| INDEX | Definitions | LadiesFirst | Vision | PAC 8 | PAC 9 |
| INDEX (To view a specific section, click the name of the section below.) |
| Definitions |
| Ladies First |
| Vision |
| = PAC 8 Codes |
| PAC 9 Codes |
| Ret= urn to Index Tab | ||||||
| Code Key | ||||||
| Prov= ider Type Codes | GOTO &nbs= p; Provider Specialty Code Descriptions | |||||
| Code Description | ||||||
| 1 Ge= neral Hospital | ||||||
| 2 Fr= eestanding Psychiatric Hospital | GOTO &nb= sp; Pricing Action Code (P.A.C.) Descriptions | |||||
| 4 D= entist | ||||||
| 5 Ph= ysician | ||||||
| 6 Po= diatrist | GOTO &nb= sp; Type of Service Code Descriptions | |||||
| 7 O= ptometrist | ||||||
| 8 Op= tician | ||||||
| 9 Ph= armacy | GOTO &nb= sp; APC Status Code Descriptions | |||||
| 10 = Home Health Agency | ||||||
| 11 Independent Radiology | ||||||
| 12 Independent Lab | ||||||
| 13 = Ambulance | ||||||
| 14 = DME Supplier | ||||||
| 15 Prosthetics/Orthotics | ||||||
| 16 = Clinic | ||||||
| 17 = Licensed Therapist | ||||||
| 18 Chiropractor | ||||||
| 19 = Masters Level Psychologist/Counselor | ||||||
| 20 = Nursing Home – Medicare Participating | ||||||
| 21 = Nursing Home - Non-Medicare Participating | ||||||
| 22 = Vermont State Nursing Home | ||||||
| 27 = Hospice | ||||||
| 28 = ICF-MR State Facility | ||||||
| 29 = ICF-MR Private Facility | ||||||
| 30 Psychologist | ||||||
| 31 = Rural Health Clinic | ||||||
| 32 = Outpatient Rehab | ||||||
| 34 = State Mental Health Hospital | ||||||
| 35 Audiologist | ||||||
| 36 = Other | ||||||
| 37 = MH Clinic | ||||||
| 38 = MR Clinic | ||||||
| 39 = MH Waiver | ||||||
| 39 = Baird | ||||||
| 39 = NFI | ||||||
| 40 = MH/DS Clinic – VHAP | ||||||
| 42 = MR Waiver | ||||||
| 39 = NF Waiver | ||||||
| T01 Psychiatric Residential Treatment Center (IMD) | ||||||
| T02 Freestanding Dialysis | ||||||
| T03 Ambulatory Surgical Center | ||||||
| T04= Personal Care Aide/Assistant | ||||||
| T05= Dental Lab | ||||||
| T06= Nurse Practitioner | ||||||
| T07= Licensed Nurse | ||||||
| T08= School Nurse | ||||||
| T09= Public Health Nurse | ||||||
| T10= Indian Health Service (100% federally funded, like rural health centers) | ||||||
| T11= Federally Qualified Health Center | ||||||
| T13= Nonprofit Transportation Agency | ||||||
| T14 Aged/Disabled Waiver (Home Health Waiver) | ||||||
| T15= Waiver Case Manager-Aging and Adult Services | ||||||
| T16= Targeted Case Management | ||||||
| T17= Case Manager/Social Worker | ||||||
| T18 Developmental Disability Agency (VDH) | ||||||
| T19 Vocational Rehab Agency | ||||||
| T20= SRS | ||||||
| T21 Children's Medical Services | ||||||
| T22 Community-Supported Living Arrangement | ||||||
| T23 Non-Medical Residential Facility | ||||||
| T24= Rehab Nursing Home | ||||||
| T25= OADAP Facility | ||||||
| T26= Adult Day Care | ||||||
| T27 Department of Education | ||||||
| T28= School District | ||||||
| T29= School | ||||||
| T30= County Health Department | ||||||
| T31= Sole Source Eyeglass Lab (Chadwick) | ||||||
| T32= Sole Source Oxygen | ||||||
| T33= HMO | ||||||
| T34= DDMHS Case Rate | ||||||
| T35= Dental Clinic (VA Hospital) | ||||||
| T36 Independently Billing High Tech Nurses | ||||||
| T37 Physicians Assistant | ||||||
| T38= Certified Adolescent ADAP Counselor | ||||||
| T39= Licensed Midwife (layperson) | ||||||
| T40= Ladies First Program | ||||||
| 0 A= ll providers | ||||||
| 999 = Default Banner Page | ||||||
| Return to Top of page | ||||||
| Provider Specialty Codes | ||||||
| Code Description/Physician | ||||||
| 1 G= eneral Practice | ||||||
| 2 G= eneral Surgery | ||||||
| 3 Allergy/Immunology | ||||||
| 4 Otalaryngology | ||||||
| 5 Anesthesiology | ||||||
| 6 C= ardiology | ||||||
| 7 D= ermatology | ||||||
| 8 F= amily Practice | ||||||
| 10 Gastroenterology | ||||||
| 11 = Internal Medicine | ||||||
| 12 Osteopathic Manipulative Therapy | ||||||
| 13 = Neurology | ||||||
| 14 Neurosurgery | ||||||
| 16 Obstetrics/Gynecology | ||||||
| 17 = PPNE Gynecology | ||||||
| 18 Ophthalmology | ||||||
| 19 = Oral Surgery (Dentistonly) | ||||||
| 20 = Orthopedic Surgery | ||||||
| 22 = Pathology | ||||||
| 24 = Plastic And Reconstructive Surgery | ||||||
| 25 = Physical Medicine And Rehabilitation | ||||||
| 26 Psychiatric | ||||||
| 28 = Colorectal Surgery (Formerly Proctology) | ||||||
| 29 = Pulmonary Disease | ||||||
| 30 = Diagnostic Radiology | ||||||
| 33 = Thoracic Surgery | ||||||
| 34 = Urology | ||||||
| 35 Chiropractic | ||||||
| 36 = Nuclear Medicine | ||||||
| 37 = Pediatric Medicine | ||||||
| 38 = Geriatric Medicine | ||||||
| 39 = Nephrology | ||||||
| 40 = Hand Surgery | ||||||
| 41 Optometrist | ||||||
| 42 = Certified Nurse Midwife | ||||||
| 43 = Certified Registered Nurse Anesthetist, Anesthesia Assistant | ||||||
| 44 = Infectious Disease | ||||||
| 46 Endocrinology | ||||||
| 48 = Podiatry | ||||||
| 50 = Nurse Practitioner | ||||||
| 51 = Medical Supply Company with Certified Orthotist | ||||||
| 52 = Medical Supply Company with Certified Prosthetist | ||||||
| 53 = Medical Supply Company with Certified Orthotist-Prosthetist | ||||||
| 54 = Medical Supply Company Not Included In 51, 52, Or 53 | ||||||
| 55 = Individual Certified Orthotist | ||||||
| 56 = Individual Certified Prosthetic | ||||||
| 57 = Individual Certified Orthotist/Prosthetic | ||||||
| 58 = Individual Not Included In 55, 56, Or 57 | ||||||
| 59 = Ambulance Service Center | ||||||
| 60 = Public Health Or Welfare Agency | ||||||
| 61 = Voluntary Health Or Charitable Agencies | ||||||
| 62 Independently-Billing Psychologist | ||||||
| 63 = Portable X-Ray Supplier | ||||||
| 64 Independently-Billing Audiologist | ||||||
| 65 Independently-Practicing Physical Therapist | ||||||
| 66 Rheumatology | ||||||
| 67 = Licensed Occupational Therapist - PCP | ||||||
| 68 = Clinical Psychologist | ||||||
| 69 Independantly-Billing Clinical Laboratory | ||||||
| 76 = Peripheral Vascular Disease | ||||||
| 77 = Vascular Surgery | ||||||
| 78 = Cardiac Surgery | ||||||
| 79 = Addiction Medicine | ||||||
| 80 = LCSW/LCMHC | ||||||
| 81 = Critical Care (Intensiveness) | ||||||
