 " N/A N/A " 11,451.88 " N/A N/A N/A N/A N/A N/A N/A " 12,196.25 " " 11,451.88 " N/A " 11,451.88 " " 17,177.82 " N/A " 20,600.79 " " 20,400.38 " N/A DRG 191.4 No Current Volume N/A " 16,968.96 " " 30,525.46 " " 21,285.86 " N/A N/A N/A " 17,594.51 " N/A N/A N/A " 21,185.75 " N/A N/A " 16,968.96 " N/A N/A N/A N/A N/A N/A N/A " 18,071.94 " " 16,968.96 " N/A " 16,968.96 " " 25,453.44 " N/A " 30,525.46 " " 30,228.51 " N/A DRG 192.1 " 118,847.66 " " 37,448.90 " " 8,119.85 " " 14,606.80 " " 10,185.54 " N/A N/A N/A " 8,419.18 " N/A N/A N/A " 10,137.63 " N/A N/A " 8,119.85 " N/A N/A N/A N/A N/A N/A N/A " 8,647.64 " " 8,119.85 " N/A " 8,119.85 " " 12,179.78 " N/A " 14,606.80 " " 14,464.70 " N/A DRG 192.2 " 44,748.44 " " 14,100.23 " " 9,990.60 " " 17,972.09 " " 12,532.21 " N/A N/A N/A " 10,358.90 " N/A N/A N/A " 12,473.26 " N/A N/A " 9,990.60 " N/A N/A N/A N/A N/A N/A N/A " 10,639.99 " " 9,990.60 " N/A " 9,990.60 " " 14,985.90 " N/A " 17,972.09 " " 17,797.25 " N/A DRG 192.3 " 72,655.35 " " 22,893.70 " " 14,602.44 " " 26,268.33 " " 18,317.30 " N/A N/A N/A " 15,140.75 " N/A N/A N/A " 18,231.15 " N/A N/A " 14,602.44 " N/A N/A N/A N/A N/A N/A N/A " 15,551.60 " " 14,602.44 " N/A " 14,602.44 " " 21,903.66 " N/A " 26,268.33 " " 26,012.79 " N/A DRG 192.4 " 90,706.54 " " 28,581.63 " " 23,916.51 " " 43,023.41 " " 30,000.87 " N/A N/A N/A " 24,798.17 " N/A N/A N/A " 29,859.76 " N/A N/A " 23,916.51 " N/A N/A N/A N/A N/A N/A N/A " 25,471.08 " " 23,916.51 " N/A " 23,916.51 " " 35,874.77 " N/A " 43,023.41 " " 42,604.87 " N/A DRG 193.1 No Current Volume N/A " 6,896.87 " " 12,406.78 " " 8,651.43 " N/A N/A N/A " 7,151.12 " N/A N/A N/A " 8,610.74 " N/A N/A " 6,896.87 " N/A N/A N/A N/A N/A N/A N/A " 7,345.17 " " 6,896.87 " N/A " 6,896.87 " " 10,345.31 " N/A " 12,406.78 " " 12,286.08 " N/A DRG 193.2 No Current Volume N/A " 8,333.49 " " 14,991.12 " " 10,453.53 " N/A N/A N/A " 8,640.70 " N/A N/A N/A " 10,404.36 " N/A N/A " 8,333.49 " N/A N/A N/A N/A N/A N/A N/A " 8,875.17 " " 8,333.49 " N/A " 8,333.49 " " 12,500.24 " N/A " 14,991.12 " " 14,845.28 " N/A DRG 193.3 No Current Volume N/A " 12,702.24 " " 22,850.06 " " 15,933.69 " N/A N/A N/A " 13,170.50 " N/A N/A N/A " 15,858.75 " N/A N/A " 12,702.24 " N/A N/A N/A N/A N/A N/A N/A " 13,527.89 " " 12,702.24 " N/A " 12,702.24 " " 19,053.36 " N/A " 22,850.06 " " 22,627.77 " N/A DRG 193.4 " 97,358.88 " " 30,677.78 " " 20,151.71 " " 36,250.91 " " 25,278.31 " N/A N/A N/A " 20,894.59 " N/A N/A N/A " 25,159.41 " N/A N/A " 20,151.71 " N/A N/A N/A N/A N/A N/A N/A " 21,461.57 " " 20,151.71 " N/A " 20,151.71 " " 30,227.57 " N/A " 36,250.91 " " 35,898.26 " N/A DRG 194.1 No Current Volume N/A " 4,073.62 " " 7,328.04 " " 5,109.95 " N/A N/A N/A " 4,223.79 " N/A N/A N/A " 5,085.91 " N/A N/A " 4,073.62 " N/A N/A N/A N/A N/A N/A N/A " 4,338.41 " " 4,073.62 " N/A " 4,073.62 " " 6,110.43 " N/A " 7,328.04 " " 7,256.75 " N/A DRG 194.2 " 35,655.49 " " 11,235.04 " " 5,384.24 " " 9,685.71 " " 6,753.99 " N/A N/A N/A " 5,582.73 " N/A N/A N/A " 6,722.22 " N/A N/A " 5,384.24 " N/A N/A N/A N/A N/A N/A N/A " 5,734.22 " " 5,384.24 " N/A " 5,384.24 " " 8,076.36 " N/A " 9,685.71 " " 9,591.49 " N/A DRG 194.3 " 65,404.02 " " 20,608.81 " " 7,788.43 " " 14,010.61 " " 9,769.81 " N/A N/A N/A " 8,075.54 " N/A N/A N/A " 9,723.85 " N/A N/A " 7,788.43 " N/A N/A N/A N/A N/A N/A N/A " 8,294.68 " " 7,788.43 " N/A " 7,788.43 " " 11,682.65 " N/A " 14,010.61 " " 13,874.31 " N/A DRG 194.4 " 97,444.98 " " 30,704.91 " " 12,739.90 " " 22,917.81 " " 15,980.93 " N/A N/A N/A " 13,209.55 " N/A N/A N/A " 15,905.77 " N/A N/A " 12,739.90 " N/A N/A N/A N/A N/A N/A N/A " 13,567.99 " " 12,739.90 " N/A " 12,739.90 " " 19,109.85 " N/A " 22,917.81 " " 22,694.86 " N/A DRG 196.1 No Current Volume N/A " 3,588.81 " " 6,455.91 " " 4,501.80 " N/A N/A N/A " 3,721.11 " N/A N/A N/A " 4,480.63 " N/A N/A " 3,588.81 " N/A N/A N/A N/A N/A N/A N/A " 3,822.08 " " 3,588.81 " N/A " 3,588.81 " " 5,383.22 " N/A " 6,455.91 " " 6,393.11 " N/A DRG 196.2 No Current Volume N/A " 4,555.69 " " 8,195.23 " " 5,714.66 " N/A N/A N/A " 4,723.63 " N/A N/A N/A " 5,687.78 " N/A N/A " 4,555.69 " N/A N/A N/A N/A N/A N/A N/A " 4,851.81 " " 4,555.69 " N/A " 4,555.69 " " 6,833.54 " N/A " 8,195.23 " " 8,115.51 " N/A DRG 196.3 No Current Volume N/A " 6,935.22 " " 12,475.77 " " 8,699.54 " N/A N/A N/A " 7,190.88 " N/A N/A N/A " 8,658.62 " N/A N/A " 6,935.22 " N/A N/A N/A N/A N/A N/A N/A " 7,386.01 " " 6,935.22 " N/A " 6,935.22 " " 10,402.83 " N/A " 12,475.77 " " 12,354.40 " N/A DRG 196.4 " 101,513.30 " " 31,986.84 " " 13,632.14 " " 24,522.86 " " 17,100.16 " N/A N/A N/A " 14,134.68 " N/A N/A N/A " 17,019.73 " N/A N/A " 13,632.14 " N/A N/A N/A N/A N/A N/A N/A " 14,518.23 " " 13,632.14 " N/A " 13,632.14 " " 20,448.21 " N/A " 24,522.86 " " 24,284.29 " N/A DRG 197.1 " 26,084.58 " " 8,219.25 " " 4,372.86 " " 7,866.34 " " 5,485.32 " N/A N/A N/A " 4,534.06 " N/A N/A N/A " 5,459.52 " N/A N/A " 4,372.86 " N/A N/A N/A N/A N/A N/A N/A " 4,657.10 " " 4,372.86 " N/A " 4,372.86 " " 6,559.29 " N/A " 7,866.34 " " 7,789.81 " N/A DRG 197.2 " 23,145.11 " " 7,293.02 " " 5,708.82 " " 10,269.60 " " 7,161.14 " N/A N/A N/A " 5,919.27 " N/A N/A N/A " 7,127.46 " N/A N/A " 5,708.82 " N/A N/A N/A N/A N/A N/A N/A " 6,079.89 " " 5,708.82 " N/A " 5,708.82 " " 8,563.23 " N/A " 10,269.60 " " 10,169.69 " N/A DRG 197.3 " 82,411.93 " " 25,968.00 " " 7,924.01 " " 14,254.50 " " 9,939.88 " N/A N/A N/A " 8,216.12 " N/A N/A N/A " 9,893.13 " N/A N/A " 7,924.01 " N/A N/A N/A N/A N/A N/A N/A " 8,439.07 " " 7,924.01 " N/A " 7,924.01 " " 11,886.02 " N/A " 14,254.50 " " 14,115.83 " N/A DRG 197.4 No Current Volume N/A " 15,526.18 " " 27,930.05 " " 19,476.04 " N/A N/A N/A " 16,098.54 " N/A N/A N/A " 19,384.44 " N/A N/A " 15,526.18 " N/A N/A N/A N/A N/A N/A N/A " 16,535.38 " " 15,526.18 " N/A " 15,526.18 " " 23,289.27 " N/A " 27,930.05 " " 27,658.34 " N/A DRG 198.1 No Current Volume N/A " 4,187.97 " " 7,533.74 " " 5,253.39 " N/A N/A N/A " 4,342.36 " N/A N/A N/A " 5,228.68 " N/A N/A " 4,187.97 " N/A N/A N/A N/A N/A N/A N/A " 4,460.19 " " 4,187.97 " N/A " 4,187.97 " " 6,281.96 " N/A " 7,533.74 " " 7,460.45 " N/A DRG 198.2 No Current Volume N/A " 4,826.17 " " 8,681.80 " " 6,053.95 " N/A N/A N/A " 5,004.08 " N/A N/A N/A " 6,025.47 " N/A N/A " 4,826.17 " N/A N/A N/A N/A N/A N/A N/A " 5,139.87 " " 4,826.17 " N/A " 4,826.17 " " 7,239.26 " N/A " 8,681.80 " " 8,597.34 " N/A DRG 198.3 No Current Volume N/A " 6,312.09 " " 11,354.82 " " 7,917.89 " N/A N/A N/A " 6,544.78 " N/A N/A N/A " 7,880.64 " N/A N/A " 6,312.09 " N/A N/A N/A N/A N/A N/A N/A " 6,722.38 " " 6,312.09 " N/A " 6,312.09 " " 9,468.14 " N/A " 11,354.82 " " 11,244.36 " N/A DRG 198.4 No Current Volume N/A " 11,473.79 " " 20,640.20 " " 14,392.72 " N/A N/A N/A " 11,896.76 " N/A N/A N/A " 14,325.03 " N/A N/A " 11,473.79 " N/A N/A N/A N/A N/A N/A N/A " 12,219.59 " " 11,473.79 " N/A " 11,473.79 " " 17,210.69 " N/A " 20,640.20 " " 20,439.41 " N/A DRG 199.1 " 78,629.10 " " 24,776.03 " " 4,158.53 " " 7,480.78 " " 5,216.46 " N/A N/A N/A " 4,311.83 " N/A N/A N/A " 5,191.92 " N/A N/A " 4,158.53 " N/A N/A N/A N/A N/A N/A N/A " 4,428.83 " " 4,158.53 " N/A " 4,158.53 " " 6,237.80 " N/A " 7,480.78 " " 7,408.01 " N/A DRG 199.2 " 30,302.12 " " 9,548.20 " " 4,812.47 " " 8,657.15 " " 6,036.76 " N/A N/A N/A " 4,989.88 " N/A N/A N/A " 6,008.37 " N/A N/A " 4,812.47 " N/A N/A N/A N/A N/A N/A N/A " 5,125.28 " " 4,812.47 " N/A " 4,812.47 " " 7,218.71 " N/A " 8,657.15 " " 8,572.93 " N/A DRG 199.3 " 26,454.09 " " 8,335.68 " " 6,386.04 " " 11,487.85 " " 8,010.65 " N/A N/A N/A " 6,621.46 " N/A N/A N/A " 7,972.97 " N/A N/A " 6,386.04 " N/A N/A N/A N/A N/A N/A N/A " 6,801.13 " " 6,386.04 " N/A " 6,386.04 " " 9,579.06 " N/A " 11,487.85 " " 11,376.09 " N/A DRG 199.4 No Current Volume N/A " 11,449.82 " " 20,597.08 " " 14,362.65 " N/A N/A N/A " 11,871.91 " N/A N/A N/A " 14,295.10 " N/A N/A " 11,449.82 " N/A N/A N/A N/A N/A N/A N/A " 12,194.06 " " 11,449.82 " N/A " 11,449.82 " " 17,174.73 " N/A " 20,597.08 " " 20,396.71 " N/A DRG 200.1 No Current Volume N/A " 4,660.46 " " 8,383.70 " " 5,846.08 " N/A N/A N/A " 4,832.26 " N/A N/A N/A " 5,818.58 " N/A N/A " 4,660.46 " N/A N/A N/A N/A N/A N/A N/A " 4,963.39 " " 4,660.46 " N/A " 4,660.46 " " 6,990.69 " N/A " 8,383.70 " " 8,302.14 " N/A DRG 200.2 No Current Volume N/A " 5,700.60 " " 10,254.81 " " 7,150.83 " N/A N/A N/A " 5,910.75 " N/A N/A N/A " 7,117.20 " N/A N/A " 5,700.60 " N/A N/A N/A N/A N/A N/A N/A " 6,071.14 " " 5,700.60 " N/A " 5,700.60 " " 8,550.90 " N/A " 10,254.81 " " 10,155.05 " N/A DRG 200.3 No Current Volume N/A " 8,554.67 " " 15,389.00 " " 10,730.98 " N/A N/A N/A " 8,870.03 " N/A N/A N/A " 10,680.51 " N/A N/A " 8,554.67 " N/A N/A N/A N/A N/A N/A N/A " 9,110.72 " " 8,554.67 " N/A " 8,554.67 " " 12,832.01 " N/A " 15,389.00 " " 15,239.29 " N/A DRG 200.4 No Current Volume N/A " 17,809.16 " " 32,036.90 " " 22,339.81 " N/A N/A N/A " 18,465.68 " N/A N/A N/A " 22,234.74 " N/A N/A " 17,809.16 " N/A N/A N/A N/A N/A N/A N/A " 18,966.76 " " 17,809.16 " N/A " 17,809.16 " " 26,713.74 " N/A " 32,036.90 " " 31,725.24 " N/A DRG 201.1 " 16,299.52 " " 5,135.98 " " 3,673.04 " " 6,607.43 " " 4,607.46 " N/A N/A N/A " 3,808.44 " N/A N/A N/A " 4,585.79 " N/A N/A " 3,673.04 " N/A N/A N/A N/A N/A N/A N/A " 3,911.79 " " 3,673.04 " N/A " 3,673.04 " " 5,509.56 " N/A " 6,607.43 " " 6,543.15 " N/A DRG 201.2 " 67,149.46 " " 21,158.79 " " 4,810.42 " " 8,653.46 " " 6,034.19 " N/A N/A N/A " 4,987.75 " N/A N/A N/A " 6,005.81 " N/A N/A " 4,810.42 " N/A N/A N/A N/A N/A N/A N/A " 5,123.10 " " 4,810.42 " N/A " 4,810.42 " " 7,215.63 " N/A " 8,653.46 " " 8,569.28 " N/A DRG 201.3 No Current Volume N/A " 7,097.51 " " 12,767.71 " " 8,903.12 " N/A N/A N/A " 7,359.15 " N/A N/A N/A " 8,861.24 " N/A N/A " 7,097.51 " N/A N/A N/A N/A N/A N/A N/A " 7,558.85 " " 7,097.51 " N/A " 7,097.51 " " 10,646.27 " N/A " 12,767.71 " " 12,643.50 " N/A DRG 201.4 No Current Volume N/A " 12,718.68 " " 22,879.63 " " 15,954.31 " N/A N/A N/A " 13,187.54 " N/A N/A N/A " 15,879.27 " N/A N/A " 12,718.68 " N/A N/A N/A N/A N/A N/A N/A " 13,545.39 " " 12,718.68 " N/A " 12,718.68 " " 19,078.02 " N/A " 22,879.63 " " 22,657.06 " N/A DRG 203.1 " 44,002.67 " " 13,865.24 " " 4,570.07 " " 8,221.10 " " 5,732.70 " N/A N/A N/A " 4,738.54 " N/A N/A N/A " 5,705.73 " N/A N/A " 4,570.07 " N/A N/A N/A N/A N/A N/A N/A " 4,867.12 " " 4,570.07 " N/A " 4,570.07 " " 6,855.11 " N/A " 8,221.10 " " 8,141.12 " N/A DRG 203.2 No Current Volume N/A " 4,980.92 " " 8,960.18 " " 6,248.07 " N/A N/A N/A " 5,164.54 " N/A N/A N/A " 6,218.68 " N/A N/A " 4,980.92 " N/A N/A N/A N/A N/A N/A N/A " 5,304.68 " " 4,980.92 " N/A " 4,980.92 " " 7,471.38 " N/A " 8,960.18 " " 8,873.01 " N/A DRG 203.3 No Current Volume N/A " 6,052.57 " " 10,887.97 " " 7,592.34 " N/A N/A N/A " 6,275.69 " N/A N/A N/A " 7,556.63 " N/A N/A " 6,052.57 " N/A N/A N/A N/A N/A N/A N/A " 6,445.99 " " 6,052.57 " N/A " 6,052.57 " " 9,078.86 " N/A " 10,887.97 " " 10,782.05 " N/A DRG 203.4 " 247,646.93 " " 78,033.55 " " 9,174.37 " " 16,503.77 " " 11,508.33 " N/A N/A N/A " 9,512.58 " N/A N/A N/A " 11,454.20 " N/A N/A " 9,174.37 " N/A N/A N/A N/A N/A N/A N/A " 9,770.70 " " 9,174.37 " N/A " 9,174.37 " " 13,761.56 " N/A " 16,503.77 " " 16,343.22 " N/A DRG 204.1 No Current Volume N/A " 4,966.54 " " 8,934.31 " " 6,230.03 " N/A N/A N/A " 5,149.63 " N/A N/A N/A " 6,200.73 " N/A N/A " 4,966.54 " N/A N/A N/A N/A N/A N/A N/A " 5,289.37 " " 4,966.54 " N/A " 4,966.54 " " 7,449.81 " N/A " 8,934.31 " " 8,847.39 " N/A DRG 204.2 " 68,368.22 " " 21,542.83 " " 5,473.95 " " 9,847.09 " " 6,866.52 " N/A N/A N/A " 5,675.74 " N/A N/A N/A " 6,834.23 " N/A N/A " 5,473.95 " N/A N/A N/A N/A N/A N/A N/A " 5,829.76 " " 5,473.95 " N/A " 5,473.95 " " 8,210.93 " N/A " 9,847.09 " " 9,751.29 " N/A DRG 204.3 " 70,737.25 " " 22,289.31 " " 6,762.66 " " 12,165.35 " " 8,483.08 " N/A N/A N/A " 7,011.96 " N/A N/A N/A " 8,443.18 " N/A N/A " 6,762.66 " N/A N/A N/A N/A N/A N/A N/A " 7,202.23 " " 6,762.66 " N/A " 6,762.66 " " 10,143.99 " N/A " 12,165.35 " " 12,047.00 " N/A DRG 204.4 " 171,276.02 " " 53,969.07 " " 11,705.92 " " 21,057.78 " " 14,683.91 " N/A N/A N/A " 12,137.45 " N/A N/A N/A " 14,614.84 " N/A N/A " 11,705.92 " N/A N/A N/A N/A N/A N/A N/A " 12,466.80 " " 11,705.92 " N/A " 11,705.92 " " 17,558.88 " N/A " 21,057.78 " " 20,852.93 " N/A DRG 205.1 No Current Volume N/A " 4,724.82 " " 8,499.48 " " 5,926.81 " N/A N/A N/A " 4,899.00 " N/A N/A N/A " 5,898.94 " N/A N/A " 4,724.82 " N/A N/A N/A N/A N/A N/A N/A " 5,031.93 " " 4,724.82 " N/A " 4,724.82 " " 7,087.23 " N/A " 8,499.48 " " 8,416.79 " N/A DRG 205.2 No Current Volume N/A " 5,339.05 " " 9,604.42 " " 6,697.30 " N/A N/A N/A " 5,535.87 " N/A N/A N/A " 6,665.80 " N/A N/A " 5,339.05 " N/A N/A N/A N/A N/A N/A N/A " 5,686.09 " " 5,339.05 " N/A " 5,339.05 " " 8,008.58 " N/A " 9,604.42 " " 9,510.98 " N/A DRG 205.3 No Current Volume N/A " 8,957.31 " " 16,113.30 " " 11,236.05 " N/A N/A N/A " 9,287.51 " N/A N/A N/A " 11,183.20 " N/A N/A " 8,957.31 " N/A N/A N/A N/A N/A N/A N/A " 9,539.54 " " 8,957.31 " N/A " 8,957.31 " " 13,435.97 " N/A " 16,113.30 " " 15,956.55 " N/A DRG 205.4 No Current Volume N/A " 21,810.20 " " 39,234.37 " " 27,358.71 " N/A N/A N/A " 22,614.21 " N/A N/A N/A " 27,230.03 " N/A N/A " 21,810.20 " N/A N/A N/A N/A N/A N/A N/A " 23,227.86 " " 21,810.20 " N/A " 21,810.20 " " 32,715.30 " N/A " 39,234.37 " " 38,852.69 " N/A DRG 206.1 No Current Volume N/A " 6,231.97 " " 11,210.69 " " 7,817.38 " N/A N/A N/A " 6,461.71 " N/A N/A N/A " 7,780.61 " N/A N/A " 6,231.97 " N/A N/A N/A N/A N/A N/A N/A " 6,637.05 " " 6,231.97 " N/A " 6,231.97 " " 9,347.96 " N/A " 11,210.69 " " 11,101.63 " N/A DRG 206.2 No Current Volume N/A " 6,275.80 " " 11,289.54 " " 7,872.36 " N/A N/A N/A " 6,507.15 " N/A N/A N/A " 7,835.34 " N/A N/A " 6,275.80 " N/A N/A N/A N/A N/A N/A N/A " 6,683.73 " " 6,275.80 " N/A " 6,275.80 " " 9,413.70 " N/A " 11,289.54 " " 11,179.71 " N/A DRG 206.3 " 45,835.73 " " 14,442.84 " " 9,419.52 " " 16,944.77 " " 11,815.85 " N/A N/A N/A " 9,766.76 " N/A N/A N/A " 11,760.27 " N/A N/A " 9,419.52 " N/A N/A N/A N/A N/A N/A N/A " 10,031.79 " " 9,419.52 " N/A " 9,419.52 " " 14,129.28 " N/A " 16,944.77 " " 16,779.93 " N/A DRG 206.4 No Current Volume N/A " 18,758.23 " " 33,744.18 " " 23,530.32 " N/A N/A N/A " 19,449.74 " N/A N/A N/A " 23,419.65 " N/A N/A " 18,758.23 " N/A N/A N/A N/A N/A N/A N/A " 19,977.51 " " 18,758.23 " N/A " 18,758.23 " " 28,137.35 " N/A " 33,744.18 " " 33,415.91 " N/A DRG 207.1 No Current Volume N/A " 4,610.47 " " 8,293.77 " " 5,783.37 " N/A N/A N/A " 4,780.43 " N/A N/A N/A " 5,756.17 " N/A N/A " 4,610.47 " N/A N/A N/A N/A N/A N/A N/A " 4,910.15 " " 4,610.47 " N/A " 4,610.47 " " 6,915.71 " N/A " 8,293.77 " " 8,213.09 " N/A DRG 207.2 No Current Volume N/A " 5,764.97 " " 10,370.60 " " 7,231.58 " N/A N/A N/A " 5,977.49 " N/A N/A N/A " 7,197.57 " N/A N/A " 5,764.97 " N/A N/A N/A N/A N/A N/A N/A " 6,139.69 " " 5,764.97 " N/A " 5,764.97 " " 8,647.46 " N/A " 10,370.60 " " 10,269.72 " N/A DRG 207.3 " 53,533.29 " " 16,868.34 " " 7,921.27 " " 14,249.57 " " 9,936.44 " N/A N/A N/A " 8,213.28 " N/A N/A N/A " 9,889.71 " N/A N/A " 7,921.27 " N/A N/A N/A N/A N/A N/A N/A " 8,436.15 " " 7,921.27 " N/A " 7,921.27 " " 11,881.91 " N/A " 14,249.57 " " 14,110.95 " N/A DRG 207.4 No Current Volume N/A " 16,034.27 " " 28,844.05 " " 20,113.39 " N/A N/A N/A " 16,625.36 " N/A N/A N/A " 20,018.79 " N/A N/A " 16,034.27 " N/A N/A N/A N/A N/A N/A N/A " 17,076.50 " " 16,034.27 " N/A " 16,034.27 " " 24,051.41 " N/A " 28,844.05 " " 28,563.45 " N/A DRG 220.1 No Current Volume N/A " 11,093.75 " " 19,956.55 " " 13,916.00 " N/A N/A N/A " 11,502.71 " N/A N/A N/A " 13,850.55 " N/A N/A " 11,093.75 " N/A N/A N/A N/A N/A N/A N/A " 11,814.84 " " 11,093.75 " N/A " 11,093.75 " " 16,640.63 " N/A " 19,956.55 " " 19,762.41 " N/A DRG 220.2 No Current Volume N/A " 16,467.72 " " 29,623.78 " " 20,657.11 " N/A N/A N/A " 17,074.79 " N/A N/A N/A " 20,559.95 " N/A N/A " 16,467.72 " N/A N/A N/A N/A N/A N/A N/A " 17,538.12 " " 16,467.72 " N/A " 16,467.72 " " 24,701.58 " N/A " 29,623.78 " " 29,335.60 " N/A DRG 220.3 No Current Volume N/A " 26,493.25 " " 47,658.71 " " 33,233.13 " N/A N/A N/A " 27,469.90 " N/A N/A N/A " 33,076.82 " N/A N/A " 26,493.25 " N/A N/A N/A N/A N/A N/A N/A " 28,215.31 " " 26,493.25 " N/A " 26,493.25 " " 39,739.88 " N/A " 47,658.71 " " 47,195.08 " N/A DRG 220.4 No Current Volume N/A " 48,553.38 " " 87,342.68 " " 60,905.36 " N/A N/A N/A " 50,343.26 " N/A N/A N/A " 60,618.89 " N/A N/A " 48,553.38 " N/A N/A N/A N/A N/A N/A N/A " 51,709.35 " " 48,553.38 " N/A " 48,553.38 " " 72,830.07 " N/A " 87,342.68 " " 86,492.99 " N/A DRG 222.1 No Current Volume N/A " 5,719.78 " " 10,289.31 " " 7,174.89 " N/A N/A N/A " 5,930.63 " N/A N/A N/A " 7,141.15 " N/A N/A " 5,719.78 " N/A N/A N/A N/A N/A N/A N/A " 6,091.57 " " 5,719.78 " N/A " 5,719.78 " " 8,579.67 " N/A " 10,289.31 " " 10,189.22 " N/A DRG 222.2 No Current Volume N/A " 9,968.01 " " 17,931.45 " " 12,503.87 " N/A N/A N/A " 10,335.47 " N/A N/A N/A " 12,445.06 " N/A N/A " 9,968.01 " N/A N/A N/A N/A N/A N/A N/A " 10,615.93 " " 9,968.01 " N/A " 9,968.01 " " 14,952.02 " N/A " 17,931.45 " " 17,757.01 " N/A DRG 222.3 No Current Volume N/A " 15,837.06 " " 28,489.29 " " 19,866.01 " N/A N/A N/A " 16,420.88 " N/A N/A N/A " 19,772.57 " N/A N/A " 15,837.06 " N/A N/A N/A N/A N/A N/A N/A " 16,866.47 " " 15,837.06 " N/A " 15,837.06 " " 23,755.59 " N/A " 28,489.29 " " 28,212.14 " N/A DRG 222.4 No Current Volume N/A " 33,508.58 " " 60,278.58 " " 42,033.16 " N/A N/A N/A " 34,743.85 " N/A N/A N/A " 41,835.46 " N/A N/A " 33,508.58 " N/A N/A N/A N/A N/A N/A N/A " 35,686.64 " " 33,508.58 " N/A " 33,508.58 " " 50,262.87 " N/A " 60,278.58 " " 59,692.18 " N/A DRG 223.1 No Current Volume N/A " 8,228.04 " " 14,801.42 " " 10,321.25 " N/A N/A N/A " 8,531.36 " N/A N/A N/A " 10,272.71 " N/A N/A " 8,228.04 " N/A N/A N/A N/A N/A N/A N/A " 8,762.86 " " 8,228.04 " N/A " 8,228.04 " " 12,342.06 " N/A " 14,801.42 " " 14,657.43 " N/A DRG 223.2 " 95,386.19 " " 30,056.19 " " 11,873.69 " " 21,359.58 " " 14,894.36 " N/A N/A N/A " 12,311.40 " N/A N/A N/A " 14,824.30 " N/A N/A " 11,873.69 " N/A N/A N/A N/A N/A N/A N/A " 12,645.48 " " 11,873.69 " N/A " 11,873.69 " " 17,810.54 " N/A " 21,359.58 " " 21,151.79 " N/A DRG 223.3 No Current Volume N/A " 18,892.45 " " 33,985.63 " " 23,698.69 " N/A N/A N/A " 19,588.90 " N/A N/A N/A " 23,587.22 " N/A N/A " 18,892.45 " N/A N/A N/A N/A N/A N/A N/A " 20,120.46 " " 18,892.45 " N/A " 18,892.45 " " 28,338.68 " N/A " 33,985.63 " " 33,655.01 " N/A DRG 223.4 No Current Volume N/A " 33,092.25 " " 59,529.65 " " 41,510.92 " N/A N/A N/A " 34,312.17 " N/A N/A N/A " 41,315.67 " N/A N/A " 33,092.25 " N/A N/A N/A N/A N/A N/A N/A " 35,243.25 " " 33,092.25 " N/A " 33,092.25 " " 49,638.38 " N/A " 59,529.65 " " 58,950.53 " N/A DRG 224.1 No Current Volume N/A " 10,048.12 " " 18,075.56 " " 12,604.36 " N/A N/A N/A " 10,418.54 " N/A N/A N/A " 12,545.08 " N/A N/A " 10,048.12 " N/A N/A N/A N/A N/A N/A N/A " 10,701.25 " " 10,048.12 " N/A " 10,048.12 " " 15,072.18 " N/A " 18,075.56 " " 17,899.72 " N/A DRG 224.2 " 95,696.13 " " 30,153.85 " " 12,829.61 " " 23,079.19 " " 16,093.46 " N/A N/A N/A " 13,302.56 " N/A N/A N/A " 16,017.77 " N/A N/A " 12,829.61 " N/A N/A N/A N/A N/A N/A N/A " 13,663.53 " " 12,829.61 " N/A " 12,829.61 " " 19,244.42 " N/A " 23,079.19 " " 22,854.67 " N/A DRG 224.3 No Current Volume N/A " 19,271.12 " " 34,666.82 " " 24,173.69 " N/A N/A N/A " 19,981.53 " N/A N/A N/A " 24,059.99 " N/A N/A " 19,271.12 " N/A N/A N/A N/A N/A N/A N/A " 20,523.74 " " 19,271.12 " N/A " 19,271.12 " " 28,906.68 " N/A " 34,666.82 " " 34,329.57 " N/A DRG 224.4 No Current Volume N/A " 33,390.12 " " 60,065.49 " " 41,884.57 " N/A N/A N/A " 34,621.02 " N/A N/A N/A " 41,687.56 " N/A N/A " 33,390.12 " N/A N/A N/A N/A N/A N/A N/A " 35,560.48 " " 33,390.12 " N/A " 33,390.12 " " 50,085.18 " N/A " 60,065.49 " " 59,481.16 " N/A DRG 226.1 No Current Volume N/A " 6,753.76 " " 12,149.34 " " 8,471.92 " N/A N/A N/A " 7,002.73 " N/A N/A N/A " 8,432.07 " N/A N/A " 6,753.76 " N/A N/A N/A N/A N/A N/A N/A " 7,192.75 " " 6,753.76 " N/A " 6,753.76 " " 10,130.64 " N/A " 12,149.34 " " 12,031.15 " N/A DRG 226.2 No Current Volume N/A " 9,815.99 " " 17,657.98 " " 12,313.18 " N/A N/A N/A " 10,177.85 " N/A N/A N/A " 12,255.26 " N/A N/A " 9,815.99 " N/A N/A N/A N/A N/A N/A N/A " 10,454.03 " " 9,815.99 " N/A " 9,815.99 " " 14,723.99 " N/A " 17,657.98 " " 17,486.20 " N/A DRG 226.3 No Current Volume N/A " 13,715.68 " " 24,673.14 " " 17,204.95 " N/A N/A N/A " 14,221.30 " N/A N/A N/A " 17,124.03 " N/A N/A " 13,715.68 " N/A N/A N/A N/A N/A N/A N/A " 14,607.20 " " 13,715.68 " N/A " 13,715.68 " " 20,573.52 " N/A " 24,673.14 " " 24,433.11 " N/A DRG 226.4 No Current Volume N/A " 28,340.72 " " 50,982.12 " " 35,550.60 " N/A N/A N/A " 29,385.48 " N/A N/A N/A " 35,383.39 " N/A N/A " 28,340.72 " N/A N/A N/A N/A N/A N/A N/A " 30,182.87 " " 28,340.72 " N/A " 28,340.72 " " 42,511.08 " N/A " 50,982.12 " " 50,486.16 " N/A DRG 227.1 No Current Volume N/A " 9,032.63 " " 16,248.80 " " 11,330.53 " N/A N/A N/A " 9,365.61 " N/A N/A N/A " 11,277.24 " N/A N/A " 9,032.63 " N/A N/A N/A N/A N/A N/A N/A " 9,619.75 " " 9,032.63 " N/A " 9,032.63 " " 13,548.95 " N/A " 16,248.80 " " 16,090.73 " N/A DRG 227.2 " 59,076.97 " " 18,615.15 " " 11,657.99 " " 20,971.56 " " 14,623.78 " N/A N/A N/A " 12,087.75 " N/A N/A N/A " 14,555.00 " N/A N/A " 11,657.99 " N/A N/A N/A N/A N/A N/A N/A " 12,415.76 " " 11,657.99 " N/A " 11,657.99 " " 17,486.99 " N/A " 20,971.56 " " 20,767.54 " N/A DRG 227.3 No Current Volume N/A " 18,152.91 " " 32,655.27 " " 22,771.01 " N/A N/A N/A " 18,822.10 " N/A N/A N/A " 22,663.91 " N/A N/A " 18,152.91 " N/A N/A N/A N/A N/A N/A N/A " 19,332.85 " " 18,152.91 " N/A " 18,152.91 " " 27,229.37 " N/A " 32,655.27 " " 32,337.59 " N/A DRG 227.4 No Current Volume N/A " 33,788.65 " " 60,782.40 " " 42,384.48 " N/A N/A N/A " 35,034.24 " N/A N/A N/A " 42,185.13 " N/A N/A " 33,788.65 " N/A N/A N/A N/A N/A N/A N/A " 35,984.91 " " 33,788.65 " N/A " 33,788.65 " " 50,682.98 " N/A " 60,782.40 " " 60,191.10 " N/A DRG 228.1 No Current Volume N/A " 6,755.81 " " 12,153.03 " " 8,474.49 " N/A N/A N/A " 7,004.86 " N/A N/A N/A " 8,434.63 " N/A N/A " 6,755.81 " N/A N/A N/A N/A N/A N/A N/A " 7,194.94 " " 6,755.81 " N/A " 6,755.81 " " 10,133.72 " N/A " 12,153.03 " " 12,034.80 " N/A DRG 228.2 " 585,766.55 " " 184,575.04 " " 9,133.29 " " 16,429.88 " " 11,456.80 " N/A N/A N/A " 9,469.98 " N/A N/A N/A " 11,402.91 " N/A N/A " 9,133.29 " N/A N/A N/A N/A N/A N/A N/A " 9,726.95 " " 9,133.29 " N/A " 9,133.29 " " 13,699.94 " N/A " 16,429.88 " " 16,270.04 " N/A DRG 228.3 No Current Volume N/A " 13,233.61 " " 23,805.94 " " 16,600.24 " N/A N/A N/A " 13,721.46 " N/A N/A N/A " 16,522.16 " N/A N/A " 13,233.61 " N/A N/A N/A N/A N/A N/A N/A " 14,093.79 " " 13,233.61 " N/A " 13,233.61 " " 19,850.42 " N/A " 23,805.94 " " 23,574.35 " N/A DRG 228.4 No Current Volume N/A " 27,991.50 " " 50,353.91 " " 35,112.54 " N/A N/A N/A " 29,023.38 " N/A N/A N/A " 34,947.39 " N/A N/A " 27,991.50 " N/A N/A N/A N/A N/A N/A N/A " 29,810.95 " " 27,991.50 " N/A " 27,991.50 " " 41,987.25 " N/A " 50,353.91 " " 49,864.06 " N/A DRG 229.1 " 57,731.23 " " 18,191.11 " " 8,910.74 " " 16,029.53 " " 11,177.63 " N/A N/A N/A " 9,239.23 " N/A N/A N/A " 11,125.06 " N/A N/A " 8,910.74 " N/A N/A N/A N/A N/A N/A N/A " 9,489.94 " " 8,910.74 " N/A " 8,910.74 " " 13,366.11 " N/A " 16,029.53 " " 15,873.59 " N/A DRG 229.2 No Current Volume N/A " 11,840.13 " " 21,299.21 " " 14,852.26 " N/A N/A N/A " 12,276.61 " N/A N/A N/A " 14,782.40 " N/A N/A " 11,840.13 " N/A N/A N/A N/A N/A N/A N/A " 12,609.74 " " 11,840.13 " N/A " 11,840.13 " " 17,760.20 " N/A " 21,299.21 " " 21,092.01 " N/A DRG 229.3 No Current Volume N/A " 17,385.30 " " 31,274.42 " " 21,808.12 " N/A N/A N/A " 18,026.19 " N/A N/A N/A " 21,705.55 " N/A N/A " 17,385.30 " N/A N/A N/A N/A N/A N/A N/A " 18,515.34 " " 17,385.30 " N/A " 17,385.30 " " 26,077.95 " N/A " 31,274.42 " " 30,970.17 " N/A DRG 229.4 " 262,054.68 " " 82,573.43 " " 32,466.38 " " 58,403.77 " " 40,725.83 " N/A N/A N/A " 33,663.23 " N/A N/A N/A " 40,534.28 " N/A N/A " 32,466.38 " N/A N/A N/A N/A N/A N/A N/A " 34,576.69 " " 32,466.38 " N/A " 32,466.38 " " 48,699.57 " N/A " 58,403.77 " " 57,835.61 " N/A DRG 230.1 No Current Volume N/A " 10,660.30 " " 19,176.81 " " 13,372.28 " N/A N/A N/A " 11,053.28 " N/A N/A N/A " 13,309.38 " N/A N/A " 10,660.30 " N/A N/A N/A N/A N/A N/A N/A " 11,353.22 " " 10,660.30 " N/A " 10,660.30 " " 15,990.45 " N/A " 19,176.81 " " 18,990.26 " N/A DRG 230.2 " 81,505.19 " " 25,682.29 " " 14,929.76 " " 26,857.15 " " 18,727.89 " N/A N/A N/A " 15,480.13 " N/A N/A N/A " 18,639.81 " N/A N/A " 14,929.76 " N/A N/A N/A N/A N/A N/A N/A " 15,900.19 " " 14,929.76 " N/A " 14,929.76 " " 22,394.64 " N/A " 26,857.15 " " 26,595.87 " N/A DRG 230.3 " 88,709.21 " " 27,952.27 " " 23,010.57 " " 41,393.71 " " 28,864.46 " N/A N/A N/A " 23,858.84 " N/A N/A N/A " 28,728.70 " N/A N/A " 23,010.57 " N/A N/A N/A N/A N/A N/A N/A " 24,506.26 " " 23,010.57 " N/A " 23,010.57 " " 34,515.86 " N/A " 41,393.71 " " 40,991.03 " N/A DRG 230.4 " 135,224.50 " " 42,609.24 " " 44,042.20 " " 79,227.51 " " 55,246.54 " N/A N/A N/A " 45,665.78 " N/A N/A N/A " 54,986.69 " N/A N/A " 44,042.20 " N/A N/A N/A N/A N/A N/A N/A " 46,904.94 " " 44,042.20 " N/A " 44,042.20 " " 66,063.30 " N/A " 79,227.51 " " 78,456.78 " N/A DRG 231.1 " 40,873.49 " " 12,879.24 " " 10,812.31 " " 19,450.26 " " 13,562.96 " N/A N/A N/A " 11,210.90 " N/A N/A N/A " 13,499.17 " N/A N/A " 10,812.31 " N/A N/A N/A N/A N/A N/A N/A " 11,515.11 " " 10,812.31 " N/A " 10,812.31 " " 16,218.47 " N/A " 19,450.26 " " 19,261.05 " N/A DRG 231.2 " 50,529.81 " " 15,921.94 " " 14,125.17 " " 25,409.77 " " 17,718.61 " N/A N/A N/A " 14,645.88 " N/A N/A N/A " 17,635.27 " N/A N/A " 14,125.17 " N/A N/A N/A N/A N/A N/A N/A " 15,043.31 " " 14,125.17 " N/A " 14,125.17 " " 21,187.76 " N/A " 25,409.77 " " 25,162.58 " N/A DRG 231.3 No Current Volume N/A " 22,084.78 " " 39,728.31 " " 27,703.15 " N/A N/A N/A " 22,898.92 " N/A N/A N/A " 27,572.85 " N/A N/A " 22,084.78 " N/A N/A N/A N/A N/A N/A N/A " 23,520.29 " " 22,084.78 " N/A " 22,084.78 " " 33,127.17 " N/A " 39,728.31 " " 39,341.83 " N/A DRG 231.4 No Current Volume N/A " 37,808.86 " " 68,014.36 " " 47,427.43 " N/A N/A N/A " 39,202.65 " N/A N/A N/A " 47,204.36 " N/A N/A " 37,808.86 " N/A N/A N/A N/A N/A N/A N/A " 40,266.44 " " 37,808.86 " N/A " 37,808.86 " " 56,713.29 " N/A " 68,014.36 " " 67,352.70 " N/A DRG 232.1 No Current Volume N/A " 8,521.12 " " 15,328.64 " " 10,688.89 " N/A N/A N/A " 8,835.24 " N/A N/A N/A " 10,638.62 " N/A N/A " 8,521.12 " N/A N/A N/A N/A N/A N/A N/A " 9,074.99 " " 8,521.12 " N/A " 8,521.12 " " 12,781.68 " N/A " 15,328.64 " " 15,179.52 " N/A DRG 232.2 No Current Volume N/A " 11,330.67 " " 20,382.74 " " 14,213.19 " N/A N/A N/A " 11,748.37 " N/A N/A N/A " 14,146.34 " N/A N/A " 11,330.67 " N/A N/A N/A N/A N/A N/A N/A " 12,067.16 " " 11,330.67 " N/A " 11,330.67 " " 16,996.01 " N/A " 20,382.74 " " 20,184.46 " N/A DRG 232.3 No Current Volume N/A " 17,301.76 " " 31,124.14 " " 21,703.33 " N/A N/A N/A " 17,939.57 " N/A N/A N/A " 21,601.25 " N/A N/A " 17,301.76 " N/A N/A N/A N/A N/A N/A N/A " 18,426.37 " " 17,301.76 " N/A " 17,301.76 " " 25,952.64 " N/A " 31,124.14 " " 30,821.36 " N/A DRG 232.4 No Current Volume N/A " 47,730.99 " " 85,863.28 " " 59,873.75 " N/A N/A N/A " 49,490.55 " N/A N/A N/A " 59,592.14 " N/A N/A " 47,730.99 " N/A N/A N/A N/A N/A N/A N/A " 50,833.50 " " 47,730.99 " N/A " 47,730.99 " " 71,596.49 " N/A " 85,863.28 " " 85,027.99 " N/A DRG 233.1 No Current Volume N/A " 8,271.18 " " 14,879.03 " " 10,375.37 " N/A N/A N/A " 8,576.09 " N/A N/A N/A " 10,326.57 " N/A N/A " 8,271.18 " N/A N/A N/A N/A N/A N/A N/A " 8,808.81 " " 8,271.18 " N/A " 8,271.18 " " 12,406.77 " N/A " 14,879.03 " " 14,734.28 " N/A DRG 233.2 " 50,575.10 " " 15,936.21 " " 10,839.70 " " 19,499.54 " " 13,597.32 " N/A N/A N/A " 11,239.30 " N/A N/A N/A " 13,533.37 " N/A N/A " 10,839.70 " N/A N/A N/A N/A N/A N/A N/A " 11,544.28 " " 10,839.70 " N/A " 10,839.70 " " 16,259.55 " N/A " 19,499.54 " " 19,309.84 " N/A DRG 233.3 No Current Volume N/A " 16,936.09 " " 30,466.33 " " 21,244.63 " N/A N/A N/A " 17,560.43 " N/A N/A N/A " 21,144.71 " N/A N/A " 16,936.09 " N/A N/A N/A N/A N/A N/A N/A " 18,036.94 " " 16,936.09 " N/A " 16,936.09 " " 25,404.14 " N/A " 30,466.33 " " 30,169.95 " N/A DRG 233.4 No Current Volume N/A " 28,923.45 " " 52,030.39 " " 36,281.58 " N/A N/A N/A " 29,989.69 " N/A N/A N/A " 36,110.93 " N/A N/A " 28,923.45 " N/A N/A N/A N/A N/A N/A N/A " 30,803.47 " " 28,923.45 " N/A " 28,923.45 " " 43,385.18 " N/A " 52,030.39 " " 51,524.23 " N/A DRG 234.1 " 30,586.29 " " 9,637.74 " " 5,966.97 " " 10,733.98 " " 7,484.97 " N/A N/A N/A " 6,186.94 " N/A N/A N/A " 7,449.76 " N/A N/A " 5,966.97 " N/A N/A N/A N/A N/A N/A N/A " 6,354.82 " " 5,966.97 " N/A " 5,966.97 " " 8,950.46 " N/A " 10,733.98 " " 10,629.56 " N/A DRG 234.2 " 52,886.50 " " 16,664.53 " " 8,294.46 " " 14,920.90 " " 10,404.57 " N/A N/A N/A " 8,600.23 " N/A N/A N/A " 10,355.63 " N/A N/A " 8,294.46 " N/A N/A N/A N/A N/A N/A N/A " 8,833.60 " " 8,294.46 " N/A " 8,294.46 " " 12,441.69 " N/A " 14,920.90 " " 14,775.75 " N/A DRG 234.3 No Current Volume N/A " 13,756.77 " " 24,747.05 " " 17,256.49 " N/A N/A N/A " 14,263.90 " N/A N/A N/A " 17,175.33 " N/A N/A " 13,756.77 " N/A N/A N/A N/A N/A N/A N/A " 14,650.96 " " 13,756.77 " N/A " 13,756.77 " " 20,635.16 " N/A " 24,747.05 " " 24,506.31 " N/A DRG 234.4 No Current Volume N/A " 22,594.93 " " 40,646.02 " " 28,343.08 " N/A N/A N/A " 23,427.87 " N/A N/A N/A " 28,209.77 " N/A N/A " 22,594.93 " N/A N/A N/A N/A N/A N/A N/A " 24,063.60 " " 22,594.93 " N/A " 22,594.93 " " 33,892.40 " N/A " 40,646.02 " " 40,250.61 " N/A DRG 240.1 No Current Volume N/A " 6,450.41 " " 11,603.64 " " 8,091.39 " N/A N/A N/A " 6,688.20 " N/A N/A N/A " 8,053.34 " N/A N/A " 6,450.41 " N/A N/A N/A N/A N/A N/A N/A " 6,869.69 " " 6,450.41 " N/A " 6,450.41 " " 9,675.62 " N/A " 11,603.64 " " 11,490.76 " N/A DRG 240.2 " 24,951.57 " " 7,862.24 " " 7,170.09 " " 12,898.27 " " 8,994.16 " N/A N/A N/A " 7,434.41 " N/A N/A N/A " 8,951.86 " N/A N/A " 7,170.09 " N/A N/A N/A N/A N/A N/A N/A " 7,636.15 " " 7,170.09 " N/A " 7,170.09 " " 10,755.14 " N/A " 12,898.27 " " 12,772.80 " N/A DRG 240.3 No Current Volume N/A " 10,189.87 " " 18,330.56 " " 12,782.17 " N/A N/A N/A " 10,565.51 " N/A N/A N/A " 12,722.05 " N/A N/A " 10,189.87 " N/A N/A N/A N/A N/A N/A N/A " 10,852.21 " " 10,189.87 " N/A " 10,189.87 " " 15,284.81 " N/A " 18,330.56 " " 18,152.23 " N/A DRG 240.4 No Current Volume N/A " 18,026.23 " " 32,427.39 " " 22,612.10 " N/A N/A N/A " 18,690.75 " N/A N/A N/A " 22,505.75 " N/A N/A " 18,026.23 " N/A N/A N/A N/A N/A N/A N/A " 19,197.93 " " 18,026.23 " N/A " 18,026.23 " " 27,039.35 " N/A " 32,427.39 " " 32,111.93 " N/A DRG 241.1 No Current Volume N/A " 5,048.71 " " 9,082.12 " " 6,333.10 " N/A N/A N/A " 5,234.83 " N/A N/A N/A " 6,303.31 " N/A N/A " 5,048.71 " N/A N/A N/A N/A N/A N/A N/A " 5,376.88 " " 5,048.71 " N/A " 5,048.71 " " 7,573.07 " N/A " 9,082.12 " " 8,993.77 " N/A DRG 241.2 " 26,781.24 " " 8,438.77 " " 6,287.44 " " 11,310.48 " " 7,886.96 " N/A N/A N/A " 6,519.22 " N/A N/A N/A " 7,849.87 " N/A N/A " 6,287.44 " N/A N/A N/A N/A N/A N/A N/A " 6,696.12 " " 6,287.44 " N/A " 6,287.44 " " 9,431.16 " N/A " 11,310.48 " " 11,200.45 " N/A DRG 241.3 " 46,684.37 " " 14,710.24 " " 9,323.65 " " 16,772.31 " " 11,695.59 " N/A N/A N/A " 9,667.36 " N/A N/A N/A " 11,640.58 " N/A N/A " 9,323.65 " N/A N/A N/A N/A N/A N/A N/A " 9,929.69 " " 9,323.65 " N/A " 9,323.65 " " 13,985.48 " N/A " 16,772.31 " " 16,609.15 " N/A DRG 241.4 No Current Volume N/A " 19,812.07 " " 35,639.93 " " 24,852.26 " N/A N/A N/A " 20,542.43 " N/A N/A N/A " 24,735.37 " N/A N/A " 19,812.07 " N/A N/A N/A N/A N/A N/A N/A " 21,099.85 " " 19,812.07 " N/A " 19,812.07 " " 29,718.11 " N/A " 35,639.93 " " 35,293.22 " N/A DRG 242.1 No Current Volume N/A " 4,609.78 " " 8,292.53 " " 5,782.51 " N/A N/A N/A " 4,779.72 " N/A N/A N/A " 5,755.31 " N/A N/A " 4,609.78 " N/A N/A N/A N/A N/A N/A N/A " 4,909.42 " " 4,609.78 " N/A " 4,609.78 " " 6,914.67 " N/A " 8,292.53 " " 8,211.86 " N/A DRG 242.2 No Current Volume N/A " 5,999.84 " " 10,793.11 " " 7,526.20 " N/A N/A N/A " 6,221.02 " N/A N/A N/A " 7,490.80 " N/A N/A " 5,999.84 " N/A N/A N/A N/A N/A N/A N/A " 6,389.83 " " 5,999.84 " N/A " 5,999.84 " " 8,999.76 " N/A " 10,793.11 " " 10,688.11 " N/A DRG 242.3 " 