{"text_format":"1","workbook":"xlsx","n_sheets":9,"sheets":["Lookup Tool","Chapters Inclusion","Field Keys","2022 Professional Fee Schedule","Updates and Corrections","Table","Parameters","MARFS_URL's","Lookup Results"],"not_rendered":{"charts":0,"images":2,"macros":1,"external_links":1,"defined_names":7,"comments":0,"pivot_tables":0},"unopened":[],"bounds":{"document_bytes":16777216,"sheet_cells":100000,"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0,"cell_chars":16384,"cell_head_chars":4096},"cells_cut":0,"cells_raw":0,"read":"whole","date_system":"1900"}

{"sheet":"Lookup Tool","index":0,"n_rows":30,"n_cols":11,"rows_kept":30,"cut":false,"hidden":false,"merged":[[12,2,12,10],[21,0,21,4],[8,2,8,10],[5,2,6,10],[5,0,11,1],[0,0,0,10],[7,2,7,10],[9,2,9,10],[10,2,10,10],[11,2,11,10]]}
["Code Lookup Tool (Professional Services Fee Schedule)"]
[null,null,{"$f":"CodeLookup[[#Headers],[Modifiers]]","v":"Modifiers"},{"$f":"CodeLookup[[#Headers],[Short Description (HCPCS and Local Only)]]","v":"Short Description (HCPCS and Local Only)"},{"$f":"CodeLookup[[#Headers],[NON-FACILITY SETTING]]","v":"NON-FACILITY SETTING"},{"$f":"CodeLookup[[#Headers],[FACILITY SETTING]]","v":"FACILITY SETTING"},{"$f":"CodeLookup[[#Headers],[FOL UP]]","v":"FOL UP"},{"$f":"CodeLookup[[#Headers],[PRE OP\n(-56)]]","v":"PRE OP\n(-56)"},{"$f":"CodeLookup[[#Headers],[INTRA OP\n(-54)]]","v":"INTRA OP\n(-54)"},{"$f":"CodeLookup[[#Headers],[POST OP\n(-55)]]","v":"POST OP\n(-55)"},{"$f":"CodeLookup[[#Headers],[PCTC\n(26/TC)]]","v":"PCTC\n(26/TC)"}]
["Enter code --> (case sensitive)",10004,{"$f":"IF(CodeLookup[Modifiers]=0,\" \",CodeLookup[Modifiers])","v":" "},{"$f":"CodeLookup[Short Description (HCPCS and Local Only)]","v":"See CPT"},{"$f":"CodeLookup[NON-FACILITY SETTING]","v":90.973799999999997},{"$f":"CodeLookup[FACILITY SETTING]","v":75.514200000000002},{"$f":"CodeLookup[FOL UP]","v":"000"},{"$f":"CodeLookup[PRE OP\n(-56)]","v":0},{"$f":"CodeLookup[INTRA OP\n(-54)]","v":0},{"$f":"CodeLookup[POST OP\n(-55)]","v":0},{"$f":"CodeLookup[PCTC\n(26/TC)]","v":0}]
["Is there a modifier?","No",{"$f":"CodeLookup[[#Headers],[MSI\n(-51)]]","v":"MSI\n(-51)"},{"$f":"CodeLookup[[#Headers],[BSI\n(-50)]]","v":"BSI\n(-50)"},{"$f":"CodeLookup[[#Headers],[ASI\n(-80)]]","v":"ASI\n(-80)"},{"$f":"CodeLookup[[#Headers],[CSI\n(-62)]]","v":"CSI\n(-62)"},{"$f":"CodeLookup[[#Headers],[TSI\n(-66)]]","v":"TSI\n(-66)"},{"$f":"CodeLookup[[#Headers],[ENDO\nBASE]]","v":"ENDO\nBASE"},{"$f":"CodeLookup[[#Headers],[FSI]]","v":"FSI"},{"$f":"CodeLookup[[#Headers],[LIC REQ]]","v":"LIC REQ"},{"$f":"CodeLookup[[#Headers],[Prior Auth]]","v":"Prior Auth"}]
[{"$f":"IF(B4=\"No\",\"\",\"Select the modifier\")","v":""},"TC",{"$f":"CodeLookup[MSI\n(-51)]","v":0},{"$f":"CodeLookup[BSI\n(-50)]","v":0},{"$f":"CodeLookup[ASI\n(-80)]","v":0},{"$f":"CodeLookup[CSI\n(-62)]","v":0},{"$f":"CodeLookup[TSI\n(-66)]","v":0},{"$f":"CodeLookup[ENDO\nBASE]","v":0},{"$f":"CodeLookup[FSI]","v":"R"},{"$f":"CodeLookup[LIC REQ]","v":0},{"$f":"IF(CodeLookup[Prior Auth]=0,\"\",CodeLookup[Prior Auth])","v":"Y-CM"}]
[null,null,"NOTE: The MARFS chapters linked below are recommended for your understanding of these codes but are not to be considered explicit context and do not remove your responsibility to bill properly in accordance with the L&I Provider Agreement, applicable RCWs and WACs, and the MARFS in its entirety."]
[]
[null,null,{"$f":"CodeLookup[[#Headers],[MARFS Chapters]]","v":"MARFS Chapters"}]
[null,null,{"$f":"IFERROR(HYPERLINK(A25,A26),\"\")","v":"Chapter 2: Information for All Providers"}]
[null,null,{"$f":"IFERROR(HYPERLINK(B25,B26),\"\")","v":"Chapter 29: Surgery Services"}]
[null,null,{"$f":"IFERROR(HYPERLINK(C25,C26),\"\")","v":""}]
[null,null,"Link to Prior Authorization Details (if applicable)"]
[null,null,{"$f":"IFERROR(HYPERLINK(D25,D26),\"\")","v":"Claim Manager Authorizations"}]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[{"$f":"CodeLookup[MARFS Chapters]","v":2},{"$f":"CodeLookup[MARFS Chapters2]","v":29},{"$f":"CodeLookup[MARFS Chapters3]","v":0}]
[{"$f":"IFERROR(VLOOKUP(A24,'MARFS_URL''s'!$B$2:$D$37,2,),\"\")","v":"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2022/2022MarfsChapter2.pdf"},{"$f":"IFERROR(VLOOKUP(B24,'MARFS_URL''s'!$B$2:$D$37,2,),\"\")","v":"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2022/2022MarfsChapter29.pdf"},{"$f":"IFERROR(VLOOKUP(C24,'MARFS_URL''s'!$B$2:$D$37,2,),\"\")","v":""},{"$f":"VLOOKUP(K5,'MARFS_URL''s'!$B$40:$D$43,2,)","v":"https://lni.wa.gov/patient-care/authorizations-referrals/authorization/claim-manager-authorizations"}]
[{"$f":"IFERROR(VLOOKUP(A24,'MARFS_URL''s'!$B$2:$D$37,3,),\"\")","v":"Chapter 2: Information for All Providers"},{"$f":"IFERROR(VLOOKUP(B24,'MARFS_URL''s'!$B$2:$D$37,3,),\"\")","v":"Chapter 29: Surgery Services"},{"$f":"IFERROR(VLOOKUP(C24,'MARFS_URL''s'!$B$2:$D$37,3,),\"\")","v":""},{"$f":"VLOOKUP(K5,'MARFS_URL''s'!$B$40:$D$43,3,)","v":"Claim Manager Authorizations"}]
[]
[]
[{"$f":"CodeLookup[[#Headers],[CODE]]","v":"CODE"}]
[{"$f":"CodeLookup[CODE]","v":10004}]

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["Professional Services Fee Schedule"]
[]
[]
[]
[null,null,null,"DOLLAR VALUE",null,null,"MODIFIERS"]
["CODE","Modifiers","Short Description (HCPCS and Local Only)","NON-FACILITY SETTING","FACILITY SETTING","FOL UP","PRE OP\n(-56)","INTRA OP\n(-54)","POST OP\n(-55)","PCTC\n(26/TC)","MSI\n(-51)","BSI\n(-50)","ASI\n(-80)","CSI\n(-62)","TSI\n(-66)","ENDO\nBASE","FSI","LIC REQ","Prior Auth","MARFS Chapters","MARFS Chapters","MARFS Chapters"]
[10004,null,"See CPT",null,90.973799999999997,null,75.514200000000002,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[10005,null,"See CPT",null,252.11040000000003,null,130.2174,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[10006,null,"See CPT",null,107.62260000000001,null,88.595399999999998,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[10007,null,"See CPT",null,559.51859999999999,null,159.94739999999999,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[10008,null,"See CPT",null,304.43520000000001,null,100.48739999999999,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[10009,null,"See CPT",null,844.33199999999999,null,195.02879999999999,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[10010,null,"See CPT",null,494.11260000000004,null,139.73099999999999,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[10011,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,2,0,0,0,0,null,"N",null,"Y-CM"]
[10012,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,0,0,0,0,0,null,"N",null,"Y-CM"]
[10021,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,0,0,0,0,null,"X"]
[10030,null,"See CPT",null,1240.9302,null,236.6508,null,"000",0,0,0,9,2,9,0,0,0,null,"R",null,"Y-CM"]
[10035,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,1,0,0,0,null,"X"]
[10036,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[10040,null,"See CPT",null,213.4614,null,91.568399999999997,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[10060,null,"See CPT",null,227.13720000000001,null,188.48820000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[10061,null,"See CPT",null,385.8954,null,328.2192,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[10080,null,"See CPT",null,478.65300000000008,null,187.89360000000002,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[10081,null,"See CPT",null,645.73559999999998,null,305.02980000000002,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[10120,null,"See CPT",null,275.2998,null,186.10980000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[10121,null,"See CPT",null,483.40980000000008,null,327.03000000000003,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[10140,null,"See CPT",null,311.57040000000001,null,211.083,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[10160,null,"See CPT",null,236.05620000000002,null,170.0556,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[10180,null,"See CPT",null,482.22059999999999,null,317.51639999999998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11000,null,"See CPT",null,106.43340000000001,null,48.757199999999997,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11001,null,"See CPT",null,48.162600000000005,null,24.973199999999999,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[11004,null,"See CPT",null,997.14419999999996,null,997.14419999999996,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11005,null,"See CPT",null,1356.8772000000001,null,1356.8772000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[11006,null,"See CPT",null,1227.2544,null,1227.2544,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11008,null,"See CPT",null,478.05839999999995,null,478.05839999999995,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[11010,null,"See CPT",null,831.84540000000004,null,488.76120000000003,null,"010",0.1,0.8,0.1,0,2,2,1,0,0,null,"R"]
[11011,null,"See CPT",null,912.1164,null,522.05880000000002,null,"000",0,0,0,0,2,2,1,0,0,null,"R"]
[11012,null,"See CPT",null,1181.4702,null,731.95260000000007,null,"000",0,0,0,0,2,2,1,0,0,null,"R"]
[11042,null,"See CPT",null,239.02919999999997,null,106.43340000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11043,null,"See CPT",null,422.166,null,270.54300000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11044,null,"See CPT",null,557.73480000000006,null,394.81439999999998,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11045,null,"See CPT",null,73.730400000000003,null,45.784199999999998,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[11046,null,"See CPT",null,131.4066,null,96.919799999999995,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[11047,null,"See CPT",null,214.6506,null,169.46100000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[11055,null,"See CPT",null,134.37959999999998,null,27.946199999999997,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11056,null,"See CPT",null,153.4068,null,38.649000000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11057,null,"See CPT",null,167.6772,null,50.540999999999997,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11102,null,"See CPT",null,189.08280000000002,null,66.595200000000006,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11103,null,"See CPT",null,93.94680000000001,null,38.649000000000001,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[11104,null,"See CPT",null,234.86700000000002,null,82.6494,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11105,null,"See CPT",null,109.4064,null,45.189599999999999,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[11106,null,"See CPT",null,290.75939999999997,null,99.892799999999994,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11107,null,"See CPT",null,132.00120000000001,null,54.703200000000002,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[11200,null,"See CPT",null,164.1096,null,136.1634,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11201,null,"See CPT",null,32.703000000000003,null,28.540800000000001,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[11300,null,"See CPT",null,189.67740000000001,null,60.054600000000001,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[11301,null,"See CPT",null,226.54259999999999,null,89.784599999999998,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[11302,null,"See CPT",null,255.678,null,105.83880000000001,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[11303,null,"See CPT",null,281.84040000000005,null,124.2714,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[11305,null,"See CPT",null,198.59639999999999,null,67.189799999999991,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[11306,null,"See CPT",null,227.73180000000002,null,86.811599999999999,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[11307,null,"See CPT",null,259.84019999999998,null,110.5956,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[11308,null,"See CPT",null,274.70519999999999,null,124.2714,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[11310,null,"See CPT",null,215.8398,null,80.271000000000001,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[11311,null,"See CPT",null,253.89419999999998,null,110.001,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[11312,null,"See CPT",null,287.1918,null,129.62280000000001,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[11313,null,"See CPT",null,334.16520000000003,null,169.46100000000001,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[11400,null,"See CPT",null,236.05620000000002,null,149.83920000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11401,null,"See CPT",null,287.78640000000001,null,189.08280000000002,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11402,null,"See CPT",null,316.3272,null,206.92080000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11403,null,"See CPT",null,361.51679999999999,null,265.19159999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11404,null,"See CPT",null,410.86860000000001,null,292.54320000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11406,null,"See CPT",null,579.1404,null,440.59860000000003,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11420,null,"See CPT",null,235.4616,null,147.46080000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11421,null,"See CPT",null,293.73240000000004,null,195.02879999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11422,null,"See CPT",null,328.81380000000001,null,242.00220000000002,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11423,null,"See CPT",null,374.0034,null,277.08359999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11424,null,"See CPT",null,427.51740000000001,null,315.73259999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11426,null,"See CPT",null,603.51900000000001,null,482.81519999999995,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11440,null,"See CPT",null,264.59700000000004,null,189.67740000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11441,null,"See CPT",null,319.89479999999998,null,237.84,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11442,null,"See CPT",null,353.78700000000003,null,261.62400000000002,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11443,null,"See CPT",null,416.22,null,318.7056,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11444,null,"See CPT",null,516.11279999999999,null,401.94959999999998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11446,null,"See CPT",null,699.24959999999999,null,567.84300000000007,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11450,null,"See CPT",null,805.68300000000011,null,469.73400000000004,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R"]
[11451,null,"See CPT",null,974.54939999999999,null,590.43780000000004,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R"]
[11462,null,"See CPT",null,783.08820000000003,null,447.13919999999996,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R"]
[11463,null,"See CPT",null,991.79279999999994,null,596.38379999999995,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R"]
[11470,null,"See CPT",null,843.14279999999997,null,511.95059999999995,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[11471,null,"See CPT",null,1006.6578,null,628.49220000000003,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[11600,null,"See CPT",null,364.4898,null,217.62360000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11601,null,"See CPT",null,419.19299999999998,null,263.40780000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11602,null,"See CPT",null,446.5446,null,286.59720000000004,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11603,null,"See CPT",null,507.19379999999995,null,341.30040000000002,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11604,null,"See CPT",null,564.87,null,375.78720000000004,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11606,null,"See CPT",null,809.25059999999996,null,560.11320000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11620,null,"See CPT",null,365.67900000000003,null,218.81280000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11621,null,"See CPT",null,420.38220000000001,null,264.59700000000004,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11622,null,"See CPT",null,461.40960000000001,null,299.67840000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11623,null,"See CPT",null,538.70760000000007,null,369.84120000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11624,null,"See CPT",null,612.4380000000001,null,420.38220000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11626,null,"See CPT",null,737.30400000000009,null,516.70740000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11640,null,"See CPT",null,374.0034,null,225.35339999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11641,null,"See CPT",null,433.46340000000004,null,275.2998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11642,null,"See CPT",null,488.76120000000003,null,322.27319999999997,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11643,null,"See CPT",null,572.59980000000007,null,401.94959999999998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11644,null,"See CPT",null,704.601,null,498.86940000000004,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11646,null,"See CPT",null,912.71100000000001,null,689.73599999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11719,null,"See CPT",null,24.973199999999999,null,13.081200000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11720,null,"See CPT",null,58.865400000000001,null,25.567799999999998,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[11721,null,"See CPT",null,79.676400000000001,null,42.2166,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[11730,null,"See CPT",null,211.67760000000001,null,94.54140000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11732,null,"See CPT",null,61.2438,null,30.3246,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[11740,null,"See CPT",null,105.24420000000001,null,56.486999999999995,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11750,null,"See CPT",null,293.13779999999997,null,180.75839999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11755,null,"See CPT",null,225.94799999999998,null,106.43340000000001,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[11760,null,"See CPT",null,346.65180000000004,null,198.0018,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11762,null,"See CPT",null,531.57240000000002,null,335.94900000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11765,null,"See CPT",null,306.21900000000005,null,164.1096,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11770,null,"See CPT",null,671.30340000000001,null,331.78680000000003,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11771,null,"See CPT",null,1160.0646000000002,null,806.27760000000001,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11772,null,"See CPT",null,1428.2292,null,1047.0906,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11900,null,"See CPT",null,103.46040000000001,null,51.730200000000004,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11901,null,"See CPT",null,127.839,null,80.865600000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11920,null,"See CPT",null,356.76,null,194.4342,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[11921,null,"See CPT",null,404.92259999999999,null,229.51560000000001,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[11922,null,"See CPT",null,109.4064,null,51.730200000000004,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[11950,null,"See CPT",null,144.48780000000002,null,91.568399999999997,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[11951,null,"See CPT",null,193.83959999999999,null,129.0282,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[11952,null,"See CPT",null,258.0564,null,181.35299999999998,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[11954,null,"See CPT",null,284.21880000000004,null,198.0018,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[11960,null,"See CPT",null,1827.8003999999999,null,1827.8003999999999,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[11970,null,"See CPT",null,1004.2794,null,1004.2794,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R"]
[11971,null,"See CPT",null,984.0630000000001,null,984.0630000000001,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R"]
[11976,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,0,0,0,0,null,"X"]
[11980,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,0,1,0,0,null,"X"]
[11981,null,"See CPT",null,183.13679999999999,null,111.1902,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[11982,null,"See CPT",null,204.54239999999999,null,130.2174,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[11983,null,"See CPT",null,256.27259999999995,null,181.94759999999999,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[12001,null,"See CPT",null,171.2448,null,79.081800000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[12002,null,"See CPT",null,205.73160000000001,null,103.46040000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[12004,null,"See CPT",null,238.43459999999999,null,127.24440000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[12005,null,"See CPT",null,321.084,null,165.89340000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[12006,null,"See CPT",null,374.59800000000001,null,203.9478,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[12007,null,"See CPT",null,420.38220000000001,null,254.48880000000003,null,"000",0,0,0,0,2,0,1,1,0,null,"R"]
[12011,null,"See CPT",null,204.54239999999999,null,96.325200000000009,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[12013,null,"See CPT",null,212.86680000000001,null,101.67659999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[12014,null,"See CPT",null,260.4348,null,130.2174,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[12015,null,"See CPT",null,311.57040000000001,null,164.70420000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[12016,null,"See CPT",null,397.78740000000005,null,224.75879999999998,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[12017,null,"See CPT",null,265.78620000000001,null,265.78620000000001,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[12018,null,"See CPT",null,301.4622,null,301.4622,null,"000",0,0,0,0,2,0,2,0,0,null,"R"]
[12020,null,"See CPT",null,551.78879999999992,null,334.16520000000003,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12021,null,"See CPT",null,322.27319999999997,null,251.51580000000004,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12031,null,"See CPT",null,487.57199999999995,null,268.75919999999996,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12032,null,"See CPT",null,557.14019999999994,null,336.54360000000003,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12034,null,"See CPT",null,614.81640000000004,null,363.30060000000003,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12035,null,"See CPT",null,714.1146,null,427.51740000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12036,null,"See CPT",null,793.19640000000004,null,501.8424,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12037,null,"See CPT",null,883.57560000000001,null,580.32960000000003,null,"010",0.1,0.8,0.1,0,2,0,0,1,0,null,"R"]
[12041,null,"See CPT",null,489.35580000000004,null,255.08340000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12042,null,"See CPT",null,570.81600000000003,null,346.65180000000004,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12044,null,"See CPT",null,701.62800000000004,null,377.57099999999997,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12045,null,"See CPT",null,748.0068,null,482.22059999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12046,null,"See CPT",null,923.41379999999992,null,567.84300000000007,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[12047,null,"See CPT",null,1007.847,null,629.68140000000005,null,"010",0.1,0.8,0.1,0,2,0,2,1,0,null,"R"]
[12051,null,"See CPT",null,523.84260000000006,null,300.27299999999997,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12052,null,"See CPT",null,580.32960000000003,null,352.59780000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12053,null,"See CPT",null,671.30340000000001,null,379.35480000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12054,null,"See CPT",null,709.3578,null,385.30080000000004,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12055,null,"See CPT",null,926.98140000000001,null,528.00480000000005,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12056,null,"See CPT",null,1064.3339999999998,null,683.79,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[12057,null,"See CPT",null,1121.4156,null,744.43920000000003,null,"010",0.1,0.8,0.1,0,2,0,2,1,0,null,"R"]
[13100,null,"See CPT",null,628.49220000000003,null,354.38159999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[13101,null,"See CPT",null,733.14179999999999,null,440.59860000000003,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[13102,null,"See CPT",null,213.4614,null,127.24440000000001,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[13120,null,"See CPT",null,654.65459999999996,null,414.43619999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[13121,null,"See CPT",null,782.49360000000001,null,454.27440000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[13122,null,"See CPT",null,230.70480000000001,null,144.48780000000002,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[13131,null,"See CPT",null,712.33080000000007,null,427.51740000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[13132,null,"See CPT",null,863.9538,null,534.54539999999997,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[13133,null,"See CPT",null,303.84060000000005,null,220.00200000000001,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[13151,null,"See CPT",null,774.76379999999995,null,491.73419999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[13152,null,"See CPT",null,908.54880000000003,null,592.22160000000008,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[13153,null,"See CPT",null,333.57060000000001,null,240.2184,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[13160,null,"See CPT",null,1418.7156,null,1418.7156,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[14000,null,"See CPT",null,1150.5510000000002,null,895.46760000000006,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[14001,null,"See CPT",null,1461.5267999999999,null,1160.0646000000002,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[14020,null,"See CPT",null,1268.8764000000001,null,1005.4686,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[14021,null,"See CPT",null,1559.6358,null,1256.9844000000001,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[14040,null,"See CPT",null,1365.7962,null,1104.7667999999999,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[14041,null,"See CPT",null,1654.7718,null,1348.5527999999999,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[14060,null,"See CPT",null,1378.8774000000001,null,1178.4972,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[14061,null,"See CPT",null,1783.8,null,1448.4456,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[14301,null,"See CPT",null,1956.2339999999999,null,1539.4194,null,"090",0.1,0.71,0.19,0,2,0,2,0,0,null,"R"]
[14302,null,"See CPT",null,379.35480000000001,null,379.35480000000001,null,"000",0,0,0,0,0,0,2,0,0,null,"R"]
[14350,null,"See CPT",null,1211.2002,null,1211.2002,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[15002,null,"See CPT",null,635.03279999999995,null,386.49,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[15003,null,"See CPT",null,126.6498,null,79.676400000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[15004,null,"See CPT",null,720.65519999999992,null,460.22040000000004,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[15005,null,"See CPT",null,211.083,null,159.3528,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[15040,null,"See CPT",null,487.57199999999995,null,217.62360000000001,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[15050,null,"See CPT",null,1086.9288000000001,null,829.46699999999998,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15100,null,"See CPT",null,1575.0953999999999,null,1276.0116,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15101,null,"See CPT",null,345.46260000000001,null,198.59639999999999,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[15110,null,"See CPT",null,1495.4189999999999,null,1259.3628000000001,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15111,null,"See CPT",null,199.78559999999999,null,178.38,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[15115,null,"See CPT",null,1445.4726000000001,null,1221.903,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15116,null,"See CPT",null,290.75939999999997,null,262.21860000000004,null,"000",0,0,0,0,0,0,1,1,0,null,"R"]
[15120,null,"See CPT",null,1526.3382000000001,null,1225.4705999999999,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15121,null,"See CPT",null,387.67919999999998,null,239.62380000000002,null,"000",0,0,0,0,0,0,1,1,0,null,"R"]
[15130,null,"See CPT",null,1314.6605999999999,null,1067.307,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15131,null,"See CPT",null,172.434,null,158.1636,null,"000",0,0,0,0,0,0,1,1,0,null,"R"]
[15135,null,"See CPT",null,1584.0144,null,1347.9582,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15136,null,"See CPT",null,170.65020000000001,null,158.1636,null,"000",0,0,0,0,0,0,1,1,0,null,"R"]
[15150,null,"See CPT",null,1277.2008000000001,null,1142.2266,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15151,null,"See CPT",null,209.8938,null,192.65040000000002,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[15152,null,"See CPT",null,259.84019999999998,null,244.38060000000002,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[15155,null,"See CPT",null,1432.9860000000001,null,1298.6064000000001,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15156,null,"See CPT",null,281.84040000000005,null,264.59700000000004,null,"000",0,0,0,0,0,0,1,1,0,null,"R"]
[15157,null,"See CPT",null,313.35419999999999,null,287.78640000000001,null,"000",0,0,0,0,0,0,1,1,0,null,"R"]
[15200,null,"See CPT",null,1516.23,null,1195.7406000000001,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15201,null,"See CPT",null,257.46179999999998,null,133.785,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[15220,null,"See CPT",null,1390.1748,null,1083.3612000000001,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15221,null,"See CPT",null,240.2184,null,121.2984,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[15240,null,"See CPT",null,1674.3936000000001,null,1413.3642,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15241,null,"See CPT",null,316.3272,null,184.92060000000001,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[15260,null,"See CPT",null,1793.9082000000001,null,1498.9866000000002,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15261,null,"See CPT",null,375.19259999999997,null,240.2184,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[15271,null,"See CPT",null,283.02960000000002,null,147.46080000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[15272,null,"See CPT",null,45.189599999999999,null,30.9192,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[15273,null,"See CPT",null,576.76199999999994,null,347.24639999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[15274,null,"See CPT",null,153.4068,null,79.676400000000001,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[15275,null,"See CPT",null,290.75939999999997,null,164.1096,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[15276,null,"See CPT",null,58.270800000000001,null,44.594999999999999,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[15277,null,"See CPT",null,632.05980000000011,null,395.40900000000005,null,"000",0,0,0,0,2,0,1,1,0,null,"R"]
[15278,null,"See CPT",null,176.59620000000001,null,99.298199999999994,null,"000",0,0,0,0,0,0,1,1,0,null,"R"]
[15570,null,"See CPT",null,1647.6366,null,1304.5524,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15572,null,"See CPT",null,1578.663,null,1303.9577999999999,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15574,null,"See CPT",null,1588.7711999999999,null,1315.2552000000001,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15576,null,"See CPT",null,1417.5264,null,1158.8753999999999,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15600,null,"See CPT",null,623.14080000000001,null,380.54400000000004,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[15610,null,"See CPT",null,673.68180000000007,null,436.43639999999999,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[15620,null,"See CPT",null,816.98040000000003,null,585.08640000000003,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15630,null,"See CPT",null,841.35900000000004,null,613.62720000000002,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15650,null,"See CPT",null,930.54899999999998,null,681.41160000000002,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[15730,null,"See CPT",null,2619.8076000000001,null,1626.231,null,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R"]
[15731,null,"See CPT",null,2019.8561999999999,null,1776.6648,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[15733,null,"See CPT",null,1833.7464,null,1833.7464,null,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R"]
[15734,null,"See CPT",null,2667.3755999999998,null,2667.3755999999998,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[15736,null,"See CPT",null,2167.9115999999999,null,2167.9115999999999,null,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R"]
[15738,null,"See CPT",null,2267.2098000000001,null,2267.2098000000001,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[15740,null,"See CPT",null,1814.1246000000001,null,1490.6622,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15750,null,"See CPT",null,1660.1232000000002,null,1660.1232000000002,null,"090",0.1,0.71,0.19,0,2,0,2,0,0,null,"R"]
[15756,null,"See CPT",null,4061.7126000000003,null,4061.7126000000003,null,"090",0.1,0.71,0.19,0,2,0,2,2,0,null,"R"]
[15757,null,"See CPT",null,4039.1178000000004,null,4039.1178000000004,null,"090",0.1,0.71,0.19,0,2,0,2,2,0,null,"R"]
[15758,null,"See CPT",null,4036.1447999999996,null,4036.1447999999996,null,"090",0.1,0.71,0.19,0,2,0,2,2,0,null,"R"]
[15760,null,"See CPT",null,1522.7706000000001,null,1244.4978000000001,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15769,null,"See CPT",null,853.84559999999999,null,853.84559999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[15770,null,"See CPT",null,1200.4974000000002,null,1200.4974000000002,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[15771,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"X"]
[15772,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,0,0,1,0,0,null,"X"]
[15773,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"X"]
[15774,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,0,0,1,0,0,null,"X"]
[15775,null,"See CPT",null,686.76300000000003,null,451.3014,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[15776,null,"See CPT",null,926.38679999999999,null,616.60019999999997,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[15777,null,"See CPT",null,378.7602,null,378.7602,null,"000",0,0,0,0,0,1,1,0,0,null,"R"]
[15780,null,"See CPT",null,1531.6896000000002,null,1174.9296000000002,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[15781,null,"See CPT",null,985.25220000000002,null,768.81780000000003,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15782,null,"See CPT",null,881.79179999999997,null,656.4384,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[15783,null,"See CPT",null,812.81820000000005,null,628.49220000000003,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[15786,null,"See CPT",null,424.5444,null,236.6508,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[15787,null,"See CPT",null,56.486999999999995,null,30.3246,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[15788,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"X"]
[15789,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"X"]
[15792,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"X"]
[15793,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"X"]
[15819,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"X"]
[15820,null,"See CPT",null,1044.1176,null,922.22460000000001,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[15821,null,"See CPT",null,1120.8210000000001,null,987.03600000000006,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[15822,null,"See CPT",null,838.98059999999998,null,718.87139999999999,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[15823,null,"See CPT",null,1121.4156,null,986.44140000000004,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[15824,null,"See CPT",null,1576.4879493792002,null,1576.4879493792002,null,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM"]
[15825,null,"See CPT",null,1355.5079139888001,null,1355.5079139888001,null,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM"]
[15826,null,"See CPT",null,1281.8334795552003,null,1281.8334795552003,null,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM"]
[15828,null,"See CPT",null,4390.6220248176014,null,4390.6220248176014,null,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM"]
[15829,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,2,1,0,0,0,null,"N",null,"Y-CM"]
[15830,null,"See CPT",null,2085.2622000000001,null,2085.2622000000001,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[15832,null,"See CPT",null,1635.7446000000002,null,1635.7446000000002,null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[15833,null,"See CPT",null,1565.5817999999999,null,1565.5817999999999,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[15834,null,"See CPT",null,1594.1225999999999,null,1594.1225999999999,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[15835,null,"See CPT",null,1658.934,null,1658.934,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[15836,null,"See CPT",null,1424.067,null,1424.067,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[15837,null,"See CPT",null,1564.9872,null,1278.9846,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[15838,null,"See CPT",null,1161.8483999999999,null,1161.8483999999999,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[15839,null,"See CPT",null,1609.5822000000001,null,1318.8227999999999,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[15840,null,"See CPT",null,1813.53,null,1813.53,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15841,null,"See CPT",null,3167.4342000000001,null,3167.4342000000001,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[15842,null,"See CPT",null,4792.4759999999997,null,4792.4759999999997,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[15845,null,"See CPT",null,1894.3956000000001,null,1894.3956000000001,null,"090",0.1,0.71,0.19,0,2,0,2,0,0,null,"R"]
[15847,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,0,0,2,1,0,null,"N",null,"Y-CM"]
[15850,null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"Bundledundled"]
[15851,null,"See CPT",null,197.40719999999999,null,79.081800000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[15852,null,"See CPT",null,82.0548,null,82.0548,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[15860,null,"See CPT",null,187.29900000000001,null,187.29900000000001,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[15876,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,0,0,0,0,null,"X"]
[15877,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,0,0,0,0,null,"X"]
[15878,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,1,0,0,0,null,"X"]
[15879,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,1,0,0,0,null,"X"]
[15920,null,"See CPT",null,1149.9564,null,1149.9564,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[15922,null,"See CPT",null,1429.4184,null,1429.4184,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[15931,null,"See CPT",null,1251.0383999999999,null,1251.0383999999999,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15933,null,"See CPT",null,1562.6088000000002,null,1562.6088000000002,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[15934,null,"See CPT",null,1694.6100000000001,null,1694.6100000000001,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15935,null,"See CPT",null,2067.4242000000004,null,2067.4242000000004,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[15936,null,"See CPT",null,1615.5282000000002,null,1615.5282000000002,null,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R"]
[15937,null,"See CPT",null,1869.4224000000002,null,1869.4224000000002,null,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R"]
[15940,null,"See CPT",null,1254.0114000000001,null,1254.0114000000001,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15941,null,"See CPT",null,1670.826,null,1670.826,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[15944,null,"See CPT",null,1673.2044000000001,null,1673.2044000000001,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[15945,null,"See CPT",null,1824.8274000000001,null,1824.8274000000001,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[15946,null,"See CPT",null,2887.3776000000003,null,2887.3776000000003,null,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R"]
[15950,null,"See CPT",null,1143.4158,null,1143.4158,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15951,null,"See CPT",null,1614.9336000000001,null,1614.9336000000001,null,"090",0.1,0.71,0.19,0,2,0,0,1,0,null,"R"]
[15952,null,"See CPT",null,1639.3122000000001,null,1639.3122000000001,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[15953,null,"See CPT",null,1807.5839999999998,null,1807.5839999999998,null,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R"]
[15956,null,"See CPT",null,2094.7757999999999,null,2094.7757999999999,null,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R"]
[15958,null,"See CPT",null,2132.2356,null,2132.2356,null,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R"]
[15999,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,2,0,0,1,1,null,"N"]
[16000,null,"See CPT",null,137.3526,null,79.081800000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[16020,null,"See CPT",null,154.596,null,96.919799999999995,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[16025,null,"See CPT",null,286.00259999999997,null,196.8126,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[16030,null,"See CPT",null,357.94919999999996,null,231.89400000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[16035,null,"See CPT",null,337.13819999999998,null,337.13819999999998,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[16036,null,"See CPT",null,137.3526,null,137.3526,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[17000,null,"See CPT",null,122.4876,null,98.703599999999994,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17003,null,"See CPT",null,12.486599999999999,null,3.5676000000000001,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[17004,null,"See CPT",null,309.19200000000001,null,173.02860000000001,null,"010",0.1,0.8,0.1,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[17106,null,"See CPT",null,618.38400000000001,null,488.76120000000003,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17107,null,"See CPT",null,805.68300000000011,null,637.41120000000001,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17108,null,"See CPT",null,1133.3075999999999,null,928.76519999999994,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[17110,null,"See CPT",null,208.7046,null,119.51459999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17111,null,"See CPT",null,243.78599999999997,null,145.67700000000002,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17250,null,"See CPT",null,165.89340000000001,null,66.595200000000006,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[17260,null,"See CPT",null,181.94759999999999,null,125.4606,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17261,null,"See CPT",null,270.54300000000001,null,152.81219999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17262,null,"See CPT",null,326.43540000000002,null,194.4342,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17263,null,"See CPT",null,352.59780000000001,null,215.24520000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17264,null,"See CPT",null,376.97640000000001,null,230.11020000000002,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17266,null,"See CPT",null,428.11200000000002,null,269.94839999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17270,null,"See CPT",null,271.13759999999996,null,166.488,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17271,null,"See CPT",null,302.65140000000002,null,184.32600000000002,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17272,null,"See CPT",null,344.27339999999998,null,213.4614,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17273,null,"See CPT",null,380.54400000000004,null,241.40759999999997,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17274,null,"See CPT",null,443.57159999999999,null,294.92160000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17276,null,"See CPT",null,514.92359999999996,null,354.97620000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17280,null,"See CPT",null,255.678,null,152.2176,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17281,null,"See CPT",null,327.62459999999999,null,208.11,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17282,null,"See CPT",null,374.0034,null,240.2184,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17283,null,"See CPT",null,440.00400000000002,null,299.0838,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17284,null,"See CPT",null,500.05860000000001,null,350.21940000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17286,null,"See CPT",null,638.60040000000004,null,472.70699999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17311,null,"See CPT",null,1223.6867999999999,null,624.33000000000004,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17312,null,"See CPT",null,748.0068,null,331.78680000000003,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[17313,null,"See CPT",null,1151.1456000000001,null,560.70780000000002,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17314,null,"See CPT",null,716.49300000000005,null,307.40820000000002,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[17315,null,"See CPT",null,139.13639999999998,null,88.000799999999998,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[17340,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"X"]
[17360,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"X"]
[17380,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,0,0,0,0,null,"X"]
[17999,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,2,0,0,1,1,null,"N"]
[19000,null,"See CPT",null,189.67740000000001,null,74.919600000000003,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[19001,null,"See CPT",null,47.568000000000005,null,36.865200000000002,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[19020,null,"See CPT",null,868.11599999999999,null,562.49160000000006,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R"]
[19030,null,"See CPT",null,304.43520000000001,null,132.5958,null,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[19081,null,"See CPT",null,950.7654,null,288.38099999999997,null,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[19082,null,"See CPT",null,749.19600000000003,null,145.08240000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[19083,null,"See CPT",null,963.84660000000008,null,272.32679999999999,null,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[19084,null,"See CPT",null,741.46620000000007,null,134.9742,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[19085,null,"See CPT",null,1487.0946000000001,null,316.3272,null,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[19086,null,"See CPT",null,1164.2267999999999,null,157.56899999999999,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[19100,null,"See CPT",null,284.8134,null,121.89299999999999,null,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[19101,null,"See CPT",null,609.46500000000003,null,400.7604,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[19105,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,1,1,0,0,null,"X"]
[19110,null,"See CPT",null,898.44060000000002,null,632.65440000000001,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[19112,null,"See CPT",null,855.03480000000002,null,582.11339999999996,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[19120,null,"See CPT",null,941.2518,null,745.62839999999994,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[19125,null,"See CPT",null,1036.3878,null,825.89940000000001,null,"090",0.1,0.71,0.19,0,2,1,1,1,0,null,"R",null,"Y-CM"]
[19126,null,"See CPT",null,281.84040000000005,null,281.84040000000005,null,"000",0,0,0,0,0,0,1,1,0,null,"R",null,"Y-CM"]
[19281,null,"See CPT",null,442.97700000000003,null,174.21780000000001,null,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[19282,null,"See CPT",null,317.51639999999998,null,86.811599999999999,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[19283,null,"See CPT",null,483.40980000000008,null,175.40700000000001,null,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[19284,null,"See CPT",null,363.89519999999999,null,88.000799999999998,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[19285,null,"See CPT",null,714.1146,null,148.65,null,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[19286,null,"See CPT",null,592.22160000000008,null,74.919600000000003,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[19287,null,"See CPT",null,1238.5518,null,221.19120000000001,null,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[19288,null,"See CPT",null,965.6303999999999,null,111.1902,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[19294,null,"See CPT",null,288.97560000000004,null,288.97560000000004,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[19296,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,1,0,0,0,null,"X"]
[19297,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[19298,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,1,0,0,0,null,"X"]
[19300,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"X"]
[19301,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"X"]
[19302,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"X"]
[19303,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"X"]
[19305,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"X"]
[19306,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"X"]
[19307,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"X"]
[19316,null,"See CPT",null,1412.175,null,1412.175,null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[19318,null,"See CPT",null,1946.7204000000002,null,1946.7204000000002,null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[19325,null,"See CPT",null,1100.01,null,1100.01,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[19328,null,"See CPT",null,991.19820000000016,null,991.19820000000016,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[19330,null,"See CPT",null,1154.7132000000001,null,1154.7132000000001,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[19340,null,"See CPT",null,1353.9041999999999,null,1353.9041999999999,null,"090",0.1,0.71,0.19,0,2,1,1,1,0,null,"R",null,"Y-CM"]
[19342,null,"See CPT",null,1359.8502000000001,null,1359.8502000000001,null,"090",0.1,0.71,0.19,0,2,1,0,1,0,null,"R",null,"Y-CM"]
[19350,null,"See CPT",null,1501.365,null,1202.8758,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[19355,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"X"]
[19357,null,"See CPT",null,2078.1270000000004,null,2078.1270000000004,null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[19361,null,"See CPT",null,2771.4306000000001,null,2771.4306000000001,null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[19364,null,"See CPT",null,4832.3141999999998,null,4832.3141999999998,null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[19367,null,"See CPT",null,3148.4070000000002,null,3148.4070000000002,null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[19368,null,"See CPT",null,3857.1702000000005,null,3857.1702000000005,null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[19369,null,"See CPT",null,3584.8434000000002,null,3584.8434000000002,null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[19370,null,"See CPT",null,1199.3082000000002,null,1199.3082000000002,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[19371,null,"See CPT",null,1271.2547999999999,null,1271.2547999999999,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[19380,null,"See CPT",null,1441.3103999999998,null,1441.3103999999998,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[19396,null,"See CPT",null,509.57220000000001,null,252.70500000000001,null,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[19499,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,2,1,0,1,1,null,"N"]
[20100,null,"See CPT",null,1066.7124000000001,null,1066.7124000000001,null,"010",0.1,0.8,0.1,0,2,1,2,0,0,null,"R"]
[20101,null,"See CPT",null,1115.4696000000001,null,375.19259999999997,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[20102,null,"See CPT",null,1160.0646000000002,null,454.27440000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[20103,null,"See CPT",null,1037.577,null,613.0326,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[20150,null,"See CPT",null,1787.3676,null,1787.3676,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[20200,null,"See CPT",null,408.49020000000002,null,166.488,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[20205,null,"See CPT",null,563.68080000000009,null,271.13759999999996,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[20206,null,"See CPT",null,429.89580000000001,null,101.08199999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[20220,null,"See CPT",null,444.76080000000002,null,152.81219999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[20225,null,"See CPT",null,735.52019999999993,null,228.32640000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[20240,null,"See CPT",null,249.13740000000001,null,249.13740000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[20245,null,"See CPT",null,611.24879999999996,null,611.24879999999996,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[20250,null,"See CPT",null,688.54679999999996,null,688.54679999999996,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[20251,null,"See CPT",null,751.57440000000008,null,751.57440000000008,null,"010",0.1,0.8,0.1,0,2,0,2,0,0,null,"R"]
[20500,null,"See CPT",null,220.5966,null,155.7852,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[20501,null,"See CPT",null,274.70519999999999,null,65.406000000000006,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[20520,null,"See CPT",null,399.57119999999998,null,264.59700000000004,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[20525,null,"See CPT",null,862.17,null,440.59860000000003,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[20526,null,"See CPT",null,148.05540000000002,null,101.08199999999999,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[20527,null,"See CPT",null,156.9744,null,115.947,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[20550,null,"See CPT",null,103.46040000000001,null,68.97359999999999,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[20551,null,"See CPT",null,104.64960000000001,null,68.97359999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[20552,null,"See CPT",null,96.919799999999995,null,66.595200000000006,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[20553,null,"See CPT",null,111.78479999999999,null,75.514200000000002,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[20555,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,0,0,0,0,null,"X"]
[20560,null,"See CPT",null,48.162600000000005,null,26.757000000000001,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[20561,null,"See CPT",null,68.378999999999991,null,39.243600000000001,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[20600,null,"See CPT",null,95.73060000000001,null,63.027600000000007,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[20604,null,"See CPT",null,148.65,null,80.865600000000001,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[20605,null,"See CPT",null,98.703599999999994,null,65.406000000000006,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[20606,null,"See CPT",null,161.7312,null,90.973799999999997,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[20610,null,"See CPT",null,117.1362,null,79.676400000000001,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[20611,null,"See CPT",null,180.75839999999999,null,104.64960000000001,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[20612,null,"See CPT",null,115.947,null,72.541200000000003,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[20615,null,"See CPT",null,461.40960000000001,null,286.00259999999997,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[20650,null,"See CPT",null,406.11180000000002,null,288.38099999999997,null,"010",0.1,0.8,0.1,0,2,0,1,1,0,null,"R"]
[20660,null,"See CPT",null,419.7876,null,419.7876,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[20661,null,"See CPT",null,916.8732,null,916.8732,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[20662,null,"See CPT",null,937.08960000000002,null,937.08960000000002,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[20663,null,"See CPT",null,863.9538,null,863.9538,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[20664,null,"See CPT",null,1573.3116,null,1573.3116,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[20665,null,"See CPT",null,209.8938,null,171.83940000000001,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[20670,null,"See CPT",null,671.30340000000001,null,258.65100000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[20680,null,"See CPT",null,1100.01,null,748.0068,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[20690,null,"See CPT",null,1063.7394000000002,null,1063.7394000000002,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[20692,null,"See CPT",null,1998.4505999999999,null,1998.4505999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[20693,null,"See CPT",null,794.98019999999997,null,794.98019999999997,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[20694,null,"See CPT",null,781.899,null,610.65419999999995,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[20696,null,"See CPT",null,2107.2624000000001,null,2107.2624000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[20697,null,"See CPT",null,3553.9242000000004,null,3553.9242000000004,null,"000",0,0,0,3,0,0,2,1,0,null,"R"]
[20700,null,"See CPT",null,149.83920000000001,null,149.83920000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[20701,null,"See CPT",null,113.5686,null,113.5686,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[20702,null,"See CPT",null,252.11040000000003,null,252.11040000000003,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[20703,null,"See CPT",null,183.73140000000001,null,183.73140000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[20704,null,"See CPT",null,266.38080000000002,null,266.38080000000002,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[20705,null,"See CPT",null,218.2182,null,218.2182,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[20802,null,"See CPT",null,4858.4766,null,4858.4766,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[20805,null,"See CPT",null,5768.8091999999997,null,5768.8091999999997,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[20808,null,"See CPT",null,6957.4146000000001,null,6957.4146000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[20816,null,"See CPT",null,3637.7628,null,3637.7628,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[20822,null,"See CPT",null,3146.6232,null,3146.6232,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[20824,null,"See CPT",null,3644.3033999999998,null,3644.3033999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[20827,null,"See CPT",null,3229.2726000000002,null,3229.2726000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[20838,null,"See CPT",null,4938.7476000000006,null,4938.7476000000006,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[20900,null,"See CPT",null,726.00660000000005,null,321.084,null,"000",0,0,0,0,2,0,2,1,0,null,"R"]
[20902,null,"See CPT",null,488.76120000000003,null,488.76120000000003,null,"000",0,0,0,0,2,0,2,1,0,null,"R"]
[20910,null,"See CPT",null,855.03480000000002,null,855.03480000000002,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[20912,null,"See CPT",null,864.54840000000002,null,864.54840000000002,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[20920,null,"See CPT",null,714.70920000000001,null,714.70920000000001,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R"]
[20922,null,"See CPT",null,1087.5234,null,869.89980000000003,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[20924,null,"See CPT",null,906.76499999999999,null,906.76499999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[20930,null,"See CPT",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
[20931,null,"See CPT",null,192.0558,null,192.0558,null,"000",0,0,0,0,0,0,1,1,0,null,"R"]
[20932,null,"See CPT",null,1328.3363999999999,null,1328.3363999999999,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR"]
[20933,null,"See CPT",null,1219.5246000000002,null,1219.5246000000002,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR"]
[20934,null,"See CPT",null,1327.1472000000001,null,1327.1472000000001,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR"]
[20936,null,"See CPT",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
[20937,null,"See CPT",null,291.35400000000004,null,291.35400000000004,null,"000",0,0,0,0,0,0,2,1,0,null,"R"]
[20938,null,"See CPT",null,320.48939999999999,null,320.48939999999999,null,"000",0,0,0,0,0,0,2,1,0,null,"R"]
[20939,null,"See CPT",null,121.2984,null,121.2984,null,"000",0,0,0,0,0,1,0,0,0,null,"R",null,"Y-UR"]
[20950,null,"See CPT",null,498.27480000000003,null,155.7852,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[20955,null,"See CPT",null,4376.2559999999994,null,4376.2559999999994,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[20956,null,"See CPT",null,4674.7452000000003,null,4674.7452000000003,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[20957,null,"See CPT",null,4868.5847999999996,null,4868.5847999999996,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[20962,null,"See CPT",null,4727.07,null,4727.07,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[20969,null,"See CPT",null,4813.2870000000003,null,4813.2870000000003,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[20970,null,"See CPT",null,5038.6403999999993,null,5038.6403999999993,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[20972,null,"See CPT",null,5023.1808000000001,null,5023.1808000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[20973,null,"See CPT",null,5306.8050000000003,null,5306.8050000000003,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[20974,null,"See CPT",null,147.46080000000001,null,88.000799999999998,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[20975,null,"See CPT",null,305.02980000000002,null,305.02980000000002,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM"]
[20979,null,"See CPT",null,99.892799999999994,null,55.297800000000002,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[20982,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,1,1,0,0,null,"X"]
[20983,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,1,1,0,0,null,"X"]
[20985,null,"See CPT",null,255.08340000000001,null,255.08340000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[20999,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,2,0,0,1,1,null,"N"]
[21010,null,"See CPT",null,1329.5255999999999,null,1329.5255999999999,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[21011,null,"See CPT",null,687.35760000000005,null,466.16640000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21012,null,"See CPT",null,608.2758,null,608.2758,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21013,null,"See CPT",null,979.30619999999999,null,719.46600000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21014,null,"See CPT",null,934.11660000000006,null,934.11660000000006,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21015,null,"See CPT",null,1250.4438,null,1250.4438,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[21016,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"X"]
[21025,null,"See CPT",null,1425.8507999999999,null,1179.0917999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[21026,null,"See CPT",null,972.17100000000005,null,767.62860000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[21029,null,"See CPT",null,1387.7963999999999,null,1106.5506,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[21030,null,"See CPT",null,843.14279999999997,null,650.49239999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[21031,null,"See CPT",null,706.38480000000004,null,489.9504,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[21032,null,"See CPT",null,682.00620000000004,null,467.9502,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[21034,null,"See CPT",null,2342.7240000000002,null,2014.5048000000002,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21040,null,"See CPT",null,855.62940000000003,null,655.84379999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[21044,null,"See CPT",null,1548.3383999999999,null,1548.3383999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21045,null,"See CPT",null,2141.7492000000002,null,2141.7492000000002,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21046,null,"See CPT",null,1802.8271999999999,null,1802.8271999999999,null,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R",null,"Y-CM"]
[21047,null,"See CPT",null,2233.3176000000003,null,2233.3176000000003,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21048,null,"See CPT",null,1815.9084,null,1815.9084,null,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R",null,"Y-CM"]
[21049,null,"See CPT",null,2176.2360000000003,null,2176.2360000000003,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21050,null,"See CPT",null,1557.8520000000001,null,1557.8520000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[21060,null,"See CPT",null,1412.175,null,1412.175,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[21070,null,"See CPT",null,1093.4694,null,1093.4694,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[21073,null,"See CPT",null,687.95220000000006,null,441.19319999999999,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[21076,null,"See CPT",null,1532.8788000000002,null,1247.4708000000001,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[21077,null,"See CPT",null,3764.4126000000001,null,3071.1089999999999,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[21079,null,"See CPT",null,2584.1316000000002,null,2067.4242000000004,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[21080,null,"See CPT",null,2993.2164000000002,null,2358.7782000000002,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[21081,null,"See CPT",null,2747.6466,null,2153.0466000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21082,null,"See CPT",null,2522.8878,null,1959.8016,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21083,null,"See CPT",null,2411.1030000000001,null,1820.0706,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21084,null,"See CPT",null,2750.6196,null,2106.0732000000003,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21085,null,"See CPT",null,1210.0110000000002,null,853.84559999999999,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[21086,null,"See CPT",null,2804.1335999999997,null,2264.8314,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[21087,null,"See CPT",null,2804.1335999999997,null,2264.8314,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21088,null,"See CPT",null,"By Report",null,"By Report",null,"090",0.1,0.69,0.21,0,0,0,0,0,0,null,"N"]
[21089,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,0,0,1,1,1,null,"N"]
[21100,null,"See CPT",null,1149.9564,null,635.03279999999995,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21110,null,"See CPT",null,1617.9066,null,1337.85,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[21116,null,"See CPT",null,415.03080000000006,null,80.271000000000001,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[21120,null,"See CPT",null,1222.4975999999999,null,925.79219999999998,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,"Y-CM"]
[21121,null,"See CPT",null,1149.3617999999999,null,951.95460000000014,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21122,null,"See CPT",null,1356.2826,null,1356.2826,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21123,null,"See CPT",null,1537.6356000000001,null,1537.6356000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21125,null,"See CPT",null,5030.3159999999998,null,1189.7946000000002,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21127,null,"See CPT",null,7727.4216000000006,null,1364.0124000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21137,null,"See CPT",null,1342.6068,null,1342.6068,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21138,null,"See CPT",null,1632.7716,null,1632.7716,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21139,null,"See CPT",null,1956.2339999999999,null,1956.2339999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21141,null,"See CPT",null,2391.4812000000002,null,2391.4812000000002,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21142,null,"See CPT",null,2454.5088000000001,null,2454.5088000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21143,null,"See CPT",null,2528.2392000000004,null,2528.2392000000004,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21145,null,"See CPT",null,2777.9712,null,2777.9712,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21146,null,"See CPT",null,2899.8642000000004,null,2899.8642000000004,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21147,null,"See CPT",null,3051.4872,null,3051.4872,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21150,null,"See CPT",null,2934.9456,null,2934.9456,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21151,null,"See CPT",null,3226.8942000000002,null,3226.8942000000002,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21154,null,"See CPT",null,3471.8694,null,3471.8694,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21155,null,"See CPT",null,3847.6565999999998,null,3847.6565999999998,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21159,null,"See CPT",null,4605.7716,null,4605.7716,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21160,null,"See CPT",null,4992.8562000000002,null,4992.8562000000002,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21172,null,"See CPT",null,3742.4123999999997,null,3742.4123999999997,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21175,null,"See CPT",null,3939.2249999999999,null,3939.2249999999999,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21179,null,"See CPT",null,2711.3760000000002,null,2711.3760000000002,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21180,null,"See CPT",null,3026.5140000000001,null,3026.5140000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21181,null,"See CPT",null,1324.7688000000001,null,1324.7688000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[21182,null,"See CPT",null,3760.8450000000003,null,3760.8450000000003,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21183,null,"See CPT",null,4089.6588000000002,null,4089.6588000000002,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21184,null,"See CPT",null,4397.6615999999995,null,4397.6615999999995,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21188,null,"See CPT",null,2844.5664000000002,null,2844.5664000000002,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21193,null,"See CPT",null,2204.1822000000002,null,2204.1822000000002,null,"090",0.1,0.69,0.21,0,2,2,2,1,0,null,"R",null,"Y-CM"]
[21194,null,"See CPT",null,2553.2123999999999,null,2553.2123999999999,null,"090",0.1,0.69,0.21,0,2,2,2,0,0,null,"R",null,"Y-CM"]
[21195,null,"See CPT",null,2417.6435999999999,null,2417.6435999999999,null,"090",0.1,0.69,0.21,0,2,2,2,0,0,null,"R",null,"Y-CM"]
[21196,null,"See CPT",null,2581.7532000000001,null,2581.7532000000001,null,"090",0.1,0.69,0.21,0,2,2,2,1,0,null,"R",null,"Y-CM"]
[21198,null,"See CPT",null,1855.152,null,1855.152,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21199,null,"See CPT",null,1814.7192,null,1814.7192,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21206,null,"See CPT",null,1735.0427999999999,null,1735.0427999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21208,null,"See CPT",null,3093.1092000000003,null,1315.2552000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21209,null,"See CPT",null,1498.9866000000002,null,1116.6588000000002,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[21210,null,"See CPT",null,3316.0842000000002,null,1350.3366000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[21215,null,"See CPT",null,7882.0176000000001,null,1401.4721999999999,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R"]
[21230,null,"See CPT",null,1340.8230000000001,null,1340.8230000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21235,null,"See CPT",null,1331.904,null,1018.5498,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[21240,null,"See CPT",null,1871.2061999999999,null,1871.2061999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[21242,null,"See CPT",null,1814.1246000000001,null,1814.1246000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[21243,null,"See CPT",null,2869.5396000000001,null,2869.5396000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[21244,null,"See CPT",null,1811.1516000000001,null,1811.1516000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[21245,null,"See CPT",null,2139.3707999999997,null,1647.0419999999999,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21246,null,"See CPT",null,1522.1760000000002,null,1522.1760000000002,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21247,null,"See CPT",null,2827.9176000000002,null,2827.9176000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[21248,null,"See CPT",null,1774.8810000000001,null,1409.202,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[21249,null,"See CPT",null,2409.3192000000004,null,1977.6396,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21255,null,"See CPT",null,2412.2921999999999,null,2412.2921999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[21256,null,"See CPT",null,2209.5335999999998,null,2209.5335999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[21260,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"X"]
[21261,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"X"]
[21263,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"X"]
[21267,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[21268,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[21270,null,"See CPT",null,1830.1788000000001,null,1333.6877999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[21275,null,"See CPT",null,1512.6624000000002,null,1512.6624000000002,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[21280,null,"See CPT",null,1048.8744000000002,null,1048.8744000000002,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[21282,null,"See CPT",null,715.30380000000002,null,715.30380000000002,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[21295,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"X"]
[21296,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"X"]
[21299,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,0,0,1,1,null,"N"]
[21315,null,"See CPT",null,278.86740000000003,null,104.64960000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[21320,null,"See CPT",null,404.32799999999997,null,168.8664,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[21325,null,"See CPT",null,816.38580000000002,null,816.38580000000002,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21330,null,"See CPT",null,975.73860000000002,null,975.73860000000002,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21335,null,"See CPT",null,1295.6333999999999,null,1295.6333999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[21336,null,"See CPT",null,1176.1188000000002,null,1176.1188000000002,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21337,null,"See CPT",null,771.79079999999999,null,541.68060000000003,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21338,null,"See CPT",null,1230.8219999999999,null,1230.8219999999999,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21339,null,"See CPT",null,1386.6072000000001,null,1386.6072000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[21340,null,"See CPT",null,1344.9852000000001,null,1344.9852000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21343,null,"See CPT",null,1966.3422,null,1966.3422,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[21344,null,"See CPT",null,2502.6714000000002,null,2502.6714000000002,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R"]
[21345,null,"See CPT",null,1453.2024000000001,null,1144.605,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21346,null,"See CPT",null,1877.7467999999999,null,1877.7467999999999,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R"]
[21347,null,"See CPT",null,1887.2603999999999,null,1887.2603999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[21348,null,"See CPT",null,1951.4772,null,1951.4772,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R"]
[21355,null,"See CPT",null,814.00739999999996,null,588.654,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R"]
[21356,null,"See CPT",null,994.76580000000001,null,727.79039999999998,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R"]
[21360,null,"See CPT",null,938.87339999999995,null,938.87339999999995,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[21365,null,"See CPT",null,1932.45,null,1932.45,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[21366,null,"See CPT",null,2276.7233999999999,null,2276.7233999999999,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[21385,null,"See CPT",null,1318.8227999999999,null,1318.8227999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[21386,null,"See CPT",null,1236.768,null,1236.768,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[21387,null,"See CPT",null,1375.3098,null,1375.3098,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[21390,null,"See CPT",null,1438.3374000000001,null,1438.3374000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[21395,null,"See CPT",null,1802.8271999999999,null,1802.8271999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[21400,null,"See CPT",null,386.49,null,299.0838,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[21401,null,"See CPT",null,937.68420000000003,null,589.84320000000002,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[21406,null,"See CPT",null,1049.4689999999998,null,1049.4689999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[21407,null,"See CPT",null,1150.5510000000002,null,1150.5510000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[21408,null,"See CPT",null,1614.3389999999999,null,1614.3389999999999,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[21421,null,"See CPT",null,1186.2269999999999,null,994.76580000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21422,null,"See CPT",null,1123.7939999999999,null,1123.7939999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[21423,null,"See CPT",null,1434.1752000000001,null,1434.1752000000001,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R"]
[21431,null,"See CPT",null,1273.6332000000002,null,1273.6332000000002,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[21432,null,"See CPT",null,1299.7955999999999,null,1299.7955999999999,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[21433,null,"See CPT",null,3086.5686000000001,null,3086.5686000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[21435,null,"See CPT",null,2509.212,null,2509.212,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[21436,null,"See CPT",null,3623.4924000000001,null,3623.4924000000001,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R"]
[21440,null,"See CPT",null,1291.4712,null,1032.8202000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21445,null,"See CPT",null,1493.0406,null,1196.3352,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[21450,null,"See CPT",null,1110.1182000000001,null,896.65679999999998,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21451,null,"See CPT",null,1436.5536,null,1193.3622,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21452,null,"See CPT",null,1423.4724000000001,null,874.06200000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21453,null,"See CPT",null,2048.3970000000004,null,1737.4212,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21454,null,"See CPT",null,869.89980000000003,null,869.89980000000003,null,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R"]
[21461,null,"See CPT",null,3448.68,null,1950.2879999999998,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R"]
[21462,null,"See CPT",null,3769.1694000000002,null,2170.8845999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[21465,null,"See CPT",null,1417.5264,null,1417.5264,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[21470,null,"See CPT",null,2075.154,null,2075.154,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[21480,null,"See CPT",null,262.21860000000004,null,54.108600000000003,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[21485,null,"See CPT",null,1834.3410000000001,null,1492.4460000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[21490,null,"See CPT",null,1396.1208000000001,null,1396.1208000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[21497,null,"See CPT",null,1327.1472000000001,null,1098.8208,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21499,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,0,0,1,1,null,"N"]
[21501,null,"See CPT",null,894.87300000000005,null,600.54599999999994,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[21502,null,"See CPT",null,907.95420000000001,null,907.95420000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[21510,null,"See CPT",null,812.22360000000003,null,812.22360000000003,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21550,null,"See CPT",null,494.7072,null,279.46199999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[21552,null,"See CPT",null,799.73699999999997,null,799.73699999999997,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21554,null,"See CPT",null,1303.9577999999999,null,1303.9577999999999,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21555,null,"See CPT",null,800.92619999999999,null,551.78879999999992,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[21556,null,"See CPT",null,951.95460000000014,null,951.95460000000014,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[21557,null,"See CPT",null,1698.7722000000001,null,1698.7722000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21558,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"X"]
[21600,null,"See CPT",null,1004.8739999999999,null,1004.8739999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[21601,null,"See CPT",null,2042.451,null,2042.451,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[21602,null,"See CPT",null,2762.5116000000003,null,2762.5116000000003,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[21603,null,"See CPT",null,2995.5948000000003,null,2995.5948000000003,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[21610,null,"See CPT",null,2126.2896000000001,null,2126.2896000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21615,null,"See CPT",null,1082.172,null,1082.172,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[21616,null,"See CPT",null,1249.8491999999999,null,1249.8491999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[21620,null,"See CPT",null,903.19740000000002,null,903.19740000000002,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[21627,null,"See CPT",null,972.17100000000005,null,972.17100000000005,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[21630,null,"See CPT",null,2342.1294000000003,null,2342.1294000000003,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21632,null,"See CPT",null,2139.9654,null,2139.9654,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21685,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"X"]
[21700,null,"See CPT",null,624.33000000000004,null,624.33000000000004,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[21705,null,"See CPT",null,931.73820000000001,null,931.73820000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[21720,null,"See CPT",null,947.19780000000003,null,947.19780000000003,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21725,null,"See CPT",null,975.14399999999989,null,975.14399999999989,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21740,null,"See CPT",null,1801.6380000000001,null,1801.6380000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21742,null,"See CPT",null," By Report ",null," By Report ",null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"N",null,"Y-CM"]
[21743,null,"See CPT",null," By Report ",null," By Report ",null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"N",null,"Y-CM"]
[21750,null,"See CPT",null,1192.7675999999999,null,1192.7675999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[21811,null,"See CPT",null,1039.3607999999999,null,1039.3607999999999,null,"000",0,0,0,0,2,1,2,0,0,null,"R"]
[21812,null,"See CPT",null,1261.1466,null,1261.1466,null,"000",0,0,0,0,2,1,2,0,0,null,"R"]
[21813,null,"See CPT",null,1724.34,null,1724.34,null,"000",0,0,0,0,2,1,2,0,0,null,"R"]
[21820,null,"See CPT",null,272.32679999999999,null,266.97540000000004,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[21825,null,"See CPT",null,982.27919999999995,null,982.27919999999995,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[21899,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,0,0,1,1,null,"N",null,"Y-UR"]
[21920,null,"See CPT",null,478.05839999999995,null,278.86740000000003,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[21925,null,"See CPT",null,906.17039999999997,null,678.43860000000006,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[21930,null,"See CPT",null,922.81920000000002,null,652.27620000000002,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[21931,null,"See CPT",null,840.16980000000001,null,840.16980000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21932,null,"See CPT",null,1185.0378000000001,null,1185.0378000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[21933,null,"See CPT",null,1318.2282,null,1318.2282,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[21935,null,"See CPT",null,1824.2328,null,1824.2328,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,"Y-CM"]
[21936,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"X"]
[22010,null,"See CPT",null,1723.1508000000001,null,1723.1508000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[22015,null,"See CPT",null,1694.0154,null,1694.0154,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[22100,null,"See CPT",null,1542.9870000000001,null,1542.9870000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[22101,null,"See CPT",null,1534.068,null,1534.068,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[22102,null,"See CPT",null,1392.5532000000001,null,1392.5532000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[22103,null,"See CPT",null,236.6508,null,236.6508,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM"]
[22110,null,"See CPT",null,1873.5846000000001,null,1873.5846000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[22112,null,"See CPT",null,2009.7479999999998,null,2009.7479999999998,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[22114,null,"See CPT",null,2009.7479999999998,null,2009.7479999999998,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[22116,null,"See CPT",null,246.16439999999997,null,246.16439999999997,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM"]
[22206,null,"See CPT",null,4309.0662000000002,null,4309.0662000000002,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22207,null,"See CPT",null,4224.0384000000004,null,4224.0384000000004,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22208,null,"See CPT",null,1025.6849999999999,null,1025.6849999999999,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR"]
[22210,null,"See CPT",null,3162.0828000000001,null,3162.0828000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[22212,null,"See CPT",null,2678.6729999999998,null,2678.6729999999998,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[22214,null,"See CPT",null,2679.8622,null,2679.8622,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[22216,null,"See CPT",null,632.65440000000001,null,632.65440000000001,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM"]
[22220,null,"See CPT",null,2868.9450000000002,null,2868.9450000000002,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[22222,null,"See CPT",null,3100.8389999999999,null,3100.8389999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[22224,null,"See CPT",null,2820.7824000000001,null,2820.7824000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[22226,null,"See CPT",null,629.08680000000004,null,629.08680000000004,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM"]
[22310,null,"See CPT",null,562.49160000000006,null,535.7346,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[22315,null,"See CPT",null,1587.5819999999999,null,1378.8774000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[22318,null,"See CPT",null,2896.2966000000001,null,2896.2966000000001,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-CM"]
[22319,null,"See CPT",null,3220.9482000000003,null,3220.9482000000003,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-CM"]
[22325,null,"See CPT",null,2603.1588000000002,null,2603.1588000000002,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[22326,null,"See CPT",null,2664.9972000000002,null,2664.9972000000002,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[22327,null,"See CPT",null,2709.5922,null,2709.5922,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[22328,null,"See CPT",null,488.16660000000007,null,488.16660000000007,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM"]
[22505,null,"See CPT",null,230.11020000000002,null,230.11020000000002,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[22510,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"X"]
[22511,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"X"]
[22512,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,0,0,1,0,0,null,"X"]
[22513,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"X"]
[22514,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"X"]
[22515,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,0,0,1,0,0,null,"X"]
[22526,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"010",0.1,0.8,0.1,9,9,9,9,9,9,null,"X"]
[22527,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[22532,null,"See CPT",null,3181.11,null,3181.11,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22533,null,"See CPT",null,2931.9726000000001,null,2931.9726000000001,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22534,null,"See CPT",null,626.70839999999998,null,626.70839999999998,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22548,null,"See CPT",null,3451.6529999999998,null,3451.6529999999998,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22551,null,"See CPT",null,2998.5677999999998,null,2998.5677999999998,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22552,null,"See CPT",null,689.73599999999999,null,689.73599999999999,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22554,null,"See CPT",null,2226.777,null,2226.777,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22556,null,"See CPT",null,2940.297,null,2940.297,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22558,null,"See CPT",null,2700.0785999999998,null,2700.0785999999998,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22585,null,"See CPT",null,567.24839999999995,null,567.24839999999995,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22586,null,"See CPT",null,3570.5729999999999,null,3570.5729999999999,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22590,null,"See CPT",null,2799.3768,null,2799.3768,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22595,null,"See CPT",null,2677.4838,null,2677.4838,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22600,null,"See CPT",null,2301.1020000000003,null,2301.1020000000003,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22610,null,"See CPT",null,2263.6422000000002,null,2263.6422000000002,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22612,null,"See CPT",null,2804.7282,null,2804.7282,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22614,null,"See CPT",null,680.81700000000001,null,680.81700000000001,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22630,null,"See CPT",null,2791.0524,null,2791.0524,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22632,null,"See CPT",null,557.14019999999994,null,557.14019999999994,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22633,null,"See CPT",null,3261.3810000000003,null,3261.3810000000003,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22634,null,"See CPT",null,863.9538,null,863.9538,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22800,null,"See CPT",null,2408.7246,null,2408.7246,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22802,null,"See CPT",null,3735.2772,null,3735.2772,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22804,null,"See CPT",null,4284.6876000000002,null,4284.6876000000002,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22808,null,"See CPT",null,3226.2995999999998,null,3226.2995999999998,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22810,null,"See CPT",null,3560.4648000000002,null,3560.4648000000002,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22812,null,"See CPT",null,3901.7652000000003,null,3901.7652000000003,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22818,null,"See CPT",null,3807.2238000000002,null,3807.2238000000002,null,"090",0.11,0.76,0.13,0,2,0,2,2,2,null,"R",null,"Y-UR"]
[22819,null,"See CPT",null,4382.7965999999997,null,4382.7965999999997,null,"090",0.11,0.76,0.13,0,2,0,2,2,2,null,"R",null,"Y-UR"]
[22830,null,"See CPT",null,1460.9322,null,1460.9322,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22840,null,"See CPT",null,1321.7958000000001,null,1321.7958000000001,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR"]
[22841,null,"See CPT",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,"Y-UR"]
[22842,null,"See CPT",null,1328.3363999999999,null,1328.3363999999999,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22843,null,"See CPT",null,1420.4994000000002,null,1420.4994000000002,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22844,null,"See CPT",null,1717.7994000000001,null,1717.7994000000001,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22845,null,"See CPT",null,1265.9033999999999,null,1265.9033999999999,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22846,null,"See CPT",null,1315.8498,null,1315.8498,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22847,null,"See CPT",null,1406.8235999999999,null,1406.8235999999999,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22848,null,"See CPT",null,627.303,null,627.303,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22849,null,"See CPT",null,2310.6156000000001,null,2310.6156000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22850,null,"See CPT",null,1311.6876,null,1311.6876,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22852,null,"See CPT",null,1260.5519999999999,null,1260.5519999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22853,null,"See CPT",null,448.923,null,448.923,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22854,null,"See CPT",null,582.70800000000008,null,582.70800000000008,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22855,null,"See CPT",null,1961.5854000000002,null,1961.5854000000002,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22856,null,"See CPT",null,2874.8910000000001,null,2874.8910000000001,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22857,null,"See CPT",null,3134.1366000000003,null,3134.1366000000003,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22858,null,"See CPT",null,882.38639999999998,null,882.38639999999998,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22859,null,"See CPT",null,579.73500000000001,null,579.73500000000001,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22861,null,"See CPT",null,4058.145,null,4058.145,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22862,null,"See CPT",null,4061.7126000000003,null,4061.7126000000003,null,"090",0.1,0.71,0.19,0,2,0,2,2,2,null,"R",null,"Y-UR"]
[22864,null,"See CPT",null,3626.4654,null,3626.4654,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22865,null,"See CPT",null,3965.9820000000004,null,3965.9820000000004,null,"090",0.1,0.71,0.19,0,2,0,2,2,2,null,"R",null,"Y-UR"]
[22867,null,"See CPT",null,1902.1253999999999,null,1902.1253999999999,null,"090",0.1,0.8,0.1,0,2,0,2,0,0,null,"R",null,"Y-UR"]
[22868,null,"See CPT",null,423.35520000000002,null,423.35520000000002,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22869,null,"See CPT",null,776.54759999999999,null,776.54759999999999,null,"090",0.1,0.8,0.1,0,2,0,2,0,0,null,"R",null,"Y-UR"]
[22870,null,"See CPT",null,209.8938,null,209.8938,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22899,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,0,2,1,1,null,"N",null,"Y-UR"]
[22900,null,"See CPT",null,1010.82,null,1010.82,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[22901,null,"See CPT",null,1192.7675999999999,null,1192.7675999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[22902,null,"See CPT",null,871.08900000000006,null,599.35680000000002,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[22903,null,"See CPT",null,788.43960000000004,null,788.43960000000004,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[22904,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.81,0.1,0,2,0,2,1,1,null,"X"]
[22905,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.81,0.1,0,2,0,2,1,1,null,"X"]
[22999,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,0,0,1,1,null,"N",null,"Y-CM"]
[23000,null,"See CPT",null,1063.7394000000002,null,667.14120000000003,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[23020,null,"See CPT",null,1240.3355999999999,null,1240.3355999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM"]
[23030,null,"See CPT",null,818.16959999999995,null,457.84200000000004,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[23031,null,"See CPT",null,789.62879999999996,null,393.62520000000001,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[23035,null,"See CPT",null,1228.4436000000001,null,1228.4436000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM"]
[23040,null,"See CPT",null,1293.2550000000001,null,1293.2550000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[23044,null,"See CPT",null,1020.3336,null,1020.3336,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-CM"]
[23065,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"X"]
[23066,null,"See CPT",null,1041.1446000000001,null,658.22220000000004,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[23071,null,"See CPT",null,753.35820000000001,null,753.35820000000001,null,"090",0.1,0.8,0.1,0,2,1,2,0,0,null,"R"]
[23073,null,"See CPT",null,1245.6869999999999,null,1245.6869999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[23075,null,"See CPT",null,962.65740000000005,null,592.81620000000009,null,"090",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[23076,null,"See CPT",null,975.73860000000002,null,975.73860000000002,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[23077,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[23078,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[23100,null,"See CPT",null,915.68400000000008,null,915.68400000000008,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23101,null,"See CPT",null,827.08860000000004,null,827.08860000000004,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[23105,null,"See CPT",null,1152.9294,null,1152.9294,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23106,null,"See CPT",null,909.14339999999993,null,909.14339999999993,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[23107,null,"See CPT",null,1189.2,null,1189.2,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23120,null,"See CPT",null,1060.1717999999998,null,1060.1717999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23125,null,"See CPT",null,1276.6061999999999,null,1276.6061999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23130,null,"See CPT",null,1118.4425999999999,null,1118.4425999999999,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[23140,null,"See CPT",null,1002.4956,null,1002.4956,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[23145,null,"See CPT",null,1252.8222000000001,null,1252.8222000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[23146,null,"See CPT",null,1124.3886,null,1124.3886,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[23150,null,"See CPT",null,1191.5783999999999,null,1191.5783999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[23155,null,"See CPT",null,1432.9860000000001,null,1432.9860000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[23156,null,"See CPT",null,1221.903,null,1221.903,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM"]
[23170,null,"See CPT",null,1019.1444,null,1019.1444,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[23172,null,"See CPT",null,1029.2526,null,1029.2526,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM"]
[23174,null,"See CPT",null,1374.7152000000001,null,1374.7152000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[23180,null,"See CPT",null,1196.3352,null,1196.3352,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-CM"]
[23182,null,"See CPT",null,1211.7947999999999,null,1211.7947999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM"]
[23184,null,"See CPT",null,1328.931,null,1328.931,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[23190,null,"See CPT",null,1037.577,null,1037.577,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23195,null,"See CPT",null,1333.0932,null,1333.0932,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[23200,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[23210,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[23220,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[23330,null,"See CPT",null,559.51859999999999,null,300.86759999999998,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R"]
[23333,null,"See CPT",null,852.06180000000006,null,852.06180000000006,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[23334,null,"See CPT",null,1893.8010000000002,null,1893.8010000000002,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[23335,null,"See CPT",null,2255.3177999999998,null,2255.3177999999998,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[23350,null,"See CPT",null,314.54340000000002,null,88.000799999999998,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[23395,null,"See CPT",null,2281.4802,null,2281.4802,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[23397,null,"See CPT",null,2028.1805999999999,null,2028.1805999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[23400,null,"See CPT",null,1739.7996000000001,null,1739.7996000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[23405,null,"See CPT",null,1114.2803999999999,null,1114.2803999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[23406,null,"See CPT",null,1335.4716000000001,null,1335.4716000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[23410,null,"See CPT",null,1469.8512000000001,null,1469.8512000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23412,null,"See CPT",null,1526.3382000000001,null,1526.3382000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23415,null,"See CPT",null,1257.579,null,1257.579,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[23420,null,"See CPT",null,1744.5563999999999,null,1744.5563999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23430,null,"See CPT",null,1337.2554,null,1337.2554,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23440,null,"See CPT",null,1356.2826,null,1356.2826,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23450,null,"See CPT",null,1691.6369999999999,null,1691.6369999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23455,null,"See CPT",null,1773.0971999999999,null,1773.0971999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23460,null,"See CPT",null,1947.3150000000001,null,1947.3150000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23462,null,"See CPT",null,1904.5038000000002,null,1904.5038000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23465,null,"See CPT",null,1997.2614000000003,null,1997.2614000000003,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23466,null,"See CPT",null,2002.6128000000001,null,2002.6128000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23470,null,"See CPT",null,2136.3978000000002,null,2136.3978000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23472,null,"See CPT",null,2571.0504000000001,null,2571.0504000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23473,null,"See CPT",null,2862.4043999999999,null,2862.4043999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23474,null,"See CPT",null,3087.1632,null,3087.1632,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23480,null,"See CPT",null,1469.8512000000001,null,1469.8512000000001,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[23485,null,"See CPT",null,1698.7722000000001,null,1698.7722000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[23490,null,"See CPT",null,1541.2032000000002,null,1541.2032000000002,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM"]
[23491,null,"See CPT",null,1816.5030000000002,null,1816.5030000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[23500,null,"See CPT",null,408.49020000000002,null,417.4092,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[23505,null,"See CPT",null,660.00599999999997,null,611.24879999999996,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[23515,null,"See CPT",null,1293.8496,null,1293.8496,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[23520,null,"See CPT",null,443.57159999999999,null,437.03100000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[23525,null,"See CPT",null,727.79039999999998,null,664.16819999999996,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[23530,null,"See CPT",null,1039.3607999999999,null,1039.3607999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[23532,null,"See CPT",null,1129.1453999999999,null,1129.1453999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[23540,null,"See CPT",null,439.40940000000001,null,432.27420000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[23545,null,"See CPT",null,645.73559999999998,null,577.95120000000009,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[23550,null,"See CPT",null,1032.2256,null,1032.2256,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23552,null,"See CPT",null,1177.9025999999999,null,1177.9025999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23570,null,"See CPT",null,431.67959999999999,null,444.76080000000002,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[23575,null,"See CPT",null,753.35820000000001,null,693.89819999999997,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[23585,null,"See CPT",null,1748.7185999999999,null,1748.7185999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[23600,null,"See CPT",null,614.81640000000004,null,581.51879999999994,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[23605,null,"See CPT",null,859.79160000000002,null,778.33140000000003,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[23615,null,"See CPT",null,1582.8252,null,1582.8252,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[23616,null,"See CPT",null,2199.4254000000001,null,2199.4254000000001,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[23620,null,"See CPT",null,498.86940000000004,null,478.65300000000008,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[23625,null,"See CPT",null,704.601,null,642.76260000000002,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[23630,null,"See CPT",null,1397.9046000000001,null,1397.9046000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[23650,null,"See CPT",null,598.76220000000001,null,539.30219999999997,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[23655,null,"See CPT",null,745.03379999999993,null,745.03379999999993,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[23660,null,"See CPT",null,1053.6312,null,1053.6312,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[23665,null,"See CPT",null,793.79099999999994,null,728.9796,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[23670,null,"See CPT",null,1556.6628000000001,null,1556.6628000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[23675,null,"See CPT",null,1006.0632000000002,null,908.54880000000003,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[23680,null,"See CPT",null,1658.934,null,1658.934,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[23700,null,"See CPT",null,352.59780000000001,null,352.59780000000001,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[23800,null,"See CPT",null,1834.9356,null,1834.9356,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[23802,null,"See CPT",null,2286.8316,null,2286.8316,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[23900,null,"See CPT",null,2463.4277999999999,null,2463.4277999999999,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[23920,null,"See CPT",null,2002.6128000000001,null,2002.6128000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[23921,null,"See CPT",null,851.46720000000005,null,851.46720000000005,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[23929,null,"See CPT",null,"Bundled",null,"Bundled",null,"000",0,0,0,0,2,0,2,1,1,null,"Bundled",null,"Y-UR"]
[23930,null,"See CPT",null,669.51959999999997,null,385.30080000000004,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[23931,null,"See CPT",null,566.05920000000003,null,289.5702,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[23935,null,"See CPT",null,921.63,null,921.63,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[24000,null,"See CPT",null,855.03480000000002,null,855.03480000000002,null,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,"Y-UR"]
[24006,null,"See CPT",null,1280.7683999999999,null,1280.7683999999999,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,"Y-UR"]
[24065,null,"See CPT",null,482.81519999999995,null,294.327,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[24066,null,"See CPT",null,1141.6320000000001,null,754.54739999999993,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24071,null,"See CPT",null,727.79039999999998,null,727.79039999999998,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[24073,null,"See CPT",null,1238.5518,null,1238.5518,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[24075,null,"See CPT",null,"994.1+E7712",null,594.00540000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24076,null,"See CPT",null,979.9008,null,979.9008,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24077,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"X"]
[24079,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[24100,null,"See CPT",null,760.49339999999995,null,760.49339999999995,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[24101,null,"See CPT",null,912.1164,null,912.1164,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[24102,null,"See CPT",null,1115.4696000000001,null,1115.4696000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24105,null,"See CPT",null,655.24919999999997,null,655.24919999999997,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24110,null,"See CPT",null,1065.5232000000001,null,1065.5232000000001,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[24115,null,"See CPT",null,1324.7688000000001,null,1324.7688000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24116,null,"See CPT",null,1540.6086,null,1540.6086,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[24120,null,"See CPT",null,963.25199999999995,null,963.25199999999995,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[24125,null,"See CPT",null,1123.7939999999999,null,1123.7939999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24126,null,"See CPT",null,1172.5511999999999,null,1172.5511999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[24130,null,"See CPT",null,922.22460000000001,null,922.22460000000001,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[24134,null,"See CPT",null,1342.6068,null,1342.6068,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[24136,null,"See CPT",null,1139.8482000000001,null,1139.8482000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24138,null,"See CPT",null,1242.1194,null,1242.1194,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[24140,null,"See CPT",null,1265.3088,null,1265.3088,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[24145,null,"See CPT",null,1072.6584,null,1072.6584,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[24147,null,"See CPT",null,1136.8752000000002,null,1136.8752000000002,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[24149,null,"See CPT",null,2108.4515999999999,null,2108.4515999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24150,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[24152,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[24155,null,"See CPT",null,1526.3382000000001,null,1526.3382000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24160,null,"See CPT",null,2229.75,null,2229.75,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[24164,null,"See CPT",null,1300.3902,null,1300.3902,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[24200,null,"See CPT",null,404.92259999999999,null,254.48880000000003,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R"]
[24201,null,"See CPT",null,1009.6308,null,659.41139999999996,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24220,null,"See CPT",null,361.51679999999999,null,116.5416,null,"000",0,0,0,0,2,1,0,0,0,null,"R"]
[24300,null,"See CPT",null,796.76400000000001,null,796.76400000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24301,null,"See CPT",null,1346.769,null,1346.769,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[24305,null,"See CPT",null,1045.3067999999998,null,1045.3067999999998,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,"Y-UR"]
[24310,null,"See CPT",null,860.98080000000004,null,860.98080000000004,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,"Y-UR"]
[24320,null,"See CPT",null,1399.6884,null,1399.6884,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[24330,null,"See CPT",null,1290.8766000000001,null,1290.8766000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[24331,null,"See CPT",null,1409.202,null,1409.202,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[24332,null,"See CPT",null,1110.7128,null,1110.7128,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[24340,null,"See CPT",null,1114.875,null,1114.875,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[24341,null,"See CPT",null,1340.8230000000001,null,1340.8230000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[24342,null,"See CPT",null,1390.7694000000001,null,1390.7694000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[24343,null,"See CPT",null,1287.309,null,1287.309,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[24344,null,"See CPT",null,1959.8016,null,1959.8016,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[24345,null,"See CPT",null,1280.7683999999999,null,1280.7683999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[24346,null,"See CPT",null,1976.4504000000002,null,1976.4504000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[24357,null,"See CPT",null,760.49339999999995,null,760.49339999999995,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR"]
[24358,null,"See CPT",null,956.71140000000003,null,956.71140000000003,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR"]
[24359,null,"See CPT",null,1192.173,null,1192.173,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR"]
[24360,null,"See CPT",null,1618.5011999999999,null,1618.5011999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[24361,null,"See CPT",null,1802.8271999999999,null,1802.8271999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[24362,null,"See CPT",null,1895.5847999999999,null,1895.5847999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[24363,null,"See CPT",null,2572.2395999999999,null,2572.2395999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[24365,null,"See CPT",null,1155.3078,null,1155.3078,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[24366,null,"See CPT",null,1225.4705999999999,null,1225.4705999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[24370,null,"See CPT",null,2732.1870000000004,null,2732.1870000000004,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[24371,null,"See CPT",null,3136.5149999999999,null,3136.5149999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[24400,null,"See CPT",null,1481.1486,null,1481.1486,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24410,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[24420,null,"See CPT",null,1924.7202,null,1924.7202,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[24430,null,"See CPT",null,1883.6928,null,1883.6928,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24435,null,"See CPT",null,1932.45,null,1932.45,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24470,null,"See CPT",null,1211.2002,null,1211.2002,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM"]
[24495,null,"See CPT",null,1475.2025999999998,null,1475.2025999999998,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[24498,null,"See CPT",null,1551.9060000000002,null,1551.9060000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24500,null,"See CPT",null,665.952,null,613.0326,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24505,null,"See CPT",null,922.22460000000001,null,824.71019999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24515,null,"See CPT",null,1580.4467999999999,null,1580.4467999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24516,null,"See CPT",null,1538.2302,null,1538.2302,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[24530,null,"See CPT",null,702.81720000000007,null,643.95180000000005,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24535,null,"See CPT",null,1126.1724000000002,null,1031.6310000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24538,null,"See CPT",null,1431.7967999999998,null,1431.7967999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24545,null,"See CPT",null,1660.7177999999999,null,1660.7177999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24546,null,"See CPT",null,1852.1789999999999,null,1852.1789999999999,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[24560,null,"See CPT",null,614.22180000000003,null,541.68060000000003,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24565,null,"See CPT",null,989.4144,null,900.22440000000006,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24566,null,"See CPT",null,1299.7955999999999,null,1299.7955999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24575,null,"See CPT",null,1317.039,null,1317.039,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24576,null,"See CPT",null,648.70860000000005,null,576.16739999999993,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24577,null,"See CPT",null,1016.7660000000001,null,924.60300000000007,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24579,null,"See CPT",null,1495.4189999999999,null,1495.4189999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24582,null,"See CPT",null,1472.2296000000001,null,1472.2296000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24586,null,"See CPT",null,1940.7744,null,1940.7744,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24587,null,"See CPT",null,1943.7474,null,1943.7474,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24600,null,"See CPT",null,684.38459999999998,null,616.60019999999997,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24605,null,"See CPT",null,869.89980000000003,null,869.89980000000003,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24615,null,"See CPT",null,1281.9576,null,1281.9576,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24620,null,"See CPT",null,1020.3336,null,1020.3336,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[24635,null,"See CPT",null,1215.3624000000002,null,1215.3624000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24640,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"X"]
[24650,null,"See CPT",null,486.38279999999997,null,451.3014,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24655,null,"See CPT",null,819.95339999999999,null,737.30400000000009,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24665,null,"See CPT",null,1187.4161999999999,null,1187.4161999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24666,null,"See CPT",null,1315.8498,null,1315.8498,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24670,null,"See CPT",null,539.89679999999998,null,492.32879999999994,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24675,null,"See CPT",null,850.87260000000003,null,768.22320000000002,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24685,null,"See CPT",null,1178.4972,null,1178.4972,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24800,null,"See CPT",null,1496.0136,null,1496.0136,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24802,null,"See CPT",null,1793.9082000000001,null,1793.9082000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[24900,null,"See CPT",null,1324.7688000000001,null,1324.7688000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[24920,null,"See CPT",null,1315.8498,null,1315.8498,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[24925,null,"See CPT",null,1027.4688000000001,null,1027.4688000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[24930,null,"See CPT",null,1387.7963999999999,null,1387.7963999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[24931,null,"See CPT",null,1664.2854,null,1664.2854,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[24935,null,"See CPT",null,2201.8038000000001,null,2201.8038000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR"]
[24940,null,"See CPT",null,2003.7910155120003,null,2003.7910155120003,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"F",null,"Y-UR"]
[24999,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,1,0,1,1,null,"N",null,"Y-UR"]
[25000,null,"See CPT",null,628.49220000000003,null,628.49220000000003,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[25001,null,"See CPT",null,630.27599999999995,null,630.27599999999995,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[25020,null,"See CPT",null,1384.8234,null,1384.8234,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[25023,null,"See CPT",null,2417.049,null,2417.049,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR"]
[25024,null,"See CPT",null,1403.8506,null,1403.8506,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[25025,null,"See CPT",null,2101.3164000000002,null,2101.3164000000002,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR"]
[25028,null,"See CPT",null,1300.3902,null,1300.3902,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25031,null,"See CPT",null,669.51959999999997,null,669.51959999999997,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25035,null,"See CPT",null,1057.1988000000001,null,1057.1988000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25040,null,"See CPT",null,1007.847,null,1007.847,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25065,null,"See CPT",null,475.68,null,284.8134,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[25066,null,"See CPT",null,662.97900000000004,null,662.97900000000004,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25071,null,"See CPT",null,761.08800000000008,null,761.08800000000008,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25073,null,"See CPT",null,962.06280000000004,null,962.06280000000004,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25075,null,"See CPT",null,969.19800000000009,null,569.03219999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25076,null,"See CPT",null,931.73820000000001,null,931.73820000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25077,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"X"]
[25078,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"X"]
[25085,null,"See CPT",null,811.03440000000001,null,811.03440000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25100,null,"See CPT",null,636.81660000000011,null,636.81660000000011,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25101,null,"See CPT",null,734.92560000000003,null,734.92560000000003,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25105,null,"See CPT",null,880.60260000000005,null,880.60260000000005,null,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R"]
[25107,null,"See CPT",null,1113.6858,null,1113.6858,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[25109,null,"See CPT",null,966.81960000000015,null,966.81960000000015,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[25110,null,"See CPT",null,630.27599999999995,null,630.27599999999995,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[25111,null,"See CPT",null,589.84320000000002,null,589.84320000000002,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25112,null,"See CPT",null,707.57400000000007,null,707.57400000000007,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25115,null,"See CPT",null,1357.4718,null,1357.4718,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25116,null,"See CPT",null,1088.1180000000002,null,1088.1180000000002,null,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R"]
[25118,null,"See CPT",null,694.49279999999999,null,694.49279999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25119,null,"See CPT",null,909.73800000000006,null,909.73800000000006,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25120,null,"See CPT",null,907.3596,null,907.3596,null,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R"]
[25125,null,"See CPT",null,1075.0367999999999,null,1075.0367999999999,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25126,null,"See CPT",null,1082.7666000000002,null,1082.7666000000002,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25130,null,"See CPT",null,818.16959999999995,null,818.16959999999995,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25135,null,"See CPT",null,1013.793,null,1013.793,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25136,null,"See CPT",null,902.6028,null,902.6028,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25145,null,"See CPT",null,943.03559999999993,null,943.03559999999993,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25150,null,"See CPT",null,1025.0903999999998,null,1025.0903999999998,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[25151,null,"See CPT",null,1054.2257999999999,null,1054.2257999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25170,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[25210,null,"See CPT",null,890.71080000000006,null,890.71080000000006,null,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R"]
[25215,null,"See CPT",null,1115.4696000000001,null,1115.4696000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25230,null,"See CPT",null,783.68280000000004,null,783.68280000000004,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[25240,null,"See CPT",null,777.73680000000002,null,777.73680000000002,null,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R"]
[25246,null,"See CPT",null,372.21960000000001,null,128.43360000000001,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[25248,null,"See CPT",null,759.30420000000004,null,759.30420000000004,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25250,null,"See CPT",null,966.22500000000002,null,966.22500000000002,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25251,null,"See CPT",null,1293.2550000000001,null,1293.2550000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25259,null,"See CPT",null,787.84500000000003,null,787.84500000000003,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25260,null,"See CPT",null,1145.7942,null,1145.7942,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[25263,null,"See CPT",null,1145.7942,null,1145.7942,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[25265,null,"See CPT",null,1350.3366000000001,null,1350.3366000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[25270,null,"See CPT",null,893.68380000000002,null,893.68380000000002,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[25272,null,"See CPT",null,1011.4146000000001,null,1011.4146000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[25274,null,"See CPT",null,1196.9297999999999,null,1196.9297999999999,null,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R"]
[25275,null,"See CPT",null,1210.0110000000002,null,1210.0110000000002,null,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R"]
[25280,null,"See CPT",null,1022.712,null,1022.712,null,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R"]
[25290,null,"See CPT",null,789.62879999999996,null,789.62879999999996,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[25295,null,"See CPT",null,952.54920000000004,null,952.54920000000004,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[25300,null,"See CPT",null,1244.4978000000001,null,1244.4978000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25301,null,"See CPT",null,1157.6861999999999,null,1157.6861999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25310,null,"See CPT",null,1118.4425999999999,null,1118.4425999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[25312,null,"See CPT",null,1286.1197999999999,null,1286.1197999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[25315,null,"See CPT",null,1381.8504,null,1381.8504,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25316,null,"See CPT",null,1642.2852,null,1642.2852,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25320,null,"See CPT",null,1768.3404,null,1768.3404,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[25332,null,"See CPT",null,1515.0408,null,1515.0408,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25335,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"X"]
[25337,null,"See CPT",null,1590.5550000000001,null,1590.5550000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25350,null,"See CPT",null,1214.1732000000002,null,1214.1732000000002,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25355,null,"See CPT",null,1374.7152000000001,null,1374.7152000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25360,null,"See CPT",null,1180.2810000000002,null,1180.2810000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25365,null,"See CPT",null,1644.069,null,1644.069,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25370,null,"See CPT",null,1814.1246000000001,null,1814.1246000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25375,null,"See CPT",null,1708.8804,null,1708.8804,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25390,null,"See CPT",null,1380.0666000000001,null,1380.0666000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25391,null,"See CPT",null,1782.6108000000002,null,1782.6108000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25392,null,"See CPT",null,1813.53,null,1813.53,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25393,null,"See CPT",null,2015.694,null,2015.694,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25394,null,"See CPT",null,1408.0128,null,1408.0128,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25400,null,"See CPT",null,1438.932,null,1438.932,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25405,null,"See CPT",null,1855.7466000000002,null,1855.7466000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25415,null,"See CPT",null,1733.8536000000001,null,1733.8536000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25420,null,"See CPT",null,2081.6945999999998,null,2081.6945999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25425,null,"See CPT",null,1726.7184,null,1726.7184,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25426,null,"See CPT",null,2004.3966,null,2004.3966,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25430,null,"See CPT",null,1315.8498,null,1315.8498,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25431,null,"See CPT",null,1413.3642,null,1413.3642,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25440,null,"See CPT",null,1378.2828,null,1378.2828,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25441,null,"See CPT",null,1680.3396,null,1680.3396,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25442,null,"See CPT",null,1454.3916000000002,null,1454.3916000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25443,null,"See CPT",null,1410.9858000000002,null,1410.9858000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25444,null,"See CPT",null,1487.6892,null,1487.6892,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25445,null,"See CPT",null,1292.0658000000001,null,1292.0658000000001,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[25446,null,"See CPT",null,2087.6406000000002,null,2087.6406000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25447,null,"See CPT",null,1492.4460000000001,null,1492.4460000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25449,null,"See CPT",null,1848.0167999999999,null,1848.0167999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25450,null,"See CPT",null,1114.875,null,1114.875,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[25455,null,"See CPT",null,1315.8498,null,1315.8498,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[25490,null,"See CPT",null,1292.6604,null,1292.6604,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25491,null,"See CPT",null,1328.3363999999999,null,1328.3363999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25492,null,"See CPT",null,1625.6364000000001,null,1625.6364000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25500,null,"See CPT",null,525.03179999999998,null,472.70699999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25505,null,"See CPT",null,924.60300000000007,null,836.00760000000002,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25515,null,"See CPT",null,1206.4433999999999,null,1206.4433999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25520,null,"See CPT",null,1053.6312,null,990.60360000000003,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25525,null,"See CPT",null,1416.9317999999998,null,1416.9317999999998,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[25526,null,"See CPT",null,1714.2318,null,1714.2318,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[25530,null,"See CPT",null,486.97739999999999,null,445.95,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25535,null,"See CPT",null,907.95420000000001,null,834.22379999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25545,null,"See CPT",null,1127.3616000000002,null,1127.3616000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25560,null,"See CPT",null,535.14,null,475.68,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25565,null,"See CPT",null,949.57620000000009,null,846.71040000000005,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25574,null,"See CPT",null,1215.3624000000002,null,1215.3624000000002,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[25575,null,"See CPT",null,1622.0688,null,1622.0688,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25600,null,"See CPT",null,625.51919999999996,null,597.57300000000009,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25605,null,"See CPT",null,985.84679999999992,null,929.95440000000008,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25606,null,"See CPT",null,1205.8488,null,1205.8488,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25607,null,"See CPT",null,1330.1202000000001,null,1330.1202000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25608,null,"See CPT",null,1485.9053999999999,null,1485.9053999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25609,null,"See CPT",null,1884.8820000000001,null,1884.8820000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25622,null,"See CPT",null,567.24839999999995,null,522.65339999999992,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25624,null,"See CPT",null,902.00819999999999,null,814.60199999999998,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25628,null,"See CPT",null,1295.6333999999999,null,1295.6333999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25630,null,"See CPT",null,562.49160000000006,null,521.46420000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25635,null,"See CPT",null,855.62940000000003,null,774.16919999999993,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25645,null,"See CPT",null,1032.2256,null,1032.2256,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25650,null,"See CPT",null,608.2758,null,561.30240000000003,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25651,null,"See CPT",null,886.54859999999996,null,886.54859999999996,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25652,null,"See CPT",null,1123.7939999999999,null,1123.7939999999999,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[25660,null,"See CPT",null,818.76419999999996,null,818.76419999999996,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25670,null,"See CPT",null,1097.6316000000002,null,1097.6316000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25671,null,"See CPT",null,959.6844000000001,null,959.6844000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25675,null,"See CPT",null,822.92640000000006,null,740.27699999999993,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25676,null,"See CPT",null,1137.4697999999999,null,1137.4697999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25680,null,"See CPT",null,963.84660000000008,null,963.84660000000008,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25685,null,"See CPT",null,1321.2012,null,1321.2012,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25690,null,"See CPT",null,894.87300000000005,null,894.87300000000005,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25695,null,"See CPT",null,1144.0103999999999,null,1144.0103999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25800,null,"See CPT",null,1314.6605999999999,null,1314.6605999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[25805,null,"See CPT",null,1521.5814,null,1521.5814,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[25810,null,"See CPT",null,1550.1222,null,1550.1222,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[25820,null,"See CPT",null,1180.8756000000001,null,1180.8756000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[25825,null,"See CPT",null,1438.3374000000001,null,1438.3374000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[25830,null,"See CPT",null,1894.3956000000001,null,1894.3956000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[25900,null,"See CPT",null,1287.9036000000001,null,1287.9036000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25905,null,"See CPT",null,1262.9304,null,1262.9304,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25907,null,"See CPT",null,1108.3344,null,1108.3344,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25909,null,"See CPT",null,1233.7950000000001,null,1233.7950000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25915,null,"See CPT",null,2078.1270000000004,null,2078.1270000000004,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25920,null,"See CPT",null,1325.9580000000001,null,1325.9580000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25922,null,"See CPT",null,1177.9025999999999,null,1177.9025999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25924,null,"See CPT",null,1296.2280000000001,null,1296.2280000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25927,null,"See CPT",null,1590.5550000000001,null,1590.5550000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25929,null,"See CPT",null,1081.5774000000001,null,1081.5774000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25931,null,"See CPT",null,1476.9864,null,1476.9864,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25999,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,1,0,1,1,null,"N"]
[26010,null,"See CPT",null,655.24919999999997,null,254.48880000000003,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[26011,null,"See CPT",null,914.49480000000005,null,334.75979999999998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[26020,null,"See CPT",null,1006.0632000000002,null,1006.0632000000002,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26025,null,"See CPT",null,762.27719999999999,null,762.27719999999999,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[26030,null,"See CPT",null,886.54859999999996,null,886.54859999999996,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[26034,null,"See CPT",null,999.5225999999999,null,999.5225999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26035,null,"See CPT",null,1546.5546000000002,null,1546.5546000000002,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26037,null,"See CPT",null,1009.0361999999999,null,1009.0361999999999,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[26040,null,"See CPT",null,574.97820000000002,null,574.97820000000002,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[26045,null,"See CPT",null,855.62940000000003,null,855.62940000000003,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[26055,null,"See CPT",null,1111.902,null,529.78859999999997,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26060,null,"See CPT",null,467.35560000000004,null,467.35560000000004,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26070,null,"See CPT",null,582.70800000000008,null,582.70800000000008,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[26075,null,"See CPT",null,613.62720000000002,null,613.62720000000002,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[26080,null,"See CPT",null,724.81740000000002,null,724.81740000000002,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26100,null,"See CPT",null,617.7894,null,617.7894,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[26105,null,"See CPT",null,621.9516000000001,null,621.9516000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[26110,null,"See CPT",null,592.22160000000008,null,592.22160000000008,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26111,null,"See CPT",null,747.41219999999998,null,747.41219999999998,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26113,null,"See CPT",null,982.87380000000007,null,982.87380000000007,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26115,null,"See CPT",null,1020.9282000000001,null,598.16759999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26116,null,"See CPT",null,945.41399999999999,null,945.41399999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26117,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"X"]
[26118,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"X"]
[26121,null,"See CPT",null,1080.9828,null,1080.9828,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[26123,null,"See CPT",null,1504.9325999999999,null,1504.9325999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[26125,null,"See CPT",null,473.89619999999996,null,473.89619999999996,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[26130,null,"See CPT",null,851.46720000000005,null,851.46720000000005,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[26135,null,"See CPT",null,1001.9010000000001,null,1001.9010000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26140,null,"See CPT",null,919.25160000000005,null,919.25160000000005,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26145,null,"See CPT",null,932.33280000000002,null,932.33280000000002,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26160,null,"See CPT",null,1155.3078,null,572.59980000000007,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26170,null,"See CPT",null,740.27699999999993,null,740.27699999999993,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26180,null,"See CPT",null,814.60199999999998,null,814.60199999999998,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26185,null,"See CPT",null,1007.847,null,1007.847,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[26200,null,"See CPT",null,812.81820000000005,null,812.81820000000005,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26205,null,"See CPT",null,1093.4694,null,1093.4694,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26210,null,"See CPT",null,811.03440000000001,null,811.03440000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26215,null,"See CPT",null,1025.0903999999998,null,1025.0903999999998,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26230,null,"See CPT",null,903.19740000000002,null,903.19740000000002,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26235,null,"See CPT",null,888.92700000000002,null,888.92700000000002,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26236,null,"See CPT",null,799.73699999999997,null,799.73699999999997,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26250,null,"See CPT",null,1900.3416,null,1900.3416,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26260,null,"See CPT",null,1427.04,null,1427.04,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26262,null,"See CPT",null,1133.3075999999999,null,1133.3075999999999,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26320,null,"See CPT",null,635.62739999999997,null,635.62739999999997,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26340,null,"See CPT",null,647.51940000000002,null,647.51940000000002,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[26341,null,"See CPT",null,215.24520000000001,null,141.51480000000001,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[26350,null,"See CPT",null,1392.5532000000001,null,1392.5532000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26352,null,"See CPT",null,1545.96,null,1545.96,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26356,null,"See CPT",null,1438.3374000000001,null,1438.3374000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26357,null,"See CPT",null,1610.1768,null,1610.1768,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26358,null,"See CPT",null,1775.4756,null,1775.4756,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26370,null,"See CPT",null,1460.3375999999998,null,1460.3375999999998,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26372,null,"See CPT",null,1696.9884,null,1696.9884,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26373,null,"See CPT",null,1635.7446000000002,null,1635.7446000000002,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26390,null,"See CPT",null,1618.5011999999999,null,1618.5011999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26392,null,"See CPT",null,1850.3952000000002,null,1850.3952000000002,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26410,null,"See CPT",null,1124.9832000000001,null,1124.9832000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26412,null,"See CPT",null,1334.2824000000001,null,1334.2824000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26415,null,"See CPT",null,1577.4738,null,1577.4738,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26416,null,"See CPT",null,1701.7452000000001,null,1701.7452000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26418,null,"See CPT",null,1168.9836,null,1168.9836,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26420,null,"See CPT",null,1384.2288000000001,null,1384.2288000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26426,null,"See CPT",null,910.33260000000007,null,910.33260000000007,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26428,null,"See CPT",null,1480.5539999999999,null,1480.5539999999999,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26432,null,"See CPT",null,1019.1444,null,1019.1444,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26433,null,"See CPT",null,1069.6853999999998,null,1069.6853999999998,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26434,null,"See CPT",null,1295.6333999999999,null,1295.6333999999999,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26437,null,"See CPT",null,1240.3355999999999,null,1240.3355999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26440,null,"See CPT",null,1218.93,null,1218.93,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26442,null,"See CPT",null,1824.8274000000001,null,1824.8274000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26445,null,"See CPT",null,1141.6320000000001,null,1141.6320000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26449,null,"See CPT",null,1257.579,null,1257.579,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26450,null,"See CPT",null,865.73760000000004,null,865.73760000000004,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26455,null,"See CPT",null,856.22400000000005,null,856.22400000000005,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26460,null,"See CPT",null,843.14279999999997,null,843.14279999999997,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26471,null,"See CPT",null,1228.4436000000001,null,1228.4436000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26474,null,"See CPT",null,1215.9569999999999,null,1215.9569999999999,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26476,null,"See CPT",null,1202.2811999999999,null,1202.2811999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26477,null,"See CPT",null,1166.0106000000001,null,1166.0106000000001,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R"]
[26478,null,"See CPT",null,1234.3896000000002,null,1234.3896000000002,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26479,null,"See CPT",null,1259.3628000000001,null,1259.3628000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26480,null,"See CPT",null,1461.5267999999999,null,1461.5267999999999,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26483,null,"See CPT",null,1612.5552,null,1612.5552,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26485,null,"See CPT",null,1548.3383999999999,null,1548.3383999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26489,null,"See CPT",null,1784.9892,null,1784.9892,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26490,null,"See CPT",null,1550.7167999999999,null,1550.7167999999999,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26492,null,"See CPT",null,1709.4750000000001,null,1709.4750000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26494,null,"See CPT",null,1556.0682000000002,null,1556.0682000000002,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26496,null,"See CPT",null,1670.826,null,1670.826,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26497,null,"See CPT",null,1669.0422000000001,null,1669.0422000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26498,null,"See CPT",null,2156.6142000000004,null,2156.6142000000004,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26499,null,"See CPT",null,1607.7983999999999,null,1607.7983999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26500,null,"See CPT",null,1243.3086000000001,null,1243.3086000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26502,null,"See CPT",null,1402.0667999999998,null,1402.0667999999998,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26508,null,"See CPT",null,1257.579,null,1257.579,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[26510,null,"See CPT",null,1195.7406000000001,null,1195.7406000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26516,null,"See CPT",null,1378.2828,null,1378.2828,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[26517,null,"See CPT",null,1599.4739999999999,null,1599.4739999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[26518,null,"See CPT",null,1619.6904,null,1619.6904,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[26520,null,"See CPT",null,1277.2008000000001,null,1277.2008000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26525,null,"See CPT",null,1281.3630000000001,null,1281.3630000000001,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R"]
[26530,null,"See CPT",null,978.11699999999996,null,978.11699999999996,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26531,null,"See CPT",null,1138.6589999999999,null,1138.6589999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26535,null,"See CPT",null,790.8180000000001,null,790.8180000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26536,null,"See CPT",null,1394.337,null,1394.337,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26540,null,"See CPT",null,1299.201,null,1299.201,null,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R"]
[26541,null,"See CPT",null,1538.2302,null,1538.2302,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26542,null,"See CPT",null,1340.2284,null,1340.2284,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26545,null,"See CPT",null,1356.2826,null,1356.2826,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26546,null,"See CPT",null,1902.1253999999999,null,1902.1253999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[26548,null,"See CPT",null,1475.2025999999998,null,1475.2025999999998,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26550,null,"See CPT",null,3002.73,null,3002.73,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[26551,null,"See CPT",null,5901.9996000000001,null,5901.9996000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[26553,null,"See CPT",null,5862.1614,null,5862.1614,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[26554,null,"See CPT",null,6814.116,null,6814.116,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[26555,null,"See CPT",null,2533.5906,null,2533.5906,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26556,null,"See CPT",null,6097.0284000000001,null,6097.0284000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26560,null,"See CPT",null,1186.2269999999999,null,1186.2269999999999,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26561,null,"See CPT",null,1805.8002000000001,null,1805.8002000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26562,null,"See CPT",null,2505.6444000000001,null,2505.6444000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26565,null,"See CPT",null,1331.3094000000001,null,1331.3094000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26567,null,"See CPT",null,1334.877,null,1334.877,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26568,null,"See CPT",null,1725.5291999999999,null,1725.5291999999999,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26580,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"X"]
[26587,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"X"]
[26590,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"X"]
[26591,null,"See CPT",null,913.30560000000003,null,913.30560000000003,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26593,null,"See CPT",null,1201.6866,null,1201.6866,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26596,null,"See CPT",null,1500.1758,null,1500.1758,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26600,null,"See CPT",null,555.95100000000002,null,528.00480000000005,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26605,null,"See CPT",null,610.65419999999995,null,548.22120000000007,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26607,null,"See CPT",null,934.71120000000008,null,934.71120000000008,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26608,null,"See CPT",null,877.03499999999997,null,877.03499999999997,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26615,null,"See CPT",null,1040.55,null,1040.55,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26641,null,"See CPT",null,771.19620000000009,null,700.43880000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[26645,null,"See CPT",null,795.5748000000001,null,721.84440000000006,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[26650,null,"See CPT",null,877.62959999999998,null,877.62959999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[26665,null,"See CPT",null,1128.5508,null,1128.5508,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[26670,null,"See CPT",null,640.97879999999998,null,570.22140000000002,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26675,null,"See CPT",null,847.30500000000006,null,770.60160000000008,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26676,null,"See CPT",null,926.98140000000001,null,926.98140000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26685,null,"See CPT",null,1042.3338000000001,null,1042.3338000000001,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R"]
[26686,null,"See CPT",null,1124.9832000000001,null,1124.9832000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26700,null,"See CPT",null,619.57320000000004,null,567.84300000000007,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26705,null,"See CPT",null,778.92600000000004,null,704.00639999999999,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26706,null,"See CPT",null,812.22360000000003,null,812.22360000000003,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26715,null,"See CPT",null,1036.9824000000001,null,1036.9824000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26720,null,"See CPT",null,369.2466,null,346.65180000000004,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26725,null,"See CPT",null,629.08680000000004,null,557.14019999999994,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26727,null,"See CPT",null,863.35919999999999,null,863.35919999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26735,null,"See CPT",null,1074.4422,null,1074.4422,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26740,null,"See CPT",null,429.30119999999999,null,405.5172,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26742,null,"See CPT",null,687.35760000000005,null,614.22180000000003,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26746,null,"See CPT",null,1336.6608000000001,null,1336.6608000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26750,null,"See CPT",null,344.27339999999998,null,346.65180000000004,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26755,null,"See CPT",null,588.654,null,502.43699999999995,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26756,null,"See CPT",null,775.95300000000009,null,775.95300000000009,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26765,null,"See CPT",null,910.92720000000008,null,910.92720000000008,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26770,null,"See CPT",null,523.84260000000006,null,474.49080000000004,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26775,null,"See CPT",null,722.43900000000008,null,645.73559999999998,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26776,null,"See CPT",null,821.14260000000002,null,821.14260000000002,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26785,null,"See CPT",null,988.81979999999999,null,988.81979999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26820,null,"See CPT",null,1534.6625999999999,null,1534.6625999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[26841,null,"See CPT",null,1432.3914,null,1432.3914,null,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R"]
[26842,null,"See CPT",null,1538.8247999999999,null,1538.8247999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[26843,null,"See CPT",null,1450.8239999999998,null,1450.8239999999998,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26844,null,"See CPT",null,1589.3658,null,1589.3658,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26850,null,"See CPT",null,1361.634,null,1361.634,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26852,null,"See CPT",null,1535.8517999999999,null,1535.8517999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26860,null,"See CPT",null,1142.8211999999999,null,1142.8211999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26861,null,"See CPT",null,179.5692,null,179.5692,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[26862,null,"See CPT",null,1418.1210000000001,null,1418.1210000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26863,null,"See CPT",null,400.16580000000005,null,400.16580000000005,null,"000",0,0,0,0,0,0,2,0,0,null,"R"]
[26910,null,"See CPT",null,1408.0128,null,1408.0128,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26951,null,"See CPT",null,1298.6064000000001,null,1298.6064000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26952,null,"See CPT",null,1268.2818,null,1268.2818,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26989,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,0,1,1,1,null,"N"]
[26990,null,"See CPT",null,1240.3355999999999,null,1240.3355999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26991,null,"See CPT",null,1294.4441999999999,null,941.84640000000002,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26992,null,"See CPT",null,1814.7192,null,1814.7192,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[27000,null,"See CPT",null,727.19580000000008,null,727.19580000000008,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[27001,null,"See CPT",null,973.36020000000008,null,973.36020000000008,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27003,null,"See CPT",null,1080.3882000000001,null,1080.3882000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27005,null,"See CPT",null,1297.4172000000001,null,1297.4172000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27006,null,"See CPT",null,1288.4982000000002,null,1288.4982000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27025,null,"See CPT",null,1651.7988,null,1651.7988,null,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R"]
[27027,null,"See CPT",null,1581.0414000000001,null,1581.0414000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27030,null,"See CPT",null,1673.2044000000001,null,1673.2044000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27033,null,"See CPT",null,1735.6374000000001,null,1735.6374000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27035,null,"See CPT",null,2069.8026,null,2069.8026,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[27036,null,"See CPT",null,1820.6652000000001,null,1820.6652000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27040,null,"See CPT",null,626.70839999999998,null,353.19240000000002,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[27041,null,"See CPT",null,1268.8764000000001,null,1268.8764000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27043,null,"See CPT",null,838.38599999999997,null,838.38599999999997,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27045,null,"See CPT",null,1309.9038,null,1309.9038,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27047,null,"See CPT",null,910.92720000000008,null,647.51940000000002,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27048,null,"See CPT",null,1089.9017999999999,null,1089.9017999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27049,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[27050,null,"See CPT",null,734.92560000000003,null,734.92560000000003,null,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R"]
[27052,null,"See CPT",null,1041.7392,null,1041.7392,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27054,null,"See CPT",null,1236.768,null,1236.768,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27057,null,"See CPT",null,1801.0434,null,1801.0434,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27059,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[27060,null,"See CPT",null,841.35900000000004,null,841.35900000000004,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27062,null,"See CPT",null,822.33180000000004,null,822.33180000000004,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[27065,null,"See CPT",null,950.17079999999999,null,950.17079999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27066,null,"See CPT",null,1462.1214,null,1462.1214,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27067,null,"See CPT",null,1850.9898000000001,null,1850.9898000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[27070,null,"See CPT",null,1606.0146000000002,null,1606.0146000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27071,null,"See CPT",null,1760.0160000000001,null,1760.0160000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27075,null,"See CPT",null,3687.7092000000002,null,3687.7092000000002,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[27076,null,"See CPT",null,4452.3647999999994,null,4452.3647999999994,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[27077,null,"See CPT",null,4963.7208000000001,null,4963.7208000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[27078,null,"See CPT",null,3635.9789999999998,null,3635.9789999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27080,null,"See CPT",null,918.06240000000003,null,918.06240000000003,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[27086,null,"See CPT",null,579.1404,null,303.84060000000005,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R"]
[27087,null,"See CPT",null,1099.4153999999999,null,1099.4153999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27090,null,"See CPT",null,1487.6892,null,1487.6892,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27091,null,"See CPT",null,2827.9176000000002,null,2827.9176000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27093,null,"See CPT",null,449.51759999999996,null,118.92,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[27095,null,"See CPT",null,605.89739999999995,null,145.67700000000002,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[27096,null,"See CPT",null,299.0838,null,145.67700000000002,null,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[27097,null,"See CPT",null,1229.6328000000001,null,1229.6328000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[27098,null,"See CPT",null,1251.633,null,1251.633,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[27100,null,"See CPT",null,1490.0675999999999,null,1490.0675999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27105,null,"See CPT",null,1561.4196000000002,null,1561.4196000000002,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[27110,null,"See CPT",null,1738.0158000000001,null,1738.0158000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27111,null,"See CPT",null,1619.0958000000001,null,1619.0958000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27120,null,"See CPT",null,2312.3994000000002,null,2312.3994000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27122,null,"See CPT",null,1969.3151999999998,null,1969.3151999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27125,null,"See CPT",null,2015.694,null,2015.694,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27130,null,"See CPT",null,2280.8856000000001,null,2280.8856000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27132,null,"See CPT",null,2963.4864000000002,null,2963.4864000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27134,null,"See CPT",null,3371.3820000000001,null,3371.3820000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27137,null,"See CPT",null,2598.9965999999999,null,2598.9965999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27138,null,"See CPT",null,2700.6732000000002,null,2700.6732000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27140,null,"See CPT",null,1598.2847999999999,null,1598.2847999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27146,null,"See CPT",null,2279.1017999999999,null,2279.1017999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27147,null,"See CPT",null,2598.9965999999999,null,2598.9965999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27151,null,"See CPT",null,2807.1066000000001,null,2807.1066000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27156,null,"See CPT",null,3022.9464000000003,null,3022.9464000000003,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27158,null,"See CPT",null,2488.9956000000002,null,2488.9956000000002,null,"090",0.1,0.69,0.21,0,2,2,2,0,0,null,"R"]
[27161,null,"See CPT",null,2175.6414000000004,null,2175.6414000000004,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27165,null,"See CPT",null,2455.1034,null,2455.1034,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27170,null,"See CPT",null,2074.5594000000001,null,2074.5594000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27175,null,"See CPT",null,1193.9567999999999,null,1193.9567999999999,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27176,null,"See CPT",null,1651.2041999999999,null,1651.2041999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27177,null,"See CPT",null,1991.3154000000002,null,1991.3154000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27178,null,"See CPT",null,1651.2041999999999,null,1651.2041999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27179,null,"See CPT",null,1751.097,null,1751.097,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[27181,null,"See CPT",null,1997.2614000000003,null,1997.2614000000003,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[27185,null,"See CPT",null,1290.8766000000001,null,1290.8766000000001,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[27187,null,"See CPT",null,1782.6108000000002,null,1782.6108000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27197,null,"See CPT",null,242.5968,null,242.5968,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[27198,null,"See CPT",null,569.6268,null,569.6268,null,"000",0,0,0,0,2,0,0,2,0,null,"R"]
[27200,null,"See CPT",null,344.27339999999998,null,345.46260000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[27202,null,"See CPT",null,946.60320000000002,null,946.60320000000002,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[27215,null,"See CPT",null,1076.2260000000001,null,1076.2260000000001,null,"090",0.1,0.69,0.21,9,9,9,9,9,9,null,"R"]
[27216,null,"See CPT",null,1589.9603999999999,null,1589.9603999999999,null,"090",0.1,0.69,0.21,9,9,9,9,9,9,null,"R"]
[27217,null,"See CPT",null,1494.8244,null,1494.8244,null,"090",0.1,0.69,0.21,9,9,9,9,9,9,null,"R"]
[27218,null,"See CPT",null,2048.3970000000004,null,2048.3970000000004,null,"090",0.1,0.69,0.21,9,9,9,9,9,9,null,"R"]
[27220,null,"See CPT",null,756.33120000000008,null,743.84460000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27222,null,"See CPT",null,1760.0160000000001,null,1760.0160000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27226,null,"See CPT",null,1881.3144,null,1881.3144,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27227,null,"See CPT",null,2927.8104000000003,null,2927.8104000000003,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27228,null,"See CPT",null,3325.0032000000001,null,3325.0032000000001,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27230,null,"See CPT",null,883.57560000000001,null,865.73760000000004,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27232,null,"See CPT",null,1314.066,null,1314.066,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27235,null,"See CPT",null,1622.6633999999999,null,1622.6633999999999,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[27236,null,"See CPT",null,2125.1004000000003,null,2125.1004000000003,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27238,null,"See CPT",null,846.71040000000005,null,846.71040000000005,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27240,null,"See CPT",null,1714.8263999999999,null,1714.8263999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27244,null,"See CPT",null,2185.7496000000001,null,2185.7496000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27245,null,"See CPT",null,2183.9657999999999,null,2183.9657999999999,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27246,null,"See CPT",null,709.3578,null,699.8442,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27248,null,"See CPT",null,1335.4716000000001,null,1335.4716000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27250,null,"See CPT",null,313.94880000000001,null,313.94880000000001,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[27252,null,"See CPT",null,1352.1204,null,1352.1204,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27253,null,"See CPT",null,1681.5288,null,1681.5288,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27254,null,"See CPT",null,2264.8314,null,2264.8314,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27256,null,"See CPT",null,551.19420000000002,null,420.38220000000001,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R"]
[27257,null,"See CPT",null,642.16800000000001,null,642.16800000000001,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R"]