| 82 Ophthalmology | ||||||
| 83 Hematology/Oncology | ||||||
| 84 = Preventive Medicine | ||||||
| 85 Maxillofacial Surgery | ||||||
| 86 Neuropsychiatry | ||||||
| 87 = All Other Suppliers | ||||||
| 89 = Certified Clinical Nurse Specialist | ||||||
| 90 = Medical Oncology | ||||||
| 93 = Emergency Medicine | ||||||
| 94 Interventional Radiology | ||||||
| 98 = Diabetic Counselors | ||||||
| 99 = Unknown Supplier/Provider | ||||||
| S01= Hospital with Swing Bed | ||||||
| S02= Teaching Hospital | ||||||
| S03= Non Teaching Hospital Without Swing Beds | ||||||
| S04 Rehabilitation | ||||||
| S05 Psychiatric Hospital | ||||||
| S06= General Dentistry | ||||||
| S07= Pharmacy | ||||||
| S08= Air Ambulance | ||||||
| S09= Medicare Participating | ||||||
| S11= Medicare Non-Participating | ||||||
| S12= Mental Health Services | ||||||
| S13= Mental Retardation Services | ||||||
| S14= Cost Based Clinic | ||||||
| S15= Certified Family Practitioner | ||||||
| S16= Certified Pediatric Practitioner | ||||||
| S17= Other Certified Nurse Practitioner | ||||||
| S18= Substance Abuse Treatment Facility | ||||||
| S19= Private | ||||||
| S20 Non-Profit | ||||||
| S21= Aide or Attendant | ||||||
| S22= RN | ||||||
| S23= LPN | ||||||
| S24= School Nurse | ||||||
| S25= Waiver (Any & all who have waiver programs =3D DDMHS, Home Health, etc.) | ||||||
| S26= Case Management | ||||||
| S27= Other Medical Care | ||||||
| S28= DME Supplier (High Tech) | ||||||
| S29= Clinic Multidisciplinary Organization | ||||||
| S30= Speech Pathologist | ||||||
| S31= DDMHS Case Rate | ||||||
| S32= Day Hospital Services | ||||||
| S34= Ladies First Non-Facility | ||||||
| S35 = Ladies First Facility | ||||||
| Return to Top of page | ||||||
| Pricing Action Codes | ||||||
| Lev= el III Pricing File (Screen RFPR) | ||||||
| Code Description | ||||||
| A LOWER OF BILLED OR (RELATIVE VAL= UE UNITS (RVU) + BILLED UNITS)*COEFFICIENT ON FILE | ||||||
| Type of Service Codes | ||||||
| Code Description | ||||||
| 1 M= edical Care | ||||||
| 2 S= urgery | ||||||
| 3 Consultation | ||||||
| 4 D= iagnostic X-ray | ||||||
| 5 D= iagnostic Lab | ||||||
| 6 X= -ray Therapy | ||||||
| 7 A= nesthesia | ||||||
| 8 A= ssistant Surgeon | ||||||
| 9 M= ental Health/Psychotherapy/Psychiatry | ||||||
| A D= ME Rental | ||||||
| B D= ME Purchase | ||||||
| C A= mbulance | ||||||
| D R= egular Drugs | ||||||
| E U= nit Dose Drugs | ||||||
| H S= upplies Purchase | ||||||
| K P= rosthetics | ||||||
| L O= rthotics | ||||||
| M P= hysician's Assistant | ||||||
| N N= urse Midwife | ||||||
| Q L= ong Term Care | ||||||
| S S= ervice Codes | ||||||
| U D= efault - Unassigned Procedure | ||||||
| X C= rossover | ||||||
| Y I= CD-9 Surgical Procedure | ||||||
| Z De= ntal | ||||||
| Return to Top of page | ||||||
| APC Status Code | ||||||
| Code Description | ||||||
| T SIGNIFICANT PROCEDURE, MULTIPLE REDUCTION APPLIES | ||||||
| A FEE SCHEDULE OTHER THAN OPPS | ||||||
| B NOT RECOG. BY OPPS WHEN SUBMITTE= D ON AN OUTPAT CLAIM | ||||||
| C INPATIENT PROCEDURE, NOT PAID UN= DER OPPS. | ||||||
| D DISCONTINUED CODES, NOT PAID UND= ER OPPS. | ||||||
| F CORNEAL TISSUE ACQ, CERTAIN CRNA= SCVS, & HEPATITIS B VAC | ||||||
| G PASS-THROUGH DRUGS AND BIOLOGICA= LS | ||||||
| H PASS-THROUGH DEVICE CAT, OR RADIOPHARM. AGENTS | ||||||
| K DRUGS, BIOLOGICALS, BRACHYTHERP,= BLOOD AND BLOOD PROD. | ||||||
| E NOT COV BY MCARE,PER STATUTE RSN INC/EXC,OR AN ALT CDE EXIST | ||||||
| L INFLUENZA VACCINE: PNEUMONOCOCCAL PNEUMONIA VACCINE | ||||||
| M ITEMS OR SRV NOT BILLABLE TO FIS= CAL INTERMEDIARY | ||||||
| N ITEMS AND SCVS PACKAGED INTO APC= RATES | ||||||
| P PARTIAL HOSPITALIZATION | ||||||
| Q PACKAGED SCVS SUBJECT TO SEP PAY= UNDER OPPS | ||||||
| S SIGNIFICANT PROCEDURE, NOT DISCO= UNTED WHEN MULTIPLE | ||||||
| V CLINIC OR EMERGENCY DEPT VISIT | ||||||
| Y NON-IMPLANTABLE DURABLE MED EQUI= P | ||||||
| X ANCILLARY SERVICES | ||||||
| CPT codes, descript= ions and other data only are copyright 2007 American Medical Association. All righ= ts | ||||||
| reserved. | ||||||
| CPT is a registered= trademark of the American Medical Association. | ||||||
| Applicable FARS\DFA= RS Restrictions Apply to Government Use. | ||||||
| Fee schedules, rela= tive value units, conversion factors and/or related components are not assigned by t= he | ||||||
| AMA, are not part o= f CPT, and the AMA is not recommending their use. The AMA does not directly or | ||||||
| indirectly practice= medicine or dispense medical services. The AMA assumes no liability for data | ||||||
| contained or not co= ntained herein. |
| Return to Index Tab | ||||||||
| Procedure Code | Provide= r Type | Provider Specialty | P.A.C.<= /td> | Pricing= Effective Date | Pricing= End Date | Max All= owable | PA | Type = of Service |
| 00400 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 18.15 | = N | ANESTHESIA |
| 00400 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 18.15 | = N | ANESTHESIA |
| 10021 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 58.89 | = N | SURGERY |
| 10021 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 121.01 | = N | SURGERY |
| 10022 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 56.71 | = N | SURGERY |
| 10022 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 127.19 | = N | SURGERY |
| 19000 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 38.66 | = N | SURGERY |
| 19000 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 98.97 | = N | SURGERY |
| 19001 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 19.15 | = N | SURGERY |
| 19001 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 23.15 | = N | SURGERY |
| 19100 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 56.73 | = N | SURGERY |
| 19100 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 118.85 | = N | SURGERY |
| 19101 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 175.98 | = N | SURGERY |
| 19101 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 270.05 | = N | SURGERY |
| 19102 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 90.33 | = N | SURGERY |