33,627.09 " " 10,595.90 " " 8,747.77 " " 15,736.36 " " 10,973.20 " N/A N/A N/A " 9,070.25 " N/A N/A N/A " 10,921.59 " N/A N/A " 8,747.77 " N/A N/A N/A N/A N/A N/A N/A " 9,316.38 " " 8,747.77 " N/A " 8,747.77 " " 13,121.66 " N/A " 15,736.36 " " 15,583.28 " N/A DRG 242.4 No Current Volume N/A " 19,178.67 " " 34,500.51 " " 24,057.72 " N/A N/A N/A " 19,885.68 " N/A N/A N/A " 23,944.57 " N/A N/A " 19,178.67 " N/A N/A N/A N/A N/A N/A N/A " 20,425.28 " " 19,178.67 " N/A " 19,178.67 " " 28,768.01 " N/A " 34,500.51 " " 34,164.88 " N/A DRG 243.1 " 29,888.46 " " 9,417.85 " " 4,389.98 " " 7,897.14 " " 5,506.79 " N/A N/A N/A " 4,551.81 " N/A N/A N/A " 5,480.89 " N/A N/A " 4,389.98 " N/A N/A N/A N/A N/A N/A N/A " 4,675.33 " " 4,389.98 " N/A " 4,389.98 " " 6,584.97 " N/A " 7,897.14 " " 7,820.31 " N/A DRG 243.2 No Current Volume N/A " 5,611.58 " " 10,094.67 " " 7,039.17 " N/A N/A N/A " 5,818.45 " N/A N/A N/A " 7,006.06 " N/A N/A " 5,611.58 " N/A N/A N/A N/A N/A N/A N/A " 5,976.33 " " 5,611.58 " N/A " 5,611.58 " " 8,417.37 " N/A " 10,094.67 " " 9,996.47 " N/A DRG 243.3 " 98,393.44 " " 31,003.77 " " 8,397.86 " " 15,106.91 " " 10,534.28 " N/A N/A N/A " 8,707.44 " N/A N/A N/A " 10,484.73 " N/A N/A " 8,397.86 " N/A N/A N/A N/A N/A N/A N/A " 8,943.72 " " 8,397.86 " N/A " 8,397.86 " " 12,596.79 " N/A " 15,106.91 " " 14,959.95 " N/A DRG 243.4 No Current Volume N/A " 18,204.95 " " 32,748.88 " " 22,836.29 " N/A N/A N/A " 18,876.06 " N/A N/A N/A " 22,728.88 " N/A N/A " 18,204.95 " N/A N/A N/A N/A N/A N/A N/A " 19,388.27 " " 18,204.95 " N/A " 18,204.95 " " 27,307.43 " N/A " 32,748.88 " " 32,430.30 " N/A DRG 244.1 " 22,104.10 " " 6,965.00 " " 4,053.76 " " 7,292.31 " " 5,085.04 " N/A N/A N/A " 4,203.20 " N/A N/A N/A " 5,061.12 " N/A N/A " 4,053.76 " N/A N/A N/A N/A N/A N/A N/A " 4,317.25 " " 4,053.76 " N/A " 4,053.76 " " 6,080.64 " N/A " 7,292.31 " " 7,221.37 " N/A DRG 244.2 " 23,860.53 " " 7,518.45 " " 5,473.95 " " 9,847.09 " " 6,866.52 " N/A N/A N/A " 5,675.74 " N/A N/A N/A " 6,834.23 " N/A N/A " 5,473.95 " N/A N/A N/A N/A N/A N/A N/A " 5,829.76 " " 5,473.95 " N/A " 5,473.95 " " 8,210.93 " N/A " 9,847.09 " " 9,751.29 " N/A DRG 244.3 No Current Volume N/A " 8,532.76 " " 15,349.58 " " 10,703.49 " N/A N/A N/A " 8,847.31 " N/A N/A N/A " 10,653.15 " N/A N/A " 8,532.76 " N/A N/A N/A N/A N/A N/A N/A " 9,087.39 " " 8,532.76 " N/A " 8,532.76 " " 12,799.14 " N/A " 15,349.58 " " 15,200.26 " N/A DRG 244.4 No Current Volume N/A " 16,947.74 " " 30,487.29 " " 21,259.25 " N/A N/A N/A " 17,572.50 " N/A N/A N/A " 21,159.25 " N/A N/A " 16,947.74 " N/A N/A N/A N/A N/A N/A N/A " 18,049.34 " " 16,947.74 " N/A " 16,947.74 " " 25,421.61 " N/A " 30,487.29 " " 30,190.70 " N/A DRG 245.1 " 25,174.72 " " 7,932.55 " " 4,880.26 " " 8,779.10 " " 6,121.80 " N/A N/A N/A " 5,060.17 " N/A N/A N/A " 6,093.00 " N/A N/A " 4,880.26 " N/A N/A N/A N/A N/A N/A N/A " 5,197.48 " " 4,880.26 " N/A " 4,880.26 " " 7,320.39 " N/A " 8,779.10 " " 8,693.70 " N/A DRG 245.2 " 26,740.79 " " 8,426.02 " " 6,360.71 " " 11,442.28 " " 7,978.87 " N/A N/A N/A " 6,595.19 " N/A N/A N/A " 7,941.35 " N/A N/A " 6,360.71 " N/A N/A N/A N/A N/A N/A N/A " 6,774.16 " " 6,360.71 " N/A " 6,360.71 " " 9,541.07 " N/A " 11,442.28 " " 11,330.97 " N/A DRG 245.3 No Current Volume N/A " 9,718.07 " " 17,481.84 " " 12,190.35 " N/A N/A N/A " 10,076.32 " N/A N/A N/A " 12,133.01 " N/A N/A " 9,718.07 " N/A N/A N/A N/A N/A N/A N/A " 10,349.74 " " 9,718.07 " N/A " 9,718.07 " " 14,577.11 " N/A " 17,481.84 " " 17,311.77 " N/A DRG 245.4 No Current Volume N/A " 21,422.62 " " 38,537.15 " " 26,872.53 " N/A N/A N/A " 22,212.35 " N/A N/A N/A " 26,746.14 " N/A N/A " 21,422.62 " N/A N/A N/A N/A N/A N/A N/A " 22,815.09 " " 21,422.62 " N/A " 21,422.62 " " 32,133.93 " N/A " 38,537.15 " " 38,162.26 " N/A DRG 246.1 " 15,176.01 " " 4,781.96 " " 4,880.26 " " 8,779.10 " " 6,121.80 " N/A N/A N/A " 5,060.17 " N/A N/A N/A " 6,093.00 " N/A N/A " 4,880.26 " N/A N/A N/A N/A N/A N/A N/A " 5,197.48 " " 4,880.26 " N/A " 4,880.26 " " 7,320.39 " N/A " 8,779.10 " " 8,693.70 " N/A DRG 246.2 " 24,808.06 " " 7,817.02 " " 6,021.07 " " 10,831.30 " " 7,552.83 " N/A N/A N/A " 6,243.03 " N/A N/A N/A " 7,517.31 " N/A N/A " 6,021.07 " N/A N/A N/A N/A N/A N/A N/A " 6,412.44 " " 6,021.07 " N/A " 6,021.07 " " 9,031.61 " N/A " 10,831.30 " " 10,725.93 " N/A DRG 246.3 No Current Volume N/A " 9,175.06 " " 16,505.02 " " 11,509.20 " N/A N/A N/A " 9,513.29 " N/A N/A N/A " 11,455.06 " N/A N/A " 9,175.06 " N/A N/A N/A N/A N/A N/A N/A " 9,771.44 " " 9,175.06 " N/A " 9,175.06 " " 13,762.59 " N/A " 16,505.02 " " 16,344.45 " N/A DRG 246.4 No Current Volume N/A " 16,382.13 " " 29,469.81 " " 20,549.74 " N/A N/A N/A " 16,986.04 " N/A N/A N/A " 20,453.09 " N/A N/A " 16,382.13 " N/A N/A N/A N/A N/A N/A N/A " 17,446.97 " " 16,382.13 " N/A " 16,382.13 " " 24,573.20 " N/A " 29,469.81 " " 29,183.13 " N/A DRG 247.1 " 19,215.85 " " 6,054.91 " " 3,808.62 " " 6,851.33 " " 4,777.53 " N/A N/A N/A " 3,949.02 " N/A N/A N/A " 4,755.06 " N/A N/A " 3,808.62 " N/A N/A N/A N/A N/A N/A N/A " 4,056.18 " " 3,808.62 " N/A " 3,808.62 " " 5,712.93 " N/A " 6,851.33 " " 6,784.68 " N/A DRG 247.2 " 35,549.53 " " 11,201.66 " " 5,132.25 " " 9,232.40 " " 6,437.89 " N/A N/A N/A " 5,321.45 " N/A N/A N/A " 6,407.61 " N/A N/A " 5,132.25 " N/A N/A N/A N/A N/A N/A N/A " 5,465.85 " " 5,132.25 " N/A " 5,132.25 " " 7,698.38 " N/A " 9,232.40 " " 9,142.59 " N/A DRG 247.3 " 39,771.87 " " 12,532.12 " " 8,280.08 " " 14,895.04 " " 10,386.53 " N/A N/A N/A " 8,585.32 " N/A N/A N/A " 10,337.68 " N/A N/A " 8,280.08 " N/A N/A N/A N/A N/A N/A N/A " 8,818.29 " " 8,280.08 " N/A " 8,280.08 " " 12,420.12 " N/A " 14,895.04 " " 14,750.13 " N/A DRG 247.4 No Current Volume N/A " 15,988.39 " " 28,761.51 " " 20,055.84 " N/A N/A N/A " 16,577.79 " N/A N/A N/A " 19,961.50 " N/A N/A " 15,988.39 " N/A N/A N/A N/A N/A N/A N/A " 17,027.64 " " 15,988.39 " N/A " 15,988.39 " " 23,982.59 " N/A " 28,761.51 " " 28,481.72 " N/A DRG 248.1 " 19,716.00 " " 6,212.51 " " 4,264.67 " " 7,671.71 " " 5,349.60 " N/A N/A N/A " 4,421.88 " N/A N/A N/A " 5,324.44 " N/A N/A " 4,264.67 " N/A N/A N/A N/A N/A N/A N/A " 4,541.87 " " 4,264.67 " N/A " 4,264.67 " " 6,397.01 " N/A " 7,671.71 " " 7,597.08 " N/A DRG 248.2 " 36,494.41 " " 11,499.39 " " 5,925.20 " " 10,658.84 " " 7,432.57 " N/A N/A N/A " 6,143.63 " N/A N/A N/A " 7,397.61 " N/A N/A " 5,925.20 " N/A N/A N/A N/A N/A N/A N/A " 6,310.34 " " 5,925.20 " N/A " 5,925.20 " " 8,887.80 " N/A " 10,658.84 " " 10,555.15 " N/A DRG 248.3 " 54,652.44 " " 17,220.98 " " 8,776.53 " " 15,788.10 " " 11,009.28 " N/A N/A N/A " 9,100.07 " N/A N/A N/A " 10,957.50 " N/A N/A " 8,776.53 " N/A N/A N/A N/A N/A N/A N/A " 9,347.00 " " 8,776.53 " N/A " 8,776.53 " " 13,164.80 " N/A " 15,788.10 " " 15,634.51 " N/A DRG 248.4 No Current Volume N/A " 18,467.21 " " 33,220.66 " " 23,165.27 " N/A N/A N/A " 19,147.99 " N/A N/A N/A " 23,056.31 " N/A N/A " 18,467.21 " N/A N/A N/A N/A N/A N/A N/A " 19,667.58 " " 18,467.21 " N/A " 18,467.21 " " 27,700.82 " N/A " 33,220.66 " " 32,897.49 " N/A DRG 249.1 " 32,772.13 " " 10,326.50 " " 3,690.16 " " 6,638.23 " " 4,628.94 " N/A N/A N/A " 3,826.19 " N/A N/A N/A " 4,607.16 " N/A N/A " 3,690.16 " N/A N/A N/A N/A N/A N/A N/A " 3,930.02 " " 3,690.16 " N/A " 3,690.16 " " 5,535.24 " N/A " 6,638.23 " " 6,573.65 " N/A DRG 249.2 " 21,998.11 " " 6,931.61 " " 4,544.05 " " 8,174.29 " " 5,700.06 " N/A N/A N/A " 4,711.56 " N/A N/A N/A " 5,673.25 " N/A N/A " 4,544.05 " N/A N/A N/A N/A N/A N/A N/A " 4,839.41 " " 4,544.05 " N/A " 4,544.05 " " 6,816.08 " N/A " 8,174.29 " " 8,094.77 " N/A DRG 249.3 " 81,580.43 " " 25,705.99 " " 6,909.88 " " 12,430.18 " " 8,667.75 " N/A N/A N/A " 7,164.61 " N/A N/A N/A " 8,626.99 " N/A N/A " 6,909.88 " N/A N/A N/A N/A N/A N/A N/A " 7,359.02 " " 6,909.88 " N/A " 6,909.88 " " 10,364.82 " N/A " 12,430.18 " " 12,309.26 " N/A DRG 249.4 No Current Volume N/A " 15,315.96 " " 27,551.88 " " 19,212.34 " N/A N/A N/A " 15,880.57 " N/A N/A N/A " 19,121.98 " N/A N/A " 15,315.96 " N/A N/A N/A N/A N/A N/A N/A " 16,311.50 " " 15,315.96 " N/A " 15,315.96 " " 22,973.94 " N/A " 27,551.88 " " 27,283.85 " N/A DRG 251.1 " 26,005.84 " " 8,194.44 " " 4,125.66 " " 7,421.65 " " 5,175.23 " N/A N/A N/A " 4,277.75 " N/A N/A N/A " 5,150.89 " N/A N/A " 4,125.66 " N/A N/A N/A N/A N/A N/A N/A " 4,393.83 " " 4,125.66 " N/A " 4,125.66 " " 6,188.49 " N/A " 7,421.65 " " 7,349.45 " N/A DRG 251.2 No Current Volume N/A " 5,220.59 " " 9,391.32 " " 6,548.71 " N/A N/A N/A " 5,413.04 " N/A N/A N/A " 6,517.91 " N/A N/A " 5,220.59 " N/A N/A N/A N/A N/A N/A N/A " 5,559.93 " " 5,220.59 " N/A " 5,220.59 " " 7,830.89 " N/A " 9,391.32 " " 9,299.96 " N/A DRG 251.3 No Current Volume N/A " 6,995.48 " " 12,584.17 " " 8,775.13 " N/A N/A N/A " 7,253.36 " N/A N/A N/A " 8,733.86 " N/A N/A " 6,995.48 " N/A N/A N/A N/A N/A N/A N/A " 7,450.19 " " 6,995.48 " N/A " 6,995.48 " " 10,493.22 " N/A " 12,584.17 " " 12,461.75 " N/A DRG 251.4 No Current Volume N/A " 12,922.73 " " 23,246.70 " " 16,210.27 " N/A N/A N/A " 13,399.12 " N/A N/A N/A " 16,134.03 " N/A N/A " 12,922.73 " N/A N/A N/A N/A N/A N/A N/A " 13,762.71 " " 12,922.73 " N/A " 12,922.73 " " 19,384.10 " N/A " 23,246.70 " " 23,020.55 " N/A DRG 252.1 No Current Volume N/A " 4,628.96 " " 8,327.04 " " 5,806.57 " N/A N/A N/A " 4,799.60 " N/A N/A N/A " 5,779.26 " N/A N/A " 4,628.96 " N/A N/A N/A N/A N/A N/A N/A " 4,929.84 " " 4,628.96 " N/A " 4,628.96 " " 6,943.44 " N/A " 8,327.04 " " 8,246.03 " N/A DRG 252.2 No Current Volume N/A " 5,971.08 " " 10,741.38 " " 7,490.12 " N/A N/A N/A " 6,191.20 " N/A N/A N/A " 7,454.89 " N/A N/A " 5,971.08 " N/A N/A N/A N/A N/A N/A N/A " 6,359.20 " " 5,971.08 " N/A " 5,971.08 " " 8,956.62 " N/A " 10,741.38 " " 10,636.88 " N/A DRG 252.3 No Current Volume N/A " 9,201.08 " " 16,551.82 " " 11,541.83 " N/A N/A N/A " 9,540.27 " N/A N/A N/A " 11,487.55 " N/A N/A " 9,201.08 " N/A N/A N/A N/A N/A N/A N/A " 9,799.15 " " 9,201.08 " N/A " 9,201.08 " " 13,801.62 " N/A " 16,551.82 " " 16,390.80 " N/A DRG 252.4 No Current Volume N/A " 20,115.42 " " 36,185.63 " " 25,232.78 " N/A N/A N/A " 20,856.96 " N/A N/A N/A " 25,114.10 " N/A N/A " 20,115.42 " N/A N/A N/A N/A N/A N/A N/A " 21,422.92 " " 20,115.42 " N/A " 20,115.42 " " 30,173.13 " N/A " 36,185.63 " " 35,833.61 " N/A DRG 253.1 " 13,399.16 " " 4,222.08 " " 4,663.88 " " 8,389.85 " " 5,850.37 " N/A N/A N/A " 4,835.81 " N/A N/A N/A " 5,822.85 " N/A N/A " 4,663.88 " N/A N/A N/A N/A N/A N/A N/A " 4,967.03 " " 4,663.88 " N/A " 4,663.88 " " 6,995.82 " N/A " 8,389.85 " " 8,308.24 " N/A DRG 253.2 " 37,846.99 " " 11,925.59 " " 6,019.01 " " 10,827.60 " " 7,550.25 " N/A N/A N/A " 6,240.90 " N/A N/A N/A " 7,514.73 " N/A N/A " 6,019.01 " N/A N/A N/A N/A N/A N/A N/A " 6,410.25 " " 6,019.01 " N/A " 6,019.01 " " 9,028.52 " N/A " 10,827.60 " " 10,722.26 " N/A DRG 253.3 " 74,064.58 " " 23,337.75 " " 8,877.19 " " 15,969.18 " " 11,135.55 " N/A N/A N/A " 9,204.44 " N/A N/A N/A " 11,083.17 " N/A N/A " 8,877.19 " N/A N/A N/A N/A N/A N/A N/A " 9,454.21 " " 8,877.19 " N/A " 8,877.19 " " 13,315.79 " N/A " 15,969.18 " " 15,813.83 " N/A DRG 253.4 " 170,054.14 " " 53,584.06 " " 16,203.40 " " 29,148.30 " " 20,325.54 " N/A N/A N/A " 16,800.73 " N/A N/A N/A " 20,229.94 " N/A N/A " 16,203.40 " N/A N/A N/A N/A N/A N/A N/A " 17,256.62 " " 16,203.40 " N/A " 16,203.40 " " 24,305.10 " N/A " 29,148.30 " " 28,864.74 " N/A DRG 254.1 " 67,563.31 " " 21,289.20 " " 4,209.89 " " 7,573.17 " " 5,280.89 " N/A N/A N/A " 4,365.08 " N/A N/A N/A " 5,256.05 " N/A N/A " 4,209.89 " N/A N/A N/A N/A N/A N/A N/A " 4,483.53 " " 4,209.89 " N/A " 4,209.89 " " 6,314.84 " N/A " 7,573.17 " " 7,499.50 " N/A DRG 254.2 " 26,655.45 " " 8,399.13 " " 5,630.07 " " 10,127.93 " " 7,062.36 " N/A N/A N/A " 5,837.62 " N/A N/A N/A " 7,029.14 " N/A N/A " 5,630.07 " N/A N/A N/A N/A N/A N/A N/A " 5,996.02 " " 5,630.07 " N/A " 5,630.07 " " 8,445.11 " N/A " 10,127.93 " " 10,029.41 " N/A DRG 254.3 " 38,119.22 " " 12,011.36 " " 8,542.34 " " 15,366.82 " " 10,715.51 " N/A N/A N/A " 8,857.25 " N/A N/A N/A " 10,665.11 " N/A N/A " 8,542.34 " N/A N/A N/A N/A N/A N/A N/A " 9,097.59 " " 8,542.34 " N/A " 8,542.34 " " 12,813.51 " N/A " 15,366.82 " " 15,217.32 " N/A DRG 254.4 No Current Volume N/A " 17,018.27 " " 30,614.17 " " 21,347.72 " N/A N/A N/A " 17,645.63 " N/A N/A N/A " 21,247.31 " N/A N/A " 17,018.27 " N/A N/A N/A N/A N/A N/A N/A " 18,124.46 " " 17,018.27 " N/A " 17,018.27 " " 25,527.41 " N/A " 30,614.17 " " 30,316.35 " N/A DRG 260.1 No Current Volume N/A " 14,979.74 " " 26,947.05 " " 18,790.59 " N/A N/A N/A " 15,531.96 " N/A N/A N/A " 18,702.21 " N/A N/A " 14,979.74 " N/A N/A N/A N/A N/A N/A N/A " 15,953.42 " " 14,979.74 " N/A " 14,979.74 " " 22,469.61 " N/A " 26,947.05 " " 26,684.91 " N/A DRG 260.2 No Current Volume N/A " 18,584.30 " " 33,431.30 " " 23,312.15 " N/A N/A N/A " 19,269.40 " N/A N/A N/A " 23,202.50 " N/A N/A " 18,584.30 " N/A N/A N/A N/A N/A N/A N/A " 19,792.28 " " 18,584.30 " N/A " 18,584.30 " " 27,876.45 " N/A " 33,431.30 " " 33,106.07 " N/A DRG 260.3 No Current Volume N/A " 28,127.08 " " 50,597.80 " " 35,282.61 " N/A N/A N/A " 29,163.96 " N/A N/A N/A " 35,116.66 " N/A N/A " 28,127.08 " N/A N/A N/A N/A N/A N/A N/A " 29,955.34 " " 28,127.08 " N/A " 28,127.08 " " 42,190.62 " N/A " 50,597.80 " " 50,105.58 " N/A DRG 260.4 No Current Volume N/A " 55,972.04 " " 100,688.10 " " 70,211.33 " N/A N/A N/A " 58,035.40 " N/A N/A N/A " 69,881.09 " N/A N/A " 55,972.04 " N/A N/A N/A N/A N/A N/A N/A " 59,610.22 " " 55,972.04 " N/A " 55,972.04 " " 83,958.06 " N/A " 100,688.10 " " 99,708.59 " N/A DRG 261.1 No Current Volume N/A " 10,780.81 " " 19,393.60 " " 13,523.45 " N/A N/A N/A " 11,178.24 " N/A N/A N/A " 13,459.84 " N/A N/A " 10,780.81 " N/A N/A N/A N/A N/A N/A N/A " 11,481.56 " " 10,780.81 " N/A " 10,780.81 " " 16,171.22 " N/A " 19,393.60 " " 19,204.93 " N/A DRG 261.2 No Current Volume N/A " 16,417.73 " " 29,533.85 " " 20,594.40 " N/A N/A N/A " 17,022.96 " N/A N/A N/A " 20,497.54 " N/A N/A " 16,417.73 " N/A N/A N/A N/A N/A N/A N/A " 17,484.88 " " 16,417.73 " N/A " 16,417.73 " " 24,626.60 " N/A " 29,533.85 " " 29,246.54 " N/A DRG 261.3 No Current Volume N/A " 24,211.64 " " 43,554.32 " " 30,371.08 " N/A N/A N/A " 25,104.18 " N/A N/A N/A " 30,228.23 " N/A N/A " 24,211.64 " N/A N/A N/A N/A N/A N/A N/A " 25,785.40 " " 24,211.64 " N/A " 24,211.64 " " 36,317.46 " N/A " 43,554.32 " " 43,130.62 " N/A DRG 261.4 No Current Volume N/A " 47,433.12 " " 85,327.44 " " 59,500.11 " N/A N/A N/A " 49,181.70 " N/A N/A N/A " 59,220.25 " N/A N/A " 47,433.12 " N/A N/A N/A N/A N/A N/A N/A " 50,516.27 " " 47,433.12 " N/A " 47,433.12 " " 71,149.68 " N/A " 85,327.44 " " 84,497.36 " N/A DRG 263.1 " 30,506.07 " " 9,612.46 " " 8,312.27 " " 14,952.94 " " 10,426.91 " N/A N/A N/A " 8,618.69 " N/A N/A N/A " 10,377.87 " N/A N/A " 8,312.27 " N/A N/A N/A N/A N/A N/A N/A " 8,852.57 " " 8,312.27 " N/A " 8,312.27 " " 12,468.41 " N/A " 14,952.94 " " 14,807.48 " N/A DRG 263.2 " 74,818.54 " " 23,575.32 " " 10,875.31 " " 19,563.60 " " 13,641.99 " N/A N/A N/A " 11,276.22 " N/A N/A N/A " 13,577.82 " N/A N/A " 10,875.31 " N/A N/A N/A N/A N/A N/A N/A " 11,582.21 " " 10,875.31 " N/A " 10,875.31 " " 16,312.97 " N/A " 19,563.60 " " 19,373.28 " N/A DRG 263.3 " 79,775.46 " " 25,137.25 " " 14,631.89 " " 26,321.31 " " 18,354.24 " N/A N/A N/A " 15,171.28 " N/A N/A N/A " 18,267.91 " N/A N/A " 14,631.89 " N/A N/A N/A N/A N/A N/A N/A " 15,582.96 " " 14,631.89 " N/A " 14,631.89 " " 21,947.84 " N/A " 26,321.31 " " 26,065.25 " N/A DRG 263.4 No Current Volume N/A " 28,303.75 " " 50,915.62 " " 35,504.22 " N/A N/A N/A " 29,347.14 " N/A N/A N/A " 35,337.23 " N/A N/A " 28,303.75 " N/A N/A N/A N/A N/A N/A N/A " 30,143.49 " " 28,303.75 " N/A " 28,303.75 " " 42,455.63 " N/A " 50,915.62 " " 50,420.30 " N/A DRG 264.1 No Current Volume N/A " 11,640.18 " " 20,939.52 " " 14,601.44 " N/A N/A N/A " 12,069.29 " N/A N/A N/A " 14,532.76 " N/A N/A " 11,640.18 " N/A N/A N/A N/A N/A N/A N/A " 12,396.79 " " 11,640.18 " N/A " 11,640.18 " " 17,460.27 " N/A " 20,939.52 " " 20,735.82 " N/A DRG 264.2 No Current Volume N/A " 12,685.81 " " 22,820.50 " " 15,913.08 " N/A N/A N/A " 13,153.46 " N/A N/A N/A " 15,838.23 " N/A N/A " 12,685.81 " N/A N/A N/A N/A N/A N/A N/A " 13,510.39 " " 12,685.81 " N/A " 12,685.81 " " 19,028.72 " N/A " 22,820.50 " " 22,598.50 " N/A DRG 264.3 No Current Volume N/A " 20,130.49 " " 36,212.74 " " 25,251.69 " N/A N/A N/A " 20,872.58 " N/A N/A N/A " 25,132.92 " N/A N/A " 20,130.49 " N/A N/A N/A N/A N/A N/A N/A " 21,438.97 " " 20,130.49 " N/A " 20,130.49 " " 30,195.74 " N/A " 36,212.74 " " 35,860.45 " N/A DRG 264.4 No Current Volume N/A " 50,175.57 " " 90,260.83 " " 62,940.24 " N/A N/A N/A " 52,025.25 " N/A N/A N/A " 62,644.20 " N/A N/A " 50,175.57 " N/A N/A N/A N/A N/A N/A N/A " 53,436.98 " " 50,175.57 " N/A " 50,175.57 " " 75,263.36 " N/A " 90,260.83 " " 89,382.76 " N/A DRG 279.1 No Current Volume N/A " 3,905.17 " " 7,025.01 " " 4,898.65 " N/A N/A N/A " 4,049.13 " N/A N/A N/A " 4,875.60 " N/A N/A " 3,905.17 " N/A N/A N/A N/A N/A N/A N/A " 4,159.01 " " 3,905.17 " N/A " 3,905.17 " " 5,857.76 " N/A " 7,025.01 " " 6,956.67 " N/A DRG 279.2 " 15,029.02 " " 4,735.64 " " 5,365.07 " " 9,651.22 " " 6,729.94 " N/A N/A N/A " 5,562.85 " N/A N/A N/A " 6,698.29 " N/A N/A " 5,365.07 " N/A N/A N/A N/A N/A N/A N/A " 5,713.80 " " 5,365.07 " N/A " 5,365.07 " " 8,047.61 " N/A " 9,651.22 " " 9,557.34 " N/A DRG 279.3 " 37,293.77 " " 11,751.27 " " 8,219.14 " " 14,785.41 " " 10,310.09 " N/A N/A N/A " 8,522.13 " N/A N/A N/A " 10,261.60 " N/A N/A " 8,219.14 " N/A N/A N/A N/A N/A N/A N/A " 8,753.38 " " 8,219.14 " N/A " 8,219.14 " " 12,328.71 " N/A " 14,785.41 " " 14,641.58 " N/A DRG 279.4 " 96,181.99 " " 30,306.95 " " 19,538.86 " " 35,148.46 " " 24,509.55 " N/A N/A N/A " 20,259.14 " N/A N/A N/A " 24,394.27 " N/A N/A " 19,538.86 " N/A N/A N/A N/A N/A N/A N/A " 20,808.89 " " 19,538.86 " N/A " 19,538.86 " " 29,308.29 " N/A " 35,148.46 " " 34,806.53 " N/A DRG 280.1 No Current Volume N/A " 3,975.70 " " 7,151.89 " " 4,987.12 " N/A N/A N/A " 4,122.26 " N/A N/A N/A " 4,963.66 " N/A N/A " 3,975.70 " N/A N/A N/A N/A N/A N/A N/A " 4,234.12 " " 3,975.70 " N/A " 3,975.70 " " 5,963.55 " N/A " 7,151.89 " " 7,082.31 " N/A DRG 280.2 " 25,993.93 " " 8,190.69 " " 5,119.93 " " 9,210.24 " " 6,422.44 " N/A N/A N/A " 5,308.67 " N/A N/A N/A " 6,392.23 " N/A N/A " 5,119.93 " N/A N/A N/A N/A N/A N/A N/A " 5,452.73 " " 5,119.93 " N/A " 5,119.93 " " 7,679.90 " N/A " 9,210.24 " " 9,120.64 " N/A DRG 280.3 " 50,266.91 " " 15,839.10 " " 7,885.66 " " 14,185.51 " " 9,891.77 " N/A N/A N/A " 8,176.36 " N/A N/A N/A " 9,845.25 " N/A N/A " 7,885.66 " N/A N/A N/A N/A N/A N/A N/A " 8,398.23 " " 7,885.66 " N/A " 7,885.66 " " 11,828.49 " N/A " 14,185.51 " " 14,047.51 " N/A DRG 280.4 " 66,487.66 " " 20,950.26 " " 17,764.65 " " 31,956.83 " " 22,283.98 " N/A N/A N/A " 18,419.53 " N/A N/A N/A " 22,179.17 " N/A N/A " 17,764.65 " N/A N/A N/A N/A N/A N/A N/A " 18,919.35 " " 17,764.65 " N/A " 17,764.65 " " 26,646.98 " N/A " 31,956.83 " " 31,645.95 " N/A DRG 281.1 No Current Volume N/A " 5,784.14 " " 10,405.09 " " 7,255.63 " N/A N/A N/A " 5,997.37 " N/A N/A N/A " 7,221.50 " N/A N/A " 5,784.14 " N/A N/A N/A N/A N/A N/A N/A " 6,160.11 " " 5,784.14 " N/A " 5,784.14 " " 8,676.21 " N/A " 10,405.09 " " 10,303.87 " N/A DRG 281.2 No Current Volume N/A " 7,349.50 " " 13,221.02 " " 9,219.21 " N/A N/A N/A " 7,620.43 " N/A N/A N/A " 9,175.85 " N/A N/A " 7,349.50 " N/A N/A N/A N/A N/A N/A N/A " 7,827.22 " " 7,349.50 " N/A " 7,349.50 " " 11,024.25 " N/A " 13,221.02 " " 13,092.40 " N/A DRG 281.3 No Current Volume N/A " 9,621.52 " " 17,308.15 " " 12,069.23 " N/A N/A N/A " 9,976.21 " N/A N/A N/A " 12,012.47 " N/A N/A " 9,621.52 " N/A N/A N/A N/A N/A N/A N/A " 10,246.92 " " 9,621.52 " N/A " 9,621.52 " " 14,432.28 " N/A " 17,308.15 " " 17,139.78 " N/A DRG 281.4 No Current Volume N/A " 15,871.98 " " 28,552.10 " " 19,909.81 " N/A N/A N/A " 16,457.09 " N/A N/A N/A " 19,816.17 " N/A N/A " 15,871.98 " N/A N/A N/A N/A N/A N/A N/A " 16,903.66 " " 15,871.98 " N/A " 15,871.98 " " 23,807.97 " N/A " 28,552.10 " " 28,274.35 " N/A DRG 282.1 " 18,313.29 " " 5,770.52 " " 3,962.69 " " 7,128.48 " " 4,970.80 " N/A N/A N/A " 4,108.77 " N/A N/A N/A " 4,947.42 " N/A N/A " 3,962.69 " N/A N/A N/A N/A N/A N/A N/A " 4,220.26 " " 3,962.69 " N/A " 3,962.69 " " 5,944.04 " N/A " 7,128.48 " " 7,059.14 " N/A DRG 282.2 " 22,464.16 " " 7,078.46 " " 5,342.47 " " 9,610.57 " " 6,701.59 " N/A N/A N/A " 5,539.42 " N/A N/A N/A " 6,670.07 " N/A N/A " 5,342.47 " N/A N/A N/A N/A N/A N/A N/A " 5,689.73 " " 5,342.47 " N/A " 5,342.47 " " 8,013.71 " N/A " 9,610.57 " " 9,517.08 " N/A DRG 282.3 No Current Volume N/A " 8,923.07 " " 16,051.71 " " 11,193.10 " N/A N/A N/A " 9,252.01 " N/A N/A N/A " 11,140.45 " N/A N/A " 8,923.07 " N/A N/A N/A N/A N/A N/A N/A " 9,503.07 " " 8,923.07 " N/A " 8,923.07 " " 13,384.61 " N/A " 16,051.71 " " 15,895.56 " N/A DRG 282.4 No Current Volume N/A " 21,951.26 " " 39,488.12 " " 27,535.66 " N/A N/A N/A " 22,760.47 " N/A N/A N/A " 27,406.15 " N/A N/A " 21,951.26 " N/A N/A N/A N/A N/A N/A N/A " 23,378.09 " " 21,951.26 " N/A " 21,951.26 " " 32,926.89 " N/A " 39,488.12 " " 39,103.97 " N/A DRG 283.1 No Current Volume N/A " 4,320.13 " " 7,771.48 " " 5,419.17 " N/A N/A N/A " 4,479.39 " N/A N/A N/A " 5,393.68 " N/A N/A " 4,320.13 " N/A N/A N/A N/A N/A N/A N/A " 4,600.94 " " 4,320.13 " N/A " 4,320.13 " " 6,480.20 " N/A " 7,771.48 " " 7,695.88 " N/A DRG 283.2 " 39,334.86 " " 12,394.41 " " 5,457.51 " " 9,817.51 " " 6,845.90 " N/A N/A N/A " 5,658.70 " N/A N/A N/A " 6,813.70 " N/A N/A " 5,457.51 " N/A N/A N/A N/A N/A N/A N/A " 5,812.25 " " 5,457.51 " N/A " 5,457.51 " " 8,186.27 " N/A " 9,817.51 " " 9,722.01 " N/A DRG 283.3 " 81,292.75 " " 25,615.35 " " 8,216.40 " " 14,780.48 " " 10,306.65 " N/A N/A N/A " 8,519.29 " N/A N/A N/A " 10,258.18 " N/A N/A " 8,216.40 " N/A N/A N/A N/A N/A N/A N/A " 8,750.47 " " 8,216.40 " N/A " 8,216.40 " " 12,324.60 " N/A " 14,780.48 " " 14,636.69 " N/A DRG 283.4 No Current Volume N/A " 17,553.06 " " 31,576.20 " " 22,018.56 " N/A N/A N/A " 18,200.14 " N/A N/A N/A " 21,915.00 " N/A N/A " 17,553.06 " N/A N/A N/A N/A N/A N/A N/A " 18,694.01 " " 17,553.06 " N/A " 17,553.06 " " 26,329.59 " N/A " 31,576.20 " " 31,269.02 " N/A DRG 284.1 " 32,352.86 " " 10,194.38 " " 5,415.06 " " 9,741.15 " " 6,792.65 " N/A N/A N/A " 5,614.68 " N/A N/A N/A " 6,760.70 " N/A N/A " 5,415.06 " N/A N/A N/A N/A N/A N/A N/A " 5,767.04 " " 5,415.06 " N/A " 5,415.06 " " 8,122.59 " N/A " 9,741.15 " " 9,646.39 " N/A DRG 284.2 " 43,412.34 " " 13,679.23 " " 6,811.96 " " 12,254.03 " " 8,544.92 " N/A N/A N/A " 7,063.08 " N/A N/A N/A " 8,504.73 " N/A N/A " 6,811.96 " N/A N/A N/A N/A N/A N/A N/A " 7,254.74 " " 6,811.96 " N/A " 6,811.96 " " 10,217.94 " N/A " 12,254.03 " " 12,134.83 " N/A DRG 284.3 " 125,464.40 " " 39,533.83 " " 9,726.29 " " 17,496.62 " " 12,200.66 " N/A N/A N/A " 10,084.84 " N/A N/A N/A " 12,143.27 " N/A N/A " 9,726.29 " N/A N/A N/A N/A N/A N/A N/A " 10,358.50 " " 9,726.29 " N/A " 9,726.29 " " 14,589.44 " N/A " 17,496.62 " " 17,326.41 " N/A DRG 284.4 " 148,470.68 " " 46,783.11 " " 18,183.72 " " 32,710.69 " " 22,809.66 " N/A N/A N/A " 18,854.05 " N/A N/A N/A " 22,702.37 " N/A N/A " 18,183.72 " N/A N/A N/A N/A N/A N/A N/A " 19,365.66 " " 18,183.72 " N/A " 18,183.72 " " 27,275.58 " N/A " 32,710.69 " " 32,392.48 " N/A DRG 301.1 " 74,708.03 " " 23,540.50 " " 12,009.27 " " 21,603.48 " " 15,064.43 " N/A N/A N/A " 12,451.98 " N/A N/A N/A " 14,993.57 " N/A N/A " 12,009.27 " N/A N/A N/A N/A N/A N/A N/A " 12,789.87 " " 12,009.27 " N/A " 12,009.27 " " 18,013.91 " N/A " 21,603.48 " " 21,393.31 " N/A DRG 301.2 " 8,330.39 " " 2,624.91 " " 12,725.52 " " 22,891.94 " " 15,962.89 " N/A N/A N/A " 13,194.64 " N/A N/A N/A " 15,887.81 " N/A N/A " 12,725.52 " N/A N/A N/A N/A N/A N/A N/A " 13,552.68 " " 12,725.52 " N/A " 12,725.52 " " 19,088.28 " N/A " 22,891.94 " " 22,669.24 " N/A DRG 301.3 No Current Volume N/A " 18,230.29 " " 32,794.47 " " 22,868.08 " N/A N/A N/A " 18,902.33 " N/A N/A N/A " 22,760.52 " N/A N/A " 18,230.29 " N/A N/A N/A N/A N/A N/A N/A " 19,415.26 " " 18,230.29 " N/A " 18,230.29 " " 27,345.44 " N/A " 32,794.47 " " 32,475.44 " N/A DRG 301.4 No Current Volume N/A " 26,975.32 " " 48,525.90 " " 33,837.84 " N/A N/A N/A " 27,969.74 " N/A N/A N/A " 33,678.69 " N/A N/A " 26,975.32 " N/A N/A N/A N/A N/A N/A N/A " 28,728.72 " " 26,975.32 " N/A " 26,975.32 " " 40,462.98 " N/A " 48,525.90 " " 48,053.84 " N/A DRG 302.1 No Current Volume N/A " 11,008.15 " " 19,802.56 " " 13,808.62 " N/A N/A N/A " 11,413.96 " N/A N/A N/A " 13,743.68 " N/A N/A " 11,008.15 " N/A N/A N/A N/A N/A N/A N/A " 11,723.68 " " 11,008.15 " N/A " 11,008.15 " " 16,512.23 " N/A " 19,802.56 " " 19,609.92 " N/A DRG 302.2 No Current Volume N/A " 12,431.08 " " 22,362.27 " " 15,593.55 " N/A N/A N/A " 12,889.34 " N/A N/A N/A " 15,520.20 " N/A N/A " 12,431.08 " N/A N/A N/A N/A N/A N/A N/A " 13,239.10 " " 12,431.08 " N/A " 12,431.08 " " 18,646.62 " N/A " 22,362.27 " " 22,144.73 " N/A DRG 302.3 No Current Volume N/A " 17,695.49 " " 31,832.42 " " 22,197.22 " N/A N/A N/A " 18,347.82 " N/A N/A N/A " 22,092.82 " N/A N/A " 17,695.49 " N/A N/A N/A N/A N/A N/A N/A " 18,845.70 " " 17,695.49 " N/A " 17,695.49 " " 26,543.24 " N/A " 31,832.42 " " 31,522.75 " N/A DRG 302.4 No Current Volume N/A " 28,004.51 " " 50,377.31 " " 35,128.86 " N/A N/A N/A " 29,036.87 " N/A N/A N/A " 34,963.63 " N/A N/A " 28,004.51 " N/A N/A N/A N/A N/A N/A N/A " 29,824.80 " " 28,004.51 " N/A " 28,004.51 " " 42,006.77 " N/A " 50,377.31 " " 49,887.23 " N/A DRG 303.1 No Current Volume N/A " 34,489.84 " " 62,043.77 " " 43,264.06 " N/A N/A N/A " 35,761.28 " N/A N/A N/A " 43,060.57 " N/A N/A " 34,489.84 " N/A N/A N/A N/A N/A N/A N/A " 36,731.68 " " 34,489.84 " N/A " 34,489.84 " " 51,734.76 " N/A " 62,043.77 " " 61,440.20 " N/A DRG 303.2 No Current Volume N/A " 42,773.35 " " 76,944.98 " " 53,654.89 " N/A N/A N/A " 44,350.15 " N/A N/A N/A " 53,402.53 " N/A N/A " 42,773.35 " N/A N/A N/A N/A N/A N/A N/A " 45,553.62 " " 42,773.35 " N/A " 42,773.35 " " 64,160.03 " N/A " 76,944.98 " " 76,196.45 " N/A DRG 303.3 No Current Volume N/A " 62,029.40 " " 111,584.69 " " 77,809.68 " N/A N/A N/A " 64,316.06 " N/A N/A N/A " 77,443.71 " N/A N/A " 62,029.40 " N/A N/A N/A N/A N/A N/A N/A " 66,061.31 " " 62,029.40 " N/A " 62,029.40 " " 93,044.10 " N/A " 111,584.69 " " 110,499.17 " N/A DRG 303.4 No Current Volume N/A " 76,985.86 " " 138,489.86 " " 96,571.06 " N/A N/A N/A " 79,823.88 " N/A N/A N/A " 96,116.85 " N/A N/A " 76,985.86 " N/A N/A N/A N/A N/A N/A N/A " 81,989.94 " " 76,985.86 " N/A " 76,985.86 " " 115,478.79 " N/A " 138,489.86 " " 137,142.61 " N/A DRG 304.1 " 140,472.14 " " 44,262.77 " " 20,984.38 " " 37,748.80 " " 26,322.81 " N/A N/A N/A " 21,757.95 " N/A N/A N/A " 26,199.00 " N/A N/A " 20,984.38 " N/A N/A N/A N/A N/A N/A N/A " 22,348.36 " " 20,984.38 " N/A " 20,984.38 " " 31,476.57 " N/A " 37,748.80 " " 37,381.57 " N/A DRG 304.2 No Current Volume N/A " 25,583.21 " " 46,021.64 " " 32,091.58 " N/A N/A N/A " 26,526.31 " N/A N/A N/A " 31,940.64 " N/A N/A " 25,583.21 " N/A N/A N/A N/A N/A N/A N/A " 27,246.12 " " 25,583.21 " N/A " 25,583.21 " " 38,374.82 " N/A " 46,021.64 " " 45,573.93 " N/A DRG 304.3 " 175,332.06 " " 55,247.13 " " 39,846.69 " " 71,680.21 " " 49,983.69 " N/A N/A N/A " 41,315.61 " N/A N/A N/A " 49,748.59 " N/A N/A " 39,846.69 " N/A N/A N/A N/A N/A N/A N/A " 42,436.72 " " 39,846.69 " N/A " 39,846.69 " " 59,770.04 " N/A " 71,680.21 " " 70,982.89 " N/A DRG 304.4 No Current Volume N/A " 60,795.47 " " 109,364.97 " " 76,261.84 " N/A N/A N/A " 63,036.64 " N/A N/A N/A " 75,903.14 " N/A N/A " 60,795.47 " N/A N/A N/A N/A N/A N/A N/A " 64,747.18 " " 60,795.47 " N/A " 60,795.47 " " 91,193.21 " N/A " 109,364.97 " " 108,301.05 " N/A DRG 305.1 No Current Volume N/A " 7,625.45 " " 13,717.42 " " 9,565.36 " N/A N/A N/A " 7,906.56 " N/A N/A N/A " 9,520.37 " N/A N/A " 7,625.45 " N/A N/A N/A N/A N/A N/A N/A " 8,121.10 " " 7,625.45 " N/A " 7,625.45 " " 11,438.18 " N/A " 13,717.42 " " 13,583.98 " N/A DRG 305.2 " 53,645.11 " " 16,903.57 " " 10,883.53 " " 19,578.38 " " 13,652.30 " N/A N/A N/A " 11,284.74 " N/A N/A N/A " 13,588.09 " N/A N/A " 10,883.53 " N/A N/A N/A N/A N/A N/A N/A " 11,590.96 " " 10,883.53 " N/A " 10,883.53 " " 16,325.30 " N/A " 19,578.38 " " 19,387.92 " N/A DRG 305.3 " 138,984.27 " " 43,793.94 " " 17,630.44 " " 31,715.40 " " 22,115.62 " N/A N/A N/A " 18,280.37 " N/A N/A N/A " 22,011.60 " N/A N/A " 17,630.44 " N/A N/A N/A N/A N/A N/A N/A " 18,776.42 " " 17,630.44 " N/A " 17,630.44 " " 26,445.66 " N/A " 31,715.40 " " 31,406.87 " N/A DRG 305.4 " 173,559.61 " " 54,688.63 " " 35,927.83 " " 64,630.57 " " 45,067.87 " N/A N/A N/A " 37,252.28 " N/A N/A N/A " 44,855.90 " N/A N/A " 35,927.83 " N/A N/A N/A N/A N/A N/A N/A " 38,263.14 " " 35,927.83 " N/A " 35,927.83 " " 53,891.75 " N/A " 64,630.57 " " 64,001.84 " N/A DRG 308.1 " 88,676.03 " " 27,941.82 " " 10,202.88 " " 18,353.96 " " 12,798.49 " N/A N/A N/A " 10,579.00 " N/A N/A N/A " 12,738.30 " N/A N/A " 10,202.88 " N/A N/A N/A N/A N/A N/A N/A " 10,866.07 " " 10,202.88 " N/A " 10,202.88 " " 15,304.32 " N/A " 18,353.96 " " 18,175.41 " N/A DRG 308.2 " 75,396.29 " " 23,757.37 " " 12,060.63 " " 21,695.87 " " 15,128.85 " N/A N/A N/A " 12,505.23 " N/A N/A N/A " 15,057.70 " N/A N/A " 12,060.63 " N/A N/A N/A N/A N/A N/A N/A " 12,844.57 " " 12,060.63 " N/A " 12,060.63 " " 18,090.95 " N/A " 21,695.87 " " 21,484.81 " N/A DRG 308.3 " 172,523.22 " " 54,362.07 " " 15,822.00 " " 28,462.20 " " 19,847.12 " N/A N/A N/A " 16,405.26 " N/A N/A N/A " 19,753.77 " N/A N/A " 15,822.00 " N/A N/A N/A N/A N/A N/A N/A " 16,850.43 " " 15,822.00 " N/A " 15,822.00 " " 23,733.00 " N/A " 28,462.20 " " 28,185.31 " N/A DRG 308.4 " 92,968.25 " " 29,294.30 " " 24,461.57 " " 44,003.92 " " 30,684.59 " N/A N/A N/A " 25,363.33 " N/A N/A N/A " 30,540.27 " N/A N/A " 24,461.57 " N/A N/A N/A N/A N/A N/A N/A " 26,051.57 " " 24,461.57 " N/A " 24,461.57 " " 36,692.36 " N/A " 44,003.92 " " 43,575.84 " N/A DRG 309.1 No Current Volume N/A " 11,014.32 " " 19,813.66 " " 13,816.36 " N/A N/A N/A " 11,420.35 " N/A N/A N/A " 13,751.38 " N/A N/A " 11,014.32 " N/A N/A N/A N/A N/A N/A N/A " 11,730.25 " " 11,014.32 " N/A " 11,014.32 " " 16,521.48 " N/A " 19,813.66 " " 19,620.91 " N/A DRG 309.2 No Current Volume N/A " 14,388.11 " " 25,882.77 " " 18,048.45 " N/A N/A N/A " 14,918.52 " N/A N/A N/A " 17,963.56 " N/A N/A " 14,388.11 " N/A N/A N/A N/A N/A N/A N/A " 15,323.34 " " 14,388.11 " N/A " 14,388.11 " " 21,582.17 " N/A " 25,882.77 " " 25,630.98 " N/A DRG 309.3 No Current Volume N/A " 19,919.58 " " 35,833.33 " " 24,987.12 " N/A N/A N/A " 20,653.90 " N/A N/A N/A " 24,869.60 " N/A N/A " 19,919.58 " N/A N/A N/A N/A N/A N/A N/A " 21,214.35 " " 19,919.58 " N/A " 19,919.58 " " 29,879.37 " N/A " 35,833.33 " " 35,484.74 " N/A DRG 309.4 No Current Volume N/A " 34,423.42 " " 61,924.29 " " 43,180.74 " N/A N/A N/A " 35,692.41 " N/A N/A N/A " 42,977.64 " N/A N/A " 34,423.42 " N/A N/A N/A N/A N/A N/A N/A " 36,660.94 " " 34,423.42 " N/A " 34,423.42 " " 51,635.13 " N/A " 61,924.29 " " 61,321.88 " N/A DRG 310.1 No Current Volume N/A " 8,753.93 " " 15,747.44 " " 10,980.93 " N/A N/A N/A " 9,076.64 " N/A N/A N/A " 10,929.28 " N/A N/A " 8,753.93 " N/A N/A N/A N/A N/A N/A N/A " 9,322.94 " " 8,753.93 " N/A " 8,753.93 " " 13,130.90 " N/A " 15,747.44 " " 15,594.25 " N/A DRG 310.2 " 134,799.84 " " 42,475.43 " " 11,187.56 " " 20,125.30 " " 14,033.68 " N/A N/A N/A " 11,599.98 " N/A N/A N/A " 13,967.67 " N/A N/A " 11,187.56 " N/A N/A N/A N/A N/A N/A N/A " 11,914.75 " " 11,187.56 " N/A " 11,187.56 " " 16,781.34 " N/A " 20,125.30 " " 19,929.52 " N/A DRG 310.3 " 72,265.77 " " 22,770.94 " " 15,515.91 " " 27,911.57 " " 19,463.16 " N/A N/A N/A " 16,087.89 " N/A N/A N/A " 19,371.61 " N/A N/A " 15,515.91 " N/A N/A N/A N/A N/A N/A N/A " 16,524.44 " " 15,515.91 " N/A " 15,515.91 " " 23,273.87 " N/A " 27,911.57 " " 27,640.04 " N/A DRG 310.4 No Current Volume N/A " 30,942.11 " " 55,661.76 " " 38,813.78 " N/A N/A N/A " 32,082.77 " N/A N/A N/A " 38,631.22 " N/A N/A " 30,942.11 " N/A N/A N/A N/A N/A N/A N/A " 32,953.35 " " 30,942.11 " N/A " 30,942.11 " " 46,413.17 " N/A " 55,661.76 " " 55,120.27 " N/A DRG 312.1 No Current Volume N/A " 9,905.01 " " 17,818.12 " " 12,424.84 " N/A N/A N/A " 10,270.15 " N/A N/A N/A " 12,366.40 " N/A N/A " 9,905.01 " N/A N/A N/A N/A N/A N/A N/A " 10,548.84 " " 9,905.01 " N/A " 9,905.01 " " 14,857.52 " N/A " 17,818.12 " " 17,644.78 " N/A DRG 312.2 " 35,319.34 " " 11,129.12 " " 13,768.41 " " 24,767.99 " " 17,271.09 " N/A N/A N/A " 14,275.97 " N/A N/A N/A " 17,189.86 " N/A N/A " 13,768.41 " N/A N/A N/A N/A N/A N/A N/A " 14,663.36 " " 13,768.41 " N/A " 13,768.41 " " 20,652.62 " N/A " 24,767.99 " " 24,527.05 " N/A DRG 312.3 No Current Volume N/A " 22,871.57 " " 41,143.67 " " 28,690.10 " N/A N/A N/A " 23,714.71 " N/A N/A N/A " 28,555.16 " N/A N/A " 22,871.57 " N/A N/A N/A N/A N/A N/A N/A " 24,358.22 " " 22,871.57 " N/A " 22,871.57 " " 34,307.36 " N/A " 41,143.67 " " 40,743.41 " N/A DRG 312.4 No Current Volume N/A " 50,674.07 " " 91,157.58 " " 63,565.55 " N/A N/A N/A " 52,542.13 " N/A N/A N/A " 63,266.58 " N/A N/A " 50,674.07 " N/A N/A N/A N/A N/A N/A N/A " 53,967.88 " " 50,674.07 " N/A " 50,674.07 " " 76,011.11 " N/A " 91,157.58 " " 90,270.79 " N/A DRG 313.1 " 123,301.53 " " 38,852.31 " " 9,224.36 " " 16,593.70 " " 11,571.04 " N/A N/A N/A " 9,564.41 " N/A N/A N/A " 11,516.61 " N/A N/A " 9,224.36 " N/A N/A N/A N/A N/A N/A N/A " 9,823.94 " " 9,224.36 " N/A " 9,224.36 " " 13,836.54 " N/A " 16,593.70 " " 16,432.27 " N/A DRG 313.2 " 116,492.03 " " 36,706.64 " " 12,431.76 " " 22,363.49 " " 15,594.40 " N/A N/A N/A " 12,890.05 " N/A N/A N/A " 15,521.05 " N/A N/A " 12,431.76 " N/A N/A N/A N/A N/A N/A N/A " 13,239.82 " " 12,431.76 " N/A " 12,431.76 " " 18,647.64 " N/A " 22,363.49 " " 22,145.94 " N/A DRG 313.3 " 75,641.55 " " 23,834.65 " " 18,233.71 " " 32,800.62 " " 22,872.37 " N/A N/A N/A " 18,905.88 " N/A N/A N/A " 22,764.79 " N/A N/A " 18,233.71 " N/A N/A N/A N/A N/A N/A N/A " 19,418.90 " " 18,233.71 " N/A " 18,233.71 " " 27,350.57 " N/A " 32,800.62 " " 32,481.53 " N/A DRG 313.4 " 142,642.22 " " 44,946.56 " " 31,157.13 " " 56,048.56 " " 39,083.50 " N/A N/A N/A " 32,305.71 " N/A N/A N/A " 38,899.68 " N/A N/A " 31,157.13 " N/A N/A N/A N/A N/A N/A N/A " 33,182.34 " " 31,157.13 " N/A " 31,157.13 " " 46,735.70 " N/A " 56,048.56 " " 55,503.31 " N/A DRG 314.1 " 76,295.54 " " 24,040.72 " " 8,897.05 " " 16,004.90 " " 11,160.46 " N/A N/A N/A " 9,225.03 " N/A N/A N/A " 11,107.97 " N/A N/A " 8,897.05 " N/A N/A N/A N/A N/A N/A N/A " 9,475.36 " " 8,897.05 " N/A " 8,897.05 " " 13,345.58 " N/A " 16,004.90 " " 15,849.20 " N/A DRG 314.2 No Current Volume N/A " 8,988.81 " " 16,169.97 " " 11,275.56 " N/A N/A N/A " 9,320.17 " N/A N/A N/A " 11,222.53 " N/A N/A " 8,988.81 " N/A N/A N/A N/A N/A N/A N/A " 9,573.08 " " 8,988.81 " N/A " 8,988.81 " " 13,483.22 " N/A " 16,169.97 " " 16,012.67 " N/A DRG 314.3 " 72,268.38 " " 22,771.76 " " 12,860.42 " " 23,134.61 " " 16,132.11 " N/A N/A N/A " 13,334.51 " N/A N/A N/A " 16,056.23 " N/A N/A " 12,860.42 " N/A N/A N/A N/A N/A N/A N/A " 13,696.35 " " 12,860.42 " N/A " 12,860.42 " " 19,290.63 " N/A " 23,134.61 " " 22,909.55 " N/A DRG 314.4 No Current Volume N/A " 25,243.57 " " 45,410.66 " " 31,665.53 " N/A N/A N/A " 26,174.15 " N/A N/A N/A " 31,516.60 " N/A N/A " 25,243.57 " N/A N/A N/A N/A N/A N/A N/A " 26,884.40 " " 25,243.57 " N/A " 25,243.57 " " 37,865.36 " N/A " 45,410.66 " " 44,968.90 " N/A DRG 315.1 " 44,940.13 " " 14,160.63 " " 6,984.52 " " 12,564.45 " " 8,761.38 " N/A N/A N/A " 7,242.00 " N/A N/A N/A " 8,720.17 " N/A N/A " 6,984.52 " N/A N/A N/A N/A N/A N/A N/A " 7,438.51 " " 6,984.52 " N/A " 6,984.52 " " 10,476.78 " N/A " 12,564.45 " " 12,442.22 " N/A DRG 315.2 " 74,975.75 " " 23,624.86 " " 11,293.01 " " 20,315.00 " " 14,165.95 " N/A N/A N/A " 11,709.32 " N/A N/A N/A " 14,099.32 " N/A N/A " 11,293.01 " N/A N/A N/A N/A N/A N/A N/A " 12,027.06 " " 11,293.01 " N/A " 11,293.01 " " 16,939.52 " N/A " 20,315.00 " " 20,117.37 " N/A DRG 315.3 No Current Volume N/A " 16,477.31 " " 29,641.03 " " 20,669.14 " N/A N/A N/A " 17,084.73 " N/A N/A N/A " 20,571.92 " N/A N/A " 16,477.31 " N/A N/A N/A N/A N/A N/A N/A " 17,548.34 " " 16,477.31 " N/A " 16,477.31 " " 24,715.97 " N/A " 29,641.03 " " 29,352.68 " N/A DRG 315.4 No Current Volume N/A " 28,895.38 " " 51,979.90 " " 36,246.36 " N/A N/A N/A " 29,960.58 " N/A N/A N/A " 36,075.88 " N/A N/A " 28,895.38 " N/A N/A N/A N/A N/A N/A N/A " 30,773.58 " " 28,895.38 " N/A " 28,895.38 " " 43,343.07 " N/A " 51,979.90 " " 51,474.23 " N/A DRG 316.1 No Current Volume N/A " 6,701.72 " " 12,055.72 " " 8,406.64 " N/A N/A N/A " 6,948.77 " N/A N/A N/A " 8,367.10 " N/A N/A " 6,701.72 " N/A N/A N/A N/A N/A N/A N/A " 7,137.33 " " 6,701.72 " N/A " 6,701.72 " " 10,052.58 " N/A " 12,055.72 " " 11,938.44 " N/A DRG 316.2 No Current Volume N/A " 8,818.30 " " 15,863.24 " " 11,061.68 " N/A N/A N/A " 9,143.38 " N/A N/A N/A " 11,009.65 " N/A N/A " 8,818.30 " N/A N/A N/A N/A N/A N/A N/A " 9,391.49 " " 8,818.30 " N/A " 8,818.30 " " 13,227.45 " N/A " 15,863.24 " " 15,708.92 " N/A DRG 316.3 No Current Volume N/A " 14,298.41 " " 25,721.41 " " 17,935.93 " N/A N/A N/A " 14,825.51 " N/A N/A N/A " 17,851.56 " N/A N/A " 14,298.41 " N/A N/A N/A N/A N/A N/A N/A " 15,227.81 " " 14,298.41 " N/A " 14,298.41 " " 21,447.62 " N/A " 25,721.41 " " 25,471.19 " N/A DRG 316.4 No Current Volume N/A " 30,405.27 " " 54,696.04 " " 38,140.37 " N/A N/A N/A " 31,526.13 " N/A N/A N/A " 37,960.98 " N/A N/A " 30,405.27 " N/A N/A N/A N/A N/A N/A N/A " 32,381.61 " " 30,405.27 " N/A " 30,405.27 " " 45,607.91 " N/A " 54,696.04 " " 54,163.95 " N/A DRG 317.1 " 101,223.74 " " 31,895.60 " " 7,595.32 " " 13,663.22 " " 9,527.57 " N/A N/A N/A " 7,875.32 " N/A N/A N/A " 9,482.76 " N/A N/A " 7,595.32 " N/A N/A N/A N/A N/A N/A N/A " 8,089.02 " " 7,595.32 " N/A " 7,595.32 " " 11,392.98 " N/A " 13,663.22 " " 13,530.30 " N/A DRG 317.2 " 60,857.59 " " 19,176.23 " " 10,267.25 " " 18,469.76 " " 12,879.24 " N/A N/A N/A " 10,645.74 " N/A N/A N/A " 12,818.66 " N/A N/A " 10,267.25 " N/A N/A N/A N/A N/A N/A N/A " 10,934.62 " " 10,267.25 " N/A " 10,267.25 " " 15,400.88 " N/A " 18,469.76 " " 18,290.08 " N/A DRG 317.3 " 213,475.36 " " 67,266.09 " " 16,400.61 " " 29,503.06 " " 20,572.93 " N/A N/A N/A " 17,005.21 " N/A N/A N/A " 20,476.16 " N/A N/A " 16,400.61 " N/A N/A N/A N/A N/A N/A N/A " 17,466.65 " " 16,400.61 " N/A " 16,400.61 " " 24,600.92 " N/A " 29,503.06 " " 29,216.05 " N/A DRG 317.4 No Current Volume N/A " 32,638.94 " " 58,714.19 " " 40,942.29 " N/A N/A N/A " 33,842.15 " N/A N/A N/A " 40,749.72 " N/A N/A " 32,638.94 " N/A N/A N/A N/A N/A N/A N/A " 34,760.47 " " 32,638.94 " N/A " 32,638.94 " " 48,958.41 " N/A " 58,714.19 " " 58,143.01 " N/A DRG 320.1 " 56,403.59 " " 17,772.77 " " 8,332.12 " " 14,988.65 " " 10,451.81 " N/A N/A N/A " 8,639.28 " N/A N/A N/A " 10,402.65 " N/A N/A " 8,332.12 " N/A N/A N/A N/A N/A N/A N/A " 8,873.71 " " 8,332.12 " N/A " 8,332.12 " " 12,498.18 " N/A " 14,988.65 " " 14,842.84 " N/A DRG 320.2 " 66,456.89 " " 20,940.57 " " 11,719.62 " " 21,082.42 " " 14,701.09 " N/A N/A N/A " 12,151.65 " N/A N/A N/A " 14,631.95 " N/A N/A " 11,719.62 " N/A N/A N/A N/A N/A N/A N/A " 12,481.40 " " 11,719.62 " N/A " 11,719.62 " " 17,579.43 " N/A " 21,082.42 " " 20,877.33 " N/A DRG 320.3 " 132,419.40 " " 41,725.35 " " 17,983.09 " " 32,349.78 " " 22,557.99 " N/A N/A N/A " 18,646.02 " N/A N/A N/A " 22,451.89 " N/A N/A " 17,983.09 " N/A N/A N/A N/A N/A N/A N/A " 19,151.99 " " 17,983.09 " N/A " 17,983.09 " " 26,974.64 " N/A " 32,349.78 " " 32,035.08 " N/A DRG 320.4 No Current Volume N/A " 31,502.93 " " 56,670.62 " " 39,517.28 " N/A N/A N/A " 32,664.26 " N/A N/A N/A " 39,331.41 " N/A N/A " 31,502.93 " N/A N/A N/A N/A N/A N/A N/A " 33,550.62 " " 31,502.93 " N/A " 31,502.93 " " 47,254.40 " N/A " 56,670.62 " " 56,119.32 " N/A DRG 321.1 " 109,443.94 " " 34,485.79 " " 13,045.99 " " 23,468.43 " " 16,364.89 " N/A N/A N/A " 13,526.92 " N/A N/A N/A " 16,287.92 " N/A N/A " 13,045.99 " N/A N/A N/A N/A N/A N/A N/A " 13,893.98 " " 13,045.99 " N/A " 13,045.99 " " 19,568.99 " N/A " 23,468.43 " " 23,240.13 " N/A DRG 321.2 " 121,306.05 " " 38,223.53 " " 16,394.45 " " 29,491.98 " " 20,565.20 " N/A N/A N/A " 16,998.82 " N/A N/A N/A " 20,468.47 " N/A N/A " 16,394.45 " N/A N/A N/A N/A N/A N/A N/A " 17,460.09 " " 16,394.45 " N/A " 16,394.45 " " 24,591.68 " N/A " 29,491.98 " " 29,205.07 " N/A DRG 321.3 " 221,897.89 " " 69,920.03 " " 24,601.26 " " 44,255.21 " " 30,859.82 " N/A N/A N/A " 25,508.17 " N/A N/A N/A " 30,714.67 " N/A N/A " 24,601.26 " N/A N/A N/A N/A N/A N/A N/A " 26,200.34 " " 24,601.26 " N/A " 24,601.26 " " 36,901.89 " N/A " 44,255.21 " " 43,824.68 " N/A DRG 321.4 No Current Volume N/A " 42,600.10 " " 76,633.32 " " 53,437.57 " N/A N/A N/A " 44,170.52 " N/A N/A N/A " 53,186.22 " N/A N/A " 42,600.10 " N/A N/A N/A N/A N/A N/A N/A " 45,369.11 " " 42,600.10 " N/A " 42,600.10 " " 63,900.15 " N/A " 76,633.32 " " 75,887.82 " N/A DRG 322.1 No Current Volume N/A " 13,003.54 " " 23,392.07 " " 16,311.64 " N/A N/A N/A " 13,482.90 " N/A N/A N/A " 16,234.92 " N/A N/A " 13,003.54 " N/A N/A N/A N/A N/A N/A N/A " 13,848.77 " " 13,003.54 " N/A " 13,003.54 " " 19,505.31 " N/A " 23,392.07 " " 23,164.51 " N/A DRG 322.2 No Current Volume N/A " 14,551.09 " " 26,175.96 " " 18,252.89 " N/A N/A N/A " 15,087.50 " N/A N/A N/A " 18,167.04 " N/A N/A " 14,551.09 " N/A N/A N/A N/A N/A N/A N/A " 15,496.91 " " 14,551.09 " N/A " 14,551.09 " " 21,826.64 " N/A " 26,175.96 " " 25,921.31 " N/A DRG 322.3 No Current Volume N/A " 19,724.43 " " 35,482.28 " " 24,742.32 " N/A N/A N/A " 20,451.55 " N/A N/A N/A " 24,625.95 " N/A N/A " 19,724.43 " N/A N/A N/A N/A N/A N/A N/A " 21,006.52 " " 19,724.43 " N/A " 19,724.43 " " 29,586.65 " N/A " 35,482.28 " " 35,137.10 " N/A DRG 322.4 No Current Volume N/A " 29,612.32 " " 53,269.60 " " 37,145.69 " N/A N/A N/A " 30,703.95 " N/A N/A N/A " 36,970.98 " N/A N/A " 29,612.32 " N/A N/A N/A N/A N/A N/A N/A " 31,537.12 " " 29,612.32 " N/A " 29,612.32 " " 44,418.48 " N/A " 53,269.60 " " 52,751.39 " N/A DRG 340.1 No Current Volume N/A " 3,583.33 " " 6,446.05 " " 4,494.93 " N/A N/A N/A " 3,715.43 " N/A N/A N/A " 4,473.79 " N/A N/A " 3,583.33 " N/A N/A N/A N/A N/A N/A N/A " 3,816.25 " " 3,583.33 " N/A " 3,583.33 " " 5,375.00 " N/A " 6,446.05 " " 6,383.34 " N/A DRG 340.2 No Current Volume N/A " 4,285.21 " " 7,708.66 " " 5,375.37 " N/A N/A N/A " 4,443.18 " N/A N/A N/A " 5,350.08 " N/A N/A " 4,285.21 " N/A N/A N/A N/A N/A N/A N/A " 4,563.75 " " 4,285.21 " N/A " 4,285.21 " " 6,427.82 " N/A " 7,708.66 " " 7,633.67 " N/A DRG 340.3 No Current Volume N/A " 6,466.16 " " 11,631.98 " " 8,111.15 " N/A N/A N/A " 6,704.53 " N/A N/A N/A " 8,073.00 " N/A N/A " 6,466.16 " N/A N/A N/A N/A N/A N/A N/A " 6,886.46 " " 6,466.16 " N/A " 6,466.16 " " 9,699.24 " N/A " 11,631.98 " " 11,518.82 " N/A DRG 340.4 No Current Volume N/A " 11,790.15 " " 21,209.30 " " 14,789.56 " N/A N/A N/A " 12,224.78 " N/A N/A N/A " 14,720.00 " N/A N/A " 11,790.15 " N/A N/A N/A N/A N/A N/A N/A " 12,556.51 " " 11,790.15 " N/A " 11,790.15 " " 17,685.23 " N/A " 21,209.30 " " 21,002.97 " N/A DRG 341.1 No Current Volume N/A " 4,075.67 " " 7,331.72 " " 5,112.52 " N/A N/A N/A " 4,225.92 " N/A N/A N/A " 5,088.47 " N/A N/A " 4,075.67 " N/A N/A N/A N/A N/A N/A N/A " 4,340.59 " " 4,075.67 " N/A " 4,075.67 " " 6,113.51 " N/A " 7,331.72 " " 7,260.40 " N/A DRG 341.2 " 22,755.06 " " 7,170.12 " " 4,800.15 " " 8,634.99 " " 6,021.31 " N/A N/A N/A " 4,977.10 " N/A N/A N/A " 5,992.99 " N/A N/A " 4,800.15 " N/A N/A N/A N/A N/A N/A N/A " 5,112.16 " " 4,800.15 " N/A " 4,800.15 " " 7,200.23 " N/A " 8,634.99 " " 8,550.99 " N/A DRG 341.3 No Current Volume N/A " 6,173.08 " " 11,104.75 " " 7,743.51 " N/A N/A N/A " 6,400.65 " N/A N/A N/A " 7,707.09 " N/A N/A " 6,173.08 " N/A N/A N/A N/A N/A N/A N/A " 6,574.33 " " 6,173.08 " N/A " 6,173.08 " " 9,259.62 " N/A " 11,104.75 " " 10,996.72 " N/A DRG 341.4 No Current Volume N/A " 14,555.19 " " 26,183.33 " " 18,258.03 " N/A N/A N/A " 15,091.76 " N/A N/A N/A " 18,172.15 " N/A N/A " 14,555.19 " N/A N/A N/A N/A N/A N/A N/A " 15,501.28 " " 14,555.19 " N/A " 14,555.19 " " 21,832.79 " N/A " 26,183.33 " " 25,928.62 " N/A DRG 342.1 No Current Volume N/A " 4,299.59 " " 7,734.53 " " 5,393.41 " N/A N/A N/A " 4,458.09 " N/A N/A N/A " 5,368.04 " N/A N/A " 4,299.59 " N/A N/A N/A N/A N/A N/A N/A " 4,579.06 " " 4,299.59 " N/A " 4,299.59 " " 6,449.39 " N/A " 7,734.53 " " 7,659.29 " N/A DRG 342.2 " 27,565.78 " " 8,685.98 " " 5,255.51 " " 9,454.14 " " 6,592.51 " N/A N/A N/A " 5,449.25 " N/A N/A N/A " 6,561.50 " N/A N/A " 5,255.51 " N/A N/A N/A N/A N/A N/A N/A " 5,597.12 " " 5,255.51 " N/A " 5,255.51 " " 7,883.27 " N/A " 9,454.14 " " 9,362.17 " N/A DRG 342.3 " 79,480.03 " " 25,044.16 " " 7,487.13 " " 13,468.60 " " 9,391.86 " N/A N/A N/A " 7,763.14 " N/A N/A N/A " 9,347.68 " N/A N/A " 7,487.13 " N/A N/A N/A N/A N/A N/A N/A " 7,973.79 " " 7,487.13 " N/A " 7,487.13 " " 11,230.70 " N/A " 13,468.60 " " 13,337.57 " N/A DRG 342.4 No Current Volume N/A " 14,447.00 " " 25,988.71 " " 18,122.32 " N/A N/A N/A " 14,979.58 " N/A N/A N/A " 18,037.08 " N/A N/A " 14,447.00 " N/A N/A N/A N/A N/A N/A N/A " 15,386.06 " " 14,447.00 " N/A " 14,447.00 " " 21,670.50 " N/A " 25,988.71 " " 25,735.89 " N/A DRG 343.1 No Current Volume N/A " 6,704.46 " " 12,060.65 " " 8,410.07 " N/A N/A N/A " 6,951.61 " N/A N/A N/A " 8,370.52 " N/A N/A " 6,704.46 " N/A N/A N/A N/A N/A N/A N/A " 7,140.25 " " 6,704.46 " N/A " 6,704.46 " " 10,056.69 " N/A " 12,060.65 " " 11,943.33 " N/A DRG 343.2 No Current Volume N/A " 7,885.66 " " 14,185.51 " " 9,891.77 " N/A N/A N/A " 8,176.36 " N/A N/A N/A " 9,845.25 " N/A N/A " 7,885.66 " N/A N/A N/A N/A N/A N/A N/A " 8,398.23 " " 7,885.66 " N/A " 7,885.66 " " 11,828.49 " N/A " 14,185.51 " " 14,047.51 " N/A DRG 343.3 No Current Volume N/A " 11,742.21 " " 21,123.06 " " 14,729.43 " N/A N/A N/A " 12,175.08 " N/A N/A N/A " 14,660.15 " N/A N/A " 11,742.21 " N/A N/A N/A N/A N/A N/A N/A " 12,505.45 " " 11,742.21 " N/A " 11,742.21 " " 17,613.32 " N/A " 21,123.06 " " 20,917.57 " N/A DRG 343.4 No Current Volume N/A " 20,916.59 " " 37,626.85 " " 26,237.77 " N/A N/A N/A " 21,687.66 " N/A N/A N/A " 26,114.36 " N/A N/A " 20,916.59 " N/A N/A N/A N/A N/A N/A N/A " 22,276.17 " " 20,916.59 " N/A " 20,916.59 " " 31,374.89 " N/A " 37,626.85 " " 37,260.81 " N/A DRG 344.1 " 105,483.63 " " 33,237.89 " " 5,471.21 " " 9,842.16 " " 6,863.09 " N/A N/A N/A " 5,672.90 " N/A N/A N/A " 6,830.81 " N/A N/A " 5,471.21 " N/A N/A N/A N/A N/A N/A N/A " 5,826.84 " " 5,471.21 " N/A " 5,471.21 " " 8,206.82 " N/A " 9,842.16 " " 9,746.41 " N/A DRG 344.2 " 50,526.54 " " 15,920.91 " " 6,874.28 " " 12,366.14 " " 8,623.10 " N/A N/A N/A " 7,127.69 " N/A N/A N/A " 8,582.54 " N/A N/A " 6,874.28 " N/A N/A N/A N/A N/A N/A N/A " 7,321.11 " " 6,874.28 " N/A " 6,874.28 " " 10,311.42 " N/A " 12,366.14 " " 12,245.84 " N/A DRG 344.3 " 44,168.21 " " 13,917.40 " " 9,915.97 " " 17,837.84 " " 12,438.59 " N/A N/A N/A " 10,281.51 " N/A N/A N/A " 12,380.09 " N/A N/A " 9,915.97 " N/A N/A N/A N/A N/A N/A N/A " 10,560.51 " " 9,915.97 " N/A " 9,915.97 " " 14,873.96 " N/A " 17,837.84 " " 17,664.31 " N/A DRG 344.4 No Current Volume N/A " 18,760.97 " " 33,749.11 " " 23,533.76 " N/A N/A N/A " 19,452.58 " N/A N/A N/A " 23,423.07 " N/A N/A " 18,760.97 " N/A N/A N/A N/A N/A N/A N/A " 19,980.43 " " 18,760.97 " N/A " 18,760.97 " " 28,141.46 " N/A " 33,749.11 " " 33,420.79 " N/A DRG 346.1 No Current Volume N/A " 5,691.70 " " 10,238.80 " " 7,139.67 " N/A N/A N/A " 5,901.52 " N/A N/A N/A " 7,106.09 " N/A N/A " 5,691.70 " N/A N/A N/A N/A N/A N/A N/A " 6,061.66 " " 5,691.70 " N/A " 5,691.70 " " 8,537.55 " N/A " 10,238.80 " " 10,139.19 " N/A DRG 346.2 " 23,192.47 " " 7,307.95 " " 7,413.86 " " 13,336.79 " " 9,299.95 " N/A N/A N/A " 7,687.17 " N/A N/A N/A " 9,256.20 " N/A N/A " 7,413.86 " N/A N/A N/A N/A N/A N/A N/A " 7,895.76 " " 7,413.86 " N/A " 7,413.86 " " 11,120.79 " N/A " 13,336.79 " " 13,207.05 " N/A DRG 346.3 No Current Volume N/A " 11,799.05 " " 21,225.31 " " 14,800.73 " N/A N/A N/A " 12,234.01 " N/A N/A N/A " 14,731.11 " N/A N/A " 11,799.05 " N/A N/A N/A N/A N/A N/A N/A " 12,565.99 " " 11,799.05 " N/A " 11,799.05 " " 17,698.58 " N/A " 21,225.31 " " 21,018.83 " N/A DRG 346.4 No Current Volume N/A " 26,932.18 " " 48,448.30 " " 33,783.73 " N/A N/A N/A " 27,925.01 " N/A N/A N/A " 33,624.83 " N/A N/A " 26,932.18 " N/A N/A N/A N/A N/A N/A N/A " 28,682.77 " " 26,932.18 " N/A " 26,932.18 " " 40,398.27 " N/A " 48,448.30 " " 47,976.99 " N/A DRG 347.1 " 54,104.73 " " 17,048.40 " " 5,142.53 " " 9,250.90 " " 6,450.79 " N/A N/A N/A " 5,332.10 " N/A N/A N/A " 6,420.45 " N/A N/A " 5,142.53 " N/A N/A N/A N/A N/A N/A N/A " 5,476.79 " " 5,142.53 " N/A " 5,142.53 " " 7,713.80 " N/A " 9,250.90 " " 9,160.90 " N/A DRG 347.2 " 31,675.02 " " 9,980.80 " " 6,132.00 " " 11,030.85 " " 7,691.98 " N/A N/A N/A " 6,358.05 " N/A N/A N/A " 7,655.80 " N/A N/A " 6,132.00 " N/A N/A N/A N/A N/A N/A N/A " 6,530.58 " " 6,132.00 " N/A " 6,132.00 " " 9,198.00 " N/A " 11,030.85 " " 10,923.54 " N/A DRG 347.3 " 104,747.71 " " 33,006.00 " " 8,238.31 " " 14,819.90 " " 10,334.14 " N/A N/A N/A " 8,542.01 " N/A N/A N/A " 10,285.53 " N/A N/A " 8,238.31 " N/A N/A N/A N/A N/A N/A N/A " 8,773.80 " " 8,238.31 " N/A " 8,238.31 " " 12,357.47 " N/A " 14,819.90 " " 14,675.73 " N/A DRG 347.4 No Current Volume N/A " 17,048.40 " " 30,668.37 " " 21,385.51 " N/A N/A N/A " 17,676.87 " N/A N/A N/A " 21,284.93 " N/A N/A " 17,048.40 " N/A N/A N/A N/A N/A N/A N/A " 18,156.55 " " 17,048.40 " N/A " 17,048.40 " " 25,572.60 " N/A " 30,668.37 " " 30,370.02 " N/A DRG 349.1 No Current Volume N/A " 4,037.33 " " 7,262.75 " " 5,064.43 " N/A N/A N/A " 4,186.16 " N/A N/A N/A " 5,040.61 " N/A N/A " 4,037.33 " N/A N/A N/A N/A N/A N/A N/A " 4,299.76 " " 4,037.33 " N/A " 4,037.33 " " 6,056.00 " N/A " 7,262.75 " " 7,192.10 " N/A DRG 349.2 " 40,665.53 " " 12,813.71 " " 5,781.40 " " 10,400.16 " " 7,252.19 " N/A N/A N/A " 5,994.53 " N/A N/A N/A " 7,218.08 " N/A N/A " 5,781.40 " N/A N/A N/A N/A N/A N/A N/A " 6,157.19 " " 5,781.40 " N/A " 5,781.40 " " 8,672.10 " N/A " 10,400.16 " " 10,298.99 " N/A DRG 349.3 No Current Volume N/A " 8,712.16 " " 15,672.30 " " 10,928.53 " N/A N/A N/A " 9,033.33 " N/A N/A N/A " 10,877.13 " N/A N/A " 8,712.16 " N/A N/A N/A N/A N/A N/A N/A " 9,278.45 " " 8,712.16 " N/A " 8,712.16 " " 13,068.24 " N/A " 15,672.30 " " 15,519.84 " N/A DRG 349.4 No Current Volume N/A " 15,808.98 " " 28,438.77 " " 19,830.78 " N/A N/A N/A " 16,391.77 " N/A N/A N/A " 19,737.51 " N/A N/A " 15,808.98 " N/A N/A N/A N/A N/A N/A N/A " 16,836.56 " " 15,808.98 " N/A " 15,808.98 " " 23,713.47 " N/A " 28,438.77 " " 28,162.12 " N/A DRG 351.1 " 76,304.91 " " 24,043.68 " " 4,256.45 " " 7,656.93 " " 5,339.29 " N/A N/A N/A " 4,413.36 " N/A N/A N/A " 5,314.18 " N/A N/A " 4,256.45 " N/A N/A N/A N/A N/A N/A N/A " 4,533.12 " " 4,256.45 " N/A " 4,256.45 " " 6,384.68 " N/A " 7,656.93 " " 7,582.44 " N/A DRG 351.2 " 23,841.41 " " 7,512.43 " " 5,013.79 " " 9,019.31 " " 6,289.30 " N/A N/A N/A " 5,198.62 " N/A N/A N/A " 6,259.72 " N/A N/A " 5,013.79 " N/A N/A N/A N/A N/A N/A N/A " 5,339.69 " " 5,013.79 " N/A " 5,013.79 " " 7,520.69 " N/A " 9,019.31 " " 8,931.57 " N/A DRG 351.3 " 270,300.64 " " 85,171.73 " " 8,379.37 " " 15,073.65 " " 10,511.08 " N/A N/A N/A " 8,688.27 " N/A N/A N/A " 10,461.64 " N/A N/A " 8,379.37 " N/A N/A N/A N/A N/A N/A N/A " 8,924.03 " " 8,379.37 " N/A " 8,379.37 " " 12,569.06 " N/A " 15,073.65 " " 14,927.01 " N/A DRG 351.4 " 26,265.15 " " 8,276.15 " " 16,105.48 " " 28,972.15 " " 20,202.71 " N/A N/A N/A " 16,699.20 " N/A N/A N/A " 20,107.69 " N/A N/A " 16,105.48 " N/A N/A N/A N/A N/A N/A N/A " 17,152.34 " " 16,105.48 " N/A " 16,105.48 " " 24,158.22 " N/A " 28,972.15 " " 28,690.30 " N/A DRG 361.1 " 65,293.90 " " 20,574.11 " " 8,901.16 " " 16,012.30 " " 11,165.62 " N/A N/A N/A " 9,229.29 " N/A N/A N/A " 11,113.10 " N/A N/A " 8,901.16 " N/A N/A N/A N/A N/A N/A N/A " 9,479.74 " " 8,901.16 " N/A " 8,901.16 " " 13,351.74 " N/A " 16,012.30 " " 15,856.53 " N/A DRG 361.2 No Current Volume N/A " 11,065.67 " " 19,906.03 " " 13,880.78 " N/A N/A N/A " 11,473.60 " N/A N/A N/A " 13,815.49 " N/A N/A " 11,065.67 " N/A N/A N/A N/A N/A N/A N/A " 11,784.94 " " 11,065.67 " N/A " 11,065.67 " " 16,598.51 " N/A " 19,906.03 " " 19,712.38 " N/A DRG 361.3 No Current Volume N/A " 18,133.05 " " 32,619.54 " " 22,746.10 " N/A N/A N/A " 18,801.51 " N/A N/A N/A " 22,639.11 " N/A N/A " 18,133.05 " N/A N/A N/A N/A N/A N/A N/A " 19,311.70 " " 18,133.05 " N/A " 18,133.05 " " 27,199.58 " N/A " 32,619.54 " " 32,302.22 " N/A DRG 361.4 No Current Volume N/A " 41,759.91 " " 75,121.90 " " 52,383.63 " N/A N/A N/A " 43,299.35 " N/A N/A N/A " 52,137.25 " N/A N/A " 41,759.91 " N/A N/A N/A N/A N/A N/A N/A " 44,474.30 " " 41,759.91 " N/A " 41,759.91 " " 62,639.87 " N/A " 75,121.90 " " 74,391.10 " N/A DRG 362.1 No Current Volume N/A " 8,500.57 " " 15,291.68 " " 10,663.12 " N/A N/A N/A " 8,813.94 " N/A N/A N/A " 10,612.96 " N/A N/A " 8,500.57 " N/A N/A N/A N/A N/A N/A N/A " 9,053.11 " " 8,500.57 " N/A " 8,500.57 " " 12,750.86 " N/A " 15,291.68 " " 15,142.92 " N/A DRG 362.2 No Current Volume N/A " 10,785.61 " " 19,402.23 " " 13,529.47 " N/A N/A N/A " 11,183.21 " N/A N/A N/A " 13,465.83 " N/A N/A " 10,785.61 " N/A N/A N/A N/A N/A N/A N/A " 11,486.67 " " 10,785.61 " N/A " 10,785.61 " " 16,178.42 " N/A " 19,402.23 " " 19,213.49 " N/A DRG 362.3 No Current Volume N/A " 14,435.36 " " 25,967.77 " " 18,107.72 " N/A N/A N/A " 14,967.51 " N/A N/A N/A " 18,022.55 " N/A N/A " 14,435.36 " N/A N/A N/A N/A N/A N/A N/A " 15,373.66 " " 14,435.36 " N/A " 14,435.36 " " 21,653.04 " N/A " 25,967.77 " " 25,715.15 " N/A DRG 362.4 No Current Volume N/A " 28,401.67 " " 51,091.76 " " 35,627.05 " N/A N/A N/A " 29,448.67 " N/A N/A N/A " 35,459.48 " N/A N/A " 28,401.67 " N/A N/A N/A N/A N/A N/A N/A " 30,247.78 " " 28,401.67 " N/A " 28,401.67 " " 42,602.51 " N/A " 51,091.76 " " 50,594.73 " N/A DRG 363.1 No Current Volume N/A " 8,868.29 " " 15,953.17 " " 11,124.38 " N/A N/A N/A " 9,195.21 " N/A N/A N/A " 11,072.06 " N/A N/A " 8,868.29 " N/A N/A N/A N/A N/A N/A N/A " 9,444.73 " " 8,868.29 " N/A " 8,868.29 " " 13,302.44 " N/A " 15,953.17 " " 15,797.97 " N/A DRG 363.2 " 49,687.99 " " 15,656.69 " " 12,096.23 " " 21,759.91 " " 15,173.51 " N/A N/A N/A " 12,542.15 " N/A N/A N/A " 15,102.14 " N/A N/A " 12,096.23 " N/A N/A N/A N/A N/A N/A N/A " 12,882.48 " " 12,096.23 " N/A " 12,096.23 " " 18,144.35 " N/A " 21,759.91 " " 21,548.22 " N/A DRG 363.3 No Current Volume N/A " 17,193.56 " " 30,929.50 " " 21,567.60 " N/A N/A N/A " 17,827.39 " N/A N/A N/A " 21,466.16 " N/A N/A " 17,193.56 " N/A N/A N/A N/A N/A N/A N/A " 18,311.14 " " 17,193.56 " N/A " 17,193.56 " " 25,790.34 " N/A " 30,929.50 " " 30,628.61 " N/A DRG 363.4 No Current Volume N/A " 21,252.80 " " 38,231.66 " " 26,659.51 " N/A N/A N/A " 22,036.27 " N/A N/A N/A " 26,534.12 " N/A N/A " 21,252.80 " N/A N/A N/A N/A N/A N/A N/A " 22,634.23 " " 21,252.80 " N/A " 21,252.80 " " 31,879.20 " N/A " 38,231.66 " " 37,859.74 " N/A DRG 364.1 " 21,054.38 " " 6,634.24 " " 5,904.66 " " 10,621.89 " " 7,406.81 " N/A N/A N/A " 6,122.33 " N/A N/A N/A " 7,371.97 " N/A N/A " 5,904.66 " N/A N/A N/A N/A N/A N/A N/A " 6,288.46 " " 5,904.66 " N/A " 5,904.66 " " 8,856.99 " N/A " 10,621.89 " " 10,518.56 " N/A DRG 364.2 " 38,240.00 " " 12,049.42 " " 8,773.11 " " 15,781.95 " " 11,004.99 " N/A N/A N/A " 9,096.52 " N/A N/A N/A " 10,953.23 " N/A N/A " 8,773.11 " N/A N/A N/A N/A N/A N/A N/A " 9,343.36 " " 8,773.11 " N/A " 8,773.11 " " 13,159.67 " N/A " 15,781.95 " " 15,628.42 " N/A DRG 364.3 " 75,335.32 " " 23,738.16 " " 14,315.53 " " 25,752.21 " " 17,957.40 " N/A N/A N/A " 14,843.26 " N/A N/A N/A " 17,872.94 " N/A N/A " 14,315.53 " N/A N/A N/A N/A N/A N/A N/A " 15,246.04 " " 14,315.53 " N/A " 14,315.53 " " 21,473.30 " N/A " 25,752.21 " " 25,501.69 " N/A DRG 364.4 " 33,775.23 " " 10,642.57 " " 28,709.81 " " 51,646.08 " " 36,013.59 " N/A N/A N/A " 29,768.17 " N/A N/A N/A " 35,844.20 " N/A N/A " 28,709.81 " N/A N/A N/A N/A N/A N/A N/A " 30,575.95 " " 28,709.81 " N/A " 28,709.81 " " 43,064.72 " N/A " 51,646.08 " " 51,143.66 " N/A DRG 380.1 No Current Volume N/A " 4,478.31 " " 8,056.03 " " 5,617.59 " N/A N/A N/A " 4,643.40 " N/A N/A N/A " 5,591.17 " N/A N/A " 4,478.31 " N/A N/A N/A N/A N/A N/A N/A " 4,769.40 " " 4,478.31 " N/A " 4,478.31 " " 6,717.47 " N/A " 8,056.03 " " 7,977.66 " N/A DRG 380.2 " 54,369.91 " " 17,131.96 " " 5,637.60 " " 10,141.48 " " 7,071.81 " N/A N/A N/A " 5,845.43 " N/A N/A N/A " 7,038.54 " N/A N/A " 5,637.60 " N/A N/A N/A N/A N/A N/A N/A " 6,004.04 " " 5,637.60 " N/A " 5,637.60 " " 8,456.40 " N/A " 10,141.48 " " 10,042.82 " N/A DRG 380.3 " 104,832.15 " " 33,032.61 " " 8,176.00 " " 14,707.81 " " 10,255.97 " N/A N/A N/A " 8,477.40 " N/A N/A N/A " 10,207.74 " N/A N/A " 8,176.00 " N/A N/A N/A N/A N/A N/A N/A " 8,707.44 " " 8,176.00 " N/A " 8,176.00 " " 12,264.00 " N/A " 14,707.81 " " 14,564.73 " N/A DRG 380.4 No Current Volume N/A " 17,012.10 " " 30,603.07 " " 21,339.98 " N/A N/A N/A " 17,639.24 " N/A N/A N/A " 21,239.61 " N/A N/A " 17,012.10 " N/A N/A N/A N/A N/A N/A N/A " 18,117.89 " " 17,012.10 " N/A " 17,012.10 " " 25,518.15 " N/A " 30,603.07 " " 30,305.35 " N/A DRG 381.1 No Current Volume N/A " 3,410.77 " " 6,135.63 " " 4,278.47 " N/A N/A N/A " 3,536.51 " N/A N/A N/A " 4,258.35 " N/A N/A " 3,410.77 " N/A N/A N/A N/A N/A N/A N/A " 3,632.47 " " 3,410.77 " N/A " 3,410.77 " " 5,116.16 " N/A " 6,135.63 " " 6,075.95 " N/A DRG 381.2 No Current Volume N/A " 5,823.17 " " 10,475.30 " " 7,304.58 " N/A N/A N/A " 6,037.84 " N/A N/A N/A " 7,270.23 " N/A N/A " 5,823.17 " N/A N/A N/A N/A N/A N/A N/A " 6,201.68 " " 5,823.17 " N/A " 5,823.17 " " 8,734.76 " N/A " 10,475.30 " " 10,373.40 " N/A DRG 381.3 No Current Volume N/A " 11,710.03 " " 21,065.17 " " 14,689.06 " N/A N/A N/A " 12,141.71 " N/A N/A N/A " 14,619.97 " N/A N/A " 11,710.03 " N/A N/A N/A N/A N/A N/A N/A " 12,471.18 " " 11,710.03 " N/A " 11,710.03 " " 17,565.05 " N/A " 21,065.17 " " 20,860.25 " N/A DRG 381.4 No Current Volume N/A " 29,762.96 " " 53,540.59 " " 37,334.66 " N/A N/A N/A " 30,860.15 " N/A N/A N/A " 37,159.06 " N/A N/A " 29,762.96 " N/A N/A N/A N/A N/A N/A N/A " 31,697.55 " " 29,762.96 " N/A " 29,762.96 " " 44,644.44 " N/A " 53,540.59 " " 53,019.74 " N/A DRG 382.1 No Current Volume N/A " 5,378.08 " " 9,674.63 " " 6,746.26 " N/A N/A N/A " 5,576.34 " N/A N/A N/A " 6,714.53 " N/A N/A " 5,378.08 " N/A N/A N/A N/A N/A N/A N/A " 5,727.66 " " 5,378.08 " N/A " 5,378.08 " " 8,067.12 " N/A " 9,674.63 " " 9,580.51 " N/A DRG 382.2 No Current Volume N/A " 6,553.81 " " 11,789.65 " " 8,221.10 " N/A N/A N/A " 6,795.41 " N/A N/A N/A " 8,182.43 " N/A N/A " 6,553.81 " N/A N/A N/A N/A N/A N/A N/A " 6,979.81 " " 6,553.81 " N/A " 6,553.81 " " 9,830.72 " N/A " 11,789.65 " " 11,674.96 " N/A DRG 382.3 No Current Volume N/A " 9,414.04 " " 16,934.92 " " 11,808.97 " N/A N/A N/A " 9,761.08 " N/A N/A N/A " 11,753.43 " N/A N/A " 9,414.04 " N/A N/A N/A N/A N/A N/A N/A " 10,025.95 " " 9,414.04 " N/A " 9,414.04 " " 14,121.06 " N/A " 16,934.92 " " 16,770.17 " N/A DRG 382.4 No Current Volume N/A " 15,368.00 " " 27,645.50 " " 19,277.62 " N/A N/A N/A " 15,934.53 " N/A N/A N/A " 19,186.95 " N/A N/A " 15,368.00 " N/A N/A N/A N/A N/A N/A N/A " 16,366.92 " " 15,368.00 " N/A " 15,368.00 " " 23,052.00 " N/A " 27,645.50 " " 27,376.56 " N/A DRG 383.1 " 26,872.16 " " 8,467.42 " " 3,458.71 " " 6,221.87 " " 4,338.61 " N/A N/A N/A " 3,586.21 " N/A N/A N/A " 4,318.20 " N/A N/A " 3,458.71 " N/A N/A N/A N/A N/A N/A N/A " 3,683.53 " " 3,458.71 " N/A " 3,458.71 " " 5,188.07 " N/A " 6,221.87 " " 6,161.35 " N/A DRG 383.2 " 48,641.15 " " 15,326.83 " " 4,801.52 " " 8,637.45 " " 6,023.03 " N/A N/A N/A " 4,978.52 " N/A N/A N/A " 5,994.70 " N/A N/A " 4,801.52 " N/A N/A N/A N/A N/A N/A N/A " 5,113.62 " " 4,801.52 " N/A " 4,801.52 " " 7,202.28 " N/A " 8,637.45 " " 8,553.43 " N/A DRG 383.3 " 60,094.15 " " 18,935.67 " " 7,359.08 " " 13,238.25 " " 9,231.23 " N/A N/A N/A " 7,630.37 " N/A N/A N/A " 9,187.81 " N/A N/A " 7,359.08 " N/A N/A N/A N/A N/A N/A N/A " 7,837.42 " " 7,359.08 " N/A " 7,359.08 " " 11,038.62 " N/A " 13,238.25 " " 13,109.47 " N/A DRG 383.4 " 136,208.35 " " 42,919.25 " " 14,977.69 " " 26,943.37 " " 18,788.01 " N/A N/A N/A " 15,529.83 " N/A N/A N/A " 18,699.65 " N/A N/A " 14,977.69 " N/A N/A N/A N/A N/A N/A N/A " 15,951.24 " " 14,977.69 " N/A " 14,977.69 " " 22,466.54 " N/A " 26,943.37 " " 26,681.26 " N/A DRG 384.1 " 12,847.95 " " 4,048.39 " " 4,358.48 " " 7,840.47 " " 5,467.28 " N/A N/A N/A " 4,519.15 " N/A N/A N/A " 5,441.56 " N/A N/A " 4,358.48 " N/A N/A N/A N/A N/A N/A N/A " 4,641.78 " " 4,358.48 " N/A " 4,358.48 " " 6,537.72 " N/A " 7,840.47 " " 7,764.20 " N/A DRG 384.2 " 23,696.88 " " 7,466.89 " " 5,602.68 " " 10,078.66 " " 7,028.00 " N/A N/A N/A " 5,809.22 " N/A N/A N/A " 6,994.95 " N/A N/A " 5,602.68 " N/A N/A N/A N/A N/A N/A N/A " 5,966.85 " " 5,602.68 " N/A " 5,602.68 " " 8,404.02 " N/A " 10,078.66 " " 9,980.61 " N/A DRG 384.3 No Current Volume N/A " 8,568.36 " " 15,413.62 " " 10,748.15 " N/A N/A N/A " 8,884.23 " N/A N/A N/A " 10,697.60 " N/A N/A " 8,568.36 " N/A N/A N/A N/A N/A N/A N/A " 9,125.30 " " 8,568.36 " N/A " 8,568.36 " " 12,852.54 " N/A " 15,413.62 " " 15,263.68 " N/A DRG 384.4 " 420,029.92 " " 132,351.43 " " 15,871.98 " " 28,552.10 " " 19,909.81 " N/A N/A N/A " 16,457.09 " N/A N/A N/A " 19,816.17 " N/A N/A " 15,871.98 " N/A N/A N/A N/A N/A N/A N/A " 16,903.66 " " 15,871.98 " N/A " 15,871.98 " " 23,807.97 " N/A " 28,552.10 " " 28,274.35 " N/A DRG 385.1 No Current Volume N/A " 3,454.60 " " 6,214.48 " " 4,333.45 " N/A N/A N/A " 3,581.95 " N/A N/A N/A " 4,313.07 " N/A N/A " 3,454.60 " N/A N/A N/A N/A N/A N/A N/A " 3,679.15 " " 3,454.60 " N/A " 3,454.60 " " 5,181.90 " N/A " 6,214.48 " " 6,154.02 " N/A DRG 385.2 " 11,206.59 " " 3,531.20 " " 4,805.62 " " 8,644.83 " " 6,028.17 " N/A N/A N/A " 4,982.78 " N/A N/A N/A " 5,999.82 " N/A N/A " 4,805.62 " N/A N/A N/A N/A N/A N/A N/A " 5,117.99 " " 4,805.62 " N/A " 4,805.62 " " 7,208.43 " N/A " 8,644.83 " " 8,560.73 " N/A DRG 385.3 No Current Volume N/A " 7,593.27 " " 13,659.53 " " 9,525.00 " N/A N/A N/A " 7,873.19 " N/A N/A N/A " 9,480.20 " N/A N/A " 7,593.27 " N/A N/A N/A N/A N/A N/A N/A " 8,086.83 " " 7,593.27 " N/A " 7,593.27 " " 11,389.91 " N/A " 13,659.53 " " 13,526.65 " N/A DRG 385.4 " 40,010.00 " " 12,607.15 " " 16,650.55 " " 29,952.67 " " 20,886.45 " N/A N/A N/A " 17,264.36 " N/A N/A N/A " 20,788.21 " N/A N/A " 16,650.55 " N/A N/A N/A N/A N/A N/A N/A " 17,732.84 " " 16,650.55 " N/A " 16,650.55 " " 24,975.83 " N/A " 29,952.67 " " 29,661.29 " N/A DRG 401.1 No Current Volume N/A " 11,067.73 " " 19,909.74 " " 13,883.36 " N/A N/A N/A " 11,475.73 " N/A N/A N/A " 13,818.06 " N/A N/A " 11,067.73 " N/A N/A N/A N/A N/A N/A N/A " 11,787.13 " " 11,067.73 " N/A " 11,067.73 " " 16,601.60 " N/A " 19,909.74 " " 19,716.05 " N/A DRG 401.2 No Current Volume N/A " 19,712.10 " " 35,460.10 " " 24,726.86 " N/A N/A N/A " 20,438.77 " N/A N/A N/A " 24,610.56 " N/A N/A " 19,712.10 " N/A N/A N/A N/A N/A N/A N/A " 20,993.39 " " 19,712.10 " N/A " 19,712.10 " " 29,568.15 " N/A " 35,460.10 " " 35,115.13 " N/A DRG 401.3 No Current Volume N/A " 23,843.92 " " 42,892.83 " " 29,909.81 " N/A N/A N/A " 24,722.91 " N/A N/A N/A " 29,769.13 " N/A N/A " 23,843.92 " N/A N/A N/A N/A N/A N/A N/A " 25,393.77 " " 23,843.92 " N/A " 23,843.92 " " 35,765.88 " N/A " 42,892.83 " " 42,475.56 " N/A DRG 401.4 No Current Volume N/A " 35,264.30 " " 63,436.95 " " 44,235.54 " N/A N/A N/A " 36,564.29 " N/A N/A N/A " 44,027.48 " N/A N/A " 35,264.30 " N/A N/A N/A N/A N/A N/A N/A " 37,556.48 " " 35,264.30 " N/A " 35,264.30 " " 52,896.45 " N/A " 63,436.95 " " 62,819.82 " N/A DRG 403.1 No Current Volume N/A " 8,040.42 " " 14,463.91 " " 10,085.90 " N/A N/A N/A " 8,336.82 " N/A N/A N/A " 10,038.46 " N/A N/A " 8,040.42 " N/A N/A N/A N/A N/A N/A N/A " 8,563.05 " " 8,040.42 " N/A " 8,040.42 " " 12,060.63 " N/A " 14,463.91 " " 14,323.20 " N/A DRG 403.2 " 44,604.01 " " 14,054.72 " " 9,811.88 " " 17,650.59 " " 12,308.02 " N/A N/A N/A " 10,173.59 " N/A N/A N/A " 12,250.13 " N/A N/A " 9,811.88 " N/A N/A N/A N/A N/A N/A N/A " 10,449.65 " " 9,811.88 " N/A " 9,811.88 " " 14,717.82 " N/A " 17,650.59 " " 17,478.88 " N/A DRG 403.3 No Current Volume N/A " 15,626.15 " " 28,109.88 " " 19,601.44 " N/A N/A N/A " 16,202.20 " N/A N/A N/A " 19,509.25 " N/A N/A " 15,626.15 " N/A N/A N/A N/A N/A N/A N/A " 16,641.85 " " 15,626.15 " N/A " 15,626.15 " " 23,439.23 " N/A " 28,109.88 " " 27,836.42 " N/A DRG 403.4 No Current Volume N/A " 48,169.92 " " 86,652.87 " " 60,424.35 " N/A N/A N/A " 49,945.66 " N/A N/A N/A " 60,140.15 " N/A N/A " 48,169.92 " N/A N/A N/A N/A N/A N/A N/A " 51,300.96 " " 48,169.92 " N/A " 48,169.92 " " 72,254.88 " N/A " 86,652.87 " " 85,809.90 " N/A DRG 404.1 No Current Volume N/A " 7,376.20 " " 13,269.05 " " 9,252.71 " N/A N/A N/A " 7,648.12 " N/A