[27258,null,"See CPT",null,1984.1801999999998,null,1984.1801999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27259,null,"See CPT",null,2741.1060000000002,null,2741.1060000000002,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[27265,null,"See CPT",null,742.65539999999999,null,742.65539999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27266,null,"See CPT",null,1054.2257999999999,null,1054.2257999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27267,null,"See CPT",null,798.54779999999994,null,798.54779999999994,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27268,null,"See CPT",null,981.68460000000016,null,981.68460000000016,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27269,null,"See CPT",null,2204.1822000000002,null,2204.1822000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27275,null,"See CPT",null,329.40840000000003,null,329.40840000000003,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[27279,null,"See CPT",null,1490.6622,null,1490.6622,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27280,null,"See CPT",null,2408.13,null,2408.13,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27282,null,"See CPT",null,1542.3924000000002,null,1542.3924000000002,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[27284,null,"See CPT",null,2843.3771999999999,null,2843.3771999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27286,null,"See CPT",null,2914.1345999999999,null,2914.1345999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27290,null,"See CPT",null,2887.3776000000003,null,2887.3776000000003,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[27295,null,"See CPT",null,2242.2366000000002,null,2242.2366000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27299,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,1,2,1,1,null,"N"]
[27301,null,"See CPT",null,1231.4166,null,910.92720000000008,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27303,null,"See CPT",null,1147.578,null,1147.578,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27305,null,"See CPT",null,872.87279999999998,null,872.87279999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27306,null,"See CPT",null,613.0326,null,613.0326,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[27307,null,"See CPT",null,755.14199999999994,null,755.14199999999994,null,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R"]
[27310,null,"See CPT",null,1315.2552000000001,null,1315.2552000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27323,null,"See CPT",null,503.62620000000004,null,311.57040000000001,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[27324,null,"See CPT",null,733.7364,null,733.7364,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27325,null,"See CPT",null,1020.3336,null,1020.3336,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM"]
[27326,null,"See CPT",null,946.0086,null,946.0086,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[27327,null,"See CPT",null,934.71120000000008,null,566.65379999999993,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27328,null,"See CPT",null,1114.2803999999999,null,1114.2803999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27329,null,"See CPT",null,1851.5844,null,1851.5844,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27330,null,"See CPT",null,764.65559999999994,null,764.65559999999994,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[27331,null,"See CPT",null,860.98080000000004,null,860.98080000000004,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27332,null,"See CPT",null,1163.0375999999999,null,1163.0375999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27333,null,"See CPT",null,1063.1448,null,1063.1448,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27334,null,"See CPT",null,1233.7950000000001,null,1233.7950000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27335,null,"See CPT",null,1375.3098,null,1375.3098,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27337,null,"See CPT",null,752.16899999999998,null,752.16899999999998,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[27339,null,"See CPT",null,1347.9582,null,1347.9582,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[27340,null,"See CPT",null,680.81700000000001,null,680.81700000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[27345,null,"See CPT",null,878.2242,null,878.2242,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27347,null,"See CPT",null,949.57620000000009,null,949.57620000000009,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27350,null,"See CPT",null,1179.0917999999999,null,1179.0917999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27355,null,"See CPT",null,1097.037,null,1097.037,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27356,null,"See CPT",null,1329.5255999999999,null,1329.5255999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27357,null,"See CPT",null,1472.2296000000001,null,1472.2296000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27358,null,"See CPT",null,483.40980000000008,null,483.40980000000008,null,"000",0,0,0,0,0,0,2,0,0,null,"R",null,"Y-UR"]
[27360,null,"See CPT",null,1636.9338,null,1636.9338,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27364,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[27365,null,"See CPT",null,3633.6006000000002,null,3633.6006000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27369,null,"See CPT",null,330.5976,null,70.162800000000004,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[27372,null,"See CPT",null,1093.4694,null,724.22280000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27380,null,"See CPT",null,1133.9022,null,1133.9022,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27381,null,"See CPT",null,1485.3108,null,1485.3108,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27385,null,"See CPT",null,1106.5506,null,1106.5506,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27386,null,"See CPT",null,1551.9060000000002,null,1551.9060000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27390,null,"See CPT",null,812.81820000000005,null,812.81820000000005,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[27391,null,"See CPT",null,1003.6848,null,1003.6848,null,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R",null,"Y-UR"]
[27392,null,"See CPT",null,1281.9576,null,1281.9576,null,"090",0.1,0.69,0.21,0,2,2,2,1,0,null,"R",null,"Y-UR"]
[27393,null,"See CPT",null,906.17039999999997,null,906.17039999999997,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27394,null,"See CPT",null,1178.4972,null,1178.4972,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR"]
[27395,null,"See CPT",null,1580.4467999999999,null,1580.4467999999999,null,"090",0.1,0.69,0.21,0,2,2,2,1,0,null,"R",null,"Y-UR"]
[27396,null,"See CPT",null,1114.2803999999999,null,1114.2803999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27397,null,"See CPT",null,1638.123,null,1638.123,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[27400,null,"See CPT",null,1252.2275999999999,null,1252.2275999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27403,null,"See CPT",null,1161.2538000000002,null,1161.2538000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27405,null,"See CPT",null,1218.3353999999999,null,1218.3353999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27407,null,"See CPT",null,1431.7967999999998,null,1431.7967999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27409,null,"See CPT",null,1731.4752000000001,null,1731.4752000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27412,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[27415,null,"See CPT",null,2444.4005999999999,null,2444.4005999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27416,null,"See CPT",null,1751.097,null,1751.097,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR"]
[27418,null,"See CPT",null,1491.2567999999999,null,1491.2567999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27420,null,"See CPT",null,1333.6877999999999,null,1333.6877999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27422,null,"See CPT",null,1334.2824000000001,null,1334.2824000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27424,null,"See CPT",null,1344.9852000000001,null,1344.9852000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27425,null,"See CPT",null,822.33180000000004,null,822.33180000000004,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[27427,null,"See CPT",null,1277.2008000000001,null,1277.2008000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27428,null,"See CPT",null,1997.8560000000002,null,1997.8560000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27429,null,"See CPT",null,2248.7772,null,2248.7772,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27430,null,"See CPT",null,1334.2824000000001,null,1334.2824000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27435,null,"See CPT",null,1446.0672,null,1446.0672,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27437,null,"See CPT",null,1187.4161999999999,null,1187.4161999999999,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[27438,null,"See CPT",null,1504.9325999999999,null,1504.9325999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27440,null,"See CPT",null,1430.6076,null,1430.6076,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27441,null,"See CPT",null,1476.3917999999999,null,1476.3917999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27442,null,"See CPT",null,1558.4466,null,1558.4466,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27443,null,"See CPT",null,1462.7160000000001,null,1462.7160000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27445,null,"See CPT",null,2233.3176000000003,null,2233.3176000000003,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27446,null,"See CPT",null,2051.37,null,2051.37,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27447,null,"See CPT",null,2278.5072,null,2278.5072,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27448,null,"See CPT",null,1449.6348,null,1449.6348,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27450,null,"See CPT",null,1808.7732000000001,null,1808.7732000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27454,null,"See CPT",null,2301.6966000000002,null,2301.6966000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27455,null,"See CPT",null,1724.9346,null,1724.9346,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27457,null,"See CPT",null,1716.0155999999999,null,1716.0155999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27465,null,"See CPT",null,2221.4256,null,2221.4256,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27466,null,"See CPT",null,2112.6138000000001,null,2112.6138000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27468,null,"See CPT",null,2387.319,null,2387.319,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27470,null,"See CPT",null,2103.1001999999999,null,2103.1001999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27472,null,"See CPT",null,2250.5610000000001,null,2250.5610000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27475,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"X"]
[27477,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"X"]
[27479,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"X"]
[27485,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"X"]
[27486,null,"See CPT",null,2494.9416000000001,null,2494.9416000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27487,null,"See CPT",null,3107.9742000000001,null,3107.9742000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27488,null,"See CPT",null,2136.9924000000001,null,2136.9924000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27495,null,"See CPT",null,2015.694,null,2015.694,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27496,null,"See CPT",null,991.19820000000016,null,991.19820000000016,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27497,null,"See CPT",null,1045.3067999999998,null,1045.3067999999998,null,"090",0.1,0.69,0.21,0,2,1,0,2,0,null,"R"]
[27498,null,"See CPT",null,1183.2539999999999,null,1183.2539999999999,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27499,null,"See CPT",null,1261.1466,null,1261.1466,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27500,null,"See CPT",null,946.60320000000002,null,867.52139999999997,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27501,null,"See CPT",null,918.06240000000003,null,899.62980000000005,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27502,null,"See CPT",null,1357.4718,null,1357.4718,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27503,null,"See CPT",null,1432.3914,null,1432.3914,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27506,null,"See CPT",null,2381.373,null,2381.373,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27507,null,"See CPT",null,1724.9346,null,1724.9346,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27508,null,"See CPT",null,956.1167999999999,null,904.38660000000004,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27509,null,"See CPT",null,1229.6328000000001,null,1229.6328000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27510,null,"See CPT",null,1216.5516,null,1216.5516,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27511,null,"See CPT",null,1773.0971999999999,null,1773.0971999999999,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27513,null,"See CPT",null,2196.4523999999997,null,2196.4523999999997,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27514,null,"See CPT",null,1721.9616000000001,null,1721.9616000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27516,null,"See CPT",null,946.0086,null,881.79179999999997,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27517,null,"See CPT",null,1240.3355999999999,null,1240.3355999999999,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27519,null,"See CPT",null,1589.3658,null,1589.3658,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27520,null,"See CPT",null,599.35680000000002,null,552.97800000000007,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27524,null,"See CPT",null,1352.7149999999999,null,1352.7149999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27530,null,"See CPT",null,569.03219999999999,null,533.35620000000006,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27532,null,"See CPT",null,1124.9832000000001,null,1046.4960000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27535,null,"See CPT",null,1599.4739999999999,null,1599.4739999999999,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27536,null,"See CPT",null,2114.3976000000002,null,2114.3976000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27538,null,"See CPT",null,890.71080000000006,null,825.30480000000011,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27540,null,"See CPT",null,1459.1484,null,1459.1484,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27550,null,"See CPT",null,938.27879999999993,null,859.197,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27552,null,"See CPT",null,1144.605,null,1144.605,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27556,null,"See CPT",null,1564.3925999999999,null,1564.3925999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27557,null,"See CPT",null,1861.6925999999999,null,1861.6925999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27558,null,"See CPT",null,2114.3976000000002,null,2114.3976000000002,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27560,null,"See CPT",null,676.06020000000001,null,614.22180000000003,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27562,null,"See CPT",null,888.92700000000002,null,888.92700000000002,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27566,null,"See CPT",null,1597.0955999999999,null,1597.0955999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27570,null,"See CPT",null,275.2998,null,275.2998,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[27580,null,"See CPT",null,2639.4294,null,2639.4294,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27590,null,"See CPT",null,1387.7963999999999,null,1387.7963999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27591,null,"See CPT",null,1723.1508000000001,null,1723.1508000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27592,null,"See CPT",null,1185.0378000000001,null,1185.0378000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27594,null,"See CPT",null,906.76499999999999,null,906.76499999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[27596,null,"See CPT",null,1267.0925999999999,null,1267.0925999999999,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[27598,null,"See CPT",null,1242.1194,null,1242.1194,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27599,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,1,2,1,1,null,"N",null,"Y-UR"]
[27600,null,"See CPT",null,721.84440000000006,null,721.84440000000006,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[27601,null,"See CPT",null,803.89919999999995,null,803.89919999999995,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27602,null,"See CPT",null,849.68340000000001,null,849.68340000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27603,null,"See CPT",null,973.95479999999998,null,705.79019999999991,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27604,null,"See CPT",null,819.95339999999999,null,576.16739999999993,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27605,null,"See CPT",null,610.05960000000005,null,326.43540000000002,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R"]
[27606,null,"See CPT",null,487.57199999999995,null,487.57199999999995,null,"010",0.1,0.8,0.1,0,2,1,1,1,0,null,"R"]
[27607,null,"See CPT",null,1069.6853999999998,null,1069.6853999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27610,null,"See CPT",null,1162.443,null,1162.443,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[27612,null,"See CPT",null,1003.0902000000001,null,1003.0902000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27613,null,"See CPT",null,464.38259999999997,null,287.1918,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[27614,null,"See CPT",null,1064.9286,null,739.68240000000003,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27615,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"X"]
[27616,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"X"]
[27618,null,"See CPT",null,906.76499999999999,null,550.59960000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27619,null,"See CPT",null,825.89940000000001,null,825.89940000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27620,null,"See CPT",null,810.4398000000001,null,810.4398000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27625,null,"See CPT",null,1029.2526,null,1029.2526,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27626,null,"See CPT",null,1079.1989999999998,null,1079.1989999999998,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[27630,null,"See CPT",null,993.5766000000001,null,645.14099999999996,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27632,null,"See CPT",null,737.89859999999999,null,737.89859999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[27634,null,"See CPT",null,1205.8488,null,1205.8488,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[27635,null,"See CPT",null,1041.1446000000001,null,1041.1446000000001,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[27637,null,"See CPT",null,1318.2282,null,1318.2282,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27638,null,"See CPT",null,1344.3905999999999,null,1344.3905999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27640,null,"See CPT",null,1488.2838000000002,null,1488.2838000000002,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[27641,null,"See CPT",null,1167.1997999999999,null,1167.1997999999999,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[27645,null,"See CPT",null,3132.3528000000001,null,3132.3528000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27646,null,"See CPT",null,2725.0517999999997,null,2725.0517999999997,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27647,null,"See CPT",null,1760.6106,null,1760.6106,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[27648,null,"See CPT",null,412.65240000000006,null,89.784599999999998,null,"000",0,0,0,0,2,1,0,0,0,null,"R"]
[27650,null,"See CPT",null,1183.8486,null,1183.8486,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27652,null,"See CPT",null,1178.4972,null,1178.4972,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[27654,null,"See CPT",null,1277.2008000000001,null,1277.2008000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27656,null,"See CPT",null,1008.4416000000001,null,634.43820000000005,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[27658,null,"See CPT",null,662.97900000000004,null,662.97900000000004,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[27659,null,"See CPT",null,842.54819999999995,null,842.54819999999995,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[27664,null,"See CPT",null,657.62760000000003,null,657.62760000000003,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,"Y-UR"]
[27665,null,"See CPT",null,759.89879999999994,null,759.89879999999994,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[27675,null,"See CPT",null,882.38639999999998,null,882.38639999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27676,null,"See CPT",null,1090.4964,null,1090.4964,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[27680,null,"See CPT",null,750.97980000000007,null,750.97980000000007,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,"Y-UR"]
[27681,null,"See CPT",null,913.30560000000003,null,913.30560000000003,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[27685,null,"See CPT",null,1195.7406000000001,null,833.03459999999995,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27686,null,"See CPT",null,954.33300000000008,null,954.33300000000008,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[27687,null,"See CPT",null,814.60199999999998,null,814.60199999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27690,null,"See CPT",null,1149.9564,null,1149.9564,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27691,null,"See CPT",null,1334.2824000000001,null,1334.2824000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27692,null,"See CPT",null,177.1908,null,177.1908,null,"000",0,0,0,0,0,0,2,1,0,null,"R"]
[27695,null,"See CPT",null,862.17,null,862.17,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[27696,null,"See CPT",null,982.27919999999995,null,982.27919999999995,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[27698,null,"See CPT",null,1140.4428,null,1140.4428,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27700,null,"See CPT",null,1097.037,null,1097.037,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27702,null,"See CPT",null,1718.394,null,1718.394,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27703,null,"See CPT",null,1975.2611999999999,null,1975.2611999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[27704,null,"See CPT",null,1025.0903999999998,null,1025.0903999999998,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[27705,null,"See CPT",null,1359.2556,null,1359.2556,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27707,null,"See CPT",null,730.76339999999993,null,730.76339999999993,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[27709,null,"See CPT",null,2035.9104000000002,null,2035.9104000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27712,null,"See CPT",null,1966.3422,null,1966.3422,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27715,null,"See CPT",null,1915.8011999999999,null,1915.8011999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27720,null,"See CPT",null,1566.1764000000001,null,1566.1764000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27722,null,"See CPT",null,1603.0416,null,1603.0416,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27724,null,"See CPT",null,2228.5607999999997,null,2228.5607999999997,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27725,null,"See CPT",null,2166.7224000000001,null,2166.7224000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27726,null,"See CPT",null,1711.2588000000001,null,1711.2588000000001,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[27727,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[27730,null,"See CPT",null,1061.3610000000001,null,1061.3610000000001,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-CM"]
[27732,null,"See CPT",null,821.14260000000002,null,821.14260000000002,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[27734,null,"See CPT",null,1184.4432000000002,null,1184.4432000000002,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[27740,null,"See CPT",null,1272.444,null,1272.444,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM"]
[27742,null,"See CPT",null,1394.337,null,1394.337,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[27745,null,"See CPT",null,1358.0663999999999,null,1358.0663999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27750,null,"See CPT",null,638.60040000000004,null,591.62699999999995,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27752,null,"See CPT",null,974.54939999999999,null,889.52160000000003,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27756,null,"See CPT",null,1045.9014,null,1045.9014,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27758,null,"See CPT",null,1605.42,null,1605.42,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27759,null,"See CPT",null,1780.827,null,1780.827,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27760,null,"See CPT",null,611.84339999999997,null,564.27539999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27762,null,"See CPT",null,881.19720000000007,null,794.98019999999997,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27766,null,"See CPT",null,1089.9017999999999,null,1089.9017999999999,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[27767,null,"See CPT",null,538.70760000000007,null,533.35620000000006,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27768,null,"See CPT",null,814.00739999999996,null,814.00739999999996,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27769,null,"See CPT",null,1307.5254,null,1307.5254,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27780,null,"See CPT",null,571.41059999999993,null,524.43720000000008,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27781,null,"See CPT",null,797.95320000000004,null,732.54719999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27784,null,"See CPT",null,1271.2547999999999,null,1271.2547999999999,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[27786,null,"See CPT",null,578.54579999999999,null,529.78859999999997,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27788,null,"See CPT",null,777.73680000000002,null,701.62800000000004,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27792,null,"See CPT",null,1161.2538000000002,null,1161.2538000000002,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[27808,null,"See CPT",null,618.97860000000003,null,563.08620000000008,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27810,null,"See CPT",null,861.57540000000006,null,773.57460000000003,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27814,null,"See CPT",null,1372.3367999999998,null,1372.3367999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27816,null,"See CPT",null,609.46500000000003,null,539.89679999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27818,null,"See CPT",null,891.9,null,793.19640000000004,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27822,null,"See CPT",null,1584.6089999999999,null,1584.6089999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27823,null,"See CPT",null,1776.6648,null,1776.6648,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27824,null,"See CPT",null,582.70800000000008,null,557.73480000000006,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27825,null,"See CPT",null,985.25220000000002,null,885.95400000000006,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27826,null,"See CPT",null,1546.5546000000002,null,1546.5546000000002,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27827,null,"See CPT",null,2019.2616,null,2019.2616,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27828,null,"See CPT",null,2388.5082000000002,null,2388.5082000000002,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27829,null,"See CPT",null,1283.1468,null,1283.1468,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27830,null,"See CPT",null,717.08760000000007,null,659.41139999999996,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27831,null,"See CPT",null,745.03379999999993,null,745.03379999999993,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27832,null,"See CPT",null,1360.4448,null,1360.4448,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27840,null,"See CPT",null,694.49279999999999,null,694.49279999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27842,null,"See CPT",null,897.846,null,897.846,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27846,null,"See CPT",null,1297.4172000000001,null,1297.4172000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27848,null,"See CPT",null,1415.1480000000001,null,1415.1480000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27860,null,"See CPT",null,297.3,null,297.3,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R"]
[27870,null,"See CPT",null,1804.6110000000001,null,1804.6110000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27871,null,"See CPT",null,1238.5518,null,1238.5518,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27880,null,"See CPT",null,1586.9874000000002,null,1586.9874000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27881,null,"See CPT",null,1515.0408,null,1515.0408,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27882,null,"See CPT",null,1045.9014,null,1045.9014,null,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R"]
[27884,null,"See CPT",null,1027.4688000000001,null,1027.4688000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27886,null,"See CPT",null,1154.7132000000001,null,1154.7132000000001,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[27888,null,"See CPT",null,1155.3078,null,1155.3078,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27889,null,"See CPT",null,1124.3886,null,1124.3886,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[27892,null,"See CPT",null,958.49520000000007,null,958.49520000000007,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27893,null,"See CPT",null,1105.9560000000001,null,1105.9560000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27894,null,"See CPT",null,1457.9592,null,1457.9592,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[27899,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,1,0,1,1,null,"N"]
[28001,null,"See CPT",null,316.92180000000002,null,170.65020000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[28002,null,"See CPT",null,455.46360000000004,null,249.73200000000003,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[28003,null,"See CPT",null,692.11440000000005,null,461.40960000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[28005,null,"See CPT",null,1021.5228,null,1021.5228,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28008,null,"See CPT",null,778.33140000000003,null,525.03179999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28010,null,"See CPT",null,419.19299999999998,null,370.43580000000003,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28011,null,"See CPT",null,564.27539999999999,null,498.86940000000004,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28020,null,"See CPT",null,1003.6848,null,662.97900000000004,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,"Y-UR"]
[28022,null,"See CPT",null,885.35940000000005,null,583.30259999999998,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-UR"]
[28024,null,"See CPT",null,828.27779999999996,null,542.86980000000005,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-UR"]
[28035,null,"See CPT",null,952.54920000000004,null,635.03279999999995,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[28039,null,"See CPT",null,888.33240000000001,null,617.7894,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[28041,null,"See CPT",null,801.52080000000001,null,801.52080000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28043,null,"See CPT",null,696.87120000000004,null,463.1934,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28045,null,"See CPT",null,865.14300000000003,null,614.81640000000004,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28046,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"X"]
[28047,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[28050,null,"See CPT",null,754.54739999999993,null,495.30180000000001,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[28052,null,"See CPT",null,708.16859999999997,null,454.86900000000003,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[28054,null,"See CPT",null,667.14120000000003,null,416.81459999999998,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28055,null,"See CPT",null,680.22239999999999,null,680.22239999999999,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28060,null,"See CPT",null,944.81940000000009,null,645.14099999999996,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28062,null,"See CPT",null,1029.8471999999999,null,712.92539999999997,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[28070,null,"See CPT",null,935.90039999999999,null,620.16779999999994,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28072,null,"See CPT",null,893.08920000000001,null,580.32960000000003,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28080,null,"See CPT",null,968.00880000000006,null,674.87099999999998,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[28086,null,"See CPT",null,978.11699999999996,null,638.00580000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[28088,null,"See CPT",null,831.25080000000003,null,515.51819999999998,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28090,null,"See CPT",null,844.33199999999999,null,548.22120000000007,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28092,null,"See CPT",null,761.68260000000009,null,481.62599999999998,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28100,null,"See CPT",null,1119.0372,null,752.16899999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[28102,null,"See CPT",null,1101.1992,null,1101.1992,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[28103,null,"See CPT",null,689.73599999999999,null,689.73599999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[28104,null,"See CPT",null,951.95460000000014,null,629.68140000000005,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[28106,null,"See CPT",null,757.5204,null,757.5204,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[28107,null,"See CPT",null,913.30560000000003,null,615.41099999999994,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[28108,null,"See CPT",null,789.03419999999994,null,513.73440000000005,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28110,null,"See CPT",null,837.19680000000005,null,519.08580000000006,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[28111,null,"See CPT",null,872.87279999999998,null,572.59980000000007,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[28112,null,"See CPT",null,879.41339999999991,null,558.32940000000008,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[28113,null,"See CPT",null,1058.9826,null,759.30420000000004,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR"]
[28114,null,"See CPT",null,1926.5039999999999,null,1494.8244,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28116,null,"See CPT",null,1395.5262,null,1041.1446000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[28118,null,"See CPT",null,1094.6586,null,752.16899999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28119,null,"See CPT",null,954.33300000000008,null,649.30320000000006,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[28120,null,"See CPT",null,1220.7138,null,888.33240000000001,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[28122,null,"See CPT",null,1068.4962,null,780.11519999999996,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28124,null,"See CPT",null,863.35919999999999,null,594.00540000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[28126,null,"See CPT",null,708.16859999999997,null,441.7878,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28130,null,"See CPT",null,1094.6586,null,1094.6586,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[28140,null,"See CPT",null,1039.3607999999999,null,764.06100000000004,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R"]
[28150,null,"See CPT",null,757.5204,null,495.30180000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28153,null,"See CPT",null,741.46620000000007,null,472.70699999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28160,null,"See CPT",null,748.60140000000001,null,478.05839999999995,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28171,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"X"]
[28173,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"X"]
[28175,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"X"]
[28190,null,"See CPT",null,446.5446,null,236.05620000000002,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[28192,null,"See CPT",null,836.60220000000004,null,554.16719999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28193,null,"See CPT",null,946.0086,null,652.27620000000002,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28200,null,"See CPT",null,903.19740000000002,null,585.68100000000004,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,"Y-UR"]
[28202,null,"See CPT",null,1076.2260000000001,null,761.08800000000008,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[28208,null,"See CPT",null,878.81880000000001,null,571.41059999999993,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,"Y-UR"]
[28210,null,"See CPT",null,1060.7664,null,746.22300000000007,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR"]
[28220,null,"See CPT",null,817.57500000000005,null,542.86980000000005,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[28222,null,"See CPT",null,943.03559999999993,null,641.57339999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[28225,null,"See CPT",null,755.14199999999994,null,472.11240000000004,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[28226,null,"See CPT",null,1133.3075999999999,null,718.87139999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[28230,null,"See CPT",null,785.46660000000008,null,506.00459999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[28232,null,"See CPT",null,689.14139999999998,null,429.89580000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-UR"]
[28234,null,"See CPT",null,743.84460000000001,null,478.05839999999995,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-UR"]
[28238,null,"See CPT",null,1212.9839999999999,null,871.08900000000006,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28240,null,"See CPT",null,808.65599999999995,null,523.84260000000006,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28250,null,"See CPT",null,1051.8474000000001,null,723.62819999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[28260,null,"See CPT",null,1283.1468,null,939.46800000000007,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[28261,null,"See CPT",null,2173.2629999999999,null,1676.1774,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28262,null,"See CPT",null,2515.1579999999999,null,2005.5857999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[28264,null,"See CPT",null,1632.7716,null,1236.768,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[28270,null,"See CPT",null,883.57560000000001,null,595.19460000000004,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28272,null,"See CPT",null,696.87120000000004,null,446.5446,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28280,null,"See CPT",null,927.57600000000002,null,620.16779999999994,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28285,null,"See CPT",null,973.36020000000008,null,684.97919999999999,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[28286,null,"See CPT",null,802.11540000000002,null,528.59940000000006,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28288,null,"See CPT",null,1097.6316000000002,null,776.54759999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28289,null,"See CPT",null,1248.6600000000001,null,818.16959999999995,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28291,null,"See CPT",null,1282.5522000000001,null,872.27819999999997,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28292,null,"See CPT",null,1258.7682000000002,null,857.41319999999996,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28295,null,"See CPT",null,2002.0182000000002,null,1102.9829999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28296,null,"See CPT",null,1625.0418,null,911.52179999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28297,null,"See CPT",null,1896.1794,null,1077.4152000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28298,null,"See CPT",null,1518.0138000000002,null,894.87300000000005,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28299,null,"See CPT",null,1839.0978,null,1047.6852000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28300,null,"See CPT",null,1160.6592000000001,null,1160.6592000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28302,null,"See CPT",null,1286.1197999999999,null,1286.1197999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28304,null,"See CPT",null,1494.8244,null,1090.4964,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28305,null,"See CPT",null,1210.0110000000002,null,1210.0110000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28306,null,"See CPT",null,1099.4153999999999,null,719.46600000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28307,null,"See CPT",null,1437.1482000000001,null,930.54899999999998,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28308,null,"See CPT",null,1035.7932000000001,null,688.54679999999996,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28309,null,"See CPT",null,1586.9874000000002,null,1586.9874000000002,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28310,null,"See CPT",null,988.81979999999999,null,643.95180000000005,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[28312,null,"See CPT",null,943.03559999999993,null,586.87019999999995,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R"]
[28313,null,"See CPT",null,957.90059999999994,null,641.57339999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28315,null,"See CPT",null,872.27819999999997,null,583.30259999999998,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[28320,null,"See CPT",null,1089.3072,null,1089.3072,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[28322,null,"See CPT",null,1420.4994000000002,null,1029.8471999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[28340,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"X"]
[28341,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"X"]
[28344,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"X"]
[28345,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"X"]
[28360,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"X"]
[28400,null,"See CPT",null,453.08519999999999,null,419.19299999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28405,null,"See CPT",null,708.16859999999997,null,635.62739999999997,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28406,null,"See CPT",null,1024.4958000000001,null,1024.4958000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28415,null,"See CPT",null,2020.4507999999998,null,2020.4507999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[28420,null,"See CPT",null,2332.0212000000001,null,2332.0212000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[28430,null,"See CPT",null,441.19319999999999,null,385.30080000000004,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28435,null,"See CPT",null,676.65480000000002,null,597.57300000000009,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28436,null,"See CPT",null,909.14339999999993,null,909.14339999999993,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28445,null,"See CPT",null,1825.422,null,1825.422,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[28446,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[28450,null,"See CPT",null,387.08459999999997,null,349.03020000000004,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28455,null,"See CPT",null,530.38319999999999,null,470.32859999999999,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[28456,null,"See CPT",null,684.97919999999999,null,684.97919999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28465,null,"See CPT",null,1145.7942,null,1145.7942,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28470,null,"See CPT",null,399.57119999999998,null,375.19259999999997,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28475,null,"See CPT",null,464.97720000000004,null,407.30099999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28476,null,"See CPT",null,712.92539999999997,null,712.92539999999997,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[28485,null,"See CPT",null,1012.6038000000001,null,1012.6038000000001,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R"]
[28490,null,"See CPT",null,258.65100000000001,null,226.54259999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28495,null,"See CPT",null,326.43540000000002,null,269.94839999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28496,null,"See CPT",null,830.65620000000001,null,443.57159999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28505,null,"See CPT",null,1195.7406000000001,null,891.9,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28510,null,"See CPT",null,218.81280000000001,null,216.43440000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28515,null,"See CPT",null,297.89459999999997,null,258.65100000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28525,null,"See CPT",null,1034.604,null,726.60120000000006,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[28530,null,"See CPT",null,206.92080000000001,null,178.38,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28531,null,"See CPT",null,603.51900000000001,null,322.86779999999999,null,"090",0.1,0.69,0.21,0,2,1,1,2,0,null,"R"]
[28540,null,"See CPT",null,354.38159999999999,null,316.92180000000002,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28545,null,"See CPT",null,567.84300000000007,null,494.7072,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28546,null,"See CPT",null,1086.3342,null,638.60040000000004,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28555,null,"See CPT",null,1556.6628000000001,null,1176.7133999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[28570,null,"See CPT",null,431.08499999999998,null,358.54380000000003,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28575,null,"See CPT",null,692.70900000000006,null,618.38400000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28576,null,"See CPT",null,694.49279999999999,null,694.49279999999999,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28585,null,"See CPT",null,1597.0955999999999,null,1243.9032000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[28600,null,"See CPT",null,395.40900000000005,null,335.3544,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[28605,null,"See CPT",null,627.303,null,556.54559999999992,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[28606,null,"See CPT",null,683.79,null,683.79,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28615,null,"See CPT",null,1489.473,null,1489.473,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[28630,null,"See CPT",null,277.6782,null,196.8126,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[28635,null,"See CPT",null,315.13799999999998,null,237.24540000000002,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[28636,null,"See CPT",null,572.59980000000007,null,356.76,null,"010",0.1,0.8,0.1,0,2,0,1,2,0,null,"R"]
[28645,null,"See CPT",null,1176.7133999999999,null,865.73760000000004,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R"]
[28660,null,"See CPT",null,222.97499999999999,null,165.89340000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[28665,null,"See CPT",null,271.73220000000003,null,225.35339999999999,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[28666,null,"See CPT",null,320.48939999999999,null,320.48939999999999,null,"010",0.1,0.8,0.1,0,2,0,1,2,0,null,"R"]
[28675,null,"See CPT",null,1048.8744000000002,null,737.30400000000009,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28705,null,"See CPT",null,2172.6684,null,2172.6684,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28715,null,"See CPT",null,1681.5288,null,1681.5288,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28725,null,"See CPT",null,1390.1748,null,1390.1748,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28730,null,"See CPT",null,1309.3091999999999,null,1309.3091999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28735,null,"See CPT",null,1395.5262,null,1395.5262,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28737,null,"See CPT",null,1224.8760000000002,null,1224.8760000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28740,null,"See CPT",null,1498.9866000000002,null,1102.9829999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28750,null,"See CPT",null,1422.2832000000001,null,1035.1985999999999,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR"]
[28755,null,"See CPT",null,922.81920000000002,null,598.16759999999999,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[28760,null,"See CPT",null,1378.2828,null,1011.4146000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28800,null,"See CPT",null,942.44100000000003,null,942.44100000000003,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28805,null,"See CPT",null,1258.1736000000001,null,1258.1736000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR"]
[28810,null,"See CPT",null,755.14199999999994,null,755.14199999999994,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[28820,null,"See CPT",null,545.2482,null,314.54340000000002,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[28825,null,"See CPT",null,535.14,null,305.62439999999998,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[28890,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"X"]
[28899,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,0,0,1,1,null,"N"]
[29000,null,"See CPT",null,630.87059999999997,null,346.05720000000002,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[29010,null,"See CPT",null,488.76120000000003,null,283.02960000000002,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[29015,null,"See CPT",null,525.03179999999998,null,318.7056,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[29035,null,"See CPT",null,459.62580000000003,null,253.2996,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[29040,null,"See CPT",null,523.84260000000006,null,304.43520000000001,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[29044,null,"See CPT",null,513.73440000000005,null,294.327,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[29046,null,"See CPT",null,563.08620000000008,null,331.78680000000003,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[29049,null,"See CPT",null,177.78540000000001,null,123.6768,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[29055,null,"See CPT",null,398.97660000000002,null,242.5968,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[29058,null,"See CPT",null,220.00200000000001,null,165.2988,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[29065,null,"See CPT",null,173.02860000000001,null,121.2984,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29075,null,"See CPT",null,155.7852,null,110.001,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29085,null,"See CPT",null,171.2448,null,119.51459999999999,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29086,null,"See CPT",null,137.3526,null,88.000799999999998,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29105,null,"See CPT",null,146.27160000000001,null,72.541200000000003,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29125,null,"See CPT",null,118.3254,null,70.757400000000004,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29126,null,"See CPT",null,139.13639999999998,null,87.406199999999998,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29130,null,"See CPT",null,73.730400000000003,null,51.730200000000004,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29131,null,"See CPT",null,94.54140000000001,null,60.6492,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29200,null,"See CPT",null,60.054600000000001,null,33.297600000000003,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[29240,null,"See CPT",null,54.703200000000002,null,32.703000000000003,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29260,null,"See CPT",null,53.514000000000003,null,33.892199999999995,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29280,null,"See CPT",null,52.919400000000003,null,35.081400000000002,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29305,null,"See CPT",null,442.38240000000002,null,279.46199999999999,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[29325,null,"See CPT",null,488.16660000000007,null,312.75959999999998,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[29345,null,"See CPT",null,242.00220000000002,null,176.0016,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29355,null,"See CPT",null,253.2996,null,187.89360000000002,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29358,null,"See CPT",null,286.59720000000004,null,181.94759999999999,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29365,null,"See CPT",null,220.00200000000001,null,154.596,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29405,null,"See CPT",null,142.70400000000001,null,102.86580000000001,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29425,null,"See CPT",null,134.9742,null,95.73060000000001,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29435,null,"See CPT",null,200.97479999999999,null,140.92020000000002,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29440,null,"See CPT",null,75.514200000000002,null,49.351799999999997,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29445,null,"See CPT",null,229.51560000000001,null,175.40700000000001,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29450,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,1,1,0,0,null,"X"]
[29505,null,"See CPT",null,156.9744,null,90.973799999999997,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29515,null,"See CPT",null,127.24440000000001,null,86.811599999999999,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29520,null,"See CPT",null,64.216800000000006,null,32.703000000000003,null,"000",0,0,0,0,2,1,0,0,0,null,"R"]
[29530,null,"See CPT",null,54.703200000000002,null,32.108400000000003,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29540,null,"See CPT",null,49.946399999999997,null,30.9192,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29550,null,"See CPT",null,34.486799999999995,null,19.6218,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29580,null,"See CPT",null,117.1362,null,46.973400000000005,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29581,null,"See CPT",null,165.2988,null,48.162600000000005,null,"000",0,0,0,0,2,1,0,0,0,null,"R"]
[29584,null,"See CPT",null,153.4068,null,27.946199999999997,null,"000",0,0,0,0,2,1,0,0,0,null,"R"]
[29700,null,"See CPT",null,110.5956,null,58.270800000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[29705,null,"See CPT",null,112.97399999999999,null,78.487200000000001,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29710,null,"See CPT",null,217.029,null,145.08240000000001,null,"000",0,0,0,0,2,1,0,0,0,null,"R"]
[29720,null,"See CPT",null,151.62299999999999,null,75.514200000000002,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[29730,null,"See CPT",null,113.5686,null,77.892600000000002,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[29740,null,"See CPT",null,176.0016,null,121.89299999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[29750,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,1,0,0,0,null,"X"]
[29799,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,0,0,1,1,null,"N"]
[29800,null,"See CPT",null,954.33300000000008,null,954.33300000000008,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[29804,null,"See CPT",null,1079.7936,null,1079.7936,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[29806,null,"See CPT",null,1893.2064,null,1893.2064,null,"090",0.1,0.69,0.21,0,3,1,1,1,0,null,"R",null,"Y-UR"]
[29828,null,"See CPT",null,1638.7175999999999,null,1638.7175999999999,null,"090",0.1,0.69,0.21,0,3,1,2,1,0,null,"R",null,"Y-UR"]
[29847,null,"See CPT",null,978.71160000000009,null,978.71160000000009,null,"090",0.1,0.69,0.21,0,3,1,2,0,0,null,"R"]
[29861,null,"See CPT",null,1286.7144000000001,null,1286.7144000000001,null,"090",0.1,0.69,0.21,0,3,1,2,1,0,null,"R",null,"Y-UR"]
[29874,null,"See CPT",null,963.84660000000008,null,963.84660000000008,null,"090",0.1,0.69,0.21,0,3,1,0,0,0,null,"R",null,"Y-UR"]
[29880,null,"See CPT",null,1010.82,null,1010.82,null,"090",0.1,0.69,0.21,0,3,1,0,1,0,null,"R",null,"Y-UR"]
[29887,null,"See CPT",null,1350.9312,null,1350.9312,null,"090",0.1,0.69,0.21,0,3,1,2,1,0,null,"R",null,"Y-UR"]
[29901,null,"See CPT",null,975.14399999999989,null,975.14399999999989,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[29915,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,3,1,2,1,0,null,"X"]
[30124,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.76,0.14000000000000001,0,2,0,1,0,0,null,"X"]
[30400,null,"See CPT",null,2283.2640000000001,null,2283.2640000000001,null,"090",0.1,0.76,0.14000000000000001,0,2,0,0,0,0,null,"R"]
[30462,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.76,0.14000000000000001,0,2,0,2,2,0,null,"X"]
[30620,null,"See CPT",null,1256.9844000000001,null,1256.9844000000001,null,"090",0.1,0.76,0.14000000000000001,0,2,0,1,0,0,null,"R"]
[30903,null,"See CPT",null,460.815,null,134.9742,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[31000,null,"See CPT",null,341.30040000000002,null,197.40719999999999,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[31084,null,"See CPT",null,2215.4796000000001,null,2215.4796000000001,null,"090",0.1,0.76,0.14000000000000001,0,2,1,2,1,0,null,"R"]
[31205,null,"See CPT",null,1717.7994000000001,null,1717.7994000000001,null,"090",0.1,0.76,0.14000000000000001,0,2,1,2,1,0,null,"R"]
[31253,null,"See CPT",null,881.79179999999997,null,881.79179999999997,null,"000",0,0,0,0,3,1,1,0,0,null,"R",null,"Y-CM"]
[31292,null,"See CPT",null,1780.827,null,1780.827,null,"010",0.1,0.8,0.1,0,3,1,0,0,0,null,"R"]
[31299,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,0,0,1,1,null,"N"]
[31382,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"X"]
[31511,null,"See CPT",null,388.27379999999999,null,233.08320000000001,null,"000",0,0,0,0,3,0,1,0,0,null,"R"]
[31515,null,"See CPT",null,394.81439999999998,null,196.8126,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[31541,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,3,0,1,0,0,null,"X"]
[31560,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,3,0,0,0,0,null,"X"]
[31579,null,"See CPT",null,362.70599999999996,null,210.48840000000001,null,"000",0,0,0,0,3,0,1,0,0,null,"R"]
[31610,null,"See CPT",null,1743.9617999999998,null,1743.9617999999998,null,"090",0.1,0.76,0.14000000000000001,0,2,0,1,0,0,null,"R"]
[31623,null,"See CPT",null,513.13980000000004,null,233.08320000000001,null,"000",0,0,0,0,3,0,1,0,0,null,"R"]
[31632,null,"See CPT",null,116.5416,null,86.216999999999999,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[31643,null,"See CPT",null,308.00279999999998,null,308.00279999999998,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[31647,null,"See CPT",null,362.1114,null,362.1114,null,"000",0,0,0,0,3,0,1,0,0,null,"R"]
[31730,null,"See CPT",null,2109.0461999999998,null,261.62400000000002,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[31780,null,"See CPT",null,2092.9920000000002,null,2092.9920000000002,null,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"R"]
[32036,null,"See CPT",null,1396.7153999999998,null,1396.7153999999998,null,"090",0.1,0.76,0.14000000000000001,0,2,1,2,1,0,null,"R"]
[32160,null,"See CPT",null,1396.7153999999998,null,1396.7153999999998,null,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"R"]
[32400,null,"See CPT",null,305.62439999999998,null,148.65,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[32488,null,"See CPT",null,4152.0918000000001,null,4152.0918000000001,null,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[32550,null,"See CPT",null,1531.6896000000002,null,357.94919999999996,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[32553,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,0,2,0,0,null,"X"]
[32608,null,"See CPT",null,656.4384,null,656.4384,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[32655,null,"See CPT",null,1670.826,null,1670.826,null,"090",0.1,0.76,0.14000000000000001,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[32668,null,"See CPT",null,271.73220000000003,null,271.73220000000003,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM"]
[32701,null,"See CPT",null,369.84120000000001,null,369.84120000000001,null,"000",0,0,0,2,0,0,0,1,0,null,"R"]
[32900,null,"See CPT",null,2475.3198000000002,null,2475.3198000000002,null,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[33016,null,"See CPT",null,408.49020000000002,null,408.49020000000002,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[33120,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"X"]
[33141,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,0,0,2,1,0,null,"X"]
[33216,null,"See CPT",null,660.00599999999997,null,660.00599999999997,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[33224,null,"See CPT",null,900.22440000000006,null,900.22440000000006,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[33236,null,"See CPT",null,1375.9044000000001,null,1375.9044000000001,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,0,2,0,null,"R",null,"Y-CM"]
[33249,null,"See CPT",null,1617.3119999999999,null,1617.3119999999999,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,1,1,0,null,"R",null,"Y-CM"]
[33264,null,"See CPT",null,716.49300000000005,null,716.49300000000005,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[33273,null,"See CPT",null,702.81720000000007,null,702.81720000000007,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[33320,null,"See CPT",null,1839.6924000000001,null,1839.6924000000001,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[33330,null,"See CPT",null,2480.0765999999999,null,2480.0765999999999,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[33405,null,"See CPT",null,3939.2249999999999,null,3939.2249999999999,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[33411,null,"See CPT",null,5809.8365999999996,null,5809.8365999999996,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[33425,null,"See CPT",null,4735.3944000000001,null,4735.3944000000001,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[33464,null,"See CPT",null,4228.2006000000001,null,4228.2006000000001,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[33502,null,"See CPT",null,2230.3445999999999,null,2230.3445999999999,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[33511,null,"See CPT",null,3687.1145999999999,null,3687.1145999999999,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[33522,null,"See CPT",null,1263.5250000000001,null,1263.5250000000001,null,"000",0,0,0,0,0,0,2,0,0,null,"R",null,"Y-CM"]
[33533,null,"See CPT",null,3251.2728000000002,null,3251.2728000000002,null,"090",0.09,0.82,0.09,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[33617,null,"See CPT",null,3753.7098000000001,null,3753.7098000000001,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[33621,null,"See CPT",null,1618.5011999999999,null,1618.5011999999999,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[33681,null,"See CPT",null,3209.0562,null,3209.0562,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[33702,null,"See CPT",null,2692.3488000000002,null,2692.3488000000002,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[33746,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,0,0,2,0,0,null,"X"]
[33771,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"X"]
[33782,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"X"]
[33788,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"X"]
[33863,null,"See CPT",null,5443.5630000000001,null,5443.5630000000001,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[33871,null,"See CPT",null,5636.2134000000005,null,5636.2134000000005,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[33895,null,"See CPT",null,1344.3905999999999,null,1344.3905999999999,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[33922,null,"See CPT",null,2421.2112000000002,null,2421.2112000000002,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[33945,null,"See CPT",null,8420.1306000000004,null,8420.1306000000004,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,2,null,"R",null,"Y-CM"]
[33955,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,0,0,1,1,null,"X"]
[33966,null,"See CPT",null,409.08479999999997,null,409.08479999999997,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[33969,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,0,0,0,0,null,"X"]
[33986,null,"See CPT",null,903.19740000000002,null,903.19740000000002,null,"000",0,0,0,0,2,0,0,1,1,null,"R",null,"Y-CM"]
[33989,null,"See CPT",null,850.87260000000003,null,850.87260000000003,null,"000",0,0,0,0,2,0,0,1,1,null,"R",null,"Y-CM"]
[34111,null,"See CPT",null,1041.1446000000001,null,1041.1446000000001,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[34471,null,"See CPT",null,1858.125,null,1858.125,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,1,1,0,null,"R",null,"Y-CM"]
[34706,null,"See CPT",null,3924.36,null,3924.36,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[34715,null,"See CPT",null,513.73440000000005,null,513.73440000000005,null,"000",0,0,0,0,0,1,2,2,0,null,"R",null,"Y-UR"]
[34831,null,"See CPT",null,3310.7328000000002,null,3310.7328000000002,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,2,0,null,"R",null,"Y-CM"]
[34834,null,"See CPT",null,221.19120000000001,null,221.19120000000001,null,"000",0,0,0,0,0,1,2,2,0,null,"R",null,"Y-CM"]
[35022,null,"See CPT",null,2512.1849999999999,null,2512.1849999999999,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[35082,null,"See CPT",null,3735.8717999999999,null,3735.8717999999999,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[35141,null,"See CPT",null,1893.2064,null,1893.2064,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[35188,null,"See CPT",null,2251.7501999999999,null,2251.7501999999999,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[35241,null,"See CPT",null,2500.8876,null,2500.8876,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R"]
[35286,null,"See CPT",null,1616.7174,null,1616.7174,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R"]
[35331,null,"See CPT",null,2502.6714000000002,null,2502.6714000000002,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[35355,null,"See CPT",null,1774.2864,null,1774.2864,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[35516,null,"See CPT",null,2095.9650000000001,null,2095.9650000000001,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[35522,null,"See CPT",null,2010.3426000000002,null,2010.3426000000002,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[35563,null,"See CPT",null,2275.5342000000001,null,2275.5342000000001,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[35570,null,"See CPT",null,2532.4014000000002,null,2532.4014000000002,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[35623,null,"See CPT",null,2260.0745999999999,null,2260.0745999999999,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[35642,null,"See CPT",null,1703.529,null,1703.529,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[35665,null,"See CPT",null,2021.64,null,2021.64,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[35681,null,"See CPT",null,136.75799999999998,null,136.75799999999998,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM"]
[35840,null,"See CPT",null,2122.1273999999999,null,2122.1273999999999,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[35875,null,"See CPT",null,1030.4417999999998,null,1030.4417999999998,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,1,1,0,null,"R",null,"Y-CM"]
[36012,null,"See CPT",null,1607.2038,null,300.27299999999997,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[36015,null,"See CPT",null,1648.2311999999999,null,296.7054,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[36224,null,"See CPT",null,3830.4132,null,627.89760000000001,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[36251,null,"See CPT",null,2481.2657999999997,null,443.57159999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[36405,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,0,1,0,0,null,"X"]
[36430,null,"See CPT",null,70.757400000000004,null,70.757400000000004,null,"000",0,0,0,5,0,0,1,0,0,null,"R"]
[36474,null,"See CPT",null,484.00440000000003,null,154.596,null,"000",0,0,0,0,0,1,1,0,0,null,"R",null,"Y-CM"]
[36478,null,"See CPT",null,1885.4766000000002,null,480.43680000000001,null,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[36557,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"X"]
[36561,null,"See CPT",null,1898.5578,null,587.46480000000008,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R"]
[36578,null,"See CPT",null,826.49400000000003,null,358.54380000000003,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[36591,null,"See CPT",null,49.351799999999997,null,49.351799999999997,null,"000",0,0,0,3,0,0,0,0,0,null,"R"]
[36625,null,"See CPT",null,184.32600000000002,null,184.32600000000002,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[36818,null,"See CPT",null,1197.5244,null,1197.5244,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[36860,null,"See CPT",null,428.70659999999998,null,193.245,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[36902,null,"See CPT",null,2330.2374,null,415.62540000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[37184,null,"See CPT",null,3306.5706,null,743.84460000000001,null,"000",0,0,0,0,2,1,1,2,0,null,"R"]
[37187,null,"See CPT",null,3320.2464000000004,null,680.22239999999999,null,"000",0,0,0,0,2,1,1,2,0,null,"R"]
[37215,null,"See CPT",null,1722.5562,null,1722.5562,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[37225,null,"See CPT",null,17296.3194,null,1033.4148,null,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[37234,null,"See CPT",null,7094.1725999999999,null,487.57199999999995,null,"000",0,0,0,0,0,1,0,0,0,null,"R",null,"Y-CM"]
[37242,null,"See CPT",null,13999.2624,null,819.35879999999997,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[37600,null,"See CPT",null,1301.5794000000001,null,1301.5794000000001,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R"]
[37607,null,"See CPT",null,655.24919999999997,null,655.24919999999997,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,1,1,0,null,"R"]
[37765,null,"See CPT",null,783.08820000000003,null,473.30160000000001,null,"010",0.1,0.8,0.1,0,2,1,1,1,0,null,"R",null,"Y-CM"]
[37785,null,"See CPT",null,645.73559999999998,null,451.89599999999996,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[38115,null,"See CPT",null,2285.6423999999997,null,2285.6423999999997,null,"090",0.11,0.73,0.16,0,2,0,2,1,0,null,"R"]
[38214,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[38242,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,0,0,0,0,null,"X"]
[38382,null,"See CPT",null,1210.6056000000001,null,1210.6056000000001,null,"090",0.11,0.73,0.16,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[38564,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.11,0.73,0.16,0,2,0,2,1,0,null,"X"]
[38572,null,"See CPT",null,1606.0146000000002,null,1606.0146000000002,null,"010",0.1,0.8,0.1,0,3,2,2,2,0,null,"R",null,"Y-CM"]
[38792,null,"See CPT",null,151.62299999999999,null,57.676200000000001,null,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[38999,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,0,0,1,1,null,"N"]
[39499,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,0,2,1,1,null,"N"]
[40527,null,"See CPT",null,1123.1994,null,1123.1994,null,"090",0.09,0.81,0.1,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[40761,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.81,0.1,0,2,0,1,0,0,null,"X"]
[40808,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"X"]
[40843,null,"See CPT",null,2182.1820000000002,null,1552.5006000000001,null,"090",0.09,0.81,0.1,0,2,2,2,0,0,null,"R",null,"Y-CM"]
[40899,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,0,0,1,1,null,"N"]
[41108,null,"See CPT",null,311.57040000000001,null,162.32580000000002,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[41113,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.81,0.1,0,2,0,1,0,0,null,"X"]
[41140,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"X"]
[41805,null,"See CPT",null,588.0594000000001,null,365.67900000000003,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[41828,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"X"]
[42000,null,"See CPT",null,297.3,null,193.83959999999999,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[42205,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.81,0.1,0,2,0,2,0,0,null,"X"]
[42220,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.81,0.1,0,2,0,2,0,0,null,"X"]
[42340,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.81,0.1,0,2,1,0,0,0,null,"X"]
[42408,null,"See CPT",null,1009.0361999999999,null,626.11379999999997,null,"090",0.09,0.81,0.1,0,2,0,0,0,0,null,"R"]
[42440,null,"See CPT",null,743.84460000000001,null,743.84460000000001,null,"090",0.09,0.81,0.1,0,2,1,2,1,0,null,"R"]
[42720,null,"See CPT",null,809.84519999999998,null,687.95220000000006,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[42820,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.81,0.1,0,2,0,0,0,0,null,"X"]
[42836,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.81,0.1,0,2,0,0,0,0,null,"X"]
[42955,null,"See CPT",null,1389.5802000000001,null,1389.5802000000001,null,"090",0.09,0.81,0.1,0,2,0,2,0,0,null,"R"]
[42962,null,"See CPT",null,925.19760000000008,null,925.19760000000008,null,"090",0.09,0.81,0.1,0,2,0,1,0,0,null,"R"]
[43116,null,"See CPT",null,8613.3756000000012,null,8613.3756000000012,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[43121,null,"See CPT",null,4967.2884000000004,null,4967.2884000000004,null,"090",0.09,0.81,0.1,0,2,0,2,2,0,null,"R",null,"Y-CM"]
[43191,null,"See CPT",null,274.11060000000003,null,274.11060000000003,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[43210,null,"See CPT",null,757.5204,null,757.5204,null,"000",0,0,0,0,3,0,1,0,0,null,"R",null,"Y-CM"]
[43214,null,"See CPT",null,339.51659999999998,null,339.51659999999998,null,"000",0,0,0,0,3,0,1,0,0,null,"R"]
[43236,null,"See CPT",null,770.00699999999995,null,242.5968,null,"000",0,0,0,0,3,0,1,0,0,null,"R"]
[43248,null,"See CPT",null,786.6558,null,291.9486,null,"000",0,0,0,0,3,0,1,0,0,null,"R"]
[43255,null,"See CPT",null,1210.0110000000002,null,353.78700000000003,null,"000",0,0,0,0,3,0,1,0,0,null,"R"]
[43263,null,"See CPT",null,629.08680000000004,null,629.08680000000004,null,"000",0,0,0,0,3,0,1,0,0,null,"R",null,"Y-CM"]
[43276,null,"See CPT",null,847.30500000000006,null,847.30500000000006,null,"000",0,0,0,0,3,0,1,0,0,null,"R"]
[43283,null,"See CPT",null,275.89439999999996,null,275.89439999999996,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM"]
[43314,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"X"]
[43337,null,"See CPT",null,2692.9434000000001,null,2692.9434000000001,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[43360,null,"See CPT",null,3917.8194000000003,null,3917.8194000000003,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[43497,null,"See CPT",null,1407.4182000000001,null,1407.4182000000001,null,"090",0.09,0.81,0.1,0,3,0,1,0,0,null,"R"]
[43605,null,"See CPT",null,1488.2838000000002,null,1488.2838000000002,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[43631,null,"See CPT",null,2566.2936,null,2566.2936,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[43645,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"X"]
[43752,null,"See CPT",null,70.757400000000004,null,70.757400000000004,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[43773,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"X"]
[43843,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.81,0.1,0,2,0,2,2,0,null,"X"]
[43865,null,"See CPT",null,3027.7031999999999,null,3027.7031999999999,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[44020,null,"See CPT",null,1730.2860000000001,null,1730.2860000000001,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R"]
[44111,null,"See CPT",null,1735.6374000000001,null,1735.6374000000001,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[44128,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,0,0,2,1,0,null,"X"]
[44145,null,"See CPT",null,2911.1615999999999,null,2911.1615999999999,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[44150,null,"See CPT",null,3285.7595999999999,null,3285.7595999999999,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[44203,null,"See CPT",null,420.38220000000001,null,420.38220000000001,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM"]
[44300,null,"See CPT",null,1494.8244,null,1494.8244,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R"]
[44322,null,"See CPT",null,1817.6922,null,1817.6922,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[44372,null,"See CPT",null,420.97680000000003,null,420.97680000000003,null,"000",0,0,0,0,3,0,1,0,0,null,"R",null,"Y-CM"]
[44381,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,3,0,1,0,0,null,"X"]
[44389,null,"See CPT",null,780.70980000000009,null,302.65140000000002,null,"000",0,0,0,0,3,0,1,0,0,null,"R",null,"Y-CM"]
[44408,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,3,0,1,0,0,null,"X"]
[44603,null,"See CPT",null,2849.9178000000002,null,2849.9178000000002,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R"]
[44700,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"X"]
[44950,null,"See CPT",null,1141.0374000000002,null,1141.0374000000002,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[45005,null,"See CPT",null,601.14059999999995,null,303.84060000000005,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[45113,null,"See CPT",null,3292.3001999999997,null,3292.3001999999997,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[45160,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"X"]
[45305,null,"See CPT",null,341.89499999999998,null,128.43360000000001,null,"000",0,0,0,0,3,0,1,0,0,null,"R",null,"Y-CM"]
[45333,null,"See CPT",null,632.05980000000011,null,165.2988,null,"000",0,0,0,0,3,0,1,0,0,null,"R",null,"Y-CM"]
[45337,null,"See CPT",null,202.16399999999999,null,202.16399999999999,null,"000",0,0,0,0,3,0,1,0,0,null,"R",null,"Y-CM"]
[45380,null,"See CPT",null,820.548,null,352.59780000000001,null,"000",0,0,0,0,3,0,1,0,0,null,"R",null,"Y-CM"]
[45395,null,"See CPT",null,3455.2206000000001,null,3455.2206000000001,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[45499,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,0,2,1,1,null,"N"]
[45560,null,"See CPT",null,1230.8219999999999,null,1230.8219999999999,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[45999,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,0,0,1,1,null,"N"]
[46060,null,"See CPT",null,879.41339999999991,null,879.41339999999991,null,"090",0.09,0.81,0.1,0,2,0,1,0,0,null,"R"]
[46260,null,"See CPT",null,871.08900000000006,null,871.08900000000006,null,"090",0.09,0.81,0.1,0,2,0,1,0,0,null,"R"]
[46270,null,"See CPT",null,991.19820000000016,null,726.00660000000005,null,"090",0.09,0.81,0.1,0,2,0,1,0,0,null,"R"]
[46607,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,3,0,1,0,0,null,"X"]
[46712,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"X"]
[46742,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"X"]
[46754,null,"See CPT",null,638.60040000000004,null,432.27420000000001,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[46945,null,"See CPT",null,620.16779999999994,null,620.16779999999994,null,"090",0.09,0.81,0.1,0,2,0,1,0,0,null,"R"]
[47001,null,"See CPT",null,180.75839999999999,null,180.75839999999999,null,"000",0,0,0,0,0,0,1,1,0,null,"R"]
[47142,null,"See CPT",null,8278.6157999999996,null,8278.6157999999996,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[47145,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,0,2,1,0,null,"N",null,"Y-CM"]
[47400,null,"See CPT",null,3811.3859999999995,null,3811.3859999999995,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[47533,null,"See CPT",null,2251.1556,null,459.62580000000003,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[47539,null,"See CPT",null,8230.4531999999999,null,731.35800000000006,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[47552,null,"See CPT",null,475.68,null,475.68,null,"000",0,0,0,0,2,0,1,1,0,null,"R"]
[47610,null,"See CPT",null,2227.3715999999999,null,2227.3715999999999,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R"]
[47712,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"X"]
[47802,null,"See CPT",null,2714.3490000000002,null,2714.3490000000002,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[48000,null,"See CPT",null,3334.5167999999999,null,3334.5167999999999,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[48160,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[48548,null,"See CPT",null,2964.6756,null,2964.6756,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[48999,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,0,2,1,1,null,"N"]
[49040,null,"See CPT",null,1788.5567999999998,null,1788.5567999999998,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R"]
[49250,null,"See CPT",null,1059.5771999999999,null,1059.5771999999999,null,"090",0.09,0.81,0.1,0,2,0,1,1,0,null,"R"]
[49324,null,"See CPT",null,688.54679999999996,null,688.54679999999996,null,"010",0.1,0.8,0.1,0,3,0,2,2,0,null,"R"]
[49418,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,0,0,0,0,null,"X"]
[49422,null,"See CPT",null,388.86840000000001,null,388.86840000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[49452,null,"See CPT",null,1504.338,null,237.24540000000002,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[49501,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.81,0.1,0,2,1,2,1,0,null,"X"]
[49540,null,"See CPT",null,1207.6325999999999,null,1207.6325999999999,null,"090",0.09,0.81,0.1,0,2,1,2,1,0,null,"R"]
[49565,null,"See CPT",null,1367.58,null,1367.58,null,"090",0.09,0.81,0.1,0,2,1,2,1,0,null,"R"]
[49606,null,"See CPT",null,2015.0994000000001,null,2015.0994000000001,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[49653,null,"See CPT",null,1658.934,null,1658.934,null,"090",0.09,0.81,0.1,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[50020,null,"See CPT",null,1785.5838000000001,null,1785.5838000000001,null,"090",0.08,0.83,0.09,0,2,0,1,1,0,null,"R"]
[50060,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.08,0.83,0.09,0,2,1,2,1,0,null,"X"]
[50234,null,"See CPT",null,2286.8316,null,2286.8316,null,"090",0.08,0.83,0.09,0,2,1,2,1,0,null,"R"]
[50323,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,0,2,1,0,null,"N",null,"Y-CM"]
[50360,null,"See CPT",null,4297.1741999999995,null,4297.1741999999995,null,"090",0.08,0.83,0.09,0,2,0,2,2,2,null,"R",null,"Y-CM"]
[50386,null,"See CPT",null,1438.932,null,281.84040000000005,null,"000",0,0,0,0,2,1,0,0,0,null,"R"]
[50434,null,"See CPT",null,1750.5024000000001,null,331.19220000000001,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[50525,null,"See CPT",null,2610.8885999999998,null,2610.8885999999998,null,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[50551,null,"See CPT",null,641.57339999999999,null,511.35599999999999,null,"000",0,0,0,0,2,1,0,0,0,null,"R"]
[50557,null,"See CPT",null,743.84460000000001,null,599.95140000000004,null,"000",0,0,0,0,3,1,0,0,0,null,"R"]
[50620,null,"See CPT",null,1584.6089999999999,null,1584.6089999999999,null,"090",0.08,0.83,0.09,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[50693,null,"See CPT",null,1918.1795999999999,null,353.19240000000002,null,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[50728,null,"See CPT",null,1293.8496,null,1293.8496,null,"090",0.08,0.83,0.09,0,2,0,2,2,0,null,"R",null,"Y-CM"]
[50760,null,"See CPT",null,1998.4505999999999,null,1998.4505999999999,null,"090",0.08,0.83,0.09,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[50840,null,"See CPT",null,2159.5871999999999,null,2159.5871999999999,null,"090",0.08,0.83,0.09,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[50940,null,"See CPT",null,1560.825,null,1560.825,null,"090",0.08,0.83,0.09,0,2,1,2,1,0,null,"R"]
[50974,null,"See CPT",null,820.548,null,820.548,null,"000",0,0,0,0,3,1,0,0,0,null,"R",null,"Y-CM"]
[51020,null,"See CPT",null,833.03459999999995,null,833.03459999999995,null,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R"]
[51550,null,"See CPT",null,1693.4208000000001,null,1693.4208000000001,null,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R"]
[51595,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.08,0.83,0.09,0,2,2,2,1,0,null,"X"]
[51705,null,"See CPT",null,177.1908,null,90.379199999999997,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[51720,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,0,1,0,0,null,"X"]
[51728,26,"See CPT",null,181.35299999999998,null,181.35299999999998,null,"000",0,0,0,1,2,0,0,0,0,null,"R"]
[51736,"TC","See CPT",null,9.5136000000000003,null,9.5136000000000003,null,"000",0,0,0,1,2,0,0,0,0,null,"R"]
[51792,26,"See CPT",null,94.54140000000001,null,94.54140000000001,null,"000",0,0,0,1,2,0,0,0,0,null,"R"]
[51797,26,"See CPT",null,69.56819999999999,null,69.56819999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[51990,null,"See CPT",null,1312.2822000000001,null,1312.2822000000001,null,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[52204,null,"See CPT",null,713.52,null,246.16439999999997,null,"000",0,0,0,0,3,0,1,0,0,null,"R"]
[52275,null,"See CPT",null,1012.0092,null,431.67959999999999,null,"000",0,0,0,0,3,0,1,0,0,null,"R"]
[52281,null,"See CPT",null,609.46500000000003,null,265.19159999999999,null,"000",0,0,0,0,3,0,1,0,0,null,"R"]
[52318,null,"See CPT",null,821.14260000000002,null,821.14260000000002,null,"000",0,0,0,0,3,0,1,0,0,null,"R"]
[52334,null,"See CPT",null,317.51639999999998,null,317.51639999999998,null,"000",0,0,0,0,3,0,1,0,0,null,"R"]
[52356,null,"See CPT",null,721.24980000000005,null,721.24980000000005,null,"000",0,0,0,0,3,1,1,0,0,null,"R",null,"Y-CM"]
[52601,null,"See CPT",null,1280.1738,null,1280.1738,null,"090",0.08,0.83,0.09,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[53060,null,"See CPT",null,338.32740000000001,null,293.73240000000004,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[53235,null,"See CPT",null,1118.4425999999999,null,1118.4425999999999,null,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[53415,null,"See CPT",null,1982.9910000000002,null,1982.9910000000002,null,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[53430,null,"See CPT",null,1712.4480000000001,null,1712.4480000000001,null,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[53452,null,"See CPT",null," By Report ",null," By Report ",null,"010",0.1,0.8,0.1,0,0,0,0,0,0,null,"N"]
[53505,null,"See CPT",null,858.60239999999999,null,858.60239999999999,null,"090",0.08,0.83,0.09,0,2,0,2,0,0,null,"R"]
[53850,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.08,0.83,0.09,0,2,0,1,0,0,null,"X"]
[54015,null,"See CPT",null,536.92379999999991,null,536.92379999999991,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[54115,null,"See CPT",null,814.00739999999996,null,755.73660000000007,null,"090",0.1,0.8,0.1,0,2,0,2,0,0,null,"R"]
[54162,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"X"]
[54240,26,"See CPT",null,114.7578,null,114.7578,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[54250,26,"See CPT",null,189.67740000000001,null,189.67740000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[54318,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.8,0.1,0,2,0,2,1,0,null,"X"]
[54360,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.8,0.1,0,2,0,2,1,0,null,"X"]
[54416,null,"See CPT",null,1265.9033999999999,null,1265.9033999999999,null,"090",0.1,0.8,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[54440,null,"See CPT",null," By Report ",null," By Report ",null,"090",0.1,0.8,0.1,0,2,0,2,1,0,null,"N"]
[54620,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"X"]
[54699,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,1,2,1,1,null,"N"]
[55000,null,"See CPT",null,218.2182,null,148.65,null,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[55060,null,"See CPT",null,673.68180000000007,null,673.68180000000007,null,"090",0.1,0.8,0.1,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[55200,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.8,0.1,0,2,2,0,0,0,null,"X"]
[55600,null,"See CPT",null,747.41219999999998,null,747.41219999999998,null,"090",0.1,0.8,0.1,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[55815,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.8,0.1,0,2,2,2,1,0,null,"X"]
[55862,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.8,0.1,0,2,0,2,1,0,null,"X"]
[55980,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[56605,null,"See CPT",null,176.59620000000001,null,104.64960000000001,null,"000",0,0,0,0,2,0,1,2,0,null,"R",null,"Y-CM"]
[56640,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.12,0.74,0.14000000000000001,0,2,1,2,1,0,null,"X"]
[56800,null,"See CPT",null,453.6798,null,453.6798,null,"010",0.1,0.8,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[57020,null,"See CPT",null,232.48860000000002,null,140.32560000000001,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[57111,null,"See CPT",null,3083.0010000000002,null,3083.0010000000002,null,"090",0.12,0.74,0.14000000000000001,0,2,2,2,1,0,null,"R",null,"Y-CM"]
[57220,null,"See CPT",null,628.49220000000003,null,628.49220000000003,null,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[57268,null,"See CPT",null,913.90019999999993,null,913.90019999999993,null,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[57295,null,"See CPT",null,902.6028,null,902.6028,null,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R"]
[57320,null,"See CPT",null,1016.1714000000001,null,1016.1714000000001,null,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[57426,null,"See CPT",null,1562.0142000000001,null,1562.0142000000001,null,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[57455,null,"See CPT",null,294.327,null,192.0558,null,"000",0,0,0,0,3,0,1,0,0,null,"R",null,"Y-CM"]
[57510,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"X"]
[57556,null,"See CPT",null,1056.6042,null,1056.6042,null,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[58152,null,"See CPT",null,2205.3714000000004,null,2205.3714000000004,null,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[58263,null,"See CPT",null,1773.6917999999998,null,1773.6917999999998,null,"090",0.12,0.74,0.14000000000000001,0,2,0,2,2,0,null,"R",null,"Y-CM"]
[58321,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,0,0,0,0,null,"X"]
[58356,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"010",0.1,0.8,0.1,0,2,0,2,2,0,null,"X"]
[58546,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.12,0.74,0.14000000000000001,0,2,0,2,2,0,null,"X"]
[58552,null,"See CPT",null,1746.3402000000001,null,1746.3402000000001,null,"090",0.12,0.74,0.14000000000000001,0,2,0,2,2,0,null,"R",null,"Y-CM"]
[58561,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,3,0,0,2,0,null,"X"]
[58600,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.12,0.74,0.14000000000000001,0,2,2,2,1,0,null,"X"]
[58679,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,1,2,1,1,null,"N"]
[58770,null,"See CPT",null,1542.3924000000002,null,1542.3924000000002,null,"090",0.12,0.74,0.14000000000000001,0,2,1,2,0,0,null,"R",null,"Y-CM"]
[58951,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.12,0.74,0.14000000000000001,0,2,2,2,1,0,null,"X"]
[58970,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,0,0,0,0,null,"X"]
[59020,"TC","See CPT",null,62.433000000000007,null,62.433000000000007,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[59025,"TC","See CPT",null,36.270600000000002,null,36.270600000000002,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[59076,null,"See CPT",null,904.38660000000004,null,904.38660000000004,null,"000",0,0,0,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[59300,null,"See CPT",null,421.57139999999998,null,256.27259999999995,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[59412,null,"See CPT",null,178.97459999999998,null,178.97459999999998,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[59618,null,"See CPT",null,4713.3941999999997,null,4713.3941999999997,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[59855,null,"See CPT",null,752.16899999999998,null,752.16899999999998,null,"090",0.17,0.6,0.23,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[59898,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,1,2,1,1,null,"N"]
[60254,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.82,0.09,0,2,0,2,1,0,null,"X"]
[60271,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.82,0.09,0,2,0,2,1,0,null,"X"]
[60512,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,0,0,2,1,0,null,"X"]
[61001,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,2,1,0,0,null,"X"]
[61120,null,"See CPT",null,1330.1202000000001,null,1330.1202000000001,null,"090",0.11,0.76,0.13,0,2,0,0,0,0,null,"R"]
[61253,null,"See CPT",null,1754.07,null,1754.07,null,"090",0.11,0.76,0.13,0,2,2,2,0,0,null,"R"]
[61330,null,"See CPT",null,3151.9746,null,3151.9746,null,"090",0.11,0.76,0.13,0,2,1,2,1,0,null,"R"]
[61460,null,"See CPT",null,3694.8444,null,3694.8444,null,"090",0.11,0.76,0.13,0,2,0,2,2,0,null,"R"]
[61521,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"X"]
[61534,null,"See CPT",null,2906.9994000000002,null,2906.9994000000002,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R"]
[61537,null,"See CPT",null,4294.7957999999999,null,4294.7957999999999,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[61556,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"X"]
[61571,null,"See CPT",null,3496.248,null,3496.248,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R"]
[61586,null,"See CPT",null,4584.366,null,4584.366,null,"090",0.11,0.76,0.13,0,2,0,2,1,2,null,"R",null,"Y-CM"]
[61607,null,"See CPT",null,4738.3674000000001,null,4738.3674000000001,null,"090",0.11,0.76,0.13,0,2,0,2,1,2,null,"R",null,"Y-CM"]
[61619,null,"See CPT",null,2511.5904,null,2511.5904,null,"090",0.11,0.76,0.13,0,2,0,2,1,2,null,"R"]
[61651,null,"See CPT",null,420.38220000000001,null,420.38220000000001,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[61697,null,"See CPT",null,7355.2020000000002,null,7355.2020000000002,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[61702,null,"See CPT",null,7004.9826000000003,null,7004.9826000000003,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[61760,null,"See CPT",null,2791.0524,null,2791.0524,null,"090",0.11,0.76,0.13,0,2,0,1,2,0,null,"R",null,"Y-CM"]
[61798,null,"See CPT",null,2424.1842000000001,null,2424.1842000000001,null,"090",0.11,0.76,0.13,0,0,0,2,0,0,null,"R",null,"Y-CM"]
[61880,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.11,0.76,0.13,0,2,1,2,1,0,null,"X"]
[62140,null,"See CPT",null,1802.2326,null,1802.2326,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R"]
[62148,null,"See CPT",null,218.2182,null,218.2182,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[62201,null,"See CPT",null,2142.3438000000001,null,2142.3438000000001,null,"090",0.11,0.76,0.13,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[62252,"TC","See CPT",null,68.378999999999991,null,68.378999999999991,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[62263,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"X"]
[62287,null,"See CPT",null,1028.0634,null,1028.0634,null,"090",0.11,0.76,0.13,0,2,0,1,0,0,null,"R",null,"Y-UR"]
[62320,null,"See CPT",null,300.27299999999997,null,176.0016,null,"000",0,0,0,0,2,9,1,0,0,null,"R",null,"Y-UR"]
[62329,null,"See CPT",null,567.84300000000007,null,194.4342,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[62365,null,"See CPT",null,527.41019999999992,null,527.41019999999992,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,"Y-UR"]
[63016,null,"See CPT",null,2686.4027999999998,null,2686.4027999999998,null,"090",0.11,0.76,0.13,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[63047,null,"See CPT",null,1958.6124,null,1958.6124,null,"090",0.11,0.76,0.13,0,2,2,2,2,0,null,"R",null,"Y-UR"]
[63056,null,"See CPT",null,2632.2942000000003,null,2632.2942000000003,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[63066,null,"See CPT",null,354.97620000000001,null,354.97620000000001,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR"]
[63091,null,"See CPT",null,309.78660000000002,null,309.78660000000002,null,"000",0,0,0,0,0,0,2,2,2,null,"R",null,"Y-UR"]
[63191,null,"See CPT",null,2436.0762,null,2436.0762,null,"090",0.11,0.76,0.13,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[63268,null,"See CPT",null,2506.8335999999999,null,2506.8335999999999,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[63277,null,"See CPT",null,2751.8088000000002,null,2751.8088000000002,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[63301,null,"See CPT",null,3870.8459999999995,null,3870.8459999999995,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[63621,null,"See CPT",null,435.84180000000003,null,435.84180000000003,null,"000",0,0,0,0,0,0,2,0,0,null,"R",null,"Y-CM"]
[63685,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"010",0.1,0.8,0.1,0,2,0,2,1,0,null,"X",null,"Y-UR"]
[63702,null,"See CPT",null,2532.9960000000001,null,2532.9960000000001,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[64418,null,"See CPT",null,159.94739999999999,null,98.703599999999994,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[64435,null,"See CPT",null,148.65,null,76.108800000000002,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[64455,null,"See CPT",null,89.19,null,58.865400000000001,null,"000",0,0,0,0,2,1,0,0,0,null,"R"]
[64484,null,"See CPT",null,207.51540000000003,null,90.973799999999997,null,"000",0,0,0,0,0,1,1,0,0,null,"R",null,"Y-UR"]
[64510,null,"See CPT",null,271.73220000000003,null,136.75799999999998,null,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[64575,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.11,0.76,0.13,0,2,0,1,0,0,null,"X"]
[64590,null,"See CPT",null,485.1936,null,286.00259999999997,null,"010",0.1,0.8,0.1,0,2,0,1,1,0,null,"R",null,"Y-UR"]
[64605,null,"See CPT",null,1179.6864,null,617.7894,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[64635,null,"See CPT",null,827.68320000000006,null,339.51659999999998,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[64644,null,"See CPT",null,323.4624,null,206.92080000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[64704,null,"See CPT",null,581.51879999999994,null,581.51879999999994,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[64719,null,"See CPT",null,734.92560000000003,null,734.92560000000003,null,"090",0.11,0.76,0.13,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[64746,null,"See CPT",null,767.62860000000001,null,767.62860000000001,null,"090",0.11,0.76,0.13,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[64783,null,"See CPT",null,378.7602,null,378.7602,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[64795,null,"See CPT",null,335.3544,null,335.3544,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[64809,null,"See CPT",null,1923.5310000000002,null,1923.5310000000002,null,"090",0.11,0.76,0.13,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[64859,null,"See CPT",null,434.05799999999999,null,434.05799999999999,null,"000",0,0,0,0,0,0,2,1,0,null,"R"]
[64866,null,"See CPT",null,2237.4798000000001,null,2237.4798000000001,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R"]
[64892,null,"See CPT",null,1867.6386,null,1867.6386,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R"]
[64902,null,"See CPT",null,1205.8488,null,1205.8488,null,"000",0,0,0,0,0,0,2,1,0,null,"R"]
[65105,null,"See CPT",null,1740.9888000000001,null,1740.9888000000001,null,"090",0.1,0.7,0.2,0,2,1,2,1,0,null,"R"]
[65205,null,"See CPT",null,51.730200000000004,null,51.730200000000004,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[65270,null,"See CPT",null,526.81560000000002,null,248.5428,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R"]
[65275,null,"See CPT",null,1061.9556,null,817.57500000000005,null,"090",0.1,0.7,0.2,0,2,1,0,0,0,null,"R"]
[65750,null,"See CPT",null,2242.2366000000002,null,2242.2366000000002,null,"090",0.1,0.7,0.2,0,2,1,2,1,0,null,"R"]
[65765,null,"See CPT",null,4655.7785967264008,null,4655.7785967264008,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[65781,null,"See CPT",null,2342.7240000000002,null,2342.7240000000002,null,"090",0.1,0.7,0.2,0,2,1,2,1,0,null,"R"]
[65850,null,"See CPT",null,1496.0136,null,1496.0136,null,"090",0.1,0.7,0.2,0,2,1,1,1,0,null,"R"]
[66130,null,"See CPT",null,1274.8224,null,997.14419999999996,null,"090",0.1,0.7,0.2,0,2,1,0,0,0,null,"R"]
[66184,null,"See CPT",null,1405.0398,null,1405.0398,null,"090",0.1,0.7,0.2,0,2,1,2,0,0,null,"R"]
[66605,null,"See CPT",null,1942.5582000000002,null,1942.5582000000002,null,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R"]
[66635,null,"See CPT",null,1012.6038000000001,null,1012.6038000000001,null,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R"]
[66850,null,"See CPT",null,1392.5532000000001,null,1392.5532000000001,null,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R"]
[66982,null,"See CPT",null,1315.8498,null,1315.8498,null,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R"]
[66991,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"X"]
[67028,null,"See CPT",null,202.16399999999999,null,161.13659999999999,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[67108,null,"See CPT",null,2095.3704000000002,null,2095.3704000000002,null,"090",0.1,0.7,0.2,0,2,1,2,1,0,null,"R"]
[67220,null,"See CPT",null,946.0086,null,881.19720000000007,null,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[67255,null,"See CPT",null,1221.903,null,1221.903,null,"090",0.1,0.7,0.2,0,2,1,2,1,0,null,"R"]
[67312,null,"See CPT",null,1173.1458,null,1173.1458,null,"090",0.1,0.7,0.2,0,2,1,1,1,0,null,"R",null,"Y-CM"]
[67412,null,"See CPT",null,1815.3138000000001,null,1815.3138000000001,null,"090",0.1,0.7,0.2,0,2,1,1,1,0,null,"R"]
[67430,null,"See CPT",null,2517.5364000000004,null,2517.5364000000004,null,"090",0.1,0.7,0.2,0,2,1,2,0,0,null,"R"]
[67715,null,"See CPT",null,494.11260000000004,null,191.46120000000002,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[67805,null,"See CPT",null,364.4898,null,288.97560000000004,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[67900,null,"See CPT",null,1174.9296000000002,null,893.08920000000001,null,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R"]
[67915,null,"See CPT",null,585.68100000000004,null,353.78700000000003,null,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R"]
[67930,null,"See CPT",null,674.27639999999997,null,415.03080000000006,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[67950,null,"See CPT",null,1060.1717999999998,null,817.57500000000005,null,"090",0.1,0.7,0.2,0,2,1,1,1,0,null,"R"]
[68320,null,"See CPT",null,1353.9041999999999,null,955.5222,null,"090",0.1,0.7,0.2,0,2,1,1,1,0,null,"R"]
[68335,null,"See CPT",null,1139.8482000000001,null,1139.8482000000001,null,"090",0.1,0.7,0.2,0,2,1,1,1,0,null,"R"]
[68525,null,"See CPT",null,453.08519999999999,null,453.08519999999999,null,"000",0,0,0,0,2,1,1,1,0,null,"R",null,"Y-CM"]
[68550,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"X"]
[68815,null,"See CPT",null,695.0874,null,393.03060000000005,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[69105,null,"See CPT",null,272.32679999999999,null,111.78479999999999,null,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[69200,null,"See CPT",null,146.27160000000001,null,83.8386,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[69310,null,"See CPT",null,2070.3971999999999,null,2070.3971999999999,null,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,1,0,0,null,"R"]
[69505,null,"See CPT",null,2264.8314,null,2264.8314,null,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[69550,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,2,0,0,null,"X"]
[69636,null,"See CPT",null,2593.6451999999999,null,2593.6451999999999,null,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,0,0,0,null,"R"]
[69642,null,"See CPT",null,2442.0221999999999,null,2442.0221999999999,null,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[69676,null,"See CPT",null,1529.3111999999999,null,1529.3111999999999,null,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[69725,null,"See CPT",null,3368.4090000000001,null,3368.4090000000001,null,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,2,0,0,null,"R"]
[69805,null,"See CPT",null,1858.125,null,1858.125,null,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,2,0,0,null,"R",null,"Y-CM"]
[69950,null,"See CPT",null,3125.2176000000004,null,3125.2176000000004,null,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[70030,26,"See CPT",null,15.4596,null,15.4596,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[70110,"TC","See CPT",null,60.054600000000001,null,60.054600000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[70140,26,"See CPT",null,17.838000000000001,null,17.838000000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[70150,26,"See CPT",null,22.594799999999999,null,22.594799999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[70200,26,"See CPT",null,24.378599999999999,null,24.378599999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[70250,"TC","See CPT",null,50.540999999999997,null,50.540999999999997,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[70300,26,"See CPT",null,8.9190000000000005,null,8.9190000000000005,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[70328,null,"See CPT",null,64.811400000000006,null,64.811400000000006,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[70350,null,"See CPT",null,29.135400000000001,null,29.135400000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[70355,"TC","See CPT",null,14.865,null,14.865,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[70390,null,"See CPT",null,225.35339999999999,null,225.35339999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[70450,null,"See CPT",null,202.7586,null,202.7586,null,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-UR"]
[70470,"TC","See CPT",null,227.13720000000001,null,227.13720000000001,null,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-UR"]
[70487,26,"See CPT",null,95.13600000000001,null,95.13600000000001,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[70491,null,"See CPT",null,356.76,null,356.76,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[70496,"TC","See CPT",null,384.70619999999997,null,384.70619999999997,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[70543,"TC","See CPT",null,483.40980000000008,null,483.40980000000008,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[70545,null,"See CPT",null,442.97700000000003,null,442.97700000000003,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[70549,"TC","See CPT",null,520.86959999999999,null,520.86959999999999,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[70551,"TC","See CPT",null,253.89419999999998,null,253.89419999999998,null,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-UR"]
[70553,26,"See CPT",null,194.4342,null,194.4342,null,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-UR"]
[71045,null,"See CPT",null,47.568000000000005,null,47.568000000000005,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[71047,"TC","See CPT",null,55.297800000000002,null,55.297800000000002,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[71100,26,"See CPT",null,19.6218,null,19.6218,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[71120,26,"See CPT",null,16.648800000000001,null,16.648800000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[71250,"TC","See CPT",null,162.92040000000003,null,162.92040000000003,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[71275,26,"See CPT",null,154.596,null,154.596,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[71550,26,"See CPT",null,124.2714,null,124.2714,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[71555,null,"See CPT",null,655.84379999999999,null,655.84379999999999,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[72070,"TC","See CPT",null,43.405799999999999,null,43.405799999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[72074,26,"See CPT",null,21.4056,null,21.4056,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[72082,null,"See CPT",null,130.81200000000001,null,130.81200000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[72110,null,"See CPT",null,95.13600000000001,null,95.13600000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[72114,26,"See CPT",null,26.162400000000002,null,26.162400000000002,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[72128,null,"See CPT",null,249.13740000000001,null,249.13740000000001,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[72129,null,"See CPT",null,328.2192,null,328.2192,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[72131,"TC","See CPT",null,163.51500000000001,null,163.51500000000001,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[72146,26,"See CPT",null,126.05520000000001,null,126.05520000000001,null,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-UR"]
[72149,null,"See CPT",null,529.19400000000007,null,529.19400000000007,null,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-UR"]
[72157,"TC","See CPT",null,431.08499999999998,null,431.08499999999998,null,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-UR"]
[72190,"TC","See CPT",null,56.486999999999995,null,56.486999999999995,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[72192,null,"See CPT",null,255.08340000000001,null,255.08340000000001,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[72196,"TC","See CPT",null,381.1386,null,381.1386,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[72197,"TC","See CPT",null,476.86919999999998,null,476.86919999999998,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[72200,26,"See CPT",null,14.2704,null,14.2704,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[72270,null,"See CPT",null,309.78660000000002,null,309.78660000000002,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[72270,26,"See CPT",null,118.92,null,118.92,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[73010,26,"See CPT",null,15.4596,null,15.4596,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[73050,26,"See CPT",null,16.054200000000002,null,16.054200000000002,null,"000",0,0,0,1,0,2,0,0,0,null,"R"]
[73070,"TC","See CPT",null,39.243600000000001,null,39.243600000000001,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[73092,26,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,1,0,3,0,0,0,null,"X"]
[73100,26,"See CPT",null,14.2704,null,14.2704,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[73120,null,"See CPT",null,57.676200000000001,null,57.676200000000001,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[73202,"TC","See CPT",null,387.67919999999998,null,387.67919999999998,null,"000",0,0,0,1,4,3,0,0,0,null,"R"]
[73206,null,"See CPT",null,579.73500000000001,null,579.73500000000001,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[73221,null,"See CPT",null,393.62520000000001,null,393.62520000000001,null,"000",0,0,0,1,4,3,0,0,0,null,"R",null,"Y-UR"]
[73501,null,"See CPT",null,60.054600000000001,null,60.054600000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[73502,26,"See CPT",null,19.6218,null,19.6218,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[73525,null,"See CPT",null,252.11040000000003,null,252.11040000000003,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[73551,null,"See CPT",null,54.108600000000003,null,54.108600000000003,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[73560,"TC","See CPT",null,48.757199999999997,null,48.757199999999997,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[73580,"TC","See CPT",null,228.32640000000001,null,228.32640000000001,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[73592,"TC","See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,1,0,3,0,0,0,null,"X"]
[73620,"TC","See CPT",null,38.649000000000001,null,38.649000000000001,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[73700,"TC","See CPT",null,163.51500000000001,null,163.51500000000001,null,"000",0,0,0,1,4,3,0,0,0,null,"R"]
[73702,26,"See CPT",null,103.46040000000001,null,103.46040000000001,null,"000",0,0,0,1,4,3,0,0,0,null,"R"]
[73719,"TC","See CPT",null,377.57099999999997,null,377.57099999999997,null,"000",0,0,0,1,4,3,0,0,0,null,"R",null,"Y-UR"]
[73722,26,"See CPT",null,139.13639999999998,null,139.13639999999998,null,"000",0,0,0,1,4,3,0,0,0,null,"R",null,"Y-UR"]
[73723,26,"See CPT",null,182.54219999999998,null,182.54219999999998,null,"000",0,0,0,1,4,3,0,0,0,null,"R",null,"Y-UR"]
[74021,26,"See CPT",null,23.189400000000003,null,23.189400000000003,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[74150,26,"See CPT",null,101.67659999999999,null,101.67659999999999,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[74175,26,"See CPT",null,153.4068,null,153.4068,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[74181,26,"See CPT",null,124.2714,null,124.2714,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[74185,null,"See CPT",null,660.60059999999999,null,660.60059999999999,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[74210,26,"See CPT",null,50.540999999999997,null,50.540999999999997,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[74235,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[74240,null,"See CPT",null,234.2724,null,234.2724,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[74251,null,"See CPT",null,720.65519999999992,null,720.65519999999992,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[74262,null,"See CPT",null,931.73820000000001,null,931.73820000000001,null,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-CM"]
[74283,null,"See CPT",null,484.00440000000003,null,484.00440000000003,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[74300,"TC","See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[74330,"TC","See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[74360,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[74410,"TC","See CPT",null,225.94799999999998,null,225.94799999999998,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[74415,"TC","See CPT",null,253.89419999999998,null,253.89419999999998,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[74440,"TC","See CPT",null,153.4068,null,153.4068,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[74450,"TC","See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[74710,"TC","See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[74713,26,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[75557,26,"See CPT",null,197.40719999999999,null,197.40719999999999,null,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-CM"]
[75563,"TC","See CPT",null,592.81620000000009,null,592.81620000000009,null,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-CM"]
[75572,26,"See CPT",null,148.05540000000002,null,148.05540000000002,null,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-CM"]
[75600,null,"See CPT",null,353.19240000000002,null,353.19240000000002,null,"000",0,0,0,1,6,0,0,0,0,null,"R"]
[75635,null,"See CPT",null,793.19640000000004,null,793.19640000000004,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[75710,null,"See CPT",null,275.89439999999996,null,275.89439999999996,null,"000",0,0,0,1,6,0,0,0,0,null,"R"]
[75733,null,"See CPT",null,309.78660000000002,null,309.78660000000002,null,"000",0,0,0,1,6,2,0,0,0,null,"R"]
[75741,"TC","See CPT",null,133.19040000000001,null,133.19040000000001,null,"000",0,0,0,1,6,0,0,0,0,null,"R"]
[75774,"TC","See CPT",null,96.919799999999995,null,96.919799999999995,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[75805,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[75810,"TC","See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[75820,"TC","See CPT",null,114.7578,null,114.7578,null,"000",0,0,0,1,6,0,0,0,0,null,"R"]
[75833,26,"See CPT",null,123.6768,null,123.6768,null,"000",0,0,0,1,6,2,0,0,0,null,"R"]
[75840,"TC","See CPT",null,140.92020000000002,null,140.92020000000002,null,"000",0,0,0,1,6,0,0,0,0,null,"R"]
[75872,"TC","See CPT",null,140.92020000000002,null,140.92020000000002,null,"000",0,0,0,1,6,0,0,0,0,null,"R"]
[75885,26,"See CPT",null,114.1632,null,114.1632,null,"000",0,0,0,1,6,0,0,0,0,null,"R"]
[75893,26,"See CPT",null,44.594999999999999,null,44.594999999999999,null,"000",0,0,0,1,6,0,0,0,0,null,"R"]
[75901,"TC","See CPT",null,408.49020000000002,null,408.49020000000002,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[75957,26,"See CPT",null,496.49099999999999,null,496.49099999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[75958,26,"See CPT",null,330.00299999999999,null,330.00299999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[76010,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[76010,26,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[76102,26,"See CPT",null,51.884189999999997,null,51.884189999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[76140,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[76390,"TC","See CPT",null,602.92439999999999,null,602.92439999999999,null,"000",0,0,0,1,9,9,9,9,9,null,"R",null,"Y-CM"]
[76497,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[76506,"TC","See CPT",null,161.13659999999999,null,161.13659999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[76510,26,"See CPT",null,69.56819999999999,null,69.56819999999999,null,"000",0,0,0,1,7,3,0,0,0,null,"R"]
[76516,26,"See CPT",null,39.838200000000001,null,39.838200000000001,null,"000",0,0,0,1,7,2,0,0,0,null,"R"]
[76519,"TC","See CPT",null,68.97359999999999,null,68.97359999999999,null,"000",0,0,0,1,7,2,0,0,0,null,"R"]
[76641,"TC","See CPT",null,130.2174,null,130.2174,null,"000",0,0,0,1,0,1,0,0,0,null,"R",null,"Y-CM"]
[76700,26,"See CPT",null,68.97359999999999,null,68.97359999999999,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[76775,26,"See CPT",null,49.351799999999997,null,49.351799999999997,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[76801,"TC","See CPT",null,133.785,null,133.785,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[76810,"TC","See CPT",null,78.487200000000001,null,78.487200000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[76811,"TC","See CPT",null,156.9744,null,156.9744,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[76817,null,"See CPT",null,172.434,null,172.434,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[76817,26,"See CPT",null,64.811400000000006,null,64.811400000000006,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[76821,26,"See CPT",null,60.054600000000001,null,60.054600000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[76827,null,"See CPT",null,130.81200000000001,null,130.81200000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[76856,null,"See CPT",null,198.0018,null,198.0018,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[76870,26,"See CPT",null,54.703200000000002,null,54.703200000000002,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[76882,null,"See CPT",null,103.46040000000001,null,103.46040000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[76885,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[76940,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[76941,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[76965,26,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[76975,"TC","See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[76981,"TC","See CPT",null,143.29860000000002,null,143.29860000000002,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[76998,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[77002,"TC","See CPT",null,168.8664,null,168.8664,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[77003,"TC","See CPT",null,145.08240000000001,null,145.08240000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[77021,26,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,1,0,0,9,0,0,null,"X"]
[77022,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[77053,26,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,1,0,0,9,0,0,null,"X"]
[77054,26,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,1,0,0,9,0,0,null,"X"]
[77065,26,"See CPT",null,68.97359999999999,null,68.97359999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[77072,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[77075,"TC","See CPT",null,137.3526,null,137.3526,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[77076,"TC","See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[77084,26,"See CPT",null,136.1634,null,136.1634,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[77085,"TC","See CPT",null,67.784399999999991,null,67.784399999999991,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[77285,"TC","See CPT",null,723.03359999999998,null,723.03359999999998,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[77290,"TC","See CPT",null,701.03339999999992,null,701.03339999999992,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[77300,"TC","See CPT",null,60.054600000000001,null,60.054600000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[77307,null,"See CPT",null,513.13980000000004,null,513.13980000000004,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[77318,"TC","See CPT",null,558.32940000000008,null,558.32940000000008,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[77331,"TC","See CPT",null,34.486799999999995,null,34.486799999999995,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[77338,"TC","See CPT",null,432.27420000000001,null,432.27420000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[77370,null,"See CPT",null,242.00220000000002,null,242.00220000000002,null,"000",0,0,0,3,0,0,0,0,0,null,"R",null,"Y-CM"]
[77424,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[77431,null,"See CPT",null,189.67740000000001,null,189.67740000000001,null,"000",0,0,0,2,0,0,0,0,0,null,"R",null,"Y-CM"]
[77523,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,3,0,0,0,0,0,null,"N",null,"Y-CM"]
[77610,null,"See CPT",null,1294.4441999999999,null,1294.4441999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[77750,26,"See CPT",null,466.16640000000001,null,466.16640000000001,null,"090",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[77762,"TC","See CPT",null,444.76080000000002,null,444.76080000000002,null,"090",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[77770,26,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[77771,"TC","See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[77799,"TC","See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM"]
[78012,26,"See CPT",null,15.4596,null,15.4596,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78016,26,"See CPT",null,58.270800000000001,null,58.270800000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78070,"TC","See CPT",null,451.89599999999996,null,451.89599999999996,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78075,26,"See CPT",null,63.622200000000007,null,63.622200000000007,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78103,null,"See CPT",null,335.3544,null,335.3544,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78120,null,"See CPT",null,132.00120000000001,null,132.00120000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78120,26,"See CPT",null,16.648800000000001,null,16.648800000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78191,null,"See CPT",null,230.70480000000001,null,230.70480000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78195,null,"See CPT",null,625.51919999999996,null,625.51919999999996,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78201,"TC","See CPT",null,302.05680000000001,null,302.05680000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78226,26,"See CPT",null,61.8384,null,61.8384,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78232,null,"See CPT",null,190.86660000000001,null,190.86660000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78261,"TC","See CPT",null,313.94880000000001,null,313.94880000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78266,"TC","See CPT",null,690.92520000000002,null,690.92520000000002,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[78267,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[78299,"TC","See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM"]
[78300,26,"See CPT",null,52.919400000000003,null,52.919400000000003,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[78315,null,"See CPT",null,611.84339999999997,null,611.84339999999997,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[78428,null,"See CPT",null,332.976,null,332.976,null,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM"]
[78431,"TC","See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-UR"]
[78433,26,"See CPT",null,183.13679999999999,null,183.13679999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-UR"]
[78452,26,"See CPT",null,136.1634,null,136.1634,null,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-UR"]
[78453,"TC","See CPT",null,438.81479999999999,null,438.81479999999999,null,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-UR"]
[78459,26,"See CPT",null,129.62280000000001,null,129.62280000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-UR"]
[78466,26,"See CPT",null,60.6492,null,60.6492,null,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM"]
[78472,null,"See CPT",null,403.73340000000002,null,403.73340000000002,null,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM"]
[78491,"TC","See CPT",null,3085.8673697280005,null,3085.8673697280005,null,"000",0,0,0,1,0,0,0,0,0,null,"F",null,"Y-UR"]
[78496,"TC","See CPT",null,35.081400000000002,null,35.081400000000002,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-UR"]
[78580,null,"See CPT",null,418.00380000000001,null,418.00380000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78599,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM"]
[78599,"TC","See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM"]
[78609,"TC","See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,9,9,9,9,9,null,"N",null,"Y-CM"]
[78610,null,"See CPT",null,310.38119999999998,null,310.38119999999998,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[78635,"TC","See CPT",null,545.2482,null,545.2482,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[78699,"TC","See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM"]
[78708,null,"See CPT",null,321.084,null,321.084,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[78725,"TC","See CPT",null,176.0016,null,176.0016,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[78799,26,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM"]
[78800,null,"See CPT",null,449.51759999999996,null,449.51759999999996,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78811,26,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[78812,26,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[78814,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[78831,26,"See CPT",null,149.24459999999999,null,149.24459999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78835,"TC","See CPT",null,138.54179999999999,null,138.54179999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[79200,26,"See CPT",null,142.10940000000002,null,142.10940000000002,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[79445,"TC","See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM"]
[79999,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM"]
[80150,null,"See CPT",null,21.564399999999999,null,21.564399999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[80156,null,"See CPT",null,20.835100000000001,null,20.835100000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[80164,null,"See CPT",null,19.362199999999998,null,19.362199999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[80180,null,"See CPT",null,25.811499999999999,null,25.811499999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[80186,null,"See CPT",null,19.6768,null,19.6768,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[80200,null,"See CPT",null,23.065899999999999,null,23.065899999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[80305,null,"See CPT",null,18.017999999999997,null,18.017999999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[80307,null,"See CPT",null,88.860199999999992,null,88.860199999999992,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[80335,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[80342,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[80345,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[80357,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[80368,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[80375,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[80417,null,"See CPT",null,62.905700000000003,null,62.905700000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[80430,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[80438,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81020,null,"See CPT",null,6.7210000000000001,null,6.7210000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[81099,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[81162,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81174,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81181,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81193,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81205,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81210,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81226,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81229,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81241,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81252,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81259,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81266,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81278,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81286,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81299,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81302,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81314,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81325,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81332,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81339,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81351,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81360,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81378,null,"See CPT",null,494.1651,null,494.1651,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[81381,null,"See CPT",null,242.95699999999999,null,242.95699999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[81410,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81425,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81434,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81442,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81493,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81507,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81523,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81529,null,"See CPT",null,10285.99,null,10285.99,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-ONC"]
[82009,null,"See CPT",null,6.4635999999999987,null,6.4635999999999987,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[82040,null,"See CPT",null,7.0785,null,7.0785,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[82085,null,"See CPT",null,13.885300000000001,null,13.885300000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[82108,null,"See CPT",null,36.436399999999999,null,36.436399999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[82157,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[82175,null,"See CPT",null,27.127099999999999,null,27.127099999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[82274,null,"See CPT",null,22.765599999999999,null,22.765599999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[82306,null,"See CPT",null,42.328000000000003,null,42.328000000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[82380,null,"See CPT",null,13.1846,null,13.1846,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[82415,null,"See CPT",null,18.118099999999998,null,18.118099999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[82482,null,"See CPT",null,14.0283,null,14.0283,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[82530,null,"See CPT",null,23.895299999999999,null,23.895299999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[82595,null,"See CPT",null,9.2520999999999987,null,9.2520999999999987,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[82615,null,"See CPT",null,13.656500000000001,null,13.656500000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[82668,null,"See CPT",null,26.869699999999998,null,26.869699999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[82672,null,"See CPT",null,31.030999999999999,null,31.030999999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[82757,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[82785,null,"See CPT",null,23.537800000000001,null,23.537800000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[82930,null,"See CPT",null,9.5952999999999999,null,9.5952999999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[82948,null,"See CPT",null,7.2071999999999994,null,7.2071999999999994,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[82985,null,"See CPT",null,23.966800000000003,null,23.966800000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[83009,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[83036,null,"See CPT",null,13.885300000000001,null,13.885300000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[83050,null,"See CPT",null,11.725999999999999,null,11.725999999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[83516,null,"See CPT",null,16.4879,null,16.4879,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[83528,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[83593,null,"See CPT",null,40.754999999999995,null,40.754999999999995,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[83633,null,"See CPT",null,16.087499999999999,null,16.087499999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[83704,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[83727,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[83876,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[83885,null,"See CPT",null,35.049300000000002,null,35.049300000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[84030,null,"See CPT",null,7.8649999999999993,null,7.8649999999999993,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[84081,null,"See CPT",null,23.6236,null,23.6236,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[84132,null,"See CPT",null,6.8067999999999991,null,6.8067999999999991,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[84135,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[84156,null,"See CPT",null,5.2481,null,5.2481,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[84165,null,"See CPT",null,15.3582,null,15.3582,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[84228,null,"See CPT",null,16.6309,null,16.6309,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[84235,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[84375,null,"See CPT",null,55.769999999999996,null,55.769999999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[84403,null,"See CPT",null,36.908299999999997,null,36.908299999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[84445,null,"See CPT",null,72.729799999999997,null,72.729799999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[84450,null,"See CPT",null,7.4073999999999991,null,7.4073999999999991,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[84510,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[84545,null,"See CPT",null,10.295999999999999,null,10.295999999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[84600,null,"See CPT",null,24.467299999999998,null,24.467299999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[84830,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[85032,null,"See CPT",null,6.1632999999999996,null,6.1632999999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[85055,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[85245,null,"See CPT",null,32.804200000000002,null,32.804200000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[85250,null,"See CPT",null,27.227199999999996,null,27.227199999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[85305,null,"See CPT",null,16.6023,null,16.6023,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[85345,null,"See CPT",null,6.7067000000000005,null,6.7067000000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[85390,null,"See CPT",null,22.136399999999998,null,22.136399999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[85421,null,"See CPT",null,14.557399999999999,null,14.557399999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[85549,null,"See CPT",null,26.8125,null,26.8125,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[85610,null,"See CPT",null,6.1346999999999996,null,6.1346999999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[85730,null,"See CPT",null,8.5942999999999987,null,8.5942999999999987,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[85999,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[86038,null,"See CPT",null,17.288699999999999,null,17.288699999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86060,null,"See CPT",null,10.439,null,10.439,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[86156,null,"See CPT",null,11.540100000000001,null,11.540100000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86215,null,"See CPT",null,18.947499999999998,null,18.947499999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86294,null,"See CPT",null,36.565100000000001,null,36.565100000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[86310,null,"See CPT",null,10.539099999999999,null,10.539099999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86329,null,"See CPT",null,20.0915,null,20.0915,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86334,26,"See CPT",null,32.108400000000003,null,32.108400000000003,null,"000",0,0,0,6,0,0,0,0,0,null,"R"]
[86341,null,"See CPT",null,33.705100000000002,null,33.705100000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86361,null,"See CPT",null,38.295400000000001,null,38.295400000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86409,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[86486,null,"See CPT",null,11.2974,null,11.2974,null,"000",0,0,0,3,0,0,0,0,0,null,"R"]
[86611,null,"See CPT",null,14.557399999999999,null,14.557399999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86625,null,"See CPT",null,18.761599999999998,null,18.761599999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86652,null,"See CPT",null,18.861699999999999,null,18.861699999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86658,null,"See CPT",null,18.632899999999999,null,18.632899999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86674,null,"See CPT",null,21.049600000000002,null,21.049600000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86696,null,"See CPT",null,27.670500000000001,null,27.670500000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86713,null,"See CPT",null,21.879000000000001,null,21.879000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86738,null,"See CPT",null,18.933199999999999,null,18.933199999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86769,null,"See CPT",null,60.245899999999999,null,60.245899999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[86787,null,"See CPT",null,18.418400000000002,null,18.418400000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86807,null,"See CPT",null,112.4695,null,112.4695,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86813,null,"See CPT",null,82.94,null,82.94,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86829,null,"See CPT",null,91.791699999999992,null,91.791699999999992,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86870,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[86911,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[86931,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[86976,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[87040,null,"See CPT",null,14.7576,null,14.7576,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87086,null,"See CPT",null,11.540100000000001,null,11.540100000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87102,null,"See CPT",null,12.026299999999999,null,12.026299999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87118,null,"See CPT",null,20.892299999999999,null,20.892299999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87164,26,"See CPT",null,33.892199999999995,null,33.892199999999995,null,"000",0,0,0,6,0,0,0,0,0,null,"R"]
[87188,null,"See CPT",null,9.4951999999999988,null,9.4951999999999988,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87209,null,"See CPT",null,25.711400000000001,null,25.711400000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87269,null,"See CPT",null,19.462299999999999,null,19.462299999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87276,null,"See CPT",null,22.9801,null,22.9801,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87305,null,"See CPT",null,17.131399999999999,null,17.131399999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87327,null,"See CPT",null,19.1906,null,19.1906,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87338,null,"See CPT",null,20.563400000000001,null,20.563400000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87400,null,"See CPT",null,20.2059,null,20.2059,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87451,null,"See CPT",null,15.029299999999999,null,15.029299999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87490,null,"See CPT",null,32.532499999999999,null,32.532499999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[87505,null,"See CPT",null,183.45469999999997,null,183.45469999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87517,null,"See CPT",null,61.261200000000002,null,61.261200000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87532,null,"See CPT",null,50.178699999999999,null,50.178699999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87535,null,"See CPT",null,50.178699999999999,null,50.178699999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87542,null,"See CPT",null,59.716799999999992,null,59.716799999999992,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87563,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[87624,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[87651,null,"See CPT",null,50.178699999999999,null,50.178699999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87803,null,"See CPT",null,22.88,null,22.88,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87811,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[87910,null,"See CPT",null,368.15349999999995,null,368.15349999999995,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[88000,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[88025,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[88104,"TC","See CPT",null,74.325000000000003,null,74.325000000000003,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[88112,null,"See CPT",null,120.70379999999999,null,120.70379999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[88130,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[88160,"TC","See CPT",null,85.622399999999999,null,85.622399999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[88162,26,"See CPT",null,68.97359999999999,null,68.97359999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[88174,null,"See CPT",null,36.2791,null,36.2791,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[88182,26,"See CPT",null,67.189799999999991,null,67.189799999999991,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[88187,null,"See CPT",null,63.027600000000007,null,63.027600000000007,null,"000",0,0,0,2,0,0,0,0,0,null,"R",null,"Y-CM"]
[88239,null,"See CPT",null,210.95359999999999,null,210.95359999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[88263,null,"See CPT",null,214.91469999999998,null,214.91469999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[88289,null,"See CPT",null,49.234899999999996,null,49.234899999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[88305,null,"See CPT",null,128.43360000000001,null,128.43360000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[88309,"TC","See CPT",null,539.30219999999997,null,539.30219999999997,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[88313,26,"See CPT",null,21.4056,null,21.4056,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[88323,null,"See CPT",null,201.5694,null,201.5694,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[88325,null,"See CPT",null,278.86740000000003,null,236.6508,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[88334,26,"See CPT",null,65.406000000000006,null,65.406000000000006,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[88344,null,"See CPT",null,312.16500000000002,null,312.16500000000002,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[88350,"TC","See CPT",null,165.2988,null,165.2988,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[88360,"TC","See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[88362,26,"See CPT",null,195.6234,null,195.6234,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[88366,26,"See CPT",null,108.81180000000001,null,108.81180000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[88369,"TC","See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[88371,null,"See CPT",null,31.788899999999998,null,31.788899999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[88377,26,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[88387,26,"See CPT",null,46.378800000000005,null,46.378800000000005,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[88740,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[89060,26,"See CPT",null,32.108400000000003,null,32.108400000000003,null,"000",0,0,0,6,0,0,0,0,0,null,"R"]
[89255,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[89281,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[89325,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[89331,null,"See CPT",null,28.0137,null,28.0137,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[90281,null,"See CPT",null,"By report",null,"By report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[90375,null,"See CPT",null,321.80200000000002,null,321.80200000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
[90399,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[90476,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[90644,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[90657,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[90668,null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[90672,null,"See CPT",null,26.88,null,26.88,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
[90698,null,"See CPT",null,"By report",null,"By report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[90710,null,"See CPT",null,"By report",null,"By report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[90736,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[90747,null,"See CPT",null,140.75200000000001,null,140.75200000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
[90837,null,"See CPT",null,263.40780000000001,null,230.70480000000001,null,"000",0,0,0,0,0,0,9,0,0,null,"R",null,"Y-CM"]
[90865,null,"See CPT",null,296.7054,null,220.00200000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[90882,null,"See CPT",null,82.955401214399998,null,82.955401214399998,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[90889,null,"See CPT",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
[90957,null,"See CPT",null,1376.499,null,1376.499,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[90961,null,"See CPT",null,523.84260000000006,null,523.84260000000006,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[90989,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[91013,null,"See CPT",null,48.162600000000005,null,48.162600000000005,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[91034,null,"See CPT",null,362.1114,null,362.1114,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[91038,"TC","See CPT",null,696.87120000000004,null,696.87120000000004,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[91110,null,"See CPT",null,1459.1484,null,1459.1484,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[91111,null,"See CPT",null,1762.989,null,1762.989,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[91132,26,"See CPT",null,46.378800000000005,null,46.378800000000005,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[91200,null,"See CPT",null,56.486999999999995,null,56.486999999999995,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[91304,null,"See CPT",null,1.03E-2,null,1.03E-2,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[92014,null,"See CPT",null,228.32640000000001,null,135.56879999999998,null,"000",0,0,0,0,0,2,0,0,0,null,"R"]
[92065,"TC","See CPT",null,65.406000000000006,null,65.406000000000006,null,"000",0,0,0,1,0,2,0,0,0,null,"R",null,"Y-CM"]
[92083,null,"See CPT",null,114.1632,null,114.1632,null,"000",0,0,0,1,7,2,0,0,0,null,"R"]
[92133,26,"See CPT",null,38.054400000000001,null,38.054400000000001,null,"000",0,0,0,1,7,2,0,0,0,null,"R"]
[92134,26,"See CPT",null,44.594999999999999,null,44.594999999999999,null,"000",0,0,0,1,7,2,0,0,0,null,"R"]
[92235,null,"See CPT",null,229.51560000000001,null,229.51560000000001,null,"000",0,0,0,1,7,2,0,0,0,null,"R"]
[92240,"TC","See CPT",null,272.92140000000001,null,272.92140000000001,null,"000",0,0,0,1,7,2,0,0,0,null,"R",null,"Y-CM"]
[92265,26,"See CPT",null,80.271000000000001,null,80.271000000000001,null,"000",0,0,0,1,7,2,0,0,0,null,"R"]
[92283,null,"See CPT",null,99.298199999999994,null,99.298199999999994,null,"000",0,0,0,1,7,2,0,0,0,null,"R",null,"Y-CM"]
[92287,null,"See CPT",null,331.78680000000003,null,331.78680000000003,null,"000",0,0,0,1,0,2,0,0,0,null,"R",null,"Y-CM"]
[92326,null,"See CPT",null,73.135800000000003,null,73.135800000000003,null,"000",0,0,0,5,0,0,0,0,0,null,"R",null,"Y-CM"]
[92358,null,"See CPT",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
[92499,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[92523,null,"See CPT",null,407.8956,null,407.8956,null,"000",0,0,0,7,5,0,0,0,0,null,"R"]
[92532,null,"See CPT",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
[92541,"TC","See CPT",null,8.9190000000000005,null,8.9190000000000005,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[92542,"TC","See CPT",null,8.3244000000000007,null,8.3244000000000007,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[92548,26,"See CPT",null,60.6492,null,60.6492,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[92556,null,"See CPT",null,74.325000000000003,null,74.325000000000003,null,"000",0,0,0,3,0,2,0,0,0,null,"R"]
[92570,null,"See CPT",null,58.865400000000001,null,52.324800000000003,null,"000",0,0,0,7,0,2,0,0,0,null,"R"]
[92575,null,"See CPT",null,129.62280000000001,null,129.62280000000001,null,"000",0,0,0,3,0,2,0,0,0,null,"R"]
[92593,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[92597,null,"See CPT",null,129.62280000000001,null,129.62280000000001,null,"000",0,0,0,7,5,0,0,0,0,null,"R"]
[92614,null,"See CPT",null,266.97540000000004,null,117.1362,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[92617,null,"See CPT",null,"Bundled",null,"Bundled",null,"000",0,0,0,0,0,0,0,0,0,null,"Bundled",null,"Y-CM"]
[92652,null,"See CPT",null,209.29920000000001,null,209.29920000000001,null,"000",0,0,0,0,0,2,0,0,0,null,"R",null,"Y-CM"]
[92934,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[92960,null,"See CPT",null,281.84040000000005,null,190.86660000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[92971,null,"See CPT",null,173.6232,null,173.6232,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[93000,null,"See CPT",null,25.567799999999998,null,25.567799999999998,null,"000",0,0,0,4,6,0,0,0,0,null,"R"]
[93016,null,"See CPT",null,38.054400000000001,null,38.054400000000001,null,"000",0,0,0,2,0,0,0,0,0,null,"R"]
[93225,null,"See CPT",null,35.676000000000002,null,35.676000000000002,null,"000",0,0,0,3,6,0,0,0,0,null,"R"]
[93228,null,"See CPT",null,45.189599999999999,null,45.189599999999999,null,"000",0,0,0,2,0,0,0,0,0,null,"R"]
[93260,"TC","See CPT",null,66.595200000000006,null,66.595200000000006,null,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM"]
[93278,"TC","See CPT",null,30.9192,null,30.9192,null,"000",0,0,0,1,6,0,0,0,0,null,"R"]
[93281,null,"See CPT",null,158.75819999999999,null,158.75819999999999,null,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM"]
[93283,26,"See CPT",null,99.892799999999994,null,99.892799999999994,null,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM"]
[93287,"TC","See CPT",null,61.2438,null,61.2438,null,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM"]
[93288,26,"See CPT",null,36.865200000000002,null,36.865200000000002,null,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM"]
[93293,"TC","See CPT",null,61.2438,null,61.2438,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[93295,null,"See CPT",null,66.000600000000006,null,66.000600000000006,null,"000",0,0,0,2,0,0,0,0,0,null,"R",null,"Y-CM"]
[93306,26,"See CPT",null,122.4876,null,122.4876,null,"000",0,0,0,1,6,0,0,0,0,null,"R"]
[93313,null,"See CPT",null,19.6218,null,19.6218,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[93317,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[93320,null,"See CPT",null,95.13600000000001,null,95.13600000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[93351,null,"See CPT",null,432.27420000000001,null,432.27420000000001,null,"000",0,0,0,1,6,0,9,9,9,null,"R"]
[93355,null,"See CPT",null,398.38200000000001,null,398.38200000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[93455,null,"See CPT",null,1930.0716,null,1930.0716,null,"000",0,0,0,1,2,0,0,0,0,null,"R",null,"Y-CM"]
[93456,null,"See CPT",null,2157.2087999999999,null,2157.2087999999999,null,"000",0,0,0,1,2,0,0,0,0,null,"R",null,"Y-CM"]
[93460,null,"See CPT",null,2374.8323999999998,null,2374.8323999999998,null,"000",0,0,0,1,2,0,0,0,0,null,"R",null,"Y-CM"]
[93464,26,"See CPT",null,156.37979999999999,null,156.37979999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[93562,26,"See CPT",null,65.00433000000001,null,65.00433000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[93567,null,"See CPT",null,200.97479999999999,null,90.379199999999997,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[93590,null,"See CPT",null,1884.8820000000001,null,1884.8820000000001,null,"000",0,0,0,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[93593,"TC","See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[93598,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[93600,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM"]
[93603,"TC","See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM"]
[93616,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM"]
[93619,26,"See CPT",null,677.84400000000005,null,677.84400000000005,null,"000",0,0,0,1,2,0,0,0,0,null,"R",null,"Y-CM"]
[93622,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM"]
[93640,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,2,0,0,0,0,null,"N",null,"Y-CM"]
[93641,"TC","See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM"]
[93660,null,"See CPT",null,287.78640000000001,null,287.78640000000001,null,"000",0,0,0,1,2,0,0,0,0,null,"R",null,"Y-CM"]
[93662,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[93724,26,"See CPT",null,424.5444,null,424.5444,null,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM"]
[93798,null,"See CPT",null,46.973400000000005,null,23.784000000000002,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[93882,"TC","See CPT",null,191.46120000000002,null,191.46120000000002,null,"000",0,0,0,1,6,0,0,0,0,null,"R"]
[93888,26,"See CPT",null,44.594999999999999,null,44.594999999999999,null,"000",0,0,0,1,6,0,0,0,0,null,"R"]
[93895,"TC","See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,6,0,0,0,0,null,"N"]
[93923,null,"See CPT",null,239.02919999999997,null,239.02919999999997,null,"000",0,0,0,1,6,2,0,0,0,null,"R"]
[93930,26,"See CPT",null,67.784399999999991,null,67.784399999999991,null,"000",0,0,0,1,6,2,0,0,0,null,"R"]
[93931,26,"See CPT",null,41.622,null,41.622,null,"000",0,0,0,1,6,0,0,0,0,null,"R"]
[93975,null,"See CPT",null,498.27480000000003,null,498.27480000000003,null,"000",0,0,0,1,6,0,0,0,0,null,"R"]
[93981,null,"See CPT",null,128.43360000000001,null,128.43360000000001,null,"000",0,0,0,1,6,0,0,0,0,null,"R"]
[93986,26,"See CPT",null,42.2166,null,42.2166,null,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM"]
[94004,null,"See CPT",null,84.433199999999999,null,84.433199999999999,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[94060,"TC","See CPT",null,53.514000000000003,null,53.514000000000003,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[94070,26,"See CPT",null,49.351799999999997,null,49.351799999999997,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[94452,"TC","See CPT",null,64.811400000000006,null,64.811400000000006,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[94453,"TC","See CPT",null,89.19,null,89.19,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[94621,"TC","See CPT",null,160.542,null,160.542,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[94680,"TC","See CPT",null,74.325000000000003,null,74.325000000000003,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[94726,null,"See CPT",null,99.892799999999994,null,99.892799999999994,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[94728,"TC","See CPT",null,50.540999999999997,null,50.540999999999997,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[94775,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,3,0,0,0,0,0,null,"X"]
[94781,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,1,0,0,null,"X"]
[95060,null,"See CPT",null,67.784399999999991,null,67.784399999999991,null,"000",0,0,0,3,0,0,0,0,0,null,"R"]
[95076,null,"See CPT",null,215.24520000000001,null,130.81200000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[95131,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[95250,null,"See CPT",null,275.2998,null,275.2998,null,"000",0,0,0,3,0,0,0,0,0,null,"R",null,"Y-CM"]
[95705,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,0,0,0,0,0,null,"N",null,"Y-CM"]
[95717,null,"See CPT",null,179.5692,null,177.78540000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[95782,26,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[95800,null,"See CPT",null,294.92160000000001,null,294.92160000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[95806,26,"See CPT",null,78.487200000000001,null,78.487200000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[95807,26,"See CPT",null,105.83880000000001,null,105.83880000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[95811,null,"See CPT",null,1169.5782000000002,null,1169.5782000000002,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[95822,null,"See CPT",null,772.98,null,772.98,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[95824,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[95860,"TC","See CPT",null,119.51459999999999,null,119.51459999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[95865,26,"See CPT",null,146.86620000000002,null,146.86620000000002,null,"000",0,0,0,1,0,2,0,0,0,null,"R"]
[95866,26,"See CPT",null,114.1632,null,114.1632,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[95872,26,"See CPT",null,269.35380000000004,null,269.35380000000004,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[95874,26,"See CPT",null,34.486799999999995,null,34.486799999999995,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[95875,26,"See CPT",null,103.46040000000001,null,103.46040000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[95907,"TC","See CPT",null,73.730400000000003,null,73.730400000000003,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[95908,"TC","See CPT",null,90.973799999999997,null,90.973799999999997,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[95912,"TC","See CPT",null,178.97459999999998,null,178.97459999999998,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[95923,26,"See CPT",null,79.081800000000001,null,79.081800000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[95925,null,"See CPT",null,342.4896,null,342.4896,null,"000",0,0,0,1,0,2,0,0,0,null,"R"]
[95929,26,"See CPT",null,140.92020000000002,null,140.92020000000002,null,"000",0,0,0,1,0,2,0,0,0,null,"R"]
[95937,null,"See CPT",null,198.0018,null,198.0018,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[95938,null,"See CPT",null,674.87099999999998,null,674.87099999999998,null,"000",0,0,0,1,0,2,0,0,0,null,"R"]
[95957,"TC","See CPT",null,297.89459999999997,null,297.89459999999997,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[95958,"TC","See CPT",null,753.95280000000002,null,753.95280000000002,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[95966,"TC","See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM"]
[95981,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[95999,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,0,0,0,0,0,null,"N"]
[96020,"TC","See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[96130,null,"See CPT",null,211.67760000000001,null,189.67740000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[96133,null,"See CPT",null,180.16379999999998,null,137.94719999999998,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[96165,null,"See CPT",null,7.7298,null,7.1352000000000002,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[96371,null,"See CPT",null,108.81180000000001,null,108.81180000000001,null,"000",0,0,0,5,0,0,0,0,0,null,"R"]
[96376,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[96409,null,"See CPT",null,194.4342,null,194.4342,null,"000",0,0,0,5,0,0,0,0,0,null,"R"]
[96450,null,"See CPT",null,309.78660000000002,null,134.9742,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[96570,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,1,0,0,null,"X"]
[96921,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,0,1,0,0,null,"X"]
[96932,null,"See CPT",null,240.2184,null,240.2184,null,"000",0,0,0,3,0,0,0,0,0,null,"R"]
[97024,null,"See CPT",null,13.081200000000001,null,13.081200000000001,null,"000",0,0,0,7,5,0,0,0,0,null,"R"]
[97124,null,"See CPT",null,54.108600000000003,null,54.108600000000003,null,"000",0,0,0,7,5,0,0,0,0,null,"R",null,"Y-CM"]
[97150,null,"See CPT",null,31.513800000000003,null,31.513800000000003,null,"000",0,0,0,7,5,0,0,0,0,null,"R"]
[97157,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[97171,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[97545,null,"See CPT",null,162.43855261919998,null,162.43855261919998,null,"000",0,0,0,7,0,0,0,0,0,null,"F",null,"Y-CM"]
[97755,null,"See CPT",null,68.378999999999991,null,68.378999999999991,null,"000",0,0,0,7,5,0,0,0,0,null,"R"]
[97763,null,"See CPT",null,98.703599999999994,null,98.703599999999994,null,"000",0,0,0,7,5,0,0,0,0,null,"R"]
[98928,null,"See CPT",null,127.839,null,103.46040000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[98971,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[98980,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[99027,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[99080,null,"See CPT",null,51.11021916,null,51.11021916,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[99151,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[99177,null,"See CPT",null,8.9190000000000005,null,8.9190000000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"R"]
[99188,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[99218,null,"See CPT",null,170.0556,null,170.0556,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[99231,null,"See CPT",null,67.189799999999991,null,67.189799999999991,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[99236,null,"See CPT",null,368.65200000000004,null,368.65200000000004,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[99245,null,"See CPT",null,386.49,null,328.2192,null,"000",0,0,0,9,9,9,9,9,9,null,"R"]
[99291,null,"See CPT",null,494.7072,null,379.35480000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[99309,null,"See CPT",null,158.75819999999999,null,158.75819999999999,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[99335,null,"See CPT",null,166.488,null,166.488,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[99339,null,"See CPT",null,134.37959999999998,null,134.37959999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"R"]
[99359,null,"See CPT",null,"Bundled",null,"Bundled",null,"000",0,0,0,0,0,0,0,0,0,null,"Bundled"]
[99379,null,"See CPT",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
[99384,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[99394,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[99411,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[99423,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[99446,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[99449,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[99466,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[99476,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[99483,null,"See CPT",null,500.05860000000001,null,344.27339999999998,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-ONC"]
[99491,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[99503,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[99511,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0003A",null,"See CPT",null,41.2,null,41.2,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["0006U",null,"See CPT",null,370.85847169919998,null,370.85847169919998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["0015F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["0021A",null,"See CPT",null,41.2,null,41.2,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["0031A",null,"See CPT",null,41.2,null,41.2,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["0071A",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["0083U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0091U",null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["0099U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0101T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["0111U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0120U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0129U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0132U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0144U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0151U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0160U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0163T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["0207U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0212U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0217T",null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,0,1,0,0,0,null,"N",null,"Y-UR"]
["0218U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0226U",null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["0232U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0238U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0241U",null,"See CPT",null,203.96089999999998,null,203.96089999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
["0285U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0294U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0302R",null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["0303U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0330T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0342T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0362T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0385R",null,"Pre-job accommodation",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["0401A",null,"Claimant - private transportation, per mile",null,"State Rate",null,"State Rate",null,"000",0,0,0,9,9,9,9,9,9,null,"S"]
["0408A",null,"Claimant - lunch",null,"State Rate",null," State Rate",null,"000",0,0,0,9,9,9,9,9,9,null,"S"]
["0413A",null,"Claimant - miscellaneous travel (must specify)",null,"State Rate",null," State Rate",null,"000",0,0,0,9,9,9,9,9,9,null,"S"]
["0414T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["0425T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["0431T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["0441T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["0448T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,0,1,0,0,null,"X"]
["0478T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0488T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0497T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,3,9,9,9,9,9,null,"X"]
["0500F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["0503T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,3,0,0,0,0,0,null,"X"]
["0514T",null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,0,0,1,0,0,null,"N",null,"Y-CM"]
["0520T",null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,2,0,1,0,0,null,"N",null,"Y-CM"]
["0525T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,0,1,0,0,null,"X"]
["0534T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,9,9,9,9,9,null,"X"]
["0541T",null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,3,9,9,9,9,9,null,"N",null,"Y-CM"]
["0551F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["0554T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["0558T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["0568T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["0578T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["0582T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["0592T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["0627T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,2,0,0,0,null,"X"]
["0636T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,3,0,0,0,null,"X"]
["0639T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["0677T",null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,2,0,1,0,0,null,"N"]
["0689T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,4,0,0,0,0,null,"X"]
["0700T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
["0707T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,1,1,0,0,null,"X"]
["0809V",null,"Stand alone job analysis ref intern",null,8.6860330127999994,null,8.6860330127999994,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["0831V",null,"Plan development services-intern",null,8.6860330127999994,null,8.6860330127999994,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["0892V",null,"Travel/wait time - intern",null,5.1056134272000007,null,5.1056134272000007,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["0895V",null,"Air travel, vrc, intern, or forensic vrc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["1003F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["1022F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["1036F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["1044M",null,"Pt in remote areas",null,50.536919347200005,null,50.536919347200005,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["1065M",null,"Attending doctor ime review written repo",null,33.337924963200003,null,33.337924963200003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["1071F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["1085M",null,"Best Practice Complex Claim",null,"Contracted",null,"Contracted",null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["1089M",null,"HEALTH SERVICES COORDINATOR-Top Tier",null,9.68,null,9.68,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["1104M",null,"Ime-addendum report",null,133.21,null,133.21,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["1122M",null,"Ime pain management impairment rating",null,579.76836540479997,null,579.76836540479997,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["1125M",null,"Ime-phys travel per mile, round trip exc",null,5.7,null,5.7,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["1137F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["1151M",null,"Omd requested consultation",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["1158F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["1181F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["1190M",null,"Comprehensive hearing loss exam",null,700.56,null,700.56,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["1205F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["1230M",null,"Ur contract:  retrospective outpatient review",null,"Contracted",null,"Contracted",null,"000",0,0,0,9,9,9,9,9,9,null,"C"]
["1249M",null,"UR, advanced imaging re-review & alternate criteria review",null,"Contracted",null,"Contracted",null,"000",0,0,0,9,9,9,9,9,9,null,"C"]
["1287M",null,"Catastrophic case mgmt travel/wait time per 6 minute unit",null,"Contracted",null,"Contracted",null,"000",0,0,0,9,9,9,9,9,9,null,"C"]