| 19102 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 198.57 | = N | SURGERY |
| 19103 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 166.57 | = N | SURGERY |
| 19103 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 514.92 | = N | SURGERY |
| 19120 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 315.22 | = N | SURGERY |
| 19120 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 373.34 | = N | SURGERY |
| 19125 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 349.73 | = N | SURGERY |
| 19125 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 411.48 | = N | SURGERY |
| 19126 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 131.55 | = N | SURGERY |
| 19126 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 131.55 | = N | SURGERY |
| 19290 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 57.26 | = N | SURGERY |
| 19290 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 145.89 | = N | SURGERY |
| 19291 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 28.18 | = N | SURGERY |
| 19291 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 63.04 | = N | SURGERY |
| 19295 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 90.63 | = N | SURGERY |
| 19295 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 90.63 | = N | SURGERY |
| 36415 | T40 | S35 | = 3 | 2005070= 1 | 2382123= 1 | 3.00 | = N | DIAGNOSTIC LAB |
| 36415 | T40 | S34 | = 3 | 2006010= 1 | 2382123= 1 | 3.00 | = N | DIAGNOSTIC LAB |
| 57452 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 78.12 | = N | SURGERY |
| 57452 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 95.55 | = N | SURGERY |
| 57454 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 117.15 | = N | SURGERY |
| 57454 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 134.23 | = N | SURGERY |
| 57455 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 95.07 | = N | SURGERY |
| 57455 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 125.95 | = N | SURGERY |
| 57456 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 88.93 | = N | SURGERY |
| 57456 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 119.08 | = N | SURGERY |
| 57460 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 140.65 | = Y | SURGERY |
| 57460 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 279.78 | = Y | SURGERY |
| 57461 | T40 | S35 | = 3 | 2006071= 5 | 2382123= 1 | 200.13 | = N | SURGERY |
| 57461 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 162.12 | = Y | SURGERY |
| 57461 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 310.33 | = Y | SURGERY |
| 57500 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 63.65 | = N | SURGERY |
| 57500 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 123.22 | = N | SURGERY |
| 57505 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 78.56 | = N | SURGERY |
| 57505 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 89.82 | = N | SURGERY |
| 57520 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 235.70 | = Y | SURGERY |
| 57520 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 270.94 | = Y | SURGERY |
| 57522 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 207.84 | = Y | SURGERY |
| 57522 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 229.99 | = Y | SURGERY |
| 58100 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 75.56 | = Y | SURGERY |
| 58100 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 96.63 | = Y | SURGERY |
| 58110 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 35.59 | = Y | SURGERY |
| 58110 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 43.23 | = Y | SURGERY |
| 71020 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 30.66 | = Y | DIAGNOSTIC X-RAY |
| 71020 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 30.66 | = Y | DIAGNOSTIC X-RAY |
| 76098 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 19.77 | = N | DIAGNOSTIC X-RAY |
| 76098 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 19.77 | = N | DIAGNOSTIC X-RAY |
| 76645 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 79.43 | = N | DIAGNOSTIC X-RAY |
| 76645 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 79.43 | = N | DIAGNOSTIC X-RAY |
| 76942 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 165.68 | = N | DIAGNOSTIC X-RAY |
| 76942 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 165.68 | = N | DIAGNOSTIC X-RAY |
| 76970 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 71.47 | = N | DIAGNOSTIC X-RAY |
| 76970 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 71.47 | = N | DIAGNOSTIC X-RAY |
| 77031 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 232.54 | = N | DIAGNOSTIC X-RAY |
| 77031 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 232.54 | = N | DIAGNOSTIC X-RAY |
| 77032 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 61.81 | = N | DIAGNOSTIC X-RAY |
| 77032 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 61.81 | = N | DIAGNOSTIC X-RAY |
| 77055 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 77.03 | = N | DIAGNOSTIC X-RAY |
| 77055 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 77.03 | = N | DIAGNOSTIC X-RAY |
| 77056 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 97.34 | = N | DIAGNOSTIC X-RAY |
| 77056 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 97.34 | = N | DIAGNOSTIC X-RAY |
| 77057 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 77.22 | = N | DIAGNOSTIC X-RAY |
| 77057 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 77.22 | = N | DIAGNOSTIC X-RAY |
| 80048 | T40 | S34 | = 3 | 2007010= 1 | 2382123= 1 | 11.83 | = N | DIAGNOSTIC LAB |
| 80048 | T40 | S35 | = 3 | 2007010= 1 | 2382123= 1 | 11.83 | = N | DIAGNOSTIC LAB |
| 80053 | T40 | S34 | = 3 | 2006010= 1 | 2382123= 1 | 14.77 | = N | DIAGNOSTIC LAB |
| 80053 | T40 | S35 | = 3 | 2006010= 1 | 2382123= 1 | 14.77 | = N | DIAGNOSTIC LAB |
| 80061 | T40 | S34 | = 3 | 2006010= 1 | 2382123= 1 | 15.34 | = N | DIAGNOSTIC LAB |
| 80061 | T40 | S35 | = 3 | 2006010= 1 | 2382123= 1 | 15.34 | = N | DIAGNOSTIC LAB |
| 82465 | T40 | S34 | = 3 | 2006010= 1 | 2382123= 1 | 6.08 | = N | DIAGNOSTIC LAB |
| 82465 | T40 | S35 | = 3 | 2006010= 1 | 2382123= 1 | 6.08 | = N | DIAGNOSTIC LAB |