N/A N/A " 9,209.19 " N/A N/A " 7,376.20 " N/A N/A N/A N/A N/A N/A N/A " 7,855.65 " " 7,376.20 " N/A " 7,376.20 " " 11,064.30 " N/A " 13,269.05 " " 13,139.96 " N/A DRG 404.2 No Current Volume N/A " 11,243.71 " " 20,226.31 " " 14,104.11 " N/A N/A N/A " 11,658.20 " N/A N/A N/A " 14,037.77 " N/A N/A " 11,243.71 " N/A N/A N/A N/A N/A N/A N/A " 11,974.55 " " 11,243.71 " N/A " 11,243.71 " " 16,865.57 " N/A " 20,226.31 " " 20,029.54 " N/A DRG 404.3 No Current Volume N/A " 18,359.02 " " 33,026.04 " " 23,029.55 " N/A N/A N/A " 19,035.81 " N/A N/A N/A " 22,921.24 " N/A N/A " 18,359.02 " N/A N/A N/A N/A N/A N/A N/A " 19,552.36 " " 18,359.02 " N/A " 18,359.02 " " 27,538.53 " N/A " 33,026.04 " " 32,704.76 " N/A DRG 404.4 No Current Volume N/A " 42,619.28 " " 76,667.82 " " 53,461.62 " N/A N/A N/A " 44,190.40 " N/A N/A N/A " 53,210.17 " N/A N/A " 42,619.28 " N/A N/A N/A N/A N/A N/A N/A " 45,389.53 " " 42,619.28 " N/A " 42,619.28 " " 63,928.92 " N/A " 76,667.82 " " 75,921.99 " N/A DRG 405.1 No Current Volume N/A " 11,167.70 " " 20,089.58 " " 14,008.76 " N/A N/A N/A " 11,579.39 " N/A N/A N/A " 13,942.87 " N/A N/A " 11,167.70 " N/A N/A N/A N/A N/A N/A N/A " 11,893.60 " " 11,167.70 " N/A " 11,167.70 " " 16,751.55 " N/A " 20,089.58 " " 19,894.14 " N/A DRG 405.2 " 71,318.51 " " 22,472.46 " " 14,030.67 " " 25,239.77 " " 17,600.07 " N/A N/A N/A " 14,547.90 " N/A N/A N/A " 17,517.29 " N/A N/A " 14,030.67 " N/A N/A N/A N/A N/A N/A N/A " 14,942.66 " " 14,030.67 " N/A " 14,030.67 " " 21,046.01 " N/A " 25,239.77 " " 24,994.24 " N/A DRG 405.3 No Current Volume N/A " 20,700.89 " " 37,238.83 " " 25,967.20 " N/A N/A N/A " 21,464.01 " N/A N/A N/A " 25,845.06 " N/A N/A " 20,700.89 " N/A N/A N/A N/A N/A N/A N/A " 22,046.45 " " 20,700.89 " N/A " 20,700.89 " " 31,051.34 " N/A " 37,238.83 " " 36,876.57 " N/A DRG 405.4 No Current Volume N/A " 44,169.57 " " 79,456.64 " " 55,406.31 " N/A N/A N/A " 45,797.84 " N/A N/A N/A " 55,145.71 " N/A N/A " 44,169.57 " N/A N/A N/A N/A N/A N/A N/A " 47,040.59 " " 44,169.57 " N/A " 44,169.57 " " 66,254.36 " N/A " 79,456.64 " " 78,683.67 " N/A DRG 420.1 " 26,164.77 " " 8,244.52 " " 3,638.11 " " 6,544.60 " " 4,563.65 " N/A N/A N/A " 3,772.23 " N/A N/A N/A " 4,542.18 " N/A N/A " 3,638.11 " N/A N/A N/A N/A N/A N/A N/A " 3,874.59 " " 3,638.11 " N/A " 3,638.11 " " 5,457.17 " N/A " 6,544.60 " " 6,480.93 " N/A DRG 420.2 " 45,118.88 " " 14,216.96 " " 4,387.24 " " 7,892.21 " " 5,503.35 " N/A N/A N/A " 4,548.97 " N/A N/A N/A " 5,477.47 " N/A N/A " 4,387.24 " N/A N/A N/A N/A N/A N/A N/A " 4,672.41 " " 4,387.24 " N/A " 4,387.24 " " 6,580.86 " N/A " 7,892.21 " " 7,815.43 " N/A DRG 420.3 " 41,234.60 " " 12,993.02 " " 6,645.57 " " 11,954.72 " " 8,336.20 " N/A N/A N/A " 6,890.55 " N/A N/A N/A " 8,296.99 " N/A N/A " 6,645.57 " N/A N/A N/A N/A N/A N/A N/A " 7,077.53 " " 6,645.57 " N/A " 6,645.57 " " 9,968.36 " N/A " 11,954.72 " " 11,838.42 " N/A DRG 420.4 " 61,650.78 " " 19,426.16 " " 14,363.46 " " 25,838.43 " " 18,017.52 " N/A N/A N/A " 14,892.96 " N/A N/A N/A " 17,932.78 " N/A N/A " 14,363.46 " N/A N/A N/A N/A N/A N/A N/A " 15,297.08 " " 14,363.46 " N/A " 14,363.46 " " 21,545.19 " N/A " 25,838.43 " " 25,587.07 " N/A DRG 421.1 No Current Volume N/A " 3,827.79 " " 6,885.81 " " 4,801.58 " N/A N/A N/A " 3,968.90 " N/A N/A N/A " 4,779.00 " N/A N/A " 3,827.79 " N/A N/A N/A N/A N/A N/A N/A " 4,076.60 " " 3,827.79 " N/A " 3,827.79 " " 5,741.69 " N/A " 6,885.81 " " 6,818.83 " N/A DRG 421.2 No Current Volume N/A " 5,462.99 " " 9,827.37 " " 6,852.77 " N/A N/A N/A " 5,664.38 " N/A N/A N/A " 6,820.54 " N/A N/A " 5,462.99 " N/A N/A N/A N/A N/A N/A N/A " 5,818.08 " " 5,462.99 " N/A " 5,462.99 " " 8,194.49 " N/A " 9,827.37 " " 9,731.77 " N/A DRG 421.3 " 38,643.45 " " 12,176.55 " " 8,842.95 " " 15,907.58 " " 11,092.60 " N/A N/A N/A " 9,168.94 " N/A N/A N/A " 11,040.42 " N/A N/A " 8,842.95 " N/A N/A N/A N/A N/A N/A N/A " 9,417.74 " " 8,842.95 " N/A " 8,842.95 " " 13,264.43 " N/A " 15,907.58 " " 15,752.83 " N/A DRG 421.4 No Current Volume N/A " 19,718.26 " " 35,471.18 " " 24,734.59 " N/A N/A N/A " 20,445.16 " N/A N/A N/A " 24,618.25 " N/A N/A " 19,718.26 " N/A N/A N/A N/A N/A N/A N/A " 20,999.95 " " 19,718.26 " N/A " 19,718.26 " " 29,577.39 " N/A " 35,471.18 " " 35,126.11 " N/A DRG 422.1 No Current Volume N/A " 3,140.98 " " 5,650.31 " " 3,940.05 " N/A N/A N/A " 3,256.77 " N/A N/A N/A " 3,921.51 " N/A N/A " 3,140.98 " N/A N/A N/A N/A N/A N/A N/A " 3,345.14 " " 3,140.98 " N/A " 3,140.98 " " 4,711.47 " N/A " 5,650.31 " " 5,595.34 " N/A DRG 422.2 " 7,271.74 " " 2,291.33 " " 4,167.43 " " 7,496.79 " " 5,227.62 " N/A N/A N/A " 4,321.06 " N/A N/A N/A " 5,203.04 " N/A N/A " 4,167.43 " N/A N/A N/A N/A N/A N/A N/A " 4,438.31 " " 4,167.43 " N/A " 4,167.43 " " 6,251.15 " N/A " 7,496.79 " " 7,423.86 " N/A DRG 422.3 No Current Volume N/A " 6,254.57 " " 11,251.35 " " 7,845.73 " N/A N/A N/A " 6,485.14 " N/A N/A N/A " 7,808.83 " N/A N/A " 6,254.57 " N/A N/A N/A N/A N/A N/A N/A " 6,661.12 " " 6,254.57 " N/A " 6,254.57 " " 9,381.86 " N/A " 11,251.35 " " 11,141.89 " N/A DRG 422.4 No Current Volume N/A " 12,517.36 " " 22,517.48 " " 15,701.78 " N/A N/A N/A " 12,978.80 " N/A N/A N/A " 15,627.92 " N/A N/A " 12,517.36 " N/A N/A N/A N/A N/A N/A N/A " 13,330.99 " " 12,517.36 " N/A " 12,517.36 " " 18,776.04 " N/A " 22,517.48 " " 22,298.43 " N/A DRG 423.1 No Current Volume N/A " 8,740.92 " " 15,724.04 " " 10,964.61 " N/A N/A N/A " 9,063.15 " N/A N/A N/A " 10,913.04 " N/A N/A " 8,740.92 " N/A N/A N/A N/A N/A N/A N/A " 9,309.08 " " 8,740.92 " N/A " 8,740.92 " " 13,111.38 " N/A " 15,724.04 " " 15,571.07 " N/A DRG 423.2 No Current Volume N/A " 10,002.93 " " 17,994.27 " " 12,547.68 " N/A N/A N/A " 10,371.68 " N/A N/A N/A " 12,488.66 " N/A N/A " 10,002.93 " N/A N/A N/A N/A N/A N/A N/A " 10,653.12 " " 10,002.93 " N/A " 10,002.93 " " 15,004.40 " N/A " 17,994.27 " " 17,819.22 " N/A DRG 423.3 No Current Volume N/A " 14,789.38 " " 26,604.62 " " 18,551.80 " N/A N/A N/A " 15,334.58 " N/A N/A N/A " 18,464.54 " N/A N/A " 14,789.38 " N/A N/A N/A N/A N/A N/A N/A " 15,750.69 " " 14,789.38 " N/A " 14,789.38 " " 22,184.07 " N/A " 26,604.62 " " 26,345.80 " N/A DRG 423.4 No Current Volume N/A " 50,969.20 " " 91,688.49 " " 63,935.76 " N/A N/A N/A " 52,848.14 " N/A N/A N/A " 63,635.05 " N/A N/A " 50,969.20 " N/A N/A N/A N/A N/A N/A N/A " 54,282.20 " " 50,969.20 " N/A " 50,969.20 " " 76,453.80 " N/A " 91,688.49 " " 90,796.53 " N/A DRG 424.1 " 36,618.39 " " 11,538.45 " " 4,480.37 " " 8,059.74 " " 5,620.18 " N/A N/A N/A " 4,645.53 " N/A N/A N/A " 5,593.74 " N/A N/A " 4,480.37 " N/A N/A N/A N/A N/A N/A N/A " 4,771.59 " " 4,480.37 " N/A " 4,480.37 " " 6,720.56 " N/A " 8,059.74 " " 7,981.33 " N/A DRG 424.2 No Current Volume N/A " 5,989.57 " " 10,774.64 " " 7,513.32 " N/A N/A N/A " 6,210.37 " N/A N/A N/A " 7,477.98 " N/A N/A " 5,989.57 " N/A N/A N/A N/A N/A N/A N/A " 6,378.89 " " 5,989.57 " N/A " 5,989.57 " " 8,984.36 " N/A " 10,774.64 " " 10,669.82 " N/A DRG 424.3 " 150,966.98 " " 47,569.70 " " 9,461.97 " " 17,021.14 " " 11,869.10 " N/A N/A N/A " 9,810.78 " N/A N/A N/A " 11,813.27 " N/A N/A " 9,461.97 " N/A N/A N/A N/A N/A N/A N/A " 10,077.00 " " 9,461.97 " N/A " 9,461.97 " " 14,192.96 " N/A " 17,021.14 " " 16,855.55 " N/A DRG 424.4 No Current Volume N/A " 20,211.29 " " 36,358.09 " " 25,353.04 " N/A N/A N/A " 20,956.36 " N/A N/A N/A " 25,233.80 " N/A N/A " 20,211.29 " N/A N/A N/A N/A N/A N/A N/A " 21,525.02 " " 20,211.29 " N/A " 20,211.29 " " 30,316.94 " N/A " 36,358.09 " " 36,004.39 " N/A DRG 425.1 No Current Volume N/A " 3,621.00 " " 6,513.82 " " 4,542.18 " N/A N/A N/A " 3,754.48 " N/A N/A N/A " 4,520.82 " N/A N/A " 3,621.00 " N/A N/A N/A N/A N/A N/A N/A " 3,856.37 " " 3,621.00 " N/A " 3,621.00 " " 5,431.50 " N/A " 6,513.82 " " 6,450.45 " N/A DRG 425.2 " 10,507.81 " " 3,311.01 " " 4,654.29 " " 8,372.60 " " 5,838.34 " N/A N/A N/A " 4,825.87 " N/A N/A N/A " 5,810.88 " N/A N/A " 4,654.29 " N/A N/A N/A N/A N/A N/A N/A " 4,956.82 " " 4,654.29 " N/A " 4,654.29 " " 6,981.44 " N/A " 8,372.60 " " 8,291.15 " N/A DRG 425.3 " 45,973.94 " " 14,486.39 " " 6,488.07 " " 11,671.39 " " 8,138.64 " N/A N/A N/A " 6,727.25 " N/A N/A N/A " 8,100.36 " N/A N/A " 6,488.07 " N/A N/A N/A N/A N/A N/A N/A " 6,909.79 " " 6,488.07 " N/A " 6,488.07 " " 9,732.11 " N/A " 11,671.39 " " 11,557.85 " N/A DRG 425.4 " 42,710.97 " " 13,458.23 " " 13,297.30 " " 23,920.51 " " 16,680.13 " N/A N/A N/A " 13,787.49 " N/A N/A N/A " 16,601.68 " N/A N/A " 13,297.30 " N/A N/A N/A N/A N/A N/A N/A " 14,161.62 " " 13,297.30 " N/A " 13,297.30 " " 19,945.95 " N/A " 23,920.51 " " 23,687.81 " N/A DRG 426.1 " 11,302.39 " " 3,561.38 " " 3,906.54 " " 7,027.47 " " 4,900.36 " N/A N/A N/A " 4,050.55 " N/A N/A N/A " 4,877.32 " N/A N/A " 3,906.54 " N/A N/A N/A N/A N/A N/A N/A " 4,160.47 " " 3,906.54 " N/A " 3,906.54 " " 5,859.81 " N/A " 7,027.47 " " 6,959.11 " N/A DRG 426.2 " 56,145.57 " " 17,691.47 " " 5,053.51 " " 9,090.76 " " 6,339.12 " N/A N/A N/A " 5,239.80 " N/A N/A N/A " 6,309.31 " N/A N/A " 5,053.51 " N/A N/A N/A N/A N/A N/A N/A " 5,381.99 " " 5,053.51 " N/A " 5,053.51 " " 7,580.27 " N/A " 9,090.76 " " 9,002.32 " N/A DRG 426.3 No Current Volume N/A " 7,532.33 " " 13,549.91 " " 9,448.55 " N/A N/A N/A " 7,810.00 " N/A N/A N/A " 9,404.11 " N/A N/A " 7,532.33 " N/A N/A N/A N/A N/A N/A N/A " 8,021.93 " " 7,532.33 " N/A " 7,532.33 " " 11,298.50 " N/A " 13,549.91 " " 13,418.09 " N/A DRG 426.4 " 33,708.26 " " 10,621.47 " " 15,160.52 " " 27,272.26 " " 19,017.36 " N/A N/A N/A " 15,719.40 " N/A N/A N/A " 18,927.91 " N/A N/A " 15,160.52 " N/A N/A N/A N/A N/A N/A N/A " 16,145.95 " " 15,160.52 " N/A " 15,160.52 " " 22,740.78 " N/A " 27,272.26 " " 27,006.95 " N/A DRG 427.1 No Current Volume N/A " 3,848.33 " " 6,922.76 " " 4,827.35 " N/A N/A N/A " 3,990.20 " N/A N/A N/A " 4,804.64 " N/A N/A " 3,848.33 " N/A N/A N/A N/A N/A N/A N/A " 4,098.47 " " 3,848.33 " N/A " 3,848.33 " " 5,772.50 " N/A " 6,922.76 " " 6,855.42 " N/A DRG 427.2 No Current Volume N/A " 5,438.34 " " 9,783.03 " " 6,821.85 " N/A N/A N/A " 5,638.82 " N/A N/A N/A " 6,789.77 " N/A N/A " 5,438.34 " N/A N/A N/A N/A N/A N/A N/A " 5,791.83 " " 5,438.34 " N/A " 5,438.34 " " 8,157.51 " N/A " 9,783.03 " " 9,687.86 " N/A DRG 427.3 No Current Volume N/A " 8,512.21 " " 15,312.61 " " 10,677.72 " N/A N/A N/A " 8,826.01 " N/A N/A N/A " 10,627.49 " N/A N/A " 8,512.21 " N/A N/A N/A N/A N/A N/A N/A " 9,065.50 " " 8,512.21 " N/A " 8,512.21 " " 12,768.32 " N/A " 15,312.61 " " 15,163.65 " N/A DRG 427.4 No Current Volume N/A " 17,068.94 " " 30,705.32 " " 21,411.28 " N/A N/A N/A " 17,698.17 " N/A N/A N/A " 21,310.57 " N/A N/A " 17,068.94 " N/A N/A N/A N/A N/A N/A N/A " 18,178.42 " " 17,068.94 " N/A " 17,068.94 " " 25,603.41 " N/A " 30,705.32 " " 30,406.61 " N/A DRG 441.1 No Current Volume N/A " 11,065.67 " " 19,906.03 " " 13,880.78 " N/A N/A N/A " 11,473.60 " N/A N/A N/A " 13,815.49 " N/A N/A " 11,065.67 " N/A N/A N/A N/A N/A N/A N/A " 11,784.94 " " 11,065.67 " N/A " 11,065.67 " " 16,598.51 " N/A " 19,906.03 " " 19,712.38 " N/A DRG 441.2 No Current Volume N/A " 18,075.53 " " 32,516.07 " " 22,673.94 " N/A N/A N/A " 18,741.87 " N/A N/A N/A " 22,567.30 " N/A N/A " 18,075.53 " N/A N/A N/A N/A N/A N/A N/A " 19,250.44 " " 18,075.53 " N/A " 18,075.53 " " 27,113.30 " N/A " 32,516.07 " " 32,199.75 " N/A DRG 441.3 No Current Volume N/A " 24,528.00 " " 44,123.42 " " 30,767.92 " N/A N/A N/A " 25,432.20 " N/A N/A N/A " 30,623.21 " N/A N/A " 24,528.00 " N/A N/A N/A N/A N/A N/A N/A " 26,122.32 " " 24,528.00 " N/A " 24,528.00 " " 36,792.00 " N/A " 44,123.42 " " 43,694.18 " N/A DRG 441.4 No Current Volume N/A " 52,563.32 " " 94,556.16 " " 65,935.43 " N/A N/A N/A " 54,501.02 " N/A N/A N/A " 65,625.31 " N/A N/A " 52,563.32 " N/A N/A N/A N/A N/A N/A N/A " 55,979.94 " " 52,563.32 " N/A " 52,563.32 " " 78,844.98 " N/A " 94,556.16 " " 93,636.30 " N/A DRG 442.1 No Current Volume N/A " 10,949.26 " " 19,696.62 " " 13,734.75 " N/A N/A N/A " 11,352.90 " N/A N/A N/A " 13,670.15 " N/A N/A " 10,949.26 " N/A N/A N/A N/A N/A N/A N/A " 11,660.96 " " 10,949.26 " N/A " 10,949.26 " " 16,423.89 " N/A " 19,696.62 " " 19,505.01 " N/A DRG 442.2 No Current Volume N/A " 12,854.26 " " 23,123.53 " " 16,124.38 " N/A N/A N/A " 13,328.12 " N/A N/A N/A " 16,048.54 " N/A N/A " 12,854.26 " N/A N/A N/A N/A N/A N/A N/A " 13,689.79 " " 12,854.26 " N/A " 12,854.26 " " 19,281.39 " N/A " 23,123.53 " " 22,898.58 " N/A DRG 442.3 No Current Volume N/A " 20,095.56 " " 36,149.90 " " 25,207.87 " N/A N/A N/A " 20,836.37 " N/A N/A N/A " 25,089.31 " N/A N/A " 20,095.56 " N/A N/A N/A N/A N/A N/A N/A " 21,401.77 " " 20,095.56 " N/A " 20,095.56 " " 30,143.34 " N/A " 36,149.90 " " 35,798.23 " N/A DRG 442.4 No Current Volume N/A " 35,449.19 " " 63,769.55 " " 44,467.46 " N/A N/A N/A " 36,755.99 " N/A N/A N/A " 44,258.31 " N/A N/A " 35,449.19 " N/A N/A N/A N/A N/A N/A N/A " 37,753.39 " " 35,449.19 " N/A " 35,449.19 " " 53,173.79 " N/A " 63,769.55 " " 63,149.19 " N/A DRG 443.1 No Current Volume N/A " 8,959.36 " " 16,116.99 " " 11,238.62 " N/A N/A N/A " 9,289.64 " N/A N/A N/A " 11,185.76 " N/A N/A " 8,959.36 " N/A N/A N/A N/A N/A N/A N/A " 9,541.72 " " 8,959.36 " N/A " 8,959.36 " " 13,439.04 " N/A " 16,116.99 " " 15,960.20 " N/A DRG 443.2 No Current Volume N/A " 11,084.85 " " 19,940.54 " " 13,904.84 " N/A N/A N/A " 11,493.48 " N/A N/A N/A " 13,839.44 " N/A N/A " 11,084.85 " N/A N/A N/A N/A N/A N/A N/A " 11,805.37 " " 11,084.85 " N/A " 11,084.85 " " 16,627.28 " N/A " 19,940.54 " " 19,746.55 " N/A DRG 443.3 No Current Volume N/A " 17,630.44 " " 31,715.40 " " 22,115.62 " N/A N/A N/A " 18,280.37 " N/A N/A N/A " 22,011.60 " N/A N/A " 17,630.44 " N/A N/A N/A N/A N/A N/A N/A " 18,776.42 " " 17,630.44 " N/A " 17,630.44 " " 26,445.66 " N/A " 31,715.40 " " 31,406.87 " N/A DRG 443.4 No Current Volume N/A " 36,207.90 " " 65,134.39 " " 45,419.19 " N/A N/A N/A " 37,542.67 " N/A N/A N/A " 45,205.56 " N/A N/A " 36,207.90 " N/A N/A N/A N/A N/A N/A N/A " 38,561.41 " " 36,207.90 " N/A " 36,207.90 " " 54,311.85 " N/A " 65,134.39 " " 64,500.75 " N/A DRG 444.1 No Current Volume N/A " 8,862.81 " " 15,943.31 " " 11,117.51 " N/A N/A N/A " 9,189.53 " N/A N/A N/A " 11,065.22 " N/A N/A " 8,862.81 " N/A N/A N/A N/A N/A N/A N/A " 9,438.89 " " 8,862.81 " N/A " 8,862.81 " " 13,294.22 " N/A " 15,943.31 " " 15,788.21 " N/A DRG 444.2 No Current Volume N/A " 12,589.26 " " 22,646.82 " " 15,791.97 " N/A N/A N/A " 13,053.35 " N/A N/A N/A " 15,717.69 " N/A N/A " 12,589.26 " N/A N/A N/A N/A N/A N/A N/A " 13,407.56 " " 12,589.26 " N/A " 12,589.26 " " 18,883.89 " N/A " 22,646.82 " " 22,426.51 " N/A DRG 444.3 No Current Volume N/A " 19,310.15 " " 34,737.03 " " 24,222.65 " N/A N/A N/A " 20,022.00 " N/A N/A N/A " 24,108.72 " N/A N/A " 19,310.15 " N/A N/A N/A N/A N/A N/A N/A " 20,565.31 " " 19,310.15 " N/A " 19,310.15 " " 28,965.23 " N/A " 34,737.03 " " 34,399.10 " N/A DRG 444.4 No Current Volume N/A " 41,581.87 " " 74,801.63 " " 52,160.30 " N/A N/A N/A " 43,114.75 " N/A N/A N/A " 51,914.96 " N/A N/A " 41,581.87 " N/A N/A N/A N/A N/A N/A N/A " 44,284.69 " " 41,581.87 " N/A " 41,581.87 " " 62,372.81 " N/A " 74,801.63 " " 74,073.94 " N/A DRG 445.1 No Current Volume N/A " 7,717.21 " " 13,882.49 " " 9,680.47 " N/A N/A N/A " 8,001.70 " N/A N/A N/A " 9,634.94 " N/A N/A " 7,717.21 " N/A N/A N/A N/A N/A N/A N/A " 8,218.83 " " 7,717.21 " N/A " 7,717.21 " " 11,575.82 " N/A " 13,882.49 " " 13,747.44 " N/A DRG 445.2 No Current Volume N/A " 10,678.79 " " 19,210.08 " " 13,395.47 " N/A N/A N/A " 11,072.45 " N/A N/A N/A " 13,332.47 " N/A N/A " 10,678.79 " N/A N/A N/A N/A N/A N/A N/A " 11,372.91 " " 10,678.79 " N/A " 10,678.79 " " 16,018.19 " N/A " 19,210.08 " " 19,023.20 " N/A DRG 445.3 No Current Volume N/A " 15,268.03 " " 27,465.66 " " 19,152.22 " N/A N/A N/A " 15,830.87 " N/A N/A N/A " 19,062.14 " N/A N/A " 15,268.03 " N/A N/A N/A N/A N/A N/A N/A " 16,260.45 " " 15,268.03 " N/A " 15,268.03 " " 22,902.05 " N/A " 27,465.66 " " 27,198.47 " N/A DRG 445.4 No Current Volume N/A " 30,269.00 " " 54,450.90 " " 37,969.43 " N/A N/A N/A " 31,384.84 " N/A N/A N/A " 37,790.85 " N/A N/A " 30,269.00 " N/A N/A N/A N/A N/A N/A N/A " 32,236.49 " " 30,269.00 " N/A " 30,269.00 " " 45,403.50 " N/A " 54,450.90 " " 53,921.20 " N/A DRG 446.1 No Current Volume N/A " 6,470.27 " " 11,639.37 " " 8,116.31 " N/A N/A N/A " 6,708.79 " N/A N/A N/A " 8,078.13 " N/A N/A " 6,470.27 " N/A N/A N/A N/A N/A N/A N/A " 6,890.84 " " 6,470.27 " N/A " 6,470.27 " " 9,705.41 " N/A " 11,639.37 " " 11,526.14 " N/A DRG 446.2 No Current Volume N/A " 8,506.74 " " 15,302.77 " " 10,670.85 " N/A N/A N/A " 8,820.33 " N/A N/A N/A " 10,620.66 " N/A N/A " 8,506.74 " N/A N/A N/A N/A N/A N/A N/A " 9,059.68 " " 8,506.74 " N/A " 8,506.74 " " 12,760.11 " N/A " 15,302.77 " " 15,153.91 " N/A DRG 446.3 No Current Volume N/A " 13,836.88 " " 24,891.16 " " 17,356.98 " N/A N/A N/A " 14,346.97 " N/A N/A N/A " 17,275.34 " N/A N/A " 13,836.88 " N/A N/A N/A N/A N/A N/A N/A " 14,736.28 " " 13,836.88 " N/A " 13,836.88 " " 20,755.32 " N/A " 24,891.16 " " 24,649.02 " N/A DRG 446.4 No Current Volume N/A " 26,043.36 " " 46,849.40 " " 32,668.79 " N/A N/A N/A " 27,003.43 " N/A N/A N/A " 32,515.13 " N/A N/A " 26,043.36 " N/A N/A N/A N/A N/A N/A N/A " 27,736.18 " " 26,043.36 " N/A " 26,043.36 " " 39,065.04 " N/A " 46,849.40 " " 46,393.64 " N/A DRG 447.1 No Current Volume N/A " 10,713.02 " " 19,271.65 " " 13,438.41 " N/A N/A N/A " 11,107.95 " N/A N/A N/A " 13,375.21 " N/A N/A " 10,713.02 " N/A N/A N/A N/A N/A N/A N/A " 11,409.37 " " 10,713.02 " N/A " 10,713.02 " " 16,069.53 " N/A " 19,271.65 " " 19,084.17 " N/A DRG 447.2 No Current Volume N/A " 12,648.15 " " 22,752.76 " " 15,865.84 " N/A N/A N/A " 13,114.41 " N/A N/A N/A " 15,791.22 " N/A N/A " 12,648.15 " N/A N/A N/A N/A N/A N/A N/A " 13,470.28 " " 12,648.15 " N/A " 12,648.15 " " 18,972.23 " N/A " 22,752.76 " " 22,531.41 " N/A DRG 447.3 No Current Volume N/A " 17,653.04 " " 31,756.05 " " 22,143.97 " N/A N/A N/A " 18,303.80 " N/A N/A N/A " 22,039.82 " N/A N/A " 17,653.04 " N/A N/A N/A N/A N/A N/A N/A " 18,800.49 " " 17,653.04 " N/A " 17,653.04 " " 26,479.56 " N/A " 31,756.05 " " 31,447.13 " N/A DRG 447.4 No Current Volume N/A " 40,843.70 " " 73,473.73 " " 51,234.34 " N/A N/A N/A " 42,349.37 " N/A N/A N/A " 50,993.36 " N/A N/A " 40,843.70 " N/A N/A N/A N/A N/A N/A N/A " 43,498.54 " " 40,843.70 " N/A " 40,843.70 " " 61,265.55 " N/A " 73,473.73 " " 72,758.97 " N/A DRG 461.1 No Current Volume N/A " 6,141.59 " " 11,048.11 " " 7,704.01 " N/A N/A N/A " 6,367.99 " N/A N/A N/A " 7,667.78 " N/A N/A " 6,141.59 " N/A N/A N/A N/A N/A N/A N/A " 6,540.79 " " 6,141.59 " N/A " 6,141.59 " " 9,212.39 " N/A " 11,048.11 " " 10,940.63 " N/A DRG 461.2 No Current Volume N/A " 7,043.41 " " 12,670.39 " " 8,835.25 " N/A N/A N/A " 7,303.06 " N/A N/A N/A " 8,793.70 " N/A N/A " 7,043.41 " N/A N/A N/A N/A N/A N/A N/A " 7,501.23 " " 7,043.41 " N/A " 7,043.41 " " 10,565.12 " N/A " 12,670.39 " " 12,547.13 " N/A DRG 461.3 " 146,400.44 " " 46,130.78 " " 10,414.47 " " 18,734.59 " " 13,063.91 " N/A N/A N/A " 10,798.39 " N/A N/A N/A " 13,002.47 " N/A N/A " 10,414.47 " N/A N/A N/A N/A N/A N/A N/A " 11,091.41 " " 10,414.47 " N/A " 10,414.47 " " 15,621.71 " N/A " 18,734.59 " " 18,552.34 " N/A DRG 461.4 No Current Volume N/A " 17,456.51 " " 31,402.52 " " 21,897.45 " N/A N/A N/A " 18,100.03 " N/A N/A N/A " 21,794.45 " N/A N/A " 17,456.51 " N/A N/A N/A N/A N/A N/A N/A " 18,591.18 " " 17,456.51 " N/A " 17,456.51 " " 26,184.77 " N/A " 31,402.52 " " 31,097.03 " N/A DRG 462.1 No Current Volume N/A " 3,943.52 " " 7,094.00 " " 4,946.75 " N/A N/A N/A " 4,088.89 " N/A N/A N/A " 4,923.48 " N/A N/A " 3,943.52 " N/A N/A N/A N/A N/A N/A N/A " 4,199.85 " " 3,943.52 " N/A " 3,943.52 " " 5,915.28 " N/A " 7,094.00 " " 7,024.99 " N/A DRG 462.2 No Current Volume N/A " 5,444.50 " " 9,794.11 " " 6,829.58 " N/A N/A N/A " 5,645.21 " N/A N/A N/A " 6,797.46 " N/A N/A " 5,444.50 " N/A N/A N/A N/A N/A N/A N/A " 5,798.39 " " 5,444.50 " N/A " 5,444.50 " " 8,166.75 " N/A " 9,794.11 " " 9,698.83 " N/A DRG 462.3 No Current Volume N/A " 10,999.25 " " 19,786.55 " " 13,797.46 " N/A N/A N/A " 11,404.73 " N/A N/A N/A " 13,732.56 " N/A N/A " 10,999.25 " N/A N/A N/A N/A N/A N/A N/A " 11,714.20 " " 10,999.25 " N/A " 10,999.25 " " 16,498.88 " N/A " 19,786.55 " " 19,594.06 " N/A DRG 462.4 No Current Volume N/A " 34,491.89 " " 62,047.46 " " 43,266.63 " N/A N/A N/A " 35,763.41 " N/A N/A N/A " 43,063.12 " N/A N/A " 34,491.89 " N/A N/A N/A N/A N/A N/A N/A " 36,733.86 " " 34,491.89 " N/A " 34,491.89 " " 51,737.84 " N/A " 62,047.46 " " 61,443.85 " N/A DRG 463.1 No Current Volume N/A " 3,906.54 " " 7,027.47 " " 4,900.36 " N/A N/A N/A " 4,050.55 " N/A N/A N/A " 4,877.32 " N/A N/A " 3,906.54 " N/A N/A N/A N/A N/A N/A N/A " 4,160.47 " " 3,906.54 " N/A " 3,906.54 " " 5,859.81 " N/A " 7,027.47 " " 6,959.11 " N/A DRG 463.2 " 43,361.24 " " 13,663.13 " " 4,774.81 " " 8,589.41 " " 5,989.52 " N/A N/A N/A " 4,950.83 " N/A N/A N/A " 5,961.35 " N/A N/A " 4,774.81 " N/A N/A N/A N/A N/A N/A N/A " 5,085.17 " " 4,774.81 " N/A " 4,774.81 " " 7,162.22 " N/A " 8,589.41 " " 8,505.85 " N/A DRG 463.3 " 30,623.85 " " 9,649.57 " " 6,566.13 " " 11,811.81 " " 8,236.55 " N/A N/A N/A " 6,808.19 " N/A N/A N/A " 8,197.81 " N/A N/A " 6,566.13 " N/A N/A N/A N/A N/A N/A N/A " 6,992.93 " " 6,566.13 " N/A " 6,566.13 " " 9,849.20 " N/A " 11,811.81 " " 11,696.90 " N/A DRG 463.4 " 100,578.68 " " 31,692.34 " " 12,350.96 " " 22,218.14 " " 15,493.04 " N/A N/A N/A " 12,806.27 " N/A N/A N/A " 15,420.17 " N/A N/A " 12,350.96 " N/A N/A N/A N/A N/A N/A N/A " 13,153.77 " " 12,350.96 " N/A " 12,350.96 " " 18,526.44 " N/A " 22,218.14 " " 22,002.00 " N/A DRG 465.1 No Current Volume N/A " 4,361.90 " " 7,846.62 " " 5,471.57 " N/A N/A N/A " 4,522.70 " N/A N/A N/A " 5,445.83 " N/A N/A " 4,361.90 " N/A N/A N/A N/A N/A N/A N/A " 4,645.42 " " 4,361.90 " N/A " 4,361.90 " " 6,542.85 " N/A " 7,846.62 " " 7,770.29 " N/A DRG 465.2 " 35,850.15 " " 11,296.38 " " 5,269.21 " " 9,478.78 " " 6,609.70 " N/A N/A N/A " 5,463.45 " N/A N/A N/A " 6,578.61 " N/A N/A " 5,269.21 " N/A N/A N/A N/A N/A N/A N/A " 5,611.71 " " 5,269.21 " N/A " 5,269.21 " " 7,903.82 " N/A " 9,478.78 " " 9,386.57 " N/A DRG 465.3 No Current Volume N/A " 8,616.30 " " 15,499.86 " " 10,808.29 " N/A N/A N/A " 8,933.93 " N/A N/A N/A " 10,757.45 " N/A N/A " 8,616.30 " N/A N/A N/A N/A N/A N/A N/A " 9,176.36 " " 8,616.30 " N/A " 8,616.30 " " 12,924.45 " N/A " 15,499.86 " " 15,349.08 " N/A DRG 465.4 No Current Volume N/A " 16,373.91 " " 29,455.03 " " 20,539.43 " N/A N/A N/A " 16,977.52 " N/A N/A N/A " 20,442.83 " N/A N/A " 16,373.91 " N/A N/A N/A N/A N/A N/A N/A " 17,438.21 " " 16,373.91 " N/A " 16,373.91 " " 24,560.87 " N/A " 29,455.03 " " 29,168.48 " N/A DRG 466.1 No Current Volume N/A " 3,994.19 " " 7,185.15 " " 5,010.31 " N/A N/A N/A " 4,141.43 " N/A N/A N/A " 4,986.75 " N/A N/A " 3,994.19 " N/A N/A N/A N/A N/A N/A N/A " 4,253.81 " " 3,994.19 " N/A " 3,994.19 " " 5,991.29 " N/A " 7,185.15 " " 7,115.25 " N/A DRG 466.2 " 32,263.18 " " 10,166.13 " " 5,250.72 " " 9,445.52 " " 6,586.50 " N/A N/A N/A " 5,444.28 " N/A N/A N/A " 6,555.52 " N/A N/A " 5,250.72 " N/A N/A N/A N/A N/A N/A N/A " 5,592.02 " " 5,250.72 " N/A " 5,250.72 " " 7,876.08 " N/A " 9,445.52 " " 9,353.63 " N/A DRG 466.3 " 45,267.83 " " 14,263.89 " " 8,116.42 " " 14,600.63 " " 10,181.24 " N/A N/A N/A " 8,415.63 " N/A N/A N/A " 10,133.35 " N/A N/A " 8,116.42 " N/A N/A N/A N/A N/A N/A N/A " 8,643.99 " " 8,116.42 " N/A " 8,116.42 " " 12,174.63 " N/A " 14,600.63 " " 14,458.59 " N/A DRG 466.4 " 96,587.71 " " 30,434.79 " " 13,632.83 " " 24,524.10 " " 17,101.02 " N/A N/A N/A " 14,135.39 " N/A N/A N/A " 17,020.59 " N/A N/A " 13,632.83 " N/A N/A N/A N/A N/A N/A N/A " 14,518.96 " " 13,632.83 " N/A " 13,632.83 " " 20,449.25 " N/A " 24,524.10 " " 24,285.52 " N/A DRG 468.1 " 15,265.99 " " 4,810.31 " " 4,179.76 " " 7,518.97 " " 5,243.09 " N/A N/A N/A " 4,333.84 " N/A N/A N/A " 5,218.43 " N/A N/A " 4,179.76 " N/A N/A N/A N/A N/A N/A N/A " 4,451.44 " " 4,179.76 " N/A " 4,179.76 " " 6,269.64 " N/A " 7,518.97 " " 7,445.82 " N/A DRG 468.2 No Current Volume N/A " 5,410.95 " " 9,733.76 " " 6,787.50 " N/A N/A N/A " 5,610.42 " N/A N/A N/A " 6,755.57 " N/A N/A " 5,410.95 " N/A N/A N/A N/A N/A N/A N/A " 5,762.66 " " 5,410.95 " N/A " 5,410.95 " " 8,116.43 " N/A " 9,733.76 " " 9,639.07 " N/A DRG 468.3 No Current Volume N/A " 7,763.09 " " 13,965.02 " " 9,738.02 " N/A N/A N/A " 8,049.27 " N/A N/A N/A " 9,692.22 " N/A N/A " 7,763.09 " N/A N/A N/A N/A N/A N/A N/A " 8,267.69 " " 7,763.09 " N/A " 7,763.09 " " 11,644.64 " N/A " 13,965.02 " " 13,829.17 " N/A DRG 468.4 No Current Volume N/A " 16,134.24 " " 29,023.88 " " 20,238.79 " N/A N/A N/A " 16,729.02 " N/A N/A N/A " 20,143.60 " N/A N/A " 16,134.24 " N/A N/A N/A N/A N/A N/A N/A " 17,182.97 " " 16,134.24 " N/A " 16,134.24 " " 24,201.36 " N/A " 29,023.88 " " 28,741.54 " N/A DRG 469.1 " 15,306.47 " " 4,823.07 " " 3,816.84 " " 6,866.11 " " 4,787.84 " N/A N/A N/A " 3,957.54 " N/A N/A N/A " 4,765.32 " N/A N/A " 3,816.84 " N/A N/A N/A N/A N/A N/A N/A " 4,064.93 " " 3,816.84 " N/A " 3,816.84 " " 5,725.26 " N/A " 6,866.11 " " 6,799.32 " N/A DRG 469.2 " 26,735.65 " " 8,424.40 " " 5,067.89 " " 9,116.63 " " 6,357.16 " N/A N/A N/A " 5,254.71 " N/A N/A N/A " 6,327.26 " N/A N/A " 5,067.89 " N/A N/A N/A N/A N/A N/A N/A " 5,397.30 " " 5,067.89 " N/A " 5,067.89 " " 7,601.84 " N/A " 9,116.63 " " 9,027.94 " N/A DRG 469.3 " 71,180.42 " " 22,428.95 " " 8,056.17 " " 14,492.24 " " 10,105.66 " N/A N/A N/A " 8,353.15 " N/A N/A N/A " 10,058.13 " N/A N/A " 8,056.17 " N/A N/A N/A N/A N/A N/A N/A " 8,579.82 " " 8,056.17 " N/A " 8,056.17 " " 12,084.26 " N/A " 14,492.24 " " 14,351.26 " N/A DRG 469.4 " 168,662.50 " " 53,145.55 " " 15,886.36 " " 28,577.97 " " 19,927.85 " N/A N/A N/A " 16,472.00 " N/A N/A N/A " 19,834.12 " N/A N/A " 15,886.36 " N/A N/A N/A N/A N/A N/A N/A " 16,918.97 " " 15,886.36 " N/A " 15,886.36 " " 23,829.54 " N/A " 28,577.97 " " 28,299.96 " N/A DRG 470.1 No Current Volume N/A " 4,065.40 " " 7,313.25 " " 5,099.64 " N/A N/A N/A " 4,215.27 " N/A N/A N/A " 5,075.65 " N/A N/A " 4,065.40 " N/A N/A N/A N/A N/A N/A N/A " 4,329.65 " " 4,065.40 " N/A " 4,065.40 " " 6,098.10 " N/A " 7,313.25 " " 7,242.10 " N/A DRG 470.2 No Current Volume N/A " 5,242.50 " " 9,430.73 " " 6,576.19 " N/A N/A N/A " 5,435.76 " N/A N/A N/A " 6,545.26 " N/A N/A " 5,242.50 " N/A N/A N/A N/A N/A N/A N/A " 5,583.26 " " 5,242.50 " N/A " 5,242.50 " " 7,863.75 " N/A " 9,430.73 " " 9,338.99 " N/A DRG 470.3 " 49,405.59 " " 15,567.70 " " 7,465.22 " " 13,429.18 " " 9,364.37 " N/A N/A N/A " 7,740.42 " N/A N/A N/A " 9,320.33 " N/A N/A " 7,465.22 " N/A N/A N/A N/A N/A N/A N/A " 7,950.46 " " 7,465.22 " N/A " 7,465.22 " " 11,197.83 " N/A " 13,429.18 " " 13,298.54 " N/A DRG 470.4 No Current Volume N/A " 14,175.84 " " 25,500.92 " " 17,782.17 " N/A N/A N/A " 14,698.42 " N/A N/A N/A " 17,698.54 " N/A N/A " 14,175.84 " N/A N/A N/A N/A N/A N/A N/A " 15,097.27 " " 14,175.84 " N/A " 14,175.84 " " 21,263.76 " N/A " 25,500.92 " " 25,252.84 " N/A DRG 480.1 No Current Volume N/A " 9,461.29 " " 17,019.91 " " 11,868.24 " N/A N/A N/A " 9,810.07 " N/A N/A N/A " 11,812.42 " N/A N/A " 9,461.29 " N/A N/A N/A N/A N/A N/A N/A " 10,076.27 " " 9,461.29 " N/A " 9,461.29 " " 14,191.94 " N/A " 17,019.91 " " 16,854.34 " N/A DRG 480.2 No Current Volume N/A " 10,426.79 " " 18,756.75 " " 13,079.37 " N/A N/A N/A " 10,811.17 " N/A N/A N/A " 13,017.85 " N/A N/A " 10,426.79 " N/A N/A N/A N/A N/A N/A N/A " 11,104.53 " " 10,426.79 " N/A " 10,426.79 " " 15,640.19 " N/A " 18,756.75 " " 18,574.28 " N/A DRG 480.3 No Current Volume N/A " 17,470.21 " " 31,427.16 " " 21,914.63 " N/A N/A N/A " 18,114.23 " N/A N/A N/A " 21,811.56 " N/A N/A " 17,470.21 " N/A N/A N/A N/A N/A N/A N/A " 18,605.77 " " 17,470.21 " N/A " 17,470.21 " " 26,205.32 " N/A " 31,427.16 " " 31,121.43 " N/A DRG 480.4 No Current Volume N/A " 36,472.90 " " 65,611.10 " " 45,751.61 " N/A N/A N/A " 37,817.44 " N/A N/A N/A " 45,536.42 " N/A N/A " 36,472.90 " N/A N/A N/A N/A N/A N/A N/A " 38,843.64 " " 36,472.90 " N/A " 36,472.90 " " 54,709.35 " N/A " 65,611.10 " " 64,972.82 " N/A DRG 482.1 No Current Volume N/A " 6,183.36 " " 11,123.25 " " 7,756.41 " N/A N/A N/A " 6,411.30 " N/A N/A N/A " 7,719.92 " N/A N/A " 6,183.36 " N/A N/A N/A N/A N/A N/A N/A " 6,585.28 " " 6,183.36 " N/A " 6,183.36 " " 9,275.04 " N/A " 11,123.25 " " 11,015.04 " N/A DRG 482.2 No Current Volume N/A " 7,500.83 " " 13,493.24 " " 9,409.04 " N/A N/A N/A " 7,777.34 " N/A N/A N/A " 9,364.79 " N/A N/A " 7,500.83 " N/A N/A N/A N/A N/A N/A N/A " 7,988.38 " " 7,500.83 " N/A " 7,500.83 " " 11,251.25 " N/A " 13,493.24 " " 13,361.98 " N/A DRG 482.3 No Current Volume N/A " 13,938.91 " " 25,074.71 " " 17,484.97 " N/A N/A N/A " 14,452.76 " N/A N/A N/A " 17,402.73 " N/A N/A " 13,938.91 " N/A N/A N/A N/A N/A N/A N/A " 14,844.94 " " 13,938.91 " N/A " 13,938.91 " " 20,908.37 " N/A " 25,074.71 " " 24,830.77 " N/A DRG 482.4 No Current Volume N/A " 24,063.73 " " 43,288.24 " " 30,185.54 " N/A N/A N/A " 24,950.82 " N/A N/A N/A " 30,043.57 " N/A N/A " 24,063.73 " N/A N/A N/A N/A N/A N/A N/A " 25,627.87 " " 24,063.73 " N/A " 24,063.73 " " 36,095.60 " N/A " 43,288.24 " " 42,867.13 " N/A DRG 483.1 No Current Volume N/A " 8,708.05 " " 15,664.91 " " 10,923.38 " N/A N/A N/A " 9,029.07 " N/A N/A N/A " 10,872.00 " N/A N/A " 8,708.05 " N/A N/A N/A N/A N/A N/A N/A " 9,274.07 " " 8,708.05 " N/A " 8,708.05 " " 13,062.08 " N/A " 15,664.91 " " 15,512.52 " N/A DRG 483.2 No Current Volume N/A " 10,439.81 " " 18,780.17 " " 13,095.70 " N/A N/A N/A " 10,824.66 " N/A N/A N/A " 13,034.10 " N/A N/A " 10,439.81 " N/A N/A N/A N/A N/A N/A N/A " 11,118.40 " " 10,439.81 " N/A " 10,439.81 " " 15,659.72 " N/A " 18,780.17 " " 18,597.48 " N/A DRG 483.3 No Current Volume N/A " 13,912.89 " " 25,027.90 " " 17,452.33 " N/A N/A N/A " 14,425.78 " N/A N/A N/A " 17,370.24 " N/A N/A " 13,912.89 " N/A N/A N/A N/A N/A N/A N/A " 14,817.23 " " 13,912.89 " N/A " 13,912.89 " " 20,869.34 " N/A " 25,027.90 " " 24,784.42 " N/A DRG 483.4 No Current Volume N/A " 30,527.15 " " 54,915.29 " " 38,293.26 " N/A N/A N/A " 31,652.51 " N/A N/A N/A " 38,113.15 " N/A N/A " 30,527.15 " N/A N/A N/A N/A N/A N/A N/A " 32,511.41 " " 30,527.15 " N/A " 30,527.15 " " 45,790.73 " N/A " 54,915.29 " " 54,381.07 " N/A DRG 484.1 No Current Volume N/A " 9,655.07 " " 17,368.51 " " 12,111.32 " N/A N/A N/A " 10,011.00 " N/A N/A N/A " 12,054.35 " N/A N/A " 9,655.07 " N/A N/A N/A N/A N/A N/A N/A " 10,282.65 " " 9,655.07 " N/A " 9,655.07 " " 14,482.61 " N/A " 17,368.51 " " 17,199.54 " N/A DRG 484.2 No Current Volume N/A " 10,595.93 " " 19,061.02 " " 13,291.53 " N/A N/A N/A " 10,986.54 " N/A N/A N/A " 13,229.02 " N/A N/A " 10,595.93 " N/A N/A N/A N/A N/A N/A N/A " 11,284.67 " " 10,595.93 " N/A " 10,595.93 " " 15,893.90 " N/A " 19,061.02 " " 18,875.59 " N/A DRG 484.3 No Current Volume N/A " 13,359.61 " " 24,032.60 " " 16,758.29 " N/A N/A N/A " 13,852.10 " N/A N/A N/A " 16,679.47 " N/A N/A " 13,359.61 " N/A N/A N/A N/A N/A N/A N/A " 14,227.98 " " 13,359.61 " N/A " 13,359.61 " " 20,039.42 " N/A " 24,032.60 " " 23,798.81 " N/A DRG 484.4 No Current Volume N/A " 37,243.25 " " 66,996.88 " " 46,717.93 " N/A N/A N/A " 38,616.19 " N/A N/A N/A " 46,498.20 " N/A N/A " 37,243.25 " N/A N/A N/A N/A N/A N/A N/A " 39,664.06 " " 37,243.25 " N/A " 37,243.25 " " 55,864.88 " N/A " 66,996.88 " " 66,345.13 " N/A DRG 500.1 No Current Volume N/A " 5,311.66 " " 9,555.15 " " 6,662.95 " N/A N/A N/A " 5,507.47 " N/A N/A N/A " 6,631.61 " N/A N/A " 5,311.66 " N/A N/A N/A N/A N/A N/A N/A " 5,656.92 " " 5,311.66 " N/A " 5,311.66 " " 7,967.49 " N/A " 9,555.15 " " 9,462.19 " N/A DRG 500.2 No Current Volume N/A " 6,406.59 " " 11,524.81 " " 8,036.43 " N/A N/A N/A " 6,642.76 " N/A N/A N/A " 7,998.63 " N/A N/A " 6,406.59 " N/A N/A N/A N/A N/A N/A N/A " 6,823.02 " " 6,406.59 " N/A " 6,406.59 " " 9,609.89 " N/A " 11,524.81 " " 11,412.70 " N/A DRG 500.3 No Current Volume N/A " 9,093.57 " " 16,358.42 " " 11,406.97 " N/A N/A N/A " 9,428.80 " N/A N/A N/A " 11,353.32 " N/A N/A " 9,093.57 " N/A N/A N/A N/A N/A N/A N/A " 9,684.65 " " 9,093.57 " N/A " 9,093.57 " " 13,640.36 " N/A " 16,358.42 " " 16,199.29 " N/A DRG 500.4 No Current Volume N/A " 15,990.45 " " 28,765.22 " " 20,058.42 " N/A N/A N/A " 16,579.92 " N/A N/A N/A " 19,964.08 " N/A N/A " 15,990.45 " N/A N/A N/A N/A N/A N/A N/A " 17,029.83 " " 15,990.45 " N/A " 15,990.45 " " 23,985.68 " N/A " 28,765.22 " " 28,485.39 " N/A DRG 501.1 No Current Volume N/A " 3,748.36 " " 6,742.92 " " 4,701.94 " N/A N/A