["1450F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["1501F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["1728M",null,"PGAP Coach Travel Time",null,8.2641708864000005,null,8.26,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["2001F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["2014M",null,"Pain clinic follow-up services: face-to face/hr",null,1.7307164160000001,null,1.7307164160000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["2026F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["2033F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["2133A",null,"Naturopathic follow up visit, routine incl eval & treatment",null,79.969915396800005,null,79.969915396800005,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["3021F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3040F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3055F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3073F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3077F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3092F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3111F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3142F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3250F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3272F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3288F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3301F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3317F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3340F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3350F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3384F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3472F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3494F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3498F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3552F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3572F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3758F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4003F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4014F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4030F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4048F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4052F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4070F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4077F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4131F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4148F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4159F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4171F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4186F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4190F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4242F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4250F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4290F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4320F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4481F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4550F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4562F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["5010F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["6005F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["6020F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["8883H",null,"Nursing facility rehab - medium (per day",null,643.30999999999995,null,643.30999999999995,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["8889H",null,"Nursing facility behavior only (per day)",null,356.11,null,356.11,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["8915H",null,"Vehicle modification",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["8970H",null,"Home health aid svscs up to 2 hrs",null,65.33454470400001,null,65.33454470400001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["9918M",null,"Electronic Provider Communication",null,50.807015999999997,null,48.138492000000006,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["9974M",null,"INTERPRETER SYSTEM PER MINUTE",null,1.0302,null,1.0302,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A0110",null,"Nonemergency transport bus",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["A0140",null,"Nonemergency transport air",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["A0420",null,"Ambulance waiting 1/2 hr",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A0428",null,"Bls",null,406.71690720330383,null,406.71690720330383,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A0436",null,"Rotary wing air mileage",null,85.869691848832332,null,85.869691848832332,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A2004",null,"Xcellistem, per sq cm",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["A4207",null,"2 cc sterile syringe&needle",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A4211",null,"Supp for self-adm injections",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A4230",null,"Infus insulin pump non needl",null,14.7906,null,14.7906,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A4233",null,"Alkalin batt for glucose mon",null,4.4820000000000002,null,4.4820000000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A4258",null,"Lancet device each",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A4265",null,"Paraffin",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,"Y-CM"]
["A4282",null,"Replacement breastpump adpt",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["A4301",null,"Implantable access syst perc",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A4322",null,"Irrigation syringe",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A4330",null,"Stool collection pouch",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A4352",null,"Coude tip urinary catheter",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A4355",null,"Bladder irrigation tubing",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A4375",null,"Drainable plastic pch w fcpl",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A4381",null,"Urinary plastic pouch w/o fp",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A4390",null,"Drainable pch ex wear convex",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A4398",null,"Ostomy irrigation bag",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A4412",null,"Ost pouch drain high output",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A4416",null,"Ost pch clsd w barrier/filtr",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A4430",null,"Ost urine pch w b/bltin conv",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A4433",null,"Urine ost pch bar w lock fln",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A4481",null,"Tracheostoma filter",null,0.46350000000000002,null,0.46350000000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A4520",null,"Incontinence garment anytype",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A4565",null,"Slings",null,9.7026000000000003,null,9.7026000000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A4575",null,"Hyperbaric o2 chamber disps",null,756.46199999999999,null,756.46199999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A4612",null,"Battery cables",null,232.36263081600001,null,232.36263081600001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A4616",null,"Tubing (oxygen) per foot",null,7.2100000000000011E-2,null,7.2100000000000011E-2,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A4634",null,"Replacement bulb th lightbox",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["A4637",null,"Repl tip cane/crutch/walker",null,3.0766694927999998,null,3.0766694927999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A4671",null,"Disposable cycler set",null,82.966799999999992,null,82.966799999999992,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A4706",null,"Bicarbonate conc sol per gal",null,54.904499999999999,null,54.904499999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A4726",null,"Dialys sol fld vol > 5999cc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["A4736",null,"Topical anesthetic, per gram",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["A4774",null,"Ammonia test strips",null,29.282399999999999,null,29.282399999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A4890",null,"Repair/maint cont hemo equip",null,585.64800000000002,null,585.64800000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["A5055",null,"Stoma cap",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A5072",null,"Urinary pouch w/o barrier",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A5121",null,"Solid skin barrier 6x6",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A5501",null,"Diabetic custom molded shoe",null,240.32990000000001,null,240.32990000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["A6010",null,"Collagen based wound filler",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A6022",null,"Collagen drsg>16<=48 sq in",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A6206",null,"Contact layer <= 16 sq in",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A6210",null,"Foam drg >16<=48 sq in w/o b",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A6224",null,"Gauze > 48 in no w/sal w/o b",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A6234",null,"Hydrocolld drg <=16 w/o bdr",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A6246",null,"Hydrogel drg >16<=48 in w/b",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A6253",null,"Absorpt drg > 48 sq in w/o b",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A6403",null,"Sterile gauze>16 <= 48 sq in",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A6410",null,"Sterile eye pad",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A6449",null,"Lt compres band >=3\" <5\"/yd",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A6453",null,"Self-adher band w <3\"/yd",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A6508",null,"Cmprs burngarment foot-thigh",null,380.67119999999994,null,380.67119999999994,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A6531",null,"Compression stocking bk30-40",null,48.978299999999997,null,48.978299999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A6545",null,"Grad comp non-elastic bk",null,113.97559999999999,null,113.97559999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A7003",null,"Nebulizer administration set",null,4.1499999999999995,null,4.1499999999999995,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A7016",null,"Nebulizer dome & mouthpiece",null,14.6412,null,14.6412,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A7020",null,"Interface, cough stim device",null,34.527999999999999,null,34.527999999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A7031",null,"Replacement facemask interfa",null,78.825099999999992,null,78.825099999999992,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A7040",null,"One way chest drain valve",null,49.738700000000001,null,49.738700000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A7508",null,"Housing & integrated adhesiv",null,3.6153,null,3.6153,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A7525",null,"Tracheostomy mask",null,2.5956000000000001,null,2.5956000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A9180",null,"Lice treatment, topical",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["A9276",null,"Disposable sensor, cgm sys",null,16.824099999999998,null,16.824099999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["A9300",null,"Exercise equipment",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["A9502",null,"Tc99m tetrofosmin",null,"By report",null,"By report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["A9510",null,"Tc99m disofenin",null,"By report",null,"By report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-PHL"]
["A9526",null,"Nitrogen n-13 ammonia",null,719.21989999999994,null,719.21989999999994,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["A9543",null,"Y90 ibritumomab, rx",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["A9553",null,"Cr51 chromate",null,"By report",null,"By report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["A9566",null,"Tc99m fanolesomab",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["A9572",null,"Indium in-111 pentetreotide",null,"By report",null,"By report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["A9585",null,"Gadobutrol injection",null,0.32200000000000001,null,0.32200000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["A9588",null,"Fluciclovine f-18",null,757.08449999999993,null,757.08449999999993,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["A9595",null,"Piflu f-18, dia 1 millicurie",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["A9700",null,"Echocardiography contrast",null,300.19439999999997,null,300.19439999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["B4100",null,"Food thickener oral",null,1.6267999999999998,null,1.6267999999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["B4152",null,"Ef calorie dense>/=1.5kcal",null,0.51500000000000001,null,0.51500000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["B4172",null,"Parenteral sol amino acid 5.",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-PHL"]
["B4189",null,"Parenteral sol amino acid &",null,232.60490000000001,null,232.60490000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["B9002","RR","Enter nutr inf pump any type",null,106.66680000000001,null,106.66680000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["B9006","NU","Parenteral infus pump statio",null,3301.7062000000001,null,3301.7062000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["C1714",null,"Cath, trans atherectomy, dir",null,"Facility Only",null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C1726",null,"Cath, bal dil, non-vascular",null,"Facility Only",null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C1753",null,"Cath, intravas ultrasound",null,"Facility Only",null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C1760",null,"Closure dev, vasc",null,"Facility Only",null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C1772",null,"Infusion pump, programmable",null,"Facility Only",null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C1780",null,"Lens, intraocular (new tech)",null,"Facility Only",null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C1815",null,"Pros, urinary sph, imp",null,"Facility Only",null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C1818",null,"Integrated keratoprosthesis",null,"Facility Only",null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C1825",null,"Gen, neuro, carot sinus baro",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["C1874",null,"Stent, coated/cov w/del sys",null,"Facility Only",null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C1884",null,"Embolization protect syst",null,"Facility Only",null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C1897",null,"Lead, neurostim test kit",null,"Facility Only",null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C2619",null,"Pmkr, dual, non rate-resp",null,"Facility Only",null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C2625",null,"Stent, non-cor, tem w/del sy",null,"Facility Only",null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C2639",null,"Brachytx, non-stranded,i-125",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["C2642",null,"Brachytx, stranded, c-131",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["C5272",null,"Low cost skin substitute app",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["C8902",null,"Mra w/o fol w/cont, abd",null,"Facility Only",null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C8913",null,"Mra w/o cont, lwr ext",null,"Facility Only",null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C8928",null,"Tte w or w/o fol w/con,stres",null,"Facility Only",null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C9041",null,"Inj, coagulation factor xa",null,"Facility Only",null,346.69800000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C9056",null,"Injection, givosiran",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["C9089",null,"Bupivacaine implant, 1 mg",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["C9093",null,"Inj., xipere, 1 mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["C9257",null,"Bevacizumab injection",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["C9358",null,"Surgimend, fetal",null,"Facility Only",null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C9459",null,"Flutemetamol f18",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["C9602",null,"Perc d-e cor stent ather s",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["C9734",null,"U/s trtmt, not leiomyomata",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["C9755",null,"Rf magnetic-guide av fistula",null,"Facility Only",null,10158.293424000001,null,"000",0,0,0,9,9,9,9,9,9,null,"O",null,"Y-ONC"]
["C9767",null,"Revasc lithotrip-stent-ather",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-UR"]
["C9774",null,"Revasc lithotr-ather tib/per",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["C9777",null,"Esophag mucosal integ add-on",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-ONC"]
["C9899",null,"Inpt implant pros dev,no cov",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["D0190",null,"Screening of a patient",null,102.176,null,102.176,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["D0277",null,"Vert bitewings 7 to 8 images",null,114.536,null,114.536,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["D0367",null,"Cone beam ct interp both jaw",null,384.80800000000005,null,384.80800000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["D0381",null,"Cone beam ct capt mandible",null,400.464,null,400.464,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["D0414",null,"Lab process microbial spec",null,240.608,null,240.608,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D0423",null,"Genetic test spec analysis",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["D0460",null,"Pulp vitality test",null,66.744,null,66.744,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["D0479",null,"Tissue in-situ hybridization",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["D0600",null,"Non-ionizing diag proc",null,84.048000000000002,null,84.048000000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["D0706",null,"Intraoral occlus radio image",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["D1206",null,"Topical fluoride varnish",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["D1510",null,"Space maintainer fxd unilat",null,361.73600000000005,null,361.73600000000005,null,"000",0,0,0,0,0,0,0,0,0,null,"F"]
["D1575",null,"Dist space maint, fixed unil",null,427.65600000000001,null,427.65600000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D1707",null,"Janssen Covid-19 vaccine administration",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["D2150",null,"Amalgam two surfaces permane",null,217.53600000000003,null,217.53600000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["D2410",null,"Dental gold foil one surface",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["D2543",null,"Dental onlay metallic 3 surf",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["D2662",null,"Dental onlay resin 2 surface",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["D2722",null,"Crown resin w/ noble metal",null,1163.4880000000003,null,1163.4880000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D2792",null,"Crown full cast noble metal",null,1263.1920000000002,null,1263.1920000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D2930",null,"Prefab stnlss steel crwn pri",null,317.24,null,317.24,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["D2951",null,"Tooth pin retention",null,93.936000000000007,null,93.936000000000007,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["D2954",null,"Prefab post/core + crown",null,386.45600000000007,null,386.45600000000007,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D2990",null,"Resin infiltration of lesion",null,215.88800000000003,null,215.88800000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D3230",null,"Pulpal therapy anterior prim",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["D3351",null,"Apexification/recalc initial",null,434.24800000000005,null,434.24800000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["D3421",null,"Root surgery premolar",null,979.7360000000001,null,979.7360000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["D3472",null,"Surg rep root res premolar",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-ONC"]
["D3950",null,"Canal prep/fitting of dowel",null,323.83199999999999,null,323.83199999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["D4245",null,"Apically positioned flap",null,1004.456,null,1004.456,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D4261",null,"Osseous surg 1 to 3 teeth",null,1081.912,null,1081.912,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D4322",null,"Splint intra-coronal",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["D4342",null,"Periodontal scaling 1-3teeth",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["D5140",null,"Dentures immediat mandible",null,2221.5040000000004,null,2221.5040000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D5223",null,"Immed max part dent metal",null,2068.2400000000002,null,2068.2400000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["D5421",null,"Dentures adjust part maxill",null,111.24000000000001,null,111.24000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D5630",null,"Rep partial denture clasp",null,312.29599999999999,null,312.29599999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D5721",null,"Dentures rebase part mandbl",null,666.6160000000001,null,666.6160000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D5731",null,"Denture reln cmplt mand chr",null,443.31200000000007,null,443.31200000000007,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D5864",null,"Overdenture partial max",null,2657.4,null,2657.4,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D5867",null,"Replacement of precision att",null,461.44,null,461.44,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D5922",null,"Nasal septal prosthesis",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["D5929",null,"Facial replacement",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["D5955",null,"Palatal lift prosthesis",null,5065.1471139984005,null,5065.1471139984005,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D5987",null,"Commissure splint",null,1305.2160000000001,null,1305.2160000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"F",null,"Y-CM"]
["D6011",null,"Second stage implant surgery",null,824.82400000000007,null,824.82400000000007,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D6040",null,"Odontics eposteal implant",null,8379.2560000000012,null,8379.2560000000012,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D6068",null,"Abutment supported retainer",null,1596.0880000000002,null,1596.0880000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D6071",null,"Abutment supported retainer",null,1577.1360000000002,null,1577.1360000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D6085",null,"Provisional implant crown",null,640.24800000000005,null,640.24800000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D6093",null,"Recement supp part denture",null,227.42400000000001,null,227.42400000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["D6110",null,"Implnt/abut remov dent max",null,3719.5360000000005,null,3719.5360000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["D6119",null,"Int/abut int fixed dent max",null,4454.5439999999999,null,4454.5439999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D6195",null,"Abut retain porc to titanium",null,1759.24,null,1759.24,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-ONC"]
["D6205",null,"Pontic-indirect resin based",null,1157.72,null,1157.72,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D6549",null,"Resin retainer",null,1070.376,null,1070.376,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["D6602",null,"Cst hgh nble mtl inlay 2 srf",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["D6613",null,"Onlay cst base mtl >=3 surfa",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["D6721",null,"Crown resin w/base metal",null,1219.52,null,1219.52,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D6790",null,"Crown full high noble metal",null,1329.9360000000001,null,1329.9360000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D6980",null,"Fixed partial repair",null,469.68,null,469.68,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D7241",null,"Impact tooth rem bony w/comp",null,672.38400000000013,null,672.38400000000013,null,"000",0,0,0,0,0,0,0,0,0,null,"F"]
["D7260",null,"Oral antral fistula closure",null,1557.3600000000001,null,1557.3600000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"F"]
["D7295",null,"Bone harvest,auto graft proc",null,1200.5680000000002,null,1200.5680000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D7298",null,"Remove screw retained plate",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["D7440",null,"Malig tumor exc to 1.25 cm",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["D7451",null,"Rem odontogen cyst > 1.25 cm",null,1122.2880000000002,null,1122.2880000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D7521",null,"Incision/drain abscess extra",null,775.38400000000013,null,775.38400000000013,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D7650",null,"Open red simp malar/zygom fx",null,4101.0480000000007,null,4101.0480000000007,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D7750",null,"Open red comp malar/zygma fx",null,4641.5920000000006,null,4641.5920000000006,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D7771",null,"Alveolus clsd reduc stblz te",null,2264.3520000000003,null,2264.3520000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D7873",null,"Tmj arthroscopy lysis adhesn",null,5032.1680000000006,null,5032.1680000000006,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D7876",null,"Tmj arthroscopy discectomy",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["D7945",null,"Bone cutting body mandible",null,8091.68,null,8091.68,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D7948",null,"Reconstruct midface no graft",null,12777.768,null,12777.768,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D7972",null,"Surg redct fibrous tuberosit",null,844.6,null,844.6,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D7994",null,"Surg place zygomatic impl",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-ONC"]
["D8040",null,"Limited dental tx adult",null,4065.6160000000004,null,4065.6160000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D8090",null,"Compre dental tx adult",null,5540.576,null,5540.576,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D8999",null,"Orthodontic procedure",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["D9130",null,"Temporomandibular joint dysf",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["D9420",null,"Hospital/asc call",null,372.44800000000004,null,372.44800000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["D9450",null,"Case presentation tx plan",null,192.81600000000003,null,192.81600000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["D9934",null,"Clean rem part denture max",null,91.464000000000013,null,91.464000000000013,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["D9948",null,"Adjust sleep apnea appliance",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["D9973",null,"Extrnl bleaching per tooth",null,280.16000000000003,null,280.16000000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["D9991",null,"Case mgmt, appt barriers",null,101.352,null,101.352,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["E0112","NU","Crutch underarm pair wood",null,46.638400000000004,null,46.638400000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0116","NU","Crutch underarm each no wood",null,30.003899999999998,null,30.003899999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0147","NU","Walker variable wheel resist",null,553.51170000000002,null,553.51170000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0148","RR","Heavyduty walker no wheels",null,11.803800000000001,null,11.803800000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0157","RR","Walker crutch attachment",null,7.5190000000000001,null,7.5190000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0165","NU","Commode chair with detacharm",null,266.22249999999997,null,266.22249999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0181","RR","Press pad alternating w/ pum",null,25.616100000000003,null,25.616100000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0186","NU","Air pressure mattress",null,238.548,null,238.548,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0197","NU","Air pressure pad for mattres",null,299.93600000000004,null,299.93600000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0198","RR","Water pressure pad for mattr",null,23.731200000000001,null,23.731200000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0232","RR","Warming card for nwt",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["E0239",null,"Hydrocollator unit portable",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["E0246","NU","Transfer tub rail attachment",null,129.79291422240001,null,129.79291422240001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0261","NU","Hosp bed semi-electr w/o mat",null,1106.117,null,1106.117,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["E0271","RR","Mattress innerspring",null,19.374299999999998,null,19.374299999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0277","RR","Powered pres-redu air mattrs",null,496.01710000000003,null,496.01710000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["E0294","RR","Hosp bed semi-elect w/ mattr",null,107.21270000000001,null,107.21270000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["E0296","NU","Hosp bed total elect w/ matt",null,1513.6880000000001,null,1513.6880000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["E0310","NU","Rails bed side full length",null,171.62889999999999,null,171.62889999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0315","RR","Bed accessory brd/tbl/supprt",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["E0350","NU","Control unit bowel system",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["E0433","RR","Portable liquid oxygen sys",null,49.841700000000003,null,49.841700000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0445","RR","Oximeter non-invasive",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-PHL"]
["E0459","NU","Chest wrap",null,266.22249999999997,null,266.22249999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["E0471","RR","Rad w/backup non inv intrfc",null,509.33500000000004,null,509.33500000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["E0480","NU","Percussor elect/pneum home m",null,553.83100000000002,null,553.83100000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0560","NU","Humidifier supplemental w/ i",null,186.27549999999999,null,186.27549999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0562","NU","Humidifier heated used w pap",null,246.15970000000002,null,246.15970000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0574","RR","Ultrasonic generator w svneb",null,50.727499999999999,null,50.727499999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0606","RR","Drainage board postural",null,28.9224,null,28.9224,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["E0618",null,"Apnea monitor",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["E0625","RR","Patient lift bathroom or toi",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["E0638","NU","Standing frame sys",null,4778.1605999999992,null,4778.1605999999992,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0639","RR","Moveable patient lift system",null,135.00209999999998,null,135.00209999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0656","NU","Segmental pneumatic trunk",null,728.21,null,728.21,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0657","RR","Segmental pneumatic chest",null,68.402299999999997,null,68.402299999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0667","NU","Seg pneumatic appl full leg",null,407.99330000000003,null,407.99330000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0675","NU","Pneumatic compression device",null,4845.7380000000003,null,4845.7380000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["E0705","RR","Transfer device",null,6.2624000000000004,null,6.2624000000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0745","RR","Neuromuscular stim for shock",null,112.8056,null,112.8056,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["E0761","RR","Nontherm electromgntc device",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["E0764","RR","Functional neuromuscularstim",null,1394.5479,null,1394.5479,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["E0783","RR","Programmable infusion pump",null,1031.6789000000001,null,1031.6789000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["E0785","NU","Replacement impl pump cathet",null,574.68438593280007,null,574.68438593280007,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["E0830","RR","Ambulatory traction device",null,55.718251617600018,null,55.718251617600018,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0880","NU","Trac stand free stand extrem",null,158.1977,null,158.1977,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0911","RR","Hd trapeze bar attach to bed",null,51.973800000000004,null,51.973800000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0935","RR","Cont pas motion exercise dev",null,28.664899999999999,null,28.664899999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["E0950","RR","Tray",null,10.094000000000001,null,10.094000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0953","NU","W/c lateral thigh/knee sup",null,98.0869,null,98.0869,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0960","RR","W/c shoulder harness/straps",null,9.1773000000000007,null,9.1773000000000007,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0966","NU","Wheelchair head rest extensi",null,86.303700000000006,null,86.303700000000006,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0969","RR","Wheelchair narrowing device",null,19.539099999999998,null,19.539099999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0981","RR","Seat upholstery, replacement",null,4.8616000000000001,null,4.8616000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0983","RR","Add pwr joystick",null,314.95339999999999,null,314.95339999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["E0994","NU","Wheelchair arm rest",null,22.217100000000002,null,22.217100000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E1006","NU","Pwr seat combo w/o shear",null,6989.683,null,6989.683,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["E1007","RR","Pwr seat combo w/shear",null,907.17250000000001,null,907.17250000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["E1020","RR","Residual limb support system",null,23.6797,null,23.6797,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E1029","NU","W/c vent tray fixed",null,401.18500000000006,null,401.18500000000006,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E1036","RR","Patient transfer system >300",null,1042.0716,null,1042.0716,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E1084","NU","Hemi-wheelchair detachable a",null,1236.2059999999999,null,1236.2059999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["E1086","NU","Hemi-wheelchair detachable a",null,2071.2152000000001,null,2071.2152000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["E1093","NU","Wheelchair wide w/ foot rest",null,1392.7660000000001,null,1392.7660000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["E1160","NU","Wheelchair fixed arms",null,787.74400000000003,null,787.74400000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["E1161","RR","Manual adult wc w tiltinspac",null,298.15410000000003,null,298.15410000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["E1220","NU","Whlchr special size/constrc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-PHL"]
["E1224","NU","Wheelchair spec size w/ leg",null,1022.5840000000001,null,1022.5840000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["E1225","RR","Manual semi-reclining back",null,50.47,null,50.47,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["E1236",null,"Folding ped wc adjustable",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["E1240","NU","Whchr litwt det arm leg rest",null,1298.3150000000001,null,1298.3150000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["E1290","NU","Wheelchair hvy duty detach a",null,822.09839999999997,null,822.09839999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["E1352","RR","O2 flow reg pos inspir press",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["E1355","RR","Oxygen supplies stand/rack",null,26.0869,null,26.0869,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["E1520","RR","Heparin infusion pump",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["E1580","RR","Unipuncture control system",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["E1594","RR","Cycler dialysis machine",null,844.7989,null,844.7989,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E1699","NU","Dialysis equipment noc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-PHL"]
["E1702","NU","Repl measr scales jaw motion",null,27.442672171200002,null,27.442672171200002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E1820","NU","Soft interface material",null,97.170200000000008,null,97.170200000000008,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2120",null,"Pulse gen sys tx endolymp fl",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["E2202","NU","Seat width 24-27 in",null,558.71320000000003,null,558.71320000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2209","RR","Arm trough each",null,10.6708,null,10.6708,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2216","NU","Foam filled propulsion tire",null,56.279200000000003,null,56.279200000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2219","NU","Foam caster tire any size ea",null,49.8005,null,49.8005,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2231","RR","Solid seat support base",null,17.726300000000002,null,17.726300000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2294",null,"Contour seat for ped size wc",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["E2313","NU","Pwc harness, expand control",null,403.76000000000005,null,403.76000000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2323","RR","Special joystick handle",null,7.4366000000000003,null,7.4366000000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2327","NU","Head control interface mech",null,2829.6160000000004,null,2829.6160000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2343","NU","W/c dpth 22-25 in seat frame",null,903.25850000000003,null,903.25850000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2360","RR","22nf nonsealed leadacid",null,12.154000000000002,null,12.154000000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2362","RR","Gr24 nonsealed leadacid",null,11.6493,null,11.6493,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2368","NU","Pwr wc drivewheel motor repl",null,517.57500000000005,null,517.57500000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2375","NU","Non-expandable controller",null,856.75400000000013,null,856.75400000000013,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2378","NU","Pw actuator replacement",null,759.8309999999999,null,759.8309999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2384","NU","Pneumatic caster tire",null,79.546900000000008,null,79.546900000000008,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2390","NU","Solid drive wheel tire",null,45.546599999999998,null,45.546599999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2394","NU","Drive wheel excludes tire",null,75.426900000000003,null,75.426900000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2500","RR","Sgd digitized pre-rec <=8min",null,49.285500000000006,null,49.285500000000006,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2504","NU","Sgd prerec msg>20min <=40min",null,1987.7661000000001,null,1987.7661000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2603","NU","Skin protect wc cus wd <22in",null,142.0164,null,142.0164,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2611","NU","Gen use back cush wdth <22in",null,260.40460000000002,null,260.40460000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2617","NU","Custom fab w/c back cushion",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["E2625","NU","Adj skin pro/pos wc cus>=22",null,441.56099999999998,null,441.56099999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["G0008",null,"Admin influenza virus vac",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["G0030",null,"Pt scr tob & cess int",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G0042",null,"Ref to therapy",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G0045",null,"Mrs 90 days post stk",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G0061",null,"Anesthesiology ss",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G0069",null,"Adm of immune drug in home",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G0079",null,"Care manag h vst new pt 60 m",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["G0086",null,"Care man home care plan 30 m",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["G0106","TC","Colon ca screen;barium enema",null,316.92180000000002,null,316.92180000000002,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
["G0120",null,"Colon ca scrn; barium enema",null,424.5444,null,424.5444,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
["G0129",null,"Partial hosp prog service",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G0130",26,"Single energy x-ray study",null,19.6218,null,19.6218,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
["G0162",null,"Hhc rn e&m plan svs, 15 min",null,45.452939875200016,null,45.452939875200016,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-ONC"]
["G0181",null,"Home health care supervision",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["G0204",null,"Dx mammo incl cad bi",null,342.74675223360009,null,342.74675223360009,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["G0219",26,"Pet img wholbod melano nonco",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,9,9,9,9,9,null,"X"]
["G0249",null,"Provide inr test mater/equip",null,88.000799999999998,null,88.000799999999998,null,"000",0,0,0,3,0,0,0,0,0,null,"R"]
["G0255",26,"Current percep threshold tst",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,9,9,9,9,9,null,"X"]
["G0279",null,"Tomosynthesis, mammo",null,95.73060000000001,null,95.73060000000001,null,"000",0,0,0,1,0,2,9,0,0,null,"R"]
["G0281",null,"Elec stim unattend for press",null,22.0002,null,22.0002,null,"000",0,0,0,7,5,0,0,0,0,null,"R",null,"Y-CM"]
["G0327",null,"Colon ca scrn;bld-bsd biomrk",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G0342",null,"Laparoscopy islet cell trans",null,"Not Covered",null,"Not Covered",null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"X"]
["G0380",null,"Lev 1 hosp type b ed visit",null,"Facility Only",null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["G0397",null,"Alcohol/subs interv >30 min",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["G0410",null,"Grp psych partial hosp 45-50",null,"Facility Only",null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["G0416",null,"Prostate biopsy, any mthd",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
["G0432",null,"Eia hiv-1/hiv-2 screen",null,27.985099999999999,null,27.985099999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
["G0436",null,"Tobacco-use counsel 3-10 min",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G0458",null,"Ldr prostate brachy comp rat",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G0468",null,"Fqhc visit, ippe or awv",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G0475",null,"Hiv combination assay",null,34.434399999999997,null,34.434399999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
["G0492",null,"Md/oth eval acut kid no esrd",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G0507",null,"Care manage serv minimum 20",null,93.977901388800007,null,62.879090788800013,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["G0514",null,"Prolong prev svcs, addl 30m",null,114.7578,null,107.62260000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
["G1003",null,"Cdsm medicalis",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G1008",null,"Cdsm cranberry pk",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G1024",null,"Cdsm radrite",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G2004",null,"Post-d/c h vst new pt 60 m",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["G2014",null,"Post-d/c care plan overs 30m",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["G2021",null,"Hea care pract tx in place",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G2074",null,"Med assist tx no drug",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G2080",null,"Add 30 mins counsel",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G2095",null,"Sys rsn no ace arn arni",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G2098",null,"Pt 66+ frailty and med dem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G2122",null,"Psy/dep/anx/apandicd noasse",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G2138",null,"Bk pain vas 9-15mo = 3",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G2148",null,"Mpm used",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G2151",null,"Dx degen neuro",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G2177",null,"Bronch w rx antibx 30d",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G2183",null,"Doc pt unable comm",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G2195",null,"Occip hdache child",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G2202",null,"No rsn no brief couns",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G2214",null,"Init/sub psych care m 1st 30",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["G4002",null,"Ep cardio ss",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G4012",null,"Interventional rad ss",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G4015",null,"Neurology ss",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G4027",null,"Plastic surgery ss",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G4033",null,"Skilled nursing facility ss",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G6003",null,"Radiation treatment delivery",null,273.51599999999996,null,273.51599999999996,null,"000",0,0,0,3,0,0,0,0,0,null,"R",null,"Y-CM"]
["G6010",null,"Radiation treatment delivery",null,335.94900000000001,null,335.94900000000001,null,"000",0,0,0,3,0,0,0,0,0,null,"R",null,"Y-CM"]
["G8397",null,"Dil macula/fundus exam/w doc",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8417",null,"Calc bmi abv up param f/u",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8433",null,"Scr for dep not cpt doc rsn",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8452",null,"Pt w/abn lvef b-bloc no rx",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8510",null,"Scr dep neg, no plan reqd",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8541",null,"No doc cur funct assess",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8568",null,"Pt no ref otolo no spec",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8598",null,"Asa/antiplat ther used",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8654",null,"Rafs crs hi no scor no surv",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8663",null,"Rafscrs si scor >= 0",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8709",null,"Pt presc doc med rsn id uri",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8712",null,"Not pres antibiotic",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8735",null,"Eld mal scrn pos no plan",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8806",null,"Perf ultrsnd to lct preg doc",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8839",null,"Sleep apnea assess",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8846",null,"Mod or severe osa",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8865",null,"Doc med reas no pneumococcal",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8880",null,"Sen lym p node biop not perf",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8911",null,"Pt doc no fall in asc",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8914",null,"Pt trans to hosp post d/c",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8934",null,"Lvef <40% or dep lv sys fcn",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8956",null,"Pt rcv hedia outpt dyls fac",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9001",null,"Mccd, initial rate",null,"Contracted",null,"Contracted",null,"000",0,0,0,9,9,9,9,9,9,null,"C"]
["G9008",null,"Mccd,phys coor-care ovrsght",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["G9054",null,"Onc supervision palliative",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9062",null,"Onc prac guide differs nos",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9072",null,"Onc dx brst stg1-2 noprogres",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9075",null,"Onc dx brst metastic/ recur",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9085",null,"Onc dx colon t4, n0 w/o prog",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9096",null,"Onc dx esophag t1-t3 noprog",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9108",null,"Onc dx pancreatic unknwn nos",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9115",null,"Onc dx ovarian stg3/4 noprog",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9133",null,"Onc dx prostate clinical met",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9143",null,"Warfarin respon genetic test",null,172.62959999999998,null,172.62959999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
["G9196",null,"Med reason for no ceph",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9212",null,"Doc of dsm-iv init eval",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9229",null,"Ptrsn no gc chl syp test",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9273",null,"Sys<140 and dia<90",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9285",null,"Site not small cell lung ca",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9292",null,"Medrsn no pt category",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9309",null,"No unplnd hosp readm in 30d",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9317",null,"No doc comm risk calc",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9351",null,"Doc >1 sinus ct w 90d dx",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9354",null,"1 or no ct sinus w/in 90d dx",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9361",null,"Doc rsn elect c-sec/induct",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9394",null,"Dx bipol, death, nhres, hosp",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9406",null,"Doc reas no 7d f/u",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9418",null,"Lungcx bx rpt docs class",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9430",null,"Spec site no cutaneous",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9455",null,"Abd imag w/us, ct or mri",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9474",null,"Diet counsel at hospice",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9477",null,"Care coord at hospice",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9501",null,"Rad expos ind/exp tm no doc",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9513",null,"Indiv pdc not > 0.8",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9520",null,"Refract not +/- 1.0 w/in 90d",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9543",null,"Doc 2x re-assess filt remov",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9557",null,"Ct/cta/mri/a no thyr <1.0cm",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9598",null,"Aor ane 5.5-5.9 cm max diam",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9611",null,"No doc order anti-plat rng",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9614",null,"Photodoc < 2 cec lndmk",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9625",null,"Pt bl srg 30 day pst srg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9642",null,"Current smoker",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9651",null,"Psor as doc no spc bm",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9668",null,"DOC MED RSN NO STAT TX/PRESC",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9695",null,"Long act inhal bronchdil pre",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9704",null,"Ajcc br ca stg i: t1 mic/t1a",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9714",null,"Pt is w/hosp during msmt per",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9721",null,"Pt not ambul/immob/wc",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9724",null,"Pt w/doc use anticoag mst yr",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9735",null,"Pt unbl cmplt shld fs prom",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9746",null,"Mit sten, valve or trans af",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9763",null,"Pt not have 2-3 hpv vaccines",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9775",null,"Recd 2 anti-emet pre/intraop",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9784",null,"Path/derm prov 2nd biop opin",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9794",null,"Doc med rsn no daily aspirin",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9808",null,"Pt no asthm cont med mst per",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9811",null,"No pdc 75% w/asth cont med",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9831",null,"Ajcc stg brt ca dx ii or iii",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9843",null,"Kras or nras gene mutation",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9861",null,"Pt more than 3d hospice",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9879",null,"2 em core ms mo 10-12 wl",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9897",null,"Pt nt prsc adr dep thrpy rng",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9907",null,"Doc med rsn no tbco interv",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9914",null,"Pt receiving anti-tnf agent",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9917",null,"Adv dem crgvr limited",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9929",null,"Trs/rev af",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9942",null,"Adtl spine proc on same date",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9960",null,"Med rsn sys antimi nt rx",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9969",null,"Pvdr rfrd pt rprt rcvd",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9994",null,"Pall serv during meas",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["H0005",null,"Alcohol and/or drug services",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["H0012",null,"Alcohol and/or drug services",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["H0015",null,"Alcohol and/or drug services",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["H0026",null,"Alcohol and/or drug preventi",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["H0033",null,"Oral med adm direct observe",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["H0045",null,"Respite not-in-home per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["H1001",null,"Antepartum management",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["H2013",null,"Psych hlth fac svc, per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["H2024",null,"Supported employ, per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["H2031",null,"Mh clubhouse svc, per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["H2034",null,"A/d halfway house, per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J0172",null,"Inj, aducanumab-avwa, 2 mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J0190",null,"Inj biperiden lactate/5 mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J0221",null,"Lumizyme injection",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J0270",null,"Alprostadil for injection",null,9.68,null,9.68,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J0300",null,"Amobarbital 125 mg inj",null,183.26,null,183.26,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J0401",null,"Inj aripiprazole ext rel 1mg",null,5.992,null,5.992,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J0485",null,"Belatacept injection",null,3.7839999999999998,null,3.7839999999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J0500",null,"Dicyclomine injection",null,26.074999999999999,null,26.074999999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J0585",null,"Injection,onabotulinumtoxina",null,6.1849999999999996,null,6.1849999999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J0592",null,"Buprenorphine hydrochloride",null,4.101,null,4.101,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J0604",null,"Cinacalcet, esrd on dialysis",null,"By report",null,"By report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-ONC"]
["J0638",null,"Canakinumab injection",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J0698",null,"Cefotaxime sodium injection",null,2.78,null,2.78,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J0720",null,"Chloramphenicol sodium injec",null,33.866,null,33.866,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J0744",null,"Ciprofloxacin iv",null,0.93100000000000005,null,0.93100000000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J0775",null,"Collagenase, clost hist inj",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J0885",null,"Epoetin alfa, non-esrd",null,8.1120000000000001,null,8.1120000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J0895",null,"Deferoxamine mesylate inj",null,7.1980000000000004,null,7.1980000000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J1071",null,"Inj testosterone cypionate",null,2.8000000000000001E-2,null,2.8000000000000001E-2,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J1130",null,"Inj diclofenac sodium 0.5mg",null,0.21,null,0.21,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J1240",null,"Dimenhydrinate injection",null,7.26,null,7.26,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J1305",null,"Inj, evinacumab-dgnb, 5mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J1335",null,"Ertapenem injection",null,20.867000000000001,null,20.867000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J1410",null,"Inj estrogen conjugate 25 mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J1448",null,"Injection, trilaciclib, 1mg",null,5.1190999999999995,null,5.1190999999999995,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["J1454",null,"Inj fosnetupitant, palonoset",null,464.38299999999998,null,464.38299999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J1557",null,"Gammaplex injection",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J1568",null,"Octagam injection",null,41.822000000000003,null,41.822000000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J1610",null,"Glucagon hydrochloride/1 mg",null,169.74100000000001,null,169.74100000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J1645",null,"Dalteparin sodium",null,11.621,null,11.621,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J1710",null,"Hydrocortisone sodium ph inj",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J1729",null,"Inj hydroxyprogst capoat nos",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J1815",null,"Insulin injection",null,0.9,null,0.9,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J1833",null,"Injection, isavuconazonium",null,0.87,null,0.87,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J1951",null,"Inj fensolvi 0.25 mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J1955",null,"Inj levocarnitine per 1 gm",null,22.459,null,22.459,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J2175",null,"Meperidine hydrochl /100 mg",null,6.66,null,6.66,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J2274",null,"Inj morphine pf epid ithc",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J2323",null,"Natalizumab injection",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J2350",null,"Injection, ocrelizumab, 1 mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J2440",null,"Papaverin hcl injection",null,37.5,null,37.5,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J2503",null,"Pegaptanib sodium injection",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J2562",null,"Plerixafor injection",null,382.64800000000002,null,382.64800000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J2650",null,"Prednisolone acetate inj",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J2760",null,"Phentolaine mesylate inj",null,377.73,null,377.73,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J2792",null,"Rho(d) immune globulin h, sd",null,30.616,null,30.616,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J2800",null,"Methocarbamol injection",null,5.88,null,5.88,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J2820",null,"Sargramostim injection",null,54.040999999999997,null,54.040999999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J3030",null,"Sumatriptan succinate / 6 mg",null,10.4,null,10.4,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J3090",null,"Inj tedizolid phosphate",null,1.661,null,1.661,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J3246",null,"Tirofiban hcl",null,4.5999999999999996,null,4.5999999999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J3262",null,"Tocilizumab injection",null,5.819,null,5.819,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J3316",null,"Inj., triptorelin xr 3.75 mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J3385",null,"Velaglucerase alfa",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J3411",null,"Thiamine hcl 100 mg",null,2.5430000000000001,null,2.5430000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J3472",null,"Ovine, 1000 usp units",null,452.33,null,452.33,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J3590",null,"Unclassified biologics",null,"By report",null,"By report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["J7050",null,"Normal saline solution infus",null,0.63900000000000001,null,0.63900000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J7178",null,"Inj human fibrinogen con nos",null,1.341,null,1.341,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J7181",null,"Factor xiii recomb a-subunit",null,15.678000000000001,null,15.678000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J7194",null,"Factor ix complex",null,1.532,null,1.532,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J7205",null,"Factor viii fc fusion recomb",null,2.1120000000000001,null,2.1120000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J7294",null,"Seg acet and eth estr yearly",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J7304",null,"Contraceptive hormone patch",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J7318",null,"Inj, durolane 1 mg",null,"By report",null,"By report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["J7324",null,"Orthovisc inj per dose",null,154.749,null,154.749,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J7351",null,"Inj bimatoprost itc imp1mcg",null,206.04,null,206.04,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-ONC"]
["J7500",null,"Azathioprine oral 50mg",null,8.1029999999999998,null,8.1029999999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J7508",null,"Tacrol astagraf ex rel oral",null,0.495,null,0.495,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J7606",null,"Formoterol fumarate, inh",null,8.9179999999999993,null,8.9179999999999993,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J7613",null,"Albuterol non-comp unit",null,4.3999999999999997E-2,null,4.3999999999999997E-2,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J7627",null,"Budesonide comp unit",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J7640",null,"Formoterol comp unit",null,"By report",null,"By report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["J7645",null,"Ipratropium bromide comp",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J7670",null,"Metaproterenol comp unit",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J7677",null,"Revefenacin inh non-com 1mcg",null,0.189,null,0.189,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J7686",null,"Treprostinil, non-comp unit",null,704.37800000000004,null,704.37800000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J8597",null,"Antiemetic drug oral nos",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["J8705",null,"Topotecan oral",null,104.3,null,104.3,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J9021",null,"Inj, aspara, rylaze, 0.1 mg",null,108.52080000000001,null,108.52080000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["J9040",null,"Bleomycin sulfate injection",null,25.981000000000002,null,25.981000000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J9045",null,"Carboplatin injection",null,2.7679999999999998,null,2.7679999999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J9119",null,"Inj., cemiplimab-rwlc, 1 mg",null,27.623000000000001,null,27.623000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J9144",null,"Daratumumab, hyaluronidase",null,44.877000000000002,null,44.877000000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-ONC"]
["J9165",null,"Diethylstilbestrol injection",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J9203",null,"Gemtuzumab ozogamicin 0.1 mg",null,211.11199999999999,null,211.11199999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J9210",null,"Inj., emapalumab-lzsg, 1 mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J9217",null,"Leuprolide acetate suspnsion",null,168.691,null,168.691,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J9247",null,"Inj, melphalan flufenami 1mg",null,514.85580000000004,null,514.85580000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["J9263",null,"Oxaliplatin",null,6.8000000000000005E-2,null,6.8000000000000005E-2,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J9293",null,"Mitoxantrone hydrochl / 5 mg",null,33.92,null,33.92,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J9301",null,"Obinutuzumab inj",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J9308",null,"Injection, ramucirumab",null,63.69,null,63.69,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J9351",null,"Topotecan injection",null,1.1160000000000001,null,1.1160000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J9358",null,"Inj fam-trastu deru-nxki 1mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J9400",null,"Inj, ziv-aflibercept, 1mg",null,8.2219999999999995,null,8.2219999999999995,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["K0005","RR","Ultralightweight wheelchair",null,232.94480000000001,null,232.94480000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["K0008",null,"Cstm manual wheelchair/base",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["K0013","RR","Custom power whlchr base",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["K0015","NU","Detach non-adj ht armrst rep",null,179.42600000000002,null,179.42600000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["K0019","RR","Arm pad repl, each",null,1.7098,null,1.7098,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["K0043","RR","Ftrst lowr exten tube rep ea",null,2.0909,null,2.0909,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["K0047","NU","Elev legrst upr hangr rep ea",null,78.496299999999991,null,78.496299999999991,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["K0052","RR","Swingaway detach ftrest repl",null,9.1464000000000016,null,9.1464000000000016,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["K0098","NU","Drive belt for pwc, repl",null,28.747299999999999,null,28.747299999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["K0195","NU","Elevating whlchair leg rests",null,177.98400000000001,null,177.98400000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["K0606",null,"Aed garment w elec analysis",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["K0609",null,"Repl electrode for aed",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["K0739",null,"Repair/svc dme non-oxygen eq",null,28.2117,null,28.2117,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["K0814","RR","Pwc gp 1 std port cap chair",null,410.94940000000003,null,410.94940000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["K0815","RR","Pwc gp 1 std seat/back",null,462.30520000000001,null,462.30520000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["K0824","RR","Pwc gp 2 hd seat/back",null,646.47950000000003,null,646.47950000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["K0830","RR","Pwc gp2 std seat elevate s/b",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["K0836","NU","Pwc gp2 std sing pow opt cap",null,5446.7429999999986,null,5446.7429999999986,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["K0842","RR","Pwc gp2 std mult pow opt cap",null,570.86720000000003,null,570.86720000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["K0848","NU","Pwc gp 3 std seat/back",null,8609.3580000000002,null,8609.3580000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["K0851","RR","Pwc gp 3 hd cap chair",null,960.19690000000003,null,960.19690000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["K0859","RR","Pwc gp3 hd sing pow opt cap",null,1093.4479999999999,null,1093.4479999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["K0860","RR","Pwc gp3 vhd sing pow opt s/b",null,1637.9884,null,1637.9884,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["K0869","RR","Pwc gp 4 std cap chair",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["K0880","RR","Pwc gp4 vhd sing pow opt s/b",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["K0886","NU","Pwc gp4 hd mult pow s/b",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["K1003","NU","Whirlpool tub walkin portabl",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["K1009","NU","Speech volume modulation sys",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-PHL"]
["K1014","NU","Ak 4 bar link hydl swg/stanc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-PHL"]
["K1030",null,"Ext recharge bat replacement",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["K1032","NU","Non pneum seq comp full leg",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["L0180",null,"Cer post col occ/man sup adj",null,510.72060000000005,null,510.72060000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L0462",null,"Tlso 3mod sacro-scap pre",null,1581.4232999999999,null,1581.4232999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L0469",null,"Tlso rig fram pelvic pre ots",null,567.34979999999996,null,567.34979999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L0623",null,"Sio rig pnl pelv/sac pre ots",null,191.79390000000001,null,191.79390000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L0630",null,"Lso r post pnl sj-t9 pre cst",null,205.12710000000001,null,205.12710000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L0633",null,"Lso sc r pos/lat pnl pre cst",null,363.20670000000001,null,363.20670000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L0710",null,"Ctlso a-p-l control w/ inter",null,2770.7225999999996,null,2770.7225999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L0820",null,"Halo cervical into body jack",null,3276.3387000000002,null,3276.3387000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L0999",null,"Add to spinal orthosis nos",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["L1080",null,"Outrigger",null,76.382999999999996,null,76.382999999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L1120",null,"Covers for upright each",null,59.642700000000005,null,59.642700000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L1499",null,"Spinal orthosis nos",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N","Y"]
["L1652",null,"Ho bi thighcuffs w sprdr bar",null,451.48379999999997,null,451.48379999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L1685",null,"Post-op hip abduct custom fa",null,1443.2943,null,1443.2943,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L1836",null,"Ko rigid w/o joints pre ots",null,147.99359999999999,null,147.99359999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L1843",null,"Ko single upright pre cst",null,1136.4462000000001,null,1136.4462000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L1904",null,"Afo molded ankle gauntlet",null,570.57240000000002,null,570.57240000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L1940",null,"Afo molded to patient plasti",null,644.63070000000005,null,644.63070000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L2005",null,"Kafo sng/dbl mechanical act",null,5190.0342000000001,null,5190.0342000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L2070",null,"Hkafo torsion unilat rot str",null,163.18409999999997,null,163.18409999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L2116",null,"Afo tibial fracture rigid",null,863.7921,null,863.7921,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L2132",null,"Kafo femoral fx cast soft",null,978.80939999999998,null,978.80939999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L2250",null,"Foot plate molded stirrup at",null,574.8528,null,574.8528,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L2265",null,"Long tongue stirrup",null,142.9014,null,142.9014,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L2370",null,"Patten bottom",null,332.83800000000002,null,332.83800000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L2397",null,"Suspension sleeve lower ext",null,160.35509999999999,null,160.35509999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L2526",null,"Th/wght bear nar m-l brim cu",null,1108.1315999999999,null,1108.1315999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L2630",null,"Pelvic control band & belt u",null,317.37689999999998,null,317.37689999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L2755",null,"Carbon graphite lamination",null,165.52109999999999,null,165.52109999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L2780",null,"Non-corrosive finish",null,109.49459999999999,null,109.49459999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L3020",null,"Foot longitud/metatarsal sup",null,251.27669999999998,null,251.27669999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L3031",null,"Foot lamin/prepreg composite",null,161.2038,null,161.2038,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L3201",null,"Oxford w supinat/pronat inf",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["L3209",null,"Surgical boot each child",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["L3225",null,"Man's shoe oxford brace",null,82.0779,null,82.0779,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L3257",null,"Orth foot add charge split s",null,91.7928,null,91.7928,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L3350",null,"Shoe heel wedge",null,29.015699999999999,null,29.015699999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L3380",null,"Shoe clubfoot wedge",null,62.779199999999996,null,62.779199999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L3520",null,"O shoe add felt w leath insl",null,40.2333,null,40.2333,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L3540",null,"Ortho shoe add full sole",null,64.451999999999998,null,64.451999999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L3649",null,"Orthopedic shoe modifica nos",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["L3677",null,"So hard plas stabili pre cst",null,164.60400000000001,null,164.60400000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L3765",null,"Ewhfo rigid w/o jnts cf",null,1478.0295000000001,null,1478.0295000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L3901",null,"Hinge ext/flex wrist finger",null,2137.7523000000001,null,2137.7523000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L3918",null,"Metacarp fx orthosis pre ots",null,121.81920000000001,null,121.81920000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L3923",null,"Hfo without joints pre cst",null,113.5167,null,113.5167,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L3975",null,"Sewhfo cap design w/o jnt cf",null,1936.6472999999999,null,1936.6472999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L3977",null,"Sewhfo cap desgn w/jnt(s) cf",null,2170.4703,null,2170.4703,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L4030",null,"Replace socket brim cust fit",null,801.72629999999992,null,801.72629999999992,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L4080",null,"Repl met band kafo-afo prox",null,145.33679999999998,null,145.33679999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L4387",null,"Non-pneum walk boot pre ots",null,200.79749999999999,null,200.79749999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L5010",null,"Mold socket ank hgt w/ toe f",null,1637.76,null,1637.76,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L5220",null,"No knee joint with artic ali",null,4947.3663999999999,null,4947.3663999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L5270",null,"Tilt table locking hip sing",null,9224.9856,null,9224.9856,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L5520",null,"Perp bk ptb thermopls direct",null,1934.528,null,1934.528,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L5535",null,"Prep bk ptb open end socket",null,2788.5440000000003,null,2788.5440000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L5614",null,"4-bar link above knee w/swng",null,2228.5056,null,2228.5056,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L5626",null,"Test socket hip disarticulat",null,735.62880000000007,null,735.62880000000007,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L5642",null,"Above knee leather socket",null,1111.296,null,1111.296,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L5650",null,"Tot contact ak/knee disart s",null,772.04480000000001,null,772.04480000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L5666",null,"Below knee cuff suspension",null,95.552000000000007,null,95.552000000000007,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L5671",null,"Bk/ak locking mechanism",null,892.19839999999999,null,892.19839999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L5692",null,"Ak pelvic control belt light",null,209.792,null,209.792,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L5695",null,"Ak sleeve susp neoprene/equa",null,219.3792,null,219.3792,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L5707",null,"Custom shape cvr hip disart",null,1897.4976000000001,null,1897.4976000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L5722",null,"Knee-shin pneum swg frct exo",null,1426.8928000000001,null,1426.8928000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L5812",null,"Endo knee-shin frct swg & st",null,849.10080000000005,null,849.10080000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L5830",null,"Endo knee-shin pneum/swg pha",null,3312.3328000000001,null,3312.3328000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L5910",null,"Endo below knee alignable sy",null,487.2192,null,487.2192,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L5930",null,"High activity knee frame",null,4445.1328000000003,null,4445.1328000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L5976",null,"Energy storing foot",null,842.17600000000004,null,842.17600000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L5979",null,"Multi-axial ankle/ft prosth",null,4054.9120000000003,null,4054.9120000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L6055",null,"Wrst mold sock w/exp interfa",null,4360.9984000000004,null,4360.9984000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L6120",null,"Elbow mold doub splt soc ste",null,4034.7647999999999,null,4034.7647999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L6382",null,"Postop dsg cast chg elb dis/",null,2165.5935999999997,null,2165.5935999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L6570",null,"Scap thorac prosth tiss shap",null,7130.5983999999999,null,7130.5983999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L6611",null,"Additional switch, ext power",null,543.7568,null,543.7568,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L6620",null,"Flexion/extension wrist unit",null,450.30400000000003,null,450.30400000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L6646",null,"Multipo locking shoulder jnt",null,4165.2479999999996,null,4165.2479999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L6648",null,"Ext pwrd shlder lock/unlock",null,4295.8591999999999,null,4295.8591999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L6689",null,"Frame typ socket shoulder di",null,1162.9567999999999,null,1162.9567999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L6692",null,"Silicone gel insert or equal",null,752.2944,null,752.2944,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L6709",null,"Term dev mech hand vol close",null,1893.0432000000001,null,1893.0432000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L6805",null,"Term dev modifier wrist unit",null,568.98559999999998,null,568.98559999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L6900",null,"Hand restorat thumb/1 finger",null,2612.1088,null,2612.1088,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L6935",null,"Below elbow myoelectronic ct",null,12003.251200000001,null,12003.251200000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L7040",null,"Prehensile actuator",null,4051.9168,null,4051.9168,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L7170",null,"Electronic elbow hosmer swit",null,8214.1823999999997,null,8214.1823999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L7402",null,"Add ue prost s/d ultlite mat",null,489.35680000000002,null,489.35680000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L7405",null,"Add ue prost s/d acrylic",null,960,null,960,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L8015",null,"Ext breastprosthesis garment",null,82.214400000000012,null,82.214400000000012,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["L8040",null,"Nasal prosthesis",null,3301.7856000000002,null,3301.7856000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L8300",null,"Truss single w/ standard pad",null,140.97919999999999,null,140.97919999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L8417",null,"Pros sheath/sock w gel cushn",null,99.327999999999989,null,99.327999999999989,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L8501",null,"Tracheostomy speaking valve",null,162.50880000000001,null,162.50880000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L8507",null,"Trach-esoph voice pros pt in",null,55.308800000000005,null,55.308800000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L8610",null,"Ocular implant",null,892.41600000000005,null,892.41600000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L8614",null,"Cochlear device",null,25271.603199999998,null,25271.603199999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L8628",null,"Cid ext controller repl",null,1697.1392000000001,null,1697.1392000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["L8670",null,"Vascular graft, synthetic",null,748.85119999999995,null,748.85119999999995,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L8688",null,"Implt nrostm pls gen dua non",null,56826.563199999997,null,56826.563199999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["L8695",null,"External recharg sys extern",null,21.977600000000002,null,21.977600000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["M0223",null,"Bebteleovimab injection home",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["M0241",null,"CASIRI AND IMDEV REPEAT HM",null,772.5,null,772.5,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["M1008",null,"<50% total pt outpt ra encts",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["M1011",null,"Dc eoc doc med rec",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["M1019",null,"Adl pt mj dep ds rs 12 phq<5",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["M1040",null,"Pt dx lum idi or cong scol",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["M1056",null,"Presc antico med in pp",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["M1069",null,"Pt scr ft fall rsk",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["M1115",null,"Oc ni pt selfdc 1-2 vis",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["M1117",null,"Docu dx degen neuro",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["M1133",null,"Oc ni pt dc 1-2 vis",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["M1141",null,"Fs no oks",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["M1149",null,"No neck fs prom incap",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["P9017",null,"Plasma 1 donor frz w/in 8 hr",null,"By report",null,"By report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["P9033",null,"Platelets leukoreduced irrad",null,"By report",null,"By report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["P9040",null,"Rbc leukoreduced irradiated",null,"By report",null,"By report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["P9054",null,"Blood, l/r, froz/degly/wash",null,"By report",null,"By report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["P9056",null,"Blood, l/r, irradiated",null,"By report",null,"By report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["Q0035",26,"Cardiokymography",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
["Q0084",null,"Chemotherapy by infusion",null,"Facility Only",null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["Q0114",null,"Fern test",null,13.9282,null,13.9282,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
["Q0174",null,"Thiethylperazine maleate10mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q0245",null,"Bamlanivimab and etesevima",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q0480",null,"Driver pneumatic vad, rep",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q0492",null,"Emr pwr cbl elec vad, rep",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q0494",null,"Emr hd pmp elec/combo, rep",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q0511",null,"Sup fee antiem,antica,immuno",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q0514",null,"Disp fee inhal drugs/90 days",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q2028",null,"Inj, sculptra, 0.5mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q2055",null,"Idecabtagene vicleucel car",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q4005",null,"Cast sup long arm adult plst",null,14.605399999999999,null,14.605399999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["Q4012",null,"Cast sup sht arm ped fbrglas",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q4024",null,"Cast sup sht arm splnt ped f",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q4026",null,"Cast sup hip spica fiberglas",null,132.91120000000001,null,132.91120000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["Q4042",null,"Cast sup lng leg splnt fbrgl",null,38.4499,null,38.4499,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["Q4045",null,"Cast sup sht leg splnt plstr",null,13.081,null,13.081,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["Q4074",null,"Iloprost non-comp unit dose",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q4111",null,"Gammagraft",null,6.899,null,6.899,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["Q4116",null,"Alloderm",null,"By report",null,"By report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["Q4132",null,"Grafix core, grafixpl core",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q4145",null,"Epifix, inj, 1mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q4147",null,"Architect ecm px fx 1 sq cm",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q4163",null,"Woundex, bioskin, per sq cm",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q4166",null,"Cytal, per square centimeter",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q4174",null,"Palingen or promatrx",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q4206",null,"Fluid flow or fluid gf 1 cc",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q4212",null,"Allogen, per cc",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q4225",null,"Amniobind, per sq cm",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q4239",null,"Amnio-maxx or lite per sq cm",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q4241",null,"Polycyte, topical only 0.5cc",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q4258",null,"Enverse, per sq cm",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q5003",null,"Hospice in lt/non-skilled nf",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["Q5010",null,"Hospice home care in hospice",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["Q5120",null,"Inj pegfilgrastim-bmez 0.5mg",null,178.55099999999999,null,178.55099999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-ONC"]
["Q9001",null,"Va chaplain assessment",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q9959",null,"Hocm 150-199mg/ml iodine,1ml",null,"By report",null,"By report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["Q9992",null,"Buprenorphine xr over 100 mg",null,1781.309,null,1781.309,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["R0075","UN","Transport port x-ray multipl",null,96.822766497600028,null,96.822766497600028,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["R0392",null,"Retraining child care licensd 7-9 hrs ea",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["S0020",null,"Injection, bupivicaine hydro",null,0.05,null,0.05,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["S0028",null,"Injection, famotidine, 20 mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S0090",null,"Sildenafil citrate, 25 mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S0106",null,"Bupropion hcl sr 60 tablets",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S0139",null,"Minoxidil, 10 mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S0170",null,"Anastrozole 1 mg",null,0.13,null,0.13,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["S0172",null,"Chlorambucil 2 mg",null,26.52,null,26.52,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["S0201",null,"Partial hospitalization serv",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S0250",null,"Comp geriatr assmt team",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S0260",null,"H&p for surgery",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S0317",null,"Disease mgmt per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S0353",null,"Cancer treatmentplan initial",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S0515",null,"Scleral lens liquid bandage",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S0595",null,"New lenses in pts old frame",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S0620",null,"Routine ophthalmological exa",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S1037",null,"Art pancreas ext receiver",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S2061",null,"Donor lobectomy (lung)",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S2067",null,"Breast \"stacked\" diep/gap",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S2118",null,"Total hip resurfacing",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S2152",null,"Solid organ transpl pkg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S2266",null,"Induced abortion 29-31 wks",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S2348",null,"Decompress disc rf lumbar",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S2404",null,"Fetal surg myelomeningo",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S3722",null,"Dose optimization auc - 5fu",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S3846",null,"Gene test beta-thalassemia",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S3852",null,"Dna analysis apoe alzheimer",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S4015",null,"Complete ivf nos case rate",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S4021",null,"Ivf canc p aspir case rate",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S4042",null,"Ovulation mgmt per cycle",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S5000",null,"Prescription drug, generic",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S5036",null,"Hit device repair",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S5131",null,"Homemaker service nos /diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S5150",null,"Unskilled respite care /15m",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S5161",null,"Emer rspns sys serv permonth",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["S5502",null,"Hit interim cath care",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S5522",null,"Hit picc insert no supp",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S8030",null,"Tantalum ring application",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S8080",null,"Scintimammography",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S8185",null,"Flutter device",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S8265",null,"Haberman feeder",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S8270",null,"Enuresis alarm",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S8301",null,"Infect control supplies nos",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["S8415",null,"Supplies for home delivery",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S8420",null,"Custom gradient sleev/glov",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["S8421",null,"Ready gradient sleev/glov",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["S8422",null,"Custom grad sleeve med",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["S8423",null,"Custom grad sleeve heavy",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["S8424",null,"Ready gradient sleeve",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["S8425",null,"Custom grad glove med",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["S8426",null,"Custom grad glove heavy",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["S8427",null,"Ready gradient glove",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["S8428",null,"Ready gradient gauntlet",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["S8429",null,"Gradient pressure wrap",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["S8430",null,"Padding for comprssn bdg",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["S8431",null,"Compression bandage",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["S8450",null,"Splint digit",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S8451",null,"Splint wrist or ankle",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S8452",null,"Splint elbow",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S8460",null,"Camisole post-mast",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S8490",null,"100 insulin syringes",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S8930",null,"Auricular electrostimulation",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S8940",null,"Hippotherapy per session",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S8948",null,"Low-level laser trmt 15 min",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S8950",null,"Complex lymphedema therapy,",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S8990",null,"Pt or manip for maint",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S8999",null,"Resuscitation bag",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9001",null,"Home uterine monitor with or",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9007",null,"Ultrafiltration monitor",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9024",null,"Paranasal sinus ultrasound",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9025",null,"Omnicardiogram/cardiointegra",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9034",null,"Eswl for gallstones",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9055",null,"Procuren or other growth fac",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9056",null,"Coma stimulation per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9061",null,"Medical supplies and equipme",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9083",null,"Urgent care center global",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9088",null,"Services provided in urgent",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9090",null,"Vertebral axial decompressio",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9097",null,"Home visit wound care",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9098",null,"Home phototherapy visit",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9110",null,"Telemonitoring/home per mnth",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9117",null,"Back school visit",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9122",null,"Home health aide or certifie",null,33.051876,null,33.051876,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-ONC"]
["S9123",null,"Nursing care in home rn",null,66.459510374399997,null,66.459510374399997,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-ONC"]
["S9124",null,"Nursing care, in the home; b",null,48.005746588800001,null,48.005746588800001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-ONC"]
["S9125",null,"Respite care, in the home, p",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9126",null,"Hospice care, in the home, p",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9127",null,"Social work visit, in the ho",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9128",null,"Speech therapy, in the home,",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9129",null,"Occupational therapy, in the",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9131",null,"Pt in the home per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9140",null,"Diabetic management program,",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9141",null,"Diabetic management program,",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9145",null,"Insulin pump initiation",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9150",null,"Evaluation by ocularist",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9152",null,"Speech therapy, re-eval",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9208",null,"Home mgmt preterm labor",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9209",null,"Home mgmt pprom",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9211",null,"Home mgmt gest hypertension",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9212",null,"Hm postpar hyper per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9213",null,"Hm preeclamp per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9214",null,"Hm gest dm per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9325",null,"Hit pain mgmt per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9326",null,"Hit cont pain per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9327",null,"Hit int pain per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9328",null,"Hit pain imp pump diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9329",null,"Hit chemo per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9330",null,"Hit cont chem diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9331",null,"Hit intermit chemo diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9335",null,"Ht hemodialysis diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9336",null,"Hit cont anticoag diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9338",null,"Hit immunotherapy diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9339",null,"Hit periton dialysis diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9340",null,"Hit enteral per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9341",null,"Hit enteral grav diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9342",null,"Hit enteral pump diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9343",null,"Hit enteral bolus nurs",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9345",null,"Hit anti-hemophil diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9346",null,"Hit alpha-1-proteinas diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9347",null,"Hit longterm infusion diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9348",null,"Hit sympathomim diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9349",null,"Hit tocolysis diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9351",null,"Hit cont antiemetic diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9353",null,"Hit cont insulin diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9355",null,"Hit chelation diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9357",null,"Hit enzyme replace diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9359",null,"Hit anti-tnf per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9361",null,"Hit diuretic infus diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9363",null,"Hit anti-spasmotic diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9364",null,"Hit tpn total diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9365",null,"Hit tpn 1 liter diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9366",null,"Hit tpn 2 liter diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9367",null,"Hit tpn 3 liter diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9368",null,"Hit tpn over 3l diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9370",null,"Ht inj antiemetic diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9372",null,"Ht inj anticoag diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9373",null,"Hit hydra total diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9374",null,"Hit hydra 1 liter diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9375",null,"Hit hydra 2 liter diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9376",null,"Hit hydra 3 liter diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9377",null,"Hit hydra over 3l diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9379",null,"Hit noc per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9381",null,"Hit high risk/escort",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9401",null,"Anticoag clinic per session",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9430",null,"Pharmacy comp/disp serv",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9432",null,"Med food non inborn err meta",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9433",null,"Medical food oral 100% nutr",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9434",null,"Mod solid food suppl",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9435",null,"Medical foods for inborn err",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9436",null,"Lamaze class",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9437",null,"Childbirth refresher class",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9438",null,"Cesarean birth class",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9439",null,"Vbac class",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9441",null,"Asthma education",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9442",null,"Birthing class",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9443",null,"Lactation class",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9444",null,"Parenting class",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9445",null,"Pt education noc individ",null,44.652483532799998,null,44.652483532799998,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["S9446",null,"Pt education noc group",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9447",null,"Infant safety class",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9449",null,"Weight mgmt class",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9451",null,"Exercise class",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9452",null,"Nutrition class",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9453",null,"Smoking cessation class",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9454",null,"Stress mgmt class",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9455",null,"Diabetic management program,",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9460",null,"Diabetic management program,",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9465",null,"Diabetic management program,",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9470",null,"Nutritional counseling, diet",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9472",null,"Cardiac rehabilitation progr",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9473",null,"Pulmonary rehabilitation pro",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9474",null,"Enterostomal therapy by a re",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9475",null,"Ambulatory setting substance",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9476",null,"Vestibular rehab per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9480",null,"Intensive outpatient psychia",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["S9482",null,"Family stabilization 15 min",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9484",null,"Crisis intervention per hour",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9485",null,"Crisis intervention mental h",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9490",null,"Hit corticosteroid/diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9494",null,"Hit antibiotic total diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9497",null,"Hit antibiotic q3h diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9500",null,"Hit antibiotic q24h diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9501",null,"Hit antibiotic q12h diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9502",null,"Hit antibiotic q8h diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9503",null,"Hit antibiotic q6h diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9504",null,"Hit antibiotic q4h diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9529",null,"Venipuncture home/snf",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9537",null,"Ht hem horm inj diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9538",null,"Hit blood products diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9542",null,"Ht inj noc per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9558",null,"Ht inj growth horm diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9559",null,"Hit inj interferon diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9560",null,"Ht inj hormone diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9562",null,"Ht inj palivizumab diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9590",null,"Ht irrigation diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9810",null,"Ht pharm per hour",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9900",null,"Christian sci pract visit",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9901",null,"Christian sci nurse visit",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9960",null,"Air ambulanc nonemerg fixed",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9961",null,"Air ambulan nonemerg rotary",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9970",null,"Health club membership yr",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9975",null,"Transplant related per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9976",null,"Lodging per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9977",null,"Meals per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9981",null,"Med record copy admin",null,28.913781124800003,null,28.913781124800003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["S9982",null,"Med record copy per page",null,0.57329981280000009,null,0.57329981280000009,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["S9986",null,"Not medically necessary svc",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9988",null,"Serv part of phase i trial",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9989",null,"Services outside us",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9990",null,"Services provided as part of",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9991",null,"Services provided as part of",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9992",null,"Transportation costs to and",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9994",null,"Lodging costs (e.g. hotel ch",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9996",null,"Meals for clinical trial par",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9999",null,"Sales tax",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1000",null,"Private duty/independent nsg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1001",null,"Nursing assessment/evaluatn",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1002",null,"Rn services up to 15 minutes",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1003",null,"Lpn/lvn services up to 15min",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1004",null,"Nsg aide service up to 15min",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1005",null,"Respite care service 15 min",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1006",null,"Family/couple counseling",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1007",null,"Treatment plan development",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1009",null,"Child sitting services",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1010",null,"Meals when receive services",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1012",null,"Alcohol/substance abuse skil",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1013",null,"Sign lang/oral interpreter",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1014",null,"Telehealth transmit, per min",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1015",null,"Clinic service",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["T1016",null,"Case management",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1017",null,"Targeted case management",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1018",null,"School-based iep ser bundled",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1019",null,"Personal care ser per 15 min",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1020",null,"Personal care ser per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1021",null,"Hh aide or cn aide per visit",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1022",null,"Contracted services per day",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1023",null,"Program intake assessment",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1024",null,"Team evaluation & management",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1025",null,"Ped compr care pkg, per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1026",null,"Ped compr care pkg, per hour",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1027",null,"Family training & counseling",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1028",null,"Home environment assessment",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1029",null,"Dwelling lead investigation",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1030",null,"Rn home care per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1031",null,"Lpn home care per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1040",null,"Comm bh clinic svc per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1041",null,"Comm bh clinic svc per month",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1502",null,"Medication admin visit",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1503",null,"Med admin, not oral/inject",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1505",null,"Elec med comp dev, noc",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1999",null,"Noc retail items andsupplies",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2001",null,"N-et; patient attend/escort",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2002",null,"N-et; per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2003",null,"N-et; encounter/trip",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2004",null,"N-et; commerc carrier pass",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2005",null,"N-et; stretcher van",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2007",null,"Non-emer transport wait time",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2010",null,"Pasrr level i",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2011",null,"Pasrr level ii",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2012",null,"Habil ed waiver, per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2013",null,"Habil ed waiver per hour",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2014",null,"Habil prevoc waiver, per d",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2015",null,"Habil prevoc waiver per hr",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2016",null,"Habil res waiver per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2017",null,"Habil res waiver 15 min",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2018",null,"Habil sup empl waiver/diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2019",null,"Habil sup empl waiver 15min",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2020",null,"Day habil waiver per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2021",null,"Day habil waiver per 15 min",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2022",null,"Case management, per month",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2023",null,"Targeted case mgmt per month",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2024",null,"Serv asmnt/care plan waiver",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2025",null,"Waiver service, nos",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2026",null,"Special childcare waiver/d",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2027",null,"Spec childcare waiver 15 min",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2028",null,"Special supply, nos waiver",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2029",null,"Special med equip, noswaiver",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2030",null,"Assist living waiver/month",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2031",null,"Assist living waiver/diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2032",null,"Res care, nos waiver/month",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2033",null,"Res, nos waiver per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2034",null,"Crisis interven waiver/diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2035",null,"Utility services waiver",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2036",null,"Camp overnite waiver/session",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2037",null,"Camp day waiver/session",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2038",null,"Comm trans waiver/service",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2039",null,"Vehicle mod waiver/service",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2040",null,"Financial mgt waiver/15min",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2041",null,"Support broker waiver/15 min",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2042",null,"Hospice routine home care",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2043",null,"Hospice continuous home care",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2044",null,"Hospice respite care",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2045",null,"Hospice general care",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2046",null,"Hospice long term care, r&b",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2047",null,"Hab prevo waiver per 15",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2048",null,"Bh ltc res r&b, per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2049",null,"N-et; stretcher van, mileage",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2050",null,"Financial mgt waiver/diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2051",null,"Support broker waiver/diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2101",null,"Breast milk proc/store/dist",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T4521",null,"Adult size brief/diaper sm",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["T4522",null,"Adult size brief/diaper med",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["T4523",null,"Adult size brief/diaper lg",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["T4524",null,"Adult size brief/diaper xl",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["T4525",null,"Adult size pull-on sm",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["T4526",null,"Adult size pull-on med",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["T4527",null,"Adult size pull-on lg",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["T4528",null,"Adult size pull-on xl",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["T4529",null,"Ped size brief/diaper sm/med",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T4530",null,"Ped size brief/diaper lg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T4531",null,"Ped size pull-on sm/med",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T4532",null,"Ped size pull-on lg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T4533",null,"Youth size brief/diaper",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["T4534",null,"Youth size pull-on",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["T4535",null,"Disposable liner/shield/pad",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["T4536",null,"Reusable pull-on any size",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["T4537",null,"Reusable underpad bed size",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["T4538",null,"Diaper serv reusable diaper",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T4539",null,"Reuse diaper/brief any size",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["T4540",null,"Reusable underpad chair size",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["T4541",null,"Large disposable underpad",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["T4542",null,"Small disposable underpad",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["T4543",null,"Adult disp brief/diap abv xl",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T4544",null,"Adlt disp und/pull on abv xl",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["T4545",null,"Incon disposable penile wrap",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["T5001",null,"Position seat spec orth need",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T5999",null,"Supply, nos",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["U0001",null,"2019-ncov diagnostic p",null,51.365600000000001,null,51.365600000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
["U0002",null,"Covid-19 lab test non-cdc",null,73.3733,null,73.3733,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
["U0003",null,"SARS-COV-2 DNA/RNA HIGH THROUGHPUT",null,107.25,null,107.25,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
["U0004",null,"2019-NCOV ANY TECHNIQUE HIGH THROUGHPUT",null,107.25,null,107.25,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
["U0005",null,"Infec agen detec ampli probe",null,35.75,null,35.75,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
["V0028",null,"Travel, vocational services, claimant",null,"State Rate",null,"State Rate",null,"000",0,0,0,9,9,9,9,9,9,null,"S"]
["V2020",null,"Vision svcs frames purchases",null,76.755600000000001,null,76.755600000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2025",null,"Eyeglasses delux frames",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V2100",null,"Lens spher single plano 4.00",null,48.482100000000003,null,48.482100000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2101",null,"Single visn sphere 4.12-7.00",null,49.862299999999998,null,49.862299999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2102",null,"Singl visn sphere 7.12-20.00",null,62.850600000000007,null,62.850600000000007,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2103",null,"Spherocylindr 4.00d/12-2.00d",null,46.051300000000005,null,46.051300000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2104",null,"Spherocylindr 4.00d/2.12-4d",null,47.400600000000004,null,47.400600000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2105",null,"Spherocylinder 4.00d/4.25-6d",null,53.467299999999994,null,53.467299999999994,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2106",null,"Spherocylinder 4.00d/>6.00d",null,57.360700000000001,null,57.360700000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2107",null,"Spherocylinder 4.25d/12-2d",null,49.718100000000007,null,49.718100000000007,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2108",null,"Spherocylinder 4.25d/2.12-4d",null,48.513000000000005,null,48.513000000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2109",null,"Spherocylinder 4.25d/4.25-6d",null,59.554600000000001,null,59.554600000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2110",null,"Spherocylinder 4.25d/over 6d",null,52.962600000000002,null,52.962600000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2111",null,"Spherocylindr 7.25d/.25-2.25",null,55.208000000000006,null,55.208000000000006,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2112",null,"Spherocylindr 7.25d/2.25-4d",null,61.161400000000008,null,61.161400000000008,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2113",null,"Spherocylindr 7.25d/4.25-6d",null,72.244200000000006,null,72.244200000000006,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2114",null,"Spherocylinder over 12.00d",null,78.712600000000009,null,78.712600000000009,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2115",null,"Lens lenticular bifocal",null,95.058700000000016,null,95.058700000000016,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2118",null,"Lens aniseikonic single",null,89.712999999999994,null,89.712999999999994,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2121",null,"Lenticular lens, single",null,100.4147,null,100.4147,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2199",null,"Lens single vision not oth c",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V2200",null,"Lens spher bifoc plano 4.00d",null,68.989400000000003,null,68.989400000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2201",null,"Lens sphere bifocal 4.12-7.0",null,69.267499999999998,null,69.267499999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2202",null,"Lens sphere bifocal 7.12-20.",null,76.178799999999995,null,76.178799999999995,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2203",null,"Lens sphcyl bifocal 4.00d/.1",null,67.691599999999994,null,67.691599999999994,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2204",null,"Lens sphcy bifocal 4.00d/2.1",null,68.021200000000007,null,68.021200000000007,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2205",null,"Lens sphcy bifocal 4.00d/4.2",null,70.390200000000007,null,70.390200000000007,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2206",null,"Lens sphcy bifocal 4.00d/ove",null,70.946399999999997,null,70.946399999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2207",null,"Lens sphcy bifocal 4.25-7d/.",null,66.167199999999994,null,66.167199999999994,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2208",null,"Lens sphcy bifocal 4.25-7/2.",null,64.920900000000003,null,64.920900000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2209",null,"Lens sphcy bifocal 4.25-7/4.",null,74.932500000000005,null,74.932500000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2210",null,"Lens sphcy bifocal 4.25-7/ov",null,84.975000000000009,null,84.975000000000009,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2211",null,"Lens sphcy bifo 7.25-12/.25-",null,92.782399999999996,null,92.782399999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2212",null,"Lens sphcyl bifo 7.25-12/2.2",null,93.482800000000012,null,93.482800000000012,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2213",null,"Lens sphcyl bifo 7.25-12/4.2",null,90.032299999999992,null,90.032299999999992,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2214",null,"Lens sphcyl bifocal over 12.",null,94.523099999999999,null,94.523099999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2215",null,"Lens lenticular bifocal",null,113.5472,null,113.5472,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2218",null,"Lens aniseikonic bifocal",null,118.86200000000001,null,118.86200000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2219",null,"Lens bifocal seg width over",null,48.1937,null,48.1937,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2220",null,"Lens bifocal add over 3.25d",null,39.088500000000003,null,39.088500000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2221",null,"Lenticular lens, bifocal",null,104.854,null,104.854,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2299",null,"Lens bifocal speciality",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V2300",null,"Lens sphere trifocal 4.00d",null,81.720200000000006,null,81.720200000000006,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2301",null,"Lens sphere trifocal 4.12-7.",null,85.871100000000013,null,85.871100000000013,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2302",null,"Lens sphere trifocal 7.12-20",null,88.775700000000001,null,88.775700000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2303",null,"Lens sphcy trifocal 4.0/.12-",null,81.205200000000005,null,81.205200000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2304",null,"Lens sphcy trifocal 4.0/2.25",null,75.0458,null,75.0458,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2305",null,"Lens sphcy trifocal 4.0/4.25",null,84.573300000000003,null,84.573300000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2306",null,"Lens sphcyl trifocal 4.00/>6",null,86.787800000000004,null,86.787800000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2307",null,"Lens sphcy trifocal 4.25-7/.",null,88.250400000000013,null,88.250400000000013,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2308",null,"Lens sphc trifocal 4.25-7/2.",null,97.860300000000009,null,97.860300000000009,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2309",null,"Lens sphc trifocal 4.25-7/4.",null,101.1769,null,101.1769,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2310",null,"Lens sphc trifocal 4.25-7/>6",null,96.614000000000004,null,96.614000000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2311",null,"Lens sphc trifo 7.25-12/.25-",null,96.449200000000005,null,96.449200000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2312",null,"Lens sphc trifo 7.25-12/2.25",null,99.322900000000004,null,99.322900000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2313",null,"Lens sphc trifo 7.25-12/4.25",null,111.40479999999999,null,111.40479999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2314",null,"Lens sphcyl trifocal over 12",null,116.3488,null,116.3488,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2315",null,"Lens lenticular trifocal",null,131.69579999999999,null,131.69579999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2318",null,"Lens aniseikonic trifocal",null,158.78479999999999,null,158.78479999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2319",null,"Lens trifocal seg width > 28",null,53.755699999999997,null,53.755699999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2320",null,"Lens trifocal add over 3.25d",null,64.179299999999998,null,64.179299999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2321",null,"Lenticular lens, trifocal",null,127.31830000000001,null,127.31830000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2399",null,"Lens trifocal speciality",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V2410",null,"Lens variab asphericity sing",null,114.845,null,114.845,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2430",null,"Lens variable asphericity bi",null,119.92290000000001,null,119.92290000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2499",null,"Variable asphericity lens",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V2500",null,"Contact lens pmma spherical",null,117.30670000000001,null,117.30670000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2501",null,"Cntct lens pmma-toric/prism",null,134.02360000000002,null,134.02360000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2502",null,"Contact lens pmma bifocal",null,165.10900000000001,null,165.10900000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2503",null,"Cntct lens pmma color vision",null,162.20439999999999,null,162.20439999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2510",null,"Cntct gas permeable sphericl",null,150.36970000000002,null,150.36970000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2511",null,"Cntct toric prism ballast",null,172.57650000000001,null,172.57650000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2512",null,"Cntct lens gas permbl bifocl",null,203.9194,null,203.9194,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2513",null,"Contact lens extended wear",null,186.93470000000002,null,186.93470000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2520",null,"Contact lens hydrophilic",null,126.60760000000001,null,126.60760000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2521",null,"Cntct lens hydrophilic toric",null,196.55490000000003,null,196.55490000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2522",null,"Cntct lens hydrophil bifocl",null,191.28130000000002,null,191.28130000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2523",null,"Cntct lens hydrophil extend",null,166.45830000000001,null,166.45830000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2524",null,"Cntct lens hydrophil photoch",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V2525",null,"Cl, hydrophilic, dual focus",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V2530",null,"Contact lens gas impermeable",null,241.43200000000002,null,241.43200000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2531",null,"Contact lens gas permeable",null,575.40949999999998,null,575.40949999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2599",null,"Contact lens/es other type",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V2600",null,"Hand held low vision aids",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["V2610",null,"Single lens spectacle mount",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["V2615",null,"Telescop/othr compound lens",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["V2623",null,"Plastic eye prosth custom",null,1164.6313,null,1164.6313,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2624",null,"Polishing artifical eye",null,87.86930000000001,null,87.86930000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2625",null,"Enlargemnt of eye prosthesis",null,534.20949999999993,null,534.20949999999993,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2626",null,"Reduction of eye prosthesis",null,287.9674,null,287.9674,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2627",null,"Scleral cover shell",null,1859.7885999999999,null,1859.7885999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2628",null,"Fabrication & fitting",null,439.1302,null,439.1302,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2629",null,"Prosthetic eye other type",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["V2630",null,"Anter chamber intraocul lens",null,128.85300000000001,null,128.85300000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2631",null,"Iris support intraoclr lens",null,128.85300000000001,null,128.85300000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2632",null,"Post chmbr intraocular lens",null,128.85300000000001,null,128.85300000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2700",null,"Balance lens",null,47.421199999999999,null,47.421199999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2702",null,"Deluxe lens feature",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["V2710",null,"Glass/plastic slab off prism",null,69.411699999999996,null,69.411699999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2715",null,"Prism lens/es",null,15.470599999999999,null,15.470599999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2718",null,"Fresnell prism press-on lens",null,30.910300000000003,null,30.910300000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2730",null,"Special base curve",null,22.8248,null,22.8248,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2744",null,"Tint photochromatic lens/es",null,19.662700000000001,null,19.662700000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2745",null,"Tint, any color/solid/grad",null,13.2973,null,13.2973,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2750",null,"Anti-reflective coating",null,20.661799999999999,null,20.661799999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2755",null,"Uv lens/es",null,19.250700000000002,null,19.250700000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2756",null,"Eye glass case",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["V2760",null,"Scratch resistant coating",null,17.334899999999998,null,17.334899999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2761",null,"Mirror coating",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["V2762",null,"Polarization, any lens",null,63.334700000000005,null,63.334700000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2770",null,"Occluder lens/es",null,21.321000000000002,null,21.321000000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2780",null,"Oversize lens/es",null,13.565100000000001,null,13.565100000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2781",null,"Progressive lens per lens",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["V2782",null,"Lens, 1.54-1.65 p/1.60-1.79g",null,68.412599999999998,null,68.412599999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2783",null,"Lens, >= 1.66 p/>=1.80 g",null,77.116100000000003,null,77.116100000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2784",null,"Lens polycarb or equal",null,50.150700000000001,null,50.150700000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2785",null,"Corneal tissue processing",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["V2786",null,"Occupational multifocal lens",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["V2787",null,"Astigmatism-correct function",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V2788",null,"Presbyopia-correct function",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V2790",null,"Amniotic membrane",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["V2797",null,"Vis item/svc in other code",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["V2799",null,"Misc vision item or service",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5008",null,"Hearing screening",null,89.919316226694221,null,89.919316226694221,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V5010",null,"Assessment for hearing aid",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["V5011",null,"Hearing aid fitting/checking",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["V5014",null,"Hearing aid repair/modifying",null,59.949888950746086,null,59.949888950746086,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["V5020",null,"Conformity evaluation",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["V5030",null,"Body-worn hearing aid air",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5040",null,"Body-worn hearing aid bone",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5050",null,"Hearing aid monaural in ear",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5060",null,"Behind ear hearing aid",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5070",null,"Glasses air conduction",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5080",null,"Glasses bone conduction",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5090",null,"Hearing aid dispensing fee",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5095",null,"Implant mid ear hearing pros",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5100",null,"Body-worn bilat hearing aid",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5110",null,"Hearing aid dispensing fee",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5120",null,"Body-worn binaur hearing aid",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5130",null,"In ear binaural hearing aid",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5140",null,"Behind ear binaur hearing ai",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5150",null,"Glasses binaural hearing aid",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5160",null,"Dispensing fee binaural",null,1702.5415361248697,null,1702.5415361248697,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V5171",null,"Hearing aid monaural ite",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5172",null,"Hearing aid monaural itc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5181",null,"Hearing aid monaural bte",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5190",null,"Hearing aid monaural glasses",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5200",null,"Disp fee contralateral monau",null,1020.4612056258048,null,1020.4612056258048,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V5211",null,"Hearing aid binaural ite/ite",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5212",null,"Hearing aid binaural ite/itc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5213",null,"Hearing aid binaural ite/bte",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5214",null,"Hearing aid binaural itc/itc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5215",null,"Hearing aid binaural itc/bte",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5221",null,"Hearing aid binaural bte/bte",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5230",null,"Hearing aid binaural glasses",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5240",null,"Disp fee contralateral binau",null,1020.4612056258048,null,1020.4612056258048,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V5241",null,"Dispensing fee, monaural",null,851.27076806243485,null,851.27076806243485,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V5242",null,"Hearing aid, monaural, cic",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5243",null,"Hearing aid, monaural, itc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5244",null,"Hearing aid, prog, mon, cic",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5245",null,"Hearing aid, prog, mon, itc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5246",null,"Hearing aid, prog, mon, ite",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5247",null,"Hearing aid, prog, mon, bte",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5248",null,"Hearing aid, binaural, cic",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5249",null,"Hearing aid, binaural, itc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5250",null,"Hearing aid, prog, bin, cic",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5251",null,"Hearing aid, prog, bin, itc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5252",null,"Hearing aid, prog, bin, ite",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5253",null,"Hearing aid, prog, bin, bte",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5254",null,"Hearing id, digit, mon, cic",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5255",null,"Hearing aid, digit, mon, itc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5256",null,"Hearing aid, digit, mon, ite",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5257",null,"Hearing aid, digit, mon, bte",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5258",null,"Hearing aid, digit, bin, cic",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5259",null,"Hearing aid, digit, bin, itc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5260",null,"Hearing aid, digit, bin, ite",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5261",null,"Hearing aid, digit, bin, bte",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5262",null,"Hearing aid, disp, monaural",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5263",null,"Hearing aid, disp, binaural",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5264",null,"Ear mold/insert",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-PHL"]
["V5265",null,"Ear mold/insert, disp",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5266",null,"Battery for hearing device",null,1.0482678907272001,null,1.0482678907272001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V5267",null,"Hearing aid sup/access/dev",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-PHL"]
["V5268",null,"Ald telephone amplifier",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5269",null,"Alerting device, any type",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5270",null,"Ald, tv amplifier, any type",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5271",null,"Ald, tv caption decoder",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5272",null,"Tdd",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5273",null,"Ald for cochlear implant",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5274",null,"Ald unspecified",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5275",null,"Ear impression",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5281",null,"Ald fm/dm system, monaural",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5282",null,"Ald fm/dm system binaural",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5283",null,"Ald neck, loop ind receiver",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5284",null,"Ald fm/dm ear level receiver",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5285",null,"Ald fm/dm aud input receiver",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5286",null,"Ald blu tooth fm/dm receiver",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5287",null,"Ald fm/dm receiver, nos",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5288",null,"Ald fm/dm transmitter ald",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5289",null,"Ald fm/dm adapt/boot couplin",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5290",null,"Ald transmitter microphone",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5298",null,"Hearing aid noc",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5299",null,"Hearing service",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["V5336",null,"Repair communication device",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["V5362",null,"Speech screening",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["V5363",null,"Language screening",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["V5364",null,"Dysphagia screening",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]

{"sheet":"Field Keys","index":2,"n_rows":398,"n_cols":11,"rows_kept":398,"cut":false,"hidden":false,"merged":[[12,0,13,16],[14,0,14,16],[18,0,18,16],[20,0,20,16],[66,0,66,11],[67,0,67,1],[67,2,67,4],[67,5,67,6],[67,7,67,15],[68,0,68,1],[68,2,68,4],[68,5,68,6],[68,7,68,15],[69,0,72,1],[69,2,72,4],[69,5,69,6],[69,7,69,15],[70,5,70,6],[70,7,70,15],[71,5,71,6],[71,7,71,15],[72,5,72,6],[72,7,72,15],[73,0,76,1],[73,2,76,4],[73,5,73,6],[73,7,73,15],[74,5,74,6],[74,7,74,15],[75,5,75,6],[75,7,75,15],[76,5,76,6],[76,7,76,15],[77,0,79,1],[77,2,79,4],[77,5,77,6],[77,7,77,15],[78,5,78,6],[78,7,78,15],[85,0,91,1],[85,2,91,4],[85,5,86,15],[87,5,87,6],[87,7,87,15],[88,5,88,6],[79,5,79,6],[79,7,79,15],[80,0,84,1],[80,2,84,4],[80,5,80,6],[80,7,80,15],[81,5,81,6],[81,7,81,15],[82,5,82,6],[82,7,82,15],[88,7,88,15],[89,5,89,6],[89,7,89,15],[90,5,90,6],[90,7,90,15],[91,5,91,15],[83,5,83,6],[83,7,83,15],[84,5,84,6],[84,7,84,15],[94,0,94,11],[95,0,95,1],[95,2,95,7],[95,8,95,9],[95,10,95,17],[96,0,97,1],[96,2,97,7],[96,8,97,9],[96,10,97,17],[104,8,104,9],[104,10,104,17],[105,8,109,9],[105,10,109,17],[110,8,110,9],[110,10,110,17],[98,0,101,1],[98,2,101,7],[98,8,101,9],[98,10,101,17],[102,0,111,1],[102,2,111,7],[102,8,102,9],[102,10,102,17],[103,8,103,9],[103,10,103,17],[115,8,119,9],[115,10,119,17],[120,8,120,9],[120,10,120,17],[121,8,121,9],[121,10,121,17],[111,8,111,9],[111,10,111,17],[112,0,121,1],[112,2,121,7],[112,8,112,9],[112,10,112,17],[113,8,113,9],[113,10,113,17],[114,8,114,9],[114,10,114,17],[131,0,133,1],[131,2,133,7],[131,8,133,9],[131,10,133,17],[134,0,136,1],[134,2,136,7],[134,8,136,9],[134,10,136,17],[125,0,125,17],[126,0,126,1],[126,2,126,7],[126,8,126,9],[126,10,126,17],[127,0,130,1],[127,2,130,7],[127,8,130,9],[127,10,130,17],[137,0,139,1],[137,2,139,7],[137,8,139,9],[137,10,139,17],[142,0,142,17],[143,0,143,1],[143,2,143,7],[143,8,143,9],[143,10,143,17],[144,0,198,1],[144,2,198,7],[144,8,148,9],[144,10,148,17],[149,8,153,9],[149,10,153,17],[154,8,159,9],[154,10,159,17],[160,8,166,9],[160,10,166,17],[186,8,186,9],[186,10,186,17],[187,8,194,9],[187,10,194,17],[195,8,198,9],[195,10,198,17],[167,8,172,9],[167,10,172,17],[173,8,179,9],[173,10,179,17],[180,8,185,9],[180,10,185,17],[200,0,200,17],[201,0,201,1],[201,2,201,7],[201,8,201,9],[201,10,201,17],[202,0,218,1],[202,2,218,7],[202,8,204,9],[202,10,204,17],[205,8,205,9],[219,0,242,1],[219,2,242,7],[219,8,221,9],[219,10,221,17],[222,8,225,9],[222,10,225,17],[205,10,205,17],[206,8,209,9],[206,10,209,17],[210,8,213,9],[210,10,213,17],[214,8,214,9],[214,10,214,17],[226,8,234,9],[226,10,234,17],[235,8,239,9],[235,10,239,17],[240,8,242,9],[240,10,242,17],[215,8,215,9],[215,10,215,17],[216,8,218,9],[216,10,218,17],[244,0,244,17],[245,0,245,1],[245,2,245,7],[245,8,245,9],[245,10,245,17],[246,0,261,1],[246,2,261,7],[246,8,251,9],[246,10,251,17],[252,8,255,9],[265,10,269,17],[270,8,273,9],[270,10,273,17],[274,8,276,9],[274,10,276,17],[278,0,278,17],[252,10,255,17],[256,8,258,9],[256,10,258,17],[259,8,261,9],[259,10,261,17],[262,0,276,1],[262,2,276,7],[262,8,264,9],[262,10,264,17],[265,8,269,9],[288,8,289,9],[288,10,289,17],[290,8,292,9],[290,10,292,17],[293,0,297,1],[293,2,297,7],[293,8,297,9],[293,10,297,17],[279,0,279,1],[279,2,279,7],[279,8,279,9],[279,10,279,17],[280,0,292,1],[280,2,292,7],[280,8,282,9],[280,10,282,17],[283,8,287,9],[283,10,287,17],[308,8,308,9],[308,10,308,17],[309,8,309,9],[309,10,309,17],[310,8,310,9],[310,10,310,17],[298,0,314,1],[298,2,314,7],[298,8,298,9],[298,10,298,17],[299,8,302,9],[299,10,302,17],[303,8,306,9],[303,10,306,17],[307,8,307,9],[307,10,307,17],[314,8,314,9],[314,10,314,17],[316,0,316,17],[317,0,317,1],[317,2,317,7],[317,8,317,9],[317,10,317,17],[311,8,311,9],[311,10,311,17],[312,8,312,9],[312,10,312,17],[313,8,313,9],[313,10,313,17],[322,0,325,1],[322,2,325,7],[322,8,323,9],[322,10,323,17],[324,8,325,9],[324,10,325,17],[318,0,321,1],[318,2,321,7],[318,8,319,9],[318,10,319,17],[320,8,321,9],[320,10,321,17],[328,0,328,11],[329,0,329,1],[329,2,329,6],[329,7,329,8],[329,9,329,17],[330,0,330,1],[330,2,330,6],[330,7,330,8],[330,9,330,17],[331,0,331,1],[331,2,331,6],[331,7,331,8],[331,9,331,17],[332,0,335,1],[332,2,335,6],[332,7,332,8],[332,9,332,17],[333,7,333,8],[333,9,333,17],[334,7,334,8],[334,9,334,17],[335,7,335,8],[335,9,335,17],[336,0,339,1],[336,2,339,6],[336,7,336,8],[336,9,336,17],[337,7,337,8],[337,9,337,17],[338,7,338,8],[338,9,338,17],[339,7,339,8],[339,9,339,17],[341,0,341,17],[342,0,342,1],[342,2,342,6],[342,7,342,8],[342,9,342,17],[347,7,347,8],[347,9,347,17],[350,0,350,11],[351,0,351,1],[351,2,351,6],[351,7,351,8],[351,9,351,17],[343,0,347,1],[343,2,347,6],[343,7,343,8],[343,9,343,17],[344,7,344,8],[344,9,344,17],[345,7,345,8],[345,9,345,17],[346,7,346,8],[346,9,346,17],[356,7,356,8],[356,9,356,17],[357,7,357,8],[357,9,357,16],[358,7,358,8],[358,9,358,17],[352,0,375,1],[352,2,375,6],[352,7,352,8],[352,9,352,17],[353,7,353,8],[353,9,353,17],[354,7,354,8],[354,9,354,17],[355,7,355,8],[355,9,355,17],[362,7,362,8],[362,9,362,17],[363,7,363,8],[363,9,363,17],[364,7,364,8],[364,9,364,17],[359,7,359,8],[359,9,359,17],[360,7,360,8],[360,9,360,17],[361,7,361,8],[361,9,361,17],[368,7,368,8],[368,9,368,17],[369,7,369,8],[369,9,369,17],[370,7,370,8],[370,9,370,17],[365,7,365,8],[365,9,365,17],[366,7,366,8],[366,9,366,17],[367,7,367,8],[367,9,367,17],[374,7,374,8],[374,9,374,17],[375,7,375,8],[375,9,375,17],[376,0,376,1],[376,2,376,6],[376,7,376,8],[376,9,376,17],[371,7,371,8],[371,9,371,17],[372,7,372,8],[372,9,372,17],[373,7,373,8],[373,9,373,17],[378,0,378,17],[379,0,379,1],[379,2,379,6],[379,7,379,8],[379,9,379,17],[380,0,380,1],[380,2,380,6],[380,7,380,8],[380,9,380,17],[381,0,381,1],[381,2,381,6],[381,7,381,8],[381,9,381,17],[382,0,385,1],[382,2,385,6],[382,7,382,8],[382,9,382,17],[383,7,383,8],[383,9,383,17],[384,7,384,8],[384,9,384,17],[385,7,385,8],[385,9,385,17],[386,0,389,1],[386,2,389,6],[386,7,386,8],[386,9,386,17],[387,7,387,8],[387,9,387,17],[388,7,388,8],[388,9,388,17],[389,7,389,8],[389,9,389,17],[391,0,391,17],[392,0,392,1],[392,2,392,6],[392,7,392,8],[392,9,392,17],[397,7,397,8],[397,9,397,17],[393,0,397,1],[393,2,397,6],[393,7,393,8],[393,9,393,17],[394,7,394,8],[394,9,394,17],[395,7,395,8],[395,9,395,17],[396,7,396,8],[396,9,396,17]]}
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
["Professional Services Fee Schedule"]
[]
["CPT® Through Local Codes"]
[]
[]
[]
["Effective for Dates of Service on or After"]
[]
["2022-07-01"]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
[]
["ANESTHESIA SERVICES FEE SCHEDULE                   "]
["FIELD KEY:  "]
["Column Title",null,"Column Description",null,null,"Column Values",null,"Value Definitions"]
["CPTÒ CODE",null,"2021 CPT® anesthesia code.",null,null,null,null,"2021 CPT® anesthesia code."]
["ANES VALUE",null,"Indicates the anesthesia base units, maximum dollar value, or coverage for the anesthesia service.",null,null,"Number",null,"Anesthesia base units for services paid with the base and time payment method."]
[null,null,null,null,null,"Dollar Value",null,"Fee schedule dollar value for services paid with the maximum fee method."]
[null,null,null,null,null,"By Report",null,"Service paid on a “by report” basis."]
[null,null,null,null,null,"Not Covered",null,"Procedure code is not covered."]
["PAYMENT METHOD",null,"Indicates the payment method for the anesthesia service.",null,null,"Base/Time",null,"Service paid with base and time units."]
[null,null,null,null,null,"By Report",null,"Service paid on a “by report” basis."]
[null,null,null,null,null,"Maximum Fee",null,"Service paid based on a maximum dollar value."]
[null,null,null,null,null,"Not Covered",null,"Procedure code is not covered,"]
["BASE SOURCE",null,"Indicates the source of the anesthesia base units.",null,null,"CMS",null,"Base unit source is the Centers for Medicare and Medicaid Services (CMS)."]
[null,null,null,null,null,"ASA",null,"Base unit source is the American Society of Anesthesiologists’ Relative Value Guide."]
[null,null,null,null,null,"N/A",null,"Service not paid by base and time unit method"]
["FSI",null,"Fee Schedule Indicator \nThis column indicates the payment status for the procedure code.",null,null,"A",null,"Paid using base units"]
[null,null,null,null,null,"F",null,"Flat Fee developed by the department"]
[null,null,null,null,null,"N",null,"No fee or RVUs available, paid By Report"]
[null,null,null,null,null,"R",null,"Fee set by RBRVS RVUs"]
[null,null,null,null,null,"X",null,"Non-covered code"]
["PRIOR AUTH",null,"Prior authorization indicator              This column indicates whether prior authorization and utilization review is required. Link provided in cell."]
[]
[null,null,null,null,null,"Y-CM",null,"Prior authorization required, contact claims manager"]
[null,null,null,null,null,"Y-UR",null,"Prior authorization and UR required"]
[null,null,null,null,null,"Y-ONC",null,"Prior authorization required, contact occupational nurse consultant"]
[null,null,null,null,null,"Y-PHL",null,"Prior authorization required, contact Provider Hotline"]
[]
[]
["EVALUATION AND MANAGEMENT THROUGH HCPCS FEES"]
["FIELD KEY:  "]
["Column Title",null,"Column Description",null,null,null,null,null,"Column Values",null,"Value Definitions"]
["CPTÒ CODE/\nHCPCS CODE",null,"2021 CPT® or HCPCS code",null,null,null,null,null,null,null,"2021 CPT® or HCPCS code"]
[]
["ABBREVIATED DESCRIPTION",null,"Abbreviated HCPCS code description. No descriptions are provided for CPTÒ codes.",null,null,null,null,null,null,null,"Abbreviated description for reference purposes only. Refer to a 2021 CPT® or HCPCS code book for complete code descriptions."]
[]
[]
[]
["DOLLAR VALUE\nNON-FACILITY SETTING",null,"This column indicates the:\n• Maximum dollar amount for covered services provided in a non-facility setting, or\n• Pricing method for the procedure code, or\n• Coverage status for the procedure code.\n",null,null,null,null,null,"Dollar Value",null,"Maximum dollar amount payable for covered services."]
[null,null,null,null,null,null,null,null,"Bundled",null,"Bundled code, not separately payable."]
[null,null,null,null,null,null,null,null,"By Report",null,"Service paid on a “by report” basis."]
[null,null,null,null,null,null,null,null,"Contracted",null,"Contracted service. Payable only to department’s contracted vendor for State Fund claims. Payable to providers treating Self-Insured injured workers."]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,"Facility Only",null,"Procedure code for facility outpatient use only."]
[null,null,null,null,null,null,null,null,"Not Covered",null,"Procedure code is not covered."]
["DOLLAR VALUE\nFACILITY SETTING",null,"This column indicates the:\n• Maximum dollar amount for covered services provided in a facility setting, or\n• Pricing method for the procedure code, or\n• Coverage status for the procedure code.\n",null,null,null,null,null,"Dollar Value",null,"Maximum dollar amount payable for covered services."]
[null,null,null,null,null,null,null,null,"Bundled",null,"Bundled code, not separately payable."]
[null,null,null,null,null,null,null,null,"By Report",null,"Service paid on a “by report” basis."]
[null,null,null,null,null,null,null,null,"Contracted",null,"Contracted service. Payable only to department’s contracted vendor for State Fund claims. Payable to providers treating Self-Insured injured workers."]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,"Hosp. Only",null,"Procedure code for hospital outpatient use only."]
[null,null,null,null,null,null,null,null,"Not Covered",null,"Procedure code is not covered."]
[]
[]
[]
["Field Key: Evaluation & Management through HCPCS (continued)"]
["Column Title",null,"Column Description",null,null,null,null,null,"Column Values",null,"Value Definitions"]
["FOL UP",null,"Follow-up Days for Global Surgery",null,null,null,null,null,"Number",null,"The number of days following surgery during which charges for normal postoperative care are bundled in the global surgery fee."]
[]
[]
[]
["PRE OP \n(-56)",null,"Preoperative Percentage\n(Modifier –56)",null,null,null,null,null,"Percent",null,"The percent of the total global surgery dollar value that is allowed when modifier –56 is billed."]
[]
[]
["INTRA OP  (-54)",null,"Intraoperative Percentage\n(Modifier –54)",null,null,null,null,null,"Percent",null,"The percent of the total global surgery dollar value that is allowed when modifier -54 is billed."]
[]
[]
["POST OP \n(-55)",null,"Postoperative Percentage\n(Modifier –55)",null,null,null,null,null,"Percent ",null,"The percent of the total global surgery dollar value that is allowed when modifier -55 is billed."]
[]
[]
[]
[]
["Field Key: Evaluation & Management through HCPCS (continued)"]
["Column Title",null,"Column Description",null,null,null,null,null,"Column Values",null,"Value Definitions"]
["PCTC\n(26/TC)",null,"Professional and Technical Component (Modifiers –26 and –TC)\nThis field identifies whether professional and technical component modifiers (-26/-TC) are valid with the procedure code.",null,null,null,null,null,0,null,"Modifiers -26 and -TC are not valid. The procedure is for physician services only; the concept of PC/TC does not apply"]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,1,null,"Modifiers -26 and -TC are valid. Diagnostic test or radiology service which has both a professional and technical component. "]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,2,null,"Modifiers -26 and -TC are not valid. Stand alone code for the professional component of a diagnostic test. An associated code describes the technical component of the diagnostic test or the global procedure (professional and technical components)."]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,3,null,"Modifiers -26 and -TC are not valid. Stand alone code for the technical component of a diagnostic test. An associated code describes the professional component of the diagnostic test or the global procedure (professional and technical components). "]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,4,null,"Modifiers -26 and -TC are not valid. Stand alone code for the global procedure for a diagnostic test. Associated codes describe the professional and technical components of the diagnostic test. "]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,5,null,"Modifiers -26 and -TC are not valid. Covered service incident to a physician’s service when provided by auxiliary personnel employed by and working under the direct supervision of the physician. This service not payable when provided to hospital inpatients or outpatients."]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,6,null,"Modifier -TC is not valid; modifier -26 may be valid. Clinical laboratory or other service for which separate payment for interpretations by laboratory physicians or other physicians may be made."]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,7,null,"This indicator is not currently in use."]
[null,null,null,null,null,null,null,null,8,null,"Professional component of a clinical laboratory code; payable only if the physician interprets an abnormal smear for a hospital inpatient. No -TC modifier billing is recognized; payment for the underlying clinical laboratory test is made to the hospital. Not payable when furnished to hospital outpatients or non-hospital patients."]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,9,null,"Modifiers -26 and -TC are not valid. Concept of a professional/technical component split does not apply."]
[]
[]
[]
[]
["Field Key: Evaluation & Management through HCPCS (continued)"]
["Column Title",null,"Column Description",null,null,null,null,null,"Column Values",null,"Value Definitions"]
["MSI",null,"Multiple Surgery Indicator\n(Modifier –51)\nThis field indicates whether multiple surgery payment rules apply to the service.\n",null,null,null,null,null,0,null,"Modifier -51 is not valid. Payment adjustment rules for multiple surgeries do not apply."]
[]
[]
[null,null,null,null,null,null,null,null,1,null,"This indicator is not currently in use."]
[null,null,null,null,null,null,null,null,2,null,"Modifier -51 is valid. Standard multiple surgery payment policy applies (100%, 50%, 50%, 50%, 50%). "]
[]
[]
[]
[null,null,null,null,null,null,null,null,3,null,"Modifier -51 may be valid. Multiple endoscopic procedures payment policy applies if this service is billed with another endoscopy in the same family. "]
[]
[]
[]
[null,null,null,null,null,null,null,null,4,null,"This indicator is not currently in use."]
[null,null,null,null,null,null,null,null,5,null,"This indicator is not currently in use."]
[null,null,null,null,null,null,null,null,9,null,"Modifier -51 is not valid. Concept of multiple surgery does not apply."]
[]
[]
["BSI",null,"Bilateral Surgery Indicator\n(Modifier –50)\nThis field indicates whether the procedure is subject to a payment adjustment for bilateral surgery.\n",null,null,null,null,null,0,null,"Modifier -50 is not valid. Payment adjustment rule for bilateral surgery does not apply. "]
[]
[]
[null,null,null,null,null,null,null,null,1,null,"Modifier -50 is valid. Payment adjustment for bilateral procedures (150%) applies to this procedure."]
[]
[]
[]
[null,null,null,null,null,null,null,null,2,null,"Modifier -50 is not valid. Payment adjustment for bilateral procedures does not apply. Procedures in this category include services for which the code descriptor specifically states that the procedure is bilateral; procedures that are usually performed as bilateral procedures; or procedures for which the code descriptor indicates the procedures may be performed either unilaterally or bilaterally. "]
[]
[]
[]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,3,null,"Modifier -50 is not valid. Payment adjustment for bilateral procedure does not apply. This is a radiology procedure which is not subject to payment rules for bilateral surgeries. "]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,9,null,"Modifier -50 is not valid. Concept of bilateral surgery does not apply. "]
[]
[]
[]
["Field Key: Evaluation & Management through HCPCS (continued)"]
["Column Title",null,"Column Description",null,null,null,null,null,"Column Values",null,"Value Definitions"]
["ASI",null,"Assistant Surgeon Indicator\n(Modifiers –80, -81, -82)\nThis field indicates whether or not an assistant surgeon may be paid for the procedure.\n",null,null,null,null,null,0,null,"Modifiers -80, -81 and -82 are not valid under normal situations. Assistant at surgery is not usually paid for this procedure. Supporting documentation is necessary to establish medical necessity. "]
[]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,1,null,"Modifiers -80, -81 and -82 are not valid. Assistant at surgery may not be paid for this procedure. "]
[]
[]
[]
[null,null,null,null,null,null,null,null,2,null,"Modifiers -80, -81 and -82 are valid. Assistant at surgery may be paid."]
[]
[]
[null,null,null,null,null,null,null,null,9,null,"Modifiers -80, -81 and -82 are not valid. Concept does not apply."]
[]
[]
["CSI",null,"Co-surgeons Indicator\n(Modifier –62)\nThis field indicates whether or not co-surgeons may be paid for the procedure.\n",null,null,null,null,null,0,null,"Modifier -62 is not valid. Co-surgeons not permitted."]
[]
[]
[null,null,null,null,null,null,null,null,1,null,"Modifier -62 is not valid under normal situations. Supporting documentation is required to establish medical necessity of two surgeons."]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,2,null,"Modifier -62 is valid. Co-surgeons may be paid for this procedure. Supporting documentation is not required if two specialty requirement is met."]
[]
[]
[]
[null,null,null,null,null,null,null,null,9,null,"Modifier -62 is not valid with this procedure. Concept of co-surgeons does not apply."]
[]
[]
[]
["Field Key: Evaluation & Management through HCPCS (continued)"]
["Column Title",null,"Column Description",null,null,null,null,null,"Column Values",null,"Value Definitions"]
["TSI",null,"Team Surgeons Indicator\n(Modifier -66)\nThis field indicates whether or not team surgeons may be paid for the procedure.\n",null,null,null,null,null,0,null,"Modifier -66 is not valid. Team surgeons not permitted."]
[]
[]
[null,null,null,null,null,null,null,null,1,null,"Modifier -66 is not valid under normal situations. Team surgeons may be payable. Supporting documentation is required to establish medical necessity of a team."]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,2,null,"Modifier -66 is valid. Team surgeons permitted."]
[]
[null,null,null,null,null,null,null,null,9,null,"Modifier -66 is not valid. Concept of team surgery does not apply."]
[]
[]
["ENDO BASE",null,"Endoscopy Base Code",null,null,null,null,null,"Code number",null,"This column contains the endoscopic base code for procedure codes that are part of an endoscopy family. The Multiple Surgery Indicator for procedures in an endoscopy family is 3."]
[]
[]
[]
[]
["FSI",null,"Fee Schedule Indicator\nThis column indicates the payment status for the procedure code.",null,null,null,null,null,"B",null,"Bundled code, not separately payable."]
[null,null,null,null,null,null,null,null,"C",null,"Contracted service. Payable only to department’s contracted vendor for State Fund claims. Payable to providers treating Self-Insured injured workers. "]
[]
[]
[]
[null,null,null,null,null,null,null,null,"D",null,"Drug fee based on Average Wholesale Price (AWP) or Average Average Wholesale Price (AAWP)."]
[]
[]
[]
[null,null,null,null,null,null,null,null,"F",null,"Flat fee developed by the department"]
[null,null,null,null,null,null,null,null,"L",null,"Clinical lab fee"]
[null,null,null,null,null,null,null,null,"N",null,"No fee or RVUs available, code paid by report."]
[null,null,null,null,null,null,null,null,"O",null,"For hospital outpatient use only."]
[null,null,null,null,null,null,null,null,"R",null,"RBRVS fee"]
[null,null,null,null,null,null,null,null,"S",null,"State Rate"]
[null,null,null,null,null,null,null,null,"T",null,"Tracking code"]
[null,null,null,null,null,null,null,null,"X",null,"Non-covered code"]
[]
["Field Key: Evaluation & Management through HCPCS (continued)"]
["Column Title",null,"Column Description",null,null,null,null,null,"Column Values",null,"Value Definitions"]
["LIC\nREQ",null,"Licensure Required",null,null,null,null,null,"Y",null,"Appropriate professional licensure is required to bill the department for these codes."]
[]
[null,null,null,null,null,null,null,null,"blank",null,"No special professional licensure is required to bill the department."]
[]
["PRIOR           AUTH",null,"Prior authorization indicator \nThis column indicates whether prior authorization and utilization review is required.",null,null,null,null,null,"Y",null,"Prior authorization required"]
[]
[null,null,null,null,null,null,null,null,"Y-UR",null,"Prior authorization and UR required"]
[]
[]
["LOCAL CODES FEE SCHEDULE"]
["FIELD KEY:  "]
["Column Title",null,"Column Description",null,null,null,null,"Column Values",null,"Value Definitions"]
["LOCAL\nCODE",null,"2021 Local Code.",null,null,null,null,null,null,"A code assigned by the department to represent a specific service that is unique to injured workers."]
["Description",null,"Local Code Description",null,null,null,null,null,null,"Description of the unique service."]
["Dollar Value Nonfacility Setting",null,"This column indicates the:\nMaximum dollar amount for covered services provided in a non-facility setting, or\nPricing method for the procedure code",null,null,null,null,"Dollar Value",null,"Maximum dollar amount payable for covered services."]
[null,null,null,null,null,null,null,"By Report",null,"No fee or RVUs available, code paid By Report"]
[null,null,null,null,null,null,null,"Contracted",null,"Contracted service. \nPayable only to department’s contracted vendor for State Fund claims. \nPayable to providers treating Self-Insured injured workers."]
[null,null,null,null,null,null,null,"State Rate",null,"Service paid at state rate for travel or lodging."]
["Dollar Value Facility Setting",null,"This column indicates the:\nMaximum dollar amount for covered services provided in a facility setting, or\nPricing method for the procedure code",null,null,null,null,"Dollar Value",null,"Maximum dollar amount payable for covered services."]
[null,null,null,null,null,null,null,"By Report",null,"No fee or RVUs available, code paid By Report"]
[null,null,null,null,null,null,null,"Contracted",null,"Contracted service. \n\nPayable only to department’s contracted vendor for State Fund claims. \n\nPayable to providers treating Self-Insured injured workers."]
[null,null,null,null,null,null,null,"State Rate",null,"Service paid at state rate for travel or lodging."]
[]
["Field Key: Local Codes (continued)"]
["Column Title",null,"Column Description",null,null,null,null,"Column Values",null,"Value Definitions"]
["Payment Policy Reference",null,"The reason for the code or a reference to a page in another document where the reason for the code can be found",null,null,null,null,"To reimburse claimant’s costs",null,"Reference to payment policies related to the local code."]
[null,null,null,null,null,null,null,"Professional Services",null,"The local code is used to pay professional services."]
[null,null,null,null,null,null,null,"Facility Services",null,"The local code is used to pay facility services."]
[null,null,null,null,null,null,null,"Medical Examiner’s Handbook",null,"A publication for Independent Medical Examiners"]
[null,null,null,null,null,null,null,"For approved DPE providers only",null,"Disability Prevention Evaluation providers"]
[]
["LOCAL CODES by SPECIALTY FEE SCHEDULE"]
["FIELD KEY:  "]
["Column Title",null,"Column Description",null,null,null,null,"Column Values",null,"Value Definitions"]
["Specialty Code",null,"Code assigned to the specialty",null,null,null,null,"AU",null,"Audiology"]
[null,null,null,null,null,null,null,"CM",null,"Case Management"]
[null,null,null,null,null,null,null,"CH",null,"Chiropractic Care"]
[null,null,null,null,null,null,null,"CL",null,"Claimant Only"]
[null,null,null,null,null,null,null,"DM",null,"Durable Medical Equipment & Supplies"]
[null,null,null,null,null,null,null,"EM",null,"Employer Reimbursement"]
[null,null,null,null,null,null,null,"HM",null,"Home Modification"]
[null,null,null,null,null,null,null,"HC",null,"Home & Attendant Care"]
[null,null,null,null,null,null,null,"HO",null,"Hospice Care"]
[null,null,null,null,null,null,null,"IM",null,"Independent Medical Exam"]
[null,null,null,null,null,null,null,"IR",null,"Impairment Rating"]
[null,null,null,null,null,null,null,"IN",null,"Interpretive Services"]
[null,null,null,null,null,null,null,"JM",null,"Job Modification"]
[null,null,null,null,null,null,null,"MS",null,"Miscellaneous & Special Services"]
[null,null,null,null,null,null,null,"PA",null,"Pain Treatment"]
[null,null,null,null,null,null,null,"RS",null,"Residential Services"]
[null,null,null,null,null,null,null,"RT",null,"Retraining"]
[null,null,null,null,null,null,null,"SR",null,"Special Reports"]
[null,null,null,null,null,null,null,"TL",null,"Travel, Lodging & Meals"]
[null,null,null,null,null,null,null,"UR",null,"Utilization Review Services"]
[null,null,null,null,null,null,null,"VM",null,"Vehicle Modification"]
[null,null,null,null,null,null,null,"VR",null,"Vocational & Related Services"]
[null,null,null,null,null,null,null,"WL",null,"Weight Loss Services"]
[null,null,null,null,null,null,null,"WH ",null,"Work Hardening"]
["Specialty Title",null,null,null,null,null,null,null,null,"Title of the area or specialty to which the local code pertains"]
[]
["Field Key: Local Codes by Specialty (continued)"]
["Column Title",null,"Column Description",null,null,null,null,"Column Values",null,"Value Definitions"]
["LOCAL\nCODE",null,"2022 Local Code.",null,null,null,null,null,null,"A code assigned by the department to represent a specific service that is unique to injured workers."]
["Description",null,"Local Code Description",null,null,null,null,null,null,"Description of the unique service."]
["Dollar Value Nonfacility Setting",null,"This column indicates the:\nMaximum dollar amount for covered services provided in a non-facility setting, or\nPricing method for the procedure code",null,null,null,null,"Dollar Value",null,"Maximum dollar amount payable for covered services."]
[null,null,null,null,null,null,null,"By Report",null,"No fee or RVUs available, code paid By Report"]
[null,null,null,null,null,null,null,"Contracted",null,"Contracted service. \n\nPayable only to department’s contracted vendor for State Fund claims. \n\nPayable to providers treating Self-Insured injured workers."]
[null,null,null,null,null,null,null,"State Rate",null,"Service paid at state rate for travel or lodging."]
["Dollar Value Facility Setting",null,"This column indicates the:\nMaximum dollar amount for covered services provided in a facility setting, or\nPricing method for the procedure code",null,null,null,null,"Dollar Value",null,"Maximum dollar amount payable for covered services."]
[null,null,null,null,null,null,null,"By Report",null,"No fee or RVUs available, code paid By Report"]
[null,null,null,null,null,null,null,"Contracted",null,"Contracted service. \n\nPayable only to department’s contracted vendor for State Fund claims. \n\nPayable to providers treating Self-Insured injured workers."]
[null,null,null,null,null,null,null,"State Rate",null,"Service paid at state rate for travel or lodging."]
[]
["Field Key: Local Codes by Specialty (continued)"]
["Column Title",null,"Column Description",null,null,null,null,"Column Values",null,"Value Definitions"]
["Payment Policy Reference",null,"The reason for the code or a reference to a page in another document where the reason for the code can be found",null,null,null,null,"To reimburse claimant’s costs",null,"Reference to payment policies related to the local code."]
[null,null,null,null,null,null,null,"Professional Services, Page nn",null,"The location within the Professional Services of the Medical Aid Rules and Fee Schedule where the code is discussed."]
[null,null,null,null,null,null,null,"Facility Services, Page nn",null,"The location within the Facility Services of the Medical Aid Rules and Fee Schedule where the code is discussed."]