| 82947 | T40 | S34 | = 3 | 2006010= 1 | 2382123= 1 | 5.48 | = N | DIAGNOSTIC LAB |
| 82947 | T40 | S35 | = 3 | 2006010= 1 | 2382123= 1 | 5.48 | = N | DIAGNOSTIC LAB |
| 82948 | T40 | S34 | = 3 | 2005050= 1 | 2382123= 1 | 3.57 | = N | DIAGNOSTIC LAB |
| 82948 | T40 | S35 | = 3 | 2005050= 1 | 2382123= 1 | 3.57 | = N | DIAGNOSTIC LAB |
| 82951 | T40 | S34 | = 3 | 2006010= 1 | 2382123= 1 | 17.99 | = N | DIAGNOSTIC LAB |
| 82951 | T40 | S35 | = 3 | 2006010= 1 | 2382123= 1 | 17.99 | = N | DIAGNOSTIC LAB |
| 83036 | T40 | S34 | = 3 | 2006010= 1 | 2382123= 1 | 13.56 | = N | DIAGNOSTIC LAB |
| 83036 | T40 | S35 | = 3 | 2006010= 1 | 2382123= 1 | 13.56 | = N | DIAGNOSTIC LAB |
| 83718 | T40 | S34 | = 3 | 2006010= 1 | 2382123= 1 | 8.06 | = N | DIAGNOSTIC LAB |
| 83718 | T40 | S35 | = 3 | 2006010= 1 | 2382123= 1 | 8.06 | = N | DIAGNOSTIC LAB |
| 83721 | T40 | S34 | = 3 | 2006071= 6 | 2382123= 1 | 12.81 | = N | DIAGNOSTIC LAB |
| 83721 | T40 | S35 | = 3 | 2006071= 6 | 2382123= 1 | 12.81 | = N | DIAGNOSTIC LAB |
| 87621 | T40 | S34 | = 3 | 2006010= 1 | 2382123= 1 | 36.39 | = N | DIAGNOSTIC LAB |
| 87621 | T40 | S35 | = 3 | 2006010= 1 | 2382123= 1 | 36.39 | = N | DIAGNOSTIC LAB |
| 88104 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 55.44 | = N | DIAGNOSTIC LAB |
| 88104 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 55.44 | = N | DIAGNOSTIC LAB |
| 88141 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 23.14 | = N | DIAGNOSTIC LAB |
| 88141 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 23.14 | = N | DIAGNOSTIC LAB |
| 88143 | T40 | S34 | = 3 | 2007010= 1 | 2382123= 1 | 14.76 | = N | DIAGNOSTIC LAB |
| 88143 | T40 | S35 | = 3 | 2007010= 1 | 2382123= 1 | 14.76 | = N | DIAGNOSTIC LAB |
| 88150 | T40 | S34 | = 3 | 2006010= 1 | 2382123= 1 | 14.76 | = N | DIAGNOSTIC LAB |
| 88150 | T40 | S35 | = 3 | 2006010= 1 | 2382123= 1 | 14.76 | = N | DIAGNOSTIC LAB |
| 88160 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 48.19 | = N | DIAGNOSTIC LAB |
| 88160 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 48.19 | = N | DIAGNOSTIC LAB |
| 88161 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 52.91 | = N | DIAGNOSTIC LAB |
| 88161 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 52.91 | = N | DIAGNOSTIC LAB |
| 88162 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 72.28 | = N | DIAGNOSTIC LAB |
| 88162 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 72.28 | = N | DIAGNOSTIC LAB |
| 88164 | T40 | S34 | = 3 | 2006010= 1 | 2382123= 1 | 14.76 | = N | DIAGNOSTIC LAB |
| 88164 | T40 | S35 | = 3 | 2006010= 1 | 2382123= 1 | 14.76 | = N | DIAGNOSTIC LAB |
| 88172 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 47.79 | = N | DIAGNOSTIC LAB |
| 88172 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 47.79 | = N | DIAGNOSTIC LAB |
| 88173 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 123.71 | = N | DIAGNOSTIC LAB |
| 88173 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 123.71 | = N | DIAGNOSTIC LAB |
| 88174 | T40 | S34 | = 3 | 2007010= 1 | 2382123= 1 | 14.76 | = N | DIAGNOSTIC LAB |
| 88174 | T40 | S35 | = 3 | 2007010= 1 | 2382123= 1 | 14.76 | = N | DIAGNOSTIC LAB |
| 88175 | T40 | S34 | = 3 | 2007010= 1 | 2382123= 1 | 14.76 | = N | DIAGNOSTIC LAB |
| 88175 | T40 | S35 | = 3 | 2007010= 1 | 2382123= 1 | 14.76 | = N | DIAGNOSTIC LAB |
| 88305 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 96.63 | = N | DIAGNOSTIC LAB |
| 88305 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 96.63 | = N | DIAGNOSTIC LAB |
| 88307 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 190.33 | = N | DIAGNOSTIC LAB |
| 88307 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 190.33 | = N | DIAGNOSTIC LAB |
| 88321 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 71.33 | = Y | DIAGNOSTIC LAB |
| 88321 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 80.05 | = Y | DIAGNOSTIC LAB |
| 88331 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 81.43 | = Y | DIAGNOSTIC LAB |
| 88331 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 81.43 | = Y | DIAGNOSTIC LAB |
| 88332 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 36.55 | = N | DIAGNOSTIC LAB |
| 88332 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 36.55 | = N | DIAGNOSTIC LAB |
| 93000 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 21.22 | = Y | MEDICAL CARE |
| 93000 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 21.22 | = Y | MEDICAL CARE |
| 99070 | T40 | S34 | = 6 | 2006071= 5 | 2382123= 1 | 0.00 | = Y | MEDICAL CARE |
| 99070 | T40 | S35 | = 6 | 2006071= 5 | 2382123= 1 | 0.00 | = Y | MEDICAL CARE |
| 99201 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 20.41 | = N | MEDICAL CARE |
| 99201 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 33.86 | = N | MEDICAL CARE |
| 99202 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 39.56 | = N | MEDICAL CARE |
| 99202 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 58.09 | = N | MEDICAL CARE |
| 99203 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 60.51 | = N | MEDICAL CARE |
| 99203 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 84.86 | = N | MEDICAL CARE |
| 99204 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 60.51 | = N | MEDICAL CARE |
| 99204 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 84.86 | = N | MEDICAL CARE |
| 99205 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 60.51 | = N | MEDICAL CARE |
| 99205 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 84.86 | = N | MEDICAL CARE |
| 99211 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 7.76 | = N | MEDICAL CARE |
| 99211 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 18.68 | = N | MEDICAL CARE |
| 99212 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 20.41 | = N | MEDICAL CARE |
| 99212 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 34.94 | = N | MEDICAL CARE |
| 99213 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 39.18 | = N | MEDICAL CARE |
| 99213 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 56.26 | = N | MEDICAL CARE |
| 99214 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 39.18 | = N | MEDICAL CARE |