N/A " 3,886.54 " N/A N/A N/A " 4,679.83 " N/A N/A " 3,748.36 " N/A N/A N/A N/A N/A N/A N/A " 3,992.00 " " 3,748.36 " N/A " 3,748.36 " " 5,622.54 " N/A " 6,742.92 " " 6,677.33 " N/A DRG 501.2 " 64,965.43 " " 20,470.61 " " 4,918.61 " " 8,848.09 " " 6,169.90 " N/A N/A N/A " 5,099.93 " N/A N/A N/A " 6,140.88 " N/A N/A " 4,918.61 " N/A N/A N/A N/A N/A N/A N/A " 5,238.32 " " 4,918.61 " N/A " 4,918.61 " " 7,377.92 " N/A " 8,848.09 " " 8,762.01 " N/A DRG 501.3 No Current Volume N/A " 7,630.25 " " 13,726.06 " " 9,571.39 " N/A N/A N/A " 7,911.53 " N/A N/A N/A " 9,526.37 " N/A N/A " 7,630.25 " N/A N/A N/A N/A N/A N/A N/A " 8,126.22 " " 7,630.25 " N/A " 7,630.25 " " 11,445.38 " N/A " 13,726.06 " " 13,592.53 " N/A DRG 501.4 No Current Volume N/A " 16,110.96 " " 28,982.01 " " 20,209.59 " N/A N/A N/A " 16,704.88 " N/A N/A N/A " 20,114.53 " N/A N/A " 16,110.96 " N/A N/A N/A N/A N/A N/A N/A " 17,158.17 " " 16,110.96 " N/A " 16,110.96 " " 24,166.44 " N/A " 28,982.01 " " 28,700.06 " N/A DRG 510.1 No Current Volume N/A " 10,176.17 " " 18,305.91 " " 12,764.99 " N/A N/A N/A " 10,551.31 " N/A N/A N/A " 12,704.95 " N/A N/A " 10,176.17 " N/A N/A N/A N/A N/A N/A N/A " 10,837.62 " " 10,176.17 " N/A " 10,176.17 " " 15,264.26 " N/A " 18,305.91 " " 18,127.83 " N/A DRG 510.2 No Current Volume N/A " 12,654.31 " " 22,763.84 " " 15,873.57 " N/A N/A N/A " 13,120.80 " N/A N/A N/A " 15,798.91 " N/A N/A " 12,654.31 " N/A N/A N/A N/A N/A N/A N/A " 13,476.84 " " 12,654.31 " N/A " 12,654.31 " " 18,981.47 " N/A " 22,763.84 " " 22,542.39 " N/A DRG 510.3 No Current Volume N/A " 21,135.71 " " 38,021.03 " " 26,512.63 " N/A N/A N/A " 21,914.86 " N/A N/A N/A " 26,387.93 " N/A N/A " 21,135.71 " N/A N/A N/A N/A N/A N/A N/A " 22,509.53 " " 21,135.71 " N/A " 21,135.71 " " 31,703.57 " N/A " 38,021.03 " " 37,651.15 " N/A DRG 510.4 No Current Volume N/A " 35,771.71 " " 64,349.73 " " 44,872.03 " N/A N/A N/A " 37,090.40 " N/A N/A N/A " 44,660.98 " N/A N/A " 35,771.71 " N/A N/A N/A N/A N/A N/A N/A " 38,096.87 " " 35,771.71 " N/A " 35,771.71 " " 53,657.57 " N/A " 64,349.73 " " 63,723.72 " N/A DRG 511.1 No Current Volume N/A " 10,567.17 " " 19,009.28 " " 13,255.46 " N/A N/A N/A " 10,956.72 " N/A N/A N/A " 13,193.11 " N/A N/A " 10,567.17 " N/A N/A N/A N/A N/A N/A N/A " 11,254.04 " " 10,567.17 " N/A " 10,567.17 " " 15,850.76 " N/A " 19,009.28 " " 18,824.36 " N/A DRG 511.2 No Current Volume N/A " 12,783.04 " " 22,995.41 " " 16,035.05 " N/A N/A N/A " 13,254.28 " N/A N/A N/A " 15,959.63 " N/A N/A " 12,783.04 " N/A N/A N/A N/A N/A N/A N/A " 13,613.94 " " 12,783.04 " N/A " 12,783.04 " " 19,174.56 " N/A " 22,995.41 " " 22,771.71 " N/A DRG 511.3 No Current Volume N/A " 19,056.10 " " 34,280.02 " " 23,903.97 " N/A N/A N/A " 19,758.59 " N/A N/A N/A " 23,791.54 " N/A N/A " 19,056.10 " N/A N/A N/A N/A N/A N/A N/A " 20,294.75 " " 19,056.10 " N/A " 19,056.10 " " 28,584.15 " N/A " 34,280.02 " " 33,946.54 " N/A DRG 511.4 No Current Volume N/A " 38,574.42 " " 69,391.52 " " 48,387.75 " N/A N/A N/A " 39,996.43 " N/A N/A N/A " 48,160.16 " N/A N/A " 38,574.42 " N/A N/A N/A N/A N/A N/A N/A " 41,081.76 " " 38,574.42 " N/A " 38,574.42 " " 57,861.63 " N/A " 69,391.52 " " 68,716.47 " N/A DRG 512.1 No Current Volume N/A " 9,770.11 " " 17,575.45 " " 12,255.63 " N/A N/A N/A " 10,130.28 " N/A N/A N/A " 12,197.98 " N/A N/A " 9,770.11 " N/A N/A N/A N/A N/A N/A N/A " 10,405.17 " " 9,770.11 " N/A " 9,770.11 " " 14,655.17 " N/A " 17,575.45 " " 17,404.47 " N/A DRG 512.2 No Current Volume N/A " 11,257.41 " " 20,250.95 " " 14,121.30 " N/A N/A N/A " 11,672.40 " N/A N/A N/A " 14,054.88 " N/A N/A " 11,257.41 " N/A N/A N/A N/A N/A N/A N/A " 11,989.14 " " 11,257.41 " N/A " 11,257.41 " " 16,886.12 " N/A " 20,250.95 " " 20,053.95 " N/A DRG 512.3 No Current Volume N/A " 17,262.04 " " 31,052.68 " " 21,653.50 " N/A N/A N/A " 17,898.39 " N/A N/A N/A " 21,551.66 " N/A N/A " 17,262.04 " N/A N/A N/A N/A N/A N/A N/A " 18,384.07 " " 17,262.04 " N/A " 17,262.04 " " 25,893.06 " N/A " 31,052.68 " " 30,750.60 " N/A DRG 512.4 No Current Volume N/A " 32,825.88 " " 59,050.48 " " 41,176.78 " N/A N/A N/A " 34,035.98 " N/A N/A N/A " 40,983.11 " N/A N/A " 32,825.88 " N/A N/A N/A N/A N/A N/A N/A " 34,959.56 " " 32,825.88 " N/A " 32,825.88 " " 49,238.82 " N/A " 59,050.48 " " 58,476.02 " N/A DRG 513.1 No Current Volume N/A " 6,944.81 " " 12,493.02 " " 8,711.57 " N/A N/A N/A " 7,200.82 " N/A N/A N/A " 8,670.60 " N/A N/A " 6,944.81 " N/A N/A N/A N/A N/A N/A N/A " 7,396.22 " " 6,944.81 " N/A " 6,944.81 " " 10,417.22 " N/A " 12,493.02 " " 12,371.48 " N/A DRG 513.2 No Current Volume N/A " 8,173.94 " " 14,704.10 " " 10,253.39 " N/A N/A N/A " 8,475.27 " N/A N/A N/A " 10,205.16 " N/A N/A " 8,173.94 " N/A N/A N/A N/A N/A N/A N/A " 8,705.25 " " 8,173.94 " N/A " 8,173.94 " " 12,260.91 " N/A " 14,704.10 " " 14,561.06 " N/A DRG 513.3 No Current Volume N/A " 14,203.23 " " 25,550.19 " " 17,816.53 " N/A N/A N/A " 14,726.82 " N/A N/A N/A " 17,732.73 " N/A N/A " 14,203.23 " N/A N/A N/A N/A N/A N/A N/A " 15,126.44 " " 14,203.23 " N/A " 14,203.23 " " 21,304.85 " N/A " 25,550.19 " " 25,301.63 " N/A DRG 513.4 No Current Volume N/A " 27,094.46 " " 48,740.22 " " 33,987.29 " N/A N/A N/A " 28,093.28 " N/A N/A N/A " 33,827.43 " N/A N/A " 27,094.46 " N/A N/A N/A N/A N/A N/A N/A " 28,855.60 " " 27,094.46 " N/A " 27,094.46 " " 40,641.69 " N/A " 48,740.22 " " 48,266.07 " N/A DRG 514.1 No Current Volume N/A " 6,117.62 " " 11,004.99 " " 7,673.94 " N/A N/A N/A " 6,343.14 " N/A N/A N/A " 7,637.85 " N/A N/A " 6,117.62 " N/A N/A N/A N/A N/A N/A N/A " 6,515.27 " " 6,117.62 " N/A " 6,117.62 " " 9,176.43 " N/A " 11,004.99 " " 10,897.93 " N/A DRG 514.2 No Current Volume N/A " 9,305.85 " " 16,740.29 " " 11,673.26 " N/A N/A N/A " 9,648.90 " N/A N/A N/A " 11,618.35 " N/A N/A " 9,305.85 " N/A N/A N/A N/A N/A N/A N/A " 9,910.73 " " 9,305.85 " N/A " 9,305.85 " " 13,958.78 " N/A " 16,740.29 " " 16,577.44 " N/A DRG 514.3 No Current Volume N/A " 19,239.62 " " 34,610.15 " " 24,134.18 " N/A N/A N/A " 19,948.87 " N/A N/A N/A " 24,020.67 " N/A N/A " 19,239.62 " N/A N/A N/A N/A N/A N/A N/A " 20,490.20 " " 19,239.62 " N/A " 19,239.62 " " 28,859.43 " N/A " 34,610.15 " " 34,273.46 " N/A DRG 514.4 No Current Volume N/A " 34,893.16 " " 62,769.31 " " 43,769.98 " N/A N/A N/A " 36,179.47 " N/A N/A N/A " 43,564.11 " N/A N/A " 34,893.16 " N/A N/A N/A N/A N/A N/A N/A " 37,161.22 " " 34,893.16 " N/A " 34,893.16 " " 52,339.74 " N/A " 62,769.31 " " 62,158.68 " N/A DRG 517.1 No Current Volume N/A " 5,440.39 " " 9,786.72 " " 6,824.43 " N/A N/A N/A " 5,640.95 " N/A N/A N/A " 6,792.33 " N/A N/A " 5,440.39 " N/A N/A N/A N/A N/A N/A N/A " 5,794.02 " " 5,440.39 " N/A " 5,440.39 " " 8,160.59 " N/A " 9,786.72 " " 9,691.51 " N/A DRG 517.2 No Current Volume N/A " 7,520.00 " " 13,527.73 " " 9,433.09 " N/A N/A N/A " 7,797.22 " N/A N/A N/A " 9,388.72 " N/A N/A " 7,520.00 " N/A N/A N/A N/A N/A N/A N/A " 8,008.80 " " 7,520.00 " N/A " 7,520.00 " " 11,280.00 " N/A " 13,527.73 " " 13,396.13 " N/A DRG 517.3 " 48,054.14 " " 15,141.86 " " 12,205.11 " " 21,955.77 " " 15,310.09 " N/A N/A N/A " 12,655.04 " N/A N/A N/A " 15,238.08 " N/A N/A " 12,205.11 " N/A N/A N/A N/A N/A N/A N/A " 12,998.44 " " 12,205.11 " N/A " 12,205.11 " " 18,307.67 " N/A " 21,955.77 " " 21,742.18 " N/A DRG 517.4 No Current Volume N/A " 25,761.93 " " 46,343.14 " " 32,315.76 " N/A N/A N/A " 26,711.62 " N/A N/A N/A " 32,163.77 " N/A N/A " 25,761.93 " N/A N/A N/A N/A N/A N/A N/A " 27,436.46 " " 25,761.93 " N/A " 25,761.93 " " 38,642.90 " N/A " 46,343.14 " " 45,892.30 " N/A DRG 518.1 No Current Volume N/A " 6,295.66 " " 11,325.26 " " 7,897.28 " N/A N/A N/A " 6,527.74 " N/A N/A N/A " 7,860.13 " N/A N/A " 6,295.66 " N/A N/A N/A N/A N/A N/A N/A " 6,704.88 " " 6,295.66 " N/A " 6,295.66 " " 9,443.49 " N/A " 11,325.26 " " 11,215.09 " N/A DRG 518.2 No Current Volume N/A " 9,407.19 " " 16,922.59 " " 11,800.38 " N/A N/A N/A " 9,753.98 " N/A N/A N/A " 11,744.88 " N/A N/A " 9,407.19 " N/A N/A N/A N/A N/A N/A N/A " 10,018.66 " " 9,407.19 " N/A " 9,407.19 " " 14,110.79 " N/A " 16,922.59 " " 16,757.97 " N/A DRG 518.3 No Current Volume N/A " 17,803.68 " " 32,027.04 " " 22,332.94 " N/A N/A N/A " 18,460.00 " N/A N/A N/A " 22,227.89 " N/A N/A " 17,803.68 " N/A N/A N/A N/A N/A N/A N/A " 18,960.92 " " 17,803.68 " N/A " 17,803.68 " " 26,705.52 " N/A " 32,027.04 " " 31,715.48 " N/A DRG 518.4 No Current Volume N/A " 32,118.53 " " 57,778.02 " " 40,289.48 " N/A N/A N/A " 33,302.55 " N/A N/A N/A " 40,099.98 " N/A N/A " 32,118.53 " N/A N/A N/A N/A N/A N/A N/A " 34,206.23 " " 32,118.53 " N/A " 32,118.53 " " 48,177.80 " N/A " 57,778.02 " " 57,215.95 " N/A DRG 519.1 No Current Volume N/A " 4,772.76 " " 8,585.72 " " 5,986.95 " N/A N/A N/A " 4,948.70 " N/A N/A N/A " 5,958.79 " N/A N/A " 4,772.76 " N/A N/A N/A N/A N/A N/A N/A " 5,082.99 " " 4,772.76 " N/A " 4,772.76 " " 7,159.14 " N/A " 8,585.72 " " 8,502.19 " N/A DRG 519.2 No Current Volume N/A " 6,152.54 " " 11,067.80 " " 7,717.75 " N/A N/A N/A " 6,379.35 " N/A N/A N/A " 7,681.45 " N/A N/A " 6,152.54 " N/A N/A N/A N/A N/A N/A N/A " 6,552.46 " " 6,152.54 " N/A " 6,152.54 " " 9,228.81 " N/A " 11,067.80 " " 10,960.13 " N/A DRG 519.3 No Current Volume N/A " 13,330.85 " " 23,980.87 " " 16,722.22 " N/A N/A N/A " 13,822.28 " N/A N/A N/A " 16,643.57 " N/A N/A " 13,330.85 " N/A N/A N/A N/A N/A N/A N/A " 14,197.36 " " 13,330.85 " N/A " 13,330.85 " " 19,996.28 " N/A " 23,980.87 " " 23,747.58 " N/A DRG 519.4 No Current Volume N/A " 25,779.05 " " 46,373.93 " " 32,337.24 " N/A N/A N/A " 26,729.37 " N/A N/A N/A " 32,185.14 " N/A N/A " 25,779.05 " N/A N/A N/A N/A N/A N/A N/A " 27,454.69 " " 25,779.05 " N/A " 25,779.05 " " 38,668.58 " N/A " 46,373.93 " " 45,922.80 " N/A DRG 530.1 No Current Volume N/A " 5,332.89 " " 9,593.34 " " 6,689.58 " N/A N/A N/A " 5,529.48 " N/A N/A N/A " 6,658.11 " N/A N/A " 5,332.89 " N/A N/A N/A N/A N/A N/A N/A " 5,679.53 " " 5,332.89 " N/A " 5,332.89 " " 7,999.34 " N/A " 9,593.34 " " 9,500.01 " N/A DRG 530.2 " 27,333.93 " " 8,612.92 " " 6,320.99 " " 11,370.83 " " 7,929.05 " N/A N/A N/A " 6,554.01 " N/A N/A N/A " 7,891.76 " N/A N/A " 6,320.99 " N/A N/A N/A N/A N/A N/A N/A " 6,731.85 " " 6,320.99 " N/A " 6,320.99 " " 9,481.49 " N/A " 11,370.83 " " 11,260.21 " N/A DRG 530.3 No Current Volume N/A " 9,257.91 " " 16,654.05 " " 11,613.12 " N/A N/A N/A " 9,599.20 " N/A N/A N/A " 11,558.50 " N/A N/A " 9,257.91 " N/A N/A N/A N/A N/A N/A N/A " 9,859.67 " " 9,257.91 " N/A " 9,257.91 " " 13,886.87 " N/A " 16,654.05 " " 16,492.04 " N/A DRG 530.4 No Current Volume N/A " 15,836.38 " " 28,488.06 " " 19,865.16 " N/A N/A N/A " 16,420.17 " N/A N/A N/A " 19,771.72 " N/A N/A " 15,836.38 " N/A N/A N/A N/A N/A N/A N/A " 16,865.74 " " 15,836.38 " N/A " 15,836.38 " " 23,754.57 " N/A " 28,488.06 " " 28,210.93 " N/A DRG 531.1 No Current Volume N/A " 3,421.05 " " 6,154.13 " " 4,291.37 " N/A N/A N/A " 3,547.16 " N/A N/A N/A " 4,271.18 " N/A N/A " 3,421.05 " N/A N/A N/A N/A N/A N/A N/A " 3,643.42 " " 3,421.05 " N/A " 3,421.05 " " 5,131.58 " N/A " 6,154.13 " " 6,094.26 " N/A DRG 531.2 No Current Volume N/A " 4,736.46 " " 8,520.42 " " 5,941.42 " N/A N/A N/A " 4,911.07 " N/A N/A N/A " 5,913.47 " N/A N/A " 4,736.46 " N/A N/A N/A N/A N/A N/A N/A " 5,044.33 " " 4,736.46 " N/A " 4,736.46 " " 7,104.69 " N/A " 8,520.42 " " 8,437.53 " N/A DRG 531.3 No Current Volume N/A " 8,493.73 " " 15,279.37 " " 10,654.53 " N/A N/A N/A " 8,806.84 " N/A N/A N/A " 10,604.42 " N/A N/A " 8,493.73 " N/A N/A N/A N/A N/A N/A N/A " 9,045.82 " " 8,493.73 " N/A " 8,493.73 " " 12,740.60 " N/A " 15,279.37 " " 15,130.73 " N/A DRG 531.4 No Current Volume N/A " 12,739.22 " " 22,916.58 " " 15,980.08 " N/A N/A N/A " 13,208.84 " N/A N/A N/A " 15,904.92 " N/A N/A " 12,739.22 " N/A N/A N/A N/A N/A N/A N/A " 13,567.27 " " 12,739.22 " N/A " 12,739.22 " " 19,108.83 " N/A " 22,916.58 " " 22,693.65 " N/A DRG 532.1 No Current Volume N/A " 3,737.40 " " 6,723.21 " " 4,688.19 " N/A N/A N/A " 3,875.18 " N/A N/A N/A " 4,666.14 " N/A N/A " 3,737.40 " N/A N/A N/A N/A N/A N/A N/A " 3,980.33 " " 3,737.40 " N/A " 3,737.40 " " 5,606.10 " N/A " 6,723.21 " " 6,657.80 " N/A DRG 532.2 No Current Volume N/A " 4,322.87 " " 7,776.41 " " 5,422.61 " N/A N/A N/A " 4,482.23 " N/A N/A N/A " 5,397.10 " N/A N/A " 4,322.87 " N/A N/A N/A N/A N/A N/A N/A " 4,603.86 " " 4,322.87 " N/A " 4,322.87 " " 6,484.31 " N/A " 7,776.41 " " 7,700.76 " N/A DRG 532.3 No Current Volume N/A " 7,243.36 " " 13,030.08 " " 9,086.07 " N/A N/A N/A " 7,510.38 " N/A N/A N/A " 9,043.33 " N/A N/A " 7,243.36 " N/A N/A N/A N/A N/A N/A N/A " 7,714.18 " " 7,243.36 " N/A " 7,243.36 " " 10,865.04 " N/A " 13,030.08 " " 12,903.32 " N/A DRG 532.4 No Current Volume N/A " 16,646.44 " " 29,945.28 " " 20,881.29 " N/A N/A N/A " 17,260.10 " N/A N/A N/A " 20,783.08 " N/A N/A " 16,646.44 " N/A N/A N/A N/A N/A N/A N/A " 17,728.46 " " 16,646.44 " N/A " 16,646.44 " " 24,969.66 " N/A " 29,945.28 " " 29,653.97 " N/A DRG 539.1 No Current Volume N/A " 3,897.64 " " 7,011.46 " " 4,889.20 " N/A N/A N/A " 4,041.32 " N/A N/A N/A " 4,866.20 " N/A N/A " 3,897.64 " N/A N/A N/A N/A N/A N/A N/A " 4,150.99 " " 3,897.64 " N/A " 3,897.64 " " 5,846.46 " N/A " 7,011.46 " " 6,943.26 " N/A DRG 539.2 No Current Volume N/A " 4,478.31 " " 8,056.03 " " 5,617.59 " N/A N/A N/A " 4,643.40 " N/A N/A N/A " 5,591.17 " N/A N/A " 4,478.31 " N/A N/A N/A N/A N/A N/A N/A " 4,769.40 " " 4,478.31 " N/A " 4,478.31 " " 6,717.47 " N/A " 8,056.03 " " 7,977.66 " N/A DRG 539.3 No Current Volume N/A " 7,773.36 " " 13,983.50 " " 9,750.90 " N/A N/A N/A " 8,059.92 " N/A N/A N/A " 9,705.04 " N/A N/A " 7,773.36 " N/A N/A N/A N/A N/A N/A N/A " 8,278.63 " " 7,773.36 " N/A " 7,773.36 " " 11,660.04 " N/A " 13,983.50 " " 13,847.46 " N/A DRG 539.4 No Current Volume N/A " 17,344.21 " " 31,200.50 " " 21,756.58 " N/A N/A N/A " 17,983.59 " N/A N/A N/A " 21,654.25 " N/A N/A " 17,344.21 " N/A N/A N/A N/A N/A N/A N/A " 18,471.58 " " 17,344.21 " N/A " 17,344.21 " " 26,016.32 " N/A " 31,200.50 " " 30,896.98 " N/A DRG 540.1 " 28,869.81 " " 9,096.88 " " 3,716.86 " " 6,686.26 " " 4,662.43 " N/A N/A N/A " 3,853.88 " N/A N/A N/A " 4,640.50 " N/A N/A " 3,716.86 " N/A N/A N/A N/A N/A N/A N/A " 3,958.46 " " 3,716.86 " N/A " 3,716.86 " " 5,575.29 " N/A " 6,686.26 " " 6,621.21 " N/A DRG 540.2 " 33,391.11 " " 10,521.54 " " 4,389.98 " " 7,897.14 " " 5,506.79 " N/A N/A N/A " 4,551.81 " N/A N/A N/A " 5,480.89 " N/A N/A " 4,389.98 " N/A N/A N/A N/A N/A N/A N/A " 4,675.33 " " 4,389.98 " N/A " 4,389.98 " " 6,584.97 " N/A " 7,897.14 " " 7,820.31 " N/A DRG 540.3 " 35,284.12 " " 11,118.03 " " 6,427.13 " " 11,561.76 " " 8,062.19 " N/A N/A N/A " 6,664.06 " N/A N/A N/A " 8,024.27 " N/A N/A " 6,427.13 " N/A N/A N/A N/A N/A N/A N/A " 6,844.89 " " 6,427.13 " N/A " 6,427.13 " " 9,640.70 " N/A " 11,561.76 " " 11,449.29 " N/A DRG 540.4 " 148,885.09 " " 46,913.69 " " 12,598.84 " " 22,664.05 " " 15,803.98 " N/A N/A N/A " 13,063.29 " N/A N/A N/A " 15,729.65 " N/A N/A " 12,598.84 " N/A N/A N/A N/A N/A N/A N/A " 13,417.76 " " 12,598.84 " N/A " 12,598.84 " " 18,898.26 " N/A " 22,664.05 " " 22,443.57 " N/A DRG 541.1 No Current Volume N/A " 4,155.79 " " 7,475.85 " " 5,213.02 " N/A N/A N/A " 4,308.99 " N/A N/A N/A " 5,188.50 " N/A N/A " 4,155.79 " N/A N/A N/A N/A N/A N/A N/A " 4,425.92 " " 4,155.79 " N/A " 4,155.79 " " 6,233.69 " N/A " 7,475.85 " " 7,403.12 " N/A DRG 541.2 No Current Volume N/A " 4,172.91 " " 7,506.65 " " 5,234.50 " N/A N/A N/A " 4,326.74 " N/A N/A N/A " 5,209.88 " N/A N/A " 4,172.91 " N/A N/A N/A N/A N/A N/A N/A " 4,444.15 " " 4,172.91 " N/A " 4,172.91 " " 6,259.37 " N/A " 7,506.65 " " 7,433.62 " N/A DRG 541.3 No Current Volume N/A " 5,434.92 " " 9,776.88 " " 6,817.56 " N/A N/A N/A " 5,635.27 " N/A N/A N/A " 6,785.50 " N/A N/A " 5,434.92 " N/A N/A N/A N/A N/A N/A N/A " 5,788.19 " " 5,434.92 " N/A " 5,434.92 " " 8,152.38 " N/A " 9,776.88 " " 9,681.77 " N/A DRG 541.4 No Current Volume N/A " 13,378.78 " " 24,067.09 " " 16,782.34 " N/A N/A N/A " 13,871.98 " N/A N/A N/A " 16,703.41 " N/A N/A " 13,378.78 " N/A N/A N/A N/A N/A N/A N/A " 14,248.40 " " 13,378.78 " N/A " 13,378.78 " " 20,068.17 " N/A " 24,067.09 " " 23,832.96 " N/A DRG 542.1 No Current Volume N/A " 2,697.94 " " 4,853.32 " " 3,384.30 " N/A N/A N/A " 2,797.40 " N/A N/A N/A " 3,368.38 " N/A N/A " 2,697.94 " N/A N/A N/A N/A N/A N/A N/A " 2,873.31 " " 2,697.94 " N/A " 2,697.94 " " 4,046.91 " N/A " 4,853.32 " " 4,806.11 " N/A DRG 542.2 " 24,489.08 " " 7,716.51 " " 3,154.68 " " 5,674.95 " " 3,957.23 " N/A N/A N/A " 3,270.97 " N/A N/A N/A " 3,938.62 " N/A N/A " 3,154.68 " N/A N/A N/A N/A N/A N/A N/A " 3,359.73 " " 3,154.68 " N/A " 3,154.68 " " 4,732.02 " N/A " 5,674.95 " " 5,619.75 " N/A DRG 542.3 No Current Volume N/A " 5,155.54 " " 9,274.30 " " 6,467.11 " N/A N/A N/A " 5,345.59 " N/A N/A N/A " 6,436.69 " N/A N/A " 5,155.54 " N/A N/A N/A N/A N/A N/A N/A " 5,490.65 " " 5,155.54 " N/A " 5,155.54 " " 7,733.31 " N/A " 9,274.30 " " 9,184.08 " N/A DRG 542.4 No Current Volume N/A " 14,095.04 " " 25,355.57 " " 17,680.82 " N/A N/A N/A " 14,614.64 " N/A N/A N/A " 17,597.66 " N/A N/A " 14,095.04 " N/A N/A N/A N/A N/A N/A N/A " 15,011.22 " " 14,095.04 " N/A " 14,095.04 " " 21,142.56 " N/A " 25,355.57 " " 25,108.90 " N/A DRG 543.1 No Current Volume N/A " 3,201.24 " " 5,758.71 " " 4,015.64 " N/A N/A N/A " 3,319.25 " N/A N/A N/A " 3,996.75 " N/A N/A " 3,201.24 " N/A N/A N/A N/A N/A N/A N/A " 3,409.32 " " 3,201.24 " N/A " 3,201.24 " " 4,801.86 " N/A " 5,758.71 " " 5,702.69 " N/A DRG 543.2 No Current Volume N/A " 3,773.70 " " 6,788.51 " " 4,733.73 " N/A N/A N/A " 3,912.81 " N/A N/A N/A " 4,711.46 " N/A N/A " 3,773.70 " N/A N/A N/A N/A N/A N/A N/A " 4,018.99 " " 3,773.70 " N/A " 3,773.70 " " 5,660.55 " N/A " 6,788.51 " " 6,722.47 " N/A DRG 543.3 No Current Volume N/A " 5,365.07 " " 9,651.22 " " 6,729.94 " N/A N/A N/A " 5,562.85 " N/A N/A N/A " 6,698.29 " N/A N/A " 5,365.07 " N/A N/A N/A N/A N/A N/A N/A " 5,713.80 " " 5,365.07 " N/A " 5,365.07 " " 8,047.61 " N/A " 9,651.22 " " 9,557.34 " N/A DRG 543.4 No Current Volume N/A " 21,372.64 " " 38,447.24 " " 26,809.84 " N/A N/A N/A " 22,160.52 " N/A N/A N/A " 26,683.74 " N/A N/A " 21,372.64 " N/A N/A N/A N/A N/A N/A N/A " 22,761.86 " " 21,372.64 " N/A " 21,372.64 " " 32,058.96 " N/A " 38,447.24 " " 38,073.22 " N/A DRG 547.1 No Current Volume N/A " 4,133.88 " " 7,436.44 " " 5,185.54 " N/A N/A N/A " 4,286.27 " N/A N/A N/A " 5,161.15 " N/A N/A " 4,133.88 " N/A N/A N/A N/A N/A N/A N/A " 4,402.58 " " 4,133.88 " N/A " 4,133.88 " " 6,200.82 " N/A " 7,436.44 " " 7,364.09 " N/A DRG 547.2 No Current Volume N/A " 5,078.16 " " 9,135.10 " " 6,370.04 " N/A N/A N/A " 5,265.36 " N/A N/A N/A " 6,340.08 " N/A N/A " 5,078.16 " N/A N/A N/A N/A N/A N/A N/A " 5,408.24 " " 5,078.16 " N/A " 5,078.16 " " 7,617.24 " N/A " 9,135.10 " " 9,046.23 " N/A DRG 547.3 " 34,760.32 " " 10,952.98 " " 7,522.06 " " 13,531.43 " " 9,435.67 " N/A N/A N/A " 7,799.35 " N/A N/A N/A " 9,391.29 " N/A N/A " 7,522.06 " N/A N/A N/A N/A N/A N/A N/A " 8,010.99 " " 7,522.06 " N/A " 7,522.06 " " 11,283.09 " N/A " 13,531.43 " " 13,399.80 " N/A DRG 547.4 No Current Volume N/A " 24,097.97 " " 43,349.84 " " 30,228.49 " N/A N/A N/A " 24,986.32 " N/A N/A N/A " 30,086.32 " N/A N/A " 24,097.97 " N/A N/A N/A N/A N/A N/A N/A " 25,664.34 " " 24,097.97 " N/A " 24,097.97 " " 36,146.96 " N/A " 43,349.84 " " 42,928.12 " N/A DRG 548.1 No Current Volume N/A " 2,786.28 " " 5,012.24 " " 3,495.11 " N/A N/A N/A " 2,888.99 " N/A N/A N/A " 3,478.67 " N/A N/A " 2,786.28 " N/A N/A N/A N/A N/A N/A N/A " 2,967.39 " " 2,786.28 " N/A " 2,786.28 " " 4,179.42 " N/A " 5,012.24 " " 4,963.48 " N/A DRG 548.2 No Current Volume N/A " 4,726.19 " " 8,501.94 " " 5,928.53 " N/A N/A N/A " 4,900.42 " N/A N/A N/A " 5,900.65 " N/A N/A " 4,726.19 " N/A N/A N/A N/A N/A N/A N/A " 5,033.39 " " 4,726.19 " N/A " 4,726.19 " " 7,089.29 " N/A " 8,501.94 " " 8,419.23 " N/A DRG 548.3 No Current Volume N/A " 9,051.12 " " 16,282.06 " " 11,353.72 " N/A N/A N/A " 9,384.78 " N/A N/A N/A " 11,300.32 " N/A N/A " 9,051.12 " N/A N/A N/A N/A N/A N/A N/A " 9,639.44 " " 9,051.12 " N/A " 9,051.12 " " 13,576.68 " N/A " 16,282.06 " " 16,123.67 " N/A DRG 548.4 No Current Volume N/A " 22,558.63 " " 40,580.72 " " 28,297.55 " N/A N/A N/A " 23,390.24 " N/A N/A N/A " 28,164.45 " N/A N/A " 22,558.63 " N/A N/A N/A N/A N/A N/A N/A " 24,024.94 " " 22,558.63 " N/A " 22,558.63 " " 33,837.95 " N/A " 40,580.72 " " 40,185.94 " N/A DRG 560.1 " 12,976.73 " " 4,088.97 " " 2,335.02 " " 4,200.47 " " 2,929.05 " N/A N/A N/A " 2,421.10 " N/A N/A N/A " 2,915.27 " N/A N/A " 2,335.02 " N/A N/A N/A N/A N/A N/A N/A " 2,486.80 " " 2,335.02 " N/A " 2,335.02 " " 3,502.53 " N/A " 4,200.47 " " 4,159.60 " N/A DRG 560.2 " 13,959.83 " " 4,398.74 " " 2,508.26 " " 4,512.11 " " 3,146.36 " N/A N/A N/A " 2,600.73 " N/A N/A N/A " 3,131.56 " N/A N/A " 2,508.26 " N/A N/A N/A N/A N/A N/A N/A " 2,671.30 " " 2,508.26 " N/A " 2,508.26 " " 3,762.39 " N/A " 4,512.11 " " 4,468.21 " N/A DRG 560.3 " 18,816.39 " " 5,929.04 " " 3,549.10 " " 6,384.48 " " 4,451.99 " N/A N/A N/A " 3,679.93 " N/A N/A N/A " 4,431.05 " N/A N/A " 3,549.10 " N/A N/A N/A N/A N/A N/A N/A " 3,779.79 " " 3,549.10 " N/A " 3,549.10 " " 5,323.65 " N/A " 6,384.48 " " 6,322.37 " N/A DRG 560.4 " 32,598.29 " " 10,271.72 " " 5,449.30 " " 9,802.75 " " 6,835.60 " N/A N/A N/A " 5,650.18 " N/A N/A N/A " 6,803.45 " N/A N/A " 5,449.30 " N/A N/A N/A N/A N/A N/A N/A " 5,803.50 " " 5,449.30 " N/A " 5,449.30 " " 8,173.95 " N/A " 9,802.75 " " 9,707.38 " N/A DRG 561.1 " 14,327.18 " " 4,514.49 " " 2,177.53 " " 3,917.16 " " 2,731.49 " N/A N/A N/A " 2,257.80 " N/A N/A N/A " 2,718.65 " N/A N/A " 2,177.53 " N/A N/A N/A N/A N/A N/A N/A " 2,319.07 " " 2,177.53 " N/A " 2,177.53 " " 3,266.30 " N/A " 3,917.16 " " 3,879.05 " N/A DRG 561.2 " 22,092.99 " " 6,961.50 " " 2,771.90 " " 4,986.37 " " 3,477.07 " N/A N/A N/A " 2,874.08 " N/A N/A N/A " 3,460.72 " N/A N/A " 2,771.90 " N/A N/A N/A N/A N/A N/A N/A " 2,952.07 " " 2,771.90 " N/A " 2,771.90 " " 4,157.85 " N/A " 4,986.37 " " 4,937.86 " N/A DRG 561.3 " 9,424.71 " " 2,969.73 " " 4,426.95 " " 7,963.64 " " 5,553.17 " N/A N/A N/A " 4,590.15 " N/A N/A N/A " 5,527.05 " N/A N/A " 4,426.95 " N/A N/A N/A N/A N/A N/A N/A " 4,714.70 " " 4,426.95 " N/A " 4,426.95 " " 6,640.43 " N/A " 7,963.64 " " 7,886.17 " N/A DRG 561.4 No Current Volume N/A " 9,644.12 " " 17,348.81 " " 12,097.58 " N/A N/A N/A " 9,999.64 " N/A N/A N/A " 12,040.68 " N/A N/A " 9,644.12 " N/A N/A N/A N/A N/A N/A N/A " 10,270.99 " " 9,644.12 " N/A " 9,644.12 " " 14,466.18 " N/A " 17,348.81 " " 17,180.04 " N/A DRG 564.1 No Current Volume N/A " 2,450.06 " " 4,407.41 " " 3,073.36 " N/A N/A N/A " 2,540.38 " N/A N/A N/A " 3,058.90 " N/A N/A " 2,450.06 " N/A N/A N/A N/A N/A N/A N/A " 2,609.31 " " 2,450.06 " N/A " 2,450.06 " " 3,675.09 " N/A " 4,407.41 " " 4,364.54 " N/A DRG 564.2 No Current Volume N/A " 2,522.64 " " 4,537.98 " " 3,164.40 " N/A N/A N/A " 2,615.64 " N/A N/A N/A " 3,149.52 " N/A N/A " 2,522.64 " N/A N/A N/A N/A N/A N/A N/A " 2,686.61 " " 2,522.64 " N/A " 2,522.64 " " 3,783.96 " N/A " 4,537.98 " " 4,493.83 " N/A DRG 564.3 No Current Volume N/A " 3,669.61 " " 6,601.26 " " 4,603.16 " N/A N/A N/A " 3,804.89 " N/A N/A N/A " 4,581.51 " N/A N/A " 3,669.61 " N/A N/A N/A N/A N/A N/A N/A " 3,908.13 " " 3,669.61 " N/A " 3,669.61 " " 5,504.42 " N/A " 6,601.26 " " 6,537.04 " N/A DRG 564.4 No Current Volume N/A " 5,610.90 " " 10,093.45 " " 7,038.31 " N/A N/A N/A " 5,817.74 " N/A N/A N/A " 7,005.21 " N/A N/A " 5,610.90 " N/A N/A N/A N/A N/A N/A N/A " 5,975.61 " " 5,610.90 " N/A " 5,610.90 " " 8,416.35 " N/A " 10,093.45 " " 9,995.26 " N/A DRG 566.1 No Current Volume N/A " 2,270.65 " " 4,084.67 " " 2,848.30 " N/A N/A N/A " 2,354.36 " N/A N/A N/A " 2,834.91 " N/A N/A " 2,270.65 " N/A N/A N/A N/A N/A N/A N/A " 2,418.24 " " 2,270.65 " N/A " 2,270.65 " " 3,405.98 " N/A " 4,084.67 " " 4,044.94 " N/A DRG 566.2 " 8,397.71 " " 2,646.12 " " 2,872.56 " " 5,167.45 " " 3,603.34 " N/A N/A N/A " 2,978.45 " N/A N/A N/A " 3,586.39 " N/A N/A " 2,872.56 " N/A N/A N/A N/A N/A N/A N/A " 3,059.28 " " 2,872.56 " N/A " 2,872.56 " " 4,308.84 " N/A " 5,167.45 " " 5,117.18 " N/A DRG 566.3 " 22,988.40 " " 7,243.64 " " 4,296.17 " " 7,728.38 " " 5,389.12 " N/A N/A N/A " 4,454.54 " N/A N/A N/A " 5,363.77 " N/A N/A " 4,296.17 " N/A N/A N/A N/A N/A N/A N/A " 4,575.42 " " 4,296.17 " N/A " 4,296.17 " " 6,444.26 " N/A " 7,728.38 " " 7,653.20 " N/A DRG 566.4 " 23,113.09 " " 7,282.93 " " 8,664.92 " " 15,587.32 " " 10,869.28 " N/A N/A N/A " 8,984.34 " N/A N/A N/A " 10,818.15 " N/A N/A " 8,664.92 " N/A N/A N/A N/A N/A N/A N/A " 9,228.14 " " 8,664.92 " N/A " 8,664.92 " " 12,997.38 " N/A " 15,587.32 " " 15,435.69 " N/A DRG 580.1 No Current Volume N/A " 2,414.45 " " 4,343.35 " " 3,028.69 " N/A N/A N/A " 2,503.46 " N/A N/A N/A " 3,014.44 " N/A N/A " 2,414.45 " N/A N/A N/A N/A N/A N/A N/A " 2,571.39 " " 2,414.45 " N/A " 2,414.45 " " 3,621.68 " N/A " 4,343.35 " " 4,301.10 " N/A DRG 580.2 No Current Volume N/A " 3,667.56 " " 6,597.57 " " 4,600.59 " N/A N/A N/A " 3,802.76 " N/A N/A N/A " 4,578.95 " N/A N/A " 3,667.56 " N/A N/A N/A N/A N/A N/A N/A " 3,905.95 " " 3,667.56 " N/A " 3,667.56 " " 5,501.34 " N/A " 6,597.57 " " 6,533.39 " N/A DRG 580.3 No Current Volume N/A " 5,698.55 " " 10,251.12 " " 7,148.26 " N/A N/A N/A " 5,908.62 " N/A N/A N/A " 7,114.64 " N/A N/A " 5,698.55 " N/A N/A N/A N/A N/A N/A N/A " 6,068.96 " " 5,698.55 " N/A " 5,698.55 " " 8,547.83 " N/A " 10,251.12 " " 10,151.40 " N/A DRG 580.4 No Current Volume N/A " 10,432.96 " " 18,767.85 " " 13,087.11 " N/A N/A N/A " 10,817.56 " N/A N/A N/A " 13,025.55 " N/A N/A " 10,432.96 " N/A N/A N/A N/A N/A N/A N/A " 11,111.10 " " 10,432.96 " N/A " 10,432.96 " " 15,649.44 " N/A " 18,767.85 " " 18,585.27 " N/A DRG 581.1 " 14,983.06 " " 4,721.16 " " 1,051.10 " " 1,890.82 " " 1,318.50 " N/A N/A N/A " 1,089.85 " N/A N/A N/A " 1,312.30 " N/A N/A " 1,051.10 " N/A N/A N/A N/A N/A N/A N/A " 1,119.42 " " 1,051.10 " N/A " 1,051.10 " " 1,576.65 " N/A " 1,890.82 " " 1,872.43 " N/A DRG 581.2 No Current Volume N/A " 1,221.61 " " 2,197.55 " " 1,532.39 " N/A N/A N/A " 1,266.64 " N/A N/A N/A " 1,525.18 " N/A N/A " 1,221.61 " N/A N/A N/A N/A N/A N/A N/A " 1,301.01 " " 1,221.61 " N/A " 1,221.61 " " 1,832.42 " N/A " 2,197.55 " " 2,176.18 " N/A DRG 581.3 No Current Volume N/A " 2,198.07 " " 3,954.11 " " 2,757.26 " N/A N/A N/A " 2,279.10 " N/A N/A N/A " 2,744.29 " N/A N/A " 2,198.07 " N/A N/A N/A N/A N/A N/A N/A " 2,340.94 " " 2,198.07 " N/A " 2,198.07 " " 3,297.11 " N/A " 3,954.11 " " 3,915.64 " N/A DRG 581.4 " 24,023.36 " " 7,569.76 " " 3,440.90 " " 6,189.84 " " 4,316.26 " N/A N/A N/A " 3,567.75 " N/A N/A N/A " 4,295.96 " N/A N/A " 3,440.90 " N/A N/A N/A N/A N/A N/A N/A " 3,664.56 " " 3,440.90 " N/A " 3,440.90 " " 5,161.35 " N/A " 6,189.84 " " 6,129.62 " N/A DRG 583.1 No Current Volume N/A " 133,016.10 " " 239,282.66 " " 166,855.40 " N/A N/A N/A " 137,919.63 " N/A N/A N/A " 166,070.60 " N/A N/A " 133,016.10 " N/A N/A N/A N/A N/A N/A N/A " 141,662.15 " " 133,016.10 " N/A " 133,016.10 " " 199,524.15 " N/A " 239,282.66 " " 236,954.88 " N/A DRG 583.2 No Current Volume N/A " 133,303.01 " " 239,798.78 " " 167,215.30 " N/A N/A N/A " 138,217.12 " N/A N/A N/A " 166,428.81 " N/A N/A " 133,303.01 " N/A N/A N/A N/A N/A N/A N/A " 141,967.71 " " 133,303.01 " N/A " 133,303.01 " " 199,954.52 " N/A " 239,798.78 " " 237,465.98 " N/A DRG 583.3 No Current Volume N/A " 225,611.68 " " 405,852.85 " " 283,007.29 " N/A N/A N/A " 233,928.67 " N/A N/A N/A " 281,676.18 " N/A N/A " 225,611.68 " N/A N/A N/A N/A N/A N/A N/A " 240,276.44 " " 225,611.68 " N/A " 225,611.68 " " 338,417.52 " N/A " 405,852.85 " " 401,904.65 " N/A DRG 583.4 No Current Volume N/A " 248,173.06 " " 446,438.52 " " 311,308.29 " N/A N/A N/A " 257,321.75 " N/A N/A N/A " 309,844.07 " N/A N/A " 248,173.06 " N/A N/A N/A N/A N/A N/A N/A " 264,304.31 " " 248,173.06 " N/A " 248,173.06 " " 372,259.59 " N/A " 446,438.52 " " 442,095.49 " N/A DRG 588.1 No Current Volume N/A " 110,163.71 " " 198,173.50 " " 138,189.36 " N/A N/A N/A " 114,224.80 " N/A N/A N/A " 137,539.39 " N/A N/A " 110,163.71 " N/A N/A N/A N/A N/A N/A N/A " 117,324.35 " " 110,163.71 " N/A " 110,163.71 " " 165,245.57 " N/A " 198,173.50 " " 196,245.63 " N/A DRG 588.2 No Current Volume N/A " 122,403.74 " " 220,192.09 " " 153,543.25 " N/A N/A N/A " 126,916.05 " N/A N/A N/A " 152,821.07 " N/A N/A " 122,403.74 " N/A N/A N/A N/A N/A N/A N/A " 130,359.98 " " 122,403.74 " N/A " 122,403.74 " " 183,605.61 " N/A " 220,192.09 " " 218,050.02 " N/A DRG 588.3 No Current Volume N/A " 135,789.37 " " 244,271.50 " " 170,334.19 " N/A N/A N/A " 140,795.13 " N/A N/A N/A " 169,533.03 " N/A N/A " 135,789.37 " N/A N/A N/A N/A N/A N/A N/A " 144,615.68 " " 135,789.37 " N/A " 135,789.37 " " 203,684.06 " N/A " 244,271.50 " " 241,895.18 " N/A DRG 588.4 No Current Volume N/A " 197,928.33 " " 356,053.27 " " 248,281.30 " N/A N/A N/A " 205,224.79 " N/A N/A N/A " 247,113.52 " N/A N/A " 197,928.33 " N/A N/A N/A N/A N/A N/A N/A " 210,793.67 " " 197,928.33 " N/A " 197,928.33 " " 296,892.50 " N/A " 356,053.27 " " 352,589.53 " N/A DRG 589.1 No Current Volume N/A " 149,867.29 " " 269,596.27 " " 187,993.53 " N/A N/A N/A " 155,392.02 " N/A N/A N/A " 187,109.31 " N/A N/A " 149,867.29 " N/A N/A N/A N/A N/A N/A N/A " 159,608.66 " " 149,867.29 " N/A " 149,867.29 " " 224,800.94 " N/A " 269,596.27 " " 266,973.59 " N/A DRG 589.2 No Current Volume N/A " 105,124.58 " " 189,108.61 " " 131,868.27 " N/A N/A N/A " 108,999.91 " N/A N/A N/A " 131,248.04 " N/A N/A " 105,124.58 " N/A N/A N/A N/A N/A N/A N/A " 111,957.68 " " 105,124.58 " N/A " 105,124.58 " " 157,686.87 " N/A " 189,108.61 " " 187,268.93 " N/A DRG 589.3 No Current Volume N/A " 95,567.43 " " 171,916.25 " " 119,879.78 " N/A N/A N/A " 99,090.44 " N/A N/A N/A " 119,315.94 " N/A N/A " 95,567.43 " N/A N/A N/A N/A N/A N/A N/A " 101,779.31 " " 95,567.43 " N/A " 95,567.43 " " 143,351.15 " N/A " 171,916.25 " " 170,243.82 " N/A DRG 589.4 No Current Volume N/A " 18,107.71 " " 32,573.96 " " 22,714.31 " N/A N/A N/A " 18,775.24 " N/A N/A N/A " 22,607.48 " N/A N/A " 18,107.71 " N/A N/A N/A N/A N/A N/A N/A " 19,284.71 " " 18,107.71 " N/A " 18,107.71 " " 27,161.57 " N/A " 32,573.96 " " 32,257.07 " N/A DRG 591.1 No Current Volume N/A " 95,036.74 " " 170,961.59 " " 119,214.09 " N/A N/A N/A " 98,540.19 " N/A N/A N/A " 118,653.37 " N/A N/A " 95,036.74 " N/A N/A N/A N/A N/A N/A N/A " 101,214.13 " " 95,036.74 " N/A " 95,036.74 " " 142,555.11 " N/A " 170,961.59 " " 169,298.45 " N/A DRG 591.2 No Current Volume N/A " 131,812.98 " " 237,118.37 " " 165,346.20 " N/A N/A N/A " 136,672.16 " N/A N/A N/A " 164,568.51 " N/A N/A " 131,812.98 " N/A N/A N/A N/A N/A N/A N/A " 140,380.82 " " 131,812.98 " N/A " 131,812.98 " " 197,719.47 " N/A " 237,118.37 " " 234,811.64 " N/A DRG 591.3 No Current Volume N/A " 136,048.21 " " 244,737.12 " " 170,658.87 " N/A N/A N/A " 141,063.51 " N/A N/A N/A " 169,856.19 " N/A N/A " 136,048.21 " N/A N/A N/A N/A N/A N/A N/A " 144,891.34 " " 136,048.21 " N/A " 136,048.21 " " 204,072.32 " N/A " 244,737.12 " " 242,356.28 " N/A DRG 591.4 No Current Volume N/A " 169,964.22 " " 305,748.64 " " 213,203.12 " N/A N/A N/A " 176,229.81 " N/A N/A N/A " 212,200.33 " N/A N/A " 169,964.22 " N/A N/A N/A N/A N/A N/A N/A " 181,011.89 " " 169,964.22 " N/A " 169,964.22 " " 254,946.33 " N/A " 305,748.64 " " 302,774.26 " N/A DRG 593.1 No Current Volume N/A " 25,509.94 " " 45,889.83 " " 31,999.67 " N/A N/A N/A " 26,450.34 " N/A N/A N/A " 31,849.16 " N/A N/A " 25,509.94 " N/A N/A N/A N/A N/A N/A N/A " 27,168.09 " " 25,509.94 " N/A " 25,509.94 " " 38,264.91 " N/A " 45,889.83 " " 45,443.41 " N/A DRG 593.2 No Current Volume N/A " 97,697.02 " " 175,747.17 " " 122,551.14 " N/A N/A N/A " 101,298.54 " N/A N/A N/A " 121,974.73 " N/A N/A " 97,697.02 " N/A N/A N/A N/A N/A N/A N/A " 104,047.33 " " 97,697.02 " N/A " 97,697.02 " " 146,545.53 " N/A " 175,747.17 " " 174,037.47 " N/A DRG 593.3 No Current Volume N/A " 113,946.99 " " 204,979.24 " " 142,935.10 " N/A N/A N/A " 118,147.55 " N/A N/A N/A " 142,262.82 " N/A N/A " 113,946.99 " N/A N/A N/A N/A N/A N/A N/A " 121,353.54 " " 113,946.99 " N/A " 113,946.99 " " 170,920.49 " N/A " 204,979.24 " " 202,985.17 " N/A DRG 593.4 No Current Volume N/A " 148,766.20 " " 267,615.52 " " 186,612.32 " N/A N/A N/A " 154,250.34 " N/A N/A N/A " 185,734.60 " N/A N/A " 148,766.20 " N/A N/A N/A N/A N/A N/A N/A " 158,436.00 " " 148,766.20 " N/A " 148,766.20 " " 223,149.30 " N/A " 267,615.52 " " 265,012.11 " N/A DRG 602.1 No Current Volume N/A " 46,293.00 " " 83,276.48 " " 58,069.94 " N/A N/A N/A " 47,999.55 " N/A N/A N/A " 57,796.81 " N/A N/A " 46,293.00 " N/A N/A N/A N/A N/A N/A N/A " 49,302.05 " " 46,293.00 " N/A " 46,293.00 " " 69,439.50 " N/A " 83,276.48 " " 82,466.35 " N/A DRG 602.2 No Current Volume N/A " 70,605.98 " " 127,013.10 " " 88,568.14 " N/A N/A N/A " 73,208.81 " N/A N/A N/A " 88,151.57 " N/A N/A " 70,605.98 " N/A N/A N/A N/A N/A N/A N/A " 75,195.37 " " 70,605.98 " N/A " 70,605.98 " " 105,908.97 " N/A " 127,013.10 " " 125,777.49 " N/A DRG 602.3 No Current Volume N/A " 88,494.57 " " 159,192.88 " " 111,007.59 " N/A N/A N/A " 91,756.85 " N/A N/A N/A " 110,485.47 " N/A N/A " 88,494.57 " N/A N/A N/A N/A N/A N/A N/A " 94,246.72 " " 88,494.57 " N/A " 88,494.57 " " 132,741.86 " N/A " 159,192.88 " " 157,644.23 " N/A DRG 602.4 No Current Volume N/A " 125,594.02 " " 225,931.08 " " 157,545.14 " N/A N/A N/A " 130,223.94 " N/A N/A N/A " 156,804.13 " N/A N/A " 125,594.02 " N/A N/A N/A N/A N/A N/A N/A " 133,757.63 " " 125,594.02 " N/A " 125,594.02 " " 188,391.03 " N/A " 225,931.08 " " 223,733.19 " N/A DRG 603.1 " 44,617.35 " " 14,058.93 " " 26,154.29 " " 47,048.95 " " 32,807.94 " N/A N/A N/A " 27,118.45 " N/A N/A N/A " 32,653.63 " N/A N/A " 26,154.29 " N/A N/A N/A N/A N/A N/A N/A " 27,854.32 " " 26,154.29 " N/A " 26,154.29 " " 39,231.44 " N/A " 47,048.95 " " 46,591.25 " N/A DRG 603.2 No Current Volume N/A " 49,620.23 " " 89,261.83 " " 62,243.62 " N/A N/A N/A " 51,449.44 " N/A N/A N/A " 61,950.86 " N/A N/A " 49,620.23 " N/A N/A N/A N/A N/A N/A N/A " 52,845.54 " " 49,620.23 " N/A " 49,620.23 " " 74,430.35 " N/A " 89,261.83 " " 88,393.48 " N/A DRG 603.3 No Current Volume N/A " 76,331.92 " " 137,313.49 " " 95,750.76 " N/A N/A N/A " 79,145.83 " N/A N/A N/A " 95,300.40 " N/A N/A " 76,331.92 " N/A N/A N/A N/A N/A N/A N/A " 81,293.49 " " 76,331.92 " N/A " 76,331.92 " " 114,497.88 " N/A " 137,313.49 " " 135,977.68 " N/A DRG 603.4 No Current Volume N/A " 98,275.64 " " 176,788.05 " " 123,276.96 " N/A N/A N/A " 101,898.49 " N/A N/A N/A " 122,697.14 " N/A N/A " 98,275.64 " N/A N/A N/A N/A N/A N/A N/A " 104,663.56 " " 98,275.64 " N/A " 98,275.64 " " 147,413.46 " N/A " 176,788.05 " " 175,068.23 " N/A DRG 607.1 No Current Volume N/A " 38,204.65 " " 68,726.34 " " 47,923.91 " N/A N/A N/A " 39,613.03 " N/A N/A N/A " 47,698.51 " N/A N/A " 38,204.65 " N/A N/A N/A N/A N/A N/A N/A " 40,687.95 " " 38,204.65 " N/A " 38,204.65 " " 57,306.98 " N/A " 68,726.34 " " 68,057.76 " N/A DRG 607.2 No Current Volume N/A " 49,692.82 " " 89,392.41 " " 62,334.67 " N/A N/A N/A " 51,524.70 " N/A N/A N/A " 62,041.49 " N/A N/A " 49,692.82 " N/A N/A N/A N/A N/A N/A N/A " 52,922.85 " " 49,692.82 " N/A " 49,692.82 " " 74,539.23 " N/A " 89,392.41 " " 88,522.79 " N/A DRG 607.3 No Current Volume N/A " 64,775.96 " " 116,525.47 " " 81,254.96 " N/A N/A N/A " 67,163.87 " N/A N/A N/A " 80,872.79 " N/A N/A " 64,775.96 " N/A N/A N/A N/A N/A N/A N/A " 68,986.40 " " 64,775.96 " N/A " 64,775.96 " " 97,163.94 " N/A " 116,525.47 " " 115,391.90 " N/A DRG 607.4 No Current Volume N/A " 101,483.04 " " 182,557.84 " " 127,300.33 " N/A N/A N/A " 105,224.13 " N/A N/A N/A " 126,701.58 " N/A N/A " 101,483.04 " N/A N/A N/A N/A N/A N/A N/A " 108,079.44 " " 101,483.04 " N/A " 101,483.04 " " 152,224.56 " N/A " 182,557.84 " " 180,781.89 " N/A DRG 608.1 No Current Volume N/A " 24,678.64 " " 44,394.41 " " 30,956.89 " N/A N/A N/A " 25,588.40 " N/A N/A N/A " 30,811.28 " N/A N/A " 24,678.64 " N/A N/A N/A N/A N/A N/A N/A " 26,282.75 " " 24,678.64 " N/A " 24,678.64 " " 37,017.96 " N/A " 44,394.41 " " 43,962.53 " N/A DRG 608.2 No Current Volume N/A " 37,232.98 " " 66,978.41 " " 46,705.05 " N/A N/A N/A " 38,605.54 " N/A N/A N/A " 46,485.38 " N/A N/A " 37,232.98 " N/A N/A N/A N/A N/A N/A N/A " 39,653.12 " " 37,232.98 " N/A " 37,232.98 " " 55,849.47 " N/A " 66,978.41 " " 66,326.83 " N/A DRG 608.3 " 1,163,654.08 " " 366,667.40 " " 53,087.84 " " 95,499.72 " " 66,593.39 " N/A N/A N/A " 55,044.88 " N/A N/A N/A " 66,280.17 " N/A N/A " 53,087.84 " N/A N/A N/A N/A N/A N/A N/A " 56,538.55 " " 53,087.84 " N/A " 53,087.84 " " 79,631.76 " N/A " 95,499.72 " " 94,570.68 " N/A DRG 608.4 No Current Volume N/A " 95,742.72 " " 172,231.58 " " 120,099.67 " N/A N/A N/A " 99,272.20 " N/A N/A N/A " 119,534.79 " N/A N/A " 95,742.72 " N/A N/A N/A N/A N/A N/A N/A " 101,966.00 " " 95,742.72 " N/A " 95,742.72 " " 143,614.08 " N/A " 172,231.58 " " 170,556.08 " N/A DRG 609.1 No Current Volume N/A " 41,657.88 " " 74,938.36 " " 52,255.64 " N/A N/A N/A " 43,193.56 " N/A N/A N/A " 52,009.86 " N/A N/A " 41,657.88 " N/A N/A N/A N/A N/A N/A N/A " 44,365.64 " " 41,657.88 " N/A " 41,657.88 " " 62,486.82 " N/A " 74,938.36 " " 74,209.35 " N/A DRG 609.2 No Current Volume N/A " 44,815.29 " " 80,618.23 " " 56,216.30 " N/A N/A N/A " 46,467.37 " N/A N/A N/A " 55,951.89 " N/A N/A " 44,815.29 " N/A N/A N/A N/A N/A N/A N/A " 47,728.28 " " 44,815.29 " N/A " 44,815.29 " " 67,222.94 " N/A " 80,618.23 " " 79,833.96 " N/A DRG 609.3 No Current Volume N/A " 77,254.28 " " 138,972.72 " " 96,907.77 " N/A N/A N/A " 80,102.20 " N/A N/A N/A " 96,451.97 " N/A N/A " 77,254.28 " N/A N/A N/A N/A N/A N/A N/A " 82,275.81 " " 77,254.28 " N/A " 77,254.28 " " 115,881.42 " N/A " 138,972.72 " " 137,620.77 " N/A DRG 609.4 No Current Volume N/A " 156,578.59 " " 281,669.23 " " 196,412.18 " N/A N/A N/A " 162,350.73 " N/A N/A N/A " 195,488.37 " N/A N/A " 156,578.59 " N/A N/A N/A N/A N/A N/A N/A " 166,756.20 " " 156,578.59 " N/A " 156,578.59 " " 234,867.89 " N/A " 281,669.23 " " 278,929.10 " N/A DRG 611.1 No Current Volume N/A " 18,172.08 " " 32,689.75 " " 22,795.06 " N/A N/A N/A " 18,841.98 " N/A N/A N/A " 22,687.84 " N/A N/A " 18,172.08 " N/A N/A N/A N/A N/A N/A N/A " 19,353.27 " " 18,172.08 " N/A " 18,172.08 " " 27,258.12 " N/A " 32,689.75 " " 32,371.74 " N/A DRG 611.2 No Current Volume N/A " 30,467.58 " " 54,808.13 " " 38,218.53 " N/A N/A N/A " 31,590.74 " N/A N/A N/A " 38,038.77 " N/A N/A " 30,467.58 " N/A N/A N/A N/A N/A N/A N/A " 32,447.97 " " 30,467.58 " N/A " 30,467.58 " " 45,701.37 " N/A " 54,808.13 " " 54,274.95 " N/A DRG 611.3 No Current Volume N/A " 50,678.18 " " 91,164.98 " " 63,570.71 " N/A N/A N/A " 52,546.39 " N/A N/A N/A " 63,271.71 " N/A N/A " 50,678.18 " N/A N/A N/A N/A N/A N/A N/A " 53,972.26 " " 50,678.18 " N/A " 50,678.18 " " 76,017.27 " N/A " 91,164.98 " " 90,278.11 " N/A DRG 611.4 No Current Volume N/A " 88,742.45 " " 159,638.79 " " 111,318.53 " N/A N/A N/A " 92,013.87 " N/A N/A N/A " 110,794.95 " N/A N/A " 88,742.45 " N/A N/A N/A N/A N/A N/A N/A " 94,510.71 " " 88,742.45 " N/A " 88,742.45 " " 133,113.68 " N/A " 159,638.79 " " 158,085.80 " N/A DRG 612.1 No Current Volume N/A " 24,738.90 " " 44,502.81 " " 31,032.48 " N/A N/A N/A " 25,650.88 " N/A N/A N/A " 30,886.52 " N/A N/A " 24,738.90 " N/A N/A N/A N/A N/A N/A N/A " 26,346.93 " " 24,738.90 " N/A " 24,738.90 " " 37,108.35 " N/A " 44,502.81 " " 44,069.88 " N/A DRG 612.2 " 209,171.61 " " 65,909.97 " " 33,624.99 " " 60,487.99 " " 42,179.19 " N/A N/A N/A " 34,864.55 " N/A N/A N/A " 41,980.80 " N/A N/A " 33,624.99 " N/A N/A N/A N/A N/A N/A N/A " 35,810.61 " " 33,624.99 " N/A " 33,624.99 " " 50,437.49 " N/A " 60,487.99 " " 59,899.56 " N/A DRG 612.3 No Current Volume N/A " 44,948.13 " " 80,857.19 " " 56,382.93 " N/A N/A N/A " 46,605.11 " N/A N/A N/A " 56,117.74 " N/A N/A " 44,948.13 " N/A N/A N/A N/A N/A N/A N/A " 47,869.76 " " 44,948.13 " N/A " 44,948.13 " " 67,422.20 " N/A " 80,857.19 " " 80,070.60 " N/A DRG 612.4 No Current Volume N/A " 65,123.81 " " 117,151.22 " " 81,691.31 " N/A N/A N/A " 67,524.55 " N/A N/A N/A " 81,307.08 " N/A N/A " 65,123.81 " N/A N/A N/A N/A N/A N/A N/A " 69,356.86 " " 65,123.81 " N/A " 65,123.81 " " 97,685.72 " N/A " 117,151.22 " " 116,011.56 " N/A DRG 613.1 No Current Volume N/A " 20,168.15 " " 36,280.49 " " 25,298.93 " N/A N/A N/A " 20,911.63 " N/A N/A N/A " 25,179.94 " N/A N/A " 20,168.15 " N/A N/A N/A N/A N/A N/A N/A " 21,479.08 " " 20,168.15 " N/A " 20,168.15 " " 30,252.23 " N/A " 36,280.49 " " 35,927.54 " N/A DRG 613.2 No Current Volume N/A " 31,570.72 " " 56,792.57 " " 39,602.31 " N/A N/A N/A " 32,734.55 " N/A N/A N/A " 39,416.04 " N/A N/A " 31,570.72 " N/A N/A N/A N/A N/A N/A N/A " 33,622.82 " " 31,570.72 " N/A " 31,570.72 " " 47,356.08 " N/A " 56,792.57 " " 56,240.08 " N/A DRG 613.3 No Current Volume N/A " 44,199.01 " " 79,509.60 " " 55,443.24 " N/A N/A N/A " 45,828.37 " N/A N/A N/A " 55,182.46 " N/A N/A " 44,199.01 " N/A N/A N/A N/A N/A N/A N/A " 47,071.95 " " 44,199.01 " N/A " 44,199.01 " " 66,298.52 " N/A " 79,509.60 " " 78,736.12 " N/A DRG 613.4 No Current Volume N/A " 76,533.92 " " 137,676.87 " " 96,004.15 " N/A N/A N/A " 79,355.28 " N/A N/A N/A " 95,552.60 " N/A N/A " 76,533.92 " N/A N/A N/A N/A N/A N/A N/A " 81,508.62 " " 76,533.92 " N/A " 76,533.92 " " 114,800.88 " N/A " 137,676.87 " " 136,337.53 " N/A DRG 614.1 " 253,886.37 " " 79,999.60 " " 13,688.98 " " 24,625.11 " " 17,171.46 " N/A N/A N/A " 14,193.61 " N/A N/A N/A " 17,090.69 " N/A N/A " 13,688.98 " N/A N/A N/A N/A N/A N/A N/A " 14,578.76 " " 13,688.98 " N/A " 13,688.98 " " 20,533.47 " N/A " 24,625.11 " " 24,385.55 " N/A DRG 614.2 " 126,996.55 " " 40,016.61 " " 23,133.15 " " 41,614.22 " " 29,018.22 " N/A N/A N/A " 23,985.93 " N/A N/A N/A " 28,881.74 " N/A N/A " 23,133.15 " N/A N/A N/A N/A N/A N/A N/A " 24,636.80 " " 23,133.15 " N/A " 23,133.15 " " 34,699.73 " N/A " 41,614.22 " " 41,209.39 " N/A DRG 614.3 No Current Volume N/A " 39,489.25 " " 71,037.21 " " 49,535.32 " N/A N/A N/A " 40,944.99 " N/A N/A N/A " 49,302.33 " N/A N/A " 39,489.25 " N/A N/A N/A N/A N/A N/A N/A " 42,056.05 " " 39,489.25 " N/A " 39,489.25 " " 59,233.88 " N/A " 71,037.21 " " 70,346.15 " N/A DRG 614.4 No Current Volume N/A " 70,282.09 " " 126,430.45 " " 88,161.85 " N/A N/A N/A " 72,872.98 " N/A N/A N/A " 87,747.19 " N/A N/A " 70,282.09 " N/A N/A N/A N/A N/A N/A N/A " 74,850.43 " " 70,282.09 " N/A " 70,282.09 " " 105,423.14 " N/A " 126,430.45 " " 125,200.52 " N/A DRG 621.1 No Current Volume N/A " 10,616.47 " " 19,097.97 " " 13,317.30 " N/A N/A N/A " 11,007.84 " N/A N/A N/A " 13,254.66 " N/A N/A " 10,616.47 " N/A N/A N/A N/A N/A N/A N/A " 11,306.54 " " 10,616.47 " N/A " 10,616.47 " " 15,924.71 " N/A " 19,097.97 " " 18,912.18 " N/A DRG 621.2 No Current Volume N/A " 22,838.70 " " 41,084.54 " " 28,648.87 " N/A N/A N/A " 23,680.63 " N/A N/A N/A " 28,514.12 " N/A N/A " 22,838.70 " N/A N/A N/A N/A N/A N/A N/A " 24,323.22 " " 22,838.70 " N/A " 22,838.70 " " 34,258.05 " N/A " 41,084.54 " " 40,684.86 " N/A DRG 621.3 No Current Volume N/A " 41,663.35 " " 74,948.20 " " 52,262.51 " N/A N/A N/A " 43,199.24 " N/A N/A N/A " 52,016.69 " N/A N/A " 41,663.35 " N/A N/A N/A N/A N/A N/A N/A " 44,371.47 " " 41,663.35 " N/A " 41,663.35 " " 62,495.03 " N/A " 74,948.20 " " 74,219.09 " N/A DRG 621.4 No Current Volume N/A " 79,661.89 " " 143,303.77 " " 99,927.87 " N/A N/A N/A " 82,598.56 " N/A N/A N/A " 99,457.87 " N/A N/A " 79,661.89 " N/A N/A N/A N/A N/A N/A N/A " 84,839.91 " " 79,661.89 " N/A " 79,661.89 " " 119,492.84 " N/A " 143,303.77 " " 141,909.69 " N/A DRG 622.1 No Current Volume N/A " 15,403.61 " " 27,709.55 " " 19,322.29 " N/A N/A N/A " 15,971.45 " N/A N/A N/A " 19,231.41 " N/A N/A " 15,403.61 " N/A N/A N/A N/A N/A N/A N/A " 16,404.84 " " 15,403.61 " N/A " 15,403.61 " " 23,105.42 " N/A " 27,709.55 " " 27,439.99 " N/A DRG 622.2 No Current Volume N/A " 20,787.85 " " 37,395.26 " " 26,076.28 " N/A N/A N/A " 21,554.18 " N/A N/A N/A " 25,953.63 " N/A N/A " 20,787.85 " N/A N/A N/A N/A N/A N/A N/A " 22,139.06 " " 20,787.85 " N/A " 20,787.85 " " 31,181.78 " N/A " 37,395.26 " " 37,031.48 " N/A DRG 622.3 No Current Volume N/A " 26,997.23 " " 48,565.32 " " 33,865.33 " N/A N/A N/A " 27,992.46 " N/A N/A N/A " 33,706.04 " N/A N/A " 26,997.23 " N/A N/A N/A N/A N/A N/A N/A " 28,752.05 " " 26,997.23 " N/A " 26,997.23 " " 40,495.85 " N/A " 48,565.32 " " 48,092.87 " N/A DRG 622.4 No Current Volume N/A " 52,405.14 " " 94,271.61 " " 65,737.01 " N/A N/A N/A " 54,337.01 " N/A N/A N/A " 65,427.82 " N/A N/A " 52,405.14 " N/A N/A N/A N/A N/A N/A N/A " 55,811.47 " " 52,405.14 " N/A " 52,405.14 " " 78,607.71 " N/A " 94,271.61 " " 93,354.52 " N/A DRG 623.1 No Current Volume N/A " 12,096.23 " " 21,759.91 " " 15,173.51 " N/A N/A N/A " 12,542.15 " N/A N/A N/A " 15,102.14 " N/A N/A " 12,096.23 " N/A N/A N/A N/A N/A N/A N/A " 12,882.48 " " 12,096.23 " N/A " 12,096.23 " " 18,144.35 " N/A " 21,759.91 " " 21,548.22 " N/A DRG 623.2 No Current Volume N/A " 17,464.73 " " 31,417.30 " " 21,907.76 " N/A N/A N/A " 18,108.55 " N/A N/A N/A " 21,804.72 " N/A N/A " 17,464.73 " N/A N/A N/A N/A N/A N/A N/A " 18,599.94 " " 17,464.73 " N/A " 17,464.73 " " 26,197.10 " N/A " 31,417.30 " " 31,111.67 " N/A DRG 623.3 No Current Volume N/A " 30,214.22 " " 54,352.36 " " 37,900.72 " N/A N/A N/A " 31,328.04 " N/A N/A N/A " 37,722.45 " N/A N/A " 30,214.22 " N/A N/A N/A N/A N/A N/A N/A " 32,178.14 " " 30,214.22 " N/A " 30,214.22 " " 45,321.33 " N/A " 54,352.36 " " 53,823.61 " N/A DRG 623.4 No Current Volume N/A " 44,816.66 " " 80,620.69 " " 56,218.02 " N/A N/A N/A " 46,468.79 " N/A N/A N/A " 55,953.60 " N/A N/A " 44,816.66 " N/A N/A N/A N/A N/A N/A N/A " 47,729.74 " " 44,816.66 " N/A " 44,816.66 " " 67,224.99 " N/A " 80,620.69 " " 79,836.40 " N/A DRG 625.1 " 73,005.04 " " 23,003.89 " " 12,953.55 " " 23,302.14 " " 16,248.93 " N/A N/A N/A " 13,431.07 " N/A N/A N/A " 16,172.51 " N/A N/A " 12,953.55 " N/A N/A N/A N/A N/A N/A N/A " 13,795.53 " " 12,953.55 " N/A " 12,953.55 " " 19,430.33 " N/A " 23,302.14 " " 23,075.45 " N/A DRG 625.2 No Current Volume N/A " 18,309.72 " " 32,937.36 " " 22,967.71 " N/A N/A N/A " 18,984.69 " N/A N/A N/A " 22,859.69 " N/A N/A " 18,309.72 " N/A N/A N/A N/A N/A N/A N/A " 19,499.85 " " 18,309.72 " N/A " 18,309.72 " " 27,464.58 " N/A " 32,937.36 " " 32,616.94 " N/A DRG 625.3 No Current Volume N/A " 27,107.48 " " 48,763.65 " " 34,003.62 " N/A N/A N/A " 28,106.77 " N/A N/A N/A " 33,843.69 " N/A N/A " 27,107.48 " N/A N/A N/A N/A N/A N/A N/A " 28,869.47 " " 27,107.48 " N/A " 27,107.48 " " 40,661.22 " N/A " 48,763.65 " " 48,289.26 " N/A DRG 625.4 No Current Volume N/A " 40,067.19 " " 72,076.87 " " 50,260.28 " N/A N/A N/A " 41,544.23 " N/A N/A N/A " 50,023.89 " N/A N/A " 40,067.19 " N/A N/A N/A N/A N/A N/A N/A " 42,671.56 " " 40,067.19 " N/A " 40,067.19 " " 60,100.79 " N/A " 72,076.87 " " 71,375.69 " N/A DRG 626.1 No Current Volume N/A " 1,554.40 " " 2,796.21 " " 1,949.84 " N/A N/A N/A " 1,611.70 " N/A N/A N/A " 1,940.67 " N/A N/A " 1,554.40 " N/A N/A N/A N/A N/A N/A N/A " 1,655.44 " " 1,554.40 " N/A " 1,554.40 " " 2,331.60 " N/A " 2,796.21 " " 2,769.01 " N/A DRG 626.2 " 20,298.61 " " 6,396.09 " " 2,801.34 " " 5,039.33 " " 3,514.00 " N/A N/A N/A " 2,904.61 " N/A N/A N/A " 3,497.47 " N/A N/A " 2,801.34 " N/A N/A N/A N/A N/A N/A N/A " 2,983.43 " " 2,801.34 " N/A " 2,801.34 " " 4,202.01 " N/A " 5,039.33 " " 4,990.31 " N/A DRG 626.3 " 14,739.75 " " 4,644.50 " " 7,831.57 " " 14,088.21 " " 9,823.92 " N/A N/A N/A " 8,120.27 " N/A N/A N/A " 9,777.72 " N/A N/A " 7,831.57 " N/A N/A N/A N/A N/A N/A N/A " 8,340.62 " " 7,831.57 " N/A " 7,831.57 " " 11,747.36 " N/A " 14,088.21 " " 13,951.16 " N/A DRG 626.4 No Current Volume N/A " 27,143.77 " " 48,828.93 " " 34,049.15 " N/A N/A N/A " 28,144.40 " N/A N/A N/A " 33,889.00 " N/A N/A " 27,143.77 " N/A N/A N/A N/A N/A N/A N/A " 28,908.12 " " 27,143.77 " N/A " 27,143.77 " " 40,715.66 " N/A " 48,828.93 " " 48,353.91 " N/A DRG 630.1 No Current Volume N/A " 24,614.96 " " 44,279.85 " " 30,877.01 " N/A N/A N/A " 25,522.37 " N/A N/A N/A " 30,731.78 " N/A N/A " 24,614.96 " N/A N/A N/A N/A N/A N/A N/A " 26,214.93 " " 24,614.96 " N/A " 24,614.96 " " 36,922.44 " N/A " 44,279.85 " " 43,849.09 " N/A DRG 630.2 No Current Volume N/A " 44,725.59 " " 80,456.86 " " 56,103.78 " N/A N/A N/A " 46,374.36 " N/A N/A N/A " 55,839.90 " N/A N/A " 44,725.59 " N/A N/A N/A N/A N/A N/A N/A " 47,632.75 " " 44,725.59 " N/A " 44,725.59 " " 67,088.39 " N/A " 80,456.86 " " 79,674.17 " N/A DRG 630.3 No Current Volume N/A " 73,033.44 " " 131,379.86 " " 91,613.15 " N/A N/A N/A " 75,725.76 " N/A N/A N/A " 91,182.25 " N/A N/A " 73,033.44 " N/A N/A N/A N/A N/A N/A N/A " 77,780.61 " " 73,033.44 " N/A " 73,033.44 " " 109,550.16 " N/A " 131,379.86 " " 130,101.77 " N/A DRG 630.4 No Current Volume N/A " 128,098.86 " " 230,437.04 " " 160,687.21 " N/A N/A N/A " 132,821.12 " N/A N/A N/A " 159,931.43 " N/A N/A " 128,098.86 " N/A N/A N/A N/A N/A N/A N/A " 136,425.29 " " 128,098.86 " N/A " 128,098.86 " " 192,148.29 " N/A " 230,437.04 " " 228,195.31 " N/A DRG 631.1 No Current Volume N/A " 16,842.28 " " 30,297.58 " " 21,126.96 " N/A N/A N/A " 17,463.16 " N/A N/A N/A " 21,027.59 " N/A N/A " 16,842.28 " N/A N/A N/A N/A N/A N/A N/A " 17,937.03 " " 16,842.28 " N/A " 16,842.28 " " 25,263.42 " N/A " 30,297.58 " " 30,002.84 " N/A DRG 631.2 No Current Volume N/A " 31,211.91 " " 56,147.10 " " 39,152.22 " N/A N/A N/A " 32,362.51 " N/A N/A N/A " 38,968.07 " N/A N/A " 31,211.91 " N/A N/A N/A N/A N/A N/A N/A " 33,240.68 " " 31,211.91 " N/A " 31,211.91 " " 46,817.87 " N/A " 56,147.10 " " 55,600.90 " N/A DRG 631.3 No Current Volume N/A " 54,857.25 " " 98,682.71 " " 68,812.93 " N/A N/A N/A " 56,879.52 " N/A N/A N/A " 68,489.28 " N/A N/A " 54,857.25 " N/A N/A N/A N/A N/A N/A N/A " 58,422.97 " " 54,857.25 " N/A " 54,857.25 " " 82,285.88 " N/A " 98,682.71 " " 97,722.71 " N/A DRG 631.4 No Current Volume N/A " 119,518.86 " " 215,002.48 " " 149,924.46 " N/A N/A N/A " 123,924.82 " N/A N/A N/A " 149,219.30 " N/A N/A " 119,518.86 " N/A N/A N/A N/A N/A N/A N/A " 127,287.59 " " 119,518.86 " N/A " 119,518.86 " " 179,278.29 " N/A " 215,002.48 " " 212,910.90 " N/A DRG 633.1 " 39,671.10 " " 12,500.36 " " 4,149.63 " " 7,464.77 " " 5,205.30 " N/A N/A N/A " 4,302.60 " N/A N/A N/A " 5,180.81 " N/A N/A " 4,149.63 " N/A N/A N/A N/A N/A N/A N/A " 4,419.36 " " 4,149.63 " N/A " 4,149.63 " " 6,224.45 " N/A " 7,464.77 " " 7,392.15 " N/A DRG 633.2 " 48,904.97 " " 15,409.96 " " 13,057.63 " " 23,489.37 " " 16,379.49 " N/A N/A N/A " 13,538.99 " N/A N/A N/A " 16,302.45 " N/A N/A " 13,057.63 " N/A N/A N/A N/A N/A N/A N/A " 13,906.38 " " 13,057.63 " N/A " 13,057.63 " " 19,586.45 " N/A " 23,489.37 " " 23,260.86 " N/A DRG 633.3 " 424,878.58 " " 133,879.24 " " 29,460.99 " " 52,997.37 " " 36,955.87 " N/A N/A N/A " 30,547.04 " N/A N/A N/A " 36,782.05 " N/A N/A " 29,460.99 " N/A N/A N/A N/A N/A N/A N/A " 31,375.95 " " 29,460.99 " N/A " 29,460.99 " " 44,191.49 " N/A " 52,997.37 " " 52,481.81 " N/A DRG 633.4 No Current Volume N/A " 68,158.66 " " 122,610.61 " " 85,498.22 " N/A N/A N/A " 70,671.27 " N/A N/A N/A " 85,096.09 " N/A N/A " 68,158.66 " N/A N/A N/A N/A N/A N/A N/A " 72,588.97 " " 68,158.66 " N/A " 68,158.66 " " 102,237.99 " N/A " 122,610.61 " " 121,417.84 " N/A DRG 634.1 " 48,968.38 " " 15,429.94 " " 6,847.57 " " 12,318.09 " " 8,589.59 " N/A N/A N/A " 7,100.00 " N/A N/A N/A " 8,549.19 " N/A N/A " 6,847.57 " N/A N/A N/A N/A N/A N/A N/A " 7,292.66 " " 6,847.57 " N/A " 6,847.57 " " 10,271.36 " N/A " 12,318.09 " " 12,198.26 " N/A DRG 634.2 No Current Volume N/A " 12,203.05 " " 21,952.07 " " 15,307.51 " N/A N/A N/A " 12,652.91 " N/A N/A N/A " 15,235.51 " N/A N/A " 12,203.05 " N/A N/A N/A N/A N/A N/A N/A " 12,996.25 " " 12,203.05 " N/A " 12,203.05 " " 18,304.58 " N/A " 21,952.07 " " 21,738.51 " N/A DRG 634.3 " 61,197.92 " " 19,283.46 " " 18,226.18 " " 32,787.08 " " 22,862.92 " N/A N/A N/A " 18,898.07 " N/A N/A N/A " 22,755.39 " N/A N/A " 18,226.18 " N/A N/A N/A N/A N/A N/A N/A " 19,410.88 " " 18,226.18 " N/A " 18,226.18 " " 27,339.27 " N/A " 32,787.08 " " 32,468.12 " N/A DRG 634.4 No Current Volume N/A " 45,580.16 " " 81,994.15 " " 57,175.75 " N/A N/A N/A " 47,260.44 " N/A N/A N/A " 56,906.83 " N/A N/A " 45,580.16 " N/A N/A N/A N/A N/A N/A N/A " 48,542.87 " " 45,580.16 " N/A " 45,580.16 " " 68,370.24 " N/A " 81,994.15 " " 81,196.50 " N/A DRG 636.1 No Current Volume N/A " 6,679.12 " " 12,015.07 " " 8,378.29 " N/A N/A N/A " 6,925.34 " N/A N/A N/A " 8,338.88 " N/A N/A " 6,679.12 " N/A N/A N/A N/A N/A N/A N/A " 7,113.26 " " 6,679.12 " N/A " 6,679.12 " " 10,018.68 " N/A " 12,015.07 " " 11,898.18 " N/A DRG 636.2 No Current Volume N/A " 10,136.46 " " 18,234.48 " " 12,715.18 " N/A N/A N/A " 10,510.13 " N/A N/A N/A " 12,655.37 " N/A N/A " 10,136.46 " N/A N/A N/A N/A N/A N/A N/A " 10,795.33 " " 10,136.46 " N/A " 10,136.46 " " 15,204.69 " N/A " 18,234.48 " " 18,057.09 " N/A DRG 636.3 No Current Volume N/A " 20,309.89 " " 36,535.46 " " 25,476.73 " N/A N/A N/A " 21,058.60 " N/A N/A N/A " 25,356.90 " N/A N/A " 20,309.89 " N/A N/A N/A N/A N/A N/A N/A " 21,630.03 " " 20,309.89 " N/A " 20,309.89 " " 30,464.84 " N/A " 36,535.46 " " 36,180.04 " N/A DRG 636.4 No Current Volume N/A " 35,981.93 " " 64,727.89 " " 45,135.73 " N/A N/A N/A " 37,308.37 " N/A N/A N/A " 44,923.44 " N/A N/A " 35,981.93 " N/A N/A N/A N/A N/A N/A N/A " 38,320.76 " " 35,981.93 " N/A " 35,981.93 " " 53,972.90 " N/A " 64,727.89 " " 64,098.21 " N/A DRG 639.1 " 25,062.94 " " 7,897.33 " " 6,364.82 " " 11,449.67 " " 7,984.03 " N/A N/A N/A " 6,599.45 " N/A N/A N/A " 7,946.48 " N/A N/A " 6,364.82 " N/A N/A N/A N/A N/A N/A N/A " 6,778.53 " " 6,364.82 " N/A " 6,364.82 " " 9,547.23 " N/A " 11,449.67 " " 11,338.29 " N/A DRG 639.2 " 161,532.03 " " 50,898.74 " " 11,315.61 " " 20,355.65 " " 14,194.30 " N/A N/A N/A " 11,732.75 " N/A N/A N/A " 14,127.54 " N/A N/A " 11,315.61 " N/A N/A N/A N/A N/A N/A N/A " 12,051.12 " " 11,315.61 " N/A " 11,315.61 " " 16,973.42 " N/A " 20,355.65 " " 20,157.63 " N/A DRG 639.3 No Current Volume N/A " 17,880.37 " " 32,165.00 " " 22,429.14 " N/A N/A N/A " 18,539.52 " N/A N/A N/A " 22,323.64 " N/A N/A " 17,880.37 " N/A N/A N/A N/A N/A N/A N/A " 19,042.59 " " 17,880.37 " N/A " 17,880.37 " " 26,820.56 " N/A " 32,165.00 " " 31,852.09 " N/A DRG 639.4 No Current Volume N/A " 30,538.79 " " 54,936.23 " " 38,307.86 " N/A N/A N/A " 31,664.58 " N/A N/A N/A " 38,127.68 " N/A N/A " 30,538.79 " N/A N/A N/A N/A N/A N/A N/A " 32,523.81 " " 30,538.79 " N/A " 30,538.79 " " 45,808.19 " N/A " 54,936.23 " " 54,401.80 " N/A DRG 640.1 " 13,753.77 " " 4,333.81 " 874.43 " 1,573.01 " " 1,096.88 " N/A N/A N/A 906.67 N/A N/A N/A " 1,091.73 " N/A N/A 874.43 N/A N/A N/A N/A N/A N/A N/A 931.27 874.43 N/A 874.43 " 1,311.65 " N/A " 1,573.01 " " 1,557.71 " N/A DRG 640.2 " 19,623.38 " " 6,183.33 " " 1,382.52 " " 2,487.02 " " 1,734.23 " N/A N/A N/A " 1,433.49 " N/A N/A N/A " 1,726.08 " N/A N/A " 1,382.52 " N/A N/A N/A N/A N/A N/A N/A " 1,472.38 " " 1,382.52 " N/A " 1,382.52 " " 2,073.78 " N/A " 2,487.02 " " 2,462.82 " N/A DRG 640.3 " 21,087.73 " " 6,644.74 " " 3,438.85 " " 6,186.15 " " 4,313.69 " N/A N/A N/A " 3,565.62 " N/A N/A N/A " 4,293.40 " N/A N/A " 3,438.85 " N/A N/A N/A N/A N/A N/A N/A " 3,662.38 " " 3,438.85 " N/A " 3,438.85 " " 5,158.28 " N/A " 6,186.15 " " 6,125.97 " N/A DRG 640.4 No Current Volume N/A " 32,255.48 " " 58,024.38 " " 40,461.27 " N/A N/A N/A " 33,444.55 " N/A N/A N/A " 40,270.97 " N/A N/A " 32,255.48 " N/A N/A N/A N/A N/A N/A N/A " 34,352.09 " " 32,255.48 " N/A " 32,255.48 " " 48,383.22 " N/A " 58,024.38 " " 57,459.91 " N/A DRG 650.1 No Current Volume N/A " 9,873.51 " " 17,761.46 " " 12,385.33 " N/A N/A N/A " 10,237.49 " N/A N/A N/A " 12,327.08 " N/A N/A " 9,873.51 " N/A N/A N/A N/A N/A N/A N/A " 10,515.29 " " 9,873.51 " N/A " 9,873.51 " " 14,810.27 " N/A " 17,761.46 " " 17,588.67 " N/A DRG 650.2 No Current Volume N/A " 13,663.64 " " 24,579.52 " " 17,139.67 " N/A N/A N/A " 14,167.34 " N/A N/A N/A " 17,059.05 " N/A N/A " 13,663.64 " N/A N/A N/A N/A N/A N/A N/A " 14,551.78 " " 13,663.64 " N/A " 13,663.64 " " 20,495.46 " N/A " 24,579.52 " " 24,340.41 " N/A DRG 650.3 " 62,642.50 " " 19,738.65 " " 23,657.67 " " 42,557.78 " " 29,676.18 " N/A N/A N/A " 24,529.79 " N/A N/A N/A " 29,536.60 " N/A N/A " 23,657.67 " N/A N/A N/A N/A N/A N/A N/A " 25,195.42 " " 23,657.67 " N/A " 23,657.67 " " 35,486.51 " N/A " 42,557.78 " " 42,143.77 " N/A DRG 650.4 No Current Volume N/A " 36,884.44 " " 66,351.42 " " 46,267.84 " N/A N/A N/A " 38,244.15 " N/A N/A N/A " 46,050.22 " N/A N/A " 36,884.44 " N/A N/A N/A N/A N/A N/A N/A " 39,281.93 " " 36,884.44 " N/A " 36,884.44 " " 55,326.66 " N/A " 66,351.42 " " 65,705.94 " N/A DRG 651.1 No Current Volume N/A " 8,372.52 " " 15,061.33 " " 10,502.49 " N/A N/A N/A " 8,681.17 " N/A N/A N/A " 10,453.09 " N/A N/A " 8,372.52 " N/A N/A N/A N/A N/A N/A N/A " 8,916.73 " " 8,372.52 " N/A " 8,372.52 " " 12,558.78 " N/A " 15,061.33 " " 14,914.81 " N/A DRG 651.2 No Current Volume N/A " 11,765.49 " " 21,164.94 " " 14,758.63 " N/A N/A N/A " 12,199.22 " N/A N/A N/A " 14,689.21 " N/A N/A " 11,765.49 " N/A N/A N/A N/A N/A N/A N/A " 12,530.25 " " 11,765.49 " N/A " 11,765.49 " " 17,648.24 " N/A " 21,164.94 " " 20,959.04 " N/A DRG 651.3 No Current Volume N/A " 19,990.80 " " 35,961.45 " " 25,076.46 " N/A N/A N/A " 20,727.74 " N/A N/A N/A " 24,958.51 " N/A N/A " 19,990.80 " N/A N/A N/A N/A N/A N/A N/A " 21,290.20 " " 19,990.80 " N/A " 19,990.80 " " 29,986.20 " N/A " 35,961.45 " " 35,611.61 " N/A DRG 651.4 No Current Volume N/A " 63,283.87 " " 113,841.35 " " 79,383.29 " N/A N/A N/A " 65,616.78 " N/A N/A N/A " 79,009.91 " N/A N/A " 63,283.87 " N/A N/A N/A N/A N/A N/A N/A " 67,397.32 " " 63,283.87 " N/A " 63,283.87 " " 94,925.81 " N/A " 113,841.35 " " 112,733.89 " N/A DRG 660.1 " 25,814.08 " " 8,134.02 " " 5,891.65 " " 10,598.49 " " 7,390.49 " N/A N/A N/A " 6,108.84 " N/A N/A N/A " 7,355.73 " N/A N/A " 5,891.65 " N/A N/A N/A N/A N/A N/A N/A " 6,274.61 " " 5,891.65 " N/A " 5,891.65 " " 8,837.48 " N/A " 10,598.49 " " 10,495.39 " N/A DRG 660.2 No Current Volume N/A " 6,983.15 " " 12,561.99 " " 8,759.66 " N/A N/A N/A " 7,240.58 " N/A N/A N/A " 8,718.46 " N/A N/A " 6,983.15 " N/A N/A N/A N/A N/A N/A N/A " 7,437.05 " " 6,983.15 " N/A " 6,983.15 " " 10,474.73 " N/A " 12,561.99 " " 12,439.78 " N/A DRG 660.3 " 81,519.00 " " 25,686.64 " " 11,467.63 " " 20,629.12 " " 14,385.00 " N/A N/A N/A " 11,890.37 " N/A N/A N/A " 14,317.34 " N/A N/A " 11,467.63 " N/A N/A N/A N/A N/A N/A N/A " 12,213.03 " " 11,467.63 " N/A " 11,467.63 " " 17,201.45 " N/A " 20,629.12 " " 20,428.44 " N/A DRG 660.4 No Current Volume N/A " 30,062.20 " " 54,078.89 " " 37,710.02 " N/A N/A N/A " 31,170.42 " N/A N/A N/A " 37,532.66 " N/A N/A " 30,062.20 " N/A N/A N/A N/A N/A N/A N/A " 32,016.24 " " 30,062.20 " N/A " 30,062.20 " " 45,093.30 " N/A " 54,078.89 " " 53,552.80 " N/A DRG 661.1 No Current Volume N/A " 6,268.27 " " 11,275.99 " " 7,862.92 " N/A N/A N/A " 6,499.34 " N/A N/A N/A " 7,825.94 " N/A N/A " 6,268.27 " N/A N/A N/A N/A N/A N/A N/A " 6,675.71 " " 6,268.27 " N/A " 6,268.27 " " 9,402.41 " N/A " 11,275.99 " " 11,166.30 " N/A DRG 661.2 No Current Volume N/A " 8,847.06 " " 15,914.98 " " 11,097.75 " N/A N/A N/A " 9,173.20 " N/A N/A N/A " 11,045.55 " N/A N/A " 8,847.06 " N/A N/A N/A N/A N/A N/A N/A " 9,422.12 " " 8,847.06 " N/A " 8,847.06 " " 13,270.59 " N/A " 15,914.98 " " 15,760.15 " N/A DRG 661.3 " 66,313.68 " " 20,895.44 " " 16,829.27 " " 30,274.17 " " 21,110.64 " N/A N/A N/A " 17,449.67 " N/A N/A N/A " 21,011.34 " N/A N/A " 16,829.27 " N/A N/A N/A N/A N/A N/A N/A " 17,923.17 " " 16,829.27 " N/A " 16,829.27 " " 25,243.91 " N/A " 30,274.17 " " 29,979.66 " N/A DRG 661.4 No Current Volume N/A " 27,416.99 " " 49,320.42 " " 34,391.87 " N/A N/A N/A " 28,427.69 " N/A N/A N/A " 34,230.11 " N/A N/A " 27,416.99 " N/A N/A N/A N/A N/A N/A N/A " 29,199.09 " " 27,416.99 " N/A " 27,416.99 " " 41,125.49 " N/A " 49,320.42 " " 48,840.63 " N/A DRG 662.1 " 32,197.85 " " 10,145.54 " " 4,387.24 " " 7,892.21 " " 5,503.35 " N/A N/A N/A " 4,548.97 " N/A N/A N/A " 5,477.47 " N/A N/A " 4,387.24 " N/A N/A N/A N/A N/A N/A N/A " 4,672.41 " " 4,387.24 " N/A " 4,387.24 " " 6,580.86 " N/A " 7,892.21 " " 7,815.43 " N/A DRG 662.2 " 31,155.63 " " 9,817.14 " " 5,919.72 " " 10,648.98 " " 7,425.70 " N/A N/A N/A " 6,137.95 " N/A N/A N/A " 7,390.77 " N/A N/A " 5,919.72 " N/A N/A N/A N/A N/A N/A N/A " 6,304.50 " " 5,919.72 " N/A " 5,919.72 " " 8,879.58 " N/A " 10,648.98 " " 10,545.39 " N/A DRG 662.3 No Current Volume N/A " 8,951.14 " " 16,102.21 " " 11,228.31 " N/A N/A N/A " 9,281.12 " N/A N/A N/A " 11,175.50 " N/A N/A " 8,951.14 " N/A N/A N/A N/A N/A N/A N/A " 9,532.96 " " 8,951.14 " N/A " 8,951.14 " " 13,426.71 " N/A " 16,102.21 " " 15,945.56 " N/A DRG 662.4 No Current Volume N/A " 18,854.78 " " 33,917.86 " " 23,651.44 " N/A N/A N/A " 19,549.85 " N/A N/A N/A " 23,540.19 " N/A N/A " 18,854.78 " N/A N/A N/A N/A N/A N/A N/A " 20,080.34 " " 18,854.78 " N/A " 18,854.78 " " 28,282.17 " N/A " 33,917.86 " " 33,587.91 " N/A DRG 663.1 " 33,976.58 " " 10,706.02 " " 4,322.87 " " 7,776.41 " " 5,422.61 " N/A N/A N/A " 4,482.23 " N/A N/A N/A " 5,397.10 " N/A N/A " 4,322.87 " N/A N/A N/A N/A N/A N/A N/A " 4,603.86 " " 4,322.87 " N/A " 4,322.87 " " 6,484.31 " N/A " 7,776.41 " " 7,700.76 " N/A DRG 663.2 " 28,303.47 " " 8,918.42 " " 5,486.96 " " 9,870.49 " " 6,882.84 " N/A N/A N/A " 5,689.23 " N/A N/A N/A " 6,850.47 " N/A N/A " 5,486.96 " N/A N/A N/A N/A N/A N/A N/A " 5,843.61 " " 5,486.96 " N/A " 5,486.96 " " 8,230.44 " N/A " 9,870.49 " " 9,774.47 " N/A DRG 663.3 " 100,739.71 " " 31,743.08 " " 7,832.25 " " 14,089.43 " " 9,824.77 " N/A N/A N/A " 8,120.98 " N/A N/A N/A " 9,778.56 " N/A N/A " 7,832.25 " N/A N/A N/A N/A N/A N/A N/A " 8,341.35 " " 7,832.25 " N/A " 7,832.25 " " 11,748.38 " N/A " 14,089.43 " " 13,952.37 " N/A DRG 663.4 No Current Volume N/A " 14,294.30 " " 25,714.02 " " 17,930.77 " N/A N/A N/A " 14,821.25 " N/A N/A N/A " 17,846.43 " N/A N/A " 14,294.30 " N/A N/A N/A N/A N/A N/A N/A " 15,223.43 " " 14,294.30 " N/A " 14,294.30 " " 21,441.45 " N/A " 25,714.02 " " 25,463.87 " N/A DRG 680.1 No Current Volume N/A " 12,372.87 " " 22,257.56 " " 15,520.53 " N/A N/A N/A " 12,828.99 " N/A N/A N/A " 15,447.53 " N/A N/A " 12,372.87 " N/A N/A N/A N/A N/A N/A N/A " 13,177.11 " " 12,372.87 " N/A " 12,372.87 " " 18,559.31 " N/A " 22,257.56 " " 22,041.03 " N/A DRG 680.2 No Current Volume N/A " 17,299.70 " " 31,120.43 " " 21,700.74 " N/A N/A N/A " 17,937.44 " N/A N/A N/A " 21,598.68 " N/A N/A " 17,299.70 " N/A N/A N/A N/A N/A N/A N/A " 18,424.18 " " 17,299.70 " N/A " 17,299.70 " " 25,949.55 " N/A " 31,120.43 " " 30,817.69 " N/A DRG 680.3 No Current Volume N/A " 28,572.86 " " 51,399.72 " " 35,841.80 " N/A N/A N/A " 29,626.17 " N/A N/A N/A " 35,673.22 " N/A N/A " 28,572.86 " N/A N/A N/A N/A N/A N/A N/A " 30,430.10 " " 28,572.86 " N/A " 28,572.86 " " 42,859.29 " N/A " 51,399.72 " " 50,899.69 " N/A DRG 680.4 No Current Volume N/A " 59,844.34 " " 107,653.98 " " 75,068.74 " N/A N/A N/A " 62,050.45 " N/A N/A N/A " 74,715.66 " N/A N/A " 59,844.34 " N/A N/A N/A N/A N/A N/A N/A " 63,734.22 " " 59,844.34 " N/A " 59,844.34 " " 89,766.51 " N/A " 107,653.98 " " 106,606.71 " N/A DRG 681.1 No Current Volume N/A " 9,757.10 " " 17,552.05 " " 12,239.31 " N/A N/A N/A " 10,116.79 " N/A N/A N/A " 12,181.74 " N/A N/A " 9,757.10 " N/A N/A N/A N/A N/A N/A N/A " 10,391.31 " " 9,757.10 " N/A " 9,757.10 " " 14,635.65 " N/A " 17,552.05 " " 17,381.30 " N/A DRG 681.2 " 68,744.49 " " 21,661.39 " " 13,611.60 " " 24,485.91 " " 17,074.39 " N/A N/A N/A " 14,113.38 " N/A N/A N/A " 16,994.08 " N/A N/A " 13,611.60 " N/A N/A N/A N/A N/A N/A N/A " 14,496.35 " " 13,611.60 " N/A " 13,611.60 " " 20,417.40 " N/A " 24,485.91 " " 24,247.70 " N/A DRG 681.3 No Current Volume N/A " 25,573.62 " " 46,004.39 " " 32,079.55 " N/A N/A N/A " 26,516.37 " N/A N/A N/A " 31,928.66 " N/A N/A " 25,573.62 " N/A N/A N/A N/A N/A N/A N/A " 27,235.91 " " 25,573.62 " N/A " 25,573.62 " " 38,360.43 " N/A " 46,004.39 " " 45,556.85 " N/A DRG 681.4 No Current Volume N/A " 56,563.67 " " 101,752.39 " " 70,953.47 " N/A N/A N/A " 58,648.84 " N/A N/A N/A " 70,619.74 " N/A N/A " 56,563.67 " N/A N/A N/A N/A N/A N/A N/A " 60,240.31 " " 56,563.67 " N/A " 56,563.67 " " 84,845.51 " N/A " 101,752.39 " " 100,762.52 " N/A DRG 690.1 No Current Volume N/A " 13,700.62 " " 24,646.05 " " 17,186.06 " N/A N/A N/A " 14,205.68 " N/A N/A N/A " 17,105.22 " N/A N/A " 13,700.62 " N/A N/A N/A N/A N/A N/A N/A " 14,591.16 " " 13,700.62 " N/A " 13,700.62 " " 20,550.93 " N/A " 24,646.05 " " 24,406.28 " N/A DRG 690.2 No Current Volume N/A " 19,343.70 " " 34,797.38 " " 24,264.74 " N/A N/A N/A " 20,056.79 " N/A N/A N/A " 24,150.61 " N/A N/A " 19,343.70 " N/A N/A N/A N/A N/A N/A N/A " 20,601.04 " " 19,343.70 " N/A " 19,343.70 " " 29,015.55 " N/A " 34,797.38 " " 34,458.87 " N/A DRG 690.3 No Current Volume N/A " 32,967.63 " " 59,305.47 " " 41,354.60 " N/A N/A N/A " 34,182.95 " N/A N/A N/A " 41,160.09 " N/A N/A " 