[null,null,null,null,null,null,null,"Medical Examiner’s Handbook",null,"A publication for Independent Medical Examiners"]
[null,null,null,null,null,null,null,"For approved DPE providers only",null,"Disability Prevention Evaluation providers"]

{"sheet":"2022 Professional Fee Schedule","index":3,"n_rows":20003,"n_cols":22,"rows_kept":4500,"cut":true,"hidden":false,"merged":[[0,0,0,11],[1,0,1,11],[4,4,4,7],[4,9,4,17],[5,4,5,5],[5,6,5,7]],"bounds":{"rows_first":2000,"rows_last":500,"rows_between":2000,"halvings":0}}
["Professional Services Fee Schedule"]
[]
[]
[]
[null,null,null,null,"DOLLAR VALUE",null,null,null,null,"MODIFIERS"]
["CODE","Modifiers","Short Description (HCPCS and Local Only)",null,"NON-FACILITY SETTING",null,"FACILITY SETTING",null,"FOL UP","PRE OP\n(-56)","INTRA OP\n(-54)","POST OP\n(-55)","PCTC\n(26/TC)","MSI\n(-51)","BSI\n(-50)","ASI\n(-80)","CSI\n(-62)","TSI\n(-66)","ENDO\nBASE","FSI","LIC REQ","Prior Auth"]
[10004,null,"See CPT",null,90.973799999999997,null,75.514200000000002,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[10005,null,"See CPT",null,252.11040000000003,null,130.2174,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[10006,null,"See CPT",null,107.62260000000001,null,88.595399999999998,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[10007,null,"See CPT",null,559.51859999999999,null,159.94739999999999,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[10008,null,"See CPT",null,304.43520000000001,null,100.48739999999999,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[10009,null,"See CPT",null,844.33199999999999,null,195.02879999999999,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[10010,null,"See CPT",null,494.11260000000004,null,139.73099999999999,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[10011,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,2,0,0,0,0,null,"N",null,"Y-CM"]
[10012,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,0,0,0,0,0,null,"N",null,"Y-CM"]
[10021,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,0,0,0,0,null,"X"]
[10030,null,"See CPT",null,1240.9302,null,236.6508,null,"000",0,0,0,9,2,9,0,0,0,null,"R",null,"Y-CM"]
[10035,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,1,0,0,0,null,"X"]
[10036,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[10040,null,"See CPT",null,213.4614,null,91.568399999999997,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[10060,null,"See CPT",null,227.13720000000001,null,188.48820000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[10061,null,"See CPT",null,385.8954,null,328.2192,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[10080,null,"See CPT",null,478.65300000000008,null,187.89360000000002,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[10081,null,"See CPT",null,645.73559999999998,null,305.02980000000002,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[10120,null,"See CPT",null,275.2998,null,186.10980000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[10121,null,"See CPT",null,483.40980000000008,null,327.03000000000003,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[10140,null,"See CPT",null,311.57040000000001,null,211.083,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[10160,null,"See CPT",null,236.05620000000002,null,170.0556,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[10180,null,"See CPT",null,482.22059999999999,null,317.51639999999998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11000,null,"See CPT",null,106.43340000000001,null,48.757199999999997,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11001,null,"See CPT",null,48.162600000000005,null,24.973199999999999,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[11004,null,"See CPT",null,997.14419999999996,null,997.14419999999996,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11005,null,"See CPT",null,1356.8772000000001,null,1356.8772000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[11006,null,"See CPT",null,1227.2544,null,1227.2544,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11008,null,"See CPT",null,478.05839999999995,null,478.05839999999995,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[11010,null,"See CPT",null,831.84540000000004,null,488.76120000000003,null,"010",0.1,0.8,0.1,0,2,2,1,0,0,null,"R"]
[11011,null,"See CPT",null,912.1164,null,522.05880000000002,null,"000",0,0,0,0,2,2,1,0,0,null,"R"]
[11012,null,"See CPT",null,1181.4702,null,731.95260000000007,null,"000",0,0,0,0,2,2,1,0,0,null,"R"]
[11042,null,"See CPT",null,239.02919999999997,null,106.43340000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11043,null,"See CPT",null,422.166,null,270.54300000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11044,null,"See CPT",null,557.73480000000006,null,394.81439999999998,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11045,null,"See CPT",null,73.730400000000003,null,45.784199999999998,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[11046,null,"See CPT",null,131.4066,null,96.919799999999995,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[11047,null,"See CPT",null,214.6506,null,169.46100000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[11055,null,"See CPT",null,134.37959999999998,null,27.946199999999997,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11056,null,"See CPT",null,153.4068,null,38.649000000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11057,null,"See CPT",null,167.6772,null,50.540999999999997,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11102,null,"See CPT",null,189.08280000000002,null,66.595200000000006,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11103,null,"See CPT",null,93.94680000000001,null,38.649000000000001,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[11104,null,"See CPT",null,234.86700000000002,null,82.6494,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11105,null,"See CPT",null,109.4064,null,45.189599999999999,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[11106,null,"See CPT",null,290.75939999999997,null,99.892799999999994,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11107,null,"See CPT",null,132.00120000000001,null,54.703200000000002,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[11200,null,"See CPT",null,164.1096,null,136.1634,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11201,null,"See CPT",null,32.703000000000003,null,28.540800000000001,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[11300,null,"See CPT",null,189.67740000000001,null,60.054600000000001,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[11301,null,"See CPT",null,226.54259999999999,null,89.784599999999998,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[11302,null,"See CPT",null,255.678,null,105.83880000000001,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[11303,null,"See CPT",null,281.84040000000005,null,124.2714,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[11305,null,"See CPT",null,198.59639999999999,null,67.189799999999991,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[11306,null,"See CPT",null,227.73180000000002,null,86.811599999999999,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[11307,null,"See CPT",null,259.84019999999998,null,110.5956,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[11308,null,"See CPT",null,274.70519999999999,null,124.2714,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[11310,null,"See CPT",null,215.8398,null,80.271000000000001,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[11311,null,"See CPT",null,253.89419999999998,null,110.001,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[11312,null,"See CPT",null,287.1918,null,129.62280000000001,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[11313,null,"See CPT",null,334.16520000000003,null,169.46100000000001,null,"000",0,0,0,0,2,9,0,0,0,null,"R"]
[11400,null,"See CPT",null,236.05620000000002,null,149.83920000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11401,null,"See CPT",null,287.78640000000001,null,189.08280000000002,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11402,null,"See CPT",null,316.3272,null,206.92080000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11403,null,"See CPT",null,361.51679999999999,null,265.19159999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11404,null,"See CPT",null,410.86860000000001,null,292.54320000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11406,null,"See CPT",null,579.1404,null,440.59860000000003,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11420,null,"See CPT",null,235.4616,null,147.46080000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11421,null,"See CPT",null,293.73240000000004,null,195.02879999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11422,null,"See CPT",null,328.81380000000001,null,242.00220000000002,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11423,null,"See CPT",null,374.0034,null,277.08359999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11424,null,"See CPT",null,427.51740000000001,null,315.73259999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11426,null,"See CPT",null,603.51900000000001,null,482.81519999999995,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11440,null,"See CPT",null,264.59700000000004,null,189.67740000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11441,null,"See CPT",null,319.89479999999998,null,237.84,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11442,null,"See CPT",null,353.78700000000003,null,261.62400000000002,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11443,null,"See CPT",null,416.22,null,318.7056,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11444,null,"See CPT",null,516.11279999999999,null,401.94959999999998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11446,null,"See CPT",null,699.24959999999999,null,567.84300000000007,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11450,null,"See CPT",null,805.68300000000011,null,469.73400000000004,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R"]
[11451,null,"See CPT",null,974.54939999999999,null,590.43780000000004,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R"]
[11462,null,"See CPT",null,783.08820000000003,null,447.13919999999996,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R"]
[11463,null,"See CPT",null,991.79279999999994,null,596.38379999999995,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R"]
[11470,null,"See CPT",null,843.14279999999997,null,511.95059999999995,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[11471,null,"See CPT",null,1006.6578,null,628.49220000000003,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[11600,null,"See CPT",null,364.4898,null,217.62360000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11601,null,"See CPT",null,419.19299999999998,null,263.40780000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11602,null,"See CPT",null,446.5446,null,286.59720000000004,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11603,null,"See CPT",null,507.19379999999995,null,341.30040000000002,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11604,null,"See CPT",null,564.87,null,375.78720000000004,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11606,null,"See CPT",null,809.25059999999996,null,560.11320000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11620,null,"See CPT",null,365.67900000000003,null,218.81280000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11621,null,"See CPT",null,420.38220000000001,null,264.59700000000004,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11622,null,"See CPT",null,461.40960000000001,null,299.67840000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11623,null,"See CPT",null,538.70760000000007,null,369.84120000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11624,null,"See CPT",null,612.4380000000001,null,420.38220000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11626,null,"See CPT",null,737.30400000000009,null,516.70740000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11640,null,"See CPT",null,374.0034,null,225.35339999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11641,null,"See CPT",null,433.46340000000004,null,275.2998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11642,null,"See CPT",null,488.76120000000003,null,322.27319999999997,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11643,null,"See CPT",null,572.59980000000007,null,401.94959999999998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11644,null,"See CPT",null,704.601,null,498.86940000000004,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11646,null,"See CPT",null,912.71100000000001,null,689.73599999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11719,null,"See CPT",null,24.973199999999999,null,13.081200000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11720,null,"See CPT",null,58.865400000000001,null,25.567799999999998,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[11721,null,"See CPT",null,79.676400000000001,null,42.2166,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[11730,null,"See CPT",null,211.67760000000001,null,94.54140000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11732,null,"See CPT",null,61.2438,null,30.3246,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[11740,null,"See CPT",null,105.24420000000001,null,56.486999999999995,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11750,null,"See CPT",null,293.13779999999997,null,180.75839999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11755,null,"See CPT",null,225.94799999999998,null,106.43340000000001,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[11760,null,"See CPT",null,346.65180000000004,null,198.0018,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11762,null,"See CPT",null,531.57240000000002,null,335.94900000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11765,null,"See CPT",null,306.21900000000005,null,164.1096,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[11770,null,"See CPT",null,671.30340000000001,null,331.78680000000003,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11771,null,"See CPT",null,1160.0646000000002,null,806.27760000000001,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11772,null,"See CPT",null,1428.2292,null,1047.0906,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[11900,null,"See CPT",null,103.46040000000001,null,51.730200000000004,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11901,null,"See CPT",null,127.839,null,80.865600000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[11920,null,"See CPT",null,356.76,null,194.4342,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[11921,null,"See CPT",null,404.92259999999999,null,229.51560000000001,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[11922,null,"See CPT",null,109.4064,null,51.730200000000004,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[11950,null,"See CPT",null,144.48780000000002,null,91.568399999999997,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[11951,null,"See CPT",null,193.83959999999999,null,129.0282,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[11952,null,"See CPT",null,258.0564,null,181.35299999999998,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[11954,null,"See CPT",null,284.21880000000004,null,198.0018,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[11960,null,"See CPT",null,1827.8003999999999,null,1827.8003999999999,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[11970,null,"See CPT",null,1004.2794,null,1004.2794,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R"]
[11971,null,"See CPT",null,984.0630000000001,null,984.0630000000001,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R"]
[11976,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,0,0,0,0,null,"X"]
[11980,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,0,1,0,0,null,"X"]
[11981,null,"See CPT",null,183.13679999999999,null,111.1902,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[11982,null,"See CPT",null,204.54239999999999,null,130.2174,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[11983,null,"See CPT",null,256.27259999999995,null,181.94759999999999,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[12001,null,"See CPT",null,171.2448,null,79.081800000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[12002,null,"See CPT",null,205.73160000000001,null,103.46040000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[12004,null,"See CPT",null,238.43459999999999,null,127.24440000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[12005,null,"See CPT",null,321.084,null,165.89340000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[12006,null,"See CPT",null,374.59800000000001,null,203.9478,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[12007,null,"See CPT",null,420.38220000000001,null,254.48880000000003,null,"000",0,0,0,0,2,0,1,1,0,null,"R"]
[12011,null,"See CPT",null,204.54239999999999,null,96.325200000000009,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[12013,null,"See CPT",null,212.86680000000001,null,101.67659999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[12014,null,"See CPT",null,260.4348,null,130.2174,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[12015,null,"See CPT",null,311.57040000000001,null,164.70420000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[12016,null,"See CPT",null,397.78740000000005,null,224.75879999999998,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[12017,null,"See CPT",null,265.78620000000001,null,265.78620000000001,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[12018,null,"See CPT",null,301.4622,null,301.4622,null,"000",0,0,0,0,2,0,2,0,0,null,"R"]
[12020,null,"See CPT",null,551.78879999999992,null,334.16520000000003,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12021,null,"See CPT",null,322.27319999999997,null,251.51580000000004,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12031,null,"See CPT",null,487.57199999999995,null,268.75919999999996,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12032,null,"See CPT",null,557.14019999999994,null,336.54360000000003,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12034,null,"See CPT",null,614.81640000000004,null,363.30060000000003,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12035,null,"See CPT",null,714.1146,null,427.51740000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12036,null,"See CPT",null,793.19640000000004,null,501.8424,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12037,null,"See CPT",null,883.57560000000001,null,580.32960000000003,null,"010",0.1,0.8,0.1,0,2,0,0,1,0,null,"R"]
[12041,null,"See CPT",null,489.35580000000004,null,255.08340000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12042,null,"See CPT",null,570.81600000000003,null,346.65180000000004,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12044,null,"See CPT",null,701.62800000000004,null,377.57099999999997,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12045,null,"See CPT",null,748.0068,null,482.22059999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12046,null,"See CPT",null,923.41379999999992,null,567.84300000000007,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[12047,null,"See CPT",null,1007.847,null,629.68140000000005,null,"010",0.1,0.8,0.1,0,2,0,2,1,0,null,"R"]
[12051,null,"See CPT",null,523.84260000000006,null,300.27299999999997,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12052,null,"See CPT",null,580.32960000000003,null,352.59780000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12053,null,"See CPT",null,671.30340000000001,null,379.35480000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12054,null,"See CPT",null,709.3578,null,385.30080000000004,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12055,null,"See CPT",null,926.98140000000001,null,528.00480000000005,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[12056,null,"See CPT",null,1064.3339999999998,null,683.79,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[12057,null,"See CPT",null,1121.4156,null,744.43920000000003,null,"010",0.1,0.8,0.1,0,2,0,2,1,0,null,"R"]
[13100,null,"See CPT",null,628.49220000000003,null,354.38159999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[13101,null,"See CPT",null,733.14179999999999,null,440.59860000000003,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[13102,null,"See CPT",null,213.4614,null,127.24440000000001,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[13120,null,"See CPT",null,654.65459999999996,null,414.43619999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[13121,null,"See CPT",null,782.49360000000001,null,454.27440000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[13122,null,"See CPT",null,230.70480000000001,null,144.48780000000002,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[13131,null,"See CPT",null,712.33080000000007,null,427.51740000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[13132,null,"See CPT",null,863.9538,null,534.54539999999997,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[13133,null,"See CPT",null,303.84060000000005,null,220.00200000000001,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[13151,null,"See CPT",null,774.76379999999995,null,491.73419999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[13152,null,"See CPT",null,908.54880000000003,null,592.22160000000008,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[13153,null,"See CPT",null,333.57060000000001,null,240.2184,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[13160,null,"See CPT",null,1418.7156,null,1418.7156,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[14000,null,"See CPT",null,1150.5510000000002,null,895.46760000000006,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[14001,null,"See CPT",null,1461.5267999999999,null,1160.0646000000002,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[14020,null,"See CPT",null,1268.8764000000001,null,1005.4686,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[14021,null,"See CPT",null,1559.6358,null,1256.9844000000001,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[14040,null,"See CPT",null,1365.7962,null,1104.7667999999999,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[14041,null,"See CPT",null,1654.7718,null,1348.5527999999999,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[14060,null,"See CPT",null,1378.8774000000001,null,1178.4972,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[14061,null,"See CPT",null,1783.8,null,1448.4456,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[14301,null,"See CPT",null,1956.2339999999999,null,1539.4194,null,"090",0.1,0.71,0.19,0,2,0,2,0,0,null,"R"]
[14302,null,"See CPT",null,379.35480000000001,null,379.35480000000001,null,"000",0,0,0,0,0,0,2,0,0,null,"R"]
[14350,null,"See CPT",null,1211.2002,null,1211.2002,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[15002,null,"See CPT",null,635.03279999999995,null,386.49,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[15003,null,"See CPT",null,126.6498,null,79.676400000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[15004,null,"See CPT",null,720.65519999999992,null,460.22040000000004,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[15005,null,"See CPT",null,211.083,null,159.3528,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[15040,null,"See CPT",null,487.57199999999995,null,217.62360000000001,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[15050,null,"See CPT",null,1086.9288000000001,null,829.46699999999998,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15100,null,"See CPT",null,1575.0953999999999,null,1276.0116,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15101,null,"See CPT",null,345.46260000000001,null,198.59639999999999,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[15110,null,"See CPT",null,1495.4189999999999,null,1259.3628000000001,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15111,null,"See CPT",null,199.78559999999999,null,178.38,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[15115,null,"See CPT",null,1445.4726000000001,null,1221.903,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15116,null,"See CPT",null,290.75939999999997,null,262.21860000000004,null,"000",0,0,0,0,0,0,1,1,0,null,"R"]
[15120,null,"See CPT",null,1526.3382000000001,null,1225.4705999999999,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15121,null,"See CPT",null,387.67919999999998,null,239.62380000000002,null,"000",0,0,0,0,0,0,1,1,0,null,"R"]
[15130,null,"See CPT",null,1314.6605999999999,null,1067.307,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15131,null,"See CPT",null,172.434,null,158.1636,null,"000",0,0,0,0,0,0,1,1,0,null,"R"]
[15135,null,"See CPT",null,1584.0144,null,1347.9582,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15136,null,"See CPT",null,170.65020000000001,null,158.1636,null,"000",0,0,0,0,0,0,1,1,0,null,"R"]
[15150,null,"See CPT",null,1277.2008000000001,null,1142.2266,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15151,null,"See CPT",null,209.8938,null,192.65040000000002,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[15152,null,"See CPT",null,259.84019999999998,null,244.38060000000002,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[15155,null,"See CPT",null,1432.9860000000001,null,1298.6064000000001,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15156,null,"See CPT",null,281.84040000000005,null,264.59700000000004,null,"000",0,0,0,0,0,0,1,1,0,null,"R"]
[15157,null,"See CPT",null,313.35419999999999,null,287.78640000000001,null,"000",0,0,0,0,0,0,1,1,0,null,"R"]
[15200,null,"See CPT",null,1516.23,null,1195.7406000000001,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15201,null,"See CPT",null,257.46179999999998,null,133.785,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[15220,null,"See CPT",null,1390.1748,null,1083.3612000000001,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15221,null,"See CPT",null,240.2184,null,121.2984,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[15240,null,"See CPT",null,1674.3936000000001,null,1413.3642,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15241,null,"See CPT",null,316.3272,null,184.92060000000001,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[15260,null,"See CPT",null,1793.9082000000001,null,1498.9866000000002,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15261,null,"See CPT",null,375.19259999999997,null,240.2184,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[15271,null,"See CPT",null,283.02960000000002,null,147.46080000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[15272,null,"See CPT",null,45.189599999999999,null,30.9192,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[15273,null,"See CPT",null,576.76199999999994,null,347.24639999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[15274,null,"See CPT",null,153.4068,null,79.676400000000001,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[15275,null,"See CPT",null,290.75939999999997,null,164.1096,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[15276,null,"See CPT",null,58.270800000000001,null,44.594999999999999,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[15277,null,"See CPT",null,632.05980000000011,null,395.40900000000005,null,"000",0,0,0,0,2,0,1,1,0,null,"R"]
[15278,null,"See CPT",null,176.59620000000001,null,99.298199999999994,null,"000",0,0,0,0,0,0,1,1,0,null,"R"]
[15570,null,"See CPT",null,1647.6366,null,1304.5524,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15572,null,"See CPT",null,1578.663,null,1303.9577999999999,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15574,null,"See CPT",null,1588.7711999999999,null,1315.2552000000001,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15576,null,"See CPT",null,1417.5264,null,1158.8753999999999,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15600,null,"See CPT",null,623.14080000000001,null,380.54400000000004,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[15610,null,"See CPT",null,673.68180000000007,null,436.43639999999999,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[15620,null,"See CPT",null,816.98040000000003,null,585.08640000000003,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15630,null,"See CPT",null,841.35900000000004,null,613.62720000000002,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15650,null,"See CPT",null,930.54899999999998,null,681.41160000000002,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[15730,null,"See CPT",null,2619.8076000000001,null,1626.231,null,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R"]
[15731,null,"See CPT",null,2019.8561999999999,null,1776.6648,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[15733,null,"See CPT",null,1833.7464,null,1833.7464,null,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R"]
[15734,null,"See CPT",null,2667.3755999999998,null,2667.3755999999998,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[15736,null,"See CPT",null,2167.9115999999999,null,2167.9115999999999,null,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R"]
[15738,null,"See CPT",null,2267.2098000000001,null,2267.2098000000001,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[15740,null,"See CPT",null,1814.1246000000001,null,1490.6622,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15750,null,"See CPT",null,1660.1232000000002,null,1660.1232000000002,null,"090",0.1,0.71,0.19,0,2,0,2,0,0,null,"R"]
[15756,null,"See CPT",null,4061.7126000000003,null,4061.7126000000003,null,"090",0.1,0.71,0.19,0,2,0,2,2,0,null,"R"]
[15757,null,"See CPT",null,4039.1178000000004,null,4039.1178000000004,null,"090",0.1,0.71,0.19,0,2,0,2,2,0,null,"R"]
[15758,null,"See CPT",null,4036.1447999999996,null,4036.1447999999996,null,"090",0.1,0.71,0.19,0,2,0,2,2,0,null,"R"]
[15760,null,"See CPT",null,1522.7706000000001,null,1244.4978000000001,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15769,null,"See CPT",null,853.84559999999999,null,853.84559999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[15770,null,"See CPT",null,1200.4974000000002,null,1200.4974000000002,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[15771,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"X"]
[15772,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,0,0,1,0,0,null,"X"]
[15773,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"X"]
[15774,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,0,0,1,0,0,null,"X"]
[15775,null,"See CPT",null,686.76300000000003,null,451.3014,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[15776,null,"See CPT",null,926.38679999999999,null,616.60019999999997,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[15777,null,"See CPT",null,378.7602,null,378.7602,null,"000",0,0,0,0,0,1,1,0,0,null,"R"]
[15780,null,"See CPT",null,1531.6896000000002,null,1174.9296000000002,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[15781,null,"See CPT",null,985.25220000000002,null,768.81780000000003,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15782,null,"See CPT",null,881.79179999999997,null,656.4384,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[15783,null,"See CPT",null,812.81820000000005,null,628.49220000000003,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[15786,null,"See CPT",null,424.5444,null,236.6508,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[15787,null,"See CPT",null,56.486999999999995,null,30.3246,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[15788,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"X"]
[15789,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"X"]
[15792,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"X"]
[15793,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"X"]
[15819,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"X"]
[15820,null,"See CPT",null,1044.1176,null,922.22460000000001,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[15821,null,"See CPT",null,1120.8210000000001,null,987.03600000000006,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[15822,null,"See CPT",null,838.98059999999998,null,718.87139999999999,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[15823,null,"See CPT",null,1121.4156,null,986.44140000000004,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[15824,null,"See CPT",null,1576.4879493792002,null,1576.4879493792002,null,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM"]
[15825,null,"See CPT",null,1355.5079139888001,null,1355.5079139888001,null,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM"]
[15826,null,"See CPT",null,1281.8334795552003,null,1281.8334795552003,null,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM"]
[15828,null,"See CPT",null,4390.6220248176014,null,4390.6220248176014,null,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM"]
[15829,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,2,1,0,0,0,null,"N",null,"Y-CM"]
[15830,null,"See CPT",null,2085.2622000000001,null,2085.2622000000001,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[15832,null,"See CPT",null,1635.7446000000002,null,1635.7446000000002,null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[15833,null,"See CPT",null,1565.5817999999999,null,1565.5817999999999,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[15834,null,"See CPT",null,1594.1225999999999,null,1594.1225999999999,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[15835,null,"See CPT",null,1658.934,null,1658.934,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[15836,null,"See CPT",null,1424.067,null,1424.067,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[15837,null,"See CPT",null,1564.9872,null,1278.9846,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[15838,null,"See CPT",null,1161.8483999999999,null,1161.8483999999999,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[15839,null,"See CPT",null,1609.5822000000001,null,1318.8227999999999,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[15840,null,"See CPT",null,1813.53,null,1813.53,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15841,null,"See CPT",null,3167.4342000000001,null,3167.4342000000001,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[15842,null,"See CPT",null,4792.4759999999997,null,4792.4759999999997,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[15845,null,"See CPT",null,1894.3956000000001,null,1894.3956000000001,null,"090",0.1,0.71,0.19,0,2,0,2,0,0,null,"R"]
[15847,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,0,0,2,1,0,null,"N",null,"Y-CM"]
[15850,null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"Bundledundled"]
[15851,null,"See CPT",null,197.40719999999999,null,79.081800000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[15852,null,"See CPT",null,82.0548,null,82.0548,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[15860,null,"See CPT",null,187.29900000000001,null,187.29900000000001,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[15876,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,0,0,0,0,null,"X"]
[15877,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,0,0,0,0,null,"X"]
[15878,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,1,0,0,0,null,"X"]
[15879,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,1,0,0,0,null,"X"]
[15920,null,"See CPT",null,1149.9564,null,1149.9564,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[15922,null,"See CPT",null,1429.4184,null,1429.4184,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[15931,null,"See CPT",null,1251.0383999999999,null,1251.0383999999999,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15933,null,"See CPT",null,1562.6088000000002,null,1562.6088000000002,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[15934,null,"See CPT",null,1694.6100000000001,null,1694.6100000000001,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15935,null,"See CPT",null,2067.4242000000004,null,2067.4242000000004,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[15936,null,"See CPT",null,1615.5282000000002,null,1615.5282000000002,null,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R"]
[15937,null,"See CPT",null,1869.4224000000002,null,1869.4224000000002,null,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R"]
[15940,null,"See CPT",null,1254.0114000000001,null,1254.0114000000001,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15941,null,"See CPT",null,1670.826,null,1670.826,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[15944,null,"See CPT",null,1673.2044000000001,null,1673.2044000000001,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[15945,null,"See CPT",null,1824.8274000000001,null,1824.8274000000001,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R"]
[15946,null,"See CPT",null,2887.3776000000003,null,2887.3776000000003,null,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R"]
[15950,null,"See CPT",null,1143.4158,null,1143.4158,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R"]
[15951,null,"See CPT",null,1614.9336000000001,null,1614.9336000000001,null,"090",0.1,0.71,0.19,0,2,0,0,1,0,null,"R"]
[15952,null,"See CPT",null,1639.3122000000001,null,1639.3122000000001,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[15953,null,"See CPT",null,1807.5839999999998,null,1807.5839999999998,null,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R"]
[15956,null,"See CPT",null,2094.7757999999999,null,2094.7757999999999,null,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R"]
[15958,null,"See CPT",null,2132.2356,null,2132.2356,null,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R"]
[15999,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,2,0,0,1,1,null,"N"]
[16000,null,"See CPT",null,137.3526,null,79.081800000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[16020,null,"See CPT",null,154.596,null,96.919799999999995,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[16025,null,"See CPT",null,286.00259999999997,null,196.8126,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[16030,null,"See CPT",null,357.94919999999996,null,231.89400000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[16035,null,"See CPT",null,337.13819999999998,null,337.13819999999998,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[16036,null,"See CPT",null,137.3526,null,137.3526,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[17000,null,"See CPT",null,122.4876,null,98.703599999999994,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17003,null,"See CPT",null,12.486599999999999,null,3.5676000000000001,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[17004,null,"See CPT",null,309.19200000000001,null,173.02860000000001,null,"010",0.1,0.8,0.1,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[17106,null,"See CPT",null,618.38400000000001,null,488.76120000000003,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17107,null,"See CPT",null,805.68300000000011,null,637.41120000000001,null,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17108,null,"See CPT",null,1133.3075999999999,null,928.76519999999994,null,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[17110,null,"See CPT",null,208.7046,null,119.51459999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17111,null,"See CPT",null,243.78599999999997,null,145.67700000000002,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17250,null,"See CPT",null,165.89340000000001,null,66.595200000000006,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[17260,null,"See CPT",null,181.94759999999999,null,125.4606,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17261,null,"See CPT",null,270.54300000000001,null,152.81219999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17262,null,"See CPT",null,326.43540000000002,null,194.4342,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17263,null,"See CPT",null,352.59780000000001,null,215.24520000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17264,null,"See CPT",null,376.97640000000001,null,230.11020000000002,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17266,null,"See CPT",null,428.11200000000002,null,269.94839999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17270,null,"See CPT",null,271.13759999999996,null,166.488,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17271,null,"See CPT",null,302.65140000000002,null,184.32600000000002,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17272,null,"See CPT",null,344.27339999999998,null,213.4614,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17273,null,"See CPT",null,380.54400000000004,null,241.40759999999997,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17274,null,"See CPT",null,443.57159999999999,null,294.92160000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17276,null,"See CPT",null,514.92359999999996,null,354.97620000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17280,null,"See CPT",null,255.678,null,152.2176,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17281,null,"See CPT",null,327.62459999999999,null,208.11,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17282,null,"See CPT",null,374.0034,null,240.2184,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17283,null,"See CPT",null,440.00400000000002,null,299.0838,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17284,null,"See CPT",null,500.05860000000001,null,350.21940000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17286,null,"See CPT",null,638.60040000000004,null,472.70699999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17311,null,"See CPT",null,1223.6867999999999,null,624.33000000000004,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17312,null,"See CPT",null,748.0068,null,331.78680000000003,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[17313,null,"See CPT",null,1151.1456000000001,null,560.70780000000002,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[17314,null,"See CPT",null,716.49300000000005,null,307.40820000000002,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[17315,null,"See CPT",null,139.13639999999998,null,88.000799999999998,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[17340,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"X"]
[17360,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"X"]
[17380,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,0,0,0,0,null,"X"]
[17999,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,2,0,0,1,1,null,"N"]
[19000,null,"See CPT",null,189.67740000000001,null,74.919600000000003,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[19001,null,"See CPT",null,47.568000000000005,null,36.865200000000002,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[19020,null,"See CPT",null,868.11599999999999,null,562.49160000000006,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R"]
[19030,null,"See CPT",null,304.43520000000001,null,132.5958,null,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[19081,null,"See CPT",null,950.7654,null,288.38099999999997,null,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[19082,null,"See CPT",null,749.19600000000003,null,145.08240000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[19083,null,"See CPT",null,963.84660000000008,null,272.32679999999999,null,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[19084,null,"See CPT",null,741.46620000000007,null,134.9742,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[19085,null,"See CPT",null,1487.0946000000001,null,316.3272,null,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[19086,null,"See CPT",null,1164.2267999999999,null,157.56899999999999,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[19100,null,"See CPT",null,284.8134,null,121.89299999999999,null,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[19101,null,"See CPT",null,609.46500000000003,null,400.7604,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[19105,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,1,1,0,0,null,"X"]
[19110,null,"See CPT",null,898.44060000000002,null,632.65440000000001,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[19112,null,"See CPT",null,855.03480000000002,null,582.11339999999996,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[19120,null,"See CPT",null,941.2518,null,745.62839999999994,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[19125,null,"See CPT",null,1036.3878,null,825.89940000000001,null,"090",0.1,0.71,0.19,0,2,1,1,1,0,null,"R",null,"Y-CM"]
[19126,null,"See CPT",null,281.84040000000005,null,281.84040000000005,null,"000",0,0,0,0,0,0,1,1,0,null,"R",null,"Y-CM"]
[19281,null,"See CPT",null,442.97700000000003,null,174.21780000000001,null,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[19282,null,"See CPT",null,317.51639999999998,null,86.811599999999999,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[19283,null,"See CPT",null,483.40980000000008,null,175.40700000000001,null,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[19284,null,"See CPT",null,363.89519999999999,null,88.000799999999998,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[19285,null,"See CPT",null,714.1146,null,148.65,null,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[19286,null,"See CPT",null,592.22160000000008,null,74.919600000000003,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[19287,null,"See CPT",null,1238.5518,null,221.19120000000001,null,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[19288,null,"See CPT",null,965.6303999999999,null,111.1902,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[19294,null,"See CPT",null,288.97560000000004,null,288.97560000000004,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[19296,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,1,0,0,0,null,"X"]
[19297,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[19298,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,1,0,0,0,null,"X"]
[19300,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"X"]
[19301,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"X"]
[19302,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"X"]
[19303,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"X"]
[19305,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"X"]
[19306,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"X"]
[19307,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"X"]
[19316,null,"See CPT",null,1412.175,null,1412.175,null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[19318,null,"See CPT",null,1946.7204000000002,null,1946.7204000000002,null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[19325,null,"See CPT",null,1100.01,null,1100.01,null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[19328,null,"See CPT",null,991.19820000000016,null,991.19820000000016,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[19330,null,"See CPT",null,1154.7132000000001,null,1154.7132000000001,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[19340,null,"See CPT",null,1353.9041999999999,null,1353.9041999999999,null,"090",0.1,0.71,0.19,0,2,1,1,1,0,null,"R",null,"Y-CM"]
[19342,null,"See CPT",null,1359.8502000000001,null,1359.8502000000001,null,"090",0.1,0.71,0.19,0,2,1,0,1,0,null,"R",null,"Y-CM"]
[19350,null,"See CPT",null,1501.365,null,1202.8758,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[19355,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"X"]
[19357,null,"See CPT",null,2078.1270000000004,null,2078.1270000000004,null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[19361,null,"See CPT",null,2771.4306000000001,null,2771.4306000000001,null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[19364,null,"See CPT",null,4832.3141999999998,null,4832.3141999999998,null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[19367,null,"See CPT",null,3148.4070000000002,null,3148.4070000000002,null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[19368,null,"See CPT",null,3857.1702000000005,null,3857.1702000000005,null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[19369,null,"See CPT",null,3584.8434000000002,null,3584.8434000000002,null,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[19370,null,"See CPT",null,1199.3082000000002,null,1199.3082000000002,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[19371,null,"See CPT",null,1271.2547999999999,null,1271.2547999999999,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[19380,null,"See CPT",null,1441.3103999999998,null,1441.3103999999998,null,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[19396,null,"See CPT",null,509.57220000000001,null,252.70500000000001,null,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[19499,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,2,1,0,1,1,null,"N"]
[20100,null,"See CPT",null,1066.7124000000001,null,1066.7124000000001,null,"010",0.1,0.8,0.1,0,2,1,2,0,0,null,"R"]
[20101,null,"See CPT",null,1115.4696000000001,null,375.19259999999997,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[20102,null,"See CPT",null,1160.0646000000002,null,454.27440000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[20103,null,"See CPT",null,1037.577,null,613.0326,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[20150,null,"See CPT",null,1787.3676,null,1787.3676,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[20200,null,"See CPT",null,408.49020000000002,null,166.488,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[20205,null,"See CPT",null,563.68080000000009,null,271.13759999999996,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[20206,null,"See CPT",null,429.89580000000001,null,101.08199999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[20220,null,"See CPT",null,444.76080000000002,null,152.81219999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[20225,null,"See CPT",null,735.52019999999993,null,228.32640000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[20240,null,"See CPT",null,249.13740000000001,null,249.13740000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[20245,null,"See CPT",null,611.24879999999996,null,611.24879999999996,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[20250,null,"See CPT",null,688.54679999999996,null,688.54679999999996,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[20251,null,"See CPT",null,751.57440000000008,null,751.57440000000008,null,"010",0.1,0.8,0.1,0,2,0,2,0,0,null,"R"]
[20500,null,"See CPT",null,220.5966,null,155.7852,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[20501,null,"See CPT",null,274.70519999999999,null,65.406000000000006,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[20520,null,"See CPT",null,399.57119999999998,null,264.59700000000004,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[20525,null,"See CPT",null,862.17,null,440.59860000000003,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[20526,null,"See CPT",null,148.05540000000002,null,101.08199999999999,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[20527,null,"See CPT",null,156.9744,null,115.947,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[20550,null,"See CPT",null,103.46040000000001,null,68.97359999999999,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[20551,null,"See CPT",null,104.64960000000001,null,68.97359999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[20552,null,"See CPT",null,96.919799999999995,null,66.595200000000006,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[20553,null,"See CPT",null,111.78479999999999,null,75.514200000000002,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[20555,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,0,0,0,0,null,"X"]
[20560,null,"See CPT",null,48.162600000000005,null,26.757000000000001,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[20561,null,"See CPT",null,68.378999999999991,null,39.243600000000001,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[20600,null,"See CPT",null,95.73060000000001,null,63.027600000000007,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[20604,null,"See CPT",null,148.65,null,80.865600000000001,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[20605,null,"See CPT",null,98.703599999999994,null,65.406000000000006,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[20606,null,"See CPT",null,161.7312,null,90.973799999999997,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[20610,null,"See CPT",null,117.1362,null,79.676400000000001,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[20611,null,"See CPT",null,180.75839999999999,null,104.64960000000001,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[20612,null,"See CPT",null,115.947,null,72.541200000000003,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[20615,null,"See CPT",null,461.40960000000001,null,286.00259999999997,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[20650,null,"See CPT",null,406.11180000000002,null,288.38099999999997,null,"010",0.1,0.8,0.1,0,2,0,1,1,0,null,"R"]
[20660,null,"See CPT",null,419.7876,null,419.7876,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[20661,null,"See CPT",null,916.8732,null,916.8732,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[20662,null,"See CPT",null,937.08960000000002,null,937.08960000000002,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[20663,null,"See CPT",null,863.9538,null,863.9538,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[20664,null,"See CPT",null,1573.3116,null,1573.3116,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[20665,null,"See CPT",null,209.8938,null,171.83940000000001,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[20670,null,"See CPT",null,671.30340000000001,null,258.65100000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[20680,null,"See CPT",null,1100.01,null,748.0068,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[20690,null,"See CPT",null,1063.7394000000002,null,1063.7394000000002,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[20692,null,"See CPT",null,1998.4505999999999,null,1998.4505999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[20693,null,"See CPT",null,794.98019999999997,null,794.98019999999997,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[20694,null,"See CPT",null,781.899,null,610.65419999999995,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[20696,null,"See CPT",null,2107.2624000000001,null,2107.2624000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[20697,null,"See CPT",null,3553.9242000000004,null,3553.9242000000004,null,"000",0,0,0,3,0,0,2,1,0,null,"R"]
[20700,null,"See CPT",null,149.83920000000001,null,149.83920000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[20701,null,"See CPT",null,113.5686,null,113.5686,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[20702,null,"See CPT",null,252.11040000000003,null,252.11040000000003,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[20703,null,"See CPT",null,183.73140000000001,null,183.73140000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[20704,null,"See CPT",null,266.38080000000002,null,266.38080000000002,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[20705,null,"See CPT",null,218.2182,null,218.2182,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[20802,null,"See CPT",null,4858.4766,null,4858.4766,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[20805,null,"See CPT",null,5768.8091999999997,null,5768.8091999999997,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[20808,null,"See CPT",null,6957.4146000000001,null,6957.4146000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[20816,null,"See CPT",null,3637.7628,null,3637.7628,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[20822,null,"See CPT",null,3146.6232,null,3146.6232,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[20824,null,"See CPT",null,3644.3033999999998,null,3644.3033999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[20827,null,"See CPT",null,3229.2726000000002,null,3229.2726000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[20838,null,"See CPT",null,4938.7476000000006,null,4938.7476000000006,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[20900,null,"See CPT",null,726.00660000000005,null,321.084,null,"000",0,0,0,0,2,0,2,1,0,null,"R"]
[20902,null,"See CPT",null,488.76120000000003,null,488.76120000000003,null,"000",0,0,0,0,2,0,2,1,0,null,"R"]
[20910,null,"See CPT",null,855.03480000000002,null,855.03480000000002,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[20912,null,"See CPT",null,864.54840000000002,null,864.54840000000002,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[20920,null,"See CPT",null,714.70920000000001,null,714.70920000000001,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R"]
[20922,null,"See CPT",null,1087.5234,null,869.89980000000003,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[20924,null,"See CPT",null,906.76499999999999,null,906.76499999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[20930,null,"See CPT",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
[20931,null,"See CPT",null,192.0558,null,192.0558,null,"000",0,0,0,0,0,0,1,1,0,null,"R"]
[20932,null,"See CPT",null,1328.3363999999999,null,1328.3363999999999,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR"]
[20933,null,"See CPT",null,1219.5246000000002,null,1219.5246000000002,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR"]
[20934,null,"See CPT",null,1327.1472000000001,null,1327.1472000000001,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR"]
[20936,null,"See CPT",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
[20937,null,"See CPT",null,291.35400000000004,null,291.35400000000004,null,"000",0,0,0,0,0,0,2,1,0,null,"R"]
[20938,null,"See CPT",null,320.48939999999999,null,320.48939999999999,null,"000",0,0,0,0,0,0,2,1,0,null,"R"]
[20939,null,"See CPT",null,121.2984,null,121.2984,null,"000",0,0,0,0,0,1,0,0,0,null,"R",null,"Y-UR"]
[20950,null,"See CPT",null,498.27480000000003,null,155.7852,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[20955,null,"See CPT",null,4376.2559999999994,null,4376.2559999999994,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[20956,null,"See CPT",null,4674.7452000000003,null,4674.7452000000003,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[20957,null,"See CPT",null,4868.5847999999996,null,4868.5847999999996,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[20962,null,"See CPT",null,4727.07,null,4727.07,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[20969,null,"See CPT",null,4813.2870000000003,null,4813.2870000000003,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[20970,null,"See CPT",null,5038.6403999999993,null,5038.6403999999993,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[20972,null,"See CPT",null,5023.1808000000001,null,5023.1808000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[20973,null,"See CPT",null,5306.8050000000003,null,5306.8050000000003,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[20974,null,"See CPT",null,147.46080000000001,null,88.000799999999998,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[20975,null,"See CPT",null,305.02980000000002,null,305.02980000000002,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM"]
[20979,null,"See CPT",null,99.892799999999994,null,55.297800000000002,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[20982,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,1,1,0,0,null,"X"]
[20983,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,1,1,0,0,null,"X"]
[20985,null,"See CPT",null,255.08340000000001,null,255.08340000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[20999,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,2,0,0,1,1,null,"N"]
[21010,null,"See CPT",null,1329.5255999999999,null,1329.5255999999999,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[21011,null,"See CPT",null,687.35760000000005,null,466.16640000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21012,null,"See CPT",null,608.2758,null,608.2758,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21013,null,"See CPT",null,979.30619999999999,null,719.46600000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21014,null,"See CPT",null,934.11660000000006,null,934.11660000000006,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21015,null,"See CPT",null,1250.4438,null,1250.4438,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[21016,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"X"]
[21025,null,"See CPT",null,1425.8507999999999,null,1179.0917999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[21026,null,"See CPT",null,972.17100000000005,null,767.62860000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[21029,null,"See CPT",null,1387.7963999999999,null,1106.5506,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[21030,null,"See CPT",null,843.14279999999997,null,650.49239999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[21031,null,"See CPT",null,706.38480000000004,null,489.9504,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[21032,null,"See CPT",null,682.00620000000004,null,467.9502,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[21034,null,"See CPT",null,2342.7240000000002,null,2014.5048000000002,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21040,null,"See CPT",null,855.62940000000003,null,655.84379999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[21044,null,"See CPT",null,1548.3383999999999,null,1548.3383999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21045,null,"See CPT",null,2141.7492000000002,null,2141.7492000000002,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21046,null,"See CPT",null,1802.8271999999999,null,1802.8271999999999,null,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R",null,"Y-CM"]
[21047,null,"See CPT",null,2233.3176000000003,null,2233.3176000000003,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21048,null,"See CPT",null,1815.9084,null,1815.9084,null,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R",null,"Y-CM"]
[21049,null,"See CPT",null,2176.2360000000003,null,2176.2360000000003,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21050,null,"See CPT",null,1557.8520000000001,null,1557.8520000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[21060,null,"See CPT",null,1412.175,null,1412.175,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[21070,null,"See CPT",null,1093.4694,null,1093.4694,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[21073,null,"See CPT",null,687.95220000000006,null,441.19319999999999,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[21076,null,"See CPT",null,1532.8788000000002,null,1247.4708000000001,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[21077,null,"See CPT",null,3764.4126000000001,null,3071.1089999999999,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[21079,null,"See CPT",null,2584.1316000000002,null,2067.4242000000004,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[21080,null,"See CPT",null,2993.2164000000002,null,2358.7782000000002,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[21081,null,"See CPT",null,2747.6466,null,2153.0466000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21082,null,"See CPT",null,2522.8878,null,1959.8016,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21083,null,"See CPT",null,2411.1030000000001,null,1820.0706,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21084,null,"See CPT",null,2750.6196,null,2106.0732000000003,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21085,null,"See CPT",null,1210.0110000000002,null,853.84559999999999,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[21086,null,"See CPT",null,2804.1335999999997,null,2264.8314,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[21087,null,"See CPT",null,2804.1335999999997,null,2264.8314,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21088,null,"See CPT",null,"By Report",null,"By Report",null,"090",0.1,0.69,0.21,0,0,0,0,0,0,null,"N"]
[21089,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,0,0,1,1,1,null,"N"]
[21100,null,"See CPT",null,1149.9564,null,635.03279999999995,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21110,null,"See CPT",null,1617.9066,null,1337.85,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[21116,null,"See CPT",null,415.03080000000006,null,80.271000000000001,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[21120,null,"See CPT",null,1222.4975999999999,null,925.79219999999998,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,"Y-CM"]
[21121,null,"See CPT",null,1149.3617999999999,null,951.95460000000014,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21122,null,"See CPT",null,1356.2826,null,1356.2826,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21123,null,"See CPT",null,1537.6356000000001,null,1537.6356000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21125,null,"See CPT",null,5030.3159999999998,null,1189.7946000000002,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21127,null,"See CPT",null,7727.4216000000006,null,1364.0124000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21137,null,"See CPT",null,1342.6068,null,1342.6068,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21138,null,"See CPT",null,1632.7716,null,1632.7716,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21139,null,"See CPT",null,1956.2339999999999,null,1956.2339999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21141,null,"See CPT",null,2391.4812000000002,null,2391.4812000000002,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21142,null,"See CPT",null,2454.5088000000001,null,2454.5088000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21143,null,"See CPT",null,2528.2392000000004,null,2528.2392000000004,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21145,null,"See CPT",null,2777.9712,null,2777.9712,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21146,null,"See CPT",null,2899.8642000000004,null,2899.8642000000004,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21147,null,"See CPT",null,3051.4872,null,3051.4872,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21150,null,"See CPT",null,2934.9456,null,2934.9456,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21151,null,"See CPT",null,3226.8942000000002,null,3226.8942000000002,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21154,null,"See CPT",null,3471.8694,null,3471.8694,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21155,null,"See CPT",null,3847.6565999999998,null,3847.6565999999998,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21159,null,"See CPT",null,4605.7716,null,4605.7716,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21160,null,"See CPT",null,4992.8562000000002,null,4992.8562000000002,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21172,null,"See CPT",null,3742.4123999999997,null,3742.4123999999997,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21175,null,"See CPT",null,3939.2249999999999,null,3939.2249999999999,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21179,null,"See CPT",null,2711.3760000000002,null,2711.3760000000002,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21180,null,"See CPT",null,3026.5140000000001,null,3026.5140000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21181,null,"See CPT",null,1324.7688000000001,null,1324.7688000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[21182,null,"See CPT",null,3760.8450000000003,null,3760.8450000000003,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21183,null,"See CPT",null,4089.6588000000002,null,4089.6588000000002,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21184,null,"See CPT",null,4397.6615999999995,null,4397.6615999999995,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21188,null,"See CPT",null,2844.5664000000002,null,2844.5664000000002,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21193,null,"See CPT",null,2204.1822000000002,null,2204.1822000000002,null,"090",0.1,0.69,0.21,0,2,2,2,1,0,null,"R",null,"Y-CM"]
[21194,null,"See CPT",null,2553.2123999999999,null,2553.2123999999999,null,"090",0.1,0.69,0.21,0,2,2,2,0,0,null,"R",null,"Y-CM"]
[21195,null,"See CPT",null,2417.6435999999999,null,2417.6435999999999,null,"090",0.1,0.69,0.21,0,2,2,2,0,0,null,"R",null,"Y-CM"]
[21196,null,"See CPT",null,2581.7532000000001,null,2581.7532000000001,null,"090",0.1,0.69,0.21,0,2,2,2,1,0,null,"R",null,"Y-CM"]
[21198,null,"See CPT",null,1855.152,null,1855.152,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21199,null,"See CPT",null,1814.7192,null,1814.7192,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21206,null,"See CPT",null,1735.0427999999999,null,1735.0427999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21208,null,"See CPT",null,3093.1092000000003,null,1315.2552000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21209,null,"See CPT",null,1498.9866000000002,null,1116.6588000000002,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[21210,null,"See CPT",null,3316.0842000000002,null,1350.3366000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[21215,null,"See CPT",null,7882.0176000000001,null,1401.4721999999999,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R"]
[21230,null,"See CPT",null,1340.8230000000001,null,1340.8230000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21235,null,"See CPT",null,1331.904,null,1018.5498,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[21240,null,"See CPT",null,1871.2061999999999,null,1871.2061999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[21242,null,"See CPT",null,1814.1246000000001,null,1814.1246000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[21243,null,"See CPT",null,2869.5396000000001,null,2869.5396000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[21244,null,"See CPT",null,1811.1516000000001,null,1811.1516000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[21245,null,"See CPT",null,2139.3707999999997,null,1647.0419999999999,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21246,null,"See CPT",null,1522.1760000000002,null,1522.1760000000002,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21247,null,"See CPT",null,2827.9176000000002,null,2827.9176000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[21248,null,"See CPT",null,1774.8810000000001,null,1409.202,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[21249,null,"See CPT",null,2409.3192000000004,null,1977.6396,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21255,null,"See CPT",null,2412.2921999999999,null,2412.2921999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[21256,null,"See CPT",null,2209.5335999999998,null,2209.5335999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[21260,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"X"]
[21261,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"X"]
[21263,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"X"]
[21267,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[21268,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[21270,null,"See CPT",null,1830.1788000000001,null,1333.6877999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[21275,null,"See CPT",null,1512.6624000000002,null,1512.6624000000002,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[21280,null,"See CPT",null,1048.8744000000002,null,1048.8744000000002,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[21282,null,"See CPT",null,715.30380000000002,null,715.30380000000002,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[21295,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"X"]
[21296,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"X"]
[21299,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,0,0,1,1,null,"N"]
[21315,null,"See CPT",null,278.86740000000003,null,104.64960000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[21320,null,"See CPT",null,404.32799999999997,null,168.8664,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[21325,null,"See CPT",null,816.38580000000002,null,816.38580000000002,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21330,null,"See CPT",null,975.73860000000002,null,975.73860000000002,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21335,null,"See CPT",null,1295.6333999999999,null,1295.6333999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[21336,null,"See CPT",null,1176.1188000000002,null,1176.1188000000002,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21337,null,"See CPT",null,771.79079999999999,null,541.68060000000003,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21338,null,"See CPT",null,1230.8219999999999,null,1230.8219999999999,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21339,null,"See CPT",null,1386.6072000000001,null,1386.6072000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[21340,null,"See CPT",null,1344.9852000000001,null,1344.9852000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21343,null,"See CPT",null,1966.3422,null,1966.3422,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[21344,null,"See CPT",null,2502.6714000000002,null,2502.6714000000002,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R"]
[21345,null,"See CPT",null,1453.2024000000001,null,1144.605,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21346,null,"See CPT",null,1877.7467999999999,null,1877.7467999999999,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R"]
[21347,null,"See CPT",null,1887.2603999999999,null,1887.2603999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[21348,null,"See CPT",null,1951.4772,null,1951.4772,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R"]
[21355,null,"See CPT",null,814.00739999999996,null,588.654,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R"]
[21356,null,"See CPT",null,994.76580000000001,null,727.79039999999998,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R"]
[21360,null,"See CPT",null,938.87339999999995,null,938.87339999999995,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[21365,null,"See CPT",null,1932.45,null,1932.45,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[21366,null,"See CPT",null,2276.7233999999999,null,2276.7233999999999,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[21385,null,"See CPT",null,1318.8227999999999,null,1318.8227999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[21386,null,"See CPT",null,1236.768,null,1236.768,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[21387,null,"See CPT",null,1375.3098,null,1375.3098,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[21390,null,"See CPT",null,1438.3374000000001,null,1438.3374000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[21395,null,"See CPT",null,1802.8271999999999,null,1802.8271999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[21400,null,"See CPT",null,386.49,null,299.0838,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[21401,null,"See CPT",null,937.68420000000003,null,589.84320000000002,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[21406,null,"See CPT",null,1049.4689999999998,null,1049.4689999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[21407,null,"See CPT",null,1150.5510000000002,null,1150.5510000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[21408,null,"See CPT",null,1614.3389999999999,null,1614.3389999999999,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[21421,null,"See CPT",null,1186.2269999999999,null,994.76580000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21422,null,"See CPT",null,1123.7939999999999,null,1123.7939999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[21423,null,"See CPT",null,1434.1752000000001,null,1434.1752000000001,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R"]
[21431,null,"See CPT",null,1273.6332000000002,null,1273.6332000000002,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[21432,null,"See CPT",null,1299.7955999999999,null,1299.7955999999999,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[21433,null,"See CPT",null,3086.5686000000001,null,3086.5686000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[21435,null,"See CPT",null,2509.212,null,2509.212,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[21436,null,"See CPT",null,3623.4924000000001,null,3623.4924000000001,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R"]
[21440,null,"See CPT",null,1291.4712,null,1032.8202000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21445,null,"See CPT",null,1493.0406,null,1196.3352,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[21450,null,"See CPT",null,1110.1182000000001,null,896.65679999999998,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21451,null,"See CPT",null,1436.5536,null,1193.3622,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21452,null,"See CPT",null,1423.4724000000001,null,874.06200000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21453,null,"See CPT",null,2048.3970000000004,null,1737.4212,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21454,null,"See CPT",null,869.89980000000003,null,869.89980000000003,null,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R"]
[21461,null,"See CPT",null,3448.68,null,1950.2879999999998,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R"]
[21462,null,"See CPT",null,3769.1694000000002,null,2170.8845999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[21465,null,"See CPT",null,1417.5264,null,1417.5264,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[21470,null,"See CPT",null,2075.154,null,2075.154,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[21480,null,"See CPT",null,262.21860000000004,null,54.108600000000003,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[21485,null,"See CPT",null,1834.3410000000001,null,1492.4460000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[21490,null,"See CPT",null,1396.1208000000001,null,1396.1208000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[21497,null,"See CPT",null,1327.1472000000001,null,1098.8208,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21499,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,0,0,1,1,null,"N"]
[21501,null,"See CPT",null,894.87300000000005,null,600.54599999999994,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[21502,null,"See CPT",null,907.95420000000001,null,907.95420000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[21510,null,"See CPT",null,812.22360000000003,null,812.22360000000003,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[21550,null,"See CPT",null,494.7072,null,279.46199999999999,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[21552,null,"See CPT",null,799.73699999999997,null,799.73699999999997,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21554,null,"See CPT",null,1303.9577999999999,null,1303.9577999999999,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21555,null,"See CPT",null,800.92619999999999,null,551.78879999999992,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[21556,null,"See CPT",null,951.95460000000014,null,951.95460000000014,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[21557,null,"See CPT",null,1698.7722000000001,null,1698.7722000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21558,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"X"]
[21600,null,"See CPT",null,1004.8739999999999,null,1004.8739999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[21601,null,"See CPT",null,2042.451,null,2042.451,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[21602,null,"See CPT",null,2762.5116000000003,null,2762.5116000000003,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[21603,null,"See CPT",null,2995.5948000000003,null,2995.5948000000003,null,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R"]
[21610,null,"See CPT",null,2126.2896000000001,null,2126.2896000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21615,null,"See CPT",null,1082.172,null,1082.172,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[21616,null,"See CPT",null,1249.8491999999999,null,1249.8491999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[21620,null,"See CPT",null,903.19740000000002,null,903.19740000000002,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[21627,null,"See CPT",null,972.17100000000005,null,972.17100000000005,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[21630,null,"See CPT",null,2342.1294000000003,null,2342.1294000000003,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21632,null,"See CPT",null,2139.9654,null,2139.9654,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21685,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"X"]
[21700,null,"See CPT",null,624.33000000000004,null,624.33000000000004,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[21705,null,"See CPT",null,931.73820000000001,null,931.73820000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[21720,null,"See CPT",null,947.19780000000003,null,947.19780000000003,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21725,null,"See CPT",null,975.14399999999989,null,975.14399999999989,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21740,null,"See CPT",null,1801.6380000000001,null,1801.6380000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[21742,null,"See CPT",null," By Report ",null," By Report ",null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"N",null,"Y-CM"]
[21743,null,"See CPT",null," By Report ",null," By Report ",null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"N",null,"Y-CM"]
[21750,null,"See CPT",null,1192.7675999999999,null,1192.7675999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[21811,null,"See CPT",null,1039.3607999999999,null,1039.3607999999999,null,"000",0,0,0,0,2,1,2,0,0,null,"R"]
[21812,null,"See CPT",null,1261.1466,null,1261.1466,null,"000",0,0,0,0,2,1,2,0,0,null,"R"]
[21813,null,"See CPT",null,1724.34,null,1724.34,null,"000",0,0,0,0,2,1,2,0,0,null,"R"]
[21820,null,"See CPT",null,272.32679999999999,null,266.97540000000004,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[21825,null,"See CPT",null,982.27919999999995,null,982.27919999999995,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[21899,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,0,0,1,1,null,"N",null,"Y-UR"]
[21920,null,"See CPT",null,478.05839999999995,null,278.86740000000003,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[21925,null,"See CPT",null,906.17039999999997,null,678.43860000000006,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[21930,null,"See CPT",null,922.81920000000002,null,652.27620000000002,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[21931,null,"See CPT",null,840.16980000000001,null,840.16980000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[21932,null,"See CPT",null,1185.0378000000001,null,1185.0378000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[21933,null,"See CPT",null,1318.2282,null,1318.2282,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[21935,null,"See CPT",null,1824.2328,null,1824.2328,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,"Y-CM"]
[21936,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"X"]
[22010,null,"See CPT",null,1723.1508000000001,null,1723.1508000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[22015,null,"See CPT",null,1694.0154,null,1694.0154,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[22100,null,"See CPT",null,1542.9870000000001,null,1542.9870000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[22101,null,"See CPT",null,1534.068,null,1534.068,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[22102,null,"See CPT",null,1392.5532000000001,null,1392.5532000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[22103,null,"See CPT",null,236.6508,null,236.6508,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM"]
[22110,null,"See CPT",null,1873.5846000000001,null,1873.5846000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[22112,null,"See CPT",null,2009.7479999999998,null,2009.7479999999998,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[22114,null,"See CPT",null,2009.7479999999998,null,2009.7479999999998,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[22116,null,"See CPT",null,246.16439999999997,null,246.16439999999997,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM"]
[22206,null,"See CPT",null,4309.0662000000002,null,4309.0662000000002,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22207,null,"See CPT",null,4224.0384000000004,null,4224.0384000000004,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22208,null,"See CPT",null,1025.6849999999999,null,1025.6849999999999,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR"]
[22210,null,"See CPT",null,3162.0828000000001,null,3162.0828000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[22212,null,"See CPT",null,2678.6729999999998,null,2678.6729999999998,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[22214,null,"See CPT",null,2679.8622,null,2679.8622,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[22216,null,"See CPT",null,632.65440000000001,null,632.65440000000001,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM"]
[22220,null,"See CPT",null,2868.9450000000002,null,2868.9450000000002,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[22222,null,"See CPT",null,3100.8389999999999,null,3100.8389999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[22224,null,"See CPT",null,2820.7824000000001,null,2820.7824000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[22226,null,"See CPT",null,629.08680000000004,null,629.08680000000004,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM"]
[22310,null,"See CPT",null,562.49160000000006,null,535.7346,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[22315,null,"See CPT",null,1587.5819999999999,null,1378.8774000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[22318,null,"See CPT",null,2896.2966000000001,null,2896.2966000000001,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-CM"]
[22319,null,"See CPT",null,3220.9482000000003,null,3220.9482000000003,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-CM"]
[22325,null,"See CPT",null,2603.1588000000002,null,2603.1588000000002,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[22326,null,"See CPT",null,2664.9972000000002,null,2664.9972000000002,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[22327,null,"See CPT",null,2709.5922,null,2709.5922,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[22328,null,"See CPT",null,488.16660000000007,null,488.16660000000007,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM"]
[22505,null,"See CPT",null,230.11020000000002,null,230.11020000000002,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[22510,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"X"]
[22511,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"X"]
[22512,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,0,0,1,0,0,null,"X"]
[22513,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"X"]
[22514,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"X"]
[22515,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,0,0,1,0,0,null,"X"]
[22526,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"010",0.1,0.8,0.1,9,9,9,9,9,9,null,"X"]
[22527,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[22532,null,"See CPT",null,3181.11,null,3181.11,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22533,null,"See CPT",null,2931.9726000000001,null,2931.9726000000001,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22534,null,"See CPT",null,626.70839999999998,null,626.70839999999998,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22548,null,"See CPT",null,3451.6529999999998,null,3451.6529999999998,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22551,null,"See CPT",null,2998.5677999999998,null,2998.5677999999998,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22552,null,"See CPT",null,689.73599999999999,null,689.73599999999999,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22554,null,"See CPT",null,2226.777,null,2226.777,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22556,null,"See CPT",null,2940.297,null,2940.297,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22558,null,"See CPT",null,2700.0785999999998,null,2700.0785999999998,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22585,null,"See CPT",null,567.24839999999995,null,567.24839999999995,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22586,null,"See CPT",null,3570.5729999999999,null,3570.5729999999999,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22590,null,"See CPT",null,2799.3768,null,2799.3768,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22595,null,"See CPT",null,2677.4838,null,2677.4838,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22600,null,"See CPT",null,2301.1020000000003,null,2301.1020000000003,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22610,null,"See CPT",null,2263.6422000000002,null,2263.6422000000002,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22612,null,"See CPT",null,2804.7282,null,2804.7282,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22614,null,"See CPT",null,680.81700000000001,null,680.81700000000001,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22630,null,"See CPT",null,2791.0524,null,2791.0524,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22632,null,"See CPT",null,557.14019999999994,null,557.14019999999994,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22633,null,"See CPT",null,3261.3810000000003,null,3261.3810000000003,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22634,null,"See CPT",null,863.9538,null,863.9538,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22800,null,"See CPT",null,2408.7246,null,2408.7246,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22802,null,"See CPT",null,3735.2772,null,3735.2772,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22804,null,"See CPT",null,4284.6876000000002,null,4284.6876000000002,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22808,null,"See CPT",null,3226.2995999999998,null,3226.2995999999998,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22810,null,"See CPT",null,3560.4648000000002,null,3560.4648000000002,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22812,null,"See CPT",null,3901.7652000000003,null,3901.7652000000003,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22818,null,"See CPT",null,3807.2238000000002,null,3807.2238000000002,null,"090",0.11,0.76,0.13,0,2,0,2,2,2,null,"R",null,"Y-UR"]
[22819,null,"See CPT",null,4382.7965999999997,null,4382.7965999999997,null,"090",0.11,0.76,0.13,0,2,0,2,2,2,null,"R",null,"Y-UR"]
[22830,null,"See CPT",null,1460.9322,null,1460.9322,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22840,null,"See CPT",null,1321.7958000000001,null,1321.7958000000001,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR"]
[22841,null,"See CPT",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,"Y-UR"]
[22842,null,"See CPT",null,1328.3363999999999,null,1328.3363999999999,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22843,null,"See CPT",null,1420.4994000000002,null,1420.4994000000002,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22844,null,"See CPT",null,1717.7994000000001,null,1717.7994000000001,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22845,null,"See CPT",null,1265.9033999999999,null,1265.9033999999999,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22846,null,"See CPT",null,1315.8498,null,1315.8498,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22847,null,"See CPT",null,1406.8235999999999,null,1406.8235999999999,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22848,null,"See CPT",null,627.303,null,627.303,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22849,null,"See CPT",null,2310.6156000000001,null,2310.6156000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22850,null,"See CPT",null,1311.6876,null,1311.6876,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22852,null,"See CPT",null,1260.5519999999999,null,1260.5519999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22853,null,"See CPT",null,448.923,null,448.923,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22854,null,"See CPT",null,582.70800000000008,null,582.70800000000008,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22855,null,"See CPT",null,1961.5854000000002,null,1961.5854000000002,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[22856,null,"See CPT",null,2874.8910000000001,null,2874.8910000000001,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22857,null,"See CPT",null,3134.1366000000003,null,3134.1366000000003,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22858,null,"See CPT",null,882.38639999999998,null,882.38639999999998,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22859,null,"See CPT",null,579.73500000000001,null,579.73500000000001,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22861,null,"See CPT",null,4058.145,null,4058.145,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22862,null,"See CPT",null,4061.7126000000003,null,4061.7126000000003,null,"090",0.1,0.71,0.19,0,2,0,2,2,2,null,"R",null,"Y-UR"]
[22864,null,"See CPT",null,3626.4654,null,3626.4654,null,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[22865,null,"See CPT",null,3965.9820000000004,null,3965.9820000000004,null,"090",0.1,0.71,0.19,0,2,0,2,2,2,null,"R",null,"Y-UR"]
[22867,null,"See CPT",null,1902.1253999999999,null,1902.1253999999999,null,"090",0.1,0.8,0.1,0,2,0,2,0,0,null,"R",null,"Y-UR"]
[22868,null,"See CPT",null,423.35520000000002,null,423.35520000000002,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22869,null,"See CPT",null,776.54759999999999,null,776.54759999999999,null,"090",0.1,0.8,0.1,0,2,0,2,0,0,null,"R",null,"Y-UR"]
[22870,null,"See CPT",null,209.8938,null,209.8938,null,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR"]
[22899,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,0,2,1,1,null,"N",null,"Y-UR"]
[22900,null,"See CPT",null,1010.82,null,1010.82,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[22901,null,"See CPT",null,1192.7675999999999,null,1192.7675999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[22902,null,"See CPT",null,871.08900000000006,null,599.35680000000002,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[22903,null,"See CPT",null,788.43960000000004,null,788.43960000000004,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[22904,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.81,0.1,0,2,0,2,1,1,null,"X"]
[22905,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.81,0.1,0,2,0,2,1,1,null,"X"]
[22999,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,0,0,1,1,null,"N",null,"Y-CM"]
[23000,null,"See CPT",null,1063.7394000000002,null,667.14120000000003,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[23020,null,"See CPT",null,1240.3355999999999,null,1240.3355999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM"]
[23030,null,"See CPT",null,818.16959999999995,null,457.84200000000004,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[23031,null,"See CPT",null,789.62879999999996,null,393.62520000000001,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[23035,null,"See CPT",null,1228.4436000000001,null,1228.4436000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM"]
[23040,null,"See CPT",null,1293.2550000000001,null,1293.2550000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[23044,null,"See CPT",null,1020.3336,null,1020.3336,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-CM"]
[23065,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"X"]
[23066,null,"See CPT",null,1041.1446000000001,null,658.22220000000004,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[23071,null,"See CPT",null,753.35820000000001,null,753.35820000000001,null,"090",0.1,0.8,0.1,0,2,1,2,0,0,null,"R"]
[23073,null,"See CPT",null,1245.6869999999999,null,1245.6869999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[23075,null,"See CPT",null,962.65740000000005,null,592.81620000000009,null,"090",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[23076,null,"See CPT",null,975.73860000000002,null,975.73860000000002,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[23077,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[23078,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[23100,null,"See CPT",null,915.68400000000008,null,915.68400000000008,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23101,null,"See CPT",null,827.08860000000004,null,827.08860000000004,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[23105,null,"See CPT",null,1152.9294,null,1152.9294,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23106,null,"See CPT",null,909.14339999999993,null,909.14339999999993,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[23107,null,"See CPT",null,1189.2,null,1189.2,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23120,null,"See CPT",null,1060.1717999999998,null,1060.1717999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23125,null,"See CPT",null,1276.6061999999999,null,1276.6061999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23130,null,"See CPT",null,1118.4425999999999,null,1118.4425999999999,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[23140,null,"See CPT",null,1002.4956,null,1002.4956,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[23145,null,"See CPT",null,1252.8222000000001,null,1252.8222000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[23146,null,"See CPT",null,1124.3886,null,1124.3886,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[23150,null,"See CPT",null,1191.5783999999999,null,1191.5783999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[23155,null,"See CPT",null,1432.9860000000001,null,1432.9860000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[23156,null,"See CPT",null,1221.903,null,1221.903,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM"]
[23170,null,"See CPT",null,1019.1444,null,1019.1444,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[23172,null,"See CPT",null,1029.2526,null,1029.2526,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM"]
[23174,null,"See CPT",null,1374.7152000000001,null,1374.7152000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[23180,null,"See CPT",null,1196.3352,null,1196.3352,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-CM"]
[23182,null,"See CPT",null,1211.7947999999999,null,1211.7947999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM"]
[23184,null,"See CPT",null,1328.931,null,1328.931,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[23190,null,"See CPT",null,1037.577,null,1037.577,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23195,null,"See CPT",null,1333.0932,null,1333.0932,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[23200,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[23210,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[23220,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[23330,null,"See CPT",null,559.51859999999999,null,300.86759999999998,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R"]
[23333,null,"See CPT",null,852.06180000000006,null,852.06180000000006,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[23334,null,"See CPT",null,1893.8010000000002,null,1893.8010000000002,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[23335,null,"See CPT",null,2255.3177999999998,null,2255.3177999999998,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[23350,null,"See CPT",null,314.54340000000002,null,88.000799999999998,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[23395,null,"See CPT",null,2281.4802,null,2281.4802,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[23397,null,"See CPT",null,2028.1805999999999,null,2028.1805999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[23400,null,"See CPT",null,1739.7996000000001,null,1739.7996000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[23405,null,"See CPT",null,1114.2803999999999,null,1114.2803999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[23406,null,"See CPT",null,1335.4716000000001,null,1335.4716000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[23410,null,"See CPT",null,1469.8512000000001,null,1469.8512000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23412,null,"See CPT",null,1526.3382000000001,null,1526.3382000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23415,null,"See CPT",null,1257.579,null,1257.579,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[23420,null,"See CPT",null,1744.5563999999999,null,1744.5563999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23430,null,"See CPT",null,1337.2554,null,1337.2554,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23440,null,"See CPT",null,1356.2826,null,1356.2826,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23450,null,"See CPT",null,1691.6369999999999,null,1691.6369999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23455,null,"See CPT",null,1773.0971999999999,null,1773.0971999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23460,null,"See CPT",null,1947.3150000000001,null,1947.3150000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23462,null,"See CPT",null,1904.5038000000002,null,1904.5038000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23465,null,"See CPT",null,1997.2614000000003,null,1997.2614000000003,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23466,null,"See CPT",null,2002.6128000000001,null,2002.6128000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23470,null,"See CPT",null,2136.3978000000002,null,2136.3978000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23472,null,"See CPT",null,2571.0504000000001,null,2571.0504000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23473,null,"See CPT",null,2862.4043999999999,null,2862.4043999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23474,null,"See CPT",null,3087.1632,null,3087.1632,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23480,null,"See CPT",null,1469.8512000000001,null,1469.8512000000001,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[23485,null,"See CPT",null,1698.7722000000001,null,1698.7722000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[23490,null,"See CPT",null,1541.2032000000002,null,1541.2032000000002,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM"]
[23491,null,"See CPT",null,1816.5030000000002,null,1816.5030000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[23500,null,"See CPT",null,408.49020000000002,null,417.4092,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[23505,null,"See CPT",null,660.00599999999997,null,611.24879999999996,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[23515,null,"See CPT",null,1293.8496,null,1293.8496,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[23520,null,"See CPT",null,443.57159999999999,null,437.03100000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[23525,null,"See CPT",null,727.79039999999998,null,664.16819999999996,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[23530,null,"See CPT",null,1039.3607999999999,null,1039.3607999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[23532,null,"See CPT",null,1129.1453999999999,null,1129.1453999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[23540,null,"See CPT",null,439.40940000000001,null,432.27420000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[23545,null,"See CPT",null,645.73559999999998,null,577.95120000000009,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[23550,null,"See CPT",null,1032.2256,null,1032.2256,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23552,null,"See CPT",null,1177.9025999999999,null,1177.9025999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[23570,null,"See CPT",null,431.67959999999999,null,444.76080000000002,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[23575,null,"See CPT",null,753.35820000000001,null,693.89819999999997,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[23585,null,"See CPT",null,1748.7185999999999,null,1748.7185999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[23600,null,"See CPT",null,614.81640000000004,null,581.51879999999994,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[23605,null,"See CPT",null,859.79160000000002,null,778.33140000000003,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[23615,null,"See CPT",null,1582.8252,null,1582.8252,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[23616,null,"See CPT",null,2199.4254000000001,null,2199.4254000000001,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[23620,null,"See CPT",null,498.86940000000004,null,478.65300000000008,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[23625,null,"See CPT",null,704.601,null,642.76260000000002,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[23630,null,"See CPT",null,1397.9046000000001,null,1397.9046000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[23650,null,"See CPT",null,598.76220000000001,null,539.30219999999997,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[23655,null,"See CPT",null,745.03379999999993,null,745.03379999999993,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[23660,null,"See CPT",null,1053.6312,null,1053.6312,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[23665,null,"See CPT",null,793.79099999999994,null,728.9796,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[23670,null,"See CPT",null,1556.6628000000001,null,1556.6628000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[23675,null,"See CPT",null,1006.0632000000002,null,908.54880000000003,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[23680,null,"See CPT",null,1658.934,null,1658.934,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[23700,null,"See CPT",null,352.59780000000001,null,352.59780000000001,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[23800,null,"See CPT",null,1834.9356,null,1834.9356,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[23802,null,"See CPT",null,2286.8316,null,2286.8316,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[23900,null,"See CPT",null,2463.4277999999999,null,2463.4277999999999,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[23920,null,"See CPT",null,2002.6128000000001,null,2002.6128000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[23921,null,"See CPT",null,851.46720000000005,null,851.46720000000005,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[23929,null,"See CPT",null,"Bundled",null,"Bundled",null,"000",0,0,0,0,2,0,2,1,1,null,"Bundled",null,"Y-UR"]
[23930,null,"See CPT",null,669.51959999999997,null,385.30080000000004,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[23931,null,"See CPT",null,566.05920000000003,null,289.5702,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[23935,null,"See CPT",null,921.63,null,921.63,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[24000,null,"See CPT",null,855.03480000000002,null,855.03480000000002,null,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,"Y-UR"]
[24006,null,"See CPT",null,1280.7683999999999,null,1280.7683999999999,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,"Y-UR"]
[24065,null,"See CPT",null,482.81519999999995,null,294.327,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[24066,null,"See CPT",null,1141.6320000000001,null,754.54739999999993,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24071,null,"See CPT",null,727.79039999999998,null,727.79039999999998,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[24073,null,"See CPT",null,1238.5518,null,1238.5518,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[24075,null,"See CPT",null,"994.1+E7712",null,594.00540000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24076,null,"See CPT",null,979.9008,null,979.9008,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24077,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"X"]
[24079,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[24100,null,"See CPT",null,760.49339999999995,null,760.49339999999995,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[24101,null,"See CPT",null,912.1164,null,912.1164,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[24102,null,"See CPT",null,1115.4696000000001,null,1115.4696000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24105,null,"See CPT",null,655.24919999999997,null,655.24919999999997,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24110,null,"See CPT",null,1065.5232000000001,null,1065.5232000000001,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[24115,null,"See CPT",null,1324.7688000000001,null,1324.7688000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24116,null,"See CPT",null,1540.6086,null,1540.6086,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[24120,null,"See CPT",null,963.25199999999995,null,963.25199999999995,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[24125,null,"See CPT",null,1123.7939999999999,null,1123.7939999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24126,null,"See CPT",null,1172.5511999999999,null,1172.5511999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[24130,null,"See CPT",null,922.22460000000001,null,922.22460000000001,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[24134,null,"See CPT",null,1342.6068,null,1342.6068,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[24136,null,"See CPT",null,1139.8482000000001,null,1139.8482000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24138,null,"See CPT",null,1242.1194,null,1242.1194,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[24140,null,"See CPT",null,1265.3088,null,1265.3088,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[24145,null,"See CPT",null,1072.6584,null,1072.6584,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[24147,null,"See CPT",null,1136.8752000000002,null,1136.8752000000002,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[24149,null,"See CPT",null,2108.4515999999999,null,2108.4515999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24150,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[24152,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[24155,null,"See CPT",null,1526.3382000000001,null,1526.3382000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24160,null,"See CPT",null,2229.75,null,2229.75,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[24164,null,"See CPT",null,1300.3902,null,1300.3902,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[24200,null,"See CPT",null,404.92259999999999,null,254.48880000000003,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R"]
[24201,null,"See CPT",null,1009.6308,null,659.41139999999996,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24220,null,"See CPT",null,361.51679999999999,null,116.5416,null,"000",0,0,0,0,2,1,0,0,0,null,"R"]
[24300,null,"See CPT",null,796.76400000000001,null,796.76400000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24301,null,"See CPT",null,1346.769,null,1346.769,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[24305,null,"See CPT",null,1045.3067999999998,null,1045.3067999999998,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,"Y-UR"]
[24310,null,"See CPT",null,860.98080000000004,null,860.98080000000004,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,"Y-UR"]
[24320,null,"See CPT",null,1399.6884,null,1399.6884,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[24330,null,"See CPT",null,1290.8766000000001,null,1290.8766000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[24331,null,"See CPT",null,1409.202,null,1409.202,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[24332,null,"See CPT",null,1110.7128,null,1110.7128,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[24340,null,"See CPT",null,1114.875,null,1114.875,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[24341,null,"See CPT",null,1340.8230000000001,null,1340.8230000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[24342,null,"See CPT",null,1390.7694000000001,null,1390.7694000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[24343,null,"See CPT",null,1287.309,null,1287.309,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[24344,null,"See CPT",null,1959.8016,null,1959.8016,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[24345,null,"See CPT",null,1280.7683999999999,null,1280.7683999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[24346,null,"See CPT",null,1976.4504000000002,null,1976.4504000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[24357,null,"See CPT",null,760.49339999999995,null,760.49339999999995,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR"]
[24358,null,"See CPT",null,956.71140000000003,null,956.71140000000003,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR"]
[24359,null,"See CPT",null,1192.173,null,1192.173,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR"]
[24360,null,"See CPT",null,1618.5011999999999,null,1618.5011999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[24361,null,"See CPT",null,1802.8271999999999,null,1802.8271999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[24362,null,"See CPT",null,1895.5847999999999,null,1895.5847999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[24363,null,"See CPT",null,2572.2395999999999,null,2572.2395999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[24365,null,"See CPT",null,1155.3078,null,1155.3078,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[24366,null,"See CPT",null,1225.4705999999999,null,1225.4705999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[24370,null,"See CPT",null,2732.1870000000004,null,2732.1870000000004,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[24371,null,"See CPT",null,3136.5149999999999,null,3136.5149999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[24400,null,"See CPT",null,1481.1486,null,1481.1486,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24410,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[24420,null,"See CPT",null,1924.7202,null,1924.7202,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[24430,null,"See CPT",null,1883.6928,null,1883.6928,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24435,null,"See CPT",null,1932.45,null,1932.45,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24470,null,"See CPT",null,1211.2002,null,1211.2002,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM"]
[24495,null,"See CPT",null,1475.2025999999998,null,1475.2025999999998,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[24498,null,"See CPT",null,1551.9060000000002,null,1551.9060000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24500,null,"See CPT",null,665.952,null,613.0326,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24505,null,"See CPT",null,922.22460000000001,null,824.71019999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24515,null,"See CPT",null,1580.4467999999999,null,1580.4467999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24516,null,"See CPT",null,1538.2302,null,1538.2302,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[24530,null,"See CPT",null,702.81720000000007,null,643.95180000000005,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24535,null,"See CPT",null,1126.1724000000002,null,1031.6310000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24538,null,"See CPT",null,1431.7967999999998,null,1431.7967999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24545,null,"See CPT",null,1660.7177999999999,null,1660.7177999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24546,null,"See CPT",null,1852.1789999999999,null,1852.1789999999999,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[24560,null,"See CPT",null,614.22180000000003,null,541.68060000000003,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24565,null,"See CPT",null,989.4144,null,900.22440000000006,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24566,null,"See CPT",null,1299.7955999999999,null,1299.7955999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24575,null,"See CPT",null,1317.039,null,1317.039,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24576,null,"See CPT",null,648.70860000000005,null,576.16739999999993,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24577,null,"See CPT",null,1016.7660000000001,null,924.60300000000007,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24579,null,"See CPT",null,1495.4189999999999,null,1495.4189999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24582,null,"See CPT",null,1472.2296000000001,null,1472.2296000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24586,null,"See CPT",null,1940.7744,null,1940.7744,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24587,null,"See CPT",null,1943.7474,null,1943.7474,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24600,null,"See CPT",null,684.38459999999998,null,616.60019999999997,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24605,null,"See CPT",null,869.89980000000003,null,869.89980000000003,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24615,null,"See CPT",null,1281.9576,null,1281.9576,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24620,null,"See CPT",null,1020.3336,null,1020.3336,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[24635,null,"See CPT",null,1215.3624000000002,null,1215.3624000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24640,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"X"]
[24650,null,"See CPT",null,486.38279999999997,null,451.3014,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24655,null,"See CPT",null,819.95339999999999,null,737.30400000000009,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24665,null,"See CPT",null,1187.4161999999999,null,1187.4161999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24666,null,"See CPT",null,1315.8498,null,1315.8498,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24670,null,"See CPT",null,539.89679999999998,null,492.32879999999994,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24675,null,"See CPT",null,850.87260000000003,null,768.22320000000002,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[24685,null,"See CPT",null,1178.4972,null,1178.4972,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24800,null,"See CPT",null,1496.0136,null,1496.0136,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[24802,null,"See CPT",null,1793.9082000000001,null,1793.9082000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[24900,null,"See CPT",null,1324.7688000000001,null,1324.7688000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[24920,null,"See CPT",null,1315.8498,null,1315.8498,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[24925,null,"See CPT",null,1027.4688000000001,null,1027.4688000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[24930,null,"See CPT",null,1387.7963999999999,null,1387.7963999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[24931,null,"See CPT",null,1664.2854,null,1664.2854,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[24935,null,"See CPT",null,2201.8038000000001,null,2201.8038000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR"]
[24940,null,"See CPT",null,2003.7910155120003,null,2003.7910155120003,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"F",null,"Y-UR"]
[24999,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,1,0,1,1,null,"N",null,"Y-UR"]
[25000,null,"See CPT",null,628.49220000000003,null,628.49220000000003,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[25001,null,"See CPT",null,630.27599999999995,null,630.27599999999995,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[25020,null,"See CPT",null,1384.8234,null,1384.8234,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[25023,null,"See CPT",null,2417.049,null,2417.049,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR"]
[25024,null,"See CPT",null,1403.8506,null,1403.8506,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[25025,null,"See CPT",null,2101.3164000000002,null,2101.3164000000002,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR"]
[25028,null,"See CPT",null,1300.3902,null,1300.3902,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25031,null,"See CPT",null,669.51959999999997,null,669.51959999999997,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25035,null,"See CPT",null,1057.1988000000001,null,1057.1988000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25040,null,"See CPT",null,1007.847,null,1007.847,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25065,null,"See CPT",null,475.68,null,284.8134,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[25066,null,"See CPT",null,662.97900000000004,null,662.97900000000004,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25071,null,"See CPT",null,761.08800000000008,null,761.08800000000008,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25073,null,"See CPT",null,962.06280000000004,null,962.06280000000004,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25075,null,"See CPT",null,969.19800000000009,null,569.03219999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25076,null,"See CPT",null,931.73820000000001,null,931.73820000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25077,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"X"]
[25078,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"X"]
[25085,null,"See CPT",null,811.03440000000001,null,811.03440000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25100,null,"See CPT",null,636.81660000000011,null,636.81660000000011,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25101,null,"See CPT",null,734.92560000000003,null,734.92560000000003,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25105,null,"See CPT",null,880.60260000000005,null,880.60260000000005,null,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R"]
[25107,null,"See CPT",null,1113.6858,null,1113.6858,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[25109,null,"See CPT",null,966.81960000000015,null,966.81960000000015,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[25110,null,"See CPT",null,630.27599999999995,null,630.27599999999995,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[25111,null,"See CPT",null,589.84320000000002,null,589.84320000000002,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25112,null,"See CPT",null,707.57400000000007,null,707.57400000000007,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25115,null,"See CPT",null,1357.4718,null,1357.4718,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25116,null,"See CPT",null,1088.1180000000002,null,1088.1180000000002,null,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R"]
[25118,null,"See CPT",null,694.49279999999999,null,694.49279999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25119,null,"See CPT",null,909.73800000000006,null,909.73800000000006,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25120,null,"See CPT",null,907.3596,null,907.3596,null,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R"]
[25125,null,"See CPT",null,1075.0367999999999,null,1075.0367999999999,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25126,null,"See CPT",null,1082.7666000000002,null,1082.7666000000002,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25130,null,"See CPT",null,818.16959999999995,null,818.16959999999995,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25135,null,"See CPT",null,1013.793,null,1013.793,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25136,null,"See CPT",null,902.6028,null,902.6028,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25145,null,"See CPT",null,943.03559999999993,null,943.03559999999993,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25150,null,"See CPT",null,1025.0903999999998,null,1025.0903999999998,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[25151,null,"See CPT",null,1054.2257999999999,null,1054.2257999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25170,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[25210,null,"See CPT",null,890.71080000000006,null,890.71080000000006,null,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R"]
[25215,null,"See CPT",null,1115.4696000000001,null,1115.4696000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25230,null,"See CPT",null,783.68280000000004,null,783.68280000000004,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[25240,null,"See CPT",null,777.73680000000002,null,777.73680000000002,null,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R"]
[25246,null,"See CPT",null,372.21960000000001,null,128.43360000000001,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[25248,null,"See CPT",null,759.30420000000004,null,759.30420000000004,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25250,null,"See CPT",null,966.22500000000002,null,966.22500000000002,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25251,null,"See CPT",null,1293.2550000000001,null,1293.2550000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25259,null,"See CPT",null,787.84500000000003,null,787.84500000000003,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25260,null,"See CPT",null,1145.7942,null,1145.7942,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[25263,null,"See CPT",null,1145.7942,null,1145.7942,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[25265,null,"See CPT",null,1350.3366000000001,null,1350.3366000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[25270,null,"See CPT",null,893.68380000000002,null,893.68380000000002,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[25272,null,"See CPT",null,1011.4146000000001,null,1011.4146000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[25274,null,"See CPT",null,1196.9297999999999,null,1196.9297999999999,null,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R"]
[25275,null,"See CPT",null,1210.0110000000002,null,1210.0110000000002,null,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R"]
[25280,null,"See CPT",null,1022.712,null,1022.712,null,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R"]
[25290,null,"See CPT",null,789.62879999999996,null,789.62879999999996,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[25295,null,"See CPT",null,952.54920000000004,null,952.54920000000004,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[25300,null,"See CPT",null,1244.4978000000001,null,1244.4978000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25301,null,"See CPT",null,1157.6861999999999,null,1157.6861999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25310,null,"See CPT",null,1118.4425999999999,null,1118.4425999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[25312,null,"See CPT",null,1286.1197999999999,null,1286.1197999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[25315,null,"See CPT",null,1381.8504,null,1381.8504,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25316,null,"See CPT",null,1642.2852,null,1642.2852,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25320,null,"See CPT",null,1768.3404,null,1768.3404,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[25332,null,"See CPT",null,1515.0408,null,1515.0408,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25335,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"X"]
[25337,null,"See CPT",null,1590.5550000000001,null,1590.5550000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25350,null,"See CPT",null,1214.1732000000002,null,1214.1732000000002,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25355,null,"See CPT",null,1374.7152000000001,null,1374.7152000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25360,null,"See CPT",null,1180.2810000000002,null,1180.2810000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25365,null,"See CPT",null,1644.069,null,1644.069,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25370,null,"See CPT",null,1814.1246000000001,null,1814.1246000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25375,null,"See CPT",null,1708.8804,null,1708.8804,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25390,null,"See CPT",null,1380.0666000000001,null,1380.0666000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25391,null,"See CPT",null,1782.6108000000002,null,1782.6108000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25392,null,"See CPT",null,1813.53,null,1813.53,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25393,null,"See CPT",null,2015.694,null,2015.694,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25394,null,"See CPT",null,1408.0128,null,1408.0128,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25400,null,"See CPT",null,1438.932,null,1438.932,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25405,null,"See CPT",null,1855.7466000000002,null,1855.7466000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25415,null,"See CPT",null,1733.8536000000001,null,1733.8536000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25420,null,"See CPT",null,2081.6945999999998,null,2081.6945999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25425,null,"See CPT",null,1726.7184,null,1726.7184,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25426,null,"See CPT",null,2004.3966,null,2004.3966,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25430,null,"See CPT",null,1315.8498,null,1315.8498,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25431,null,"See CPT",null,1413.3642,null,1413.3642,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25440,null,"See CPT",null,1378.2828,null,1378.2828,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25441,null,"See CPT",null,1680.3396,null,1680.3396,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25442,null,"See CPT",null,1454.3916000000002,null,1454.3916000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25443,null,"See CPT",null,1410.9858000000002,null,1410.9858000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25444,null,"See CPT",null,1487.6892,null,1487.6892,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25445,null,"See CPT",null,1292.0658000000001,null,1292.0658000000001,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[25446,null,"See CPT",null,2087.6406000000002,null,2087.6406000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25447,null,"See CPT",null,1492.4460000000001,null,1492.4460000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25449,null,"See CPT",null,1848.0167999999999,null,1848.0167999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25450,null,"See CPT",null,1114.875,null,1114.875,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[25455,null,"See CPT",null,1315.8498,null,1315.8498,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[25490,null,"See CPT",null,1292.6604,null,1292.6604,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25491,null,"See CPT",null,1328.3363999999999,null,1328.3363999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25492,null,"See CPT",null,1625.6364000000001,null,1625.6364000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25500,null,"See CPT",null,525.03179999999998,null,472.70699999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25505,null,"See CPT",null,924.60300000000007,null,836.00760000000002,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25515,null,"See CPT",null,1206.4433999999999,null,1206.4433999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25520,null,"See CPT",null,1053.6312,null,990.60360000000003,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25525,null,"See CPT",null,1416.9317999999998,null,1416.9317999999998,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[25526,null,"See CPT",null,1714.2318,null,1714.2318,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[25530,null,"See CPT",null,486.97739999999999,null,445.95,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25535,null,"See CPT",null,907.95420000000001,null,834.22379999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25545,null,"See CPT",null,1127.3616000000002,null,1127.3616000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25560,null,"See CPT",null,535.14,null,475.68,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25565,null,"See CPT",null,949.57620000000009,null,846.71040000000005,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25574,null,"See CPT",null,1215.3624000000002,null,1215.3624000000002,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[25575,null,"See CPT",null,1622.0688,null,1622.0688,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25600,null,"See CPT",null,625.51919999999996,null,597.57300000000009,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25605,null,"See CPT",null,985.84679999999992,null,929.95440000000008,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25606,null,"See CPT",null,1205.8488,null,1205.8488,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25607,null,"See CPT",null,1330.1202000000001,null,1330.1202000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25608,null,"See CPT",null,1485.9053999999999,null,1485.9053999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25609,null,"See CPT",null,1884.8820000000001,null,1884.8820000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25622,null,"See CPT",null,567.24839999999995,null,522.65339999999992,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25624,null,"See CPT",null,902.00819999999999,null,814.60199999999998,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25628,null,"See CPT",null,1295.6333999999999,null,1295.6333999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25630,null,"See CPT",null,562.49160000000006,null,521.46420000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25635,null,"See CPT",null,855.62940000000003,null,774.16919999999993,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25645,null,"See CPT",null,1032.2256,null,1032.2256,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25650,null,"See CPT",null,608.2758,null,561.30240000000003,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25651,null,"See CPT",null,886.54859999999996,null,886.54859999999996,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25652,null,"See CPT",null,1123.7939999999999,null,1123.7939999999999,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[25660,null,"See CPT",null,818.76419999999996,null,818.76419999999996,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25670,null,"See CPT",null,1097.6316000000002,null,1097.6316000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25671,null,"See CPT",null,959.6844000000001,null,959.6844000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25675,null,"See CPT",null,822.92640000000006,null,740.27699999999993,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25676,null,"See CPT",null,1137.4697999999999,null,1137.4697999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25680,null,"See CPT",null,963.84660000000008,null,963.84660000000008,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25685,null,"See CPT",null,1321.2012,null,1321.2012,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25690,null,"See CPT",null,894.87300000000005,null,894.87300000000005,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25695,null,"See CPT",null,1144.0103999999999,null,1144.0103999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[25800,null,"See CPT",null,1314.6605999999999,null,1314.6605999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[25805,null,"See CPT",null,1521.5814,null,1521.5814,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[25810,null,"See CPT",null,1550.1222,null,1550.1222,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[25820,null,"See CPT",null,1180.8756000000001,null,1180.8756000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[25825,null,"See CPT",null,1438.3374000000001,null,1438.3374000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[25830,null,"See CPT",null,1894.3956000000001,null,1894.3956000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[25900,null,"See CPT",null,1287.9036000000001,null,1287.9036000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25905,null,"See CPT",null,1262.9304,null,1262.9304,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25907,null,"See CPT",null,1108.3344,null,1108.3344,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25909,null,"See CPT",null,1233.7950000000001,null,1233.7950000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25915,null,"See CPT",null,2078.1270000000004,null,2078.1270000000004,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25920,null,"See CPT",null,1325.9580000000001,null,1325.9580000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25922,null,"See CPT",null,1177.9025999999999,null,1177.9025999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25924,null,"See CPT",null,1296.2280000000001,null,1296.2280000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25927,null,"See CPT",null,1590.5550000000001,null,1590.5550000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[25929,null,"See CPT",null,1081.5774000000001,null,1081.5774000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[25931,null,"See CPT",null,1476.9864,null,1476.9864,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[25999,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,1,0,1,1,null,"N"]
[26010,null,"See CPT",null,655.24919999999997,null,254.48880000000003,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[26011,null,"See CPT",null,914.49480000000005,null,334.75979999999998,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[26020,null,"See CPT",null,1006.0632000000002,null,1006.0632000000002,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26025,null,"See CPT",null,762.27719999999999,null,762.27719999999999,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[26030,null,"See CPT",null,886.54859999999996,null,886.54859999999996,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[26034,null,"See CPT",null,999.5225999999999,null,999.5225999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26035,null,"See CPT",null,1546.5546000000002,null,1546.5546000000002,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26037,null,"See CPT",null,1009.0361999999999,null,1009.0361999999999,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[26040,null,"See CPT",null,574.97820000000002,null,574.97820000000002,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[26045,null,"See CPT",null,855.62940000000003,null,855.62940000000003,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[26055,null,"See CPT",null,1111.902,null,529.78859999999997,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26060,null,"See CPT",null,467.35560000000004,null,467.35560000000004,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26070,null,"See CPT",null,582.70800000000008,null,582.70800000000008,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[26075,null,"See CPT",null,613.62720000000002,null,613.62720000000002,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[26080,null,"See CPT",null,724.81740000000002,null,724.81740000000002,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26100,null,"See CPT",null,617.7894,null,617.7894,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[26105,null,"See CPT",null,621.9516000000001,null,621.9516000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[26110,null,"See CPT",null,592.22160000000008,null,592.22160000000008,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26111,null,"See CPT",null,747.41219999999998,null,747.41219999999998,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26113,null,"See CPT",null,982.87380000000007,null,982.87380000000007,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26115,null,"See CPT",null,1020.9282000000001,null,598.16759999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26116,null,"See CPT",null,945.41399999999999,null,945.41399999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26117,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"X"]
[26118,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"X"]
[26121,null,"See CPT",null,1080.9828,null,1080.9828,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[26123,null,"See CPT",null,1504.9325999999999,null,1504.9325999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[26125,null,"See CPT",null,473.89619999999996,null,473.89619999999996,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[26130,null,"See CPT",null,851.46720000000005,null,851.46720000000005,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[26135,null,"See CPT",null,1001.9010000000001,null,1001.9010000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26140,null,"See CPT",null,919.25160000000005,null,919.25160000000005,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26145,null,"See CPT",null,932.33280000000002,null,932.33280000000002,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26160,null,"See CPT",null,1155.3078,null,572.59980000000007,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26170,null,"See CPT",null,740.27699999999993,null,740.27699999999993,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26180,null,"See CPT",null,814.60199999999998,null,814.60199999999998,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26185,null,"See CPT",null,1007.847,null,1007.847,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[26200,null,"See CPT",null,812.81820000000005,null,812.81820000000005,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26205,null,"See CPT",null,1093.4694,null,1093.4694,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26210,null,"See CPT",null,811.03440000000001,null,811.03440000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26215,null,"See CPT",null,1025.0903999999998,null,1025.0903999999998,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26230,null,"See CPT",null,903.19740000000002,null,903.19740000000002,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26235,null,"See CPT",null,888.92700000000002,null,888.92700000000002,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26236,null,"See CPT",null,799.73699999999997,null,799.73699999999997,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26250,null,"See CPT",null,1900.3416,null,1900.3416,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26260,null,"See CPT",null,1427.04,null,1427.04,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26262,null,"See CPT",null,1133.3075999999999,null,1133.3075999999999,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26320,null,"See CPT",null,635.62739999999997,null,635.62739999999997,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26340,null,"See CPT",null,647.51940000000002,null,647.51940000000002,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[26341,null,"See CPT",null,215.24520000000001,null,141.51480000000001,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[26350,null,"See CPT",null,1392.5532000000001,null,1392.5532000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26352,null,"See CPT",null,1545.96,null,1545.96,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26356,null,"See CPT",null,1438.3374000000001,null,1438.3374000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26357,null,"See CPT",null,1610.1768,null,1610.1768,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26358,null,"See CPT",null,1775.4756,null,1775.4756,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26370,null,"See CPT",null,1460.3375999999998,null,1460.3375999999998,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26372,null,"See CPT",null,1696.9884,null,1696.9884,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26373,null,"See CPT",null,1635.7446000000002,null,1635.7446000000002,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26390,null,"See CPT",null,1618.5011999999999,null,1618.5011999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26392,null,"See CPT",null,1850.3952000000002,null,1850.3952000000002,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26410,null,"See CPT",null,1124.9832000000001,null,1124.9832000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26412,null,"See CPT",null,1334.2824000000001,null,1334.2824000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26415,null,"See CPT",null,1577.4738,null,1577.4738,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26416,null,"See CPT",null,1701.7452000000001,null,1701.7452000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26418,null,"See CPT",null,1168.9836,null,1168.9836,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26420,null,"See CPT",null,1384.2288000000001,null,1384.2288000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26426,null,"See CPT",null,910.33260000000007,null,910.33260000000007,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26428,null,"See CPT",null,1480.5539999999999,null,1480.5539999999999,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26432,null,"See CPT",null,1019.1444,null,1019.1444,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26433,null,"See CPT",null,1069.6853999999998,null,1069.6853999999998,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26434,null,"See CPT",null,1295.6333999999999,null,1295.6333999999999,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26437,null,"See CPT",null,1240.3355999999999,null,1240.3355999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26440,null,"See CPT",null,1218.93,null,1218.93,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26442,null,"See CPT",null,1824.8274000000001,null,1824.8274000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26445,null,"See CPT",null,1141.6320000000001,null,1141.6320000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26449,null,"See CPT",null,1257.579,null,1257.579,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26450,null,"See CPT",null,865.73760000000004,null,865.73760000000004,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26455,null,"See CPT",null,856.22400000000005,null,856.22400000000005,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26460,null,"See CPT",null,843.14279999999997,null,843.14279999999997,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26471,null,"See CPT",null,1228.4436000000001,null,1228.4436000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26474,null,"See CPT",null,1215.9569999999999,null,1215.9569999999999,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26476,null,"See CPT",null,1202.2811999999999,null,1202.2811999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26477,null,"See CPT",null,1166.0106000000001,null,1166.0106000000001,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R"]
[26478,null,"See CPT",null,1234.3896000000002,null,1234.3896000000002,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26479,null,"See CPT",null,1259.3628000000001,null,1259.3628000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26480,null,"See CPT",null,1461.5267999999999,null,1461.5267999999999,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26483,null,"See CPT",null,1612.5552,null,1612.5552,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26485,null,"See CPT",null,1548.3383999999999,null,1548.3383999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26489,null,"See CPT",null,1784.9892,null,1784.9892,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26490,null,"See CPT",null,1550.7167999999999,null,1550.7167999999999,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26492,null,"See CPT",null,1709.4750000000001,null,1709.4750000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26494,null,"See CPT",null,1556.0682000000002,null,1556.0682000000002,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26496,null,"See CPT",null,1670.826,null,1670.826,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26497,null,"See CPT",null,1669.0422000000001,null,1669.0422000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26498,null,"See CPT",null,2156.6142000000004,null,2156.6142000000004,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26499,null,"See CPT",null,1607.7983999999999,null,1607.7983999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26500,null,"See CPT",null,1243.3086000000001,null,1243.3086000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26502,null,"See CPT",null,1402.0667999999998,null,1402.0667999999998,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26508,null,"See CPT",null,1257.579,null,1257.579,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[26510,null,"See CPT",null,1195.7406000000001,null,1195.7406000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26516,null,"See CPT",null,1378.2828,null,1378.2828,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[26517,null,"See CPT",null,1599.4739999999999,null,1599.4739999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[26518,null,"See CPT",null,1619.6904,null,1619.6904,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[26520,null,"See CPT",null,1277.2008000000001,null,1277.2008000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26525,null,"See CPT",null,1281.3630000000001,null,1281.3630000000001,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R"]
[26530,null,"See CPT",null,978.11699999999996,null,978.11699999999996,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26531,null,"See CPT",null,1138.6589999999999,null,1138.6589999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26535,null,"See CPT",null,790.8180000000001,null,790.8180000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26536,null,"See CPT",null,1394.337,null,1394.337,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26540,null,"See CPT",null,1299.201,null,1299.201,null,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R"]
[26541,null,"See CPT",null,1538.2302,null,1538.2302,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26542,null,"See CPT",null,1340.2284,null,1340.2284,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26545,null,"See CPT",null,1356.2826,null,1356.2826,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26546,null,"See CPT",null,1902.1253999999999,null,1902.1253999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[26548,null,"See CPT",null,1475.2025999999998,null,1475.2025999999998,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26550,null,"See CPT",null,3002.73,null,3002.73,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[26551,null,"See CPT",null,5901.9996000000001,null,5901.9996000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[26553,null,"See CPT",null,5862.1614,null,5862.1614,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[26554,null,"See CPT",null,6814.116,null,6814.116,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[26555,null,"See CPT",null,2533.5906,null,2533.5906,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26556,null,"See CPT",null,6097.0284000000001,null,6097.0284000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26560,null,"See CPT",null,1186.2269999999999,null,1186.2269999999999,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26561,null,"See CPT",null,1805.8002000000001,null,1805.8002000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26562,null,"See CPT",null,2505.6444000000001,null,2505.6444000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26565,null,"See CPT",null,1331.3094000000001,null,1331.3094000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26567,null,"See CPT",null,1334.877,null,1334.877,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26568,null,"See CPT",null,1725.5291999999999,null,1725.5291999999999,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26580,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"X"]
[26587,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"X"]
[26590,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"X"]
[26591,null,"See CPT",null,913.30560000000003,null,913.30560000000003,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26593,null,"See CPT",null,1201.6866,null,1201.6866,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26596,null,"See CPT",null,1500.1758,null,1500.1758,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26600,null,"See CPT",null,555.95100000000002,null,528.00480000000005,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26605,null,"See CPT",null,610.65419999999995,null,548.22120000000007,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26607,null,"See CPT",null,934.71120000000008,null,934.71120000000008,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26608,null,"See CPT",null,877.03499999999997,null,877.03499999999997,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26615,null,"See CPT",null,1040.55,null,1040.55,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26641,null,"See CPT",null,771.19620000000009,null,700.43880000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[26645,null,"See CPT",null,795.5748000000001,null,721.84440000000006,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[26650,null,"See CPT",null,877.62959999999998,null,877.62959999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[26665,null,"See CPT",null,1128.5508,null,1128.5508,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[26670,null,"See CPT",null,640.97879999999998,null,570.22140000000002,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26675,null,"See CPT",null,847.30500000000006,null,770.60160000000008,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26676,null,"See CPT",null,926.98140000000001,null,926.98140000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26685,null,"See CPT",null,1042.3338000000001,null,1042.3338000000001,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R"]
[26686,null,"See CPT",null,1124.9832000000001,null,1124.9832000000001,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[26700,null,"See CPT",null,619.57320000000004,null,567.84300000000007,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26705,null,"See CPT",null,778.92600000000004,null,704.00639999999999,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26706,null,"See CPT",null,812.22360000000003,null,812.22360000000003,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26715,null,"See CPT",null,1036.9824000000001,null,1036.9824000000001,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26720,null,"See CPT",null,369.2466,null,346.65180000000004,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26725,null,"See CPT",null,629.08680000000004,null,557.14019999999994,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26727,null,"See CPT",null,863.35919999999999,null,863.35919999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26735,null,"See CPT",null,1074.4422,null,1074.4422,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26740,null,"See CPT",null,429.30119999999999,null,405.5172,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26742,null,"See CPT",null,687.35760000000005,null,614.22180000000003,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26746,null,"See CPT",null,1336.6608000000001,null,1336.6608000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26750,null,"See CPT",null,344.27339999999998,null,346.65180000000004,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26755,null,"See CPT",null,588.654,null,502.43699999999995,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26756,null,"See CPT",null,775.95300000000009,null,775.95300000000009,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26765,null,"See CPT",null,910.92720000000008,null,910.92720000000008,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26770,null,"See CPT",null,523.84260000000006,null,474.49080000000004,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26775,null,"See CPT",null,722.43900000000008,null,645.73559999999998,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26776,null,"See CPT",null,821.14260000000002,null,821.14260000000002,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26785,null,"See CPT",null,988.81979999999999,null,988.81979999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26820,null,"See CPT",null,1534.6625999999999,null,1534.6625999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[26841,null,"See CPT",null,1432.3914,null,1432.3914,null,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R"]
[26842,null,"See CPT",null,1538.8247999999999,null,1538.8247999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[26843,null,"See CPT",null,1450.8239999999998,null,1450.8239999999998,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26844,null,"See CPT",null,1589.3658,null,1589.3658,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26850,null,"See CPT",null,1361.634,null,1361.634,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26852,null,"See CPT",null,1535.8517999999999,null,1535.8517999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26860,null,"See CPT",null,1142.8211999999999,null,1142.8211999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26861,null,"See CPT",null,179.5692,null,179.5692,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[26862,null,"See CPT",null,1418.1210000000001,null,1418.1210000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[26863,null,"See CPT",null,400.16580000000005,null,400.16580000000005,null,"000",0,0,0,0,0,0,2,0,0,null,"R"]
[26910,null,"See CPT",null,1408.0128,null,1408.0128,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26951,null,"See CPT",null,1298.6064000000001,null,1298.6064000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26952,null,"See CPT",null,1268.2818,null,1268.2818,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26989,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,0,1,1,1,null,"N"]
[26990,null,"See CPT",null,1240.3355999999999,null,1240.3355999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[26991,null,"See CPT",null,1294.4441999999999,null,941.84640000000002,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[26992,null,"See CPT",null,1814.7192,null,1814.7192,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[27000,null,"See CPT",null,727.19580000000008,null,727.19580000000008,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[27001,null,"See CPT",null,973.36020000000008,null,973.36020000000008,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27003,null,"See CPT",null,1080.3882000000001,null,1080.3882000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27005,null,"See CPT",null,1297.4172000000001,null,1297.4172000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27006,null,"See CPT",null,1288.4982000000002,null,1288.4982000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27025,null,"See CPT",null,1651.7988,null,1651.7988,null,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R"]
[27027,null,"See CPT",null,1581.0414000000001,null,1581.0414000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27030,null,"See CPT",null,1673.2044000000001,null,1673.2044000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27033,null,"See CPT",null,1735.6374000000001,null,1735.6374000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27035,null,"See CPT",null,2069.8026,null,2069.8026,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[27036,null,"See CPT",null,1820.6652000000001,null,1820.6652000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27040,null,"See CPT",null,626.70839999999998,null,353.19240000000002,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[27041,null,"See CPT",null,1268.8764000000001,null,1268.8764000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27043,null,"See CPT",null,838.38599999999997,null,838.38599999999997,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27045,null,"See CPT",null,1309.9038,null,1309.9038,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27047,null,"See CPT",null,910.92720000000008,null,647.51940000000002,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27048,null,"See CPT",null,1089.9017999999999,null,1089.9017999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27049,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[27050,null,"See CPT",null,734.92560000000003,null,734.92560000000003,null,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R"]
[27052,null,"See CPT",null,1041.7392,null,1041.7392,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27054,null,"See CPT",null,1236.768,null,1236.768,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27057,null,"See CPT",null,1801.0434,null,1801.0434,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27059,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[27060,null,"See CPT",null,841.35900000000004,null,841.35900000000004,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27062,null,"See CPT",null,822.33180000000004,null,822.33180000000004,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[27065,null,"See CPT",null,950.17079999999999,null,950.17079999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27066,null,"See CPT",null,1462.1214,null,1462.1214,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27067,null,"See CPT",null,1850.9898000000001,null,1850.9898000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[27070,null,"See CPT",null,1606.0146000000002,null,1606.0146000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27071,null,"See CPT",null,1760.0160000000001,null,1760.0160000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27075,null,"See CPT",null,3687.7092000000002,null,3687.7092000000002,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[27076,null,"See CPT",null,4452.3647999999994,null,4452.3647999999994,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[27077,null,"See CPT",null,4963.7208000000001,null,4963.7208000000001,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[27078,null,"See CPT",null,3635.9789999999998,null,3635.9789999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27080,null,"See CPT",null,918.06240000000003,null,918.06240000000003,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[27086,null,"See CPT",null,579.1404,null,303.84060000000005,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R"]
[27087,null,"See CPT",null,1099.4153999999999,null,1099.4153999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27090,null,"See CPT",null,1487.6892,null,1487.6892,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27091,null,"See CPT",null,2827.9176000000002,null,2827.9176000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27093,null,"See CPT",null,449.51759999999996,null,118.92,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[27095,null,"See CPT",null,605.89739999999995,null,145.67700000000002,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[27096,null,"See CPT",null,299.0838,null,145.67700000000002,null,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[27097,null,"See CPT",null,1229.6328000000001,null,1229.6328000000001,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[27098,null,"See CPT",null,1251.633,null,1251.633,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[27100,null,"See CPT",null,1490.0675999999999,null,1490.0675999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27105,null,"See CPT",null,1561.4196000000002,null,1561.4196000000002,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[27110,null,"See CPT",null,1738.0158000000001,null,1738.0158000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27111,null,"See CPT",null,1619.0958000000001,null,1619.0958000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27120,null,"See CPT",null,2312.3994000000002,null,2312.3994000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27122,null,"See CPT",null,1969.3151999999998,null,1969.3151999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27125,null,"See CPT",null,2015.694,null,2015.694,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27130,null,"See CPT",null,2280.8856000000001,null,2280.8856000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27132,null,"See CPT",null,2963.4864000000002,null,2963.4864000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27134,null,"See CPT",null,3371.3820000000001,null,3371.3820000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27137,null,"See CPT",null,2598.9965999999999,null,2598.9965999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27138,null,"See CPT",null,2700.6732000000002,null,2700.6732000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27140,null,"See CPT",null,1598.2847999999999,null,1598.2847999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27146,null,"See CPT",null,2279.1017999999999,null,2279.1017999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27147,null,"See CPT",null,2598.9965999999999,null,2598.9965999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27151,null,"See CPT",null,2807.1066000000001,null,2807.1066000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27156,null,"See CPT",null,3022.9464000000003,null,3022.9464000000003,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27158,null,"See CPT",null,2488.9956000000002,null,2488.9956000000002,null,"090",0.1,0.69,0.21,0,2,2,2,0,0,null,"R"]