| 99214 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 56.26 | = N | MEDICAL CARE |
| 99215 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 39.18 | = N | MEDICAL CARE |
| 99215 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 56.26 | = N | MEDICAL CARE |
| 99241 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 29.08 | = N | CONSULTATION |
| 99241 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 44.70 | = N | CONSULTATION |
| 99242 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 61.42 | = N | CONSULTATION |
| 99242 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 82.86 | = N | CONSULTATION |
| 99243 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 85.80 | = N | CONSULTATION |
| 99243 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 113.78 | = N | CONSULTATION |
| 99244 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 135.10 | = N | CONSULTATION |
| 99244 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 167.07 | = N | CONSULTATION |
| 99245 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 135.10 | = N | CONSULTATION |
| 99245 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 167.07 | = N | CONSULTATION |
| 99385 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 60.51 | = N | MEDICAL CARE |
| 99385 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 84.86 | = N | MEDICAL CARE |
| 99386 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 60.51 | = N | MEDICAL CARE |
| 99386 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 84.86 | = N | MEDICAL CARE |
| 99387 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 60.51 | = N | MEDICAL CARE |
| 99387 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 84.86 | = N | MEDICAL CARE |
| 99395 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 39.18 | = N | MEDICAL CARE |
| 99395 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 56.26 | = N | MEDICAL CARE |
| 99396 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 39.18 | = N | MEDICAL CARE |
| 99396 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 56.26 | = N | MEDICAL CARE |
| 99397 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 39.18 | = N | MEDICAL CARE |
| 99397 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 56.26 | = N | MEDICAL CARE |
| G0202 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 77.22 | = N | DIAGNOSTIC X-RAY |
| G0202 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 77.22 | = N | DIAGNOSTIC X-RAY |
| G0204 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 97.34 | = N | DIAGNOSTIC X-RAY |
| G0204 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 97.34 | = N | DIAGNOSTIC X-RAY |
| G0206 | T40 | S34 | = 3 | 2008020= 1 | 2382123= 1 | 77.03 | = N | DIAGNOSTIC X-RAY |
| G0206 | T40 | S35 | = 3 | 2008020= 1 | 2382123= 1 | 77.03 | = N | DIAGNOSTIC X-RAY |
| <= /td> | ||||||||
| CPT codes, descriptions and other data only are copyright 2007 American Medic= al Association. | ||||||||
| All rights reserved. | ||||||||
| CPT is a registered trademark of the American Medical Association. | ||||||||
| Applicable FARS\DFARS Restrictions Apply to Government Use. | ||||||||
| Fee schedules, relative value units, conversion factors and/or related compon= ents are not assigned | ||||||||
| by the AMA, are not part of CPT, and the AMA is not recommending their use. = The AMA does not | ||||||||
| directly or indirectly practice medicine or dispense medical services. The AMA ass= umes no liability | ||||||||
| for data contained or not contain= ed herein. |
| Return to Index Tab | ||||||||
| Procedure Code | Provide= r Type | Provider Specialty | P.A.C.<= /td> | Pricing= Effective Date | Pricing= End Date | Max All= owable | PA? | Type = of Service |
| 92015 | 000 | 000 | = 3 | 2004070= 1 | 2382123= 1 | 17.20 | = N | SUPPLIES PURCHASE |
| 92120 | 000 | 000 | = 3 | 2002100= 1 | 2382123= 1 | 12.34 | = N | SUPPLIES PURCHASE |
| 92130 | 000 | 000 | = 3 | 2002100= 1 | 2382123= 1 | 12.34 | = N | SUPPLIES PURCHASE |
| 92140 | 000 | 000 | = 3 | 2002100= 1 | 2382123= 1 | 13.58 | = N | SUPPLIES PURCHASE |
| 92225 | 000 | 000 | = 3 | 2005070= 1 | 2382123= 1 | 12.56 | = N | SUPPLIES PURCHASE |
| 92311 | 000 | 000 | = 6 | 2008010= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| 92313 | 000 | 000 | = 3 | 2005070= 1 | 2382123= 1 | 101.11 | = Y | SUPPLIES PURCHASE |
| 92341 | 000 | 000 | = 3 | 2006010= 1 | 2382123= 1 | 32.50 | = N | SUPPLIES PURCHASE |
| 92342 | 000 | 000 | = 3 | 2006010= 1 | 2382123= 1 | 32.50 | = N | SUPPLIES PURCHASE |
| 92352 | 000 | 000 | = 3 | 2002100= 1 | 2382123= 1 | 4.23 | = N | SUPPLIES PURCHASE |
| 92353 | 000 | 000 | = 3 | 2002100= 1 | 2382123= 1 | 6.76 | = N | SUPPLIES PURCHASE |
| 92370 | 000 | 000 | = 3 | 2006010= 1 | 2382123= 1 | 30.00 | = N | SUPPLIES PURCHASE |
| 92371 | 000 | 000 | = 3 | 2002100= 1 | 2382123= 1 | 6.04 | = N | SUPPLIES PURCHASE |
| 92499 | 000 | 000 | = 6 | 1981010= 1 | 2382123= 1 | 0.00 | = Y | SUPPLIES PURCHASE |
| V2020 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2025 | 000 | 000 | = 4 | 2004020= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2100 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2101 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2102 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2103 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2104 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2105 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2106 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2107 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2108 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2109 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2110 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2111 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2112 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2113 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2114 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2115 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2118 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2121 | 000 | 000 | = 4 | 2006110= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2199 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2200 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2201 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2202 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2203 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2204 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2205 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2206 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2207 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2208 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2209 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2210 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2211 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2212 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2213 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2214 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2215 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2218 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2219 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2220 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2221 | 000 | 000 | = 4 | 2006110= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2299 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2300 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2301 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2302 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2303 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2304 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2305 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2306 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2307 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2308 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2309 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2310 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2311 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2312 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2313 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2314 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2315 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2318 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2319 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2320 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2399 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2410 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2430 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2499 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2500 | 000 | 000 | = 3 | 1982010= 1 | 2382123= 1 | 30.00 | = Y | SUPPLIES PURCHASE |
| V2510 | 000 | 000 | = 3 | 1982010= 1 | 2382123= 1 | 30.00 | = Y | SUPPLIES PURCHASE |
| V2511 | 000 | 000 | = 3 | 2001051= 4 | 2382123= 1 | 162.50<= /td> | = Y | SUPPLIES PURCHASE |
| V2513 | 000 | 000 | = 3 | 1982010= 1 | 2382123= 1 | 30.00 | = Y | SUPPLIES PURCHASE |
| V2520 | 000 | 000 | = 3 | 1982010= 1 | 2382123= 1 | 30.00 | = Y | SUPPLIES PURCHASE |
| V2521 | 000 | 000 | = 3 | 1991110= 1 | 2382123= 1 | 50.00 | = Y | SUPPLIES PURCHASE |
| V2523 | 000 | 000 | = 3 | 1995090= 1 | 2382123= 1 | 81.00 | = Y | SUPPLIES PURCHASE |
| V2599 | 000 | 000 | = 6 | 1981010= 1 | 2382123= 1 | 0.00 | = Y | SUPPLIES PURCHASE |
| V2615 | 000 | 000 | = 6 | 2004020= 1 | 2382123= 1 | 0.00 | = N | DME PURCHASE |
| V2623 | 000 | 000 | = 3 | 2001120= 1 | 2382123= 1 | 747.00<= /td> | = N | PROSTHETICS |
| V2624 | 000 | 000 | = 3 | 2001120= 1 | 2382123= 1 | 48.00 | = N | PROSTHETICS |
| V2625 | 000 | 000 | = 3 | 2001120= 1 | 2382123= 1 | 277.00<= /td> | = N | PROSTHETICS |
| V2626 | 000 | 000 | = 3 | 2001120= 1 | 2382123= 1 | 150.00<= /td> | = N | PROSTHETICS |
| V2627 | 000 | 000 | = 3 | 2001120= 1 | 2382123= 1 | 966.00<= /td> | = N | PROSTHETICS |
| V2628 | 000 | 000 | = 3 | 2001120= 1 | 2382123= 1 | 240.00<= /td> | = N | PROSTHETICS |
| V2629 | 000 | 000 | = 6 | 2004020= 1 | 2382123= 1 | 0.00 | = Y | PROSTHETICS |
| V2630 | 000 | 000 | = 4 | 2004020= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2631 | 000 | 000 | = I | 2008010= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2632 | 000 | 000 | = 4 | 2004020= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2700 | 000 | 000 | = 3 | 2004020= 1 | 2382123= 1 | 36.82 | = N | SUPPLIES PURCHASE |
| V2710 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2715 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2718 | 000 | 000 | = 3 | 2004020= 1 | 2382123= 1 | 29.60 | = N | SUPPLIES PURCHASE |
| V2730 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2744 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = Y | SUPPLIES PURCHASE |
| V2745 | 000 | 000 | = 4 | 2006110= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2750 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2755 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2756 | 000 | 000 | = 3 | 2006010= 1 | 2382123= 1 | 3.50 | = N | SUPPLIES PURCHASE |
| V2760 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2761 | 000 | 000 | = 4 | 2006110= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2762 | 000 | 000 | = 4 | 2006110= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2780 | 000 | 000 | = 4 | 1991120= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2781 | 000 | 000 | = I | 2003010= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2784 | 000 | 000 | = 4 | 2004010= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2790 | 000 | 000 | = I | 2008010= 1 | 2382123= 1 | 0.00 | = N | SUPPLIES PURCHASE |
| V2799 | 014 | 054 | = 4 | 2005010= 1 | 2382123= 1 | 0.00 | = N | DME PURCHASE |
| V2799 | 000 | 000 | = 4 | 2005010= 1 | 2382123= 1 | 0.00 | = Y | DME PURCHASE |
| <= /td> | ||||||||
| <= /td> | ||||||||
| CPT codes, descriptions and other data only are copyright 2007 American Medic= al Association. All rights | ||||||||
| reserved. | ||||||||
| CPT is a registered trademark of the American Medical Association. | ||||||||