32,967.63 " N/A N/A N/A N/A N/A N/A N/A " 35,110.53 " " 32,967.63 " N/A " 32,967.63 " " 49,451.45 " N/A " 59,305.47 " " 58,728.54 " N/A DRG 690.4 No Current Volume N/A " 56,159.66 " " 101,025.61 " " 70,446.68 " N/A N/A N/A " 58,229.94 " N/A N/A N/A " 70,115.34 " N/A N/A " 56,159.66 " N/A N/A N/A N/A N/A N/A N/A " 59,810.04 " " 56,159.66 " N/A " 56,159.66 " " 84,239.49 " N/A " 101,025.61 " " 100,042.82 " N/A DRG 691.1 No Current Volume N/A " 9,065.50 " " 16,307.93 " " 11,371.76 " N/A N/A N/A " 9,399.69 " N/A N/A N/A " 11,318.28 " N/A N/A " 9,065.50 " N/A N/A N/A N/A N/A N/A N/A " 9,654.76 " " 9,065.50 " N/A " 9,065.50 " " 13,598.25 " N/A " 16,307.93 " " 16,149.28 " N/A DRG 691.2 No Current Volume N/A " 10,381.60 " " 18,675.46 " " 13,022.68 " N/A N/A N/A " 10,764.31 " N/A N/A N/A " 12,961.43 " N/A N/A " 10,381.60 " N/A N/A N/A N/A N/A N/A N/A " 11,056.40 " " 10,381.60 " N/A " 10,381.60 " " 15,572.40 " N/A " 18,675.46 " " 18,493.78 " N/A DRG 691.3 No Current Volume N/A " 16,502.64 " " 29,686.60 " " 20,700.91 " N/A N/A N/A " 17,111.00 " N/A N/A N/A " 20,603.55 " N/A N/A " 16,502.64 " N/A N/A N/A N/A N/A N/A N/A " 17,575.31 " " 16,502.64 " N/A " 16,502.64 " " 24,753.96 " N/A " 29,686.60 " " 29,397.80 " N/A DRG 691.4 No Current Volume N/A " 33,300.42 " " 59,904.13 " " 41,772.05 " N/A N/A N/A " 34,528.01 " N/A N/A N/A " 41,575.57 " N/A N/A " 33,300.42 " N/A N/A N/A N/A N/A N/A N/A " 35,464.95 " " 33,300.42 " N/A " 33,300.42 " " 49,950.63 " N/A " 59,904.13 " " 59,321.37 " N/A DRG 692.1 No Current Volume N/A " 8,433.47 " " 15,170.97 " " 10,578.94 " N/A N/A N/A " 8,744.36 " N/A N/A N/A " 10,529.19 " N/A N/A " 8,433.47 " N/A N/A N/A N/A N/A N/A N/A " 8,981.65 " " 8,433.47 " N/A " 8,433.47 " " 12,650.21 " N/A " 15,170.97 " " 15,023.38 " N/A DRG 692.2 No Current Volume N/A " 14,175.84 " " 25,500.92 " " 17,782.17 " N/A N/A N/A " 14,698.42 " N/A N/A N/A " 17,698.54 " N/A N/A " 14,175.84 " N/A N/A N/A N/A N/A N/A N/A " 15,097.27 " " 14,175.84 " N/A " 14,175.84 " " 21,263.76 " N/A " 25,500.92 " " 25,252.84 " N/A DRG 692.3 No Current Volume N/A " 18,834.24 " " 33,880.91 " " 23,625.67 " N/A N/A N/A " 19,528.55 " N/A N/A N/A " 23,514.55 " N/A N/A " 18,834.24 " N/A N/A N/A N/A N/A N/A N/A " 20,058.47 " " 18,834.24 " N/A " 18,834.24 " " 28,251.36 " N/A " 33,880.91 " " 33,551.32 " N/A DRG 692.4 No Current Volume N/A " 40,017.20 " " 71,986.94 " " 50,197.58 " N/A N/A N/A " 41,492.40 " N/A N/A N/A " 49,961.47 " N/A N/A " 40,017.20 " N/A N/A N/A N/A N/A N/A N/A " 42,618.32 " " 40,017.20 " N/A " 40,017.20 " " 60,025.80 " N/A " 71,986.94 " " 71,286.64 " N/A DRG 694.1 No Current Volume N/A " 5,788.25 " " 10,412.48 " " 7,260.78 " N/A N/A N/A " 6,001.63 " N/A N/A N/A " 7,226.63 " N/A N/A " 5,788.25 " N/A N/A N/A N/A N/A N/A N/A " 6,164.49 " " 5,788.25 " N/A " 5,788.25 " " 8,682.38 " N/A " 10,412.48 " " 10,311.19 " N/A DRG 694.2 No Current Volume N/A " 6,940.70 " " 12,485.63 " " 8,706.41 " N/A N/A N/A " 7,196.56 " N/A N/A N/A " 8,665.46 " N/A N/A " 6,940.70 " N/A N/A N/A N/A N/A N/A N/A " 7,391.85 " " 6,940.70 " N/A " 6,940.70 " " 10,411.05 " N/A " 12,485.63 " " 12,364.16 " N/A DRG 694.3 " 153,175.31 " " 48,265.54 " " 10,377.49 " " 18,668.07 " " 13,017.52 " N/A N/A N/A " 10,760.05 " N/A N/A N/A " 12,956.30 " N/A N/A " 10,377.49 " N/A N/A N/A N/A N/A N/A N/A " 11,052.03 " " 10,377.49 " N/A " 10,377.49 " " 15,566.24 " N/A " 18,668.07 " " 18,486.46 " N/A DRG 694.4 No Current Volume N/A " 19,962.04 " " 35,909.71 " " 25,040.38 " N/A N/A N/A " 20,697.92 " N/A N/A N/A " 24,922.61 " N/A N/A " 19,962.04 " N/A N/A N/A N/A N/A N/A N/A " 21,259.57 " " 19,962.04 " N/A " 19,962.04 " " 29,943.06 " N/A " 35,909.71 " " 35,560.38 " N/A DRG 695.1 No Current Volume N/A " 5,427.38 " " 9,763.31 " " 6,808.11 " N/A N/A N/A " 5,627.46 " N/A N/A N/A " 6,776.08 " N/A N/A " 5,427.38 " N/A N/A N/A N/A N/A N/A N/A " 5,780.16 " " 5,427.38 " N/A " 5,427.38 " " 8,141.07 " N/A " 9,763.31 " " 9,668.33 " N/A DRG 695.2 No Current Volume N/A " 7,719.95 " " 13,887.42 " " 9,683.91 " N/A N/A N/A " 8,004.54 " N/A N/A N/A " 9,638.36 " N/A N/A " 7,719.95 " N/A N/A N/A N/A N/A N/A N/A " 8,221.75 " " 7,719.95 " N/A " 7,719.95 " " 11,579.93 " N/A " 13,887.42 " " 13,752.32 " N/A DRG 695.3 No Current Volume N/A " 21,108.32 " " 37,971.76 " " 26,478.28 " N/A N/A N/A " 21,886.46 " N/A N/A N/A " 26,353.74 " N/A N/A " 21,108.32 " N/A N/A N/A N/A N/A N/A N/A " 22,480.36 " " 21,108.32 " N/A " 21,108.32 " " 31,662.48 " N/A " 37,971.76 " " 37,602.36 " N/A DRG 695.4 No Current Volume N/A " 55,084.59 " " 99,091.67 " " 69,098.11 " N/A N/A N/A " 57,115.24 " N/A N/A N/A " 68,773.11 " N/A N/A " 55,084.59 " N/A N/A N/A N/A N/A N/A N/A " 58,665.09 " " 55,084.59 " N/A " 55,084.59 " " 82,626.89 " N/A " 99,091.67 " " 98,127.69 " N/A DRG 696.1 No Current Volume N/A " 6,650.36 " " 11,963.33 " " 8,342.21 " N/A N/A N/A " 6,895.52 " N/A N/A N/A " 8,302.97 " N/A N/A " 6,650.36 " N/A N/A N/A N/A N/A N/A N/A " 7,082.63 " " 6,650.36 " N/A " 6,650.36 " " 9,975.54 " N/A " 11,963.33 " " 11,846.95 " N/A DRG 696.2 No Current Volume N/A " 8,502.63 " " 15,295.38 " " 10,665.70 " N/A N/A N/A " 8,816.07 " N/A N/A N/A " 10,615.53 " N/A N/A " 8,502.63 " N/A N/A N/A N/A N/A N/A N/A " 9,055.30 " " 8,502.63 " N/A " 8,502.63 " " 12,753.95 " N/A " 15,295.38 " " 15,146.59 " N/A DRG 696.3 No Current Volume N/A " 14,173.10 " " 25,495.99 " " 17,778.74 " N/A N/A N/A " 14,695.58 " N/A N/A N/A " 17,695.12 " N/A N/A " 14,173.10 " N/A N/A N/A N/A N/A N/A N/A " 15,094.35 " " 14,173.10 " N/A " 14,173.10 " " 21,259.65 " N/A " 25,495.99 " " 25,247.96 " N/A DRG 696.4 No Current Volume N/A " 31,296.82 " " 56,299.85 " " 39,258.73 " N/A N/A N/A " 32,450.55 " N/A N/A N/A " 39,074.08 " N/A N/A " 31,296.82 " N/A N/A N/A N/A N/A N/A N/A " 33,331.11 " " 31,296.82 " N/A " 31,296.82 " " 46,945.23 " N/A " 56,299.85 " " 55,752.16 " N/A DRG 710.1 No Current Volume N/A " 8,546.45 " " 15,374.21 " " 10,720.67 " N/A N/A N/A " 8,861.51 " N/A N/A N/A " 10,670.24 " N/A N/A " 8,546.45 " N/A N/A N/A N/A N/A N/A N/A " 9,101.97 " " 8,546.45 " N/A " 8,546.45 " " 12,819.68 " N/A " 15,374.21 " " 15,224.65 " N/A DRG 710.2 " 72,929.92 " " 22,980.22 " " 13,012.44 " " 23,408.08 " " 16,322.80 " N/A N/A N/A " 13,492.13 " N/A N/A N/A " 16,246.03 " N/A N/A " 13,012.44 " N/A N/A N/A N/A N/A N/A N/A " 13,858.25 " " 13,012.44 " N/A " 13,012.44 " " 19,518.66 " N/A " 23,408.08 " " 23,180.36 " N/A DRG 710.3 " 169,607.06 " " 53,443.19 " " 20,787.85 " " 37,395.26 " " 26,076.28 " N/A N/A N/A " 21,554.18 " N/A N/A N/A " 25,953.63 " N/A N/A " 20,787.85 " N/A N/A N/A N/A N/A N/A N/A " 22,139.06 " " 20,787.85 " N/A " 20,787.85 " " 31,181.78 " N/A " 37,395.26 " " 37,031.48 " N/A DRG 710.4 " 247,799.49 " " 78,081.62 " " 39,640.58 " " 71,309.44 " " 49,725.14 " N/A N/A N/A " 41,101.90 " N/A N/A N/A " 49,491.26 " N/A N/A " 39,640.58 " N/A N/A N/A N/A N/A N/A N/A " 42,217.22 " " 39,640.58 " N/A " 39,640.58 " " 59,460.87 " N/A " 71,309.44 " " 70,615.73 " N/A DRG 711.1 No Current Volume N/A " 8,366.36 " " 15,050.25 " " 10,494.76 " N/A N/A N/A " 8,674.78 " N/A N/A N/A " 10,445.40 " N/A N/A " 8,366.36 " N/A N/A N/A N/A N/A N/A N/A " 8,910.17 " " 8,366.36 " N/A " 8,366.36 " " 12,549.54 " N/A " 15,050.25 " " 14,903.83 " N/A DRG 711.2 No Current Volume N/A " 11,497.75 " " 20,683.30 " " 14,422.78 " N/A N/A N/A " 11,921.61 " N/A N/A N/A " 14,354.94 " N/A N/A " 11,497.75 " N/A N/A N/A N/A N/A N/A N/A " 12,245.10 " " 11,497.75 " N/A " 11,497.75 " " 17,246.63 " N/A " 20,683.30 " " 20,482.09 " N/A DRG 711.3 No Current Volume N/A " 20,436.57 " " 36,763.35 " " 25,635.63 " N/A N/A N/A " 21,189.95 " N/A N/A N/A " 25,515.06 " N/A N/A " 20,436.57 " N/A N/A N/A N/A N/A N/A N/A " 21,764.95 " " 20,436.57 " N/A " 20,436.57 " " 30,654.86 " N/A " 36,763.35 " " 36,405.71 " N/A DRG 711.4 " 125,421.11 " " 39,520.19 " " 40,004.87 " " 71,964.76 " " 50,182.11 " N/A N/A N/A " 41,479.62 " N/A N/A N/A " 49,946.08 " N/A N/A " 40,004.87 " N/A N/A N/A N/A N/A N/A N/A " 42,605.19 " " 40,004.87 " N/A " 40,004.87 " " 60,007.31 " N/A " 71,964.76 " " 71,264.68 " N/A DRG 720.1 " 26,949.37 " " 8,491.75 " " 4,504.33 " " 8,102.84 " " 5,650.23 " N/A N/A N/A " 4,670.38 " N/A N/A N/A " 5,623.66 " N/A N/A " 4,504.33 " N/A N/A N/A N/A N/A N/A N/A " 4,797.11 " " 4,504.33 " N/A " 4,504.33 " " 6,756.50 " N/A " 8,102.84 " " 8,024.01 " N/A DRG 720.2 " 40,936.41 " " 12,899.06 " " 6,023.81 " " 10,836.23 " " 7,556.27 " N/A N/A N/A " 6,245.87 " N/A N/A N/A " 7,520.73 " N/A N/A " 6,023.81 " N/A N/A N/A N/A N/A N/A N/A " 6,415.36 " " 6,023.81 " N/A " 6,023.81 " " 9,035.72 " N/A " 10,836.23 " " 10,730.82 " N/A DRG 720.3 " 52,490.49 " " 16,539.75 " " 9,320.23 " " 16,766.16 " " 11,691.30 " N/A N/A N/A " 9,663.81 " N/A N/A N/A " 11,636.31 " N/A N/A " 9,320.23 " N/A N/A N/A N/A N/A N/A N/A " 9,926.04 " " 9,320.23 " N/A " 9,320.23 " " 13,980.35 " N/A " 16,766.16 " " 16,603.06 " N/A DRG 720.4 " 249,203.09 " " 78,523.89 " " 17,546.90 " " 31,565.12 " " 22,010.83 " N/A N/A N/A " 18,193.75 " N/A N/A N/A " 21,907.30 " N/A N/A " 17,546.90 " N/A N/A N/A N/A N/A N/A N/A " 18,687.45 " " 17,546.90 " N/A " 17,546.90 " " 26,320.35 " N/A " 31,565.12 " " 31,258.05 " N/A DRG 721.1 " 6,654.52 " " 2,096.84 " " 4,548.16 " " 8,181.69 " " 5,705.21 " N/A N/A N/A " 4,715.82 " N/A N/A N/A " 5,678.38 " N/A N/A " 4,548.16 " N/A N/A N/A N/A N/A N/A N/A " 4,843.79 " " 4,548.16 " N/A " 4,548.16 " " 6,822.24 " N/A " 8,181.69 " " 8,102.09 " N/A DRG 721.2 " 57,970.03 " " 18,266.36 " " 6,296.34 " " 11,326.49 " " 7,898.13 " N/A N/A N/A " 6,528.45 " N/A N/A N/A " 7,860.98 " N/A N/A " 6,296.34 " N/A N/A N/A N/A N/A N/A N/A " 6,705.60 " " 6,296.34 " N/A " 6,296.34 " " 9,444.51 " N/A " 11,326.49 " " 11,216.30 " N/A DRG 721.3 " 146,680.84 " " 46,219.13 " " 10,458.98 " " 18,814.66 " " 13,119.74 " N/A N/A N/A " 10,844.54 " N/A N/A N/A " 13,058.04 " N/A N/A " 10,458.98 " N/A N/A N/A N/A N/A N/A N/A " 11,138.81 " " 10,458.98 " N/A " 10,458.98 " " 15,688.47 " N/A " 18,814.66 " " 18,631.63 " N/A DRG 721.4 " 110,577.04 " " 34,842.83 " " 19,932.59 " " 35,856.74 " " 25,003.44 " N/A N/A N/A " 20,667.39 " N/A N/A N/A " 24,885.84 " N/A N/A " 19,932.59 " N/A N/A N/A N/A N/A N/A N/A " 21,228.21 " " 19,932.59 " N/A " 19,932.59 " " 29,898.89 " N/A " 35,856.74 " " 35,507.92 " N/A DRG 722.1 " 39,718.71 " " 12,515.37 " " 3,238.90 " " 5,826.46 " " 4,062.88 " N/A N/A N/A " 3,358.30 " N/A N/A N/A " 4,043.77 " N/A N/A " 3,238.90 " N/A N/A N/A N/A N/A N/A N/A " 3,449.43 " " 3,238.90 " N/A " 3,238.90 " " 4,858.35 " N/A " 5,826.46 " " 5,769.78 " N/A DRG 722.2 No Current Volume N/A " 4,778.23 " " 8,595.56 " " 5,993.81 " N/A N/A N/A " 4,954.38 " N/A N/A N/A " 5,965.62 " N/A N/A " 4,778.23 " N/A N/A N/A N/A N/A N/A N/A " 5,088.81 " " 4,778.23 " N/A " 4,778.23 " " 7,167.35 " N/A " 8,595.56 " " 8,511.94 " N/A DRG 722.3 " 87,837.25 " " 27,677.52 " " 6,786.63 " " 12,208.47 " " 8,513.15 " N/A N/A N/A " 7,036.81 " N/A N/A N/A " 8,473.11 " N/A N/A " 6,786.63 " N/A N/A N/A N/A N/A N/A N/A " 7,227.76 " " 6,786.63 " N/A " 6,786.63 " " 10,179.95 " N/A " 12,208.47 " " 12,089.70 " N/A DRG 722.4 No Current Volume N/A " 12,485.86 " " 22,460.81 " " 15,662.26 " N/A N/A N/A " 12,946.14 " N/A N/A N/A " 15,588.60 " N/A N/A " 12,485.86 " N/A N/A N/A N/A N/A N/A N/A " 13,297.44 " " 12,485.86 " N/A " 12,485.86 " " 18,728.79 " N/A " 22,460.81 " " 22,242.31 " N/A DRG 723.1 No Current Volume N/A " 3,067.71 " " 5,518.50 " " 3,848.14 " N/A N/A N/A " 3,180.80 " N/A N/A N/A " 3,830.04 " N/A N/A " 3,067.71 " N/A N/A N/A N/A N/A N/A N/A " 3,267.11 " " 3,067.71 " N/A " 3,067.71 " " 4,601.57 " N/A " 5,518.50 " " 5,464.82 " N/A DRG 723.2 " 25,566.36 " " 8,055.96 " " 4,480.37 " " 8,059.74 " " 5,620.18 " N/A N/A N/A " 4,645.53 " N/A N/A N/A " 5,593.74 " N/A N/A " 4,480.37 " N/A N/A N/A N/A N/A N/A N/A " 4,771.59 " " 4,480.37 " N/A " 4,480.37 " " 6,720.56 " N/A " 8,059.74 " " 7,981.33 " N/A DRG 723.3 No Current Volume N/A " 7,331.01 " " 13,187.75 " " 9,196.02 " N/A N/A N/A " 7,601.26 " N/A N/A N/A " 9,152.77 " N/A N/A " 7,331.01 " N/A N/A N/A N/A N/A N/A N/A " 7,807.53 " " 7,331.01 " N/A " 7,331.01 " " 10,996.52 " N/A " 13,187.75 " " 13,059.46 " N/A DRG 723.4 No Current Volume N/A " 19,008.85 " " 34,195.02 " " 23,844.70 " N/A N/A N/A " 19,709.60 " N/A N/A N/A " 23,732.55 " N/A N/A " 19,008.85 " N/A N/A N/A N/A N/A N/A N/A " 20,244.43 " " 19,008.85 " N/A " 19,008.85 " " 28,513.28 " N/A " 34,195.02 " " 33,862.37 " N/A DRG 724.1 " 36,743.38 " " 11,577.84 " " 4,878.89 " " 8,776.64 " " 6,120.08 " N/A N/A N/A " 5,058.75 " N/A N/A N/A " 6,091.29 " N/A N/A " 4,878.89 " N/A N/A N/A N/A N/A N/A N/A " 5,196.02 " " 4,878.89 " N/A " 4,878.89 " " 7,318.34 " N/A " 8,776.64 " " 8,691.25 " N/A DRG 724.2 " 70,793.33 " " 22,306.98 " " 5,785.51 " " 10,407.55 " " 7,257.34 " N/A N/A N/A " 5,998.79 " N/A N/A N/A " 7,223.21 " N/A N/A " 5,785.51 " N/A N/A N/A N/A N/A N/A N/A " 6,161.57 " " 5,785.51 " N/A " 5,785.51 " " 8,678.27 " N/A " 10,407.55 " " 10,306.31 " N/A DRG 724.3 " 44,100.69 " " 13,896.13 " " 10,372.70 " " 18,659.45 " " 13,011.51 " N/A N/A N/A " 10,755.08 " N/A N/A N/A " 12,950.32 " N/A N/A " 10,372.70 " N/A N/A N/A N/A N/A N/A N/A " 11,046.93 " " 10,372.70 " N/A " 10,372.70 " " 15,559.05 " N/A " 18,659.45 " " 18,477.93 " N/A DRG 724.4 No Current Volume N/A " 24,018.54 " " 43,206.95 " " 30,128.86 " N/A N/A N/A " 24,903.96 " N/A N/A N/A " 29,987.15 " N/A N/A " 24,018.54 " N/A N/A N/A N/A N/A N/A N/A " 25,579.75 " " 24,018.54 " N/A " 24,018.54 " " 36,027.81 " N/A " 43,206.95 " " 42,786.63 " N/A DRG 740.1 No Current Volume N/A " 11,166.33 " " 20,087.11 " " 14,007.04 " N/A N/A N/A " 11,577.97 " N/A N/A N/A " 13,941.16 " N/A N/A " 11,166.33 " N/A N/A N/A N/A N/A N/A N/A " 11,892.14 " " 11,166.33 " N/A " 11,166.33 " " 16,749.50 " N/A " 20,087.11 " " 19,891.70 " N/A DRG 740.2 " 75,098.74 " " 23,663.61 " " 11,857.25 " " 21,330.01 " " 14,873.73 " N/A N/A N/A " 12,294.36 " N/A N/A N/A " 14,803.78 " N/A N/A " 11,857.25 " N/A N/A N/A N/A N/A N/A N/A " 12,627.97 " " 11,857.25 " N/A " 11,857.25 " " 17,785.88 " N/A " 21,330.01 " " 21,122.51 " N/A DRG 740.3 No Current Volume N/A " 21,817.73 " " 39,247.91 " " 27,368.16 " N/A N/A N/A " 22,622.02 " N/A N/A N/A " 27,239.44 " N/A N/A " 21,817.73 " N/A N/A N/A N/A N/A N/A N/A " 23,235.88 " " 21,817.73 " N/A " 21,817.73 " " 32,726.60 " N/A " 39,247.91 " " 38,866.10 " N/A DRG 740.4 No Current Volume N/A " 49,253.89 " " 88,602.82 " " 61,784.08 " N/A N/A N/A " 51,069.59 " N/A N/A N/A " 61,493.48 " N/A N/A " 49,253.89 " N/A N/A N/A N/A N/A N/A N/A " 52,455.39 " " 49,253.89 " N/A " 49,253.89 " " 73,880.84 " N/A " 88,602.82 " " 87,740.88 " N/A DRG 750.1 " 46,735.56 " " 14,726.37 " " 3,793.55 " " 6,824.22 " " 4,758.63 " N/A N/A N/A " 3,933.40 " N/A N/A N/A " 4,736.25 " N/A N/A " 3,793.55 " N/A N/A N/A N/A N/A N/A N/A " 4,040.13 " " 3,793.55 " N/A " 3,793.55 " " 5,690.33 " N/A " 6,824.22 " " 6,757.83 " N/A DRG 750.2 " 62,568.00 " " 19,715.18 " " 4,168.80 " " 7,499.25 " " 5,229.34 " N/A N/A N/A " 4,322.48 " N/A N/A N/A " 5,204.75 " N/A N/A " 4,168.80 " N/A N/A N/A N/A N/A N/A N/A " 4,439.77 " " 4,168.80 " N/A " 4,168.80 " " 6,253.20 " N/A " 7,499.25 " " 7,426.30 " N/A DRG 750.3 " 107,087.45 " " 33,743.25 " " 7,982.21 " " 14,359.20 " " 10,012.88 " N/A N/A N/A " 8,276.47 " N/A N/A N/A " 9,965.79 " N/A N/A " 7,982.21 " N/A N/A N/A N/A N/A N/A N/A " 8,501.05 " " 7,982.21 " N/A " 7,982.21 " " 11,973.32 " N/A " 14,359.20 " " 14,219.51 " N/A DRG 750.4 No Current Volume N/A " 21,085.04 " " 37,929.88 " " 26,449.07 " N/A N/A N/A " 21,862.32 " N/A N/A N/A " 26,324.67 " N/A N/A " 21,085.04 " N/A N/A N/A N/A N/A N/A N/A " 22,455.57 " " 21,085.04 " N/A " 21,085.04 " " 31,627.56 " N/A " 37,929.88 " " 37,560.89 " N/A DRG 751.1 " 21,110.53 " " 6,651.93 " " 2,922.54 " " 5,257.36 " " 3,666.03 " N/A N/A N/A " 3,030.28 " N/A N/A N/A " 3,648.79 " N/A N/A " 2,922.54 " N/A N/A N/A N/A N/A N/A N/A " 3,112.51 " " 2,922.54 " N/A " 2,922.54 " " 4,383.81 " N/A " 5,257.36 " " 5,206.21 " N/A DRG 751.2 " 46,599.16 " " 14,683.40 " " 3,532.66 " " 6,354.90 " " 4,431.37 " N/A N/A N/A " 3,662.89 " N/A N/A N/A " 4,410.53 " N/A N/A " 3,532.66 " N/A N/A N/A N/A N/A N/A N/A " 3,762.28 " " 3,532.66 " N/A " 3,532.66 " " 5,298.99 " N/A " 6,354.90 " " 6,293.08 " N/A DRG 751.3 " 266,532.54 " " 83,984.40 " " 7,145.44 " " 12,853.93 " " 8,963.24 " N/A N/A N/A " 7,408.85 " N/A N/A N/A " 8,921.08 " N/A N/A " 7,145.44 " N/A N/A N/A N/A N/A N/A N/A " 7,609.89 " " 7,145.44 " N/A " 7,145.44 " " 10,718.16 " N/A " 12,853.93 " " 12,728.89 " N/A DRG 751.4 No Current Volume N/A " 13,400.01 " " 24,105.28 " " 16,808.97 " N/A N/A N/A " 13,893.99 " N/A N/A N/A " 16,729.91 " N/A N/A " 13,400.01 " N/A N/A N/A N/A N/A N/A N/A " 14,271.01 " " 13,400.01 " N/A " 13,400.01 " " 20,100.02 " N/A " 24,105.28 " " 23,870.78 " N/A DRG 752.1 No Current Volume N/A " 2,968.42 " " 5,339.89 " " 3,723.59 " N/A N/A N/A " 3,077.85 " N/A N/A N/A " 3,706.07 " N/A N/A " 2,968.42 " N/A N/A N/A N/A N/A N/A N/A " 3,161.37 " " 2,968.42 " N/A " 2,968.42 " " 4,452.63 " N/A " 5,339.89 " " 5,287.94 " N/A DRG 752.2 " 20,855.17 " " 6,571.46 " " 3,260.81 " " 5,865.87 " " 4,090.36 " N/A N/A N/A " 3,381.02 " N/A N/A N/A " 4,071.12 " N/A N/A " 3,260.81 " N/A N/A N/A N/A N/A N/A N/A " 3,472.76 " " 3,260.81 " N/A " 3,260.81 " " 4,891.22 " N/A " 5,865.87 " " 5,808.81 " N/A DRG 752.3 No Current Volume N/A " 7,099.56 " " 12,771.40 " " 8,905.69 " N/A N/A N/A " 7,361.28 " N/A N/A N/A " 8,863.80 " N/A N/A " 7,099.56 " N/A N/A N/A N/A N/A N/A N/A " 7,561.03 " " 7,099.56 " N/A " 7,099.56 " " 10,649.34 " N/A " 12,771.40 " " 12,647.16 " N/A DRG 752.4 No Current Volume N/A " 32,921.75 " " 59,222.94 " " 41,297.04 " N/A N/A N/A " 34,135.38 " N/A N/A N/A " 41,102.80 " N/A N/A " 32,921.75 " N/A N/A N/A N/A N/A N/A N/A " 35,061.66 " " 32,921.75 " N/A " 32,921.75 " " 49,382.63 " N/A " 59,222.94 " " 58,646.81 " N/A DRG 753.1 " 23,292.27 " " 7,339.40 " " 2,909.53 " " 5,233.95 " " 3,649.71 " N/A N/A N/A " 3,016.79 " N/A N/A N/A " 3,632.55 " N/A N/A " 2,909.53 " N/A N/A N/A N/A N/A N/A N/A " 3,098.65 " " 2,909.53 " N/A " 2,909.53 " " 4,364.30 " N/A " 5,233.95 " " 5,183.04 " N/A DRG 753.2 " 34,313.15 " " 10,812.07 " " 3,421.73 " " 6,155.35 " " 4,292.22 " N/A N/A N/A " 3,547.87 " N/A N/A N/A " 4,272.03 " N/A N/A " 3,421.73 " N/A N/A N/A N/A N/A N/A N/A " 3,644.14 " " 3,421.73 " N/A " 3,421.73 " " 5,132.60 " N/A " 6,155.35 " " 6,095.47 " N/A DRG 753.3 " 78,270.00 " " 24,662.88 " " 6,381.25 " " 11,479.23 " " 8,004.64 " N/A N/A N/A " 6,616.49 " N/A N/A N/A " 7,966.99 " N/A N/A " 6,381.25 " N/A N/A N/A N/A N/A N/A N/A " 6,796.03 " " 6,381.25 " N/A " 6,381.25 " " 9,571.88 " N/A " 11,479.23 " " 11,367.56 " N/A DRG 753.4 No Current Volume N/A " 15,215.99 " " 27,372.04 " " 19,086.94 " N/A N/A N/A " 15,776.91 " N/A N/A N/A " 18,997.16 " N/A N/A " 15,215.99 " N/A N/A N/A N/A N/A N/A N/A " 16,205.03 " " 15,215.99 " N/A " 15,215.99 " " 22,823.99 " N/A " 27,372.04 " " 27,105.76 " N/A DRG 754.1 " 18,375.36 " " 5,790.08 " " 2,597.28 " " 4,672.25 " " 3,258.03 " N/A N/A N/A " 2,693.03 " N/A N/A N/A " 3,242.70 " N/A N/A " 2,597.28 " N/A N/A N/A N/A N/A N/A N/A " 2,766.10 " " 2,597.28 " N/A " 2,597.28 " " 3,895.92 " N/A " 4,672.25 " " 4,626.79 " N/A DRG 754.2 " 26,334.03 " " 8,297.85 " " 3,132.08 " " 5,634.30 " " 3,928.88 " N/A N/A N/A " 3,247.54 " N/A N/A N/A " 3,910.40 " N/A N/A " 3,132.08 " N/A N/A N/A N/A N/A N/A N/A " 3,335.67 " " 3,132.08 " N/A " 3,132.08 " " 4,698.12 " N/A " 5,634.30 " " 5,579.49 " N/A DRG 754.3 No Current Volume N/A " 5,438.34 " " 9,783.03 " " 6,821.85 " N/A N/A N/A " 5,638.82 " N/A N/A N/A " 6,789.77 " N/A N/A " 5,438.34 " N/A N/A N/A N/A N/A N/A N/A " 5,791.83 " " 5,438.34 " N/A " 5,438.34 " " 8,157.51 " N/A " 9,783.03 " " 9,687.86 " N/A DRG 754.4 No Current Volume N/A " 13,892.35 " " 24,990.95 " " 17,426.56 " N/A N/A N/A " 14,404.48 " N/A N/A N/A " 17,344.60 " N/A N/A " 13,892.35 " N/A N/A N/A N/A N/A N/A N/A " 14,795.35 " " 13,892.35 " N/A " 13,892.35 " " 20,838.53 " N/A " 24,990.95 " " 24,747.83 " N/A DRG 755.1 " 15,810.11 " " 4,981.76 " " 2,541.82 " " 4,572.48 " " 3,188.46 " N/A N/A N/A " 2,635.52 " N/A N/A N/A " 3,173.46 " N/A N/A " 2,541.82 " N/A N/A N/A N/A N/A N/A N/A " 2,707.04 " " 2,541.82 " N/A " 2,541.82 " " 3,812.73 " N/A " 4,572.48 " " 4,528.00 " N/A DRG 755.2 " 20,397.18 " " 6,427.15 " " 4,021.58 " " 7,234.42 " " 5,044.67 " N/A N/A N/A " 4,169.83 " N/A N/A N/A " 5,020.94 " N/A N/A " 4,021.58 " N/A N/A N/A N/A N/A N/A N/A " 4,282.98 " " 4,021.58 " N/A " 4,021.58 " " 6,032.37 " N/A " 7,234.42 " " 7,164.04 " N/A DRG 755.3 No Current Volume N/A " 5,597.20 " " 10,068.80 " " 7,021.13 " N/A N/A N/A " 5,803.54 " N/A N/A N/A " 6,988.10 " N/A N/A " 5,597.20 " N/A N/A N/A N/A N/A N/A N/A " 5,961.02 " " 5,597.20 " N/A " 5,597.20 " " 8,395.80 " N/A " 10,068.80 " " 9,970.85 " N/A DRG 755.4 No Current Volume N/A " 9,700.95 " " 17,451.04 " " 12,168.87 " N/A N/A N/A " 10,058.57 " N/A N/A N/A " 12,111.64 " N/A N/A " 9,700.95 " N/A N/A N/A N/A N/A N/A N/A " 10,331.51 " " 9,700.95 " N/A " 9,700.95 " " 14,551.43 " N/A " 17,451.04 " " 17,281.27 " N/A DRG 756.1 No Current Volume N/A " 3,966.80 " " 7,135.88 " " 4,975.95 " N/A N/A N/A " 4,113.03 " N/A N/A N/A " 4,952.55 " N/A N/A " 3,966.80 " N/A N/A N/A N/A N/A N/A N/A " 4,224.64 " " 3,966.80 " N/A " 3,966.80 " " 5,950.20 " N/A " 7,135.88 " " 7,066.46 " N/A DRG 756.2 " 25,595.14 " " 8,065.03 " " 4,776.18 " " 8,591.87 " " 5,991.24 " N/A N/A N/A " 4,952.25 " N/A N/A N/A " 5,963.06 " N/A N/A " 4,776.18 " N/A N/A N/A N/A N/A N/A N/A " 5,086.63 " " 4,776.18 " N/A " 4,776.18 " " 7,164.27 " N/A " 8,591.87 " " 8,508.29 " N/A DRG 756.3 " 25,195.83 " " 7,939.21 " " 5,491.07 " " 9,877.89 " " 6,888.00 " N/A N/A N/A " 5,693.49 " N/A N/A N/A " 6,855.60 " N/A N/A " 5,491.07 " N/A N/A N/A N/A N/A N/A N/A " 5,847.99 " " 5,491.07 " N/A " 5,491.07 " " 8,236.61 " N/A " 9,877.89 " " 9,781.79 " N/A DRG 756.4 No Current Volume N/A " 12,801.53 " " 23,028.67 " " 16,058.24 " N/A N/A N/A " 13,273.45 " N/A N/A N/A " 15,982.71 " N/A N/A " 12,801.53 " N/A N/A N/A N/A N/A N/A N/A " 13,633.63 " " 12,801.53 " N/A " 12,801.53 " " 19,202.30 " N/A " 23,028.67 " " 22,804.65 " N/A DRG 757.1 " 15,474.75 " " 4,876.09 " " 3,909.28 " " 7,032.40 " " 4,903.80 " N/A N/A N/A " 4,053.39 " N/A N/A N/A " 4,880.74 " N/A N/A " 3,909.28 " N/A N/A N/A N/A N/A N/A N/A " 4,163.38 " " 3,909.28 " N/A " 3,909.28 " " 5,863.92 " N/A " 7,032.40 " " 6,963.99 " N/A DRG 757.2 " 12,671.04 " " 3,992.64 " " 5,271.26 " " 9,482.47 " " 6,612.27 " N/A N/A N/A " 5,465.58 " N/A N/A N/A " 6,581.17 " N/A N/A " 5,271.26 " N/A N/A N/A N/A N/A N/A N/A " 5,613.89 " " 5,271.26 " N/A " 5,271.26 " " 7,906.89 " N/A " 9,482.47 " " 9,390.22 " N/A DRG 757.3 No Current Volume N/A " 10,767.12 " " 19,368.97 " " 13,506.28 " N/A N/A N/A " 11,164.04 " N/A N/A N/A " 13,442.75 " N/A N/A " 10,767.12 " N/A N/A N/A N/A N/A N/A N/A " 11,466.98 " " 10,767.12 " N/A " 10,767.12 " " 16,150.68 " N/A " 19,368.97 " " 19,180.55 " N/A DRG 757.4 No Current Volume N/A " 27,458.76 " " 49,395.56 " " 34,444.27 " N/A N/A N/A " 28,471.00 " N/A N/A N/A " 34,282.26 " N/A N/A " 27,458.76 " N/A N/A N/A N/A N/A N/A N/A " 29,243.58 " " 27,458.76 " N/A " 27,458.76 " " 41,188.14 " N/A " 49,395.56 " " 48,915.04 " N/A DRG 758.1 " 17,329.32 " " 5,460.47 " " 3,606.62 " " 6,487.95 " " 4,524.14 " N/A N/A N/A " 3,739.57 " N/A N/A N/A " 4,502.87 " N/A N/A " 3,606.62 " N/A N/A N/A N/A N/A N/A N/A " 3,841.05 " " 3,606.62 " N/A " 3,606.62 " " 5,409.93 " N/A " 6,487.95 " " 6,424.83 " N/A DRG 758.2 " 17,634.00 " " 5,556.47 " " 4,780.97 " " 8,600.49 " " 5,997.25 " N/A N/A N/A " 4,957.22 " N/A N/A N/A " 5,969.04 " N/A N/A " 4,780.97 " N/A N/A N/A N/A N/A N/A N/A " 5,091.73 " " 4,780.97 " N/A " 4,780.97 " " 7,171.46 " N/A " 8,600.49 " " 8,516.82 " N/A DRG 758.3 No Current Volume N/A " 7,507.68 " " 13,505.57 " " 9,417.63 " N/A N/A N/A " 7,784.44 " N/A N/A N/A " 9,373.34 " N/A N/A " 7,507.68 " N/A N/A N/A N/A N/A N/A N/A " 7,995.68 " " 7,507.68 " N/A " 7,507.68 " " 11,261.52 " N/A " 13,505.57 " " 13,374.18 " N/A DRG 758.4 No Current Volume N/A " 11,543.63 " " 20,765.84 " " 14,480.33 " N/A N/A N/A " 11,969.18 " N/A N/A N/A " 14,412.22 " N/A N/A " 11,543.63 " N/A N/A N/A N/A N/A N/A N/A " 12,293.97 " " 11,543.63 " N/A " 11,543.63 " " 17,315.45 " N/A " 20,765.84 " " 20,563.82 " N/A DRG 759.1 No Current Volume N/A " 6,677.07 " " 12,011.38 " " 8,375.72 " N/A N/A N/A " 6,923.21 " N/A N/A N/A " 8,336.32 " N/A N/A " 6,677.07 " N/A N/A N/A N/A N/A N/A N/A " 7,111.08 " " 6,677.07 " N/A " 6,677.07 " " 10,015.61 " N/A " 12,011.38 " " 11,894.53 " N/A DRG 759.2 No Current Volume N/A " 10,452.82 " " 18,803.58 " " 13,112.02 " N/A N/A N/A " 10,838.15 " N/A N/A N/A " 13,050.35 " N/A N/A " 10,452.82 " N/A N/A N/A N/A N/A N/A N/A " 11,132.25 " " 10,452.82 " N/A " 10,452.82 " " 15,679.23 " N/A " 18,803.58 " " 18,620.65 " N/A DRG 759.3 No Current Volume N/A " 16,098.64 " " 28,959.84 " " 20,194.13 " N/A N/A N/A " 16,692.10 " N/A N/A N/A " 20,099.15 " N/A N/A " 16,098.64 " N/A N/A N/A N/A N/A N/A N/A " 17,145.05 " " 16,098.64 " N/A " 16,098.64 " " 24,147.96 " N/A " 28,959.84 " " 28,678.12 " N/A DRG 759.4 No Current Volume N/A " 26,661.70 " " 47,961.73 " " 33,444.44 " N/A N/A N/A " 27,644.56 " N/A N/A N/A " 33,287.13 " N/A N/A " 26,661.70 " N/A N/A N/A N/A N/A N/A N/A " 28,394.71 " " 26,661.70 " N/A " 26,661.70 " " 39,992.55 " N/A " 47,961.73 " " 47,495.15 " N/A DRG 760.1 " 42,406.96 " " 13,362.43 " " 4,164.01 " " 7,490.64 " " 5,223.33 " N/A N/A N/A " 4,317.51 " N/A N/A N/A " 5,198.77 " N/A N/A " 4,164.01 " N/A N/A N/A N/A N/A N/A N/A " 4,434.67 " " 4,164.01 " N/A " 4,164.01 " " 6,246.02 " N/A " 7,490.64 " " 7,417.77 " N/A DRG 760.2 " 14,742.45 " " 4,645.35 " " 6,950.97 " " 12,504.10 " " 8,719.30 " N/A N/A N/A " 7,207.21 " N/A N/A N/A " 8,678.29 " N/A N/A " 6,950.97 " N/A N/A N/A N/A N/A N/A N/A " 7,402.78 " " 6,950.97 " N/A " 6,950.97 " " 10,426.46 " N/A " 12,504.10 " " 12,382.46 " N/A DRG 760.3 " 99,822.87 " " 31,454.19 " " 11,134.83 " " 20,030.45 " " 13,967.53 " N/A N/A N/A " 11,545.31 " N/A N/A N/A " 13,901.84 " N/A N/A " 11,134.83 " N/A N/A N/A N/A N/A N/A N/A " 11,858.59 " " 11,134.83 " N/A " 11,134.83 " " 16,702.25 " N/A " 20,030.45 " " 19,835.59 " N/A DRG 760.4 No Current Volume N/A " 20,752.25 " " 37,331.22 " " 26,031.62 " N/A N/A N/A " 21,517.26 " N/A N/A N/A " 25,909.18 " N/A N/A " 20,752.25 " N/A N/A N/A N/A N/A N/A N/A " 22,101.15 " " 20,752.25 " N/A " 20,752.25 " " 31,128.38 " N/A " 37,331.22 " " 36,968.06 " N/A DRG 770.1 " 19,625.73 " " 6,184.07 " " 1,672.86 " " 3,009.31 " " 2,098.44 " N/A N/A N/A " 1,734.53 " N/A N/A N/A " 2,088.57 " N/A N/A " 1,672.86 " N/A N/A N/A N/A N/A N/A N/A " 1,781.60 " " 1,672.86 " N/A " 1,672.86 " " 2,509.29 " N/A " 3,009.31 " " 2,980.03 " N/A DRG 770.2 " 20,772.00 " " 6,545.26 " " 2,622.62 " " 4,717.83 " " 3,289.81 " N/A N/A N/A " 2,719.30 " N/A N/A N/A " 3,274.34 " N/A N/A " 2,622.62 " N/A N/A N/A N/A N/A N/A N/A " 2,793.09 " " 2,622.62 " N/A " 2,622.62 " " 3,933.93 " N/A " 4,717.83 " " 4,671.94 " N/A DRG 770.3 " 18,289.19 " " 5,762.92 " " 4,811.79 " " 8,655.93 " " 6,035.91 " N/A N/A N/A " 4,989.17 " N/A N/A N/A " 6,007.52 " N/A N/A " 4,811.79 " N/A N/A N/A N/A N/A N/A N/A " 5,124.56 " " 4,811.79 " N/A " 4,811.79 " " 7,217.69 " N/A " 8,655.93 " " 8,571.72 " N/A DRG 770.4 " 15,489.56 " " 4,880.76 " " 10,550.05 " " 18,978.48 " " 13,233.98 " N/A N/A N/A " 10,938.97 " N/A N/A N/A " 13,171.74 " N/A N/A " 10,550.05 " N/A N/A N/A N/A N/A N/A N/A " 11,235.80 " " 10,550.05 " N/A " 10,550.05 " " 15,825.08 " N/A " 18,978.48 " " 18,793.86 " N/A DRG 772.1 No Current Volume N/A - - - N/A N/A N/A - N/A N/A N/A - N/A N/A - N/A N/A N/A N/A N/A N/A N/A - - N/A - - N/A - - N/A DRG 772.2 No Current Volume N/A - - - N/A N/A N/A - N/A N/A N/A - N/A N/A - N/A N/A N/A N/A N/A N/A N/A - - N/A - - N/A - - N/A DRG 772.3 No Current Volume N/A - - - N/A N/A N/A - N/A N/A N/A - N/A N/A - N/A N/A N/A N/A N/A N/A N/A - - N/A - - N/A - - N/A DRG 772.4 No Current Volume N/A - - - N/A N/A N/A - N/A N/A N/A - N/A N/A - N/A N/A N/A N/A N/A N/A N/A - - N/A - - N/A - - N/A DRG 773.1 No Current Volume N/A " 2,091.93 " " 3,763.17 " " 2,624.12 " N/A N/A N/A " 2,169.05 " N/A N/A N/A " 2,611.77 " N/A N/A " 2,091.93 " N/A N/A N/A N/A N/A N/A N/A " 2,227.91 " " 2,091.93 " N/A " 2,091.93 " " 3,137.90 " N/A " 3,763.17 " " 3,726.56 " N/A DRG 773.2 " 28,327.10 " " 8,925.87 " " 3,056.76 " " 5,498.81 " " 3,834.40 " N/A N/A N/A " 3,169.44 " N/A N/A N/A " 3,816.36 " N/A N/A " 3,056.76 " N/A N/A N/A N/A N/A N/A N/A " 3,255.45 " " 3,056.76 " N/A " 3,056.76 " " 4,585.14 " N/A " 5,498.81 " " 5,445.31 " N/A DRG 773.3 No Current Volume N/A " 6,083.38 " " 10,943.39 " " 7,630.99 " N/A N/A N/A " 6,307.64 " N/A N/A N/A " 7,595.10 " N/A N/A " 6,083.38 " N/A N/A N/A N/A N/A N/A N/A " 6,478.80 " " 6,083.38 " N/A " 6,083.38 " " 9,125.07 " N/A " 10,943.39 " " 10,836.93 " N/A DRG 773.4 No Current Volume N/A " 15,712.43 " " 28,265.09 " " 19,709.67 " N/A N/A N/A " 16,291.66 " N/A N/A N/A " 19,616.97 " N/A N/A " 15,712.43 " N/A N/A N/A N/A N/A N/A N/A " 16,733.74 " " 15,712.43 " N/A " 15,712.43 " " 23,568.65 " N/A " 28,265.09 " " 27,990.12 " N/A DRG 774.1 No Current Volume N/A " 2,758.20 " " 4,961.73 " " 3,459.89 " N/A N/A N/A " 2,859.88 " N/A N/A N/A " 3,443.61 " N/A N/A " 2,758.20 " N/A N/A N/A N/A N/A N/A N/A " 2,937.48 " " 2,758.20 " N/A " 2,758.20 " " 4,137.30 " N/A " 4,961.73 " " 4,913.46 " N/A DRG 774.2 " 23,207.33 " " 7,312.63 " " 3,064.29 " " 5,512.35 " " 3,843.85 " N/A N/A N/A " 3,177.25 " N/A N/A N/A " 3,825.77 " N/A N/A " 3,064.29 " N/A N/A N/A N/A N/A N/A N/A " 3,263.47 " " 3,064.29 " N/A " 3,064.29 " " 4,596.44 " N/A " 5,512.35 " " 5,458.73 " N/A DRG 774.3 " 93,664.00 " " 29,513.53 " " 5,484.22 " " 9,865.56 " " 6,879.41 " N/A N/A N/A " 5,686.39 " N/A N/A N/A " 6,847.05 " N/A N/A " 5,484.22 " N/A N/A N/A N/A N/A N/A N/A " 5,840.69 " " 5,484.22 " N/A " 5,484.22 " " 8,226.33 " N/A " 9,865.56 " " 9,769.59 " N/A DRG 774.4 " 207,124.34 " " 65,264.88 " " 15,865.13 " " 28,539.78 " " 19,901.22 " N/A N/A N/A " 16,449.99 " N/A N/A N/A " 19,807.61 " N/A N/A " 15,865.13 " N/A N/A N/A N/A N/A N/A N/A " 16,896.36 " " 15,865.13 " N/A " 15,865.13 " " 23,797.70 " N/A " 28,539.78 " " 28,262.14 " N/A DRG 775.1 " 18,152.93 " " 5,719.99 " " 2,853.38 " " 5,132.95 " " 3,579.28 " N/A N/A N/A " 2,958.57 " N/A N/A N/A " 3,562.44 " N/A N/A " 2,853.38 " N/A N/A N/A N/A N/A N/A N/A " 3,038.85 " " 2,853.38 " N/A " 2,853.38 " " 4,280.07 " N/A " 5,132.95 " " 5,083.01 " N/A DRG 775.2 " 25,529.21 " " 8,044.25 " " 4,063.35 " " 7,309.56 " " 5,097.07 " N/A N/A N/A " 4,213.14 " N/A N/A N/A " 5,073.09 " N/A N/A " 4,063.35 " N/A N/A N/A N/A N/A N/A N/A " 4,327.47 " " 4,063.35 " N/A " 4,063.35 " " 6,095.03 " N/A " 7,309.56 " " 7,238.45 " N/A DRG 775.3 " 63,361.89 " " 19,965.33 " " 6,970.83 " " 12,539.83 " " 8,744.21 " N/A N/A N/A " 7,227.80 " N/A N/A N/A " 8,703.08 " N/A N/A " 6,970.83 " N/A N/A N/A N/A N/A N/A N/A " 7,423.93 " " 6,970.83 " N/A " 6,970.83 " " 10,456.25 " N/A " 12,539.83 " " 12,417.84 " N/A DRG 775.4 No Current Volume N/A " 18,051.56 " " 32,472.95 " " 22,643.88 " N/A N/A N/A " 18,717.02 " N/A N/A N/A " 22,537.37 " N/A N/A " 18,051.56 " N/A N/A N/A N/A N/A N/A N/A " 19,224.91 " " 18,051.56 " N/A " 18,051.56 " " 27,077.34 " N/A " 32,472.95 " " 32,157.05 " N/A DRG 776.1 " 15,978.13 " " 5,034.71 " " 3,692.89 " " 6,643.14 " " 4,632.36 " N/A N/A N/A " 3,829.03 " N/A N/A N/A " 4,610.57 " N/A N/A " 3,692.89 " N/A N/A N/A N/A N/A N/A N/A " 3,932.93 " " 3,692.89 " N/A " 3,692.89 " " 5,539.34 " N/A " 6,643.14 " " 6,578.51 " N/A DRG 776.2 " 34,254.56 " " 10,793.61 " " 4,406.41 " " 7,926.69 " " 5,527.40 " N/A N/A N/A " 4,568.85 " N/A N/A N/A " 5,501.40 " N/A N/A " 4,406.41 " N/A N/A N/A N/A N/A N/A N/A " 4,692.83 " " 4,406.41 " N/A " 4,406.41 " " 6,609.62 " N/A " 7,926.69 " " 7,849.58 " N/A DRG 776.3 " 16,823.79 " " 5,301.18 " " 7,576.15 " " 13,628.74 " " 9,503.52 " N/A N/A N/A " 7,855.44 " N/A N/A N/A " 9,458.82 " N/A N/A " 7,576.15 " N/A N/A N/A N/A N/A N/A N/A " 8,068.60 " " 7,576.15 " N/A " 7,576.15 " " 11,364.23 " N/A " 13,628.74 " " 13,496.15 " N/A DRG 776.4 No Current Volume N/A " 11,933.94 " " 21,467.96 " " 14,969.93 " N/A N/A N/A " 12,373.88 " N/A N/A N/A " 14,899.52 " N/A N/A " 11,933.94 " N/A N/A N/A N/A N/A N/A N/A " 12,709.65 " " 11,933.94 " N/A " 11,933.94 " " 17,900.91 " N/A " 21,467.96 " " 21,259.12 " N/A DRG 792.1 No Current Volume N/A " 12,292.07 " " 22,112.20 " " 15,419.17 " N/A N/A N/A " 12,745.21 " N/A N/A N/A " 15,346.65 " N/A