[27161,null,"See CPT",null,2175.6414000000004,null,2175.6414000000004,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27165,null,"See CPT",null,2455.1034,null,2455.1034,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27170,null,"See CPT",null,2074.5594000000001,null,2074.5594000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27175,null,"See CPT",null,1193.9567999999999,null,1193.9567999999999,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27176,null,"See CPT",null,1651.2041999999999,null,1651.2041999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27177,null,"See CPT",null,1991.3154000000002,null,1991.3154000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27178,null,"See CPT",null,1651.2041999999999,null,1651.2041999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27179,null,"See CPT",null,1751.097,null,1751.097,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[27181,null,"See CPT",null,1997.2614000000003,null,1997.2614000000003,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[27185,null,"See CPT",null,1290.8766000000001,null,1290.8766000000001,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[27187,null,"See CPT",null,1782.6108000000002,null,1782.6108000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27197,null,"See CPT",null,242.5968,null,242.5968,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[27198,null,"See CPT",null,569.6268,null,569.6268,null,"000",0,0,0,0,2,0,0,2,0,null,"R"]
[27200,null,"See CPT",null,344.27339999999998,null,345.46260000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[27202,null,"See CPT",null,946.60320000000002,null,946.60320000000002,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[27215,null,"See CPT",null,1076.2260000000001,null,1076.2260000000001,null,"090",0.1,0.69,0.21,9,9,9,9,9,9,null,"R"]
[27216,null,"See CPT",null,1589.9603999999999,null,1589.9603999999999,null,"090",0.1,0.69,0.21,9,9,9,9,9,9,null,"R"]
[27217,null,"See CPT",null,1494.8244,null,1494.8244,null,"090",0.1,0.69,0.21,9,9,9,9,9,9,null,"R"]
[27218,null,"See CPT",null,2048.3970000000004,null,2048.3970000000004,null,"090",0.1,0.69,0.21,9,9,9,9,9,9,null,"R"]
[27220,null,"See CPT",null,756.33120000000008,null,743.84460000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27222,null,"See CPT",null,1760.0160000000001,null,1760.0160000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27226,null,"See CPT",null,1881.3144,null,1881.3144,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27227,null,"See CPT",null,2927.8104000000003,null,2927.8104000000003,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27228,null,"See CPT",null,3325.0032000000001,null,3325.0032000000001,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27230,null,"See CPT",null,883.57560000000001,null,865.73760000000004,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27232,null,"See CPT",null,1314.066,null,1314.066,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27235,null,"See CPT",null,1622.6633999999999,null,1622.6633999999999,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[27236,null,"See CPT",null,2125.1004000000003,null,2125.1004000000003,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27238,null,"See CPT",null,846.71040000000005,null,846.71040000000005,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27240,null,"See CPT",null,1714.8263999999999,null,1714.8263999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27244,null,"See CPT",null,2185.7496000000001,null,2185.7496000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27245,null,"See CPT",null,2183.9657999999999,null,2183.9657999999999,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27246,null,"See CPT",null,709.3578,null,699.8442,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27248,null,"See CPT",null,1335.4716000000001,null,1335.4716000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27250,null,"See CPT",null,313.94880000000001,null,313.94880000000001,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[27252,null,"See CPT",null,1352.1204,null,1352.1204,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27253,null,"See CPT",null,1681.5288,null,1681.5288,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27254,null,"See CPT",null,2264.8314,null,2264.8314,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27256,null,"See CPT",null,551.19420000000002,null,420.38220000000001,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R"]
[27257,null,"See CPT",null,642.16800000000001,null,642.16800000000001,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R"]
[27258,null,"See CPT",null,1984.1801999999998,null,1984.1801999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27259,null,"See CPT",null,2741.1060000000002,null,2741.1060000000002,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[27265,null,"See CPT",null,742.65539999999999,null,742.65539999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27266,null,"See CPT",null,1054.2257999999999,null,1054.2257999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27267,null,"See CPT",null,798.54779999999994,null,798.54779999999994,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27268,null,"See CPT",null,981.68460000000016,null,981.68460000000016,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27269,null,"See CPT",null,2204.1822000000002,null,2204.1822000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27275,null,"See CPT",null,329.40840000000003,null,329.40840000000003,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[27279,null,"See CPT",null,1490.6622,null,1490.6622,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27280,null,"See CPT",null,2408.13,null,2408.13,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27282,null,"See CPT",null,1542.3924000000002,null,1542.3924000000002,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[27284,null,"See CPT",null,2843.3771999999999,null,2843.3771999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27286,null,"See CPT",null,2914.1345999999999,null,2914.1345999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27290,null,"See CPT",null,2887.3776000000003,null,2887.3776000000003,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[27295,null,"See CPT",null,2242.2366000000002,null,2242.2366000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27299,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,1,2,1,1,null,"N"]
[27301,null,"See CPT",null,1231.4166,null,910.92720000000008,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27303,null,"See CPT",null,1147.578,null,1147.578,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27305,null,"See CPT",null,872.87279999999998,null,872.87279999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27306,null,"See CPT",null,613.0326,null,613.0326,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[27307,null,"See CPT",null,755.14199999999994,null,755.14199999999994,null,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R"]
[27310,null,"See CPT",null,1315.2552000000001,null,1315.2552000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27323,null,"See CPT",null,503.62620000000004,null,311.57040000000001,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[27324,null,"See CPT",null,733.7364,null,733.7364,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27325,null,"See CPT",null,1020.3336,null,1020.3336,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM"]
[27326,null,"See CPT",null,946.0086,null,946.0086,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[27327,null,"See CPT",null,934.71120000000008,null,566.65379999999993,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27328,null,"See CPT",null,1114.2803999999999,null,1114.2803999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27329,null,"See CPT",null,1851.5844,null,1851.5844,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27330,null,"See CPT",null,764.65559999999994,null,764.65559999999994,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[27331,null,"See CPT",null,860.98080000000004,null,860.98080000000004,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27332,null,"See CPT",null,1163.0375999999999,null,1163.0375999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27333,null,"See CPT",null,1063.1448,null,1063.1448,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27334,null,"See CPT",null,1233.7950000000001,null,1233.7950000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27335,null,"See CPT",null,1375.3098,null,1375.3098,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27337,null,"See CPT",null,752.16899999999998,null,752.16899999999998,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[27339,null,"See CPT",null,1347.9582,null,1347.9582,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[27340,null,"See CPT",null,680.81700000000001,null,680.81700000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[27345,null,"See CPT",null,878.2242,null,878.2242,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27347,null,"See CPT",null,949.57620000000009,null,949.57620000000009,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27350,null,"See CPT",null,1179.0917999999999,null,1179.0917999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27355,null,"See CPT",null,1097.037,null,1097.037,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27356,null,"See CPT",null,1329.5255999999999,null,1329.5255999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27357,null,"See CPT",null,1472.2296000000001,null,1472.2296000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27358,null,"See CPT",null,483.40980000000008,null,483.40980000000008,null,"000",0,0,0,0,0,0,2,0,0,null,"R",null,"Y-UR"]
[27360,null,"See CPT",null,1636.9338,null,1636.9338,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27364,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[27365,null,"See CPT",null,3633.6006000000002,null,3633.6006000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27369,null,"See CPT",null,330.5976,null,70.162800000000004,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[27372,null,"See CPT",null,1093.4694,null,724.22280000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27380,null,"See CPT",null,1133.9022,null,1133.9022,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27381,null,"See CPT",null,1485.3108,null,1485.3108,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27385,null,"See CPT",null,1106.5506,null,1106.5506,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27386,null,"See CPT",null,1551.9060000000002,null,1551.9060000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27390,null,"See CPT",null,812.81820000000005,null,812.81820000000005,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[27391,null,"See CPT",null,1003.6848,null,1003.6848,null,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R",null,"Y-UR"]
[27392,null,"See CPT",null,1281.9576,null,1281.9576,null,"090",0.1,0.69,0.21,0,2,2,2,1,0,null,"R",null,"Y-UR"]
[27393,null,"See CPT",null,906.17039999999997,null,906.17039999999997,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27394,null,"See CPT",null,1178.4972,null,1178.4972,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR"]
[27395,null,"See CPT",null,1580.4467999999999,null,1580.4467999999999,null,"090",0.1,0.69,0.21,0,2,2,2,1,0,null,"R",null,"Y-UR"]
[27396,null,"See CPT",null,1114.2803999999999,null,1114.2803999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27397,null,"See CPT",null,1638.123,null,1638.123,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[27400,null,"See CPT",null,1252.2275999999999,null,1252.2275999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27403,null,"See CPT",null,1161.2538000000002,null,1161.2538000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27405,null,"See CPT",null,1218.3353999999999,null,1218.3353999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27407,null,"See CPT",null,1431.7967999999998,null,1431.7967999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27409,null,"See CPT",null,1731.4752000000001,null,1731.4752000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27412,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[27415,null,"See CPT",null,2444.4005999999999,null,2444.4005999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27416,null,"See CPT",null,1751.097,null,1751.097,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR"]
[27418,null,"See CPT",null,1491.2567999999999,null,1491.2567999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27420,null,"See CPT",null,1333.6877999999999,null,1333.6877999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27422,null,"See CPT",null,1334.2824000000001,null,1334.2824000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27424,null,"See CPT",null,1344.9852000000001,null,1344.9852000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27425,null,"See CPT",null,822.33180000000004,null,822.33180000000004,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[27427,null,"See CPT",null,1277.2008000000001,null,1277.2008000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27428,null,"See CPT",null,1997.8560000000002,null,1997.8560000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27429,null,"See CPT",null,2248.7772,null,2248.7772,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27430,null,"See CPT",null,1334.2824000000001,null,1334.2824000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27435,null,"See CPT",null,1446.0672,null,1446.0672,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27437,null,"See CPT",null,1187.4161999999999,null,1187.4161999999999,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[27438,null,"See CPT",null,1504.9325999999999,null,1504.9325999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27440,null,"See CPT",null,1430.6076,null,1430.6076,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27441,null,"See CPT",null,1476.3917999999999,null,1476.3917999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27442,null,"See CPT",null,1558.4466,null,1558.4466,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27443,null,"See CPT",null,1462.7160000000001,null,1462.7160000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27445,null,"See CPT",null,2233.3176000000003,null,2233.3176000000003,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27446,null,"See CPT",null,2051.37,null,2051.37,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27447,null,"See CPT",null,2278.5072,null,2278.5072,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27448,null,"See CPT",null,1449.6348,null,1449.6348,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27450,null,"See CPT",null,1808.7732000000001,null,1808.7732000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27454,null,"See CPT",null,2301.6966000000002,null,2301.6966000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27455,null,"See CPT",null,1724.9346,null,1724.9346,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27457,null,"See CPT",null,1716.0155999999999,null,1716.0155999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27465,null,"See CPT",null,2221.4256,null,2221.4256,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27466,null,"See CPT",null,2112.6138000000001,null,2112.6138000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27468,null,"See CPT",null,2387.319,null,2387.319,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27470,null,"See CPT",null,2103.1001999999999,null,2103.1001999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27472,null,"See CPT",null,2250.5610000000001,null,2250.5610000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27475,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"X"]
[27477,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"X"]
[27479,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"X"]
[27485,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"X"]
[27486,null,"See CPT",null,2494.9416000000001,null,2494.9416000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27487,null,"See CPT",null,3107.9742000000001,null,3107.9742000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27488,null,"See CPT",null,2136.9924000000001,null,2136.9924000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27495,null,"See CPT",null,2015.694,null,2015.694,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27496,null,"See CPT",null,991.19820000000016,null,991.19820000000016,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27497,null,"See CPT",null,1045.3067999999998,null,1045.3067999999998,null,"090",0.1,0.69,0.21,0,2,1,0,2,0,null,"R"]
[27498,null,"See CPT",null,1183.2539999999999,null,1183.2539999999999,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27499,null,"See CPT",null,1261.1466,null,1261.1466,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27500,null,"See CPT",null,946.60320000000002,null,867.52139999999997,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27501,null,"See CPT",null,918.06240000000003,null,899.62980000000005,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27502,null,"See CPT",null,1357.4718,null,1357.4718,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27503,null,"See CPT",null,1432.3914,null,1432.3914,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27506,null,"See CPT",null,2381.373,null,2381.373,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27507,null,"See CPT",null,1724.9346,null,1724.9346,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27508,null,"See CPT",null,956.1167999999999,null,904.38660000000004,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27509,null,"See CPT",null,1229.6328000000001,null,1229.6328000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27510,null,"See CPT",null,1216.5516,null,1216.5516,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27511,null,"See CPT",null,1773.0971999999999,null,1773.0971999999999,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27513,null,"See CPT",null,2196.4523999999997,null,2196.4523999999997,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27514,null,"See CPT",null,1721.9616000000001,null,1721.9616000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27516,null,"See CPT",null,946.0086,null,881.79179999999997,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27517,null,"See CPT",null,1240.3355999999999,null,1240.3355999999999,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27519,null,"See CPT",null,1589.3658,null,1589.3658,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27520,null,"See CPT",null,599.35680000000002,null,552.97800000000007,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27524,null,"See CPT",null,1352.7149999999999,null,1352.7149999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27530,null,"See CPT",null,569.03219999999999,null,533.35620000000006,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27532,null,"See CPT",null,1124.9832000000001,null,1046.4960000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27535,null,"See CPT",null,1599.4739999999999,null,1599.4739999999999,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27536,null,"See CPT",null,2114.3976000000002,null,2114.3976000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27538,null,"See CPT",null,890.71080000000006,null,825.30480000000011,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27540,null,"See CPT",null,1459.1484,null,1459.1484,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27550,null,"See CPT",null,938.27879999999993,null,859.197,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27552,null,"See CPT",null,1144.605,null,1144.605,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27556,null,"See CPT",null,1564.3925999999999,null,1564.3925999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27557,null,"See CPT",null,1861.6925999999999,null,1861.6925999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27558,null,"See CPT",null,2114.3976000000002,null,2114.3976000000002,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27560,null,"See CPT",null,676.06020000000001,null,614.22180000000003,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27562,null,"See CPT",null,888.92700000000002,null,888.92700000000002,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27566,null,"See CPT",null,1597.0955999999999,null,1597.0955999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27570,null,"See CPT",null,275.2998,null,275.2998,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[27580,null,"See CPT",null,2639.4294,null,2639.4294,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27590,null,"See CPT",null,1387.7963999999999,null,1387.7963999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27591,null,"See CPT",null,1723.1508000000001,null,1723.1508000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27592,null,"See CPT",null,1185.0378000000001,null,1185.0378000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27594,null,"See CPT",null,906.76499999999999,null,906.76499999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[27596,null,"See CPT",null,1267.0925999999999,null,1267.0925999999999,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[27598,null,"See CPT",null,1242.1194,null,1242.1194,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27599,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,1,2,1,1,null,"N",null,"Y-UR"]
[27600,null,"See CPT",null,721.84440000000006,null,721.84440000000006,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[27601,null,"See CPT",null,803.89919999999995,null,803.89919999999995,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27602,null,"See CPT",null,849.68340000000001,null,849.68340000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27603,null,"See CPT",null,973.95479999999998,null,705.79019999999991,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27604,null,"See CPT",null,819.95339999999999,null,576.16739999999993,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27605,null,"See CPT",null,610.05960000000005,null,326.43540000000002,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R"]
[27606,null,"See CPT",null,487.57199999999995,null,487.57199999999995,null,"010",0.1,0.8,0.1,0,2,1,1,1,0,null,"R"]
[27607,null,"See CPT",null,1069.6853999999998,null,1069.6853999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27610,null,"See CPT",null,1162.443,null,1162.443,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[27612,null,"See CPT",null,1003.0902000000001,null,1003.0902000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27613,null,"See CPT",null,464.38259999999997,null,287.1918,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[27614,null,"See CPT",null,1064.9286,null,739.68240000000003,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27615,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"X"]
[27616,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"X"]
[27618,null,"See CPT",null,906.76499999999999,null,550.59960000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27619,null,"See CPT",null,825.89940000000001,null,825.89940000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27620,null,"See CPT",null,810.4398000000001,null,810.4398000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27625,null,"See CPT",null,1029.2526,null,1029.2526,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27626,null,"See CPT",null,1079.1989999999998,null,1079.1989999999998,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[27630,null,"See CPT",null,993.5766000000001,null,645.14099999999996,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27632,null,"See CPT",null,737.89859999999999,null,737.89859999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[27634,null,"See CPT",null,1205.8488,null,1205.8488,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[27635,null,"See CPT",null,1041.1446000000001,null,1041.1446000000001,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[27637,null,"See CPT",null,1318.2282,null,1318.2282,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27638,null,"See CPT",null,1344.3905999999999,null,1344.3905999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27640,null,"See CPT",null,1488.2838000000002,null,1488.2838000000002,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[27641,null,"See CPT",null,1167.1997999999999,null,1167.1997999999999,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[27645,null,"See CPT",null,3132.3528000000001,null,3132.3528000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27646,null,"See CPT",null,2725.0517999999997,null,2725.0517999999997,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27647,null,"See CPT",null,1760.6106,null,1760.6106,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[27648,null,"See CPT",null,412.65240000000006,null,89.784599999999998,null,"000",0,0,0,0,2,1,0,0,0,null,"R"]
[27650,null,"See CPT",null,1183.8486,null,1183.8486,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27652,null,"See CPT",null,1178.4972,null,1178.4972,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[27654,null,"See CPT",null,1277.2008000000001,null,1277.2008000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27656,null,"See CPT",null,1008.4416000000001,null,634.43820000000005,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[27658,null,"See CPT",null,662.97900000000004,null,662.97900000000004,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[27659,null,"See CPT",null,842.54819999999995,null,842.54819999999995,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[27664,null,"See CPT",null,657.62760000000003,null,657.62760000000003,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,"Y-UR"]
[27665,null,"See CPT",null,759.89879999999994,null,759.89879999999994,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[27675,null,"See CPT",null,882.38639999999998,null,882.38639999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27676,null,"See CPT",null,1090.4964,null,1090.4964,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[27680,null,"See CPT",null,750.97980000000007,null,750.97980000000007,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,"Y-UR"]
[27681,null,"See CPT",null,913.30560000000003,null,913.30560000000003,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[27685,null,"See CPT",null,1195.7406000000001,null,833.03459999999995,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27686,null,"See CPT",null,954.33300000000008,null,954.33300000000008,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[27687,null,"See CPT",null,814.60199999999998,null,814.60199999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27690,null,"See CPT",null,1149.9564,null,1149.9564,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27691,null,"See CPT",null,1334.2824000000001,null,1334.2824000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27692,null,"See CPT",null,177.1908,null,177.1908,null,"000",0,0,0,0,0,0,2,1,0,null,"R"]
[27695,null,"See CPT",null,862.17,null,862.17,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[27696,null,"See CPT",null,982.27919999999995,null,982.27919999999995,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[27698,null,"See CPT",null,1140.4428,null,1140.4428,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27700,null,"See CPT",null,1097.037,null,1097.037,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27702,null,"See CPT",null,1718.394,null,1718.394,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27703,null,"See CPT",null,1975.2611999999999,null,1975.2611999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR"]
[27704,null,"See CPT",null,1025.0903999999998,null,1025.0903999999998,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[27705,null,"See CPT",null,1359.2556,null,1359.2556,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27707,null,"See CPT",null,730.76339999999993,null,730.76339999999993,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[27709,null,"See CPT",null,2035.9104000000002,null,2035.9104000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27712,null,"See CPT",null,1966.3422,null,1966.3422,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27715,null,"See CPT",null,1915.8011999999999,null,1915.8011999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27720,null,"See CPT",null,1566.1764000000001,null,1566.1764000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27722,null,"See CPT",null,1603.0416,null,1603.0416,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27724,null,"See CPT",null,2228.5607999999997,null,2228.5607999999997,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27725,null,"See CPT",null,2166.7224000000001,null,2166.7224000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27726,null,"See CPT",null,1711.2588000000001,null,1711.2588000000001,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[27727,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[27730,null,"See CPT",null,1061.3610000000001,null,1061.3610000000001,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-CM"]
[27732,null,"See CPT",null,821.14260000000002,null,821.14260000000002,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[27734,null,"See CPT",null,1184.4432000000002,null,1184.4432000000002,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[27740,null,"See CPT",null,1272.444,null,1272.444,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM"]
[27742,null,"See CPT",null,1394.337,null,1394.337,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[27745,null,"See CPT",null,1358.0663999999999,null,1358.0663999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27750,null,"See CPT",null,638.60040000000004,null,591.62699999999995,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27752,null,"See CPT",null,974.54939999999999,null,889.52160000000003,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27756,null,"See CPT",null,1045.9014,null,1045.9014,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27758,null,"See CPT",null,1605.42,null,1605.42,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27759,null,"See CPT",null,1780.827,null,1780.827,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27760,null,"See CPT",null,611.84339999999997,null,564.27539999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27762,null,"See CPT",null,881.19720000000007,null,794.98019999999997,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27766,null,"See CPT",null,1089.9017999999999,null,1089.9017999999999,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[27767,null,"See CPT",null,538.70760000000007,null,533.35620000000006,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27768,null,"See CPT",null,814.00739999999996,null,814.00739999999996,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27769,null,"See CPT",null,1307.5254,null,1307.5254,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27780,null,"See CPT",null,571.41059999999993,null,524.43720000000008,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27781,null,"See CPT",null,797.95320000000004,null,732.54719999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27784,null,"See CPT",null,1271.2547999999999,null,1271.2547999999999,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[27786,null,"See CPT",null,578.54579999999999,null,529.78859999999997,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27788,null,"See CPT",null,777.73680000000002,null,701.62800000000004,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27792,null,"See CPT",null,1161.2538000000002,null,1161.2538000000002,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[27808,null,"See CPT",null,618.97860000000003,null,563.08620000000008,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27810,null,"See CPT",null,861.57540000000006,null,773.57460000000003,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27814,null,"See CPT",null,1372.3367999999998,null,1372.3367999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27816,null,"See CPT",null,609.46500000000003,null,539.89679999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27818,null,"See CPT",null,891.9,null,793.19640000000004,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27822,null,"See CPT",null,1584.6089999999999,null,1584.6089999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27823,null,"See CPT",null,1776.6648,null,1776.6648,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27824,null,"See CPT",null,582.70800000000008,null,557.73480000000006,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27825,null,"See CPT",null,985.25220000000002,null,885.95400000000006,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27826,null,"See CPT",null,1546.5546000000002,null,1546.5546000000002,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27827,null,"See CPT",null,2019.2616,null,2019.2616,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27828,null,"See CPT",null,2388.5082000000002,null,2388.5082000000002,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27829,null,"See CPT",null,1283.1468,null,1283.1468,null,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R"]
[27830,null,"See CPT",null,717.08760000000007,null,659.41139999999996,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27831,null,"See CPT",null,745.03379999999993,null,745.03379999999993,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27832,null,"See CPT",null,1360.4448,null,1360.4448,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27840,null,"See CPT",null,694.49279999999999,null,694.49279999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27842,null,"See CPT",null,897.846,null,897.846,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27846,null,"See CPT",null,1297.4172000000001,null,1297.4172000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27848,null,"See CPT",null,1415.1480000000001,null,1415.1480000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27860,null,"See CPT",null,297.3,null,297.3,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R"]
[27870,null,"See CPT",null,1804.6110000000001,null,1804.6110000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27871,null,"See CPT",null,1238.5518,null,1238.5518,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[27880,null,"See CPT",null,1586.9874000000002,null,1586.9874000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27881,null,"See CPT",null,1515.0408,null,1515.0408,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27882,null,"See CPT",null,1045.9014,null,1045.9014,null,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R"]
[27884,null,"See CPT",null,1027.4688000000001,null,1027.4688000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[27886,null,"See CPT",null,1154.7132000000001,null,1154.7132000000001,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[27888,null,"See CPT",null,1155.3078,null,1155.3078,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[27889,null,"See CPT",null,1124.3886,null,1124.3886,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[27892,null,"See CPT",null,958.49520000000007,null,958.49520000000007,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27893,null,"See CPT",null,1105.9560000000001,null,1105.9560000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[27894,null,"See CPT",null,1457.9592,null,1457.9592,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[27899,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,1,0,1,1,null,"N"]
[28001,null,"See CPT",null,316.92180000000002,null,170.65020000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[28002,null,"See CPT",null,455.46360000000004,null,249.73200000000003,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[28003,null,"See CPT",null,692.11440000000005,null,461.40960000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[28005,null,"See CPT",null,1021.5228,null,1021.5228,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28008,null,"See CPT",null,778.33140000000003,null,525.03179999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28010,null,"See CPT",null,419.19299999999998,null,370.43580000000003,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28011,null,"See CPT",null,564.27539999999999,null,498.86940000000004,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28020,null,"See CPT",null,1003.6848,null,662.97900000000004,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,"Y-UR"]
[28022,null,"See CPT",null,885.35940000000005,null,583.30259999999998,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-UR"]
[28024,null,"See CPT",null,828.27779999999996,null,542.86980000000005,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-UR"]
[28035,null,"See CPT",null,952.54920000000004,null,635.03279999999995,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[28039,null,"See CPT",null,888.33240000000001,null,617.7894,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[28041,null,"See CPT",null,801.52080000000001,null,801.52080000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28043,null,"See CPT",null,696.87120000000004,null,463.1934,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28045,null,"See CPT",null,865.14300000000003,null,614.81640000000004,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28046,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"X"]
[28047,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[28050,null,"See CPT",null,754.54739999999993,null,495.30180000000001,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[28052,null,"See CPT",null,708.16859999999997,null,454.86900000000003,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[28054,null,"See CPT",null,667.14120000000003,null,416.81459999999998,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28055,null,"See CPT",null,680.22239999999999,null,680.22239999999999,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28060,null,"See CPT",null,944.81940000000009,null,645.14099999999996,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28062,null,"See CPT",null,1029.8471999999999,null,712.92539999999997,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[28070,null,"See CPT",null,935.90039999999999,null,620.16779999999994,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28072,null,"See CPT",null,893.08920000000001,null,580.32960000000003,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28080,null,"See CPT",null,968.00880000000006,null,674.87099999999998,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[28086,null,"See CPT",null,978.11699999999996,null,638.00580000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[28088,null,"See CPT",null,831.25080000000003,null,515.51819999999998,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28090,null,"See CPT",null,844.33199999999999,null,548.22120000000007,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28092,null,"See CPT",null,761.68260000000009,null,481.62599999999998,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28100,null,"See CPT",null,1119.0372,null,752.16899999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[28102,null,"See CPT",null,1101.1992,null,1101.1992,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[28103,null,"See CPT",null,689.73599999999999,null,689.73599999999999,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[28104,null,"See CPT",null,951.95460000000014,null,629.68140000000005,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[28106,null,"See CPT",null,757.5204,null,757.5204,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[28107,null,"See CPT",null,913.30560000000003,null,615.41099999999994,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R"]
[28108,null,"See CPT",null,789.03419999999994,null,513.73440000000005,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28110,null,"See CPT",null,837.19680000000005,null,519.08580000000006,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[28111,null,"See CPT",null,872.87279999999998,null,572.59980000000007,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[28112,null,"See CPT",null,879.41339999999991,null,558.32940000000008,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[28113,null,"See CPT",null,1058.9826,null,759.30420000000004,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR"]
[28114,null,"See CPT",null,1926.5039999999999,null,1494.8244,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28116,null,"See CPT",null,1395.5262,null,1041.1446000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[28118,null,"See CPT",null,1094.6586,null,752.16899999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28119,null,"See CPT",null,954.33300000000008,null,649.30320000000006,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[28120,null,"See CPT",null,1220.7138,null,888.33240000000001,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[28122,null,"See CPT",null,1068.4962,null,780.11519999999996,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28124,null,"See CPT",null,863.35919999999999,null,594.00540000000001,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[28126,null,"See CPT",null,708.16859999999997,null,441.7878,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28130,null,"See CPT",null,1094.6586,null,1094.6586,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[28140,null,"See CPT",null,1039.3607999999999,null,764.06100000000004,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R"]
[28150,null,"See CPT",null,757.5204,null,495.30180000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28153,null,"See CPT",null,741.46620000000007,null,472.70699999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28160,null,"See CPT",null,748.60140000000001,null,478.05839999999995,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28171,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"X"]
[28173,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"X"]
[28175,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"X"]
[28190,null,"See CPT",null,446.5446,null,236.05620000000002,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[28192,null,"See CPT",null,836.60220000000004,null,554.16719999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28193,null,"See CPT",null,946.0086,null,652.27620000000002,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28200,null,"See CPT",null,903.19740000000002,null,585.68100000000004,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,"Y-UR"]
[28202,null,"See CPT",null,1076.2260000000001,null,761.08800000000008,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[28208,null,"See CPT",null,878.81880000000001,null,571.41059999999993,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,"Y-UR"]
[28210,null,"See CPT",null,1060.7664,null,746.22300000000007,null,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR"]
[28220,null,"See CPT",null,817.57500000000005,null,542.86980000000005,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[28222,null,"See CPT",null,943.03559999999993,null,641.57339999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[28225,null,"See CPT",null,755.14199999999994,null,472.11240000000004,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[28226,null,"See CPT",null,1133.3075999999999,null,718.87139999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[28230,null,"See CPT",null,785.46660000000008,null,506.00459999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[28232,null,"See CPT",null,689.14139999999998,null,429.89580000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-UR"]
[28234,null,"See CPT",null,743.84460000000001,null,478.05839999999995,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-UR"]
[28238,null,"See CPT",null,1212.9839999999999,null,871.08900000000006,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28240,null,"See CPT",null,808.65599999999995,null,523.84260000000006,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28250,null,"See CPT",null,1051.8474000000001,null,723.62819999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[28260,null,"See CPT",null,1283.1468,null,939.46800000000007,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[28261,null,"See CPT",null,2173.2629999999999,null,1676.1774,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28262,null,"See CPT",null,2515.1579999999999,null,2005.5857999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[28264,null,"See CPT",null,1632.7716,null,1236.768,null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R"]
[28270,null,"See CPT",null,883.57560000000001,null,595.19460000000004,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28272,null,"See CPT",null,696.87120000000004,null,446.5446,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28280,null,"See CPT",null,927.57600000000002,null,620.16779999999994,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28285,null,"See CPT",null,973.36020000000008,null,684.97919999999999,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[28286,null,"See CPT",null,802.11540000000002,null,528.59940000000006,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28288,null,"See CPT",null,1097.6316000000002,null,776.54759999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28289,null,"See CPT",null,1248.6600000000001,null,818.16959999999995,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28291,null,"See CPT",null,1282.5522000000001,null,872.27819999999997,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28292,null,"See CPT",null,1258.7682000000002,null,857.41319999999996,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28295,null,"See CPT",null,2002.0182000000002,null,1102.9829999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28296,null,"See CPT",null,1625.0418,null,911.52179999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28297,null,"See CPT",null,1896.1794,null,1077.4152000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28298,null,"See CPT",null,1518.0138000000002,null,894.87300000000005,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28299,null,"See CPT",null,1839.0978,null,1047.6852000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28300,null,"See CPT",null,1160.6592000000001,null,1160.6592000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28302,null,"See CPT",null,1286.1197999999999,null,1286.1197999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28304,null,"See CPT",null,1494.8244,null,1090.4964,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28305,null,"See CPT",null,1210.0110000000002,null,1210.0110000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28306,null,"See CPT",null,1099.4153999999999,null,719.46600000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28307,null,"See CPT",null,1437.1482000000001,null,930.54899999999998,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28308,null,"See CPT",null,1035.7932000000001,null,688.54679999999996,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28309,null,"See CPT",null,1586.9874000000002,null,1586.9874000000002,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28310,null,"See CPT",null,988.81979999999999,null,643.95180000000005,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[28312,null,"See CPT",null,943.03559999999993,null,586.87019999999995,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R"]
[28313,null,"See CPT",null,957.90059999999994,null,641.57339999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28315,null,"See CPT",null,872.27819999999997,null,583.30259999999998,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R"]
[28320,null,"See CPT",null,1089.3072,null,1089.3072,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[28322,null,"See CPT",null,1420.4994000000002,null,1029.8471999999999,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[28340,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"X"]
[28341,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"X"]
[28344,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"X"]
[28345,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"X"]
[28360,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"X"]
[28400,null,"See CPT",null,453.08519999999999,null,419.19299999999998,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28405,null,"See CPT",null,708.16859999999997,null,635.62739999999997,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28406,null,"See CPT",null,1024.4958000000001,null,1024.4958000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28415,null,"See CPT",null,2020.4507999999998,null,2020.4507999999998,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[28420,null,"See CPT",null,2332.0212000000001,null,2332.0212000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[28430,null,"See CPT",null,441.19319999999999,null,385.30080000000004,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28435,null,"See CPT",null,676.65480000000002,null,597.57300000000009,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28436,null,"See CPT",null,909.14339999999993,null,909.14339999999993,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28445,null,"See CPT",null,1825.422,null,1825.422,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[28446,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X"]
[28450,null,"See CPT",null,387.08459999999997,null,349.03020000000004,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28455,null,"See CPT",null,530.38319999999999,null,470.32859999999999,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[28456,null,"See CPT",null,684.97919999999999,null,684.97919999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28465,null,"See CPT",null,1145.7942,null,1145.7942,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28470,null,"See CPT",null,399.57119999999998,null,375.19259999999997,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28475,null,"See CPT",null,464.97720000000004,null,407.30099999999999,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28476,null,"See CPT",null,712.92539999999997,null,712.92539999999997,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[28485,null,"See CPT",null,1012.6038000000001,null,1012.6038000000001,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R"]
[28490,null,"See CPT",null,258.65100000000001,null,226.54259999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28495,null,"See CPT",null,326.43540000000002,null,269.94839999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28496,null,"See CPT",null,830.65620000000001,null,443.57159999999999,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28505,null,"See CPT",null,1195.7406000000001,null,891.9,null,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R"]
[28510,null,"See CPT",null,218.81280000000001,null,216.43440000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28515,null,"See CPT",null,297.89459999999997,null,258.65100000000001,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28525,null,"See CPT",null,1034.604,null,726.60120000000006,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[28530,null,"See CPT",null,206.92080000000001,null,178.38,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28531,null,"See CPT",null,603.51900000000001,null,322.86779999999999,null,"090",0.1,0.69,0.21,0,2,1,1,2,0,null,"R"]
[28540,null,"See CPT",null,354.38159999999999,null,316.92180000000002,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28545,null,"See CPT",null,567.84300000000007,null,494.7072,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28546,null,"See CPT",null,1086.3342,null,638.60040000000004,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28555,null,"See CPT",null,1556.6628000000001,null,1176.7133999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[28570,null,"See CPT",null,431.08499999999998,null,358.54380000000003,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28575,null,"See CPT",null,692.70900000000006,null,618.38400000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28576,null,"See CPT",null,694.49279999999999,null,694.49279999999999,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R"]
[28585,null,"See CPT",null,1597.0955999999999,null,1243.9032000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R"]
[28600,null,"See CPT",null,395.40900000000005,null,335.3544,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[28605,null,"See CPT",null,627.303,null,556.54559999999992,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[28606,null,"See CPT",null,683.79,null,683.79,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28615,null,"See CPT",null,1489.473,null,1489.473,null,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R"]
[28630,null,"See CPT",null,277.6782,null,196.8126,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[28635,null,"See CPT",null,315.13799999999998,null,237.24540000000002,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[28636,null,"See CPT",null,572.59980000000007,null,356.76,null,"010",0.1,0.8,0.1,0,2,0,1,2,0,null,"R"]
[28645,null,"See CPT",null,1176.7133999999999,null,865.73760000000004,null,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R"]
[28660,null,"See CPT",null,222.97499999999999,null,165.89340000000001,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[28665,null,"See CPT",null,271.73220000000003,null,225.35339999999999,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[28666,null,"See CPT",null,320.48939999999999,null,320.48939999999999,null,"010",0.1,0.8,0.1,0,2,0,1,2,0,null,"R"]
[28675,null,"See CPT",null,1048.8744000000002,null,737.30400000000009,null,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R"]
[28705,null,"See CPT",null,2172.6684,null,2172.6684,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28715,null,"See CPT",null,1681.5288,null,1681.5288,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28725,null,"See CPT",null,1390.1748,null,1390.1748,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28730,null,"See CPT",null,1309.3091999999999,null,1309.3091999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28735,null,"See CPT",null,1395.5262,null,1395.5262,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28737,null,"See CPT",null,1224.8760000000002,null,1224.8760000000002,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28740,null,"See CPT",null,1498.9866000000002,null,1102.9829999999999,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28750,null,"See CPT",null,1422.2832000000001,null,1035.1985999999999,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR"]
[28755,null,"See CPT",null,922.81920000000002,null,598.16759999999999,null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR"]
[28760,null,"See CPT",null,1378.2828,null,1011.4146000000001,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28800,null,"See CPT",null,942.44100000000003,null,942.44100000000003,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[28805,null,"See CPT",null,1258.1736000000001,null,1258.1736000000001,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR"]
[28810,null,"See CPT",null,755.14199999999994,null,755.14199999999994,null,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R"]
[28820,null,"See CPT",null,545.2482,null,314.54340000000002,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[28825,null,"See CPT",null,535.14,null,305.62439999999998,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[28890,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"X"]
[28899,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,0,0,1,1,null,"N"]
[29000,null,"See CPT",null,630.87059999999997,null,346.05720000000002,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[29010,null,"See CPT",null,488.76120000000003,null,283.02960000000002,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[29015,null,"See CPT",null,525.03179999999998,null,318.7056,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[29035,null,"See CPT",null,459.62580000000003,null,253.2996,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[29040,null,"See CPT",null,523.84260000000006,null,304.43520000000001,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[29044,null,"See CPT",null,513.73440000000005,null,294.327,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[29046,null,"See CPT",null,563.08620000000008,null,331.78680000000003,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[29049,null,"See CPT",null,177.78540000000001,null,123.6768,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[29055,null,"See CPT",null,398.97660000000002,null,242.5968,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[29058,null,"See CPT",null,220.00200000000001,null,165.2988,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[29065,null,"See CPT",null,173.02860000000001,null,121.2984,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29075,null,"See CPT",null,155.7852,null,110.001,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29085,null,"See CPT",null,171.2448,null,119.51459999999999,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29086,null,"See CPT",null,137.3526,null,88.000799999999998,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29105,null,"See CPT",null,146.27160000000001,null,72.541200000000003,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29125,null,"See CPT",null,118.3254,null,70.757400000000004,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29126,null,"See CPT",null,139.13639999999998,null,87.406199999999998,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29130,null,"See CPT",null,73.730400000000003,null,51.730200000000004,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29131,null,"See CPT",null,94.54140000000001,null,60.6492,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29200,null,"See CPT",null,60.054600000000001,null,33.297600000000003,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[29240,null,"See CPT",null,54.703200000000002,null,32.703000000000003,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29260,null,"See CPT",null,53.514000000000003,null,33.892199999999995,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29280,null,"See CPT",null,52.919400000000003,null,35.081400000000002,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29305,null,"See CPT",null,442.38240000000002,null,279.46199999999999,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[29325,null,"See CPT",null,488.16660000000007,null,312.75959999999998,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[29345,null,"See CPT",null,242.00220000000002,null,176.0016,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29355,null,"See CPT",null,253.2996,null,187.89360000000002,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29358,null,"See CPT",null,286.59720000000004,null,181.94759999999999,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29365,null,"See CPT",null,220.00200000000001,null,154.596,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29405,null,"See CPT",null,142.70400000000001,null,102.86580000000001,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29425,null,"See CPT",null,134.9742,null,95.73060000000001,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29435,null,"See CPT",null,200.97479999999999,null,140.92020000000002,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29440,null,"See CPT",null,75.514200000000002,null,49.351799999999997,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29445,null,"See CPT",null,229.51560000000001,null,175.40700000000001,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29450,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,1,1,0,0,null,"X"]
[29505,null,"See CPT",null,156.9744,null,90.973799999999997,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29515,null,"See CPT",null,127.24440000000001,null,86.811599999999999,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29520,null,"See CPT",null,64.216800000000006,null,32.703000000000003,null,"000",0,0,0,0,2,1,0,0,0,null,"R"]
[29530,null,"See CPT",null,54.703200000000002,null,32.108400000000003,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29540,null,"See CPT",null,49.946399999999997,null,30.9192,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29550,null,"See CPT",null,34.486799999999995,null,19.6218,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29580,null,"See CPT",null,117.1362,null,46.973400000000005,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29581,null,"See CPT",null,165.2988,null,48.162600000000005,null,"000",0,0,0,0,2,1,0,0,0,null,"R"]
[29584,null,"See CPT",null,153.4068,null,27.946199999999997,null,"000",0,0,0,0,2,1,0,0,0,null,"R"]
[29700,null,"See CPT",null,110.5956,null,58.270800000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[29705,null,"See CPT",null,112.97399999999999,null,78.487200000000001,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[29710,null,"See CPT",null,217.029,null,145.08240000000001,null,"000",0,0,0,0,2,1,0,0,0,null,"R"]
[29720,null,"See CPT",null,151.62299999999999,null,75.514200000000002,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[29730,null,"See CPT",null,113.5686,null,77.892600000000002,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[29740,null,"See CPT",null,176.0016,null,121.89299999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[29750,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,1,0,0,0,null,"X"]
[29799,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,0,0,1,1,null,"N"]
[29800,null,"See CPT",null,954.33300000000008,null,954.33300000000008,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[29804,null,"See CPT",null,1079.7936,null,1079.7936,null,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[29806,null,"See CPT",null,1893.2064,null,1893.2064,null,"090",0.1,0.69,0.21,0,3,1,1,1,0,null,"R",null,"Y-UR"]
[29828,null,"See CPT",null,1638.7175999999999,null,1638.7175999999999,null,"090",0.1,0.69,0.21,0,3,1,2,1,0,null,"R",null,"Y-UR"]
[29847,null,"See CPT",null,978.71160000000009,null,978.71160000000009,null,"090",0.1,0.69,0.21,0,3,1,2,0,0,null,"R"]
[29861,null,"See CPT",null,1286.7144000000001,null,1286.7144000000001,null,"090",0.1,0.69,0.21,0,3,1,2,1,0,null,"R",null,"Y-UR"]
[29874,null,"See CPT",null,963.84660000000008,null,963.84660000000008,null,"090",0.1,0.69,0.21,0,3,1,0,0,0,null,"R",null,"Y-UR"]
[29880,null,"See CPT",null,1010.82,null,1010.82,null,"090",0.1,0.69,0.21,0,3,1,0,1,0,null,"R",null,"Y-UR"]
[29887,null,"See CPT",null,1350.9312,null,1350.9312,null,"090",0.1,0.69,0.21,0,3,1,2,1,0,null,"R",null,"Y-UR"]
[29901,null,"See CPT",null,975.14399999999989,null,975.14399999999989,null,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[29915,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.69,0.21,0,3,1,2,1,0,null,"X"]
[30124,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.76,0.14000000000000001,0,2,0,1,0,0,null,"X"]
[30400,null,"See CPT",null,2283.2640000000001,null,2283.2640000000001,null,"090",0.1,0.76,0.14000000000000001,0,2,0,0,0,0,null,"R"]
[30462,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.76,0.14000000000000001,0,2,0,2,2,0,null,"X"]
[30620,null,"See CPT",null,1256.9844000000001,null,1256.9844000000001,null,"090",0.1,0.76,0.14000000000000001,0,2,0,1,0,0,null,"R"]
[30903,null,"See CPT",null,460.815,null,134.9742,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[31000,null,"See CPT",null,341.30040000000002,null,197.40719999999999,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[31084,null,"See CPT",null,2215.4796000000001,null,2215.4796000000001,null,"090",0.1,0.76,0.14000000000000001,0,2,1,2,1,0,null,"R"]
[31205,null,"See CPT",null,1717.7994000000001,null,1717.7994000000001,null,"090",0.1,0.76,0.14000000000000001,0,2,1,2,1,0,null,"R"]
[31253,null,"See CPT",null,881.79179999999997,null,881.79179999999997,null,"000",0,0,0,0,3,1,1,0,0,null,"R",null,"Y-CM"]
[31292,null,"See CPT",null,1780.827,null,1780.827,null,"010",0.1,0.8,0.1,0,3,1,0,0,0,null,"R"]
[31299,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,0,0,1,1,null,"N"]
[31382,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"X"]
[31511,null,"See CPT",null,388.27379999999999,null,233.08320000000001,null,"000",0,0,0,0,3,0,1,0,0,null,"R"]
[31515,null,"See CPT",null,394.81439999999998,null,196.8126,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[31541,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,3,0,1,0,0,null,"X"]
[31560,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,3,0,0,0,0,null,"X"]
[31579,null,"See CPT",null,362.70599999999996,null,210.48840000000001,null,"000",0,0,0,0,3,0,1,0,0,null,"R"]
[31610,null,"See CPT",null,1743.9617999999998,null,1743.9617999999998,null,"090",0.1,0.76,0.14000000000000001,0,2,0,1,0,0,null,"R"]
[31623,null,"See CPT",null,513.13980000000004,null,233.08320000000001,null,"000",0,0,0,0,3,0,1,0,0,null,"R"]
[31632,null,"See CPT",null,116.5416,null,86.216999999999999,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[31643,null,"See CPT",null,308.00279999999998,null,308.00279999999998,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[31647,null,"See CPT",null,362.1114,null,362.1114,null,"000",0,0,0,0,3,0,1,0,0,null,"R"]
[31730,null,"See CPT",null,2109.0461999999998,null,261.62400000000002,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[31780,null,"See CPT",null,2092.9920000000002,null,2092.9920000000002,null,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"R"]
[32036,null,"See CPT",null,1396.7153999999998,null,1396.7153999999998,null,"090",0.1,0.76,0.14000000000000001,0,2,1,2,1,0,null,"R"]
[32160,null,"See CPT",null,1396.7153999999998,null,1396.7153999999998,null,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"R"]
[32400,null,"See CPT",null,305.62439999999998,null,148.65,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[32488,null,"See CPT",null,4152.0918000000001,null,4152.0918000000001,null,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[32550,null,"See CPT",null,1531.6896000000002,null,357.94919999999996,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[32553,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,0,2,0,0,null,"X"]
[32608,null,"See CPT",null,656.4384,null,656.4384,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[32655,null,"See CPT",null,1670.826,null,1670.826,null,"090",0.1,0.76,0.14000000000000001,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[32668,null,"See CPT",null,271.73220000000003,null,271.73220000000003,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM"]
[32701,null,"See CPT",null,369.84120000000001,null,369.84120000000001,null,"000",0,0,0,2,0,0,0,1,0,null,"R"]
[32900,null,"See CPT",null,2475.3198000000002,null,2475.3198000000002,null,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[33016,null,"See CPT",null,408.49020000000002,null,408.49020000000002,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[33120,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"X"]
[33141,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,0,0,2,1,0,null,"X"]
[33216,null,"See CPT",null,660.00599999999997,null,660.00599999999997,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[33224,null,"See CPT",null,900.22440000000006,null,900.22440000000006,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[33236,null,"See CPT",null,1375.9044000000001,null,1375.9044000000001,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,0,2,0,null,"R",null,"Y-CM"]
[33249,null,"See CPT",null,1617.3119999999999,null,1617.3119999999999,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,1,1,0,null,"R",null,"Y-CM"]
[33264,null,"See CPT",null,716.49300000000005,null,716.49300000000005,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[33273,null,"See CPT",null,702.81720000000007,null,702.81720000000007,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[33320,null,"See CPT",null,1839.6924000000001,null,1839.6924000000001,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[33330,null,"See CPT",null,2480.0765999999999,null,2480.0765999999999,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[33405,null,"See CPT",null,3939.2249999999999,null,3939.2249999999999,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[33411,null,"See CPT",null,5809.8365999999996,null,5809.8365999999996,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[33425,null,"See CPT",null,4735.3944000000001,null,4735.3944000000001,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[33464,null,"See CPT",null,4228.2006000000001,null,4228.2006000000001,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[33502,null,"See CPT",null,2230.3445999999999,null,2230.3445999999999,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[33511,null,"See CPT",null,3687.1145999999999,null,3687.1145999999999,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[33522,null,"See CPT",null,1263.5250000000001,null,1263.5250000000001,null,"000",0,0,0,0,0,0,2,0,0,null,"R",null,"Y-CM"]
[33533,null,"See CPT",null,3251.2728000000002,null,3251.2728000000002,null,"090",0.09,0.82,0.09,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[33617,null,"See CPT",null,3753.7098000000001,null,3753.7098000000001,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[33621,null,"See CPT",null,1618.5011999999999,null,1618.5011999999999,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[33681,null,"See CPT",null,3209.0562,null,3209.0562,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[33702,null,"See CPT",null,2692.3488000000002,null,2692.3488000000002,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[33746,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,0,0,2,0,0,null,"X"]
[33771,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"X"]
[33782,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"X"]
[33788,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"X"]
[33863,null,"See CPT",null,5443.5630000000001,null,5443.5630000000001,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[33871,null,"See CPT",null,5636.2134000000005,null,5636.2134000000005,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[33895,null,"See CPT",null,1344.3905999999999,null,1344.3905999999999,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[33922,null,"See CPT",null,2421.2112000000002,null,2421.2112000000002,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[33945,null,"See CPT",null,8420.1306000000004,null,8420.1306000000004,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,2,null,"R",null,"Y-CM"]
[33955,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,0,0,1,1,null,"X"]
[33966,null,"See CPT",null,409.08479999999997,null,409.08479999999997,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[33969,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,0,0,0,0,null,"X"]
[33986,null,"See CPT",null,903.19740000000002,null,903.19740000000002,null,"000",0,0,0,0,2,0,0,1,1,null,"R",null,"Y-CM"]
[33989,null,"See CPT",null,850.87260000000003,null,850.87260000000003,null,"000",0,0,0,0,2,0,0,1,1,null,"R",null,"Y-CM"]
[34111,null,"See CPT",null,1041.1446000000001,null,1041.1446000000001,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[34471,null,"See CPT",null,1858.125,null,1858.125,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,1,1,0,null,"R",null,"Y-CM"]
[34706,null,"See CPT",null,3924.36,null,3924.36,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[34715,null,"See CPT",null,513.73440000000005,null,513.73440000000005,null,"000",0,0,0,0,0,1,2,2,0,null,"R",null,"Y-UR"]
[34831,null,"See CPT",null,3310.7328000000002,null,3310.7328000000002,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,2,0,null,"R",null,"Y-CM"]
[34834,null,"See CPT",null,221.19120000000001,null,221.19120000000001,null,"000",0,0,0,0,0,1,2,2,0,null,"R",null,"Y-CM"]
[35022,null,"See CPT",null,2512.1849999999999,null,2512.1849999999999,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[35082,null,"See CPT",null,3735.8717999999999,null,3735.8717999999999,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[35141,null,"See CPT",null,1893.2064,null,1893.2064,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[35188,null,"See CPT",null,2251.7501999999999,null,2251.7501999999999,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[35241,null,"See CPT",null,2500.8876,null,2500.8876,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R"]
[35286,null,"See CPT",null,1616.7174,null,1616.7174,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R"]
[35331,null,"See CPT",null,2502.6714000000002,null,2502.6714000000002,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[35355,null,"See CPT",null,1774.2864,null,1774.2864,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[35516,null,"See CPT",null,2095.9650000000001,null,2095.9650000000001,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[35522,null,"See CPT",null,2010.3426000000002,null,2010.3426000000002,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[35563,null,"See CPT",null,2275.5342000000001,null,2275.5342000000001,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[35570,null,"See CPT",null,2532.4014000000002,null,2532.4014000000002,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[35623,null,"See CPT",null,2260.0745999999999,null,2260.0745999999999,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[35642,null,"See CPT",null,1703.529,null,1703.529,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[35665,null,"See CPT",null,2021.64,null,2021.64,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[35681,null,"See CPT",null,136.75799999999998,null,136.75799999999998,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM"]
[35840,null,"See CPT",null,2122.1273999999999,null,2122.1273999999999,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[35875,null,"See CPT",null,1030.4417999999998,null,1030.4417999999998,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,1,1,0,null,"R",null,"Y-CM"]
[36012,null,"See CPT",null,1607.2038,null,300.27299999999997,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[36015,null,"See CPT",null,1648.2311999999999,null,296.7054,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[36224,null,"See CPT",null,3830.4132,null,627.89760000000001,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[36251,null,"See CPT",null,2481.2657999999997,null,443.57159999999999,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[36405,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,0,1,0,0,null,"X"]
[36430,null,"See CPT",null,70.757400000000004,null,70.757400000000004,null,"000",0,0,0,5,0,0,1,0,0,null,"R"]
[36474,null,"See CPT",null,484.00440000000003,null,154.596,null,"000",0,0,0,0,0,1,1,0,0,null,"R",null,"Y-CM"]
[36478,null,"See CPT",null,1885.4766000000002,null,480.43680000000001,null,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[36557,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"X"]
[36561,null,"See CPT",null,1898.5578,null,587.46480000000008,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R"]
[36578,null,"See CPT",null,826.49400000000003,null,358.54380000000003,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[36591,null,"See CPT",null,49.351799999999997,null,49.351799999999997,null,"000",0,0,0,3,0,0,0,0,0,null,"R"]
[36625,null,"See CPT",null,184.32600000000002,null,184.32600000000002,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[36818,null,"See CPT",null,1197.5244,null,1197.5244,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[36860,null,"See CPT",null,428.70659999999998,null,193.245,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[36902,null,"See CPT",null,2330.2374,null,415.62540000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[37184,null,"See CPT",null,3306.5706,null,743.84460000000001,null,"000",0,0,0,0,2,1,1,2,0,null,"R"]
[37187,null,"See CPT",null,3320.2464000000004,null,680.22239999999999,null,"000",0,0,0,0,2,1,1,2,0,null,"R"]
[37215,null,"See CPT",null,1722.5562,null,1722.5562,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[37225,null,"See CPT",null,17296.3194,null,1033.4148,null,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[37234,null,"See CPT",null,7094.1725999999999,null,487.57199999999995,null,"000",0,0,0,0,0,1,0,0,0,null,"R",null,"Y-CM"]
[37242,null,"See CPT",null,13999.2624,null,819.35879999999997,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[37600,null,"See CPT",null,1301.5794000000001,null,1301.5794000000001,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R"]
[37607,null,"See CPT",null,655.24919999999997,null,655.24919999999997,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,1,1,0,null,"R"]
[37765,null,"See CPT",null,783.08820000000003,null,473.30160000000001,null,"010",0.1,0.8,0.1,0,2,1,1,1,0,null,"R",null,"Y-CM"]
[37785,null,"See CPT",null,645.73559999999998,null,451.89599999999996,null,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[38115,null,"See CPT",null,2285.6423999999997,null,2285.6423999999997,null,"090",0.11,0.73,0.16,0,2,0,2,1,0,null,"R"]
[38214,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[38242,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,0,0,0,0,null,"X"]
[38382,null,"See CPT",null,1210.6056000000001,null,1210.6056000000001,null,"090",0.11,0.73,0.16,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[38564,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.11,0.73,0.16,0,2,0,2,1,0,null,"X"]
[38572,null,"See CPT",null,1606.0146000000002,null,1606.0146000000002,null,"010",0.1,0.8,0.1,0,3,2,2,2,0,null,"R",null,"Y-CM"]
[38792,null,"See CPT",null,151.62299999999999,null,57.676200000000001,null,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[38999,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,0,0,1,1,null,"N"]
[39499,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,0,2,1,1,null,"N"]
[40527,null,"See CPT",null,1123.1994,null,1123.1994,null,"090",0.09,0.81,0.1,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[40761,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.81,0.1,0,2,0,1,0,0,null,"X"]
[40808,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"X"]
[40843,null,"See CPT",null,2182.1820000000002,null,1552.5006000000001,null,"090",0.09,0.81,0.1,0,2,2,2,0,0,null,"R",null,"Y-CM"]
[40899,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,0,0,1,1,null,"N"]
[41108,null,"See CPT",null,311.57040000000001,null,162.32580000000002,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[41113,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.81,0.1,0,2,0,1,0,0,null,"X"]
[41140,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"X"]
[41805,null,"See CPT",null,588.0594000000001,null,365.67900000000003,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[41828,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"X"]
[42000,null,"See CPT",null,297.3,null,193.83959999999999,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[42205,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.81,0.1,0,2,0,2,0,0,null,"X"]
[42220,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.81,0.1,0,2,0,2,0,0,null,"X"]
[42340,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.81,0.1,0,2,1,0,0,0,null,"X"]
[42408,null,"See CPT",null,1009.0361999999999,null,626.11379999999997,null,"090",0.09,0.81,0.1,0,2,0,0,0,0,null,"R"]
[42440,null,"See CPT",null,743.84460000000001,null,743.84460000000001,null,"090",0.09,0.81,0.1,0,2,1,2,1,0,null,"R"]
[42720,null,"See CPT",null,809.84519999999998,null,687.95220000000006,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[42820,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.81,0.1,0,2,0,0,0,0,null,"X"]
[42836,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.81,0.1,0,2,0,0,0,0,null,"X"]
[42955,null,"See CPT",null,1389.5802000000001,null,1389.5802000000001,null,"090",0.09,0.81,0.1,0,2,0,2,0,0,null,"R"]
[42962,null,"See CPT",null,925.19760000000008,null,925.19760000000008,null,"090",0.09,0.81,0.1,0,2,0,1,0,0,null,"R"]
[43116,null,"See CPT",null,8613.3756000000012,null,8613.3756000000012,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[43121,null,"See CPT",null,4967.2884000000004,null,4967.2884000000004,null,"090",0.09,0.81,0.1,0,2,0,2,2,0,null,"R",null,"Y-CM"]
[43191,null,"See CPT",null,274.11060000000003,null,274.11060000000003,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[43210,null,"See CPT",null,757.5204,null,757.5204,null,"000",0,0,0,0,3,0,1,0,0,null,"R",null,"Y-CM"]
[43214,null,"See CPT",null,339.51659999999998,null,339.51659999999998,null,"000",0,0,0,0,3,0,1,0,0,null,"R"]
[43236,null,"See CPT",null,770.00699999999995,null,242.5968,null,"000",0,0,0,0,3,0,1,0,0,null,"R"]
[43248,null,"See CPT",null,786.6558,null,291.9486,null,"000",0,0,0,0,3,0,1,0,0,null,"R"]
[43255,null,"See CPT",null,1210.0110000000002,null,353.78700000000003,null,"000",0,0,0,0,3,0,1,0,0,null,"R"]
[43263,null,"See CPT",null,629.08680000000004,null,629.08680000000004,null,"000",0,0,0,0,3,0,1,0,0,null,"R",null,"Y-CM"]
[43276,null,"See CPT",null,847.30500000000006,null,847.30500000000006,null,"000",0,0,0,0,3,0,1,0,0,null,"R"]
[43283,null,"See CPT",null,275.89439999999996,null,275.89439999999996,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM"]
[43314,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"X"]
[43337,null,"See CPT",null,2692.9434000000001,null,2692.9434000000001,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[43360,null,"See CPT",null,3917.8194000000003,null,3917.8194000000003,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[43497,null,"See CPT",null,1407.4182000000001,null,1407.4182000000001,null,"090",0.09,0.81,0.1,0,3,0,1,0,0,null,"R"]
[43605,null,"See CPT",null,1488.2838000000002,null,1488.2838000000002,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[43631,null,"See CPT",null,2566.2936,null,2566.2936,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[43645,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"X"]
[43752,null,"See CPT",null,70.757400000000004,null,70.757400000000004,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[43773,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"X"]
[43843,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.81,0.1,0,2,0,2,2,0,null,"X"]
[43865,null,"See CPT",null,3027.7031999999999,null,3027.7031999999999,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[44020,null,"See CPT",null,1730.2860000000001,null,1730.2860000000001,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R"]
[44111,null,"See CPT",null,1735.6374000000001,null,1735.6374000000001,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[44128,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,0,0,2,1,0,null,"X"]
[44145,null,"See CPT",null,2911.1615999999999,null,2911.1615999999999,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[44150,null,"See CPT",null,3285.7595999999999,null,3285.7595999999999,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[44203,null,"See CPT",null,420.38220000000001,null,420.38220000000001,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM"]
[44300,null,"See CPT",null,1494.8244,null,1494.8244,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R"]
[44322,null,"See CPT",null,1817.6922,null,1817.6922,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[44372,null,"See CPT",null,420.97680000000003,null,420.97680000000003,null,"000",0,0,0,0,3,0,1,0,0,null,"R",null,"Y-CM"]
[44381,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,3,0,1,0,0,null,"X"]
[44389,null,"See CPT",null,780.70980000000009,null,302.65140000000002,null,"000",0,0,0,0,3,0,1,0,0,null,"R",null,"Y-CM"]
[44408,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,3,0,1,0,0,null,"X"]
[44603,null,"See CPT",null,2849.9178000000002,null,2849.9178000000002,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R"]
[44700,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"X"]
[44950,null,"See CPT",null,1141.0374000000002,null,1141.0374000000002,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[45005,null,"See CPT",null,601.14059999999995,null,303.84060000000005,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[45113,null,"See CPT",null,3292.3001999999997,null,3292.3001999999997,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[45160,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"X"]
[45305,null,"See CPT",null,341.89499999999998,null,128.43360000000001,null,"000",0,0,0,0,3,0,1,0,0,null,"R",null,"Y-CM"]
[45333,null,"See CPT",null,632.05980000000011,null,165.2988,null,"000",0,0,0,0,3,0,1,0,0,null,"R",null,"Y-CM"]
[45337,null,"See CPT",null,202.16399999999999,null,202.16399999999999,null,"000",0,0,0,0,3,0,1,0,0,null,"R",null,"Y-CM"]
[45380,null,"See CPT",null,820.548,null,352.59780000000001,null,"000",0,0,0,0,3,0,1,0,0,null,"R",null,"Y-CM"]
[45395,null,"See CPT",null,3455.2206000000001,null,3455.2206000000001,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[45499,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,0,2,1,1,null,"N"]
[45560,null,"See CPT",null,1230.8219999999999,null,1230.8219999999999,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[45999,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,0,0,1,1,null,"N"]
[46060,null,"See CPT",null,879.41339999999991,null,879.41339999999991,null,"090",0.09,0.81,0.1,0,2,0,1,0,0,null,"R"]
[46260,null,"See CPT",null,871.08900000000006,null,871.08900000000006,null,"090",0.09,0.81,0.1,0,2,0,1,0,0,null,"R"]
[46270,null,"See CPT",null,991.19820000000016,null,726.00660000000005,null,"090",0.09,0.81,0.1,0,2,0,1,0,0,null,"R"]
[46607,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,3,0,1,0,0,null,"X"]
[46712,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"X"]
[46742,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"X"]
[46754,null,"See CPT",null,638.60040000000004,null,432.27420000000001,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[46945,null,"See CPT",null,620.16779999999994,null,620.16779999999994,null,"090",0.09,0.81,0.1,0,2,0,1,0,0,null,"R"]
[47001,null,"See CPT",null,180.75839999999999,null,180.75839999999999,null,"000",0,0,0,0,0,0,1,1,0,null,"R"]
[47142,null,"See CPT",null,8278.6157999999996,null,8278.6157999999996,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[47145,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,0,2,1,0,null,"N",null,"Y-CM"]
[47400,null,"See CPT",null,3811.3859999999995,null,3811.3859999999995,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[47533,null,"See CPT",null,2251.1556,null,459.62580000000003,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[47539,null,"See CPT",null,8230.4531999999999,null,731.35800000000006,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[47552,null,"See CPT",null,475.68,null,475.68,null,"000",0,0,0,0,2,0,1,1,0,null,"R"]
[47610,null,"See CPT",null,2227.3715999999999,null,2227.3715999999999,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R"]
[47712,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"X"]
[47802,null,"See CPT",null,2714.3490000000002,null,2714.3490000000002,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[48000,null,"See CPT",null,3334.5167999999999,null,3334.5167999999999,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[48160,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[48548,null,"See CPT",null,2964.6756,null,2964.6756,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[48999,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,0,2,1,1,null,"N"]
[49040,null,"See CPT",null,1788.5567999999998,null,1788.5567999999998,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R"]
[49250,null,"See CPT",null,1059.5771999999999,null,1059.5771999999999,null,"090",0.09,0.81,0.1,0,2,0,1,1,0,null,"R"]
[49324,null,"See CPT",null,688.54679999999996,null,688.54679999999996,null,"010",0.1,0.8,0.1,0,3,0,2,2,0,null,"R"]
[49418,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,0,0,0,0,null,"X"]
[49422,null,"See CPT",null,388.86840000000001,null,388.86840000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[49452,null,"See CPT",null,1504.338,null,237.24540000000002,null,"000",0,0,0,0,2,0,0,0,0,null,"R"]
[49501,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.81,0.1,0,2,1,2,1,0,null,"X"]
[49540,null,"See CPT",null,1207.6325999999999,null,1207.6325999999999,null,"090",0.09,0.81,0.1,0,2,1,2,1,0,null,"R"]
[49565,null,"See CPT",null,1367.58,null,1367.58,null,"090",0.09,0.81,0.1,0,2,1,2,1,0,null,"R"]
[49606,null,"See CPT",null,2015.0994000000001,null,2015.0994000000001,null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[49653,null,"See CPT",null,1658.934,null,1658.934,null,"090",0.09,0.81,0.1,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[50020,null,"See CPT",null,1785.5838000000001,null,1785.5838000000001,null,"090",0.08,0.83,0.09,0,2,0,1,1,0,null,"R"]
[50060,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.08,0.83,0.09,0,2,1,2,1,0,null,"X"]
[50234,null,"See CPT",null,2286.8316,null,2286.8316,null,"090",0.08,0.83,0.09,0,2,1,2,1,0,null,"R"]
[50323,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,0,2,1,0,null,"N",null,"Y-CM"]
[50360,null,"See CPT",null,4297.1741999999995,null,4297.1741999999995,null,"090",0.08,0.83,0.09,0,2,0,2,2,2,null,"R",null,"Y-CM"]
[50386,null,"See CPT",null,1438.932,null,281.84040000000005,null,"000",0,0,0,0,2,1,0,0,0,null,"R"]
[50434,null,"See CPT",null,1750.5024000000001,null,331.19220000000001,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[50525,null,"See CPT",null,2610.8885999999998,null,2610.8885999999998,null,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[50551,null,"See CPT",null,641.57339999999999,null,511.35599999999999,null,"000",0,0,0,0,2,1,0,0,0,null,"R"]
[50557,null,"See CPT",null,743.84460000000001,null,599.95140000000004,null,"000",0,0,0,0,3,1,0,0,0,null,"R"]
[50620,null,"See CPT",null,1584.6089999999999,null,1584.6089999999999,null,"090",0.08,0.83,0.09,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[50693,null,"See CPT",null,1918.1795999999999,null,353.19240000000002,null,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[50728,null,"See CPT",null,1293.8496,null,1293.8496,null,"090",0.08,0.83,0.09,0,2,0,2,2,0,null,"R",null,"Y-CM"]
[50760,null,"See CPT",null,1998.4505999999999,null,1998.4505999999999,null,"090",0.08,0.83,0.09,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[50840,null,"See CPT",null,2159.5871999999999,null,2159.5871999999999,null,"090",0.08,0.83,0.09,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[50940,null,"See CPT",null,1560.825,null,1560.825,null,"090",0.08,0.83,0.09,0,2,1,2,1,0,null,"R"]
[50974,null,"See CPT",null,820.548,null,820.548,null,"000",0,0,0,0,3,1,0,0,0,null,"R",null,"Y-CM"]
[51020,null,"See CPT",null,833.03459999999995,null,833.03459999999995,null,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R"]
[51550,null,"See CPT",null,1693.4208000000001,null,1693.4208000000001,null,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R"]
[51595,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.08,0.83,0.09,0,2,2,2,1,0,null,"X"]
[51705,null,"See CPT",null,177.1908,null,90.379199999999997,null,"000",0,0,0,0,2,0,1,0,0,null,"R"]
[51720,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,0,1,0,0,null,"X"]
[51728,26,"See CPT",null,181.35299999999998,null,181.35299999999998,null,"000",0,0,0,1,2,0,0,0,0,null,"R"]
[51736,"TC","See CPT",null,9.5136000000000003,null,9.5136000000000003,null,"000",0,0,0,1,2,0,0,0,0,null,"R"]
[51792,26,"See CPT",null,94.54140000000001,null,94.54140000000001,null,"000",0,0,0,1,2,0,0,0,0,null,"R"]
[51797,26,"See CPT",null,69.56819999999999,null,69.56819999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[51990,null,"See CPT",null,1312.2822000000001,null,1312.2822000000001,null,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[52204,null,"See CPT",null,713.52,null,246.16439999999997,null,"000",0,0,0,0,3,0,1,0,0,null,"R"]
[52275,null,"See CPT",null,1012.0092,null,431.67959999999999,null,"000",0,0,0,0,3,0,1,0,0,null,"R"]
[52281,null,"See CPT",null,609.46500000000003,null,265.19159999999999,null,"000",0,0,0,0,3,0,1,0,0,null,"R"]
[52318,null,"See CPT",null,821.14260000000002,null,821.14260000000002,null,"000",0,0,0,0,3,0,1,0,0,null,"R"]
[52334,null,"See CPT",null,317.51639999999998,null,317.51639999999998,null,"000",0,0,0,0,3,0,1,0,0,null,"R"]
[52356,null,"See CPT",null,721.24980000000005,null,721.24980000000005,null,"000",0,0,0,0,3,1,1,0,0,null,"R",null,"Y-CM"]
[52601,null,"See CPT",null,1280.1738,null,1280.1738,null,"090",0.08,0.83,0.09,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[53060,null,"See CPT",null,338.32740000000001,null,293.73240000000004,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[53235,null,"See CPT",null,1118.4425999999999,null,1118.4425999999999,null,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[53415,null,"See CPT",null,1982.9910000000002,null,1982.9910000000002,null,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[53430,null,"See CPT",null,1712.4480000000001,null,1712.4480000000001,null,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[53452,null,"See CPT",null," By Report ",null," By Report ",null,"010",0.1,0.8,0.1,0,0,0,0,0,0,null,"N"]
[53505,null,"See CPT",null,858.60239999999999,null,858.60239999999999,null,"090",0.08,0.83,0.09,0,2,0,2,0,0,null,"R"]
[53850,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.08,0.83,0.09,0,2,0,1,0,0,null,"X"]
[54015,null,"See CPT",null,536.92379999999991,null,536.92379999999991,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R"]
[54115,null,"See CPT",null,814.00739999999996,null,755.73660000000007,null,"090",0.1,0.8,0.1,0,2,0,2,0,0,null,"R"]
[54162,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"X"]
[54240,26,"See CPT",null,114.7578,null,114.7578,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[54250,26,"See CPT",null,189.67740000000001,null,189.67740000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[54318,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.8,0.1,0,2,0,2,1,0,null,"X"]
[54360,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.8,0.1,0,2,0,2,1,0,null,"X"]
[54416,null,"See CPT",null,1265.9033999999999,null,1265.9033999999999,null,"090",0.1,0.8,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[54440,null,"See CPT",null," By Report ",null," By Report ",null,"090",0.1,0.8,0.1,0,2,0,2,1,0,null,"N"]
[54620,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"X"]
[54699,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,1,2,1,1,null,"N"]
[55000,null,"See CPT",null,218.2182,null,148.65,null,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[55060,null,"See CPT",null,673.68180000000007,null,673.68180000000007,null,"090",0.1,0.8,0.1,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[55200,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.8,0.1,0,2,2,0,0,0,null,"X"]
[55600,null,"See CPT",null,747.41219999999998,null,747.41219999999998,null,"090",0.1,0.8,0.1,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[55815,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.8,0.1,0,2,2,2,1,0,null,"X"]
[55862,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.8,0.1,0,2,0,2,1,0,null,"X"]
[55980,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[56605,null,"See CPT",null,176.59620000000001,null,104.64960000000001,null,"000",0,0,0,0,2,0,1,2,0,null,"R",null,"Y-CM"]
[56640,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.12,0.74,0.14000000000000001,0,2,1,2,1,0,null,"X"]
[56800,null,"See CPT",null,453.6798,null,453.6798,null,"010",0.1,0.8,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[57020,null,"See CPT",null,232.48860000000002,null,140.32560000000001,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[57111,null,"See CPT",null,3083.0010000000002,null,3083.0010000000002,null,"090",0.12,0.74,0.14000000000000001,0,2,2,2,1,0,null,"R",null,"Y-CM"]
[57220,null,"See CPT",null,628.49220000000003,null,628.49220000000003,null,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[57268,null,"See CPT",null,913.90019999999993,null,913.90019999999993,null,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[57295,null,"See CPT",null,902.6028,null,902.6028,null,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R"]
[57320,null,"See CPT",null,1016.1714000000001,null,1016.1714000000001,null,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[57426,null,"See CPT",null,1562.0142000000001,null,1562.0142000000001,null,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[57455,null,"See CPT",null,294.327,null,192.0558,null,"000",0,0,0,0,3,0,1,0,0,null,"R",null,"Y-CM"]
[57510,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"X"]
[57556,null,"See CPT",null,1056.6042,null,1056.6042,null,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[58152,null,"See CPT",null,2205.3714000000004,null,2205.3714000000004,null,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[58263,null,"See CPT",null,1773.6917999999998,null,1773.6917999999998,null,"090",0.12,0.74,0.14000000000000001,0,2,0,2,2,0,null,"R",null,"Y-CM"]
[58321,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,0,0,0,0,null,"X"]
[58356,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"010",0.1,0.8,0.1,0,2,0,2,2,0,null,"X"]
[58546,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.12,0.74,0.14000000000000001,0,2,0,2,2,0,null,"X"]
[58552,null,"See CPT",null,1746.3402000000001,null,1746.3402000000001,null,"090",0.12,0.74,0.14000000000000001,0,2,0,2,2,0,null,"R",null,"Y-CM"]
[58561,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,3,0,0,2,0,null,"X"]
[58600,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.12,0.74,0.14000000000000001,0,2,2,2,1,0,null,"X"]
[58679,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,1,2,1,1,null,"N"]
[58770,null,"See CPT",null,1542.3924000000002,null,1542.3924000000002,null,"090",0.12,0.74,0.14000000000000001,0,2,1,2,0,0,null,"R",null,"Y-CM"]
[58951,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.12,0.74,0.14000000000000001,0,2,2,2,1,0,null,"X"]
[58970,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,0,0,0,0,null,"X"]
[59020,"TC","See CPT",null,62.433000000000007,null,62.433000000000007,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[59025,"TC","See CPT",null,36.270600000000002,null,36.270600000000002,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[59076,null,"See CPT",null,904.38660000000004,null,904.38660000000004,null,"000",0,0,0,0,2,0,2,0,0,null,"R",null,"Y-CM"]
[59300,null,"See CPT",null,421.57139999999998,null,256.27259999999995,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[59412,null,"See CPT",null,178.97459999999998,null,178.97459999999998,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[59618,null,"See CPT",null,4713.3941999999997,null,4713.3941999999997,null,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[59855,null,"See CPT",null,752.16899999999998,null,752.16899999999998,null,"090",0.17,0.6,0.23,0,2,0,0,0,0,null,"R",null,"Y-CM"]
[59898,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,0,2,1,2,1,1,null,"N"]
[60254,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.82,0.09,0,2,0,2,1,0,null,"X"]
[60271,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.09,0.82,0.09,0,2,0,2,1,0,null,"X"]
[60512,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,0,0,2,1,0,null,"X"]
[61001,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,0,2,2,1,0,0,null,"X"]
[61120,null,"See CPT",null,1330.1202000000001,null,1330.1202000000001,null,"090",0.11,0.76,0.13,0,2,0,0,0,0,null,"R"]
[61253,null,"See CPT",null,1754.07,null,1754.07,null,"090",0.11,0.76,0.13,0,2,2,2,0,0,null,"R"]
[61330,null,"See CPT",null,3151.9746,null,3151.9746,null,"090",0.11,0.76,0.13,0,2,1,2,1,0,null,"R"]
[61460,null,"See CPT",null,3694.8444,null,3694.8444,null,"090",0.11,0.76,0.13,0,2,0,2,2,0,null,"R"]
[61521,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"X"]
[61534,null,"See CPT",null,2906.9994000000002,null,2906.9994000000002,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R"]
[61537,null,"See CPT",null,4294.7957999999999,null,4294.7957999999999,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[61556,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"X"]
[61571,null,"See CPT",null,3496.248,null,3496.248,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R"]
[61586,null,"See CPT",null,4584.366,null,4584.366,null,"090",0.11,0.76,0.13,0,2,0,2,1,2,null,"R",null,"Y-CM"]
[61607,null,"See CPT",null,4738.3674000000001,null,4738.3674000000001,null,"090",0.11,0.76,0.13,0,2,0,2,1,2,null,"R",null,"Y-CM"]
[61619,null,"See CPT",null,2511.5904,null,2511.5904,null,"090",0.11,0.76,0.13,0,2,0,2,1,2,null,"R"]
[61651,null,"See CPT",null,420.38220000000001,null,420.38220000000001,null,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM"]
[61697,null,"See CPT",null,7355.2020000000002,null,7355.2020000000002,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[61702,null,"See CPT",null,7004.9826000000003,null,7004.9826000000003,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[61760,null,"See CPT",null,2791.0524,null,2791.0524,null,"090",0.11,0.76,0.13,0,2,0,1,2,0,null,"R",null,"Y-CM"]
[61798,null,"See CPT",null,2424.1842000000001,null,2424.1842000000001,null,"090",0.11,0.76,0.13,0,0,0,2,0,0,null,"R",null,"Y-CM"]
[61880,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.11,0.76,0.13,0,2,1,2,1,0,null,"X"]
[62140,null,"See CPT",null,1802.2326,null,1802.2326,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R"]
[62148,null,"See CPT",null,218.2182,null,218.2182,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[62201,null,"See CPT",null,2142.3438000000001,null,2142.3438000000001,null,"090",0.11,0.76,0.13,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[62252,"TC","See CPT",null,68.378999999999991,null,68.378999999999991,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[62263,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"X"]
[62287,null,"See CPT",null,1028.0634,null,1028.0634,null,"090",0.11,0.76,0.13,0,2,0,1,0,0,null,"R",null,"Y-UR"]
[62320,null,"See CPT",null,300.27299999999997,null,176.0016,null,"000",0,0,0,0,2,9,1,0,0,null,"R",null,"Y-UR"]
[62329,null,"See CPT",null,567.84300000000007,null,194.4342,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[62365,null,"See CPT",null,527.41019999999992,null,527.41019999999992,null,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,"Y-UR"]
[63016,null,"See CPT",null,2686.4027999999998,null,2686.4027999999998,null,"090",0.11,0.76,0.13,0,2,0,2,2,0,null,"R",null,"Y-UR"]
[63047,null,"See CPT",null,1958.6124,null,1958.6124,null,"090",0.11,0.76,0.13,0,2,2,2,2,0,null,"R",null,"Y-UR"]
[63056,null,"See CPT",null,2632.2942000000003,null,2632.2942000000003,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[63066,null,"See CPT",null,354.97620000000001,null,354.97620000000001,null,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR"]
[63091,null,"See CPT",null,309.78660000000002,null,309.78660000000002,null,"000",0,0,0,0,0,0,2,2,2,null,"R",null,"Y-UR"]
[63191,null,"See CPT",null,2436.0762,null,2436.0762,null,"090",0.11,0.76,0.13,0,2,1,2,1,0,null,"R",null,"Y-UR"]
[63268,null,"See CPT",null,2506.8335999999999,null,2506.8335999999999,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[63277,null,"See CPT",null,2751.8088000000002,null,2751.8088000000002,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[63301,null,"See CPT",null,3870.8459999999995,null,3870.8459999999995,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[63621,null,"See CPT",null,435.84180000000003,null,435.84180000000003,null,"000",0,0,0,0,0,0,2,0,0,null,"R",null,"Y-CM"]
[63685,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"010",0.1,0.8,0.1,0,2,0,2,1,0,null,"X",null,"Y-UR"]
[63702,null,"See CPT",null,2532.9960000000001,null,2532.9960000000001,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[64418,null,"See CPT",null,159.94739999999999,null,98.703599999999994,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[64435,null,"See CPT",null,148.65,null,76.108800000000002,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[64455,null,"See CPT",null,89.19,null,58.865400000000001,null,"000",0,0,0,0,2,1,0,0,0,null,"R"]
[64484,null,"See CPT",null,207.51540000000003,null,90.973799999999997,null,"000",0,0,0,0,0,1,1,0,0,null,"R",null,"Y-UR"]
[64510,null,"See CPT",null,271.73220000000003,null,136.75799999999998,null,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[64575,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.11,0.76,0.13,0,2,0,1,0,0,null,"X"]
[64590,null,"See CPT",null,485.1936,null,286.00259999999997,null,"010",0.1,0.8,0.1,0,2,0,1,1,0,null,"R",null,"Y-UR"]
[64605,null,"See CPT",null,1179.6864,null,617.7894,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[64635,null,"See CPT",null,827.68320000000006,null,339.51659999999998,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[64644,null,"See CPT",null,323.4624,null,206.92080000000001,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[64704,null,"See CPT",null,581.51879999999994,null,581.51879999999994,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM"]
[64719,null,"See CPT",null,734.92560000000003,null,734.92560000000003,null,"090",0.11,0.76,0.13,0,2,1,1,0,0,null,"R",null,"Y-UR"]
[64746,null,"See CPT",null,767.62860000000001,null,767.62860000000001,null,"090",0.11,0.76,0.13,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[64783,null,"See CPT",null,378.7602,null,378.7602,null,"000",0,0,0,0,0,0,1,0,0,null,"R"]
[64795,null,"See CPT",null,335.3544,null,335.3544,null,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM"]
[64809,null,"See CPT",null,1923.5310000000002,null,1923.5310000000002,null,"090",0.11,0.76,0.13,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[64859,null,"See CPT",null,434.05799999999999,null,434.05799999999999,null,"000",0,0,0,0,0,0,2,1,0,null,"R"]
[64866,null,"See CPT",null,2237.4798000000001,null,2237.4798000000001,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R"]
[64892,null,"See CPT",null,1867.6386,null,1867.6386,null,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R"]
[64902,null,"See CPT",null,1205.8488,null,1205.8488,null,"000",0,0,0,0,0,0,2,1,0,null,"R"]
[65105,null,"See CPT",null,1740.9888000000001,null,1740.9888000000001,null,"090",0.1,0.7,0.2,0,2,1,2,1,0,null,"R"]
[65205,null,"See CPT",null,51.730200000000004,null,51.730200000000004,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[65270,null,"See CPT",null,526.81560000000002,null,248.5428,null,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R"]
[65275,null,"See CPT",null,1061.9556,null,817.57500000000005,null,"090",0.1,0.7,0.2,0,2,1,0,0,0,null,"R"]
[65750,null,"See CPT",null,2242.2366000000002,null,2242.2366000000002,null,"090",0.1,0.7,0.2,0,2,1,2,1,0,null,"R"]
[65765,null,"See CPT",null,4655.7785967264008,null,4655.7785967264008,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[65781,null,"See CPT",null,2342.7240000000002,null,2342.7240000000002,null,"090",0.1,0.7,0.2,0,2,1,2,1,0,null,"R"]
[65850,null,"See CPT",null,1496.0136,null,1496.0136,null,"090",0.1,0.7,0.2,0,2,1,1,1,0,null,"R"]
[66130,null,"See CPT",null,1274.8224,null,997.14419999999996,null,"090",0.1,0.7,0.2,0,2,1,0,0,0,null,"R"]
[66184,null,"See CPT",null,1405.0398,null,1405.0398,null,"090",0.1,0.7,0.2,0,2,1,2,0,0,null,"R"]
[66605,null,"See CPT",null,1942.5582000000002,null,1942.5582000000002,null,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R"]
[66635,null,"See CPT",null,1012.6038000000001,null,1012.6038000000001,null,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R"]
[66850,null,"See CPT",null,1392.5532000000001,null,1392.5532000000001,null,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R"]
[66982,null,"See CPT",null,1315.8498,null,1315.8498,null,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R"]
[66991,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"X"]
[67028,null,"See CPT",null,202.16399999999999,null,161.13659999999999,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[67108,null,"See CPT",null,2095.3704000000002,null,2095.3704000000002,null,"090",0.1,0.7,0.2,0,2,1,2,1,0,null,"R"]
[67220,null,"See CPT",null,946.0086,null,881.19720000000007,null,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[67255,null,"See CPT",null,1221.903,null,1221.903,null,"090",0.1,0.7,0.2,0,2,1,2,1,0,null,"R"]
[67312,null,"See CPT",null,1173.1458,null,1173.1458,null,"090",0.1,0.7,0.2,0,2,1,1,1,0,null,"R",null,"Y-CM"]
[67412,null,"See CPT",null,1815.3138000000001,null,1815.3138000000001,null,"090",0.1,0.7,0.2,0,2,1,1,1,0,null,"R"]
[67430,null,"See CPT",null,2517.5364000000004,null,2517.5364000000004,null,"090",0.1,0.7,0.2,0,2,1,2,0,0,null,"R"]
[67715,null,"See CPT",null,494.11260000000004,null,191.46120000000002,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[67805,null,"See CPT",null,364.4898,null,288.97560000000004,null,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R"]
[67900,null,"See CPT",null,1174.9296000000002,null,893.08920000000001,null,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R"]
[67915,null,"See CPT",null,585.68100000000004,null,353.78700000000003,null,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R"]
[67930,null,"See CPT",null,674.27639999999997,null,415.03080000000006,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[67950,null,"See CPT",null,1060.1717999999998,null,817.57500000000005,null,"090",0.1,0.7,0.2,0,2,1,1,1,0,null,"R"]
[68320,null,"See CPT",null,1353.9041999999999,null,955.5222,null,"090",0.1,0.7,0.2,0,2,1,1,1,0,null,"R"]
[68335,null,"See CPT",null,1139.8482000000001,null,1139.8482000000001,null,"090",0.1,0.7,0.2,0,2,1,1,1,0,null,"R"]
[68525,null,"See CPT",null,453.08519999999999,null,453.08519999999999,null,"000",0,0,0,0,2,1,1,1,0,null,"R",null,"Y-CM"]
[68550,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"X"]
[68815,null,"See CPT",null,695.0874,null,393.03060000000005,null,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R"]
[69105,null,"See CPT",null,272.32679999999999,null,111.78479999999999,null,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[69200,null,"See CPT",null,146.27160000000001,null,83.8386,null,"000",0,0,0,0,2,1,1,0,0,null,"R"]
[69310,null,"See CPT",null,2070.3971999999999,null,2070.3971999999999,null,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,1,0,0,null,"R"]
[69505,null,"See CPT",null,2264.8314,null,2264.8314,null,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,0,0,0,null,"R",null,"Y-CM"]
[69550,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,2,0,0,null,"X"]
[69636,null,"See CPT",null,2593.6451999999999,null,2593.6451999999999,null,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,0,0,0,null,"R"]
[69642,null,"See CPT",null,2442.0221999999999,null,2442.0221999999999,null,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[69676,null,"See CPT",null,1529.3111999999999,null,1529.3111999999999,null,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,1,0,0,null,"R",null,"Y-CM"]
[69725,null,"See CPT",null,3368.4090000000001,null,3368.4090000000001,null,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,2,0,0,null,"R"]
[69805,null,"See CPT",null,1858.125,null,1858.125,null,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,2,0,0,null,"R",null,"Y-CM"]
[69950,null,"See CPT",null,3125.2176000000004,null,3125.2176000000004,null,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,2,1,0,null,"R",null,"Y-CM"]
[70030,26,"See CPT",null,15.4596,null,15.4596,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[70110,"TC","See CPT",null,60.054600000000001,null,60.054600000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[70140,26,"See CPT",null,17.838000000000001,null,17.838000000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[70150,26,"See CPT",null,22.594799999999999,null,22.594799999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[70200,26,"See CPT",null,24.378599999999999,null,24.378599999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[70250,"TC","See CPT",null,50.540999999999997,null,50.540999999999997,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[70300,26,"See CPT",null,8.9190000000000005,null,8.9190000000000005,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[70328,null,"See CPT",null,64.811400000000006,null,64.811400000000006,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[70350,null,"See CPT",null,29.135400000000001,null,29.135400000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[70355,"TC","See CPT",null,14.865,null,14.865,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[70390,null,"See CPT",null,225.35339999999999,null,225.35339999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[70450,null,"See CPT",null,202.7586,null,202.7586,null,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-UR"]
[70470,"TC","See CPT",null,227.13720000000001,null,227.13720000000001,null,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-UR"]
[70487,26,"See CPT",null,95.13600000000001,null,95.13600000000001,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[70491,null,"See CPT",null,356.76,null,356.76,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[70496,"TC","See CPT",null,384.70619999999997,null,384.70619999999997,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[70543,"TC","See CPT",null,483.40980000000008,null,483.40980000000008,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[70545,null,"See CPT",null,442.97700000000003,null,442.97700000000003,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[70549,"TC","See CPT",null,520.86959999999999,null,520.86959999999999,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[70551,"TC","See CPT",null,253.89419999999998,null,253.89419999999998,null,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-UR"]
[70553,26,"See CPT",null,194.4342,null,194.4342,null,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-UR"]
[71045,null,"See CPT",null,47.568000000000005,null,47.568000000000005,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[71047,"TC","See CPT",null,55.297800000000002,null,55.297800000000002,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[71100,26,"See CPT",null,19.6218,null,19.6218,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[71120,26,"See CPT",null,16.648800000000001,null,16.648800000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[71250,"TC","See CPT",null,162.92040000000003,null,162.92040000000003,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[71275,26,"See CPT",null,154.596,null,154.596,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[71550,26,"See CPT",null,124.2714,null,124.2714,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[71555,null,"See CPT",null,655.84379999999999,null,655.84379999999999,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[72070,"TC","See CPT",null,43.405799999999999,null,43.405799999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[72074,26,"See CPT",null,21.4056,null,21.4056,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[72082,null,"See CPT",null,130.81200000000001,null,130.81200000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[72110,null,"See CPT",null,95.13600000000001,null,95.13600000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[72114,26,"See CPT",null,26.162400000000002,null,26.162400000000002,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[72128,null,"See CPT",null,249.13740000000001,null,249.13740000000001,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[72129,null,"See CPT",null,328.2192,null,328.2192,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[72131,"TC","See CPT",null,163.51500000000001,null,163.51500000000001,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[72146,26,"See CPT",null,126.05520000000001,null,126.05520000000001,null,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-UR"]
[72149,null,"See CPT",null,529.19400000000007,null,529.19400000000007,null,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-UR"]
[72157,"TC","See CPT",null,431.08499999999998,null,431.08499999999998,null,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-UR"]
[72190,"TC","See CPT",null,56.486999999999995,null,56.486999999999995,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[72192,null,"See CPT",null,255.08340000000001,null,255.08340000000001,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[72196,"TC","See CPT",null,381.1386,null,381.1386,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[72197,"TC","See CPT",null,476.86919999999998,null,476.86919999999998,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[72200,26,"See CPT",null,14.2704,null,14.2704,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[72270,null,"See CPT",null,309.78660000000002,null,309.78660000000002,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[72270,26,"See CPT",null,118.92,null,118.92,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[73010,26,"See CPT",null,15.4596,null,15.4596,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[73050,26,"See CPT",null,16.054200000000002,null,16.054200000000002,null,"000",0,0,0,1,0,2,0,0,0,null,"R"]
[73070,"TC","See CPT",null,39.243600000000001,null,39.243600000000001,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[73092,26,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,1,0,3,0,0,0,null,"X"]
[73100,26,"See CPT",null,14.2704,null,14.2704,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[73120,null,"See CPT",null,57.676200000000001,null,57.676200000000001,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[73202,"TC","See CPT",null,387.67919999999998,null,387.67919999999998,null,"000",0,0,0,1,4,3,0,0,0,null,"R"]
[73206,null,"See CPT",null,579.73500000000001,null,579.73500000000001,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[73221,null,"See CPT",null,393.62520000000001,null,393.62520000000001,null,"000",0,0,0,1,4,3,0,0,0,null,"R",null,"Y-UR"]
[73501,null,"See CPT",null,60.054600000000001,null,60.054600000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[73502,26,"See CPT",null,19.6218,null,19.6218,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[73525,null,"See CPT",null,252.11040000000003,null,252.11040000000003,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[73551,null,"See CPT",null,54.108600000000003,null,54.108600000000003,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[73560,"TC","See CPT",null,48.757199999999997,null,48.757199999999997,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[73580,"TC","See CPT",null,228.32640000000001,null,228.32640000000001,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[73592,"TC","See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,1,0,3,0,0,0,null,"X"]
[73620,"TC","See CPT",null,38.649000000000001,null,38.649000000000001,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[73700,"TC","See CPT",null,163.51500000000001,null,163.51500000000001,null,"000",0,0,0,1,4,3,0,0,0,null,"R"]
[73702,26,"See CPT",null,103.46040000000001,null,103.46040000000001,null,"000",0,0,0,1,4,3,0,0,0,null,"R"]
[73719,"TC","See CPT",null,377.57099999999997,null,377.57099999999997,null,"000",0,0,0,1,4,3,0,0,0,null,"R",null,"Y-UR"]
[73722,26,"See CPT",null,139.13639999999998,null,139.13639999999998,null,"000",0,0,0,1,4,3,0,0,0,null,"R",null,"Y-UR"]
[73723,26,"See CPT",null,182.54219999999998,null,182.54219999999998,null,"000",0,0,0,1,4,3,0,0,0,null,"R",null,"Y-UR"]
[74021,26,"See CPT",null,23.189400000000003,null,23.189400000000003,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[74150,26,"See CPT",null,101.67659999999999,null,101.67659999999999,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[74175,26,"See CPT",null,153.4068,null,153.4068,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[74181,26,"See CPT",null,124.2714,null,124.2714,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[74185,null,"See CPT",null,660.60059999999999,null,660.60059999999999,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[74210,26,"See CPT",null,50.540999999999997,null,50.540999999999997,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[74235,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[74240,null,"See CPT",null,234.2724,null,234.2724,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[74251,null,"See CPT",null,720.65519999999992,null,720.65519999999992,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[74262,null,"See CPT",null,931.73820000000001,null,931.73820000000001,null,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-CM"]
[74283,null,"See CPT",null,484.00440000000003,null,484.00440000000003,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[74300,"TC","See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[74330,"TC","See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[74360,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[74410,"TC","See CPT",null,225.94799999999998,null,225.94799999999998,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[74415,"TC","See CPT",null,253.89419999999998,null,253.89419999999998,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[74440,"TC","See CPT",null,153.4068,null,153.4068,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[74450,"TC","See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[74710,"TC","See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[74713,26,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[75557,26,"See CPT",null,197.40719999999999,null,197.40719999999999,null,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-CM"]
[75563,"TC","See CPT",null,592.81620000000009,null,592.81620000000009,null,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-CM"]
[75572,26,"See CPT",null,148.05540000000002,null,148.05540000000002,null,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-CM"]
[75600,null,"See CPT",null,353.19240000000002,null,353.19240000000002,null,"000",0,0,0,1,6,0,0,0,0,null,"R"]
[75635,null,"See CPT",null,793.19640000000004,null,793.19640000000004,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[75710,null,"See CPT",null,275.89439999999996,null,275.89439999999996,null,"000",0,0,0,1,6,0,0,0,0,null,"R"]
[75733,null,"See CPT",null,309.78660000000002,null,309.78660000000002,null,"000",0,0,0,1,6,2,0,0,0,null,"R"]
[75741,"TC","See CPT",null,133.19040000000001,null,133.19040000000001,null,"000",0,0,0,1,6,0,0,0,0,null,"R"]
[75774,"TC","See CPT",null,96.919799999999995,null,96.919799999999995,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[75805,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[75810,"TC","See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[75820,"TC","See CPT",null,114.7578,null,114.7578,null,"000",0,0,0,1,6,0,0,0,0,null,"R"]
[75833,26,"See CPT",null,123.6768,null,123.6768,null,"000",0,0,0,1,6,2,0,0,0,null,"R"]
[75840,"TC","See CPT",null,140.92020000000002,null,140.92020000000002,null,"000",0,0,0,1,6,0,0,0,0,null,"R"]
[75872,"TC","See CPT",null,140.92020000000002,null,140.92020000000002,null,"000",0,0,0,1,6,0,0,0,0,null,"R"]
[75885,26,"See CPT",null,114.1632,null,114.1632,null,"000",0,0,0,1,6,0,0,0,0,null,"R"]
[75893,26,"See CPT",null,44.594999999999999,null,44.594999999999999,null,"000",0,0,0,1,6,0,0,0,0,null,"R"]
[75901,"TC","See CPT",null,408.49020000000002,null,408.49020000000002,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[75957,26,"See CPT",null,496.49099999999999,null,496.49099999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[75958,26,"See CPT",null,330.00299999999999,null,330.00299999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[76010,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[76010,26,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[76102,26,"See CPT",null,51.884189999999997,null,51.884189999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[76140,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[76390,"TC","See CPT",null,602.92439999999999,null,602.92439999999999,null,"000",0,0,0,1,9,9,9,9,9,null,"R",null,"Y-CM"]
[76497,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[76506,"TC","See CPT",null,161.13659999999999,null,161.13659999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[76510,26,"See CPT",null,69.56819999999999,null,69.56819999999999,null,"000",0,0,0,1,7,3,0,0,0,null,"R"]
[76516,26,"See CPT",null,39.838200000000001,null,39.838200000000001,null,"000",0,0,0,1,7,2,0,0,0,null,"R"]
[76519,"TC","See CPT",null,68.97359999999999,null,68.97359999999999,null,"000",0,0,0,1,7,2,0,0,0,null,"R"]
[76641,"TC","See CPT",null,130.2174,null,130.2174,null,"000",0,0,0,1,0,1,0,0,0,null,"R",null,"Y-CM"]
[76700,26,"See CPT",null,68.97359999999999,null,68.97359999999999,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[76775,26,"See CPT",null,49.351799999999997,null,49.351799999999997,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[76801,"TC","See CPT",null,133.785,null,133.785,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[76810,"TC","See CPT",null,78.487200000000001,null,78.487200000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[76811,"TC","See CPT",null,156.9744,null,156.9744,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[76817,null,"See CPT",null,172.434,null,172.434,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[76817,26,"See CPT",null,64.811400000000006,null,64.811400000000006,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[76821,26,"See CPT",null,60.054600000000001,null,60.054600000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[76827,null,"See CPT",null,130.81200000000001,null,130.81200000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[76856,null,"See CPT",null,198.0018,null,198.0018,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[76870,26,"See CPT",null,54.703200000000002,null,54.703200000000002,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[76882,null,"See CPT",null,103.46040000000001,null,103.46040000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[76885,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[76940,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[76941,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[76965,26,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[76975,"TC","See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[76981,"TC","See CPT",null,143.29860000000002,null,143.29860000000002,null,"000",0,0,0,1,4,0,0,0,0,null,"R"]
[76998,null,"See CPT",null," By Report ",null," By Report ",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[77002,"TC","See CPT",null,168.8664,null,168.8664,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[77003,"TC","See CPT",null,145.08240000000001,null,145.08240000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[77021,26,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,1,0,0,9,0,0,null,"X"]
[77022,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[77053,26,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,1,0,0,9,0,0,null,"X"]
[77054,26,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,1,0,0,9,0,0,null,"X"]
[77065,26,"See CPT",null,68.97359999999999,null,68.97359999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[77072,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[77075,"TC","See CPT",null,137.3526,null,137.3526,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[77076,"TC","See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[77084,26,"See CPT",null,136.1634,null,136.1634,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[77085,"TC","See CPT",null,67.784399999999991,null,67.784399999999991,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[77285,"TC","See CPT",null,723.03359999999998,null,723.03359999999998,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[77290,"TC","See CPT",null,701.03339999999992,null,701.03339999999992,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[77300,"TC","See CPT",null,60.054600000000001,null,60.054600000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[77307,null,"See CPT",null,513.13980000000004,null,513.13980000000004,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[77318,"TC","See CPT",null,558.32940000000008,null,558.32940000000008,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[77331,"TC","See CPT",null,34.486799999999995,null,34.486799999999995,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[77338,"TC","See CPT",null,432.27420000000001,null,432.27420000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[77370,null,"See CPT",null,242.00220000000002,null,242.00220000000002,null,"000",0,0,0,3,0,0,0,0,0,null,"R",null,"Y-CM"]
[77424,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[77431,null,"See CPT",null,189.67740000000001,null,189.67740000000001,null,"000",0,0,0,2,0,0,0,0,0,null,"R",null,"Y-CM"]
[77523,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,3,0,0,0,0,0,null,"N",null,"Y-CM"]
[77610,null,"See CPT",null,1294.4441999999999,null,1294.4441999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[77750,26,"See CPT",null,466.16640000000001,null,466.16640000000001,null,"090",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[77762,"TC","See CPT",null,444.76080000000002,null,444.76080000000002,null,"090",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[77770,26,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[77771,"TC","See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[77799,"TC","See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM"]
[78012,26,"See CPT",null,15.4596,null,15.4596,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78016,26,"See CPT",null,58.270800000000001,null,58.270800000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78070,"TC","See CPT",null,451.89599999999996,null,451.89599999999996,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78075,26,"See CPT",null,63.622200000000007,null,63.622200000000007,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78103,null,"See CPT",null,335.3544,null,335.3544,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78120,null,"See CPT",null,132.00120000000001,null,132.00120000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78120,26,"See CPT",null,16.648800000000001,null,16.648800000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78191,null,"See CPT",null,230.70480000000001,null,230.70480000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78195,null,"See CPT",null,625.51919999999996,null,625.51919999999996,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78201,"TC","See CPT",null,302.05680000000001,null,302.05680000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78226,26,"See CPT",null,61.8384,null,61.8384,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78232,null,"See CPT",null,190.86660000000001,null,190.86660000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78261,"TC","See CPT",null,313.94880000000001,null,313.94880000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78266,"TC","See CPT",null,690.92520000000002,null,690.92520000000002,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[78267,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[78299,"TC","See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM"]
[78300,26,"See CPT",null,52.919400000000003,null,52.919400000000003,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[78315,null,"See CPT",null,611.84339999999997,null,611.84339999999997,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[78428,null,"See CPT",null,332.976,null,332.976,null,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM"]
[78431,"TC","See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-UR"]
[78433,26,"See CPT",null,183.13679999999999,null,183.13679999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-UR"]
[78452,26,"See CPT",null,136.1634,null,136.1634,null,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-UR"]
[78453,"TC","See CPT",null,438.81479999999999,null,438.81479999999999,null,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-UR"]
[78459,26,"See CPT",null,129.62280000000001,null,129.62280000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-UR"]
[78466,26,"See CPT",null,60.6492,null,60.6492,null,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM"]
[78472,null,"See CPT",null,403.73340000000002,null,403.73340000000002,null,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM"]
[78491,"TC","See CPT",null,3085.8673697280005,null,3085.8673697280005,null,"000",0,0,0,1,0,0,0,0,0,null,"F",null,"Y-UR"]
[78496,"TC","See CPT",null,35.081400000000002,null,35.081400000000002,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-UR"]
[78580,null,"See CPT",null,418.00380000000001,null,418.00380000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78599,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM"]
[78599,"TC","See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM"]
[78609,"TC","See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,9,9,9,9,9,null,"N",null,"Y-CM"]
[78610,null,"See CPT",null,310.38119999999998,null,310.38119999999998,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[78635,"TC","See CPT",null,545.2482,null,545.2482,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[78699,"TC","See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM"]
[78708,null,"See CPT",null,321.084,null,321.084,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[78725,"TC","See CPT",null,176.0016,null,176.0016,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[78799,26,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM"]
[78800,null,"See CPT",null,449.51759999999996,null,449.51759999999996,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78811,26,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[78812,26,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[78814,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[78831,26,"See CPT",null,149.24459999999999,null,149.24459999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[78835,"TC","See CPT",null,138.54179999999999,null,138.54179999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[79200,26,"See CPT",null,142.10940000000002,null,142.10940000000002,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[79445,"TC","See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM"]
[79999,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM"]
[80150,null,"See CPT",null,21.564399999999999,null,21.564399999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[80156,null,"See CPT",null,20.835100000000001,null,20.835100000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[80164,null,"See CPT",null,19.362199999999998,null,19.362199999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[80180,null,"See CPT",null,25.811499999999999,null,25.811499999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[80186,null,"See CPT",null,19.6768,null,19.6768,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[80200,null,"See CPT",null,23.065899999999999,null,23.065899999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[80305,null,"See CPT",null,18.017999999999997,null,18.017999999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[80307,null,"See CPT",null,88.860199999999992,null,88.860199999999992,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[80335,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[80342,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[80345,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[80357,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[80368,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[80375,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[80417,null,"See CPT",null,62.905700000000003,null,62.905700000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[80430,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[80438,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81020,null,"See CPT",null,6.7210000000000001,null,6.7210000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[81099,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[81162,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81174,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81181,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81193,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81205,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81210,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81226,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81229,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81241,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81252,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81259,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81266,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81278,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81286,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81299,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81302,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81314,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81325,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81332,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81339,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81351,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81360,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81378,null,"See CPT",null,494.1651,null,494.1651,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[81381,null,"See CPT",null,242.95699999999999,null,242.95699999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[81410,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81425,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81434,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81442,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81493,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81507,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81523,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[81529,null,"See CPT",null,10285.99,null,10285.99,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-ONC"]
[82009,null,"See CPT",null,6.4635999999999987,null,6.4635999999999987,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[82040,null,"See CPT",null,7.0785,null,7.0785,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[82085,null,"See CPT",null,13.885300000000001,null,13.885300000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[82108,null,"See CPT",null,36.436399999999999,null,36.436399999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[82157,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[82175,null,"See CPT",null,27.127099999999999,null,27.127099999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[82274,null,"See CPT",null,22.765599999999999,null,22.765599999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[82306,null,"See CPT",null,42.328000000000003,null,42.328000000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[82380,null,"See CPT",null,13.1846,null,13.1846,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[82415,null,"See CPT",null,18.118099999999998,null,18.118099999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[82482,null,"See CPT",null,14.0283,null,14.0283,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[82530,null,"See CPT",null,23.895299999999999,null,23.895299999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[82595,null,"See CPT",null,9.2520999999999987,null,9.2520999999999987,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[82615,null,"See CPT",null,13.656500000000001,null,13.656500000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[82668,null,"See CPT",null,26.869699999999998,null,26.869699999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[82672,null,"See CPT",null,31.030999999999999,null,31.030999999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[82757,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[82785,null,"See CPT",null,23.537800000000001,null,23.537800000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[82930,null,"See CPT",null,9.5952999999999999,null,9.5952999999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[82948,null,"See CPT",null,7.2071999999999994,null,7.2071999999999994,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[82985,null,"See CPT",null,23.966800000000003,null,23.966800000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[83009,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[83036,null,"See CPT",null,13.885300000000001,null,13.885300000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[83050,null,"See CPT",null,11.725999999999999,null,11.725999999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[83516,null,"See CPT",null,16.4879,null,16.4879,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[83528,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[83593,null,"See CPT",null,40.754999999999995,null,40.754999999999995,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[83633,null,"See CPT",null,16.087499999999999,null,16.087499999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[83704,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[83727,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[83876,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[83885,null,"See CPT",null,35.049300000000002,null,35.049300000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[84030,null,"See CPT",null,7.8649999999999993,null,7.8649999999999993,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[84081,null,"See CPT",null,23.6236,null,23.6236,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[84132,null,"See CPT",null,6.8067999999999991,null,6.8067999999999991,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[84135,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[84156,null,"See CPT",null,5.2481,null,5.2481,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[84165,null,"See CPT",null,15.3582,null,15.3582,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[84228,null,"See CPT",null,16.6309,null,16.6309,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[84235,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[84375,null,"See CPT",null,55.769999999999996,null,55.769999999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[84403,null,"See CPT",null,36.908299999999997,null,36.908299999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[84445,null,"See CPT",null,72.729799999999997,null,72.729799999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[84450,null,"See CPT",null,7.4073999999999991,null,7.4073999999999991,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[84510,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[84545,null,"See CPT",null,10.295999999999999,null,10.295999999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[84600,null,"See CPT",null,24.467299999999998,null,24.467299999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[84830,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[85032,null,"See CPT",null,6.1632999999999996,null,6.1632999999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[85055,null,"See CPT",null,"Not Covered",null,"Not Covered ",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[85245,null,"See CPT",null,32.804200000000002,null,32.804200000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[85250,null,"See CPT",null,27.227199999999996,null,27.227199999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[85305,null,"See CPT",null,16.6023,null,16.6023,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[85345,null,"See CPT",null,6.7067000000000005,null,6.7067000000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[85390,null,"See CPT",null,22.136399999999998,null,22.136399999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[85421,null,"See CPT",null,14.557399999999999,null,14.557399999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[85549,null,"See CPT",null,26.8125,null,26.8125,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[85610,null,"See CPT",null,6.1346999999999996,null,6.1346999999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[85730,null,"See CPT",null,8.5942999999999987,null,8.5942999999999987,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[85999,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[86038,null,"See CPT",null,17.288699999999999,null,17.288699999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86060,null,"See CPT",null,10.439,null,10.439,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[86156,null,"See CPT",null,11.540100000000001,null,11.540100000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86215,null,"See CPT",null,18.947499999999998,null,18.947499999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86294,null,"See CPT",null,36.565100000000001,null,36.565100000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[86310,null,"See CPT",null,10.539099999999999,null,10.539099999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86329,null,"See CPT",null,20.0915,null,20.0915,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86334,26,"See CPT",null,32.108400000000003,null,32.108400000000003,null,"000",0,0,0,6,0,0,0,0,0,null,"R"]
[86341,null,"See CPT",null,33.705100000000002,null,33.705100000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86361,null,"See CPT",null,38.295400000000001,null,38.295400000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86409,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[86486,null,"See CPT",null,11.2974,null,11.2974,null,"000",0,0,0,3,0,0,0,0,0,null,"R"]
[86611,null,"See CPT",null,14.557399999999999,null,14.557399999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86625,null,"See CPT",null,18.761599999999998,null,18.761599999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86652,null,"See CPT",null,18.861699999999999,null,18.861699999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86658,null,"See CPT",null,18.632899999999999,null,18.632899999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86674,null,"See CPT",null,21.049600000000002,null,21.049600000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86696,null,"See CPT",null,27.670500000000001,null,27.670500000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86713,null,"See CPT",null,21.879000000000001,null,21.879000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86738,null,"See CPT",null,18.933199999999999,null,18.933199999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86769,null,"See CPT",null,60.245899999999999,null,60.245899999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[86787,null,"See CPT",null,18.418400000000002,null,18.418400000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86807,null,"See CPT",null,112.4695,null,112.4695,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86813,null,"See CPT",null,82.94,null,82.94,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86829,null,"See CPT",null,91.791699999999992,null,91.791699999999992,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[86870,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[86911,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[86931,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[86976,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[87040,null,"See CPT",null,14.7576,null,14.7576,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87086,null,"See CPT",null,11.540100000000001,null,11.540100000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87102,null,"See CPT",null,12.026299999999999,null,12.026299999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87118,null,"See CPT",null,20.892299999999999,null,20.892299999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87164,26,"See CPT",null,33.892199999999995,null,33.892199999999995,null,"000",0,0,0,6,0,0,0,0,0,null,"R"]
[87188,null,"See CPT",null,9.4951999999999988,null,9.4951999999999988,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87209,null,"See CPT",null,25.711400000000001,null,25.711400000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87269,null,"See CPT",null,19.462299999999999,null,19.462299999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87276,null,"See CPT",null,22.9801,null,22.9801,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87305,null,"See CPT",null,17.131399999999999,null,17.131399999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87327,null,"See CPT",null,19.1906,null,19.1906,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87338,null,"See CPT",null,20.563400000000001,null,20.563400000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87400,null,"See CPT",null,20.2059,null,20.2059,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87451,null,"See CPT",null,15.029299999999999,null,15.029299999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87490,null,"See CPT",null,32.532499999999999,null,32.532499999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[87505,null,"See CPT",null,183.45469999999997,null,183.45469999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87517,null,"See CPT",null,61.261200000000002,null,61.261200000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87532,null,"See CPT",null,50.178699999999999,null,50.178699999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87535,null,"See CPT",null,50.178699999999999,null,50.178699999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87542,null,"See CPT",null,59.716799999999992,null,59.716799999999992,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87563,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[87624,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[87651,null,"See CPT",null,50.178699999999999,null,50.178699999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87803,null,"See CPT",null,22.88,null,22.88,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[87811,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[87910,null,"See CPT",null,368.15349999999995,null,368.15349999999995,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[88000,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[88025,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[88104,"TC","See CPT",null,74.325000000000003,null,74.325000000000003,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[88112,null,"See CPT",null,120.70379999999999,null,120.70379999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[88130,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[88160,"TC","See CPT",null,85.622399999999999,null,85.622399999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[88162,26,"See CPT",null,68.97359999999999,null,68.97359999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[88174,null,"See CPT",null,36.2791,null,36.2791,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[88182,26,"See CPT",null,67.189799999999991,null,67.189799999999991,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[88187,null,"See CPT",null,63.027600000000007,null,63.027600000000007,null,"000",0,0,0,2,0,0,0,0,0,null,"R",null,"Y-CM"]
[88239,null,"See CPT",null,210.95359999999999,null,210.95359999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[88263,null,"See CPT",null,214.91469999999998,null,214.91469999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[88289,null,"See CPT",null,49.234899999999996,null,49.234899999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[88305,null,"See CPT",null,128.43360000000001,null,128.43360000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[88309,"TC","See CPT",null,539.30219999999997,null,539.30219999999997,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[88313,26,"See CPT",null,21.4056,null,21.4056,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[88323,null,"See CPT",null,201.5694,null,201.5694,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[88325,null,"See CPT",null,278.86740000000003,null,236.6508,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[88334,26,"See CPT",null,65.406000000000006,null,65.406000000000006,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[88344,null,"See CPT",null,312.16500000000002,null,312.16500000000002,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[88350,"TC","See CPT",null,165.2988,null,165.2988,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[88360,"TC","See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[88362,26,"See CPT",null,195.6234,null,195.6234,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[88366,26,"See CPT",null,108.81180000000001,null,108.81180000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[88369,"TC","See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[88371,null,"See CPT",null,31.788899999999998,null,31.788899999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
[88377,26,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[88387,26,"See CPT",null,46.378800000000005,null,46.378800000000005,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[88740,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[89060,26,"See CPT",null,32.108400000000003,null,32.108400000000003,null,"000",0,0,0,6,0,0,0,0,0,null,"R"]
[89255,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[89281,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[89325,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[89331,null,"See CPT",null,28.0137,null,28.0137,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
[90281,null,"See CPT",null,"By report",null,"By report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[90375,null,"See CPT",null,321.80200000000002,null,321.80200000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
[90399,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[90476,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[90644,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[90657,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[90668,null,"See CPT",null,0,null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[90672,null,"See CPT",null,26.88,null,26.88,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
[90698,null,"See CPT",null,"By report",null,"By report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[90710,null,"See CPT",null,"By report",null,"By report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[90736,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[90747,null,"See CPT",null,140.75200000000001,null,140.75200000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
[90837,null,"See CPT",null,263.40780000000001,null,230.70480000000001,null,"000",0,0,0,0,0,0,9,0,0,null,"R",null,"Y-CM"]
[90865,null,"See CPT",null,296.7054,null,220.00200000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[90882,null,"See CPT",null,82.955401214399998,null,82.955401214399998,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[90889,null,"See CPT",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
[90957,null,"See CPT",null,1376.499,null,1376.499,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[90961,null,"See CPT",null,523.84260000000006,null,523.84260000000006,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[90989,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[91013,null,"See CPT",null,48.162600000000005,null,48.162600000000005,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[91034,null,"See CPT",null,362.1114,null,362.1114,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[91038,"TC","See CPT",null,696.87120000000004,null,696.87120000000004,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[91110,null,"See CPT",null,1459.1484,null,1459.1484,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[91111,null,"See CPT",null,1762.989,null,1762.989,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[91132,26,"See CPT",null,46.378800000000005,null,46.378800000000005,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[91200,null,"See CPT",null,56.486999999999995,null,56.486999999999995,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[91304,null,"See CPT",null,1.03E-2,null,1.03E-2,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
[92014,null,"See CPT",null,228.32640000000001,null,135.56879999999998,null,"000",0,0,0,0,0,2,0,0,0,null,"R"]
[92065,"TC","See CPT",null,65.406000000000006,null,65.406000000000006,null,"000",0,0,0,1,0,2,0,0,0,null,"R",null,"Y-CM"]
[92083,null,"See CPT",null,114.1632,null,114.1632,null,"000",0,0,0,1,7,2,0,0,0,null,"R"]
[92133,26,"See CPT",null,38.054400000000001,null,38.054400000000001,null,"000",0,0,0,1,7,2,0,0,0,null,"R"]
[92134,26,"See CPT",null,44.594999999999999,null,44.594999999999999,null,"000",0,0,0,1,7,2,0,0,0,null,"R"]
[92235,null,"See CPT",null,229.51560000000001,null,229.51560000000001,null,"000",0,0,0,1,7,2,0,0,0,null,"R"]
[92240,"TC","See CPT",null,272.92140000000001,null,272.92140000000001,null,"000",0,0,0,1,7,2,0,0,0,null,"R",null,"Y-CM"]
[92265,26,"See CPT",null,80.271000000000001,null,80.271000000000001,null,"000",0,0,0,1,7,2,0,0,0,null,"R"]
[92283,null,"See CPT",null,99.298199999999994,null,99.298199999999994,null,"000",0,0,0,1,7,2,0,0,0,null,"R",null,"Y-CM"]
[92287,null,"See CPT",null,331.78680000000003,null,331.78680000000003,null,"000",0,0,0,1,0,2,0,0,0,null,"R",null,"Y-CM"]
[92326,null,"See CPT",null,73.135800000000003,null,73.135800000000003,null,"000",0,0,0,5,0,0,0,0,0,null,"R",null,"Y-CM"]
[92358,null,"See CPT",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
[92499,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[92523,null,"See CPT",null,407.8956,null,407.8956,null,"000",0,0,0,7,5,0,0,0,0,null,"R"]
[92532,null,"See CPT",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
[92541,"TC","See CPT",null,8.9190000000000005,null,8.9190000000000005,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[92542,"TC","See CPT",null,8.3244000000000007,null,8.3244000000000007,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[92548,26,"See CPT",null,60.6492,null,60.6492,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[92556,null,"See CPT",null,74.325000000000003,null,74.325000000000003,null,"000",0,0,0,3,0,2,0,0,0,null,"R"]
[92570,null,"See CPT",null,58.865400000000001,null,52.324800000000003,null,"000",0,0,0,7,0,2,0,0,0,null,"R"]
[92575,null,"See CPT",null,129.62280000000001,null,129.62280000000001,null,"000",0,0,0,3,0,2,0,0,0,null,"R"]
[92593,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[92597,null,"See CPT",null,129.62280000000001,null,129.62280000000001,null,"000",0,0,0,7,5,0,0,0,0,null,"R"]
[92614,null,"See CPT",null,266.97540000000004,null,117.1362,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[92617,null,"See CPT",null,"Bundled",null,"Bundled",null,"000",0,0,0,0,0,0,0,0,0,null,"Bundled",null,"Y-CM"]
[92652,null,"See CPT",null,209.29920000000001,null,209.29920000000001,null,"000",0,0,0,0,0,2,0,0,0,null,"R",null,"Y-CM"]
[92934,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[92960,null,"See CPT",null,281.84040000000005,null,190.86660000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[92971,null,"See CPT",null,173.6232,null,173.6232,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[93000,null,"See CPT",null,25.567799999999998,null,25.567799999999998,null,"000",0,0,0,4,6,0,0,0,0,null,"R"]
[93016,null,"See CPT",null,38.054400000000001,null,38.054400000000001,null,"000",0,0,0,2,0,0,0,0,0,null,"R"]
[93225,null,"See CPT",null,35.676000000000002,null,35.676000000000002,null,"000",0,0,0,3,6,0,0,0,0,null,"R"]
[93228,null,"See CPT",null,45.189599999999999,null,45.189599999999999,null,"000",0,0,0,2,0,0,0,0,0,null,"R"]
[93260,"TC","See CPT",null,66.595200000000006,null,66.595200000000006,null,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM"]
[93278,"TC","See CPT",null,30.9192,null,30.9192,null,"000",0,0,0,1,6,0,0,0,0,null,"R"]
[93281,null,"See CPT",null,158.75819999999999,null,158.75819999999999,null,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM"]
[93283,26,"See CPT",null,99.892799999999994,null,99.892799999999994,null,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM"]
[93287,"TC","See CPT",null,61.2438,null,61.2438,null,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM"]
[93288,26,"See CPT",null,36.865200000000002,null,36.865200000000002,null,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM"]
[93293,"TC","See CPT",null,61.2438,null,61.2438,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[93295,null,"See CPT",null,66.000600000000006,null,66.000600000000006,null,"000",0,0,0,2,0,0,0,0,0,null,"R",null,"Y-CM"]
[93306,26,"See CPT",null,122.4876,null,122.4876,null,"000",0,0,0,1,6,0,0,0,0,null,"R"]
[93313,null,"See CPT",null,19.6218,null,19.6218,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[93317,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[93320,null,"See CPT",null,95.13600000000001,null,95.13600000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[93351,null,"See CPT",null,432.27420000000001,null,432.27420000000001,null,"000",0,0,0,1,6,0,9,9,9,null,"R"]
[93355,null,"See CPT",null,398.38200000000001,null,398.38200000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[93455,null,"See CPT",null,1930.0716,null,1930.0716,null,"000",0,0,0,1,2,0,0,0,0,null,"R",null,"Y-CM"]
[93456,null,"See CPT",null,2157.2087999999999,null,2157.2087999999999,null,"000",0,0,0,1,2,0,0,0,0,null,"R",null,"Y-CM"]
[93460,null,"See CPT",null,2374.8323999999998,null,2374.8323999999998,null,"000",0,0,0,1,2,0,0,0,0,null,"R",null,"Y-CM"]
[93464,26,"See CPT",null,156.37979999999999,null,156.37979999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[93562,26,"See CPT",null,65.00433000000001,null,65.00433000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[93567,null,"See CPT",null,200.97479999999999,null,90.379199999999997,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[93590,null,"See CPT",null,1884.8820000000001,null,1884.8820000000001,null,"000",0,0,0,0,2,0,2,1,0,null,"R",null,"Y-UR"]
[93593,"TC","See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[93598,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[93600,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM"]
[93603,"TC","See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM"]
[93616,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM"]
[93619,26,"See CPT",null,677.84400000000005,null,677.84400000000005,null,"000",0,0,0,1,2,0,0,0,0,null,"R",null,"Y-CM"]
[93622,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM"]
[93640,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,2,0,0,0,0,null,"N",null,"Y-CM"]
[93641,"TC","See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM"]
[93660,null,"See CPT",null,287.78640000000001,null,287.78640000000001,null,"000",0,0,0,1,2,0,0,0,0,null,"R",null,"Y-CM"]