| Applicable FARS\DFARS Restrictions Apply to Government Use. | ||||||||
| Fee schedules, relative value units, conversion factors and/or related compon= ents are not assigned by the | ||||||||
| AMA, are not part of CPT, and the AMA is not recommending their use. The AMA d= oes not directly or | ||||||||
| indirectly practice medicine or dispense medical services. The AMA assumes no liabil= ity for data | ||||||||
| contained or not contained herein. |
| Return to Index Tab | |||||
| Procedure Code | Provide= r Type | Provider Specialty | P.A.C.<= /td> | Pricing= Effective Date | Pricing= End Date |
| 000 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 002 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 003 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 0055T | 000 | 000 | 8 | 2= 0080101 | 2= 3821231 |
| 006 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 009 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 010 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 011 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 012 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 015 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 01905 | 000 | 000 | 8 | 2= 0080101 | 2= 3821231 |
| 01964 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 01995 | 000 | 000 | 8 | 2= 0070101 | 2= 3821231 |
| 020 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 021 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 023 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 024 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 029 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 030 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 032 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 033 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 035 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 037 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 040 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 041 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 044 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 047 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 048 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 049 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 051 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 052 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 053 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 058 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 060 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 061 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 063 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 065 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 068 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 069 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 070 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 071 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 072 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 074 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 075 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 076 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 077 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 078 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 079 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 080 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 081 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 082 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 083 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 084 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 085 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 086 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 087 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 088 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 089 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 090 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 091 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 092 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 094 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 095 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 098 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 099 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 1001F | 000 | 000 | 8 | 2= 0070101 | 2= 3821231 |
| 102 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 103 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 104 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 109 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 112 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 113 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 114 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 115 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 116 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 117 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 119 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 120 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 121 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 122 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 123 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 124 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 125 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 126 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 127 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 128 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 129 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 130 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 131 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 134 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 135 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 136 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 137 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 140 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 141 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 142 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 143 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 144 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 15000 | 000 | 000 | 8 | 2= 0070101 | 2= 3821231 |