N/A " 12,292.07 " N/A N/A N/A N/A N/A N/A N/A " 13,091.05 " " 12,292.07 " N/A " 12,292.07 " " 18,438.11 " N/A " 22,112.20 " " 21,897.09 " N/A DRG 792.2 " 52,902.15 " " 16,669.47 " " 14,201.18 " " 25,546.50 " " 17,813.96 " N/A N/A N/A " 14,724.69 " N/A N/A N/A " 17,730.17 " N/A N/A " 14,201.18 " N/A N/A N/A N/A N/A N/A N/A " 15,124.26 " " 14,201.18 " N/A " 14,201.18 " " 21,301.77 " N/A " 25,546.50 " " 25,297.98 " N/A DRG 792.3 No Current Volume N/A " 21,811.56 " " 39,236.82 " " 27,360.42 " N/A N/A N/A " 22,615.63 " N/A N/A N/A " 27,231.73 " N/A N/A " 21,811.56 " N/A N/A N/A N/A N/A N/A N/A " 23,229.31 " " 21,811.56 " N/A " 21,811.56 " " 32,717.34 " N/A " 39,236.82 " " 38,855.11 " N/A DRG 792.4 " 202,590.63 " " 63,836.31 " " 45,001.55 " " 80,953.29 " " 56,449.94 " N/A N/A N/A " 46,660.49 " N/A N/A N/A " 56,184.44 " N/A N/A " 45,001.55 " N/A N/A N/A N/A N/A N/A N/A " 47,926.65 " " 45,001.55 " N/A " 45,001.55 " " 67,502.33 " N/A " 80,953.29 " " 80,165.76 " N/A DRG 793.1 No Current Volume N/A " 7,417.29 " " 13,342.96 " " 9,304.25 " N/A N/A N/A " 7,690.72 " N/A N/A N/A " 9,260.49 " N/A N/A " 7,417.29 " N/A N/A N/A N/A N/A N/A N/A " 7,899.41 " " 7,417.29 " N/A " 7,417.29 " " 11,125.94 " N/A " 13,342.96 " " 13,213.16 " N/A DRG 793.2 " 72,434.74 " " 22,824.19 " " 10,493.90 " " 18,877.48 " " 13,163.55 " N/A N/A N/A " 10,880.75 " N/A N/A N/A " 13,101.63 " N/A N/A " 10,493.90 " N/A N/A N/A N/A N/A N/A N/A " 11,176.00 " " 10,493.90 " N/A " 10,493.90 " " 15,740.85 " N/A " 18,877.48 " " 18,693.83 " N/A DRG 793.3 No Current Volume N/A " 16,758.06 " " 30,146.07 " " 21,021.31 " N/A N/A N/A " 17,375.83 " N/A N/A N/A " 20,922.44 " N/A N/A " 16,758.06 " N/A N/A N/A N/A N/A N/A N/A " 17,847.33 " " 16,758.06 " N/A " 16,758.06 " " 25,137.09 " N/A " 30,146.07 " " 29,852.81 " N/A DRG 793.4 No Current Volume N/A " 33,157.30 " " 59,646.67 " " 41,592.52 " N/A N/A N/A " 34,379.62 " N/A N/A N/A " 41,396.89 " N/A N/A " 33,157.30 " N/A N/A N/A N/A N/A N/A N/A " 35,312.52 " " 33,157.30 " N/A " 33,157.30 " " 49,735.95 " N/A " 59,646.67 " " 59,066.41 " N/A DRG 794.1 No Current Volume N/A " 6,350.44 " " 11,423.81 " " 7,965.99 " N/A N/A N/A " 6,584.54 " N/A N/A N/A " 7,928.52 " N/A N/A " 6,350.44 " N/A N/A N/A N/A N/A N/A N/A " 6,763.22 " " 6,350.44 " N/A " 6,350.44 " " 9,525.66 " N/A " 11,423.81 " " 11,312.67 " N/A DRG 794.2 No Current Volume N/A " 8,858.02 " " 15,934.69 " " 11,111.50 " N/A N/A N/A " 9,184.56 " N/A N/A N/A " 11,059.24 " N/A N/A " 8,858.02 " N/A N/A N/A N/A N/A N/A N/A " 9,433.79 " " 8,858.02 " N/A " 8,858.02 " " 13,287.03 " N/A " 15,934.69 " " 15,779.68 " N/A DRG 794.3 No Current Volume N/A " 13,667.75 " " 24,586.92 " " 17,144.83 " N/A N/A N/A " 14,171.60 " N/A N/A N/A " 17,064.19 " N/A N/A " 13,667.75 " N/A N/A N/A N/A N/A N/A N/A " 14,556.15 " " 13,667.75 " N/A " 13,667.75 " " 20,501.63 " N/A " 24,586.92 " " 24,347.73 " N/A DRG 794.4 No Current Volume N/A " 27,893.58 " " 50,177.76 " " 34,989.71 " N/A N/A N/A " 28,921.85 " N/A N/A N/A " 34,825.13 " N/A N/A " 27,893.58 " N/A N/A N/A N/A N/A N/A N/A " 29,706.66 " " 27,893.58 " N/A " 27,893.58 " " 41,840.37 " N/A " 50,177.76 " " 49,689.62 " N/A DRG 810.1 No Current Volume N/A " 4,222.90 " " 7,596.57 " " 5,297.21 " N/A N/A N/A " 4,378.57 " N/A N/A N/A " 5,272.29 " N/A N/A " 4,222.90 " N/A N/A N/A N/A N/A N/A N/A " 4,497.39 " " 4,222.90 " N/A " 4,222.90 " " 6,334.35 " N/A " 7,596.57 " " 7,522.67 " N/A DRG 810.2 No Current Volume N/A " 5,755.38 " " 10,353.35 " " 7,219.55 " N/A N/A N/A " 5,967.55 " N/A N/A N/A " 7,185.59 " N/A N/A " 5,755.38 " N/A N/A N/A N/A N/A N/A N/A " 6,129.48 " " 5,755.38 " N/A " 5,755.38 " " 8,633.07 " N/A " 10,353.35 " " 10,252.63 " N/A DRG 810.3 No Current Volume N/A " 9,711.22 " " 17,469.51 " " 12,181.75 " N/A N/A N/A " 10,069.22 " N/A N/A N/A " 12,124.46 " N/A N/A " 9,711.22 " N/A N/A N/A N/A N/A N/A N/A " 10,342.45 " " 9,711.22 " N/A " 9,711.22 " " 14,566.83 " N/A " 17,469.51 " " 17,299.57 " N/A DRG 810.4 No Current Volume N/A " 17,566.76 " " 31,600.84 " " 22,035.74 " N/A N/A N/A " 18,214.34 " N/A N/A N/A " 21,932.10 " N/A N/A " 17,566.76 " N/A N/A N/A N/A N/A N/A N/A " 18,708.60 " " 17,566.76 " N/A " 17,566.76 " " 26,350.14 " N/A " 31,600.84 " " 31,293.43 " N/A DRG 811.1 No Current Volume N/A " 2,678.08 " " 4,817.60 " " 3,359.38 " N/A N/A N/A " 2,776.81 " N/A N/A N/A " 3,343.58 " N/A N/A " 2,678.08 " N/A N/A N/A N/A N/A N/A N/A " 2,852.16 " " 2,678.08 " N/A " 2,678.08 " " 4,017.12 " N/A " 4,817.60 " " 4,770.73 " N/A DRG 811.2 No Current Volume N/A " 3,987.34 " " 7,172.83 " " 5,001.72 " N/A N/A N/A " 4,134.33 " N/A N/A N/A " 4,978.19 " N/A N/A " 3,987.34 " N/A N/A N/A N/A N/A N/A N/A " 4,246.52 " " 3,987.34 " N/A " 3,987.34 " " 5,981.01 " N/A " 7,172.83 " " 7,103.05 " N/A DRG 811.3 " 77,589.92 " " 24,448.58 " " 7,645.31 " " 13,753.15 " " 9,590.28 " N/A N/A N/A " 7,927.15 " N/A N/A N/A " 9,545.17 " N/A N/A " 7,645.31 " N/A N/A N/A N/A N/A N/A N/A " 8,142.26 " " 7,645.31 " N/A " 7,645.31 " " 11,467.97 " N/A " 13,753.15 " " 13,619.36 " N/A DRG 811.4 No Current Volume N/A " 16,562.90 " " 29,795.00 " " 20,776.50 " N/A N/A N/A " 17,173.48 " N/A N/A N/A " 20,678.78 " N/A N/A " 16,562.90 " N/A N/A N/A N/A N/A N/A N/A " 17,639.49 " " 16,562.90 " N/A " 16,562.90 " " 24,844.35 " N/A " 29,795.00 " " 29,505.15 " N/A DRG 812.1 " 20,325.85 " " 6,404.68 " " 3,057.44 " " 5,500.03 " " 3,835.25 " N/A N/A N/A " 3,170.15 " N/A N/A N/A " 3,817.21 " N/A N/A " 3,057.44 " N/A N/A N/A N/A N/A N/A N/A " 3,256.17 " " 3,057.44 " N/A " 3,057.44 " " 4,586.16 " N/A " 5,500.03 " " 5,446.52 " N/A DRG 812.2 No Current Volume N/A " 4,345.47 " " 7,817.07 " " 5,450.96 " N/A N/A N/A " 4,505.66 " N/A N/A N/A " 5,425.32 " N/A N/A " 4,345.47 " N/A N/A N/A N/A N/A N/A N/A " 4,627.93 " " 4,345.47 " N/A " 4,345.47 " " 6,518.21 " N/A " 7,817.07 " " 7,741.02 " N/A DRG 812.3 " 23,621.29 " " 7,443.07 " " 6,360.71 " " 11,442.28 " " 7,978.87 " N/A N/A N/A " 6,595.19 " N/A N/A N/A " 7,941.35 " N/A N/A " 6,360.71 " N/A N/A N/A N/A N/A N/A N/A " 6,774.16 " " 6,360.71 " N/A " 6,360.71 " " 9,541.07 " N/A " 11,442.28 " " 11,330.97 " N/A DRG 812.4 " 132,915.62 " " 41,881.71 " " 11,972.29 " " 21,536.95 " " 15,018.04 " N/A N/A N/A " 12,413.64 " N/A N/A N/A " 14,947.40 " N/A N/A " 11,972.29 " N/A N/A N/A N/A N/A N/A N/A " 12,750.49 " " 11,972.29 " N/A " 11,972.29 " " 17,958.44 " N/A " 21,536.95 " " 21,327.44 " N/A DRG 813.1 " 136,246.39 " " 42,931.24 " " 4,578.97 " " 8,237.11 " " 5,743.86 " N/A N/A N/A " 4,747.77 " N/A N/A N/A " 5,716.84 " N/A N/A " 4,578.97 " N/A N/A N/A N/A N/A N/A N/A " 4,876.60 " " 4,578.97 " N/A " 4,578.97 " " 6,868.46 " N/A " 8,237.11 " " 8,156.98 " N/A DRG 813.2 No Current Volume N/A " 5,789.62 " " 10,414.95 " " 7,262.50 " N/A N/A N/A " 6,003.05 " N/A N/A N/A " 7,228.34 " N/A N/A " 5,789.62 " N/A N/A N/A N/A N/A N/A N/A " 6,165.95 " " 5,789.62 " N/A " 5,789.62 " " 8,684.43 " N/A " 10,414.95 " " 10,313.63 " N/A DRG 813.3 " 128,927.97 " " 40,625.20 " " 8,731.34 " " 15,706.81 " " 10,952.59 " N/A N/A N/A " 9,053.21 " N/A N/A N/A " 10,901.08 " N/A N/A " 8,731.34 " N/A N/A N/A N/A N/A N/A N/A " 9,298.88 " " 8,731.34 " N/A " 8,731.34 " " 13,097.01 " N/A " 15,706.81 " " 15,554.01 " N/A DRG 813.4 No Current Volume N/A " 17,503.76 " " 31,487.51 " " 21,956.72 " N/A N/A N/A " 18,149.02 " N/A N/A N/A " 21,853.44 " N/A N/A " 17,503.76 " N/A N/A N/A N/A N/A N/A N/A " 18,641.50 " " 17,503.76 " N/A " 17,503.76 " " 26,255.64 " N/A " 31,487.51 " " 31,181.20 " N/A DRG 815.1 No Current Volume N/A " 3,544.30 " " 6,375.84 " " 4,445.97 " N/A N/A N/A " 3,674.96 " N/A N/A N/A " 4,425.06 " N/A N/A " 3,544.30 " N/A N/A N/A N/A N/A N/A N/A " 3,774.68 " " 3,544.30 " N/A " 3,544.30 " " 5,316.45 " N/A " 6,375.84 " " 6,313.82 " N/A DRG 815.2 No Current Volume N/A " 4,987.09 " " 8,971.28 " " 6,255.81 " N/A N/A N/A " 5,170.93 " N/A N/A N/A " 6,226.38 " N/A N/A " 4,987.09 " N/A N/A N/A N/A N/A N/A N/A " 5,311.25 " " 4,987.09 " N/A " 4,987.09 " " 7,480.64 " N/A " 8,971.28 " " 8,884.00 " N/A DRG 815.3 No Current Volume N/A " 9,065.50 " " 16,307.93 " " 11,371.76 " N/A N/A N/A " 9,399.69 " N/A N/A N/A " 11,318.28 " N/A N/A " 9,065.50 " N/A N/A N/A N/A N/A N/A N/A " 9,654.76 " " 9,065.50 " N/A " 9,065.50 " " 13,598.25 " N/A " 16,307.93 " " 16,149.28 " N/A DRG 815.4 No Current Volume N/A " 25,158.66 " " 45,257.91 " " 31,559.02 " N/A N/A N/A " 26,086.11 " N/A N/A N/A " 31,410.59 " N/A N/A " 25,158.66 " N/A N/A N/A N/A N/A N/A N/A " 26,793.97 " " 25,158.66 " N/A " 25,158.66 " " 37,737.99 " N/A " 45,257.91 " " 44,817.64 " N/A DRG 816.1 No Current Volume N/A " 4,360.53 " " 7,844.16 " " 5,469.85 " N/A N/A N/A " 4,521.28 " N/A N/A N/A " 5,444.12 " N/A N/A " 4,360.53 " N/A N/A N/A N/A N/A N/A N/A " 4,643.96 " " 4,360.53 " N/A " 4,360.53 " " 6,540.80 " N/A " 7,844.16 " " 7,767.85 " N/A DRG 816.2 No Current Volume N/A " 4,844.66 " " 8,715.06 " " 6,077.14 " N/A N/A N/A " 5,023.25 " N/A N/A N/A " 6,048.56 " N/A N/A " 4,844.66 " N/A N/A N/A N/A N/A N/A N/A " 5,159.56 " " 4,844.66 " N/A " 4,844.66 " " 7,266.99 " N/A " 8,715.06 " " 8,630.28 " N/A DRG 816.3 No Current Volume N/A " 5,821.80 " " 10,472.84 " " 7,302.87 " N/A N/A N/A " 6,036.42 " N/A N/A N/A " 7,268.52 " N/A N/A " 5,821.80 " N/A N/A N/A N/A N/A N/A N/A " 6,200.22 " " 5,821.80 " N/A " 5,821.80 " " 8,732.70 " N/A " 10,472.84 " " 10,370.95 " N/A DRG 816.4 " 24,382.91 " " 7,683.05 " " 11,488.85 " " 20,667.29 " " 14,411.61 " N/A N/A N/A " 11,912.38 " N/A N/A N/A " 14,343.83 " N/A N/A " 11,488.85 " N/A N/A N/A N/A N/A N/A N/A " 12,235.63 " " 11,488.85 " N/A " 11,488.85 " " 17,233.28 " N/A " 20,667.29 " " 20,466.24 " N/A DRG 817.1 " 25,886.16 " " 8,156.73 " " 2,997.18 " " 5,391.63 " " 3,759.66 " N/A N/A N/A " 3,107.67 " N/A N/A N/A " 3,741.98 " N/A N/A " 2,997.18 " N/A N/A N/A N/A N/A N/A N/A " 3,192.00 " " 2,997.18 " N/A " 2,997.18 " " 4,495.77 " N/A " 5,391.63 " " 5,339.18 " N/A DRG 817.2 " 26,455.13 " " 8,336.01 " " 3,892.16 " " 7,001.61 " " 4,882.33 " N/A N/A N/A " 4,035.64 " N/A N/A N/A " 4,859.36 " N/A N/A " 3,892.16 " N/A N/A N/A N/A N/A N/A N/A " 4,145.15 " " 3,892.16 " N/A " 3,892.16 " " 5,838.24 " N/A " 7,001.61 " " 6,933.49 " N/A DRG 817.3 " 63,066.05 " " 19,872.11 " " 6,614.75 " " 11,899.27 " " 8,297.54 " N/A N/A N/A " 6,858.60 " N/A N/A N/A " 8,258.52 " N/A N/A " 6,614.75 " N/A N/A N/A N/A N/A N/A N/A " 7,044.71 " " 6,614.75 " N/A " 6,614.75 " " 9,922.13 " N/A " 11,899.27 " " 11,783.52 " N/A DRG 817.4 " 119,885.17 " " 37,775.82 " " 13,409.60 " " 24,122.53 " " 16,821.00 " N/A N/A N/A " 13,903.93 " N/A N/A N/A " 16,741.89 " N/A N/A " 13,409.60 " N/A N/A N/A N/A N/A N/A N/A " 14,281.22 " " 13,409.60 " N/A " 13,409.60 " " 20,114.40 " N/A " 24,122.53 " " 23,887.86 " N/A DRG 841.1 No Current Volume N/A " 36,547.54 " " 65,745.37 " " 45,845.23 " N/A N/A N/A " 37,894.83 " N/A N/A N/A " 45,629.60 " N/A N/A " 36,547.54 " N/A N/A N/A N/A N/A N/A N/A " 38,923.13 " " 36,547.54 " N/A " 36,547.54 " " 54,821.31 " N/A " 65,745.37 " " 65,105.79 " N/A DRG 841.2 No Current Volume N/A " 37,178.20 " " 66,879.86 " " 46,636.33 " N/A N/A N/A " 38,548.74 " N/A N/A N/A " 46,416.98 " N/A N/A " 37,178.20 " N/A N/A N/A N/A N/A N/A N/A " 39,594.78 " " 37,178.20 " N/A " 37,178.20 " " 55,767.30 " N/A " 66,879.86 " " 66,229.25 " N/A DRG 841.3 No Current Volume N/A " 57,211.45 " " 102,917.68 " " 71,766.04 " N/A N/A N/A " 59,320.50 " N/A N/A N/A " 71,428.50 " N/A N/A " 57,211.45 " N/A N/A N/A N/A N/A N/A N/A " 60,930.19 " " 57,211.45 " N/A " 57,211.45 " " 85,817.18 " N/A " 102,917.68 " " 101,916.48 " N/A DRG 841.4 No Current Volume N/A " 120,969.17 " " 217,611.44 " " 151,743.73 " N/A N/A N/A " 125,428.60 " N/A N/A N/A " 151,030.01 " N/A N/A " 120,969.17 " N/A N/A N/A N/A N/A N/A N/A " 128,832.17 " " 120,969.17 " N/A " 120,969.17 " " 181,453.76 " N/A " 217,611.44 " " 215,494.48 " N/A DRG 842.1 No Current Volume N/A " 11,530.62 " " 20,742.43 " " 14,464.01 " N/A N/A N/A " 11,955.69 " N/A N/A N/A " 14,395.98 " N/A N/A " 11,530.62 " N/A N/A N/A N/A N/A N/A N/A " 12,280.11 " " 11,530.62 " N/A " 11,530.62 " " 17,295.93 " N/A " 20,742.43 " " 20,540.65 " N/A DRG 842.2 No Current Volume N/A " 17,971.45 " " 32,328.84 " " 22,543.39 " N/A N/A N/A " 18,633.95 " N/A N/A N/A " 22,437.36 " N/A N/A " 17,971.45 " N/A N/A N/A N/A N/A N/A N/A " 19,139.59 " " 17,971.45 " N/A " 17,971.45 " " 26,957.18 " N/A " 32,328.84 " " 32,014.34 " N/A DRG 842.3 No Current Volume N/A " 34,171.43 " " 61,470.99 " " 42,864.64 " N/A N/A N/A " 35,431.13 " N/A N/A N/A " 42,663.03 " N/A N/A " 34,171.43 " N/A N/A N/A N/A N/A N/A N/A " 36,392.57 " " 34,171.43 " N/A " 34,171.43 " " 51,257.15 " N/A " 61,470.99 " " 60,872.99 " N/A DRG 842.4 No Current Volume N/A " 75,301.36 " " 135,459.62 " " 94,458.03 " N/A N/A N/A " 78,077.28 " N/A N/A N/A " 94,013.75 " N/A N/A " 75,301.36 " N/A N/A N/A N/A N/A N/A N/A " 80,195.95 " " 75,301.36 " N/A " 75,301.36 " " 112,952.04 " N/A " 135,459.62 " " 134,141.84 " N/A DRG 843.1 " 19,522.25 " " 6,151.46 " " 5,154.85 " " 9,273.06 " " 6,466.24 " N/A N/A N/A " 5,344.88 " N/A N/A N/A " 6,435.83 " N/A N/A " 5,154.85 " N/A N/A N/A N/A N/A N/A N/A " 5,489.92 " " 5,154.85 " N/A " 5,154.85 " " 7,732.28 " N/A " 9,273.06 " " 9,182.85 " N/A DRG 843.2 No Current Volume N/A " 6,320.99 " " 11,370.83 " " 7,929.05 " N/A N/A N/A " 6,554.01 " N/A N/A N/A " 7,891.76 " N/A N/A " 6,320.99 " N/A N/A N/A N/A N/A N/A N/A " 6,731.85 " " 6,320.99 " N/A " 6,320.99 " " 9,481.49 " N/A " 11,370.83 " " 11,260.21 " N/A DRG 843.3 No Current Volume N/A " 9,333.24 " " 16,789.57 " " 11,707.62 " N/A N/A N/A " 9,677.30 " N/A N/A N/A " 11,652.55 " N/A N/A " 9,333.24 " N/A N/A N/A N/A N/A N/A N/A " 9,939.90 " " 9,333.24 " N/A " 9,333.24 " " 13,999.86 " N/A " 16,789.57 " " 16,626.23 " N/A DRG 843.4 No Current Volume N/A " 22,373.75 " " 40,248.14 " " 28,065.63 " N/A N/A N/A " 23,198.54 " N/A N/A N/A " 27,933.63 " N/A N/A " 22,373.75 " N/A N/A N/A N/A N/A N/A N/A " 23,828.04 " " 22,373.75 " N/A " 22,373.75 " " 33,560.63 " N/A " 40,248.14 " " 39,856.60 " N/A DRG 844.1 No Current Volume N/A " 3,293.00 " " 5,923.78 " " 4,130.74 " N/A N/A N/A " 3,414.39 " N/A N/A N/A " 4,111.31 " N/A N/A " 3,293.00 " N/A N/A N/A N/A N/A N/A N/A " 3,507.05 " " 3,293.00 " N/A " 3,293.00 " " 4,939.50 " N/A " 5,923.78 " " 5,866.15 " N/A DRG 844.2 No Current Volume N/A " 5,265.10 " " 9,471.39 " " 6,604.54 " N/A N/A N/A " 5,459.19 " N/A N/A N/A " 6,573.48 " N/A N/A " 5,265.10 " N/A N/A N/A N/A N/A N/A N/A " 5,607.33 " " 5,265.10 " N/A " 5,265.10 " " 7,897.65 " N/A " 9,471.39 " " 9,379.25 " N/A DRG 844.3 No Current Volume N/A " 8,768.31 " " 15,773.31 " " 10,998.97 " N/A N/A N/A " 9,091.55 " N/A N/A N/A " 10,947.24 " N/A N/A " 8,768.31 " N/A N/A N/A N/A N/A N/A N/A " 9,338.25 " " 8,768.31 " N/A " 8,768.31 " " 13,152.47 " N/A " 15,773.31 " " 15,619.87 " N/A DRG 844.4 No Current Volume N/A " 21,130.92 " " 38,012.41 " " 26,506.63 " N/A N/A N/A " 21,909.89 " N/A N/A N/A " 26,381.95 " N/A N/A " 21,130.92 " N/A N/A N/A N/A N/A N/A N/A " 22,504.43 " " 21,130.92 " N/A " 21,130.92 " " 31,696.38 " N/A " 38,012.41 " " 37,642.62 " N/A DRG 850.1 No Current Volume N/A " 14,384.01 " " 25,875.40 " " 18,043.30 " N/A N/A N/A " 14,914.26 " N/A N/A N/A " 17,958.44 " N/A N/A " 14,384.01 " N/A N/A N/A N/A N/A N/A N/A " 15,318.97 " " 14,384.01 " N/A " 14,384.01 " " 21,576.02 " N/A " 25,875.40 " " 25,623.68 " N/A DRG 850.2 " 105,165.72 " " 33,137.72 " " 19,185.52 " " 34,512.83 " " 24,066.32 " N/A N/A N/A " 19,892.78 " N/A N/A N/A " 23,953.12 " N/A N/A " 19,185.52 " N/A N/A N/A N/A N/A N/A N/A " 20,432.58 " " 19,185.52 " N/A " 19,185.52 " " 28,778.28 " N/A " 34,512.83 " " 34,177.09 " N/A DRG 850.3 No Current Volume N/A " 25,337.38 " " 45,579.41 " " 31,783.21 " N/A N/A N/A " 26,271.42 " N/A N/A N/A " 31,633.72 " N/A N/A " 25,337.38 " N/A N/A N/A N/A N/A N/A N/A " 26,984.31 " " 25,337.38 " N/A " 25,337.38 " " 38,006.07 " N/A " 45,579.41 " " 45,136.01 " N/A DRG 850.4 No Current Volume N/A " 59,796.41 " " 107,567.76 " " 75,008.62 " N/A N/A N/A " 62,000.75 " N/A N/A N/A " 74,655.82 " N/A N/A " 59,796.41 " N/A N/A N/A N/A N/A N/A N/A " 63,683.18 " " 59,796.41 " N/A " 59,796.41 " " 89,694.62 " N/A " 107,567.76 " " 106,521.32 " N/A DRG 860.1 No Current Volume N/A " 4,212.63 " " 7,578.10 " " 5,284.32 " N/A N/A N/A " 4,367.92 " N/A N/A N/A " 5,259.47 " N/A N/A " 4,212.63 " N/A N/A N/A N/A N/A N/A N/A " 4,486.45 " " 4,212.63 " N/A " 4,212.63 " " 6,318.95 " N/A " 7,578.10 " " 7,504.38 " N/A DRG 860.2 No Current Volume N/A " 4,548.16 " " 8,181.69 " " 5,705.21 " N/A N/A N/A " 4,715.82 " N/A N/A N/A " 5,678.38 " N/A N/A " 4,548.16 " N/A N/A N/A N/A N/A N/A N/A " 4,843.79 " " 4,548.16 " N/A " 4,548.16 " " 6,822.24 " N/A " 8,181.69 " " 8,102.09 " N/A DRG 860.3 No Current Volume N/A " 7,613.13 " " 13,695.26 " " 9,549.91 " N/A N/A N/A " 7,893.78 " N/A N/A N/A " 9,504.99 " N/A N/A " 7,613.13 " N/A N/A N/A N/A N/A N/A N/A " 8,107.98 " " 7,613.13 " N/A " 7,613.13 " " 11,419.70 " N/A " 13,695.26 " " 13,562.03 " N/A DRG 860.4 No Current Volume N/A " 11,827.81 " " 21,277.05 " " 14,836.80 " N/A N/A N/A " 12,263.83 " N/A N/A N/A " 14,767.02 " N/A N/A " 11,827.81 " N/A N/A N/A N/A N/A N/A N/A " 12,596.62 " " 11,827.81 " N/A " 11,827.81 " " 17,741.72 " N/A " 21,277.05 " " 21,070.06 " N/A DRG 861.1 " 30,158.42 " " 9,502.92 " " 4,059.24 " " 7,302.17 " " 5,091.91 " N/A N/A N/A " 4,208.88 " N/A N/A N/A " 5,067.96 " N/A N/A " 4,059.24 " N/A N/A N/A N/A N/A N/A N/A " 4,323.09 " " 4,059.24 " N/A " 4,059.24 " " 6,088.86 " N/A " 7,302.17 " " 7,231.13 " N/A DRG 861.2 No Current Volume N/A " 4,903.54 " " 8,820.98 " " 6,151.00 " N/A N/A N/A " 5,084.31 " N/A N/A N/A " 6,122.07 " N/A N/A " 4,903.54 " N/A N/A N/A N/A N/A N/A N/A " 5,222.27 " " 4,903.54 " N/A " 4,903.54 " " 7,355.31 " N/A " 8,820.98 " " 8,735.17 " N/A DRG 861.3 " 53,364.68 " " 16,815.21 " " 6,913.99 " " 12,437.58 " " 8,672.91 " N/A N/A N/A " 7,168.87 " N/A N/A N/A " 8,632.12 " N/A N/A " 6,913.99 " N/A N/A N/A N/A N/A N/A N/A " 7,363.40 " " 6,913.99 " N/A " 6,913.99 " " 10,370.99 " N/A " 12,437.58 " " 12,316.58 " N/A DRG 861.4 " 85,201.69 " " 26,847.05 " " 15,020.14 " " 27,019.73 " " 18,841.26 " N/A N/A N/A " 15,573.85 " N/A N/A N/A " 18,752.64 " N/A N/A " 15,020.14 " N/A N/A N/A N/A N/A N/A N/A " 15,996.45 " " 15,020.14 " N/A " 15,020.14 " " 22,530.21 " N/A " 27,019.73 " " 26,756.88 " N/A DRG 862.1 No Current Volume N/A " 4,316.02 " " 7,764.09 " " 5,414.02 " N/A N/A N/A " 4,475.13 " N/A N/A N/A " 5,388.55 " N/A N/A " 4,316.02 " N/A N/A N/A N/A N/A N/A N/A " 4,596.56 " " 4,316.02 " N/A " 4,316.02 " " 6,474.03 " N/A " 7,764.09 " " 7,688.56 " N/A DRG 862.2 No Current Volume N/A " 5,411.63 " " 9,734.98 " " 6,788.35 " N/A N/A N/A " 5,611.13 " N/A N/A N/A " 6,756.42 " N/A N/A " 5,411.63 " N/A N/A N/A N/A N/A N/A N/A " 5,763.39 " " 5,411.63 " N/A " 5,411.63 " " 8,117.45 " N/A " 9,734.98 " " 9,640.28 " N/A DRG 862.3 " 8,373.39 " " 2,638.46 " " 9,055.23 " " 16,289.45 " " 11,358.88 " N/A N/A N/A " 9,389.04 " N/A N/A N/A " 11,305.45 " N/A N/A " 9,055.23 " N/A N/A N/A N/A N/A N/A N/A " 9,643.82 " " 9,055.23 " N/A " 9,055.23 " " 13,582.85 " N/A " 16,289.45 " " 16,130.99 " N/A DRG 862.4 " 8,667.54 " " 2,731.14 " " 15,745.30 " " 28,324.22 " " 19,750.90 " N/A N/A N/A " 16,325.74 " N/A N/A N/A " 19,658.01 " N/A N/A " 15,745.30 " N/A N/A N/A N/A N/A N/A N/A " 16,768.74 " " 15,745.30 " N/A " 15,745.30 " " 23,617.95 " N/A " 28,324.22 " " 28,048.68 " N/A DRG 863.1 No Current Volume N/A " 6,903.04 " " 12,417.88 " " 8,659.17 " N/A N/A N/A " 7,157.51 " N/A N/A N/A " 8,618.45 " N/A N/A " 6,903.04 " N/A N/A N/A N/A N/A N/A N/A " 7,351.74 " " 6,903.04 " N/A " 6,903.04 " " 10,354.56 " N/A " 12,417.88 " " 12,297.08 " N/A DRG 863.2 No Current Volume N/A " 17,041.55 " " 30,656.04 " " 21,376.92 " N/A N/A N/A " 17,669.77 " N/A N/A N/A " 21,276.38 " N/A N/A " 17,041.55 " N/A N/A N/A N/A N/A N/A N/A " 18,149.25 " " 17,041.55 " N/A " 17,041.55 " " 25,562.33 " N/A " 30,656.04 " " 30,357.82 " N/A DRG 863.3 No Current Volume N/A " 39,174.26 " " 70,470.58 " " 49,140.19 " N/A N/A N/A " 40,618.39 " N/A N/A N/A " 48,909.06 " N/A N/A " 39,174.26 " N/A N/A N/A N/A N/A N/A N/A " 41,720.59 " " 39,174.26 " N/A " 39,174.26 " " 58,761.39 " N/A " 70,470.58 " " 69,785.03 " N/A DRG 863.4 No Current Volume N/A " 82,122.22 " " 147,729.66 " " 103,014.11 " N/A N/A N/A " 85,149.59 " N/A N/A N/A " 102,529.59 " N/A N/A " 82,122.22 " N/A N/A N/A N/A N/A N/A N/A " 87,460.16 " " 82,122.22 " N/A " 82,122.22 " " 123,183.33 " N/A " 147,729.66 " " 146,292.52 " N/A DRG 890.1 No Current Volume N/A " 6,843.46 " " 12,310.70 " " 8,584.44 " N/A N/A N/A " 7,095.74 " N/A N/A N/A " 8,544.06 " N/A N/A " 6,843.46 " N/A N/A N/A N/A N/A N/A N/A " 7,288.28 " " 6,843.46 " N/A " 6,843.46 " " 10,265.19 " N/A " 12,310.70 " " 12,190.94 " N/A DRG 890.2 No Current Volume N/A " 7,397.43 " " 13,307.24 " " 9,279.34 " N/A N/A N/A " 7,670.13 " N/A N/A N/A " 9,235.69 " N/A N/A " 7,397.43 " N/A N/A N/A N/A N/A N/A N/A " 7,878.26 " " 7,397.43 " N/A " 7,397.43 " " 11,096.15 " N/A " 13,307.24 " " 13,177.78 " N/A DRG 890.3 No Current Volume N/A " 10,161.11 " " 18,278.82 " " 12,746.10 " N/A N/A N/A " 10,535.69 " N/A N/A N/A " 12,686.15 " N/A N/A " 10,161.11 " N/A N/A N/A N/A N/A N/A N/A " 10,821.58 " " 10,161.11 " N/A " 10,161.11 " " 15,241.67 " N/A " 18,278.82 " " 18,101.00 " N/A DRG 890.4 " 226,822.91 " " 71,471.90 " " 21,986.86 " " 39,552.16 " " 27,580.32 " N/A N/A N/A " 22,797.39 " N/A N/A N/A " 27,450.59 " N/A N/A " 21,986.86 " N/A N/A N/A N/A N/A N/A N/A " 23,416.01 " " 21,986.86 " N/A " 21,986.86 " " 32,980.29 " N/A " 39,552.16 " " 39,167.39 " N/A DRG 892.1 No Current Volume N/A " 4,894.64 " " 8,804.97 " " 6,139.84 " N/A N/A N/A " 5,075.08 " N/A N/A N/A " 6,110.96 " N/A N/A " 4,894.64 " N/A N/A N/A N/A N/A N/A N/A " 5,212.79 " " 4,894.64 " N/A " 4,894.64 " " 7,341.96 " N/A " 8,804.97 " " 8,719.31 " N/A DRG 892.2 No Current Volume N/A " 6,011.48 " " 10,814.05 " " 7,540.80 " N/A N/A N/A " 6,233.09 " N/A N/A N/A " 7,505.33 " N/A N/A " 6,011.48 " N/A N/A N/A N/A N/A N/A N/A " 6,402.23 " " 6,011.48 " N/A " 6,011.48 " " 9,017.22 " N/A " 10,814.05 " " 10,708.85 " N/A DRG 892.3 " 61,537.21 " " 19,390.37 " " 7,947.97 " " 14,297.60 " " 9,969.93 " N/A N/A N/A " 8,240.97 " N/A N/A N/A " 9,923.04 " N/A N/A " 7,947.97 " N/A N/A N/A N/A N/A N/A N/A " 8,464.59 " " 7,947.97 " N/A " 7,947.97 " " 11,921.96 " N/A " 14,297.60 " " 14,158.51 " N/A DRG 892.4 No Current Volume N/A " 13,686.92 " " 24,621.40 " " 17,168.87 " N/A N/A N/A " 14,191.48 " N/A N/A N/A " 17,088.12 " N/A N/A " 13,686.92 " N/A N/A N/A N/A N/A N/A N/A " 14,576.57 " " 13,686.92 " N/A " 13,686.92 " " 20,530.38 " N/A " 24,621.40 " " 24,381.88 " N/A DRG 893.1 No Current Volume N/A " 4,247.55 " " 7,640.92 " " 5,328.13 " N/A N/A N/A " 4,404.13 " N/A N/A N/A " 5,303.07 " N/A N/A " 4,247.55 " N/A N/A N/A N/A N/A N/A N/A " 4,523.64 " " 4,247.55 " N/A " 4,247.55 " " 6,371.33 " N/A " 7,640.92 " " 7,566.59 " N/A DRG 893.2 No Current Volume N/A " 6,062.15 " " 10,905.20 " " 7,604.36 " N/A N/A N/A " 6,285.63 " N/A N/A N/A " 7,568.59 " N/A N/A " 6,062.15 " N/A N/A N/A N/A N/A N/A N/A " 6,456.19 " " 6,062.15 " N/A " 6,062.15 " " 9,093.23 " N/A " 10,905.20 " " 10,799.11 " N/A DRG 893.3 No Current Volume N/A " 8,092.46 " " 14,557.53 " " 10,151.18 " N/A N/A N/A " 8,390.78 " N/A N/A N/A " 10,103.44 " N/A N/A " 8,092.46 " N/A N/A N/A N/A N/A N/A N/A " 8,618.47 " " 8,092.46 " N/A " 8,092.46 " " 12,138.69 " N/A " 14,557.53 " " 14,415.91 " N/A DRG 893.4 No Current Volume N/A " 14,383.32 " " 25,874.15 " " 18,042.44 " N/A N/A N/A " 14,913.55 " N/A N/A N/A " 17,957.58 " N/A N/A " 14,383.32 " N/A N/A N/A N/A N/A N/A N/A " 15,318.24 " " 14,383.32 " N/A " 14,383.32 " " 21,574.98 " N/A " 25,874.15 " " 25,622.45 " N/A DRG 894.1 No Current Volume N/A " 4,628.96 " " 8,327.04 " " 5,806.57 " N/A N/A N/A " 4,799.60 " N/A N/A N/A " 5,779.26 " N/A N/A " 4,628.96 " N/A N/A N/A N/A N/A N/A N/A " 4,929.84 " " 4,628.96 " N/A " 4,628.96 " " 6,943.44 " N/A " 8,327.04 " " 8,246.03 " N/A DRG 894.2 No Current Volume N/A " 5,404.79 " " 9,722.68 " " 6,779.77 " N/A N/A N/A " 5,604.03 " N/A N/A N/A " 6,747.88 " N/A N/A " 5,404.79 " N/A N/A N/A N/A N/A N/A N/A " 5,756.10 " " 5,404.79 " N/A " 5,404.79 " " 8,107.19 " N/A " 9,722.68 " " 9,628.09 " N/A DRG 894.3 No Current Volume N/A " 7,045.46 " " 12,674.08 " " 8,837.83 " N/A N/A N/A " 7,305.19 " N/A N/A N/A " 8,796.26 " N/A N/A " 7,045.46 " N/A N/A N/A N/A N/A N/A N/A " 7,503.41 " " 7,045.46 " N/A " 7,045.46 " " 10,568.19 " N/A " 12,674.08 " " 12,550.78 " N/A DRG 894.4 No Current Volume N/A " 9,690.68 " " 17,432.56 " " 12,155.99 " N/A N/A N/A " 10,047.92 " N/A N/A N/A " 12,098.81 " N/A N/A " 9,690.68 " N/A N/A N/A N/A N/A N/A N/A " 10,320.57 " " 9,690.68 " N/A " 9,690.68 " " 14,536.02 " N/A " 17,432.56 " " 17,262.98 " N/A DRG 910.1 No Current Volume N/A " 21,168.58 " " 38,080.16 " " 26,553.87 " N/A N/A N/A " 21,948.94 " N/A N/A N/A " 26,428.97 " N/A N/A " 21,168.58 " N/A N/A N/A N/A N/A N/A N/A " 22,544.54 " " 21,168.58 " N/A " 21,168.58 " " 31,752.87 " N/A " 38,080.16 " " 37,709.71 " N/A DRG 910.2 No Current Volume N/A " 22,907.18 " " 41,207.73 " " 28,734.77 " N/A N/A N/A " 23,751.63 " N/A N/A N/A " 28,599.61 " N/A N/A " 22,907.18 " N/A N/A N/A N/A N/A N/A N/A " 24,396.15 " " 22,907.18 " N/A " 22,907.18 " " 34,360.77 " N/A " 41,207.73 " " 40,806.85 " N/A DRG 910.3 No Current Volume N/A " 31,240.67 " " 56,198.84 " " 39,188.30 " N/A N/A N/A " 32,392.33 " N/A N/A N/A " 39,003.98 " N/A N/A " 31,240.67 " N/A N/A N/A N/A N/A N/A N/A " 33,271.31 " " 31,240.67 " N/A " 31,240.67 " " 46,861.01 " N/A " 56,198.84 " " 55,652.13 " N/A DRG 910.4 No Current Volume N/A " 57,926.33 " " 104,203.68 " " 72,662.79 " N/A N/A N/A " 60,061.74 " N/A N/A N/A " 72,321.02 " N/A N/A " 57,926.33 " N/A N/A N/A N/A N/A N/A N/A " 61,691.54 " " 57,926.33 " N/A " 57,926.33 " " 86,889.50 " N/A " 104,203.68 " " 103,189.96 " N/A DRG 911.1 No Current Volume N/A " 14,935.92 " " 26,868.23 " " 18,735.62 " N/A N/A N/A " 15,486.52 " N/A N/A N/A " 18,647.50 " N/A N/A " 14,935.92 " N/A N/A N/A N/A N/A N/A N/A " 15,906.75 " " 14,935.92 " N/A " 14,935.92 " " 22,403.88 " N/A " 26,868.23 " " 26,606.85 " N/A DRG 911.2 " 132,304.04 " " 41,689.00 " " 16,681.37 " " 30,008.12 " " 20,925.11 " N/A N/A N/A " 17,296.31 " N/A N/A N/A " 20,826.69 " N/A N/A " 16,681.37 " N/A N/A N/A N/A N/A N/A N/A " 17,765.66 " " 16,681.37 " N/A " 16,681.37 " " 25,022.06 " N/A " 30,008.12 " " 29,716.19 " N/A DRG 911.3 No Current Volume N/A " 21,182.96 " " 38,106.03 " " 26,571.91 " N/A N/A N/A " 21,963.85 " N/A N/A N/A " 26,446.93 " N/A N/A " 21,182.96 " N/A N/A N/A N/A N/A N/A N/A " 22,559.85 " " 21,182.96 " N/A " 21,182.96 " " 31,774.44 " N/A " 38,106.03 " " 37,735.32 " N/A DRG 911.4 " 206,169.49 " " 64,964.01 " " 49,640.77 " " 89,298.78 " " 62,269.38 " N/A N/A N/A " 51,470.74 " N/A N/A N/A " 61,976.50 " N/A N/A " 49,640.77 " N/A N/A N/A N/A N/A N/A N/A " 52,867.42 " " 49,640.77 " N/A " 49,640.77 " " 74,461.16 " N/A " 89,298.78 " " 88,430.07 " N/A DRG 912.1 No Current Volume N/A " 13,722.53 " " 24,685.46 " " 17,213.54 " N/A N/A N/A " 14,228.40 " N/A N/A N/A " 17,132.58 " N/A N/A " 13,722.53 " N/A N/A N/A N/A N/A N/A N/A " 14,614.49 " " 13,722.53 " N/A " 13,722.53 " " 20,583.80 " N/A " 24,685.46 " " 24,445.31 " N/A DRG 912.2 " 153,165.17 " " 48,262.35 " " 15,109.85 " " 27,181.11 " " 18,953.80 " N/A N/A N/A " 15,666.86 " N/A N/A N/A " 18,864.65 " N/A N/A " 15,109.85 " N/A N/A N/A N/A N/A N/A N/A " 16,091.99 " " 15,109.85 " N/A " 15,109.85 " " 22,664.78 " N/A " 27,181.11 " " 26,916.69 " N/A DRG 912.3 " 216,923.31 " " 68,352.53 " " 24,384.88 " " 43,865.96 " " 30,588.39 " N/A N/A N/A " 25,283.81 " N/A N/A N/A " 30,444.52 " N/A N/A " 24,384.88 " N/A N/A N/A N/A N/A N/A N/A " 25,969.90 " " 24,384.88 " N/A " 24,384.88 " " 36,577.32 " N/A " 43,865.96 " " 43,439.23 " N/A DRG 912.4 " 252,731.61 " " 79,635.73 " " 48,288.38 " " 86,865.97 " " 60,572.94 " N/A N/A N/A " 50,068.49 " N/A N/A N/A " 60,288.04 " N/A N/A " 48,288.38 " N/A N/A N/A N/A N/A N/A N/A " 51,427.12 " " 48,288.38 " N/A " 48,288.38 " " 72,432.57 " N/A " 86,865.97 " " 86,020.92 " N/A DRG 930.1 No Current Volume N/A " 5,893.70 " " 10,602.18 " " 7,393.06 " N/A N/A N/A " 6,110.97 " N/A N/A N/A " 7,358.28 " N/A N/A " 5,893.70 " N/A N/A N/A N/A N/A N/A N/A " 6,276.79 " " 5,893.70 " N/A " 5,893.70 " " 8,840.55 " N/A " 10,602.18 " " 10,499.04 " N/A DRG 930.2 " 41,640.61 " " 13,120.95 " " 7,426.19 " " 13,358.97 " " 9,315.41 " N/A N/A N/A " 7,699.95 " N/A N/A N/A " 9,271.60 " N/A N/A " 7,426.19 " N/A N/A N/A N/A N/A N/A N/A " 7,908.89 " " 7,426.19 " N/A " 7,426.19 " " 11,139.29 " N/A " 13,358.97 " " 13,229.01 " N/A DRG 930.3 " 116,368.20 " " 36,667.62 " " 11,875.74 " " 21,363.27 " " 14,896.93 " N/A N/A N/A " 12,313.53 " N/A N/A N/A " 14,826.86 " N/A N/A " 11,875.74 " N/A N/A N/A N/A N/A N/A N/A " 12,647.66 " " 11,875.74 " N/A " 11,875.74 " " 17,813.61 " N/A " 21,363.27 " " 21,155.44 " N/A DRG 930.4 " 189,367.29 " " 59,669.63 " " 25,801.64 " " 46,414.57 " " 32,365.58 " N/A N/A N/A " 26,752.80 " N/A N/A N/A " 32,213.35 " N/A N/A " 25,801.64 " N/A N/A N/A N/A N/A N/A N/A " 27,478.75 " " 25,801.64 " N/A " 25,801.64 " " 38,702.46 " N/A " 46,414.57 " " 45,963.04 " N/A DRG 950.1 No Current Volume N/A " 11,562.12 " " 20,799.10 " " 14,503.52 " N/A N/A N/A " 11,988.35 " N/A N/A N/A " 14,435.31 " N/A N/A " 11,562.12 " N/A N/A N/A N/A N/A N/A N/A " 12,313.66 " " 11,562.12 " N/A " 11,562.12 " " 17,343.18 " N/A " 20,799.10 " " 20,596.76 " N/A DRG 950.2 " 102,792.21 " " 32,389.82 " " 15,659.71 " " 28,170.25 " " 19,643.54 " N/A N/A N/A " 16,236.99 " N/A N/A N/A " 19,551.15 " N/A N/A " 15,659.71 " N/A N/A N/A N/A N/A N/A N/A " 16,677.59 " " 15,659.71 " N/A " 15,659.71 " " 23,489.57 " N/A " 28,170.25 " " 27,896.21 " N/A DRG 950.3 No Current Volume N/A " 21,233.63 " " 38,197.18 " " 26,635.47 " N/A N/A N/A " 22,016.39 " N/A N/A N/A " 26,510.19 " N/A N/A " 21,233.63 " N/A N/A N/A N/A N/A N/A N/A " 22,613.82 " " 21,233.63 " N/A " 21,233.63 " " 31,850.45 " N/A " 38,197.18 " " 37,825.59 " N/A DRG 950.4 " 221,413.90 " " 69,767.52 " " 44,772.84 " " 80,541.86 " " 56,163.05 " N/A N/A N/A " 46,423.35 " N/A N/A N/A " 55,898.89 " N/A N/A " 44,772.84 " N/A N/A N/A N/A N/A N/A N/A " 47,683.07 " " 44,772.84 " N/A " 44,772.84 " " 67,159.26 " N/A " 80,541.86 " " 79,758.34 " N/A DRG 951.1 No Current Volume N/A " 8,820.35 " " 15,866.93 " " 11,064.25 " N/A N/A N/A " 9,145.51 " N/A N/A N/A " 11,012.21 " N/A N/A " 8,820.35 " N/A N/A N/A N/A N/A N/A N/A " 9,393.67 " " 8,820.35 " N/A " 8,820.35 " " 13,230.53 " N/A " 15,866.93 " " 15,712.57 " N/A DRG 951.2 No Current Volume N/A " 12,621.44 " " 22,704.71 " " 15,832.33 " N/A N/A N/A " 13,086.72 " N/A N/A N/A " 15,757.87 " N/A N/A " 12,621.44 " N/A N/A N/A N/A N/A N/A N/A " 13,441.83 " " 12,621.44 " N/A " 12,621.44 " " 18,932.16 " N/A " 22,704.71 " " 22,483.83 " N/A DRG 951.3 No Current Volume N/A " 18,912.30 " " 34,021.34 " " 23,723.59 " N/A N/A N/A " 19,609.49 " N/A N/A N/A " 23,612.01 " N/A N/A " 18,912.30 " N/A N/A N/A N/A N/A N/A N/A " 20,141.60 " " 18,912.30 " N/A " 18,912.30 " " 28,368.45 " N/A " 34,021.34 " " 33,690.37 " N/A DRG 951.4 " 53,574.68 " " 16,881.38 " " 37,581.52 " " 67,605.40 " " 47,142.26 " N/A N/A N/A " 38,966.93 " N/A N/A N/A " 46,920.53 " N/A N/A " 37,581.52 " N/A N/A N/A N/A N/A N/A N/A " 40,024.32 " " 37,581.52 " N/A " 37,581.52 " " 56,372.28 " N/A " 67,605.40 " " 66,947.72 " N/A DRG 952.1 No Current Volume N/A " 7,485.08 " " 13,464.91 " " 9,389.28 " N/A N/A N/A " 7,761.01 " N/A N/A N/A " 9,345.12 " N/A N/A " 7,485.08 " N/A N/A N/A N/A N/A N/A N/A " 7,971.61 " " 7,485.08 " N/A " 7,485.08 " " 11,227.62 " N/A " 13,464.91 " " 13,333.92 " N/A DRG 952.2 " 31,051.94 " " 9,784.47 " " 10,641.81 " " 19,143.55 " " 13,349.09 " N/A N/A N/A " 11,034.11 " N/A N/A N/A " 13,286.30 " N/A N/A " 10,641.81 " N/A N/A N/A N/A N/A N/A N/A " 11,333.53 " " 10,641.81 " N/A " 10,641.81 " " 15,962.72 " N/A " 19,143.55 " " 18,957.32 " N/A DRG 952.3 " 95,353.87 " " 30,046.01 " " 17,103.86 " " 30,768.13 " " 21,455.08 " N/A N/A N/A " 17,734.38 " N/A N/A N/A " 21,354.17 " N/A N/A " 17,103.86 " N/A N/A N/A N/A N/A N/A N/A " 18,215.61 " " 17,103.86 " N/A " 17,103.86 " " 25,655.79 " N/A " 30,768.13 " " 30,468.82 " N/A DRG 952.4 " 209,710.71 " " 66,079.84 " " 36,055.20 " " 64,859.70 " " 45,227.64 " N/A N/A N/A " 37,384.34 " N/A N/A N/A " 45,014.92 " N/A N/A " 36,055.20 " N/A N/A N/A N/A N/A N/A N/A " 38,398.79 " " 36,055.20 " N/A " 36,055.20 " " 54,082.80 " N/A " 64,859.70 " " 64,228.73 " N/A