[93662,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[93724,26,"See CPT",null,424.5444,null,424.5444,null,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM"]
[93798,null,"See CPT",null,46.973400000000005,null,23.784000000000002,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[93882,"TC","See CPT",null,191.46120000000002,null,191.46120000000002,null,"000",0,0,0,1,6,0,0,0,0,null,"R"]
[93888,26,"See CPT",null,44.594999999999999,null,44.594999999999999,null,"000",0,0,0,1,6,0,0,0,0,null,"R"]
[93895,"TC","See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,6,0,0,0,0,null,"N"]
[93923,null,"See CPT",null,239.02919999999997,null,239.02919999999997,null,"000",0,0,0,1,6,2,0,0,0,null,"R"]
[93930,26,"See CPT",null,67.784399999999991,null,67.784399999999991,null,"000",0,0,0,1,6,2,0,0,0,null,"R"]
[93931,26,"See CPT",null,41.622,null,41.622,null,"000",0,0,0,1,6,0,0,0,0,null,"R"]
[93975,null,"See CPT",null,498.27480000000003,null,498.27480000000003,null,"000",0,0,0,1,6,0,0,0,0,null,"R"]
[93981,null,"See CPT",null,128.43360000000001,null,128.43360000000001,null,"000",0,0,0,1,6,0,0,0,0,null,"R"]
[93986,26,"See CPT",null,42.2166,null,42.2166,null,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM"]
[94004,null,"See CPT",null,84.433199999999999,null,84.433199999999999,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[94060,"TC","See CPT",null,53.514000000000003,null,53.514000000000003,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[94070,26,"See CPT",null,49.351799999999997,null,49.351799999999997,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[94452,"TC","See CPT",null,64.811400000000006,null,64.811400000000006,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[94453,"TC","See CPT",null,89.19,null,89.19,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[94621,"TC","See CPT",null,160.542,null,160.542,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[94680,"TC","See CPT",null,74.325000000000003,null,74.325000000000003,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[94726,null,"See CPT",null,99.892799999999994,null,99.892799999999994,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[94728,"TC","See CPT",null,50.540999999999997,null,50.540999999999997,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[94775,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,3,0,0,0,0,0,null,"X"]
[94781,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,1,0,0,null,"X"]
[95060,null,"See CPT",null,67.784399999999991,null,67.784399999999991,null,"000",0,0,0,3,0,0,0,0,0,null,"R"]
[95076,null,"See CPT",null,215.24520000000001,null,130.81200000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[95131,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
[95250,null,"See CPT",null,275.2998,null,275.2998,null,"000",0,0,0,3,0,0,0,0,0,null,"R",null,"Y-CM"]
[95705,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,0,0,0,0,0,null,"N",null,"Y-CM"]
[95717,null,"See CPT",null,179.5692,null,177.78540000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[95782,26,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
[95800,null,"See CPT",null,294.92160000000001,null,294.92160000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[95806,26,"See CPT",null,78.487200000000001,null,78.487200000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[95807,26,"See CPT",null,105.83880000000001,null,105.83880000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[95811,null,"See CPT",null,1169.5782000000002,null,1169.5782000000002,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
[95822,null,"See CPT",null,772.98,null,772.98,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[95824,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[95860,"TC","See CPT",null,119.51459999999999,null,119.51459999999999,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[95865,26,"See CPT",null,146.86620000000002,null,146.86620000000002,null,"000",0,0,0,1,0,2,0,0,0,null,"R"]
[95866,26,"See CPT",null,114.1632,null,114.1632,null,"000",0,0,0,1,0,3,0,0,0,null,"R"]
[95872,26,"See CPT",null,269.35380000000004,null,269.35380000000004,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[95874,26,"See CPT",null,34.486799999999995,null,34.486799999999995,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[95875,26,"See CPT",null,103.46040000000001,null,103.46040000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[95907,"TC","See CPT",null,73.730400000000003,null,73.730400000000003,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[95908,"TC","See CPT",null,90.973799999999997,null,90.973799999999997,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[95912,"TC","See CPT",null,178.97459999999998,null,178.97459999999998,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[95923,26,"See CPT",null,79.081800000000001,null,79.081800000000001,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[95925,null,"See CPT",null,342.4896,null,342.4896,null,"000",0,0,0,1,0,2,0,0,0,null,"R"]
[95929,26,"See CPT",null,140.92020000000002,null,140.92020000000002,null,"000",0,0,0,1,0,2,0,0,0,null,"R"]
[95937,null,"See CPT",null,198.0018,null,198.0018,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[95938,null,"See CPT",null,674.87099999999998,null,674.87099999999998,null,"000",0,0,0,1,0,2,0,0,0,null,"R"]
[95957,"TC","See CPT",null,297.89459999999997,null,297.89459999999997,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[95958,"TC","See CPT",null,753.95280000000002,null,753.95280000000002,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
[95966,"TC","See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM"]
[95981,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[95999,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,0,0,0,0,0,null,"N"]
[96020,"TC","See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,1,0,0,0,0,0,null,"N"]
[96130,null,"See CPT",null,211.67760000000001,null,189.67740000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[96133,null,"See CPT",null,180.16379999999998,null,137.94719999999998,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[96165,null,"See CPT",null,7.7298,null,7.1352000000000002,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[96371,null,"See CPT",null,108.81180000000001,null,108.81180000000001,null,"000",0,0,0,5,0,0,0,0,0,null,"R"]
[96376,null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
[96409,null,"See CPT",null,194.4342,null,194.4342,null,"000",0,0,0,5,0,0,0,0,0,null,"R"]
[96450,null,"See CPT",null,309.78660000000002,null,134.9742,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM"]
[96570,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,1,0,0,null,"X"]
[96921,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,0,1,0,0,null,"X"]
[96932,null,"See CPT",null,240.2184,null,240.2184,null,"000",0,0,0,3,0,0,0,0,0,null,"R"]
[97024,null,"See CPT",null,13.081200000000001,null,13.081200000000001,null,"000",0,0,0,7,5,0,0,0,0,null,"R"]
[97124,null,"See CPT",null,54.108600000000003,null,54.108600000000003,null,"000",0,0,0,7,5,0,0,0,0,null,"R",null,"Y-CM"]
[97150,null,"See CPT",null,31.513800000000003,null,31.513800000000003,null,"000",0,0,0,7,5,0,0,0,0,null,"R"]
[97157,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[97171,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[97545,null,"See CPT",null,162.43855261919998,null,162.43855261919998,null,"000",0,0,0,7,0,0,0,0,0,null,"F",null,"Y-CM"]
[97755,null,"See CPT",null,68.378999999999991,null,68.378999999999991,null,"000",0,0,0,7,5,0,0,0,0,null,"R"]
[97763,null,"See CPT",null,98.703599999999994,null,98.703599999999994,null,"000",0,0,0,7,5,0,0,0,0,null,"R"]
[98928,null,"See CPT",null,127.839,null,103.46040000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[98971,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[98980,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[99027,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[99080,null,"See CPT",null,51.11021916,null,51.11021916,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
[99151,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[99177,null,"See CPT",null,8.9190000000000005,null,8.9190000000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"R"]
[99188,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[99218,null,"See CPT",null,170.0556,null,170.0556,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[99231,null,"See CPT",null,67.189799999999991,null,67.189799999999991,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[99236,null,"See CPT",null,368.65200000000004,null,368.65200000000004,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[99245,null,"See CPT",null,386.49,null,328.2192,null,"000",0,0,0,9,9,9,9,9,9,null,"R"]
[99291,null,"See CPT",null,494.7072,null,379.35480000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[99309,null,"See CPT",null,158.75819999999999,null,158.75819999999999,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[99335,null,"See CPT",null,166.488,null,166.488,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
[99339,null,"See CPT",null,134.37959999999998,null,134.37959999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"R"]
[99359,null,"See CPT",null,"Bundled",null,"Bundled",null,"000",0,0,0,0,0,0,0,0,0,null,"Bundled"]
[99379,null,"See CPT",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
[99384,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[99394,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[99411,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[99423,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[99446,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[99449,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[99466,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[99476,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[99483,null,"See CPT",null,500.05860000000001,null,344.27339999999998,null,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-ONC"]
[99491,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
[99503,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
[99511,null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0003A",null,"See CPT",null,41.2,null,41.2,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["0006U",null,"See CPT",null,370.85847169919998,null,370.85847169919998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["0015F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["0021A",null,"See CPT",null,41.2,null,41.2,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["0031A",null,"See CPT",null,41.2,null,41.2,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["0071A",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["0083U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0091U",null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["0099U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0101T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["0111U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0120U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0129U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0132U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0144U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0151U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0160U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0163T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["0207U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0212U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0217T",null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,0,1,0,0,0,null,"N",null,"Y-UR"]
["0218U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0226U",null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["0232U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0238U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0241U",null,"See CPT",null,203.96089999999998,null,203.96089999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
["0285U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0294U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0302R",null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["0303U",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0330T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0342T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0362T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0385R",null,"Pre-job accommodation",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["0401A",null,"Claimant - private transportation, per mile",null,"State Rate",null,"State Rate",null,"000",0,0,0,9,9,9,9,9,9,null,"S"]
["0408A",null,"Claimant - lunch",null,"State Rate",null," State Rate",null,"000",0,0,0,9,9,9,9,9,9,null,"S"]
["0413A",null,"Claimant - miscellaneous travel (must specify)",null,"State Rate",null," State Rate",null,"000",0,0,0,9,9,9,9,9,9,null,"S"]
["0414T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["0425T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["0431T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["0441T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["0448T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,0,1,0,0,null,"X"]
["0478T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0488T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["0497T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,3,9,9,9,9,9,null,"X"]
["0500F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["0503T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,3,0,0,0,0,0,null,"X"]
["0514T",null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,0,0,1,0,0,null,"N",null,"Y-CM"]
["0520T",null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,2,0,1,0,0,null,"N",null,"Y-CM"]
["0525T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,0,1,0,0,null,"X"]
["0534T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,9,9,9,9,9,null,"X"]
["0541T",null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,3,9,9,9,9,9,null,"N",null,"Y-CM"]
["0551F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["0554T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["0558T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["0568T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["0578T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["0582T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["0592T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["0627T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,2,0,0,0,null,"X"]
["0636T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,3,0,0,0,null,"X"]
["0639T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["0677T",null,"See CPT",null,"By Report",null,"By Report",null,"000",0,0,0,0,2,0,1,0,0,null,"N"]
["0689T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,4,0,0,0,0,null,"X"]
["0700T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
["0707T",null,"See CPT",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,2,1,1,0,0,null,"X"]
["0809V",null,"Stand alone job analysis ref intern",null,8.6860330127999994,null,8.6860330127999994,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["0831V",null,"Plan development services-intern",null,8.6860330127999994,null,8.6860330127999994,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["0892V",null,"Travel/wait time - intern",null,5.1056134272000007,null,5.1056134272000007,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["0895V",null,"Air travel, vrc, intern, or forensic vrc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["1003F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["1022F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["1036F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["1044M",null,"Pt in remote areas",null,50.536919347200005,null,50.536919347200005,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["1065M",null,"Attending doctor ime review written repo",null,33.337924963200003,null,33.337924963200003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["1071F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["1085M",null,"Best Practice Complex Claim",null,"Contracted",null,"Contracted",null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["1089M",null,"HEALTH SERVICES COORDINATOR-Top Tier",null,9.68,null,9.68,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["1104M",null,"Ime-addendum report",null,133.21,null,133.21,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["1122M",null,"Ime pain management impairment rating",null,579.76836540479997,null,579.76836540479997,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["1125M",null,"Ime-phys travel per mile, round trip exc",null,5.7,null,5.7,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["1137F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["1151M",null,"Omd requested consultation",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["1158F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["1181F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["1190M",null,"Comprehensive hearing loss exam",null,700.56,null,700.56,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["1205F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["1230M",null,"Ur contract:  retrospective outpatient review",null,"Contracted",null,"Contracted",null,"000",0,0,0,9,9,9,9,9,9,null,"C"]
["1249M",null,"UR, advanced imaging re-review & alternate criteria review",null,"Contracted",null,"Contracted",null,"000",0,0,0,9,9,9,9,9,9,null,"C"]
["1287M",null,"Catastrophic case mgmt travel/wait time per 6 minute unit",null,"Contracted",null,"Contracted",null,"000",0,0,0,9,9,9,9,9,9,null,"C"]
["1450F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["1501F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["1728M",null,"PGAP Coach Travel Time",null,8.2641708864000005,null,8.26,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["2001F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["2014M",null,"Pain clinic follow-up services: face-to face/hr",null,1.7307164160000001,null,1.7307164160000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["2026F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["2033F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["2133A",null,"Naturopathic follow up visit, routine incl eval & treatment",null,79.969915396800005,null,79.969915396800005,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["3021F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3040F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3055F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3073F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3077F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3092F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3111F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3142F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3250F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3272F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3288F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3301F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3317F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3340F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3350F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3384F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3472F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3494F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3498F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3552F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3572F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["3758F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4003F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4014F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4030F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4048F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4052F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4070F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4077F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4131F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4148F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4159F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4171F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4186F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4190F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4242F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4250F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4290F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4320F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4481F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4550F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["4562F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["5010F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["6005F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["6020F",null,"See CPT",null,"Tracking",null,"Tracking",null,"000",0,0,0,9,9,9,9,9,9,null,"T"]
["8883H",null,"Nursing facility rehab - medium (per day",null,643.30999999999995,null,643.30999999999995,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["8889H",null,"Nursing facility behavior only (per day)",null,356.11,null,356.11,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["8915H",null,"Vehicle modification",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["8970H",null,"Home health aid svscs up to 2 hrs",null,65.33454470400001,null,65.33454470400001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["9918M",null,"Electronic Provider Communication",null,50.807015999999997,null,48.138492000000006,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["9974M",null,"INTERPRETER SYSTEM PER MINUTE",null,1.0302,null,1.0302,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A0110",null,"Nonemergency transport bus",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["A0140",null,"Nonemergency transport air",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["A0420",null,"Ambulance waiting 1/2 hr",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A0428",null,"Bls",null,406.71690720330383,null,406.71690720330383,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A0436",null,"Rotary wing air mileage",null,85.869691848832332,null,85.869691848832332,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A2004",null,"Xcellistem, per sq cm",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["A4207",null,"2 cc sterile syringe&needle",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A4211",null,"Supp for self-adm injections",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A4230",null,"Infus insulin pump non needl",null,14.7906,null,14.7906,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A4233",null,"Alkalin batt for glucose mon",null,4.4820000000000002,null,4.4820000000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A4258",null,"Lancet device each",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A4265",null,"Paraffin",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,"Y-CM"]
["A4282",null,"Replacement breastpump adpt",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["A4301",null,"Implantable access syst perc",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A4322",null,"Irrigation syringe",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A4330",null,"Stool collection pouch",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A4352",null,"Coude tip urinary catheter",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A4355",null,"Bladder irrigation tubing",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A4375",null,"Drainable plastic pch w fcpl",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A4381",null,"Urinary plastic pouch w/o fp",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A4390",null,"Drainable pch ex wear convex",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A4398",null,"Ostomy irrigation bag",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A4412",null,"Ost pouch drain high output",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A4416",null,"Ost pch clsd w barrier/filtr",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A4430",null,"Ost urine pch w b/bltin conv",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A4433",null,"Urine ost pch bar w lock fln",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A4481",null,"Tracheostoma filter",null,0.46350000000000002,null,0.46350000000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A4520",null,"Incontinence garment anytype",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A4565",null,"Slings",null,9.7026000000000003,null,9.7026000000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A4575",null,"Hyperbaric o2 chamber disps",null,756.46199999999999,null,756.46199999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A4612",null,"Battery cables",null,232.36263081600001,null,232.36263081600001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A4616",null,"Tubing (oxygen) per foot",null,7.2100000000000011E-2,null,7.2100000000000011E-2,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A4634",null,"Replacement bulb th lightbox",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["A4637",null,"Repl tip cane/crutch/walker",null,3.0766694927999998,null,3.0766694927999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A4671",null,"Disposable cycler set",null,82.966799999999992,null,82.966799999999992,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A4706",null,"Bicarbonate conc sol per gal",null,54.904499999999999,null,54.904499999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A4726",null,"Dialys sol fld vol > 5999cc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["A4736",null,"Topical anesthetic, per gram",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["A4774",null,"Ammonia test strips",null,29.282399999999999,null,29.282399999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A4890",null,"Repair/maint cont hemo equip",null,585.64800000000002,null,585.64800000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["A5055",null,"Stoma cap",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A5072",null,"Urinary pouch w/o barrier",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A5121",null,"Solid skin barrier 6x6",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A5501",null,"Diabetic custom molded shoe",null,240.32990000000001,null,240.32990000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["A6010",null,"Collagen based wound filler",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A6022",null,"Collagen drsg>16<=48 sq in",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A6206",null,"Contact layer <= 16 sq in",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A6210",null,"Foam drg >16<=48 sq in w/o b",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A6224",null,"Gauze > 48 in no w/sal w/o b",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A6234",null,"Hydrocolld drg <=16 w/o bdr",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A6246",null,"Hydrogel drg >16<=48 in w/b",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A6253",null,"Absorpt drg > 48 sq in w/o b",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A6403",null,"Sterile gauze>16 <= 48 sq in",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A6410",null,"Sterile eye pad",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A6449",null,"Lt compres band >=3\" <5\"/yd",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A6453",null,"Self-adher band w <3\"/yd",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["A6508",null,"Cmprs burngarment foot-thigh",null,380.67119999999994,null,380.67119999999994,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A6531",null,"Compression stocking bk30-40",null,48.978299999999997,null,48.978299999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A6545",null,"Grad comp non-elastic bk",null,113.97559999999999,null,113.97559999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A7003",null,"Nebulizer administration set",null,4.1499999999999995,null,4.1499999999999995,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A7016",null,"Nebulizer dome & mouthpiece",null,14.6412,null,14.6412,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A7020",null,"Interface, cough stim device",null,34.527999999999999,null,34.527999999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A7031",null,"Replacement facemask interfa",null,78.825099999999992,null,78.825099999999992,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A7040",null,"One way chest drain valve",null,49.738700000000001,null,49.738700000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A7508",null,"Housing & integrated adhesiv",null,3.6153,null,3.6153,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A7525",null,"Tracheostomy mask",null,2.5956000000000001,null,2.5956000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["A9180",null,"Lice treatment, topical",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["A9276",null,"Disposable sensor, cgm sys",null,16.824099999999998,null,16.824099999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["A9300",null,"Exercise equipment",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["A9502",null,"Tc99m tetrofosmin",null,"By report",null,"By report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["A9510",null,"Tc99m disofenin",null,"By report",null,"By report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-PHL"]
["A9526",null,"Nitrogen n-13 ammonia",null,719.21989999999994,null,719.21989999999994,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["A9543",null,"Y90 ibritumomab, rx",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["A9553",null,"Cr51 chromate",null,"By report",null,"By report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["A9566",null,"Tc99m fanolesomab",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["A9572",null,"Indium in-111 pentetreotide",null,"By report",null,"By report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["A9585",null,"Gadobutrol injection",null,0.32200000000000001,null,0.32200000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["A9588",null,"Fluciclovine f-18",null,757.08449999999993,null,757.08449999999993,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["A9595",null,"Piflu f-18, dia 1 millicurie",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["A9700",null,"Echocardiography contrast",null,300.19439999999997,null,300.19439999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["B4100",null,"Food thickener oral",null,1.6267999999999998,null,1.6267999999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["B4152",null,"Ef calorie dense>/=1.5kcal",null,0.51500000000000001,null,0.51500000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["B4172",null,"Parenteral sol amino acid 5.",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-PHL"]
["B4189",null,"Parenteral sol amino acid &",null,232.60490000000001,null,232.60490000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["B9002","RR","Enter nutr inf pump any type",null,106.66680000000001,null,106.66680000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["B9006","NU","Parenteral infus pump statio",null,3301.7062000000001,null,3301.7062000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["C1714",null,"Cath, trans atherectomy, dir",null,"Facility Only",null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C1726",null,"Cath, bal dil, non-vascular",null,"Facility Only",null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C1753",null,"Cath, intravas ultrasound",null,"Facility Only",null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C1760",null,"Closure dev, vasc",null,"Facility Only",null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C1772",null,"Infusion pump, programmable",null,"Facility Only",null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C1780",null,"Lens, intraocular (new tech)",null,"Facility Only",null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C1815",null,"Pros, urinary sph, imp",null,"Facility Only",null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C1818",null,"Integrated keratoprosthesis",null,"Facility Only",null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C1825",null,"Gen, neuro, carot sinus baro",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["C1874",null,"Stent, coated/cov w/del sys",null,"Facility Only",null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C1884",null,"Embolization protect syst",null,"Facility Only",null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C1897",null,"Lead, neurostim test kit",null,"Facility Only",null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C2619",null,"Pmkr, dual, non rate-resp",null,"Facility Only",null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C2625",null,"Stent, non-cor, tem w/del sy",null,"Facility Only",null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C2639",null,"Brachytx, non-stranded,i-125",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["C2642",null,"Brachytx, stranded, c-131",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["C5272",null,"Low cost skin substitute app",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["C8902",null,"Mra w/o fol w/cont, abd",null,"Facility Only",null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C8913",null,"Mra w/o cont, lwr ext",null,"Facility Only",null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C8928",null,"Tte w or w/o fol w/con,stres",null,"Facility Only",null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C9041",null,"Inj, coagulation factor xa",null,"Facility Only",null,346.69800000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C9056",null,"Injection, givosiran",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["C9089",null,"Bupivacaine implant, 1 mg",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["C9093",null,"Inj., xipere, 1 mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["C9257",null,"Bevacizumab injection",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["C9358",null,"Surgimend, fetal",null,"Facility Only",null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["C9459",null,"Flutemetamol f18",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["C9602",null,"Perc d-e cor stent ather s",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["C9734",null,"U/s trtmt, not leiomyomata",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["C9755",null,"Rf magnetic-guide av fistula",null,"Facility Only",null,10158.293424000001,null,"000",0,0,0,9,9,9,9,9,9,null,"O",null,"Y-ONC"]
["C9767",null,"Revasc lithotrip-stent-ather",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-UR"]
["C9774",null,"Revasc lithotr-ather tib/per",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["C9777",null,"Esophag mucosal integ add-on",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-ONC"]
["C9899",null,"Inpt implant pros dev,no cov",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["D0190",null,"Screening of a patient",null,102.176,null,102.176,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["D0277",null,"Vert bitewings 7 to 8 images",null,114.536,null,114.536,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["D0367",null,"Cone beam ct interp both jaw",null,384.80800000000005,null,384.80800000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["D0381",null,"Cone beam ct capt mandible",null,400.464,null,400.464,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["D0414",null,"Lab process microbial spec",null,240.608,null,240.608,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D0423",null,"Genetic test spec analysis",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["D0460",null,"Pulp vitality test",null,66.744,null,66.744,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["D0479",null,"Tissue in-situ hybridization",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["D0600",null,"Non-ionizing diag proc",null,84.048000000000002,null,84.048000000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["D0706",null,"Intraoral occlus radio image",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["D1206",null,"Topical fluoride varnish",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["D1510",null,"Space maintainer fxd unilat",null,361.73600000000005,null,361.73600000000005,null,"000",0,0,0,0,0,0,0,0,0,null,"F"]
["D1575",null,"Dist space maint, fixed unil",null,427.65600000000001,null,427.65600000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D1707",null,"Janssen Covid-19 vaccine administration",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["D2150",null,"Amalgam two surfaces permane",null,217.53600000000003,null,217.53600000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["D2410",null,"Dental gold foil one surface",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["D2543",null,"Dental onlay metallic 3 surf",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["D2662",null,"Dental onlay resin 2 surface",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["D2722",null,"Crown resin w/ noble metal",null,1163.4880000000003,null,1163.4880000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D2792",null,"Crown full cast noble metal",null,1263.1920000000002,null,1263.1920000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D2930",null,"Prefab stnlss steel crwn pri",null,317.24,null,317.24,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["D2951",null,"Tooth pin retention",null,93.936000000000007,null,93.936000000000007,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["D2954",null,"Prefab post/core + crown",null,386.45600000000007,null,386.45600000000007,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D2990",null,"Resin infiltration of lesion",null,215.88800000000003,null,215.88800000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D3230",null,"Pulpal therapy anterior prim",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["D3351",null,"Apexification/recalc initial",null,434.24800000000005,null,434.24800000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["D3421",null,"Root surgery premolar",null,979.7360000000001,null,979.7360000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["D3472",null,"Surg rep root res premolar",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-ONC"]
["D3950",null,"Canal prep/fitting of dowel",null,323.83199999999999,null,323.83199999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["D4245",null,"Apically positioned flap",null,1004.456,null,1004.456,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D4261",null,"Osseous surg 1 to 3 teeth",null,1081.912,null,1081.912,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D4322",null,"Splint intra-coronal",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["D4342",null,"Periodontal scaling 1-3teeth",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["D5140",null,"Dentures immediat mandible",null,2221.5040000000004,null,2221.5040000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D5223",null,"Immed max part dent metal",null,2068.2400000000002,null,2068.2400000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["D5421",null,"Dentures adjust part maxill",null,111.24000000000001,null,111.24000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D5630",null,"Rep partial denture clasp",null,312.29599999999999,null,312.29599999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D5721",null,"Dentures rebase part mandbl",null,666.6160000000001,null,666.6160000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D5731",null,"Denture reln cmplt mand chr",null,443.31200000000007,null,443.31200000000007,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D5864",null,"Overdenture partial max",null,2657.4,null,2657.4,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D5867",null,"Replacement of precision att",null,461.44,null,461.44,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D5922",null,"Nasal septal prosthesis",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["D5929",null,"Facial replacement",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["D5955",null,"Palatal lift prosthesis",null,5065.1471139984005,null,5065.1471139984005,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D5987",null,"Commissure splint",null,1305.2160000000001,null,1305.2160000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"F",null,"Y-CM"]
["D6011",null,"Second stage implant surgery",null,824.82400000000007,null,824.82400000000007,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D6040",null,"Odontics eposteal implant",null,8379.2560000000012,null,8379.2560000000012,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D6068",null,"Abutment supported retainer",null,1596.0880000000002,null,1596.0880000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D6071",null,"Abutment supported retainer",null,1577.1360000000002,null,1577.1360000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D6085",null,"Provisional implant crown",null,640.24800000000005,null,640.24800000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D6093",null,"Recement supp part denture",null,227.42400000000001,null,227.42400000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["D6110",null,"Implnt/abut remov dent max",null,3719.5360000000005,null,3719.5360000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["D6119",null,"Int/abut int fixed dent max",null,4454.5439999999999,null,4454.5439999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D6195",null,"Abut retain porc to titanium",null,1759.24,null,1759.24,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-ONC"]
["D6205",null,"Pontic-indirect resin based",null,1157.72,null,1157.72,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D6549",null,"Resin retainer",null,1070.376,null,1070.376,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["D6602",null,"Cst hgh nble mtl inlay 2 srf",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["D6613",null,"Onlay cst base mtl >=3 surfa",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["D6721",null,"Crown resin w/base metal",null,1219.52,null,1219.52,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D6790",null,"Crown full high noble metal",null,1329.9360000000001,null,1329.9360000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D6980",null,"Fixed partial repair",null,469.68,null,469.68,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D7241",null,"Impact tooth rem bony w/comp",null,672.38400000000013,null,672.38400000000013,null,"000",0,0,0,0,0,0,0,0,0,null,"F"]
["D7260",null,"Oral antral fistula closure",null,1557.3600000000001,null,1557.3600000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"F"]
["D7295",null,"Bone harvest,auto graft proc",null,1200.5680000000002,null,1200.5680000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D7298",null,"Remove screw retained plate",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["D7440",null,"Malig tumor exc to 1.25 cm",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["D7451",null,"Rem odontogen cyst > 1.25 cm",null,1122.2880000000002,null,1122.2880000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D7521",null,"Incision/drain abscess extra",null,775.38400000000013,null,775.38400000000013,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D7650",null,"Open red simp malar/zygom fx",null,4101.0480000000007,null,4101.0480000000007,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D7750",null,"Open red comp malar/zygma fx",null,4641.5920000000006,null,4641.5920000000006,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D7771",null,"Alveolus clsd reduc stblz te",null,2264.3520000000003,null,2264.3520000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D7873",null,"Tmj arthroscopy lysis adhesn",null,5032.1680000000006,null,5032.1680000000006,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D7876",null,"Tmj arthroscopy discectomy",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["D7945",null,"Bone cutting body mandible",null,8091.68,null,8091.68,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D7948",null,"Reconstruct midface no graft",null,12777.768,null,12777.768,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D7972",null,"Surg redct fibrous tuberosit",null,844.6,null,844.6,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D7994",null,"Surg place zygomatic impl",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-ONC"]
["D8040",null,"Limited dental tx adult",null,4065.6160000000004,null,4065.6160000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D8090",null,"Compre dental tx adult",null,5540.576,null,5540.576,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["D8999",null,"Orthodontic procedure",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["D9130",null,"Temporomandibular joint dysf",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["D9420",null,"Hospital/asc call",null,372.44800000000004,null,372.44800000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["D9450",null,"Case presentation tx plan",null,192.81600000000003,null,192.81600000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["D9934",null,"Clean rem part denture max",null,91.464000000000013,null,91.464000000000013,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["D9948",null,"Adjust sleep apnea appliance",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["D9973",null,"Extrnl bleaching per tooth",null,280.16000000000003,null,280.16000000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["D9991",null,"Case mgmt, appt barriers",null,101.352,null,101.352,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["E0112","NU","Crutch underarm pair wood",null,46.638400000000004,null,46.638400000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0116","NU","Crutch underarm each no wood",null,30.003899999999998,null,30.003899999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0147","NU","Walker variable wheel resist",null,553.51170000000002,null,553.51170000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0148","RR","Heavyduty walker no wheels",null,11.803800000000001,null,11.803800000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0157","RR","Walker crutch attachment",null,7.5190000000000001,null,7.5190000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0165","NU","Commode chair with detacharm",null,266.22249999999997,null,266.22249999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0181","RR","Press pad alternating w/ pum",null,25.616100000000003,null,25.616100000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0186","NU","Air pressure mattress",null,238.548,null,238.548,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0197","NU","Air pressure pad for mattres",null,299.93600000000004,null,299.93600000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0198","RR","Water pressure pad for mattr",null,23.731200000000001,null,23.731200000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0232","RR","Warming card for nwt",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["E0239",null,"Hydrocollator unit portable",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["E0246","NU","Transfer tub rail attachment",null,129.79291422240001,null,129.79291422240001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0261","NU","Hosp bed semi-electr w/o mat",null,1106.117,null,1106.117,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["E0271","RR","Mattress innerspring",null,19.374299999999998,null,19.374299999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0277","RR","Powered pres-redu air mattrs",null,496.01710000000003,null,496.01710000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["E0294","RR","Hosp bed semi-elect w/ mattr",null,107.21270000000001,null,107.21270000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["E0296","NU","Hosp bed total elect w/ matt",null,1513.6880000000001,null,1513.6880000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["E0310","NU","Rails bed side full length",null,171.62889999999999,null,171.62889999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0315","RR","Bed accessory brd/tbl/supprt",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["E0350","NU","Control unit bowel system",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["E0433","RR","Portable liquid oxygen sys",null,49.841700000000003,null,49.841700000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0445","RR","Oximeter non-invasive",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-PHL"]
["E0459","NU","Chest wrap",null,266.22249999999997,null,266.22249999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["E0471","RR","Rad w/backup non inv intrfc",null,509.33500000000004,null,509.33500000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["E0480","NU","Percussor elect/pneum home m",null,553.83100000000002,null,553.83100000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0560","NU","Humidifier supplemental w/ i",null,186.27549999999999,null,186.27549999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0562","NU","Humidifier heated used w pap",null,246.15970000000002,null,246.15970000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0574","RR","Ultrasonic generator w svneb",null,50.727499999999999,null,50.727499999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0606","RR","Drainage board postural",null,28.9224,null,28.9224,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["E0618",null,"Apnea monitor",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["E0625","RR","Patient lift bathroom or toi",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["E0638","NU","Standing frame sys",null,4778.1605999999992,null,4778.1605999999992,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0639","RR","Moveable patient lift system",null,135.00209999999998,null,135.00209999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0656","NU","Segmental pneumatic trunk",null,728.21,null,728.21,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0657","RR","Segmental pneumatic chest",null,68.402299999999997,null,68.402299999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0667","NU","Seg pneumatic appl full leg",null,407.99330000000003,null,407.99330000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0675","NU","Pneumatic compression device",null,4845.7380000000003,null,4845.7380000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["E0705","RR","Transfer device",null,6.2624000000000004,null,6.2624000000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0745","RR","Neuromuscular stim for shock",null,112.8056,null,112.8056,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["E0761","RR","Nontherm electromgntc device",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["E0764","RR","Functional neuromuscularstim",null,1394.5479,null,1394.5479,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["E0783","RR","Programmable infusion pump",null,1031.6789000000001,null,1031.6789000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["E0785","NU","Replacement impl pump cathet",null,574.68438593280007,null,574.68438593280007,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["E0830","RR","Ambulatory traction device",null,55.718251617600018,null,55.718251617600018,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0880","NU","Trac stand free stand extrem",null,158.1977,null,158.1977,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0911","RR","Hd trapeze bar attach to bed",null,51.973800000000004,null,51.973800000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0935","RR","Cont pas motion exercise dev",null,28.664899999999999,null,28.664899999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["E0950","RR","Tray",null,10.094000000000001,null,10.094000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0953","NU","W/c lateral thigh/knee sup",null,98.0869,null,98.0869,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0960","RR","W/c shoulder harness/straps",null,9.1773000000000007,null,9.1773000000000007,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0966","NU","Wheelchair head rest extensi",null,86.303700000000006,null,86.303700000000006,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0969","RR","Wheelchair narrowing device",null,19.539099999999998,null,19.539099999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0981","RR","Seat upholstery, replacement",null,4.8616000000000001,null,4.8616000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E0983","RR","Add pwr joystick",null,314.95339999999999,null,314.95339999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["E0994","NU","Wheelchair arm rest",null,22.217100000000002,null,22.217100000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E1006","NU","Pwr seat combo w/o shear",null,6989.683,null,6989.683,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["E1007","RR","Pwr seat combo w/shear",null,907.17250000000001,null,907.17250000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["E1020","RR","Residual limb support system",null,23.6797,null,23.6797,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E1029","NU","W/c vent tray fixed",null,401.18500000000006,null,401.18500000000006,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E1036","RR","Patient transfer system >300",null,1042.0716,null,1042.0716,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E1084","NU","Hemi-wheelchair detachable a",null,1236.2059999999999,null,1236.2059999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["E1086","NU","Hemi-wheelchair detachable a",null,2071.2152000000001,null,2071.2152000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["E1093","NU","Wheelchair wide w/ foot rest",null,1392.7660000000001,null,1392.7660000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["E1160","NU","Wheelchair fixed arms",null,787.74400000000003,null,787.74400000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["E1161","RR","Manual adult wc w tiltinspac",null,298.15410000000003,null,298.15410000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["E1220","NU","Whlchr special size/constrc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-PHL"]
["E1224","NU","Wheelchair spec size w/ leg",null,1022.5840000000001,null,1022.5840000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["E1225","RR","Manual semi-reclining back",null,50.47,null,50.47,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["E1236",null,"Folding ped wc adjustable",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["E1240","NU","Whchr litwt det arm leg rest",null,1298.3150000000001,null,1298.3150000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["E1290","NU","Wheelchair hvy duty detach a",null,822.09839999999997,null,822.09839999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["E1352","RR","O2 flow reg pos inspir press",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["E1355","RR","Oxygen supplies stand/rack",null,26.0869,null,26.0869,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["E1520","RR","Heparin infusion pump",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["E1580","RR","Unipuncture control system",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["E1594","RR","Cycler dialysis machine",null,844.7989,null,844.7989,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E1699","NU","Dialysis equipment noc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-PHL"]
["E1702","NU","Repl measr scales jaw motion",null,27.442672171200002,null,27.442672171200002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E1820","NU","Soft interface material",null,97.170200000000008,null,97.170200000000008,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2120",null,"Pulse gen sys tx endolymp fl",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["E2202","NU","Seat width 24-27 in",null,558.71320000000003,null,558.71320000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2209","RR","Arm trough each",null,10.6708,null,10.6708,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2216","NU","Foam filled propulsion tire",null,56.279200000000003,null,56.279200000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2219","NU","Foam caster tire any size ea",null,49.8005,null,49.8005,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2231","RR","Solid seat support base",null,17.726300000000002,null,17.726300000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2294",null,"Contour seat for ped size wc",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["E2313","NU","Pwc harness, expand control",null,403.76000000000005,null,403.76000000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2323","RR","Special joystick handle",null,7.4366000000000003,null,7.4366000000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2327","NU","Head control interface mech",null,2829.6160000000004,null,2829.6160000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2343","NU","W/c dpth 22-25 in seat frame",null,903.25850000000003,null,903.25850000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2360","RR","22nf nonsealed leadacid",null,12.154000000000002,null,12.154000000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2362","RR","Gr24 nonsealed leadacid",null,11.6493,null,11.6493,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2368","NU","Pwr wc drivewheel motor repl",null,517.57500000000005,null,517.57500000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2375","NU","Non-expandable controller",null,856.75400000000013,null,856.75400000000013,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2378","NU","Pw actuator replacement",null,759.8309999999999,null,759.8309999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2384","NU","Pneumatic caster tire",null,79.546900000000008,null,79.546900000000008,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2390","NU","Solid drive wheel tire",null,45.546599999999998,null,45.546599999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2394","NU","Drive wheel excludes tire",null,75.426900000000003,null,75.426900000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2500","RR","Sgd digitized pre-rec <=8min",null,49.285500000000006,null,49.285500000000006,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2504","NU","Sgd prerec msg>20min <=40min",null,1987.7661000000001,null,1987.7661000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2603","NU","Skin protect wc cus wd <22in",null,142.0164,null,142.0164,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2611","NU","Gen use back cush wdth <22in",null,260.40460000000002,null,260.40460000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["E2617","NU","Custom fab w/c back cushion",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["E2625","NU","Adj skin pro/pos wc cus>=22",null,441.56099999999998,null,441.56099999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["G0008",null,"Admin influenza virus vac",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["G0030",null,"Pt scr tob & cess int",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G0042",null,"Ref to therapy",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G0045",null,"Mrs 90 days post stk",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G0061",null,"Anesthesiology ss",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G0069",null,"Adm of immune drug in home",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G0079",null,"Care manag h vst new pt 60 m",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["G0086",null,"Care man home care plan 30 m",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["G0106","TC","Colon ca screen;barium enema",null,316.92180000000002,null,316.92180000000002,null,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM"]
["G0120",null,"Colon ca scrn; barium enema",null,424.5444,null,424.5444,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
["G0129",null,"Partial hosp prog service",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G0130",26,"Single energy x-ray study",null,19.6218,null,19.6218,null,"000",0,0,0,1,0,0,0,0,0,null,"R"]
["G0162",null,"Hhc rn e&m plan svs, 15 min",null,45.452939875200016,null,45.452939875200016,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-ONC"]
["G0181",null,"Home health care supervision",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["G0204",null,"Dx mammo incl cad bi",null,342.74675223360009,null,342.74675223360009,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["G0219",26,"Pet img wholbod melano nonco",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,9,9,9,9,9,null,"X"]
["G0249",null,"Provide inr test mater/equip",null,88.000799999999998,null,88.000799999999998,null,"000",0,0,0,3,0,0,0,0,0,null,"R"]
["G0255",26,"Current percep threshold tst",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,9,9,9,9,9,null,"X"]
["G0279",null,"Tomosynthesis, mammo",null,95.73060000000001,null,95.73060000000001,null,"000",0,0,0,1,0,2,9,0,0,null,"R"]
["G0281",null,"Elec stim unattend for press",null,22.0002,null,22.0002,null,"000",0,0,0,7,5,0,0,0,0,null,"R",null,"Y-CM"]
["G0327",null,"Colon ca scrn;bld-bsd biomrk",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G0342",null,"Laparoscopy islet cell trans",null,"Not Covered",null,"Not Covered",null,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"X"]
["G0380",null,"Lev 1 hosp type b ed visit",null,"Facility Only",null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["G0397",null,"Alcohol/subs interv >30 min",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["G0410",null,"Grp psych partial hosp 45-50",null,"Facility Only",null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["G0416",null,"Prostate biopsy, any mthd",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
["G0432",null,"Eia hiv-1/hiv-2 screen",null,27.985099999999999,null,27.985099999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
["G0436",null,"Tobacco-use counsel 3-10 min",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G0458",null,"Ldr prostate brachy comp rat",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G0468",null,"Fqhc visit, ippe or awv",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G0475",null,"Hiv combination assay",null,34.434399999999997,null,34.434399999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
["G0492",null,"Md/oth eval acut kid no esrd",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G0507",null,"Care manage serv minimum 20",null,93.977901388800007,null,62.879090788800013,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["G0514",null,"Prolong prev svcs, addl 30m",null,114.7578,null,107.62260000000001,null,"000",0,0,0,0,0,0,0,0,0,null,"R"]
["G1003",null,"Cdsm medicalis",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G1008",null,"Cdsm cranberry pk",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G1024",null,"Cdsm radrite",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G2004",null,"Post-d/c h vst new pt 60 m",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["G2014",null,"Post-d/c care plan overs 30m",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["G2021",null,"Hea care pract tx in place",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G2074",null,"Med assist tx no drug",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G2080",null,"Add 30 mins counsel",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G2095",null,"Sys rsn no ace arn arni",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G2098",null,"Pt 66+ frailty and med dem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G2122",null,"Psy/dep/anx/apandicd noasse",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G2138",null,"Bk pain vas 9-15mo = 3",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G2148",null,"Mpm used",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G2151",null,"Dx degen neuro",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G2177",null,"Bronch w rx antibx 30d",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G2183",null,"Doc pt unable comm",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G2195",null,"Occip hdache child",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G2202",null,"No rsn no brief couns",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G2214",null,"Init/sub psych care m 1st 30",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["G4002",null,"Ep cardio ss",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G4012",null,"Interventional rad ss",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G4015",null,"Neurology ss",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G4027",null,"Plastic surgery ss",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G4033",null,"Skilled nursing facility ss",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G6003",null,"Radiation treatment delivery",null,273.51599999999996,null,273.51599999999996,null,"000",0,0,0,3,0,0,0,0,0,null,"R",null,"Y-CM"]
["G6010",null,"Radiation treatment delivery",null,335.94900000000001,null,335.94900000000001,null,"000",0,0,0,3,0,0,0,0,0,null,"R",null,"Y-CM"]
["G8397",null,"Dil macula/fundus exam/w doc",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8417",null,"Calc bmi abv up param f/u",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8433",null,"Scr for dep not cpt doc rsn",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8452",null,"Pt w/abn lvef b-bloc no rx",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8510",null,"Scr dep neg, no plan reqd",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8541",null,"No doc cur funct assess",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8568",null,"Pt no ref otolo no spec",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8598",null,"Asa/antiplat ther used",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8654",null,"Rafs crs hi no scor no surv",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8663",null,"Rafscrs si scor >= 0",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8709",null,"Pt presc doc med rsn id uri",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8712",null,"Not pres antibiotic",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8735",null,"Eld mal scrn pos no plan",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8806",null,"Perf ultrsnd to lct preg doc",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8839",null,"Sleep apnea assess",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8846",null,"Mod or severe osa",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8865",null,"Doc med reas no pneumococcal",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8880",null,"Sen lym p node biop not perf",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8911",null,"Pt doc no fall in asc",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8914",null,"Pt trans to hosp post d/c",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8934",null,"Lvef <40% or dep lv sys fcn",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G8956",null,"Pt rcv hedia outpt dyls fac",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9001",null,"Mccd, initial rate",null,"Contracted",null,"Contracted",null,"000",0,0,0,9,9,9,9,9,9,null,"C"]
["G9008",null,"Mccd,phys coor-care ovrsght",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["G9054",null,"Onc supervision palliative",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9062",null,"Onc prac guide differs nos",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9072",null,"Onc dx brst stg1-2 noprogres",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9075",null,"Onc dx brst metastic/ recur",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9085",null,"Onc dx colon t4, n0 w/o prog",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9096",null,"Onc dx esophag t1-t3 noprog",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9108",null,"Onc dx pancreatic unknwn nos",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9115",null,"Onc dx ovarian stg3/4 noprog",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9133",null,"Onc dx prostate clinical met",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9143",null,"Warfarin respon genetic test",null,172.62959999999998,null,172.62959999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
["G9196",null,"Med reason for no ceph",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9212",null,"Doc of dsm-iv init eval",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9229",null,"Ptrsn no gc chl syp test",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9273",null,"Sys<140 and dia<90",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9285",null,"Site not small cell lung ca",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9292",null,"Medrsn no pt category",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9309",null,"No unplnd hosp readm in 30d",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9317",null,"No doc comm risk calc",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9351",null,"Doc >1 sinus ct w 90d dx",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9354",null,"1 or no ct sinus w/in 90d dx",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9361",null,"Doc rsn elect c-sec/induct",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9394",null,"Dx bipol, death, nhres, hosp",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9406",null,"Doc reas no 7d f/u",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9418",null,"Lungcx bx rpt docs class",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9430",null,"Spec site no cutaneous",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9455",null,"Abd imag w/us, ct or mri",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9474",null,"Diet counsel at hospice",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9477",null,"Care coord at hospice",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9501",null,"Rad expos ind/exp tm no doc",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9513",null,"Indiv pdc not > 0.8",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9520",null,"Refract not +/- 1.0 w/in 90d",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9543",null,"Doc 2x re-assess filt remov",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9557",null,"Ct/cta/mri/a no thyr <1.0cm",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9598",null,"Aor ane 5.5-5.9 cm max diam",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9611",null,"No doc order anti-plat rng",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9614",null,"Photodoc < 2 cec lndmk",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9625",null,"Pt bl srg 30 day pst srg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9642",null,"Current smoker",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9651",null,"Psor as doc no spc bm",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9668",null,"DOC MED RSN NO STAT TX/PRESC",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9695",null,"Long act inhal bronchdil pre",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9704",null,"Ajcc br ca stg i: t1 mic/t1a",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9714",null,"Pt is w/hosp during msmt per",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9721",null,"Pt not ambul/immob/wc",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9724",null,"Pt w/doc use anticoag mst yr",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9735",null,"Pt unbl cmplt shld fs prom",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9746",null,"Mit sten, valve or trans af",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9763",null,"Pt not have 2-3 hpv vaccines",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9775",null,"Recd 2 anti-emet pre/intraop",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9784",null,"Path/derm prov 2nd biop opin",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9794",null,"Doc med rsn no daily aspirin",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9808",null,"Pt no asthm cont med mst per",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9811",null,"No pdc 75% w/asth cont med",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9831",null,"Ajcc stg brt ca dx ii or iii",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9843",null,"Kras or nras gene mutation",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9861",null,"Pt more than 3d hospice",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9879",null,"2 em core ms mo 10-12 wl",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9897",null,"Pt nt prsc adr dep thrpy rng",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9907",null,"Doc med rsn no tbco interv",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9914",null,"Pt receiving anti-tnf agent",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9917",null,"Adv dem crgvr limited",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9929",null,"Trs/rev af",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9942",null,"Adtl spine proc on same date",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9960",null,"Med rsn sys antimi nt rx",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9969",null,"Pvdr rfrd pt rprt rcvd",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["G9994",null,"Pall serv during meas",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["H0005",null,"Alcohol and/or drug services",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["H0012",null,"Alcohol and/or drug services",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["H0015",null,"Alcohol and/or drug services",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["H0026",null,"Alcohol and/or drug preventi",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["H0033",null,"Oral med adm direct observe",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["H0045",null,"Respite not-in-home per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["H1001",null,"Antepartum management",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["H2013",null,"Psych hlth fac svc, per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["H2024",null,"Supported employ, per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["H2031",null,"Mh clubhouse svc, per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["H2034",null,"A/d halfway house, per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J0172",null,"Inj, aducanumab-avwa, 2 mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J0190",null,"Inj biperiden lactate/5 mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J0221",null,"Lumizyme injection",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J0270",null,"Alprostadil for injection",null,9.68,null,9.68,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J0300",null,"Amobarbital 125 mg inj",null,183.26,null,183.26,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J0401",null,"Inj aripiprazole ext rel 1mg",null,5.992,null,5.992,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J0485",null,"Belatacept injection",null,3.7839999999999998,null,3.7839999999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J0500",null,"Dicyclomine injection",null,26.074999999999999,null,26.074999999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J0585",null,"Injection,onabotulinumtoxina",null,6.1849999999999996,null,6.1849999999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J0592",null,"Buprenorphine hydrochloride",null,4.101,null,4.101,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J0604",null,"Cinacalcet, esrd on dialysis",null,"By report",null,"By report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-ONC"]
["J0638",null,"Canakinumab injection",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J0698",null,"Cefotaxime sodium injection",null,2.78,null,2.78,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J0720",null,"Chloramphenicol sodium injec",null,33.866,null,33.866,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J0744",null,"Ciprofloxacin iv",null,0.93100000000000005,null,0.93100000000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J0775",null,"Collagenase, clost hist inj",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J0885",null,"Epoetin alfa, non-esrd",null,8.1120000000000001,null,8.1120000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J0895",null,"Deferoxamine mesylate inj",null,7.1980000000000004,null,7.1980000000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J1071",null,"Inj testosterone cypionate",null,2.8000000000000001E-2,null,2.8000000000000001E-2,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J1130",null,"Inj diclofenac sodium 0.5mg",null,0.21,null,0.21,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J1240",null,"Dimenhydrinate injection",null,7.26,null,7.26,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J1305",null,"Inj, evinacumab-dgnb, 5mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J1335",null,"Ertapenem injection",null,20.867000000000001,null,20.867000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J1410",null,"Inj estrogen conjugate 25 mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J1448",null,"Injection, trilaciclib, 1mg",null,5.1190999999999995,null,5.1190999999999995,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["J1454",null,"Inj fosnetupitant, palonoset",null,464.38299999999998,null,464.38299999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J1557",null,"Gammaplex injection",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J1568",null,"Octagam injection",null,41.822000000000003,null,41.822000000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J1610",null,"Glucagon hydrochloride/1 mg",null,169.74100000000001,null,169.74100000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J1645",null,"Dalteparin sodium",null,11.621,null,11.621,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J1710",null,"Hydrocortisone sodium ph inj",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J1729",null,"Inj hydroxyprogst capoat nos",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J1815",null,"Insulin injection",null,0.9,null,0.9,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J1833",null,"Injection, isavuconazonium",null,0.87,null,0.87,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J1951",null,"Inj fensolvi 0.25 mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J1955",null,"Inj levocarnitine per 1 gm",null,22.459,null,22.459,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J2175",null,"Meperidine hydrochl /100 mg",null,6.66,null,6.66,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J2274",null,"Inj morphine pf epid ithc",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J2323",null,"Natalizumab injection",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J2350",null,"Injection, ocrelizumab, 1 mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J2440",null,"Papaverin hcl injection",null,37.5,null,37.5,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J2503",null,"Pegaptanib sodium injection",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J2562",null,"Plerixafor injection",null,382.64800000000002,null,382.64800000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J2650",null,"Prednisolone acetate inj",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J2760",null,"Phentolaine mesylate inj",null,377.73,null,377.73,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J2792",null,"Rho(d) immune globulin h, sd",null,30.616,null,30.616,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J2800",null,"Methocarbamol injection",null,5.88,null,5.88,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J2820",null,"Sargramostim injection",null,54.040999999999997,null,54.040999999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J3030",null,"Sumatriptan succinate / 6 mg",null,10.4,null,10.4,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J3090",null,"Inj tedizolid phosphate",null,1.661,null,1.661,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J3246",null,"Tirofiban hcl",null,4.5999999999999996,null,4.5999999999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J3262",null,"Tocilizumab injection",null,5.819,null,5.819,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J3316",null,"Inj., triptorelin xr 3.75 mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J3385",null,"Velaglucerase alfa",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J3411",null,"Thiamine hcl 100 mg",null,2.5430000000000001,null,2.5430000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J3472",null,"Ovine, 1000 usp units",null,452.33,null,452.33,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J3590",null,"Unclassified biologics",null,"By report",null,"By report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["J7050",null,"Normal saline solution infus",null,0.63900000000000001,null,0.63900000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J7178",null,"Inj human fibrinogen con nos",null,1.341,null,1.341,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J7181",null,"Factor xiii recomb a-subunit",null,15.678000000000001,null,15.678000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J7194",null,"Factor ix complex",null,1.532,null,1.532,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J7205",null,"Factor viii fc fusion recomb",null,2.1120000000000001,null,2.1120000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J7294",null,"Seg acet and eth estr yearly",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J7304",null,"Contraceptive hormone patch",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J7318",null,"Inj, durolane 1 mg",null,"By report",null,"By report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["J7324",null,"Orthovisc inj per dose",null,154.749,null,154.749,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J7351",null,"Inj bimatoprost itc imp1mcg",null,206.04,null,206.04,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-ONC"]
["J7500",null,"Azathioprine oral 50mg",null,8.1029999999999998,null,8.1029999999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J7508",null,"Tacrol astagraf ex rel oral",null,0.495,null,0.495,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J7606",null,"Formoterol fumarate, inh",null,8.9179999999999993,null,8.9179999999999993,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J7613",null,"Albuterol non-comp unit",null,4.3999999999999997E-2,null,4.3999999999999997E-2,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J7627",null,"Budesonide comp unit",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J7640",null,"Formoterol comp unit",null,"By report",null,"By report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["J7645",null,"Ipratropium bromide comp",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J7670",null,"Metaproterenol comp unit",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J7677",null,"Revefenacin inh non-com 1mcg",null,0.189,null,0.189,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J7686",null,"Treprostinil, non-comp unit",null,704.37800000000004,null,704.37800000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J8597",null,"Antiemetic drug oral nos",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["J8705",null,"Topotecan oral",null,104.3,null,104.3,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J9021",null,"Inj, aspara, rylaze, 0.1 mg",null,108.52080000000001,null,108.52080000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["J9040",null,"Bleomycin sulfate injection",null,25.981000000000002,null,25.981000000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J9045",null,"Carboplatin injection",null,2.7679999999999998,null,2.7679999999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J9119",null,"Inj., cemiplimab-rwlc, 1 mg",null,27.623000000000001,null,27.623000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J9144",null,"Daratumumab, hyaluronidase",null,44.877000000000002,null,44.877000000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-ONC"]
["J9165",null,"Diethylstilbestrol injection",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J9203",null,"Gemtuzumab ozogamicin 0.1 mg",null,211.11199999999999,null,211.11199999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J9210",null,"Inj., emapalumab-lzsg, 1 mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J9217",null,"Leuprolide acetate suspnsion",null,168.691,null,168.691,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J9247",null,"Inj, melphalan flufenami 1mg",null,514.85580000000004,null,514.85580000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["J9263",null,"Oxaliplatin",null,6.8000000000000005E-2,null,6.8000000000000005E-2,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J9293",null,"Mitoxantrone hydrochl / 5 mg",null,33.92,null,33.92,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J9301",null,"Obinutuzumab inj",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J9308",null,"Injection, ramucirumab",null,63.69,null,63.69,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["J9351",null,"Topotecan injection",null,1.1160000000000001,null,1.1160000000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["J9358",null,"Inj fam-trastu deru-nxki 1mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["J9400",null,"Inj, ziv-aflibercept, 1mg",null,8.2219999999999995,null,8.2219999999999995,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["K0005","RR","Ultralightweight wheelchair",null,232.94480000000001,null,232.94480000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["K0008",null,"Cstm manual wheelchair/base",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["K0013","RR","Custom power whlchr base",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["K0015","NU","Detach non-adj ht armrst rep",null,179.42600000000002,null,179.42600000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["K0019","RR","Arm pad repl, each",null,1.7098,null,1.7098,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["K0043","RR","Ftrst lowr exten tube rep ea",null,2.0909,null,2.0909,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["K0047","NU","Elev legrst upr hangr rep ea",null,78.496299999999991,null,78.496299999999991,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["K0052","RR","Swingaway detach ftrest repl",null,9.1464000000000016,null,9.1464000000000016,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["K0098","NU","Drive belt for pwc, repl",null,28.747299999999999,null,28.747299999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["K0195","NU","Elevating whlchair leg rests",null,177.98400000000001,null,177.98400000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["K0606",null,"Aed garment w elec analysis",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["K0609",null,"Repl electrode for aed",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["K0739",null,"Repair/svc dme non-oxygen eq",null,28.2117,null,28.2117,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["K0814","RR","Pwc gp 1 std port cap chair",null,410.94940000000003,null,410.94940000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["K0815","RR","Pwc gp 1 std seat/back",null,462.30520000000001,null,462.30520000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["K0824","RR","Pwc gp 2 hd seat/back",null,646.47950000000003,null,646.47950000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["K0830","RR","Pwc gp2 std seat elevate s/b",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["K0836","NU","Pwc gp2 std sing pow opt cap",null,5446.7429999999986,null,5446.7429999999986,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["K0842","RR","Pwc gp2 std mult pow opt cap",null,570.86720000000003,null,570.86720000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["K0848","NU","Pwc gp 3 std seat/back",null,8609.3580000000002,null,8609.3580000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["K0851","RR","Pwc gp 3 hd cap chair",null,960.19690000000003,null,960.19690000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["K0859","RR","Pwc gp3 hd sing pow opt cap",null,1093.4479999999999,null,1093.4479999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["K0860","RR","Pwc gp3 vhd sing pow opt s/b",null,1637.9884,null,1637.9884,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["K0869","RR","Pwc gp 4 std cap chair",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["K0880","RR","Pwc gp4 vhd sing pow opt s/b",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["K0886","NU","Pwc gp4 hd mult pow s/b",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["K1003","NU","Whirlpool tub walkin portabl",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["K1009","NU","Speech volume modulation sys",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-PHL"]
["K1014","NU","Ak 4 bar link hydl swg/stanc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-PHL"]
["K1030",null,"Ext recharge bat replacement",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["K1032","NU","Non pneum seq comp full leg",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["L0180",null,"Cer post col occ/man sup adj",null,510.72060000000005,null,510.72060000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L0462",null,"Tlso 3mod sacro-scap pre",null,1581.4232999999999,null,1581.4232999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L0469",null,"Tlso rig fram pelvic pre ots",null,567.34979999999996,null,567.34979999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L0623",null,"Sio rig pnl pelv/sac pre ots",null,191.79390000000001,null,191.79390000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L0630",null,"Lso r post pnl sj-t9 pre cst",null,205.12710000000001,null,205.12710000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L0633",null,"Lso sc r pos/lat pnl pre cst",null,363.20670000000001,null,363.20670000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L0710",null,"Ctlso a-p-l control w/ inter",null,2770.7225999999996,null,2770.7225999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L0820",null,"Halo cervical into body jack",null,3276.3387000000002,null,3276.3387000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L0999",null,"Add to spinal orthosis nos",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["L1080",null,"Outrigger",null,76.382999999999996,null,76.382999999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L1120",null,"Covers for upright each",null,59.642700000000005,null,59.642700000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L1499",null,"Spinal orthosis nos",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N","Y"]
["L1652",null,"Ho bi thighcuffs w sprdr bar",null,451.48379999999997,null,451.48379999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L1685",null,"Post-op hip abduct custom fa",null,1443.2943,null,1443.2943,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L1836",null,"Ko rigid w/o joints pre ots",null,147.99359999999999,null,147.99359999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L1843",null,"Ko single upright pre cst",null,1136.4462000000001,null,1136.4462000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L1904",null,"Afo molded ankle gauntlet",null,570.57240000000002,null,570.57240000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L1940",null,"Afo molded to patient plasti",null,644.63070000000005,null,644.63070000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L2005",null,"Kafo sng/dbl mechanical act",null,5190.0342000000001,null,5190.0342000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L2070",null,"Hkafo torsion unilat rot str",null,163.18409999999997,null,163.18409999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L2116",null,"Afo tibial fracture rigid",null,863.7921,null,863.7921,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L2132",null,"Kafo femoral fx cast soft",null,978.80939999999998,null,978.80939999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L2250",null,"Foot plate molded stirrup at",null,574.8528,null,574.8528,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L2265",null,"Long tongue stirrup",null,142.9014,null,142.9014,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L2370",null,"Patten bottom",null,332.83800000000002,null,332.83800000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L2397",null,"Suspension sleeve lower ext",null,160.35509999999999,null,160.35509999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L2526",null,"Th/wght bear nar m-l brim cu",null,1108.1315999999999,null,1108.1315999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L2630",null,"Pelvic control band & belt u",null,317.37689999999998,null,317.37689999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L2755",null,"Carbon graphite lamination",null,165.52109999999999,null,165.52109999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L2780",null,"Non-corrosive finish",null,109.49459999999999,null,109.49459999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L3020",null,"Foot longitud/metatarsal sup",null,251.27669999999998,null,251.27669999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L3031",null,"Foot lamin/prepreg composite",null,161.2038,null,161.2038,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L3201",null,"Oxford w supinat/pronat inf",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["L3209",null,"Surgical boot each child",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["L3225",null,"Man's shoe oxford brace",null,82.0779,null,82.0779,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L3257",null,"Orth foot add charge split s",null,91.7928,null,91.7928,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L3350",null,"Shoe heel wedge",null,29.015699999999999,null,29.015699999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L3380",null,"Shoe clubfoot wedge",null,62.779199999999996,null,62.779199999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L3520",null,"O shoe add felt w leath insl",null,40.2333,null,40.2333,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L3540",null,"Ortho shoe add full sole",null,64.451999999999998,null,64.451999999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L3649",null,"Orthopedic shoe modifica nos",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["L3677",null,"So hard plas stabili pre cst",null,164.60400000000001,null,164.60400000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L3765",null,"Ewhfo rigid w/o jnts cf",null,1478.0295000000001,null,1478.0295000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L3901",null,"Hinge ext/flex wrist finger",null,2137.7523000000001,null,2137.7523000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L3918",null,"Metacarp fx orthosis pre ots",null,121.81920000000001,null,121.81920000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L3923",null,"Hfo without joints pre cst",null,113.5167,null,113.5167,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L3975",null,"Sewhfo cap design w/o jnt cf",null,1936.6472999999999,null,1936.6472999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L3977",null,"Sewhfo cap desgn w/jnt(s) cf",null,2170.4703,null,2170.4703,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L4030",null,"Replace socket brim cust fit",null,801.72629999999992,null,801.72629999999992,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L4080",null,"Repl met band kafo-afo prox",null,145.33679999999998,null,145.33679999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L4387",null,"Non-pneum walk boot pre ots",null,200.79749999999999,null,200.79749999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L5010",null,"Mold socket ank hgt w/ toe f",null,1637.76,null,1637.76,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L5220",null,"No knee joint with artic ali",null,4947.3663999999999,null,4947.3663999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L5270",null,"Tilt table locking hip sing",null,9224.9856,null,9224.9856,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L5520",null,"Perp bk ptb thermopls direct",null,1934.528,null,1934.528,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L5535",null,"Prep bk ptb open end socket",null,2788.5440000000003,null,2788.5440000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L5614",null,"4-bar link above knee w/swng",null,2228.5056,null,2228.5056,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L5626",null,"Test socket hip disarticulat",null,735.62880000000007,null,735.62880000000007,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L5642",null,"Above knee leather socket",null,1111.296,null,1111.296,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L5650",null,"Tot contact ak/knee disart s",null,772.04480000000001,null,772.04480000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L5666",null,"Below knee cuff suspension",null,95.552000000000007,null,95.552000000000007,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L5671",null,"Bk/ak locking mechanism",null,892.19839999999999,null,892.19839999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L5692",null,"Ak pelvic control belt light",null,209.792,null,209.792,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L5695",null,"Ak sleeve susp neoprene/equa",null,219.3792,null,219.3792,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L5707",null,"Custom shape cvr hip disart",null,1897.4976000000001,null,1897.4976000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L5722",null,"Knee-shin pneum swg frct exo",null,1426.8928000000001,null,1426.8928000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L5812",null,"Endo knee-shin frct swg & st",null,849.10080000000005,null,849.10080000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L5830",null,"Endo knee-shin pneum/swg pha",null,3312.3328000000001,null,3312.3328000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L5910",null,"Endo below knee alignable sy",null,487.2192,null,487.2192,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L5930",null,"High activity knee frame",null,4445.1328000000003,null,4445.1328000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L5976",null,"Energy storing foot",null,842.17600000000004,null,842.17600000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L5979",null,"Multi-axial ankle/ft prosth",null,4054.9120000000003,null,4054.9120000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L6055",null,"Wrst mold sock w/exp interfa",null,4360.9984000000004,null,4360.9984000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L6120",null,"Elbow mold doub splt soc ste",null,4034.7647999999999,null,4034.7647999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L6382",null,"Postop dsg cast chg elb dis/",null,2165.5935999999997,null,2165.5935999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L6570",null,"Scap thorac prosth tiss shap",null,7130.5983999999999,null,7130.5983999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L6611",null,"Additional switch, ext power",null,543.7568,null,543.7568,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L6620",null,"Flexion/extension wrist unit",null,450.30400000000003,null,450.30400000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L6646",null,"Multipo locking shoulder jnt",null,4165.2479999999996,null,4165.2479999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L6648",null,"Ext pwrd shlder lock/unlock",null,4295.8591999999999,null,4295.8591999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L6689",null,"Frame typ socket shoulder di",null,1162.9567999999999,null,1162.9567999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L6692",null,"Silicone gel insert or equal",null,752.2944,null,752.2944,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L6709",null,"Term dev mech hand vol close",null,1893.0432000000001,null,1893.0432000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L6805",null,"Term dev modifier wrist unit",null,568.98559999999998,null,568.98559999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L6900",null,"Hand restorat thumb/1 finger",null,2612.1088,null,2612.1088,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L6935",null,"Below elbow myoelectronic ct",null,12003.251200000001,null,12003.251200000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L7040",null,"Prehensile actuator",null,4051.9168,null,4051.9168,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L7170",null,"Electronic elbow hosmer swit",null,8214.1823999999997,null,8214.1823999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM"]
["L7402",null,"Add ue prost s/d ultlite mat",null,489.35680000000002,null,489.35680000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L7405",null,"Add ue prost s/d acrylic",null,960,null,960,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L8015",null,"Ext breastprosthesis garment",null,82.214400000000012,null,82.214400000000012,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["L8040",null,"Nasal prosthesis",null,3301.7856000000002,null,3301.7856000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L8300",null,"Truss single w/ standard pad",null,140.97919999999999,null,140.97919999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L8417",null,"Pros sheath/sock w gel cushn",null,99.327999999999989,null,99.327999999999989,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L8501",null,"Tracheostomy speaking valve",null,162.50880000000001,null,162.50880000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L8507",null,"Trach-esoph voice pros pt in",null,55.308800000000005,null,55.308800000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["L8610",null,"Ocular implant",null,892.41600000000005,null,892.41600000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L8614",null,"Cochlear device",null,25271.603199999998,null,25271.603199999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L8628",null,"Cid ext controller repl",null,1697.1392000000001,null,1697.1392000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["L8670",null,"Vascular graft, synthetic",null,748.85119999999995,null,748.85119999999995,null,"000",0,0,0,9,9,9,9,9,9,null,"F","Y"]
["L8688",null,"Implt nrostm pls gen dua non",null,56826.563199999997,null,56826.563199999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["L8695",null,"External recharg sys extern",null,21.977600000000002,null,21.977600000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["M0223",null,"Bebteleovimab injection home",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["M0241",null,"CASIRI AND IMDEV REPEAT HM",null,772.5,null,772.5,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["M1008",null,"<50% total pt outpt ra encts",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["M1011",null,"Dc eoc doc med rec",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["M1019",null,"Adl pt mj dep ds rs 12 phq<5",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["M1040",null,"Pt dx lum idi or cong scol",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["M1056",null,"Presc antico med in pp",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["M1069",null,"Pt scr ft fall rsk",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["M1115",null,"Oc ni pt selfdc 1-2 vis",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["M1117",null,"Docu dx degen neuro",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["M1133",null,"Oc ni pt dc 1-2 vis",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["M1141",null,"Fs no oks",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["M1149",null,"No neck fs prom incap",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["P9017",null,"Plasma 1 donor frz w/in 8 hr",null,"By report",null,"By report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["P9033",null,"Platelets leukoreduced irrad",null,"By report",null,"By report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["P9040",null,"Rbc leukoreduced irradiated",null,"By report",null,"By report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["P9054",null,"Blood, l/r, froz/degly/wash",null,"By report",null,"By report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["P9056",null,"Blood, l/r, irradiated",null,"By report",null,"By report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["Q0035",26,"Cardiokymography",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,1,0,0,0,0,0,null,"X"]
["Q0084",null,"Chemotherapy by infusion",null,"Facility Only",null,0,null,"000",0,0,0,9,9,9,9,9,9,null,"O"]
["Q0114",null,"Fern test",null,13.9282,null,13.9282,null,"000",0,0,0,9,9,9,9,9,9,null,"L"]
["Q0174",null,"Thiethylperazine maleate10mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q0245",null,"Bamlanivimab and etesevima",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q0480",null,"Driver pneumatic vad, rep",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q0492",null,"Emr pwr cbl elec vad, rep",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q0494",null,"Emr hd pmp elec/combo, rep",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q0511",null,"Sup fee antiem,antica,immuno",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q0514",null,"Disp fee inhal drugs/90 days",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q2028",null,"Inj, sculptra, 0.5mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q2055",null,"Idecabtagene vicleucel car",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q4005",null,"Cast sup long arm adult plst",null,14.605399999999999,null,14.605399999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["Q4012",null,"Cast sup sht arm ped fbrglas",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q4024",null,"Cast sup sht arm splnt ped f",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q4026",null,"Cast sup hip spica fiberglas",null,132.91120000000001,null,132.91120000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["Q4042",null,"Cast sup lng leg splnt fbrgl",null,38.4499,null,38.4499,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["Q4045",null,"Cast sup sht leg splnt plstr",null,13.081,null,13.081,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["Q4074",null,"Iloprost non-comp unit dose",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q4111",null,"Gammagraft",null,6.899,null,6.899,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["Q4116",null,"Alloderm",null,"By report",null,"By report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["Q4132",null,"Grafix core, grafixpl core",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q4145",null,"Epifix, inj, 1mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q4147",null,"Architect ecm px fx 1 sq cm",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q4163",null,"Woundex, bioskin, per sq cm",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q4166",null,"Cytal, per square centimeter",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q4174",null,"Palingen or promatrx",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q4206",null,"Fluid flow or fluid gf 1 cc",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q4212",null,"Allogen, per cc",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q4225",null,"Amniobind, per sq cm",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q4239",null,"Amnio-maxx or lite per sq cm",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q4241",null,"Polycyte, topical only 0.5cc",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q4258",null,"Enverse, per sq cm",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q5003",null,"Hospice in lt/non-skilled nf",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["Q5010",null,"Hospice home care in hospice",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["Q5120",null,"Inj pegfilgrastim-bmez 0.5mg",null,178.55099999999999,null,178.55099999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-ONC"]
["Q9001",null,"Va chaplain assessment",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["Q9959",null,"Hocm 150-199mg/ml iodine,1ml",null,"By report",null,"By report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["Q9992",null,"Buprenorphine xr over 100 mg",null,1781.309,null,1781.309,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["R0075","UN","Transport port x-ray multipl",null,96.822766497600028,null,96.822766497600028,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["R0392",null,"Retraining child care licensd 7-9 hrs ea",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["S0020",null,"Injection, bupivicaine hydro",null,0.05,null,0.05,null,"000",0,0,0,9,9,9,9,9,9,null,"D"]
["S0028",null,"Injection, famotidine, 20 mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S0090",null,"Sildenafil citrate, 25 mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S0106",null,"Bupropion hcl sr 60 tablets",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S0139",null,"Minoxidil, 10 mg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S0170",null,"Anastrozole 1 mg",null,0.13,null,0.13,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["S0172",null,"Chlorambucil 2 mg",null,26.52,null,26.52,null,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM"]
["S0201",null,"Partial hospitalization serv",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S0250",null,"Comp geriatr assmt team",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S0260",null,"H&p for surgery",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S0317",null,"Disease mgmt per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S0353",null,"Cancer treatmentplan initial",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S0515",null,"Scleral lens liquid bandage",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S0595",null,"New lenses in pts old frame",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S0620",null,"Routine ophthalmological exa",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S1037",null,"Art pancreas ext receiver",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S2061",null,"Donor lobectomy (lung)",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S2067",null,"Breast \"stacked\" diep/gap",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S2118",null,"Total hip resurfacing",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S2152",null,"Solid organ transpl pkg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S2266",null,"Induced abortion 29-31 wks",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S2348",null,"Decompress disc rf lumbar",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S2404",null,"Fetal surg myelomeningo",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S3722",null,"Dose optimization auc - 5fu",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S3846",null,"Gene test beta-thalassemia",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S3852",null,"Dna analysis apoe alzheimer",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S4015",null,"Complete ivf nos case rate",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S4021",null,"Ivf canc p aspir case rate",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S4042",null,"Ovulation mgmt per cycle",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S5000",null,"Prescription drug, generic",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S5036",null,"Hit device repair",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S5131",null,"Homemaker service nos /diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S5150",null,"Unskilled respite care /15m",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S5161",null,"Emer rspns sys serv permonth",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["S5502",null,"Hit interim cath care",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S5522",null,"Hit picc insert no supp",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S8030",null,"Tantalum ring application",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S8080",null,"Scintimammography",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S8185",null,"Flutter device",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S8265",null,"Haberman feeder",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S8270",null,"Enuresis alarm",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S8301",null,"Infect control supplies nos",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["S8415",null,"Supplies for home delivery",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S8420",null,"Custom gradient sleev/glov",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["S8421",null,"Ready gradient sleev/glov",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["S8422",null,"Custom grad sleeve med",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["S8423",null,"Custom grad sleeve heavy",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["S8424",null,"Ready gradient sleeve",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["S8425",null,"Custom grad glove med",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["S8426",null,"Custom grad glove heavy",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["S8427",null,"Ready gradient glove",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["S8428",null,"Ready gradient gauntlet",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["S8429",null,"Gradient pressure wrap",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["S8430",null,"Padding for comprssn bdg",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["S8431",null,"Compression bandage",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["S8450",null,"Splint digit",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S8451",null,"Splint wrist or ankle",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S8452",null,"Splint elbow",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S8460",null,"Camisole post-mast",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S8490",null,"100 insulin syringes",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S8930",null,"Auricular electrostimulation",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S8940",null,"Hippotherapy per session",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S8948",null,"Low-level laser trmt 15 min",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S8950",null,"Complex lymphedema therapy,",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S8990",null,"Pt or manip for maint",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S8999",null,"Resuscitation bag",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9001",null,"Home uterine monitor with or",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9007",null,"Ultrafiltration monitor",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9024",null,"Paranasal sinus ultrasound",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9025",null,"Omnicardiogram/cardiointegra",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9034",null,"Eswl for gallstones",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9055",null,"Procuren or other growth fac",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9056",null,"Coma stimulation per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9061",null,"Medical supplies and equipme",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9083",null,"Urgent care center global",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9088",null,"Services provided in urgent",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9090",null,"Vertebral axial decompressio",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9097",null,"Home visit wound care",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9098",null,"Home phototherapy visit",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9110",null,"Telemonitoring/home per mnth",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9117",null,"Back school visit",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9122",null,"Home health aide or certifie",null,33.051876,null,33.051876,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-ONC"]
["S9123",null,"Nursing care in home rn",null,66.459510374399997,null,66.459510374399997,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-ONC"]
["S9124",null,"Nursing care, in the home; b",null,48.005746588800001,null,48.005746588800001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-ONC"]
["S9125",null,"Respite care, in the home, p",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9126",null,"Hospice care, in the home, p",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9127",null,"Social work visit, in the ho",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9128",null,"Speech therapy, in the home,",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9129",null,"Occupational therapy, in the",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9131",null,"Pt in the home per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9140",null,"Diabetic management program,",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9141",null,"Diabetic management program,",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9145",null,"Insulin pump initiation",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9150",null,"Evaluation by ocularist",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9152",null,"Speech therapy, re-eval",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9208",null,"Home mgmt preterm labor",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9209",null,"Home mgmt pprom",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9211",null,"Home mgmt gest hypertension",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9212",null,"Hm postpar hyper per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9213",null,"Hm preeclamp per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9214",null,"Hm gest dm per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9325",null,"Hit pain mgmt per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9326",null,"Hit cont pain per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9327",null,"Hit int pain per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9328",null,"Hit pain imp pump diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9329",null,"Hit chemo per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9330",null,"Hit cont chem diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9331",null,"Hit intermit chemo diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9335",null,"Ht hemodialysis diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9336",null,"Hit cont anticoag diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9338",null,"Hit immunotherapy diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9339",null,"Hit periton dialysis diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9340",null,"Hit enteral per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9341",null,"Hit enteral grav diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9342",null,"Hit enteral pump diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9343",null,"Hit enteral bolus nurs",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9345",null,"Hit anti-hemophil diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9346",null,"Hit alpha-1-proteinas diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9347",null,"Hit longterm infusion diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9348",null,"Hit sympathomim diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9349",null,"Hit tocolysis diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9351",null,"Hit cont antiemetic diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9353",null,"Hit cont insulin diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9355",null,"Hit chelation diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9357",null,"Hit enzyme replace diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9359",null,"Hit anti-tnf per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9361",null,"Hit diuretic infus diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9363",null,"Hit anti-spasmotic diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9364",null,"Hit tpn total diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9365",null,"Hit tpn 1 liter diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9366",null,"Hit tpn 2 liter diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9367",null,"Hit tpn 3 liter diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9368",null,"Hit tpn over 3l diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9370",null,"Ht inj antiemetic diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9372",null,"Ht inj anticoag diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9373",null,"Hit hydra total diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9374",null,"Hit hydra 1 liter diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9375",null,"Hit hydra 2 liter diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9376",null,"Hit hydra 3 liter diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9377",null,"Hit hydra over 3l diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9379",null,"Hit noc per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9381",null,"Hit high risk/escort",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9401",null,"Anticoag clinic per session",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9430",null,"Pharmacy comp/disp serv",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9432",null,"Med food non inborn err meta",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9433",null,"Medical food oral 100% nutr",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9434",null,"Mod solid food suppl",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9435",null,"Medical foods for inborn err",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9436",null,"Lamaze class",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9437",null,"Childbirth refresher class",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9438",null,"Cesarean birth class",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9439",null,"Vbac class",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9441",null,"Asthma education",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9442",null,"Birthing class",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9443",null,"Lactation class",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9444",null,"Parenting class",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9445",null,"Pt education noc individ",null,44.652483532799998,null,44.652483532799998,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["S9446",null,"Pt education noc group",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9447",null,"Infant safety class",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9449",null,"Weight mgmt class",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9451",null,"Exercise class",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9452",null,"Nutrition class",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9453",null,"Smoking cessation class",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9454",null,"Stress mgmt class",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9455",null,"Diabetic management program,",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9460",null,"Diabetic management program,",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9465",null,"Diabetic management program,",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9470",null,"Nutritional counseling, diet",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9472",null,"Cardiac rehabilitation progr",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9473",null,"Pulmonary rehabilitation pro",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9474",null,"Enterostomal therapy by a re",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9475",null,"Ambulatory setting substance",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9476",null,"Vestibular rehab per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9480",null,"Intensive outpatient psychia",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["S9482",null,"Family stabilization 15 min",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9484",null,"Crisis intervention per hour",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9485",null,"Crisis intervention mental h",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9490",null,"Hit corticosteroid/diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9494",null,"Hit antibiotic total diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9497",null,"Hit antibiotic q3h diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9500",null,"Hit antibiotic q24h diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9501",null,"Hit antibiotic q12h diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9502",null,"Hit antibiotic q8h diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9503",null,"Hit antibiotic q6h diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9504",null,"Hit antibiotic q4h diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9529",null,"Venipuncture home/snf",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9537",null,"Ht hem horm inj diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9538",null,"Hit blood products diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9542",null,"Ht inj noc per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9558",null,"Ht inj growth horm diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9559",null,"Hit inj interferon diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9560",null,"Ht inj hormone diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9562",null,"Ht inj palivizumab diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9590",null,"Ht irrigation diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9810",null,"Ht pharm per hour",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9900",null,"Christian sci pract visit",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9901",null,"Christian sci nurse visit",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9960",null,"Air ambulanc nonemerg fixed",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9961",null,"Air ambulan nonemerg rotary",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9970",null,"Health club membership yr",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9975",null,"Transplant related per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9976",null,"Lodging per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9977",null,"Meals per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9981",null,"Med record copy admin",null,28.913781124800003,null,28.913781124800003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["S9982",null,"Med record copy per page",null,0.57329981280000009,null,0.57329981280000009,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["S9986",null,"Not medically necessary svc",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9988",null,"Serv part of phase i trial",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9989",null,"Services outside us",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9990",null,"Services provided as part of",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9991",null,"Services provided as part of",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9992",null,"Transportation costs to and",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9994",null,"Lodging costs (e.g. hotel ch",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9996",null,"Meals for clinical trial par",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["S9999",null,"Sales tax",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1000",null,"Private duty/independent nsg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1001",null,"Nursing assessment/evaluatn",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1002",null,"Rn services up to 15 minutes",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1003",null,"Lpn/lvn services up to 15min",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1004",null,"Nsg aide service up to 15min",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1005",null,"Respite care service 15 min",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1006",null,"Family/couple counseling",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1007",null,"Treatment plan development",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1009",null,"Child sitting services",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1010",null,"Meals when receive services",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1012",null,"Alcohol/substance abuse skil",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1013",null,"Sign lang/oral interpreter",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1014",null,"Telehealth transmit, per min",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1015",null,"Clinic service",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["T1016",null,"Case management",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1017",null,"Targeted case management",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1018",null,"School-based iep ser bundled",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1019",null,"Personal care ser per 15 min",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1020",null,"Personal care ser per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1021",null,"Hh aide or cn aide per visit",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1022",null,"Contracted services per day",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1023",null,"Program intake assessment",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1024",null,"Team evaluation & management",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1025",null,"Ped compr care pkg, per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1026",null,"Ped compr care pkg, per hour",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1027",null,"Family training & counseling",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1028",null,"Home environment assessment",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1029",null,"Dwelling lead investigation",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1030",null,"Rn home care per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1031",null,"Lpn home care per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1040",null,"Comm bh clinic svc per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1041",null,"Comm bh clinic svc per month",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1502",null,"Medication admin visit",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1503",null,"Med admin, not oral/inject",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1505",null,"Elec med comp dev, noc",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T1999",null,"Noc retail items andsupplies",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2001",null,"N-et; patient attend/escort",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2002",null,"N-et; per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2003",null,"N-et; encounter/trip",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2004",null,"N-et; commerc carrier pass",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2005",null,"N-et; stretcher van",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2007",null,"Non-emer transport wait time",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2010",null,"Pasrr level i",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2011",null,"Pasrr level ii",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2012",null,"Habil ed waiver, per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2013",null,"Habil ed waiver per hour",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2014",null,"Habil prevoc waiver, per d",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2015",null,"Habil prevoc waiver per hr",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2016",null,"Habil res waiver per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2017",null,"Habil res waiver 15 min",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2018",null,"Habil sup empl waiver/diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2019",null,"Habil sup empl waiver 15min",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2020",null,"Day habil waiver per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2021",null,"Day habil waiver per 15 min",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2022",null,"Case management, per month",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2023",null,"Targeted case mgmt per month",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2024",null,"Serv asmnt/care plan waiver",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2025",null,"Waiver service, nos",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2026",null,"Special childcare waiver/d",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2027",null,"Spec childcare waiver 15 min",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2028",null,"Special supply, nos waiver",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2029",null,"Special med equip, noswaiver",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2030",null,"Assist living waiver/month",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2031",null,"Assist living waiver/diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2032",null,"Res care, nos waiver/month",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2033",null,"Res, nos waiver per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2034",null,"Crisis interven waiver/diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2035",null,"Utility services waiver",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2036",null,"Camp overnite waiver/session",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2037",null,"Camp day waiver/session",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2038",null,"Comm trans waiver/service",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2039",null,"Vehicle mod waiver/service",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2040",null,"Financial mgt waiver/15min",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2041",null,"Support broker waiver/15 min",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2042",null,"Hospice routine home care",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2043",null,"Hospice continuous home care",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2044",null,"Hospice respite care",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2045",null,"Hospice general care",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2046",null,"Hospice long term care, r&b",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2047",null,"Hab prevo waiver per 15",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2048",null,"Bh ltc res r&b, per diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2049",null,"N-et; stretcher van, mileage",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2050",null,"Financial mgt waiver/diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2051",null,"Support broker waiver/diem",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T2101",null,"Breast milk proc/store/dist",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T4521",null,"Adult size brief/diaper sm",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["T4522",null,"Adult size brief/diaper med",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["T4523",null,"Adult size brief/diaper lg",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["T4524",null,"Adult size brief/diaper xl",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["T4525",null,"Adult size pull-on sm",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["T4526",null,"Adult size pull-on med",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["T4527",null,"Adult size pull-on lg",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["T4528",null,"Adult size pull-on xl",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["T4529",null,"Ped size brief/diaper sm/med",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T4530",null,"Ped size brief/diaper lg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T4531",null,"Ped size pull-on sm/med",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T4532",null,"Ped size pull-on lg",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T4533",null,"Youth size brief/diaper",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["T4534",null,"Youth size pull-on",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["T4535",null,"Disposable liner/shield/pad",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["T4536",null,"Reusable pull-on any size",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["T4537",null,"Reusable underpad bed size",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["T4538",null,"Diaper serv reusable diaper",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T4539",null,"Reuse diaper/brief any size",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["T4540",null,"Reusable underpad chair size",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["T4541",null,"Large disposable underpad",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["T4542",null,"Small disposable underpad",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["T4543",null,"Adult disp brief/diap abv xl",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T4544",null,"Adlt disp und/pull on abv xl",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["T4545",null,"Incon disposable penile wrap",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["T5001",null,"Position seat spec orth need",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["T5999",null,"Supply, nos",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["U0001",null,"2019-ncov diagnostic p",null,51.365600000000001,null,51.365600000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
["U0002",null,"Covid-19 lab test non-cdc",null,73.3733,null,73.3733,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
["U0003",null,"SARS-COV-2 DNA/RNA HIGH THROUGHPUT",null,107.25,null,107.25,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
["U0004",null,"2019-NCOV ANY TECHNIQUE HIGH THROUGHPUT",null,107.25,null,107.25,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
["U0005",null,"Infec agen detec ampli probe",null,35.75,null,35.75,null,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM"]
["V0028",null,"Travel, vocational services, claimant",null,"State Rate",null,"State Rate",null,"000",0,0,0,9,9,9,9,9,9,null,"S"]
["V2020",null,"Vision svcs frames purchases",null,76.755600000000001,null,76.755600000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2025",null,"Eyeglasses delux frames",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V2100",null,"Lens spher single plano 4.00",null,48.482100000000003,null,48.482100000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2101",null,"Single visn sphere 4.12-7.00",null,49.862299999999998,null,49.862299999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2102",null,"Singl visn sphere 7.12-20.00",null,62.850600000000007,null,62.850600000000007,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2103",null,"Spherocylindr 4.00d/12-2.00d",null,46.051300000000005,null,46.051300000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2104",null,"Spherocylindr 4.00d/2.12-4d",null,47.400600000000004,null,47.400600000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2105",null,"Spherocylinder 4.00d/4.25-6d",null,53.467299999999994,null,53.467299999999994,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2106",null,"Spherocylinder 4.00d/>6.00d",null,57.360700000000001,null,57.360700000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2107",null,"Spherocylinder 4.25d/12-2d",null,49.718100000000007,null,49.718100000000007,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2108",null,"Spherocylinder 4.25d/2.12-4d",null,48.513000000000005,null,48.513000000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2109",null,"Spherocylinder 4.25d/4.25-6d",null,59.554600000000001,null,59.554600000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2110",null,"Spherocylinder 4.25d/over 6d",null,52.962600000000002,null,52.962600000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2111",null,"Spherocylindr 7.25d/.25-2.25",null,55.208000000000006,null,55.208000000000006,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2112",null,"Spherocylindr 7.25d/2.25-4d",null,61.161400000000008,null,61.161400000000008,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2113",null,"Spherocylindr 7.25d/4.25-6d",null,72.244200000000006,null,72.244200000000006,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2114",null,"Spherocylinder over 12.00d",null,78.712600000000009,null,78.712600000000009,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2115",null,"Lens lenticular bifocal",null,95.058700000000016,null,95.058700000000016,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2118",null,"Lens aniseikonic single",null,89.712999999999994,null,89.712999999999994,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2121",null,"Lenticular lens, single",null,100.4147,null,100.4147,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2199",null,"Lens single vision not oth c",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V2200",null,"Lens spher bifoc plano 4.00d",null,68.989400000000003,null,68.989400000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2201",null,"Lens sphere bifocal 4.12-7.0",null,69.267499999999998,null,69.267499999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2202",null,"Lens sphere bifocal 7.12-20.",null,76.178799999999995,null,76.178799999999995,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2203",null,"Lens sphcyl bifocal 4.00d/.1",null,67.691599999999994,null,67.691599999999994,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2204",null,"Lens sphcy bifocal 4.00d/2.1",null,68.021200000000007,null,68.021200000000007,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2205",null,"Lens sphcy bifocal 4.00d/4.2",null,70.390200000000007,null,70.390200000000007,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2206",null,"Lens sphcy bifocal 4.00d/ove",null,70.946399999999997,null,70.946399999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2207",null,"Lens sphcy bifocal 4.25-7d/.",null,66.167199999999994,null,66.167199999999994,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2208",null,"Lens sphcy bifocal 4.25-7/2.",null,64.920900000000003,null,64.920900000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2209",null,"Lens sphcy bifocal 4.25-7/4.",null,74.932500000000005,null,74.932500000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2210",null,"Lens sphcy bifocal 4.25-7/ov",null,84.975000000000009,null,84.975000000000009,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2211",null,"Lens sphcy bifo 7.25-12/.25-",null,92.782399999999996,null,92.782399999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2212",null,"Lens sphcyl bifo 7.25-12/2.2",null,93.482800000000012,null,93.482800000000012,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2213",null,"Lens sphcyl bifo 7.25-12/4.2",null,90.032299999999992,null,90.032299999999992,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2214",null,"Lens sphcyl bifocal over 12.",null,94.523099999999999,null,94.523099999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2215",null,"Lens lenticular bifocal",null,113.5472,null,113.5472,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2218",null,"Lens aniseikonic bifocal",null,118.86200000000001,null,118.86200000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2219",null,"Lens bifocal seg width over",null,48.1937,null,48.1937,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2220",null,"Lens bifocal add over 3.25d",null,39.088500000000003,null,39.088500000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2221",null,"Lenticular lens, bifocal",null,104.854,null,104.854,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2299",null,"Lens bifocal speciality",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V2300",null,"Lens sphere trifocal 4.00d",null,81.720200000000006,null,81.720200000000006,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2301",null,"Lens sphere trifocal 4.12-7.",null,85.871100000000013,null,85.871100000000013,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2302",null,"Lens sphere trifocal 7.12-20",null,88.775700000000001,null,88.775700000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2303",null,"Lens sphcy trifocal 4.0/.12-",null,81.205200000000005,null,81.205200000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2304",null,"Lens sphcy trifocal 4.0/2.25",null,75.0458,null,75.0458,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2305",null,"Lens sphcy trifocal 4.0/4.25",null,84.573300000000003,null,84.573300000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2306",null,"Lens sphcyl trifocal 4.00/>6",null,86.787800000000004,null,86.787800000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2307",null,"Lens sphcy trifocal 4.25-7/.",null,88.250400000000013,null,88.250400000000013,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2308",null,"Lens sphc trifocal 4.25-7/2.",null,97.860300000000009,null,97.860300000000009,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2309",null,"Lens sphc trifocal 4.25-7/4.",null,101.1769,null,101.1769,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2310",null,"Lens sphc trifocal 4.25-7/>6",null,96.614000000000004,null,96.614000000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2311",null,"Lens sphc trifo 7.25-12/.25-",null,96.449200000000005,null,96.449200000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2312",null,"Lens sphc trifo 7.25-12/2.25",null,99.322900000000004,null,99.322900000000004,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2313",null,"Lens sphc trifo 7.25-12/4.25",null,111.40479999999999,null,111.40479999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2314",null,"Lens sphcyl trifocal over 12",null,116.3488,null,116.3488,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2315",null,"Lens lenticular trifocal",null,131.69579999999999,null,131.69579999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2318",null,"Lens aniseikonic trifocal",null,158.78479999999999,null,158.78479999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2319",null,"Lens trifocal seg width > 28",null,53.755699999999997,null,53.755699999999997,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2320",null,"Lens trifocal add over 3.25d",null,64.179299999999998,null,64.179299999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2321",null,"Lenticular lens, trifocal",null,127.31830000000001,null,127.31830000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2399",null,"Lens trifocal speciality",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V2410",null,"Lens variab asphericity sing",null,114.845,null,114.845,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2430",null,"Lens variable asphericity bi",null,119.92290000000001,null,119.92290000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2499",null,"Variable asphericity lens",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V2500",null,"Contact lens pmma spherical",null,117.30670000000001,null,117.30670000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2501",null,"Cntct lens pmma-toric/prism",null,134.02360000000002,null,134.02360000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2502",null,"Contact lens pmma bifocal",null,165.10900000000001,null,165.10900000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2503",null,"Cntct lens pmma color vision",null,162.20439999999999,null,162.20439999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2510",null,"Cntct gas permeable sphericl",null,150.36970000000002,null,150.36970000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2511",null,"Cntct toric prism ballast",null,172.57650000000001,null,172.57650000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2512",null,"Cntct lens gas permbl bifocl",null,203.9194,null,203.9194,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2513",null,"Contact lens extended wear",null,186.93470000000002,null,186.93470000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2520",null,"Contact lens hydrophilic",null,126.60760000000001,null,126.60760000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2521",null,"Cntct lens hydrophilic toric",null,196.55490000000003,null,196.55490000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2522",null,"Cntct lens hydrophil bifocl",null,191.28130000000002,null,191.28130000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2523",null,"Cntct lens hydrophil extend",null,166.45830000000001,null,166.45830000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2524",null,"Cntct lens hydrophil photoch",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V2525",null,"Cl, hydrophilic, dual focus",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V2530",null,"Contact lens gas impermeable",null,241.43200000000002,null,241.43200000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2531",null,"Contact lens gas permeable",null,575.40949999999998,null,575.40949999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V2599",null,"Contact lens/es other type",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V2600",null,"Hand held low vision aids",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["V2610",null,"Single lens spectacle mount",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["V2615",null,"Telescop/othr compound lens",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["V2623",null,"Plastic eye prosth custom",null,1164.6313,null,1164.6313,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2624",null,"Polishing artifical eye",null,87.86930000000001,null,87.86930000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2625",null,"Enlargemnt of eye prosthesis",null,534.20949999999993,null,534.20949999999993,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2626",null,"Reduction of eye prosthesis",null,287.9674,null,287.9674,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2627",null,"Scleral cover shell",null,1859.7885999999999,null,1859.7885999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2628",null,"Fabrication & fitting",null,439.1302,null,439.1302,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2629",null,"Prosthetic eye other type",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["V2630",null,"Anter chamber intraocul lens",null,128.85300000000001,null,128.85300000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2631",null,"Iris support intraoclr lens",null,128.85300000000001,null,128.85300000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2632",null,"Post chmbr intraocular lens",null,128.85300000000001,null,128.85300000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2700",null,"Balance lens",null,47.421199999999999,null,47.421199999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2702",null,"Deluxe lens feature",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["V2710",null,"Glass/plastic slab off prism",null,69.411699999999996,null,69.411699999999996,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2715",null,"Prism lens/es",null,15.470599999999999,null,15.470599999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2718",null,"Fresnell prism press-on lens",null,30.910300000000003,null,30.910300000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2730",null,"Special base curve",null,22.8248,null,22.8248,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2744",null,"Tint photochromatic lens/es",null,19.662700000000001,null,19.662700000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2745",null,"Tint, any color/solid/grad",null,13.2973,null,13.2973,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2750",null,"Anti-reflective coating",null,20.661799999999999,null,20.661799999999999,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2755",null,"Uv lens/es",null,19.250700000000002,null,19.250700000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2756",null,"Eye glass case",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["V2760",null,"Scratch resistant coating",null,17.334899999999998,null,17.334899999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2761",null,"Mirror coating",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["V2762",null,"Polarization, any lens",null,63.334700000000005,null,63.334700000000005,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2770",null,"Occluder lens/es",null,21.321000000000002,null,21.321000000000002,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2780",null,"Oversize lens/es",null,13.565100000000001,null,13.565100000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2781",null,"Progressive lens per lens",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["V2782",null,"Lens, 1.54-1.65 p/1.60-1.79g",null,68.412599999999998,null,68.412599999999998,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2783",null,"Lens, >= 1.66 p/>=1.80 g",null,77.116100000000003,null,77.116100000000003,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2784",null,"Lens polycarb or equal",null,50.150700000000001,null,50.150700000000001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V2785",null,"Corneal tissue processing",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["V2786",null,"Occupational multifocal lens",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["V2787",null,"Astigmatism-correct function",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V2788",null,"Presbyopia-correct function",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V2790",null,"Amniotic membrane",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["V2797",null,"Vis item/svc in other code",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["V2799",null,"Misc vision item or service",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5008",null,"Hearing screening",null,89.919316226694221,null,89.919316226694221,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V5010",null,"Assessment for hearing aid",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["V5011",null,"Hearing aid fitting/checking",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["V5014",null,"Hearing aid repair/modifying",null,59.949888950746086,null,59.949888950746086,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL"]
["V5020",null,"Conformity evaluation",null,"Bundled",null,"Bundled",null,"000",0,0,0,9,9,9,9,9,9,null,"Bundled"]
["V5030",null,"Body-worn hearing aid air",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5040",null,"Body-worn hearing aid bone",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5050",null,"Hearing aid monaural in ear",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5060",null,"Behind ear hearing aid",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5070",null,"Glasses air conduction",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5080",null,"Glasses bone conduction",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5090",null,"Hearing aid dispensing fee",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5095",null,"Implant mid ear hearing pros",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5100",null,"Body-worn bilat hearing aid",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5110",null,"Hearing aid dispensing fee",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5120",null,"Body-worn binaur hearing aid",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5130",null,"In ear binaural hearing aid",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5140",null,"Behind ear binaur hearing ai",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5150",null,"Glasses binaural hearing aid",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5160",null,"Dispensing fee binaural",null,1702.5415361248697,null,1702.5415361248697,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V5171",null,"Hearing aid monaural ite",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5172",null,"Hearing aid monaural itc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5181",null,"Hearing aid monaural bte",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5190",null,"Hearing aid monaural glasses",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5200",null,"Disp fee contralateral monau",null,1020.4612056258048,null,1020.4612056258048,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V5211",null,"Hearing aid binaural ite/ite",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5212",null,"Hearing aid binaural ite/itc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5213",null,"Hearing aid binaural ite/bte",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5214",null,"Hearing aid binaural itc/itc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5215",null,"Hearing aid binaural itc/bte",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5221",null,"Hearing aid binaural bte/bte",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5230",null,"Hearing aid binaural glasses",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5240",null,"Disp fee contralateral binau",null,1020.4612056258048,null,1020.4612056258048,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V5241",null,"Dispensing fee, monaural",null,851.27076806243485,null,851.27076806243485,null,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM"]
["V5242",null,"Hearing aid, monaural, cic",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5243",null,"Hearing aid, monaural, itc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5244",null,"Hearing aid, prog, mon, cic",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5245",null,"Hearing aid, prog, mon, itc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5246",null,"Hearing aid, prog, mon, ite",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5247",null,"Hearing aid, prog, mon, bte",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5248",null,"Hearing aid, binaural, cic",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5249",null,"Hearing aid, binaural, itc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5250",null,"Hearing aid, prog, bin, cic",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5251",null,"Hearing aid, prog, bin, itc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5252",null,"Hearing aid, prog, bin, ite",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5253",null,"Hearing aid, prog, bin, bte",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5254",null,"Hearing id, digit, mon, cic",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5255",null,"Hearing aid, digit, mon, itc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5256",null,"Hearing aid, digit, mon, ite",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5257",null,"Hearing aid, digit, mon, bte",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5258",null,"Hearing aid, digit, bin, cic",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5259",null,"Hearing aid, digit, bin, itc",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5260",null,"Hearing aid, digit, bin, ite",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5261",null,"Hearing aid, digit, bin, bte",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM"]
["V5262",null,"Hearing aid, disp, monaural",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5263",null,"Hearing aid, disp, binaural",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5264",null,"Ear mold/insert",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-PHL"]
["V5265",null,"Ear mold/insert, disp",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5266",null,"Battery for hearing device",null,1.0482678907272001,null,1.0482678907272001,null,"000",0,0,0,9,9,9,9,9,9,null,"F"]
["V5267",null,"Hearing aid sup/access/dev",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-PHL"]
["V5268",null,"Ald telephone amplifier",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5269",null,"Alerting device, any type",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5270",null,"Ald, tv amplifier, any type",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5271",null,"Ald, tv caption decoder",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5272",null,"Tdd",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5273",null,"Ald for cochlear implant",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5274",null,"Ald unspecified",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5275",null,"Ear impression",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5281",null,"Ald fm/dm system, monaural",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5282",null,"Ald fm/dm system binaural",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5283",null,"Ald neck, loop ind receiver",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5284",null,"Ald fm/dm ear level receiver",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5285",null,"Ald fm/dm aud input receiver",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5286",null,"Ald blu tooth fm/dm receiver",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5287",null,"Ald fm/dm receiver, nos",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5288",null,"Ald fm/dm transmitter ald",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5289",null,"Ald fm/dm adapt/boot couplin",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5290",null,"Ald transmitter microphone",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5298",null,"Hearing aid noc",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,9,9,9,9,9,9,null,"X"]
["V5299",null,"Hearing service",null,"Not Covered",null,"Not Covered",null,"000",0,0,0,0,0,0,0,0,0,null,"X"]
["V5336",null,"Repair communication device",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["V5362",null,"Speech screening",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["V5363",null,"Language screening",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]
["V5364",null,"Dysphagia screening",null,"By Report",null,"By Report",null,"000",0,0,0,9,9,9,9,9,9,null,"N"]

{"sheet":"Updates and Corrections","index":4,"n_rows":16,"n_cols":4,"rows_kept":16,"cut":false,"hidden":false,"merged":[[0,0,0,2],[4,3,5,5]]}
["Updates and Corrections"]
["Posting date","Policy Area","Description"]
[]
[]
[null,null,null,"*Background query may take up to 20 seconds to complete."]