| 15001 | 000 | 000 | 8 | 2= 0070101 | 2= 3821231 |
| 15342 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 15343 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 15350 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 15351 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 15810 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 15811 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 15831 | 000 | 000 | 8 | 2= 0070101 | 2= 3821231 |
| 16010 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 16015 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 17304 | 000 | 000 | 8 | 2= 0070101 | 2= 3821231 |
| 17305 | 000 | 000 | 8 | 2= 0070101 | 2= 3821231 |
| 17306 | 000 | 000 | 8 | 2= 0070101 | 2= 3821231 |
| 17307 | 000 | 000 | 8 | 2= 0070101 | 2= 3821231 |
| 17310 | 000 | 000 | 8 | 2= 0070101 | 2= 3821231 |
| 19160 | 000 | 000 | 8 | 2= 0070101 | 2= 3821231 |
| 19162 | 000 | 000 | 8 | 2= 0070101 | 2= 3821231 |
| 19180 | 000 | 000 | 8 | 2= 0070101 | 2= 3821231 |
| 19182 | 000 | 000 | 8 | 2= 0070101 | 2= 3821231 |
| 19200 | 000 | 000 | 8 | 2= 0070101 | 2= 3821231 |
| 19220 | 000 | 000 | 8 | 2= 0070101 | 2= 3821231 |
| 19240 | 000 | 000 | 8 | 2= 0070101 | 2= 3821231 |
| 2003F | 000 | 000 | 8 | 2= 0070101 | 2= 3821231 |
| 21300 | 000 | 000 | 8 | 2= 0070101 | 2= 3821231 |
| 21493 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 24350 | 000 | 000 | 8 | 2= 0080101 | 2= 3821231 |
| 24351 | 000 | 000 | 8 | 2= 0080101 | 2= 3821231 |
| 24352 | 000 | 000 | 8 | 2= 0080101 | 2= 3821231 |
| 24354 | 000 | 000 | 8 | 2= 0080101 | 2= 3821231 |
| 24356 | 000 | 000 | 8 | 2= 0080101 | 2= 3821231 |
| 25611 | 000 | 000 | 8 | 2= 0070101 | 2= 3821231 |
| 25620 | 000 | 000 | 8 | 2= 0070101 | 2= 3821231 |
| 27315 | 000 | 000 | 8 | 2= 0070101 | 2= 3821231 |
| 27320 | 000 | 000 | 8 | 2= 0070101 | 2= 3821231 |
| 28030 | 000 | 000 | 8 | 2= 0070101 | 2= 3821231 |
| 3000F | 000 | 000 | 8 | 2= 0070101 | 2= 3821231 |
| 3002F | 000 | 000 | 8 | 2= 0070101 | 2= 3821231 |
| 3047F | 000 | 000 | 8 | 2= 0080101 | 2= 3821231 |
| 3076F | 000 | 000 | 8 | 2= 0080101 | 2= 3821231 |
| 31700 | 000 | 000 | 8 | 2= 0070101 | 2= 3821231 |
| 31710 | 000 | 000 | 8 | 2= 0070101 | 2= 3821231 |
| 32000 | 000 | 000 | 8 | 2= 0080101 | 2= 3821231 |
| 32002 | 000 | 000 | 8 | 2= 0080101 | 2= 3821231 |
| 32005 | 000 | 000 | 8 | 2= 0080101 | 2= 3821231 |
| 32019 | 000 | 000 | 8 | 2= 0080101 | 2= 3821231 |
| 32020 | 000 | 000 | 8 | 2= 0080101 | 2= 3821231 |
| 323 | 000 | 000 | 8 | 2= 0071031 | 2= 3821231 |
| 324 | 000 | 000 | 8 | 2= 0071001 | 2= 3821231 |
| 325 | 000 | 000 | 8 | 2= 0071001 | 2= 3821231 |
| 32520 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 32525 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 33200 | 000 | 000 | 8 | 2= 0070101 | 2= 3821231 |
| 33201 | 000 | 000 | 8 | 2= 0070101 | 2= 3821231 |
| 33245 | 000 | 000 | 8 | 2= 0070101 | 2= 3821231 |
| 33246 | 000 | 000 | 8 | 2= 0070101 | 2= 3821231 |
| 33253 | 000 | 000 | 8 | 2= 0070101 | 2= 3821231 |
| 35381 | 000 | 000 | 8 | 2= 0070101 | 2= 3821231 |
| 35541 | 000 | 000 | 8 | 2= 0070101 | 2= 3821231 |
| 35546 | 000 | 000 | 8 | 2= 0070101 | 2= 3821231 |
| 35641 | 000 | 000 | 8 | 2= 0070101 | 2= 3821231 |
| 36540 | 000 | 000 | 8 | 2= 0080101 | 2= 3821231 |
| 36550 | 000 | 000 | 8 | 2= 0080101 | 2= 3821231 |
| 37720 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 42325 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 43639 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 43750 | 000 | 000 | 8 | 2= 0080101 | 2= 3821231 |
| 44152 | 000 | 000 | 8 | 2= 0070101 | 2= 3821231 |
| 44153 | 000 | 000 | 8 | 2= 0070101 | 2= 3821231 |
| 44200 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 44201 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 44239 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 47719 | 000 | 000 | 8 | 2= 0080101 | 2= 3821231 |
| 48005 | 000 | 000 | 8 | 2= 0070101 | 2= 3821231 |
| 49085 | 000 | 000 | 8 | 2= 0070101 | 2= 3821231 |
| 49200 | 000 | 000 | 8 | 2= 0080101 | 2= 3821231 |
| 49201 | 000 | 000 | 8 | 2= 0080101 | 2= 3821231 |
| 51000 | 000 | 000 | 8 | 2= 0080101 | 2= 3821231 |
| 51005 | 000 | 000 | 8 | 2= 0080101 | 2= 3821231 |
| 51010 | 000 | 000 | 8 | 2= 0080101 | 2= 3821231 |
| 52510 | 000 | 000 | 8 | 2= 0080101 | 2= 3821231 |
| 54152 | 000 | 000 | 8 | 2= 0070101 | 2= 3821231 |
| 54820 | 000 | 000 | 8 | 2= 0070101 | 2= 3821231 |
| 550 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 551 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 552 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 553 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 558 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 55859 | 000 | 000 | 8 | 2= 0070101 | 2= 3821231 |
| 559 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 563 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 564 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 565 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 566 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 567 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 56720 | 000 | 000 | 8 | 2= 0070101 | 2= 3821231 |
| 568 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 569 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 571 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 572 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 573 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 574 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 575 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 577 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 578 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 57820 | 000 | 000 | 8 | 2= 0070101 | 2= 3821231 |
| 582 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 583 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 584 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 589 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 590 | 000 | 000 | 8 | 2= 0060101 | 2= 3821231 |
| 591 |