["Posting date","Description","Updated Version"]
["2022-05-31","New HCPCS and Deleted HCPCS codes. See file for effective dates.​","New and Deleted HCPCS July 2022"]
[]
["Posting date","Policy Area","Description"]
[]
[]
["Posting date","Description","Updated Version"]
[]
[]
["Posting date","Policy Area","Description"]
["2022-06-30","Temporary Telehealth IME and Record Review Policy​","To help support containment of the COVID-19 outbreak, the Temporary IME and Record Review policy allows temporary coverage for independent medical examiners to complete exams via telehealth. This policy is effective 3/9/2020 and expires 12/31/2022​. This is an emerging situation, and this policy may be updated as needed.​ ​"]

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[null,null,null,"DOLLAR VALUE",null,null,"MODIFIERS"]
["CODE","Modifiers","Modcheck","Short Description (HCPCS and Local Only)","NON-FACILITY SETTING","FACILITY SETTING","FOL UP","PRE OP\n(-56)","INTRA OP\n(-54)","POST OP\n(-55)","PCTC\n(26/TC)","MSI\n(-51)","BSI\n(-50)","ASI\n(-80)","CSI\n(-62)","TSI\n(-66)","ENDO\nBASE","FSI","LIC REQ","Prior Auth","MARFS Chapters","MARFS Chapters2","MARFS Chapters3"]
[10004,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",90.973799999999997,75.514200000000002,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[10005,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",252.11040000000003,130.2174,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[10006,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",107.62260000000001,88.595399999999998,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[10007,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",559.51859999999999,159.94739999999999,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[10008,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",304.43520000000001,100.48739999999999,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[10009,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",844.33199999999999,195.02879999999999,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[10010,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",494.11260000000004,139.73099999999999,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[10011,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,0,2,0,0,0,0,null,"N",null,"Y-CM",2,29]
[10012,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,0,0,0,0,0,0,null,"N",null,"Y-CM",2,29]
[10021,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,0,2,0,0,0,0,null,"X",null,null,2,29]
[10030,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1240.9302,236.6508,"000",0,0,0,9,2,9,0,0,0,null,"R",null,"Y-CM",2,29]
[10035,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,0,2,1,0,0,0,null,"X",null,null,2,29]
[10036,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2,29]
[10040,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",213.4614,91.568399999999997,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[10060,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",227.13720000000001,188.48820000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[10061,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",385.8954,328.2192,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[10080,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",478.65300000000008,187.89360000000002,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[10081,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",645.73559999999998,305.02980000000002,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[10120,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",275.2998,186.10980000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[10121,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",483.40980000000008,327.03000000000003,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[10140,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",311.57040000000001,211.083,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[10160,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",236.05620000000002,170.0556,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[10180,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",482.22059999999999,317.51639999999998,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11000,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",106.43340000000001,48.757199999999997,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11001,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",48.162600000000005,24.973199999999999,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[11004,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",997.14419999999996,997.14419999999996,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11005,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1356.8772000000001,1356.8772000000001,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[11006,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1227.2544,1227.2544,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11008,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",478.05839999999995,478.05839999999995,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[11010,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",831.84540000000004,488.76120000000003,"010",0.1,0.8,0.1,0,2,2,1,0,0,null,"R",null,null,2,29]
[11011,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",912.1164,522.05880000000002,"000",0,0,0,0,2,2,1,0,0,null,"R",null,null,2,29]
[11012,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1181.4702,731.95260000000007,"000",0,0,0,0,2,2,1,0,0,null,"R",null,null,2,29]
[11042,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",239.02919999999997,106.43340000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11043,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",422.166,270.54300000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11044,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",557.73480000000006,394.81439999999998,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11045,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",73.730400000000003,45.784199999999998,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[11046,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",131.4066,96.919799999999995,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[11047,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",214.6506,169.46100000000001,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[11055,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",134.37959999999998,27.946199999999997,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11056,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",153.4068,38.649000000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11057,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",167.6772,50.540999999999997,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11102,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",189.08280000000002,66.595200000000006,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11103,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",93.94680000000001,38.649000000000001,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[11104,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",234.86700000000002,82.6494,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11105,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",109.4064,45.189599999999999,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[11106,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",290.75939999999997,99.892799999999994,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11107,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",132.00120000000001,54.703200000000002,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[11200,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",164.1096,136.1634,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11201,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",32.703000000000003,28.540800000000001,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11300,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",189.67740000000001,60.054600000000001,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11301,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",226.54259999999999,89.784599999999998,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11302,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",255.678,105.83880000000001,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11303,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",281.84040000000005,124.2714,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11305,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",198.59639999999999,67.189799999999991,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11306,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",227.73180000000002,86.811599999999999,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11307,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",259.84019999999998,110.5956,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11308,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",274.70519999999999,124.2714,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11310,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",215.8398,80.271000000000001,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11311,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",253.89419999999998,110.001,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11312,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",287.1918,129.62280000000001,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11313,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",334.16520000000003,169.46100000000001,"000",0,0,0,0,2,9,0,0,0,null,"R",null,null,2,29]
[11400,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",236.05620000000002,149.83920000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11401,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",287.78640000000001,189.08280000000002,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11402,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",316.3272,206.92080000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11403,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",361.51679999999999,265.19159999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11404,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",410.86860000000001,292.54320000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11406,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",579.1404,440.59860000000003,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11420,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",235.4616,147.46080000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11421,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",293.73240000000004,195.02879999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11422,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",328.81380000000001,242.00220000000002,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11423,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",374.0034,277.08359999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11424,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",427.51740000000001,315.73259999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11426,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",603.51900000000001,482.81519999999995,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11440,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",264.59700000000004,189.67740000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11441,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",319.89479999999998,237.84,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11442,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",353.78700000000003,261.62400000000002,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11443,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",416.22,318.7056,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11444,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",516.11279999999999,401.94959999999998,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11446,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",699.24959999999999,567.84300000000007,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11450,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",805.68300000000011,469.73400000000004,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,null,2,29]
[11451,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",974.54939999999999,590.43780000000004,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,null,2,29]
[11462,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",783.08820000000003,447.13919999999996,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,null,2,29]
[11463,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",991.79279999999994,596.38379999999995,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,null,2,29]
[11470,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",843.14279999999997,511.95059999999995,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[11471,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1006.6578,628.49220000000003,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[11600,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",364.4898,217.62360000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11601,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",419.19299999999998,263.40780000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11602,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",446.5446,286.59720000000004,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11603,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",507.19379999999995,341.30040000000002,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11604,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",564.87,375.78720000000004,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11606,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",809.25059999999996,560.11320000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11620,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",365.67900000000003,218.81280000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11621,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",420.38220000000001,264.59700000000004,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11622,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",461.40960000000001,299.67840000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11623,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",538.70760000000007,369.84120000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11624,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",612.4380000000001,420.38220000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11626,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",737.30400000000009,516.70740000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11640,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",374.0034,225.35339999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11641,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",433.46340000000004,275.2998,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11642,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",488.76120000000003,322.27319999999997,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11643,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",572.59980000000007,401.94959999999998,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11644,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",704.601,498.86940000000004,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11646,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",912.71100000000001,689.73599999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11719,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",24.973199999999999,13.081200000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11720,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",58.865400000000001,25.567799999999998,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[11721,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",79.676400000000001,42.2166,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[11730,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",211.67760000000001,94.54140000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11732,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",61.2438,30.3246,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[11740,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",105.24420000000001,56.486999999999995,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11750,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",293.13779999999997,180.75839999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11755,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",225.94799999999998,106.43340000000001,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[11760,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",346.65180000000004,198.0018,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11762,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",531.57240000000002,335.94900000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11765,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",306.21900000000005,164.1096,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[11770,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",671.30340000000001,331.78680000000003,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11771,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1160.0646000000002,806.27760000000001,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11772,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1428.2292,1047.0906,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[11900,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",103.46040000000001,51.730200000000004,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11901,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",127.839,80.865600000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[11920,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",356.76,194.4342,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[11921,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",404.92259999999999,229.51560000000001,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[11922,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",109.4064,51.730200000000004,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[11950,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",144.48780000000002,91.568399999999997,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[11951,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",193.83959999999999,129.0282,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[11952,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",258.0564,181.35299999999998,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[11954,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",284.21880000000004,198.0018,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[11960,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1827.8003999999999,1827.8003999999999,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[11970,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1004.2794,1004.2794,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,null,2,29]
[11971,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",984.0630000000001,984.0630000000001,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,null,2,29]
[11976,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,0,2,0,0,0,0,null,"X",null,null,2,29]
[11980,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,0,2,0,1,0,0,null,"X",null,null,2,29]
[11981,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",183.13679999999999,111.1902,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[11982,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",204.54239999999999,130.2174,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[11983,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",256.27259999999995,181.94759999999999,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[12001,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",171.2448,79.081800000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[12002,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",205.73160000000001,103.46040000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[12004,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",238.43459999999999,127.24440000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[12005,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",321.084,165.89340000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[12006,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",374.59800000000001,203.9478,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[12007,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",420.38220000000001,254.48880000000003,"000",0,0,0,0,2,0,1,1,0,null,"R",null,null,2,29]
[12011,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",204.54239999999999,96.325200000000009,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[12013,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",212.86680000000001,101.67659999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[12014,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",260.4348,130.2174,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[12015,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",311.57040000000001,164.70420000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[12016,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",397.78740000000005,224.75879999999998,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[12017,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",265.78620000000001,265.78620000000001,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[12018,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",301.4622,301.4622,"000",0,0,0,0,2,0,2,0,0,null,"R",null,null,2,29]
[12020,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",551.78879999999992,334.16520000000003,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12021,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",322.27319999999997,251.51580000000004,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12031,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",487.57199999999995,268.75919999999996,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12032,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",557.14019999999994,336.54360000000003,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12034,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",614.81640000000004,363.30060000000003,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12035,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",714.1146,427.51740000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12036,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",793.19640000000004,501.8424,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12037,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",883.57560000000001,580.32960000000003,"010",0.1,0.8,0.1,0,2,0,0,1,0,null,"R",null,null,2,29]
[12041,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",489.35580000000004,255.08340000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12042,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",570.81600000000003,346.65180000000004,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12044,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",701.62800000000004,377.57099999999997,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12045,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",748.0068,482.22059999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12046,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",923.41379999999992,567.84300000000007,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[12047,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1007.847,629.68140000000005,"010",0.1,0.8,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[12051,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",523.84260000000006,300.27299999999997,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12052,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",580.32960000000003,352.59780000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12053,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",671.30340000000001,379.35480000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12054,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",709.3578,385.30080000000004,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12055,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",926.98140000000001,528.00480000000005,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[12056,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1064.3339999999998,683.79,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[12057,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1121.4156,744.43920000000003,"010",0.1,0.8,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[13100,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",628.49220000000003,354.38159999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[13101,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",733.14179999999999,440.59860000000003,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[13102,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",213.4614,127.24440000000001,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[13120,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",654.65459999999996,414.43619999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[13121,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",782.49360000000001,454.27440000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[13122,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",230.70480000000001,144.48780000000002,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[13131,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",712.33080000000007,427.51740000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[13132,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",863.9538,534.54539999999997,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[13133,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",303.84060000000005,220.00200000000001,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[13151,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",774.76379999999995,491.73419999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[13152,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",908.54880000000003,592.22160000000008,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[13153,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",333.57060000000001,240.2184,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[13160,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1418.7156,1418.7156,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[14000,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1150.5510000000002,895.46760000000006,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[14001,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1461.5267999999999,1160.0646000000002,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[14020,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1268.8764000000001,1005.4686,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[14021,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1559.6358,1256.9844000000001,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[14040,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1365.7962,1104.7667999999999,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[14041,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1654.7718,1348.5527999999999,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[14060,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1378.8774000000001,1178.4972,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[14061,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1783.8,1448.4456,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[14301,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1956.2339999999999,1539.4194,"090",0.1,0.71,0.19,0,2,0,2,0,0,null,"R",null,null,2,29]
[14302,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",379.35480000000001,379.35480000000001,"000",0,0,0,0,0,0,2,0,0,null,"R",null,null,2,29]
[14350,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1211.2002,1211.2002,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15002,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",635.03279999999995,386.49,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[15003,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",126.6498,79.676400000000001,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[15004,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",720.65519999999992,460.22040000000004,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[15005,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",211.083,159.3528,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[15040,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",487.57199999999995,217.62360000000001,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15050,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1086.9288000000001,829.46699999999998,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15100,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1575.0953999999999,1276.0116,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15101,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",345.46260000000001,198.59639999999999,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15110,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1495.4189999999999,1259.3628000000001,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15111,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",199.78559999999999,178.38,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15115,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1445.4726000000001,1221.903,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15116,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",290.75939999999997,262.21860000000004,"000",0,0,0,0,0,0,1,1,0,null,"R",null,null,2,29]
[15120,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1526.3382000000001,1225.4705999999999,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15121,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",387.67919999999998,239.62380000000002,"000",0,0,0,0,0,0,1,1,0,null,"R",null,null,2,29]
[15130,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1314.6605999999999,1067.307,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15131,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",172.434,158.1636,"000",0,0,0,0,0,0,1,1,0,null,"R",null,null,2,29]
[15135,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1584.0144,1347.9582,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15136,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",170.65020000000001,158.1636,"000",0,0,0,0,0,0,1,1,0,null,"R",null,null,2,29]
[15150,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1277.2008000000001,1142.2266,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15151,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",209.8938,192.65040000000002,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15152,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",259.84019999999998,244.38060000000002,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15155,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1432.9860000000001,1298.6064000000001,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15156,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",281.84040000000005,264.59700000000004,"000",0,0,0,0,0,0,1,1,0,null,"R",null,null,2,29]
[15157,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",313.35419999999999,287.78640000000001,"000",0,0,0,0,0,0,1,1,0,null,"R",null,null,2,29]
[15200,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1516.23,1195.7406000000001,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15201,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",257.46179999999998,133.785,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15220,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1390.1748,1083.3612000000001,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15221,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",240.2184,121.2984,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15240,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1674.3936000000001,1413.3642,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15241,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",316.3272,184.92060000000001,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15260,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1793.9082000000001,1498.9866000000002,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15261,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",375.19259999999997,240.2184,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15271,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",283.02960000000002,147.46080000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[15272,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",45.189599999999999,30.9192,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15273,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",576.76199999999994,347.24639999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[15274,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",153.4068,79.676400000000001,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15275,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",290.75939999999997,164.1096,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[15276,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",58.270800000000001,44.594999999999999,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15277,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",632.05980000000011,395.40900000000005,"000",0,0,0,0,2,0,1,1,0,null,"R",null,null,2,29]
[15278,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",176.59620000000001,99.298199999999994,"000",0,0,0,0,0,0,1,1,0,null,"R",null,null,2,29]
[15570,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1647.6366,1304.5524,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15572,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1578.663,1303.9577999999999,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15574,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1588.7711999999999,1315.2552000000001,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15576,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1417.5264,1158.8753999999999,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15600,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",623.14080000000001,380.54400000000004,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15610,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",673.68180000000007,436.43639999999999,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15620,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",816.98040000000003,585.08640000000003,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15630,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",841.35900000000004,613.62720000000002,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15650,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",930.54899999999998,681.41160000000002,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15730,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2619.8076000000001,1626.231,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R",null,null,2,29]
[15731,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2019.8561999999999,1776.6648,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15733,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1833.7464,1833.7464,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R",null,null,2,29]
[15734,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2667.3755999999998,2667.3755999999998,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,null,2,29]
[15736,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2167.9115999999999,2167.9115999999999,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R",null,null,2,29]
[15738,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2267.2098000000001,2267.2098000000001,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,null,2,29]
[15740,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1814.1246000000001,1490.6622,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15750,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1660.1232000000002,1660.1232000000002,"090",0.1,0.71,0.19,0,2,0,2,0,0,null,"R",null,null,2,29]
[15756,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4061.7126000000003,4061.7126000000003,"090",0.1,0.71,0.19,0,2,0,2,2,0,null,"R",null,null,2,29]
[15757,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4039.1178000000004,4039.1178000000004,"090",0.1,0.71,0.19,0,2,0,2,2,0,null,"R",null,null,2,29]
[15758,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4036.1447999999996,4036.1447999999996,"090",0.1,0.71,0.19,0,2,0,2,2,0,null,"R",null,null,2,29]
[15760,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1522.7706000000001,1244.4978000000001,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15769,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",853.84559999999999,853.84559999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[15770,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1200.4974000000002,1200.4974000000002,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,null,2,29]
[15771,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,0,1,0,0,null,"X",null,null,2,29]
[15772,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,0,0,0,1,0,0,null,"X",null,null,2,29]
[15773,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,0,1,0,0,null,"X",null,null,2,29]
[15774,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,0,0,0,1,0,0,null,"X",null,null,2,29]
[15775,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",686.76300000000003,451.3014,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[15776,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",926.38679999999999,616.60019999999997,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[15777,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",378.7602,378.7602,"000",0,0,0,0,0,1,1,0,0,null,"R",null,null,2,29]
[15780,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1531.6896000000002,1174.9296000000002,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15781,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",985.25220000000002,768.81780000000003,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15782,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",881.79179999999997,656.4384,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15783,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",812.81820000000005,628.49220000000003,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15786,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",424.5444,236.6508,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[15787,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",56.486999999999995,30.3246,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[15788,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.71,0.19,0,2,0,1,0,0,null,"X",null,null,2,29]
[15789,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.71,0.19,0,2,0,1,0,0,null,"X",null,null,2,29]
[15792,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.71,0.19,0,2,0,0,0,0,null,"X",null,null,2,29]
[15793,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.71,0.19,0,2,0,0,0,0,null,"X",null,null,2,29]
[15819,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.71,0.19,0,2,0,0,0,0,null,"X",null,null,2,29]
[15820,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1044.1176,922.22460000000001,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[15821,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1120.8210000000001,987.03600000000006,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[15822,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",838.98059999999998,718.87139999999999,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[15823,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1121.4156,986.44140000000004,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[15824,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1576.4879493792002,1576.4879493792002,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,29]
[15825,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1355.5079139888001,1355.5079139888001,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,29]
[15826,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1281.8334795552003,1281.8334795552003,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,29]
[15828,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4390.6220248176014,4390.6220248176014,"000",0,0,0,0,2,1,0,0,0,null,"F",null,"Y-CM",2,29]
[15829,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,0,2,1,0,0,0,null,"N",null,"Y-CM",2,29]
[15830,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2085.2622000000001,2085.2622000000001,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[15832,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1635.7446000000002,1635.7446000000002,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[15833,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1565.5817999999999,1565.5817999999999,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[15834,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1594.1225999999999,1594.1225999999999,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[15835,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1658.934,1658.934,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[15836,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1424.067,1424.067,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[15837,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1564.9872,1278.9846,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[15838,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1161.8483999999999,1161.8483999999999,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[15839,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1609.5822000000001,1318.8227999999999,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[15840,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1813.53,1813.53,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15841,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3167.4342000000001,3167.4342000000001,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,null,2,29]
[15842,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4792.4759999999997,4792.4759999999997,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,null,2,29]
[15845,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1894.3956000000001,1894.3956000000001,"090",0.1,0.71,0.19,0,2,0,2,0,0,null,"R",null,null,2,29]
[15847,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,0,0,0,2,1,0,null,"N",null,"Y-CM",2,29]
[15850,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",0,0,"000",0,0,0,9,9,9,9,9,9,null,"Bundledundled",null,null,2,29]
[15851,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",197.40719999999999,79.081800000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[15852,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",82.0548,82.0548,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[15860,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",187.29900000000001,187.29900000000001,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[15876,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,0,2,0,0,0,0,null,"X",null,null,2,29]
[15877,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,0,2,0,0,0,0,null,"X",null,null,2,29]
[15878,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,0,2,1,0,0,0,null,"X",null,null,2,29]
[15879,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,0,2,1,0,0,0,null,"X",null,null,2,29]
[15920,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1149.9564,1149.9564,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15922,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1429.4184,1429.4184,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,null,2,29]
[15931,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1251.0383999999999,1251.0383999999999,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15933,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1562.6088000000002,1562.6088000000002,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15934,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1694.6100000000001,1694.6100000000001,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15935,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2067.4242000000004,2067.4242000000004,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,null,2,29]
[15936,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1615.5282000000002,1615.5282000000002,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R",null,null,2,29]
[15937,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1869.4224000000002,1869.4224000000002,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R",null,null,2,29]
[15940,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1254.0114000000001,1254.0114000000001,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15941,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1670.826,1670.826,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15944,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1673.2044000000001,1673.2044000000001,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15945,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1824.8274000000001,1824.8274000000001,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,null,2,29]
[15946,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2887.3776000000003,2887.3776000000003,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R",null,null,2,29]
[15950,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1143.4158,1143.4158,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,null,2,29]
[15951,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1614.9336000000001,1614.9336000000001,"090",0.1,0.71,0.19,0,2,0,0,1,0,null,"R",null,null,2,29]
[15952,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1639.3122000000001,1639.3122000000001,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,null,2,29]
[15953,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1807.5839999999998,1807.5839999999998,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R",null,null,2,29]
[15956,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2094.7757999999999,2094.7757999999999,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R",null,null,2,29]
[15958,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2132.2356,2132.2356,"090",0.1,0.71,0.19,0,2,0,1,1,0,null,"R",null,null,2,29]
[15999,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,0,2,0,0,1,1,null,"N",null,null,2,29]
[16000,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",137.3526,79.081800000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[16020,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",154.596,96.919799999999995,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[16025,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",286.00259999999997,196.8126,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[16030,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",357.94919999999996,231.89400000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[16035,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",337.13819999999998,337.13819999999998,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[16036,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",137.3526,137.3526,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[17000,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",122.4876,98.703599999999994,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17003,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",12.486599999999999,3.5676000000000001,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17004,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",309.19200000000001,173.02860000000001,"010",0.1,0.8,0.1,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17106,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",618.38400000000001,488.76120000000003,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17107,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",805.68300000000011,637.41120000000001,"090",0.1,0.71,0.19,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17108,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1133.3075999999999,928.76519999999994,"090",0.1,0.71,0.19,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[17110,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",208.7046,119.51459999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17111,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",243.78599999999997,145.67700000000002,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17250,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",165.89340000000001,66.595200000000006,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[17260,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",181.94759999999999,125.4606,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17261,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",270.54300000000001,152.81219999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17262,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",326.43540000000002,194.4342,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17263,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",352.59780000000001,215.24520000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17264,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",376.97640000000001,230.11020000000002,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17266,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",428.11200000000002,269.94839999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17270,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",271.13759999999996,166.488,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17271,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",302.65140000000002,184.32600000000002,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17272,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",344.27339999999998,213.4614,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17273,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",380.54400000000004,241.40759999999997,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17274,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",443.57159999999999,294.92160000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17276,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",514.92359999999996,354.97620000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17280,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",255.678,152.2176,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17281,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",327.62459999999999,208.11,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17282,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",374.0034,240.2184,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17283,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",440.00400000000002,299.0838,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17284,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",500.05860000000001,350.21940000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17286,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",638.60040000000004,472.70699999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17311,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1223.6867999999999,624.33000000000004,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17312,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",748.0068,331.78680000000003,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17313,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1151.1456000000001,560.70780000000002,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17314,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",716.49300000000005,307.40820000000002,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17315,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",139.13639999999998,88.000799999999998,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[17340,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","010",0.1,0.8,0.1,0,2,0,1,0,0,null,"X",null,null,2,29]
[17360,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","010",0.1,0.8,0.1,0,2,0,1,0,0,null,"X",null,null,2,29]
[17380,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,0,2,0,0,0,0,null,"X",null,null,2,29]
[17999,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,0,2,0,0,1,1,null,"N",null,null,2,29]
[19000,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",189.67740000000001,74.919600000000003,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[19001,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",47.568000000000005,36.865200000000002,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[19020,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",868.11599999999999,562.49160000000006,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,null,2,29]
[19030,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",304.43520000000001,132.5958,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[19081,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",950.7654,288.38099999999997,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[19082,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",749.19600000000003,145.08240000000001,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[19083,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",963.84660000000008,272.32679999999999,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[19084,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",741.46620000000007,134.9742,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[19085,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1487.0946000000001,316.3272,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[19086,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1164.2267999999999,157.56899999999999,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[19100,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",284.8134,121.89299999999999,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[19101,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",609.46500000000003,400.7604,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[19105,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,0,2,1,1,0,0,null,"X",null,null,2,29]
[19110,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",898.44060000000002,632.65440000000001,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[19112,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",855.03480000000002,582.11339999999996,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[19120,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",941.2518,745.62839999999994,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[19125,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1036.3878,825.89940000000001,"090",0.1,0.71,0.19,0,2,1,1,1,0,null,"R",null,"Y-CM",2,29]
[19126,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",281.84040000000005,281.84040000000005,"000",0,0,0,0,0,0,1,1,0,null,"R",null,"Y-CM",2,29]
[19281,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",442.97700000000003,174.21780000000001,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[19282,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",317.51639999999998,86.811599999999999,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[19283,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",483.40980000000008,175.40700000000001,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[19284,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",363.89519999999999,88.000799999999998,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[19285,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",714.1146,148.65,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[19286,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",592.22160000000008,74.919600000000003,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[19287,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1238.5518,221.19120000000001,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[19288,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",965.6303999999999,111.1902,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[19294,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",288.97560000000004,288.97560000000004,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[19296,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,0,2,1,0,0,0,null,"X",null,null,2,29]
[19297,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2,29]
[19298,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,0,2,1,0,0,0,null,"X",null,null,2,29]
[19300,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.71,0.19,0,2,1,1,0,0,null,"X",null,null,2,29]
[19301,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.71,0.19,0,2,1,0,0,0,null,"X",null,null,2,29]
[19302,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.71,0.19,0,2,1,2,1,0,null,"X",null,null,2,29]
[19303,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.71,0.19,0,2,1,2,1,0,null,"X",null,null,2,29]
[19305,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.71,0.19,0,2,1,2,1,0,null,"X",null,null,2,29]
[19306,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.71,0.19,0,2,1,2,1,0,null,"X",null,null,2,29]
[19307,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.71,0.19,0,2,1,2,1,0,null,"X",null,null,2,29]
[19316,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1412.175,1412.175,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[19318,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1946.7204000000002,1946.7204000000002,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[19325,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1100.01,1100.01,"090",0.1,0.71,0.19,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[19328,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",991.19820000000016,991.19820000000016,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[19330,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1154.7132000000001,1154.7132000000001,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[19340,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1353.9041999999999,1353.9041999999999,"090",0.1,0.71,0.19,0,2,1,1,1,0,null,"R",null,"Y-CM",2,29]
[19342,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1359.8502000000001,1359.8502000000001,"090",0.1,0.71,0.19,0,2,1,0,1,0,null,"R",null,"Y-CM",2,29]
[19350,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1501.365,1202.8758,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[19355,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.71,0.19,0,2,1,0,0,0,null,"X",null,null,2,29]
[19357,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2078.1270000000004,2078.1270000000004,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[19361,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2771.4306000000001,2771.4306000000001,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[19364,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4832.3141999999998,4832.3141999999998,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[19367,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3148.4070000000002,3148.4070000000002,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[19368,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3857.1702000000005,3857.1702000000005,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[19369,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3584.8434000000002,3584.8434000000002,"090",0.1,0.71,0.19,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[19370,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1199.3082000000002,1199.3082000000002,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[19371,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1271.2547999999999,1271.2547999999999,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[19380,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1441.3103999999998,1441.3103999999998,"090",0.1,0.71,0.19,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[19396,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",509.57220000000001,252.70500000000001,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[19499,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,0,2,1,0,1,1,null,"N",null,null,2,29]
[20100,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1066.7124000000001,1066.7124000000001,"010",0.1,0.8,0.1,0,2,1,2,0,0,null,"R",null,null,2,29]
[20101,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1115.4696000000001,375.19259999999997,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[20102,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1160.0646000000002,454.27440000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[20103,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1037.577,613.0326,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[20150,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1787.3676,1787.3676,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[20200,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",408.49020000000002,166.488,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[20205,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",563.68080000000009,271.13759999999996,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[20206,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",429.89580000000001,101.08199999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[20220,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",444.76080000000002,152.81219999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[20225,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",735.52019999999993,228.32640000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[20240,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",249.13740000000001,249.13740000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[20245,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",611.24879999999996,611.24879999999996,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[20250,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",688.54679999999996,688.54679999999996,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[20251,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",751.57440000000008,751.57440000000008,"010",0.1,0.8,0.1,0,2,0,2,0,0,null,"R",null,null,2,29]
[20500,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",220.5966,155.7852,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[20501,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",274.70519999999999,65.406000000000006,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[20520,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",399.57119999999998,264.59700000000004,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[20525,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",862.17,440.59860000000003,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[20526,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",148.05540000000002,101.08199999999999,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[20527,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",156.9744,115.947,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[20550,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",103.46040000000001,68.97359999999999,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[20551,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",104.64960000000001,68.97359999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[20552,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",96.919799999999995,66.595200000000006,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[20553,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",111.78479999999999,75.514200000000002,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[20555,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,0,0,0,null,"X",null,null,2,29]
[20560,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",48.162600000000005,26.757000000000001,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[20561,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",68.378999999999991,39.243600000000001,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[20600,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",95.73060000000001,63.027600000000007,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[20604,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",148.65,80.865600000000001,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[20605,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",98.703599999999994,65.406000000000006,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[20606,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",161.7312,90.973799999999997,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[20610,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",117.1362,79.676400000000001,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[20611,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",180.75839999999999,104.64960000000001,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[20612,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",115.947,72.541200000000003,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[20615,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",461.40960000000001,286.00259999999997,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[20650,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",406.11180000000002,288.38099999999997,"010",0.1,0.8,0.1,0,2,0,1,1,0,null,"R",null,null,2,29]
[20660,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",419.7876,419.7876,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[20661,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",916.8732,916.8732,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[20662,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",937.08960000000002,937.08960000000002,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[20663,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",863.9538,863.9538,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[20664,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1573.3116,1573.3116,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[20665,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",209.8938,171.83940000000001,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[20670,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",671.30340000000001,258.65100000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[20680,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1100.01,748.0068,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[20690,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1063.7394000000002,1063.7394000000002,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[20692,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1998.4505999999999,1998.4505999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20693,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",794.98019999999997,794.98019999999997,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[20694,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",781.899,610.65419999999995,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[20696,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2107.2624000000001,2107.2624000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20697,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3553.9242000000004,3553.9242000000004,"000",0,0,0,3,0,0,2,1,0,null,"R",null,null,2,29]
[20700,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",149.83920000000001,149.83920000000001,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[20701,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",113.5686,113.5686,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[20702,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",252.11040000000003,252.11040000000003,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[20703,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",183.73140000000001,183.73140000000001,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[20704,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",266.38080000000002,266.38080000000002,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[20705,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",218.2182,218.2182,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[20802,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4858.4766,4858.4766,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[20805,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",5768.8091999999997,5768.8091999999997,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[20808,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",6957.4146000000001,6957.4146000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[20816,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3637.7628,3637.7628,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20822,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3146.6232,3146.6232,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20824,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3644.3033999999998,3644.3033999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[20827,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3229.2726000000002,3229.2726000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[20838,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4938.7476000000006,4938.7476000000006,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[20900,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",726.00660000000005,321.084,"000",0,0,0,0,2,0,2,1,0,null,"R",null,null,2,29]
[20902,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",488.76120000000003,488.76120000000003,"000",0,0,0,0,2,0,2,1,0,null,"R",null,null,2,29]
[20910,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",855.03480000000002,855.03480000000002,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[20912,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",864.54840000000002,864.54840000000002,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[20920,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",714.70920000000001,714.70920000000001,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,null,2,29]
[20922,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1087.5234,869.89980000000003,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20924,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",906.76499999999999,906.76499999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20930,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2,29]
[20931,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",192.0558,192.0558,"000",0,0,0,0,0,0,1,1,0,null,"R",null,null,2,29]
[20932,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1328.3363999999999,1328.3363999999999,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR",2,29]
[20933,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1219.5246000000002,1219.5246000000002,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR",2,29]
[20934,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1327.1472000000001,1327.1472000000001,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR",2,29]
[20936,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2,29]
[20937,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",291.35400000000004,291.35400000000004,"000",0,0,0,0,0,0,2,1,0,null,"R",null,null,2,29]
[20938,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",320.48939999999999,320.48939999999999,"000",0,0,0,0,0,0,2,1,0,null,"R",null,null,2,29]
[20939,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",121.2984,121.2984,"000",0,0,0,0,0,1,0,0,0,null,"R",null,"Y-UR",2,29]
[20950,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",498.27480000000003,155.7852,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[20955,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4376.2559999999994,4376.2559999999994,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20956,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4674.7452000000003,4674.7452000000003,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20957,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4868.5847999999996,4868.5847999999996,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20962,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4727.07,4727.07,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20969,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4813.2870000000003,4813.2870000000003,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20970,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",5038.6403999999993,5038.6403999999993,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[20972,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",5023.1808000000001,5023.1808000000001,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[20973,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",5306.8050000000003,5306.8050000000003,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[20974,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",147.46080000000001,88.000799999999998,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[20975,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",305.02980000000002,305.02980000000002,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM",2,29]
[20979,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",99.892799999999994,55.297800000000002,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[20982,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,0,2,1,1,0,0,null,"X",null,null,2,29]
[20983,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,0,2,1,1,0,0,null,"X",null,null,2,29]
[20985,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",255.08340000000001,255.08340000000001,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[20999,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,0,2,0,0,1,1,null,"N",null,null,2,29]
[21010,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1329.5255999999999,1329.5255999999999,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[21011,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",687.35760000000005,466.16640000000001,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21012,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",608.2758,608.2758,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21013,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",979.30619999999999,719.46600000000001,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21014,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",934.11660000000006,934.11660000000006,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21015,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1250.4438,1250.4438,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[21016,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,0,2,0,0,null,"X",null,null,2,29]
[21025,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1425.8507999999999,1179.0917999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21026,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",972.17100000000005,767.62860000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21029,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1387.7963999999999,1106.5506,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[21030,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",843.14279999999997,650.49239999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[21031,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",706.38480000000004,489.9504,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[21032,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",682.00620000000004,467.9502,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[21034,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2342.7240000000002,2014.5048000000002,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21040,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",855.62940000000003,655.84379999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[21044,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1548.3383999999999,1548.3383999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21045,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2141.7492000000002,2141.7492000000002,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21046,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1802.8271999999999,1802.8271999999999,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R",null,"Y-CM",2,29]
[21047,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2233.3176000000003,2233.3176000000003,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21048,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1815.9084,1815.9084,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R",null,"Y-CM",2,29]
[21049,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2176.2360000000003,2176.2360000000003,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21050,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1557.8520000000001,1557.8520000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[21060,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1412.175,1412.175,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[21070,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1093.4694,1093.4694,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[21073,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",687.95220000000006,441.19319999999999,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[21076,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1532.8788000000002,1247.4708000000001,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[21077,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3764.4126000000001,3071.1089999999999,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[21079,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2584.1316000000002,2067.4242000000004,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21080,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2993.2164000000002,2358.7782000000002,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21081,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2747.6466,2153.0466000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21082,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2522.8878,1959.8016,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21083,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2411.1030000000001,1820.0706,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21084,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2750.6196,2106.0732000000003,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21085,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1210.0110000000002,853.84559999999999,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[21086,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2804.1335999999997,2264.8314,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[21087,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2804.1335999999997,2264.8314,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21088,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","090",0.1,0.69,0.21,0,0,0,0,0,0,null,"N",null,null,2,29]
[21089,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT"," By Report "," By Report ","000",0,0,0,0,0,0,1,1,1,null,"N",null,null,2,29]
[21100,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1149.9564,635.03279999999995,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21110,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1617.9066,1337.85,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21116,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",415.03080000000006,80.271000000000001,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[21120,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1222.4975999999999,925.79219999999998,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,"Y-CM",2,29]
[21121,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1149.3617999999999,951.95460000000014,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21122,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1356.2826,1356.2826,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21123,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1537.6356000000001,1537.6356000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21125,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",5030.3159999999998,1189.7946000000002,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21127,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",7727.4216000000006,1364.0124000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21137,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1342.6068,1342.6068,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21138,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1632.7716,1632.7716,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21139,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1956.2339999999999,1956.2339999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21141,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2391.4812000000002,2391.4812000000002,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21142,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2454.5088000000001,2454.5088000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21143,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2528.2392000000004,2528.2392000000004,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21145,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2777.9712,2777.9712,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21146,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2899.8642000000004,2899.8642000000004,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21147,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3051.4872,3051.4872,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21150,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2934.9456,2934.9456,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21151,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3226.8942000000002,3226.8942000000002,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21154,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3471.8694,3471.8694,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21155,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3847.6565999999998,3847.6565999999998,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21159,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4605.7716,4605.7716,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21160,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4992.8562000000002,4992.8562000000002,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21172,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3742.4123999999997,3742.4123999999997,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21175,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3939.2249999999999,3939.2249999999999,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21179,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2711.3760000000002,2711.3760000000002,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21180,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3026.5140000000001,3026.5140000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21181,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1324.7688000000001,1324.7688000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[21182,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3760.8450000000003,3760.8450000000003,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21183,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4089.6588000000002,4089.6588000000002,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21184,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4397.6615999999995,4397.6615999999995,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21188,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2844.5664000000002,2844.5664000000002,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21193,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2204.1822000000002,2204.1822000000002,"090",0.1,0.69,0.21,0,2,2,2,1,0,null,"R",null,"Y-CM",2,29]
[21194,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2553.2123999999999,2553.2123999999999,"090",0.1,0.69,0.21,0,2,2,2,0,0,null,"R",null,"Y-CM",2,29]
[21195,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2417.6435999999999,2417.6435999999999,"090",0.1,0.69,0.21,0,2,2,2,0,0,null,"R",null,"Y-CM",2,29]
[21196,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2581.7532000000001,2581.7532000000001,"090",0.1,0.69,0.21,0,2,2,2,1,0,null,"R",null,"Y-CM",2,29]
[21198,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1855.152,1855.152,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21199,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1814.7192,1814.7192,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21206,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1735.0427999999999,1735.0427999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21208,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3093.1092000000003,1315.2552000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21209,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1498.9866000000002,1116.6588000000002,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[21210,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3316.0842000000002,1350.3366000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21215,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",7882.0176000000001,1401.4721999999999,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,null,2,29]
[21230,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1340.8230000000001,1340.8230000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21235,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1331.904,1018.5498,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21240,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1871.2061999999999,1871.2061999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[21242,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1814.1246000000001,1814.1246000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[21243,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2869.5396000000001,2869.5396000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[21244,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1811.1516000000001,1811.1516000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21245,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2139.3707999999997,1647.0419999999999,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21246,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1522.1760000000002,1522.1760000000002,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21247,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2827.9176000000002,2827.9176000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21248,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1774.8810000000001,1409.202,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21249,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2409.3192000000004,1977.6396,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21255,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2412.2921999999999,2412.2921999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21256,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2209.5335999999998,2209.5335999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21260,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,0,2,1,0,null,"X",null,null,2,29]
[21261,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,0,2,1,0,null,"X",null,null,2,29]
[21263,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,0,2,1,0,null,"X",null,null,2,29]
[21267,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X",null,null,2,29]
[21268,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X",null,null,2,29]
[21270,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1830.1788000000001,1333.6877999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21275,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1512.6624000000002,1512.6624000000002,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21280,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1048.8744000000002,1048.8744000000002,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[21282,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",715.30380000000002,715.30380000000002,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[21295,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,1,0,0,0,null,"X",null,null,2,29]
[21296,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,1,0,0,0,null,"X",null,null,2,29]
[21299,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT"," By Report "," By Report ","000",0,0,0,0,2,0,0,1,1,null,"N",null,null,2,29]
[21315,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",278.86740000000003,104.64960000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[21320,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",404.32799999999997,168.8664,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[21325,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",816.38580000000002,816.38580000000002,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21330,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",975.73860000000002,975.73860000000002,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21335,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1295.6333999999999,1295.6333999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21336,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1176.1188000000002,1176.1188000000002,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21337,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",771.79079999999999,541.68060000000003,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21338,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1230.8219999999999,1230.8219999999999,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21339,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1386.6072000000001,1386.6072000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21340,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1344.9852000000001,1344.9852000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21343,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1966.3422,1966.3422,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21344,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2502.6714000000002,2502.6714000000002,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,null,2,29]
[21345,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1453.2024000000001,1144.605,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21346,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1877.7467999999999,1877.7467999999999,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,null,2,29]
[21347,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1887.2603999999999,1887.2603999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21348,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1951.4772,1951.4772,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,null,2,29]
[21355,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",814.00739999999996,588.654,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R",null,null,2,29]
[21356,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",994.76580000000001,727.79039999999998,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R",null,null,2,29]
[21360,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",938.87339999999995,938.87339999999995,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[21365,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1932.45,1932.45,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21366,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2276.7233999999999,2276.7233999999999,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[21385,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1318.8227999999999,1318.8227999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21386,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1236.768,1236.768,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[21387,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1375.3098,1375.3098,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[21390,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1438.3374000000001,1438.3374000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21395,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1802.8271999999999,1802.8271999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21400,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",386.49,299.0838,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[21401,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",937.68420000000003,589.84320000000002,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[21406,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1049.4689999999998,1049.4689999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21407,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1150.5510000000002,1150.5510000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21408,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1614.3389999999999,1614.3389999999999,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[21421,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1186.2269999999999,994.76580000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21422,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1123.7939999999999,1123.7939999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21423,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1434.1752000000001,1434.1752000000001,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,null,2,29]
[21431,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1273.6332000000002,1273.6332000000002,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[21432,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1299.7955999999999,1299.7955999999999,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[21433,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3086.5686000000001,3086.5686000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21435,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2509.212,2509.212,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[21436,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3623.4924000000001,3623.4924000000001,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,null,2,29]
[21440,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1291.4712,1032.8202000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21445,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1493.0406,1196.3352,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[21450,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1110.1182000000001,896.65679999999998,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21451,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1436.5536,1193.3622,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21452,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1423.4724000000001,874.06200000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21453,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2048.3970000000004,1737.4212,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21454,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",869.89980000000003,869.89980000000003,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R",null,null,2,29]
[21461,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3448.68,1950.2879999999998,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,null,2,29]
[21462,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3769.1694000000002,2170.8845999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21465,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1417.5264,1417.5264,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21470,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2075.154,2075.154,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21480,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",262.21860000000004,54.108600000000003,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[21485,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1834.3410000000001,1492.4460000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[21490,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1396.1208000000001,1396.1208000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[21497,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1327.1472000000001,1098.8208,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21499,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT"," By Report "," By Report ","000",0,0,0,0,2,0,0,1,1,null,"N",null,null,2,29]
[21501,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",894.87300000000005,600.54599999999994,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21502,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",907.95420000000001,907.95420000000001,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[21510,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",812.22360000000003,812.22360000000003,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[21550,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",494.7072,279.46199999999999,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[21552,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",799.73699999999997,799.73699999999997,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21554,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1303.9577999999999,1303.9577999999999,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21555,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",800.92619999999999,551.78879999999992,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[21556,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",951.95460000000014,951.95460000000014,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[21557,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1698.7722000000001,1698.7722000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21558,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,0,2,1,0,null,"X",null,null,2,29]
[21600,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1004.8739999999999,1004.8739999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[21601,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2042.451,2042.451,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,null,2,29]
[21602,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2762.5116000000003,2762.5116000000003,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,null,2,29]
[21603,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2995.5948000000003,2995.5948000000003,"090",0.1,0.71,0.19,0,2,0,2,1,0,null,"R",null,null,2,29]
[21610,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2126.2896000000001,2126.2896000000001,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21615,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1082.172,1082.172,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[21616,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1249.8491999999999,1249.8491999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[21620,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",903.19740000000002,903.19740000000002,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21627,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",972.17100000000005,972.17100000000005,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[21630,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2342.1294000000003,2342.1294000000003,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21632,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2139.9654,2139.9654,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21685,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"X",null,null,2,29]
[21700,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",624.33000000000004,624.33000000000004,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[21705,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",931.73820000000001,931.73820000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[21720,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",947.19780000000003,947.19780000000003,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21725,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",975.14399999999989,975.14399999999989,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21740,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1801.6380000000001,1801.6380000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[21742,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT"," By Report "," By Report ","090",0.1,0.69,0.21,0,2,0,2,1,0,null,"N",null,"Y-CM",2,29]
[21743,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT"," By Report "," By Report ","090",0.1,0.69,0.21,0,2,0,2,1,0,null,"N",null,"Y-CM",2,29]
[21750,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1192.7675999999999,1192.7675999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21811,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1039.3607999999999,1039.3607999999999,"000",0,0,0,0,2,1,2,0,0,null,"R",null,null,2,29]
[21812,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1261.1466,1261.1466,"000",0,0,0,0,2,1,2,0,0,null,"R",null,null,2,29]
[21813,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1724.34,1724.34,"000",0,0,0,0,2,1,2,0,0,null,"R",null,null,2,29]
[21820,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",272.32679999999999,266.97540000000004,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21825,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",982.27919999999995,982.27919999999995,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[21899,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT"," By Report "," By Report ","000",0,0,0,0,2,0,0,1,1,null,"N",null,"Y-UR",2,29]
[21920,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",478.05839999999995,278.86740000000003,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[21925,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",906.17039999999997,678.43860000000006,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21930,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",922.81920000000002,652.27620000000002,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[21931,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",840.16980000000001,840.16980000000001,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[21932,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1185.0378000000001,1185.0378000000001,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[21933,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1318.2282,1318.2282,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[21935,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1824.2328,1824.2328,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,"Y-CM",2,29]
[21936,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,0,2,1,0,null,"X",null,null,2,29]
[22010,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1723.1508000000001,1723.1508000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[22015,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1694.0154,1694.0154,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[22100,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1542.9870000000001,1542.9870000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22101,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1534.068,1534.068,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22102,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1392.5532000000001,1392.5532000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22103,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",236.6508,236.6508,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22110,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1873.5846000000001,1873.5846000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22112,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2009.7479999999998,2009.7479999999998,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22114,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2009.7479999999998,2009.7479999999998,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22116,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",246.16439999999997,246.16439999999997,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22206,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4309.0662000000002,4309.0662000000002,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22207,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4224.0384000000004,4224.0384000000004,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22208,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1025.6849999999999,1025.6849999999999,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22210,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3162.0828000000001,3162.0828000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22212,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2678.6729999999998,2678.6729999999998,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22214,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2679.8622,2679.8622,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22216,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",632.65440000000001,632.65440000000001,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22220,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2868.9450000000002,2868.9450000000002,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22222,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3100.8389999999999,3100.8389999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22224,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2820.7824000000001,2820.7824000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22226,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",629.08680000000004,629.08680000000004,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22310,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",562.49160000000006,535.7346,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[22315,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1587.5819999999999,1378.8774000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[22318,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2896.2966000000001,2896.2966000000001,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-CM",2,29]
[22319,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3220.9482000000003,3220.9482000000003,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-CM",2,29]
[22325,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2603.1588000000002,2603.1588000000002,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22326,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2664.9972000000002,2664.9972000000002,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22327,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2709.5922,2709.5922,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22328,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",488.16660000000007,488.16660000000007,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22505,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",230.11020000000002,230.11020000000002,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[22510,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","010",0.1,0.8,0.1,0,2,0,1,0,0,null,"X",null,null,2,29]
[22511,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","010",0.1,0.8,0.1,0,2,0,1,0,0,null,"X",null,null,2,29]
[22512,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,0,0,0,1,0,0,null,"X",null,null,2,29]
[22513,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","010",0.1,0.8,0.1,0,2,0,1,0,0,null,"X",null,null,2,29]
[22514,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","010",0.1,0.8,0.1,0,2,0,1,0,0,null,"X",null,null,2,29]
[22515,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,0,0,0,1,0,0,null,"X",null,null,2,29]
[22526,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","010",0.1,0.8,0.1,9,9,9,9,9,9,null,"X",null,null,2,29]
[22527,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,29]
[22532,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3181.11,3181.11,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22533,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2931.9726000000001,2931.9726000000001,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22534,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",626.70839999999998,626.70839999999998,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22548,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3451.6529999999998,3451.6529999999998,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22551,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2998.5677999999998,2998.5677999999998,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22552,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",689.73599999999999,689.73599999999999,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22554,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2226.777,2226.777,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22556,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2940.297,2940.297,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22558,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2700.0785999999998,2700.0785999999998,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22585,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",567.24839999999995,567.24839999999995,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22586,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3570.5729999999999,3570.5729999999999,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22590,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2799.3768,2799.3768,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22595,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2677.4838,2677.4838,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22600,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2301.1020000000003,2301.1020000000003,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22610,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2263.6422000000002,2263.6422000000002,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22612,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2804.7282,2804.7282,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22614,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",680.81700000000001,680.81700000000001,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22630,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2791.0524,2791.0524,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22632,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",557.14019999999994,557.14019999999994,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22633,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3261.3810000000003,3261.3810000000003,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22634,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",863.9538,863.9538,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22800,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2408.7246,2408.7246,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22802,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3735.2772,3735.2772,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22804,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4284.6876000000002,4284.6876000000002,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22808,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3226.2995999999998,3226.2995999999998,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22810,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3560.4648000000002,3560.4648000000002,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22812,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3901.7652000000003,3901.7652000000003,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22818,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3807.2238000000002,3807.2238000000002,"090",0.11,0.76,0.13,0,2,0,2,2,2,null,"R",null,"Y-UR",2,29]
[22819,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4382.7965999999997,4382.7965999999997,"090",0.11,0.76,0.13,0,2,0,2,2,2,null,"R",null,"Y-UR",2,29]
[22830,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1460.9322,1460.9322,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22840,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1321.7958000000001,1321.7958000000001,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22841,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,"Y-UR",2,29]
[22842,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1328.3363999999999,1328.3363999999999,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22843,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1420.4994000000002,1420.4994000000002,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22844,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1717.7994000000001,1717.7994000000001,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22845,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1265.9033999999999,1265.9033999999999,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22846,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1315.8498,1315.8498,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22847,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1406.8235999999999,1406.8235999999999,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22848,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",627.303,627.303,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22849,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2310.6156000000001,2310.6156000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22850,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1311.6876,1311.6876,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22852,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1260.5519999999999,1260.5519999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22853,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",448.923,448.923,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22854,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",582.70800000000008,582.70800000000008,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22855,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1961.5854000000002,1961.5854000000002,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[22856,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2874.8910000000001,2874.8910000000001,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22857,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3134.1366000000003,3134.1366000000003,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22858,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",882.38639999999998,882.38639999999998,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22859,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",579.73500000000001,579.73500000000001,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22861,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4058.145,4058.145,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22862,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4061.7126000000003,4061.7126000000003,"090",0.1,0.71,0.19,0,2,0,2,2,2,null,"R",null,"Y-UR",2,29]
[22864,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3626.4654,3626.4654,"090",0.1,0.69,0.21,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22865,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3965.9820000000004,3965.9820000000004,"090",0.1,0.71,0.19,0,2,0,2,2,2,null,"R",null,"Y-UR",2,29]
[22867,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1902.1253999999999,1902.1253999999999,"090",0.1,0.8,0.1,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[22868,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",423.35520000000002,423.35520000000002,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22869,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",776.54759999999999,776.54759999999999,"090",0.1,0.8,0.1,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[22870,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",209.8938,209.8938,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[22899,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT"," By Report "," By Report ","000",0,0,0,0,2,0,2,1,1,null,"N",null,"Y-UR",2,29]
[22900,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1010.82,1010.82,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22901,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1192.7675999999999,1192.7675999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22902,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",871.08900000000006,599.35680000000002,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22903,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",788.43960000000004,788.43960000000004,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[22904,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.09,0.81,0.1,0,2,0,2,1,1,null,"X",null,null,2,29]
[22905,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.09,0.81,0.1,0,2,0,2,1,1,null,"X",null,null,2,29]
[22999,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT"," By Report "," By Report ","000",0,0,0,0,2,0,0,1,1,null,"N",null,"Y-CM",2,29]
[23000,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1063.7394000000002,667.14120000000003,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[23020,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1240.3355999999999,1240.3355999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM",2,29]
[23030,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",818.16959999999995,457.84200000000004,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[23031,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",789.62879999999996,393.62520000000001,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[23035,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1228.4436000000001,1228.4436000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM",2,29]
[23040,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1293.2550000000001,1293.2550000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[23044,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1020.3336,1020.3336,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-CM",2,29]
[23065,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","010",0.1,0.8,0.1,0,2,1,1,0,0,null,"X",null,null,2,29]
[23066,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1041.1446000000001,658.22220000000004,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[23071,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",753.35820000000001,753.35820000000001,"090",0.1,0.8,0.1,0,2,1,2,0,0,null,"R",null,null,2,29]
[23073,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1245.6869999999999,1245.6869999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[23075,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",962.65740000000005,592.81620000000009,"090",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[23076,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",975.73860000000002,975.73860000000002,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23077,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X",null,null,2,29]
[23078,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X",null,null,2,29]
[23100,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",915.68400000000008,915.68400000000008,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23101,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",827.08860000000004,827.08860000000004,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[23105,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1152.9294,1152.9294,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23106,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",909.14339999999993,909.14339999999993,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[23107,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1189.2,1189.2,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23120,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1060.1717999999998,1060.1717999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23125,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1276.6061999999999,1276.6061999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23130,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1118.4425999999999,1118.4425999999999,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[23140,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1002.4956,1002.4956,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[23145,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1252.8222000000001,1252.8222000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[23146,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1124.3886,1124.3886,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[23150,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1191.5783999999999,1191.5783999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[23155,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1432.9860000000001,1432.9860000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[23156,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1221.903,1221.903,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM",2,29]
[23170,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1019.1444,1019.1444,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[23172,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1029.2526,1029.2526,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM",2,29]
[23174,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1374.7152000000001,1374.7152000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[23180,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1196.3352,1196.3352,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-CM",2,29]
[23182,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1211.7947999999999,1211.7947999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM",2,29]
[23184,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1328.931,1328.931,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[23190,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1037.577,1037.577,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23195,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1333.0932,1333.0932,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[23200,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X",null,null,2,29]
[23210,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X",null,null,2,29]
[23220,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X",null,null,2,29]
[23330,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",559.51859999999999,300.86759999999998,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R",null,null,2,29]
[23333,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",852.06180000000006,852.06180000000006,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[23334,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1893.8010000000002,1893.8010000000002,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[23335,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2255.3177999999998,2255.3177999999998,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[23350,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",314.54340000000002,88.000799999999998,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[23395,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2281.4802,2281.4802,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[23397,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2028.1805999999999,2028.1805999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[23400,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1739.7996000000001,1739.7996000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[23405,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1114.2803999999999,1114.2803999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[23406,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1335.4716000000001,1335.4716000000001,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[23410,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1469.8512000000001,1469.8512000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23412,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1526.3382000000001,1526.3382000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23415,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1257.579,1257.579,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[23420,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1744.5563999999999,1744.5563999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23430,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1337.2554,1337.2554,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23440,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1356.2826,1356.2826,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23450,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1691.6369999999999,1691.6369999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23455,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1773.0971999999999,1773.0971999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23460,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1947.3150000000001,1947.3150000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23462,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1904.5038000000002,1904.5038000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23465,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1997.2614000000003,1997.2614000000003,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23466,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2002.6128000000001,2002.6128000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23470,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2136.3978000000002,2136.3978000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23472,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2571.0504000000001,2571.0504000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23473,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2862.4043999999999,2862.4043999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23474,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3087.1632,3087.1632,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23480,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1469.8512000000001,1469.8512000000001,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[23485,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1698.7722000000001,1698.7722000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[23490,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1541.2032000000002,1541.2032000000002,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM",2,29]
[23491,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1816.5030000000002,1816.5030000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[23500,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",408.49020000000002,417.4092,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23505,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",660.00599999999997,611.24879999999996,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23515,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1293.8496,1293.8496,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[23520,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",443.57159999999999,437.03100000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[23525,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",727.79039999999998,664.16819999999996,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[23530,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1039.3607999999999,1039.3607999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[23532,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1129.1453999999999,1129.1453999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[23540,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",439.40940000000001,432.27420000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23545,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",645.73559999999998,577.95120000000009,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[23550,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1032.2256,1032.2256,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23552,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1177.9025999999999,1177.9025999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[23570,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",431.67959999999999,444.76080000000002,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23575,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",753.35820000000001,693.89819999999997,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[23585,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1748.7185999999999,1748.7185999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[23600,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",614.81640000000004,581.51879999999994,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23605,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",859.79160000000002,778.33140000000003,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23615,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1582.8252,1582.8252,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[23616,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2199.4254000000001,2199.4254000000001,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[23620,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",498.86940000000004,478.65300000000008,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23625,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",704.601,642.76260000000002,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23630,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1397.9046000000001,1397.9046000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[23650,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",598.76220000000001,539.30219999999997,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23655,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",745.03379999999993,745.03379999999993,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23660,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1053.6312,1053.6312,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[23665,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",793.79099999999994,728.9796,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23670,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1556.6628000000001,1556.6628000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[23675,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1006.0632000000002,908.54880000000003,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[23680,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1658.934,1658.934,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[23700,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",352.59780000000001,352.59780000000001,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[23800,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1834.9356,1834.9356,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[23802,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2286.8316,2286.8316,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[23900,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2463.4277999999999,2463.4277999999999,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[23920,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2002.6128000000001,2002.6128000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[23921,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",851.46720000000005,851.46720000000005,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[23929,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Bundled","Bundled","000",0,0,0,0,2,0,2,1,1,null,"Bundled",null,"Y-UR",2,29]
[23930,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",669.51959999999997,385.30080000000004,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[23931,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",566.05920000000003,289.5702,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[23935,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",921.63,921.63,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[24000,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",855.03480000000002,855.03480000000002,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,"Y-UR",2,29]
[24006,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1280.7683999999999,1280.7683999999999,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,"Y-UR",2,29]
[24065,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",482.81519999999995,294.327,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[24066,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1141.6320000000001,754.54739999999993,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24071,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",727.79039999999998,727.79039999999998,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[24073,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1238.5518,1238.5518,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[24075,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","994.1+E7712",594.00540000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24076,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",979.9008,979.9008,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24077,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,1,1,1,0,null,"X",null,null,2,29]
[24079,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X",null,null,2,29]
[24100,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",760.49339999999995,760.49339999999995,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24101,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",912.1164,912.1164,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[24102,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1115.4696000000001,1115.4696000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24105,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",655.24919999999997,655.24919999999997,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24110,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1065.5232000000001,1065.5232000000001,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[24115,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1324.7688000000001,1324.7688000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24116,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1540.6086,1540.6086,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[24120,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",963.25199999999995,963.25199999999995,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[24125,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1123.7939999999999,1123.7939999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24126,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1172.5511999999999,1172.5511999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[24130,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",922.22460000000001,922.22460000000001,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[24134,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1342.6068,1342.6068,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[24136,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1139.8482000000001,1139.8482000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24138,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1242.1194,1242.1194,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[24140,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1265.3088,1265.3088,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[24145,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1072.6584,1072.6584,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[24147,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1136.8752000000002,1136.8752000000002,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[24149,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2108.4515999999999,2108.4515999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24150,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X",null,null,2,29]
[24152,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X",null,null,2,29]
[24155,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1526.3382000000001,1526.3382000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24160,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2229.75,2229.75,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[24164,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1300.3902,1300.3902,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[24200,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",404.92259999999999,254.48880000000003,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R",null,null,2,29]
[24201,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1009.6308,659.41139999999996,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24220,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",361.51679999999999,116.5416,"000",0,0,0,0,2,1,0,0,0,null,"R",null,null,2,29]
[24300,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",796.76400000000001,796.76400000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24301,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1346.769,1346.769,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[24305,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1045.3067999999998,1045.3067999999998,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,"Y-UR",2,29]
[24310,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",860.98080000000004,860.98080000000004,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,"Y-UR",2,29]
[24320,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1399.6884,1399.6884,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[24330,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1290.8766000000001,1290.8766000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[24331,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1409.202,1409.202,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[24332,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1110.7128,1110.7128,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[24340,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1114.875,1114.875,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24341,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1340.8230000000001,1340.8230000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24342,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1390.7694000000001,1390.7694000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24343,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1287.309,1287.309,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24344,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1959.8016,1959.8016,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24345,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1280.7683999999999,1280.7683999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24346,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1976.4504000000002,1976.4504000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24357,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",760.49339999999995,760.49339999999995,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[24358,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",956.71140000000003,956.71140000000003,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[24359,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1192.173,1192.173,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[24360,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1618.5011999999999,1618.5011999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24361,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1802.8271999999999,1802.8271999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24362,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1895.5847999999999,1895.5847999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[24363,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2572.2395999999999,2572.2395999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[24365,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1155.3078,1155.3078,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24366,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1225.4705999999999,1225.4705999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24370,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2732.1870000000004,2732.1870000000004,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[24371,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3136.5149999999999,3136.5149999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[24400,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1481.1486,1481.1486,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24410,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X",null,null,2,29]
[24420,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1924.7202,1924.7202,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24430,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1883.6928,1883.6928,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24435,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1932.45,1932.45,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24470,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1211.2002,1211.2002,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM",2,29]
[24495,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1475.2025999999998,1475.2025999999998,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[24498,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1551.9060000000002,1551.9060000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24500,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",665.952,613.0326,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24505,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",922.22460000000001,824.71019999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24515,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1580.4467999999999,1580.4467999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24516,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1538.2302,1538.2302,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[24530,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",702.81720000000007,643.95180000000005,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24535,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1126.1724000000002,1031.6310000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24538,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1431.7967999999998,1431.7967999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24545,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1660.7177999999999,1660.7177999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24546,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1852.1789999999999,1852.1789999999999,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[24560,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",614.22180000000003,541.68060000000003,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24565,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",989.4144,900.22440000000006,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24566,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1299.7955999999999,1299.7955999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24575,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1317.039,1317.039,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24576,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",648.70860000000005,576.16739999999993,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24577,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1016.7660000000001,924.60300000000007,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24579,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1495.4189999999999,1495.4189999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24582,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1472.2296000000001,1472.2296000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24586,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1940.7744,1940.7744,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24587,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1943.7474,1943.7474,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24600,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",684.38459999999998,616.60019999999997,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24605,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",869.89980000000003,869.89980000000003,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24615,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1281.9576,1281.9576,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24620,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1020.3336,1020.3336,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[24635,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1215.3624000000002,1215.3624000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24640,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","010",0.1,0.8,0.1,0,2,1,0,0,0,null,"X",null,null,2,29]
[24650,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",486.38279999999997,451.3014,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24655,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",819.95339999999999,737.30400000000009,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24665,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1187.4161999999999,1187.4161999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24666,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1315.8498,1315.8498,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24670,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",539.89679999999998,492.32879999999994,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24675,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",850.87260000000003,768.22320000000002,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[24685,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1178.4972,1178.4972,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24800,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1496.0136,1496.0136,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[24802,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1793.9082000000001,1793.9082000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[24900,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1324.7688000000001,1324.7688000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24920,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1315.8498,1315.8498,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[24925,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1027.4688000000001,1027.4688000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[24930,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1387.7963999999999,1387.7963999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[24931,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1664.2854,1664.2854,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[24935,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2201.8038000000001,2201.8038000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[24940,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2003.7910155120003,2003.7910155120003,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"F",null,"Y-UR",2,29]
[24999,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT"," By Report "," By Report ","000",0,0,0,0,2,1,0,1,1,null,"N",null,"Y-UR",2,29]
[25000,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",628.49220000000003,628.49220000000003,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[25001,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",630.27599999999995,630.27599999999995,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[25020,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1384.8234,1384.8234,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[25023,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2417.049,2417.049,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[25024,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1403.8506,1403.8506,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[25025,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2101.3164000000002,2101.3164000000002,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[25028,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1300.3902,1300.3902,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25031,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",669.51959999999997,669.51959999999997,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25035,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1057.1988000000001,1057.1988000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25040,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1007.847,1007.847,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25065,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",475.68,284.8134,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[25066,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",662.97900000000004,662.97900000000004,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25071,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",761.08800000000008,761.08800000000008,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25073,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",962.06280000000004,962.06280000000004,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25075,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",969.19800000000009,569.03219999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25076,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",931.73820000000001,931.73820000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25077,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,1,1,0,0,null,"X",null,null,2,29]
[25078,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,1,2,0,0,null,"X",null,null,2,29]
[25085,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",811.03440000000001,811.03440000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25100,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",636.81660000000011,636.81660000000011,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25101,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",734.92560000000003,734.92560000000003,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25105,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",880.60260000000005,880.60260000000005,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,null,2,29]
[25107,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1113.6858,1113.6858,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[25109,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",966.81960000000015,966.81960000000015,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[25110,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",630.27599999999995,630.27599999999995,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[25111,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",589.84320000000002,589.84320000000002,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25112,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",707.57400000000007,707.57400000000007,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25115,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1357.4718,1357.4718,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25116,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1088.1180000000002,1088.1180000000002,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,null,2,29]
[25118,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",694.49279999999999,694.49279999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25119,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",909.73800000000006,909.73800000000006,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25120,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",907.3596,907.3596,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,null,2,29]
[25125,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1075.0367999999999,1075.0367999999999,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25126,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1082.7666000000002,1082.7666000000002,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25130,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",818.16959999999995,818.16959999999995,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25135,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1013.793,1013.793,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25136,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",902.6028,902.6028,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25145,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",943.03559999999993,943.03559999999993,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25150,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1025.0903999999998,1025.0903999999998,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[25151,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1054.2257999999999,1054.2257999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25170,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X",null,null,2,29]
[25210,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",890.71080000000006,890.71080000000006,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R",null,null,2,29]
[25215,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1115.4696000000001,1115.4696000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25230,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",783.68280000000004,783.68280000000004,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[25240,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",777.73680000000002,777.73680000000002,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,null,2,29]
[25246,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",372.21960000000001,128.43360000000001,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[25248,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",759.30420000000004,759.30420000000004,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25250,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",966.22500000000002,966.22500000000002,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25251,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1293.2550000000001,1293.2550000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25259,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",787.84500000000003,787.84500000000003,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25260,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1145.7942,1145.7942,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[25263,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1145.7942,1145.7942,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[25265,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1350.3366000000001,1350.3366000000001,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[25270,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",893.68380000000002,893.68380000000002,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[25272,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1011.4146000000001,1011.4146000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[25274,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1196.9297999999999,1196.9297999999999,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R",null,null,2,29]
[25275,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1210.0110000000002,1210.0110000000002,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,null,2,29]
[25280,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1022.712,1022.712,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R",null,null,2,29]
[25290,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",789.62879999999996,789.62879999999996,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[25295,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",952.54920000000004,952.54920000000004,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[25300,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1244.4978000000001,1244.4978000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25301,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1157.6861999999999,1157.6861999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25310,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1118.4425999999999,1118.4425999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[25312,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1286.1197999999999,1286.1197999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[25315,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1381.8504,1381.8504,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25316,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1642.2852,1642.2852,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25320,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1768.3404,1768.3404,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[25332,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1515.0408,1515.0408,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25335,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,1,2,0,0,null,"X",null,null,2,29]
[25337,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1590.5550000000001,1590.5550000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25350,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1214.1732000000002,1214.1732000000002,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25355,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1374.7152000000001,1374.7152000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25360,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1180.2810000000002,1180.2810000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25365,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1644.069,1644.069,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25370,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1814.1246000000001,1814.1246000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25375,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1708.8804,1708.8804,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25390,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1380.0666000000001,1380.0666000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25391,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1782.6108000000002,1782.6108000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25392,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1813.53,1813.53,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25393,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2015.694,2015.694,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25394,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1408.0128,1408.0128,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25400,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1438.932,1438.932,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25405,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1855.7466000000002,1855.7466000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25415,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1733.8536000000001,1733.8536000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25420,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2081.6945999999998,2081.6945999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25425,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1726.7184,1726.7184,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25426,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2004.3966,2004.3966,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25430,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1315.8498,1315.8498,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25431,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1413.3642,1413.3642,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25440,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1378.2828,1378.2828,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25441,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1680.3396,1680.3396,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25442,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1454.3916000000002,1454.3916000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25443,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1410.9858000000002,1410.9858000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25444,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1487.6892,1487.6892,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25445,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1292.0658000000001,1292.0658000000001,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[25446,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2087.6406000000002,2087.6406000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25447,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1492.4460000000001,1492.4460000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25449,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1848.0167999999999,1848.0167999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25450,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1114.875,1114.875,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[25455,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1315.8498,1315.8498,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[25490,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1292.6604,1292.6604,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25491,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1328.3363999999999,1328.3363999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25492,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1625.6364000000001,1625.6364000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25500,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",525.03179999999998,472.70699999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25505,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",924.60300000000007,836.00760000000002,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25515,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1206.4433999999999,1206.4433999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25520,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1053.6312,990.60360000000003,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25525,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1416.9317999999998,1416.9317999999998,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[25526,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1714.2318,1714.2318,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[25530,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",486.97739999999999,445.95,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25535,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",907.95420000000001,834.22379999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25545,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1127.3616000000002,1127.3616000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25560,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",535.14,475.68,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25565,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",949.57620000000009,846.71040000000005,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25574,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1215.3624000000002,1215.3624000000002,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[25575,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1622.0688,1622.0688,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25600,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",625.51919999999996,597.57300000000009,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25605,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",985.84679999999992,929.95440000000008,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25606,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1205.8488,1205.8488,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25607,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1330.1202000000001,1330.1202000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25608,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1485.9053999999999,1485.9053999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25609,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1884.8820000000001,1884.8820000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25622,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",567.24839999999995,522.65339999999992,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25624,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",902.00819999999999,814.60199999999998,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25628,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1295.6333999999999,1295.6333999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25630,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",562.49160000000006,521.46420000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25635,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",855.62940000000003,774.16919999999993,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25645,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1032.2256,1032.2256,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25650,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",608.2758,561.30240000000003,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25651,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",886.54859999999996,886.54859999999996,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25652,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1123.7939999999999,1123.7939999999999,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[25660,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",818.76419999999996,818.76419999999996,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25670,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1097.6316000000002,1097.6316000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25671,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",959.6844000000001,959.6844000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25675,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",822.92640000000006,740.27699999999993,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25676,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1137.4697999999999,1137.4697999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25680,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",963.84660000000008,963.84660000000008,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25685,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1321.2012,1321.2012,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25690,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",894.87300000000005,894.87300000000005,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25695,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1144.0103999999999,1144.0103999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[25800,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1314.6605999999999,1314.6605999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[25805,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1521.5814,1521.5814,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[25810,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1550.1222,1550.1222,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[25820,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1180.8756000000001,1180.8756000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[25825,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1438.3374000000001,1438.3374000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[25830,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1894.3956000000001,1894.3956000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[25900,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1287.9036000000001,1287.9036000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25905,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1262.9304,1262.9304,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25907,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1108.3344,1108.3344,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25909,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1233.7950000000001,1233.7950000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25915,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2078.1270000000004,2078.1270000000004,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25920,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1325.9580000000001,1325.9580000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25922,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1177.9025999999999,1177.9025999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25924,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1296.2280000000001,1296.2280000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25927,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1590.5550000000001,1590.5550000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[25929,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1081.5774000000001,1081.5774000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[25931,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1476.9864,1476.9864,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[25999,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT"," By Report "," By Report ","000",0,0,0,0,2,1,0,1,1,null,"N",null,null,2,29]
[26010,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",655.24919999999997,254.48880000000003,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[26011,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",914.49480000000005,334.75979999999998,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[26020,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1006.0632000000002,1006.0632000000002,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26025,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",762.27719999999999,762.27719999999999,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[26030,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",886.54859999999996,886.54859999999996,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[26034,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",999.5225999999999,999.5225999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26035,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1546.5546000000002,1546.5546000000002,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26037,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1009.0361999999999,1009.0361999999999,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[26040,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",574.97820000000002,574.97820000000002,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[26045,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",855.62940000000003,855.62940000000003,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[26055,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1111.902,529.78859999999997,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26060,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",467.35560000000004,467.35560000000004,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26070,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",582.70800000000008,582.70800000000008,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[26075,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",613.62720000000002,613.62720000000002,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[26080,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",724.81740000000002,724.81740000000002,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26100,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",617.7894,617.7894,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[26105,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",621.9516000000001,621.9516000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[26110,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",592.22160000000008,592.22160000000008,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26111,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",747.41219999999998,747.41219999999998,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26113,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",982.87380000000007,982.87380000000007,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26115,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1020.9282000000001,598.16759999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26116,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",945.41399999999999,945.41399999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26117,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,0,1,0,0,null,"X",null,null,2,29]
[26118,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,0,2,0,0,null,"X",null,null,2,29]
[26121,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1080.9828,1080.9828,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[26123,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1504.9325999999999,1504.9325999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[26125,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",473.89619999999996,473.89619999999996,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[26130,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",851.46720000000005,851.46720000000005,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[26135,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1001.9010000000001,1001.9010000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26140,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",919.25160000000005,919.25160000000005,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26145,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",932.33280000000002,932.33280000000002,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26160,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1155.3078,572.59980000000007,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26170,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",740.27699999999993,740.27699999999993,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26180,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",814.60199999999998,814.60199999999998,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26185,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1007.847,1007.847,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[26200,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",812.81820000000005,812.81820000000005,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26205,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1093.4694,1093.4694,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26210,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",811.03440000000001,811.03440000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26215,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1025.0903999999998,1025.0903999999998,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26230,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",903.19740000000002,903.19740000000002,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26235,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",888.92700000000002,888.92700000000002,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26236,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",799.73699999999997,799.73699999999997,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26250,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1900.3416,1900.3416,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26260,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1427.04,1427.04,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26262,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1133.3075999999999,1133.3075999999999,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26320,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",635.62739999999997,635.62739999999997,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26340,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",647.51940000000002,647.51940000000002,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[26341,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",215.24520000000001,141.51480000000001,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[26350,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1392.5532000000001,1392.5532000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26352,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1545.96,1545.96,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26356,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1438.3374000000001,1438.3374000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26357,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1610.1768,1610.1768,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26358,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1775.4756,1775.4756,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26370,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1460.3375999999998,1460.3375999999998,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26372,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1696.9884,1696.9884,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26373,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1635.7446000000002,1635.7446000000002,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26390,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1618.5011999999999,1618.5011999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26392,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1850.3952000000002,1850.3952000000002,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26410,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1124.9832000000001,1124.9832000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26412,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1334.2824000000001,1334.2824000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26415,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1577.4738,1577.4738,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26416,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1701.7452000000001,1701.7452000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26418,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1168.9836,1168.9836,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26420,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1384.2288000000001,1384.2288000000001,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26426,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",910.33260000000007,910.33260000000007,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26428,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1480.5539999999999,1480.5539999999999,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26432,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1019.1444,1019.1444,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26433,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1069.6853999999998,1069.6853999999998,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26434,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1295.6333999999999,1295.6333999999999,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26437,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1240.3355999999999,1240.3355999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26440,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1218.93,1218.93,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26442,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1824.8274000000001,1824.8274000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26445,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1141.6320000000001,1141.6320000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26449,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1257.579,1257.579,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26450,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",865.73760000000004,865.73760000000004,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26455,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",856.22400000000005,856.22400000000005,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26460,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",843.14279999999997,843.14279999999997,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26471,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1228.4436000000001,1228.4436000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26474,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1215.9569999999999,1215.9569999999999,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26476,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1202.2811999999999,1202.2811999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26477,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1166.0106000000001,1166.0106000000001,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,null,2,29]
[26478,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1234.3896000000002,1234.3896000000002,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26479,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1259.3628000000001,1259.3628000000001,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26480,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1461.5267999999999,1461.5267999999999,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26483,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1612.5552,1612.5552,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26485,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1548.3383999999999,1548.3383999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26489,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1784.9892,1784.9892,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26490,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1550.7167999999999,1550.7167999999999,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26492,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1709.4750000000001,1709.4750000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26494,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1556.0682000000002,1556.0682000000002,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26496,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1670.826,1670.826,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26497,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1669.0422000000001,1669.0422000000001,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26498,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2156.6142000000004,2156.6142000000004,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26499,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1607.7983999999999,1607.7983999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26500,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1243.3086000000001,1243.3086000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26502,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1402.0667999999998,1402.0667999999998,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26508,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1257.579,1257.579,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[26510,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1195.7406000000001,1195.7406000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26516,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1378.2828,1378.2828,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[26517,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1599.4739999999999,1599.4739999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[26518,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1619.6904,1619.6904,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[26520,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1277.2008000000001,1277.2008000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26525,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1281.3630000000001,1281.3630000000001,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,null,2,29]
[26530,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",978.11699999999996,978.11699999999996,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26531,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1138.6589999999999,1138.6589999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26535,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",790.8180000000001,790.8180000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26536,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1394.337,1394.337,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26540,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1299.201,1299.201,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R",null,null,2,29]
[26541,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1538.2302,1538.2302,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26542,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1340.2284,1340.2284,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26545,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1356.2826,1356.2826,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26546,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1902.1253999999999,1902.1253999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[26548,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1475.2025999999998,1475.2025999999998,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26550,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3002.73,3002.73,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[26551,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",5901.9996000000001,5901.9996000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[26553,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",5862.1614,5862.1614,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[26554,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",6814.116,6814.116,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[26555,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2533.5906,2533.5906,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26556,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",6097.0284000000001,6097.0284000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26560,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1186.2269999999999,1186.2269999999999,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26561,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1805.8002000000001,1805.8002000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26562,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2505.6444000000001,2505.6444000000001,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26565,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1331.3094000000001,1331.3094000000001,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26567,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1334.877,1334.877,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26568,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1725.5291999999999,1725.5291999999999,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26580,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,1,2,0,0,null,"X",null,null,2,29]
[26587,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,0,2,0,0,null,"X",null,null,2,29]
[26590,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,0,2,0,0,null,"X",null,null,2,29]
[26591,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",913.30560000000003,913.30560000000003,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26593,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1201.6866,1201.6866,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26596,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1500.1758,1500.1758,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26600,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",555.95100000000002,528.00480000000005,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26605,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",610.65419999999995,548.22120000000007,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26607,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",934.71120000000008,934.71120000000008,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26608,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",877.03499999999997,877.03499999999997,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26615,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1040.55,1040.55,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26641,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",771.19620000000009,700.43880000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[26645,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",795.5748000000001,721.84440000000006,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[26650,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",877.62959999999998,877.62959999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[26665,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1128.5508,1128.5508,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[26670,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",640.97879999999998,570.22140000000002,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26675,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",847.30500000000006,770.60160000000008,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26676,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",926.98140000000001,926.98140000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26685,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1042.3338000000001,1042.3338000000001,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,null,2,29]
[26686,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1124.9832000000001,1124.9832000000001,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[26700,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",619.57320000000004,567.84300000000007,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26705,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",778.92600000000004,704.00639999999999,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26706,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",812.22360000000003,812.22360000000003,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26715,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1036.9824000000001,1036.9824000000001,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26720,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",369.2466,346.65180000000004,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26725,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",629.08680000000004,557.14019999999994,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26727,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",863.35919999999999,863.35919999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26735,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1074.4422,1074.4422,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26740,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",429.30119999999999,405.5172,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26742,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",687.35760000000005,614.22180000000003,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26746,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1336.6608000000001,1336.6608000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26750,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",344.27339999999998,346.65180000000004,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26755,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",588.654,502.43699999999995,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26756,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",775.95300000000009,775.95300000000009,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26765,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",910.92720000000008,910.92720000000008,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26770,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",523.84260000000006,474.49080000000004,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26775,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",722.43900000000008,645.73559999999998,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26776,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",821.14260000000002,821.14260000000002,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26785,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",988.81979999999999,988.81979999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26820,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1534.6625999999999,1534.6625999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[26841,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1432.3914,1432.3914,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,null,2,29]
[26842,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1538.8247999999999,1538.8247999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[26843,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1450.8239999999998,1450.8239999999998,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26844,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1589.3658,1589.3658,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26850,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1361.634,1361.634,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26852,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1535.8517999999999,1535.8517999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26860,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1142.8211999999999,1142.8211999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26861,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",179.5692,179.5692,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[26862,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1418.1210000000001,1418.1210000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[26863,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",400.16580000000005,400.16580000000005,"000",0,0,0,0,0,0,2,0,0,null,"R",null,null,2,29]
[26910,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1408.0128,1408.0128,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26951,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1298.6064000000001,1298.6064000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26952,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1268.2818,1268.2818,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26989,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT"," By Report "," By Report ","000",0,0,0,0,2,0,1,1,1,null,"N",null,null,2,29]
[26990,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1240.3355999999999,1240.3355999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[26991,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1294.4441999999999,941.84640000000002,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[26992,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1814.7192,1814.7192,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[27000,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",727.19580000000008,727.19580000000008,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27001,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",973.36020000000008,973.36020000000008,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27003,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1080.3882000000001,1080.3882000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27005,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1297.4172000000001,1297.4172000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27006,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1288.4982000000002,1288.4982000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27025,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1651.7988,1651.7988,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,null,2,29]
[27027,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1581.0414000000001,1581.0414000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27030,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1673.2044000000001,1673.2044000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27033,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1735.6374000000001,1735.6374000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27035,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2069.8026,2069.8026,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[27036,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1820.6652000000001,1820.6652000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27040,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",626.70839999999998,353.19240000000002,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[27041,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1268.8764000000001,1268.8764000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27043,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",838.38599999999997,838.38599999999997,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27045,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1309.9038,1309.9038,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27047,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",910.92720000000008,647.51940000000002,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27048,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1089.9017999999999,1089.9017999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27049,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X",null,null,2,29]
[27050,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",734.92560000000003,734.92560000000003,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,null,2,29]
[27052,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1041.7392,1041.7392,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27054,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1236.768,1236.768,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27057,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1801.0434,1801.0434,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27059,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X",null,null,2,29]
[27060,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",841.35900000000004,841.35900000000004,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27062,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",822.33180000000004,822.33180000000004,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27065,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",950.17079999999999,950.17079999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27066,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1462.1214,1462.1214,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27067,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1850.9898000000001,1850.9898000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27070,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1606.0146000000002,1606.0146000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27071,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1760.0160000000001,1760.0160000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27075,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3687.7092000000002,3687.7092000000002,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[27076,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4452.3647999999994,4452.3647999999994,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[27077,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4963.7208000000001,4963.7208000000001,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[27078,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3635.9789999999998,3635.9789999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27080,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",918.06240000000003,918.06240000000003,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[27086,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",579.1404,303.84060000000005,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R",null,null,2,29]
[27087,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1099.4153999999999,1099.4153999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27090,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1487.6892,1487.6892,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27091,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2827.9176000000002,2827.9176000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27093,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",449.51759999999996,118.92,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[27095,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",605.89739999999995,145.67700000000002,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[27096,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",299.0838,145.67700000000002,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[27097,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1229.6328000000001,1229.6328000000001,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27098,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1251.633,1251.633,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27100,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1490.0675999999999,1490.0675999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27105,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1561.4196000000002,1561.4196000000002,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27110,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1738.0158000000001,1738.0158000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27111,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1619.0958000000001,1619.0958000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27120,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2312.3994000000002,2312.3994000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27122,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1969.3151999999998,1969.3151999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27125,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2015.694,2015.694,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27130,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2280.8856000000001,2280.8856000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27132,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2963.4864000000002,2963.4864000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27134,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3371.3820000000001,3371.3820000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27137,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2598.9965999999999,2598.9965999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27138,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2700.6732000000002,2700.6732000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27140,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1598.2847999999999,1598.2847999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27146,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2279.1017999999999,2279.1017999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27147,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2598.9965999999999,2598.9965999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27151,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2807.1066000000001,2807.1066000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27156,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3022.9464000000003,3022.9464000000003,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27158,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2488.9956000000002,2488.9956000000002,"090",0.1,0.69,0.21,0,2,2,2,0,0,null,"R",null,null,2,29]
[27161,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2175.6414000000004,2175.6414000000004,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27165,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2455.1034,2455.1034,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27170,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2074.5594000000001,2074.5594000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27175,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1193.9567999999999,1193.9567999999999,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27176,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1651.2041999999999,1651.2041999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27177,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1991.3154000000002,1991.3154000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27178,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1651.2041999999999,1651.2041999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27179,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1751.097,1751.097,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27181,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1997.2614000000003,1997.2614000000003,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27185,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1290.8766000000001,1290.8766000000001,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27187,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1782.6108000000002,1782.6108000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27197,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",242.5968,242.5968,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[27198,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",569.6268,569.6268,"000",0,0,0,0,2,0,0,2,0,null,"R",null,null,2,29]
[27200,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",344.27339999999998,345.46260000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[27202,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",946.60320000000002,946.60320000000002,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[27215,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1076.2260000000001,1076.2260000000001,"090",0.1,0.69,0.21,9,9,9,9,9,9,null,"R",null,null,2,29]
[27216,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1589.9603999999999,1589.9603999999999,"090",0.1,0.69,0.21,9,9,9,9,9,9,null,"R",null,null,2,29]
[27217,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1494.8244,1494.8244,"090",0.1,0.69,0.21,9,9,9,9,9,9,null,"R",null,null,2,29]
[27218,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2048.3970000000004,2048.3970000000004,"090",0.1,0.69,0.21,9,9,9,9,9,9,null,"R",null,null,2,29]
[27220,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",756.33120000000008,743.84460000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27222,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1760.0160000000001,1760.0160000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27226,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1881.3144,1881.3144,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27227,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2927.8104000000003,2927.8104000000003,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27228,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3325.0032000000001,3325.0032000000001,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27230,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",883.57560000000001,865.73760000000004,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27232,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1314.066,1314.066,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27235,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1622.6633999999999,1622.6633999999999,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27236,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2125.1004000000003,2125.1004000000003,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27238,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",846.71040000000005,846.71040000000005,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27240,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1714.8263999999999,1714.8263999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27244,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2185.7496000000001,2185.7496000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27245,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2183.9657999999999,2183.9657999999999,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27246,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",709.3578,699.8442,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27248,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1335.4716000000001,1335.4716000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27250,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",313.94880000000001,313.94880000000001,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[27252,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1352.1204,1352.1204,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27253,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1681.5288,1681.5288,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27254,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2264.8314,2264.8314,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27256,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",551.19420000000002,420.38220000000001,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R",null,null,2,29]
[27257,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",642.16800000000001,642.16800000000001,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R",null,null,2,29]
[27258,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1984.1801999999998,1984.1801999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27259,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2741.1060000000002,2741.1060000000002,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27265,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",742.65539999999999,742.65539999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27266,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1054.2257999999999,1054.2257999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27267,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",798.54779999999994,798.54779999999994,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27268,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",981.68460000000016,981.68460000000016,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27269,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2204.1822000000002,2204.1822000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27275,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",329.40840000000003,329.40840000000003,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[27279,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1490.6622,1490.6622,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27280,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2408.13,2408.13,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27282,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1542.3924000000002,1542.3924000000002,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[27284,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2843.3771999999999,2843.3771999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27286,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2914.1345999999999,2914.1345999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27290,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2887.3776000000003,2887.3776000000003,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[27295,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2242.2366000000002,2242.2366000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27299,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT"," By Report "," By Report ","000",0,0,0,0,2,1,2,1,1,null,"N",null,null,2,29]
[27301,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1231.4166,910.92720000000008,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27303,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1147.578,1147.578,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27305,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",872.87279999999998,872.87279999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27306,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",613.0326,613.0326,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27307,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",755.14199999999994,755.14199999999994,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,null,2,29]
[27310,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1315.2552000000001,1315.2552000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27323,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",503.62620000000004,311.57040000000001,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[27324,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",733.7364,733.7364,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27325,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1020.3336,1020.3336,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM",2,29]
[27326,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",946.0086,946.0086,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[27327,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",934.71120000000008,566.65379999999993,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27328,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1114.2803999999999,1114.2803999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27329,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1851.5844,1851.5844,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27330,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",764.65559999999994,764.65559999999994,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[27331,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",860.98080000000004,860.98080000000004,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27332,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1163.0375999999999,1163.0375999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27333,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1063.1448,1063.1448,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27334,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1233.7950000000001,1233.7950000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27335,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1375.3098,1375.3098,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27337,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",752.16899999999998,752.16899999999998,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27339,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1347.9582,1347.9582,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27340,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",680.81700000000001,680.81700000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[27345,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",878.2242,878.2242,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27347,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",949.57620000000009,949.57620000000009,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27350,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1179.0917999999999,1179.0917999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27355,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1097.037,1097.037,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27356,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1329.5255999999999,1329.5255999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27357,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1472.2296000000001,1472.2296000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27358,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",483.40980000000008,483.40980000000008,"000",0,0,0,0,0,0,2,0,0,null,"R",null,"Y-UR",2,29]
[27360,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1636.9338,1636.9338,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27364,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X",null,null,2,29]
[27365,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3633.6006000000002,3633.6006000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27369,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",330.5976,70.162800000000004,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[27372,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1093.4694,724.22280000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27380,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1133.9022,1133.9022,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27381,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1485.3108,1485.3108,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27385,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1106.5506,1106.5506,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27386,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1551.9060000000002,1551.9060000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27390,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",812.81820000000005,812.81820000000005,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[27391,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1003.6848,1003.6848,"090",0.1,0.69,0.21,0,2,0,0,1,0,null,"R",null,"Y-UR",2,29]
[27392,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1281.9576,1281.9576,"090",0.1,0.69,0.21,0,2,2,2,1,0,null,"R",null,"Y-UR",2,29]
[27393,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",906.17039999999997,906.17039999999997,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27394,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1178.4972,1178.4972,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[27395,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1580.4467999999999,1580.4467999999999,"090",0.1,0.69,0.21,0,2,2,2,1,0,null,"R",null,"Y-UR",2,29]
[27396,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1114.2803999999999,1114.2803999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27397,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1638.123,1638.123,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[27400,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1252.2275999999999,1252.2275999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27403,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1161.2538000000002,1161.2538000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27405,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1218.3353999999999,1218.3353999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27407,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1431.7967999999998,1431.7967999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27409,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1731.4752000000001,1731.4752000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27412,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X",null,null,2,29]
[27415,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2444.4005999999999,2444.4005999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27416,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1751.097,1751.097,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[27418,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1491.2567999999999,1491.2567999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27420,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1333.6877999999999,1333.6877999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27422,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1334.2824000000001,1334.2824000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27424,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1344.9852000000001,1344.9852000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27425,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",822.33180000000004,822.33180000000004,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[27427,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1277.2008000000001,1277.2008000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27428,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1997.8560000000002,1997.8560000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27429,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2248.7772,2248.7772,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27430,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1334.2824000000001,1334.2824000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27435,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1446.0672,1446.0672,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27437,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1187.4161999999999,1187.4161999999999,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[27438,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1504.9325999999999,1504.9325999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27440,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1430.6076,1430.6076,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27441,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1476.3917999999999,1476.3917999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27442,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1558.4466,1558.4466,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27443,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1462.7160000000001,1462.7160000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27445,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2233.3176000000003,2233.3176000000003,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27446,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2051.37,2051.37,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27447,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2278.5072,2278.5072,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27448,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1449.6348,1449.6348,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27450,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1808.7732000000001,1808.7732000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27454,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2301.6966000000002,2301.6966000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27455,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1724.9346,1724.9346,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27457,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1716.0155999999999,1716.0155999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27465,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2221.4256,2221.4256,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27466,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2112.6138000000001,2112.6138000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27468,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2387.319,2387.319,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27470,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2103.1001999999999,2103.1001999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27472,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2250.5610000000001,2250.5610000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27475,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,1,1,1,0,null,"X",null,null,2,29]
[27477,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,1,1,1,0,null,"X",null,null,2,29]
[27479,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,1,2,0,0,null,"X",null,null,2,29]
[27485,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,1,1,0,0,null,"X",null,null,2,29]
[27486,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2494.9416000000001,2494.9416000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27487,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3107.9742000000001,3107.9742000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27488,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2136.9924000000001,2136.9924000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27495,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2015.694,2015.694,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27496,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",991.19820000000016,991.19820000000016,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27497,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1045.3067999999998,1045.3067999999998,"090",0.1,0.69,0.21,0,2,1,0,2,0,null,"R",null,null,2,29]
[27498,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1183.2539999999999,1183.2539999999999,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27499,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1261.1466,1261.1466,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27500,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",946.60320000000002,867.52139999999997,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27501,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",918.06240000000003,899.62980000000005,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27502,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1357.4718,1357.4718,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27503,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1432.3914,1432.3914,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27506,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2381.373,2381.373,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27507,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1724.9346,1724.9346,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27508,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",956.1167999999999,904.38660000000004,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27509,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1229.6328000000001,1229.6328000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27510,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1216.5516,1216.5516,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27511,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1773.0971999999999,1773.0971999999999,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27513,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2196.4523999999997,2196.4523999999997,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27514,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1721.9616000000001,1721.9616000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27516,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",946.0086,881.79179999999997,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27517,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1240.3355999999999,1240.3355999999999,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27519,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1589.3658,1589.3658,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27520,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",599.35680000000002,552.97800000000007,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27524,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1352.7149999999999,1352.7149999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27530,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",569.03219999999999,533.35620000000006,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27532,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1124.9832000000001,1046.4960000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27535,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1599.4739999999999,1599.4739999999999,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27536,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2114.3976000000002,2114.3976000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27538,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",890.71080000000006,825.30480000000011,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27540,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1459.1484,1459.1484,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27550,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",938.27879999999993,859.197,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27552,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1144.605,1144.605,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27556,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1564.3925999999999,1564.3925999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27557,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1861.6925999999999,1861.6925999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27558,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2114.3976000000002,2114.3976000000002,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27560,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",676.06020000000001,614.22180000000003,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27562,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",888.92700000000002,888.92700000000002,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27566,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1597.0955999999999,1597.0955999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27570,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",275.2998,275.2998,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[27580,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2639.4294,2639.4294,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27590,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1387.7963999999999,1387.7963999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27591,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1723.1508000000001,1723.1508000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27592,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1185.0378000000001,1185.0378000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27594,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",906.76499999999999,906.76499999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[27596,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1267.0925999999999,1267.0925999999999,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[27598,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1242.1194,1242.1194,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27599,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT"," By Report "," By Report ","000",0,0,0,0,2,1,2,1,1,null,"N",null,"Y-UR",2,29]
[27600,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",721.84440000000006,721.84440000000006,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27601,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",803.89919999999995,803.89919999999995,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27602,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",849.68340000000001,849.68340000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27603,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",973.95479999999998,705.79019999999991,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27604,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",819.95339999999999,576.16739999999993,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27605,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",610.05960000000005,326.43540000000002,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R",null,null,2,29]
[27606,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",487.57199999999995,487.57199999999995,"010",0.1,0.8,0.1,0,2,1,1,1,0,null,"R",null,null,2,29]
[27607,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1069.6853999999998,1069.6853999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27610,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1162.443,1162.443,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[27612,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1003.0902000000001,1003.0902000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27613,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",464.38259999999997,287.1918,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[27614,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1064.9286,739.68240000000003,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27615,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,1,0,1,0,null,"X",null,null,2,29]
[27616,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,1,0,1,0,null,"X",null,null,2,29]
[27618,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",906.76499999999999,550.59960000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27619,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",825.89940000000001,825.89940000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27620,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",810.4398000000001,810.4398000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27625,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1029.2526,1029.2526,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27626,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1079.1989999999998,1079.1989999999998,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[27630,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",993.5766000000001,645.14099999999996,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27632,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",737.89859999999999,737.89859999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27634,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1205.8488,1205.8488,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27635,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1041.1446000000001,1041.1446000000001,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27637,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1318.2282,1318.2282,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27638,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1344.3905999999999,1344.3905999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27640,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1488.2838000000002,1488.2838000000002,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27641,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1167.1997999999999,1167.1997999999999,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27645,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3132.3528000000001,3132.3528000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27646,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2725.0517999999997,2725.0517999999997,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27647,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1760.6106,1760.6106,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27648,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",412.65240000000006,89.784599999999998,"000",0,0,0,0,2,1,0,0,0,null,"R",null,null,2,29]
[27650,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1183.8486,1183.8486,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27652,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1178.4972,1178.4972,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[27654,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1277.2008000000001,1277.2008000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27656,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1008.4416000000001,634.43820000000005,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27658,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",662.97900000000004,662.97900000000004,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[27659,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",842.54819999999995,842.54819999999995,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[27664,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",657.62760000000003,657.62760000000003,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,"Y-UR",2,29]
[27665,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",759.89879999999994,759.89879999999994,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[27675,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",882.38639999999998,882.38639999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27676,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1090.4964,1090.4964,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[27680,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",750.97980000000007,750.97980000000007,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,"Y-UR",2,29]
[27681,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",913.30560000000003,913.30560000000003,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[27685,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1195.7406000000001,833.03459999999995,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27686,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",954.33300000000008,954.33300000000008,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[27687,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",814.60199999999998,814.60199999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27690,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1149.9564,1149.9564,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27691,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1334.2824000000001,1334.2824000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27692,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",177.1908,177.1908,"000",0,0,0,0,0,0,2,1,0,null,"R",null,null,2,29]
[27695,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",862.17,862.17,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[27696,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",982.27919999999995,982.27919999999995,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[27698,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1140.4428,1140.4428,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27700,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1097.037,1097.037,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27702,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1718.394,1718.394,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27703,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1975.2611999999999,1975.2611999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[27704,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1025.0903999999998,1025.0903999999998,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[27705,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1359.2556,1359.2556,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27707,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",730.76339999999993,730.76339999999993,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[27709,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2035.9104000000002,2035.9104000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27712,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1966.3422,1966.3422,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27715,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1915.8011999999999,1915.8011999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27720,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1566.1764000000001,1566.1764000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27722,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1603.0416,1603.0416,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27724,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2228.5607999999997,2228.5607999999997,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27725,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2166.7224000000001,2166.7224000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27726,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1711.2588000000001,1711.2588000000001,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27727,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X",null,null,2,29]
[27730,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1061.3610000000001,1061.3610000000001,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-CM",2,29]
[27732,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",821.14260000000002,821.14260000000002,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[27734,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1184.4432000000002,1184.4432000000002,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[27740,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1272.444,1272.444,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-CM",2,29]
[27742,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1394.337,1394.337,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[27745,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1358.0663999999999,1358.0663999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27750,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",638.60040000000004,591.62699999999995,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27752,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",974.54939999999999,889.52160000000003,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27756,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1045.9014,1045.9014,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27758,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1605.42,1605.42,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27759,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1780.827,1780.827,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27760,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",611.84339999999997,564.27539999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27762,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",881.19720000000007,794.98019999999997,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27766,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1089.9017999999999,1089.9017999999999,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27767,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",538.70760000000007,533.35620000000006,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27768,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",814.00739999999996,814.00739999999996,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27769,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1307.5254,1307.5254,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27780,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",571.41059999999993,524.43720000000008,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27781,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",797.95320000000004,732.54719999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27784,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1271.2547999999999,1271.2547999999999,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27786,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",578.54579999999999,529.78859999999997,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27788,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",777.73680000000002,701.62800000000004,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27792,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1161.2538000000002,1161.2538000000002,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27808,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",618.97860000000003,563.08620000000008,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27810,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",861.57540000000006,773.57460000000003,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27814,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1372.3367999999998,1372.3367999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27816,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",609.46500000000003,539.89679999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27818,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",891.9,793.19640000000004,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27822,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1584.6089999999999,1584.6089999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27823,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1776.6648,1776.6648,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27824,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",582.70800000000008,557.73480000000006,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27825,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",985.25220000000002,885.95400000000006,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27826,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1546.5546000000002,1546.5546000000002,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27827,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2019.2616,2019.2616,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27828,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2388.5082000000002,2388.5082000000002,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27829,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1283.1468,1283.1468,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[27830,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",717.08760000000007,659.41139999999996,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27831,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",745.03379999999993,745.03379999999993,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27832,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1360.4448,1360.4448,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27840,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",694.49279999999999,694.49279999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27842,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",897.846,897.846,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27846,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1297.4172000000001,1297.4172000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27848,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1415.1480000000001,1415.1480000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27860,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",297.3,297.3,"010",0.1,0.8,0.1,0,2,1,0,0,0,null,"R",null,null,2,29]
[27870,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1804.6110000000001,1804.6110000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27871,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1238.5518,1238.5518,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[27880,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1586.9874000000002,1586.9874000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27881,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1515.0408,1515.0408,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27882,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1045.9014,1045.9014,"090",0.1,0.69,0.21,0,2,1,0,1,0,null,"R",null,null,2,29]
[27884,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1027.4688000000001,1027.4688000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[27886,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1154.7132000000001,1154.7132000000001,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27888,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1155.3078,1155.3078,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[27889,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1124.3886,1124.3886,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[27892,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",958.49520000000007,958.49520000000007,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27893,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1105.9560000000001,1105.9560000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[27894,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1457.9592,1457.9592,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[27899,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT"," By Report "," By Report ","000",0,0,0,0,2,1,0,1,1,null,"N",null,null,2,29]
[28001,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",316.92180000000002,170.65020000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[28002,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",455.46360000000004,249.73200000000003,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[28003,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",692.11440000000005,461.40960000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[28005,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1021.5228,1021.5228,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28008,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",778.33140000000003,525.03179999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28010,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",419.19299999999998,370.43580000000003,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28011,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",564.27539999999999,498.86940000000004,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28020,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1003.6848,662.97900000000004,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,"Y-UR",2,29]
[28022,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",885.35940000000005,583.30259999999998,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-UR",2,29]
[28024,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",828.27779999999996,542.86980000000005,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-UR",2,29]
[28035,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",952.54920000000004,635.03279999999995,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[28039,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",888.33240000000001,617.7894,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[28041,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",801.52080000000001,801.52080000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28043,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",696.87120000000004,463.1934,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28045,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",865.14300000000003,614.81640000000004,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28046,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,1,1,1,0,null,"X",null,null,2,29]
[28047,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X",null,null,2,29]
[28050,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",754.54739999999993,495.30180000000001,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[28052,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",708.16859999999997,454.86900000000003,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[28054,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",667.14120000000003,416.81459999999998,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28055,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",680.22239999999999,680.22239999999999,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28060,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",944.81940000000009,645.14099999999996,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28062,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1029.8471999999999,712.92539999999997,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[28070,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",935.90039999999999,620.16779999999994,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28072,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",893.08920000000001,580.32960000000003,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28080,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",968.00880000000006,674.87099999999998,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[28086,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",978.11699999999996,638.00580000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[28088,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",831.25080000000003,515.51819999999998,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28090,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",844.33199999999999,548.22120000000007,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28092,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",761.68260000000009,481.62599999999998,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28100,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1119.0372,752.16899999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[28102,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1101.1992,1101.1992,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[28103,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",689.73599999999999,689.73599999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[28104,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",951.95460000000014,629.68140000000005,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[28106,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",757.5204,757.5204,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[28107,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",913.30560000000003,615.41099999999994,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,null,2,29]
[28108,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",789.03419999999994,513.73440000000005,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28110,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",837.19680000000005,519.08580000000006,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[28111,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",872.87279999999998,572.59980000000007,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[28112,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",879.41339999999991,558.32940000000008,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[28113,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1058.9826,759.30420000000004,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[28114,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1926.5039999999999,1494.8244,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28116,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1395.5262,1041.1446000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[28118,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1094.6586,752.16899999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28119,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",954.33300000000008,649.30320000000006,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[28120,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1220.7138,888.33240000000001,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[28122,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1068.4962,780.11519999999996,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28124,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",863.35919999999999,594.00540000000001,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[28126,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",708.16859999999997,441.7878,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28130,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1094.6586,1094.6586,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[28140,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1039.3607999999999,764.06100000000004,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,null,2,29]
[28150,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",757.5204,495.30180000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28153,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",741.46620000000007,472.70699999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28160,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",748.60140000000001,478.05839999999995,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28171,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,0,2,0,0,null,"X",null,null,2,29]
[28173,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,0,1,1,0,null,"X",null,null,2,29]
[28175,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,0,1,1,0,null,"X",null,null,2,29]
[28190,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",446.5446,236.05620000000002,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[28192,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",836.60220000000004,554.16719999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28193,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",946.0086,652.27620000000002,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28200,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",903.19740000000002,585.68100000000004,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,"Y-UR",2,29]
[28202,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1076.2260000000001,761.08800000000008,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[28208,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",878.81880000000001,571.41059999999993,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,"Y-UR",2,29]
[28210,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1060.7664,746.22300000000007,"090",0.1,0.69,0.21,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[28220,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",817.57500000000005,542.86980000000005,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[28222,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",943.03559999999993,641.57339999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[28225,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",755.14199999999994,472.11240000000004,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[28226,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1133.3075999999999,718.87139999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[28230,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",785.46660000000008,506.00459999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[28232,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",689.14139999999998,429.89580000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-UR",2,29]
[28234,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",743.84460000000001,478.05839999999995,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,"Y-UR",2,29]
[28238,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1212.9839999999999,871.08900000000006,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28240,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",808.65599999999995,523.84260000000006,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28250,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1051.8474000000001,723.62819999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[28260,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1283.1468,939.46800000000007,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[28261,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2173.2629999999999,1676.1774,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28262,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2515.1579999999999,2005.5857999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[28264,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1632.7716,1236.768,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,null,2,29]
[28270,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",883.57560000000001,595.19460000000004,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28272,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",696.87120000000004,446.5446,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28280,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",927.57600000000002,620.16779999999994,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28285,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",973.36020000000008,684.97919999999999,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[28286,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",802.11540000000002,528.59940000000006,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28288,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1097.6316000000002,776.54759999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28289,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1248.6600000000001,818.16959999999995,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28291,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1282.5522000000001,872.27819999999997,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28292,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1258.7682000000002,857.41319999999996,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28295,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2002.0182000000002,1102.9829999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28296,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1625.0418,911.52179999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28297,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1896.1794,1077.4152000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28298,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1518.0138000000002,894.87300000000005,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28299,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1839.0978,1047.6852000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28300,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1160.6592000000001,1160.6592000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28302,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1286.1197999999999,1286.1197999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28304,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1494.8244,1090.4964,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28305,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1210.0110000000002,1210.0110000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28306,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1099.4153999999999,719.46600000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28307,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1437.1482000000001,930.54899999999998,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28308,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1035.7932000000001,688.54679999999996,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28309,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1586.9874000000002,1586.9874000000002,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28310,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",988.81979999999999,643.95180000000005,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[28312,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",943.03559999999993,586.87019999999995,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,null,2,29]
[28313,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",957.90059999999994,641.57339999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28315,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",872.27819999999997,583.30259999999998,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,null,2,29]
[28320,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1089.3072,1089.3072,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[28322,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1420.4994000000002,1029.8471999999999,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[28340,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,0,1,0,0,null,"X",null,null,2,29]
[28341,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,0,1,0,0,null,"X",null,null,2,29]
[28344,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,1,1,1,0,null,"X",null,null,2,29]
[28345,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,0,0,0,0,null,"X",null,null,2,29]
[28360,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,1,2,0,0,null,"X",null,null,2,29]
[28400,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",453.08519999999999,419.19299999999998,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28405,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",708.16859999999997,635.62739999999997,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28406,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1024.4958000000001,1024.4958000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28415,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2020.4507999999998,2020.4507999999998,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[28420,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2332.0212000000001,2332.0212000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[28430,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",441.19319999999999,385.30080000000004,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28435,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",676.65480000000002,597.57300000000009,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28436,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",909.14339999999993,909.14339999999993,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28445,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1825.422,1825.422,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[28446,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,1,2,1,0,null,"X",null,null,2,29]
[28450,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",387.08459999999997,349.03020000000004,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28455,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",530.38319999999999,470.32859999999999,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[28456,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",684.97919999999999,684.97919999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28465,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1145.7942,1145.7942,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28470,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",399.57119999999998,375.19259999999997,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28475,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",464.97720000000004,407.30099999999999,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28476,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",712.92539999999997,712.92539999999997,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[28485,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1012.6038000000001,1012.6038000000001,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,null,2,29]
[28490,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",258.65100000000001,226.54259999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28495,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",326.43540000000002,269.94839999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28496,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",830.65620000000001,443.57159999999999,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28505,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1195.7406000000001,891.9,"090",0.1,0.69,0.21,0,2,1,1,0,0,null,"R",null,null,2,29]
[28510,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",218.81280000000001,216.43440000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28515,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",297.89459999999997,258.65100000000001,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28525,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1034.604,726.60120000000006,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[28530,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",206.92080000000001,178.38,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28531,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",603.51900000000001,322.86779999999999,"090",0.1,0.69,0.21,0,2,1,1,2,0,null,"R",null,null,2,29]
[28540,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",354.38159999999999,316.92180000000002,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28545,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",567.84300000000007,494.7072,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28546,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1086.3342,638.60040000000004,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28555,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1556.6628000000001,1176.7133999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[28570,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",431.08499999999998,358.54380000000003,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28575,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",692.70900000000006,618.38400000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28576,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",694.49279999999999,694.49279999999999,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,null,2,29]
[28585,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1597.0955999999999,1243.9032000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,null,2,29]
[28600,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",395.40900000000005,335.3544,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[28605,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",627.303,556.54559999999992,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[28606,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",683.79,683.79,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28615,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1489.473,1489.473,"090",0.1,0.69,0.21,0,2,0,2,1,0,null,"R",null,null,2,29]
[28630,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",277.6782,196.8126,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[28635,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",315.13799999999998,237.24540000000002,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[28636,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",572.59980000000007,356.76,"010",0.1,0.8,0.1,0,2,0,1,2,0,null,"R",null,null,2,29]
[28645,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1176.7133999999999,865.73760000000004,"090",0.1,0.69,0.21,0,2,0,1,1,0,null,"R",null,null,2,29]
[28660,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",222.97499999999999,165.89340000000001,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[28665,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",271.73220000000003,225.35339999999999,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[28666,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",320.48939999999999,320.48939999999999,"010",0.1,0.8,0.1,0,2,0,1,2,0,null,"R",null,null,2,29]
[28675,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1048.8744000000002,737.30400000000009,"090",0.1,0.69,0.21,0,2,0,1,0,0,null,"R",null,null,2,29]
[28705,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2172.6684,2172.6684,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28715,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1681.5288,1681.5288,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28725,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1390.1748,1390.1748,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28730,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1309.3091999999999,1309.3091999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28735,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1395.5262,1395.5262,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28737,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1224.8760000000002,1224.8760000000002,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28740,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1498.9866000000002,1102.9829999999999,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28750,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1422.2832000000001,1035.1985999999999,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[28755,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",922.81920000000002,598.16759999999999,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[28760,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1378.2828,1011.4146000000001,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28800,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",942.44100000000003,942.44100000000003,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[28805,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1258.1736000000001,1258.1736000000001,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[28810,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",755.14199999999994,755.14199999999994,"090",0.1,0.69,0.21,0,2,0,0,0,0,null,"R",null,null,2,29]
[28820,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",545.2482,314.54340000000002,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[28825,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",535.14,305.62439999999998,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[28890,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.69,0.21,0,2,1,1,1,0,null,"X",null,null,2,29]
[28899,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT"," By Report "," By Report ","000",0,0,0,0,2,0,0,1,1,null,"N",null,null,2,29]
[29000,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",630.87059999999997,346.05720000000002,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[29010,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",488.76120000000003,283.02960000000002,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[29015,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",525.03179999999998,318.7056,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[29035,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",459.62580000000003,253.2996,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[29040,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",523.84260000000006,304.43520000000001,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[29044,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",513.73440000000005,294.327,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[29046,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",563.08620000000008,331.78680000000003,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[29049,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",177.78540000000001,123.6768,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[29055,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",398.97660000000002,242.5968,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[29058,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",220.00200000000001,165.2988,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[29065,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",173.02860000000001,121.2984,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29075,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",155.7852,110.001,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29085,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",171.2448,119.51459999999999,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29086,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",137.3526,88.000799999999998,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29105,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",146.27160000000001,72.541200000000003,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29125,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",118.3254,70.757400000000004,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29126,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",139.13639999999998,87.406199999999998,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29130,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",73.730400000000003,51.730200000000004,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29131,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",94.54140000000001,60.6492,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29200,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",60.054600000000001,33.297600000000003,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[29240,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",54.703200000000002,32.703000000000003,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29260,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",53.514000000000003,33.892199999999995,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29280,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",52.919400000000003,35.081400000000002,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29305,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",442.38240000000002,279.46199999999999,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[29325,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",488.16660000000007,312.75959999999998,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[29345,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",242.00220000000002,176.0016,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29355,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",253.2996,187.89360000000002,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29358,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",286.59720000000004,181.94759999999999,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29365,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",220.00200000000001,154.596,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29405,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",142.70400000000001,102.86580000000001,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29425,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",134.9742,95.73060000000001,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29435,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",200.97479999999999,140.92020000000002,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29440,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",75.514200000000002,49.351799999999997,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29445,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",229.51560000000001,175.40700000000001,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29450,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,0,2,1,1,0,0,null,"X",null,null,2,29]
[29505,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",156.9744,90.973799999999997,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29515,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",127.24440000000001,86.811599999999999,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29520,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",64.216800000000006,32.703000000000003,"000",0,0,0,0,2,1,0,0,0,null,"R",null,null,2,29]
[29530,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",54.703200000000002,32.108400000000003,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29540,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",49.946399999999997,30.9192,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29550,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",34.486799999999995,19.6218,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29580,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",117.1362,46.973400000000005,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29581,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",165.2988,48.162600000000005,"000",0,0,0,0,2,1,0,0,0,null,"R",null,null,2,29]
[29584,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",153.4068,27.946199999999997,"000",0,0,0,0,2,1,0,0,0,null,"R",null,null,2,29]
[29700,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",110.5956,58.270800000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[29705,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",112.97399999999999,78.487200000000001,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[29710,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",217.029,145.08240000000001,"000",0,0,0,0,2,1,0,0,0,null,"R",null,null,2,29]
[29720,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",151.62299999999999,75.514200000000002,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[29730,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",113.5686,77.892600000000002,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[29740,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",176.0016,121.89299999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[29750,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,0,2,1,0,0,0,null,"X",null,null,2,29]
[29799,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT"," By Report "," By Report ","000",0,0,0,0,2,0,0,1,1,null,"N",null,null,2,29]
[29800,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",954.33300000000008,954.33300000000008,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[29804,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1079.7936,1079.7936,"090",0.1,0.69,0.21,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[29805,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",844.92660000000001,844.92660000000001,"090",0.1,0.69,0.21,0,2,1,1,1,0,null,"R",null,"Y-UR",2,29]
[29806,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1893.2064,1893.2064,"090",0.1,0.69,0.21,0,3,1,1,1,0,null,"R",null,"Y-UR",2,29]
[29807,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1847.4222,1847.4222,"090",0.1,0.69,0.21,0,3,1,1,1,0,null,"R",null,"Y-UR",2,29]
[29819,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1056.0096000000001,1056.0096000000001,"090",0.1,0.69,0.21,0,3,1,1,1,0,null,"R",null,"Y-UR",2,29]
[29821,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1070.28,1070.28,"090",0.1,0.69,0.21,0,3,1,2,1,0,null,"R",null,"Y-UR",2,29]
[29836,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1053.6312,1053.6312,"090",0.1,0.69,0.21,0,3,1,2,1,0,null,"R",null,"Y-UR",2,29]
[29855,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1400.2830000000001,1400.2830000000001,"090",0.1,0.69,0.21,0,2,1,2,2,0,null,"R",null,null,2,29]
[29866,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1881.3144,1881.3144,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-UR",2,29]
[29881,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",974.54939999999999,974.54939999999999,"090",0.1,0.69,0.21,0,3,1,0,0,0,null,"R",null,"Y-UR",2,29]
[29884,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1110.7128,1110.7128,"090",0.1,0.69,0.21,0,3,1,2,1,0,null,"R",null,"Y-UR",2,29]
[29892,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1137.4697999999999,1137.4697999999999,"090",0.1,0.69,0.21,0,2,1,2,0,0,null,"R",null,"Y-UR",2,29]
[29902,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1033.4148,1033.4148,"090",0.1,0.69,0.21,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[30000,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",504.22080000000005,217.029,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[30150,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1473.4188000000001,1473.4188000000001,"090",0.1,0.76,0.14000000000000001,0,2,0,1,1,0,null,"R",null,null,2,29]
[30435,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2480.6711999999998,2480.6711999999998,"090",0.1,0.76,0.14000000000000001,0,2,0,2,0,0,null,"R",null,null,2,29]
[30520,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1243.9032000000002,1243.9032000000002,"090",0.1,0.76,0.14000000000000001,0,2,0,1,0,0,null,"R",null,null,2,29]
[30905,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",660.00599999999997,185.51520000000002,"000",0,0,0,0,2,2,1,0,0,null,"R",null,null,2,29]
[30920,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1596.5010000000002,1596.5010000000002,"090",0.1,0.76,0.14000000000000001,0,2,0,1,0,0,null,"R",null,null,2,29]
[31032,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1088.1180000000002,1088.1180000000002,"090",0.1,0.76,0.14000000000000001,0,2,1,1,0,0,null,"R",null,null,2,29]
[31085,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2280.8856000000001,2280.8856000000001,"090",0.1,0.76,0.14000000000000001,0,2,1,2,1,0,null,"R",null,null,2,29]
[31231,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",350.81400000000002,112.37939999999999,"000",0,0,0,0,2,2,1,0,0,null,"R",null,null,2,29]
[31257,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",785.46660000000008,785.46660000000008,"000",0,0,0,0,3,1,1,0,0,null,"R",null,"Y-CM",2,29]
[31296,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3292.8948,315.73259999999999,"000",0,0,0,0,3,1,2,0,0,null,"R",null,null,2,29]
[31365,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"X",null,null,2,29]
[31502,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",61.8384,61.8384,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[31520,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,0,2,0,0,0,0,null,"X",null,null,2,29]
[31527,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",342.4896,342.4896,"000",0,0,0,0,3,0,0,0,0,null,"R",null,null,2,29]
[31545,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",635.62739999999997,635.62739999999997,"000",0,0,0,0,3,1,1,0,0,null,"R",null,null,2,29]
[31571,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",437.62560000000002,437.62560000000002,"000",0,0,0,0,3,0,1,0,0,null,"R",null,null,2,29]
[31590,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1703.529,1703.529,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"R",null,null,2,29]
[31614,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1297.4172000000001,1297.4172000000001,"090",0.1,0.76,0.14000000000000001,0,2,0,1,0,0,null,"R",null,null,2,29]
[31626,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1525.1489999999999,344.27339999999998,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[31638,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",432.86880000000002,432.86880000000002,"000",0,0,0,0,3,0,1,0,0,null,"R",null,null,2,29]
[31648,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",346.65180000000004,346.65180000000004,"000",0,0,0,0,3,0,1,0,0,null,"R",null,null,2,29]
[31652,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2466.4007999999999,387.67919999999998,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[31750,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2483.6442000000002,2483.6442000000002,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"R",null,null,2,29]
[31786,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"X",null,null,2,29]
[32100,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1416.3371999999999,1416.3371999999999,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"R",null,null,2,29]
[32225,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1746.3402000000001,1746.3402000000001,"090",0.1,0.76,0.14000000000000001,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[32442,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",5290.1562000000004,5290.1562000000004,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[32506,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",270.54300000000001,270.54300000000001,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM",2,29]
[32554,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",445.35540000000003,156.9744,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[32557,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1277.2008000000001,261.62400000000002,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[32609,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",445.35540000000003,445.35540000000003,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[32659,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1282.5522000000001,1282.5522000000001,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[32672,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2641.8078,2641.8078,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[32820,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2326.0751999999998,2326.0751999999998,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[32940,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2149.4789999999998,2149.4789999999998,"090",0.1,0.76,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33030,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3476.6262000000002,3476.6262000000002,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33202,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1346.1744000000001,1346.1744000000001,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,1,0,0,null,"R",null,null,2,29]
[33207,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",844.33199999999999,844.33199999999999,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,1,2,0,null,"R",null,"Y-CM",2,29]
[33217,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",654.06000000000006,654.06000000000006,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[33227,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",601.73519999999996,601.73519999999996,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[33241,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",383.517,383.517,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[33255,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2829.1068,2829.1068,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33267,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1824.8274000000001,1824.8274000000001,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,null,2]
[33305,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",7070.3886000000002,7070.3886000000002,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33335,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3246.5160000000001,3246.5160000000001,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33362,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,0,2,0,0,2,1,null,"X",null,null,2,29]
[33390,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3346.4088000000002,3346.4088000000002,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[33414,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3719.8176000000003,3719.8176000000003,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33440,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"X",null,"Y-CM",2,29]
[33474,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3780.4668000000001,3780.4668000000001,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33505,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3564.0324000000001,3564.0324000000001,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33518,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",708.76319999999998,708.76319999999998,"000",0,0,0,0,0,0,2,0,0,null,"R",null,"Y-CM",2,29]
[33534,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3814.3590000000004,3814.3590000000004,"090",0.09,0.82,0.09,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[33542,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4537.3926000000001,4537.3926000000001,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33611,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3379.7064,3379.7064,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33645,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3003.3245999999999,3003.3245999999999,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33692,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"X",null,null,2,29]
[33726,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3519.4373999999998,3519.4373999999998,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33762,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"X",null,null,2,29]
[33779,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"X",null,null,2,29]
[33800,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,2,0,null,"X",null,null,2,29]
[33813,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"X",null,null,2,29]
[33853,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"X",null,null,2,29]
[33880,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3088.3523999999998,3088.3523999999998,"090",0.09,0.84,7.0000000000000007E-2,0,2,2,2,2,0,null,"R",null,null,2,29]
[33916,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",7223.2008000000005,7223.2008000000005,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33927,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4392.9047999999993,4392.9047999999993,"000",0,0,0,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[33948,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",415.03080000000006,415.03080000000006,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[33956,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1440.7157999999999,1440.7157999999999,"000",0,0,0,0,2,0,0,1,1,null,"R",null,"Y-CM",2,29]
[33970,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",612.4380000000001,612.4380000000001,"000",0,0,0,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[33974,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1557.8520000000001,1557.8520000000001,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[33983,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3977.2793999999999,3977.2793999999999,"000",0,0,0,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[33992,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",327.03000000000003,327.03000000000003,"000",0,0,0,0,2,0,2,0,0,null,"R",null,null,2,29]
[34401,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2581.1585999999998,2581.1585999999998,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[34510,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1758.8267999999998,1758.8267999999998,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[34709,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",553.57260000000008,553.57260000000008,"000",0,0,0,0,0,0,2,2,0,null,"R",null,"Y-UR",2,29]
[34716,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",639.78959999999995,639.78959999999995,"000",0,0,0,0,0,1,2,2,0,null,"R",null,"Y-UR",2,29]
[34839,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT"," By Report "," By Report ","000",0,0,0,0,0,0,0,0,0,null,"N",null,"Y-CM",2,29]
[34843,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT"," By Report "," By Report ","000",0,0,0,0,2,0,2,2,0,null,"N",null,null,2,29]
[35011,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1749.9078,1749.9078,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[35102,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3230.4618,3230.4618,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[35180,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"X",null,null,2,29]
[35206,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1366.3908000000001,1366.3908000000001,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,null,2,29]
[35256,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1760.6106,1760.6106,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,null,2,29]
[35301,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1952.6664000000003,1952.6664000000003,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[35361,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2614.4562000000001,2614.4562000000001,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[35372,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1680.9341999999999,1680.9341999999999,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[35511,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1924.7202,1924.7202,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[35526,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3006.2976000000003,3006.2976000000003,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[35571,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2284.4531999999999,2284.4531999999999,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[35585,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2876.0801999999999,2876.0801999999999,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[35632,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3101.4335999999998,3101.4335999999998,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[35645,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1631.5824,1631.5824,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[35682,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",605.89739999999995,605.89739999999995,"000",0,0,0,0,0,0,0,1,0,null,"R",null,"Y-CM",2,29]
[35686,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",275.89439999999996,275.89439999999996,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-CM",2,29]
[35703,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",728.9796,728.9796,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[35881,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1764.1782000000001,1764.1782000000001,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[36100,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1036.9824000000001,264.59700000000004,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[36200,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1143.4158,239.62380000000002,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[36227,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",429.89580000000001,205.73160000000001,"000",0,0,0,0,0,1,1,0,0,null,"R",null,null,2,29]
[36252,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2664.4026000000003,618.97860000000003,"000",0,0,0,0,2,2,1,0,0,null,"R",null,null,2,29]
[36416,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4.3877999999999995,4.3877999999999995,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,29,23]
[36456,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,0,2,0,0,0,0,null,"X",null,null,2,29]
[36470,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,0,2,1,1,0,0,null,"X",null,null,2,29]
[36482,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3241.1646000000001,310.97580000000005,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[36563,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2158.3979999999997,643.35720000000003,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[36568,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,0,0,0,1,0,0,null,"X",null,null,2,29]
[36582,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1701.1505999999999,506.5992,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[36592,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",55.297800000000002,55.297800000000002,"000",0,0,0,3,0,0,0,0,0,null,"R",null,null,2,29]
[36800,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",213.4614,213.4614,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[36823,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.09,0.84,7.0000000000000007E-2,0,2,0,1,0,0,null,"X",null,null,2,29]
[36833,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1403.8506,1403.8506,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[36905,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4413.7157999999999,770.60160000000008,"000",0,0,0,0,2,0,1,1,0,null,"R",null,"Y-CM",2,29]
[37188,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2842.1879999999996,481.62599999999998,"000",0,0,0,0,0,1,1,2,0,null,"R",null,null,2,29]
[37193,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2876.0801999999999,599.95140000000004,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[37218,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1418.7156,1418.7156,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[37226,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",16138.038600000002,893.08920000000001,"000",0,0,0,0,2,1,0,0,0,null,"R",null,"Y-CM",2,29]
[37238,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",6730.8720000000003,528.59940000000006,"000",0,0,0,0,2,1,0,0,0,null,"R",null,null,2,29]
[37247,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1041.1446000000001,291.9486,"000",0,0,0,0,0,1,1,0,0,null,"R",null,"Y-UR",2,29]
[37500,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1092.2802000000001,1092.2802000000001,"090",0.09,0.84,7.0000000000000007E-2,0,2,1,1,1,0,null,"R",null,"Y-CM",2,29]
[37616,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1930.6661999999999,1930.6661999999999,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,null,2,29]
[37788,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"X",null,null,2,29]
[38100,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2035.3157999999999,2035.3157999999999,"090",0.11,0.73,0.16,0,2,0,2,1,0,null,"R",null,null,2,29]
[38208,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,29]
[38215,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,29]
[38308,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.11,0.73,0.16,0,2,0,2,1,0,null,"X",null,null,2,29]
[38520,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",831.84540000000004,831.84540000000004,"090",0.11,0.73,0.16,0,2,1,1,0,0,null,"R",null,null,2,29]
[38550,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",939.46800000000007,939.46800000000007,"090",0.11,0.73,0.16,0,2,0,0,0,0,null,"R",null,null,2,29]
[38700,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1440.1212,1440.1212,"090",0.11,0.73,0.16,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[39000,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",885.35940000000005,885.35940000000005,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,null,2,29]
[39220,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1984.7748000000001,1984.7748000000001,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[39599,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT"," By Report "," By Report ","000",0,0,0,0,2,0,2,1,1,null,"N",null,null,2,29]
[40530,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1024.4958000000001,729.57420000000002,"090",0.09,0.81,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[40804,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",347.24639999999999,202.16399999999999,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[40816,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.09,0.81,0.1,0,2,0,1,0,0,null,"X",null,null,2,29]
[40831,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",574.3836,375.19259999999997,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[41010,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",409.08479999999997,199.78559999999999,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[41114,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.09,0.81,0.1,0,2,0,0,0,0,null,"X",null,null,2,29]
[41120,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.09,0.81,0.1,0,2,0,2,1,0,null,"X",null,null,2,29]
[41510,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.09,0.81,0.1,0,2,0,0,0,0,null,"X",null,null,2,29]
[41806,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",769.41239999999993,511.95059999999995,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[41872,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",866.92680000000007,544.65359999999998,"090",0.09,0.81,0.1,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[42107,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.09,0.81,0.1,0,2,0,1,0,0,null,"X",null,null,2,29]
[42180,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",470.32859999999999,334.75979999999998,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[42281,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",416.22,290.16480000000001,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[42409,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",735.52019999999993,413.84160000000003,"090",0.09,0.81,0.1,0,2,0,2,0,0,null,"R",null,null,2,29]
[42420,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.09,0.81,0.1,0,2,1,2,1,0,null,"X",null,null,2,29]
[42600,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1006.6578,638.00580000000002,"090",0.09,0.81,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[42725,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1426.4453999999998,1426.4453999999998,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[42830,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.09,0.81,0.1,0,2,0,0,0,0,null,"X",null,null,2,29]
[42860,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.09,0.81,0.1,0,2,0,0,0,0,null,"X",null,null,2,29]
[42900,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",591.03239999999994,591.03239999999994,"010",0.1,0.8,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[43030,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",935.90039999999999,935.90039999999999,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[43122,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4478.5271999999995,4478.5271999999995,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[43130,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.09,0.81,0.1,0,2,0,2,1,0,null,"X",null,null,2,29]
[43200,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",500.05860000000001,154.596,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[43211,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",412.65240000000006,412.65240000000006,"000",0,0,0,0,3,0,1,0,0,null,"R",null,null,2,29]
[43220,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1770.1242,208.11,"000",0,0,0,0,3,0,1,0,0,null,"R",null,null,2,29]
[43240,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",689.14139999999998,689.14139999999998,"000",0,0,0,0,3,0,1,0,0,null,"R",null,null,2,29]
[43245,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1149.3617999999999,308.59740000000005,"000",0,0,0,0,3,0,1,0,0,null,"R",null,null,2,29]
[43260,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",567.24839999999995,567.24839999999995,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[43277,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",665.952,665.952,"000",0,0,0,0,3,0,1,0,0,null,"R",null,null,2,29]
[43280,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1909.8552,1909.8552,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[43305,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1949.0988,1949.0988,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[43327,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1454.3916000000002,1454.3916000000002,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[43335,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2324.886,2324.886,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[43410,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1836.7194,1836.7194,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[43453,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1579.8522,152.81219999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[43620,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3506.3562000000002,3506.3562000000002,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[43647,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,0,2,0,2,1,0,null,"X",null,null,2,29]
[43652,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1364.0124000000001,1364.0124000000001,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[43763,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",658.22220000000004,149.83920000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[43800,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1652.3933999999999,1652.3933999999999,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[43840,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2409.9138000000003,2409.9138000000003,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[43882,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,0,2,0,2,1,0,null,"X",null,null,2,29]
[44005,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1934.2338000000002,1934.2338000000002,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[44125,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2081.6945999999998,2081.6945999999998,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[44141,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3218.5698000000002,3218.5698000000002,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[44151,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3821.4941999999996,3821.4941999999996,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[44186,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1160.0646000000002,1160.0646000000002,"090",0.09,0.84,7.0000000000000007E-2,0,2,0,2,1,0,null,"R",null,null,2,29]
[44206,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3075.8658,3075.8658,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[44227,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2929.5942,2929.5942,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[44360,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",252.70500000000001,252.70500000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[44366,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",420.97680000000003,420.97680000000003,"000",0,0,0,0,3,0,1,0,0,null,"R",null,null,2,29]
[44385,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",406.11180000000002,128.43360000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[44405,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,0,3,0,1,0,0,null,"X",null,null,2,29]
[44604,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1862.2872,1862.2872,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[44650,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2544.8879999999999,2544.8879999999999,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[44715,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT"," By Report "," By Report ","000",0,0,0,0,2,0,2,1,0,null,"N",null,null,2,29]
[44899,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT"," By Report "," By Report ","000",0,0,0,0,2,0,2,1,1,null,"N",null,null,2,29]
[45110,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3223.3265999999999,3223.3265999999999,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[45116,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2720.8896,2720.8896,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[45190,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.09,0.81,0.1,0,2,0,1,1,0,null,"X",null,null,2,29]
[45330,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",352.59780000000001,99.298199999999994,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[45338,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",567.24839999999995,212.2722,"000",0,0,0,0,3,0,1,0,0,null,"R",null,"Y-CM",2,29]
[45350,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,0,3,0,1,0,0,null,"X",null,null,2,29]
[45384,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",921.63,401.35500000000002,"000",0,0,0,0,3,0,1,0,0,null,"R",null,"Y-CM",2,29]
[45392,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",534.54539999999997,534.54539999999997,"000",0,0,0,0,3,0,1,0,0,null,"R",null,"Y-CM",2,29]
[45540,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1867.6386,1867.6386,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[45563,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2956.3512000000001,2956.3512000000001,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[46040,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1025.0903999999998,769.41239999999993,"090",0.09,0.81,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[46255,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",965.6303999999999,643.95180000000005,"090",0.09,0.81,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[46275,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1044.1176,764.65559999999994,"090",0.09,0.81,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[46600,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",227.13720000000001,72.541200000000003,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[46611,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",429.89580000000001,142.70400000000001,"000",0,0,0,0,3,0,1,0,0,null,"R",null,"Y-CM",2,29]
[46707,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",914.49480000000005,914.49480000000005,"090",0.09,0.81,0.1,0,2,0,0,0,0,null,"R",null,null,2,29]
[46750,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1340.2284,1340.2284,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[46761,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1630.3932000000002,1630.3932000000002,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[46948,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",809.84519999999998,809.84519999999998,"090",0.09,0.81,0.1,0,2,0,1,0,0,null,"R",null,"Y-UR",2,29]
[47135,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",9502.3026000000009,9502.3026000000009,"090",0.09,0.81,0.1,0,2,0,2,1,2,null,"R",null,"Y-CM",2,29]
[47146,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",573.78899999999999,573.78899999999999,"000",0,0,0,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[47370,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2217.8579999999997,2217.8579999999997,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[47460,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2262.453,2262.453,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[47531,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",824.71019999999999,122.4876,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[47543,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",743.25,247.94819999999999,"000",0,0,0,0,0,0,1,0,0,null,"R",null,null,2,29]
[47554,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",903.79199999999992,903.79199999999992,"000",0,0,0,0,3,0,1,1,0,null,"R",null,null,2,29]
[47700,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.09,0.81,0.1,0,2,0,2,1,0,null,"X",null,null,2,29]
[47785,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",5688.5382,5688.5382,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[48001,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4077.7667999999999,4077.7667999999999,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[48145,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2896.2966000000001,2896.2966000000001,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[48510,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1959.8016,1959.8016,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[48545,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2392.0758000000001,2392.0758000000001,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[49013,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",800.92619999999999,800.92619999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-UR",2,29]
[49062,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1367.58,1367.58,"090",0.09,0.81,0.1,0,2,0,2,1,0,null,"R",null,null,2,29]
[49321,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",613.62720000000002,613.62720000000002,"010",0.1,0.8,0.1,0,3,0,2,2,0,null,"R",null,"Y-CM",2,29]
[49407,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1432.9860000000001,359.13839999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[49423,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1155.3078,121.89299999999999,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[49435,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",208.11,208.11,"000",0,0,0,0,0,0,2,1,0,null,"R",null,null,2,29]
[49491,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.09,0.81,0.1,0,2,1,2,1,0,null,"X",null,null,2,29]
[49496,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.09,0.81,0.1,0,2,1,2,1,0,null,"X",null,null,2,29]
[49557,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1290.8766000000001,1290.8766000000001,"090",0.09,0.81,0.1,0,2,1,2,1,0,null,"R",null,null,2,29]
[49568,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",466.16640000000001,466.16640000000001,"000",0,0,0,0,0,0,2,1,0,null,"R",null,null,2,29]
[49650,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",774.76379999999995,774.76379999999995,"090",0.09,0.81,0.1,0,2,1,2,1,0,null,"R",null,null,2,29]
[49657,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2337.9672,2337.9672,"090",0.09,0.81,0.1,0,2,1,2,1,0,null,"R",null,"Y-UR",2,29]
[50065,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.08,0.83,0.09,0,2,1,2,0,0,null,"X",null,null,2,29]
[50125,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1726.1238000000001,1726.1238000000001,"090",0.08,0.83,0.09,0,2,1,2,1,0,null,"R",null,null,2,29]
[50250,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.08,0.83,0.09,0,2,0,2,1,0,null,"X",null,null,2,29]
[50300,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3992.8060396224,3992.8060396224,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,29]
[50382,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1938.3960000000002,438.22020000000003,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[50389,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",812.22360000000003,92.163000000000011,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[50437,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",432.86880000000002,432.86880000000002,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[50542,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.08,0.83,0.09,0,2,1,2,1,0,null,"X",null,null,2,29]
[50561,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",842.54819999999995,684.97919999999999,"000",0,0,0,0,3,1,0,0,0,null,"R",null,null,2,29]
[50580,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1052.442,1052.442,"000",0,0,0,0,3,1,0,0,0,null,"R",null,null,2,29]
[50660,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2003.2074,2003.2074,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[50688,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",136.1634,136.1634,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[50770,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2019.8561999999999,2019.8561999999999,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[50780,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1949.6933999999999,1949.6933999999999,"090",0.08,0.83,0.09,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[50900,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1483.527,1483.527,"090",0.08,0.83,0.09,0,2,1,2,1,0,null,"R",null,null,2,29]
[50949,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT"," By Report "," By Report ","000",0,0,0,0,2,1,2,1,1,null,"N",null,null,2,29]
[51030,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",838.98059999999998,838.98059999999998,"090",0.08,0.83,0.09,0,2,0,0,0,0,null,"R",null,"Y-CM",2,29]
[51100,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",134.37959999999998,67.784399999999991,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[51570,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2574.6179999999999,2574.6179999999999,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R",null,null,2,29]
[51585,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.08,0.83,0.09,0,2,2,2,1,0,null,"X",null,null,2,29]
[51725,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",426.9228,426.9228,"000",0,0,0,1,2,0,0,0,0,null,"R",null,null,2,29]
[51725,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",294.92160000000001,294.92160000000001,"000",0,0,0,1,2,0,0,0,0,null,"R",null,null,2,29]
[51729,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",219.4074,219.4074,"000",0,0,0,1,2,0,0,0,0,null,"R",null,null,2,29]
[51784,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",115.947,115.947,"000",0,0,0,1,2,0,1,0,0,null,"R",null,null,2,29]
[51798,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",19.6218,19.6218,"000",0,0,0,3,0,0,0,0,0,null,"R",null,null,2,29]
[51865,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1582.2306000000001,1582.2306000000001,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R",null,null,2,29]
[52000,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",453.08519999999999,140.92020000000002,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[52007,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",852.06180000000006,288.38099999999997,"000",0,0,0,0,3,1,1,0,0,null,"R",null,"Y-CM",2,29]
[52282,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",583.30259999999998,583.30259999999998,"000",0,0,0,0,3,0,1,0,0,null,"R",null,null,2,29]
[52283,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",654.06000000000006,349.62479999999999,"000",0,0,0,0,3,0,1,0,0,null,"R",null,null,2,29]
[52327,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",456.65280000000001,456.65280000000001,"000",0,0,0,0,3,1,1,0,0,null,"R",null,null,2,29]
[52344,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",641.57339999999999,641.57339999999999,"000",0,0,0,0,3,1,1,0,0,null,"R",null,null,2,29]
[52442,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1692.8262,87.406199999999998,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[52648,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3031.8654000000001,1218.93,"090",0.08,0.83,0.09,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[53200,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",280.0566,247.94819999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[53220,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.08,0.83,0.09,0,2,0,0,0,0,null,"X",null,null,2,29]
[53431,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2021.0454000000002,2021.0454000000002,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[53440,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1325.3634,1325.3634,"090",0.08,0.83,0.09,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[53460,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",809.84519999999998,809.84519999999998,"090",0.08,0.83,0.09,0,2,0,0,0,0,null,"R",null,null,2,29]
[53600,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",158.75819999999999,110.5956,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[53899,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT"," By Report "," By Report ","000",0,0,0,0,2,0,0,1,1,null,"N",null,null,2,29]
[54057,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",257.46179999999998,172.434,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[54130,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.8,0.1,0,2,2,2,1,0,null,"X",null,null,2,29]
[54160,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","010",0.1,0.8,0.1,0,2,0,1,0,0,null,"X",null,null,2,29]
[54250,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",26.162400000000002,26.162400000000002,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,29]
[54300,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.8,0.1,0,2,0,2,1,0,null,"X",null,null,2,29]
[54326,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.8,0.1,0,2,0,2,1,0,null,"X",null,null,2,29]
[54400,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",940.65719999999999,940.65719999999999,"090",0.1,0.8,0.1,0,2,0,1,1,0,null,"R",null,"Y-CM",2,29]
[54435,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",732.54719999999998,732.54719999999998,"090",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[54512,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",947.79239999999993,947.79239999999993,"090",0.1,0.8,0.1,0,2,1,1,1,0,null,"R",null,null,2,29]
[54660,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",635.03279999999995,635.03279999999995,"090",0.1,0.8,0.1,0,2,1,0,0,0,null,"R",null,null,2,29]
[54690,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1154.7132000000001,1154.7132000000001,"090",0.1,0.8,0.1,0,2,1,2,1,0,null,"R",null,null,2,29]
[55100,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",420.38220000000001,297.89459999999997,"010",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[55110,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",689.73599999999999,689.73599999999999,"090",0.1,0.8,0.1,0,2,0,1,0,0,null,"R",null,null,2,29]
[55400,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.8,0.1,0,2,1,2,1,0,null,"X",null,null,2,29]
[55700,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",442.97700000000003,226.54259999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[55842,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.8,0.1,0,2,0,2,1,0,null,"X",null,null,2,29]
[55873,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.08,0.83,0.09,0,2,0,1,0,0,null,"X",null,null,2,29]
[56440,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","010",0.1,0.8,0.1,0,2,0,1,0,0,null,"X",null,null,2,29]
[56501,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","010",0.1,0.8,0.1,0,2,0,1,0,0,null,"X",null,null,2,29]
[56805,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"X",null,null,2,29]
[56810,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",488.16660000000007,488.16660000000007,"010",0.1,0.8,0.1,0,2,0,2,2,0,null,"R",null,"Y-CM",2,29]
[57061,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","010",0.1,0.8,0.1,0,2,0,1,0,0,null,"X",null,null,2,29]
[57150,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",110.001,46.378800000000005,"000",0,0,0,0,2,0,1,0,0,null,"R",null,null,2,29]
[57260,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1392.5532000000001,1392.5532000000001,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[57283,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1250.4438,1250.4438,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[57305,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1771.9080000000001,1771.9080000000001,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[57335,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"X",null,null,2,29]
[57456,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",276.48900000000003,178.38,"000",0,0,0,0,3,0,1,0,0,null,"R",null,"Y-CM",2,29]
[57460,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",588.0594000000001,280.0566,"000",0,0,0,0,3,0,1,0,0,null,"R",null,"Y-CM",2,29]
[57520,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.12,0.74,0.14000000000000001,0,2,0,1,0,0,null,"X",null,null,2,29]
[57800,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",142.70400000000001,84.433199999999999,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[58240,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"X",null,null,2,29]
[58280,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1893.2064,1893.2064,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[58340,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,0,2,0,1,0,0,null,"X",null,null,2,29]
[58410,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1460.3375999999998,1460.3375999999998,"090",0.12,0.74,0.14000000000000001,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[58553,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1991.91,1991.91,"090",0.12,0.74,0.14000000000000001,0,2,0,2,2,0,null,"R",null,"Y-CM",2,29]
[58554,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2319.5346,2319.5346,"090",0.12,0.74,0.14000000000000001,0,2,0,2,2,0,null,"R",null,"Y-CM",2,29]
[58565,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.12,0.74,0.14000000000000001,0,3,2,1,2,0,null,"X",null,null,2,29]
[58660,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1214.7678000000001,1214.7678000000001,"090",0.09,0.84,7.0000000000000007E-2,0,3,0,2,2,0,null,"R",null,"Y-CM",2,29]
[58750,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.12,0.74,0.14000000000000001,0,2,1,2,1,0,null,"X",null,null,2,29]
[58822,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.12,0.74,0.14000000000000001,0,2,1,2,1,0,null,"X",null,null,2,29]
[58954,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.12,0.74,0.14000000000000001,0,2,2,2,1,0,null,"X",null,null,2,29]
[58976,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,0,2,0,2,1,0,null,"X",null,null,2,29]
[59030,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,0,2,0,0,0,0,null,"X",null,null,2,29]
[59050,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",87.406199999999998,87.406199999999998,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[59121,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1445.4726000000001,1445.4726000000001,"090",0.17,0.6,0.23,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[59400,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4237.7141999999994,4237.7141999999994,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[59430,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",476.86919999999998,313.94880000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[59820,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",797.35860000000002,690.92520000000002,"090",0.17,0.6,0.23,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[59866,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,0,2,0,2,1,0,null,"X",null,null,2,29]
[60100,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",197.40719999999999,134.37959999999998,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[60280,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.09,0.82,0.09,0,2,0,2,1,0,null,"X",null,null,2,29]
[60281,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.09,0.82,0.09,0,2,0,2,1,0,null,"X",null,null,2,29]
[60522,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2390.8866000000003,2390.8866000000003,"090",0.09,0.82,0.09,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[61050,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",142.10940000000002,142.10940000000002,"000",0,0,0,0,2,0,0,0,0,null,"R",null,null,2,29]
[61140,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2241.6420000000003,2241.6420000000003,"090",0.11,0.76,0.13,0,2,0,2,0,0,null,"R",null,null,2,29]
[61313,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3483.1668,3483.1668,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,null,2,29]
[61343,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3850.6296000000002,3850.6296000000002,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,null,2,29]
[61510,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.11,0.76,0.13,0,2,0,2,1,0,null,"X",null,null,2,29]
[61530,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.11,0.76,0.13,0,2,0,1,2,0,null,"X",null,null,2,29]
[61531,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2163.7494000000002,2163.7494000000002,"090",0.11,0.76,0.13,0,2,0,2,2,0,null,"R",null,null,2,29]
[61540,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3814.9535999999998,3814.9535999999998,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[61559,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.11,0.76,0.13,0,2,0,2,1,0,null,"X",null,null,2,29]
[61575,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4383.3912,4383.3912,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[61595,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4293.6066000000001,4293.6066000000001,"090",0.11,0.76,0.13,0,2,1,1,1,2,null,"R",null,"Y-CM",2,29]
[61613,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",5813.9988000000003,5813.9988000000003,"090",0.11,0.76,0.13,0,2,1,2,1,2,null,"R",null,"Y-CM",2,29]
[61626,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,0,2,0,1,0,0,null,"X",null,null,2,29]
[61686,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",7817.8007999999991,7817.8007999999991,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[61690,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3821.4941999999996,3821.4941999999996,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[61708,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4454.1485999999995,4454.1485999999995,"090",0.11,0.76,0.13,0,2,0,2,0,0,null,"R",null,"Y-CM",2,29]
[61782,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",304.43520000000001,304.43520000000001,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,29]
[61799,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",523.24800000000005,523.24800000000005,"000",0,0,0,0,0,0,2,0,0,null,"R",null,"Y-CM",2,29]
[62000,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1828.395,1828.395,"090",0.11,0.76,0.13,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[62143,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1847.4222,1847.4222,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,null,2,29]
[62162,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3317.8679999999999,3317.8679999999999,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[62230,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1490.6622,1490.6622,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-CM",2,29]
[62252,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",148.05540000000002,148.05540000000002,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,29]
[62268,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",451.3014,451.3014,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[62292,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1026.2796000000001,1026.2796000000001,"090",0.11,0.76,0.13,0,2,0,0,0,0,null,"R",null,"Y-UR",2,29]
[62321,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",489.9504,189.08280000000002,"000",0,0,0,0,2,9,1,0,0,null,"R",null,"Y-UR",2,29]
[62360,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",577.95120000000009,577.95120000000009,"010",0.1,0.8,0.1,0,2,0,0,1,0,null,"R",null,"Y-UR",2,29]
[62369,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",170.65020000000001,62.433000000000007,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[63030,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1731.4752000000001,1731.4752000000001,"090",0.11,0.76,0.13,0,2,1,2,2,0,null,"R",null,"Y-UR",2,29]
[63052,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",449.51759999999996,449.51759999999996,"000",0,0,0,0,0,0,2,2,0,null,"R",null,null,2]
[63053,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",336.54360000000003,336.54360000000003,"000",0,0,0,0,0,0,2,2,0,null,"R",null,null,2]
[63077,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2648.3483999999999,2648.3483999999999,"090",0.11,0.76,0.13,0,2,0,2,2,0,null,"R",null,"Y-UR",2,29]
[63103,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",510.76139999999998,510.76139999999998,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR",2,29]
[63197,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3009.2705999999998,3009.2705999999998,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[63273,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3283.3811999999998,3283.3811999999998,"090",0.11,0.76,0.13,0,2,0,2,0,0,null,"R",null,"Y-UR",2,29]
[63281,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3683.547,3683.547,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[63304,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",4119.3887999999997,4119.3887999999997,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[63662,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.11,0.76,0.13,0,2,0,2,1,0,null,"X",null,null,2,29]
[63663,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","010",0.1,0.8,0.1,0,2,0,2,1,0,null,"X",null,null,2,29]
[63707,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1663.6908000000001,1663.6908000000001,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,"Y-UR",2,29]
[64425,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",205.137,96.919799999999995,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[64445,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",232.48860000000002,94.54140000000001,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[64479,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",493.51800000000003,231.89400000000001,"000",0,0,0,0,2,1,1,0,0,null,"R",null,"Y-UR",2,29]
[64488,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",255.678,120.1092,"000",0,0,0,0,2,2,1,0,0,null,"R",null,"Y-CM",2,29]
[64530,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",434.65260000000001,167.08260000000001,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[64583,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.11,0.76,0.13,0,2,1,0,1,1,null,"X",null,null,2]
[64584,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.11,0.76,0.13,0,2,1,0,1,1,null,"X",null,null,2]
[64612,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",245.56979999999999,211.083,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[64642,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",274.11060000000003,190.27200000000002,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[64645,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",218.81280000000001,144.48780000000002,"000",0,0,0,0,0,0,1,0,0,null,"R",null,"Y-CM",2,29]
[64714,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1351.5258000000001,1351.5258000000001,"090",0.11,0.76,0.13,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[64726,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",481.03140000000002,481.03140000000002,"090",0.11,0.76,0.13,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[64763,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",923.41379999999992,923.41379999999992,"090",0.11,0.76,0.13,0,2,1,2,1,0,null,"R",null,"Y-CM",2,29]
[64788,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",727.79039999999998,727.79039999999998,"090",0.11,0.76,0.13,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[64790,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1491.8514,1491.8514,"090",0.11,0.76,0.13,0,2,0,0,1,0,null,"R",null,"Y-CM",2,29]
[64821,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1239.1464000000001,1239.1464000000001,"090",0.11,0.76,0.13,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[64864,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1523.9597999999999,1523.9597999999999,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,null,2,29]
[64868,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1790.3406,1790.3406,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,null,2,29]
[64897,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2246.9933999999998,2246.9933999999998,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,null,2,29]
[64910,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1380.6612,1380.6612,"090",0.11,0.76,0.13,0,2,0,2,1,0,null,"R",null,null,2,29]
[65114,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2843.3771999999999,2843.3771999999999,"090",0.1,0.7,0.2,0,2,1,2,1,0,null,"R",null,null,2,29]
[65175,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1429.4184,1429.4184,"090",0.1,0.7,0.2,0,2,1,1,1,0,null,"R",null,null,2,29]
[65260,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1748.7185999999999,1748.7185999999999,"090",0.1,0.7,0.2,0,2,1,2,0,0,null,"R",null,null,2,29]
[65286,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1270.6602,877.62959999999998,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R",null,null,2,29]
[65757,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT"," By Report "," By Report ","000",0,0,0,0,0,0,0,0,0,null,"N",null,null,2,29]
[65767,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT"," By Report "," By Report ","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,29]
[65810,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",821.73720000000003,821.73720000000003,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R",null,null,2,29]
[65865,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",851.46720000000005,851.46720000000005,"090",0.1,0.7,0.2,0,2,1,1,1,0,null,"R",null,null,2,29]
[66160,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1749.9078,1749.9078,"090",0.1,0.7,0.2,0,2,1,1,1,0,null,"R",null,null,2,29]
[66183,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.8,0.1,0,2,1,2,0,0,null,"X",null,null,2,29]
[66505,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",777.1422,777.1422,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R",null,null,2,29]
[66700,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",808.65599999999995,692.11440000000005,"090",0.1,0.7,0.2,0,2,1,0,0,0,null,"R",null,null,2,29]
[66930,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1515.6353999999999,1515.6353999999999,"090",0.1,0.7,0.2,0,2,1,0,0,0,null,"R",null,null,2,29]
[66983,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT"," By Report "," By Report ","090",0.1,0.7,0.2,0,2,1,1,0,0,null,"N",null,null,2,29]
[67015,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1081.5774000000001,1081.5774000000001,"090",0.1,0.7,0.2,0,2,1,1,1,0,null,"R",null,null,2,29]
[67036,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1582.8252,1582.8252,"090",0.1,0.7,0.2,0,2,1,2,1,0,null,"R",null,null,2,29]
[67115,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",881.79179999999997,881.79179999999997,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R",null,null,2,29]
[67218,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.7,0.2,0,2,1,1,0,0,null,"X",null,null,2,29]
[67229,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",0.1,0.7,0.2,0,2,1,1,0,0,null,"X",null,null,2,29]
[67318,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1214.1732000000002,1214.1732000000002,"090",0.1,0.7,0.2,0,2,1,1,1,0,null,"R",null,"Y-CM",2,29]
[67415,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,0,2,1,0,0,0,null,"X",null,null,2,29]
[67440,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2444.4005999999999,2444.4005999999999,"090",0.1,0.7,0.2,0,2,1,2,1,0,null,"R",null,null,2,29]
[67715,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",494.11260000000004,191.46120000000002,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,null,2,29]
[67820,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",33.892199999999995,39.243600000000001,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2,29]
[67903,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1091.6856,849.08879999999999,"090",0.1,0.7,0.2,0,2,1,1,1,0,null,"R",null,null,2,29]
[67914,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",898.44060000000002,581.51879999999994,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R",null,null,2,29]
[67923,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1116.6588000000002,759.30420000000004,"090",0.1,0.7,0.2,0,2,1,1,0,0,null,"R",null,null,2,29]
[67971,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1269.471,1269.471,"090",0.1,0.7,0.2,0,2,1,1,1,0,null,"R",null,null,2,29]
[68328,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1245.6869999999999,1245.6869999999999,"090",0.1,0.7,0.2,0,2,1,0,0,0,null,"R",null,null,2,29]
[68340,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1107.7398000000001,704.00639999999999,"090",0.1,0.7,0.2,0,2,1,0,0,0,null,"R",null,null,2,29]
[68525,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",453.08519999999999,453.08519999999999,"000",0,0,0,0,2,1,1,1,0,null,"R",null,"Y-CM",2,29]
[68720,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1453.2024000000001,1453.2024000000001,"090",0.1,0.7,0.2,0,2,1,2,1,0,null,"R",null,null,2,29]
[68841,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",67.784399999999991,57.081600000000002,"000",0,0,0,0,2,1,1,0,0,null,"R",null,null,2]
[69100,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",177.78540000000001,82.0548,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,29]
[69150,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,0,1,1,0,null,"X",null,null,2,29]
[69420,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",353.19240000000002,216.43440000000001,"010",0.1,0.8,0.1,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[69535,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,1,1,0,null,"X",null,null,2,29]
[69552,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,2,0,0,null,"X",null,null,2,29]
[69636,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2593.6451999999999,2593.6451999999999,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,0,0,0,null,"R",null,null,2,29]
[69645,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2723.8626000000004,2723.8626000000004,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,1,0,0,null,"R",null,"Y-CM",2,29]
[69706,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",5499.4553999999998,428.70659999999998,"000",0,0,0,0,3,2,0,0,0,null,"R",null,"Y-CM",2,29]
[69720,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",2164.9386,2164.9386,"090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,0,1,0,null,"R",null,null,2,29]
[69799,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT"," By Report "," By Report ","000",0,0,0,0,2,1,0,1,1,null,"N",null,null,2,29]
[69970,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","090",7.0000000000000007E-2,0.79,0.14000000000000001,0,2,1,2,1,0,null,"X",null,null,2,29]
[70100,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",15.4596,15.4596,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[70110,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",21.4056,21.4056,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[70140,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",17.838000000000001,17.838000000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[70160,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",14.865,14.865,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[70210,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",14.865,14.865,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[70250,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",66.595200000000006,66.595200000000006,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[70300,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",23.189400000000003,23.189400000000003,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[70330,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",99.892799999999994,99.892799999999994,"000",0,0,0,1,0,2,0,0,0,null,"R",null,null,2,26]
[70355,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",32.703000000000003,32.703000000000003,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[70360,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",58.270800000000001,58.270800000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[70390,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",225.35339999999999,225.35339999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[70460,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",285.40800000000002,285.40800000000002,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-UR",2,26]
[70480,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",195.6234,195.6234,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[70487,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",197.40719999999999,197.40719999999999,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[70490,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",178.97459999999998,178.97459999999998,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[70498,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",384.11160000000001,384.11160000000001,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[70544,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",317.51639999999998,317.51639999999998,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[70545,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",341.30040000000002,341.30040000000002,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[70549,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",520.86959999999999,520.86959999999999,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[70552,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",375.19259999999997,375.19259999999997,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-UR",2,26]
[70554,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","Not Covered","Not Covered ","000",0,0,0,1,4,3,0,0,0,null,"X",null,null,2,26]
[70559,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","Not Covered","Not Covered ","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,26]
[71046,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",18.432600000000001,18.432600000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[71101,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",23.189400000000003,23.189400000000003,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[71130,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",18.432600000000001,18.432600000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[71250,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",91.568399999999997,91.568399999999997,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[71275,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",154.596,154.596,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[71551,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",147.46080000000001,147.46080000000001,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[72020,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",45.189599999999999,45.189599999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[72070,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",60.6492,60.6492,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[72074,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",82.6494,82.6494,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[72083,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",146.27160000000001,146.27160000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[72114,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",115.3524,115.3524,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[72125,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",164.70420000000001,164.70420000000001,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[72128,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",249.13740000000001,249.13740000000001,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[72130,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",385.30080000000004,385.30080000000004,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[72132,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",221.78579999999999,221.78579999999999,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[72146,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",244.38060000000002,244.38060000000002,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-UR",2,26]
[72148,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",244.9752,244.9752,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-UR",2,26]
[72158,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",428.70659999999998,428.70659999999998,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-UR",2,26]
[72191,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",442.97700000000003,442.97700000000003,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[72193,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",98.703599999999994,98.703599999999994,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[72196,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",381.1386,381.1386,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[72198,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",507.78839999999997,507.78839999999997,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[72202,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",19.6218,19.6218,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[72265,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",70.757400000000004,70.757400000000004,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[72285,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",99.892799999999994,99.892799999999994,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-UR",2,26]
[73020,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",13.081200000000001,13.081200000000001,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2,26]
[73060,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",13.675800000000001,13.675800000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[73085,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",212.2722,212.2722,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2,26]
[73092,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","Not Covered","Not Covered ","000",0,0,0,1,0,3,0,0,0,null,"X",null,null,2,26]
[73110,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",14.865,14.865,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2,26]
[73130,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",67.784399999999991,67.784399999999991,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2,26]
[73202,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",491.73419999999999,491.73419999999999,"000",0,0,0,1,4,3,0,0,0,null,"R",null,null,2,26]
[73218,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",601.73519999999996,601.73519999999996,"000",0,0,0,1,4,3,0,0,0,null,"R",null,"Y-UR",2,26]
[73222,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",620.76239999999996,620.76239999999996,"000",0,0,0,1,4,3,0,0,0,null,"R",null,"Y-UR",2,26]
[73502,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",87.406199999999998,87.406199999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[73521,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",57.081600000000002,57.081600000000002,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[73525,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",252.11040000000003,252.11040000000003,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2,26]
[73552,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",65.406000000000006,65.406000000000006,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2,26]
[73562,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",59.46,59.46,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2,26]
[73592,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","Not Covered","Not Covered ","000",0,0,0,1,0,3,0,0,0,null,"X",null,null,2,26]
[73600,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",45.784199999999998,45.784199999999998,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2,26]
[73630,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",49.351799999999997,49.351799999999997,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2,26]
[73701,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",222.97499999999999,222.97499999999999,"000",0,0,0,1,4,3,0,0,0,null,"R",null,null,2,26]
[73706,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",629.08680000000004,629.08680000000004,"000",0,0,0,1,4,3,0,0,0,null,"R",null,null,2,26]
[73721,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",276.48900000000003,276.48900000000003,"000",0,0,0,1,4,3,0,0,0,null,"R",null,"Y-UR",2,26]
[73723,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",182.54219999999998,182.54219999999998,"000",0,0,0,1,4,3,0,0,0,null,"R",null,"Y-UR",2,26]
[73725,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",152.2176,152.2176,"000",0,0,0,1,4,3,0,0,0,null,"R",null,null,2,26]
[74160,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",462.00419999999997,462.00419999999997,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[74160,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",108.81180000000001,108.81180000000001,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[74176,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",148.05540000000002,148.05540000000002,"000",0,0,0,1,4,0,9,0,0,null,"R",null,null,2,26]
[74182,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",147.46080000000001,147.46080000000001,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[74185,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",508.97760000000005,508.97760000000005,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[74221,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",59.46,59.46,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[74240,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",234.2724,234.2724,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[74246,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",266.97540000000004,266.97540000000004,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[74262,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",720.06060000000002,720.06060000000002,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-CM",2,26]
[74263,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1324.7688000000001,1324.7688000000001,"000",0,0,0,1,9,9,9,9,9,null,"R",null,"Y-CM",2,26]
[74290,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",165.2988,165.2988,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[74301,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT"," By Report "," By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,null,2,26]
[74330,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",51.730200000000004,51.730200000000004,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[74400,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",258.0564,258.0564,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[74415,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",253.89419999999998,253.89419999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[74420,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",98.703599999999994,98.703599999999994,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[74450,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",27.946199999999997,27.946199999999997,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[74455,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",171.83940000000001,171.83940000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[74712,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","Not Covered","Not Covered ","000",0,0,0,1,4,0,0,0,0,null,"X",null,null,2,26]
[74740,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","Not Covered","Not Covered ","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,26]
[75559,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",739.08780000000002,739.08780000000002,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-CM",2,26]
[75571,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",140.92020000000002,140.92020000000002,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-CM",2,26]
[75600,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",353.19240000000002,353.19240000000002,"000",0,0,0,1,6,0,0,0,0,null,"R",null,null,2,26]
[75605,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",222.38040000000001,222.38040000000001,"000",0,0,0,1,6,0,0,0,0,null,"R",null,null,2,26]
[75710,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",145.67700000000002,145.67700000000002,"000",0,0,0,1,6,0,0,0,0,null,"R",null,null,2,26]
[75716,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",297.89459999999997,297.89459999999997,"000",0,0,0,1,6,2,0,0,0,null,"R",null,null,2,26]
[75736,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",259.24560000000002,259.24560000000002,"000",0,0,0,1,6,0,0,0,0,null,"R",null,null,2,26]
[75743,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",135.56879999999998,135.56879999999998,"000",0,0,0,1,6,2,0,0,0,null,"R",null,null,2,26]
[75774,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",82.0548,82.0548,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[75809,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",152.81219999999999,152.81219999999999,"000",0,0,0,1,6,0,0,0,0,null,"R",null,null,2,26]
[75820,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",114.7578,114.7578,"000",0,0,0,1,6,0,0,0,0,null,"R",null,null,2,26]
[75822,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",123.6768,123.6768,"000",0,0,0,1,6,2,0,0,0,null,"R",null,null,2,26]
[75840,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",96.919799999999995,96.919799999999995,"000",0,0,0,1,6,0,0,0,0,null,"R",null,null,2,26]
[75842,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",164.1096,164.1096,"000",0,0,0,1,6,2,0,0,0,null,"R",null,null,2,26]
[75880,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",140.32560000000001,140.32560000000001,"000",0,0,0,1,6,0,0,0,0,null,"R",null,null,2,26]
[75887,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",115.947,115.947,"000",0,0,0,1,6,0,0,0,0,null,"R",null,null,2,26]
[75894,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT"," By Report "," By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,null,2,26]
[75956,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT"," By Report "," By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,null,2,26]
[75958,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",330.00299999999999,330.00299999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[75959,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",290.75939999999997,290.75939999999997,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76080,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",111.78479999999999,111.78479999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76080,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",44.594999999999999,44.594999999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76120,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",34.486799999999995,34.486799999999995,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[76376,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",24.973199999999999,24.973199999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76390,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",121.2984,121.2984,"000",0,0,0,1,9,9,9,9,9,null,"R",null,"Y-CM",2,26]
[76499,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT"," By Report "," By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,null,2,26]
[76510,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",69.56819999999999,69.56819999999999,"000",0,0,0,1,7,3,0,0,0,null,"R",null,null,2,26]
[76511,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",63.027600000000007,63.027600000000007,"000",0,0,0,1,7,3,0,0,0,null,"R",null,null,2,26]
[76519,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",53.514000000000003,53.514000000000003,"000",0,0,0,1,7,3,0,0,0,null,"R",null,null,2,26]
[76529,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",101.08199999999999,101.08199999999999,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2,26]
[76642,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",99.298199999999994,99.298199999999994,"000",0,0,0,1,0,1,0,0,0,null,"R",null,"Y-CM",2,26]
[76705,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",50.540999999999997,50.540999999999997,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[76776,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",279.46199999999999,279.46199999999999,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[76801,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",83.8386,83.8386,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76811,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",156.9744,156.9744,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76812,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",152.81219999999999,152.81219999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76818,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",211.083,211.083,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[76818,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",90.379199999999997,90.379199999999997,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[76825,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",141.51480000000001,141.51480000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[76828,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",90.973799999999997,90.973799999999997,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76856,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",139.13639999999998,139.13639999999998,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[76872,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",381.73320000000001,381.73320000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76885,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,26]
[76886,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,26]
[76941,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT"," By Report "," By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,null,2,26]
[76942,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",105.83880000000001,105.83880000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76975,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT"," By Report "," By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,null,2,26]
[76977,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",8.3244000000000007,8.3244000000000007,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[76981,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",51.135599999999997,51.135599999999997,"000",0,0,0,1,4,0,0,0,0,null,"R",null,null,2,26]
[76998,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT"," By Report "," By Report ","000",0,0,0,1,0,0,0,0,0,null,"N",null,null,2,26]
[77003,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",145.08240000000001,145.08240000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[77011,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",310.97580000000005,310.97580000000005,"000",0,0,0,1,0,0,9,0,0,null,"R",null,"Y-CM",2,26]
[77022,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","Not Covered","Not Covered ","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,26]
[77046,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",293.13779999999997,293.13779999999997,"000",0,0,0,1,4,0,0,0,0,null,"R",null,"Y-UR",2,26]
[77054,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","Not Covered","Not Covered ","000",0,0,0,1,0,0,9,0,0,null,"X",null,null,2,26]
[77061,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","Not Covered","Not Covered ","000",0,0,0,1,0,0,9,0,0,null,"X",null,null,2,26]
[77066,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",294.92160000000001,294.92160000000001,"000",0,0,0,1,0,2,0,0,0,null,"R",null,"Y-CM",2,26]
[77072,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","Not Covered","Not Covered ","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,26]
[77076,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","Not Covered","Not Covered ","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,26]
[77077,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",57.081600000000002,57.081600000000002,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[77085,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",26.162400000000002,26.162400000000002,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[77086,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",45.784199999999998,45.784199999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[77290,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",701.03339999999992,701.03339999999992,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77293,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",583.8972,583.8972,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77300,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",57.676200000000001,57.676200000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77307,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",269.35380000000004,269.35380000000004,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77321,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",88.595399999999998,88.595399999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77332,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",42.2166,42.2166,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77371,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,3,0,0,0,0,0,null,"N",null,"Y-CM",2,26]
[77373,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1887.855,1887.855,"000",0,0,0,3,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77431,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",189.67740000000001,189.67740000000001,"000",0,0,0,2,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77469,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2,26]
[77525,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,3,0,0,0,0,0,null,"N",null,"Y-CM",2,26]
[77610,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",1172.5511999999999,1172.5511999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77761,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",390.65220000000005,390.65220000000005,"090",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77763,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",573.78899999999999,573.78899999999999,"090",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[77771,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","Not Covered","Not Covered ","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,26]
[77772,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","Not Covered","Not Covered ","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,26]
[78012,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",15.4596,15.4596,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78013,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",30.9192,30.9192,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78018,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",554.76179999999999,554.76179999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78070,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",66.595200000000006,66.595200000000006,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78099,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","By Report","By Report","000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM",2,26]
[78104,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",442.38240000000002,442.38240000000002,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78121,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",144.48780000000002,144.48780000000002,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78121,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",23.189400000000003,23.189400000000003,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78195,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",625.51919999999996,625.51919999999996,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78199,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM",2,26]
[78215,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",306.81360000000001,306.81360000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78227,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",775.35839999999996,775.35839999999996,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78258,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",378.16560000000004,378.16560000000004,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78262,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",376.3818,376.3818,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78268,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,26]
[78278,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",533.35620000000006,533.35620000000006,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[78300,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",52.919400000000003,52.919400000000003,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[78305,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",69.56819999999999,69.56819999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[78351,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",26.757000000000001,26.757000000000001,"000",0,0,0,9,9,9,9,9,9,null,"R",null,null,2,26]
[78428,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",268.16460000000001,268.16460000000001,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78432,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","By Report","By Report","000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-UR",2,26]
[78434,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",51.730200000000004,51.730200000000004,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-UR",2,26]
[78453,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",83.244,83.244,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-UR",2,26]
[78456,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",83.8386,83.8386,"000",0,0,0,1,6,9,9,9,9,null,"R",null,"Y-CM",2,26]
[78466,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",60.6492,60.6492,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78468,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",67.189799999999991,67.189799999999991,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78481,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",315.13799999999998,315.13799999999998,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78491,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",125.4606,125.4606,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-UR",2,26]
[78499,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","By Report","By Report","000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM",2,26]
[78582,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",587.46480000000008,587.46480000000008,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78600,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",326.43540000000002,326.43540000000002,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[78605,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",354.97620000000001,354.97620000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[78610,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",310.38119999999998,310.38119999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[78630,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",598.76220000000001,598.76220000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[78650,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",447.73380000000003,447.73380000000003,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[78700,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",303.24599999999998,303.24599999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[78709,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",652.87080000000003,652.87080000000003,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[78730,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",120.70379999999999,120.70379999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[78800,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",394.81439999999998,394.81439999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78802,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",483.40980000000008,483.40980000000008,"000",0,0,0,1,2,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78812,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","Not Covered","Not Covered ","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,26]
[78813,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","Not Covered","Not Covered ","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,26]
[78816,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,26]
[78832,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1628.0147999999999,1628.0147999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[78999,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","By Report","By Report","000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM",2,26]
[79300,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","By Report","By Report","000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM",2,26]
[79999,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","By Report","By Report","000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM",2,26]
[80053,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",15.1008,15.1008,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[80156,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",20.835100000000001,20.835100000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[80159,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",28.814499999999995,28.814499999999995,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[80171,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",30.988100000000003,30.988100000000003,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[80181,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",26.655200000000001,26.655200000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[80189,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",38.767299999999999,38.767299999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[80203,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",18.947499999999998,18.947499999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[80320,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[80326,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[80338,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[80345,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[80351,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[80359,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[80366,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[80400,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",46.646599999999992,46.646599999999992,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[80422,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[80434,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81003,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3.2174999999999998,3.2174999999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[81099,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,23]
[81110,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81164,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81172,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81184,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81201,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81207,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81222,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81229,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81235,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81243,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81250,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81262,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81274,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81283,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81295,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81302,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81308,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81316,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81323,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81335,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81347,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81353,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81374,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",106.2919,106.2919,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[81381,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",242.95699999999999,242.95699999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[81403,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81412,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81420,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81437,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81470,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81503,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81519,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[81529,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",10285.99,10285.99,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-ONC",2,23]
[81541,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[82013,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",17.574699999999996,17.574699999999996,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82024,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",55.226599999999991,55.226599999999991,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82104,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",20.677800000000001,20.677800000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82140,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",20.835100000000001,20.835100000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82163,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",29.343599999999999,29.343599999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82261,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[82306,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",42.328000000000003,42.328000000000003,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[82355,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",16.5594,16.5594,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82383,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",41.584399999999995,41.584399999999995,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82390,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",15.3582,15.3582,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82507,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",39.753999999999998,39.753999999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82565,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",7.3216000000000001,7.3216000000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82607,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",21.564399999999999,21.564399999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82634,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",41.870399999999997,41.870399999999997,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82672,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",31.030999999999999,31.030999999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[82705,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",7.2929999999999993,7.2929999999999993,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82760,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[82777,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[82943,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",20.434699999999999,20.434699999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[82965,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",18.804500000000001,18.804500000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[83002,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",26.483599999999999,26.483599999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[83014,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",11.239800000000001,11.239800000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[83050,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",11.725999999999999,11.725999999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[83070,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",6.7924999999999995,6.7924999999999995,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[83519,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",26.311999999999998,26.311999999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[83525,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",16.344899999999999,16.344899999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[83625,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",18.289699999999996,18.289699999999996,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[83695,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[83719,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",18.232499999999998,18.232499999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[83789,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",34.4773,34.4773,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[83885,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",35.049300000000002,35.049300000000002,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[83930,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",9.4522999999999993,9.4522999999999993,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[84060,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",10.925199999999998,10.925199999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[84078,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",11.8118,11.8118,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[84135,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[84152,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",26.297699999999999,26.297699999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[84160,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",8.0222999999999995,8.0222999999999995,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[84181,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",24.352900000000002,24.352900000000002,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[84235,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[84270,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",31.073899999999998,31.073899999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[84377,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[84392,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[84450,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",7.4073999999999991,7.4073999999999991,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[84484,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",17.832100000000001,17.832100000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[84520,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",5.6485000000000003,5.6485000000000003,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[84578,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",6.3920999999999992,6.3920999999999992,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[84681,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",29.758299999999998,29.758299999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[85002,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",6.8925999999999998,6.8925999999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[85044,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",6.1632999999999996,6.1632999999999996,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[85048,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3.6322000000000001,3.6322000000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[85250,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",27.227199999999996,27.227199999999996,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[85300,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",16.945499999999999,16.945499999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[85307,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",21.907599999999999,21.907599999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[85362,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",9.8526999999999987,9.8526999999999987,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[85400,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",11.0253,11.0253,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[85445,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[85557,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",19.104799999999997,19.104799999999997,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[85597,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",25.711400000000001,25.711400000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[85999,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,23]
[86022,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",26.269100000000002,26.269100000000002,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86051,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered ","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
[86079,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",93.94680000000001,87.406199999999998,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,23]
[86161,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",17.16,17.16,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86226,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",17.317299999999999,17.317299999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86301,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",29.758299999999998,29.758299999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[86308,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",7.4073999999999991,7.4073999999999991,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86334,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",32.108400000000003,32.108400000000003,"000",0,0,0,6,0,0,0,0,0,null,"R",null,null,2,23]
[86343,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",17.817800000000002,17.817800000000002,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86344,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",14.857699999999999,14.857699999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86367,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",111.22539999999999,111.22539999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86431,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",8.1081000000000003,8.1081000000000003,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86510,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",13.675800000000001,13.675800000000001,"000",0,0,0,3,0,0,0,0,0,null,"R",null,null,2,23]
[86615,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",18.861699999999999,18.861699999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86619,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",19.133400000000002,19.133400000000002,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86658,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",18.632899999999999,18.632899999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86677,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",24.095500000000001,24.095500000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86682,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",18.604299999999999,18.604299999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86703,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",19.6053,19.6053,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86723,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",18.861699999999999,18.861699999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86744,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",22.8657,22.8657,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86774,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",21.164000000000001,21.164000000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86780,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",18.933199999999999,18.933199999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[86813,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",82.94,82.94,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86830,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",136.59359999999998,136.59359999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86831,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",117.08839999999999,117.08839999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86890,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",87.963661843199986,87.963661843199986,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,23]
[86922,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,23]
[86940,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",12.541099999999998,12.541099999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[86978,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,23]
[87046,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",13.499199999999998,13.499199999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87102,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",12.026299999999999,12.026299999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87140,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",7.9650999999999996,7.9650999999999996,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87143,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",17.903599999999997,17.903599999999997,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87169,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",6.1632999999999996,6.1632999999999996,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87205,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",6.1060999999999988,6.1060999999999988,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87220,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",6.1060999999999988,6.1060999999999988,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87271,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",19.1906,19.1906,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87279,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",23.494899999999998,23.494899999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87327,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",19.1906,19.1906,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87339,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",22.88,22.88,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87340,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",14.771899999999999,14.771899999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87427,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",17.131399999999999,17.131399999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87475,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",28.671499999999998,28.671499999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87492,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",76.462099999999992,76.462099999999992,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[87507,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",595.9953999999999,595.9953999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87521,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",50.178699999999999,50.178699999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87535,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",50.178699999999999,50.178699999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87550,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",28.671499999999998,28.671499999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87551,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",68.983199999999997,68.983199999999997,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87590,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",38.438399999999994,38.438399999999994,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[87632,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",311.82580000000002,311.82580000000002,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[87653,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",50.178699999999999,50.178699999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[87806,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[87880,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",23.637900000000002,23.637900000000002,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[88000,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,23]
[88027,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,23]
[88028,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[88106,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",33.297600000000003,33.297600000000003,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,23]
[88120,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1141.6320000000001,1141.6320000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,23]
[88141,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",39.838200000000001,39.838200000000001,"000",0,0,0,2,0,0,0,0,0,null,"R",null,"Y-CM",2,23]
[88161,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",134.37959999999998,134.37959999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,23]
[88165,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",60.374599999999994,60.374599999999994,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[88177,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",38.054400000000001,38.054400000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,23]
[88188,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",110.001,110.001,"000",0,0,0,2,0,0,0,0,0,null,"R",null,"Y-CM",2,23]
[88189,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",147.46080000000001,147.46080000000001,"000",0,0,0,2,0,0,0,0,0,null,"R",null,"Y-CM",2,23]
[88248,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",247.63309999999998,247.63309999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[88269,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",248.3338,248.3338,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
[88299,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,0,0,0,0,0,0,null,"N",null,null,2,23]
[88305,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",63.027600000000007,63.027600000000007,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,23]
[88311,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",37.459800000000001,37.459800000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,23]
[88319,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",256.86720000000003,256.86720000000003,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,23]
[88329,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",103.46040000000001,62.433000000000007,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,23]
[88331,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",184.32600000000002,184.32600000000002,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,23]
[88341,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",161.13659999999999,161.13659999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,23]
[88344,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",244.9752,244.9752,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,23]
[88355,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,23]
[88361,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,23]
[88364,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",252.70500000000001,252.70500000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,23]
[88368,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,23]
[88372,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",37.494599999999998,37.494599999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[88372,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",32.108400000000003,32.108400000000003,"000",0,0,0,6,0,0,0,0,0,null,"R",null,null,2,23]
[88380,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2,23]
[88387,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",14.2704,14.2704,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,23]
[88749,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,23]
[89125,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",8.4084000000000003,8.4084000000000003,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[89258,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[89310,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",12.312299999999999,12.312299999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,23]
[89335,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[89337,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[90284,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By report","By report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,16]
[90376,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",332.82100000000003,332.82100000000003,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
[90461,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",22.594799999999999,22.594799999999999,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,16]
[90581,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,16]
[90648,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",10.85,10.85,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
[90662,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,16]
[90673,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",93.89,93.89,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
[90674,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
[90702,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
[90713,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",36.89,36.89,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
[90739,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
[90749,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,16]
[90839,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",251.51580000000004,221.19120000000001,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,17]
[90870,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",312.75959999999998,186.70440000000002,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,17]
[90899,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,0,0,0,0,0,0,null,"N",null,"Y-CM",2,17]
[90901,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",73.730400000000003,33.892199999999995,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,17,6]
[90959,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",579.73500000000001,579.73500000000001,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2]
[90962,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",360.92220000000003,360.92220000000003,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2]
[90997,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",156.9744,156.9744,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2]
[91013,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",16.054200000000002,16.054200000000002,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2]
[91034,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",88.000799999999998,88.000799999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2]
[91040,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",87.406199999999998,87.406199999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2]
[91111,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",1682.1233999999999,1682.1233999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[91111,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",80.865600000000001,80.865600000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[91133,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",861.57540000000006,861.57540000000006,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[91200,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",37.459800000000001,37.459800000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2]
[91307,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
[92018,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",244.38060000000002,244.38060000000002,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2]
[92071,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",65.406000000000006,57.081600000000002,"000",0,0,0,0,0,1,0,0,0,null,"R",null,null,2]
[92082,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",36.270600000000002,36.270600000000002,"000",0,0,0,1,7,2,0,0,0,null,"R",null,null,2]
[92134,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",28.540800000000001,28.540800000000001,"000",0,0,0,1,7,2,0,0,0,null,"R",null,null,2]
[92136,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",89.784599999999998,89.784599999999998,"000",0,0,0,1,7,2,0,0,0,null,"R",null,null,2]
[92235,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",74.325000000000003,74.325000000000003,"000",0,0,0,1,7,2,0,0,0,null,"R",null,null,2]
[92240,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",83.244,83.244,"000",0,0,0,1,7,2,0,0,0,null,"R",null,"Y-CM",2]
[92270,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",198.59639999999999,198.59639999999999,"000",0,0,0,1,7,2,0,0,0,null,"R",null,null,2]
[92283,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",15.4596,15.4596,"000",0,0,0,1,7,2,0,0,0,null,"R",null,"Y-CM",2]
[92311,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",193.245,92.757600000000011,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2]
[92325,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",85.622399999999999,85.622399999999999,"000",0,0,0,5,0,0,0,0,0,null,"R",null,null,2]
[92499,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","By Report","By Report","000",0,0,0,1,0,0,0,0,0,null,"N",null,null,2]
[92499,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","By Report","By Report","000",0,0,0,1,0,0,0,0,0,null,"N",null,null,2]
[92526,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",153.4068,153.4068,"000",0,0,0,7,5,0,0,0,0,null,"R",null,null,2]
[92533,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2]
[92541,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",45.784199999999998,45.784199999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[92544,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",25.567799999999998,25.567799999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[92549,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2]
[92555,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",46.973400000000005,46.973400000000005,"000",0,0,0,3,0,2,0,0,0,null,"R",null,null,2]
[92576,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",70.162800000000004,70.162800000000004,"000",0,0,0,3,0,2,0,0,0,null,"R",null,null,2]
[92577,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",34.486799999999995,34.486799999999995,"000",0,0,0,3,0,2,0,0,0,null,"R",null,null,2]
[92595,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,29]
[92601,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,7,0,0,0,0,0,null,"X",null,null,2]
[92612,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",356.16540000000003,118.3254,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29,26]
[92620,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",163.51500000000001,143.29860000000002,"000",0,0,0,9,0,2,0,0,0,null,"R",null,"Y-CM",2,29]
[92700,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,0,0,0,0,0,0,null,"N",null,null,2,26]
[92933,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,0,0,0,null,"X",null,null,2,26]
[92973,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",306.21900000000005,306.21900000000005,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[92974,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2,26]
[93010,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",14.2704,14.2704,"000",0,0,0,2,0,0,0,0,0,null,"R",null,null,2,26]
[93017,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",65.406000000000006,65.406000000000006,"000",0,0,0,3,6,0,0,0,0,null,"R",null,null,2,26]
[93050,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",28.540800000000001,28.540800000000001,"000",0,0,0,1,6,2,0,0,0,null,"R",null,null,2,26]
[93241,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,4,6,0,0,0,0,null,"N",null,"Y-CM",2,26]
[93261,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",65.406000000000006,65.406000000000006,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93278,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",52.324800000000003,52.324800000000003,"000",0,0,0,1,6,0,0,0,0,null,"R",null,null,2,26]
[93282,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",74.325000000000003,74.325000000000003,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93284,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",197.40719999999999,197.40719999999999,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93288,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",107.02800000000001,107.02800000000001,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93289,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",136.1634,136.1634,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93292,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",36.865200000000002,36.865200000000002,"000",0,0,0,1,6,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93297,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",46.378800000000005,46.378800000000005,"000",0,0,0,2,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93307,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",179.5692,179.5692,"000",0,0,0,1,6,0,0,0,0,null,"R",null,null,2,26]
[93312,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",189.67740000000001,189.67740000000001,"000",0,0,0,1,6,0,0,0,0,null,"R",null,null,2,26]
[93318,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","By Report","By Report","000",0,0,0,1,6,0,0,0,0,null,"N",null,null,2,26]
[93320,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",31.513800000000003,31.513800000000003,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[93351,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",147.46080000000001,147.46080000000001,"000",0,0,0,1,6,0,9,9,9,null,"R",null,null,2,26]
[93356,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",70.162800000000004,20.811,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93454,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",1321.2012,1321.2012,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93456,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",539.30219999999997,539.30219999999997,"000",0,0,0,1,2,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93460,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",649.89779999999996,649.89779999999996,"000",0,0,0,1,2,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93464,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",256.27259999999995,256.27259999999995,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93564,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2,26]
[93571,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,1,0,0,0,0,0,null,"N",null,null,2,26]
[93592,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",686.16839999999991,686.16839999999991,"000",0,0,0,0,0,0,2,1,0,null,"R",null,"Y-UR",2,26]
[93593,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,26]
[93597,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,26]
[93600,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",205.73160000000001,205.73160000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93609,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM",2,26]
[93615,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",66.000600000000006,66.000600000000006,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93621,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM",2,26]
[93622,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",298.48919999999998,298.48919999999998,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93640,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",310.38119999999998,310.38119999999998,"000",0,0,0,1,2,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93641,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",541.08600000000001,541.08600000000001,"000",0,0,0,1,2,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93656,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1947.9096,1947.9096,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-UR",2,26]
[93662,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",162.92040000000003,162.92040000000003,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[93740,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,26]
[93797,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",30.3246,16.054200000000002,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,26]
[93886,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",81.460200000000015,81.460200000000015,"000",0,0,0,1,6,0,0,0,0,null,"R",null,null,2,26]
[93890,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",425.73360000000002,425.73360000000002,"000",0,0,0,1,6,0,0,0,0,null,"R",null,null,2,26]
[93922,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",131.4066,131.4066,"000",0,0,0,1,6,2,0,0,0,null,"R",null,null,2,26]
[93924,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",42.811199999999999,42.811199999999999,"000",0,0,0,1,6,2,0,0,0,null,"R",null,null,2,26]
[93930,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",367.46280000000002,367.46280000000002,"000",0,0,0,1,6,2,0,0,0,null,"R",null,null,2,26]
[93970,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",293.73240000000004,293.73240000000004,"000",0,0,0,1,6,2,0,0,0,null,"R",null,null,2,26]
[93975,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",98.108999999999995,98.108999999999995,"000",0,0,0,1,6,0,0,0,0,null,"R",null,null,2,26]
[93980,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",104.64960000000001,104.64960000000001,"000",0,0,0,1,6,0,0,0,0,null,"R",null,null,2,26]
[93998,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,0,0,0,0,1,1,null,"N",null,null,2,26]
[94010,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",48.757199999999997,48.757199999999997,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[94070,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",112.37939999999999,112.37939999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[94200,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",22.594799999999999,22.594799999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[94450,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",31.513800000000003,31.513800000000003,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2,26]
[94610,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",97.514399999999995,97.514399999999995,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,26]
[94625,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",118.3254,32.703000000000003,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2]
[94680,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",96.919799999999995,96.919799999999995,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[94727,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",58.865400000000001,58.865400000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[94729,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",108.21720000000001,108.21720000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[94777,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,2,0,0,0,0,0,null,"X",null,null,2]
[95012,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",35.081400000000002,35.081400000000002,"000",0,0,0,5,0,0,0,0,0,null,"R",null,null,2]
[95052,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",11.892000000000001,11.892000000000001,"000",0,0,0,5,0,0,0,0,0,null,"R",null,null,2]
[95115,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",17.243399999999998,17.243399999999998,"000",0,0,0,5,0,0,0,0,0,null,"R",null,"Y-CM",2]
[95133,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
[95249,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,3,0,0,0,0,0,null,"X",null,null,2]
[95714,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,0,0,0,0,0,0,null,"N",null,"Y-CM",2]
[95719,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",278.27279999999996,275.89439999999996,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2]
[95783,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2]
[95801,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",72.541200000000003,72.541200000000003,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2]
[95806,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",166.488,166.488,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2]
[95808,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",1083.9558,1083.9558,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2]
[95811,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",218.2182,218.2182,"000",0,0,0,1,0,0,0,0,0,null,"R",null,"Y-CM",2]
[95819,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",101.08199999999999,101.08199999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[95852,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",31.513800000000003,9.5136000000000003,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2]
[95861,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",302.65140000000002,302.65140000000002,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[95866,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",240.81299999999999,240.81299999999999,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2]
[95868,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",154.00139999999999,154.00139999999999,"000",0,0,0,1,0,2,0,0,0,null,"R",null,null,2]
[95870,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",34.486799999999995,34.486799999999995,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[95875,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",149.83920000000001,149.83920000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[95885,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",86.811599999999999,86.811599999999999,"000",0,0,0,1,0,3,0,0,0,null,"R",null,null,2]
[95907,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",93.94680000000001,93.94680000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[95911,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",159.94739999999999,159.94739999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[95913,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",331.19220000000001,331.19220000000001,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[95924,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",152.81219999999999,152.81219999999999,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[95926,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",49.351799999999997,49.351799999999997,"000",0,0,0,1,0,2,0,0,0,null,"R",null,null,2]
[95929,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",450.70679999999999,450.70679999999999,"000",0,0,0,1,0,2,0,0,0,null,"R",null,null,2]
[95937,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",61.2438,61.2438,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[95938,26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT",80.865600000000001,80.865600000000001,"000",0,0,0,1,0,2,0,0,0,null,"R",null,null,2]
[95957,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",478.05839999999995,478.05839999999995,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
[95965,"TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"See CPT","By Report","By Report","000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM",2,22]
[95967,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM",2,22]
[95983,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
[95992,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",77.892600000000002,64.811400000000006,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2]
[96113,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
[96132,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",231.89400000000001,185.51520000000002,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2]
[96137,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",71.946600000000004,32.108400000000003,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2]
[96360,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",63.027600000000007,63.027600000000007,"000",0,0,0,5,0,0,0,0,0,null,"R",null,null,2]
[96366,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",38.054400000000001,38.054400000000001,"000",0,0,0,5,0,0,0,0,0,null,"R",null,null,2]
[96379,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,0,0,0,0,0,0,null,"N",null,null,2,25]
[96413,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",252.70500000000001,252.70500000000001,"000",0,0,0,5,0,0,0,0,0,null,"R",null,null,2,25]
[96446,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",366.8682,45.784199999999998,"000",0,0,0,5,0,0,0,0,0,null,"R",null,"Y-CM",2,25]
[96904,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,5,0,0,0,0,0,null,"X",null,null,2,25]
[96931,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",318.7056,318.7056,"000",0,0,0,4,0,0,0,0,0,null,"R",null,null,2,25]
[96934,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",221.19120000000001,221.19120000000001,"000",0,0,0,4,0,0,0,0,0,null,"R",null,null,2,25]
[97034,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",26.162400000000002,26.162400000000002,"000",0,0,0,7,5,0,0,0,0,null,"R",null,null,2,25]
[97039,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",20.725329081600002,20.725329081600002,"000",0,0,0,7,0,0,0,0,0,null,"F",null,null,2,25]
[97152,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2,25]
[97161,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",180.75839999999999,180.75839999999999,"000",0,0,0,7,5,0,0,0,0,null,"R",null,null,2]
[97170,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
[97606,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Bundled","Bundled","000",0,0,0,0,0,0,0,0,0,null,"Bundled",null,"Y-CM",2,23]
[97761,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",75.514200000000002,75.514200000000002,"000",0,0,0,7,5,0,0,0,0,null,"R",null,null,2]
[97802,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",66.000600000000006,57.676200000000001,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2]
[98943,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
[98962,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",19.027200000000001,19.027200000000001,"000",0,0,0,9,9,9,9,9,9,null,"R",null,null,2,10]
[99000,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2,10]
[99051,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2,10]
[99078,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2,10]
[99170,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,1,0,0,null,"X",null,null,2,10]
[99184,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2,10]
[99191,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,10]
[99219,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",230.70480000000001,230.70480000000001,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,10]
[99222,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",235.4616,235.4616,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,10]
[99239,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",184.32600000000002,184.32600000000002,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,10]
[99252,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",128.43360000000001,128.43360000000001,"000",0,0,0,9,9,9,9,9,9,null,"R",null,null,2,10]
[99288,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",40.109352940800001,40.109352940800001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,10]
[99325,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",137.94719999999998,137.94719999999998,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,10]
[99337,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",337.13819999999998,337.13819999999998,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,10]
[99341,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",94.54140000000001,94.54140000000001,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2,10]
[99360,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",105.83880000000001,105.83880000000001,"000",0,0,0,9,9,9,9,9,9,null,"R",null,null,2,10]
[99368,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",64.216800000000006,64.216800000000006,"000",0,0,0,9,9,9,9,9,9,null,"R",null,null,2,10]
[99386,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,10]
[99396,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,10]
[99409,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",120.70379999999999,114.7578,"000",0,0,0,9,9,9,9,9,9,null,"R",null,null,2,10]
[99424,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
[99448,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
[99451,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
[99467,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
[99471,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
[99485,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
[99493,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",262.81319999999999,180.75839999999999,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-ONC",2]
[99502,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
[99512,null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0005F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["0008U",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",855.01129999999989,855.01129999999989,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2]
["0015M",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1866.6790999999998,1866.6790999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-ONC",2,23]
["0016U",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0042A",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",41.2,41.2,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["0072A",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["0082U",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0092U",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",3557.8399999999997,3557.8399999999997,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2]
["0100U",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0102T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["0112U",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0115U",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0131U",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0134U",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0143U",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0152U",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0162U",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0165T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["0208T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,3,0,0,0,0,0,null,"N",null,null,2]
["0210T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,3,0,0,0,0,0,null,"N",null,null,2]
["0218T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,0,0,1,0,0,0,null,"N",null,"Y-UR",2]
["0219U",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",1036.75,1036.75,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2]
["0225U",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",595.9953999999999,595.9953999999999,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2]
["0233U",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,30]
["0240U",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT",203.96089999999998,203.96089999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2]
["0263T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["0286U",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0289U",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0303R",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Retraining, plan travel, bridge/ferry toll","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["0304U",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0329T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0345T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0375R",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Retraining, relocation costs","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,30]
["0389R",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Job mod/pre-job mod - non voc, job mod/pre-job mod",12.277269576,12.277269576,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,18]
["0402A",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["0403T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["0414A",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Claimant - taxi one way, or mileage","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["0415T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["0424T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["0432T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["0443T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,0,0,0,0,0,0,null,"N",null,"Y-CM",2]
["0450T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["0479T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,1,0,0,null,"X",null,null,2]
["0483T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,0,2,1,null,"X",null,null,2]
["0499T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,1,0,0,null,"X",null,null,2]
["0501F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["0509F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["0515T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,0,2,0,1,0,0,null,"N",null,"Y-CM",2]
["0521T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,1,9,9,9,9,9,null,"N",null,"Y-CM",2]
["0526T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,1,0,0,null,"X",null,null,2]
["0535F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["0537T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["0553T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["0555T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["0562T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2,30]
["0569T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2,30]
["0580F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2,30]
["0583T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["0593T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["0622T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,1,0,0,0,null,"X",null,null,2,27]
["0638T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,1,0,3,0,0,0,null,"X",null,null,2,7,25]
["0672T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,2,0,1,0,0,null,"X",null,null,2]
["0681T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","By Report","By Report","000",0,0,0,0,2,0,1,0,0,null,"N",null,null,2,27]
["0690T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2]
["0702T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,3,0,0,0,0,0,null,"X",null,null,2,25]
["0709T",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Not Covered","Not Covered","000",0,0,0,0,0,0,1,0,0,null,"X",null,null,2]
["0810V",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Assessment services",10.189592899200003,10.189592899200003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,30]
["0830V",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Plan development services",10.189592899200003,10.189592899200003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,13]
["0894V",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Professional mileage, intern, per mile","State Rate","State Rate","000",0,0,0,9,9,9,9,9,9,null,"S",null,null,2,13]
["0897V",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hotel charges (voc) [out-of-state only]","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,30]
["1007F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["1026F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["1038M",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Revw job offer/analysis for empl,per job",57.773477361600001,57.773477361600001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,12]
["1046M",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Provider travel per mile, round trip exc",5.7005471952000004,5.7005471952000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,22]
["1066F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["1070M",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Refer for assessment of impediments","Contracted","Contracted","000",0,0,0,9,9,9,9,9,9,null,"C",null,null,2]
["1088M",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"HEALTH SERVICES COORDINATOR-SURGICAL",9.68,9.68,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,22]
["1091F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2,22]
["1110F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["1123F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2,22]
["1126M",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Additional Complex IME Provider",875.69,875.69,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,13]
["1140M",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"IME, no show fee for missed PCE",331.63,331.63,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,13]
["1152F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["1157M",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Omd contracted consultant claim review","Contracted","Contracted","000",0,0,0,9,9,9,9,9,9,null,"C",null,null,2,7]
["1183F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["1192M",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Impairment rating by a/p, complex",875.69,875.69,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,12]
["1220M",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Nurse case mgmt phone call per unit",11.66,11.66,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,20]
["1243M",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ur contract:  retrospective inpatient review without bill audit","Contracted","Contracted","000",0,0,0,9,9,9,9,9,9,null,"C",null,null,2]
["1277M",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"CCM, NCM CASE RATE, 15 MIN","Contracted","Contracted","000",0,0,0,9,9,9,9,9,9,null,"C",null,null,2]
["1291M",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"COE care mgmt subsequent                ","Contracted","Contracted","000",0,0,0,9,9,9,9,9,9,null,"C",null,null,2]
["1451F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["1500F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["2000F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["2004F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["2018F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["2027F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["2040F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3006F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3022F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3038F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3060F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3075F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3082F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3093F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3115F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3155F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3260F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3271F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3291F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3316F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3321F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3341F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3352F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3388F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3475F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3495F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3515F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3570F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3750F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["3759F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4000F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4016F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4042F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4049F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4064F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4075F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4090F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4132F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4144F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4164F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4178F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2,36]
["4187F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2,36]
["4210F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2,33]
["4248F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4261F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4293F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4305F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4510F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4556F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["4563F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["5094V",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hearing aid domes/tubes replacement, bilateral",25,25,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,5]
["6015F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2,28,9]
["6070F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2,28,9]
["8884H",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Nursing facility rehab - low (per day)",607.12,607.12,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,36]
["8887H",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Nursing facility clinically complex (per",511.6,511.6,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,36]
["8917H",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Home/vehicle modification mileage, lodging, airfare, car rental","State Rate","State Rate","000",0,0,0,9,9,9,9,9,9,null,"S",null,null,2,18]
["9005F",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"See CPT","Tracking","Tracking","000",0,0,0,9,9,9,9,9,9,null,"T",null,null,2]
["9959M",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"HLTH BHV INVNJ AUDIO",118.45,118.45,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28,9]
["9997M",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Document translation at insurer request","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,14]
["A0130",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Noner transport wheelch van","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["A0190",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Noner transport meals recip","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["A0422",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ambulance 02 life sustaining","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2]
["A0426",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Als 1",744.53502798870636,744.53502798870636,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["A0998",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ambulance response/treatment","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["A2010",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Apis, per square centimeter","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,28,9]
["A4208",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"3 cc sterile syringe&needle","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2,28,9]
["A4216",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Sterile water/saline, 10 ml","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2,28,9]
["A4232",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Syringe w/needle insulin 3cc",4.1499999999999995,4.1499999999999995,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28,9]
["A4238",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Adju cgm supply allowance","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,28,9]
["A4259",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lancets per box","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2,28,9]
["A4263",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Permanent tear duct plug","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2,28,9]
["A4284",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Replcmnt breast pump shield","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,28,9]
["A4313",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Catheter w/bag 3-way","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2,28,9]
["A4326",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Male external catheter","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2,28,9]
["A4334",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Urinary cath leg strap","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2,28,9]
["A4354",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cath insertion tray w/bag","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2,28,9]
["A4360",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Disposable ext urethral dev","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2,28,9]
["A4376",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Drainable rubber pch w fcplt","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2,28,9]
["A4379",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Urinary plastic pouch w fcpl","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2,28,9]
["A4392",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Urinary pouch w st wear barr","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2,28,9]
["A4406",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pectin based ostomy paste","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2,28,9]
["A4413",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"2 pc drainable ost pouch","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2,28,9]
["A4420",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ost pch clsd for bar w lk fl","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2,28,9]
["A4432",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Os pch urine w bar/fange/tap","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2,28,9]
["A4452",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Waterproof tape","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2,28,9]
["A4483",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Moisture exchanger",7.8102999999999998,7.8102999999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28,9]
["A4500",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Below knee surgical stocking",34.162799999999997,34.162799999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28,9]
["A4570",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Splint","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,28,9]
["A4602",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Replace lithium battery 1.5v",9.1881000000000004,9.1881000000000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28,9]
["A4613",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Battery charger",197.50823619360003,197.50823619360003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28,9]
["A4620",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Variable concentration mask",0.8034,0.8034,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28,9]
["A4636",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Handgrip for cane etc",5.8570025471999996,5.8570025471999996,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28,9]
["A4641",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Radiopharm dx agent noc","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,28,9]
["A4672",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Drainage ext line, dialysis",8.2418999999999993,8.2418999999999993,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28,9]
["A4680",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Activated carbon filter, ea",244.01999999999998,244.01999999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28,9]
["A4730",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Fistula cannulation set, ea",19.521599999999999,19.521599999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28,9]
["A4765",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Dialysate conc pow per pack","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,28,9]
["A4802",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Protamine sulfate per 50 mg",4.8803999999999998,4.8803999999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28,9]
["A4927",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Non-sterile gloves",18.343,18.343,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28,9]
["A5057",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"1 pc ost pou w built-in conv","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2,28,9]
["A5072",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Urinary pouch w/o barrier","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2,28,9]
["A5122",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Solid skin barrier 8x8","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2,28,9]
["A5200",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Percutaneous catheter anchor",14.2346,14.2346,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28,9]
["A6021",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Collagen dressing <=16 sq in","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2,28,9]
["A6197",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Alginate drsg >16 <=48 sq in","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2,28,9]
["A6207",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Contact layer >16<= 48 sq in","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2,28,9]
["A6214",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Foam drg > 48 sq in w/border","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2,28,9]
["A6229",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Gauze >16<=48 sq in watr/sal","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2,28,9]
["A6234",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hydrocolld drg <=16 w/o bdr","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2,28,9]
["A6247",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hydrogel drg > 48 sq in w/b","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2,28,9]
["A6251",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Absorpt drg <=16 sq in w/o b","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2,28,9]
["A6407",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Packing strips, non-impreg","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2,28,9]
["A6443",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Conform band n/s w>=3\"<5\"/yd","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2,28,9]
["A6450",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lt compres band >=5\"/yd","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2,28,9]
["A6457",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Tubular dressing","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2,28,9]
["A6510",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Compres burn garment leotard","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,28,9]
["A6531",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Compression stocking bk30-40",48.978299999999997,48.978299999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28,9]
["A6549",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"G compression stocking","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,28,9]
["A7001",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Nondisposable pump canister",39.043199999999999,39.043199999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,28,9]
["A7018",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Water distilled w/nebulizer",0.43259999999999998,0.43259999999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28,9]
["A7030",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cpap full face mask",249.84659999999997,249.84659999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28,9]
["A7032",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Replacement nasal cushion",58.913400000000003,58.913400000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28,9]
["A7046",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Repl water chamber, pap dev",34.403500000000001,34.403500000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,28,9]
["A7520",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Trach/laryn tube non-cuffed",59.832700000000003,59.832700000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["A7525",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Tracheostomy mask",2.5956000000000001,2.5956000000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["A9270",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Non-covered item or service","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["A9274",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ext amb insulin delivery sys",37.35,37.35,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["A9501",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Technetium tc-99m teboroxime","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,9]
["A9509",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Iodine i-123 sod iodide mil",1057.8615,1057.8615,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["A9512",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Tc99m pertechnetate","By report","By report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-PHL",2,35]
["A9530",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"I131 iodide sol, rx",35.482500000000002,35.482500000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,35]
["A9547",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"In111 oxyquinoline","By report","By report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-PHL",2,35]
["A9553",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cr51 chromate","By report","By report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,35]
["A9567",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Technetium tc-99m aerosol",168.86349999999999,168.86349999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,35]
["A9575",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj gadoterate meglumi 0.1ml",0.153,0.153,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,35]
["A9587",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Gallium ga-68","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,35]
["A9594",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Gallium ga-68 psma-11, ucla","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,35]
["A9597",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pet, dx, for tumor id, noc","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,35]
["AA436",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Irr supply sleev reus per mo","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,35]
["B4103",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ef ped fluid and electrolyte","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,35]
["B4152",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ef calorie dense>/=1.5kcal",0.51500000000000001,0.51500000000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,35]
["B4176",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Parenteral sol amino acid 7-",62.747600000000006,62.747600000000006,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,35]
["B4197",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Parenteral sol 74-100 gm pro",365.9178,365.9178,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,35]
["B9004","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Parenteral infus pump portab",522.66319999999996,522.66319999999996,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,35]
["C1713",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Anchor/screw bn/bn,tis/bn","Facility Only",0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2,35]
["C1715",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Brachytherapy needle","Facility Only",0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2,35]
["C1730",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cath, ep, 19 or few elect","Facility Only",0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2,35]
["C1755",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Catheter, intraspinal","Facility Only",0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2,35]
["C1760",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Closure dev, vasc","Facility Only",0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2,35]
["C1773",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ret dev, insertable","Facility Only",0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2,35]
["C1782",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Morcellator","Facility Only",0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2,35]
["C1817",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Septal defect imp sys","Facility Only",0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2,35]
["C1824",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Generator, ccm, implant","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-UR",2,35]
["C1830",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Power bone marrow bx needle","Facility Only",0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2,35]
["C1878",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Matrl for vocal cord","Facility Only",0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2,35]
["C1886",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Catheter, ablation","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,35]
["C1897",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lead, neurostim test kit","Facility Only",0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2,35]
["C2620",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pmkr, single, non rate-resp","Facility Only",0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2,35]
["C2627",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cath, suprapubic/cystoscopic","Facility Only",0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2,35]
["C2641",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Brachytx, non-stranded,p-103","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,35]
["C5271",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Low cost skin substitute app","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,35]
["C5273",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Low cost skin substitute app","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,35]
["C8908",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Mri w/o fol w/cont, breast,","Facility Only",0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2]
["C8918",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Mra w/cont, pelvis","Facility Only",0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2]
["C8928",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Tte w or w/o fol w/con,stres","Facility Only",0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2]
["C9046",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cocaine hcl nasal solution","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["C9058",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Injection,pegfilgrastim-bmez","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["C9092",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Sirolimus, protein-bound,1mg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["C9254",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Injection, lacosamide","By report","By report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["C9285",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Patch, lidocaine/tetracaine","By report","By report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["C9362",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Implnt,bon void filler-strip","Facility Only",0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2]
["C9462",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Injection, delafloxacin","By report","By report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["C9602",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Perc d-e cor stent ather s","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,28,8]
["C9738",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Blue light cysto imag agent","Facility Only",0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2]
["C9757",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Spine/lumbar disk surgery","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-UR",2]
["C9769",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cysto w/temp pros implant","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-ONC",2]
["C9776",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Fluo bile duct imaging w/icg","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-ONC",2]
["C9778",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Colpopexy, min/inv, ex-perit","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["D0150",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Comprehensve oral evaluation",111.24000000000001,111.24000000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,8]
["D0210",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Intraor complete film series",157.38400000000001,157.38400000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,8]
["D0277",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Vert bitewings 7 to 8 images",114.536,114.536,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,8]
["D0368",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cone beam ct interprete tmj",423.53600000000006,423.53600000000006,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,8]
["D0383",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cone beam ct both jaws",417.76800000000003,417.76800000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,8]
["D0416",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Viral culture","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,8]
["D0431",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Diag tst detect mucos abnorm","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,8]
["D0470",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Diagnostic casts",141.72800000000001,141.72800000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,8]
["D0483",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Indirect immunofluorescence","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,8]
["D0602",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Caries risk assess mod risk",85.696000000000012,85.696000000000012,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D0706",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Intraoral occlus radio image","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,8]
["D1208",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Topical app fluorid ex vrnsh","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,28,8]
["D1517",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Fixed bilat space maint, man",495.22400000000005,495.22400000000005,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D1702",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pfizer-BioNTech Covid-19 vaccine administration - second dose","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,8]
["D2140",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Amalgam one surface permanen",172.21600000000001,172.21600000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,8]
["D2160",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Amalgam three surfaces perma",266.15200000000004,266.15200000000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,8]
["D2420",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Dental gold foil two surface","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,8]
["D2544",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Dental onlay metl 4/more sur","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,8]
["D2662",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Dental onlay resin 2 surface","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,8]
["D2740",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Crown porcelain/ceramic",1308.5120000000002,1308.5120000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D2794",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Crown-titanium",1269.7840000000003,1269.7840000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D2934",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Prefab steel crown primary",423.53600000000006,423.53600000000006,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,8]
["D2953",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Each addtnl cast post",372.44800000000004,372.44800000000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D2955",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Post removal",338.66400000000004,338.66400000000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,8]
["D2999",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Dental unspec restorative pr","By Report","By Report","000",0,0,0,0,0,0,0,0,0,null,"N",null,"Y-CM",2,8]
["D3240",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pulpal therapy posterior pri","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,8]
["D3351",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Apexification/recalc initial",434.24800000000005,434.24800000000005,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,8]
["D3425",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Root surgery molar",1123.1120000000001,1123.1120000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,8]
["D3473",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Surg rep root res molar","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-ONC",2,8]
["D4212",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Gingivectomy/plasty rest",353.49600000000004,353.49600000000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D4260",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Osseous surgery 4 or more",1346.4160000000002,1346.4160000000002,"000",0,0,0,0,0,0,0,0,0,null,"F",null,"Y-CM",2,8]
["D4263",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Bone replce graft first site",795.16,795.16,"000",0,0,0,0,0,0,0,0,0,null,"F",null,"Y-CM",2,8]
["D4323",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Splint extra-coronal","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,8]
["D4346",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Scaling gingiv inflammation","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,8]
["D5140",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Dentures immediat mandible",2221.5040000000004,2221.5040000000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D5224",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Immed mand part dent metal",2062.4720000000002,2062.4720000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,8]
["D5422",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Dentures adjust part mandbl",111.24000000000001,111.24000000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D5670",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Replc tth&acrlc on mtl frmwk",864.37600000000009,864.37600000000009,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D5730",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Denture reln cmplt maxil ch",443.31200000000007,443.31200000000007,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D5740",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Denture reln part maxil chr",437.54400000000004,437.54400000000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D5865",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Overdenture complete mandib",2701.8960000000002,2701.8960000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D5875",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Prosthesis modification",556.20000000000005,556.20000000000005,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D5922",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Nasal septal prosthesis","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,8]
["D5931",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Surgical obturator",4433.9440000000004,4433.9440000000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D5958",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Intraoral con def inter plt",2961.1476180000004,2961.1476180000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D5986",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Fluoride applicator","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,8]
["D6013",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Surgical place mini implant",1468.3680000000002,1468.3680000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D6050",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Odontics transosteal implnt",6071.2320000000009,6071.2320000000009,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D6069",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Abutment supported retainer",1607.6240000000003,1607.6240000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D6072",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Abutment supported retainer",1669.4240000000002,1669.4240000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D6085",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Provisional implant crown",640.24800000000005,640.24800000000005,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D6094",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Abut support crown titanium",1596.0880000000002,1596.0880000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D6111",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Implnt/abut remov dent mand",3547.32,3547.32,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,8]
["D6118",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Imp/abut int fixed dent man",4149.6640000000007,4149.6640000000007,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D6199",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Implant procedure",1020.936,1020.936,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D6210",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Prosthodont high noble metal",1315.1040000000003,1315.1040000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D6600",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Porcelain/ceramic inlay 2srf","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,8]
["D6603",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cst hgh nble mtl inlay >=3sr","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,8]
["D6613",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Onlay cst base mtl >=3 surfa","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,8]
["D6722",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Crown resin w/noble metal",1206.336,1206.336,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D6791",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Crown full base metal cast",1207.9839999999999,1207.9839999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D6950",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Precision attachment",748.19200000000012,748.19200000000012,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D7251",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Coronectomy",554.55200000000002,554.55200000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,28,8]
["D7261",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Primary closure sinus perf",975.6160000000001,975.6160000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,8]
["D7296",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Corticotomy, 1-3 teeth",1197.2720000000002,1197.2720000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D7299",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Rem anchorage device w/flap","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,8]
["D7412",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Excision benign lesion compl",1189.0320000000002,1189.0320000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D7460",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Rem nonodonto cyst to 1.25cm",722.64800000000002,722.64800000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D7530",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Removal fb skin/areolar tiss",433.42400000000004,433.42400000000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D7640",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Clsd red simpl mandible fx",3856.32,3856.32,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D7770",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Open reduc compd alveolus fx",3090,3090,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D7780",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Reduct compnd facial bone fx",9662.224000000002,9662.224000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D7874",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Tmj arthroscopy disc reposit",7008.12,7008.12,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D7877",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Tmj arthroscopy debridement","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,8]
["D7940",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Reshaping bone orthognathic",4534.4720000000007,4534.4720000000007,"000",0,0,0,0,0,0,0,0,0,null,"F",null,null,2,8]
["D7949",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Reconstruct midface w/graft",15575.248000000001,15575.248000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D7979",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Non-surgical sialolithotomy",748.19200000000012,748.19200000000012,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D7993",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Surg place craniofacial impl","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-ONC",2,8]
["D8080",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Compre dental tx adolescent",5595.7840000000006,5595.7840000000006,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D8210",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Orthodontic rem appliance tx",977.26400000000012,977.26400000000012,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["D9110",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Tx dental pain minor proc",159.85600000000002,159.85600000000002,"000",0,0,0,0,0,0,0,0,0,null,"F",null,null,2,8]
["D9210",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Dent anesthesia w/o surgery",90.64,90.64,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,8]
["D9248",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Sedation (non-iv)",365.03200000000004,365.03200000000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,8]
["D9610",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Dent therapeutic drug inject",123.60000000000001,123.60000000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,8]
["D9935",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Clean rem part denture mand",88.992000000000004,88.992000000000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,8]
["D9947",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Sleep apnea appliance","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,8]
["D9975",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"External bleaching home app","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,8]
["D9992",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Case mgmt, care coordination",119.48,119.48,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,8]
["E0113","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Crutch underarm each wood",26.646100000000001,26.646100000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0117","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Underarm springassist crutch",303.49779999999998,303.49779999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0143","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Walker folding wheeled w/o s",93.369500000000002,93.369500000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0149","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Heavy duty wheeled walker",190.55,190.55,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0158","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Walker leg extenders set of4",30.261399999999998,30.261399999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0163","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Commode chair with fixed arm",100.72370000000001,100.72370000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0182","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Replace pump, alt press pad",28.819400000000002,28.819400000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0186","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Air pressure mattress",23.854800000000001,23.854800000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0197","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Air pressure pad for mattres",29.993600000000001,29.993600000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0199","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Dry pressure pad for mattres",38.223300000000002,38.223300000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0225",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hydrocollator unit","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["E0240","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Bath/shower chair",143.76429999999999,143.76429999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0247","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Trans bench w/wo comm open",127.7868,127.7868,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0260","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Hosp bed semi-electr w/ matt",112.55840000000001,112.55840000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E0272","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Mattress foam rubber",18.7254,18.7254,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0277","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"POWERED PRES-REDU AIR MATTRS",4960.1710000000003,4960.1710000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E0295","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Hosp bed semi-elect w/o matt",1022.6870000000001,1022.6870000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E0296","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Hosp bed total elect w/ matt",151.36880000000002,151.36880000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E0304","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Hosp bed xtra hvy dty x wide",7046.7449999999999,7046.7449999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E0316","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Bed safety enclosure",2214.5,2214.5,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0352","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Disposable pack w/bowel syst","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,9]
["E0431","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Portable gaseous 02",27.768800000000002,27.768800000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E0446","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Topical ox deliver sys, nos","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,9]
["E0459","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Chest wrap",26.626399999999997,26.626399999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E0472","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Rad w backup invasive intrfc",5890.2610000000004,5890.2610000000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E0480","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Percussor elect/pneum home m",55.383100000000006,55.383100000000006,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0487",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Electronic spirometer","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["E0565","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Compressor air power source",57.690300000000001,57.690300000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0575","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Nebulizer ultrasonic",1295.2250000000001,1295.2250000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0605","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Vaporizer room type",33.2896,33.2896,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0620","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Cap bld skin piercing laser",1101.6879999999999,1101.6879999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0627","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Seat lift mech, electric any",363.80629999999996,363.80629999999996,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E0638","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Standing frame sys",479.20049999999998,479.20049999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0642","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Dynamic standing frame"," By Report "," By Report ","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,9]
["E0652","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Pneum compres w/cal pressure",6078.6788999999999,6078.6788999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E0660","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Pneumatic appliance full leg",201.3135,201.3135,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0667","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Seg pneumatic appl full leg",46.071899999999999,46.071899999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0673","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Pressure pneum appl half leg",33.7943,33.7943,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0720",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Tens two lead","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["E0746","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Electromyograph biofeedback","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-PHL",2,9]
["E0762",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Trans elec jt stim dev sys","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["E0770","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Functional electric stim nos",841.26310000000001,841.26310000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E0781","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"External ambulatory infus pu",301.41919999999999,301.41919999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-ONC",2,9]
["E0786","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Implantable pump replacement",10063.203000000001,10063.203000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E0840","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Tract frame attach headboard",92.3292,92.3292,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0870","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Tract frame attach footboard",16.9023,16.9023,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0912","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Hd trapeze bar free standing",110.5087,110.5087,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0936","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Cpm device, other than knee","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-PHL",2,9]
["E0951","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Loop heel",17.963200000000001,17.963200000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0955","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Cushioned headrest",19.436100000000003,19.436100000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0958","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Whlchr att- conv 1 arm drive",51.695700000000002,51.695700000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E0966","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Wheelchair head rest extensi",8.5696000000000012,8.5696000000000012,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0970","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Wheelchair no. 2 footplates",159.73349999999999,159.73349999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E0981","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Seat upholstery, replacement",48.121600000000001,48.121600000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0988","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Lever-activated wheel drive",3640.8107715408005,3640.8107715408005,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E0994","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Wheelchair arm rest",2.0497000000000001,2.0497000000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E1006","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Pwr seat combo w/o shear",698.9683,698.9683,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E1010","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Add pwr leg elevation",1224.0520000000001,1224.0520000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E1016","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Shock absorber for power w/c",136.46470000000002,136.46470000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E1029","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"W/c vent tray fixed",40.118500000000004,40.118500000000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E1037",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Transport chair, ped size","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["E1083","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Hemi-wheelchair fixed arms",99.219899999999996,99.219899999999996,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E1089","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Wheelchair lightwt fixed arm",53.244500000000002,53.244500000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E1093","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Wheelchair wide w/ foot rest",139.2766,139.2766,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E1160","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Wheelchair fixed arms",78.7744,78.7744,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E1172","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Wheelchair amputee detach ar",1234.6610000000001,1234.6610000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E1195","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Wheelchair amputee heavy dut",1583.0070000000001,1583.0070000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E1224","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Wheelchair spec size w/ leg",102.25840000000001,102.25840000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E1226","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Manual fully reclining back",564.55330000000004,564.55330000000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E1235",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Rigid ped wc adjustable","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["E1270","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Wheelchair lightweight leg r",99.477400000000003,99.477400000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E1290","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Wheelchair hvy duty detach a",58.133200000000002,58.133200000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["E1353","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Oxygen supplies regulator",25.895999999999997,25.895999999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E1372","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Oxy suppl heater for nebuliz",22.248000000000001,22.248000000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E1405","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"O2/water vapor enrich w/heat",191.32249999999999,191.32249999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,9]
["E1590","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Hemodialysis machine","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,9]
["E1600","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Deli/install chrg hemo equip","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,9]
["E1639","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Scale, each","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,9]
["E1811","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Sps knee device",169.00240000000002,169.00240000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E1821","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Replacement interface spsd",132.61250000000001,132.61250000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2201","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Man w/ch acc seat w>=20\"<24\"",413.59650000000005,413.59650000000005,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2204","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Frame depth 22 to 25 in",93.832999999999998,93.832999999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2207","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Crutch and cane holder",5.3869000000000007,5.3869000000000007,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2217","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Foam filled caster tire each",49.8005,49.8005,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2220","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Solid propuls tire, repl, ea",34.844900000000003,34.844900000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2231","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Solid seat support base",177.21150000000003,177.21150000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2310","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Electro connect btw control",122.3331,122.3331,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2313","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Pwc harness, expand control",40.376000000000005,40.376000000000005,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2324","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Chin cup interface",47.596299999999999,47.596299999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2330","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Head control proximity switc",3704.8070000000002,3704.8070000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2341","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"W/c wdth 24-27 in seat frame",677.42070000000012,677.42070000000012,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2361","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"22nf sealed leadacid battery",142.52110000000002,142.52110000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,26]
["E2362","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Gr24 nonsealed leadacid",116.51360000000001,116.51360000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,26]
["E2369","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Pwr wc drivewheel gear repl",46.895900000000005,46.895900000000005,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,11]
["E2372","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Gr27 non-sealed leadacid","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,35]
["E2381","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Pneum drive wheel tire",75.983099999999993,75.983099999999993,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,26]
["E2384","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Pneumatic caster tire",7.9619000000000009,7.9619000000000009,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,26]
["E2388","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Foam drive wheel tire",5.3250999999999999,5.3250999999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2397","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Pwc acc, lith-based battery",51.891400000000004,51.891400000000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2502","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Sgd prerec msg >8min <=20min",1506.8488,1506.8488,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,26]
["E2504","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Sgd prerec msg>20min <=40min",198.80029999999999,198.80029999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,25]
["E2602","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Gen w/c cushion wdth >=22 in",113.5472,113.5472,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,23]
["E2606","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Position wc cush wdth>=22 in",423.39179999999999,423.39179999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E2619","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Replace cover w/c seat cush",54.414900000000003,54.414900000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,35]
["E2626","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Seo mobile arm sup att to wc",765.55780000000004,765.55780000000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["E8000",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Posterior gait trainer","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["G0036",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt/ptn decln assess","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G0043",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt mech pros ht valv","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
["G0046",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"No mrs 90 days post stk","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G0060",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Allergy/immunology ss","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G0064",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cert nurse midwife ss","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G0080",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Care manag h vst new pt 75 m","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["G0087",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Care man home care plan 60 m","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2,11]
["G0105",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Colorectal scrn; hi risk ind",634.43820000000005,324.65160000000003,"000",0,0,0,0,2,0,1,0,0,null,"R",null,"Y-CM",2,17]
["G0122","TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Colon ca scrn; barium enema",540.4914,540.4914,"000",0,0,0,1,9,9,9,9,9,null,"R",null,"Y-CM",2]
["G0130",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Single energy x-ray study",66.595200000000006,66.595200000000006,"000",0,0,0,1,0,0,0,0,0,null,"R",null,null,2]
["G0141",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Scr c/v cyto,autosys and md",39.838200000000001,39.838200000000001,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2]
["G0161",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hhc slp ea 15 min","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G0175",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Opps service,sched team conf","Facility Only",0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2]
["G0204","TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Dx mammo incl cad bi",246.69199114560001,246.69199114560001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["G0219","TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Pet img wholbod melano nonco","Not Covered","Not Covered","000",0,0,0,1,9,9,9,9,9,null,"X",null,null,2]
["G0246",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Followup eval of foot pt lop","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["G0255","TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Current percep threshold tst","Not Covered","Not Covered","000",0,0,0,1,9,9,9,9,9,null,"X",null,null,2]
["G0279",26,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Tomosynthesis, mammo",51.730200000000004,51.730200000000004,"000",0,0,0,1,0,2,9,0,0,null,"R",null,null,2]
["G0282",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Elect stim wound care not pd","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["G0307",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cbc without platelet",9.2520999999999987,9.2520999999999987,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2]
["G0333",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Dispense fee initial 30 day","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G0381",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lev 2 hosp type b ed visit","Facility Only",0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2]
["G0398",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Home sleep test/type 2 porta","By Report","By Report","000",0,0,0,1,0,0,0,0,0,null,"N",null,"Y-CM",2]
["G0407",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inpt/tele follow up 25","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["G0416","TC",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Prostate biopsy, any mthd","Not Covered","Not Covered","000",0,0,0,1,0,0,0,0,0,null,"X",null,null,2]
["G0433",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Elisa hiv-1/hiv-2 screen",26.154699999999998,26.154699999999998,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2]
["G0437",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Tobacco-use counsel>10min","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G0455",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Fecal microbiota prep instil","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["G0463",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hospital outpt clinic visit","Facility Only",0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2,26]
["G0476",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hpv combo assay ca screen","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,26]
["G0493",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Rn care ea 15 min hh/hospice","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G0504",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Init/sub psych care add 30 m",129.91190097600003,84.307523414399995,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["G0516",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Insert drug del implant, >=4",368.65200000000004,171.2448,"000",0,0,0,0,2,0,0,0,0,null,"R",null,"Y-ONC",2]
["G1004",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cdsm ndsc","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G1009",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cdsm sage health","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G1023",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cdsm persivia","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G1027",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt hemo < 3mo","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G2015",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Post-d/c care plan overs 60m","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2]
["G2022",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Benef refuses service, mod","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G2071",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Med tx remove implant","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G2081",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt 66+ snp or ltc pos > 90d","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G2096",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"No rsn ace arb arni","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G2099",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt 66+ frailty and adv ill","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G2121",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Psy dep anx ap and icd asse","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G2127",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt 66+ frailty med dem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G2149",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"No mpm med rsn","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G2152",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Res change sc =0","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G2174",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Uri new rx antibiotic 30d","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G2184",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"No caregiver","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G2196",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Screen unhlthy etoh use","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G2203",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Med rsn no etoh couns","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G2213",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Initiat med assist tx in er",120.70379999999999,114.1632,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2]
["G2250",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Remot img sub by pt, non e/m",21.4056,16.054200000000002,"000",0,0,0,0,0,0,0,0,0,null,"R",null,null,2]
["G4013",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Mentl/behav health ss","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G4016",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Neurosurgical ss","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G4024",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pediatric ss","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G4034",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Speech language path ss","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G6004",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Radiation treatment delivery",245.56979999999999,245.56979999999999,"000",0,0,0,3,0,0,0,0,0,null,"R",null,"Y-CM",2]
["G6011",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Radiation treatment delivery",448.32839999999999,448.32839999999999,"000",0,0,0,3,0,0,0,0,0,null,"R",null,"Y-CM",2]
["G8396",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lvef not performed","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8404",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Low extemity neur exam docum","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8450",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Beta-bloc rx pt w/abn lvef","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8465",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"High risk recurrence pro ca","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8483",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Flu imm no admin doc rea","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8542",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Doc funct no deficiencies","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
["G8569",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Prol intubation req","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8599",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"No asa/antiplat ther use rng","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8652",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Rafscrs hi scor < 0","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8658",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Rafscrs llfai no scor + surv","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8710",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt pres antibiotic","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8721",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt, pn, hist grade doc","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8752",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Sys bp less 140","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8807",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"No ta tv ultrasnd","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8840",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Doc reas no sleep apnea","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8849",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Doc reas no pos air press","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8864",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pneumococcal vaccine admin","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8869",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Doc immune hep b antitnf","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8912",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt doc with wrong event","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8915",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt not trans to hosp at d/c","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8936",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt not eligible ace/arb","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G8958",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Assess vol mgmt not doc","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9002",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Mccd,maintenance rate","Contracted","Contracted","000",0,0,0,9,9,9,9,9,9,null,"C",null,null,2]
["G9009",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Mccd, risk adj, level 3","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["G9053",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Onc expectant management pt","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9057",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Onc pract mgmt differs trial","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9073",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Onc dx brst stg3-hr, no pro","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9077",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Onc dx prostate t1no progres","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9087",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Onc dx colon metas evid dx","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9097",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Onc dx esophageal t4 no prog","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9109",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Onc dx head/neck t1-t2no prg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9116",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Onc dx ovarian recurrence","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9132",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Onc dx prostate mets no cast","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9140",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Frontier extended stay demo","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9197",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Order for ceph","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9213",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"No doc of dsm-iv","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9231",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Doc esrd dia trans preg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9274",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Bp out of nrml limits","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9286",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Antibio rx w in 10d of sympt","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9293",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"No pt category on report","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9308",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Unpl ret or w/compl w/in 30d","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9316",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Doc comm risk calc","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9352",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Not >1 sinus ct w 90d dx","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9355",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"No early ind/delivery","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9367",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},">= 2 same hi-rsk med ord","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9395",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ini phq9 >9 no remiss >=5","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9407",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"No 7d f/u","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9419",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Med reas not incl histo type","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9429",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Doc med rsn no pt cat","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9454",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"No scr hcv inf 12 mth rp","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9475",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Other counselor at hospice","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9478",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Othe therapist at hospice","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9504",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Doc rsn hep b stat not asses","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9514",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Req ret or w/in 90d of surg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9521",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Er and ip hosp <2 in 12 mos","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9544",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"No filt remov w/in 3mos plcm","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9556",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ct/cta/mri/a no follup imag","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9597",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"No low pecarn ped head traum","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9612",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Phodoc 2 mr cec lndmk","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9618",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Doc scr uter mal or us/samp","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9627",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt no bl srg 30 day pst srg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9643",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Elective surgery","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9654",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Mon anesth care","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9674",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt w/clin ascvd dx","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9694",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hosp srv used pt in msmt per","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9703",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Child anbx 30 prior dx phary","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9715",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt w/hosp anytime msmt per","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9722",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Doc hx renal fail or cr+ >4","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9726",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Refused to participate","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9736",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Refused to participate","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9751",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt died w/in 24 mos rpt time","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9764",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt treatd w/oral syst or bio","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9774",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt had hyst","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9782",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hx dx fam/pure hypercholes","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["G9795",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt no daily asa/antiplat","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["G9809",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt w/hosp anytime msmt per","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["G9813",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt not died w/in 30d of proc","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["G9832",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Brt ca dx i, no t1/t1a/t1b","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["G9844",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt no recd anti-egfr ther","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["G9862",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Doc rsn no 10 yr follow","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["G9884",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"2 em ongoing ms mo 19-21 wl","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["G9896",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Doc pt rsn no adr dep thrpy","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["G9908",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"No pt tbco cess interv rng","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["G9915",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"No documntd hbv results rcd","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["G9919",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Scrn nd pos nd prov of rec","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["G9930",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Com care","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["G9943",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Bk pn nt msr vas scl pre/pst","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["G9961",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Systemic antimicro presc","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["G9976",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"DOC HAT RSN NO MAC EXM PERF ","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["G9993",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pall serv during meas","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["H0006",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Alcohol and/or drug services","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,16]
["H0013",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Alcohol and/or drug services","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,16]
["H0017",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Alcohol and/or drug services","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,16]
["H0027",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Alcohol and/or drug preventi","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["H0034",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Med trng & support per 15min","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["H0046",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Mental health service, nos","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["H1005",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Prenatalcare enhanced srv pk","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,16]
["H2013",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Psych hlth fac svc, per diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["H2025",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Supp maint employ, 15 min","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["H2032",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Activity therapy, per 15 min","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["H2036",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"A/d tx program, per diem","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,16]
["J0172",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj, aducanumab-avwa, 2 mg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J0180",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Agalsidase beta injection",198.73599999999999,198.73599999999999,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J0222",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj., patisiran, 0.1 mg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J0282",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Amiodarone hcl",0.28999999999999998,0.28999999999999998,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J0300",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Amobarbital 125 mg inj",183.26,183.26,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J0456",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Azithromycin",2.8319999999999999,2.8319999999999999,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J0490",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Belimumab injection","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J0517",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj., benralizumab, 1 mg",165.57,165.57,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J0585",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Injection,onabotulinumtoxina",6.1849999999999996,6.1849999999999996,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J0588",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Incobotulinumtoxin a",5.0629999999999997,5.0629999999999997,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J0606",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj, etelcalcetide, 0.1 mg",3.27,3.27,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J0670",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj mepivacaine hcl/10 ml",2.95,2.95,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J0698",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cefotaxime sodium injection",2.78,2.78,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J0725",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Chorionic gonadotropin/1000u",24.539000000000001,24.539000000000001,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J0745",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj codeine phosphate /30 mg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J0791",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj crizanlizumab-tmca 5mg",124.181,124.181,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-ONC",2,16]
["J0885",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Epoetin alfa, non-esrd",8.1120000000000001,8.1120000000000001,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J0890",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Peginesatide injection","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J1094",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj dexamethasone acetate","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J1170",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hydromorphone injection",2.8620000000000001,2.8620000000000001,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J1240",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Dimenhydrinate injection",7.26,7.26,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J1290",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ecallantide injection","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J1364",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Erythro lactobionate /500 mg",77.177000000000007,77.177000000000007,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J1427",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj. viltolarsen","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J1448",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Injection, trilaciclib, 1mg",5.1190999999999995,5.1190999999999995,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,16]
["J1452",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Intraocular fomivirsen na","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J1558",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj. xembify, 100 mg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J1572",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Flebogamma injection",38.716000000000001,38.716000000000001,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J1610",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Glucagon hydrochloride/1 mg",169.74100000000001,169.74100000000001,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J1632",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj., brexanolone, 1 mg","By report","By report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-ONC",2,16]
["J1720",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hydrocortisone sodium succ i",14.743,14.743,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J1738",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj. meloxicam 1 mg","By report","By report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,16]
["J1815",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Insulin injection",0.9,0.9,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J1826",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Interferon beta-1a inj",952.64,952.64,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J1952",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Leuprolide inj, camcevi, 1mg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J1990",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Chlordiazepoxide injection","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J2175",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Meperidine hydrochl /100 mg",6.66,6.66,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J2250",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj midazolam hydrochloride",0.13300000000000001,0.13300000000000001,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J2325",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Nesiritide injection","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J2354",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Octreotide inj, non-depot",0.84599999999999997,0.84599999999999997,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J2440",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Papaverin hcl injection",37.5,37.5,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J2501",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Paricalcitol",0.80200000000000005,0.80200000000000005,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J2590",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Oxytocin injection","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J2690",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Procainamide hcl injection",107.864,107.864,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J2760",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Phentolaine mesylate inj",377.73,377.73,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J2786",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Injection, reslizumab, 1mg",10.231999999999999,10.231999999999999,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J2805",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Sincalide injection","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J2850",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj secretin synthetic human","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J3030",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Sumatriptan succinate / 6 mg",10.4,10.4,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,28,16]
["J3060",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj, taliglucerase alfa 10 u","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J3250",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Trimethobenzamide hcl inj",43.09,43.09,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,28,16]
["J3300",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Triamcinolone a inj prs-free",3.9,3.9,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J3316",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj., triptorelin xr 3.75 mg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J3364",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Urokinase 5000 iu injection","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J3415",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pyridoxine hcl 100 mg",10.127000000000001,10.127000000000001,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J3470",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hyaluronidase injection",55.8,55.8,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J3590",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Unclassified biologics","By report","By report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,16]
["J7040",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Normal saline solution infus",1.278,1.278,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J7179",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Vonvendi inj 1 iu vwf:rco",1.8049999999999999,1.8049999999999999,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J7186",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Antihemophilic viii/vwf comp",1.151,1.151,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J7194",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Factor ix complex",1.532,1.532,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J7201",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Factor ix alprolix recomb",3.1459999999999999,3.1459999999999999,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,16]
["J7295",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Eth estr and eton monthly","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J7300",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Intraut copper contraceptive","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["J7318",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj, durolane 1 mg","By report","By report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,16]
["J7322",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hymovis injection 1 mg",28.53,28.53,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["J7352",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Afamelanotide implant, 1 mg","By report","By report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-ONC",2,16]
["J7504",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lymphocyte immune globulin",2355.9459999999999,2355.9459999999999,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2]
["J7508",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Tacrol astagraf ex rel oral",0.495,0.495,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2]
["J7527",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Oral everolimus",5.6820000000000004,5.6820000000000004,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2]
["J7614",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Levalbuterol non-comp unit",6.4000000000000001E-2,6.4000000000000001E-2,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2]
["J7624",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Betamethasone comp unit","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["J7640",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Formoterol comp unit","By report","By report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["J7643",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Glycopyrrolate comp unit","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["J7674",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Methacholine chloride, neb",0.80700000000000005,0.80700000000000005,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2]
["J7683",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Triamcinolone comp con",0.56000000000000005,0.56000000000000005,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2]
["J7686",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Treprostinil, non-comp unit",704.37800000000004,704.37800000000004,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2]
["J8540",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Oral dexamethasone",6.4000000000000001E-2,6.4000000000000001E-2,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2]
["J8999",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Oral prescription drug chemo","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,"Y-CM",2]
["J9019",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Erwinaze injection",427.26900000000001,427.26900000000001,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2]
["J9040",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Bleomycin sulfate injection",25.981000000000002,25.981000000000002,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2]
["J9043",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cabazitaxel injection","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["J9120",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Dactinomycin injection",809.05600000000004,809.05600000000004,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2]
["J9153",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj daunorubicin, cytarabine","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["J9165",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Diethylstilbestrol injection","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["J9199",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Injection, infugem, 200 mg","By report","By report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-ONC",2]
["J9211",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Idarubicin hcl injection",42.223999999999997,42.223999999999997,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2]
["J9215",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Interferon alfa-n3 inj",8.6,8.6,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2]
["J9247",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj, melphalan flufenami 1mg",514.85580000000004,514.85580000000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["J9266",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pegaspargase injection",21561.046999999999,21561.046999999999,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2]
["J9295",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Injection, necitumumab, 1 mg",5.7370000000000001,5.7370000000000001,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2]
["J9305",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pemetrexed injection",76.384,76.384,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2]
["J9308",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Injection, ramucirumab",63.69,63.69,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2]
["J9330",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Temsirolimus injection",35.347999999999999,35.347999999999999,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2]
["J9359",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj lon tesirin-lpyl 0.075mg",198.31620000000001,198.31620000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["J9390",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Vinorelbine tartrate inj",11.003,11.003,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2]
["K0005","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Ultralightweight wheelchair",232.94480000000001,232.94480000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["K0008","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Cstm manual wheelchair/base","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,9]
["K0014","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Other power whlchr base","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,9]
["K0018","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Detach adjust armrst upper",29.952399999999997,29.952399999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["K0019","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Arm pad repl, each",1.7098,1.7098,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["K0041","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Large size footplate each",5.5208000000000004,5.5208000000000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["K0047","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Elev legrst upr hangr rep ea",7.8589000000000002,7.8589000000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["K0051","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Cam rel asm ft/legrst rep ea",5.5826000000000002,5.5826000000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["K0098","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Drive belt for pwc, repl",28.747299999999999,28.747299999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["K0455","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Pump uninterrupted infusion",3337.6120000000001,3337.6120000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["K0607",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Repl batt for aed","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["K0733","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"12-24hr sealed lead acid",32.805500000000002,32.805500000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["K0739",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Repair/svc dme non-oxygen eq",28.2117,28.2117,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["K0812","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Power operated vehicle noc","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,9]
["K0816","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Pwc gp 1 std cap chair",4373.9980000000005,4373.9980000000005,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["K0823","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Pwc gp 2 std cap chair",491.27910000000003,491.27910000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["K0830","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Pwc gp2 std seat elevate s/b","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,9]
["K0837","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Pwc gp 2 hd sing pow opt s/b",6441.723,6441.723,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["K0843","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Pwc gp2 hd mult pow opt s/b",6836.1100000000006,6836.1100000000006,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["K0850","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Pwc gp 3 hd seat/back",9986.2620000000006,9986.2620000000006,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["K0851","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Pwc gp 3 hd cap chair",960.19690000000003,960.19690000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["K0857","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Pwc gp3 std sing pow opt cap",942.62509999999997,942.62509999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["K0861","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Pwc gp3 std mult pow opt s/b",9255.7860000000001,9255.7860000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["K0868","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Pwc gp 4 std seat/back","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,9]
["K0880","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Pwc gp4 vhd sing pow opt s/b","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,9]
["K0890","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Pwc gp5 ped sing pow opt s/b","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["K1003","RR",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Whirlpool tub walkin portabl","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["K1009","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Speech volume modulation sys","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-PHL",2,9]
["K1014","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Ak 4 bar link hydl swg/stanc","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-PHL",2,9]
["K1026",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Mech allergen parti barrier","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["K1033","U",{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"Y"},"Non pneum seq comp half leg","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,9]
["L0172",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cerv col sr foam 2pc pre ots",166.3698,166.3698,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L0462",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Tlso 3mod sacro-scap pre",1581.4232999999999,1581.4232999999999,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L0472",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Tlso rigid frame hyperex pre",585.63990000000001,585.63990000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L0624",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Sio panel custom","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,9]
["L0630",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lso r post pnl sj-t9 pre cst",205.12710000000001,205.12710000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L0633",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lso sc r pos/lat pnl pre cst",363.20670000000001,363.20670000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L0649",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lso sc r pos/lat pnl pre ots",311.11619999999999,311.11619999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L0830",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Halo cerv into milwaukee typ",4595.5259999999998,4595.5259999999998,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L0982",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Stocking sup grips 4 pre ots",21.020699999999998,21.020699999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L1080",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Outrigger",76.382999999999996,76.382999999999996,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L1210",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lateral thoracic extension",317.48759999999999,317.48759999999999,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L1600",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ho flex frejka w/cov pre cst",156.35759999999999,156.35759999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L1652",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ho bi thighcuffs w sprdr bar",451.48379999999997,451.48379999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L1685",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Post-op hip abduct custom fa",1443.2943,1443.2943,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L1831",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Knee orth pos locking joint",372.77609999999999,372.77609999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L1844",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ko w/adj jt rot cntrl molded",2552.8404,2552.8404,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L1900",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Afo sprng wir drsflx calf bd",360.90660000000003,360.90660000000003,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L1940",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Afo molded to patient plasti",644.63070000000005,644.63070000000005,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L2010",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Kafo sng solid stirrup w/o j",1481.3136,1481.3136,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L2080",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hkafo unilat torsion cable",503.10689999999994,503.10689999999994,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L2116",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Afo tibial fracture rigid",863.7921,863.7921,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L2132",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Kafo femoral fx cast soft",978.80939999999998,978.80939999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L2220",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Dorsi & plantar flex ass/res",117.41579999999999,117.41579999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L2270",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Varus/valgus strap padded/li",86.887199999999993,86.887199999999993,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L2350",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Prosthetic type socket molde",1219.7664,1219.7664,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L2397",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Suspension sleeve lower ext",160.35509999999999,160.35509999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L2540",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Thigh/wght bear lacer molded",647.06610000000001,647.06610000000001,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L2640",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pelvic control band & belt b",494.64449999999994,494.64449999999994,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L2755",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Carbon graphite lamination",165.52109999999999,165.52109999999999,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L2780",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Non-corrosive finish",109.49459999999999,109.49459999999999,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L3001",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Foot insert remov molded spe",167.52599999999998,167.52599999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3040",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ft arch suprt premold longit",59.593500000000006,59.593500000000006,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3160",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Shoe styled positioning dev",137.17439999999999,137.17439999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3209",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Surgical boot each child","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,9]
["L3225",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Man's shoe oxford brace",82.0779,82.0779,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3310",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Shoe lift elev heel/sole neo",103.09859999999999,103.09859999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3350",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Shoe heel wedge",29.015699999999999,29.015699999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3380",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Shoe clubfoot wedge",62.779199999999996,62.779199999999996,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3520",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"O shoe add felt w leath insl",40.2333,40.2333,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3550",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"O shoe add standard toe tap",11.2422,11.2422,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3630",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Trans shoe solid stirrup new",127.25579999999999,127.25579999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3677",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"So hard plas stabili pre cst",164.60400000000001,164.60400000000001,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L3765",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ewhfo rigid w/o jnts cf",1478.0295000000001,1478.0295000000001,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L3908",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Who cock-up nonmolde pre ots",94.845299999999995,94.845299999999995,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3918",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Metacarp fx orthosis pre ots",121.81920000000001,121.81920000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3923",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hfo without joints pre cst",113.5167,113.5167,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3975",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Sewhfo cap design w/o jnt cf",1936.6472999999999,1936.6472999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L3978",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Sewhfo airplane w/jnt(s) cf",2286.5331000000001,2286.5331000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L4010",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Replace trilateral socket br",971.14649999999995,971.14649999999995,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L4080",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Repl met band kafo-afo prox",145.33679999999998,145.33679999999998,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L4387",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Non-pneum walk boot pre ots",200.79749999999999,200.79749999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L5000",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Sho insert w arch toe filler",679.69280000000003,679.69280000000003,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5220",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"No knee joint with artic ali",4947.3663999999999,4947.3663999999999,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5270",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Tilt table locking hip sing",9224.9856,9224.9856,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5520",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Perp bk ptb thermopls direct",1934.528,1934.528,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5540",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Prep bk ptb laminated socket",2976.4223999999999,2976.4223999999999,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5611",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ak 4 bar link w/fric swing",2373.3888000000002,2373.3888000000002,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5626",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Test socket hip disarticulat",735.62880000000007,735.62880000000007,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5642",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Above knee leather socket",1111.296,1111.296,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5649",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Isch containmt/narrow m-l so",2707.3791999999999,2707.3791999999999,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5666",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Below knee cuff suspension",95.552000000000007,95.552000000000007,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5671",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Bk/ak locking mechanism",892.19839999999999,892.19839999999999,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L5692",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ak pelvic control belt light",209.792,209.792,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5696",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ak/knee disartic pelvic join",331.86559999999997,331.86559999999997,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5705",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Custom shape cover ak",1346.7520000000002,1346.7520000000002,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L5722",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Knee-shin pneum swg frct exo",1426.8928000000001,1426.8928000000001,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5812",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Endo knee-shin frct swg & st",849.10080000000005,849.10080000000005,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5828",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Endo knee-shin fluid swg/sta",3798.8864000000003,3798.8864000000003,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5910",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Endo below knee alignable sy",487.2192,487.2192,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5930",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"High activity knee frame",4445.1328000000003,4445.1328000000003,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L5976",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Energy storing foot",842.17600000000004,842.17600000000004,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5980",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Flex foot system",5453.6448,5453.6448,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L5999",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lowr extremity prosthes nos","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N","Y","Y-CM",2,9]
["L6120",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Elbow mold doub splt soc ste",4034.7647999999999,4034.7647999999999,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L6382",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Postop dsg cast chg elb dis/",2165.5935999999997,2165.5935999999997,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L6550",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Shldr disar prosth tiss shap",6396.8128000000006,6396.8128000000006,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L6611",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Additional switch, ext power",543.7568,543.7568,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L6620",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Flexion/extension wrist unit",450.30400000000003,450.30400000000003,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L6646",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Multipo locking shoulder jnt",4165.2479999999996,4165.2479999999996,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L6650",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Shoulder universal joint",459.94239999999996,459.94239999999996,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L6680",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Test sock wrist disart/bel e",320.01279999999997,320.01279999999997,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L6692",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Silicone gel insert or equal",752.2944,752.2944,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,9]
["L6709",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Term dev mech hand vol close",1893.0432000000001,1893.0432000000001,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L6722",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hook/hand, hvy dty, vol clos",2677.6576,2677.6576,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,23]
["L6900",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hand restorat thumb/1 finger",2612.1088,2612.1088,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,23]
["L6935",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Below elbow myoelectronic ct",12003.251200000001,12003.251200000001,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,23]
["L7040",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Prehensile actuator",4051.9168,4051.9168,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,16]
["L7180",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Electronic elbow sequential",49286.720000000001,49286.720000000001,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,16]
["L7364",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Twelve volt battery utah/equ",701.00479999999993,701.00479999999993,"000",0,0,0,9,9,9,9,9,9,null,"F","Y","Y-CM",2,16]
["L7405",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Add ue prost s/d acrylic",960,960,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,16]
["L8015",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ext breastprosthesis garment",82.214400000000012,82.214400000000012,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,23]
["L8039",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Breast prosthesis nos","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,16]
["L8300",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Truss single w/ standard pad",140.97919999999999,140.97919999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,24]
["L8417",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pros sheath/sock w gel cushn",99.327999999999989,99.327999999999989,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L8501",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Tracheostomy speaking valve",162.50880000000001,162.50880000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L8509",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Trach-esoph voice pros md in",144.2176,144.2176,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,9]
["L8604",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Dextranomer/hyaluronic acid","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,9]
["L8614",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cochlear device",25271.603199999998,25271.603199999998,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,9]
["L8628",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cid ext controller repl",1697.1392000000001,1697.1392000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,9]
["L8659",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Interphalangeal joint repl",2548.3904000000002,2548.3904000000002,"000",0,0,0,9,9,9,9,9,9,null,"F","Y",null,2,16]
["L8688",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Implt nrostm pls gen dua non",56826.563199999997,56826.563199999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,28]
["L8695",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"External recharg sys extern",21.977600000000002,21.977600000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,28]
["M0223",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Bebteleovimab injection home","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,28]
["M0243",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"CASIRIVI AND IMDEVI INFUSION",463.5,463.5,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,28]
["M0301",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Fabric wrapping of aneurysm","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,28]
["M1011",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Dc eoc doc med rec","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,28]
["M1019",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Adl pt mj dep ds rs 12 phq<5","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,28]
["M1039",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt dx lum sp reg inf","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["M1056",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Presc antico med in pp","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["M1069",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt scr ft fall rsk","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["M1115",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Oc ni pt selfdc 1-2 vis","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["M1118",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Oc ni pt 1-2 vis","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["M1127",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Docu dx degen neuro","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["M1141",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Fs no oks","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["M1149",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"No neck fs prom incap","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["P9016",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Rbc leukocytes reduced","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["P9033",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Platelets leukoreduced irrad","By report","By report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["P9040",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Rbc leukoreduced irradiated","By report","By report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["P9054",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Blood, l/r, froz/degly/wash","By report","By report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["P9057",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Rbc, frz/deg/wsh, l/r, irrad","By report","By report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["P9603",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"One-way allow prorated miles",1.1357826480000002,1.1357826480000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["Q0084",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Chemotherapy by infusion","Facility Only",0,"000",0,0,0,9,9,9,9,9,9,null,"O",null,null,2,11]
["Q0114",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Fern test",13.9282,13.9282,"000",0,0,0,9,9,9,9,9,9,null,"L",null,null,2,16]
["Q0173",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Trimethobenzamide hcl 250mg",1.08,1.08,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2]
["Q0245",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Bamlanivimab and etesevima","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,26]
["Q0480",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Driver pneumatic vad, rep","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,26]
["Q0492",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Emr pwr cbl elec vad, rep","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,28]
["Q0499",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Belt/vest elec/combo vad rep","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,30]
["Q0504",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pwr adpt pneum vad, rep veh","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,30]
["Q0514",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Disp fee inhal drugs/90 days","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["Q2028",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj, sculptra, 0.5mg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["Q2054",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lisocabtagene mara car pos t","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,24]
["Q4005",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cast sup long arm adult plst",14.605399999999999,14.605399999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,24]
["Q4012",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cast sup sht arm ped fbrglas","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,24]
["Q4024",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cast sup sht arm splnt ped f","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,24]
["Q4031",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cast sup lng leg ped plaster","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,24]
["Q4036",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cast sup lngleg cylndr ped f","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4045",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cast sup sht leg splnt plstr",13.081,13.081,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["Q4074",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Iloprost non-comp unit dose","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4110",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Primatrix",40.328000000000003,40.328000000000003,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2]
["Q4123",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Alloskin","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4132",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Grafix core, grafixpl core","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4145",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Epifix, inj, 1mg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4152",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Dermapure 1 square cm","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4157",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Revitalon 1 square cm","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,29]
["Q4166",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cytal, per square centimeter","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4174",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Palingen or promatrx","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4205",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Membrane graft or wrap sq cm","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4217",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Woundfix biowound plus xplus","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4225",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Amniobind, per sq cm","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4239",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Amnio-maxx or lite per sq cm","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4247",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Amniotext patch, per sq cm","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q4252",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Vendaje, per square centimet","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["Q5003",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hospice in lt/non-skilled nf","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,36]
["Q5010",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hospice home care in hospice","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,36]
["Q5119",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj ruxience, 10 mg",49.816000000000003,49.816000000000003,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-ONC",2,16]
["Q9951",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Locm >= 400 mg/ml iodine,1ml","By report","By report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["Q9959",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hocm 150-199mg/ml iodine,1ml","By report","By report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["Q9992",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Buprenorphine xr over 100 mg",1781.309,1781.309,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2]
["R0075",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Transport port x-ray multipl",32.2778611584,32.2778611584,"000",0,0,0,3,0,0,0,0,0,null,"F",null,null,2]
["R0320",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Retraining examination and license fees","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2,30]
["S0020",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Injection, bupivicaine hydro",0.05,0.05,"000",0,0,0,9,9,9,9,9,9,null,"D",null,null,2,16]
["S0028",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Injection, famotidine, 20 mg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,16]
["S0088",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Imatinib 100 mg",3.14,3.14,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2]
["S0122",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Inj menotropins 75 iu","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S0139",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Minoxidil, 10 mg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S0170",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Anastrozole 1 mg",0.13,0.13,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2]
["S0178",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lomustine 10 mg","By report","By report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,28]
["S0189",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Testosterone pellet 75 mg",108.18,108.18,"000",0,0,0,9,9,9,9,9,9,null,"D",null,"Y-CM",2,28]
["S0250",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Comp geriatr assmt team","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S0260",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"H&p for surgery","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S0316",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Follow-up/reassessment","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S0500",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Dispos cont lens","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,11]
["S0515",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Scleral lens liquid bandage","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S0595",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"New lenses in pts old frame","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S0810",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Photorefractive keratectomy","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S1016",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Non-pvc intravenous administ","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S2061",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Donor lobectomy (lung)","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S2067",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Breast \"stacked\" diep/gap","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S2117",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Arthroereisis, subtalar","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S2208",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Minimally invasive direct co","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S2266",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Induced abortion 29-31 wks","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S2348",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Decompress disc rf lumbar","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S3000",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Bilat dil retinal exam","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S3630",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Eosinophil blood count","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S3846",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Gene test beta-thalassemia","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S3852",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Dna analysis apoe alzheimer","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S4014",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Compl zift case rate","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S4027",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Store prev froz embryos","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S4042",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ovulation mgmt per cycle","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S5000",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Prescription drug, generic","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S5108",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Homecare train pt 15 min","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S5116",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Nonfamily hc train/session","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S5150",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Unskilled respite care /15m","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S5161",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Emer rspns sys serv permonth","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["S5520",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit picc insert kit","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S5553",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Insulin long acting 5 u","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,28]
["S8030",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Tantalum ring application","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S8080",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Scintimammography","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,28]
["S8185",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Flutter device","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
["S8265",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Haberman feeder","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,23]
["S8270",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Enuresis alarm","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,30]
["S8301",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Infect control supplies nos","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,30]
["S8415",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Supplies for home delivery","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S8420",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Custom gradient sleev/glov","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["S8421",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ready gradient sleev/glov","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["S8422",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Custom grad sleeve med","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["S8423",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Custom grad sleeve heavy","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["S8424",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ready gradient sleeve","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["S8425",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Custom grad glove med","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["S8426",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Custom grad glove heavy","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["S8427",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ready gradient glove","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["S8428",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ready gradient gauntlet","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["S8429",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Gradient pressure wrap","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["S8430",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Padding for comprssn bdg","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["S8431",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Compression bandage","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["S8450",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Splint digit","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S8451",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Splint wrist or ankle","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S8452",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Splint elbow","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S8460",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Camisole post-mast","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S8490",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"100 insulin syringes","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S8930",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Auricular electrostimulation","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S8940",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hippotherapy per session","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S8948",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Low-level laser trmt 15 min","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S8950",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Complex lymphedema therapy,","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S8990",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt or manip for maint","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S8999",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Resuscitation bag","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9001",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Home uterine monitor with or","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9007",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ultrafiltration monitor","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9024",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Paranasal sinus ultrasound","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9025",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Omnicardiogram/cardiointegra","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9034",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Eswl for gallstones","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9055",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Procuren or other growth fac","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9056",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Coma stimulation per diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9061",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Medical supplies and equipme","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9083",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Urgent care center global","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9088",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Services provided in urgent","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9090",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Vertebral axial decompressio","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9097",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Home visit wound care","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9098",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Home phototherapy visit","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9110",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Telemonitoring/home per mnth","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9117",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Back school visit","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9122",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Home health aide or certifie",33.051876,33.051876,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-ONC",2]
["S9123",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Nursing care in home rn",66.459510374399997,66.459510374399997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-ONC",2]
["S9124",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Nursing care, in the home; b",48.005746588800001,48.005746588800001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-ONC",2]
["S9125",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Respite care, in the home, p","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9126",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hospice care, in the home, p","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9127",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Social work visit, in the ho","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9128",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Speech therapy, in the home,","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9129",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Occupational therapy, in the","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9131",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt in the home per diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9140",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Diabetic management program,","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9141",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Diabetic management program,","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9145",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Insulin pump initiation","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9150",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Evaluation by ocularist","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9152",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Speech therapy, re-eval","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9208",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Home mgmt preterm labor","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9209",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Home mgmt pprom","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9211",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Home mgmt gest hypertension","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9212",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hm postpar hyper per diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9213",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hm preeclamp per diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9214",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hm gest dm per diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9325",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit pain mgmt per diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9326",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit cont pain per diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9327",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit int pain per diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9328",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit pain imp pump diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9329",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit chemo per diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9330",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit cont chem diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9331",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit intermit chemo diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9335",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ht hemodialysis diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9336",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit cont anticoag diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9338",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit immunotherapy diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9339",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit periton dialysis diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9340",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit enteral per diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9341",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit enteral grav diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9342",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit enteral pump diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9343",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit enteral bolus nurs","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9345",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit anti-hemophil diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9346",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit alpha-1-proteinas diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9347",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit longterm infusion diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9348",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit sympathomim diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9349",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit tocolysis diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9351",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit cont antiemetic diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9353",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit cont insulin diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9355",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit chelation diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9357",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit enzyme replace diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9359",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit anti-tnf per diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9361",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit diuretic infus diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9363",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit anti-spasmotic diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9364",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit tpn total diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9365",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit tpn 1 liter diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9366",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit tpn 2 liter diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9367",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit tpn 3 liter diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9368",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit tpn over 3l diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9370",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ht inj antiemetic diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9372",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ht inj anticoag diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9373",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit hydra total diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9374",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit hydra 1 liter diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9375",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit hydra 2 liter diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9376",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit hydra 3 liter diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9377",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit hydra over 3l diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9379",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit noc per diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9381",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit high risk/escort","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9401",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Anticoag clinic per session","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9430",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pharmacy comp/disp serv","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9432",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Med food non inborn err meta","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9433",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Medical food oral 100% nutr","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9434",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Mod solid food suppl","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9435",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Medical foods for inborn err","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9436",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lamaze class","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9437",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Childbirth refresher class","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9438",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cesarean birth class","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9439",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Vbac class","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9441",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Asthma education","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9442",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Birthing class","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9443",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lactation class","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9444",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Parenting class","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9445",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt education noc individ",44.652483532799998,44.652483532799998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["S9446",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pt education noc group","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9447",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Infant safety class","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9449",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Weight mgmt class","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9451",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Exercise class","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9452",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Nutrition class","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9453",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Smoking cessation class","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9454",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Stress mgmt class","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9455",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Diabetic management program,","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9460",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Diabetic management program,","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,28,28]
["S9465",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Diabetic management program,","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,28,28]
["S9470",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Nutritional counseling, diet","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9472",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cardiac rehabilitation progr","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,28,28]
["S9473",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pulmonary rehabilitation pro","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9474",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Enterostomal therapy by a re","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9475",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ambulatory setting substance","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9476",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Vestibular rehab per diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9480",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Intensive outpatient psychia","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["S9482",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Family stabilization 15 min","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9484",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Crisis intervention per hour","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9485",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Crisis intervention mental h","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9490",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit corticosteroid/diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9494",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit antibiotic total diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9497",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit antibiotic q3h diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9500",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit antibiotic q24h diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9501",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit antibiotic q12h diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9502",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit antibiotic q8h diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9503",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit antibiotic q6h diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9504",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit antibiotic q4h diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9529",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Venipuncture home/snf","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9537",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ht hem horm inj diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9538",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit blood products diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9542",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ht inj noc per diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9558",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ht inj growth horm diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9559",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hit inj interferon diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9560",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ht inj hormone diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9562",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ht inj palivizumab diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9590",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ht irrigation diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9810",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ht pharm per hour","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9900",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Christian sci pract visit","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9901",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Christian sci nurse visit","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9960",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Air ambulanc nonemerg fixed","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9961",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Air ambulan nonemerg rotary","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9970",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Health club membership yr","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9975",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Transplant related per diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9976",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lodging per diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9977",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Meals per diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9981",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Med record copy admin",28.913781124800003,28.913781124800003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["S9982",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Med record copy per page",0.57329981280000009,0.57329981280000009,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["S9986",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Not medically necessary svc","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9988",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Serv part of phase i trial","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9989",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Services outside us","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9990",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Services provided as part of","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9991",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Services provided as part of","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9992",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Transportation costs to and","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9994",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lodging costs (e.g. hotel ch","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9996",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Meals for clinical trial par","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["S9999",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Sales tax","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1000",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Private duty/independent nsg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1001",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Nursing assessment/evaluatn","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1002",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Rn services up to 15 minutes","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1003",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lpn/lvn services up to 15min","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1004",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Nsg aide service up to 15min","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1005",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Respite care service 15 min","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1006",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Family/couple counseling","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1007",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Treatment plan development","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1009",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Child sitting services","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1010",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Meals when receive services","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1012",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Alcohol/substance abuse skil","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1013",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Sign lang/oral interpreter","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1014",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Telehealth transmit, per min","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1015",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Clinic service","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["T1016",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Case management","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1017",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Targeted case management","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1018",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"School-based iep ser bundled","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1019",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Personal care ser per 15 min","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1020",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Personal care ser per diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1021",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hh aide or cn aide per visit","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1022",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Contracted services per day","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1023",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Program intake assessment","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1024",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Team evaluation & management","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1025",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ped compr care pkg, per diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1026",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ped compr care pkg, per hour","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1027",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Family training & counseling","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1028",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Home environment assessment","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1029",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Dwelling lead investigation","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1030",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Rn home care per diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1031",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lpn home care per diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1040",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Comm bh clinic svc per diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1041",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Comm bh clinic svc per month","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1502",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Medication admin visit","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1503",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Med admin, not oral/inject","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1505",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Elec med comp dev, noc","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T1999",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Noc retail items andsupplies","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2001",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"N-et; patient attend/escort","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2002",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"N-et; per diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2003",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"N-et; encounter/trip","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2004",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"N-et; commerc carrier pass","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2005",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"N-et; stretcher van","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2007",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Non-emer transport wait time","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2010",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pasrr level i","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2011",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Pasrr level ii","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2012",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Habil ed waiver, per diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2013",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Habil ed waiver per hour","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2014",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Habil prevoc waiver, per d","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2015",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Habil prevoc waiver per hr","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2016",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Habil res waiver per diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2017",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Habil res waiver 15 min","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2018",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Habil sup empl waiver/diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2019",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Habil sup empl waiver 15min","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2020",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Day habil waiver per diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2021",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Day habil waiver per 15 min","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2022",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Case management, per month","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2023",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Targeted case mgmt per month","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2024",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Serv asmnt/care plan waiver","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2025",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Waiver service, nos","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2026",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Special childcare waiver/d","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2027",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Spec childcare waiver 15 min","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2028",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Special supply, nos waiver","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2029",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Special med equip, noswaiver","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2030",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Assist living waiver/month","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2031",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Assist living waiver/diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2032",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Res care, nos waiver/month","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2033",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Res, nos waiver per diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2034",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Crisis interven waiver/diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2035",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Utility services waiver","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2036",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Camp overnite waiver/session","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2037",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Camp day waiver/session","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2038",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Comm trans waiver/service","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2039",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Vehicle mod waiver/service","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2040",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Financial mgt waiver/15min","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2041",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Support broker waiver/15 min","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2042",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hospice routine home care","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2043",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hospice continuous home care","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2044",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hospice respite care","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2045",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hospice general care","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2046",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hospice long term care, r&b","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2047",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hab prevo waiver per 15","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2048",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Bh ltc res r&b, per diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2049",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"N-et; stretcher van, mileage","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2050",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Financial mgt waiver/diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2051",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Support broker waiver/diem","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T2101",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Breast milk proc/store/dist","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T4521",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Adult size brief/diaper sm","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2]
["T4522",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Adult size brief/diaper med","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2]
["T4523",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Adult size brief/diaper lg","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2]
["T4524",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Adult size brief/diaper xl","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2]
["T4525",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Adult size pull-on sm","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2]
["T4526",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Adult size pull-on med","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2]
["T4527",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Adult size pull-on lg","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2]
["T4528",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Adult size pull-on xl","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2]
["T4529",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ped size brief/diaper sm/med","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T4530",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ped size brief/diaper lg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T4531",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ped size pull-on sm/med","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T4532",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ped size pull-on lg","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T4533",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Youth size brief/diaper","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2]
["T4534",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Youth size pull-on","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2]
["T4535",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Disposable liner/shield/pad","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2]
["T4536",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Reusable pull-on any size","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2]
["T4537",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Reusable underpad bed size","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2]
["T4538",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Diaper serv reusable diaper","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T4539",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Reuse diaper/brief any size","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2]
["T4540",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Reusable underpad chair size","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2]
["T4541",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Large disposable underpad","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2]
["T4542",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Small disposable underpad","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2]
["T4543",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Adult disp brief/diap abv xl","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T4544",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Adlt disp und/pull on abv xl","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2]
["T4545",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Incon disposable penile wrap","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2]
["T5001",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Position seat spec orth need","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["T5999",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Supply, nos","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["U0001",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"2019-ncov diagnostic p",51.365600000000001,51.365600000000001,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
["U0002",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Covid-19 lab test non-cdc",73.3733,73.3733,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
["U0003",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"SARS-COV-2 DNA/RNA HIGH THROUGHPUT",107.25,107.25,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
["U0004",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"2019-NCOV ANY TECHNIQUE HIGH THROUGHPUT",107.25,107.25,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
["U0005",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Infec agen detec ampli probe",35.75,35.75,"000",0,0,0,9,9,9,9,9,9,null,"L",null,"Y-CM",2,23]
["V0028",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Travel, vocational services, claimant","State Rate","State Rate","000",0,0,0,9,9,9,9,9,9,null,"S",null,null,2,30]
["V2020",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Vision svcs frames purchases",76.755600000000001,76.755600000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2025",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Eyeglasses delux frames","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2100",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens spher single plano 4.00",48.482100000000003,48.482100000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2101",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Single visn sphere 4.12-7.00",49.862299999999998,49.862299999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2102",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Singl visn sphere 7.12-20.00",62.850600000000007,62.850600000000007,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2103",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Spherocylindr 4.00d/12-2.00d",46.051300000000005,46.051300000000005,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2104",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Spherocylindr 4.00d/2.12-4d",47.400600000000004,47.400600000000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2105",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Spherocylinder 4.00d/4.25-6d",53.467299999999994,53.467299999999994,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2106",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Spherocylinder 4.00d/>6.00d",57.360700000000001,57.360700000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2107",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Spherocylinder 4.25d/12-2d",49.718100000000007,49.718100000000007,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2108",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Spherocylinder 4.25d/2.12-4d",48.513000000000005,48.513000000000005,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2109",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Spherocylinder 4.25d/4.25-6d",59.554600000000001,59.554600000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2110",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Spherocylinder 4.25d/over 6d",52.962600000000002,52.962600000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2111",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Spherocylindr 7.25d/.25-2.25",55.208000000000006,55.208000000000006,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2112",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Spherocylindr 7.25d/2.25-4d",61.161400000000008,61.161400000000008,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2113",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Spherocylindr 7.25d/4.25-6d",72.244200000000006,72.244200000000006,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2114",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Spherocylinder over 12.00d",78.712600000000009,78.712600000000009,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2115",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens lenticular bifocal",95.058700000000016,95.058700000000016,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2118",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens aniseikonic single",89.712999999999994,89.712999999999994,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2121",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lenticular lens, single",100.4147,100.4147,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2199",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens single vision not oth c","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2200",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens spher bifoc plano 4.00d",68.989400000000003,68.989400000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2201",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphere bifocal 4.12-7.0",69.267499999999998,69.267499999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2202",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphere bifocal 7.12-20.",76.178799999999995,76.178799999999995,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2203",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphcyl bifocal 4.00d/.1",67.691599999999994,67.691599999999994,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2204",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphcy bifocal 4.00d/2.1",68.021200000000007,68.021200000000007,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2205",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphcy bifocal 4.00d/4.2",70.390200000000007,70.390200000000007,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2206",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphcy bifocal 4.00d/ove",70.946399999999997,70.946399999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2207",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphcy bifocal 4.25-7d/.",66.167199999999994,66.167199999999994,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2208",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphcy bifocal 4.25-7/2.",64.920900000000003,64.920900000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2209",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphcy bifocal 4.25-7/4.",74.932500000000005,74.932500000000005,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2210",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphcy bifocal 4.25-7/ov",84.975000000000009,84.975000000000009,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2211",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphcy bifo 7.25-12/.25-",92.782399999999996,92.782399999999996,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2212",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphcyl bifo 7.25-12/2.2",93.482800000000012,93.482800000000012,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2213",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphcyl bifo 7.25-12/4.2",90.032299999999992,90.032299999999992,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2214",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphcyl bifocal over 12.",94.523099999999999,94.523099999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2215",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens lenticular bifocal",113.5472,113.5472,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2218",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens aniseikonic bifocal",118.86200000000001,118.86200000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2219",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens bifocal seg width over",48.1937,48.1937,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2220",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens bifocal add over 3.25d",39.088500000000003,39.088500000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2221",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lenticular lens, bifocal",104.854,104.854,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2299",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens bifocal speciality","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2300",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphere trifocal 4.00d",81.720200000000006,81.720200000000006,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2301",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphere trifocal 4.12-7.",85.871100000000013,85.871100000000013,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2302",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphere trifocal 7.12-20",88.775700000000001,88.775700000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2303",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphcy trifocal 4.0/.12-",81.205200000000005,81.205200000000005,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2304",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphcy trifocal 4.0/2.25",75.0458,75.0458,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2305",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphcy trifocal 4.0/4.25",84.573300000000003,84.573300000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2306",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphcyl trifocal 4.00/>6",86.787800000000004,86.787800000000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2307",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphcy trifocal 4.25-7/.",88.250400000000013,88.250400000000013,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2308",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphc trifocal 4.25-7/2.",97.860300000000009,97.860300000000009,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2309",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphc trifocal 4.25-7/4.",101.1769,101.1769,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2310",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphc trifocal 4.25-7/>6",96.614000000000004,96.614000000000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2311",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphc trifo 7.25-12/.25-",96.449200000000005,96.449200000000005,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2312",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphc trifo 7.25-12/2.25",99.322900000000004,99.322900000000004,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2313",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphc trifo 7.25-12/4.25",111.40479999999999,111.40479999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2314",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens sphcyl trifocal over 12",116.3488,116.3488,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2315",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens lenticular trifocal",131.69579999999999,131.69579999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2318",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens aniseikonic trifocal",158.78479999999999,158.78479999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2319",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens trifocal seg width > 28",53.755699999999997,53.755699999999997,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2320",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens trifocal add over 3.25d",64.179299999999998,64.179299999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2321",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lenticular lens, trifocal",127.31830000000001,127.31830000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2399",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens trifocal speciality","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2410",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens variab asphericity sing",114.845,114.845,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2430",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens variable asphericity bi",119.92290000000001,119.92290000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2499",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Variable asphericity lens","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2500",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Contact lens pmma spherical",117.30670000000001,117.30670000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2501",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cntct lens pmma-toric/prism",134.02360000000002,134.02360000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2502",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Contact lens pmma bifocal",165.10900000000001,165.10900000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2503",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cntct lens pmma color vision",162.20439999999999,162.20439999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2510",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cntct gas permeable sphericl",150.36970000000002,150.36970000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2511",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cntct toric prism ballast",172.57650000000001,172.57650000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2512",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cntct lens gas permbl bifocl",203.9194,203.9194,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2513",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Contact lens extended wear",186.93470000000002,186.93470000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2520",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Contact lens hydrophilic",126.60760000000001,126.60760000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2521",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cntct lens hydrophilic toric",196.55490000000003,196.55490000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2522",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cntct lens hydrophil bifocl",191.28130000000002,191.28130000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2523",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cntct lens hydrophil extend",166.45830000000001,166.45830000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2524",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cntct lens hydrophil photoch","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2525",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Cl, hydrophilic, dual focus","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["V2530",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Contact lens gas impermeable",241.43200000000002,241.43200000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2531",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Contact lens gas permeable",575.40949999999998,575.40949999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2]
["V2599",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Contact lens/es other type","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2600",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hand held low vision aids","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V2610",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Single lens spectacle mount","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V2615",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Telescop/othr compound lens","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V2623",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Plastic eye prosth custom",1164.6313,1164.6313,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2624",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Polishing artifical eye",87.86930000000001,87.86930000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2625",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Enlargemnt of eye prosthesis",534.20949999999993,534.20949999999993,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2626",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Reduction of eye prosthesis",287.9674,287.9674,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2627",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Scleral cover shell",1859.7885999999999,1859.7885999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2628",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Fabrication & fitting",439.1302,439.1302,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2629",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Prosthetic eye other type","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V2630",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Anter chamber intraocul lens",128.85300000000001,128.85300000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2631",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Iris support intraoclr lens",128.85300000000001,128.85300000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2632",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Post chmbr intraocular lens",128.85300000000001,128.85300000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2700",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Balance lens",47.421199999999999,47.421199999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2702",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Deluxe lens feature","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V2710",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Glass/plastic slab off prism",69.411699999999996,69.411699999999996,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2715",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Prism lens/es",15.470599999999999,15.470599999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2718",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Fresnell prism press-on lens",30.910300000000003,30.910300000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2730",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Special base curve",22.8248,22.8248,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2744",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Tint photochromatic lens/es",19.662700000000001,19.662700000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2745",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Tint, any color/solid/grad",13.2973,13.2973,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2750",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Anti-reflective coating",20.661799999999999,20.661799999999999,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2755",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Uv lens/es",19.250700000000002,19.250700000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2756",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Eye glass case","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V2760",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Scratch resistant coating",17.334899999999998,17.334899999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2761",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Mirror coating","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V2762",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Polarization, any lens",63.334700000000005,63.334700000000005,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2770",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Occluder lens/es",21.321000000000002,21.321000000000002,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2780",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Oversize lens/es",13.565100000000001,13.565100000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2781",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Progressive lens per lens","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V2782",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens, 1.54-1.65 p/1.60-1.79g",68.412599999999998,68.412599999999998,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2783",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens, >= 1.66 p/>=1.80 g",77.116100000000003,77.116100000000003,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2784",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Lens polycarb or equal",50.150700000000001,50.150700000000001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2]
["V2785",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Corneal tissue processing","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V2786",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Occupational multifocal lens","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V2787",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Astigmatism-correct function","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V2788",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Presbyopia-correct function","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["V2790",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Amniotic membrane","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V2797",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Vis item/svc in other code","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V2799",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Misc vision item or service","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V5008",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hearing screening",89.919316226694221,89.919316226694221,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,5]
["V5010",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Assessment for hearing aid","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2,5]
["V5011",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hearing aid fitting/checking","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2,5]
["V5014",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hearing aid repair/modifying",59.949888950746086,59.949888950746086,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-PHL",2,5]
["V5020",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Conformity evaluation","Bundled","Bundled","000",0,0,0,9,9,9,9,9,9,null,"Bundled",null,null,2,5]
["V5030",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Body-worn hearing aid air","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,5]
["V5040",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Body-worn hearing aid bone","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,5]
["V5050",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hearing aid monaural in ear","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,5]
["V5060",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Behind ear hearing aid","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,5]
["V5070",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Glasses air conduction","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V5080",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Glasses bone conduction","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V5090",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hearing aid dispensing fee","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,5]
["V5095",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Implant mid ear hearing pros","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,5]
["V5100",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Body-worn bilat hearing aid","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,5]
["V5110",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hearing aid dispensing fee","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,5]
["V5120",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Body-worn binaur hearing aid","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,5]
["V5130",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"In ear binaural hearing aid","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,5]
["V5140",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Behind ear binaur hearing ai","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,5]
["V5150",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Glasses binaural hearing aid","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V5160",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Dispensing fee binaural",1702.5415361248697,1702.5415361248697,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,5]
["V5171",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hearing aid monaural ite","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,5]
["V5172",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hearing aid monaural itc","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,5]
["V5181",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hearing aid monaural bte","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,5]
["V5190",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hearing aid monaural glasses","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,5]
["V5200",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Disp fee contralateral monau",1020.4612056258048,1020.4612056258048,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,5]
["V5211",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hearing aid binaural ite/ite","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,5]
["V5212",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hearing aid binaural ite/itc","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,5]
["V5213",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hearing aid binaural ite/bte","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,5]
["V5214",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hearing aid binaural itc/itc","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,5]
["V5215",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hearing aid binaural itc/bte","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,5]
["V5221",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hearing aid binaural bte/bte","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,5]
["V5230",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hearing aid binaural glasses","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2]
["V5240",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Disp fee contralateral binau",1020.4612056258048,1020.4612056258048,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,5]
["V5241",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Dispensing fee, monaural",851.27076806243485,851.27076806243485,"000",0,0,0,9,9,9,9,9,9,null,"F",null,"Y-CM",2,5]
["V5242",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hearing aid, monaural, cic","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,5]
["V5243",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hearing aid, monaural, itc","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,5]
["V5244",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hearing aid, prog, mon, cic","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,5]
["V5245",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hearing aid, prog, mon, itc","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,5]
["V5246",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hearing aid, prog, mon, ite","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,5]
["V5247",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hearing aid, prog, mon, bte","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,5]
["V5248",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hearing aid, binaural, cic","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,5]
["V5249",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hearing aid, binaural, itc","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,5]
["V5250",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hearing aid, prog, bin, cic","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,5]
["V5251",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hearing aid, prog, bin, itc","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,5]
["V5252",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hearing aid, prog, bin, ite","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,5]
["V5253",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hearing aid, prog, bin, bte","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,5]
["V5254",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hearing id, digit, mon, cic","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,5]
["V5255",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hearing aid, digit, mon, itc","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,5]
["V5256",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hearing aid, digit, mon, ite","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,5]
["V5257",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hearing aid, digit, mon, bte","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,5]
["V5258",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hearing aid, digit, bin, cic","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,5]
["V5259",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hearing aid, digit, bin, itc","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,5]
["V5260",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hearing aid, digit, bin, ite","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,5]
["V5261",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hearing aid, digit, bin, bte","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-CM",2,5]
["V5262",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hearing aid, disp, monaural","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,5]
["V5263",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hearing aid, disp, binaural","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,5]
["V5264",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ear mold/insert","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-PHL",2,5]
["V5265",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ear mold/insert, disp","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,5]
["V5266",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Battery for hearing device",1.0482678907272001,1.0482678907272001,"000",0,0,0,9,9,9,9,9,9,null,"F",null,null,2,5]
["V5267",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hearing aid sup/access/dev","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,"Y-PHL",2,5]
["V5268",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ald telephone amplifier","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["V5269",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Alerting device, any type","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["V5270",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ald, tv amplifier, any type","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["V5271",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ald, tv caption decoder","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["V5272",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Tdd","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["V5273",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ald for cochlear implant","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["V5274",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ald unspecified","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["V5275",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ear impression","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,5]
["V5281",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ald fm/dm system, monaural","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["V5282",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ald fm/dm system binaural","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["V5283",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ald neck, loop ind receiver","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["V5284",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ald fm/dm ear level receiver","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["V5285",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ald fm/dm aud input receiver","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["V5286",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ald blu tooth fm/dm receiver","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["V5287",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ald fm/dm receiver, nos","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["V5288",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ald fm/dm transmitter ald","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["V5289",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ald fm/dm adapt/boot couplin","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["V5290",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Ald transmitter microphone","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2]
["V5298",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hearing aid noc","Not Covered","Not Covered","000",0,0,0,9,9,9,9,9,9,null,"X",null,null,2,5]
["V5299",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Hearing service","Not Covered","Not Covered","000",0,0,0,0,0,0,0,0,0,null,"X",null,null,2,5]
["V5336",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Repair communication device","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V5362",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Speech screening","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V5363",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Language screening","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]
["V5364",null,{"$f":"IF(Table1[[#This Row],[Modifiers]]<>\"\",\"Y\",\"N\")","v":"N"},"Dysphagia screening","By Report","By Report","000",0,0,0,9,9,9,9,9,9,null,"N",null,null,2]

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{"sheet":"MARFS_URL's","index":7,"n_rows":43,"n_cols":4,"rows_kept":43,"cut":false,"hidden":true,"merged":[]}
[null,"Chapter number","URL","Friendly Text"]
[null,1,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2022/2022MARFSChapter1.pdf","Chapter 1: Introduction"]
[null,2,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2022/2022MarfsChapter2.pdf","Chapter 2: Information for All Providers"]
[null,3,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2022/2022MARFSChapter3.pdf","Chapter 3: Ambulance Services"]
[null,4,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2022/2022MARFSChapter4.pdf","Chapter 4: Ambulance, Taxi, and Other Transportation Services"]
[null,5,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2022/2022MARFSChapter5.pdf","Chapter 5: Audiology and Hearing Services"]
[null,6,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2022/2022MARFSChapter6.pdf","Chapter 6: Biofeedback, Electrocardiograms (EKG), Electrodiagnostic services, & Extracorporeal Shockwave Therapy (ESWT)"]
[null,7,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2022/2022MARFSChapter7.pdf","Chapter 7: Chiropractic Services"]
[null,8,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2022/2022MARFSChapter8.pdf","Chapter 8: Dental Services"]
[null,9,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2022/2022MARFSChapter9.pdf","Chapter 9: Durable Medical Equipment (DME)"]
[null,10,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2022/2022MARFSChapter10.pdf","Chapter 10: Evaluation and Management (E/M) Services"]
[null,11,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2022/2022MarfsChapter11.pdf","Chapter 11: Home Health Services"]
[null,12,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2022/2022MARFSChapter12.pdf","Chapter 12: Impairment Rating Services"]
[null,13,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2022/2022MARFSChapter13.pdf","Chapter 13: Independent Medical Exams (IME)"]
[null,14,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2022/2022MARFSChapter14.pdf","Chapter 14: Language Access Services"]
[null,15,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2022/2022MARFSChapter15.pdf","Chapter 15: Medical Testimony"]
[null,16,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2022/2022MARFSChapter16.pdf","Chapter 16: Medication Administration and Injections"]
[null,17,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2022/2022MARFSChapter17.pdf","Chapter 17: Mental Health Services"]
[null,18,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2022/2022MARFSChapter18.pdf","Chapter 18: Modifications to Home and Vehicle"]
[null,19,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2022/2022MARFSChapter19.pdf","Chapter 19: Naturopathic Physicians and Acupuncture Services"]
[null,20,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2022/2022MarfsChapter20.pdf","Chapter 20: Nurse Case Management"]
[null,21,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2022/2022MarfsChapter21.pdf","Chapter 21: Obesity Treatment"]
[null,22,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2022/2022MarfsChapter22.pdf","Chapter 22: Other Services"]
[null,23,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2022/2022MarfsChapter23.pdf","Chapter 23: Pathology and Laboratory Services"]
[null,24,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2022/2022MarfsChapter24.pdf","Chapter 24: Pharmacy Services"]
[null,25,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2022/2022MarfsChapter25.pdf","Chapter 25: Physical Medicine Services"]
[null,26,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2022/2022MarfsChapter26.pdf","Chapter 26: Radiology Services"]
[null,27,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2022/2022MarfsChapter27.pdf","Chapter 27: Reports and Forms"]
[null,28,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2022/2022MarfsChapter28.pdf","Chapter 28: Supplies, Materials, and Bundled Services"]
[null,29,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2022/2022MarfsChapter29.pdf","Chapter 29: Surgery Services"]
[null,30,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2022/2022MarfsChapter30.pdf","Chapter 30: Vocational Services"]
[null,31,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2022/2022MarfsChapter31.pdf","Chapter 31: Washington RBRVS Payment System"]
[null,32,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2022/2022MarfsChapter32.pdf","Chapter 32: Ambulatory Surgery Centers (ASCs)"]
[null,33,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2022/2022MarfsChapter33.pdf","Chapter 33: Brain Injury Rehabilitation Services"]
[null,34,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2022/2022MarfsChapter34.pdf","Chapter 34: Chronic Pain Management"]
[null,35,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2022/2022MarfsChapter35.pdf","Chapter 35: Hospitals"]
[null,36,"https://lni.wa.gov/patient-care/billing-payments/marfsdocs/2022/2022MarfsChapter36.pdf","Chapter 36: Nursing Home and Other Residential Care Services"]
[]
[null,"Authcode","url","Name"]
[null,"Y-CM","https://lni.wa.gov/patient-care/authorizations-referrals/authorization/claim-manager-authorizations","Claim Manager Authorizations"]
[null,"Y-UR","https://lni.wa.gov/patient-care/authorizations-referrals/authorization/utilization-review","Utilization Review"]
[null,"Y-ONC","https://lni.wa.gov/patient-care/authorizations-referrals/authorization/occupational-nurse-consultant-authorization","Occupational Nurse Consultant Authorization"]
[null,"Y-PHL","https://lni.wa.gov/patient-care/authorizations-referrals/authorization/provider-hotline-authorizations","Provider Hotline Authorizations"]

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["CODE","Modifiers","Modcheck","Short Description (HCPCS and Local Only)","NON-FACILITY SETTING","FACILITY SETTING","FOL UP","PRE OP\n(-56)","INTRA OP\n(-54)","POST OP\n(-55)","PCTC\n(26/TC)","MSI\n(-51)","BSI\n(-50)","ASI\n(-80)","CSI\n(-62)","TSI\n(-66)","ENDO\nBASE","FSI","LIC REQ","Prior Auth","MARFS Chapters","MARFS Chapters2","MARFS Chapters3"]
[10004,null,"N","See CPT",90.973799999999997,75.514200000000002,"000",0,0,0,0,0,0,0,0,0,null,"R",null,"Y-CM",2,29]